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PubMed1996

Crack use in Puerto Rico: evidence of a recent epidemic.

This study examines the prevalence of crack use among out-of-treatment drug users in the San Juan metropolitan area. Of the sample of 849 drug users, 310 (36.5%) were crack users only, 179 (21.1%) were drug injectors and crack users, and 360 (42.4%) were drug injectors only. To study the characteristics of crack users we selected the subjects who reported the use of crack only. Of the 310 subjects, 193 (62.3%) men and 117 (37.7%) women, the mean age was 29 years. Significant differences were observed by gender. Females reported higher education, living in a nuclear family, crack/cocaine as the first drug used, history of sexually transmitted diseases and higher rates of HIV seropositivity. Males were more likely to report income from illegal activities, incarceration, use of multiple drugs, and more years of drug use. Among those sexually active, females were more likely to practice unprotected vaginal sex, have multiple sex partners, engage in prostitution (exchange of sex for money and/or drugs) and use condoms.

Adult↗
PubMed1997

Interactions between dystrophin and the sarcolemma membrane.

Dystrophin serves as a link between the subsarcolemmal cytoskeleton and the extracellular matrix. The NH2 terminus attaches to the cytoskeleton, while the COOH terminus attaches to the dystrophin associated protein (DAP) complex, which can be separated into the dystroglycan, sarcoglycan, and syntrophin subcomplexes. While the function of each DAP is not known, the dystroglycan complex binds laminin in the extracellular matrix, and binds the dystrophin COOH terminus in vitro. The syntrophins also bind the dystrophin COOH terminus in vitro, but no evidence has been reported for an interaction between dystrophin and the sarcoglycans. Human mutations have been found in dystrophin, the sarcoglycans and laminin, all of which lead to various types of muscular dystrophy. We have been studying the dystrophin domains necessary for formation of a functional complex by generating transgenic mdx (dystrophin minus) mice expressing internally truncated dystrophins. These mice provide in vivo models to study the localization of truncated dystrophin isoforms, the association of the truncated proteins with the DAP complex, and the functional capacity of the assembled DAP complexes. Expression of a dystrophin deleted for most of the NH2-terminal domain in mdx mice leads to only a mild dystrophy, indicating that dystrophin can attach to the cytoskeleton by multiple mechanisms. Truncation of the central rod domain leads to normal DAP complex formation and almost fully prevents development of dystrophy. Deletion analysis of the COOH-terminal regions indicates that a broad cysteine-rich domain is indispensable for dystrophin function. This region coincides with the in vitro identified beta-dystroglycan binding domain. Mice lacking this latter domain express very low levels of the sarcoglycans, indicating that the sarcoglycan complex binds dystrophin via dystroglycan. All deletion constructs tested lead to normal expression of the syntrophins, indicating that syntrophin associates with the DAP complex via multiple binding partners.

Actins↗
PubMed1997

Correlates of college student marijuana use: results of a US National Survey.

This study examines which personal student background and college characteristics are associated with marijuana use. A self-administered survey was mailed to a national representative sample of 17592 students at 140 American colleges. One of four (24.8%) students reported using marijuana within the past year. Rates of use among the colleges ranged from zero per cent at the lowest use schools to 54% at the highest use schools. Multiple regression models, constructed to determine the college and student characteristics predicting marijuana use, suggest that use was higher among students at non-commuter colleges and at colleges with pubs on campus. Student characteristics associated with marijuana use included being single, white, spending more time at parties and socializing with friends, and less time studying. Marijuana use was higher among students who participate in other high risk behaviors such as binge drinking, cigarette smoking and having multiple sexual partners, and among students who perceived parties as important, and religion and community service as not important. The study points to the social nature of drug use in college, and demonstrates that this behavior is of continuing concern for public health.

Adolescent↗
PubMed1997

Social differences in sexual behaviour and cervical cancer.

