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PubMed1996

[Questionnaire on psychosexual development of children--development of a guideline for diagnosis of sexual abuse].

The purpose of this paper is to present a questionnaire which can collate data on the psychosexual development of children. There are as yet few contributions from the field of empirical research dealing with the question of "normal" psychosexual development patterns. There is also a lack of standardised procedures by which this aspect of child development can be assessed. For this reason we have developed a questionnaire relating to the theme of child sexuality which can be used in the framework of history and which was examined as part of a clinical study supported by a grant from the Deutsche Forschungsgemeinschaft. The questionnaire contents questions put to parents relating to the sexual development of children, on how sexuality is talked about and dealt with in the family, and on precisely-defined and described experiences of the child and other members of the family. At the time we present a method of judging normative sexual development of the child and of disturbances such a sexual abuse. In order to deal with this question the collation of information from four different areas is required: physical development and symptoms, behaviour of the child, family context including psychosocial adversities and parent-child interaction. Case studies will illustrate how data from the four areas are related and can accordingly be assessed in order to be able to make judgments on the psychosexual development of children. We see this method as helpful in order to determine whether or not a child was sexual abused. Thus, consideration of each individual case in context is necessary if a balanced judgment is to be arrived at.

Adolescent↗
PubMed2000

Aerosolized diuretics for preterm infants with (or developing) chronic lung disease.

BACKGROUND: Lung disease in preterm infants is often complicated with lung edema. OBJECTIVES: The aim of this review is to assess the risks and benefits of aerosolized diuretic administration in preterm infants with or developing chronic lung disease (CLD). Primary objectives are to assess effects on short term outcome (changes in need for oxygen or ventilatory support) and effects on long-term outcome. Secondary objectives are to assess changes in pulmonary mechanics and potential complications of therapy. SEARCH STRATEGY: We used the standard search method of the Cochrane Neonatal Review Group. We used the following keywords: ¿ or ¿ and , limited to and limited to or . We searched Medline (1966-1998), Embase (1974-1998) and the Cochrane Controlled Trials Register (CCTR) from the Cochrane Library (1998, Issue 4). In addition, we hand searched several abstract books of national and international American and European Societies. SELECTION CRITERIA: We included in this analysis trials in which preterm infants with or developing chronic lung disease and at least five days of age were all randomly allocated to receive an aerosolized loop diuretic. Eligible studies needed to assess at least one of the outcome variables defined a priori for this systematic review. Primary outcome variables included important clinical outcomes, and secondary outcome variables included pulmonary mechanics and potential complications of therapy. DATA COLLECTION AND ANALYSIS: We used the standard method for the Cochrane Collaboration which is described in the Cochrane Collaboration Handbook. Two investigators extracted, assessed and coded separately all data for each study, using a form that was designed specifically for this review. Any disagreement was resolved by discussion. We combined parallel and cross-over trials and, whenever possible, transformed baseline and final outcome data measured on a continuous scale into change scores using Follmann's formula. MAIN RESULTS: We identified eight studies which met selection criteria. Most studies focused on pathophysiological parameters and did not assess effects on important clinical outcomes defined in this review or the potential complications of diuretic therapy. No study assessed the amount of diuretic effectively delivered to the patient. Furosemide was the only diuretic used in the eight studies included in this review. Among preterm infants < 3 weeks of age developing CLD, not enough information is available to assess the effect of aerosolized furosemide on outcome or lung function. Among infants > 3 weeks with CLD, a single aerosolized dose of 1 mg/kg of furosemide may transiently improve pulmonary mechanics. Not enough information is available to assess the effect of chronic administration of aerosolized furosemide on oxygenation and pulmonary mechanics. REVIEWER'S CONCLUSIONS: In preterm infants > 3 weeks with CLD administration of a single dose of aerosolized furosemide improves pulmonary mechanics. In view of the lack of data from randomized trials concerning effects on important clinical outcomes, routine or sustained use of aerosolized loop diuretics in infants with (or developing) CLD cannot be recommended based on current evidence. More double-blinded randomized trials are needed (1) to analyze factors likely to affect the response to aerosolized furosemide, e.g. , washout period and delivery of furosemide to distal airways, and (2) to assess the effects of chronic administration of aerosolized furosemide on mortality, O2 dependency, ventilator dependency, length of hospital stay and long-term outcome.

Aerosols↗
PubMed1978

Golgi studies on Purkinje cell development in the frog during spontaneous metamorphosis. I. General pattern of development.

