OBJECTIVE: To assess barriers to implementation of TB-HIV collaborative services in five districts in Uganda.

DESIGN: In this qualitative study, focus groups and key informant and in-depth interviews were conducted for patients (HIV, TB), health providers and community members. TB registers were also assessed for data on use of TB-HIV collaborative services.

RESULTS: Of 333 adult TB

patients registered between July and September 2006, 185 (56%) were tested for HIV, of whom 1.34 were HIV-co-infected. Of these, 52% were on cotrimoxazole preventive therapy (CPT), 12% were on antiretroviral therapy (ART) and CPT, while 36% had not received any HIV service. Health system barriers identified included poor TB-HIV planning, coordination and leadership, P5091 Ubiquitin inhibitor inadequate dissemination of policy, inadequate provider knowledge, limited TB-HIV interclinic referral, poor service integration and recording, logistical shortages, high costs of services and provider shortages amidst high patient loads.

CONCLUSION: Implementation and utilisation of collaborative TB-HIV services remains suboptimal. The barriers identified

highlight the need for TB and HIV programmes to support districts CH5424802 Protein Tyrosine Kinase inhibitor to plan, coordinate and invest resources in TB-HIV collaborative services, especially in policy dissemination, training health providers, integration of TB-HIV services, logistical management and monitoring.”
“There is strong evidence that Alzheimer’s disease (AD) pathology starts decades before clinical onset. Cognitive reserve (CR) and brain reserve can be a good predictive model for AD development.

Neuroimaging can help in describing cerebral reserves, as well as in detecting AD brain pathology before the onset of clinical dementia. Education and occupation GSK2126458 cell line act as proxies for CR and are associated with a lower risk of AD and delayed onset of symptoms. The apolipoprotein E (ApoE)-epsilon 4 allele is a strong risk factor for AD and is associated with lower hippocampal volume even in normal aging. A fluorodeoxyglucose positron emission tomography study of brain metabolism shows different metabolic phenotypes among subjects with different educational levels and ApoE genotypes. More highly educated subjects reach a clinical level when the cerebral areas involved in coping with network disruption are seriously impaired, and the AD-epsilon 4 carriers show more global metabolic brain impairment compared with non-epsilon 4 carriers. Thus, CR can counteract a genetically unfavorable background, suggesting a possible preventive strategy. AD research findings have already produced results, since recent epidemiological studies report a decreasing incidence of AD in the years. (C) 2013 S. Karger AG, Basel”
“Background: Ingestion and/or aspiration of foreign bodies (FB) are avoidable incidents.