Communities' views on prerequisites for collaboration between modern and traditional health sectors in relation to STI/HIV/AIDS care in Zambia

Traditional, complementary and alternative medicine (TM/CAM) is globally increasing in popularity. The World Health Organization (WHO) has advocated for the integration of TM/CAM in national public health policies to enhance health care resources. Interest in collaboration between traditional and biomedical health sectors has been renewed in attempts to strengthen control of the AIDS epidemic. However, studies exploring communities' views on the prerequisites for such collaboration are inexistent. We conducted 21 focus group discussions with community members in two Zambian urban centres (Ndola and Kabwe) to explore their perspectives on preconditions for useful collaboration between traditional and modern health workers in the management of STIs and HIV/AIDS. This study shows that laypersons' perspectives can be rich and inform complex policy issues. Five categories indicating key areas of actions were identified, including protection of traditional medicine and of compensation of healers, education of both groups of providers and adequate community involvement. The respect for some degree of secrecy in traditional medicine was also called for. As part of efforts to strengthen available resources for better care of STI/HIV/AIDS, this study provides policymakers, researchers and practitioners with an outline of fundamentals in terms of needed crucial changes at health policy level, among providers and in the community for sustainable collaboration between modern and traditional health practitioners.     

Lead accumulation in tidemark of articular cartilage

OBJECTIVE: Determination of the spatial distribution of the toxic element lead (Pb) and other trace elements in normal articular cartilage and subchondral bone from adult humans with no history of work-related exposure to Pb. METHODS: Four macroscopically normal femoral heads and three patellas were harvested from randomly selected forensic autopsies. All subjects died of acute illnesses, had no history of work-related exposure to Pb and had no metabolic bone disease. The elemental distribution of lead (Pb) together with zinc (Zn), strontium (Sr) and calcium (Ca) in the chondral and subchondral region was detected using high resolution synchrotron radiation induced micro X-ray fluorescence (SR mu-XRF) analysis. SR mu-XRF line scans in conventional and SR mu-XRF area scans in confocal geometry were correlated to backscattered electron (BE) images visualizing the mineralized tissue. RESULTS: In all samples, we found a highly specific accumulation of Pb in the tidemark, the transition zone between calcified and non-calcified articular cartilage. Pb fluorescence intensities in the tidemark, which is thought to be a metabolically active mineralization front, were 13-fold higher when compared to subchondral bone. Pb intensities in the subchondral region were strongly correlated with Zn, but were distinctly different from Ca and Sr. CONCLUSIONS: The finding of the highly specific accumulation of lead in the tidemark of human articular cartilage is novel. However at this point, the exact mechanisms of the local Pb accumulation as well as its clinical implications are unknown.     

Sensitivity of differentPseudomonas species andAeromonas hydrophila to trimethoprim and sulfamethoxazole separately and in combination

An agar dilution method was used to determine thein vitro sensitivity of differentPseudomonas species andAeromonas hydrophila to trimethoprim, sulfamethoxazole, and a combination of these drugs maintaining a ratio of one to twenty. The fluorescent pseudomonads (Pseudomonas aeruginosa, P. putida, andP. fluorescens) were generally resistant to the drugs separately and combined. For otherPseudomonas species the sensitivity of the isolated strains to the drugs were variable and a synergistic effect of the combination was found for about half of the strains.Aeromonas hydrophila was generally sensitive to both drugs and a stronger synergistic effect of the combination was found than for the pseudomonads.     

Use of complementary and alternative medicine in the Scandinavian countries

OBJECTIVE: To describe the prevalence of use of complementary and alternative medicine (CAM) in Norway, Denmark and Stockholm County. DESIGN, SETTING, AND SUBJECTS: In Norway, a national representative sample of 1000 participants completed telephone interviews regarding their CAM use in 1997 (response rate 51). In Denmark, a national representative sample of 16 690 participants completed questionnaires and interviews regarding their health and morbidity in 2000 (response rate 74). In Stockholm County, a randomly selected sample of 1001 participants completed telephone interviews about their CAM use in 2000 (response rate 63). RESULTS: Prevalence of ever-use of CAM was 34% in Norway, 45% in Denmark, and 49% in Stockholm. Use of CAM is associated with poor self-reported health in all three studies, and with visits to a medical doctor in Denmark and Norway. More women than men, and more with higher education, reported use of CAM. Most frequently used CAM therapy was homeopathy in Norway, reflexology in Denmark, and massage in Stockholm County. CONCLUSIONS: Use of CAM is common in the Scandinavian countries, and there are national differences regarding therapy preferences. Many individuals use both CAM and conventional health services.     

