Chlamydia trachomatis, herpes simplex virus 2, and human T-cell lymphotrophic virus type 1 are not associated with grade of cervical neoplasia in Jamaican colposcopy patients.

BACKGROUND: A few recent studies have suggested that other sexually transmitted infections may increase the likelihood of a human papillomavirus (HPV) infection progressing to high-grade cervical neoplasia and cancer. GOAL: The goal was to assess whether exposures to Chlamydia trachomatis, human T-cell lymphotrophic virus type 1 (HTLV-I), and/or human simplex virus type 2 (HSV-2) are greater in colposcopy patients with cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) than in patients with low-grade cervical neoplasia (CIN1). STUDY DESIGN: Sequential patients (n=447) attending a colposcopy clinic in Kingston, Jamaica, a country with high cervical cancer rates and high HTLV-I prevalence, were tested for (1) HPV DNA by L1 consensus primer (MY09/11) polymerase chain reaction assays, (2) C trachomatis DNA by ligase chain reaction, (3) C trachomatis antibodies by both microimmunofluorescence and a peptide (VS4) enzyme linked immunosorbent assay (ELISA), (4) HTLV-I antibodies by ELISA confirmed by western blotting, and (5) HSV-2 antibodies by a recombinant HSV-2-specific ELISA. Odds ratios and 95% confidence intervals were estimated with use of multinomial logistic regression models. RESULTS: HPV DNA detection was associated with grade of cervical neoplasia but other evaluated sexually transmitted infections were not. CONCLUSIONS: HTLV-I, C trachomatis, and/or HSV-2 were not associated with severity of cervical neoplasia in Jamaican women.

The impact of parenting on conduct disorder in Jamaican male adolescents

The present study examined the feasibility of using a new theoretical model to determine the association between parenting factors and conduct disorder in Jamaican male adolescents. The issues are discussed within the framework of family, peer group, and biological factors associated with conduct disorder.(Au)

The role of the cytology laboratory in the diagnosis and screening of breast cancer

The use of fine needle aspiration cytology as a diagnostic and screening tool was examined. Cytology reports for five hundred and forty-five aspirates for the period 1993-1995 were used and findings reported as (1) malignant 97; (2) suspicious 27; (3) atypical 37; (4) benign 229; and (5) unsatisfactory 155. Histology results were obtained for 208 of the 545 cases (38.2 percent) and confirmed carcinoma in 92/97 malignant, 25/27 suspicious and 14/37 atypical cases. Biopsy of 73/229 benign lesions showed carcinoma in 4. There were no false positive cases. Statistical analysis showed a sensitivity rate of 87 percent and a positive predictive value of 100 percent. In response to questionnaires submitted to consultants and residents in the Department of surgery 15 replies were received. The analysis of responses revealed scores of above 67 percent (13/15) for knowledge questions. The majority used FNA technique more than half of the time in the management of patients with palpable lesions. There was general acceptance of FNAC by both doctors and patients. Thirty-two patients responded to questionnaires issued. The majority of patients showed good tolerance of the technique and the analysis revealed a good understanding of the role of the FNAC procedure (AU)

Type-specific prevalence of human papillomavirus DNA among Jamaican colposcopy patients

Human papillomavirus (HPV) types differ in their associations with cervical cancer. Therefore, the types of HPV in precancerous lesions are important. In many regions with high cancer incidence, the HPV types in precancerous lesions have not been well studied. In Jamaica, a country that has high cervical cancer incidence, 174 colposcopy patients were tested for HPV DNA using polymerase chain reaction. HPV DNA detection was strongly related to presence and grade of cervical neoplasia (P<.001). Furthermore, severe neoplastic change was most highly associated with HPV DNA types also considered high-risk for severe neoplassia in other populations. HPV-45 DNA, a high-risk type uncommon in most previously tested countries, was detected in 12 percent of patients who had neoplasia. Thus, cervical neoplasia in Jamaica, as elsewhere, is linked to HPV. The high prevalence of HPV-45 DNA was notable, and its relation to high cervical cancer incidence in Jamaica must be assessed. (AU)

Human T-cell lymphotropic virus type I and severe neoplasia of the cervix in Jamaica

Human T-cell lymphotropic virus type I (HTLV-I) was associated with carcinoma of the cervix in Japan in a recent study that compared hospital cases with healthy population-based controls. To test this relationship in women more alike for cervical neoplasia risk factors (including sexual behavior and human papilloma virus: HPV), we enrolled consecutive patients from a colposcopy clinic in Kingston, Jamaica (an HTLV-1 endemic area). Patients underwent Pap smear, calopscopy, biopsy and cervical swab for detection of HPV by polymerase chain reaction. Cases were defined as women with CIN-3 or invasive cancer (CIN-3/CA). Controls included all patients with either CIN-1 or koilocytotic atypia, atypical squamous cells of undetermined significane or benign cervical pathology (all but one had at least inflammatory changes). Patients with CIN-2 were excluded to minimize risk of case-control misclassification. Cases were much more likely to be HTLV-1 seropositive than controls. Although mean age differed significantly between cases (mean age = 39 years) and controls (mean age = 33 years), control for age did not explain the relation of CIN-3/CA with HTLV-1. Among HPV DNA positive subjects the age-adjusted association was not diminished but lost statistical significance. HTLV-1 seroprevalence may be independently associated with progression to severe neoplasia of the cervix (AU)

