ABSTRACT
Many kinds of body/mind practices are capable of producing remarkable behaviors and altered body states. A typology of such behaviors and states, defined as observable and intentional "extreme" alterations to the body, is presented. Epistemological and methodological issues are discussed: limitations of observational data, and role of meaning, intentionality, and consciousness. Rapprochement between Western medicine and Indo-Tibetan medicine requires rethinking biomedicine's radical grounding in physicality and reliance on "evidence-based medicine," and guarding against an ethnocentric Western intellectual hegemony motivating medical science and clinical practice to colonize and subvert non-Western traditions like Indo-Tibetan Buddhist medicine.
Subject(s)
Behavior/physiology , Cognition/physiology , Evidence-Based Medicine/methods , Brazil , Consciousness/physiology , Cross-Cultural Comparison , Humans , India , Medicine, Traditional , TibetABSTRACT
OBJECTIVE: To evaluate the effects of rituximab (anti-CD20 monoclonal antibody) on the disease course in pediatric patients with multisystem autoimmune diseases. METHODS: Four patients with multisystem autoimmune diseases refractory to conventional immunosuppressive medications, each with central nervous system (CNS) involvement, were treated with four weekly infusions of rituximab. Their clinical and laboratory responses were evaluated. RESULTS: Each of the patients had improvement in clinical symptoms and laboratory parameters. One patient with autoimmune cytopenias and autoimmune CNS and peripheral nervous system disease had resolution of the cytopenias and marked improvement in neurologic symptoms; he currently receives no immunosuppressive medications. Two half-siblings with lymphoplasmacytic colitis, pulmonary nodules, and CNS disease had improvement of their symptoms. A fourth patient with chorea and seizures secondary to primary antiphospholipid antibody syndrome had improvement in fine and gross motor function and reduced seizure frequency. There were no serious adverse events. CONCLUSIONS: The biologic response modifier rituximab, designed to eliminate B lymphocytes, was safe and effective in four pediatric patients with multisystem autoimmune disorders. It appears to be beneficial in autoimmune conditions presumably mediated by a variety of B-cell-related mechanisms, and may decrease or eliminate the need for other immunosuppressive medications.
Subject(s)
Antibodies, Monoclonal/therapeutic use , Antineoplastic Agents/therapeutic use , Autoimmune Diseases/therapy , Leukocytosis/complications , Leukocytosis/drug therapy , Neutropenia/drug therapy , Peripheral Nervous System Diseases/complications , Peripheral Nervous System Diseases/drug therapy , Purpura, Thrombocytopenic, Idiopathic/drug therapy , Adolescent , Antibodies/immunology , Antibodies, Monoclonal/administration & dosage , Antibodies, Monoclonal, Murine-Derived , Antineoplastic Agents/administration & dosage , Autoimmune Diseases/complications , Autoimmune Diseases/immunology , Bronchitis/complications , Child , Child, Preschool , Female , Humans , Male , Neutropenia/complications , Purpura, Thrombocytopenic, Idiopathic/complications , Purpura, Thrombocytopenic, Idiopathic/immunology , Rituximab , Sinusitis/complicationsABSTRACT
OBJECTIVE: To determine the effect of oral administration of low doses of pentobarbital on cytochrome P450 (CYP) isoforms and CYP-mediated reactions in immature Beagles. ANIMALS: 42 immature (12-week-old) Beagles. PROCEDURE: Dogs were grouped and treated orally as follows for 8 weeks: low-dose pentobarbital (50 microg/d; 4 males, 4 females), mid-dose pentobarbital (150 microg/d; 4 males, 4 females), high-dose pentobarbital (500 microg/d; 4 males, 4 females), positive-pentobarbital control (10 mg/kg/d; 2 males, 2 females), positive-phenobarbital control (10 mg/kg/d; 2 males, 2 females), and negative control (saline 10.9% NaCl] solution; 5 males, 5 females). Serum biochemical and hematologic values were monitored. On necropsy examination, organ weights were determined, and histologic evaluation of tissue sections of liver, kidney, small intestine, testes, epididymis, and ovaries was performed. Hepatic and intestinal drug-metabolizing enzyme activities were measured, and relative amounts of CYP isoforms were determined by western blot analysis. RESULTS: The amount of a hepatic CYP2A-related isoform in dogs from the high-dose pentobarbital treatment group was twice that of dogs from the negative control group. CYP2C was not detectable in small intestinal mucosa of dogs from the negative control group; measurable amounts of CYP2C were found in dogs from the various (low-, mid-, and high-dose) pentobarbital treatment groups and from positive-pentobarbital and positive phenobarbital control groups. Several CYP-mediated reactions increased in a dose-dependent manner. The lowest calculated effective dose of pentobarbital ranged from 200 to 450 microg/d. CONCLUSIONS AND CLINICAL RELEVANCE: Several CYP isoforms and their associated reactions were induced in dogs by oral administration of low amounts of pentobarbital.
