Acceptability of prenatal, voluntary HIV counselling and testing and interventions to reduce mother-to-child transmission of HIV infection in rural South Africa.
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AIDS Serodiagnosis↗
Biomedical subjects
D Wilkinson
Publications and source records attributed to D Wilkinson.
Drugs for treatment of Alzheimer's disease.
Alzheimer's disease is already an international problem of enormous significance, with an estimated 500,000 sufferers in the UK alone. There are currently four licensed compounds available for the symptomatic treatment of mild to moderate Alzheimer's disease, yet there is still considerable debate over their effectiveness. A variety of anti-dementia agents affecting the various aspects of the disease are in development and the debate will continue over the potential rationing of such treatments in the future. Drugs developed from the cholinergic and glutamatergic hypotheses will be discussed, and a number of other potential treatments aimed at reducing the oxidative stress and inflammatory response associated with dementia will be reviewed. The arrival of these new treatments for Alzheimer's disease has focused attention on the management of dementia in general and has provided the catalyst for the widespread development of memory clinics to enable proper assessment of patients with dementing disorders, providing hope for both patients and carers.
Alzheimer Disease↗
Establishing a practice based primary care research network. The University Family Practice Network in South Australia.
BACKGROUND: Practice based research networks enable the study of primary care problems in a primary care setting. To be successful, our experience indicates that a network will need to incorporate a number of key components. In South Australia, a University Family Practice Network has been established to undertake primary health care research and teaching and to contribute to the general practice workforce. The University Family Practice Network is composed of five practices and is managed jointly by the Department of General Practice, Adelaide University and the South Australian Centre for Rural and Remote Health, Adelaide University and the University of South Australia. OBJECTIVE: This article details the successful establishment of the University Family Practice Network in the hope of providing a model for other universities who may be interested in setting up a practice based research network. DISCUSSION: The characteristics of this network include fractional academic positions for general practitioners, computerised medical records, location in rural and urban sites, regular meetings and the appointment of a research fellow. A number of benefits have arisen since the network's establishment that will assist its future development and sustainability. These include collocation with allied health services, development of local expertise and workforce support.
Australia↗
Public-private health sector partnerships for STD control in South Africa--perspectives from the Hlabisa experience.
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Developing Countries↗
Effect of removing user fees on attendance for curative and preventive primary health care services in rural South Africa.
User fees are used to recover costs and discourage unnecessary attendance at primary care clinics in many developing countries. In South Africa, user fees for children aged under 6 years and pregnant women were removed in 1994, and in 1997 all user fees at all primary health care clinics were abolished. The intention of these policy changes was to improve access to health services for previously disadvantaged communities. We investigated the impact of these changes on clinic attendance patterns in Hlabisa health district. Average quarterly new registrations and total attendances for preventive services (antenatal care, immunization, growth monitoring) and curative services (treatment of ailments) at a mobile primary health care unit were studied from 1992 to 1998. Regression analysis was undertaken to assess whether trends were statistically significant. There was a sustained increase in new registrations (P = 0.0001) and total attendances (P = 0.0001) for curative services, and a fall in new registrations (P = 0.01) and total attendances for immunization and growth monitoring (P = 0.0002) over the study period. The upturn in demand for curative services started at the time of the first policy change. The decreases in antenatal registrations (P = 0.07) and attendances (P = 0.09) were not statistically significant. The number of new registrations for immunization and growth monitoring increased following the first policy change but declined thereafter. We found no evidence that the second policy change influenced underlying trends. The removal of user fees improved access to curative services but this may have happened at the expense of some preventive services. Governments should remain vigilant about the effects of new health policies in order to ensure that objectives are being met.
Ambulatory Care Facilities↗
Acceptability of the female condom in different groups of women in South Africa--a multicentred study to inform the national female condom introductory strategy.
OBJECTIVES: To assess the acceptability of the female condom to different groups of women and their partners in South Africa. DESIGN: Descriptive, cross-sectional study. SETTING: Multicentre study conducted in five sites. SUBJECTS: The study recruited 678 women from five centres to an acceptability trial of the female condom. Acceptability and successful use varied between the centres. OUTCOME MEASURES: Factors affecting successful use and willingness and intention to use the method again. RESULTS: In total, 209 women used the condom at least once. Discontinuation rates were high, with partner reluctance to try the method as the main reason given for discontinuation at all sites. Women who had previous experience with the male condom or who received a more intensive training session generally found the device easier to use. The main issues concerning women were over-lubrication (27%) and concern that the device was too large (28%). The majority of women said that they would be interested in using the method again (86%) and would recommend it to friends (95%). CONCLUSIONS: Overcoming partner opposition is an important issue to address when introducing the method. The study was used to address the national introductory strategy of the female condom, which began in 1998.
Adolescent↗
Preparing Australian medical students for safe overseas clinical placements in the era of HIV.
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Australia↗
Use of type-specific HSV serology in the management of a 37-year-old woman diagnosed with primary genital herpes.
