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PubMed1996

WHO Expert Committee on specifications for pharmaceutical preparations.

This report presents the recommendations of an international group of experts convened by the World Health Organization to consider matters concerning the quality assurance of pharmaceuticals and specifications for drug substances and dosage forms. Of particular relevance to drug regulatory authorities, the report discusses activities related to the further development of The international pharmacopoeia, as well as simple test methodology, the stability of dosage forms, good manufacturing practices, legal and administrative aspects of the functioning of national drug regulatory authorities, and quality assurance in the supply system. The report is complemented by numerous annexes, including guidelines for the graphic representation of chemical formulae, lists of available International Chemical Reference Substances and International Infrared Reference Spectra, general recommendations for the preparation and use of infrared spectra in pharmaceutical analysis, and guidelines on stability testing of pharmaceutical products. In the context of good manufacturing practices, guidance is provided on the validation of manufacturing processes and for the manufacture both of investigational products for clinical trials and of herbal medicinal products. The final annexes contain guidelines adopted or endorsed by the Committee on registration requirements to establish the interchangeability of multisource pharmaceutical products, implementation of the WHO Certification Scheme on the Quality of Pharmaceutical Products Moving in International Commerce, the assessment of herbal medicines, and import procedures for pharmaceutical products.

Amino Acid Sequence↗
PubMedDate not supplied

Control of imported communicable diseases: preparation and response.

Control of imported communicable diseases hitherto has been based on a paradigm of exclusion, isolationism and quarantine. Yet such policy is inconsistent with globalization of communication, commerce and travel, thus ignoring the potential for rapid dissemination of infectious disease worldwide. Prevention and containment strategies founded on such a premise ultimately cannot be effective. Instead, the perspective in control of communicable diseases must become international with monitoring and study of disease emergence, vector and reservoir patterns, and factors which facilitate and impede pathogen traffic. Our public health system must be reorganized with an international focus to ensure adequacy of surveillance mechanisms, related applied research, prevention and control strategies (including vaccination and information dissemination and education), and maintenance of optimal infrastructure--nationally, locally and internationally. Clear national and provincial contingency plans must be developed, ideally with international cooperation, for dealing with emerging infectious disease threats.

Canada↗
PubMed1997

A contribution to the history of common salt.

Salt has influenced human nutrition, health, politics, taxation, economy, freight, transport, and commerce throughout the ages. All human activities have been influenced by salt including economy, religious beliefs and practices, art, literature, psychoanalysis, superstitions, and exorcism. Salt is recognized as a symbol for friendship, hospitality, chastity, alliance, table fellowship, fidelity, fertility, blessing, curse and endurance, etc. The Bible is the first book of salt and contains no fewer than 24 references to this substance. In the Gospels the parable of salt is a central one. Many many church fathers have written on salt a substance, which up to 1969 was a relevant element in the rite of Baptism. This paper reviews the importance of common salt for human life, and by drawing from various scientific and literary sources makes a special discussion of its various symbolisms.

Europe↗
PubMed1997

Epidemiological factors influencing the emergence of antimicrobial resistance.

Antimicrobial resistance is becoming an important public health problem for both hospital- and community-acquired infections. In the hospital, infections caused by drug-resistant Staphylococcus aureus, Mycobacterium tuberculosis, enterococci, and a variety of Gram-negative rods are resulting in increased morbidity, mortality and costs, in part because of prolonged hospitalization and the use of more expensive antimicrobial agents. Drug-resistant, community-acquired infections are also causing important problems in both the developed and the developing world. Although the relative importance of specific pathogens varies with the geographical area, community-acquired pathogens including Salmonella, Shigella, Neisseria gonorrhoeae, Haemophilus influenzae and Streptococcus pneumoniae are causing both sporadic cases and outbreaks of drug-resistant illness. The emergence of antimicrobial resistance is being attributed to a series of societal, technological, environmental and microbial changes. These include increasing populations of susceptible hosts, international travel and commerce, changes in technology and industry, microbial adaptation and change, and the breakdown of public health measures. Addressing emerging problems and antimicrobial resistance will require enhanced surveillance, prudent use of existing antimicrobial drugs, development of new antimicrobial agents, increased emphasis on infection control and hygienic practices, effective disease control programs, better use of existing vaccines, and development of more and better vaccines.

