Is the future in the cards?

Smart cards have yet to catch on in health care. Applications for data security and marketing, however, could boost their use.     

Monoamine oxidase inhibitors: have they a place, have they a future?

The legacy of the hepatotoxic effect and the "cheese reaction" of monoamine oxidase inhibitors still overshadows these useful drugs, despite near-resolution of many of the problems. This short article reviews the indications, adverse effects and progress and future of these agents in psychopharmacology.     

Vertical integration: the wave of the future?

In today's environment, health care facilities need to expend more resources in developing comprehensive and coordinated health care systems that provide, preferably on one site, ambulatory and acute care, long-term care, mental health, physical medicine and rehabilitation, home health, wellness centers, and an integrated prepayment plan as a joint venture with the institution's medical staff. The wave of the future (the next several years) will be toward vertical diversification because of increased price competition for a broad range of services, an industry with a surplus of acute care beds, and an interest by existing multihospital systems in improving their present positions by diversification rather than growth for growth's sake.     

Are Medicare HMOs the promise of the future?

Companies are looking at using HMOs to reduce their retiree medical costs. But first there are obstacles to overcome.     

SiRNA technology, the gene therapy of the future?

A new era in genetics started 17 years ago, when co-suppression in petunia was discovered. Later, co-suppression was identified as RNA interference (RNAi) in many plant and lower eukaryote animals. Although an ancient antiviral host defense mechanism in plants, the physiologic role of RNAi in mammals is still not completely understood. RNAi is directed by short interfering RNAs (siRNAs), one subtype of short double stranded RNAs. In this review we summarize the history and mechanisms of RNAi. We also aim to highlight the correlation between structure and efficacy of siRNAs. Delivery is the most important obstacle for siRNA based gene therapy. Viral and nonviral deliveries are discussed. In vivo delivery is the next obstacle to clinical trials with siRNAs. Although hydrodynamic treatment is effective in animals, it cannot be used in human therapy. One possibility is organ selective catheterization. The known side effects of synthesized siRNAs are also discussed. Although there are many problems to face in this new field of gene therapy, successful in vitro and in vivo experiments raise hope for treating human disease with siRNA.     

Who is shaping the food choices of the future?

A conference was held by the British Nutrition Foundation in October 2017 to explore future trends in agriculture, manufacturing and retailing, and the relationship between these trends and food choice. Topics explored by the speakers included sustainability, climate change, Brexit, the ageing population, technological advances in food production, product reformulation, consumer behaviour and public health agendas. This report summarises the conference proceedings.     

Testing at home--the screening of the future?

Cardiovascular diseases (CVD) and diabetes mellitus (DM) aremajor public health concerns in modern society. Although mortalityfrom CVD has decreased substantially in many European countriesin the past 30 years due to better prevention (e.g. encouragingpeople to stop smoking and discouraging people from starting)and better medicinal treatment, CVD remains the category ofdiseases with the highest number of life-years lost. Due tosedentary lifestyles and unfavourable nutrition habits, obesityhas developed into a new ‘epidemic’ with adverseconsequences for CVD and DM. Type 2 diabetes is     

Web-based questionnaires: the future in epidemiology?

The traditional epidemiologic modes of data collection, including paper-and-pencil questionnaires and interviews, have several limitations, such as decreasing response rates over the last decades and high costs in large study populations. The use of Web-based questionnaires may be an attractive alternative but is still scarce in epidemiologic research because of major concerns about selective nonresponse and reliability of the data obtained. The authors discuss advantages and disadvantages of Web-based questionnaires and current developments in this area. In addition, they focus on some practical issues and safety concerns involved in the application of Web-based questionnaires in epidemiologic research. They conclude that many problems related to the use of Web-based questionnaires have been solved or will most likely be solved in the near future and that this mode of data collection offers serious benefits. However, questionnaire design issues may have a major impact on response and completion rates and on reliability of the data. Theoretically, Web-based questionnaires could be considered an alternative or complementary mode in the range of epidemiologic methods of data collection. Practice and comparisons with the traditional survey techniques should reveal whether they can fulfill their expectations.     

Self-management in anticoagulant therapy--implications for the future?

Recent meta-analysis has demonstrated that self-management in oral anticoagulant therapy results in fewer thromboembolic complications and a decrease in mortality in comparison to conventional treatment, while the number of bleeding complications remains unchanged. We discuss the importance of these findings for the situation in the Netherlands with its specialized anticoagulation clinics and the possible consequences for the introduction of new anticoagulants like dabigatran and rivaroxaban.     

What is the future of prepaid medical practice?

Prepaid medical practice, bolstered in its growth over the past eight years by government legislative and financial support, is currently at a unique crossroad. Confronted with a reduction in federal support as a result of the 1981 amendments to the HMO Act, and faced with an undefined investment commitment from the private sector, HMO expansion and future growth rates are subject to some uncertainty. An assessment of the future of HMOs must take into account not only the immediate past, but also how present, evolving marketplace factors will shape trends in the years ahead.