The development of Purkinje cells was studied in the bullfrog from prometamorphic tadpoles to 10-week-old postmetamorphic froglets by the Golgi-Kopsch method. In this species, the rate of Purkinje cell development is unusually slow and proceeds in two waves. The first wave of development begins prior to the establishment of the external granular layer (EGL), and proceeds slowly for two to three months during the formation of the EGL; then accelerating as metamorphosis is being completed, the cells reach near-adult dimensions a month later. Even prior to the formation of the EGL these cells are already present in the stage of dendritic orientation and flattening which, however, varies from the norm. The second wave of Purkinje cell development begins during metamorphosis and proceeds at a more rapid pace until two months after metamorphosis, at which time they appear to have reached adult dimensions. In these cells the development of the apical dendrite does not always coincide with the stellate stage but may proceed directly to the stage of dendritic orientation and flattening which, in accordance with the norm, is towards the pia and in the sagittal plane. Many variations are present in the dendritic trees and orientation of the dendritic branches of Purkinje cells throughout their development. These variations are similar to those seen in mammals, however, since the frog cerebellum consists of a simple plate, they cannot be attributed to a Cartesian transformation of dendrites to accomodate the curvatures of a folial pattern. Similarly, since these morphological variations occur in the course of normal development they cannot be attributed to a reaction to, or recovery from, injury during development.

Animals↗
PubMed1986

Delayed development of song control nuclei in the zebra finch is related to behavioral development.

The postnatal development of two visual areas (nucleus rotundus and ectostriatum) and two song control areas (hyperstriatum ventrale pars caudale, HVc, and nucleus robustus archistriatalis, RA) of the zebra finch brain was followed from birth to adulthood. The following parameters were investigated: (1) neuron size, (2) volume of the brain nuclei, and (3) myelination of axons. The nucleus rotundus, the diencephalic station of the tectofugal pathway, exhibits the fastest development: rotundal neurons reach their maximum size at 20 days of age; the volume of this structure reaches adult size at the same time. The process of myelination begins between day 5 and day 10 and is completed at 40 days of age. A similar temporal sequence of development is seen in the ectostriatum, except myelination starts some days later. Thus the development of these visual areas is completed at 40 days. In contrast, the development of the song control nuclei is delayed. Neurons in RA and HVc grow steadily up to 40 days of age, attaining a size larger than that observed in adults. Whereas the volume of HVc increases until day 40 and remains stable thereafter, RA volume increases until day 70 and evidences a decrease thereafter. It is not until postnatal day 20 (RA) and day 40 (HVc) that the myelination process starts in the song control areas. Adult myelin density is achieved by 70 days in RA and by 100 days in HVc. It can be demonstrated that the development of the visual system parallels the development of visual performance of the birds. Delayed growth of song control nuclei coincides with development of song.

Aging↗
PubMed1991

Development of the olfactory nerve in the African clawed frog, Xenopus laevis: I. Normal development.

Quantitative and morphological data were obtained on developing olfactory axons in the African clawed frog, Xenopus laevis, during late premetamorphosis (stages 48-54), prometamorphosis (stages 55-57), and halfway through metamorphic climax (stages 58-62). Larval axons throughout these stages of development did not change with respect to morphology or diameter and were similar in all respects to olfactory axons described in other vertebrate species. The number of axons in the olfactory nerve increased throughout development, more rapidly after stage 54. Based on comparisons of the number of axons in proximal and distal regions of the nerve, there also appeared to be more axons growing into the olfactory nerve at early metamorphic climax than during premetamorphosis. Through the onset of metamorphic climax, the number of olfactory axons was correlated with other measures of body growth. In the later stages of climax, however, the number of olfactory axons continued to rise, whereas body weight, length, and width, as well as olfactory nerve length, decreased. Not all animals developed at the same rate, but for all quantitative measurements in this study, stage was a better predictor of any given parameter than age of the animal. Rearing conditions affected the rate of development but did not have a significant effect on most of the features analyzed quantitatively. Although most of the new olfactory axons in these larval animals probably represent addition of fibers resulting from development, the ensheathing glial cells at all stages showed evidence of phagocytic activity, suggesting that there might be turnover of olfactory receptor cells during larval development. The results presented here provide a baseline for future reports on various factors that may influence normal development in this system.

Animals↗
PubMed1978

[Light microscopic studies on the development of Theileria annulata (Dschunkowsky and Luhs, 1904) in Hyalomma anatolicum excavatum (Koch, 1844). II. The development in haemolymph and salivary glands (author's transl)].

