Road traffic injury on rural roads in Tanzania: measuring the effectiveness of a road safety program.

OBJECTIVE: Road traffic injuries (RTIs) are a major public health burden, especially in low- and middle-income countries. There is limited data on RTIs in low-volume, rural African settings. This study attempted to survey all individuals living in households within 200 m of two low-volume rural roads in Tanzania and to collect data on RTIs. METHODS: Local communities and users of the Bago to Talawanda road (intervention site) and Kikaro to Mihuga road (control site) were targeted and received an intensive program of road safety measures tailored using the crash characteristics of the baseline sample. Demographic data on all household members were collected, and those individuals who suffered an RTI in the previous 3 months had comprehensive information collected about the crash characteristics and the socioeconomic impact. The follow-up data collection occurred nine months after the baseline data were collected. RESULTS: The majority of crashes that caused an RTI involved a motorcycle (71%) and the majority of victims were male (82%) with an average age of 27. Injuries to the legs (55%) were most common and the average length of time away from normal activity was 27 (±33) days. RTI incidence at the intervention site increased during the course of the study (incidence before vs. incidence after) and was unchanged in the community control (incidence before vs. incidence after). CONCLUSION: The incidence of RTIs in the low-volume rural setting is unacceptably high and most commonly associated with motorcycles. The change in incidence is unreliable due to logistic restraints of the project and more research is needed to quantify the impact of various RTI prevention strategies in this setting. This study provides insight into road traffic injuries on low-volume rural roads, areas where very little research has been captured. Additionally, it provides a replicable study design for those interested in collecting similar data on low-volume rural roads.

Out of time and out of pocket: experiences of women seeking state-subsidized insurance for abortion care in Massachusetts.

BACKGROUND: Massachusetts has implemented reforms aimed at providing universal health care coverage and covers abortion through subsidized state insurance programs. Three Massachusetts abortion funds evaluated their referral processes for low-income women from April to October 2010 to learn about women's experiences applying for subsidized insurance and to identify barriers to obtaining insurance or its use for abortion services. METHODS: Follow-up interviews were conducted with 39 low-income women thought eligible for subsidized insurance at least 1 month after their initial contact with the funds. RESULTS: Health insurance literacy was low, and participants reported confusion distinguishing between levels of subsidized insurance. The process of applying for subsidized insurance delayed a substantial proportion of procedures. More than two thirds of the women who applied for state coverage had become insured or expected to become insured shortly, but only one third of respondents who applied were able to secure insurance in time for their abortion care. Two women were unable to obtain abortions as a result of delays. Delays also limited low-income women's ability to obtain medication abortion. CONCLUSION: This analysis suggests that the process for enrolling in subsidized insurance does not currently meet the goal of providing women with coverage for abortion care (and other health needs) in a timely way. Systemic improvements are needed to ensure that enrollments are processed quickly and disruptions in coverage are minimized. Information resources should be developed to help women and their families understand health insurance and coverage of services.

Slow actions of neuroactive steroids at GABAA receptors.

Neuroactive steroids are potent and efficacious modulators of GABA(A) receptor activity and are potent sedatives and anesthetics. These positive modulators of GABA(A) receptors both potentiate the actions of GABA at the receptor and, at higher concentrations, directly gate the channel. The contribution of direct gating to the cellular and behavioral effects of neuroactive steroids is considered of little significance because it has been generally found that concentrations well above those needed for anesthesia are required to gate channels. By studying solitary glutamatergic neurons devoid of synaptic GABA input, we show that direct gating occurs and significantly alters membrane excitability at concentrations < or =100 nm. We propose that the relevance of direct gating has been overlooked partly because of the extremely slow kinetics of receptor activation and deactivation. We show that slow deactivation of directly gated currents does not result from an inherently tight ligand-receptor interaction because the slow deactivation is markedly accelerated by gamma-cyclodextrin application. We hypothesize that steroids access the relevant GABA(A) receptor site from a non-aqueous reservoir, likely the plasma membrane, and that it is slow reservoir accumulation and departure that accounts for the slow kinetics of receptor gating by neuroactive steroids.