Health services and the legitimation of the colonial state: British Malaya 1786-1941

This article is concerned with the establishment and extension of health care and medical services in British colonial Malaya. Initially, medical care was provided for the colonial elite and those in their direct employment. With the expansion of colonial control beyond trade centers into the hinterland and with the growth of agriculture and mining. Western medicine was extended both to labor involved in these export industries and to others whose ill health might jeopardize the welfare of the colonists. Public health programs in the twentieth century continued to focus on medical problems that had direct impact on the colonial economy, but programs were extended to ensure the reproduction as well as the maintenance of the labor force. This article develops the notion of a legitimation vacuum, and the role of the state provision of social services, including medical services, in legitimizing colonial presence and control.     

Time-limited psychiatric hospitalization of children: a model and three-year outcome

Current emphasis on reducing length of hospital stay has stimulated a review of the philosophical, clinical, and administrative approaches to brief psychiatric hospitalization of children. A model of time-limited hospitalization on an eight-bed children's unit was designed to stabilize the patients and triage them back to appropriate levels of community aftercare within 28 days. Clinical and administrative strategies used to facilitate this process included a community-based case manager for each patient, focused clinical intervention, and strong parent involvement. The treatment model was generally successful in meeting the goals of hospitalization. Of 212 admissions over three years, 37 percent of the patients at discharge continued to need complex, multi-modal treatments, and 63 percent were referred for less intensive outpatient care.     

The effect of intravenously injected beta very low density lipoprotein on small and large arterial injuries

A series of daily injections of beta very low density lipoprotein (beta-VLDL) was administered over 4-5 days to rabbits whose arteries contained either experimental circumferential lesions or areas of intimal thickening. The circumferential lesions were similar to those that occur spontaneously and were produced by the application of longitudinal tension. The intimal thickening was produced by denuding the endothelium with a balloon catheter. Over the period of injection of beta-VLDL the plasma cholesterol levels rose in a pulse-like manner from 60 to 100 mg/dl. Following cessation of injections the cholesterol levels initially rose further and then decreased to normal levels within 4 weeks. Injections of beta-VLDL, commencing 1-2 days after production of the circumferential lesions, resulted in an increase in the number of mononuclear leukocytes (primarily macrophages) and in a moderate accumulation of lipid by these cells and the medial smooth muscle cells. If the injections were started 14 days postinjury there was some accumulation of lipid in the large lesions but none in small lesions. There was no lipid accumulation in any lesions if the beta-VLDL was administered 3 months postinjury or if the animals were injected 2 days after injury and examined 3 months later. A very slight accumulation of lipid occurred in the intimal thickening, or neo-intima, following a series of beta-VLDL injections given to rabbits 2 or 6 weeks after balloon catheter injury. The series of injections produced a significant increase in the number of mononuclear leukocyte profiles per area of the neo-intima, suggesting an increased infiltration of these cells into the injured artery. These results suggest that a small transient increase in the plasma concentration of cholesterol-carrying lipoproteins may lead to increased infiltration of mononuclear leukocytes into areas of intimal thickening or areas of "spontaneously occurring" injury.     

Menstrual Problems and Health Seeking in Sri Lanka

Menstruation is associated with some morbidity, although it is a normal physiological event. In this article, we draw on qualitative research conducted in Sri Lanka in 2006–2007, which included eight key informant interviews with healthcare providers, six focus group discussions with eight women in each, and five case studies. We describe and analyze women's perceptions of menstruation and menstrual problems, their help-seeking behaviors to reduce these health problems, and the consequences of them on their lives. The majority of women perceived menstruation as a physiological process and related problems to changes in hormone levels, pathological conditions of the uterus, and the side effects of contraceptive methods. Menstrual problems significantly affected their daily activities, mental well-being, social life, and sexual life, but few sought medical advice to resolve these problems. Implications of the findings included the need for health care providers and educators to provide accurate information on menstruation to girls and women to enable them to identify normal variation of menstruation and to take appropriate action regarding health care.     

Maternal Identity Change as a Consequence of Antenatal Hospitalization

Despite low fertility rates in Western countries, maternity remains one of the major goals of women from various socioeconomic backgrounds. While most women will have low-risk pregnancies, common serious disorders of pregnancy, such as preeclampsia, premature rupture of the membranes, placenta previa, or fetal growth restriction, may compromise maternal and infant outcomes. The experiences of urban and rural women in Australia who have had difficulties in maintaining their pregnancies are analyzed in this article. We study the impact of individual and social factors that facilitate or impede women's adjustment to the risks associated with these disorders. The analysis of in-depth interviews with 27 women hospitalized antenatally indicates that most women were unfamiliar with the diagnoses and acted as passive “decision takers,” complying with medical advice to remain in the hospital. Admission to a tertiary hospital ward that provided care to women with pregnancy disorders promoted the formation of a new identity, that of a woman whose pregnancy did not follow the expected path. Further, hospitalization offered women the opportunity to interact with others in similar difficult situations and, hence, feel less isolated.     

