Sunday, May 31, 2009
A study by Indiana University neuroscientist Heather Rupp found that a woman's partner status influenced her interest in the opposite sex. In the study, women both with and without sexual partners showed little difference in their subjective ratings of photos of men when considering such measures as masculinity and attractiveness. However, the women who did not have sexual partners spent more time evaluating photos of men, demonstrating a greater interest in the photos.
No such difference was found between men who had sexual partners and those who did not. "These findings may reflect sex differences in reproductive strategies that may act early in the cognitive processing of potential partners and contribute to sex differences in sexual attraction and behavior," said Rupp, assistant scientist at The Kinsey Institute for Research in Sex, Gender and Reproduction.
For the study, 59 men and 56 women rated 510 photos of opposite-sex faces for realism, masculinity/femininity, attractiveness, or affect. Participants were instructed to give their "gut" reaction and to rate the pictures as quickly as possible. The men and women ranged in age from 17 to 26, were heterosexual, from a variety of ethnic backgrounds and were not using hormonal contraception. Of the women, 21 reported they had a current sexual partner; 25 of the men reported having a sexual partner. This is the first study to report whether having a current sexual partner influences interest in the opposite sex. Other studies have demonstrated that hormones, relationship goals and social context influence such interest.
"That there were no detectable effects of sexual partner status on women's subjective ratings of male faces, but there were on response times, which emphasizes the subtlety of this effect and introduces the possibility that sexual partner status impacts women's cognitive processing of novel male faces but not necessarily their conscious subjective appraisal," the authors wrote in the journal article. The researchers also note that influence of partner status in women could reflect that women, on average, are relatively committed in their romantic relationships, "which possibly suppresses their attention to and appraisal of alternative partners."
Partner Status Influences Women’s Interest in the Opposite Sex
Heather Rupp et al
Human Nature Volume 20, Number 1 / March, 2009 DOI10.1007/s12110-009-9056-6
Link to Human Nature abstract
— As President Barack Obama calls for streamlining heath care by fully converting to electronic medical records and as Congress prepares to debate issues of patient privacy, one question has largely gone unasked: What do patients want?
A qualitative study led by a research team at Beth Israel Deaconess Medical Center (BIDMC) helps answer that question. Reported in the June 2009 issue of the Journal of General Internal Medicine (JGIM), the findings provide key insights into consumer preferences, suggesting that patients want full access to all of their medical records, are willing to make some privacy concessions in the interest of making their medical records completely transparent, and that, going forward, fully expect that computers will play a major role in their medical care, even substituting for face-to-face doctor visits.
"We set out to study patient attitudes toward electronic personal health records and other emerging and future electronic health information technologies," explains the study's lead author Jan Walker, RN, MBA, Instructor in Medicine in the Division of General Medicine and Primary Care at BIDMC and Harvard Medical School. "And we learned that, for the most part, patients are very comfortable with the idea of computers playing a central role in their care." In fact, she adds, patients said they not only want computers to bring them customized medical information, they fully expect that in the future they will be able to rely on electronic technology for many routine medical issues.
"Patients know how busy their doctors are and they want to reserve us for what they really need us for – treating serious illness and conditions," adds senior author Tom Delbanco, MD, the Richard and Florence Koplow-James Tullis Professor of General Medicine and Primary Care at Harvard Medical School and BIDMC. "They may be more than happy to rely on computer protocols and 'faceless doctors' to help them manage garden-variety medical problems."
Focus groups were held in four cities: Boston, MA; Portland, ME; Tampa, FL; and Denver, CO. The locations were selected to represent various geographic areas, to include both rural and urban populations and to incorporate ethnic and cultural diversity. Six of the eight groups (consisting of nine to 12 participants each) were made up of consumers. The last two groups were made up of health care professionals from Boston and Denver, assembled to provide their perspectives on the role of health information technology and to compare their opinions with those of consumers. In each case, participants were asked how they currently organize the information they need to manage their health and medical care, and explored how they would ideally like to manage and use this information, including how technologies could address any gaps.
"The discussions showed that, for the most part, consumers want computers to take into account their personal profiles in order to bring them customized information and advice," explains Walker. "They also expect that technologies will 'watch' over them, monitoring their health and giving them real-time feedback, including communicating with clinicians when needed. Participants also said they expect computers to act as 'personal coaches,' and to foster self care."
Strikingly, she adds, privacy of health care information was of less importance to the groups than might be expected. "It seems that as the population ages and finds itself facing more illness and serious medical conditions, privacy of health information becomes much less important to patients than it is when they are healthy," she notes. "Patients are willing to trade some privacy in order to have records fully available in emergency settings and available to new caregivers as well as to multiple clinicians."
Insights for Internists “I Want the Computer to Know Who I Am”.
Jan Walker, David K. Ahern, Lan X. Le and Tom Delbanco
Journal of General Internal Medicine Volume 24, Number 6 / 727-732 June, 2009 doi 10.1007/s11606-009-0973-1
Link to JGIM abstract
Saturday, May 30, 2009
Science Daily (May 24, 2009)
'Intoxication' May Not Always Be Visible
One well-known and often deadly consequence of alcohol intoxication is impaired driving. Yet still today, it is difficult for even trained observers to fully identify "intoxication," given that so many factors contribute to it. This review examines the very definition of intoxication, as well as methods designed to prevent impaired driving.
"It is important to understand and recognize intoxication because of the risk for injury that results from it," said John Brick, lead author and executive director of Intoxikon International. "Understanding and recognizing an intoxicated person can help us make decisions about allowing a person to drive, accepting a ride from someone, or cutting off a drinker."
Key points of the review include:
- "Obvious intoxication" as defined in some courts is not always the same as "visible intoxication."
