Preventive Medicine Practices Research Articles

Aile Hekimlerinin güneşten korunma davranışları ve deri kanserine yönelik koruyucu hekimlik uygulamalarının değerlendirilmesi

Aile Hekimlerinin güneşten korunma davranışları ve deri kanserine yönelik koruyucu hekimlik uygulamalarının değerlendirilmesi

Excessive Daytime Sleepiness and Related Factors in Adults

Objective: This study was aimed to determine excessive daytime sleepiness and related factors in adults. Materials and Methods: This cross-sectional study was conducted in Corum an inland province in the Black Sea Region of Turkey, with 575 adults between the ages of 18-64 who registered at a Family Health Center. In this study, a self-administered 37-item questionnaire and the Turkish version of The Epworth Sleepiness Scale were used. Results: In our study, overall prevalence of excessive day-time sleepiness was 11.3%. It was significantly prevalent among adults under the age of 25 years of age with the increased risk being 1.18 fold. Also it was more prevalent among women. Increased risk of excessive day-time sleepiness was 3.05 fold higher in adults with chronic disease and 1.78 fold higher with adults having a stressful life. Among the sleep-related habits, it was more often in adults with ‘sleep speaking, restless sleep, breathing pauses, subjective sense of having a problem related with sleep, waking up feeling unrefreshed. Conclusion: The results of our study showed that nearly one in ten adults were suffering from excessive daytime sleepiness. It is suggested that to improve sleep hygiene and to manage chronic disease for people with daytime sleepiness should be a priority for public health and preventive medicine practices.

What should be the appropriate minimal duration for patient examination and evaluation in pulmonary outpatient clinics?

INTRODUCTION:Patient examinations performed in a limited time period may lead to impairment in patient and physician relationship, defective and erroneous diagnosis, inappropriate prescriptions, less common use of preventive medicine practices, poor patient satisfaction, and increased violent acts against health-care staff.OBJECTIVE:This study aimed to determine the appropriate minimal duration of patient examination in the pulmonary practice.METHODS:A total of 49 researchers from ten different study groups of the Turkish Thoracic Society participated in the study. The researchers were asked to examine patients in an almost ideal manner, without time constraint under available conditions.RESULTS:A total of 1680 patient examinations were reviewed. The mean duration of patient examination in ideal conditions was determined to be 20.4 ± 9.6 min. Among all steps of patient examination, the longest time was spent for “taking medical history.” The total time spent for patient examination was statistically significantly longer in the university hospitals than in the governmental hospitals and training and research hospitals (P < 0.001). Among different patient categories, the patients with a chronic disorder presenting for the first time and were referred from primary or secondary to tertiary care for further evaluation have required the longest time for patient examination.CONCLUSION:According to our study, the appropriate minimal duration for patient examination is 20 min. It has been observed that in university hospitals and in patients with chronic pulmonary diseases, this duration has been increased to above 25 min. The durations in clinical practice should be planned accordingly.

Off-the-person electrocardiography: performance assessment and clinical correlation

Previous work by our group introduced a novel concept and sensor design for “off-the-person” ECG, for which evidence on how it compares against standard clinical-grade equipment has been largely missing. Our objectives with this work are to characterise the off-the-person approach in light of the current ECG systems landscape, and assess how the signals acquired using this simplified setup compare with clinical-grade recordings. Empirical tests have been performed with real-world data collected from a population of 38 control subjects, to analyze the correlation between both approaches. Results show off-the-person data to be correlated with clinical-grade data, demonstrating the viability of this approach to potentially extend preventive medicine practices by enabling the integration of ECG monitoring into multiple dimensions of people’s everyday lives.

Preventive medicine practices by primary care providers in Karachi.

Preventive medicine is the cornerstone of any healthcare system. It has become an important aspect of medical practice in the West over the last decade and entails intervening before the disease starts, identifying and treating asymptomatic conditions and limiting further complications of the disease. Clinically, this includes vaccination, behavioural counseling, screening and primary prophylaxis.1 Disease prevention and health promotion are the most effective interventions for solving Pakistan’s healthcare crisis. The burden of preventable diseases in the developing countries is escalating. An estimated 33.4 million deaths were caused by preventable diseases and injuries in 2002. Of these, 72% occurred in the developing countries.2,3 Besides causing mortality, preventable diseases have great economic implications as they incur huge costs in care and lost productivity.2 A Primary Care Physician (PCP) is the one who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. PCPs play a vital role in mitigating preventable health problems. Their relationship with patients enables them to assess risk factors, effect behavioural change, recommend screening and prescribe appropriate chemoprophylaxis.4 Inadequate provision of preventive services has been described world over,4-6 but there have been no recent studies on this subject in Pakistan. This study was performed to determine the current practice patterns of PCPs regarding preventive medicine in out-patient clinics in Karachi, Pakistan.

