The economic burden of HIV and AIDS on households in Nigeria

The study estimates the economic burden of HIV and AIDS on households in a Nigerian population. The data derive from a cross-sectional survey of households affected by HIV or AIDS in Ife-Ijesa Zone, Osun State, Nigeria. The sample consisted of 117 purposively selected, consenting adult HIV patients attending a general and teaching hospital. Participants were asked to self-report monetary expenses for HIV-related care, loss of savings, and funeral costs. The data show a significantly sharp drop in the participants' household income as a result of care for HIV-related illnesses, from the time of knowing one's HIV status to the time of illness, among three occupational categories (artisans, civil servants and unemployed; p = 0.02). Mean income among those in the unemployed category fell by 84.1%, income among artisans dropped by 72.6%, and income among civil servants decreased by 44.4%. The monetary loss during the course of HIV-related illnesses was heaviest for the artisan group, followed by the unemployed and the civil servants. Those who had lost a substantial part of their savings to HIV-related care were most numerous among the unemployed, followed by artisans and civil servants. Out of 16 households, 11 (42.3%) had received support from relatives during a funeral ceremony. There was a significant association between the occupational group and working for more hours after illness (χ² = 9.28, df = 4; p = 0.05). Nearly all orphaned children were distributed to the extended family following the AIDS death of a parent. Among all the occupational groups, borrowing from a cooperative society during the course of HIV-related sickness was the commonest form. The findings add to data showing that despite the extended family support system, adult deaths due to AIDS continue to undermine the viability of sub-Saharan African households.     

The reform of medical education: a Canadian model †

The Flexner reforms of the early 20th century were successful in correcting a mismatch between medical education and the newly available knowledge from the laboratory sciences. At the same time, they set in motion changes which have resulted in another mismatch, this time between medical education and society's needs. Five major corrective changes are described, with particular reference to the role of family medicine (general practice) in attaining them: (1) a change in the environment of learning, (2) a reawakening of concern with the subjective aspects of medicine, (3) a shift of emphasis from content to process, (4) a change in our concept of health and (5) a rapprochement between personal and population medicine. New medical schools have had an important influence on the reform of medical education. However, it is important also to study examples of successful adaptive change in older institutions. Changes at the University of Western Ontario are described as an example of successful adaptation. Some reasons are given for the failure of many institutions to adapt. Five conditions are necessary if a medical school is to adapt successfully to change: (1) the school should penetrate the entire health care system, (2) all sections of the profession should be represented on the faculty, (3) the school should be strongly rooted in its region, (4) it should have a flow of information from the ‘grass roots’ and (5) society should have some means of ensuring that its needs are met.     

Development of dentition: From initiation to occlusion and related diseases

BackgroundThe development of dentition begins in the embryonic oral cavity and progresses in the branchial arches and alveolar bone. Continuous cellular and molecular crosstalk occurs during crown formation, after which the tooth germ begins to migrate apically through the alveolar process into the oral cavity. It eventually comes in contact with its antagonist in the contralateral jaw to establish functional occlusion. Any defect in either step can result in delayed tooth development, the spectrum of which varies from a congenitally missing tooth to an impacted tooth (infraocclusion) with an eruption problem, both of which can impair oral function.HighlightCongenitally missing teeth or eruption problems may result from genetic mutations. Several different mutations have been identified, each causing a distinct phenotype. Thus, it is imperative that medical providers understand the fundamentals of these genetic principles that govern such dental diseases.ConclusionIn this review, we focus on several diseases, including congenitally missing teeth and tooth eruption problems. We review these diseases with aspect to their association with a particular syndrome, as well as independently in a non-syndromic capacity. We also review previously identified genetic mutations and discuss the possible mechanisms that cause individual phenotypes by analyzing previous investigations. We also discuss future prospects of how genetic diagnosis and precision medicine could impact the clinical environment in the field of dentistry.Ethical approvalPresent study has been carried out in accordance with The Code of Ethics of the World Medical Association and approved by Institutional Review Board of Osaka University Graduate School of Dentistry.     

