RESUMO
Despite the widespread use of combination antiretroviral therapy (cART), HIV-associated neurocognitive impairment (NCI) remains a health concern. However, limited research has been done to identify factors associated with neurocognitive decline. We assessed risk factors associated with neurocognitive decline in people living with HIV using a definition of decline that is statistically easy to adopt, is based on a commonly used neuropsychological cut-off and may be clinically relevant. Cox proportional hazards modeling was performed using the CNS HIV Antiretroviral Therapy Effects Research (CHARTER) study database. 581 participants were followed for up to 12 years. Neurocognitive decline was defined as the first observed drop in global T-scores of at least 2.67. Lifetime methamphetamine use had the strongest association with neurocognitive decline (adjusted Hazard Ratio; aHR = 1.48; 95% CI = 0.92-2.39) followed by no current antiretroviral medication use (aHR = 1.32; 95% CI = 0.91-1.92). Other risk factors included Hispanic ethnicity, lifetime history of major depressive disorder, lifetime cannabis use, hepatitis-C infection, and difficulty eating, dressing, bathing, or using the toilet. Results indicate that consistent use of ART may be of high significance to preserving neurocognition. Furthermore, Hispanic patients, those with a history of depression and substance use, and those having difficulty in essential activities of daily living may require vigilant follow-up.
Assuntos
Transtorno Depressivo Maior , Infecções por HIV , Atividades Cotidianas , Terapia Antirretroviral de Alta Atividade , Transtorno Depressivo Maior/complicações , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Testes NeuropsicológicosRESUMO
OBJECTIVES: Chronic exposure to arsenic has been reported as a risk factor for nonmelanoma skin cancer, notably squamous cell carcinoma. However, current knowledge is limited about the association between arsenic exposure and melanoma. Our objectives were to (1) measure the association between total urinary arsenic levels and melanoma compared with nonmelanoma skin cancer and no cancer and (2) analyze the association between water source and melanoma and nonmelanoma skin cancer. METHODS: We collected cross-sectional data from the 2003-2016 cycles of the National Health and Nutrition Examination Survey. We conducted univariate and multivariate logistic regressions. To evaluate the possible association of skin cancer with source of tap water, we calculated odds ratios for participants with melanoma and nonmelanoma skin cancer, compared with participants with no cancer. RESULTS: White race, higher education, higher socioeconomic status, and smoking history were associated with melanoma and nonmelanoma skin cancer in the full study population. After adjusting for age and race/ethnicity, the adjusted odds ratio of participants with >50 µg/L of total urinary arsenic for melanoma or nonmelanoma skin cancer was 1.87 (95% CI, 0.58-6.05) and 2.23 (95% CI, 1.12-4.45) times higher compared with no cancer, respectively. Participants with nonmelanoma skin cancer had 2.06 increased odds of reporting a nonmunicipal water source compared with participants without cancer. CONCLUSIONS: We did not find a relationship between the incidence of melanoma and exposure to arsenic among US adults. Nonmunicipal water sources were associated with nonmelanoma skin cancer and should be further investigated.
Assuntos
Arsênio , Melanoma , Neoplasias Cutâneas , Adulto , Arsênio/urina , Estudos Transversais , Humanos , Melanoma/complicações , Melanoma/epidemiologia , Inquéritos Nutricionais , Neoplasias Cutâneas/induzido quimicamente , Neoplasias Cutâneas/epidemiologia , ÁguaRESUMO
HIV-related neurocognitive impairment (NCI) may increase the risk of death. However, a survival disadvantage for patients with NCI has not been well studied in the post-combination antiretroviral therapy (cART) era. Specifically, limited research has been conducted considering the reversible nature and variable progression of the impairment and this area demands further evaluation. We performed multivariable Cox proportional hazards modeling to assess the association between baseline NCI (global T scores) and mortality. A joint modeling approach was then used to model the trajectory of global neurocognitive functioning over time and the association between neurocognitive trajectory and mortality. Among the National NeuroAIDS Tissue Consortium's (NNTC) HIV-infected participants, we found a strong negative association between NCI and mortality in the older age groups (e.g., at age = 55, HR = 0.79; 95% CI 0.64-0.99). Three neurocognitive sub-domains (abstraction and executive functioning, speed of information processing, and motor) had the strongest negative association with mortality. Joint modelling indicated a 33% lower hazard for every 10-unit increase in global T scores (HR = 0.67; 95% CI 0.56-0.80). The study identified older HIV-infected individuals with NCI as a group needing special attention for the longevity of life. The study has considerable prognostic utility by not only predicting mortality hazard, but also future cognitive status.
