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Biomedical subjects

J Thomason

Publications and source records attributed to J Thomason.

18 recordsLinked to original sources
PubMed1995

Decentralization of health services in Western Highlands Province, Papua New Guinea: an attempt to administer health service at the subdistrict level.

In 1990, Western Highlands Province in Papua New Guinea, decentralized the administration of health services from the province (population 264,000) to 14 districts (equivalent to subdistricts elsewhere). Two years later interviews were conducted with health workers and district and provincial heads. Productivity data were obtained from the provincial health information system and financial data from the provincial and national budgetary report. Health workers had a predominately negative opinion of the results of the decentralization. The most common complaints listed were lack of qualifications of District Assistant Secretaries, a diversion of funds to other programs, unavailability of transportation, a lack of equity in personnel between districts and a lack of adequate professional supervision. The problems which developed in this attempt at further decentralization related to a lack of professional support and oversight of health professionals, a lack of role definition for provincial and district administrators, lack of management training for district officials, inadequate oversight by local elected officials and inadequate budgets.

Adolescent↗
PubMed1995

Case management quality assessment in rural areas of Papua New Guinea.

A study was carried out to assess the quality of case management of malaria, malnutrition, diarrhoea and acute respiratory tract infections in children in rural primary health services in Papua New Guinea. In particular, the study focused on the knowledge and skills of different categories of rural health workers (HW) in history taking, examination, diagnosis, treatment and patient education. Quality criteria were defined and health centre (HCW) and aidpost workers' (APWs) knowledge and practices were assessed. Primary health workers' (PHW) knowledge of case management was weak, but in all cases better than their actual practice. History taking and examination practices were rudimentary. HWs tended not to make or record diagnoses. Treatment knowledge was often incorrect, with inappropriate or insufficient drugs prescribed, being worst at aidpost level. These findings raise serious questions about the effectiveness of providing health services through small, isolated health units. Far greater attention must now be directed to focus on the institutionalization of problem-based training, continuous supportive supervision and maintenance of clinical skills and provision of essential drugs, supplies and equipment to ensure that rural health workers (RHW) can provide sound care.

Child↗
PubMed1994

User charges for rural health services in Papua New Guinea.

This paper reports on a review of user charges for health services in rural areas of Papua New Guinea. Facilities implementing both fee for service and community risk sharing schemes were studied. This study found that there is a lack of any policy framework or practical guidelines on cost recovery. In some areas fees are being used as a fiscal tool rather than to further health policy. This study from Papua New Guinea raises serious questions about the virtue of cost recovery for health services in rural areas. Equity is an issue and the fees are creating a barrier both for entry and continuation in the health system; accountability is poor, and issues of cross subsidization are not addressed; fee revenues from rural health services are small and primarily of local significance; and are not being used to improve quality of health services. Cost recovery schemes in rural areas have the potential to provide a valuable contributory source of income to operate and improve health services. In practice, few are achieving this. It is concluded that health sector financing focus could be more fruitfully directed to financing mechanisms with greater potential to improve and expand health services.

Community Health Services↗
PubMed1992

Comparison of solution structures of mutant bovine pancreatic trypsin inhibitor proteins using two-dimensional nuclear magnetic resonance.

Structural perturbations due to a series of mutations at the 30-51 disulfide bond of bovine pancreatic trypsin inhibitor have been explored using NMR. The mutants replaced cysteines at positions 30 and 51 by alanine at position 51 and alanine, threonine, or valine at position 30. Chemical shift changes occur in residues proximate to the site of mutation. NOE assignments were made using an automated procedure, NASIGN, which used information from the wild-type crystal structure. Intensity information was utilized by a distance geometry algorithm, VEMBED, to generate a series of structures for each protein. Statistical analyses of these structures indicated larger averaged structural perturbations than would be expected from crystallographic and other information. Constrained molecular dynamics refinement using AMBER at 900 K was useful in eliminating structural movements that were not a necessary consequence of the NMR data. In most cases, statistically significant movements are shown to be those greater than approximately 1 A. Such movements do not appear to occur between wild type and A30A51, a result confirmed by crystallography (Eigenbrot, C., Randal, M., & Kossiakoff, A.A., 1990, Protein Eng. 3, 591-598). Structural alterations in the T30A51 or V30A51 mutant proteins near the limits of detection occur in the beta-loop (residues 25-28) or C-terminal alpha-helix, respectively.

Amino Acid Sequence↗
PubMed1992

The rise of private practice: a growing disquiet with public services?

