RESUMO
While considerable research has documented stigma toward key populations affected by HIV and AIDS - men who have sex with men (MSM), sex workers (SWs) - it provided limited empirical evidence on the presence of layered stigma among health-care professionals providing services for these populations. C-Change conducted a survey among 332 staff of health-care and social service agencies in Jamaica and The Bahamas to understand the levels of stigma toward people living with HIV (PLHIV), including MSM and SWs and factors associated with stigma. While most health-care professionals responding to the survey said that PLHIV, MSM, and SWs deserved quality care, they expressed high levels of blame and negative judgments, especially toward MSM and SWs. Across a stigma assessment involving eight vignette characters, the highest levels of stigma were expressed toward PLHIV who were also MSM or SWs, followed by PLHIV, MSM, and SWs. Differences were assessed by gender, country, type of staff, type of agency, and exposure to relevant training. Findings indicate higher reported stigma among nonclinical vs. clinical staff, staff who worked in general vs. MSM/SW-friendly health facilities, and among untrained vs. training staff. This implies the need for targeted staff capacity strengthening as well as improved facility environments that are MSM/SW-friendly.
Assuntos
Infecções por HIV/psicologia , Pessoal de Saúde , Homossexualidade Masculina , Profissionais do Sexo , Estigma Social , Serviço Social , Adulto , Atitude do Pessoal de Saúde , Bahamas/epidemiologia , Crime , Estudos Transversais , Atenção à Saúde , Medo , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/terapia , Pessoal de Saúde/educação , Pessoal de Saúde/psicologia , Necessidades e Demandas de Serviços de Saúde , Homossexualidade Masculina/psicologia , Humanos , Jamaica/epidemiologia , Masculino , Garantia da Qualidade dos Cuidados de Saúde , Profissionais do Sexo/psicologia , Serviço Social/educaçãoRESUMO
In the aftermath of the devastating Haitian earthquake, we became the primary relief service for a large group of severely injured earthquake victims. Finding ourselves virtually isolated with extremely limited facilities and a group of critically injured patients whose needs vastly outstripped the available resources we employed a disaster triage system to organize their clinical care. This report describes the specific injury profile of this group of patients, their clinical course, and the management philosophy that we employed. It provides useful lessons for similar situations in the future.
Assuntos
Planejamento em Desastres/organização & administração , Terremotos , Serviços Médicos de Emergência/organização & administração , Traumatismo Múltiplo/terapia , Triagem/organização & administração , Ferimentos e Lesões/terapia , Feminino , Haiti/epidemiologia , Humanos , Masculino , Incidentes com Feridos em Massa , Traumatismo Múltiplo/epidemiologia , Úlcera por Pressão/epidemiologia , Úlcera por Pressão/terapia , Sepse/epidemiologia , Ferimentos e Lesões/epidemiologiaRESUMO
Acute respiratory infections are the leading cause of childhood death in developing countries. Current efforts at mortality control focus on case management and immunization, but other preventive strategies may have a broader and more sustainable effect. This review, commissioned by the World Health Organization, examines the relations between pneumonia and nutritional factors and estimates the potential effect of nutritional interventions. Low birth weight, malnutrition (as assessed through anthropometry), and lack of breast-feeding appear to be important risk factors for childhood pneumonia, and nutritional interventions may have a sizeable effect in reducing deaths from pneumonia. For all regions except Latin America, interventions to prevent malnutrition and low birth weight look more promising than does breast-feeding promotion. In Latin America, breast-feeding promotion would have an effect similar to that of improving birth weights, whereas interventions to prevent malnutrition are likely to have less of an effect. These findings emphasize the need for tailoring interventions to specific national and even local conditions.
