Ambulatoorne vererõhu monitooring pediaatrias

Vererõhu kõikumiste täpsemaks hindamiseks lastel ja noorukitel on kasutusele võetud vererõhu ambulatoorne registreerimine, mida saab teha kindla ajavahemiku järel ööpäev ringi. Meetod võimaldab vererõhku registreerida pikema perioodi jooksul uuritava tavalises elukeskkonnas. Ka Eestis on alustatud selle meetodi juurutamist. Artiklis on käsitletud vererõhu ambulatoorse monitooringu metoodilisi aspekte, kasutamist tervetel lastel ja selle osa hüpertensiooni hindamisel. Eesti Arst 2003; 82 (1): 10–1

Riskid õendustegevuses ja patsiendi ohutus

Haiglates on õenduseriala töötajatel oluline roll ohutu raviteenuse osutamisel. Ettevaatav suhtumine patsiendi ohutusesse tähendab võimet määrata ja vajaduse korral ära hoida tööga seotud riske. Hinnates inimtegureid, on võimalik mõista, kuidas mõjutab töö korraldamine patsiendi ohutust ravi ajal. Töö eesmärk oli välja selgitada õdede hinnang oma kvalif ikatsiooni, töökeskkonna ja tööülesannete kohta, et oleks võimalik prognoosida võimalike vigade tekkimise allikaid. Ankeetküsitluse meetodil uuriti 119 eesti keelt kõnelevat õde lastehaigla statsionaaris. Enam kui 80% vastanutest pidas Tallinna Lastehaiglat õesõbralikuks. Selgus, et õdede enesehinnangu alusel oli enamiku õdede pädevus, väljaõpe ja oskused head. Tervisega seotud riskiteguritest esines kroonilisi haigusi 24%-l õdedest, 16% õdesid suitsetas. Kaks kolmandikku õdedest väitis stressi esinemist ja segavaid tegureid tööprotsessis. Peaaegu kõik õed hindasid oma tegevust keerukaks ja täitsid kompleksseid ülesandeid. Muutusi töökeskkonnas soovis umbes kolmandik vastanutest. Teades neid tegureid, mis võivad soodustada vigade tekkimist raviprotsessis, ja kasutades ettevaatavat käsitlust, on võimalik ära hoida vigu ja patsiendile kahju tekitamist. Uuringu andmed on aluseks patsiendi ohutuse täiendusõppe planeerimisele ja korraldamisele lastehaiglas. Eesti Arst 2009; 88(Lisa4):57−6

Ambulatoorne vererõhu monitooring lastel ja noorukitel

Eestis on vererõhu ambulatoorset monitooringut rakendatud 11–18 aasta vanuste laste ja noorukite seas, kellel oli eelnevalt leitud vererõhu kõrgenemine. Selle uue meetodi abil on võimalik hinnata vererõhu erinevaid parameetreid ja ööpäevast kõikumist. Artiklis on analüüsitud vererõhu monitooringu tulemusi erinevatest aspektidest ja näidatud selle meetodi eeliseid vererõhu tavalise mõõtmise ees. Eesti Arst 2003; 82 (1): 5–

Ka patsiendil on kohustused

Eesti Arst 2016; 95(5):340–34

Water Allocation and the Sustainability of Dairying in the Upper Waitaki River Basin

Water as a resource management issue is gaining prominence in New Zealand, both in terms of quality and quantity. In the Waitaki this became critical in 2003 when several proposed development schemes exposed the inadequacies of the RMA and highlighted the need for a catchment wide plan. Legislation was promulgated and a Regional Plan developed to address the issues of efficient allocation. This thesis aimed to question the efficiency of water allocation within the recent legislation and to examine the sustainability of dairying in this area with regard to cumulative effects to the hydrological system. It was found the Plan has failed to achieve its stated aims. Dairying in the upper Waitaki is currently increasing and applications for resource consent are being heard under legislation that is not backed by the science required within its policies. Fieldwork was undertaken to explore some of the science required under the Regional Plan to enable a 'reasonable use' test to be made. The aim was to assess the response of soils in the upper Waitaki to intensive irrigation. This revealed that the potential impacts of intensive irrigation in this area are significant and highlighted the need for further research. This is a study of how poor policy and planning, based on a lack of robust science has resulted in the inefficient allocation of water. This has implications for long-term sustainable resource use

Vastsündinute jälgimine Tallinna perearstipraksistes

Töö eesmärgiks oli hinnata vastsündinute jälgimise vastavust terve lapse jälgimise juhendile, vastsündinu terviseseisundit ning emade rahulolu perearsti ja -õe tegevusega. Ankeetküsitluse meetodil uuriti 256 ema, kelle lapsed sündisid kahes Tallinna sünnitusmajas 2007. aastal. Selgus, et juhendi kohaselt jälgis vastsündinuid 24% perearstidest ja 2% pereõdedest. Ligi pooled emadest jätkasid vastsündinu tervisekontrolli sünnitusmajade juures. Ligi kahel kolmandikul vastsündinutest esines terviseprobleeme, mille lahendas ühel neljandikul juhtudest perearst, ülejäänud said võrdselt abi kas lastehaigla vastuvõtutoast või mujalt. Seevastu on perearstikeskuste külastamine sage ja vastab ettenähtule. Uuritavad väljendasid rahulolu pereõega ligi 60%-l ja perearstiga 85%-l juhtudest. 95,7% emadest soovis lastearsti osalemist vastsündinu jälgimises. Eesti Arst 2009; 88(7−8):461−46

