The Jamaican adolescent's perspective on violence and its effects

The Caribbean and in particular Jamaica is experiencing an epidemic of violence which adversely affects its youth who are the main perpetrators and victims. Early and protracted exposure to violence is part of the socialization experience that results in violence-related behaviours. This paper examines the impact of the early and sustained exposure to violence on the attitudes and behaviours of Jamaican adolescents from their perspective. An analysis of qualitative data collected from three studies between 2005 and 2009 among adolescents across Jamaica was conducted using the recurrent theme approach. Exposure to violence was common and increased with age and lower socioeconomic status and was most marked among marginalized inner city youth. While attitudes and behaviours in response to the violence varied among adolescents, there was a "dose response effect" in relation to age and lower social status. It is necessary to alter the socialization process in order to break the cycle of violence through wide ranging interventions that touch on every aspect of the spheres of influence in the life of Jamaican adolescents.

Are parents in tune with music their adolescent children enjoy? Are there missed opportunities for sexual and reproductive health dialogue?

The perspectives of adolescents were solicited on the issue of sexual and reproductive health messages they received through dancehall music as well as their perceptions of parents' views of such messages and adolescents' indulgence with this genre of music.

METHODS

This sequential mixed methods study was completed in 2008. The study's qualitative component was summarized as the novel ALODAC (Ask, Listen and Observe, Discuss, Analyse and Confirm) model, involving a series of steps to engage adolescents 10-19 years to share their perspectives on sexual and reproductive health messages enunciated in the dancehall music to which they listen. The quantitative component saw 1626 adolescents in public schools responding to an interviewer-administered questionnaire which included questions about their families and how they respond to dancehall content. Five messages determined from content analysis of songs on adolescents' music menu were used to initiate discussions with adolescents about the issues.

RESULTS

Almost equal proportions of respondents in the survey lived with either their mothers (37.3%) or both parents (35.6%). Most adolescents reported enjoying dancehall music and learning specific messages even when some parents were against use of such music. There were significant gender differences observed regarding perceptions about parents agreement with lyrics on transactional sex (p < 0.001), prevention of pregnancy (p < 0.01), condom use (p < 0.01) and multiple relationships (p < 0.01).

CONCLUSIONS

Whether or not parents are in tune with the music their adolescent children listen to does not seem to affect the pleasure and lessons adolescents gain from this medium. Opportunities for discussing sexual issues common in Jamaican dancehall music exist but are missed.

On-farm paddock-scale comparisons across southern Australia confirm that increasing the nutrition of Merino ewes improves their production and the lifetime performance of their progeny

Experiments conducted by Lifetimewool at plot-scale have shown that differences in the maternal liveweight during pregnancy and lactation (liveweight profiles) of individual Merino ewes influences their wool production and reproductive rate as well as the birthweight, survival, weaning weight and lifetime wool production of their lambs in a predictable manner. This study determined whether these impacts of nutrition of the ewe on ewe and progeny performance are measurable on commercial properties across southern Australia at a paddock-scale where ewes were aggregated into flocks with a greater spread of the date of conception and where the liveweight profile of the flocks were managed based on random samples of 100 ewes and liveweight was uncorrected for fleece weight or conceptus. Eighteen paddock-scale experiments at 15 sites were conducted in cooperation with wool producers across Victoria, Western Australia, New South Wales, South Australia, and Tasmania. Each co-operator joined up to 1000 mixed aged adult Merino ewes. The flock was scanned using ultrasound at Day 50 from the start of joining to identify those ewes that conceived during the first 21 days of joining. These ewes were then split at random into two treatments and fed to achieve a target difference in liveweight of 10 kg or ~1 condition score/fat score at lambing. The production of ewes during their year of pregnancy and following their next joining was measured as was the performance of their progeny up to their third shearing. Only the 13 paddock-scale experiments that achieved a difference in liveweight profile at lambing of at least 4 kg were included in the final analysis. In these 13 experiments, increasing the nutrition of Merino ewes during pregnancy clearly increased the clean fleece weight and fibre diameter in ewes and the survival and lifetime wool production of their lambs. In most cases the size of the effect was not significantly different to that predicted by the relationship derived using individual liveweight profiles in the plot-scale experiments. This confirms that managing average ewe liveweight or condition score/fat score profile through better nutrition will lead to predictable increases in the performance of ewes and their progeny performance under commercial conditions and validates the use of the plot-scale relationships in economic analyses.

