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PubMed1997

Nonhuman primate spumavirus infections among persons with occupational exposure--United States, 1996.

Nonhuman primate (NHP) species used in biomedical research may be infected with a variety of retroviruses including simian immunodeficiency virus (SIV), simian spumaviruses (i.e., simian foamy viruses [SPV]), simian T-lymphotrophic viruses (STLV), and/or simian type D retroviruses. All of these retroviruses cause life-long infections in NHPs, and some are transmissible through sexual contact, blood, or breast-feeding. Following the detection of SIV infection in a worker with occupational exposure to SIV, in 1993 CDC and the National Institutes of Health conducted an anonymous serosurvey using stored specimens collected from U.S. workers with similar exposures. SIV seroreactivity was present in three (0.6%) of 427 stored serum samples. As a result of this finding, in 1993 CDC implemented a voluntary testing and counseling surveillance program to link specific exposures or health outcomes with the SIV serostatus of persons with potential occupational exposure to SIV. In 1995, the linked surveillance program was expanded to include voluntary testing and counseling for exposure to SFV, STLV and simian type D retroviruses. As of November 20, 1996, samples from 231 of the participating volunteer workers had been tested for SFV; infection was documented in three (1.3%). This report presents laboratory findings and case descriptions of these three infections, which indicate that SFV from NHPs can persistently infect exposed humans and may or may not cause disease or be transmitted among humans.

Animals↗
PubMed1991

Characterization and regional mapping of new anonymous chromosome 20-specific DNA markers isolated from a flow-sorted DNA library.

Employing the flow-sorted chromosome 20-specific DNA library LL20NS01, we isolated seven novel unique poly- and monomorphic DNA markers specific to human chromosome 20. Initially, 201 phage clones were analyzed regarding insert size and repetitivity. By testing 14 single- and low-copy number clones for their ability to detect RFLPs, three polymorphisms were revealed by two probes, pFMS22-1.4 [D20S22] and pFMS76 [D20S23]. Seven of twenty probes (35%) were assigned to chromosome 20 using a somatic cell hybrid DNA panel. Five of them were regionally mapped by in situ hybridization. Three DNA markers, pFMS51 [D20S29], pFMS76 [D20S23], and pFMS106 [D20S30], were assigned to 20p11.2-p12, and two markers, pFMS22-1.4 [D20S22] and pFMS135 [D20S31], to 20q12-q13.3. Our new chromosome 20-specific DNA markers should be useful for the molecular characterization of this rather underpopulated human chromosome.

Bacteriophages↗
PubMed2004

Multimerization of the Toxoplasma gondii MIC2 integrin-like A-domain is required for binding to heparin and human cells.

Toxoplasma gondii is an obligate intracellular parasite that causes toxoplasmosis in humans and animals. To invade host cells, T. gondii deploys the contents of its apically oriented secretory organelles that include the micronemes. Contained within the micronemes are proteins that possess adhesive motifs resembling those found in mammalian proteins. The micronemal protein MIC2 is a member of the thrombospondin-related anonymous protein (TRAP) family of adhesive proteins, which characteristically feature at least one integrin-like A-domain. Because of its strict conservation within the family, we sought to define the role of this domain by testing the adhesive properties of recombinant MIC2 A-domain fusion proteins. Since MIC2 is found as a multimeric species in parasite lysate, we also wanted to test whether recombinant MIC2 A-domain bound to its substrate in a multimeric state. In vitro assays of binding to several different potential receptors revealed that the MIC2 A-domain binds specifically to heparin, a ubiquitous sulfated proteoglycan found in the extracellular matrix (ECM). Additional studies demonstrated that this binding is not dependent on the MIDAS site, a well-conserved divalent cation-binding motif that the MIC2 A-domain shares with its mammalian counterparts. The recombinant MIC2 A-domain bound to heparin as a high molecular weight species, as did MIC2 from parasite lysate, indicating that the recombinant A-domain mimics the binding of native MIC2. Multimerization of MIC2 may increase the number of interactions with host cell receptors, thereby forming a multivalent adhesive junction during parasite entry.

Amino Acid Motifs↗
PubMed2005

Evaluation of the mandatory child abuse course for physicians: do we need to repeat it?

