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PubMed1998

Use of amoxicillin-clavulanate and resistance in Escherichia coli over a 4-year period.

OBJECTIVE: To reduce the use of amoxicillin-clavulanate after high-resistance rates in Escherichia coli were detected. DESIGN: Intervention study; the interventions were introduced successively over a 4-year period while closely monitoring the resistance patterns. SETTING: A 260-bed acute-care hospital in Switzerland. INTERVENTIONS: Introduction of therapeutic guidelines for specific departments or indications, which proposed alternative antibiotics to amoxicillin-clavulanate. The perioperative prophylactic use of amoxicillin-clavulanate was eliminated completely. RESULTS: The absolute amount of amoxicillin-clavulanate consumed decreased by 23%, from 24.8 g per 100 patient days in 1992 to 18.5 g per 100 patient days in 1995. The number of courses, a parameter that takes the prophylactic use into account, decreased by 62% from 2.3 per 100 patient days in 1992 to 0.9 per 100 patient days in 1995. The percentage of sensitive strains increased from 54.9% (n=512) in 1992 and 54.0% (n=506) in 1993 to 72.1% (n=546) in 1994 and 83.1% (n=668) in 1995. No major changes were detected for other antimicrobials, such as cotrimoxazole, tetracycline, or cefuroxime, used in this 4-year period. CONCLUSIONS: A decrease in the use of amoxicillin-clavulanate was followed by an increase in susceptibility of E coli to it. It was not possible to prove a causative relationship. Only a temporal association was discovered. The reduction of the use of amoxicillin-clavulanate was achieved through the implementation of treatment guidelines, facilitated through a close collaboration among the clinical pharmacists, the infection control practitioner, the microbiology laboratory, and the physicians in charge of the respective departments.

Amoxicillin-Potassium Clavulanate Combination↗

PubMed1998

A qualitative assessment of inner city elementary school children's perceptions of their neighborhood.

Three hundred seventy-nine youths from an inner city elementary school were surveyed to determine their perceptions of their neighborhood. Using a qualitative, word association format, older students responded to 20 descriptive words (e.g., dirty, safe, quiet, dangerous) while younger youths drew pictures in response to three words (safe, sad, happy). Using content analysis techniques, findings indicated that the youths found neighborhood areas and residents that were perceived as safe, quiet, beautiful, friendly, fun/happy, and helpful. However, safety issues and a dirty, noisy neighborhood also emerged as major themes. Collaborative initiatives focusing on cleaning up the neighborhood and reducing violence are suggested, as are areas of intervention and further research.

Age Factors↗

PubMed2006

Application of molecular techniques to the study of hospital infection.

Nosocomial infections are an important source of morbidity and mortality in hospital settings, afflicting an estimated 2 million patients in United States each year. This number represents up to 5% of hospitalized patients and results in an estimated 88,000 deaths and 4.5 billion dollars in excess health care costs. Increasingly, hospital-acquired infections with multidrug-resistant pathogens represent a major problem in patients. Understanding pathogen relatedness is essential for determining the epidemiology of nosocomial infections and aiding in the design of rational pathogen control methods. The role of pathogen typing is to determine whether epidemiologically related isolates are also genetically related. To determine molecular relatedness of isolates for epidemiologic investigation, new technologies based on DNA, or molecular analysis, are methods of choice. These DNA-based molecular methodologies include pulsed-field gel electrophoresis (PFGE), PCR-based typing methods, and multilocus sequence analysis. Establishing clonality of pathogens can aid in the identification of the source (environmental or personnel) of organisms, distinguish infectious from noninfectious strains, and distinguish relapse from reinfection. The integration of molecular typing with conventional hospital epidemiologic surveillance has been proven to be cost-effective due to the associated reduction in the number of nosocomial infections. Cost-effectiveness is maximized through the collaboration of the laboratory, through epidemiologic typing, and the infection control department during epidemiologic investigations.

Bacteria↗

PubMed1998

Integration host factor and cyclic AMP receptor protein are required for TyrR-mediated activation of tpl in Citrobacter freundii.

