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PubMedDate not supplied

Changing patterns of diabetic deaths in youth and young adults by gender in the major developed countries 1974-97.

UNLABELLED: The objective was to examine any changes in "Diabetic Deaths" in major developed countries 1974-97 and to determine whether youth (aged 15-24 years) and young adult (aged 25-44 years) males are at greater risk of Diabetic Death (DD) than women by comparing DD with "All Cause Deaths" (ACD) by gender. DESIGN: Based upon WHO standardized mortality data, three year average death rates for 1974-76 were contrasted against three year average for 1995-97 for ACD and DD rate per million, by gender. Ratios of change for each country were calculated, which were then used for comparison between countries, thus ensuring comparison of like with like, resolving the inherent problem of differential recording between countries. Ratios of ratios were calculated between the ACD and DD ratios by gender indicating any changes between mortalities by gender over the period. Chi square tests examined differences between the gender. RESULTS: ALL CAUSE DEATHS: Wide range of male ACD, lowest Japan 939 (per million p.m) to USA 2039 p.m. but there were substantial falls (< 0.2) in five countries. Female ACD ranged from Japan 485 p.m. to USA 889 but fell substantially in every country except the Netherlands. DIABETIC DEATHS: Male DD highest in USA at 24 p.m., lowest Italy 6 p.m. with substantial falls in 8 countries. Female DD were 17 p.m. in USA and 3 p.m. in France and Spain. Fell substantially in every country except the USA. DD:ACD male rates saw substantial improvements in Ratio of Ratios (RoR) in France, Italy and Spain but rose 1.22 in USA. Female RoR showed better improvements in DD in France, Netherlands and Spain but substantial rises in Canada and USA. DD AND GENDER: In every country there were more male than female DD and over time male DD worsened significantly compared to female DD in Japan, Netherlands, Spain and USA. CONCLUSIONS: Whilst diabetes continues to be associated with greater mortality, over the period there have been major improvements in DD relative to ACD deaths, especially amongst females. Nonetheless, there are still gains to be made if compliance can be further improved amongst male patients.

Adolescent↗
PubMed1997

Risk factors for palmo-plantar pustulosis in a developing country.

Twenty patients with palmo-plantar pustulosis (10 males and 10 females) with a mean age of 41 +/- 6.4 years were compared to 20 controls (10 males and 10 females, mean age 42 +/- 7.2 years, for possible risk factors for palmo-plantar pustulosis. No statistically significant difference was found when the two groups were compared as regards history of atopy diabetes mellitus and thyroid disease. A statistically significant difference was found with regard to cigarette smoking (P < 0.001) and presence of joint symptoms (P < 0.01). This pattern, with minor variations, is similar to the findings in Western countries. There is a need for increased awareness of this association in developing countries. A larger population based study will be highly desirable.

Adult↗
PubMedDate not supplied

Computer-assisted rapid surveys in developing countries.

Health surveys are an important source of population-based data in much of the developing world. Unfortunately, sample surveys often take more time to plan, process, and analyze than is practical, given the information needs of the local decision-makers. Rapid survey methodology (RSM) has been developed to permit health professionals to answer quickly questions about the health status and activities of people at the community level. These answers may be necessary for determining program priorities or for monitoring program activities. Rapid surveys are meant to supplement, rather than replace, information derived from existing sources of vital and health statistics data. RSM combines sample survey methods with contemporary software used in portable, battery-powered microcomputers. The ability to do rapid surveys in developing countries also requires knowledge of how to use appropriate computer hardware and software and how to apply cluster sampling theory in the local environment. RSM was used for the first time in Hlegu Township, Burma, to conduct a health survey of young children. The survey team started the field work on May 4, 1987. Four days later, while still in the field, the data were processed and rapidly analyzed by portable microcomputers for presentation to the local township medical officer and his staff. Within 10 days of starting the field work, we issued a detailed 50-page report of the study findings. This paper provides (a) a description of the components of rapid survey methodology, including the sample survey method, computer hardware, and computer software; (b) the general requirements for portable computer hardware in less developed regions of the world; (c) the procedures for doing a rapid survey; and (d) a summary of our experiences with RSM in Burma.