In this chapter we first describe the variation of cervical cancer in relation to social class. Thereafter we examine the causes for the occurrence of socioeconomic differences in invasive cervical cancer, using data from two case-control studies carried out in Colombia and Spain. Cervical cancer is the most common cancer in developing countries and the sixth most common in developed countries. In all areas, it is more frequent among women of low socioeconomic status, it is associated with multiple sexual partners and early age at first sexual intercourse, and both incidence and mortality are reduced by screening. According to population-based surveys in industrialized countries, men of low socioeconomic status report fewer sexual partners than men of high socioeconomic status but there is no clear indication that the same is true of women of low socioeconomic status. In the case-control studies in Spain and Colombia, the human papillomavirus and all other sexually transmitted diseases were more prevalent among women in low socioeconomic strata. Number of sexual partners and particularly contacts with prostitutes were higher among husbands of women of low socioeconomic status. Other potential risk factors for the disease, such as smoking and oral contraceptive use, and also cervical cancer screening (Pap smears), were more common in women of high social strata. Women with no schooling had a threefold higher risk in Spain and a fivefold higher risk in Colombia of having cervical cancer compared with women who had achieved a higher educational level. After adjustment for sexual behaviour, HPV DNA status, history of Pap smears and husband's contact with prostitutes, this association was considerably reduced. These results are indicative that socioeconomic differences in the incidence of cervical cancer can be partly explained by differences in the prevalence of HPV DNA. Men's sexual behaviour and particularly contacts with prostitutes might be a major contributor to the higher prevalence of HPV DNA among the poor.

Adolescent↗
PubMed1997

Traditional Balinese youth groups as a venue for prevention of AIDS and other sexually transmitted diseases.

OBJECTIVES: Our aims were to assess the feasibility of conducting peer-led educational interventions against AIDS and other sexually transmitted diseases (STDs) through traditional Balinese youth groups and to gather information on sexual risk-taking and its correlates among Balinese youth. DESIGN: A cross-sectional survey was conducted, with follow-up questionnaires for pilot intervention participants. SUBJECTS AND METHODS: A self-administered questionnaire was given to 375 subjects (aged 16-25 years) from 12 youth groups representing four main resort areas in Bali. Post-intervention data were collected from 97 of these subjects who had taken part in pilot educational programs. Focus groups supplemented survey data in evaluating the intervention and understanding risk behaviors. RESULTS: In a cross-sectional survey, one-quarter of males and few females reported sexual activity; subsequent focus groups suggested under-reporting by females. While knowledge and worries about HIV/AIDS were high, only 10% of sexually active males and no females reported consistent condom use. The mean age of first sexual intercourse was highly correlated with first alcohol consumption (P = 0.0003). Peer educators from selected youth groups planned and implemented interventions for their own groups. Post-intervention data indicated significant increases in communication about sexual issues with friends and parents. Condom attitudes became less negative and efficacy increased. Participants reported this as a first experience with peer-led health education, preferred interactive activities to adult-led lectures and recommended follow-up educational sessions. CONCLUSIONS: Peer educators from traditional youth groups can plan and conduct prevention programs for HIV/STDs that are well-received by their group memberships. Using such venues may be an efficient way to reach a wide range of pre-sexual Balinese youth, as well as those already at risk for HIV/STD due to unprotected sex, alcohol consumption and multiple sexual partners.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Sexually transmitted disease control in China (1949-1994).

This paper summarizes the historical experiences in venereal disease control in China during the 1950s. Venereal diseases had been all but eliminated in the whole country till 1964. However, along with the implementation of open-door policy and economic reform in the 1980s, the social environment was changed to a great extent in this country. Sexually transmitted diseases (STDs) were re-introduced in the Chinese mainland and new foci of infection established themselves in some cities. During the recent 8 years the national STD case-reporting and sentinel surveillance systems have been set up. The results of surveillance show that the annual incidence of STD has been on the increase. The existing factors associated with the increasing incidence of STD mainly are; population movement, increasing affluence in a part of population, the availability of multiple sexual partners (including the prostitution) and asymptomatic STD increased. Finally, the strategies for STD control are discussed in detail.

China↗
PubMed1997

Establishing a link between cultural evolution and sexually transmitted diseases.

It is argued that archaic sexually transmitted diseases influenced cultural traditions by reducing multiple sexual partners within communities. In this article, the adverse consequences of current sexually transmitted diseases are surveyed: Such infections decrease fertility of women and increase infant mortality; those adverse consequences are especially potent when antibiotics are not readily available. Cultural (cross-generational transmission of learned) responses to the threat of widespread infertility and elevated infant mortality rates are hypothesized to include the implementation of expectations for restricted numbers of sexual partners. These expectations, formal or informal, have been instituted within the context of biological predispositions, the "certainty of paternity" model, already-established traditions, and the need for a social father to be aligned with the mother-child dyad. A case study of the contemporary United States is offered as a heuristic example of how and why cultural choices may be developed and sustained.