The tpl gene of Citrobacter freundii encodes an enzyme that catalyzes the conversion of L-tyrosine to phenol, pyruvate, and ammonia. This gene is known to be positively regulated by TyrR. The amplitude of regulation attributable to this transcription factor is at least 20-fold. Three TyrR binding sites, designated boxes A, B, and C, centered at coordinates -272.5, -158.5, and -49.5, respectively, were identified in the upstream region of the tpl promoter. The results of mutational experiments suggest that TyrR binds in cooperative fashion to these sites. The nonavailability of any TyrR site impairs transcription. Full TyrR-mediated activation of tpl required integration host factor (IHF) and the cAMP receptor protein (CRP). By DNase I footprinting, it was shown that the IHF binding site is centered at coordinate -85 and that there are CRP binding sites centered at coordinates -220 and -250. Mutational alteration of the IHF binding site reduced the efficiency of the tpl promoter by at least eightfold. The proposed roles of CRP and IHF are to introduce bends into tpl promoter DNA between boxes A and B or B and C. Multimeric TyrR dimers were demonstrated by a chemical cross-linking method. The formation of hexameric TyrR increased when tpl DNA was present. The participation of both IHF and CRP in the activation of the tpl promoter suggests that molecular mechanisms quite different from those that affect other TyrR-activated promoters apply to this system. A model wherein TyrR, IHF, and CRP collaborate to regulate the expression of the tpl promoter is presented.

Adenosine Triphosphate↗

PubMed2003

A multisite survey of suctioning techniques and airway management practices.

BACKGROUND: Ventilator-associated pneumonia, common in critically ill patients, is associated with microaspiration of oropharyngeal secretions and may be related to suctioning and airway management practices. OBJECTIVES: To describe institutional policies and procedures related to closed-system suctioning and airway management of intubated patients, and to compare practices of registered nurses and respiratory therapists. METHODS: A descriptive, comparative, multisite study of facilities that use closed-system suctioning devices on most intubated adults was conducted. Nurses and respiratory therapists who worked at the sites completed surveys related to their practices. RESULTS: A total of 1665 nurses and respiratory therapists at 27 sites throughout the United States responded. The typical respondent had at least 6 years' experience with patients receiving mechanical ventilation (61%) and a baccalaureate degree or higher (54%). Most sites had policies for management of endotracheal tube cuffs (93%), hyperoxygenation (89%) and use of gloves (70%) with closed-system suctioning, and instillation of isotonic sodium chloride solution for thick secretions (74%). Only 48% of policies addressed oral care and 37% addressed oral suctioning. Nurses did more oral suctioning and oral care than respiratory therapists did, and respiratory therapists instilled sodium chloride solution more and rinsed the suctioning device more often than nurses did. CONCLUSIONS: Policies vary widely and do not always reflect current research. Consistent performance of practices such as wearing gloves for airway management and maintaining endotracheal cuff pressures must be evaluated. Collaborative, research-based policies and procedures must be developed and implemented to ensure best practices for intubated patients.

Adult↗

PubMedDate not supplied

[Discrepancy in attitudes toward diabetes between physicians and diabetic patients attending the private, social security or state medical services].

OBJECTIVE: One of the biggest challenges of the Mexican Health System is to get results of the treatment goals in diabetic patients, which can be frustrated by physician and patient's attitudes. The present study evaluates divergence of attitude of health providers and diabetic patients according to health sectors: private, social security or State medical services. MATERIAL AND METHODS: They contributed 255 physicians and 255 diabetic patients in ambulatory care from three health sectors: private, social security and welfare (employees and patients were exclusive providers and patients of corresponding institutions). The Diabetes Attitude Scale 3 (DAS-3) was applied, a self-administered instrument used to compare attitudes between health care professionals and patients. Discrepancies were analyzed with t-tests, chi2, one-way ANOVA and post hoc multiple comparisons for observed means based on the Tukey test. RESULTS: Physician and patient's attitudes differed in all scales except for psychosocial impact of diabetes, which was independent of the health sector. Attitudes were not alike with respect to severity of the disease, value of tight control of glucose levels and patient autonomy, with no distinction of health sector. Discrepancy of need for special training was the only attitude that varied by health sector (F = 4.1; p = 0.02); it was similar for the private and social security sector but different for the welfare sector. CONCLUSIONS: All health sectors should recognize attitude discrepancies between doctors and patients to favor collaborative strategies that benefit a better control of the disease.

Adult↗

PubMed1975

[Serum dixogin determination. Clinical significance, results and error consideration based on comparative studies with different radioimmunoassays].

