High Cryptococcal Antigen Titers in Blood Are Predictive of Subclinical Cryptococcal Meningitis Among Human Immunodeficiency Virus-Infected Patients

Background High mortality rates among asymptomatic cryptococcal antigen (CrAg)–positive patients identified through CrAg screening, despite preemptive fluconazole treatment, may be due to undiagnosed cryptococcal meningitis. Methods Symptoms were reviewed in CrAg-positive patients identified by screening 19233 individuals with human immunodeficiency virus infection and CD4 cell counts <100/µL at 17 clinics and 3 hospitals in Johannesburg from September 2012 until September 2015, and at 2 hospitals until June 2016. Cerebrospinal fluid samples from 90 of 254 asymptomatic patients (35%) and 78 of 173 (45%) with headache only were analyzed for cryptococcal meningitis, considered present if Cryptococcus was identified by means of India ink microscopy, culture, or CrAg test. CrAg titers were determined with stored blood samples from 62 of these patients. The associations between blood CrAg titer, concurrent cryptococcal meningitis, and mortality rate were assessed. Results Cryptococcal meningitis was confirmed in 34% (95% confidence interval, 25%–43%; 31 of 90) of asymptomatic CrAg-positive patients and 90% (81%–96%; 70 of 78) with headache only. Blood CrAg titer was significantly associated with concurrent cryptococcal meningitis in asymptomatic patients (P 160 (sensitivity, 88.2%; specificity, 82.1%); the odds ratio for concurrent cryptococcal meningitis was 34.5 (95% confidence interval, 8.3–143.1; P < .001). Conclusions About a third of asymptomatic CrAg-positive patients have concurrent cryptococcal meningitis. More effective clinical assessment strategies and antifungal regimens are required for CrAg-positive patients, including investigation for cryptococcal meningitis irrespective of symptoms. Where it is not possible to perform lumbar punctures in all CrAg-positive patients, blood CrAg titers should be used to target those most at risk of cryptococcal meningitis

Access to contraception and sexual and reproductive health information post-abortion: a systematic review of literature from low- and middle-income countries

Aim: This systematic literature review documented, analysed and critiqued the accessibility of contraception and sexual and reproductive health (SRH) information for women living in low- and middle-income countries who have undergone medical or surgical abortion. Methodology: This review systematically collated relevant and recent empirical evidence regarding women's access to contraception and SRH information post-abortion within low- and middle-income countries. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework Guidelines, Flow Diagram and Checklist were utilised to undertake the review. The Ovid (MEDLINE), ProQuest, Science Direct, Web of Science, PUBMED and CINAHL databases were searched and studies that met edibility criteria were assessed for validity and analysis. A narrative synthesis of characteristics and results of the included studies is presented. Findings: After detailed assessment of available and relevant literature, nine studies were selected for inclusion in the review. Studies highlighted barriers to contraception and SRH information including supply limitation, lack of comprehensive education and counselling, lack of skilled post-abortion care (PAC) providers and abortion stigma. Conclusions: The review found that with access to a wide range of contraceptive methods combined with comprehensive SRH information and education, contraception uptake in women post-abortion does increase. The review also highlights the inconsistencies in clinic-reported ‘counselling’ and what this term actually involves within a PAC setting

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Abstract This study aims to determine the disability prevalence and changes in active life expectancy of the Thai older people between 1997 and 2004. Data on disability of older people aged ≥60 years were obtained from the National Health Examination Surveys. Disability refers to one or more restrictions on the activities of daily living. The Sullivan method was used to calculate active life expectancy. A total of 4048 older people in 1997 and 19 372 older people in 2004 were included in the analysis. Active life expectancy at age 60 of men was 16.5 years in 1997 and 17.6 years in 2004, whereas that of women was 17.9 and 19.9 years, respectively. Women spent a greater proportion of the remaining life with disability. The proportion of active life for both genders also increased during the 7-year period suggesting an evidence of the compression of morbidity in Thai older people

Examining the Use of Corporate Governance Mechanisms in Public-Private Partnerships: Why Do They Not Deliver Public Accountability?

The paper examines corporate governance mechanisms which aim to ensure financial accountability in the context of long-term Public-Private Partnership (PPP) contracts in Britain, and assesses the degree to which they provide taxpayers with control and accountability. The corporate governance arrangements are drawn from the private sector, and therefore downplay the traditional concepts of probity and stewardship, in part due to the British Treasury’s adoption of private sector financial reporting.The paper draws on Shaoul et al.’s (2012) framework governance-based reporting framework to critique the corporate governance mechanisms of structure, financial reporting, contracts and scrutiny in relation to British PPP projects. It shows that the way these mechanisms are set up means there is a lack of control by the public sector, thus rendering public accountability ineffective.<br/