Assuntos
Disfunção Cognitiva/mortalidade , Disfunção Cognitiva/fisiopatologia , Infecções por HIV/mortalidade , Adulto , Antirretrovirais/uso terapêutico , Cognição/fisiologia , Disfunção Cognitiva/virologia , Estudos de Coortes , Bases de Dados Factuais , Função Executiva/fisiologia , Feminino , HIV/metabolismo , HIV/patogenicidade , Infecções por HIV/tratamento farmacológico , Infecções por HIV/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Neurocognitivos/mortalidade , Transtornos Neurocognitivos/fisiopatologia , Transtornos Neurocognitivos/virologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
Protection at the peak of Plasmodium chabaudi blood-stage malaria infection is provided by CD4 T cells. We have shown that an increase in Th1 cells also correlates with protection during the persistent phase of malaria; however, it is unclear how these T cells are maintained. Persistent malaria infection promotes protection and generates both effector T cells (Teff), and effector memory T cells (Tem). We have previously defined new CD4 Teff (IL-7Rα-) subsets from Early (TeffEarly, CD62LhiCD27+) to Late (TeffLate, CD62LloCD27-) activation states. Here, we tested these effector and memory T cell subsets for their ability to survive and protect in vivo. We found that both polyclonal and P. chabaudi Merozoite Surface Protein-1 (MSP-1)-specific B5 TCR transgenic Tem survive better than Teff. Surprisingly, as Tem are associated with antigen persistence, Tem survive well even after clearance of infection. As previously shown during T cell contraction, TeffEarly, which can generate Tem, also survive better than other Teff subsets in uninfected recipients. Two other Tem survival mechanisms identified here are that low-level chronic infection promotes Tem both by driving their proliferation, and by programming production of Tem from Tcm. Protective CD4 T cell phenotypes have not been precisely determined in malaria, or other persistent infections. Therefore, we tested purified memory (Tmem) and Teff subsets in protection from peak pathology and parasitemia in immunocompromised recipient mice. Strikingly, among Tmem (IL-7Rαhi) subsets, only TemLate (CD62LloCD27-) reduced peak parasitemia (19%), though the dominant memory subset is TemEarly, which is not protective. In contrast, all Teff subsets reduced peak parasitemia by more than half, and mature Teff can generate Tem, though less. In summary, we have elucidated four mechanisms of Tem maintenance, and identified two long-lived T cell subsets (TemLate, TeffEarly) that may represent correlates of protection or a target for longer-lived vaccine-induced protection against malaria blood-stages.
Assuntos
Linfócitos T CD4-Positivos/imunologia , Memória Imunológica/imunologia , Malária/imunologia , Malária/prevenção & controle , Plasmodium chabaudi/imunologia , Subpopulações de Linfócitos T/imunologia , Animais , Interferon gama/biossíntese , Malária/patologia , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BLRESUMO
Scrub typhus is a serious public health problem in the Asia-Pacific area. It threatens one billion people globally, and causes illness in one million people each year. Caused by Orientia tsutsugamushi, scrub typhus can result in severe multiorgan failure with a case fatality rate up to 70% without appropriate treatment. The antigenic heterogeneity of O. tsutsugamushi precludes generic immunity and allows reinfection. As a neglected disease, there is still a large gap in our knowledge of the disease, as evidenced by the sporadic epidemiologic data and other related public health information regarding scrub typhus in its endemic areas. Our objective is to provide a systematic analysis of current epidemiology, prevention and control of scrub typhus in its long-standing endemic areas and recently recognized foci of infection.
