Socio-political aspects of the implantation of the Transplant Center of Piauí

A qualitative study aiming at understanding the socio-political aspects that mediate the implantation of the Transplant Center of Piauí, identify the social topics involved in this implantation and analyze the participation of the organized civil society. Ten people directly related to the implantation of the transplant center were involved in the study, selected through the "snowball" technique. A loosely structured interview, taped, transcribed and submitted for thematic analysis was used. It was concluded that the implantation of the transplant center in Piauí was the fruit of a complex series of negotiations and interests among the State and organized civil society, as there was no political project for action in the area of transplants. This distancing from the responsibility of the public sector characterizes the importance that was given to this implantation.     

Can the science of communication inform the art of the medical humanities?

CONTEXT There is increasing interest in establishing the medical humanities as core integrated provision in undergraduate medicine curricula, but sceptics point to the lack of evidence for their impact upon patient care. Further, the medical humanities culture has often failed to provide a convincing theoretical rationale for the inclusion of the arts and humanities in medical education. DISCUSSION Poor communication with colleagues and patients is the main factor in creating the conditions for medical error; this is grounded in a historically determined refusal of democracy within medical work. The medical humanities may play a critical role in educating for democracy in medical culture generally, and in improving communication in medical students specifically, as both demand high levels of empathy. Studies in the science of communication can provide a valuable evidence base justifying the inclusion of the medical humanities in the core curriculum. A case is made for the potential of the medical humanities – as a form of ‘adult play’– to educate for collaboration and tolerance of ambiguity or uncertainty, providing a key element of the longer‐term democratising force necessary to change medical culture and promote safer practice. CONCLUSION The arts and humanities can provide important contextual media through which the lessons learned from the science of communication in medicine can be translated and promoted as forms of medical education.     

Estimation of the prevalence of epilepsy in the Benin region of Zinvié using the capture-recapture method

BACKGROUND: The prevalence of epilepsy was estimated in two villages of 3134 inhabitants, in Benin, in April and May 1997 using the capture-recapture method. METHODS: Information was obtained from (i) a door-to-door cross-sectional study, (ii) a non-medical source consisting of key informants (traditional practitioners, teachers, village leaders, and religious representatives) and (iii) a medical source through evaluation of medical records in health centres. In all the three situations, the diagnosis of epilepsy was confirmed by a neurologist. RESULTS: The door-to-door survey found 50 epileptics, i.e. a prevalence of 15.9 per 1000. The non-medical source found 26 patients. The medical source found only four patients. In total, 66 epileptics were found by combining the three sources, giving a prevalence of 21.1 per 1000. After application of the capture-recapture method, the estimated number of cases from the door-to-door survey and non-medical source was 105, and 110 cases when the medical source was considered as well. The respective prevalences were 33.5 per 1000, and 35.1 per 1000. CONCLUSIONS: The door-to-door survey has been usefully improved by using key informants. The epilepsy prevalence estimate found by capture-recapture is clearly higher than that found by traditional cross-sectional methods, and could better depict the frequency of epilepsy in Africa.     