Anti-Bacterial Agents↗
PubMed1997

Infectious diseases in the 21st century.

Infecto-contagious diseases in the twenty-first century with respect to precedent will see themselves deprived of smallpox, dracunculiasis and very probably of paralyzing poliomyelitis. Vaccination-preventable diseases, such as measles, whooping cough, diphtheria, tetanus, rabies, some forms of meningitis, yellow fever and episodes of disseminated tuberculosis will greatly diminish in their rates of morbi-lethality; the elimination of some, and the eradication of measles, are expected. Other diseases such as diarrhea (including cholera), geo-helminthiasis, some severe respiratory tract infections and the majority of vector-transmitted infectious diseases will decrease due to improvements in potable water services, drainage, sanitary food control, living quarters, and individual and community anti-vector action. Leprosy, onchocerciasis and several parasitoses will be controlled by the available antimicrobial drugs. Infectious diseases will continue to be an important health problem due to: Reduction in the immunocompetence resulting from the aging of the population, chemotherapies necessary for neoplasms, and autoimmune pathology and the survival of persons with primary immunodeficiencies; lifestyles prone to infectious pathology, such as mega-city urbanization, children in day care centers, industrialized foods, intravenous drug addiction, sexual liberation, global commerce, and tourism; antibiotic-multiresistant microbial flora; environmental disturbances as a result of global warming, deforestation, the settling of virgin areas, dams, the large-scale use of pesticides, fertilizers and antimicrobials, and natural/social disasters generators of poverty, violence and deprivation will result in emergence or re-emergence of infectious diseases already controlled in the past.

Communicable Disease Control↗
PubMedDate not supplied

[Shigellosis in Moscow: new trends in the epidemiological process and their social determinants].

In Moscow for a long time morbidity in acute enteric infections, and in Shigella infections as their main constituent, steadily decreased. In recent years the opposite tendency was noted: a rise in morbidity. A pronounced tendency for Shigella infections, especially Flexner's dysentery, to affect older ages was observed. New risk groups, including adults busy in "shuttle" commerce and different asocial elements, appeared. The number of lethal cases considerably increased. Unusual manifestations of the epidemic process are socially determined and reflect a decrease in the living standards of the population, sharp social changes in its way of life and social instability in the country. Sporadic morbidity with low focality prevails. The so-called chronic multifactor alimentary route of infection transmission is mainly realized; its neutralization presents great objective difficulties.

Acute Disease↗
PubMedDate not supplied

Computers in home care. Application of change theory.

Home health care is the fastest growing sector in providing health care in the United States (US Commerce Department, 1993). Among the reasons for this exceptional growth rate are several factors, including an aging population, patient preference for care provided in their own homes, earlier discharge from acute care settings, and reimbursement sources demanding that health care providers reduce costs while expanding patient services in a wider variety settings. As a result, home health care agencies are under increasing pressure to provide efficient, high-quality, cost-effective nursing services to growing numbers of patients. In an effort to maximize productivity and efficiency while reducing costs in home health care, one strategy has been to computerize the nursing records. However, there has been little or no research in the literature on the nursing applications of computer technology in home care settings. Based on Lippitt's Theory of Planned Change as the theoretical model, this case study examines the author's experience as a consultant to the Nursing Department of a home health care agency in automating their nursing records. Included in the discussion are an analysis of the costs and benefits derived by the agency in phases of planned change, evaluation of the process, and recommendations for the future.

Community Health Nursing↗
PubMed1997

Investing in a master's degree.

