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PubMed1996

[HIV infection in pregnant women in Dakar (Senegal)].

The epidemiologic and sociodemographic characteristics of human deficiency virus (HIV) infection vary from one country to another. The objective of this study was to determine the prevalence of HIV infection in pregnant women in Dakar and associated factors. Systematic anonymous screening was performed in pregnant women admitted to the maternity ward. Women whose seropositivity was confirmed by Western blot retroviral serology were included. One woman out of four was assigned by simple random selection to the case control group. Over a 24 month period, 12,498 women were tested. 104 were seropositive (44 HIV1, 58HIV2, and 2 HIV1-HIV2 giving a prevalence of 0.8%. Factors associated with HIV1 and HIV2 were different: mean age 21.7 years for HIV1 versus 30.6 for HIV 2 (p = 0.05); origin in Guinea-Bissau for HIV2 (p = 0.001); mean number of pregnancies 2.6 for HIV1 versus 5.9 for HIV2 (p = 0.001); mean parity 1.5 for HIV1 versus 4.5 for HIV2 (p < 0.01); vitality of the conception product in 85.1% for HIV2 versus 67.5% for HIV1 (p = 0.0001). These data confirm the low prevalence of HIV infection in pregnant women, with a predominance for HIV2. The factors identified in associated with virus type suggest a different mode of transmission and/or reduced virulence or HIV2 compared with HIV1. Knowledge of these factors helps orient management strategies, especially in pregnant women.

Adolescent↗
PubMed1998

Secrecy, anonymity, and deception in donor insemination: a genetic, psycho-social and ethical critique.

The number of medically assisted conceptions involving donors is increasing. At the same time, due to advances in medicine, greater emphasis has been placed on an individual's genetic origins. This trend places individuals who have no access to information on their genetic origins in a vulnerable position. Because of the secrecy and anonymity that has surrounded donor inseminations, many individuals who were so conceived are irreversibly cut off from any possible contact with or even knowledge about their genetic fathers, who will also never have the opportunity to meet their offspring. In view of the accumulated evidence concerning the detrimental effect of secrecy, anonymity and deception in donor insemination, this paper argues that these practices are not only psychologically and socially harmful but also ethically unacceptable.

Choice Behavior↗
PubMed1988

Alcoholics remaining anonymous: resident diagnosis of alcoholism in a family practice center.

Family practice residents rarely detect more than one half of the alcoholic patients they see. This study examines detection rates in terms of the patient's presenting complaint, the clinical encounter, and the resident's attitudes. Over four months 218 patients of the family practice center of a large community hospital completed a survey that included the Short Michigan Alcoholism Screening Test (SMAST). Chart audits of each patient's visit assessed each resident's behavior in recording questions about the patient's use of alcohol. After the first four months, each resident completed a survey of his or her experiences and attitudes concerning alcoholism. Using the SMAST scores and chart audits, 25 of the 218 patients were identified as alcoholic. The residents detected only 12 of the 25 alcoholics. Of 51 patients who presented for physical examinations, the residents recorded asking only 28 about their drinking; of 157 patients who presented for more limited visits, the residents recorded asking only six about their drinking. Residents rated the alcoholic patient as less motivated, more dangerous, less hopeful, and much sicker than the average person. First-year residents rated alcoholics much more negatively than did upper-level residents. The SMAST again proved to be much more effective than clinical interviews in detecting alcoholism in patients.

Adult↗
PubMed2000

The allele frequency of mutations in four genes that confer enhanced susceptibility to venous thromboembolism in an unselected group of New York State newborns.

The frequencies of Factor V G1691A (FVL), prothrombin (PT) G20210A, 5'10'methylenetetrahydrofolate reductase (MTHFR) C677T, and methionine synthase (MS) A2756G (four mutations associated with an increased risk of venous thromboembolism [VTE]) were determined in a sample of approximately 1500 New York State residents. Dried blood spots from approximately equal numbers of Caucasians, African-Americans and Hispanics were anonymously obtained from the New York State Department of Health Newborn Screening Program. Following PCR amplification of dried blood spot DNA, allele-specific oligonucleotide hybridization was used to detect mutant alleles. The total number of individuals at increased genetic risk for VTE was 271 (17.5%) of the 1553 persons tested. Increased genetic risk was defined as the heterozygous state for FVL or PT and the homozygous state for the MTHFR or MS polymorphisms. Sixteen individuals had more than one genetic risk factor. The MS gene variant allele frequencies for African-Americans and Hispanics are the first to be reported. This report also provides an estimate of the variant PT allele in the largest group of Hispanics studied to date.

