Polycyclic aromatic hydrocarbon (PAH) exposure and DNA adduct semi-quantitation in archived human tissues.

Polycyclic aromatic hydrocarbons (PAHs) are combustion products of organic materials, mixtures of which contain multiple known and probable human carcinogens. PAHs occur in indoor and outdoor air, as well as in char-broiled meats and fish. Human exposure to PAHs occurs by inhalation, ingestion and topical absorption, and subsequently formed metabolites are either rendered hydrophilic and excreted, or bioactivated and bound to cellular macromolecules. The formation of PAH-DNA adducts (DNA binding products), considered a necessary step in PAH-initiated carcinogenesis, has been widely studied in experimental models and has been documented in human tissues. This review describes immunohistochemistry (IHC) studies, which reveal localization of PAH-DNA adducts in human tissues, and semi-quantify PAH-DNA adduct levels using the Automated Cellular Imaging System (ACIS). These studies have shown that PAH-DNA adducts concentrate in: basal and supra-basal epithelium of the esophagus, cervix and vulva; glandular epithelium of the prostate; and cytotrophoblast cells and syncitiotrophoblast knots of the placenta. The IHC photomicrographs reveal the ubiquitous nature of PAH-DNA adduct formation in human tissues as well as PAH-DNA adduct accumulation in specific, vulnerable, cell types. This semi-quantative method for PAH-DNA adduct measurement could potentially see widespread use in molecular epidemiology studies.

Assessment of quality of services in private clinics in Addis Ababa, Ethiopia.

Involvement of the private sector in provision of health services has progressively increased in many developing countries including Ethiopia. Promotion of the private sector involvement is also one of the elements in the health care financing strategy in Ethiopia. A cross sectional descriptive study was done on quality of care in private clinics in Addis Ababa during the period of April, 2000. Different levels of clinics were randomly selected and assessments were done on structural aspects, performance of health workers in polyclinic outpatient department and patients satisfaction with the medical care given. It was found that most clinics fulfill the requirements of the Ministry of Health (MOH) with regard to staffing, equipment and medications. Nevertheless few clinics were found not to fulfill the minimum requirements put in the guideline. With regard to performance, various aspects of mal-performance were observed where the highest problem was concerning treatments given to patients. High rates of satisfaction were generally reported in all aspects of medical care that include: waiting time, cleanliness of facilities and equipment, courtesy and competence of providers and the effectiveness of the services provided. Relatively lower proportion of respondents has reported dissatisfaction with the services provided. The aspects of the private sector services for which dissatisfaction was reported were too high service charge and too little information given about nature and prospect of diseases. These imply that the private facilities included in the study are generally doing well in terms of structural as well as in most process attributes of quality while provider-patient interaction and competitive pricing of services seem to be areas that need improvement. Findings are discussed in comparison with findings in public and private health facilities in Ethiopia and other countries. In addition, the inclusion of periodic assessment of process of care in quality control measures is recommended.