A 37-year-old woman attended a Genitourinary Medicine Clinic in London, UK, concerned about the reliability of a culture-based diagnosis of genital herpes that she had received while abroad. She was in a longterm monogamous relationship with a partner who recalled no history of genital herpes. She was unsure as to how she had acquired genital herpes and wished to know whether she was newly infected. Typespecific serological testing indicated a true primary herpes simplextype-2 (HSV-2) infection. The patient's partner did not attend the clinic but reported a (negative blood test for herpes) at a clinic elsewhere. No details were provided as to the type of assay used, so the possibility that this result was inaccurate cannot be ruled out. It is possible that he may have been an asymptomatic carrier of HSV (either HSV-2 or both HSV-1 and-2) or had mild unrecognized symptoms of genital HSV. This case highlights the advantages and pitfalls of using a type-specific serological test for the diagnosis of genital herpes and also the need for appropriate counselling. An initial explanation of the significance of the HSV culture result she received abroad may have reduced the patient's anxiety about the reliability of the initial diagnosis.
Adult↗
Spectroscopic study of 1,2-indandione.
This paper describes the spectroscopic study of the new fingerprint reagent, 1,2-indandione, using nuclear magnetic resonance spectroscopy (NMR) and mass spectrometry (MS). When 1,2-indandione is dissolved in methanol, NMR and MS show formation of a hemiketal similar to that proposed for DFO when it is dissolved in methanol. In contrast to DFO where reactivity with amino acids appears to be enhanced by hemiketal formation with alcohol solvents, the reactivity of 1,2-indandione towards amino acids is diminished by hemiketal formation. Alcohols should be avoided in 1,2-indandione formulations.
Alcohols↗
Syndrome packets and health worker training improve sexually transmitted disease case management in rural South Africa: randomized controlled trial.
BACKGROUND: Sexually transmitted diseases (STD) are important co-factors in HIV transmission. We studied the impact of health worker training and STD syndrome packets (containing recommended drugs, condoms, partner notification cards and information leaflets) on the quality of STD case management in primary care clinics in rural South Africa. METHODS: A randomized controlled trial of five matched pairs of clinics compared the intervention with routine syndromic management. Outcomes were measured by simulated patients using standardized scripts, and included the proportion given recommended drugs; correctly case managed (given recommended drugs plus condoms and partner cards); adequately counselled; reporting good staff attitude; and consulted in privacy. RESULTS: At baseline, the quality of STD case management was similarly poor in both groups. Only 36 and 46% of simulated patients visiting intervention and control clinics, respectively, were given recommended drugs. After the intervention, intervention clinics provided better case management than controls: 88 versus 50% (P < 0.01) received recommended drugs; 83 versus 12% (P < 0.005) were correctly case managed; 68 versus 46% (P = 0.06) were adequately counselled; 84 versus 58% experienced good staff attitude (P = 0.07); and 92 versus 86% (P = 0.4) were consulted privately. A syndrome packet cost US$1.50; the incremental cost was US$6.80. The total intervention cost equalled 0.3% of annual district health expenditure. INTERPRETATION: A simple and affordable health service intervention achieved substantial improvements in STD case management. Although this is a critical component of STD control and can reduce HIV transmission, community-level interventions to influence health-seeking behaviour are also needed.
Adolescent↗
Associations between rural background and where South Australian general practitioners work.
OBJECTIVE: To determine the association between rural background on practice location of general practitioners (GPs) (rural or urban). DESIGN: Comparison of data from two postal surveys. SUBJECTS: 268 rural and 236 urban GPs practising in South Australia. MAIN OUTCOME MEASURES: Association between practice location (rural or urban) and demographic characteristics, training, qualifications, and rural background. RESULTS: Rural GPs were younger than urban GPs (mean age 47 versus 50 years, P < 0.01) and more likely to be male (81% versus 67%, P = 0.001), to be Australian-born (72% versus 61%, P = 0.01), to have a partner (95% versus 85%, P = 0.001), and to have children (94% versus 85%, P = 0.001). Similar proportions of rural and urban GPs were trained in Australia and were Fellows of the Royal Australian College of General Practitioners, but more rural GPs were vocationally registered (94% versus 84%, P = 0.001). Rural GPs were more likely to have grown up in the country (37% versus 27%, P = 0.02), to have received primary (33% versus 19%, P = 0.001) and secondary (25% versus 13%, P = 0.001) education there, and to have a partner who grew up in the country (49% versus 24%, P = 0.001). In multivariate analysis, only primary education in the country (odds ratio [OR], 2.43; 95% CI, 1.09-5.56) and partner of rural background (OR, 3.14; 95% CI, 1.96-5.10) were independently associated with rural practice. CONCLUSION: Our findings support the policy of promoting entry to medical school of students with a rural background and provide an argument for policies that address the needs of partners and maintain quality primary and secondary education in the country.
Family Practice↗
Genetic susceptibility to tuberculosis in Africans: a genome-wide scan.
