Prevention of HPV-related oral cancer: assessing dentists' readiness.

OBJECTIVES: Epidemiological research indicates an association between the Human Papillomavirus (HPV) with a subset of oral cancers (OC). Dentists may play a role in primary prevention of HPV-related OC by discussing the HPV vaccine with patients. This study assessed dentists' readiness to discuss the HPV vaccine with female patients. STUDY DESIGN: Cross-sectional web-based survey. METHODS: A web-based survey based on the Transtheoretical Model was administered among Florida dentists (n = 210). RESULTS: The majority of participants (97%) fell into the precontemplation and contemplation stages of readiness to discuss the HPV vaccine with patients. Perceived role and liability were determined to be predictive of dentists in contemplation stage as opposed to those in precontemplation (P < 0.05). CONCLUSIONS: Findings suggest liability and perceived role as processes of change necessary to guide dentists to primary prevention of HPV-related OC despite high levels of knowledge. As public awareness of HPV-related OC increases, dentists may become more involved in primary prevention. Results of the current study may assist in developing intervention strategies for engaging dentists in discussing the HPV vaccine with patients.

Teaching women's health from a public health perspective: development of an innovative undergraduate course.

INTRODUCTION: A review of women's health courses across academic disciplines revealed gaps in addressing the full range of issues that impact women throughout the lifespan. METHODS: We designed an undergraduate course in women's health that is taught from a public health perspective, but includes a multidisciplinary approach that addresses health issues across the lifespan. Details related to syllabi, curriculum development, and course delivery are reviewed. RESULTS: Curriculum and topics were developed by reviewing existing women's health courses and identifying strengths and gaps. Course readings are drawn from a textbook, peer-reviewed scientific literature, news/media articles, and popular press. Classes included a mix of lectures, class/group discussions, group activities, videos and/or short media clips, student presentations (individual and group), and invited guest speakers. Of special interest are the innovative and varied student assessments that this course offers and the breadth of knowledge and critical skills that students acquire. DISCUSSION: Although the particular health topics women face may vary by geographic location, the theoretical underpinnings and lifespan approach will stay the same. Students learn health literacy and critical appraisal skills, appreciate the many dimensions of health, and recognize diverse antecedent factors and disparities that influence health. Utilizing this type of course structure, coupled with innovative and flexible student assignments, would be applicable to other courses in any country or setting such as men's, population, or mental health. The presented framework and experiences can facilitate college health professionals in future course development activities and assist in enabling students to be informed health advocates.

Development of muscle insulin resistance after liver insulin resistance in high-fat-fed rats.

Muscle and hepatic insulin resistance are two major defects of non-insulin-dependent diabetes mellitus. Dietary factors may be important in the etiology of insulin resistance. We studied progressive changes in the development of high-fat-diet-induced insulin resistance in tissues of the adult male Wistar rat. In vivo insulin action was compared 3 days and 3 wk after isocaloric synthetic high-fat or high-starch feeding (59 and 10% cal as fat, respectively). Basal and insulin-stimulated glucose metabolism were assessed in the conscious 5- to 7-h fasted state with the euglycemic clamp (600 pM insulin) with a [3-3H]-glucose infusion. Fat feeding significantly reduced suppressibility of hepatic glucose output by insulin after both 3 days and 3 wk of diet (P less than 0.01). However, a significant impairment of insulin-mediated peripheral glucose disposal was only present after 3 wk of diet. Further in vivo [3H]-2-deoxyglucose uptake studies supported this finding and demonstrated adipose but not muscle insulin resistance after 3 days of high-fat feeding. Muscle triglyceride accumulation due to fat feeding was not significant at 3 days but had doubled by 3 wk in red muscle (P less than 0.001) compared with starch-fed controls. By 3 wk, high-fat-fed animals had developed significant glucose intolerance. We conclude that fat feeding induces insulin resistance in liver and adipose tissue before skeletal muscle with early metabolic changes favoring an oversupply of energy substrate to skeletal muscle relative to metabolic needs. This may generate later muscle insulin resistance.