Subject(s)
Cytochrome P-450 Enzyme System/biosynthesis , Dogs/metabolism , Pentobarbital/pharmacology , 7-Alkoxycoumarin O-Dealkylase/biosynthesis , Animals , Blotting, Western , Body Weight , Enzyme Induction/drug effects , Female , Intestinal Mucosa/drug effects , Intestinal Mucosa/enzymology , Isoenzymes/biosynthesis , Male , Microsomes, Liver/enzymology , Organ Size , Oxidoreductases, N-Demethylating/biosynthesis , Random AllocationABSTRACT
Examines consistency of self-reports of sexual activity among young adolescents in Jamaica. Reporting of sexual activity, especially among boys; Highlight of limitations of relying on self-reported data to identify sexually active adolescents.(AU)
Subject(s)
Adolescent , Female , Male , Sexual Behavior , Self Disclosure , Jamaica , Self-Evaluation Programs/methodsABSTRACT
Despite their increasing numbers, few of the sexuality education and pregnancy prevention programs in developing countries have been evaluated. This study, conducted in 1995-1997, assesses the impact of of a school-based sexuality education program, the Grade 7 Project, on 945 Jamaican seventh graders (aged 11-14) and their initiation of sexual activity and use of contraception at first intercourse, as well as the knowledge and attitudes that influence their behaviours. Using a quasi-experimental design, the studies measured the effect of the Grade 7 Project when the nine-month intervention was completed (short term) and one year after that (long term). Multivariate logistic regression analysis indicated that the project had no effect on initiation of sexual activity, but it had a positive short-term impact on the use of contraception at first intercourse (P = .08); adolescents in the intervention group were more than twice as likely to use contraception. The project also had a positive effect on several aspects of the adolescents' knowledge of and attitudes about sexuality and pregnancy. The modest impact of the Grade 7 Project is encouraging, as school-based sexuality education programs of limited duration rarely have a long-term impact. Moreover, competing socioeconomic and cultural forces in Jamaica encourage early sexuality and parenthood among adolescents. The use of more participatory teaching methods and smaller class sizes might strengthen the Grade 7 Project and enhance its impact. (AU)
Subject(s)
Child , Female , Humans , Male , Comparative Study , Adolescent , Sex Education , Contraception , Data Interpretation, Statistical , Evaluation Study , Follow-Up Studies , Jamaica , Health Knowledge, Attitudes, Practice , Pregnancy , Sexual Behavior , Time FactorsABSTRACT
Despite their increasing numbers, few of the sexuallity education and pregnancy preventative programs in developing countries have been evaluated. This study, conducted in 1995-1997, assesses the impact of a school-based sexuality education program, the Grade 7 Project, on 945 Jamaican seventh graders (aged 11-14) and their initiation of sexual activity and the use of contraception at first intercourse, as well as the knowledge and attitudes that influence their behaviors. Using a quasi-experimental design, the study measured the effects of the Grade 7 Project when the nine-month intervention was completed (short term) and one year after that (long term). Multivariate logistic regression analysis indicated that the project had no effect on initiation of sexual activity, but it had a positive short-term impact on use of contraception at first intercourse (P=.08); adolescents in the intervention group were more than twice as likely to use contraception. The project also had a positive short-term influence on several aspects of the adolescents' knowledge of and attitudes about sexuality and pregnancy. The modest impact of the Grade 7 project is encouraging, as school-based sexuality education programs of limited duration rarely have a long-term impact. Moreover, competing socioeconomic and cultural forces in Jamaica encourage early sexuality and parenthood among adolescents. The use of more participatory teaching methods and smaller class sizes might strengthen the Grade 7 Project and enhance its impact (AU)
Subject(s)
Humans , Adolescent , Adolescent Behavior , Jamaica , Sex Education/statistics & numerical data , Sexuality , Pregnancy in Adolescence , Caribbean RegionABSTRACT
Despite their increasing numbers, few of the sexuality education and pregnancy prevention programs in developing countries have been evaluated. This study, conducted in 1995-1997, assesses the impact of a school-based sexuality education program, the Grade 7 Project, on 945 Jamaican seventh graders (aged 11-14) and their initiation of sexual activity and use of contraception at first intercourse, as well as the knowledge and attitudes that ingluence their behaviors. Using a quasi-experimental design, the study measured the effects of the Grade 7 Project when the nine-month intervention was completed (short term) and one year after that (long term). Multivariate logistic regression analysis indicated that the project had no effect on initiation of sexual activity, but it had a positive short-term impact on use of contraception at first intercourse (P=.08); adolescents in the intervention group were more than twice as likely to use contraception. The project also had a positive short-term influence on several aspects of the adolescents' knowledge of and attitudes about sexuality and pregnancy. The modest impact of the Grade 7 Project is encouraging, as school-based sexuality education programs of limited duration rarely have a long-term impact. Moreover, competing socioeconomic and cultural forces in Jamaica encourage early sexuality and parenthood among adolescents. The use of more participatory teaching methods and smaller class sizes might strengthen the Grade 7 Project and enhance its impact
