RESUMO
Over the past 50 years, survival for children in high-income countries has increased from 30% to over 80%, compared to 10-30% in low and middle income countries (LMIC). Given this gap in survival, established paediatric cancer treatment centres, such as The Hospital for Sick Children (SickKids) are well positioned to share clinical expertise. Through the SickKids Centre for Global Child Health, the SickKids-Caribbean Initiative (SCI) was launched in March 2013 to improve the outcomes and quality of life for children with cancer and blood disorders in the Caribbean. The six participating Caribbean countries are among those defined by the United Nations as Small Island Developing States, due to their small size, remote location and limited accessibility. Telemedicine presents an opportunity to increase their accessibility to health care services and has been used by SCI to facilitate two series of interprofessional rounds. Case Consultation Review Rounds are a forum for learning about diagnostic work-up, management challenges and treatment recommendations for these diseases. To date, 54 cases have been reviewed by SickKids staff, of which 35 have been presented in monthly rounds. Patient Care Education Rounds provide nurses and other staff with the knowledge base needed to safely care for children and adolescents receiving treatment. Five of these rounds have taken place to date, with over 200 attendees. Utilized by SCI for both clinical and non-clinical meetings, telemedicine has enhanced opportunities for collaboration within the Caribbean region. By building capacity and nurturing expert knowledge through education, SCI hopes to contribute to closing the gap in childhood survival between high and low-resource settings.
Assuntos
Países em Desenvolvimento , Doenças Hematológicas/terapia , Área Carente de Assistência Médica , Neoplasias/terapia , Pediatria/organização & administração , Telemedicina/organização & administração , Região do Caribe , Atenção à Saúde/organização & administração , Feminino , Promoção da Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Doenças Hematológicas/diagnóstico , Hematologia/organização & administração , Humanos , Masculino , Oncologia/organização & administração , Neoplasias/diagnóstico , Índias OcidentaisAssuntos
Transtornos Relacionados ao Uso de Cocaína/diagnóstico , Abuso de Maconha/diagnóstico , Mecônio/química , Detecção do Abuso de Substâncias/métodos , Adolescente , Adulto , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Hospitais Universitários , Humanos , Abuso de Maconha/epidemiologia , Gravidez , Complicações na Gravidez , Prevalência , Fatores Socioeconômicos , Trinidad e Tobago/epidemiologia , Adulto JovemRESUMO
Neurodevelopmental abilities of 33 very-low-birthweight (VLBW) Trinidadian children and randomly selected matched pairs of classmates who were of normal birth weight were tested in 1998 at ages 68-88 months, using the McCarthy Scales of Children's Abilities. The 1 min Apgar score was significantly lower in the VLBW children, 6.5 (SD 1.0) versus 7.7 (SD 1.27), PAssuntos
Sistema Nervoso Central/crescimento & desenvolvimento
, Recém-Nascido de muito Baixo Peso
, Testes Neuropsicológicos
, Índice de Apgar
, Criança
, Desenvolvimento Infantil
, Pré-Escolar
, Cognição
, Feminino
, Humanos
, Recém-Nascido
, Masculino
, Processos Mentais
, Doenças do Sistema Nervoso/diagnóstico
, Percepção
, Trinidad e Tobago
RESUMO
Neurodevelopment abilities of 33 very-low-birthweight (VLBW) Trinidadian children and randomly selected matched pairs of classmates who were of normal birth weight were tested in 1998 at ages 68-88 months, using the McCarthy Scales of Children's Abilities. The 1 min Apgar score was significantly lower in the VLBW children, 6.5 (SD 1.0) versus 7.7 (SD 1.27), less than or equal to 0.001. These differences may reflect a delay in the neurodevelopment of these children. However, the effect of child-rearing practices and the inappropriateness of the test for the population cannot be ruled out (AU)
Assuntos
Humanos , Criança , Peso ao Nascer , Biologia do Desenvolvimento , Trinidad e Tobago , Recém-Nascido/crescimento & desenvolvimento , Recém-Nascido/fisiologia , Região do CaribeRESUMO
The fetal demand for docosahexaenoic acid (DHA) has to be satisfied by the mother. We determined the fatty acids in maternal plasma non-esterified fatty acid (NEFA), triacylglycerol (TAG) and phosphatidylcholine (PC), in a cross-sectional study of non-pregnant (n = 10), pregnant (n = 19), and postpartum (n = 9) women. There were lipid class-dependent differences in plasma polyunsaturated fatty acid (PUFA) concentrations between groups. During pregnancy, DHA was most highly enriched in PC, about 230%, with more modest enrichment for linoleic acid (LA) and arachidonic acid (AA), and no enrichment of alpha-linolenic acid (alpha-LNA). There was relative enrichment of LA, AA and alpha-LNA in TAG, but not of DHA. There was no specific enrichment of any PUFA in the NEFA pool. These data accord with the suggestion that the enrichment of alpha-LNA in TAG and of DHA in phospholipids reflects hepatic regulation of n-3 PUFA metabolism which potentially enhances the delivery of DHA to the placenta.