Five-year continuation rate and reasons for early removal of Norplant® in Shiraz,Iran

Norplant^® has been the focus of controversy in Iran because of its relatively high premature removal rate. This study assessed the reasons for Norplant removal and its 5-year continuation rate to clarify the determining factors on elimination of this method. Subjects were identified via a retrospective chart review of Norplant users in Shiraz, Iran who were followed for 5 years. The mean age and weight of acceptors were 23.6 ± 4.1 years and 54.4 ± 8.5 kg, respectively. The most common reasons for removal were menstrual disturbances and personal reasons (each 41%). The 5-year continuation rate was 45%; on average, Norplant capsules were in place for 4.1 ± 0.09 years. Norplant has been shown to be an acceptable option in other Muslim countries, so the relatively high rate of removal in Iran could not be attributed to the Norplant itself, but is probably linked to other factors that are in need of improvement.     

Cycle characteristics after discontinuation of oral contraceptives

Nearly 60% of the women between 20 and 40 years of age who do not want to conceive choose oral contraceptives (OCs) for contraception in Germany. In an ongoing prospective study on the use of natural family planning in Germany, 175 women have been observed for 3048 cycles immediately after having discontinued OCs (post-pill group). They were compared to a control group of 284 women observed for 6251 cycles, who had never taken OCs. Both groups were comparable in age and sociodemographic characteristics. After discontinuing OCs, 57.9% of all first cycles were ovulatory with sufficient luteal phases. However, for the total post-pill group the cycle length was significantly prolonged up to the ninth cycle. A significantly higher number of luteal phases were insufficient in the post-pill group. Major cycle disturbances (cycle length > 35 days or luteal phase of < 10 days of elevated basal body temperature or anovulatory cycles) were significantly more frequent in the post-pill group up to the seventh cycle. Cycle disturbances after discontinuing OCs were reversible but the time of regeneration took up to 9 months (significant) or even longer (not significant). These results will help to counsel couples who wish to conceive after discontinuing OCs or who want to continue contraception with alternative methods.     

Bcl-2 Gene Family and Related Proteins in Mammary Gland Involution and Breast Cancer

The Bcl-2 gene family regulates tissuedevelopment and tissue homeostasis through the interplayof survival and death factors. Family members arecharacterized as either pro-apoptotic or anti-apoptotic, depending on cellular context. In addition toits anti-apoptotic effect, Bcl-2 also inhibitsprogression through the cell cycle. Functionalinteractions between family members as well as bindingto other cellular proteins modulate their activities.Mammary gland tissue, similar to many other tissues,expresses a number of different Bcl-2 relativesincluding bclx, bax, bak, bad, bcl-w, bfl-1, bcl-2 aswell as the bcl-2 binding protein Bag-1. Bcl-2 isexpressed in the nonpregnant mammary gland and earlypregnancy. In contrast, expression of bcl-x and baxcontinues through late pregnancy, is down-regulated during lactation, and upregulated with thestart of involution. Bak, bad, bcl-w, and bfl-1 are alsoup-regulated during involution. The specific roles ofindividual gene products are investigated using dominant gain of function and loss of functionmice. Finally, different Bcl-2 family members arecommonly over- or under-expressed in human breastcancers. Bcl-2 expression in human breast cancers hasbeen associated with a good prognosis, whiledecreased Bax expression has been linked to poorclinical outcome. Understanding the role Bcl-2 familymembers play in regulating mammary epithelial cellsurvival is salient to both normal mammary glandphysiology and the development of new therapeuticapproaches to breast cancer.     

Vulnerability to HIV infection among Luo female adolescent orphans in Western Kenya

Large-scale surveys have reported that about 55% of orphans worldwide are adolescents. In Kenya, the majority of HIV-infected adolescents are females. The current study used the anthropological methods of in-depth case studies to analyse how migratory life situations of individual female adolescent orphans in the Luo community of Western Kenya may increase their exposure to HIV. The study shows that the ability of the female adolescent orphans to adopt risk-preventive behaviour in relation to HIV is determined by a range of factors beyond their control of individual sexual behaviour. Although analysis of a single case study limits generalisation of the findings, the results provide insights into the reason for sex differentials in HIV infection rates among adolescents as reported in some large-scale surveys. The paper recommends that HIV prevention strategies for adolescents should examine the specific life situations of female orphans by focusing on the impacts of HIV and AIDS and poverty on the protective role of the family. It also recommends that keeping female adolescent orphans in school or in vocational training can be an effective HIV prevention strategy for them.     

