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Biomedical subjects

A Mills

Publications and source records attributed to A Mills.

At least 19 recordsLinked to original sources
PubMed2006

Fever treatment and household wealth: the challenge posed for rolling out combination therapy for malaria.

OBJECTIVE: To investigate the variation in malaria parasitaemia, reported fever, care seeking, antimalarials obtained and household expenditure by socio-economic status (SES), and to assess the implications for ensuring equitable and appropriate use of antimalarial combination therapy. METHODS: A total of 2,500 households were surveyed in three rural districts in southern Tanzania in mid-2001. Blood samples and data on SES were collected from all households. Half the households completed a detailed questionnaire on care seeking and treatment costs. Households were categorised into SES thirds based on an index of household wealth derived using principal components analysis. RESULTS: Of individuals completing the detailed survey, 16% reported a fever episode in the previous 2 weeks. People from the better-off stratum were significantly less likely to be parasitaemic, and significantly more likely to obtain antimalarials than those in the middle or poor stratum. The better treatment obtained by the better off led them to spend two to three times more than the middle and poor third spent. This reflected greater use of non-governmental organisation (NGO) facilities, which were the most expensive source of care, and higher expenditure at NGO facilities and drug stores. CONCLUSION: The coverage of appropriate malaria treatment was low in all SES groups, but the two poorer groups were particularly disadvantaged. As countries switch to antimalarial combination therapy, distribution must be targeted to ensure that the poorest groups fully benefit from these new and highly effective medicines.

Adolescent↗
PubMed2006

The costs of changing national policy: lessons from malaria treatment policy guidelines in Tanzania.

OBJECTIVE: To document the cost incurred by the Tanzanian government by changing the policy on first-line treatment of malaria, from chloroquine to sulfadoxine-pyrimethamine. METHODS: Costs were analysed from the perspective of the Ministry of Health and included all sources of funding. Costs external to the public health sector (e.g. private and community costs) were not included. The base case analysis adopted an incremental rather than a full cost approach, assuming that an organizational infrastructure was already in place. However, specific attention was paid to the burden placed on National Malaria Control Program staff. We also costed activities planned but not implemented to estimate the total expense for an 'ideal' process. RESULTS: Total costs were Tsh 795 million (USD 813,743), with the largest proportion accounted for by training. Costs of the policy change process were equivalent to about 4% of annual government and donor expenditure on malaria and to about 1% of overall public expenditure on health. A number of planned activities were not implemented; including these would bring the total cost to Ts 880 million (USD 896,130). CONCLUSION: On top of extra costs for the drugs themselves, a change in treatment policy requires time, resources and substantial management capacity at national and local level. A better understanding of these issues and the costs involved benefits countries planning and implementing policy change.

Amodiaquine↗
PubMed2005

Single-fiber electromyography correlates more closely with incontinence scores than pudendal nerve terminal motor latency.

BACKGROUND: The investigation of fecal incontinence is important in deciding the most appropriate treatment. The presence of neuropathy has been shown to affect surgical outcomes adversely. Latency studies are of dubious value in assessing neuropathy; needle electromyography is the gold standard test. The relationship between these two tests and the symptoms of fecal incontinence has not been studied. METHOD: A cohort of 57 patients underwent neurologic and symptom assessment using latency studies, concentric and single-fiber electromyography, and symptom assessment using the Cleveland Clinic Scoring System. RESULTS: There was a significant correlation between left mean fiber density and Cleveland Clinic Scoring (correlation: 0.32, P = 0.02) but not between right or left latency studies. CONCLUSION: Single-fiber electromyography gave relevant results that could be obtained easily on modern equipment. Latency values were not reliable.

Adult↗
PubMed2004

Characterization of microbial and chemical composition of shuttle wet waste with permanent gas and volatile organic compound analyses.

