Molecular characterization of cat factor XII gene and identification of a mutation causing factor XII deficiency in a domestic shorthair cat colony.

Coagulation factor XII (FXII) may be important in cardiovascular and inflammatory diseases. We have identified and characterized a naturally occurring mutation in the feline FXII gene that results in a mutant protein and enzymatic loss of activity. Feline intron/exon gene structure and sequence were acquired by comparing DNA sequences obtained from a fragmented Felis catus genomic sequence and the National Center for Biotechnology Information's Cross Species Megablast of multiple species' FXII gene sequences. Fourteen exons ranging in size from 57 to 222 base pairs were confirmed spanning 8 Kb on chromosome A1. The 1828-base pair feline FXII messenger RNA (mRNA) sequence contains an open reading frame that encodes a protein of 609 amino acids with high homology to human FXII protein. Total RNA and mRNA purified from liver tissue of 4 wild-type/normal and 8 FXII-deficient cats confirmed the predicted mRNA sequence and identified one important single-nucleotide polymorphism (SNP). A single base deletion in exon 11 of the FXII coding gene in our colony of cats results in deficient FXII activity. Translation of the mRNA transcript shows a frame shift at L441 (C441fsX119) resulting in a nonsense mutation and a premature stop codon with a predicted 560-amino acid protein. The mutant FXII protein is truncated in the 3' proteolytic light chain region of the C-terminus, explaining its loss of enzymatic activity. This study is the first molecular characterization of the feline FXII gene and the first identification of an FXII mutation in the domestic cat, providing insights into the origin and nature of feline FXII deficiency.

Tell me what you mean by "sí": perceptions of quality of prenatal care among immigrant Latina women.

Individual perceptions form the basis of many health research reports related to access, utilization, continuity, and quality. Many health care providers are not well equipped for designing studies or collecting data with immigrant populations. In this article, the authors examine issues in data collection on topics related to perceptions of quality of prenatal care among immigrant Latino populations. The conceptual model is Donabedian's framework for quality. Two instruments--a qualitative interview with photographs representing components of quality and a questionnaire--were used for data collection. Examples of narrative responses given by women in response to the photo-narrative prompts are presented and compared to shorter survey responses. The authors emphasize the importance of designing research instruments that reflect the perceptions of the research subjects rather than simply those of the investigators.

The influence of maternal intergenerational education on health behaviors of women in peri-urban Bolivia.

The influence of maternal education on infant mortality has been demonstrated repeatedly in health and social science literature. Less explored is the influence of the education level of the mother's mother. In the present paper the authors examine the possible effect of grandmother's education on maternal behaviors. The relationship between intergenerational education and selected health behaviors, including utilization of health services for prenatal care, breast-feeding and family planning, are reported. The data were collected in peri-urban Santa Cruz, Bolivia among mothers of infants between 0 and 18 months of age. It appears that grandmother's education does exert an effect on health behaviors above and beyond the effect of maternal education. This effect is more pronounced for health services which fall clearly in the domain of the formal health care system. While the results are exploratory, the results suggest the worth of further study and consideration of the influence of mothers' mothers in the design of culturally sensitive quality health services.

Explaining the birth weight paradox: Latina immigrants' perceptions of resilience and risk.

In the US, prenatal care is positively associated with improved birth outcomes. However, among Mexican-born Latinos, rates of low birth weight are lower than those of US-born counterparts despite the fact that recently arrived Latino immigrants are less likely to have received adequate prenatal care. The "birth weight paradox," identified through analysis of the HHANES, appears to hold constant across variations in age, marital status or educational attainment. The authors explore Latina immigrant's perceptions of resilience factors related to these better birth outcomes through focused group interviews, photonarratives, and documentation of local kin networks. The women's responses are grouped into five resilience factors and one risk complex that have the potential to further explain the HHANES findings. Women's responses, the stories of their photographs, and kin networks are presented. Knowledge of these protective and risk factors can be useful to health professionals and Latino advocacy groups in the design of community-based interventions that protect health status and promote the practice of protective health behaviors within immigrant families and communities.

From efficacy to effectiveness: selecting indicators for a community-based lactational amenorrhoea method promotion programme.