Region-specific corpus callosum atrophy correlates with the regional pattern of cortical glucose metabolism in Alzheimer disease.

BACKGROUND: Positron emission tomographic studies of patients with Alzheimer disease (AD) suggest a loss of metabolic functional interactions between different cortical regions. Atrophy of the corpus callosum as the major tract of intracortical connective fibers may reflect decreased cortical functional integration in AD. OBJECTIVES: To investigate whether regional atrophy of the corpus callosum is correlated with regional reductions of cortical glucose metabolism, as shown by positron emission tomography, and whether primary white matter degeneration is a possible cofactor of corpus callosum atrophy in AD. PATIENTS AND METHODS: We measured total and regional cross-sectional areas of the corpus callosum on midsagittal magnetic resonance imaging scans from 12 patients with AD and 15 age-matched control subjects. Regional cerebral metabolic rates for glucose in cortical lobes were measured by positron emission tomography using fludeoxyglucose F 18. White matter hyperintensities were rated in T2-weighted magnetic resonance imaging scans. RESULTS: The total cross-sectional area of corpus callosum was significantly reduced in patients with AD, with the most prominent changes in the rostrum and splenium and relative sparing of the body of the corpus callosum. Frontal and parietal lobe metabolism was correlated with the truncal area of the corpus callosum in AD. The ratios of frontal to parietal and of frontal to occipital metabolism were correlated with the ratio of anterior to posterior corpus callosum area in the group with AD. White matter hyperintensities did not correlate with corpus callosum atrophy in the patients with AD. CONCLUSION: The regional pattern of corpus callosum atrophy correlated with reduced regional glucose metabolism independently of primary white matter degeneration in the patients with AD.

Dissociation between corpus callosum atrophy and white matter pathology in Alzheimer's disease.

OBJECTIVE: To determine whether the size of the corpus callosum is related to the extent of white matter pathology in patients with AD and age-matched healthy control subjects. METHODS: White matter hyperintensity load and corpus callosum size were compared between 20 clinically diagnosed AD patients and 21 age-matched healthy control subjects. We investigated the effect of age and disease severity on corpus callosum size and white matter hyperintensity, in addition to the relation between corpus callosum areas and white matter hyperintensity load. RESULTS: We found significant regional atrophy of the corpus callosum in AD when compared with control subjects, although the groups did not differ in their white matter hyperintensity load. We further showed a region-specific correlation between corpus callosum size and white matter hyperintensity in the control group but not in AD patients. In the AD group, corpus callosum size correlated with age and dementia severity, whereas white matter hyperintensity correlated only with age. CONCLUSION: Corpus callosum atrophy in AD can occur independent of white matter degeneration, likely reflecting specific AD pathology in projecting neurons.

Presence and growth of Listeria monocytogenes in naturally-contaminated meats.

A total of 101 retail samples of pâté were analysed for the presence of Listeria spp., with 12 and seven samples respectively, found to contain L. innocua and L. monocytogenes, and one each containing L. welshimeri and L. ivanovii. The ability of Listeria spp. to grow on these pâté products was assessed over a 3-week storage period at 4 degrees C. L. monocytogenes was able to survive on the four naturally-contaminated pâtés tested, but growth was only apparent for L. innocua in a turkey-based pâté. Similar findings were noted with growth studies done with L. monocytogenes on naturally-contaminated wieners, ham and turkey breast. Very low numbers (< 10 cfu/g) of the organism were found initially on these products, with L. monocytogenes being found capable of surviving for long periods at 4 degrees C, but being incapable of multiplying. Similarly, pâtés artificially-inoculated with L. monocytogenes showed survival but not growth of the organism over a 3-week storage period at 4 degrees C.

The development of an efficient and rapid enzyme linked fluorescent assay method for the detection of Listeria spp. from foods.

