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PubMed2000

[Improvement of transrectal ultrasound. Artificial neural network analysis (ANNA) in detection and staging of prostatic carcinoma].

As a result of the enhanced clinical application of prostate specific antigen (PSA), an increasing number of men are becoming candidates for prostate cancer work-up. A high PSA value over 20 ng/ml is a good indicator of the presence of prostate cancer, but within the range of 4-10 ng/ml, it is rather unreliable. Even more alarming is the fact that prostate cancer has been found in 12-37% of patients with a "normal" PSA value of under 4 ng/ml (Hybritech). While PSA is capable of indicating a statistical risk of prostate cancer in a defined patient population, it is not able to localize cancer within the prostate gland or guide a biopsy needle to a suspicious area. This necessitates an additional effective diagnostic technique that is able to localize or rule out a malignant growth within the prostate. The methods available for the detection of these prostate cancers are digital rectal examination (DRE) and Transrectal ultrasound (TRUS). DRE is not suitable for early detection, as about 70% of the palpable malignancies have already spread beyond the prostate. The classic problem of visual interpretation of TRUS images is that hypoechoic areas suspicious for cancer may be either normal or cancerous histologically. Moreover, about 25% of all cancers have been found to be isoechoic and therefore not distinguishable from normal-appearing areas. None of the current biopsy or imaging techniques are able to cope with this dilemma. Artificial neural networks (ANN) are complex nonlinear computational models, designed much like the neuronal organization of a brain. These networks are able to model complicated biologic relationships without making assumptions based on conventional statistical distributions. Applications in Medicine and Urology have been promising. One example of such an application will be discussed in detail: A new method of Artificial Neural Network Analysis (ANNA) was employed in an attempt to obtain existing subvisual information, other than the gray scale, from conventional TRUS and to improve the accuracy of prostate cancer identification.

Adult↗
PubMed1987

Local circuit neurons in the rat ventrobasal thalamus--a GABA immunocytochemical study.

The ventrobasal thalamus of seven rats was processed for immunocytochemistry using antisera to glutamate decarboxylase or gamma-aminobutyrate (GABA). Glutamate decarboxylase-stained sections showed a network of stained fibers and terminals but no stained cell bodies. GABA-stained sections had fewer stained fibers and terminals but did show a few stained cell bodies. Cell bodies were especially apparent when carbazole was used for a chromogen for the peroxidase-antiperoxidase visualization. The GABA-stained cells were found to be distributed throughout the ventrobasal complex, to have smaller soma cross-sectional areas than most other cells (81 +/- 34 microns vs 105 +/- 36 microns for all cells) and to make up 0.4 +/- 0.3% of the neuronal population of the ventrobasal complex. Injections of horseradish peroxidase into the somatosensory cortex (SI) retrogradely filled many neurons in the ventrobasal thalamus, but none of these labeled neurons were double labeled with GABA. These results indicate that the GABA-labeled cells probably represent a small population of local circuit neurons in the rat ventrobasal thalamus.

Animals↗
PubMed2005

Invisibility, safety and psycho-social distress among same-sex attracted women in rural South Australia.