Cultural Evolution↗
PubMed1997

The efficacy of the health belief model for predicting condom usage and risky sexual practices in university students.

This investigation examined the ability of the health belief model (HBM) to predict condom usage and risky sexual practices in 122 white heterosexual college students (ages 17 to 33 years). The HBM did not significantly explain condom usage in the 58 men and 64 women surveyed; rather it partially explained the variance in sexual risk behaviors. Results were not consistent for men and women. The HBM components significantly explained 18% of the variance in multiple sexual partnerships in men and 22% of the variance in this behavior in women. The HBM constructs also explained 9% of the variance in the likelihood of women being intoxicated or high during sex and 18% of the variance in the number of sexual risk behaviors endorsed by women. These findings suggest that the HBM has differential and limited utility for predicting sexual practices in university students. Future research is needed to examine more comprehensive models of behavior change.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Management of hepatitis C.

OBJECTIVE: To provide health care providers, patients, and the general public with a responsible assessment of current available methods to diagnose, treat, and manage hepatitis C. PARTICIPANTS: A non-Federal, nonadvocate, 12-member panel representing the fields of general internal medicine, hepatology, gastroenterology, infectious diseases, medical ethics, transfusion medicine, epidemiology, biostatistics, and the public. In addition, 25 experts from these same fields presented data to the panel and a conference audience of 1,600. EVIDENCE: The literature was searched through Medline and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. CONSENSUS PROCESS: The panel members, answering predefined questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. CONCLUSIONS: Hepatitis C is a common infection with a variable course that can lead to chronic hepatitis, cirrhosis, and hepatocellular carcinoma. The course of illness may be adversely affected by various factors, especially alcohol consumption. Therefore, more than one drink per day is strongly discouraged in patients with hepatitis C, and abstinence from alcohol is recommended. Initial therapy with interferon alfa (or equivalent) should be 3 million units three times per week for 12 months. Patients not responding to therapy after 3 months should not receive further treatment with interferon alone, but should be considered for combination therapy of interferon and ribavirin or for enrollment in investigational studies. Individuals infected with the hepatitis C virus should not donate blood, organs, tissues, or semen. Safe sexual practices, including the use of latex condoms, is strongly encouraged for individuals with multiple sexual partners. Expansion of needle exchange programs should be considered in an effort to reduce the rate of transmission of hepatitis C among injection drug users.

Acute Disease↗
PubMed1997

Why do we continue to take unnecessary smears?

A questionnaire survey of all general practices and family planning doctors in Manchester Health Authority was undertaken to determine why many more smears are taken in primary care than are scheduled by the screening programme. An 82% response rate was obtained. The indications for additional smear tests most frequently cited by responders were postcoital (88%), postmenopausal (84%), or intermenstrual bleeding (55%); genital warts (87%); and multiple sexual partners (52%). Forty-six per cent think that a woman should have a repeat test within one year of her first ever test. We discuss why these are not valid indications for additional smear tests.

England↗
PubMed1998

Factors related to condom use among four groups of female sex workers in Bali, Indonesia.

This article tests a behavioral model of condom use for four groups of female commercial sex workers. Data were drawn from a study of 614 female sex workers conducted in Bali, Indonesia. AIDS knowledge, risk behaviors, and factors related to condom use varied substantially among the four groups of women and reflect the social context of their work. Interventions for each group need to reflect these differences. Important factors to consider include the level of AIDS and STD knowledge in their environment, the characteristics of the clients served, and the degree of supervision that they receive.

Acquired Immunodeficiency Syndrome↗
PubMed1997

HIV seroconversion among factory workers in Harare: who is getting newly infected?

