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Background Hundreds of variants associated with atopic dermatitis (AD) and psoriasis, 2 common inflammatory skin disorders, have previously been discovered through genome-wide association studies (GWASs). The majority of these variants are in noncoding regions, and their target genes remain largely unclear. Objective We sought to understand the effects of these noncoding variants on the development of AD and psoriasis by linking them to the genes that they regulate. Methods We constructed genomic 3-dimensional maps of human keratinocytes during differentiation by using targeted chromosome conformation capture (Capture Hi-C) targeting more than 20,000 promoters and 214 GWAS variants and combined these data with transcriptome and epigenomic data sets. We validated our results with reporter assays, clustered regularly interspaced short palindromic repeats activation, and examination of patient gene expression from previous studies. Results We identified 118 target genes of 82 AD and psoriasis GWAS variants. Differential expression of 58 of the 118 target genes (49%) occurred in either AD or psoriatic lesions, many of which were not previously linked to any skin disease. We highlighted the genes AFG1L, CLINT1, ADO, LINC00302, and RP1-140J1.1 and provided further evidence for their potential roles in AD and psoriasis. Conclusions Our work focused on skin barrier pathology through investigation of the interaction profile of GWAS variants during keratinocyte differentiation. We have provided a catalogue of candidate genes that could modulate the risk of AD and psoriasis. Given that only 35% of the target genes are the gene nearest to the known GWAS variants, we expect that our work will contribute to the discovery of novel pathways involved in AD and psoriasis.

In the early days of professionalism, occupations were characterised by decision-making freedoms and strong jurisdictional rights. Since then, several ways of controlling and monitoring professiona...

This article examines the lived experiences of young people in the process of leaving the care of SOS Children’s Villages in both Nigeria and Portugal. Interviews were conducted with 12 young people and data were analysed using content analysis. Young people’s lived experiences were captured in three emerging dimensions of past, present and future experiences. The study recommends resolving young people’s childhood conflicts towards a successful transition into adulthood. It also has implications for policy practice in tailoring the present experiences in preparing young people for the demands of life after care.

Lipid rescue is used as treatment of various poisonings despite weak scientific evidence. Some experimental studies have indicated a positive effect, but others have not. Clinical studies are lacking, wherefore a systematic review of virtually all published human case reports is presented. The case reports were searched for in PubMed and Web of Science and examined by two experts according to an assessment form grading the probability for a causal connection between lipid rescue and improved symptoms. A total of 160 cases were finally included, of which 30 had no positive effect of lipid rescue. Among the 130 included cases with alleged positive effect, 94 were oral poisonings and 36 were cases with local anesthetic systemic toxicity (LAST). The experts’ assessment resulted in a “certain” causal connection in three cases with LAST but not in oral poisoning. Moreover, the mean assessment score among the oral poisonings was significantly worse than the corresponding score in the cases with LAST. The average log p-value of the main toxins among the oral poisonings was significantly lower than the corresponding p-value in the cases with LAST. Among the oral poisonings, 91% had received some other resuscitative treatment more or less simultaneously with lipid rescue. Considering the findings of this study and the increasingly reported adverse effects of lipid rescue, it’s reasonable to strictly limit its use in clinical practice. We would not recommend it in oral poisonings.

Supplemental Digital Content is available in the text., Background: Genetic variant landscape of coronary artery disease is dominated by noncoding variants among which many occur within putative enhancers regulating the expression levels of relevant genes. It is crucial to assign the genetic variants to their correct genes both to gain insights into perturbed functions and better assess the risk of disease. Methods: In this study, we generated high-resolution genomic interaction maps (≈750 bases) in aortic endothelial, smooth muscle cells and THP-1 (human leukemia monocytic cell line) macrophages stimulated with lipopolysaccharide using Hi-C coupled with sequence capture targeting 25 429 features, including variants associated with coronary artery disease. We also sequenced their transcriptomes and mapped putative enhancers using chromatin immunoprecipitation with an antibody against H3K27Ac. Results: The regions interacting with promoters showed strong enrichment for enhancer elements and validated several previously known interactions and enhancers. We detected interactions for 727 risk variants obtained by genome-wide association studies and identified novel, as well as established genes and functions associated with cardiovascular diseases. We were able to assign potential target genes for additional 398 genome-wide association studies variants using haplotype information, thereby identifying additional relevant genes and functions. Importantly, we discovered that a subset of risk variants interact with multiple promoters and their expression levels were strongly correlated. Conclusions: In summary, we present a catalog of candidate genes regulated by coronary artery disease–related variants and think that it will be an invaluable resource to further the investigation of cardiovascular pathologies and disease.

The aim of this mixed-method study was to explore the trajectories of leaving home, and views and experiences among children and youth in the Kagera region in Tanzania, who have lived on the streets or been domestic workers. The main results showed that orphanhood and mistreatment were the main reasons for leaving home: few children lived with their parents before they left, and leaving home was a complex process over several years where three trajectories were identified. The children who had left home showed strong agency and competency but lived in vulnerable conditions, especially young children living on the streets.

An increasing demand for dairy products with long shelf-life is foreseen. A limiting factor for maintaining high quality of these products is the activity of spoilage enzymes during storage. Lipase and protease activities in Swedish raw milk at farm and dairy level were investigated, analysing milk samples from three geographical regions and two seasons. Lipase activity in milk at farm level was affected by regional and seasonal variations, whereas at dairy level only season had an effect. Lipase activity was positively correlated with ionic calcium. For protease activity, no effect of either region or season was seen. Degradation products, e.g., free fatty acids, peptides and plasmin proteolysis products, varied differently between season and geographical origin at both farm and dairy level. The results indicate that lipase and protease activities are important for raw milk quality, while ionic calcium might be a future indicator for milk fat stability.

