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PubMed2005

Sexual dysfunction after a first trimester induced abortion in a Chinese population.

OBJECTIVE: To evaluate the short-term effect of a first trimester induced abortion on sexuality in a Chinese population. STUDY DESIGN: This is a cross-sectional study. One hundred and four women attending the post-abortion clinic 3-4 months after a first trimester induced abortion were recruited. They completed a self-administered questionnaire anonymously. The associations of various factors with sexual behavior after abortion were analyzed by the Chi-square test. RESULTS: More than 30% of the women reported a reduction in both frequency of vaginal intercourse and sexual desire. Their partners also had a reduction in sexual desire. The reduction of vaginal intercourse is more significant among young, unmarried women and those not having sterilization (P=0.01). In addition, the prevalence of reduction in sexual desire and enjoyment among those women who had repeated abortion was significantly higher (P<0.01). CONCLUSION: The sexuality of both women and their partners are affected after abortion. It may be due to both psychological trauma and the worry of another unwanted pregnancy. Proper counseling may relieve their anxiety and improve sexual lives.

Abortion, Induced↗
PubMed2002

In defense of the internet: the relationship between Internet communication and depression, loneliness, self-esteem, and perceived social support.

As more people connect to the Internet, researchers are beginning to examine the effects of Internet use on users' psychological health. Due in part to a study released by Kraut and colleagues in 1998, which concluded that Internet use is positively correlated with depression, loneliness, and stress, public opinion about the Internet has been decidedly negative. In contrast, the present study was designed to test the hypothesis that Internet usage can affect users beneficially. Participants engaged in five chat sessions with an anonymous partner. At three different intervals they were administered scales measuring depression, loneliness, self-esteem, and social support. Changes in their scores were tracked over time. Internet use was found to decrease loneliness and depression significantly, while perceived social support and self-esteem increased significantly.

Communication↗
PubMed2002

HIV incidence on the increase among homosexual men attending an Amsterdam sexually transmitted disease clinic: using a novel approach for detecting recent infections.

OBJECTIVE: Dramatic increases have occurred in sexually transmitted diseases (STD) and in sexual risk behaviour among homosexual men in Amsterdam and internationally. We investigated whether these trends indicate a resurgence of the HIV epidemic. METHODS: HIV incidence was determined among homosexual attendees of an STD clinic in Amsterdam, who had participated in semi-annual anonymous unlinked cross-sectional HIV prevalence studies from 1991 to 2001. Stored HIV-seropositive samples were tested with a less-sensitive HIV assay and, if non-reactive, were further tested for the presence of antiretroviral drugs, indicative of the use of highly active antiretroviral therapy. Seropositive men who tested non-reactive on the less-sensitive assay and had not used antiretroviral drugs were classified as recently infected (< 170 days). Annual HIV incidence and its changes were examined. RESULTS: Among 3090 homosexual participants (median age 34 years), 454 were HIV infected, of whom 37 were recently infectioned. From 1991 to 2001 the overall incidence was 3.0 infections/100 person-years. Incidence increased over time (P = 0.02) and, strikingly, the increase was evident in older (> or = 34 years) men (P < 0.01), but not in the young. Of men recently infected, 84% (n = 31) were unaware of their infection and 70.3% (n = 26) had a concurrent STD. These 26 men reportedly had sex with a total of 315 men in the preceding 6 months. CONCLUSION: HIV incidence is increasing among homosexual attendees of an STD clinic. It is imperative to trace recently infected individuals, because they are highly infectious, and can thus play a key role in the spread of HIV.

Adult↗
PubMed1997

Sexual abuse is more frequently reported by IBS patients than by patients with organic digestive diseases or controls. Results of a multicentre inquiry. French Club of Digestive Motility.