Assuntos
Estado Nutricional , Pneumonia/prevenção & controle , Aleitamento Materno , Pré-Escolar , Ensaios Clínicos como Assunto , Países em Desenvolvimento , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Pneumonia/complicações , Desnutrição Proteico-Calórica/complicações , Fatores de RiscoRESUMO
Immunohistochemical and in situ hybridization techniques were used to localize the beta 4 subunit of the neuronal nicotinic acetylcholine receptors (nAChRs) in the ground squirrel retina. The beta 4 nAChR subunit was detected in both transverse and horizontal sections of the retina using a subunit-specific antiserum and the avidin-biotin complex technique. Two bands of labeled processes were seen in the inner plexiform layer, corresponding approximately to the laminae where the cholinergic cells arborize. Labeled cells were found in the ganglion cell layer and the inner third of the inner nuclear layer. The cells in the ganglion cell layer were medium- to large-sized and were frequently observed to give rise to axon-like processes. Most of the labeled neurons in the inner nuclear layer were small presumptive amacrine cells, but a few medium-to-large cells were also labeled. These could constitute a different class of amacrine cells or displaced ganglion cells. The latter possibility is supported by the existence of nAChR-containing displaced ganglion cells in the avian retina. In situ hybridization with a 35S-labeled cRNA probe revealed the expression of mRNA coding for the nAChR beta 4 subunit in the ganglion cell layer and the inner third of the inner nuclear layer. This finding confirmed the immunohistochemical data of the cellular localization of beta 4 nAChR subunit. These results indicate that the beta 4 nAChR subunit is expressed by specific subtypes of neurons on the ground squirrel retina.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Receptores Nicotínicos/metabolismo , Retina/metabolismo , Acetilcolina/metabolismo , Animais , Técnicas Imunoenzimáticas , Hibridização In Situ , Neurônios/metabolismo , Sondas RNA , RNA Mensageiro/metabolismo , Receptores Nicotínicos/genética , Células Ganglionares da Retina/metabolismo , SciuridaeRESUMO
To settle the ongoing controversy regarding differential uridine diphosphoglucose (UDPG) and uridine diphosphogalactose (UDPGal) content of erythrocytes, which may be important in evaluating the metabolic abnormality in patients with galactosemia, we derived a combined enzymatic-high-performance liquid chromatography (HPLC) assay. Uridine diphosphoglucuronate (UDPGA), the unique product of UDPG dehydrogenase activity, was separated and quantified by HPLC in extracts of human erythrocytes. The quantity of UDPGA produced in cell filtrates incubated with the enzyme corresponds to the amount of UDPG directly determined by HPLC. The amount of UDPGA produced was independent of the enzyme purity or activity used. On the other hand, the amounts of UDPG estimated by fluorometric measurement of the production of reduced nicotinamide adenine dinucleotide varied with the enzyme purity and activity. The combined enzymatic-HPLC method confirms the direct determinations of UDPG content of normal erythrocytes. The results indicate that, under appropriate conditions, the fluorometric-based assay will give accurate estimates of UDPG, but the direct HPLC method yields consistent and correct UDPG and UDPGal determinations.
Assuntos
Cromatografia Líquida de Alta Pressão/métodos , Eritrócitos/química , Uridina Difosfato Glucose/sangue , Humanos , Valores de Referência , Uridina Difosfato Galactose/sangue , Uridina Difosfato Glucose/metabolismo , Uridina Difosfato Glucose DesidrogenaseRESUMO
Uridine sugar nucleotides are important intermediates in galactose metabolism and may play a role in the long-term galactose toxicity in human galactose-1-phosphate uridyltransferase deficiency galactosemia. Since administration of uridine, a precursor of uridine nucleotides, has been considered as a therapeutic measure, we have investigated the effects of this compound on the activity of rat hepatic transferase. Uridine has been found to be an inhibitor of the enzyme in in vitro studies and to cause an increase in galactose-1-phosphate in liver perfused with galactose which is consistent with physiologic inhibition of the enzyme. Uridine is a partial linear competitive inhibitor of UDPglucose and an uncompetitive inhibitor of galactose-1-phosphate. These findings suggest caution should be applied in giving the compound to subjects with genetically limited transferase activity because of the possibility of inhibiting the small amount of residual enzyme.