A position paper on the use of whole bowel irrigation (WBI) was first published in 1997 by the American Academy of Clinical Toxicology (AACT) and the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) and updated in 2004. The aims of this paper are to briefly summarize the content of the 2004 Position Paper and to present any new data and recommendations.A systematic review of the literature from January 2003 to February 28, 2013 was conducted using multiple online databases for articles concerning WBI for gastrointestinal decontamination. An evidence table was created for applicable articles. The authors produced the initial draft that was reviewed by AACT and EAPCCT.The literature search produced 60 articles with the possibility of applicable human data. Based mainly on volunteer studies, WBI can be considered for potentially toxic ingestions of sustained-release or enteric-coated drugs particularly for those patients presenting later than 2 h after drug ingestion when activated charcoal is less effective. WBI can be considered for patients who have ingested substantial amounts of iron, lithium, or potassium as the morbidity is high and there is a lack of other potentially effective options for gastrointestinal decontamination. WBI can be considered for removal of ingested packets of illicit drugs in "body packers." However, controlled data documenting improvement in clinical outcome after WBI are lacking. WBI is contraindicated in patients with bowel obstruction, perforation, or ileus, and in patients with hemodynamic instability or compromised unprotected airways. WBI should be used cautiously in debilitated patients and in patients with medical conditions that might be further compromised by its use. The concurrent administration of activated charcoal and WBI might decrease the effectiveness of the charcoal. The clinical relevance of this interaction is uncertain.WBI can facilitate removal of select toxicants from the gastrointestinal tract in some patients, but there is no convincing evidence from clinical studies that it improves the outcome of poisoned patients. There is no new evidence that would require a major revision of the conclusions of the 2004 position statement.

A closed head trauma induces incompletely characterized temporary movement and deformation of the brain, contributing to the primary traumatic brain injury. We used the pressure patterns recorded with light-operated miniature sensors in anaesthetized adult rabbits exposed to a sagittal plane rotational acceleration of the head, lasting 1 ms, as a measure of brain deformation. Two exposure levels were used and scaled to correspond to force levels reported to cause mild and moderate diffuse injury in an adult man, respectively. Flexion induced transient, strong, extended, and predominantly negative pressures while extension generated a short positive pressure peak followed by a minor negative peak. Low level flexion caused as strong, extended negative pressures as did high level extension. Time differences were demonstrated between the deformation of the cerebrum, brainstem, and cerebellum. Available X-ray and MRI techniques do not have as high time resolution as pressure recordings in demonstrating complex, sequential compression and stretching of the brain during a trauma. The exposure to flexion caused more protracted and extensive deformation of the brain than extension, in agreement with a published histopathological report. The severity and extent of the brain deformation generated at a head trauma thus related to the direction at equal force.

This article is about the support given to pregnant women and mothers, at an antenatal and child welfare team in Gothenburg (Sweden), specialised on working with mothers who abuse alcohol and/or other substances. The study consists of interviews with 17 women. The aim of the article is to account for how the women experienced the support they got and how they perceived the impact. The results show the importance for the staff of finding the balance between control and support and of creating a non-judgmental attitude in order to build trusting relationships with the women. The organization of the MBHV-team is a prerequisite for the staff to be able to design support based on an assessment of the mother's whole situation.

The aim was to study if locally produced organic legume seeds as protein supplement could improve the performance of dairy cows. The experiment was a cyclic change over design were the control diet consisted of grass silage and barley (60:40) on a dry matter (DM) basis. Barley was replaced with rapeseed expeller (RSE), or isonitrogenous supplements of peas, untreated field beans (UFB), heat-treated FB (TFB) or a lower level of TFB (TFB-low) that provided the same dietary metabolizable protein concentrations as of UFB. None of the legume protein supplementations had effect on DM intake (DMI) neither on energy corrected milk yield compared to control. The RSE treatment increased milk (24.8 vs. 23.6 kg d-1) and protein yield (913 vs. 863 g d-1) compared to other protein supplements. Heat-treated FB had no effect on DMI, milk or protein yield compared to UFB. Only RSE resulted in improvements in dairy cows performance in relation to the control diet.

Summary In Sweden, decision making in child protection is heavily dependent on laypersons appointed to municipal child protection committees (CPCs). These laypersons have the power to decide upon proposals coming from professionals. Members of the committees are appointed from among their political party’s members. In the committee, they are supposed to act as judicious laypersons equipped with sound judgement. In this study, 31 committee meetings in three municipalities were followed using observational techniques and audio recordings. The appointed CPC members’ decision-making processes and communicative strategies to influence social work practice were analysed. Findings The results show differences between the CPCs, indicating localized decision-making cultures. The representatives worked (not as party politicians, but) as a team with the professionals as counterparts. Communication strategies, most frequently questions, were used to govern the social work practice, over and above the decision making. Questions served both to obtain the information needed and also to exert normative influence by setting up a normative grid for ways to pass the committee. Applications This research shows that social work in Sweden has a long way to go until it is acknowledged full professional status. The study also suggests that improvements in the CPCs’ decision making need to be based on a closer look at the laypersons’ knowledge, values and common sense and how these aspects affect decision making.

The article describes and analyses laypersons’ role in networks of expertise and their relationship to professions. It is suggested that networks of expertise are a profitable way of analysing claims-making activities, as it opens up for groups other than professions to be included in the discussion. In the first part of the article, three interest groups—professions, laypersons, and service users—who base their legitimacy on knowledge, are described, analysed, and compared. It is argued that what is special about laypersons’ claims-making activities is that they are built on general common sense instead of the more specialized knowledge that professions and service users build their legitimacy on. In the second part, child protection systems in three countries are compared. The US system is described as professionalized, the English one as semi-professional and the Swedish case as deprofessionalized (or laypersonalized). The third part of the article looks closer at Sweden and asks: who are the laypersons in the Swedish child protection system? How much can the laypersons be regarded as professionals working in a layperson system and how strong is the political affiliation? The conclusions include that laypersons are identified as having two roles: holding executive powers, as in child protection in Sweden and England, and a more consultative and supervisory role. Either way it can be seen as a weakness for a profession to be subordinated to laypersons, yet it can also be a strength for a specific network of expertise.

