The impact of family planning service provision on contraceptive-use dynamics in Morocco

This article uses linked data from the 1995 Morocco DHS calendar and the 1992 Morocco DHS service-availability module to study the effect of service environment on contraceptive discontinuation, switching, and adoption of a modern method following a birth. The 1995 Morocco DHS also collected information on the source of supply for each episode of use of a modern method recorded in the calendar, allowing study of the association between the source of supply and discontinuation and switching rates. Multilevel event-history models are used to evaluate the impact of individual-level sociodemographic characteristics and community-level indicators of family planning service provision. The findings show that the presence of a nearby public health center is associated with higher modern-method adoption after a birth and lower method-failure rates; the presence of a pharmacy is associated with lower discontinuation due to side effects or health concerns. The degree of method-choice potential has a positive impact on both the rate of switching from the pill to another modern method and on modern-method adoption after a birth.     

Ondansetron is more effective than metoclopramide for the treatment of opioid-induced emesis in post-surgical adult patients. Ondansetron OIE Post-Surgical Study Group

Nausea and vomiting are common side effects of opioids administered for pain control. This double-blind, randomized, parallel-group study evaluated the anti-emetic efficacy and tolerability of single intravenous (i.v.) doses of ondansetron 8 mg, ondansetron 16 mg and metoclopramide 10 mg in the treatment of opioid-induced emesis. Adult patients undergoing low emetogenic surgical procedures, using a standardized anaesthesia regimen were assessed for 24 h following administration of study anti-emetic to treat established post-surgical opioid-induced emesis. A total of 4511 patients were enrolled of whom 1366 experienced opioid-induced emesis and received randomized study medication. Ondansetron 8 mg and 16 mg were significantly better than metoclopramide 10 mg (P < 0.05) for both complete control of emesis, complete control of nausea and other efficacy measures. There were no significant differences between the two ondansetron groups. All three treatments were well tolerated. In conclusion, this large, multicentre study demonstrates that ondansetron is more effective than metoclopramide in the treatment of opioid-induced emesis following administration of post-surgical opioids to control pain.     

Comparison of GENEHUNTER and MFLINK for analysis of COGA linkage data

We compared the NPLALL statistic from GENEHUNTER with two-point and three-point MALODs and MFLODs from MFLINK for all autosomal markers in the Collaborative Study on the Genetics of Alcoholism (COGA) data set. In general MFLINK produced more significant results than GENEHUNTER and implicated two regions containing candidate genes (ADH3 and DRD2). Many regions of interest identified in other studies reported at this workshop produced MALODs significant at p < or = 0.05, but these would not have been picked up by GENEHUNTER unless a less significant threshold were used.     

Back to the future for wound care?

The European Renaissance was a time of enormous change and rapid progress in the arts, sciences, and medicine. A glimpse of wound care in the last phase of the European Renaissance is provided by the analysis of work by Wilhelm Fabry, the "father of German surgery," as provided in his book De Combustionibus ("Burns") which details his range of treatments for the burn wound, as well as his approach to the later problems of scarring and contracture. We describe some of the historic events which may have stimulated Fabry's writings, in particular, the influences passed down from the medical school of Padua which thereby advanced the cause of wound care and surgery. Finally, we briefly explore the potential of such an approach to the works of our medical forefathers.     

Lysis of venous clots by local intraarterial Thrombolysin injection in the rat

Intravascular coagulation is the final common pathway of failure in replanted digits and "free" tissue transfers. To address this clinical problem, a model based upon intimal damage and stasis in the rat femoral vein was developed. The ability of local, intraarterially administered Thrombolysin to achieve "local" clot lysis was investigated. "Systemic anticoagulation" was measured by standard hematologic monitoring and "systemic thrombolysis" by lysis of a contralateral standard femoral vein clot. The mean drug volume required for local clot lysis was proportional to the clots' duration time; 7.8 ml required for the 30-minute, and 17.0 ml required for the 60-minute clot (p less than 0.05). Lysis was achieved by local intraarterial Thrombolysin in 87% of the clots of 30 minutes' duration and in 94% of the clots of 60 minutes' duration. Overall, just 3.6% of contralateral clots lysed (p less than 0.001). Systemic anticoagulation did not occur.     

DNA repair in human bronchial epithelial cells

The purpose of this investigation was to compare the responseof human cell types (bronchial epithelial cells and fibroblastsand skin fibroblasts) to various DNA damaging agents. Repairof DNA single strand breaks (SSB) induced by 5 krads of X-raywas similar for all cell types; 90% of the DNA SSB were rejoinedwithin one hour. During excision repair of DNA damage from u.v.-radiation,the frequencies of DNA SSB as estimated by the alkaline elutiontechnique, were similar in all cell types. Repair replicationas measured by BND cellulose chromatography was also similarin epithelial and fibroblastic cells after u.v.-irradiation.Similar levels of SSB were also observed in epithelial and fibroblasticcells after exposure to chemical carcinogens: 7,12-dimethylbenz[a]anthracene;benzo[a]pyrene diol epoxidle (BPDE); or N-methyl-N-nitro-N-nitrosoguanidine.Significant repair replication of BPDE-induced DNA damage wasdetected in both bronchial epithelial and fibroblastic cells,although the level in fibroblasts was 40% of that in epithelialcells. The pulmonary carcinogen asbestos did not damage DNA.DNA-protein crosslinks induced by formaldehyde were rapidlyremoved in bronchial cells. Further, epithelial and fibroblasticcells, which were incubated with formaldehyde and the polymeraseinhibitor combination of cytosine arabinoside and hydroxyurea,accumulated DNA SSB at approximately equal frequencies. Theseresults should provide a useful background for further investigationsof the response of human bronchial cells to various DNA damagingagents.     

Auditory toxicity effects of long-term cis-dichlorodiammineplatinum II therapy in genitourinary cancer patients

To determine the auditory toxicity effects of long-term cis-dichlorodiammineplatinum II therapy, pure tone hearing thresholds were measured prior to therapy and repeated before each subsequent treatment. CDDP was given by a slow intravenous drip method at a low dose of 1 mg/kg body weight, with 37.5 gm mannitol, once a week for six treatments and every 3 weeks thereafter. From a group of 173 genitourinary cancer patients treated, 50 male patients were selected who received at least 12 months of CDDP with no active conductive ear pathology, and whose audiograms obtained at baseline, 6th weeks, 26th weeks, and 52nd weeks of treatment were all available for comparison. Pure tone threshold levels deteriorated across time particularly by the 52nd week and at the higher frequencies. Threshold differences across time were statistically significant and within a linear trend. Of the 50 cases, 30% showed suspect or no ototoxicity, 26% mild, 32% moderate, 2% marked, and 4% showed severe ototoxic changes. Of the two cases who developed severe ototoxicity, one showed complete recovery. There was partial recovery in 26% and no recovery in 54%. Individual variability in susceptibility to and recovery from ototoxicity necessitates systematic audiometric monitoring throughout the therapy.     

From state hospital to integrated human service system: managing the transition

If a human service facility can treat a mental patient at one-fifth the cost incurred at a parallel state mental hospital, and do it better, there is compelling reason for mental health care managers to consider the benefits of matrix organization.