The Soviet health care system placed great emphasis on specialist hospitalization. Primary care, in contrast, was viewed primarily as prophylactic and also identified patients for admission to hospital. This led to long lengths of stays, since patients were provided with outpatient type care in hospital, and unnecessary admissions. The reduction in funding for the health system has exacerbated the top heavy nature of the system and made restructuring of the sector essential. Rural areas in Kazakstan follow a similar structure to other parts of the former Soviet Union. In 1996 a project was undertaken to review the provision of hospital services in one rural rayon (district) just outside Almaty. The approach taken was to emphasize the relationship between activity and financial data. It did this by analysing the link between clinical decisions taken to reduce lengths of stay, management decisions to modify staffing and costs of care. It was shown that substantial savings could be made together with improvements in the quality of care, through a programme of planned restructuring. Some success in inducing change is reported but without a major change in approach to local level management. In order to achieve changes it is important that short and long term alternatives to hospitalization are developed.

Catchment Area, Health↗

PubMedDate not supplied

Informal payments in transitional economies: implications for health sector reform.

Since the collapse of the Soviet Union increasing evidence is emerging of informal payments by patients for health care services that are officially free. There is little information, however, on the characteristics of these payments and the effect that they have on health care reform initiatives. This paper examines these issues and concludes that the endemic and complex nature of such payments suggests that a range of policy tools are necessary to address the negative features of informal payments in those countries undergoing transition.

Cost Sharing↗

PubMedDate not supplied

Kinetic parameters of amikacin in cystic fibrosis children.

35 kinetic studies have been performed, in nine CF children three to 15 years old; six kinetic studies were performed in four non-CF children, one to 12 years old. The dosage was 5 to 12.5 mg/kg, i.v. during 0.5 to 1.0 h, three to four times per day. Amikacin concentrations were measured in the plasma of all children, and in the sputum of CF-patients, by fluorescent polarization (TDX Abbott). The pharmacokinetic parameters in the plasma did not differ significantly in both groups of patients. In CF children t1/2 = 0.94 h (SD = 0.25 h), Vd (area) = 0.257 l/kg (SD = 0.06 l/kg), total body clearance = 130.7 ml/min/1.73 m2 (SD = 32.4 ml/min/1.73 m2). In non-CF children t1/2 = 0.83 h (SD = 0.15 h), Vd (area) = 0.265 l/kg (SD = 0.04 l/kg) and clearance = 155 ml/min/1.73 m2 (SD = 17.4 ml/min/1.73 m2). The parameters were not affected by the dosage of amikacin. The peak plasma concentrations ranged from 19 to 43.8 mg/l. Amikacin peak level in the sputum of CF children never reached the average MIC (4 mg/l) of Pseudomonas aeruginosa strains isolated in these patients. Amikacin concentration in the sputum reached its highest value about 2 h after the completion of i.v. infusion and was directly related to the peak plasma concentration. According to these parameters, the best dosage regimen appeared to be 7.5 to 8 mg/kg or 225 to 240 mg/m2 administered intravenously in 1.0 h, three times per day.

Adolescent↗

PubMedDate not supplied

The signal peptide of pro-opiomelancortin: validation of a specific radioimmunoassay.

The N-terminus portion of the POMC leader sequence (signal peptide) was synthesized, and an antiserum was raised against it. A radioimmunoassay was developed which is effective at a dilution of 1:500,000, and sensitive at less than 1 fmole/tube. Since leader sequences often exhibit structural homologies, and since synthetic peptides are not readily available, we resorted to an unusual procedure to establish specificity. This involved extraction of pituitary RNA, cell-free translation to produce the pre-prohormones, and purification by B-END and signal antibody affinity columns. The eluates were then tested by SDS gel electrophoresis and by multiple immunoprecipitations. All results showed that the signal antibody captured a single molecular species, approximately 30,000 in MW, which was also captured by the B-END column, and was immunoprecipitable by B-END and ACTH antisera. It therefore appears that this antibody selectively measures the POMC leader sequence and should be valuable in measuring the newly synthesized pre-prohormone.

Amino Acid Sequence↗

PubMedDate not supplied

Aminopropeptide of human procollagen type I: a marker for the identification of blood from children in the mosquito blood meal.

A capture enzyme-linked immunosorbent assay (ELISA) to distinguish between blood from children and adults in the mosquito blood meal was examined using the alpha 1 chain of the aminopropeptide of human procollagen type I (PINP) as antigenic marker. Rabbit anti-human PINP (alpha 1) antibody was used as catching antibody, and either normal serum from 288 African and 58 Caucasian children and adults, or blood meals from 93 fed Aedes aegypti, were examined. PINP in excess of 40 optical density units (ODU) was detected in all children aged 0-13 years, whereas adults aged 21-77 years had PINP levels less than 25 ODU. In the transitional age group (14-20 years), the PINP levels ranged from 1 to 166 ODU. The PINP levels in 95% of the mosquito blood meals obtained from children exceeded the control levels, using 13 ODU as a cut-off value, whereas none of the blood meals from adults exceeded 13 ODU. The PINP levels in the mosquito blood meals were constant 1 and 8 h after ingestion, but they had decreased significantly after 16-19 h. Our data suggest that the test can be used to identify host preferences in studies of mosquitoes collected within 16 h after the blood meal. A field evaluation is necessary to determine the potential of the antigenic marker PINP as a tool in the identification of mosquito host preference.

