Community Involvement For Women's Health: Mechanisms Within Primary Care Services

Community Involvement For Women’s Health: Mechanisms Within Primary Care Services The Women.s Health Council is a statutory body established in 1997 to advise the Minister for Health and Children on all aspects of women.s health. Following a recommendation in the Report of the Second Commission on the Status of Women (1993), Developing a Policy for Women’s Health. A Discussion Document was published in 1995. One of the recommendations in the Plan was a proposal that a Women’s Health Council be set up as a centre of expertise on women.s health issues, to foster research into women.s health, evaluate the success of this Plan in improving women’s health and advise the Minister for Health on women’s issues generally. Click here to download PDF 644kb  

Food and Nutrition Guidelines for Primary Schools

Food & Nutrition Guidelines for Primary Schools The Government has identified school children as one group to be given priority during the planning and delivery of programmes and initiatives for good health throughout life. In the Governmentâ?Ts National Health Promotion Strategy 2000/2005, the two major objectives for children are: Click here to download PDF 458kb

Parents and primary care physicians have different views about copying medical letters to parents after paediatric outpatient visits.

AIM: We assessed how satisfied parents were when they received a copy of the letter sent to their primary care physician after their child attended a hospital outpatient clinic and compared their views with those of the primary care physician. METHODS: Anonymised questionnaires were sent to parents, and their primary care physician, after their child had visited a paediatric nephrology unit. RESULTS: We received responses from 112 parents (46%) and 69 primary care physicians (93%). Most parents (97%) were satisfied with the process, 94% thought that the letter was a true reflection of the outpatient consultation and easy to understand, and 55% read it to their child. However, 21% would have preferred a simpler letter. More than a third (37%) of the primary care physicians did not approve of the parents being sent the letter, and 30% felt that the letter was difficult for the parents to understand and should be replaced with a simpler letter. CONCLUSION: Most parents (97%) appreciated receiving a copy of the letter following their child's outpatient clinic visit, and 95% understood its contents. More than half (55%) read the letter to their child. However, 37% of primary care physicians did not approve of the practice.

Food & Nutrition Guidelines for Primary Schools

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Community Involvement For Women's Health: Mechanisms Within Primary Care Services

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The National Primary Care Steering Group - Progress Report

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Primary Care - A New Direction

Primary Care: A New Direction acknowledges the central role of primary care in the future development of our health services and proposes the introduction of an inter-disciplinary team-based approach which will be introduced on a phased basis using existing infrastructure and encouraging the use of public-private partnerships where practical. Download the Report here

On separation of a degenerate differential operator in Hilbert space

A coercive estimate for a solution of a degenerate second order di fferential equation is installed, and its applications to spectral problems for the corresponding dif ferential operator is demonstrated. The suffi cient conditions for existence of the solutions of one class of the nonlinear second order diff erential equations on the real axis are obtained.

Reduction of the hand representation in the ipsilateral primary motor cortex following unilateral section of the corticospinal tract at cervical level in monkeys.

