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PubMedDate not supplied

Effect of design interventions on a dementia care setting.

This study examined the effects of particular design interventions in a long-term care facility on residents with dementia and staff perceptions of care delivery. Major renovations were carried out in a care facility in the Midwestern United States. Renovations included a new addition of a dementia care unit designed as a cluster of resident rooms around living and dining areas, and two renovated wings with decentralized dining areas. The research methods used in the study included environmental assessment with the Professional Environmental Assessment Protocol (PEAP), behavioral mapping, and focus-group interviews with staff members. The renovated environment scored higher in PEAP and was perceived by the staff members as a more homelike setting. Although behavioral observations indicate that there was more involvement in programmed activities by the residents, the decentralized neighborhood design did not meet all the behavioral expectations due to a lack of appropriate activities, high staff turnover, and family members' resistance to the relocation of their loved ones. Organizational commitment, advanced planning for appropriate staffing levels, and dementia-related training is crucial for fuller realization of the potential of a household design.

Aged↗
PubMed1982

Pineal is required for testicular maintenance in the turkish hamster (mesocricetus brandti).

The effect of pinealectomy on reproductive function was examined in the Turkish hamster, Mesocricetus brandti. Pinealectomy resulted in testicular regression in this species. This result was unexpected since pinealectomy prevents short day-induced regression of the gonads in the closely related Syrian hamster, Mesocricetus auratus. Decentralization of the superior cervical ganglia and exposure to continuous illumination also caused testicular regression in the Turkish hamster. These manipulations are believed to block pineal melatonin synthesis. In each case (i.e. pinealectomy, decentralization of the superior cervical ganglia, exposure to continuous illumination), the testes regressed after approximately 3--9 weeks and underwent recrudescence after approximately 16--28 weeks. This cycle of testicular regression and recrudescence was similar to that observed in Turkish hamsters exposed to a short day photoperiod. In further experiments, the effects of exogenous melatonin were studied in Turkish and Syrian hamsters. The results of these studies suggest that, in Turkish hamsters, pineal melatonin may be involved in both the maintenance of testis function during exposure to a long day photoperiod and also in the suppression of reproductive function in short days. This is in contrast to the Syrian hamster, in which melatonin appears to be important only for inhibition of gonadal function in short days.

Animals↗
PubMed1976

Changes in (3H)leucine incorporation into pineal proteins following estradiol or testosterone administration: involvement of the sympathetic superior cervical ganglion.

Pineal denervation by superior cervical ganglionectomy (Gx) decreased high affinity binding of estradiol (E2) to the pineal cytosol of female rats and of testosterone to the cytosol of male rats by 40 and 26% and by 75 and 80%, 5 and 14 days after sugery; hormone binding remained unchanged up to 24 h after surgery. Binding to the nuclear fraction decreased sigificantly by 2 weeks after incorporation of (3H) leucine into pineal proteins in Gx. A single injection of E2 (mug) to testosterone propionate (TP) (500 mug) failed to increase the Gx rats when injected 1 or 5 days after surgery. Significant increases were observed in sham-operated controls or in rats subjected to bilateral decentralization of ganglia; however on the 5th day an impairment was observed in hormone ability to enhance [3H]leucine incorporation in decentralized rats. The administration of isoproterenol 19 and 3 h before sacrifice replenished pineal-binding sites for E2 and testosterone in Gx rats, but failed to restore the responsiveness of denervated pineals to hormone administration. Moreover, E2 or TP treatment blocked the increase in labeled amino acid incorporation into proteins brought about by isoproterenol per se. The administration of propranolol 2 and 7 h after hormone injection decreased the ability of E2 and TP to enhance [3H]leucine incorporation by 55 and 41%, respectively. Tyrosine hydroxylase activity of the superior cervical ganglia decreased by 36 and 41% 6 h after E2 or TP administration, and by 43 and 47% after 3 daily injections of the hormones, whereas pineal tyrosine hydroxylase remained unchanged. Hormone treatment for 3 days increased the in vitro uptake of norepinephrine by the ganglia but did not affect uptake in the pineal gland. These data indicate that the integrity of neurons of the superior cervical ganglia is an absolute requirement for E2 and testosterone to enhance [3H]leucine incorporation into pineal proteins in rats.

Adrenergic beta-Antagonists↗
PubMed2001

The impact of South Africa's new constitution on the organization of health services in the post-apartheid era.

