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PubMed2004

Missed treatment opportunities, for pregnant and breast-feeding women, in onchocerciasis mass-treatment programmes in south-eastern Nigeria.

During annual rounds of mass treatment against onchocerciasis, women who are pregnant or nursing neonates should not to be offered ivermectin. The aim of the present study was to determine how many women were not treated, as a result of this policy, in four villages in south-eastern Nigeria. Of the 1714 women of reproductive age present during the 2000 round of mass treatment, 599 (35%) were excluded because they were pregnant or nursing babies aged < 1 month. Most (56%) of the 599 excluded women were, however, treated individually later in the year. Of the 264 excluded women who did not receive a dose of ivermectin at all in 2000, 123 (47%) said they would have actively sought ivermectin treatment had they been made aware of the short duration of exclusion for nursing. If they had all known of the short duration of the exclusion and when and how to locate and receive treatment in their villages after the round of mass treatment, 91% of the women excluded from the round of mass treatment would probably have been treated later in the year. Better treatment systems, follow-up and health education, targeted at pregnant and lactating women, would improve treatment coverage of this group after parturition and early nursing.

Adult↗
PubMedDate not supplied

Health, development and the Millennium Development Goals.

The Millennium Development Goals (MDG), which emerged from the United Nations Millennium Summit in 2000, are increasingly recognized as the over-arching development framework. As such, the MDG are increasingly guiding the policies of poor countries and aid agencies alike. This article reviews the challenges and opportunities for health presented by the MDG. The opportunities include that three of the eight MDG relate to health--a recognition that health is central to global agenda of reducing poverty, as well as an important measure of human well-being in its own right. A related point is that the MDG help to focus attention on those health conditions that disproportionally affect the poor (communicable disease, child health and maternal health), which should, in turn, help to strengthen the equity focus of health policies in low-income countries. Further, because the MDG are concrete, it is possible to calculate the cost of achieving them, which in turn strengthens the long-standing calls for higher levels of aid for health. The challenges include that, while the MDG focus on specific diseases and conditions, they cannot be achieved without strengthening health systems. Similarly, progress towards the MDG will require health to be prioritized within overall development and economic policies. In practice, this means applying a health 'lens' to processes such as civil-service reform, decentralization and the drawing-up of frameworks of national expenditure. Finally, the MDG cannot be met with the resources available in low-income countries. While the MDG framework has created pressure for donors to commit to higher levels of aid, the challenge remains to turn these commitments into action. Data are presented to show that, at current rates of progress, the health-related MDG will not be achieved. This disappointing trend could be reversed, however, if the various challenges outlined are met.

Developing Countries↗
PubMed2006

Hypoxaemia among children in rural hospitals in Papua New Guinea: epidemiology and resource availability--a study to support a national oxygen programme.

AIMS: To support a national approach to oxygen systems in Papua New Guinea, we conducted a study to document the incidence of hypoxaemia, its geographical distribution, epidemiological determinants and resource availability in several regions of the country. We also established baseline mortality rate data for all children admitted to five hospitals, for children with a diagnosis of pneumonia and for neonates to evaluate a future intervention. METHODS: Data were collected prospectively from over 1300 hospital admissions in five hospitals in 2004. To establish the baseline case fatality rates, data on outcome were collected retrospectively over 3 years (2001-2003) for over 20,000 children admitted to five hospitals. RESULTS: A total of 1313 admissions were studied prospectively in the five hospitals. Altogether, 384 (29.25%, 95% CI 26.8-31.8) had hypoxaemia, defined as SpO(2) <90%. The incidence of hypoxaemia was much greater in highland hospitals (40% of all admissions) than on the coast (10% of all admissions). This large difference in incidence persisted when the uniform definition of hypoxaemia was adjusted for altitude, and was largely because of differences in the incidence of acute respiratory tract infection. Oxygen was not available on the day of admission for 22% of children (range between hospitals, 3-38), including 13% of all children with hypoxaemia. Oxygen was less available in remote rural district hospitals than in provincial hospitals in regional towns. Clinical signs proposed by WHO as indicators for oxygen would have missed 29% of children with hypoxaemia and, if these clinical signs were used, 30% of children without hypoxaemia would have been considered in need of supplemental oxygen. CONCLUSIONS: Based on this study, an approach to improving the detection of hypoxaemia and the availability of oxygen has been trialled in these five hospitals where a programme of clinical and technical training in the use and maintenance of pulse oximetry and oxygen concentrators has been introduced.

