Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Local adaptation”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 991 records · Page 55Linked to original sources
PubMed2001

Community-based noncommunicable disease interventions: lessons from developed countries for developing ones.

Community-based programmes for prevention and control of cardiovascular diseases (CVD) started in Europe and the USA in the early 1970s. High mortality from CVD in Finland led to the start of the North Karelia Project. Since then, a vast amount of scientific literature has accumulated to present results and discuss experience. The results indicate that heart health programmes have a high degree of generalizability, are cost-effective and can influence health policy. In the 1980s the focus of programmes expanded from CVD to noncommunicable diseases (NCD), mainly because of the common risk factors. Attention has now turned to promoting this approach in developing countries, where the prevalence of NCD is growing. Theory and experience show that community-based NCD programmes should be planned, run and evaluated according to clear principles and rules, collaborate with all sectors of the community, and maintain close contact with the national authorities. In view of the burden of disease they represent and of globalization, there is a great need for international collaboration. Practical networks with common guidelines but adaptable to local cultures in a flexible way have proved to be very useful.

Cardiovascular Diseases↗
PubMedDate not supplied

Present data concerning the renin-angiotensin system of extrarenal origin.

After a brief historical incursion regarding RAS of renal origin, we present the main extrarenal angiotensin-forming enzymes, starting with isorenin, tonin, D and G cathepsin and ending with the conversion enzyme and chymase. This is followed by a short presentation of data concerning tissue RAS in the heart and vessels, brain and neurocranial accessory glands, cortico-suprarenal and gonadal glandular territory. In the end we refer to the relations between circulating RAS of renal origin and the extrarenal RAS specific to tissue underlying the fact that the two RAS components cooperate and constitute a unitary hormonal system, regulating the major functions of the organism and maintaining the main homeostatic equilibria. While the circulating RAS of renal origin is acutely activated to contribute to the accomplishment of short term homeostatic reactions, tissue RAS, in paracrine or autocrine ways, exerts local-regional adaptive actions of long duration.

Angiotensins↗
PubMed2002

DOTS-based tuberculosis treatment and control during civil conflict and an HIV epidemic, Churachandpur District, India.

OBJECTIVE: To pilot the WHO guidelines on DOTS for tuberculosis (TB) among displaced people affected by conflict in Churachandpur District, Manipur State, north-east India, which has endured an HIV epidemic, injecting drug use, civil unrest, high levels of TB, and poor TB treatment and prevention services for many years. METHODS: Prerequisites for TB control programmes were established. WHO guidelines and protocols were adapted for local use. Outreach workers were appointed from each ethnic group involved in the conflict, and training was conducted. Quality control and evaluation processes were introduced. FINDINGS: TB was diagnosed in 178 people between June and December 1998. Of the 170 with pulmonary disease, 85 were smear-positive. Successful outcomes were recorded in 91% of all patients and in 86% of smear-positive cases of pulmonary TB. The default rate and the mortality rate were low at 3% each. HIV positive serostatus was the only factor associated with a poor treatment outcome. CONCLUSION: TB treatment and control were possible in a conflict setting and WHO targets for cure were attainable. The factors associated with the success of the programme were strong local community support, the selection of outreach workers from each ethnic group to allow access to all areas and patients, the use of directly observed therapy three times a week instead of daily in the interest of increased safety, and the limiting of distances travelled by both outreach workers and patients.

Blood-Borne Pathogens↗
PubMed1989

Demographic and budgetary influence on the geography of the poll tax: alarm or false alarm?

"The paper examines the influence of demographic change and the adaptation of local authority budgets on the level of poll tax between local authorities. The changes introduced by the Local Government Finance Act [in the United Kingdom] are argued to make almost all the possible variation between areas depend upon demography and local decisions on expenditure. Means of assessing local expenditure need are outlined and a consistent measure is developed which is used to estimate the relative contributions of changing need, tax base, new expenditures and grants over the period 1974-85 and up to 1991. 'New realism' in local authority spending is argued to combine with demographic change to allow radically reduced potential poll tax levies to be estimated than have been forecast by other sources. The reductions are particularly significant in inner London and many metropolitan districts."

Demography↗
PubMed1992

Health consequences of unsafe abortions.