In order to compare 5 different radioimmunoassays (RIA's) and their results we determined the digoxin concentration in the serum of 186 patients and point out some sources of error. We consider the following points important: 1. There were found varying results in the determination of digoxin concentration in patient's sera using different RIA's. 2. One of the essential reasons for these differences are discrepancies of the RIA standards which belong to each kit. 3. It should be required that the control standard is equal to all RIA's. 4. Each laboratory which carries out digoxin determinations should, in collaboration with the clinic, work out and announce its own guide-line values for the RIA used in regard to the optimal therapeutic range and also to overdoses.

Cross Reactions↗

PubMed1996

Heroin addiction in Bahrain: 15 years experience.

This study describes the development and outcome of a new treatment programme for the management of heroin addiction in Bahrain. The problem reached its peak in the early 1980s with several reported deaths and with the involvement of many disciplines in the overall response. In 1983, treatment of all addicts was restricted by law to the government psychiatric hospital. The newly established specialized drug unit was overwhelmed by the number of patients seeking treatment. The lack of sufficient resources and suitably trained staff forced the unit to adopt an outpatient maintenance therapy approach for most of its clients. In 1987, a new comprehensive treatment programme was introduced that relies on a clear philosophy, safe detoxification (using objective scales for withdrawal manifestations) rather than maintenance therapy, followed by psychological and social rehabilitation. A national committee for drug addiction was formed and an intensive programme of education was started at all levels. The results indicate an initial increase at inpatient level but a marked drop of outpatient attendance. The use of the Opioid Objective Withdrawal Manifestations Scale (OOWMS) revealed that only a small number of our patients developed moderate or severe signs of withdrawal that required detoxification, and the rate of dispensed controlled medication was reduced by 99%. The effect of this approach is discussed, with special reference to the need for a collaborative effort from all disciplines in planning, implementing, continuously evaluating and modifying the national programmes for handling the serious problem of addiction.

Bahrain↗

PubMed1997

Immunohistochemical detection of 4-hydroxy-2-nonenal adducts in Alzheimer's disease is associated with inheritance of APOE4.

Cumulative oxidative damage, including lipid peroxidation, is a central component of cellular aging and is thought to play a role in the pathogenesis of late-onset Alzheimer's disease (AD). Lipid peroxidation produces several cytotoxic aldehydes, one of the most potent being 4-hydroxy-2-nonenal (HNE). We have shown previously that HNE is a potent neurotoxin that covalently modifies and cross-links neuronal cytoskeletal protein in neuroglial cultures, suggesting that HNE may contribute to the pathogenesis of AD. In addition to aging, inheritance of the epsilon 4 allele of APOE is the other major risk factor for development of late-onset AD; however, the mechanisms through which aging and apolipoprotein E isoforms may collaborate in the onset or progression of AD are not known. We tested the hypothesis that HNE may yield a particular type of protein modification, pyrrole adduction, and that this may contribute to the pathogenesis of AD. Our data demonstrated that HNE formed pyrrole adducts with protein. Polyclonal antiserum was raised that specifically recognized HNE pyrrole adducts, and immunohistochemical analysis was performed on hippocampus and temporal cortex of 10 patients with histologically verified AD. Pyramidal neuron cytoplasm was immunoreactive in 4 of 4 APOE4 homozygotes, 2 of 3 APOE3/4 heterozygotes, and none of 3 APOE3 homozygotes (P < 0.05). The pattern of staining was highly suggestive of neurofibrillary tangles as the primary immunoreactive structure. These data suggest that differences in neuronal protein modification by HNE may account in part for the APOE-associated stratification of risk for late-onset AD.

Aged↗

PubMed2003

Discrepant attitudes about teamwork among critical care nurses and physicians.

OBJECTIVE: To measure and compare critical care physicians' and nurses' attitudes about teamwork. DESIGN: Cross-sectional surveys. SETTING: Eight nonsurgical intensive care units in two teaching and four nonteaching hospitals in the Houston, TX, metropolitan area. SUBJECTS: Physicians and nurses who worked in the intensive care units. MEASUREMENTS AND MAIN RESULTS: Three hundred twenty subjects (90 physicians and 230 nurses) responded to the survey. The response rate was 58% (40% for physicians and 71% for nurses). Only 33% of nurses rated the quality of collaboration and communication with the physicians as high or very high. In contrast, 73% of physicians rated collaboration and communication with nurses as high or very high. By using factor analysis, we developed a seven-item teamwork scale. Multivariate analysis of variance of the items yielded an omnibus ( [7, 163] = 8.37; p <.001), indicating that physicians and nurses perceive their teamwork climate differently. Analysis of individual items revealed that relative to physicians, nurses reported that it is difficult to speak up, disagreements are not appropriately resolved, more input into decision making is needed, and nurse input is not well received. CONCLUSIONS: Critical care physicians and nurses have discrepant attitudes about the teamwork they experience with each other. As evidenced by individual item content, this discrepancy includes suboptimal conflict resolution and interpersonal communication skills. These findings may be the result of the differences in status/authority, responsibilities, gender, training, and nursing and physician cultures.

