Voluntary Screening Research Articles

Voluntary STD Testing and Treatment Program at a Metropolitan Correctional Facility

Few studies have addressed challenges of diagnosis and treatment of sexually transmitted diseases (STDs) within correctional facilities. Initiatives that screen all inmates can be cost-prohibitive, while symptom-based screening undoubtedly fails to recognize significant numbers of asymptomatically infected persons. This study discusses a voluntary STD screening and treatment program developed at the Douglas County (Nebraska) Department of Corrections where student volunteers interviewed, screened, and educated 456 inmates. Inmate urine samples and interview responses about risk behaviors and motivators for participation in the screening program were analyzed. The results support the ongoing project method to screen and treat inmates in the community correctional facility. Risk factor analysis suggests that targeted testing and treatment efforts may have a role in providing cost-effective care for STD among the incarcerated population.

Human Papillomavirus (HPV) Infection in Women Participating in Cervical Cancer Screening from 2006 to 2010 in Shenzhen City, South China

Human papillomavirus (HPV) infection plays an important role in the development of cervical cancer, but the prevalence of HPV infection in women of Shenzhen city remains unclear. The present study was performed to describe the change of cervical HPV infection in females who participated in voluntary cervical cancer screening from 2006 to 2010 in Shenzhen city, China. A total of 4, 413 women were recruited. HPV infections were genotyped by polymerase chain reaction (PCR) and reversed dot blot hybridization in Shenzhen Maternity and Child Health Hospital. The prevalence of HPV infection was 13.8%. The five most commonly found HPV types were HPV16 (3.47%), HPV58 (1.68%), HPV33 (1.38%), HPV43 (1.36%) and HPV18 (1.27%). The secular trends of major HPV type-specific were diverse. Among of them, the prevalence of HPV18 increased sharply while others increased slowly or even decreased in the period. The change of total HPV, single HPV and multiple HPV infection were similar during the five years. Our findings suggested that HPV infection is common with HPV16 and HPV 58 as the primary subtypes in women in Shenzhen city. The prevalence of HPV 18 infection is increasing faster than any others, which will lead it to be one of the main subtypes in this city in the future.

P3.351 Congenital Syphilis Prevention In Honduras

<h3>Introduction</h3> Honduras is a Central American country whose priority is the elimination of congenital syphilis in 2015. <h3>Objective</h3> To prevent transplacental transmission of syphilis from mother to daughter/son during the gestational period. <h3>Materials and Methods</h3> Descriptive retrospective analysis from January 2008 to December 2012 in 117 health units without a laboratory from the Preventive Program transmission of syphilis from mother to daughter/son that detects syphilis during pregnancy in attending antenatal women, using rapid tests for free and voluntary screening. <h3>Results</h3> Year 2008 4.950 pregnant women were screened, 10 of them were reactive, with a prevalence of 0.2%, in 2009 7.285 pregnant women were screened of which 17 were reactive with a prevalence of 0.2%, in the year 2010 5.310 pregnant women were screened, 5 out were reactive with a prevalence of 0.09%, in 2011 8.343 pregnant women were screened of which 20 were reactive with prevalence of 0.2% and 2012 9.320 women were screened of which 14 were reactive with a prevalence of 0.1%. <h3>Conclusions</h3> During the five years 66 pregnant women were screened with syphilis, all received treatment with their partners and were followed until delivery, of which 57 (86%) of the children born were free of congenital syphilis, 7 pregnant women have not yet reached the time birth and 1 pregnant woman did not return for follow-up service. Screening for syphilis during pregnancy is key to preventing transplacental transmission of syphilis mother daughter/son The free screening with rapid tests for syphilis in pregnant women in places that do not have clinical laboratories, improved the access and permitted the early capture, and were provided with timely treatment with their sexual partner. Rapid tests for syphilis are essential tool for early diagnosis of congenital syphilis prevention.

