The struggle to make ends meet

Morocco's severe financial problems have threatened its health-for-all goals. Restrictions have affected the recruitment and replacement of health personnel, the purchase and maintenance of equipment and buildings, hospital catering services and drug procurement. Several methods have been used to try and ease this crisis, rationalization and better deployment of resources, mobilization of national resources, and mobilization of external resources. In attaining the 1st, restrictions on the credits allocated to the Ministry of Public health have forced it to work out better ways of using its resources. These have included plans for better administrative and financial management of hospitals, improvements in drug procurement and distribution, new methods of personnel management, and efforts at improving information facilities and analytical capabilities at the central and local levels. To mobilize internal resources several steps were taken. These included revising too-low hospital charges, and charging people with social security coverage or those able to pay directly, raising funds through private charities, and the establishment of alternative, less expensive types of health centers. Morocco's continued need for funds to achieve health-for-all goals led it to also receive substantial assistance from international agencies (including the World Bank, UNICEF, UNFPA, and USAID) and friendly countries. External assistance cannot provide definitive solutions however, because of 1) the use of foreign experts and the payment of salaries abroad, 2) the purchase of products from the countries providing assistance, and 3) the unpredictability of external support and the danger programs may have to be abandoned. In times of financial crisis it is necessary to continue to budget adequately in order to reach health objectives.     

Findings and implications from preadmission screening of elderly patients waiting for elective surgery

Volunteers trained by a social worker did a telephone screening of 716 elderly persons waiting for elective surgery to determine in advance of admission their need for social services. On the basis of their findings patients were given a risk rating by a social worker. While the survey was experienced positively by patients, volunteers, and social workers, the results do not establish its value in terms of shortened length of stay. Aging females living alone required the greatest amount of social work and had the longest length of stay. This group requires further study, along with the connection between intensity of illness with social problem vulnerability. The study raises other important questions critical to programming for an increasingly older population.     

Use of plant- and period-specific job-exposure matrices in studies on occupational cancer

Job-exposure matrices were constructed and applied in the estimation of past exposures in a case-referent study nested within a cohort of Finnish woodworkers. The objective was to avoid bias in the risk estimates because of a misclassification of exposures. The matrices were constructed separately for each plant under study and each calendar year of follow-up. The level of exposure was incorporated in the matrices, since rather comprehensive data on exposures were available. The individual work histories were converted to exposure histories by a computer program which calculated several exposure indicators (eg, level and dose, with and without allowance for a latency period). The comparison between several indicators was thought to provide additional information for the final evaluation of results. The use of the plant- and period-specific job exposure matrices may be considered in cohort and nested case-referent studies on occupational hazards as an alternative to other procedures used in the estimation of exposures. Specific matrices may find broader applicability along with the increasing availability of detailed hygienic data.     

Risk for reduced sperm quality among metal workers, with special reference to welders

The purpose of this study was to investigate whether men employed in the metal industry have sperm of poorer quality than men in other types of work. A postal questionnaire was sent to men employed in the metal industry, certain other types of nonmetal industries, and other types of employment in which the factors suspected to influence sperm quality were not present. By means of this questionnaire survey, it was hoped to define the possible influences of the work environment on sperm quality. Out of the total of 3,119 men included in the investigation, 2,517 (81%) filled out the questionnaire satisfactorily. Semen analysis was performed for all 3,119 men. There was a greater risk for poor sperm quality among welders than among men not employed in welding. The risk for poor sperm quality was increased for those welders who worked with stainless steel. Welding in general, and specifically with stainless steel, is connected with a risk of reduced sperm quality.     

Bumpy muscles

A 63-year-old man developed bilateral conjunctival injection and irritation followed by periocular discomfort and diplopia. Within weeks left proptosis and intermittent fever were noted. Orbital CT scan showed bilateral nodular enlargement of multiple extraocular muscles. Fine needle aspiration biopsy of the extraocular muscles revealed neoplastic cells compatible with a renal cell carcinoma. The bilateral extraocular muscle metastases were the initial manifestations of the underlying malignancy.     

Poverty, health services, and health status in rural America

Access to health services for everyone has been a major policy goal in the United States: inequitable access is assumed to lead to inequitable health status, particularly for low-income groups. A sophisticated model of the relation between poverty, health care needs, service use, and health outcomes is used to analyze cross-sectional data on 7,823 adults from 36 rural communities. Improved access and use are helpful, but evidence clearly indicates that combined health and social initiatives will be necessary to reduce inequalities in health status.     

Immunopathologic study of Vogt-Koyanagi-Harada syndrome

We studied an enucleated eye from a patient with a 30-year history of Vogt-Koyanagi-Harada syndrome using both conventional and immunohistochemical techniques. Clinically, the eye was in the end stage of Vogt-Koyanagi-Harada syndrome, and was characterized by the absence of inflammation, large areas of chorioretinal scarring, and pigmentary changes. Histopathologic examination showed marked retinal gliosis, extensive chorioretinal adhesion and scar formation, migration of pigment into the retina, and severe retinal pigment epithelial changes. However, foci of mild to moderate nongranulomatous inflammation of the uvea were observed. These foci contained infiltrating cells that were mainly T lymphocytes with B lymphocyte aggregates at the center. Scattered macrophages were also noted in the uvea and retina. These findings suggest that both the cell-mediated and humoral immune arms may play roles in the pathogenesis of Vogt-Koyanagi-Harada syndrome.