Impact of reminder on medication adherence: a structural equation model, based on study in Sikkim, India

The problem of medication non-adherence has persisted over decades. The rate of adherence decreases with time and improvement in health condition. When patients cannot follow their prescribed medication regime, it leads to deterioration of their health condition and increases their financial costs. This research aims to find the effect of reminder on medication adherence behaviour of patients when "Acceptance of Side Effect", "Quality of Life" and "Medication Beliefs" act as mediators. The sample size of the research was 505. Sampling units comprised patients suffering from different diseases in Central Referral Hospital, Sikkim, India. By developing a Structural Equation Model, the effect of reminder on the mediators and adherence was analysed. The results show a significant positive association between reminder and the three mediators. Reminder has a significant positive effect on adherence (ß=0.637, e=0.055, p=0.001). The effect is higher in the presence of mediators (ß=0.7, e=0.037, p=0.001).

TrackingStorm: Visualization Tool for a Storm Detector Network (SDN) in the LF Spectrum

Abstract During the last year the Group of Atmospheric Electricity Phenomena (FEA/UFPR) developed a short range lightning location network based on a sensor device called Storm Detector Network (SDN), along with a set of algorithms that enables to track storms, determining the Wide Area Probability (WAP) of lightning occurrence, risk level of lightning and Density Extension of the Flashes (DEF), using the geo-located lightning information as input data. These algorithms compose a Dashboard called Tracking Storm Interface (TSI), which is the visualization tool for an experimental short range Storm Detector network prototype in use on the region of Curitiba-Paraná, Brazil. The algorithms make use of Geopandas and clustering algorithms to locate storms, estimate centroids, determine dynamic storm displacement and compute parameters of thunderstorms like velocity, head edge of electrified cloud, Mean Stroke Rate, and tracking information, which are important parameters to improve the alert system which is subject of this research. To validate these algorithms we made use of a simple storm simulation, which enabled to test the system with huge amounts of data. We found that, for long duration storms, the tracking results, velocity and directions of the storms are coherent with the values of simulation and can be used to improve an alert system for the Storm Detector network. WAP can reach at least 75% of prediction efficiency when used 6 past WAP data, but can reach 98.86% efficiency when more data is available. We use storm dynamics to make improved alert predictions, reaching an efficiency of ~87%.

Recordatorio a través de múltiples cartas para vacunación contra influenza / Multiple mail reminders to increase adherence to influenza vaccination

INTRODUCCIÓN: Distintas intervenciones han sido propuestas para reforzar el uso de la vacuna contra la influenza. El uso de recordatorios, ya sea a través de cartas, llamadas telefónicas, panfletos o aplicaciones tecnológicas, entre otras, ha destacado dentro de aquellas orientadas a incrementar la adherencia al tratamiento. Sin embargo, su efectividad no está clara. En este resumen, que forma parte de una serie de evaluaciones de recordatorios, se abordará el envío de múltiples recordatorios enviados por correo. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un meta-análisis y prepara-mos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos ocho revisiones sistemáticas que en conjunto incluyeron 35 estudios primarios, de los cuales cuatro corresponden a ensayos aleatorizados que analizan el uso de múltiples recordatorios enviados por correo. Concluimos que más de un recordatorio enviado por correo probablemente aumenta la adherencia a vacunación contra influenza en pacientes mayores de 60 años, mien-tras que podría resultar en poca o nula diferencia en menores de 6 años, pero la certeza de la evidencia es baja.