An update of the first position paper on ipecac syrup from 1997 was published by the American Academy of Clinical Toxicology and the European Association of Poison Centres and Clinical Toxicologists in 2004. The aims of this paper are to briefly summarize the content of the 2004 Position Paper and to present any new data.A systematic review of the literature from the year 2003 forward.The literature search yielded a limited number of meaningful articles, and there remains no convincing evidence from clinical studies that ipecac improves the outcome of poisoned patients. Furthermore, the availability of ipecac is rapidly diminishing.The routine administration of ipecac at the site of ingestion or in the emergency department should definitely be avoided. Ipecac may delay the administration or reduce the effectiveness of activated charcoal, oral antidotes, and whole bowel irrigation. There is not sufficient evidence to warrant any change in the previous ipecac position papers. There are, however, insufficient data to support or exclude ipecac administration soon after ingestion of some specific poisons in rare situations.

Background Patients presenting unconscious may reasonably be categorized as suffering from a metabolic or structural condition. Study Objective The objective was to investigate if some routinely recorded clinical features may help to distinguish between these 2 main forms of coma in the emergency department (ED). Methods Adults admitted to an ED in Stockholm between February 2003 and May 2005 with a Glasgow Coma Scale (GCS) score less than 11 were enrolled prospectively. The GCS score was entered into a protocol that was complemented with available data within 1 month. Results The study population of 875 patients was classified into 2 main groups: one with a metabolic (n = 633; 72%) and one with a structural disorder (n = 242; 28%). Among the clinical features recorded in the ED, 3 were found to be strongly associated with a metabolic disorder, namely, young age, low or normal blood pressure, and absence of focal signs in the neurological examination. Patients younger than 51 years with a systolic blood pressure less than 151 mm Hg who did not display signs of focal pathology had a probability of 96% for having a metabolic coma. The mean GCS score on admission was identical in the groups. Hospital mortality was 14% in the metabolic and 56% in the structural group. Conclusions These findings indicate that unconscious young adults who present without a traumatic incident with a low or normal blood pressure and without signs of focal pathology most probably suffer from a metabolic disorder, wherefore computed tomography of the brain may be postponed and often avoided.

Two feeding experiments were performed to study the effects of silage botanical composition, regrowth interval and α-tocopherol supplementation on the fatty acid (FA) composition and α-tocopherol, β-carotene and retinol concentrations of milk. In Exp. 1, 24 Swedish Red dairy cows were fed two- or three-cut red clover–grass silages (R2 and R3, respectively) or two-cut birdsfoot trefoil–grass silage (B2). In Exp. 2, 16 Norwegian Red dairy cows were fed short-term ley silage with red clover (S3) or long-term ley silage with white clover (L3) in combination with the supplementation of RRR-α-tocopheryl acetate (1600 mg/day). The FA proportions in the milk and the recoveries of C18:2n-6 and C18:3n-3 were higher on the red clover diets R2 and S3 than on B2 and L3, respectively, and the n-6/n-3 FA ratio was also higher on the red clover diets. Shorter regrowth interval increased both the concentrations of FA in silage and the proportions of unsaturated FA in milk. Intakes of α-tocopherol, β-carotene and lutein were higher on B2 than on R2 due to higher silage intake on B2. However, the highest intake was seen on diet R3 due to the higher concentrations in the silage mixture. In Exp. 2, intakes of α-tocopherol, β-carotene and lutein were higher on L3. However, not all of these differences affected the milk, since the only significant differences related to silage diet in the two experiments were a higher milk α-tocopherol concentration on L3 than on S3 and a slightly lower β-carotene concentration on B2 than on R2. Supplementation with α-tocopherol increased milk α-tocopherol concentrations from 0.77 to 1.05 and from 1.07 to 1.24 mg/kg milk for S3 and L3, respectively, but did not affect milk FA composition. A higher concentration of antioxidants in the feed could be beneficial as a larger proportion of the animal's vitamin requirements would be met by the forage and the need for supplementation might decrease.

Background: Studies of patients presenting with coma are limited, and little is known about the prognosis of these cases. Objective: The aim of this study was to investigate the acute and long-term prognosis after an episode of non-traumatic coma. Methods: Adults admitted consecutively to an emergency department in Stockholm, Sweden between February 2003 and May 2005 with a Glasgow Coma Scale (GCS) score of 10 or below were enrolled prospectively. All available data were used to explore the cause of the impaired consciousness on admission. Patients surviving hospitalization were followed-up for 2 years regarding survival. Results: The final study population of 865 patients had the following eight different coma etiologies: poisoning (n = 329), stroke (n = 213), epilepsy (n = 113), circulatory failure (n = 60), infection (n = 56), metabolic disorder (n = 44), respiratory insufficiency (n = 33), and intracranial malignancy (n = 17). The hospital mortality rate among the 865 patients was 26.5%, varying from 0.9% for epilepsy to 71.7% for circulatory failure. The accumulated total 2-year mortality rate was 43.0%, varying from 13.7% for poisoning to 88.2% for malignancy. The level of consciousness on admission also influenced the prognosis: a GCS score of 3–6 was associated with a significantly higher hospital mortality rate than a GCS score of 7–10. Conclusion: The prognosis in patients presenting with non-traumatic coma is serious and depends largely on both the level of consciousness on admission and the etiology of the coma. Adding the suspected coma etiology to the routine coma grading of these emergencies may more accurately predict their prognosis.

The decision to take a young person away from his or her family into out‐of‐home care and treatment is the most drastic intervention within the statutory powers bestowed upon social services. The results of reports on the quality of residential treatment reveal that state supervision has not proven to be a good substitute for parental care. In this paper we analyse the decision‐making process when young persons are placed in residential care. Focus groups and individual interviews with different stakeholders were conducted. The results show that the placements are a collective process involving negotiations between the different parties with a coordinating social worker in the middle, with the aim to bring something to build hope on in often desperate situations, regardless of the specific treatment method used. To inform the process, the social workers draw on a 'collective memory' shared among colleagues in the department. Important signs of quality of a residential unit were the relational and collaborative competence from the staff. The inclination to use soft, diffuse information in decision‐making shows a striking lack of evidence upon which social workers can build well‐informed and knowledge‐based decisions.

