Enhancement of reaching performance via self-speech in people with Parkinson's disease.

OBJECTIVE: To evaluate the effects of self-speech as an internal cue on reaching performance in people with Parkinson's disease. SUBJECTS: Eight people with Parkinson's disease were voluntarily recruited from the upstate New York community. DESIGN AND SETTING: This study was a repeated measure analysis of reaching performance under four randomized counterbalanced vocalization (speech) conditions that include a no vocalization control condition. The study was conducted in a university-based motion analysis laboratory. Participants performed a simple sequential daily reaching performance of reaching for a bottle, grasping and placing it on a simulated cabinet. Under counterbalanced randomized conditions, before each performance, participants either self-vocalized the word 'yaah' (self-cue), listened to the word 'yaah' vocalized by the experimenter (external cue), imagined vocalizing the word 'yaah', or just simply performed the task without any vocalization (control - no vocalization). MAIN MEASURES: The following dependent kinematic measures were extracted from the movement: total movement time, total movement unit, peak velocities and durations of reaching and placing segments. RESULTS: People with Parkinson's disease took significantly shorter time under self-vocalization conditions (2390.00 (326.63) ms) compared with the other three conditions including control - no vocalization conditions (no_voc, 3015.66 (340.83) ms; ext_voc, 2853.12 (376.44) ms; imaginary-voc, 3000.37 (320.54) ms). Under self-vocalization conditions the movements were also significantly smoother as evidenced by significantly lower numbers of movement units (3.43 (0.41)) compared with the other three conditions (no_voc, 4.47 (0.57); ext_voc, 4.16 (0.51); imaginary-voc, 4.16 (0.55)). CONCLUSIONS: Self-vocalization of a positive reinforcing word enabled people with Parkinson's disease to perform a daily upper extremity task faster and more smoothly.

Prevalence of self-reported symptoms of reproductive tract infections among recently pregnant women in Uttar Pradesh, India.

This study examines the prevalence of self-reported reproductive tract infections (RTIs) and treatment seeking among married, recently pregnant women in Uttar Pradesh state, India. Associations between RTI symptom reporting and background characteristics are examined in a population-based sample of 18,506 married women with a pregnancy in the 3 years prior to a 1995 statewide survey. Logistic regression analyses are used to assess the effects of sociodemographic covariates on the probability of reporting an RTI symptom. Nearly one out of four women reports experiencing at least one RTI symptom, with the most common symptoms being abnormal vaginal discharge and pain during urination. Reporting of RTI symptoms significantly increases if the woman's last pregnancy did not end in a live birth or if she has low economic status. Symptom reports also increase with age and decrease with parity. Only one-third of women reporting an RTI symptom sought treatment. The results indicate that survey interviews can be a cost-effective option for measuring the magnitude of RTI symptoms experienced and identifying sociodemographic influences. The findings suggest the need for improved RTI screening procedures and treatment at health facilities in this populous state of northern India.

Sexual behaviors and reproductive health outcomes: associations with wife abuse in India.

CONTEXT: Wife abuse has been associated with a variety of health concerns. Associations between abuse and reproductive health in India are not well known. OBJECTIVE: To examine relationships between men's reports of wife abuse and reproductive health issues in northern India. DESIGN: Structured face-to-face interviews were conducted as part of the male reproductive health supplement of the PERFORM System of Indicators Survey, a systematic multistage survey conducted in 1995-1996. SETTING: The northern state of Uttar Pradesh, one of the least developed states in India. PARTICIPANTS: A total of 6632 married men aged 15 to 65 years who lived with their wives and completed all survey questions for the study variables reported here. MAIN MEASURES: Physically and sexually abusive behaviors toward wives, sexual activities outside marriage, sexually transmitted disease (STD) symptoms, contraception use, unplanned pregnancies, and sociodemographic characteristics. RESULTS: Fifty-four percent of men reported not abusing their wives, while 17% reported physically but not sexually abusing their wives, 22% reported sexual abuse without physical force, and 7% reported sexual abuse with physical force. Abuse was more common among men who had extramarital sex (for sexual abuse using force: odds ratio [OR], 6.22; 95% confidence interval [CI], 3.98-9.72). Similarly, men who had STD symptoms were more likely to abuse their wives (with current symptoms: OR, 2.43; 95% CI, 1.73-3.42). Unplanned pregnancies were significantly more common among wives of abusive men, especially sexually abusive men who used force (OR, 2.62; 95% CI, 1.91-3.60). CONCLUSIONS: Wife abuse appears to be fairly common in northern India. Our findings that abusive men were more likely to engage in extramarital sex and have STD symptoms suggest that these men may be acquiring STDs from their extramarital relationships, thereby placing their wives at risk for STD acquisition, sometimes via sexual abuse. These abusive sexual behaviors also may result in an elevated rate of unplanned pregnancies.

Domestic violence in northern India.

