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Aim The study aim was to further clarify the relationship between psychological factors and myocardial infarction (MI) by simultaneously examining anger, depression, and anxiety as risk factors for incident MI in a healthy working sample. Subject and method Baseline measurements of psychological variables were assessed through a self-reported questionnaire in a healthy cohort of 968 middle-aged men working at the Volvo Corporation. Single-item questions assessed depression and anxiety. Anger was assessed by the Trait Anger subscale of the Spielberger State-Trait Anger Expression Inventory. The endpoint was incident MI verified by national registers or medical records with follow up after 22 years. The main outcome was computed through logistic regression, reported as odds ratios. Additional correlation analyses were performed between psychological variables and coronary risk factors. Results None of the psychological variables was significantly associated with the outcome; thus, the results failed to show an association between anger, depression, or anxiety and incident MI in this sample. There were some significant, but weak, correlations between psychological factors and negative health behaviors. Other components of traditional risk scoring instruments did not correlate with the psychological factors. Conclusion A cohort restricted to middle-age healthy men limits applicability. However, our failure to replicate earlier results of population samples suggests a need for further research on associations between psychological factors and MI in healthy samples.

Background In 1993, 1000 randomly selected employed Swedish men aged 45–50 years were invited to a nurse-led health examination with a survey on life style, fasting lab tests, and a 12-lead ECG. A repeat examination was offered in 1998. The ECGs were classified according to the Minnesota Code. Upon ethical approval, endpoints in terms of MI and death over 25 years were collected from Swedish national registers with the purpose of analyzing the independent association of ECG abnormalities as risk factors for myocardial infarction and death. Results Seventy-nine of 977 participants had at least one ECG abnormality 1993 or 1998. One hundred participants had a first MI over the 25 years. Odds ratio for having an MI in the group that had one or more ECG abnormality compared with the group with two normal ECGs was estimated to 3.16. 95%CI (1.74; 5.73), p value 0.0001. One hundred fifty-seven participants had died before 2019. For death, similarly no statistically significant difference was shown, OR 1.52, 95%CI (0.83; 2.76). Conclusions Our study suggests that presence of ST- and R-wave changes is associated with an independent 3–4-fold increased risk of MI after 25 years follow-up, but not of death. A 12-lead resting ECG should be included in any MI risk calculation on an individual level.

Background A plateau in childhood overweight and obesity has been reported in some developed countries while in almost all developing countries this problem is on the rise. The aim of this paper is to describe the changes in prevalence of overweight and obesity within a cohort of preschool children followed for 3 years, and to estimate and compare the incidences in urban and rural children of Hanoi, Vietnam. Methods A longitudinal study of a cohort of 2677 children aged 3 to 6 years old at the beginning of the study was conducted in urban DodaLab and rural FilaBavi, Hanoi, Vietnam. Overall, 2602 children, 1311 urban and 1291 rural, were followed for 3 years with identical measurements of weight and height in 2013, 2014 and 2016. Standard methods were used to estimate prevalence and incidence as well as confidence intervals. Results During the three-year follow-up, the overall estimated prevalence of overweight increased from 9.1% to 16.7%. For the urban children, the increase was considerably higher. The overall prevalence of obesity decreased from 6.4% to 4.5% with less decrease in the urban children. In the group of children who were overweight and obese at the start of the study, 41.4% and 30.7%, respectively, remained in the same state three years later. The incidence of overweight and obesity during the three years were 12.4% and 2.7%, respectively. Boys were more likely to develop obesity than girls. Conclusions Already in preschool age, the prevalence of overweight is high and it continues to increase with age, especially in the urban area. Prevention and intervention programs need to start at early preschool age and actions in urban areas deserve priority.

The Nordic School of Public Health (NHV) was jointly founded in 1953 by the Nordic countries. Until 1979, the school provided ad hoc courses on public health topics, using external teachers drawn mainly from the Nordic countries. At the time, the permanent staff of the school was small. In 1979, it began a Master’s degree programme and a few academic positions were established and filled, to support these courses. The programme included four main areas: Epidemiology, Social Medicine, Environmental Health and Health Services Administration. Epidemiology was compulsory in all Master of Public Health (MPH) exams, but there were a handful of optional courses that could be substituted for the other subjects. This paper tells the story of Epidemiology at NHV from about 1980, up until closure of the school in 2014. The original MPH model ran until 1995. Nursing Science entered NHV from about 1985 and worked mainly with qualitative research that often focused on individual patients. The new methods attracted nurses, midwives, psychologists and other groups that previously had been less represented in NHV. Being quantitative and population oriented, Epidemiology lost its unique position as a mandatory subject for the MPH examination. In addition the ‘New Public Health’ proposed by the World Health Organisation (WHO) that advocated health promotion and the philosophy of salutogenesis became a challenge for the programme in epidemiology: pathogenesis no longer was of primary interest. From 1995, the MPH format changed repeatedly and a DrPH programme was begun. For the last 8 years of its existence, NHV offered a reasonably comprehensive, basic course in Epidemiology. Throughout the years, epidemiology training and research at NHV were very traditional. In being a relatively free institution in terms of academic choices, NHV should have contributed to the development and innovation of epidemiology in public health. For several reasons, this did not happen.

Choices for delivery care are made based on the available resources and influence health outcomes of women and their children. The aim of the paper is to study utilization and preference for delivery care and related factors in one urban and one rural area of northern Vietnam. Two cohorts of pregnant women were carried out in DodaLab and FilaBavi Health and Demographic Surveillance Sites (HDSS) in Hanoi, Vietnam from April 2008 to December 2009. Together, 2515 pregnant women were identified and followed until delivery through quarterly household interviews using structured questionnaires. Almost all women delivered at health care facilities. Most of the rural women gave birth at primary health care facilities (88.5%) while urban women primarily used secondary and tertiary hospitals (93.6%). Caesarean section (CS) was used for 38.5% of births in the urban area and 12.4% in the rural. Giving birth in hospitals and CS were more common among highly educated women, employed women, women living in households or communities with good economic conditions, and women expected to give birth to a son. Technology preference in delivery care was associated with better socioeconomic conditions and expecting a boy. Improving the quality and reputation of primary health care facilities, informing women about CS risks and monitoring indications of CS are important policy issues.

