Introducing quality management into primary health care services in Uganda.

In 1994, a national quality assurance programme was established in Uganda to strengthen district-level management of primary health care services. Within 18 months both objective and subjective improvements in the quality of services had been observed. In the examples documented here, there was a major reduction in maternal mortality among pregnant women referred to Jinja District Hospital, a reduction in waiting times and increased patient satisfaction at Masaka District Hospital, and a marked reduction in reported cases of measles in Arua District.

Tuberculosis screening and anergy in a homeless population.

Background: Tuberculosis has again emerged as a growing public health concern in the United States. Among the homeless population, increased risk factors contribute to immunodeficiency, which can cause false-negative results on purified protein derivative (tuberculin) (PPD) skin testing, the standard screening procedure for tuberculosis in individuals. We evaluated the accuracy of PPD skin test results by determining anergy status of patients when offering the PPD test.

Costs and financing of improvements in the quality of maternal health services through the Bamako Initiative in Nigeria.

This paper reports on a study to assess the quality of maternal health care in public health facilities in Nigeria and to identify the resource implications of making the necessary quality improvements. Drawing upon unifying themes from quality assurance, basic microeconomics and the Bamako Initiative, locally defined norms were used to estimate resource requirements for improving the quality of maternal health care. Wide gaps existed between what is required (the norm) and what was available in terms of fixed and variable resources required for the delivery of maternal health services in public facilities implementing the Bamako Initiative in the Local Government Areas studied.

Concepts and methods for assessing the quality of essential obstetric care.

Approaches to reducing maternal mortality and morbidity have attracted much attention in the last decade. It is recognized that availability and use of essential obstetric care (EOC) of sound quality by women in labor would reduce the burden of illness and death resulting from pregnancy. However, the literature on methods for defining, assessing and improving the quality of EOC at the point of service delivery in developing countries is quite weak.

Potato growth in a porous tube water and nutrient delivery system.

Potato (Solanum tuberosum L.) cv. 'Norland', vegetative growth and tuber productivity grown in the porous water and nutrient delivery system (PTNDS) developed by the Wisconsin Center for Space Automation and Robotics were compared with the vegetative growth and tuber productivity of plants grown in a peat:vermiculite potting mixture (PT/VR).

Overdentures. Principles and procedures.

Although advances in methods and improved materials have contributed to better treatment results, caries and periodontal problems still remain significant threats to overdenture service life. The prevention of caries and recurrent periodontal disease thus becomes a most important aspect of postinsertion care. Undoubtedly, there are a number of successful overdenture methods.

Health policy approaches to measuring and valuing human life: conceptual and ethical issues.

To achieve more cost-effective and equitable use of health resources, improved methods for defining disease burdens and for guiding resource allocations are needed by health care decision makers. Three approaches are discussed that use indicators that combine losses due to disability with losses due to premature mortality as a measure of disease burden. These indicators can also serve as outcome measures for health status in economic analyses.

The prognostic factors in the prenatal diagnosis of the echogenic fetal lung.

The prenatal diagnosis of an echogenic fetal lung (EFL) is now often made in the early second trimester using high-resolution ultrasound. This ultrasound appearance is usually caused by a congenital cystic adenomatoid lung malformation (CCAM), an intrapulmonary lung sequestration or obstruction of a major airway. In order to provide prognostic guidelines to parents who may be considering termination of a fetus with these findings, we have analysed a series of 11 cases diagnosed in our centre over the past 2 years in conjunction with 60 cases from major published series.

Midtrimester thoracoamniotic shunting for the treatment of fetal hydrops.

The management of fetal hydrops in the second trimester is changing as the underlying etiologies are better understood. We report a case which was diagnosed at 18 weeks gestation. There was no underlying anatomical abnormality.

Reduced placental villous tree elaboration in small-for-gestational-age pregnancies: relationship with umbilical artery Doppler waveforms.

Objective: Our purpose was to investigate the three-dimensional architecture of placental villi from normal and growth-restricted fetuses and relate findings to umbilical artery blood flow velocity waveforms.

Study Design: Placentas from term (n = 15) and preterm (n = 5) appropriately grown and term (n = 9) and preterm (n = 7) growth-restricted fetuses (birth weight < 10th percentile) were examined to determine the number of arteries per stem villus and the three-dimensional configuration of the villous trees and their vessels. Umbilical blood flow before delivery was assessed by Doppler ultrasonography.

