Contraceptive use dynamics of Asian women in Britain

In-depth interviews were conducted with married Asian women from Indian, Pakistani and Bangladeshi backgrounds, to investigate patterns of contraceptive use and influences on contraceptive decision making. The results show two distinctively different contraceptive 'lifecycles'. Non-professional women typically have little knowledge about contraception until after their marriage or first birth. Their patterns of contraceptive behaviour show low levels of contraceptive use until after their first birth, when condom use is most prevalent. Non-professional women are influenced by their extended family, religion and cultural expectations on their fertility and family planning decisions. Professional women show an entirely different pattern of contraceptive behaviour. They are more likely to have knowledge about contraception before marriage, use some method of contraception throughout their childbearing years (typically the pill) and cite personal, practical or economic considerations in their fertility decisions rather than religious, cultural or extended family influences.

Safer sex at holiday centres: providing contraceptive services to seasonal workers

Many seasonal workers experience an increase in sexual activity whilst employed at a holiday centre. Evidence of sexual risk-taking while at a holiday centre has important social and health implications for purchasers and providers of sexual health services in areas which experience an annual influx of seasonal workers. This research investigates the contraceptive behaviour of seasonal workers and focuses on their access to contraception and sexual health services. In-depth interviews were conducted with seasonal workers at holiday centres along the south coast of England. Respondents were, interviewed at the beginning of the season and again, five months later at the end of the season. This longitudinal methodology enabled changes in contraceptive behaviour to be identified as well as the strategies for seeking contraception and sexual health services throughout the season. The results of this study show that there are a range of different motivations which influence seasonal worker' use of contraception and sexual risk-taking while at a holiday centre. Categories of contraceptive protection are developed to assist purchasers and providers to identify the variety of sexual health needs of workers at holiday centres and determine the most effective strategies for delivering contraceptive and sexual health services to these workers. The paper describes the motivations which influence contraceptive use and sexual risk-taking amongst seasonal workers, identifies the contraceptive and sexual health needs of these workers, and discusses the difficulties workers experienced in meeting these needs while at a holiday centre.

Stomatocytosis is absent in "stomatin"-deficient murine red blood cells

To examine the relationship between erythrocyte membrane protein 7. 2b deficiency and the hemolytic anemia of human hereditary stomatocytosis, we created 7.2b knock-out mice by standard gene targeting approaches. Immunoblots showed that homozygous knock-out mice completely lacked erythrocyte protein 7.2b. Despite the absence of protein 7.2b, there was no hemolytic anemia and mouse red blood cells (RBCs) were normal in morphology, cell indices, hydration status, monovalent cation content, and ability to translocate lipids. The absence of the phenotype of hereditary stomatocytosis implies that protein 7.2b deficiency plays no direct role in the etiology of this disorder and casts doubt on the previously proposed role of this protein as a mediator of cation transport in RBC.

Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis

Fifteen centers for orthopaedic treatment of the foot and ankle participated in a prospective randomized trial to compare several nonoperative treatments for proximal plantar fasciitis (heel pain syndrome). Included were 236 patients (160 women and 76 men) who were 16 years of age or older. Most reported duration of symptoms of 6 months or less. Patients with systemic disease, significant musculoskeletal complaints, sciatica, or local nerve entrapment were excluded. We randomized patients prospectively into five different treatment groups. All groups performed Achilles tendon- and plantar fascia-stretching in a similar manner. One group was treated with stretching only. The other four groups stretched and used one of four different shoe inserts, including a silicone heel pad, a felt pad, a rubber heel cup, or a custom-made polypropylene orthotic device. Patients were reevaluated after 8 weeks of treatment. The percentages improved in each group were: (1) silicone insert, 95%; (2) rubber insert, 88%; (3) felt insert, 81%; (4)stretching only, 72%; and (5) custom orthosis, 68%. Combining all the patients who used a prefabricated insert, we found that their improvement rates were higher than those assigned to stretching only (P = 0.022) and those who stretched and used a custom orthosis (P = 0.0074). We conclude that, when used in conjunction with a stretching program, a prefabricated shoe insert is more likely to produce improvement in symptoms as part of the initial treatment of proximal plantar fasciitis than a custom polypropylene orthotic device.