Assuntos
Doenças Negligenciadas/epidemiologia , Tifo por Ácaros/epidemiologia , Tifo por Ácaros/prevenção & controle , Ásia/epidemiologia , Humanos , Doenças Negligenciadas/microbiologia , Doenças Negligenciadas/prevenção & controle , Orientia tsutsugamushi/isolamento & purificação , Tifo por Ácaros/microbiologia , Tifo por Ácaros/parasitologiaRESUMO
The World Health Organization's International Classification of Functioning, Disability and Health (ICF) is a universal classification system of health and health-related domains. The ICF has been successfully applied to a wide range of health conditions and diseases; however, its application in the field of burn recovery has been minimal. This systematic review uses the domains of the ICF component 'activities and participation' to explore: (1) the extent to which return to daily activities and community participation after burn has been examined in the pediatric population, (2) the most common assessments used to determine activity and participation outcomes, and (3) what activity and participation areas are most affected in the pediatric burn population after discharge from acute care. Results determined that it is difficult to draw overarching conclusions in the area of return to 'activities and participation' for children with burn based on the paucity of current evidence. Of the studies conducted, few examined the same subtopics or used similar measurements. This suggests a need for more robust studies in this area in order to inform and improve burn rehabilitation practices to meet the potential needs of burn patients beyond an acute care setting.
Assuntos
Atividades Cotidianas , Queimaduras/reabilitação , Classificação Internacional de Funcionalidade, Incapacidade e Saúde , Recuperação de Função Fisiológica , Queimaduras/fisiopatologia , Humanos , Volta ao EsporteRESUMO
OBJECTIVE: To examine the effect of obesity on incidence of disability and mortality among non-disabled older Mexicans at baseline. MATERIALS AND METHODS: The sample included 8 415 Mexicans aged ≥ 50 years from the Mexican Health and Aging Study (2001 -2012), who reported no limitations in activities of daily living (ADLs) at baseline and have complete data on all covariates. Sociodemographics, smoking status, comorbidities, ADL activities, and body mass index (BMI) were collected. RESULTS: The lowest hazard ratio (HR) for disability was at BMI of 25 to < 30 (HR = 0.97;95% confidence interval [CI], 0.85-1.12).The lowest HR for mortality were seen among participants with BMIs 25 to < 30 (HR = 0.85; 95%CI, 075-0.97), 30 to < 35 (HR = 0.86; 95 %CI, 0.72-1.02), and > 35 (HR = 0.92; 95 %CI, 0.70-1.22). CONCLUSION: Mexican older adults with a BMI of 25 to < 30 were at less risk for both disability and mortality.
Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Mortalidade , Obesidade/epidemiologia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Antropometria , Índice de Massa Corporal , Feminino , Seguimentos , Inquéritos Epidemiológicos , Humanos , Incidência , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de RiscoRESUMO
Objective. To examine the effect of obesity on incidence of disability and mortality among non-disabled older Mexicans at baseline. Materials and methods. The sample included 8 415 Mexicans aged ≥ 50 years from the Mexican Health and Aging Study (2001 -2012), who reported no limitations in activities of daily living (ADLs) at baseline and have complete data on all covariates. Sociodemographics, smoking status, comorbidities, ADL activities, and body mass index (BMI) were collected. Results. The lowest hazard ratio (HR) for disability was at BMI of 25 to < 30 (HR = 0.97;95% confidence interval [CI], 0.85-1.12).The lowest HR for mortality were seen among participants with BMIs 25 to < 30 (HR = 0.85; 95%CI, 075-0.97), 30 to < 35 (HR = 0.86; 95 %CI, 0.72-1.02), and > 35 (HR = 0.92; 95 %CI, 0.70-1.22). Conclusion. Mexican older adults with a BMI of 25 to < 30 were at less risk for both disability and mortality.
