A price to pay: The impact of user charges in ashanti-akim district,Ghana

In present constrained economic circumstances, many governments have introduced or increased user charges for health services. This has been advocated by the World Bank, justified by reference to the raising of revenue, efficiency and, controversially, even the promotion of equity. This paper examines the impact of user charges on utilisation in the Ashanti-Akim district of Ghana since the introduction of charges in 1985. In many ways, user charges have been a success: in recovering fees and maintaining urban utilisation. However some advantages have not materialised because the health infrastructure has not changed adequately. More importantly, equity and affordability have been problematical. For some of the population, services are no longer affordable.     

Agonist and antagonist interactions with D1 dopamine receptors: agonist-induced masking of D1 receptors depends on intrinsic activity.

The effects of agonist and antagonist compounds on the equilibrium binding of the D1 antagonist ligand [3H]SCH 23390 were examined in membranes from the striatum of the rat. The antagonist SK&F 83566 interacted with D1 receptors in the manner of a competitive antagonist, causing a decrease in the affinity of the binding of [3H]SCH 23390, without altering the maximum number of binding sites (Bmax). The interaction of agonist compounds with the D1 receptor appeared to be more complex. The drug SK&F 75670, a weak partial agonist, also acted competitively at D1 sites. However, agonists with moderate (SK&F 38393, CY 208-243) or full (dopamine) intrinsic activity to stimulate adenylate cyclase, interacted with D1 binding sites in a mixed competitive/non-competitive manner, causing both a decrease in ligand affinity and a decrease in Bmax. The benzazepine analogue, which also has full agonist activity, SK&F 82958, only caused a reduction in Bmax. Furthermore, there was a positive relationship between the intrinsic activity of agonists and the magnitude of the reductions in Bmax which they induced. In the presence of the GTP analogue, Gpp(NH)p, CY 208-243 no longer caused an apparent reduction in the number of receptors. These data suggests that the apparent loss of D1 receptors, induced by agonists, may result from an interaction with a guanine-nucleotide sensitive, high affinity agonist binding site and that the degree of interaction with this site depends on the intrinsic D1 activity of the agonist.     

Assessment of bioequivalence after subcutaneous and intramuscular administration of urinary gonadotrophins

The objective was to demonstrate bioequivalence between s.c. and i.m. administration of Humegon (FSH/LH ratio 1:1) and Normegon (FSH/LH ratio 3:1). In two randomized, single-centre, cross-over studies, 18 healthy volunteers on each formulation were assigned to one of the two administration sequences. Subjects were given single doses of one of the above gonadotrophins after endogenous gonadotrophin production had first been suppressed using high-dose oral contraceptive. Subsequently, rate (Cmax, tmax) and extent (AUC) of absorption of follicle stimulating hormone (FSH) and luteinizing hormone (LH) were determined for 14 days. For Cmax and AUC, analysis of variance (ANOVA) was performed on log-transformed data and for tmax ANOVA was performed on ranks. Intramuscular and s.c. injections of Humegon were bioequivalent with respect to the main pharmacokinetic parameters, being AUC and Cmax of FSH absorption. Intramuscular and s.c. injections of Normegon were bioequivalent with respect to the AUC of FSH and not bioequivalent with respect to the Cmax of FSH. For tmax of FSH as well as for most LH variables of both preparations, bioequivalence could not be proven due to the high intra- and interindividual variability and/or concentrations being close to the detection limit. Thus, the main pharmacokinetic FSH variables after i.m. and s.c. administration of Humegon and Normegon were bioequivalent.      

Evidence for association and epistasis at the DAOA/G30 and D-amino acid oxidase loci in an Irish schizophrenia sample.

The D-amino acid oxidase (DAO) signaling pathway has been implicated in schizophrenia pathogenesis. This may be mediated through modulation of NMDA function by DAO, which is in turn activated by DAO activator (DAOA, formerly G72). Chumakov et al. (2002); PNAS 99: 13675-13680, identifying the novel schizophrenia susceptibility gene DAOA/G30 and a number of independent studies have since reported evidence of association between the DAOA and DAO genes and schizophrenia. However, at least two studies have failed to replicate the epistatic interaction between these loci described in the original report and there have been differences in the associated alleles/haplotypes reported at each locus. In this study, we performed association and epistasis analyses of the DAOA/G30 and DAO loci in a sample of 373 cases with DSM-IV schizophrenia/schizoaffective disorder and 812 controls from the Republic of Ireland. Corrected for the number of tests performed, we found evidence for association between markers at both genes and schizophrenia: DAOA/G30 (P = 0.005, OR = 1.34 (1.09, 1.65)) and DAO (P = 0.003, OR = 1.43 (1.12, 1.84). The data suggest that evidence for association at DAO (marker rs2111902) is more consistent than previously realized, particularly in Caucasian schizophrenia populations. We identified evidence for epistatic interaction between the associated SNPs at DAOA and DAO genes in contributing to schizophrenia risk (OR = 9.3 (1.4, 60.5). Based on these data, more systematic investigation of genes involved in DAO signaling is required.     

Rotational behaviour and cGMP responses following manipulation of nigral mechanisms with chlordiazepoxide

Summary Unilateral stereotaxic injections of 1 g of the soluble benzodiazepine chlordiazepoxide hydrochloride into the predominantly GABA-containing zona reticulata of the substantia nigra of amphetamine-pretreated rats induced rotational behaviour similar to that seen following unilateral elevation of nigral GABA levels and amphetamine treatment; this effect was not seen following injections into the vicinity of the predominantly dopamine-containing zona compacta. Chlordiazepoxide-induced rotations were abolished by the GABA-antagonist picrotoxin. Both chlordiazepoxide and GABA depressed production of cyclic 3,5-guanosine monophosphate in samples of nigral tissue in vitro as estimated by radioimmunoassay. It is concluded that chlordiazepoxide may enhance GABA transmission within the substantia nigra, by some as yet unidentified mechanism, to create asymmetric activity in GABA-modulated neurones and hence induce rotation.