This paper describes early experience with the Sector-Wide Approach (SWAp), an emerging trend in development practice in low-income countries. The paper describes what a SWAp is, and why it is now being pursued. The SWAp is characterized as a sustained government-led partnership with donor agencies and other groups. By applying sector-wide policies to an expenditure framework and national implementation systems, explicit health sector reforms are undertaken to meet sectoral and national development objectives. The approach has changed the dynamic between governments and donor agencies, requiring systemic changes in policy-making and management in both governments and donor agencies. With the SWAp, ongoing joint assessment and negotiations around sectoral plans and review of performance replaces the old way of preparing and supervising projects. Early experiences in countries undergoing SWAps are discussed, including the problem of reconciling priority programs and old practices with broader health sector reforms and new ways of managing development assistance. The paper concludes by identifying some of the key challenges for the future of SWAps.

Developing Countries↗

PubMedDate not supplied

Estrogen receptor determination in fine needle aspirates of the breast. Correlation with histologic grade and comparison with biochemical analysis.

Material obtained by fine needle aspiration (FNA) of 25 surgically removed breast carcinomas was tested for the immunocytochemical localization of estrogen receptor (ER) using the peroxidase-antiperoxidase method and a monoclonal antibody developed against human breast cancer ER. The results were compared to those obtained by the conventional biochemical analysis of cytosol protein. A semiquantitative relationship between the immunoperoxidase stain and the biochemical analysis suggests that cases in which greater than 70% of the cells stain and in which intense staining is present are likely to contain ER in a concentration of greater than 250 fmol/mg of cytosol. Less than 15% stained cells and an absence of intense staining is indicative of a concentration of less than 10 fmol/mg. In only one case was there a significant difference in positivity between the two methods, possibly as a result of a functional heterogeneity of the tumor cell population. Intense staining is strongly suggestive of a tumor of low histologic grade and was never seen in tumors with a high histologic grade or nuclear grade. The immunoperoxidase method of ER detection on material obtained by FNA is a semiquantitative means of selecting patients with breast cancer who are likely to respond to hormonal therapy. The method overcomes many important disadvantages of cytosol analysis and provides clinically significant information regarding the ER content and the degree of tumor differentiation.

Adult↗

PubMedDate not supplied

Interactive effects of chronic maternal ethanol and nicotine exposure upon offspring development and function.

Nicotine injections (3.0 mg/kg twice daily), oral alcohol (10% solution), nicotine and alcohol, or saline injections were administered to gravid Sprague-Dawley rats for the entire gestational period. Food intake was adjusted so that all rats received the same number of calories on each day of pregnancy. Offspring performance was monitored from birth to 15 months of age. An interaction was found in which the combined effect of nicotine and alcohol was greater than would have been predicted from the effects of either drug along. NIC/ALC offspring were born later, and suffered more stillbirths and neonatal deaths. Surviving NIC/ALC offspring were more advanced on some developmental measures, more active neonatally and less active in adulthood. Initially, they were able to discriminate contingencies less well in a punishment paradigm, initiated fewer shock-on periods and received fewer reinforcements. Possible mechanisms for the drug interaction effects are discussed.

Animals↗

PubMedDate not supplied

[Action of elastic compression on valvular closing time].

The study was carried out in ten patients with venous insufficiency of limbs verified by clinical standards, photopletismography and descending venogram witch, previous venous stasis ulcer and branquial/ankle doppler index greater than 0.9. The valvular closing time (VCT) was measured with Duplex scanning, at the level of popliteal vein bellow de lesser safenous vein entrance. The ten patients showed an initial VCT greater than 0.5 sec, with the utilization of the elastic compression and new measurement of VCT, seven showed a normalization of VCT (valves lower than 0.5 sec). The elastic compression of limbs is efficient in reducing the venous reflux and it could be evaluated individually with a non invasive test--The Duplex scanning.

Bandages↗