Search PubMed⌕ Search

Biomedical subjects

A Harrison

Publications and source records attributed to A Harrison.

At least 73 records · Page 4Linked to original sources
PubMed1999

Inadequate treatment for sexually transmitted diseases in the South African private health sector.

Correct management of sexually transmitted diseases (STDs) is important for their control, and to reduce HIV transmission. Guidelines on syndromic management of STDs were introduced by the provincial Department of Health in KwaZulu/Natal (KZN) in South Africa in 1995. The drug treatment provided for STDs by the 11 private general practitioners in one rural district was assessed and compared with provincial guidelines. Information was gathered through semistructured interviews which asked the 11 doctors, who all dispense prescribed drugs as part of the consultation fee, how they would treat 3 hypothetical cases of STD syndromes. In all 33 prescriptions, the treatment did not correspond exactly with provincial recommendations and only 3 (9%) were adequate. All other prescriptions were inadequate because dose or duration was incorrect in 6 (18%), or because incorrect drugs were prescribed in 24 (73%) of cases. Eight of the 11 doctors did not provide adequate treatment for any of their cases. A continuing medical education programme for the doctors and their staff was devised to improve the STD treatment in the private sector in this South African district.

Adult↗
PubMed1999

Unrecognized sexually transmitted infections in rural South African women: a hidden epidemic.

Sexually transmitted infections (STIs) are of major public health concern in developing countries, not least because they facilitate transmission of human immunodeficiency virus (HIV). The present article presents estimates of the prevalence, on any given day, of STIs among women in rural South Africa and the proportion who are asymptomatic, symptomatic but not seeking care, and symptomatic and seeking care. The following data sources from Hlabisa district were used: clinical surveillance for STI syndromes treated in health facilities, microbiological studies among women attending antenatal and family planning clinics, and a community survey. Population census provided denominator data. Adequacy of drug treatment was determined through quality of care surveys. Of 55,974 women aged 15-49 years, a total of 13,943 (24.9%) were infected on any given day with at least one of Trichomonas vaginalis, Neisseria gonorrhoeae, Chlamydia trachomatis, or Treponema pallidum. Of the women investigated, 6697 (48%) were asymptomatic, 6994 (50%) were symptomatic but not seeking care, 238 (1.7%) were symptomatic and would seek care, and 14 (0.3%) were seeking care on that day. Only 9 of the 14 women (65%) were adequately treated. STIs remained untreated because either women were asymptomatic or the symptoms were not recognized and acted upon. Improved case management alone is therefore unlikely to have a major public health impact. Improving partner treatment and women's awareness of symptoms is essential, while the potential of mass STI treatment needs to be explored.

Adolescent↗
PubMed1999

Managing acutely disturbed behaviour.

Managing acutely disturbed behaviour is difficult, particularly in environments which are not designed for dealing with such conduct. An understanding of factors which can lead to this behaviour and clear management policies and procedures are needed.

Acute Disease↗
PubMed1998

Improving quality of sexually transmitted disease case management in rural South Africa.

OBJECTIVE: To measure quality of sexually transmitted disease (STD) syndromic case management and aspects of health-seeking behaviour at baseline in an intervention trial. SETTING: Ten rural primary care clinics, Hlabisa district, South Africa. DESIGN: Simulated patients (fieldworkers trained to present with STD syndromes) made a total of 44 clinic visits; 49 STD patients were interviewed when exiting clinics; facilities were assessed for availability of necessary equipment and drugs; 10 focus group discussions were held with staff; and STD syndrome surveillance was performed in all 10 clinics. RESULTS: A total of 9% of simulated patients were correctly managed (given correct drugs, plus condoms and partner notification cards), recommended drug treatment was given in only 41% of visits, and appropriate counselling was given in 48% of visits. Among patients leaving the clinic, although 39% waited over an hour to be seen and only 37% were consulted in private, all reported staff attitudes as satisfactory or good. Only six clinics had syndromic management protocols available, three reported intermittent drug shortages, and seven lacked partner notification cards. Focus group discussions revealed good staff knowledge about STD, but showed lack of training in syndromic management and low morale. Surveillance data showed that while 75% of those presenting for care did so within 1 week of symptom onset, 27% had been treated for an STD in the preceding 3 months, and only 6% of those treated were contacts. CONCLUSIONS: Quality of STD case management was poor despite good staff knowledge and availability of most essential resources. An intervention comprising staff training and STD syndrome packets has been designed to improve quality of case management.