This study examined the prevalence and characteristics of wife abuse as reported by nearly 6,700 married men living in five districts of northern India during 1995-1996. In addition, associations between wife abuse and sociodemographic factors were investigated to enable two theoretical/conceptual perspectives regarding abuse to be evaluated: that abuse is more common among families under stress and among more "private" families. The district-specific percentages of men who reported physically abusing their wives ranged from 18% to 45%, with 18-40% of the men in each district having had nonconsensual sex with their wives and 4-9% having physically forced their wives to have sex. The authors used logistic regression analyses to control for a variety of sociodemographic variables and found positive associations between wife abuse and stress-related factors, including the husband having a low educational level, the couple living in poverty, the husband being young when he first lived with his wife, and the couple having multiple children. Contrariwise, there was no strong empirical support for the idea that wife abuse may be more common in more "private" families.

Evidence for D1 dopamine receptor-mediated modulation of the synaptic transmission from motor axon collaterals to Renshaw cells in the rat spinal cord.

The possible modulatory role of D1 dopamine receptors on the excitability of lumbar spinal Renshaw cells was studied in anesthetized rats spinalized at T4 level. Burst responses elicited by single electrical shocks to ipsilateral ventral roots L6 (frequency 0.5 Hz, stimulus width 0.1 ms) and spontaneous activity were recorded extracellularly using conventional 3 M KCl filled glass micropipettes. The specific D1 agonist SKF 38393 (0.5-1 mg/kg i.v.) enhanced Renshaw cell burst responses by 20-60% (n = 7) and increased their spontaneous discharge rate (n = 3). This effect was clearly antagonized by the specific D1 antagonist SCH 23390 (1 mg/kg i.v.) although SCH 23390 proved ineffective per se. We conclude that SKF 38393 induced facilitation was due to activation of the specific D1 receptors which could be the functional counterpart of the presynaptic D2 receptors described earlier by us in the same synapse.

Dopaminergic influence on the excitability of antidromically activated Renshaw cells in the lumbar spinal cord of the rat.

The interaction between dopaminergic and cholinergic systems in the mammalian central nervous system, which is thought to have important implications in the pathophysiology of major extrapyramidal disorders, has never been adequately demonstrated in vivo. Renshaw cell burst responses to single electrical shocks to lumbar ventral roots in spinalized and decerebrated rats were studied. In this monosynaptic cholinergic pathway, apomorphine, a dopaminergic receptor agonist, inhibited whereas the D2-antagonist sulpiride facilitated the burst responses. The mutual antagonism of the two drugs and the depression coupled with the faster decay of post-tetanic potentiation of Renshaw cells by apomorphine demonstrate the involvement of presynaptic D2-receptors through which dopamine can modulate acetylcholine-mediated central synaptic transmission in vivo. The study also provides further evidence for the involvement of the spinal cord in extrapyramidal disorders.

Presynaptic dopaminergic inhibition of the spinal reflex in rats.

Dopaminergic influence on spinal monosynaptic transmission was examined in rats. Monosynaptic mass reflex (MMR) was recorded from the ventral root L6 following supramaximal stimulation (0.2 Hz; 0.1 ms) to the ipsilateral dorsal root L6 in spinalized rat under pentobarbitone sodium (40 mg/kg, i.p.) anaesthesia. MMR was inhibited by intravenous administration of the dopaminergic agonist, apomorphine (50-200 ug/kg) in a dose-dependent manner. The attenuatory effect of apomorphine (200 ug/kg i.v.) on the reflex could be reversed by the dopaminergic antagonist haloperidol (0.5 mg/kg, i.v.). Under tetanic stimulation (200 Hz; 15s), the pretetanic relative inhibition induced by apomorphine (200 ug/kg, i.v.) was increased only for a short period immediately after the cessation of tetanic stimulation. The results indicate existence of presynaptic dopamine receptors on the afferent terminals converging on the motoneurone which may functionally modulate the spinal motor output.

Supersensitivity of spinal dopaminergic receptors in rat after chronic haloperidol.

In order to examine the effect of chronic neuroleptics on spinal dopaminergic system, rats were treated with haloperidol (0.5 mg/kg IP) for 21 days and the monosynaptic mass reflex (MMR) as well as dopamine (DA) metabolism were investigated. MMR, recorded from ventral root L6 following supramaximal stimulation to ipsilateral dorsal root L6 in spinalized rats, were found to be unaffected following chronic haloperidol treatment when compared to control. Apomorphine (0.1 mg/kg IV) caused 10-20% depression of MMR in control animals which was augmented to 40-50% in chronically haloperidol-treated animals suggesting an upregulation of DA receptors in the spinal cord. DA content of lumbar region of the spinal cord was unaffected whereas its major metabolite, homovanillic acid, was significantly reduced in chronic haloperidol-treated animals. This decreased utilization of DA may compensate the upregulation of DA receptors to maintain the physiological homeostasis of the spinal dopaminergic system.

ICMR's multicentre study on comprehensive MCH care.