Objetivo. Examinar el efecto de la obesidad sobre la incidencia de discapacidad y mortalidad en adultos mayores mexicanos sin discapacidad al inicio del estudio. Material y métodos. La muestra incluyó 8 415 Mexicanos ≥ 50 años de edad del Estudio Nacional de Salud y Envejecimiento en México (2001 -2012), quienes no reportaron discapacidad en las actividades de la vida diaria en la encuesta basal y tenían información completa de todas las covariables. Resultados. La razón de riesgo más baja (HR) para discapacidad se observó con un IMC de 25 a < 30 (HR=0.97;95%CI, 0.85-1.12). La razón de riesgo más baja para mortalidad se observó con IMC de 25 a < 30 (HR = 0.85;95%CI,075-0.97),de 30 a < 35 (HR = 0.86; 95%CI, 0.72-1.02), y > 35 (HR = 0.92; 95%CI, 0.70-1.22). Conclusión. Los adultos mayores mexicanos con un IMC de 25 a < 30 tuvieron menor riesgo de discapacidad y mortalidad.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Mortalidade , Pessoas com Deficiência/estatística & dados numéricos , Obesidade/epidemiologia , Atividades Cotidianas , Índice de Massa Corporal , Modelos de Riscos Proporcionais , Antropometria , Incidência , Estudos Prospectivos , Fatores de Risco , Seguimentos , Inquéritos Epidemiológicos , México/epidemiologiaRESUMO
INTRODUCTION: The objective of our study was to estimate the long-term cost-effectiveness of a lifestyle modification program led by community health workers (CHWs) for low-income Hispanic adults with type 2 diabetes. METHODS: We forecasted disease outcomes, quality-adjusted life years (QALYs) gained, and lifetime costs associated with attaining different hemoglobin A1c (A1c) levels. Outcomes were projected 20 years into the future and discounted at a 3.0% rate. Sensitivity analyses were conducted to assess the extent to which our results were dependent on assumptions related to program effectiveness, projected years, discount rates, and costs. RESULTS: The incremental cost-effectiveness ratio of the intervention ranged from $10,995 to $33,319 per QALY gained when compared with usual care. The intervention was particularly cost-effective for adults with high glycemic levels (A1c > 9%). The results are robust to changes in multiple parameters. CONCLUSION: The CHW program was cost-effective. This study adds to the evidence that culturally sensitive lifestyle modification programs to control diabetes can be a cost-effective way to improve health among Hispanics with diabetes, particularly among those with high A1c levels.
Assuntos
Agentes Comunitários de Saúde/economia , Diabetes Mellitus/etnologia , Promoção da Saúde/economia , Hispânico ou Latino/psicologia , Pobreza , Adolescente , Adulto , Análise Custo-Benefício , Diabetes Mellitus/terapia , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/terapia , Feminino , Recursos em Saúde/economia , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/economia , Pobreza/etnologia , Desenvolvimento de Programas , Anos de Vida Ajustados por Qualidade de Vida , Autocuidado/economia , Fatores Socioeconômicos , TexasRESUMO
OBJECTIVES: The incidence of hepatocellular carcinoma (HCC) in the United States has increased dramatically over the last two decades, largely because of an increase in the number of people with advanced hepatitis C virus (HCV) infection. U.S. prisoners are at high risk for HCC, given their elevated rates of HCV infection, comorbid hepatitis B virus (HBV) infection, and alcoholic liver disease. The purpose of our study was to examine the prevalence and mortality of HCC in the nation's largest state prison system. METHODS: The study population consisted of 325,477 male Texas Department of Criminal Justice (TDCJ) inmates who were incarcerated between January 1, 2003, and July 31, 2006. Information on medical conditions and demographic characteristics was obtained from an institution-wide medical information system. RESULTS: During the 3.5-year study period, 176 male TDCJ inmates (54 per 100,000) were diagnosed with HCC and 108 (33 per 100,000) died as a result of HCC. Inmates who were Hispanic, older, and infected with HCV, HBV, or human immunodeficiency virus had elevated rates of both HCC prevalence and mortality. After adjusting for all study covariates, HCC prevalence, but not mortality, was modestly elevated among inmates with diabetes. CONCLUSIONS: Our study showed that the Texas male prison population had a sevenfold higher prevalence of HCC than the general U.S. male population and a fourfold higher death rate from HCC. These findings likely reflect the high concentration of HCC-related risk factors, particularly HCV, among prisoners.
Assuntos
Carcinoma Hepatocelular/mortalidade , Neoplasias Hepáticas/mortalidade , Prisioneiros , Adolescente , Adulto , Idoso , Humanos , Sistemas de Informação , Masculino , Pessoa de Meia-Idade , Texas/epidemiologia , Adulto JovemRESUMO
Recent studies have linked hepatitis C virus (HCV) infection with carotid atherosclerosis. We investigated the association between HCV seropositivity and acute myocardial infarction using a well-established cohort of young men in the US military and found no evidence to support this association.
