Voluntary Screening Research Articles

Citopatológico de colo uterino entre gestantes no Sul do Brasil: um estudo transversal de base populacional

To determine the prevalence and risk factors associated with failure of voluntary screening for cervical cancer during the gestational period in Rio Grande, Rio Grande do Sul State, Southern Brazil. Previously trained interviewers applied a standardized questionnaire in the maternity to all mothers from this municipality who had delivered from January 1st to December 31st 2010 to obtain information about the demographic characteristics of the pregnant women, family socioeconomic status, and prenatal care received. The χ² test was used to compare proportions and Poisson regression with robust adjustment of variance was used in the multivariate analysis. Among the 2,288 respondents, 33% were not submitted to the Pap smear during pregnancy. Two thirds of these women stated that they were not aware of the need to perform it, 18% were not screened out of fear or shame, and the rest for other reasons. After adjustment, the highest prevalence ratios (PR) for noncompliance with the Pap smear occurred among young women (PR=1.5; 95%CI 1.25 - 1.80), with lower educational level (PR=1.5; 95%CI 1.12 - 2.12), who were living without a partner (PR=1.4; 95%CI 1.24 - 1.62), smokers (PR=1.2; 95%CI 1.07 - 1.39), who did not plan the current pregnancy (PR=1.3; 95%CI 1,21 - 1.61), who had attended less than six medical visits during the prenatal period (PR=1.4; 95%CI 1.32 - 1.69) and among users of oral contraceptives (PR=1.2; 95%CI 1.04 - 1.38). The higher the risk for uterine cervical cancer, the less likely a pregnant woman is to undergo a Pap smear. This definitely contributed to the increased morbidity and mortality from this disease in this setting.

First trimester combined screening for Down′s Syndrome with NT, Free-βhCG and PAPP-A

Objective To explore the sensitivity of using NT, combined with serum biochemical markers (Free-βhCG，PAPP-A) for Down′s Syndrome screening in early stage of pregnancy. Methods Collect pregnant women aged 17-45 years old voluntary antenatal screening in our hospital from March 2009 to October 2010, a total of 11882 cases.Serum Free-βhCG and PAPP-A were measured NT value was determined by ultrasound at 11-13w+6d of gestation.Calculating combined screening (NT, Free-βhCG, PAPP-A), and serum integrated screening (Free-beta hCG, PAPP-A) risk, respectively, using the risk calculation software for the same person. Results Early pregnancy screening was performed in 11 882 patients, 18 had a fetus with Down′s syndrome, a rate of 0.15%.The detection rates of Down′s syndrome in combined screening and serum integrated screening were 83.3% and 72.2% respectively.The specificities were 98.4% and 97.3% and detection efficiency were 7.18%, 3.90% respectively.Areas under the curve (AUCs) of first-trimester combined screening and serum integrated screening were 0.975（95% CI:0.943,1.007）, 0.901 (95% CI:0.789, 1.013) respectively. Conclusion In early stage of pregnancy, combined screening for Down′s syndrome has higher sensitivity and specificity than serological screening, has higher detection rate in the same false-positive rate case, which can effectively reduce the pregnant women to receive invasive puncture.（Chin J Lab Med，2012,35：932-935） Key words: Pregnancy trimester; first; Down syndrome; Prenatal diagnosis; Nuchal translucency measurement

Evaluation of Factors Influencing the Natural History of Nocturia in Elderly Subjects: Results of the Fujiwara-kyo Study

We evaluated the natural history of nocturia and determined factors influencing the incidence or remission of nocturia. Study subjects were 4,427 volunteers 65 years old or older who participated in the Fujiwara-kyo Study. The nocturia prevalence was assessed at baseline and 1 year later. Nocturia incidence and remission rates were calculated and factors influencing these results were evaluated based on characteristics, including gender, age, body mass index, HbA1c, creatinine clearance, life style, comorbidities, depressive status, metabolic syndrome and voiding symptoms. Independent factors were determined by multivariate analysis. Of the 4,427 subjects 3,685 provided complete replies to self-administered questionnaires at baseline and 1 year later. The prevalence of nocturia at baseline and 1 year later was 47.0% and 50.3%, and nocturia incidence and remission rates were 20.0% and 15.4%, respectively. Male gender, high body mass index, voiding symptom deterioration and new onset overactive bladder were independent factors associated with the nocturia incidence. Male gender, sum of the voiding symptoms, age and new onset overactive bladder were independent negative factors associated with nocturia remission. The prevalence of nocturia worsened with time, although nocturia in older subjects progressed dynamically. Male gender, age, body mass index, sum of voiding symptoms, voiding symptom deterioration and new onset overactive bladder influence the natural history of nocturia.

