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PubMed1999

An electrophysiological and morphological investigation of the projections of growth hormone-releasing peptide-6-responsive neurons in the rat arcuate nucleus to the median eminence and to the paraventricular nucleus.

Growth hormone-releasing peptide-6 injection induces c-fos messenger RNA expression in many arcuate nucleus neurons, and sub-populations of neurons in this region project to the hypothalamic paraventricular nucleus. We examined electrophysiologically whether arcuate nucleus neurons that project to the paraventricular nucleus also project to the median eminence, and whether these neurons are activated by systemic injection of growth hormone-releasing peptide-6. Of 116 arcuate nucleus neurons tested, 43 were antidromically-identified as projecting to the paraventricular nucleus and a further 30 as projecting to the median eminence; these populations displayed distinct electrophysiological characteristics, and contrasting patterns of orthodromic response to stimulation of the median eminence and paraventricular nucleus, indicating that these two populations are functionally distinct with limited communication between them. Only one cell was antidromically-identified as projecting to both these regions. Three of 10 arcuate nucleus neurons that projected to the paraventricular nucleus were activated by injection of growth hormone-releasing peptide-6. In parallel experiments, we examined whether Fos protein expression is induced in arcuate nucleus neurons that project to the paraventricular nucleus, as identified by retrograde-labelling with FluoroGold. Immunocytochemical studies revealed that 20% of arcuate nucleus neurons that were retrogradely-labelled from the paraventricular nucleus were Fos-positive following growth hormone-releasing peptide-6 injection, although cells that were both Fos-positive and retrogradely-labelled accounted for less than 5% of the total number of Fos-positive arcuate nucleus neurons. These results confirm that there is a direct projection from the arcuate nucleus to the paraventricular nucleus and indicate that growth hormone-releasing peptide-6 activates some of these neurons.

Animals↗
PubMedDate not supplied

Species differences in the projections from the entorhinal cortex to the hippocampus.

Both differences and similarities exist between mammalian species in the projections from entorhinal cortex to the hippocampal formation. In most species, layer II cells of the entorhinal cortex project to the dentate gyrus, and they terminate in the outer two-thirds of the molecular layer of the dentate gyrus. The axons from layer III cells project bilaterally to areas CA(1) and CA(3) of the hippocampus, terminating in the stratum lacunosum moleculare. We have analyzed these projections in mice, and in general, the entorhinal cortex-to-hippocampus projections are similar to those in rats. Axons from layer II neurons terminate in the outer and middle thirds of the molecular layer of the dentate gyrus, and axons from layer III neurons terminate bilaterally in the stratum lacunosum moleculare of areas CA(1) and CA(3), and in the molecular layer of the subiculum. However, in contrast to rat, mouse entorhinal cortex neurons do not appreciably project to the contralateral dentate gyrus. Most species, including mice, show a similar topographical organization of the entorhinal-hippocampal projections, with neurons in the lateral part of both the lateral and medial entorhinal cortex projecting to the dorsal part or septal pole of the hippocampus, whereas the projection to the ventral hippocampus originates primarily from neurons in medial parts of the entorhinal cortex.

Animals↗
PubMed1997

Preventing the spread of AIDS in youth: principles of practice from 11 diverse projects.

PURPOSE: The purpose of this study was to identify the factors that contributed to intervention effectiveness in acquired immunodeficiency syndrome (AIDS) prevention projects targeting youth. METHODS: Eleven AIDS prevention projects funded by the Robert Wood Johnson Foundation whose target populations consisted of at least 60% youth were studied. A blended methodology resulted in quantitative data (i.e., survey responses) from all 11 projects supplemented with qualitative data (i.e., open-ended interviews) drawn from in-depth site visits to six projects. RESULTS: Projects reported using a mean of 16.6 intervention activities (selected from a list of 30). Six activities were used by all 11 projects. Small group discussions were rated as one of three most effective activities by 72.7% of the projects that used them. Project staff identified three elements of effective interventions: involvement of peer educators, recognition of the role of adults (e.g., parents, teachers), and use of structured settings to gain access to the target population (e.g., schools, clubs). CONCLUSIONS: The most powerful strategies described by project staff for reaching adolescents at risk for human immunodeficiency virus (HIV) transmission also bring considerable challenges. Opportunity costs associated with using peer educators, gatekeeper support, and structured settings may include limited control of the message, impaired credibility, and failure to reach those youth at greatest risk of HIV infection, respectively. Health educators will do well to consider the advantages and disadvantages of these factors when developing, implementing, and evaluating AIDS prevention programs for youth.