OBJECTIVES: The aim of this multicentre inquiry was to evaluate the prevalence of sexual abuse among IBS patients consulting a gastroenterologist, in comparison to healthy controls and patients with organic digestive diseases. PATIENTS AND METHODS: Patients with irritable bowel syndrome (IBS; Rome Criteria) were included by eight university hospitals (n = 196; 41.2 +/- 20.6 years; sex ratio (M/F) = 0.23). Control groups were: (i) patients consulting for the follow-up of non-neoplastic organic digestive diseases (n = 135; 41.5 +/- 17.0 years; 1.21); (ii) patients attending ophthalmology units (n = 200; 43.8 +/- 20.7 years; 0.81); (iii) healthy subjects seen in centres of the National Health System (n = 172; 40.3 +/- 16.3 years; 0.83). Each patient filled in an anonymous questionnaire, without help. Prevalence of sexual abuse in the various groups was compared by the chi 2 test. RESULTS: Sixty-two instance of sexual abuse (55 females, 7 males) were recorded among the 196 IBS patients (31.6%); 8 cases of verbal aggression, 4 of exhibitionism, 11 of sexual harassment, 22 sexual touches, 17 rapes. The prevalence of sexual abuse was 14.0% for the patients with organic digestive diseases (P = 0.0005 vs. IBS), 12.5% among ophthalmology patients (P < 0.0001) and 7.6% in healthy controls (P < 0.0001). Sexual abuse was accompanied by physical abuse in 23 IBS patients and 19 patients from control groups (not significant). Twenty-six IBS patients reported isolated physical abuse (14.7%) versus 40 from control groups (8.8%; P = 0.041). There was a significant trend towards more severe attacks of abuse among IBS patients than in others. CONCLUSION: This study confirms the high prevalence of sexual abuse among IBS patients consulting in Gastroenterology. Some of these patients would benefit from appropriate therapy. (In the majority of cases, this will be psychotherapy.)

Adolescent↗
PubMed2006

Prevalence and estimated incidence of blood-borne viral pathogen infection in organ and tissue donors from northern Alberta.

To determine the potential safety benefit of introducing nucleic acid testing (NAT) in tissue and organ donors, the risk of virus transmission was examined in a Canadian population. Anonymous data on Northern Alberta tissue and organ donors from 1998 to 2004 were used to determine the seroprevalence and estimate the seroincidence and residual risk of HIV, HBV, HCV and HTLV infection. Of the 3372 donors identified, 71.1% were surgical bone, 13.2% were living organ and 15.6% were deceased organ/tissue donors. Seroprevalence was: HIV 0.00%, HBV 0.09%, HCV 0.48% and HTLV 0.03%. Incidence (/100,000 p-yrs) and residual risks (/100,000 donors) could only be estimated for HBV (24.2 and 3.9) and HCV (11.2 and 2.2). Risk estimates were higher for deceased donors than surgical bone donors. HCV had the highest prevalence and HBV had the highest estimated incidence. HIV and HTLV risks were extremely low precluding accurate quantification. In this region of low overall viral prevalence, HCV NAT would be most effective in deceased organ donors. In surgical bone donors the cost of implementing NAT is high without significant added safety benefit.

Adolescent↗
PubMed2006

Protocol of the COSMIN study: COnsensus-based Standards for the selection of health Measurement INstruments.

BACKGROUND: Choosing an adequate measurement instrument depends on the proposed use of the instrument, the concept to be measured, the measurement properties (e.g. internal consistency, reproducibility, content and construct validity, responsiveness, and interpretability), the requirements, the burden for subjects, and costs of the available instruments. As far as measurement properties are concerned, there are no sufficiently specific standards for the evaluation of measurement properties of instruments to measure health status, and also no explicit criteria for what constitutes good measurement properties. In this paper we describe the protocol for the COSMIN study, the objective of which is to develop a checklist that contains COnsensus-based Standards for the selection of health Measurement INstruments, including explicit criteria for satisfying these standards. We will focus on evaluative health related patient-reported outcomes (HR-PROs), i.e. patient-reported health measurement instruments used in a longitudinal design as an outcome measure, excluding health care related PROs, such as satisfaction with care or adherence. The COSMIN standards will be made available in the form of an easily applicable checklist. METHOD: An international Delphi study will be performed to reach consensus on which and how measurement properties should be assessed, and on criteria for good measurement properties. Two sources of input will be used for the Delphi study: (1) a systematic review of properties, standards and criteria of measurement properties found in systematic reviews of measurement instruments, and (2) an additional literature search of methodological articles presenting a comprehensive checklist of standards and criteria. The Delphi study will consist of four (written) Delphi rounds, with approximately 30 expert panel members with different backgrounds in clinical medicine, biostatistics, psychology, and epidemiology. The final checklist will subsequently be field-tested by assessing the inter-rater reproducibility of the checklist. DISCUSSION: Since the study will mainly be anonymous, problems that are commonly encountered in face-to-face group meetings, such as the dominance of certain persons in the communication process, will be avoided. By performing a Delphi study and involving many experts, the likelihood that the checklist will have sufficient credibility to be accepted and implemented will increase.

