Associations between migrant status and sexually transmitted infections among female sex workers in Tijuana, Mexico.

OBJECTIVE: To examine associations between migration and sexually transmitted infection (STI) prevalence among Mexican female sex workers (FSW). METHODS: FSW aged 18 years and older in Tijuana, Baja California (BC) underwent interviews and testing for HIV, syphilis, gonorrhoea and chlamydia. Multivariate logistic regressions identified correlates of STI. RESULTS: Of 471 FSW, 79% were migrants to BC. Among migrant FSW, prevalence of HIV, syphilis, gonorrhoea, chlamydia and any STI was 6.6%, 13.2%, 7.8%, 16.3% and 31.1% compared with 10.9%, 18.2%, 13.0%, 19.0% and 42.4% among FSW born in BC. A greater proportion of migrant FSW were registered with local health services and were ever tested for HIV. Migrant status was protective for any STI in unadjusted models (unadjusted odds ratio 0.61, 95% CI 0.39 to 0.97). In multivariate models controlling for confounders, migrant status was not associated with an elevated odds of STI acquisition and trended towards a protective association. CONCLUSIONS: Unexpectedly, migrant status (vs native-born status) appeared protective for any STI acquisition. It is unclear which social or economic conditions may protect against STI and whether these erode over time in migrants. Additional research is needed to inform our understanding of whether or how geography, variations in health capital, or social network composition and information-sharing attributes can contribute to health protective behaviours in migrant FSW. By capitalising on such mechanisms, efforts to preserve protective health behaviours in migrant FSW will help control STI in the population and may lead to the identification of strategies that are generalisable to other FSW.

AMKL chimeric transcription factors are potent inducers of leukemia.

Acute megakaryoblastic leukemia in patients without Down syndrome is a rare malignancy with a poor prognosis. RNA sequencing of fourteen pediatric cases previously identified novel fusion transcripts that are predicted to be pathological including CBFA2T3-GLIS2, GATA2-HOXA9, MN1-FLI and NIPBL-HOXB9. In contrast to CBFA2T3-GLIS2, which is insufficient to induce leukemia, we demonstrate that the introduction of GATA2-HOXA9, MN1-FLI1 or NIPBL-HOXB9 into murine bone marrow induces overt disease in syngeneic transplant models. With the exception of MN1, full penetrance was not achieved through the introduction of fusion partner genes alone, suggesting that the chimeric transcripts possess a unique gain-of-function phenotype. Leukemias were found to exhibit elements of the megakaryocyte erythroid progenitor gene expression program, as well as unique leukemia-specific signatures that contribute to transformation. Comprehensive genomic analyses of resultant murine tumors revealed few cooperating mutations confirming the strength of the fusion genes and their role as pathological drivers. These models are critical for both the understanding of the biology of disease as well as providing a tool for the identification of effective therapeutic agents in preclinical studies.

Second order theory of excitations in trapped bose condensates at finite temperatures

We present a finite temperature field theory for collective excitations of trapped Bose condensates which includes the dynamics of the thermal cloud. In spherical traps we show that excitations couple strongly to a small number of modes, giving resonance structure in their frequency spectra. Where possible, we derive energy shifts and lifetimes of excitations. For the l = 0 mode we show that the simple picture of a decay rate fails, which should be observable in suitable experiments. It also suggests a possible explanation for the anomalous behavior of the m = 0 mode observed in anisotropic traps.

Psychological adjustment in children after traumatic disfiguring injuries: a 12-month follow-up.

The psychological adjustment of 57 children (age range, 3 to 12 years) who sustained mutilating traumatic injuries to the face or upper or lower extremities was assessed over a 12-month interval. The injuries had occurred as a result of boating, lawn mower, or home accidents or dog bites. Within 5 days of the traumatic event, 98 percent of the children were symptomatic for posttraumatic stress disorder, depression, or anxiety. One month after the injury, 82 percent were symptomatic. Symptom frequency had declined by the time of the 3-month and 6-month evaluations, but 44 percent of the children continued to report symptoms at 12-month follow-up visits, and 21 percent met the diagnostic criteria for posttraumatic stress disorder. Typical symptoms included flashbacks, fear of re-injury, mood disorders, body-image changes secondary to disfigurement, sleep disturbances, and anxiety. These findings support the importance of psychological evaluation and treatment of children who suffer mutilating injuries that require the attention of plastic surgeons.

