Male circumcision reduces risk of HIV transmission from women

In the study, published in the Feb. 15 issue of The Journal of Infectious Diseases, now available online, Jared Baeten and colleagues from the United States and Kenya collected detailed sexual data from a group of male Kenyan truckers and, using statistical models, developed infectivity measures that estimate the per-sexual-act probability of HIV transmission. The study is the first to calculate the probability of infection for men who have multiple, concurrent heterosexual partners, which was found to be significantly higher than infectivity rates calculated in the past from studies of monogamous couples. Their results may help explain the rapid spread of HIV in settings where circumcision is not common and multiple sexual partnerships are.

Between 1993 and 1997, 745 male employees of trucking companies based in Mombasa, Kenya were followed for the study. Initially they were evaluated for circumcision status and HIV-negativity. Over the length of the study the men were asked to give information concerning the number of sexual encounters with three different partner types–wives, casual partners, and prostitutes–and were screened for HIV and other sexually transmitted infections. At the end of the study the probability of infection was calculated using a statistical model that incorporated published data to estimate the rates of HIV infection among the three types of sexual partners.

For the men in the study, the overall probably of becoming HIV-infected following a single act of intercourse was calculated to be .0063, or one in 160. Uncircumcised men had a more than two-fold increased risk of infection per sexual act compared with circumcised men–one in 80 versus one in 200. Read more »

Anemia

Background
Anemia, like a fever, is a symptom of disease that requires investigation to determine the underlying etiology. Often, practicing physicians overlook mild anemia. This is similar to failing to seek the etiology of a fever. The purpose of this article is to provide a method of determining the etiology of an anemia.

Anemia is strictly defined as a decrease in red blood cell (RBC) mass. Methods for measuring RBC mass are time consuming, are expensive, and usually require transfusion of radiolabeled erythrocytes. Thus, in practice, anemia is usually discovered and quantified by measurement of the RBC count, hemoglobin (Hb) concentration, and hematocrit (Hct). These values should be interpreted cautiously because they are concentrations affected by changes in plasma volume. For example, dehydration elevates these values, and increased plasma volume in pregnancy can diminish them without affecting the RBC mass.
Pathophysiology
Erythroid precursors develop in bone marrow at rates usually determined by the requirement for sufficient circulating Hb to oxygenate tissues adequately. Erythroid precursors differentiate sequentially from stem cells to progenitor cells to erythroblasts to normoblasts in a process requiring growth factors and cytokines. This process of differentiation requires several days. Normally, erythroid precursors are released into circulation as reticulocytes.

Reticulocytes remain in the circulation for approximately 1 day before reticulin is excised by reticuloendothelial cells with the delivery of the mature erythrocyte into circulation. The mature erythrocyte remains in circulation for about 120 days before being engulfed and destroyed by phagocytic cells of the reticuloendothelial system. Read more »

Dengue Fever

Background
Dengue, the most common arboviral illness transmitted worldwide, is caused by infection with 1 of the 4 serotypes of dengue virus, family Flaviviridae, genus Flavivirus (single-stranded nonsegmented RNA viruses). Dengue is transmitted by mosquitoes of the genus Aedes, which are widely distributed in subtropical and tropical areas of the world, and is classified as a major global health threat by the World Health Organization (WHO).

Initial dengue infection may be asymptomatic (50%-90%), may result in a nonspecific febrile illness, or may produce the symptom complex of classic dengue fever (DF). A small percentage of persons who have previously been infected by one dengue serotype develop bleeding and endothelial leak upon infection with another dengue serotype. This syndrome is termed dengue hemorrhagic fever (DHF), although dengue vasculopathy has been proposed as a better term, as fluid loss into tissue spaces can lead to prolonged shock and complications, including gastrointestinal bleeding, a greater fatality risk than bleeding per se. Some patients with dengue hemorrhagic fever develop shock (dengue shock syndrome [DSS]), which may cause death.

