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1.
Vaccine ; 39(34): 4810-4816, 2021 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-34294478

RESUMO

BACKGROUND: Chronic infection with high-risk human papillomavirus is a necessary cause for cervical carcinogenesis. This study examined prevalence of nonavalent vaccine preventable HPV types over four months among sexually active women in the United States. METHODS: This sub-study obtained meta-data for 80 of the 1,365 women (18-25 years), enrolled in the BRAVO study, a randomized, open-label trial of home screening and treatment of asymptomatic bacterial vaginosis at high-risk for sexually transmitted infections conducted between 2008 and 2013. Participants were randomized to treatment or standard-of-care, and followed every 2-months for 12 months. Stored vaginal swabs from the first three visits were tested for the nine vaccine preventable HPV types using quantitative PCR. Prevalence and associated 95% confidence intervals for the HPV types were assessed using R (version 3.6.1). RESULTS: The average age of the participants was 21.5 (SD ± 2.11) years, with 60% having ever been pregnant and all were African-American. Majority (71%) reported ≥ two sex partners in the prior year with 89% having unprotected vaginal sex and 45% having a new sex partner in the prior year. About 30% had ≥ one of the nine nonavalent vaccine HPV types at all three time points over a period of four months, 15% at two of any three visits, 19% at one of the three visits and 36% were negative for all nine vaccine HPV types at all time points. The most frequently detected HPV vaccine types were 52, 58, 16, and 18. The prevalence of any vaccine HPV types, and high-risk HPV types was 63.8% and 58.8%, respectively. CONCLUSIONS: Our findings suggest that HPV vaccination which is currently recommended for all unvaccinated persons through age 26 years, is likely to be more beneficial than previously thought as nonavalent HPV vaccine was not available during the time these data were collected.


Assuntos
Infecções por Papillomavirus , Vacinas contra Papillomavirus , Neoplasias do Colo do Útero , Adulto , Negro ou Afro-Americano , Cidades , Feminino , Humanos , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/prevenção & controle , Prevalência , Vacinas Combinadas , Adulto Jovem
2.
AIDS Behav ; 22(5): 1411-1422, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-28593404

RESUMO

To describe patterns of depressive symptoms across 10-years by HIV status and to determine the associations between depressive symptom patterns, HIV status, and clinical profiles of persons living with HIV from the Multicenter AIDS Cohort Study (N = 980) and Women's Interagency HIV Study (N = 1744). Group-based trajectory models were used to identify depressive symptoms patterns between 2004 and 2013. Multinomial logistic regressions were conducted to determine associations of depression risk patterns. A 3-group model emerged among HIV-negative women (low: 58%; moderate: 31%; severe: 11%); 5-groups emerged among HIV-positive women (low: 28%; moderate: 31%; high: 25%; decreased: 7%; severe: 9%). A 4-group model emerged among HIV-negative (low: 52%; moderate: 15%; high: 23%; severe: 10%) and HIV-positive men (low: 34%; moderate: 34%; high: 22%; severe: 10%). HIV+ women had higher odds for moderate (adjusted odds ratio [AOR] 2.10, 95% CI 1.63-2.70) and severe (AOR 1.96, 95% CI 1.33-2.91) depression risk groups, compared to low depression risk. HIV+ men had higher odds for moderate depression risk (AOR 3.23, 95% CI 2.22-4.69), compared to low risk. The Framingham Risk Score, ART use, and unsuppressed viral load were associated with depressive symptom patterns. Clinicians should consider the impact that depressive symptoms may have on HIV prognosis and clinical indicators of comorbid illnesses.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Depressão/diagnóstico , Depressão/psicologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Adulto , Fármacos Anti-HIV/administração & dosagem , Estudos de Coortes , Comorbidade , Depressão/epidemiologia , Depressão/etiologia , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Fatores de Risco , Estados Unidos/epidemiologia , Carga Viral
3.
Drug Alcohol Depend ; 181: 235-241, 2017 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-29121596