Study of the protein profile of the Adélé tribe of Togo

Plasma proteins provide precise information about the physiological status of an individual. In this study, we compared the plasma protein profiles of 168 individuals from the Adélé ethnic group, from an isolated rural area of Togo, with those of 159 individuals from an urban population from the capital, Lomé. The Adélé villages are located in the Atakora mountains. The subjects were volunteers, all apparently healthy and aged between 18 and 65 years. We separated serum proteins by electrophoresis and identified proteins specific for nutritional, inflammatory and immune status. The Adélé significantly higher total serum protein concentrations than the urban individuals, with higher concentrations of a1 globulins (2.35 +/- 0.57 g/L versus 1.94 +/- 0.52 g/L) and g globulins (22.19 +/- 5.67 g/L versus 16.98 +/- 5.23 g/L) and lower concentrations of b globulins (6.83 +/- 1.56 g/L versus 7.34 +/- 1. 52 g/L). The Adélé also had lower plasma concentrations of albumin (41.91 +/- 5.74 g/L versus 44.56 +/- 6.32 g/L), tranferrin (2.5 +/- 0.52 g/L versus 3.03 +/- 0.6 g/L), haptoglobin (0.57 +/- 0.59 g/L versus 1.32 +/- 0.89 g/L) and IgA (2.3 +/- 0.89 g/L versus 2.88 +/- 1.12 g/L) and higher plasma concentrations of orosomucoid (0.85 +/- 0.26 g/L versus 0.69 +/- 0.27 g/L); IgG (25.3 +/- 7.11 g/L versus 21. 79 +/- 6.5 g/L) and IgM (4.25 +/- 2.83 g/L versus 2.25 +/- 1.0 g/L). The data obtained for the Adélé and urban populations were similar to those obtained for European populations except for IgM (higher in the Adélé than in the urban and European populations), IgG and CRP (higher for the Adélé and urban populations than for European populations). Nutritional status, as estimated by albumin and transferrin concentrations, was higher in the urban population of Lomé than in the Adélé population but the Adélé population suffered no malnutrition problems. These results are consistent with those of a previous study, using apo A-I concentrations as an index of nutritional status. Apo A-I has also been shown to be a reliable indicator of nutritional status, as prealbumin concentration alone is sufficient for the early diagnosis of protein malnutrition. The very high concentrations of plasma CRP obtained indicate the presence of an inflammatory syndrome in the Adélé and urban populations, as this protein is the first acute phase protein to be detected. However, the orosomucoid concentrations obtain-ed provide no evidence of significant inflammation. The high affinity of haptoglobin (Hp) for hemoglobin (Hb) results in the formation of soluble Hp-Hb complexes, reducing the value of Hp as a marker of the acute phase of inflammation. The frequency os sickle cell disease was higher in the Adélé population than in the urban population (10-25% versus 2-6%). Hemoglobinopathies are correlated with haptoglobin concentration and thus plasma haptoglobin concentration was lower in the Adélé population than in the urban population. The plasma concentrations of a1-antitrypsin in this study were similar to those reported for Europeans. The plasma concentration of protease inhibitors, such as a1-antitrypsin, increased as protease levels increased. These data confirm that the Adélé and urban populations suffer no disease due to high levels of protease release into the bloodstream. They also show that a1-antitrypsin is of some value as an acute phase marker protein. The acute nature of the inflammatory syndrome (as assessed by CRP concentration) in the Adélé and urban populations was confirmed by the hyperglobulinemia (high levels of production of IgM and IgG antibodies) observed in these populations. The Adélé and Lomé urban populations live in a tropical environment in which they are continuously in contact with infectious agents. This results in repeated stimulation of the immune system in both these populations. This study of plasma proteins in the Adélé provides insight into the physiological conditions of this ethnic group, w     

South-East Asian ovalocytosis among the population of the Highlands of Madagascar: a vestigé of the island's settlement

In the Madagascar Highlands, 0.76% of children from 168 random primary schools, and 19 of 150 families from 3 villages, had oval-shaped erythrocytes. Most harboured the deletion in the band 3 gene characteristic of South-East Asian ovalocytosis. This genetic trait supports the Indonesian origin of the Madagascar settlement.     

A re-evaluation of the modern psychiatric hospital from the standpoint of the Kyoto school’s critique of modernity

Medicine, Health Care and Philosophy - Michel Foucault defines the modern psychiatric hospital as an institution of power that excludes and disciplines those who are deemed immoral, perverse, or...     

Wading for food the driving force of the evolution of bipedalism?

Evidence is accumulating that suggests that the large human brain is most likely to have evolved in littoral and estuarine habitats rich in naturally occurring essential fatty acids. This paper adds further weight to this view, suggesting that another key human trait, our bipedality might also be best explained as an adaptation to a water-side niche. Evidence is provided here that extant apes, although preferring to keep dry, go into water when driven to do so by hunger. The anecdotal evidence has suggested that they tend to do this bipedally. Here, a new empirical study of captive bonobos found them to exhibit 2% or less bipedality on the ground or in trees but over 90% when wading in water to collect food. The skeletal morphology of AL 288-1 ("Lucy") is shown to indicate a strong ability to abduct and adduct the femur. These traits, together with a remarkably platypelloid pelvis, have not yet been adequately explained by terrestrial or arboreal models for early bipedalism but are consistent with those expected in an ape that adopted a specialist side-to-side 'ice-skating' or sideways wading mode. It is argued that this explanation of A. afarensis locomotor morphology is more parsimonious than others which have plainly failed to produce a consensus. Microwear evidence of Australopithecus dentition is also presented as evidence that the drive for such a wading form of locomotion might well have been waterside foods. This model obtains further support from the paleo-habitats of the earliest known bipeds, which are consistent with the hypothesis that wading contributed to the adaptive pressure towards bipedality.