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PubMed2004

Transforming written guidelines into electronic formats--international perspectives.

The Guidelines International Network (G-1-N www.g-i-n.net) is a major new international initiative involving guideline-developing organisations from around the world. G-I-N seeks to improve the quality of health care by promoting systematic development of clinical practice guidelines and their application into practice. The Network now has over 45 international members, most of whom prepare evidence-based clinical practice guidelines, or actively promote the use of evidence in practice. One of the priorities of the organisation is to share evidence tables and adapt guidelines for local circumstances based on international evidence. In the longer term, guideline developers are planning to create 'living guidelines' that can be continuously updated and used by a number of different countries. A major consideration for guideline developers is how to communicate and work with information technology scientists to develop standards and protocols for the translation of these trans-national guidelines into electronic formats. To be effective, there must be formal internationally agreed standards that allow electronic guidelines to be shared and automatically updated. The Guidelines International Network will be taking a leading international role in working with designers and vendors of electronic decision support systems and tools to guarantee the integrity of guidelines when translated into electronic formats. This presentation by Catherine Marshall, Kitty Rosenbrand and Guenter Ollenschlaeger will: --explore current experiences from New Zealand, Germany and the Netherlands --identify issues from the perspective of guideline developers --make recommendations for establishing opportunities for software designers, vendors and informatics experts to collaborate with guideline developers to ensure that up to date evidence can be easily implemented and shared throughout the world.

Decision Support Techniques↗
PubMed2004

[Chronic TVT infection: mechanisms and consequences].

Despite the simplicity and efficacy of TVT, this technique, like all surgical treatments, is nevertheless associated with sometimes very serious complications. The authors report a case of chronic infection of a polypropylene implant presenting with cutaneous fistula of a retropubic abscess without an associated septic syndrome, ten months after TVT insertion. The TVT was removed by mini-laparotomy after failure of three weeks of adapted antibiotics and local wound care. These infections can be explained by the capacity of certain micro-organisms to bind to biomaterials and produce a biofilm, protecting from the action of antibiotics and immune cells.

Aged↗
PubMed2005

Decision analysis for the assessment of a record linkage procedure: application to a perinatal network.

OBJECTIVES: According to European legislation, we must develop computer software allowing the linkage of medical records previously rendered anonymous. Some of them, like AUTOMATCH, are used in daily practice either to gather medical files in epidemiologic studies or for clinical purpose. In the first situation, the aim is to avoid homonymous errors, and in the second one, synonymous errors. The objective of this work is to study the effect of different parameters (number of identification variables, phonetic treatments of names, direct or probabilistic linkage procedure) on the reliability of the linkage in order to determine which strategy is the best according to the purpose of the linkage. METHODS: The assessment of the Burgundy Perinatal Network requires the linking of discharge abstracts of mothers and neonates, collected in all the hospitals of the region. Those data are used to compare direct and probabilistic linkage, using different parameterization strategies. RESULTS: If the linkage has to be performed in real time, so that no validation of indecisions generated by probabilistic linkage is possible, probabilistic linkage using three variables without any phonetic treatment seems to be the most appropriate approach, combined with a direct linkage using four variables applied to non-conclusive links. If a validation of indecisions is possible in an epidemiological study, probabilistic linkage using five variables, with a phonetic treatment adapted to the local language has to be preferred. For medical purpose, it should be combined with a direct linkage with four or five variables. CONCLUSION: This paper reveals that the time and money available to manage indecision as well as the purpose of the linkage are of paramount importance for choosing a linkage strategy.

France↗
PubMed2005

[Precision surgery of varicosity: techniques and results].

The paper describes an experience gained with surgical treatment of 211 patients suffering from different forms of varicosity, seen between 1998 and 2003. In these patients, use was made of the technical procedures that provide for application of microaccesses. The complex of such procedures was in a good agreement with the notion "precision surgery of the veins" which implied: 1) the high precision of the topical diagnosis of varicose veins; 2) the use of a specialized kit of miniaturized tools and local bias lighting adapted to microaccesses; 3) primary use of microaccesses for venectomies of varicose vessels; 4) location of microaccesses above the involved veins, first of all, in the area of their tributaries. For integral evaluation of the degree of skin lesion the authors propose the use of an objective characterization, namely "the total length of skin incisions". It is determined by summarization of the lengths of all surgical incisions performed. In patients who underwent operation on one leg, it accounted for 15 to 50 mm (28+/-3 mm.). The precision approach to venous surgery provided for rapid painless return to the initial status after operation and complete rehabilitation of the patients for the first week, with positive rememberances evidencing the high easiness of the treatment carried out. All the patients operated on in such a way noted the high level of the quality of life both on the day of operation and subsequently in the immediate postoperative period.

