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PubMed1994

The role of an electronic mail system in the educational strategies of a residency in obstetrics and gynecology.

Computerized electronic mail (E-mail) systems provide a rapid means of data sharing and are used in a variety of commercial and industrial settings for the widespread distribution of memoranda. We adapted an E-mail system to our program to determine the feasibility of incorporating such a system into didactic resident education in obstetrics and gynecology and to assess resident response to this form of computer-based learning. The system was programmed to distribute one review question per day to 24 resident physicians for 60 days. Residents were given 24 hours to respond and comment. Each question was discussed and appropriate references distributed within 48 hours of presentation. All questions and responses were then stored in an electronic file folder for later review. An examination was given at completion of the project (post-test), and these scores were compared to performance during the project (pre-test). An anonymous questionnaire was distributed upon completion of the project to assess the residents' overall satisfaction with the program. The system was well received by the residents. On a scale of 1 to 6 (1 = lowest; 6 = highest), resident satisfaction was high, with an overall average rating of 5.0. Using this scale, residents assessed their frustration level as 1.5. Average daily participation was 85%. An average of 9 minutes was required to complete each question and review prior responses and discussion; this interval was not significantly different among the postgraduate years. Scores on the examination at project completion were significantly higher than performance during the project.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer Communication Networks↗
PubMed1994

Awareness of sexual partners' HIV status as an influence upon high-risk sexual behaviour among gay men.

OBJECTIVE: To evaluate the extent to which 'high-risk' sexual behaviour is influenced by awareness of partners' HIV status among gay men. DESIGN: Structured interviews and collection of saliva samples for anonymous linked testing for HIV-1 antibodies. SETTING: Genitourinary medicine clinics and the gay community. SUBJECTS: Men (n = 677) who reported sexual contact with another man in the last 5 years. RESULTS: The majority of respondents (63%) had had an HIV-antibody test. Analysis of data showed that in 15% of the respondents' 1380 partnerships, HIV status was known by both parties. However, the majority of partnerships involved only safe sex. Only 26% of the partnerships in which unprotected penetrative anal sex had occurred involved mutual knowledge of HIV status and was most likely to occur with regular rather than non-regular/causal partners. Logistic regression revealed that this latter association could not be explained in terms of mutual HIV status knowledge. CONCLUSIONS: Despite widespread HIV testing, the majority of gay men engaging in high-risk sex are unaware of their partner's HIV status.

Adolescent↗
PubMed1993

Drug injectors in Glasgow: a community at risk? A report from a multidisciplinary group. The Possilpark Group.

In 1987 it became apparent that the number of drug injectors with HIV infection living in a district in the north of Glasgow was increasing. As this area was well served by a wide variety of clinical, epidemiological and laboratory facilities, a multidisciplinary group was convened to examine the extent and spread of infection, and its relationship to behavioural and environmental factors. By 1989 a World Health Organisation working group had developed a standardised methodology, consisting of an interview schedule and voluntary anonymous HIV testing procedures. The study has been implemented annually in Glasgow since 1990, with a collateral project evaluating prevalence of injecting drug use in the general population. The Glasgow HIV Behavioural and Prevalence Study was designed to yield as representative as possible a sample of the city's injectors, respondents being drawn from a variety of in-treatment and out-of-treatment sites. Of the estimated 8,500 injectors in Glasgow (1.35% of the population aged 15-55), 503 and 535 injectors were recruited to the study in 1990 and 1991 respectively. Over 90% of respondents injected daily and reported injecting, on average, four different types of drugs in the six months prior to interview, the three most commonly injected drugs being buprenorphine, heroin and temazepam. There is evidence of HIV risk reduction for sharing of injecting equipment and for using condoms with casual sexual partners. Salivary testing has proved to be successful, less than 5% of respondents refusing to be tested; the prevalence rate was 1.8% in 1990 and 1.1% in 1991. While HIV prevalence remains low, all-cause mortality among injectors in Glasgow is high; drug injecting is probably responsible for more deaths among people aged under 40 than any other factor. At the present time, the drug injecting epidemic in Glasgow poses a considerable challenge to the city's public health services.

Adolescent↗
PubMed1995

Ethics in nursing practice: confidentiality for women and their children with HIV/AIDS.

HIV-positive women and their children experience substantial problems brought about by the illness itself and service-delivery issues. Significant ethical concerns are raised when providing care to this patient population, and the ramifications of compromises in patient confidentiality are extremely serious. All practicing nurses should be familiar with the issues and potential solutions.

Adult↗
PubMedDate not supplied

A population-based hepatitis B seroprevalence and risk factor study in a northern Ontario town.