RESUMO

BACKGROUND: Level of alcohol consumption is associated with differential risk of atherosclerosis, but little research has investigated this association among HIV+ persons. We evaluated the association between long-term alcohol use and incident atherosclerosis among HIV+ persons. METHODS: We utilized data from HIV+ participants of the Women's Interagency HIV Study (n=483) and the Multicenter AIDS Cohort Study (n=305) without history of cardiovascular disease. Atherosclerosis was assessed two times by B-mode carotid artery ultrasound imaging from 2004 to 2013. Presence of plaque was defined as focal carotid intima-media thickness over 1.5mm. Those with no plaque at baseline and plaque at follow-up were considered incident cases of atherosclerosis. Group-based trajectory models were used to categorize participants into 10-year drinking patterns representing heavy, moderate, or abstinent-low. Multivariable logistic regressions were conducted to assess the association of long-term moderate and heavy use on atherosclerosis, compared to abstinent-low. RESULTS: Heavy alcohol consumption was not statistically significantly associated with risk for incident atherosclerosis in women (AOR 1.10, CI 0.40-3.02) or men (AOR 1.31, CI 0.43-4.00), compared to abstinence-low. Moderate consumption was associated with 54% lower odds for incident disease in men (AOR 0.46, CI 0.21-1.00), but not in women (AOR 1.08, CI 0.58-2.00). In cohort-combined analyses, alcohol consumption was not statistically significantly association with incident atherosclerosis (moderate AOR 0.78, CI 0.48-1.27; heavy AOR 1.33, CI 0.66-2.69). CONCLUSION: Moderate alcohol consumption was associated with a significant protective effect on incident atherosclerosis in men only. No other levels of alcohol consumption significantly predicted atherosclerosis in men and women compared to abstinent-low.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Aterosclerose/virologia , Infecções por HIV/complicações , Adulto , Aterosclerose/diagnóstico por imagem , Aterosclerose/epidemiologia , Espessura Intima-Media Carotídea , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Proteção , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Estados Unidos/epidemiologia
4.
Addict Sci Clin Pract ; 12(1): 22, 2017 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-28950912

RESUMO

BACKGROUND: Alcohol consumption has been associated with poor antiretroviral therapy (ART) adherence but less is known about its relationship to HIV viral suppression, or whether certain drinking patterns have a stronger association than others. The objectives of this study were to determine the association of different patterns of alcohol consumption to HIV viral suppression and ART adherence, and to determine whether any associations of alcohol with HIV viral suppression were mediated by poor ART adherence. METHODS: This observational study used baseline data from 619 HIV+ participants, recruited across 8 clinical and community settings across Florida as part of the Florida Cohort from 2014 to 2016. Alcohol consumption was measured by self-report, and grouped into four categories: heavy drinking (>7/week for women or >14 drinks/week for men); binge, but not heavy drinking (≥4 or >5 drinks/occasion for women and men, respectively), low level drinking (neither heavy nor binge), and abstinence. Serum HIV RNA measurements were obtained from statewide HIV surveillance data, and durable viral suppression was defined as achieving HIV viral suppression (<200 copies/ml) at every assessment in the past 12 months. RESULTS: The majority of the 619 participants were male (63%) and aged 45 or greater (65%). The proportion of participants with heavy, binge, low-level drinking and abstinence was 9, 25, 37 and 30%, respectively. Optimal ART adherence (≥95%) was reported by 68%, and 60% achieved durable viral suppression. In multivariable analysis controlling for demographic factors, drug use, and homelessness, heavy drinking (compared to abstinence) was associated with increased odds of failing to achieve durable viral suppression (OR 2.16, 95% CI 1.08-4.32) whereas binge drinking alone was not significantly associated with this outcome (OR 1.04, 95% CI 0.64-1.70). Both heavy drinking and binge drinking were significantly associated with suboptimal ART adherence. Mediation analyses suggested that only a small proportion of the relationship between heavy drinking and suboptimal viral suppression was due to poor ART adherence. CONCLUSIONS: Exceeding weekly recommended levels of alcohol consumption (heavy drinking) was significantly associated with poor HIV viral suppression and ART non-adherence, while binge drinking was associated with suboptimal ART adherence in this sample. Clinicians should attempt to address heavy drinking in their patients with HIV.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Infecções por HIV/tratamento farmacológico , Comportamentos Relacionados com a Saúde , Adesão à Medicação/estatística & dados numéricos , Resposta Viral Sustentada , Adulto , Fármacos Anti-HIV/administração & dosagem , Feminino , Florida , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pobreza , Fatores Socioeconômicos
6.
Exp Parasitol ; 105(3-4): 179-83, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-14990310