Adolescent↗
PubMed2004

[Permanence of the piamontese culture on food practices in third generation descendants in Piamonte (Province of Santa Fe, Argentina)].

This paper describes the influence of the piemontese culture on food practices of students living in Piamonte, Santa Fe, Argentina. Food practices of 96 students with Piamontese ancestry (PA) (n = 57) and without Piamontese ancestry (No-PA) (n = 39) were studied along 2002 using a self-administered questionnare. Data were analysed by Chi square test, Fisher's exact test, multiple correspondance analysis and logistic regression. Consumption of bagna cauda (p < 0.05) and polenta (p < 0.1) were higher among PA. Differences on the elaboration of polenta and pasta were found: PA add them cheese (p < 0.05) and cream (p < 0.05) whereas no-PA make use of meat (p < 0.05) and tomato sauce (p < 0.05), respectively. The frequency of consumption of traditional Piamontese meals and the role of the mother in the purchase, the elaboration and the serving of the food were similar on both groups. In conclusion, food practices of Piamontese's descendants recall the food culture of their ancestry with some reasonable adaptations to the local context.

Adolescent↗
PubMed2005

River contract in Wallonia (Belgium) and its application for water management in the Sourou valley (Burkina Faso).

Inspired by the experience of a river contract in Wallonia (Belgium) since 1990, the implementation of a first river contract has been initiated in a West African country, Burkina Faso. This application is not limited to a simple transposition of the Walloon model. The Burkina context calls for adaptation to the local environmental and socio-economical realities with an adequate partnership management. The importance of the mobilization around this project of institutional partners, as well as local collectivities, agricultural producers and water users in general reveals the great expectations of the actors concerning this new tool of water participative management. But will the latter be equal to the task? A first assessment has been drawn up one year after the launch. During the first year of the project, a participative diagnostic was implemented but the understanding of basic notions of water management such as 'river' (not translatable in the local language), 'watershed', 'contract' were not obvious. After the identification of functions and uses of water in the basin, an environmental survey was started. This approach allows study with the river committees of the priority actions to be developed as a first project of restoration of the gallery forest alongside the stream to fight against desertification. This project of integrated and participative management of water at sub-basin level is a concrete example of solidarity and exchange know-how between North and South in the context of a sustainable development.

Agriculture↗
PubMed2006

[Self-treatment of fever in the northern district of Dakar, Senegal].

Malaria is assimilated with its cardinal symptom, i.e., fever. Treatment of fever with antimalarial drugs is crucial to the prevention of malaria-related death in Senegal. The objective of this study was to analyze fever-treatment practices as a basis for making realistic recommendations for self-treatment in the northern health district of Dakar, Senegal. This cross-sectional study was conducted from March 1 to April 30, 2003. The population included all patients with body temperature higher or equal to 37.5 degrees C (99.5 degrees F) associated with at least one of the following symptoms: headache, shivering, vomiting and diarrhoea. Study endpoints included demographic data and fever treatment modalities including the nature, dosage, and duration of the drugs used. Malaria was suspected in 180 of the 271 patients enrolled in the study. Treatment had already been undertaken in 134 patients including 108 (81%) who had initiated self-treatment. Drugs included antipyretics, antibiotics, and/or antimalarials. Antimalarial drug dosage was incorrect in 84% of those who initiated self-treatment. Dosage errors involved number of daily doses (55%), duration of treatment (13%), or both (32%). Only 45% of patients fully completed treatment. Medical advice was sought in 30% of the cases and drugs were obtained over the counter in pharmacies in 59%. Patients under the age of 15 years were significantly more likely to initiate self-treatment (p=6.10-6), to treat symptoms early, and to use an antimalarial (p=4.10-6). Although self-treatment shortened the delay between onset of symptoms and initiation of treatment, it is likely that indiscriminate and incomplete treatment is responsible for development of resistance to chloroquine in the northern health district of Dakar. Strategies must be adapted to numerous local factors influencing self-treatment including the availability of health-care services and drugs of quality. Special attention must be given to the improvement of antimalarial drug packaging and of the awareness of people that provide self-treatment drugs.

