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Gastroenterology in developing countries:Issues and advances

World Journal of Gastroenterology 2009年第23期15卷 2839-2854页

作者： Kate L Mandeville Justus Krabshuis Nimzing Gwamzhi Ladep Chris JJ Mulder Eamonn MM Quigley Shahid A Khan Centre for Infectious Diseases Epidemiology Department of Primary Care and Population Sciences University College London Hampstead Campus Royal Free Hospital London NW3 2PF United Kingdom Highland Data Les Charleix 24390 Tourtoirac Dordogne France Department of Medicine University of Jos and Jos University Teaching Hospital Jos Plateau State P.M.B. 2076 Nigeria Department of Gastroenterology VU University Medical Center Amsterdam 1081 HV Holland World Gastroenterology Organisation and Department of Medicine National University of Ireland Cork University Hospital Clinical Sciences Building Wilton Cork Ireland Department of Hepatology and Gastro-enterology Faculty of Medicine Imperial College London St Mary's Campus London W2 1NY United Kingdom

Developing countries shoulder a considerable burden of gastroenterological disease. Infectious diseases in particular cause enormous morbidity and mortality. Diseases which afflict both western and developing countries are often seen in more florid forms in poorer countries. Innovative techniques continuously improve and update gastroenterological practice. However, advances in diagnosis and treatment which are commonplace in the West, have yet to reach many developing countries. Clinical guidelines, based on these advances and collated in resource-rich environments, lose their relevance outside these settings. In this two-part review, we first highlight the global burden of gastroenterological disease in three major areas： diarrhoeal diseases, hepatitis B, and Helicobacter pylori. Recent progress in their management is explored, with consideration of future solutions. The second part of the review focuses on the delivery of clinical services in developing countries. Inadequate numbers of healthcare workers hamper efforts to combat gastroenterological disease. Reasons for this shortage are examined, along with possibilities for increased specialist training. Endoscopy services, the mainstay of gastroenterology in the West, are in their infancy in many developing countries. The challenges faced by those se^ing up a service are illustrated by the example of a Nigerian endoscopy unit. Finally, we highlight the limited scope of many clinical guidelines produced in western countries. Guidelines which take account of resource limitations in the form of ＂cascades＂ are advocated in order to make these guidelines truly global. Recognition of the different working conditions facing practitioners worldwide is an important step towards narrowing the gap between gastroenterology in rich and poor countries.

关键词： Helicobacter pylori Developing countries Gastrointestinal diseases health care delivery Practice guidelines

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Association of types of diabetes and insulin dependency on birth outcomes

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World Journal of Clinical Cases 2022年第7期10卷 2147-2158页

作者： Pamela K Xaverius Steven W Howard Deborah Kiel Jerry E Thurman Ethan Wankum Catherine Carter Clairy Fang Romi Carriere Department of Epidemiology and Biostatistics Saint Louis UniversitySt.LouisMO 63104United States Department of health Management and Policy Saint Louis UniversitySt.LouisMO 63104United States Department of Endocrinology Diabetes and MetabolismSSM HealthSt.CharlesMO 63303United States Division of Epidemiology Institute for Health and EquityMedical College of WisconsinMilwaukeeWI 53226United States Department of Epidemiology Fielding School of Public HealthUniversity of CaliforniaLos AngelesCA 90095United States Population health Sciences Institute Centre for Ageing and VitalityNewcastle UniversityNewcastle upon TyneEngland NE45PLUnited Kingdom

BACKGROUND Diabetes rates among pregnant women in the United States have been increasing and are associated with adverse pregnancy *** To investigate differences in birth outcomes(preterm birth,macrosomia,and neonatal death)by diabetes *** Cross-sectional design,using linked Missouri birth and death certificates(singleton births only),2010 to 2012(n=204057).Exposure was diabetes non-diabetic,pre-pregnancy diabetes-insulin dependent(PD-I),pre-pregnancy diabetes-non-insulin dependent(PD-NI),gestational diabetes-insulin dependent(GD-I),and gestational diabetes-non-insulin dependent(GD-NI).Outcomes included preterm birth,macrosomia,and infant *** included demographic characteristics,adequacy of prenatal care,body mass index,smoking,hypertension,and previous preterm *** and multivariate logistic regression assessed differences in outcomes by diabetes *** Women with PD-I,PD-NI,and GD-I remained at a significantly increased odds for preterm birth(aOR 2.87,aOR 1.77,and aOR 1.73,respectively)and having a very large baby[macrosomia](aOR 3.01,aOR 2.12,and aOR 1.96,respectively);in reference to non-diabetic *** with GDNI were at a significantly increased risk for macrosomia(aOR1.53),decreased risk for their baby to die before their first birthday(aOR 0.41)and no difference in risk for preterm birth in reference to non-diabetic *** Diabetes is associated with the poor birth *** management of diabetes during pregnancy and healthy lifestyle behaviors before pregnancy can reduce the risk for diabetes and poor birth outcomes.