Adult↗

PubMed1999

Current guidelines for the treatment and prevention of nosocomial infections.

Nosocomial infections (NIs) are among the most difficult problems confronting clinicians who deal with severely ill patients. The incidence of these hospital-acquired infections varies with the size of hospitals, with specialities of wards, and with many other factors such as length of hospital stay, local trends in antibiotic usage, nursing and hygiene conditions, hospital design and geographical distribution of patients at risk. An average incidence of NI can be estimated at 5 to 10%, with higher rates in large university hospitals, reaching up to 28% in the intensive care unit (ICU). Changing epidemiology of NI and emerging resistance problems have resulted in evolving strategies of antibiotic usage in patients at risk. Several recent antibiotic resistance problems have been identified, for instance in Gram-positive organisms, and have been surveyed, in addition to those previously well known in Gram-negative bacilli. The choice of empiric antibiotic therapy for the treatment of any NI before microbiology is available has become a difficult challenge, requiring: (i) surveillance data on a regular basis of predominant organisms in units at risk; (ii) surveillance of the current resistance patterns of these organisms; (iii) identification of outbreaks involving the prevalent organisms, using modern molecular techniques for typing the strain and assess cross-contamination. In documented infection, monotherapy vs combination therapy has been often discussed in the treatment of serious Gram-negative hospital infections, but these concepts vary with the site of infection, the nature of organism involved and its pattern of resistance, the kind of antibiotic which may more or less quickly select resistant mutants. Antibiotic therapy concepts vary significantly between countries, and combinations either empirical or based on laboratory data are often preferred in European countries than in the US. Frequent collaborative studies and an increasing communication between experts of different countries, make guidelines and consensus conferences, established in a particular country, useful elsewhere and may contribute to improvement in the management of NI. Guidelines for the prevention and the control of NI are well established in many developed countries and they may have resulted in the improvement of the prevention and the treatment of NI. However, there is still potential progress that should be made, including individual preventive practices, improvement in nursing practices, control of antibiotic use, trend to shorten the hospital stay and early discharge from hospital, which results in significant cost savings.

Cross Infection↗

PubMed2002

Crossing international boundaries: implications for the Term Breech Trial Data Coordinating Centre.

The Term Breech Trial (TBT) is a multicenter, international randomized trial that compared a policy of planned cesarean section with a policy of planned vaginal birth for selected pregnancies with a fetus in breech presentation at term. The TBT involved 121 centers in 26 countries that recruited 2088 women between January 9, 1997 and April 21, 2000. This paper briefly describes the impact of broad international collaboration on data coordinating center activities, including center selection, obtaining ethics approvals, data management, center funding, and recruitment.

Clinical Trials as Topic↗

PubMed1998

Demographic, clinical and social factors associated with human immunodeficiency virus infection and other sexually transmitted diseases in a cohort of women from the United Kingdom and Ireland. MRC Collaborative Study of women with HIV.

