[The feasibility of synthetic enhancer substances for preventive nanotherapy]

Nanotechnology, the great promise of the 21st century, may revolutionize also the art of healing. Previously unexpected broadening of diagnostic procedures and methods to deliver specific drugs acting in lower than nanomolecular concentrations right to the target cells may play a crucial role in the rapid development of preventive medicine. In this context, (-)-deprenyl/selegiline, a drug developed 40 years ago and still world-wide used to treat Parkinson's disease, Alzheimer's disease and depression, by enhancing the activity of catecholaminergic neurons in the brain stem via a previously unknown mechanism [catecholaminergic activity enhancer (CAE) effect], is a highly promising experimental tool for further research in this direction. The same fits for (-)-BPAP, the newly developed enhancer substance, 100 times more potent than (-)-deprenyl, which in contrast to the latter is not only an enhancer of the catecholaminergic neurons but also of the serotonergic neurons in the brain stem. Tiny amounts of enhancer substances are closed in liposomes and marked with a specific signal to help identify the exact location of the target cells, through the activation of which the drug exerts its specific enhancer effect. The method also offers an approach to better understand the up-to-the-present unknown mechanism of the enhancer effect.

Genomics and general practice: the next 10 years

Should general practitioners care about genomics? Perhaps not right now, but definitely within the next decade.

In the vanguard of biomedicine? The curious and contradictory case of anti-ageing medicine

The rise of anti-ageing medicine is emblematic of the current conditions of American biomedicine. Through in-depth interviews with 31 anti-ageing practitioners, we examine how practitioners strive for-and justify-a model of care that runs counter to what they see as the 'assembly line' insurance-managed industry of healthcare. Their motivation, however, is not merely a reaction to conventional medicine. It is derived from what they see as a set of core beliefs about the role of the physician, the nature of the physician-patient relationship, and the function of biomedicine. We analyse this ideology to underscore how anti-ageing medicine is built on a 'technology of the self', a self in need of constant surveillance, intervention, and maintenance. The ultimate goal is to create an optimal self, not just a self free of illness. A fundamental irony is that, despite their self-presentation and the perception of the public, anti-ageing providers do not use practices that are especially 'high-tech' or unconventional. Instead, the management of ageing bodies rests on providers' perceived knowledge of their patients, tailored treatments, and a collaborative pact between the provider and patient.

The potential benefits of low-molecular-weight heparins in cancer patients

Cancer patients are at increased risk of venous thromboembolism due to a range of factors directly related to their disease and its treatment. Given the high incidence of post-surgical venous thromboembolism in cancer patients and the poor outcomes associated with its development, thromboprophylaxis is warranted. A number of evidence-based guidelines delineate anticoagulation regimens for venous thromboembolism treatment, primary and secondary prophylaxis, and long-term anticoagulation in cancer patients. However, many give equal weight to several different drugs and do not make specific recommendations regarding duration of therapy. In terms of their efficacy and safety profiles, practicality of use, and cost-effectiveness the low-molecular-weight heparins are at least comparable to, and offer several advantages over, other available antithrombotics in cancer patients. In addition, data are emerging that the antithrombotics, and particularly low-molecular-weight heparins, may exert an antitumor effect which could contribute to improved survival in cancer patients when given for long-term prophylaxis. Such findings reinforce the importance of thromboprophylaxis with low-molecular-weight heparin in cancer patients.

[Scientific basis of national strategy concept in primary glaucoma control in Ukraine]

The results of research substantiated National strategy conception of primary glaucoma control in Ukraine, determined the aims and tasks, organizational system and functional connections among subjects, which are drawn into its realization according to the requirements of WHO.

