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PubMed2003

Behavioral and infectious disease risks in young blood donors: implications for recruitment.

BACKGROUND: Recruitment of young donors is critical to expand the donor base and sustain the blood supply. Nevertheless, there is concern that younger blood donors may have a higher risk profile than their older counterparts. STUDY DESIGN AND METHODS: The prevalence of behavioral risks associated with transfusion-transmissible viral infections and the incidence of viral markers were compared between younger and older donors. Behavioral risks included unreported deferrable risks (UDRs) and HIV test seeking estimated from anonymous donor surveys administered in 1993 and 1998. The incidence of HIV, HCV, or HBV was estimated from donors giving at five US blood centers between 1996 and 2000. RESULTS: Donors younger than 25 years of age were significantly more likely to report a UDR or HIV test seeking than those 25 years or older. ORs comparing donors 18 to 19 and 20 to 24 years of age to those 25 years or older were 2.0 (95% CI, 1.5-2.6) and 1.5 (95% CI, 1.2-1.9) for UDR and 4.5 (95% CI, 3.0-6.9) and 5.5 (95% CI, 4.2-7.1) for test seeking, respectively. Although incidence estimates did not significantly differ between age groups, HIV incidence appeared to be highest in 18- to 19-year-old donors, whereas HBV incidence was highest in 20- to 24-year-old donors. CONCLUSIONS: Donors younger than 25 years of age appeared to have a higher behavioral risk profile than older donors. The message not to donate when a behavioral risk is present or for obtaining HIV tests needs to be reinforced in younger donors.

Adult↗
PubMed2000

Assessment of the prevalence of vCJD through testing tonsils and appendices for abnormal prion protein.

The objective of this study was to determine the age group or groups which will provide the most information on the potential size of the vCJD epidemic in Great Britain via the sampling of tonsil and appendix material to detect the presence of abnormal prion protein (PrP(Sc)). A subsidiary aim was to determine the degree to which such an anonymous age-stratified testing programme will reduce current uncertainties in the size of the epidemic in future years. A cohort- and time-stratified model was used to generate epidemic scenarios consistent with the observed vCJD case incidence. These scenarios, together with data on the age distribution of tonsillectomies and appendectomies, were used to evaluate the optimal age group and calendar time for undertaking testing and to calculate the range of epidemic sizes consistent with different outcomes. The analyses suggested that the optimal five-year age group to test is 25-29 years, although a random sample of appendix tissue from all age groups is nearly as informative. A random sample of tonsil tissue from all age groups is less informative, but the information content is improved if sampling is restricted to tissues removed from those over ten years of age. Based on the assumption that the test is able to detect infection in the last 75% of the incubation period, zero detected infections in an initial random sample of 1000 tissues would suggest that the epidemic will be less than 870,000 cases. If infections are detected, then the model prediction suggests that both relatively small epidemics (800+ cases if one is detected or 8300+ if two are detected) and larger epidemics (21,000+ cases if three or more are detected) are possible. It was concluded that testing will be most informative if undertaken using appendix tissues or tonsil tissues removed from those over ten years of age. Large epidemics can only be excluded if a small number of infections are detected and the test is able to detect infection early in the incubation period.

Adolescent↗
PubMed1992

HIV-1 seroprevalence in pregnant women testing positive on serologic screening for syphilis.

Epidemic increases in active syphilis have been reported in the geographic areas hit hard by acquired immunodeficiency syndrome. Although both epidemics have been associated with illicit substance abuse, the extent to which recent increases in syphilis are linked to the human immunodeficiency virus (HIV-1) epidemic is uncertain. In order to define the frequency of syphilis and HIV-1 coinfection in the pregnant patients seen at City Hospital Center at Elmhurst, we saved syphilis-positive serologic specimens from obstetrical patients for anonymous HIV-1 antibody testing. Of 120 women who tested positive for syphilis, 7/120 (5.8%) had antibodies to HIV-1; of the 44 women with VDRL titers greater than or equal to 1:16 (suggestive of a recent infection), 1/44 (2.3%) had antibodies to HIV-1.

