Eileen D. Dickman

Human papillomavirus vaccine acceptability among parents of 10- to 15-year-old adolescents.

Objective. To determine human papillomavirus (HPV) vaccine acceptance among parents of 10- to 15-year-old adolescents. Materials and Methods. Five hundred seventy-five parents or guardians completed a 30-question survey regarding their knowledge of HPV and acceptance of an HPV vaccine. Afterward, subjects read an HPV educational fact sheet and completed a 26-question survey. Results were compared using the χ2 test, analysis of variance, and McNemars test. Results. More than 60% of subjects had a general understanding of HPV. Parents opposed to the HPV vaccine were more likely to believe it would promote earlier initiation of coitus compared with parents supportive or undecided about vaccination (24%, 9%, and 6%, respectively; p = .003). Of the subjects initially opposed to or undecided about the HPV vaccine, 37% and 65%, respectively, supported HPV vaccination after an educational intervention. Conclusions. A brief educational intervention significantly improved parents acceptance of the HPV vaccine. The negative impact of an HPV vaccine perceived as condoning early initiation of sexual intercourse seems to be minimal.

Decreased neural crest stem cell expansion is responsible for the conotruncal heart defects within the Splotch (Sp2H)/Pax3 mouse mutant

OBJECTIVE Several mouse models of cardiac neural crest cell (NCC)-associated conotruncal heart defects exist, but the specific cellular and molecular defects within cardiac NCC morphogenesis remain largely unknown. Our objective was to investigate the underlying mechanisms resulting in outflow tract defects and why insufficient cardiac NCC reach the heart of the Splotch (Sp(2H)) mouse mutant embryo. METHODS For this study we used in vitro cell culture techniques, in vivo mouse-chick chimeras, BrdU cell proliferation labeling, TUNEL labeling to visualize apoptosis and the molecular markers AP-2, Wnt-1 and Wnt-3a to characterize NCC morphogenesis in vivo. RESULTS Expression of the NCC marker AP-2 revealed an extensive reduction in migratory NCC, however the rates of cell proliferation and apoptosis were unaffected, and do not account for the Sp(2H) NCC-associated heart defects. Further expression analysis revealed that Wnt-1, but not Wnt-3a, is expressed at decreased levels within Sp(2H) and that the cardiac NCC fail to undergo normal NC stem cell proliferative expansion prior to migration while still in the neural folds. However, when placed into a wild-type matrix or a tissue culture environment, the Sp(2H) cardiac NCC could migrate normally. Additionally, this reduced population of Sp(2H) NC stem cells do migrate properly within the Sp(2H) environment, as observed by neurofilament expression and cardiac innervation. CONCLUSIONS Taken together, all these data indicate that the Sp(2H) defect is intrinsic to the NC stem cells themselves and that there is a decrease in the number of pre-migratory cardiac NCC that form. It appears that this decrease in NCC number is the primary defect that ultimately leads to a lack of a cardiac NCC-derived Sp(2H) outflow tract septum.

Abnormal skeletogenesis occurs coincident with increased apoptosis in theSplotch (Sp2H) mutant: Putative roles forPax3 andPDGFR? in rib patterning

Although the importance of the transcription factor Pax3 has been identified in many embryological processes including neural crest cell migration, neural tube closure, and limb muscle formation, its role in proper formation of the ribs has not been well characterized. We have used the Splotch mouse which has a mutation in the Pax3 gene to determine what role Pax3 may play in rib morphogenesis. Homozygous Splotch embryos collected from days 13.5 to 16.5 of gestation displayed severe rib abnormalities including fusions at both the proximal and distal regions. Given its expression in the dermomyotome, we sought to determine when Pax3 expression in the Splotch mutant initially becomes abnormal and which rib segment progenitors may be affected. Prior to somite differentiation at 9.5 dpc (days post coitum), Pax3 is normally expressed in the somites; after differentiation, however, Pax3 expression is diminished in Splotch embryos. We also determined that significantly increased levels of apoptosis occur in the thoracic region by 11.0 dpc relative to wild‐type littermates. Because Patch mouse mutants which fail to express PDGF α‐receptor also have rib abnormalities, we sought to determine whether Pax3 may influence the expression of this receptor. By in situ hybridization, we determined that initially the expression of PDGFRα is normal in Splotch mutants at 10.0 dpc, but decreases by 12.5 dpc in the thoracic somite region, suggesting that Pax3 may act upstream of PDGFRα. Taken together, our results show that Pax3 expression is important for normal rib development and that increased apoptosis occurs in the thoracic muscles. We suggest that Pax3 may influence the expression of PDGFRα, and that the reduced and/or deficient thoracic muscles may contribute to the resulting rib abnormalities. Anat Rec 255:353–361, 1999.

