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PubMedDate not supplied

An ethnographic study of cervical cancer among women in rural Kenya: is there a folk causal model?

This article assesses knowledge, attitudes, and practices regarding cervical cancer among rural women of Kenya. One hundred and sixty women (mean age 37.9 years) who sought various health care services at Tigoni subdistrict hospital, Limuru, Kenya, were interviewed using a semistructured questionnaire. In addition, three focus group discussions (25 participants) were held, five case narratives recorded, and a free list of cervical cancer risk factors obtained from a group of 41 women respondents. All women were aged between 20 and 50 years. About 40% knew cervical cancer, although many still lack factual information. A history of sexually transmitted diseases (61.5%), multiple sexual partners (51.2%), and contraceptive use (33%) were identified as risk factors. Other factors mentioned include smoking, abortion, and poor hygiene standards. High parity, early sexual debut, and pregnancy were not readily mentioned as risk factors. We propose a folk causal model to explain the link between these factors and cervical cancer. Lack of knowledge constrains utilization of screening services offered at the clinics. Consequently, respondents support educating women as a way to tackling issues on cervical cancer. It is recommended that an integrated reproductive health program that addresses comprehensively women's health concerns be put in place.

Adult↗
PubMedDate not supplied

An appraisal of the level of awareness and utilization of the Pap smear as a cervical cancer screening test among female health workers in a tertiary health institution.

Papanicolaou (Pap) smear test is considered the best approach to reduce cervical cancer incidence worldwide. We surveyed 195 female health workers with structured questionnaires to identify factors that could influence the awareness and utilization of the Pap smear as a cervical cancer screening test. More than 65% of the respondents were aware of the disease, cervical cancer, and approximately 64% were aware of the Pap smear test. Seven three (39.7%) of the respondents had their sexual debut (coitarche) before the age of 20 years, while 109 (59.9%) have had multiple sexual partners. The modal number of sexual partners was 3, range 0-8. Pap smear awareness level significantly varied among the categories of the female health workers (P < 0.001). A minority of 14.1% have had a Pap test. There was a significant variation in utilization of Pap test across the various categories of the health workers (Pearson Chi-square 14.67, P < 0.05), and a significant correlation between Pap smear awareness and utilization (P < 0.001). The majority, 89%, believed that they were not at risk of developing cervical cancer. The self-reported utilization of Pap test among health workers was low. While there was a positive correlation between Pap test awareness and utilization, screening uptake was very poor due to a combination of inappropriate beliefs, misapprehension, and deficient knowledge. There is an urgent need for an aggressive awareness campaign and the provision of a screening program nationally.

Adult↗
PubMed2005

Brief report: Methadone treatment of injecting opioid users for prevention of HIV infection.

OBJECTIVE: To assess the effects of oral substitution treatment for opioid-dependent injecting drug users on HIV risk behaviors and infections. DATA SOURCES: Multiple electronic databases were searched. Reference lists of retrieved articles were checked. METHODS: Because of varying methodologies of available studies, this systematic review was limited to a descriptive summary, looking at consistency of outcomes across studies. RESULTS: Twenty-eight studies involving methadone treatment were included in the review. Methadone maintenance treatment is associated with statistically significant reductions in injecting use and sharing of injecting equipment. It is also associated with reductions in numbers of injecting drug users reporting multiple sex partners or exchanges of sex for drugs or money, but has little effect on condom use. It appears that the reductions in risk behaviors do translate into fewer cases of HIV infection. CONCLUSIONS: Methadone maintenance treatment for injecting drug users significantly reduces the risk of transmission of HIV and should be provided as a component of a strategic approach to the prevention and control of HIV infection. There is insufficient evidence to determine whether other forms of oral substitution treatment also reduce the risk of HIV transmission.

HIV Infections↗
PubMedDate not supplied

Infectious disease capsules: a pox on your house.