Adolescent↗
PubMedDate not supplied

[Tridimensional evaluation model of health promotion in school -- a proposition].

A good school health programme can be one of the most cost effective investments for simultaneously improving education and health. The general direction of WHO's European Network of Health Promoting Schools and Global Schools Health Initiative is guided by the holistic approach and the Ottawa Charter for Health Promotion (1986). A health promoting school strives to improve the health and well-being of school pupils as well as school personnel, families and community members; and works with community leaders to help them understand how the community contributes to health and education. Evaluation research is essential to describe the nature and effectiveness of school health promoting activity. The overall aim of this paper is to help school leaders and health promotion coordinators to measure their work well and effectively. The specific aim is to offer a practical three-dimensional evaluation model for health promoting schools. The material is presented in two sections. The first one is a 'theoretical base' for health promotion which was identified from broad based daily health promotion practical activities, strategies and intersectional interventions closely related to the philosophy of the holistic approach. The three dimensions refer to: 1. 'areas' -- according to the mandala of health. 2. 'actions' -- according to Ottawa Charter strategies which should be adapted to the local school networks. 3. 'data'-- according to different groups of evidence (process, changes and progress). The second one, as a result of the mentioned base, represents the three 'core elements': standards, criteria and indicators. In conclusion, this article provides a practical answer to the dilemma of the evaluation model in the network of local school environment. This proposition is addressed to school staff and school health promotion providers to make their work as effective as possible to improve pupils health. Health promoting school can be characterized as a school constantly strengthening its capacity as a healthy setting for learning and working. But only proper documentation of progress and evidence base procedures related to local networks can prove the constructive work of people and create progress and partners for the development of health in schools.

Child↗
PubMed2006

The outbreak of SARS at Tan Tock Seng Hospital--relating epidemiology to control.

INTRODUCTION: The outbreak of severe acute respiratory syndrome (SARS) began after the index case was admitted on 1 March 2003. We profile the cases suspected to have acquired the infection in Tan Tock Seng Hospital (TTSH), focussing on major transmission foci, and also describe and discuss the impact of our outbreak control measures. MATERIALS AND METHODS: Using the World Health Organization (WHO) case definitions for probable SARS adapted to the local context, we studied all cases documented to have passed through TTSH less than 10 days prior to the onset of fever. Key data were collected in liaison with clinicians and through a team of onsite epidemiologists. RESULTS: There were 105 secondary cases in TTSH. Healthcare staff (57.1%) formed the majority, followed by visitors (30.5%) and inpatients (12.4%). The earliest case had onset of fever on 4 March 2003, and the last case, on 5 April 2003. Eighty-nine per cent had exposures to 7 wards which had cases of SARS that were not isolated on admission. In 3 of these wards, major outbreaks resulted, each with more than 20 secondary cases. Attack rates amongst ward-based staff ranged from 0% to 32.5%. Of 13 inpatients infected, only 4 (30.8%) had been in the same room or cubicle as the index case for the ward. CONCLUSIONS: The outbreak of SARS at TTSH showed the challenges of dealing with an emerging infectious disease with efficient nosocomial spread. Super-spreading events and initial delays in outbreak response led to widespread dissemination of the outbreak to multiple wards.

Adolescent↗
PubMed2006

Ensuring the quality of asthma case management.

An evaluation based on recording the number of patients and evaluating their treatment outcomes provides the information necessary to plan the provision of care, determine the analysis of the situation and revise practice if the results are not satisfactory. The standardised tools proposed for this evaluation are: a district register for new persistent asthma patients, quarterly reports of case finding and an annual report of cohort patient follow-up. The main indicators of quality of care based on register information given by the cohort analysis are the percentage of defaulters and the percentage of patients whose asthma is controlled or well controlled after 1 year of follow-up. The services involved in asthma management should be adapted to the local situation in each country. In particular, the health service structure and national guidelines must be respected, and services involved in asthma management should be implemented in stages. Operational research within the services is essential to ensure that the services provided are appropriate. This type of research involves the health personnel responsible for patient management, provides them with new knowledge and helps them to resolve problems they are confronted with on a regular basis. It also inspires critical thinking, which is crucial to both research and practice.

Asthma↗
PubMed2004

Maternal serum alpha fetoprotein among pregnant females in Alexandria.