Basal Ganglia involvement in Wernicke encephalopathy: report of 2 cases

We present the neuroimaging and clinical findings in 2 nonalcoholic adult patients with WE as assessed by MR imaging. The first patient presented with gait ataxia and changes in consciousness. MR imaging disclosed bilateral lesions in the dorsal striatum and cerebellum. None of the regions typically affected in WE were involved. The second patient showed symmetric lesions in the posterior putamen associated with the alterations frequently and infrequently found WE.

T cells reactive with the NC16A domain of BP180 are present in vulval lichen sclerosus and lichen planus

BACKGROUND

Lichen sclerosus (LS) is a chronic inflammatory skin condition. The recent demonstration of circulating autoantibodies to extracellular matrix protein 1 and to basement membrane zone (BMZ) components, chiefly BP180, suggests that autoimmunity to these components might contribute to pathogenesis. However, there is no binding of autoantibodies in vivo and as LS is characterized by a lymphocytic infiltrate, it seems likely that LS is mediated, in part, by antigen-specific lymphocytes. Similar mechanisms may apply to vulval lichen planus (LP), an interface dermatitis, with clinical and immunological overlap with LS.

OBJECTIVES

This study aims to test the hypothesis that T cells reactive with the NC16A domain of BP180 are present in the peripheral blood of patients with vulval LS and LP.

METHODS

Isolated peripheral blood mononuclear cells from 14 patients with vulval LS, 5 with vulval LP and 4 healthy controls were grown in vitro. We examined for immunogenicity of overlapping peptides spanning the NC16A domain of BP180 using interferon-gamma enzyme-linked immunospot assay (ELIspot) on the cultured T-cell lines. BMZ antibodies were assayed, HLA type determined and clinical parameters noted.

RESULTS

Significant interferon-gamma production was observed in response to the NC16A peptides in 6 of the 14 vulval LS and 2 of the 5 LP patients, but not in the control subjects. There was an associated autoantibody response to BP180 in 3 LS and 1 LP patient with T-cell responses. These data suggest that in some vulval LS and LP patients, NC16A domain-specific T cells circulate at sufficiently high frequency to be detectable in vitro and show rapid effector function. There was no association with HLA type or clinical parameters.

CONCLUSION

We have demonstrated that in > 40% of our vulval LS and LP patients, the NC16A domain of BP180 is a target for circulating T cells, and in vulval LS and LP there are associated autoantibodies to BP180.

Determinants of risk behaviour of sex-workers in Jamaica. A qualitative approach

The practice of evidence-based medicine is well established and research is a key element. Evidence-based approaches require an understanding of the complexities of the interactions and dynamics that influence decision-making. Qualitative research methods are increasingly being used to complement the findings of the traditional quantitative methods. A qualitative study which examines the sexual choices of commercial sex-workers is described to demonstrate the usefulness of this type of study. Focus group discussions give the reasons for the non-regular use of condoms and identify other factors needing intervention. These include low self-esteem and poor job satisfaction as well as problems with violence and drug use. It provides vital information for HIV/AIDS prevention activities for commercial sex-workers.

Single measurement reliability and reproducibility of volitional and magnetically-evoked indices of neuromuscular performance in adults

This study documents intra-session and inter-day reproducibility (coefficient of variation [V%]) and single measurement reliability (intra-class correlations [R(I)]; standard error of a single measurement [SEM%] [95% confidence limits]) of indices of neuromuscular performance elicited during peripheral nerve magnetic stimulation. Twelve adults (five men and seven women) completed 3 assessment sessions on 3 days, during which multiple assessments of knee flexor volitional and magnetically-evoked indices of electromechanical delay (EMD(V); EMD(E)), rate of force development (RFD(V); RFD(E)), peak force (PF(V); P(T)F(E)), and compound muscle action potential latency (LAT(E)) and amplitude (AMP(E)) were obtained. Results showed that magnetically-evoked indices of neuromuscular performance offered statistically equivalent levels of measurement reproducibility (V%: 4.3-31.2%) and reliability (R(I): 0.98-0.51) compared to volitional indices (V%: 3.7-25.2%; R(I): 0.98-0.64), which support the efficacy of both approaches to assessment and the indices PF(V), EMD(V), EMD(E) and LAT(E) offer the greatest practical utility for assessing neuromuscular performance.

