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PubMed2004

Does knowledge about sexually transmitted infections increase the likelihood of consistent condom use?

BACKGROUND: We aimed to assess the association between knowledge about sexually transmitted infections (STIs) and consistent condom use among university students controlling for selected socio-demographic factors. METHOD: An anonymous questionnaire survey was carried out among 720 undergraduate students (76% women) at the University of Tirana, Albania, in October-November 2002. The questionnaire included socio-demographic data, 10 multiple-choice test questions on knowledge about STIs, sexual activity and use of condoms. Two hundred seventy-nine students reported having sexual experience and provided data on condom use as well as knowledge about STIs. Binary logistic regression was used to assess the "independent" association between knowledge about STIs and condom use. RESULTS: In multivariable models, there was an overall association of knowledge about STIs with consistent condom use (OR = 1.74, 95% CI = 1.37-2.23, P < 0.001). There was evidence for an interaction between knowledge and parental education (P = 0.04): there was a positive association among students with highly educated parents (OR = 1.48, 95% CI = 1.11-1.99, P = 0.01), and particularly so among students with low-and-middle educated parents (OR = 4.75, 95% CI = 2.03-11.08, P < 0.01). CONCLUSIONS: Knowledge about STIs is an independent predictor of consistent condom use among university students. Augmentation of knowledge per se should be a component of school-based prevention programs along with the intensification of efforts toward improving students' sexual practices.

Adolescent↗

PubMed1999

Survey of genetic screening for oocyte donors.

OBJECTIVE: To describe current screening practices of oocyte donation programs in the Society for Assisted Reproductive Technologies (SART). DESIGN: Descriptive data from a mailed questionnaire. SETTING: Academic medical center. PARTICIPANT(S): In vitro fertilization programs in SART. INTERVENTION(S): Survey mailed to IVF programs in the SART registry. MAIN OUTCOME MEASURE(S): Current practices, opinions, and genetic criteria for oocyte donor selection. RESULT(S): Results from 159 of 229 (69%) eligible oocyte donation programs are described. Most centers (70%) completed fewer than 25 cycles and used both anonymous and directed donors. There was considerable variability in limits on numbers of cycles or births allowed per donor, with many centers having no limits. As well, the use of well-established screening tests for genetic disorders, such as sickle cell anemia and cystic fibrosis, varied considerably. Consultation with a geneticist was possible at most (89%) centers and specifically mentioned by some centers as a means to help make decisions. CONCLUSION(S): Most programs follow recommendations made by the American Society of Reproductive Medicine (ASRM) for screening of gamete donors, but a significant percentage does not use well-established testing. The widespread availability of genetic consultation should promote responsible screening practices.

Female↗

PubMed2004

New estimates of herpes simplex virus type 2 seroprevalence in England: 'high' but stable seroprevalence over the last decade.

OBJECTIVES: There have been few recent population-based herpes simplex virus type 2 (HSV-2) seroprevalence studies in England, but reports from the United States have indicated a 30% rise in HSV-2 seroprevalence between 1976 and 1994. This study aimed to ascertain trends in HSV-2 infection in England between 1991 and 2000. STUDY DESIGN: Anonymized serum residues collected through public health laboratories across England from individuals aged 16 to 64 years seeking health care through the National Health Service in 1991 (n = 2259) and 2000 (n = 3646) were tested for anti-HSV-2 IgG using the HerpeSelect 2 enzyme-linked immunosorbent assay IgG (Focus). RESULTS: In 9 sites across England, the age- and sex-standardized HSV-2 seroprevalence was 9.7% (95% confidence interval, 8.4-11.0%). Data from 4 sites common to both study years indicated no change in HSV-2 seroprevalence between 1991 and 2000. CONCLUSIONS: After adjustment for age, sex, and geographic location, there was no evidence of a change in seroprevalence between 1991 and 2000.

Adolescent↗

PubMed1995

National survey of emergency medicine resident moonlighting. SAEM Inservice Examination Survey Task Force.