One of the most important decisions you will ever make is the decision to invest your time and money in a master's degree. It is a big investment and often requires real sacrifice for you and your family. Since this decision is of paramount importance over the life of your career, it should be approached as a major topic to research. The first step in the process is a thorough review of your own goals and career expectations. Once you decide returning to graduate school is right for you, then you must turn your attention to finding the school that meets your goals for specialized study, as well as the location that best suits your lifestyle. A good place to start the search is in the library among a number of up-to-date references on master's nursing programs. A second source is the Internet. To find out more about the school locations, two good sources are the city's chamber of commerce and the Internet. Acquiring a master's degree in nursing will be a challenge, but one that will pay big dividends in your future nursing career.

Career Mobility↗
PubMed1997

Women: work and health.

OBJECTIVES: This report describes the sociodemographics, household characteristics, and health of women according to workforce status and job conditions. The report also presents data on men for comparison. METHODS: This report combines data from numerous data systems, including: The National Health Interview Survey, National Health and Nutrition Examination Survey, National Maternal and Infant Health Survey, National Hospital Ambulatory Medical Care Survey, National Traumatic Occupational Fatalities Surveillance System, and the National Occupational Mortality Surveillance System, which are conducted by the U.S. Department of Health and Human Services; the Census of Fatal Occupational Injuries and Annual Survey of Occupational injuries and illnesses conducted by the U.S. Department of Labor; and the Current Population Survey conducted by the U.S. Department of Commerce. The report also presents selected tables from publications of the Women's Bureau and the Bureau of Labor Statistics, U.S. Department of Labor. RESULTS: The report presents summary data on physical conditions and exposures, health conditions attributed to work, other health conditions that impact on work, health promotion in the workplace, and health-related benefits provided by employers. Most estimates are shown according to sex, age, race, ethnicity, educational attainment, and major occupational group.

Absenteeism↗
PubMed1998

Trends in health care practitioner credentialing.

Once a risk management process limited to hospitals, the practice of practitioner credentialing has expanded to include many other health care organizations, including insurers, health maintenance organizations, preferred provider organizations, management services organizations, medical groups, and independent practice associations. Standards set by recognized accreditation bodies, including the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission), National Committee for Quality Assurance (NCQA), and American Accreditation Health Care Commission/Utilization Review Accreditation Committee mandate a substantial effort to properly evaluate the credentials of health care practitioners. A sector of commerce called the credentials verification organization (CVO) industry has undertaken the mission to make the process of practitioner credentialing more consistent and efficient, faster, and less expensive.

Cost-Benefit Analysis↗
PubMed1998

[AIDS in Madagascar. I. Epidemiology, projections, socioeconomic impact, interventions].

Madagascar is still among the rare states of low prevalence of HIV. The seroprevalence rate is nevertheless rising. The aim of this study is to show the current view of the epidemic, its future tendency, its economical and social impact on people and what measures to be taken at the national scale. In Madagascar, we can state by 1995 20 cases of notified AIDS and probably 130 cases of non-notified AIDS. Seroprevalence data are collected every year by the National Reference Laboratory STD/AIDS. But, they are insufficient to estimate the number of infected people. So, they had been completed by a serosurveillance study of AIDS and syphilis in middle of 1995 and at the beginning of 1996. Pregnant women, persons with STDs and prostitutes are been screened in the six biggest cities of the Island. Results show, not only a high prevalence of syphilis, but also indicate that now, we have about 5,000 seropositive people in the country. Besides, by the number of people with STDs, it is estimated that one million Malgasy adults risk to be infected. Based on estimates of the epidemic, be it the cases of a high scenario, (Kenya) or of a low one (Thailand) by the year 2015, the seroprevalence rate could represent 3% or 15% of adults. Demographic consequences of the epidemic will be serious, particularly if HIV spreads quickly. Nevertheless, it does not stop the increase of population. Therefore, there will be more infected people with the disease, especially young people between 15 and 49 years old. The increase of dead people will be serious. Social consequences of the epidemic (case of high scenario) will be gravely felt, in particular by the rise of the number of AIDS orphans. Tuberculosis outbreak can be observed too. This disease is already a serious problem in Madagascar. At last, the epidemic will bring with it a high increase of money spent on health and will have grave consequences on agriculture, industry and commerce. Nevertheless, Madagascar still benefit a big luck which is the prevention of the epidemic not to be exploded in a near future. For this, struggle against it is particularly effective on its start. In addition to counselling given to infected people and care-given to patients, means of prevention of AIDS contamination in all target groups must be set up quickly. It is about broadcasting information on AIDS, community education, controlling other STDs e.g. (importance of medicaments' program), promoting the use of condoms and screening HIV new cases. Only an urgent coordination of everyone's efforts can control the epidemic of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Identification and production of local carotene-rich foods to combat vitamin A malnutrition.