In vivo blood flow abnormalities in the transgenic knockout sickle cell mouse

The accepted importance of circulatory impairment to sickle cell anemia remains to be verified by in vivo experimentation. Intravital microscopy studies of blood flow in patients are limited to circulations that can be viewed noninvasively and are restricted from deliberate perturbations of the circulation. Further knowledge of sickle blood flow abnormalities has awaited an animal model of human sickle cell disease. We compared blood flow in the mucosal-intestinal microvessels of normal mice with that in transgenic knockout sickle cell mice that have erythrocytes containing only human hemoglobin S and that exhibit a degree of hemolytic anemia and pathological complications similar to the human disease. In sickle cell mice, in addition to seeing blood flow abnormalities such as sludging in all microvessels, we detected decreased blood flow velocity in venules of all diameters. Flow responses to hyperoxia in both normal and sickle cell mice were dramatic, but opposite: Hyperoxia promptly slowed or halted flow in normal mice but markedly enhanced flow in sickle cell mice. Intravital microscopic studies of this murine model provide important insights into sickle cell blood flow abnormalities and suggest that this model can be used to evaluate the causes of abnormal flow and new approaches to therapy of sickle cell disease.

Intellectual, mnemonic, and frontal functions in dementia with Lewy bodies: A comparison with early and advanced Parkinson's disease

Both Parkinson's disease (PD) and dementia with Lewy bodies (DLB) share a common neuropathological marker, the presence of Lewy bodies in brain stem and basal forebrain nuclei. DLB, in addition, is associated with Lewy bodies in the neocortex, and, in it's more common form, with Alzheimer-type pathological markers, particularly amyloid plaques. Published neuropsychological studies have focused on the differential profiles of DLB and Alzheimer's disease (AD). However, it is presently unclear whether DLB should be classified as a variant of AD or PD. In the present study we compare a healthy age-matched control group with three groups of patients, one with DLB, and two with PD. One of the PD groups was early in the course (PD-E) and the second, more advanced group (PD-A), was matched on severity of cognitive impairment with the DLB group. The results show that DLB was associated with a different pattern of neuropsychological impairment than the PD-A group, particularly in tests believed to be mediated by prefrontal cortical regions.

TenderWet: an innovation in moist wound healing

The use of moisture-retentive dressings (dressings that are capable of maintaining a warm moist environment) has been shown to provide the optimal environment for wound healing, accelerating the healing process and promoting tissue growth. TenderWet, produced by Paul Hartmann, is an innovative dressing that not only provides a moist warm environment but also incorporates the unique properties of Ringer's solution which actively cleanses (debrides) the wound.

Cushions and specialist chairs for pressure sore management

Many patients spend more time sitting out of bed than being cared for in bed. Consequently, the demand for specialist support surfaces for chairs to reduce the risk of pressure damage while the patient is up sitting is rising. This product focus examines a number of seating support surfaces produced by Karomed.

Massive lymphocytic infiltration of uterine leiomyomas associated with GnRH agonist treatment

AIMS

To report two unusual cases of massive lymphocytic infiltration of uterine leiomyomas, following GnRH agonist treatment. Previous reports have described a variety of alterations in leiomyoma histology following such therapy.

METHODS AND RESULTS

These cases were studied using haematoxylin and eosin stains, and immunohistochemistry for B and T-cell markers (CD20/CD79a and CD3/UCHL-1) was performed. Leiomyomas were heavily infiltrated predominantly by mature lymphocytes of T-cell phenotype. Associated myocyte degenerative changes were present.

CONCLUSIONS

Massive lymphocytic infiltration of leiomyomas may occur as a result of GnRH agonist treatment, although the mechanism is unclear.

Asian women's use of family planning services

Detailed research on the family planning needs of Asian women is extremely important in informing public policy in the new purchaser-provider environment of the National Health Service (NHS), which was introduced in 1991. In depth interviews were conducted with Asian women of Indian, Pakistani and Bangladeshi backgrounds in the South and West Regional Health Authority area, to investigate their family planning behaviour and use of family planning services. This research shows significant diversity in the knowledge and use of contraception between married professional women, married non-professional women and unmarried women. This paper examines the different family planning service implications for each group of women. The results show that professional married women and unmarried women are able to meet their family planning needs by utilising existing family planning services. However, married non-professional women experience significant difficulties in using family planning services largely due to communication problems with health professionals and their low levels of personal autonomy. Most Asian women in this study showed a strong preference for a female GP and a non-Asian GP for sexual health and contraceptive services.

Computed Tomography Artefacts: An Experimental Investigation of Causative Factors

N Strumas, O Antonyshyn, MJ Yaffe, G Mawdsley, P Cooper. Computed tomography artefacts: An experimental investigation of causative factors. Can J Plast Surg 1998;6(1):23-29.

