Frequent detection of acute HIV infection in pregnant women

BACKGROUND: Universal prenatal HIV antibody testing, which does not detect acute HIV, is standard for pregnant women in the United States. Unrecognized HIV acquisition during pregnancy may result in higher rates of perinatal transmission. OBJECTIVE: To determine the prevalence of acute (antibody-negative) HIV infection in pregnant women and to assess the potential for prompt initiation of antiretroviral therapy to prevent perinatal transmission. METHODS: From 1 November 2002 to 30 April 2005, all publicly funded HIV testing sites participated in North Carolina's Screening and Tracing Active Transmission (STAT) Program, which retested all specimens that were HIV antibody negative for HIV RNA using specimen pooling. All patients with acute HIV infection were immediately traced for evaluation, confirmatory testing, counseling, and referral services. For this study, all pregnant women with acute HIV were immediately initiated onto antiretroviral therapy and followed prospectively for pregnancy outcomes. RESULTS: During the study period, 443 women were HIV positive by antibody testing; 15 were HIV antibody negative but positive by RNA assay and of these five were pregnant at the time of testing. The pregnant women received antiretroviral drugs and delivered HIV-uninfected infants. Maternal testing records of all six HIV-infected infants born in North Carolina showed three mothers with chronic HIV infection and three HIV antibody negative at private prenatal testing facilities. CONCLUSIONS: In resource-rich settings, a substantial proportion of residual perinatal transmission may be from HIV acquisition during pregnancy. Standard antibody tests miss acute HIV infection and so algorithms that include pooled HIV RNA testing may improve its detection and represent a further opportunity to prevent perinatal transmission.     

Price sensitivity and smoking smuggled cigarettes

Background: This study analysed the socio-economic factors thatinfluence a smoker's decision to consume smuggled cigaretteswhen faced with the rising costs of legal cigarettes. We hopeour findings will help public health authorities create policiesthat simultaneously discourage consumption of smuggled cigarettesand lower overall smoking levels. Methods: We conducted a national telephone survey from Aprilto June 2004. We then applied Multiple Logistic Regression tothe collected data to answer the following questions: do socio-economicallydisadvantaged smokers differ significantly in their characteristics?If so, which characteristics are most influential in the decisionto purchase smuggled cigarettes? Results: Smokers with a personal monthly income of less thanNew Taiwan dollar (NT$) 10 000 are 24% more likely to smokesmuggled cigarettes than are smokers who earn NT$10 000 or more.Smokers with the least amount of education are 21% more likelyto smoke smuggled cigarettes than those with higher levels ofeducation. Smokers with the most experience purchasing smuggledcigarettes are 31% more likely to do so than those with lessexperience. Finally, smokers who have a personal monthly incomeof less than NT$10 000 and the least amount of education are54% more likely to smoke smuggled cigarettes than those withjust one—or none—of these characteristics. Conclusion: Low-income, poorly-educated smokers are most likelyto purchase smuggled cigarettes. To alter such behaviour, governmentmust understand the motivations and opinions of this populationand create marketing messages targeted specifically to theirneeds.     

Continuity of care and cancer screening among health plan enrollees

CONTEXT: Although having a usual source of care has been associated with cancer screening, whether there is additional benefit from continuity with a specific physician is uncertain. In addition, little is known about the relationship between continuity of care and receipt of colorectal and prostate cancer screening. METHODS: Subjects were enrolled in a Washington State health plan that operates an integrated delivery system that emphasizes access to primary care. Among patients age 50-78 years old with 2 or more primary care visits in 2002-2003 (N = 67,633), we determined whether higher continuity (>/=50% of visits with the most visited primary care provider) was associated with colorectal, breast, and prostate cancer screening. Random-effects logistic regression estimated adjusted percentages of patients who received fecal occult blood testing, lower endoscopy (sigmoidoscopy or colonoscopy), screening mammography, and prostate specific antigen (PSA) testing. RESULTS: Patients with higher continuity were more likely to receive fecal occult blood testing than patients with lower continuity (28.9% vs. 26.8%; P < 0.001) but less likely to receive lower endoscopy (12.9% vs. 14.3%; P < 0.001). Although higher continuity was not significantly associated with screening mammography (P = 0.38), men with higher continuity were more likely to receive PSA testing than men with lower continuity (39.4% vs. 37.4%; P = 0.008). CONCLUSIONS: In an insured population with a high degree of primary care access, continuity with a specific primary care physician was associated with the selection of less invasive colorectal cancer screening tests by patients and physicians and greater likelihood of PSA testing.     

"Health is strength": a community health education program to improve breast and cervical cancer screening among Korean American Women in Alameda County, California

BACKGROUND: A 48-month community intervention was conducted to improve breast and cervical cancer (BCC) screening among Korean American (KA) women in Alameda County (AL), California. KA women in Santa Clara (SC) County, California served as a comparison group. METHODS: Random samples of KA women from each county were surveyed by telephone in 1994 (n=818) and 2002 (n=1084). Propensity score analyses were used to estimate the difference between counties in changes over time in screening (Pap tests, breast self-examinations, clinical breast examinations, and mammography), and to estimate differences in screening between participants and non-participants in an educational workshop among women in AL in 2002. RESULTS: Mammography screening and clinical breast examinations increased over time in both counties. Pap tests increased in AL but not SC, and breast self-examinations did not change significantly in either county. None of the intervention-comparison group differences over time were significant. In 2002, compared to non-participants, women who attended a workshop were more likely to report a recent Pap test (P<.08). CONCLUSIONS: Although our overall intervention did not appear to enhance screening practices at the community-level, attendance at a women's health workshop appears to have increased cervical cancer screening.     

The influence of tumor oxygenation on hypoxia imaging in murine squamous cell carcinoma using [64Cu]Cu-ATSM or [18F]Fluoromisonidazole positron emission tomography

[64Cu]Cu(II)-ATSM (64Cu-ATSM) and [18F]-Fluoromisonidazole (18F-FMiso) tumor binding as assessed by positron emisson topography (PET) was used to determine the responsiveness of each probe to modulation in tumor oxygenation levels in the SCCVII tumor model. Animals bearing the SCCVII tumor were injected with 64Cu-ATSM or 18F-FMiso followed by dynamic small animal PET imaging. Animals were imaged with both agents using different inspired oxygen mixtures (air, 10% oxygen, carbogen) which modulated tumor hypoxia as independently assessed by the hypoxia marker pimonidazole. The extent of hypoxia in the SCCVII tumor as monitored by the pimonidazole hypoxia marker was found to be in the following order: 10% oxygen>air>carbogen. Tumor uptake of 64Cu-ATSM could not be changed if the tumor was oxygenated using carbogen inhalation 90 min post-injection suggesting irreversible cellular uptake of the 64Cu-ATSM complex. A small but significant paradoxical increase in 64Cu-ATSM tumor uptake was observed for animals breathing air or carbogen compared to 10% oxygen. There was a positive trend toward 18F-FMiso tumor uptake as a function of changing hypoxia levels in agreement with the pimonidazole data. 64Cu-ATSM tumor uptake was unable to predictably detect changes in varying amounts of hypoxia when oxygenation levels in SCCVII tumors were modulated. 18F-FMiso tumor uptake was more responsive to changing levels of hypoxia. While the mechanism of nitroimidazole binding to hypoxic cells has been extensively studied, the avid binding of Cu-ATSM to tumors may involve other mechanisms independent of hypoxia that warrant further study.