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The perinatal prognosis in cases of eclampsia could be improved if it were possible to predict its onset so that appropriate treatment could be given as early as possible. The investigators performed cerebral magnetic resonance imaging (MRI) in 41 women with severe preeclampsia in an attempt to identify ways in which this imaging procedure can be most effective. Six patients had systemic seizures and 14 had visual symptoms apart from retinal detachment. Urinary protein exceeding 2.5 g daily was noted in 12 cases. All patients received magnesium sulfate prophylactically, and some also received alpha methyldopa, labetalol hydrochloride, or calcium channel blockers such as nicardipine. All participants had MRI studies regardless of whether headaches or visual symptoms were part of the picture.Abnormal MR images were obtained in 11 patients, 9 with vasogenic edema and 3 with minor cerebral embolism. Vasoconstriction was observed in 4 cases. Six of the 11 patients with abnormal MRI findings had seizures. Abnormal cerebral MRI findings had a predictive accuracy of 85%. Only 14% of patients had been diagnosed by radiologic imaging. Diastolic blood pressure and elevated serum levels of liver enzymes predicted abnormal MRI findings with 83% accuracy. Thirty-three women underwent emergency cesarean section. Labor was induced in 5 cases, leading to vaginal delivery. Three women delivered spontaneously. The neonatal prognosis was consistently good, and all women recovered without sequelae.Although MRI may not be clinically cost-effective when done routinely in women with preeclampsia, it is recommended when delivery is delayed in those with severe preeclampsia. This is especially the case when diastolic blood pressure and liver enzymes are elevated. In women with eclampsia, MRI should be repeated until cerebral edema no longer is present. ABSTRACTPreterm birth (PTB) remains the leading cause of perinatal morbidity and mortality and also is associated with cerebral palsy and suboptimal performance at school. Adverse outcomes are especially likely if there is intrauterine infection and inflammation. Because of its subclinical nature, however, the diagnosis depends on examining amniotic fluid, a relatively invasive procedure. In this study, amniotic fluid and cervical fluid were evaluated, and the presence in the latter of interleukin (IL)-6 and IL-8 was related to microbial invasion of amniotic fluid, intraamniotic inflammation, and PTB in women with singleton pregnancies who were in preterm labor before 34 weeks gestation and whose membranes were intact. Cervical fluid was sampled from the external cervical os within 12 hours of admission in 91 women and amniotic fluid in 56. The polymerase chain reaction technique was used to detect Ureaplasma urealyticum and Mycoplasma hominis. Interleukins 6 and 8 were estimated by enzyme-linked immunosorbent assay.Women had a median gestational age of 30 weeks at the time of the study; 38% delivered before 34 weeks gestation. No woman had clinical chorioamnionitis. Although the presence o...

BackgroundTelehealth is the delivery of health care at a distance, using information and communication technology. The major rationales for its introduction have been to decrease costs, improve efficiency and increase access in health care delivery. This systematic review assesses the economic value of one type of telehealth delivery - synchronous or real time video communication - rather than examining a heterogeneous range of delivery modes as has been the case with previous reviews in this area.MethodsA systematic search was undertaken for economic analyses of the clinical use of telehealth, ending in June 2009. Studies with patient outcome data and a non-telehealth comparator were included. Cost analyses, non-comparative studies and those where patient satisfaction was the only health outcome were excluded.Results36 articles met the inclusion criteria. 22(61%) of the studies found telehealth to be less costly than the non-telehealth alternative, 11(31%) found greater costs and 3 (9%) gave the same or mixed results. 23 of the studies took the perspective of the health services, 12 were societal, and one was from the patient perspective. In three studies of telehealth to rural areas, the health services paid more for telehealth, but due to savings in patient travel, the societal perspective demonstrated cost savings. In regard to health outcomes, 12 (33%) of studies found improved health outcomes, 21 (58%) found outcomes were not significantly different, 2(6%) found that telehealth was less effective, and 1 (3%) found outcomes differed according to patient group. The organisational model of care was more important in determining the value of the service than the clinical discipline, the type of technology, or the date of the study.ConclusionDelivery of health services by real time video communication was cost-effective for home care and access to on-call hospital specialists, showed mixed results for rural service delivery, and was not cost-effective for local delivery of services between hospitals and primary care.