OBJECTIVES: To address, with respect to improvement of human vitamin A status by dietary approaches, the three theoretical postulates that: 1) the most practical and economical manner to increase the amount of dietary vitamin A available to low-income persons in low-income nations is through plant sources of provitamin A carotenoids; 2) there will be constraints and limitation to the efficiency of a given intervention approach related to behavioural, cultural, biological and botanical considerations; and 3) the nature of these constraints and limitations must be understood, and then overcome where possible, to maximize the impact of such interventions on the vitamin A status of developing country populations. CONCLUSIONS: We review how local plant sources of provitamin A that would be acceptable for the at-risk populations and outline six settings and scenarios for the processing of carotene-rich foods: 1) cooking for hygiene; 2) long-term preservation; 3) compacting to reduce volume; 4) formulation for specific consumers; 5) improving bioavailability and bioconversion; and 6) to increase 'value added' in commerce. We describe our experiences in Guatemala (with sweet potato flakes), and those of others in the Caribbean, the African Sahel, and East Africa (with solar-drying for preservation of a variety of plants), and in Sri Lanka (with leaf concentrates) in promoting increased carotene-rich food intake, and the lessons learned from their evaluations. This overall approach to combatting endemic hypovitaminosis A in developing countries is evaluated within the constraints of: 1) the volumes of plant-based foods required to satisfy vitamin A requirements; and 2) the controversy over the true bioconversion efficiency of provitamin A from plant sources into the biologically-available active vitamin.

Carotenoids↗
PubMed1998

Ecology, economics and political will: the vicissitudes of malaria strategies in Asia.

The documented history of malaria in parts of Asia goes back more than 2,000 years, during which the disease has been a major player on the socioeconomic stage in many nation states as they waxed and waned in power and prosperity. On a much shorter time scale, the last half century has seen in microcosm a history of large fluctuations in endemicity and impact of malaria across the spectrum of rice fields and rain forests, mountains and plains that reflect the vast ecological diversity inhabited by this majority aggregation of mankind. That period has seen some of the most dramatic changes in social and economic structure, in population size, density and mobility, and in political structure in history: all have played a part in the changing face of malaria in this extensive region of the world. While the majority of global malaria cases currently reside in Africa, greater numbers inhabited Asia earlier this century before malaria programs savored significant success, and now Asia harbors a global threat in the form of the epicenter of multidrug resistant Plasmodium falciparum which is gradually encompassing the tropical world. The latter reflects directly the vicissitudes of economic change over recent decades, particularly the mobility of populations in search of commerce, trade and personal fortunes, or caught in the misfortunes of physical conflicts. The period from the 1950s to the 1990s has witnessed near "eradication" followed by resurgence of malaria in Sri Lanka, control and resurgence in India, the influence of war and postwar instability on drug resistance in Cambodia, increase in severe and cerebral malaria in Myanmar during prolonged political turmoil, the essential disappearance of the disease from all but forested border areas of Thailand where it remains for the moment intractable, the basic elimination of vivax malaria from many provinces of central China. Both positive and negative experiences have lessons to teach in the debate between eradication and control as alternative strategies. China has for years held high the goal of "basic elimination", eradication by another name, in sensible semi-defiance of WHO dictates. The Chinese experience makes it clear that, given community organization, exhaustive attention to case detection, management and focus elimination, plus the political will at all levels of society, it is possible both to eliminate malaria from large areas of an expansive nation and to implement surveillance necessary to maintain something approaching eradication status in those areas. But China has not succeeded in the international border regions of the tropical south where unfettered population movement confounds the program. Thailand, Malaysia and to an extent Vietnam have also reached essential elimination in their rice field plains by vigorous vertical programs but fall short at their forested borders. Economics is central to the history of the rise and fall of nations, and to the history of disease in the people who constitute nations. The current love affair with free market economics as the main driving force for advance of national wealth puts severe limitations on the essential involvement of communities in malaria management. The task of malaria control or elimination needs to be clearly related to the basic macroeconomic process that preoccupies governments, not cloistered away in the health sector Historically malaria has had a severe, measurable, negative impact on the productivity of nations. Economic models need rehoning with political aplomb and integrating with technical and demographic strategies. Recent decades in Chinese malaria history carry some lessons that may be relevant in this context.