Solid-waste treatment in space for Advanced Life Support, ALS, applications requires that the material can be safely processed and stored in a confined environment. Many solid-wastes are not stable because they are wet (40-90% moisture) and contain levels of soluble organic compounds that can contribute to the growth of undesirable microorganisms with concomitant production of noxious odors. In the absence of integrated Advanced Life Support systems on orbit, permanent gas, trace volatile organic and microbiological analyses were performed on crew refuse returned from the volume F "wet" trash of three consecutive Shuttle missions (STS-105, 109, and 110). These analyses were designed to characterize the short-term biological stability of the material and assess potential crew risks resulting from microbial decay processes during storage. Waste samples were collected post-orbiter landing and sorted into packaging material, food waste, toilet waste, and bulk liquid fractions deposited during flight in the volume F container. Aerobic and anaerobic microbial loads were determined in each fraction by cultivation on R2A and by acridine orange direct count (AODC). Dry and ash weights were performed to determine both water and organic content of the materials. Experiments to determine the aerobic and anaerobic biostability of refuse stored for varying periods of time were performed by on-line monitoring of CO2 and laboratory analysis for production of hydrogen sulfide and methane. Volatile organic compounds and permanent gases were analyzed using EPA Method TO15 by USEPA et al. [EPA Method TO15, The Determination of Volatile Organic Compounds (VOCs) in Ambient Air using SUMMA, Passivated Canister Sampling and Gas Chromatographic Analysis,1999] with gas chromatography/mass spectrometry and by gas chromatography with selective detectors. These baseline measures of waste stream content, labile organics, and microbial load in the volume F Shuttle trash provide data for waste subsystem analysis and atmospheric management within the ALS Project.

Aerobiosis↗
PubMed2004

A simplified endogenous erythroid colony assay for the investigation of polycythaemia.

The in vitro growth of erythroid colonies in the absence of erythropoietin, known as endogenous erythroid colonies (EEC) forms part of the diagnostic criteria for polycythaemia vera (PV). The availability of EEC culture in routine laboratory setting is limited as culture methods are technically demanding, difficult to standardize, expensive and laborious. In this study, we assessed the performance characteristics of a simplified method using ammonium chloride red cell lysis followed by culture on commercially available, batch-tested, methylcellulose media. Seventy-six patients were included; four were secondarily excluded on the basis of culture failure. Of the 14 patients with PV, 13 (93%) were positive for EEC on at least one occasion: 90% (nine of 10) of bone marrow and 67% (six of nine) of peripheral blood specimens were positive. All 30 patients with secondary polycythaemia (n = 12) or apparent polycythaemia (n = 18) were negative for EEC. The incidence of EEC in idiopathic erythrocytosis was 40% (eight of 28); 50% (five of 10) in those who met one of the minor criteria for PV and 17% (three of 18) in those who did not. We conclude that our EEC assay yield results comparable with that of more elaborate methods.

Ammonium Chloride↗
PubMed2003

Factorial correspondence analysis of fear-related behaviour traits in Japanese quail.

Factorial correspondence analysis was performed on 341 quails from a F2 cross between two lines divergently selected on the duration of tonic immobility over 29 generations. Several fear- or stress-related traits were recorded, i.e. tonic immobility duration, number of inductions needed to induce tonic immobility, open-field behaviour (time spent walking, latency before first movement and number of defecations), asymmetry of tibia lengths and corticosterone concentration after restraint stress. Variables were categorised in classes and analysed by factorial correspondence analysis. The first axis was mostly described by open-field behaviour, and the second by tonic immobility traits (duration of tonic immobility and number of inductions), which showed that these behaviours were almost independent. No relationship was found between axes of the factorial correspondence analysis and corticosterone concentration or asymmetry of tibia lengths, showing that these variables reflected other characteristics of stress susceptibility than those described by tonic immobility and open-field behaviour. These results show that reaction to stress of quails is a multidimensional trait and cannot be summarised by one trait.

Journal Article↗
PubMed2003

Comparison of ultrasound and manometric sphincter length and incontinence scores.

PURPOSE: Fecal incontinence can be assessed by a wide variety of means that vary in their clinical relevance. This study assesses the correlation between two methods of recording sphincter length and incontinence scores. METHODS: A retrospective review of results from 1999 to 2001 of 137 patients with fecal incontinence was undertaken on patients who had both ultrasound and manometric assessment. Incontinence scores, ultrasonic sphincter length, and manometrically derived sphincter length were recorded. The data were analyzed using the Spearman rank correlation coefficient (r(s)) for nonparametric data. RESULTS: There was negative correlation between incontinence scores and manometric sphincter length (r(s) = -0.27; P = 0.002) but not with ultrasonic length (r(s) = -0.08; P = 0.38). There was correlation between manometric and ultrasonic lengths (r(s) = 0.21; P = 0.02). In males, all three correlated but none of the values were significant (n = 12). Internal and external sphincter defects had no effect on correlation coefficients. CONCLUSION: Given that all measurements include a degree of subjectivity, manometry more closely correlates with the fecal incontinence scores than ultrasound measurements. There seems to be little benefit in measuring the sphincter length with ultrasound. Manometric sphincter length measurement seems to have a role in assessing patients with fecal incontinence.

