Public sector policies often try to extend access and redirect public resources, depending on private sector actions. These strategies focus on reducing demand, improving efficiency, and generating increased revenues in the public sector. In order to provide incentives for efficiency, acquire capital, and redirect limited public resources to public priorities, there must be an expanded role for the private market in the provision of health services. This presents opportunities to improve the focus of resources on high-priority health activities in the public sector and to make more effective and efficient use of the resources of the private sector. The authors discuss the form that such policies may take. However, while the overall set of options available to policy makers can be identified, what is an effective strategy in one country may be neither appropriate nor feasible in another. The challenge to policy research is not to identify what works, but rather to understand the conditions that make a policy effective in some settings but not in others. The objective is not to prescribe the actions to take but to understand the factors that create the current experience in a specific setting.

Delivery of Health Care↗

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Primary use of silicone oil tamponade in the management of perforating globe injury secondary to inadvertent local anaesthesia injection for ophthalmic surgery.

Perforating and penetrating globe injuries secondary to peribulbar and retrobulbar anaesthesia are often complicated by vitreous haemorrhage and retinal detachment. We describe the effectiveness of primary silicone oil tamponade in the repair of three perforated globes secondary to local anaesthesia for ophthalmic surgery. Three patients with axial myopia had peribulbar and retrobulbar anaesthesia for extracapsular cataract extraction (two patients) and cryotherapy (one patient). All eyes sustained a vitreous haemorrhage obscuring the view to the fundus. Retinal detachments were detected by B-scan ultrasound. In all eyes, scleral buckling, pars plana vitrectomy and silicone oil tamponade were performed as a primary surgical procedure. All the patients had complete anatomic reposition. In two patients, after two years follow-up, visual acuity was between 6/12 to 6/36 with the retina attached and no proliferative vitreoretinopathy (PVR). The third patient had blind painful eye and enucleation was performed. Primary use of silicone oil tamponade, in the management of perforated globe with retinal detachment due to local anaesthesia injection, is recommended.

Adult↗

PubMedDate not supplied

Effect of pentamidine on cytokine (IL-1 beta, TNF alpha, IL-6) production by human alveolar macrophages in vitro.

Pentamidine (Pe) is an aromatic diamidine drug used clinically to treat Pneumocystis carinii pneumonia by aerosol inhalation. Nothing has been reported about the effects of this drug on human alveolar macrophage (AM) properties. In this study AM were exposed in vitro to various concentrations of Pe (10(-4)-10(-6) M) alone or in combination with bacterial endotoxin (LPS). Supernatants were collected at 3, 6, and 24 h and assayed for secreted IL-1 beta, IL-6, and TNF alpha. While the drug did not induce release of these cytokines, LPS-induced secretion of all three cytokines was inhibited by Pe in a dose-dependent manner. At the most effective Pe dose, 10(-5) M, AM viability (as determined by trypan blue dye exclusion) was reduced by 14% at 24 h, while no effect on viability was seen at lower concentrations. mRNA expression of all three cytokines was examined by PCR and Northern analysis to establish if the decrease in cytokine secretion was determined on a pre- or post-translational level. Reduced steady-state mRNA levels were found as early as 3 h after LPS stimulation, with Pe concentrations corresponding to those that decreased cytokine secretion. At the later time points, Pe also inhibited beta-actin, ornithine decarboxylase, and GAPDH mRNA expression, indicating that pentamidine had a general toxic effect on mRNA transcription in the macrophages. It is concluded that Pe, at pharmaceutically relevant concentrations and with apparent low cytotoxicity as determined by dye uptake, nonspecifically inhibits cytokine production by a toxic effect on transcriptional events.

Base Sequence↗

PubMedDate not supplied

Corticosteroid resistant orbital hemangioma with proptosis treated with interferon alfa-2-a and partial tarsorrhaphy.

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Combined Modality Therapy↗

PubMedDate not supplied

Macular changes in type I Gaucher's disease.

The authors illustrate the spectrum of Gaucher's disease involving the eye in the case of a 51-year-old man suffering from Type I Gaucher's disease who presented with unusual macular changes. This is the first report of chronic adult non-neuronopathic disease (Type I) with a plaque-like mass at the fovea. Our hypothesis is that the lesion at the fovea is probably an aggregation of Gaucher's cells.

Fluorescein Angiography↗

PubMedDate not supplied

Retrocorneal membrane after penetrating keratoplasty.

Retrocorneal membranes after penetrating keratoplasty (PKP) is a well known complications, resulting from unintentional retention of the host Descemet's membrane (DM), or donor DM detachment. We describe for the first time the formation of a retrocorneal inflammatory membrane that mimics donor DM detachment or retained recipient DM, and discuss the differential diagnosis of a retrocorneal membrane after PKP. Two patients who underwent PKP and subsequently developed a retrocorneal membrane are described. In both patients' eyes a retrocorneal membrane was observed immediately following penetrating keratoplasty. While the first patient's membrane persisted for 33 months in the presence of a clear graft, the second patient's membrane disintegrated and dissolved within two weeks following treatment with topical steroids. The first case describes a patient with retained Descemet's membrane, while in the second case, it turned out that the retrocorneal membrane was actually an inflammatory membrane.

Administration, Topical↗

PubMedDate not supplied

["Violence" and child guidance].

The subject of this article is violence among children and adolescents as seen in the field of work of a counseling center for educational and family problems. Impressions, experiences, and these concerning the phenomenon of violence are presented with regard to the macrosocial conditions as well as to the microsocial context of counseling. Furthermore, possibilities of out-patient treatment of aggression in children and adolescents are discussed. Preliminary results of working on conflicts with psychological and educational methods in a group setting for children are reported.

Adaptation, Psychological↗