INTRODUCTION: Available work from North America indicates that same-sex attracted (SSA) individuals enjoy aspects of rural life but nonetheless report encountering homophobia and experiencing isolation from SSA networks. The experience of prejudice and social isolation are often associated with psycho-social distress among the general population of same-sex attracted individuals. Little is known of how SSA women experience life in rural areas of Australia and how this influences their psycho-social wellbeing. METHODS: This was a small-scale qualitative study using guided interviews to explore the experience of SSA women living in rural areas of South Australia. Seven women identifying as same-sex attracted were interviewed. In addition, a woman who provides a counseling and support service for same-sex attracted women was also interviewed. All interviews were audiotaped and transcribed verbatim and were then analysed for emergent themes. Summaries of the interviews, based on the emergent themes, were sent to all interviewees so that they could verify or challenge the validity of the emergent themes, as well as to allow them to remove any information they felt might identify them. RESULTS: Most women had felt 'different' while growing up; almost unanimously describing themselves as having been 'tomboys'. However, the lack of visible SSA role models in rural areas, together with a lack of SSA social networks, did not allow some of the women to identify and name their same-sex attraction. For many of the women in this study, it was visits to the state capital, where they had the opportunity to meet other SSA women, which precipitated them identifying themselves as same-sex attracted. In light of this new knowledge, some women denied their same-sex attraction and entered into heterosexual relationships, often entailing marriage. Other women entered same-sex relationships but tried to keep them invisible within their communities. Rural communities are frequently close-knit environments, where 'everybody knows everybody'. In such settings, much of the conduct of daily life is visible to other community members and may be closely scrutinized. In such locations, women initially try to keep their same sex attraction invisible. Women rarely comment on the threat of violence that underpins the attempt to keep same-sex identity or relationships secret. Nevertheless, even while it remains a largely unarticulated factor, it was a powerful one fueling the maintenance of their invisibility. Fear of violence ranges from the threat of overt physical violence to more commonly voiced concerns over 'mundane' harassment. Fear of social violence, in the form of rejection and ostracism, is the most frequently nominated factor motivating women to keep same-sex attraction invisible in rural settings. While keeping their same-sex identity and relationships invisible offers women some safety from physical and social violence, it may pose dangers for their psycho-social well-being. Trying to keep SSA relationships invisible within communities involves women censoring their behaviour while in public. Invisibility also gives rise to isolation, since women do not have the opportunity to form same-sex attracted social networks. Furthermore, some women experience great psycho-social distress as their awareness of their same-sex attraction becomes increasingly incongruent with the established pattern of their lives. Women find it very difficult to seek appropriate forms of help if they do experience psycho-social problems. Concerns over confidentiality means that women are extremely reluctant to seek help and support locally. Distance is a powerful mediating factor in both women's experience of distress and their capacity to seek help to ameliorate it. For women who live in closer proximity to the state capital, the capacity to meet other SSA women and engage in same-sex attracted social activities helps ease their sense of difference and isolation. Likewise, should they wish to utilize counseling or support services, it is relatively easy for them to do so. However, women living at greater distances from a capital city experience greater isolation and loneliness. Moreover, their ability to confidentially access appropriate services is markedly curtailed. CONCLUSIONS: Same-sex attracted women living in rural areas need social contact with other SSA women, where their safety and confidentiality can be assured. They also need access to safe, confidential and appropriate services. Telephone and internet services are one way of anonymously and confidentially giving women access to information and support. Peer support networks, internet and telephone networks need to be further developed. Ways in which specialist gay and lesbian services and locally based health and human services could collaborate to provide accessible and acceptable services and to help women develop safe and confidential social networks need to be identified and trialled.

Adolescent↗
PubMed1996

Use of V-Y flap for vulvar reconstruction.

Less extensive surgical treatment has become possible for limited vulvar cancer. However, primary closure is advisable only when the defect is minimal and tissue replacement is always needed in radical excisions. Local flaps are always considered the first choice because of their characteristics of similarity to the resected area. The V-Y island flaps from the medial side of thigh constitute one of the numerous options. Clinical experience and anatomical studies demonstrate that this procedure is extremely safe thanks to the rich subcutaneous vascular network. After illustrating the theoretical bases and the indications of this surgical procedure, we report our experience. The V-Y technique is reliable, ensures good healing, and provides almost normal sensation. We conclude that, in most instances, it can be considered a good option for vulvar reconstruction for its versatility and rapidity of execution.

Aged↗
PubMed2001

Therapeutic application of repetitive transcranial magnetic stimulation: a review.