BACKGROUND: After sub-total hemi-section of cervical cord at level C7/C8 in monkeys, the ipsilesional hand exhibited a paralysis for a couple of weeks, followed by incomplete recovery of manual dexterity, reaching a plateau after 40-50 days. Recently, we demonstrated that the level of the plateau was related to the size of the lesion and that progressive plastic changes of the motor map in the contralesional motor cortex, particularly the hand representation, took place following a comparable time course. The goal of the present study was to assess, in three macaque monkeys, whether the hand representation in the ipsilesional primary motor cortex (M1) was also affected by the cervical hemi-section.¦RESULTS: Unexpectedly, based on the minor contribution of the ipsilesional hemisphere to the transected corticospinal (CS) tract, a considerable reduction of the hand representation was also observed in the ipsilesional M1. Mapping control experiments ruled out the possibility that changes of motor maps are due to variability of the intracortical microstimulation mapping technique. The extent of the size reduction of the hand area was nearly as large as in the contralesional hemisphere in two of the three monkeys. In the third monkey, it represented a reduction by a factor of half the change observed in the contralesional hemisphere. Although the hand representation was modified in the ipsilesional hemisphere, such changes were not correlated with a contribution of this hemisphere to the incomplete recovery of the manual dexterity for the hand affected by the lesion, as demonstrated by reversible inactivation experiments (in contrast to the contralesional hemisphere). Moreover, despite the size reduction of M1 hand area in the ipsilesional hemisphere, no deficit of manual dexterity for the hand opposite to the cervical hemi-section was detected.¦CONCLUSION: After cervical hemi-section, the ipsilesional motor cortex exhibited substantial reduction of the hand representation, whose extent did not match the small number of axotomized CS neurons. We hypothesized that the paradoxical reduction of hand representation in the ipsilesional hemisphere is secondary to the changes taking place in the contralesional hemisphere, possibly corresponding to postural adjustments and/or re-establishing a balance between the two hemispheres.

Regulation of membrane trafficking and organ separation by the NEVERSHED ARF-GAP protein.

Cell separation, or abscission, is a highly specialized process in plants that facilitates remodeling of their architecture and reproductive success. Because few genes are known to be essential for organ abscission, we conducted a screen for mutations that alter floral organ shedding in Arabidopsis. Nine recessive mutations that block shedding were found to disrupt the function of an ADP-ribosylation factor-GTPase-activating protein (ARF-GAP) we have named NEVERSHED (NEV). As predicted by its homology to the yeast Age2 ARF-GAP and transcriptional profile, NEV influences other aspects of plant development, including fruit growth. Co-localization experiments carried out with NEV-specific antiserum and a set of plant endomembrane markers revealed that NEV localizes to the trans-Golgi network and endosomes in Arabidopsis root epidermal cells. Interestingly, transmission electron micrographs of abscission zone regions from wild-type and nev flowers reveal defects in the structure of the Golgi apparatus and extensive accumulation of vesicles adjacent to the cell walls. Our results suggest that NEV ARF-GAP activity at the trans-Golgi network and distinct endosomal compartments is required for the proper trafficking of cargo molecules required for cell separation.

Ruling out coronary heart disease in primary care patients with chest pain : a clinical prediction score

ABSTRACT: BACKGROUND: Chest pain raises concern for the possibility of coronary heart disease. Scoring methods have been developed to identify coronary heart disease in emergency settings, but not in primary care. METHODS: Data were collected from a multicenter Swiss clinical cohort study including 672 consecutive patients with chest pain, who had visited one of 59 family practitioners' offices. Using delayed diagnosis we derived a prediction rule to rule out coronary heart disease by means of a logistic regression model. Known cardiovascular risk factors, pain characteristics, and physical signs associated with coronary heart disease were explored to develop a clinical score. Patients diagnosed with angina or acute myocardial infarction within the year following their initial visit comprised the coronary heart disease group. RESULTS: The coronary heart disease score was derived from eight variables: age, gender, duration of chest pain from 1 to 60 minutes, substernal chest pain location, pain increases with exertion, absence of tenderness point at palpation, cardiovascular risks factors, and personal history of cardiovascular disease. Area under the receiver operating characteristics curve was of 0.95 with a 95% confidence interval of 0.92; 0.97. From this score, 413 patients were considered as low risk for values of percentile 5 of the coronary heart disease patients. Internal validity was confirmed by bootstrapping. External validation using data from a German cohort (Marburg, n = 774) revealed a receiver operating characteristics curve of 0.75 (95% confidence interval, 0.72; 0.81) with a sensitivity of 85.6% and a specificity of 47.2%. CONCLUSIONS: This score, based only on history and physical examination, is a complementary tool for ruling out coronary heart disease in primary care patients complaining of chest pain.