Improving physicians' preventive health care behavior through peer review and financial incentives.

We assessed improvement of preventive health care behaviors by physicians in an independent practice association-health maintenance organization. A before-after, 3-year study of a defined cohort measured changes through chart audit, accompanied by peer review, feedback, and financial incentives. Outcome measures consisted of rates of mump-measles-rubella (MMR) immunization, screening for cholesterol levels, and charting adequacy.

The ASTROCULTURE(TM) flight experiment series, validating technologies for growing plants in space.

A flight experiment, ASTROCULTURE(TM)-1 (ASC-1), to evaluate the operational characteristics and hardware performance of a porous tube nutrient delivery system (PTNDS) was flown on STS-50 as part of the U.S. Microgravity Laboratory-1 mission, 25 June to 9 July, 1992.

Fetal blood transfusion.

The concept of transfusing the fetus in utero is simple, but its success demands an experienced, dedicated team, with excellent laboratory back-up. High-resolution ultrasound has enabled us to sample fetal blood. This allows immediate, precise assessment and rational treatment of the anemic fetus, with improved outcome for all such fetuses and, particularly, for the hydropic, moribund group.

Vascular responsiveness in the unstressed borderline hypertensive rat.

This study compares vascular responses of unstressed borderline hypertensive rats (BHR) to age-matched Wistar-Kyoto (WKY) and spontaneously hypertensive rats (SHR). Rings of thoracic aorta were mounted for isometric force determinations in tissue baths. Cumulative additions of phenylephrine (PE) or serotonin (5-HT) produced contractile responses in BHR aorta that were less than WKY but greater than SHR.

Use of Laplace transform analysis to describe the effect of placental embolisation on umbilical arterial Doppler waveforms in fetal sheep.

This is the first study to investigate changes in umbilical arterial Doppler shift waveforms caused by placental embolisation in fetal lambs described by a Laplace transform analysis method. The complete maximum velocity envelope of the waveform was quantified mathematically by the coefficients of the Laplace transform. The changes in the dominant coefficient were significantly correlated with changes in umbilico-placental vascular resistance.

Value of faecal alpha-1-antitrypsin, haemoglobin and a chemical occult blood test in the detection of gastrointestinal disease.

Specimens from hospital out-patients and in-patients sent for faecal occult blood tests were also analysed for faecal alpha-1-antitrypsin and faecal haemoglobin. 453 stool specimens from 222 patients were analysed. The clinicians were only aware of the faecal occult blood test results, and diagnoses were made using conventional clinical and investigative criteria.

Quality assurance management methods applied to a local-level primary health care system in rural Nigeria.

Introduction. Management of primary health care (PHC) systems in less developed countries is often impeded by factors such as poorly trained personnel, limited financial resources, and poor worker morale. This study explored the ability of local-level PHC supervisors in rural Nigeria to use quality assurance (QA) management methods to improve the quality of the PHC system.

Silver acetate mouth spray as an aid in smoking cessation: results of a double-blind trial.

Background: We studied the use of an aversive technique to improve the outcome of smoking-cessation efforts. We hypothesized that a silver acetate mouth spray, which produces a strong aversive taste when cigarettes are smoked, would increase the quit rate among smokers.

Methods: Our study was a double-blind, placebo-controlled trial that was carried out in a private family practice office in an urban area.

Absent end-diastolic flow velocity waveforms in the umbilical artery--the subsequent pregnancy.

Objective: Our purpose was to assess the recurrence risk, course, and outcome of subsequent pregnancies in women with absent umbilical end-diastolic velocity.

Study Design: Absent umbilical end-diastolic velocity was detected in 88 women. Sixteen of them were prospectively followed up in their 19 subsequent pregnancies.

Prenatal diagnosis and management of anterior abdominal wall defects in the west of Scotland.

An attempt was made to identify all the cases of abdominal wall defects occurring in the West of Scotland over a 7-year period to determine the current incidence, prenatal diagnosis, management, and prognosis for fetuses and neonates with abdominal wall defects. Cases were identified because they presented either for prenatal diagnosis, or to the Department of Pathology following termination or spontaneous pregnancy loss, or as neonates to the Neonatal Surgical Department. The incidence of abdominal wall defects was found to be 1 in 2500 births.