Anal Canal↗
PubMed2002

The distribution of health planning and management responsibilities between centre and periphery: historical patterns and reform trends in four Caribbean territories.

The degree to which health planning and management functions are decentralised has been one of the key questions in developing countries from when they first gained independence. This paper's aim is to examine the question of the historical distribution of responsibilities within the health sector of four territories, Trinidad and Tobago, the Bahamas, Martinique, and Suriname, in order to identify the roles of the different levels, changes over time and recent reform trends, and to seek to explain the reasons for changes. These territories were selected deliberately, on the grounds of their different colonial backgrounds. Common features included identification over several decades of management structures and skills as key problems; proposals for regionalisation and greater hospital autonomy as desirable solutions; and in three of the four territories, recent implementation of major structural reforms. Important influences on the timing and nature of decentralisation reforms included political and economic factors, the attitudes of the public service unions and the medical profession, and external funders who were particularly important in financing reforms and supporting the development of detailed implementation plans. The bureaucratic inheritance of the two English-speaking countries provided major barriers to structural change, which they have addressed through reforms involving the creation of agencies with delegated authority.

Bahamas↗
PubMed2002

Financing of health care in four Caribbean territories: a comparison with reforms in Europe.

This paper considers health care finance in four Caribbean territories and plans for reform in comparison with developments in European countries, to which these territories are historically linked. European health care reforms are aimed at making resource allocation in health care more efficient and more responsive to consumers' demands and preferences. These reforms in Europe have been continuing without appearing to have influenced the developments in the Caribbean very much, except in Martinique. In Trinidad and Tobago current reform entails delegation of responsibility for providing services to four regional health authorities and no purchaser/provider split at the regional or facility level as in the UK has been implemented. In the Bahamas, managed care arrangements are likely to emerge given the proximity of the United States. Recent universal coverage reform in Martinique was aimed at harmonisation of finance by bringing social security and social aid functions together under one management structure and may provide more opportunities for contracting and other initiatives towards greater efficiency. The first priority in Suriname is to restore proper functioning of the current system. Reforms in the four Caribbean territories have a largely administrative character and affect the organisation of the third party role in health care rather than fundamentally changing the relationship between this third party and the various other parties in health care.

Bahamas↗
PubMed2001

Intellectual problems shown by 11-year-old children whose mothers had postnatal depression.

The aim of the study was to examine long-term sequelae in the children of mothers who were depressed at 3 months postpartum. In a community sample from two general practices in South London. 149 women were given psychiatric interviews at 3 months postpartum and 132 of their children (89 %) were tested at 11 years of age. The children of women who were depressed at 3 months postpartum had significantly lower IQ scores. They also had attentional problems and difficulties in mathematical reasoning. and were more likely than other children to have special educational needs. Boys were more severely affected than girls, with the sex difference most pronounced on Performance IQ. The links between postnatal depression and the children's intellectual problems were not mediated by parental IQ and were not accounted for by measures of social disadvantage nor by the mother's later mental health problems. Breastfeeding did not remove the effect of the mother's illness on Full Scale IQ, but exerted its own influence on Verbal IQ and appeared to mediate the link with mathematical ability. The findings show that adverse experiences in infancy predict cognitive ability and academic performance a decade later.

Adult↗
PubMed2000

3'-minor groove binder-DNA probes increase sequence specificity at PCR extension temperatures.

DNA probes with conjugated minor groove binder (MGB) groups form extremely stable duplexes with single-stranded DNA targets, allowing shorter probes to be used for hybridization based assays. In this paper, sequence specificity of 3'-MGB probes was explored. In comparison with unmodified DNA, MGB probes had higher melting temperature (T(m)) and increased specificity, especially when a mismatch was in the MGB region of the duplex. To exploit these properties, fluorogenic MGB probes were prepared and investigated in the 5'-nuclease PCR assay (real-time PCR assay, TaqMan assay). A 12mer MGB probe had the same T(m)(65 degrees C) as a no-MGB 27mer probe. The fluorogenic MGB probes were more specific for single base mismatches and fluorescence quenching was more efficient, giving increased sensitivity. A/T rich duplexes were stabilized more than G/C rich duplexes, thereby leveling probe T(m)and simplifying design. In summary, MGB probes were more sequence specific than standard DNA probes, especially for single base mismatches at elevated hybridization temperatures.

Base Pair Mismatch↗
PubMed2000

Spatiotemporal distribution of zonulae adherens and associated actin bundles in both epithelium and fiber cells during chicken lens development.

