Perspectives on child diarrhoea management and health service use among ethnic minority caregivers in Vietnam

<p>Abstract</p> <p>Background</p> <p>In Vietnam, primary government health services are now accessible for the whole population including ethnic minority groups (EMGs) living in rural and mountainous areas. However, little is known about EMGs' own perspectives on illness treatment and use of health services. This study investigates treatment seeking strategies for child diarrhoea among ethnic minority caregivers in Northern Vietnam in order to suggest improvements to health services for EMGs and other vulnerable groups.</p> <p>Methods</p> <p>The study obtained qualitative data from eight months of field work among four EMGs in lowland and highland villages in the Northern Lao Cai province. Triangulation of methods included in-depth interviews with 43 caregivers of pre-school children (six years and below) who had a case of diarrhoea during the past month, three focus group discussions (FGDs) with men, and two weeks of observations at two Communal Health Stations (CHGs). Data was content-analyzed by ordering data into empirically and theoretically inspired themes and sub-categories assisted by the software NVivo8.</p> <p>Results</p> <p>This study identified several obstacles for EMG caregivers seeking health services, including: gender roles, long travelling distances for highland villagers, concerns about the indirect costs of treatment and a reluctance to use government health facilities due to feelings of being treated disrespectfully by health staff. However, ethnic minority caregivers all recognized the danger signs of child diarrhoea and actively sought simultaneous treatment in different health care systems and home-based care. Treatments were selected by matching the perceived cause and severity of the disease with the 'compatibility' of different treatments to the child.</p> <p>Conclusions</p> <p>In order to improve EMGs' use of government health services it is necessary to improve the communication skills of health staff and to acknowledge both EMGs' explanatory disease models and the significant socio-economic constraints they experience. Broader health promotion programs should address the significant gender roles preventing highland mothers from seeking health services and include family elders and fathers in future health promotion programs. Encouraging existing child health care practices, including continued breastfeeding during illness and the use of home-made rehydration solutions, also present important opportunities for future child health promotion.</p

Clinical and laboratory experience of vorinostat (suberoylanilide hydroxamic acid) in the treatment of cutaneous T-cell lymphoma

The most common cutaneous T-cell lymphomas (CTCLs) – mycosis fungoides (MF) and Sézary Syndrome – are characterised by the presence of clonally expanded, skin-homing helper-memory T cells exhibiting abnormal apoptotic control mechanisms. Epigenetic modulation of genes that induce apoptosis and differentiation of malignant T cells may therefore represent an attractive new strategy for targeted therapy for T-cell lymphomas. In vitro studies show that vorinostat (suberoylanilide hydroxamic acid or SAHA), an oral inhibitor of class I and II histone deacetylases, induces selective apoptosis of malignant CTCL cell lines and peripheral blood lymphocytes from CTCL patients at clinically achievable doses. In a Phase IIa clinical trial, vorinostat therapy achieved a meaningful partial response (>50% reduction in disease burden) in eight out of 33 (24%) patients with heavily pretreated, advanced refractory CTCL. The most common major toxicities of oral vorinostat therapy were fatigue and gastrointestinal symptoms (diarrhoea, altered taste, nausea, and dehydration from not eating). Thrombocytopenia was dose limiting in patients receiving oral vorinostat at the higher dose induction levels of 300 mg twice daily for 14 days. These studies suggest that vorinostat represents a promising new agent in the treatment of CTCL patients. Additional studies are underway to define the exact mechanism (s) of by which vorinostat induces selective apoptosis in CTCL cells and to further evaluate the antitumour efficacy of vorinostat in a Phase IIb study in CTCL patients

Binding of alpha,omega-alkyldiammonium ions by cucurbit[n]urils in the gas phase

We investigated gas-phase complexes of a,v-n-alkyldiammonium ions with cucurbit[5]uril (CB[5]), decamethylcucurbit[5] uril (mc5), penta(cyclohexyl)cucurbit[5]uril (CB*[5]), hexa(cyclohexyl)cucurbit[6]uril (CB*[6]), cucurbit[7]uril (CB[7]) and cucurbit[8]uril (CB[8]) using electrospray Fourier transform ion cyclotron resonance mass spectrometry and collisioninduced dissociation techniques. The five-membered cucurbit[n]urils (CB[n]s) form singly charged 1:1 and doubly charged 2:1 diamine:CB[n] complexes. All dissociate via loss of neutral a,v-n-alkyldiamine with only weak dependence of dissociation thresholds on chain length. For a given diamine, threshold energies are in the order CB[5] , mc5 , CB*[5]. This is consistent with guest hydrogen bonding on the portals of the CB[5]s with no threading into the host’s interior. The n $ 6 CB[n]s form 1:1 complexes with doubly protonated a,v-n-alkyldiamines. These collisionally dissociate via four channels: loss of singly protonated a,v-n-alkyldiammonium; fragmentation of the CB[n] cage; loss of neutral a,v-nalkyldiamine and fragmentation of the a,v-n-alkyldiamine. The dissociation threshold energies and branching ratios exhibit strong dependence on the length of the a,v-n-alkyldiamine and the size of the CB[n]. The data suggest that the optimum a, v-n-alkyldiamine length for binding CB*[6] is three to four methylene groups; for CB[7], four to five methylene groups and for CB[8], five to six methylene groups, indicating an increasing tendency for the guest to span the host cavity diagonally as the size of the CB[n] increases.1221sciescopu