New Insights into Retinoid Signaling in Cardiac Development and Physiology

Retinoic acid (RA) and the retinoids are potent hormones derived from the nutrient vitamin A; they bind members of the nuclear steroid receptor family (RAR, RXR), which are ligand-dependent trans-activators of target gene transcription. Although classic nutrition studies largely ignored heart as a retinoid target, recent interest in this subject stems from RAs potent cardiac teratogenicity, the identification of retinoid receptors in the heart, and the cardiac malformations observed in retinoid receptor null mutant mice. This review summarizes recent research into retinoid contributions predominantly in the embryonic heart. (Trends Cardiovasc Med 1997;7:324-329).

Personal digital assistants used to document compliance of bacterial vaginosis treatment

Objective: The objective of this study was to estimate patient compliance with oral and vaginal metronidazole treatment of bacterial vaginosis using personal digital assistants (PDAs) and paper diaries. Goal: The goal of this study was to assess a novel compliance documentation approach. Study: After each dose of intravaginal or oral metronidazole, 71 subjects recorded the time on a paper diary and answered questions on a PDA. All PDA entries were unknowingly time-date-stamped. Subjects returned for 2- and 6-week posttreatment examinations. Compliance was calculated using a repeated-measures multivariate analysis of variance (ANOVA). Results: Mean patient compliance rates within the oral metronidazole group were greater with the paper diary compared with the PDA (68.3% and 50.0%, respectively, P = 0.001). The observed rate of compliance agreement for PDA versus paper diary was 69.0% (kappa = 0.4). The majority of noncompliant subjects reported they were compliant with the PDA and paper diary. Conclusions: PDAs could more accurately document true compliance rates and could be reasonable instruments to assess compliance in intravaginal antimicrobial drug or contraceptive trials.

Telemedicine network telecolposcopy compared with computer-based telecolposcopy.

Objectives. To compare computer-based telecolposcopy with telemedicine network telecolposcopy. Materials and Methods. An on-site expert and local clinician at two rural sites conducted colposcopic examinations on 264 women. Colposcopic images were captured and transmitted to two other experts at a remote location using a statewide telemedicine system and a computer and modem-based system. Sensitivity and specificity, agreement of examination adequacy and management, effects of delayed interpretations, and costs were compared for each system. Results. A greater rate of satisfactory colposcopy results was reported by the telemedicine network (66.1%) compared with computer-based (43.6%) telecolposcopy (p < .0001). Greater rates of cervical biopsy (p = .005) and endocervical curettage (p = .03) were required by delayed telecolposcopy compared with immediate telecolposcopic services. There were no significant differences in sensitivity of detecting cervical neoplasia among the types of the telecolposcopy. Computer-based telecolposcopy cost

Women's Responses to Cervical Interrogation by Fluorescent and Reflective Spectroscopy

28 less per patient than telemedicine network telecolposcopy. Conclusions. Computer-based telecolposcopy may be a reasonable, cost-effective adjunct to on-site colposcopy for evaluating women in medically underserved areas. Synchronous telecolposcopic examination minimizes histologic sampling and improves consultation.

Patient acceptance of fluorescent and reflective spectroscopy as a replacement test for the pap smear

Objective. To determine womens responses to cervical interrogation by fluorescent and reflective spectroscopy (FRS). Materials and Methods. A convenience sample of women scheduled for a colposcopic examination was interrogated by a cervical FRS system. Thereafter, women completed a 24-item questionnaire that assessed their responses to the spectroscopic test. Likert-scale responses were compared among subgroups using the &khgr;2 test for trend. Results. Most women favored FRS used for locating (97.7%; 170/174) and selectively sampling (96.6%; 168/174) cervical neoplasia. Fewer women (81.0%; 141/174) wanted FRS to replace the Pap smear. Most women were neither nervous (73.6%; 128/174) nor bothered (89.1%; 155/174) by the extra time for the FRS assessment. Womens acceptance was substantiated by 84.9% (146/174) and 90.8% (157/173) wanting their doctor to have and insurance company to pay for FRS, respectively. Conclusions. Use of FRS as a colposcopic adjunct was supported very favorably by women. Fewer women supported FRS replacing Pap smears. These high rates of approval by women should help the implementation of FRS technology.

Temporally-regulated retinoic acid depletion produces specific neural crest, ocular and nervous system defects

Objective. To determine womens acceptance of fluorescent and reflective spectroscopy (FRS) as a potential replacement test for the Pap smear. Materials and Methods. Women scheduled for a colposcopic examination, or a colposcopic and FRS examination, completed a 22-item questionnaire that included demographic data, medical history, and preference-type questions. Data were compared using &khgr;2 and Wilcoxons rank sum tests. Results. Women considered accuracy, comfort, and quick results to be the most important characteristics for new cervical cancer tests. Immediate test results were preferred strongly by both groups (control, 84.5%; scanned, 88.6%). Provided FRS was more accurate than the Pap smear, most women (control, 74.7%; scanned, 68.2%) would rather have FRS if it cost the same as a Pap smear. Conclusions. Women consider accuracy, comfort, and time critical issues with respect to FRS used as a primary screening test. Acceptance of this new technology will be facilitated by designing equipment accordingly to satisfy the concerns of women.