An Australian case study of patient attitudes towards the use of computerised medical records and unique identifiers.

Research into patient attitudes towards the use of technology in health care needs to be given much greater attention within health informatics. Past research has often focused more on the needs of health care providers rather than the end users. This article attempts to redress this knowledge bias by reporting on a case study of the responses gained from patients in a selected Australian medical practice towards the use of computerised medical records and unique identifiers. The responses (n=138) were gained from a survey of patients over a 13 day period of practice operation. This case study serves as an example of the type of future consumer health informatics research which can be undertaken not just in Australia but also in other countries, both at local regional levels and at a national level.

[Results of screening tests for gestational diabetes mellitus at Medical University in Warsaw]. / Badania przesiewowe w kierunku rozpoznawania cukrzycy ciezarnych na materiale I i II Kliniki Poloznictwa i Ginekologii Akademii Medycznej w Warszawie.

Our purpose was to determine the incidence of screening for gestational diabetes among the population of women delivering at I and II Departments of the First Faculty of Medical University in Warsaw. A retrospective review of 647 pregnancies was performed. The incidence of gestational diabetes mellitus screening was determined and the rate of occurrence of GDM analyzed. 310 (48%) pregnancies were screened for gestational diabetes mellitus with a 1-hour, 50 gm oral glucose challenge test. 49 (16.07%) of the screens had positive results at a plasma glucose level of > 139 mg/dl. Two-hour 75 gm oral glucose tolerance tests (according to the 1994 World Health Organization panel recommendations) were performed on screen-positive women, eleven of whom (22.45%) were diagnosed with gestational diabetes mellitus. Despite of positive oral 50 gm glucose test, (plasma glucose level 140-179 mg/l) 15 women (30%) haven't had the 75 gm oral glucose test. The incidence of GDM among analyzed population is 4% and when GDM screening is carried out, exceeds 7%. Early gestational glucose screening, if performed, may be beneficial in detecting gestational diabetes. Consideration should be given to fulfill it more frequently and for sure, repeat glucose testing in patients with positive one-hour screening tests.

[Risk factors for gestational diabetes mellitus and results of glucose tolerance tests]. / Czynniki ryzyka cukrzycy ciazowej a wyniki testów obciazenia glukoza.

The authors made an effort to verify the connection between the presence of risk factors for GDM and results of screening and diagnostic tests. Study group consisted 302 patients. Gestational diabetes was more frequently diagnosed when an excessive maternal weight and family history of diabetes occurred. Among women with gestational diabetes recognised on the basis of the tests results (screening or diagnostic), 1/3 of patients had no evidence of any risk factor. There is no correlation between the number of risk factors and the occurrence of gestational diabetes. The risk factors were present in half of the investigated patients.

[The effect of selected factors on the birthweight of the newborns in gestational diabetes]. / Wplyw wybranych czynników na mase urodzeniowa noworodków matek z cukrzyca ciezarnych.

Fetal macrosomia is commonly associated with gestational diabetes mellitus (GDM) which may lead to various complications. We attended to establish maternal constitutional and metabolic risk factors responsible for the genesis of macrosomia. 219 GDM mothers were divided into two groups treated by diet or insulin. This study shows that maternal glycemic status and maternal nutritional status before pregnancy are important determinants of fetal macrosomia.

[Pregnancy in women with diabetes complicated by nephropathy and proliferative retinopathy]. / Ciaza u kobiet chorych na cukrzyce powiklana nefropatia i retinopatia proliferacyjna.

Nephropathy and proliferative retinopathy are widely known as the most serious complications of diabetes. In the paper the analysis of the course of pregnancy, labour and neonatal complications among mothers with White class F, R, FR and T was made. The study group consisted of 44 patients. Primary hypertension was observed in 17 (38.6%) patients. The percentage of complications both maternal and neonatal was very high. Among maternal complications were pregnancy induced hypertension (43.2%), urinary tract infections (36%), anaemia (22.7%), threatened preterm labor (13.6%). Nearly 50% of patients has diurnal proteinuria in nearly 50% of patients exceed 3 g. In the opinion of the authors there is a strong need to establish the national supraregional centers designed specially to deal with the problems of pregnant women with diabetic nephropathy and retinopathy.