Clinical Protocols↗
PubMed1993

Cancer by another name: a randomized trial of the effects of euphemism and uncertainty in communicating with cancer patients.

PURPOSE: In this study we tested some assumptions about the use of euphemism in communicating with cancer patients. Does an explicit statement about the diagnosis of cancer cause patients to respond with greater anxiety than when uncertainty or ambiguity is allowed to persist? Do patients believe they cope better with cancer when the diagnosis is explicit? METHODS: A heterogeneous sample of 165 cancer patients completed a new measure of emotional adjustment to cancer using random assignment among four testing variables: agent (self-report v interview), terminology (the words cancer v illness), identification (patient identified v anonymous), and supervision (clinic v home). Internal consistency (Cronbach's alpha) for the 39-item set was 0.74 and face and content validity were determined using the focus-group technique and preliminary factor analysis. After answering the adjustment measures, subjects completed the Spielberger State-Trait Anxiety Inventory (STAI). RESULTS: Overall anxiety levels were significantly lower in the sample than published norms for general medical and surgical patients. Exposure to the word cancer as distinct from illness increased anxiety, but did not alter adjustment scores. Supervision and agent conditions did not affect anxiety, but reported adjustment was poorer in the interview condition compared with the self-report condition. Ambiguous instructions, such as asking patients to complete the questionnaire anonymously but return it in person to staff in the clinic, resulted in poorer adjustment, which was reversed by the consistent instruction to complete the questionnaire anonymously at home and return it by mail. CONCLUSION: Use of the word cancer generated anxiety to levels similar to those reported in general medical and surgical patients, but did not produce any distortion in reported adjustment. However, any ambiguity associated with the conditions under which adjustment is assessed may lead to distortion and an increase in the patient's reported psychologic distress.

Adult↗
PubMed2000

Prevalence of the use of herbal products in a low-income population.

OBJECTIVES: This study determined the prevalence of herb/supplement use in a low-income population and determined the providers' level of knowledge about herbs/supplements. METHODS: Adult English-speaking patients seen at a rural family practice residency clinic were offered an anonymous survey. Another survey was developed for the clinic providers. Data were analyzed using the chi-square test. RESULTS: Fifty-six percent of a low-income population use herbs/supplements; 41% of all users cited friends or relatives as their main source of information, and 53% of users had not informed their provider. In the provider survey, 69% of the providers indicated that they had received no education about herbs/supplements, yet 71% were asked about them by patients at least twice a month. CONCLUSIONS: Because herb/supplement use occurs across all demographic groups, all patients should be questioned about their use of such substances. Currently, few providers are prepared to guide their patients about herbs/supplements. Efforts should be made to educate health care providers about common herbs/supplements.

Adolescent↗
PubMed2002

Evaluation of the BioSign PSA membrane test for the identification of semen stains in forensic casework.

AIM: To evaluate BioSign prostate specific antigen (PSA), a membrane test device used as a clinical aid in the diagnosis of prostate cancer, to determine whether it can be used in forensic laboratories for identifying semen stains. METHODS: Biological fluids were obtained under ethical approval from anonymous consenting donors. BioSign PSA was evaluated in terms of its specificity, sensitivity and cost to replace an ELISA (enzyme linked immunosorbent assay) method of PSA detection. RESULTS: Semen stain extracts and semen diluted 10(5) tested positive with BioSign PSA. Animal semen, other human body fluids and commonly encountered household products tested negative. Anomalous results were observed with semen-free condoms containing nonoxynol-9. The cause of these false positive results is not known. CONCLUSIONS: These results and the ease of use of the BioSign PSA kit indicate that it is a valuable addition to forensic laboratories and can adequately replace the ELISA method of PSA detection. BioSign PSA was not suitable for testing condoms for semen.

Animals↗
PubMed2003

[Tropical fish salesmen's knowledge and behaviour concerning "fish tank granuloma"].

