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Fine structure mapping of the hypoxanthine-guanine phosphoribosyltransferase (HPRT) gene region of the human X chromosome (Xq26).

The Xq26-q27 region of the X chromosome is interesting, as an unusually large number of genes and anonymous RFLP probes have been mapped in this area. A number of studies have used classical linkage analysis in families to map this region. Here, we use mutant human T-lymphocyte clones known to be deleted for all or part of the hypoxanthine-guanine phosphoribosyltransferase (hprt) gene, to order anonymous probes known to map to Xq26. Fifty-seven T-cell clones were studied, including 44 derived from in vivo mutation and 13 from in vitro irradiated T-lymphocyte cultures. Twenty anonymous probes (DXS10, DXS11, DXS19, DXS37, DXS42, DXS51, DXS53, DXS59, DXS79, DXS86, DXS92, DXS99, DXS100d, DXS102, DXS107, DXS144, DXS172, DXS174, DXS177, and DNF1) were tested for codeletion with the hprt gene by Southern blotting methods. Five of these probes (DXS10, DXS53, DXS79, DXS86 and DXS177) showed codeletion with hprt in some mutants. The mutants established the following unambiguous ordering of the probes relative to the hprt gene: DXS53-DXS79-5'hprt3'-DXS86-DXS10-DXS177 . The centromere appears to map proximal to DXS53. These mappings order several closely linked but previously unordered probes. In addition, these studies indicate that rather large deletions of the functionally haploid X chromosome can occur while still retaining T-cell viability.

Adult↗

[The seroprevalence of HIV, HBV and HCV infections in patients coming to the departments of general surgery of a public hospital (S. Camillo, Rome)].

An anonymous unlinked seroprevalence study of HIV, HBV and HCV infections has been conducted on 485 sera consecutively submitted to the virology laboratory to be tested for HBsAg; sera came from patients attending general surgery at San Camillo Hospital in Rome. Carriers of HBsAg were 12 (2.5%); antibodies against HIV have been identified in 4 sera (0.8%) and against HCV in 35 (7.2) by ELISA (first generation assay); 25/35 of anti HCV ELISA positive sera were reactive also by RIBA (first generation assay). The observed prevalences of potentially infectious patients represent a risk of occupational transmission for health care workers. Vaccination against HBV, adherence with universal precautions and development of safer surgical devices and techniques are needed to prevent the risk of exposure and, consequently, of occupational acquired infections.

Adolescent↗

The developmental antecedents of sexual coercion against women: testing alternative hypotheses with structural equation modeling.

A unified model of the origin of sexual aggression against women on both adult and juvenile sexual offender samples has been developed and successfully tested. This model proposed three major causal paths to sexual coercion against women. In the first path, physical and verbal abuse was hypothesized to produce callousness and lack of emotionality, which disinhibited sexual drive and sexual fantasies. These in turn disinhibited hostile sexual fantasies, and led to sexual coercion. In the second causal path, sexual abuse contributed directly to the disinhibition of sexual drive and sexual fantasies, which through hostile sexual fantasies led to sexual coercion. The third path operated through early antisocial behavior, including aggressive acts. It developed as a result of both physical/verbal abuse and callousness/lack of emotion. It in turn directly affected sexual coercion and worked indirectly through the hostile sexual fantasies path. In the present study, the anonymous responses of a group of 168 blue-collar, community males to an inventory (the Multidimensional Assessment of Sex and Aggression) were used in a structural equation model to test the validity of this model. Moreover, this model was pitted against (Malamuth's (1998)) two-path model. Whereas the three-path model had an excellent fit with the data (CFI =.951, RMSEA =.047), the two-path model fit less well (CFI =.857, RMSEA =.079). These results indicate the superiority of the three-path model and suggest that it constitutes a solid, empirically disconfirmable heuristic for the etiology of sexual coercion against women.

Adolescent↗

Incidence of intrauterine cocaine exposure in a suburban setting.

This study endeavored to determine the incidence of intrauterine cocaine exposure in a socioeconomically mixed suburban setting. It also assessed the effectiveness of an anonymous questionnaire in eliciting information on maternal use of illicit drugs during pregnancy. Meconium was collected from 500 consecutively born infants and analyzed for the presence of cocaine and its metabolites. An anonymous two-page questionnaire also was distributed to all postpartum mothers. Of the infants' mothers, (73.2%) were covered by some form of insurance (private), whereas 26.8% either had no insurance or were covered by Medicaid (clinic). Fifty-nine (11.8%) babies tested positive for cocaine. The meconium of 6.3% of the babies whose mothers had private insurance tested positive, while the meconium of 26.9% of the babies whose mothers had Medicaid or no insurance tested positive. 316 (63.2%) of the mothers returned a questionnaire. 73% had private insurance and 27% were covered by Medicaid (clinic). Only five mothers with no insurance or covered by Medicaid admitted using cocaine. It appears that neonatal exposure to cocaine may be an even greater problem than previously imagined, particularly in the private population. In addition, anonymous maternal self-reporting forms probably will not be helpful in identifying infants at risk for illicit exposure to drugs.

