Improved contact tracing for Chlamydia trachomatis with experienced tracers, tracing for one year back in time and interviewing by phone in remote areas.

OBJECTIVES: To evaluate the Swedish model for contact tracing and especially the "Västerbotten model" with centralised, extended contact interview periods, sometimes by telephone. METHODS: Using questionnaires, the contact tracing and interview procedure was evaluated during 2002, followed by an evaluation of contact interviewing by phone in 2005-6. RESULTS: Patients with diagnosed Chlamydia trachomatis infection reported on average 2.5 sexual contacts, 3.0 contacts when contact interviewing was performed at the clinic, and 2.3 contacts when performed by phone. 65% of the sexual contacts with a known test result were infected. CONCLUSION: Centralised contact tracing, exploring the sexual history for at least 12 months back in time, shows good results. Combined with screening of certain risk groups it is probably one effective way of preventing C trachomatis infections. Preventing C trachomatis by primary prevention such as information and counselling is, however, still of great importance.

Lp(a) lipoprotein, IgG, IgA and IgM antibodies to Chlamydia pneumoniae and HLA class II genotype in early coronary artery disease.

The associations previously found between lipoprotein(a) (Lp(a)) levels and atherosclerotic disorders, diabetes, rheumatoid arthritis and renal diseases suggest that Lp(a) may be involved in autoimmune reactions. The relation found between Lp(a) levels and the HLA class II genotype in males with early coronary artery disease (CAD) further support that assumption. It was suggested that an autoimmune process, perhaps triggered by a concomitant intracellular infection may occur especially in patients with inherited high Lp(a) levels in combination with certain inherited HLA class II genotypes. In this study a Chlamydia pneumoniae IgG titer > or = 32 was significantly more common (P = 0.036) in CAD patients than in matched controls. This is in agreement with previous reports by other investigators. In addition, an IgG titer > or = 256 in combination with an Lp(a) level > or = 120 mg/l was found to occur significantly more often (P = 0.011) in male patients than in male controls. Certain HLA class II DR genotypes in combination with high Lp(a) levels and C. pneumoniae titers occurred more frequently in both male and female patients than in controls. Some combinations were very common in male patients, and the difference in comparison with male controls was highly significant.

Failure to demonstrate Chlamydia pneumoniae in cardiovascular tissue from children with Kawasaki disease.

Chlamydia pneumoniae has been associated with atherosclerosis and myocardial infarction in adults. Coronary artery tissues of five fatal cases of Kawasaki disease were examined by PCR; none was positive.

A preliminary evaluation of a new enzyme immunoassay to detect Chlamydia pneumoniae-specific antibodies.

New enzyme immunoassays (EIAs) for determination of specific IgG, IgA, and IgM antibody titers to Chlamydia pneumoniae were evaluated independently in three research laboratories. Specificity of the EIAs was enhanced by removing LPS from the chlamydial antigen. The performance of these EIAs was evaluated in comparison with the microimmunofluorescence (MIF) test using specimens from: (i) a group of adult patients with community-acquired pneumonia (CAP) previously diagnosed as having an acute chlamydial infection by the complement fixation test or the whole inclusion fluorescence test; (ii) from a group of adult patients with acute respiratory tract infections; and (iii) from a group of young children consecutively presenting with acute respiratory tract infections. The MIF test and the EIAs detected acute infections in paired serum specimens from 12 of 14 patients from the first group. Eleven of these 12 patients were positive in both tests. The MIF test detected seven acute infections in single convalescence serum specimens from eight patients. Two of these were also positive in the EIAs. Paired serum specimens from the second group of adult patients (n=12) were collected during an epidemic of C. pneumoniae. The EIAs detected six acute infections. The MIF test detected two additional patients with acute infections. From the group of young children (n=30), the EIAs detected two patients with acute infections. Our conclusion from this preliminary evaluation is that these EIAs could be useful for laboratory diagnosis of acute C. pneumoniae infections. Comprehensive prospective studies should provide suitable data to calculate the sensitivity, specificity, and predictive values.