Fully differentiated kinetes, average length 17.6 micrometer, appeared in the haemolymph of engorged nymphs usually 17 to 20 days after repletion. Kinetes were observed at first in the salivary glands on day 18 after repletion. The kinetes then transformed into fission bodies of about 10 micrometer in diameter, mainly in type III alveoli and less frequently in type II alveoli. The fission bodies grew up to a size of about 20 micrometer after several divisions of their nucleus. At this time the ticks moulted and no further development occurred until activation. Shortly before infestation the salivary glands began to proliferate, and rapid growth of the fission bodies was observed, especially in young ticks where development of 'infective particles' ('sporozoites') was concluded within two days. Development in feeding adult ticks apparently occurred in four major steps: (1) Division of primary fission bodies (sporonts) into numerous secondary fission bodies ('primary sporoblasts'), (2) division of secondary fission bodies into tertiary fission bodies ('secondary sporoblasts'), (3) production of particles ('sporozoites') by tertiary fission bodies and release of particles into the saliva, and (4) degeneration of fission bodies and their host cell but further release of particles. The host cell was stimulated to giant growth, thus its diameter increased, on average, from 15 to 110 micrometer. Heavy infections resulting from parasitaemias of greater than 40% caused disease and mortality in the tick population. Development was much retarded by aging. In ticks starved for six months 'sporozoites' did not develop before day five to seven of infestation. 'Sporozoites' did not develop before day five to seven of infestation. 'Sporozoites' may not develop at all in six to nine month old female ticks during the infestation period. The significance of the described developmental stages of T. annulata was discussed and a sexual generation postualted. The hypothetic development of T. annulata in its tick vector was illustrated.

Animals↗
PubMed2004

The endocrine disruptors nonylphenol and octylphenol exert direct effects on T cells to suppress Th1 development and enhance Th2 development.

Some endocrine disrupting chemicals (EDCs) have been evidenced to affect cytokine production and lymphocyte proliferation. However, it is unknown whether EDCs disturb Th1/Th2 development. We chose alkylphenols that have been widely used as plastic additives and surfactants, and some of them are recognized as xenoestrogens. We examined whether they exert direct effects on T cells to suppress or enhance Th1/Th2 development. We used two experimental systems with isolated T cells in vitro. In one system, isolated CD4+CD8+ thymocytes differentiated into Th1 and Th2 by two transient stimulations and cytokine treatment. In the second system, purified naïve CD4+ T cells from DO11.10 T cell receptor-transgenic and RAG-2-deficient mice differentiate into Th1 and Th2 by the treatment with cytokines and antibodies to CD3 and CD28. In both systems, 1-10 microM of p-n-nonylphenol suppressed Th1 development and enhanced Th2 development, whereas estrogen by itself failed to affect Th1/Th2 development. p-n-Octylphenol elicited similar effects, but 4-nonylphenol and p-t-octylphenol elicited much weaker effects. p-n-Dodecylphenol or p-n-octylbenzene failed to affect Th1/Th2 development. Thus, the length and branching of the alkyl side chain appeared to affect the activity. Although some alkylphenols have been suggested to have a weak affinity to retinoic acid receptors (RAR) or progesterone receptor (PRGR), antagonists of RAR, PRGR, glucocorticoid receptor (GCR), or retinoid X receptors (RXR) failed to inhibit the activity. These results suggest that p-n-nonylphenol and p-n-octylphenol directly suppress Th1 development and enhance Th2 development through mechanisms independent of estrogen receptors, RAR, RXR, PRGR, and GCR.

Animals↗
PubMedDate not supplied

Disasters and development: Part I. Relationships between disasters and development.

This module introduces a paradigm for understanding the disaster/development interface. Specifically, the module asserts that disasters and development are linked closely in that disasters can both destroy development initiatives and create development opportunities, and that development schemes can both increase and decrease vulnerability. The module consists of four parts: Part One introduces these concepts and discusses how disasters can vary from one type of hazard to another, as well as from one type of economic condition to another. Part Two develops the paradigm in depth, and provides case examples to amplify the points made in the text. Part Three describes and discusses different methods and tools for analyzing decisions for potential investment of resources, and should enhance the reader's capacity to analyze the mitigational benefits of development alternatives in both the pre- and post-disaster context. Part Four conceptualizes the role of UN agencies, NGOs, and the affected communities in promoting development based on the concepts discussed in the module. This training module, Disasters and Development, initially was designed to introduce this aspect of disaster management to an audience of UN organization professionals who form disaster management teams, as well as to government counterpart agencies, non-governmental organizations (NGOs), and donors. The educational process has been designed to increase the audience's awareness of the nature and management of disasters, in order to lead to better performance in disaster preparedness and response. The content has been written by experts in the field of disaster management and in general follows the UNDP/UNDRO Disaster Management Manual and its principles, procedures, and terminology.

