Retention of health workers in Malawi: perspectives of health workers and district management

Background  

Shortage of human resources is a major problem facing Malawi, where more than 50% of the population lives in rural areas. Most of the district health services are provided by clinical health officers specially trained to provide services that would normally be provided by fully qualified doctors or specialists. As this cadre and the cadre of enrolled nurses are the mainstay of the Malawian health service at the district level, it is important that they are supported and motivated to deliver a good standard of service to the population. This study explores how these cadres are managed and motivated and the impact this has on their performance.     

Cortisol response to interpersonal stress in young adults with borderline personality disorder: a pilot study.

Hypothalamic-pituitary-adrenal axis dysregulation after stress was found to be associated with borderline personality disorder (BPD). Nine female BPD young adults and 12 control subjects were investigated for stress reactivity and recovery after an interpersonal conflict discussion with their mothers. BPD subjects showed a delayed cortisol response after psychosocial stress.     

International educational partnership for practice: Brazil and the United Kingdom

BACKGROUND: To enhance healthcare globally, successful academic partnerships between institutes of higher education are crucial to strengthen collaboration between countries and identify new ways of working. The desire to reduce maternal mortality and morbidity among childbearing women in north-east Brazil urged professional nurses to seek new ways of working through such a partnership. Reflections on the success of the link identify the key qualities uniting the partnership. AIMS. This paper explores the key qualities of a higher education partnership between the United Kingdom and north-east Brazil. These qualities can act as a guide to other faculties engaged in such links to facilitate successful collaborative working for gains on both sides. RESULTS. Critical reflections from both partners revealed that the key qualities identified are effective communication, deep commitment and the need for both partners to understand each other's context of care. CONCLUSIONS. Examination of each of these qualities illustrates that the shared perspectives, mutual respect and enriched educational experience are valuable and essential to successful partnership working. This critical reflection illustrates the process of success and how others can benefit from the lessons learned, whatever the nature of partnership. Understanding the nature of collaborative working has strengthened each education and practice community, encouraged them to take risks, and remain committed to collective success.     

Neonatal ventral hippocampus lesion induces increase in no levels which is attenuated by subchronic haloperidol treatment

Haloperidol is a potent dopamine receptor antagonist and used to treat psychotic disorders, such as schizophrenia. Recent clinical and preclinical studies demonstrated the overactivity of the nitric oxide (NO) system in schizophrenia. Neonatal ventral hippocampal (nVH) lesions in rats have been widely used as a neurodevelopmental model that mimics schizophrenia‐like behaviors. Here, we investigate first whether the nVH lesion causes changes in NO levels in different limbic brain regions in young adults, postnatal day (PD) 81, and second, whether haloperidol treatment from PD60 to PD81 reverses these changes, by determining the accumulation of nitrites. The results show that NO levels at the level of the prefrontal cortex, occipital cortex, and cerebellum are higher in the nVH lesion animals, and that the haloperidol, in part, attenuates these altered NO levels. The NO levels observed in the nVH lesion animals with and without haloperidol treatment may be relevant to behaviors observed in schizophrenia. Synapse 64:941–947, 2010. © 2010 Wiley‐Liss, Inc.     

Molecular characterization of <Emphasis Type="Italic">Histoplasma capsulatum</Emphasis> isolated from an outbreak in treasure hunters

Background  

In Mexico, primary pulmonary histoplasmosis is the most relevant clinical form of the disease. The geographical distribution of specific strains of Histoplasma capsulatum circulating in Mexico has not been fully established. Outbreaks must be reported in order to have current, updated information on this disease, identifying new endemic areas, manner of exposure to the fungi, and molecular characterization of the causative agents. We report a recent outbreak of histoplasmosis in treasure hunters and the molecular characterization of two isolates obtained from these patients.     

Is lysyl oxidase-like protein-1, alpha-1 antitrypsin, and neutrophil elastase site specific in pelvic organ prolapse?

Introduction and hypothesis  

We investigated whether the expression of alpha-1 antitrypsin (ATT), neutrophil elastase (NE), and lysyl oxidase-like protein 1 (LOXL-1) vary within the vagina in subjects with pelvic organ prolapse (POP).     

Identification of beneficiaries of free anti-retroviral drugs in Malawi: a community consensus process

Malawi is a southeastern Africa country that has been heavily affected by the AIDS pandemic. It is estimated that about 170,000 people were in need of highly active antiretroviral therapy (HAART) for the treatment of AIDS in 2006. At the end of 2006, at least 55,000 people in Malawi were on HAART treatment, mostly through the free public sector program. At the time the program was being initiated, an ethical question needed to be answered in respect to who would be targeted for free treatment in an environment where medications, human and other resources were not enough to cater for all who were clinically eligible to be on treatment. In this paper we report on a qualitative study that was carried out to obtain public perceptions and input as to which criteria ought to have been applied to identify persons or groups of persons to be targeted in the free HAART program. In general, there was no agreement as to who should be prioritised for HAART, whether treatment should be free to user or whether cost-sharing should be introduced. While it may have been relatively straightforward in obtaining consensus and agreement among medical practitioners on the clinical criteria for HART in Malawi, deciding on the social criteria was complex. The decision to start the nationwide HAART program was started with the understanding that virtually every social group could be justified as worth of free HAART.