Assuntos
Anticorpos Anti-Hepatite C/sangue , Hepatite C/complicações , Infarto do Miocárdio/virologia , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Hepatite C/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Fatores de Risco , Testes Sorológicos , Estados UnidosRESUMO
OBJECTIVE: To determine if television viewing is associated with the risk of initiating sexual intercourse in young adolescents. DESIGN: Secondary analysis of data obtained from 1994 through 1996. SETTING: The National Longitudinal Study of Adolescent Health. PARTICIPANTS: The 4808 students younger than 16 years who had not initiated intercourse before baseline interview. EXPOSURES: Primary exposure was self-reported daily television watching, categorized as low (< 2 hours) or high (> or =2 hours) use. Secondary exposure was parental regulation of television programming watched. MAIN OUTCOME MEASURE: Odds ratio for initiating intercourse by 1-year follow-up, adjusted for potential confounders. RESULTS: At baseline, 2414 (48.8%) subjects watched television 2 or more hours per day. By 1-year follow-up, 791 (15.6%) subjects had initiated intercourse. Sexual initiation was associated with high television use (adjusted odds ratio, 1.35; 95% confidence interval, 1.01-1.79) and lack of parental regulation of television programming (adjusted odds ratio, 1.35; 95% confidence interval, 1.01-1.80). Most subjects (73.8%) reported strong parental disapproval of sex; their overall rate of initiation was 12.5%, and their risk was independently associated with high television use (adjusted odds ratio, 1.72; 95% confidence interval, 1.24-2.40) and lack of parental regulation of television programming (adjusted odds ratio, 1.35; 95% confidence interval, 1.01-1.81). Among adolescents who did not report strong parental disapproval, the rate of sexual initiation was higher (24.1%) but unrelated to television use. CONCLUSION: Among young adolescents who reported strong parental disapproval of sex, watching television 2 or more hours per day and lack of parental regulation of television programming were each associated with increased risk of initiating sexual intercourse within a year.
Assuntos
Comportamento do Adolescente , Coito , Televisão , Adolescente , Análise de Variância , Fatores de Confusão Epidemiológicos , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Razão de Chances , Relações Pais-Filho , Poder Familiar , Fatores de Risco , Autorrevelação , Comportamento Sexual/estatística & dados numéricos , Televisão/estatística & dados numéricos , Fatores de Tempo , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: In 2000, the Wisconsin Strategic Plan for the Elimination of Tuberculosis (TB) sets goals of 90 percent treatment completion and 95 percent documentation of treatment improvement for all reported cases of TB. This study measures the success in achieving these goals. METHODS: Data were abstracted from charts of all 249 reported TB cases during 2000-2002. Treatment completion was considered for patients indicated for completion in 12 months or less. Documentation of treatment improvement included therapy adherence, sputum culture conversion, and chest radiograph improvement for pulmonary cases, and therapy adherence and clinical improvement for extrapulmonary cases. RESULTS: Treatment completion was measured in 204 of 249 TB cases; 87.1 percent completed treatment in 12 months or less. There was a significant difference in completion by site of disease, 89.9 percent for pulmonary cases and 66.1 percent for extrapulmonary cases (P < .01). Documentation of treatment improvement was 61.2 percent among pulmonary cases and 83.6 percent among extrapulmonary cases (P < .01). During the study period, there was a significant decrease in documentation rates for patients with pulmonary TB (P < .01). CONCLUSIONS: The goal of 90 percent treatment completion was nearly accomplished but the goal of 95 percent documentation of treatment improvement was not achieved. Barriers to TB treatment in Wisconsin need to be identified. Case management of TB is necessary for control and prevention of TB.