Subject(s)
Sex Education , Program Evaluation , Adolescent , Pregnancy in Adolescence , JamaicaABSTRACT
Despite their increasing numbers, few of the sexuality education and pregnancy prevention programs in developing countries have been evaluated. This study, conducted in 1995-1997, assesses the impact of a school-based sexuality education program, the Grade 7 Project, on 945 Jamaican seventh graders (aged 11-14) and their initiation of sexual activity and use of contraception at first intercourse, as well as the knowledge and attitudes that ingluence their behaviors. Using a quasi-experimental design, the study measured the effects of the Grade 7 Project when the nine-month intervention was completed (short term) and one year after that (long term). Multivariate logistic regression analysis indicated that the project had no effect on initiation of sexual activity, but it had a positive short-term impact on use of contraception at first intercourse (P=.08); adolescents in the intervention group were more than twice as likely to use contraception. The project also had a positive short-term influence on several aspects of the adolescents' knowledge of and attitudes about sexuality and pregnancy. The modest impact of the Grade 7 Project is encouraging, as school-based sexuality education programs of limited duration rarely have a long-term impact. Moreover, competing socioeconomic and cultural forces in Jamaica encourage early sexuality and parenthood among adolescents. The use of more participatory teaching methods and smaller class sizes might strengthen the Grade 7 Project and enhance its impact
Pese a su número creciente, son pocos los programas de educación sexual y prevención del embarazo que han sido evaluados en los países en desarrollo. Este estudio, realizado entre 1995 y 1997, evalúa en 945 escolares jamaiquinos de 7o grado (11 a 14 años de edad) el impacto de un programa escolar de educación sexual, el denominado "Proyecto de 7o grado", sobre la iniciación de su actividad sexual, el empleo de anticonceptivos durante el primer coito y los conocimientos y actitudes que influyen en sus comportamientos. Utilizando un diseño casi experimental, el estudio midió los efectos del proyecto al final de los nueve meses de intervención (corto plazo) y un año más tarde (largo plazo). El análisis de regresión logística multivariado reveló que el proyecto no tuvo efectos sobre la edad de inicio de la actividad sexual, aunque sí tuvo un impacto positivo a corto plazo sobre el empleo de anticonceptivos en el primer coito (P = 0,08); la probabilidad de utilizar anticonceptivos fue dos veces mayor en los adolescentes del grupo sometido a la intervención educativa. El proyecto también tuvo una influencia positiva a corto plazo sobre varios aspectos de los conocimientos y actitudes de los adolescentes hacia la sexualidad y el embarazo. El moderado impacto del proyecto es alentador, dado que los programas escolares de educación sexual de duración limitada raramente tienen impacto a largo plazo y que, además, en Jamaica existen fuerzas socioeconómicas y culturales antagónicas que alientan la sexualidad temprana y la paternidad entre los adolescentes. El empleo de métodos educativos más participatorios y la reducción del número de alumnos por clase podría fortalecer el "Proyecto de 7o grado" y aumentar su impacto
Subject(s)
Humans , Male , Female , Pregnancy , Adolescent , Pregnancy in Adolescence , Adolescent , Sex Education , Program Evaluation , JamaicaABSTRACT
Describes the attitudes and behaviour among low-income adolescents in Jamaica. Contributing factors to early sexual activity and pregnancy; Social pressure and encouragement among boys to be sexually active; Branding of young girls who become pregnant as having loose morals; Motivations for engaging in sex among girls and boys.(AU)
Subject(s)
Female , Male , Adolescent , Sexual Behavior , Adolescent Behavior , Jamaica , Pregnancy in Adolescence , Sex EducationABSTRACT
