Implementation of isoniazid preventive therapy in southern Lima,Peru: an analysis of health center characteristics

Background::Tuberculosis (TB) prevention through the use of preventive treatment is a critical activity in the elimination of TB. In multiple settings, limited ...     

Surveillance with serial serum carcinoembryonic levels detect colorectal cancer recurrences in patients who are initial nonsecretors

Serum carcinoembryonic antigen (CEA) levels, elevated in a subgroup of patients with colorectal cancer (CRC) at presentation, are serially followed as part of recommended surveillance after initial resection. The value of following serial CEA levels in patients who initially present with less than or normal levels of CEA (nonsecretors) is controversial. This study sought to determine the use of follow-up CEA levels in nonsecretors. A retrospective review was performed of patients with resected Stage I, II, and III CRC. We excluded patients who did not have a pretreatment CEA level, at least two follow-up CEA levels, or in whom CEA levels did not normalize after resection. The patients were grouped by initial CEA values: CEA 5 ng/mL or less (nonsecretors) and CEA 5 + ng/mL: (secretors). We identified 186 patients with CRC; 146 were initial nonsecretors. We identified 22 patients with recurrent colorectal cancer; 6 were secretors and 16 patients were nonsecretors. In the secretors group, CEA was elevated with recurrence in four (66%) of the patients. In the nonsecretors, CEA was elevated with recurrence in eight (50%) of the patients. In summary, many recurrences of CRC are marked by an elevation of CEA regardless of whether the patients initially presented as secretors or nonsecretors.     

Continuing nursing education policy in China and its impact on health equity

XIAO LD. Nursing Inquiry 2010; 17 : 208–220
Continuing nursing education policy in China and its impact on health equity The aim of this study was to evaluate the mandatory continuing nursing education (MCNE) policy in China and to examine whether or not the policy addresses health equity. MCNE was instituted in 1996 in China to support healthcare reform was to include producing greater equity in health‐care. However, the literature increasingly reports inequity in participation in MCNE, which is likely to have had a detrimental effect on the pre‐existing discrepancies of education in the nursing workforce, and thereby failing to really address health equity. Despite a growing appeal for change, there is lack of critical reflection on the issues of MCNE policy. Critical ethnography underpinned by Habermas’ Communicative Action Theory and Giddens’ Structuration Theory were used to guide this study. Findings are presented in four themes: (i) inaccessibility of learning programs for nurses; (ii) undervaluation of workplace‐based learning; (iii) inequality of the allocation of resources; and (iv) demands for additional support in MCNE from non‐tertiary hospitals. The findings strongly suggest the need for an MCNE policy review based on rational consensus with stakeholders while reflecting the principles of health equity.     

Viral loads of herpes simplex virus in clinical samples—A 5‐year retrospective analysis

Viral loads of herpes simplex virus (HSV) are not monitored usually for the effective clinical management of HSV‐related diseases. However, recently, there has been more interest about the typical HSV levels in clinical specimens, and how such data may improve understanding of the behavior of this virus in such clinical presentations, particularly in immunocompromised patients, where more prolonged therapy using higher doses of antiviral drugs may be required. Using an in‐house quantitative HSV‐1/HSV‐2 polymerase chain reaction assay, an observational, retrospective 5‐year analysis of diagnostic, quantitative HSV‐1 and HSV‐2 DNA levels was conducted. The results (all in median log₁₀ DNA copies/ml), including perhaps the first quantitative comparison of cerebrospinal fluid (CSF) HSV viral loads, were as follows: CSF: HSV‐1, 3.40 (range 2.30–8.98) versus HSV‐2, 3.60 (range 2.31–6.86) (P = 0.559); plasma: HSV‐1, 3.20 (range 2.23–5.51) versus HSV‐2, 3.20 (range 3.18–3.41) (P = 0.905); genital swabs: HSV‐1, 6.79 (range 2.28–8.48) versus HSV‐2, 6.97 (range 3.40–9.66) (P = 0.810); oral swabs: HSV‐1, 7.28 (range 2.46–10.04) versus HSV‐2, 5.62 (range 4.60–6.63) (P = 0.529). Note that with the samples usually collected for HSV testing (i.e., CSF, plasma, oral, and genital swabs) there was no significant difference in the viral loads between HSV‐1 and HSV‐2 types, nor between immunocompetent and immunocompromised patients for each of these different HSV types. Indeed, even between immunocompromised patients with similar diseases, for these samples, the HSV loads were found to vary considerably. These findings may therefore limit the usefulness of monitoring HSV loads in everyday clinical practice. J. Med. Virol. 82:1911–1916, 2010. © 2010 Wiley‐Liss, Inc.     

Sexological Competence of Different Rehabilitation Disciplines and Effects of a Discipline-specific Sexological Training

Dealing with sexual problems due to disease or disability is part of medical rehabilitation, but both patients and professionals experience barriers to discuss sexual issues. A brief discipline-specific sexological training for rehabilitation professionals was therefore developed and evaluated in two rehabilitation centers in The Netherlands. Among the 283 participants were physicians (42), physical therapists (38), occupational therapists (40), psychologists and social workers (26), nurses (101), and other disciplines (36). Measurements before training, after training, and at 3–4 months follow-up showed increase of self-rated sexological competence and of scores on the Knowledge, Comfort, Approach, and Attitudes towards Sexuality Scale (KCAASS) during the training that were maintained at follow-up. Disciplines differed in sexual competence before training and in increase of sexual competence after training. Implementation of the training in other rehabilitation centers is recommended.     

Chromosomal breakage in myelodysplatic syndrome.

The myelodysplastic syndrome (MDS) represents a group of clonal hematological disorders characterized by progressive cytopenia reflecting defects in erythroid, myeloid and mega karyocytic maturation. The incidence of MDS is greter in older age groups. Detailed studies on MDS from India are not available. Cytogenetic study using GTG-banding and FISH revealed 54.5% clonal chromosomal abnormalities. We have carried out chromosomal breakage study from peripheral blood cultures induced with mitomycin C, in karyotypically normal MDS (49) and 15 (30.6%) showed significant (p < 0.001) increase in chromosome damage compared to controls. Among 22 occupationally exposed MDS, 6 (27.3%) showed a high frequency of chromosome breakage while in the non-exposure (n=27) group, high chromosome breakage was noted in 9 (33.3% ) MDS patients. Our results suggest that the high chromosome damage may be due to acquired Fanconi anemia which leads to multiple defects in chromosomes and clonal chromosome anomalies.     

Fundus photography for measurement of macular pigment density distribution in children

PURPOSE: To evaluate a photographic procedure for reflectometry of the topographic distribution of macular pigment density in normal pediatric subjects. METHODS: Digitized blue (480 nm) and green (540 nm) photographic images were aligned and subtracted to generate optical density difference maps. An 8 degrees x 8 degrees area concentric with the fovea was analyzed. Gaussian curves were fitted through the foveola along the vertical and horizontal meridians. The peak density and full widths at half maximum (FWHMs) were calculated. The subjects (n = 23; median age 10.5 years) had normal eyes and good acuity. RESULTS: The peak macular pigment (MP) density was 0.13 +/- 0.04 density units (DU) which is at the lower end of the range previously obtained by other reflectometry procedures. Density distributions were circularly symmetrical. The FWHM ranged was 2.4 degrees +/- 0.5 degrees. Neither MP nor FWHM varied significantly with age. CONCLUSIONS: The photographic method is feasible and provides quantitative assessment of topographic properties of macular pigment in young subjects. Future application to clinical studies of pediatric patients is envisioned.