BACKGROUND: Clinical experience suggests many women with HIV infection have experienced no other sexually transmitted diseases (STD). Our objective was to test the hypothesis that a substantial proportion of women with HIV infection in the United Kingdom and Ireland have experienced no other diagnosed STD and to describe the demographic, clinical and social factors associated with the occurrence of other STD in a cohort of HIV infected women. METHOD: Analysis of cross-sectional baseline data from a prospective study of 505 women with diagnosed HIV infection. The setting was 15 HIV treatment centres in the United Kingdom and Ireland. The main outcome measures were occurrence of other STD diagnosed for the first time before and after HIV diagnosis. Data were obtained from interview with women and clinic notes. We particularly focused on occurrence of gonorrhoea, chlamydia and trichomoniasis after HIV diagnosis, as these are the STD most likely to reflect recent unprotected sexual intercourse. RESULTS: The women were mainly infected via heterosexual sex (n = 304), and injection drug use (n = 174). 151 were black Africans. A total of 250 (49.5%) women reported never having been diagnosed with an STD apart from HIV, 255 (50.5%) women had ever experienced an STD besides HIV, including 109 (21.6%) who had their first other STD diagnosed after HIV. Twenty-five (5%) women reported having had chlamydia, gonorrhoea or trichomoniasis diagnosed for the first time after HIV diagnosis, possibly reflecting unprotected sexual intercourse since HIV diagnosis. In all 301 (60%) women reported having had sex with a man in the 6 months prior to entry to the study. Of these, 168 (58%) reported using condoms 'always', 66(23%) 'sometimes' and 56 (19%) 'never'. CONCLUSIONS: Half the women in this study reported having never experienced any other diagnosed STD besides HIV. However, after HIV diagnosis most women remain sexually active and at least 5% had an STD diagnosed which reflect unprotected sexual intercourse.

Adolescent↗

PubMed1982

Cellular analysis of specificity of antibodies and of delayed type hypersensitivity responses toward some structurally related synthetic antigens: boosting is determined by specificity of T cells.

The crossreactivity between the random synthetic polypeptide antigen poly(Tyr,Glu)-poly(DLAla)--poly(Lys) [(T,G)-A--L] and its ordered-sequence analogs (Tyr-Tyr-Glu-Glu)-poly(DLAla)--poly(Lys) [(T-T-G-G)-A--L] and (Tyr-Glu-Tyr-Glu)-poly(DLAla)--poly(Lys) [(T-G-T-G)-A--L] at the level of humoral and cellular responses was studied. For delayed type hypersensitivity responses, (T,G)-A--L-activated T cells could be challenged with the homologous antigen as well as with the ordered analogs. T cells activated by (T-T-G-G)-A--L could be challenged with either the homologous antigen or with (T,G)-A--L but not with (T-G-T-G)-A--L. Similarly, no cross stimulation was observed between (T-G-T-G)-A--L-activated cells and (T-T-G-G)-A--L, whereas (T,G)-A--L could challenge the latter cells to mediate significant responses. Similar but not identical cross reactions were observed when primed spleen cells or lymph nodes were transferred to irradiated recipients that were boosted for the production of antibodies. In contrast to observations at the level of cellular responses, (T-G-T-G)-A--L-primed spleen or lymph node cells could not be boosted with (T,G)-A--L for the production of detectable amounts of antibodies, although boosting with the homologous antigen resulted in significant levels of (T-G-T-G)-A--L-specific antibodies. Transfer experiments in which mixtures of T and B cells, each primed to a different ordered polypeptide antigen, were injected into irradiated recipients showed that successful cooperation occurs provided that the boost is given with the T-cell-specific antigen. The antibodies produced were specific to the antigen used for B-cell priming. The T-cell-B-cell collaboration probably occurs through specific determinants that are shared between the two antigens in which the ordered peptides are attached to the same multichain polymer and that are recognized by both the T and the B cells.

Amino Acid Sequence↗

PubMed1987

Determining drug-drug interactions and related effects on microcomputers.

Algorithms for determining drug-drug interactions are described. They handle all the generic drugs in the British National Formulary (BNF) (Number 5, British Medical Association and Pharmaceutical Society of Great Britain, 1984) and allow these drugs to be identified by generic or trade name. They also accept and identify interactions for compound drugs prescribed by a single trade name. The algorithms can be implemented on any microcomputer and in a number of languages. The choice of algorithm and number of drugs handled depend on size and disk storage of the microcomputer. It was tested in collaboration with the Department of Geriatric Medicine, Liverpool University, and is used in a prescribing monitoring system operational in some wards of the Royal Liverpool Hospital. The drug data are stored in the form given in the BNF and can be easily updated from this publication. The algorithms can also handle drug allergies and cross-sensitivities.

Algorithms↗

PubMed2003

e+ e- annihilation into J/psi + J/psi.

Recent measurements by the Belle Collaboration of the exclusive production of two charmonia in e(+)e(-) annihilation differ substantially from theoretical predictions. We suggest that a significant part of the discrepancy can be explained by the process e(+)e(-)-->J/psi+J/psi. Because the J/psi+J/psi production process can proceed through fragmentation of two virtual photons into two cc pairs, its cross section may be larger than that for J/psi+eta(c) by about a factor of 3.7, in spite of a suppression factor alpha(2)/alpha(2)(s) that is associated with the QED and QCD coupling constants.