This paper reports an evaluation of a 3-year pilot community care project to extend 'hospice standards' of palliative care to nursing home residents in Nottingham. The evaluation involved two questionnaire surveys of all matrons of nursing homes with registered palliative care beds (39 and 43 matrons, respectively) and 35 interviews with a sample of local stakeholders selected to give a range of views regarding the project's impact. The interview sample included nursing home matrons (10) and care staff (7); nursing home residents and their relatives (4); community nurses (3); members of the Health Authority and Social Services (6); and local palliative care experts (5). Other sources of data included referral forms, evaluation of training sessions and a reflective account given by the project coordinator. The analysis used descriptive statistics to summarize the quantitative data and an iterative procedure to generate themes from the qualitative data. The overall perception of the project's impact was that it had helped to overcome the barriers that exist between NHS services and the independent sector. By providing assistance with individual care and access to specialist advice, equipment and training, the project was thought to have decreased the isolation experienced by staff and residents and improved equity of access to specialist palliative care for nursing home residents. Although it was widely agreed that the nursing home is an appropriate setting for palliative care, concern was expressed about the quality of care that can be given with mostly unqualified care staff. Ongoing needs for training and liaison between nursing homes and specialist palliative care services were identified.
Subject(s)
Anthropology , Cultural Diversity , Developing Countries , International Cooperation , Internationality , Patient Care , Risk Assessment , Risk , Social Values , Western World , Humans , Pharmaceutical Preparations , Sociology, Medical , South America , Withholding Treatment , Wounds and InjuriesABSTRACT
In order to improve the effectiveness and subtainability of the family planning programme, the National Family Planning Board has devised a strategy to shift users to longer-acting methods and increase the role of the private sector. To design interventions, a better understanding of existing services was thought to be necessary. This study examines the distribution of family planning service delivery points in Jamaica and the services offered by the public and private sectors through an examination of records and questionnaire interviews. The study found that, because of the concentration of private sector providers - the main outlets for longer-acting methods - in urban areas, rural areas had poor access to these methods. Because rural areas are not attractive to private sector providers, the public sector should recognize the need to continue to serve these areas (AU)
Subject(s)
Humans , Health Services Accessibility , Family Planning Services/supply & distribution , Family Planning Services , Urban Population , Rural Population , Family Planning Services/economics , Medically Underserved Area , Jamaica , ContraceptionABSTRACT
A new fee structure was introduced to the Advanced Training and Research in Fertility Management Unit in 1992. The study looked at the effect of the new fees on attendance and the choice of contraceptive methods through an examination of clinic records and a questionnaire survey. There was a decline in attendance of roughly 28 per cent between 1992 and 1993. The decline affected mainly new clients and those who accepted injectables. A reduction in the price of injectables is suggested since the fee for this short-term method is more in line with those charged for long-term and permanent methods. (AU)
Subject(s)
Humans , Female , Fees, Medical , Family Planning Services/economics , Family Planning Services/statistics & numerical data , Appointments and Schedules , Patient Dropouts/statistics & numerical data , Jamaica , Contraceptive Devices/statistics & numerical dataABSTRACT
Reports on a project aimed at importing the effectiveness and sustainability of Jamaica's National Family Planning Programme in light of the planned phasedown of international donor support particularly the reduction of USAID-donated contraceptive supplies. A "Mapping Study and Private Physicians Survey" was designed to collect background information on the existing infrastructure of service delivery points (SDPs)and a better undrestanding of physicians' skill and interest levels pertaining to long-term and permanent methods. This information would enable interventions to be designed that would target less-well-served areas offer appropriate incentives for private-practice physicians to become more involved in family planning, and meet specific needs among the private physician community as they try to become more involved. Among the noteworthy findings of this study are, given that a key goal of the project is to increase use of longer-acting methods, these methods are not readily available at affordable prices to rural consumers/patients ie. half the Jamaican population. long-term and permanent methods are concentrated in urban areas and offered primarily by private physicians. Short-term or supply methods were widely available to both urban and rural users and were quite affordable. Another significant finding is that private physicians have an interest in increasing their understanding of and involvement in family planning, widespread interest