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Comparative behavioral epidemiology of gonococcal and chlamydial infections among patients attending a Baltimore, Maryland, sexually transmitted disease clinic.

Between April 1988 and May 1989, 400 males and 400 females attending a Baltimore, Maryland, sexually transmitted disease clinic were enrolled in a study evaluating and comparing behaviors associated with culture-proven gonococcal or chlamydial infection. The subjects were enrolled consecutively, and were all seen by the same clinician. Among participants of each sex, gonorrhea but not chlamydia was associated with increasing numbers of recent (the past 30 days) sexual partners. Compared with males with neither infection, factors independently associated with increased risk of gonorrhea included age less than 20 years (odds ratio (OR) = 1.93), the presence of genitourinary symptoms (OR = 8.07), and recent exposure to a new sexual partner (OR = 2.78); risk for chlamydial infection in males was associated with genitourinary symptoms (OR = 2.83) and was significantly reduced in those reporting multiple recent (OR = 0.19) or new (OR = 0.07) sexual partners. Among females, age less than 20 years was independently associated with gonococcal (OR = 1.86) and chlamydial (OR = 7.79) infections in comparison with females with neither infection. No other behavioral factors were associated with chlamydial infection for females in this study; however, having a regular sexual partner was associated with significantly elevated risk of gonorrhea (OR = 3.85), while the presence of genital tract symptoms was associated with diminished risk (OR = 0.29) for gonorrhea. These data suggest that there are differences in the behaviors associated with gonorrheal and chlamydial infections and that different strategies may be useful in efforts to control these infections.

Adolescent↗

Using a new HPV detection system in epidemiological research: change of views on cervical dyskaryosis?

UNLABELLED: The prevalence of human papillomavirus (HPV) rises with increasing histological severity of neoplasia, more cigarettes smoked per day and higher lifetime number of sexual partners in women with cervical dyskaryosis. Recently, the highly sensitive SPF10 primers and Inno-LiPA (line probe assay) HPV prototype research assay became available for the detection and typing of HPV. BACKGROUND: using this system, we challenged the previously reported findings. STUDY DESIGN: the study group comprised 304 women referred because of abnormal pap smears in whom a histological diagnosis was made. Data on the lifetime number of sexual partners and smoking behaviour were obtained by questionnaire. HPV analysis was performed on cervical scrapes obtained at the enrollment visit. RESULTS: oncogenic HPV was found in 288 (95%) women. A total of 86 (30%) out of these 288 women disclosed multiple types. HPV 16 occurred significantly less often in multiple infections than was expected on the basis of chance alone. The grade of neoplasia was significantly associated with the presence of oncogenic HPV, and this association depended on the presence of HPV type 16. No association was found between grade of neoplasia and the presence of multiple HPV types. Neither the lifetime number of sexual partners nor smoking were associated with oncogenic HPV, the five most frequent HPV types separately or the presence of multiple types. CONCLUSION: we conclude that the association between the detection of HPV and the epidemiological risk factors, as found with the GP5/6 PCR in the past, could not be confirmed when using SPF10 PCR primers and LiPA HPV genotyping. We suggest that the number of sexual partners and smoking may be determinants of high HPV viral load rather than determinants of the presence of HPV per se.

Cervix Uteri↗

Violence and HIV-related risk among young men who have sex with men.

Limited research has been conducted on threats or violence by family members and sexual partners against young men who have sex with men (MSM). Young MSM, aged 15-22 years, who attended public venues in New York City were enrolled in an anonymous, cross-sectional HIV seroprevalence and risk-behavior study. About two-thirds (68%) of the young MSM reported ever experiencing threats or violence from either family or partners and 25% reported threats or violence by both family and partners. In multivariate analysis, threats or violence by partners was significantly associated with older age, a history of forced sex and a history of running away from home. Recent unprotected anal sex and club drug use were significantly associated with a history of threats or violence by both family and partners. HIV prevention interventions need to include multiple factors that may have an impact on risk, including substance use and abuse, anti-violence and other mental-health issues.

Adolescent↗

Intimate partner violence victimization prior to and during pregnancy among women residing in 26 U.S. states: associations with maternal and neonatal health.