Conventional isolation methods, including the Health Products and Food Branch (HPFB), Health Canada method used for the isolation and identification of Listeria species and Listeria monocytogenes from foods and environmental samples, can take a week or more to complete and are usually labor-intensive. This has led to the development of various rapid methods which attempt to generate results comparable to standard methods but in a reduced time-frame with less hands-on operation. Our previous work with rapid detection systems indicated that the recommended enrichment protocols failed to grow the Listeria to detectable levels in a reliable and consistent manner. In the present study, a novel enrichment protocol is described and consists of samples being pre-enriched in Palcam broth (incubated at 35 degrees C for 26 h), enriched in UVM 2 (30 degrees C for 26 h) and then plated and analysed by a rapid detection kit, with results being generated after 52 h of incubation. In total, 200 naturally contaminated samples were analysed by both the HPFB standard method and the Palcam method. The results showed that the Palcam method is comparable to the HPFB method. Further analysis involved a rapid detection system, which applies ELISA techniques and automation in an enzyme-linked fluorescent assay (ELFA) system. This system, referred to as the Vitek Immuno Diagnostic Assay System or VIDAS, can identify Listeria to the genus or species (L. monocytogenes) level. In this comparison, an additional 324 naturally contaminated samples were analysed by both the Palcam and ELFA methods. The sensitivity and specificity of the ELFA method were 98.1% and 97.0%, respectively, while the efficiency was 97.5%. False-negative and false-positive rates were 1.9% and 3.0%, respectively. These results show that the ELFA method (when using the Palcam method for pre- and secondary enrichment) was efficient and gave reliable results after 52 h of incubation, and met Health Canada's criteria for approval as a rapid method.

Survival of Listeria spp. on raw whole chickens cooked in microwave ovens.

The prevalence of microwave ovens in North American homes has increased dramatically within the last decade. Although microwave ovens are primarily used for reheating of foods, they are now more commonly being applied to the cooking of raw foods. Although cooking of raw foods, according to manufacturers' instructions targets an organoleptically acceptable end product, the process does not address the microbiological safety of the cooked food. Seventeen microwave ovens from various commercial suppliers were used to cook naturally contaminated whole raw broilers (< or = 1.8 kg) and roasters (> 1.8 kg) according to manufacturers' instructions. Temperature probes (six per chicken) were used to measure the temperature of chickens immediately after cooking and during the holding period. Of 81 Listeria-positive raw broilers and 93 raw roasters, 1 (1.2%) and 9 (9.7%), respectively, yielded viable Listeria spp. after microwave cooking. Of these, two were undercooked (visual inspection), one was over the maximum weight stipulated by the oven manufacturer and another one was over the maximum weight and undercooked. A significantly greater proportion of contaminated cooked birds was observed with roasters than with broilers, where for one of these contaminated roasters, the temperature at all six measured sites was > or = 87 degrees C. Most of the postcook Listeria-positive birds were associated with 2 of the 17 microwave ovens. Factors such as wattage, cavity size, and the presence or absence of a turntable seemingly did not play a significant role in the survival of Listeria spp. in microwave-cooked chicken. However, the general inability of microwave ovens to uniformly heat chicken carcasses was noted. In order to promote greater safety of microwave-cooked foods, general recommendations for consumers are provided.

Clinical update on the role of HPV and cervical cancer.

In the mid-1980s, a clear connection was made between infection by the human papillomavirus (HPV) and cervical cancer. This association led to the generation of a large body of literature about the diagnosis, testing, treatment, transmission and, virological life span of HPV-related neoplasms and cancers. Because of advances in virology, molecular biology, and biochemistry, more is known about HPV and its effects on cervical neoplasms than ever before. Because deaths from cervical cancer, while less common in the United States and western Europe, account for 20% of cancer deaths in women worldwide (1), accurate knowledge of the disease and its prevention is critical for nurses working with patients both with preinvasive and invasive disease.

Developing a measure of health-related quality of life for women with cervical dysplasia resulting from human papillomavirus infection.

Human papillomavirus (HPV) infection is the most common sexually transmitted infection in the USA, and has major physical and psychological consequences including fear, anxiety and stigma. To date, there is no measure of health-related quality of life specifically designed to assess symptoms and functioning for people with cervical dysplasia resulting from HPV infection. In the present study, we set out to develop a disease-specific measure of health-related quality of life among women with low-grade cervical dysplasia. We conducted literature reviews, open-ended interviews with patients, clinician surveys and cognitive interviews which guided item development. The result is a preliminary 36-item measure, the Functional Assessment of Chronic Illness Therapy-Cervical Dysplasia (FACIT-CD), which sets out to assess the physical and psychological health-related quality-of-life aspects of cervical dysplasia and will be validated in an upcoming study.

