Search

In Oregon, an important new mechanism for prioritizing health care resources is about to be introduced. It is based on a relatively simple cost/benefit formula, the best of available scientific knowledge as well as public opinion and sentiment. The formula is based on three factors: the cost of each treatment or procedure, the improvement in quality of life by giving the treatment and how long a patient would be healthy after treatment. The Oregon experiment may influence the delivery of health care not only in the United States. In modified form this approach may have even more wide-ranging implications in the Scandinavian countries where most of the health services are publicly funded.

Within the sphere of health and welfare, Canada has more in common with the Scandinavian countries than with the United States. This article describes and discusses the unique role of the College of Family Physicians of Canada and the education and training for family medicine, both on the undergraduate and postgraduate levels in Canada. The development of the Master of Clinical Science in Family Medicine degree programme at the University of Western Ontario is considered to be an important vehicle for strengthening academic family medicine in Canada. The amalgamation of current knowledge not only from clinical sciences and educational research, but also from the social sciences, is seen as fundamental to the continued improvement of this discipline.

The importance of avoiding mismatches (MM) at Class I and Class II HLA antigens in cyclosporine-treated renal allograft patients is controversial. In order to assess the role of HLA, 200 consecutive cadaveric renal allografts over a 4-year period were analysed. All patients received cyclosporine/predinisone immunosuppression and 75% were induced with ALG. Minimum follow-up period was one year. HLA A, B, DR, DQ, and DRw52/53 typing were available on 77-100% of allografts. A beneficial effect was noted at the HLA A locus. One-year survival was 87.2% in the 0 and 1 HLA A MM group combined vs 73.8% in the 2 HLA A MM group (p less than 0.05). The mean creatinine level at one year was also lower in the 0 plus 1 MM vs 2 MM group: 152.8 mumol/L vs 184.8 mumol/L, respectively (p less than 0.05). Significantly fewer rejection episodes occurred in the 0 and 1 HLA DQ MM group combined vs the 2 MM group. Steroid-resistant rejection episodes (SRRE) were not associated with the number of HLA MM. Patients who had an SRRE had significantly higher mean current and historical peak panel reactive antibodies (PRA) than patients who did not have SRRE. These results indicate that avoiding mismatches at the HLA A locus may improve renal allograft survival, and matching at HLA DQ may predispose patients to a more quiescent post-transplant course. The degree of preoperative sensitization may be an important etiologic factor in SRRE.

The major Canadian universities are connected via a computer communications network called `Netnorth'. We have used Netnorth's accessible, low-cost, electronic mail system to develop a network of academic Family Medicine users (Famnet). We then tested Famnet's utility for conducting rapid surveys. Famnet shows promise of being a useful means of undertaking regular inter-departmental communication. This system may also increase collegiality among Canadian Departments of Family Medicine and facilitate international communication in family medicine.

Medical expert systems have been developed for more than 20 years, in particular in the United States. Most existing systems are prototypes, and only a few commercial systems are available. The prototypes are generally limited in scope or functions (and have not been transferred to other users). However, in the near future we can expect useful applications to appear in special areas of medicine. In Norway we probably do not have the resources required to develop large commercial medical expert systems. If we want to develop medical expert systems, we should concentrate on limited areas. We must prepare the ground for future use of such systems in Norway. An important first step is to give health personnel basic education in the use of computers.

This article gives an overview of North American electronic networks and on-line databanks containing medical and health-related information. It discusses costs and benefits for physicians and other health care personnel. The article concludes with practical information on ways to connect a Norwegian medical practice to these networks and databanks.

This article describes an extramural university course in epidemiology and medical statistics taught using a computer conferencing system, microcomputers and data communications. Computer conferencing was shown to be a powerful, yet quite easily mastered, vehicle for distance education. It allows health personnel unable to attend regular classes due to geographical or time constraints, to take part in an interactive learning environment at low cost. This overcomes part of the intellectual and social isolation associated with traditional correspondence courses. Teaching of epidemiology and medical statistics is well suited to computer conferencing, even if the asynchronicity of the medium makes discussion of the most complex statistical concepts a little cumbersome. Computer conferencing may also prove to be a useful tool for teaching other medical and health related subjects.

Patient-administrative systems are becoming increasingly accepted in general practice. The market is now more mature than before. Many physicians are now purchasing computer systems for general practice the second time. Due to national characteristics of the health services the market for these systems is not truly international. In Norway this market is dominated by two makes: Infodoc and Profdoc. In future more physicians will use systems for general practice, and more functions will be added, although the usefulness of these may be a matter for discussion. Furthermore, the importance of telecommunications is expected to increase, and similarly, integration with other services. This development would be furthered by central government action for the purpose of harmonizing and standardizing data, systems and possibly user-interface.

The migration of Tokelauans from a traditional atoll in the Pacific to urban New Zealand is associated with an increased prevalence and incidence of Type 2 (non-insulin-dependent) diabetes mellitus over the period 1968-1982. During the same period, a lesser but definite increase is seen among non-migrants in Tokelau. The age standardised prevalence rates rose from 7.5 and 11.7 to 10.8 and 19.9 per 100 respectively in the male and female migrants compared with an increase from 3.0 and 8.7 to 7.0 and 14.3 per 100 in the non-migrant males and females respectively. The incidence of diabetes is shown to be consistently higher in the migrants compared to the non-migrants giving relative risks of 1.5 in males and 1.9 in females. The factors most likely contributing to this difference, are changes to a higher calorie, high protein diet, higher alcohol consumption, a greater weight gain and altered levels of physical activity in the migrants. A number of populations in the Pacific have been shown to have a low rate of diabetes in their traditional setting, but may have a genetic predisposition for diabetes which responds to factors in the urban industrialised environment and life-style. The social and economic changes taking place in Tokelau are also clearly increasing the risk of diabetes. To reverse these trends and prevent the development of complications of Type 2 diabetes, it will be important to institute preventive programmes and to follow up the population in both environments for long-term outcomes, including mortality.

This article proposes the establishment of a central, on-line information bank for the Norwegian health services. The article discusses the potential content and functions of the information bank. It is concluded that, in addition to increasing the availability of health-related information, such an information bank might also improve communication at several levels of the health care system.

Prevalence rates for three hepatitis B virus (HBV) markers in two groups of personnel within the Canadian Armed forces (1848 incoming recruits and 210 crew members from a destroyer) were determined. Blood specimens for analysis were provided twice. The initial prevalence rates fell at the lower end of the spectrum when compared with those found in United States military personnel, Canadian military health personnel, and certain Canadian civilian populations. Eleven recruits and one destroyer crew member seroconverted for at least one of the markers between the first and the second testing. Their serological profiles are discussed in detail. No transmission of HBV between individuals in the group of recruits studied was established. However, evidence was found for a probable limited transmission of HBV between two crew members of HMCS Margaree. These findings combined with the high cost of the hepatitis B vaccine indicate that mass immunization for HBV in the Canadian Forces population cannot be justified on the basis of this study.