Pathogenèse, dépistage et prise en charge de l'anévrysme de l'aorte abdominale

RESUME L'anévrysme de l'aorte abdominale est une dilatation permanente et localisée de l'aorte abdominale d'un diamètre transverse supérieur à 30 mm. Il s'agit d'une maladie dégénérative et inflammatoire fréquente de l'aorte, présente chez environ 5% des hommes de 65 à 74 ans de la population générale, et chez 10% des hommes hospitalisés pour une revascularisation coronarienne chirurgicale. En effet, bien que la pathogenèse de l'anévrysme de l'aorte abdominale diffère de celle du processus d'athérosclérose, les deux maladies partagent de nombreux facteurs de risque, en particulier l'âge, l'hypertension artérielle et le tabagisme. L'anévrysme de l'aorte abdominale est une maladie silencieuse, et dans 20% des cas, sa première manifestation clinique est la rupture aiguë avec choc hémorragique. La mortalité totale d'une telle complication dépasse 90% et sa mortalité strictement opératoire est d'environ 50%. Ces chiffres contrastent étonnamment avec une mortalité inférieure à 5% en cas de cure chirurgicale élective de l'anévrysme, justifiant un programme de dépistage systématique de cette maladie par ultrasonographie abdominale. Plusieurs études ont actuellement prouvé l'efficience de tels programmes, tant du point de vue de leur impact sur la mortalité que de leur rapport coût-efficacité. La question d'un dépistage systématique de la population générale ou de celui de souspopulations sélectionnées en fonction de leurs facteurs de risque reste toutefois débattue. La prise en charge de l'anévrysme de l'aorte abdominale est en principe conservatrice pour les anévrysmes de faibles diamètres, la mortalité d'une telle approche étant comparable à celle d'une attitude d'emblée chirurgicale. L'indication opératoire est par contre posée pour les anévrysmes d'un diamètre supérieur à 55 mm en raison du risque inacceptable de rupture, la valeur du diamètre transverse de l'aorte représentant le facteur prédictif de rupture le plus fréquemment utilisé en pratique quotidienne. La cure chirurgicale ouverte est le traitement de référence de l'anévrysme de l'aorte abdominale, mais la cure minimale invasive par endoprothèse, disponible depuis le début des années 1990, représente une alternative attrayante. Le choix de l'approche thérapeutique dépend fortement des caractéristiques anatomiques de l'aorte, ainsi que des comorbidités et de la préférence du patient.

Characterization of [Ca2+]i responses in primary cultures of mouse cardiomyocytes induced by Trypanosoma cruzi trypomastigotes

Trypanosoma cruzi, the protozoan responsible for Chagas disease, employs distinct strategies to invade mammalian host cells. In the present work we investigated the participation of calcium ions on the invasion process using primary cultures of embryonic mice cardiomyocytes which exhibit spontaneous contraction in vitro. Using Fura 2-AM we found that T. cruzi was able to induce a sustained increase in basal intracellular Ca2+ level in heart muscle cells (HMC), the response being associated or not with Ca2+ transient peaks. Assays performed with both Y and CL strains indicated that the changes in intracellular Ca2+ started after parasites contacted with the cardiomyocytes and the evoked response was higher than the Ca2+ signal associated to the spontaneous contractions. The possible role of the extracellular and intracellular Ca2+ levels on T. cruzi invasion process was evaluated using the extracellular Ca2+ chelator EGTA alone or in association with the calcium ionophore A23187. Significant dose dependent inhibition of the invasion levels were found when intracellular calcium release was prevented by the association of EGTA +A23187 in calcium free medium. Dose response experiments indicated that EGTA 2.5 mM to 5 mM decreased the invasion level by 15.2 to 35.1% while A23187 (0.5 µM) alone did not induce significant effects (17%); treatment of the cultures with the protease inhibitor leupeptin did not affect the endocytic index, thus arguing against the involvement of leupeptin sensitive proteases in the invasion of HMC.