INTRODUCTION: Different interventions have been proposed to reinforce the use of the influenza vaccine. The use of reminders, whether through letters, phone calls, pamphlets or technological applications, among others, has stood out among those aimed at increasing ad-herence to treatment. However, its effectiveness is not clear. In this summary, which is part of a series of reminder evaluations, we assess the use of multiple mail reminders. METHODS: We conducted a search in Epistemonikos, the largest database of systematic health reviews, which is maintained by screening multiple sources of information, including MEDLINE, EMBASE, Cochrane, among others. We extracted the data from the identified reviews, analyzed the data from the primary studies, performed a meta-analysis and prepared a summary table of the results using the GRADE method. RESULTS AND CONCLUSIONS: We identified eight systematic reviews including 35 primary studies, of which four analyze the use of more than one letter as a reminder. We conclude that the use of multiple mail reminders probably increase adherence to influenza vaccination in patients over 60; while it may make little or no difference in children under 6 years, but the certainty of the evidence is low.

Viabilidade da aplicação do método R24h para coleta de dados dietéticos por plataforma informatizada e padronizada - GloboDiet em estudos epidemiológicos / Feasibility of applying the 24HR method for dietary data collection by computerized and standardized platform - GloboDiet in epidemiological studies

Introdução. Avanços tecnológicos vêm proporcionando o desenvolvimento de softwares que informatizaram e padronizaram os instrumentos de coleta de dados dietéticos, como o recordatório de 24 horas. Objetivo. Avaliar a viabilidade e percepções da versão brasileira do software GloboDiet, presencial e telefônico, na rotina de um estudo epidemiológico nacional. Métodos. Foi aplicado em participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) avaliados no Centro de Investigação de São Paulo-SP, R24h guiado pelo software GloboDiet, presencialmente (n= 2.093) e, em uma subamostra (n= 1.084), uma segunda medida predominantemente por telefone. As frequências de adesão foram captadas das planilhas de controle de entrevista preenchidas pelos entrevistadores e utilizou-se o teste Qui-quadrado para estudar as diferenças entre os grupos (sexo e faixa etária) e o status de adesão final dos participantes. Para o tempo de duração das entrevistas, os dados foram apresentados como mediana e intervalo interquartil (IQ) Q1 - Q3 (25-75%), e a partir dos testes de Mann-Whitney, Kruskal-Wallis e Wilcoxon foram analisadas as diferenças entre as modalidades presencial e por telefone e entre as categorias de sexo, idade e Índice de Massa Corporal (IMC) para o tempo de duração total e das etapas da entrevista do GloboDiet. Para avaliar a aplicabilidade do GloboDiet por parte dos entrevistadores (n= 8) foi aplicada a técnica de grupo focal aliada à Análise de Conteúdo. Para avaliar a aplicabilidade do software por parte dos entrevistados, foi encaminhado um questionário por e-mail e empregados procedimentos de estatísticas descritivas e os testes Qui-quadrado e Exato de Fisher para estudar as diferenças entre sexo e faixa etária e as respostas fornecidas. Resultados. As frequências de adesão foram de 71% e 50% nas entrevistas em formato presencial e predominantemente por telefone, respectivamente. A duração total das entrevistas presencial e por telefone foi de 30,7 (intervalo interquartil [IQ], 23,3-40,7) e 35,3 (IQ, 25,3-49,7) minutos (p<0,001). Quanto ao grupo focal, cinco temas principais emergiram durante a discussão, apontando que o GloboDiet possui potencialidades relacionadas ao seu nível de detalhamento e capacidade de orientar o entrevistador durante a coleta, e limitações na etapa de treinamento e na base de dados de receitas. No questionário encaminhado aos entrevistados, foi obtida resposta de 18,6% (n= 540), e os resultados apontaram uma boa aceitação do software, do tempo de entrevista e do manual fotográfico por parte dos entrevistados, e a preferência pelo formato presencial de entrevista. Conclusão. A partir dos resultados encontrados neste estudo foi possível evidenciar que o software GloboDiet é viável à rotina de um estudo epidemiológico e aceitável por parte dos entrevistados e entrevistadores.