Effects of oral contraceptives on body composition and physical performance in female athletes

Menstrual disturbances are common among female athletes, and oral contraceptives (OCs) are often recommended as estrogen substitution. However, there is little information about the effects of OC use in athletes, and there is great concern that OCs might impair physical performance. The aim of this study was to investigate the effects of OC use on body composition and physical performance in female athletes. Twenty-six endurance athletes (13 with oligo-/amenorrhea and 13 regularly menstruating athletes) and 12 sedentary controls were examined before and after 10 months of treatment with a low dose, monophasic, combined OC. Significant changes in body composition were recorded in the athletes, but not in the controls. There was an increase in weight and fat mass only in athletes with oligo-/amenorrhea. These changes were associated with a decrease in ovarian androgens. OC treatment also increased bone mineral density, with the largest increase in athletes with a low bone mineral density at baseline. Despite significant changes in body composition, little impact on physical performance was recorded. We have demonstrated that OC treatment in female athletes has predominantly beneficial effects on body composition without adverse effects on physical performance and could be used for the prevention of osteoporosis in athletic amenorrhea. However, it cannot be excluded that a marked increase in fat mass might have unfavorable effects for athletic performance in individual women.     

Mechanism for top-down control of working memory capacity

Working memory capacity, the maximum number of items that we can transiently store in working memory, is a good predictor of our general cognitive abilities. Neural activity in both dorsolateral prefrontal cortex and posterior parietal cortex has been associated with memory retention during visuospatial working memory tasks. The parietal cortex is thought to store the memories. However, the role of the dorsolateral prefrontal cortex, a top-down control area, during pure information retention is debated, and the mechanisms regulating capacity are unknown. Here, we propose that a major role of the dorsolateral prefrontal cortex in working memory is to boost parietal memory capacity. Furthermore, we formulate the boosting mechanism computationally in a biophysical cortical microcircuit model and derive a simple, explicit mathematical formula relating memory capacity to prefrontal and parietal model parameters. For physiologically realistic parameter values, lateral inhibition in the parietal cortex limits mnemonic capacity to a maximum of 2–7 items. However, at high loads inhibition can be counteracted by excitatory prefrontal input, thus boosting parietal capacity. Predictions from the model were confirmed in an fMRI study. Our results show that although memories are stored in the parietal cortex, interindividual differences in memory capacity are partly determined by the strength of prefrontal top-down control. The model provides a mechanistic framework for understanding top-down control of working memory and specifies two different contributions of prefrontal and parietal cortex to working memory capacity.     

Development of a superior frontal-intraparietal network for visuo-spatial working memory

Working memory capacity increases throughout childhood and adolescence, which is important for the development of a wide range of cognitive abilities, including complex reasoning. The spatial-span task, in which subjects retain information about the order and position of a number of objects, is a sensitive task to measure development of spatial working memory. This review considers results from previous neuroimaging studies investigating the neural correlates of this development. Older children and adolescents, with higher capacity, have been found to have higher brain activity in the intraparietal cortex and in the posterior part of the superior frontal sulcus, during the performance of working memory tasks. The structural maturation of white matter has been investigated by diffusion tensor magnetic resonance imaging (DTI). This has revealed several regions in the frontal lobes in which white matter maturation is correlated with the development of working memory. Among these is a superior fronto-parietal white matter region, located close to the grey matter regions that are implicated in the development of working memory. Furthermore, the degree of white matter maturation is positively correlated with the degree of cortical activation in the frontal and parietal regions. This suggests that during childhood and adolescence, there is development of networks related to specific cognitive functions, such as visuo-spatial working memory. These networks not only consist of cortical areas but also the white matter tracts connecting them. For visuo-spatial working memory, this network could consist of the superior frontal and intraparietal cortex.     

Early treatment of severe pancreatitis with imipenem: A prospective randomized clinical trial

Objective. The main causes of death in severe pancreatitis are multiorgan failure and septic complications. Prophylactic treatment with effective antibiotics is therefore a tempting therapeutic option. However, there could be side effects such as selection of resistant microbes and fungi. The aim of the present study was to compare the rate of infectious complications, interventions, days in the intensive care unit (ICU), morbidity and mortality in patients with severe pancreatitis randomized to prophylactic therapy with imipenem compared with those receiving no treatment at all. Material and methods. Seventy-three patients with severe pancreatitis were included in a prospective, randomized, clinical study in seven Norwegian hospitals. The number of patients was limited to 73 because of slow patient accrual. Severe pancreatitis was defined as a C-reactive protein (CRP) level of >120 mg/l after 24 h or CRP >200 48 h after the start of symptoms. The patients were randomized to either early antibiotic treatment (imipenem 0.5 g×3 for 5–7 days) (imipenem group) (n=36) or no antibiotics (control group) (n=37). Results. The groups were similar in age, cause of pancreatitis, duration of symptoms and APACHE II score. Patients in the imipenem group experienced lower rates of complications (12 versus 22 patients) (p=0.035) and infections (5 versus16 patients) (p=0.009) than those in the control group. There was no difference in length of hospital stay (18 versus 22 days), need of intensive care (8 versus 7 patients), need of acute interventions (10 versus 13), nor for surgery (3 versus 3) or 30-day mortality rates (3 versus 4). Conclusions. The study, although underpowered, supports the use of early prophylactic treatment with imipenem in order to reduce the rate of septic complications in patients with severe pancreatitis.