was expressed in the Private Physicians' Pilot Project. The private sector it was found offers the most SDPs, the widest range of methods and the greatest number of hours of operation, however, it is the public sector that provides the most services ie. about 60 percent of family planning services. These was a tendency for private sector providers to be concentrated in urban areas due to available supporting medical services; a further intra-urban clustering of private sector sites was also found; ther was a tendency among newer doctors to establish practices in urban areas outside of Kingston; a more evenly distributed pattern for public sector SDP was found, along with a clear emphasis on serving rural communities; an expansionary trend in terms of number of SDPs in urban areas is noticeable whereas a slight reduction in overall number of SDPs serving rural areas was noted. The recommendations are, to use the findings from this mapping study to plan future activities; to improve availability on long-term and permanent methods for rural groups; to encourage the private sector to increase its participation in family planning; to engage pharmacies and private physicians in expanded social marketingprogrammes; and that the social marketing programme be encouraged to expand its marketing support to include longer-acting methods.
Subject(s)
Family Planning Services , International Agencies , Jamaica , PhysiciansABSTRACT
Reports of a project aimed at importing the effectiveness and sustainability of Jamaica's National Family Planning Programme in light of the planned phasedown of international donor support particularly the reduction of USAID-donated contraceptive supplies. A "Mapping Study and Private Physicians Survey" was designed to collect background information on the existing infrastructure of service delivery points (SDPs)and a better undrestanding of physicians' skill and interest levels pertaining to long-term and permanent methods. This information would enable interventions to be designed that would target less-well-served areas offer appropriate incentives for private-practice physicians to become more involved in family planning, and meet specific needs among the private physician community as they try to become more involved. Among the noteworthy findings of this study are, given that a key goal of the project is to increase use of longer-acting methods, these methods are not readily available at affordable prices to rural consumers/patients ie. half the Jamaican population. long-term and permanent methods are concentrated in urban areas and offered primarily by private physicians. Short-term or supply methods were widely available to both urban and rural users and were quite affordable. Another significant finding is that private physicians have an interest in increasing their understanding of and involvement in family planning, widespread interest was expressed in the Private Physicians' Pilot Project. The private sector it was found offers the most SDPs, the widest range of methods and the greatest number of hours of operation, however, it is the public sector that provides the most services ie. about 60 percent of family planning services. These was a tendency for private sector providers to be concentrated in urban areas due to available supporting medical services; a further intra-urban clustering of private sector sites was also found; ther was a tendency among newer doctors to establish practices in urban areas outside of Kingston; a more evenly distributed pattern for public sector SDP was found, along with a clear emphasis on serving rural communities; an expansionary trend in terms of number of SDPs in urban areas is noticeable whereas a slight reduction in overall number of SDPs serving rural areas was noted. The recommendations are, to use the findings from this mapping study to plan future activities; to improve availability on long-term and permanent methods for rural groups; to encourage the private sector to increase its participation in family planning; to engage pharmacies and private physicians in expanded social marketingprogrammes; and that the social marketing programme be encouraged to expand its marketing support to include longer-acting methods. (AU)
Subject(s)
Family Planning Services , Family Planning Services , Jamaica , International Agencies , PhysiciansSubject(s)
Humans , Child , Female , Women, Working , Social Support , Feeding Behavior , Jamaica , Child Nutrition , Nutritional StatusABSTRACT
Survey attempts to explore the attitudes of young adults towards to sex education and sexual activity, the history of their sexual experience and the use of contraceptives and to arrest fertility trends among Jamaican youths. Project aimed to: to obtain the necessary data on sexual behaviour and contraceptive use of young adults and to provide information for the development of new programme strategy of existing national family planning programmes and strategies, provide information to develop new educational material in the national programme and to make available data for regional comparisons (AU)