Human genetic variation is an important determinant of the outcome of infection with Mycobacterium tuberculosis. We have conducted a two-stage genome-wide linkage study to search for regions of the human genome containing tuberculosis-susceptibility genes. This approach uses sibpair families that contain two full siblings who have both been affected by clinical tuberculosis. For any chromosomal region containing a major tuberculosis-susceptibility gene, affected sibpairs inherit the same parental alleles more often than expected by chance. In the first round of the screen, 299 highly informative genetic markers, spanning the entire human genome, were typed in 92 sibpairs from The Gambia and South Africa. Seven chromosomal regions that showed provisional evidence of coinheritance with clinical tuberculosis were identified. To identify whether any of these regions contained a potential tuberculosis-susceptibility gene, 22 markers from these regions were genotyped in a second set of 81 sibpairs from the same countries. Markers on chromosomes 15q and Xq showed suggestive evidence of linkage (lod = 2.00 and 1.77, respectively) to tuberculosis. The potential identification of susceptibility loci on both chromosomes 15q and Xq was supported by an independent analysis designated common ancestry using microsatellite mapping. These results indicate that genome-wide linkage analysis can contribute to the mapping and identification of major genes for multifactorial infectious diseases of humans. An X chromosome susceptibility gene may contribute to the excess of males with tuberculosis observed in many different populations.
Adolescent↗
High HIV incidence and prevalence among young women in rural South Africa: developing a cohort for intervention trials.
OBJECTIVE: To measure prevalence and model incidence of HIV infection. SETTING: 2013 consecutive pregnant women attending public sector antenatal clinics in 1997 in Hlabisa health district, South Africa. Historical seroprevalence data, 1992-1995. METHODS: Serum remaining from syphilis testing was tested anonymously for antibodies to HIV to determine seroprevalence. Two models, allowing for differential mortality between HIV-positive and HIV-negative people, were used. The first used serial seroprevalence data to estimate trends in annual incidence. The second, a maximum likelihood model, took account of changing force of infection and age-dependent risk of infection, to estimate age-specific HIV incidence in 1997. Multiple logistic regression provided adjusted odds ratios (OR) for risk factors for prevalent HIV infection. RESULTS: Estimated annual HIV incidence increased from 4% in 1992/1993 to 10% in 1996/1997. In 1997, highest age-specific incidence was 16% among women aged between 20 and 24 years. In 1997, overall prevalence was 26% (95% confidence interval [CI], 24%-28%) and at 34% was highest among women aged between 20 and 24 years. Young age (<30 years; odds ratio [OR], 2.1; p = .001), unmarried status (OR 2.2; p = .001) and living in less remote parts of the district (OR 1.5; p = .002) were associated with HIV prevalence in univariate analysis. Associations were less strong in multivariate analysis. Partner's migration status was not associated with HIV infection. Substantial heterogeneity of HIV prevalence by clinic was observed (range 17%-31%; test for trend, p = .001). CONCLUSIONS: This community is experiencing an explosive HIV epidemic. Young, single women in the more developed parts of the district would form an appropriate cohort to test, and benefit from, interventions such as vaginal microbicides and HIV vaccines.
Adolescent↗
Study of the reaction mechanism of 1,8-diazafluoren-9-one with the amino acid, L-alanine.
This paper describes the study of the reaction between 1, 8-diazafluoren-9-one (DFO) with the amino acid L-alanine in methyl alcohol. Particular interest was paid to the possible role of the solvent which appears to react with the DFO to form a hemiketal that is the reactive species. A potential reaction pathway is proposed based on the current data collected. The reaction intermediates and products were identified by a variety of spectroscopic methods including mass spectrometry (MS), nuclear magnetic resonance (NMR) spectroscopy, and X-ray crystallography.
Alanine↗
Effectiveness of rivastigmine in Alzheimer's disease. Participation in trials should be based on clinical uncertainty, not enforcement.
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Alzheimer Disease↗
Rivastigmine in the treatment of dementia with Lewy bodies: preliminary findings from an open trial.
The objective of this study was to assess the tolerability and efficacy of rivastigmine in a group of patients with probable dementia with Lewy bodies (DLB), using an open label study. Open label treatment was with rivastigmine up to maximum tolerated dose (mean 9.6 mg daily, range 3-12 mg). Eleven patients with DLB, mean age 78.5 years, were treated with this cholinesterase inhibitor. After 12 weeks of treatment, mean Neuropsychiatric Inventory scores fell by 73% for delusions, 63% for apathy, 45% for agitation and 27% for hallucinations. Five of the patients (45%) experienced very significant clinical improvements that had not been achieved with other treatments, including low dose neuroleptics. Medication was well tolerated and parkinsonian symptoms tended to improve. Cholinesterase inhibition may be a safe and effective alternative to neuroleptic treatment in DLB. Such effects may also prove to be applicable to the management of neuropsychiatric symptoms in Parkinson's disease and Alzheimer's disease.
Aged↗