Case Management↗
PubMed1998

Neural systems underlying arousal and attention. Implications for drug abuse.

The monoaminergic and cholinergic systems are implicated in different forms of behavioral arousal that can be dissected in terms of their forebrain targets and the nature of the behavioral processes they modulate in distinct regions. Thus, evidence in rats with selective neurochemical manipulations tested behaviorally using an analog of an attentional task developed for human subjects indicates that the coeruleo-cortical noradrenergic system is implicated in divided and selective attention, the basal forebrain cholinergic system in stimulus detection, the mesostriatal and mesolimbic dopaminergic systems in response speed and vigor, and the mesencephalic serotoninergic or 5-HT systems in response inhibition. Our recent studies have focused on fractionating, in the same task, the differential contributions of the dorsal and median raphé 5-HT systems as well as elucidating the functions of the mesocortical dopaminergic system, each of which may be relevant to understanding the behavioral and cognitive sequelae of cocaine administration in human subjects as well as in experimental animals.

Animals↗
PubMed1998

Waiting lists. The wrong target.

The numbers now waiting for treatment in the NHS are more than double what they were in 1948 despite huge increases in activity. Increased activity has not reduced the time patients wait. Mean waiting times in the 1990s were 13-14 weeks, the same as in the 1960s and 1970s. An increase in activity to reduce the numbers waiting for treatment may, in fact, increase the number being put on the waiting list. Government targets should concentrate on how long individual patients have to wait, rather than reducing the numbers on the waiting list.

Elective Surgical Procedures↗
PubMed1998

Identification of the t complex-encoded cytoplasmic dynein light chain tctex1 in inner arm I1 supports the involvement of flagellar dyneins in meiotic drive.

The cytoplasmic dynein light chain Tctex1 is a candidate for one of the distorter products involved in the non-Mendelian transmission of mouse t haplotypes. It has been unclear, however, how the t-specific mutations in this protein, which is found associated with cytoplasmic dynein in many tissues, could result in a male germ cell-specific phenotype. Here, we demonstrate that Tctex1 is not only a cytoplasmic dynein component, but is also present both in mouse sperm and Chlamydomonas flagella. Genetic and biochemical dissection of the Chlamydomonas flagellum reveal that Tctex1 is a previously undescribed component of inner dynein arm I1. Combined with the recent identification of another putative t complex distorter, Tctex2, within the outer dynein arm, these results support the hypothesis that transmission ratio distortion (meiotic drive) of mouse t haplotypes involves dysfunction of both flagellar inner and outer dynein arms but does not require the cytoplasmic isozyme.

Amino Acid Sequence↗
PubMed1998

Computer-generated study of the correlation between tooth, face, arch forms, and palatal contour.

STATEMENT OF PROBLEM: Several factors have been suggested as aids for artificial tooth selection. Numerous methods have been devised for the evaluation of reliable esthetic factors in determining artificial tooth form. There is no universally accepted single esthetic factor that can be used reliably to aid artificial tooth selection. PURPOSE: This article describes a new method incorporating a computer program to analyze four esthetic factors: form of the face, arch form, palatal contour, tooth shape, and to determine whether there was correlation between tooth, face, and arch forms and palatal contour. MATERIAL AND METHOD: Impressions were made of the maxillary dentition of 50 dentate undergraduate dental students with irreversible hydrocolloid impression material and casts formed. A standardized photographic procedure was used to record portrait slides of each subject's face and of maxillary dental arches and central incisors made from dental casts. A comprehensive computer program was developed to correlate esthetic factors by superimposition. RESULTS: Superimposing outline form between face, tooth, and arch showed that for tooth to face form nearly half the comparisons were dissimilar and only 22% corresponded. This is the lowest level of correspondence in this group. Highest correspondence (28%) occurred between arch to face form, followed by arch to tooth form (24%). Arch to tooth showed the lowest level of dissimilarity (32%). For correlation among the four factors across the sample group based on a comparison of classifications in each subject, men tended to dominate tapering classes, whereas women dominated square and ovoid classes. CONCLUSION: Correspondence of outline forms through superimposition revealed an insignificant correlation between face, tooth, and arch forms. Although this method applies high technology, it does not improve the accuracy of determining shape and size of teeth in an edentulous patient. The cost and complexity of the method of measurement may also make it impractical for common application.