Developing Countries↗
PubMed2003

Breeding chemists in Giessen.

The factors that contributed to Liebig's success in founding a research school at Giessen have been well known since the publication of Jack Morrell's seminal paper in 1972. Here the familiar Liebig-Giessen story is re-centred in a local geographical and historical context. Historical and political factors played a role in calling Liebig to Giessen and in ousting the existing chair holder, Zimmerman. Working in partnership with the government, Liebig's developed pharmacy teaching as part of the state's plan of modernization. Liebig's success necessarily led to the expansion of the laboratory after 1833. Comparisons with Buff's and Hundeshagen's attempts to do for physics and forestry what Liebig achieved in chemistry show that the encouragement of private enterprise was a key feature of the Hessen-Darmstadt government's strategy for the modernisation of the university.

Chemistry↗
PubMed2005

The costs and effects of a nationwide insecticide-treated net programme: the case of Malawi.

BACKGROUND: Insecticide-treated nets (ITNs) are a proven intervention to reduce the burden of malaria, yet there remains a debate as to the best method of ensuring they are universally utilized. This study is a cost-effectiveness analysis of an intervention in Malawi that started in 1998, in Blantyre district, before expanding nationwide. Over the 5-year period, 1.5 million ITNs were sold. METHODS: The costs were calculated retrospectively through analysis of expenditure data. Costs and effects were measured as cost per treated-net year (cost/TNY) and cost per net distributed. RESULTS: The mean cost/TNY was calculated at $4.41, and the mean cost/ITN distributed at $2.63. It also shows evidence of economies of scale, with the cost/TNY falling from $7.69 in year one (72,196 ITN) to $3.44 in year five (720,577 ITN). Cost/ITN distributed dropped from $5.04 to $1.92. CONCLUSION: Combining targeting and social marketing has the potential of being both cost-effective and capable of achieving high levels of coverage, and it is possible that increasing returns to scale can be achieved.

Animals↗
PubMed2005

Socio-economic inequity in demand for insecticide-treated nets, in-door residual house spraying, larviciding and fogging in Sudan.

BACKGROUND: In order to optimally prioritize and use public and private budgets for equitable malaria vector control, there is a need to determine the level and determinants of consumer demand for different vector control tools. OBJECTIVES: To determine the demand from people of different socio-economic groups for indoor residual house-spraying (IRHS), insecticide-treated nets (ITNs), larviciding with chemicals (LWC), and space spraying/fogging (SS) and the disease control implications of the result. METHODS: Ratings and levels of willingness-to-pay (WTP) for the vector control tools were determined using a random cross-sectional sample of 720 householdes drawn from two states. WTP was elicited using the bidding game. An asset-based socio-economic status (SES) index was used to explore whether WTP was related to SES of the respondents. RESULTS: IRHS received the highest proportion of highest preferred rating (41.0%) followed by ITNs (23.1%). However, ITNs had the highest mean WTP followed by IRHS, while LWC had the least. The regression analysis showed that SES was positively and statistically significantly related to WTP across the four vector control tools and that the respondents' rating of IRHS and ITNs significantly explained their levels of WTP for the two tools. CONCLUSION: People were willing to pay for all the vector-control tools, but the demand for the vector control tools was related to the SES of the respondents. Hence, it is vital that there are public policies and financing mechanisms to ensure equitable provision and utilisation of vector control tools, as well as protecting the poor from cost-sharing arrangements.

Animals↗
PubMed1978

The politics of health care regulation: the case of the National Health Planning and Resources Development Act.