One of the traits of ageism is the categorization of the aged into stereotypes. One such concept is that old people participate less socially and are lonely. If the variation among the aged is greater than among younger persons, the stereotype is increasingly misrepresenting the aging population. Such variation is rarely studied in properties assessed by ordinal scale measurements. Is the variation in social participation measured on ordinal scale increasing as a function of age? A measurement of ordinal dispersion was used. The data was from the longitudinal-studied random sample of one thousand one hundred and forty-eight 70-year-old persons born on 1901/1902 who lived in Gothenburg, Sweden in 1971. This sample has been referred to as the H70 sample. Seven aspects of social participation were assessed by interviews. In all but one aspects of social participation there was an increase in dispersion by increasing age. This increase in dispersion by increasing age is not in accordance with a stereotype concept of aging. This result points to an increased risk of ageism by increasing age as the dispersion in social participation increases with age in several aspects.

Background: Three repeated cross-sectional surveys, using representative samples of children, aged 2-17 years, stratified for age and sex, were conducted in each of the five Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) in 1984, 1996 and 2011. The aim of the present study was to analyze how the health of Nordic 13-17 years old children developed over time, using results from the three surveys in relation to changes in economy and social capital. Methods: Data from 2,905 children in 1984, 2,922 in 1996 and 2,257 in 2011 were collected using mailed questionnaires. Indicators in three areas were used. The Health indicator was taken as absence of psychosomatic complaints. Economy was represented by social class, housing and disposable income. Social capital contained absence of bullying, the child's organized group activities, parents playing with their children, and parents’ position of trust. Three composite indices one for each area were formed and called Health, Economy and Social Capital Index. Results: There were statistically significant increases of psychosomatic health complaints for children 13-17 years in all the Nordic countries, strongest among girls, at the same time as the economy and social capital of the families increased, particularly in the first period (1984-1996). Conclusions: In spite of the families’ growing economy and improved standard of living there is an increasingly harsh climate in society, with stress, dissatisfaction, bullying and mental health problems. It supports conclusions from other studies that only economic growth is not enough for the full wellbeing of the population. It also supports the importance of the social cohesion, affiliation and solidarity, advanced and reinforced by equitable distribution of the wealth. Social cohesion is important for schooling, on the values of self help, equity, to seek solutions for health among youths.

Background : Childhood overweight and obesity is a new and emerging problem in Vietnam. The so far observed prevalence increases have pointed to the need for public health intervention strategies with parents as crucial resources for change. Objective : The aim of this study was to understand mothers’ conceptions of childhood overweight. Design : Four focus group discussions were conducted with a total of 33 mothers of preschool children, 4–6 years old, living in urban and rural districts of Hanoi, Vietnam. The discussions were audio taped and transcribed verbatim. The obtained data were analyzed using the principles of phenomenography. Results : Four main categories with 13 subcategories emerged in the process of analysis. The first category, called ‘Concept of overweight’, contained mothers’ views on childhood overweight. A major concern was the negative aspects of overweight such as impaired social interaction and health problems. The second category, ‘Identification of overweight’, described the ways mothers use to recognize overweight in children: own experience, growth chart, and public or health care system’s information. The third category, ‘Causes of overweight’, showed mothers’ understanding of factors possibly contributing to overweight development: unhealthy food and lifestyle, genetic susceptibility, parent’s lack of knowledge, and limited time to take care of children as well as economic improvement. The fourth category, ‘Management of overweight’, described the ways mothers use to manage a child’s weight problem: control of their food intake, increasing their physical activity, and encouraging their child self-control. However, they find such strategies difficult to implement and their intentions are sometimes challenged by the child’s grandparents. Conclusions : The study gives an understanding of the mothers’ conceptions of four important and practically useful aspects of overweight in children. The findings highlight the roles of media and the health care system in enhancing a social awareness of the problem and the need for prevention. Growth charts need to be used more regularly and consciously in child health care for early detection of children at risk and as a tool for information to parents. When designing intervention programs, the entire extended families, especially grandparents and their roles, need to be considered. Keywords: childhood overweight; mothers’ conceptions; preschool children; qualitative study; Vietnam (Published: 23 March 2016) Citation: Glob Health Action 2016, 9 : 30215 - http://dx.doi.org/10.3402/gha.v9.30215

Background : Childhood obesity may soon be an equally important health threat as undernutrition and infectious diseases. Accurate information about prevalence and risk factors of obesity in children is important for the design of prevention. Objective : The aim of this study was to estimate prevalence of overweight and obesity for preschool children in two Vietnamese areas, one urban and one rural, and to identify risk factors. Design : A cross-sectional study was conducted in urban Dong Da and rural Ba Vi districts, Hanoi, Vietnam. Totally, 2,677 children, 1,364 urban and 1,313 rural, were weighed and measured. Caregivers were interviewed. Background information about children and families was obtained from regular household surveys. Results : The prevalence of overweight and obesity combined were 21.1% (95% CI 18.9–23.3) in the urban area and 7.6% (95% CI 6.2–9.2) in the rural. Multiple logistic regression revealed that at the individual level, in both sites, the risk increased with increased child age. The identified urban risk factors were being a boy, consuming large amounts of food, eating fast, and indoor activity less than 2 hours per day. The rural risk factors were frequent consumption of fatty food. At the family level, significant association was found in rural areas with frequent watching of food advertisements on television. Conclusions : Overweight and obesity are emerging problems in Vietnam, particularly in the urban context. Prevention programs should focus on education about healthy eating habits at early preschool age and need to be tailored separately for urban and rural areas since the risk factors differ. Non-healthy food advertisement needs to be restricted. Keywords: overweight; obesity; preschool children; Vietnam (Published: 8 October 2015) Citation: Glob Health Action 2015, 8 : 28615 - http://dx.doi.org/10.3402/gha.v8.28615

Understanding parents’ feeding control practices and their associations with various factors is useful for prevention of childhood obesity, an emerging problem in low- and middle-income countries. The aim of this paper is to describe the control practices used by parents of preschool children in Vietnam and factors associated with these. Two cross-sectional studies were conducted in urban DodaLab (n = 1364) and rural FilaBavi (n = 1313), Health and Demographic Surveillance Sites (HDSS), Hanoi, Vietnam. For 94.9 % of the children, both parents answered the Child Feeding Questionnaire and additional questions about nutritional practices. Children’s and parents’ weight and height were measured. Simple Pearson correlation coefficients, multiple regression and exploratory factor analysis were used for the statistical analysis. Mothers reported the use of more restriction, pressure to eat and monitoring than the fathers. The measured child’s body mass index (BMI) and the mother’s perception of the child’s weight were negatively associated with pressure to eat and positively associated with monitoring. A positive association was found between restriction and the mother’s perception of the child’s weight. In the rural area, high consumption of fatty food, sweets and snacks was associated with high use of restriction and monitoring. The amount of food consumed was negatively associated with the use of pressure to eat. In the urban area, consumption of fatty food and sweets was positively correlated both with restriction and pressure to eat. Monitoring was negatively associated with consumption of fatty food and snacks and positively with the amount of food. Higher education of the mothers was associated with higher use of monitoring, restriction (in the urban area) and pressure to eat (in the rural area). While feeding practices in Vietnam differed between mothers and fathers and between urban and rural areas, the associations with children’s BMI and socioeconomic factors were weak. This implies that parental roles as well as sociodemographic factors should be considered when designing programs for prevention of childhood overweight and obesity.