Journal Article↗

PubMed2005

Comparative study of retinal nerve fiber layer measurement by StratusOCT and GDx VCC, II: structure/function regression analysis in glaucoma.

PURPOSE: To evaluate the structure/function relationship between visual field sensitivity and retinal nerve fiber layer (RNFL) thickness measured by StratusOCT (Carl Zeiss Meditec, Inc., Dublin, CA) and GDx VCC (Laser Diagnostic Technologies, Inc., San Diego, CA). METHODS: Eighty-nine subjects (27 who had healthy eyes, 21 who were glaucoma suspect, 41 who had glaucoma) were enrolled in this cross-sectional study. RNFL thickness was measured using the StratusOCT and the GDx VCC, and visual field (VF) was examined using the Humphrey VF analyzer. The relationship between RNFL thickness and VF sensitivity-expressed in terms of mean deviation (MD) in decibel (dB) scale, unlogged 1/lambert (L), and Advanced Glaucoma Intervention Study (AGIS) and Collaborative Initial Glaucoma Treatment Study (CIGTS) VF scores-were evaluated with linear and nonlinear regression models. Coefficient of determination (R(2)) was calculated, and regression models were compared using the Akaike information criterion and the F test. RESULTS: In plotting MD against RNFL thickness, curvilinear regression models demonstrated the best fit, whereas linear regression attained the best associations when VF sensitivity was expressed in 1/L. However, when healthy subjects were excluded from the analyses, the second-order polynomial was better than linear regression in describing the relation between 1/L and GDx VCC-measured RNFL thickness. Regression profiles between AGIS/CIGTS VF scores and RNFL thickness were best described in the linear and the first-order inverse models for GDx VCC and StratusOCT RNFL measurements, respectively. In general, StratusOCT RNFL measurements achieved higher associations with visual function in all the respective regression analyses than did GDx VCC. CONCLUSIONS: Description of structure/function relationships in glaucoma depends on the choice of perimetry scale, the type of RNFL measuring device, and the characteristics of the studied groups. The higher association with visual function in StratusOCT RNFL measurements compared with that in GDx VCC suggested optical coherence tomography might be a better approach for evaluating structure/function relationships. Curvilinear regression profiles found between StratusOCT RNFL thickness and MD/VF scores provide an explanation for those longitudinal observations, showing that VFs with higher AGIS/CIGTS VF scores or worse MD at baseline are at higher risk for deterioration. Regression analysis of the structure/function profile could provide important information in the assessment of the trend and pattern of glaucoma progression.

Disease Progression↗

PubMed1999

Hepatitis B virus infection among street youths in Montreal.

BACKGROUND: Street youths are at high risk for many health problems, including sexually transmitted diseases and bloodborne infections. The authors conducted a cross-sectional anonymous study from December 1995 to September 1996 involving street youths in Montreal to estimate the prevalence of risk behaviours for hepatitis B virus (HBV) infection and of markers of past and present HBV infection. METHODS: Participants were 437 youths aged 14 to 25 meeting specific criteria for itinerancy who were recruited in collaboration with the 20 major street youth agencies in Montreal. Sociodemographic and lifetime risk factor data were obtained during a structured interview, and a blood sample was taken to test for HBV markers (hepatitis B surface antigen and antibodies to the hepatitis B core antigen). Univariate analyses and multivariate logistic regressions were conducted. RESULTS: The mean age of the subjects was 19.5 years; 69.3% (303/437) were males. Many subjects had high-risk behaviours: 45.8% (200/437) had injected drugs, 24.5% (107/436) had engaged in prostitution, and 8.7% (38/437) reported having a sexual partner with a history of unspecified hepatitis. The prevalence rate for one or both HBV markers was 9.2% (40/434) (95% confidence interval [CI] 6.7%-12.3%). Multivariate logistic regression analysis showed that being over 18 years of age (adjusted odds ratio [OR] 4.5, 95% CI 1.8-11.7), having injected drugs (adjusted OR 3.5, 95% CI 1.5-8.3) and having had a sexual partner who had unspecified hepatitis (adjusted OR 3.2, 95% CI 1.3-7.5) were all associated with HBV infection. INTERPRETATION: Street youths are at high risk for HBV infection. Early and complete HBV vaccination among this vulnerable population is urgently needed.

Adolescent↗