This paper reviews the results of clinical trials and community studies of lactational amenorrhoea and its role as a contraceptive method (LAM). Indicators which are used in efficacy trials and effectiveness interventions are compared and sets of indicators of effectiveness appropriate to community-based LAM programmes are recommended. A five-tiered ecological framework is used to facilitate selection of indicators which range from individual to policy level outcomes. The indicator framework is intended as a tool for health practitioners in family planning and maternal and child health service delivery settings who are interested in designing programmatic interventions for the promotion of LAM, particularly among less well-educated women of lower socioeconomic communities.

PIP: If lactational amenorrhea (LAM) is to reach its full potential as a method of child spacing, additional programmatic interventions must be conducted at the community level--especially in developing countries--to demonstrate its effectiveness. A review of clinical trials and community studies of LAM conducted both before and after the Bellagio Consensus Conference was undertaken in order to develop a set of indicators for the effectiveness of LAM promotion efforts under a range of field conditions. The resultant framework is intended as a tool for health professionals in family planning and maternal-child health service delivery settings who are interested in designing community-based LAM programs. A 5-tiered (individual, interpersonal, community, health system, and macro-policy factors) ecological systems model was used as the framework for indicator development. Laboratory, physiological, and behavioral measures were rated and weighted according to their scientific rigor (quality of data collected, technical feasibility), administrative feasibility (cost to administer, time required and likelihood of compliance), and community appropriateness (cultural sensitivity, contribution to women's knowledge and skills). Included among the suggested indicators are hormonal levels in urine or blood samples, timing of first vaginal bleed, duration of breast feeding, use of pacifiers or nipples, breast feeding knowledge and cultural influences, number of breast feeds per 24 hours, and frequency of intercourse.

Oral contraceptives and hormone replacement therapy do not increase the incidence of arterial thrombosis in a nonhuman primate model.

Older oral contraceptive (OC) formulations containing high doses of potent synthetic estrogens and progestins are associated with increased risk of thrombosis. To examine the effects of current low-dose OC and hormone replacement therapy (HRT) regimens on arterial thrombosis, premenopausal and surgically postmenopausal cynomolgus monkeys were divided into four treatment groups. Premenopausal monkeys were given either no OCs or ethinyl estradiol and levonorgestrel as an OC at a dose equivalent to that currently given to women. Postmenopausal monkeys were given either no HRT or conjugated equine estrogens and medroxyprogesterone as an HRT at a dose equivalent to that currently given to women. The monkeys were fed an atherogenic diet containing these treatments for 27 to 30 months. At the end of this time, arterial thrombosis was evaluated with a standardized stenosis/injury procedure in the left carotid artery. Blood flow velocity was monitored for cyclic or permanent occlusive thrombosis. The current OC and HRT regimens did not increase the susceptibility of the artery wall to develop an occlusive thrombus following injury and stenosis. In fact, there was a reduction in the incidence of thrombosis in the OC animals compared with untreated controls. Increased amounts of atherosclerosis were associated with an increased incidence of occlusive arterial thrombosis. Several selected coagulation parameters [von Willebrand factor, protein C, lipoprotein(a), and platelet aggregation] did not appear to be associated with either the amount of atherosclerosis or incidence of arterial thrombosis.

Integrated use of qualitative and quantitative methods to elicit women's differential knowledge of breastfeeding and lactational amenorrhea in periurban Bolivia.

PIP: Exclusive and extended breast feeding is responsible for much of the fertility limitation and child spacing throughout the world. In many developing countries, where breast feeding is almost universal and of long duration, postpartum amenorrhea protects women from closely spaced subsequent pregnancies. However, at the same time, increased pressures toward modernization, rapid rural-to-urban migration, frequent advertisements of powdered milk substitutes, and the increased employment of women outside of the home are adversely affecting traditional breast feeding practices. In Bolivia, almost all women breast feed their newborn infants, for periods up to 2 years. This paper reports findings which describe and compare patterns of women's differential knowledge of breast feeding and lactational amenorrhea resulting from data collection using a survey instrument and a focus group guide. The findings are part of a larger study on infant feeding and child spacing conducted in periurban communities in Bolivia. Current and historical trends with regard to paradigm and methodology in social science research are reviewed and the survey/focus group research method is described.^ieng

Assessment of infant and early childhood development in a periurban Bolivian population.