[Ways of improving a preventive medical examination system]

In Moscow, a model of the medical educational center that integrates occupational hygienic training and preventive medical examinations of the workers of epidemiologically significant projects has been developed and put into practice, which permits the complete "one-window" drawing-up of a personal medical record. Analysis of the results of practical application of the model of the medical educational center based on the existing medical organizations has indicated their effectiveness: with the legislatively established reduction in the number of check-ups by state sanitary-and-epidemiological surveillance bodies, there is an increase in the hygienic education and preventive medical examination coverage of the population groups to be examined and there is a functioning mechanism of the feedback required to analyze results and to evaluate the efficiency of performed medical examinations and hygienic education of the workers.

[Normative-legal support for implementation of national strategy of glaucoma control in Ukraine]

The review of normative legal database for implementation of national strategy of glaucoma control has demonstrated that there are all terms and conditions for implementation of national strategy on the national level. There is no necessity to change present normative legal database in the field of public health for the purpose of strategy implementation.

European silver paper on the future of health promotion and preventive actions, basic research and clinical aspects of age-related disease

The current article is a statement of the meeting with international and multidisciplinary participation, held in Wrocław, Poland on September 11-13, 2008. The meeting was devoted to working out a position focusing on the challenge for individuals, health care systems, biological, psychosocial, epidemiological, medical, and public health sciences in the ageing populations of the twenty-first century. The statement is presented as an overview, in tabular format, of the current European situation regarding basic biological research on ageing, health promotion and preventive action, clinical care for older people, and recommendations for future actions.

Prevention of necrotising enterocolitis: Year 2004 and beyond

The incidence of necrotising enterocolitis (NEC) has not changed significantly despite the dramatic advances in perinatal-neonatal care. The absolute number of survivors of NEC is expected to rise, as prevention of prematurity, the single most important risk factor for the illness, continues to be difficult. Prevention of NEC has thus become an area of research priority. Given the role of inflammatory mediators in its pathogenesis newer immune modulators are being studied as potential agents for prevention/treatment of NEC. Caution, however, is warranted because the failure of sepsis trials in adults has clearly indicated that the concept of down-regulating the inflammatory response is deceptively simple. Clinical trials of any such promising preventative agent(s) need to be designed carefully and must include long-term neurodevelopmental outcomes as almost an entire population of high-risk preterm neonates will be exposed to their adverse effects. As new frontiers continue to be explored, the proven benefits of simple and safe interventions like antenatal glucocorticoid therapy and the preferential use of breast milk for feeding high-risk neonates must not be forgotten. Given that a single effective agent is unlikely in the near future, utilizing a package of "potentially better practices" seems to be the most appropriate strategy to prevent and minimize NEC.

[Prevention in XXI century: analysis of conceptual approaches]

The notion of prevention was theoretically based upon the doctrines of the development of nature and society, the organism and environment relationship and on the biological and social patterns determining the public and individual health. The concept of dispanserization of population proved to be the most fruitful of all ideas of prevention. In the conditions of XXI century, the disease prevention became the reflection of the social essence of medicine. This prevention approach is really effective when its purposes, forms and methods are coordinated with the public health characteristics. The progress of disease prevention is inseparable from public responsibility for protection and promotion of public health and maintenance of healthy environment and conditions of work. In present situation, the dispanserization has to be supported with the new organizational technologies to carry out medical, preventive and periodical check-ups and to arrange the dispanserization quotas according the disease nosologies and to rank them for the subsequent dynamic monitoring of profile specialists. The most effective is the dispanserization related to the diseases which can be subjected to the modern techniques of early diagnostics implementing screening and other high-tech technologies in the framework of evidence-based medicine.

Perspectives on advancing preventative medicine through vaccinology at the comparative veterinary, human and conservation medicine interface: not missing the opportunities

