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PubMed1996

[Management of psychiatric patients in the community--developments up to now, current problems and future perspectives exemplified by the Tübingen district].

The development of the care of mentally ill persons in the last 25 years is shown by the example of the district of Tübingen with about 200,000 inhabitants, a district that did not take part in the model program of the Government. Considering the current care situation, the problems of cooperation and coordination as well as the ensuring of quality, which are actually most important, are discussed; approaches for solutions are outlined. We try a view on the coming 25 years.

Activities of Daily Living↗
PubMed1976

Dental manpower needs in a developing community: a critical analysis of the West African scene.

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.

Adolescent↗
PubMedDate not supplied

Recent developments in the nutritional management of diarrhoea. 3. Practical approaches towards dietary management of acute diarrhoea in developing communities.

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.

Acute Disease↗
PubMed1995

Physicians' approach to the management of hypertension in a developing community.

General physicians' (GP) approach to the management of hypertension was assessed by a standard questionnaire. Each of the 42 physicians studied see about 42 patients in a clinic day. Over half do not usually measure the blood pressure (BP) of all new patients. A third do not investigate before starting therapy. Over half commence drug therapy with less than three BP readings, while over two thirds do so from appropriate BP levels. Over 70% employ sedatives in treatment (50% as the only initial therapy); 45% employ parenteral drugs from a diastolic BP of 110 mmHg. Over 40% do not educate their patients on the implications of hypertension and the need for regular treatment and follow-up, but most give follow-up appointments. Patients are requested to stop therapy once BP is normalised by 25.9% of GPs. These practices were not significantly influenced by years of experience or by being a GP in a teaching hospital system (P > 0.1 and P > 0.5, respectively). The study suggests that physician recognition and management of hypertension is still inadequate and this might in part be related to a general heavy patient load. In addition, continued medical education is essential for physicians for the purpose of improving our management skills.

Antihypertensive Agents↗
PubMed1989

Intestinal permeability assessed with polyethylene glycols in children with diarrhea due to rotavirus and common bacterial pathogens in a developing community.

Intestinal permeability was assessed with different-sized polyethylene glycols (PEG 400 and PEG 1,000) in small children with acute diarrhea. All children with acute diarrhea absorbed and excreted less PEG of all molecular sizes into the urine when compared with healthy control children (p less than 0.001). Children with acute rotavirus infection excreted significantly less PEG of all sizes than children with Shigella, Salmonella, and enteropathogenic Escherichia coli (EPEC) infection (p less than 0.001-0.01), suggesting a more severe mucosal lesion caused by rotavirus. In patients with severe malnutrition there was also a significant decrease in absorption of PEGs observed. In addition, malnourished patients with rotavirus diarrhea showed a pronounced decrease of PEGs in comparison with well-nourished patients. The ratio between the recovery of a large PEG molecule, 1,074 Da, and a small molecule, 370 Da, was utilized to assess the absorption of large molecules in relation to that of smaller ones. On applying this ratio, it was noted that the intestine in children with Shigella and EPEC infection was relatively more permeable to larger molecules than in healthy controls, while in rotavirus and Salmonella infection it was less permeable to larger molecules. In this study significant differences in the permeability characteristics were observed, suggesting etiology-specific effects on the mucosal barrier.

Child, Preschool↗
PubMed1996

Prison deprivation and protein nutritional status of inmates of a developing community prison.

OBJECTIVE: This study assesses the protein nutritional status of inmates of a small prison, in the light of a changing serum protein pattern in the environment. DESIGN: Survey of prison inmates. SETTING: A male prison and low social class hospital workers. SUBJECTS: 81 inmates and 62 randomly selected controls, of which 42 of the former and 28 of the latter were further randomly selected. METHODS: Nutritional and confinement history were obtained by a questionnaire, Weights and heights were measured and serum and urine samples collected for protein estimations. RESULTS: The prisoners were confined for 229.1 (SD 210.1) days. 48.1% had BMI < 20 kg/m2 compared to 28.6% of controls (p = 0.04). Their diet was predominantly carbohydrate. Mean total serum protein was 81.5gm/L (6.1) (95% CI = 79.3-83.5) (prisoners); 88.7 gm/L (8.1) (95% CI = 85.7-91.7) (controls). Serum globulin was 44.9 gm/L (6.3) (95% CI = 42.9-46.9) (prisoners); 55.4 gm/L (8.2) (95% CI = 52.3-58.5) (controls) (p <0.001 respectively). More prisoners than controls had severe hypo- albuminaemia (p =0.001). All values were lower in those awaiting trial compared to convicted inmates. Total protein and albumin weakly correlated with duration of confinement (r = -0.23 and -0.15, respectively). CONCLUSION: The study suggest that the prisoners might be undernourished with lower serum proteins than controls, within an average of seven months confinement. The picture appears worse in those awaiting trial and with prolonged duration of confinement.

