Hepatitis B: perceptions, knowledge and vaccine acceptance among registered nurses in high-risk occupations in a university hospital.

We employed a questionnaire to survey 334 registered nurses regarding their knowledge, perceptions and vaccine acceptance for Hepatitis B virus (HBV) infections. The study population was those persons working in areas considered at high-risk for contracting HBV. The nurses were asked to provide information regarding blood and body fluid exposures and the reporting of these exposures. The questionnaire was completed by 169 nurses (50.6%). Less than half of the respondents (42%) had been vaccinated. We found that 13 of 14 black nurses, compared to 85 of 154 nonblack nurses, had not been vaccinated (p less than .01). No other demographic differences between recipients and nonrecipients were noted. Partially or totally incorrect answers regarding transmittal knowledge were given by 108 of 160 (68%) respondents. Reasons for failure to be vaccinated were varied. Fear of side effects of the vaccine, contracting AIDS or hepatitis from the vaccine, or doubt of efficacy of the vaccine were cited by 50 of 88 (58%) respondents as reasons for not being vaccinated. Inability to schedule an appointment or unawareness of the vaccine's availability were expressed by 23% and 17% of the individuals, respectively. Our data allow us to conclude that to improve vaccination compliance, the vaccine must be made more readily available, possibly through workplace on-site administration. Additionally, a concerted effort to educate our staff regarding HBV with particular emphasis on minorities is needed.

Pelvic actinomycosis and the intrauterine contraceptive device. A cyto-histomorphologic study.

In 350 pancervico-vaginal (Fast) smears obtained from women using intrauterine contraceptive devices, organisms consistent with Actinomycetes have been found. Actinomycetes, representing cervicitis, endometritis, and pelvic abscesses clinically, have been observed histologically in some of these cases. Special stains, immunofluorescence, and anaerobic cultures have confirmed these organisms to be Actinomyces israelii. Actinomyces in the Fast smear occur in isolated clumps, revealing branching, filamentous organisms, and sulfur granules. They can be detected and diagnosed in a Papanicolaou-stained routine pancervico-vaginal smear. This diagnosis in Fast smears can identify users of intrauterine contraceptive devices who may have Actinomyces infection in the genital tract and who are at risk of developing clinical disease related to this infection.

Peripartal cardiomyopathy.

Three patients with peripartal cardiomyopathy are presented. The clinical presentations of the patients are quite varied and demonstrate the wide spectrum of this syndrome. All three patients died of their disease. The clinical findings and necropsy evaluations are reviewed. Autopsy results were consistent with cardiomyopathy, and no etiologic factors were determined.

A correlative study of Papanicolaou smear, fluorescent antibody, and culture for the diagnosis of Chlamydia trachomatis.

A prospective study of 300 patients undergoing therapeutic termination of pregnancy was conducted. A Papanicolaou smear was obtained and a clinical evaluation of the cervix was made. Specimens from the cervix were examined by both direct fluorescent antibody and culture techniques for the presence of Chlamydia trachomatis. The presence of inflammation on Papanicolaou smear could be correlated with C trachomatis isolation. Papanicolaou smear findings consistent with C trachomatis lacked both sensitivity and specificity when compared with direct fluorescent antibody and/or culture techniques. A correlation was found between the clinical diagnosis of cervicitis and C trachomatis. This interrelationship was absent when the component findings of cervicitis (ectopy, friability, and purulent mucus) were examined independently.

Single-dose ampicillin for cesarean section prophylaxis.

A single 2-g dose of ampicillin or a placebo identical in appearance was administered intravenously in a randomized, prospective, double-blind manner to 71 patients undergoing cesarean section. The solutions were given either on call to the operating room or during the intraoperative period. Postoperative morbidity from infection occurred in 59.4% of patients receiving placebo and in 14.7% of those receiving ampicillin (P less than .0001). In those individuals undergoing primary cesarean section the incidence of infection with placebo was 65% and with ampicillin 6.3% (P less than .0004). In patients undergoing repeat cesarean section the incidence was 53% in the placebo group and 22% in the treatment group (P greater than .05). There were no differences in the effectiveness of the drug whether given preoperatively or intraoperatively. Serious infections and wound infections were not encountered in patients receiving ampicillin.

The relationship between recent cocaine use and pregnancy outcome.