RESUMO

An efficient technique was developed for separating early and late stages of embryonic development in eggs of Heterodera glycines. This technique takes advantage of density changes that occur during embryogenesis in the developing embryo and egg to partition the egg within a sucrose step gradient. Sorted samples of eggs separated with 82% enrichment for pre-gastrula early embryos and 93% enrichment for first and second stage unhatched juveniles as late embryos. Subpopulations enriched for either developmental stage are available for use in generating stage-specific cDNA libraries, normalization of subpopulations to synchronize development, biochemical characterization, and many other uses.


Assuntos
Glycine max/parasitologia , Tylenchoidea/embriologia , Tylenchoidea/isolamento & purificação , Animais , Proteínas de Caenorhabditis elegans/biossíntese , Proteínas de Caenorhabditis elegans/genética , Centrifugação com Gradiente de Concentração/métodos , DNA Complementar/biossíntese , Feminino , Regulação da Expressão Gênica no Desenvolvimento , Proteínas de Helminto/biossíntese , Proteínas de Helminto/genética , Metaloendopeptidases/biossíntese , Metaloendopeptidases/genética , Óvulo , RNA de Helmintos/genética , RNA de Helmintos/isolamento & purificação , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Tylenchoidea/genética
7.
Sex Transm Infect ; 78(3): 190-3, 2002 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12238651

RESUMO

OBJECTIVES: Few data are available on the prevalence of sexually transmitted diseases (STDs) in men who have sex with men (MSM), making it difficult to develop STD screening guidelines for this population. The objective of the study was to determine the prevalence of urethral infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae within a large, community based population of MSM, and to assess the feasibility of rectal screening in this population. METHODS: This was a cross sectional study of 566 MSM, who were predominantly middle aged, white, asymptomatic, and engaged in sex with multiple partners. All provided a urine sample to screen for chlamydial and gonorrhoea infections using a PCR assay; rectal screening was performed on 48 participants. RESULTS: Urethral C. trachomatis infections were detected in 1/566 participants (prevalence 0.2%, 95% CI 0.004% to 1.0%), and rectal C. trachomatis infections were detected in 2/48 men (prevalence 4.2%, 95% CI 0.5% to 14.2%). No gonorrhoea infections were detected, and none of the 117 HIV positive men had either infection. CONCLUSIONS: Chlamydial and gonorrhoea infections were uncommon in this sample of MSM, even among those with multiple sexual partners or HIV infection. These data call into question recommendations to screen all MSM based on their individual sexual behaviours or HIV. Additional data are needed on the prevalence of these infections in MSM from different settings.


Assuntos
Infecções por Chlamydia/epidemiologia , Gonorreia/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Chlamydia/diagnóstico , Chlamydia trachomatis/isolamento & purificação , Preservativos/estatística & dados numéricos , Estudos Transversais , Gonorreia/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Illinois/epidemiologia , Masculino , Pessoa de Meia-Idade , Neisseria gonorrhoeae/isolamento & purificação , Doenças Retais/microbiologia , Assunção de Riscos , Sensibilidade e Especificidade , Parceiros Sexuais
8.
J Gen Intern Med ; 16(2): 83-8, 2001 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-11251758

