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Biomedical subjects

R C Bailey

Publications and source records attributed to R C Bailey.

At least 19 recordsLinked to original sources
PubMed2002

The acceptability of male circumcision to reduce HIV infections in Nyanza Province, Kenya.

Compelling epidemiological evidence showing a significant association between lack of male circumcision and HIV infection has prompted calls for consideration of male circumcision interventions as a strategy for reducing HIV prevalence in highly affected areas where circumcision is little practiced and transmission is predominantly heterosexual. Little is known about whether male circumcision interventions would be acceptable or feasible in traditionally non-circumcisng areas of Africa. This study assesses the acceptability of male circumcision in the Luo, a large, traditionally non-circumcising ethnic group in western Kenya. Separate focused group discussions with adult Luo men and women and semi-structured interviews with clinicians were conducted in Nyanza Province, Kenya. The primary barriers to acceptance of male circumcision were cultural identification, fear of pain and excessive bleeding and cost. The main facilitators were association of male circumcision with better hygiene and reduced risk of infection. Both men and women were eager for promotion of genital hygiene and male circumcision, and they desired availability of circumcision clinical services in the Province's health facilities. Clinicians lacked the knowledge and resources to offer safe circumcision counselling and services. If results from this study are valid for other areas of sub-Saharan Africa, acceptability of male circumcision as a means to reduce STDs and HIV is higher than previously suspected. Further studies are needed in other regions to assess the feasibility of introducing acceptable male circumcision information and services to reduce HIV transmission.

Adolescent↗
PubMed2001

Eight hundred-year-old human remains from the Ituri tropical forest, Democratic Republic of Congo: the rock shelter site of Matangai Turu Northwest.

Little is known about human prehistory in the central African lowland tropical forest due to a paucity of archaeological evidence. Here we report results from our archaeological investigations of a late Holocene site in the northeast Congo Basin, with emphasis on a single skeleton from the rock shelter site of Matangai Turu Northwest, in the Ituri Forest, Democratic Republic of Congo. The skeleton dates from approximately 810 BP (1235 calibrated AD) and is associated with Later Stone Age lithics, animal bone and shell remains from wild taxa, fruit endocarps from forest trees, phytoliths from tropical forest plants, Late Iron Age ceramics, and a single iron artifact. Phytolith analysis indicates that the habitat was dense tropical forest, without evidence of domesticated food.

Adult↗
PubMed2001

Male circumcision and HIV prevention: current knowledge and future research directions.

Over the past decade, numerous epidemiological studies have reported a significant association between lack of male circumcision and risk for HIV infection, leading to recommendations for male circumcision to be added to the armamentarium of effective HIV prevention strategies. We review the epidemiological data from studies that have investigated this association, including ecological, cross-sectional/case-control, and prospective studies. We discuss problematic issues in interpreting the epidemiological data, including the presence of other sexually transmitted infections, age of circumcision, and potential confounders such as religion, cultural practices, and genital hygiene. In addition, we review studies of biological mechanisms by which the presence of the foreskin may increase HIV susceptibility, data on risks associated with the circumcision procedure, and available data on the acceptability and feasibility of introducing male circumcision in societies where it is traditionally not practised. Although the evidence in support of male circumcision as an effective HIV prevention measure is compelling, residual confounding in observational studies cannot be excluded. Taken together with concerns over the potential disinhibiting effect of male circumcision on risk behaviour, and safety of the circumcision procedure, randomised trials of male circumcision to prevent HIV infection are recommended. An individual's choice to undergo male circumcision or a community's decision to promote the practice should be made in the light of the best available scientific evidence. More knowledge is required to assist individuals and communities in making those decisions. We conclude with recommendations for future research.

Age Factors↗
PubMed2000

Complications of tube thoracostomy in trauma.

OBJECTIVE: To assess the complication rate of tube thoracostomy in trauma. To consider whether this rate is high enough to support a selective reduction in the indications for tube thoracostomy in trauma. METHODS: A retrospective case series of all trauma patients who underwent tube thoracostomy during a 12 month period at a large UK teaching hospital with an accident and emergency (A&E) department seeing in excess of 125,000 new patients/year. These patients were identified using the hospital audit department computerised retrieval system supplemented by a hand search of both the data collected for the Major Trauma Outcome Study and the A&E admission unit log book. The notes were assessed with regard to the incidence of complications, which were divided into insertional, infective, and positional. RESULTS: Fifty seven chest drains were placed in 47 patients over the 12 month period. Seven patients who died within 48 hours of drain insertion were excluded. The commonest indications for tube thoracostomy were pneumothorax (54%) and haemothorax (20%); 90% of tubes were placed as a result of blunt trauma. The overall complication rate of the procedure was 30%. There were no insertional complications and only one (2%) major complication, which was empyema thoracis. CONCLUSION: This study reveals no persuasive evidence to support a selective reduction in the indications for tube thoracostomy in trauma. A larger study to confirm or refute these findings must be performed before any change in established safe practice.

