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Biomedical subjects

S C Sorensen

Publications and source records attributed to S C Sorensen.

At least 19 recordsLinked to original sources
PubMed1997

Utilisation rates and expenditure for public and private, curative-care services in semi-urban Guatemala.

In November 1994, a retrospective survey was conducted for two purposes; to investigate patterns of health-care uptake for childhood and maternal illness in semi-urban Guatemala; and to gain an insight into the expenditure incurred by the subjects when they consulted the various health-care providers. The subjects, who all belonged to a semi-urban ladina community, had easy geographical access to the health-care providers, of all types, operating in Sacatepequez, in the central highlands of Guatemala. The community was divided into clusters of roughly equal population size and 20 of these were selected. Within each selected cluster, eight households that had at least one young child (< 5 years of age) were investigated. Mothers belonging to each household were asked whether, how frequently, and where they had sought outside help for any health problem that had possibly affected them or their children during the past year. Subsequently, they were also invited to recall the expenditure incurred on the last visit, if any, to each type of health-care provider established in the area. The crude utilisation rates, for all providers combined, were 1.0/women.year and 0.8/child.year. Overall, 61% of women had no uptake of curative care for themselves and 12% of families no such uptake for their children. Lay curers and clinics run by non-governmental organizations were hardly utilised. Drug vendors accounted for 38% of contacts by women and 26% by children, private physicians for 34% and 38%, and public services for 22% and 33%, respectively. The utilisation rate of the official sector attained roughly 0.3/person.year in both women and children. Dissatisfaction with the treatment received and the lack of drugs were often given as reasons for not attending public services. The median total expenditure incurred per curative, health-care contact ranged from 0 quetzales in the official health centres to 63 quetzales with private physicians (a U.S.$ being equivalent to 5.5 quetzales at the time of the study). Although for each type of provider (except the health centres), expenditure was nearly equal for a woman or for a child contact, it consisted of a different mix of cost elements (consultation fee, drugs and transport) for each of the various categories of provider. The willingness for a more prominent role of the public sector. It would seem that there is, in the socio-economic environment of semi-urban Sacatepequez, room for experimenting with alternative modes of health-care financing to increase the quality and attractiveness of public services and their utilisation.

Adult↗
PubMed1996

Health seeking behaviour for child illness in rural Guatemala.

Considerable efforts were made in Guatemala to cover rural areas with health centres, and health programmes have been launched to treat and prevent the most important childhood diseases. Despite this, the utilization rate of public health services has reportedly been low throughout the past two decades. How, and how effectively, do mothers resolve the health problems of their children? To gain better insight into health care behaviour, we conducted a health services utilization survey in two highland communities in the department of Sacatepequez in 1992-1993. We asked 324 mothers in two villages whether, and where, they had sought help the last time their children under 5 years of age had suffered from diarrhoea, fever, cough symptoms or worms. Mothers relied on home care in 63-83% of reported episodes and the use of health services-Western or traditional-was consistently low. Although Western health care was easily accessible, it was used in only 8-15% of cases. The only identifiable significant independent determinants of utilization were occupational status of the mother (RR = 1.5 if employed) and overall level of socioeconomic development of the community (RR = 1.7). Inquiry into treatments used revealed that except for worms, which were frequently treated with herbs (31%) or external remedies (20%) alone, modern pharmaceuticals predominated. Antibiotics were the remedy of choice against diarrhoea (63%), antipyretics in case of fever (83%) and cough syrups with expectorants or antitussives against cough (65%). One hundred and twenty-one of the children born after 1975 died; in only 64 cases (53%) was a Western health service consulted between onset of disease and death. No relation was found between attendance and socioeconomic characteristics of the parents, but a positive linear association between duration of the fatal illness episode and age of the child could be identified. Independent sources report a drop in infant mortality of 53 and 35% respectively in the two communities between 1977 and 1991. Our findings seem to indicate that this reduction was achieved despite under-utilization of Western health services.

