Test offering, not additional information, may increase HIV testing uptake in a knowledgeable population

A CAJM journal article.Objectives: To evaluate patient HIV knowledge and testing experience and assess the effect of an HIV informational handout on HIV testing propensity. Design: Cross sectional, descriptive techniques were employed to assess demographics, HIV knowledge and HIV testing experience. A randomized controlled trial was performed to determine if an HIV/AIDS information sheet influenced testing propensity. Setting: Blantyre Adventist Hospital Outpatient Clinic. Subjects: Non-emergency patients over 18 years old attending during consulting hours. Interventions: All subjects answered a questionnaire. For the randomized controlled trial component, half received an HIV information handout. Main Outcome Measures: Proportions were calculated to evaluate testing experience. Logistic regression was used to assess impact of written information and demographics on HIV testing propensity. Results: 490 participants were recruited, of whom 57% had never been tested for HIV. Of the untested, 88% had never been offered an HIV test. Of those that had never been offered a test, 46% desired one. The sample was highly knowledgeable about HIV. Reading an information sheet had no impact on HIV knowledge (p=0.736 to 0.788) or desire for testing (p=0.387). However, age (OR=0.97,95%CI (0.95,0.99)) and gender (OR=1.85, 95%CI (1.06, 3.23)) significantly correlated with testing propensity. Conclusions: A large percentage of patients who have never been offered HIV testing desire testing. More frequent HIV test offering by clinicians could improve testing rates. Clinician education programmes should be developed to increase test offering. Furthermore, written health information in a setting of high HIV/AIDS knowledge may not change behaviour. Alternative methods should be employed to encourage HIV testing uptake

Malaria and Fetal Growth Alterations in the 3(rd) Trimester of Pregnancy: A Longitudinal Ultrasound Study.

Pregnancy associated malaria is associated with decreased birth weight, but in-utero evaluation of fetal growth alterations is rarely performed. The objective of this study was to investigate malaria induced changes in fetal growth during the 3(rd) trimester using trans-abdominal ultrasound. An observational study of 876 pregnant women (398 primi- and secundigravidae and 478 multigravidae) was conducted in Tanzania. Fetal growth was monitored with ultrasound and screening for malaria was performed regularly. Birth weight and fetal weight were converted to z-scores, and fetal growth evaluated as fetal weight gain from the 26th week of pregnancy. Malaria infection only affected birth weight and fetal growth among primi- and secundigravid women. Forty-eight of the 398 primi- and secundigravid women had malaria during pregnancy causing a reduction in the newborns z-score of -0.50 (95% CI: -0.86, -0.13, P = 0.008, multiple linear regression). Fifty-eight percent (28/48) of the primi- and secundigravidae had malaria in the first half of pregnancy, but an effect on fetal growth was observed in the 3(rd) trimester with an OR of 4.89 for the fetal growth rate belonging to the lowest 25% in the population (95%CI: 2.03-11.79, P<0.001, multiple logistic regression). At an individual level, among the primi- and secundigravidae, 27% experienced alterations of fetal growth immediately after exposure but only for a short interval, 27% only late in pregnancy, 16.2% persistently from exposure until the end of pregnancy, and 29.7% had no alterations of fetal growth. The effect of malaria infections was observed during the 3(rd) trimester, despite infections occurring much earlier in pregnancy, and different mechanisms might operate leading to different patterns of growth alterations. This study highlights the need for protection against malaria throughout pregnancy and the recognition that observed changes in fetal growth might be a consequence of an infection much earlier in pregnancy.\u

The Unknown Risk of Vertical Transmission in Sleeping Sickness—A Literature Review

Children with human African trypanosomiasis (HAT) present with a range of generally non-specific symptoms. Late diagnosis is frequent with often tragic outcomes. Trypanosomes can infect the foetus by crossing the placenta. Unequivocal cases of congenital infection that have been reported include newborn babies of infected mothers who were diagnosed with HAT in the first 5 days of life and children of infected mothers who had never entered an endemic country themselves

Anti-malarial drugs and the prevention of malaria in the population of malaria endemic areas