Female↗
PubMed1998

Indirect methods for estimating prevalent HIV infections: adults in England and Wales at the end of 1993.

Two indirect methods were used to estimate the point prevalence of HIV infection in England and Wales at the end of 1993 using data on diagnosed HIV infections, AIDS cases, HIV-related deaths and HIV testing behaviour from unlinked anonymous surveys. The methods estimated the proportion of all prevalent HIV infections that diagnosed infections represented. Most of those exposed to HIV infection through injecting drug use or sexual intercourse between men had had their infections diagnosed compared to less than half of those exposed through heterosexual intercourse. The total estimated number of prevalent infections was 22,350 for the diagnosis interval method and 20,540 for the test history method, and about 56-57% of these were in homo/bisexual men. These indirect methods are cheap and simple applications of surveillance data which provide estimates that compare favourably with those produced by more complex methods.

England↗
PubMed2002

Enhanced care of hypertensive patients using the Internet.

BACKGROUND: Medical guidelines provide recommendations that ought to help physicians in medical decision-making under different circumstances. To develop electronic medical guidelines and to make them available for physicians using the Internet can further enhance the quality and efficiency of health care, especially with the simultaneous use of electronic health records. OBJECTIVES: This study aims to outline the needs for web-based systems that support the use of medical guidelines in practice; and to focus on the development of web-based electronic medical guidelines for treatment of arterial hypertension. METHODS: The importance of electronic health record in cardiology for data acquisition, data storage and data mining is considered. The anonymized database of approximately 1800 hypertensive patients has been created to compare medical practice with guidelines and discover features of diseases that can help with their management. Using this database we evaluated several web-based electronic guidelines systems. RESULTS: The 1999 WHO/ISH Guidelines for the Management of Hypertension were formalized and interpreted using the Guide-X methodology, using the Apollo system and web-based electronic guidelines. The web-based electronic guidelines were tested on the smaller anonymous recent data set of 840 hypertensive patients. CONCLUSIONS: An easy transfer of knowledge from medical guidelines to structured electronic guidelines opens new possibilities for easy reusability of medical knowledge by general practitioners and clinicians.

Cardiology↗
PubMed2001

Absence of risk factors for false-positive test results in blood donors with a reactive test result in an automated treponemal test (PK-TP) for syphilis.

BACKGROUND: Screening and confirmatory serologic tests for syphilis are known to generate false-positive results in low-risk populations, which include blood donors. This study assessed whether conditions previously reported to cause biological false-positive (BFP) test results for syphilis are relevant to contemporary syphilis testing of blood donors and the extent to which seropositive donors report a history of syphilis. STUDY DESIGN AND METHODS: A history of conditions reported to be associated with BFP syphilis tests or a history of syphilis infection was assessed by a case-control study of donors with reactive and nonreactive automated treponemal test results, using an anonymous mail survey. Analysis of cases was stratified by fluorescent treponemal antibody absorption (FTA-ABS) result. RESULTS: Adjusted ORs (95% CIs) for reported BFP-associated conditions were 1.3 (0.8-2.1) for FTA-ABS-positive cases and 0.8 (0.3-1.9) for FTA-ABS-negative cases. Among responding blood donors, syphilis history was reported in 78 (51%) of 153 FTA-ABS-positive cases, 0 of 142 FTA-ABS-negative cases, and 3 (0.4%) of 716 automated treponemal test (PK-TP)-negative controls. CONCLUSION: Approximately half of donors with FTA-ABS-positive test results reported a syphilis history. There was no difference between reported BFP conditions for FTA-ABS-positive or FTA-ABS-negative cases and controls. This information may be useful when providing donors with better predonation or post-test counseling information about syphilis testing.

Adolescent↗
PubMed2006

Does the recent increase in HIV diagnoses among men who have sex with men in the UK reflect a rise in HIV incidence or increased uptake of HIV testing?

