The Uptake of Integrated Perinatal Prevention of Mother-to-Child HIV Transmission Programs in Low- and Middle-Income Countries: A Systematic Review

BACKGROUND: The objective of this review was to assess the uptake of WHO recommended integrated perinatal prevention of mother-to-child transmission (PMTCT) of HIV interventions in low- and middle-income countries. METHODS AND FINDINGS: We searched 21 databases for observational studies presenting uptake of integrated PMTCT programs in low- and middle-income countries. Forty-one studies on programs implemented between 1997 and 2006, met inclusion criteria. The proportion of women attending antenatal care who were counseled and who were tested was high; 96% (range 30-100%) and 81% (range 26-100%), respectively. However, the overall median proportion of HIV positive women provided with antiretroviral prophylaxis in antenatal care and attending labor ward was 55% (range 22-99%) and 60% (range 19-100%), respectively. The proportion of women with unknown HIV status, tested for HIV at labor ward was 70%. Overall, 79% (range 44-100%) of infants were tested for HIV and 11% (range 3-18%) of them were HIV positive. We designed two PMTCT cascades using studies with outcomes for all perinatal PMTCT interventions which showed that an estimated 22% of all HIV positive women attending antenatal care and 11% of all HIV positive women delivering at labor ward were not notified about their HIV status and did not participate in PMTCT program. Only 17% of HIV positive antenatal care attendees and their infants are known to have taken antiretroviral prophylaxis. CONCLUSION: The existing evidence provides information only about the initial PMTCT programs which were based on the old WHO PMTCT guidelines. The uptake of counseling and HIV testing among pregnant women attending antenatal care was high, but their retention in PMTCT programs was low. The majority of women in the included studies did not receive ARV prophylaxis in antenatal care; nor did they attend labor ward. More studies evaluating the uptake in current PMTCT programs are urgently needed

A Q-methodology study of flare help-seeking behaviours and different experiences of daily life in rheumatoid arthritis

© 2014 Lin et al.; licensee BioMed Central Ltd. Background: Previous studies have not addressed rheumatoid arthritis (RA) patients' help-seeking behaviours for RA flares, and only one small qualitative study has addressed how patients experience daily life on current treatment regimes. Thus, this study aims to identify clusters of opinion related to RA patients' experiences of daily life on current treatments, and their help-seeking behaviours for RA flares. Methods: Using Q-methodology (a methodology using qualitative and quantitative methods to sort people according to subjective experience), two separate studies were conducted with the same sample of RA patients (mean age 55, 73% female). Thirty participants sorted 39 statements about daily life (Q-study 1) and 29 participants separately sorted 23 statements about flare help-seeking (Q-study 2). Data were examined using Q-factor analysis. Results: Daily life with RA (Q-study 1): Three factors relating to the experience of living with RA were extracted and explained. Patients belonging to Factor A (mean age 62, 86% female) use effective self-management techniques to control the daily impact of RA. Those in Factor B (mean age 55, 75% male) struggle to self-manage and cope. Whilst patients in Factor C (mean age 42, 100% female) prioritise life responsibilities over their RA, reporting less impact. Flare help-seeking (Q-study 2): Two factors explaining the experience of flare help-seeking (unrelated to the factors from Q-study 1) were extracted and explained. Factor X (68.8% on biologics) reported seeking help quickly, believing the medical team is there to help. Factor Y (0% on biologics) delay help-seeking, concerned about wasting the rheumatologist's time, believing they should manage alone. All participants agreed they sought help due to intense pain and persistent, unmanageable symptoms. Conclusions: Patients with different characteristics appear to manage RA life in different ways and men may struggle more than women. Whilst all patients are prompted to seek help by persistent, unmanageable symptoms, some delay help-seeking. Further research is needed to quantify the severity of daily symptoms, the level of symptoms needed for patients to define themselves as in flare and to understand the support needs of RA men

Risk factors in the development of stem cell therapy

Stem cell therapy holds the promise to treat degenerative diseases, cancer and repair of damaged tissues for which there are currently no or limited therapeutic options. The potential of stem cell therapies has long been recognised and the creation of induced pluripotent stem cells (iPSC) has boosted the stem cell field leading to increasing development and scientific knowledge. Despite the clinical potential of stem cell based medicinal products there are also potential and unanticipated risks. These risks deserve a thorough discussion within the perspective of current scientific knowledge and experience. Evaluation of potential risks should be a prerequisite step before clinical use of stem cell based medicinal products

HerMES: detection of cosmic magnification of submillimetre galaxies using angular cross-correlation