5-Methyltetrahydrofolate-Homocysteine S-Methyltran↗
PubMedDate not supplied

Analysis of 2000 consecutive UK tonsillectomy specimens for disease-related prion protein.

Variant Creutzfeldt-Jakob disease (CJD) is thought to be caused by dietary or other exposure to bovine spongiform encephalopathy (BSE) prions. The prevalence of preclinical or subclinical prion infection in the UK is currently unknown. Since clinical variant CJD is uniformly associated with tonsillar prion infection, we screened 2000 anonymous surgical tonsillectomy specimens for disease-associated prion protein. Analysis by both high sensitivity immunoblotting and immunohistochemistry detected no positive cases. However, this negative result cannot provide reassurance that relevant community infection is unlikely because of the fairly small sample size, demographic and age-related factors, and unknown test sensitivity during the prolonged incubation period. Nevertheless, our findings establish a protocol for prevalence screening on a national scale.

Animals↗
PubMed2004

Mate Aaraikore A Muri Ake Nei: experiences of Maori New Zealanders living with HIV.

BACKGROUND: This paper is drawn from the first comprehensive study in New Zealand of the health and social experiences of HIV positive people and specifically addresses the experiences of HIV positive Maori. METHODS: A total of 226 HIV positive men and women completed an anonymous, self-administered HIV Futures New Zealand questionnaire. Twenty-five Maori completed the survey (17 male, 7 female, 1 transgendered). The majority identified as takataapui (Maori and homosexual) five were heterosexual women, and four identified with other sexualities. RESULTS: Seven respondents indicated that they had received pre-test counselling, and 18 that they had received post-test counselling. The mean CD4 count at most recent test was 462.4 cells/microL. The mean HIV viral load result at most recent test was 558.1 copies/mL. Two-thirds of respondents were currently using antiretroviral treatments, and half had taken a break from them. The most commonly cited source of social support was their doctor. Eight respondents were in full-time work; most received benefits or a pension as their main income source; five were living below the poverty line. Only two respondents did not personally know another person with HIV. All had disclosed their status to someone; fifteen said that unwanted disclosure had occurred. Eight reported experiencing discrimination concerning accommodation, nine in a medical setting and seven in relation to employment. CONCLUSIONS: Maori people in New Zealand have access to a comprehensive health care system, nonetheless it is of concern that a number report discrimination and unwanted disclosure of their HIV status, most particularly within health care settings.

Adult↗
PubMed2003

Truth and consequences: using the bogus pipeline to examine sex differences in self-reported sexuality.

Men report more permissive sexual attitudes and behavior than do women. This experiment tested whether these differences might result from false accommodation to gender norms (distorted reporting consistent with gender stereotypes). Participants completed questionnaires under three conditions. Sex differences in self-reported sexual behavior were negligible in a bogus pipeline condition in which participants believed lying could be detected, moderate in an anonymous condition, and greatest in an exposure threat condition in which the experimenter could potentially view participants responses. This pattern was clearest for behaviors considered less acceptable for women than men (e.g., masturbation, exposure to hardcore & softcore erotica). Results suggest that some sex differences in self-reported sexual behavior reflect responses influenced by normative expectations for men and women.

Adolescent↗
PubMed1999

Prevalence of hepatitis C in prisons: WASH-C surveillance linked to self-reported risk behaviours.