Introduction. Technological advances have enabled the development of software that computerized and standardized the instruments for collecting dietary data, such as the 24-hour recall. Objective. Evaluate the feasibility and applicability of the Brazilian version of the GloboDiet software, in two measurements, in the routine of a national epidemiological study. Methods. A Longitudinal Study of Adult Health (ELSA-Brasil) evaluated at the Research Center of São Paulo-SP was applied to participants, 24HR guided by the GloboDiet software, in person (n = 2,093) and, in a subsample (n = 1,084), a second measure predominantly by telephone. The adherence rates were captured from the interview control spreadsheets completed by the interviewers and the Chi-square test was used to study the differences between the groups (gender and age group) and the final adherence status of the participants. For the duration of the interviews, data were presented as median and interquartile range (IQR) Q1 - Q3 (25-75%), and from the Mann-Whitney, Kruskal-Wallis and Wilcoxon tests, the differences between the modalities in person and by telephone and between the categories of sex, age and BMI for the total duration and stages of the GloboDiet interview. To assess the applicability of GloboDiet by the interviewers (n = 8), the focus group technique combined with Content Analysis was applied. To assess the applicability of the software by the interviewees, a questionnaire was sent by e-mail and employees used descriptive statistics procedures and the Chi-square and Fisher's Exact tests to study the differences between sex and age group and the answers provided. Results. adherence rates were 71% and 50% in face-to-face and predominantly telephone interviews, respectively. The total duration of face-to-face and telephone interviews was 30.7 (interquartile range [IQR], 23.3-40.7) and 35.3 (IQR, 25.3-49.7) minutes (p <0.001). As for the focus group, five main themes emerged during the discussion, pointing out that GloboDiet has potentialities related to its level of detail and ability to guide the interviewer during the collection, and limitations in the training stage and in the recipe database. In the questionnaire sent to the interviewees, a response rate of 18.6% (n = 540) was obtained, and the results indicated a good acceptance of the software, the interview time and the photographic manual by the interviewees, and the preference for face-to-face interview format. Conclusion. From the results found in this study, it was possible to show that the GloboDiet software is viable to the routine of an epidemiological study and acceptable to the interviewees and interviewers.

Achieving 100 percent compliance to perioperative antibiotic administration: a quality improvement initiative

INTRODUCTION@#Timely administration of prophylactic antibiotics within 60 minutes before surgical incision is important for reducing surgical site infections. This quality improvement initiative aimed to work towards achieving 100% compliance with perioperative antibiotic administration.@*METHODS@#We examined the workflow in our Anaesthesia Information Management System (AIMS) and proposed interventions using cause-and-effect analysis of anonymised anaesthetic records from eligible surgical cases extracted from AIMS. This ultimately led to the implementation of an antibiotic pop-up reminder. The overall process was done in a few small plan-do-study-act cycles involving raising awareness, education and reorganisation of AIMS before implementation of the antibiotic pop-up reminder. Data analysis took place from August 2014 to September 2016. Compliance was defined as documented antibiotic administration within 60 minutes before surgical incision, or as documented reason for omission.@*RESULTS@#The median monthly compliance rate, for 33,038 cases before and 28,315 cases after the reminder was implemented, increased from 67.0% at baseline to 94.5%. This increase was consistent and sustained for a year despite frequent personnel turnover. Documentation of antibiotic administration also improved from 81.7% to 99.3%, allowing us to identify and address novel problems that were initially not apparent, and resulting in several department recommendations. These included administering antibiotics later for cases with predicted longer-than-expected preparation times and bringing forward antibiotic administration in lower-segment Caesarean sections.@*CONCLUSION@#The use of information technology and implementation of an antibiotic pop-up reminder on AIMS streamlined our work processes and brought us closer to achieving 100% on-time compliance with perioperative antibiotic administration.

