Examining the contraceptive decisions of young,HIV-infected women: A qualitative study

This study qualitatively examined factors that influenced contraceptive choices in a sample of young, HIV-infected women. Individual qualitative interviews were conducted among 30 vertically and horizontally HIV-infected women (n = 26 African American) from the ages of 14 to 24 years (Mean age = 20.9 years). We recruited sample groups with the following characteristics: (a) current contraceptive/condom use with ≥1 child (n = 11); (b) current contraceptive/condom use with no children (n = 12); and (c) no current contraceptive/condom use with no children (n = 7). A semi-structured interview guide was used to ask participants about factors influencing past and current contraceptive choices. Individual interviews were digitally recorded and transcribed verbatim; analyses to identify core themes were informed by the Grounded Theoretical approach. Young, HIV-infected women did not identify their HIV serostatus or disease-related concerns as influential in their contraceptive decisions. However, they reported that recommendations from health-care providers and input from family and friends influenced their contraceptive choices. They also considered a particular method’s advantages (e.g., menstrual cycle improvements) and disadvantages (e.g., increased pill burden) when selecting a method. Findings suggested that HIV-infected young women’s contraceptive decisions were influenced by factors other than those related to their infection.     

Dietary calcium intake and bone loss from the spine in healthy postmenopausal women

Controversy exists over the relationship between calcium intake and axial bone loss. We measured bone density of the spine (L2-4) by dual photon absorptiometry (DPA) two times, 7 mo apart, in 76 healthy postmenopausal women aged 40-70 y. Ca intake was assessed by food-frequency questionnaire. Women with a Ca intake less than 405 mg/d lost spine density at a rate that was significantly greater than that of women with an intake greater than 777 mg/d, p = 0.026. There appears to be a threshold of Ca intake below which increased Ca in the diet is likely to be beneficial in reducing spine mineral loss.     

Precision of dual-photon absorptiometry

Summary Precision of dual-photon absorptiometry (DPA) measurements was determined in a lumbar spine phantom and in humans. Approximately half of the measurements were made before and half after a¹⁵³gadolinium source change. The phantom was measured with different amounts of acrylic, which simulates human soft tissue, in order to evaluate the influence of body thickness on bone mineral density (BMD). Results of scans analyzed with two software versions from Lunar Radiation Corp., the widely used 08B and a prototype 08C, are compared. DPA with a cold source significantly overestimated BMD in the phantom in the presence of large amounts (more than 25 cm) of soft tissue equivalent with version 08B but not with the newer version 08C. Similiarly, in nine subjects, there was a significant decrease in spine BMD after a source change when scans were analyzed with version 08B (mean difference 0.026 g/cm²,P=0.002) but not with 08C (0.01 g/cm²,P=0.234). No systematic effect of source change on femoral BMD measurements was observed. The SD of the mean difference of two measurements of the nine subjects was 0.019 g/cm² (1.6% of the mean value) for the spine with software version 08B and 0.024 g/cm² (2.0%) with version 08C, 0.03 g/cm² (3.3%) for the femur neck, 0.03 g/cm² (4.0%) for the greater trochanter, and 0.04 g/cm² (4.9%) for Ward's triangle region of the proximal femur. The spine phanton was scanned on two other commercial bone densitometers in order to assess inter-instrument variation. Phantom measurements of L2-4 BMD made on two Lunar Radiation Corp model DP3 scanners which differed by 2% were 10 and 12% higher than those with a Norland Corp. model 2600 scanner.     

Calcium supplementation and plasma ferritin concentrations in premenopausal women.

The effect of calcium supplement use on iron stores was examined in a randomized controlled study in free-living, healthy, premenopausal women. Of 109 women who completed the study, 52 were in the control group and 57 took two tablets containing 250 mg Ca as the carbonate with each of two meals daily for 12 wk. In all subjects at baseline, plasma ferritin concentrations were positively correlated with heme-iron intake (r = 0.21, P = 0.04), serum iron concentration (r = 0.19, P = 0.04), transferrin saturation (r = 0.31, P = 0.001), and hemoglobin concentration (r = 0.22, P = 0.02), and negatively correlated with total iron-binding capacity (TIBC, r = -0.42, P < 0.001). No significant differences in absolute or percent changes in plasma ferritin concentrations, serum iron concentrations, TIBC, transferrin saturation, hemoglobin concentrations, or hematocrit were observed between the treatment and control groups. Thus, over a 12-wk period, use of 1000 mg Ca as the carbonate daily with meals does not appear to be detrimental to iron stores in healthy, free-living, premenopausal women.     

