Optogenetically stimulating intact rat corticospinal tract post-stroke restores motor control through regionalized functional circuit formation.

Current neuromodulatory strategies to enhance motor recovery after stroke often target large brain areas non-specifically and without sufficient understanding of their interaction with internal repair mechanisms. Here we developed a novel therapeutic approach by specifically activating corticospinal circuitry using optogenetics after large strokes in rats. Similar to a neuronal growth-promoting immunotherapy, optogenetic stimulation together with intense, scheduled rehabilitation leads to the restoration of lost movement patterns rather than induced compensatory actions, as revealed by a computer vision-based automatic behavior analysis. Optogenetically activated corticospinal neurons promote axonal sprouting from the intact to the denervated cervical hemi-cord. Conversely, optogenetically silencing subsets of corticospinal neurons in recovered animals, results in mistargeting of the restored grasping function, thus identifying the reestablishment of specific and anatomically localized cortical microcircuits. These results provide a conceptual framework to improve established clinical techniques such as transcranial magnetic or transcranial direct current stimulation in stroke patients.

The variant methylenetetrahydrofolate reductase c.1298A>C (p.E429A) is associated with multiple sclerosis in a German case-control study.

Multiple sclerosis (MS) is an inflammatory demyelinating autoimmune disease of the central nervous system. We investigated the association of two missense variants of the MTHFR gene, i.e. MTHFR c.677C>T (p.A222V) and c.1298A>C (p.E429A), in 138 patients with clinically definite multiple sclerosis of relapsing-remitting course and 138 age- and gender-matched healthy controls. No significant differences were found in the frequency of the MTHFR c.677C>T polymorphism between MS patients and healthy controls. However, the genotype frequencies of the missense variant MTHFR c.1298A>C were significantly different between patients (AA/AC/CC: 0.34/0.55/0.11) and controls (0.52/0.36/0.12; Pearson's chi(2)=11.1; p=0.004). These results suggest that homozygosity for the A allele of MTHFR c.1298A>C may be protective against the incidence of MS. If confirmed in an independent study sample, the underlying mechanisms should be investigated, which may lead to novel insights in biochemical factors influencing the aetiology and pathophysiology of MS.

Emergency contraception: Who are the users?

CONTEXT: Data collected from two community family planning services are used to discuss the characteristics of users of emergency contraception (EC). OBJECTIVE: To investigate the characteristics of women attending for emergency contraception. DESIGN: A descriptive survey design was used to collect data. Questionnaires were completed over a 4-week period. Data were analysed using SPSS. SETTING: Community family planning services in South West Surrey and Newham, East London. PARTICIPANTS: Consenting women aged 14-44 years attending for emergency contraception (n = 171). MAIN OUTCOME MEASURES: Description of the users, the current episode and contact with contraceptive services were analysed by age. RESULTS: The age range was 14-37 years (mean 20.2 years). A majority were smokers. Of the women, 97.7% attended the clinic within the 72-hour time frame for issuing oral EC, however only 4% came within 12 hours of intercourse; 55% said that they had used contraception. Condom breakage was the commonest reason for failure. Reasons for not using contraception included getting 'carried away' (35%), not having condoms available (22%) and having drunk alcohol (13%). Of the sample 55.6% were previous users of EC. DISCUSSION: The study demonstrates a high incidence of sexual risk taking and need for EC, especially amongst smokers and drinkers. The message that soonest is best still requires promotion. Providers of EC must co-ordinate their services to ensure access within the 12-hour time frame in a local area. CONCLUSION: Health professionals need to ensure that clients have appropriate information about EC and regular contraceptive methods and that user friendly provision is widely available.

Repeated use of hormonal emergency contraception by younger women in the UK.

