The MemoryMinder Personal Health Journal

Reviewed By:
Barry J Goldlist, MD, FRCPC, FACP

In health care in the 1990's, the major changes from the health care professional's point of view concern restructuring of the delivery system. In the United States, managed care has had tremendous growth, and in many parts of Canada restructuring of the hospital system has been dramatic.

However, I think it is likely that the recipients of health care are more interested in another fundamental change, the 'empowering' of patients. This has been manifested by scientific meetings that include disease sufferers and advocates (HIV, breast cancer), an explosion of self help groups and publications, and an almost ubiquitous interest in complementary medicine.

The MemoryMinder is a personal health journal that allows people to track numerous aspects of health in a systematic manner. Each double page (covers one day) has space for the following: (1) Date, (2) Weather, (3) Morning and afternoon weight, temperature, and blood pressure, (4) Blood sugars, (5) Hours slept at night, (6) Naps and time spent napping, (7) Drugs/medications, (8) Vitamins/herbs, (9) Physical activity, (10) Pain/discomfort/ skin changes (with diagram and rating scale), (11) General feeling, (12) Today's conditions and symptoms (organized anatomically), (13) Today's diet, and (14) Comments

Theoretically this will allow users of the journal to assist their doctors, discover patterns in their own health, and remain more focussed on their dietary and physical activity goals.

I think more limited journals, e.g. for tracking diabetes mellitus, that are easier to complete, would be more usable for the average patient. Of course, there is nothing to prevent patients from only filling out the portions they are particularly concerned about.

In summary, the MemoryMinder is an interesting concept, but I am unsure whether it will be helpful in actual clinical practice.

The Memory Minder Personal Health Journal is available from MemoryMinder Journals by writing PO Box 23108 Eugene, Oregon 97402-0425, calling 1-541-342-2300 or on the Web at www.memoryminder.com

Old, Female, and Rural: What is the Reality?

Reviewed By:
Barry J Goldlist, MD, FRCPC, FACP
Old, Female, and Rural
Editor: B. Jan McCulloch, Ph.D.
Haworth Press, Inc.
Binghamton, New York, 1998
ISBN 0789006715

This book, Old, Female, and Rural, has been co-published simultaneously as Journal of Women & Aging, volume 10, number 4, 1998. It consists of four research articles with a critical review. The topics covered include use of health care, economic realities, and family relationships. As well, the initial article gives a case study of a 90-year-old woman living in rural Minnesota.

Although the book seems overly specialized, much of the information is relevant to older women wherever they live. Even when the information is particular to the rural setting, comparisons to the urban setting are made which also convey very useful information to health care providers in cities.

The first article, the case study, particularly impressed me. The interviewee's view that use of formal support services implies a failure of informal supports also applies to many of my patients. The article on the economic circumstances of older women is not at all surprising, but the high prevalence of poverty in this group is nonetheless disturbing.

In summary, this book is clearly a 'niche' publication. It is a valuable publication for health care providers in rural areas, and provides interesting information for those of us practicing in urban areas. Although it is based on American demographics and research, I suspect that the general principles hold for Canada as well.

For Medicine That’s Rewarding, There is Nothing Like Home Visits

Caring in an Aging Multicultural Society: Operating A Culturally Sensitive Practice

Gail Elliot, MA
McMaster University
Office of Gerontological Studies

Canada consists of over 100 ethnocultural groups. The 65+ age group is comprised of a population that largely identifies with an ethnic origin other than Canadian.¹ Research has too often documented that the health care practices in this country are ethnocentric, focusing on westernized, scientific based practices that too often ignore the alternative methods of care and cure.^2,3,4

In a multicultural country such as Canada, cultural sensitivity should be intricately woven throughout all interactions in the health and social service delivery system. Not only should cultural sensitivity be considered for the purpose of providing patient-centred care, it must also be recognized that this country as a whole has adopted statutory and constitutional policy, and regulations that are intended to place "equality for all" at the forefront of individual rights and freedoms. In fact, Canada has spent nearly thirty years developing policies that are designed to encourage "all of us to work together to build a society in which the principles of multiculturalism are fully realized in practice.

Alzheimer’s Disease--Current Treatment and Future Prospects

Alzheimer's Disease--Current Treatment and Future Prospects
Author: William M. Brown
Publisher: Financial Times, Pharmaceuticals/FT Pharmaceuticals
ISBN: 1 86067 355 4
Price: £ 475/US $740
Pages: 155

Reviewed by: Barry J Goldlist, MD, FRCPC, FACP
When I first saw the advertisement for Alzheimer's Disease--Current Treatment and Future Prospects I was intrigued by the price, $740 US. I did not realize until the book arrived for review that the target audience was not physicians or neuroscientists, but the financial community. The book, even with the references and glossary, is only 155 pages long. All the information contained in the book is already available (although scattered) in the public domain.

