Intended and unintended consequences of abortion law reform: perspectives of abortion experts in Victoria, Australia.

INTRODUCTION: In Victoria, Australia, abortion was decriminalised in October 2008, bringing the law in line with clinical practice and community attitudes. We describe how experts in abortion service provision perceived the intent and subsequent impact of the 2008 Victorian abortion law reform. METHODS: Experts in abortion provision in Victoria were recruited for a qualitative semi-structured interview about the 2008 law reform and its perceived impact, until saturation was reached. Nineteen experts from a range of health care settings and geographic locations were interviewed in 2014/2015. Thematic analysis was conducted to summarise participants' views. RESULTS: Abortion law reform, while a positive event, was perceived to have changed little about the provision of abortion. The views of participants can be categorised into: (1) goals that law reform was intended to address and that have been achieved; (2) intent or hopes of law reform that have not been achieved; (3) unintended consequences; (4) coincidences; and (5) unfinished business. All agreed that law reform had repositioned abortion as a health rather than legal issue, had shifted the power in decision making from doctors to women, and had increased clarity and safety for doctors. However, all described outstanding concerns; limited public provision of surgical abortion; reduced access to abortion after 20 weeks; ongoing stigma; lack of a state-wide strategy for equitable abortion provision; and an unsustainable workforce. CONCLUSION: Law reform, while positive, has failed to address a number of significant issues in abortion service provision, and may have even resulted in a 'lull' in action.

Inhibition of Eyes Absent Homolog 4 expression induces malignant peripheral nerve sheath tumor necrosis.

Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive sarcomas without effective therapeutics. Bioinformatics was used to identify potential therapeutic targets. Paired Box (PAX), Eyes Absent (EYA), Dachsund (DACH) and Sine Oculis (SIX) genes, which form a regulatory interactive network in Drosophila, were found to be dysregulated in human MPNST cell lines and solid tumors. We identified a decrease in DACH1 expression, and increases in the expressions of PAX6, EYA1, EYA2, EYA4, and SIX1-4 genes. Consistent with the observation that half of MPNSTs develop in neurofibromatosis type 1 (NF1) patients, subsequent to NF1 mutation, we found that exogenous expression of the NF1-GTPase activating protein-related domain normalized DACH1 expression. EYA4 mRNA was elevated more than 100-fold as estimated by quantitative real-time PCR in most MPNST cell lines. In vitro, suppression of EYA4 expression using short hairpin RNA reduced cell adhesion and migration and caused cellular necrosis without affecting cell proliferation or apoptotic cell death. MPNST cells expressing shEYA4 either failed to form tumors in nude mice or formed very small tumors, with extensive necrosis but similar levels of proliferation and apoptosis as control cells. Our findings identify a role of EYA4 and possibly interacting SIX and DACH proteins in MPNSTs and suggest the EYA4 pathway as a rational therapeutic target.

Oxygen tension directs the differentiation pathway of human cytotrophoblast cells.

During placental development, human cytotrophoblast cells can differentiate to either villous syncytiotrophoblast cells or invasive extravillous trophoblast cells. We hypothesize that oxygen tension plays a critical role in determining the pathway of cytotrophoblast differentiation. A highly purified preparation of cytotrophoblast cells from human third trimester placenta was cultured for 5 days in either 20% or 1% oxygen tension. The cells incubated at 20% oxygen formed a syncytium as determined by immunohistochemistry using an anti-desmosomal protein antibody that identifies cell membranes. In addition, the mRNA was markedly induced for syncytin, a glycoprotein shown to be essential for syncytiotrophoblast formation, and for human placental lactogen (hPL), which is a specific marker for syncytiotrophoblast cells. In contrast, the cell incubated at 1% oxygen tension did not fuse by morphologic analysis and did not express syncytin or hPL mRNA. However, these cells expressed abundant amounts of HLA-G, a specific marker for extravillous trophoblast cells, which was not seen in cells incubated at 20% oxygen tension. These results suggest that low oxygen tension directs differentiation along the extravillous trophoblast cell pathway while greater oxygen tension directs differentiation along the villous trophoblast cell pathway.

Dietary and lifestyle factors affecting plasma vitamin D levels in Asian children living in England.

OBJECTIVE: To determine the vitamin D status of a sample of young Asian children living in England by measurement of plasma 25-hydroxycholecalciferol levels; to relate biochemical measurements with parameters of diet, lifestyle and iron status in this population. DESIGN: The 'Infant Feeding in Asian Families' survey covered infants born to mothers of Bangladeshi, Indian or Pakistani origin, plus a sample of children born to White mothers in 41 local authority areas. The current study describes vitamin D values in a sub sample of Asian children from that survey. SETTING: Forty-one local authority areas which covered 95% of the Asian population at the time of the 1991 Census and include areas with the highest and lowest density of Asians. SUBJECTS: Seventy-one percent (2382) of mothers who were originally eligible were interviewed on four occasions up to the time their infant was 15 months. One thousand, seven hundred and thirty-eight of these children were followed up for this current study. Of these 618 had a blood sample analysed for vitamin D. OUTCOME MEASURES: Previous day's food intake, normal dietary intake, indicators of iron status and plasma vitamin D levels. RESULTS: Plasma vitamin D values are lower in the three groups of Asian children than values reported for children of a similar age in the National Diet and Nutrition Survey. Between one third and a half of children with a low haemoglobin also had low plasma vitamin D values; there was a significant association between failure to take a vitamin supplement, chapati consumption and low vitamin D values. CONCLUSIONS: It is particularly important that pre-school Asian children receive a vitamin D supplement. Children with low haemoglobin values should be screened for vitamin D deficiency.