We used cross-sectional willing anonymous salivary hepatitis C (WASH-C) surveillance linked to self-completed risk-factor questionnaires to estimate the prevalence of salivary hepatitis C antibodies (HepCAbS) in five Scottish prisons from 1994 to 1996. Of 2121 available inmates, 1864 (88%) participated and 1532/1864 (82%) stored samples were suitable for testing. Overall 311/1532 (20.3%, prevalence 95% CI 18.3-22.3%) were HepCAbS-positive: 265/536 (49%, 95% CI 45-54%) injector-inmates but only 27/899 (3%, 95% CI 2-4%) non-injector-inmates. Among injectors, HepCAbS positivity was only slightly higher (p = 0.03) in those who had injected inside prison (53%, 162/305) than in those who had not (44%, 98/224). Those who began injecting in 1992-96 were much less likely to be HepCAbS-positive than those who started pre-1992 (31%, 35/114 vs. 55%, 230/422; p < 0.001). Even with injectors who began in 1992-96 but had never injected inside prison, the prevalence of hepatitis C carriage was 17/63 (95% CI 16-38%). The prevalence and potential transmissibility of hepatitis C in injector-inmates are both high. Promoting 'off injecting' before 'off drugs' (both inside and outside prison), methadone prescription during short incarcerations, alternatives to prison, and support of HepCAbS-positive inmates in becoming eligible for treatment, all warrant urgent consideration.

Adult↗
PubMed1992

Prevalence of hepatitis B surface antigen, hepatitis C antibody, and HIV-1 antibody among residents of a long-term-care facility.

OBJECTIVE: To determine the prevalence of hepatitis B antigen (HBsAg), antibody to hepatitis C virus (anti-HCV), and antibody to human immunodeficiency virus (anti-HIV) among residents of a long-term care facility. DESIGN: Anonymous unlinked serosurvey. SETTING: Accredited university-affiliated long-term-care facility in Toronto with 300 chronic-care hospital patients, 350 nursing home residents, and 200 residents of a senior citizens' apartment complex. INTERVENTIONS: Sera from left-over blood samples obtained from residents in November 1990 were tested for HBsAg, anti-HCV, and anti-HIV using standard methods. RESULTS: A total of 508 sera were tested. The number (%) positive for HBsAg, anti-HCV, and anti-HIV, respectively were: 3(0.6%), 7(1.4%), and 0(0%). CONCLUSIONS: This is the first report defining rates of infection with bloodborne infective agents among residents of a long-term care facility. These results support the use of hepatitis B vaccine for medical and nursing staff and the implementation of universal precautions in long-term care facilities.

Aged↗
PubMed2006

Variations in clinical decision-making between cardiologists and cardiac surgeons; a case for management by multidisciplinary teams?

OBJECTIVE: To assess variations in decisions to revascularise patients with coronary heart disease between general cardiologists, interventional cardiologists and cardiac surgeons DESIGN: Six cases of coronary heart disease were presented at an open meeting in a standard format including clinical details which might influence the decision to revascularise. Clinicians (n = 53) were then asked to vote using an anonymous electronic system for one of 5 treatment options: medical, surgical (CABG), percutaneous coronary intervention (PCI) or initially medical proceeding to revascularisation if symptoms dictated. Each case was then discussed in an open forum following which clinicians were asked to revote. Differences in treatment preference were compared by chi squared test and agreement between groups and between voting rounds compared using Kappa. RESULTS: Surgeons were more likely to choose surgery as a form of treatment (p = 0.034) while interventional cardiologists were more likely to choose PCI (p = 0.056). There were no significant differences between non-interventional and interventional cardiologists (p = 0.13) in their choice of treatment. There was poor agreement between all clinicians in the first round of voting (Kappa 0.26) but this improved to a moderate level of agreement after open discussion for the second vote (Kappa 0.44). The level of agreement among surgeons (0.15) was less than that for cardiologists (0.34) in Round 1, but was similar in Round 2 (0.45 and 0.45 respectively). CONCLUSION: In this case series, there was poor agreement between cardiac clinical specialists in the choice of treatment offered to patients. Open discussion appeared to improve agreement. These results would support the need for decisions to revascularise to be made by a multidisciplinary panel.

Cardiology↗
PubMed1988

Use of the personal orientation inventory with disabled athletes.

Athletes who are blind or have impairments in hand-eye coordination that prevent writing are unable to complete psychological inventories in the standardized manner, i.e., read silently and answered independently and anonymously. Two studies were conducted on the oral administration of the Personal Orientation Inventory as a measure of self-actualization of disabled athletes. Reliabilities were examined across modalities (oral vs written) by administering the inventory both ways to 25 high school and college athletes, M age = 21.6 yr. Test-retest reliability for oral administration was affirmed in a study of 15 blind elite male athletes and 15 cerebral palsied elite male and female athletes. It was concluded that the inventory, administered orally, may be appropriately used with disabled athletes.