Thirteen patients with schizophrenia received injections of 25, 50, or 75 mg of long-acting risperidone every 2 wk. Brain D2 receptor occupancy was assessed with [11C]raclopride 2 wk after the last (fifth) injection (day 71) in seven subjects and 2 wk after the third injection (day 44) in one subject. Stable plasma concentrations were reached after the third injection and steady-state concentrations of the active moiety (risperidone + 9-hydroxyrisperidone) after the fourth injection. Steady-state plasma concentrations were maintained for 4-5 wk after the last injection and then declined rapidly. After injections of 25, 50 and 75 mg on day 44 or day 71, D2 receptor occupancy ranged from 25-48%, 59-83% and 62-72% respectively, while plasma active-moiety levels ranged from 4.4-8.8, 15.0-31.1 and 22.5-26.3 ng/ml respectively. The results indicate that brain D2 receptor occupancy at steady state after injections of long-acting risperidone was in the range found in patients effectively treated with 2-6 mg of oral risperidone.

This experimental study was undertaken to assess the effect of different levels of exemption, 25%, 50% and 75%, from health centre user fees on health service utilization and treatment seeking behaviour for malaria by a high risk group of pregnant women and children under 5 years. These are groups in need of special medical attention to prevent progression of the disease into complicated or severe malaria. Sinnar State, one of Sudan's highly endemic malaria regions, was selected to be the experimental area. Exemptions were introduced for one year in six health centres. Two centres for each exemption level, and a further two health centres without exemptions were studied. At the beginning and the end of the trial year, households surveys were conducted in the catchment areas of the health centres, and focus group discussions with pregnant women and mothers of children under 5 years were conducted. Routine data were reviewed for malaria cases in the health centres and six studies on malaria cases were done upon exit from the health centres. In-depth interviews with health staff of the health centres were conducted. Exemption from user fees increased health services utilization, improved treatment-seeking behaviour and promoted early diagnosis. The changes during the experimental year were the largest in the centres with the largest exemption. Therefore, policy changes towards exemptions are necessary to facilitate early diagnosis and treatment of malaria.

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: Assessment was made of the validity of mortality estimates based on data collected during 1999 - 2000 by quarterly follow-up visits and compared with other methods (re-census, communal death registration, and neighbourhood survey). Methods: This study was carried out within a longitudinal epidemiological laboratory in Bavi District, Vietnam (called FilaBavi), covering a sample of 11,089 households with 51,024 inhabitants. Deaths within FilaBavi during 1999 - 2000 were collected by four methods and compared: quarterly household follow-ups, the re-census carried out in 2001, the Commune Population Registration System (CPRS), and a neighbourhood survey. Results: Within these four methods, a total of 471 deaths were detected in the FilaBavi sample. Quarterly household follow-ups detected 470 deaths (99.8%). The re-census missed 19 deaths, of which eight were infants, and two-thirds of the missed deaths fell in 1999. The CPRS missed 89 cases (19%), the majority being infant and elderly deaths. The neighbourhood survey over-reported deaths. Conclusions: Quarterly follow-ups were the best method for death registration. The re-census approach was less complete, with problems of recall bias. The completeness and quality of death registration by CPRS was low, especially for infant and elderly mortality.

The H70 longitudinal study of aging, Goteborg, Sweden is used to empirically test the compression of morbidity theory advanced by Fries (1980) and Fries and Crapo (1981). We reconceptualize compression as postponement of morbidity in the sense of decreasing amounts of illness for increasingly long life spans. Operationally, morbidity is defined as the average number of hospital days in the last year of life. The date of death and the date of 1-year prior to death define the risk period. The linear regression model with age at death, age at death squared, year of birth, and sex are statistically significant with the oldest having the fewest hospital days. The findings offer partial support for the compression of morbidity theory.

The aim of this study was to investigate the correlations between epidemiological indices (objective) and self-perceived oral health (subjective) in adolescents at school level, and to study gender differences in epidemiological indices and in self-perceived oral health. The study comprised two sets of data from Skaraborg County, Sweden: 1. Self-reported questionnaires answered by adolescents at all senior level schools (n = 9,559, 13-15 years). 2. Epidemiological indices based on clinical registrations of oral health in 13-15-year-old adolescents were collected in all 17 municipalities (n = 7,899). Simple and partial Pearson correlation coefficients were used to study correlations between subjective and objective oral health in the adolescents at school level. Gender differences in adolescents' subjective and objective oral health were estimated using a logistic regression model. The correlations between epidemiological index registrations and self-perceived oral health were weak. The strongest correlations were found between epidemiological indices and self-perceived gingival bleeding: 0.416 between the DS (decayed surfaces) index and self-perceived bleeding. Girls were less likely to be satisfied with the appearance of their teeth than boys were in municipalities with clinical good oral health OR 0.76 (95%) CI 0.59-0.98) and with poor clinical oral health OR 0.74 (CI 0.57-0.94). No gender differences were found in the epidemiological index registrations. The currently used epidemiological indices did not reflect adolescents' own perceptions of their oral health at school level and they could not recognize or identify gender differences. Surveillance of oral health in young people should include information on self-perceived oral health.