A cohort of women aged 14-29 in 1993 was identified from the General Practice Research Database and followed up for a period of 4 years. Patient files were searched for evidence of use of emergency contraception and regular contraception. Of the 95 007 women, 15 105 (16%) had received emergency contraception during the study period (an average of 5% per annum). There was a small year on year increase in uptake of emergency contraception between 1994 and 1997. Only 4% of emergency contraception users received emergency contraception more than twice in any year. More than 70% of those who had no previous record of use of regular contraception had used regular contraception within 1 year of using emergency contraception. Teenagers were more likely than other age groups to use emergency contraception, to be repeat users of emergency contraception and to fail to start regular contraception after first use of emergency contraception until later in the study period. These results disprove the notion of widespread repeated use of emergency contraception. They show that provision of an emergency contraception service does not result in failure to initiate regular contraception or abandonment of regular contraception; rather they show many women using regular contraception for the first time after use of emergency contraception.

The epidemiology of dementia in Africa: a review.

Very few of the 100 studies of the prevalence of dementia have been carried out in Africa. Much of the early work concerned small hospitalised samples. However, a series of studies from Ibadan, Nigeria, have produced consistently low rates for dementia, especially for Alzheimer's Disease. The most recent studies reveal rather higher rates, but still lower than surveys carried out elsewhere. The possible reasons for these findings are considered: differential survival rates, the hiding of cases by relatives because of stigma, reluctance to seek medical assistance as inappropriate, poor access to medical care, the feeling that the old person has come to the end of his useful life and defective case-finding techniques. The need for further research is emphasised.

Patterns of prescription of PC4 by general practitioners in England and Wales.

OBJECTIVE: To study the pattern of general practitioner prescribing of PC4, the most commonly used method of hormonal emergency contraception, in England and Wales. METHOD: The UK General Practice Research Database was used to identify, from a total population of 4.2 million people on the lists of contributing practices, all women aged 10-44 years who were prescribed PC4. Rates of prescribing were calculated to produce rates over time by age group, by day of week and month of year, and by region. RESULTS: The rate for PC4 prescribing rose from about 1.5 per 1,000 women per month in 1992 to about 3.0 in 1995, then remained relatively constant until 1998. Rates were highest among 15-19-year-old women and next highest among those aged 20-24 years. Rates were higher in Wales than in each of the English regions. Excesses of prescribing took place in the summer months and between Saturdays and Mondays. CONCLUSION: Reasons for the increase in PC4 prescribing rates in the early years of the study are unclear, although increasing knowledge of the technique among the population may have contributed. There was no evidence of an increase in prescribing following the pill scare of October 1995, although there was an increase some months earlier. The concentration of requests at weekends suggests the need for weekend access to emergency contraception. The summer peak may also indicate a heightened need in holiday areas at that time.

Are we providing for ethnic diversity in accident & emergency (A&E) departments?

OBJECTIVES: The aim of the study was to find what data on ethnicity are collected in North Thames Accident & Emergency (A&E) departments. Also to investigate how the data are used, what staff recruitment and training policies were in place, and to discover whether written material in different languages and interpreters were available. METHODS: This was a qualitative study using semi-structured questionnaires. A range of staff working in A&E departments in North Thames (that had a primary care initiative in place) were interviewed. RESULTS: Ethnic origin was recorded in all units but not on every patient. Only one unit had actively recruited staff from an ethnic minority. None of the units had formal training in place for staff to gain an appreciation of issues facing patients from ethnic minorities. Interpreters and written material in appropriate languages were available in all units. CONCLUSIONS: Whilst the needs of patients from ethnic minorities were recognised in all of the units there appeared to be scope for further research and development. There is a need for providers to undertake comprehensive studies on the utilisation and health needs of ethnic minorities attending both primary care and A&E services. Only with this information can more appropriate services be provided.

Influences on the care of demented elderly people in the People's Republic of China.

The elderly population of the People's Republic of China is increasing rapidly. Yet few studies of dementia have been carried out outside the large cities. Prevalence rates are approaching those in the West. Influences on the system of care for demented old people include the growth of one-child families; decreasing levels of filial care; changing levels of residential care provision; a low level of specialist medical care and other welfare services; a low level of public awareness of dementia; and the weakening of the extended family, associated especially with urbanization and the increasing mobility of labour. These trends may create a difficult situation for dementia sufferers and their carers.

The geography of dementia: an approach through epidemiology.

Dementia is an extremely common condition among the elderly. Over 100 epidemiological surveys have now been published from many countries. Methodological differences make comparisons difficult, although meta-studies carried out in Europe provide baseline material for developed countries. Surveys within each geographical area which has been studied are discussed. Differences in the distribution of sub-types of dementia and the resultant challenges to governments and researchers are set out.