Modelling the Effect of Screening and Treatment on Transmission of HIV/AIDS Infection in a Population

This paper examines the effect of screening and treatment on the transmission of HIV/AIDS infection in a population. A nonlinear mathematical model for the problem is proposed and analysed qualitatively using the stability theory of the differential equations. The effective reproduction number of the normalised model system (3) was obtained by using the next generation operator method. The results show that the disease free equilibrium is locally stable by using Routh Hurwitz criteria at threshold parameter less than unity and unstable at threshold parameter greater than unity. Globally, the disease free equilibrium is not stable due existence of forward bifurcation at threshold parameter equal to unity. Using Lyapunov method, endemic equilibrium is globally stable under certain conditions. However, analysis shows that, screening of unaware HIV infectives and treatment of screened HIV infectives have the effect of reducing the transmission of the disease. Numerical simulation of the model is implemented to investigate the sensitivity of certain key parameters on the voluntary screening and treatment of the screened infectives and full blown AIDS victims.

Prevalence of HPV Infection and Genotype Distribution in Women From Africa Seeking Asylum in Puglia, Italy

HPV type-specific distribution was evaluated in genital samples collected from 151 women from West Africa and Horn of Africa, living in the Asylum Seeker Center in Bari Palese (Italy), undergoing voluntary screening correlated with cytological abnormalities. HPV-DNA was assayed by Linear Array HPV genotyping test. HPV DNA was detected in 39.1 % of the women, 42.5 % of which had multiple infection and 69.5 % had high-risk HPV infection. Age-prevalence rates evidenced a peak of HPV infection in women ≤ 20 years of age (53.1 %). HPV 53 and 16 were the most common viral types (13.5 and 12.0 % respectively). Abnormal Pap test results were found in 4.4 % of women with known cytological result. Although a prevalence of HPV positive women higher in African than in European women was expected, the differing rate between residents and migrants African women must be investigated in future studies.

Effect of Ethnicity on Plasma Levels of proBNP, BNP and NTproBNP in Subjects at Risk for Cardiovascular Disease

Background: B-type natriuretic peptide (BNP), a hormone secreted by the heart in response to cardiac stress, has cardiac unloading, anti-fibrotic and other pleiotropic actions. Given that elevation of plasma BNP is associated with cardiovascular disease and poorer outcomes, a variety of assays have been developed. However, genetic and ethnic factors may influence plasma levels, potentially confounding BNP’s value as a biomarker. Using a diverse population we sought to determine the impact of ethnicity on three forms of BNP, specifically the prohormone proBNP1-108 (the activation of which has been shown to be reduced in some African Americans), BNP1-32 (the most active cleavage product of proBNP), and NTproBNP (the inactive cleavage product of proBNP). Methods: Subjects 45 years and older from Dade County, FL who self-identified as being at cardiovascular risk were recruited during a free, voluntary cardiovascular screening. Ethnicities represented were: Hispanic, Caucasian, and African-American. Detailed echocardiography was performed on all subjects and medical history, physical exam, and blood samples were obtained. ProBNP was measured with a novel assay (BioRad), which uses a capture antibody specific to the cleavage site of proBNP. BNP1-32 was measured with the Shionogi BNP assay, and NTproBNP with the Roche assay. Results: A total of 726 subjects were enrolled: 467 Hispanics, 200 Caucasians, and 59 African-Americans. After adjusting for age gender, BSA, BMI, use of anti-hypertensive medication, blood pressure, renal function, diabetes mellitus, left ventricular dimension and mass and left atrial dimension, NT-proBNP was found to be significantly lower (p50.02) in African Americans than in the other two ethnicities. Ethnicity however did not significantly affect either BNP1-32 or proBNP1-108. Conclusions: Compared to Caucasians, Hispanic and African American ethnicity did not affect levels of proBNP1-108 or BNP. However, African Americans had significantly lower NT-proBNP levels than Caucasians. It remains to be established whether this difference significantly affects test characteristics of NTproBNP as a biomarker. In addition, given that the NTproBNP assay is affected by the glycosylation status of its epitopes on NTproBNP, it should be investigated whether ethnicity affects glycosylation.