Telehealth, the delivery of health care services at a distance using information and communications technology, has been slow to be adopted and difficult to sustain. Researchers developing theories concerning the introduction of complex change into health care usually take a multifactorial approach; we intentionally sought a single point of intervention that would have maximum impact on implementation. We conducted a qualitative interview study of 36 Australian telehealth services, sampled for maximum variation, and used grounded theory methods to develop a model from which we chose the most important factor affecting the success of telehealth. We propose that clinician acceptance explains much of the variation in the uptake, expansion, and sustainability of Australian telehealth services, and that clinician acceptance could, in most circumstances, overcome low demand, technology problems, workforce pressure, and lack of resourcing. We conclude that our model offers practical advice to those seeking to implement change with limited resources.

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BackgroundSelf medication with antibiotics has become an important factor driving antibiotic resistance. This study investigated the period prevalence, patterns of use, and socio-demographic factors associated with self medication with antibiotics in Yogyakarta City Indonesia. This cross-sectional population-based survey used a pre-tested questionnaire which was self-administered to randomly selected respondents (over 18 years old) in Yogyakarta City Indonesia in 2010 (N = 625). Descriptive statistics, chi-square and logistic regression were applied.ResultsA total of 559 questionnaires were analyzed (response rate = 90%). The period prevalence of self medication with antibiotics during the month prior to the study was 7.3%. Amoxicillin was the most popular (77%) antibiotic for self medication besides ampicilline, fradiomisin-gramisidin, tetracycline, and ciprofloxacin to treat the following symptoms: the common-cold including cough and sore throat, headache, and other minor symptoms; with the length of use was mostly less than five days. Doctors or pharmacists were the most common source of information about antibiotics for self medication (52%). Antibiotics were usually purchased without prescription in pharmacies (64%) and the cost of the purchases was commonly less than US $1 (30%). Previous experience was reported to be the main reason for using non-prescribed antibiotics (54%). There were no socio-demographic variables significantly associated with the actual practice of using non-prescribed antibiotics. However, gender, health insurance, and marital status were significantly associated with the intent to self medicate with antibiotics (P < 0.05). Being male (Odds Ratio = 1.7 (1.2 - 2.6)) and having no health insurance (Odds Ratio = 1.5 (1.0 -2.3)) is associated with the intent to self medicate with antibiotics.ConclusionsThis study is the first population-based study of self-medication with antibiotics among the Indonesian population. Usage of non-prescribed antibiotics as well as intent of doing so is common across socio-demographic categories. Given the findings, factors influencing people's intentions to self medicate with antibiotics are required to be investigated to better understand such behavior. Impact of health insurance coverage on self medication with antibiotics should also be further investigated.

The context in which public health programmes operate can play an important role in influencing their implementation and effectiveness. An intervention that has been shown to be effective in one setting may turn out to be ineffective somewhere else, even supposing it can be implemented there. Therefore, systematic reviews of public health interventions should appraise the applicability of the intervention process and the transferability of the intervention effectiveness to other localities. However, applicability and transferability appraisal is seldom reported in systematic reviews of public health and health promotion interventions. This paper aims to introduce an innovative approach to bridging this gap. A list of attributes that may impact on applicability and transferability can be developed, based on knowledge of the proposed intervention. Then the applicability and transferability of the intervention to the local setting can be rated, and given a score, based on knowledge of the local setting. This approach provides a useful tool for evaluating public health interventions and provides a reliable basis for informed decision making in resource-poor settings, where rigorous primary studies are lacking and where very limited resources put a high demand on evidence-based approaches to health promotion.