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Benzidine dihydrochloride as a chromogen for single- and double-label light and electron microscopic immunocytochemical studies.

Although very sensitive chromogens have been adapted for localization of horseradish peroxidase in anterograde and retrograde tracing studies, they have not been successfully applied in immunocytochemical studies. This report describes a protocol which uses benzidine dihydrochloride (BDHC) as the chromogen for light (LM) and electron microscopic (EM) immunocytochemical studies. The protocol is comparable to that used for tetramethylbenzidine, except that the pH of the reaction is above 6.0. At the LM level, the BDHC reaction product is bluish-green and crystalline. Both the color and form of the product are readily distinguished from the reddish-brown DAB reaction product. LM double-labeling studies are therefore feasible. The use of BDHC also increases significantly the sensitivity of the immunoreaction. Higher fixative concentrations can be used, less detergent is necessary, and higher primary antibody dilutions are possible. By osmicating at 45 degrees C in an s-collidine buffer it is possible to preserve the soluble BDHC reaction product for EM analysis. Immunoreactive cells are particularly well labeled with this new protocol. The BDHC crystals are easily detected at the EM level and can be distinguished from flocculent DAB reaction product. This feature makes EM double-labeling studies possible.

3,3'-Diaminobenzidine↗

Integrated care pathways: a tool to improve infant monitoring in a neonatal unit.

An integrated care pathway (ICP) is a structured chart that prompts for key observations and interventions in patients to be recorded at set times by medical and nursing staff. ICPs were introduced into the neonatal department of the Queen Elizabeth Central Hospital in Blantyre, Malawi. The number of observations of babies recorded in the year before and 2 years after the introduction of ICPs were compared. When ICPs were in use, 9-96% of the 18 possible daily observations were recorded as having been carried out, compared with 0-33% before their introduction. In the 2nd of the 3 years, there was a fall-off in some observations made, probably because of staff shortages. The ICPs proved effective and easy to use. When adapted to local needs they play an important role in delivering neonatal care.

Critical Pathways↗

Comparison of Two Questionnaires on Respiratory Symptoms in a Nicaraguan Population: Value in Diagnosis of Chronic Bronchitis.

Two questionnaires about respiratory symptoms were evaluated for reliability and ability to diagnose chronic bronchitis in a study population of 129 Nicaraguans (110 workers and 19 patients with chronic bronchitis). The first questionnaire (AQ) had symptom questions that were based on British Medical Research Council (MRC) questions, adapted to local Spanish. The second questionnaire (MRCQ) contained MRC symptom questions translated directly into Spanish. The reliability of the questions was measured in a test-retest procedure. The questionnaire-based diagnosis of chronic bronchitis was compared with the diagnosis made by a physician (for workers) or from the hospital records (for patients). The questions concerning symptoms in both questionnaires were of acceptable reliability. For the diagnosis of chronic bronchitis in workers, the AQ showed similar sensitivity, a somewhat higher specificity, and a substantially higher positive predictive value (90%) than the MRCQ (57%). Among the patients, the AQ identified 17 patients as positive (sensitivity 89%), while the MRCQ identified 15 (sensitivity 79%). respiratory questionnaire; reliability; chronic bronchitis; Nicaragua Hanley & Belfus, Inc. Int J Occup Environ Health 1077-3525 2 2 1996 April/June Chronic Exposure to Cigarette Smoke Inhibits the Stimulating Effects of Mineral Fibers on the Production of Tumor Necrosis Factor by Alveolar Macrophages of Rats 95 98 EN Yasuo Morimoto Department of Environmental Health Engineering, University of Occupational and Environmental Health, Japan 1-1, Iseigaoka, Yahatanishiku, Kitakyushu 807, Japan. Ziro Nambu Hajime Hori Tohru Tsuda Hiroshi Yamato Toshiaki Higashi Yasuyuki Yokosaki Masamitsu Kido Isamu Tanaka The objective of this study was to evaluate the chronic combined effects of mineral fibers and cigarette smoke on the production of tumor necrosis factor (TNF) by alveolar macrophages. The authors chronically exposed ten rats to cigarette smoke in vivo and measured the production of TNF by alveolar macrophages in the presence of mineral fibers in vitro. For smoke exposure, rats were divided into two groups. Five rats were exposed daily to a concentration of 10 mg/m(3) of cigarette smoke for six hours a day, five days a week, for four weeks, and five rats (control) were not exposed to smoke. A broncho-alveolar lavage was performed after the smoke exposure, and the recovered alveolar macrophages were incubated with either chrysotile or ceramic fibers on a microplate for 24 hours. TNF activity in the supernatant was determined by the L929 bioassay. When alveolar macrophages were not stimulated by mineral fibers, TNF production tended to be lower in smoke-exposed alveolar macrophages than in unexposed ones, although the difference was not significant statistically. When alveolar macrophages were stimulated in vitro by chrysotile or ceramic fibers, both fibers stimulated TNF production, but TNF production in smoke-exposed alveolar macrophages was lower than that in unexposed macrophages. These results revealed that long-term exposure to cigarette smoke inhibited the stimulating effect of mineral fibers on the production of TNF.

