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Biomedical subjects

K E Rogstad

Publications and source records attributed to K E Rogstad.

At least 37 records · Page 2Linked to original sources
PubMed2002

Standards for comprehensive sexual health services for young people under 25 years.

This document is a first response to the need to develop sexual health services for young people on a single site whilst awaiting research from pilot studies of 'one stop shops' suggested in the Sexual Health and HIV strategy. It is a document which is intended to be a tool to use for those wishing to set up a service providing testing for sexually transmitted infections and provision of contraceptive services for those under 25 years. It is not intended that such a service would replace existing specialist or general practice care but complement it, allowing clients to choose the service most appropriate and acceptable to them, with close links and clear pathways of care for referral between services. This paper should be used as a template when initiating and monitoring a clinic but some of the standards may not be achievable without significant financial input. However, economic limitations should not detract from striving to achieve the best possible care for those most at risk from sexually transmitted infections and unwanted pregnancies. For example, not all clinics will be able to provide the recommended tests for the diagnosis for gonorrhoea and chlamydia immediately, but should work towards achieving them. Although the upper age limit in this document is defined as 25 years, some providers may wish to limit clinics to those under 20 depending on local needs. Detailed information on specific issues such as consent and confidentiality, provision of contraception, investigation of non-sexually transmitted vaginal infections and sexually transmitted infection management and diagnosis are referenced and we recommend these are accessed by the users of this document. Many of the references themselves are live documents available on the worldwide web, and are constantly updated. The Sexual Health and HIV Strategy has now been published and these standards are aimed at those who wish to provide a level 2 sexual health service for young people wherever the setting e.g. genitourinary outreach clinic, contraceptive services, general practice. This document is a starting point to be reviewed and updated as new research becomes available, as the Sexual Health Strategy is implemented and with further input from providers of care (family planning, general practice, genitourinary medicine, gynaecology and paediatrics) and service users. All service providers must maintain a high quality of care and have networks both with those who provide more specialized services (Level 3) and Level 1 services. This document is an initial attempt to ensure that there is equity of clinical provision wherever a Level 2 sexual health service is provided and should be a useful tool for those setting up or monitoring services.

Adolescent↗
PubMed2002

Doncaster: the public health response to a local cluster of heterosexually acquired HIV infection.

In recent years, clusters of sexually transmitted HIV infection have attracted some media prominence in the UK. We describe our response to a local HIV cluster of five cases that acquired a high media profile. Practical difficulties encountered included: ensuring medical confidentiality in an outbreak control team which included many professional groups; handling a large volume of helpline calls; differing views on how specific health promotion should be; and the impact of summer leave on the control team's continuity. Following publicity, two further cases of HIV infection were found, bringing the total cluster to seven. Both later cases named the man at the centre of the cluster as a sexual partner. Of these two cases, one was local, identified as a direct result of the campaign. The other, living 170 miles distant in London, was identified as a result of increased media awareness. Eventually, the press named the man they thought to be the source case, which the outbreak control team had avoided doing. Good inter-disciplinary working made a co-ordinated public health response possible, and the 1,600 helpline calls dealt with served to reassure the public. Over 1,000 of the callers were advised to contact the Genito Urinary Medicine (GUM) department of their local hospital for counselling and testing of whom 772 took the advice. However, the longer-term effect on sexual behaviour was minimal as evidence by a subsequent survey.

Adult↗
PubMed2001

The prevalence of Chlamydia trachomatis infection in male undergraduates: a postal survey.

OBJECTIVES: To determine the prevalence of Chlamydia trachomatis infection in male undergraduates and to investigate whether prevalence increases with time spent at university. To investigate the feasibility of screening men for C trachomatis by self sampling and posting of urine specimens. METHODS: The study design was a postal survey undertaken by the Department of Genito-Urinary Medicine (GUM) and Student University Health Service (SUHS) in SHEFFIELD: 2607 male undergraduates from the SUHS patient list were invited to participate in the study by providing a first void urine specimen and posting it to the laboratory. The main outcome measure was the detection of C trachomatis infection. RESULTS: 758 students participated in the study, a response rate of 29.1%. Nine students (1.2%) tested positive for C trachomatis. The prevalence of infection in the first, second, and third year of study was 0.7%, 1.5%, and 1.6% of participants respectively. There was no statistically significant difference in prevalence of infection between first and third year students (chi(2) test, p = 0.32). However, students with chlamydia had a higher median age (Mann-Whitney U test, p < or = 0.05). Contact tracing identified four further cases of C trachomatis infection. CONCLUSION: Screening for C trachomatis infection by postal survey is feasible. However, the response rate in this study was poor and the estimated sample size was not reached. Therefore, it has not been possible to determine the true prevalence of infection in this population or to accurately assess changes in prevalence with time spent at university.

