HIV/AIDS policies, practices and conditions in South African prisons: Criticisms and alternatives. Towards a research agenda

The level of HIV infection in South African prisoners is unknown. However, given that 4.2 million citizens or 20% of the adult population are infected by HIV then the problem of infection within the prison system would seem to be a large and a significant management issue. Policies to treat HIV+ prisoners and prevent HIV transmission have been developed. However, the efficacy of those programmes implemented to prevent HIV transmission is questionable. The reasons for this situation include lack of resources like condoms, lubricant, disinfectants and availability of testing. Prison conditions also militate against success especially overcrowding, poor health care and nutrition. Little research has been undertaken into HIV within the prison system and the lack of transparency in management of the system is a major hindrance in achieving better public policy outcomes. The issues of importance to policy research on HIV/AIDS in prison, which should receive early attention, include: 1) Prevalence rate determination; 2) Treatment of HIV+ prisoners; 3) Education programmes; and 4) Early release policy and practices.

An evaluation of the effectiveness of the Zambian Health Worker Retention Scheme (ZHWRS) for rural areas

BACKGROUND

Zambian Health Workers Retention Scheme (ZHWRS) commenced in 2003. The schemes' original aim was to retain and recruit Zambian doctors in rural and remote districts. The aim of the ZHWRS subsequently expanded to also include other health workers, in either rural or urban areas. The scheme was formulated to address, in part, the drastic shortage of health workers.

OBJECTIVES

To evaluate the effectiveness of the ZHWRS in achieving its aim.

METHODS

The data on the number of health workers recruited by the ZHWRS and the spatial distribution of them was reviewed. A survey of health workers was undertaken to elicit their views of their working conditions, their job satisfaction and the effectiveness of retention schemes in retaining or increasing the numbers of and overall satisfaction of health workers.

RESULTS

The ZHWRS has not been successful in recruiting sufficient numbers of health workers to reverse the shortage problem or even to meet the modest targets of the scheme itself. However, these improvements do not decrease the likelihood of Department of Health (DoH) workers leaving their rural based positions.

CONCLUSIONS

The ZHWRS has not fully met either its original or revised aims. The drastic shortage of health workers in Zambia continues.

Police officer anxiety after occupational blood and body fluid exposure

BACKGROUND

In the course of their work, police staff are at risk of exposure to blood and body fluids (BBF) and potentially at risk of acquiring a blood-borne viral infection.

AIMS

To examine levels of anxiety among Scottish police staff following an occupational exposure to BBF.

METHODS

Police staff who reported an incident of exposure to their occupational health (OH) provider were invited to complete a postal questionnaire about their levels of self-reported anxiety after the incident and after contact with medical services (namely, OH and accident and emergency (A&E)).

RESULTS

Seventy exposed individuals (66% of those invited to take part) completed a questionnaire. Participants' self-reported anxiety after the incident varied widely. Levels of anxiety reduced over time and following contact with medical services. A&E staff were more likely to be the first point of medical contact for the most anxious individuals. Pre-incident training was not associated with post-incident anxiety.

CONCLUSIONS

The findings suggest that contact with medical services helps to alleviate post-exposure anxieties among police staff.

Laboratory 20-km cycle time trial reproducibility

This study evaluated the reproducibility of laboratory based 20-km time trials in well trained versus recreational cyclists. Eighteen cyclists (age = 34 +/- 8 yrs; body mass index = 23.1 +/- 2.2 kg/m (2); VO(2max) = 4.19 +/- 0.65 L/min) completed three 20-km time trials over a month on a Velotron cycle ergometer. Average power output (PO) (W), speed, and heart rate (HR) were significantly lower in the first time trial compared to the second and third time trial. The coefficients of variation (CV) between the second and third trial of the top eight performers for average PO, time to completion, and speed were 1.2 %, 0.6 %, 0.5 %, respectively, compared to 4.8 %, 2.0 %, and 2.3 % for the bottom ten. In addition, the average HR, VO(2), and percentage of VO(2max) were similar between trials. This study demonstrated that (1) a familiarization session improves the reliability of the measurements (i.e., average PO, time to completion and speed), and (2) the CV was much smaller for the best performers.