RESUMO

OBJECTIVE: To examine the relation between problem drinking and medication adherence among persons with HIV infection. DESIGN: Cross-sectional survey. SETTING/PARTICIPANTS: Two hundred twelve persons with HIV infection who visited 2 outpatient clinics between December 1997 and February 1998. MEASUREMENTS AND MAIN RESULTS: Nineteen percent of subjects reported problem drinking during the previous month, 14% missed at least 1 dose of medication within the previous 24 hours, and 30% did not take their medications as scheduled during the previous week. Problem drinkers were slightly more likely to report a missed dose (17% vs 12 %, P =.38) and significantly more likely to report taking medicines off schedule (45% vs 26%, P =.02). Among drinking subtypes, taking medications off schedule was significantly associated with both heavy drinking (high quantity/frequency) (adjusted odds ratio [OR], 4.70; 95% confidence interval [95% CI], 1.49 to 14.84; P <.05) and hazardous drinking (adjusted OR, 2.64; 95% CI, 1.07 to 6.53; P <.05). Problem drinkers were more likely to report missing medications because of forgetting (48% vs 35%, P =.10), running out of medications (15% vs 8%, P =.16), and consuming alcohol or drugs (26 % vs 3 %, P <.001). CONCLUSION: Problem drinking is associated with decreased medication adherence, particularly with taking medications off schedule during the previous week. Clinicians should assess for alcohol problems, link alcohol use severity to potential adherence problems, and monitor outcomes in both alcohol consumption and medication adherence.


Assuntos
Alcoolismo/complicações , Infecções por HIV/tratamento farmacológico , Cooperação do Paciente/psicologia , Adulto , Estudos Transversais , Feminino , Infecções por HIV/complicações , Infecções por HIV/psicologia , Humanos , Masculino , Análise Multivariada , Razão de Chances
9.
J Adolesc Health ; 28(3): 204-10, 2001 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11226843

RESUMO

PURPOSE: To determine the proportion of primary care physicians who screen sexually active teenage women for chlamydia and to determine demographic factors, practice characteristics, and attitudes associated with chlamydia screening. METHODS: We obtained a random sample of 1600 Pennsylvania physicians from the American Medical Association masterfile, stratified to include at least 40% women and equal numbers of family physicians, internists, obstetricians/gynecologists, and pediatricians. In January 1998, physicians received mailed questionnaires; nonrespondents received two follow-up mailings. Physician characteristics associated with chlamydia screening were determined using bivariate and logistic regression analyses. RESULTS: Only one-third of physicians responded that they would screen asymptomatic, sexually active teenage women for chlamydia during a routine gynecologic examination. In multivariate analysis, physicians were significantly (p <.05) more likely to screen if they were female (43% vs. 24%), worked in a clinic versus solo practice (60% vs. 18%), worked in a metropolitan location (46% vs. 26%), or had a patient population > or = 20% African-American (54% vs. 25%). Attitudes associated with screening included the belief that most 18-year-old women in their practice were sexually active (36% vs. 12%), feeling responsible for providing information about the prevention of sexually transmitted diseases to their patients (42% vs. 21%), or knowing that screening for chlamydia prevents pelvic inflammatory disease (37% vs. 13%). Physicians were less likely to screen if they believed that the prevalence of chlamydia was low (10% vs. 41%). CONCLUSIONS: A majority of physicians do not adhere to recommended chlamydia screening practices for teenage women. Interventions to improve chlamydia screening might target physicians who are male, in private practice, or who practice in rural areas, and should focus on increasing awareness of the prevalence of chlamydia and benefits of screening.


Assuntos
Atitude do Pessoal de Saúde , Infecções por Chlamydia/prevenção & controle , Programas de Rastreamento , Padrões de Prática Médica , Atenção Primária à Saúde , Adolescente , Adulto , Feminino , Fidelidade a Diretrizes , Humanos , Modelos Logísticos , Masculino , Análise Multivariada , Pennsylvania , Comportamento Sexual , Serviços de Saúde da Mulher
10.
Clin Infect Dis ; 28(5): 1002-7, 1999 May.
Artigo em Inglês | MEDLINE | ID: mdl-10452625

RESUMO

This study sought to determine factors associated with chlamydial infection in a low-prevalence college health setting and to determine the testing characteristics of a polymerase chain reaction (PCR) assay for chlamydial infection (AMPLICOR chlamydia test; Roche Diagnostic Systems, Indianapolis) in this population. Young women (n = 1,149) at a university student health clinic underwent testing for cervical chlamydial infection by PCR assay and culture; the characteristics of women with and without chlamydial infection were compared. Chlamydial infection was diagnosed for 26 students (2.3%). The sensitivity and specificity of PCR assay and culture were 85% and 100% and 54% and 100%, respectively. Students with chlamydial infection were more likely to be 20 years of age or younger, have symptoms, report prior chlamydial infection or gonorrhea, report exposure to a sexually transmitted disease (STD), be black, or have cervical signs during examination; however, none of these were significant predictors for asymptomatic women. PCR assay detected significantly more cervical infections than did culture in this college student population. These data are consistent with recommendations for testing college women with symptoms, STD exposure, or age of younger than 25 years.


