Urine-derived cells provide a readily accessible cell type for feeder-free mRNA reprogramming.

Over a decade after their discovery, induced pluripotent stem cells (iPSCs) have become a major biological model. The iPSC technology allows generation of pluripotent stem cells from somatic cells bearing any genomic background. The challenge ahead of us is to translate human iPSCs (hiPSCs) protocols into clinical treatment. To do so, we need to improve the quality of hiPSCs produced. In this study we report the reprogramming of multiple patient urine-derived cell lines with mRNA reprogramming, which, to date, is one of the fastest and most faithful reprogramming method. We show that mRNA reprogramming efficiently generates hiPSCs from urine-derived cells. Moreover, we were able to generate feeder-free bulk hiPSCs lines that did not display genomic abnormalities. Altogether, this reprogramming method will contribute to accelerating the translation of hiPSCs to therapeutic applications.

Pharmacovigilance and new essential drugs in Africa: Zambia draws lessons from its own experiences and beyond.

Jolted into action by the thalidomide tragedy, developed Western countries began to establish national systems for identifying and responding to adverse drug reactions and events (or pharmacovigilance systems) about 40 years ago. These systems focus on side effects, adverse reactions, and drug interactions. In developing countries, especially in Africa, the scope for pharmacovigilance needs to be broader (despite the additional challenges this brings) because of growing problems with substandard and counterfeit drugs and the need to have an early warning signal system for the development of antimicrobial resistance to the 'new essential drugs' that are barely beyond the clinical trial stage in Africa, e.g. artemisinin-combination therapy (ACT) for malaria and antiretrovirals (ARV) for HIV/AIDS. Zambia learned important lessons from its own initial experiences in attempting to use ACT as a pathfinder for pharmacovigilance, as well as its experience with other drug information systems. In preparing its own renewed plans, it also drew lessons from international experience, including the weaknesses of the Food and Drug Administration's approach to pharmacovigilance in the USA, the UK's 'yellow card scheme', Brazil's fledgling pharmacovigilance systems for AIDS treatment, and the guidance provided by the World Health Organization and the Uppsala Monitoring Centre. These lessons are relevant for other African countries and even for developed countries seeking to improve pharmacovigilance systems.

Crossing the public-private sector divide with reproductive health in Cambodia: out-patient services in a local NGO and the national MCH clinic.

Set within the context of recent literature on the private-public divide in the health sector of developing countries generally and Asia specifically, this study considers the major government and the major indigenous non-government clinics offering out-patient reproductive health services in Phnom Penh, Cambodia. Reproductive health is of critical importance in Cambodia, which has one of the highest levels of unmet need for family planning in the developing world and suffers from what is arguably the most severe STD and HIV/AIDS problem in Asia. The study is unusual in that it examines and compares aspects of service delivery and pricing along with the socio-economic profile and health-seeking behaviour of clients self-selecting services in the two settings. The socio-economic status of clients was much higher than the norm in Cambodia but did not differ significantly between the two clinics. A few service indicators suggested that the quality of care was better in the NGO clinic. Underlying variables--such as the broader mandate of the public sector institution and the significant discrepancy between public and private sector salaries--offer an obvious explanation for these differences. The Ministry of Health in Cambodia has been developing policies related to the NGO sector, which has expanded rapidly in Cambodia during the 1990s, and it is struggling to increase staff remuneration within the public sector.

Women helping women in Cambodia.

PIP: Dr. Ouk Vong Vathiny is the first director of the Reproductive Health Association of Cambodia (RHAC), the International Planned Parenthood's newest affiliate. Dr. Vathiny's interest in reproductive health began with her first position in a clinic serving women working in Phnom Penh's commercial sex district. Today, she works with RHAC staff to provide a full range of reproductive health services to a wide variety of rural and urban women. Under the direction of Dr. Ping Chutema, the RHAC clinic provides a standard package of safe motherhood services and highlights provision of birth spacing counseling and methods. Although it operates in only three of 22 provinces, the RHAC now distributes between a fourth and a third of all contraceptives dispensed by government services. Dr. Vathiny and Dr. Chutema note that the biggest problem they face is the fact that most women in Cambodia have very little education and that rumors spread faster than real information. Efforts to insure safe motherhood are challenged by high rates of sexually transmitted diseases and by a high prevalence and rate of increase of HIV infection, both of which are exacerbated by the popularity of commercial sex among married men. Domestic violence and women's low nutritional status are also problems. RHAC considers education and counseling essential elements of its safe motherhood package and even trains community-based contraceptive distributors to counsel women on ways to negotiate with their husbands.^ieng

Health financing policy formulation in the Eastern Caribbean.

