Skin cancer screening in primary care: prevalence and barriers.

BACKGROUND: Skin cancer incidence is increasing, but whether primary care providers routinely screen for skin cancer is not known. OBJECTIVE: We assessed whether primary care practitioners are performing skin cancer screening within the context of primary care and whether barriers exist that might act as impediments to the implementation of this practice. METHODS: A total of 465 primary care providers belonging to their respective county medical societies in either New Haven County, Connecticut, or Miami-Dade County, Florida were randomly selected and surveyed by mailed questionnaire regarding their skin cancer screening practices. RESULTS: Only 31% of responding physicians reported performing skin cancer screening on all of their adult patients. Of those not performing skin cancer screening on all adult patients, only 31% report performing screening on high-risk patients. Almost half of physicians reported that they do not perform skin cancer screening. We found that physicians' lack of confidence in identifying suspect lesions was a common barrier. Fear of patient embarrassment, inadequate lighting, or lack of studies demonstrating mortality benefits were not frequent deterrents. Furthermore, there was no statistical difference in screening rates between the more northern latitude and the more southern latitude. CONCLUSION: Skin cancer screening is not being performed within the context of primary care visits. Barriers exist that may impede skin cancer screening.

Derivation and biological characterization of a molecular clone of SHIV(KU-2) that causes AIDS, neurological disease, and renal disease in rhesus macaques.

Previously, we described the derivation of a pathogenic strain of simian-human immunodeficiency virus (SHIV(KU-2)) consisting of the tat, rev, vpu, and env genes of HIV-1 (strain HXB2) in a genetic background of SIV(mac)239 that causes AIDS and productive infection of the CNS in rhesus macaques (Macca mulatta) (Raghavan et al., 1997, Brain Pathol. 7, 851-861). We report here on the characterization of a molecular clone of SHIV(KU-2), designated SHIV(KU-2MC4), that caused CD4(+) T cell loss as well as neurological and renal disease in macaques. DNA sequence analysis of selected SIV regions of SHIV(KU-2MC4) revealed 10 nucleotide changes in the LTR, whereas Gag, Vif, Vpr, Vpx, and Nef had 1, 1, 1, 2, and 13 predicted amino acid substitutions, respectively, compared to SIV(mac)239. DNA sequence analysis of HIV-1 derived regions of SHIV(KU-2MC4) revealed 2, 1, 2, and 18 predicted amino acid substitutions in the Tat, Rev, Vpu, and Env proteins, respectively, when compared to SHIV-4. Unlike the parental SHIV-4, which is not tropic for macrophages, SHIV(KU-2MC4) replicated efficiently in macrophage cultures as determined by p27 assays. However, despite the numerous changes in the Env protein and newly acquired tropism for macrophages, SHIV(KU-2MC4), like the parental SHIV-4, used CXCR4 exclusively as its coreceptor for entry into susceptible cells. Inoculation of SHIV(KU-2MC4) into two rhesus macaques resulted in severe infection in which the numbers of circulating CD4(+) T cells in the blood declined rapidly by 2 weeks postinoculation and virus producing cells in the peripheral blood mononuclear cells were identified throughout the course of infection. At the time of euthanasia (20 and 22 weeks), both macaques had lost a significant amount of weight and had no circulating CD4(+) T cells. In addition, one macaque developed intension tremors and uncoordinated movements. Virological examination of tissues at necropsy revealed active virus replication in both lymphoid and nonlymphoid tissues such as the lung and brain. Histological examination revealed that the induced immunodeficiency was associated with lymphoid depletion of the lymph nodes and spleen, opportunistic infections, lentiviral encephalitis, and severe glomerulosclerosis of the kidney. This molecular clone will serve as the basis for analyzing the molecular determinants through which SHIV(KU-2) causes severe CD4(+) T cell loss, neurological disease, and SHIV nephropathy in rhesus macaques.