Zonulae adherens and associated actin bundles (ZA/AB) are believed to play a major role in epithelial folding and invagination during morphogenesis of neural tube and other vesicular structures. The lens morphogenesis is associated with the formation of the lens vesicle in which ZA/AB would be needed during the formation process. However, the existence of ZA/AB in the lens has never been established. In this study we report for the first time the existence of ZA/AB in both lens epithelium and fiber cells during embryonic development of chicken lens from E4 to E20. Light microscopy revealed contacts between the lens epithelium and primary fiber cells, and between the lens epithelium and secondary fiber cells at E4 and E11, respectively. Thin-section electron microscopy consistently revealed ZA/AB near both the apical ends of lens epithelial cells and primary fiber cells at E4. This arrangement manifests as a parallel pair of belt-like ZA/AB along the epithelium-fiber interface. In semi-tangential sections, a continuous belt-like ZA/AB was also evidenced in individual epithelial cells and fiber cells. Furthermore, the same ZA/AB arrangement was observed near both the apical ends of epithelial cells and secondary fiber cells at E11. Besides ZA/AB, macular-type fasciae adherens were distributed regularly between epithelial cells, between primary fibers, between secondary fibers, and between epithelium and both primary and secondary fibers. Immunofluorescence strongly and preferentially labeled N-cadherin at both the apical ends of lens epithelium and primary or secondary fibers at the corresponding ages, suggesting a direct association with the zonulae adherens. Also punctate N-cadherin labeling was commonly seen along various regions of primary and secondary fiber cells at different ages, and to a larger extent in the mature fibers of older lenses. This study suggests that: (1) ZA/AB located at the apices of lens epithelial cells may play a crucial role in the early stages of lens morphogenesis (e.g. lens vesicle formation); (2) ZA/AB of primary and secondary fiber cells originate from the epithelial cells during their elongation and differentiation; (3) owing to the restricted distribution of ZA/AB, abundant fasciae adherens are needed to maintain the structural stability of the epithelium and fiber cells during development and maturation; and (4) N-cadherin is the principle adhesion protein for both the zonulae adherens and fasciae adherens in the lens.

Actins↗
PubMed2000

The response of providers to capitation payment: a case-study from Thailand.

Those designing payment systems for health care in low and middle income countries are increasingly looking to capitation payment, in order to avoid the cost inflation experienced with fee-for-service payment. However, there is virtually no documentation of the experience of introducing capitation payment, or of its effects. This paper draws on several research studies to explore responses by health care providers at both the market and facility level to the introduction of capitation payment, in the context of a new compulsory insurance scheme for workers in Thailand. The paper ends by identifying lessons for both Thailand itself and for other countries.

Capitation Fee↗
PubMed2000

Household costs of 'malaria' morbidity: a study in Matale district, Sri Lanka.

Short-run economic consequences of 'malaria' on households were examined in a household survey in Matale, a malaria-endemic district of Sri Lanka. On average a household incurred a total cost of Rs 318 (US$ 7) per patient who fully recovered from 'malaria'. 24% of this was direct cost, 44% indirect cost for the patient and 32% indirect cost for the household. Direct costs were greater for those seeking treatment in the private sector. Notably a large proportion of direct costs was spent on complementary goods such as vitamins and foods considered to be nutritional. Indirect cost was measured and valued on the basis of output/ income losses incurred at the household level rather than using a general indicator such as average wage rate. Loss of output and wages accounted for the highest proportion of the indirect cost of the patients as well as the households. Relative to children, more young adults and middle-aged people had 'malaria' which also caused greater economic loss in these age groups. Women tended to care for patients rather than substitute their labour to cover productive work lost due to illness. We compare the methods used by other researchers for valuing indirect cost, demonstrating the significant impact that methods of measurement and valuation can have on the estimation of indirect cost, and justify the recommendation for methodological research in this area.

Absenteeism↗
PubMed2000

What can we learn from international comparisons of health systems and health system reform?

Most commonly, lessons derived from comparisons of international health sector reform can only be generalized in a limited way to similar countries. However, there is little guidance as to what constitutes "similarity" in this respect. We propose that a framework for assessing similarity could be derived from the performance of individual policies in different contexts, and from the cause and effect processes related to the policies. We demonstrate this process by considering research evidence in the "public-private mix", and propose variables for an initial framework that we believe determine private involvement in the public health sector. The most influential model of public leadership places the private role in a contracting framework. Research in countries that have adopted this model suggests an additional list of variables to add to the framework. The variables can be grouped under the headings "demand factors", "supply factors", and "strength of the public sector". These illustrate the nature of a framework that could emerge, and which would help countries aiming to learn from international experience.

Benchmarking↗