Future desire for children among women living with HIV in Atlanta,Georgia

Little is known regarding family planning desires among women living with HIV in the United States. This study aimed to identify factors influencing desire for children in the future among HIV-infected women in Atlanta, Georgia. HIV-infected women ages 18–45 completed an ACASI (audio computer-assisted self-interview) questionnaire. Chi-square, t-tests, and multivariate logistic regression evaluated factors associated with desire for future children. Of 181 participants, 62 (34.3%) expressed desire for children in the future, with increased desire among younger women (age <26) and those with seronegative partners. Concerns for horizontal and vertical HIV transmission were deterrents to future childbearing. Condom use and overall knowledge of transmission risk was low. Over a third of women desiring a child never discussed their desire with a physician. Misinformation regarding HIV transmission risks persists and is a notable concern influencing desire for children. Providers should reassess family planning desires regularly through integrated HIV care.     

Adherence to transition guidelines in European paediatric nephrology units

Background

There is increasing focus on the problems involved in the transition and transfer of young adult patients from paediatric to adult renal units. This situation was addressed by the 2011 International Pediatric Nephrology Association/International Society of Nephrology (IPNA/ISN) Consensus Statement on transition.

Methods

We performed a survey of transition practices of 15 paediatric nephrology units across Europe 2 years after publication of the consensus statement.

Results

Two thirds of units were aware of the guidelines, and one third had integrated them into their transition practice. Forty-seven per cent of units transfer five or fewer patients with chronic kidney disease (CKD) stage 5 per year to a median of five adult centres, with higher numbers of CKD stages 2–4 patients. Seventy-three per cent of units were required by the hospital or government to transfer patients by a certain age. Eighty per cent of units commenced transition planning after the patient turned 15 years of age and usually within 1–2 years of the compulsory transfer age. Forty-seven per cent of units used a transition or transfer clinic. Prominent barriers to effective transition were patient and parent attachment to the paediatric unit and difficulty in allowing the young person to perform self-care.

Conclusions

Whereas awareness of the consensus statement is suboptimal, it has had some impact on practice. Adult nephrologists receive transferred patients infrequently, and the process of transition is introduced too late by paediatricians. Government- and hospital-driven age-based transfer policies distract focus from the achievement of competencies in self care. Variable use of transition clinics, written patient information and support groups is probably due to economic and human-resource limitations. The consensus statement provides a standard for evolving and evaluating transition policies jointly agreed upon by paediatric and adult units.     

No evidence of chikungunya virus and antibodies shortly before the outbreak on Sri Lanka

A massive outbreak of chikungunya disease occurred on Sri Lanka in 2006. Reasons for the explosive nature of the epidemic are being intensively discussed. According to recognised and anecdotal concepts, absence of human population immunity against chikungunya virus (CHIKV) might have supported virus amplification. However, formal proof of concept is lacking. This study determined the prevalence of anti-CHIKV IgG antibodies as well as CHIKV RNA shortly before the outbreak. Two hundred and six human sera were collected from patients with acute febrile illness in 2004/2005. Validated indirect immunofluorescence and real-time RT-PCR assays for dengue as well as CHIKV were employed. Laboratory evidence of dengue virus infection was seen in 67% of patients, indicating virus activity and exposure to Aedes spp. vectors. These vectors are the same as for chikungunya. However, no evidence of acute or previous chikungunya infection could be demonstrated in the same cohort. This study gives formal evidence that the absence of human population immunity correlated with a large chikungunya epidemic. M. Panning and D. Wichmann contributed equally to this work.     

Camptodactyly-arthropathy-coxa vara-pericarditis syndrome versus juvenile idiopathic arthropathy

OBJECTIVE: The objective of our article was to highlight the important clinical and radiographic features of camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome. In particular, we emphasize those features that allow differentiation of CACP syndrome from juvenile idiopathic arthropathy. CONCLUSION: CACP syndrome should be considered in all patients who present with a noninflammatory arthropathy or with "atypical juvenile idiopathic arthritis," particularly if radiographs reveal an absence of erosions. In the correct clinical setting, large acetabular cysts on pelvic radiographs may be considered pathognomonic of CACP syndrome.