Adult↗
PubMed1994

Health seeking behaviour and self-treatment for common childhood symptoms in rural Guatemala.

This study was conducted in the Guatemalan highland department of Sacatepequez, in a sample of 146 rural women insured by the Social Security system. It examined their health care behaviour when their children presented common childhood symptoms such as diarrhoea, fever, cough and worms. The mothers generally sought help and treatment advice from an older woman in the family, and did so more often for diarrhoea (82%) and fever (64%) than for cough (43%) or worms (28%). Obtaining advice in a pharmacy or from a drug seller ranked second (range: 8%-38%, depending on the symptom), before the procurement of professional help at a medical service (range: 8%-23%). Traditional healers were hardly consulted (range: 0%-3%). In the case of self-treatment the women predominantly relied on Western drugs: around 80% in diarrhoea and fever, and above 50% in cough. Herbs and traditional external remedies were little used, except in cough (27% herbs) and worms (58% external remedies). None of the mothers reported ORS as home treatment for diarrhoea. Problems of geographical or financial accessibility could not explain the low utilisation of the Western health care system. The acceptability of public services, however, was poor. Largely because the Social Security clinic did not prescribe the "potent" modern drugs mothers preferred for the treatment of childhood symptoms--at least, not for uncomplicated illness episodes. Women hence turned to the--partially informal--private sector, which unabashedly responds to their demands. Clear away the discrepancy between the "rational" needs perceived by the official health sector and the demands of the population is one of the bigger challenges to health care planning in transitional communities such as the one studied.

Adult↗
PubMed1984

Meningeal carcinomatosis in patients with primary breast or lung cancer.

We reviewed the records of 35 patients with meningeal carcinomatosis and primary lung or breast cancer in an effort to identify prognostic factors. No definite associations were found. The prognosis for these patients continues to be poor; the median duration of survival after the diagnosis of meningeal carcinomatosis was 43 days in our study group.

Adult↗
PubMed1977

Changes in cisternal fluid potassium concentration following cardiac arrest.

The purpose of this study was to measure the changes in potassium concentration in human cisternal cerebrospinal fluid following successful resuscitation after cardiac arrest. We also wished to examine whether or not changes in potassium concentration in the cisternal cerebrospinal fluid could be correlated to the ability to regain normal cerebral function. 41 patients were studied, of whom 20 regained consciousness and 21 did not. In those who did not regain consciousness there was a significant increase in the potassium concentration found in samples obtained between 40 and 50 min, and between 50 and 60 min after cardiac arrest. The potassium concentration decreased to normal values during the following hours. Lumbar spinal fluid did not reflect the changes in cisternal fluid. The results suggest that the potassium concentration of cisternal cerebrospinal fluid, obtained soon after cardiac arrest, might give an indication of the degree of cerebral damage caused by cardiac arrest.

Cisterna Magna↗
PubMed1977

Spinal tumours associated with increased intracranial pressure. Report of two cases and a discussion on the pathophysiology.

Two cases of increased intracranial pressure associated with lumbar intraspinal tumours are reported. On the basis of protein investigations and constant flow infusion manometric tests, the pathophysiology of the increased intracranial pressure is discussed. It is demonstrated that protein macromolecules leak from the tumour into the cerebrospinal fluid and suggested that these are responsible for mechanical obstruction of the outflow channels for the cerebrospinal fluid.

Adult↗
PubMed1975

No-flow state following cerebral ischemia. Role of increase in potassium concentration in brain interstitial fluid.

Rats were subjected to total cerebral ischemia by occluding outflow from the heart. In control experiments and following different periods of ischemia, potassium concentration was measured in cisternal cerebrospinal fluid (CSF). It rose to 19.4 mEq/liter following 16 minutes of ischemia. Changes in cerebrovascular resistance (CVR) were also assessed by measuring the cerebral perfusion rate (CPR). Following two minutes of ischemia, CVR was decreased to half control value. After 8 and 16 minutes of ischemia, CVR was markedly increased, and "no-flow" state was approached after 16 minutes of ischemia. The CVR increased concomitantly with increase in potassium concentration in cisternal CSF. We suggest that the increase in CVR following cerebral ischemia is due to increase in potassium concentration in brain extracellular fluid and is part of a vicious circle that leads to brain death.

