Gonorrhea and syphilis serve as models for the definition of criteria for the evaluation of screening programs for detection of disease. Mass screening and selective screening are distinguished from individual screening (case finding). Important characteristics of screening tests are sensitivity, specificity, efficiency, precision, accuracy, and acceptability. Program evaluation includes process evaluation and outcome evaluation. Major criteria to consider in the evaluation of mass screening programs are prevalence and incidence of disease, predictive value of tests used, yield, available screening tests, acceptance, follow-up services, costs and benefits, and control over the spread of infection. All forms of screening programs should be evaluated by available methods so that they will operate with maximal efficiency and so that nonproductive programs can be discarded.

Communicable Disease Control↗

PubMedDate not supplied

Risk profiles and epidemiologic interrelationships of sexually transmitted diseases.

In this study, the risk profiles and epidemiologic interrelationships of 13 sexually transmitted diseases (STD) were studied in 12,170 men and 6,125 women attending the Adelaide STD Clinic in South Australia from 1988 to 1991. Fifteen independent variables for men and 19 independent variables for women were analyzed by multiple logistic regression. Risk profiles were depicted graphically from the odds ratios of independent associations with the factors studied. These profiles showed a marked influence of socioeconomic factors on the epidemiology of hepatitis B infection, syphilis, scabies (in contrast with the pattern for pediculosis pubis), gonorrhea, and trichomoniasis. The risk profiles for warts, herpes, and molluscum contagiosum are similar and contrast with those of gonorrhea and chlamydia. The vaginitides showed clear differences, with bacterial vaginosis being directly associated with and candidiasis inversely associated with variables relating to sexual activity. In women, gonorrhea was a strong predictor of chlamydial infection and women with gonorrhea had twice the rate of other STDs collectively, compared with women who did not have gonorrhea. However, most other associations between individual STDs and other STDs collectively were of an inverse nature, although several strong associations between individual STDs were found on univariate analysis.

Adult↗

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Maternal attitudes in prepared and unprepared cesarean deliveries.

Cesarean preparation classes were instituted in an Eastern hospital and are described here briefly. One hundred and forty-three prepared and unprepared women delivering vaginally and by cesarean during a six-week period at that hospital were tested with the Maternal Attitude to Pregnancy Instrumemt. Prepared cesarean women had a significantly greater desire for active participation in the delivery than women unprepared for cesarean delivery. Multiparous cesarean-delivery mothers with previous vaginal deliveries had a significantly more positive attitude than those who had never delivered vaginally.

Attitude↗

PubMedDate not supplied

Factors associated with trichomoniasis, candidiasis and bacterial vaginosis.

Of 6125 women attending an STD clinic from 1988 to 1991, 5365 (88%) were tested for vaginitis of whom 97 (1.8%) had trichomoniasis, 945 (17.6%) had candidiasis, 734 (13.7%) had bacterial vaginosis and 3628 (67.6%) were free of vaginal infection. Dual infections occurred in 49 (0.9%) patients. Independent predictors for trichomoniasis by multivariate analysis were being pregnant (odds ratio (OR) = 2.4), having vaginal discharge or dysuria (OR = 4.7), being Aboriginal (OR = 4.3), being Asian (OR = 5.0), being unemployed (OR = 2.1) or tattoed (OR = 1.9). Many factors, including use of oral contraception (OR = 1.2) and current antibiotic medication (OR = 1.5), had a small significant association with candidiasis. Independent predictors for bacterial vaginosis were having multiple sex partners in the past month (OR = 1.6), being unmarried (OR = 1.5), being unemployed (OR = 1.3) being a prostitute (OR = 1.5) and not currently using antibiotic medication (OR = 2.5). The epidemiological profiles were consistent with trichomoniasis and bacterial vaginosis being sexually transmitted diseases with epidemiology different from that of gonorrhoea and chlamydia and different from each other, and candidiasis being a disease in which constitutional factors are more important than issues relating to sexual transmission.

Candidiasis↗

PubMedDate not supplied

Factors associated with hepatitis B infection.

Men and women patients not previously immunized or tested, attending the Adelaide (South Australia) STD clinic from 1988-1991, were tested for hepatitis B infection, and potential risk factors detected by multiple logistic regression. Of 7055 men and 3425 women patients tested 811 (11.5%) men and 250 (7.3%) women were seropositive. Among men seropositivity was associated with being Asian (odds ratio (OR) = 14.5), being Aboriginal (OR = 2.2), homosexual behaviour (OR = 3.8), intravenous drug use (OR = 3.2) being over 24 (OR = 2.7), previous STD (OR = 1.8), being unemployed (OR = 1.3) and having sex outside the state in the past 3 months (OR = 1.3). Among women seropositivity was associated with being Asian (OR = 10.3), being Aboriginal (OR = 2.4), intravenous drug use (OR = 3.8), being over 24 (OR = 1.6) and having vaginal discharge or dysuria (OR = 1.4). Seropositivity was not independently associated with being a prostitute or having multiple sex partners in the past 3 months. Among seropositive individuals, risk factors were not readily identifiable for 15% of men and 43% of women. Univariate analysis may provide misleading indicators of risk factors because of the confounding influence of other factors, particularly intravenous drug use. In selective vaccination campaigns the target group should be determined on the basis of local circumstances. In South Australia this group should include men with an STD. The success of selective campaigns will be jeopardized by the failure to identify risk factors in many of those who become infected, and in such situations universal vaccination or widespread screening may be more appropriate strategies.

Adolescent↗

PubMedDate not supplied

The epidemiology of genital chlamydial infection in South Australia.

All laboratory tests performed and medical reports received in South Australia in 1990-1991 and screening results for Chlamydia trachomatis at the central STD clinic from 1988-1991 were analysed to clarify the epidemiology of genital chlamydial infection. From 70,494 laboratory tests in 1990-1991, 2449 (3.5%) infections were detected of which 2431 (99%) were also reported by clinicians. Infections were detected in 1335 (6.4%) of 21,004 patients (71% of 29,401 attendees) screened at the central STD clinic from 1988 to 1991. STD clinic yields suggest a male:female ratio of 1.08:1 (95% confidence intervals = 1.05:1-1.11:1), with 46% of infections in males and 67% of infections in females being asymptomatic. For both males and females, infection rates were highest in 15-19-year-olds and decreased with increasing age, but were not independently related to marital status. The statewide epidemiological pattern was probably distorted in medical reports because of selection biases in testing (89% of tests performed by non-STD clinicians were on females) which resulted in decreased detection in asymptomatic females, symptomatic and asymptomatic males, married persons and unmarried young persons 15-19-year-old females and 15-24-year-old males) by private practitioners. A cost-effective method for increased detection of chlamydial infection in undertested groups (particularly of asymptomatic unmarried males aged 15-24) will be required to control transmission of chlamydial infection in South Australia. Increased detection in young married persons is also desirable.

Adolescent↗

PubMedDate not supplied

Judging the success of reform: the view from within.

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Health Care Reform↗

PubMedDate not supplied

Drug cultures in context.

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Attitude to Health↗