Journal Article↗

Adrenomedullin messenger ribonucleic acid expression in the placentae of normal and preeclamptic pregnancies.

In pathological pregnancies, alterations in circulating maternal and fetal adrenomedullin (ADM) concentrations may mediate compensatory vascular responses in the fetal or placental circulation. To address whether ADM is a potential paracrine vasoactive factor within the placenta, the regional distribution and cellular localization of ADM mRNA expression were determined by Northern blot and in situ hybridization of different regions of the placenta and fetal membranes from pregnancies complicated by severe preeclampsia [<28 wk (n = 7) and >28 wk (n = 13)] and from normotensive pregnancies [<28 wk (n = 6) and >28 wk (n = 15)]. Northern blotting revealed that ADM mRNA (1.3 kb) was expressed in chorionic villi and basal plate regions, but was most abundantly expressed in the choriodecidua. By in situ hybridization, ADM mRNA was localized to the syncytiotrophoblasts and the extravillous cytotrophoblasts in the basal plate and choriodecidua regions. ADM mRNA expression was increased in the choriodecidua, syncytial knots, and cytotrophoblasts in peri-infarct regions in preeclampsia. In chorionic villous explant studies maintained at reduced oxygen tension, ADM mRNA abundance was increased at 12, 24, and 48 h. ADM mRNA expressed in syncytiotrophoblasts and cytotrophoblasts in the basal plate decidua and choriodecidua may contribute to the maternal and fetal plasma levels. In preeclampsia, regional increases in ADM mRNA may be induced by hypoxia and mediate local fetal/placental adaptive responses to reduced placental perfusion.

Adrenomedullin↗

Evaluation of 2 techniques of HIV pre-test counselling for pregnant women in west Africa. DITRAME Study Group.

This study compares the effect of group and individual pre-test counselling on uptake of HIV voluntary counselling and testing (VCT) by African pregnant women and knowledge about HIV/AIDS in 2 antenatal clinics of Bobo-Dioulasso, Burkina Faso. Pre-test counselling was offered to 3958 pregnant women, 927 by group counselling and 3031 by individual counselling. Acceptance of the test improved with individual counselling, which was already high with group counselling (93.3% versus 89.4%). The return rate for results was independent of the pre-test counselling technique. At post-test session, knowledge about HIV/AIDS was better after group than individual counselling, except for reporting the existence of an asymptomatic stage of HIV infection. At a public health level, group pre-test counselling can be easily integrated into existing sessions of antenatal care counselling, routinely performed by the current clinic staff. Our findings may help programme managers in the field of maternal and child health to choose optimal options of pre-test counselling adapted to local circumstances in resource-poor settings.

Adult↗

Home care, continuing care and medicare: a Canadian model or innovative models for Canadians?

Why is home care excluded from the Canada Health Act? In the 1960s, the Hall Commission suggested that home care be covered through medicare. History decided otherwise--only "medically" necessary care was insured. Today, home-care services are provided in conjunction with episodes of hospital care, or are delivered to frail individuals as part of their social and healthcare needs. However, healthcare can no longer be defined simply as a state of absence of disease. Health also includes individuals' physical and mental functional abilities. Coverage for health services should include those services aimed at preserving and maintaining functional abilities. Moreover, access to home care is inequitable in Canada. Financing mechanisms should improve integration of care, not increase barriers between medical, hospital and social care. As home-care services are provided to persons with different needs, financing and organizational mechanisms have to guarantee that resources are distributed most effectively to meet these needs. Finally, home-care delivery should adapt to local, regional and provincial realities. There is no such thing as "one" Canadian home-care model. Already, a number of experiments with home care are being implemented in Canada. It is in the search for innovative service delivery modalities that Canadians will best be served.