Nosocomial and community acquired uropathogenic isolates of Proteus mirabilis and antimicrobial susceptibility profiles at a university hospital in Sub–Saharan Africa

ObjectiveTo ascertain antimicrobial susceptibility profile of Proteus mirabilis (P. mirabilis) from clinical urine specimens at a university hospital in the spate of its recorded increasing resistance patterns.MethodsThe study was retrospective in nature. Data generated from urine cultures of patients at University of Calabar Teaching Hospital for a period of five years (2004–2009) were compiled. Relevant information obtained were age and gender of patients, organisms recovered and their antibiotic susceptibility patterns. P. mirabilis was identified using standard laboratory procedures.ResultsP. mirabilis showed the highest resistance against ampicillin, cloxacillin, amoxicillin, tetracycline, co-trimoxazole, erythromycin and chloramphenicol (100%–37.2%) while colistin, ofloxacin, ciprofloxacin, ceftriaxone, nalidixic acid and nitrofurantoin recorded the highest activity (59.1%–96.9%) with no drug recording 100% activity. The resistance of the nosocomial isolates of the organism were significantly higher than the community acquired isolates against that of the common antibiotics in use (P<0.05).ConclusionsExtreme caution should be exercised in antibiotic administration in hospital setting and the potential benefits adequately assessed while control of nosocomial infections be given a priority so as to limit the spread of resistant bacteria.     

Bacterial colonization of chronic leg ulcers: current results compared with data 5 years ago in a specialized dermatology department

Background In nearly every chronic wound different bacteria species can be detected. Nevertheless, the presence of such microorganisms is not necessarily obligatory associated with a delayed wound healing. But from this initially unproblematic colonization an infection up to a sepsis can arise in some patients. The aim of our clinical investigation was to analyse the spectrum of microbial colonization of patients with a chronic leg ulcer in our specialized dermatological outpatient wound clinic, and to compare them with the results of comparable data already collected 5 years ago. Objectives In our retrospective investigation the results of bacteriological swabs were documented in 100 patients with a total of 107 chronic leg ulcers. All patients visited the specialized wound outpatient clinic, Department of Dermatology, University of Essen in Germany. Methods A total of 60 patients were female, 40 were male. The mean age was 65 years. Altogether a total of 191 bacterial isolates and 25 different bacterial species could be identified. Results The most often detected species were Staphylococcus aureus (n = 60), Pseudomonas aeruginosa (n = 36) as well as Proteus mirabilis (n = 17). In 10 patients (10%) we identified a colonization with methicillin resistant S. aureus (MRSA). Merely in 6 patients the taken swabs were sterile. Five years ago a comparable investigation was already carried out in our wound outpatient clinic. At that time we could detect in particular more frequent MRSA (21.5% vs. 10%) and rarely P. aeruginosa (24.1% vs. 33.6%). Conclusion The results of our investigation demonstrate the current spectrum of the bacterial colonization in patients with chronic leg ulcers in a university dermatological wound centre in comparison to the last 5 years. In our institution we were able to demonstrate a shift of the detected bacterial species from gram‐positive in direction to gram‐negative germs. Beside the already known problems with MRSA, in future therapeutic strategies in patients with chronic leg ulcers the increasing amount of gram‐negative bacteria and especially of P. aeruginosa should considered.     

Acquired immune hemolytic anemia associated with IgA erythrocyte coating: investigation of hemolytic mechanisms

We have investigated the hemolytic mechanisms in a patient with acquired immune hemolytic anemia whose red cells appeared to be coated with IgA alone. The clinical course was similar to that of patients with hemolytic anemia mediated by warm-reacting IgG antibody. Splenic sequestration of red cells was demonstrated, and marked reduction of hemolysis occurred after corticosteroid therapy. Antibody was eluted from the patient's red cells and used to sensitize normal red cells in vitro. These sensitized red cells were not lysed by fresh autologous serum, nor did they fix detectable amounts of C3. However, red cells sensitized by eluted antibody were lysed by normal human peripheral blood monocytes in a system designed to demonstrate antibody-dependent cell-mediated cytotoxicity. Monocyte-mediated hemolysis of sensitized red cells was inhibited by the addition of low concentrations of normal serum IgA to the system, but not by IgG. The ability of the eluate to induce monocyte-mediated hemolysis was abolished by its adsorption on Sepharose-bound anti-IgA, but not by preincubation with Sepharose-bound anti-IgG. In addition, normal human monocytes were demonstrated to ingest eluate-sensitized red cells. These data demonstrate an in vitro interaction of IgA-sensitized red cells with leukocytes and suggest a possible mechanism for the patient's hemolysis.