The differentiation of cholesterol and pigment gallstones

Gallbladder biles and stones were obtained at 116 cholecystectomies for symptomatic gallstone disease. All 33 patients younger than 50 years had cholesterol stones, whereas 40% of the older patients had pigment stones. We compared the reliability of three different bile tests for the differentiation between cholesterol and pigment stone patients. Whereas both the presence of cholesterol monohydrate crystals in fresh gallbladder bile and a nucleation time 20 days in ultrafiltered gallbladder bile had a specificity of 100% for cholesterol gallstone disease, biliary supersaturation with cholesterol (cholesterol saturation index >1.0) had a low specificity. The sensitivity of nucleation time 20 days for cholesterol gallstone disease was 78% in concentrated gallbladder biles (biliary total lipid concentration 5 g/dl) but only 21% in dilute biles (biliary total lipid concentration <5 g/dl). In contrast, examination for the presence of cholesterol crystals in fresh bile was reasonably sensitive both in concentrated and diute gallbladder biles (sensitivity, 84% and 72%, respectively). In addition, duodenal bile obtained from 16 patients (10 cholesterol, 6 pigment) before cholecystectom showed cholesterol crystals in 7 of the cholesterol but in none of the pigment stone patients. We conclude that examination of fresh bile for cholesterol crystals is a specific and reasonably sensitive test for cholsterol gallstone disease

Improving Laws and Legal Authorities for Obesity Prevention and Control

This is the second paper in a two part series on the laws and legal authorities for obesity prevention and control. In this paper, the authors present the applicable laws and legal authorities that public health professionals and lawyers can consider implementing to close the legal gaps identified in the first paper (“Assessing Laws and Legal Authorities for Obesity Prevention and Control”). This set of legal action items encompass the federal, tribal, state, local, and community levels and should be considered when developing, implementing, and evaluating obesity prevention and control strategies and interventions. The paper organizes the action items within three key domains: healthy lifestyles, healthy places, and healthy societies. In the healthy lifestyles domain, the goal is to make the default environment one that fosters healthy lifestyles by making the healthy option the easier choice through actions such as altering farm subsidies to increase the affordability of healthy foods and the regulation of marketing practices targeting children. The healthy places domain recognizes that the surrounding community, workplace, and transportation options influence the ability to make healthy choices. Actions under this domain include the strategic use of zoning, the support of public transportation, and employer incentivization for healthy lifestyles at the workplace. The final domain of healthy societies addresses the complex societal causes and contributors to obesity, disparities, and discrimination. This domain includes actions such as the strengthening of public policies for school nutrition standards and increased physical activity, increasing access to health care (including preventative services), and addressing weight discrimination to ensure social justice and adequate care

Wirtschaftswissenschaft im Dienste der Armen : Ökonomen propagieren neue Evaluationsmethoden in der Entwicklungshilfe

Die Entwicklungshilfe steht gegenwärtig häufig in der Kritik. Eine junge Forschungsrichtung in der Ökonomie sucht mit wissenschaftlich sehr präzisen Methoden zu zeigen, welche Hilfsprojekte wirklich wirksam sind. Die Resultate sind bisweilen überraschend

The promise of microfinance and women's empowerment: what does the evidence say?

The microfinance revolution has transformed access to financial services for low-income populations worldwide. As a result, it has become one of the most talked-about innovations in global development in recent decades. However, its expansion has not been without controversy. While many hailed it as a way to end world poverty and promote female empowerment, others condemned it as a disaster for the poor. Female empowerment has often been seen as one of the key promises of the industry. In part, this is based on the fact that more than 80% of its poorest clients, i.e., those who live on less than $1.25/day, are women. This paper discusses what we have learned so far about the potential and limits of microfinance and how insights from research and practice can help inform the industry's current products, policies and future developments