Decrease of D2 receptor binding but increase in D2-stimulated G-protein activation, dopamine transporter binding and behavioural sensitization in brains of mice treated with a chronic escalating dose 'binge' cocaine administration paradigm

Understanding the neurobiology of the transition from initial drug use to excessive drug use has been a challenge in drug addiction. We examined the effect of chronic 'binge' escalating dose cocaine administration, which mimics human compulsive drug use, on behavioural responses and the dopaminergic system of mice and compared it with a chronic steady dose (3 x 15 mg/kg/day) 'binge' cocaine administration paradigm. Male C57BL/6J mice were injected with saline or cocaine in an escalating dose paradigm for 14 days. Locomotor and stereotypy activity were measured and quantitative autoradiographic mapping of D(1) and D(2) receptors, dopamine transporters and D(2)-stimulated [(35)S]GTPgammaS binding was performed in the brains of mice treated with this escalating and steady dose paradigm. An initial sensitization to the locomotor effects of cocaine followed by a dose-dependent increase in the duration of the locomotor effect of cocaine was observed in the escalating but not the steady dose paradigm. Sensitization to the stereotypy effect of cocaine and an increase in cocaine-induced stereotypy score was observed from 3 x 20 to 3 x 25 mg/kg/day cocaine. There was a significant decrease in D(2) receptor density, but an increase in D(2)-stimulated G-protein activity and dopamine transporter density in the striatum of cocaine-treated mice, which was not observed in our steady dose paradigm. Our results document that chronic 'binge' escalating dose cocaine treatment triggers profound behavioural and neurochemical changes in the dopaminergic system, which might underlie the transition from drug use to compulsive drug use associated with addiction, which is a process of escalation.

Prevalence of type-specific HPV infection by age and grade of cervical cytology: data from the ARTISTIC trial

Human papillomavirus (HPV) infection causes cervical cancer and premalignant dysplasia. Type-specific HPV prevalence data provide a basis for assessing the impact of HPV vaccination programmes on cervical cytology. We report high-risk HPV (HR-HPV) type-specific prevalence data in relation to cervical cytology for 24 510 women (age range: 20–64; mean age 40.2 years) recruited into the ARTISTIC trial, which is being conducted within the routine NHS Cervical Screening Programme in Greater Manchester. The most common HR-HPV types were HPV16, 18, 31, 51 and 52, which accounted for 60% of all HR-HPV types detected. There was a marked decline in the prevalence of HR-HPV infection with age, but the proportion due to each HPV type did not vary greatly with age. Multiple infections were common below the age of 30 years but less so between age 30 and 64 years. Catch-up vaccination of this sexually active cohort would be expected to reduce the number of women with moderate or worse cytology by 45%, but the number with borderline or mild cytology would fall by only 7%, giving an overall reduction of 12% in the number of women with abnormal cytology and 27% in the number with any HR-HPV infection. In the absence of broader cross-protection, the large majority of low-grade and many high-grade abnormalities may still occur in sexually active vaccinated women.

The tragedy of TRIUMPH for nitric oxide synthesis inhibition in cardiogenic shock: where do we go from here?

Cardiogenic shock following an acute coronary syndrome (ACS) continues to be associated with significant mortality despite modern reperfusion strategies and inotropic support. There is mounting evidence that an acute inflammatory response accompanies the well documented decrement in left ventricular systolic function associated with cardiogenic shock and that this response may affect outcomes. In the past 2 decades it has also become apparent that nitric oxide (NO), a heteroatomic free radical has numerous biologic activities, among them the maintenance of vascular tone. The production of NO is mediated by three nitric oxide synthases (NOS); the transcription of one of these (NOS2 or inducible NOS [iNOS]) is induced by inflammatory stimuli. The iNOS gene product produces NO at very high and potentially pathologic levels. The up-regulation of iNOS transcription and overproduction of NO have been implicated in the pathogenesis of shock states where excess NO is thought to cause catecholamine resistant vasodilatation and reduced myocardial inotropy, resulting in hypotension and a fall in cardiac output. NO can also react with superoxide to produce peroxynitrate, a molecule directly toxic to the cells via modification of proteins and DNA. Inhibitors of NOS have long been utilized in the laboratory characterization of the NOS. More recently, attempts have been made to determine if the inhibition of NOS might have clinical utility in the setting of circulatory shock. With respect to septic shock, early animal studies and small trials in humans proved encouraging, but a larger trial was terminated early because of a trend toward harm among patients receiving the NO inhibitor. Studies have been undertaken in the setting of cardiogenic shock. Animal studies and small trials with humans again proved encouraging, but the large randomized TRIUMPH trial evaluating tilarginine (NG-monomethyl-L-arginine; L-NMMA) was recently terminated because of a lack of efficacy. These studies evaluated compounds with little selectivity for iNOS and their failure may have been due, in part, to the inhibition of the other NOS isoforms. In this review, we describe the biochemistry of NO synthesis, the regulation of NO production, and the clinical trials evaluating the efficacy of NOS inhibition with an eye to future trials with more selective inhibitors of iNOS.