OBJECTIVE: To conduct a population-based assessment of associations of intimate partner violence in the year prior to and during pregnancy with maternal and neonatal morbidity. STUDY DESIGN: Data from women giving birth in 26 U.S. states and participating in the 2000 to 2003 Pregnancy Risk Assessment Monitoring System (n = 118,579) were analyzed. RESULTS: Women reporting intimate partner violence in the year prior to pregnancy were at increased risk for high blood pressure or edema (adjusted odds ratio 1.37-1.40), vaginal bleeding (adjusted odds ratio 1.54-1.66), severe nausea, vomiting or dehydration (adjusted odds ratio 1.48-1.63), kidney infection or urinary tract infection (adjusted odds ratio 1.43-1.55), hospital visits related to such morbidity (adjusted odds ratio 1.45-1.48), and delivery preterm (adjusted odds ratio 1.37), of a low-birthweight infant (adjusted odds ratio 1.17), and an infant requiring intensive care unit care (adjusted odds ratio 1.31-1.33) compared with those not reporting intimate partner violence. Women reporting intimate partner violence during but not prior to pregnancy experienced higher rates of a subset of these concerns. CONCLUSION: Women experiencing intimate partner violence both prior to and during pregnancy are at risk for multiple poor maternal and infant health outcomes, suggesting prenatal risks to children from mothers' abusive partners.

Cross-Sectional Studies↗

Partnering for quality.

This article discusses efforts being made by multiple stakeholders to improve quality and safety in intensive care units (ICUs). The Leapfrog Group (Washington, DC), a consortium of purchasers, is reaching for quality by implementing safety standards. One standard, staffing ICUs with intensivists, is associated with a 30% reduction in hospital mortality and a 40% reduction in ICU mortality. While Leapfrog is addressing quality improvements on a structural level, JCAHO is developing empiric measures for ICU quality, which are being beta tested, to complement Leapfrogs' efforts. JCAHO used rigorously defined processes to develop and refine these measures. These measures include deep venous thrombosis prophylaxis, peptic ulcer disease prophylaxis, catheter-related blood stream infections, mortality and length of stay-APACHE III risk adjustment. Finally, ICU providers at Hopkins implemented an 8-step unit-based safety program. This comprehensive program is run at the unit level, works to improve safety culture, addresses staff safety concerns, partners hospital leaders with unit workers, helps staff implement improvement initiatives, uses rigorous data collection methods, and easily disseminated in other clinical areas. Providers can frame their efforts after 3 fundamental concepts from these initiatives: create a culture that supports quality and safety, standardize work processes by reducing complexity and using independent redundancy, and automate. The take home message is, when we come to work every day, we must be committed to quality and safety, and lead our teams to do the same.

Hospital Mortality↗

Predictors of bleach use among current African-American injecting drug users: a community study.

One hundred seventeen African-American current injecting drug users were interviewed in a closely matched pair of census tract communities in Dallas, Texas. A brief street intercept interview was administered that included an eligibility screener and questions on sexual behaviors with main or other partners and on injection drug paraphernalia bleaching behavior. Multiple regressions were conducted to determine significant predictors of frequency and duration of cleaning needles with bleach using different models (risk, attitude, exposure, and full). The variables measuring risk behaviors were age, frequency of sharing, exchanging sex for money, and sexual partner's use of injecting drugs. The predictors for the attitude model included normative, attitudinal, and self-efficacy items. The exposure to HIV information variables included seeing/hearing information; talking to someone about HIV, condoms, cleaning needles; and antibody testing for HIV. The full model combined predictors from each of the other models. Overall, bleach use is best explained in terms of specific attitudes rather than risk behaviors or information about HIV.

Adult↗

Partners of distressed transvestites.

The authors studied partners of 18 transvestites who sought consultation because of their disorder. They found that all of these women were moral masochists and that all tolerated the self-centered, obsessive-compulsive behavior of their transvestic spouses. Many of these women had experienced multiple losses and poor parenting, and their transvestic partners fulfilled their dependency needs. The authors recommend supportive and insight-oriented therapy for such women who, in order to stay with a transvestic man, sacrifice their own self-esteem and desire to engage in a mutual relationship.