OBJECTIVES: To survey emergency medicine (EM) residents regarding moonlighting practices and perceptions for clarifying: 1) resident moonlighting remuneration; 2) any association of perceived educational debt with moonlighting income and hours; and 3) perceptions related to moonlighting (including motivations, impact on resident training, and potential medicolegal difficulties). METHODS: A confidential, voluntary survey was administered to all allopathic EM residents in the United States. This written survey was provided to residents at their in-service examinations. Completed forms were anonymously returned by residents or local administrative staff to a central site where all identifiers were removed prior to mailing en mass to the investigators. Comparisons between groups were made using chi-square tests and correlations were assessed using the Pearson correlation coefficient. RESULTS: Seventy-six percent (1,826/2,407) of the surveys were returned. There was a weak correlation (r = 0.11) between educational debt and moonlighting hours for residents in the second year and above, but no association of debt with moonlighting income. Most (88%) of the residents reported that their programs permitted moonlighting. Nearly half (49%) reported that they did moonlight in some way. Most (82%) thought moonlighting provided experience not available in the residency. Only 13 (2%) respondents stated they had been sued for malpractice while moonlighting. Most (66%) moonlighting respondents stated that they moonlighted for financial reasons, with educational debt the primary motivating factor. Of the moonlighting residents, 28% were unsure of their type of malpractice insurance coverage, and 9% had no coverage at all. CONCLUSIONS: Education about EM practice matters including the risks of moonlighting should begin early in residency, because moonlighting is widespread. Residents are vulnerable to medicolegal action while moonlighting and have insufficient knowledge of their malpractice insurance coverage. Although educational debt is perceived as a strong motivating factor for moonlighting, there is only a weak relationship between educational debt and moonlighting hours.

Analysis of Variance↗

PubMed2002

Effect of a scoring system and protocol for sedation on duration of patients' need for ventilator support in a surgical intensive care unit.

PROBLEM: Need for improved sedation strategy for adults receiving ventilator support. DESIGN: Observational study of effect of introduction of guidelines to improve the doctors' and nurses' performance. The project was a prospective improvement and was part of a national quality improvement collaborative. BACKGROUND AND SETTING: A general mixed surgical intensive care unit in a university hospital; all doctors and nurses in the unit; all adult patients (>18 years) treated by intermittent positive pressure ventilation for more than 24 hours. KEY MEASURES FOR IMPROVEMENT: Reduction in patients' mean time on a ventilator and length of stay in intensive care over a period of 11 months; anonymous reporting of critical incidents; staff perceptions of ease and of consequences of changes. STRATEGIES FOR CHANGE: Multiple measures (protocol development, educational presentations, written guidelines, posters, flyers, emails, personal discussions, and continuous feedback) were tested, rapidly assessed, and adopted if beneficial. EFFECTS OF CHANGE: Mean ventilator time decreased by 2.1 days (95% confidence interval 0.7 to 3.6 days) from 7.4 days before intervention to 5.3 days after. Mean stay decreased by 1.0 day (-0.9 to 2.9 days) from 9.3 days to 8.3 days. No accidental extubations or other incidents were identified. LESSONS LEARNT: Relatively simple changes in sedation practice had significant effects on length of ventilator support. The change process was well received by the staff and increased their interest in identifying other areas for improvement.

Adult↗

PubMed2004

Effect of a scoring system and protocol for sedation on duration of patients' need for ventilator support in a surgical intensive care unit.

Adult↗

PubMed1997

Physician concurrence with primary care guidelines for persons with HIV disease.

An anonymous questionnaire was mailed to 3 groups of physicians in British Columbia: 659 registrants of a province-wide human immunodeficiency virus (HIV) drug treatment programme (Group 1); 765 who had had a patient test positive for HIV (Group 2); and a random sample of 484 (Group 3). Questionnaires provided data about: physician's demographic and personal characteristics; HIV-related patient care experience; and 12 knowledge-based items. Responses were received from 65% of Group 1, 68% of Group 2 and 70% of Group 3, with complete information received from 38% of Group 1 and 50% of Groups 2 and 3. Summary knowledge scores were computed by comparing physician responses to recommendations of contemporary guidelines. Regression techniques identified associations between physician characteristics and knowledge scores. Multivariate analysis revealed an inverse relationship between knowledge and physician age in all groups (all P < 0.01). Increased knowledge was associated with the number of currently active HIV-positive patients in Groups 1 and 2 (all P < 0.001), and lack of specialization in Groups 2 and 3 (both P < 0.001).

Adult↗

PubMed1991

Sexual dysfunction in female adult children of alcoholics.