Acquired Immunodeficiency Syndrome↗
PubMed1998

The effects of projection geometry and trabecular texture on estimated fractal dimensions in two alveolar bone models.

OBJECTIVES: To study the effects of trabecular texture and projection geometry on estimates of fractal dimensions from simulated alveolar bone. METHODS: Two models, one scale-variant and the other relatively scale-invariant, were used. Projections of 2-D slices through both the models were calculated, a uniform series of projections computed for the angular orientations between (0 degree and 180 degrees). Results of the 128 stacked projections are the projection of the 3-D object from different angles. Power spectra were produced by calculating the squared magnitude from the data and plotted as the logarithm of the power against the logarithm of the frequency, to give the fractal dimension. RESULTS: In the scale-variant model, the alveolar trabecular texture produced with a relatively thicker cylindrical diameter yielded a smaller fractal dimension (t = 8.44, P = 0.00). Linear regression analysis showed that the correlation between projection angle and the resulting fractal dimension was low for both the thicker cylinder (r = 0.02, P = 0.82), and for thinner cylinder (r = 0.02, P = 0.84). The scale-invariant model, also yielded a relatively smaller estimated fractal dimension (t = 7.23, P = 0.00). However, the correlation between projection angle and the resulting estimate of the fractal dimension was found to be low for both trabecular configurations (r = 0.10, P = 0.29 and r = 0.07, P = 0.45 respectively). CONCLUSIONS: Fractal dimensions increased when the diameter of the simulated cylindrical trabeculae decreased irrespective of the differences in self-similarity. The degree to which they varied with projection angle was relatively less for the scale-invariant (self-similar) model. However, fractal dimensions changed significantly with projection geometry.

Alveolar Process↗
PubMed2001

Corticonuclear projections of the cerebellum preserve both anteroposterior and mediolateral pairing patterns.

The aim of the present study was to establish whether a diverging arrangement of the corticonuclear cerebellar projections exists and, if so, what relation it has with the inferior olivary complex. Iontophoretic injections of a 1 : 1 mixture of tetramethylrhodamine dextran amine and biotinylated dextran amine into the cerebellar cortex orthogradely labelled fibre terminals in the cerebellar nuclei and retrogradely labelled cell bodies in the inferior olivary complex. The injections were into A, B, C2, C3, D1 and D2 bands. These injections showed diverging projections to the cerebellar nuclei, with 'primary projections' directed to the nuclear region previously reported to be specifically connected with the injected band and 'secondary projections' directed to other nuclear regions. Secondary projections from the A, C2 and C3 bands diverged to nuclear regions primarily controlled by cortical bands lateral to those injected. Secondary projections from the D1, and D2 bands diverged to nuclear regions primarily controlled by cortical bands medial to those injected. Moreover, injections distributed along the D1 and D2 bands showed similar sets of nuclear targets, while those distributed along the A, C2 and C3 bands showed two sets of nuclear targets in relation to the anteroposterior location of the injected area within these bands. The cortical areas that projected to the same set of nuclear targets were innervated from single olivary regions, while those that projected to different sets of nuclear targets were innervated from different subsets of single regions of the inferior olive. The results suggest that the olivary bands of the cerebellar cortex project to the cerebellar nuclei with a diverging pattern that is organized in both the mediolateral and the anteroposterior axes.

Animals↗
PubMed2000

Undergraduate projects - do they have to be within the conventional medical environment?

OBJECTIVES: Undergraduate medical curricula now include increasing amounts of project work aimed at developing skills related to lifelong learning. One course allows students to choose from a wide range of projects, including 'conventional' hospital specialties and also from topics outside the mainstream of medicine. DESIGN: 'Conventional' and 'external' projects were compared in terms of the prior academic abilities of the students undertaking them, the assessment results and student and supervisor feedback, in order to consider whether the unconventional projects were equally valid within the undergraduate medical curriculum. SETTING: School of Medicine, University of Leeds, UK. SUBJECTS: Medical students. RESULTS: No difference between the assessment results of the student groups was present, with over 85% of all students reaching a standard of 'excellent' or 'good' in their overall final grade. There was no difference in prior academic abilities between the student groups. Enjoyment of modules was comparable between student groups ('conventional' 89%, 'external' 93%) with good levels of satisfaction with the quality of supervision. There were no differences in students' self-appraisal of generic skill acquisition. Students who had undertaken 'external' projects felt they had gained less experience in data-handling and problem-solving skills. However, 'external' projects were rated higher by students in terms of having realistic and achievable objectives, and the supervisors of these projects were also more realistic about time commitments involved in project supervision. CONCLUSIONS: 'External' modules were very popular, with over 45% of students requesting places which were available for fewer than 20% of students per year. Concerns regarding the appropriateness of self-directed undergraduate medical student projects outside the mainstream of medical practice were unfounded.