This essay evaluates the transformation of the health care system in South Africa in the five years following the end of apartheid. This period has witnessed dramatic and wide-ranging changes in the roles of the central and provincial governments as well as many of the same problems related to decentralization as have been seen elsewhere in the world. The importance of effective intergovernmental relations to the creation of a national health system is highlighted. Negotiation. contracting, and coordination skills and mechanisms need to be strengthened to ensure a more effective national health system within a decentralized political system.

Constitution and Bylaws↗
PubMed1984

Serotonin in the rat sympathetic ganglion: microdetermination of monoamines and their metabolites by high-performance liquid chromatographic electrochemical detection.

We attempted to determine the existence of a functional serotonergic small intensely fluorescent (SIF) cell in the rat superior cervical sympathetic ganglion (SCG) by evaluating the effects of pargyline, decentralization and electrical stimulation on the preganglionic sympathetic fibers. The objective was to assess changes in serotonin (5-HT) metabolism compared with findings in the case of dopamine (DA) metabolism. The contents (ng/ganglion, n = 8, average +/- S.E.) in the adult male Wistar rat SCG of 5-HT and 5-hydroxyindoleacetic acid (5-HIAA) were 1.19 +/- 0.11 and 0.11 +/- 0.01, respectively, determined by our reverse-phase high-performance liquid chromatographic electrochemical method. A relatively large amount of 5-HT was detected in the capsule of the SCG (0.62 +/- 0.16 ng/capsule, n = 8) without detection of 5-HIAA. The pargyline injection increased the DA content and decreased the 3,4-dihydroxyphenylacetic acid (DOPAC) content rapidly. The increase of the 5-HT content was observed without changes in the capsule 5-HT. The mode of pargyline induced-increase in the 5-HT content and decrease of the 5-HIAA content was slow compared to that of DA and DOPAC. Decentralization did not alter the 5-HIAA content, whereas the DOPAC content was markedly reduced. Although electrical stimulation significantly increased the DOPAC content, changes in the 5-HIAA content were not observed. It would thus appear that 5-HT is produced in the rat SCG, and if so, then support for existence of a serotonergic SIF cell in the rat sympathetic ganglion can be obtained. A direct connection between pre- and postganglionic sympathetic neurons through the serotonergic SIF cell was not demonstrated.

3,4-Dihydroxyphenylacetic Acid↗
PubMed1990

Evaluation of drugs for treatment of urinary bladder dysfunction in conscious rats with intact pelvic nerve and after resection of the left pelvic nerve.

We studied the effects of drugs used for treatment of bladder dysfunction in conscious rats with intact pelvic nerves and also in rats at one or two weeks after nerve decentralization on the left side. Bladder contraction accompanying micturition was continuously induced by infusion of solution at a constant rate. When the effects of oxybutynin (3 mg/kg, i.p.) and terodiline (3 and 10 mg/kg, i.p.) on the cystometrogram were studied for about 2 hr, these drugs shortened and then prolonged the micturition interval (MI), but atropine (1 and 5 mg/kg, i.p.), butylscopolamine (20 mg/kg, i.p.) and nifedipine (3 mg/kg, i.p.) exhibited only a shortening effect on the MI. After injection of oxybutynin (10 mg/kg, i.p.), solution dribbled from the urethra for about 30 min. Terodiline (3 mg/kg) caused ischuria in the rats one week after resection of the left pelvic nerve, but not in the rats two weeks after surgery. Physostigmine (0.3 mg/kg, i.p.) improved micturition in the rats one week after surgery, but the effect was not evident in the rats with intact pelvic nerves. It was found that the drugs used for treating failure to store or expel urine exhibited a beneficial effect on micturition in rats with intact pelvic nerves and also in rats one week after nerve decentralization, respectively.

Animals↗
PubMed2003

Effect of cervical vagal nerve stimulation on defibrillation energy: a possible adjunct to efficient defibrillation.