OBJECTIVES: To determine whether the increase in HIV diagnoses since 1997 among men who have sex with men (MSM) in the UK reflects a rise in HIV incidence or an increase in HIV testing. METHODS: Estimates of HIV incidence were derived using data from UK HIV surveillance systems (HIV diagnoses; CD4 surveillance; unlinked anonymous surveys) for 1997-2004. Data on HIV testing were provided by KC60 statutory returns, voluntary testing and unlinked anonymous surveys in sentinel genitourinary medicine (GUM) clinics. RESULTS: HIV diagnoses among MSM in the UK rose by 54% between 1997 and 2004 (from 1382 to 2124), with variation by age and geographical location. The number of HIV diagnoses among MSM <35 years of age in London showed no increase, but in all other groups it increased. Throughout the UK, uptake of HIV testing increased significantly among MSM attending GUM clinics between 1997 and 2004, including "at-risk" MSM (p<0.001). Direct incidence estimates (serological testing algorithm for recent HIV seroconversion assay) provided no evidence of a statistically significant increase or decrease in HIV incidence. Indirect estimates suggested that there may have been a rise in HIV incidence, but these estimates were influenced by the increased uptake of HIV testing. CONCLUSIONS: The number of HIV diagnoses increased among MSM in the UK between 1997 and 2004, except among younger MSM in London, in whom there was no change. The increase in HIV diagnoses among MSM in the UK since 1997 seems to reflect an increase in HIV testing rather than a rise in HIV incidence.

Adult↗
PubMed2003

Prevalence of sexually transmitted infections and performance of STI syndromes against aetiological diagnosis, in female sex workers of red light area in Surat, India.

OBJECTIVES: To measure prevalence of selected sexually transmitted infections (STI) and HIV among female sex workers (SWs) in the red light area of Surat, India, and to evaluate the performance of STI syndrome guidelines (for general population women in India) in this group against the standard aetiological diagnosis of STIs by laboratory methods. METHODS: In a cross sectional study, 124 out of an estimated total of 500 SWs were mobilised to a health camp near the red light area during 2000. After obtaining consent, a behavioural questionnaire was administered, followed by clinical examination and specimen collection for different STIs. 118 SWs completed all aspects of the survey. HIV testing was unlinked and anonymous. RESULTS: The mean number of different sexual partners of SWs per day was five. 94.9% reported consistent condom use with the clients. 58.5% of SWs had no symptoms related to STDs at the time of examination. Reported symptoms included lower abdominal pain (19.5%), abnormal vaginal discharge (12.7%), painful sexual intercourse (12.7%), painful micturition (11.0%), itching around the genital area (10.2%), and genital ulcer (5.9%). The prevalence of STI "syndromes" were vaginal discharge syndrome 51.7%, pain in lower abdomen 19.5%, enlarged inguinal lymph nodes 11.9%, and genital ulcer 5.9%. Based on the laboratory reports (excluding HIV tests), 62 (52.5%) SWs did not have any of the four tested STIs. Prevalence of laboratory confirmed STIs were syphilis 22.7% (based on reactive syphilis serology tests), gonorrhoea 16.9%, genital chlamydial infection 8.5%, and trichomoniasis 14.4%. HIV prevalence was 43.2%. The performance of Indian recommended treatment guidelines for vaginal discharge syndrome (VDS) and genital ulcer syndrome (GUS) against aetiological diagnosis was poor. CONCLUSION: Prevalence of different STIs and HIV among the FSWs in the Surat red light area is high despite high reported condom use with clients. Syndromic case management is missing a large number of asymptomatic cases and providing treatment in the absence of disease. Therefore, it is necessary to explore alternative strategies for control of STIs in female sex workers. STI services need to be improved.

Adolescent↗
PubMed2004

Nationwide HIV prevalence survey in general population in Niger.