PIP: A study was conducted of infant development in Quintanilla Area, a group of recently settled communities in periurban Cochabamba, Bolivia. The research was a substudy of a larger investigation supported by the World Health Organization (WHO) into the changing patterns of breast-feeding and child spacing. 400 mothers with children aged 6-18 months were enrolled in the WHO study and interviewed in the household setting during June-July 1991. The infant development substudy administered the Bayley Scales of Infant Development (BSID) to a convenience sample of 18 boys and 12 girls of these mothers. With a mean score of 100 and a standard deviation of 15, the BSID provides a Mental Development Index and a Psychomotor Developmental Index. Scores more than 1.5 standard deviations below the mean can be indicative of developmental delay. Three boys and three girls, or 20% of the infants in this study were found to have scores more than 1.5 standard deviations below the mean and may therefore be considered to potentially be developmentally disabled. Compared to the US, a larger proportion of children in this study was disabled. 20% is also at the high end of UNICEF and UNESCO estimates. The authors note that one third of the mothers of children with suspected disabilities received no prenatal care, but each of these women was attended by a physician at the birth of the child. No prenatal care and the attendance of a physician at delivery, in this environment, is often indicative of an high-risk delivery potentially including conditions such as placenta previa, prolonged labor, and asphyxiation of the newborn. High-risk delivery may also be the result of trauma associated with traditional practices such as manteo, during which a pregnant woman is swung and bounced in a blanket or hammock with the goal of repositioning the fetus. The authors also caution the possibility that convenience sampling and small sample size may have over-identified children with developmental delays compared to other children of their same cultural background.^ieng

The focus group as a tool for health research: issues in design and analysis.

The focus group is a technique for eliciting information from specific population subgroups. Issues addressed may be little known or relatively well known to the researcher. The method is most effectively used when the objective of the investigation is to elicit points of view of client or consumer groups which may differ from those of providers. Despite the frequency with which focus groups are used, few published materials describe the practical application of the method. This paper presents a detailed methodology for the conduct of focus groups and analysis of focus-group data with the intention of improving its use among researchers and health-care professionals. Data from two studies, immunization compliance in West Africa, and barriers to use of prenatal-care services in Bolivia, are used as illustrative examples.

Infant feeding in Bolivia: a critique of the World Health Organization indicators applied to demographic and health survey data.

Infant feeding is a multidimensional activity that can be described and analysed in many different ways. The World Health Organization (WHO) has recently issued recommended indicators for assessing infant feeding practices. This paper presents these indicators and demonstrates their applications using the 1989 Demographic and Health Survey (DHS) data for Bolivia. The results indicate that, although most Bolivian infants are breastfed and two-thirds are breastfed for > 1 year, supplementary feeding practices deviate considerably from international recommendations. Only 58% of infants < 4 months old are receiving breastmilk alone (the 'exclusive breastfeeding rate') and a similarly low percentage (54.7%) of 6-9 month olds are receiving the recommended combination of breast milk plus solid or semi-solid foods (the 'timely complementary feeding rate'). Furthermore, almost half of breastfed infants < 12 months old are also receiving bottle feeds. The infant feeding practices of city residents are least likely to conform to the infant feeding recommendations, while practices of mothers who have always lived in the country are most likely to be similar to the WHO guidelines. Mothers who have moved to the city since the age of 12 are most likely to be giving their infants other milks in addition to breast milk and to be bottle feeding their infants. The WHO infant feeding indicators provide a useful framework for quantifying infant feeding practices, and most of the indicators can readily be applied to DHS data. Nonetheless, improvements can be made in both the indicators themselves and the DHS questionnaire to improve reporting of internationally comparable infant feeding information.

PIP: 1989 Demographic and Health Survey data for Bolivia is used to examine trends in World Health Organization (WHO) designated breast feeding measures. WHO measures are evaluated. WHO measures are the exclusive breast feeding rate (under 4 months), predominant breast feeding with supplementation of nonmilk liquids (under 4 months), timely complementary feeding rate, continuous breast feeding rate for children aged 12-15 months, bottle feeding rate, ever breast fed rate, and median duration of breast feeding. The timely complementary feeding rate or those 6-9 months receiving solid or semisolid foods is 55%. The continuous feeding rate is 66% for the 12-15 month old infants, and just under 50% for infants aged 20-23 months. Almost 50% of breast feeding infants also receive bottle feeding. 97% are ever breast fed. The median duration of breast feeding is 17 months. At under 4 months 57.6% receive both breast milk and other milk and not solids, and 8% are not breast fed. At 6-9 months 54.7% are receiving breast milk and solids, and almost 33% receive breast milk and other milk. About 15% are not being breast fed. At 10-11 months about 15% are still being exclusively breast fed, and almost 25% are not being breast fed at all. At 12 months about 4% receive breast milk and no solids. Exclusive breast feeding occurs among just under 50% of mothers who have always lived in the city and among those who migrated to the city. The highest rates are among women who lived in the country. The greatest differences in breast feeding are among mothers who always either lived in a city or the country. The lowest complementary feeding rate occurs in the city-always group (39.3%). The highest complementary feeding rate occurs among the town group (73.1%). Continued breast feeding is lowest in the city-always group. The highest proportion of infants receiving bottles is among infants with mothers who migrated to the city (72.0%) followed by city-always mothers (60.1%). The WHO indicators are found to be useful standards for guiding research and developing policy and practice norms.