Transcranial magnetic stimulation (TMS), a non-invasive means of electrically stimulating neurons in the human cerebral cortex, is able to modify neuronal activity locally and at distant sites when delivered in series or trains of pulses. Data from stimulation of the motor cortex suggest that the type of effect on the excitability of the cortical network depends on the frequency of stimulation. These data, as well as results from studies in rodents, have been generalized across brain areas and species to provide rationales for using repetitive TMS (rTMS) to treat various brain disorders, most notably depression. Research into clinical applications for TMS remains active and has the potential to provide useful data, but, to date, the results of blinded, sham-controlled trials do not provide clear evidence of beneficial effects that replace or even match the effectiveness of conventional treatments in any disorder. In this review, we discuss the clinical and scientific bases for using rTMS as treatment, and review the results of trials in psychiatric and neurological disorders to date.

Animals↗
PubMed1987

Interaction of plasma membrane-associated filaments and H-2 histocompatibility antigens before and after induced patching and capping.

The interaction of H-2 antigens and plasma membrane-associated filaments was studied on dry-cleaved preparations of immunogold-labelled lymphoma cells. In prefixed cells, the plasma membrane-associated network was isotropic without any prevailing direction of the filaments, and the gold-labelled H-2 antigens were preferentially localized over or at a very short distance from membrane-associated filaments. Incubation of unfixed cells with anti-H-2 antibodies followed by fixation and incubation with anti-Ig, did not induce detectable redistribution of H-2 antigens or of the filament network. Notwithstanding this apparent absence of rearrangement of H-2 antigens and filaments, a detergent-resistant linkage to the cytoskeleton was induced. Before immune incubations, virtually all H-2 antigens were solubilized by extraction with Triton X-100, while after incubation with anti-H-2 antibodies about 50% of the H-2 antigens were linked to the Triton X-100-insoluble cytoskeleton. Sequential addition of anti-H-2 and anti-Ig antibodies to unfixed cells induced formation of patches and caps of H-2 antigens. Under these conditions, the majority of the H-2 antigens became linked to the detergent-resistant cytoskeleton. Redistribution into patches and caps was often accompanied by a local rearrangement of the isotropic network into bundles of parallel filaments immediately adjacent to the plasma membrane. Patches were seen to overly both isotropic networks and these parallel filaments. Large sheets of plasma membrane overlying parallel filaments were frequently devoid of gold-labelled H-2 antigens and coated pits, and thus most probably represented areas away from caps. This observation suggests that capping is accompanied by a rearrangement of filaments close to the membrane.

Animals↗
PubMed1993

Clinical diagnosis of pigmented lesions using digital epiluminescence microscopy. Grading protocol and atlas.

BACKGROUND AND DESIGN: Epiluminescence microscopy (ELM) is a clinical technique that permits in vivo visual inspection of pigmented anatomic structures of the epidermis, dermoepidermal junction, and papillary dermis. A protocol is proposed for systematic visual inspection of pigmented lesions. Seventy pigmented lesions were imaged with a digital ELM camera system. Images were visually inspected for eight "global" ELM features, 23 "local" ELM features, and 18 network features. An atlas of the most clinically significant ELM features is presented with pilot estimates of their sensitivity and specificity for detecting melanoma. RESULTS: Preliminary data suggest that ELM features that may be most specific for melanoma include multicomponent pattern, nodular pattern, pseudopods, radial streaming, blue-gray areas, whitish veil (milky way), and sharp network margins. Epiluminescence microscopic features that may be most sensitive for melanoma include pigment dots, peripheral erythema, peripheral dark network patches, marked mean network irregularity, network line thickness variability, radial streaming, blue-gray areas, and whitish veil (milky way). Epiluminescence microscopic features that may be most sensitive for severe melanocyte atypia include pigment dots, peripheral erythema, hypopigmented network patches, peripheral dark network patches, marked mean network irregularity, and focal absence of network. In addition, features that may have a very high specificity for benign lesions include saccular pattern (suggests hemangioma), globular pattern (suggests a compound or dermal nevus), and multiple comedolike openings (suggests seborrheic keratosis). CONCLUSIONS: Features most sensitive for severe atypia and melanoma could form the basis for a screening test for considering biopsy. Features most specific for melanoma then could be applied to further triage management of pigmented lesions that meet initial screening criteria. In addition, features with very high specificity for benign lesions may help develop ELM criteria to avoid unnecessary surgery.