We conducted urine screening for cocaine metabolite in 500 consecutive women admitted to a labor and delivery unit. The pregnancy outcome of 411 of the women was determined at that admission. The prevalence of cocaine-positive urines was 15.3% (95% confidence interval 11.8-18.8%). A subset of this population that had not received prenatal care had a prevalence of 62% (95% confidence interval 47.2-76.6%). Women with positive urines were almost four times more likely to have preterm labor and over twice as likely to deliver a premature infant or one with a 1-minute Apgar score of 6 or lower. Our findings support the concept that urine drug screening for cocaine and/or other drugs of abuse should be considered in patients who present with no prenatal care, premature labor, premature delivery, and delivery of an infant with a 1-minute Apgar score of 6 or less. This strategy may enable us to identify and bring to therapy a population of women that could potentially go unrecognized.

Unilateral ovarian abscess associated with the intrauterine device.

Four cases of primary ovarian abscess associated with intrauterine contraceptive devices are presented. It is proposed that both their unilaterality and the fact that they were primary in the ovary rather than tuboovarian are due to the fact that bacteria from the intrauterine device are shed continuously through the fallopian tubes, resulting in the inoculation of the corpus luteum, a unilateral structure. Removal of the ovarian abscess without additional surgical therapy is sufficient for a patient with this type of pelvic infection.

The minimum single oral metronidazole dose for treating trichomoniasis: a randomized, blinded study.

OBJECTIVE: To identify the minimum effective single oral dose of metronidazole for trichomoniasis. METHODS: Women attending an inner-city sexually transmitted disease clinic who had Trichomonas vaginalis vaginitis diagnosed by microscopy were recruited for this randomized, double-blind study. Subjects were given a 0.5-, 1-, 1.5-, or 2-g single oral dose of metronidazole, taken under direct observation. Demographic information, symptoms, and clinical findings were collected from patient interviews, and physical examinations were conducted at the time of enrollment and at the follow-up visit. The primary outcome measure was treatment success at the follow-up visit, established by negative culture and microscopy. RESULTS: Three (1.8%) of the 167 women enrolled were excluded because of vomiting after taking metronidazole, and 66 (40%) of the 164 remaining subjects did not return for the follow-up visit. No associations were found between the proportion of subjects lost to follow-up and the characteristics of these subjects across assignment groups. The treatment success ratio was highest in subjects who received the 1.5-g dose (23, 85%), followed by the 2-g (16, 84%), 1-g (18, 62%), and the 0.5-g dose (8, 35%). CONCLUSION: A single 1.5-g dose of metronidazole has efficacy equivalent to a single 2-g dose for the treatment of T vaginalis vaginitis.

The in vitro and in vivo effects of a surgical lubricant on the recovery of gonococci from the endocervical canal.

A surgical lubricant containing phenylmercuric borate, tested in vitro, was shown to alter the recovery of the gonococcus. In vivo studies of 150 patients, 60 (40%) of whom were infected with Neisseria gonorrhoeae, were performed to determine if examination with the surgical lubricant, as compared to tap water, altered the ability to recover N. gonorrhoeae from the cervix. Results indicated that although the surgical lubricant containing phenylmercuric borate was bacteriostatic in vitro, it did not alter the recovery of N. gonorrhoese from infected patients.

Cephalothin prophylaxis for midtrimester abortion.

A randomized prospective double-blind study was conducted to determine the efficacy of prophylactic antibiotics as compared with placebo in 198 women undergoing second-trimester intraamniotic injection abortions. Patients received either sodium cephalothin or placebo intravenously before the procedure and for up to 8 additional doses. In 11 patients postabortion endometritis developed; 2 had received the antibiotic and 9 had received a placebo (P less than .05). Prophylactic cephalothin decreased the incidence of endometritis in patients undergoing midtrimester injection abortion. An injection-abortion interval greater than 24 hours appears to identify patients at risk for the development of postabortion endometritis.

The clinical diagnosis of trichomoniasis.