Fluoroscopic Screening of Asymptomatic Patients Implanted With the Recalled Riata Lead Family

The Food and Drug Administration recently issued a class I recall of the St. Jude Medical Riata implantable cardioverter-defibrillator lead presumably because of increased risk of electric failure and mechanical separation via inside-out abrasion. We sought to examine the incidence and time dependence of inside-out abrasion in asymptomatic patients implanted with the Riata lead. Asymptomatic patients implanted with the Riata lead at our institution were offered voluntary fluoroscopic screening in 3 views. Electric testing of the Riata lead with provocative isometric muscle contraction was performed at the time of fluoroscopic screening. Of the 245 patients undergoing fluoroscopic screening, 53 (21.6%) patients showed clear evidence of lead separation. Of these externalized leads, 0%, 13%, and 26% had a dwell time of <3 years, 3 to 5 years, and >5 years, respectively (P=0.037). Externalized leads had a significantly pronounced decrease in R-wave amplitude (-1.7±2.9 mV versus +0.35±2.5 mV; P<0.001), and more patients with externalized leads had ≥25% decrease in R-wave amplitude from baseline (28.0% versus 8.1%; P=0.018). One patient with externalization exhibited new noise on near-field electrogram. The Riata lead exhibits time-dependent high rates of cable externalization exceeding 20% at >5 years of dwell time. Externalized leads are associated with a more pronounced decrease in R-wave amplitude, which may be an early marker of future electric failure. The use of fluoroscopic and electric screening of asymptomatic patients with the Riata lead remains controversial in the management of patients affected by the recent Food and Drug Administration recall.

Validation of a rapid lateral flow test for the simultaneous determination of β-lactam drugs and flunixin in raw milk.

β-Lactam antibiotics are the most commonly used drugs on dairy farms. β-Lactam residues in milk are kept out of the human milk supply with good agricultural practices and mandatory truck screening performed by the dairy industry under Appendix N of the Pasteurized Milk Ordinance. Flunixin, a nonsteroidal and anti-inflammatory drug, appears in dairy cattle tissue residues with a frequency similar to the occurrence of penicillin G. This creates concern that flunixin residues could be in milk and would go undetected under current milk screening programs. A single test that combines mandatory β-lactam screening with voluntary flunixin screening is an economical approach for monitoring and controlling for potential flunixin or 5-hydroxyflunixin, the primary flunixin metabolite marker in milk. The objective of this study was to validate a β-lactam and flunixin rapid lateral flow test (LFT) and compare the results obtained with a liquid chromatography-triple quadrupole tandem mass spectrometry (LC-MS/MS) method for the simultaneous determination of flunixin and 5-hydroxyflunixin in raw milk with a limit of detection of , 1 ppb, equivalent to 1 ng/ml. Using the LFT, three combined manufactured lots of test strips detected penicillin G at 2.0 ppb, ampicillin at 6.8 ppb, amoxicillin at 5.9 ppb, cephapirin at 13.4 ppb, ceftiofur (total metabolites) at 63 ppb, and 5-hydroxyflunixin at 1.9 ppb at least 90% of the time with 95% confidence. The LFT also detected incurred flunixin milk samples that were analyzed with the LC-MS/MS and diluted to tolerance in raw milk. The detection levels for the LFT are lower than the U.S. safe levels or tolerances and qualify the test to be used in compliance with U.S. milk screening programs.