The book is basically a synopsis on neurodegenerative diseases, predominatly Alzheimer's disease, and the current and upcoming treatments. The author is a neuroscientist, but more importantly, a clear and concise writer. I have rarely seen medical information transmitted so clearly. The content is up-to-date (although there is no mention of chromosome 12 and a possible relationship to Alzheimer's disease) and the description of possible therapies and their mechanisms is exhaustive. A neuroscientist might not learn anything new, but a practising physician in the area, such as myself, would learn about new drugs in the pipeline.

The most obvious lesson I learned is that the economics of practising medicine and the economics of business are quite different. At $740 US there is not enough value for a physician, but I suspect there is for an astute business person. Certainly that person will receive a beautifully written, concise, yet thorough review of market opportunities relating to the treatment of Alzheimer's disease. Further information regarding this book can be obtained by calling +44 (0) 171 896 2184.

Enhanced clinician awareness of HIV in the elderly is needed

Adults over age 50 now account for at least ten percent of reported AIDS cases. More research surrounding diagnosis, treatment, and prevention of AIDS in older persons is needed. HIV-infected older people do not survive as long as younger people, are less likely to use condoms or participate in routine HIV testing. Chiao, Ries and Sande offer a current literature review concerning the epidemiology of AIDS in older adults as well as information about AIDS-related morbidity and mortality, treatment and prevention behaviours among the elderly.

Source: Chiao EY, Ries KM, Sande MA. AIDS and the elderly. Clinical infectious diseases 1999;28(4):740-5.

Letter to the Editor May/June 1999

The article "SPECT May Help Resolve Dementia Diagnosis," in the January/February issue fails to mention EEG in diagnosis of dementia, a test cheaper than SPECT and CT. EEG is quite sensitive, correlates with prognosis, and is specific withing a given clinical context.

Your title "May Help Resolve" may generate unnecessary referrals for SPECT scanning in this situation. At a time of rigorous health care funding, we need to utilise only those tests which are clearly going to benefit the patient in a cost-effective manner. This article does not advance that goal.

Sincerely,

Warren T. Blume, MD, FRCPC,
Professor,
Department of Clinical Neurological Sciences,
Epilepsy and Clinical Neurological Sciences,
London Health Sciences Centre,
London, Ontario

P.S. The cost of EEG versus SPECT scanning is $51.20 and $162.50 respectively.

Addressing the Health Care Needs of our Rapidly Aging Population

Honourable Minister Cam Jackson

Olya Lechky

The Honourable Cam Jackson, Ontario's Minister of Long-Term Care with Responsibility for Seniors, has a personal interest in health issues that goes back to his boyhood days in Hamilton, Ontario. Born in this industrial city in February, 1951, of a Ukrainian-Canadian mother and Canadian father, he and his siblings saw firsthand the struggles of their parents to keep a large family healthy. "Raising a family of eight children in the fifties when there was no health insurance, no drug plan, no dental plan was challenging in the absence of this kind of support. I was impressed very early on with the importance of accessibility to health care. In those days, doctors still made house calls. Of course, things have changed tremendously since those days and people face different obstacles in accessing health care services."

After briefly pursuing a career in real estate development in his early twenties, Mr. Jackson decided to follow his true calling of serving the public.

Elderly continue to account for most hospital use

Historically, the elderly (65 and over) accounted for a large proportion of the total hospital days in Canada. Of the 33.9 million hospital days in 1996/97, the elderly accounted for 62% (or 20.9 million days), although they represented only 12% of the population that year.

As the number of people aged 65 and over and their share of the total population continue to increase over the next several decades, total hospital bed requirements, especially including long-term care, are expected to increase.

Source: Canadian Institute for Health Information (CIHI),

www.cihi.ca and Statistics Canada, www.statcan.ca.

NACPAC website offers help for chronic pain sufferers

The North American Chronic Pain Association of Canada (NACPAC) is a "self-help organization dedicated to providing support to people in chronic pain, and to giving them assistance in living their lives to the fullest." NACPAC is a registered Canadian Charity and has its own web-site at http://www3.sympatico.ca/nacpac. The website offers information about chronic pain, support groups in Canada, a directory of Canadian pain clinics and pain specialists, related associations and resource lists, links to other chronic pain information on the web, medical information, reference material, book suggestions and more.

November 8th to14th is Chronic Pain Awareness Week in Canada. NACPAC encourages anyone touched by chronic pain to educate others on the plight of chronic pain sufferers in Canada. If you are unable to access NACPAC via the web, their toll free number is 1-800-616-7246.