Prise en charge du cancer du col utérin métastatique au CHU de Treichville et résultas/ / Management of metastatic cervical cancer at the University Hospital of Treichville and results

la prise en charge du cancer col métastatique s'est enrichie depuis 2017 par la disponibilité des thérapies ciblées dans notre pays. Cette étude avait pour objectifs de déterminer les caractéristiques épidémiologiques, cliniques et thérapeutiques des patientes prises en charge pour cancer du col métastatique dans notre structure. Methodes. il s'agit d'une étude rétrospective à visé descriptive menée dans les services de gynécologie et d'oncologie du CHUT, du janvier 2018 ­ octobre 2021. Elle a concerné les dossiers de patientes traitées pour un cancer du col de l'utérus métastatique confi rmé. Ont été inclus les dossiers des patientes qui ont reçu au moins 06 cures de chimiothérapie associées ou non à la thérapie ciblée, et dont la dernière cure a été réalisée 24 mois avant la fi n de l'étude. Resultats. Nous avons colligé 47 dossiers dont les patientes avaient un âge moyen de 54 ans. Elles avaient toutes déjà accouché, et étaient sans activités dans 57% des cas. La tumeur initiale était un carcinome épidermoïde dans la majorité des cas (87%). Les sites métastatiques les plus fréquents étaient lespoumons (39%), le foie (26%), les os (15%). Elles ont toutes bénéfi cié de la combinaison PaclitaxelCisplatine ­Bévacizumab comme traitement spécifi que. La survie globale a été de 52 % à 24 mois, et était meilleur chez les patientes qui ont reçu le Bévacizumab dans leur traitement.

Risk factors and interventions associated with mortality or survival in adult COVID-19 patients admitted to critical care: a systematic review and meta-analysis

Patients with confirmed COVID-19 admitted to intensive care units have a high mortality rate, which appears to be associated with increasing age, male sex, smoking history, hypertension and diabetes mellitus. Methods: A systematic review to determine risk factors and interventions associated with mortality/survival in adult patients admitted to an intensive care unit (ICU) with confirmed COVID-19/SARS-CoV-2 infection. The protocol was registered with PROSPERO (CRD42020181185).Results: The search identified 483 abstracts between 1 January and 7 April 2020, of which nine studies were included in the final review. Only one study was of low bias. Advanced age (odds ratio [OR] 11.99, 95% confidence interval [CI] 5.35­18.62) and a history of hypertension were associated with mortality (OR 4.17, 95% CI 2.90­5.99). Sex was not associated with mortality. There was insufficient data to assess the association between other comorbidities, laboratory results or critical care risk indices and mortality.The critical care interventions of mechanical ventilation (OR 6.25, 95% CI 0.75­51.93), prone positioning during ventilation (OR 2.06, 95% CI 0.20­21.72), and extracorporeal membrane oxygenation (ECMO) (OR 8.00, 95% CI 0.69, 92.33) were not associated with mortality. The sample size was insufficient to conclusively determine the association between these interventions and ICUmortality. The need for inotropes or vasopressors was associated with mortality (OR 6.36, 95% CI 1.89­21.36). Conclusion: The studies provided little granular data to inform risk stratification or prognostication of patients requiring intensive

Predictors of mortality in COVID-19 patients at Kinshasa University Hospital, Democratic Republic of the Congo (from March to June 2020)

Introduction: since the 1st case of coronavirus disease 2019 (COVID-19) in Kinshasa on March 10th 2020, mortality risk factors have not yet been reported. The objectives of the present study were to assess survival and to identify predictors of mortality in COVID-19 patients at Kinshasa University Hospital.Methods: a retrospective cohort study was conducted, 141 COVID-19 patients admitted at the Kinshasa University Hospital from March 23 to June 15, 2020 were included in the study. Kaplan Meier's method was used to described survival. Predictors of mortality were identified by COX regression models.Results: of the 141 patients admitted with COVID-19, 67.4 % were men (sex ratio 2H:1F); their average age was 49.6±16.5 years. The mortality rate in hospitalized patients with COVID-19 was 29% during the study period with 70% deceased within 24 hours of admission. Survival was decreased with the presence of hypertension, diabetes mellitus, low blood oxygen saturation (BOS), severe or critical stage disease. In multivariate analysis, age between 40 and 59 years [adjusted Hazard Ratio (aHR): 4.07; 95% CI: 1.16 - 8.30], age at least 60 years (aHR: 6.65; 95% CI: 1.48-8.88), severe or critical COVID-19 (aHR: 14.05; 95% CI: 6.3-15.67) and presence of dyspnea (aHR: 5.67; 95% CI: 1.46-21.98) were independently and significantly associated with the risk of death.Conclusion: older age, severe or critical COVID-19 and dyspnea on admission were potential predictors of mortality in patients with COVID-19. These predictors may help clinicians identify patients with a poor prognosis

Improving survival of preterm babies in low- to middle-income countries ­ what can we do?

