An evaluation of type 2 diabetes care in the primary care setting

Objectives: To assess the clinical outcome of type 2 diabetes care currently provided at the primary healthcare centres. Method: A clinical audit was performed among 110 type 2 diabetes patients in the two major primary healthcare centres. The measurements of fasting blood glucose, HbA1c, serum lipid profile, blood pressure, serum creatinine, body mass index and waist circumference were carried out during a clinical examination. Knowledge, behaviour and attitude among the participants were assessed via a questionnaire composed of four sections concerning diabetes and its complications, physical activity, nutrition and smoking. Results: The ideal standards recommended by the International Diabetes Federation were employed for data analysis. HbA1c level was controlled in 37. 3%, systolic blood pressure was controlled in 44. 5%, cholesterol was controlled in 30% while LDL was controlled in 10.9 % of patients. Body Mass Index was above the normal threshold in 72.7% of participants while waist circumference was abnormally high in 96.3% of females and 64.7% of males. Serum creatinine level was controlled in 60% of patients. Significant correlations with HbA1c were registered for BMI (p-value 0.038) and serum creatinine (p-value 0.04). Patients showed limited knowledge on diabetes, its complications and exercise but were better informed on nutrition and smoking. Inappropriate eating habits were evident among participants while better behaviour was demonstrated in relation to the adherence to medication, physical activity and smoking. Conclusion: The framework for structured care is in place at the primary healthcare centres and compliance with process measures was confirmed. The present local care is based on good practice and is compatible with that provided in developed countries. However the health status of these patients is under imminent threat by a cluster of risk factors. This necessitates improvement in all components of present care while additional efforts must address the inadequacies in cardiovascular risk and lifestyle management.peer-reviewe

Mental Health Injuries: The Invisible Wounds of War

As early as the Civil War, terms like "soldier's heart" and "nostalgia" were used to describe the psychological injuries incurred by combat veterans. In later wars, "shell shock" and "battle fatigue" described a similar array of symptoms. It was only in the aftermath of the Vietnam War, however, that veterans' mental health injuries were examined scientifically. A 1988 Congressionally mandated study estimated that 15 percent of Vietnam veterans suffered from Post-Traumatic Stress Disorder (PTSD) at the time of the conflict.During the Iraq and Afghanistan wars, American troops' mental health injuries have been documented as they occur, and rates are already comparable to Vietnam. Thanks to today's understanding of mental health screening and treatment, the battle for mental health care fought by the Vietnam veterans need not be repeated. We have an unprecedented opportunity to respond immediately and effectively to the veterans' mental health crisis.Rates of mental health problems among new veterans are high and rising. The best evidence to date suggests that about one in three Iraq veterans will face a serious psychological injury, such as depression, anxiety, or PTSD.1 About 1.5 million people have served in Iraq and Afghanistan, so approximately half a million troops are returning with combat-related psychological wounds. And problems are likely to worsen. Multiple tours and inadequate time between deployments increase rates of combat stress by 50 percent.These psychological injuries exact a severe toll on military families. Rates of marital stress, substance abuse, and suicide have all increased. Twenty percent of married troops in Iraq say they are planning a divorce. Tens of thousands of Iraq and Afghanistan veterans have been treated for drug or alcohol abuse. And the current Army suicide rate is the highest it has been in 26 years.According to the American Psychological Association, there are "significant barriers to receiving mental health care in the Department of Defense (DOD) and Veterans Affairs (VA) system."Instead of screening returning troops through a face-toface interview with a mental health professional, the DOD relies on an ineffective system of paperwork to conduct mental health evaluations. There are significant disincentives for troops to fill out the forms accurately, and those who indicate they need care do not consistently get referrals. In addition, access to mental health care is in short supply. According to the Pentagon's Task Force on Mental Health, the military's "current complement of mental health professionals is woefully inadequate." Moreover, 90 percent of military psychiatrists, psychologists and social workers reported no formal training or supervision in the recommended PTSD therapies.Effective treatment is also scarce for veterans who have left the military. As of May 2007, the VA has given preliminary mental health diagnoses to over 100,000 Iraq and Afghanistan veterans. The veterans' mental health system is simply overwhelmed by the influx; waiting lists now render mental health and substance abuse care "virtually inaccessible" at some clinics, according to the VA's own experts. The VA has exacerbated the shortage by consistently underestimating the number of new veterans who would need care, and by failing to spend millions earmarked by Congress for mental health treatment.No one comes home from war unchanged. But with early screening and ready access to counseling, the mental health effects of combat are treatable. In the military and in the veterans' community, however, psychologically wounded troops are falling through the cracks. Decisive action must be taken to fix the gaps in the mental health system if we are to reach this generation of combat veterans in time