INTRODUCTION: Child abuse is one of the most common disorders affecting children of all ages. The objective of this study was to measure and assess the effectiveness of the mandated New York State child abuse and maltreatment course, and to identify and define the need for a refresher course. METHODS: This study was conducted in two parts. Part 1 consisted of a web-based survey among the paediatric members of 'Physicians Online' in New York State, and Part 2 consisted of an anonymous questionnaire survey using conventional US mail among the registered physicians in New York State who took the mandatory 'Recognition of Child Abuse and Maltreatment Course' between January 1988 and December 1998. The questionnaire included demographic information, test questions, and opinions of the physicians regarding the need for a refresher course. RESULTS: The web survey yielded 239/664 (36%) responses in 1 week. Approximately 45% of the respondents agreed that participation in the course produced a significant difference in their knowledge base and recommended that the course should be repeated every 5 years. The response rate for the mail survey was 56% (424/756). Among the respondents, 88% agreed that participation in the course produced an increased source of knowledge and practice (mean score of 3.2 +/- 1.2 using a scale of 1-5; where 1 = disagree and 5 = agree). The time since the course was taken (1-5 years vs >5 years ago) did not significantly influence their responses. Although 84% of the respondents answered the test questions correctly, significant differences were noted across practice specialty (P<0.05). In response to the question regarding the necessity for a refresher course, the mean score was 2.55 +/- 1.6 using a linear scale of 0-5 (where 0 = strongly disagree and 5 = strongly agree). CONCLUSIONS: These data suggest that practice specialty, not the time since the course was taken, made a significant difference in the knowledge of recognition and reporting of child abuse.

Adolescent↗
PubMed2002

[Burnout in primary care doctors of the province of cáceres].

OBJECTIVES: To analyse the degree of professional burnout in primary care doctors from our province and the effect of various factors.Design. Descriptive and analytic cross-sectional study. SETTING: Primary care (PC) in the province. PARTICIPANTS: All the PC doctors in the province of Cáceres (n=255). MAIN MEASUREMENTS AND RESULTS: Self-administered anonymous questionnaire: the Maslach Burnout Inventory that evaluates Depersonalisation (DP), Self-esteem (SE), and Emotional Exhaustion (EE); social and personal variables, work data, personal questions and measures taken if there was work stress. Student s t test, ANOVA (means), and Chi-square or Fisher test (percentages) were used. 157 valid questionnaires were returned (62% response rate). Mean age was 41.5 years old 7.2; 75% were male, 80.2% married, 73.2% had tenure, 48.9% worked in towns, and their mean case-load was 40.5 16.5 patients/day. Mean values found were: DP, 8.3 5.8; SE, 35.2 8.4; EE, 22 11.3; 65.8% scored high on one of the three. For EE mean scores were significantly higher in men, doctors with tenure, in towns, those with >10 years seniority or who saw >40 patients a day. 50% had had psycho-physical disorders in the previous 3 months; 33% withstood a lot of bureaucracy; both groups had EE averages. Dedicating <2 hours a day to leisure was associated with >EE; and being a tutor with a significantly higher level of burnout. Disorders in the family or social/work sphere were associated with high levels of DP and EE (P<.001). CONCLUSIONS: Like other studies, we found a moderate level of burnout in our sample. Seniority, social/labour or family conflict, and certain personal and job characteristics were associated with high burnout.

Adult↗
PubMed1989

First year medical students' attitudes and knowledge about AIDS.

Medical students attitudes and resulting behaviors about treating HIV-infected patients are critical and will become increasingly so in the years ahead. An anonymous self-administered questionnaire of 135 first year medical students at Boston University School of Medicine conducted in May 1988 queried students' knowledge of HIV transmission; concerns about contracting HIV; ethical and legal responsibilities; attitudes about testing for HIV and treatment of HIV-infected patients; the effect the epidemic poses for their medical careers; changes in personal sexual and drug use practices. Results indicate that students' careers are being affected because they are worried about contracting HIV, that the epidemic will affect their final choice of specialty, and that they believe they should be allowed to refuse to treat AIDS patients during their medical school training. The findings raise serious questions concerning why medical students hold these beliefs and suggest that students' willingness to care for AIDS patients may be a function of their level of knowledge and understanding of HIV infection and the disease AIDS. The results have implications for curriculum reform to address the AIDS crisis.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Prevalence of HIV, hepatitis C and syphilis among injecting drug users in Russia: a multi-city study.