Costs of screening for colorectal cancer: an Australian programme

The total costs (direct and indirect) associated with the operation of an Australian community based screening programme for colorectal cancer (CRC) were estimated. One-year costs of the programme were estimated to be AUS$1 347 948 to screen 24 000 participants. This corresponded to AUS$8868 per polyp and AUS$28 679 per cancer detected. The results presented here are quite favourable compared with the only other Australian screening programme that has reported costs. That programme estimated a cost per cancer detected of AUS$24 233 (adjusted). The recent Australian public health literature has been almost unanimously against recommending the operation of population based CRC screening programmes. More recently, overseas randomized control trials have reported reduced mortality (15 to 33%) as a result of these programmes. Cost data, as presented here combined with the epidemiological evidence, indicate the challenge the Federal Government is now confronted with in formulating policy to control the increasing number of deaths from the disease.

Excimer laser photorefractive keratectomy: one year follow-up

BACKGROUND AND OBJECTIVE

To confirm the effectiveness of the 193 nm excimer laser to correct low myopia (1.00 to 6.00 D), moderate myopia (6.00 to 10.00 D), and high myopia (10.00 D and above).

PATIENTS AND METHODS

One hundred eighty-one eyes of 114 patients underwent excimer laser photorefractive keratectomy (PRK). The minimum follow-up was 12 months.

RESULTS

After one year, 96% of the eyes in the low myopia group, 69% in the moderate myopia group and 29% in the high myopia group achieved uncorrected visual acuity of 20/40 or better with one treatment using a single application with a 5 mm optic zone. There were no significant major complications.

CONCLUSION

PRK is a safe, effective and relatively accurate procedure to correct low to moderate myopia.

Detection of picornavirus genomic and template RNA strands by a novel semi-nested polymerase chain reaction-technique and agarose-gel electrophoresis

Attempts to evaluate the relative levels of enteroviral genomic and template RNA strands in small biopsy tissue samples from patients have yielded ambiguous data, largely due to the limited amount of RNA available. A novel semi-nested polymerase chain reaction (PCR) technique was developed to enable RNA levels to be examined more accurately. PCR products were visualised by horizontal agarose gel electrophoresis. This technique was demonstrated on linear single-stranded plasmid DNA; viral RNA isolated from a human rhabdomyosarcoma (RD) cell line persistently infected with a mutated coxsackie B5 virus (piRD) and two cell lines, RD and HEp2 cells, acutely infected with a wild-type clinical isolate of coxsackie B5 virus.

Characterization of HIV-1 neutralization escape mutants

Infection by molecularly cloned HIV-1, in the presence of a high-titre neutralizing monoclonal antibody (MAb), resulted in the selection of plaques in MT4 cells releasing HIV resistant to neutralization by the same MAb. The epitope recognized by the MAb was mapped to the V3 neutralization epitope at amino acids 305-321. The HIV-1 variants showed a reduced binding capacity for the selecting MAb as determined by immunofluorescence. Polymerase chain reaction (PCR) amplification of complementary DNA derived from viral RNA, cloning and sequencing identified a base pair (bp) change C----G at position 6663 in variant 110.5/1, predicting a change at amino acid 308 Arg----Gly. No other changes in the epitope were observed by sequencing three other variants. Differential hybridization of PCR amplified viral RNA and DNA, with oligonucleotides specific for the observed bp change or the 'wild type' sequence, indicated that the variants 110.5/1 and 110.5/7 were genotypically mixed for 308Gly/Arg. Subsequent screening of biologically 'recloned' variants 110.5/1 and 110.5/7 identified two subclones homozygous for the 308Gly change. The Arg----Gly change appears to affect the binding of the antibody to the epitope, since the linear peptide substituting 308Gly for 'wild type' 308Arg was 100 times less potent in blocking the neutralization of parental HIV. Amino-acid residue 308 thus appears to be crucial for antibody binding to the epitope. In addition, mutations distant from the monoclonal antibody binding site may also affect neutralization by antibodies recognizing the V3 loop.