A national population-based survey was carried out in Niger in 2002 to assess HIV prevalence in the population aged 15-49 years. A two-stage cluster sampling was used and the blood specimens were collected on filter paper and tested according to an algorithm involving up to three diagnostic tests whenever appropriate. Testing was unlinked and anonymous. The refusal rate was 1.1% and 6056 blood samples were available for analysis. The adjusted prevalence of HIV was 0.87% (95% CI, 0.5-1.3%) and the 95% CI of the estimated number of infected individuals was 22 864-59 640. HIV-1 and HIV-2 represented, respectively, 95.6% and 2.9% of infections while dual infections represented 1.5%. HIV positivity rate was 1.0% in women and 0.7% in men. It was significantly higher among urban populations than among rural ones (respectively, 2.1% and 0.6%, P < 10(-6)). Using logistic regression, the variables significantly related to the risk of being tested positive for HIV were urban housing, increasing age and being either widowed or divorced. The estimate from the national survey was lower than the prevalence assessed from antenatal clinic data (2.8% in 2001). In the future, the representativeness of sentinel sites should be improved by increasing the representation of rural areas accounting for more than 80% of the population. Compared with other sub-Saharan countries, the HIV prevalence in Niger is still moderate. This situation represents a strong argument for enhancing prevention programmes and makes realistic the projects promoting an access to potent antiretroviral therapies for the majority.

Adolescent↗
PubMed1993

A survey of attitudes, knowledge, and behavior related to HIV testing of adolescents and young adults enrolled in alcohol and drug treatment.

The objectives of this study were to assess attitudes, knowledge, and behavior related to human immunodeficiency virus (HIV) antibody testing of adolescents and young adults undergoing treatment for alcohol and drug problems. Setting and subjects were 101 adolescents and young adults enrolled in a New England substance abuse rehabilitation program. All subjects had heard about acquired immunodeficiency syndrome (AIDS) and 84% desired an HIV antibody test if it were anonymous and confidential. If found to be HIV positive, 83% stated that they would be less likely to continue substance-abuse treatment, 64% would be more likely to continue drug use, and 62% would be more likely to continue alcohol use. The likelihood of continuing school would decrease for 60%. Sixty percent would be more likely to increase use of condoms. Males were more likely than females to want to leave treatment and school, return to alcohol and drug use, and increase risk-taking behavior (p < 0.02). These findings suggest that teenagers undergoing treatment for substance-abuse problems require careful and comprehensive pre- and post-test counseling and follow-up when undergoing HIV antibody testing. Deciding when to test for HIV may impact on the success of substance-abuse treatment, as well as ability to control spread of HIV infection.

Adolescent↗
PubMed2005

The cystic fibrosis transmembrane conductance regulator gene and ion channel function in patients with idiopathic pancreatitis.

Cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations are associated with cystic fibrosis (CF)-related monosymptomatic conditions, including idiopathic pancreatitis. We evaluated prospectively enrolled patients who had idiopathic recurrent acute pancreatitis or idiopathic chronic pancreatitis, healthy controls, CF heterozygotes, and CF patients (pancreatic insufficient or sufficient) for evidence of CFTR gene mutations and abnormalities of ion transport by sweat chloride and nasal potential difference testing. DNA samples from anonymous blood donors were controls for genotyping. At least one CFTR mutation or variant was carried in 18 of 40 patients (45%) with idiopathic chronic pancreatitis and in 6 of 16 patients (38%) with idiopathic recurrent acute pancreatitis but in only 11 of the 50 controls (22%, P=0.005). Most identified mutations were rare and would not be identified in routine genetic screening. CFTR mutations were identified on both alleles in six patient (11%). Ion transport measurements in patients with pancreatitis showed a wide range of results, from the values in patients with classically diagnosed CF to those in the obligate heterozygotes and healthy controls. In general, ion channel measurements correlated with the number and severity of CFTR mutations. Twelve of 56 patients with pancreatitis (21%) fulfilled current clinical criteria for the diagnosis of CF, but CFTR genotyping alone confirmed the diagnosis in only two of these patients. We concluded that extensive genotyping and ion channel testing are useful to confirm or exclude the diagnosis of CF in the majority of patients with idiopathic pancreatitis.

Adult↗
PubMed1990

Assessing the quality of pharmacist answers to telephone drug information questions.

