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Reprint requests and correspondence: Dr. Kristian Wachtell, Rigshospitalet, Department of Medicine B2142, 9 Blegdamsvej, DK-2100 Copenhagen, Denmark. E-mail: kristian wachtell.
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What little high ground is available. Urbanization will play an increasingly important role as more people move to over-crowded low lying areas with minimal health services and inadequate shelter. For organizations working in the health and development field, the floods bring more than just a disruption to research or intervention activities; they uncover the real vulnerability of the medically underserved, and inadequacies in supportive infrastructure. If floods of the magnitude of 2004 become a recurrent pattern, the urban poor will increasingly need help in the form of crisis intervention, not only during the floods but even more so as the waters recede. The challenge for the health sector is to develop a timely, appropriate and coordinated response that is informed by rapid appraisal methods. The challenge to the donor and relief agencies will be to create systems to make their aid available as soon as those needs are determined. Together, these will require greater leadership, resulting in improved communication and coordination amongst these parties. ICDDR, B's health and demographic surveillance sites provided a unique opportunity to gauge the needs of the population at the beginning of the floods. In Kamalapur we quickly determined those in the community who were in greatest need of food, medical care, and safe water, regardless of their participation in our research, and then worked to provide those services through cooperation with our donors and other partners in the area. We gratefully acknowledge the contributions of our donors during this time, which allowed us to meet the needs of those we serve. It is imperative that we understand these tragic floods as more than just a time to endure but as an opportunity to learn and improve. The lessons learned from this and past floods should influence the way we respond during future crises. As evidenced by contaminated water sources and increases in diarrhoea during this flood, water treatment should be a high priority. We learned that contaminated water could be made safe by using an inexpensive substance, alum potash, which is readily available in the community. We also were able to document acute health care needs, including more severe forms of disease at our Dhaka Hospital and increased barriers to accessing care in the community. Finally, although we were able to quickly document the effects of the floods, it took weeks to put some relief interventions, particularly food distribution, into place. To respond in a more timely manner during the next flood, ICDDR, B is using this year's flood response effort to create a data-driven flood plan which can be put into effect at the start of future floods, and be flexible and adaptable enough to meet future needs.
By Mike Harrold The past 2 years of my life have been an exercise of disbelief and perplexity. What I cannot believe or at least have a hard time swallowing ; is how, in the world's greatest nation, there exists a perpetual group of people with a terminal condition lacking the sufficient source of funds to find a life saving treatment? In other words, why is it socially acceptable that EVERY 12 years, we lose more people to ALS than in the Viet Nam War? As an American, I firmly believe as a nation there is nothing we can't accomplish. Didn't we set a goal to land on the moon in the 60's? And after essentially writing a blank check to NASA, we landed and returned safely home in July of 1969. All we have to do is open the governmental checkbook and all problems can be solved. Last year I found that the National Institutes of Health fund ALS research at about $20 million. Compare that amount to AIDS funding which is over $2 billion annually. This figure is from the NIH's $20 billion budget and doesn't include corporate research funding from pharmaceutical companies! ; Having ALS is bad, but NOT allocating funds to find some life extending medication is criminal. I even searched the archives of the public budget hearings held at the NIH for the previous 3 years. The word ALS was only used 3 times, and 2 of the references were condemning the independent startup ALS foundations, such as Project ALS. When I look over all the research programs of the NIH, there are many such as Obesity, Smoking, etc. that shouldn't even be funded by tax dollars. I can't believe and we have money to find out what happens if a person habitually eats fast food and drinks cola while smoking 2 packs of Marlboro a day. And these are not small programs. Out of the $20 billion and isordil.
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60%-75% ; reported that they had a general knowledge of which products to use. However, only 29% said their PCP recommended symptomatic treatments. Finally, almost all respondents 90% ; stated that they wanted to learn more about self-care of URI. Discussion This study attempted to determine the feasibility of a protocoldriven community pharmacy intervention program to decrease inappropriate BSA use in the treatment of URI. Notable findings are that it is feasible for a community pharmacist to collect clinically meaningful information about indications for antimicrobial use from patients, with the vast majority of patients being willing to discuss their illness and treatment with a pharmacist. Pharmacists were able to work patient data collection, tentative diagnosis, and a preliminary assessment of treatment appropriateness into their workflow; it required an average of 3 minutes. The second question, that of the feasibility of a community pharmacist to intercept inappropriate prescriptions through a process of patient consent and communication with the ordering clinician to decrease BSA use in URI, went largely untested because the majority of eligible patients were unwilling to provide informed consent for the intervention. Most patients who refused to participate were insistent about receiving an antimicrobial, but the reasoning behind the insistence, or whether a different narrow-spectrum antimicrobial might be acceptable, could not be determined. Few patients resented the pharmacy interference. Very limited data from completed intervention cases suggested that providers in this rural environment were accessible within the 20-minute time frame and were and colchicine.
AMENDMENTS TO D&C RULES 1. ; These rules may be called the Drugs and Cosmetics IV Amendment ; Rules, 2005. 2 ; They shall come into force on the date of their publication in the Official Gazette. 2. In the Drugs and Cosmetics Rules, 1945, in Schedule 'P' a ; Under the heading 'Other Vaccines' for serial number 2 and the entries relating thereto, the following words, figures and letter shall be substituted, namely: 1 "2. BCG Vaccine 3 24 4 cold place.
The sample represents 80% of 258 children who participated in the first lab visit at 4 months of age. Of the 52 families not seen at 5 years, 15 moved out of the area, 10 declined to participate, 18 could not be contacted, 1 child and 2 mothers died, and 6 children went to foster parents who declined to participate. There were no significant differences in the distributions of cocaine exposure, gender, perinatal medical risk, or environmental risk between children who participated and those who refused to continue or were lost to the study from the neonatal period through 5 years of age. Participation was voluntary, and incentives were provided in the form of vouchers for use at local stores. The study was approved by the Institutional Review Boards of the participating hospitals, as well as the medical school. Informed consent was obtained at the time of the study from the child's legal guardian.
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