Urethritis/Cervicitis Pathogen Prevalence and Associated Risk Factors Among Asymptomatic HIV-Infected Patients in South Africa

To determine sexually transmitted infection (STI) prevalence, and patient characteristics associated with detection of urethritis/cervicitis pathogens, among HIV-infected individuals offered voluntary STI screening at a South African HIV treatment center. Individuals, asymptomatic for genital discharge, were screened for Neisseria gonorrhoeae (NG), Chlamydia trachomatis, Trichomonas vaginalis (TV), Mycoplasma genitalium (MG) infections (real-time polymerase chain reaction assay), for syphilis and herpes simplex type 2 (serologically), and for bacterial vaginosis and Candida (microscopy, women only). Patients' most recent CD4 and viral load results were recorded. Demographic, clinical, and behavioral data were collected by nurse-administered questionnaire. Compared with men (n = 551), women (n = 558) were younger (mean age, 35.0 vs. 37.9 years; P < 0.001), reported more STIs in the past year (65.5% vs. 56.5%; P = 0.002), had more urethritis/cervicitis pathogens detected (21.3% vs.16.4%, P = 0.035), and were less aware of their partner's HIV status (53.1% vs. 62.3%; P = 0.007). The overall prevalence of individual urethritis/cervicitis pathogens was TV (7.6%), MG (6.1%), NG (5.4%), and C. trachomatis (2.1%). Multivariate analysis highlighted 4 significant factors associated with the detection of specific urethritis/cervicitis pathogens, namely female gender (TV, adjusted odds ratio [aOR] 2.53, 95% confidence interval [CI]: 1.47-4.37), having a regular sexual partner in the past 3 months (NG, aOR 2.26, 95% CI: 1.01-5.08), suboptimal condom use with regular partners (TV, aOR 2.07, 95% CI: 1.25-3.42), and a history of genital warts in the past year (NG, 2.25, 95% CI: 1.26-4.03). Asymptomatic urethritis/cervicitis pathogens were highly prevalent in this population. Few urethritis/cervicitis pathogen-associated patient characteristics were identified, emphasizing the need for affordable STI diagnostics to screen HIV-infected patients.

Prevalence of atrial fibrillation in adults participating in a large-scale voluntary screening programme in Belgium

Objective Atrial fibrillation (AF) is a common arrhythmia in clinical practice. AF fulfils many of the criteria for a screening programme. No data about the prevalence of AF in non-hospitalized patients are available in Belgium. The aim of the study was to assess feasibility and effectiveness of a nationwide-organized voluntary screening programme in the general population in Belgium.Methods A total of 13.564 participants were screened, of whom 10,758 were older than 40 years (GSP group). Participants filled in stroke risk stratification questionnaires (CHADS2 and CHA2DS2-VASc). A one-lead electrocardiogram was performed.Results 228 participants had AF at the time of screening (AF group), with 125 women and 103 men (i.e. 1.9% and 2.6% of total women and men), representing a prevalence of 2.2% (95% CI 1.3% and 3.0%) of the screened population. Age of the AF group was 67 ± 12 y (range 40-87 y). Using the CHADS2-score, 58% of participants with a positive AF screening had a high risk score, and 21% had an intermediate risk score. Using the CHA2DS2-VAScscore, 72% of the participants had a high risk score, and 21% had an intermediate risk score.Conclusion AF was present in 2.2% of the respondents. At least 60% of AF group had an increased risk for thrombo-embolism. Although substantial methodological issues limit the exact interpretation of these results, the present study shows that a volunatry screening programme with a simple screening protocol is able to detect an important number of patients with previously undetected AF.