Development and Evaluation of a Smartphone Application for Managing Gestational Diabetes Mellitus / 대한의료정보학회지

OBJECTIVES: The purpose of this study was to develop and evaluate an application (app) that provides tailored recommendations based on lifestyle and clinical data entered by the user. METHODS: Knowledge and functions required for the gestational diabetes mellitus (GDM) management app were extracted from clinical practice guidelines and evaluated through an online survey. Common and tailored recommendations were developed and evaluated with a content validity index. Algorithms to link tailored recommendations with a patient's data were developed and evaluated by experts. An Android-based app was developed and evaluated by comparing the process of data entry and recommendation retrieval and the usability of the app. After the app was revised, the user acceptance of the app was evaluated. RESULTS: Six domains of knowledge and 14 functions were extracted. Seven common and 49 tailored recommendations were developed. Nine lifestyle and clinical data elements were modeled. Eight algorithms with 18 decision nodes presenting tailored recommendations based on patient's data and 12 user interface screens were developed. All recommendations obtained from the use of app concurred with recommendations derived by algorithms. The average usability score was 69.5 out of 100. The user acceptance score with behavioral intention to use was 5.5, intrinsic motivation 4.3, the perceived ease of use score was 4.6, and the perceived usefulness score was 5.0 out of 7, respectively. CONCLUSIONS: The GDM management knowledge and tailored recommendations obtained in this study could be of help in managing GDM.

Alertas a alergias y su omisión: una revisión narrativa / Alertas contra alergias e sua omissão: uma revisão narrativa / Allergy alerts and it's override: an overview

OBJETIVO, realizar uma revisão narrativa sobre alertas contra alergias. MÉTODOS, busca em MEDLINE utilizando as palavras-chave "clinical decision support system", "allergy" e "alert". A faixa de tempo definida foi de 16anos (a presente data, 2016). Foram incluídos 17 artigos. RESULTADOS. Os estudos recentes arrojaram valores altos de omissão multifactoriais. CONCLUSÕES. As problemáticas: uma fonte de informação que é incompleta ou inexata, a falta de distinção e esquematização na história clínica entre uma reação imunomediada vs. não imunomediada, ausência de atualização da lista de problemas do paciente. Falta de contexto. Alertas de baixo risco. A fadiga de alertas. Então,é importante obter claridade, exatidão e confiabilidade em cada passo do ciclo de alertas contra alergias. Mais ainda,uma retroalimentação das ações dos usuários, uma avaliação dos alertas omitidos; e una monitoração estrita das reações adversas a fármacos ocorridas em pacientes nos que um alerta tenha sido deflagrada.

OBJETIVO, llevar a cabo una revisión narrativa sobre alertas de alergias. MÉTODOS, búsqueda en MEDLINE usando las palabras clave "clinical decision support system", "allergy" y "alert". El rango establecido de 16 años(hasta la fecha actual, 2016). Se incluyeron 17 artículos. RESULTADOS. Estudios recientes arrojaron altos valores de omisión multifactoriales. CONCLUSIONES. La problemática: una fuente de información incompleta o inexacta, la falta dedistinción y esquematización en la historia clínica de una reacción inmunomediada vs. no inmunomediada, la faltade actualización de la lista de problemas del paciente. La falta de contexto. Alertas de bajo riesgo. Fatiga de alertas. Espor eso importante obtener claridad, precisión y fiabilidad en cada paso del ciclo de alertas de alergias. Aun más, unaretroalimentación de las acciones del usuario, una evaluación de alertas omitidas; y una monitorización estricta de las reacciones adversas producidas en pacientes en los que una alerta se ha activado.