Adult↗
PubMed1999

Sexual behaviors and other HIV risk factors in circumcised and uncircumcised men in Uganda.

OBJECTIVE: To study the differences in sexual practices, hygienic behaviors, and other HIV risk factors between circumcised and uncircumcised men. DESIGN: A cross-sectional study of men >17 years of age selected by single stage cluster sampling in the Industrial Borough, Mbale, Uganda. METHODS: Using a structured questionnaire, 188 circumcised and 177 uncircumcised consenting Ugandan men were interviewed in one of four native languages during April and May, 1997. RESULTS: Among non-Muslims, circumcised men had a higher risk profile than uncircumcised men in that they were more likely to drink alcohol in conjunction with sex (odds ratio [OR], 1.86: 95% confidence interval [CI], 1.09-3.16), to have sexual contacts with women on the first day of meeting (OR, 2.37; 95% CI, 1.39-4.04), to have had sexual contacts in exchange for money or gifts (OR, 2.08; 95% CI, 1.21-3.09), to have experienced episodes of pain on urination or to have experienced penile discharge (OR, 1.68; 95% CI, 1.07-2.64), had an earlier age at sexual debut (15.7 versus 16.9 years), and had more extramarital sex partners in the last year (1.13 versus 0.62). Circumcised men also reported a preference for nonwet sex. Muslims generally had a lower risk profile than other circumcised men except they were less likely to have ever used a condom (OR, 0.34; 95% CI, 0.15-0.78) or to have used a condom during the last sex encounter (OR, 0.37; 95% CI, 0.14-0.87). CONCLUSIONS: These results suggest that differences between circumcised and uncircumcised men in their sex practices and hygienic behaviors do not account for the higher risk of HIV infection found among uncircumcised men. Further consideration should be given to male circumcision as a prevention strategy in areas of high prevalence of HIV and other sexually transmitted diseases. Studies of the feasibility and acceptability of male circumcision in traditionally noncircumcising societies are warranted.

Adult↗
PubMed1999

Women's strategies to alleviate nutritional stress in a rural African society.

Many agricultural populations are subject to chronic or seasonal undernutrition, reproductive women and children often being most vulnerable. This paper presents quantitative and qualitative data on food consumption, food distribution practices, food taboos, garden sizes and work effort to show how Lese horticulturalist women living in the Ituri Forest of northeast Democratic Republic of Congo attempt to alleviate nutritional stress. The Lese experience an annual hunger season when approximately one quarter of the population suffer from energy deficiency. Nutritional intake is also compromised by a complex system of food taboos against meat from wild forest animals. Anthropometric data collected over several years suggest that Lese women suffer from nutritional stress more than men during the hunger season. They also have more food taboos particularly during pregnancy and lactation. Their low fertility is compounded by nutritional stress. Despite these inequities, Lese women use several strategies to improve their food intake. Since they are responsible for all household cooking, they manipulate food portions. During the hunger season, they snack frequently, and increase their consumption of palliative foods. Women with more food taboos plant larger gardens to supplement their diet with vegetable foods. Although this results in their consumption of more daily protein, they work harder compared to women with smaller gardens. Women cheat in their adherence to specific food taboos by actively discounting them, or by eating prophylactic plants that supposedly prevent the consequences (usually illness) of eating tabooed foods. In addition, women resort to subterfuge to access desirable resources. Lese women do not reduce work effort during the hunger season, but adapt physiologically by reducing resting metabolic rates during periods of weight loss. These results point to the ability of Lese women to minimize the ecological and cultural constraints on their nutrition. More data, however, are required to assess the long-term effectiveness of these strategies.

Adult↗
PubMed1999

Growth of children according to maternal and child HIV, immunological and disease characteristics: a prospective cohort study in Kinshasa, Democratic Republic of Congo.