Atlases as Topic↗
PubMedDate not supplied

[Study of functional neuro-anatomy of perception using positron emission tomography].

The investigation by means of functional neuroimaging techniques, notably positron emission tomography, of the neural networks involved in perceptual processes is presently carried out according to two different though complementary approaches. In one of them, the relationships between impairments in perceptual processes and alterations in resting brain metabolism are studied in brain-damaged subjects, according to the classic paradigm of neuropsychology, but here the metabolic alterations reflect the functional disruption of neural networks directly or indirectly affected by the focal brain lesion. In the other approach, one records the changes in local synaptic activity in response to a given stimulation or task, as compared to a reference condition; thus far this second approach has been mainly applied to the normal human subject. Though different, both approaches highlight the neural networks involved in a given perceptual or cognitive task, which appear as a set of brain areas more extensive than that revealed by classic neuropsychology as necessary to perform the task. PET activation studies in the healthy subject have allowed to investigate, within each domain of perception, the successive "bottom-up" steps of information processing, from the most elementary ones carried out passively, to the most complex ones involving e.g., the semantic representations. The attentional aspects of perception have also been extensively investigated, notably selective "top-down" attention (which modulates the response of those brain areas that process the given perceptual attribute), sustained vigilance (which activates a parieto-prefrontal network in the non-dominant hemisphere), and mental imagery (which activates in a "top-down" fashion the entire perceptual network, including the primary cortices). The wide-scale application of this approach to brain-damaged subjects will seemingly soon provide important clues regarding the neural mechanisms of impaired perception and recovery therefrom.

Brain↗
PubMed1998

Topology of EEG coherence changes may reflect differential neural network activation in cold and pain perception.

Pain perception in the brain can be analyzed by neuroimaging (PET, fMRI) and electrophysiological parameter mapping (EEG, ERP/MEG, MEF). These studies have generally been focused on the localization of cerebral activation. Whether pain can be conceptualized as localized function or best be understood by distributed function is important to the theory of human pain processing in the brain. Here, we report that cold and pain perception in the brain is characterized by webs of EEG coherence changes which may reflect coupling or de-coupling of different cortical areas during cold and pain processing. EEG was recorded during cold and pain perception (right hand immersion in 15 degrees C cool-water vs. 0.3 degrees C ice-water for 3 min.) with eyes opened. Subjects rated the cold perception at 2.3 (cool to cold, but no pain) and the pain perception at 6.7 (moderate-strong pain) in a 1-10 scale. The obtained EEG spectral parameters were compared with the corresponding parameters of the resting baseline using paired Wilcoxon tests in the sense of statistical filters to depict those differences which differ clearly from changes by chance. The results were presented in probability maps. The EEG results indicated highly differential coherence networks between cold and pain perception. The cold perception was characterized as decreased coherence in the theta band mainly between frontal electrodes and increased interhemispheric coherence in the alpha range mainly between central and frontal positions. During pain perception almost no coherence changes in the theta band were observed, but great coherence increase in the delta band between central, parietal and frontal electrodes. The network of coherence changes in the alpha band showed strong involvement of electrode C3 concerning coherence increases with frontal positions. In the beta-1 band coherence increase within the left hemisphere was much more pronounced during pain than during cold. The differential characteristics of EEG coherence changes based on neural networks and their spatial organization in the neocortex indicate the distributed brain processing between cold and pain perception in man. This study may contribute to our understanding of the large scale neural networks in cognition based on neurophysiological binding hypothesis and network connections of neural ensembles.

Adult↗
PubMed2001

Orientation tuning properties of simple cells in area V1 derived from an approximate analysis of nonlinear neural field models.