Anti-malarial drugs can make a significant contribution to the control of malaria in endemic areas when used for prevention as well as for treatment. Chemoprophylaxis is effective in preventing deaths and morbidity from malaria, but it is difficult to sustain for prolonged periods, may interfere with the development of naturally acquired immunity and will facilitate the emergence and spread of drug resistant strains if applied to a whole community. However, chemoprophylaxis targeted to groups at high risk, such as pregnant women, or to periods of the year when the risk from malaria is greatest, can be an effective and cost effective malaria control tool and has fewer drawbacks. Intermittent preventive treatment, which involves administration of anti-malarials at fixed time points, usually when a subject is already in contact with the health services, for example attendance at an antenatal or vaccination clinic, is less demanding of resources than chemoprophylaxis and is now recommended for the prevention of malaria in pregnant women and infants resident in areas with medium or high levels of malaria transmission. Intermittent preventive treatment in older children, probably equivalent to targeted chemoprophylaxis, is also highly effective but requires the establishment of a specific delivery system. Recent studies have shown that community volunteers can effectively fill this role. Mass drug administration probably has little role to play in control of mortality and morbidity from malaria but may have an important role in the final stages of an elimination campaign

ПРОЦЕССЫ ДЕСОРБЦИИ КИСЛОРОДА В ВЫСОКОПЛОТНОМ ЛАНТАН СТРОНЦИЕВОМ МАНГАНИТЕ La0.6Sr0.4MnO3-d

Characteristic properties of the formation of physical - chemical properties of a manganite with the composition La0.6Sr0.4MnO3-d were considered. It was determined that two titration current minima depending on the heating rate and the partial pressure of oxygen (pO2) exist at different temperatures, heating rates and partial pressures of oxygen. It is supposed that extreme values of the titration current are caused by breaking of bands of anions existing in two different forms with the tetravalent manganese, as well as by the excessive superstoichiometric oxygen which partially compensate the presence of Mn4+ cations, and by oxygen recovering the electroneutrality of the system appearing due to a decrease of the charge value due to the introduction of Sr2+. It was established that the activation energy of oxygen diffusion is decreasing and reached the minimal value 241 kJ/mole at pO2=5 Pa, with a subsequent increase up to ~273 kJ/mole at pO2= 150 Pa and d=0,004, with the increase of oxygen defects concentration in the La0.6Sr0.4MnO3-d anion sublattice. Concentration dependence of the activation energy of oxygen diffusion is motivated by a formation of the stressed layer, placed near the surface of grains which are depleted with oxygen and at the same time they are a buffer for the oxygen diffusion.Расcмотрены особенности формирования физико-химических свойств манганита состава La0.6Sr0.4MnO3-d. В процессе выделения кислорода из La0.6Sr0.4MnO3-d при различных температурах, скоростях нагрева и парциальных давлениях кислорода существует два минимума тока титрования, зависящих от скорости нагрева и парциального давления кислорода. Экстремумы тока титрования, по-видимому, обусловлены разрывами связей между анионами, находящимися в двух различных формах, и четырехвалентным марганцем. Первая форма - это сверхстехиометрический кислород, частично компенсирующий присутствие катионов Mn4+. Вторая форма - кислород, восстанавливающий электронейтральность при введении Sr2+. При изменении концентрации кислородных дефектов в анионной подрешетке La0.6Sr0.4MnO3-d изменяется и энергия активации диффузии кислорода в интервале 0,0024≤d≤0,0031. Минимальное значение энергии активации при pO2=5 Па составляет 241 кДж/моль. При pO2=150 Па и d=0,004 она возрастает до ~ 273 кДж/моль. Концентрационная зависимость энергии активации диффузии кислорода обосновывается образованием напряженного слоя, расположенного вблизи поверхности зерен, обедненных кислородом и одновременно являющимся буфером для его диффузии