OBJECTIVES: Mycobacterium marinum is responsible for "fish tank granuloma", a chronic and sometimes disabling skin infection, which in France would be the most frequent "atypical" cutaneous mycobacteriosis. Tropical fish salesmen are concerned about this disease because they might sell contaminated fish and be infected themselves. A review of the literature indicated that one quarter of the patients were aquarium workers. This original study tested the salesmen's knowledge and behaviour regarding "fish tank granuloma". METHOD: This national study consisted in an anonymous questionnaire with 24 questions. RESULTS: Among forty salesmen, six of them (15 p. 100) knew this human disease well. Thirty (75 p. 100) ignored it. Among the few salesmen (22.5 p. 100) who had studied to become aquarium workers, only one third were taught about Mycobacterium marinum. Eight salesmen (20 p. 100) were concerned about the human disease: three of them were personally infected and five others had known infected colleagues or purchasers. Most of the aquarium workers immersed their hands without gloves in the fish tanks every day. Only a few destroyed all the fishes from a contaminated tank. CONCLUSIONS: Most of the tropical fish salesmen ignored "fish tank granuloma" although 20 p. 100 of them were concerned. This chronic disease, sometimes disabling, should be better known by aquarium salesmen. The national tropical fish salesmen were informed of the results of this study.

Animals↗
PubMed2004

HIV incidence appears constant in men who have sex with men despite widespread use of effective antiretroviral therapy.

OBJECTIVE: To estimate the trend in HIV incidence between 1995 and 2001 in men who have sex with men (MSM) attending sexually transmitted infection (STI) clinics in the UK. DESIGN: The Serological Testing Algorithm for Recent HIV Seroconversion (STARHS) was applied to serum specimens from MSM attending 15 STI clinics collaborating in an HIV unlinked anonymous prevalence serosurvey. METHODS: STARHS was performed on anti-HIV-1 positive specimens and HIV incidence rates determined. Specimens from MSM with previously diagnosed HIV or an AIDS defining condition were excluded. National data on uptake of antiretroviral therapy (ART), AIDS mortality and diagnoses of gonorrhoea in MSM were used to aid interpretation of the HIV incidence findings. RESULTS: Of 43,100 specimens collected from MSM 3565 were anti-HIV-1 positive. Of these, 1645 were eligible and available for STARHS testing, of which 317 were deemed to come from recently acquired infections. The overall estimated annual incidence ranged from 1.5% (1999) to 3.3% (1996). In 2001 it was 2.45%, with a 3.1% incidence in London and 1.0% elsewhere. No significant trends in HIV incidence were found. CONCLUSIONS: Despite the widespread use of ART there was no significant decline in HIV incidence. Individuals whose HIV infection has been diagnosed should be less infectious. However, over 20% of infections in MSM remain undiagnosed, many with acute STI, and this pool of unmanaged HIV infection may be an important driver of the ongoing epidemic. Initiatives to diagnose and treat a greater proportion of HIV infections may be the key to reducing HIV incidence in MSM.

Adult↗
PubMedDate not supplied

Automated interviewing for hepatitis B risk assessment and vaccination referral.

INTRODUCTION: This study describes a convenient, anonymous, and private method to assess risk for hepatitis B and recommend vaccination for those determined to be at risk. METHODS: We used an automated telephone interview and computerized risk assessment to inform callers of their hepatitis B risk status and direct those at risk for testing, counseling, and vaccination. The project's efficacy was compared to previously reported projects, and the expense was compared to estimates assuming universal vaccination. RESULTS: This pilot project found that 63% of completed interviews indicated risk. Of those at risk, 47% reported for testing, and 89% of those tested required vaccination. Of those requiring vaccine, 75% (32% of at-risk callers) completed the three-dose series. Of those tested, 9% previously had natural infections and 2% were carriers. CONCLUSIONS: Until adolescents are universally vaccinated, computerized hepatitis B risk assessment can facilitate prevention and decrease vaccination program costs. Privacy and anonymity may increase participation of groups difficult to reach before the onset of risky behaviors that results in treatment for STDs and drug abuse.

Adult↗
PubMed2002

Attitudes of pediatric residents toward ethical issues associated with genetic testing in children.