Lover,mother or worker: women's multiple roles and the HIV/AIDS and reproductive health agenda in Tanzania

International and national campaigns to prevent HIV/AIDS and efforts to promote reproductive health remain separate in terms of conceptualisation and implementation. Local negotiations around reproductive health issues similarly seem to lack explicit attention to HIV/AIDS. This paper argues that even in reproductive health clinics a gap exists between the extent of knowledge of HIV/AIDS and AIDS talk. There also appears to be a mismatch between collective knowledge of the behavioural and biomedical context of HIV/AIDS and the socio-economic context of AIDS as a lived experience. Using an ethnographic account, I explore how one woman's lived experience and her knowledge of AIDS can teach us to take HIV/AIDS into account when theorising, promoting or providing services for improving African women's reproductive health. The background for this ethnography comes from data collected during 25 months of fieldwork at 10 maternal and child health/family planning (MCH/FP) clinic sites in the Morogoro, Ruvuma and Kilimanjaro regions of Tanzania. Rehema's story shows that AIDS, like other diseases, is significantly linked to host-susceptibility and economic vulnerability. Separate and competing vertical programmes on AIDS and MCH/FP, as commonly encountered throughout Africa, cannot meet the needs of women in countries like Tanzania. Yet, we still hear most often of abstinence, anti-retrovirals and condom use as the primary focus of HIV/AIDS prevention and intervention in Africa.     

Palliative care for people with non-malignant conditions in a New Zealand community

Abstract

Introduction: Little is known about the experiences of people with non-malignant, life-threatening conditions in the community who are not receiving hospice palliative care. The aim of this study was to understand the experiences and needs of people dying in the community with respiratory, renal, cardiac, neurological diseases, and cancer and those of the people caring for them, both formal health professionals and informal carers.

Subjects and Methods: This is qualitative research where 13 people with life-limiting illness, eight spousal caregivers, three adult children, three specialists, one general practitioner and one psychotherapist were interviewed – a total of 29 participants. Analysis was thematic and interpretive within a phenomenological framework.

Conclusions: Non-malignant disease makes similar demands on patients, families and health professionals, yet malignant disease is more likely to have the terminal phase identified so that people can access palliative care services. There were a number of spousal caregivers, who also had life-limiting conditions thus increasing the level of burden experienced by not only themselves, but their families. This research identified the needs of individuals and their families with non-malignant conditions compared with those with malignant conditions and confirmed the findings of previous literature. Understanding the burden families' experience and how they rely on health professionals will assist in developing collaborative ways of working to break down barriers and provide palliative care for these individuals and their families.     

Reproductive health: knowledge and opinions of university students in Erzurum,Turkey

Background: The aim of this study was to assess knowledge of reproductive health and the opinions of university students towards reproductive health education and family planning services. Methods: A questionnaire about reproductive health knowledge and the opinions of students was submitted to 673 systematically and randomly selected students at Ataturk University. A set of 39 questions was used to determine the level of knowledge of reproductive health. Results: The level of reproductive health knowledge was below the theoretical mean value. An association was found between gender, residential area, parents' education and sibling number with the reproductive health knowledge score. Most of the students approved of formal reproductive health education (88.4%). Approval of family planning services was lower than that of reproductive health education (71.6%). The percentage of men who support family planning services and reproductive health education was lower than that of women. Students who had graduated from Islamic religious schools had more negative opinions towards family planning services. Conclusions: University students lack knowledge about reproductive health and most of them agree that reproductive health education should be given in schools. Knowledge about reproductive health differs significantly depending on some sociodemographic variables. Some students have negative opinions towards family planning services and reproductive health education.