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At least 811 records · Page 45Linked to original sources
PubMed2005

External audit of clinical practice and medical decision making in a new Asian oncology center: results and implications for both developing and developed nations.

PURPOSE: The external audit of oncologist clinical practice is increasingly important because of the incorporation of audits into national maintenance of certification (MOC) programs. However, there are few reports of external audits of oncology practice or decision making. Our institution (The Cancer Institute, Singapore) was asked to externally audit an oncology department in a developing Asian nation, providing a unique opportunity to explore the feasibility of such a process. METHODS AND MATERIALS: We audited 100 randomly selected patients simulated for radiotherapy in 2003, using a previously reported audit instrument assessing clinical documentation/quality assurance and medical decision making. RESULTS: Clinical documentation/quality assurance, decision making, and overall performance criteria were adequate 74.4%, 88.3%, and 80.2% of the time, respectively. Overall 52.0% of cases received suboptimal management. Multivariate analysis revealed palliative intent was associated with improved documentation/clinical quality assurance (p = 0.07), decision making (p = 0.007), overall performance (p = 0.003), and optimal treatment rates (p = 0.07); non-small-cell lung cancer or central nervous system primary sites were associated with better decision making (p = 0.001), overall performance (p = 0.03), and optimal treatment rates (p = 0.002). CONCLUSIONS: Despite the poor results, the external audit had several benefits. It identified learning needs for future targeting, and the auditor provided facilitating feedback to address systematic errors identified. Our experience was also helpful in refining our national revalidation audit instrument. The feasibility of the external audit supports the consideration of including audit in national MOC programs.

Accreditation↗
PubMed2003

Information and communication technology in cardiovascular disease prevention in developing countries: hype and hope. Report of the International Collaboration on Information Use in Cardiovascular Health Promotion in Developing Countries.

Information can be an important tool in promoting a prevention strategy to address the emerging epidemic of cardiovascular disease in developing countries. Advances in information and communication technology offer new promises for global access to information and for global mobilization to prevent and control cardiovascular disease. This is especially true for health professionals, whose needs in areas such as networking, exchange of expertise and access to relevant advances remain unfulfilled. Information technology can also sensitize the lay public to the magnitude of cardiovascular diseases, creating awareness about risk states, and highlighting preventive strategies. Effective application mandates that the technology be relevant to local needs. Cost, feasibility, and relevance of information need to be considered before wide adoption is advocated. Several initiatives, such as ProCOR, Global Cardiovascular Infobase, Heartfile, and the Virtual Congress of Cardiology, have successfully utilized information technology to promote cardiovascular prevention. The experience of these initiatives suggests that, while information technology holds great potential, there are many potential perils, such as the widening global information gap, inequitable access, and irrelevant information. For now, information technology must be viewed as part of a broader strategy, which includes conventional communication media, to address the unmet information needs for cardiovascular prevention globally. Enlightened policies can exploit the energies of the recent information boom for promoting cardiovascular prevention, taking into account the considered limitations.

Cardiovascular Diseases↗
PubMed2003

Interventions for micronutrient deficiency control in developing countries: past, present and future.

There has been an evolution in our understanding of the causes of undernutrition and of the nutrition intervention programs that should be prioritized. This article discusses why nutrition programs have shifted their primary emphasis from control of protein deficiency, to energy deficiency, and now to micronutrient deficiencies. It has become recognized by the nutrition community that micronutrient malnutrition is very widespread, and is probably the main nutritional problem in the world. The most commonly used strategies for micronutrient deficiency control are supplementation and fortification, because they are cost-effective and to some extent, relatively easy to deliver. They have important limitations, however. Relatively little emphasis has been placed on food-based approaches to control micronutrient malnutrition. Evidence from several past studies, including the Nutrition Collaborative Research Support Program (N-CRSP), indicated a strong positive association between animal source food (ASF) intake, micronutrient status, and many human functions. This association motivated the intervention studies supported by the Global Livestock CRSP and described in this supplement, which found benefits of increasing ASF intake. In contrast to the common assumption that increasing consumption of ASF in poor communities is infeasible, and will only cause environmental problems, the articles in this supplement show the potential economic benefits of animal ownership in poor communities, and provide examples of innovative programs that have increased local production and consumption. Much more communication is needed among the nutrition, agriculture and development communities to achieve improved dietary quality for poor populations.

Animals↗
PubMed2005

Infectious diarrhea in developed and developing countries.