Stakeholders formulating policies on national health insurance (NHI) in the Eastern Caribbean have circled the abstract concept called NHI like the proverbial blind men explaining the elephant. Definitions of NHI have shifted depending on their perspectives and philosophical leanings, their understanding of the issues, and their degree of influence on the process. Based on NHI feasibility studies, market research, and stakeholder analysis conducted in five countries, this article analyses the policy formulation stage of NHI development in these tiny countries. Given the level of economic development and the existing administrative capacity of the governments, this 'phase one' NHI could be a pragmatic first step in introducing a health insurance component into the social security systems of the countries, and gradually reforming other aspects of the health sector. The article is structured around key questions which help to define the positions and relationships of key stakeholders, and then evaluate NHI plans in terms of economic viability, equity, administrative feasibility and efficiency, cost containment incentives, and political palatability. These are the elements that--in combination with economic and political context--will determine the success or failure of NHI in the Eastern Caribbean.

The first private sector health insurance company in Ghana.

This article analyses the development of Ghana's first private sector health insurance company, the Nationwide Medical Insurance Company. Taking both policy and practical considerations into account (stakeholders' perspectives, economic viability, equity and efficiency), it is structured around key questions which help to define the position and roles of stakeholders--the insurance agency itself, contributors, beneficiaries, and providers--and how they relate to one another and the insurance scheme. These relationships will to a large extent determine Nationwide's long-term success or failure. By creating a unique alliance between physician providers and private sector companies, Nationwide has used employers' interest in cost containment and physicians' interest in expanding their client base as an entrée into the virgin territory of health insurance, and created a hybrid variety of private sector insurance with some of the attributes of a health maintenance organization or managed care. The case study is unusual in that, while public sector programs are often open to academic scrutiny, researchers have rarely had access to detailed data on the establishment of a single private sector insurance company in a developing country. Given that Ghana is planning to launch a national health insurance plan, the article concludes by considering what the experience of this private sector initiative might have to offer public sector planners.

Cost containment through pharmaceutical procurement: a Caribbean case study.

This article discusses the potential for health sector cost containment in developing countries through improved pharmaceutical procurement. By describing the specific example of the Eastern Caribbean Drug Service (ECDS), which provides a pooled procurement service to nine ministries of health in the small island nations of the Caribbean, it examines the elements of the procurement operation that allowed ECDS to reduce unit costs for pharmaceuticals by over 50 per cent during its first procurement cycle. The analysis of ECDS considers: (1) political will, institutional alliances, and the creation of a public sector monopsony; (2) pooling demand; (3) restricted international tendering and the pharmaceutical industry; (4) estimating demand and supplier guarantees; (5) reducing variety and increasing volume through standardizing pack sizes, dosage forms and strengths; (6) generic bidding and therapeutic alternative bidding; (7) mode of transport from foreign suppliers; (8) financing mechanisms, including choice of currency, foreign exchange, and terms of payment; (9) market conditions and crafting and enforcing supplier contracts; and, (10) the adjudication process, including consideration of suppliers' past performance, precision requirements in the manufacturing process, number of products awarded to suppliers, and issues of judgment. The authors consider the relevance of this agency's experience to other developing countries by providing a blueprint that can be adopted or modified to suit other situations.

Effect of alkali treatment on physiological activity of cotton condensed tannin.

Cotton dusts contain condensed tannins and endotoxins, which are suspected of contributing to the development of acute and chronic biological responses in some cotton textile mill workers. Condensed tannin extracted from cotton dust was coated on to cellulose powder, and the tannin coated powder was treated with an alkali solvent system previously developed to reduce the endotoxin content and pulmonary toxicity of cotton dust. Physiological activities of the dusts and powders were compared by assaying the production of the arachidonic acid metabolites prostaglandin F2 alpha (PGF2 alpha), thromboxane A2 (TxA2) (the precursor to thromboxane B2 (TxB2], leukotriene C4 (LTC4), and prostaglandin E2 (PGE2) by guinea pig pulmonary cells obtained by lung lavage. Cotton dust stimulated the pulmonary cells to produce a total of 29 pg metabolites per 10(6) cells. Production of metabolites by cells stimulated with tannin coated cellulose powder was reduced to 8.3 pg/10(6) cells. Alkali treatment of the tannin coated cellulose powder resulted in a further decrease in its ability to stimulate the cells, producing 3.5 pg metabolites per 10(6) cells. The ability of the dusts and powders to stimulate production of metabolites of arachidonic acid by pulmonary cells from guinea pigs was highly correlated with tannin content of the materials, but not with endotoxin content as measured by the Limulus amoebocyte lysate (LAL) assay.

A computer-based therapy for the treatment of aphasic subjects with writing disorders.

A computer-controlled rehabilitation for aphasics with writing impairments is presented. Subjects were asked to type words under dictation. Each time a letter was typed in its correct position, it was displayed on a screen. If the contrary, the error was not displayed, thus avoiding visual reinforcement of false choices. This method of rehabilitation has proved efficient as concerns typewriting. More importantly, some learning transfer to handwriting was observed at the completion of experimental training. The results showed a significant reduction in the number of misspelled words as well as in the erroneous choice and serial ordering of letters. The stability of the observed improvement is discussed in relationship to variables such as the time elapsed since brain damage and the type of writing difficulty.