OBJECTIVE: To assess the attitudes of pediatric residents toward molecular genetic testing and some associated ethical issues that accompany its use in pediatric patients. METHODS: A questionnaire study of pediatric residents (n = 160; response rate: 40%) enrolled in training programs at 3 New York metropolitan area hospitals was designed to determine their attitudes toward genetic testing in children and adolescents. The study instrument presented 2 clinical vignettes that described scenarios where a pediatric patient was at risk for being affected with or a carrier of a genetic disorder. Residents returned the questionnaire anonymously. RESULTS: Most pediatric residents recognized the importance of educating family members (95%) and at-risk individuals (89%) about the inheritance pattern of the disorders they were at risk for. However, a substantial number would order predictive testing for Huntington disease in a child at the request of a parent (39% at age 10 and 52% at age 17), and more than half would order fragile X carrier studies on the cognitively normal sister of an affected male (56%). CONCLUSIONS: An effort must be made to educate all physicians during their residency training about the ethical issues associated with genetic testing. For pediatric residents, such education must include instruction on the complexities associated with offering such testing in this age group.

Adolescent↗
PubMedDate not supplied

Acceptability of pharmacy-based bone density measurement by women and primary healthcare providers.

OBJECTIVES: To assess women's information sources regarding, and monetary value placed on, pharmacy-based bone density screening. In addition, we evaluated clinicians' response to peripheral bone mass measurements. DESIGN: We recruited 197 women 50 years of age or older in four rural Midwestern community pharmacies. Each woman completed a questionnaire and underwent calcaneal bone density testing. Results were sent to participants' primary care providers. These providers, and others practicing within a 50-mile radius, were surveyed anonymously to evaluate usefulness of bone density data provided by this program or pharmacy-based osteoporosis screening in general. In addition, clinicians were asked how they would manage a woman with a calcaneal T-score of -1.3. RESULTS: Fifty-six percent of participants [95% CI, 49%-63%] became interested in screening through the media, and only 6% (CI, 3%-9%) became interested through contact with their primary care provider. Women were willing to pay a median of $25 for screening. Of 18 responding clinicians with patients in this study, 72% (CI, 47%-90%) found the results useful. Of the 67 responding clinicians, 51% (CI, 39%-63%) supported pharmacy-based bone mass measurement. For a case scenario of a woman with a calcaneal T-score of -1.3, 57% (CI, 46%-68%) of clinicians indicated that they would have ordered central dual-energy x-ray absorptiometry, and 20% (CI, 11%-29%) would have prescribed antiresorptive therapy. CONCLUSIONS: This study suggests that (1) women are an important force in obtaining bone density testing outside the clinic setting, both by self-education and willingness to pay, and (2) primary care clinicians receiving such results find them useful and indicate willingness to use them in decision-making.

Aged↗
PubMed1994

Comparison of 79 DNA polymorphisms tested in Australians, Japanese and Papua New Guineans with those of five other human populations.

Seventy-nine DNA polymorphisms from 57 loci (28 genes and 29 anonymous DNA segments) have been typed in eight human populations. Here we present allele frequencies for three populations (Japanese, New Guineans, and Australians) as well as revised frequencies for a Chinese sample: allele frequencies for five additional populations (Biaka and Mbuti Pygmies, Melanesians, Chinese, and Europeans) were described previously [Bowcock et al 1991a]. Evaluation of Hardy-Weinberg equilibrium for these polymorphisms suggested that the New Guinean sample may be from a highly substructured population. Average FST value for the 79 markers (polymorphisms) was 0.147 +/- 0.011 across the eight populations: Fst values for some markers changed dramatically with the addition of three populations--in particular, Australians and New Guineans. Average heterozygosity for eight populations was 0.307 +/- 0.014. Genetic distances indicated that the Australian sample may have some European ancestry. An average linkage tree inferred from these distances suggested that the first split of modern humans was between Africans and non-Africans, while the second major split was between Australians/New Guineans and all other non-Africans. The neighbor-joining tree also separated the African populations from all others. European polymorphism ascertainment bias and European admixture appear to have influenced both estimation of population heterozygosity and tree inference.

Alleles↗
PubMed2003

Voluntary HIV antibody testing amongst youth in Hong Kong.