The efficacy of electrical defibrillation is considered to be related to the autonomic status. In search of a possible adjunct to enhance the therapeutic performance of an implantable cardioverter-defibrillator. we investigated whether parasympathetic manipulation by cervical vagal nerve stimulation (VNS) increases defibrillation efficacy. The effects of VNS on transcardiac defibrillation threshold (DFT) were assessed in 55 anesthetized dogs. In neurally intact dogs, right and left unilateral VNS at 10 mA for 7 seconds significantly decreased the DFT after 10 seconds of ventricular fibrillation (control: 3.1 +/- 0.9 J, right: 2.1 +/- 0.9 J [delta-35 +/- 12%, P < 0.0001], left: 2.2 +/- 0.8 J [delta-31 +/- 11%, P < 0.0005]), while bilateral VNS did not (2.8 +/- 1.0 J). In dogs with decentralized vagus nerves, both unilateral and bilateral VNS decreased the DFT. The extent of the VNS-induced decrease in DFT was dependent on the current and the duration of stimulation. We conclude that unilateral VNS decreases the DFT, while bilateral VNS paradoxically has no effect on the DFT unless the vagi are decentralized.

Animals↗
PubMedDate not supplied

The Chilean health system: 20 years of reforms.

The Chilean health care system has been intensively reformed in the past 20 years. Reforms under the Pinochet government (1973-1990) aimed mainly at the decentralization of the system and the development of a private sector. Decentralization involved both a deconcentration process and the devolution of primary health care to municipalities. The democratic governments after 1990 chose to preserve the core organization but introduced reforms intended to correct the system's failures and to increase both efficiency and equity. The present article briefly explains the current organization of the Chilean health care system. It also reviews the different reforms introduced in the past 20 years, from the Pinochet regime to the democratic governments. Finally, a brief discussion describes the strengths and weaknesses of the system, as well as the challenges it currently faces.

Chile↗
PubMedDate not supplied

[Perspectives of vector borne diseases control in Brazil].

The analysis of vector borne disease control in Brazil should consider three aspects: the urbanization of the population, change from a rural pattern to concomitant urban or peri-urban transmission and decentralization of control to municipalities. The great majority of the population now lives in urban areas. Some diseases are being transmitted in urban areas, due to the emergence or reemergence of their vectors, such as dengue, malaria and visceral leishmaniasis. Difficulties in control occur, as it is easier to apply control measures in rural areas, because there is more population adherence than in urban areas and so the coverage is higher and disease control is better. The decentralization of control activities to states and municipalities is being implemented and difficulties occur as these levels of government have insufficient accumulated experience in control. For more effective control, political commitment, multi-sector articulation and rational use of insecticide are required.

Animals↗
PubMed1996

[Health information systems at the local level]

Information systems have assumed paramount importance in modern society, becoming an strategic resource of power in all areas. Therefore, it is important that the process of decentralization of the health sector should not be limited to services, but should also consider the decentralization of information. The author discusses the sharing of political and technical responsibility between various governmental spheres, and the need to rethink and redirect the process of making accessible information on health. This is a matter of overcoming vertical relations between government and society and of moving toward cooperative management capable of minimizing regional inequalities and optimizing the utilization of resources.

Journal Article↗
PubMedDate not supplied

[Pharmaceutical care in primary health care: the experience of 3 Brazilian States].

In the context of recent changes in the Brazilian drug supply system at the national level, mainly the deactivation of CEME (a government agency under the Ministry of Health that dealt with drug supply policy) and the increasing decentralization of activities under the Unified National Health System (SUS), three Brazilian States - Paraná, São Paulo, and Minas Gerais - have established programs for the distribution of essential drugs for primary health care. A nationwide program for the procurement and supply of 32 drugs for primary health care (the so-called "Basic Pharmacy Program") is currently being implemented by the Ministry of Health, to be decentralized subsequently. This article discusses the establishment of State-level drug policies for primary health care through the analysis of the three pioneering programs encompassing drug selection, procurement, storage, distribution, and use.

Brazil↗
PubMedDate not supplied

[Shared local health system management and community participation in Brazil].

The introduction of the Unified Health System (SUS) by the Brazilian government has helped enhance community participation. A survey in 12 municipalities in different States of the country focused on the decentralization process implemented by the Federal government (Basic Operational Ruling NOB01/93). Based on the ruling's implementation, community participation has improved in the municipalities, the number of local health councils has increased, and more local people have become involved in the process. Another important aspect of the new health policy has been the direct influence of the local health councils in managing the system. Local health councils have thus been an efficient channel for community involvement. This paper discusses how the population has been represented in such councils in the wake of the decentralization process. The authors ask, what is the relationship between social democracy and political democracy, and what kind of state reform should be carried out?

Brazil↗
PubMed2005

[Entomological surveillance for Chagas disease in the mid-western region of Minas Gerais State, Brazil, from 2000 to 2003].

