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PubMedDate not supplied

[Control of the quality of water in the framework of a national rural water program on the Ivory Coast. Preliminary results].

In the framework of a National Hydraulic Village Program (NHVP) which aim is to equip each village of the Ivory Coast with wells or drillings, a water quality control service was designed, directly on the field, at the Health Rural Sector Bases. The standards of drinkability were revised according to the NHVP constraints. The technics used were adapted to local conditions. Sanitary education was part of the technics used by the field agents. 1,553 wells were analysed by the end of 1978, 17.7% of which were "polluted". Pollution was transient without treatment in 68% of the above cases. The most polluted cases had a rate of fecal coliforms a 1,000 time inferior to the average traditional wells. The drillings were less polluted (10%) than the large diameter wells (24%): in the latter there was a direct correlation between rain fall and pollution. The technical visits by the agents in the villages represented privileged moments of sensibilisation and education of the villagers.

Cote d'Ivoire↗
PubMed1984

On the food favoritism of twins.

In the present study, there is a continuation of the authors' earlier investigations concerning food preference/refusal patterns in a group of Hungarian adult MZ and DZ twin pairs. A "Food Like/Dislike Chart" (FLDC), adapted to local nutritional habits, was applied. In order to characterize the degree of intra-pair concordance referring to the food favoritism, the concept of the "Taste Concordance Point" (TCP) was introduced. On the basis of the comparison of the TCP values obtained for the MZ and DZ pairs the conclusion can be drawn that gustatory habits are presumably influenced also by genetic factors. The results allow the possibility of applying TCP to testing zygosity.

Adolescent↗
PubMedDate not supplied

The Adolescent Family Life Program as a prevention measure.

Adolescent pregnancy and parenthood remain a source of considerable concern, not only due to the well-documented adverse consequences of teenage pregnancy, but also because of certain trends that emerged during the seventies. Survey results showed a dramatic upsurge in premarital sexual activity, while pregnancies and sexually transmitted diseases rose. Out-of-wedlock births also increased. The Adolescent Family Life Program is a new Federal Government effort to deal with the resultant complex of problems.THE PROGRAM HAS TWO MAJOR THRUSTS: (a) preventing adolescent pregnancies by emphasizing the strategy of reaching adolescents before they become sexually active and (b) preventing various negative consequences of pregnancy that often occur among adolescent parents and their off spring. The Program is funding projects that demonstrate and evaluate innovative services in order to obtain knowledge about what works best under given circumstances in both instances. Later, proven models will be made available for adaptation by local communities.Education about the responsibilities of sexuality and parenting will be among the prevention services encouraged in the funded projects. Care services to parenting adolescents include pre and postnatal care, nutrition counseling, continuing education, and vocational services.Through its research component, the Adolescent Family Life Program also has the potential for contributing to an understanding of how to prevent adolescent pregnancies and their adverse consequences. Research projects may encompass the causes and consequences of adolescent sexual relations, use of contraceptives, pregnancy, and child-rearing.Family involvement is a consistent theme in all efforts of the Adolescent Family Life Program. It is anticipated that results of the projects funded by the Program will illuminate ways to incorporate the family into a successful partnership aimed at preventing the problems of adolescent pregnancy.

Abortion, Induced↗
PubMed1981

[Differential peridural analgesia for vaginal delivery. A randomised study of its influence on the progress and mode of delivery (author's transl)].

This randomised study of 611 deliveries deals with the side effects of a modified extradural analgesic technique. The modification is based on a flexible reduction of local anaesthetic concentration (bupivacaine) which allows a reliable analgesia without a marked loss of labour sensation and bearing down reflex. Randomisation was achieved by offering this analgesia to the parturients in an alternating 24 hours rhythm. Statistical comparisons were carried out for the following groups of deliveries: 1. for deliveries on both of the two alternating days (Group A). 2. for deliveries with and without extradural analgesia of the peridural days (Group B). - 3. for all deliveries with and without extradural analgesia (Group C). - 4. For deliveries without extradural analgesia on "peridural days" and on "alternating days" (Group D). - The main subjects of investigation were the duration of the two stages of delivery, the dynamics of both the cervical dilation and the movement of the fetal head and the frequency, modes and causes of operative and instrumental deliveries. The safety of the analgesic technique was investigated by evaluating its influence on the status of the newborn and on the maternal regulation of body temperature and circulation. The results were obtained as follows: 1. In the group of parturients who had chosen extradural analgesia several antenatal factors accumulated which evidently had a greater influence on the course of delivery than the analgesic technique itself. - 2. The low concentration of local anaesthetic adapted to the labour pain produced a sufficient analgesia in almost every case. - 3. The duration of both stages of delivery was not altered directly by this technique. An average increase of the duration of the second stage by 116 minutes was due to postponed indications of instrumental and operative deliveries by analgesia. - 4. There was no influence on the overall frequency of operative and instrumental deliveries. Extradural analgesia, however, significantly reduced the frequency of caesarean sections to the same extent as it increased instrumental deliveries from the bottom of the pelvis. - 5. The extradural analgesia had no influence on the status of the newborn. - 6. The regulatory mechanisms of circulation and body temperature were not altered by this dosage of extradural analgesia.