Antibodies against Chlamydia pneumoniae, cytomegalovirus, enteroviruses and respiratory syncytial virus in patients with polymyalgia rheumatica.

OBJECTIVES: To investigate the association between the onset of polymyalgia rheumatica (PMR) and prior or persistent infection with Chlamydia pneumoniae or cytomegalovirus (CMV) (both known to infect the vessel wall) enteroviruses (EV) or respiratory syncytial virus (RSV). METHODS: Serum samples were collected from 48 patients with newly-diagnosed PMR and from 22 controls of the same age. The presence of IgG, IgA and IgM antibodies to C. pneumoniae, IgG and IgM antibodies to CMV and EV, and complement fixing antibodies to RSV were analysed. RESULTS: Clinical symptoms of infection preceding PMR symptoms were associated with the presence of synovitis at the first visit. There were no significant differences in the seroprevalence rates of antibodies to C. pneumoniae, CMV, EV or RSV between PMR patients and controls. IgM antibodies to EV were found in two patients and IgM antibodies to CMV in another two patients. CONCLUSION: Serological evidence of an association between newly-diagnosed PMR and prior or chronic infection with C. pneumoniae was not found. IgM antibodies to EV in two patients, consistent with ongoing or recent infection, suggest that EV could represent one of perhaps several microbes which are able to trigger PMR.

Etiology of small bowel obstruction.

BACKGROUND: Small bowel obstruction (SBO) is a major cause of morbidity and financial expenditure in hospitals around the world. The leading cause of SBO in the western world has become adhesions. The goal of this study was to determine the causes of SBO. METHODS: The medical records of all patients admitted to one hospital between 1986 and 1996 with the diagnosis of SBO were reviewed retrospectively. This included 552 patients accounting for 1,001 admissions. RESULTS: The etiology of SBO was adhesions (74%), Crohn's disease (7%), neoplasia (5%), hernia (2%), radiation (1%), and miscellaneous (11%). Patients with Crohn's disease were younger than patients with other etiologies. Surprisingly, recurrence rates were similar for patients treated operatively as for those treated nonoperatively with the exception in the hernia group where higher recurrence rates were noted for patients initially treated in a nonoperative manner. CONCLUSION: The most common cause of SBO is adhesions followed by Crohn's disease and neoplasia.

Glomerular basement membrane antibodies in hantavirus disease (hemorrhagic fever with renal syndrome).

The prevalence of antibodies against glomerular basement membrane (GBM) antigens in sera from 47 patients with serologically verified hantavirus (Puumala serotype) infection were investigated. Antibodies were measured by immunoassays using as antigen a crude human GBM preparation and the NC1 portion of type IV collagen (Goodpasture antigen), respectively. Seventy-seven percent of the patients had IgM antibodies against the non-Goodpasture glomerular basement membrane (non-GP GBM) in their acute phase serum samples as compared to only 4% seropositivity rate in convalescent phase samples. However, there was no correlation between the non-GP GBM IgM antibody levels and the decrease in GFR as measured by Cr EDTA clearance. None of the patients had antibodies against the Goodpasture antigen. In a control group of 10 patients with influenza and parainfluenza infections serum IgM against non-GP GBM could not be demonstrated, neither in acute phase nor in convalescent phase sera. The possible pathophysiological implications of these findings are discussed.

Patterns of breastfeeding and work: the Canadian experience.

Monthly semi-structured interviews were conducted with 61 mothers who intended to continue breastfeeding after they returned to work. Thirty-six mothers successfully combined breastfeeding and work for a mean of 18.05 weeks. Characteristics of their employment and five strategies used to facilitate the transition from breastfeeding on demand to acquiring a new pattern of breastfeeding to manage lactation in the workplace are described. Revised definitions for patterns of mixed feeding and recommendations for research and practice are included.