"While most people would use these terms interchangeably to mean that someone was clearly drunk," said Brick, "laws in some states differentiate between the terms. For example, in some states 'obvious' intoxication means that if someone has consumed a large number of drinks, it should be obvious that they are intoxicated and not capable of driving. Other state laws define 'visible' intoxication as specific types of behavior, such as trouble walking, slurred speech and other common signs of alcohol intoxication. Thus, it is possible to have a unique legal situation where someone is obviously intoxicated, but not visibly intoxicated based on specific legal definitions."
In most people reliable signs of intoxication are present by casual observation at a blood alcohol concentration (BAC) of 150 mg/dl or more, even in most tolerant individuals. At a BAC of less than 150 mg/dl, signs of visible intoxication are not reliably present in most drinkers, and the likelihood of identifying signs of impairment is less than chance.
"This presents a particular challenge to preventionists," said Brick. "For example, how do you intervene or make an informed decision about driving with someone if they do not appear visibly intoxicated? People who are too impaired to drive are not typically staggering, slurring their speech, or presenting gross signs of intoxication."
Unfortunately, there is no easy way to determine how someone can reach a BAC of 150 mg/dl, he added.
"A very small woman drinking rapidly could attain a BAC of 150 mg/dl with only four standard drinks, whereas a large man might require 10 or 12 such drinks, again depending on how long they were drinking and other scientific factors," he said. "While these analyses can be calculated scientifically based on specific individuals and circumstances, for general purposes it may be better to focus on observable signs of intoxication."
- Drink counting can be a useful prevention approach in some cases.
In situations where exceptionally tolerant individuals do not show signs of visible intoxication even though they are very intoxicated, the only way to know if they are intoxicated might be to count drinks, Brick explained.
"Although helpful in some cases, this is not without difficulty because you do not know how much the person consumed before they started drinking at your restaurant or party," said Brick. "Also, if you have a policy that allows a certain number of drinks per hour, for example, you may rely on counting rather than paying attention to behavior, and end up overserving. Drink counting is also problematic in a busy bar, restaurant, or social gathering … and drink sizes can vary widely." He said there is a need for further research to establish a reasonable maximum number of drinks to be served, coupled with training to identify signs of intoxication.
"Our review is important for scientists, law enforcement and the legal community, and particularly everyday people," said Brick. "We want readers to know that just because someone who has been drinking does not look visibly intoxicated it does not mean they are not impaired to drive. Similarly, if after drinking someone is showing one or more signs of visible intoxication such as decreased inhibitions, doing or saying things they would not if sober, or psychomotor impairment, showing trouble walking, standing, or slurred speech, or cognitive impairment, as in easily confused, or impaired memory, judgment and mental tasks, then that person is probably well above the legal definition of intoxication in the US and probably has a BAC in excess of 150 mg/dl. Their risk for a serious accident is also very high."
While prevention efforts have become more sensitive to drinking and driving, he said, establishing "intoxication" has also become more dependent on special tests, such as those used by police, and not available to the general public. "Ultimately," he said, "if there is uncertainty as to whether someone is intoxicated, it is better to err on the side of caution, terminate service, and arrange for alternate transportation."
Intoxication Is Not Always Visible: An Unrecognized Prevention Challenge
John Brick, Carlton K. Erickson
Alcoholism: Clinical & Experimental Research Published Online: May 28 2009 DOI: 10.1111/j.1530-0277.2009.00979.x
Link to ACER abstract
Daily Alcohol Intake Can Lead To Binge Drinking
Sipping wine, beer or spirits three to four times per week increases the risk of binge drinking, particularly among young men, according to a new study published in the journal Addiction. Researchers from the Université de Montréal and the University of Western Ontario analyzed the drinking habits of Canadians and found that frequent alcohol consumption can lead to binge drinking among all genders and all age groups.
The study also found that infrequent drinkers rarely exceed two servings when they do consume alcoholic beverages. "The relationship between drinking frequency and consumption per occasion might be both cultural and biological," says study coauthor Andrée Demers, a Université de Montréal sociology professor and director of the Research Group on the Social Aspects of Health and Prevention. "The Canadian drinking culture has a 'time-out' depiction of drinking. Alcohol is a boundary mark between week and weekend, work and leisure, and therefore between routine and time off."
The investigation established one drink as 5 oz. of wine, 1.5 oz. of liquor, 12 oz. of beer or cooler, 3 oz of port, sherry or vermouth. Regardless of drinking preferences, the study found that many Canadians consume alcoholic beverages on a daily basis to experience its mood-altering affects.
"Regular drinking builds up tolerance, therefore daily drinkers will need more than their usual drink or two to make a difference with everyday life and gain that festive feeling," says lead author Catherine Paradis, a Université de Montréal PhD candidate. "That fosters drinking beyond healthy limits – at least sporadically and perhaps weekly – to five drinks or more per occasion. And five units is above the recommended limits of healthy drinking."
Study data was obtained from the GENACIS Canada project, an international collaboration examining how social and cultural variations can influence the drinking habits of men and women. Close to 11,000 respondents – 5,743 women and 4,723 men – were asked to report on their alcohol consumption within the last 12 months. Participants were asked questions such as:
- "How often did you usually have any kind of drink containing alcohol?"
- "How often did you usually have five drinks or more on one occasion?"
According to health-related organizations in Canada and elsewhere, women should never consume more than four drinks per occasion and alcohol is beneficial only when consumed in small quantities. Very little is known concerning the relationship between drinking frequency and risky drinking patterns.
"There is no clear and universal understanding of what is moderate drinking – its meaning varies between cultures and within cultures according to gender, age, socio-economic status and people's self-reported tolerance," says Professor Paradis. "Since regular drinking could increase alcohol abuse, Canadian drinking guidelines should take this aspect of the drinking pattern into account."
The importance of drinking frequency in evaluating individuals' drinking patterns: implications for the development of national drinking guidelines.
