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PubMed2003

Impact of HIV on childhood respiratory illness: differences between developing and developed countries.

The main differences of the impact of HIV on childhood respiratory illness between developed and developing countries, and particularly some countries in Africa, are the scale of the problem and the lack of resources to address problems of prevention, diagnosis, and management. Recent data from HIV-infected African children are reviewed and show that the pattern of respiratory disease in these children is not markedly different to the pattern that was reported from the USA and Europe prior to the use of antiretroviral therapy and routine Pneumocystis jiroveci pneumonia (PCP) prophylaxis for HIV-exposed infants. Bacterial pneumonia is very common in all age groups. PCP and cytomegalovirus (CMV) are especially common in infants, and lymphoid interstitial pneumonitis (LIP) is common in older children. One difference is that pulmonary tuberculosis (PTB) is relatively more common in HIV-infected African children. This is likely to reflect the higher prevalence of smear-positive PTB in the region and therefore of exposure/infection compared to developed countries. Autopsy studies have provided a lot of useful data, but more prospective clinical and intervention studies from different parts of the region are needed in order to improve clinical diagnosis and management.

Child↗

PubMed1983

Program development and maternal-child health consultation: a conceptual model for role enactment in developing countries.

Increasingly, nurses are serving as consultants in designing programs to improve the health of individuals in developing countries. In order to be effective, such programs must reflect the socio-cultural context in which identified health problems occur. This can become problematic when nurses work as consultants in cultures with which they are unfamiliar. This paper proposes the use of the World Health Organization's risk strategy approach as a conceptual framework for developing culture specific programs in maternal-infant health. Suggested consultant role behaviors are articulated with this approach and the various phases of program development using an ongoing project in Juarez, Mexico to which the author has provided nursing consultation as a concrete example.

Child Health Services↗

PubMed2005

Does pleural tuberculosis disease pattern differ among developed and developing countries.

BACKGROUND: A number of reports from developed countries have documented a rising age at which pleural tuberculosis occurs and increase in the frequency of reactivation disease being as the main cause of pleural involvement. OBJECTIVE: To determine the age at which pleural tuberculosis occurs, study its clinical pattern, and to determine whether pleural tuberculosis is a result of reactivation of pulmonary tuberculosis or it is a primary one comparing our findings with results from developed countries. METHOD: Retrospective study of 100 cases discharged from Hamad General Hospital with the diagnosis of pleural tuberculosis from January 1996 to December 2002. RESULTS: Pleural tuberculosis tends to affect younger age groups (84% are below the age of 45 years, with mean age of 31.5). The disease tends to be mostly a primary infection. Fever is the most common symptom (90%) and the disease is usually an acute or sub acute one. Weight loss precedes other symptoms. Exudative pleural effusion with predominant lymphocytosis is characteristic. Majority of patients have no predisposing conditions for the disease. CONCLUSION: In contrast to what has been reported in some developed countries, Pleural tuberculosis tends to be a primary disease in the present study. Younger age groups are particularly affected.

AIDS-Related Opportunistic Infections↗

PubMed2004

Diarrhoea in children: an interface between developing and developed countries.

Despite much progress in the understanding of pathogenesis and of management, diarrhoeal illnesses remain one of the most important causes of global childhood mortality and morbidity. Infections account for most illnesses, with pathogens employing ingenious mechanisms to establish disease. In the developed world, an upsurge in immune-mediated gut disorders might have resulted from a disruption of normal bacterial-epithelial cross-talk and impaired maturation of the gut's immune system. Oral rehydration therapies are the mainstay of management of gastroenteritis, and their composition continues to improve. Malnutrition remains the major adverse prognostic indicator for diarrhoea-related mortality, emphasising the importance of nutrition in early management. Drugs are of little use, except for specific indications although new agents that target mechanisms of secretory diarrhoea show promise, as do probiotics. However, preventive strategies on a global scale might ultimately hold the greatest potential to reduce the burden of diarrhoeal disease. These strategies include vaccines and, most importantly, policies to address persisting inequalities between the developed and developing worlds with respect to nutrition, sanitation, and access to safe drinking water.

Child↗

PubMed1994

The role of vaccine research and development in the scientific development of middle-income countries.

As a new global strategy for improving public health, the Children's Vaccine Initiative implicitly raises, once again, the question of the role of science in developing countries. If there are to be new and improved vaccines, better delivery systems, and simplified immunization schedules, there must be substantial analysis, laboratory activity, and fieldwork to ensure that the new products are ready for effective use. In the context of these requirements, this paper reviews the possibilities for vaccine research and development in middle-income countries and the benefits in terms of fostering socioeconomic development through integrated scientific health research.