Costs and Cost Analysis↗
PubMedDate not supplied

Disasters and development: Part 2: understanding and exploiting disaster-development linkages.

Disasters can impede the effectiveness of development resource allocation. The damage sustained from an event can be classified into four categories: (1) Loss of resources; (2) Interruption of programs and switching of crucial resources to other, shorter-term needs; (3) Negative impacts upon investment climates; and/or (4) Disruption of the non-formal sector (local businesses). Disasters have a particularly destructive economic impact in areas in which there are few alternatives for assets that are destroyed or in areas in which the resources already are at critical levels. Development processes can both increase and/or decrease the vulnerability of a society to hazards. There are dearly established linkages between poverty, marginalization, over-population, and vulnerability. To a large extent, vulnerability derives from poverty. The poor are more likely to live in vulnerable areas (slopes prone to landslides, flood plains, marginal agricultural land), have difficulty accessing education and information, have fewer assets to invest in resources to reduce vulnerability, and are more prone to become malnourished and have chronic illnesses that predispose them to injury and death. Development may be associated with the production of new hazards accepted by a society because the perceived benefits of the development project far exceed the relative risk associated with the project. Therefore, risk assessments must be part of any program planning and evaluation. Training and education are of critical importance in preventing increased vulnerability as a result of development strategies. Development also can progress in a manner that will result in mitigation of the impacts of an event on a given society (increase absorbing capacity and/or buffering capacity, elimination of hazards or the risk of them producing a disaster). Such mitigation measures can be either structural or nonstructural. There exists a wide range of options for incorporating mitigation measures in development projects. Two case studies provide exercises that incorporate the concepts provided in this discussion: (1) The 1985 earthquake in Mexico City; and (2) Agricultural development in northern Sudan.

Agriculture↗
PubMedDate not supplied

Major regulatory factors in the evolution of development: the roles of goosecoid and Msx in the evolution of the direct-developing sea urchin Heliocidaris erythrogramma.

The transcription factors Gsc and Msx are expressed in the oral ectoderm of the indirect-developing sea urchin Heliocidaris tuberculata. Their patterns of expression are highly modified in the direct developer Heliocidaris erythrogramma, which lacks an oral ectoderm. We here test the hypothesis that they are large effect genes responsible for the loss of the oral ectoderm module in the direct-developing larva of H. erythrogramma as well as for the restoration of an overt oral ectoderm in H.e. xH.t. hybrids. We undertook misexpression/overexpression and knockdown assays in the two species and in hybrids by mRNA injection. The results indicate that dramatic changes of function of these transcription factors has occurred. One of these genes, Gsc, has the ability when misexpressed to partially restore oral ectoderm in H. erythrogramma. On the other hand, Msx has lost any oral function and instead has a role in mesoderm proliferation and patterning. In addition, we found that the H. tuberculataGsc is up regulated in H.e. xH.t. hybrids, showing a preferential use of the indirect developing parental gene in the development of the hybrid. We suggest that Gsc qualifies as a gene of large evolutionary effect and is partially responsible for the evolution of direct development of H. erythrogramma. We discuss these results in light of modularity and genetic networks in development, as well as in their implications for the rapid evolution of large morphological changes in development.

Animals↗
PubMed2003

Origin and possible roles of the SOX8 transcription factor gene during sexual development.

SOX8 is a member of the SOX family of developmental transcription factor genes and is closely related to SOX9, a critical gene involved in mammalian sex determination and differentiation. Both genes encode proteins with the ability to bind similar DNA target sequences, and to activate transcription in in vitro assays. Expression studies indicate that the two genes have largely overlapping patterns of activity during mammalian embryonic development. A knockout of SOX8 in mice has no obvious developmental phenotype, suggesting that the two genes are able to act redundantly in a variety of developmental contexts. In particular, both genes are expressed in the developing Sertoli cell lineage of the developing testes in mice, and both proteins are able to activate transcription of the gene encoding anti-Müllerian hormone (AMH), through synergistic action with steroidogenic factor 1 (SF1). We have hypothesized that SOX8 may substitute for SOX9 in species where SOX9 is expressed too late to be involved in sex determination or regulation of AMH expression. However, our studies involving the red-eared slider turtle indicate that SOX8 is expressed at similar levels in males and females throughout the sex-determining period, suggesting that SOX8 is neither a transcriptional regulator for AMH, nor responsible for sex determination or gonad differentiation in that species. Similarly, SOX8 is not expressed in a sexually dimorphic pattern during gonadogenesis in the chicken. Since a functional role(s) for SOX8 is implied by its conservation during evolution, the significance of SOX8 for sexual and other aspects of development will need to be uncovered through more directed lines of experimentation. Copyright 2003 S. Karger AG, Basel