PIP: The Indian Council of Medical Research (ICMR) is conducting an 8-center study which applies known risk factors to design a system and feasible methodology which uses the high risk approach to maternal and child health (MCH) care within the existing health care system in India. The primary health centers or subcenters include Delhi, Ahmedabad, Chandigarh, Gwalior, Jaipur, Lucknow, Pune, and Varanasi. 3 stages make up the study: situation analysis of each health center (6 months), developmental phase (1 year), and intervention period (3.5 years). The situation analysis has revealed that even though the health centers and subcenters had medical officers, they lacked adequate numbers of paramedicals. Paramedicals lacked practical knowledge and experience. The community did not use MCH services. All the centers needed resuscitation equipment and anesthesia and lacked other equipment. As part of the developmental phase, ICMR has obtained necessary equipment. It also has done some baseline surveys at the centers. ICMR has assigned 1 intervention to each health center which serves 80,000-1,690,000 people. Broad intervention strategies are reorientation training of paramedicals and medical officers, community education, decentralization of MCH/family planning, goals, and development of a referral system. 2.5 years into the intervention stage indicates improvement in prenatal registration (50-80%), detection of high risk mothers and infants (0 to 6-50%), basic services to registered pregnant women, and referral of risk cases. This MCH care program is attempting to provide sterile and safer care for pregnant mothers via traditional birth attendants and delivery kits.^ieng

Indian experience of home based mothers card: ICMR task force study.

To improve the quality of MCH services, a Home Based Mothers Card (HBMC) prepared and recommended by World Health Organization was adapted to Indian situation, and introduced in 1.5 lakh population of rural area covered by 6 participating centres under the aegis of Indian Council of Medical Research. Two thousand four hundred and forty six mothers were given this card and were followed up for a period of 2 years. Only 89.2 percent retrieval of the cards was possible after a period of 18 months. Screening of the population for "at risk" women monitoring and referral could be undertaken with the help of this card. Improved antenatal, and referral services were observed during the study period. The card (HBMC) was acceptable to the mothers as well as to the health workers, as a tool for improving the quality and coverage of MCH services being rendered at the Primary Health Centre.

PIP: Health workers at 6 primary health centers in different areas of India introduced the home-based mothers card (HBMC) to 2446 pregnant and mostly illiterate women in November 1984-October 1985 and followed them for 2 years to evaluate the acceptability and feasibility of the HBMC among rural women. Overall retrieval of the HBMCs after 18 months was 89.2%. 66.9% had at least 1 maternal risk factor. The most common risk factors were previous abortions (7.8%), neonatal deaths (5.9%), and fetal deaths (5%). The risk factors associated with the highest perinatal mortality rates were eclampsia (133.3) and fetal deaths (118.2). The researchers learned that they needed to revise the criteria for identifying at-risk mothers by using risk factors associated with the higher risk of perinatal mortality. Women with 3-4 risk factors were more likely to experience perinatal mortality than those with 1-2 risk factors (39.7 and 56.5 vs. 122.5 and 105). Health workers should refer women at highest risk (3-4 risk factors) to a health care facility for delivery. Of the 66.9% at-risk mothers, only 10% experienced risk factors during delivery. The risk factors during delivery were associated with a high relative risk (RR) of perinatal death, e.g., RRs ranged from 1.8 to 4.6. Prenatal care can detect the 2 delivery risk factors with the highest perinatal mortality (multiple pregnancy and abnormal presentation). Health workers should also refer mothers with these risk factors to a health care facility. 78% of at-risk mothers who had been referred to a health facility did indeed go for referral care. Health workers at the centers found the HBMC to be helpful, but it would be more so if it were to include infant health. Anganwadi workers would be more accepting of the card if it had pictorial illustrations.

Haloperidol on rat phrenic hemidiaphragm.

The butyrophenone neuroleptic haloperidol (10.65-85.2 microM) blocked the indirectly elicited twitch response of rat phrenic nerve diaphragm preparation. The depression was poorly reversible and was not mediated through dopamine receptors since neither dopamine nor apomorphine could alter the haloperidol blockade. Experiments on the isolated phrenic nerve indicated that the excitability of the nerve was blocked by haloperidol (42.6 microM) and that this blocking effect was minimized in presence of a high concentration of Ca2+ (5 mM) in the bathing fluid. Haloperidol (10.65-85.2 microM) also concentration-dependently inhibited acetylcholine (2.7 microM) contracture, without affecting the potassium chloride (0.5 M) and caffeine (15 mM) contracture. We conclude that haloperidol acts as a local anaesthetic on the motor nerve, probably by affecting calcium channels.

Metoclopramide on rat phrenic hemidiaphragm.

The effect of metoclopramide on skeletal muscle and its neurotransmission was studied employing innervated and denervated rat diaphragm. Metoclopramide, at concentrations from 0.035 to 0.14 mM, inhibited the twitch contractions of rat diaphragm stimulated either directly or indirectly. Inhibition was greater in indirectly stimulated preparations, at a given concentration of metoclopramide, than in directly stimulated preparations. Inhibition of indirect twitch by metoclopramide could be intensified by raising the concentration of magnesium chloride, but was unaffected by physostigmine or d-tubocurarine. Metoclopramide also inhibited the submaximal contractures of denervated diaphragm elicited by potassium chloride and acetylcholine. In calcium-free physiological solution, metoclopramide inhibited the caffeine-induced contractures of denervated diaphragm as a function of its concentration. It is suggested that metoclopramide possesses a calcium antagonistic action in the rat diaphragm.