A 31-year-old, previously healthy white man presented to the emergency department with complaints of malaise, fevers, shortness of breath, a non-productive cough, and a "rash." His physical exam revealed a temperature of 100.2F, a pulse of 129 bpm, respiratory rate of 14 BPM, and blood pressure of 140/74 mm Hg. He was alert, oriented, and in no distress. His oropharynx was dry, his neck was supple, and cervical lymphadenopathy was absent. He had tachycardia, bilateral wheezes, and rhonchi with prolonged expirations. There was a diffuse vesicular eruption enveloping his entire body with involvement sparing his palms and soles (Figures 1 and 2). Laboratory values showed a hemoglobin of 16.0 g/dL and a white blood cell count of 7100 cells/pL, with 39%neutrophils, 23% bands, and 35% lymphocytes. His platelet count was mildly decreased to 86,000 x 103/pL. Chest radiograph revealed bilateral diffuse interstitial infiltrates. A diagnosis of acute varicella-zoster virus pneumonia (varicella pneumonia) was made, and the patient was started on IV acyclovir (10 mg/kg every 8 hours). Upon further questioning, the patient stated that his daughter had been diagnosed with "chickenpox" 7 days ago. The patient had numerous exposures to chickenpox in the past but had never developed clinical expressions of varicella. He was not at risk for HIV infection, not having multiple sexual partners, IV drug abuse, or blood transfusions. During the 1 day of in-hospitalization, his fever abated and the pulmonary signs diminished. Following discharge, IV acyclovir was replaced by valacyclovir to complete a 7-day course of therapy.

Acyclovir↗
PubMed2000

Trends and determinants of contraceptive use in Rakai District, Uganda, 1995-98.

A prospective study conducted between 1995 and 1998 assessed trends in contraceptive use in rural Rakai District, Uganda. Over a period of 30 months, women's use of modern contraceptives increased significantly from 11 percent to 20 percent. Male condom use increased from 10 percent to 17 percent. The prevalence of pregnancy among sexually active women 15-49 declined significantly from 15 percent to 13 percent. Women practicing family planning for pregnancy prevention were predominantly in the 20-39-year age group, married, better educated, and had higher parity than others, whereas women or men adopting condoms were predominantly young, unmarried, and better educated. Condom use was particularly high among individuals reporting multiple sexual partners or extramarital relationships. Contraceptive use was higher among women who desired fewer children, among those who wished to space or terminate childbearing, and among women with previous experience of unwanted births or abortions. Self-perception of HIV risk increased condom use, but HIV testing and counseling had only modest effects. Contraception for pregnancy prevention and for HIV/STD prophylaxis are complementary.

Abortion, Induced↗
PubMed1995

Characteristics associated with the risk of unintended pregnancy among urban homeless women: use of the Shuler Nurse Practitioner Practice Model in research.

In this pilot study, family planning practices and risk for unintended pregnancy among 50 homeless women residing in the downtown area of Los Angeles were investigated through the retrospective analysis of data collected through a wholistic clinic intake questionnaire. Those women who were least likely to use a birth control method in this study were Black, used cocaine daily, had multiple sources of emotional support, were satisfied with their sex lives, and reported access problems to family planning services (p < or = .05). Furthermore, over half of the total sample was at risk for unintended pregnancy. These at risk women were more likely to be separated from their children (p < or = .05), report current (p < or = .05) and past (p < or = .01) drug problems, have multiple sex partners (p < or = .001), engage in prostitution (p < or = .01), have a past history of sexually transmitted diseases (p < or = .05), and were least likely to be satisfied with their sex lives (p < or = .05). The findings suggest that homeless women are in great need of family planning health services, and that such services should be combined with vocational, social service, and drug treatment programs.

Adult↗
PubMed1991

Bacterial vaginosis.

Bacterial vaginosis (BV) is the most common of the vaginitides affecting women of reproductive age. It appears to be due to an alteration in the vaginal ecology by which Lactobacillus spp., the predominant organisms in the healthy vagina, are replaced by a mixed flora including Prevotella bivia, Prevotella disiens, Porphyromonas spp., Mobiluncus spp., and Peptostreptococcus spp. All of these organisms except Mobiluncus spp. are also members of the endogenous vaginal flora. While evidence from treatment trials does not support the notion that BV is sexually transmitted, recent studies have shown an increased risk associated with multiple sexual partners. It has also been suggested that the pathogenesis of BV may be similar to that of urinary tract infections, with the rectum serving as a reservoir for some BV-associated flora. The organisms associated with BV have also been recognized as agents of female upper genital tract infection, including pelvic inflammatory disease, and the syndrome BV has been associated with adverse outcome of pregnancy, including premature rupture of membranes, chorioamnionitis, and fetal loss; postpartum endometritis; cuff cellulitis; and urinary tract infections. The mechanisms by which the BV-associated flora causes the signs of BV are not well understood, but a role for H2O2-producing Lactobacillus spp. in protecting against colonization by catalase-negative anaerobic bacteria has been recognized. These and other aspects of BV are reviewed.

Female↗
PubMed1995

Cervical cancer: is herpes simplex virus type II a cofactor?