Developing Countries↗
PubMed2003

Work-related research, education, and training in developing countries.

Work-related research, education, and training (WRET) have not been widely recognised in many developing countries (DCs) as the most important factor for sustainable workplace improvement. There are many reasons why WRET is still neglected or remains unrecognised. Empirical research, advanced studies, and training abroad do not seem to be cost-effective for many people living in DCs because of enormous obstacles. Therefore, it is not easy to demonstrate that WRET result in workplace improvement in diverse situations in each DC. Taking into consideration poor health and safety in various workplaces, this paper aims to stimulate critical opinions and discussions on WRET, which are yet to be given high priority in the national agenda to ensure industrial production and social progress.

Developing Countries↗
PubMed1994

Value orientations of expatriate nurses in the developing countries.

This paper represents some of the findings from a study of expatriate nurses working in developing countries. The aim of the study was to identify the value orientations of Western nurses and to suggest to what extent those values influenced practice. A values clarification exercise was carried out and classified within Kluckhohn and Strodbeck's values orientation continuum (1961, Variations in Value Orientations. Row Paterson & Co., New York). Western nurses saw themselves as knowing what was right for others. They were essentially activists seeking to 'do' many things focusing on individuals while at the same time working towards community planning. Western nurses although powerless to alter the values of the system within which they worked were able to initiate change. The ability to adapt and reconstruct individual value systems in response to working in a cross-cultural situation influenced the effectiveness of the nurse in practice.

Adult↗
PubMed1995

Occupational disorders affecting agricultural workers in tropical developing countries: results of a literature review.

This paper presents the results of a literature review undertaken to determine the nature and extent of occupational health problems in tropical agriculture and to identify opportunities for ergonomics intervention. Occupational disorders were categorized as follows: disorders associated with the use of pesticides; disorders associated with biomechanical and postural demands; and disorders associated with harmful materials other than pesticides. It was concluded that the high rate of pesticide poisoning in tropical agriculture is partly a consequence of the inappropriate transfer of technology from industrialized to developing countries. Ergonomics intervention has the potential to reduce the incidence of occupational pesticide poisoning in developing countries. Biomechanical disorders are commonly presumed to be prevalent in tropical agriculture, but the evidence to confirm this is lacking. Again, ergonomics intervention has the potential to minimize such disorders, but the cultural significance associated with traditional tools and practices must be considered in such a development programme. Disorders associated with contact with harmful materials have been described as occupational diseases. Pesticides aside, these have received little attention, partly because it is difficult to distinguish between occupational and non-occupational incidences of such diseases. Opportunities to reduce the occurrence of these occupational diseases could be limited.

Journal Article↗
PubMed2000

Benchmarks of fairness for health care reform: a policy tool for developing countries.

Teams of collaborators from Colombia, Mexico, Pakistan, and Thailand have adapted a policy tool originally developed for evaluating health insurance reforms in the United States into "benchmarks of fairness" for assessing health system reform in developing countries. We describe briefly the history of the benchmark approach, the tool itself, and the uses to which it may be put. Fairness is a wide term that includes exposure to risk factors, access to all forms of care, and to financing. It also includes efficiency of management and resource allocation, accountability, and patient and provider autonomy. The benchmarks standardize the criteria for fairness. Reforms are then evaluated by scoring according to the degree to which they improve the situation, i.e. on a scale of -5 to 5, with zero representing the status quo. The object is to promote discussion about fairness across the disciplinary divisions that keep policy analysts and the public from understanding how trade-offs between different effects of reforms can affect the overall fairness of the reform. The benchmarks can be used at both national and provincial or district levels, and we describe plans for such uses in the collaborating sites. A striking feature of the adaptation process is that there was wide agreement on this ethical framework among the collaborating sites despite their large historical, political and cultural differences.

Benchmarking↗
PubMed2003

Design and quality control issues related to dietary assessment, randomized clinical trials and meta-analysis of field-based studies in developing countries.