Animals↗
PubMed1974

The ultrastructure of the carotid body in chronically hypoxic rabbits.

1. The ultrastructure of the carotid body in the rabbit has been examined by electron microscopy.2. A comparison was made between the ultrastructure of the carotid bodies in sea level rabbits, in rabbits which had been exposed to hypoxia equivalent to an altitude of 6000 m for 7 days and in rabbits which always had lived at an altitude of 4000-4300 m.3. We could not detect any difference in the ultrastructure between the two groups of hypoxic rabbits.4. When the hypoxic rabbits were compared with sea level rabbits there was a marked increase in the number of dense cored vesicles and mitochondria in the type I cells in the hypoxic rabbits. The Golgi region also appeared to be enlarged in the type I cells in the hypoxic rabbits.5. The finding suggests that in the rabbit the production of amines, probably dopamine, within the type I cells is increased during prolonged hypoxia which might explain the lowered ventilatory response to hypoxia observed in human high altitude residents.6. If the carotid bodies are organs of internal secretion the finding is compatible with an increased production of a hormone produced within the type I cells.

Altitude↗
PubMed1974

The ontogenetic development of concentration differences for protein and ions between plasma and cerebrospinal fluid in rabbits and rats.

1. The purpose of this study was to study in rats and rabbits the ontogenetic development of the blood-brain barrier to macromolecules and the ontogenetic development of concentration differences between plasma and cerebrospinal fluid for ions which are known to be transported actively across the choroid plexus and the blood-brain barrier.2. By comparing the development of concentration differences for ions with the development of the blood-brain barrier to macromolecules we wanted to evaluate an eventual relationship between the development of these two functions of the blood-brain barrier.3. The concentration of protein in cerebrospinal fluid and plasma was measured in foetal, juvenile and adult rabbits and in new-born, juvenile and adult rats. The concentration of protein was similar in rabbit foetuses at 23 days of gestational age (term at 31 days) and in new-born rats, and the ratio decreases at approximately the same rate in the two species.4. The high concentration of proteins in cerebrospinal fluid might reflect either a high rate of entry of protein into the brain or a low production rate of cerebrospinal fluid. Injection of Diamox(R) (100 mg/kg) 2 hr before sampling of cerebrospinal fluid did not change the concentration of protein in cerebrospinal fluid in new-born rats whereas it increased the concentration in older rats. This finding suggests that new-born rat produces little (if any) cerebrospinal fluid suggesting that the high concentration of protein in cerebrospinal fluid in new-born rats reflect a low rate of turnover of cerebrospinal fluid.5. The concentration of sodium, potassium, chloride and magnesium in plasma and cisternal cerebrospinal fluid was measured in rabbits of different age, from 23 days of gestation until adulthood, and in rats of different ages from birth until adulthood.6. Concentration differences between plasma and cerebrospinal fluid for these were established in the youngest animals examined, indicating that the active transport mechanisms for these ions were functioning at an age where the concentration of protein in cerebrospinal fluid was very high.7. The maintenance of concentration differences for ions at a time where the concentration of proteins in cerebrospinal fluid is high, is difficult to explain if the high concentration of proteins in cerebrospinal fluid is due to a leakiness of the intercellular junctions between cerebral endothelial cells. However, the findings might be explained either by a low rate of production of cerebrospinal fluid in the youngest animals and/or by a pinocytotic transfer of proteins across the blood-brain barrier in these animals.8. In rats concentration gradients for ions are established at an age (new-borns) with a low or absent bulk formation of cerebrospinal fluid and at an age where the capillaries are still not enveloped by astrocytic foot processes. These facts suggest that the active transport mechanisms for the ions must be located in the cerebral endothelial cells.

Acetazolamide↗