In many ways, cervical cancer behaves as a sexually transmitted disease. The major risk factors are multiple sexual partners and early onset of sexual activity. Although high-risk types of human papillomaviruses (HPV) play an important role in the development of nearly all cases of cervical cancer, other sexually transmitted infectious agents may be cofactors. Herpes simplex virus type 2 (HSV-2) is transmitted primarily by sexual contact and therefore has been implicated as a risk factor. Several independent studies suggest that HSV-2 infections correlate with a higher than normal incidence of cervical cancer. In contrast, other epidemiological studies have concluded that infection with HSV-2 is not a major risk factor. Two separate transforming domains have been identified within the HSV-2 genome, but continued viral gene expression apparently is not necessary for neoplastic transformation. HSV infections lead to unscheduled cellular DNA synthesis, chromosomal amplifications, and mutations. These observations suggest that HSV-2 is not a typical DNA tumor virus. It is hypothesized that persistent or abortive infections induce permanent genetic alterations that interfere with differentiation of cervical epithelium and subsequently induce abnormal proliferation. Thus, HSV-2 may be a cofactor in some but not all cases of cervical cancer.

Female↗
PubMed2005

Use of an immunochromatographic assay for rapid detection of Trichomonas vaginalis in vaginal specimens.

Trichomonas vaginalis infection is estimated to be the most widely prevalent nonviral sexually transmitted infection in the world. Wet-mount microscopy is the most common diagnostic method, although it is less sensitive than culture. The OSOM Trichomonas Rapid Test (Genzyme Diagnostics, Cambridge, Mass.) (referred to here as OSOM) is a new point-of-care diagnostic assay for T. vaginalis that uses an immunochromatographic capillary flow (dipstick) assay and provides results in 10 min. The purpose of this study was to determine the test characteristics of OSOM compared to those of a composite reference standard (CRS) comprised of wet-mount microscopy and T. vaginalis culture. This multicenter cross-sectional study enrolled sexually active women > or =18 years of age who presented with symptoms of vaginitis, exposure to T. vaginalis, or multiple sexual partners. Vaginal-swab specimens were obtained for T. vaginalis culture, wet mount, and rapid testing. The prevalence of T. vaginalis in this sample was 23.4% (105 of 449) by the CRS. The sensitivity and specificity of OSOM vaginal-swab specimens were 83.3 and 98.8%, respectively, while wet mount had a sensitivity and specificity of 71.4 and 100%, respectively, compared to the CRS. OSOM performed significantly better than wet mount (P = 0.004) and detected T. vaginalis in samples that required 48 to 72 h of incubation prior to becoming culture positive. The performance of the rapid test was not affected by the presence of coinfections with chlamydia and gonorrhea. The OSOM Trichomonas Rapid Test is a simple, objective test that can be expected to improve the diagnosis of T. vaginalis, especially where microscopy and culture are unavailable.

Adolescent↗
PubMed1997

The N terminus of hamster polyomavirus middle T antigen carries a determinant for specific activation of p59c-Fyn.

Transformation by rodent polyomaviruses is mediated primarily by middle T antigen, a membrane-bound protein that does not carry an intrinsic enzymatic activity but interacts and subverts the activity of cellular regulators of proliferation. The multiple protein partners of murine polyomavirus (Py) middle T antigen include the tyrosine kinases c-Src and, to a lesser extent, c-Fyn and c-Yes. By contrast, the hamster polyomavirus (HaPV) middle T antigen selectively activates the c-Fyn gene product. This difference may account for the contrasting tumor patterns induced by the two viruses. The sequences of the respective N-terminal and C-terminal functional domains of murine Py and HaPV middle T antigens are highly conserved whereas the intervening stretches are clearly divergent, leading to the speculation that this divergence may direct the specificity for tyrosine kinase activation. We have addressed this issue by constructing a chimera middle T antigen molecule carrying the N-terminal domain from HaPV (exon 1) in phase with the other two domains from murine Py (exon 2). The biological properties of this chimera molecule are indistinguishable from those of HaPV middle T antigen; it specifically activates p59c-Fyn and carries the transforming phenotype of the HaPV middle T antigen on rat fibroblasts.

Animals↗
PubMed1997

The product of the murine homolog of the Drosophila extra sex combs gene displays transcriptional repressor activity.