O padrão etário na dinâmica temporal da dengue no Brasil

Dengue é uma doença viral provocada por quatro sorotipos de arbovírus e transmitida aos seres humanos por mosquitos do gênero Aedes. A dispersão geográfica dos vetores e dos vírus levou a uma reemergência global deste agravo, com destaque para as epidemias e o aparecimento de formas graves nosúltimos anos. Se, por um lado, as recentes publicações revelam baixo impacto nas estratégias de controle vetorial para dengue, por outro lado, houve grande expectativa com o lançamento de vacinas para a prevenção da doença. Em vários países onde a ocorrência de dengue é relevante, a distribuição dos casos por faixa etária não é homogênea, levantando dúvidas sobre quais os fatores interferem na dinâmica da incidência de dengue segundo a idade. Objetivo: Caracterizar o padrão de incidência de dengue e dengue grave ao longo do tempo segundo a faixa etária no período de 2007 a 2012 nas capitais estaduais brasileira.Métodos: Foi realizada a seleção das capitais com maior taxa de incidência entre as séries de dengue edengue grave por faixa etária em cada região do país para prosseguimento da pesquisa, totalizando a análise estatística de 4 capitais, referentes a suas respectivas regiões: Rio Branco (Região Norte), Aracaju(Região Nordeste), Cuiabá (Região Centro-Oeste) e Vitória (Região Sudeste). Seguiu-se a regressão das curvas de incidência de dengue e dengue grave, segundo faixa etária ao longo do tempo, utilizando Modelos Lineares Generalizados com distribuição de probabilidade de Poisson. Resultados e Discussão:Em função da análise exploratória das séries, foram construídos dois modelos de Poisson que incluíram como variáveis dependentes um termo autorregressivo, o grupo etário (<15 e ≥15 anos) e o tempo; no segundo modelo de Poisson, incluiu-se ainda um termo de interação entre o grupo etário e o tempo...

Dengue is a viral disease caused by 4 serotypes of arbovirus and transmitted to humans byAedes mosquitoes. The geographical dispersion of these vectors and viruses has led to a globalresurgence of this disease, with the occurrence of epidemics and the appearance of severe forms in thelast years. Prior studies have shown that vector control can have only limited impact on dengueincidence. We currently have 2 vaccines available to prevent dengue and there is great expectationwith the application of these vaccines on a large scale. In several countries where the incidence ofdengue is relevant, the distribution of cases by age group is not homogeneous, raising questions aboutwhich factors influence the dynamics of dengue incidence according to age. Objective: To characterizethe pattern of the incidence of dengue and severe dengue over time according to age group from 2007to 2012 in the Brazilian state capitals. Methods: Brazilian capitals with highest incidence rate ofdengue and severe dengue by age group in each region of the country were selected for furtherresearch, totaling the statistical analysis of 4 capitals, referring to their respective regions: Rio Branco(North Region), Aracaju (Northeast), Cuiabá (Midwest Region) and Vitória (Southeast). The incidencerate of dengue and severe dengue, according to age over time, were modeled using Generalized LinearModels with Poisson probability distribution. Results and Discussion: Descriptive statistics guided thecreation of two models that included an autoregressive term, age group and time as explanatoryvariables. The second model included also an interaction term of age group and time. In cases ofdengue in Rio Branco, Aracaju and Vitoria, the age group ≥15 years had a incidence rate that wassignificantly higher than that observed among those who were <15 years...

Finite element study on modification of bracket base and its effects on bond strength

OBJECTIVE: This article aims to analyze the difference in stresses generated in the bracket-cement-tooth system by means of a peel load in single and double-mesh bracket bases using a three-dimensional finite element computer model. MATERIAL AND METHODS: A three-dimensional finite element model of the bracket-cement-tooth system was constructed and consisted of 40,536 bonds and 49,201 finite elements using a commercial mesh generating programmer (ANSYS 7.0). Both single and double-mesh bracket bases were modified by varying the diameter from 100-400 µm progressively, and the spacing between the mesh wires was kept at 300 µm for each diameter of wire. A peel load was applied on the model to study the stresses generated in different layers. RESULTS: In case of double-mesh bracket base, there was reduction in stress generation at the enamel in comparison to single-mesh bracket base. There was no difference in stress generated at the bracket layer between single and double-mesh bracket bases. At the impregnated wire mesh (IWM), layer stresses increased as the wire diameter of the mesh increased. CONCLUSION: Results show that bracket design modification can improve bonding abilities and simultaneously reduce enamel damage while debonding. These facts may be used in bringing about the new innovative bracket designs for clinical use. .