English

OBJECTIVES: Voluntary donor selection and screening of donor's blood for infective agents are the cornerstones of transfusion medicine. Donor selection is of paramount importance because infected individuals serve as an asymptomatic reservoir and a potential source of transmission to healthy persons. MATERIALS AND METHODS: During the period of five years (01.01.2008 to 31.12.2012), out of a total number of 14026 healthy voluntary donors, there were 13601 males and 425 were females. Age ranged from 18-60 years. Blood was collected in Citrate Phosphate Dextrose Adenine (CPDA-1) bags. STASTICAL ANALYSIS USED: Data was statistically analysed with statistix 9 software. A p value less than 0.05 was considered significant. RESULTS: The seroprevalence of HIV, HBsAg, HCV and syphilis was 0.25%, 1.42%, 1.10%, 0.62% respectively in total donors. CONCLUSION: This study reflects that blood transfusion is the leading risk factor for spread of the transfusion transmitted infections (TTI), which showed the need and importance of the mandatory screening of these infectious markers in blood donations.

Research and Implementation of Voluntary Screening Algorithm in Online Course Registration System

The algorithm is a key part of the online course registration system. It plays a vital role on the online course registration system to ensure most of issues like fairness, network bottleneck, multi-registration and multi-dropping be solved well. By supporting the registration way of multi-level, multi-category, and multi-willingness, introducing the willingness of students into the calculation of course priority and letting the willingness of students affect the selective probability, it meets the registration requirement maximally and solves the issues well including fake registration number and random registration. This article will introduce the design and implementation of the algorithm.

Our Toxics Regulatory System and Why Risk Assessment Does Not Work: Endocrine Disrupting Chemicals as a Case in Point

Our current toxics regulatory system is based on the fundamental premise that the public expects a high degree of safety -- close to absolute safety -- in the regulation of toxins in our environment. To implement a system based on this fundamental assumption, we assume further that we can use risk assessment to develop health-based safety standards and use command and control regulation to implement them. This Article suggests that the fundamental premise that we can and should develop and apply standards that ensure safety to human health in our toxics regulatory schemes5 has little basis in current political and scientific reality. Politically, human safety is not the true goal of toxics regulation, and scientifically, human safety is not an achievable goal. Rather, politicians obfuscate the true regulatory goal-to regulate toxins so that they present acceptable risk-by using terminology and standards that imply safety. Even if safety were the true goal of toxics regulation, the creation of safety-based standards to regulate toxins is not a particularly practical goal. This Article asserts that, at least as to chemicals that disrupt the human endocrine system-chemicals that have the potential for grave harm to humans-it is not currently feasible to determine exposure levels in the complex and interrelated world in which we live. Second, even if we could determine such levels, we would still face the enormously difficult task of ensuring compliance with these predetermined safe exposure levels. This article specifically highlights the inherent problems with quantitative risk assessment in toxics regulation, as it has been applied to toxic chemicals in general and will likely be applied to endocrine disrupting chemicals. The article ultimately suggests that political and societal honesty is needed in the future regulation of toxic chemicals. Our normative position must be to admit publicly that toxies regulation is not designed to ensure safety to human health, but to regulate toxins so that they present a level of risk that is acceptable to the public. Rather, our goal has been to regulate and manage the risk of toxins so that they present politically acceptable risk. If this regulatory goal were more transparent, the public could realistically assess the current regulatory paradigm, and consider alternatives. I thus suggest a fundamental shift in the philosophy of toxics regulation. Our society must have an open discussion about the dangers of synthetic chemicals and must move toward reducing our overall use and discharge of these chemicals-particularly those suspected of disrupting our endocrine systems. This shift in thinking would force chemical manufacturers to initiate voluntary screening of existing and new chemicals before they are produced and marketed for use and to reduce the overall discharge of chemicals suspected of endocrine disruption. Barring such voluntary action by the chemical industry, the government must make screening for endocrine effects mandatory for new chemicals and must require manufacturers to begin screening existing chemicals for endocrine effects.

Maine Coon renal screening: ultrasonographical characterisation and preliminary genetic analysis for common genes in cats with renal cysts.

