Obstetric professionals’ perceptions of non-invasive prenatal testing for Down syndrome: clinical usefulness compared with existing tests and ethical implications

Background: While non-invasive prenatal testing (NIPT) for fetal aneuploidy is commercially available in many countries, little is known about how obstetric professionals in non-Western populations perceive the clinical usefulness of NIPT in comparison with existing first-trimester combined screening (FTS) for Down syndrome (DS) or invasive prenatal diagnosis (IPD), or perceptions of their ethical concerns arising from the use of NIPT. Methods: A cross-sectional survey among 327 obstetric professionals (237 midwives, 90 obstetricians) in Hong Kong. Results: Compared to FTS, NIPT was believed to: provide more psychological benefits and enable earlier consideration of termination of pregnancy. Compared to IPD, NIPT was believed to: provide less psychological stress for high-risk women and more psychological assurance for low-risk women, and offer an advantage to detect chromosomal abnormalities earlier. Significant differences in perceived clinical usefulness were found by profession and healthcare sector: (1) obstetricians reported more certain views towards the usefulness of NIPT than midwives and (2) professionals in the public sector perceived less usefulness of NIPT than the private sector. Beliefs about earlier detection of DS using NIPT were associated with ethical concerns about increasing abortion. Participants believing that NIPT provided psychological assurance among low-risk women were less likely to be concerned about ethical issues relating to informed decision-making and pre-test consultation for NIPT. Conclusions: Our findings suggest the need for political debate initially on how to ensure pregnant women accessing public services are informed about commercially available more advanced technology, but also on the potential implementation of NIPT within public services to improve access and equity to DS screening services

Dengue Incidence in Urban and Rural Cambodia: Results from Population-Based Active Fever Surveillance, 2006–2008

Dengue is a major public health problem in South-East Asia. Several dengue vaccine candidates are now in late-stage development and are being evaluated in clinical trials. Accurate estimates of true dengue disease burden will become an important factor in the public-health decision-making process for endemic countries once safe and effective vaccines become available. However, estimates of the true disease incidence are difficult to make, because national surveillance systems suffer from disease under-recognition and reporting. Dengue is mainly reported among children, and in some countries, such as Cambodia, the national case definition only includes hospitalized children. This study used active, community-based surveillance of febrile illness coupled with laboratory testing for DENV infection to identify cases of dengue fever in rural and urban populations. We found a high burden of dengue in young children and late adolescents in both rural and urban communities at a magnitude greater than previously described. The study also confirmed the previously observed focal nature of dengue virus transmission

Complete genes may pass from food to human blood

Our bloodstream is considered to be an environment well separated from the outside world and the digestive tract. According to the standard paradigm large macromolecules consumed with food cannot pass directly to the circulatory system. During digestion proteins and DNA are thought to be degraded into small constituents, amino acids and nucleic acids, respectively, and then absorbed by a complex active process and distributed to various parts of the body through the circulation system. Here, based on the analysis of over 1000 human samples from four independent studies, we report evidence that meal-derived DNA fragments which are large enough to carry complete genes can avoid degradation and through an unknown mechanism enter the human circulation system. In one of the blood samples the relative concentration of plant DNA is higher than the human DNA. The plant DNA concentration shows a surprisingly precise log-normal distribution in the plasma samples while non-plasma (cord blood) control sample was found to be free of plant DNA

Método híbrido para categorización de texto basado en aprendizaje y reglas

En este artículo se presenta un nuevo método híbrido de categorización automática de texto, que combina un algoritmo de aprendizaje computacional, que permite construir un modelo base de clasificación sin mucho esfuerzo a partir de un corpus etiquetado, con un sistema basado en reglas en cascada que se emplea para filtrar y reordenar los resultados de dicho modelo base. El modelo puede afinarse añadiendo reglas específicas para aquellas categorías difíciles que no se han entrenado de forma satisfactoria. Se describe una implementación realizada mediante el algoritmo kNN y un lenguaje básico de reglas basado en listas de términos que aparecen en el texto a clasificar. El sistema se ha evaluado en diferentes escenarios incluyendo el corpus de noticias Reuters-21578 para comparación con otros enfoques, y los modelos IPTC y EUROVOC. Los resultados demuestran que el sistema obtiene una precisión y cobertura comparables con las de los mejores métodos del estado del arte

Screening for HIV infection in women with newly diagnosed cervical cancer

Objective. This study aimed to investigate the prevalence of human immunodeficiency virus (HIV) infection in women with cervical cancer and to decide whether HIV testing should be included as part of the initial work-up of invasive cervical cancer. Methods. This was a prospective case controlled study. Women with newly diagnosed cervical cancer were tested and age-matched women with benign gynecologic conditions were selected as control. Serum samples were tested for HIV I and HIV II antibodies at diagnosis and 3 months later. Results. Two hundred twenty-five consecutive patients with newly diagnosed cervical cancer and two hundred twenty-three age-matched women with benign gynaecological conditions were tested. In comparison with the control, women with cervical cancer started sexual intercourse at an earlier age and had a statistically significant higher number of sexual partners. All the HIV tests were negative. The HIV prevalence rate was estimated to be 0.0-1.6% for both groups. Conclusion. HIV screening should not be a part of the initial work-up for cervical cancer in a population with a low background prevalence. © 2003 Elsevier Inc. All rights reserved.link_to_subscribed_fulltex

Could precolposcopy information and counseling reduce women's anxiety and improve knowledge and compliance to follow-up?

To investigate the effects of precolposcopy counseling on women's anxiety, knowledge about colposcopy and compliance to follow-up. Two hundred and twenty women referred for colposcopy for the first time were recruited. They attended precolposcopy sessions in which written and video information were given and subsequently were randomized to have either further explanation and discussion with an experienced colposcopic nurse (study group) or no further discussion (control group). Each subject completed a Chinese version of the state-anxiety questionnaire (STAI) and a knowledge questionnaire before and immediately after the precolposcopy sessions and also before the colposcopy examination. Women's concern and opinion on the programme were also assessed. Follow-up data was compared with those who did not attend the precolposcopy sessions. Women's knowledge about colposcopy significantly improved after the precolposcopy sessions. The improvement was more significant in the study group than in the control group immediately after the sessions (P = 0.003). The difference between the groups in knowledge scores remained statistically significant before colposcopic examination (P = 0.015) but the difference diminished between these two assessment points. There was no statistically significant difference between the two groups in the anxiety scores at all assessment points. Women who attended the precolposcopy sessions had a significantly higher attendance rates and better compliance to follow-up than those who did not attend the sessions. Precolposcopy session with explanation and discussion improves women's knowledge about colposcopy, but has negligible effects on women's anxiety before colposcopy. Provision of written and video information at the precolposcopy sessions can improve compliance to follow-up after colposcopy. © 2004 Elsevier Inc. All rights reserved.link_to_subscribed_fulltex