The importance of levels of knowledge in developing a unified theory for HIV / AIDS counselling: a comparison of two culturally different samples.
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Acquired Immunodeficiency Syndrome↗
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Sexual risk behavior, knowledge, and condom use among adolescents in juvenile detention.
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Adolescent↗
Sexual behavior patterns of customers of male street prostitutes.
Information about male customers of male prostitutes, including sociodemographic and life-style characteristics, sexual and drug use behaviors, and knowledge about HIV infection were collected from a convenience sample of 211 male street prostitutes and a convenience sample of 15 male customers as part of a feasibility study. Data from these two groups indicate that despite knowledge of HIV infection and its transmission, customers engage in high-risk sexual and drug use behaviors with prostitutes. Because there is a high HIV infection rate within the male prostitute sample (175/1000) and because these customers for the most part describe themselves as bisexual or heterosexual, it is likely that male customers of male prostitutes serve as a vector of transmission of HIV infection to their other partners including the heterosexual population.
Adult↗
Sexual behavior and attitudes of university students in Northern Ireland.
Two surveys of a Northern Ireland student sample were conducted in 1987 and 1988. A total of 419 female and 201 male subjects completed self-administered anonymous questionnaires concerning their behavior, knowledge, and attitudes towards sex, AIDS, homosexuality, contraception, and relationships. Results indicated a relatively low level of sexual experience, and for those with experience, relatively few partners. The possible influences of gender and religiosity on sexual behavior and attitudes, in the context of Northern Ireland, are discussed. Subjects reported considerable variation in the amount of sex education, but the majority received little or none. This student sample held relatively conservative attitudes towards love, sex, and marriage and this was particularly true for females and for regular churchgoers. In addition, attitudes towards homosexuality were negative (particularly among regular churchgoers). Attitudes towards contraception were more positive than expected among Catholic subjects, and few indicated that they would refuse to use contraceptives on principle. Responses to items about AIDS were highly uniform, suggesting that much of the information made available to the public has been absorbed. However, the lack of uniformity of response to more general items about sex, relationships, and contraception may indicate that fundamental changes in sexual behavior are unlikely to be brought about by influencing a rather narrowly defined set of attitudes about AIDS.
Acquired Immunodeficiency Syndrome↗
Coming out and AIDS-related high-risk sexual behavior.
How the withdrawal of social support associated with the coming out of gay men influences AIDS-related sexual risk-taking among Flemish (Belgian) gay men is analyzed. Recruited via key persons, the 379 gay men in this nonclinical cohort completed a lengthy, computerized questionnaire dealing with diverse aspects of gay life and culture. Independent variables include demographic characteristics, AIDS knowledge, coming-out histories, six social support dimensions, and personal resources. The dependent variables were insertive and receptive anal intercourse with and without a condom. Stepwise regression explained, respectively, 41.2, 38.4, 18.4, and 14.2% of the variance. Absence of appraisal (the view that others approve of the way one does things or feels about things) led to higher frequencies of insertive anal sex (both with and without a condom). The experience of emotional conflict lowered the use of condoms by the insertive partner in anal intercourse. Disapproval by significant others of being gay also led to higher levels of receptive anal intercourse without a condom. Subjects with a high belief in mastery had higher frequencies of risk-taking, suggesting that the combination of the experience of negative reactions and high mastery lead to greater involvement in risky sexual behavior. Findings are interpreted within the theoretical framework of the coming-out process and gay identity formation.
Acquired Immunodeficiency Syndrome↗
The contraceptive transition in Flanders.
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Age Factors↗
Alcohol use and contraception in first sexual experiences.
Recent research has suggested that the use of alcohol or drugs in conjunction with sexual intercourse is associated with nonuse of contraception, particularly in first intercourse experiences. This paper reports findings from a nationally representative sample of adolescents and young adults aged 18-30 who were asked a number of questions about the circumstances and characteristics of the first time they had intercourse. Results showed that drinking at the time of first intercourse was more prevalent among those who first had sex prior to 1985; moreover, members of this cohort were less likely to use condoms or other forms of birth control at the time of first intercourse. Drinking was associated with nonuse of contraception only among those who had their first sexual experience prior to 1985. The results are discussed in terms of historical changes in the sexual climate of the AIDS era.
Acquired Immunodeficiency Syndrome↗
Contraceptive choice in Vigevano, Italy, 1983-1993.