Delay in presentation to primary care physicians is the main reason why patients with rheumatoid arthritis are seen late by rheumatologists.

OBJECTIVES: To study the delay from the time of symptom onset to assessment by a Rheumatologist in patients with rheumatoid arthritis (RA) and to determine the contributions of patient and physician dependent factors to this delay. METHODS: Data were collected from 169 consecutive patients with RA at the time of assessment by Rheumatologists working in hospitals serving an inner city population in Birmingham, UK. Dates were recorded for: (i) onset of inflammatory joint symptoms; (ii) initial assessment in primary care; and (iii) referral from primary to secondary care. (iv) initial assessment by a rheumatologist in secondary care. RESULTS: The median delay from the onset of symptoms to a patient being assessed in secondary care was 23 weeks (IQR 12-54 weeks). The median delay before the patient was assessed in primary care was 12 weeks (IQR 4-28 weeks). For 96 patients (57%) more than half of the overall delay in assessment in secondary care was accounted for by a delay in assessment in primary care. CONCLUSIONS: Patient dependent factors, leading to a delay in consulting primary care physicians, are the principal reasons for the delay in patients with RA being seen by Rheumatologists in our population. A considerable body of evidence demonstrates that the earlier that therapy is introduced the better the clinical outcome. Consequently it is important to understand why some patients with RA delay in seeking medical advice, in order to allow effective interventions to reduce this delay.

Chlorimipramine: a novel anticancer agent with a mitochondrial target.

Mitochondria have been suggested to be a potential intracellular target for cancer chemotherapy. In this report, we demonstrate the ability of the tricyclic antidepressant chlorimipramine to kill human glioma cells in vitro by a molecular mechanism resulting in an increase in caspase 3 activity following inhibition of glioma oxygen consumption. Studies with isolated rat mitochondria showed that chlorimipramine specifically inhibited mitochondrial complex III activity, which causes decreased mitochondrial membrane potential as well as mitochondrial swelling and vacuolation. The use of chlorimipramine in human as an effective, non-toxic cancer therapeutic having a strong selectivity between cancer cells and normal cells on the basis of their mitochondrial function is discussed.

Fate of Listeria monocytogenes on Modified-Atmosphere Packaged Turkey Roll Slices.

The growth of Listeria monocytogenes on turkey roll slices stored at 4 and 10°C under a variety of different modified-atmospheres (Ms) was examined. While increasing in numbers on turkey roll slices stored in air, or in environments containing CO2 levels of 30 or 50% (remainder N2), L. monocytogenes was inhibited by a MAs containing 70% CO2, 30% N2. In all cases, Listeria did not grow as well in any of the MAs as compared to air. In addition, for all MAs tested, pseudomonads were inhibited to an equal or greater extent than L. monocytogenes . It is recommended that any MA-packaged turkey sandwiches with a shelf-life approaching 30 days, should be stored in a MA containing at least 70% CO2 to guard against the potential growth of L. monocytogenes .

Performance of the Microplate BacTrace™ ELISA Technique for Detection of Foodborne Salmonella.

The developmental BacTrace™ ELISA system which recognizes a common structural antigen (CSA-1) in the cell wall of target microorganisms was tested with pure cultures and naturally contaminated foods. The system readily detected all of the 104 Salmonella test strains but produced 38 (52.1%) false-positive reactions upon examination of 73 nonsalmonellae cultures. Citrobacter freundii , Escherichia coli , and Proteus mirabilis were primarily responsible for erroneous results. Of 119 foods tested, 37 (31.1%) were found to contain Salmonella by a standard cultural procedure. Parallel BacTrace™ testing of the nutrient broth (NB), tetrathionate brilliant green (TBG43), and selenite cystine (SC35) broth cultures arising from standard cultural analyses identified 24 (64.9%), 25 (67.6%), and 31 (83.8%) Salmonella contaminated foods, respectively. Maximum sensitivity of the test system (89.2%) could be attained through combination of ELISA results from both TBG43 and SC35. False-positive reactions were particularly prominent with high moisture foods.