Adolescent↗
PubMed2000

Exploring the sexual histories of older GUM clinic attenders.

Little is known either of the factors motivating clinic attendance in later life, or the sexual health histories of older clinic attenders. A self-administered questionnaire study linked to patient note data aiming to explore these issues was undertaken within 3 genitourinary medicine (GUM) clinics in the Trent region. Participants comprised 224 individuals aged 50 years and older attending the 3 clinics during the study period. The majority of study participants were attending the clinic with a suspected sexually transmitted infection (STI) (n = 145, 64.7%) and approximately half (n=119, 53.1%) were first-time GUM clinic attenders. Data available for participants recruited from the Sheffield clinic indicated that, although the majority of participants reported having had only one sexual partner during the last 12 months, a significant minority reported considerably higher numbers of partners, including those classed 'higher risk' for STI acquisition. These data indicate that older people engage in behaviours that place them at risk of STI acquisition and many attend GUM clinics for the first time in later life.

Age Factors↗
PubMed2000

Community control of Chlamydia trachomatis.

UNLABELLED: In order to determine the amount of Chlamydia trachomatis that is diagnosed outside genitourinary medicine (GUM) clinics in a large university city, a review of all positive chlamydial infections diagnosed on specimens received from hospitals (non-GUM) and community sources in 1996 was performed. It was also ascertained whether these patients subsequently attended at GUM. Eight hundred and nine cases of C. trachomatis were diagnosed during the study period. Three hundred and ninety-seven (49%) were initially diagnosed outside GUM of which 264 (66.5%) were referred, giving an overall involvement of GUM in 667 (83.6%) of all cases. The proportion of cases referred varied according to service: Family Planning Clinics 94.5%, Obstetrics and Gynaecology 73%, General Practice 52.5%. Referral rates also showed within service variation, with University Health Services referring 19% vs 73% (P < 0.001). High levels of referral to GUM of patients diagnosed with C. trachomatis are achievable, but referrals show inter- and intra-service variations. Efforts should be made to improve referral rates from those services with the lowest rates. IN CONCLUSION: (1) The proportion of cases of C. trachomatis diagnosed in the community who are referred to a GUM clinic, varies according to service type. (2) Referral rates vary within services and (3) Distance of services from a GUM clinic does not appear to influence referral rates.

Chlamydia Infections↗
PubMed2000

Vulvar vestibulitis: aetiology, diagnosis and treatment.

Chronic vulval pain can have multi-factorial causes. One of its leading causes, vulvar vestibulitis, is reviewed. A study of vulvar vestibulitis-its epidemiology, aetiology, histopathology, diagnosis and treatment is undertaken. More research is needed on this condition as it is important to make an accurate diagnosis and thus raise awareness before providing proper treatment.

Combined Modality Therapy↗
PubMed1999

Knowledge of Chlamydia trachomatis infection in genitourinary medicine clinic attenders.