Canada↗

Hinged cast and roller traction for fractured femur. A system of treatment for the Third World.

Hinged casts and roller traction were used in two developing countries to treat fractured femora, most of which were due to road traffic accidents or civil violence. This method of treatment, developed by Neufeld, is particularly useful in the Third World because it uses local materials, adapted in a hospital workshop, and circumvents the difficulties and complications of standard traction and of operative treatment. The results are reported from 11 patients treated in Uganda in 1979 and from 110 treated in the Dominican Republic in 1981 and 1982. All but one fracture united without complication or significant shortening after a brief period in hospital. The method was easily taught to hospital staff and is strongly recommended.

Adolescent↗

How the philosophies, styles, and methods of family medicine affect the research agenda.

Family physicians provide person-centered, continuous, comprehensive care that is accessible and available at the time of need. Although this core philosophy is shared around the world, its translation into actual practice can vary greatly with time and from place to place as family physicians adapt to local constraints and conditions. Factors driving these local variations include entrenched habits and patterns of care, funding systems, patient expectations, public policy, and the availability and quality of other critical health system components. This diversity provides both an opportunity and a challenge for family medicine research. The potential for fruitful comparisons and contrasts arising from natural experiments may require investigators to use multiple research methods capable of evaluating complex interventions and comparisons. Family medicine has the capacity to be an excellent laboratory in which research in representative populations can offer the pragmatic answers needed by practicing physicians. The nature of the research questions and interventions require the involvement of clinicians in the formulation of research questions and evaluation of the applicability of research results. The variations in implementation of the family medicine philosophy can be a potential asset because of the research opportunities they provide.

Biomedical Research↗

Image acquisition and image processing for the intraocular vision aid.

The contribution describes an "intraocular vision aid (IOVA)" system for patients suffering from corneal opacification. In order to gain patients' acceptance the system has to be miniaturized to a magnitude that image acquisition, image processing, and power supply can be integrated into a portable unit. A CMOS camera whose dynamic range covers more than 100 dB takes pictures of the scenery. Its image sensor has a resolution of 380 x 300 pixel. In order to reduce fixed pattern noise correlated double sampling is implemented on-chip. In addition, this sensor stands out for low power consumption, random pixel access, and local brightness adaptation. An analog-digital-converter allows direct coupling to an external signal processor or a monolithically integrated unit for image processing to compress data.

Computer Systems↗

[Health care reform and social participation].

This article begins by briefly reviewing different forms of citizen participation in the health system. The article then suggests the need for mechanisms for society to control each of the tasks that the health system should perform: defining overall policies, financing, insurance, service provision, and evaluating the effectiveness and efficiency of the system. In general, in the countries of Latin America and the Caribbean, health sector policy formulation continues to be carried out in a centralized manner, with limited involvement by individuals and little adaptation to local realities. The reform processes in the Region are progressing in defining or improving the financing responsibility so as to better reconcile the objectives of equity, efficiency, and freedom of choice. Nevertheless, little has been done to develop instruments for citizens to control the functions of financing and insurance. Appropriate instruments are still lacking for citizens to effectively manage service providers. Among the principal obstacles to citizen participation in the health sector in the Region are: inequality in the distribution of income and other forms of power, an embryonic recognition of the rights of people when they are dealing with public services, limited information concerning those rights and the absence of mechanisms for people to truly exercise them, the weakness with which existing control mechanisms recognize social diversity and incorporate the views of minorities or of the most marginalized groups in society, and weak civic organizations.

Caribbean Region↗

[Community diabetes educational intervention at the primary care level].

OBJECTIVE: To offer an educational alternative on diabetes, with the participation of patients with type 2 diabetes, their family members, and health care providers, adapted to local conditions and to these person's felt needs. METHODS: Focused on the primary-care level, this program was carried out in the health area of El Guarco, which is in the province of Cartago, Costa Rica. The first stage of the project included a qualitative study of the knowledge and practices of both patients and health care providers, looking at diabetes prevention and control and the local availability of foods. Based on those results, an educational methodology was developed, educational manuals were written, and courses for health care providers, patients, and patients' families were implemented. Other strategies were developed to make the effort sustainable. RESULTS: We found that patients did not associate family history or obesity with diabetes and that those persons were also confused about the symptoms of diabetes. Patients also received inconsistent nutrition messages from health care providers. Using the diabetes education manual as a base, the providers increased their knowledge of diabetes prevention, treatment, and education by an average of 85%. The diabetic patients who received educational training (mean age, 57.0 years, with a standard deviation of 8.9 years; 92% women) improved their glycemic control. Blood glucose levels decreased from 189 +/- 79 mg/dL (average and standard deviation) to 157 +/- 48 mg/dL (P < 0.05), and glycosylated hemoglobin (HbA1c) went from 11.3% +/- 2.4% to 9.7% +/- 2.3% (P = 0.05). There were no significant changes in body weight or lipid profile, except for triglycerides, which declined (P < 0.05). CONCLUSIONS: This educational program was successfully incorporated into the regular activities of the El Guarco-area health centers. The primary-care level is ideal for carrying out educational programs for diabetes treatment and early detection that are directed at patients, their families, and health care providers.