Adolescent↗
PubMed1989

Ethnicity and other characteristics predictive of coronary heart disease in a developing community: principal results of the St James Survey, Trinidad.

A ten-year community survey was undertaken to investigate the high coronary heart disease (CHD) incidence among people of Indian (South Asian) descent in Trinidad, West Indies. Of 2491 individuals aged 35-69 years, 2215 (89%) were examined and 2069 (83%) found to be clinically free of CHD at baseline. After exclusion of 71 of minority ethnic groups, 786 African, 598 Indian, 147 European and 467 adults of Mixed descent were followed for CHD morbidity and mortality. In both sexes, adults of Indian origin had higher prevalence rates of diabetes mellitus, a low concentration of high-density lipoprotein (HDL) cholesterol, and recent abstinence from alcohol than other ethnic groups. Indian men also had larger skinfold thicknesses than other men. In participants free of CHD at entry, the age-adjusted relative risk of a cardiac event believed due to CHD was at least twice as high in Indian men and women as in other ethnic groups. In men, blood pressure, diabetes mellitus and low-density lipoprotein (LDL) cholesterol concentration were positively and independently related to risk of CHD, whereas alcohol consumption and HDL cholesterol concentration were inversely associated with risk after allowing for age and ethnic group. The ethnic contrasts in CHD persisted when these characteristics were taken into account. In the smaller sample of women, only ethnic group was predictive of CHD as defined. The failure of point estimates of risk to explain the high CHD incidence in Indians calls for focus on age of onset of risk and examination of other potential risk factors such as insulin concentration.

Adult↗
PubMed1980

Anticipated and actual barriers to developing community mental health programs for the elderly.

Teams of state and local agency professionals responsible for mental health and aging services participated in a model project utilizing education and consultation to facilitate community mental health programming for the elderly. Participants identified both anticipated and actual barriers to programming. Competing program priorities and lack of staff knowledge about mental health and aging were anticipated and confirmed as major barriers. Agency-organizational barriers were unanticipated, yet there were severe problems in cooperative interagency programming.

Aged↗
PubMed1996

Urinary tract infections in adult and adolescent females of a developing community: pattern, bacteriology and genitourinary predisposing factors.

One hundred and twenty-seven consecutive adult and adolescent female patients with culture-proven urinary tract infections were analyzed to determine the pattern, bacteriology and the predisposing causes. Age ranged from 13 to 70 years (median 32, mean 35.7 years). Community acquired urinary tract infections occurred in 85%, while hospital acquired infections in 15% of cases. Urinary tract stones were the most frequently identified genitourinary predisposing causes, which occurred in 16 patients (15%). However, 52.3% of all patients had no identifiable predisposing cause. E. coli, the most frequently isolated organisms from patients with community acquired urinary tract infections, occurred in only 55.6%, while gram-positive cocci isolated from 28 patients (22%) are emerging as important hospital and community acquired urinary tract pathogens. The implications of these findings and a comparison with the reported literature are discussed.

Adolescent↗
PubMedDate not supplied

Building community. Developing skills for interprofessional health professions education and relationship-centered care.

In 1995, the National League for Nursing commissioned a Panel on Interdisciplinary/Transdisciplinary Education. The focus of the Panel's work was to examine educational issues that transcend the health professions and to make recommendations for future implementation of an interdisciplinary approach to addressing them. This article is being simultaneously published by several professional journals. The goal is to seek as much feedback as possible.

Curriculum↗
PubMedDate not supplied

[A sickness called unemployment: a long-term unemployment. Association of Community Development (ACD)].

OBJECTIVES: The general objective of this investigation is to know the possible consequences of long-term unemployment on the family and social environment, as well as the mechanisms which lead to the appearance of health problems among long-term unemployed people. METHODS: The subjects of this study were long-term unemployed people of 35 to 55 years of age of the municipal term of Madrid, with families depending on them. This is a qualitative-intensive investigation, with special emphasis on the individual, social, sanitary and economical aspects. The instrument of common measurement was the combination of the discussion group integrated by five people, during approximately 120 minutes, with focused and individual interviews (48) over a semistructured script, during approximately 60 minutes, using recording instruments (audio tape). RESULTS: During the development of the discussion group a worsening of the psychological health and family situation was observed as a consequence of remaining unemployed. In the more thorough interviews we could detect clear differences according to the impact of unemployment on health depending on the low socioeconomical area, women and older unemployed people. CONCLUSIONS: The effects of unemployment on health cannot be isolated from other underlying bad social and economical conditions, that is to say, from social, economical, educative inequalities, etc., previous to the unemployment situation.

Adult↗