This paper examines the political and bureautic dynamics of health regulation under the National Health Planning and Resources Development Act and, to a lesser extent, the Carter Cost Proposal now before Congress. A number of underlying issues that affect the day-to-day exercise of health planning are considered, including the contest between state and local and federal government for program control, jurisdictional conflict between state and local planning agencies, and the unsettled roles to be played by professional planners, consumers, and providers. When we assess regulatory policy in health, these complicating factors must be added to the long list of handicaps that already exist. One important finding is that local planning agencies have embraced the task of health regulation somewhat more fully than had generally been expected. A number of explanations for this are offered. In short, the controlling factors in health planning are political, not technical, and there is more occurring at the state and local levels than many had predicted, although any impact is not likely to be dramatic.

Costs and Cost Analysis↗
PubMed1997

Social science and the public agenda: reflections on the relation of knowledge to policy in the United States and abroad.

It is tempting to oversell the practical value of applied research. A hard look at the effects of U.S. social science on public policy in areas such as active labor market policies (training, job creation, placement, etc.), crime prevention, fiscal policy, poverty reduction, and health care reform suggests an inverse relationship between social science consensus and policy and budgetary decisions. Fragmented and decentralized political economies (e.g., the United States) foster policy segmentation and isolated, short-run single-issue research--often politicized and misleading. More corporatist democracies (such as Sweden, Norway, Austria, and Germany) evidence a tighter relation between knowledge and power in which a wider range of issues is connected, longer-range effects are sometimes considered, and research is more often actually used for planning and implementation. Even in less hospitable societies, however, social science does make its way in the long run. Favorable conditions and examples are discussed.

Cross-Cultural Comparison↗
PubMed1998

Boundaries in the Drosophila wing imaginal disc organize vein-specific genetic programs.

Previous studies have suggested that vein primordia in Drosophila form at boundaries along the A/P axis between discrete sectors of the larval wing imaginal disc. Genes involved in initiating vein development during the third larval instar are expressed either in narrow stripes corresponding to vein primordia or in broader 'provein' domains consisting of cells competent to become veins. In addition, genes specifying the alternative intervein cell fate are expressed in complementary intervein regions. The regulatory relationships between genes expressed in narrow vein primordia, in broad provein stripes and in interveins remains unknown, however. In this manuscript, we provide additional evidence for veins forming in narrow stripes at borders of A/P sectors. These experiments further suggest that narrow vein primordia produce secondary short-range signal(s), which activate expression of provein genes in a broad pattern in neighboring cells. We also show that crossregulatory interactions among genes expressed in veins, proveins and interveins contribute to establishing the vein-versus-intervein pattern, and that control of gene expression in vein and intervein regions must be considered on a stripe-by-stripe basis. Finally, we present evidence for a second set of vein-inducing boundaries lying between veins, which we refer to as paravein boundaries. We propose that veins develop at both vein and paravein boundaries in more 'primitive' insects, which have up to twice the number of veins present in Drosophila. We present a model in which different A/P boundaries organize vein-specific genetic programs to govern the development of individual veins.

Animals↗
PubMed1999

Differential patterning of ventral midline cells by axial mesoderm is regulated by BMP7 and chordin.

Ventral midline cells in the neural tube have distinct properties at different rostrocaudal levels, apparently in response to differential signalling by axial mesoderm. Floor plate cells are induced by sonic hedgehog (SHH) secreted from the notochord whereas ventral midline cells of the rostral diencephalon (RDVM cells) appear to be induced by the dual actions of SHH and bone morphogenetic protein 7 (BMP7) from prechordal mesoderm. We have examined the cellular and molecular events that govern the program of differentiation of RDVM cells under the influence of the axial mesoderm. By fate mapping, we show that prospective RDVM cells migrate rostrally within the neural plate, passing over rostral notochord before establishing register with prechordal mesoderm at stage 7. Despite the co-expression of SHH and BMP7 by rostral notochord, prospective RDVM cells appear to be specified initially as caudal ventral midline neurectodermal cells and to acquire RDVM properties only at stage 7. We provide evidence that the signalling properties of axial mesoderm over this period are regulated by the BMP antagonist, chordin. Chordin is expressed throughout the axial mesoderm as it extends, but is downregulated in prechordal mesoderm coincident with the onset of RDVM cell differentiation. Addition of chordin to conjugate explant cultures of prechordal mesoderm and neural tissue prevents the rostralization of ventral midline cells by prechordal mesoderm. Chordin may thus act to refine the patterning of the ventral midline along the rostrocaudal axis.

