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PubMed1998

[Current epidemiology of vulvar cancer].

Cancer of the vulva is a rare disease accounting for only 3 to 5% of all gynaecologic cancers. The incidence rates of this cancer vary depending upon the country considered, the lowest rates being reported for Asian and African populations. An increased incidence of in situ carcinomas of the vulva has been noted recently among young women. In this population, the risk factors are: a young age at first sexual intercourse, multiple sexual partners, a low socio-cultural level, previous infection by human papilloma virus (HPV) and smoking. An association has also been found with other types of cancers, either in relation with HPV-infection or with tobacco use. In contrast, older women are usually diagnosed with advanced-stage, squamous or keratinous invasive forms of the disease with no clear link with either smoking experience or previous HPV-infection.

Female↗

PubMed1996

Heterosexual experiences and partnerships of urban, low-income African-American and Hispanic youth.

We have used data from a probability sample of African-American and Hispanic youth living in low-income urban household to describe their heterosexual experiences and the influence of relationships with different kinds of sexual partners (married/lived with, well known, casual) on types of intercourse (oral, anal, vaginal), condom use, and use of other birth control methods. The Generalized Estimating Equation method for data sets with multiple observations on the same subject was used to examine whether an individual's behavior differs with different kinds of partners and how behavior with a given partner is affected by experience with other relationships. Results indicate that (a) with the exception of African-American men, sexual and contraceptive behavior varied considerably with different kinds of partners; (b) heterosexual oral and anal intercourse is more common among Hispanic than African- American youth; and (c) regardless of experience with other relationships, consistent condom use as well as use of any type of contraceptive method tend to be less likely with a casual sex partner. Data regarding percentages of consistent condom use (20%-45%) and increased involvement in risky behavior associated with multiple partners further emphasize the need for interventions that enhance condom use and discourage involvement with multiple partners.

Adolescent↗

PubMed2003

Continuation of caregiving among partners who give total care to spouses with multiple sclerosis.

As is expressed in the term 'caregiving career', caregiving is a dynamic phenomenon. The present study addresses the total care phase in which spouses give direct and ongoing personal care to their partners with multiple sclerosis (MS). The dyadic nature of caregiving is stressed by examining the roles which both spouses play in establishing a commitment that results in the continuation of caregiving. For this purpose, 17 couples facing MS were selected in the Netherlands and Belgium. Ten females and seven males were disabled, and all were living with partners who provided a full range of care. Both partners were interviewed separately about their motivation to give care, dependency on help, the continuation of caregiving and their relationship. The analysis consisted of fragmenting and connecting the data, and involved close reading and constant comparison. The present findings support those previous studies, i.e. that continuation of caregiving is the result of an interchange between the partners. The commitment that is established can be expressed in terms of inevitability, shared misfortune, reciprocity and the desire to prevent admission to a nursing home. Three aspects appear to contribute to the creation of commitment and the ensuing continuation of caregiving: namely, marital loyalty, and the arbitrariness of the disease and its serious nature. For community care, it is important to consider the negotiations between partners and the impact of caregiving on their relationship.

Adult↗

PubMed1998

Post-exposure prophylaxis for HIV infection in gay and bisexual men. Implications for the future of HIV prevention.

OBJECTIVE: To assess the psychological and behavioral characteristics of gay and bisexual men who intend to use antiretroviral post-exposure prophylaxis (PEP) to prevent HIV infection. METHODS: Gay and bisexual men who had not tested HIV seropositive and were not in long-term exclusive sexual relationships (n = 327) completed anonymous surveys consisting of demographic characteristics, gay community acculturation, experience with and attitudes toward PEP, substance use, and sexual behavior in the past 6 months. SETTING: A large annual Gay Pride festival in Atlanta, Georgia. RESULTS: There were 8 (3%) men who had already used PEP and 85 (26%) who planned to use PEP to prevent themselves from becoming HIV infected. Compared to the 242 (74%) men who did not indicate plans to use PEP, those planning to use PEP were younger, less well educated, more likely to have used illicit substances in the past 6 months, and were more likely to have a history of injection drug use. Men intending to use PEP were also more likely to have practiced unprotected anal and oral intercourse as the receptive partner and were more likely to have multiple anal intercourse partners with whom they were receptive. CONCLUSIONS: Gay and bisexual men are generally supportive of the immediate use of PEP and a significant number of men are planning to use PEP, particularly less educated men who use multiple substances and practice the highest-risk sexual behaviors. Concurrent behavioral interventions must, therefore, be considered critical in the advancement of PEP.