Molecular analysis of Philadelphia positive essential thrombocythemia

Seven patients with Philadelphia (Ph) chromosome positive essential thrombocythemia (ET) were investigated for the presence of a rearrangement within the major breakpoint cluster region (M-bcr) using the Southern blot technique and, in six cases, for the presence of the hybrid bcr-abl mRNA using the polymerase chain reaction (PCR). The molecular studies showed rearrangement of M-bcr in all cases; there was evidence of the b2a2 mRNA junction in one case and of b3a2 junction in five cases. These findings are identical to what might have been expected in Ph-positive chronic myeloid leukemia. These features may explain the poor prognosis of Ph-positive ET in comparison with cytogenetically normal cases. Conversely, the differences in clinical presentation may be due to other genetic changes.

Polymerase chain reaction for detection of residual leukaemia

The occasional finding of cells positive for the Philadelphia (Ph) chromosome months or years after bone-marrow transplantation for chronic myeloid leukaemia raises the possibility that the Ph-positive clone may never be eradicated. The polymerase chain reaction with probes able to detect the transcript of the bcr/abl hybrid gene at very low levels was used to study marrow cells from seven patients in continuing haematological and cytogenetic remission 5-7 years after allogeneic bone-marrow transplantation for chronic myeloid leukaemia. No evidence of the leukaemic mRNA was found. Thus, it seems that all leukaemic cells were eradicated in these patients and that they are truly cured.

Absence of alternative splicing in bcr-abl mRNA in chronic myeloid leukemia cell lines

The major consequence of the Philadelphia (Ph) translocation in chronic myeloid leukemia (CML) is the formation of a bcr-abl hybrid oncogene encoding a tumor cell-specific protein P210bcr-abl. In contrast to this, in Ph chromosome-positive acute lymphoblastic leukemia (Ph + ALL), a P190bcr-abl can be observed. This P190bcr-abl has been implicated in acute rather than chronic leukemogenesis. Therefore, it can be hypothesized that the transition from chronic to blast phase in CML is accompanied by an alternative splice in the bcr-abl mRNA, which results in a switch of the production of P210bcr-abl into P190bcr-abl. Initial S1 nuclease protection mapping supported this theory. However, this result appears to be based on an artifact in the S1 analysis. By using the polymerase chain reaction we provide evidence for the absence of alternative splicing in bcr-abl mRNA in two CML blast crisis cell lines.

Rearrangement of the breakpoint cluster region and expression of P210 BCR-ABL in a "masked" Philadelphia chromosome-positive acute myeloid leukemia

The Philadelphia (Ph) translocation t(9;22)(q34;q11) occurs frequently in chronic myeloid leukemia (CML) but is less common in acute lymphoblastic leukemia (ALL) and rare in acute myeloid leukemia (AML). In most cases of CML and some cases of Ph+ ALL the protooncogene ABL from 9q34 is translocated to the breakpoint cluster region (bcr) of the BCR gene at 22q11 to form a chimeric gene encoding a novel 210-kd protein (P210 BCR-ABL) with enhanced tyrosine kinase activity. In other patients with Ph+ ALL and Ph+ AML, the breakpoint probably occurs in the first intron of the BCR gene; this results in a smaller chimeric gene which encodes a P190 BCR-ABL. We studied a patient with AML (FAB M6) arising de novo who had a "masked" Ph chromosome in association with extensive karyotypic changes. The leukemic cells initially showed rearrangement of the bcr, presence of a hybrid mRNA, and expression of the P210 BCR-ABL. These changes were absent in remission. These results support the concept that the BCR-ABL chimeric gene plays a crucial role in leukemogenesis but suggest that factors other than the position of the breakpoint in the BCR gene determine the lineage of the target cell for malignant transformation.