Diarrhea from gastrointestinal infection remains a common problem. In industrialized countries, management is aimed at reducing morbidity and defining groups that may benefit from further investigation. Most infectious diarrhea is self-limiting and only requires supportive management. Viral agents are increasingly recognized as causative agents of epidemic and sporadic diarrhea. In developing countries, diarrhea is a major cause of mortality in children. Oral rehydration therapy, guided by a clinical assessment of the degree of dehydration, is cheap, simple, and effective and remains the mainstay of management of infant diarrhea. Controversies focus on the optimal formulation of oral rehydration solution. A vaccine against rotavirus has the potential to save millions of lives worldwide.

Algorithms↗
PubMedDate not supplied

The relation of child care to cognitive and language development. National Institute of Child Health and Human Development Early Child Care Research Network.

Children from 10 sites in the United States were followed from birth to age 3 to determine how experiences in child care relate to cognitive and language development (Ns varied between 595 and 856, depending on the assessment). Multiple assessments of family and child care environments and of cognitive and language competence were collected. Analyses that adjusted for maternal vocabulary score, family income, child gender, observed quality of the home environment, and observed maternal cognitive stimulation indicated that the overall quality of child care, and language stimulation in particular, was consistently but modestly related to cognitive and language outcomes at ages 15, 24, and 36 months. The effect sizes for high (top quartile) versus low (bottom quartile) quality ranged from .18 to .48. After adjusting for child care quality, cumulative experience in center-based care was associated with better outcomes than was participation in other types of care. The amount of time children spent in care was not related to outcomes. Children in exclusive maternal care did not differ systematically from children in child care. Tests for lagged relations of earlier child care experiences to later performance (adjusting for current child care) showed that language stimulation predicted subsequent cognitive and language performance 9 to 12 months later. Although children in center care at age 3 performed better than children in other types of care, earlier experience in child care homes was associated with better performance at age 3 than was experience in other types of care. The relations of child care variables to outcomes did not vary consistently as a function of family income, quality of home environment, child gender, or ethnic group.

Age Factors↗
PubMed2002

Drug-induced urticaria and angioedema: pathomechanisms and frequencies in a developing country and in developed countries.

A careful drug history should be obtained from all patients with acute or chronic urticaria/angioedema, especially in the elderly. Although strictly comparable data are lacking, drug-induced urticaria appears to be more common in developed countries than in Malaysia, at least in a Hospital setting. Culprit drugs include antibiotics, analgesics and contrast media. Pseudoallergic drug-induced urticaria mimicks true allergic urticaria, but without an evident immunological basis, and is at least as common as the allergic type. In Malaysia, and in many other countries compulsory, ingredient labelling of 'traditional' medicines would do much to reduce the frequency of drug-induced urticaria.

Adolescent↗
PubMed1988

Recent trends in migration between core and peripheral regions in developed and advanced developing countries.

"The main finding of this article is that net internal migration to the core regions in the countries of the developed world, which subsided in the 1970s, increased in the 1980s, although not to the level of the 1960s. In some countries of northwest Europe there is a balance now in net flows between core and periphery. In the countries of the periphery of Europe and Japan net internal migration to the core regions increased slightly in the 1980s. Net migration flows to the periphery have completely reversed in Canada, and net flows out of the core regions of the United States have been significantly reduced. In eastern Europe, however, there is still moderate net migration to the core regions without any interruption as seen in western Europe, North America, and Japan. In South Korea and Taiwan rates of net migration to the core regions have been reduced from their high levels of the 1970s, but they are still quite high and show no clear sign of a break from the past."

Asia↗
PubMedDate not supplied

HIV and infant feeding: issues in developed and developing countries.

Women in developed countries who are human immunodeficiency virus (HIV)-positive generally feed their infants formula to avoid virus transmission via breastfeeding. However, for most of the world's women who are HIV positive, the choice of infant feeding method is not so clear. Poor socioeconomic and living conditions place infants on breast milk substitutes at higher risk of non-HIV infectious diseases as compared with breastfed infants. Mothers in these settings who are HIV positive must weigh the risks and benefits of breastfeeding to choose the best infant feeding option.

Breast Feeding↗
PubMedDate not supplied

Prosocial involvement as a positive youth development construct: conceptual bases and implications for curriculum development.