Assuntos
Qualidade da Assistência à Saúde , Tuberculose/tratamento farmacológico , Adolescente , Adulto , Idoso , Administração de Caso , Feminino , Humanos , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Controle de Qualidade , WisconsinRESUMO
BACKGROUND: Several investigators have found that Chlamydia pneumoniae and cytomegalovirus infections may be risk factors for coronary heart disease. However, the data remain controversial. To address this hypothesis, data and specimens were collected from a well-established prospective cohort of active-duty personnel from the US military. METHODS: A nested case-control study was conducted with 300 case patients and 300 matched control subjects. Case patients were men (age, 30-50 years) with a medically documented, first-time hospitalization for acute myocardial infarction (MI) and from whom a serum specimen had been drawn >or=1 year before the time of the acute MI. Population-based control subjects were chosen from the same cohort and were individually matched by age, race, and time of specimen collection. Evidence of past infections with C. pneumoniae and cytomegalovirus were measured by microimmunofluorescence assay and enzyme-linked immunosorbent assay, respectively. RESULTS: Significant risk was associated with high titer (>or=1 : 64) to C. pneumoniae immunoglobulin A (IgA) (adjusted relative risk [RR(adj)], 1.67; 95% confidence interval [CI], 1.04-2.70). This increased risk was greatest when specimens were collected 1-5 years before the event (RR(adj), 2.11; 95% CI, 1.06-4.21). High titer (>or=1 : 256) to C. pneumoniae immunoglobulin G (IgG) was also associated with an elevated risk (RR(adj), 1.74; 95% CI, 0.90-3.34) after full adjustment for cardiovascular risk factors, whereas no independent risk for acute MI was associated with cytomegalovirus IgG seropositivity. CONCLUSIONS: This study demonstrates a significant association between high titers to C. pneumoniae IgG and IgA and acute MI in a cohort of young men and suggests that recent or chronic active infections could be associated with an increased risk for MI.
Assuntos
Infecções por Chlamydophila/complicações , Chlamydophila pneumoniae/imunologia , Infarto do Miocárdio/etiologia , Adulto , Anticorpos Antibacterianos/sangue , Estudos de Casos e Controles , Infecções por Chlamydophila/microbiologia , Humanos , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Masculino , Pessoa de Meia-Idade , Risco , Fatores de RiscoRESUMO
OBJECTIVE: The objective of this study was to assess the feasibility of an intervention for sexually transmitted diseases (STDs) and a screening program for Chlamydia trachomatis and Neisseria gonorrhoeae infections in male Army recruits. GOALS: The goals of this study were to identify and treat chlamydia and gonorrhea infections in recruits, assess their perceptions of risk, and increase their STD knowledge and behavioral intentions. STUDY DESIGN: Volunteers (n = 3911) entering basic training (July 1999-June 2000) at Fort Jackson, South Carolina, attended an educational intervention, completed pre- and post-questionnaires, and provided a urine specimen for chlamydia and gonorrhea screening by nucleic acid amplification testing. RESULTS: Chlamydia and gonorrhea prevalences were 4.7% and 0.4%, respectively. The mean STD knowledge score, intent to use condoms, and confidence in using condoms correctly increased (P <0.001). Participants reported increased risk perception and considered the educational program valuable (96.9%) and a learning experience (94.6%). CONCLUSIONS: A linked educational and screening program is feasible and acceptable in male Army recruits.
Assuntos
Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/prevenção & controle , Gonorreia/epidemiologia , Gonorreia/prevenção & controle , Militares/estatística & dados numéricos , Educação de Pacientes como Assunto , Adulto , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/etiologia , Infecções por Chlamydia/urina , Estudos de Viabilidade , Gonorreia/diagnóstico , Gonorreia/etiologia , Gonorreia/urina , Humanos , Masculino , Programas de Rastreamento/métodos , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/etiologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Infecções Sexualmente Transmissíveis/urina , Inquéritos e Questionários , Estados Unidos/epidemiologiaRESUMO
Public health laboratories play an important role in screening programs for asymptomatic diseases of public health importance in high-risk and underserved populations. The implementation of targeted screening strategies for communicable diseases requires thorough planning and evaluation. The Wisconsin State Laboratory of Hygiene (WSLH) systematically selects and evaluates laboratory tests used in communicable disease control programs coordinated by the Wisconsin Division of Public Health. To do this, the epidemiologic features of the disease in potential target populations are carefully assessed, with the choice of laboratory tests based on performance as well as practical and cost considerations. Laboratory testing at WSLH plays a crucial role in screening programs for sexually transmitted and bloodborne infections. Hallmarks of these programs are cross-sector collaboration, empirical selection of laboratory testing methods, and the use of epidemiologic data to develop and evaluate targeted screening strategies.