UNLABELLED: Maternal serum alpha fetoprotein (MSAFP) was introduced as a screening test for congenital malformations especially neural tube defects (NTDs) two decades ago. However, many factors were known to affect its level. From these are racial differences and maternal weight. The aim of the present work is to illustrate the normal distribution of MSAFP among working pregnant women in Alexandria in gestational age 16-18 weeks, to identify some of its determinants, and to determine the specificity and sensitivity of MSAFP for the detection of congenital anomalies and adverse pregnancy outcome. MATERIAL AND METHODS: A sample of 608 pregnant working women who were 16-18 week gestation was recruited for the study from the antenatal clinic affiliated to Gamal Abdel Nasser Health Insurance Hospital in Alexandria. The enrolled women were interviewed using a structured questionnaire and a blood sample was collected from each of them to measure the level of MSAFP. At the expected time of delivery, Gamal Abd el Nasser Health Insurance Hospital was visited to collect data about the outcome of pregnancy of the enrolled women. RESULTS: The median of MSAFP level for deliveries with no congenital anomalies were 25.5, 33.5, and 53.2 IU/ml, at gestational weeks 16, 17 and 18 respectively. The significant variables related positively to MSAFP level included abortion or stillbirth, congenital anomalies in the index pregnancy, gestational age, bleeding during pregnancy, gestational diabetes, twin pregnancy, consanguinity between maternal parents, history of congenital or genetic diseases in maternal family, and caesarian section deliveries. Fatigue score was negatively correlated to MSAFP level. Using MSAFP multiples of median (MOM), 42.9 % of abortions and stillbirths, 57.1 % of twin pregnancies, 31.25 % of preterm deliveries and 27.3 % of low birth weight had levels of 3 MOM or more. One fourth of the congenital anomalies were below 0.5 MOM and 41.7 % were at or above 3 MOM. The sensitivity of MSAFP test for the detection of NTDs (cutoff point 2.5+ MOM) or Down syndrome (cutoff point <0.5 MOM) among the study sample was 100% (CI: 19.8-100%). Specificity for NTDs was 92.7% (CI: 90.3-94.6%), while the specificity for Down syndrome was 89.1% (86.3-91.4%). The sensitivity for adverse pregnancy outcome (cutoff point <0.5 or 2.5+ MOM) was 41.6, and the specificity was 85.8%. In conclusion, the cutoff points of MSAFP of the study sample are different from those for other populations. Different factors affect the level of MSAFP including adverse pregnancy outcomes. It is recommended to introduce antenatal screening for congenital anomalies as a routine screening test during pregnancy using levels adapted from the local population for cutoff point determination.

Adult↗
PubMed1977

[Water resources and health problems in developing countries].

The rapidly increasing use of water for agricultural and hydroelectric development in developing countries is causing serious health problems. These can be divided into two categories; the diseases whose transmission depends on water; and the changes in the life style of the population. We review briefly the principal health problems and analyze the principles to be followed in solving them, and the reasons of the success or failure of health programs. Among the topics we consider, are the development versus health, the collaboration of health service personnel with the rest of the personnel participating in water development schemes, the necessity of ensuring a multidisciplinary approach to the solutions of these health problems, the necessity of integration of the public health component within the administrative and budgetary levels and the coordination of public health measures with the development of project from the planning phase through the completion and maintenance phases, the purely medical aspects of the health problems involved appearing as being of secondary importance. Common sense, and the use of simple, cheap methods adapted to the local conditions, and applied focaly, provide better solutions than the sophisticated, more general and expensive approaches. The time and budget accorded for surveys and research, usually excessive, should be limited. It is necessary to adhere to a disciplined use of water. Ambitions and utopian dreams and strategies of disease eradication should, in general, give way to more limited, but accessible objectives, whose attainment would lead to a decrease of the clinical and socioeconomic gravity of the health problems to a "reasonable" level.

Adult↗
PubMed1989

Skills for adolescence: experience with the International Lions-Quest program.

This article describes the development of the Lions-Quest Skills for Adolescence program. The primary purpose of this program is to respond to the needs of young people by helping them become more self aware, more skilled, more able to make positive and healthy choices, and better able to make informed, aware, and considered decisions about their own behavior. Skills for Adolescence is one school/community/parent-based curricular program that attempts to address health, life skills, and prevention issues in ways that have clearly struck a common chord in numerous countries. The program's emphasis on effective communication, on self-efficacy and social skills, and on strengthening the family appear to have a strong appear in many different contexts and cultures. Careful attention to local needs during adaptation while employing collaborative strategies is an essential ingredient to crossing cultural and national boundaries.