Pro-social involvement programmes are significant and important for the healthy growth of adolescents as well as for the development of society. Pro-social involvement of adolescence refers to paid-job, volunteer works, sport and games. It serves the functions of making adolescents aware of and to accept the social norms and moral standard of the society, which would bring positive changes to the adolescents and consequently benefit the society as a whole. Past studies showed that adolescents who participated in pro-social involvement programmes tended to have positive self-perception, more social skills, and less anti-social behaviors. In Hong Kong, professionals in education and social services have fully recognized the benefits of pro-involvement programmes. They have organized multi-level and diverse pro-social involvement programmes and encouraged adolescents to participate. Through participation, adolescents could be helped to redefine their relationship with the society, and maximize their potentials for growth. The current programme described in this article is designed in the P.A.T.H.S. Project, support by the Hong Kong Jockey Club Charities Trust.

Adolescent↗
PubMed1993

Development and maintenance of hemophilia programs in developing countries.

A hemophilia care program should be able to provide comprehensive medical care to the person with hemophilia and fundamental to the provision of such care is the ability to provide adequate hemostatic support to the hemophilic person with his congenital hemorrhagic diathesis. Development of such a program depends on the presence and commitment of key medical and paramedical personnel and on the recognition of the fact that hemophilia exists in a particular country or community. Support programs ultimately require government assistance for provision of diagnostic facilities and most importantly for a blood transfusion service where production of blood and preparation of blood components for therapy can be undertaken. To maintain a hemophilia care program there should be viability and education of staff and an undertaking by governments for the provision of an on-going infrastructural financial support. As patients mature, new problems will arise, some of which may be a direct complication of hemophilia. Involved medical staff require support and continuing education to continue to provide essential support to the people with hemophilia. Finally, it must be stressed that hemophilia care does not stand alone but must be incorporated into the network of provision of health care based on an efficient and viable blood transfusion service.

Blood Banks↗
PubMed1995

The status of the developing occlusion of 8-9 year-old children from a lower socio-economic group in a developing country.

The aim of this study was to determine the percentage of developing malocclusions that are present at the age of 8-9 years. This data will be used for a follow-up study on the same sample two years hence, in order to formulate soundly based recommendations to Public Health Authorities on the implementation of a community directed, preventive and interceptive orthodontic programme. A total of 936 children were examined by 3 investigators, at 9 primary schools in the lower socio-economic suburbs of a large urban area. The majority of subjects (66.5 per cent) presented with Class I malocclusions. A significantly higher percentage of white children however, presented with Class II malocclusions, while black children showed a higher tendency toward Class III malocclusion. Well circumscribed anterior openbites were found in 27.8 per cent of black children, but no specific causative factors could be identified. Early loss of primary molars and canines occurred in both groups. There was a statistically significant difference (p < 0.05) between the mean posterior arch lengths of the two groups, the black children having on average 2.2 mm longer arch lengths.

Child↗
PubMed1998

The role of ISHAM: how developing and developed countries can benefit from it. International Society for Human and Animal Mycology.

The international community of mycologists, ISHAM, is faced increasingly with the needs and demands of supporting the development of organizational structures worldwide in the field of medical mycology. This goes beyond the classical objectives of a scientific association, namely organizing international congresses and publishing a journal. In the early part of the next century, this will become a major challenge to ISHAM. Symposia discussing this subject were presented at the 12th Congress of ISHAM held in Adelaide, Australia, in 1994. This paper outlines the reflections and discussions held by members of our Society in 1997.

Animals↗
PubMed1975

The effects of exogenous cortisone acetate on development (especially skeletal development) and on circulating levels of corticosteroids in chick embryos.

Chick embryos were treated with cortisone acetate on day 8 of incubation and the subsequent growth of the whole embryo and the development of the tibia studied to day 18 of incubation. Cortisone, at 10 ng to 2 mg/embryo decreased general body growth; above 0.5 mg/embryo it also retarded morphogenesis by as much as 3 Hamilton-Hamburger stages; and above 1 mg/embryo gross abnormalities were produced. The growth and differentiation of the tibia were affected to a greater extent than was the whole body. The reductions in tibial and total body weight were not linearly related to dose of cortisone injected. The exogenous cortisone acetate resulted in drastic alterations in the circulating levels of cortisone, cortisol, corticosterone, and progesterone, but plasma progesterone level was most readily correlated with the growth retardation. This study emphasizes that avian embryos can readily compensate for exogenous corticosteroids and that caution must be exercised when attributing causality to the substance administered.