Adult↗

PubMedDate not supplied

Cost-benefit analysis of selective screening criteria for Chlamydia trachomatis infection in women attending Colorado family planning clinics.

Women attending family planning clinics in Colorado during 1988 were screened for Chlamydia trachomatis infection by enzyme immunoassay (EIA, Chlamydiazyme, Abbott Laboratories; Abbott Park, IL). Cervical specimens from 11,793 women attending 22 family planning clinics were analyzed. Patient history and physical exams were used to assess risk factors for infection. A total of 913 individuals (7.7%) had positive culture results for C. trachomatis. Multivariate analysis showed that infection was significantly related to endocervical bleeding, cervical mucopurulent discharge, a new sexual partner in the last 3 months or multiple previous sexual partners (greater than 3) in the last year, pregnancy, the use of oral contraceptives, and age. Increased odd ratios were observed for the combination of endocervical bleeding and mucopurulent discharge and sexual history that included partners over the previous year as well as the most recent 3 months. A combination of these criteria was used to selectively screen women attending Colorado family planning clinics on an ongoing basis. A cost-benefit analysis employing a model reported previously showed a significant financial benefit associated with universal screening over either selective screening or no screening for C. trachomatis in this population.

Adolescent↗

PubMedDate not supplied

Sexual behaviour and condom acceptance among Nigerian drivers.

A survey of 180 randomly selected drivers was carried out in June 1994 in Ilorin, Nigeria in order to gain information about high-risk sexual behaviours, to ascertain condom use and to identify obstacles to condom acceptance so as to facilitate the design of an intervention to prevent Sexually Transmitted Diseases/Acquired Immuno-deficiency Disease in this target population. Data was collected through face-to-face interview. Three-quarters of the respondents were married. Multiplicity of sexual partners including casual and commercial contacts, was common. Half of the respondents engaged in high-risk sexual behaviour and a high proportion of them (60 percent) reported unwillingness to use the condom. This was mainly due to general dislike and lack of knowledge of the method. Risk perception was poor. These findings support the need for male reproductive health services especially for this sub-population.

Acquired Immunodeficiency Syndrome↗

PubMed2006

Intimate partner violence: new directions.

This review examines multiple forms of intimate partner violence, including women's use of violence, and argues for development of more complex conceptualizations of intimate partner violence. As new victims are identified, partner violence has been reconceptualized. Research findings indicate that women are both victims and perpetrators in intimate partner violence, challenging previous conceptualizations and explanations. The authors argue that how researchers conceptualize intimate partner violence influences how they study and measure it. The authors call for researchers to develop more complex constructions of gender, and to distinguish between distinct forms of intimate partner violence.

Aggression↗

PubMed2002

Typing of Neisseria gonorrhoeae reveals rapid reinfection in rural South Africa.

A recent study afforded us the opportunity to collect pre- and post-treatment isolates of Neisseria gonorrhoeae from women who supposedly failed to eradicate the organism when tested 8 to 10 days following treatment with a single, directly observed 250-mg dose of ciprofloxacin. In an attempt to differentiate true treatment failure from reinfection, we determined the ciprofloxacin MICs and performed auxotyping, serotyping, and opa typing of the pre- and post-treatment isolates. Paired isolates of N. gonorrhoeae were obtained from seven different women, despite susceptibility of the initial isolates to ciprofloxacin. Six of seven patients were infected with gonococcal isolates that differed significantly from their primary isolate. These most probably represent reinfection with a different strain, which could originate from the same partner infected with multiple strains or reinfected with a new strain or from a different partner. The susceptibility to ciprofloxacin of all isolates makes the possibility of multiple strains in the patient unlikely. The diversity of the isolates within the pairs therefore suggests rapid reinfection within the partnerships.