Adult↗
PubMedDate not supplied

[Indications and long term results after surgical treatment for necrotic acute pancreatitis (author's transl)].

A series of 50 patients with acute pancreatitis, all complicated by necrosis and hemorrhage, is presented. Cases are broken down into 3 main categories depending on clinical and laboratory data. Thirty-nine partial pancreatectomies and 11 excisions of necrotic tissue were performed. Operative mortality is 36%. Causes of death and morbidity were analysed. Are discussed modalities of surgery from clinical and intraoperative findings. Surgical procedure is completed by generous washings of the abdominal cavity followed by continuous drainage. External biliary diversion is assumed by mews of choledocostomy. Surgical procedure is to be adapted to local conditions because a too systemic attitude is dangerous and possibly responsible of over treatment complications. Postoperative clinical behavior is of great importance when one know that reoperatives in such difficult situation are frequent.

Acute Disease↗
PubMed1980

Patient participation in primary health care.

Patient participation groups have been established in about 20 practices, six of which were visited. They did not conform to a particular model but each had adapted to local circumstances. As well as giving patients a say in the practice, they were involved in health education, voluntary work, and campaigns for better secondary care facilities, although these activities were influenced by the way the groups were elected. The emphasis was on participation rather than patient power and their constructive approach to improve services made patient participation a valuable innovation.

Community Health Centers↗
PubMed1995

Simulated microgravity increases cutaneous blood flow in the head and leg of humans.

BACKGROUND: The cutaneous microcirculation vasodilates during acute 6 degrees head-down tilt (HDT, simulated microgravity) relative to upright conditions, more in the lower body than in the upper body. HYPOTHESIS: We expected that relative magnitudes of and differences between upper and lower body cutaneous blood flow elevation would be sustained during initial acclimation to simulated microgravity. METHODS: We measured cutaneous microvascular blood flow with laser-Doppler flowmetry at the leg (over the distal tibia) and cheek (over the zygomatic arch) of eight healthy men before, during, and after 24 h of HDT. Results were calculated as a percentage of baseline value (100% measured during pre-tilt upright sitting). RESULTS: Cutaneous blood flow in the cheek increased significantly to 165 +/- 37% (mean +/- SE, p < 0.05) at 9-12 h HDT, then returned to near baseline values by 24 h HDT (114 +/- 29%, NSD), despite increased local arterial pressure. Microvascular flow in the leg remained significantly elevated above baseline throughout 24 h HDT (427 +/- 85% at 3 h HDT and 215 +/- 142% at 24 h HDT, p < 0.05). During the 6-h upright sitting recovery period, cheek and leg blood flow levels returned to near pre-tilt baseline values. CONCLUSIONS: Because hydrostatic effects of HDT increase local arterial pressure at the carotid sinus, baroreflex-mediated withdrawal of sympathetic tone probably contributed to increased microvascular flows at the head and leg during HDT. In the leg, baroreflex effects combined with minimal stimulation of local veno-arteriolar and myogenic autoregulatory vasoconstriction to elicit relatively larger and more sustained increases in cutaneous flow during HDT. In the cheek, delayed myogenic vasoconstriction and/or humoral effects apparently compensated for flow elevation by 24 h of HDT. Therefore, localized vascular adaptations to gravity probably explain differences in acclimation of lower and upper body blood flow to HDT and actual microgravity.

Adult↗
PubMed1995

[Senegal: installation of a microcomputer in the emergency admission service of the Ziguinchor Regional Hospital].