Vaccination has historically and remains one of the most cost-effective and safest forms of medicine today. Along with basic understanding of germ theory and sanitation, vaccination, over the past 50 years, has transformed lives and economies in both rich and poor countries by its direct impact on human and animal life--resulting in the eradication of small pox, huge reductions in the burden of previously common human and animal diseases such as polio, typhoid, measles in human medicine and contagious bovine pleuropneumonia, foot-and-mouth disease, screwworm and hog cholera and the verge of eradicating brucellosis, tuberculosis, and pseudorabies in veterinary medicine. In addition vaccination along with other animal production changes has provided the ability to produce otherwise unaffordable animal protein and animal health worldwide. The landscape however on which vaccinology was discovered and applied over the past 200 years, even in the past 10 years has and is undergoing continuous change. For vaccination as a public health tool to have its greatest impacts in human and veterinary medicine, these great medical sciences will have to come together, policy-relevant science for sustainable conservation in developing and developed countries needs to become the norm and address poverty (including lack of basic health care) in communities affected by conservation, and to consider costs and benefits (perceived or not) affecting the well-being of all stakeholders, from the local to the multinational. The need to return to and/or develop new education-based models for turning the tide from the heavily return-on-investment therapeutic era of the last century into one where the investment into the preventative sciences and medicine lead to sustainable cultural and cost-effective public health and economic changes of the future is never more evident than today. The new complex problems of the new millennium will require new educational models that train para- and professional people for thinking and solving complex inter-related biological, ecological, public-, political/economic problems. The single profession that is best positioned to impact vaccinology is Veterinary Medicine. It's melding with human medicine and their role in future comparative and conservation-based programs will be critical to the successful application of vaccines into the 21st century.

[Prophylactic medical examination of state frontier military personnel of Ukraine: state and perspective of the development]

The article presents main indices obtained from prophylactic medical examination of state frontier military personnel of Ukraine for the period from 2005 till 2007 years, shortcomings found and ways of their correction.

[Prophylactic medicine--a foreground direction of medical support of the air staff of aviation of the Armed Forces of Russian Federation]

The first prophylaxis of chronic not-infection diseases obtains more and more value. Level of these diseases among air staff is rather high and has a tendency of increasing. It's bounded up with defects in the system of the first medical unit, insufficient conducting of ecological and sanitarium-hygiene screening and taking steps on decreasing of the influence of noxious agent on the human organism, improvement of working conditions of air specialists, decreasing of the value of psychoemotional stress and other factors. An important factor during the conducting the first and the second prophylaxis is an early detection of changes in health by the air staff and technical-engineer staff, diagnostics of diseases on early stages, when they conduct without any symptoms, forehanded rehabilitation and treatment.

Functional food science and food for specified health use policy in Japan: state of the art

PURPOSE OF REVIEW

The science and policy of functional foods are a matter of global concern and this review provides up-to-date information about the Japanese 'food for specified health use' policy based on functional food science.

RECENT FINDINGS

A great many studies on nonnutritive but physiologically functional food components have provided more precise evidence regarding the structure-function relationships that underlie the approval of food for specified health use products.

SUMMARY

Functional foods, defined as those that have the potential to reduce the risk of lifestyle-related diseases and associated abnormal modalities, have garnered global interest since the 1980s when the systematic research had humble beginnings as a national project in Japan. In 1991, the project led to the launch of the national food for specified health use policy; 703 food for specified health use products with 11 categories of health claims have been approved up to the present (31 August 2007). The development of this policy has been supported basically by nutritional epidemiology, food chemistry and biochemistry, physiology and clinical medicine, and even the genomics on food and nutrition. This review also highlights the current academia-industry collaboration in Japan.

[Current problems of formation of individual human health and population health enhancement]

The current health status of the Russian population requires substantial emphasis on the preventive slant of the public health service. This strategy should be based on the development of methodology for analysis, evaluation, and correction of medicosocial and ecosocial factors having adverse effect on human health. The main scientific problem in this context is the development of diagnostic tools for the assessment of general biological and pathological conditions preceding the appearance of a disease. Solution of this task would provide a basis for the preventive treatment at the prenosological level. The integrated system of prophylactic and rehabilitative medicine needs to be created in this country to ensure the overall protection from adverse environmental factors. The main instrument for the diagnosis of individual health is the Diamed hardware/software complex developed under the guidance of the author for the rapid comprehensive assessment of the health status. This approach permits to substantially raise cost effectiveness of preventive measures.