In Minas Gerais State, Brazil, after the elimination of Triatoma infestans by the Brazilian Chagas Disease Control Program, some triatomine species, such as Panstrongylus megistus, have merited the attention of entomological surveillance authorities. After the decentralization of the Brazilian health system, certain administrative and operational difficulties have been observed in some municipalities (counties). This study aims to evaluate entomological surveillance for Chagas disease in the 54 municipalities supervised by the Division of Decentralized Health Activities in Divinopolis, Minas Gerais, from 2000 to 2003. In 46 municipalities, 1,531 triatomines were captured, of which 94.1% were P. megistus. The infection rate for T. cruzi in the vectors was 1.3%. A total of 850 reports were received and 835 site visits were conducted, showing that the program is active and efficient in the majority of the municipalities analyzed. The importance of the maintenance and improvement of entomological surveillance in the region was demonstrated, since triatomine bugs continue to invade (and can colonize) the domiciliary environment, although with low density.

Animals↗
PubMed2006

[Regional health systems management: a case study in Rio Grande do Sul, Brazil].

This article analyzes the management system in a health district in the State of Rio Grande do Sul, Brazil, through qualitative analysis, using a case study as the methodology and macro-organization theory as the analytical framework. For the current management system in the 6th Health Region, a clear mission statement and wide acceptance by health workers are facilitating factors for the current organizational practices within the health system. Nevertheless, the way health coordinators are currently prioritizing their time has diverted necessary resources from critical problems towards more remedial issues. The 6th Health Region has encouraged social control (or public oversight) in order to improve accountability. However, there is room for improvement in quality assurance management, since there were no well-defined goals, objectives, or accountability. Decentralized consultancy provided to the municipalities and the funding model itself have both promoted decentralization and autonomy, although the strategy requires better regional integration and greater commitment in managerial practices.

Brazil↗
PubMed2006

[Spatial analysis of leprosy cases treated at public health care facilities in Brazil].

Hansen disease or leprosy is a major endemic disease in Brazil. Well-designed strategies, including decentralization of basic care, are needed to reduce its prevalence. The article begins by describing the structure and supply of services for treating leprosy cases in the country, after which it analyzes the trends in epidemiological and operational indicators, comparing the periods before and after decentralization of services to the municipal (local) level. Finally, spatial analysis allowed identifying the territorial distribution of this endemic and analyzing the pattern of geographic areas according to care provided by health facilities and its evolution. Based on the location of the geographic centers in the census tracts by place of residence, and using spatial smoothing technique based on Kernel estimation, the study constructed domain areas of care for each health facility or unit. Following municipalization of care, there was an increase in the detection and treatment by the municipalities themselves, reducing patient evasion to neighboring counties and causing changes in demand trends, with an increase in use of services by the clientele and important alterations in the epidemiological and operational indicators.

Brazil↗
PubMed2006

District health programmes and health-sector reform: case study in the Lao People's Democratic Republic.

The Lao People's Democratic Republic (Lao PDR) is classified by the World Bank as a low-income country under stress. Development partners have sought to utilize effective aid instruments to help countries classified in this way achieve the Millennium Development Goals; these aid instruments include sector-wide approaches (SWAps) that support decentralized district health systems and seek to avoid fragmentation and duplication. In Asia and the Pacific, only Bangladesh, Papua New Guinea and the Solomon Islands have adopted SWAps. Since 1991, a comprehensive primary health care programme in the remote Sayaboury Province of Lao PDR has focused on strengthening district health management, improving access to health facilities and responding to the most common causes of mortality and morbidity among women and children. Between 1996 and 2003, health-facility utilization tripled, and the proportion of households that have access to a facility increased to 92% compared with only 61% nationally. By 2003, infant and child mortality rates were less than one-third of the national rates. The maternal mortality ratio decreased by 50% despite comprehensive emergency obstetric care not being available in most district hospitals. These trends were achieved with an investment of approximately 4 million US dollars over 12 years (equivalent to US 1.00 US dollars per person per year). However, this project did not overcome weaknesses in some national disease-control programmes, especially the expanded programme on immunization, that require strong central management. In Lao PDR, which is not yet committed to using SWAps, tools developed in Sayaboury could help other district health offices assume greater planning responsibilities in the recently decentralized system. Development partners should balance their support for centrally managed disease-specific programmes with assistance to horizontally integrated primary health care at the district level.