Cost estimation and planning for HIV/AIDS oral healthcare services: a Malaysian experiment

Background Reuters reported that 8400 HIV cases were detected in the voluntary screening of drug addicts in Harm Reduction Programmes, and screening in prison and Narcotics Rehabilitation Centers in 2011. However, dental treatment for HIV inmates is highly constrained by high uncertainty resulting from the changes of epidemic profile after receiving medical treatment, relative inadequacy of dental treatment and rules and regulations. Thus institutional HIV dental care cost could pose challenges to government healthcare expenditure. Methods The marginal cost for dental treatment is estimated based on the case scenario of prison X in Malaysia. Based on literature review and economic reasoning, an integrated cost planning model is formed to address the current needs in cost planning. Results The marginal cost for prison dental treatment is estimated to increase by at least 3 folds for prevalence cases and by at least 7 folds for surveillance case in short run. The cost pyramid is formed with the base of cost-consequences, cost efficiency and cost effectiveness planning followed by cost benefit and financial risk planning at the second layer, and cost utility planning at the peak layer. All cost planning components are integrated vertically and horizontally. Conclusion HIV dental care costs for inmates will be at the expense of government revenue if the increased marginal cost is above the average cost. Therefore, cost estimation coupled with the integrated cost planning model is essential for evaluation, monitoring and budget allocation enhancement.

Clinic-Based Infant Screening for Duchenne Muscular Dystrophy: A Feasibility Study

Purpose. The purpose of this study was to assess the desirability of Duchenne muscular dystrophy (DMD) screening, the effectiveness of the consent process, and the feasibility of conducting DMD screening in a pediatric office. Methods. Infant males who attended a 12-month routine well-child visit at a participating pediatric clinic were screened for DMD. Parents and providers completed post-screening questionnaires to assess their experiences with and attitudes toward screening. Results. A total of 264 male infants were screened for DMD. Approximately 78% of parents indicated support of voluntary DMD screening and 91% of providers were in favor of screening for DMD. About 75% of parents correctly answered three of five questions testing their knowledge of DMD screening. Conclusion. DMD screening is feasible in a pediatric office when conducted as part of a research study. Infant screening for DMD eventually could be offered in pediatric health care provider offices as an optional public health service outside of newborn screening.

The relationship between HIV testing and CD4 counts at HIV diagnosis among newly diagnosed HIV-1 patients in Japan

The aim of this study was to investigate the factors relating to CD4 level at HIV diagnosis and HIV testing behaviour. Participants were newly diagnosed patients (n = 654) in Japan from 2000 to 2005. Around 75% of participants were diagnosed at hospital and clinics. Mean CD4 counts at diagnosis through voluntary HIV testing, screening tests and testing due to concomitant sexually transmitted infection (STI) were 368, 336 and 316 cells/μL, respectively. In contrast, the mean CD4 count where testing was due to the presence of HIV-related clinical symptoms was 151 cells/μL (P < 0.0001). Compared with those diagnosed at their first HIV test, those who had undertaken multiple HIV tests prior to diagnosis showed CD4 counts that increased significantly (P < 0.0001) in relation to the number of tests undertaken: CD4 count at first test was 232 cells/μL, second test 346 cells/μL and third or additional tests 439 cells/μL. According to our results, HIV testing policy that promotes HIV testing in medical settings and among STI patients is needed to facilitate earlier HIV diagnosis in Japan.

Metabolic Health of People Admitted to a Psychiatric Intensive Care Unit in Adelaide, South Australia

Metabolic Health of People Admitted to a Psychiatric Intensive Care Unit in Adelaide, South Australia

Factors Affecting Clinician Educator Encouragement of Routine HIV Testing Among Trainees

Adoption of CDC recommendations for routine, voluntary HIV screening of all Americans age 13–64 years has been slow. One method to increase adherence to clinical practice guidelines is through medical school and residency training. To explore the attitudes, barriers, and behaviors of clinician educators (CEs) regarding advocating routine HIV testing to their trainees. We analyzed CE responses to a 2009 survey of Society of General Internal Medicine members from community, VA, and university-affiliated clinics regarding HIV testing practices. Clinician educators were asked about their outpatient practices, knowledge and attitudes regarding the revised CDC recommendations and whether they encouraged trainees to perform routine HIV testing. Associations between HIV testing knowledge and attitudes and encouraging trainees to perform routine HIV testing were estimated using bivariate and multivariable logistic regression. Of 515 respondents, 367 (71.3%) indicated they supervised trainees in an outpatient general internal medicine clinic. These CEs demonstrated suboptimal knowledge of CDC guidelines and over a third reported continued risk-based testing. Among CEs, 196 (53.4%) reported that they encourage trainees to perform routine HIV testing. Higher knowledge scores (aOR 5.10 (2.16, 12.0)) and more positive attitudes toward testing (aOR 8.83 (4.21, 18.5)) were independently associated with encouraging trainees to screen for HIV. Reasons for not encouraging trainees to screen included perceived low local prevalence (37.2%), competing teaching priorities (34.6%), and a busy clinic environment (34.0%). Clinician educators have a special role in the dissemination of the CDC recommendations as they impact the knowledge and attitudes of newly practicing physicians. Despite awareness of CDC recommendations, many CEs do not recommend universal HIV testing to trainees. Interventions that improve faculty knowledge of HIV testing recommendations and address barriers in resident clinics may enhance adoption of routine HIV testing.