The essential design and quality control aspects of dietary assessment, randomized controlled trials (RCT) in developing countries and their subsequent meta-analysis are reviewed. Dietary assessment protocols consist of three stages: measurement of food intakes using a method appropriate for the study objectives, calculation of nutrient intakes and finally an evaluation of their nutrient adequacy. The latter may involve: 1) assessment of dietary diversity (average number of different foods consumed per day) and selected indices of dietary quality such as intakes of animal source foods (g/d); 2) percentage of energy from protein, fat and animal protein; 3) selected nutrient densities; and 4) dietary phytate:zinc molar ratio, as well as the prevalence of inadequate nutrient intakes calculated using a probability approach. To establish causality between the nutrient inadequacies identified and adverse health outcomes, RCT must be undertaken. A prerequisite of RCT is double-blind randomization, a procedure designed to eliminate biases arising from baseline confounding variables, unintended interventions and ascertainment bias. Results from existing RCT can be summarized via meta-analysis to gain a better understanding of the population relationship. Meta-analysis is a statistical technique involving linear models or generalized linear models, which can be performed after locating the individual studies, and selecting and abstracting all the necessary data.

Developing Countries↗
PubMed1994

The social impact of HIV/AIDS in developing countries.

This paper highlights some of the main areas of social impact of HIV and AIDS in developing countries and suggests that these must constitute priority areas for action among international and national policy makers, as well as others concerned with HIV and AIDS. The areas of impact which are considered are: economic and demographic; labour productivity; agricultural production and development; pressures on the health sector; the role of families and households; children; women; HIV/AIDS discrimination; and the impact of HIV/AIDS on the individual. Some of the responses which have already been developed to the impact of HIV and AIDS are considered, and many of these are seen to be at least partially effective ways of addressing some of the consequences of pandemic. The paper concludes however that the escalating cost of HIV and AIDS, in personal, social and economic terms, demands a greater degree of considered, concerted and coordinated action by international, national and local agencies.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

The study of caries prevalence in children in a developing country.

This study has shown that prevalence of dental caries in a rural section of a developing country is related to age, socioeconomic status, and specific location. Caries prevalence is also directly correlated with family consumption of sugar. No correlation could be found, however, with regard to sex. Further study should be conducted on the relationship of individual practices (sugar consumption and hygiene) to caries-prevalence. In particular, data could be collected on practices in the communities where the school surveys were conducted in order to define the factors underlying the high prevalence of caries in some and lower prevalence in the others. The fluoride levels in the drinking water and the possible effect of hypoplasia on caries-prevalence in primary teeth are topics for further research. The latter condition should be investigated to determine the cause of its high prevalence, which might be an important consideration in future dental health interventions. Dental health education should be directed as soon as possible to communities, such as those in this study, where dental caries prevalence and sugar consumption are still low. It is usually more successful to encourage the adoption of new behaviors and attitudes or redirect them in a similar direction than to ask people to give up a valued behavior. In this situation, it would be preferable to encourage continuation and effective use of traditional hygiene methods and the current low levels of sugar consumption than to wait until sugar consumption is likely to become entrenched at high levels and traditional hygiene practices abandoned.

Adolescent↗
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↗
PubMedDate not supplied

[The status of women and fertility: the experience of developed countries].

The author critically examines recent studies that have cited various changes in women's status in developed countries as the cause of changes in the number of children desired. It is suggested that "the number has decreased as a consequence of the social pressures tending to limit the total fertility of women so as to be compatible with the new behaviour patterns of an industrialized society." (summary in ENG, ITA)

Behavior↗
PubMed1997

Are recommendations from carcinoma of the cervix Patterns of Care Studies (PCS) in the United States of America (USA) applicable to centers in developing countries?

