Do Greek healthcare users and healthcare providers share cancer care priorities? Analysing the results from two Delphi studies.

Traditionally healthcare providers have determined how healthcare resources should be allocated. However, in recent years, healthcare users have increasingly been invited to identify those priorities important to them. Yet, healthcare users' priorities do not always match the priorities set by healthcare providers. In Greece, there has not been any research to measure the extent of agreement between healthcare providers and users on cancer care priorities. This project aimed to identify the priorities of healthcare users and providers with regards to the areas of cancer care that needed to be developed or improved in Greece and to examine the extent of agreement between the two groups. Two parallel Delphi surveys were conducted to identify the priorities and arrive at a consensus. Thirty participants formed the panel of healthcare providers and 30 participants the panel of healthcare users. The participants identified 18 key cancer care areas that require development or improvement; however, there were significant differences on the prioritisation between the two panels. It is encouraging that 18 key areas were shared by both panels. These areas can form an agenda for further exploration. Healthcare users can participate in developing priorities for cancer care; however, education is required so that they are better able to make informed choices.

Reasons for tooth extraction in four general dental practices in South Wales.

Tooth retention has been one of the main aims of oral care which in turn could have contributed to the social oral health divide. To investigate this issue further, data collected for a group audit was used to study the reasons for tooth extraction for patients attending for routine treatment at four dental practices. The practices served populations in areas with different levels of deprivation in South Wales. In 558 teeth extracted over 417 visits, the reasons for extractions were: caries 59%, periodontal disease 29.1%, pre-prosthetic 1%, wisdom teeth 4.6%, orthodontic 5.5%, trauma 1.2%, patient request 2.4% and 6.2% other reason. The number of extraction visits per day within the group of dental surgeons varied with three practitioners performing more than three extraction visits per day while one practitioner had only 0.51. These reasons did not significantly depend on levels of deprivation. However, significantly more teeth were extracted for caries in the most deprived group in comparison to the least deprived. Therefore, could there be a case for appropriate extractions in the quest for equitable care?

Temporary expatriation is related to HIV-1 infection in rural Senegal.

OBJECTIVES: To assess temporary expatriation as a risk factor for HIV infection in a rural area of Senegal and to examine the transmission of HIV from expatriates to their families. DESIGN: Cross-sectional study in identified expatriates and in a representative cluster sample of the general population from the same geographical area in northern Senegal. METHODS: In 1989, a survey (including questionnaire and serological tests for HIV-1 and HIV-2) was conducted in all expatriates currently living in 11 villages in northern Senegal and spouses of all expatriates (present or not) from this area ('expatriate' group, n = 258). In parallel, a cluster sample of 600 adults was drawn from eight villages of the same area, of whom 414 were selected as the control group since they and their spouses had not travelled outside Senegal in the last 10 years. RESULTS: In the 'expatriate' group, sera from 39 subjects were confirmed as HIV-positive by Western blot [17 out of 63 men (27.0%) and 22 out of 195 women (11.3%)]. Of these subjects, 33 were infected by HIV-1, four by HIV-2 and two had a dual HIV-1/2 profile. In contrast, only two subjects (one man and one woman) from the control group were infected by HIV-2 and none by HIV-1. In men, HIV-1 seroprevalence was associated with age < 40 years [odds ratio (OR), 7.4; P = 0.03] and previous sexually transmitted disease (STD) symptoms (OR, 13.5; P = 0.03), whereas the risk factors in women were age < 25 years (OR, 3.7; P = 0.04), being a widow (OR, 30.4; P < 0.01) and presence of sexual activity over the last 2 years (OR, 21.3; P < 0.01). CONCLUSIONS: Penetration of HIV-1 infection in a country where HIV-2 is endemic shows that the HIV-1 epidemic is currently spreading to rural West Africa. Migrant workers appear to play a major role in this epidemic.

Detection of hepatitis B virus DNA by polymerase chain reaction in HBsAg negative Senegalese patients suffering from cirrhosis or primary liver cancer.

The polymerase chain reaction was used to search for hepatitis B virus (HBV)-DNA sequences in the sera of HBsAg-negative Senegalese patients suffering from liver cirrhosis or liver cancer. Amplified HBV-DNA sequences were detected by hybridization with a digoxigenin-labelled HBV-DNA probe. HBV-DNA was detected in 17% of HBsAg negative Senegalese subjects from the general population and in 44% and 58% of the patients suffering from cirrhosis or primary hepatocellular carcinoma (PHCC) respectively. In the control group, amplified HBV-DNA was detected in 25% of the subjects without HBsAg and anti-HBs antibodies, and in 6% of subjects positive for anti-HBs antibodies. This study confirmed the hypothesis that there is an etiologic link between HBV and PHCC in HBsAg-negative patients.

Experiences in intracranial surgery for aneurysms.

This is a report of 54 cases of saccular aneurysms operated upon intracranially with a total operative mortality of 7.4%, poor results in four cases (7.4%) and excellent results in 46 cases (85.1%). For 53 supratentorial aneurysms, the operative mortality was 5.6%, with two operative deaths (4.8%) in the last 41 cases. Intermittent vascular occlusion with a newly developed special forceps and the use of moderate arterial hypotension were of value in dealing with these aneurysms.

Intra-aneurysmal pressure difference in human saccular aneurysms.