The authors, after general consideration of family planning programs, present a study of 22714 women, who, in the decade 1983-1993, required contraceptive protection from the Family Planning Centers in the region of Vigevano (Italy). The authors underline the importance of a protocol used before beginning treatment to help prevent women receiving methods carrying too great a health risk. The results show a very high prevalence of oral contraception, increasing in recent years with the introduction of triphasic pills, while use of intrauterine contraception seems to be declining. Other conventional methods, such as barrier (diaphragm and condom) and 'natural' methods, had a low incidence in the sample studied. The reasons for these behaviors are analyzed and the relative trends discussed.
Adolescent↗
Prostitutes: a high risk group for HIV infection?
Female prostitutes are at increased risk for sexually transmitted diseases and HIV infection. However, the prevalence rate of HIV infection among prostitutes varies geographically, with the highest rates occurring in Africa and in areas with large numbers of HIV infected intravenous drug users (IVDU). In Europe the most important risk factors for HIV infection in prostitutes are intravenous drug use and unprotected intercourse with non-paying partners. Whereas in Europe, there is as yet no evidence that female prostitutes are a source of HIV infection for the heterosexual population, they are playing a major role in the spread of HIV in Africa. Education about safe sex practices should be included in prevention programmes aimed at IVDUs. HIV infection should be monitored in prostitutes, and health education on AIDS prevention should be offered to prostitutes and their clients.
Acquired Immunodeficiency Syndrome↗
Physicians' attitudes towards treatment guidelines: differences between teaching and nonteaching hospitals.
OBJECTIVE: To investigate whether physicians' attitudes towards treatment guidelines for primary and secondary care differ between teaching and nonteaching hospitals shortly before and 4 years after the guidelines' introduction. METHODS: Possible barriers and facilitators of joint treatment guidelines were obtained by self-administered questionnaires twice during the study period. Questionnaires were distributed among all internists and cardiologists in the Groningen region of The Netherlands. RESULTS: Physicians from teaching and nonteaching hospitals differed in attitude regarding the content and usefulness of the guidelines. Physicians from nonteaching hospitals more often believed that the guidelines are too restrictive (64% vs. 18%) and too rigid to apply to individual patients (14% vs. 6%) and that they oversimplify medical practice (79% vs. 35%). Physicians from teaching hospitals more often agreed that good recommendations for first-choice drugs had been made (76% vs. 50%) and that these guidelines are a convenient source of advice (94% vs. 57%), can facilitate communication with general practitioners (94% vs. 71%), and can improve the quality of pharmacotherapeutic care (88% vs. 43%). Four years later, a larger proportion of physicians from both hospital settings had a negative attitude towards the usefulness of the guidelines, but the difference in attitude between teaching and nonteaching hospitals remained the same. CONCLUSION: Physicians from nonteaching hospitals were less positive about the usefulness of joint treatment guidelines than physicians from teaching hospitals were. Results from studies on the implementation of guidelines in teaching hospitals can therefore not be transferred to nonteaching settings.
Attitude of Health Personnel↗
Wound infections in pediatric surgery: a study of 575 patients in a university hospital.
Surgical wound infections (WI) remain a significant source of postoperative morbidity. This epidemiologic study was undertaken to determine retrospectively the incidence of postoperative WI in children in a university hospital and include critical comparisons of pediatric surgery WI rates between different international reports. As few data exist on postoperative WIs in pediatric patients, in contrast to numerous reports in adults, all infants and children undergoing operations in the pediatric surgical service in our institution during a 7-year period were reviewed for development of a WI, a total of 537 patients who underwent 575 operations. WIs occurred in 39 cases (6.7%). Clean wounds (56.8% of patients) had an infection rate of 2.7%, clean-contaminated (23.1%) 10.5%, contaminated (12.9%) 13.5%, and dirty/infected (7.2%) 14.6%. Increasing duration of operation ( P < 0.001), contamination at operation ( P < 0.001), and a new element in the operation - a resident or intern - ( P < 0.001) were all associated with a higher incidence of infection, despite efforts at infection-control practices including improved sterilization methods and barriers, surgical technique, and availability of antimicrobial prophylaxis. The total incidence of wound infection in this population was comparable to that in other reports. Comparing children who developed a wound infection with those who did not, there were no significant differences in age, sex, American Society of Anesthesiologists preoperative assessment score, length of preoperative hospitalization, location of operation (intensive care unit vs operating room), the presence of a coexisting disease or remote infection, or the use of perioperative antibiotics. These baseline data may aid in forming strategies to lower the risk of WI in children. Our results suggest that WIs in children are related more to factors at operation than to the patients overall physiologic status.