Cosmic magnification is due to the weak gravitational lensing of sources in the distant Universe by foreground large-scale structure leading to coherent changes in the observed number density of the background sources. Depending on the slope of the background source number counts, cosmic magnification causes a correlation between the background and foreground galaxies, which is unexpected in the absence of lensing if the two populations are spatially disjoint. Previous attempts using submillimetre (sub-mm) sources have been hampered by small number statistics. The large number of sources detected in the {\it Herschel} Multi-tiered Extra-galactic Survey (HerMES) Lockman-SWIRE field enables us to carry out the first robust study of the cross-correlation between sub-mm sources and sources at lower redshifts. Using ancillary data we compile two low-redshift samples from SDSS and SWIRE with ~ 0.2 and 0.4, respectively, and cross-correlate with two sub-mm samples based on flux density and colour criteria, selecting galaxies preferentially at z ~ 2. We detect cross-correlation on angular scales between ~1 and 50 arcmin and find clear evidence that this is primarily due to cosmic magnification. A small, but non-negligible signal from intrinsic clustering is likely to be present due to the tails of the redshift distribution of the sub-mm sources overlapping with those of the foreground samples.Comment: 7 pages, 2 figues, accepted for publication in MNRA

HerMES: LYMAN BREAK GALAXIES INDIVIDUALLY DETECTED AT 0.7 <= z <= 2.0 IN GOODS-N WITH HERSCHEL/SPIRE

As part of the Herschel Multi-tiered Extragalactic Survey we have investigated the rest-frame far-infrared (FIR) properties of a sample of more than 4800 Lyman break galaxies (LBGs) in the Great Observatories Origins Deep Survey North field. Most LBGs are not detected individually, but we do detect a sub-sample of 12 objects at 0.7 2.5. The UV-to-FIR spectral energy distributions of the objects detected in the rest-frame FIR are investigated using the code CIGALE to estimate physical parameters. We find that LBGs detected by SPIRE are high-mass, luminous infrared galaxies. It appears that LBGs are located in a triangle-shaped region in the A(FUV) versus log L-FUV = 0 diagram limited by A(FUV) = 0 at the bottom and by a diagonal following the temporal evolution of the most massive galaxies from the bottom right to the top left of the diagram. This upper envelop can be used as upper limits for the UV dust attenuation as a function of L-FUV. The limits of this region are well explained using a closed-box model, where the chemical evolution of galaxies produces metals, which in turn lead to higher dust attenuation when the galaxies age

DYNAMICAL STRUCTURE OF THE MOLECULAR INTERSTELLAR MEDIUM IN AN EXTREMELY BRIGHT, MULTIPLY LENSED z similar or equal to 3 SUBMILLIMETER GALAXY DISCOVERED WITH HERSCHEL

We report the detection of CO(J = 5 → 4), CO(J = 3 → 2), and CO(J = 1 → 0) emission in the strongly lensed, Herschel/SPIRE-selected submillimeter galaxy (SMG) HERMES J105751.1+573027 at z = 2.9574 ± 0.0001, using the Plateau de Bure Interferometer, the Combined Array for Research in Millimeter-wave Astronomy, and the Green Bank Telescope. The observations spatially resolve the molecular gas into four lensed images with a maximum separation of ~9'' and reveal the internal gas dynamics in this system. We derive lensing-corrected CO line luminosities of L'CO(1-0) = (4.17 ± 0.41), L'CO(3-2) = (3.96 ± 0.20), and L'CO(5-4) = (3.45 ± 0.20) × 1010 (μL/10.9)–1 K km s–1 pc2, corresponding to luminosity ratios of r 31 = 0.95 ± 0.10, r 53 = 0.87 ± 0.06, and r 51 = 0.83 ± 0.09. This suggests a total molecular gas mass of M gas = 3.3×1010 (αCO/0.8) (μL/10.9)–1 M ☉. The gas mass, gas mass fraction, gas depletion timescale, star formation efficiency, and specific star formation rate are typical for an SMG. The velocity structure of the gas reservoir suggests that the brightest two lensed images are dynamically resolved projections of the same dust-obscured region in the galaxy that are kinematically offset from the unresolved fainter images. The resolved kinematics appear consistent with the complex velocity structure observed in major, "wet" (i.e., gas-rich) mergers. Major mergers are commonly observed in SMGs and are likely to be responsible for fueling their intense starbursts at high gas consumption rates. This study demonstrates the level of detail to which galaxies in the early universe can be studied by utilizing the increase in effective spatial resolution and sensitivity provided by gravitational lensing

Pharmacologic Treatment of Knee Osteoarthritis in Athletic Women

There is a greater incidence of anterior cruciate ligament tears due to noncontact sports injuries in women compared with men. Anterior cruciate ligament tears are associated with accelerated development of knee osteoarthritis (OA), which is also more prevalent in women than in men. This article considers therapeutic modalities that are best suited for athletic women with knee OA. Clinical data on the safety and efficacy of pharmacotherapies for knee OA, including acetaminophen, oral nonsteroidal anti-inflammatory drugs (NSAIDs), and topical NSAIDs, are discussed, with attention paid to special considerations for women who participate in athletic activity. Adverse events associated with the use of acetaminophen and oral NSAIDs place potential limits on the dose and duration of therapy and may be of greater concern in female athletes than in other patient groups. Topical NSAIDs, which effect relief through the same mechanism of action as oral NSAIDs, produce dramatically lower systemic NSAID exposure compared with oral NSAIDs and are associated with a lower incidence of systemic adverse events. These findings, along with additional future studies, may have particular relevance to the choice of the most effective treatment options for athletic women with OA of the knee