Delivery of Health Care↗

PubMed2000

Demographic and nutritional trends among the elderly in developed and developing regions.

Aging for an individual and aging for a population are related but not the same. For an individual, aging first involves survival to more advanced years, which will inevitably be accompanied by progressive changes in the structure and function of somatic tissues due to a programmed failure of the organism maximally to invest in their maintenance. For a population, aging means an increase in the median age, a dual function of longer survival of individuals and a decrease in fertility. In the wilds of nature, and for all but the recent decades for the human species, survival beyond the peak reproductive years is rare. The hostility of natural selection has its greatest impact on the young and the old. Only captive fowl and beasts, domesticated animal species and Homo sapiens achieve long survival. For humans, life expectancy from birth and from any age thereafter is increasing; median ages of populations and the percentage of persons over 60 y are rising. The affluent developed countries led the way, but developing countries are closing the gap. As of about 1966, a majority of the world's elderly live in developing societies. The rarity of growing old left a dearth of knowledge in the domain of gerontological nutrition, both for lack of motivation to learn and lack of individuals and populations to study. The convening of this workshop signifies that the polarity of interest has shifted 180 degrees. Social, economic, physiological and psychological changes with aging and growing older can both be influenced by diet and influence eating patterns and nutritional status. Many assumptions have been made about these changes, but only recently, with concerted metabolic studies of nutrient requirements in healthy elderly and carefully designed multi-center surveys of the health and nutrition of older segments of populations can a true portrait of the issues be delineated.

Aged↗

PubMed1989

The concurrent validity of the Minnesota Child Development Inventory as a measure of young children's language development.

The extent to which the Minnesota Child Development Inventory (MCDI), could be used to estimate levels of language development in 2-year-old children was examined. Fifty-seven children between 23 and 28 months were given the Sequenced Inventory of Communication Development (SICD), and at the same time a parent completed the MCDI. In addition the mean length of utterance (MLU) was obtained for each child from a spontaneous speech sample. The MCDI Expressive Language scale was found to be a strong predictor of both the SICD Expressive scale and MLU. The MCDI Comprehension-Conceptual scale, presumably a receptive language measure, was moderately correlated with the SICD Receptive scale; however, it was also strongly correlated with the expressive measures. These results demonstrated that the Expressive Language scale of the MCDI was a valid predictor of expressive language for 2-year-old children. The MCDI Comprehension-Conceptual scale appeared to assess both receptive and expressive language, thus complicating its interpretation.

Child Development↗

PubMed1998

The transfer of technology from the developed to the developing world.

The treatment of haemophilia in both the developed and developing world countries need not be complicated. The person with haemophilia can be treated and managed by common sense and the application of basic knowledge and understanding of the physiology and pathology. Emphasis needs to be placed on training people rather than on technology in the areas of clinical medicine, laboratory medicine and blood transfusion medicine. Within these specialties, there are a number of practical aspects in which a critical degree of expertise is required. Such expertise may not be available in the developing country and hence there is a very justifiable reason for the exchange of knowledge, technology and goodwill.

Blood Transfusion↗

PubMed2005

Development and behavior of non-handicapped preterm children from a developing country.

BACKGROUND: There are many studies, mainly conducted in industrialized countries, concerning developmental and behavioral outcomes of preterm children. However, little is known about the outcomes of preterm children from developing countries. METHOD: Forty-three non-handicapped Turkish preterm children, 15 with very low birth weight and 28 with low birth weight at preschool age, as well as 36 term controls were compared on rates of developmental, emotional and behavioral impairments. Data were collected by review of hospital records and application of various questionnaires and inventories to both children and their parents. RESULTS: Preterm children had significant delays in general development and significant rise in somatic complaints with unknown medical etiologies. The very low birth weight group also had significant delay in language and cognitive development. Parents of the preterm children displayed significantly higher rates of democratic attitudes. Developmental outcome was significantly associated with birth weight and authoritarian parental attitudes where behavioral outcome was significantly influenced by birth weight. CONCLUSION: Presence of developmental delay is in accordance with existing data on the outcomes of preterm children from industrialized countries. An isolated increase in somatic complaints is an uncommon finding which might also be related to cultural factors.

Case-Control Studies↗

PubMed2004

Some puzzling situations in the onset, occurrence and future of coronary heart disease in developed and developing populations, particularly such in sub-Saharan Africa.