The longitudinal association of venue stability with consistent condom use among female sex workers in two Mexico-USA border cities.

We examined the relationship between venue stability and consistent condom use (CCU) among female sex workers who inject drugs (FSW-IDUs; n = 584) and were enrolled in a behavioural intervention in two Mexico-USA border cities. Using a generalized estimating equation approach stratified by client type and city, we found venue stability affected CCU. In Tijuana, operating primarily indoors was significantly associated with a four-fold increase in the odds of CCU among regular clients (odds ratio [OR]: 3.77, 95% confidence interval [CI]: 1.44, 9.89), and a seven-fold increase among casual clients (OR: 7.18, 95% CI: 2.32, 22.21), relative to FSW-IDUs spending equal time between indoor and outdoor sex work venues. In Ciudad Juarez, the trajectory of CCU increased over time and was highest among those operating primarily indoors. Results from this analysis highlight the importance of considering local mobility, including venue type and venue stability, as these characteristics jointly influence HIV risk behaviours.

Mapping violence and policing as an environmental-structural barrier to health service and syringe availability among substance-using women in street-level sex work.

BACKGROUND: Within street-based sex work and substance-using populations, there is growing evidence to support the role of place, both physical setting and social meanings attached to place, in mediating the effectiveness and reach of health and harm reduction services. METHODS: Social mapping was used to explore how health service and syringe availability may be impacted at the geographic level by avoidance of physical settings due to violence and policing among women in street-level sex work. Through a community-based research partnership and extensive peer-led outreach over a 6-month period, women were invited to participate in interview-questionnaires and mapping of their community, working conditions, and access to resources. Results were compiled used ArcGIS software and GIS street maps. In secondary analysis, logistic regression was used to model the geographic association (using likelihood ratio and significance at p<0.05) and stratified models were run to assess differential patterns of avoidance based on age, ethnicity and drug use. RESULTS: The findings reveal a significant geographic relationship between a heavily concentrated core area of health and syringe availability and avoidance of physical settings due to violence and policing by 198 women in street-level sex work in Vancouver, Canada. Of particular concern, this correlation is significantly elevated among younger and Aboriginal women, active injection drug users, and daily crack cocaine smokers, suggesting significant environmental-structural barriers to interventions among these vulnerable populations. CONCLUSIONS: The resultant displacement of sex work to primarily industrial settings and side streets pushes women further from health and social supports and reduces access to safer injection and drug use paraphernalia. This study offers important evidence for environmental-structural level prevention and safer environment interventions, supported by legal reforms, that facilitate safer sex work environments, including spatial programming, peer-based prevention, outreach and mobile resources, and peer-supervised safer sex work settings.

Psychological response to trauma.

Severe traumatic injuries to the hands, extremities, and face can produce significant psychological reactions. Adjustment problems are more pronounced when the injuries result in disfigurement and significant loss of function. Long after the traumatic event, persistent fear, depression, avoidance, and body image changes result in substantial impairment in personal, social, and occupational functioning.

Characteristic pattern and management of intra-articular knee lesions in different pediatric age groups.

Posttraumatic hemarthrosis of the knee joint usually leads to arthroscopy. In a retrospective study we defined an age-specific spectrum of injuries and, subsequently, assigned an age-dependent diagnostic management for children up to 16 years. From January 1986 to December 1996, 1,273 patients up to 16 years of age with knee trauma presented to the emergency department. Overall, soft-tissue lesions prevailed (82%). Hemarthrosis occurred in only 18.0%. The patients were classified in three groups: group 1 (528 children younger than 10 years of age) with hemarthrosis in only 5.7% (mainly metaphyseal fractures and patellar dislocations), group 2 (207 preadolescents from 11 to 12 years of age) with hemarthrosis in 17.9% (patellar dislocations and fractures), and group 3 (538 adolescents between the age of 13 and 16 years) with hemarthrosis in 30.3% (main findings were intra-articular fractures and patellar dislocations, additionally, 16 ligamentous and two meniscal lesions). Correspondingly, physical examination, conventional radiography, and magnetic resonance imaging (most appropriate diagnostic tool for patellar dislocation) were sufficient to reveal injuries in children up to 13 years of age. Arthroscopy was predominantly justified in those older than 13 years of age, but only if it leads to therapeutic consequences.

Use of antiretroviral therapy among HIV positive individuals living in British Columbia.

