E-mail: a realistic conduit for patient-doctor communications?

This article explores the potential of E-mail as a medium of patient-physician communication. It introduces control tactics that physicians can consider to increase the efficiency of the medium. These include pre-qualifying the patients receiving the physician's E-mail address, establishing a code for high-risk patients, responding to E-mail only during "down time," using response templates, off-loading standard questions, establishing a quota, and establishing user expectations. The author suggests that if physicians develop a discipline around handling E-mail, they can increase their effectiveness by developing closer ties with patients without sacrificing extra time.     

Towards better nutrition: lip service or a realistic fight?

Progress towards the objective of the World Food Conference of 1974 that "no child should go to bed hungry" is reviewed. The low market price of primary products keeps developing countries poor. Yet in these countries industry rather than agriculture has been supported by governments. All regions are increasing total food production but population growth threatens to offset this increase. In some areas there is decrease in food production per head of population. In many countries the social situation of women affects the nutrition of families. Other causes of malnutrition are discussed and future policies are recommended.     

Is remission of depressive symptoms in primary care a realistic goal? A meta-analysis

Background  

A primary goal of acute treatment for depression is clinical remission of symptoms. Most meta-analyses of remission rates involve randomized controlled trials (RCTs) using patients from psychiatric settings, but most depressed patients are treated in primary care. The goal of this study was to determine remission rates obtained in RCTs of treatment interventions for Major Depressive Disorder (MDD) conducted in primary care settings.     

Postdatism -- a perinatal problem?

It has been traditionally accepted that maternal and fetal complications are at their lowest levels 37-42 weeks into gestation. 20% of pregnancies completed after 42 weeks gestation are thought to be affected by the postmaturity syndrome of uteroplacental insufficiency resulting in oligohydramnios, meconium passage, loss of fetal subcutaneous tissue, fetal asphyxia, and fetal death. Some workers, however, have also found that pregnancies completed between 40 and 42 weeks carry significant risk. The authors explored this question in a case-control study of 464 women seen at the Mahatma Gandhi Institute of Medical Sciences in Maharashtra, India. The cases of postdatism occurred in the absence of any other medical or obstetric problem. The operative delivery rate increased significantly among these patients compared to deliveries between 39 and 40 weeks. There was neither significant asphyxia nor perinatal loss in term completed normal patients. Asphyxia and perinatal mortality did, however, occur with postdatism. The authors note the likely role of oligohydramnios combined with placental dysfunction.     

How well does a telephone questionnaire measure drinking water intake?

BACKGROUND: Few studies have assessed the validity or reliability of drinking water intake estimations. In studies investigating potential waterborne disease, this is very important. METHODS: We carried out a validity and reliability study to evaluate water intake estimations. The validity part of the study compared a telephone questionnaire to a diary. The reliability part of the study compared two telephone questionnaires. RESULTS: 253 participants were recruited. The most commonly consumed water intake categories were plain and boiled tap water. For persons aged less than 12 years, the median volume of plain water consumption was 2.9 glasses/day according to the diary. For persons aged 12 years and over, the median volume of plain water consumption was 3.0 glasses/day and for boiled water 3.0 glasses/day according to the diary. There was negligible systematic over or under reporting by participants for the telephone questionnaire in comparison to the diary and for the comparison of both telephone questionnaires. Water intake estimates were converted to categorical variables and the per cent agreement and weighted kappa statistics were calculated. For both the validity and reliability parts of the study the per cent agreement was 57-78% and the weighted kappa was 0.57-0.81. CONCLUSION: Water intake estimates show only moderate levels of validity and reliability when using a telephone questionnaire in comparison to a diary. IMPLICATIONS: Investigators of potential waterborne disease or nutritional research should exercise some caution in drawing conclusions from minor differences in drinking water intake that are obtained from a telephone questionnaire.     

Strategic constraints in health informatics: are expectations realistic?

In response to demands to enhance the efficiency and accountability of health systems, a range of different information technologies are being promoted. These technologies include integrated hospital systems, community health information networks and data repositories. However, the record of such technologies inside and outside the health industry suggest that such technologies cannot necessarily be relied on. The reason identified is that information systems are inherently logical and rational systems, and often come into conflict with the less rational social systems of organizations. Health information is identified in terms of three basic dimensions of information; that associated with managers; with professionals; and, with patients. The information of these dimensions are focused on very different objectives, have different structures and functions and are controlled by very different social processes. The information is also very complex and diverse within the dimensions. In the clinical encounter the clinician draws on specialist expertise, satisfies administrative requirements, and provides a clinical record. Thus, these dimensions converge at that point. However, collecting information is costly, and an efficient service demands economy in data collection. However, the technologies being promoted demand 'complete' data acquisition based on consistent and stable data definitions and data structures. The article argues that there is, thus, a conflict between the requirements of these technologies, and the realities of providing efficient services within a changing organizational, professional and social environment.     

Is there still a problem with lead in drinking water in the European Union?

The presence of lead in drinking water poses a range of risks to human health, including the retardation of some aspects of child development, the inducement of abortion, and other clinical disorders. The extent of these risks has not been quantified at the European Union (EU) scale. A number of sampling methods are in use across the EU, some of which are inadequate for determining the concentrations of lead in drinking water at consumers' taps. In consequence, non-compliance with the EU standards for lead in drinking water has been under-estimated. Emerging data indicates significant non-compliance with these standards in some countries, particularly with the 10 mg l^-1 standard that will become a legal requirement in 2013; the current interim standard of 25 mg l^-1 is also exceeded in some locations. An initial estimate is that 25% of domestic dwellings in the EU have a lead pipe, either as a connection to the water main, or as part of the internal plumbing, or both, potentially putting 120 million people at risk from lead in drinking water within the EU. These issues are relevant to the implementation of the Protocol on Water and Health and to drinking water safety planning.