Process Support for Cooperative Work on the World Wide Web

The World Wide Web is becoming a dominating factor in information technology. Consequently, computer supported cooperative work on the Web has recently drawn a lot of attention. “Process Support for Cooperative Work” (PSCW) is a Web based system supporting both structured and unstructured forms of cooperation. It is a combination of the “Basic Support for Cooperative Work” (BSCW) shared workspace system and the Merlin Process Support Environment. The current PSCW prototype offers a loose connection, in effect extending BSCW with a gateway to Merlin. With this prototype we have successfully addressed the technical issues involved; further integration of functionality should not pose any real problems. We focus on the technical side of the PSCW system, which gives a good insight into the issues that have to be addressed generally in the construction of Web based groupware

Impact of NICE guidance on laparoscopic surgery for inguinal hernias: analysis of interrupted time series

After the introduction of Bassini's procedure in the late 19th century, methods of repairing hernias changed little until the 1990s, when synthetic mesh and laparoscopic methods arrived. In contrast to the open mesh technique, laparoscopic surgery remains uncommon. In January 2001, the National Institute for Clinical Excellence (NICE) issued guidance that stated, "For repair of primary inguinal hernia, open [mesh] should be the preferred surgical procedure." We describe patterns of surgical repair of inguinal hernias and assess the impact of NICE's guidance

Accurate user directed summarization from existing tools

This paper describes a set of experimental results produced from the TIPSTER SUMMAC initiative on user directed summaries: document summaries generated in the context of an information need expressed as a query. The summarizer that was evaluated was based on a set of existing statistical techniques that had been applied successfully to the INQUERY retrieval system. The techniques proved to have a wider utility, however, as the summarizer was one of the better performing systems in the SUMMAC evaluation. The design of this summarizer is presented with a range of evaluations: both those provided by SUMMAC as well as a set of preliminary, more informal, evaluations that examined additional aspects of the summaries. Amongst other conclusions, the results reveal that users can judge the relevance of documents from their summary almost as accurately as if they had had access to the document’s full text

Universal Spectrum of Normal Modes in Low-Temperature Glasses: an Exact Solution

We report an analytical study of the vibrational spectrum of the simplest model of jamming, the soft perceptron. We identify two distinct classes of soft modes. The first kind of modes are related to isostaticity and appear only in the close vicinity of the jamming transition. The second kind of modes instead are present everywhere in the glass phase and are related to the hierarchical structure of the potential energy landscape. Our results highlight the universality of the spectrum of normal modes in disordered systems, and open the way towards a detailed analytical understanding of the vibrational spectrum of low-temperature glasses.Comment: 6 pages, 3 figures, submitted to PNA

Invisible Wounds: Psychological and Neurological Injuries Confront a New Generation of Veterans

As early as 1919, doctors began to track a psychological condition among combat veterans of World War I known as "shell shock." Veterans were suffering from symptoms such as fatigue and anxiety, but science could offer little in the way of effective treatment. Although there remains much more to learn, our understanding of war's invisible wounds has dramatically improved. Thanks to modern screening and treatment, we have an unprecedented opportunity to respond immediately and effectively to the veterans' mental health crisis. Among Iraq and Afghanistan veterans, rates of psychological and neurological injuries are high and rising. According to a landmark 2008 RAND study, nearly 20 percent of Iraq and Afghanistan veterans screen positive for Post Traumatic Stress Disorder or depression. Troops in Iraq and Afghanistan are also facing neurological damage,. Traumatic Brain Injury, or TBI, has become the signature wound of the Iraq War. The Department of Defense is tracking about 5,500 troops with TBIs, but many veterans are not being diagnosed. No one comes home from war unchanged, but with early screening and adequate access to counseling, the psychological and neurological effects of combat are treatable. In the military and in the veterans' community, however, those suffering from the invisible wounds of war are still falling through the cracks. We must take action now to protect this generation of combat veterans from the struggles faced by those returning from the Vietnam War