Adrenal Cortex Hormones↗
PubMed2000

Association between methylmercury exposure from fish consumption and child development at five and a half years of age in the Seychelles Child Development Study: an evaluation of nonlinear relationships.

Studies to date of the developmental effects of pre- and postnatal methylmercury exposure from fish consumption in the Seychelles Islands, using linear regression models for analysis, have not shown adverse effects on neurodevelopmental test scores. In this study we evaluated whether nonlinear effects of methylmercury exposure were present, using scores on six tests administered to cohort children in the Seychelles Child Development Study at 66 months of age. Prenatal exposure was determined by measuring mercury in a segment of maternal scalp hair representing growth during pregnancy. Postnatal exposure was measured in a segment of the child's hair taken at 66-months of age. Generalized additive models (GAMs), which make no assumptions about the functional form of the relationship between exposure and test score, were used in the analysis. GAMs similar to the original linear regression models were used to reanalyze the six primary developmental endpoints from the 66-month test battery. Small nonlinearities were identified in the relationships between prenatal exposure and the Preschool Language Scale (PLS) Total score and Child Behavior Check List (CBCL) and between postnatal exposure and the McCarthy General Cognitive Index (GCI) test scores. The effects are best described graphically but can be summarized by computing the change in the predicted test score from 0 to either 10 or 15 ppm and then above this point. For the PLS the trend involved a decline of 0.8 points between 0 and 10 ppm followed by an increase (representing improvement) of 1.3 points above 10 ppm. For the CBCL there was an increase of 1 point from 0 to 15 ppm, and then a decline (improvement) of 4 points above 15 ppm. The GCI increased by 1.8 points through 10 ppm and then declined 3.2 points (representing worse performance) above 10 ppm. These results are not entirely consistent. Two of the trends involve what appear to be beneficial effects of prenatal exposure. The one possibly adverse trend involves postnatal exposure. In every case the trend changes direction, so that an effect in one direction is followed by an effect in the opposite direction. Because of the descriptive nature of GAMs it is difficult to provide a precise level of statistical significance for the estimated trends. Certainly above 10 ppm there is less data and trends above this level are estimated less precisely. Overall there was no clear evidence for consistent (across the entire range of exposure levels) adverse effects of exposure on the six developmental outcomes. Further nonlinear modeling of these data may be appropriate, but there is also the risk of fitting complex models without a clear biological rationale.

Animals↗
PubMed1984

[Development conditions and development status of 10-year-old children in Basle].

Children from the "Basle Kindergarten Study" (born 1971-73) were re-examined during their 4th year of primary school, i.e. at the age of ten (1981-84) (Follow-up of a representative sample of 10% of all children in the first year of kindergarten). The aim of this study is to analyse differences in physical and psycho-social development of children living in different conditions, particularly between immigrant and Swiss children. First results are discussed.

Child↗
PubMedDate not supplied

Recent developments in the nutritional management of diarrhoea. 1. Nutritional strategies to prevent diarrhoea among children in developing countries.

This paper discusses various ways in which diarrhoea may be prevented from occurring in children living in developing countries, where it is still a major cause of morbidity and mortality. Possible strategies include promotion of breastfeeding, dietary supplementation with vitamin A, zinc and iron, the prevention of protein-energy malnutrition as far as possible, and improvement in the standard of preparation and hygiene of available weaning foods, involving in particular the wider use of fermented foods.

Breast Feeding↗
PubMedDate not supplied

Royal Society of Tropical Medicine and Hygiene Meeting at Manson House, London, 16 February 1995. Aspects of Helicobacter pylori infection in the developing and developed world. Helicobacter pylori infection, nutrition and growth of West African infants.

Helicobacter pylori is probably the commonest bacterial infection of humankind. In adults, colonization of the stomach is associated with chronic gastritis and duodenal ulcer disease. However, children in the developing world acquire H. pylori soon after birth, and there is evidence that it plays a part, through suppression of the gastric acid barrier, in the pathogenesis of the syndrome of diarrhoea, malnutrition and growth failure. Infants born of mothers who secrete milk with high levels of anti-H. pylori immunoglobulin A (IgA) antibody acquire the infection later than those born of mothers with low specific antibody levels. Enhancement of maternal breast milk anti-H. pylori IgA levels may protect infants from H. pylori infection during the vulnerable weaning period when many are susceptible to enteric infections, leading to recurrent diarrhoea and adverse consequences on nutrition and growth.

Child, Preschool↗