Surviving prematurity poses the greatest challenge in neonatal care in low- to middle-income countries (LMICs). South Africa has not made much progress in improving the survival of preterm babies. Neonatal survival of preterm infants has become a national priority since the serious failure to reach the Millennium Development Goal targets in 2015. High rates of prevention are particularly relevant in LMICs, where the neonatal mortality rate is at its highest owing to a lack of simple and effective measures. Preventing prematurity and related complications begins with a healthy pregnancy. Antenatal care and maternal corticosteroids are antenatal interventions that could improve the survival of preterm babies. Postnatal interventions include: the management of neonatal sepsis, meningitis and pneumonia;prevention of hypothermia after delivery, for example, the plastic bag/wrap and cap, which has been extensively researched and is found to be an effective, low-cost method for reducing hypothermia in preterm infants; the use of continuous positive airway pressure (CPAP),including the low-cost CPAP device, which is a cost-effective strategy for providing respiratory support for premature neonates with respiratory distress syndrome; exogenous surfactant; early feeding with breastmilk; and kangaroo mother care. The use of cost-effective,evidence-based interventions can be implemented in LMICs to reduce neonatal mortality

Facteurs associés à la survie du nouveau-né prématuré à l'Hôpital de la Mère et de l'Enfant de N'Djaména au Tchad

Introduction : la prématurité est responsable d'une lourde morbi-mortalité qui freine la réduction de la mortalité néonatale et infanto-juvénile dans les pays à faible niveau de développement sanitaire comme le Tchad. L'objectif de la présente étude était de rechercher les facteurs associés à la survie du nouveau-né prématuré à N'Djaména au Tchad, un pays à faible revenu. Patients et méthodes : il s'agissait d'une étude descriptive et analytique qui a été conduite de mai à octobre 2015 dans le service de néonatologie de l'Hôpital de la Mère et de l'Enfant de N'Djaména.Elle avait concerné tous les 172 nouveau-nés prématurés hospitalisés au cours de la période d'étude. Les données collectées comportaient l'anamnèse gestationnelle, la morbidité en cours d'hospitalisation, le taux de survie et les facteurs associés. Le test de Chi2 avait servi à l'analyse statistique avec un seuil de signification de 5%. Résultats : La fréquence de la prématurité était de 21,4%. L'âge gestationnel était inférieur à 33 semaines d'aménorrhée chez 75% des nouveau-nés prématurés. La morbidité était dominée par la détresse respiratoire (57,6%), l'anémie (28,5%) et les infections (25%). La survie était de 57,6% avec un seuil de viabilité de 26 semaines d'aménorrhée. Les facteurs de bon pronostic étaient l'âge gestationnel proche du terme (p=0,000), la cotation d'APGAR normale (p=0,002), l'accouchement par césarienne (p=0,000), la naissance à l'hôpital de référence (p=0,004), l'admission précoce (p=0,039) et l'absence de détresse respiratoire (p=0,000). Conclusion : La survie du prématuré, encore faible à l'Hôpital de la Mère et de l'Enfant de N'Djaména peut être améliorée par des actions de périnatologie basées sur les facteurs de bon pronostic identifiés

Survival of patients with Kaposi's sarcoma in the South African antiretroviral treatment era: A retrospective cohort study