Adolescent↗
PubMed1978

On "problems" with integrated curricula in nursing.

Curriculum development is many things; it is the study of impact on students, a process through which faculty are moving. It usually does not represent a final decision- like all issues in higher education it is altered as different people and issues arise. The integrated curriculum movement in nursing, while a seminal change, has in a way been like a shadow- incompletely described with lack of clarity about base for comparison. It seems to have become the mode for many schools to develop their own conceptual frameworks and curricular plans. While adaptation to the local setting is expected, one must question how much of the total development effort is necessary and due in part to lack of fully developed curriculum models and dissemination and not building systematically toward improvement in the field. In such a situation we all may be making the same mistakes. If these identified "problems" are indeed just that, they all are amenable to correction. Each solution will require hard conceptual work.

Curriculum↗
PubMed1978

[Legal and organizational bases of health care in the textile industry of the Congress Kingdom of Poland in the 19th and beginning of 20th cent. (forms of insurance, work safety and sanitary regulations)].

The origins of state interventionism in the field of health care in the textile industry of the Congress Kingdom of Poland go back to the first half of the XIX-th century. It could not, however, be developed earlier than in the last quarter of this century, at which time it resulted from the class struggle of textile workers, mainly in Lódź and Zyraŕdów. Legal and organizational patterns of health care were of foreign origin, but soon they were modified and adapted to the local conditions of the Congress Kingdom of Poland. It has to be underlined that it was the textile industry that stimulated legal and organizational changes in the field of industrial health care, not only in the Congress Kingdom of Poland but also in the whole contemporary Europe.

Accident Prevention↗
PubMed1985

Evaluation of Dunedin Plunket family units.

The 249 new cases who presented to Dunedin's two family units during an eight month period in 1983 are described. Data including demographic details, the nature of the presenting problems, the types and frequency of interventions used, and the outcome as perceived by unit staff, referring agency and the child's mother, were collected. Commonly the presenting problem was but one of several identified by unit staff. The number and duration of family unit contacts did not differ greatly for different types of presenting problems. Outcome ratings by the involved health care workers agreed closely with those who made the referral (usually Plunket nurses) and suggested a definite improvement in the majority of cases. There was a high level of consumer satisfaction. Family units are still evolving and adapting to suit local needs, and it seems that they are providing an efficient and effective service which is unique in New Zealand.

Child Care↗
PubMed1984

[Brain function and artificial respiration].

Haemodynamic changes (cerebral perfusion pressure, cerebral blood flow) and variations of blood gases (especially paCO2) induced by mechanical ventilation, can influence cerebral function. The cerebral response to these changes is modified by the individual pathophysiology of the cranial contents. The cerebral mechanisms of adaptation allow a safe ventilation of a patient without cerebral disorders, provided ventilation is within normal clinical limits. In patients, however, whose mechanisms of adaption are impaired locally or globally, the pathophysiological situation may become grossly changed by variations in the ventilatory pattern. A therapeutical application of this interaction is controlled hyperventilation to lower intracranial pressure. On the other hand, changes in the ventilatory pattern (variation of PEEP-level, variation of minute volume, bronchial toilet) can impair cerebral function critically. As the individual reactions cannot be predicted in this group of patients, monitoring of haemodynamic parameters (MAP, CVP, CO), blood gases, intracranial pressure, and EEG is of utmost importance.

Acid-Base Equilibrium↗
PubMed1984

[Population genetics of taiga hunters and reindeer breeders in central Siberia. The biochemical markers of genes Hp, Tf, Gc, A1b, GLO1, PGM1, AcP and EsD].

Biochemical markers of gene systems Alb, Tf, Gc, Hp, GLO1, PGM1, EsD, AcP were analysed in the native population of Evenc national region. It is shown that native population of Central Siberia, in spite of its mongoloid racial type, posseses the complex of gene frequencies for protein loci studied which is not typical for mongoloids. The complex may be called "central-siberian" and its origin may be connected with the process of adaptation to environment of the Central Siberian geographical region. The system of gene markers analysed may be considered as a sensitive one in the studies of processes of gene adaptation to the local environmental factors and, in this connection, being perspective in these studies among native population of Siberia.

Animals↗