Inadequacy of Small Transfer Volume and Short (6 h) Selective Enrichment for the Detection of Foodborne Salmonella.

The propensity of short (6 h) selective enrichment combined with a preenrichment to enrichment transfer volume ratio of 1:100 to provide greater method brevity could not be demonstrated. Inoculation of tetrathionate brilliant green (35 and 43°C), Rappaport-Vassiliadis (43°C), and selenite cystine (35°C) enrichment broths (9.0 ml) with 0.1 ml of preenrichment culture and incubation for 6 h identified, respectively, 107 (84.9%), 104 (82.5%), 112 (88.9%), and 113 (89.7%) of the 126 contaminated samples detected in the present study; homologous results with the 1.0-ml transfer volume showed a marginal increase in sensitivity. Recoveries of foodborne salmonellae with the standard (24-h) period of selective enrichment were generally transfer volume-independent and consistently exceeded that obtained with 6-h enrichment cultures. Results further underlined the importance of enrichment at an elevated (43°C) temperature for the effective repression of competitive microflora, and the facilitated isolation of Salmonella on plating media.

The inhibitory properties of various sponges on Listeria spp.

Various retail and environmental sponges were tested for inhibitory properties against Listeria species and several other bacterial genera. Sterile sponges, unrinsed and rinsed in sterile distilled water or sterile neutralizing buffer, were placed on seeded plates of tryptic soy agar with 0.6% yeast extract. Plates were incubated at 30 degrees C for 24 h and zones of inhibition measured. The Systems Plus environmental sponge and the Technical Service Consultants Ltd sponge (sTc) proved to be the only sponges which consistently demonstrated no inhibitory properties. Results using scanning electron microscopy showed considerable bacterial attachment to the Systems Plus sponge, further corroborating these findings.

Feeding trials of Listeria monocytogenes with a nonhuman primate model.

One of the major unanswered questions regarding the presence of Listeria monocytogenes in foods is how many cells must be ingested in order to cause illness. To answer this question, studies were undertaken by using Macaca fascicularis (cynomolgus monkey) as an animal model. Healthy nonhuman primates were dosed with various concentrations of L. monocytogenes suspended in sterile whole milk. Final concentrations of 10(5), 10(7), and 10(9) total cells of the organism were used; a control was also included. Blood samples, as well as fecal and nasal specimens, were taken at various time intervals. Only animals that received 10(9) cells of L. monocytogenes became noticeably ill, with symptoms of septicemia, irritability, loss of appetite, and occasional diarrhea. Monkeys that received 10(7) and 10(9) cells shed L. monocytogenes in the feces for approximately 21 days. In monkeys that received the dose of 10(9) cells, severe lymphopenia and neutrophilia occurred within 48 h. In a separate trial, monkeys received Maalox to reduce the gastric acidity of the stomach. However, no substantial differences were observed between Maalox-treated and control monkeys.

Fermentation of wort containing deoxynivalenol and zearalenone.

Wort containing deoxynivalenol and zearalenone, each added at a level of 1.9 µg/mL, was fermented by 3 strains ofSaccharomyces cerevisiae for 7 or 9 days to make beer. Analysis showed that deoxynivalenol was stable during this process. The major metabolite of zearalenone was ß - zearalenol, which formed in up to 69% of the initial zearalenone concentration, while up to 8.1% of the initial zearalenone was converted to α - zearalenol. The major part of the metabolism of zearalenone occurred by 1 - 2 days. Control experiments, where the yeasts were omitted and deoxynivalenol, zearalenone and α - and ß - zearalenol were added, showed good recovery and stability of the mycotoxins over the 7-9 day time period. No deoxynivalenol, zearalenone, α-zearalenol or ß-zearalenol was detected in control yeast fermentations where they were not added to the wort.