Due to the nature of the manufacturing and support activities associated with long life cycle products, the parts that products required need to be dependably and consistently available. However, the parts that comprise long lifetime products are susceptible to a variety of supply chain disruptions. In order to minimize the impact of these unavoidable disruptions to production, manufacturers can implement proactive mitigation strategies. Two mitigation strategies in particular have been proven to decrease the penalty costs associated with disruptions: second sourcing and buffering. Second sourcing involves selecting two distinct suppliers from which to purchase parts over the life of the part’s use within a product or organization. Second sourcing reduces the probability of part unavailability (and its associated penalties), but at the expense of qualification and support costs for multiple suppliers. An alternative disruption mitigation strategy is buffering (also referred to as hoarding). Buffering involves stocking enough parts in inventory to satisfy the forecasted part demand (for both manufacturing and maintenance requirements) for a fixed future time period so as to offset the impact of disruptions. Careful selection of the mitigation strategy (second sourcing, buffering, or a combination of the two) is key, as it can dramatically impact a part’s total cost of ownership. This paper studies the effectiveness of traditional analytical models compared to a simulation-based approach for the selection of an optimal disruption mitigation strategy. A verification case study was performed to check the accuracy and applicability of the simulation-based model. The case study results show that the simulation model is capable of replicating results from operations research models, and overcomes significant scenario restrictions that limit the usefulness of analytical models as decision-making tools. Four assumptions, in particular, severely limit the realism of most analytical models but do not constrain the simulation-based model. These limiting assumptions are: 1) no fixed costs associated with part orders, 2) infinite-horizon, 3) perfectly reliable backup supplier, and 4) disruptions lasting full ordering periods (as opposed to fractional periods).

Objectives: The objective of this study was to assess the effectiveness of government regulation of private pharmacy practice in a low-income country.Methods: The intervention comprised inspections of the pharmacies, information, and distribution of documents to drug sellers and sanctions. It was implemented at two different intensity levels, active and regular intervention. The methods used to assess the effect of the interventions were interviews with the district drug inspectors, drug sellers and customers, inspection of drug purchases, and indicator surveys of pharmacies. Indicators for pharmacy-specific quality as well as for dispensing quality were developed.Results: The main finding was one of strong overall improvements from initially low levels. The improvements were particularly marked by increases in the availability of essential materials for dispensing by 34% and in order in the pharmacy by 19%. Information given to customers increased from 35% to 51% and the mixing of different drugs in the same package went down from 17% to 9%. The pharmacies in the active intervention districts showed greater improvements for four of the six indicators, although statistically significant compared with the regular intervention districts only for the essential materials indicator.Conclusions: It was concluded that the regulatory activities have probably been an important factor behind the service quality improvements. It appeared feasible as well as effective to regulate private pharmacy practice in this particular low-income setting.

The clinical significance and the effects of pharmacological treatment of patients with Alzheimer's disease (AD) were evaluated by measurement of acetylcholinesterase (AChE) in the cerebrospinal fluid (CSF). CSF-AChE of AD patients was lower, not significantly, compared with controls. However, CSF-AChE was significantly increased after treatment of AD patients with AChE inhibitors (donepezil and galantamine). The increase was higher in patients treated with donezepil than in those treated with galantamine, which might be related to different mechanisms for the substances. The increase was also dose-dependent, and was especially marked in patients showing a clinical response. These data suggest that CSF biomarkers are capable not only of identifying a biochemical effect of drugs, but also of differentiating between different compounds in a dose-dependent manner.

The private sector is a dominant actor in the provision of pharmaceuticals, particularly in developing countries. Private provision of drugs has been associated with risks regarding availability, affordability, rational use and drug quality. Ensuring an effective regulatory framework is therefore a major challenge for governments, yet the capacity of regulatory authorities is often outstripped by private sector growth. In the Lao People's Democratic Republic (Lao P.D.R.), a poor, landlocked country in South East Asia, the private provision of drugs has increased dramatically since the liberalisation of the economy in the late 1980s. This paper aims to describe the quality of the private pharmacy services in the Savannakhet province of Lao P.D.R. In order to do this, a monitoring instrument which serves to make the concept of Good Pharmacy Practice (GPP) operational was developed and applied to a sample of pharmacies. Service quality, as measured by three facility-specific indicators, showed a tendency to be lower in the most distant districts. Poor dispensing practices were manifest by a lack of information about drugs sold in 59% of cases, drugs not being labelled in 47% and different drugs being mixed in the same package in 26% of cases. The prices of four sample drugs were slightly higher in the remote districts. A 10-fold price difference for the same drug was recorded in one district. After reporting the findings, the paper discusses the possible influence of district and pharmacy variables on the quality of services, and goes on to discuss the price differences. It is concluded that further government interventions are needed in order to improve the quality of services and to focus regulatory action on a limited number of aspects, to ensure that drugs can be traced before trying to establish a comprehensive regulatory system.

This paper reports the results of a cross-national comparison of the 'H70' longitudinal study of elders in Gothenburg, Sweden, with the 'Rural Missouri Elders' longitudinal study in Missouri, USA. Analysis of the combined data sets focused on the question of how longevity was affected by culturally divergent forms of social network participation. The H70 study was a representative, systematic 3/10 sample of 70-year-old (in 1971) men and women living in Gothenburg. Follow-up data was gathered when the respondents were 75, 79, 81, 82, 83, 85, 88, 90 and 95 years of age. Face-to-face interviews and physical medical examinations were the major source of data. The Missouri study involved a representative cluster proportional-to-size sample of all rural Missourians 65 years of age and older. Face-to-face interviews were conducted in 1966, 1974 and 1987. Logistic regression and cross-tabular analyses revealed that social networks were important predictors of longevity for both samples. However, marital status and participation in formal organizations predicted longevity for the Americans, whereas contact with children emerged as the predictor variable for the Swedes. Specific functions of the different network patterns in the two countries are discussed.

Long life cycle products, commonly found in aviation, medical and critical infrastructure applications, are often fielded and supported for long periods of time (20 years or more). The manufacture and support of long life cycle products rely on the availability of suitable parts, which over long periods of time, leaves the parts susceptible to supply chain disruptions such as suppliers exiting the market, allocation issues, counterfeit part risks, and part obsolescence. Proactive mitigation strategies exist that can reduce the impact of supply chain disruptions. One solution to mitigating the supply chain risk is the strategic formulation of part sourcing strategies (optimally selecting one or more suppliers from which to purchase parts over the life of the part’s use within a product or organization). Strategic sourcing offers a way of avoiding the risk of part unavailability (and its associated penalties), but at the expense of qualification and support costs for multiple suppliers. An alternative disruption mitigation strategy is hoarding. Hoarding involves stocking enough parts in inventory to satisfy the forecasted part demand (for both manufacturing and maintenance requirements) of a fixed future time period. This excess inventory provides a buffer that reduces the effect of supply chain disruptions on the part total cost of ownership (TCO), but increases the total holding cost. This paper presents a method of performing tradeoff analyses and identifying the optimal combination of second sourcing and hoarding for a specific part and product scenario. A case study was performed to examine the effects of hoarding on both single and second sourced parts. The case study results show that hoarding can contribute to a decrease in the cumulative TCO and a decrease in its variance.