Assuntos
Infecções por Chlamydia/diagnóstico , Chlamydia trachomatis , Reação em Cadeia da Polimerase , Adulto , Fatores Etários , Infecções por Chlamydia/epidemiologia , Estudos de Avaliação como Assunto , Feminino , Humanos , Modelos Logísticos , Programas de Rastreamento , Prevalência , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade
11.
Ann Intern Med ; 131(2): 136-43, 1999 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-10419430

RESUMO

Treatment advances and outcomes data have raised new concerns about how to optimize care for patients with HIV infection. This paper reviews evidence on 1) the relation between experience and type of training and patient outcomes, 2) the relation between the components of primary care and patient outcomes, and 3) primary care physicians' basic HIV knowledge and skills in screening and prevention. Several studies indicate that greater experience in HIV care leads to improved patient outcomes. The relation between outcomes and type of training (subspecialist or generalist) is less clear, and studies have not distinguished between type of training and experience. Less experienced physicians may be able to provide high-quality care if appropriate consultation from expert physicians is available. Components of primary care, including accessibility, continuity, coordination, and comprehensiveness, are associated with better patient outcomes. Optimal care of HIV infection requires a combination of disease-specific expertise and primary care skills and organization. Criteria for expertise in HIV management should focus on actual patient care experience and HIV expertise rather than on subspecialty training per se. The management of HIV has become sufficiently complex that primary care physicians cannot be routinely expected to have extensive specialized knowledge in this area. However, many primary care physicians have weaknesses in the basic HIV-related skills that are needed in most settings, such as HIV test counseling and recognition of important HIV-related symptom complexes. Primary care physicians need to strengthen these basic HIV-related medical skills.


Assuntos
Competência Clínica , Infecções por HIV/terapia , Conhecimentos, Atitudes e Prática em Saúde , Avaliação de Resultados em Cuidados de Saúde , Médicos de Família/normas , Humanos , Garantia da Qualidade dos Cuidados de Saúde
12.
Am J Public Health ; 89(3): 369-73, 1999 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-10076487

RESUMO

OBJECTIVES: The purpose of this study was to determine whether county syphilis rates were increased along Interstate Highway 95 (I-95) in North Carolina during a recent epidemic. METHODS: Ecological data on syphilis cases demographic data, highway data, and drug activity data were used to conduct a cross-sectional and longitudinal study of North Carolina countries from 1985 to 1994. Crude and adjusted incidence rate ratios (IRRs) were determined by means of standard and longitudinal Poisson regression models adjusted for sociodemographic factors and drug use. RESULTS: Ten-year syphilis rates in I-95 counties greatly exceeded rates in non-I-95 counties (38 vs 16 cases per 100,000 persons) and remained higher after adjustment for race, age, sex, poverty, large cities, and drug activity (adjusted IRR = 2.05, 95% confidence interval [CI] = 1.84, 2.28). Syphilis rates were stable until 1989, when rates increased sharply in I-95 counties but remained stable in non-I-95 counties. Increased drug activity in I-95 counties preceded the rise in syphilis cases. CONCLUSIONS: A better understanding of the relationship between high-ways and the spread of sexually transmitted diseases may guide future prevention interventions.