The heterogeneous nuclear ribonucleoprotein K protein represents a novel class of proteins that may act as docking platforms that orchestrate cross-talk among molecules involved in signal transduction and gene expression. Using a fragment of K protein as bait in the yeast two-hybrid screen, we isolated a cDNA that encodes a protein whose primary structure has extensive similarity to the Drosophila melanogaster extra sex combs (esc) gene product, Esc, a putative silencer of homeotic genes. The cDNA that we isolated is identical to the cDNA of the recently positionally cloned mouse embryonic ectoderm development gene, eed. Like Esc, Eed contains six WD-40 repeats in the C-terminal half of the protein and is thought to repress homeotic gene expression during mouse embryogenesis. Eed binds to K protein through a domain in its N terminus, but interestingly, this domain is not found in the Drosophila Esc. Gal4-Eed fusion protein represses transcription of a reporter gene driven by a promoter that contains Gal4-binding DNA elements. Eed also represses transcription when recruited to a target promoter by Gal4-K protein. Point mutations within the eed gene that are responsible for severe embryonic development abnormalities abolished the transcriptional repressor activity of Eed. Results of this study suggest that Eed-restricted homeotic gene expression during embryogenesis reflects the action of Eed as a transcriptional repressor. The Eed-mediated transcriptional effects are likely to reflect the interaction of Eed with multiple molecular partners, including K protein.

Amino Acid Sequence↗
PubMed2003

Proteolytic cleavage of MLL generates a complex of N- and C-terminal fragments that confers protein stability and subnuclear localization.

The mixed-lineage leukemia gene (MLL, ALL1, HRX) encodes a 3,969-amino-acid nuclear protein homologous to Drosophila trithorax and is required to maintain proper Hox gene expression. Chromosome translocations in human leukemia disrupt MLL (11q23), generating chimeric proteins between the N terminus of MLL and multiple translocation partners. Here we report that MLL is normally cleaved at two conserved sites (D/GADD and D/GVDD) and that mutation of these sites abolishes the proteolysis. MLL cleavage generates N-terminal p320 (N320) and C-terminal p180 (C180) fragments, which form a stable complex that localizes to a subnuclear compartment. The FYRN domain of N320 directly interacts with the FYRC and SET domains of C180. Disrupting the interaction between N320 and C180 leads to a marked decrease in the level of N320 and a redistribution of C180 to a diffuse nuclear pattern. These data suggest a model in which a dynamic post-cleavage association confers stability to N320 and correct nuclear sublocalization of the complex, to control the availability of N320 for target genes. This predicts that MLL fusion proteins of leukemia which would lose the ability to complex with C180 have their stability conferred instead by the fusion partners, thus providing one mechanism for altered target gene expression.

Amino Acid Motifs↗
PubMed1991

Dynamics of spread of HIV-I infection in a rural district of Uganda.

OBJECTIVE: To define the geographical distribution of HIV infection and the community characteristics associated with HIV prevalence in a rural population of Uganda. DESIGN: Seroprevalence survey and interviews of the population aged 13 years and older in 21 randomly selected clusters. SETTING: Rural population of Rakai district, south west Uganda. SUBJECTS: 1292 adults, of whom 594 men and 698 women gave a blood sample and answered the questionnaire. MAIN OUTCOME MEASURES: HIV status determined by ELISA and western blotting in relation to community characteristics. RESULTS: The weighted seroprevalence of HIV for the district was 12.6% with prevalence by cluster varying from 1.2% to 52.8%. Seroprevalence was highest in main road trading centres (men 26%, women 47%), intermediate in rural trading villages on secondary roads (men 22%, women 29%), and lowest in rural agricultural villages (men 8%, women 9%). For both men and women, multiple regression showed a strong negative association between cluster seroprevalence and the proportion of the population employed in agriculture (beta = -0.677 for men, -0.807 for women). Among women, cluster seroprevalence increased with a higher proportion of the population reporting multiple sex partners (beta = 0.814), external travel (beta = 0.579), and injections (beta = 0.483). CONCLUSIONS: Community characteristics, particularly the proportion of the population in agriculture, are associated with HIV prevalence and can be used for targeting interventions. The seroprevalences of HIV suggest spread of infection from main road trading centres, through intermediate trading villages, to rural agricultural villages.

Adolescent↗
PubMed1987

Risk factors for hepatitis B virus infection in US Army soldiers in Europe.

Cross-sectional and case-control studies were conducted in a US Army unit which had experienced a protracted outbreak of viral hepatitis. Serological, demographic, and exposure data were collected. The cross-sectional study found that there was no association between the prevalence of hepatitis B virus (HBV) infection and ethnicity, education, and rank. There was an association with age and duration of assignment to the unit. Having social contact with an identified hepatitis patient and the sharing of personal hygiene items with a case were significant risk factors for HBV infection. Through the use of anonymous questionnaires, the case-control study evaluated various behavioural factors. Univariate analysis indicated moderate but not significant increases in risk associated with a history of multiple sex partners and a history of disciplinary problems while in the military. Six drug-use related risk factors were significantly associated with HBV infection on univariate analysis. When evaluated with multivariate analysis, the only risk factor that was significantly associated with HBV infection was injection of drugs while assigned to the study unit. Two sources of misclassification bias were identified, both of which acted to underestimate the true risk associated with identified risk factors.