Rationale: Health and demographic surveillance sites (HDSSs) are important sources for health planning and policy in many low and middle income countries. Almost all HDSSs are in rural settings. The article aims to present the experiences and some concrete results for the first three years of operation of an urban HDSS in Hanoi, Vietnam, and discuss advantages and disadvantages of conducting health studies in HDSSs. Design, population and sample size: The DodaLab urban HDSS was established in 2007 in three communes at different economic levels in Dong Da district, Hanoi, Vietnam. Demographic, social and economic information about 10,000 households and their 37,000 persons was obtained through household interviews. Quarterly follow-up was initiated to provide information about vital events, birth, death and migration. A new household survey was undertaken in 2009. The existing rural HDSS FilaBavi, started in 1999, with 12,000 households and 52,000 persons, was used as the blueprint. Conclusions: It was possible to establish and run an urban HDSS with experiences from the rural site. The urban and rural contexts are different and demographically, economically and socially complex, but the use of HDSSs can facilitate research beyond very simplified models for comparisons. General statements about external validity of results from the HDSS cannot be made. This issue has to be considered specifically in every situation as an integral part of the research so that the results can be made useful outside the researched HDSS and in performing relevant comparisons.

Background The aim of this study was to describe and compare breastfeeding practices in rural and urban areas of Vietnam and to study associations with possibly influencing person and household factors. This type of study has not been conducted in Vietnam before. Methods Totally 2,690 children, born from 1st March 2008 to 30th June 2010 in one rural and one urban Health and Demographic Surveillance Site, were followed from birth to the age of 12 months. Information about demography, economy and education for persons and households was obtained from household surveys. Standard statistical methods including survival and regression analyses were used. Results Initiation of breastfeeding during the first hour of life was more frequent in the urban area compared to the rural (boys 40% vs. 35%, girls 49% vs. 40%). High birth weight and living in households with large number of assets significantly increased the probability for early initiation of breastfeeding. Exclusive breastfeeding at three months of age was more commonly reported in the rural than in the urban area (boys 58% vs. 46%, girls 65% vs. 53%). The duration of exclusive breastfeeding as well as of any breastfeeding was longer in the rural area than in the urban area (medians for boys 97 days vs. 81 days, for girls 102 days vs. 91 days). The percentages of children with exclusive breastfeeding lasting at least 6 months, as recommended by WHO, were low in both areas. The duration of exclusive breastfeeding was significantly shorter for mothers with three or more antenatal care visits or Caesarean section in both areas. High education level of mothers was associated with longer duration of exclusive breastfeeding in the rural area. No significant associations were found between duration of exclusive breastfeeding and mother’s age, household economy indicators or household size. Conclusion Intervention programs with the aim to promote breastfeeding are needed. Mothers should particularly be informed about the importance of starting breastfeeding early and to prolong exclusive breastfeeding. In order to reach the WHO recommendation of six months exclusive breastfeeding, we propose an extended maternity leave legislation to at least six months.

Between 1975 and 1980, 30 patients with type I corporeal gastric ulcer were randomly allocated to undergo selective proximal vagotomy with ulcer excision or partial gastrectomy with gastroduodenostomy. Sixteen patients underwent selective proximal vagotomy (1 was excluded from the follow-up since microscopic examination of the excised ulcer revealed an early gastric cancer) and 14 underwent partial gastrectomy. No significant differences in the clinical results were found 3 years after surgery. During a median follow-up of 10 years, ulcer recurred in 3 patients after selective proximal vagotomy and in 2 after partial gastrectomy. One patient in each group had recurrent ulcer without symptoms and received no treatment. Two selective proximal vagotomy patients and three partial gastrectomy patients had epigastric pain with or without ulcer. One patient with selective proximal vagotomy underwent a second operation because of epigastric pain and recurrent ulcer. Bowel habits remained unchanged in all but one patient in each group, and mild or moderate dumping was recorded for two patients in each group. Very good or good results (modified Visick scale) were recorded for 11 of 15 patients after selective proximal vagotomy and for 10 of 14 patients after partial gastrectomy. Except for one patient in each group who had moderate dumping, patients classified as Visick III or IV had no symptoms during treatment with antacids or H2-blockers, or had asymptomatic ulcers and needed no treatment. Selective proximal vagotomy reduced the median acid response to insulin hypoglycemia and to pentagastrin by 100% and 80%, respectively, for at least 3 to 5 years, and partial gastrectomy reduced the median acid response to pentagastrin by 97%. In our opinion, selective proximal vagotomy with ulcer excision is an alternative to partial gastrectomy for surgically treating type I gastric ulcer.

The effect of the selective serotonin-2 antagonist ritanserin was investigated in an open study of patients with schizophrenia. The patients were in an acute psychotic state considered to require neuroleptic medication. No neuroleptic drug was allowed during the study or during the last month preceeding the study. Oxazepam or nitrazepam were allowed for sedation or sleep inducement. Safety, tolerability, potential antipsychotic effect, and drug effects on monoamine metabolites in serum and CSF and prolactin in serum were evaluated. Central D2-dopamine receptor occupancy was determined by positron emission tomography. Ten male patients (mean age 32.4) fulfilling DSM-III-R criteria for schizophrenia were included in the study. Nine of these patients completed 4 weeks' treatment with ritanserin 10 mg b.i.d. The clinical effect was evaluated by means of CPRS and SANS and significant improvement was seen after 4 weeks' treatment both in positive and negative symptoms. Ritanserin was well tolerated and no extrapyramidal symptoms or akathisia were seen. Concentrations of monoamine metabolites and prolactin did not change during treatment. Ritanserin did not occupy D2-dopamine receptors. Thus, no indications of any D2-dopamine-antagonistic activity were obtained. All patients had expected ritanserin levels in plasma during the whole study. This first study of a selective serotonin-2 antagonist in the treatment of acute schizophrenic patients demonstrated significant clinical effects. However, the open design of the study does not allow us to conclude with any certainty that the patients' improvement was due to a specific blockade of serotonin-2 receptors or unspecific factors, although a direct D2-dopamine blockade could be ruled out.