The factors that produce computed tomography (CT) artefacts associated with craniofacial fixation devices were analyzed. The effects of attenuation, motion, partial volume and implant shape were evaluated. By using a CT phantom model with an engine to produce reproducible motion, a vitallium rod, fixation plate and blank were scanned sequentially. for each experimental condition, the degree of artefact produced was quantified by measuring the standard deviation of the CT number at standardized regions of interest, and a comparative analysis was performed. Motion produced the greatest degree of artefact. Both the frequency and direction of motion were important, with high frequency motion in the plane of the CT slice producing the greatest degree of CT artefact. Partial volume artefacts increased as the volume of material in the plane of section increased. The amount of artefact produced was dependent on the volume of material x-rays passed through the object rather than on the geometric configuration. Attenuation effects were evaluated. Results revealed that the amount of artefact was greatest between highly attenuating objects.

Protein C and protein S in homozygous sickle cell disease: does hepatic dysfunction contribute to low levels?

The aim of this study was to confirm reports of low protein C (PC) and S (PS) concentrations in steady-state patients with homozygous sickle cell (SS) disease when compared to a racially matched normal haemoglobin (AA) control group and to examine the mechanisms of this reduction with respect to hepatic function, coagulation activation and haematological indices. In 36 SS patients and 35 AA race-matched controls PC (functional and immunoreactive), PS (free and total) were measured. C4B binding protein (C4B) was assessed by immunoelectrophoresis and D-dimer by ELISA. Hepatic function was assessed by prothrombin (PT) time (49 SS, 64 AA), factor V (34 SS, 36 AA) and factor VII concentrations (28 SS, 29 AA). Proteins induced in vitamin K absence or antagonism (PIVKA) were sought in 12 SS's. The relationship between PC, PS and total bilirubin, haemoglobin (Hb) F and reticulocyte count was also assessed. PC, PS and C4B were lower in SS disease. SS patients had longer PT times, and lower factor V and VII concentrations in comparison to AA controls. PC (functional and immuno-reactive) and free PS correlated with PT. Within SS genotype PT correlated negatively with factor V and factor VII. Factor V and VII were positively correlated. PIVKAs were not detected. There was no correlation between PC, PS and D-dimer, haemolytic rate or Hb F concentration. Prolongation of PT time, low factor V and VII suggest that hepatic dysfunction, rather than coagulation activation or haemolytic rate, accounts for the reduced concentrations of PC and PS in steady-state SS disease. The absence of PIVKAs suggests a hepatocellular problem.

An outbreak of bartonellosis in Zamora Chinchipe Province in Ecuador

We report an outbreak of human bartonellosis in Zamora Chinchipe Province in Ecuador, which occurred in 1995-1996. Nineteen cases were seen, of which 18 presented with classical oroya fever (fever and profound anaemia) and one with verruga peruana; 11 of the cases (58%) had positive blood films containing Bartonella bacilliformis. The houses of cases and neighbouring controls were visited; blood samples for thin films and cultures were collected from members of each house and a questionnaire was administered to investigate possible risk factors for disease transmission. In none of those sampled was B. bacilliformis bacteriologically demonstrable. All case houses were located in isolated areas at the margin of forest and the presence of dead rodents was reported only in case houses (P < 0.05). We suggest that human bartonellosis is a zoonosis with a natural rodent reservoir and that migrant humans infected in this way may become a temporary reservoir host in populated areas.

The PRINTS database of protein fingerprints: a novel information resource for computational molecular biology

PRINTS is a compendium of protein motif fingerprints derived from the OWL composite sequence database. Fingerprints are groups of motifs within sequence alignments whose conserved nature allows them to be used as signatures of family membership. Fingerprints inherently offer improved diagnostic reliability over single motif methods by virtue of the mutual context provided by motif neighbors. To date, 650 fingerprints have been constructed and stored in PRINTS, the size of which has doubled in the last 2 years. The current version, 14.0, encodes 3500 motifs, covering a range of globular and membrane proteins, modular polypeptides, and so on. The database is now accessible via the UCL Bioinformatics Server on http:@ www.biochem.ucl.ac.uk/bsm/dbbrowser/. We describe here progress with the database, its compilation and interrogation software, and its Web interface.

Activated protein C resistance in homozygous sickle cell disease

The activated protein C resistance (APC-R) ratios in 50 patients with steady state homozygous sickle cell (SS) disease and 59 healthy AA controls was measured. There was a significant reduction in median APC-R ratio in sickle cell disease compared to controls. This reduction in APC-R ratio was not explained by (1) the presence of the factor V Leiden, found in only one of 165 patients with SS disease including those tested for APC-R, or (2) the presence of lupus anticoagulants. However, the raised levels of factor VIIIC in SS patients in this study may be contributing to increased resistance to APC, which in turn may contribute to the vaso-occlusive complications of SS disease.

