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CONTEXT: The perinatal mortality rate (PMR) in Macedonia is among the highest in Europe. The World Bank supported a consultant (HEJ) to collaborate with a Macedonian team to develop a national perinatal strategy with the goal of reducing the PMR. Education was given priority in the form of a hospital-based initiative to develop the capacity of health professionals to introduce evidence-based perinatal practice into 16 participating hospitals. A 'train the teachers' approach was used, with trainees introduced to modern education and clinical practice in Sydney and subsequently supported to train their colleagues in Skopje. OBJECTIVES: To describe the development, implementation and evaluation of the educational intervention. METHODS: A curriculum, based on specific Macedonian needs, was developed in order to integrate teaching in the knowledge, skills and attitudinal domains of learning, using small group, interactive techniques. Twenty-five Macedonian doctors and nurses participated in 4-month (phase 1a) and 6-month (phase 1b) teaching programmes at a tertiary perinatal unit in Sydney. Australian staff conducted 4 2-week modules for 36 trainees in Macedonia (phase 2). The phase 1 trainees conducted 8 modules for 57 colleagues in Skopje (phase 3). The intervention was evaluated by trainee questionnaires, assessments of competence, changes in hospital practice and pre- (1997-99) and post-intervention (2000-01) comparisons of PMR. RESULTS: A total of 115 doctors and nurses graduated from the programme. Positive responses to the education programme exceeded 80%. Evidence-based practice in 16 participating hospitals (covering 91% of all Macedonian births) was verified in 6 key areas of neonatology. The PMR fell significantly from 27.4 to 21.5 per 1000 births (RR 0.79, 95% CI 0.73, 0.85). The early neonatal death rate in babies weighing over 1000 g fell by 36%. CONCLUSIONS: The intervention has increased the capacity of Macedonians to practise best-evidence perinatal medicine and improve outcomes. Sustainability is predicted by the 'train the teachers' approach, with concurrent strengthening of the infrastructure and organisational framework. [ABSTRACT FROM AUTHOR]

PURPOSE: Few studies have evaluated cancer risk associated with low-dose occupational ionizing radiation exposure to women. We present data on incident cancer risks among a predominantly (77%) female cohort of 73,963 U. S. radiologic technologists followed up from 1983 through 1998.METHODS: Cancer incidence information and data on work history, selected cancer risk factors, personal radiation exposure and other health outcomes were obtained from two mailed questionnaires (administered ~1984 and ~1995). Incident cancers were ascertained from the second survey and supplemented by mortality records. Medical records, obtained for 74% of all self-reported cancers, confirmed the cancer in 85%. We computed standardized incidence ratios (SIR) using cancer incidence rates from the National Cancer Institute''s Surveillance Epidemiology and End Results Program.RESULTS: The SIR for all cancers combined in both sexes was 1.04 (95% confidence interval (CI): 1.00, 1.07; n = 3292). The incidence of solid cancers was elevated in women (SIR = 1.06, 95% CI: 1.02, 1.10), but lower than expected among men (SIR = 0.92 , 95% CI 0.85, 0.98). Female technologists had an elevated incidence of breast cancer (SIR = 1.16, 95% CI: 1.09, 1.23). Among both sexes combined, elevated risks were seen for melanoma (SIR = 1.59, 95% CI: 1.38, 1.80) and thyroid cancers (SIR = 1.61, 95% CI: 1.34, 1.88), and decreased risks were observed for buccal cavity/pharynx (SIR = 0.73, 95% CI: 0.55, 0.90), rectum (SIR = 0.62, 95% CI: 0.48, 0.76), and lung (SIR = 0.77, 95% CI: 0.70, 0.85) cancers.CONCLUSION: The elevated risk for breast cancer may be related to occupational radiation exposure. The observed melanoma and thryoid cancer excesses may reflect, at least in part, increased screening among medical workers with easy access to health care. [Copyright &y& Elsevier]