Suchergebnisse

The management of childhood diarrhoea at the household level was studied in a population-based survey in four states in north-east Brazil. Of a representative sample of 6524 children under 5 years of age, 982 (15.1%) had diarrhoea on the day of the interview or had had diarrhoea at some time during the previous 15 days. A total of 66% of the children were not taken for treatment, while government health services were used by 14%, private doctors by 1%, and traditional healers (rezadeiras) by 24%. Oral rehydration therapy was given to 24.3% of the children as follows: solutions of oral rehydration salts (ORS) were received by 6.8%, salt-and-sugar solutions by 14.7%, and solutions of commercial ORS brands by 4.3%. Although 95% of the caretakers knew about rehydration solutions, only 18% prepared them correctly, the most common error being the use of insufficient water. Of the rehydration solutions used, 39% had a sodium concentration that was potentially dangerous (greater than 120 mmol/l), and 8% had a sodium concentration that was very low. Of those solutions prepared using ORS, 38% had too high a sodium concentration, while 14% of the salt-and-sugar solutions prepared using either the "scoop-and-pinch" approach or a plastic spoon were too concentrated. However, potentially the most dangerous were the salt-and-sugar solutions prepared using nonstandard recipes. More than half of these had an unacceptably high sodium concentration or osmolarity.

Osteoarthritis is a syndrome affecting a variety of patient profiles. A European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis and the European Union Geriatric Medicine Society working meeting explored the possibility of identifying different patient profiles in osteoarthritis. The risk factors for the development of osteoarthritis include systemic factors (e.g., age, sex, obesity, genetics, race, and bone density) and local biomechanical factors (e.g., obesity, sport, joint injury, and muscle weakness); most also predict disease progression, particularly joint injury, malalignment, and synovitis/effusion. The characterization of patient profiles should help to better orientate research, facilitate trial design, and define which patients are the most likely to benefit from treatment. There are a number of profile candidates. Generalized, polyarticular osteoarthritis and local, monoarticular osteoarthritis appear to be two different profiles; the former is a feature of osteoarthritis co-morbid with inflammation or the metabolic syndrome, while the latter is more typical of post-trauma osteoarthritis, especially in cases with severe malalignment. Other biomechanical factors may also define profiles, such as joint malalignment, loss of meniscal function, and ligament injury. Early- and late-stage osteoarthritis appear as separate profiles, notably in terms of treatment response. Finally, there is evidence that there are two separate profiles related to lesions in the subchondral bone, which may determine benefit from bone-active treatments. Decisions on appropriate therapy should be made considering clinical presentation, underlying pathophysiology, and stage of disease. Identification of patient profiles may lead to more personalized healthcare, with more targeted treatment for osteoarthritis.