The objective of this study was to assess the prevalence of renal cysts and other renal abnormalities in purebred Maine Coon cats, and to characterise these through genetic typing. Voluntary pre-breeding screening programmes for polycystic kidney disease (PKD) are offered for this breed throughout Switzerland, Germany and other northern European countries. We performed a retrospective evaluation of Maine Coon screening for renal disease at one institution over an 8-year period. Renal ultrasonography was performed in 187 healthy Maine Coon cats. Renal changes were observed in 27 of these cats. Renal cysts were found in seven cats, and were mostly single and unilateral (6/7, 85.7%), small (mean 3.6 mm) and located at the corticomedullary junction (4/6, 66.7%). Sonographical changes indicating chronic kidney disease (CKD) were observed in 10/187 (5.3%) cats and changes of unknown significance were documented in 11/187 (5.9%) cats. All six cats genetically tested for PKD1 were negative for the mutation, and gene sequencing of these cats did not demonstrate any common genetic sequences. Cystic renal disease occurs with a low prevalence in Maine Coons and is unrelated to the PKD observed in Persians and related breeds. Ultrasonographical findings compatible with CKD are not uncommon in juvenile Maine Coons.

Clinical Impact and Cost-Effectiveness of Expanded Voluntary HIV Testing in India

BackgroundDespite expanding access to antiretroviral therapy (ART), most of the estimated 2.3 to 2.5 million HIV-infected individuals in India remain undiagnosed. The questions of whom to test for HIV and at what frequency remain unclear.MethodsWe used a simulation model of HIV testing and treatment to examine alternative HIV screening strategies: 1) current practice, 2) one-time, 3) every five years, and 4) annually; and we applied these strategies to three population scenarios: 1) the general Indian population (“national population”), i.e. base case (HIV prevalence 0.29%; incidence 0.032/100 person-years [PY]); 2) high-prevalence districts (HIV prevalence 0.8%; incidence 0.088/100 PY), and 3) high-risk groups (HIV prevalence 5.0%; incidence 0.552/100 PY). Cohort characteristics reflected Indians reporting for HIV testing, with a median age of 35 years, 66% men, and a mean CD4 count of 305 cells/µl. The cost of a rapid HIV test was $3.33. Outcomes included life expectancy, HIV-related direct medical costs, incremental cost-effectiveness ratios (ICERs), and secondary transmission benefits. The threshold for “cost-effective” was defined as 3x the annual per capita GDP of India ($3,900/year of life saved [YLS]), or for “very cost-effective” was <1x the annual per capita GDP ($1,300/YLS).ResultsCompared to current practice, one-time screening was very cost-effective in the national population (ICER: $1,100/YLS), high-prevalence districts (ICER: $800/YLS), and high-risk groups (ICER: $800/YLS). Screening every five years in the national population (ICER: $1,900/YLS) and annual screening in high-prevalence districts (ICER: $1,900/YLS) and high-risk groups (ICER: $1,800/YLS) were also cost-effective. Results were most sensitive to costs of care and linkage-to-care.ConclusionsIn India, voluntary HIV screening of the national population every five years offers substantial clinical benefit and is cost-effective. Annual screening is cost-effective among high-risk groups and in high-prevalence districts nationally. Routine HIV screening in India should be implemented.

There are calls for a national screening programme for prostate cancer: what is the evidence to justify such a national screening programme?

Prostate cancer is the commonest cancer in men and a major health issue worldwide. Screening for early disease has been available for many years, but there is still no national screening programme established in the United Kingdom. To assess the latest evidence regarding prostate cancer screening and whether it meets the necessary requirements to be established as a national programme for all men. Electronic databases and library catalogues were searched electronically and manual retrieval was performed. Only primary research results were used for the analysis. In recent years, several important randomised controlled trials have produced varied outcomes. In Europe the largest study thus far concluded that screening reduced prostate cancer mortality by 20%. On the contrary, a large American trial found no reduction in mortality after 7-10 years follow-up. Most studies comment on the adverse effects of screening - principally those of overdiagnosis and subsequent overtreatment. Further information about the natural history of prostate cancer and accuracy of screening is needed before a screening programme can be truly justified. In the interim, doctors and patients should discuss the risks, benefits and sequelae of taking part in voluntary screening for prostate cancer.

Abstract 2358: Serum biomarkers Carcinoembryonic Antigen (CEA) and Human Aspartyl (Asparaginyl) Beta Hydroxylase (HAAH) compared in normal volunteers, smokers, and stage I/II lung cancer patients.