Assuntos
Surtos de Doenças/estatística & dados numéricos , Saúde da População Rural , Sífilis/epidemiologia , Meios de Transporte , Adulto , Estudos Transversais , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , North Carolina/epidemiologia , Vigilância da População , Análise de Regressão , Características de Residência , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/complicações , Sífilis/transmissão
13.
Appl Opt ; 38(9): 1467-75, 1999 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-18305768

RESUMO

A compact, pulsed Nd:YAG laser-based instrument has been built to measure in situ absolute gas temperatures in large industrial furnaces by use of spontaneous anti-Stokes Raman scattering. The backscattering configuration was used to simplify the optics alignment and increase signal-to-noise ratios. Gated signal detection significantly reduced the background emission that is found in combustion environments. The anti-Stokes instead of the Stokes component was used to eliminate contributions to spectra from cold atmospheric nitrogen. The system was evaluated in a methane/air flame and in a bench-top oven, and the technique was found to be a reliable tool for nonintrusive absolute temperature measurements with relatively clean gas streams. A water-cooled insertion probe was integrated with the Raman system for measurement of the temperature profiles inside an industrial furnace. Gas temperatures near 1500-1800 K at atmospheric pressure in an industrial furnace were inferred by fitting calculated profiles to experimental spectra with a standard deviation of less than 1% for averaging times of approximately 200 s. The temperatures inferred from Raman spectra are in good agreement with data recorded with a thermocouple probe.

14.
Acad Med ; 73(4): 423-6, 1998 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-9580720

RESUMO

PURPOSE: To examine the benefits of the shift of medical education into ambulatory primary care settings by investigating whether medical students exposed to a common primary care problem (low back pain) in ambulatory care settings develop better clinical skills. METHOD: In 1995, the authors categorized 420 students from all four North-Carolina medical schools into groups that had previously encountered patients with low back pain in ambulatory primary care settings, tertiary care settings, both, or neither. The clinical skills of the groups were determined using data collected during standardized-patient examination in which students took the history of, physically examined, and chose a diagnostic strategy for patients with acute, uncomplicated low back pain. RESULTS: In general, there was no difference between the performances of the student groups associated with the settings of their previous encounters with low back pain. On average, the students failed to ask 35% of the history items and failed to perform 35% of the physical examination items. Many students chose inappropriate diagnostic strategies. CONCLUSION: The lack of difference between the groups' clinical performances indicates a need to more rigorously define and evaluate outcomes of education in ambulatory care settings. The generally poor clinical performance of all groups suggests that the current curriculum inadequately teaches clinical skills needed to assess and manage common problems. Clearer expectations of competencies and assurances that preceptors in ambulatory care settings will help students meet those learning objectives might lead to better outcomes.


Assuntos
Estágio Clínico , Competência Clínica , Estudantes de Medicina , Assistência Ambulatorial , Análise de Variância , Distribuição de Qui-Quadrado , Currículo , Tomada de Decisões , Educação Médica , Avaliação Educacional/métodos , Hospitais , Humanos , Aprendizagem , Modelos Logísticos , Dor Lombar/diagnóstico , Dor Lombar/terapia , Anamnese , North Carolina , Simulação de Paciente , Exame Físico , Preceptoria , Atenção Primária à Saúde , Avaliação de Programas e Projetos de Saúde , Ensino/métodos
15.
Acad Med ; 73(3): 342-6, 1998 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-9526464

RESUMO

PURPOSE: To determine whether medical students were prepared to assess risk and counsel patients about prevention of HIV infection, and whether HIV-related experience produced better knowledge and counseling skills. METHOD: In 1995, students at four North Carolina medical schools interviewed a standardized patient portraying a young woman concerned about HIV infection. The standardized patient recorded whether students asked risk-behavior questions and provided risk-reduction advice. A 21-item questionnaire assessed the students' knowledge of HIV testing and prevention. Students indicated whether they had had experience in educational settings related to HIV or STDs. RESULTS: 415 students completed both the patient interview and the questionnaire. Many failed to ask the patient about several HIV-risk behaviors. Although nearly all (98%) inquired about condom use, fewer than two thirds asked about the patient's history of STDs, number of sexual partners, or specific sexual practices. Most students advised the patient to use condoms. The average score on the knowledge test was 79%; 70% of students confused anonymous with confidential testing, more than half overestimated the risk of HIV transmission from a needle stick, and nearly one in ten did not know how to use a condom. Educational exposures did not produce significantly better risk assessment, counseling information, or knowledge scores. CONCLUSION: A majority of experienced medical students did not assess several important risk factors of a patient concerned about HIV infection, and many would have provided incorrect information related to HIV testing and prevention of infection. Patient contact in traditional clinical settings did not influence prevention knowledge or behavior. More innovative methods are needed to train students in HIV-infection prevention and counseling.