Adolescent↗

PubMed1990

Using the partner in the psychosocial treatment of schizophrenia: a multiple single case design.

This report describes the treatment of six couples where one partner had a long psychiatric history and a long-standing diagnosis of schizophrenia. Using a multiple single case design, the effects of providing the couples with information about schizophrenia and systematic family management (comprising problem solving and communication training) were assessed. The results showed that providing information alone had no effect on presenting symptoms but did improve the partners' perception of their ability to cope and solve problems. While a causal effect of treatment on improvement was not conclusively proven, the cycle of readmission and relapse was altered.

Adaptation, Psychological↗

PubMed2005

Knowledge, practices and behaviours related to HIV transmission among the Brazilian population in the 15-54 years age group, 2004.

OBJECTIVE: To describe transmission vulnerability for acquiring HIV infection among the Brazilian population aged 15-54 years. DESIGN: A population-based survey. METHODS: Sampling was stratified by geographical region. A total of 6006 interviews were conducted. Indicators of knowledge and sexual practices and the relative sizes of the vulnerable subgroups were estimated. Logistic regression analysis was used to determine the main factors associated with safe sex practices. RESULTS: Regarding knowledge indicators in the age group 15-24 years, a high percentage (91%) spontaneously cited sexual intercourse as a form of HIV transmission, and 62% had correct knowledge of the modes of HIV transmission (five correct items). The proportion of consistent condom use with casual partners was 52%, increasing to 59% in the youngest age group. Higher proportions of inconsistent condom use with any kind of partner were found among women and among the poorest. A multiplicity of sexual partners, low socio-economic status and cocaine use were important predictors of unprotected sex among men living without a companion. Among individuals aged 15-49 years, 0.2% currently inject cocaine, 4.6% of the men paid for sex at least once over the past year and 1.0% of the women were paid in exchange for sex. Among sexually active men of the same age group, 3.5% reported sexual relations with other men. CONCLUSION: Besides the need to establish the role exercised by the vulnerable subgroups in the HIV transmission dynamics, results indicate that it is necessary to investigate unsafe sexual practices further among the poorer sectors of society.

Adolescent↗

PubMed2000

Distress in MEN 2 family members and partners prior to DNA test disclosure. Multiple endocrine neoplasia type 2.

Multiple endocrine neoplasia type 2 (MEN 2) is an autosomal dominant early-onset cancer disorder. In the Netherlands presymptomatic genetic testing for MEN 2 is offered to testees from the age of five years. We report on adults requesting testing for themselves (n=90) and on parents who want an at-risk child to be tested (n=26). Sociodemographic, personality, and attitude characteristics, and levels of psychological distress, were determined for applicants and their partners in the predisclosure phase of testing. These participants showed only mildly increased levels of psychological distress, defined as heightened scores on measures of general and test-related anxiety, and of psychological complaints. Compared with a normal population, high levels of anxiety and health complaints were found in applicants who were younger than 25 years and single, and in persons who generally tended to react to distressful situations with anxiety or depression. These characteristics were particularly evident in young applicants (<25 years). Our study shows that people who feel ambivalent towards DNA testing and who are more vulnerable to psychological distress are more likely to agree to participate in the test as part of a collective application by members of a hereditary cancer family.

Adolescent↗

PubMed2006

An assessment of high risk sexual behaviour and HIV transmission among migrant oil workers in the Niger Delta area of Nigeria.