In vivo coagulation activation following infusion of highly purified factor XI concentrate

The use of factor XI concentrates has been associated with thrombosis. Plasma markers of coagulation activation were measured before and 30, 60, 120 and 240 min after six infusions of the BPL factor XI concentrate. Five studies were completed before surgical intervention, one was undertaken in a patient with an intracerebral haemorrhage. Significant elevation of levels of fibrinopeptide A (FpA) (P < 0.05) and thrombin-antithrombin (TAT) were demonstrated following six infusions and prothrombin fragment F1.2 following four. Levels of all three markers had risen 60 min following concentrate administration and FpA levels remained elevated throughout the study period. Levels of D-dimer rose in four patients at 240 min. These results indicate significant thrombin generation by 60 min and subsequent plasmin generation consistent with coagulation activation by the factor XI concentrate. The greatest elevation of activation markers was seen in those subjects with pre-existing coagulation activation. We advise caution in the use of these products and awareness of the risks in patients who may already have activated coagulation states.

Changing incidence of invasive adenocarcinoma of the uterine cervix in East Anglia

OBJECTIVE

To determine trends in incidence of invasive adenocarcinoma of the uterine cervix in East Anglia.

METHODS

Cervical cancer incidence data for both squamous cell carcinomas and adenocarcinomas were obtained from the East Anglian Cancer Registry for the period 1971-94. Similar data were obtained for England and Wales. European age standardised rates (ASRs) were used for comparisons.

RESULTS

The mean incidence (ASR) of cervical adenocarcinoma was 0.85 per 10(5) in 1971-76, rising to 2.54 per 10(5) in 1989-94. There has been a marked age shift, with the main increase in incidence occurring in younger women aged 30-39. The mean incidence (ASR) of squamous cell carcinoma of the cervix has decreased from 9.78 to 8.74 per 10(5) over the periods 1971-76 and 1989-94. Again there has been an age shift, moving from a single incidence peak in the 45-59 age band in earlier years to incidence peaks in both the 30-39 and 55-69 age bands in more recent years. Similar trends were noted when data for England and Wales were analysed. Birth cohort analyses show that both tumours are occurring progressively earlier (about five years earlier in each five year birth cohort).

CONCLUSION

Although the overall incidence of cervical carcinoma is declining, this study has shown an increased incidence of cervical adenocarcinoma, particularly in the younger age groups. In future it would seem advisable to publish separate incidence and mortality data for squamous cell carcinoma and adenocarcinoma of the uterine cervix. All practitioners involved in the cervical cancer screening programme would then be aware of the very real significance of this tumour.

Direct in situ nucleic acid amplification: control of artefact and use of labelled primers

Aims-To evaluate factors which ameliorate false positive artefacts with direct in situ PCR using labelled dNTPs; to investigate the use of labelled primers to overcome this artefact whilst maintaining sensitivity.Methods-Sections of measles (RNA virus) infected Vero cells with cytoplasmic signal or cytomegalovirus (DNA virus) infected fibroblasts with nuclear signal were collected. In situ PCR (or in situ RT-PCR) was carried out by methods permitting evaporation. Reagents or conditions which may control false positive artefacts using labelled dNTPs were investigated systematically. Labelled primers were tested to overcome artefacts, with adjuncts which improve sensitivity.Results-No reagent nor condition investigated was able to control the artefact with labelled dNTPs. Excessive digestion and incomplete DNAse treatments exacerbated the artefact, whereas novobiocin decreased both specific signal and artefact. However, the artefact was controlled by labelled primers, albeit with relatively low sensitivity. Sensitivity using labelled primers could be increased using alcohol fixation, albumin or Perfectmatch.Conclusions-A repair process is implicated for the artefact using labelled dNTPs. Excessive digestion or DNAse treatment may exacerbate DNA damage by disrupting histones or the DNA, respectively. Labelled primers control this artefact, albeit with reduced sensitivity, which may be improved by precipitation fixatives (alcohol) and reagents which enhance specific reaction.

The cognitive development of 5-year-old children of postnatally depressed mothers

As part of a longitudinal study of the influence of postnatal depression on child development, the cognitive functioning of index and control children was assessed at age 5 years. There was no evidence of an adverse effect of postnatal depression, even amongst sub-groups of children suggested to be vulnerable (boys and children from low SES families). However, early experience of insensitive maternal interactions predicted the persistence of poorer cognitive functioning. A number of factors in the child's current environment, including stimulation at home, social class and, for boys, the experience of schooling, contributed to cognitive performance. The findings are considered in relation to the ongoing debate on sensitive periods.