Quantifying the rural-urban gradient in Latin America and the Caribbean

This paper addresses the deceptively simple question: What is the rural population of Latin America and the Caribbean (LAC)? It argues that rurality is a gradient, not a dichotomy, and nominates two dimensions to that gradient: population density and remoteness from large metropolitan areas. It uses geographically referenced population data (from the Gridded Population of the World, version 3) to tabulate the distribution of populations in Latin America and in individual countries by population density and by remoteness. It finds that the popular perception of Latin America as a 75 percent urban continent is misleading. Official census criteria, though inconsistent between countries, tend to classify as"urban"small settlements of less than 2,000 people. Many of these settlements are however embedded in an agriculturally based countryside. The paper finds that about 13 percent of Latin America populations live at ultra-low densities of less than 20 per square kilometer. Essentially these people are more than an hour's distance from a large city, and more than half live more than four hours'distance. A quarter of the population of Latin America is estimated to live at densities below 50, again essentially all of them more than an hour's distance from a large city. Almost half (46 pecent) of Latin America live at population densities below 150 (a conventional threshold for urban areas), and more than 90 percent of this group is at least an hour's distance from a city; about one-third of them (18 percent of the total) are more than four hours distance from a large city.Agricultural Research,Demographics,Health Indicators,,Health Information&Communications Technologies

Customer satisfaction with Internet banking web sites: An empirical test and validation of a measuring instrument

Measuring user satisfaction with information systems has attracted widespread research attention, given it is often used as an indicator of success. The Internet has allowed applications to be extended to customers of an organization, where interaction can take place through a web site, typically from home or office. The focus of attention with such applications is customer satisfaction. In this research, a 21-item, 7-factor instrument developed to measure customer satisfaction with web sites that market generic digital products and services was modified slightly, and then empirically tested and validated in the context of Internet banking specifically. A 19-item, 5-factor validated instrument emerged, the factors being Customer Support, Security, Ease of Use, Transactions and Payment, and Information Content and Innovation. The difference in number of factors as compared to the generic instrument was attributed to the unique nature of Internet banking web sites. These and other findings are discussed in the paper, and their implications examined

Medical management of primary open-angle glaucoma: Best practices associated with enhanced patient compliance and persistency

Primary open angle glaucoma is a chronic optic neuropathy often requiring lifelong treatment. Patient compliance, adherence and persistence with therapy play a vital role in improved outcomes by reducing morbidity and the economic consequences that are associated with disease progression. A literature review including searches of The Cochrane Library, MEDLINE, PubMed, conference proceedings, and bibliographies of identified articles reveals the enormous public health burden in various populations due to the impact of glaucoma associated visual impairment on the overall quality of life eg, fear of blindness, inability to work in certain occupations, driving restrictions, motor vehicle accidents, falls, and general health status. Providing specific definitions for the frequently misunderstood terms “compliance, persistence and adherence” with reference to medication use is central not only for monitoring patients’ drug dosing histories and clinical outcomes but also for subsequent research. In this review article, a summary of the advantages/disadvantages including cost-effectiveness of various medical approaches to glaucoma treatment, techniques employed for measuring patient compliance and actual patient preferences for therapy are outlined. We conclude by identifying the key barriers to ongoing treatment and suggest some best practices to enhance compliance and persistence

Nitric oxide regulates skeletal muscle fatigue, fiber type, microtubule organization, and mitochondrial ATP synthesis efficiency through cGMP-dependent mechanisms

Aim: Skeletal muscle nitric oxide–cyclic guanosine monophosphate (NO-cGMP) pathways are impaired in Duchenne and Becker muscular dystrophy partly because of reduced nNOSμ and soluble guanylate cyclase (GC) activity. However, GC function and the consequences of reduced GC activity in skeletal muscle are unknown. In this study, we explore the functions of GC and NO-cGMP signaling in skeletal muscle. Results: GC1, but not GC2, expression was higher in oxidative than glycolytic muscles. GC1 was found in a complex with nNOSμ and targeted to nNOS compartments at the Golgi complex and neuromuscular junction. Baseline GC activity and GC agonist responsiveness was reduced in the absence of nNOS. Structural analyses revealed aberrant microtubule directionality in GC1−/− muscle. Functional analyses of GC1−/− muscles revealed reduced fatigue resistance and postexercise force recovery that were not due to shifts in type IIA–IIX fiber balance. Force deficits in GC1−/− muscles were also not driven by defects in resting mitochondrial adenosine triphosphate (ATP) synthesis. However, increasing muscle cGMP with sildenafil decreased ATP synthesis efficiency and capacity, without impacting mitochondrial content or ultrastructure. Innovation: GC may represent a new target for alleviating muscle fatigue and that NO-cGMP signaling may play important roles in muscle structure, contractility, and bioenergetics. Conclusions: These findings suggest that GC activity is nNOS dependent and that muscle-specific control of GC expression and differential GC targeting may facilitate NO-cGMP signaling diversity. They suggest that nNOS regulates muscle fiber type, microtubule organization, fatigability, and postexercise force recovery partly through GC1 and suggest that NO-cGMP pathways may modulate mitochondrial ATP synthesis efficiency

The African Hospitalist Fellowship

The African Paediatric Fellowship Programme is rolling out a training course for newly qualified paediatricians to equip them with the leadership skills to function in complex general paediatric settings. The care of children in Africa carries its own unique demands, from the layering effects of multiple conditions through to establishing and sustaining services under severe resource constraints. This novel training concept aims to strengthen confidence and knowledge in areas that are not priorities during standard general paediatric training. The skills gained are considered of great relevance in assisting general paediatricians to achieve their full potential in their careers

Role of micronutrients in HIV infection

More than 60% of the estimated 40 million persons with HIV/AIDS worldwide live in sub-Saharan Africa, where poverty, social insecurity, food shortages and malnutrition are major problems.1 In children under the age of 5 years, who live in developing countries, malnutrition has been associated with 50% of the 10.8 million deaths mainly caused by neonatal disorders, diarrhoea, pneumonia, malaria and HIV/AIDS.2 Likewise micronutrient deficiencies are widespread and are associated with increased morbidity and mortality particularly in relation to infectious diseases.3 This review focuss on the interaction between micronutrients and HIV/AIDS and discusses recent research findings that may have important public health implications in terms of the case management of persons with HIV/AIDS Southern African Journal of HIV Medicine Vol. 6 (2) 2005: pp. 18-2

Infected epidermal cyst of the clitoris in an infant

Clitoral enlargement in the pediatric population is a rare condition, usually related to problems of sexual differentiation, but malignant and benign clitoral lesions have also been described. We report the case of a newborn infant, investigated at birth for an intersex disorder because of clitoromegaly. Hormonal screening was normal and ultrasound (US) did not show a pelvic or abdominal mass. Three weeks later, the lesion was larger, tense and erythematous. An abscess was suspected. A drainage was then performed, and the bacteriological culture revealed the presence of Staphylococci aurei. A magnetic resonance imaging (MRI) performed to exclude a tumor of the soft tissue was normal. A diagnosis of infected epidermal cyst was confirmed by the pathology. Two months later, the external genital aspect was normal and the child asymptomatic