A quality assurance (QA) program is described in which frontline pharmacists were asked test drug information questions via anonymous telephone calls. The program was instituted at a university hospital that began providing decentralized pharmaceutical services in 1985. Questions were developed on the basis of a pilot study conducted to determine the types and complexity of drug information questions received by frontline pharmacists at the hospital. Data on departmental clinical productivity were used to determine the number of questions that would be posed during each shift in the various service areas. The questions were posed during a 10-day period; the pharmacists were aware of the program, but the callers did not identify their affiliation with it. In response to 105 questions asked, 86 were judged to have been answered correctly, 13 answers were deemed incomplete, and 6 were judged incorrect. Pharmacists were more likely to respond incorrectly to complex questions and questions posed during the night shift. As a result of the audit, staff members with advanced clinical knowledge were asked to help less experienced pharmacists, the position of assistant director for drug information and staff development was created, and educational programs were instituted. The QA audit has been repeated twice. Posing test drug information questions via anonymous telephone calls is effective in assessing the quality of drug information provided by pharmacists in patient-care areas.

Drug Information Services↗
PubMed1995

Use of pooling and outpatient laboratory specimens in an anonymous seroprevalence survey of HIV infection in British Columbia, Canada.

OBJECTIVE: To conduct an anonymous HIV seroprevalence survey to establish a baseline estimate of HIV seroprevalence in a general population; to evaluate serum pooling and alternative testing strategies as cost-saving measures. DESIGN: Prospective anonymous HIV seroprevalence study using outpatient laboratory specimens. SETTING: Two large non-hospital-associated outpatient chemistry testing laboratories in the major population centers in British Columbia, Canada. PATIENTS AND SERA: Leftover sera received for chemistry screen testing in outpatient laboratories were provided to the study after chemistry testing was completed. Those from patients aged < 15 and > or = 55 years were excluded. METHODS: Patient identifiers were erased from samples. Sera were pooled 10:1 and tested by viral lysate enzyme-linked immunosorbent assay (ELISA). Sera from HIV-positive pools were tested individually. All individual HIV-positive specimens were retested for verification of positivity using a recombinant protein ELISA. MAIN OUTCOME MEASURES: HIV seroprevalence rates were stratified by sex, age group, and geographic area; and costs of pooling and alternative algorithm strategy were compared with those of conventional methods. RESULTS: A total of 80,238 sera were collected from 66,658 individuals (53% women, 47% men). Of these, 276 men (88.3 per 10,000) and 24 women (6.8 per 10,000) were HIV-seropositive. The highest rates were in those aged 30-34 years, for both men and women. Using pooling and non-Western blot verification saved US$2.07 per specimen, or 80% of the cost for conventional testing. CONCLUSIONS: The anonymous outpatient laboratory setting is practicable to obtain a reasonable estimate of HIV seroprevalence rates in a general population. Such studies can be made cost-effective by pooling sera and using alternative confirmatory strategies.

AIDS Serodiagnosis↗
PubMed2001

Human immunodeficiency virus seroprevalence trends: five hospitals in south Georgia, 1993 through 1997.

BACKGROUND: Human immunodeficiency virus (HIV) seroprevalence surveys help determine the extent of HIV and the need for routine HIV counseling and testing. We sought to describe trends in five south Georgia hospitals and compare two protocols for conducting anonymous HIV surveys. METHODS: From 1993 to 1997, each hospital tested approximately 1,400 anonymous, leftover blood specimens per year. Two hospitals (C and E) tested all specimens, and three hospitals (A, B, and D) excluded blood known to be HIV-related. RESULTS: The mean HIV seroprevalence at hospitals C and E was between 2.0% and 2.3% each year. The mean HIV seroprevalence at hospitals A, B, and D increased from 0.5% to 1.0% during 1993 to 1995, then decreased to 0.3% in 1997. CONCLUSIONS: In hospitals C and E, the level of HIV disease was constant. In hospitals A, B, and D, the HIV seroprevalence decreased to 0.3%, suggesting that routine HIV counseling and testing is not currently needed in these hospitals. Hospitals should consider conducting periodic anonymous HIV seroprevalence surveys, sampling from all patients and distinguishing between specimens known to be HIV-related and those that are not.

AIDS Serodiagnosis↗
PubMed1988

Comparison of HIV-antibody prevalence in patients consenting to and declining HIV-antibody testing in an STD clinic.

