Process evaluation of a tobacco prevention program in Indian schools--methods, results and lessons learnt.

In India, 57% of men between 15 and 54 years and 10.8% of women between 15 and 49 years use tobacco. A wide variety of tobacco gets used and the poor and the underprivileged are the dominant victims of tobacco and its adverse consequences. Project MYTRI (Mobilizing Youth for Tobacco-Related Initiatives in India) was a tobacco prevention intervention program, a cluster-randomized trial in 32 Indian schools which aimed to decrease susceptibility to tobacco use among sixth- to ninth-grade students in urban settings in India. This culture-specific intervention, which addressed both smokeless and smoked forms of tobacco, was Indian in content and communication. We qualitatively developed indicators which would help accurately measure the dose of the intervention given, received and reached. A multi-staged process evaluation was done through both subjective and objective measures. Training the teachers critically contributed toward a rigorous implementation and also correlated with the outcomes, as did a higher proportion of students participating in the classroom discussions and better peer-leader-student communication. A sizeable proportion of subjective responses were 'socially desirable', making objective assessment a preferred methodology even for 'dose received'. The peer-led health activism was successful. Teachers' manuals need to be concise.

Health promotion: private voluntary organisations in action.

PIP: Since the country's independence in 1947, India has come a long way in its efforts to improve health services. One initiative taken by the Government is the involvement of private voluntary organizations (PVOs) in the health promotion activity. Several grant-in-aid schemes have been initiated, whereby PVOs obtain government funding for the provision of services and the promotion of health and family welfare activities. The US Agency for International Development has supported the government in this endeavor. Keeping these in mind, Tamil Nadu Voluntary Health Association, a state-level association of voluntary health organizations such as hospitals, dispensaries and community-based health organizations, worked out a proposal for support and collaboration with the Government of India. This association aims to promote health through networking and coordinating with voluntary organizations, strengthening of nongovernmental organization activities, collection and dissemination of relevant information, lobbying, campaigning and liaisoning for health issues. This article highlights the experience of the Association in conceiving and carrying out its proposal/project. In particular, it describes the planning and implementation of the Integrated Project for Development of Primary Health Care and Women's Welfare in Tamil Nadu as well as the achievements of the project. The main goal of this project is to coordinate with various levels of health services to improve the health status of rural Tamil Nadu.^ieng

[Arterial blood flow in congenital idiopathic clubfoot]. / Zur arteriellen Gefässversorgung bei kongenitalen idiopathischen Klumpfüssen.

A doppler ultrasound study investigated vascularity in congenital idiopathic clubfeet (talipes equinovarus, (TEV) pretreated only by casting and physiotherapy. The studies were performed on 40 TEV (27 patients) aged 4-72 months (average 15.1). In 12 unilateral cases of TEV, the opposite normal foot and 74 normal feet of 37 healthy children aged 3-35 months (average 8.7) were used as controls. Dorsalis pedis (DP), posterior tibial (PT), and peroneal (P) pulses were recorded by an unidirectional 8 MHZ continuous wave technique. At rest, DP pulses and PT pulses were present in all investigated TEVs. P pulse was absent in only one case of TEV. In the group of controls DP pulse was absent in one case and P pulse was absent in an other case of normal foot with contralateral TEV. All the other pulses in normal feet were present at physiological location. We propose that a vascular etiology for the origin of congenital idiopathic clubfoot, as reported in literature, is unlikely. The influence of postnatal casting in TEV on the vascular arterial condition is slight or even absent. Doppler assessment is readily available, noninvasive, and a reproducible mean of monitoring vascular integrity in clubfeet. Relating to vascular complications after surgery, perhaps caused by a preextant arterial anomaly, doppler assessment is indicated routinely in syndromes of multiple malformations with clubfoot deformity before surgical treatment. In congenital idiopathic clubfeet it is not necessary as a routine check.

Release of inflammatory mediators in association with collection of wound drainage blood during orthopaedic surgery.

Ten patients undergoing hip replacement surgery were studied regarding activation of complement and leukocytes in association with collection of wound drainage blood. The blood was collected postoperatively but not reinfused due to the possible risks with reinfusion of blood containing inflammatory mediators. Blood samples for analysis of complement activation (TCC), leukocyte activation (PMN elastase) and cytokines (Interleukin-6) were drawn preoperatively from the patients. Blood samples were also drawn intraoperatively from the wound. Samples were also drawn from the collected wound drainage blood, before and after blood was passed through a microporous filter. There were elevated concentrations of TCC, PMN elastase and IL-6 in the collected wound drainage blood before and after the filter. The filtration did not significantly reduce the concentrations of these factors. In the wound blood the concentrations were higher compared to those found in the systemic blood preoperatively, but lower compared to concentrations found in the collected drainage blood. The study demonstrates that the collection of wound drainage whole blood is associated with activation of complement, release of PMN elastase and cytokines.

Congenital cerebrospinal fluid-containing intracranial abnormalities: a sonographic classification.

Ultrasound is useful as a primary modality for diagnosis of complex nonhydrocephalic intracranial malformations. We present 10 cases of intracranial cerebrospinal fluid containing abnormalities that may be diagnosed by ultrasound. Congenital abnormalities presented include holoprosencephaly, hydranencephaly, agenesis of the corpus callosum with interhemispheric cyst, porencephaly, schizencephaly, and arachnoid cyst. Ultrasound may be used in the fetus or neonate in detecting and separating these abnormalities from hydrocephalus.

Occurrence and fate of corpora amylacea in the bovine udder.

The presence and location of corpora amylacea were studied quantitatively by biopsy technique in separate glands of a normal cow during a lactation cycle. Corpora amylacea were present in alveoli throughout lactation without any evidence of an abnormal bacterial flora or an inflammatory reaction. The corpora amylacea were most numerous during the decline in lactation, approximately 95% being in the alveoli. During the nonlactating (dry) period, there was approximately a 50% decrease in the number of corpora amylacea, with about 90% of those remaining being in the interstitial tissue. They appeared to enter the interstitial tissue passively coincident with atrophy of alveoli.

Polarography of arsenic.

The polarographic behaviour of arsenic in various media is reviewed with particular emphasis on the mechanisms of the electrode reactions and on the use of polarographic methods for the determination of the element.