Journal Article↗
PubMed1990

Influence of different developing solutions and developing times on radiographic caries diagnosis.

One hundred extracted premolars were radiographed under standardized conditions with D- and E-speed films. The films were developed with conventional and rapid processors using varying developing times. The influence of different developers and developing times on the diagnostic accuracy of radiographic caries diagnosis was evaluated with the aid of ROC technique. Rapid processing using the developing time recommended by the manufacturer led to a lower density and contrast compared with the conventional developer. Underdeveloped films using the rapid processors resulted in an unacceptable low level of diagnostic accuracy, but otherwise it was the same for all developers, developing times and both types of film.

Bicuspid↗
PubMed1991

Patients who develop postanesthesia shaking show no difference in postoperative temperature from those who do not develop shaking.

While the cause of postanesthesia shaking (PS) remains unknown, nurses traditionally believe that the etiology of PS is hypothermia. Two theoretical constructs have been proposed to describe the development of PS. The first is based on classic thermoregulation theory. The second is based on spinal reflex hyperactivity. The purpose of this comparison study was to determine if significant differences in postoperative temperature, as well as change in preoperative to postoperative temperature, exists between patients who develop and who do not develop PS. The study also examined the difference in postoperative temperature between women and men. Postoperative axillary temperature was measured on admission to the PACU. The nonprobability convenience sample consisted of patients between the ages of 18 and 89 years who were extubated and breathing spontaneously following general anesthesia. PS developed in 120 of 533 patients. By t-test analysis, there was no statistical significant difference between groups in postoperative mean temperature (P greater than .10) or in preoperative to postoperative mean temperature change (P greater than .40). The group that developed PS had a narrower and higher range of postoperative temperature and a smaller preoperative to postoperative temperature change than those who did not develop PS. In both groups, 52% of the patients were hypothermic (less than 35 degrees C[less than 95 degrees F]) on PACU admission. Women had lower postoperative mean temperature than men (P less than .05). Findings indicate that temperature on PACU admission is not a variable of difference between groups of patients who develop or who do not develop PS. As postoperative temperature decreases, the incidence of PS does not increase.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Vision development in the monocular individual: implications for the mechanisms of normal binocular vision development and the treatment of infantile esotropia.

PURPOSE: The purpose of this research is to study the vision development in monocular individuals so as to better understand normal binocular vision development and to refine the treatment of infants with infantile esotropia. METHODS: Thirty-six subjects with one clinically normal eye and one eye with no vision (no light perception or history of enucleation) are studied. In addition to measurement of standard parameters of development such as visual acuity, measurement of motion processing is made by both optokinetic and electrophysiologic techniques. A comparison is made of vision development among three populations: the monocular population, the normal population, and patients with a history of infantile esotropia. Such comparison is made to study the relative effects of interruption of binocularity and binocular competition. The monocular population represents individuals who have interruption of binocularity, whereas the infantile esotropia population has both interruption of binocularity and binocular competition. RESULTS: The OKN data suggest that the monucular population is more similar to the normal population than the esotropia population. The electrophysiologic data shows a statistically significant difference in the three populations. Motion processing is more fully developed in the monocular population than in the infantile esotropia population when compared to the normal population. CONCLUSIONS: 1. The development of motion processing appears to be particularly vulnerable to abnormal experience during the first year of life. 2. Monocular subjects have a less abnormal motion processing system when compared to patients with infantile esotropia even when monocularity is congenital. 3. The results indirectly support the premise that prealignment alternate occlusion is of benefit to the patient with infantile esotropia prior to realignment. 4. Development of the motion processing system does not necessarily parallel the development of other binocular functions.

Adolescent↗
PubMed2004

Cancer of the oral cavity: a comparison between institutions in a developing and a developed nation.