Background. When South Africa (SA) implemented its antiretroviral therapy (ART) programme in 2004, the model for treating HIV-positive Kaposi's sarcoma (KS) patients shifted from symptomatic palliation to potential cure.Objective. To evaluate survival and changes over time in AIDS-KS patients treated at a tertiary academic hospital oncology unit (the Steve Biko Academic Hospital medical oncology unit) in Pretoria, SA, in the context of ART availability in SA. Methods. We conducted a retrospective review of electronic and paper records of KS patients who accessed cancer care between May 2004 and September 2012. We used Kaplan-Meier survival functions to estimate 1- and 2-year survival, and Cox regression models to identify changes over time and prognostic factors.Results. Our study included 357 AIDS-KS patients, almost all of whom were black Africans (n=353, 98.9%); 224 (62.7%) were men. The median age at cancer diagnosis was 37 (interquartile range (IQR) 30 - 43) years, and the median baseline CD4+ count was 242 (IQR 130 - 403) cells/µL. Most patients received ART (n=332, 93.0%) before or after KS diagnosis; 169 (47.3%) were treated with chemotherapy and 209 (58.6%) with radiation therapy. Mortality was 62.7% lower (adjusted hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.19 - 0.73) in the late (2009 - 2012) than in the early (2004 - 2008) ART period. Receiving chemotherapy (adjusted HR 0.3, 95% CI 0.15 - 0.61) and poor-risk AIDS Clinical Trials Group KS stage (adjusted HR 2.88, 95% CI 1.36 - 6.09) predicted mortality.Conclusions. Our results show that large national ART roll-out programmes can successfully reduce KS-related mortality at the individual patient level. If ART coverage is extended, KS-associated morbidity and mortality are likely to drop

Lactate clearance predicts outcome after major trauma

Introduction:To determine a correlation between lactate clearance within 48h and survival in trauma patients at a Level I trauma centre in a developing country and compare to previous international lactate clearance studies.Methods:We conducted a retrospective study of a prospectively collected database at a Level I trauma centre from March 2007 to November 2010. Patients of all ages were included. Metabolic parameters from initial arterial blood gas were measured in all patients; an abnormal lactate beindefined as 2.5mmol/L. A subgroup analysis of blunt versus penetrating injury was performed. Results:Of the 657 patients in the database; 493 had complete lactate data. The survival rate of patients with lactate values 2.5mmol/L was 88. Of the patients with high lactate levels that cleared within 24 and 48h the survival rates were 81 and 71; respectively. The survival rate amongst patients not achieving a normal lactate within 48h was 46 but was higher in those with penetrating as opposed to blunt injury (67 versus 38). The overall survival was 81.Conclusion:The present results confirm previous studies showing that prolonged lactate clearance predicts increased mortality in severely injured trauma patients. Thus; the measurements of arterial serum lactate trends are simple and effective predictors of outcome

Survival of Extremely Low-Birth-Weight Infants

Objectives. Survival of extremely low-birth-weight (ELBW) infants in a resource-limited public hospital setting is still low in South Africa. This study aimed to establish the determinants of survival in this weight category of neonates; who; owing to limited intensive care facilities; were not mechanically ventilated. Design. A retrospective study in which patient data were retrieved from the departmental computer database.Setting. The neonatal unit at Charlotte Maxeke Johannesburg Academic Hospital; Johannesburg; South Africa. Subjects. Neonates admitted at birth between January 2006 and December 2010 with birth weights of =900 g. Outcome measures. Survival at discharge was the major outcome. Maternal variables were age; parity; gravidity; antenatal care; antenatal steroids; place and mode of delivery and HIV status. Neonatal variables were gestational age (GA); birth weight (BW); gender; place of birth; hypothermia; resuscitation at birth; sepsis; necrotising enterocolitis; intraventricular haemorrhage; jaundice; nasal continuous positive airway pressure (NCPAP) with or without surfactant; and Apgar scores. Results. A total of 382 neonates were included in the study. Overall survival was 26.5. The main causes of death; as per the Perinatal Problem Identification Programme (PPIP) classification; were extreme multi-organ immaturity and respiratory distress syndrome. The main determinants of survival were BW (odds ratio (OR) 0.994; 95 confidence interval (CI) 0.991 - 0.997) and GA (OR 0.827; 95 CI 0.743 - 0.919). Overall the rate of NCPAP use was 15.5; and NCPAP was not associated with improved survival. Conclusion. Survival of ELBW infants is low. BW and GA were the strongest predictors of survival. Effective steps are required to avoid extreme prematurity; encourage antenatal care; and provide antenatal steroids when preterm birth is anticipated

Barriers to Postnatal Care and Exclusive Breastfeeding among Urban Women in Southeastern Nigeria