BACKGROUND: A cross--sectional behavioural survey undertaken amongst migrant oil-workers of an oil exploration outfit operating in the Niger-Delta of Nigeria with the aim of assessing the interplay of migrancy, high-risk sexual behaviour and HIV transmission. METHOD: A total of 300 randomly selected migrant oil workers were assessed using structured questionnaires to evaluate key high - risk sexual behavioral parameters such as multiplicity of sexual partners, bisexuality (closet homosexuality), high grade sexual behaviour and lesbianism. Sampling period was two months with a control cohort of 200. RESULT: The prevalence of high risk sexual behaviour (HRSB) amongst the migrant oil workers was found to be 7.7% while low-risk sexual behaviour (LRSB) was 92.3%. There was no record of HRSB in the control group. We did not also encounter any lesbian sexual orientation in this study. The distribution of HRSB amongst the migrant oil workers showed that the commonest variety was bisexuality (closet homosexuality) with 10(43.5%) followed by high-risk sexual behaviour 7(30.4%), while the least common was multiplicity of sexual partners with 6 (26.1%). Furthermore, majority of these individuals 19 (82.6%) were above the age of 35 years. The index of condom-use and acceptance was high. Here 14 (60.9%) found condom-use convenient while 13 (56.5%) regularly used the condom. CONCLUSION: This study confirms the existence of HRSB among migrant oil workers in the Niger delta. It is therefore advisable to focus interventionist and prevention programmes on this group which appear to be pivotal in the transmission and spread of HIV/AIDS in this environment.

Acquired Immunodeficiency Syndrome↗

PubMed2006

The human CD94 gene encodes multiple, expressible transcripts including a new partner of NKG2A/B.

CD94/NKG2A is an inhibitory receptor expressed by natural killer (NK) cells and a subset of CD8+ T cells. Ligation of CD94/NKG2A by its ligand HLA-E results in tyrosine phosphorylation of the NKG2A immunoreceptor tyrosine-based inhibitory motifs, and recruitment and activation of the SH2 domain-bearing tyrosine phosphatase-1, which in turn suppresses activation signals. The nkg2a gene encodes two isoforms, NKG2A and NKG2B, with the latter lacking the stem region. We identified three new alternative transcripts of the cd94 gene in addition to the originally described canonical CD94Full. One of the transcripts, termed CD94-T4, lacks the portion that encodes the stem region. CD94-T4 associates with both NKG2A and NKG2B, but preferentially associates with the latter. This is probably due to the absence of a stem region in both CD94-T4 and NKG2B. CD94-T4/NKG2B is capable of binding HLA-E and, when expressed in E6-1 Jurkat T cells, inhibits TCR mediated signals, demonstrating that this heterodimer is functional. Coevolution of stemless isoforms of CD94 and NKG2A that preferentially pair with each other to produce a functional heterodimer indicates that this may be more than a serendipitous event. CD94-T4/NKG2B may contribute to the plasticity of the NK immunological synapse by insuring an adequate inhibitory signal.

Alternative Splicing↗

PubMed1997

HIV-seropositive men who engage in high-risk sexual behaviour: psychological characteristics and implications for prevention.

A minority of people who test HIV seropositive continue to engage in sexual behaviour that places their partners at high risk for HIV infection. However, little is known about factors that contribute to sexual risk behaviour among. HIV-seropositive men. In this study, HIV-seropositive men participating in substance abuse support groups and HIV prevention programmes (n = 223) completed measures of demographic characteristics, sexual behaviour history, sensation-seeking (the propensity to seek optimal stimulation), and sexual compulsivity (persistent sexual preoccupations). Twenty-six per cent of the sample reported having recent multiple unprotected sexual intercourse partners. Across support group and prevention programme participants, men with multiple unprotected partners reported greater sexual compulsivity than men with one or no unprotected partners, but groups did not differ in terms of sensation-seeking. Results suggest that intensive therapeutic interventions are needed for a relatively small number of people who may contribute significantly to the HIV epidemic.

Adult↗

PubMed2004

Exploring the association between HIV and violence: young people's experiences with infidelity, violence and forced sex in Dar es Salaam, Tanzania.

CONTEXT: Prior research has shown a strong correlation between HIV infection and a history of intimate partner violence, particularly among young women. However, the role violence plays in the sexual relationships of young people in Sub-Saharan Africa is not well understood. METHODS: Locally trained interviewers conducted semi-structured interviews with 40 young men and 20 young women aged 16-24 who were recruited from public venues in Dar es Salaam, Tanzania. RESULTS: The participants described complex interactions among violence, forced sex and infidelity in their sexual relationships. Men who were violent toward female partners also frequently described forced sex and sexual infidelity in these partnerships. Men with multiple concurrent sexual partners reported becoming violent when their female partners questioned their fidelity, and reported forcing regular partners to have sex when these partners resisted their sexual advances. Youth who felt that violence and forced sex could not be justified under any circumstances were often those who had not yet initiated sexual relationships or who were in monogamous partnerships. CONCLUSIONS: The association between HIV and violence identified among young people in prior research may be partially explained by their experiences with infidelity and forced sex in their intimate partnerships. HIV prevention interventions that fail to take into account the infidelity, violence and forced sex frequently involved in youth's sexual relationships will have a limited impact.

