The involvement of Phospholipase, A2 in Wallerian degeneration /

Phospholipase A2 (PLA2) enzymes target membrane phospholipids to liberate free fatty acids, such as arachidonic acid, a precursor of inflammatory mediators, as well as lysophospholipids which disrupt membrane structure. Unlike the PNS, Wallerian degeneration is very slow in the injured adult mammalian CNS. This slow removal of myelin, which contains axon growth inhibitors, contributes to the failure of CNS regeneration. Via its metabolic products, PLA2 may help mediate myelin breakdown and macrophage recruitment for debris clearance in Wallerian degeneration. In this study, immunohistochemical analysis was used to assess whether PLA2 expression correlates with differing rates of Wallerian degeneration. Indeed, cytosolic (cPLA2) and secreted PLA2 (sPLA2) are strongly upregulated early (five hours) in the crushed adult rat sciatic nerve (PNS) and continue to be expressed for up to ten days, i.e. during the period of myelin breakdown and phagocytosis. In the injured optic nerve (CNS) however, both forms of PLA2 are upregulated very late (eight weeks) after lesioning. Furthermore, in C57BL/Wlds mutant mice, a strain that undergoes delayed Wallerian degeneration in injured peripheral nerves and also has a null mutation for the story type II sPLA2, no cPLA 2 expression was observed up to ten days post-crush (duration of study) in contrast to the wild-type mouse. Blocking cPLA2 activity in transected sciatic nerves of C57BL/6J mice, also deficient in sPLA2 type II, markedly slowed myelin breakdown and phagocytosis. Together, these observations show strong evidence for the involvement of both forms of PLA 2 in mediating rapid Wallerian degeneration

Utilization of HIV-related services from the private health sector: A multi-country analysis

Increasing the participation of the private health sector in the AIDS response could help to achieve universal access to comprehensive HIV prevention, treatment, care and support. Yet little is known about the extent to which the private health sector is delivering HIV-related services. This study uses data from the Demographic and Health Surveys (DHS) and AIDS Indicator Surveys (AIS) from 12 countries in Africa, Asia and Latin America and the Caribbean to explore use of HIV testing and STI care from the private for-profit sector, and its association with household wealth status. The analysis indicates that the private for-profit health sector is active in HIV-related service delivery, although the level of participation varies by region and country. From 3 to 45 percent of women and 6 to 42 percent of men reported the private for-profit sector as their source of the most recent HIV testing. While in some countries, use of the private for-profit health sector for HIV testing and STI care increases with wealth, in others the relationship is not clear, as there are no significant differences in using private for-profit HIV-related services between the rich and the poor. We conclude that as the global AIDS response evolves from emergency relief to sustained country programs, broader consideration of the role of the private for-profit health sector may be warranted.HIV/AIDS Services utilization Private health sector Household wealth

An assessment of interactions between global health initiatives and country health systems

Since 2000, the emergence of several large disease-specific global health initiatives (GHIs) has changed the way in which international donors provide assistance for public health. Some critics have claimed that these initiatives burden health systems that are already fragile in countries with few resources, whereas others have asserted that weak health systems prevent progress in meeting disease-specific targets. So far, most of the evidence for this debate has been provided by speculation and anecdotes. We use a review and analysis of existing data, and 15 new studies that were submitted to WHO for the purpose of writing this Report to describe the complex nature of the interplay between country health systems and GHIs. We suggest that this Report provides the most detailed compilation of published and emerging evidence so far, and provides a basis for identification of the ways in which GHIs and health systems can interact to mutually reinforce their effects. On the basis of the findings, we make some general recommendations and identify a series of action points for international partners, governments, and other stakeholders that will help ensure that investments in GHIs and country health systems can fulfil their potential to produce comprehensive and lasting results in disease-specific work, and advance the general public health agenda. The target date for achievement of the health-related Millennium Development Goals is drawing close, and the economic downturn threatens to undermine the improvements in health outcomes that have been achieved in the past few years. If adjustments to the interactions between GHIs and country health systems will improve efficiency, equity value for money, and outcomes in global public health, then these opportunities should not be missed