Tervise edendamine ja kvaliteedi tagamine Eesti haiglates

1990. aastate keskpaigas algatati Maailma Terviseorganisatsiooni eestvedamisel tervist edendavate haiglate (TEH) liikumine, mille eesmärgiks oli lisaks diagnostikale ja ravile julgus tada haiglaid tegelema rohkem ka haiguste ennetamise ning tervise edendamisega. Tervist edendav haigla peaks kaasa aitama nii oma patsientide kui ka töötajate tervise edendamisele ning seeläbi tagama ka kvaliteetsema tervishoiuteenuse osutamise. Eestis algas TEH-liikumine 1999. aastal, 2005. aasta lõpuks on võrgustikuga ühinenud 22 haiglat. Käesolevas töös on analüüsitud ning võrreldud TEH-võrgustikuga ühinenud ja võrgustikku mittekuuluvate Eesti haiglate tegevust tervise edendamise ja tervishoiuteenuste kvaliteedi tagamise valdkonnas. Eesti Arst 2006; 85 (1): 2–

Obesity and Eating Disorders in Children and Adolescents : the Bidirectional Link

Obesity, eating disorders and unhealthy dieting practices among children and adolescents are alarming health concerns due to their high prevalence and adverse effects on physical and psychosocial health. We present the evidence that eating disorders and obesity can be managed or prevented using the same interventions in the pediatric age. In the presence of obesity in the pediatric age, disordered eating behaviors are highly prevalent, increasing the risk of developing eating disorders. The most frequently observed in subjects with obesity are bulimia nervosa and binge-eating disorders, both of which are characterized by abnormal eating or weight-control behaviors. Various are the mechanisms overlying the interaction including environmental and individual ones, and different are the approaches to reduce the consequences. Evidence-based treatments for obesity and eating disorders in childhood include as first line approaches weight loss with nutritional management and lifestyle modification via behavioral psychotherapy, as well as treatment of psychiatric comorbidities if those are not a consequence of the eating disorder. Drugs and bariatric surgery need to be used in extreme cases. Future research is necessary for early detection of risk factors for prevention, more precise elucidation of the mechanisms that underpin these problems and, finally, in the cases requiring therapeutic intervention, to provide tailored and timely treatment. Collective efforts between the fields are crucial for reducing the factors of health disparity and improving public health

An evaluation of a model for the systematic documentation of hospital based health promotion activities: results from a multicentre study

BACKGROUND: The first step of handling health promotion (HP) in Diagnosis Related Groups (DRGs) is a systematic documentation and registration of the activities in the medical records. So far the possibility and tradition for systematic registration of clinical HP activities in the medical records and in patient administrative systems have been sparse. Therefore, the activities are mostly invisible in the registers of hospital services as well as in budgets and balances.A simple model has been described to structure the registration of the HP procedures performed by the clinical staff. The model consists of two parts; first part includes motivational counselling (7 codes) and the second part comprehends intervention, rehabilitation and after treatment (8 codes).The objective was to evaluate in an international study the usefulness, applicability and sufficiency of a simple model for the systematic registration of clinical HP procedures in day life. METHODS: The multi centre project was carried out in 19 departments/hospitals in 6 countries in a clinical setup. The study consisted of three parts in accordance with the objectives.A: Individual test. 20 consecutive medical records from each participating department/hospital were coded by the (coding) specialists at local department/hospital, exclusively (n = 5,529 of 5,700 possible tests in total).B: Common test. 14 standardized medical records were coded by all the specialists from 17 departments/hospitals, who returned 3,046 of 3,570 tests.C: Specialist evaluation. The specialists from the 19 departments/hospitals evaluated if the codes were useful, applicable and sufficient for the registration in their own department/hospital (239 of 285). RESULTS: A: In 97 to 100% of the local patient pathways the specialists were able to evaluate if there was documentation of HP activities in the medical record to be coded.B: Inter rater reliability on the use of the codes were 93% (57 to 100%) and 71% (31 to 100%), respectively.C: The majority of the study participants found the codes to be useful (71%), applicable (92%) and sufficient (92%). CONCLUSION: Systematic registration of HP activities is relevant in clinical day life and the suggested codes proved to be applicable for international use. HP is an essential part of the clinical pathway or the value chain. This model promises to improve the documentation and thereby facilitate analysis of records for evidence based medicine as well as cost and policy analyses

Health-promoting hospitals in Estonia: what are they doing differently?

The health-promoting hospitals (HPH) movement in Estonia was initiated in 1999. This study aimed to compare the implementation of health-promoting and quality-related activities in HPH and those which have not joined the HPH network (non-HPH). In the beginning of 2005, a postal survey was conducted among the top managers of 54 Estonian hospitals. The questionnaire was based on the WHO standards for HPH and on the set of the national quality assurance (QA) requirements for health services. The study demonstrated some significant differences in the uptake of health promotion and QA activities between HPH and non-HPH. For example, regular patient satisfaction studies were conducted in 83% of HPH and 46% of non-HPH (P < 0.03) and 65% of HPH and 46% of non-HPH cooperated with various patient organizations (P < 0.03). Systems for reporting and analysis of complications were implemented in 71% of HPH and 33% of non-HPH (P < 0.03); also, the implementation of various guidelines was more developed in HPH. All HPH have carried out a risk analysis on the workplace and staff job satisfaction studies were conducted in 89% of HPH and 41% non-HPH (P < 0.05). This study indicates that the concepts of HPH and QA are closely related. Making progress in health promotion is accompanied with QA and vice versa. Implementation of health-promoting activities in hospitals will promote the well-being and health of patients and hospital staff, and creates a supportive environment to provide safe and high-quality health services