[The sociological study of the nonresident patients]

The study of opinions of the patients dwelling in the various regions of the Russian Federation concerning their treatment in the curative preventive institutions of Samarskaya Oblast. Among nonresident patients 52% had an opportunity to pay for additional medical services in the medical institutions of Samarskaya Oblast. This fact testify that among population of neighboring regions the solvent demand of certain kinds of medical care is formed. The patients from neighboring and distant regions much more actively use the free market niches of medical and hospital services. The role of planning in the accessible specialized medical care (oncopathology, nervous and cardiovascular diseases, respiratory diseases, digestive system diseases, etc.) on the interregional level. This approach is to take into account the procedure of medical caring, its tariffs and the conditions of its provision in the concrete region for the nonresident patients. The higher satisfaction of the medical care quality testifies the proper level of provided medical care in the Samarskaya Oblast. At the same time, the lower informative level of materials from advertising sources and medical insurance companies targeted at the nonresident patients consists a poor effort in promoting the Samarskaya Oblast in the medical services market.

[Medical support of Russian Armed Forces: the results and perspectives]

The results of work of the Russian Federation Armed Forces medical service obtained in 2007 were summarized and the main problems of its activities in the current year and the very near future were determined. So the work at defining medical support as a type of Army and Navy support was began. The most important task of medical service in 2008 is realization of the Armed Forces medical support conception and goal-oriented program "The improvement of Russian Federation Armed Forces medical support in 2008-2012", the formation of two-level system of personnel's medical support. During the task realization the medical units and institutions are reorganized into federal state institutions. The RF DM Main Military Medical Headquarters works at significant improvement of war and military service veterans' medical attendance. The departmental program "Development of material and technical basis of military medical institutions for 2001-2010" is successfully realized. The measures to optimize the assignment of graduates from military medical higher schools are carried out. The tasks to improve the research work were outlined. The new principles of organization of military medical service control and work will be based on centralization of planning and decentralization of decision implementation, the possibility of military medical units to carry it out taking into account the common intention, safe feedback in order to make the work of army and navy medical specialists more effective in any conditions.

The future pediatrician: promoting children's health and development

The field of pediatrics in the US began in late-nineteenth century urban slums, where young children were monitored to ensure they received safe milk and mothers were educated about nutrition and hygiene. The subsequent reduction of infectious disease through sanitation and vaccination, and a continuing appreciation of the powerful impact of the social context of children's well being, reinforced this early emphasis on preventive care. The past several decades have seen a shift in the distribution of childhood morbidity, as changing social patterns of family life and access to health care have increased the prevalence of chronic illness and developmental and emotional problems. More recently, practitioners and policymakers have recognized the importance of children's social and physical environments on life-long health and social competence. These changes are casting increasing attention on the preventive care available to young children and their families. Whereas public policies have provided most children with access to health care, questions have been raised about the content and quality of that care. Recommendations to improve the quality of preventive care include such strategies as risk-based individualized care plans; greater use of tested practice management tools, such as flow sheets and e-mail; team care; and standardized data collection, including structured screening. Both the content of preventive care and the training of practitioners to provide that care should be guided by a predetermined set of measurable outcomes for which providers should be held accountable, as well as other outcomes to which they should be expected to contribute.

[Further development of prophylactic medical examination of military personnel in Ukraine]

The article presents new principles of carrying out prophylactic medical examination of military personnel: criteria of definition of health groups were proposed, pivotal role of general practitioner in performing of prophylactic medical examination, treatment-and heaIth-improving measures were highlighted. Positive results of introduction of this system of prophylactic medical examination in Kiev garrison enables to recommend it in a wide use to enhance the efficiency of regular medical check-ups in armed forces of Ukraine and other power authorities.