International variation in Helicobacter pylori infection and rates of oesophageal cancer

AIM

To examine the association between gastric atrophy, Helicobacter pylori and CagA status, and ratio of oesophageal squamous cell carcinoma to oesophageal adenocarcinoma (OSCC:OAC) amongst international heterogeneous populations.

METHODS

Standardised protocols were used to collect and process questionnaire data and serum samples for PgA and PgC levels and H. pylori and CagA serology. The OSCC:OAC were used to construct appropriate models.

RESULTS

There were significant correlations between the OSCC:OAC and both rates of low PgA:PgC ratios and serological markers of H. pylori infection, in males, but not females. A significant correlation between OSCC:OAC and overall CagA-seropositivity was seen in males, but not females, but this was not independently associated with increasing OSCC:OAC.

CONCLUSIONS

In males, populations with higher rates of gastric atrophy or H. pylori infection have a higher OSCC:OAC. CagA seropositivity rates seem to have no additional effect.

Investigations into the taxonomy of the mushroom pathogen Verticillium fungicola and its relatives based on sequence analysis of nitrate reductase and ITS regions

The full sequence of the nitrate reductase gene was obtained from a type isolate of Verticilliumfungicola var. fungicola and used for phylogenetic analysis against other ascomycete fungi. Sequencing obtained 2749 bp of coding region, 668 bp of 5' flanking sequence and 731 bp of 3' flanking sequence. In silico analysis indicated that the coding region contains a single intron and translates into an 893 amino acid protein, with BLAST analysis identifying five conserved nitrate reductase domains within the protein. The 5' flanking sequence contains numerous conserved sites putatively involved in binding nitrogen regulatory proteins, indicating that the regulation of the gene is likely to be subject to the same regulation as that of model fungi such as Aspergillus nidulans. The central portion of this gene was amplified and sequenced from a number of V.fungicola isolates and related fungi and the resulting phylogenies compared to those obtained from analysis of the rDNA internal transcribed spacer regions for these fungi. Both nitrate reductase and ITS analyses provide additional evidence that reinforces previous findings that suggest the mushroom pathogenic Verticillium species are more related to other chitinolytic fungi such as the insect pathogens Verticillium lecanii and Beauveria bassiana than to the plant pathogenic Verticillia.

Vinorelbine/carboplatin vs gemcitabine/carboplatin in advanced NSCLC shows similar efficacy, but different impact of toxicity

This randomised phase III study in advanced non-small cell lung cancer (NSCLC) patients was conducted to compare vinorelbine/carboplatin (VC) and gemcitabine/carboplatin (GC) regarding efficacy, health-related quality of life (HRQOL) and toxicity. Chemonaive patients with NSCLC stage IIIB/IV and WHO performance status 0–2 were eligible. No upper age limit was defined. Patients received vinorelbine 25 mg m⁻² or gemcitabine 1000 mg m⁻² on days 1 and 8 and carboplatin AUC4 on day 1 and three courses with 3-week cycles. HRQOL questionnaires were completed at baseline, before chemotherapy and every 8 weeks until 49 weeks. During 14 months, 432 patients were included (VC, n=218; GC, n=214). Median survival was 7.3 vs 6.4 months, 1-year survival 28 vs 30% and 2-year survival 7 vs 7% in the VC and GC arm, respectively (P=0.89). HRQOL, represented by global QOL, nausea/vomiting, dyspnoea and pain, showed no significant differences. More grade 3–4 anaemia (P<0.01), thrombocytopenia (P<0.01) and transfusions of blood (P<0.01) or platelets (P<0.01) were observed in the GC arm. There was more grade 3–4 leucopoenia (P<0.01) in the VC arm, but the rate of neutropenic infections was the same (P=0.87). In conclusion, overall survival and HRQOL are similar, while grade 3–4 toxicity requiring interventions are less frequent when VC is compared to GC in advanced NSCLC.