Objective. To describe birth rates and pregnancy outcomes, specifically stillbirth, preterm delivery and low birth weight (LBW) in relation to socio-demographic characteristics, among adolescent women in a rural district in northern Vietnam.Material and method. Within an epidemiological field laboratory, quarterly surveillance of 7767 adolescent women in the ages 15–19 during the period January 1999 to December 2005 was conducted. Birth rates were calculated and pregnancy outcomes were described in relation to background factors.Result. A total of 1021 pregnancies were reported by 926 adolescent women during the period of whom 17% were below 18years. The estimated adolescent birth rate during 1999–2005 was 27/1000 women-years. The incidence of stillbirth among all births was 19/1000 births. These were more likely to be delivered preterm. The incidence of preterm deliveries and LBW infants was 193 and 75 per 1000 live births, respectively. There were no differences in socio-demographic background for stillbirth, preterm delivery or LBW.Conclusion. Adolescent birth rates were similar to those found in the recent Vietnamese DHS and considerably lower than the average for South-East Asia. Higher rates of stillbirth and preterm delivery were found than those previously reported for Vietnam, indicating the need for careful monitoring of adolescent pregnancies and their infants. Further research is needed to explore if and how much socio-demographic variables influence pregnancy outcome, comparing more differentiated groups, as a basis for interventions to assure access to adequate reproductive health care services for all women.

The transition from a placement in care to an independent life can be a problematic phase for young people. In Sweden, special care-leaving services are almost non-existent. What then happens to young people when they leave a placement in out-of-home care? This paper draws on the results of a study in which 16 young care leavers between the ages of 18 and 22 years were interviewed. Telephone interviews were also performed with the young care leavers' parents, social workers, foster carers and institutional staff. The aim of the study was to investigate how young care leavers perceive the transition from care to an independent life. The Swedish welfare model, the prolonged transition to adulthood and the family-oriented welfare discourse have been used as analytical perspectives. The results show that young care leavers have a pronounced need for social, emotional, practical and financial support. Whilst such support is occasionally provided by foster carers and residential staff, it is seldom given by social services or biological parents. This group is at risk of facing severe problems in the transitional phase from care to independent life, a fact that is not acknowledged by the Swedish welfare system.

Short time effects of ampicillin on viability and levels of intracellular ATP were studied in bacterial cultures and a close relationship between intracellular ATP levels and viability was demonstrated. The connection between the effects observed and MIC values is discussed. The possibility of using the phenomenon for rapid antibioitc susceptibility testing was studied in clinical isolates incubated for 2 hours followed by luciferase assay of intracellular ATP. A positive correlation was demonstrated between ampicillin-induced decreases in intracellular ATP and inhibitory zone diameters, as measured by the agar diffusion technique.

A double-blind randomized study was performed to evaluate the efficacy and safety of flumazenil, a benzodiazepine antagonist. The study comprised 52 patients admitted to an intensive care unit because of suspected pure or mixed benzodiazepine poisoning. The degree of consciousness was assessed according to a modified Glasgow Coma Scale (MGCS), graded from 4 to 20, immediately before and at consecutive intervals after an i.v. injection of flumazenil or placebo. If there were no clear signs of arousal within 5 min after the blind injection, an injection of flumazenil was given in open design. Five minutes after the blind administration of active drug the MGCS score was increased by an average of 7.4 (p less than 0.001) in the flumazenil group. In the placebo group the average MGCS score of 7.8 on admission was not significantly increased by placebo, but 5 min after flumazenil injection it had increased by 7.3 to 15.1 (p less than 0.001). Patients who had ingested both alcohol and benzodiazepines were aroused as promptly and clearly (MGCS +8.8; p less than 0.001) as those who had taken benzodiazepines alone (MGCS +8.4; p less than 0.001). The patients poisoned with a combination of benzodiazepines and other hypnotic drugs responded less, but still highly significantly (MGCS +5.8; p less than 0.001). Flumazenil was well tolerated and the safety of the antidote seems acceptable. It is concluded that flumazenil can facilitate differential diagnosis and that it is an effective tool in the treatment of drug overdosage when benzodiazepines are involved.

Zusammenfassung 1 24 Brunnen in Sm$aRland und Halland sind auf fakale Verunreinigung untersucht worden durch Bestimmung ihrer Garungstiter (45° C) bei drei (zwei) Gelegenheiten. Von 65 Proben waren nur 10 frei (100 < j). Ein Drittel aller Proben hatte eine Garungstiter 1 < j ≤ 10 oder noch schlimmer. Kein Brunnen war in allen Proben ganz frei von jeder fakalen Infektion 2 Die fakale Infektion der Brunnen scheint im waldigen Gebirgsland durch die Lage der Brunnen in Verhaltnis zu Wohnhausern, Aborten, Stallen und Fahrstrassen hauptsachlich bestimmt zu sein. In den Planen kommt bestimmend hierzu die Naihe der Brunnen zu gedungtem Acker. 3 Im kropfarmen Kustenland waren die Trinkwasser mehr verunreinigt als im kropfreichen Binnenland. Zwischen Kropfhofe und kropfarme Hofe war in Bezug auf die Sauberkeit der Brunnen kein Unterschied zu entdecken. Zu dieser Untersuchung ist von der Fysiografischer Gesellschaft zu Lund ein Beitrag erhalten, wofur der Verfasser zu Dank verpflichtet ist.

SUMMARY A fatal case of hepatic failure in a five-year-old girl who had been treated with phenytoin and valproic acid is presented. The report emphasizes the need for caution in the use of valproate, especially in children with altered liver function, and in combination with phenytoin or phenobarbitone. RESUME Insuffisance hepatique mortelle chez un enfant traite par phenytoine et acide valproique L'article rapporte le cas d'une insuffisance hepatique mortelle chez une fillette de cinq ans qui avait ete traitee par phenytoine et acide valproique. Les auteurs insistent sur la necessite de prudence dans l'usage du valproate, specialement chez les enfants ayant une fonction hepatique alteree et en cas d'association avec phenytoine ou phenobarbital. ZUSAMMENFASSUNG Todliches Leberversagen bei einem Kind, das mit Phenytoin und Valproat behandelt wurde Es wird uber ein funfjahriges Madchen berichtet, das mit Phenytoin und Valproat behandelt worden war und an einem Leberversagen gestorben ist. In dem Bericht wird die Notwendigkeit unterstrichen, bei der Anwendung von Valproat vorsichtig zu sein, insbesondere bei Kindern mit veranderter Leberfunktion und in Kombination mit Phenytoin oder Phenobarbital. RESUMEN Fallo hepatico fatal en un nino tratado con fenitoina y acido valproico Se presenta un caso fatal de fallo hepatico en una nina de cinco anos de edad que habia sido tratada con fenitoina y acido valproico. La comunicacion insiste en la necesidad de ser cauteloso en el uso del valproato, especialmente en ninos con funcion hepatica alterada y en combinacion con fenitoina o fenobarbital.