Two hundred twenty-six consecutive women attending an inner-city clinic for sexually transmitted diseases were evaluated. Problem-directed histories and physical examinations were conducted and vaginal specimens for wet preparation and Trichomonas vaginalis culture were obtained from each patient. One hundred patients were found to be infected. Patients with multiple sex partners were found to be at increased risk of trichomoniasis (P less than .05). Those with abnormal discharge noted on examination had a higher frequency of positive cultures for T vaginalis (P less than .001). Only 50% of patients with trichomoniasis had an abnormal discharge. Patients with greater than 10 white blood cells per high power field on wet preparation, regardless of whether trichomonads were visualized, had a higher incidence of trichomoniasis (P less than .01). Factors that were not associated with Trichomonas infection included patient age, frequency of coitus, date of most recent coitus, day of menstrual cycle on which patient was examined, recent antibiotic use, use of contraceptives or specific contraceptive methods, symptoms of discharge or pruritus, or the finding of Leptothrix on wet preparation. These data support the contention that the classic description of trichomoniasis cannot be uniformly relied upon for diagnosis, but that patients with multiple sex partners, abnormal vaginal discharge and/or greater than 10 white blood cells per high power field on wet preparation are at increased risk of infection by T vaginalis.

Postabortal endometritis and isolation of Chlamydia trachomatis.

A prospective study of 505 unselected women presenting for induced abortion was undertaken to determine the prevalence of Chlamydia trachomatis and to determine if cervical isolation of C trachomatis before abortion increases the risk of postabortal endometritis. A comparison of direct fluorescent antibody (slide) test with tissue culture for diagnosing C trachomatis infection also was evaluated in this population. C trachomatis was identified by culture in 89 patients (17.6%) and by direct slide test in 85 patients (16.8%). Six of 17 patients with postabortal endometritis were culture positive for C trachomatis, with a significant correlation between C trachomatis infection and development of endometritis observed (P less than .05). These data suggest C trachomatis may play an important role in postabortal endometritis.

Pathogenicity of Trichomonas vaginalis: cytopathologic and histopathologic changes of the cervical epithelium.

Virulence of 52 Trichomonas vaginalis isolates was estimated by the subcutaneous mouse assay. A positive linear relationship was found between the mean volumes of subcutaneous abscesses caused by the parasites in mice and severity of cervical epithelial abnormalities observed in the patients from whom these strains had been isolated. This relationship implies that virulence of the human urogenital trichomonad, as measured by the mouse assay, may be related to some factors associated with dysplastic changes in the cervical epithelium. No relationships appeared to exist between the results of the mouse assay and inflammation of the vagina and cervix as evaluated clinically or pathologically, although these data were not analyzed statistically; likewise, no relationships were found between the mouse assay and nonprotozoal microorganisms identified in donors of the trichomonad strains.

Population surveillance for physical violence among adult men and women, Montana 1998.

BACKGROUND: Few epidemiologic studies of physical violence or intimate partner violence provide population-based surveillance data. OBJECTIVES: To estimate the prevalence and describe the characteristics associated with physical violence among adult men and women in the past year. METHODS: A random sample of Montana households was contacted via the Behavioral Risk Factor Surveillance System telephone survey in 1998 (N=1804). RESULTS: Five percent of men (39/787) and 3% of women (33/1017) reported experiencing physical violence in the past year. Among respondents reporting physical violence in the past year, women were more likely than men to report that the perpetrator was a current/former partner (58% vs 10%, p/=0.05). Men who reported experiencing physical violence in the past year were more likely to be younger and not to be living with a current partner. Women who reported experiencing physical violence in the past year were more likely to be younger, not currently living with a partner, have no health insurance, and have more days with mental health problems in the past month. CONCLUSIONS: Recent physical violence is common for both men and women; however, the perpetrators, locations, and demographic characteristics differ. Further study is needed to better understand the factors associated with physical violence among men and women in the context of designing and implementing appropriate interventions to reduce violence.

Bacteriologic culture results obtained before and after elective midtrimester urea abortion.

Twenty patients undergoing elective midtrimester abortion by urea amnioinfusion had bacteriologic culture data obtained before and after the procedure. Despite the presence of pathogens in the vagina and cervix prior to the procedure, only 20% of patients exhibited endometrial growth following abortion. Factors that seem to favor such endometrial growth include increased injection-abortion intervals and the requirement for curettage to manage incomplete abortion.

Epidemiology of sexually transmitted diseases.

The epidemiology of STDs is a vast topic. It includes examining not only the frequency of disease but also those factors that influence the frequency. It requires taking into account not only the characteristics of the infected persons and their risk factors but also the characteristics of the causative organisms. There is a commonality between various STDs that results in people frequently harboring one or more agent. In view of this, efforts should be made to evaluate patients for inapparent disease. Another important aspect is recognizing that patients do not acquire their infection except through sexual contact, indicating that another person is involved. Therefore, for control purposes, treatment of all sexual contacts also must be addressed.