Cocaine↗

A case-specific approach to the treatment of alcoholism: the application of control mastery theory to alcoholics anonymous and professional practice.

Effective treatment of alcoholism requires adopting a psychodynamically informed case-specific approach. Control mastery theory provides a powerful way to understand and treat the alcoholic patient. The theory posits that individuals hold unconscious pathogenic beliefs that contribute to the development and maintenance of alcoholism. The primary therapeutic goal is to create a safe atmosphere that enables patients to disabuse themselves of their maladaptive beliefs and their attendant guilt. In this way, patients become freer to more accurately test reality and thus more effectively pursue normal developmental goals. The treatment of the alcoholic patient progresses through phases, each of which poses different therapeutic challenges. The salient therapeutic tasks addressed in this article are denial, containing affect, relapse prevention, and Alcoholics Anonymous involvement. By understanding the individual's unique pathogenic belief system, the therapist is better equipped to help the patient through the generic phases and tasks of the recovery process.

Alcoholics Anonymous↗

Seroprevalence, risk factors and attitude to HIV-1 in a representative sample of lesbians in Turin.

OBJECTIVE: To estimate the HIV-1 seroprevalence, behavioural risks and attitude to HIV-1 infection among lesbians. SETTING: Institute of Infectious Diseases, University of Turin, Italy. SUBJECTS: From March 1992 to May 1993, 181 lesbians were tested for HIV-1 and included in the study. METHODS: Sociodemographic details, nonsexual risks for HIV-1, sexual behaviour, STD history and attitude to HIV-1 were obtained from an anonymous, standardised, self-administered, 30-item questionnaire. Snow-ball techniques were used to recruit the largest possible number of participants. RESULTS: 11 lesbians (6.1%) were found to be HIV-1 antibody positive. Of them, 10 were intravenous (i.v.) drug users. STD episodes were higher among lesbians with HIV-1 than without (p = 0.04), increasing in both groups over time. Syphilis, genital herpes and viral hepatitis were highly associated with HIV-1 (p = 0.000). In univariate analysis, i.v. drug use, bisexual behaviour, history of STDs, sex during menses and vaginal/anal manipulation were significantly linked to HIV-1 (p = 0.000). In multivariate analysis only history of i.v. drug use (p = 0.04) and bisexual behaviour (p = 0.06) remained independently associated with HIV-1. Seventy-one participants (39.3%) had already undergone AIDS testing. Only 3.5% admitted to be at risk for HIV-1 and 11% changed their sex habits after first hearing of AIDS. No lesbian had ever practised safe-sex. Television was the most important source of information on HIV-1 (84%). CONCLUSION: I.v. drug use was the most likely means of HIV-1 infecting the lesbians of Turin. The high rate of STDs and the low perceived risk to HIV-1 require programmes of STD prevention and AIDS information to be targeted at the lesbian community.

Acquired Immunodeficiency Syndrome↗

Understanding why women decline HIV testing.

BACKGROUND: The Department of Health (DH) set a target for HIV testing--uptake should be at least 90% by 31 December 2002 (Department of midwife Health, 2000), i the number of 80% decrease in n order to see a babies born with HIV (Tookey et al, 2002). As an exercise to measure Newham Healthcare Trust against this standard and review the antenatal care HIV-positive women received, the maternity unit undertook an audit. One in 160 pregnant women receiving antenatal care in the London Borough of Newham are HIV positive (Communicable Disease Screening Centre, 2003), according to the HIV anonymous screening programme, however the rate of transmission to the baby is virtually zero, when babies were followed up at birth, six months and one year Healthcare NH S Trust, 2003). Newham's HIV testing uptake ranges from 80% to 90% (with an average of 88%). A strategy for improving the uptake has been to explore why the 10% to 20% of women decline testing; hence the Trust underwent an audit to explore the reasons women gave when they declined testing. Audit findings Some 2138 forms were returned over a seven-month period, of which 328 (15%) were from women who declined HIV testing. Uptake within that period ranged from 74% to 90%. Ten new positive women were identified. The HIV-specialist midwife carries a caseload and is aware of all positive women, therefore was able to identify the new cases. The reasons given for decline ranged from cultural and religious beliefs to those who said they were not at risk. Practice implications Where women are aware of their HIV status, services can be put in place to support them through their pregnancy and life as a positive parent, equally important is the ability to minimise the risk of transmission to babies, therefore it is vital that women understand the purpose of early diagnosis through testing and its consequences. Midwives have a vital role to play in ensuring pregnant women receive adequate information to form their decision. If a woman chooses not to have the test, midwives should explore her reasons without prejudice. It is also recommended that women who decline testing are reoffered the HIV test at their subsequent antenatal visit, allowing them the opportunity to digest the information and discuss it with a partner. The purpose of the audit was to assess how the Trust would meet the DH target (90% uptake), as part of a review of the maternity HIV service.

