Acceptability of PRO2000 vaginal gel among HIV un-infected women in Pune, India

Acceptability of PRO2000 Gel, a candidate vaginal microbicide, among participants of its Phase I safety study in Pune, India is reported here. Forty-two eligible women were enrolled in a study requiring twice daily intra-vaginal product use for 14 consecutive days between menses. Acceptability was assessed at study exit through structured questionnaires among 41 participants who completed the product use, and five focus group discussions involving 31 study participants. The participants generally liked the product (40/41, 97.2%), especially its colour (40, 97.2%) and consistency (35, 85.3%). Thirty-four participants reported sexual intercourse within one hour of product use, at least once during the study period and sexual pleasure was reported to be better or unaffected among (30, 88.2%) participants. Nearly 70% did not like its smell and mentioned preference for a product that would be unnoticeable to the male partner. Participating women were concerned about privacy in usage and storage of the product. Acceptability of PRO2000 vaginal gel was good, but its smell will have to be improved. Counselling to address women's concerns about privacy and storage will be crucial. Women's preference for unnoticeable product indicates their empowerment and willingness to accept female-controlled options for HIV prevention.

Challenging endoscopy reprocessing guidelines: a prospective study investigating the safe shelf life of flexible endoscopes in a tertiary gastroenterology unit

BACKGROUND AND STUDY AIMS

Professional practice guidelines for endoscope reprocessing recommend reprocessing endoscopes between each case and proper storage following reprocessing after the last case of the list. There is limited empirical evidence to support the efficacy of endoscope reprocessing prior to use in the first case of the day; however, internationally, many guidelines continue to recommend this practice. The aim of this study is to estimate a safe shelf life for flexible endoscopes in a high-turnover gastroenterology unit.

MATERIALS AND METHODS

In a prospective observational study, all flexible endoscopes in active service during the 3-week study period were microbiologically sampled prior to reprocessing before the first case of the day (n = 200). The main outcome variables were culture status, organism cultured, and shelf life.

RESULTS

Among the total number of useable samples (n = 194), the overall contamination rate was 15.5%, with a pathogenic contamination rate of 0.5%. Mean time between last case one day and reprocessing before the first case on the next day (that is, shelf life) was 37.62 h (SD 36.47). Median shelf life was 18.8 h (range 5.27-165.35 h). The most frequently identified organism was coagulase-negative Staphylococcus, an environmental nonpathogenic organism.

CONCLUSIONS

When processed according to established guidelines, flexible endoscopes remain free from pathogenic organisms between last case and next day first case use. Significant reductions in the expenditure of time and resources on reprocessing endoscopes have the potential to reduce the restraints experienced by high-turnover endoscopy units and improve service delivery.

A five-year audit of anal cancer in Wales

OBJECTIVES

A retrospective audit has been undertaken of Squamous (epidermoid) type of anal cancer diagnosed and treated in the principality of Wales over a five-year period (1995-99) with follow-up until 2005. The referral pattern, distribution, presenting symptoms, predisposing conditions, clinical findings and staging modalities were documented. The surgical and oncological treatment together with their outcome was analysed.

METHODS

Patients were identified from the Welsh Cancer Registry and the pathology databases of the 17 acute hospitals in Wales. Data was collected from the clinical and oncology case notes onto a purpose designed Microsoft access database.

RESULTS

There was a wide variation in data quality from the individual units. Twenty-six anal cancers were diagnosed per year in the region. Median age was 69 years. Ten percent had documented perianal Human Papilloma Virus related disease. Radiology was inconsistently used for staging. Eighty percent were referred for an oncology opinion; 50% had chemo-radiotherapy with a curative intent. The over-all Stoma rate was 35% and of these 18% had an abdomino perineal resection. The overall five-year survival was 45%.

CONCLUSIONS

This is a unique regional audit of anal cancer. Improvements need to be made in documentation particularly of staging, treatment, pathology reporting and outcome. This study concurs that Human Papilloma Virus appears to predispose to Squamous anal cancer. Radiological staging needs to be standardized according to best clinical practice. As recommended by NICE all patients should be referred to a multidisciplinary anal cancer team, which can provide individual treatment plans. Increased specialization could mean specialist regional MDTs for anal cancer.

The MicroRNA pathway plays a regulatory role in stem cell division

One of the key characteristics of stem cells is their capacity for self-renewal for long periods of time. In this respect, stem cells are similar to cancer cells, which also have the ability to escape cell cycle stop signals. Therefore, a critical question in stem cell and cancer biology is how cell division is regulated in these cell types. In this review, we summarize recent progress and describe future challenges to understanding the role the microRNA pathway plays in regulating mechanisms controlling stem cell division.