Maternal morbidity and mortality due to complications of unsafe abortion constitute a major public health concern in many countries. It is estimated that of the approximately 150,000 unwanted pregnancies that are terminated every day by induced abortion, 1/3 are performed under unsafe conditions, resulting in some 500 deaths every day. In many developing countries a substantial proportion of the limited national reproductive health care resources are spent on the management of abortion-related problems. To evaluate further the public health consequences of unsafe abortions, the Programme is supporting hospital-based studies of complications of abortion and their cost to the health care system in countries where safe abortion is not readily available. The studies employ a core protocol adapted to local conditions. Bangladesh, Chile, Ethiopia, and Thailand have completed such research, and similar studies are currently under way in 4 more countries--Benin, Brazil, Senegal, and Uganda. In Bangladesh, 1301 cases of abortion-related diagnoses admitted to hospital were included in the study. Some 46% were judged to have certainly had an induced abortion and another 16% were judged as possible cases of induced abortion. While no deaths occurred in women with spontaneous abortions, 18 of those who had had an induced abortion died. More hospital resources in terms of duration of stay, antibiotics, and blood were spent on cases of induced abortion compared to cases of spontaneous abortion. The study also found that on average abortion cases occupied hospital beds for a much longer duration compared to other obstetric cases.

Abortion, Induced↗
PubMed1989

The 1990 World Population and Housing Census Programme.

A population census is the primary source of demographic information for every country. In planning for the 1990 round of censuses, the international community has adopted a number of recommendations for changes for countries and regions to consider in planning for and carrying out their census. In particular, alternatives for the measurement of economic activity have been proposed in order to obtain a more realistic indication of employment and unemployment in countries where the agriculture and informal sectors are important. New recommendations have also been made for the measurement of stocks and flows of international migrants. In each of the major regions, recommendations have been adapted to local concerns. Preparations are being made for technical cooperation in the 190 census round, and a calendar of the census dates in all countries is shown to be nearly complete.

Agriculture↗
PubMed1995

Technologies -- appropriate and inappropriate.

People often think that "technology" means "machines". But according to WHO a technology is an association of methods, procedures, techniques, and equipment which, together with the people using them, can contribute to solving a health problem. An appropriate technology is one that is scientifically sound, adapted to local needs, acceptable to those who use it or for whom it is used, and that can be maintained and utilized with resources that the community can afford. Many different technologies have contributed enormously to reducing maternal and perinatal mortality and morbidity. Yet, very often, not enough attention is paid to the economic, human, and infrastructure implications of the technology or to the implications of introducing it into a new setting. This issue of Safe Motherhood looks at some of the technologies currently widely available in maternal and neonatal health care and asks two simple questions. Has this technology been evaluated in different settings? And at which level of the health care system can this technology be used appropriately?

Delivery of Health Care↗
PubMed2001

Breast cancer audit: adapting national audit frameworks for local review of clinical practice.

OBJECTIVE: To assess the value of using a nationally devised data set for breast cancer audit at a local level for reviewing clinical practice. DESIGN: Audit proforma based on the Scottish Cancer Therapy Network (SCTN) minimum data set and database completed prospectively from January 1999. SETTING: Hairmyres Hospital, a district general hospital within Lanarkshire Acute Services NHS Trust. SUBJECTS: The inclusion criteria were those developed by SCTN for the core minimum data set for breast cancer (SCTN 1999). RESULTS: The results indicate that the SCTN minimum data set can be usefully employed to collect prospective data on breast cancer. The data set is sensitive enough to identify any problem areas, which can be reviewed at greater detail when required. This datset is a robust mechanism for collecting meaningful and comparable data both at a local and national level. CONCLUSIONS: The use of SCTN's minimum data set has been successful for local review of practice. This has led to the identification of "out-liers" from the normal range of process indicators and further internal examination of these at a local level by individual clinicians is under way. This exercise has also proved fruitful in identification of other fields, which can be added to the data set to refine the data collected. The database provided by SCTN is easily manipulated allowing for refinement where required. Breast cancer audit carried out in this way is a useful way of reflecting on clinical practice throughout the multidisciplinary team.

Breast Neoplasms↗
PubMed1992

A model protocol for a diabetes and other noncommunicable disease field survey.

Field surveys of diabetes and other noncommunicable diseases and their risk factors are increasingly being performed in both developed and developing countries. Although individual priorities and circumstances will influence survey design, a model survey manual and protocol is described which might assist investigators in formulating plans and preparing manuals for their own surveys. The model presented has been successfully used in developing countries, for both rural and urban communities, over more than a decade. It describes examples of survey objectives, and gives specific details of survey procedures and measurement techniques which may be utilized. It contains sufficient flexibility to allow its adaptation to local circumstances.

