Are professionals jumping the gun in the fight against chronic diseases?

The first steps in implementing a national nutrition policy of providing a food supply which meets the nutritional requirements of our population have been the periodic issuance of the Recommended Dietary Allowances. More recently, the "Dietary Goals for the United States" have been released by the Select Committee on Nutrition and Human Needs of the U.S. Senate, developed in the belief that they would, if followed, serve as one avenue of preventing coronary heart disease. The author presents a "critique" of the Dietary Goals, including a re-examination of food consumption statistics and a summary of intervention trials in five countries in which diet or drug therapy was aimed at lowering serum cholesterol. Listed are four criteria for evaluating recommendations to the public about diet and chronic disease. Rather than making a major revision in the proportion of fat and carbohydrates in our national diet, he recommends only limitation of the overall amounts to achieve weight control for those who need it.     

How can the community contribute in the fight against HIV/AIDS and tuberculosis? An example from a rural district in Malawi

This paper describes (a) the experience of initiating community involvement in HIV/AIDS and tuberculosis (TB) activities in a rural district in Malawi and (b) some of the different ways in which the community is contributing in the fight against these two diseases and the outcomes of their involvement. During a 2-year period, a total of 21,358 (41%) of 52,510 HIV tests performed at voluntary counselling and HIV testing (VCT) sites in the district were conducted by lay community counsellors. A team of 465 community volunteers, 1,362 trained family caregivers and 9 community nurses provided care and support to 5,106 HIV-positive individuals, of whom 2,006 (39%) were in WHO stage III or IV. All those in WHO stage III or IV were on co-trimoxazole prophylaxis and 895 (45%) of these were also on antiretroviral treatment. A total of 2,714 TB patients, of whom 1627 (60%) were HIV-positive, also received care and support. A total of 1,694 orphans were trained in vocational skills. Twelve vegetable gardens and three maize farms were set up, and pre-school activities were organised for 900 orphans. Communities can play an important contributory role in reducing the burden of HIV/AIDS and TB and in mitigating its impact. Despite this, community resources in most settings are often under-exploited and their role remains undefined.     

Dietary antioxidants: Do they have a role to play in the ongoing fight against abnormal glucose metabolism?

Overfeeding, an increased intake of saturated fatty acids, and sugary foods are key dietary changes that have occurred in recent decades in addition to the emergence of the obesity epidemic. In addition to an increase in energy storage as fat, these dietary changes are accompanied by an increase in mitochondrial macronutrient oxidation, leading to an excessive free radical production and, hence, oxidative stress. The latter has long been considered a central mechanism linking nutrient overload, insulin resistance, the metabolic syndrome, and diabetes. However, food, through fruit and vegetable consumption, also can be a great source of antioxidants that protect the body against oxidative damage and insulin resistance and thus help cope with the metabolic backlash of the energy-dense Westernized diet. Experimental data are in favor of the beneficial role conveyed by antioxidants in glucose metabolism, but clinical data in humans remain controversial. This review therefore aimed to sort out any underlying discrepancies and provide an overall clear view of the role of antioxidants in the ongoing fight against abnormal glucose metabolism.     

Can Southern hospitals fight the unions?

As unions turn their attention southward to the vast, largely untapped potential here; can they find widespread success in organizing hospitals in the region? They can, according to the author, a High Point, NC labor attorney, unless hospital management becomes more skilled. Sheahan points out that legislation and other factors have created a climate favorable to organizing activity in even non-profit hospitals.     

Where Does the Money Go? Analyzing the Patient Experience in Safety-Net Hospitals

BackgroundLow-income, publicly insured admissions historically cost more to treat than does the average patient. To ensure that hospitals are reimbursed an adequate amount for care of indigent populations, Medicare reimburses hospitals an additional percentage amount according to federally set financial schedule. At 15% of a disproportionate patient percentage, a hospital is reimbursed an extra 2.5% of the standard prospective payment rate.ObjectiveThis research seeks to determine whether hospital qualification as a Medicare Disproportionate Share Hospital results in higher patient experience ratings.MethodsA regression discontinuity method was used to determine the effect of lagged Disproportionate Share Hospital (DSH) status on next year patient experience ratings. The Hospital Consumer Assessment of Healthcare Providers and Systems data provide publicly available patient ratings.ResultsOn average, hospital ratings increase by 6% as a result of DSH status. Hospital ratings increase by an average of 6.5% when nonprofit hospitals are analyzed. This finding is primarily driven by patient facility cleanliness and medical provider communication ratings.ConclusionsThe federal mandate that individuals purchase health insurance in the United States coupled with the state expansion of Medicaid coverage will theoretically eliminate the need for Medicare DSH payments. It is calculated, however, that hospitals will need increased Medicaid reimbursements of more than $300 per patient to make up for the loss of Medicare DSH reimbursements. Hospitals will likely suffer financially as a direct result of reduced Medicare reimbursements through the DSH program.     

The fight against sexually transmitted diseases in Ivory Coast: what strategies can we use in the face of HIV/AIDS?