Collaboration between traditional and biomedically trained health workers is regarded as key in HIV/AIDS control. However, few studies have focused on exploring ways of enhancing this collaboration. Using a pre- and postintervention questionnaire, the authors assessed changes in attitudes to and practices of collaboration among 19 biomedical and 28 traditional health care providers following a 12-month dialogue-building intervention in Ndola, Zambia. The intervention consisted of peer group discussions, interactive group discussions, training sessions, and peer-influenced networking. The results show that although both groups of providers had fairly positive attitudes toward each other before the intervention, further improvements in attitudes were observed after the intervention. Referrals between the two sectors and cross visits increased. However, some attitudes to collaboration became more negative and cautious after the intervention. Dialogue-building interventions involving traditional and biomedical providers are not only feasible but also complex. Intersectoral collaboration needs time and coordination between all relevant actors in the community.

Three new reciprocal translocations in the domestic pig were identified in boars deemed responsible for decreased litter size though having a normal semen picture. The translocations were described by the use of handing techniques and involved both one- and biarmed chromosomes. The translocated segments were of variable size. The same translocations, with the addition of a fourth one earlier described, were investigated by synaptonemal complex analysis of spermatocytes. Measurements of paired segments were carried out in early and late pachytene and compared with rough measurements of the translocated segments observable in the mitotic chromosomes. The translocated chromosomes and their normal homologues formed almost exclusively a quadrivalent, and very few pairings with other chromosomes were seen. In early pachytene, there was a pairing of homologous segments with the formation of a cross-shaped configuration, most often having a buckle centrally, due to unpaired chromosome segments, or showing complete pairing. One translocation, however, demonstrated, in late zygotene and early pachytene, a quite unexpected shape of the quadrivalent because of nonhomologous pairing. In late pachytene, the quadrivalent demonstrated heterologous pairing and there was a tendency for the largest and the smallest one of the four chromosomes involved in the translocation not to pair hetcrologously. In diakinesis-metaphase 1 the translocation chromosomes formed ring- or both ring- and chain-shaped configurations.

The present study aimed to explore secondary school students' needs in relation to sexual and reproductive health in order to inform efforts to improve the quality of health services available to young people. The study involved data collection from 716 11-22-year-old students in four secondary schools in an urban area in Zambia. Students completed a questionnaire and were invited to write down any inquiries they had regarding sexuality and reproduction. Findings revealed that boys and girls lack adequate information about human reproduction and STIs, including HIV. To avoid misconceptions and myths, they also need clear information on contraceptives and masturbation. Responses indicate that young people would welcome guidance and support related to contraception, pregnancy, abortion and STIs/HIV, but also on love and relationships. Culture, religion and gender are important factors influencing sexuality and sexual abuse. These issues need to be taken into consideration when developing youth-friendly programmes for young people.

Ryanodine receptor (RyR) is a tetrameric, high molecular weight protein that functions as a calcium release channel. It plays a key role in phenomena such as signal transduction, excitation-contraction and excitation-secretion coupling. Hyperthermia maligna, central core disease and myocardial infarction have been related with RyR dysfunction. RyR is present as three isoforms in vertebrates: RyR 1 mainly localized in skeletal muscle, RyR 2 in cardiac muscle, and RyR 3 in nervous system. RyR is regulated by a number of physiological and pharmacological factors. Main physiological modulators: calcium, kinases and phosphatases, redox state and energy charge. Main pharmacological regulators: caffeine, dantrolene, ruthenium red, heavy metals and ryanodine. Purines have to do with both, physiological and pharmacological regulation of the RyR activity. So far, the mechanisms of RyR activation by ATP and caffeine have been described in detail using [3H]-ryanodine binding assays and unitary channel activity recorded in planar lipid bilayers. However, some questions remain to be addressed and are at present aim of active scrutiny: How many sites for purines are present in the RyR? Is the same site recognized by nucleotides and methylxanthines? What differences exist among the interaction between RyR and purine bases, nucleosides and nucleotides? Are the phosphate groups important for the recognition of nucleotides? Is the sugar moiety important for the recognition of nucleosides? The review article will examine the most recent specialized literature about the mechanism of activation of RyR by purines with emphasis on reports with approaches of structure-function and structure-activation.

A rotational acceleration impulse to a head, as occurs at traffic accidents, sport injuries, assaults and falls, induces a diffuse brain damage that eventually could result in persistent neuropsychiatric deficits and neurodegeneration. Emphasis has been concentrated on the relative motion of the brain inside the skull during head impact, whereas less attention has been paid to whether intracranial pressure changes are generated and, if so, the implications thereof. In the present experimental study we investigated in an animal model system, based on rabbits, if a sagittal, anterior-posterior rotational acceleration of a head generated intracranial pressure changes, recorded by fibre optic pressure sensors, inserted ipsilaterally in the parieto-temporal and the occipital lobes. Two levels of rotational acceleration were used in the experiments; one higher, corresponding to the threshold limit for moderate diffuse brain injury, and one lower, close to being noninjurious. Several pressure recordings were performed in each rabbit at the two acceleration levels. The pressure recordings invariably revealed the same general characteristics of rapid, positive and negative pressures within the brain, with variations in amplitude and duration, lasting for up to 10 ms. A major finding was the generation of powerful negative pressures, as low as 0.3 bars in absolute pressure. The most prominent difference in amplitudes of the negative peak pressures between the two applied acceleration levels was demonstrated at the parieto-temporal location. The presented pressure recordings are the first to disclose the generation of transient, powerful intracerebral pressures at rotational acceleration of the head, which must be considered in studies of brain injury generation and distribution as well as prevention.

