Prophylactic appendicectomy during caesarean section in a developing community.
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The theoretical frame of reference in connection with prevention, some theoretical approaches, and the practical consequences of giving priority to prevention are discussed. The following points are stressed: that one must expand the theoretical frame of reference of prevention to include theory on local community, social networks and concepts of mutuality and self-supporting processes that preventive work is most efficient when it is developed in the form of fruitful interaction between primary intervention and selective intervention that giving priority to preventive work rather than implementing continuous expansion of institutions and fields of administration involves changes in the ones that already exist.
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One hundred and sixteen children (less than 2 years old) admitted to a London hospital with acute gastroenteritis were randomized to receive either an oral rehydration solution (ORS) with low sodium and high glucose concentration (Na+ 35, glucose 200 mmol/L), an ORS with a high sodium but low glucose concentration (Na+ 60, glucose 111 mmol/L), or an ORS containing glycine and a glucose polymer (Na+ 50, glucose 50, glycine 50 mmol/L). Clinical, biochemical and haematological features of the three groups were similar on admission. Rotavirus was common (31%); the majority of children had minimal dehydration or acid-base disturbance. The clinical outcome, including ORS intake, prevention of dehydration, rehydration, and duration of hospital stay was similar in the three treatment groups. All initial electrolyte abnormalities were corrected; no child developed hypernatraemia or hyponatraemia. At 24 h, the mean serum urea was higher in those who received the ORS containing glycine than in other groups, and it had not fallen significantly since admission. Eighteen per cent of children had carbohydrate intolerance: four children with greater than or equal to 2% reducing substances in their stool had all received ORS with a high glucose content and had numerous watery green stools containing rotavirus. All ORS solutions were safe and effective for rehydration and correction of biochemical abnormalities, however carbohydrate intolerance was more prevalent in children who received the ORS with a high glucose content.
Research findings from various countries in West Africa clearly indicate that over 94 per cent of the adult population above 40 years of age suffer from periodontal disease in various degrees of severity. Those living in rural areas in West Africa, where dental health care services are not yet available, suffer more from this common disease. With progressive urbanization and changes in diet and eating habits, consumption of refined sugars is rising steeply (Table II) and dental caries has become a serious problem particularly in children from high socioeconomic homes. In Nigeria, DMF of 4-3 in the female and 3-9 in the male has been reported. There is general paucity of all cadres of dental manpower in all areas in West Africa. Dentist: population ratios range from 1 : 111,000 in Senegal to 1 : 1,935,000 in Tchad Republic (Table I). In Senegal, Ghana and Nigeria, Dental schools have been established and attempts are being made to meet the pressing need for dental manpower by the expansion of existing treatment centres and training institutions and the establishment of new ones (Table IV & V). Emphasis is laid on preventive dental health care programmes and the formal training of dental auxiliary personnel: Dental Therapists, Dental Hygienists, Dental Technicians and Dental Surgery Assistants, is taking place in Nigeria and Senegal. Dental Nurses/Therapists and Dental Hygienists if adequately trained in sufficient numbers can play an all-important role in the delivery of dental care and the execution of preventive programmes in the vast rural areas in the developing countries of West Africa with a population of over 122 million people.
Diarrhoeal diseases are a major cause of malnutrition, partly due to poor dietary practices. Misconceptions among the general population and medical personnel lead to withholding of food or avoiding the use of nutritious, locally available and affordable foods. Breast-feeding should not be interrupted during diarrhoea. Many recent studies have shown that when cow's milk is used, full-strength milk should be fed throughout the disease and in convalescence. The concept of diluting milk with water should be altogether avoided. If necessary, full-strength milk should be mixed with equal amounts of other foods. Other recent studies have shown that several diets based on local staples are excellent choices for the dietary management of diarrhoea. An all-vegetable diet commonly eaten in Guatemala produced a sharp decrease in the duration of acute diarrhoea (median duration after feeding began: 1.8 d) and its macronutrients were reasonably well absorbed. Practical recommendations are given, including nutritional, physiological, cultural and economic considerations.