bcr-abl oncogene activation in Philadelphia chromosome-positive acute lymphoblastic leukemia

Tumor-specific alterations in oncogenes are thought to play a central role in the development of cancer. An example is the consistent fusion of the bcr gene to the c-abl oncogene on the Ph chromosome in CML. The Ph chromosome can also be observed in ALL. About 50% of Ph+ ALL cases, in contrast to CML, do not exhibit chromosomal breakpoints in the major cluster region or mcr (Ph+ mcr- ALL). These cases may have a novel bcr-abl fusion gene instead. We tested this hypothesis in eight Ph+ mcr- ALL patients by amplifying the putative hybrid part of the bcr-abl cDNA, using the polymerase chain reaction method. All cases examined showed the same joining of the first exon of the bcr gene to the c-abl oncogene. Thus, the novel bcr-abl fusion in Ph+ mcr- ALL is the result of a molecularly distinct Ph chromosome. This allows the definition of Ph+ leukemias by their respective bcr-abl oncogene activation. Moreover, the cDNA amplification method we use is a clinically useful tool to screen for bcr-abl oncogene activations in leukemia patients.

RAS mutations in myelodysplasia detected by amplification, oligonucleotide hybridization, and transformation

Members of the RAS gene family have been implicated in many neoplasms with activating mutations around amino acid positions 12 and 61. We have assessed the mutational activation of H, K, and NRAS in myelodysplasia (MDS) by polymerase chain reaction and hybridization with synthetic oligonucleotide probes. Using this method, point mutations in codons 12/13 and 61 of these RAS genes were detected in 20 of 50 patients including two with refractory anemia with ringed sideroblasts (RARS). Ten normal individuals had no detectable RAS mutations. In 11 instances, DNA from patients with detectable RAS mutations were shown to register in either NIH3T3 focus-forming or nude mouse tumorigenicity assays. In addition, one patient (RARS) was shown to have an activated NRAS gene detected by a tumorigenicity assay and Southern blot analyses. Two MDS patients had mutations detected in two different RAS genes. DNA from one of these patients was observed to give rise to transformants with activated N and HRAS. Two patients with detectable NRAS mutations in the MDS stage progressed to AML and DNA from the AML stage registered positively in a transformation assay with NRAS activation. These results show that RAS mutations can occur at early, as well as late, stages of leukemic progression. The incidence of RAS mutations appears to be significantly higher in CMML than in the other subgroups (p = 0.02).

Activation of Ha-ras in human chronic granulocytic and chronic myelomonocytic leukaemia

DNAs from chronic granulocytic leukaemia (CGL) and chronic myelomonocytic leukaemia (CMML) were assayed for transforming genes by transfection into NIH 3T3 cells. Foci DNA was tagged with a geneticin-resistance cosmid, then followed through a drug selection and tumorigenicity assay. Activated Ha-ras genes, with point mutations at codon 12 (glycine to valine) were subsequently detected. The mutation was detected in the original samples by either MspI/HpaII digestion or polymerase chain reaction (PCR). Although mutations in the ras gene family may occur frequently in leukaemias, these are the first examples of Ha-ras mutations in CGL (blast crisis) and CMML.

An articulation study of 15,255 Seattle first grade children with and without kindergarten

This study attempted to determine articulation differences between two large groups of first grade children—those who did and did not have kindergarten experience. When these two groups entered first grade, their articulation errors were essentially the same. However, kindergarten experience appeared to be a factor in the reduction of sound errors of the children who were not enrolled in speech therapy. Normative data regarding the articulation of first grade children were obtained and compared with that of previous studies.