Adolescent↗
PubMed2004

Physician attitudes regarding bacille Calmette-Guérin vaccination and treatment of latent tuberculosis infection.

OBJECTIVE: To investigate the attitudes of international medical graduates (IMGs) about treatment of latent tuberculosis infection (LTBI). DESIGN: Anonymous survey among physicians in training, all IMGs from TB endemic countries. Attitudes were assessed through hypothetical scenarios regarding the protective effect of BCG and LTBI treatment. RESULTS: Of 77 participants, 72.4% were male, the mean age was 31.4 years, and mean years post-graduation 8. Positive tuberculin skin tests (TSTs) were reported among 64.0%, and 89.6% had received BCG vaccine. Over a quarter of IMGs (27.4%) believed that BCG protects for many years. Only 59.2% believed that LTBI treatment was effective and 16% that the risks of treatment were greater than the benefits. Most would treat BCG-vaccinated patients with positive TST in various scenarios (63-94.7%), with less agreement about treating themselves (49.3%) or their family members (54.2%). For recent converters, more than 80% would recommend LTBI treatment. Over half felt that LTBI treatment should be mandatory for new immigrants with positive TST. CONCLUSIONS: IMGs are cautious about LTBI treatment except for recent converters. They are less likely to treat themselves and family members than others. Educational efforts should address discrepancies between these physicians' attitudes and current guidelines for treating LTBI in the US.

Adult↗
PubMed2006

Screening practices of patients presenting for resection of a colorectal neoplasm.

Multiple studies demonstrate the efficacy of colorectal cancer (CRC) screening in patients over 50 years of age. However, there is a lack of consensus regarding which screening method to use, and compliance has been poor. The objective of this study was to identify the CRC screening practices at two institutions and determine the relationship between screening and pathologic stage for patients presenting with a colorectal neoplasm. This study, conducted at the University of Virginia (UVA) Health System and the Salem Veterans Affairs Medical Center (VAMC) between October 30, 2000, and September 1, 2004, included 198 patients > or = 50 years who presented for resection of a primary colorectal neoplasm. Pathologic stage and prior screening were identified retrospectively through chart review and patient response to an anonymous survey. Prior screening was demonstrated in 71 per cent of patients. Colonoscopy was the most commonly used modality. There was a higher percentage of CRC screening at VAMC compared with UVA (80% vs 62%, P < 0.0008). Patients at UVA were more likely screened with colonoscopy, whereas fecal occult blood testing (FOBT) was most common at VAMC (P < 0.0001). Prior CRC screening and cancer stage were inversely related. Ninety-one per cent of patients with benign polyps had been screened prior to diagnosis, compared with 72 per cent of patients with stage I and II cancer and 54 per cent of patients with stage III and IV cancer (P < 0.05). Of patients presenting for surgery, 71 per cent underwent CRC screening. Variability exists in the methods employed for CRC screening. CRC screening facilitates diagnosis at an early stage.

Aged↗
PubMed1989

HIV screening and counseling for intravenous drug abuse patients. Staff and patient attitudes.

At least one third of patients enrolled in a methadone maintenance treatment program are willing to comply voluntarily with screening for and counseling about human immunodeficiency virus (HIV). A questionnaire about knowledge, attitudes, and behavior concerning acquired immunodeficiency syndrome was answered anonymously by 79% (46) of the clinical staff and 67% (868) of the enrolled patients. On their own initiative, 21% of the patients had already received voluntary anonymous HIV screening and brief counseling, seldom discussing the result with the staff. Approximately 90% of the staff and a majority of the patients (72%) thought a voluntary HIV screening program should be offered to all patients. Almost all staff (98%), but only 50% of the patients, felt the HIV test results should be known to physicians, nurses, and counselors at the clinic. Few staff members (15%) believed that patients had changed their sex behavior; more (48%) felt that needle sharing was reduced. Patients believed methadone patients in general had changed their sex behavior (49.2%) and reduced needle sharing (62%) to prevent becoming infected. Patients reported statistically significant reductions both in number of sex partners and in personal needle sharing during the past year.