Abstract Serological biomarkers for detection of cancer are often based upon measuring the ectopic expression of particular proteins that are otherwise only expressed during embryonic development. Perhaps the oldest and best known cancer biomarker in this class is carcinoembryonic antigen (CEA), which despite having some limitations, has been very popular in its longstanding use. We have compared CEA with HAAH (Human Aspartyl (Asparaginyl) beta hydroxylase), an emerging biomarker protein that like CEA has an onco-developmental re-expression pattern in a number of cancers including lung cancer. One of the limitations of CEA that precludes its routine utility for early serological screening and detection of lung cancer is that cigarette smokers, a lung cancer high risk group, frequently have elevated and variable CEA levels compared to normal non-smoking individuals. We compared serum CEA by ELISA (using a commercial kit) with serum HAAH (using Panacea's technology) in 26 individuals each who were either normal, cigarette smokers, or a population of patients with either stage I or II lung cancer. Both assays used a double monoclonal antibody sandwich format, and a peroxidase /TMB detection system with suitable calibration standards . The CEA assay had a simultaneous format, differing from the HAAH ELISA which had a sequential homolgous antibody format. The mean CEA level of smokers (2.7 ng/ mL, range 0.84-6.4) was double that of normal (1.3 ng/ mL range 0.77- 2.4) as expected. Several individuals clustered near or exceeded the cut off of 5ng /mL. More striking was the significant overlap of CEA levels between smokers and the lung cancer patients (&amp;gt;80 %) (whereas &amp;gt; 53% overlap between normals and lung cancer). It is even more striking to observe a 100% overlap between smokers and stage I lung cancer. It's interesting that a similar pattern of HAAH expression was seen between normals and smokers (two times higher). However, both of these groups mostly clustered below a pre-established cutoff of 2 ng/ mL and were scored negative and non-detectable by our acceptance parameters. Comparison of HAAH levels between normals/smokers and lung cancer patients clearly shows a distinction between these groups with 0 % overlap between normals/smokers and cancer patients. The concept of ELISA based serological screening for lung cancer is generally very well received as a cost effective non-invasive potential means for detection. Our early assessment of HAAH levels in smokers indicates that such testing performs favorably when compared to CEA testing in the effective detection of early stage lung cancer. Since cigarette smokers contribute to an overall 87% association with lung cancer, it's more likely that these individuals would be selected for voluntary screening and would therefore benefit from the superior performance of the HAAH ELISA. Citation Format: Mark A. Semenuk, Hossein A. Ghanbari. Serum biomarkers Carcinoembryonic Antigen (CEA) and Human Aspartyl (Asparaginyl) Beta Hydroxylase (HAAH) compared in normal volunteers, smokers, and stage I/II lung cancer patients. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2358. doi:10.1158/1538-7445.AM2013-2358

Take-Home Lead Exposure Among Children With Relatives Employed at a Battery Recycling Facility—Puerto Rico, 2011

The recycling of lead has increased during the past 20 years, with more workers and their families potentially being exposed to lead from recycling facilities, including facilities that recycle lead-acid batteries. During November 2010-May 2011, four voluntary blood lead screening clinics for children of employees of a battery recycling facility in Puerto Rico were conducted. A total of 227 persons from 78 families had blood lead tests. Among 68 children aged <6 years, 11 (16%) had confirmed blood lead levels (BLLs) ≥10 µg/dL, the BLL at which CDC recommended individual intervention to reduce BLLs in 2010, and 39 (57%) children aged <6 years had venous or capillary BLLs ≥5 µg/dL, the reference value for elevated BLLs in children established by CDC in 2012. To determine whether take-home lead exposure contributed to the children's BLLs of ≥10 µg/dL, vehicle and household environmental samples were collected and analyzed. Eighty-five percent of vehicle dust samples and 49% of home dust samples exceeded the U.S. Environmental Protection Agency (EPA) level of concern of ≥40 µg/ft² (430.6 µg/m²) [corrected]. EPA began clean-up of employee homes and vehicles, focusing first on homes with children with BLLs ≥10 µg/dL. EPA also required that the company set up shower facilities, shoe washes, and clean changing areas at the battery recycling facility. Lastly, CDC assigned a case manager to provide education, environmental follow-up, and case management of all children with BLLs ≥5 µg/dL. On average, children's BLLs have decreased 9.9 µg/dL since being enrolled in case management.

Imported malaria: a possible threat to the elimination of malaria from Sri Lanka?

