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Free-standing emergency clinics: community development guidelines.

When a free-standing emergency clinic (FEC) unexpectedly opened in Montgomery County, Maryland, the local emergency medical services council thought the FEC's operational plan was in conflict with the community concept of emergency medical services (EMS). Because there were no agreed upon factual guidelines with which to judge the FEC, the council established a task force to study the problem and to develop standards and guidelines. This article is based on that report. We recommend that if a facility physically separate from a hospital uses the words "emergency" in offering medical services, it means at least 24 hours of operation with standards at least equal to those offered by the local EMS system.

Allied Health Personnel

Community development and preventive work.

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.

Community Mental Health Services

Diabetes in a developing community. Epidemiology and management problems.

An epidemiological study of 299 Black patients attending the Ga-Rankuwa Diabetic Clinic was undertaken in order to establish a management baseline and identify specific problem areas. The survey revealed several management problems, such as overweight patients, a low percentage of patients being controlled by diet only, and a high incidence of hypertension. One-third of the patients had not eaten on the morning of the visit, which made the value of urine glucose measurements questionable. In addition, no patient wore any form of 'Medicalert' identification. Considering these factors, a plan of action has been developed. Identification bracelets have been supplied and a system for doing urine glucose tests at home introduced. Greater attention is being given to the diet and the feasibility of Hb A1C measurements is under consideration.

Adolescent

Psychiatric disorders in a developing community as reflected by archival material.

We surveyed the clinical records kept at the outpatient psychiatric clinic at the Umtata Hospital, Transkei. The four commonest psychiatric disorders diagnosed at the clinic were schizophrenia, depression, epilepsy, and anxiety states. Other diagnoses included alcoholism, hysteria, confusional states and organic brain syndromes.

Adolescent

Evaluation of three oral rehydration solutions designed for use in developed communities.

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.

Acid-Base Equilibrium

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