BACKGROUND: Most HIV-infection in children occurs in sub-Saharan Africa where antiretroviral therapy is seldom available. This study compares the growth progression and retardation of HIV-infected and uninfected children in the Democratic Republic of Congo (formerly Zaire). It estimates the risk for child growth retardation according to child and maternal immunological factors, severity of maternal and child illness, and maternal socioeconomic and marital status. METHODS: In a prospective cohort study of 258 children born to HIV seropositive mothers and 256 children of seronegative mothers in Kinshasa, Congo, the growth in length, weight, and weight-for-length of infected children (n = 68), uninfected children born to seropositive mothers (n = 190), and uninfected children born to uninfected mothers (n = 256) was compared. Serological, anthropometric and other clinical measures were collected monthly from 3-12 months and bi-monthly during the second year of life. Polymerase chain reaction for HIV was performed on bloods drawn at 2 days and 3 months post partum. Length-for-age, weight-for-age, and weight-for-length mean z-scores against National Center for Health Statistics (NCHS) reference data were calculated, and Cox proportional hazards models were used to estimate the risk of falling below -2.00 z-scores as a function of child and maternal immunological, clinical and sociodemographic variables. RESULTS: There was no difference in mean length-for-age at birth between HIV-infected (Group 1) children, uninfected children of infected mothers (Group 2) or Control children, but by 3 months old, HIV-infected children were shorter than both Group 2 and Controls. In weight-for-age and weight-for-length, Group 1 infants were lighter and more wasted at birth and onwards. Group 2 newborns were lighter than Controls at birth, but by three months they had caught up to Controls in both length and weight and remained the same as Controls thereafter. The odds of falling below -2.00 z-scores by 20 months for length, weight, and weight-for-length for HIV-infected children compared to uninfected children were 2.10, 2.84, and 2.56 respectively. Both HIV-infection and associated illnesses were factors associated with child stunting, underweight and wasting. The mother's age, socioeconomic status, presence of father, stage of illness and immune status had no detectable effect on the child's growth in the first two years of life. CONCLUSION: The HIV-infected children in Congo with no access to antiretroviral therapy were stunted, underweight, and wasted compared to same age uninfected children. Both HIV infection and HIV-associated signs and symptoms, not maternal immunological or socioeconomic circumstances, placed children at risk for growth retardation.

Adult↗
PubMed1998

'Best clinical practice': assessment of processes of care and of outcomes in the US Military Health Services System.

The National Quality Management Program of the Military Health Services System of the United States has undertaken a series of projects whose objective is the active, on-going monitoring and improvement of the effectiveness and efficiency of the care provided to a broad population that encompasses troops on active duty, retirees and dependents. The analytic activities consist of (1) identification by clinical panels of conditions and procedures of interest; (2) collection of data from electronic repositories and from charts to characterize the patients, how they are managed, the clinical outcomes they experience, the resource costs their care entails, and, from questionnaires, their functional status and level of satisfaction, and (3) generation of 'report cards' that inform organizational units down to the level of the hospital of the characteristics of their patients, their practices, and the risk-adjusted outcomes they achieve. The patterns of care employed by the hospitals that obtain the best risk-adjusted outcomes and resource utilization ('best clinical practice') are identified and made known. In addition, (4) a systematic process of developing outcomes-based practice guidelines has been devised. It intent is to serve as a decision-support tool for clinicians. Initial estimates have been obtained of the probable consequences of the application of this tool to operative interventions in childbirth. Use of the tool would result in a higher occurrence of elective Caesarean sections, a reduced rate of emergency Caesarean sections and much lower use of forceps, with an overall improvement in outcomes and lower resource costs. This program is currently in the early phases of implementation. The two principal requirements for the immediate future are (1) education of the clinical and administrative communities in the use of the data and the decision-support tools and (2) evaluation of the consequences of the use of the data by the clinical and administrative communities.

Benchmarking↗
PubMed1998

Male circumcision: assessment of health benefits and risks.

