Medicine sellers' perspectives on their role in providing health care in North-West Cameroon: a qualitative study.

BACKGROUND: Increasing recognition of the importance of medicine sellers in low-resource settings has emerged alongside assumptions that their motives and capacities primarily relate to profit maximization. This article suggests a need to reframe thinking about the role of medicine sellers in developing country health systems. METHODS: We used in-depth interviews to explore perceptions of medicine seller roles among a restricted random sample of 20 medicine sellers in North-West Cameroon. Interviews and analysis explored self-perception of their work/role, community perceptions, skills and knowledge, regulation, future plans, links with the formal health system and diversity among medicine sellers. RESULTS: Medicine sellers in our study were a varied, yet distinct group. They saw themselves as closely integrated in the social and medical landscapes of clients. Although some client interactions were described as simple sales, many respondents presented themselves as gatekeepers of medicines and knowledge, reflecting a conceptualization of the distinctness of medicines over other commodities. Acknowledgement of limits in knowledge and resources led to recognition of the need for formal healthcare providers and justified a restricted scope of practice and the need for referral. Motivation was derived from a desire for both financial and social capital combined with a proximity to medicines and repeated exposure to ill health. Legitimacy was perceived to be derived from: a historical mandate; informal and formal training and effective 'community regulation'. CONCLUSIONS: The distinct role that medicine sellers describe themselves as occupying in this study area can be characterized as provision of 'first aid', urgent, reactive and sometimes providing intermediate care prior to referral. Medicine sellers suggest that they do not aspire to be doctors and emphasize the complementary, rather than competitive, nature of their relationship with formal providers. We discuss the challenges and opportunities of characterizing medicine sellers as a distinctive group of 'first aiders' in this setting.

Nerve growth factor-treated, neurite-bearing PC12 cells continue to synthesize DNA.

Cultures of rat pheochromocytoma (PC12) cells treated with beta-nerve growth factor (NGF) for up to 15 days continue to synthesize DNA. The present study compares the extent of maintained DNA synthesis in cells with and without processes and asks whether the observed DNA synthesis in differentiated PC12 cells reflects either the continued division of the cells or the formation of polyploid cells, or both. PC12 cells were grown on tissue coverslips for various lengths of time with or without 50 ng/ml of beta-NGF and then assayed for DNA synthesis by [3H]thymidine labeling and autoradiography. In 8-day-old control cultures (no NGF), 30% of the cells had labeled nuclei after a 2-hr [3H]thymidine pulse. In contrast, in cultures treated for 8 days with NGF, only 7% of the cells were labeled (i.e., still synthesizing DNA). The fractions of process-bearing and non-process-bearing cells with labeled nuclei were identical. Even after 14 days in NGF, 7% of the cells with neurites were still synthesizing DNA during any 2-hr period. With continuous [3H]thymidine labeling in the presence of NGF from 8 to 13 days, nearly 70% of the cells with neurites were labeled. The presence of neurites induced by NGF does not preclude continued (albeit reduced) DNA synthesis in these PC12 cells. To determine the fate of this newly synthesized DNA, nuclei extracted from NGF-treated PC12 cells were analyzed for the cellular distribution of DNA by combined propidium iodine staining and flow microfluorimetry. NGF treatment resulted in a 3-fold increase in the number of G2+M/4N cells along with the appearance of 8N cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of auditory brainstem response and behavioral audiometry in infants.

Sixty-three normal hearing infants, ranging from 1 to 12 months of age, were evaluated with Behavioral Observation Audiometry (BOA), Visual Reinforcement Audiometry (VRA), and Auditory Brainstem Response Audiometry (ABR). BOA thresholds decreased with increasing age for infants 0 to 6 months of age, while ABR threshold were essentially constant as a function of subject age. In general, VRA threshold were obtained only for infants over 4 months of age, and were relatively constant for the age range of 4 to 12 months. For neonates, BOA thresholds were significantly higher than ABR thresholds. BOA, VRA, and ABR thresholds tended to converge at a subject age of approximately 6 months, with VRA yielding the lowest and BOA the highest threshold. ABR provided the most consistent threshold for all subjects tested, regardless of age.