This study investigated sexual dysfunction and selected related characteristics attributed to female adult children of alcoholics (ACOAs). Using a variety of established measures, data were collected on 30 female ACOAs and 30 non-ACOA control subjects from the general population. The results indicated that female ACOAs manifested lower self-esteem, more distrust, and more sexual dysfunction, compared to the control subjects. These findings provide strong empirical evidence that female ACOAs may be at high risk for experiencing sexual problems.

Adult↗

PubMed2001

[Evaluation of management of asthma African adults. National survey among general physicians from Ivory Coast].

A cross sectional study of asthma management of adults in Africa based on an anonymous questionnaire was conducted among 149 general practitioners working in the principal 18 cities in the Ivory Coast located in 6 geographical regions drawn for the purpose of this study. Data collected included: complementary tests prescribed at first diagnosis, typical prescriptions for acute asthma and for long-term control, knowledge of metered-dose inhalation techniques, regular measurement of FEV1 and prescription of sports activities. Forty-one percent of the physicians were unaware of the usefulness of expiration volume measurements and FEV1 measurements were prescribed by only 8%. The most widely prescribed tests were chest x-ray, blood cell counts, and ENT consultation. Lung function tests were requested by 12.75% of the physicians and skin allergy tests by 10.74%. Beta 2 agonists were prescribed for acute asthma, basically by inhalation or subcutaneous administration and were generally combined with corticosteroid therapy. Nebulization was rarely prescribed. Aberrant prescriptions (delayed release tablets, corticosteroid sprays, delayed release corticoidsteriods) were also given. For long term management, delay release beta 2-agonists were most widely used. Delayed release corticosteroid injections were prescribed by 18.5% of the physicians and metered dosers by 14%. Dry powders were rarely used. These findings emphasize the poor management of asthma in Africa. Directives taking into account the social and economic setting in the Ivory Coast should be initiated.

Adult↗

PubMed2005

Exploration of the impact of preferred drug lists on hospital and physician visits and the costs to Medicaid.

OBJECTIVE: To conduct an exploratory investigation of the possible effects of the implementation of a state Medicaid preferred drug list (PDL) on the average number of visits by Medicaid patients to hospitals and physicians, and to provide preliminary estimates of the Medicaid reimbursement costs of these additional visits. STUDY DESIGN: A regression-based, difference-in-differences retrospective analysis using anonymized patient-level data on cardiovascular-related inpatient and outpatient hospital visits and procedures, and physician visits and procedures. METHODS: The impact of the implementation of a state Medicaid PDL on a test group of Medicaid cardiovascular patients was examined. A contemporaneous group of non-Medicaid cardiovascular patients from the same state were used as controls. RESULTS: There was a statistically significant increase in the number of outpatient hospital visits and physician visits for the test group compared with the control group in the first 6 months after PDL implementation. There was a positive but statistically insignificant increase in the number of inpatient hospital visits. All increases in visits for the test group compared with the control group in the second 6 months after PDL implementation were positive but statistically insignificant. As a result, estimated average Medicaid reimbursement costs for cardiovascular patients in the state increased during that year. CONCLUSION: The observed range of increases in hospital and physician visits is evidence for the possible existence of an unintended consequence of PDL implementation by state Medicaid programs. Precautionary research in this area is clearly called for.

Adult↗

PubMed1994

Neuropsychological symptoms in a cross-sectional sample of abstinent alcoholics.

This study examined the neuropsychological symptom reports of a cross-sectional sample of 205 abstinent alcoholics. Analysis indicated that early-abstinent alcoholics reported mild cognitive distress with a gradual course of observed recovery which eventually reached the normal range. The recovery process was essentially the same for both men and women. A nonsignificant increase in symptom reporting was found for subjects who were beyond the acute stage of detoxification, which is thought to reflect improved awareness of neuropsychological functioning. Symptoms of frustration were rated highest by alcoholics at all stages of abstinence.

Adult↗

PubMed1997

DnaSP version 2.0: a novel software package for extensive molecular population genetics analysis.

