Articles: health.
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Family physicians must make complex decisions regarding which procedures to learn in training and which to perform in practice. Factors that influence these decisions include community needs, the potential profitability of a procedure, and the desires and skills of the individual physician. ⋯ Family physicians in Wisconsin vary greatly in the number and types of procedures performed. Community size, sex, and age are important variables associated with the number and type of procedures performed. The performance of procedures is dynamic: physicians both discontinue learned procedures and learn new procedures. The profitability of the procedure influences the learning and discontinuation of procedures.
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Ethiopian medical journal · Oct 1994
The relation of early nutrition, infections and socio-economic factors to the development of childhood diabetes.
The relationship of development of diabetes from birth up to 15 years of age to the type of feeding in infancy, childhood infections and vaccination was studied in 55 patients attending Endocrinology Clinics of the Ethio-Swedish Children's and Tikur Anbessa Hospitals over a period of two years (January 1990 to December 1991). Seventy-four unaffected siblings and 107 unrelated controls were interviewed for comparison. No significant difference was found in relation to type of feeding up to the ages of three, six and 12 months or older between patients and unaffected siblings. ⋯ The odds ratios between diabetics and unrelated controls for introduction of bottle-feeding at three months and six months of age were 0.32 (confidence intervals 0.14-0.74) and 0.31 (confidence intervals 0.13-0.77) respectively. The use of cow's milk and other formulas in bottle-feeding showed a significant negative association with the development of diabetes chi 2 = 5.8 (p < 0.025), chi 2 = 3.8 (p < 0.05) respectively. A history of vaccination against tuberculosis, measles, diphtheria, pertussis, tetanus (DPT) and polio was significantly more common among unrelated controls than diabetics, chi 2 from 4.6 to 11.4 (p < 0.05 to p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
Comparison of arm circumference against standard anthropometric indices using data from a high density town near Harare, Zimbabwe.
In a limited controlled sample, the performance of the middle upper arm circumference (MUAC) was compared to those of standard indices (weight for age, height for age and weight for height), using 90 children aged one to four years living in a high density town near Harare, Zimbabwe. Using a cut off point of 15,5 cm, the MUAC performed best in relation to the weight for age (sensitivity 66,7 pc (95 pc confidence interval (CI) 53,3-80,0 pc), specificity 76,2 pc (95 pc CI 61,7-80,5 pc)) than to any other standard index. Nevertheless, this performance was unsatisfactory because about 30 in every 100 (28,9 pc) children would have been inaccurately identified as healthy or diseased. Although we do not have evidence from the present study to recommend the use of the MUAC in identifying children who are malnourished and living in similar high density areas, the MUAC may be applicable to children living in areas of higher prevalence of malnutrition.
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The Safe Motherhood Initiative has successfully stimulated much interest in reducing maternal mortality. To accelerate programme implementation, this paper reviews lessons learned from the experience of industrial countries and from demonstration projects in developing countries, and proposes intervention strategies of policy dialogue, improved services and behavioural change. A typological approach with three hypothetical settings from resource poor to resource rich environments is used to address the variability in health behaviours and infrastructure encountered when programming for safe motherhood.
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Review Comparative Study
BCG vaccination in India and tuberculosis in children: newer facets.
With the extended programme of immunisation and since 1985 the universal programme of immunisation and the coverage status of BCG vaccination in India has been very good, although it is still unsatisfactory in the eastern states. It is emphasized that BCG vaccination cannot prevent natural tuberculous infection of the lungs and its local complications, although it reduces the haematogenous complications of primary infection. However, this is not true for malnourished children who, inspite of BCG vaccination, develop serious, and often fatal types of tuberculosis such as miliary, meningitic and disseminated tuberculosis. ⋯ Similarly, vaccinated children may present with hepatomegaly, splenomegaly or isolated organ disease. It is important to relearn the new patterns of tuberculosis disease seen in vaccinated, non-malnourished children, and to a lesser extent in children with grade 1 to 2 protein energy malnutrition (PEM). With these limitations of BCG vaccination, other strategies like chemoprophylaxis need multicentric trials in high risk children, in different parts of the country.