Adult↗
PubMed2003

Web-based classroom data collection in ADHD: a best practices case study.

BACKGROUND: Best practices research identifies and disseminates effective clinical strategies developed and refined by clinicians for their practices. As opposed to the content of health care, medical students and residents are typically not trained in the process of its provision. This paper illustrates a best practices approach to development of a Web-based classroom data collection method to improve medication management in attention deficit hyperactivity disorder (ADHD). OBJECTIVES: 1) To increase Primary Care Physician (PCP) awareness of the process of best practices research, and; 2) to highlight the use of the World Wide Web as a tool for integration of care of children with ADHD. METHODS: Based on the review of a large national study in ADHD, the key ingredients for the best pharmacotherapy practices were identified. The lessons from the literature were adapted for local practice using the framework and steps for best practices outlined by Mold and Gregory. A conceptual model of managing information provided by parents/caregivers and teachers to PCPs was developed. Several steps were identified, including Web-based classroom behavioral data collection by a care manager and feedback reports to PCPs from a child psychiatrist based on the data collected. This model is currently being tested. CONCLUSION: Our preliminary experience suggests that a best practices approach has potential applications to a variety of primary care settings in South Dakota. We encourage PCPs to consider best practice strategies for their own practices. The practice-based research network (Rush Net) being developed by the Center for Rural Health Improvement of the University of South Dakota School of Medicine's Department of Family Medicine can be helpful in this regard.

Attention Deficit Disorder with Hyperactivity↗
PubMedDate not supplied

[Mode of the rational use of Pseudomonas aeruginosa bacteriophages in therapeutic and epidemic control practice].

Ecological aspects of the circulation of P. aeruginosa and P. aeruginosa bacteriophages under hospital conditions were under study. The statement concerning the formation of triple parasitic systems was put forward. The influence of these systems on the formation of phage and antibiotic resistance in P. aeruginosa hospital strains was studied. Spontaneous circulation of faintly virulent phages taking part in the formation of triple parasitic systems was shown not to ensure the elimination of P. aeruginosa hospital strains in clinics. Construction of highly virulent phages adapted to local P. aeruginosa strains was the only way of ensuring the protection of patients. Theoretical and practical approaches to the use of highly active bacteriophages for controlling P. aeruginosa infection were substantiated. The realization of these approaches resulted in achieving not only a clinical, but also essential epidemic control effect in cases of purulent septic infections caused by P. aeruginosa (a decreased frequentcy of hospital infections from 40.8% to 8.93%).

Bacteremia↗
PubMed2003

The yellow nail syndrome.

The yellow nail syndrome is a rare clinical entity which combines three main features: yellow discolouration of the nails, chronic lymphedema, and pleural effusion. Since 1994, chronic rhinosinusitis is associated in this syndrome. A lot of other pathologic conditions are often present. The most frequent are: bronchiectasis, recurrent pneumonia, pericardic effusion, humoral immunity deficiencies. Among the etiopathogeneses advocated, the more credible ones deal with changes of the lymphatic network with hypoplastic vessels leading to inadequate adaptation, after local damage of the tissues. When this syndrome is suspected on the basis of the examination of the nails, an extensive investigation (dermatologic, pneumologic, lymphographic, biologic) has to be launched to exclude underlying neoplasma, or autoimmune disease, frequently associated with this syndrome. The treatment is controversial and poorly effective. Vitamin A and E, Zn sulfate and itraconazole are drugs the most often advised. Spontaneous healing is reported in 30% of the cases. Endoscopic endonasal surgery in such cases, when the sinusal mucosa is involved, is controversial and its outcome is not yet documented.

Aged↗
PubMed2003

The forgotten strategy.

Most multinationals see globalization as a matter of replication--spreading a single business model as widely as possible to maximize economies of scale. From this perspective, the key strategic challenge is choosing how much of the model to keep standard and how much to grudgingly adapt to local tastes. But focusing exclusively on that choice is a mistake, for it blinds companies to the very real opportunities they can still gain from arbitrage--from exploiting differences as opposed to similarities. Indeed, the scope for arbitrage is as wide as the differences that remain among countries, and those differences continue to be broad and deep. They can, in fact, be divided into four main categories--cultural, administrative, economic, and geographic. In each category, old opportunities persist and new ones are arising, sometimes very quickly. Consider the continued cachet of French culture in its wines and haute couture. Witness, too, how swiftly the Finns have become known for their expertise in wireless communications. Clearly, legal and other administrative differences, particularly in tax laws and the cost of capital, remain large. So do purely economic wage differentials, especially for knowledge workers and other skilled employees. And if modern transportation and other technologies have reduced geographic advantages and brought down the price of spices, they've also made possible expanded trade in other goods like perishable flowers and out-of-season produce. Both the differences that make arbitrage valuable and the similarities that make replication important will remain with us for the foreseeable future, and combining the two, while necessary, is tricky. But that spells competitive advantage for those companies that have the imagination to see the full range of possibilities.