Animals↗
PubMed2006

Multifunctional roles of MT1-MMP in myofiber formation and morphostatic maintenance of skeletal muscle.

Sequential activation of muscle-specific transcription factors is the critical basis for myogenic differentiation. However, the complexity of this process does not exclude the possibility that other molecules and systems are regulatory as well. We observed that myogenic differentiation proceeded through three distinct stages of proliferation, elongation and fusion, which are distinguishable by their cellular morphologies and gene expression patterns of proliferation- and differentiation-specific markers. Treatment of the differentiating myoblasts with inhibitors of matrix metalloproteinases (MMPs) revealed that MMP activity at the elongation stage is a critical prerequisite to complete the successive myoblast cell fusion. The MMP regulated the myogenic differentiation independently from the genetic program that governs expression of the myogenic genes. Membrane-type 1 matrix metalloproteinase (MT1-MMP) was identified as a major contributor to this checkpoint for morphological differentiation and degraded fibronectin, a possible inhibitory factor for myogenic cell fusion. A MT1-MMP deficiency caused similar myogenic impediments forming smaller myofibers in situ. Additionally, the mutant mice demonstrated some central nucleation of the myofibers typically found in muscular dystrophy and MT1-MMP was found to cleave laminin-2/4 in the basement membrane. Thus, MT1-MMP is a new multilateral regulator for muscle differentiation and maintenance through processing of stage-specific distinct ECM substrates.

Animals↗
PubMed2006

Values underlying the National Service Framework for coronary heart disease in England: a discourse analysis.

OBJECTIVES: The National Service Framework (NSF) for Coronary Heart Disease--published by the English Department of Health in 2000--sets out how those within the health service should seek to prevent and treat coronary heart disease and care for people with the disease. Its prescriptions are partly based on what is known about coronary heart disease and partly on its underlying 'values'. This paper seeks to identify those values. METHODS: An analysis of the discourses within the text of the NSF based on critical discourse analysis. RESULTS: Three different discourses can be identified: the managerial, the clinical and the political. The managerial discourse is dominant. Each discourse has its own values. The main 'aspirational' values within the NSF are efficiency, effectiveness, autonomy (choice), universalism and equity. Some aspirational values--particularly equity--appear to be largely rhetorical and lead to few recommendations or prescriptions. Some values that might have been expected to underlie the framework, such as compassion and democracy, are largely absent. CONCLUSIONS: Discourse analysis provides a more systematic and transparent method of describing the values behind health care policy than the methods that have been used previously.

Coronary Disease↗
PubMed2001

An analysis of why telehealth systems in Australia have not always succeeded.

Telehealth programmes are rather similar to humans in the way that they are planned, develop, grow and ultimately die or disappear. To achieve good life expectancy for a telehealth programme there appear to be three major needs: nurturing, which includes the provision of money, ideas, education, training and innovation; experience, which involves an integrated management process, the achievement of long and wide patterns of usage, the development of updated policies and procedures and the involvement of multiple disciplines; success, which involves evidence of outcomes, evaluation and research, and, most important, the sharing of information through scientific and popular press publications, and conferences and collaborations with internal and external groups. The future of telehealth in Australia is at a watershed. There are now a substantial number of programmes, and there has been a large amount of financial and human investment in telehealth around the nation. There is, however, no forum for national leadership, no national association and little support at federal government level.

Australia↗
PubMed2001

A review of the experience with teleradiology in Australia.

Because of the geographical dispersion of the Australian population (25-30% of the total population of 20 million live outside metropolitan areas), there has been considerable interest in the use of teleradiology. In general, the provision of teleradiology by private radiology practices has been successful. However, as regards the provision of publicly funded, statewide teleradiology services, progress has been slower than expected, following enthusiastic support for the technology in the early 1990s. While there have been some notable successes in the implementation of publicly funded teleradiology services, given the delays that have been experienced in Australia, there is a case for a closer connection between the conduct of teleradiology evaluation studies and the incorporation of the results into health policy. This link would ensure that the benefits of technology are made available to the public in as short a time as possible.

Australia↗

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