Adult↗

Intimate relationship characteristics associated with condom use among drug users and their sex partners: a multilevel analysis.

Few studies have examined sexual risk behaviors among drug users in the context of their primary sexual relationships. The aim of this study is to examine characteristics of sexual partners associated with inconsistent condom use among a sample of 703 cocaine and opiate users from Baltimore, MD who participated in a network oriented intervention study of human immunodeficiency syndrome (HIV) risk behaviors among drug users. The current study examines relationship characteristics between drug users and their sexual partners (n=1003). Some of the study participants had more than one sexual partner, accounting for the greater number of sexual pairs than study participants. Study participants reported using multiple drugs (56% injected, 48% sniffed heroin, and 48% smoked crack) and that 70% of their sexual partners also used heroin and/or cocaine. Forty percent reported consistent condom use in the past 3 months. In multiple logistic regression, characteristics associated with consistent condom use were, the drug user being HIV infected; not living with their sexual partners; and not being financially interdependent. Previous research has demonstrated lower rates of condom use with main compared with casual and exchange partners. Primary sexual partners provide a sense of stability and introducing condoms may not be desirable or realistic. HIV prevention programs that target drug users should focus on the benefits, such as trust and a sense of security, and risks of not using condoms in primary relationships. Programs should also focus on enhancing communication and negotiation skills through targeting individuals as well as couples.

Adolescent↗

Dilemmas of talking about lifestyle changes among couples coping with a cardiac event.

Persons who have experienced a myocardial infarction (MI) and/or coronary artery bypass graft (CABG) surgery may benefit from a low-fat diet, regular exercise, smoking cessation, and stress management. Yet many patients do not make these changes. A spouse or partner's attempts at support may facilitate or interfere with patient behavior change. The present study explores dilemmas that may arise when couples talk about lifestyle changes following one person's MI or CABG. In interviews carried out in Urbana-Champaign, Illinois, and surrounding communities with 25 patients and 16 partners we found communicating support for lifestyle change may be interpreted as undesired control or criticism. The caring conveyed by talking may be viewed positively but can also threaten patient autonomy and entrap partners in unwanted expectations and obligations. Finally, lifestyle change conversations may reflect empowered patients collaborating with partners to take control of health but can also serve as potent reminders of loss. These multiple, potentially conflicting meanings give an account for why talking with a partner does not always facilitate patient lifestyle change. Understanding these dilemmas also suggests practical implications for helping patients and partners.

Adaptation, Psychological↗

Evaluation of first 406 patients in urology department based Center for Male Sexual Dysfunction.

Four hundred six patients with a complaint of erectile dysfunction were evaluated in a urology department based Male Sexual Dysfunction Center. Results of physical examination, medical and psychosexual history, nocturnal penile tumescence (NPT), penile blood pressure, visual sexual stimulation, hormonal screen, and partner interview were used in establishing the final diagnosis. A summary of the final diagnoses is as follows: organic impotence 117 (28.8%), psychogenic impotence 161 (39.7%), combined factors 102 (25.1%), and dysfunction of unknown origin 26 (6.4%). Data analysis confirms that to establish a diagnosis of organic erectile failure multiple objective measurements in combination with patient and partner history are necessary.

Aged↗

Direct sequencing of HPV DNA detected in gynaecologic outpatients in Rome, Italy.

In order to assess the frequency of different human papillomavirus (HPV) types in Rome and the association between HPV and behavioural characteristics, we tested cervical scrapes of a population of sexually active women referring to university clinics for routine gynaecologic care. The presence of HPV DNA was revealed by polymerase chain reaction on two genome regions (L1 and E6/E7) followed by sequencing. Thirty different HPV types were identified; HPV 16 was the most prevalent (14.18%), followed by HPV 53 (9.21%), HPV 58 (7.80%), HPV 6 and 66 (both 5.67%) whereas all the other genotypes ranged below 5%. In univariate analysis the characteristics significantly associated with HPV DNA detection were the youngest age (P<0.01), the high number of lifetime partners (P<0.001) and the smoking habit (P<0.01). In multiple logistic regression analyses, the characteristics significantly associated with HPV DNA detection remained the younger age and the higher number of lifetime sexual partners. This study may be interesting in order to evaluate the circulation of HPV genotypes in Italy and to add a contribution to anti-cancer vaccine development.