MOTIVATION: Several methods in molecular population genetics have recently been described to estimate the amount and pattern of the DNA polymorphism in natural populations, and also to test the neutral theory of molecular evolution. These methods are essential for understanding the molecular evolutionary process. However, a comprehensive computer program for the analysis is not currently available. RESULTS: Here we present DnaSP (DNA Sequence Polymorphism) version 2.0, a software package for Windows that performs extensive population genetics analyses on DNA sequence data. DnaSP estimates several measures of DNA sequence variation within and between populations, linkage disequilibrium, recombination, gene flow and gene conversion (a new algorithm to detect gene conversion tracts has been included). DnaSP can also carry out several tests of neutrality: those of Fu and Li; Hudson, Kreitman and Aguadé; and Tajima. The results of the analyses are displayed in tabular and graphic form. AVAILABILITY: For academic uses, DnaSP is available via anonymous ftp: ftp.ebi.ac.uk in the directory/pub/software/dos.

Algorithms↗

PubMed1995

The distribution of linkage disequilibrium over anonymous genome regions.

Linkage disequilibrium (LD), the association of alleles at different loci, is a powerful tool for genetic mapping and for investigating, at the population level, processes such as recombination, selection, mutation and admixture. Little is known about the distribution of LD across mammalian genomes. Therefore, a survey was undertaken, using microsatellite loci, to evaluate the distribution of LD over several regions of human chromosome 4. Radiation hybrid (RH) and linkage maps provided information on physical and genetic distances between these loci. A Finnish population sample was genotyped using 32 microsatellite loci, and partial marker haplotypes were determined. Assessment of LD was performed, between all pairs of loci, using the Fisher's exact test. LD was detected between several loci that were separated by more than 1 Mb or 1 cM. Detection of LD was strongly associated with small physical distance; its relation to genetic distance was more equivocal. This result may support the hypothesis that linkage maps are relatively inaccurate over small distances. Our results suggest that LD is widely distributed in anonymous regions of the human genome and its use may allow more accurate measurement of small genetic distances than does standard linkage analysis. Alternative explanations are considered for comparisons in which LD is not detected between tightly linked loci.

Alleles↗

PubMed1992

Screening for maternal depression in pediatric clinics.

OBJECTIVE: The purpose of this study was to assess the frequency of and risk factors for depressive disorders among mothers of young children and to compare the eight-item RAND screening instrument for depressive disorders with an easily scored three-item version of the test. DESIGN: A cross-sectional survey. SETTING: Five pediatric clinics in the Seattle-Tacoma, Washington area, two private practices, two university-affiliated teaching clinics, and the Madigan Army Medical Center pediatric clinic. PARTICIPANTS: Convenience sample of 667 English-speaking mothers who completed the depression items on an anonymous self-administered questionnaire on family health. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The results of women surveyed showed that 19% were positive for depression on the RAND instrument. Women whose survey results were positive were younger (28.2 vs 30.3 years of age), had less education (12.9 vs 14.4 years), and had lower monthly incomes ($1803 vs $2923) than those who results were not positive. Positive scores were more common among women surveyed in teaching clinics (20%) and military clinics (24%) than among women surveyed in private practices (12%), among single vs married mothers (32% vs 15%), among nonwhites vs whites (29% vs 16%), and among those with positive screening test results for drugs compared with those with negative screening test results (45% vs 17%) (P less than .01 for all comparisons). Compared with the eight-item instrument, the three-item version had a sensitivity of 100%, a specificity of 88%, and a positive predictive value of 66%. CONCLUSIONS: Depression is common among mothers of young children. The three-item version compares favorably with the eight-item RAND screening instrument for depressive disorders.

Adult↗

PubMed1995

Crack, crack house sex, and HIV risk.

Limited attention has been focused on HIV risk behaviors of crack smokers and their sex partners, yet there is evidence that the crack house and the crack-using life-style may be playing significant roles in the transmission of HIV and other sexually transmitted diseases. The purposes of this research were to study the attributes and patterns of "sex for crack" exchanges, particularly those that occurred in crack houses, and to assess their potential impact on the spread of HIV. Structured interviews were conducted with 17 men and 35 women in Miami, Florida, who were regular users of crack and who had exchanged sex for crack (or for money to buy crack) during the past 30 days. In addition, participant observation was conducted in 8 Miami crack houses. Interview and observational data suggest that individuals who exchange sex for crack do so with considerable frequency, and through a variety of sexual activities. Systematic data indicated that almost a third of the men and 89% of the women had had 100 or more sex partners during the 30-day period prior to study recruitment. Not only were sexual activities anonymous, extremely frequent, varied, uninhibited (often undertaken in public areas of crack houses), and with multiple partners but, in addition, condoms were not used during the majority of contacts. Of the 37 subjects who were tested for HIV and received their test results 31% of the men and 21% of the women were HIV seropositive.