Complex sociopolitical, economic, and geographical realities cause the 20 million residents of Mexico City to suffer from some of the worst air pollution conditions in the world. Greenhouse gas emissions from the city are also substantial, and opportunities for joint local-global air pollution control are being sought. Although a plethora of measures to improve local air quality and reduce greenhouse gas emissions have been proposed for Mexico City, resources are not available for implementation of all proposed controls and thus prioritization must occur. Yet policy makers often do not conduct comprehensive quantitative analyses to inform these decisions. We reanalyze a subset of currently proposed control measures, and derive cost and health benefit estimates that are directly comparable. This study illustrates that improved quantitative analysis can change implementation prioritization for air pollution and greenhouse gas control measures in Mexico City.

Aims: Poverty concepts and measurements have occupied philosophers for centuries and are subject to debate by researchers. A wide range of possible measures have been developed and used. Most research is country specific and different methods produce different pictures of poverty. This study aimed to compare measures of poverty within an epidemiological field laboratory in Bavi District, northern Vietnam (FilaBavi) and specifically to find out whether the official economic classification made by the local authority matched other measurements of socioeconomic status. Methods: Structured questionnaires were used to collect socioeconomic information in 11,547 households. In addition, the official classification for individual households was recorded. Five economic indicators were constructed: income, expenditure, household assets, housing conditions, and local authority's estimation. Results: Official economic classification and housing score were symmetrically distributed, while assets score and particularly income were highly skewed. Design effects were high because of high intra-cluster correlations. No indicator was closely correlated with any other. Sensitivity and positive predictive value for poverty were generally low for all indicators. Discussion: The authors' findings do not suggest that any of the indicators used is substantially better than the other or better than the Official Economic Classification made by local authority. The results also show that no indicator is particularly useful to predict the values of any other indicator and different poverty indicators may classify different socioeconomic groups as poor.

Aims: Building on the experiences of an initial study in 1993, the current survey was conducted to enhance understanding of men's sexual health and prospects for behaviour change in Chiawa, rural Zambia. Methods: Seventy-nine randomly selected men in the age range 16 - 25 years were interviewed using a questionnaire. Results: The obstacles to good sexual health reported were: inadequate access to health facilities (35%); unemployment (24%); diseases in general (20%); and HIV/AIDS (17%). Nineteen (24%) had suffered from an STI in the past. Five (13%) of the married and 16 (33%) of the single men had extra or pre-marital relationships at the time of the interviews. In 1993, 50% of the single men had pre-marital relationships. A real man (murume chaiye) was considered to be married, have children, have a job and sexually satisfy his wife; 97% considered themselves to be real men. Some 91% perceived themselves to be at risk of HIV infection; 76 (96%) were aware that HIV could be passed from mother to child, although 51 (61%) would not think about HIV when making decisions about having children. Sixty-eight (86%) believed that condoms could reduce the risk of HIV and 27% used condoms all the time they had sex. In 1993, 6% used condoms all the time they had sex. Conclusions: There are prospects for behaviour change among the men. Prevention messages need to build on what they already know and practise. The messages must aim to change their local sexual norms, which perpetuate risky practices.

The structural and electronic parameters of the horminone molecule, an abietan diterpene quinone, were studied by means of all-electron calculations using Hartree–Fock and density functional theory-based methods, as implemented in the Gaussian98 program. The 6-31G orbital basis sets were used for the C, H, O, and Mg atoms. The results allow the identification of the negative site of horminone (HM) most favorable for its binding to the Mg2+ ion. The HM–Mg2+ complex is assumed to play a significant role in the antibacterial activity. First, it penetrates the membrane cell. Then, through its interaction with rRNA, it inhibits the protein synthesis in several types of bacteria. © 2003 Wiley Periodicals, Inc. Int J Quantum Chem 93: 411–421, 2003

Aims : The aim of this study is to describe the use of public health services in different social and ethnic groups and to explore the implementation of user fee exemption in a mountainous area in Vietnam. Methods: A cross-sectional household survey with a structured questionnaire and a four-week diary were used to collect information on illnesses, health seeking behaviour and socioeconomic factors. Three communes in a mountainous district in Northern Vietnam were selected and a random sample of 1,452 individuals in 300 households was drawn. Results: Self-medication was most common (57%) while 30% used public health services when suffering from a health problem. Persons living far from health services attended public health services less frequently than the others (adjusted OR=0.28; 95% CI 0.15-0.51). This was especially the case for ethnic minorities who were less likely to use public health services than the others were (adjusted OR=0.47; 95% CI 0.25-0.87). Persons with mild conditions tended to use public health services less than those with more severe conditions (OR=0.19; 95% CI 0.10-0.37). Health services use was similar among women and men, but the total expenditure per visit was higher for men. Almost no patients supposed to get free attendance had been exempted from user fees. Conclusions : It was found that there was a geographical inequity in use of public health services while there was relatively equal use of these services between social, gender, and ethnic groups. Long distance in combination with failure of the fee exemption may increase inequity in use of health services in remote and isolated areas. These observations contribute to the basis for implementation of the Vietnamese health policy, emphasizing efficiency and equity.

The purpose of this study was to investigate the factors influencing sexual partner referral using the Attitude-Social influence self-Efficacy model as a guiding theoretical framework. The data was collected in an interview survey with 236 women and 190 men attending a sexually transmitted disease clinic in Kampala, Uganda. Intention, attitude, subjective norm, self-efficacy, and past behaviour in relation to partner referral as well as partner type were collected at time 1. At time 2 (1 month later), sexual partner referral was assessed. Intention, self-efficacy, and previous behaviour predicted partner referral for women whereas intention, partner type and previous behaviour predicted partner referral for men. For the women the strongest predictors for intention were self-efficacy followed by attitude and partner type. For the men the strongest predictor was attitude followed by partner type and self-efficacy. Social influence was a better predictor of intention for women than for men. An analysis of underlying cognitive beliefs discriminating those who referred and those who did not refer the sexual partner showed that attitudinal beliefs were the most important for men whereas self-efficacy beliefs were the most important for women. The targeting of the gender-based discriminatory beliefs in intervention may improve compliance with sexual partner referral.