Assuntos
Aconselhamento , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Estudantes de Medicina , Humanos , Fatores de Risco , Assunção de Riscos , Inquéritos e Questionários
16.
Sex Transm Dis ; 25(3): 144-50, 1998 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-9524992

RESUMO

BACKGROUND AND OBJECTIVES: There are conflicting opinions on whether to recommend spermicides containing nonoxynol-9 for prevention of sexually transmitted diseases, including human immunodeficiency virus (HIV). GOAL: To systematically review and summarize the medical literature on the effect of spermicides containing nonoxynol-9 on prevention of gonorrhea, chlamydial infection, and HIV. STUDY DESIGN: Meta-analysis. Potential articles were identified through computerized literature searches. Articles were included if the design was clinical trial, cohort, case-control, or cross-sectional; original outcome data were presented for gonorrhea, chlamydial infection, or HIV; and spermicides containing nonoxynol-9 were used separately from other barrier methods. Study characteristics including design, population, spermicide dose, and delivery method were abstracted. Relative risks (RR) and 95% confidence intervals (CI) were determined from information published in the study or from study authors. Summary risk estimates were computed for clinical trials. RESULTS: Twelve eligible articles were identified, including six clinical trials and six observational studies. Eleven articles evaluated gonorrhea; each found a reduced risk of infection with spermicide use. Among six clinical trials, the summary RR was 0.62 (95% CI, 0.49-0.78). The five articles evaluating chlamydial infection also found significant reduction among spermicide users, with the four clinical trials having a summary RR of 0.75 (95% CI, 0.62-0.91). The degree of spermicidal protection against gonorrhea and chlamydial infection did not differ materially among studies with different study designs or spermicidal preparations (i.e., sponge, gel, suppository, or film). Three studies evaluated degree of protection according to consistency of use and found stronger protection with more consistent use. The two studies on spermicidal prevention of HIV had contrasting results: An observational study found a significant protective effect (RR = 0.1), whereas a clinical trial found a nonsignificantly increased risk (RR = 1.7). CONCLUSIONS: Nonoxynol-9-containing spermicides have an appreciable protective effect against both gonorrhea and chlamydial infection, and wider use of spermicides might substantially reduce the incidence of these diseases. However, insufficient data exist to judge their effect on HIV transmission, and more research on the effect of nonoxynol-9 on HIV transmission is urgently needed to make evidence-based clinical decisions and public health recommendations in the future.


PIP: Computerized literature searches were conducted to identify, review, and summarize the medical literature on the effect of spermicides containing nonoxynol-9 in preventing gonorrhea, chlamydial infection, and HIV. 12 eligible articles were identified, including 6 clinical trials and 6 observational studies. Each of the 11 articles which evaluated gonorrhea found a reduced risk of infection with spermicide use, while the 5 articles evaluating chlamydial infection also found a significant reduction in infection among spermicide users. The available data show that nonoxynol-9-containing spermicides have an appreciable protective effect against both gonorrhea and chlamydial infection. The broad use of spermicides may therefore substantially reduce the incidence of those diseases. However, insufficient data exist to judge the effect of nonoxynol-9 upon HIV transmission.


Assuntos
Nonoxinol/uso terapêutico , Infecções Sexualmente Transmissíveis/prevenção & controle , Espermicidas/uso terapêutico , Infecções por Chlamydia/prevenção & controle , Feminino , Gonorreia/prevenção & controle , Infecções por HIV/prevenção & controle , Humanos , Masculino
17.
Int J Food Microbiol ; 36(2-3): 127-33, 1997 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-9217101

