Can women's autonomy impede male involvement in pregnancy health in Katmandu, Nepal?

Women's empowerment programs focus primarily on increasing the decision-making power of women, while male involvement/couple-friendly programs emphasize communication and negotiation within couples in making decisions. In-depth-interviews and focus group discussions were conducted to investigate patterns of household decision-making and the context of male involvement behaviors in Katmandu, Nepal. A questionnaire focusing on household decision-making and husbands' roles during pregnancy was administered to 592 pregnant women receiving antenatal services at a large maternity hospital. Multivariate regression techniques were used to compare male involvement behaviors across varying levels of women's autonomy, represented by different decision-making patterns. Higher women's autonomy, as measured by her sole final decision-making power, was associated with significantly lower male involvement in pregnancy health. After adjustment for other covariates, each additional decision in which a woman had final say was associated with a significantly lower likelihood of her husband accompanying her to antenatal care (OR=0.70, p<0.01). Conversely, joint decision-making between the husband and wife was associated with significantly higher levels of male involvement in pregnancy health. For each additional decision made jointly with husbands, women were more likely to discuss health with their husbands (OR=1.47, p<0.001), to make birth preparations (OR=1.19, p<0.05), and to experience a high level of male involvement (OR=1.29, p<0.05). The positive associations between joint decision-making and male involvement imply that couple communication and shared negotiation strategies can improve health practices. These results indicate that programs intended to increase women's empowerment and/or women's health must consider the dynamics and ramifications of including or excluding males in their efforts. Involving husbands and encouraging couples' joint decision-making in reproductive and family health may provide an important strategy in achieving both women's empowerment and women's health goals.     

In vivo biodistribution and pharmacokinetics of 18F-labelled Spiegelmers: a new class of oligonucleotidic radiopharmaceuticals

Purpose Single-stranded mirror-image oligonucleotides (Spiegelmers) are highly resistant to nuclease degradation and are capable of tightly and specifically binding to protein targets. Here we explored the potential of Spiegelmers as in vivo imaging probes for positron emission tomography (PET).Methods We investigated the biodistribution and pharmacokinetics of [¹⁸F]-l-DNA and [¹⁸F]-l-RNA Spiegelmers by dynamic quantitative whole-body PET imaging after intravenous administration in non-human primates. Their metabolic profile was explored in primates and rats, and ex vivo autoradiography of [¹²⁵I]-l-RNA was performed in rat kidneys, the major organ for Spiegelmer uptake.Results Both [¹⁸F]-l-DNA and [¹⁸F]-l-RNA Spiegelmers were metabolically stable in plasma during 2 h after injection. No evidence of non-specific binding was found with either type of Spiegelmer in any tissue.Conclusion The biodistribution and metabolic profiles of [¹⁸F]-l-DNA and [¹⁸F]-l-RNA Spiegelmers highlight their potential as radiotracers for in vivo imaging applications.     

Respiratory reflex responses of the larynx differ between sevoflurane and propofol in pediatric patients

BACKGROUND: The effects of anesthetics on airway protective reflexes have not been extensively characterized in children. The aim of this study was to compare the laryngeal reflex responses in children anesthetized with either sevoflurane or propofol under two levels of hypnosis using the Bispectral Index score (BIS). The authors hypothesized that the incidence of apnea with laryngospasm evoked by laryngeal stimulation would not differ between sevoflurane and propofol when used in equipotent doses and that laryngeal responsiveness would be diminished with increased levels of hypnosis. METHODS: Seventy children, aged 2-6 yr, scheduled to undergo elective surgery were randomly allocated to undergo propofol or sevoflurane anesthesia while breathing spontaneously through a laryngeal mask airway. Anesthesia was titrated to achieve the assigned level of hypnosis (BIS 40 +/- 5 or BIS 60 +/- 5) in random order. Laryngeal and respiratory responses were elicited by spraying distilled water on the laryngeal mucosa, and a blinded reviewer assessed evoked responses. RESULTS: Apnea with laryngospasm occurred more often during anesthesia with sevoflurane compared with propofol independent of the level of hypnosis: episodes lasting longer than 5 s, 34% versus 19% at BIS 40 and 34% versus 16% at BIS 60; episodes lasting longer than 10 s, 26% versus 10% at BIS 40 and 26% versus 6% at BIS 60 (group differences P < 0.04 and P < 0.01, respectively). In contrast, cough and expiration reflex occurred significantly more frequently in children anesthetized with propofol. CONCLUSION: Laryngeal and respiratory reflex responses in children aged 2-6 yr were different between sevoflurane and propofol independent of the levels of hypnosis examined in this study.     

Complications and comorbidities of type 2 diabetes

A number of children and adolescents are at risk for complications and comorbidities of type 2 diabetes, prediabetes, or metabolic syndrome. These complications and comorbidities are likely to present significant personal burdens and societal costs. The pediatrician should be aware of screening and interventions to lessen the effect of these risks on their patients. Societal-wide lifestyle changes are needed desperately to reduce the prevalence of these largely preventable diseases.     

