Marked HIV prevalence declines in higher educated young people: evidence from population-based surveys (1995-2003) in Zambia

OBJECTIVES: Higher educational attainment has been associated with a greater risk of HIV infection in sub-Saharan Africa. We investigated change over time in HIV prevalence by educational attainment in the general population. METHODS: The data stem from serial population-based HIV surveys conducted in selected urban and rural communities in 1995 (n = 2989), 1999 (n = 3506) and 2003 (n = 4442). Analyses were stratified by residence, sex and age-group. Logistic regression was used to estimate age-adjusted odds ratio of HIV between low (< or = 4 school years) and higher education (> or = 8 years) for the rural population and between low (< or = 7 school years) and higher education (> or = 11 years) for the urban population. RESULTS: There was a universal shift towards reduced risk of HIV infection in groups with higher than lower education in both sexes among urban young people [odds ratio (OR), 0.20; 95% confidence interval (CI), 0.05-0.73] in men and (OR, 0.33; 95% CI, 0.15-0.72) in women. A similar pattern was observed in rural young men (OR, 0.17; 95% CI, 0.05-0.59) but was less prominent and not statistically significant in rural women. In age 25-49 years, higher educated urban men had reduced risk in 2003 (OR, 0.43; 95%CI, 0.26-0.72) but this was less prominent in women. CONCLUSIONS: The findings suggested a shift in the association between educational attainment and HIV infection between 1995 and 2003. The most convincing sign was the risk reduction among more educated younger groups where most infections can be assumed to be recent. The changes in older groups are probably largely influenced by differential mortality rates. The stable risk among groups with lower education might also indicate limitations in past preventive efforts.     

Optimizing medication adherence with home-monitoring – A feasibility study using capillary microsampling and mHealth in solid organ-transplanted adolescents

Background

Reliable methods to detect and reduce medication nonadherence in solid organ-transplanted (SOT) adolescents are warranted. We aimed to evaluate the feasibility of combining a medication-manager application (TusenTac®-app) with home-sampling of tacrolimus (Tac) in young SOT recipients.

Methods

Kidney and combined SOT recipients between 14 and 25 years were included. During an 8-week intervention period, the participants were instructed to use the transplant-specific, age-adapted TusenTac®-app daily and to perform weekly at-home Tac trough finger-prick microsampling. Microsample Tac concentrations were controlled against timed venous samples twice. Medication implementation and persistence adherence were measured with BAASIS© questionnaires, TusenTac®-registrations, Tac trough concentration coefficient of variation (CV%) and self-reporting by interview. For comparison, venous Tac trough CV% were obtained from the year before and after the short-term intervention.

Results

Twenty-two recipients were included, two withdrawals, leaving 20; median age 17.9 (14.5–24.8) years, 12 females (60%). The participants registered their dosage intake 88% (1502/1703) of the expected times, and 90% (106/118) of the microsamples were obtained correctly. At inclusion, 11 recipients (55%) were nonadherent assessed with BAASIS© questionnaire, four of these (36%) turned adherent during the intervention period. At the end, 70% reported improved timing-adherence at the interview. There was no significant change in TacCV% from the year before to the year after the short-term intervention. Home-sampling was reliable and measured Tac concentrations accurately.

Conclusions

Home-monitoring, combining Tac finger-prick microsampling and a medication-manager app, is feasible in adolescent SOT recipients with 70% perceived improvement in medication timing-adherence. There were no significant long-term changes in TacCV% confirming the need for continuous use and individualized interventions.     

Digitally delivered education and exercises for patients with hand osteoarthritis—An observational study

Hand osteoarthritis (OA) is a common form of OA, for which education and exercise are considered the first-line treatment. The aim of the present study was to examine pain and perceived hand function in participants following 3 months of digitally delivered first-line treatment for hand OA. Three-hundred-and-seventy-nine of 846 participants with clinical signs and symptoms of hand OA completed the study. The digital hand OA treatment program consists of video instructed daily exercises and patient education through text lessons. Pain (NRS, 0 no pain, 10 worst) was the primary outcome, and stiffness (NRS) and the Functional Index for Hand OsteoArthritis (FIHOA, 0 best, 30 worst) were among secondary outcomes. The McNemar test and linear mixed effect regression model were used to assess the changes in outcomes from baseline to 3-month. After three months, the digitally delivered program was associated with a significant decrease in pain intensity (mean change −1.30 (95% CI −1.49, −1.12)) and hand stiffness (mean change -0.81 (95% CI −1.02, −0.60)) but no conclusive changes in the FIHOA scores (mean change 0.3 (95% CI −0.2, 0.7)). The results agree with reports on face-to-face delivered first-line treatment for hand OA suggesting that digital treatment is a viable treatment option in patients with hand OA.     

