Development process of the Practical Approach to Lung Health in Kyrgyzstan.

The Practical Approach to Lung Health (PAL) strategy was adopted by the Ministry of Health of Kyrgyzstan to improve the quality of case management of priority respiratory illnesses, including tuberculosis (TB). The process of development and implementation of the strategy is described in the present study. The World Health Organization stepwise framework was adapted and used to initiate the PAL strategy within the Kyrgyzstan primary health care (PHC) system. The process followed 10 steps which included the government decision to support PAL development, and the establishment of a national working group in charge of adapting guidelines, developing training materials and testing the feasibility and impact of the guidelines. On the basis of the test results, the guidelines and training materials were revised and a national PAL implementation plan was developed. The ongoing health sector reform which focuses, in priority, on strengthening PHC services and the assistance from the government of Finland, generated favourable political, technical and financial circumstances for the development and implementation of the PAL strategy.

The asthma programme of Finland: an evaluation survey in primary health care.

OBJECTIVE: To evaluate the basic structures and processes of asthma care 6 years after the launch of the Finnish Asthma Programme. The evaluation will serve as the baseline for the implementation of the evidence-based guidelines for asthma published in 2000. DESIGN: A descriptive type-2 evaluation (managerial monitoring of a policy implementation), based on operationalised statements of the Asthma Programme. RESULTS: A co-ordinating doctor for asthma, usually a general practitioner (GP), was interviewed in 248 (91%) health centres; 83% of the health centres have at least one GP nominated as the local asthma co-ordinator and 94% have a nurse. Asthma education for the professionals had been organised in 71% of the health centres in the previous 2 years. First-line treatment consists of an inhaled corticosteroid. Guided self-management is used in 98% of the health centres, but its components were not clear to the doctors. CONCLUSION: The basic structure of equipment and organisation for the diagnosis and treatment of asthma has been set up in the primary health care services.

The complexity of labor pain: experiences of 278 women.

All women giving birth over a period of 2 weeks in a major city of Sweden, except non-Swedish speaking women and those with elective Caesarean sections, were asked about their experience of pain 2 days after the birth. The sensory (pain intensity) and effective (negative or positive experience) dimensions of pain, as well as need for pain relief during labor were explored. The 278 women who returned completed questionnaires (91%) reported high levels of pain, 41% worst imaginable pain, in spite of wide use of pharmacological pain relief. Only 9% had no analgesia. Pain was not an entirely negative experience, 28% assessing it as more positive than negative, suggesting that coping with pain is a rewarding experience for some women. More than 30 different explanatory variables were included in regression analysis to explain the variation in pain intensity and pain attitude scores, but only five contributed to the respective model. Most of the variables explaining pain intensity, namely anxiety during labor, expected pain, expected birth experience, midwife support and duration of labor, differed from the variables explaining attitude to pain. These were pain intensity, anxiety, expected birth experience physical well-being during pregnancy and emergency Caesarean section. The explanatory values were relatively low, especially for the model explaining pain intensity (R2 = 15%). The findings are discussed in the light of the different character and meaning of childbirth pain compared with pain related to disease.

The fatigue strength of the interface between Ag-Pd alloy and hydrothermal ceramic.

OBJECTIVE: The purpose of this paper was to investigate the fatigue strength of a hydrothermal ceramic fused to Ag-Pd alloy. This study compared the values with those of other metal-ceramic systems previously reported by other authors. METHODS: This investigation was performed on 48 specimens made of Ag-Pd alloy frames (45 x 12 x 4 mm) on which the hydrothermal ceramic was fused (25 x 12 x 2 gmm). The specimens were divided into two groups. The first group of specimens was dynamically loaded immediately after casting and fusing, while the other group of specimens was thermocycled (1000 times at 0 degree C and 55 degrees C) before dynamic loading. The dynamic loading tests were carried out by using a modified three-point load method in a universal testing machine. RESULTS: The determined dynamic loading limit was up to 550 N for thermocycled, and up to 850 N for non-thermocycled specimens. These results are very respectable in comparison with other metal-ceramics. A statistically significant difference between maximal dynamic forces and number of loading cycles for thermocycled and non-thermocycled samples was determined. SIGNIFICANCE: From the data obtained in this study and current literature profiles, it is concluded that the tested metal-ceramic system is more durable than other metal-ceramic systems.

The tooth reduction and abrasion in a group of elderly home residents.

The degree of tooth loss and abrasion was the objective of the study on a group of 73 partially dentate elderly home residents, with particular interest in the type of missing and abraded tooth and the type of the interocclusal contacts according to the Eichner classification. The patients were examined by a dental mirror and a probe. The obtained data of dental status as well as medical and dental history were recorded in a specially designed questionnaire according to the WHO recommendations. The results confirmed the hypothesis about the molars being the most commonly missing teeth, with average values of 4.49 present teeth in lateral section and 5.82 present teeth in frontal section of the dental arch. The Eichner index class III was the most often interocclusal relationship found within 74% of the elderly home residents. Lower teeth were abraded more often than the upper teeth, showing higher abrasion degrees (class 2 and 3).

A survey of Swedish mothers' view on breastfeeding and experiences of social and professional support.

The purpose of this cross-sectional study was to investigate conditions for breastfeeding among 452 mothers. Three different groups of women, participating in the Swedish health care system, were asked to complete a questionnaire about breastfeeding and related issues: 1) pregnant women attending the pregnancy care centres (n = 186), 2) women staying at the maternity wards after delivery (n = 171) and 3) women with two-month-old child attending the child health stations (n = 95). We found that the majority of the mothers were in favour of breastfeeding and intended to or had begun to breastfeed their infants. The main problems were "sore nipples", "children who cannot take the breast" and "insufficient milk production". Negative experiences of previous breastfeeding and overwhelming demands were motives for weaning. The personnel within the health care system were shown to be important for the mothers as regards advice and support. However, we found that certain routines could be revised to strengthen the mothers' attitude towards breastfeeding: 1) information on and discussions about breastfeeding occurred infrequently at the pregnancy care centres. 2) Water or formulated milk was often given to the newborn baby at the maternity wards and 3) the participation of the fathers was limited. Continuous surveillance of the routines and education of the health care staff would be desirable to enable them to give the mothers the right breastfeeding support and advice at the right time.

Involvement of maternity and health care staff in breast-feeding.

The prerequisites of the staff for their interest and concern in working with questions related to breast-feeding have been studied by questionnaires which were answered by 133 nurses at pregnancy care centres, child health centres and maternity wards. The intention was to identify possible obstacles for the staff in supporting the mother's breast-feeding. In spite of extensive experience and positive attitudes to breast-feeding, about half of the staff found it difficult to work with these questions and to give enough support. The most common reasons for this fact were insufficient knowledge about breast-feeding, few possibilities for further training and a heavy workload. It was also evident that some routines need to be corrected. For instance, information about breast-feeding was provided late during pregnancy, the fathers were infrequently engaged and the communication between the departments was limited. A reorganization of the staff's working routines and their continuous further training in issues related to breast-feeding are recommended.