Curriculum↗
PubMed2003

A quantitative and morphological study of projection neurons in lamina I of the rat lumbar spinal cord.

In the rat lumbar spinal cord the major supraspinal targets for lamina I projection neurons are the caudal ventrolateral medulla (CVLM), lateral parabrachial area (LPb) and periaqueductal grey matter (PAG). In this study we have estimated the number of lamina I neurons retrogradely labelled from each of these sites in the L4 segment, as well as the proportion that can be labelled by injecting different tracers into two separate sites. Our results suggest that this segment contains approximately 400 lamina I projection neurons on each side, and that approximately 85% of these can be labelled from either the CVLM or the LPb on the contralateral side. Around 120 lamina I cells in L4 project to the PAG, and over 90% of these cells can also be labelled from the CVLM or LPb. Most lamina I neurons projecting to CVLM or LPb are located in the contralateral dorsal horn, but in each case some cells were found to have bilateral projections. We also examined horizontal sections to investigate morphology and the expression of the neurokinin 1 (NK1) receptor in cells labelled from CVLM, LPb or PAG. There were no consistent morphological differences between these groups, however, while cells with strong or moderate NK1 receptor-immunostaining were labelled from LPb or CVLM, they seldom projected to the PAG. These results suggest that many lamina I cells project to more than one site in the brain and that those projecting to PAG may represent a distinct subclass of lamina I projection neuron.

Animals↗
PubMed2005

[Integrated sustainability-oriented reporting--key indicators for communities and cities. Results of a research and development project].

In our research project -- supported by the German Federal Ministry for Education and Research (BMBF) - 35 key indicators were developed in an ongoing process in co-operation with 10 East German cities, which are all members in the German cities healthy network. With these indicators the cities should take up integrated sustainability - oriented health reporting, from which actions and projects for health promotion and prevention can be derived. The conceptual background for the research project and the reports to be made by the project in co-operation with the cities, are the three policy programmes that to be realised on a county level: Healthy Cities, Local Agenda 21 and the German city development programme "Soziale Stadt (socially oriented city)". The common goal of these programmes is the sustainable improvement of the quality of life in the counties. The project is part of the BMBF-supported research field "problem - oriented regional reporting systems", in which other projects are involved which are mainly being conducted in the newly-formed East German "Lander". In this article we describe the co-operative process of the development of the indicators. A synopsis of already applied or proposed sets of indicators for municipal reporting was the basis for the development of the project's set of 35 key indicators. The set of indicators is presented according to its usefulness for planning and realisation of actions for health promotion on county level. For each of the 35 indicators a meta - data description was made to support the counties and cities in our project for health reporting. These indicator profiles are also helpful and supportive for all counties and citiesaiming at such health reporting. The project started in May 2002 and lasts till Mai 2005, so that most reports should be completed in the spring of 2005.

Community Health Services↗
PubMed1988

Differential loss of striatal projection neurons in Huntington disease.

Huntington disease (HD) is characterized by the loss of striatal projection neurons, which constitute the vast majority of striatal neurons. To determine whether there is differential loss among different populations of striatal projection neurons, the integrity of the axon terminal plexuses arising from the different populations of substance P-containing and enkephalin-containing striatal projection neurons was studied in striatal target areas by immunohistochemistry. Analysis of 17 HD specimens indicated that in early and middle stages of HD, enkephalin-containing neurons projecting to the external segment of the globus pallidus were much more affected than substance P-containing neurons projecting to the internal pallidal segment. Furthermore, substance P-containing neurons projecting to the substantia nigra pars reticulata were more affected than those projecting to the substantia nigra pars compacta. At the most advanced stages of the disease, projections to all striatal target areas were depleted, with the exception of some apparent sparing of the striatal projection to the substantia nigra pars compacta. These findings may explain some of the clinical manifestations and pharmacology of HD. They also may aid in identifying the neural defect underlying HD and provide additional data with which to evaluate current models of HD pathogenesis.