关键词： Epidemiology Pregnancy health care delivery Birth outcomes Gestational diabetes Insulin

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Applying the ADDIE—Analysis, Design, Development, Implementation and Evaluation—Instructional Design Model to Continuing Professional Development for Primary care Physicians in Saudi Arabia

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International Journal of Clinical Medicine 2016年第8期7卷 538-546页

作者： Rabaa K. Almomen David Kaufman Haifa Alotaibi Noura Abdullah Al-Rowais Mohamad Albeik Saad M. Albattal Family & Community Medicine Department Prince Sultan Medical Military City Riyadh KSA Faculty of Education Simon Fraser University Burnaby BC Canada

Background: As professionals, family physicians are obliged to remain current on advances and trends in medicine and health care delivery. This is usually achieved through engagement in continuing professional development. Instructional design is a systematic method of development of education and training programs for improved learner performance. ADDIE is an instructional systems design model for building effective education and training in five phases: analysis, design, development, implementation and evaluation. Purpose: The purpose of this study was to introduce a professional development program for primary care physicians using the ADDIE instructional design model. Methods: Program requirements were defined using a needs assessment questionnaire and consultation observations. Interactive sessions were designed and developed based on the analysis results. The sessions were evaluated with interim and final feedback forms, a final problem-based questionnaire, a self-assessment questionnaire, and focus groups. Results: Scores on the final knowledge assessment were lower than expected. However, at least 50% of participants self-reported their learning improvement as “great” for 16 out of 23 topics. Focus group feedback was generally positive but also identified areas for improvement. Conclusion: Applying a structured instructional design model for creating professional development program for physicians is a fruitful, relevant experience in primary healthcare. 1) Continuing professional development (CPD) is an essential method to help physicians maintain and further develop knowledge and expertise;2) The ADDIE (analysis, design, development, implementation, evaluation) model provides an established and useful structure for creating effective CPD programs;3) The ADDIE process ensures that physicians’ appropriate learning needs are met effectively;4) The evaluation phase of the ADDIE process provides feedback that can lead to improvement in the CPD program’s future

关键词： ADDIE health care delivery

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The men’s health center:Disparities in gender specific health services among the top 50“best hospitals”in America

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Asian Journal of Urology 2015年第3期2卷 170-174页

作者： Jeremy Choy James A.Kashanian Vidit Sharma Puneet Masson James Dupree Brian Le Robert E.Brannigan Department of Medicine The Warren Alpert Medical School of Brown UniversityProvidenceRLUSA Department of Urology Northwestern UniversityFeinberg School of MedicineChicagoILUSA Department of Urology Mayo ClinicMayo Medical SchoolRochesterMNUSA Department of Urology Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA Department of Urology The University of Michigan Medical SchoolAnn ArborMIUSA Department of Urology Meriter Health ServicesMadisonWIUSA

Objective:Gender-specific integrated health services have long existed in the arena of women’s health care,but men’s health centers(MHCs)have only recently emerged as a novel practice ***,we seek to evaluate the prevalence and format of MHCs found in the leading academic medical centers in the United ***:The US News&World Report’s Top 50 Ranked Hospitals for Urology was used as our *** were gathered on the presence of MHCs and types of providers and conditions *** equivalent search was performed for women’s health centers(WHCs).Results:Sixteen of 50(32%)promoted some type of MHC,compared to 49 of 50(98%)offering a *** of the top 15 ranked institutions(53%)had an MHC compared to eight of 35(23%)remaining *** of 16 MHCs incorporated providers from a variety of medical disciplines,including urologists,internists,endocrinologists,cardiologists,and psychologists,while another six of 16 MHCs were staffed solely by *** of 16 provided services for exclusively urologic issues,four of 16 offered additional services in treatment of other medical conditions,and four of 16 did not specify.

关键词： Disparity health care delivery Men’s health Women’s health Urology

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Information seeking and anxiety among colonoscopy-na?ve adults: direct-to-colonoscopy vs traditional consult-first pathways

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World Journal of Gastrointestinal Endoscopy 2016年第19期8卷 701-708页

作者： Jocelyn A Silvester Harmandeep Kalkat Lesley A Graff John R Walker Harminder Singh Donald R Duerksen Faculty of health Sciences College of MedicineUniversity of Manitoba Celiac Research Program Boston Children’s Hospital and Beth Israel Deaconess Medical CenterHarvard Medical School

AIM To investigate the effects of direct to colonoscopy pathways on information seeking behaviors and anxiety among colonoscopy-na?ve *** Colonoscopy-na?ve patients at two tertiary care hospitals completed a survey immediately prior to their scheduled outpatient procedure and before receiving *** items included clinical pathway(direct or consult),procedure indication(cancer screening or symptom investigation),telephone and written contact from the physician endoscopist office,information sources,and pre-procedure *** reported pre-procedure anxiety using a 10 point scale anchored by "very relaxed"(1) and "very nervous"(10).At least three months following the procedure,patient medical records were reviewed to determine sedative dose,procedure indications and any adverse *** primary comparison was between the direct and consult *** the very different implications,a secondary analysis considering the patient-reported indication for the procedure(symptoms or screening).Effects of pathway(direct vs consult) were compared both within and between the screening and symptom *** Of 409 patients who completed the survey,34% followed a direct *** for colonoscopy were similar in each *** majority of the participants were women(58%),married(61%),and internet users(81%).The most important information source was family physicians(Direct) and specialist physicians(Consult).Use of other information sources,including the internet(20% vs 18%) and Direct family and friends(64% vs 53%),was similar in the Direct and Consult groups,*** 31% of the 81% who were internet users accessed internet health *** sought fundamental information such as what a colonoscopy is or why it is ***-procedure anxiety did not differ between care *** undergoing colonoscopy for symptoms reported greater anxiety [mean 5.3,95%CI: 5.0-5.7(10 point Likert scale)] than those for scr

关键词： Direct access colonoscopy Colonoscopy/ utilization Information seeking behavior Referral and consultation health care delivery Anxiety

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