Adult↗
PubMed1996

[Surveillance of the HIV-epidemic in Norway].

Surveillance of HIV infection and AIDS is still a cornerstone in the efforts to prevent spread of HIV in Norway. The surveillance system aims at measuring the incidence and prevalence of HIV infection in the country. We describe the development of the surveillance from 1983 until 1996 based on the National Notification System for Infectious Diseases. New cases of HIV infection are reported anonymously but cases of AIDS are reported with name. Key information on each case includes age, gender, residence and the most likely time, place and route of transmission. The notification system is supplemented by screening of pregnant women, military recruits and blood donors, and by surveys of the number of tests performed, and other information. The information is analysed regularly, interpreted and communicated to the health services and the public.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Linkage analysis in juvenile neuronal ceroid lipofuscinosis.

Neuronal ceroid lipofuscinosis (NCL, Batten disease) is an autosomal recessive disease characterized by progressive mental retardation, cortical atrophy, seizures, and retinal degeneration. Several subtypes have been delineated on the basis of age-at-onset and histological characteristics; the most common is the juvenile (JNCL) form. Recently, the gene for JNCL was shown to reside on chromosome 16 through linkage studies to the haptoglobin locus and anonymous DNA markers using numerous European families. We have now examined 8 families from North America with JNCL for linkage to markers in 16q21-23. Results in 3 families tend to support linkage to chromosome 16;3 families remained uninformative, and 2 families produced negative lod scores in this region. A test of homogeneity was suggestive, but could not significantly reject the null hypothesis of homogeneity. We are continuing to collect families, particularly those with multiple living affecteds, and are identifying other probes in this region. Given close localization on chromosome 16 for JNCL, molecular strategies, including candidate gene strategies, are being explored.

Child↗
PubMed1994

A linkage study of distal chromosome 5q and bipolar disorder.

There are well-established abnormalities of hypothalamic-pituitary-adrenal (HPA) axis and beta 2 adrenergic receptor function in affective disorders. The genes for the glucocorticoid receptor (GRL) and the beta 2 adrenergic receptor (ADRB2) have been cloned and mapped to distal chromosome 5q. In this study, we have examined polymorphisms of these two candidate genes and other nearby markers for linkage to bipolar disorder in Amish pedigree 110 and three large Icelandic pedigrees. These loci were tested for linkage in two-point and multipoint analyses using a model of autosomal dominant transmission with age-dependent reduced penetrance. Two-point analyses revealed a maximum LOD score of 1.14 at theta = 0.20 from GRL. Linkage could be excluded to ADRB2, as well as to three nearby anonymous markers, D5S207, D5S70, and D5S119. Analyses of another anonymous marker, D5S36, were inconclusive. Multipoint analyses excluded linkage to a 55 cM region including the interval between D5S207 and D5S36 and flanking regions, with the exception of a 7 cM interval between GRL and ADRB2. Despite the intriguing positive LOD score obtained with GRL, linkage to bipolar disorder could not be demonstrated in the region examined.

Adolescent↗
PubMed2005

Symptoms of post-traumatic stress disorder among emergency medicine residents.

There have been anecdotal reports of post-traumatic stress disorder (PTSD) in physicians responding to mass casualty events. No formal, prospective study has addressed the presence of PTSD symptoms as a result of the work of Emergency Medicine residents in non-mass casualty settings. The purpose of this study is to evaluate the presence of symptoms of PTSD among Emergency Medicine residents (EMR). The study was a survey of EMR, administered in an anonymous, voluntary format in late June 2001. The survey was conducted at an Emergency Medicine residency program that serves a large, urban, county hospital. Four groups, incoming interns and three EM resident classes were surveyed. PTSD symptoms were divided into three categories according to the DSM IV. The Jonckheere-Terpstra test for trends was applied to each of the three categories of symptoms. Sixty-three surveys were administered, with a 93.6% response rate. All respondents reported experience with patient death or dying. Seven residents reported sufficient symptoms to meet the DSM IV criteria for PTSD. Each of the three symptom categories showed a statistically significant increase in the proportion of positive responses as the resident time in training increased (p < 0.01). In conclusion, many EM residents reported symptoms of PTSD. Symptoms of PTSD significantly increased as resident level of training increased.

Emergency Medicine↗