Jensen-Urstad M, Samad BA, Jensen-Urstad K, Hulting J, Ruiz H, Bouvier F, Hojer J (Karolinska Hospital, Karolinska Institute, Stockholm; Soder Hospital, Karolinska Institute, Stockholm; Karolinska Hospital, Karolinska Institute, Stockholm; and Soder Hospital, Karolinska Institute, Stockholm, Sweden). Risk assessment in patients with acute myocardial infarction treated with thrombolytic therapy. J Intern Med 2001; 249: 527–537. Objective. Several noninvasive methods have prognostic information regarding mortality and new coronary events after an acute myocardial infarction (AMI). The practical for clinical decision-making in the immediate postmyocardial infarction (MI) period is, however, less evident. We investigated consecutive patients with AMI treated with thrombolysis to further clarify this issue. Design. A total of 100 patients (27% women) aged 64 ± 9 years (mean ± SD) were studied. Risk assessment based on a clinical score system, myocardial perfusion scintigraphy single photon emission computed tomography (SPECT) at rest and during adenosine stress, echocardiography, radionuclide angiography, symptom-limited exercise stress test, and 24-h Holter ECG recording with ST-analysis and analysis of heart rate variability (HRV) were performed 5–8 days after hospital admission. Mortality, nonfatal reinfarction, and the need for revascularization were followed during 12 months. Setting. A university hospital. Results. A total of 6 patients died, seven had a nonfatal reinfarction, and 23 were revascularized. Inability to perform an exercise test (P=0.004) and an ejection fraction (EF)

Patient-based partner referral (PBPR) which is the main method for treating sexual partners of patients with sexually transmitted diseases (STDs) has limited effectiveness. The authors compared the efficacy of PBPR with patient-delivered partner medication (PDPM) among patients attending the Mulago STD clinic in Kampala Uganda. A total of 383 patients (187 women 196 men) with STDs were randomized to the PBPR or PDPM group. The proportion of sexual partners treated in either group was compared using the chi-square statistic by intention to treat for partners whose follow-up status was unknown. The two groups had similar background characteristics. Of the 237 partners elicited 176 (74%) were reported treated in the PDPM group. In the PBPR group in which 234 partners were elicited 79 (34%) were referred to the treatment clinic. This difference was statistically significant (risk ratio [RR] 2.44; 95% confidence interval [CI] 1.95-3.07; P < 0.001). Furthermore PDPM was more effective than PBPR for women and for casual partners for whom PBPR is considered difficult. For women 86 of 103 partners in the PDPM group were reported treated compared with 23 of 104 partners in the PBPR group (RR 4.55; 95% CI 2.92-7.08; P < 0.001). For casual partners 18 of 51 (34%) were reported treated in the PDPM group compared with only three of 45 partners (7%) who were referred in the PBPR group (RR 1.43; 95% CI 1.40-2.65; P < 0.01). Patient-delivered partner medication is more effective than patient-based partner referral in the treatment of sexual partners. (authors)

In order to understand and elicit the psychosocial factors influencing compliance with sexual partner referral, 10 focus group discussions (FGDs) and 40 individual interviews based on the attitude-social influence-self efficacy (ASE) model were held in Mbarara District of Uganda. The focus groups were derived from both rural and urban areas. Informal interviews were held with 20 men and 20 women presenting with symptoms of a sexually transmitted disease (STD) at the outpatient department of Mbarara Hospital. The emerging outcome of attitudinal beliefs regarding health consequences of partner referral were mainly positive. However, outcome beliefs relating to the relationship with the partners were mainly negative. Social influence for sexual partner referral was from health-care providers, partner(s), friends and relatives. The self-efficacy beliefs were mainly negative especially among women. Barriers hampering sexual partner referral were related to poor quality of health care, gender relations and type of sexual partners. There is a need to target these beliefs and self-efficacy expectations in health education and STD counselling and for more research to evaluate the psychosocial determinants of sexual partner referral quantitatively.

Lately there has been increasing interest regarding the practice of traditional healers and their use of indigenous plants to treat illnesses. Twenty-three local healers (n’ganga) in Chiawa, rural Zambia, were interviewed about knowledge, practices, and their use of indigenous plants in the diagnosis and treatment of sexually transmitted illnesses (STIs) among male clients. They were also asked about their perceptions of modern medicine. The study revealed that all the n’ganga diagnosed and treated three main types of STIs. They named them as: songeya, doroba and bola - bola. They treated the illnesses with Strychnos cocculoides ; Musa species; Solanum delegoense ; Ximenia caffra ; Diplorynchus condylocarpon ; and Croton megalobotrys . Ten of the n’ganga perceived modern medicine to be effective against STIs and five of them sometimes referred some of the clients to the local health centre. It is being argued that a scheme to incorporate the n’ganga into STD control activities in which they can be utilised to refer clients to modern medical facilities can be baneficial. Given the necessary health information and support, the n’ganga may effectively execute this scheme.