Catherine Paradis et al
Addiction, 2009; DOI: 10.1111/j.1360-0443.2009.02586.x
Link to Addiction abstract
Genetically modified primates that glow green and pass the trait on to their offspring could aid the fight against human disease. Though primates that make a glowing protein have been created before, these are the first to keep the change in their bloodlines. Future modifications could lead to treatments for a range of diseases.
The "transgenic" marmosets, created by a Japanese team, have been described in the journal Nature.
The work raises a number of ethical questions about deliberately exposing a bloodline of animals to such diseases. Scientists have managed to modify the genes of many living organisms in recent years, ranging from bacteria to mice. Mice have been particularly useful experimental models for studying a wide range of human diseases as modified genes are passed on from parents to progeny.
However, mice are not useful for some human diseases because they are not sufficiently similar to produce effects that are meaningful to human disease. Studies of mice with Alzheimer's disease, for example, were stymied simply because their brains were too small to scan at sufficient resolution.
Now, Erika Sasaki of the Central Institute for Experimental Animals in Japan, and her colleagues, have introduced a gene into marmoset embryos that allows them to build green fluorescent protein (GFP) in their tissues.
The protein is so-called because it glows green in a process known as fluorescence.
GFP was originally isolated from the jellyfish Aequorea victoria , which glows green when exposed to blue light.
The protein has become a standard in biology and genetic engineering, and its discovery even warranted a Nobel prize.
From 91 embryos, a total of five GFP-enabled transgenic marmosets were born, including twins Kei and Kou ("keikou" is Japanese for "fluorescence").
Crucially, the team was able to show that their method is maintained in the family - or germline.
They used the sperm from a member of the first generation of transgenic marmosets to fertilize an egg from a normal animal. A significant proportion of the resulting offspring also glowed under ultraviolet light.
Until now, efforts to establish transgenic lines of primates have been unsuccessful. In 2001, a team at the Oregon Regional Primate Research Center, US, succeeded in creating a rhesus macaque that expressed GFP.
Last year, a team at Yerkes National Primate Research Center, Atlanta, US, created rhesus macaque monkeys with Huntington's disease, but the disease killed off all but one of them. The team is now waiting to breed a second set of Huntington's macaques.
The new method improves on previous work using so-called "retroviruses".
These virus "vectors" were added to a soup of sugary solution and this was in turn injected into the monkey embryos.
Although the work demonstrates the principle that a gene can be introduced into a primate bloodline, study co-author Hideyuki Okano of the Keio University School of Medicine said it may not be suitable for studying all diseases.
"We can just introduce genes by virus vectors," he told BBC News, "so the limitation comes from the sizes of genes that can be carried by the retroviruses."
That limitation is about 10,000 bases, or letters, of the genetic code. That upper bound will constrain the diseases that can be studied.
Genes implicated in Parkinson's disease and amyotrophic lateral sclerosis (ALS, a form of motor neurone disease) may well be suitable. However, genetic regions implicated in Huntington's disease might not fit into a retrovirus.
The work has raised a number of ethical questions about the use of primates in disease research.
Marmosets are New World monkeys and therefore more distantly related to humans than, for example, chimpanzees. But they are particularly useful for the study of disease because they reproduce often and from a young age.
Jarrod Bailey, science consultant to the British Union for the Abolition of Vivisection (BUAV), says he is "disappointed" both ethically and scientifically with the results.
"This sort of research on animals as sentient as monkeys and apes does not have public support," he told BBC News.
Furthermore, he thinks the underlying science is flawed. Animal researchers, he said, "have failed in research to find treatments for Aids, for hepatitis, for malaria, for strokes. Many treatments for strokes work in monkeys but don't work in humans."
"Monkeys do not predict human response and do not tell us about human disease," he added.
However, scientists argue that, because primates are more similar to humans than mice, they present a more refined model of human disease. This would allow scientists to test treatments more effectively, meaning that fewer animals need be experimented on in the long run.
"This experiment is reminiscent of the exciting early days of transgenic research where it was initially difficult to fully know what the potential applications and future research directions might be," said Mark Hill, a cell biologist at the University of New South Wales in Australia.
"As always in this area of research, there needs to be a close linkage between the scientific work, ethical issues and regulatory guidelines."
As the BBC report also points out, two of the first transgenic marmosets did their own genetic trick: they are twins
Generation of transgenic non-human primates with germline transmission
Erika Sasaki et al
Nature 459, 523-527 (28 May 2009) | doi:10.1038/nature08090
Link to Nature abstract
Editorial: Time to connect
Nature 459, 483 (28 May 2009) | doi:10.1038/459483a
Link to Nature editorial
Investigators and health officials in Spokane. Washington fear the number of sex partners Zuriel Roush exposed to the HIV could be as high as 80.
“Since I’ve been here we’ve not had an investigation of this magnitude,” said Julie Graham, spokeswoman for the Spokane Regional Health District, who’s been with the district for at least five years.
At his arraignment Wednesday, Roush, age 22, pleaded not guilty to charges of first-degree assault before Spokane County Superior Court Judge Ellen Kalama Clark.
Roush is being held on $100,000 bond. The case against him alleges he lied about his HIV status to a married man he had sex with last month. The man later learned Roush had HIV and called police, according to court documents.
In Spokane, the health district has its own process in place for stopping risky behavior by clients. Those steps include the issuance of a cease-and-desist order in an attempt to stop the client from endangering others. Such an order would land the client in the court system.
“On a rare occasion that we find out that someone has intentionally put others at risk, we would take the actions first to keep that from happening,” Graham said. “This is our first time where we have had our records subpoenaed by police as a first step.”
According to court documents, Roush’s caseworker at the health district’s Public Health Clinic told detectives Roush had been an HIV-positive client since August or September. At that time, Roush signed paperwork warning him it was a crime to expose people to the virus without telling them, court records show.