Iron status of Asian children aged 2 years living in England.

Haemoglobin and ferritin values were analysed in blood from 1057 children, aged 2 years, of Asian parents living in England. Children who had thalassaemia trait or a current/recent infection were excluded. Twenty nine per cent of Pakistani, 25% of Bangladeshi, and 20% of Indian children had haemoglobin < 110.0 g/l. The recent national diet and nutrition survey of preschool children found a prevalence of 12% of 2 year olds with haemoglobin < 110.0 g/l. No single factor accounted for more than a small proportion of the variance in haemoglobin and ferritin values, but the most significant factors that had a negative effect on iron status included the amount of cows' milk consumed, the use of a baby bottle, and mother's place of birth being outside of the UK. Taking vitamin or iron supplements was positively associated with iron status in one or more of the three groups.

A prospective study of viral and mycoplasma infections in chronic inflammatory bowel disease.

Seventy-two children with chronic inflammatory bowel disease were investigated for infections with various viruses and Mycoplasma pneumoniae, Chlamydia psittaci, and Coxiella burnetii to determine whether these pathogens are associated with acute onset exacerbations. Altogether 54 infections were identified serologically, of which 23 (42.6%) were associated with exacerbations. This corresponded to 24.2% of the recorded exacerbations during the study period. The respiratory pathogens accounted for 59.3% of the infections and 43.8% of these were associated with gastrointestinal symptoms. This is consistent with the observation that up to 40% of the exacerbations were associated with symptoms of antecedent or concurrent infection, most commonly involving the respiratory tract. Rubella virus, Epstein-Barr virus, and adenovirus were associated with acute exacerbations in 5 children. Thus, common pathogens were frequently associated with exacerbations and account for a large proportion of the commonly reported symptoms of a concurrent infection. The possible causal relationship between these pathogens and exacerbation of inflammatory bowel disease is discussed. Reactivation of latent herpesviruses was identified in 4 children with active disease and indicates that the converse relationship may also occur.

Screening tests for antibodies to cytomegalovirus: an evaluation of five commercial products.

Four hundred and ninety two samples of serum from blood donors were screened for the presence of antibodies specific to cytomegalovirus using radioimmunoassay, a modified complement fixation test, and five commercially available tests: the Cetus CMV IHA, Abbott CMV total AB EIA, Cytomegalisa Stat EIA, Enzygnost EIA, and Virenz G-CMV EIA. A wide variation in results was found, with only 53.5% of the sera giving total concordance by all methods. Rates of seropositivity in the different tests ranged from 34.9% to 59.3%, with sensitivities ranging from 75.2% to 99.1% compared with the radioimmunoassay. Of 211 sera which gave positive results with four or more of the tests, none was negative by the radioimmunoassay and Abbott EIA, three were negative in Cetus IHA and Enzygnost EIA, and 11 were negative in the modified complement fixation test. Virenz G and Cytomegalisa Stat EIAs, however, gave 40 (19%) and 49 (23.2%), respectively, as negative. The results confirmed the reliability of the radioimmunoassay for the detection of the antibody status to CMV, but this test is too elaborate for a screening procedure. The Abbott EIA and Cetus IHA were found to be the most suitable for this purpose in spite of high false positive rates.

Cytomegalovirus infection in dialysis patients.

We have studied cytomegalovirus (CMV) infection in 197 patients on regular dialysis treatment and 170 healthy platelet donors. Evidence of past CMV infection was found significantly more often in patients than in controls (137 of 197 v 60 of 170; p less than 0.001) at the commencement of the study. During a 12 month period 4 of the 60 dialysis patients initially found to be seronegative, but none of the 110 seronegative controls, developed primary CMV infection. Five of the 137 dialysis patients and one of the 60 controls initially found to be seropositive showed evidence of recurrent infection. Typically, there was only a transient elevation of CMV IgM antibody titer in both primary and recurrent infection. However, one dialysis patient with recurrent infection and another 5 initially seropositive patients showed persistence of CMV:IgM antibody production suggesting that they were experiencing chronic active infection. Neither primary nor recurrent infection was invariably a consequence of transfusion of blood or blood products. There were no clear-cut clinical sequelae from any of the three forms of infection documented.

Hotting-up the complement-fixation test.

A detailed investigation into the effect of modifying the incubation temperature of the complement-fixation (CF) test is described. For varicella-zoster virus cytomegalovirus and rubella virus, increasing the incubation temperature progressively increased the sensitivity of the CF test to reach a maximum at 15 degrees C, at which temperature the geometric mean titre of seropositive samples was significantly greater than that found at 4 degrees C. For these three viruses, each serum shown to contain IgG antibodies by ultrasensitive radioimmunoassay procedures was detected by CF following incubation at 15 degrees C. No false-positive reactions occurred at 15 degrees C, but it was our impression that anticomplementary activity was enhanced at this temperature. Significant increases in antibody titre at 15 degrees C were also seen when measles virus, respiratory syncytial virus, adenovirus and Mycoplasma pneumoniae were employed as CF antigens. The results demonstrate that the CF test should be performed at 15 degrees C if optimum sensitivity is to be achieved. The ability of the test to detect significant rises in antibody titre was not impaired at the higher incubation temperature.