OBJECTIVE—To evaluate the benefits and risks of symptom limited exercise testing versus low level exercise testing soon after a thrombolytic treated acute myocardial infarction. DESIGN AND PATIENTS—98 patients (71 men, 27 women), mean (SD) age 64 (9) years (range 45-75 years), were investigated 5-8 days after admittance to hospital. An ergometer cycle test was used, starting at 30 W with 10 W increments per minute. Each exercise test was interpreted at the symptom limited end point and a low level end point, which was defined as the point at which the patient rated exhaustion as 13 on the 6-20 point Borg scale for rating perceived exertion. SETTING—A university hospital. RESULTS—75 of the 98 patients were able to perform a predischarge exercise test. Of the remaining 23 patients who could not perform an early exercise test (because of unstable angina, heart failure, or thrombus detected at echocardiography), five died or had a myocardial infarction and six underwent bypass surgery or percutaneous transluminal coronary angioplasty (PTCA) during a follow up period of one year. There were no complications related to the symptom limited exercise tests. The test results were positive in 15 patients at the low level end point and in 39 patients (p

Background: The use of corticosteroids in toxic lung injury caused by exposure to an irritating gas such its ammonia has not been adequately studied. Objective: To evaluate the effects of budesonide inhalation in a rabbit model of toxic lung injury induced by ammonia. Design: Randomized, blind placebo-controlled laboratory investigation employing 16 New Zealand White rabbits. Lung injury was induced by inhalation of a defined amount of aerosolized ammonia. Thirty minutes later, the rabbits were randomized to receive either inhalation therapy with 0.5 mg budesonide or placebo. After another 2 hours, a second treatment inhalation, identical to the first one, was administered. Results: Airway pressures, hemodynamics, and gas exchange were measured at baseline, 5, and 15 minutes after ammonia administration and every 30 minutes during a 6-hour period after the first blind inhalation of corticosteroids or placebo. The ammonia inhalation resulted in an acute severe lung injury, detected after 15 minutes its a d...

The aim of this study was to: (1) compare the usefulness, in clinical practice, of different echocardiographic methods of left ventricular (LV) function determination in patients with a recent thrombolytic-treated acute myocardial infarction (AMI); (2) compare these measurements with the reference method radionuclide imaging; and (3) evaluate the reproducibility of visual estimation of the LV ejection fraction (EF) and the use of the biplane method of discs (Simpson’s rule) in clinical practice. Echocardiography and radionuclide imaging were performed within 2 hours of each another, 5 to 8 days after hospital admission. Ninety-six patients (70 men and 26 women) age 64 ± 9 years (range 45 to 75) were studied. The echocardiographic study was performed by 2 experienced physicians, independently of each another. LV wall motion score index and visual estimation of the EF correlated best with the radionuclide EF (r = 0.72 and r = 0.71), thereafter simply counting the number of affected LV segments (r = 0.67) or atrioventricular plane measurements (r = 0.64). Simpson’s rule had low correlation to the radionuclide EF (r = 0.45 to 0.51) and could not be used in approximately half of the patients due to poor identification of endocardial borders. The interobserver coefficient of variation for independent visual echocardiographic estimation of the EF was 10%, for Simpson’s rule 18%, and for the radionuclide EF 5%. We conclude that the EF estimated from quantitative echocardiographic volume calculations (Simpson’s rule) may differ substantially from radionuclide methods of measuring the EF. However, with experienced sonographers, the LV wall motion score index or visual estimation of the EF had reasonable agreement with the radionuclide EF in most of the patients. Atrioventricular plane measurement is an acceptable alternative.

The objective of this study was to evaluate the safety of myocardial perfusion scintigraphy with Tc-99 m sestamibi during adenosine stress in patients with recent thrombolytically treated myocardial infarction. Eighty-four patients with thrombolytically treated myocardial infarction, 59 males and 25 females, aged 62.9 +/- 8.4, were eligible for myocardial perfusion scintigraphy during adenosine provocation. Exclusion criteria for adenosine stress were hypotension, unstable angina pectoris, cardiac failure, pericarditis and atrioventricular block (AV block) II-III. Adenosine-stress and resting myocardial perfusion scintigraphy was performed 2-5 days after thrombolysis. Scintigraphy at rest was done 24 h after the stress study. Sixty patients (71%) experienced some kind of side-effects during adenosine infusion. The most frequent side-effects were dyspnoea in 43/84 patients (51%) and unspecific chest discomfort in 26/84 patients (31%). During infusion, ST depressions or elevations on ECG were seen in 9 patients (11%), 5 of whom experienced atypical chest discomfort. Five patients (6%) described typical angina but none of them showed electrographic signs of myocardial ischaemia during infusion. Six patients (7%) developed transient AV block I-II. Reversible scintigraphic perfusion defects were seen in 67 patients (79%). No serious complications, such as death, reinfarction or severe arrhythmias, occurred during adenosine infusion or during a 3-day clinical follow-up period. In conclusion, MIBI-SPECT during adenosine stress is a safe diagnostic method that can be performed in most patients early on after thrombolytically treated acute myocardial infarction. Side-effects are common but benign, and not different from those seen in patients with chronic coronary artery disease.

This study was conducted to investigate the relationship between various socio-economic factors, and child morbidity and mortality during a period of rapid social change in Vietnam. One-thousand-one-hundred-and-thirty-two rural mothers with children under 5 years of age were interviewed regarding their reproductive history, survival of their children, and morbidity of their children under 5 years of age. Causes of child death were established by a verbal autopsy technique. Fifty-seven per cent of the children were reported to have suffered from some illness during the preceding 2 weeks. Acute respiratory infection (ARI) (46 per cent of all children) was most common. Two-thirds of the sick children had been treated with antibiotics. Eighty-one children under 5 years of age had died during the 10-year period 1982-1992. Two-thirds of these deaths occurred in infancy, most of them were related to prematurity, asphyxia or tetanus. ARI was more common in poor families while neither education nor occupation were associated with ARI occurrence. No significant relationship between education or occupation of the mother and mortality was found. The low under-5 mortality (U5MR) in spite of the high morbidity may be related to good child health care both by families and by the health care system.

The first update of the 1997 gastric lavage position paper was published by the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists in 2004. This second update summarizes the 2004 content and reviews new data.A systematic review of the literature from January 2003 to March 2011 yielded few studies directly addressing the utility of gastric lavage in the treatment of poisoned patients.Sixty-nine new papers were reviewed. Recent publications continue to show that gastric lavage may be associated with serious complications. A few clinical studies have recently been published showing beneficial outcomes, however, all have significant methodological flaws.At present there is no evidence showing that gastric lavage should be used routinely in the management of poisonings. Further, the evidence supporting gastric lavage as a beneficial treatment in special situations is weak, as is the evidence to exclude benefit in all cases. Gastric lavage should not be performed routinely, if at all, for the treatment of poisoned patients. In the rare instances in which gastric lavage is indicated, it should only be performed by individuals with proper training and expertise.