Rural origin as a risk factor for maternal and child health in periurban Bolivia.

Rapid migration in Latin America is settling rural women and their families next to those of urban origin in sprawling urban settings. Those born and reared in rural areas bring with them knowledge and skills learned and adapted to rural areas; those same skills may be maladaptive in urban areas. Hypothesized is that urban women of rural origin are more likely to have poorer health outcomes for themselves and their children than lifelong urban counterparts. Identification of specific risk factors affecting child and/or maternal health status in peri-urban barrios can assist health workers to target limited resources to those least likely to access available services.

Bacterial cell wall polymers (peptidoglycan-polysaccharide) cause reactivation of arthritis.

Intraperitoneal (i.p.) injection of peptidoglycan-polysaccharide derived from group A streptococci (PG-APS) causes chronic arthritis with spontaneous remissions and exacerbations. We hypothesized that, following i.p. injection, PG-APS released from hepatic stores mediated spontaneous recurrences of arthritis. We tested whether transplanted livers with large amounts of PG-APS were able to reactivate quiescent arthritis. Saline-loaded (group 1) or PG-APS-loaded (group 2) livers were transplanted into rats which had been injected intra-articularly 10 days earlier with PG-APS in one joint and saline in the other. A comparison was made with the arthritis that occurred in rats injected i.p. with PG-APS which did not receive transplants (group 3). Arthritis was monitored by serial measurement of joint diameters. Transplantation of saline-loaded livers (group 1) caused no reactivation of arthritis. However, transplantation of PG-APS-loaded livers (group 2) reactivated arthritis (P < 0.0001). Injection of PG-APS i.p. (group 3) induced the most-severe arthritis. PG-APS levels in plasma decreased with time, and PG-APS accumulated in the spleen in groups 2 and 3. Plasma and hepatic levels of PG-APS in rats injected i.p. with PG-APS were greater than levels in rats transplanted with PG-APS-loaded livers, which in turn were greater than levels in rats with saline-loaded livers. Plasma tumor necrosis factor did not correlate with recurrence of arthritis. Transplantation with PG-APS-loaded livers induced reactivation of arthritis in preinjured joints. The extent of arthritis was proportional to hepatic PG-APS content. Reactivation of arthritis may be mediated by slow release of liver-sequestered PG-APS or cytokines (not tumor necrosis factor) released by the liver.

Validation of self-report of literacy among periurban women in Bolivia.

Many surveys ask women to rate their literacy level, but the validity of these self-reports is not usually evaluated. In this study of infant health, conducted in Cochabamba, Bolivia, maternal literacy was assessed by the mother herself and by the interviewer, based on the mother's reading a short text aloud. The two ratings were highly correlated (P < 0.001). This finding suggests that maternal self-reports of literacy are very reliable.

Maternal and infant feeding practices in rural Bolivia.

Seventy-four members of mothers' clubs in a rural area outside of La Paz, Bolivia, were interviewed in order to learn more about maternal and infant nutritional practices and use of child health services. Most of the women used a combination of western and traditional child health services, though a substantial percentage used only traditional services. Almost all of their deliveries were attended solely by family members, most notably the pregnant woman's husband. All the interviewed mothers breast-fed their infants, although most gave them other prelacteal liquids in the immediate postpartum period. Breast milk supplementation generally began when the infants were between four and eight months old, occasionally later. Most of those interviewed said they stopped breast-feeding when they knew they were pregnant again; some continued breast-feeding through all or part of the pregnancy; only a small number stopped breast-feeding before they knew that they were pregnant. Almost all the women increased their food intake when they were breast-feeding, primarily by consuming additional liquids. These findings suggest that some current maternal and infant nutritional practices in the study area (such as universal breast-feeding and increased consumption of liquids by lactating mothers) should be encouraged, while others (particularly prelacteal feeding of liquids other than breast milk and late supplementation) should be discouraged. Both traditional and western health providers should be mobilized to perform this task.