– The purpose of the study was to evaluate the caries preventive effect and cost of an intensive application of Duraphat varnish, added to the regular preventive program for 11–15-yr-old children in a Swedish Dental Community Clinic. In 1987, the 134 11-yr-old children in Floda were divided into two groups, every second child to each. Children with fixed orthodontic appliances were excluded. The test group received three applications of Duraphat varnish during 1 week, once a year, by a dental nurse. The control group received one application at the annual check-up. Both groups were included in the regular preventive program at the clinic. The total time cost for the clinic was estimated and used to calculate the cost per hour for dentists and nurses. The caries increment and progression were estimated both by routine diagnosis and by a careful study of radiographs taken at the beginning and end of the study period. There was a smaller caries increment and progression in the lest group as compared to the control group. The difference was statistically significant for all aspects studied. The costs were about the same in both groups but more time was used in the test group. The administrative effort for the staff was considerable for the intensive Duraphat application.

Applying methods assuming independence when observations are positively correlated means that confidence intervals become too short and significance levels of statistical tests are less extreme. This paper discusses elements of life-table analysis based on the standard product-limit estimator and a modified Greenwood formula for its variance to be used for dependent observations. An application from oral surgery is given. Erroneously assuming independence in the analysis of a life table could have serious consequences. It is demonstrated in a simulation study that the confidence levels can be much too low. The proposed modification of the Greenwood formula for the variance of the estimated survival function most often results in confidence levels not too much below the required level. Using the upper bound for the variance will give conservative confidence intervals but also larger standard errors. Averaging individual group survival curves should only be considered for situations with large groups.

The properties of ester fluids and mineral oils differ in many cases in a qualitative way. This means that these liquids may look like very similar in some experiments while in others they behave very differently. These differences must be understood and taken into account in the design of ester filled transformers to avoid unexpected failures. Classic models such as the two-parameter Weibull statistics of breakdown voltage are in some respects too simple to properly catch the underlying physics. We discuss the importance of segregating initiation and propagation processes to properly interpret results of experiments with esters and mineral oil. In transformer design it is in some parts more important to avoid initiation while in others it is more important to stop propagating streamers. Furthermore, to obtain low probability statistics from high probability breakdown experiments, both average and spread of breakdown voltages are required. The difference in spread of initiation and propagation voltages is discussed. Esters and mineral oils behave in a qualitatively similar way regarding initiation while they differ substantially in the propagation process. In this paper we compare some different experiments in terms of initiation and propagation.

Background The worldwide increase in antibiotic resistant bacteria is of great concern. One of the main causes is antibiotic use which is likely to be high but is poorly described in India. The aim was to analyze and compare antibiotic prescribing for inpatients, in two private sector tertiary care hospitals; one Teaching and one Non-teaching, in Ujjain, India. Methods A cross-sectional study with manual data collection was carried out in 2008. Antibiotic prescribing was recorded for all inpatients throughout their hospital stay. Demographic profile of inpatients and prescribed antibiotics were compared. WHO Anatomical Therapeutic Chemical (ATC) classifications for antibiotics was used and Defined Daily Doses (DDD) were calculated per patient day. Results A total of 8385 inpatients were admitted during the study period. In the Teaching hospital (TH) 82% of 3004 and in the Non-teaching hospital (NTH) 79% of 5381 patients were prescribed antibiotics. The most commonly prescribed antibiotic groups were; fluoroquinolones and aminoglycosides in the TH and, 3rd generation cephalosporins and combination of antibiotics in the NTH. Of the prescriptions, 51% in the TH and 87% in the NTH (p Conclusions The results from both hospitals show extensive antibiotic prescribing. High use of combinations of antibiotics in the NTH might indicate pressure from pharmaceutical companies. There is a need to formulate and implement; based on local prescribing and resistance data; contextually appropriate antibiotic prescribing guidelines and a local antibiotic stewardship program.

We prospectively explored prescribing patterns, with an emphasis on seasonal and hospital differences, for adults and children under 5 y of age reporting to the outpatient clinics of 2 hospitals (1 teaching hospital and 1 non-teaching hospital) in Ujjain, India.The study was done over 15 months from November 2007 to February 2009, covering 4 seasons (2 winters, 1 summer and 1 rainy season). The treating consultant completed diagnosis prescribing forms for first consultations with outpatients for selected infectious disease complaints (n = 5623). Antibiotics were coded according to the World Health Organization, Anatomic Therapeutic Chemical classification with defined daily dose (ATC/ DDD). All DDD were calculated per 1000 patients per diagnosis (DDD/TPD).The study covered 80% of all first consultations. Antibiotics were prescribed to 66.3% (3732/5623) of patients. Indications of antibiotic prescribing were respiratory tract infections (42.9%), vaginal discharge (24.2%), urinary tract infections (11.5%), skin and soft tissue infections (10.5%), diarrhoea (9.4%), dysentery (1.2%) and prophylaxis (0.6%). The most commonly prescribed antibiotic group was the quinolones. The antibiotic prescribing rate differed by diagnosis, age group, education, hospital and season, and was 11.3 percentage units less in the teaching hospital compared to the non-teaching hospital (p0.001). The study showed higher prescribing of broad-spectrum antibiotics in the non-teaching hospital, with a peak-prescribing rate (75%) during the summer, while the teaching hospital had a peak prescribing rate (70%) during the rainy season.The peak prescribing rates during the summer and rainy season probably reflect the higher diagnostic and follow-up uncertainties faced by the treating physicians. The method used in this study could be used in busy outpatient settings.