OBJECTIVES: Globally approximately 25% of men are circumcised for religious, cultural, medical, or parental choice reasons. However, controversy surrounds the procedure, and its benefits and risks to health. We review current knowledge of the health benefits and risks associated with male circumcision. METHODS: We have used, where available, previously conducted reviews of the relation between male circumcision and specific outcomes as "benchmarks", and updated them by searching the Medline database for more recent information. RESULTS: There is substantial evidence that circumcision protects males from HIV infection, penile carcinoma, urinary tract infections, and ulcerative sexually transmitted diseases. We could find little scientific evidence of adverse effects on sexual, psychological, or emotional health. Surgical risks associated with circumcision, particularly bleeding, penile injury, and local infection, as well as the consequences of the pain experienced with neonatal circumcision, are valid concerns that require appropriate responses. CONCLUSION: Further analyses of the utility and cost effectiveness of male circumcision as a preventive health measure should, in the light of this information, be research and policy priorities. A decision as to whether to recommend male circumcision in a given society should be based upon an assessment of the risk for and occurrence of the diseases which are associated with the presence of the foreskin, versus the risk of the complications of the procedure. In order for individuals and their families to make an informed decision, they should be provided with the best available evidence regarding the known benefits and risks.

Circumcision, Male↗
PubMed1997

Hereditarian scientific fallacies.

Some have recently declared that a hereditarian or more balanced approach has triumphed over environmentalism as an explanatory tool for variation in the cognitive ability and behaviour of humans. However, the entire debate is constrained by several fallacies described here. Heritability of a trait, does not predict the effect of environmental or genetic changes on the trait (Fallacy #1), so knowing heritability does not assist in writing prescriptions for societal ills or budget cuts. Heritability estimates themselves are inaccurate, given the potential for gene-environment covariance and interaction, as well as other non-additive effects on behavior or cognitive ability (Fallacy #2). The 'revolution in molecular genetics' has provided more effective tools for describing the genome, but doesn't permit separation of gene and environmental effects on traits (Fallacy #3). If we were able to measure heritability accurately, it would give us absolutely no indication of whether or not group differences are genetically based (Fallacy #4). Finally, any proposed models of the evolutionary divergence of human groups must more adequately answer the basic questions of such a study, and are not supported by high heritability in present populations (Fallacy #5). Humans are not and should never be exposed to artificial selection and crossing experiments, so behavior geneticists will continue to be very limited in their ability to partition the effects of genes, the environment, and their covariance and interaction on human behavior and cognitive ability.

Biological Evolution↗
PubMed1996

Allometry and adaptation of body proportions and stature in African pygmies.

We have analyzed the growth allometry of external body proportions in Efe pygmies from Zaire and combined these data with values from the literature for comparable dimensions in adult pygmies and nonpygmies. We sequentially tested the hypotheses that adult proportion differences between 1) male vs. female Efe, and 2) pygmies vs. nonpygmies result from ontogenetic scaling, or the differential extension of common patterns of growth allometry. Results indicate an almost complete concordance of allometric trajectories for male and female Efe. These preliminary analyses also strongly suggest that adult nonpygmy Africans generally differ from pygmies in their terminal size and correlated allometric consequences, rather than in more fundamental alterations of underlying patterns of growth. Biacromial diameter emerges as the measurement most likely to depart from this general pattern. These results provide further evidence that shifts in systemic growth hormones yielding differences in terminal overall body size may be accompanied by global and coordinated allometric transformations. Certain proportion differences previously interpreted by some as specific evidence of primitive retention in pygmies in fact reflect simple growth allometric correlates of the derive rapid size decrease in these groups. Selected divergent body proportions characterizing adult pygmies, previously interpreted by some as independent evidence of climatic adaptation, also reflect such allometric correlates of ontogenetic scaling. We critically assess arguments that the small overall body size of pygmies was specifically selected for reasons of thermoregulatory efficiency, and consider an alternative or complementary scenario, based on selection for small size in order to reduce caloric requirements.

Adaptation, Physiological↗
PubMed1996

IGF-I resistance in virus-transformed B-lymphocytes from African Efe Pygmies.

To investigate IGF-I resistance in African Efe Pygmies, we examined clonal responsiveness to IGF-I in Epstein-Barr virus-transformed B-lymphocytes from three Efe Pygmies and three American control subjects. The Efe B-lymphoblasts did not increase clonal responsiveness when incubated with IGF-I (as high as 250 micrograms/liter) in contrast to the control B-lymphoblasts which showed a bimodal dose-response with a maximal stimulation of 50% above baseline. The proliferative response of Efe B-lymphoblasts was similar to that of control B-lymphoblasts when incubated with another growth factor, phorbol 12-myristate 13-acetate, which does not activate the IGF-I receptor. These findings indicate that Efe Pygmy B-lymphoblasts are resistant to IGF-I as measured by in vitro clonal proliferation assays. Coupled with our previous report of IGF-I unresponsiveness in Efe Pygmy HTLV-II-transformed T-lymphocytes, these data suggest that IGF-I resistance is generalized and may play a central role in the etiology of short stature in this population.

