Monitoring of human papillomavirus vaccination.

Persistent infection with oncogenic human papillomavirus (HPV) is a necessary causal factor in the development of cervical cancer. Moreover, HPV, predominately type 16 and to a lesser degree type 18, is linked causally to varying proportions of other anogenital cancers (vulva, vagina, penis, anus) as well as cancers elsewhere in the body (oropharynx, larynx, conjunctiva). HPV types 6 and 11 cause most of genital warts and recurrent respiratory papillomatosis. Effective prophylactic vaccines have been developed. In this review, we address briefly the immunological aspects of HPV infection and the results of HPV vaccination trials. Internationally standardized monitoring and evaluation of prophylactic HPV vaccination programmes will be essential for arriving at the most cost-effective strategies for cancer control.

The human laminin receptor is a member of the integrin family of cell adhesion receptors.

A receptor for the adhesive basement membrane protein, laminin, was isolated from human glioblastoma cells by affinity chromatography on laminin. This receptor has a heterodimeric structure similar to that of receptors for other extracellular matrix proteins such as fibronectin and vitronectin. Incorporation of the laminin receptor into liposomal membranes makes it possible for liposomes to attach to surfaces coated with laminin. The receptor liposomes also attached to some extent to surfaces coated with fibronectin, but not with other matrix proteins. These properties identify the laminin receptor as a member of the integrin family of cell adhesion receptors.

Detection of the BC 24 transforming fragment of the herpes simplex virus type 2 (HSV-2) DNA in cervical carcinoma tissue by polymerase chain reaction (PCR).

The polymerase chain reaction (PCR) was used to investigate samples from Indonesian and Swedish patients with cervical intraepithelial neoplasia grade III (CIN III), squamous cell carcinoma or adenocarcinoma of the cervix for the presence of a transforming fragment (BC 24) of herpes simplex virus type 2 (HSV-2) DNA. The PCR test for HSV-2 DNA was more sensitive than the infectivity endpoint titer in a cell culture system and no cross reactivity was found with either varicella-zoster virus, cytomegalovirus, Epstein-Barr virus, human papillomavirus 16 or 18, or human genomic DNA. Using this PCR test, 2 out of 5 cases with CIN III, 10 of 71 squamous cell carcinomas, and 3 of 11 adenocarcinomas of the uterine cervix were found to contain DNA sequences homologous to the BC 24 fragment of the HSV-2 genome. Only two of the samples containing this transforming region of the HSV-2 DNA were positive in a PCR assay for the HSV-2 DNA polymerase gene. The great majority of the HSV-2 BC 24 DNA positive (12 of 15) came from the Indonesian group of patients. All 15 CIN III or cancer samples positive for the HSV-2 BC 24 fragment were also positive for papillomavirus DNA. In line with observations made by others, our data support the hypothesis that HSV infection could represent one of several possible oncogenic cofactors leading to cervical carcinoma. The HSV cofactor might be more important in the Indonesian than in the Swedish population.

Senior house officers: the lost tribes.

There are more senior house officers than doctors in any other training grade in Britain but nobody knows what they do in hospitals or has a clear idea what skills they should be learning. Nobody is responsible for them and they suffer from having a poor career structure and inadequate training. Now that there are government initiatives to reduce the hours that junior doctors work and to limit the time it takes to train to become a specialist, the problems that senior house officers face can no longer be ignored. A conference for senior house officers held last week talked about the problems that they face and tried to find some solutions.

Inequalities cause reproductive deaths.

PIP: A US organization, Population Action International, is reported in this article to have released findings on the health risks for women in 118 countries. Countries are ranked on 10 indicators, including such indicators as the number of births to women aged under 19 years, the availability of legal abortion, maternal mortality, and level of prenatal care. Italy, Denmark, Norway, and Sweden are identified as countries with low reproductive risk for women. The worst ranked countries are identified as Zaire, Angola, and Somalia. 21 countries were placed in the high risk group, of which only two, Haiti and Afghanistan, are not located in Africa. Editorial comment in the report is described in this article as reflecting the position that countries fail in investing in women's health, with devastating consequences. Some poor countries, such as Cuba, Tunisia, and Costa Rica, are cited for their investments in health care and family planning. The report is described as asserting that low status also prevents women from maintaining good health. Both access to reproductive health services and changing social norms supporting traditional roles in early and frequent childbearing are important to women's improved health status. It is also important for women to have educational and economic opportunities. Population Action International is seeking greater foreign aid contributions for family planning services in developing countries, emergency care in childbirth, health education, AIDS education, and access to safe abortion services.^ieng

Pill scare linked to rise in abortions.

PIP: It is argued that the British media exposure of the potential harmful side effects from oral contraceptive use contributed to raising fears and panic among users. The government in 1995 announced that there was double the risk of deep vein thrombosis from use of contraceptive pills containing gestodene or desogestrel. The government was advised by the Committee on Safety of Medicines. The British Pregnancy Advisory Service (BPAS) announced that the rise in abortions after the announcement could have been due to the pill scare. BPAS reported that during December 1995-February 1996 the number of abortions performed increased by 823 over the number reported in the same period a year before. The increase reversed a declining trend in abortions performed by a service that carries out 20% of all abortions in Great Britain. A BPAS spokesperson suggested that women panicked and stopped taking their pills, even though the government warned against an abrupt stop in usage. Women appeared to have not understood that risk was highest among overweight women and women with a prior history of thromboses. Findings from a BPAS survey that was conducted among almost 300 women with unplanned pregnancies showed that over 40% of women stopped taking their contraceptive pills immediately after the government's warning. 61% did not finish taking their remaining pills in the month's cycle. Under 20% of women switched to another contraceptive method. Another BPAS survey among 90 women that sought contraceptive advice at BPAS clinics found that nearly 50% of women expected the pill to be an unsafe method. It was suggested that media messages should have emphasized that the risk of unplanned pregnancies was much greater than the risks of deep vein thromboses.^ieng