Adolescent↗
PubMed1988

Birth of projection neurons in the higher vocal center of the canary forebrain before, during, and after song learning.

The higher vocal center (HVc) of the canary brain projects to two forebrain nuclei: robustus archistriatalis (RA) and area X of lobus parolfactorius. The time of birth of HVc neurons projecting to these two regions was determined by combining [3H]thymidine autoradiography and retrograde fluorogold uptake. Birds were sacrificed at 13 months of age, 4 days after fluorogold injections into area X or RA. A single injection of [3H]thymidine in ovo (embryonic day 9) labeled 76% of area X-projecting cells and 0.8% of cells projecting to RA. The great majority of RA-projecting cells were produced during posthatching development (posthatching day 10-240; P10-P240), with a peak at P60 and a hiatus at P120. HVc reaches full adult size by P240, yet at that age the production of new RA-projecting cells continued at a rate comparable to that recorded during posthatching development. Late production of neurons interconnecting two distant regions of the brain may regulate source to target cell population size. Male canaries start to sing at P40. During subsequent months, they imitate external models and their song becomes more structured and stereotyped. At sexual maturity (P240), song is stable. Three interpretations are offered: (i) neurogenesis of RA-projecting cells is related to learning, and learning continues even after achievement of pattern stability; (ii) neurogenesis of RA-projecting cells is not related to learning; (iii) the production of RA-projecting cells serves different purposes during development and after sexual maturity.

Aging↗
PubMed1989

Transient projection from the superior temporal sulcus to area 17 in the newborn macaque monkey.

Area 17 in the neonate of numerous species receives projections from cortical areas that do not project to area 17 in the adult. To investigate if this were the case in the developing primate, we have made injections of retrograde tracers in area 17 of newborn monkeys (Macaca irus) and examined the areal distribution of labeled neurons. Neurons projecting to area 17 were found to be restricted to those cortical regions that project to area 17 in the adult. The projection to area 17 in the neonate did appear to be very different in that in the superior temporal sulcus there was a large contingent of labeled neurons in supragranular layers. This constitutes a transient projection because in the adult area 17 projecting neurons in this cortical region originate almost exclusively from infragranular layers. To test if a change in the laminar distribution of area 17 projecting neurons in extrastriate cortex is a general feature of postnatal development, we have computed in neonates and adults the proportion of area 17 afferent neurons in infra- and supragranular layers for each cortical region that projects to area 17. This revealed (i) that in the adult the laminar distribution of area 17 afferents is characteristic for each cortical area and (ii) that this distribution emerges during development from an immature state in which labeled neurons are more numerous in supragranular layers. These results show that there is an extensive remodeling of the neuronal circuitry connecting visual cortical areas during postnatal development in the monkey and that the transient connectivity of primate area 17 is very different from that observed in other mammalian species.

Aging↗
PubMed1995

Layer-specific programs of development in neocortical projection neurons.

How are long-range axonal projections from the cerebral cortex orchestrated during development? By using both passively and actively transported axonal tracers in fetal and postnatal ferrets, we have analyzed the development of projections from the cortex to a number of thalamic nuclei. We report that the projections of a cortical area to its corresponding thalamic nuclei follow highly cell-specific programs of development. Axons from cells in the deepest layers of the cerebral cortex (layer 6 and superficial subplate neurons) appear to grow very slowly and be delayed for several weeks in the cerebral white matter, reaching the thalamus over a protracted period. Neurons of layer 5, on the other hand, develop their projections much faster; despite being born after the neurons of deeper layers, layer 5 neurons are the first to extend their axons out of the cortical hemisphere and innervate the thalamus. Layer 5 projections are massive in the first postnatal weeks but may become partly eliminated later in development, being overtaken in number by layer 6 cells that constitute the major corticothalamic projection by adulthood. Layer 5 projections are area-specific from the outset and arise as collateral branches of axons directed to the brainstem and spinal cord. Our findings show that the early development of corticofugal connections is determined not by the sequence of cortical neurogenesis but by developmental programs specific for each type of projection neuron. In addition, they demonstrate that in most thalamic nuclei, layer 5 neurons (and not subplate or layer 6 neurons) establish the first descending projections from the cerebral cortex.

Animals↗
PubMed2006

Improving the performance of the health service delivery system? Lessons from the Towards Unity for Health projects.

