Accelerating clinical drug development for children with tuberculosis.

Despite urgent need, the development, approval and availability of child-friendly anti-tuberculosis drugs lag significantly behind that of adults, with children having been ignored in anti-tuberculosis drug development research. This paper outlines possible strategies for accelerating and better integrating the development of drugs and regimens for pediatric tuberculosis (TB) into existing drug development pathways for adults: initiation of pediatric studies of new treatments as soon as promising efficacy data have been generated in adults following successful phase II studies, shifting from the current age de-escalated approach to concomitant enrollment of children from the various age groups in studies, and leveraging the concepts of both the Unified Pathway and regimen development that have helped speed the study and development of novel regimens in adults.

Screening for breast cancer in Ghent, Belgium: first results of a programme involving the existing health services.

In 1992, a population-based breast cancer screening programme was initiated in the municipality of Ghent: all women aged 40-69 years were personally invited to attend a local radiology unit for a mammogram, after being examined by a general practitioner or gynaecologist of their choice. The results of history taking, clinical breast examination, first and second reading, further investigation and primary treatment were registered. In total, 24.3% of the eligible population was screened in the period 1992-1994. The recall and biopsy rates were 2.9% and 1.4%, respectively. The cancer detection rate was 8.1 per 1000 women screened. Of all cancers detected, 88.0% (66/75) were invasive. Of these, 35.9% (23/64) measured 10 mm or less in diameter. The benign to malignant biopsy ratio was 0.7. Apart from the low participation, these results suggest that the programme is effective, compared with reference standards and the results of other studies.

Organization of obstetrical care in Belgium.

Belgium, with its pluralistic health care system, has many small-sized maternity units staffed almost exclusively with obstetricians. The maternal and perinatal mortality and morbidity rates are still higher than in some of the neighboring countries. The new regulations with regard to the accreditation of maternity units might improve the figures. Other measures must be taken, however, to ensure that only low-risk patients are taken into small maternity units and that all high-risk cases and all those developing complications are cared for in large, well-equipped and well-staffed hospitals. Some form of peer review would also be beneficial.