The role of infectious agents in cancer of the ocular region

The purpose of the study was to investigate the association between infectious agents and the development of cancer in the ocular adnexa. A comprehensive literary study was carried out, reviewing and summarizing previous reports on the topic. A broad range of malignancies of the ocular adnexa are associated with infectious agents. A strong association and possible causal relationship between the infectious agent and the development of ocular adnexal cancer are seen in Merkel cell carcinoma (Merkel cell polyomavirus), Burkitt lymphoma (Epstein–Barr virus) and Kaposi sarcoma (human herpesvirus 8). Infection with Chlamydia psittaci has been associated with the development of extranodal marginal zone B-cell lymphoma in Italy. Human papillomavirus infection has been associated with the development of squamous cell carcinomas of the ocular adnexa, although with a highly variable reported prevalence. By exploring the role of infectious agents in the ocular adnexa and the mechanism by which they contribute to oncogenesis, the diagnostics, management and prevention of these malignancies may also improve. Antibiotic treatment and vaccines against infectious agents may be valuable in future treatment. Additionally, the presence of infectious agents within the tumours may have a prognostic or predictive value.     

Induction of invasion in an organotypic oral cancer model by CoCl2, a hypoxia mimetic

Brusevold IJ, Husvik C, Schreurs O, Schenck K, Bryne M, Søland TM. Induction of invasion in an organotypic oral cancer model by CoCl ₂ , a hypoxia mimetic. Eur J Oral Sci 2010; 118: 168–176. © 2010 The Authors. Journal compilation © 2010 Eur J Oral Sci Invasion is a hallmark of malignancy. The aim of this study was to develop an in vitro model that can be used for experimental studies of cancer cell invasion. The organotypic oral cancer model was constructed by growing oral squamous cell carcinoma (OSCC) cells on a collagen matrix in which normal human fibroblasts were incorporated. Immunohistochemical staining of the model showed that the expression of invasion‐related molecules such as phosphorylated extracellular signal‐regulated kinases 1 and 2 (p‐ERK1/2), cyclooxygenase‐2 (COX‐2), p75^NTR, and hepatocyte growth factor receptor (Met) was similar to that seen in OSCC. Treatment of the model with cobalt chloride (CoCl₂) to mimic hypoxic conditions increased cancer cell invasion, defined as the appearance of cancer cell islands protruding into the matrix. Models treated with CoCl₂ showed increased expression of p75^NTR and laminin‐5 in the cancer cells, and a more pronounced fragmentation of collagen IV in the basal membrane area, in contrast to models that were left untreated. The results indicate that the present model is well suited for studies on cancer cell invasion in the matrix and that the addition of CoCl₂ on day 3 of the experiment is indicated because it markedly increases the invasion and improves the model.     

Encouraging adolescents to contact their GP: a community-based trial

Background

Adolescents, especially males, often fail to see their GP.

Aim

To determine whether an informative letter could enhance the accessibility and utilisation of healthcare facilities and services.

Design and setting

A community-based trial in one town in Oslo, using a retrospective control group.

Method

GPs in one town in Oslo sent a personal, informative letter at the beginning of 2008 and 2009 to individuals in their practice population who were turning 16 years of age that year. The pooled data for the same year for each surgery were collected. Retrospective data from 1990 and 1991 served as controls for the intervention groups of data collected in 2006 and 2007 respectively. An International Classification of Primary Care-2 diagnosis was given for each contact.

Results

The proportion of adolescents in contact with a GP increased from 59% in the control group to 69% in the intervention group (P<0.001). For the males, the increase was from 54% to 72% (P<0.001). This reduced sex differences in healthcare seeking. For diagnoses mentioned in the informative letter the incidence rose from 38% in the control group to 55% in the intervention group (P<0.001). For the females, there was a non-significant increase in the proportion in contact with the GP, from 63% to 66% in control and intervention groups, respectively. The most frequent contact reasons were respiratory disorders, followed by general and unspecified complaints, skin disorders, musculoskeletal disorders, and psychological disorders. This pattern did not change because of the intervention.

Conclusion

An information letter about health problems and health rights (such as the protection of the adolescent’s privacy) seems to enhance the accessibility and utilisation of GPs, as measured by contact rate, particularly for males.     

