Physician behaviour and compliance.

Four major components are involved in physician behaviour that may impact on patient compliance with treatment regimens: compassion, communication, activating patient self-motivation and shared responsibility with the patient. An attitude of concern coupled with hope and interest in the patient's future well-being effect compliance. Other facets of compliance may be outside the physician's control: factors within the patient or within the environment and factors intrinsic to hypertension in itself suggest that physician behaviour is the factor most easily controlled by the physician to enhance compliance.

Chlamydial infection in women with cervical dysplasia.

The prevalence of antibodies to chlamydiae, particularly to TRIC (trachoma-inclusion conjunctivitis) agents, was studied in women with cervical dysplasia and in women attending selected clinics (obstetrics, cancer-screening, and gynecology). In addition, attempts were made to isolate TRIC agents and herpesviruses from the cervices of these women. TRIC agent recovery rates 4.1 per cent for women with dysplasia, 5.4 per cent for pregnant women, 7.8 per cent in the women's clinic, and 0.8 per cent in the cancer-screening clinic. Herpesvirus recovery rates were lower, on the order of 1 per cent or less in each clinic. Complement-fixing antibodies to chlamydial group antigen were detected in 21.5 per cent of women with dysplasia. With a more sensitive fluorescent antibody method, 77.6 per cent of the women with dysplasia or cervical cancer were shown to have antibodies to chlamydiae. In general, antichlamydial antibodies were less prevalent in the other clinic populations. The results of this study indicate that women with cervical dysplasia or cancer may have a high prevalence of antibodies to sexually transmitted agents other than herpesvirus type 2.

Diagnosis of Herpesvirus hominis infections in a general hospital laboratory.

There is a greatly increased interest in Herpesvirus hominis infections especially those of type 2 associated with genital lesions or neonatal disease. Physicians are eager to confirm the clinical impression with a specific virologic diagnosis such as isolation of the agent and its typing, and type-specific antibody responses. Procedures are reviewed here which permit such studies in general microbiology laboratories equipped for simple cell culture and immunofluorescence. This paper recounts experience with several laboratory methods and evaluates their efficiency and practicability in a general laboratory. Virus isolation was optimal if specimens were obtained from visible lesions early in their evolution and it often provided a specific diagnosis, including typing of the isolate by immunofluorescence, within 24 to 48 h. Estimation of serum antibodies to herpes simplex virus type 1 and 2 by indirect immunofluorescence was more sensitive and perhaps also more specific than by microneutralization test. A pilot study of herpes simplex virus antibody titers in mothers and in the cord blood of the offspring suggested the need to evaluate a possible protective role of high titer antibody in the fetus.

Inactivation of Herpesvirus hominis types 1 and 2 by silver nitrate in vitro and in vivo.

Herpes simplex virus (HSV) types 1 and 2 (two strains each) were inactivated at different rates in vitro by 40 muM AgNO(3). The inactivation of HSV type 1 strains was virtually complete in 10 to 15 min, whereas almost half of the infectivity of HSV type 2 strains survived this exposure. One strain of type 1 inoculated into rabbit eyes was almost completely inactivated by 1% AgNO(3) solution dropped into the eye 20 min later, so that there was markedly reduced viral replication and less corneal herpetic disease. One strain of HSV type 2 in the rabbit eye was not effectively inactivated by 1% AgNO(3). From these results, it seems likely that AgNO(3) instillation into the eyes of a newborn who has passed through a birth canal infected with HSV might prevent eye infection with HSV type 1 but not with type 2. The greater resistance of HSV type 2 strains to chemical inactivation in vitro and in vivo may be of medical concern.