AIDS Serodiagnosis↗

Incentives for voluntary HIV testing in NHS staff.

BACKGROUND: HIV seroprevalence is rising in the United Kingdom. While acceptability of HIV testing has been explored among many groups there is a paucity of data regarding voluntary HIV counselling and testing (VCT) among NHS staff. AIMS: To understand the barriers to HIV testing among NHS employees. To observe how these may be overcome. To assess which factors would motivate staff to undergo VCT and which would be a disincentive. METHODS: Completion of a cross-sectional anonymous postal questionnaire survey of new employees at a London district general hospital. Demographic and attitudinal factors were collected. Respondents were able to give multiple responses to questions regarding reasons for and against VCT. Those unable to communicate in English were excluded. RESULTS: There was a 63% response rate; of 69 respondents, 76% were female, 72% had English as their first language and 30% self-identified as white British. Thirty-nine percent were nurses, 19% doctors and the remainder a variety of professions. Of these, 41% had had a previous HIV test; none were known positive. Sixty-two percent would consider future testing. The commonest reasons to consider testing were knowledge of status (79%), treatment benefit (40%) and to inform family members (44%). The commonest reasons not to test were already tested negative (30%) and rather not know (26%). CONCLUSIONS: Since the NHS is recruiting staff from areas of high HIV prevalence, VCT should be encouraged. NHS staff require information on how to access testing as well as the benefits of early detection of blood-borne viruses.

AIDS Serodiagnosis↗

In search for increased prevalence rates of strabismus and microstrabismus in two Bavarian districts, Oberpfalz and Niederbayern, to spot populations for gene identification.

PURPOSE: This study was intended to identify communities with an increased prevalence rate of inherited eye diseases (different forms of strabismus, juvenile maculopathy, AMD, myopia magna, etc.) in the districts Oberpfalz (Opf.) and Niederbayern (Ndb.). The data obtained in this study will serve to identify larger families and inbred populations for genetic testing to identify the cause of eye diseases with autosomal recessive and multifactorial inheritance. DESIGN: In cooperation with the local ophthalmologists in two Bavarian districts anonymized lists were compiled correlating diagnosis, postal code, and municipality of strabismus patients. The office software used in the participating practices was a limiting factor as well as the hand-written records used in most of these. The collected data were correlated with the published prevalence rates in the general population. RESULTS: Of the 104 local ophthalmologists who were invited to participate, only 17 provided information. The results indicate an increased prevalence rate of strabismus and microstrabismus patients from Neumarkt (Opf.) / Postbauer-Heng, Amberg, Hauzenberg and Pocking. CONCLUSION: Documentation as it is currently done - local ophthalmologist generally have written records and computer systems that are unsuitable for detailed surveys - restricts the possibility of completing the survey in the whole area. Nevertheless, regional accumulations of strabismus/microstrabismus could be described, providing populations for further investigations to uncover the genetic causes.

Chromosome Mapping↗

Safe medication prescribing: training and experience of medical students and housestaff at a large teaching hospital.

PURPOSE: To assess medical students' and housestaff's knowledge, attitudes, and behaviors regarding safe prescribing. METHOD: In 2003, 214 housestaff (interns and residents) and 77 medical students in medicine and surgery at Barnes-Jewish Hospital, St. Louis, Missouri, were asked to complete an anonymous, self-administered questionnaire about safe prescribing. Questions asked about training in and attitudes about safe-prescribing and current prescribing behaviors. Fisher exact test was used to compare attitudes and behaviors among subgroups. RESULTS: Of the 175 (60%) respondents, 73 (59%) of 123 housestaff and eight (15%) of 52 students agreed that their safe-prescribing training was adequate (p < .001), and 145 (83%) total respondents agreed that prescribing errors were unacceptable. Respondents reported always doing the following: 156 (89%) checked prescribing information before prescribing new drugs, 131 (75%) checked for drug allergies, 103 (59%) double-checked dosage calculations, 98 (56%) checked for renal impairment, and 53 (30%) checked for potential drug-drug interactions. CONCLUSION: Routine use of safe medication prescribing behaviors among housestaff and medical students was poor. Contributing factors may have included inadequate training and a culture that does not support safe prescribing. Effective strategies to increase safe medication prescribing need to be identified and implemented.