Immune response to immunostimulatory complexes (ISCOMs) prepared from human immunodeficiency virus type 1 (HIV-1) or the HIV-1 external envelope glycoprotein (gp120)

In mice, immunostimulatory complexes (ISCOMs) prepared from HIV-1 B external envelope glycoprotein (gp120) induced 10-fold higher antibody titres than gp120 emulsified in depot adjuvant, as measured by enzyme-linked immunosorbent assay (ELISA). Rhesus monkeys immunized with gp120 ISCOMs produced precipitating and virus neutralizing antibody titres equivalent to those seen in HIV-infected chimpanzees and humans. After multiple immunizations with HIV-1 B gp120 ISCOMs, a rhesus monkey developed a neutralizing response to the HIV-1 isolates RF and MN, but not to the CC isolate. Antisera from ISCOM-immunized rhesus monkeys recognized gp120 on the membranes of HIV-1 B-infected H9 cells, indicating the preservation of epitope structure in the ISCOMs matrix.     

Intact parathyrin in postmenopausal women

To establish a reference range, we measured intact parathyrin (parathyroid hormone, PTH) in 245 healthy postmenopausal women, ages 42-75 years, with use of the Allegro Intact PTH Kit from Nichols Institute Diagnostics. We also assayed serum from a subset of 120 of the women with kits specific for mid-molecule PTH. The mean intact PTH concentration for the 245 women was 32 ng/L (95% confidence interval 14-60 ng/L). Intact PTH values in these subjects were not normally distributed, although calcium concentrations in the same samples were. There was positive, but not significant (r = 0.12, P = 0.06), correlation between intact PTH and age, and a significant negative correlation between serum calcium and intact PTH that was not observed between calcium and mid-molecule PTH. The improved sensitivity of the intact PTH assay makes it useful in studies of calcium homeostasis in the normal population.     

Population-based randomized controlled trial of a stage-targeted physical activity intervention

Background: Intervention trials with self-selected participants have shown that mailed stage-targeted print materials can increase participation in physical activity in the short term. We examined the effects of a mailed stage-targeted print intervention designed to promote physical activity, in a random sample of adults living in a regional city.Method: Participants (n = 462, 40–60 years of age) were randomly allocated to an intervention in - 227) or control group (n - 235). Measures included validated 2-week physical activity recall and stage of motivational readiness for physical activity. The intervention consisted of a single mailing of a letter and full-color stage-targeted booklets (specific to precontemplation, contemplation, preparation, and action/maintenance) 1 week postbaseline. Follow-up interviews were conducted at 2 and 6 months postbaseline.Results: After 2 months, participants in the intervention group were significantly More likely to meet the current American College of Sports Medicine/Centers for Disease Control and Prevention recommendation for sufficient physical activity than those in the control group (adjusted odds ratio [OR] - 2.40; 95% confidence interval [CI] = 1.44–3.99). After 6 months, intervention participants who reported receiving and reading the intervention materials were significantly more likely to be meeting the sufficient physical activity criterion compared with the control group (adjusted OR = 2.03; 95% Cl = 1.16–3.56).Conclusions: The stage-targeted print intervention was effective in promoting short-term increases in physical activity and was most effective for participants who recognized and used the materials. This low-cost, generalizable intervention has demonstrated potential as a practical population-based physical activity promotion strategy. Further research is required before widespread dissemination would be justified, as additional strategies may be required to ensure sustained change. This project was supported by a National Heart Foundation of Australia Research Project Grant. David Crawford was supported by a Nutrition Research fellowship from the National Heart Foundation.     

Updates on bacterial resistance and empirical antibiotics treatment of complicated acute appendicitis in children

Objective: Through historical comparison with our previous study published 10 years ago, this paper aims to provide latest analysis of local bacteriology of acute complicated appendicitis and evaluate the effects of early escalation of potent antibiotics on course of postoperative recovery.Methods: A 5-year retrospective review of all children receiving emergency laparoscopic appendicectomies for acute appendicitis from December 2014 to November 2019 was conducted.Results: 257 cases of acute appendicitis were included, 126 were complicated appendicitis (38 gangrenous, 88 ruptured). 96 had positive peritoneal swab culture, 53 (42.1%) grew resistant bacterial strains, including extended spectrum beta-lactamase producing E. coli (ESBL E. coli), Pseudomonas aeruginosa, against traditional empirical triple antibiotics. The prevalence had significantly increased over the past decade (p = 0.008). In our patients, piperacillin/tazobactam, ertapenem, gentamicin provided coverage of 69.8%, 45.3% and 45.3% respectively. For patients with early escalation of postoperative antibiotics, no statistical significance was identified in terms of postoperative complications (p = 0.883), or duration of antibiotics (p = 0.0615).Conclusion: Growing prevalence of resistant strains were observed over the decade. Piperacillin/tazobactam provided the best coverage (69.8%) against resistant bacterial strains in our patients. Early escalation of antibiotics failed to reduce postoperative complications and antibiotics duration.Type of Study: Clinical Research, Retrospective Historical Comparative StudyLevel of Evidence: Level III