RESUMO

The recent ratification of the World Trade Organisation Agreement will arguably be the most important factor in developing new sanitary measures for the international trade in food over the next decade. There is a markedly increased desire for quantitative data on the microbial risks associated with different classes of foods, and traditional good manufacturing practice (GMP)-based food hygiene requirements are coming under increasing challenge. As the risk assessment paradigm is increasing applied and as decision-making criteria for risk management become established, more emphasis will be placed on predictive microbiology as a means of generating exposure data and establishing critical limits for Hazard Analysis Critical Control Point (HACCP) plans. In this respect, developing international guidelines for risk management arguably presents the greatest challenge in establishing and maintaining quantitative Sanitary and Phytosanitary (SP) measures for food in international trade, and for judging their equivalence. Where specific industry sectors and regulators do not have jurisdiction over the entire food chain, from production of raw materials through to consumption, it will be difficult to apply the risk assessment paradigm in the design of HACCP plans. Thus, it appears that default to food safety objectives for many segments of food production chains subject to application of HACCP plans is inevitable in the medium term.


Assuntos
Microbiologia de Alimentos , Medição de Risco , Humanos , Gestão de Riscos
18.
Plant Dis ; 81(11): 1335, 1997 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30861760

RESUMO

During July 1997, Epichloe typhina (Pers.:Fr.) Tul. in Tul. & C. Tul., the cause of choke disease, was found in four fields of an unnamed, experimental cultivar of orchardgrass (Dactylis glomerata L.) grown for seed near Halsey, OR. Disease occurrence in each of three fields was estimated by counting choked tillers in about 50 quadrats, 1 × 0.3 m, taken at 30-m intervals along three or four diagonal transects. In two fields, the disease was present in most quadrats (3% tillers infected). In the third field, choke was clustered in two areas, each with 1 to 8% infected tillers. A collection of E. typhina was deposited at the Oregon State University Mycological Herbarium (accession number 56,395). The disease had not been previously observed in commercial cultivars grown for seed in Oregon, with the exception of an infected tiller collected from an orchard-grass seed field during 1996. This is the first report of choke in Oregon on orchardgrass. Choke is an important disease in France, where it reduces seed yields of orchardgrass. Ten Oregon cultivars of orchardgrass were evaluated under field conditions in France in 1993 and 1994 for susceptibility to E. typhina. All cultivars were found susceptible to the disease; incidence of infected tillers ranged from 4 to 11%, with a mean of 7% (G. Sicard and R. E. Welty, unpublished). During 1996, several fragments of stroma of E. typhina were found among seed from a seed lot submitted to the Oregon State University Seed Lab for purity testing. This indicates that stroma may occur as a contaminant with seed, although it is not known if E. typhina would survive with the seed. E. typhina has not been reported to be seed-borne in orchardgrass.

19.
Int J Food Microbiol ; 29(2-3): 335-52, 1996 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-8796433

RESUMO

'Blown pack' spoilage of vacuum-packed chilled beef, lamb and venison, and of a cooked meat product, chilled dog rolls packed in an oxygen-impermeable plastic casing, was characterised by sensory, chemical and microbiological analysis. Investigation of the probable causative agents led to the isolation of eight strains of psychrotrophic clostridia. Three strains have been provisionally identified as C. difficile, C. beijerinckii and C. lituseburense; the other five remain unidentified. In inoculation studies only one isolate produced significant amount of gas on meat, causing pack 'blowing'. It is, therefore, possible that 'blown pack' spoilage involves a synergism with one or more other organisms.


Assuntos
Clostridium/isolamento & purificação , Contaminação de Alimentos/análise , Embalagem de Alimentos/métodos , Gases/análise , Produtos da Carne/microbiologia , Carne/microbiologia , Clostridium/citologia , Clostridium/crescimento & desenvolvimento , Microscopia Eletrônica , Temperatura , Vácuo
20.
Appl Opt ; 32(6): 894-8, 1993 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-20802764

RESUMO

A feasibility study of temperature measurement with multiplex HCl coherent anti-Stokes Raman spectroscopy (CARS) is investigated. The HCl CARS spectra of a 100% HCl gas sample are recorded in a quartz sample cell placed in a furnace at 1 atm pressure and at different temperatures. The nonlinear susceptibility of HCl (chi(nr)(HCl)), which is measured with the present CARS experimental setup, is reported. The experimental spectra are fit by using a library of simulated HCl CARS spectra with a least-squares-fitting program to infer the temperature. The inferred temperatures from HCl CARS spectra are in agreement with thermocouple temperatures.

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