On the physical interpretation of the initial bending of a Shapiro-Konopicky-Heckel compression profile

The relationship between the natural logarithm of the tablet porosity and the applied pressure is used to describe the compression behavior of a powder. Such a relationship, here referred to as a Shapiro-Konopicky-Heckel (SKH) profile, is usually divided into three regions, of which the first often is non-linear. The objective of this work was to address the question of the mechanisms controlling the compression and the bending of the first region of a SKH profile for dense particles. In this paper, the first region was described by the Shapiro General Compression Equation, from which a compression parameter was derived as a measure of the bending. The results indicate that for powders undergoing significant particle rearrangement at low applied pressures, the particle rearrangement is the major cause for the initial bending of the SKH profile. For powders showing limited particle rearrangement, the initial bending is mainly caused by the change in particle diameter due to particle fragmentation. It is concluded that the evaluation of the first region of a SKH profile in terms of bending may be used to assess particle fragmentation. The SKH profile could hence be a useful tool to describe powder compression behavior in terms of particle fragmentation and particle deformation from one single compression analysis.     

Oral capecitabine in anthracycline- and taxane-pretreated advanced/metastatic breast cancer

An open-label, non-randomized, compassionate-use study was carried out to investigate the effects of oral capecitabine at a dose of 1 250 mg/m2 twice daily on days 1 to 14 every 21 days in anthracycline- and taxane-pretreated advanced/metastatic breast cancer patients. Forty-eight patients were enrolled from April 2000 to December 2001. Twenty-four patients (50%) had metastases to the liver, 18 to bone, 13 to lung, 10 to regional lymph nodes, 8 to pleura, 7 to the thoracic wall, 5 to skin, 3 to the mediastinum, 1 to breast and 1 had metastasis to the abdomen. Thirty-three patients (69%) had metastases to more than one site. Median age of the patients was 55 years (range 35-74). Three patients had an ECOG performance status (PS) of 0, 32 PS 1 and 13 PS 2, respectively. Fourteen patients (29%; 95% CI 16 to 42%) obtained a partial response (PR) while 16 (33%) had stable disease (SD) as the best response, of whom 6 had stabilization for more than 24 weeks. This gives a clinical benefit (PR + SD > 24 weeks) of 42% (95% CI 28 to 56). Dose reduction was necessary in 29% of the patients. Median dose reduction was 25%. Grades 2 and 3 hand-foot syndrome (PPE) was observed in 17 patients (36%). Eleven patients experienced grades 2 and 3 gastrointestinal toxicity, and haematological toxicity grade 3 was observed in 3 patients (6%). Median time to progression was 107 days (CI 95% 85 to 129), and median overall survival was 281 days (CI 95% 164 to 398). Third-line, oral capecitabine in anthracycline- and taxane-pretreated metastatic breast cancer appears to be effective and has an acceptable toxicity profile.     

Reliability of the Canadian Occupational Performance Measure in patients with ankylosing spondylitis

OBJECTIVE: The Canadian Occupational Performance Measure (COPM) is a client-centered measure, designed to detect changes in occupational performance over time. The main aim of our study was to examine the test-retest reliability of the Norwegian version of the COPM in patients with ankylosing spondylitis (AS) in 3 different retest modes of data collection. METHODS: A total of 119 patients with AS completed the baseline COPM interview before randomization into one of 3 modes of retest data collection performed 2 weeks later: by personal interview, telephone interview, or mailed questionnaire. Scores were computed for Performance and Satisfaction, and the 2 sets of scores were examined for reliability by intraclass correlations (ICC), and by the Bland-Altman procedure for calculation of smallest detectable difference (SDD). RESULTS: The ICC coefficients for Performance and Satisfaction were as follows: 0.92 and 0.93 (rescoring by personal interview), 0.73 and 0.73 (rescoring by telephone interview), and 0.90 and 0.90 (rescoring by mail). SDD for the Performance and Satisfaction scores were 1.47 and 1.80, respectively, for rescoring by personal interview; 3.14 and 4.00 for rescoring by telephone interview; and 2.20 and 2.41 for rescoring by mailed survey. CONCLUSION: The results confirm that the COPM is a reliable instrument for use in clinical practice in patients with AS, and may serve as an instrument to promote a patient-centered approach in the planning and evaluation of rehabilitation programs. Mailed questionnaires may replace personal interview in followup examinations, while rescoring by telephone interview is less reliable.