Adult↗
PubMed1998

Strains and tensile stress distribution in loaded disc-shaped ceramic specimens. An FEA study.

Disc-shaped specimens are frequently tested in order to establish an understanding of the properties of ceramic material. In this study three-dimensional finite element stress analysis has been used to investigate the loading characteristics of this shape of specimen and the effect of incorporating scratches and voids into its structure. The results indicated that stress increased as loading was carried out nearer to the centre of the specimen. The presence of cracks did not affect these stresses whereas the presence of a void resulted in a very high stress concentration.

Compressive Strength↗
PubMed1998

Automated fluorescence microscopic measurement of apoptosis frequency following ionizing radiation exposure in cultured mammalian cells.

PURPOSE: To develop and assess an automated image cytometric method of apoptotic cell classification for use under conditions in which apoptosis is a rare event (e.g. fibroblastoid cell lines or low-dose irradiation). METHOD: Image acquisition software was adapted to gather double-stained cell images from slides prepared using cell fixation and staining methods that emphasized apoptotic morphology. Chinese hamster ovary cells (CHO) were classified individually by discriminant analysis of morphological and nuclear texture features calculated for each image. Discriminant functions were constructed from a manually classified set of over 60000 cell images categorized as 'normal', 'apoptotic', 'cell doublets' or 'debris' and all subsequent cell images collected were classified using these functions. RESULTS: Application of this technique resulted in a 99.8% accuracy in classification of the normal cell population, and 81.7% classification accuracy for apoptotic cells. This method was then applied to study the time course of the apoptotic response of CHO cells following X-irradiation. Following irradiation with 5 Gy no increase above control levels of apoptosis was noted until 18 h post-irradiation, which corresponded with the release of the G2 block as determined by DNA-content analysis. Apoptotic frequency increased to a peak level of 12.1 +/- 4.6% at 42 h post-irradiation. CONCLUSIONS: Automated image cytometry provides an efficient and consistent method of apoptosis measurement. This study represents the first detailed characterization of the time course and the role of cell division in CHO cell apoptosis.

Animals↗
PubMed1998

Sexually transmitted disease syndromes in rural South Africa. Results from health facility surveillance.

BACKGROUND AND OBJECTIVE: Surveillance for sexually transmitted diseases (STD) is important for priority setting, service development, and evaluating interventions. GOAL: To conduct health facility-based surveillance for STDs to inform design of a control program and to provide baseline measures for evaluation of interventions. STUDY DESIGN: Surveillance system for patients with STD syndromes in public and private sector health facilities in Hlabisa, South Africa. RESULTS: Over a 5-month period, 4,781 patients with an STD were reported, 3,126 (65%) by clinics and 1,655 (35%) by general practitioners; 2,582 (54%) were in men. Most were diagnosed with a single syndrome. Discharge was most common (49% of both male and female patients), followed by ulcer (36% of men and 14% of women). Mean symptom duration was 18 days for women and 10 days for men (p < 0.0001). A quarter reported having another STD in the previous 3 months. The highest age-specific incidence was estimated at 16.4% among women 20 to 24 years of age. CONCLUSIONS: The burden of STDs is high in rural South Africa. There is considerable scope for improved disease control, and the private sector has an important role to play.

Adolescent↗
PubMed1998

The correlation between selected factors which influence dental aesthetics.

This study evaluated the inter-relationship between five aesthetic factors: the form of the face, tooth and arch, maxillary anterior tooth arrangement and palatal contour. An assessment was made to determine if correlation was sufficient to recommend their use as reliable aesthetic factors for the selection of suitable tooth moulds for edentulous and partially edentulous patients. This would enable the clinician to select a tooth mould at the chairside, based on an evaluation of the individual's aesthetic factors where, for example, the maxillary incisors should have the same outline shape as the individual's face. A computer program was developed incorporating images of the factors taken from 50 Caucasian adults aged 20-31 years and assessment of correlation made by outline superimposition and classification. The objectives were to design a computer program to analyse, classify and evaluate correlation between the five factors in each case by superimposition and classification. Correlation by superimposition recorded some concurrence between forms. The findings of this study suggest that there was insufficient correlation to support Nelson's 'Aesthetic Triangle', or Williams' face form/tooth theory. The incidence of correlation by classification between anterior tooth arrangement and arch form was sufficiently high to suggest their value as an aesthetic aid.