Child↗
Para-capillary electron-dense deposits reduce glomerular filtration in patients with primary glomerular diseases.
BACKGROUND: Electron-dense deposits are often found around glomerular capillary lumens in patients with glomerulonephritis, forming a portion of the blood-urine barrier (BUB). METHODS: Four hundred and four patients with primary glomerular diseases or donors for living-related kidney transplantation who underwent both percutaneous renal biopsy and renal clearance tests were included in the study. Sodium thiosulfate and paraamino hippurate double-clearance studies were performed with catheterized urinary collection. The filtration fraction (FF) was determined as follows: FF = sodium thiosulfate clearance/paraamino hippurate clearance (CPAH: ). Histomorphometric analyses were performed in 53 patients with overt para-capillary electron-dense deposits (PCEDD) by electron microscopic observations. RESULTS: Patients with membranous nephropathy and membranoproliferative glomerulonephritis showed significantly lower levels of FF than the donors for living-rebated kidney transplantation (normal controls). FF levels were significantly lower in patients with PCEDD than in those without (P < 0.001), while the levels of mean blood pressure and CPAH: were comparable in the two groups. The PCEDD/BUB ratio demonstrated a significant negative correlation with FF (P < 0.0001; r(2) = 0.331). Patients with a ratio of 0.5 or more showed significantly lower FF levels than those with a ratio of 0.25 or less. CONCLUSIONS: PCEDD significantly affected FF levels in patients with primary glomerular diseases. FF may not be an accurate indicator of intraglomerular blood pressure in patients with overt PCEDD.
Adult↗
Culture of Calu-3 cells at the air interface provides a representative model of the airway epithelial barrier.
PURPOSE: The aim of this study was to compare the effect of liquid-covered culture (LCC) and air-interfaced culture (AIC) on Calu-3 cell layer morphology and permeability, thus assessing the fitness of these culture systems as models of airway epithelium barrier function. METHODS: Cell layers were grown on 0.33 cm2 Transwell polyester cell culture supports. Cell layers grown using LCC and AIC were evaluated by using light and electron microscopy, transepithelial electrical resistance (TER), and permeability to the transepithelial flux of fluorescein sodium (flu-Na), and by varying molecular weight dextrans labeled with fluorescein isothiocyanate (FITC-dex). The tight junction protein, zona occludens protein-1 (ZO-1), was visualized by confocal microscopy and apical glycoprotein secretions were identified by using alcian blue. RESULTS: Cells grown via AIC produced a more columnar epithelium with a more rugged apical topography and greater glycoprotein secretion compared to cells grown via LCC. Apical protrusions appearing to be cilia-like structures were observed on occasional cells using AIC, but typical airway ciliated cell phenotypes were not produced under either condition. Secretory granules were observed in cells cultured under both conditions. Cells cultured using LCC exhibited higher levels of ZO-1 protein than the AIC counterpart. The maximal TER of cells using LCC, 1,086 +/- 113 ohms cm2 at 11-16 days, was significantly greater than the TER of cells cultured using AIC, 306 +/- 53 ohms cm2 at 11-13 days. Apparent permeability (P(app)) values for the transport of flu-Na using LCC and AIC were 1.48 +/- 0.19x10(-7) and 3.36 +/- 0.47x10(-7) cm s(-1), respectively. Transport rates of flu-Na and FITC-dex were inversely proportional to molecular weight, and were significantly lower (p < 0.05) in cell layers grown using LCC than AIC. Renkin analysis fitted the data to single pore populations of radii 7.7 and 11.0 nm for LCC and AIC, respectively. CONCLUSION: Distinct differences in morphology and permeability result when Calu-3 cells are grown using AIC or LCC. Cells cultured using AIC generate a model more morphologically representative of the airway epithelium than cells cultured using LCC.
Bronchi↗
The effect of condom use on squamous cell cervical intraepithelial neoplasia.
Between January 1, 1968, and July 1, 1980, 377 of a total 412 patients with biopsy-proven cervical intraepithelial neoplasia (CIN) were seen in the private office of the authors and followed for more than 6 months after biopsy and the start of treatment. Thirty-five patients were lost to follow-up. Ninety-one were treated primarily by hysterectomy. The 286 patients in whom childbearing function was to be preserved were instructed, as soon as the diagnosis of CIN was confirmed, to use a mechanical barrier (the condom) throughout intercourse. In addition to the use of the condom, 40 of the 286 underwent surgical conization and 107 underwent cryosurgery. All of these 147 patients eventually showed cytologic and colposcopic regression of the disease. One hundred and thirty-nine patients were treated with the condom alone. One hundred and thirty-six of the 139 showed complete regression of the disease. Eighteen (6.2%) of the 286 patients had late recurrences of the disease; 12 of these experienced regression again with the resumption of the use of the condom. No patients showed progression of the disease while using the condom. All grades of CIN proved to be reversible. It is recommended that a mechanical barrier at intercourse be added to any program for conservative treatment of CIN.
