Juvenile suicides in secure detention facilities: Correction of published rates

The calculation of previously published 1978 national rates of suicide of juveniles in jails, lockups, and juvenile detention centers is discussed. It is concluded that the derivation of those rates was flawed and that comparison of the reported rates with a U.S. juvenile suicide rate was misleading. Data from a 1978 jail census, findings on length of stay of juveniles in juvenile detention centers from a 1977 national study, the national suicide rate of persons aged 12 through 24 during 1979, and data used in derivation of the published rates are used to calculate substitute estimated rates of suicide of juveniles in adult jails and juvenile detention centers during 1978. The estimated rate for juveniles in adult jails is 2,041 per 100,000, and the rate for juveniles in juvenile detention centers is 57 per 100,000.     

Study of bias in antenatal clinic HIV-1 surveillance data in a high contraceptive prevalence population in sub-Saharan Africa

OBJECTIVE: To describe patterns, sources and consequences of bias in antenatal clinic (ANC) HIV prevalence estimates in a high contraceptive prevalence population. BACKGROUND: HIV surveillance in Africa relies on data from pregnant women attending ANCs. HIV estimates from pregnant women understate female infection levels in low income, high fertility populations. Bias in high contraceptive use, delayed sexual debut populations remains undescribed. DESIGN AND METHOD: Comparison of parallel cross-sectional population and antenatal survey data from rural Zimbabwe, where 60% of women are recent contraceptive users. RESULTS: HIV prevalence in recently pregnant women (25.7%; n = 576) and all women (25.5%; n = 5138) is similar over the age-range 15-44 years. As in high fertility populations, HIV prevalence is higher in pregnant women at young ages and lower at older ages but the crossover point occurs later due to delayed sexual activity. HIV understatement at older ages due to HIV-associated infertility is mitigated by less HIV infection and less frequent ANC attendance in contraceptive users. The local ANC HIV prevalence estimate is lower [21.2%; n = 1215; risk ratio versus pregnant women in the general population, 0.8; 95% confidence interval (CI), 0.7-1.0], possibly because women from more remote areas are included. ANC estimates overstate the relative risk of HIV in more educated women (age-adjusted odds ratio, 1.1; 95% CI, 0.8-1.4 versus 0.7; 95% CI, 0.6-0.9). CONCLUSIONS: ANC estimates understate female HIV prevalence in this low fertility population but, here, the primary cause is not selection of pregnant women. ANC estimate adjustment procedures that control for contraceptive use and age at first sex are needed.     

闸门控制理论在结肠镜检查中的应用

目的探讨应用闸门控制理论在结肠镜检查中进行护理所起的作用。方法将220例结肠镜检查患者随机分为对照组和观察组,对照组给予常规护理,观察组给予闸门控制理论护理。从2组的疼痛程度、检查完成时间、检查成功率和对检查的满意度4个方面进行比较。结果2组的疼痛程度和检查完成时间比较,有显著性差异(P<0.05),观察组的疼痛程度和检查完成时间明显低于对照;2组的检查成功率和对检查的满意度比较,有显著性差异(P<0.05),观察组的检查成功率和对检查的满意度明显高于对照组。结论应用闸门控制理论在结肠镜检查中进行护理,具有减轻疼痛、缩短检查完成时间、提高检查成功率和提高患者满意度的重要作用。     

Cervical Brachytherapy Exchange: Steps Toward Oncology Capacity Building in Botswana

To help share technical knowledge of brachytherapy and the care of patients with cervical cancer in Botswana, a series of visits was organized by two centers in the United States, Massachusetts General Hospital and the University of Pennsylvania. As a result of those visits, necessary future steps were recognized. Such clinical visits are important for facilitating the exchange of knowledge and learning between institutions in developing and developed countries.In the past three decades, the number of cervical cancer cases globally has increased from an estimated 378,000 cases in 1980 to 454,000 in 2010, with 17% of these cases in Sub-Saharan Africa [1]. Sub-Saharan Africa is burdened by more than 60% of all human immunodeficiency virus (HIV) cases in the world [2]. With increased utilization of antiretroviral therapy as HIV-infected patients live longer, rates of malignancies in this population are rising [3]. HIV-infected women have a higher risk of human papillomavirus (HPV) infection and, consequently, the development of invasive cervical cancer [4]. In Botswana, where 18% of the population is HIV positive, cervical cancer is the leading cause of cancer-related death in women.Because of the lack of widespread screening, a majority of patients in Botswana present with advanced disease at diagnosis. The primary treatment for locally advanced cervical cancer is radiation therapy (RT) with or without cisplatin-based chemotherapy. Curative RT generally consists of external-beam RT delivered with either a linear accelerator or a cobalt-60 unit with brachytherapy.Brachytherapy is an essential component of the treatment of cervical cancer and increases the likelihood of cure; however, it is not readily accessible in Africa [5]. A recent review highlighted that only 20 countries in Africa have brachytherapy services; 75% of these facilities are concentrated in Northern Africa and in South Africa [6]. Brachytherapy is commonly delivered using low-dose-rate or high-dose-rate (HDR) sources. Using a HDR source allows for more rapid completion of treatment and a higher volume of treatments in an outpatient setting but requires specialized equipment and shielding, imaging, software, and training for the physician, the physicist, and support staff [7].Local practitioners in Botswana and international collaborators [8, 9] identified cervical cancer as one of several areas for high focus. In Botswana, Gaborone Private Hospital (GPH), the only radiation oncology facility, acquired an HDR brachytherapy unit in February 2011 and started its treatment program in 2012, drawing patients countrywide. To help share technical knowledge of brachytherapy and the care of patients with cervical cancer, a series of visits was organized from Massachusetts General Hospital (MGH), followed by the University of Pennsylvania. Visits were focused on clinical care, brachytherapy planning, and nursing. Exchange at GPH was conducted through participation in clinical care with the radiation oncologist and nurses and highlighted insertion techniques and symptom management, treatment planning with physicists and dosimetrists, and focused didactics on clinical issues of interest to the staff. MGH facilitated a donation of applicators to GPH through Mick Nuclear (Mick Radio-Nuclear Instruments, Inc., Mount Vernon, NY, http://www.micknuclear.com).As a result of these visits, the following necessary future steps were recognized: procurement of an ultrasound machine for visualization during insertions; standardization of treatment-approval, safety, and quality-assurance processes; development of patient education material; and future exposure and training in interstitial brachytherapy technique for gynecological cancers.By 2030, more than 70% of cancer patients will be diagnosed in the developing world [10]. In addition to the implementation of screening programs, cancer-care capacity building is essential to address the increasing burden of disease. Clinical visits such as those described are an important step in the effort to build capacity while facilitating the exchange of knowledge and learning between institutions in developing and developed countries. There are many other examples of similar collaborations between Western academic institutions and providers in low- and middle-income countries to establish effective facilities for cancer treatment, and such exchanges should be forged with a long-term relationship in mind.     