Adolescent↗

Alcohol consumption and sexually transmitted disease risk behavior: partner mix among male Korean university students.

BACKGROUND: This study examined alcohol consumption and sexually transmitted disease risk behavior as related to prostitute visits and sex partner mix among male Korean university students in 1993 to 1994. METHODS: Questionnaires were completed by a representative sample of 1103 university students in Seoul. Lifetime sexually transmitted disease risk behavior was categorized as none, only one, and multiple sexual experiences with prostitutes, whereas risk according to partner mix was classified as no sexual experience with prostitutes, sexual experience with prostitutes only, and with both prostitutes and girlfriends. The proportional odds model was applied to the data. RESULTS: A total of 25.8% of the university students had visited prostitutes--17.6% visited twice or more, and 12.9% had sexual experiences with both prostitutes and girlfriends. Heavier alcohol consumption was significantly related to multiple visits to prostitutes (odds ratio = 1.71) and to sexual experiences with both prostitutes and girlfriends (odds ratio = 2.30). CONCLUSIONS: In this first systematic study of the association between alcohol consumption and sexual experiences among Korean male university students, alcohol use was associated with risky sexual behaviors, and with first and most recent sexual experience with prostitutes, supporting our hypotheses.

Adolescent↗

Gynecological health impact of sexual assault.

We examined the relationship between sexual assault and gynecological health symptoms (e.g., pelvic pain, painful intercourse) in a sample of predominately African American female veterans. Those who had been sexually victimized experienced significantly more frequent gynecological health symptoms than those who had not been assaulted. Multiple forced penetrations, assault by an intimate partner, having weapons used, physical injury, belief that the victim's life was in danger during the assault, and serving in the military at the time of assault increased the likelihood of reporting particular gynecological health symptoms. Screening women in health care settings for a history of violence can link women to resources and treatment for assault-related health symptoms.

Adult↗

Analysis of the C5a anaphylatoxin core domain using a C5a phage library selected on differentiated U937 cells.

The human anaphylatoxin C5a is a 74-amino acid comprising polypeptide with a plethora of biological functions. Site directed mutagenesis studies suggest that several residues within the core and the C-terminus mediate the interaction with the C5a receptor. However, the contribution of particular core residues to receptor binding remained to be clarified. By means of the phage display technique, the loop between positions 35-40 was randomly mutated and the resulting C5a[35-40] fusion phage library affinity selected on C5a receptor expressing U937 cells. After five rounds of affinity enrichment, residues Arg37 and Arg40 were preferably selected. Enrichment was as high as 100% for Arg37 and 79% for Arg40. No significant enrichment of consensus residues could be obtained for positions 35, 36, 38 and 39. The core mutant C5a[A35E36R37A38S39R40], in which only Arg37/40 and Ala38 are of the native C5a sequence, was as potent as native C5a in both receptor binding and enzyme release examined on U937 cells. In contrast, replacement of Arg40 as in the mutant C5a[Q35E36R37I38L39N40] resulted in a 10-fold decrease in both binding and functional activities. Thus, selected out of a multiplicity of possibilities by the natural binding partner, Arg37 as well as Arg40 appear to be anchor residues in binding to the C5a receptor.

Antigens, CD↗

Mass spectrometry--not just a structural tool: the use of guided ion beam tandem mass spectrometry to determine thermochemistry.