All patients attending a sexually transmitted disease (STD) clinic were offered voluntary, anonymous human immunodeficiency virus (HIV)-antibody testing and counseling as part of routine clinical evaluation. During a three-month evaluation period, 82% of patients accepted HIV testing. Testing was accepted equally by men and women and by heterosexual and homosexual men. Black men were more likely to refuse testing than men from other ethnic groups. Eight (0.7%) of 1146 STD clinic patients tested were infected with HIV. A blinded study of 237 patients who refused testing identified nine (3.8%) additional HIV-infected patients. Men who refused testing were 5.3 times more likely to be infected than men who accepted testing. Male homosexuals and black and Hispanic men who refused testing were 7.3 and 8.8 times, respectively, more likely to be infected with HIV than were their counterparts who accepted testing. Human immunodeficiency virus testing and counseling should be routinely offered to STD clinic patients. Male STD clinic patients, especially homosexual or minority men, who refuse voluntary HIV testing should be counseled regarding reducing their risk for HIV transmission.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Career satisfaction among female nurses.

OBJECTIVE: To study the personal characteristics, measurement of psychological well-being, work environment and its impact as determinants of career satisfaction among nurses. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: One public and private hospital in Islamabad and Rawalpindi each, from 12th February to 30th March 2001. SUBJECTS AND METHODS: Nurses currently working in inpatient hospitals, for at least one year, were given a structured, self-administered, anonymous and pre-tested questionnaire with both closed and open-ended questions. RESULTS: Out of 261 nurses participating in this study, 210 (80.4%) responded as always or almost always, satisfied with their career as a nurse. Almost all nurses reported their work related stress as either severe or moderate. Over two-third of them reported as always or almost always being in control of work life. CONCLUSION: An overwhelming number of nurses in these settings are satisfied with their career; however, links between working conditions and levels of satisfaction among them are elusive.

Adult↗
PubMed1995

The incidence of rubella virus infections in Switzerland after the introduction of the MMR mass vaccination programme.

We have collected data on the incidence of rubella in Switzerland from 1987 to 1992 to help evaluating the impact of the measles, mumps and rubella (MMR) mass vaccination programme which started in 1985 in this country. We used detailed informations on samples submitted for diagnostic testing in conjunction with anonymous laboratory notifications to the Swiss Federal Office for Public Health, and data from the Swiss sentinel network of general practitioners to find trends in the incidence of rubella after the introduction of mass vaccination. We observed an unabated seasonal oscillation without decreasing trend during the observation period and were unable to detect a shift in the age distribution of cases. An important proportion of laboratory-confirmed rubella occurred in women of childbearing age. Immigrants from regions with low endemicity of rubella were at increased risk of contracting rubella and transmitting it to their offspring. We conclude, that MMR mass vaccination has not interrupted the circulation of rubella virus in Switzerland, and that improvements in the implementation and surveillance of the MMR vaccination campaign are necessary in order to avoid untoward effects of it.

Adolescent↗
PubMed2001

Image quality of digital chest X-rays: wet versus dry laser printers.

The aim of this study was to compare the image quality of digital chest x-rays (Thoravision) obtained with 2 "wet" laser imagers of different matrix sizes and a "dry" system. Fifty chest x-rays in 2 planes were printed out in normal (100%) and reduced (61%) format using 3 different systems: 2 "wet" laser imagers (Agfa Matrix LR 3300, 4256 x 5174 pixels, 315 dpi; Agfa Scopix LR 5200, 8512 x 10348 pixels, 630 dpi), and one "dry" system (Agfa Drystar 3000,4352 x 5295 pixels, 330 dpi). All tests yielded normal findings. Anonymous images were evaluated by 4 independent reviewers on record forms rating the detectability of predefined anatomic structures. When the image quality of diagnosis-relevant, anatomic structures was evaluated on digital chest x-rays reproduced in normal and reduced format, the wet laser imagers did not show significant advantages over the dry system, Agfa Drystar 3000. The Agfa Drystar 3000 system is a feasible alternative for reproducing digital images, particularly for decentralized archives.

Adult↗