The objective of this study was to examine the level of antiretroviral use and characterize individuals accessing antiretroviral therapy in British Columbia. The study was conducted by the British Columbia Persons with AIDS Society and the British Columbia Centre for Excellence in HIV/AIDS. Self-administered questionnaires were mailed out to HIV-positive members from May to September of 2002. Comparisons of sociodemographic characteristics and disease status were made using Pearson's Chi2 and the Kruskal-Wallis test for continuous variables. A total of 764 (51%) HIV-positive participants returned the questionnaire. Of these, 80% reported ever using antiretroviral therapy and 64.5% indicated current use. Reasons for never taking antiretroviral therapy were high CD4 or doctor's advice (74/126; 59%), feeling healthy (50/126; 40%) and being afraid of side-effects (35/126; 28%). Those reporting current antiretroviral use were more likely to be older (p<0.001), white (p=0.01), male (p<0.001), gay or bisexual (p<0.001), graduated from high school (p=0.001), non-injecting drug user (IDU) (p<0.001) and earning a household income greater than CAN$10,000/year (p=0.003). IDU status and length of time since diagnosis remained significantly associated with antiretroviral use in multivariate models. The differences in current antiretroviral use by sociodemographic characteristics such as IDU suggest that the need remains to target marginalized populations in order to maximize the health benefits from antiretroviral therapy.

Psychometric assessment of patients with chronic upper extremity pain attributed to workplace exposure.

Upper extremity pain attributed to workplace exposure is a growing concern in medicine today. This study was undertaken to investigate the psychological findings in patients with chronic upper extremity pain attributed to workplace exposure. Sixty-three consecutive patients were evaluated. All patients underwent a history and physical examination by a hand surgeon and a psychological evaluation by a licensed psychologist, including a Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Physical and psychological findings were then compared. Forty-one patients (65%) showed abnormalities on MMPI-2 examination (t score > 70 = 97% confidence). This result is far above what generally would be expected in medical patients. When physical findings were grouped with psychological findings, 5 distinct groups were identified: 1 patient had normal physical and psychological results, 6 patients had normal physical findings but abnormal psychological assessments, 21 patients had abnormal physical findings but normal psychological assessments, 28 patients had both abnormal physical and psychological findings, and 7 patients had abnormal physical results but invalid MMPI-2 evaluations due to purposeful attempts to deny psychological symptoms. Identification of these groups may have diagnostic, prognostic, and treatment value. In addition, identification of these groups may help clarify several aspects of the debate over the role of psychosocial factors in the development and maintenance of chronic upper extremity pain that patients attribute to workplace exposure.

Quantitative test of thermal field theory for Bose-Einstein condensates.

We present numerical results from a second-order quantum field theory of Bose-Einstein condensates applied to the 1997 JILA experiment [Phys. Rev. Lett. 78, 764 (1997)]]. Good agreement is found for the energies and decay rates for both the lowest-energy m=2 and m=0 modes. The anomalous behavior of the m=0 mode is due to experimental perturbation of the noncondensate. The theory is gapless and includes the coupled dynamics of the condensate and thermal cloud, the anomalous pair average, and all relevant finite size effects.

Hemarthrosis after trauma to the pediatric knee joint: what is the value of magnetic resonance imaging in the diagnostic algorithm?

In children, compulsory arthroscopy for hemarthrosis after knee trauma is not justified because ligamentous and meniscal damage is rare. In a prospective study, we analyzed the diagnostic value of radiography, magnetic resonance imaging (MRI), and arthroscopy in 51 patients up to 14 years of age with acute knee trauma. Plain radiography revealed 16 osseous lesions (5 metaphyseal, 3 patellar, 4 physeal fractures, 3 avulsions of the tibial spine, and 1 osseous ligamentous tear). In 29 patients, the cause of hemarthrosis remained unclear. All patients were evaluated by MRI. A diagnosis could be assigned to all 29 patients. MRI demonstrated lesions in 38 patients. In addition, the following lesions were discovered: 8 patellar dislocations, 13 bruises, 1 rupture of the anterior cruciate ligament, 1 osteochondritis dissecans, and 13 joint effusions. In 13 patients, MRI was followed by arthroscopy to confirm the diagnosis. Both, MRI and arthroscopy missed two osteochondral fractures. In addition, three chondral lesions were not picked up by MRI. MRI is a reliable tool for assessing the extent of knee lesions in children.