CONTEXT: The World Health Organization developed the Towards Unity for Health (TUFH) strategy in 2000 for the improvement of health system performance. Twelve projects worldwide were supported to put this strategy into practice. A standard evaluation and monitoring framework was developed on the basis of which project coordinators prepared technical progress reports. OBJECTIVES: To review the utility and effectiveness of the evaluation criteria recommended by TUFH and their application in four of the original twelve projects. METHODS: We reviewed status reports provided by European project coordinators and developed a standardized reporting template to extract information using original TUFH evaluation criteria. RESULTS: The original TUFH evaluation framework is very comprehensive and has only partly been followed by the field projects. The evaluation strategies employed by the projects were insufficient to demonstrate the connections between the intervention and the desired process improvements, and few of the evaluation measures address outcomes. DISCUSSION: The evaluation strategies employed by the projects are limited in allowing us to associate the intervention with the desired process improvements. Few measures address outcomes. The evaluation of complex community interventions poses many challenges, however, tools are available to assess impact on structures and process, and selected outcome indicators may be identified to monitor progress in future projects. CONCLUSION: Based on the review of evaluation status of the TUFH projects and resources available we recommend moving away from uniform evaluation and towards monitoring minimal, context-specific performance indicators criteria.

Delivery of Health Care↗
PubMed1992

Actin- and tubulin-dependent functions during Saccharomyces cerevisiae mating projection formation.

Several conditional-lethal mutant alleles of the single-copy Saccharomyces cerevisiae beta-tubulin and actin genes were used to evaluate the roles of microtubules and actin filaments in the pheromone-induced extension of mating projections. Mutants defective in tubulin assembly form projections indistinguishable in appearance from those formed by wild-type cells. However, the tubulin mutants are unable to move their nuclei into the projections and to orient the spindle pole body associated with each nucleus toward the projection tip. Actin mutants are defective in spatial orientation of cell-surface growth required for formation of normal mating projections. Migration of nuclei into mating projections and Spa2p segregation to projection tips are also defective in actin mutants. Studies with abp1 null mutants showed that the function of the Abp1p actin-binding protein is either not required for projection formation or there are other proteins in yeast with similar functions. Our findings demonstrate that actin is required to restrict cell-surface growth to a defined region for pheromone-induced morphogenesis and suggest that nuclear position and orientation in mating projections depend on direct or indirect interaction of microtubules with actin filaments.

Actins↗
PubMedDate not supplied

Transitory corpus callosum axons projecting throughout developing rat visual cortex revealed by Dil.

Anatomical tracing was used to determine the extent and distribution of CC axons in mammalian visual cortex. Postnatal development of rat CC was studied by in vitro callosal labeling with the lipophilic carbocyanine dye Dil in 59 rats. Solid Dil crystals were placed in the mid-sagittal region of the CC in aldehyde-fixed brain slabs. Coronal sections through visual cortex were photographed and reconstructed to show the overall distribution of Dil-labeled callosal projections as well as the locations of individual callosal axons and their presumed synaptic boutons. During postnatal weeks 1 and 2, CC axons were found to project to layer I throughout the entire mediolateral extent of areas 17, 18a, and 18b. Numerous varicosities on callosal axons are located en passant and at axon terminals in layer I. During postnatal week 3 the tangential density of callosal projections was significantly reduced, so that fewer callosal axons extended to layer I throughout areas 17, 18a, and 18b than in younger postnatal rats. However, at this age some CC axons could still be found extending to layer I throughout the mediolateral extent of areas 17, 18a, and 18b. By postnatal week 4 the tangential distribution of callosal projections was greatly restricted; most callosal axons projecting to layer I were located at the borders of the visual cortical areas. Nevertheless, there were still callosal axons projecting into cortex and terminating in supragranular and infragranular layers in areas 17, 18a, and 18b; this was most pronounced in area 18a. Thus, in the rat there are many elaborately formed transitory CC axons projecting throughout visual cortex for several weeks postnatal. These projections extend to layer I and have varicosities in all cortical layers. With increasing age, fewer axons extended to layer I; subsequently most axons not at cytoarchitectonic borders fail to extend to layer I. If some of the varicosities on the transitory rat callosal axons were to form synapses, there would be extensive opportunities for the CC to provide input to all layers of visual cortical areas while cortical microcircuitry is being established. The same type of study in the cat has shown similar results during early postnatal development. Cat CC axons project to all parts of primary and association visual cortical areas; even in regions found to be acallosal in the adult, the neonatal callosal axons extend through all layers of cortex to reach layer I (Elberger, 1993).(ABSTRACT TRUNCATED AT 400 WORDS)

Aging↗
PubMed1997

Cortical projections of area V2 in the macaque.