Available evidence shows that only a small proportion of Nigerian women access postnatal care and practice exclusive breastfeeding. Given that both interventions are critical to the survival of both the mother and the new born; it is important to identify factors that militate against an effective postnatal care and exclusive breastfeeding in the country; in order to scale up services. The aim was to determine the major barriers to postnatal care and exclusive breastfeeding among urban women in southeastern Nigeria. Materials and Methods: A cross-sectional survey of 400 urban market women using semistructured questionnaires and focus group discussions. Results: Out of 400 women interviewed; 365 (91.7) attended postnatal clinic. Lack of knowledge about postnatal care services (42.2; n = 14); distant location of the hospitals (36.4; n = 12) and feeling that postnatal visits was not necessary (21.1; n = 7) were the main reasons for non-attendance to postnatal clinic. With respect to exclusive breastfeeding; 143 (35.9) of the women practiced EBF. The main reasons for nonpractice of EBF were that EBF was very stressful (26.2; n = 67); mother's refusal (23.5; n = 60); and the feeling that EBF was not necessary (18.1; n = 46). Thirty five (13.7) of the women were constrained by time while the husband's refusal accounted for 1.5 (n = 3) of the reasons for nonpractice of exclusive breastfeeding. Conclusion: Poor knowledge and inaccessibility to health facilities were the main obstacles to postnatal care while the practice of exclusive breastfeeding was limited by the stress and mothers refusal

A Survival Analysis of South African Children Under the Age of Five Years

The South African Demographic Health Survey data set (SADHS) of 2003 contains massive individual-level information on South African children under the age of five years selected from a random sample of 7756 households. The data set contains data on socio-economic; demographic; health-related and sanitary variables gathered by using multistage cluster sampling. The objective of the study was to identify key predictors of mortality amongst children under the age of five years. Logistic regression analysis and Cox regression were used for data analysis. Under-five mortality was significantly influenced by three predictor variables (breastfeeding; marital status; and ownership of a flush toilet). The hazard ratio of the variable 'breastfeeding' was 3.09 with P = 0.000 and 95 confidence interval (CI) of (1.899; 5.033). The hazard ratio of the variable 'toilet' was 2.35 with P = 0.016 and 95 confidence interval of (1.172; 4.707). The hazard ratio of the variable 'marital status' was 1.74 with P = 0.035 and 95 confidence interval of (1.041; 2.912). Adjustment was factored in for the mother's level of education and wealth index

Using Lot Quality Assurance Sampling Methodology to Evaluate the Uthukela District Child Survival Project of Kwazulu-Natal

Abstract:Health services programmes and interventions require objective measures on coverage and quality to ensure that managers have the evidence to adopt and expand health interventions effectively and efficiently. Over the past 15 years; the uThukela District Child Survival Project of South Africa achieved this through regular two- to three-year project evaluations using cluster sampling. Results of these surveys have improved the ability of Child Survival Projects to identify priorities; define objectives based on data; and measure progress towards these objectives. However; the inability to disaggregate information to composite Supervision Areas (SAs) was a limitation. Lot quality assurance sampling (LQAS) was adopted as an improved method based on its ability to assess performance in disaggregated units within a study population and to reliably compare coverage and health status indicators for routine monitoring of child survival activities. This study assessed the feasibility and reliability of LQAS to evaluate the Child Survival Project and compare the results of a rapid manual analysis with a secondary electronic analysis of the same data. The accuracy of the manual analysis was comparable and provides evidence that LQAS and rapid manual analysis can be used to evaluate intervention programmes; particularly in settings of limited electronic technology and expertise

Differentials in Under-Five Mortality in Zambia:Persistent Gaps in Child Survival Interventions?