Background There is increasing evidence that community acquired S. aureus infections are spreading among healthy children. Nasal colonization with S. aureus plays pivotal role in the increasing prevalence of resistant community acquired S. aureus infections worldwide. A regular surveillance system is important in ensuring quality of patient care. The aim of the study was to assess the prevalence of and the factors associated with nasal carriage of S. aureus and its antibiotic sensitivity pattern among healthy children in Ujjain, India. Methods A prospective study was done in paediatric outpatient clinics of R.D. Gardi medical college Ujjain, India. Healthy children from 1 month to 59 months of age were included. Information on previously known risk factors for nasal colonization was collected using a pre-tested questionnaire. Swabs from anterior nares were collected and transported in Amies transport media with charcoal and cultured on 5% sheep blood agar. Antibiotic sensitivity tests were performed using Kirby Bauer's disc diffusion method according to performance standards of Clinical and Laboratory Standard Institute guidelines. Results Of the 1,562 children from 1-month up-to five years of age included in the study 98 children tested positive for nasal carriage of S. aureus. The prevalence of nasal carriage of S. aureus was 6.3% (95% CI 5.1-7.5) out of which 16.3% (95% CI 8.9-23.8) were methicillin-resistant S. aureus (MRSA). The factors associated with nasal carriage were "child attending preschool" (OR 4.26, 95% CI 2.25-8.03; P = 0.007) or "school" (OR 3.02, 95% CI 1.27-7.18; P < 0.001) and "family size more than 10 members" (OR 2.76 95% CI 1.06-7.15; P = 0.03). The sensitivity pattern of isolated S. aureus showed resistance to commonly used oral antibiotics while resistance to glycopeptides was not noted. Conclusions We found a relatively low rate of nasal carriage of S. aureus in children below five years when compared to children of older age groups in India. Yet, prevalence of MRSA was relatively high.

Few prospective studies regarding antibiotic use for mild acute respiratory infections (ARI) have been conducted in community settings. This paper aimed to assess knowledge of children's caregivers and actual antibiotic use for children under five and to identify factors associated with antibiotic treatment for mild ARIs. Caregivers in 828 households in Bavi, Vietnam, were interviewed using a structured questionnaire assessing both knowledge and practice. Subsequently, 823 children were followed for 28 days to collect information regarding symptoms and drug use. For management of ARIs, only 13% of caregivers demonstrated correct overall knowledge in accordance with standard guidelines. The symptoms of the most recent illness were consistent with mild ARI in 79% of cases, and antibiotics were used in 71% of these. During the 28-day period, 62% of children had been given antibiotics and 63% of antibiotic courses were used for mild ARIs. One-half of the mild ARI episodes and 63% of the children with mild ARIs were treated with antibiotics. Most of the unnecessary antibiotic treatment was recommended by healthcare providers (82%). Most of the children had been administered antibiotics for common colds, although most caregivers believed that antibiotics were not required. Antibiotics were unnecessarily recommended at health facilities in the area.

Background Streptococcus pneumoniae is the most significant bacterial cause of community-acquired pneumonia among children under five years worldwide. Updated resistance information of S. pneumoniae among children is essential to adjust the recommendations for empirical treatment of community-acquired pneumonia, which will have immense implications for local and global health. This study investigated the prevalence of antibiotic resistance in isolated strains of S. pneumoniae and relationship with antibiotic use and demographic factors of children under five in rural Vietnam in 2007. Methods In Bavi district, 847 children 6 to 60 months were selected from 847 households. The main child-caregivers in the households were interviewed weekly using structured questionnaires to collect information of daily illness symptoms and drug use for the selected child over a four-week period (from March through June 2007). In the 3rd week, the children were invited for a clinical examination and to collect nasopharyngeal samples for S. pneumoniae identification. Etest and disk diffusion were used to test antibiotic susceptibility. Results Of 818 participating children, 258 (32%) had ongoing respiratory infections, 421 (52%) carried S. pneumoniae, and 477 (58%) had used antibiotics within the previous three weeks. Of the 421 isolates, 95% were resistant to at least one antibiotic (401/421). Resistance to co-trimoxazole, tetracycline, phenoxymethylpenicillin, erythromycin and ciprofloxacin was 78%, 75%, 75%, 70% and 28%, respectively. Low resistance was noted for amoxicillin (4%), benzylpenicillin (4%), and cefotaxime (2%). The intermediate resistance to amoxicillin was 32%. Multidrug-resistance was seen in 60%. The most common pattern was co-resistance to co-trimoxazole, tetracycline and erythromycin. The proportion of children carrying resistant bacteria was higher among the children who had used antibiotics in the previous three weeks. Conclusions Resistance to commonly used antibiotics and multidrug-resistance of S. pneumoniae in the area is remarkably high. High-dose amoxicillin is the only investigated oral antibiotic that can possibly be used for treatment of community-acquired pneumococcal infections. Strategies to promote appropriate prescribing and dispensing of effective antibiotics should be immediately implemented for the benefit of local and global health.

Between 1973 and 1981, 161 patients with prepyloric, pyloric, or duodenal ulcers were randomly allocated to selective vagotomy with pyloroplasty, selective proximal vagotomy with pyloroplasty, or selective proximal vagotomy alone. No significant differences in clinical results were found 3 years after surgery by Emas and Fernstrom (Am J Surg 1985; 149: 236–42). There was one postoperative death, and one patient lost to follow-up. Of 159 patients, 52 underwent selective vagotomy with pyloroplasty, 55 selective proximal vagotomy with pyloroplasty, and 52 selective proximal vagotomy alone. Fifteen patients did not undergo endoscopy, but they had no epigastric complaints. From 1 to 16 years after surgery, recurrent ulcer was detected in 13%, 18%, and 23%, respectively, after selective vagotomy with pyloroplasty, selective proximal vagotomy with pyloroplasty, or selective proximal vagotomy with pyloroplasty, or selective proximal vagotomy without pyloroplasty. Twenty-eight percent of the patients with recurrent ulcer had no symptoms and received no treatment. Sixteen patients died within 8 years after surgery of causes unrelated to the ulcer disease. At their final examination, 14 of the 16 patients had Visick I or II (modified Visick scale) results, and the disease that caused their deaths obscured evaluation in 2 patients. The remaining 143 patients were followed up for 8 to 16 years (average: 12 years). Epigastric pain with or without ulcer was recorded more often (significant) after selective proximal vagotomy alone (40%) than after selective vagotomy with pyloroplasty (17%) or selective proximal vagotomy with pyloroplasty (14%). Bowel habits were unchanged in 96% of patients who underwent selective vagotomy with pyloroplasty or selective proximal vagotomy with pyloroplasty and 100% of patients who had selective proximal vagotomy alone. Mild dumping tended to be more common after vagotomy with pyloroplasty but was a minor nuisance in only a few patients. Very good or good results (Visick I or II) were recorded in 75% of the patients after selective vagotomy with pyloroplasty or selective proximal vagotomy with pyloroplasty and in 54% after selective proximal vagotomy alone (significant difference). Seventeen patients underwent reoperation with antrectomy and gastrojejunostomy Roux-en-Y (13 patients) or gastroduodenostomy (4 patients) with no mortality. The results of the reoperations were graded as Visick I or II results in all but one patient. The final grading, including the reoperations, were Visick I or II in 85% of patients after selective vagotomy with pyloroplasty and selective proximal vagotomy with pyloroplasty and in 55% after selective proximal vagotomy alone (significant difference). However, most of the remaining patients with Visick III or IV results needed no treatment (asymptomatic ulcer) or had no symptoms during treatment with antacids or ranitidine. From the overall results after 8 to 16 years of follow-up, we conclude that selective vagotomy with pyloroplasty and selective proximal vagotomy with pyloroplasty are superior to selective proximal vagotomy alone for the treatment of prepyloric-pyloric and duodenal ulcers. Ulcers recurring after selective vagotomy or selective proximal vagotomy have a benign course and respond well to H 2 -receptor antagonist treatment.