OBJECTIVES: To estimate the prevalence of HIV, hepatitis C virus (HCV) and syphilis in injecting drug users (IDUs) in Russia. METHODS: Unlinked anonymous cross-sectional survey of 1473 IDUs recruited from non-treatment settings in Moscow, Volgograd and Barnaul (Siberia), with oral fluid sample collection for HIV, HCV antibody (anti-HIV, anti-HCV) and syphilis testing. RESULTS: Prevalence of antibody to HIV was 14% in Moscow, 3% in Volgograd and 9% in Barnaul. HCV prevalence was 67% in Moscow, 70% in Volgograd and 54% in Barnaul. Prevalence of positive syphilis serology was 8% in Moscow, 20% in Volgograd and 6% in Barnaul. Half of those HIV positive and a third of those HCV positive were unaware of their positive status. Common risk factors associated with HIV and HCV infection across the cities included both direct and indirect sharing of injecting equipment and injection of home-produced drugs. Among environmental risk factors, we found increased odds of anti-HIV associated with being in prison in Moscow, and some association between official registration as a drug user and anti-HIV and anti-HCV. No associations were found between sexual risk behaviours and anti-HIV in any city. CONCLUSIONS: HIV prevalence among IDUs was markedly higher than city routine surveillance data suggests and at potentially critical levels in terms of HIV prevention in two cities. HCV prevalence was high in all cities. Syphilis prevalence highlights the potential for sexual risk and sexual HIV transmission. Despite large-scale testing programmes, knowledge of positive status was poor. The scaling-up of harm reduction for IDUs in Russia, including sexual risk reduction, is an urgent priority.

Adolescent↗
PubMed2000

Prevalence of HIV infection and risk behaviours among Montreal street youth.

We aim to estimate HIV prevalence and associated risk factors among street youth in Montreal, Canada. We conducted a one-year cross-sectional anonymous study in 1995. We recruited youth aged 13-25 years meeting specific criteria for itinerancy through the 20 major Montreal street youth agencies. Participation included a structured interview and provision of an oral specimen for HIV testing. Among the 909 subjects studied, 99.3% had been sexually active, 25.9% had exchanged sex for money, gifts, drugs, a place to sleep, or other things; 31.8% reported anal sex; and 36.4% reported having ever injected drugs. Overall, HIV prevalence was 1.9% (1.1% in girls and 2.2% in boys). Multivariate logistic regression showed that being over 20 years of age (adjusted odds ratio (AOR) 7.09), having injected drugs (AOR 4.48), having engaged in prostitution (AOR 3.32), and being born outside Canada (AOR 4.41) were all independently associated with HIV infection.

Adolescent↗
PubMed1997

[Factors affecting smoking of elementary and high school children from Chile].

INTRODUCTION: Despite the harmful effects of tobacco millions of people continue to smoke. Many of these smokers, including most news smokers, are adolescents-both in Chile and in other countries. This study sought to determine the prevalence of smoking among Chilean elementary and high school children and to quantify the relative impact of socioeconomic, socio-cultural, familial, mass media exposure, demographic, educational and psychosocial factors on smoking. MATERIAL AND METHOD: A representative sample of 2,967 elementary and high school children from Chile's Metropolitan Region were chosen at random, by grade (IV, VI, and VIII elementary school grades and I and IV high school grades), sex, type of school and geographical area. Prevalence of smoking was determined through an anonymous self-administered questionnaire. Socioeconomic status (SES) was measured by means of Graffar's modified method and family conditions, mass media exposure and psychosocial factors were registered. Scholastic achievement was measured by a language and mathematics test and other educational variables were considered. Statistical procedures included analysis of variance. Student's test and Scheffe's test for comparison of means, correlation, stepwise multiple regression, chisquared and PAHO/WHO risk approach methodology. RESULTS: Prevalence of smoking (10.6%) increased significantly with age, from 1.3% in school children aged < 13 years to 15.4% and 36.9%, in adolescent students aged 13-15 years and > or = 16 years, respectively (p < 0.001) and was higher in females than in males. Pleasure level (r = 0.499 p < 0.001), level of rebelliousness (r = 0.124 p < 0.0001), family recreation level (r = -0.131 p < 0.0001) and the percentage of school attendance (r = -0.118 p < 0.0001) were the independent variables with the greatest explanatory power in smoking variance (r2 = 0.2860), but pleasure level was the variable with the greatest explanatory power in the explained variance (89.2%) and with the greatest RR (34.3). The relative impact of the independent variables on smoking varied according to age, sex and SES. CONCLUSIONS: The result demonstrate that pleasure level, level of rebelliousness, family recreation level and the percentage of school attendance were the independent variables with the greatest explanatory power in smoking. These findings may be useful in the implementation of education and health policies with a view to the reduction of this serious public health risk factor.