Commerce↗
PubMed1992

[Quality assurance in an emergency department--what is it?].

To date, the medical profession has worked mainly on the improvement of medical treatment and has concentrated less on the methods used and the information given to patients and colleagues. The different aspects of quality in the daily routines are described, and some of these are used as examples of how a system for quality assurance can be developed. It is important that each department develop its own system of quality assurance adapted to local difficulties and different specialties.

Emergency Service, Hospital↗
PubMed2004

[Larynx preservation: nonsurgical approaches].

The question of larynx preservation is central in the management of patients with a carcinoma of the larynx or hypopharynx, especially to preserve the main functions of the larynx. In early stages (T1-earlyT2) Larynx preservation can generally be obtained with partial surgery or radiotherapy. Some other approaches such as exclusive chemotherapy require further investigations. In locally advanced and infiltrating larynx/hypopharynx carcinomas, (advancedT2-T3), several ways have been used to preserve the larynx including exclusive radiotherapy which can be improved by modified fractionation and acceleration. The efficacy of radiotherapy can be also markedly increased by adding concomitant cisplatin based chemotherapy, as reported recently in a large randomized trial. An alternative approach consisted in using induction chemotherapy (cisplatin-5FU) and followed by a local treatment adapted to the response to chemotherapy. The combined analysis of 3 such randomized trials (GETTEC, Veteran et EORTC) showed that this approach has to be used with caution, and could be safer in good responders to induction chemotherapy. Finally, larynx preservation is generally not proposed in patients with deeply infiltrating tumors and or tumor invading the cartilage or soft tissue in the neck (T4).

Antimetabolites, Antineoplastic↗
PubMed2004

Daily Emergency Department Surveillance System --- Bergen County, New Jersey.

The purpose of the Daily Emergency Department Surveillance System (DEDSS) is to provide consistent, timely, and robust data that can be used to guide public health activities in Bergen County, New Jersey. DEDSS collects data on all emergency department visits in four hospitals in Bergen County and analyzes them for aberrant patterns of disease or single instances of certain diseases or syndromes. The system monitors for clusters of patients with syndromes consistent with the prodrome of a terrorism-related illness (e.g., anthrax or smallpox) or naturally occurring disease (e.g., pandemic influenza or food and waterborne outbreaks). The health department can use these data to track and characterize the temporal and geographic spread of a known outbreak or demonstrate the absence of cases during the same period (e.g., severe acute respiratory syndrome [SARS] or anthrax). DEDSS was designed to be flexible and readily adaptable as local, state, or federal surveillance needs evolve.

Bioterrorism↗
PubMed2005

[Role of vitamin deficiency in pancytopenia in Djibouti. Findings in a series of 81 consectutive patients].

The purpose of this study of patients with pancytopenia in Republic of Djibouti was to identify etiologic factors and attempt to define diagnostic and therapeutic strategies adapted to local conditions. Clinical, biological and radiological assessment was performed in 81 patients hospitalized for pancytopenia. There were 56 men and 25 women. Mean hemoglobin, leukocyte and platelet rates were 56,5 +/- 22,7 g/l, 2,1 +/- 0,7.g/l and 56,2 +/- 24,7 g/l respectively. Vitamin deficiency was the most common cause of pancytopenia (49%), followed by hypersplenism (9%), HIV infection (6%) and leishmaniasis (6%). Vitamin-deficient patients had significantly more severe anemia and thrombopenia and significantly higher mean corpuscular volume than patients with pancytopenia related to other causes. Hemoglobin rate lower than 40 g/L and platelet rate lower than 35 G/L showed a positive predictive values of 90% and 100% respectively for a vitamin deficient pancytopenia. Vitamin deficiency is the most frequent etiology of pancytopenia and causes the most severe cytopenia in Djibouti. Rapid vitamin supplementation after minimal etiologic assessment including a myelogram is an effective treatment strategy for this public health problem.

Adult↗