Attitude of Health Personnel↗

Sexual risk behaviour among gay men in a relationship.

OBJECTIVE: To examine whether gay men in a relationship have adopted negotiated safety as an HIV risk reduction strategy. METHODS: A confidential, anonymous questionnaire was completed by 1004 gay men attending gyms in central London in September-October 1997. Information was sought on sociodemographic characteristics, HIV testing and sexual risk behaviour. Men reporting unprotected anal intercourse (UAI) in the previous 3 months were classified as 'status-unknown' if they did not know their own HIV status, that of their UAI partner(s) or both. Men who knew their own and their UAI partner's HIV status were classified as 'status-known'. RESULTS: Of the 1004 men surveyed, 986 provided complete information on relationship, personal HIV test history and HIV status of UAI partner. Over half (539) said they were currently in a relationship with another man, of whom 173 reported UAI in the previous 3 months; 140 (80.9%) with their main partner only, 18 (10.4%) with a casual partner only and 15 (8.7%) with both their main and casual partners. Of the 140 men reporting UAI only with their main partner, 62 (44.3%) did not know their own HIV status or that of their partner. Overall, a quarter (26.0%) of the men in a relationship reported UAI only with their main partner in the previous 3 months; 11.5% status-unknown UAI, 14.5% status-known UAI. In a multivariate logistic model, both age and being in a relationship were significantly associated with UAI (status-unknown and status-known). CONCLUSION: Gay men in a relationship, surveyed in central London gyms, have for the most part adopted the first principle of negotiated safety: only to have UAI with their main partner. However, not all have embraced the second principle: to establish HIV seroconcordance. Nearly half the men reporting UAI only with their main partner were unaware of their own HIV status, their partner's or both. As a consequence, more than one in 10 men in a relationship reported high-risk (i.e. status-unknown) UAI with their main partner. Because the study population, from central London gyms, was not randomly selected, these findings may not be generalizable to all gay men in London. Nonetheless, HIV prevention programmes should continue to encourage gay men in a relationship to seek an HIV test and establish seroconcordance if they wish to have UAI with each other.

Adult↗

[Professional burnout in dentists and stomatologists of the Galician Health Service].

AIM: To analyse the degree of professional burnout in primary care dentists of the Galician Health Service (GHS). DESIGN: Descriptive, cross-sectional study. SETTING: Dental care units of the GHS primary care network. SUBJECTS: All primary care dentists of the new primary care model of the GHS (N=79). Response rate: 50% (N=35). MEASUREMENTS: Anonymous self-applied questionnaire: the Maslach Burnout Inventory, that evaluates emotional exhaustion, depersonalization, and personal achievements; a social and personal questionnaire. Student's t test, ANOVA, 2 or Fisher's exact test were used. MAIN RESULTS: Mean age: 46.58+/-9.47; sex: 74.3% males; temporary job: 82.9%; years in the GHS: 15.25+/-8.34. High values were detected in: emotional exhaustion 54.3%; depersonalization 55.6%; personal achievements 6.9%. No statistically significant differences were identified in terms of age, sex, marital status, type of contract, rural vs urban areas, number of patients treated, or years in the GHS, apart from the "personal achievements" subscale, that was rated, significantly higher (P=.046) by those who had shorter experience at for the GHS. CONCLUSION: GHS dentists show a degree of professional burnout close to the one described for family doctors at the Spanish National Health System.

Adult↗

Women's views of registered nurses as Papanicolaou smear providers: a pilot study.

BACKGROUND: Registered nurse Papanicolaou (Pap) smear providers (RN PSPs) were introduced to improve women's accessibility to Pap smear services through the National Cervical Screening Program. This pilot study assessed women's attitudes towards RNs as providers. METHOD: One hundred women attending a Family Planning Queensland (FPQ) centre for a routine appointment with a doctor or registered nurse were recruited. Participants completed an anonymous questionnaire. RESULTS: A response rate of 86% (n = 100) was achieved. Only 15% of participants indicated they had seen a RN for a Pap test prior to this visit and 67% were unaware that registered nurses provided Pap smear services. Participants reported positive attitudes toward RN PSPs (M = 44.53, SD = 7.85, range 13 - 60). The majority of participants considered RN PSPs would be responsive to their needs (92%) and well-qualified to perform Pap smears (70%). The majority (79%) would not hesitate to see a RN PSP for a Pap smear. Some uncertainty existed about the competence of nurses to provide this service (25% of respondents were uncertain). Older women were more likely to report less positive attitudes toward RN PSP (r = -.267, p <.05). Women reporting previous awareness of the role of nurses as Pap smear providers were more likely to report positive attitudes (Chi-square = 12.96, p < .0001) compared to women with no awareness of this role. DISCUSSION AND CONCLUSIONS: While women are positive about RN PSPs, there is a need for promotion and community education about the role of RNs in providing cervical screening services.