Adolescent↗

PubMedDate not supplied

Organic mood disorder: a valid psychiatry consultation diagnosis?

To determine the validity of the DSM-IIIR category organic mood disorder, we compared 50 psychiatric consultations with this diagnosis to 50 psychiatric consultations diagnosed with major depression in the medically ill. Organic mood disorder patients were more likely to be in the index affective disorder episode and have a negative family history of depression. Despite similar pharmacologic treatment between groups, the organic mood disorder group was less likely to be completely recovered at 4 years follow-up. This study suggests organic mood disorder is a valid diagnosis in the psychiatry consultation service.

Adult↗

PubMedDate not supplied

Identification of proopiomelanocortin neurones in rat hypothalamus by in situ cDNA-mRNA hybridization.

Ardrenocorticotropic hormone (ACTH), beta-endorphin and the melanotropins (MSHs) are all derived from a single large precursor molecule, proopiomelanocortin (POMC) by individual processing through a series of co- and post-translational modifications. Although the primary site of synthesis is in the pituitary, POMC-derived peptides have been identified in various tissues, notably the brain (see refs 6, 7 for review). A major question concerning brain POMC is whether it is synthesized within the central nervous system (CNS) itself or whether it is taken up from plasma flowing in a retrograde fashion from the pituitary. POMC peptides have been detected immunohistochemically and biochemically in the medial basal hypothalamus, the amygdala and throughout the brain stem. POMC peptide-containing cell bodies have been identified only in two cell groups, however, principally in the periarcuate region of the hypothalamus and to a lesser extent in the nucleus of the tractus solitarius. These and other observations have suggested that POMC peptides are synthesized locally in the medial basal hypothalamus and reach other regions of the CNS by axonal transport. Civelli et al. identified POMC mRNAs in nucleic acid extracts of rat and bovine hypothalami by solution hybridization as well as Northern gel blot analysis, but because of the close proximity of the hypothalamus to the pituitary and the extremely low amounts of POMC mRNA being measured in the hypothalamus, the possibility of tissue contamination during dissection could not be ruled out. We report here the anatomical co-localization of POMC-related peptides and POMC-specific mRNAs to a single major cell group in the medial basal hypothalamus. The presence of POMC-specific mRNA in a POMC peptide-containing cell in the brain is strong support for POMC biosynthesis within brain tissue.

Adrenocorticotropic Hormone↗

PubMedDate not supplied

Importance of format and design in print patient information.

PURPOSE: The purposes of this descriptive study were to: identify characteristics of print education materials that healthcare providers report as important to patients; compare whether Physician Data Query (PDQ) information that was provided in its original form, or was redesigned in color and black and white, influenced the distribution of this information; and explore whether providing PDQ information via patient information racks would increase patients' awareness of and use of PDQ information. DESCRIPTION OF STUDY: Forty-four oncology healthcare professionals were asked to complete a survey identifying characteristics that they believed important for effective print educational materials. PDQ statements were reformatted and placed in brochure racks for a 6-month period. The number of statements distributed before and after this time period were compared. Subsequently, PDQ statements were placed sequentially for a 3-week period in brochure racks in the following formats: original form as printed from the computer, redesigned with color print; and redesigned with black ink only. RESULTS: The following characteristics were rated "very important" aspects of print educational materials by oncology healthcare professionals: appropriate reading level; clarity; credibility of the information; whether information is current/up-to-date; and patient acceptance of material. The characteristic receiving the fewest "very important" marks was attractiveness/eye appeal. The reported low marks on attractiveness/eye appeal contradict the concurrent findings that, after the redesign of PDQ statements (change in booklet size, use of color, increase in foot size for text and headings, and inclusion of a vertical bar to separate columns), there was a ninefold increase in the number PDQ statements distributed. Eighty-nine percent of the statements distributed were the redesigned version. The use of color, however, did not appear to make a difference in the number of PDQ statements disseminated after the redesign. CLINICAL IMPLICATIONS: In developing print education materials for cancer patients, the format, design, and placement of materials for patient access need to be considered. There are many valuable educational materials available on computer databases. Downloading the information and placing it in a brochure format may be an ideal approach for providing access to this information. Furthermore, because physicians and nurses have different priorities for printed patient education materials, it is important to involve both groups in the developments of the brochures.

Ambulatory Care Facilities↗