Court records also state that a friend of Roush’s told police that Roush “routinely meets anonymous men on a Web site called Manhunt.com and routinely goes to People’s Park for anonymous sex.”.
A trial has been set for July 20. A request for a reduced bond was denied. Deputy Prosecutor Rachel Sterett objected to any reduction in bond, saying Roush poses a community safety risk.
“I believe he was interviewed by several of the news media and said on camera that he’s been having unprotected sex on purpose with as many people as he can knowing that he is HIV positive,” she said.
This is also covered by KOMO TV News. The video interview is posted on their site. It reports that Roush claims men are not concerned as they used to be about catching this deadly virus
“Nowadays it’s like if somebody has HIV it’s like they really don’t care. You know they don’t care about asking.”
Friday, May 29, 2009
That's one conclusion from a new study that looked at how virulence evolves in parasites. The research examined whether parasites evolve to be more or less aggressive depending on whether they are closely connected to their hosts or scattered among more isolated clusters of hosts.
The research was led by Geoff Wild, an NSERC-funded mathematician at the University of Western Ontario, with colleagues from the University of Edinburgh.
"Our study follows up on some recent findings that suggest that reduced dispersal of parasites across scattered host clusters favors the evolution of parasites with lower virulence – in the case of influenza, for example, a milder, possibly less deadly, case of flu," said Dr. Wild.
"Some researchers had contended from this that the parasites were evolving to support the overall fitness of the group," he added. "The argument for adaptation at the group level is that the parasites become more prudent to prevent overexploitation and hence to avoid causing the extinction of the local host population."
However, Dr. Wild and his colleagues were not convinced that Darwinian theory – so successful in providing explanations based on the notion that adaptation maximizes individual fitness – was ready for such a major makeover.
The researchers decided to move the arguments from words to harder science. Together they developed a formal mathematical model that incorporated variable patch sizes and the host parasite population dynamics. It was then run to determine the underlying evolutionary mechanisms, the results of which were published in the Nature paper.
"The model revealed solid reasons why lowered virulence enhanced individual fitness," said Dr. Wild.
The researchers used an "inclusive" notion of individual fitness that has been used by biologists in other situations since the 1960's. This "inclusive" approach recognizes that an individual has a vested interest not only in its own success, but also the success of its relatives (not the group as a whole, per se).
"Basically, we replace the notion of self-interest – an idea that underlies much early evolutionary theory – with the notion of self-and-family interest," he said. "The difference between self-and-family interest versus group interests is subtle, but important."
"There are several reasons why lowered virulence enhances the success of genetic lineages of parasites," he said. For one thing, he explained, it means lower host-to-host disease transmission.
"While the more virulent strain of parasite can move among hosts readily, it does so to the detriment not of the group, but rather certain members of the group (namely individuals of the same strain – its relatives)," said Dr. Wild.
"Besides settling an argument over adaptation, we now understand better the importance of dispersal to the evolution of parasites."
"The findings also suggest that as human activity makes the world more connected, natural selection will favour more virulent and dangerous parasites."
Dr. Wild said the modeling approach the group took makes it possible to expand virulence theory to examine a range of potentially important biological factors.
Adaptation and the evolution of parasite virulence in a connected world
Geoff Wild, Andy Gardner & Stuart A. West
Nature advance online publication 27 May 2009 | doi:10.1038/nature08071
Link to Nature abstract
Kingston University, London reports (May 28, 2009)
Warning On Athletes' Use Of Prescription Drugs
Athletes could be putting their lives at risk by doping themselves with powerful prescription drugs, an academic has warned. Professor Declan Naughton, Professor of Biomolecular Sciences at Kingston University in South West London, cautioned sportsmen and women against trying to improve their performance by taking drugs known as nitrites without clinical supervision.
Speaking at a conference on drug-taking in sport, he warned that they could suffer a range of side effects from convulsions to coma, and could even kill themselves.
Professor Naughton, who is based in the School of Life Sciences, is one of the scientists who first discovered the beneficial effects of nitrite. These can include treatment for heart and blood disorders, and may have future potential in the treatment of inflammatory diseases such as rheumatoid arthritis, and some cancers where a better blood supply helps to deliver oxygen and medicines.
He said he was concerned that athletes are unlikely to be aware of the effects of misusing it.
“Based on current research on the levels of abuse of performance enhancing drugs by athletes, the future uptake of this drug by the athletic community is of real concern,” he said.
“Nitrite has enormous potential as a treatment for diseases characterized by inadequate blood supply but if taken in supplement form without clinical supervision, nitrite may lead to a number of serious side effects including cardiovascular collapse, coma, convulsions and death.”
Professor Naughton said the potentially harmful side-effects of nitrite had been established and are documented in the medical reference guide Martindale, which contains information on drugs in clinical use worldwide. Although athletes are routinely tested for prohibited drugs, nitrite is not on the list of substances banned by the international sporting authorities and athletes face no penalty or disciplinary action for taking it. Professor Naughton said it would be difficult to enforce a ban because small doses are found in foods such as cured meats and lettuce and it is expelled from the body in urine.
Speaking at the same conference, Dr Andrea Petroczi, a Reader in Public Health at Kingston University, said that her research on performance enhancing drugs suggested that there was a possibility that nitrites could be taken up by athletes. She analyzed information from UK Sport’s Drug Information Database, which allowed athletes, coaches and team doctor to check the status of most UK licensed pharmaceutical products in the run-up to the 2008 Beijing Olympics. Among her findings, Dr Petroczi discovered that checks on Viagra-type medication had almost doubled during the months leading up to the Olympics compared to the previous two years.
She also reported that some athletes were taking as many as 26 different drugs and supplements in a single day. “Studies using declarations made by athletes during doping controls highlight two concerning issues: a marked increase in the use of asthma medications and the use of non steroidal anti-inflammatory drugs well above the appropriate level for reported illnesses or injuries,” she said.