Assuntos
Ácidos Docosa-Hexaenoicos/análise , Ácidos Graxos não Esterificados/sangue , Fígado/metabolismo , Fosfolipídeos/química , Período Pós-Parto/sangue , Gravidez/sangue , Adulto , Estudos Transversais , Feminino , Humanos , Necessidades Nutricionais , Fosfatidilcolinas/sangue , Fosfatidilcolinas/química , Fosfolipídeos/sangue , Projetos Piloto , Segundo Trimestre da Gravidez/sangue , Terceiro Trimestre da Gravidez/sangue , Triglicerídeos/sangue , Triglicerídeos/química , Trinidad e TobagoRESUMO
The fetal demand for docosahexaenoic acid (DHA) has to be satisfied by the mother. We determined the fatty acids in maternal plasma non-esterified fatty acid (NEFA), triacylglycerol (TAG) and phosphatidylcholine (PC), in a cross-sectional study of non-pregnant (n = 10), pregnant (n = 19), and postpartum (n = 9) women. There were lipid class-dependent differences in plasma polyunsaturated fatty acid (PUFA) concentrations between groups. During pregnancy, DHA was most highly enriched in PC, about 230 percent, with more modest enrichment for linoleic acid (LA) and arachidonic acid (AA), and no enrichment of alpha-linolenic acid (-LNA). There was relative enrichment of LA, AA and -LNA in TAG, but not of DHA. There was no specific enrichment of any PUFA in the NEFA pool. These data accord with the suggestion that the enrichment of -LNA in TAG and of DHA in phospholipids reflects hepatic regulation of n-3 PUFA metabolism which potentially enhances the delivery of DHA to the placenta.
Assuntos
Gravidez , Humanos , Gravidez/sangue , Plasma/química , Ácidos Graxos Insaturados , Trinidad e Tobago , Região do CaribeRESUMO
This retrospective study to determine the incidence of bacterial septicaemia in neonates at the Mount Hope Women's Hospital, Trinidad during a 2-year period, 1996 to 1997, included all neonates whose blood or cerebrospinal fluid cultured positive for bacteria. There were 9866 live births (LB), 102 of whom were diagnosed with bacterial sepsis, an incidence of 10/1000 LB. Thirty-one neonates had a positive culture for group B Streptococcus, an incidence of 3/1000 LB. Gram-negative organisms accounted for 63% of positive cultures. There were three outbreaks of nosocomial infection, two caused by Enterobacter spp with mortality rates of 37% and 50% and one outbreak caused by Pseudomonas aeruginosa with a mortality rate of 25%. The overall mortality rate was 27% (27/102), 63% were boys and 58% were preterm. The incidence of neonatal bacterial sepsis of 10/1000 LB is the highest recorded for the Caribbean and indicates that infection might be an important cause of the high perinatal mortality rate.
Assuntos
Bacteriemia/epidemiologia , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Infecção Hospitalar/epidemiologia , Feminino , Humanos , Incidência , Recém-Nascido , Masculino , Estudos Retrospectivos , Infecções Estreptocócicas/epidemiologia , Streptococcus agalactiae , Trinidad e Tobago/epidemiologiaRESUMO
The University of the West Indies was founded at Mona, Jamaica in 1948. After fifty two years, the format of the final Bachelor of Medicine clinical examination in Medicine and Therapeutics has been radically revised. The change from the traditional to an evidence-based, objective structured clinical examination (OSCE) was undertaken in November/December 2000. Assessment drives learning and both the methods chosen for assessment and the manner in which they are applied determine how students learn. The philosophical underpinnings of the change in format are discussed in this paper. (AU)