OBJECTIVES: To determine the level of awareness of genital chlamydial infection, and level of knowledge related to this infection, in genitourinary medicine (GUM) clinic attenders. METHODS: 500 consecutive patients attending a GUM clinic for the first time during a 3 month study period were invited to complete an anonymous self administered questionnaire on aspects of chlamydial infection. RESULTS: 482 (96.4%) questionnaires were available for analysis (57% female). 289 (60%) respondents had heard of Chlamydia trachomatis compared with 472 (98%) for thrush, 467 (97%) for HIV/AIDS, and 434 (90%) for gonorrhoea. Subjective knowledge of chlamydia, relative to the other infections, was poor. Overall, the mean chlamydial knowledge score was 0.38 (range 0.0-1.0). Females scored significantly higher than males (0.45 v 0.26; p < 0.00001) and younger females scored significantly higher than older females (p = 0.001). More females had experienced genital chlamydial infection than males (22.4% v 12.1%, p = 0.004). Those with prior exposure to C trachomatis had higher mean knowledge scores than those without (males 0.55 v 0.25, p < 0.00001; females 0.68 v 0.37, p < 0.00001). CONCLUSION: Even for a population considered as "high risk" by their attendance at a GUM clinic, there was poor awareness of genital chlamydial infection, and mean knowledge scores were low. Whether increased knowledge was due to successful health education at the time of diagnosis in those with previous infection remains to be determined. In the future, one would hope for increased knowledge scores in those at risk before the acquisition of infection, which may be achieved by national health education programmes for C trachomatis.

Adolescent↗
PubMed1999

Cardiovascular autonomic neuropathy in HIV infected patients.

OBJECTIVE: To evaluate the presence and extent of autonomic dysfunction in HIV infected individuals of one ethnic group. DESIGN: Prospective, age-sex matched study. METHODS: 25 patients (seven asymptomatic (HIV), eight AIDS related complex (ARC), 10 AIDS) and 25 controls were recruited from patients and staff at the Aga Khan Hospital, Nairobi. Autonomic function was assessed by measurement of pulse rate variability on standing, rest, deep breathing, Valsalva manoeuvre, isometric exercise, cold face test, and mental stress. Blood pressure was measured during standing, supine resting, and on Valsalva manoeuvre. CD4 count was correlated with number of abnormal test results. RESULTS: 21 patients had at least one abnormal test of autonomic function compared with one control (p < 0.0001). There were significant differences between AIDS patients and controls for supine heart rate (p < 0.001), Valsalva ratio (p = 0.05), and cold face test (p = 0.05), and almost significant results for mental stress (p = 0.051). Evidence of autonomic hypersensitivity was found in response to exercise and/or mental stress in some patients with HIV or ARC. No difference was found in blood pressure measurements. Abnormalities in autonomic function occurred at all CD4 counts and all patients with four abnormal tests of heart rate variation had a CD4 count less than 300 x 10(6)/l. CONCLUSIONS: There is evidence of substantial autonomic dysfunction in AIDS patients compared with controls and mild abnormalities in the majority of HIV infected patients studied irrespective of CD4 count. Autonomic hypersensitivity may precede loss of function in some cases.

AIDS-Related Complex↗
PubMed1999

Delay in symptom presentation among a sample of older GUM clinic attenders.

Prior research undertaken with predominantly youthful populations has established that delay between symptom recognition and health-care presentation is a common feature of sexually transmitted infection (STI) related illness behaviour. However, it is not known whether similar behaviours are exhibited by older populations with genitourinary symptoms. The present analyses therefore aim to clarify this issue by focusing upon (1) extent of delay behaviour, (2) reasons for delay behaviour and (3) variables predicting delay behaviour among a sample of genitourinary medicine (GUM) clinic attenders aged over 50 years. A self-administered questionnaire study linked to patient note data was undertaken within 3 GUM clinics in the Trent region between January 1997 and March 1998 (Sheffield, Nottingham and Leicester). Of 121 symptomatic older attenders with suspected STI, 43.8% (n=53) waited over 2 weeks between symptom recognition and clinic attendance. Reasons given for delay included wanting to 'wait and see' if symptoms improved and being embarrassed or afraid to attend clinic. A logistic regression analysis identified that delay behaviour was predicted by history of HIV testing. Comparisons with previous research undertaken in this field indicate that levels of delay behaviour reported by this older sample are higher than those exhibited by youthful populations with genitourinary symptoms. This finding has significant implications for health-care professionals working both within a GUM setting, and with older people, especially when viewed in the context of an ageing population.

Aged↗
PubMed1999

Contact tracing for gonorrhoea in homosexual and heterosexual men.