We present a general approximation method for the mathematical analysis of spatially localized steady-state solutions in nonlinear neural field models. These models comprise several layers of excitatory and inhibitory cells. Coupling kernels between and inside layers are assumed to be gaussian shaped. In response to spatially localized (i.e., tuned) inputs, such networks typically reveal stationary localized activity profiles in the different layers. Qualitative properties of these solutions, like response amplitudes and tuning widths, are approximated for a whole class of nonlinear rate functions that obey a power law above some threshold and that are zero below. A special case of these functions is the semilinear function, which is commonly used in neural field models. The method is then applied to models for orientation tuning in cortical simple cells: first, to the one-layer model with "difference of gaussians" connectivity kernel developed by Carandini and Ringach (1997) as an abstraction of the biologically detailed simulations of Somers, Nelson, and Sur (1995); second, to a two-field model comprising excitatory and inhibitory cells in two separate layers. Under certain conditions, both models have the same steady states. Comparing simulations of the field models and results derived from the approximation method, we find that the approximation well predicts the tuning behavior of the full model. Moreover, explicit formulas for approximate amplitudes and tuning widths in response to changing input strength are given and checked numerically. Comparing the network behavior for different nonlinearities, we find that the only rate function (from the class of functions under study) that leads to constant tuning widths and a linear increase of firing rates in response to increasing input is the semilinear function. For other nonlinearities, the qualitative network response depends on whether the model neurons operate in a convex (e.g., x(2)) or concave (e.g., sqrt(x)) regime of their rate function. In the first case, tuning gradually changes from input driven at low input strength (broad tuning strongly depending on the input and roughly linear amplitudes in response to input strength) to recurrently driven at moderate input strength (sharp tuning, supralinear increase of amplitudes in response to input strength). For concave rate functions, the network reveals stable hysteresis between a state at low firing rates and a tuned state at high rates. This means that the network can "memorize" tuning properties of a previously shown stimulus. Sigmoid rate functions can combine both effects. In contrast to the Carandini-Ringach model, the two-field model further reveals oscillations with typical frequencies in the beta and gamma range, when the excitatory and inhibitory connections are relatively strong. This suggests a rhythmic modulation of tuning properties during cortical oscillations.

Cerebral Cortex↗
PubMed2006

Spatial analysis of volatile organic compounds from a community-based air toxics monitoring network in Deer Park, Texas, USA.

In the summer of 2003, ambient air concentrations of volatile organic compounds (VOCs) were measured at 12 sites within a 3-km radius in Deer Park, Texas near Houston. The purpose of the study was to assess local spatial influence of traffic and other urban sources and was part of a larger investigation of VOC spatial and temporal heterogeneity influences in selected areas of Houston. Seventy 2-h samples were collected using passive organic vapor monitors. Most measurements of 13 VOC species were greater than the method detection limits. Samplers were located at 10 residential sites, a regulatory air monitoring station, and a site located at the centroid of the census tract in which the regulatory station was located. For residential sites, sampler placement locations (e. g., covered porch vs. house eaves) had no effect on concentration with the exception of methyl tertiary-butyl ether (MTBE). Relatively high correlations (Pearson r > 0.8) were found between toluene, ethylbenzene, and o,m,p-xylenes suggesting petroleum-related influence. Chloroform was not correlated with these species or benzene (Pearson r < 0.35) suggesting a different source influence, possibly from process-related activities. As shown in other spatial studies, wind direction relative to source location had an effect on VOC concentrations.

Organic Chemicals↗
PubMed1990

Localization and characterization of neuropeptide Y in the brain of Microcebus murinus (Primate, Lemurian).