Adolescent↗
PubMedDate not supplied

Internet usage by pediatric dental practices in Connecticut.

PURPOSE: The aim of this study was to determine Internet usage by pediatric dental practices in Connecticut. METHODS: A seven-item anonymous survey was mailed to all the 64 pediatric dentists in private practice in Connecticut. Each survey form was mailed along with a stamped and pre-addressed return envelope. Frequency distribution analyses and chi-square tests were performed. RESULTS: The survey had a response rate of 73%. More than three-fourths of the pediatric dental practices were connected to the Internet. Seventy-two percent of the practices submitted third-party claims electronically. Almost all of the respondents did not use email to communicate with patients or to discuss individual patient issues with other health care providers. Only two-fifths of the practices had a World Wide Web site. CONCLUSIONS: Most of the pediatric dental practices in Connecticut were connected to the Internet. Electronic third-party claims submission was the predominant Internet service used by these practices.

Chi-Square Distribution↗
PubMed1997

First-year medical students' knowledge of, attitudes toward, and personal histories of family violence.

PURPOSE: To assess first-year students' knowledge of, attitudes toward, and personal histories of family violence. METHOD: An anonymous, self-administered, 70-item questionnaire was developed and distributed in the first six months of medical school to 390 first-year students at three New England medical schools in 1991-92. The students were tested on knowledge and asked questions about their personal histories. Attitude questions were scored on a five-point Likert scale. Attitude scales were developed by dividing questions into three content groups (education about family violence, the physician as advocate, acceptability of violent behaviors) and removing items for which inter-item coefficients with all other items were less than .20. Two-tailed t-tests were performed on continuous variables and chi-square tests on categorical variables. Ninety-five percent Cls were calculated for point estimates. RESULTS: In all, 370 students (95%) responded. Of these, 139 (38%) reported personal histories of abuse. The mean knowledge score was 11.3 (of 16 questions). One-third of the students answered more than 75% of these questions correctly; 12% answered less than half of the questions correctly. The women felt more strongly than the men about the need for violence education (p < .001). The students who reported histories of abuse more strongly favored education (p < .05) and advocacy roles (p < .001) for physicians. In addition, the students who had histories of family violence were more likely to report histories of suicidal thoughts (p < .0001). CONCLUSION: The students lacked knowledge but felt a need to learn more about family violence. Family violence curricula should be better integrated into medical education. These curricula should be sensitive to students' attitudes, given the reported high prevalence of personal histories of family violence among students.

Adult↗
PubMed1997

Outcomes of regular vs. extended alcohol/drug outpatient treatment: I. Relapse, aftercare, and treatment re-entry.

Alcohol and drug patients were randomized into two groups, one receiving three months and the other six months of outpatient treatment to determine differences in treatment outcomes. Most clients had received prior 30 days of inpatient treatment. Patients were contacted after the first 70 days of outpatient treatment and 12 refused participation. Consenters were randomized and assigned into control (n = 103) and experimental (n = 127) groups, and interviewed at discharge, and three and six months later. A gratuity of $10.00 was offered after a completed phone interview. Data were analyzed using chi-square, t-test, and multivariate logistic regression techniques. Controls had lower treatment drop-out and higher follow-up attrition rates than experimentals. There were no major differences in reported subsequent alcohol/drug use, or attendance to aftercare, Alcohol Anonymous (AA) and support groups during the 3 and 6 months follow-up surveys. More controls re-entered treatment than experimentals at 3 months post-treatment, but there was no such difference at 6 months post-treatment. In terms of ancillary effects, experimentals had slightly more desirable outcomes with respect to abstinence at time of discharge, and use of cocaine at 3 months follow-up. Controls were more likely to use cocaine and less likely to re-enter inpatient treatment or attend aftercare than experimentals. At six months the few who reported using painkillers were controls. Relapse was predictably influenced both at 3 and 6 months by pretreatment use of cocaine as primary drug, and by duration of abstinence from all chemicals. The predictive influence of cocaine was greater at 3 than at 6 months post-discharge.

Adult↗
PubMed2004

Changing attitudes toward homeless people.