Dengue virus transmission follows two general patterns—epidemic dengue and hyperendemic dengue. Epidemic dengue transmission occurs when dengue virus is introduced into a region as an isolated event that involves a single viral strain. If the number of vectors and susceptible pediatric and adult hosts is sufficient, explosive transmission can occur, with an infection incidence of 25%-50%. Mosquito-control efforts, changes in weather, and herd immunity contribute to the control of these epidemics. Transmission appears to begin in urban centers and then spreads to the rest of a country. This is the current pattern of transmission in parts of Africa and South America, areas of Asia where the virus has reemerged, and small island nations. Travelers to these areas are at increased risk of acquiring dengue during these periods of epidemic transmission.

Hyperendemic dengue transmission is characterized by the continuous circulation of multiple viral serotypes in an area where a large pool of susceptible hosts and a competent vector (with or without seasonal variation) are constantly present. This is the predominant pattern of global transmission. In these populations, antibody prevalence increases with age and most adults are immune. Hyperendemic transmission appears to be a major risk for dengue hemorrhagic fever. Travelers to these areas are more likely to be infected than are travelers to areas that experience only epidemic transmission. Read more »

Medical Alert Companies Comparison – Medical Alert Monitoring Systems

When you compare medical alert companies, you are not comparing companies medical alert device companies but service provider companies. This makes comparison process little tricky. Let me use industry knowledge and experience to act as shopper and market researcher.

Think you are going out to stay at a hotel that you’ve never been to before. We will use this analogy to compare medical alert companies. The hotel may appear clean, have nice surrounding, and great amenities, but the wait staff may not be providing good service you are expecting you may have been better off asking a friend what their experience was like, read reviews by others online, or a review by a local travel critic. That’s where we come in.

Assume the hotel is type of the medical alert monitoring device that you will use. Does it have all of the physical features, functions, or the look and feel that you want?

What kinds of Medical Alert Companies are there?

• Full Service These medical alert companies provide the entire operation from sales, to equipment service, to central station monitoring, all themselves. They do not source-out the operations to any third parties.

• Reseller/Marketing Only These medical alert companies take care of the marketing only of the product and service. In today’s digital age, they typically have a website and place ads in magazines, on television, or through retail displays in their storefronts.

• Partial Service These medical alert companies typically take care of the sales and service, but hire out the central station monitoring to a third party. This is due to the very high costs of opening and maintaining a central monitoring station; especially if it is certified or listed by one or more agencies like Underwriters Laboratories (UL).

• The hostess is like the sales person you’ll be speaking with. Are they able to give you an accurate estimate of how long your wait time may be for a table? If they tell you they can accommodate your group size, or maybe a request for special accommodations for a handicapper or a child playing areas?

• The hotel staff is like the customer service representatives and central dispatch operators. These are the people that you or your loved one will spend the most of your time communicating with and get the most satisfaction from. Are they attentive, knowledgeable, friendly, and patient? Are they maintaining the highest standards available and required to have continual training to be sure they are?

Who are then actual Medical Alert Monitoring Companies?

That can sometimes be very difficult finding out who is really who. The full service companies can be easy as they will usually come right out and tell you! The partial service companies will usually tell you who will monitor your loved one typically after you come right out and ask. Very few are up front about it, but some are.

It is not easy to get correct information from some reseller companies. We try to uncover who these companies are, and let you know who is providing the monitoring services for them, so you can read about the actual medical alert company servicing your loved one.

Why You Should Care about Medical Alert Companies?

The full service medical alert companies have a much larger capital and human investment than the partial and marketing only companies. That gives them a vested interest in the quality and care provided to their customers from end-to-end.

The partial service companies have a much greater investment than the reseller/marketing only companies because they take care of the sales, customer service, equipment service, shipping, etc. themselves. They don’t handle the monitoring, but they do more than just market the service.

It is very important to find-out what type of medical alert company you are dealing with. The more services that are under one roof could mean higher customer satisfaction and better quality control.

If you can get a quality, full service, and highly rated company in the same price range as a marketing only or partial company, would you pick the full service company?