Serosurvey of selected avian pathogens in brazilian commercial Rheas (Rhea americana) and Ostriches (Struthio camelus)

Ratite farming of has expanded worldwide. Due to the intensive farming methods used by ratite producers, preventive medicine practices should be established. In this context, the surveillance and control of some avian pathogens are essential for the success of the ratite industry; however, little is known on the health status of ratites in Brazil. Therefore, the prevalence of antibodies against Newcastle Disease virus, Chlamydophila psittaci, Mycoplasma gallisepticum, Mycoplasma synoviae, and Salmonella Pullorum were evaluated in 100 serum samples collected from commercial ostriches and in 80 serum samples from commercial rheas reared in Brazil. All sampled animals were clinically healthy. The results showed that all ostriches and rheas were serologically negative to Newcastle disease virus, Chlamydophila psittaci, Mycoplasma gallisepticum, and Mycoplasma synoviae. Positive antibody responses against Salmonella Pullorum antigen were not detected in ostrich sera, but were detected in two rhea serum samples. These results can be considered as a warning as to the presence of Salmonella spp. in ratite farms. Therefore, the implementation of good health management and surveillance programs in ratite farms may contribute to improve not only animal production, but also public health conditions.

Management practices used by white-tailed deer farms in Pennsylvania and herd health problems

To determine current management practices used by white-tailed deer farms in Pennsylvania and identify animal health problems that exist in these herds. Cross-sectional study. Owners and managers of 233 farms in Pennsylvania that raised white-tailed deer. A self-administered questionnaire was mailed to participants. Herds ranged in size from 1 to 350 deer. Land holdings ranged from 0.07 to 607 hectares (0.17 to 1,500 acres). Stocking density ranged from 0.1 to 118.6 deer/hectare (0.04 to 48 deer/acre). Most (84%) respondents raised deer for breeding or hunting stock; 13% raised deer exclusively as pets or for hobby purposes, and purpose varied by herd size. Multiple associations were identified between management or disease factors and herd size. The use of vaccines, use of veterinary and diagnostic services, use of pasture, and use of artificial insemination increased as herd size increased. The most common conditions in herds of all sizes were respiratory tract disease, diarrhea, parasitism, and sudden death. The prevalence of respiratory tract disease increased as herd size increased. Results suggested that many aspects of herd management for white-tailed deer farms in Pennsylvania were associated with herd size, but that regardless of herd size, many preventive medicine practices were improperly used or underused in many herds.

The Attitudes and Practices of Governmental Health Care Professionals Toward Preventive Medicine

The purpose of this study was to identify the personal attitudes and habits as well as the professional practices of selected governmental health care professionals toward preventive medicine. The subject pool included all of the health care professionals (n=121) working in the Houston VA Medical Center's ambulatory clinics. A questionnaire was utilized to determine personal and professional preventive medicine practices. The study used descriptive statistics to describe the subjects’ habits and knowledge of personal preventive medicine information. Descriptive statistics were also used to show the perceived barriers these professionals identified to promoting preventive medicine to their patients. Spearman correlation coefficients were used to identify if there was a relationship between what these professionals practice in their own lives with the extent in which they promote it to their patients. The results showed that these subjects practiced preventive medicine in their own lives to a significant extent but this did not predict whether they would promote it in their patients. Several relationships were found in how important the subjects perceived preventive medicine practices to be in their own effort to reduce their health risks and how effective they found these same interventions to work for their patients. Several barriers to promoting preventive medicine interventions were identified the most significant being lack of time and patient apathy toward the interventions. Examining current practices and barriers to promoting preventive medicine is essential to designing effective preventive medicine strategies.