Preventive Cardiology: the SHAPE of the Future

Traditional guidelines for prevention of atherosclerotic cardiovascular disease (ACVD) fail to identify very-high-risk individuals (the vulnerable patient) who have extensive atherosclerotic plaques in coronary and other arteries thereby at risk for a near future adverse event. They solely rely on screening for traditional risk factors of atherosclerosis (e.g., cholesterol, blood pressure, smoking, etc.) and do not treat differently those with and without extensive atherosclerotic plaques who have a similar risk factor profile (e.g., Framingham Risk Score). Recent studies have consistently shown that individuals with extensive plaque burden regardless of their risk factor profile are very high risk. Traditional risk factor-based guidelines clearly miss to identify the vulnerable patient whose risk factor profile is normal or borderline (i.e., low- or intermediate-risk categories). Often individuals with similar risk factor profiles have different levels of coronary plaque burden and are on different trajectories for a future cardiovascular event. Risk factors of atherosclerosis are at best predictors of ACVD but cannot identify who has or does not have the disease. While such an approach was the best available method in the 70s and 80s, we now have new noninvasive tools capable of detecting atherosclerosis itself. The existing traditional guidelines for primary prevention of ACVD need to be updated to save the vulnerable patient. To address this problem, the Association for Eradication of Heart Attack, a grassroots organization founded by a group of cardiovascular physicians and researchers, has proposed the SHAPE (Screening for Heart Attack Prevention and Education) guideline based on consensus among an international group of distinguished cardiovascular experts. The SHAPE guideline aims to complement existing guidelines in preventive cardiology and address the detection and treatment of the vulnerable patient. The SHAPE Task Force has thoroughly reviewed available evidence including recent studies and recommended that all asymptomatic men 45-75 years and women 55-75 years (except for a small group < 5% with a very low risk factor profile) must undergo noninvasive screening to detect and measure the amount of hidden atherosclerotic plaques in their coronary or carotid arteries. The higher the amount of plaques the more intensive treatment is recommended. The SHAPE Task Force urges health-care policy makers to update existing national guidelines for primary prevention of atherosclerotic cardiovascular disease.

Preventive health care for children with and without special health care needs

OBJECTIVE

The objective of this study was to compare the receipt of preventive health services for children with and without special health care needs and to identify predictors of these health services for children with special health care needs using nationally representative data.

METHODS

Data from the 2002 and 2003 Medical Expenditure Panel Surveys were analyzed. A total of 18,279 children aged 3 to 17 years were included in our study. The Child Preventive Health Supplement was used to identify caregiver recall of specific health screening measures and anticipatory guidance during the previous 12 months. Odds ratios were calculated for predictive factors of preventive services for children with special health care needs.

RESULTS

The prevalence of special health care needs in children aged 3 to 17 years was 21.6%. Based on caregiver reports, 87.5% of children with special health care needs had > or = 1 health screening measure checked in the past year compared with 73.1% of children without special health care needs. Receipt of > or = 1 topic of anticipatory guidance was reported for 69.8% of children with special health care needs compared with 55.2% of children without special health care needs. Black and Hispanic caregivers of children with special health care needs were more likely than others to report receipt of all 6 categories of anticipatory guidance measured in this study.

CONCLUSIONS

We found that caregivers of children with special health care needs were more likely to report receipt of anticipatory guidance and health screening than were caregivers of children without special health care needs. Although a majority of these caregivers reported receiving some health screening and anticipatory guidance on an annual basis, there are clear gaps in the delivery of preventive health services. This study identifies areas for improvement in the delivery of preventive health services for children with special health care needs and children in general.

Integrating evidence-based clinical and community strategies to improve health

Multiple and diverse preventive strategies in clinical and community settings are necessary to improve health. This paper (1) introduces evidence-based recommendations from the U.S. Preventive Services Task Force sponsored by the Agency for Healthcare Research and Quality and the Community Task Force sponsored by the Centers for Disease Control and Prevention, (2) examines, using a social-ecologic model, the evidence-based strategies for use in clinical and community settings to address preventable health-related problems such as tobacco use and obesity, and (3) advocates for prioritization and integration of clinical and community preventive strategies in the planning of programs and policy development, calling for additional research to develop the strategies and systems needed to integrate them.