Study of the factors associated with the development of conduct disorder in Jamaican male adolescents

Using an adapted multi-dimensional etiological model examines some of the factors which are said to contribute to the development of conduct disorder in adolescence. Three hypotheses which postulates specific relationships among the incidence of conduct disorder and three major factors (family, peer group and biological factors), were used to test the credibility of the model. The model was tested with black male adolescents in Kingston, Jamaica. Findings indicate that two of the three hypotheses are supported, i.e. there seemed to be some association between family factors and the presence of conduct disorder, little association with severity of conduct disorder; however there seemed to be significant association between peer group factors, specifically with peer group relations and the severity of conduct disorder; but there there appeared to be no association between biological factors and the presence or severity of conduct disorder. It therefore appears that the several factors thought to contribute to delinquency do not seem to operate with the same force in terms of the presence and severity of conduct disorder. Concludes that it may be possible to isolate one or more sets of factors which seem to be more influential in the development of juvenile delinquency; suggests that social policy makers look in some depth at specific family factors identified from study (absence of mother, low contact with mother, number of changes in living arrangements, and the presence of a negative parental role) which are associated with this disorder in order to develop preventive social policy initiatives. (AU)

Study of the factors associated with the development of conduct disorder in Jamaican male adolescents

Using an adapted multi-dimensional etiological model examines some of the factors which are said to contribute to the development of conduct disorder in adolescence. Three hypotheses which postulates specific relationships among the incidence of conduct disorder and three major factors (family, peer group and biological factors), were used to test the credibility of the model. The model was tested with black male adolescents in Kingston, Jamaica. Findings indicate that two of the three hypotheses are supported, i.e. there seemed to be some association between family factors and the presence of conduct disorder, little association with severity of conduct disorder; however there seemed to be significant association between peer group factors, specifically with peer group relations and the severity of conduct disorder; but there there appeared to be no association between biological factors and the presence or severity of conduct disorder. It therefore appears that the several factors thought to contribute to delinquency do not seem to operate with the same force in terms of the presence and severity of conduct disorder. Concludes that it may be possible to isolate one or more sets of factors which seem to be more influential in the development of juvenile delinquency; suggests that social policy makers look in some depth at specific family factors identified from study (absence of mother, low contact with mother, number of changes in living arrangements, and the presence of a negative parental role) which are associated with this disorder in order to develop preventive social policy initiatives.

Lymph node pathology in infants of HTLV-I seropositive mothers - abstract

In a cohort of seronegative mother-infant pairs being studied for perinatal transmission of the human T-lymphotropic virus type (HTLV-I), it was noticed that some infants developed persistent lymphadenopathy for which no specific cause was apparent. In order to determine whether this lymphadenopathy reflected a specific lymphoreticular abnormality, the lymph node pathology was studied, using morphological and immunohistochemical methods. Of 17 infants with lymphadenopathy, 16 were from seropositive mothers. Twenty-four infants (7.0 percent) in the cohort group seroconverted. Only 4 of these were infants with lymphadenopathy. Seroconversion in these tended to occur later than in infants without lymphadenopathy (mean 12 months; range 10 - 18 months). The lymph node histology showed non-specific reactive hyperplasia with a predominance (14/15) of mixed and paracortical hyperplasia. On immunohistochemistry, CD25 staining, characteristic of neoplastic transformation by HTLV-I, was positive in 6/11 cases but without correlation with seropositivity in these infants. This pattern of hyperplasia is unusual in infancy. As in HIV-induced lymphodenopathy, although the changes are not specific, they are sufficiently distinctive, particularly in HTLV-I endemic areas, to warrant serological testing of infants and mothers. The immune reponse without seroconversion appears aberrant. (AU)

Measurement of cardiac output in man with a U.S. $150 plethysmograph

It has been found possible to adapt a simple battery-operated plethysmograph costing U.S.$150 for the measurement of cardiac output. Although the method is certainly less convenient and possibly less accurate than the computerized impedance cardiographs(costing $23 000) now often used in the United States, it provides a useful measurement of changes in cardiac output over a period of time. In developing countries, it can be recommended for the repeated assessment or monitoring of patients during surgery, in Critical Care Units and in the evaluation of patients during circulatory stress tests (AU)