Regulating assisted reproduction technologies

Legislation in the area of assisted reproduction has been a slow process and one dogged by conflicting ethical views. Where legislation has been introduced in Europe it has not been consistent, representing the different cultural environments of the countries concerned and in a number of countries legislation has still not been introduced. Although the 1997 European Convention on Human Rights and Biomedicine represented a landmark in trying to introduce an international consensus on embryo research and its control, there is little or no regulation of assisted reproduction services even in those countries where legislation has been introduced. This may not be in the best interest of patients, particularly where a new technique is being introduced. A survey of those providing assisted reproduction services has indicated support for some form of technical standardization within Europe.

Reliability of spectral EMG parameters of healthy back extensors during submaximum isometric fatiguing contractions and recovery

Spectral EMG parameters are being used as an objective evaluation of low back rehabilitation programs. The reliability of these spectral parameters is important in determining the validity of this evaluation tool. Two groups of eight subjects, with no history of back pain, were measured: the first group every day for one week; the second group one day per week for four weeks. During each session, subjects performed a 30-second isometric fatiguing contraction of the back extensors at 60% MVC followed by a 60-second rest and a 10-second repeat contraction. The intraclass correlation coefficient (ICC) did not demonstrate high reliability (ICC < 0.6) for the rate of median power frequency (MedPF) change (Hz/s), the magnitude of the recovery (Hz) and differences between the dominant and the non-dominant sides within a subject. However, the initial MedPF (Hz) of the fatigue and repeat contractions demonstrated excellent reliability (ICC > 0.8) with five or more repeated measures. The practical implication of this work is that the experimental condition must have sufficiently large changes in MedPF (signal)--at least larger than the variability inherent in the MedPF (noise)--to constitute a valid measure.

Oocyte donation: the legislative framework in Western Europe

Relatively few countries have legislation addressing oocyte donation. Where such legislation does exist it is entirely in the context of broader legislation concerned with the regulation of in-vitro fertilization (IVF) or assisted reproduction more generally. Within Western Europe only nine countries so far have passed Acts addressing assisted reproduction. These countries fall into two groups in their approach to oocyte donation: those which do not allow gamete donation, and hence oocyte donation, in the context of IVF (Austria, Germany, Norway and Sweden) and those which specifically permit the use of donor oocytes in the treatment of infertility or to avoid the transmission of disease (Denmark, France, Spain and the UK). In Switzerland, a federation of cantons, where legislation relating to assisted reproduction is primarily a cantonal matter, except where it affects constitutional rights, the picture is similar. The Canton of Aargau does not allow gamete donation in the context of IVF, the Cantons of Glarus and Basel do not permit gamete donation at all and the remaining cantons follow the guidelines of the Swiss Academy of Medical Sciences.

Health care seeking by heartburn sufferers is associated with psychosocial factors

AIM

To determine whether individuals who consult a doctor because of gastroesophageal reflux disease have psychological characteristics and social support patterns that distinguish them from those who remain within the community.

METHODS

Comparison of 138 consecutive patients presenting to a gastrointestinal clinic for the first time because of heartburn with 39 heartburn sufferers who had never sought medical help for their reflux disease and 40 healthy individuals with no heartburn. Instruments used were the State-Trait Anxiety Index, the Crown-Crisp Experiential Index, the Hassles Scale, and the Interview Schedule for Social Interaction.

RESULTS

Heartburn sufferers who remained within the community in no way differed from healthy controls. Patients who sought medical attention were older and their heartburn was more severe than community heartburn sufferers. When these variables were controlled for in the analysis, patients experienced greater phobia, obsessionality, and somatization, more hassles but of significantly lower intensity, and had less-adequate close social support than those who did not seek medical help.

CONCLUSION

Psychological and social factors are associated with individuals with gastroesophageal reflux disease who seek medical help.

Improving adherence to screening follow-up among women with abnormal Pap smears: results from a large clinic-based trial of three intervention strategies

In a large randomized trial involving over 2,000 women with abnormal cervical cytology (pap smear), three clinic-based interventions were tested as strategies to increase return rates for screening follow-up: 1) a personalized follow-up letter and pamphlet; 2) a slide-tape program on pap smears; and 3) transportation incentives (bus passes/parking permits). The three interventions were evaluated using a 2 x 2 x 2 factorial design. Results of this study confirm a high rate of loss to screening follow-up (i.e., no return visits) among women with abnormal pap smears (29% overall), with substantial variability among the 12 participating clinics (13% to 42/%). For the sample as a whole, both transportation incentives and the combined intervention condition of personalized follow-up and slide-tape program had a significant positive impact on screening follow-up. However, transportation incentives emerged as the dominant intervention condition among patient subgroups that can be characterized as more disadvantaged socioeconomically and at higher risk of developing cervical cancer, including patients receiving care from the county health department (odds ratio (OR) = 1.51; P less than .05); patients without health insurance (OR = 1.77; P less than .01); and patients with more severe pap smear results (OR = 1.71; P less than .05). In contrast, among patient subgroups that can be characterized as relatively more advantaged and at lower risk of developing cervical cancer, only the combined intervention condition of personalized follow-up and slide-tape program was associated with a higher patient return rate. Subgroups reflecting this pattern included patients seen in noncounty clinics (OR = 4.54; P less than .05) and patients with less severe pap smear results (OR = 5.16; P less than .01). The implications of these findings are discussed in terms of designing clinic-based interventions to improve screening follow-up.