Professor Naughton and Dr Petroczi highlighted the need for better education among athletes to warn them of the dangers of using performance enhancing substances. To help raise awareness, a conference on sport and drugs would be held at Kingston University each year in the run up to the 2012 London Olympics, Professor Naughton said.
This year’s conference, The Dark Side of Sport: Chemical Enhancement of Athletic Performance, took place on 11 May..
Science Daily (May 29, 2009)
Knock-Out Drugs: Narrow Window For Detection
Drug-facilitated sexual crimes are increasing. The Bonn Institute for Forensic Medicine has recorded that the number of examinations on the use of intoxicants in sexual offences within their catchment area increased 10-fold between 1997 and 2006.
In the current edition of Deutsches Ärzteblatt International, Burkhard Madea and Frank Musshoff present the modes of action and the detection windows for the most frequent substances.
Many substances can be used as knock-out drugs, for example alcohol and liquid ecstasy. However, the most important are benzodiazepines and other hypnotics, which can act within 10 minutes. The victims report disturbed perception, a dazed feeling, nausea, disinhibition and lack of willpower. This was often followed by loss of consciousness for several hours, so that the victim could not remember the incident. It is often difficult to detect knock-out drugs, as they are rapidly broken down by the body. Benzodiazepines can be detected in the blood for a maximum of 24 hours and liquid ecstasy for only 8 hours.
For this reason, if the administration of knock-out drugs is suspected, 100 mL urine and at least 10 mL blood should be taken as quickly as possible. If the interval between the incident and the medical examination is longer, a hair sample should be taken. This can be done up to 4 weeks after the incident. Involuntarily taken drugs are only detected in routine testing after 2% of offences.
Knock-Out Drugs: Their Prevalence, Modes of Action,and Means of Detection.
Burkhard Madea, Frank Mußhoff
Dtsch Arztebl Int, 2009; 106 (20): 341-7 DOI: 10.3238/arztebl.2009.0341
Link to Arztebl article
Africa: Prevention efforts and infection patterns mismatched
In at least five African countries, scarce resources are being spent on national HIV prevention campaigns that do not reach the people most at risk of infection, new research has found.
Between 2007 and 2008, UNAIDS and the World Bank partnered with the national AIDS authorities of Kenya, Lesotho, Swaziland, Uganda and Mozambique to find out how and where most HIV infections were occurring in each country, and whether existing prevention efforts and expenditure matched these findings.
The recently released reports reveal that few prevention programs are based on existing evidence of what drives HIV/AIDS epidemics in the five countries surveyed.
In Lesotho, where nearly one in four are living with HIV, an analysis of national prevalence and behavioral data found that most new infections were occurring because people had more than one partner at a time, both before and during marriage. But Lesotho has no prevention strategies to address the problem of concurrent partnerships, or target couples who are married or in long-term relationships.
An evaluation of Mozambique's prevention response found that an estimated 19 percent of new HIV infections resulted from sex work, 3 percent from injecting drug use, and 5 percent from men who have sex with men (MSM), yet there are very few programs targeting sex workers, and none aimed at drug users and MSM.
The research also found that spending on HIV prevention was often simply too low: Lesotho spent just 13 percent of its national AIDS budget on prevention, whereas Uganda spent 34 percent, despite having an HIV infection rate of only 5.4 percent.
Debrework Zewdie, director of the World Bank's Global HIV/AIDS Unit, noted that the current global economic downturn made it more important than ever to get the most impact out of investments in HIV prevention. "These syntheses use the growing amounts of data and information available to better understand each country's epidemic and response, and identify how prevention might be more effective."
Link to UNAIDS reports
Those in the United States living with HIV/AIDS are more likely to use marijuana than those in Kenya, South Africa or Puerto Rica to alleviate their symptoms, according to a new study published in Clinical Nursing Research. Those who did use marijuana rate it as effective as prescribed or over the counter (OTC) medicines for the majority of common symptoms, once again raising the issue that therapeutic marijuana use merits further study and consideration among policy makers.
A significant percentage of those with HIV/AIDS use marijuana as a symptom management approach for anxiety, depression, fatigue, diarrhea, nausea, and peripheral neuropathy. Members of the University of California, San Francisco (UCSF) International HIV/AIDS Nursing Research Network examined symptom management and quality of life experiences among those with HIV/AIDS in the US, Africa, and Puerto Rico, to gain a fuller picture of marijuana’s effectiveness and use in this population.
Either marijuana use for symptom management is vastly higher in the US, or participants elsewhere chose not to disclose that they use it: nine tenths of study participants who said they used marijuana live in the US. No African participants said they used it, and the remaining ten percent were from Puerto Rico.
The researchers found no differences between marijuana users and nonusers in age, race, and education level, income adequacy, having an AIDS diagnosis, taking ARV medications, or years on ARV medications. But the two groups did differ in that marijuana users had been HIV positive longer, and were more likely to have other medical conditions. Transgender participants were also more likely to use marijuana.
Participants using marijuana as a management strategy were spread fairly consistent across all six symptoms, ranging from a low of 20% for fatigue to a high of 27% for nausea. Prescribed medications were used by 45% of those with fatigue, ranging down to almost 18% of those with neuropathy.
The findings contained nuances when comparing marijuana to other medications. Those who used marijuana rated their anxiety significantly lower than those who did not, and women who used marijuana had more intense nausea symptoms. For those who use both marijuana and medications for symptom management, antidepressants were considered more effective than marijuana for anxiety and depression, but marijuana was rated more highly than anti-anxiety medications. Immodium was better for diarrhea than marijuana, as were prescribed medications for fatigue. However, marijuana was perceived to be more effective than either prescribed or OTC medications for nausea and neuropathy. However, the differenced in perceived efficacy in all these results were slight.