Asia, Southeastern↗
PubMed1998

Compressive properties of chemically cured, resin modified glass ionomer luting cements.

This study compared the responses of three proprietary chemically cured hybrid glass ionomer luting cements to compressive loading. These cements bear the trade names Advance, Fuji DUET and Vitremer Luting Cement, and are distributed and sold through ordinary domestic and international channels of dental commerce. The findings are as follows: 1. Advance, and Fuji DUET were stronger and stiffer than Vitremer Luting Cement. On the other hand, Vitremer exhibited the highest toughness. 2. The compressive properties of Advance were not affected significantly by increasing the specimen aging period to 28 days from seven days. 3. Prolonged aging of Fuji DUET and Vitremer specimens in a humid environment elicited significant changes in compressive strength and modulus of elasticity. Whereas the strength and elastic modulus changes for Fuji DUET were negative, the changes experienced by Vitremer were positive. 4. Extending the specimen aging period to 28 days from seven days did not affect significantly the toughness of either Fuji DUET or Vitremer Luting Cement. Relatively low elastic moduli limit the application of the chemically cured hybrid glass ionomers to the cementation of one- to three-unit cast fixed restorations.

Analysis of Variance↗
PubMed2000

Interventions for preventing tobacco sales to minors.

BACKGROUND: Laws restricting sales of tobacco products to minors exist in many countries, but young people may still purchase cigarettes easily. OBJECTIVES: The review assesses the effects of interventions to reduce underage access to tobacco by deterring shopkeepers from making illegal sales. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction group trials register and Medline. Date of the most recent searches: July 1999. SELECTION CRITERIA: We included controlled trials and uncontrolled studies with pre- and post intervention assessment of interventions to change retailers' behaviour. The outcomes were changes in retailer compliance with legislation (assessed by test purchasing), changes in young people's smoking behaviour, and perceived ease of access to tobacco products. DATA COLLECTION AND ANALYSIS: Studies were prescreened for relevance by one person and assessed for inclusion by two people independently. Data from included studies were extracted by one person and checked by a second. Study designs and types of intervention were heterogeneous so results were synthesised narratively, with greater weight given to controlled studies. MAIN RESULTS: We identified 27 studies of which 13 were controlled. Giving retailers information was less effective in reducing illegal sales than active enforcement and/or multicomponent educational strategies. No strategy achieved complete, sustained compliance. In three controlled trials, there was little effect of intervention on youth perceptions of access or prevalence of smoking. REVIEWER'S CONCLUSIONS: Interventions with retailers can lead to large decreases in the number of outlets selling tobacco to youths. However, few of the communities studied in this review achieved sustained levels of high compliance. This may explain why there is limited evidence for an effect of intervention on youth perception of ease of access to tobacco, and on smoking behaviour.

Adolescent↗