OBJETIVO: o objetivo do presente artigo é analisar a diferença entre as tensões geradas na interface braquete-cemento-dente por meio do teste peel load em bases de braquete de malha simples e dupla e do método de elementos finitos tridimensional. MÉTODOS: foi construído um modelo de elementos finitos do sistema composto pela interface braquete-cemento-dente. Esse modelo consistiu de 40.536 nós e 49.201 elementos finitos. A análise foi feita com a ajuda do programa ANSYS 7.0. Tanto a base de braquete de malha única quanto a de malha dupla sofreram modificações no diâmetro, que variou de 100 a 400µm, progressivamente. O espaço entre os fios das malhas foi mantido a 300µm para o diâmetro de cada fio. O teste peel load foi aplicado ao modelo para investigar as tensões geradas nas diferentes camadas. RESULTADOS: quando comparadas às bases de braquetes de malha simples, as bases de braquetes de malha dupla geraram menos tensão no esmalte dentário. Não foram detectadas diferenças entre as tensões geradas na superfície dos braquetes com bases de malha simples e dupla. Na malha de fios impregnados (MFI), houve um aumento na tensão com o aumento do diâmetro dos fios que compõem a malha. CONCLUSÃO: os resultados revelam que as modificações no desenho do braquete podem aumentar a colagem e, ao mesmo tempo, minimizar os danos causados no esmalte durante o processo de descolagem. Esses fatos podem ser utilizados no desenvolvimento de desenhos de braquetes inovadores, destinados à utilização clínica. .

Compliance of antiviral therapy and influencing factors in people living with HIV/AIDS in Nanjing / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the compliance of highly active anti-retroviral therapy (HAART) and influencing factors in people living with HIV/AIDS (PLWHA) in Nanjing.</p><p><b>METHODS</b>PLWHA receiving HAART in No. 2 Hospital of Nanjing during May-June 2014 were recruited in this study. Self-administrated questionnaire was used to collect the data about HAART compliance and socio-demographic characteristics of PLWHA surveyed. Descriptive and multivariate statistical analysis were conducted to examine the effects of the factors on self-reported HAART adherence.</p><p><b>RESULTS</b>A total of 276 PLWHA were surveyed, According to the evaluation criterion of Center for Adherence Support Evaluation (CASE), 252 cases showed good compliance (91.3%). logistic regression analysis revealed that smoking, progress of the disease and side effects, reminding of taking drug and age were correlated with self-reported HAART adherence.</p><p><b>CONCLUSION</b>It is suggested to strengthen the education about antiviral therapy compliance in PLWHA with mild infection and those who are smokers and young, suffer from side effects, have no reminding methods for taking drug.</p>

Use of short message service reminders to improve attendance at an internal medicine outpatient clinic in Saudi Arabia: a randomized controlled trial

Non-attendance at outpatient appointments is a major problem. This study aimed to evaluate the efficacy of sending short message service [SMS] reminders to patients' mobile phones in reducing non-attendance at scheduled appointments. A randomized clinical trial was conducted in 2011 in an internal medicine outpatient clinic at a hospital in Eastern Province, Saudi Arabia. Eligible patients [n = 502] were randomly allocated to receive an SMS reminder of their appointment [intervention group] or no reminder [control group]. The non-attendance rate was significantly lower in the reminder group [26.3%] than the non-reminder group [39.8%]. In multivariate logistic regression, age, sex and nationality did not affect attendance rates but having their first contact with the hospital [OR = 7.40] and not receiving an SMS reminder [OR = 0.56] were significant factors in non-attendance. All patients surveyed about their perceptions of the SMS reminder [n = 76] reported they would like to continue to receive SMS reminders in the future

Overcoming Barriers to Mammography Screening: A Quasi-randomised Pragmatic Trial in a Community-based Primary Care Setting