As found in previous studies, those who used marijuana were less likely to comply with their regime of ARV medications. But perhaps counter-intuitively of the many reasons given for skipping pills, ‘forgetfulness’ was no different in this group than among those who did not use marijuana. Marijuana use is known to contribute to patients’ lack of compliance with ARV drugs, however those who use marijuana to target a particular symptom are actually more likely to stick closely to their ARV regimen too. The researchers point out that of those who used marijuana for their symptoms, it is not known whether they also used the drug for recreation. Patterns of how marijuana use interferes with patients’ adherence to medication regimens, along with other drugs, warrant further study.
The 775 participants were recruited from Kenya, South Africa, two sites in Puerto Rico, and ten sites in the United States. They had on average been diagnosed for a decade - the majority (70%) were taking anti-retroviral (ARV) medications and more than half had other medical conditions alongside HIV/AIDS. It is hard to pinpoint the marijuana use targeted to alleviate symptoms of those other illnesses as distinct from those relating solely to HIV/AIDS.
Data suggest that marijuana is a trigger among those susceptible to psychosis, and is also associated with the risk of suicidal thoughts. However it is not linked to an increased risk of lung cancer (over and above risks associated with smoking it along with tobacco).
The question of the use of marijuana for symptom management when legal drugs are available remains a practice and policy issue.
“Given that marijuana may have other pleasant side effects and may be less costly than prescribed or OTC drugs, is there a reason to make it available?” asks study leader Inge Corless. “These are the political ramifications of our findings. Our data indicate that the use of marijuana merits further inquiry.”
Marijuana Effectiveness as an HIV Self-Care Strategy.
Inge B. Corless, RN, PhD, FAAN et al
Clinical Nursing Research, 2009; 18 (2): 172 DOI: 10.1177/1054773809334958.
Link to CNR abstract
The large number of undiagnosed HIV infections in the UK is “appalling”, a former government official is quoted as saying in an editorial published in the May 30th edition of The Lancet.
“There is no credible strategy to diagnose and care for those living with, but unaware of HIV in Britain today”, writes the author of the editorial.
There are 77,000 people living with HIV in the UK. However, it is estimated that 21,000 of these individuals are unaware of their HIV infection.
Many of these undiagnosed individuals will only have their HIV detected when they are already seriously ill with an AIDS-defining illness. Late diagnosis of HIV is the underlying cause of the majority of HIV deaths still seen in the UK. With earlier diagnosis these individuals would have been able to take appropriate treatment for HIV and other infections meaning that these deaths are entirely avoidable.
Furthermore, there is accumulating evidence that the undiagnosed individuals are the principal source of new HIV infections in the UK. A presentation by Dr Valerie Delpech at a recent NAM symposium on the potential of HIV treatment to help control the spread of HIV emphasized the importance of undiagnosed HIV to the continued epidemiology of HIV. One of the event's take home messages was that reducing the number of undiagnosed HIV infections is essential to the control of the epidemic.
“It should be a matter of deep concern to the UK’s Department of Health that so many individuals are entirely unaware of their positive HIV status”, states the editorial. Recommendations from the Health Protection Agency that individuals with any risk or possible symptoms of HIV infection should be offered an HIV test “have largely been ignored”, write the author.
“No one is listening” to urgent pleas for action to reduce the high number of undiagnosed infections, continues the editorial. At a recent seminar on late diagnosis of HIV, a senior HIV consultant described the rejection by a specialist GP journal of a study showing that symptoms of primary HIV infection were often missed in general practice and the potentially serious consequences of this. Nor are hospitals paying adequate attention “to their public health responsibilities, of which HIV diagnosis is an important part.” Furthermore, primary care trusts have exhibited little interest in “this serious public health challenge.”
The Lancet editorial recommends that all patients registered with GPs and admitted to hospital who are aged between 15 and 59 should be offered an HIV test. It notes that routine antenatal HIV testing in the UK has a very high acceptance rate.
Failure to develop a strategy to deal with the high level of undiagnosed HIV infections in the UK “is an extraordinary failure of public health”, concludes the editorial, adding “this failure needs an urgent response.”
Editorial: The UK’s appalling failure to tackle HIV.
The Lancet 373: 1820, May 30, 2009 doi:10.1016/S0140-6736(09)61001-1
Lin k to Lancet editorial
Thursday, May 28, 2009
In an article published in Science, teams from the Institut Pasteurand the University of Limoges, associated with the CNRS and Inserm, decipher for the first time the molecular mechanism that enables bacteria to acquire multi-resistance to antibiotics, and that even allows them to adapt this resistance to their environment. This discovery highlights the difficulties that will have to be tackled by public health strategies if they are to address the problems created by multi-resistance.
Multi-resistance of bacteria to antibiotics is a phenomenon that appeared when these drugs began to be used in the 1950s. It was subsequently discovered that resistance genes were easily captured, disseminated and exchanged from one bacterium to another by a system involving genetic "copying and pasting" of the structures containing these genes, known as integrons. But the dynamics of these exchanges, which governs the multi -resistance development in bacteria, remained unknown.
The work of researchers from the Institut Pasteur associated with the CNRS (Bacterial Genome Plasticity unit, CNRS URA 2171) and from Inserm, within the Limoges Faculty of Medicine (EA3175, Inserm, Avenir Team), in cooperation with Spanish teams, reveals for the first time today how bacteria acquire these multi -resistance properties. It is actually the antibiotics themselves that trigger the synthesis of the bacterial enzyme that captures the resistance genes and enables their expression in the integron.