Improving vaccination completion rates in liberia: evaluation of an intervention trial.

Reported are findings from an evaluation of a community-based strategy employing local chiefs and traditional midwives as extenders of the Ministry vaccination team for the purpose of increasing vaccination completion in Liberia, West Africa. The intervention strategy-a training workshop and two subsequent supervisory visits-was selected from among those generated in Stage 1 of a three-stage operational research design. Evaluation of the intervention was carried out after an eight-month follow-up period. Visits to intervention and control villages, for the purpose of interviewing chiefs, traditional midwives (TMs) nand mothers of children under one year of age, were the means by which data were gathered. Both process and outcome indicators were identified as means of assessing the effectiveness of the strategy. Vaccination rosters and holding of a town meeting were used as evidence of the former. A vaccination coverage survey using a cluster sample methodology was used to evaluate differences in vaccination coverage. Results showed that knowledge about vaccination, treatment of side effects and the importance of the RTH Card was greater among chiefs/TMs and mothers in the intervention districts than in control districts. Coverage rates for fully immunized children were greater in the intervention districts (56% intervention vs. 45% control). When stratified by type of leadership, coverage rates were higher in intervention districts where TMs rather than chiefs served as vaccination team extenders, although chiefs were more effective than controls. As a result of this study, the Ministry of Health has decided to extend this activity into other counties and to add additional information on other PHC messages.

The health needs of the majority versus the health needs of the individual: the reorganization of medical education in Colombia.

The challenge of excellence in community health services has been taken up by medical educators in Colombia. Confronted with a nation where the primary indicators of disease mortality and morbidity (cardiovascular disease and infant mortality) were characteristic of First and Third World patterns, respectively, the Ministry of Health and La Asociacion Colombiana de Facultades de Medicina (ASCOFAME), representatives of institutions of medical education, have collaborated to conduct a needs assessment of the country's health needs and devised an implementation plan designed to better address the needs of the majority of that nation's people. As a model, the Colombian reorganization of medical education is an example which could be emulated by the U.S. where policy makers are struggling with troublesome questions of cost, equity and quality.

A review of dietary interventions aimed at controlling hypertension.

Before planning programs to change dietary behavior in groups of individuals, evidence about the effectiveness of different interventions is needed. Articles published in the journals indexed by Index Medicus between the years 1975-84 were reviewed for evidence concerning the effectiveness of dietary modification programs in achieving dietary change. All program evaluations published in English and aimed at control of blood pressure levels in adults were eligible for review. Twenty-nine articles relevant to the synthesis contained sufficient information evaluating the contribution of dietary intervention. These 20 studies addressed changes in fat consumption, reduction in salt intake and reduction in calories consumed. The methods of intervention ranged from residential programs, through individual counseling and group discussion involving spouses, to audiovisual tapes. The studies had varying periods of follow-up; among those with one or more years of follow-up, a number of studies were able to demonstrate effectiveness using different outcome measures. For some dietary components, notably changes in fat intake and reduction in salt consumption, it has been possible to identify a minimal effective intervention, such as self-help materials or individual instruction, while changes in calorie intake or weight seem to require group counseling with family member involvement. The findings from this information synthesis should prove useful to those planning dietary interventions.

Bridging the gap: the village health worker as the cornerstone of the primary health care model.

The Alma-Ata Conference in 1978 reiterated the goal of 'Health for All by the Year 2000' and declared primary health care (PHC) the vehicle through which this lofty goal was to be achieved. National governments were recognized as responsible agents for developing and implementing PHC plans. The emphasis on community-oriented delivery of care places great importance on the village health worker (VHW), the individual who serves as the 'interface' between the formal health care system and the community. Despite the acknowledged importance of the VHW role, the question of whether the PHC model, with the VHW as the cornerstone can be effectively implemented without a "fundamental shift of wealth and power" (Sidel) continues to be asked. This paper examines the evolution and current status of the VHW role in Costa Rica, Nicaragua and Columbia, three Latin American nations which have adopted the PHC model. The authors discuss the evolution of the PHC model in each country with particular reference to the occurrence or non-occurrence of fundamental changes in the society. The conclude that the primary determiner of successful implementation of PHC is a national commitment to PHC including recognition of the importance of community participation which is best achieved through reliance on the village health worker.