Evaluation of the surgical treatment of vulvar vestibulitis.

OBJECTIVE: To assess the efficacy of perineoplasty in the management of vulvar vestibulitis. STUDY DESIGN: Forty-two women who had undergone operative perineoplasty for the treatment of vulvar vestibulitis completed a questionnaire, a mean of 4.8 years postoperatively. RESULTS: Vulvodynia was constant or daily in 29 (69%) before surgery and in eight (19%) of respondents after surgery. In all, 27 (80%) of 34 women who had preoperative vulvar discomfort reported that the discomfort was much better or absent following surgery. Before surgery, 26 (70%) of 37 women who were not celibate for reasons other than vulvar vestibulitis, were celibate because of vulvar vestibulitis or always had pain during coitus and sometimes had to discontinue coitus because of pain. In contrast, only two (5.7%) of 35 women had this degree of dyspareunia following surgery. Similarly, 28 (85%) of 33 sexually active women who had dyspareunia before surgery reported that intercourse was much less painful or pain-free following surgery. CONCLUSION: Perineoplasty has a role in the management of vulvar vestibulitis for women who do not achieve satisfactory relief of vulvodynia and/or dyspareunia with nonoperative treatments.

Pediatric primary care provider's knowledge of HIV/AIDS care.

To respond to the difficulties that community-based providers face in keeping abreast of the rapid changes in HIV-related care, an intensive pediatric HIV mentoring program (Pediatric HIV Miniresidency [MR]) was developed, linking a regional AIDS Education and Training Center (AETC) with an urban children's hospital HIV outpatient care site. The purpose of this study was to evaluate HIV-related knowledge and perceived skills, abilities, and willingness of community-based primary care pediatric providers and providers completing the MR. A convenience sample of community-based primary pediatric practitioners and those participants in the MR program completed a three-part mailed survey. The survey assessed practice characteristics, knowledge of pediatric HIV clinical care, and perceived skills, ability, and willingness (PSAW) to provide HIV-related care. The main outcome measures were overall knowledge and PSAW scores. One hundred nineteen community-based practitioners (NMRs), 20% of those surveyed, completed the instrument, as did 19 of 20 MR participants. NMRs exhibited low knowledge scores in key areas relating to the identification and evaluation of HIV-exposed children. Fewer than half of these respondents correctly answered questions related to HIV antibody incidence in HIV-exposed newborns and recommended diagnostic testing of such infants. Providers completing the MR scored significantly higher on the knowledge survey (15.2 vs. 8.8, p < 0.001), and had higher PSAW scores (45.8 vs. 33.9, p < 0.001). Although the generalizability of our study is limited by the low response rate, community-based physicians completing the survey demonstrated a lack of knowledge we believe necessary to provide pediatric HIV-related care (as defined by Public Health Service practice guidelines). Physicians completing the MR program had substantial HIV-related knowledge and expressed a willingness to provide care to HIV-exposed/infected children. An effective MR program provides a mechanism for developing a network of dedicated community-based physicians who are willing and capable of providing care to HIV-infected or exposed infants and children.

The cold sterilization of abortion cannulae.

The purpose of this study was to determine if cold sterilization is a feasible method for sterilizing abortion cannulae and, if so, to find the appropriate solutions and time intervals for this sterilization process. Study findings show that abortion cannulae can be cold sterilized by soaking them for a minimum of 10 minutes in a solution of Cidex or 95% ethanol. Soaking the cannulae for 20 minutes in a 2% tincture of iodine solution also appears to be useful for decontamination purposes.

Pelvic inflammatory disease.

Pelvic inflammatory disease (PID) is a genital tract infection that affects a predominantly young and sexually active population. While its exact pathogenesis has yet to be determined, it appears to be caused by several micro-organisms that develop in response to one or more of the following: foreign bodies, such as intrauterine contraceptive devices, retained tampons and douching solutions, and surgery, such as endometrial biopsy and hysterosalpingography. The most common risk factor for PID is multiple sexual partners. The disease is associated with infertility, sterility and adverse pregnancy outcomes. Management calls for aggressive antibiotic therapy and the temporary suspension of sexual activity.