We performed a study to estimate the prevalence of and factors associated with human immunodeficiency virus (HIV) antibody-testing behaviour among youth in Hong Kong. It was a population-based cross-sectional study. Questions on HIV testing were asked as part of a youth sexuality study conducted in July to December 1996 among young adults in Hong Kong. A total of 517 (53.6%) males and 447 (46.4%) females aged 17 to 28 years completed an anonymous structured self-administered questionnaire. Respondents had good knowledge about correct modes of HIV transmission and prevention. 9.4% (95% confidence interval [CI]: 7.0, 12.3) of males and 6.4% (95% CI: 4.3, 9.1) of females had been tested for HIV through blood donation. Excluding blood donation, 3.7% (95% CI: 2.2, 5.7) of males and 3.6% (95% CI: 2.1, 5.9) of females had been tested (voluntary testing). 47.5% (95% CI: 44.4, 50.7) of subjects reported at least one major risk factor for HIV infection. In multivariate analyses, factors independently associated with both voluntary HIV testing and HIV testing by blood donation were age and having had sex with multiple partners. A higher educational level was a predictor of HIV testing by blood donation. Self-assessment of having sufficient sex education was also significantly associated with voluntary HIV testing. HIV testing is not widespread in Hong Kong and those at risk are more likely to have been tested. It is of concern, however, that many of those reporting risk factors have not been tested.

AIDS Serodiagnosis↗
PubMed1997

[Knowledge and behavior of pregnant women towards HIV infection and its screening].

OBJECTIVES: To assess knowledge and attitudes of pregnant women towards HIV infection and testing, and to compare them according to the outcome of the pregnancy (elective abortion vs delivery). METHODS: Between March 30 and April 26, 1992, all women ending their pregnancy in a medical center located in South Eastern France, were asked to complete an anonymous questionnaire: 3,589 (89.6%) responded: 2,825 women who delivered and 764 who chose abortion. RESULTS: 61.7% of the women who delivered and 24.1% of the women who chose abortion declared having been tested for HIV during pregnancy (p < 0.001). Among women who reported not having been tested, very few did so because they refused the test (2% among women who deliver and 1.5% among women who terminated pregnancy). A total of 2.6% of women tested during prenatal care and 19.6% in the context of abortion did not know the result of their test (p < 0.001). Knowledge about HIV transmission among women who delivered dit not differ significantly from that of women who terminated pregnancy. However risky behaviors were more frequent among the latter group (38.8% vs 17.7%, p < 0.001). CONCLUSION: This research confirms that systematic HIV screening during prenatal care was already diffused in France but remained mainly motive by foetal concerns and was not always associated with adequate preventive counselling, specially for migrant women and women with a low level of education. HIV screening and counselling is not guaranteed for women coming for elective abortion although they are more at risk for HIV infection. In spite of psychological difficulties, systematic proposal of HIV screening should be extended to the context of elective abortion.

Abortion, Legal↗
PubMed1999

Factors associated with success or failure in radiological interpretation: diagnostic thinking approaches.

RATIONALE AND OBJECTIVES: To identify those radiological diagnostic thinking approaches associated with success or failure in film interpretation. METHODS: A questionnaire was designed, piloted and tested for validity and reliability prior to use. This questionnaire was adapted and modified from the 'diagnostic thinking inventory' by Bordage et al. 21 One hundred and eighty students anonymously answered the questionnaire prior to their 15-case comprehensive film interpretation examination. Oral film-reading sessions were performed on a stratified random sample (n = 48) of students with complete transcripts of each session recorded. Spearman's correlation coefficient and multiple regression analysis statistics were applied to the questionnaire data. The unpaired t-test, ANOVA and correlation statistics were used to analyse the oral film-reading sessions. RESULTS: The most successful students were those who could easily see the integration of radiology with other subjects (P = 0.0042), students who could easily link the clinical information to the radiographic signs (P = 0.0354), and students who could easily identify the 'key' abnormal radiographic findings (P = 0.047). Students who used a flexible but complete search pattern performed significantly better (P = 0.0235) than students using any other search pattern approach. CONCLUSIONS: Radiology is a classic example of clinical problem solving and thus should be taught in that format. Those same factors which differentiate expert from novice diagnosticians are also evident in more successful vs. less successful students in radiology.

Chiropractic↗