An assessment of community health workers in Nicaragua.

In 1981, the Ministry of Health of Nicaragua began a series of health campaigns whose front-line workers were volunteers from the community called 'brigadistas.' These volunteers have since evolved into a type of community health worker with a multi-disciplinary role and are now called 'primary health care brigadistas'. These brigadistas were formed with the intention of encouraging local community involvement in health and as a means of overcoming rural health manpower shortages. However, in field research at two sites, these primary health care brigadistas were found to have rather limited roles and were dependent upon the nurse auxiliary for direction. A current debate in the Ministry of Health centers around the future role of the brigadistas and their degree of accountability to the Ministry of Health and the Popular Organizations. This article suggests that the brigadistas may be underutilized at present and that increasing their training and expanding their role may be necessary to adequately meet rural health care needs.

Neuronal degeneration is observed in multiple regions outside the hippocampus after lithium pilocarpine-induced status epilepticus in the immature rat.

Although hippocampal sclerosis is frequently identified as a possible epileptic focus in patients with temporal lobe epilepsy, neuronal loss has also been observed in additional structures, including areas outside the temporal lobe. The claim from several researchers using animal models of acquired epilepsy that the immature brain can develop epilepsy without evidence of hippocampal neuronal death raises the possibility that neuronal death in some of these other regions may also be important for epileptogenesis. The present study used the lithium pilocarpine model of acquired epilepsy in immature animals to assess which structures outside the hippocampus are injured acutely after status epilepticus. Sprague-Dawley rat pups were implanted with surface EEG electrodes, and status epilepticus was induced at 20 days of age with lithium pilocarpine. After 72 h, brain tissue from 12 animals was examined with Fluoro-Jade B, a histochemical marker for degenerating neurons. All animals that had confirmed status epilepticus demonstrated Fluoro-Jade B staining in areas outside the hippocampus. The most prominent staining was seen in the thalamus (mediodorsal, paratenial, reuniens, and ventral lateral geniculate nuclei), amygdala (ventral lateral, posteromedial, and basomedial nuclei), ventral premammillary nuclei of hypothalamus, and paralimbic cortices (perirhinal, entorhinal, and piriform) as well as parasubiculum and dorsal endopiriform nuclei. These results demonstrate that lithium pilocarpine-induced status epilepticus in the immature rat brain consistently results in neuronal injury in several distinct areas outside of the hippocampus. Many of these regions are similar to areas damaged in patients with temporal lobe epilepsy, thus suggesting a possible role in epileptogenesis.