We assessed the impact of a 2-week required rotation in homeless health care on primary care residents' attitudes toward homeless people. Attitudes were assessed before and after the course using the Attitudes Toward Homelessness Inventory (ATHI), an instrument previously validated among undergraduate students. Attitude scores on the ATHI improved from 46 to 52 (range of possible scores 11 to 66; P =.001). The ATHI subscales showed, after the course, that residents had a greater belief that homelessness had societal causes and felt more comfortable affiliating with homeless people. After the course, residents also reported an increased interest in volunteering with homeless populations on an anonymous survey.

Attitude of Health Personnel↗
PubMed2005

Unintended pregnancy risk in an emergency department population.

OBJECTIVE: To assess unintended pregnancy risk and associated factors among female urban Baltimore emergency department (ED) attendees. METHODS: A cross-sectional anonymous questionnaire study was completed by 790 women, sufficient to detect a 5% difference of unintended pregnancy risk in the national population and a 10% intersite difference with 80% power. The results were analyzed with chi-square tests, univariate and multivariate logistic regression analyses. RESULTS: Female ED attendees are at greater risk for unintended pregnancy (33.5%), particularly those of lower income (p=.006) and without a primary care provider (p=.003). Unintended pregnancy risk did not vary between sites by any variable except young age despite the fact that sites varied significantly by race, insurance and income measures. CONCLUSION: Women using the ED are at increased risk for unintended pregnancy and are less likely to have access to a regular medical care source; thus, the ED represents a possible contraceptive provision site.

Adolescent↗
PubMed2002

A critical evaluation of the morbidity and mortality conference.

BACKGROUND: This study was designed to evaluate the impact of changes made to our morbidity and mortality (M&M) conference. METHODS: A 23-item survey using corresponding Likert-type scales was created. Faculty and residents were asked to anonymously complete the surveys in June 1999. Based on this information, specific modifications were made to the conference. The same survey was administered to faculty and residents in the Fall of 2000. Analysis was performed using Student t tests. RESULTS: Postsurvey findings showed residents felt eight components improved significantly (P <0.05). Faculty noted nonsignificant improvement in nine survey items and decline in nine items (five unchanged). CONCLUSIONS: Changes in content and structure made to enhance our M&M conference's educational value resulted in significant improvements as perceived by the surgical residents. Interestingly, these changes had only minimal impact on faculty perceptions.

Clinical Competence↗
PubMed1994

The attitudes of midwives to maternal serum screening for Down's syndrome.

An anonymous questionnaire was sent to determine the opinions and attitudes of 342 Leicestershire midwives who are responsible for counselling antenatal patients about maternal serum screening for Down's syndrome. This asked questions regarding grade, background training, attitudes towards testing for spina bifida and Down's syndrome, and opinions upon termination of pregnancy for these and other conditions. A total of 188 (55%) midwives completed the questionnaire. In all, 40.4% of midwives admitted that they did not feel confident counselling for the serum screening test for Down's syndrome; 38.3% of midwives did not feel termination of pregnancy for Down's syndrome was justified; 25% of midwives admitted that they were not in favour of this prenatal test. In conclusion, if such a screening programme is to be introduced across the UK, more attention must be paid in advance to the views and training requirements of those midwives who will be associated with the test. It should not be assumed that ethical considerations, relating to a prenatal test, are of minor significance to those health care professionals involved in its implementation.

Abortion, Induced↗
PubMed2004

What is Alcoholics Anonymous affiliation?

An increasing body of research evidence supports the use of 12-step program affiliation as an effective adjunct and aftercare for formal treatment. Recently, three brief (9- or 10-item) measures of affiliation have been developed. However, the brief scales are difficult to interpret, and the question of exactly what is affiliation (or disaffiliation) remains unclear. This analysis examines the question of what is the essence of affiliation vs. disaffiliation. Data from the Project MATCH 1-year posttreatment Alcoholics Anonymous Involvement (AAI) scale (N=1506) are used to identify the most salient items of Alcoholics Anonymous (AA) affiliation predicting 1-year posttreatment drinking outcomes. Analysis using stepwise regression suggests that a three-item solution can explain a similar amount of variance in the proportion of days abstinent in months 9 through 12 posttreatment, as does using the nine items. These three "core items predicting recovery" include AA attendance, sum of steps completed, and identifying self as an AA member. As an affiliation composite scale, these three items are easier to interpret and administer than the full AAI scale, and when combined, possess adequate reliability (alpha=0.72).

Adult↗