The distribution of neuropeptide Y (NPY) in the brain of the lemur Microcebus murinus was determined by immunocytochemistry with the aid of a highly specific antiserum against synthetic porcine NPY. When compared with previous immunohistochemical data obtained in primates and other mammalian species, the localization of NPY-immunoreactive (IR) structures in the Microcebus murinus brain revealed particular features. (1) Numerous NPY-IR perikarya and a dense network of IR nerve terminals were found in the supraoptic and suprachiasmatic nuclei, respectively. The occurrence of NPY-IR perikarya in the supraoptic nucleus, also reported in the squirrel monkey, seems to be specific to primates. In the squirrel monkey, the suprachiasmatic nucleus exhibits only a moderate innervation, whereas in humans it appears totally devoid of NPY-IR fibers. (2) IR perikarya and axon processes were observed in many upper brainstem areas, in particular in the interpeduncular, raphe pontine, dorsal tegmental, parabrachial, and dorsal raphe nuclei, in the locus coeruleus, the nucleus of the solitary tract, and the reticular formation; in this latter area, the occurrence of two categories of NPY-IR neurons was demonstrated on the basis of their morphology and localization, suggesting that they may play distinct roles. (3) NPY-IR nerve processes could be traced over a long distance. (4) For the first time, numerous NPY-IR terminals were observed close to the lumen of the various cerebral ventricles. The immunoreactive NPY-like peptide was characterized by combining high performance liquid chromatography (HPLC) analysis and radioimmunoassay quantification. The dilution curves obtained with synthetic porcine NPY and serial dilutions of occipital cortex, paraventricular and supraoptic hypothalamus, posterior hypothalamus, medulla oblongata, or preoptic area extracts were parallel. The highest amounts of NPY were measured in the hypothalamus and telencephalon. HPLC analysis resolved a single peak of NPY-like immunoreactivity that exhibited the same retention time as synthetic porcine NPY. The distribution of NPY in the lemurian brain is discussed with respect to phylogeny and putative functions.

Animals↗
PubMed2001

Gamma synuclein: subcellular localization in neuronal and non-neuronal cells and effect on signal transduction.

Synucleins are small, highly conserved proteins in vertebrates, especially abundant in neurons and typically enriched in presynaptic terminals. alpha-Synuclein protein and a fragment of it, called NAC, have been found in association with pathological lesions of neurodegenerative diseases. Recently, mutations in a alpha-synuclein gene have been reported in families susceptible to an inherited form of Parkinson's diseases. In addition, alpha-synuclein has been implicated in the pathophysiology of other neurodegenerative diseases, including Alzheimer's disease and multiple system atrophy. Far less is known about other members of the synuclein family, beta- and gamma-synucleins. gamma-synuclein is up-regulated in several types of cancer and may affect the integrity of the neurofilament network, while its bovine ortholog, synoretin, activates the Elk-1 signal transduction pathway. In this paper, we present data about the localization and properties of human and bovine gamma-synuclein in several neuronal and non-neuronal cell cultures derived from ocular tissues. We show that gamma-synuclein is present in the perinuclear area and is localized to centrosomes in several types of human interphase cells and in bovine retinal pigment epithelium. In mitotic cells, gamma-synuclein staining is localized to the poles of the spindle. Further, overexpression of synoretin in retinoblastoma cells up-regulates MAPK and Elk-1. These results support the view that gamma-synuclein is a centrosome protein that may be involved in signal transduction pathways.

Animals↗
PubMedDate not supplied

Factors affecting membership in specialty nursing organizations.

A discouraging trend in many specialty nursing organizations is the stagnant or declining membership. The research committee of the Southeast Texas Chapter of the Association of Rehabilitation Nurses (ARN) collected data and studied this trend to determine what changes would be necessary to increase membership. Using Herzberg's motivational theory as a framework, a review of the literature was initiated. There were few current studies on this issue, but relevant information was found about nursing's emerging workforce, as well as implications of the growth of magnet hospitals, which affect whether nurses join specialty nursing organizations. A multifaceted data-collection approach using convenience samples was designed. First, relevant literature was reviewed. Second, a survey was sent by e-mail to other ARN chapters. Third, a telephone survey on other specialty organizations in the geographic region was completed. Finally, members of the local ARN chapter and four other specialty organizations, as well staff nurses in the geographic area, were given questionnaires to complete. Descriptive statistics and cross tabulations were used to determine why nurses do and do not join specialty organizations (N = 81). The most frequent reasons for joining an organization were to increase knowledge, benefit professionally, network, and earn continuing education units. Reasons for choosing not to participate were family responsibilities, lack of information about these organizations, and lack of time. Ways to reverse the decline in membership are discussed.