OBJECTIVE: To determine a) population-based hepatitis B seroprevalence rates; and b) associated behavioural risk factors. SETTING: A remote northern Ontario town with a cluster of hepatitis B cases. INTERVENTIONS: Anonymous blood testing linked with risk-factor questionnaires. RESULTS: 635 persons aged 14 to 30 years (51% of the eligible age cohort) donated blood in return for free vaccination; four were anti-HBs positive, and none was HBsAg positive. In all, 19% of participants reported two or more sexual partners in the previous year, 6% reported at least one tattooing in the previous year, and 1% reported illicit injection drug use. Of persons with multiple sexual partners 84% did not consistently use condoms. CONCLUSIONS: When the serological results of the original cluster (and contacts) were considered, the age cohort's HBsAg seroprevalence rate was estimated to be between 0.24% and 0.47%. While the serosurvey did not discover additional HBsAg positive cases, there was great potential for heterosexual transmission.

Adolescent↗
PubMed1991

Anxiety in voluntary HIV-antibody testing in pregnancy and its implications for preventive strategies.

During a three-month period in 1989, 820 pregnant women attending the antenatal clinic of the Aarhus University Hospital, Denmark, were offered a HIV-antibody test and asked to fill out an anonymous questionnaire about attitudes to HIV-antibody testing; 779 (95.0%) agreed to do so. One hundred and fifty-six women (20.0% of the participants) had been tested on a previous occasion, and 629 (80.7%) accepted the present offer to be tested. The most prevalent reasons to decline testing were indifference to the epidemic (45.3% of those declining), refusal of (further) blood testing (34.7%) and fear of being infected (16.7%). Women who consented to be tested most often expressed fear of being infected (21.8%). Fear of registration worried less than 5% of study group members; only 1% declined to be tested because of such worry. The pattern of worries expressed by the pregnant women is interpreted as one of anxiety and, in part at least, perplexity as concerns how to take rational consequences of public messages about the HIV epidemic. It is suggested that future surveillance be based primarily on voluntary testing and, whenever needed and possible, supplied with anonymous unlinked testing of existing blood samples from groups and persons declining to be tested. Such surveillance strategies should be supported in individual patient contacts and public health educational campaigns underscoring the risk of heterosexual transmission of HIV and the need for repeated HIV-antibody testing of selected groups and individuals.

AIDS Serodiagnosis↗
PubMed2002

Social networks as mediators of the effect of Alcoholics Anonymous.

AIMS: This study tested the hypothesis that the relationship between Alcoholics Anonymous (AA) involvement and reduced substance use is partially explained (or 'mediated') by changes in social networks. DESIGN: This is a naturalistic longitudinal study of the course of alcohol problems. SETTING: Study sites were the 10 largest public and private alcohol treatment programs in a northern California county. PARTICIPANTS: Three hundred and seventy-seven men and 277 women were recruited upon seeking treatment at study sites. MEASUREMENTS: At baseline and 1-year follow-up, we assessed alcohol consequences and dependence symptoms, consumption, social support for abstinence, pro-drinking social influences and AA involvement. FINDINGS: In the structural equation model, AA involvement was a significant predictor of lower alcohol consumption and fewer related problems. The size of this effect decreased by 36% when network size and support for drinking were included as mediators. In logistic regression models predicting abstinence at follow-up, AA remained highly significant after including social network variables but was again reduced in magnitude. Thirty-day abstinence was predicted by AA involvement (OR=2.9), not having pro-drinking influences in one's network (OR=0.7) and having support for reducing consumption from people met in AA (versus no support; OR=3.4). In contrast, having support from non-AA members was not a significant predictor of abstinence. For alcohol-related outcomes other than abstinence, significant relationships were found for both AA-based and non-AA-based support. CONCLUSIONS: The type of social support specifically given by AA members, such as 24-hour availability, role modeling and experientially based advice for staying sober, may help to explain AA's mechanism of action. Results highlight the value of focusing on outcomes reflective of AA's goals (such as abstinence) when studying how AA works.

Adult↗
PubMed1998

Are medical students ready to provide HIV-prevention counseling?

PURPOSE: To determine whether medical students were prepared to assess risk and counsel patients about prevention of HIV infection, and whether HIV-related experience produced better knowledge and counseling skills. METHOD: In 1995, students at four North Carolina medical schools interviewed a standardized patient portraying a young woman concerned about HIV infection. The standardized patient recorded whether students asked risk-behavior questions and provided risk-reduction advice. A 21-item questionnaire assessed the students' knowledge of HIV testing and prevention. Students indicated whether they had had experience in educational settings related to HIV or STDs. RESULTS: 415 students completed both the patient interview and the questionnaire. Many failed to ask the patient about several HIV-risk behaviors. Although nearly all (98%) inquired about condom use, fewer than two thirds asked about the patient's history of STDs, number of sexual partners, or specific sexual practices. Most students advised the patient to use condoms. The average score on the knowledge test was 79%; 70% of students confused anonymous with confidential testing, more than half overestimated the risk of HIV transmission from a needle stick, and nearly one in ten did not know how to use a condom. Educational exposures did not produce significantly better risk assessment, counseling information, or knowledge scores. CONCLUSION: A majority of experienced medical students did not assess several important risk factors of a patient concerned about HIV infection, and many would have provided incorrect information related to HIV testing and prevention of infection. Patient contact in traditional clinical settings did not influence prevention knowledge or behavior. More innovative methods are needed to train students in HIV-infection prevention and counseling.