Adult↗

The Agita São Paulo Program as a model for using physical activity to promote health.

The "Agita São Paulo" Program applies a multilevel intervention approach to promoting physical activity among the 37 million inhabitants of the state of São Paulo, Brazil. The verb "agita" means to move the body, but the term also suggests changing the way of thinking and becoming a more active citizen. Since being launched in 1996, the Program has been widely copied throughout Brazil and in other countries of Latin America, and the World Health Organization has characterized it as a model for other developing countries. The Program aims to disseminate a clear and simple message to the community as well as establish partnerships with governmental and nongovernmental organizations and other entities. The Agita São Paulo message encourages people to adopt an active lifestyle by accumulating at least 30 minutes of moderate physical activity per day, on most days of the week. The Program has three main target groups: students, workers, and the elderly. The Program organizes "mega-events" that simultaneously reach and involve large numbers of people, and it also conducts ongoing activities with institutions that become partners of the Program. Intervention studies that the Program has carried out on specific, small groups have found both changes in behavior and an increasing awareness of the Program's name and message. In addition, surveys have found that a growing number of persons in the state of São Paulo have become aware of the Program and its message and have changed their physical activity level. A number of the special features of and lessons learned from the Agita São Paulo Program may have contributed to its success, including: a multisectorial approach; broad use of partnerships; the inclusion principle (avoiding messages or attitudes that might exclude any social group); the scientific basis for all the Program activities; the extensive free media coverage that the Program has received; a "two-hats" approach, using either governmental or nongovernmental methodologies to promote physical activity, depending on the circumstances; cultural adaptation (using local culture to disseminate the message and make its assimilation easier); encouraging activities that are pleasurable; the clear, simple, feasible message of promoting physical activity; and evaluation of the various Program efforts. These distinctive characteristics help make the Agita São Paulo Program a model that could be used in other countries as an effective way to promote health through physical activity.

Brazil↗

Collagen fibers, reticular fibers and elastic fibers. A comprehensive understanding from a morphological viewpoint.

Fibrous components of the extracellular matrix are light-microscopically classified into three types of fibers: collagen, reticular and elastic. The present study reviews the ultrastructure of these fibrous components as based on our previous studies by light, electron, and atomic force microscopy. Collagen fibers present a cord- or tape-shape 1-20 microm wide and run a wavy course in tissues. These fibers consist of closely packed thin collagen fibrils (30-100 nm thick in ordinary tissues of mammals), and exhibit splitting and joining in altering the number of the fibrils to form a three-dimensional network as a whole. Individual collagen fibrils (i.e., unit fibrils) in collagen fibers have a characteristic D-banding pattern whose length is ranges from 64 to 67 nm, depending on tissues and organs. During fibrogenesis, collagen fibrils are considered to be produced by fusing short and thin fibrils with tapered ends. Reticular fibers are usually observed as a delicate meshwork of fine fibrils stained black by the silver impregnation method. They usually underlie the epithelium and cover the surface of such cells of muscle cells, adipose cells and Schwann cells. Electronmicroscopically, reticular fibers are observed as individual collagen fibrils or a small bundle of the fibrils, although the diameter of the fibrils is thin (about 30 nm) and uniform. Reticular fibers are continuous with collagen fibers through the exchange of these collagen fibrils. In silver-impregnated specimens, individual fibrils in reticular fibers are densely coated with coarse metal particles, probably due to the high content of glycoproteins around the fibrils. Elastic fibers and laminae are composed of microfibrils and elastin components. Observations of the extracted elastin have revealed that elastin components are comprised of elastin fibrils about 0.1-0.2 microm thick. Elastic fibers and laminae are continuous with networks and/or bundles of microfibrils (or oxytalan fibers), and form an elastic network specific to individual tissues. The fibrous components of the extracellular matrix are thereby morphologically categorized into two systems: the collagen fibrillar system as a supporting framework of tissues and cells, and the microfibrilelastin system for uniformly distributing stress to maintain the resilience adapted to local tissue requirements.