OBJECTIVE: Zimbabwe, like other countries in sub-Saharan Africa, is experiencing a rapidly growing HIV/AIDS epidemic. It is crucial to determine risk events and socio-demographic characteristics associated with incident infections in order to tailor prevention messages accordingly. A cohort was established among factory workers with the objectives of estimating HIV incidence, seroprevalence, correlates of infection and subsequently evaluating the impact of prevention interventions. SETTING: 40 factories in Harare, Zimbabwe. DESIGN AND METHODS: HIV seroindicence [total new infections over person time (years) follow up] was estimated in a longitudinal cohort of male factory workers before and during a randomised peer education intervention. Correlates of seroconversion were identified using Cox regression analysis. RESULTS: Of 2,992 subjects enrolled there were 129 seroconversions during 1993 to 1996 follow up, yielding a 2.96 per 100 person year (PY) seroconversion incidence (95% CI = 2.47 to 3.52). Reporting a genital ulcer during follow up (Hazard ratio [HR] = 4.9, p = 0.001) having multiple sexual partners (HR = 1.9, p = 0.04), having a urethral discharge (HR = 2.1, p = 0.001), being single (HR = 2.3, p = 0.001), widowed or married but not residing with wife were independent factors significantly associated with risk of HIV seroconversion. CONCLUSIONS: Incidence of HIV identified in this economically productive sector is unacceptably high, and, disturbingly, is increasing in some age groups. Although the impact of the present intervention remains to be evaluated, the high incidence of HIV infection, points to the need for a more aggressive prevention effort in the general population.

Adult↗
PubMed1996

Clinical pattern of human immunodeficiency virus infection (HIV) in pulmonary tuberculosis patients in Jos, Nigeria.

A study of determine the seroprevalence rate and clinical presentation of HIV-associated pulmonary tuberculosis was carried out in Jos between October 1990 and September 1991. Out of the 180 newly diagnosed pulmonary tuberculosis patients, 11(6.1%) were confirmed seropositive for HIV-1 and 2. The peak age range for both tuberculosis and HIV infection in both sexes is 20-40 years. The risk of HIV infection was associated with multiple sex partners and blood transfusion. There was no significant difference in the clinical presentation of pulmonary tuberculosis between HIV-seropositive and seronegative patients (P > 0.1). However, diarrhoea, lymphadenopathy and marked weight loss were found to be significantly associated with HIV infection (P < 0.05). The mean lymphocyte count of HIV seropositives was significantly lower than seronegatives (P < 0.01).

Adolescent↗
PubMed1997

[The problem of hepatitis C virus infection in blood donors. Clinico-epidemiological, virological and histological evaluation].

Our aim was to identify prospectively, with a case-control survey, risk factors for hepatitis C virus (HCV) infection in volunteer blood donors and to assess the histological features and their correlation with transaminase (ALT) level and viremia. In a Liver Unit of a referral-based University Hospital, 248 blood donors were evaluated for risk factors, according to definitive ELISA test and 132 were considered true positive. Of these, 132 anti-HCV(+) blood donors were age and sex-matched with the anti-HCV-negative group (n = 116). There was a high frequency in the anti-HCV(+) group of intravenous drug abuse (IVDA) (22%), history of major surgery (20.4%), tattooing (12.1%), non IVDA (17.4%), and multiple sexual partners or history of sexual transmitted diseases (25.7%). At least one risk factor was identified in 76.52% of the antiHCV(+) donors vs 34.4% in the anti-HCV (-) group (p = 0.000). A total of 71 patients accepted a liver biopsy; chronic liver disease was present in 85.9% (n = 61) (mean Knodell score 6.75). ALT was elevated in 69% (n = 49) and HCV RNA was detectable in 76% of patients. It can be concluded that in our study 76.5% of anti HCV positive blood donors showed at least one risk factor for HCV infection detected by a second highly efficient interview. Twenty two percent admitted to prior intravenous drug use although this disqualifies them for blood donation, but was not identified by the screening process. Most blood donors with anti HCV(+) had chronic hepatitis C regardless of their serum ALT levels. Normal ALT did not exclude liver disease.

Adolescent↗
PubMed1998

Trends in sexual risk behaviors among high school students--United States, 1991-1997.

Each year, approximately three million cases of sexually transmitted diseases (STDs) occur among teenagers, and approximately one million become pregnant. Human immunodeficiency virus (HIV) infection is the sixth leading cause of death among persons aged 15-24 years in the United States. Unprotected sexual intercourse and multiple sex partners place young persons at risk for HIV infection, other STDs, and pregnancy. To determine trends in sexual risk behaviors among high school students, CDC analyzed data from the Youth Risk Behavior Survey (YRBS) for the years 1991, 1993, 1995, and 1997. This report summarizes the results of this analysis, which indicate that, from 1991 to 1997, the percentage of U.S. high school students who had ever had sexual intercourse decreased, and the prevalence of condom use among currently sexually active students increased.