Teenage mothers as breastfeeders: attitudes and behaviour.

Surveys have repeatedly shown that teenage mothers are less likely to breastfeed than older mothers. A sample of 55 young mothers and expectant mothers contacted through agencies caring for young mothers revealed that decisions about breastfeeding are sometimes left till late in the pregnancy, and that breastfeeding is often of short duration. Only about half had discussed breastfeeding with a health worker. As with older mothers, the partners and the teenagers' own mothers often influenced their decision, sometimes in a hostile way. Many young mothers had never witnessed breastfeeding at first-hand. These results suggest ways in which breastfeeding could be more successfully promoted among young mothers.

Jewish and Celtic attitudes to breast feeding compared.

OBJECTIVE: To examine reasons for the high rate of breast feeding among one UK ethnic group (Jews) and the low rate among Celtic (Scots and Irish) populations. DESIGN: A manual literature search of ethnic variation in breast feeding rates in the UK was conducted over several years. A computerised search yielded 31 additional references. Seven of these were added. ANALYSIS: Positive Jewish attitudes to breast feeding were underpinned by scriptural references, and rates of breast feeding were found to be especially high among Orthodox samples in the UK and Israel. Low Scottish and Irish rates appear to reflect prudishness, fashion, and possibly poor health. Reasons for falling rates among these populations in the twentieth century were not clear. IMPLICATIONS FOR PRACTICE: Health education needs to address cultural attitudes throughout society if effective change is to be introduced, and the overall rate of breast feeding is to be increased.

Socio-cultural and economic aspects of AIDS in Uganda: a review.

AIDS is long-established in Uganda; prevalence rates are high. Most transmission is by heterosexual intercourse, and has been associated with population movements, especially of traders. Treatment resources are very limited and expensive. Some sexual practices inhibit contraceptive use. Attitudes towards AIDS and its testing reveal contradictions, although contraceptive knowledge is widespread. Folk beliefs have not been studied. Government guidelines have been produced, although these do not inform clinical attitudes. Indications suggest that prevalence in the long-term may be decreasing.

PIP: As of the end of 1995, 48,312 AIDS cases had been reported from all parts of Uganda since the first cases of AIDS in the country were recognized in 1982. An estimated 1.5 million of Uganda's almost 20 million population are thought to be infected with HIV, with evidence suggesting that there was exposure to HIV before 1973. In the rural areas of Rakai and Masaka, 12-13% of the population over age 12 years is HIV-positive. AIDS is therefore highly prevalent in Uganda and transmitted largely through heterosexual intercourse. The spread of HIV in Uganda is also associated with population movements, especially those of traders. AIDS and the demography of Uganda, the spread of AIDS, treatment, public attitudes, folk beliefs, contraceptive use, multiple sex partners, and health service responses are discussed. The severe shortage of appropriate and necessary resources combined with the heavy AIDS patient caseloads have overwhelmed Ugandan hospitals. There is some evidence of a decline in HIV prevalence in Uganda.

Afro-Surinamese women in The Netherlands: sexual education, the initiation of sex, and contraceptive use.

Surinamese women in Holland have a higher fertility rate and a much higher abortion rate than Dutch women in general. A sample of 60 Surinamese women throughout Holland were interviewed about their experience of sexual education, their initial sexual experiences, their use of contraception and pregnancies. Factors in their sexual career associated with a heightened risk of an unplanned pregnancy are recorded.

Senile dementia in Japan: prevalence and response.

Early studies of the prevalence of dementia in Japan indicated low rates, but more recently rates have been rising to the levels shown in other countries. Extended family care of the elderly has been typical, but recent developments suggest that this is declining. The implications of recent social changes for the care of the demented elderly are discussed.

Strategies to promote breastfeeding in inner cities.

Women's decisions whether to breastfeed are influenced by a number of powerful factors, not least of which are poverty, class and ethnic culture. Breastfeeding rates are falling overall, yet some ethnic minority groups have higher rates than the white UK population. Bernard Ineichen discusses the issues, and proposes some strategies for action.