To discuss epidemiological aspects of imported malaria and the potential impact of imported malaria cases reported in Sri Lanka 2008-2011 in terms of a possible resurgence of the disease. The national malaria database was used to assess details regarding country where the infection was possibly acquired, species of Plasmodium, number of days lapsed between disembarkation in Sri Lanka and diagnosis, compliance with national treatment guidelines including percentage of patients followed up as per the national guidelines. After the strengthening of malaria surveillance, during the 4-year period, 152 imported malaria cases were recorded: an increase of 176% in the number of cases. Most of the imported malaria infections were acquired by Sri Lankan Nationals mainly from South Asia, especially India. Plasmodium vivax accounted for 64% of the infections. Approximately 50% of the cases were diagnosed in the Western Province. The average period from disembarkation in Sri Lanka to malaria diagnosis was 3.6days. Patients were managed and treated according to the national guidelines. 82% of the patients were followed up for 28days to ensure parasite clearance. There is a possible increasing risk of re-introduction of malaria to the country from imported cases. Enhanced surveillance activities and the increase in international travel have contributed to an increase in recorded case numbers. There is a need to further strengthen surveillance, especially for monitoring and timely addressing of imported malaria, if the country is to prevent the re-establishment of transmission within. The importance of having an efficient response mechanism to deal with imported malaria is also highlighted.

A High School-Based Voluntary Cardiovascular Risk Screening Program: Issues of Feasibility and Correlates of Electrocardiographic Outcomes

Risk factors for adult cardiovascular events can be identified from the prenatal period through childhood. We performed a cardiovascular risk-screening program in students from grades 9-12 in 7 high schools in Hillsborough County, FL. We obtained blood pressure (BP) measurements and calculated body mass index (BMI) as risk factors for future cardiovascular events as well as obtained an electrocardiogram (ECG) for the purposes of detecting possible life-threatening arrhythmias. Of ~14,000 students contacted, 600 (4 %) participated in the screening. Of these, 517 (86 %) were diagnosed with normal, 71 (12 %) with borderline, and 12 (1 %) with abnormal ECGs. Although no participant had any cardiac history, two of the abnormal ECGs indicated a cardiac diagnosis associated with the potential for sudden cardiac death. Both systolic and diastolic BP increased as the ECG diagnosis moved from normal (115.6/73.8) through borderline (121.0/75.9) to an abnormal (125.0/80.7) diagnosis (all P ≤ .0016). An increase in BMI was only observed when an ECG diagnosis was abnormal (P = .0180). Boys had a greater prevalence (18.97 %) of borderline or abnormal ECGs compared with girls (6.75 %), whereas no discernible differences were seen in ECG diagnosis between white and nonwhite individuals (15.09 and 12.26 %, respectively). Although participation rates were low, a high school-based cardiovascular risk-screening program including ECG is feasible. Although ECG diagnosis tended to be related to other known cardiovascular risk factors (BP, BMI), the utility of an abnormal ECG in adolescence as a predictor of future cardiovascular risk will require further evaluation in more controlled settings.

Factors influencing the decision to participate in medical premarital examinations in Hubei Province, Mid-China

BackgroundTo investigate the attitudes of premarital couples towards the premarital screening program after the abolition of compulsory screening in China and to study the factors influencing participation.MethodsBetween July 1st 2010 to August 31st 2010, 650 people who registered for marriage at the civil affairs bureau of Wuhan, Suizhou, Zaoyang in Hubei province were studied using questionnaires. Logistic regression was used to examine the factors influencing participation in the premarital screening program.ResultsThe premarital screening rate was 34.8% (95% Confidence Interval: 31.0% to 38.5%). Several demographic factors (age, residence, profession), awareness, knowledge, and attitudes towards premarital screening all had significant influence on participation in the premarital screening program.ConclusionsPromotion activities and health education to improve knowledge and attitudes to premarital screening will help increase the rate of voluntary premarital screening.