To determine the locus, extent and topograhic organization of cortical projections of area V2, we injected tritiated amino acids under electrophysiological control into 15 V2 sites in 14 macaques. The injection sites included the foveal representation and representations ranging from central to far peripheral eccentricities in both the upper and lower visual fields. The results indicated that all V2 sites project topographically back to V1 and forward to V3, V4 and MT. There is also a topographically organized projection from V2 to V4t, but this projection is limited to the lower visual field representation. V2 thus appears to project to virtually all the visual cortex within the occipital lobe. In addition to these projections to occipital visual areas, V2 sites representing eccentricities of approximately 30 degrees and greater project to three visual areas in parietal cortex-the medial superior temporal (MST), parieto-occipital (PO) and ventral intraparietal (VIP) areas. This peripheral field representation of V2 also projects to area VTF, a visual area located in area TF on the posterior parahippocampal gyrus. Projections from the peripheral field representation of V2 of parietal areas could provide a direct route for rapid activation of circuits serving spatial vision and spatial attention.

Amino Acids↗
PubMed1995

Epidemiological measures of participation in community health promotion projects.

BACKGROUND: The paper is concerned with the use of epidemiological methods to measure the rates at which different strata of a defined population participate in community health promotion projects. The specific aim was to estimate the incidence rates of participation in projects sponsored by the Western Australian Health Promotion Foundation (Healthway), separately for sociodemographic and health-related behavioural subgroups. METHODS: Data were drawn from Healthway sponsorship projects in 1992. Each sport, arts and racing project was associated with promotion of a health message and creation of a health promoting environment. The study used a two-stage sampling design. Thirteen of 57 large sponsorship projects and 30 of 129 small projects were selected. In the second stage, respondents were randomly surveyed from among project participants. A total of 4060 respondents aged > or = 10 years was sampled from the 43 selected projects. Population-based incident participants were estimated and were related to person-years at risk. RESULTS: The total participation rate was 4.01 per person-year. The rate was very high at ages 10-14 years and thereafter declined with increasing age. Compared with the least socially disadvantaged 25% of population, the participation rate fell by around one-third in the medium and high disadvantage groups, but exceeded the baseline by a ratio of 1.85 (95% confidence interval: 1.57-2.18) in the most disadvantaged 10% of population. The effect was most pronounced at ages 10-19 years. Participation was higher in those who smoked, drank alcohol unsafely, reported sunburn and reported low consumption of fruit and vegetables. However, participation was reduced in people who were sedentary. CONCLUSIONS: Epidemiological methods can be used to evaluate the distribution of participation of a population in community health promotion projects. The Western Australian Health Promotion Foundation has been successful in reaching disadvantaged youth.

Adolescent↗
PubMed2005

Perceptions of community participation and health gain in a community project for the South Asian population: a qualitative study.

BACKGROUND: The new public health rejects old individualist attempts at improving health and embraces community-based approaches in reducing health inequalities. Primary Care Trusts in England face the challenge of converting community participation in health into reality. This study explores differences in perception of participation between lay and professional stakeholders of a community health project for a South Asian population in Greater Manchester. METHODS: In-depth interviews and focus groups were used to explore the views of professional and lay stakeholders. All data were audio-taped, transcribed and analysed for emerging themes using a qualitative framework. RESULTS: Professionals talked of working in partnership with the community but lay stakeholders did not feel that they had control over the project. There were problems in engaging the community and local health professionals in the project. Lack of cultural awareness hampered participation in the project. There was agreement that the project improved the self-confidence of participants and created a more informed population. However, there was little support for claims of improvements in social cohesion and changes in lifestyle directly as a result of the project. CONCLUSION: Converting the rhetoric of community participation in health into reality is a greater challenge than was envisaged by policy makers. Marginalized communities may not be willing participants and issues of language and cultural sensitivity are important. Project outcomes need to be agreed to ensure projects are evaluated appropriately. Projects with South Asian communities should not be seen to be dealing with all 'ethnic health' issues without addressing changes in statutory organizations and other wider social determinants of health.

Asia↗