Community Health Planning↗
PubMed2026

From spillover to systems: evidence gaps in One Health preparedness for emerging infectious diseases in Latin America and the Caribbean.

Latin America and the Caribbean are a global hotspot for emerging and re-emerging infectious diseases, yet regional One Health preparedness remains uneven and incompletely operationalized. This narrative Mini Review synthesizes evidence published mainly between 2015 and 2026 on One Health preparedness for emerging infectious diseases in the region, emphasizing how environmental disruption and climate change shape zoonotic and vector-borne spillover risk. Available regional surveys suggest broad professional familiarity with the One Health concept but limited operational implementation, with environmental health frequently identified as the least-integrated domain. We argue that spillover risk-and the failure to detect and contain spillover once it occurs-should be understood as a system-level outcome shaped by ecological disruption, socioeconomic vulnerability, surveillance capacity, and governance, rather than as an isolated biological event: deforestation, agricultural and extractive expansion-including illegal mining and logging-unplanned urbanization, and climate variability generate new human-animal-vector interfaces, while fragmented governance, uneven and poorly decentralized laboratory capacity, and limited reservoir and environmental surveillance leave these interfaces unmonitored. Environmental and climatic drivers are robustly linked to spillover, although the pathways are disease-specific rather than universal, and socioeconomic vulnerability concentrates the resulting burden in Indigenous, rural, and marginalized populations. We identify priority gaps in integrated surveillance, decentralized diagnostics, genomic capacity, reservoir ecology, governance, financing, and equity, and propose an agenda for anticipatory, climate-informed, and context-sensitive preparedness.

Latin America↗
PubMedDate not supplied

Surgical correction of high myopia in phakic eyes with Worst-Fechner myopia intraocular lenses.

BACKGROUND: Implanting an anterior chamber intraocular lens in a phakic eye is an effective surgical procedure for the correction of high myopia. However, the potential risks on the anterior segment structures are not well-known. We conducted a prospective study to evaluate the effectiveness, predictability, and safety after Worst-Fechner lenses were implanted to correct high myopia. METHODS: We studied 32 eyes with preoperative myopia from -9.50 to -27.00 diopters (D) (-16.60 +/- 6.29 D). All 32 eyes were studied by clinical specular microscopy, and the endothelium was analyzed for cell density. Twenty eyes were additionally examined by fluorophotometry for lens transmittance changes. Thirty eyes were additionally examined using the flare mode of a laser flare cell photometer for anterior chamber inflammation; the patients were divided into three subgroups of ten eyes each according to when the postoperative flare measurements were done: 12 months, 18 months, and 24 months. Thirteen phakic eyes with myopia greater than -6.00 D were used as a control group for the flare study. The mean follow-up was 18.3 +/- 8 months (range 6 to 24 mo). RESULTS: Fifty-seven per cent of eyes (16 of 28) had an uncorrected visual acuity of 20/40 or better 12 months after surgery, and 58% (10 of 17 eyes) at 24 months. Spectacle-corrected visual acuity improved: 0.15 at 12 months and 0.16 at 24 months (0.1 = one line) from preoperative values. Visual acuity was stable after 3 months. Eighty per cent of eyes (25 of 31) at 6 months, 75% (21 of 28) at 12 months, and 76.5% (13 of 17) at 24 months had been correctly planned to within +/-1.00 D of emmetropia. The refractive results were stable 3 months after surgery. The mean endothelial cell loss was 7.2% at 3 months, 10.6% at 6 months, 13% at 12 months, and 17.6% at 24 months after surgery. The mean lens transmittance loss was 0.62% at 3 months, 0.72% at 6 months, 0.82% at 12 months, and 1.03% at 18 months after surgery. Flare values were significantly higher for eyes implanted with Worst-Fechner lenses than were those of the control group in all periods under consideration (Mann-Whitney test, p < 0.05). A decentration greater than 0.5 mm was present in 43% of eyes (14 of 32), and halos in 56% (18 of 32). In three eyes (9.3%), fixation of the lens to the iris was not stable. CONCLUSIONS: Our results for the Worst-Fechner myopia lens confirm earlier findings on the effectiveness of the refractive results. However, our study showed a continual decrease in endothelial cell density, a decrease in lens transmittance, and a chronic subclinical inflammation after the implantation of these lenses. Moreover, decentration was common, and the fixation of the IOL to the iris was not stable in some eyes.

Adult↗