Hormone Replacement Therapy is Associated With a Decreased Prevalence of Peripheral Arterial Disease in Postmenopausal Women

The effect of hormone replacement therapy (HRT) in postmenopausal women on the development of peripheral atherosclerosis remains in question. The goal of this study was to analyze the use of HRT in a large population of postmenopausal women and to determine its association with the prevalence of peripheral arterial disease (PAD). A prospective database of patients who underwent voluntary vascular screening was used. Identification of patients as postmenopausal, and their use of HRT, was based on patient questionnaires. PAD was defined to be present if either lower extremity ankle-brachial index was ≤0.9. Analysis was performed on data from 847,982 postmenopausal women; 433,178 (51.1%) reported having used HRT. HRT subjects were slightly older than patients who had not used HRT (64.5 years vs. 63.6 years). Caucasian women were significantly more likely to have used HRT than non-Caucasian women (52.4% vs. 47.6%). HRT subjects were significantly more likely to have smoked cigarettes (42.8% vs. 40.6%), to have hypertension (47.9% vs. 45.1%), and to have hypercholesterolemia (55% vs. 51.5%) than women who had not used HRT (all P < 0.001). However, HRT subjects were significantly less likely to have diabetes mellitus (8.6% vs. 10.2%, P < 0.001). Despite the increased prevalence of several atherosclerotic risk factors among women who used HRT, they were significantly less likely to have PAD (3.3% vs. 4.1%, P < 0.001). Multivariate analysis adjusting for age, race, and medical comorbidities that predispose toward the development of atherosclerosis confirmed that HRT was independently associated with a decreased risk of PAD (odds ratio: 0.8, 95% confidence interval: 0.78-0.82). In subsets of postmenopausal women with known atherosclerotic risk factors, the significant effect of HRT on the prevalence of PAD was maintained; in women with either a smoking history, hypertension, hypercholesterolemia, diabetes, or age of ≥70 years, the odds ratio of HRT use with regard to PAD remained approximately 0.8. The use of HRT in postmenopausal women appears to be associated with a significant reduction in the prevalence of PAD in this population-based study. This association appeared to be significant even in postmenopausal women with known atherosclerotic risk factors. These observational data may suggest a relationship between HRT and the prevalence of PAD that has not been the specific subject of previous randomized prospective studies.

Caregiver opinions about fragile X population screening

PurposeWe sought to determine caregiver perceptions about population screening for fragile X and to examine factors potentially associated with support for screening. MethodsWe asked 1,099 caregivers of a child with fragile X syndrome or a fragile X carrier to rate whether free, voluntary screening should be offered preconception, prenatally, neonatally, or when problems occur. Caregivers chose a preferred time for screening, reported whether screening would affect parent–child bonding, indicated preferences for carrier detection, and gave reasons for their choices. ResultsCaregivers endorsed all forms of screening, but prenatal screening was less strongly endorsed than preconception or postnatal screening. Most (79%) preferred preconception carrier testing, allowing more options when making reproductive decisions. Most thought that screening should also disclose carrier status and believed a positive screen would not negatively affect parent–child bonding. Maternal education, caregiver depression, family impact, and severity of disability were not associated with screening opinions, but parents who only had carrier children were less likely to endorse prenatal screening. ConclusionCaregivers of children with fragile X widely endorse screening. However, because different parents will make different choices, screening may need to be offered at multiple times with careful consideration of consent and informed decision-making.Genet Med 2012:14(1):115–121.