A survey of 325 national patients attending six private clinics in Port Moresby was carried out to determine the characteristics of those using private medical services. Most patients were employed in professional or clerical occupations. A sizeable proportion of private patients were from low and moderate income categories and over 40% of those interviewed said that they had to borrow the money to pay for the consultation. Education level was positively associated with both attending a private practitioner as first choice of treatment and enrollment in a medical insurance scheme. 15% of patients were medically insured, and they were more likely to choose a private practitioner as first treatment choice. The most common reason given for choosing private sector health care was that it was quicker, but a notable proportion, particularly amongst those who had previously attended government health services for the same complaint, thought that private clinics had better doctors or gave better medicine. The findings are discussed and contrasted with those from other developing countries. Conclusions are drawn regarding the significance of these findings both in relation to the upgrading of the public health services and the regulation and monitoring of private health services.

Adolescent↗
PubMed1991

Effects of limited input distance constraints upon the distance geometry algorithm.

In this paper we examine the distance geometry (DG) algorithm in the form used to determine the structure of proteins. We focus on three aspects of the algorithm: bound smoothing with the triangle inequality, the random selection of distances within the bounds, and the number of distances needed to specify a structure. Computational experiments are performed using simulated and real data for basic pancreatic trypsin inhibitor (BPTI) from nmr and crystallographic measurements. We find that the upper bounds determined by bound smoothing to be a linear function of the true crystal distance. A simple model that describes the results obtained with randomly selected trial distances is proposed. Using this representation of the trial distances, we show that BPTI DG structures are more compact than the true crystal structure. We also show that the DG-generated structures no longer resemble test structures when the number of these interresidue distance constraints is less than the number of degrees of freedom of the protein backbone. While the actual model will be sensitive the way distances are chosen, our conclusions are likely to apply to other versions of the DG algorithm.

Algorithms↗
PubMed1991

An outbreak of psittacosis.

An outbreak of chlamydia infection affecting seven people from a small town in Grampian is described. The origin of the outbreak seemed to be a local pet shop. The difficulties of diagnosis and tracing the connections with the pet shop are discussed. The clinical histories of the seven patients are described including those of the two who died.

Adolescent↗
PubMed1991

The cost of rural health services in Papua New Guinea.

In 1988 a countrywide study was conducted on the costs of rural health services in Papua New Guinea. 16% of all health centres and subcentres were surveyed. Information was collected on physical facilities, recurrent costs, staff time allocation, service outputs and quality of services. Wide variation was found in the costs of rural health facilities overall, and significant differences were found between the costs and outputs of health centres and subcentres. Average levels of service output were found to be similar at church and government facilities but average levels of utilization by the population were higher at church facilities. Despite government policy on extension of preventive health care, a strong emphasis was found on curative care. Many facilities were found to have significant excess bed capacity. Recurrent financing for transportation and maintenance was found to be inadequate.

Cost Allocation↗
PubMed1988

Combined procedure of distance geometry and restrained molecular dynamics techniques for protein structure determination from nuclear magnetic resonance data: application to the DNA binding domain of lac repressor from Escherichia coli.

The technique of two-dimensional nuclear magnetic resonance (2D-NMR) has recently assumed an active role in obtaining information on structures of polypeptides, small proteins, sugars, and DNA fragments in solution. In order to generate spatial structures from the atom-atom distance information obtained by the NMR method, different procedures have been developed. Here we introduce a combined procedure of distance geometry (DG) and molecular dynamics (MD) calculations for generating 3D structures that are consistent with the NMR data set and have reasonable internal energies. We report the application of the combined procedure on the lac repressor DNA binding domain (headpiece) using a set of 169 NOE and 17 "hydrogen bond" distance constraints. Eight of ten structures generated by the distance geometry algorithm were refined within 10 ps MD simulation time to structures with low internal energies that satisfied the distance constraints. Although the combination of DG and MD was designed to combine the good sampling properties of the DG algorithm with an efficient method of lowering the internal energy of the molecule, we found that the MD algorithm contributes significantly to the sampling as well.

Algorithms↗
PubMed1988

Headaches in civil servants: effect on work and leisure.