Adult↗

PubMed1999

Scraggly, a new hair loss mutation on mouse chromosome 19.

By use of chlorambucil, we have generated a mouse mutation called scraggly (sgl) that exhibits skin and hair defects. Homozygous mutant mice exhibit hair loss, skin defects, and abnormalities in sebaceous lipid composition. We have constructed a high-resolution genetic map of mouse Chromosome (Chr) 19 that links this mutation to the anonymous DNA marker D19Umi1. An additional cross, (BALB/c x CAST/Ei) F(1) x BALB/c, was used to map markers around this mutation as well as to map the potential candidate genes, Fgf8 and Cyp17. Allelism tests between sgl and asebia (ab), another hair loss mutation on mouse Chr 19, showed that these genes were separate and distinct.

Animals↗

PubMed1995

Prevalence of hepatitis B, hepatitis C, and human immunodeficiency virus infection among women attending prenatal clinics in San Juan, Puerto Rico, from 1989-1990.

OBJECTIVE: To evaluate the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) among pregnant women in Puerto Rico. METHODS: An anonymous serosurvey was conducted in four prenatal clinics in San Juan, Puerto Rico, involving women presenting consecutively for their first prenatal visit. RESULTS: Nineteen of 997 pregnant women (1.9%, 95% confidence interval [CI] 1.2-3.0) tested positive for HCV antibody (anti-HCV), and eight (0.8%, 95% CI 0.4-1.6) were HIV seropositive. Of the 992 women for whom serum samples were tested for HBV markers, 91 (9.2%, 95% CI 7.5-11.2) had evidence of past or current HBV infection, and four (0.4%, 95% CI 0.1-1.1) were HBV carriers. The age-specific HBV prevalence ranged from 4.1% among women 15-19 years old to 18.5% among those at least 30 years old (P < .001, chi 2 test for trend). Anti-HCV prevalence was also higher among women at least 30 years old compared to younger women (3.1 versus 1.9%; prevalence ratio 1.6, 95% CI 0.6-4.9), although the difference was not statistically significant. Anti-HCV prevalence was higher among women with past or current HBV infection than among women who were not infected (7.7 versus 1.3%; prevalence ratio 5.8, 95% CI 2.3-14.3). CONCLUSIONS: The prevalence of chronic HBV and HCV infection among pregnant women tested in San Juan, Puerto Rico, is comparable to that among pregnant women in the United States. The prevalence of HIV infection among pregnant women in San Juan is higher than among childbearing women in the United States.

Adolescent↗

PubMed2004

Public attitude toward xenotransplantation: opinion survey.

BACKGROUND: Although xenotransplantation is still in an experimental phase, it is presented herein as a possible solution to the organ shortage. However, there are few data concerning how the general public would accept treatment with animal organs, especially after recent incidents of infections of animal origin, such as "avian influenza" or "SARS disease." The aim of this study was to determine the attitude of the general public toward xenotransplantation of organs. MATERIALS AND METHODS: Using an opinion survey, a study was performed on a random sample of 250 subjects in an urban setting. The questionnaire was administered by personnel from the regional transplant coordination center. Completion of the form was self-directed and anonymous for each respondent. The attitude toward donation of human and animal organs was evaluated by analyzing different psychosocial variables that may influence this attitude. A descriptive statistical study was performed using Student's t test and the chi-square test. RESULTS: Ninety-eight percent of respondents completed the survey (n=245). As for human donation, 60% are in favor of cadaveric donation with 21% are in favor of living donation, a rate that increases to 74% if it is for a living partner. As for animal donation, if the results were similar to those obtained with human organs, 74% (n=181) would accept an animal organ if they needed it, as opposed to 18% (n=45) who were undecided and 8% (n=19) against (P <.005). Analysis of variables that influence attitudes toward xenotransplantation showed that this attitude was more positive among those having had a previous experience with transplantation (P=.028) and those having a positive attitude toward cadaveric donation (P=.007). Factors traditionally related to cadaveric donation, such as manipulation of the body or pro-social activities, showed no influence. CONCLUSIONS: In the population studied, a positive attitude toward xenotransplantation was greater than toward cadaveric donation, assuming the results of these two types of transplants were comparable. Such an attitude is related to human donation, although it is not influenced by many traditional factors.

Animals↗