Intra-aneurysmal pressure and piezometric head differences with respect to common carotid values have been recorded by unidirectional and differential transducers in two patients undergoing craniotomy for aneurysms of the anterior communicating and middle cerebral arteries. Recordings were taken under normal systemic arterial pressure during temporary occlusion of the common carotid artery, during intra operative carotid arteriography and under controlled arterial hypotension. Predominance of the common carotid pressure head and piezometric head over the aneurysmal value was found in the two cases.

Fine tuning the day surgery process.

This review suggests that nurses need to be more knowledgeable when it comes to the assessment of post-operative pain. The authors recommend the employment of a universal pre-operative assessment and discharge protocol, based on the patient's perspective.

[Epidemiological aspects of neonatal purulent meningitis in Dakar]. / Aspects épidémiologiques des méningites purulentes néo-natales à Dakar.

The authors point out that, after tetanus, purulent meningitis is a very common neo-natal infection. Their epidemiology is dominated by the existence of particular obstetric and associated factors, which play an important role in the early development of this sickness. Numerous forms of bacteria, particularly pneumococci, were isolated. In spite of everything, the mortality rate is high, so attention should be given to preventing this illness. Better follow-up during pregnancy coupled with better conditions for delivery could help this prophylaxis.

[Pleuropneumopathies in children in an infectious pathology department in Dakar. Epidemiological, clinical and radiological features. Apropos of 150 cases]. / Les pleuropneumopathies de l'enfant dans un service de pathologie infectieuse à Dakar. Aspects épidémiologiques, cliniques et radiologiques. A propos de 150 cas.

The high rate of pleuropulmonary afflictions in children makes this pathology a daily concern for the practitioner in both industrialized and developing countries. This study concerns 150 patients aged between 0 and 15 years admitted to the Infectious Illnesses Unit at Dakar (Fann) U.H.C. between January 1st, 1985 and December 31st, 1987. The following observations are made: in this Unit, a morbidity of 1.7% has been recorded for pleuro-pneumopathies, which occur throughout the year with high points in January and during the rainy season; the 0-5 year age group is the most affected, with a sex ratio of 1/2 for males; hospitalization, which can be long, averages 8 days; a combination of measles and whooping cough, present in 36.6% of the cases, provides a prime breeding group for pleuro-pneumopathies; in 77% of the cases, recovery requires at least 20 days, partly because of delay in consultation. 10% require more than 30 days; the small proportion of patients vaccinated (14% completely treated) underlines the need for publicity and mass health education. Clinical polymorphism is normal; however, 80% of the children were found to be hyperthermic while (only) 6% show a productive cough. From a radiological point of view, suppurated afflictions are the most numerous, with a majority of alveolar or mixed attacks. Treatment produced generally satisfactory results in 83.7% of the cases.

[Acute pure lobar pneumonia in the child (P.F.L.A.). Apropos of 42 cases collected in the infectious disease department of Dakar U.H.C]. / Les pneumonies franches lobaires aiguës de l'enfant (P.F.L.A.). A propos de 42 cas colligés dans le service des maladies infectieuses du C.H.U. de Dakar.

Systematic, non-suppurate, acute pneumopathies (PANSS) or acute, clear-cut, lobary pneumonia (PFLA) constitute a pathology in babies aged 0-1 years. The clinic found 83.3% of these little patients to be feverish, dyspneic and suffering from a dry cough. 85% of the cases presented the alveolary filling syndrome with acric bronchogramme. After a 3 day apyrexy period on penicillin, the evolution was favourable in 83.4% of the cases.

[Health and structural adjustment]. / Sante et ajustement structurel

PIP: During the 1980's structural adjustment policies were introduced to Africa causing a severe state of poverty, especially in the most vulnerable group--women. This economic crisis has profoundly affected the health sector in: 1)budget reductions in health care; 2) the exodus of trained personnel; 3) the return of chronic and epidemic diseases; 4) cutbacks in prenatal care and 5) a growing number of malnourished mothers. WHO's strategy of Health for All by The year 2000 that evolved from the 1978 Alma Ata Conference has barely worked in Africa because no one knew how to make the strategy work. It became clear in 1985 at the Conference in Lusaka, where all the Ministers of Health met and determined a region-specific strategy. However, Governments inability to implement such strategies are not due to the lack of political will, but to the economic crisis. WHO's strategies for Africa during the 1980's were the Bamako Initiative and projects for women in development highlighting the role of women in management ranging from the village to the national level. Because Africa's population growth rate of 3% is much higher than the region's economic growth rate, all governments have accepted family planning as part of maternal and child health.^ieng

Outbreak of intestinal schistosomiasis in the Senegal River Basin.

Intestinal schistosomiasis has never been reported in the delta of the Senegal River Basin. A year and a half after the Diama dam became operational, a first case of Schistosoma mansoni infection was detected at Richard-Toll. In 1988 and 1989, 1,935 stool examinations out of a sample of 3,926 were found positive for S. mansoni. The progression of positive stool samples is rapid in all neighbourhoods of Richard-Toll: 1.9% positive examinations in 1988 compared to 71.5% in the last quarter of 1989. One thousand nine hundred and sixty nine Biomphalaria pfeifferi were collected during several malacological surveys carried out from February 1989 to December 1989 at three observation points. An emission of S. mansoni furcocercariae was determined in 44 out of 926 B. pfeifferi (4.75%) examined during this same period. Intestinal schistosomiasis is new in this area and spreading quickly. Rapid intervention measures are required immediately.