Screening blood donors for diabetes: analysis of use, accuracy, and cost

The objective was to determine if a free, voluntary diabetes screening program as a part of the blood donation process might be cost-effective. During the first 6 months of the program, 26,415 donors were screened using a single random plasma glucose (RPG) level. All donors were asked to eat before donation. Low-, moderate-, and high-risk groups were formed based on RPG levels (<140, 140-200, and >200 mg/dL). Contact with a telephone questionnaire was made with 139 of 178 (78%) of the persons in the high-risk group with 33 new cases of diabetes diagnosed by the donor's physician and 26 donors indicating that they were not diagnosed with diabetes. Sex- and age-matched donors in the low- and moderate-risk groups were contacted and administered the same questionnaire. The three risk groups were similar, except for body mass index (28.1 ± 5.4 kg/m2 vs. 29.9 ± 5.5 kg/m2 vs. 32.7 ± 5.6 kg/m2 , p < 0.001). The discriminative effectiveness of screening was evaluated by the area under the receiver operating characteristics (AROC) curve. The AROC curve was 0.950 (95% confidence interval, 0.920-0.979) for the identification of diabetes. Using a RPG cutoff of 200 mg/dL, sensitivity was 100%, specificity was 82%, and positive predictive value was 56%. Cost analyses showed that the mean cost to screen, per donor, was less than $1. Cost per case identified was estimated to be less than $500 for a RPG cutoff of 200 mg/dL. Screening during the blood donation process appears to be accurate, convenient, and inexpensive.

The Use of Narcotics and Street Drugs During Pregnancy

All prenatal care providers should offer routine voluntary substance use screening to all patients. Parturients who screen positive for illicit substances require a multidisciplinary team approach to drug rehabilitation and prenatal care. This review will examine the pharmacological properties and the neonatal consequences of the use of opioids and amphetamines. Substance-abusing parturients typically abuse multiple substances simultaneously and have other comorbidities including psychosocial instability and mental illness. These comorbidities must be effectively addressed to achieve optimal health outcomes for both mother and infant.

Screening Legal Claims Based on Third-Party Litigation Finance Agreements and Other Signals of Quality

The advent of third-party litigation finance introduces a new gatekeeper to the legal process. Before deciding to lend money to a plaintiff, a litigation finance company will conduct at least some review and make an assessment of the quality of the case. Since litigation finance loans are generally non-recourse, a litigation finance company is likely to refuse to loan money to plaintiffs with the weakest cases. Such voluntary claim screening may improve social welfare by reducing the incidence of frivolous claims. But the volume of frivolous claims may still be higher than it would be in a world without third-party litigation finance. In particular, third-party litigation finance companies, which lend money to litigants to enable them to pursue cases, might sometimes finance claims that would have a very low probability of prevailing at trial on the assumption that such claims may encourage nuisance settlements. This danger may be greater than when a plaintiff self-finances, because the provision of outside financing may help make credible a threat to proceed to trial in the absence of a settlement. This possibility makes the social welfare consequences of alternative litigation finance an empirical question. Surely, many financed claims will be meritorious, in the probabilistic sense that if the plaintiffs were to receive financing, they would be more likely than not to win at trial. It is uncertain, however, whether the beneficial economic effects of enabling such claims outweigh the negative effects of facilitating claims that courts are highly likely to reject. The answer may vary based on the type of claim or the type of litigation finance arrangement.