Adolescent↗

PubMed1993

Factors associated with genital chlamydial and gonococcal infection in males.

BACKGROUND: Predictors of chlamydia and gonorrhoea can be used to increase the cost-effectiveness and acceptability of screening programmes, and allow targeting of control strategies. METHOD: All men attending an STD clinic in 1988-1990 were offered screening for chlamydia and gonorrhoea, and the test results correlated with a wide range of potential predictors using multiple logistic regression. RESULTS: Of 9622 attenders, 7992 (82.3%) were tested over a total of 10,110 episodes for chlamydia and 10,090 episodes for gonorrhoea, yielding 729 (7.2%) chlamydial and 123 (1.2%) gonococcal infections. Having urethral discharge and/or dysuria, being heterosexual, and STD contact, unmarried, uncircumcised, tattooed and not having had an STD previously were independently associated with chlamydial infection. Having urethral discharge and/or dysuria, being Aboriginal, an STD contact, homosexual, uncircumcised, tattooed and having sex outside the state in the past three months, no steady partner in the past three months and multiple partners in the past month were associated with urethral gonococcal infection. Selective screening criteria for gonorrhoea provided 90% of positives, eliminated the need for 58% of tests and resulted in an increased yield ratio of 2.2 whereas the corresponding outcomes for screening criteria for chlamydia were 93% 20% and 1.2 respectively. CONCLUSIONS: The widespread influence of confounding on potential predictors for both gonorrhoea and chlamydia may provide misleading indicators of risk factors by univariate analysis. In the setting studied the benefits of selective screening for gonorrhoea in men would be substantial, whereas satisfactory criteria for selective screening for chlamydia could not be identified.

Adult↗

PubMed2002

Influences of partners' views of asthma self-management and family environment on asthmatic adults' asthma quality of life.

Influences of partners' views of the adult asthmatic's self-management and family environment were explored from the perspective of a collaborative care system. Adults (N = 172, 86 couples) completed questionnaires: perceived control of asthma, perceived ability to care for self, asthma quality of life (AQOL), and an asthma opinion survey. Significant relationships between perceptions of adults with asthma (AWA) and partners were found (r ranged from.32 to.74). Multiple regression analysis of partners' perceptions on AWA AQOL yielded a 3-factor solution (R(2) = 39%). Family cohesion had a significant effect on AWA AQOL (F [1, 168] = 4.43, p <or=.04). Clinical implications are discussed.

Adult↗

PubMed1994

Changes in HIV-related information sources, instruction, knowledge, and behaviors among US high school students, 1989 and 1990.

OBJECTIVES: Few data have been available among adolescents to determine behavioral changes that may prevent human immunodeficiency virus (HIV) infection. This analysis examines changes in the prevalence of self-reported HIV-related information sources, instruction, knowledge, and behaviors among high school students in the United States. METHODS: Two independent, multistage national probability samples of students in grades 9 through 12 were surveyed in 1989 (n = 8098) and 1990 (n = 11,631) with self-administered, anonymous questionnaires that included similar items. RESULTS: Compared with students surveyed in 1989, a significantly greater proportion of students surveyed in 1990 had received HIV instruction in school. Significant decreases were found in the proportion of White and female students who reported having had sexual intercourse, in the proportion of White students reporting two or more lifetime sex partners, and in the proportion of 15- and 16-year-olds, White students, and female students who reported having had four or more lifetime sex partners. For both years, students who had a greater level of HIV knowledge were less likely to have had multiple lifetime sex partners or to have injected illicit drugs. CONCLUSIONS: The findings suggest that school-based HIV education and knowledge may be contributing factors in reducing certain risk behaviors that can lead to HIV transmission among secondary school youth.

Acquired Immunodeficiency Syndrome↗