Drug information is a technology which is rarely evaluated. Practical and ethical considerations limit the use of a classical experimental method (a randomized controlled trial) in studying the effect of drug information in primary care. An alternative approach, randomization by group, is preferable for several reasons: it avoids contamination of the control group; the effect of information can be evaluated in the natural working environment; and the impact of information is increased via diffusion. This article describes the selection of a control group, the Hawthorne effect and 'blindness' in information experiments. Sample size tables and power calculations are presented when randomization by group is used. The study power is influenced by the number of health centres and the variance between them. The number of doctors per health centre plays a less important role, and the number of patients is relatively unimportant. There is also a need to use qualitative methods to prepare information and to understand factors influencing change of behaviour among prescribers.

To estimate changes in resource usage, hospitalization rates, and costs in actual practice in Sweden for schizophrenia patients after switching to long-acting injectable risperidone (Risperdal Consta). A retrospective chart review within-subject mirror-image study using actual practice chart review data was used to compare annual hospital bed-days and annual hospital episodes for adults with schizophrenia or schizoaffective disorder before and after switching to Risperdal Consta in the period 1 January 2003 to 30 June 2005. Secondary endpoints included mean length of hospital stay per episode, the cost of hospitalization, and the cost of antipsychotic treatment. The base case analytical approach allocated all hospital episodes overlapping the switch date entirely to pre-switch treatment. In order to investigate the impact of inpatient care ongoing at the time of the switch, the change in bed-days per year was also estimated using an alternative analytical approach inspired by economic modelling. One-hundred sixty-four patients were enrolled at nine geographically diverse sites. The switch to Risperdal Consta was associated with a significant reduction in mean annual days in hospital from 39 to 21 days per year (45%), which was linked to a significant reduction in the number of hospitalizations from 0.86 to 0.63 per year (27%). The alternative “modelling-inspired” estimate of the reduction in mean annual days in hospital was also 27%. A naturalistic mirror-image study found that switching to long-acting injectable risperidone led to sizeable reductions in inpatient resource use. These results coincide with the findings of other international studies.

Ericsson has successfully transferred to lead-free solder for its high volume telecom network infrastructure products. By implementing measures for lead-free soldering in all stages of the product development process, from design and component selection to the production process, reliable products are ensured. As the high volume consumer electronic products are driving the components market towards lead-free soldering, the availability of components and materials are better for lead-free than for leaded soldering. Components can be obtained from approved sources, which is the basis for quality assurance and reduces the potential problems with counterfeit components. Lead-free conversion has also reduced the number of Last Time Buy (LTB) cases affecting Ericsson.

OBJECTIVE To assess knowledge, practical competence and reported practices among health-care providers about antibiotics to treat acute respiratory infections in children under five in rural Vietnam. METHOD Health-care providers prescribing or dispensing western drugs for children self-completed a structured questionnaire. Recommendations concerning antibiotic use from WHO and national guidelines were used to assess the appropriateness of reported treatment of acute respiratory infections. RESULTS Ninety-six per cent of 409 eligible health care providers participated. Only 27% demonstrated correct knowledge regarding the consequences of resistance. Seventy-nine per cent would use antibiotics for common colds with fever, and 21% in cases with no fever. Nineteen per cent had overall knowledge compliant with recommended guidelines. Stated antibiotic use in written scenarios for common colds (81%) was not significantly different from that for non-referral cases of pneumonia (87%). The proportion of antibiotic use in the common cold scenario was significantly lower among health-care providers who had the correct overall knowledge. According to reported symptoms from the most recent encounter with a sick child, the diseases seen were 62% mild acute respiratory infections, 19% severe, and 19% non-respiratory infections. Among those, antibiotics, most commonly beta-lactams, were used in 90%, 87% and 78% of cases, respectively. CONCLUSIONS Antibiotics are often prescribed or dispensed to treat common colds. Interventions to change prescribing and dispensing practices should be developed and implemented in collaboration with local and national paediatricians. Continuous training of health-care providers, particularly drug sellers, is important.

Background: Ambulatory health care services are a major contributor to the large and inequitable health financing burdens (largely out-of-pocket) faced by households in India. The private sector has a virtual monopoly over ambulatory curative services in rural and urban India. Despite this, there is little knowledge about who these providers are, their numbers, distribution, and activities. Aim: This study describes the numbers, gender, distribution, and characteristics of private individual ambulatory care providers in Madhya Pradesh (60.4 million people), one of India’s largest provinces. It discusses the suitability of this provider mix to deal with maternal and child health, a major health priority in the province. Method: A survey enlisting all health care providers was conducted in the 52,117 villages and 394 towns of the province. Results: There were 14,046 private qualified physicians (12.5% women), 57,684 qualified paramedics (3.4% women), and 89,090 unqualified providers (10% women) providing ambulatory services in individual setups. In addition, 55,393 traditional birth attendants provided home-based intranatal care. The macro organization of these providers in this setting is presented. Given the high levels of maternal and child mortality in the province, excessive reliance is placed on less than competent providers as these present lower access barriers. Conclusion: Given the public health priorities in this province (maternal and child health), the provider mix is not optimally suited to the populations’ needs. There is a lack of competent qualified care required to deal with the major causes of morbidity and mortality, particularly in rural areas. Access to qualified women providers is low. The lack of a cadre of qualified midwives possibly contributes to some of the high maternal mortality observed in this province.