Risk Profiles for Mild Cognitive Impairment Vary by Age and Sex: The Sydney Memory and Ageing Study

OBJECTIVES:: To examine age- and sex-related differences in risk and protective factors for mild cognitive impairment (MCI) in community-based elderly individuals. DESIGN:: Cross-sectional study. SETTING:: The population-based Sydney Memory and Ageing Study. PARTICIPANTS:: A total of 757 nondemented, community-dwelling elderly individuals from an English-speaking background categorized as younger (70-79 years) or older (80-90 years). MEASUREMENTS:: Risk of MCI was determined for sociodemographic, lifestyle, and cardiac, physical, mental, and general health factors using age- (and sex-) adjusted multiple regressions comprising initially significant univariate factors. RESULTS:: The point prevalence of MCI within our sample was 39.1% overall: it was lowest in younger women (32.3%) and similar across men and older women (41.9%-43.6%). The risk of MCI across all participants was increased by the APOE ?4 allele, high homocysteine, and heart disease; and decreased by better odor identification, visual acuity, and mental activity. Risk factors in all younger participants were slow 6-m walk, poor odor identification, and high homocysteine. Risk of MCI was associated in younger women with history of depression, less mental activity, slower 6-m walk, poorer visual acuity, and higher homocysteine; and in younger men with poorer odor identification and higher homocysteine. Older participants showed no significant risk factors for MCI, except for poorer visual acuity in men. Supporting these findings were statistically significant interactions that reflected the differences in risk factor profiles between age and/or sex groups. CONCLUSIONS:: Risk factors for MCI differ in men and women and vary with age. This has implications for preventing MCI and possibly dementia.     

Histological characterization of interneurons in Alzheimer's disease reveals a loss of somatostatin interneurons in the temporal cortex

Neuronal dysfunction and synaptic loss are major hallmarks of Alzheimer's disease (AD) which correlate with symptom severity. Impairment of the γ-aminobutyric acid (GABA)ergic inhibitory interneurons, which form around 20% of the total neuronal network, may be an early event contributing to neuronal circuit dysfunction in neurodegenerative diseases. This study examined the expression of two of the main classes of inhibitory interneurons, parvalbumin (PV) and somatostatin (SST) interneurons in the temporal cortex and hippocampus of AD and control cases, using immunohistochemistry. We report a significant regional variation in the number of PV and SST interneurons with a higher number identified per mm² in the temporal cortex compared to the hippocampus. Fewer SST interneurons, but not PV interneurons, were identified per mm² in the temporal cortex of AD cases compared to control subjects. Our results support regional neuroanatomical effects on selective interneuron classes in AD, and suggest that impairment of the interneuronal circuit may contribute to neuronal dysfunction and cognitive decline in AD.     

Assessing HIV/AIDS Stigma and Discrimination in Developing Countries

HIV/AIDS-related stigma and discrimination are barriers to HIV prevention effectiveness, voluntary counseling and testing uptake, and accessing care in many international settings. Most published stigma scales are not comprehensive and have been primarily tested in developed countries. We sought to draw on existing literature to develop a scale with strong psychometric properties that could easily be used in developing countries. From 82 compiled questions, we tested a 50-item scale which yielded 3 dimensions with 22 items in pilot testing in rural northern Thailand (n = 200) and urban and peri-urban Zimbabwe (n = 221). The three factors (shame, blame and social isolation; perceived discrimination; equity) had high internal consistency reliability and good divergent validity in both research settings. Systematic and significant differences in stigmatizing attitudes were found across countries, with few differences by age or sex noted within sites. This short, comprehensive and standardized measure can be easily incorporated into questionnaires in international research settings.