Facilitating student involvement in large classroom settings.

Diminishing resources and increasing student enrollment in the basic and post-basic programs at the Faculty of Nursing, University of Alberta, have led to large teacher-student ratios in the area of classroom lectures. This article is a discussion about the issue of student involvement in the learning process where there may be 100 or more students in one class. The meaning of student involvement, factors which inhibit student involvement, and strategies to increase student involvement in a large classroom situation are addressed.

[Arteriosclerosis caused by infection? A possible link between Chlamydia pneumoniae and atherosclerosis]. / Infektion orsakar åderförkalkning? Möjligt samband mellan Chlamydia pneumoniae och ateroskleros.

Infection as a possible underlying cause of atherosclerosis has aroused increasing interest in recent years, Chlamydia pneumoniae being one of the organisms upon which attention has been focused. Newly published results of antibiotic treatment of vascular disease not only appear to provide further support for the infection hypothesis, but also suggest a quite different approach to the treatment of atheromatous cardiovascular disease. However, confirmatory clinical trials will be needed before antibiotic treatment can be considered in such cases.

Estramustine versus conventional estrogenic hormones in the initial treatment of highly or moderately differentiated prostatic carcinoma. A randomized study.

In a prospective randomized multicenter trial patients with highly or moderately differentiated prostatic carcinoma, previously untreated, were allotted either to oral Estramustine phosphate or to intramuscular polyestradiol phosphate plus oral ethinyl estradiol. As regards frequency and duration of tumour remission there was no statistical difference between the two groups. Nor did they differ significantly with respect to adverse reactions. This is an interim report and will be followed later on by a final evaluation.

Intra-urban air pollution in a rapidly growing Sahelian city.

In this paper we analyze spatial and temporal variations of air pollution (PM(1), PM(2.5), PM(10), CO, NO(x), O(3), Toluene and Benzene) and climate in areas of different development typology in Ouagadougou, Burkina Faso. Analyses are based on measurements from fixed sites and car traverse measurements during field studies in 2007 and 2010. Large spatial and temporal variations were found, showing a generally poor air quality situation, with extreme levels of PM(10), commonly exceeding air quality guidelines of WHO. Pollution levels increase considerably with increased atmospheric stability. Important sources were transported dust and re-suspension of dust from unpaved roads, but also traffic emissions and biomass burning. The spatial variations are examined with focus on effects for variations in potential exposure depending on for example area of residence and daily activity pattern, showing that great differences are likely to exist. Ouagadougou, like most developing countries worldwide, currently experiences an extremely rapid population growth in combination with limited financial means. This is likely to create increasingly harmful air pollution situations for the rapidly growing populations of these areas, and shows an urgent need for increased understanding of the pollution situation as well as development of mitigation strategies.

Asking about condom use: a key to individualized care when screening for chlamydia.

Chlamydia trachomatis (CT) infection has been a target for both selective and national screening programmes, and Sweden has an opportunistic approach. A national plan of action states that risk groups should be identified and offered risk reduction counselling. Patients attending a drop-in sexually transmitted infection (STI) clinic reception at the University Hospital, Umeå, Sweden, were invited to complete a questionnaire regarding sociodemographic characteristics, symptoms and sexual risk behaviour; all had a CT test taken. A total of 1305 patients were included, 58% men, mean age 27.8 years. CT prevalence was 11%; 51% of those with CT were ≥ 25 years old. Only 5% used a condom during the entire sexual intercourse with their last new/temporary partner. Sexually active inconsistent condom users comprised 62% of the study population and contributed to 81% of the chlamydia infections. Asking whether a condom was used could quickly triage patients into groups with a 'higher risk' (none or inconsistent use of condoms and at least one new/temporary partners), and 'lower risk' (with more consistent condom use, although not always accurate) allowing for individualized care and counselling when screening for chlamydia. Evaluating whether a condom was used throughout the sexual intercourse did not add any useful information.