<p><b>INTRODUCTION</b>Breast cancer is the leading cancer among women in Singapore. Five years after a population-wide breast cancer screening programme was introduced, screening rates remained relatively low at 41%. Studies have shown decreased screening propensity among medically underserved women typically of minority or socioeconomically disadvantaged status. We conducted a quasi-randomised pragmatic trial aimed at encouraging mammography screening among underscreened or unscreened women in a publicly funded primary care facility in Singapore.</p><p><b>MATERIALS AND METHODS</b>The study was conducted from May to August 2010. Components of intervention included (1) tailored education, (2) doctor's reminder, and (3) cost reduction. Researchers administered a structured questionnaire to eligible female polyclinic attendees and patient companions aged 40 to 69 years. Individual knowledge, attitudes, beliefs, and barriers towards mammography screening were identified and educational messages tailored. Doctor's reminder and cost reduction were implemented additively.</p><p><b>RESULTS</b>Overall, out of 448 participants, 87 (19.4%, 95% confidence interval (CI), 15.8% to 23.1%) completed mammography screening across 3 arms of study. Participants who received a cost reduction were more likely to attend screening compared to participants in other intervention arms (adjusted odds ratio (OR) 2.4, 95% CI, 1.2 to 4.5, P = 0.009). Cost of screening, ethnicity, prior screening history, and attitudes towards mammography screening were identified as significant factors predicting mammogram attendance.</p><p><b>CONCLUSION</b>Including a cost reduction component was the most effective intervention that increased mammography screening rates. Women's underlying beliefs, attitudes, and other predisposing factors should also be considered for integration into existing breast cancer screening programmes.</p>

Encuesta nutricional pediátrica / Pediatric nutrition survey

Luego de los años setenta, y a partir de la experiencia norteamericana, en varios países, se comienza a medir el estado alimenticio de la población y los cambios a través del tiempo. La encuesta nacional, con el fin de ofrecer información periódica y actualizada, permite desarrollar, monitorear y establecer políticas en relación a la salud y nutrición de la población infantil. Entre los métodos de encuesta nutricional más utilizados están el recordatorio de 24 horas, el registro diario de alimentos, peso directo de los alimentos y frecuencia semi-cuantitativa.

After the seventies, and from the American experience in several countries, begin to measure the nutritional status of the population and changes over time. The national survey, in order to provide regular and updated information, can develop, monitor and develop policies in relation to health and nutrition of children. Among the nutritional survey methods most used are the 24-hour recall, the journal of food, live weight of food and often semi-quantitative.

Defaulters among lung cancer patients in a suburban district in a developing country

This study was carried out to determine the prevalence, patient's characteristic and reasons for defaulting follow-up and treatment among patients with lung cancer. Patients with histologically confirmed lung cancer were recruited. Patient's detailed demographic data, occupation, socioeconomic status, and educational level of both the patients and their children were recorded. Defaulters were classified as either intermittent or persistent defaulters. By using Chi-square test, defaulter status was compared with various demographic and disease characteristic factors. The reasons for default were determined. Ninety five patients were recruited. Among them, 81.1% patients were males; 66.3% were Malays. The mean age [SD] was 60 +/- 10.5 years. About 46.3% of the patients had Eastern Cooperation Oncology Group [ECOG] functional status 0/1 and 96.8% of the patients presented with advanced stage [Stage 3b or 4]. Overall, 20 patients [21.1%] were defaulters [35.0% intermittent defaulters; 65.0% persistent defaulters]. Among the intermittent defaulters, 8 patients defaulted once and one patient defaulted 3 times. Among the 20 defaulters, only 2 [10%] patients turned up for the second follow-up appointment after telephone reminder. Two main reasons for default were 'too ill to come' [38.5.5%] and logistic difficulties [23.1%]. No correlation was found between patient education, children education, income, ECOG status, stage of the disease, race, and gender with the defaulter rate. Defaulter rate among lung cancer patients was 21.1%. Children education level is the only significant factor associated with the defaulter rate