This enzyme also promotes the random rearrangement of the resistance genes within the integron. The order of these genes in the integron determines the degree of priority for their expression: the first are expressed most highly and give the bacteria the corresponding resistance. The last remain silent, although they are kept in reserve. When a new rearrangement occurs, triggered by taking an antibiotic, for example, they are likely to be moved to the first positions, and give the bacteria the required resistance to this drug. The bacteria with the right "combination" of genes will therefore be able to survive and ensure that the resistance potential is maintained from generation to generation.
This work shows the extent to which strategies of bacterial adaptation to antibiotics are effective, in both the short and the long term. It therefore clearly demonstrates the difficulties associated with bacterial genetics that future public health measures will have to take into account if they are to tackle the problem of multi-resistance.
The SOS Response Controls Integron Recombination.
Émilie Guerin ET AL
Science, 2009; 324 (5930): 1034 DOI: 10.1126/science.1172914
Link to Science abstract
In what could be a major pharmaceutical breakthrough, research published in The Federation of American Societies for Experimental Biology Journal, describes how scientists from St George's University, London have devised a one-two punch to stop HIV. First the report describes a new protein that can kill the virus when used as a microbicide. Then the report shows how it might be possible to manufacture this protein in quantities large enough to make it affordable for people in developing countries.
"We desperately need to control the spread of HIV, particularly in developing countries," said Julian Ma of the Department of Cellular and Molecular Medicine at St. George's and the senior researcher involved in the work. "A vaccine is still some way off, but microbicides could provide a more immediate solution, provided we can overcome major hurdles of high efficacy, low cost, and wide availability—all of which we address in this study."
In the research paper, Ma and colleagues describe how they combined two protein microbicides (b12 monoclonal antibody and cyanovirin-N) into a single "fusion" molecule and showed that this molecule is more active against HIV than either of its individual components. They designed synthetic DNA for producing this molecule and introduced this DNA into plant cells. After regenerating transgenic plants that produce the fusion molecule, they prepared the microbicide from a plant extract made by grinding the leaves.
"This study is nothing short of a breakthrough—not only does it yield a new drug to fight the spread of HIV, but it also shows us how we can produce it on the scale necessary to get it into the hands of those who need it most," said Gerald Weissmann, M.D., Editor-in-Chief of The FASEB Journal. "Unlike their unregulated counterparts in the dietary supplement industry, these scientists are using the engines of nature to manufacture pharmaceuticals that must undergo extensive safety and efficacy testing long before the first gel or cream is administered."
Design, expression, and characterization of a multivalent, combination HIV microbicide.
Amy Sexton, Sarah Harman, Robin J. Shattock, and Julian K.-C. Ma
The FASEB Journal, 2009; DOI: 10.1096/fj.09-131995
Link to FASEB abstract
Focusing HIV drug development on immune cells called macrophages instead of traditionally targeted T cells could bring us closer to eradicating the disease, according to new research from University of Florida and five other institutions.
In the largest study of its kind, researchers found that in diseased cells — such as cancer cells — that are also infected with HIV, almost all the virus was packed into macrophages, whose job is to "eat" invading disease agents.
What's more, up to half of those macrophages were hybrids, formed when pieces of genetic material from several parent HIV viruses combined to form new strains.
Such "recombination" is responsible for formation of mutants that easily elude immune system surveillance and escape from anti-HIV drugs.
"Macrophages are these little factories producing new hybrid particles of the virus, making the virus probably even more aggressive over time," said study co-author Marco Salemi, Ph.D., an assistant professor in the department of pathology, immunology and laboratory medicine at the UF College of Medicine. "If we want to eradicate HIV we need to find a way to actually target the virus specifically infecting the macrophages."
The researchers set out to see if HIV populations that infect abnormal tissues are different from those that infect normal ones, and whether particular strains are associated with certain types of illness.
They tackled the question using frozen post-autopsy tissue samples, pathology results and advanced computational techniques. They analyzed 780 HIV sequences from 53 normal and abnormal tissues from seven patients who had died between 1995 and 2003 from various AIDS-related conditions, including HIV-associated dementia, non-Hodgkin's lymphoma and generalized infections throughout the body. Four patients had been treated with highly active antiretroviral therapy, called HAART, at or near the time of death.
The researchers compared brain and lymphoma tissues, which had heavy concentrations of macrophages, with lymphoid tissues — such as from the spleen and lymph nodes— that had a mix of HIV-infected macrophages and T cells.
The analyses revealed great diversity in the HIV strains present, with different tissues having hybrid viruses made up of slightly different sets of genes. A high frequency of such recombinant viruses was also found in tissues generally associated with disease processes, such as the meninges, spleen and lymph nodes.
The researchers concluded that HIV-infected macrophages might be implicated in tumor-producing mechanisms.
The higher frequency of recombinant virus in diseased tissues likely is because macrophages multiply as a result of an inflammatory response, the researchers said.
"The study points to macrophages as a site of recombination in active disease," said neurobiologist Kenneth C. Williams, Ph.D., a Boston College associate professor and AIDS expert who was not involved in the study. "So people can say this is one spot where these viruses come from."
T cells — the so-called conductors of the immune system orchestra, whose decline is the hallmark of HIV disease — are an obvious target for HIV drug development because they die soon after infection, and are readily sampled from the blood and cultured. But although current drugs are effective at blocking infection of new cells and lowering viral loads to barely detectable levels, they never reduce the viral level in an infected person to zero.
"Where is it coming from?" said Michael S. McGrath, the University of California, San Francisco, professor who led the research team. "We believe it's coming from these macrophages ."
Macrophages, like T cells, can be infected multiple times by HIV. But unlike T cells, when they get infected, they don't die within days, but live for several months, all the while being re-infected with multiple viruses of different genetic makeup. That situation is ripe for the emergence of hybrids.
"Most people who look at viral sequences assume that evolution of the virus is linear. In the real world that doesn't happen — large parts of the virus are swapped in and out. This group has shown that in this model," Williams said. "It sort of overturns the old way of trying to match virus sequence with pathology."