In the AIDS era, sexually transmitted diseases (STDs) have become a major health problem in developing countries, particularly in Africa. Delays in the diagnosis and treatment of such infections may result in complications, many of which primarily affect women. Epidemiological studies in Abidjan have shown that more than 10% of the pregnant women attending antenatal clinics present STDs potentially serious for their own health or that of their infants (gonorrhea, chlamydia infection, genital ulcers or active syphilis). There is evidence that STDs increase the transmission of HIV and that improving the syndromic management of STDs reduces the incidence of HIV infection. This provides a strong argument in favor of controlling STDs in areas of high HIV prevalence. In Ivory Coast, as in other African countries, a STD control program has been integrated into the AIDS control program since 1992, as recommended by the World Health Organization. During the first six years of the STD program, considerable progress was made in some areas, but not without difficulty. Simple syndrome-based decision trees have been adopted for the management of STDs in primary health care. Clinical studies have shown these therapeutic algorithms to be effective. At the same time, effective and affordable drugs for treating STDs were added to the list of essential drugs in Ivory Coast, after an international invitation to tender. The entire staff of the public health sector in Abidjan has been trained in syndromic STD management. Training is now being extended to other parts of Ivory Coast, including the private health sector and, in particular, private nurses. The surveillance of syndromic STDs, mainly genital ulcers in both sexes and urethral discharge in men, facilitates monitoring and evaluation of the STD program, following health care activities and adapting orders for drugs for treating STDs to real needs. In the near future, some parts of the STD program will be strengthened, particularly the management of sexual partners of STD patients and reduction of the cost of STD treatment for pregnant women.     

Postneonatal mortality in Alabama: why no progress in the 90s?

PURPOSE: To examine the factors associated with postneonatal mortality. METHODS: Logistic regression was used to examine the effects of various variables on postneonatal mortality in Alabama. RESULTS: The most important predictor of postneonatal mortality was birth weight. Social and economic variables were also important in explaining postneonatal mortality. CONCLUSIONS: Reductions in postneonatal mortality may require closer case management of low birth weight neonatal survivors. Survival of these infants creates a cohort at risk of postneonatal mortality. Many of these low birth weight infants are born into an environment where their mothers' parenting potential is compromised by youth and poverty. This may be responsible for the failure to reduce postneonatal mortality and explain its increasing proportion of infant deaths; deaths may be being postponed from the neonatal to the postneonatal period.     

Vending Machines in Australian Hospitals: Are They Meeting the Needs of the Consumer?

The current report explores how well vending machines are meeting the needs of health care organizations and their staff and visitors in Australia. Hospital vending machines often provide the only source of food through the night to staff and visitors and traditionally offer less-healthy options. Findings presented in this report suggest that vending machines are not meeting current statewide policies and guidelines for healthier food environments in health care. This is despite widespread support for healthier refreshments in hospitals by staff, visitors, and patients. Alternatives to traditional vending and opportunities for nutrition educators and researchers are discussed.     

Changes of olfactory performance during the process of aging – Psychophysical testing and its relevance in the fight against malnutrition

Objectives

Olfactory performance plays a vital role in several aspects of everyday life. A decrease in olfactory function leading to reduced appetite and inadequate food intake could contribute to higher risk of malnutrition and has a significant impact on quality of life. Early detection of olfactory impairment may help to maintain normal, or — through early training — to improve olfactory function and could thus contribute to the prevention of malnutrition. This review summarizes recent findings on the association between decreased olfactory performance in older adults, its implication for overall health and discusses issues regarding the assessment of olfactory performance in older people.

Methods

A non-systematic literature search using databases (PubMed, ScienceDirect, Google Scholar) was conducted up to March 2016 to review recent findings on the topics of olfactory impairment, age, malnutrition and issues in psychophysical testing.

Results

Although the association of olfactory impairment and malnutrition is widely accepted strong evidence is scarce. This could be because existing psychophysiological olfactory performance tests are not suitable and inefficient for older adults or people with cognitive impairment due to their required time and concentration. Since prevalence of olfactory impairment remains poorly documented in European regions and varies from 13.9% to >60% depending on age and due to considerable methodological diversity in studies there is need to develop rapid and efficient screening tools which are suitable for this target group.

Conclusion

Due to numerous causes and health consequences of olfactory impairment in older people, early detection of olfactory malfunction by rapid, inexpensive but valid tests, which could be used by geriatricians and other healthcare professionals, might be useful in patient counselling by identifying individuals at nutritional risk.

     

The new European guideline on cardiovascular disease prevention; how to make progress in general practice?

The new guideline on cardiovascular disease (CVD) prevention, issued by the European Society of Cardiology was endorsed by 10 other societies, including Wonca Europe. It advices on how to reduce the cardiovascular (CV) risk in the population and attributes an important role to the general practitioner (GP). The GP is involved in treatment of the high-risk population as well as in public health measures to encourage a healthy lifestyle and CV risk factor reduction in the whole population. The new guideline gives room for a personalized approach and emphasizes that CV risk estimation and counselling need regular follow-up. We highlight the recommendations that most caught our eye and comment on the challenges for general practice.