Introduction:The millennium Development Goal (MDG) focused on child mortality aims at reducing the under-fire mortality rate (U5MR) by two thirds between 1990 and 2015. for Zambia ; this means reducing the 2007 U5MR of 119 to 64 deaths per thousand live infant mortality from 95 to 32 deaths per thousands live births . The question facing policy markers in Zambia is how can currend child survival interventions be realized and effectively contribute the attainment of the MDG on child mortality in the next decade. To answers this question; a secondary data analysis was done. Methodology: U5MR in Zambia was analyzed using secondary data from Zambia health and Demographic surveys 1992; 1996 ;2001 /2 and 2007( Preliminary data) other sources of data were health management information system (2004-2008) and censures 1960 ; 1970; 1980; 1990 ;and 2000 . Trends in U5MR were mapped for various parameters levels and patterns of U5MR; distribution by geographical areas and cause of death. Results : U5MR in Zambia has had periods of improvement and regression and is currently estimated at 119 deaths per thousand live births .thirty four percent (34) of all deaths among under-five children occur in the neonatal period (0-20 days );while 48occur in the post -neonatal period and more than a half (53) of neonate die with in the first week of their life . Marked disparities in the levels of under- five mortality and within provinces exist; raising issues of equiet in health services. Although strides have been made to roll out key child survival interventions; large proportions of children under five are still not reached and disparities are observed in coverage .The top five causes of health facility based mortality are due to preventable diseases while malnutrition and HIV/Aids are both the cause and contributor. Recommendation: Include need to (I) routinely review child survival interventions to identify elements that work to reduce child mortality (II) undertake operational research grounded in relevant theoretical framework which will specify causal pathways linking child mortality rate and its proximal and distal determinants in U5MR by age and in coverge of child survival interventions. Definitions 1-Under-five mortality: Probability of dying between bird and age 5 expressed per thousand live births ; 2-Neonatal mortality :deaths during the first 28 days of life ;3-Post -neonatal mortality :Deaths between the ages of 28 days and 12 months ; 4-Death rate under the age of 1 expressed per thousand live births; 5-Child mortality: the probability between 12 months and 59 months of age expressed per thousand live births ; 6-full vaccination: A child is considered fully vaccination if he or she receives a BCG vaccination against tuberculosis ; three doses of DPT vaccine to prevent diphtheria ; pertussis ; and tetanus(DPT) ; at least three doses of polio vaccine; and one doses of measles vaccine. These vaccinations should be received during the first year of life.7-MDG number 4: reduce by two thirds; between 1990 and 2015; the under-five mortality rate

Improved Survival of Non-Ventilated Very-Low-Birth-Weight Infants at Madadeni Hospital; KwaZulu-Natal

Most reports of survival of very-low-birth-weight (VLBW) babies focus on infants in tertiary care centres in large metropolitan areas.1-5 Extrapolating data from major centres to peripheral hospitals is problematic because of various factors; including poor socio-economic conditions; absence of intensive/special-care facilities and equipment; and limited number of staff with knowledge and skills in neonatal care in smaller hospitals.3 We were able to raise the survival rate (SR) from 21 to 40 following the use of low-cost measures between 2002 and 2005

The Changing Face of Neonatal Intensive Care in South Africa

In 1991 a cut-off weight of 1 000 g and/or 28 weeks' gestation for neonatal intensive care unit (NICU) admission was decided on by attending neonatologists at a Priorities in Perinatal Care Conference. These recommendations were not based on published evidence. At the time there were few data on the outcome of babies born in the public sector who received NICU. Aim. The aim of this study was to describe the demographic data (mother and baby) and outcomes of babies admitted to a tertiary NICU. Methods. During 1992 - 1996 (1992 cohort) and 1999 - 2000 (1999 cohort) two cohorts of babies treated in the NICU at Tygerberg Hospital; Western Cape; South Africa; were studied. Demogra- phic data were collected prospectively on all admissions with a birth weight of less than 1 501 g and a gestational age of less than 32 weeks. Outcome data were survival; days of ventilation and NICU stay. Results. There were 455 babies in the 1992 cohort and 272 in the 1999 cohort. The mothers' mean income was R892 per month and was higher in the 1999 cohort.The 1999 cohort comprised significantly smaller babies; at a mean birth weight of 1 119 g v. 1 198 g. The mean gestational age in the 1999 cohort was lower (29.2 v. 30.3 weeks); but so was the mortality rate (21.6v. 26.1). The main differences between the survivors and non-survivors were in their birth weight and gestational age and the mean income of their mothers. The mean number of ventilation days needed by these infants was low at 8.5 days; with an average stay in the NICU of 13 days. Discussion. Babies admitted to an NICU have a good chance of survival at a low mean number of ventilation and NICU days. The increase in survival in the 1999 cohort; in spite of low income; is in keeping with international trends and underlines the good short-term outcome of these small babies