Congenital malaria in Urabá, Colombia

<p>Abstract</p> <p>Background</p> <p>Congenital malaria has been considered a rare event; however, recent reports have shown frequencies ranging from 3% to 54.2% among newborns of mothers who had suffered malaria during pregnancy. There are only a few references concerning the epidemiological impact of this entity in Latin-America and Colombia.</p> <p>Objective</p> <p>The aim of the study was to measure the prevalence of congenital malaria in an endemic Colombian region and to determine some of its characteristics.</p> <p>Methods</p> <p>A prospective, descriptive study was carried out in the mothers who suffered malaria during pregnancy and their newborns. Neonates were clinically evaluated at birth and screened for <it>Plasmodium spp</it>. infection by thick smear from the umbilical cord and peripheral blood, and followed-up weekly during the first 21 days of postnatal life through clinical examinations and thick smears.</p> <p>Results</p> <p>116 newborns were included in the study and 80 umbilical cord samples were obtained. Five cases of congenital infection were identified (four caused by <it>P. vivax </it>and one by <it>P. falciparum</it>), two in umbilical cord blood and three in newborn peripheral blood. One case was diagnosed at birth and the others during follow-up. Prevalence of congenital infection was 4.3%. One of the infected newborns was severely ill, while the others were asymptomatic and apparently healthy. The mothers of the newborns with congenital malaria had been diagnosed with malaria in the last trimester of pregnancy or during delivery, and also presented placental infection.</p> <p>Conclusions</p> <p>Congenital malaria may be a frequent event in newborns of mothers who have suffered malaria during pregnancy in Colombia. An association was found between congenital malaria and the diagnosis of malaria in the mother during the last trimester of pregnancy or during delivery, and the presence of placental infection.</p

Intermittent preventive treatment for the prevention of malaria during pregnancy in high transmission areas

Malaria in pregnancy is one of the major causes of maternal morbidity and adverse birth outcomes. In high transmission areas, its prevention has recently changed, moving from a weekly or bimonthly chemoprophylaxis to intermittent preventive treatment (IPTp). IPTp consists in the administration of a single curative dose of an efficacious anti-malarial drug at least twice during pregnancy – regardless of whether the woman is infected or not. The drug is administered under supervision during antenatal care visits. Sulphadoxine-pyrimethamine (SP) is the drug currently recommended by the WHO. While SP-IPTp seems an adequate strategy, there are many issues still to be explored to optimize it. This paper reviewed data on IPTp efficacy and discussed how to improve it. In particular, the determination of both the optimal number of doses and time of administration of the drug is essential, and this has not yet been done. As both foetal growth and deleterious effects of malaria are maximum in late pregnancy women should particularly be protected during this period. Monitoring of IPTp efficacy should be applied to all women, and not only to primi- and secondigravidae, as it has not been definitively established that multigravidae are not at risk for malaria morbidity and mortality. In HIV-positive women, there is an urgent need for specific information on drug administration patterns (need for higher doses, possible interference with sulpha-based prophylaxis of opportunistic infections). Because of the growing level of resistance of parasites to SP, alternative drugs for IPTp are urgently needed. Mefloquine is presently one of the most attractive options because of its long half life, high efficacy in sub-Saharan Africa and safety during pregnancy. Also, efforts should be made to increase IPTp coverage by improving the practices of health care workers, the motivation of women and their perception of malaria complications in pregnancy. Because IPTp is not applicable in early pregnancy, which is a period when malaria may also be deleterious for women and their offspring, there is a necessity to integrate this strategy with other preventive measures which can be applied earlier in pregnancy such as insecticide-treated nets

ОПТИМИЗАЦИЯ УСЛОВИЙ СИНТЕЗА КОМПОЗИТОВ ЦИРКОНАТА-ТИТАНАТА СВИНЦА БАРИЯ, СОДЕРЖАЩИХ АТОМЫ МЕТАЛЛОВ, И ИХ ДИЭЛЕКТРИЧЕСКИЕ СВОЙСТВА

Composition materials on the base of Pb0,75Ba0,15Zr0,53Ti0,47O3 (PBZT) with micro-inclusions of Cu and Ni are prepared by a complex ceramic technology. This technology includes metallization procedures by means of the chemical deposition method from standard solutions of nickel and copper. At determination of correlation of the structure of PBZT composites and their dielectric properties it was shown that dielectric losses increase with decreasing temperature. This is caused by the domination of the real part of the complex dielectric permittivity.C помощью комплексной керамической технологии, включающей процедуры металлизации методом химического осаждения из стандартных растворов никеля и меди, подготовлены композиционные материалы на основе соединения Pb0,75Ba0,15Zr0,53Ti0,47O3 (ЦТБС) с микро-включениями Cu и Ni. При установлении корреляций между структурой композитов ЦТБС и их диэлектрическими характеристиками показано, что при низких частотах диэлектрические потери возрастают с увеличением температуры, что обусловлено доминированием действительной части комплексной диэлектрической проницаемости