Adolescent↗
PubMed1998

Cervical cancer awareness and risk factors among female university students.

Population cervical screening programmes are necessary for meaningfully reducing cervical cancer morbidity and mortality. Because of the high incidence of cervical cancer in South Africa, the need for a national screening programme has become evident. The success of such a programme will depend on, among others, the level of cervical cancer awareness among the target population, and their willingness to utilise cytological services and to comply with treatment and follow up protocols. We conducted a survey among female university students, as an elite group of women, to determine their level of cervical cancer awareness and the prevalence of the major risk factors for cervical cancer among them, their rate of utilisation of existing Pap smear services, and their attitudes to Pap smears in general. The majority of respondents were young, single (93.0%) and sexually active (86.9%,) having initiated sexual activity at a mean age of 17.27 +/- 2.18 years. There was a high prevalence of the major risk factors for cervical cancer among the respondents, and these included initiation of coitus before 18 years (53.3%), multiple sexual partners (73.6%), male partner with other partners (37.7%), and previous history of sexually transmitted diseases (42.2%) and vulval warts (4.7%). Their overall knowledge of cervical cancer was poor, although the majority of respondents were able to identify the major risk factors from a given list. This level of awareness of cervical cancer risk factors, however, did not translate into appreciation of personal risk of cervical cancer, safer sex practices or utilisation of Pap smear services. In conclusion, this elite group of women is at a high risk of cervical cancer and would benefit from cervical screening programmes. This would have to be coupled with measures to increase the level of awareness and knowledge of cervical cancer and its prevention.

Adolescent↗
PubMed1998

HIV-related attitudes and risk behavior of young adolescent mothers.

This article reports on the prevalence of HIV-related risk behaviors among young adolescent mothers. To determine the facilitators and barriers to condom use for young adolescent mothers, a survey of HIV-related knowledge, attitudes and behavior and focus groups was conducted. Young mothers (N = 58) have basic knowledge and some personal concern about HIV, but also hold common misconceptions about HIV and people with AIDS. Despite their anxiety about HIV, almost half rarely or never protect themselves against HIV by using a condom. Although 70% of the sample use hormonal contraceptives, more than one third of the sample have had a second child within an average of 18 months after the birth of their first baby. Personal concern about HIV was significantly associated with consistency of condom use. Because of low rates of condom use and substantial rates of multiple sex partners, STDs and second pregnancies, disadvantaged adolescent mothers are at risk of exposure to HIV. Increased personalized concern for HIV may lead to greater motivations for safer behavior for these mothers. In addition to protecting their own safety, the protection of their child may be an important motivator for safe behavior. Cultural taboos against safe sex and the perception of such behavior as "unfeminine" also need to be addressed for these women.

Adolescent↗
PubMed1998

Integration of palliative care with alternative medicine in patients who have refused curative cancer therapy: a report of two cases.

This article describes two young, potentially curable patients who chose a course of treatment that ultimately resulted in death. Their choice was in part influenced by the prospect of the disfiguring surgery that would have been required for cure. In the first patient this would have meant massive head and neck surgery, in the second, a radical hysterectomy that would have resulted in surgical menopause. The availability of practitioners who promised an easier cure was also a factor in swaying the first patient away from truly curative therapy. Denial also played a role in both of these patients' decisions. Part of their denial may have been exacerbated by the fact that both of their cancers have as risk factors behaviors that the patients may have considered inconsistent with their value system. In the first type of cancer, alcohol and chewing tobacco are major risk factors (11), neither of which would have been acceptable to the patient's family. In the second type, multiple sexual partners are a major risk for cervical cancer (12), a behavior which is inconsistent with the teachings of the patient's fundamentalist Christian beliefs. The approach that we have described--expressions of respect for the patient's belief system combined with the nonconfrontational offering of treatments with immediate symptomatic benefit--resulted in the development of an effective working relationship between patient, family, and palliative care team.

Adult↗