An Emergency Department was opened at the Regional Hospital of Ziguinchor in August 1993. Although adapted to local conditions, facilities are state-of-the-art and allow 24-hour reception of patients regardless of the gravity of their condition. There are many people involved: family, police, firemen, administration ... and there are also many questions. Records must be efficiently and accurately managed and the computer is the ideal tool for this purpose. The department was able to install a system at a particularly low cost since the PC computer and Epi-Info software were provided at no charge by the World Health Organization. To ensure consistent data entry, a coding system was used with some codes being specific to the department. Thanks to this system the department now has a 24 hour source of information for day-to-day management, statistical reporting, regional morbidity assessment, comparison of performance with similar facilities, and patient follow-up. Our experience shows that this type of low-cost computer system and simple processing techniques are perfectly suited to the special requirements of medical practice in Black Africa.

Abstracting and Indexing↗
PubMed1994

[Granulometry and measurement of a aerosol drug deposit (fusafungine) in normal and pathological airways].

We measured with a laser velocimeter granulometric deposit of an aerosol anti-infectious agent, fusafungin, administered with a controlled inhalator. Total drug deposit was determined on the basis of a granulometric spectrum of the polydispered aerosol (mass mean aerodynamic diameter (MMAD) = 2.8 +/- 1.7 microns) and dispersion in the airways was estimated using the Stahlhofen model. We first compared deposits obtained with oral inhalation in 19 normal subjects and 20 patients with chronic obstructive lung disease. Total deposit in the airways of patients with chronic obstructive lung disease (82%) was not significantly different from that in normal subjects (85%). Estimated dispersion in normal airways was 27% in the alveoles, 8.4% in the tracheobronchic region and 23.5% in the extrathoracic regions. We then compared deposits after nasal inhalation in 22 normal subjects and 21 patients with rhinitis: nasal deposit was significantly greater in patients with rhinitis (54.5%) than in controls (44.7%). We conclude that such an inhalator can be adapted for local treatment of ENT infections and upper respiratory infections. Deposit is not modified in case of obstructive bronchopathy.

Adult↗
PubMed1994

[Therapy and prevention of esophageal varices hemorrhage: current status].

Acute bleeding from esophageal varices is a medical emergency. It requires a structured therapeutic strategy adapted to local resources. The primary goal is to stop bleeding, preferably by endoscopic sclerotherapy or ligation. If endoscopic intervention is not possible as a first-line treatment, balloon tamponade or vasoactive drugs (terlipressin or octreotid) are therapeutic options to be followed as soon as possible by sclerotherapy or ligation. After successful hemostasis, the next goal is to prevent rebleeding. This is achieved primarily by eradicating sclerotherapy or ligation. In special situations, long-term therapy with a non-cardioselective beta receptor blocker is an alternative. The combined approach using sclerotherapy or ligation plus beta receptor blocker offers no significant advantage. Primary prophylaxis of bleeding from esophageal varices by long-term beta receptor blocker therapy is advised in patients with medium-sized or large varices. Apart from strategies aimed at the therapy or prophylaxis of bleeding from esophageal varices, measures to prevent or treat chronic liver diseases should be implemented in order to reduce the development of liver cirrhosis as the leading cause of esophageal varices.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

A description of the content of army family practice.

BACKGROUND: For decisions about residency curricula and downsizing the US Army medical corps, decision makers must know the practice content of the various specialties. Little is known about the content of Army family practice. The purpose of our study was to describe the content of Army family practice. METHODS: We analyzed a random sample of 28,849 family practice encounters from the US Army Ambulatory Care Data Base Study. Variables included patient demographics, diagnoses, visit duration, procedures, and medical facility. Patient age and visit duration were compared using analysis of variance; facility profiles were compared by age category and sex of patients, family member position, and procedure frequency using chi-square analysis. Diagnostic content of the facilities was compared by both chi-square and Kendall's tau B tests. RESULTS: The typical patient was a 26-year-old woman. The 25 most frequent diagnoses accounted for three-fourths of all encounters, with variation by patient age. The majority of visits did not include a procedure, but procedure frequency varied by patient age and diagnostic certainty. Mean visit duration was 16.4 minutes and varied by age. There were differences among the sites for all variables. CONCLUSIONS: Army family physicians see patients of all ages, of whom more are the family members of soldiers than the soldiers themselves; they frequently do procedures and are usually certain of their diagnoses, which include a broad spectrum of illnesses. Army family physicians are flexible, adapt to local patient and environmental needs, and are uniquely qualified to form the basis of Army medicine.