Counseling↗
PubMed1994

Evaluation of an antenatal HIV testing programme in an inner London health district.

OBJECTIVE: To study an antenatal human immunodeficiency virus (HIV) testing programme in an inner London health district. DESIGN: A standardised research interview was given to women in the first half of pregnancy and the findings were compared with those of the routine clinical interview. The observations were analysed in relation to the results of HIV antibody testing, either attributable by consent or anonymously, in these women. SETTING: The Homerton Hospital, London. SUBJECTS: Three thousand seven hundred and twenty-nine women, of whom 1696 (45.5%) consented to testing. RESULTS: Four women who had consented to testing had a positive result. Amongst the 2,033 women (54.5%) who declined the test, four (or five) had a positive result. The number of risk factors ascertained by the research study interview was substantially greater than that elicited by the preceding routine interview. In addition, more information was obtained by a routine computer interview than by its unstructured equivalent. There was no obvious association between the presence of a risk factor and whether or not the women had consented to the test. CONCLUSIONS: Our formal voluntary testing programme detected nearly 44% of HIV seropositive individuals. Thus, there were four known positives during the study period against a total of nine detected by anonymous testing. Since all the known positive results in the study were associated with recognised risk factors, there is some doubt as to the value of a universal testing programme. However, if testing is to be based upon the existence of a risk factor elicited at the booking history, then the deficiencies in this history revealed by the present study need to be corrected.

Female↗
PubMed1993

Screening for carriers of Tay-Sachs disease in the ultraorthodox Ashkenazi Jewish community in Israel.

A screening program for the detection of Tay-Sachs disease (TSD) carriers in the ultra Orthodox community of Ashkenazi Jews has operated in Israel since 1986. The purpose of this program is the prevention of marriages of 2 heterozygotes. The screened individuals are mostly couples in the engagement process or students in religious high schools. Two mandatory requirements guide this program. First, anonymity of the tested individuals who are identified only by code numbers; second completion of the test results of couples in the engagement process within a few days. The screening program is performed by the determination of hexosaminidase A (Hex A) activity in serum which is repeated in serum and leukocyte extracts in couples where both partners were found in the heterozygote range in the initial tests. The minimal carrier frequency was estimated to be 1:26 or higher, which is higher then in the general Jewish Ashkenazi population. This higher carrier frequency apparently stems from the fact that most members of this community originate from central Europe where the TSD carrier frequency was previously reported to be the highest in the Ashkenazi population. Since the beginning of the screening program no TSD child has been born to newlywed couples of this community in Israel.

Anonymous Testing↗
PubMed1997

Harm reduction measures and injecting inside prison versus mandatory drugs testing: results of a cross sectional anonymous questionnaire survey. The European Commission Network on HIV Infection and Hepatitis in Prison.

OBJECTIVES: (a) To determine both the frequency of injecting inside prison and use of sterilising tablets to clean needles in the previous four weeks; (b) to assess the efficiency of random mandatory drugs testing at detecting prisoners who inject heroin inside prison; (c) to determine the percentage of prisoners who had been offered vaccination against hepatitis B. DESIGN: Cross sectional willing anonymous salivary HIV surveillance linked to a self completion risk factor questionnaire. SETTING: Lowmoss prison, Glasgow, and Aberdeen prison on 11 and 30 October 1996. SUBJECTS: 293 (94%) of all 312 inmates at Lowmoss and 146 (93%) of all 157 at Aberdeen, resulting in 286 and 143 valid questionnaires. MAIN OUTCOME MEASURES: Frequency of injecting inside prison in the previous four weeks by injector inmates who had been in prison for at least four weeks. RESULTS: 116 (41%) Lowmoss and 53 (37%) Aberdeen prisoners had a history of injecting drug use but only 4% of inmates (17/395; 95% confidence interval 2% to 6%) had ever been offered vaccination against hepatitis B. 42 Lowmoss prisoners (estimated 207 injections and 258 uses of sterilising tablets) and 31 Aberdeen prisoners (229 injections, 221 uses) had injected inside prison in the previous four weeks. The prisons together held 112 injector inmates who had been in prison for more than four weeks, of whom 57 (51%; 42% to 60%) had injected in prison in the past four weeks; their estimated mean number of injections was 6.0 (SD 5.7). Prisoners injecting heroin six times in four weeks will test positive in random mandatory drugs testing on at most 18 days out of 28. CONCLUSIONS: Sterilising tablets and hepatitis B vaccination should be offered to all prisoners. Random mandatory drugs testing seriously underestimates injector inmates' harm reduction needs.

Cross-Sectional Studies↗