Awareness of Consensus Preventive Medicine Practice Guidelines Among Primary Care Physicians

Since documented low use of preventive medicine practices may be due to lack of acquaintance with recommended practices, we measured the level of awareness of specific consensus recommendations and assessed factors that might influence awareness. We surveyed 326 randomly selected Kansas primary care physicians stratified by urban-rural location and medical specialty (family practice, internal medicine, obstetrics-gynecology, and pediatrics) using a structured computer-assisted interview or questionnaire composed of 11 specialty-specific multiple choice knowledge questions based on selected published consensus recommendations. With a 90% response rate to our survey, chi 2 testing and analysis of variance (ANOVA) showed (1) correct response rates ranging from 27% (hypertension treatment threshold) to 99% (follow-up mammography) with a correct response rate of at least 70% for seven of the 11 questions; (2) no consistent differences for overall correct response rates among medical specialties and between practice location, gender, years in practice, preventive medicine exposure during residency or through continuing medical education courses, or acquaintance with source publications; and (3) higher correct response rates for six of 11 questions among physicians with board certification. Our results suggest that low use of prevention practices by physicians is likely due to factors other than lack of physician knowledge of published consensus recommendations.

Integrating individual and public health perspectives for treatment of tobacco dependence under managed health care: A combined stepped-care and matching model

There is an increasing momentum to integrate prevention into mainstream health care. Three decades of research on tobacco dependence can provide insights into the conceptual, clinical, economic, and service delivery challenges to such an integration. Biological sciences, cognitive-behavioral, clinical treatment outcome, and public health arenas are selectively reviewed. The key conceptual issues are explored relevant to the optimal delivery of quality smoking cessation treatments for the general population of adult smokers at reasonable cost. A comprehensive model for adult smoking cessation treatment is developed. The model consists of an overarching public health approach, focusing on enhancing motivational level from low motivation to quit to high motivation. A common outcome metric of overall impact is proposed to facilitate comparisons between clinical and public health interventions. Smokers are then assessed and triaged into one of three treatment steps of minimal, moderate, and maximal intensity and cost. Smoker individual differences at both the population and individual level are also taken into account as part of a tailoring or matching strategy within and across the stepped interventions. Smoker profiles include sociocultural, nicotine dependence, and comorbidity factors. The result is a hybrid stepped-care matching model. The model serves to illustrate some of the needs and challenges facing future tobacco dependence research and practice. Comparisons are made between tobacco control and other preventive medicine practices in terms of cost per quality adjusted life-year saved. The barriers and opportunities under managed care are explored. The conceptual principles identified here could be used as a guidepost for integrating other preventive medicine programs into the evolving managed health care system.

A pseudo-outbreak of skin disease in British troops.

When a newspaper report claimed that a serious outbreak of skin disease had occurred in British Army troops stationed at the Bocac Dam, in western Bosnia, all troops at the Bocac Dam location (n = 96), followed by a matched control group of troops (n = 91) at a nearby location, were examined by two investigators. 14% of the study population and 21% of the control group were found to have skin disorders. Most were complaints that are commonly encountered in general medical practice. There was a striking absence of skin infestations. The historical consultation rate for skin disorders had not increased. It was concluded that an outbreak of skin disease had not occurred in British troops guarding the dam. This epidemiological study shows that, even under conditions of modern field hygiene, up to one in five soldiers will have skin disease. Skin infestations, however, have become progressively less common during military campaigns this century, probably because of better personal hygiene, good preventive medicine practices and better access to effective health care.

Emphasizing a preventive medicine orientation during primary care/family practice residency training

In the wake of managed care, primary care physicians are expected to be gatekeepers in the overall healthcare system. As such, preventive medicine, rather than disease-oriented medicine, will play a key role in keeping medical costs in line. To that end, the authors review the current preventive medicine practices and guidelines and suggest ways in which these practices can be implemented in the training of primary care/family practice residents.

Survey of Milking Management Practices on Large Dairies and Their Relationship to Udder Health and Production Variables

A survey of 91 milking management practices and 5 measures of udder health and production was conducted on 50 randomly selected dairies in Tulare County, CA. Data were collected by a combination of interview and site visit. On many dairies, there was inconsistent application of recommended milking practices such as careful teat dipping, attending liner slips, maintaining treatment records, efficient parlor usage as measured by throughput, and use of paper towels. Thirteen of 91 practices were associated with at least one measure of udder health or production; the categories of practices that appear to have the most influence are practices related to environmental management and practices related to milking procedures. The implications of the study are that better preventive medicine education programs are needed as well as better analytical tools to permit producers to evaluate quantitatively the economic benefit of preventive medicine practices.