Adolescent↗
PubMedDate not supplied

[Patterns of adaptive mobilization of proteins from skeletal muscles during development of compensatory hypertrophy of internal organs].

These studies were dealing with muscle protein depletion in rats under the heart hypertrophy induced by aorta coarctation or under liver regeneration after partial hepatectomy. The last experimental model was also used in order to establish how far such protein mobilization from muscles is realized during their simultaneous adaptation to local overload or disuse induced by a surgical method. 3 and 7 days after induction of hypertrophy of organs investigated, the quantities of sarcoplasmic, myofibrillar and stroma proteins were measured in last-twitch (m. extensor digitorum longus, m. biceps brachii) and slow-twitch (m. soleus) muscles. The contributions of protein biosynthesis and/or protein degradation change into muscle protein loss were evaluated by specially elaborated radiotracer method. The data obtained demonstrate that the pattern of muscle protein mobilization depends on nature of organ and rate of its hypertrophy. The process occurs differently in muscle of different type and in various muscle structures. It appears to be potentiated in overloaded muscles and to a lesser extent in unused ones. The loss of muscle proteins is certainly associated with inhibition of their biosynthesis. Increased degradation (or release) of preformed (non-labelled) protein molecules may also contribute to this loss whereas degradation of newly-formed (labelled) molecules does not change appreciably, possibly because their distribution in muscle structures is non-uniform.

Animals↗
PubMed1996

Characteristic properties of superficial lumbrical spindles in the cat hind limb, related to their bag1 fibres.

Superficial lumbrical spindles of the cat show several important differences as compared with the classic picture of the spindle, derived principally from tenuissimus. Thus long chain fibres occur in a high proportion of superficial lumbrical spindles, and there is great individual variation in the number of bag fibres present. This study is especially concerned with the morphology and relationships of the bag1, fibre, which are again highly unusual. Most notably, bag1 fibres were almost always the longest intrafusal fibres, typically exceeding bag2 fibres by about 2 mm in total length. They also commonly exhibited the greatest diameter, especially in the extracapsular region where, uniquely, they normally increased in size on leaving the capsule, often becoming similar to extrafusal fibres in this respect. In a few spindles where there was only a single bag fibre this was more often a bag1 than is the case for similar spindles in tenuissimus, and in tandem-linked spindles the continuous bag fibres were more often bag1 than bag2. These results contribute to growing evidence that different muscles exhibit characteristic features of the structure and innervation of their proprioceptors, which may reflect adaptations to local control requirements.

Animals↗
PubMedDate not supplied

[Global changes and trends in work safety and health].

A description is given of the occupational health and safety problems which are common to workers all over the world, where these must be tackled with a view to achieving coherent and ongoing occupational safety for workers in their jobs. Occupational safety and health will continue to be priorities in international collaboration. Although the nature of the problems and solutions vary as a function of real priorities and needs, it is necessary to place greater emphasis on the application of overall activities concerning safety and health so that measures can be made and policies taken whose development is sustainable. International standards must be turned into actions on a national and company level with the active participation of social workers. The tripartite consensus will continue to be necessary for drawing up plans of action adapted to local situations, with a view to introducing improvements in work centres.

Accidents, Occupational↗
PubMed1997

Type II diabetes mellitus clinical guidelines at primary health care level. A SEMDSA Consensus Document, 1997, in association with DESSA, ADSA.