Collagen↗

Cigarette smoking among San Francisco Hispanics: the role of acculturation and gender.

We conducted a phone survey of 1,669 San Francisco Hispanics ages 15 to 64 years. The age-adjusted overall smoking prevalence was 25.4 per cent (95% CI = 23.3, 27.5) with more men (32.4 per cent) smoking than women (16.8 per cent). Age-adjusted smoking rates were higher among the less acculturated males (37.5 vs 26.7 per cent) and among the more acculturated females (22.6 vs 13.6 per cent). The more acculturated, however, smoked a greater number of cigarettes per day independent of gender. Community-based smoking cessation interventions, adapted to local conditions, may have a greater potential for success among Hispanics.

Acculturation↗

Lessons for (and from) America.

Drawing lessons from international experience for health care reform in the United States requires striking a difficult balance between historical determinism and free will, between cynical pessimism and naïve optimism. The key to this puzzle may lie in a paradox: the United States is the most successful exporter of public health policy ideas and instruments yet has failed to build an effective health care system. General ideas (like notions about the role of competition) and microinstruments (like diagnosis-related groups) travel better than do health care systems. Ideas can be adapted to local circumstances, and instruments may easily fit into preexisting systems. Importing systems from countries with different histories and institutions would require a tectonic shift in the American political landscape.

Europe↗

A framework for an institutional high level security policy for the processing of medical data and their transmission through the Internet.

BACKGROUND: The Internet provides many advantages when used for interaction and data sharing among health care providers, patients, and researchers. However, the advantages provided by the Internet come with a significantly greater element of risk to the confidentiality, integrity, and availability of information. It is therefore essential that Health Care Establishments processing and exchanging medical data use an appropriate security policy. OBJECTIVE: To develop a High Level Security Policy for the processing of medical data and their transmission through the Internet, which is a set of high-level statements intended to guide Health Care Establishment personnel who process and manage sensitive health care information. METHODS: We developed the policy based on a detailed study of the existing framework in the EU countries, USA, and Canada, and on consultations with users in the context of the Intranet Health Clinic project. More specifically, this paper has taken into account the major directives, technical reports, law, and recommendations that are related to the protection of individuals with regard to the processing of personal data, and the protection of privacy and medical data on the Internet. RESULTS: We present a High Level Security Policy for Health Care Establishments, which includes a set of 7 principles and 45 guidelines detailed in this paper. The proposed principles and guidelines have been made as generic and open to specific implementations as possible, to provide for maximum flexibility and adaptability to local environments. The High Level Security Policy establishes the basic security requirements that must be addressed to use the Internet to safely transmit patient and other sensitive health care information. CONCLUSIONS: The High Level Security Policy is primarily intended for large Health Care Establishments in Europe, USA, and Canada. It is clear however that the general framework presented here can only serve as reference material for developing an appropriate High Level Security Policy in a specific implementation environment. When implemented in specific environments, these principles and guidelines must also be complemented by measures, which are more specific. Even when a High Level Security Policy already exists in an institution, it is advisable that the management of the Health Care Establishment periodically revisits it to see whether it should be modified or augmented.

Access to Information↗

[Identification of the groups most vulnerable to infant malnutrition through the measuring of poverty level].

OBJECTIVE: To test an instrument measuring the socioeconomic level, specially designed for low income urban populations, to be used in the identification of groups more vulnerable to infant malnutrition. POPULATION AND METHODS: This is a cross-sectional study, with a sample of 477 children aged 12 to 59 months old living in low income census sectors at "Vila Grande Cruzeiro", in Porto Alegre, RS. The children were submitted to anthropometric evaluation and their families were stratified according to socioeconomic level measured through an instrument developed in Chile for urban poor populations and adapted to local conditions. Children with weight/age, height/age and/or weight/height below - 2 standard deviation from the median of the reference population (NCHS) were considered malnourished. RESULTS: The children from families belonging to the lowest quartile in the socioeconomic classification had a 3.4 times higher chance of having low weight for age, a 2.7 times higher chance of being stunted and a 11.0 times higher chance of presenting low weight for height, controlling for potential confounders. CONCLUSION: The instrument measuring poverty level was useful to identify those children with higher risk for malnutrition.

English Abstract↗