Evaluation of a new method for assessing symptoms.

BACKGROUND: Many studies in rhinology are based on results from symptom scoring. Numerous methods are used to estimate symptoms. With some of them the patients choose between various alternatives for estimating the severity of their symptoms, but the commonest method is the visual analogue scale (VAS), which is regarded as reliable. METHODS: In this study, we evaluate a new method for assessing symptoms, with which the patient uses the telephone to call a computer. We compare the results using the new method with those using symptoms estimation with VAS. RESULTS: The results are based on 487 observations in patients with birch pollen allergic rhinitis in the pollen season. A high correlation was found between the results using the new method and those using the VAS. In a questionnaire, the patients answered questions concerning the two methods. Most patients preferred the new telephone method. They found it easier to estimate their symptoms properly and easier to perform. CONCLUSION: We conclude that telephone scoring of symptoms is a reliable and adequate method when symptom scoring is used as hard data in a study.

Effects of sustained-release oral phenylpropanolamine on the nasal mucosa of healthy subjects.

Phenylpropanolamine (PPA) is widely used as a nasal decongestant administered orally in sustained release preparations and, in Sweden, the recommended dose nowadays is 50 mg twice daily for adults. The aim of this placebo-controlled, cross-over study was to determine the onset and duration of the decongestive effect of 50 and 100 mg PPA in 15 healthy subjects. All subjects arrived at the laboratory at 07.30 h. After an acclimatisation, the nasal mucosal baseline was established with rhinostereometry and the minimal cross-sectional area was measured using acoustic rhinometry. The systolic and diastolic blood pressures were also determined. Then all subjects were given their study drugs for the day and the measurements were repeated every hour for 8 h. This procedure was repeated for 3 days at 48 h intervals between the days. For purposes of comparison, the decongestive effect of oxymetazoline nasal spray was studied on a separate day. The decongestive effect of 100 mg PPA was similar to that of topical oxymetazoline. It develops after 1 h and lasts for approximately 6 h. The decongestive effect of oxymetazoline was significantly greater than that of 50 mg PPA and that of 100 mg PPA was significantly greater than that of 50 mg PPA using rhinostereometry, but not when using acoustic rhinometry. However, 50 mg PPA had no significant decongestive effect, compared with placebo, with rhinostereometry or acoustic rhinometry. In the first 3 h after administration of PPA, there was a dose-response increase in the systolic and diastolic blood pressures, which then returned to baseline. In conclusion, this study shows that PPA in double the recommended dose, i.e. 100 mg, has a significant decongestive effect on the nasal mucosa in healthy subjects. However, when the dose of PPA is increased the systolic and diastolic blood pressures also increase.

Country watch: Pakistan.

PIP: In Pakistan, which has a high fertility rate, affordable prices of condoms and family planning services attract low-income residents. This was shown by the two projects: the condom distribution scheme and the family planning franchise. A condom social marketing (CSM) program started by Population Services International (PSI) increased contraceptive use in urban areas and sold low-priced condoms. However, in 1991 the price doubled in order to recover the costs, which resulted in a decline in sales. Thus, in 1995 PSI and Social Marketing Pakistan franchised the Green Star project that aimed to raise the quality of private sector family planning clinics serving low-income women and to increase the availability and use of female-controlled contraception. By 1996, the CSM project was selling over 80 million condoms annually.^ieng

Utilisation of acute care hospital beds by levels of care.

An exploratory analysis of utilisation patterns of acute care hospitals in the Province of Alberta, Canada was carried out to develop a methodology for assessing bed utilisation profiles of acute care hospitals by levels of care. The utilisation of Alberta acute care hospital beds was measured in terms of primary, secondary and tertiary levels of hospital services. Patient origin-destination methodology was applied and a regionalisation perspective employed. The data used for this study were hospital separation abstracts compiled by all Alberta acute care hospitals during year 1986, this coincided with the most recent available Canadian census data. It was estimated that approximately 10-11% of Alberta beds were used for tertiary care as derived from population based utilisation rates and patient flow patterns. With respect to per capita measurement, the number of beds used per 1,000 residents was: 3.5 to 3.9 for primary, 1.2 to 1.6 for secondary, and about 0.6 for tertiary levels of care. Regression analysis revealed that the marginal cost per bed at each level was approximately 75-79, 87-88, and 201-209 thousand Canadian dollars per year in 1986 for primary, secondary and tertiary care respectively. The profiles thus estimated explained about 65% of per bed hospital cost variation.