Population-based prevention of influenza in Dutch general practice.

BACKGROUND: Although the effectiveness of influenza vaccination in high-risk groups has been proven, vaccine coverage continues to be less than 50% in The Netherlands. To improve vaccination rates, data on the organizational factors, which should be targeted in population-based prevention of influenza, is essential. AIM: To assess the organizational factors in Dutch general practice, which were associated with the influenza vaccination rate in 1994. METHOD: A retrospective questionnaire study was undertaken in 1586 of the 4758 Dutch general practices, which were randomly selected. A total of 1251 (79%) practices returned a questionnaire. The items verified were practice profile, urbanization, delegation index, use of computer-based patient records, influenza vaccination characteristics and influenza vaccination rate. RESULTS: No differences were found with regard to the percentage of single-handed practices (65%), practices situated in urban area (38%), practices with a pharmacy (12%), patients insured by the National Health Service (59%) and use of computer-based patient records (57%) when compared with national statistics. The mean overall influenza vaccination rate was 9.0% (SD 4.0%). Using a logistic regression analysis, a high vaccination rate (> or = 9%) was associated with the use of personal reminders (odds ratio (OR) 1.7, 1.3-2.2), monitoring patient compliance (OR 1.8, 1.3-2.4), marking risk patients in computer-based patient records (OR 1.3, 1.0-1.6), a small number of patients per full-time practice assistant (OR 1.5, 1.1-1.9), urban areas (OR 1.6, 1.3-2.1) and single-handed practices (OR 1.5, 1.1-1.9). CONCLUSION: Improvement of vaccination rates in high-risk patients may be achievable by promoting the use of personal reminders and computer-based patient records, as well as monitoring patient compliance. In addition, the role of practice assistants with regard to preventive activities should be developed further. Practices situated in rural areas and group practices may need more support with a population-based approach for the prevention of influenza.     

Hospitals in sub-Saharan Africa: why we need more of what does not work as it should

This paper analyses the origins of today's crisis in the hospital sector in sub-Saharan Africa. Present trends in availability of hospital services are extrapolated to the future in order to provide a low-end estimate of the need for expansion of first referral level hospitals. This will not be possible without giving due priority to this sector, a commitment to considerable investments and reorientation of resources from tertiary to first referral level hospitals. It is to be feared that if this is not done, the backlog will increase, and, given the time lag before investments translate into operational services, there will be a major shortage of hospital services in sub-Saharan Africa within a decade.     

Effects of postoperative pain on lung volume in patients undergoing aortic surgery

To evaluate the potential advantages of the administration of extradural morphine to control postoperative pain and its effects on respiratory function, 39 patients were randomly assigned to one of two groups before aortic surgery. The first group (20 patients) received intravenous analgesia as required (control group). The second group (19 patients) received extradural morphine in a programmed fashion. During the immediate postoperative period the following parameters were measured in both groups: respiratory rate, vital capacity, peak expiratory volume in the first second, PaO2, PaCO2, arterial pH, heart rate, and systolic and diastolic blood pressure. In the group treated with morphine the postoperative increase in heart and respiratory rate was significantly smaller than in the control group (p less than 0.01). Postoperative forced pulmonary volumes were higher in the morphine group (p less than 0.01). However, there were no differences in time of hospitalization between both groups. There were more complications in the control group, but the difference did not reach statistical significance.     

Urethral closure function in women with prolapse

In 19 patients with different types of severe descensus, all without clinical evidence of stress incontinence, urethral stress pressure profiles and stress tests were done before and after repositioning of the prolapse. In 13 of the 19 patients, continence was artificial, because during repositioning they showed leakage of urine; however, 6 of the patients remained continent. The pressure transmission ratios decreased in different parts of the urethra in all the patients when repositioning with a gynecological speculum was done. The drop was most significant in those patients who lost urine after repositioning, showing poor urethral function. In women with genito-urinary prolapse, a test of urethral function is essential, even if there is no clinical evidence of incontinence after removal of the descensus. In cases of severe stress incontinence under this condition, a procedure for bladder neck stabilization should be added to routine prolapse surgery.     

Early biochemical changes produced by malathion on toad embryos

The exposure of newly fertilized amphibian embryos to malathion (44 mg/L) produces 67% mortality on the fifth day of exposure. Clinical signs of intoxication are evident on the fourth day. A variety of biochemical parameters, such as enzyme activity, lipid and protein content, was examined in control and malathion-treated embryos. The activity of acetyl, butyrylcholinesterase and aliesterase are quickly inhibited. An interference with cellular protein synthesis and redistribution is possible. A slight increase in total phospholipids is evident after 24 hr of exposure.     

Biodistribution of radioactive epidermal growth factor in normal and tumor bearing mice

The biodistribution of iodinated epidermal growth factor in normal and tumor bearing mice was analyzed. The uptake of epidermal growth factor was high in the liver, skin and submaxillary gland, which all have detected receptors for the growth factor. Organs, such as lung, heart, spleen, intestine, bone and central nervous system, which lack the receptor, did not retain the growth factor. In tumor bearing mice, the growth factor accumulated in receptor positive tumors, but to a lesser extent than in the liver. This finding will probably prevent the use of epidermal growth factor as a carrier for radionuclides for a therapeutic purpose.