Guided ion beam tandem mass spectrometry has proved to be a robust tool for the measurement of thermodynamic information. Over the past twenty years, we have elucidated a number of factors necessary to make such thermochemistry accurate. Careful attention must be paid to the reduction of the raw data, ion intensities versus laboratory ion energies, to a more useful form, reaction cross sections versus relative kinetic energy. Analysis of the kinetic energy dependence of cross sections for endothermic reactions can then reveal thermodynamic data for both bimolecular and collision-induced dissociation (CID) processes. Such analyses need to include consideration of the explicit kinetic and internal energy distributions of the reactants, the effects of multiple collisions, the identity of the collision partner in CID processes, the kinetics of the reaction being studied, and competition between parallel reactions. This work provides examples illustrating the need to consider this multitude of effects along with details of the procedures developed in our group for handling each of them.

Journal Article↗

Acute hepatitis B in Edinburgh 1975-92: a retrospective study in a population where human immunodeficiency virus is highly prevalent.

A retrospective study of notified hepatitis B virus (HBV) infection in Edinburgh during 1975-92 identified 525 acute cases. For 343 where a probable transmission route could be determined, 215 were due to shared equipment by injection drug users (IDUs), 29 to homosexual intercourse, 25 to heterosexual or household contact with IDUs, 21 to heterosexual contact with infected non-IDU partners and 53 to various other or multiple routes. Cases were unevenly distributed geographically, particularly those among IDUs. The highest incidence within a post code district was approximately 2.5 times that for all Edinburgh. Annual cases peaked in 1984 then declined to low levels in the early 1990s. This reduction was most marked among IDUs, and may be ascribed both to changed injecting behaviour and decreased susceptibility within this group. The latter factor implies that HBV infections may be an unreliable guide to human immunodeficiency virus (HIV) infection in populations where HBV is highly prevalent.

Adolescent↗

Health beliefs and promotion of HIV-preventive intentions among teenagers: a Scottish perspective.

Beliefs concerning the spread of the human immunodeficiency virus (HIV) and preventive behaviors were examined in a sample of 351 sexually active Scottish teenagers. A postal questionnaire, including measures of variables specified by the health belief model (HBM) and preventive intentions, was employed. The relation between HBM measures and reported endorsement of HIV-preventive intentions was investigated. Results indicated that, in general, respondents intended to use condoms with new sexual partners. The majority also intended to carry condoms if they thought they might have sex with a new partner and to ask potential partners about their previous sexual history. Multiple-regression analyses showed that measures of health beliefs, gender, age, sexual experience, and previous condom use accounted for 17.8% to 24.3% of the variance in reported preventive intentions. Perceived barriers to preventive behaviors were found to be important predictors. However, the overall pattern of results raised questions concerning the adequacy of the HBM as a model of the determinants of HIV-preventive intentions, and the need for an extended model is discussed. Separate analyses were conducted for men and women and for 16- and 18-year-olds, and the implications for modeling intention formation in these subgroups are considered. The relevance of these findings to HIV-preventive campaigns is also discussed.

Adolescent↗

Spectroscopic evidence for a common electron transfer pathway for two tryptophan tryptophylquinone enzymes.

Aromatic amine dehydrogenase (AADH) and methylamine dehydrogenase (MADH) are the only two enzymes known to use the cofactor tryptophan tryptophylquinone (TTQ). Each catalyzes oxidative deamination of a distinct class of primary amines. A detailed comparison of their circular dichroic spectra indicates that both proteins share a similar fold with their TTQ cofactors residing in similar environments and that this may be a useful diagnostic probe for TTQ enzymes. Alcaligenes faecalis cells induced to express AADH also express a large amount of the blue copper protein, azurin. Oxidized azurin is rapidly reduced by a catalytic amount of AADH in the presence of the substrate, tyramine. Three A. faecalis cytochromes-c and three other cytochromes-c were tested for electron transfer activity with AADH. Azurin markedly facilitated electron transfer from AADH to each cytochrome. This suggests that AADH and azurin may form an electron transfer complex with a c-type cytochrome, analogous to the crystallographically determined MADH-amicyanin-cytochrome c-551i complex (Chen, L., Durley, R. C. E., Matthews, F. S., and Davidson, V. L. (1994) Science 264, 86-90). The similarities of MADH and AADH plus the demonstration of azurin and multiple cytochromes as functional electron-transfer partners suggest that both TTQ-bearing enzymes share common mechanisms for oxidative deamination and subsequent electron transfer.

Alcaligenes↗