Tertiary Level Health Care Research Articles

Diabetes care in Slovenia: now and in the future

AbstractSlovenia has about two million inhabitants: the estimated total number of diabetic patients is approximately 100‐000 (prevalence circa 5%). The first specialised hospital diabetes department was established in 1945. Today, diabetes health care is delivered at primary, secondary and tertiary health care levels. Patients on diet and exercise or oral hypoglycemic agents are treated by general practitioners and those on insulin by specialist diabetologists. Specialist out‐patient diabetes clinics are held at all general hospitals. A structured foot care prevention and treatment programme is running at the majority of out‐patient diabetes clinics, as well as screening for retinopathy. Renal dialysis is available throughout the country for those patients with end‐stage renal failure. A specialised clinic for diabetic pregnancy has been set up at the University Hospital in Ljubljana. Diabetic health care in Slovenia is provided free of charge.The Slovenian Endocrinology Association (which brings together physicians engaged in diabetology), the Slovenian Nurse Endocrinology and Diabetology Association, and the Slovenian Diabetic Foot Working Group were established in 1970, 1988 and 1995, respectively. Postgraduate diabetology courses for doctors have been run since 1982, and for nurses since 1996; diabetic foot training courses have been held since 1995. In addition, countrywide there are 39 diabetic patients' societies which are united under the umbrella of the Slovenian Diabetic Association. Copyright © 2004 John Wiley & Sons, Ltd.

Is it ethical for health workers to strike? Issues from the 2001 QECH general hospital strike.

Between 5th and 19th October 2001, a general strike in which virtually all workers at the Queen Elizabeth Central Hospital (QECH) were involved was effected. Hospital workers' grievances included low remuneration and poor work environment. The strike resulted in the virtual closure of the QECH, as the 1500-bed hospital was maintained less than a hundred in-patients. The outpatient department was closed. Patients that were still in hospital were being cared for by volunteer workers who included; the Red Cross, medical and nursing students and their lecturers. The two-week strike at QECH has left an almost indelible mark in as far as tertiary level health care delivery in Malawi is concerned. We report on the conduct of the hospital workers strike and discuss ethical issues in the light of the socio-political context of Malawi. While many people suggest that damage has definitely been done and felt, the ethical issues involved remain contentious as ever.

Evaluation of haematology analyzer CELL-DYN 3700 SL

Research on the parameters of full blood count and differential white blood count is included in the program of all medical laboratories of primary, secondary and tertiary health care levels. Today, all haematological tests are exclusively performed on the haematology analyzers. Automation of haematology laboratories is a result of the huge requires for haematological test performing, timely issuing of the haematological findings, and possibility of the usage of modern techniques. This work is an evaluation of laser haematology analyzer Cell-Dyn 3700 SL. It investigates the reliability of test results throughout the following parameters: precision, accuracy, sensitivity and specificity of determination methods. It also explores the influence of sample transferring and correlation with haematology analyzer MAXM Retti. Haematology parameters that have been investigated are: white blood cell (WBC), neutrophils (NEU), lymphocytes (LXM), monocytes (MONO), eosinophils (EOS), basophils (BASO), red blood cells (RBC), haemoglobin (HGB), haematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCHC) red cell distribution width (RDW), platelet (PLT), mean platelet volume (MPV), plateletocrit (PCT), and platelet distribution width (PDW). The results confirms that precision of analyzer fulfils the reproducibility of testing parameters: WBC, RBC, HGB, MCV, MCH, MCHC, and PLT. Correlation coefficient values (r) gained throughout the statistical analysis, that is linear regression results obtained throughout the comparison of two analyzers are adequate except for MCHC (r = 0.64), what is in accordance with literature data. Accuracy is tested by haematology analyzer method and microscopic differentiating method. Correlation coefficient results for granulocytes, lymphocytes and monocytes point the accuracy of methods. Sensitivity and specificity parameters fulfil the analytical criteria. It is confirmed that haematology analyzer Cell-Dyn 3700 SL is reliable for the determination of full blood count in everyday work. Analyzer and its program for differential white blood count can be used for the research and separation of normal and pathological blood counts with addition of microscopic methods confirming distribution or morphologic changes of leukocytes.

The role of epilepsy centers in delivering care to patients with intractable epilepsy

Epilepsy is a disorder that can profoundly influence people's ability to participate fully in society. To ameliorate the effects of the disorder, the health care system should provide mechanisms that explicitly facilitate consultations among primary-, secondary-, and tertiary-level health care providers. Second, it should develop schedules for compensating for both the less and the more technologically intensive methods of diagnosis and treatment. These should allow improved or complete seizure control in a significant portion of patients with intractable seizures. Although there are costs for such changes, the costs of not making them may be higher.

Psychiatric morbidity in a pregnant population in Nigeria

Psychiatric morbidity among 240 pregnant women attending an antenatal unit was assessed by a two-stage screening procedure, using the General Health Questionnaire (GHQ-30) and Present State Examination Schedule (PSE). The prevalence of psychiatric morbidity was found to be significantly associated with younger age (<24 years), being primigravid, married for less than 1 year, having an unsupportive husband, and a previous history of induced abortion. It is suggested that more attention needs to be paid to the mental health of pregnant women in developing countries (where pregnancy rates and the risks associated with pregnancy/delivery are much higher than in the developed countries) at the primary, secondary, and tertiary levels of health care.

Are children with asthma affected by smog?

To assess the relationship between atmospheric smog and emergency department attendances in children with asthma. The number of child attendances with acute asthma was calculated retrospectively for each day of the 1989 calendar year. Daily smog data for 1989 were then obtained from the Environment Protection Authority of Victoria, and were related statistically to asthma attendances. The Emergency Department of the Royal Children's Hospital, Melbourne, which provides primary, secondary and tertiary level health care to the children of Victoria. All children over two years of age with acute asthma. The number of attendances with asthma each day for the 1989 calendar year. Smog alerts (smog days predicted by the Environment Protection Authority) and smog episodes (actual smog days of all types) were not significantly related to asthma attendances. A significant relationship was noted, however, between asthma attendances and days when the airborne particulate index was above the acceptable threshold. No relationship was found between asthma attendances and ozone levels (a marker of photo-oxidant smog), or between any smog index and days of unusually high asthma attendance (asthma epidemic days). All smog variables combined explained only 2.3% of the variance in asthma attendance. Although the overall contribution of smog to asthma attendances in children is small, the correlation between asthma attacks and airborne particles is a hitherto unreported finding in Australia and is potentially of public health importance.