BACKGROUND: The literature suggests that the natural history of squamous cell carcinoma of the oral cavity may vary and the prognosis is different in patients from developing and developed nations. The objective of this study was to compare the clinical presentation, management, and outcome of patients with oral cancer treated at tertiary care cancer institutions in a developing nation (Brazil- Centro de Tratamento e Pesquisa Hospital do Cancer A. C. Camargo [HCACC]) with those from a developed nation (United States- Memorial Sloan-Kettering Cancer Center [MSKCC]). METHODS: Between January 1990 and December 1994, 602 patients underwent initial treatment in the study institutions. RESULTS: Overall, patients from HCACC had a higher predominance of men (78.8% vs 54.6%; p <.001) and a higher prevalence of tobacco (88.1% vs 77.8%; p =.002) and alcohol consumption (80.9% vs 69.8%; p =.004). More patients at HCACC had advanced disease (stage III/IV; 73.4% vs 37.4%; p<.001). Even though the overall outcome was poorer in patients from HCACC (p <.001), after controlling for stage, there was not a statistically significant difference in disease-free or overall survival between the two institutions. Only at cancer-specific survival for early-stage disease (stage I/II) patients showed a difference (p =.05). Moreover, clinical stage (RR, 3.7; 95% CI, 2.6-5.5) and definitive treatment (RR, 3.3; 95% CI, 2.4-4.6) were the only factors that remained as significant predictors of outcome on multivariate analysis. Finally, the rate of subsequent second primary cancers was higher in patients from HCACC (p =.03). CONCLUSIONS: Statistically significant differences were found in clinical presentation, tumor characteristics, and outcome in OC patients between the two institutions from a developing and developed nation. Overall outcome was poorer in HACC patients. However, after controlling for site, stage, and treatment, the outcome of these patients was similar, with the exception of a higher rate of occurrence of second primary cancers in patients from HACC. Given that the use of standard protocols of treatment offer similar outcomes, the establishment of education programs and screening measures for early diagnosis might be the best chance to improve overall outcome in OC patients in developing nations.

Alcohol Drinking↗
PubMed2000

Mental health economic studies from developing countries reviewed in the context of those from developed countries.

OBJECTIVE: Mental health economic studies from developing countries were reviewed in the context of such studies from developed countries. METHOD: Mental health economic studies were ascertained through a systematic Medline search, chasing references at the end of papers acquired from the initial medline search and details of studies furnished by members of the WHO collaborating centre. RESULTS: Only a small number of mental health economic studies from developing countries were identified. They were mainly cost-of-illness and cost-effectiveness studies. CONCLUSION: Psychiatric disorders impose a significant burden in developing countries. It is not always possible to extrapolate findings from developed countries to developing countries. Potential avenues for future research and development are discussed.

Clinical Trials as Topic↗
PubMed2005

Pharmaceutical innovation and the burden of disease in developing and developed countries.

I perform two analyses of the relationship across diseases between pharmaceutical innovation and the burden of disease in developed and developing countries. Both analyses indicate that the amount of pharmaceutical innovation is positively related to the burden of disease in developed countries but not to the burden of disease in developing countries. The most plausible explanation for the lack of a relationship between the burden of disease in developing countries and the amount of pharmaceutical innovation is that incentives for firms to develop medicines for diseases primarily afflicting people in developing countries have been weak or nonexistent.

Developed Countries↗
PubMed2000

Mutual benefits from epilepsy surgery in developed and developing countries.

The last three decades have seen tremendous progress in the surgical management of patients with intractable epilepsy involving all facets of diagnosis, localization, operative technique, and research. Unfortunately, such progress has taken place and is in operation only in the developed countries of North America, Europe, and Japan. Epilepsy surgery programs in the developing countries of South America, Asia, and particularly Africa, if they exist at all, are the result of the individual efforts of physicians who were fortunate enough to receive their training abroad. These physicians face difficulties in financing their programs and in obtaining the necessary equipment, and they work without the assistance of trained personnel or technicians. The exchange of experience between physicians in developed and developing countries may be mutually beneficial. In the face of the high cost of health care in developed countries, it is unrealistic to expect patients with intractable epilepsy to continue to undergo elaborate investigative procedures indefinitely. On the other hand, physicians in developing countries need to keep updated on the latest technology and research and have to receive the necessary support from developed countries to slowly build up their programs. The global perspective of physicians dealing with epilepsy patients may be broadened by exposure to the experience from the "other side of the fence" and will ultimately lead to better patient education and more focused patient care.

Delivery of Health Care↗