We aimed to determine whether the success of partner notification for gonorrhoea in men was affected by sexual orientation. Analysis of standard clinic and health adviser records of all male patients found to be infected with gonorrhoea between October 1992 and September 1993 were carried out. Of the 278 cases of gonorrhoea in men, 9% (25) were acquired through homosexual intercourse and 91% (253) by heterosexual contact. Fifteen per cent (24) of Caucasians were homosexual but only 0.9% (1) of Afro-Caribbeans were. The mean number of contacts was 1.36 for homosexuals and 1.38 for heterosexuals. Contact information was given by 55% of heterosexuals and 48% of homosexuals. The proportion of acknowledged contacts attending was 38% for homosexuals and 56% for heterosexuals (P = 0.054). Fifty-two per cent of homosexuals and 59% of heterosexuals had at least one contact attend. Data analysis on Caucasians only showed Caucasian gay men had a higher mean number of contacts (1.38) than Caucasian heterosexuals (1.28). Caucasian homosexuals had a lower proportion of contacts attending (40% vs. 77%) (P = 0.05), 54% of homosexual men and 60% of heterosexual men had at least one contact attending (P = 0.74). There is a trend for partner notification to be less successful in homosexual men when all ethnic groups are considered together. In Caucasian men with gonorrhoea, homosexuals have a greater number of partners than heterosexuals and have a lower proportion of total contacts attending but there is no difference in the proportion having at least one contact attending. Data on sexual orientation and ethnicity should be reported in studies assessing efficacy of contact tracing.

Contact Tracing↗
PubMed1999

An audit of diagnostic coding in genitourinary medicine clinics. Trent Region Genitourinary Medicine Audit Group.

The KC60 diagnostic code information provides an epidemiological monitor of sexually transmitted infection (STI) and a means of standardizing clinical workload in genitourinary medicine (GUM) departments. We aimed to assess the coding process and its uniformity within the Trent region by means of a confidential self-administered coding exercise with simulated case presentations. The correct coding for STIs ranged from 59.4% to 100% in different scenarios. Difficulty was identified in the coding of vulvitis and balanitis where no organism was isolated, as represented by a wide range of codes. HIV pre-test counselling without testing was coded by only 57.8% of respondents. Over 95% indicated correctly the first hepatitis B vaccine dose but 21% failed to code once only for the course. Coding practice also varied within individual sites with a 21-100% discordance. In parts diagnostic accuracy was good but there were areas of non-uniformity both within sites and cross-regionally. Regional discussions have resulted in increased training opportunities and guidelines have been developed to increase uniformity and achieve consensus in uncertain areas.

Female Urogenital Diseases↗
PubMed1998

Attitudes to HIV testing in general practice.

Newer therapies for the treatment of HIV infection and the effectiveness of zidovudine in reducing vertical transmission mean that it is becoming increasingly important to diagnose HIV infection earlier. General practitioners (GPs) attending a local study day on sexually transmitted diseases (STDs) were asked about their likelihood of raising the subject of HIV antibody testing, and their anxiety when doing so, for different patient groups. A high level of anxiety was found when raising this topic in certain patient groups, and a proportion of GPs would never discuss HIV testing, even in very high-risk groups. No respondents were aware that vertical transmission could be reduced by antiretroviral drug therapy. These data advocate that the barriers to raising the issue of HIV testing and the methods of reducing GPs' anxiety associated with it, need to be addressed.

AIDS Serodiagnosis↗
PubMed1998

Urinary neopterin as a prognostic index of survival time in HIV-1 infection.

A prospective semi-longitudinal study was undertaken to determine if urinary neopterin was a predictor for survival in HIV-positive patients. One hundred and one HIV-positive subjects attending a department of genitourinary medicine over a 41-month period were included. Survival data were analysed 6 months after the end of recruitment. Ninety-two subjects were followed up for a minimum of 6 months. Survival figures at 1 and 2 years were 93% (SE 3%) and 79% (SE 5%). There was an inverse relationship between urinary neopterin excretion and 1 and 2-year survival. Two-year survival fell from 70% (SE 6%) for neopterin levels > or = 300 mmol/mol creatinine to 25% (SE 9%) for levels > or = 700 mmol/mol creatinine (P < 0.001). Urinary neopterin may be a useful non-invasive technique in predicting survival in HIV-positive patients.

CD4 Lymphocyte Count↗