Extensive HIV-1 Intra-Host Recombination Is Common in Tissues with Abnormal Histopathology
Susanna L. Lamers et al
PLoS ONE 4(3): e5065. doi:10.1371/journal.pone.0005065
Link to PLoS ONE abstract
— Researchers long ago rejected the theory that vaccines cause autism, yet many parents don't believe them. Can scientists bridge the gap between evidence and doubt?
This week, the open-access journal PLoS Biology investigates why the debunked vaccine-autism theory won't go away. Senior science writer/editor Liza Gross talks to medical anthropologists, science historians, vaccine experts, social scientists, and pediatricians to explore the factors keeping the dangerous notion alive—and its proponents so vitriolic.
Pediatrician Paul Offit has made it his mission to set the record straight: vaccines don't cause autism. But he won't go on Larry King Live—where he could reach millions of viewers—or anyplace celebrity anti-vaccine crusaders like Jenny McCarthy appear. ''Every story has a hero, victim, and villain,'' he explains. ''McCarthy is the hero, her child is the victim—and that leaves one role for you.''
When she read that hecklers were issuing death threats to spokespeople who simply reported studies showing that vaccines were safe, anthropologist Sharon Kaufman dropped her life's work on aging to study the theory's grip on public discourse. To Kaufman, a researcher with a keen eye for detecting major cultural shifts, these unsettling events signaled a deeper trend. ''What happens when the facts of bioscience are relayed to the public and there is disbelief, lack of trust?'' Kaufman wondered. ''Where does that lead us?''
Despite overwhelming evidence that vaccines don't cause autism, one in four Americans still think they do. Not surprisingly, the first half of 2008 saw the largest US outbreak of measles—one of the first infectious diseases to reappear after vaccination rates drop—since 2000, when the native disease was declared eliminated. Mumps and whooping cough have also made a comeback. Last year in Minnesota, five children contracted Hib, the most common cause of meningitis in young children before the vaccine was developed in 1993. Three of the children, including a 7-month-old who died, hadn't received Hib vaccines because their parents either refused or delayed vaccination.
Now, more than ten years after unfounded doubts about vaccine safety first emerged, scientists and public health officials are still struggling to get the story out. Their task is made far more difficult by the explosion of misinformation on the Internet, talk shows, and high-profile media outlets, by journalists' tendency to cover the issue as a "debate," and, as Kaufman argues, by an erosion of trust in experts.
Information technology has transformed the way trust and knowledge are produced, Kaufman says: ''Scientists have to consider their role in this changed landscape and how to compete with these other sources of knowledge.'' Simply relating the facts of science isn't enough. No matter that the overwhelming weight of evidence shows that vaccines don't cause autism. When scientists find themselves just one more voice in a sea of ''opinions'' about a complex scientific issue, misinformation takes on a life of its own.
A Broken Trust: Lessons from the Vaccine-Autism Wars.
PLoS Biology, 2009; 7 (5): e1000114 DOI: 10.1371/journal.pbio.1000114
Link to PLoS Bio abstract
Wednesday, May 27, 2009
Circus animals spend most of their time confined to cages or enclosures far smaller than those in zoos
"Whether it's lack of space and exercise, or lack of social contact, all factors combined show it's a poor quality of life compared with the wild," says lead researcher Stephen Harris of the University of Bristol, UK.
On average, circus animals were found to spend just 1 to 9 per cent of their time training, and the rest confined to cages or enclosures typically covering a quarter of the area recommended for zoos. While domesticated animals such as dogs or horses can adapt to these conditions, species such as elephants, lions, tigers and bears cannot, the researchers say.
Many of the confined animals exhibit stress behaviors such as pacing up and down for hours on end. "Even if they are in a larger circus pen, there's no enrichment such as logs to play with, in case they use them to break the fence and escape," says Harris,
Some countries, including Austria, have already banned wild animals from circuses, but they still feature prominently in the US and much of Europe.
Are wild animals suited to a travelling circus life?
Iossa, G.; Soulsbury, C.D.; Harris, S.
Animal Welfare, Volume 18, Number 2, May 2009 , pp. 129-140(12)
Link to AW abstract
A guide explaining prosecutions for HIV transmission has been produced by UK HIV charities. |
Since 2003, a number of people with HIV have been imprisoned for “reckless” HIV transmission and many more cases have been investigated by the police without reaching court.
The new guide explains that these prosecutions have been brought using the 1861 Offences Against the Persons Act and that the individuals have been convicted of grievous bodily harm.
For a person to be guilty of reckless HIV transmission, it is necessary for five criteria to apply at the time the alleged offence was committed:
- The person must know they have HIV.
- They did not use a condom.
- HIV was transmitted to their sexual partner.
There is information in the guide about the circumstances in which an offence has not been committed. For example, a person cannot be prosecuted for reckless HIV transmission if they had unprotected sex that did not result in HIV be transmitted.
Scientific evidence has been used to “prove” that a person transmitted HIV to another individual. The new guide explains that this involves complex tests known as phylogentic analysis. Although this can show if the virus in two individuals is similar, it cannot prove that a person transmitted HIV to another.
It is vital that individuals accused of reckless HIV transmission obtain expert legal advice as soon as possible. There is information in the guide about how to obtain this.
Finding out that you have HIV can be a shocking experience and difficult to come to terms with. Anger and blame are common experiences. However, feeling about living with HIVcan change over time, and the guide notes that tens of thousands of people with HIV are living normal, productive lives. It therefore urges people not to rush into an allegation of reckless transmission. It also notes that the sexual history of a person making a complaint will be thoroughly investigated ,in effect “put on trial” and previous sexual partners will need to be contacted and tested to rule out the possibility that they were the source of the HIV infection.
Link to Prosecutions for HIV Transmission [pdf]