Adult↗
Seventeen-year review of sexual and contraceptive behavior on a college campus.
OBJECTIVES: We reviewed current sexual and contraceptive behavior of college-age men and women and compared the findings with those of similar studies in 1974 and 1979. STUDY DESIGN: A randomly selected population questionnaire was provided to students registered in the spring 1991 semester. Of the 1921 survey forms mailed, 772 (40.2%) were returned. The CHIFIT test was used to determine representativeness of sample population to target population. RESULTS: Proportionately more women than men responded, although the age grouping and academic standing were consistent with the university population. Of the 772 responses, 84.2% were sexually active with a mean age at onset of 17.8 years. Half (50.3%) always used contraception with oral contraceptives as the first choice and condoms second. Sexually transmitted diseases were reported by 19.1%. More than one fourth (27.8%) had been tested for human immunodeficiency virus or acquired immunodeficiency syndrome. Fifteen percent (15.1%) reported being forced to have sex, and 50% of these incidents had occurred before age 19. CONCLUSIONS: On a comparison with findings in 1974 and 1979, more students had participated in sexual activity beginning at a younger age with slightly less use of contraception.
Contraception↗
An improvised mould for vaginoplasty.
The use of a simple, improvised mould for vaginoplasty is described. It is made of rubber foam rolled over a winged infusion cannula and covered over by condoms. It offers a number of advantages over conventional moulds, the main ones being its simplicity of construction and its ease of application and removal from the neo-vagina.
Catheterization↗
Relationship between condom strength and failure during use.
The relationship between condom strength and failure during use was examined in six volunteers using artificially deteriorated condoms. Samples of each condom set exposed to ultraviolet light for three to eleven hours were tested for strength by air burst procedures. The remaining condoms were used by volunteers protected from pregnancy by other means. Burst pressure fell to 35% and burst volume to 17% of untreated levels after six hours of ultraviolet exposure. A maximum mean breakage rate during use of 30% was obtained at this time, although individuals experienced breakage rates up to 70% at this stage of deterioration. No failures occurred during use until condoms had deteriorated by more than 25%. Conclusions were: 1) that burst test parameters can effectively and sensitively measure changes in condom strength, 2) that condoms produced to western industrial standards carry a wide margin of strength over and above the minimum required for effective use, 3) that stored condoms should not necessarily be thrown out if they are uniform in strength but fall below original acceptance standards.
Contraceptive Devices, Male↗
An assessment of burst strength distribution data for monitoring quality of condom stocks in developing countries.
Laboratory tests were conducted on condoms to examine the changes that occur over time in indicators of condom burst strength, and to determine the relationship between laboratory-assessed condom burst strength and breakage during use in a developing country setting. Three groups of unaged condoms purchased directly from the manufacturer were used: one group exposed to UV light for 10 hours; one group exposed for five hours; and one group unexposed. A sample of each of these groups was tested according to ISO condom air burst test protocols. The remaining condoms were individually packaged in coded polyethylene bags for shipment to the developing country study site. Also used in the study was a group of condoms that had been aged for over 40 months under field conditions in a tropical climate; a sample from this group was tested by the ISO air burst test protocol and the remainder distributed to the study site. One-hundred-thirty Indonesian urban males participated in the double-blind study. Volunteers were not relying on the condom for contraceptive purposes. Each volunteer was given one individually packaged untreated condom, one condom from each treatment group, and four condoms aged in the field. Study participants were instructed to return all used condoms. Each condom that was returned after use was examined for breakage, and the unbroken condoms were subjected to an air inflation test to determine volume and pressure at burst. A comparison of the air burst volume data for a sample of unused and used condoms from the same treatment group indicates that most of the condoms that broke during use had air burst volumes below 11 liters. Therefore, a significant downward shift in the burst strength distribution as measured in the laboratory is likely to result in an increased breakage rate during use. A Condom Deterioration Index calculated from regular periodic testing of stored condom stocks is a convenient and sensitive means of monitoring trends in the distribution and deterioration of condom strength.
Air↗