Costs and effects of a 'healthy living' approach to community development in two deprived communities: findings from a mixed methods study

Background  

Inequalities in health have proved resistant to 'top down' approaches. It is increasingly recognised that health promotion initiatives are unlikely to succeed without strong local involvement at all stages of the process and many programmes now use grass roots approaches. A healthy living approach to community development (HLA) was developed as an innovative response to local concerns about a lack of appropriate services in two deprived communities in Pembrokeshire, West Wales. We sought to assess feasibility, costs, benefits and working relationships of this HLA.     

Rectal cancer surgery: volume–outcome analysis

Purpose  

There is strong evidence supporting the importance of the volume–outcome relationship with respect to lung and pancreatic cancers. This relationship for rectal cancer surgery however remains unclear. We review the currently available literature to assess the evidence base for volume outcome in relation to rectal cancer surgery.     

In silico modeling of interstitial lung mechanics: implications for disease development and repair

In this perspective, we first review some of the published literature on structural modeling of the mechanical properties of the lung parenchyma. Based on a recent study, we demonstrate why mechanical dysfunction accompanying parenchymal diseases such as pulmonary fibrosis and emphysema can follow a very different course from the progression of the underlying microscopic pathophysiology itself, particularly in the early stages. The key idea is related to the concept of percolation on elastic networks where the bulk modulus of the network suddenly changes when the fibrotic stiff regions or the emphysematous holes become suddenly connected across the network. We also introduce the concept of depercolation as a basis for the rational optimization of tissue repair. Specifically, we use these network models to predict the functional improvements that a hypothetical biological or tissue engineering repair could achieve. We find that rational targeted repair can have significant benefits over generic random repair. This concept may find application in the treatment of lung fibrosis, surgical, bronchoscopic, or biological lung volume reduction, or any future alveolar regeneration or tissue engineering solution to the repair of connective tissue damage of the lung.     

Characterisation and controlled drug release from novel drug-loaded hydrogels.

Hydrogel based devices belong to the group of swelling controlled drug delivery systems. Temperature responsive poly(N-isopropylacrylamide)-poly(vinylpyrrolidinone) random copolymers were produced by free radical polymerisation, using 1-hydroxycyclohexylphenyketone as an ultraviolet-light sensitive initiator, and poly(ethylene glycol) dimethacrylate as the crosslinking agent (where appropriate). The hydrogels were synthesised to have lower critical solution temperatures (LCST) near body temperature, which is favourable particularly for 'smart' drug delivery applications. Two model drugs (diclofenac sodium and procaine HCl) were entrapped within these xerogels, by incorporating the active agents prior to photopolymerisation. The properties of the placebo samples were contrasted with the drug-loaded copolymers at low levels of drug integration. Modulated differential scanning calorimetry (MDSC), attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR) and atomic force microscopy (AFM) were used to investigate the influence of the drugs incorporated on the solid-state properties of the xerogels. MDSC and swelling studies were carried out to ascertain their effects on the LCST and swelling behaviour of the hydrated samples. In all cases, drug dissolution analysis showed that the active agent was released at a slower rate at temperatures above the phase transition temperature. Finally, preliminary in vitro cytotoxicity evaluations were performed to establish the toxicological pattern of the gels.     

Cystic fibrosis, genetics, and DNA technology

Advances in molecular genetics are leading to changes in practice that have a direct impact on the obstetrician and gynecologist. New techniques of prenatal screening, diagnosis, and potentially therapy are rapidly evolving. Recent developments in cystic fibrosis, preimplantation genetics, fragile X syndrome, neurofibromatosis, muscular dystrophy, and Marfan syndrome are discussed.     

Characteristics of three vaginal flora patterns assessed by gram stain among pregnant women. Vaginal Infections and Prematurity Study Group.

This study was undertaken to define the characteristics and persistence of vaginal flora in 7918 pregnant women at 23 to 26 weeks' gestation. Vaginal smears were categorized as normal (predominant lactobacilli), intermediate (reduced lactobacilli), or positive for bacterial vaginosis. The women with normal flora were least likely to have elevated vaginal pH, amine odor, milky discharge, or colonization by Gardnerella, Bacteroides, or genital mycoplasmas. Women with intermediate vaginal flora had intermediate frequencies of these clinical signs and microorganisms. Group B streptococci and yeast were associated with normal or intermediate flora, whereas Neisseria gonorrhoeae and Chlamydia trachomatis were recovered more frequently from women with intermediate flora or bacterial vaginosis. Trichomonas vaginalis was most associated with intermediate flora. At follow-up, 81% of the women with normal flora had remained normal. Of the women with intermediate flora, 32% acquired bacterial vaginosis and 30% shifted to normal flora. Only 12% of the women with bacterial vaginosis had shifted to normal flora. We conclude that there are two primary stable vaginal flora patterns (normal flora or bacterial vaginosis) and a third less distinct transitional flora pattern between these two.     

Comparison of amniotic fluid disaturated phosphatidylcholine and the lecithin-sphingomyelin ratio in the prediction of fetal lung maturity

Although use of the lecithin-sphingomyelin (L/S) ratio has contributed to a reduction in the frequency of respiratory distress syndrome (RDS), its accuracy in pregnancies complicated by fetomaternal disease has been questioned. Disaturated phosphatidylcholine is the major active component of surfactant and has been advocated as being a more specific indicator of fetal lung maturity. A study of 105 pregnancies in which a L/S ratio and disaturated phosphatidylcholine assay were performed on amniotic fluid was carried out to ascertain if amniotic fluid disaturated phosphatidylcholine is indeed a more accurate predictor of RDS. The results of this investigation reveal no significant difference in the reliability of these two tests in predicting neonatal RDS. Five infants developed RDS with a mature L/S ratio ranging from 2.0 to 3.36, suggesting that the disaturated phosphatidylcholine assay may be a helpful adjunctive test in instances in which the L/S ratio is less than 3.5.     

Alternatives to HIV-1 RNA concentration and CD4 count to predict mortality in HIV-1-infected children in resource-poor settings

Cheaper, simpler alternatives to CD4 lymphocyte count and HIV-1 RNA detection for assessing the prognosis of HIV-1 infection are needed for resource-poor settings. However, little is known about the predictive value of alternative assays, in particular in children. We assessed the prognostic value of total lymphocyte count, immune complex-dissociated p24 antigen, white blood cell count, packed-cell volume (haematocrit), and serum albumin for mortality in 376 HIV-1-infected, mainly African-American or Hispanic children enrolled during March, 1988 to January, 1991. In a Cox proportional hazards model, including all assay-alternatives to CD4 and RNA, total lymphocyte count (p<0.0001) and serum albumin (p=0.0107) independently predicted mortality. Further assessment of these markers is warranted in resource-poor settings.