[Factors affecting birthweight in insulin-dependent diabetes mellitus pregnancy]. / Wplyw wybranych czynników na mase urodzeniowa noworodków matek z przedciazowa cukrzyca insulinozalezna.

Fetal growth is affected by various maternal factors. Metabolic disturbances often present in pregnancy complicated by insulin-dependent diabetes mellitus may have important effect on birthweight. The aim of this study was to evaluate the influence of maternal morphometric and metabolic factors on birthweight parameters in women with IDDM. Data were analyzed from 124 diabetic women who delivered in I Department of Obstetrics and Gynaecology University Medical School in Warsaw between 1989-1998. Maternal morphometric factors, glycemic control, insulin requirement, glycosylated hemoglobin and fructosamine levels were correlated with birthweight and birthweight ratios. Glycemic control in first weeks of second part of pregnancy as well as maternal height and weight gain during pregnancy affected birthweight in women with insulin-dependent diabetes mellitus.

[The impact of selected factors on birth weight of newborns whose mothers were treated with fenoterol due to imminent preterm labor]. / Wplyw wybranych czynników na mase urodzeniowa noworodków matek otrzymujacych fenoterol z powodu zagrazajacego porodu przedwczesnego.

Various maternal genetic, morphometric and environmental factors may have important effect on birth weight. The aim of this study was to evaluate the influence of maternal pregravid weight, height, body mass index, weight gain during gestation and the length of fenoterol therapy on birth weight in case of imminent preterm labor. The study was performed in the group of 148 pregnant women who delivered after 36th week of gestation as a result of successful tocolytic treatment. Analyzed parameters were correlated with birth weight index and birth weight ratio, also in relation to parity. It was established that birth weight was significantly correlated with maternal morphometric factors but not with fenoterol therapy.

[Analysis of female infertility structural factors]. / Analiza czynników bioracych udzial w strukturze nieplodnosci kobiecej.

The study was aimed to evaluate, within the population of infertile women, the interrelations between such characteristics as patient's age, duration and type (primary, secondary) of infertility, its etiologic factor as well as the treatment outcome (pregnancy rate). Retrospective analysis was performed in 176 women aged 20-43 years (mean age 29.5 years). Primary infertility was less common in older women (above 35 years). Duration of primary infertility was independent of age, on an average 1.5 years shorter compared to secondary infertility. Participation of all causal factors in the structure of infertility was steady--11.6-20.2%. The most frequent reasons of secondary infertility were unexplained infertility 55.3% and tubal pathology--19.1%. The pregnancy rate was 30% in all treated women. In the studied population of women, pregnancy rate was not significantly influenced by the patients's age, type of infertility and its cause.

A comparative study of computerised medical records usage among general practitioners in Australia and Sweden.

This article is based on a major empirical study of the state of adoption of Computerised Medical Records (CMRs) among General Practitioners (GPs) in Australia and Sweden. Responses were gained from a mail out questionnaire to random samples of GPs in both countries (n = 600/country). This paper will report on the main findings gained emphasising some of the various similarities and differences between the two sample groups. This comparative study adds to the existing body of CMR literature by way of providing a cross cultural perspective on GP adoption states. As a result, some concluding comments are offered for understanding high and low diffusion rates of CMRs among GPs and the implications for health policy and technology adoption strategies.

Australian healthcare: a smart card for a clever country.

In this paper we give an overview of smart card technology how a smart card could be used as a healthcare card and the benefits that would most likely result from doing so. The smart card memory can be zoned into different security levels. The top security zone may contain an individual's full medical history while the lowest security zone may contain the cardholders name and address. Access to the different zones depends on the level of security of the zone. The higher the security level the more restrictive the access method. Were smart cards adopted for the storage of medical histories it would change the form of medical information recorded, not merely convert paper files to electronic ones. Storage of an individual's medical history on a smart card raises important privacy issues. These privacy issues are discussed particularly as they relate to the Australian community.