PURPOSE: To compare patient demographics, treatment resources, practice patterns, and outcome results for squamous cell carcinoma of the uterine cervix (SCC) between the 1978 and 1983 Patterns of Care studies (PCS) in the United States of America (USA) and a nonacademic center within a developing country. METHOD AND MATERIALS: Patient details (race, age, stage, and number per year), treatment used, and treatment outcome were retrieved from the charts of the 1160 cases registered at this center with SCC of the cervix between 1976 and 1985. Demographic variables and Kaplan-Meier survival estimates were calculated and compared with results from published PCS reviews. RESULTS: There is a significant difference in the racial group presentation of cervix cancer at this center compared with the PCS reviews (p < 0.005), and median ages are significantly lower at this center (t = p < 0.001). The proportion of patients with Stage III or more was significantly higher at this center than the PCS centers (24 vs. 47%, p < 0.001). There were also vast differences in facility resources. Fewer cases at this center underwent intracavitary insertions than at PCS centers. Mean Point A doses were significantly reduced for this center compared with the PCS reviews. Kaplan-Meier estimates were similar for Stage I and II in PCS centers and this center, but were inferior for this center in Stage III patients (p < 0.05 for OS and p < 0.01 for LC). Late morbidity rates were similar for both PCS centers and this center. CONCLUSION: PCS recommendations may be applicable to nonacademic centers within developing countries, if the latter use staging techniques that are consistent with the PCS staging guidelines.

Brachytherapy↗
PubMed2002

Outdoor air pollution and acute respiratory infections among children in developing countries.

Acute respiratory infections (ARIs) are the most common cause of illness and death in children in the developing world. This review focuses on outdoor air pollutants associated with pediatric ARI mortality and morbidity. Studies were identified using MEDLINE and other electronic databases. Four studies showed an increase in infant mortality in relation to outdoor air pollution. Short-term follow-up and time-series studies suggest that air pollutants act as risk factors for respiratory infection. Air pollution exposure increases the incidence of upper- and lower-respiratory infections in children. Because complex pollution mixtures are present in the studied urban areas, pollutant levels at which ARI risk would be expected to increase cannot be determined. Children may be at greater risk, given the poor environmental and nutritional conditions prevalent in developing countries.

Acute Disease↗
PubMed2001

Antibiotic resistance in developing countries.

During the past decade there have been major changes in the susceptibility of bacteria that cause various infections. Resistance to anti-infective agents, including antibiotics, is worldwide, both in developed and developing countries. Almost all bacterial species can develop resistance to anti-infective agents and resistance can readily be transferred among bacteria by transmissible elements (plasmids). Measures to prevent the emergence of resistance must be implemented urgently. A multiplicity of factors drive antibiotic resistance and solutions require the collaboration of governmental agencies, pharmaceutical companies, healthcare providers and consumers. Knowledge of resistance patterns and of the ways by which resistance is overcome is vital to the future of antimicrobial chemotherapy.

Developing Countries↗
PubMed1997

Control of rubella and congenital rubella syndrome (CRS) in developing countries, Part 2: Vaccination against rubella.

In 1995-96 we conducted a review of rubella immunization strategies. Worldwide, 78 countries (more than one-third) reported a national policy of using rubella vaccine. This was closely related to country economic status. Based on the United Nations country classification, rubella vaccine is used in 92% of industrialized countries, 36% of those with economies-in-transition, and 28% of developing countries. Cases of congenital rubella syndrome (CRS) may be prevented as follows: by providing direct protection to women and/or schoolgirls (a selective vaccination strategy); by vaccinating boys and girls to provide indirect protection by reducing the transmission of rubella virus (a childhood vaccination strategy); or by a combination of these approaches (a combined strategy). A combined strategy was most commonly reported (60% of countries); seven countries (9%) reported a selective strategy; and 24 countries (31%) reported only childhood immunization. Experience has shown that it is essential to include vaccination of women of childbearing age in any rubella control strategy. Childhood vaccination alone may pose a risk of an increase in CRS cases. Although many countries have introduced rubella vaccine, few report any data on the impact of vaccination. Countries using rubella vaccine need to establish surveillance for rubella and CRS and monitor coverage in each of the target groups.

Adolescent↗