HIV/AIDS outbreak investigation in Jalalpur Jattan (JPJ), Gujrat, Pakistan

BackgroundIn June–July 2008 a non-governmental organization (NGO) in Jalalpur Jattan (JPJ), Gujrat, Pakistan arranged two voluntary HIV screening camps after numerous HIV-infected persons reported to their treatment center in Lahore; 88 (35.8%) of 246 persons screened in those camps were positive by rapid test. Intense media coverage made the residents of JPJ hostile to further inquiries. The Pakistan Field Epidemiology Training and Laboratory Training Program (FELTP) was requested by the Provincial AIDS Control Program to carry out an epidemiological investigation. MethodsHIV-positive persons or family members of patients who died of AIDS and consented to be interviewed during the period 15 December 2008 to 2 January 2009 were investigated. Enhanced contact tracing was done to identify additional cases. A structured questionnaire was used to collect data regarding clinical history, risk factors, and HIV knowledge and practices. The national HIV/STI Referral Laboratory collected blood samples for HIV serology and molecular studies independently following pre- and post-counseling. ResultsA total of 53 HIV-infected persons were investigated. Out of these, 47 (88.7%) were alive at the time of investigation and 27 (50.9%) of the cases were female with 6 children aged 10years or less. Median age was 35years (mean 34.7, range 3–70). Most frequent symptoms were unexplained fever 42 (79.2%), diarrhea 34 (64.15%) and skin infections 27 (50.9%); 13 (24.5%) had co-infection with tuberculosis (TB) and 10 (18.9%) with hepatitis (B or C). Use of injections 51 (96.2%), dental procedures 21 (40%) and barber shop visits among males 18 (72%) were common risk factors. Extramarital sex was reported by 4 (9.4%). Only 19 (35.8%) were aware that HIV can be sexually transmitted and 18 (34%) were aware of HIV transmission by blood transfusion. Phylogenetic analysis revealed HIV infection in this group was HIV-1 Subtype A, transmitted over a decade, and the situation is endemic rather than an outbreak. ConclusionThe investigation indicates high rates of HIV infection in JPJ. Unlike other studies from Pakistan, a high proportion of cases in females and children less than 10years of age were observed. Socio-cultural norms and stigmatization limited in-depth investigation of sexual and behavioral practices and history of drug abuse. A shift of HIV infection from high-risk groups to the general population was seen and requires vigilant surveillance besides targeted health education, clinical management, lab facilities for diagnosis and monitoring, and voluntary counseling and testing services to limit disease spread.

The Associations of Arcussenilis with Age and Metabolic Abnormalities

From a voluntary ophthalmic screening program, involving 1876 people, carried out in Columbus, Georgia, 273 (14.6%) were found to have arcussenilis. 973 (51.9%) of the total population screened, were found to have evidence of a high risk of hypertension, hyperglycemia, or hyperlipidemia, and were invited to participate in further assessments. 623 (64.0%) of these high risk subjects, including all of the patients with arcussenilis, agreed to further testing. 70% of the subjects has abnormal BMI, 64% had abnormal blood pressure, and 64% had evidence of abnormal fasting blood sugar, either by elevated fasting blood sugar or Hgb A1c > 6%. A minority had abnormality of LDL cholesterol, HDL cholesterol, or fasting serum triglycerides. Comparisons were then made between the 273 patients who had arcussenilis versus the 350 patients, who did not. Patients, who had arcussenilis has lower BMI values (32.6 ± 0.4 vs. 34.6 ± 0.4 kg/m2, p=0.005) and higher fasting blood sugar (133.6 ± 3.6 vs. 125.7 ± 2.3 mg/ dl, p=0.0488) than those who did not have arcus. By multi-variate analysis, increasing age (p<001), fasting blood sugar (p<0.004), Hgb A1c (p<0.01), systolic (p<0.007) and diastolic (p=0.02) blood pressure, and decreasing BMI (p=0.012) were associated with increasing prevalence of arcussenilis. Fasting LDL cholesterol, HDL cholesterol, LDL/HDL ratios, or serum triglycerides showed no association with the prevalence of arcus. We conclude that hyperglycemia and hypertension, but not hyperlipidemia, are the primary metabolic characteristics associated with the occurrence of arcussenilis, and age appears to have a significant association with the occurrence of arcus. These observations suggest that older individuals, who are found they have arcussenilis, should be screened for evidence of hyperglycemia.

Birth weight predicts both proteinuria and overweight/obesity in a rural population of Aboriginal and non-Aboriginal Canadians

The risk for many chronic diseases appears to be mediated in part by birth weight. Among Aboriginal Canadians, the prevalence of end-stage renal disease and cardiovascular disease risk is disproportionately high, largely because of elevated diabetes prevalence. The relationships between birth weight (and other potential risk factors) and diabetes, hypertension, proteinuria and overweight/obesity were explored in 1439 rural Albertans (Canada), of whom 67.3% were Aboriginal. At voluntary outreach screening programs, demographic and clinical data were measured and recalled birth weights recorded. Statistical modeling using logistic regression was used to evaluate the relationships. In the final adjusted models, associations remained for low birth weight and proteinuria [odds ratio (OR) 2.36; 95% CI 1.24-4.49], as well as for high birth weight and overweight/obesity (OR 1.58; 95% CI 1.00-2.53). These findings emphasize the need to strive for healthy pregnancies, with appropriate weight gains in these and other disadvantaged populations around the world.