Lay perceptions of predictive testing for diabetes based on DNA test results versus family history assessment: a focus group study

<p>Abstract</p> <p>Background</p> <p>This study assessed lay perceptions of issues related to predictive genetic testing for multifactorial diseases. These perceived issues may differ from the "classic" issues, e.g. autonomy, discrimination, and psychological harm that are considered important in predictive testing for monogenic disorders. In this study, type 2 diabetes was used as an example, and perceptions with regard to predictive testing based on DNA test results and family history assessment were compared.</p> <p>Methods</p> <p>Eight focus group interviews were held with 45 individuals aged 35-70 years with (n = 3) and without (n = 1) a family history of diabetes, mixed groups of these two (n = 2), and diabetes patients (n = 2). All interviews were transcribed and analysed using Atlas-ti.</p> <p>Results</p> <p>Most participants believed in the ability of a predictive test to identify people at risk for diabetes and to motivate preventive behaviour. Different reasons underlying motivation were considered when comparing DNA test results and a family history risk assessment. A perceived drawback of DNA testing was that diabetes was considered not severe enough for this type of risk assessment. In addition, diabetes family history assessment was not considered useful by some participants, since there are also other risk factors involved, not everyone has a diabetes family history or knows their family history, and it might have a negative influence on family relations. Respect for autonomy of individuals was emphasized more with regard to DNA testing than family history assessment. Other issues such as psychological harm, discrimination, and privacy were only briefly mentioned for both tests.</p> <p>Conclusion</p> <p>The results suggest that most participants believe a predictive genetic test could be used in the prevention of multifactorial disorders, such as diabetes, but indicate points to consider before both these tests are applied. These considerations differ with regard to the method of assessment (DNA test or obtaining family history) and also differ from monogenic disorders.</p

Malaria incidence in rural Benin: does economics matter in endemic area?

Malaria represents a major health problem with over 1 million annual deaths in Africa alone. There are a limited number of policies tackling the health problems of people at greater risk, namely the poor and rural communities. This is partly due to the lack of evidence available on the range of factors affecting their health status. Despite endemic malarial situations, there is still little understanding of the relative importance of economic factors that contribute to people acquiring malaria. This paper examines the socio-economic and economic factors that affect the incidence of malaria in rural community households in Benin, where malaria is endemic. A sample of 1585 households was determined to collect information on socio-economic characteristics and the presence of malaria symptoms. Probit estimation techniques were used to assess the impact of socio-demographic and socio-economic factors on the incidence of malaria, comparing households with and without malaria patients. Predisposing characteristics of the household head such as age, knowledge of malaria, education and the size of the household significantly affect the incidence of malaria as anticipated by economic theory. Enabling factors reflecting higher economic status, measured by monthly expenditure and a socio-economic index, have a statistically significant and positive impact on the incidence of malaria. This could reflect that better-off have improved case reporting and are likely to seek treatment. Variations in socio-economic and economic characteristics are significant in explaining the incidence of malaria, even in an endemic malarial setting

Brief Communication - SURGICAL SITE INFECTION IN CLEAN AND CLEAN-CONTAMINATED CASES

The rate of surgical site infections and the frequency of various pathogens causing surgical site infection with their antibiotic resistance pattern in general surgery units were studied. In the period from May 2001 to July 2002, 190 patients admitted for surgery (clean and clean-contaminated elective cases) were assessed preoperatively, intraoperatively and postoperatively. Normal microbial flora was studied within 24 to 48 hours of admission and patients were followed up to 30 days postoperatively. Infected wounds were studied bacteriologically and clinically. The overall infection rate was 8.95%. Surgical site infection rate was 3.03% in clean surgeries and 22.41% in clean-contaminated surgeries. Significant increase was seen in surgical site infection rate with an increase in preoperative stay. The increase in duration of surgery was associated with a significant rise in the rate of surgical site infection. Surgical site infection rate was much higher (22.41%) in cases where a drain was used than in non-drained wounds (3.03%). The most common isolate was Staphylococcus aureus followed by Pseudomonas aeruginosa

Cutaneous histoplasmosis in AIDS

A patient with human immunodeficiency virus (HIV) infection presented with multiple cutaneous lesions on upper extremities, trunk, face and with ulcers involving oral mucosa. Histoplasma capsulatum was isolated in culture from scrapings from both cutaneous as well as oral mucosal lesions. The patient responded well initially to the treatment with Amphotericin B followed by itraconazole; however, lesions recurred after three months with the further deterioration of immune status of the patient indicated by decline in CD4 counts. The same treatment was restarted and the patient is still being followed-up

Male circumcision for HIV prevention in sub-Saharan Africa: who, what and when?

BACKGROUND AND OBJECTIVE: Male circumcision (circumcision) reduces HIV incidence in men by 50-60%. The United Nations Joint Programme on HIV/AIDS (UNAIDS) recommends the provision of safe circumcision services in countries with high HIV and low circumcision prevalence, prioritizing 12-30 years old HIV-uninfected men. We explore how the population-level impact of circumcision varies by target age group, coverage, time-to-scale-up, level of risk compensation and circumcision of HIV infected men. DESIGN AND METHODS: An individual-based model was fitted to the characteristics of a typical high-HIV-prevalence population in sub-Saharan Africa and three scenarios of individual-level impact corresponding to the central and the 95% confidence level estimates from the Kenyan circumcision trial. The simulated intervention increased the prevalence of circumcision from 25 to 75% over 5 years in targeted age groups. The impact and cost-effectiveness of the intervention were calculated over 2-50 years. Future costs and effects were discounted and compared with the present value of lifetime HIV treatment costs (US$ 4043). RESULTS: Initially, targeting men older than the United Nations Joint Programme on HIV/AIDS recommended age group may be the most cost-effective strategy, but targeting any adult age group will be cost-saving. Substantial risk compensation could negate impact, particularly if already circumcised men compensate. If circumcision prevalence in HIV uninfected men increases less because HIV-infected men are also circumcised, this will reduce impact in men but would have little effect on population-level impact in women. CONCLUSION: Circumcision is a cost-saving intervention in a wide range of scenarios of HIV and initial circumcision prevalence but the United Nations Joint Programme on HIV/AIDS/WHO recommended target age group should be widened to include older HIV-uninfected men and counselling should be targeted at both newly and already circumcised men to minimize risk compensation. To maximize infections-averted, circumcision must be scaled up rapidly while maintaining quality