Aged↗

[Clinical characteristics and possibilities of early diagnosis of Chlamydia trachomatis infection in adolescent girls].

UNLABELLED: Genital Chlamydia trachomatis infection is the most frequently found sexually transmitted disease among sexually active adolescent girls aged 15-19 years. In general, C. trachomatis infection tends to be less abrupt in onset, clinical course is usually asymptomatic or with mild symptoms. Infection results in changes of inner genitalia and can be the reason of serious late complications (pelvic inflammatory disease and infertility). Purpose of the study was to evaluate complaints, clinical peculiarities, results of gynecologic examination and possibilities of early diagnosis of C. trachomatis infection among adolescent girls. METHODS: Anonymous questionnaire was used in the study, in which 487 girls aged 15-19 years participated. All 240 sexually active girls were advised to perform tests for STD in Kaunas University of Medicine Hospital. Gynecologic examination, CT/NG DNA hybridisation test from vagina and PCR from cervix for detection C. trachomatis infection were performed. RESULTS: Eighteen percent of examined girls were infected with C. trachomatis. Complaints of fool odor discharge from vagina, non-specific changes of vagina and cervix let us suspect for C. trachomatis infection with statistical significance. CONCLUSIONS: The high prevalence of C. trachomatis infection among adolescent girls was found; the C. trachomatis infection could be suspected with non-specific changes of vagina and cervix and complaints of fool odor discharge from vagina, which helps us to prescribe early and adequate treatment.

Adolescent↗

[Sensitisation about condom use in Gabon (1999): evaluation of the impact of a comic book].

The authors report the evaluation of the impact of a comic book about condom use distributed to Gabonese high school students in Libreville and Lambarene in 1999. This evaluation was conducted through a self-administered questionnaire completed by 954 students in 11 high schools immediately before distribution of a comic book about condoms and by 771 students 15-30 days afterwards. The anonymous questionnaire contained multiple-choice and open questions about knowledge, attitudes and practices. During the second survey (same schools and same classes), the questions tested knowledge about AIDS and about the stories in the book. The student populations who responded to the two questionnaires were homogeneous for sex, age, school class, and province of residence. Knowledge about the modes of HIV/AIDS contamination improved substantially between the two questionnaires, with knowledge about the mother-child transmission pathway increasing from 47% to 75% of responders. At the same time, and without any significant difference by sex, class or province, individual adhesion to the role of the condom as a means of prevention against AIDS progressed from 64% to 95%. The students questioned wanted AIDS prevention information to be better integrated into their curriculum and, in particular, they wanted educational activities in this area in their school, either by their teachers or in special information areas. Thus, the 48-page comic book by young Gabonese artists was perceived as a good method of condom education for the young (75%) and as an excellent method for inducing awareness about it among them (89%). The book's contents had been absorbed, and the students found that the stories and the message were well matched. Moreover, the extension of the readership beyond the initial distribution at the first evaluation (7.5 readers reported per copy) showed that the messages in the book spread well beyond the student group.

Acquired Immunodeficiency Syndrome↗

[Alcohol dependent patients in family doctor's practice in Gdańsk].

Polish family doctors have been given legal rights to diagnose and treat patients with alcohol dependency. Unfortunately, majority of general practitioners do not have proper knowledge and motivation required for this kind of treatment. The aim of the study was to evaluate the preparedness of family doctors in Gdańsk to diagnose and treat patients with alcohol dependency. Fifty family doctors from Gdańsk were included in the study. Forty five agreed to answer the anonymous questionnaire. Forty two out of 45 family doctors did not know the basic notions connected with diagnosis and therapy of alcohol dependency. The screening tests, helpful in the diagnosis of alcohol dependency, were not used by general practitioners--42 of them (almost 94%) did not treat alcohol abusers pharmacologically, and 18 (aprox. 40%) did not have time for such patients. It seems that there is an urgent need to provide further education for general practitioners and make better use of the existing structures engaged in the diagnosis and therapy of alcohol abusers.

Adult↗