We report the results of a randomized controlled multicentre study on interferon-gamma (IFN-gamma) treatment of systemic sclerosis as determined by skin sclerosis, renal and other organ involvement, global assessment, subjective symptoms and quality of life. Forty-four patients were enrolled into the trial, 27 in the treatment group and 17 in the control group. All patients presented with type I or type II scleroderma. Twenty-nine patients (64%) finished the study. The mean duration of Raynaud's phenomenon and skin sclerosis was 15.3 and 10.8 years, respectively. The skin scores tended to improve in the treatment group (P > 0.05). Mouth aperture increased significantly from 38.5 to 47.7 mm in the treatment group (P < 0.001). Subanalysis of IFN-gamma treated patients with normalized skin sclerosis scores >/=1 showed significant improvement in both skin involvement and subjective symptoms (P < 0.05). Organ involvement improved in eight of 18 treatment patients and in three of 11 control patients. It worsened in three of 18 treatment patients and in four of 11 control patients. One control patient died due to cardiorespiratory failure during the study. No deterioration of renal function occurred during IFN-gamma treatment. There was a significant improvement in quality of life parameters in the control group but not in the treatment group. Plasma levels of neopterin increased significantly during IFN-gamma treatment but not in the control group, whereas N-terminal procollagen III peptide levels did not change in either group. There was a high frequency of mild to moderate influenza-like adverse events during IFN-gamma treatment. Only four of nine drop-out patients, however, experienced symptoms most probably associated with IFN-gamma treatment. We conclude that IFN-gamma therapy has mild beneficial effects on skin sclerosis and disease-associated symptoms in type I and II scleroderma. IFN-gamma treatment was associated with acceptable tolerability and did not induce major renal dysfunction in our patients.

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We suggest the use of low-allergen latex products identified by IgE binding, basophil histamine release assays and skin testing as a feasible preventive measure for latex allergy.

Results of an ethnographic study suggest that, despite stereotypes to the contrary, urban Aymara women in Bolivia want to regulate their fertility, and sociocultural norms support fertility regulation. However, the norms also make such regulation difficult to achieve. One barrier is a deep suspicion of modern medicine and medical practitioners, who are not seen as reliable sources of information. This suspicion is reinforced when the quality of health services is inadequate. Among urban Aymara, the level of acceptability of most modern methods of contraception is low. Many would prefer to use traditional methods, even when use of these methods entails considerable sacrifice and risk of conflict with their partners, unwanted pregnancies, and recourse to unsafe abortion.

The voices and views of clients are an essential, but often neglected, aspect in initiatives to improve the quality of care provided by family planning and reproductive health programs. Methods: In anticipation of an increased emphasis on clinic-based services in Bangladesh's national family planning program, a small qualitative study was undertaken in six villages in late 1996. In-depth interviews were conducted with 34 clients of six government and two nongovernment clinics, and researchers spent one day at each clinic observing how providers and clients interacted. Results: Hierarchical modes of interaction and poor communication dominated many of the encounters, and women had to beg for services in some clinics. Providers appeared to selectively apply interpersonal skills and common courtesy; rudeness to clients was not merely a reflection of ignorance, since the paramedics appeared to know the basic principles of counseling. Limited access to medication and often arbitrary ways of determining when to dispense it created suspicion and tension between providers and clients. Most clients expressed a willingness to overlook rude treatment, long waits and unhygienic conditions, saying that because they were poor, they could not expect better care and had no service alternatives. Conclusions: Technical solutions, such as training in counseling, may not be enough to improve the quality of care provided in clinics in rural Bangladesh. Institutional policies, norms and incentives need to become more client-oriented if the transition from in-home delivery to clinics is to be a success.