Adult↗
PubMed1997

Dimerization of the highly conserved light chain shared by dynein and myosin V.

The Mr 8,000 light chain originally identified in Chlamydomonas flagellar dynein is also a component of both cytoplasmic dynein and myosin V. Furthermore, this small protein has been implicated as an inhibitor of neuronal nitric oxide synthase, suggesting that it may play multiple regulatory roles within the cell. Covalent cross-linking of both dynein and myosin V using 1,5-difluoro-2, 4-dinitrobenzene revealed that this light chain exists as a dimer in situ. This observation was confirmed using two additional amine-selective cross-linking reagents (dimethyl pimelimidate and disuccinimidyl suberate). When expressed as a C-terminal fusion with maltose-binding protein, the presence of the light chain caused the recombinant molecule to dimerize. Analysis of fusions containing truncated light chains identified the predicted amphiphilic helix (residues 14-32) as sufficient to cause dimerization; cross-linking required a second helical segment (residues 33-46). Together the data presented suggest that two light chains interact to form a parallel dimeric structure. This arrangement has significant implications for the potential functions of this highly conserved molecule and suggests a mechanism by which it might dissociate nitric oxide synthase.

Carrier Proteins↗
PubMed1997

A Chlamydomonas homologue of the putative murine t complex distorter Tctex-2 is an outer arm dynein light chain.

Molecular analysis of a 19,000-Mr protein from the Chlamydomonas flagellum reveals that it is homologous to the t complex-encoded protein Tctex-2, which is a candidate for one of the distorter products that cause the extreme transmission ratio distortion (meiotic drive) of the murine t complex. The 19,000-Mr protein is extracted from the axoneme with 0.6 M NaCl and comigrates with the outer dynein arm in sucrose density gradients. This protein also is specifically missing in axonemes prepared from a mutant that does not assemble the outer arm. These data raise the possibility that Tctex-2 is a sperm flagellar dynein component. Combined with the recent identification of Tctex-1 (another distorter candidate) as a light chain of cytoplasmic dynein, these results lead to a biochemical model for how differential defects in spermiogenesis that result in the phenomenon of meiotic drive might be generated in wild-type vs t-bearing sperm.

Animals↗
PubMed1997

Complete dentures--the soft option. An update for general dental practice.

Permanent soft linings are frequently used as a 'soft option' blanket treatment for problems such as chronic pain under a lower denture, when it would be more appropriate to diagnose and eliminate any possible precipitating factors. The aim of this article is to provide an update on temporary and permanent soft materials and to give guidance on their indications and limitations of use, together with advice on their maintenance.

Dental Impression Technique↗
PubMed1997

Funding the NHS. Is the NHS sustainable?

The survival of the NHS lies largely in the hands of government, and this article suggests steps that it should take to deal with pressures on the NHS in terms of funding, managing efficiency, and demands. Changes to the system of funding may be unfeasible, but management could be improved by research to allow greater understanding of the local effects of national policies. Alternatively health authorities could be given more freedom to manage funds, although this would have to be accompanied by stiff sanctions for those who failed. Demand could be contained by strengthening policies to ensure that new technologies are cost effective. The government could try to reduce demands arising from increased expectations by encouraging informed public debate about priorities and influencing the availability of private health care. All these efforts should be guided by the values underpinning the NHS, which should be debated and decided collectively and confirmed in a new charter for NHS's 50th anniversary in 1998.

Demography↗
PubMed1997

Funding the NHS. A little local difficulty?

The media have been full of reports of crisis in the NHS. Although national analyses suggest that the NHS should be able to cope within the increases in spending it has been given, local pressures can leave parts of the service struggling. Firstly, the change to allocation of funds on the basis of population needs has meant that some authorities and trusts have had effective cuts in their budgets, requiring them to trim services. Secondly, the government's insistence on an annual 3% increase in efficiency may have resulted in authorities taking short term measures that actually decrease efficiency in the long term. Thirdly, health authorities have had to bear the costs of national targets such as reducing waiting lists and junior doctors' hours as well as local problems such as higher numbers of mentally disordered offenders. However, all these factors can be controlled by national or local management and so their impact is not inevitable.

Efficiency↗