Development of swimming in the medicinal leech, the gradual acquisition of a behavior

Observing the development of behavior provides an assay for the developmental state of an embryo's nervous system. We have previously described the development of behaviors that were largely confined to one or a few segments. We now extend the work to a kinematic analysis of the development of swimming, a behavior that requires coordination of the entire body. When leech embryos first begin to swim they make little forward progress, but within several days they swim as effectively as adults. This increase in efficacy depends on changes in body shape and on improved intersegmental coordination of the swim central pattern generator. These kinematic details suggest how the swim central pattern generating circuit is assembled during embryogenesis.

Synergistic effects of dust and ammonia on the occupational health effects of poultry production workers

OBJECTIVE

As production methods for livestock and poultry moved towards large industrial-scale confinement facilities, the occupational health community reported risks for respiratory illnesses in workers. Likely, greater risks for respiratory disease will occur with the continuing trend towards full-time confinement workers, who inspire a combination of bioaerosols, particulates, and gases. Although there have been numerous studies on the individual health effects of air contaminants inside confined animal production facilities, there have been no reports on the effects of combined exposures. The objective of this study was to investigate the combined health effects of air contaminants on poultry production workers.

SAMPLE POPULATION

Two hundred and fifty-seven poultry production workers participated in this study. The workers represented various areas of the poultry industry, including turkey growing, broiler production, egg laying, and unloading/shakeling in poultry processing. Worker procedures pulmonary function testing was conducted before and after a four-hour work shift. The work environment was assessed for total and respirable dust, ammonia, endotoxin and CO2. The relationship of simultaneous total dust and ammonia exposures was examined by correlation, logistic modeling, and synergy index calculations.

RESULTS

Synergy between ammonia levels and airborne dust explained up to 43% and 63% of the decline (respectively for Forced Expiratory Volume (FEV) in one second and Forced Expiratory Flow (FEF25-75) in pulmonary function over the work shift. Furthermore, assessing the synergy index indicated the combined effect of dust and ammonia is from 53 to 156% (greater combined than individually). The proportion of health effect due to synergy is 35%-61%.

CONCLUSIONS

Synergy of simultaneous dust and ammonia exposures in a working environment raises the question of redefining exposure limits for organic dust and ammonia when workers are exposed simultaneously to these substances.

CLINICAL RELEVANCE

Control of both dust and ammonia in livestock facilities is extremely important. Lack of control of both these contaminants will increase the risk of respiratory dysfunction to all exposed to this environment, including workers and veterinarians.

Size-dependent absorption and defect states in CdSe nanocrystals in various multilayer structures

GeS2-CdSe superlattices and composite films are prepared by consecutive thermal evaporation of CdSe and GeS2 in vacuum. CdSe layer thickness varies between 1 and 10 nm, while the thickness of GeS2 layers is either equal (in superlattices) to or 20 times greater (in composite films) than that of CdSe layers. Standard spectral photocurrent measurements and various constant photocurrent methods are used to study optical absorption of all samples. An overall blueshift is observed with decreasing CdSe layer thickness of superlattices. This shift is related to a size-induced increase of the optical band gap of CdSe due to one-dimensional carrier confinement in the continuous nanocrystalline CdSe layers. A number of features are observed in the absorption spectra of composite films containing CdSe nanocrystals with average radii of approximately 2.5 and approximately 3.3 nm. They are discussed in terms of three-dimensional carrier confinement and are considered a manifestation of excited electron states in CdSe nanocrystals embedded in GeS2 thin film matrix. In addition to these discrete features, the exponential dependence of the optical absorption (Urbach) edge indicates a distribution of "valence band" tail states associated with disorder. Transient photoconductivity measurements made on similarly prepared SiOx-CdSe superlattices exhibit a rapid fall in photocurrent by a power law decay over several orders of magnitude of time, which is consistent with multi-pletrapping transport via an extensive distribution of deep defects.

Pesticide use and practices in an Iowa farm family pesticide exposure study

Residents of Iowa were enrolled in a study investigating differences in pesticide contamination and exposure factors between 25 farm homes and 25 non-farm homes. The target pesticides investigated were atrazine, metolachlor, acetochlor, alachlor, 2,4-D, glyphosate, and chlorpyrifos; all were applied to either corn or soybean crops. A questionnaire was administered to all participants to determine residential pesticide use in and around the home. In addition, a questionnaire was administered to the farmers to determine the agricultural pesticides they used on the farm and their application practices. Non-agricultural pesticides were used more in and around farm homes than non-farm homes. Atrazine was the agricultural pesticide used most by farmers. Most farmers applied pesticides themselves but only 10 (59%) used tractors with enclosed cabs, and they typically wore little personal protective equipment (PPE). On almost every farm, more than one agricultural pesticide was applied. Corn was grown by 23 (92%) farmers and soybeans by 12 (48%) farmers. Of these, 10 (40%) grew both soybeans and corn, with only 2 (8%) growing only soybeans and 13 (52%) growing only corn. The majority of farmers changed from their work clothes and shoes in the home, and when they changed outside or in the garage, they usually brought their clothes and shoes inside. Applying pesticides using tractors with open cabs, not wearing PPE, and changing from work clothes in the home may increase pesticide exposure and contamination. Almost half of the 66 farm children less than 16 years of age were engaged in some form of farm chores, with 6 (9%) potentially directly exposed to pesticides, while only 2 (4%) of the 52 non-farm children less than 16 years of age had farm chores, and none were directly exposed to pesticides. Farm homes may be contaminated with pesticides in several ways, resulting in potentially more contamination than non-farm homes, and farm children may be directly exposed to pesticides through farm chores involving pesticides. In addition to providing a description of pesticide use, the data presented here will be useful in evaluating potential contributing factors to household pesticide contamination and family exposure.