Prevalence of HIV, Hepatitis B, Hepatitis C and Syphilis in donor’s blood: A study from eastern part of India

Objectives: Voluntary donor selection and screening of donor’s blood for infective agents are the cornerstones of transfusion medicine. Strict donor selection criterion, proper counselling and deferred collection may reduce wastage of resources. Materials and Methods: During the period of 01.01.2007 to 31.12.2008, a total number of 44,173 units of blood were collected from healthy voluntary donors. There were 39,734 males and 4,439 were females with a ratio of 9:1. Age ranged from 18-60 years. Blood was collected CPDA-1 bags. Discussion: All blood samples were tested for HIV I & II, Hepatitis B surface Antigen, Hepatitis C and VDRL (Reagin) for Syphilis. It was observed that 283 tested positive for HIV (0. 64%), 1001 were positive for HbsAg (2.27%), 717 were positive for HCV (1.62%) and 577(1.31%) were Reagin (VDRL) positive. Total 2,578 Units (5.8%) of blood were discarded due to presence of infective agents. There was a significant increment in HbsAg prevalence among blood donors from 2007 to 2008. Conclusion: Strict quality control, proper counselling of donors and training of blood transfusion personnel including deferring of suspected donors may help wastage of huge resources and reduce inventory.

Prevalence of positive tuberculosis skin tests during 5 years of screening in a Swiss remand prison

Tuberculosis (TB) screening in prisons is recommended, but the appropriate methods remain controversial. Studies evaluating screening in remand prisons are scarce. Between 1997 and 2001, voluntary screening based on the tuberculin skin test (TST) was offered to all prisoners on entry into the largest remand prison in Switzerland. Prisoners with positive results underwent chest X-rays. We analysed this information collected in an anonymous database. A total of 4890 prisoners entered the prison and were eligible for screening; 3779 (77.3%) had TST performed on average 9 days after arrival: 46.9% were positive (induration ≥ 10 mm). Positive TST rates were similar over the 5 years. Women were more likely to have a negative TST (60.4%) than men (47.7%; P < 0.001, Pearson's (2) 16.5). Positive TSTs varied according to the prisoner's country of origin (64% for sub-Saharan Africa, 57% for Eastern Europe, 56% for North Africa, 51% for Asia and 34% for North and West Europe). The percentage of TST-positive subjects was high, and most did not receive preventive treatment for latent TB. The usefulness of systematic TST for all prisoners on entry is limited, as diagnosis of TB disease usually remains the priority in prisons.

Pregnancy Rate and Outcome in Swedish Women With Turner Syndrome

The rate of spontaneous pregnancies in women with Turner syndrome (TS) is low (2% to 5%). Oocyte donation is an option for these women and enables many to become pregnant. Some investigators question the use of pregnancy induction in TS because of the high risk for aortic dissection or other serious cardiac events. A cardiac evaluation is recommended before pregnancy is planned in TS. Among patients with TS who use their own oocytes to become pregnant, 45% suffered a miscarriage. The aim of this study was to assess pregnancy rate and outcome in a population of Swedish women with spontaneous pregnancies or who were induced using donated oocytes. Cytogenetic karyotype also was examined; mosaicism was defined as the presence of more than 5% 46, XX cells. The study subjects were 482 women with TS who had participated in a voluntary screening program conducted at Swedish Turner Centers. Among the 482 women with TS, 57 (12%) had pregnancies, including spontaneous pregnancies. The live-born rate was 67 of 124 (54%). The patient's own oocytes were used in 27 (47%) of the pregnancies and oocyte donation in 30 (53%) of pregnancies. Spontaneous pregnancies occurred in 23 of 57 women (40%) with TS. Most pregnancies using the patient's own oocytes occurred in those with 45, X/46, XX mosaic karyotype. The miscarriage rate was 26% after oocyte donation and 45% with the use of the patient's own oocytes. Five liveborns (7%) had birth defects or a serious illness; 4 of these were born after spontaneous pregnancies. Only 1 live-born had coarctation of the aorta.