Adult↗
PubMed1996

IGF-I does not mediate T-lymphoblast colony formation in response to estradiol, testosterone, 1,25(OH)2 vitamin D3, and triiodothyronine: studies in control and pygmy T-cell lines.

The mechanism by which estradiol, testosterone, 1,25(OH)2 vitamin D3, and triiodothyronine promote tissue growth is unknown, although, in some tissues, a role for local IGF-I has been suggested. We previously showed that HTLV-II-transformed T-cell lines from healthy adults augmented basal colony formation in response to peptide (growth hormone, parathormone, and adrenocorticotrophin) and glycoprotein (thyroid-stimulating hormone) hormones through stimulation of local IGF-I. T-cell lines from African Efe Pygmies, however, were resistant to the direct growth-promoting action of IGF-I, as well as to the growth-promoting action of growth hormone, parathormone, adrenocorticotrophin, and thyroid-stimulating hormone. We, therefore, used these cell lines to determine the mechanism of T-cell growth in response to steroid and thyroid hormones. We quantified colony formation of American control T-cell lines in the presence and absence of alpha IR-3 antibody against the type 1 IGF receptor and Pygmy T-cell lines in response to estradiol (36.7-1835 pmol/ liter), testosterone (34.7-17,350 pmol/liter), 1,25(OH)2 vitamin D3 (2.4-24,000 pmol/liter), and triiodothyronine (1536-192,000 pmol/liter). There were no statistically significant differences by ANOVA in overall response curves for any of the four hormones comparing control clonal responses in the presence or absence of alpha IR-3 and no statistically significant difference in overall responsiveness between control and Pygmy T-cell lines. From these data, we conclude that (i) normal T-cell lines grow in response to estradiol, testosterone, 1,25(OH)2 vitamin D3, and triiodothyronine; (ii) these responses are not mediated through local IGF-I since they are not blocked by pretreatment with antibody to the type 1 IGF receptor; and (iii) Pygmy T-cell lines, which are genetically resistant to IGF-I, grow equivalently to control T-cell lines in response to estradiol, testosterone, 1,25(OH)2 vitamin D3, and triiodothyronine, further underscoring the IGF-I independence of this stimulation in our system.

Analysis of Variance↗
PubMed1996

Design and application of a low-temperature Peltier-cooling microscope stage.

A light microscopy system has been designed for freezing and lyophilization studies of protein pharmaceuticals. The system consists of a cascade of four Peltier thermoelectric modules in the lyophilization cell to freeze samples to -60 degrees C, controllers to regulate temperature and pressure conditions, and a video camera to record the events under study. Specific demonstration of the system was conducted using recombinant CD4-IgG and human growth hormone (hGH) as model proteins. Observations of recrystallization during warming of frozen CD4-IgG solution and lyophilization of hGH solution are discussed. These examples demonstrate that the system is a useful tool for the fundamental understanding of freezing and lyophilization of protein pharmaceuticals.

CD4 Antigens↗
PubMed1996

Decreased insulin-like growth factor I receptor expression and function in immortalized African Pygmy T cells.

Efe Pygmies of northeast Zaire have the shortest mean adult stature of any population on earth. Although various alterations in the GH/insulin-like growth factor I (IGF-I) axis have been suggested, the basis for short stature in the Pygmy is unknown. We previously described IGF-I unresponsiveness in a T lymphoblast cell line derived from an Efe Pygmy, and studies in five additional lines have confirmed severe IGF-I resistance in these cells. We have now performed experiments to determine the molecular basis for the IGF-I resistance in these cells. We found markedly decreased cell surface expression of IGF-I receptors with normal ligand binding affinity. The Pygmy IGF-I receptors were not autophosphorylated and did not transmit a signal in response to physiological concentrations of IGF-I. There was a substantially decreased level of IGF-I receptor messenger ribonucleic acid in the Pygmy cells with a normal messenger ribonucleic acid half-life. The nucleotide sequence of the full-length IGF receptor complementary DNA in Pygmy 1 showed no significant variation. These results indicate decreased IGF-I receptor gene transcription and IGF-I receptor signaling as the primary variation in the Pygmy cell lines. The findings point to the IGF-I receptor as the locus governing short stature in the African Pygmy and suggest that human stature may be genetically controlled by expression of the IGF-I receptor.

Base Sequence↗