Citizens advice in primary care for families with young children

BACKGROUND

Citizens advice can help clients avoid the worst consequences of poverty and hence has the potential to reduce inequalities in health. Previous studies of providing citizens advice from primary care have concentrated largely on older clients.

AIM

To measure the benefits obtained by families with young children from a citizens advice service in primary care.

METHOD

An advice worker was placed in three practices. Eligible families had a child less than 1 year of age. Quantitative analysis of data on benefits obtained by all families using the service was performed. Qualitative analysis of interviews with five users and five non-users of the service was undertaken.

RESULTS

Out of 107 families recruited, 23 used the CAB service, seeking advice on 49 different problems and obtaining benefit on 32 of these, most frequently on welfare benefits, debt management and housing. One-off financial benefits totalled pound sterlings 17 857 with annual recurring payments of pound sterlings 6480. The interviews raised five general themes: (1) the stresses surrounding the birth of a child; (2) factors associated with uptake of the service; (3) the content and value of the advice received; (4) the benefits to their health of the advice; and (5) their perception of the links between health and financial adversity.

CONCLUSIONS

Citizens advice offers considerable benefits to families with young children. It may have positive effects on maternal and child health. An advice service is a useful component of primary health care for young families.

Debt, social disadvantage and maternal depression

Depression is common among women with young children, and is strongly associated with financial adversity. Debt is a common feature of such adversity, yet its relationship with depression has not been examined before. We have used longitudinal data, collected over six months, on 271 families with young children, to examine this relationship. Multiple regression was used to identify independent predictors of the total Edinburgh Post-natal Depression Scale score from a range of socioeconomic, demographic, social support and child health related variables. Worry about debt was the strongest independent socioeconomic predictor of the depression score at both initial and follow-up occasions. To account for the possibility of reverse causation, i.e. depression causing worry about debt, alternative regression models are reported which show that owing money by itself predicts depression and earlier debt worries predicts depression six months later. We were unable to show that earlier debt worries independently predicted subsequent depression scores after the initial depression score had been taken into account in the analysis. Although debt has not been shown to be an independent prospective predictor of depression, our results suggest it has a central place in the association between socioeconomic hardship and maternal depression. Evidence from qualitative studies on poverty and from studies on the causes of depression support this hypothesis. The implications for policy are that strategies to enable families to control debt should be an explicit part of wider antipoverty measures which are designed to reduce depression and psychological distress among mothers of young children.

Inhibitory effect of 1-O (2 methoxy) hexadecyl glycerol and phenylbutyrate on the malignant properties of human prostate cancer cells

The ability of the naturally occurring ether lipid, 1-O (2 methoxy) hexadecyl glycerol (MHG), and phenylbutyrate (BP) to inhibit cellular proliferation, anchorage-independent growth and cellular invasion in the human prostate cancer LnCap and DU145 cells was determined. Both MHG and PB inhibited the malignant properties of these prostate cancer cells. The concentrations required to achieve similar inhibitory effect, however, were significantly different for these two agents. MHG inhibited cell growth with equal potency in these cell lines with an IC-50 value of 93 microM for LnCap, and 97 microM for DU145. The IC-50 values for PB were 1.3 mM and 7.3 mM, respectively, for LnCap and DU145 cells. Both MHG and PB (IC-50 concentrations) inhibited the anchorage-independent growth and cellular invasion in these cells. Over 50% inhibition of anchorage-independent growth was achieved for both LnCap and DU145 cells by PB, while a lesser degree of inhibition was achieved with MHG. Both MHG- and PB-treated cells showed a reduced propensity to invade matrigels. Invasion of PB-treated LnCap and DU145 cells was reduced, respectively, by approximate 41 and 30% when compared to untreated control cells, while invasion of MHG-treated LnCap and DU145 cells was reduced to a lesser extent. Because differentiation-inducing agents may possess chemopreventive properties, the use of naturally occurring MHG and nontoxic PB in the chemoprevention of malignant diseases warrants further investigation.