OBJECTIVE: To develop effective education and management programmes for all aspects of diagnosis, treatment and prevention of complications of type II diabetes mellitus in the primary care setting. OPTIONS: The approach suggested is intended to be adaptable to both optimal and minimal health care settings and to individual patient differences both in the public and the private sectors. OUTCOMES: Few long-term studies are currently available worldwide comparing patient outcome (In terms of macrovascular morbidity and overall mortality) with the various treatment regimens or the clinical and biochemical targets recommended. As complications cannot be totally prevented with our current state of knowledge and therapeutics, attention must still be focused on secondary and tertiary prevention to slow the progression of complications after they have been detected. EVIDENCE: Working groups of diabetologists, epidemiologists, gynaecologists, primary care physicians, nurse specialist educators, dieticians, podiatrists and patient-interest organisations reviewed and discussed the current scientific knowledge and clinical recommendations as reflected by the latest overseas position and consensus statements on the subject. The format and spirit of the document are based on the 'Guidelines for the management of non-insulin-dependent diabetes in Africa, 1996' and adapted through local clinical experience to the needs and realities of our country at a primary health care level setting. RECOMMENDATIONS: These include details on the provision of information for early detection, effective management and integration of clinical services for type II diabetes into a multidisciplinary chronic (non-communicable) diseases programme within the existing and evolving national health care system, emphasis on lifestyle modification, appropriate education and medication, the prevention and treatment of complications and timely referrals to a higher level of health care, and the concept of the patient charter of rights and responsibilities in the hope of achieving an optimal level of self-management within the constraints of the disease. VALIDATION: Relevant organisations involved in the education and care of people with diabetes were asked to select representatives to participate in the guidelines working group of the National Diabetes Advisory Board (SEMDSA). Draft documents on 12 topics were produced, amended and widely circulated for comments, criticisms, consensus and endorsement. SPONSORS: The consensus conference and the complication and publication of this document were supported by a generous educational grant from Servier Laboratories (SA).

Diabetes Mellitus, Type 2↗
PubMed1996

[Skin expansion on the extremities].

The indications for skin expansion in the limbs are now well defined. This technique is particularly irreplaceable below the knee, and allows the resection of very large lesions despite a minimal skin capital. More than in other sites, it is a difficult technique which requires rigour and a sound basis in reconstructive surgery. The operative plan must include precise assessment of the tissue gain with selection of prostheses adapted to local conditions. The techniques of insertion, filling and resection must be irreproachable. The functional and aesthetic indications are numerous and the technique often provides a minimal residual scar.

Dermatologic Surgical Procedures↗
PubMed1998

[Depression in Sub-Saharan Africa].

We now have a better knowledge of the specific features of depression in sub-Saharan Africa. Anthropologically speaking, the Western model is irrelevant. Depression in sub-Saharan Africa involves the relationship of the subject to himself or others in a mode specific to African cultures. Ignoring this fact can lead to simplistic ethnocentrism. From a clinical standpoint, depressive illness characterized by somatic manifestations, delusions of persecution, and anxiety are increasingly uncommon. As African societies modernize, these traditional forms are being gradually supplanted by states with symptoms and prognoses more like those observed in industrialized countries. Hybrid depressive syndromes are now the most widespread. Epidemiologically the notion widely held only a few decades ago that depression is a rare occurrence in Africa has now been dispelled. Many studies have been conducted to determine the exact incidence, age distribution, and sex ratio but more precise data is still needed. This investigation will require improvement in screening and diagnostic methods which must be not only suitable for clinical use but also adaptable to local conditions. This is also true with regard to management which has the same goals as anywhere else in the world. Treatment facilities are different in urban and rural areas but care is often dispensed in unconventional settings and may be combined with traditional methods. Drug availability is limited by problems involving supply and cost. This explains why electro-convulsive therapy which was introduced into sub-Saharan Africa long ago still plays a major role in the treatment of depression.

Adult↗
PubMed1998

Differences in adult excretory-secretory products between geographical isolates of Echinostoma caproni.

Because of the potentially important role of parasite excretory-secretory (ES) products in regulating intermate relationships and host-parasite interactions, we investigated intraspecific variability of adult ES products from a trematode species. Adults from 3 geographical isolates of Echinostoma caproni were collected and maintained under in vitro conditions. ES products were collected at 4, 8, and 22 hr of in vitro maintenance. In order to test for interspecific variability, ES products from a different echinostome species (Echinostoma sp.) were collected in a similar way. Major ES polypeptides were characterized by sodium dodecyl sulfate-polyacrylamide gel electrophoresis separation and silver staining. The polypeptide patterns of total ES products appeared very stable in time for each isolate. ES products from Echinostoma sp. showed a distinct polypeptide profile with none of the major bands being shared with the E. caproni isolates. Although polypeptide patterns from the 3 E. caproni isolates shared most major bands, isolate-specific bands could be observed. Two isolates exhibited a band at 85 and 119 kDa, respectively, whereas the third isolate was characterized by the absence of both bands. These results, together with the previously reported role of ES products in molecular signaling raise the question of the importance of intraspecific ES product differences in evolutionary processes such as assortative mating or local host adaptation.

Animals↗