Coronary heart disease (CHD) was rare in developed populations until the early 1900s; this prevailed even among the small segments who were prosperous and who, in measure, had most of the currently recognised risk factors. However, in the 1930s, with improved circumstances from general rises in socio-economic state, there were major increases in the occurrence and mortality rate from the disease, the latter reaching a third of the total mortality in some countries, as in the United Kingdom (UK). Puzzlingly, the inter-population diversity of the increases in CHD has been such that there are as much as five fold differences in CHD mortality rates, as, for example, between Poland and Spain. Within recent years, with appropriate treatments, the mortality rate has halved in some countries, again, as in the UK. However, the incidence rate of the disease has diminished little or hardly at all. Risk factors include a familial component and, nutritionally, over-eating, a high fat intake, relatively low intakes of plant foods, especially of vegetables and fruit and, non-nutritionally, smoking, excessive alcohol consumption and a low level of everyday physical activity. On the one hand, known risk factors, broadly, are considered to be capable of explaining only about half of the variation in the occurrence of the disease. Even at present, known risk factors far from fully explain the epidemiological differences in mortality rates. Yet, on the other hand, there is abundant evidence that in population groups, among whom risk factors are low or have been reduced, CHD incidence and mortality rates are lower. Notwithstanding this knowledge, broadly, there is very little interest in the general public in taking avoiding measures. As to the situation in developing populations, in sub-Saharan Africa, in urban Africans, as in Johannesburg, South Africa, despite considerable westernisation of life style and with rises in risk factors, CHD remains of very low occurrence, the situation thereby resembling, historically, its relatively slow emergence in developed populations. In most eastern countries, mortality rates remain relatively low, as in Russia and Japan. However, in major contrast, in India, rates have risen considerably in urban dwellers. Indeed, in Indian immigrants, as in those in the UK, their rate actually exceeds that in the country's white population. In brief, much remains to be explained in the epidemiology of the disease.

Africa South of the Sahara↗

PubMed2003

The ethics of developed nations recruiting nurses from developing countries: the case of Malawi.

There is currently a global shortage of nurses. Developing countries such as Malawiare among those hardest hit by this shortage. The demands on available nurses have increased and at the same time there is a lack of interest in becoming a nurse owing to the poor working conditions among those still employed in the service. It is questionable if developed nations should recruit nurses from countries such as Malawi, where severe human resource constraints are being experienced. We argue in this article that the current phenomenon of nurses leaving developing nations for western countries is complex. Human rights issues of individual autonomy and public interest are at stake.

Conflict, Psychological↗

PubMed2003

Recommendations for cervical cancer screening programs in developing countries. The need for equity and technological development.

The cervical cancer screening programs (CCSP) have not been very efficient in the developing countries. This explains the need to foster changes on policies, standards, quality control mechanisms, evaluation and integration of new screening alternatives considered as low and high cost, as well as to regulate colposcopy practices and the foundation of HPV laboratories. Cervical cancer (CC) is a disease most frequently found in poverty-stricken communities and reflecting a problem of equity at both levels gender and regional, and this, is not only due to social and economic development inequalities, but to the infrastructure and human resources necessary for primary care. For this reason, the CCSP program must be restructured, a) to primarily address unprivileged rural and urban areas; b) to foster actions aimed at ensuring extensive coverage as well as a similar quality of that coverage in every region; c) to use screening strategies in keeping with the availability of health care services. In countries with a great regional heterogeneity, a variety of screening procedures must be regulated and standardized, including a combination of assisted visual inspection, cervical cytology and HPV detection; d) regional community intervention must be set up to assess the effectiveness of using HPV detection as an strategy in addition to cervical cytology (pap smear); e) the practice of colposcopy must be regulated to prevent the use of it in healthy women at a population level, thus preventing unnecessary diagnosis and treatment which not only are expensive but also causes unnecessary anxiety to women at risk; f) the operation of those clinical laboratories using HPV as a detection strategy must likewise be accredited and regulated and g) the CCSP program for assuring health care quality should meet the expectations of its beneficiaries, and increase the knowledge in cervical cancer related matters. Finally, though a variety of clinical tests on prophylactic and therapeutic vaccines against HPV are recently being developed worldwide; it will take at least from 5 to 10-years time to have them available in the market. For this reason, it will be necessary to intensify the CCSP programs. All these reasons lay emphasis on the need to reinforce actions for CCSP programs. This paper is available too at: http://www.insp.mx/salud/index.html.

Developing Countries↗

PubMed1992

Population growth and economic development in a developing context: problems and policies.