Adult↗
PubMedDate not supplied

Pleomorphic xanthoastrocytoma: a report of two cases.

We report two cases of a recently isolated variety of astrocytoma, pleomorphic xanthoastrocytoma, affecting the cerebral cortex and meninges of children and young adults. The first tumor was localized in the left frontal lobe of a 9-year-old girl. The second appeared in the right parietal lobe of a 14-year-old girl. Both tumors displayed a pleomorphic cellular proliferation, with spindle-shaped and bizarre multinucleated giant cells, some positive for neutral lipids, with a prominent reticulin network and areas highly suggestive of malignant fibrohistiocytomas (fibroxanthosarcomas). The glial fibrillary acidic protein was demonstrated by the immunoperoxidase method in the cytoplasm of the giant and the spindle cells. Ultrastructural studies confirmed the glial nature of the tumor. This type of tumor seems to carry a much better prognosis than other tumors from which it has to be separated, e.g., glioblastoma and meningeal sarcomas.

Adolescent↗
PubMed2003

Telemedicine in Western Africa: lessons learned from a pilot project in Mali, perspectives and recommendations.

OBJECTIVE: to evaluate the feasibility, potential and risks of an internet-based telemedicine network in developing countries of Western Africa. METHODS: a project for the development of a national telemedicine network in Mali was initiated in 2001, using internet-based technologies for distance learning and teleconsultations. RESULTS: the telemedicine network has been in productive use for 12 months and has enabled various collaboration channels, including North-South, South-South, and South-North distance learning and teleconsultations. It also unveiled a set of potential problems: a) limited pertinence of North-South collaborations when there are major differences in available resources or socio-cultural contexts between the collaborating parties; b) risk of induced digital divide if the periphery of the health system is not involved in the development of the network, and c) need for the development of local medical contents management skills. CONCLUSION: the identified risks must be taken into account when designing large-scale telemedicine projects in developing countries and can be mitigated by the fostering of South-South collaboration channels, the use of satellite-based internet connectivity in remote areas, and the valorization of local knowledge and its publication on-line.

Africa, Western↗
PubMed1993

At the grass roots. How I helped my community restore its health care system. Interview by Rhonda Bergman.

The late 1980s saw the unraveling of the health care system in rural northern Pend Oreille County, WA. It began when the area's only physician left, followed by the shuttering of the only area hospital. Kathy Grass, office manager of the local health clinic and a longtime hospital employee, was one of many who stepped forward to help. Given the title "community encourager" by other local volunteers, Grass began working with other residents to restore the local health care system and recruit providers. In a recent interview with Hospitals & Health Networks staff editor Rhonda Bergman, Grass described the challenges faced by her community.

Community Health Services↗
PubMed2003

Dr John has gone: assessing health professionals' contribution to remote rural community sustainability in the UK.

Due mainly to increasing difficulties in recruiting and retaining health professionals to work in remote and peripheral areas of Scotland, there is discussion of the need to implement new models of primary health care provision. However, innovative service models may imply a reduction in the number of health professionals who live and work in remote communities. Currently decisions about remodelling service provision are being taken by National Health Service stakeholders, apparently with little consideration of the wider social and economic impacts of change. This paper aims to argue that health professionals contribute to the fabric of rural life in a number of ways and that decisions about health service redesign need to take this into account. As well as fulfilling a wide health and social care role for patients, the authors seek to show that health professionals are important to the social sustainability of rural communities as, due to their unique position, they are often at the heart of networks within and between communities. The wider economic contribution of health services in remote communities is important, but often underplayed. The authors propose that theories of capital, principally the concept of social capital, could help in investigating the wider contribution of health professionals to their local communities. Ultimately, it is proposed that health services, as embodied in nurses, doctors and others, could be highly important to the ongoing livelihood and social infrastructure of fragile remote communities. Since this area is poorly understood, there is a need for prospective primary research and evaluation of service redesign initiatives.

Community Health Nursing↗