Headaches in a group of civil servants and their effects on work and leisure activities, the medication taken, and numbers consulting their general practitioners during a year were assessed by a self administered questionnaire sent to 1000 civil servants in sections of a government department in London. The response rate was 74.7%. Altogether 77% of the respondents reported having had headaches in the previous 12 months. There was a higher prevalence in women (88%) than men (70%) and a significant decrease with increasing age. Women also had more frequent and severe headaches than men: 34% reported that headaches had interfered with work, either by impaired performance, making them leave work early, or by stopping them coming into work. About half of those who reported having severe headaches denied that they had affected their work, indicating difficulty in interpreting the term "severe." Nevertheless, 22% said that headaches interfered with their leisure activities as well as work which may be regarded as further evidence that the condition was truly disabling. Eighty per cent of those with headaches took medication, but within the past year only 11% had consulted their general practitioner and only 2.2% had been referred for further specialist opinion. Of the 22% who had not had a headache during the previous 12 months, 5.6% had never had a headache. In this group there was a larger proportion of men, a higher proportion with increasing age, and a higher proportion in non-desk working grades. Differentiation of the causes of headaches was not attempted in this survey but it is concluded that the extent to which they interfere with work and leisure is an important guide to their severity. It is suggested that the occupational health services may have an important role in assessing the causes of headaches and instituting preventive measures that benefit both the worker and industry.

Adolescent↗
PubMed1988

Gardnerella vaginalis in the urinary tract: incidence and significance in a hospital population.

The significance of Gardnerella vaginalis in urine was studied by comparing urine culture results, urinalysis data, and clinical findings. Over a two-year period, G vaginalis was reported in 2.3% of all urine cultures. Of 72 patients with pure cultures (greater than 10(4) cfu/mL), 43 patients (59.7%) were found to have G vaginalis urinary tract infections. Furthermore, four of the infected patients had pyelonephritis. Symptoms associated with G vaginalis urinary tract infections varied, and pyuria was detected in only 58% of the cases. Conditions associated with G vaginalis urinary tract infection included a history of recurrent urinary tract infections and/or instrumentation and upper urinary tract disease.

Adolescent↗
PubMed1983

Bone stress in the horse forelimb during locomotion at different gaits: a comparison of two experimental methods.

Longitudinal stresses acting in the cranial and caudal cortices of the radius and the dorsal and palmar cortices of the metacarpus in the horse were determined using two independent methods simultaneously. One approach involved the use of rosette strain gauges to record in vivo bone strain; the other involved filming the position of the horse's forelimb as it passed over a force plate. Agreement between the two analyses was better for the radius than for the metacarpus. Both methods showed the radius to be loaded primarily in sagittal bending, acting to place the caudal cortex in compression and the cranial cortex in tension. At each gait the magnitude of peak stress in each cortex based on the film/force analysis was 1.5-2 times higher than that determined from the bone strain recordings. In the metacarpus, the magnitude of stress in each cortex calculated from the film/force method was 2-3 times greater at each gait than that shown by the bone strain recordings. However, whereas the film/force analysis indicated that the metacarpus was loaded in sagittal bending (acting to place the palmar cortex in compression and the dorsal cortex in tension), the bone strain recordings showed the metacarpus to be loaded primarily in axial compression at each gait. Because the film/force method depends on an accurate measure of limb segment orientation relative to the direction of ground reaction force, comparatively small errors in calculations of bending moments may lead to a significant difference in the level and distribution of stress determined to act in the bone's cortices. The discrepancy in metacarpal loading obtained by the two methods may be explained in part by the simplicity of the biomechanical model which, for instance, neglected the force exerted by the sesamoids on the distal end of the metacarpus. The records of stress determined from the in vivo bone strain recordings showed that each bone was subjected to a consistent loading regime despite changes of gait. Such a consistent strain distribution should allow these bones to maximize economy in the use of tissue required to support the dynamic loads applied. Peak stresses measured from the bone strain recordings in the radius during locomotion at constant speed (-40.8 +/- 4.1 MN m-2) were significantly larger than those in the metacarpus (-25.1 +/- 2.8 MN m-2), regardless of speed and gait. During acceleration and deceleration, however, peak stress rose dramatically in the metacarpus (-40.6 +/- 3.4 MN m-2) but remained constant in the radius (-37.8 +/- 5.8 MN m-2).(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1980

Anencephaly, twins and HLA-B27.

A patient with a twin pregnancy where both infants were affected with anencephaly is reported, and the world's literature on anencephaly in twins is summarized. The anomalies were diagnosed by ultrasound during the prenatal period. Studies of the genetic histocompatible lymphocyte antigens (HLA) types of both parents were performed, and they failed to demonstrate the HLA-B27 locus in either. Anencephaly in twins is an unusual phenomenon, with concordance even more rare. The possibility that anencephaly is a heterogeneous entity, both morphologically and genetically, and its relationship to the HLA locus are discussed.

Adult↗
PubMed1976

Acute meningococcemia without meningitis in association with influenza-like illness.

An outbreak of meningococcal disease in a family of six resulted in four simultaneous cases of meningococcemia without meningitis. Although no definite explanation for this unusual collection of meningococcemia cases could be identified, a preceding influenza-like illness in the family may have increased their susceptibility to meningococcemia.

Adult↗