Behavior↗
PubMed2005

A prediction rule for selective screening of Chlamydia trachomatis infection.

BACKGROUND: Screening for Chlamydia trachomatis infections is aimed at the reduction of these infections and subsequent complications. Selective screening may increase the cost effectiveness of a screening programme. Few population based systematic screening programmes have been carried out and attempts to validate selective screening criteria have shown poor performance. This study describes the development of a prediction rule for estimating the risk of chlamydial infection as a basis for selective screening. METHODS: A population based chlamydia screening study was performed in the Netherlands by inviting 21,000 15-29 year old women and men in urban and rural areas for home based urine testing. Multivariable logistic regression was used to identify risk factors for chlamydial infection among 6303 sexually active participants, and the discriminative ability was measured by the area under the receiver operating characteristic curve (AUC). Internal validity was assessed with bootstrap resampling techniques. RESULTS: The prevalence of C trachomatis (CT) infection was 2.6% (95% CI 2.2 to 3.2) in women and 2.0% (95% CI 1.4 to 2.7) in men. Chlamydial infection was associated with high level of urbanisation, young age, Surinam/Antillian ethnicity, low/intermediate education, multiple lifetime partners, a new contact in the previous two months, no condom use at last sexual contact, and complaints of (post)coital bleeding in women and frequent urination in men. A prediction model with these risk factors showed adequate discriminative ability at internal validation (AUC 0.78). CONCLUSION: The prediction rule has the potential to guide individuals in their choice of participation when offered chlamydia screening and is a promising tool for selective CT screening at population level.

Adolescent↗
PubMed2006

Understanding male sexual behaviour in planning HIV prevention programmes: lessons from Laos, a low prevalence country.

METHODS: Focus group discussions were conducted with a range of young men in Vientiane, Laos; interviews were conducted with male sex workers. A questionnaire survey was conducted with a purposive sample of 800 young men. RESULTS: Most young men initiate sex at an early age and have multiple sex partners. Married men are more likely to pay for sex and most sex for money is negotiated in non-brothel settings. Despite high reported condom use for last intercourse with a casual partner, decisions on condom use are subjective. Many men have extramarital sex when their partner is pregnant and post partum. 18.5% of men report having had sex with another man; most of these men also report having sex with women. Moreover, more men report having had anal sex with a woman than with a man. CONCLUSIONS: Although not a probability sample survey, this study of a broad range of young men in Vientiane reveals sexual behaviours that could lead to accelerated HIV transmission. Education should emphasise the need to use condoms in all sexual encounters outside the primary relationship. This needs special emphasis when the partner is pregnant or post partum. Advice on safe sex with other men needs to be integrated into all sexual health education for young men.

Adolescent↗
PubMed1986

Sexual lifestyle and clinical findings related to HTLV-III/LAV status in homosexual men.

A study of 304 sexually active homosexual men, most of whom had multiple casual partners, showed that receptive anogenital intercourse, independent of anal bleeding, was the only risk factor for HTLV-III/LAV transmission. There was no evidence that HTLV-III/LAV infection, measured by seropositivity, was transmitted by oroanal or orogenital routes, or that insertive penile intercourse constituted a risk. The strongest predictor of seropositivity proved to be homosexual activity for more than five years, which may lead to enhanced susceptibility to infection. Sexual exposure to European men seemed to be even more hazardous than sexual exposure to men from the United States of America, and emphasised the epidemiological importance of the promiscuous homosexual abroad. Skin complaints were the most common presenting symptoms in men with antibody to HTLV-III/LAV. Extrainguinal lymphadenopathy was the commonest sign, which was present in just under half of those who were seropositive. More than one quarter of seropositive patients had had sexual intercourse with a woman in the five years before being tested.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Who defaults after treatment for gonorrhoea? Randomised controlled study of effect of an educational leaflet.

A study of patients with gonorrhoea showed that those who defaulted most from follow up were male, heterosexual, and had multiple sexual partners. A prospective, blind, randomised controlled trial showed that a leaflet giving information about gonorrhoea had a positive effect on follow up attendance by women, but no appreciable effect on rates of defaulting overall. This has implications for the initial treatment schedules.

Adolescent↗