"This study addresses the issue of population growth and economic development and shows that a two way relationship exists between both concepts. It isolates some pertinent factors responsible for high fertility rates in [developing countries] and Nigeria in particular. On the basis of these factors the study then suggests both direct and indirect measures such as birth controls and mass education, among others, to reduce high fertility. Above all, development should be designed in such a way as to eliminate distortionary macro-economic policies that favour the richer groups in the economy."

Africa↗

PubMed1984

Psychopathology and development: II. Childhood experiences and personality development.

Concepts and empirical findings are reviewed with regard to personality development and to the role of childhood experiences in that process. It is concluded that personality development cannot be reduced to the stabilisation of behavioural traits, to the production of a fixed personality structure or to the acquisition of social-cognitive skills, although there is some form of personality organisation in terms of habits, attitudes, concepts and styles of behaviour. Personality development takes place in a social context, with both continuities and discontinuities stemming from maturational and experiential factors and interactions between them. Chains of indirect linkages result from complex patterns of circular processes involving reciprocal interactions between children and their environments. No single mechanism is responsible and no one theory provides an explanation.

Adolescent↗

PubMedDate not supplied

Nursing development units: progress and developments.

Nursing development units (NDUs) are centres where groups of nurses, midwives, public health nurses and health visitors use a comprehensive planned strategy to develop themselves and their practice. Some of the early defining work on NDUs is considered and a brief history is outlined in this article. The strategic approach taken by the Eastern Health Shared Services in Dublin has led to the development of many NDUs in the Dublin area over a five-year period. The NDUs are based on a strategic, supportive approach. Six now exist in the state-funded health service system, but the project has also been widened to include the private and voluntary sectors and this has stimulated several other units to emerge. Focus group work with NDU leaders and facilitators has led to a gradual redefining of the principles of NDUs and the emergence of an accreditation system run by the board. The authors summarise these findings.

Accreditation↗

PubMedDate not supplied

Demographic development in a developing economy: a case study of Uttar Pradesh.

"Patterns of and trends in demographic development in the Indian state of Uttar Pradesh have been analysed in this paper. Indices of urbanisation, literacy and occupational structure were used for this purpose. Their aggregate index represented the level of demographic development." The data are for 242 subdivisions of Uttar Pradesh for the census years 1971 and 1981. Particular attention is given to regional differentials in demographic indicators. The relationships among economic development and the measurements of literacy, urbanization, and occupational status are explored

Asia↗

PubMed2006

Development and implementation of a comprehensive faculty development program in PBL core skills.

Large curricular changes associated with changes in teaching and learning methods should be accompanied by faculty development programs linked to the new pedagogy. This article describes a framework for the development and implementation of a program designed to assist faculty with the transition of the dental curriculum to a problem-based learning (PBL) pedagogy. A faculty committee created a PBL core skills program based on experiential, developmentally appropriate approaches that resulted in constructive and social learning opportunities for the faculty participants. Nearly 70 percent of faculty members have participated in the facilitation preparation workshops and contributed to the D.D.S. curriculum as small-group, inquiry-based learning facilitators. Faculty development programs geared toward acquisition of specific teaching skills and based on adult learning principles can be devised locally and result in increased participation in a new curriculum.

Adult↗

PubMed2006

Public investment in strengthening Veterinary Services and other food safety authorities: issues affecting developed and developing countries.

During the negotiation of the Agreement on the Application of Sanitary and Phytosanitary Measures (the SPS Agreement), there was clear recognition of the problems that developing countries would face in complying with the SPS Agreement. The agreement included provisions related to technical assistance and special differential treatment for developing countries. Both topics are discussed in the SPS Committee as a regular agenda item and have been subject to substantive consideration during both reviews of the SPS Agreement, in 1999 and latterly in 2005. The SPS Committee is currently considering proposals to make these provisions more precise, effective and operational. The Standards and Trade Development Facility (STDF) was formally established in mid-2002 by the Food and Agriculture Organization, World Organisation for Animal Health (OIE), World Bank, World Health Organization and World Trade Organization as a financing and coordinating mechanism. The STDF maintains a database which provides information on SPS-related technical assistance and capacity-building projects. From the limited data gathered, it would appear that the focus of the technical assistance provided so far has been knowledge transfer. Only a small minority of the projects reported deal with the strengthening of hard infrastructure such as laboratory facilities. It is also clear that in terms of the overall number and value of projects, animal health lags well behind the food safety sector. The World Bank estimates that annual expenditure by donor agencies on trade-related SPS programmes has been running at some USdollars 65 million to USdollars 70 million annually. However, there is under-reporting of technical cooperation activities in the STDF database.

Animals↗