Donnees sur l'incidence et la survie du registre du cancer de Setif

Les registres des cancers constituent de plus en plus une source majeure d'information sur le profil de cette maladie dans une localite donnee. Ici a ete appliquee la technique; qui est d'ailleurs clairement expliquee; de recolte des informations pour editer le registre des cancers de Serif en Algerie. Les auteurs ont principalement insiste sur l'incidence et la survie. Chez l'homme le taux le plus eleve concerne les cancers bronchopulmonaires (18;3) et chez les femmes les cancers du sein avec 18;8

Birth Intervals and Child Survival in Kenya

This paper examines the effect of birth intervals on child survival in Kenya; using the data drawn from the 1988/89 Kenya Demographic and Health Survey. Logistic regression is used as the major method of data analysis. The results show that the birth intervals have strong negative effects on infant and child mortality. Their effects remain strong even after a large number of other explanatory variables are taken into account This paper provides empirical evidence that birth intervals of at least two years enhance the prospects of child survival in Kenya

Factors Affecting the Prognosis and Survival of Individuals with SCA

"The morbidity and mortality of sickle cell anaemia depends on the particular individual and his/her environment. In Uganda and most parts of the sickle cell belt of Sub Sahara Africa where the sickle cell anemia carries a high morbidity and mortality; a large proportion of these patients used to die in early childhood. Today; sizeable proportions of SCA individuals survival into adulthood; and lead productive lives. The oldest known Hbss patient attending Professor Ndugwa's SCA clinic at New Mulago Hospital Kampala is now aged 60 years and also the Co-Chairman of the Uganda Sickle Cell Association is about 57 years of age. Many members of the Association who are SCA; are above 20 years of age. The OBJECTIVES of the present study were the reassess the factors determining the improvement in the prognosis and survival of individuals with sickle cell anaemia. METHOD: A study carried out on the age groups of the SCA patients attending Professor Ndugwa's Clinic at New Mulago Hospital Kampala; and also on SCA patients of the Uganda Sickle Cell Association. Their environment such as: Family socio-economic status; Education; protection methods against malaria; Vaccinations received; distance to their health clinic; were all evaluated. CONCLUSION: Observations retrospectively re-affirm that the environment is certainly one of the most important factors. As economic; social and medical conditions improve; the outlook becomes brighter; alghough the severity of SCA is variable. In the absence of any ""cure"" of sickle cell anemia; management is principally to control and improve those environmental factors; such as malaria; which affects the prognosis and survival rate of individuals with Hbss. While our zeal for new and better methods of medical management continues; we must not lose sight of the individual. Each has his or her special problems; anxieties and needs which must not be overlooked."

Factors Affecting the Prognosis and Survival of Individuals with SCA

"The morbidity and mortality of sickle cell anemia depends on the particular individual and his/her environment. In Uganda and most parts of the sickle cell belt of Sub Sahara Africa where the sickle cell anemia carries a high morbidity and mortality; a large proportion of these patients used to die in early childhood. Today; sizeable proportions of SCA individuals survive into adulthood; and lead productive lives. The oldest known Hbss patient attending Professor Ndugwa's SCA clinic at New Mulago Hospital Kampala is now aged 60 years and also the Co-Chairman of the Uganda Sickle Cell Association is about 57 years of age. Many members of the Association who are SCA; are above 20 years of age. Many members of the Association who are SCA; are above 20 years of age. The Objectives of the present study were to reasses the factors determining the improvement in the prognosis and survival of individuals with sickle cell anaemia. Method: A study carried out on the age groups of the SCA patients attending Professor Ndugwa's Clinic at New Mulago Hospital Kampala; and also on SCA patients of the Uganda Sickle Cell Association. Their environment such as: Family Socio-Economic Status; Education; protection methods against malaria; Vaccinations received; distance to their health clinic; were all evaluated. Conclusion: Observations retrospectively re-affirm that the environment is certainly one of the most important factors. As economic; social and medical conditions improve; the outlook becomes brighter; although the severity of SCA is variable. In the absence of any ""cure"" of sickle cell anaemia; management is principally to control and improve those environmental factors; such as malaria; which affects the prognosis and survival rate of individuals with Hbss. While our zeal for new and better methods of medical management continues; we must not lose sight of the individual. Each has his or her speciall problems; anxieties and needs which must not be overlooked. (Source: UNAPSA Congress Proceedings; December 1996)"