New protein fold revealed by a 2.3-A resolution crystal structure of nerve growth factor

Nerve growth factor (NGF) is a member of an expanding family of neurotrophic factors (including brain-derived neurotrophic factor and the neurotrophins) that control the development and survival of certain neuronal populations both in the peripheral and in the central nervous systems. Its biological effects are mediated by a high-affinity ligand-receptor interaction and a tyrosine kinase signalling pathway. A potential use for NGF and its relatives in the treatment of neurological disorders such as Alzheimer's disease and Parkinson's disease requires an understanding of the structure-function relationships of NGF. NGF is a dimeric molecule, with 118 amino acids per protomer. We report the crystal structure of the murine NGF dimer at 2.3-A resolution, which reveals a novel protomer structure consisting of three antiparallel pairs of beta strands, together forming a flat surface. Two subunits associate through this surface, thus burying a total of 2,332 A. Four loop regions, which contain many of the variable residues observed between different NGF-related molecules, may determine the different receptor specificities. A clustering of positively charged side chains may provide a complementary interaction with the acidic low-affinity NGF receptor. The structure provides a model for rational design of analogues of NGF and its relatives and for testing the NGF-receptor recognition determinants critical for signal transduction.

Screening for cervical cancer in emergency centers and sexually transmitted disease clinics

Low-income women are at increased risk of developing cervical cancer compared with middle- and upper-income women. How can poor women be reached for screening and early diagnosis of cervical cancer and its precursor stages? One answer to this question is based on the observation that a high percentage of the unscreened population has received some form of medical care within the previous 5 years. Emergency centers and sexually transmitted disease (STD) clinics often provide such care to patients who lack a regular source of health care. Thus, they represent potential resources for cervical cancer screening. However, in a survey of 19 hospitals whose patient populations include a high proportion of low-income patients, only five reported a protocol for cervical cancer screening in their emergency centers. Similarly, all 11 STD clinics included in this survey reported that fewer than 5% of their female patients had a Papanicolaou smear taken even though virtually all of them received a pelvic examination. Based on these findings, it appears that health care administrators and policymakers could intensify their cancer prevention programs by mobilizing these resources for cancer control.

A comparison of parenteral sulbactam/ampicillin versus clindamycin/gentamicin in the treatment of pelvic inflammatory disease

60 hospitalized patients with pelvic inflammatory disease entered a randomised study to compare the therapeutic efficacy and tolerability of parenteral sulbactam/ampicillin with that of clindamycin/gentamicin. All 49 pathogens isolated at entry from 21 evaluable patients in the sulbactam/ampicillin group were eradicated. 34 out of 35 pathogens isolated from 18 evaluable patients in the clindamycin/gentamicin group were eradicated. All pathogens resistant to ampicillin in vitro were eradicated. The bacteriological, clinical and overall responses for the sulbactam/ampicillin group were 100%, 85.7% and 85.7%, respectively, compared with 97.1%, 94.4% and 94.4%, respectively, for the clindamycin/gentamicin group. The sulbactam/ampicillin combination was well tolerated.

Synthesis and biophysical studies of short oligodeoxynucleotides with novel modifications: a possible approach to the problem of mixed base oligodeoxynucleotide synthesis

The syntheses of 1,2-dideoxy-D-ribofuranose and 1,2-dideoxy-1-phenyl-beta-D-ribofuranose are described. Oligodeoxynucleotides containing these analogues have been synthesised and hybridized to their complementary strands. Hypochromicity studies have shown that these duplices are less stable than either the totally complementary duplex or those containing A.C and G.T mismatches.

Psychiatric pharmacy in a partial hospital program

Psychiatric pharmacy practice in a partial hospital program (PHP) is described. The program's objectives are: (1) to provide a transitional setting in which to assist persons with psychiatric disorders to reenter the community after hospitalization; (2) to provide more structured and intensive therapy than is available in an outpatient setting; and (3) to diagnose and treat early psychiatric symptoms, providing an alternative to hospitalization. The pharmacist conducts medication history interviews, co-directs a weekly medication group, participates in weekly medication clinic, provides individual consultation, teaches pharmacy students, participates in health care group, and provides inservice education to the staff. Clinical pharmacy services in a psychiatric partial hospital program increase knowledge of psychotropic drug efficacy and side effects in PHP staff, increase learning about these medications in PHP clients, and can result in safer and more effective use of medication.

Raman spectroscopic determination of the secondary structure of crystalline nerve growth factor

The secondary structure of crystalline nerve growth factor (NGF) has been measured with 90% confidence to contain between 0 and 11% helix and between 53 and 67% antiparallel beta-strand using the intensity distribution of the amide I region of the Raman spectrum. A comparison of spectra collected from crystals and solutions confirms that the secondary structure of NGF is the same in these two states. The helical content of NGF as determined by Raman differs substantially from predictions based on sequence. The amide I band of NGF is substantially different from that of insulin, indicating that no structural hemology is likely to exist between these two proteins.