Mycophenolate mofetil suspension in pediatric renal transplantation: three-year data from the tricontinental trial

Mycophenolate mofetil (MMF) is widely used to prevent acute rejection in adult solid organ transplant recipients, but data in children and adolescents are scarce. This prospective, multicenter, open-labeled, single-arm study investigated the efficacy and safety of an MMF-based immunosuppressive regimen in 100 pediatric renal transplant recipients over a 3-yr period of time. Three age groups were formed (<6 yr, n = 33; 6 to <12 yr, n = 34; 12-18 yr, n = 33). Basic immunosuppression consisted of MMF (600 mg/m(2) b.i.d), cyclosporin A microemulsion and corticosteroids. Seventy-three percent of patients were given anti-lymphocyte antibody induction therapy, of whom 74% received anti-thymocyte globulin. Patient and graft survival 3 yr after transplantation amounted to 98 and 95%, respectively. Twenty-five percent of all patients suffered a biopsy-proven acute rejection episode in the first 6 month post-transplant. Children undergoing induction therapy exhibited a numerically lower rejection rate (21 vs. 37%, p = 0.11). Three years after transplantation, the acute rejection rate added up to 30% (26% with induction therapy vs. 41% without induction therapy, p = 0.21). The number of patients with acute rejection was lowest in the youngest age group (18%), in comparison with 39% in the 6 to <12 yr and 33% in the 12-18 yr age group, respectively. For the entire patient population, the rate of patients who withdrew prematurely because of adverse events was low (12%). The present study shows that MMF therapy in pediatric renal transplant recipients leads to an excellent patient and graft survival 3 yr post-transplant with an acceptable safety profile.     

Implicit theories--the problems of thought economy

Based upon the presentation of the concept of naive implicit theories the article relates experience and action-guiding knowledge in critical nursing situations. Nineteen experienced and inexperienced nurses had to deal with two simulated nursing situations. Thereafter their implicit knowledge was explicated. Separate analyses for experienced and inexperienced persons regarding the adequacy of this knowledge and naive theories were performed. The results show for example, that in both groups naive theories can be found which relate especially to the perception of the patient. They led to inadequate action even though adequate knowledge was also represented. Finally, it is discussed how such (often not consciously used) naive theories can be changed in practice and which processes play a role in this change.     

Diagnostic value of galectin-3 as a marker for malignancy in follicular patterned thyroid lesions

BACKGROUND: The determination of malignancy in follicular patterned thyroid lesions is based on postoperative histologic findings. Therefore, affected patients are referred for surgery, although only 20% will have a final diagnosis of malignancy. The aim of this study was to investigate the potential of galectin-3 as a marker of malignancy in these lesions. METHODS: Fifty-four tissue specimens of follicular patterned thyroid lesions were immunohistochemically stained for galectin-3. Area and intensity scores were recorded. RESULTS: Significant differences were found between the benign and malignant lesions. The sensitivity, specificity, positive predictive values, and negative predictive values of galectin-3 staining were 82%, 68%, 75%, and 77%, respectively (p=.0002). Significant differences were also found between the subgroups of benign and malignant lesions (p < or =.05). CONCLUSIONS: Galectin-3 staining is highly sensitive for malignancy in follicular patterned thyroid lesions. Diagnostic problems may arise in the presence of Hurthle cell proliferation or minimally invasive follicular carcinoma.     

Histologic and immunohistochemical characterization of tumor and inflammatory infiltrates in oral squamous cell carcinomas treated with local multikine immunotherapy: the macrophage at the front line

Squamous cell carcinomas of the head and neck (SCCHN) are excellent candidates for local immunotherapy owing to their accessibility and their infiltration by mononuclear cells that are susceptible to immunomodulation. A response rate of 25–60% has been reported for treatment with natural IL-2 or a mixture of natural lymphokines. In the present study, biopsies and posttreatment excision specimens from nine patients with operable SCCHN treated systemically with a variety of immunomodulators and locally with natural lymphokines (multikine, CelSci) were analyzed in an attempt to correlate clinical response to histopathological and immunohistochemical changes. Formalin-fixed, paraffin-embedded tissues were stained with antibodies against lymphocytes (CD45, CD3, CD4, CD8, CD20), macrophages (CD68) including dendritic cells (S-100), markers for lymphocyte activation (CD30, HLA-DR), natural killer cells (CD56 and CD57), beta-2-microglobulin and keratin. One patient showed a complete response to treatment and two a partial response. Tumor size was significantly smaller after therapy. Clinical and pathological regression were more prominent in the smaller tumors. Numerous macrophages, both mononucleated and multinucleated, were present along the tumor-stroma interface in the posttreatment specimens of seven patients, most prominently in the three patients with tumor regression. The increase in the number of CD68+ and S-100+ macrophages after treatment was statistically significant. Lymphocytic infiltrates, which showed some increase following treatment, were composed of a mixture of T and B lymphocytes, the former mostly in contact with the tumor and the latter placed more peripherally. CD8+ lymphocytes extended into the tumors, whereas CD4+ lymphocytes showed minimal extension. Intensity of beta-2-microglobulin staining in tumors was significantly higher following therapy and associated with a better outcome. The marked increase in macrophages following treatment may indicate that the macrophage plays a major role in tumor recognition, destruction and clearance. An increase in the number of macrophages in a posttreatment specimen may indicate immunoresponsiveness.This study is a CISEPO project and was supported in part by the Saul A. Silverman Family Foundation.