Mercury concentrations in bald eagles across an impacted watershed in Maine, USA.

Mercury (Hg) exposure was evaluated in bald eagles (Haliaeetus leucocephalus) in the lower Penobscot River watershed (PRW) in Maine to assess whether Hg discharges from a chlor-alkali plant (HoltraChem) influenced Hg concentrations in nestling tissues. Mean Hg concentrations in nestling blood and breast feathers sampled in marine and estuarine areas potentially contaminated with Hg from HoltraChem (the potential Hg impact zone) were significantly greater than those from reference sites spanning the Maine coast. To place Hg exposure in the potential Hg impact zone into a broader context, Hg exposure in bald eagle nestlings from four habitat types in the PRW was assessed. Mercury concentrations varied significantly across habitat types within the PRW, generally following the pattern: marine=estuarine

Change in attitudes and knowledge of problem drug use and harm reduction among a community cohort in Kabul, Afghanistan.

This pre-post evaluation aimed to measure changes in knowledge and attitudes towards drug users among community representatives in Kabul, Afghanistan, over a period of expansion of harm reduction and drug dependence programming. A convenience sample of 160 professionals aged 18+ years completed interview questionnaires in 2007 and 2009. Views endorsing programme quality and the provision of condoms, infection counselling/testing and needle/syringe distribution increased significantly over the 2-year period. In 13 of 38 statements, there was a substantial (> 10%) change in agreement level, most commonly among men and medical professionals. Attitudes concerning support of drug users remained largely positive, with substantial attitude changes in some subgroups of the population. Further community education through the media and a more cohesive government drug policy may be needed to strengthen community support for harm reduction/drug treatment in Afghanistan.

Change in attitudes and knowledge of problem drug use and harm reduction among a community cohort in Kabul, Afghanistan

هذا التقييم لما قبل ومابعد تطبيق البرنامج يهدف الى قياس التغيرات التي طرأت على المعارف والاتجاهات تجاه متعاطي المخدرات لدي ممثلين عن المجتمع في كابول بافغانستان خلال فتره من فترات التوسع في تطبيق برنامج لمعالجه ادمان المخدرات والحد من اضرارها فقد قامت عينه ملائمه تضم 160 مهنيا اعمارهم 18 سنه فما فوق بملء استبيانات مقابله في عامي 2007 و 2009 فتبين ان الآراء المؤيدة لجودة البرنامج ولتوفير الواقي الذكري وتقديم المشورة والاختبارات الخاصة بالعدوي وتوزيع الابر والمحاقن قد ازدادت زيادة ملحوظة خلال هذين العامين وكان هناك تغير جوهري في مستوي القبول ( اكثر من 10%)في 13 بيانا من اصل 38 لاسيما لدي الرجال واصحاب المهن الطبيه المتعلقه بدعم متعاطي المخدرات ايجابيه الى حد كبير مع تغيرات كبيره في مواقف بعض المجموعات السكانيه الفرعيه ربما تكون هناك حاجة الى مزيد من تثقيف المجتمع عن طريق وسائل الاعلام والى سياسه حكوميه اكثر تماسكا بشأن المخدرات تعزز دعم المجتمع لمعالجة تعاطي المخدرات والحد من اضرارها في افغانستان

La presente evaluation pre-post visait a mesurer ['acquisition de connaissances et les changements d'attitudes a I'egard des toxicomanes parmi les representants d'une communaute a Kaboul [Afghanistan]au cours d'une periode d'elargissement des programmes de reduction des effets nocifs et de traitement de la clependance aux drogues.Un echantillon de commodite de 160 professionnels ages de plus de 18 ans a rempli des questionnaires dans le cadre d'entretiens en 2007 et en 2009.Les opinions au sujet de ['application de programmes de qualite et de la fourniture de preservatifs,du conseil et du depistage en matiere defections,ainsi que de la distribution d/aiguilles/de seringues se sont considerablement ameliorees au cours de ces deux annees.Dans 13 des 38 declarations,on a pu noter un changement notable [>10 %]dans le niveau d'acceptation,le plus souvent parmi les hommes et les professionnels de sante.Les attitudes concernant le soutien a apporter aux toxicomanes sont restees positives dans une large mesure,avec des changements d'attitude notables dans certains sous-groupes de la population.Une education plus poussee des communautes par le biais des medias et des politiques gouvernementales de lutte contre la drogue plus coherentes sont necessaires pour renforcer le soutien communautaire a la reduction des effets nocifs/au traitement des toxicomanies en Afghanistan

This pre-post evaluation aimed to measure changes in knowledge and attitudes towards drug users among community representatives in Kabul,Afghanistan,over a period of expansion of harm reduction and drug dependence programming.A convenience sample of 160 professionals aged 18+ years completed interview questionnaires in 2007 and 2009.Views endorsing programme quality and the provision of condoms,infection counselling/testing and needle/syringe distribution increased significantly over the 2-year period.In 13 of 38 statements,there was a substantial [>10%]change in agreement level,most commonly among men and medical professionals.Attitudes concerning support of drug users remained largely positive,with substantial attitude changes in some subgroups of the population.further community education through the media and a more cohesive government drug policy may be needed to strengthen community support for harm reduction/drug treatment in Afghanistan

Prevalence and correlates of HIV, syphilis, and hepatitis knowledge among intrapartum patients and health care providers in Kabul, Afghanistan.

Little is known about blood-borne infection awareness and knowledge among obstetric populations and health care providers in Afghanistan. HIV and hepatitis B awareness and knowledge are described among 4452 intrapartum patients completing an interviewer-administered questionnaire and whole-blood rapid testing and 123 obstetric care providers completing a questionnaire between June 2006 and September 2006. Participants were enrolled from three Kabul public maternity hospitals. Most participants were aware of HIV (50.8% of patients and 95.9% of providers) and hepatitis (72.1% of patients and 91.1% of providers). Correct transmission knowledge (defined as naming three correct routes and no incorrect routes) was lower for both groups (HIV: 19.4% for patients and 59.7% for providers; hepatitis B: 1.90% for patients and 33.9% for providers). Correct HIV transmission knowledge among providers was independently associated with level of education (AOR=1.75, 95% CI: 1.20-2.55). While HIV and hepatitis B awareness is common, correct and comprehensive knowledge is not. Continuing education for providers and health communications strategies should address identified knowledge gaps.

A nascent HIV type 1 epidemic among injecting drug users in Kabul, Afghanistan is dominated by complex AD recombinant strain, CRF35_AD.

Injecting drug use (IDU), common in global centers of heroin production, confers significant risk for HIV-1 infection. Once introduced into IDU networks, an explosive rise in HIV-1 infection typically occurs, fueled principally by needle sharing. New HIV-1 epidemics in IDUs have occurred in Russia, China, Thailand, Spain, Iran, and in other countries, and some have spread into other risk groups in their respective countries. In Afghanistan, the introduction of HIV-1 into IDU networks has begun, but a recent report of 3% HIV-1 prevalence suggests that the epidemic is still at an early stage. Here we establish, by complete genome sequencing and phylogenetic analysis of four viral strains from Afghan IDUs, that all are the same complex recombinant strain, combining HIV-1 subtypes A and D and herein termed CRF35_AD. Published partial HIV-1 sequences from an HIV-1 epidemic among IDUs in Iran, already at 23.2% HIV-1 prevalence, are either CRF35_AD or a related recombinant. Voluntary HIV-1 screening and harm reduction programs in Afghanistan, applied now, could limit the spread of HIV-1, both in IDUs and in other social networks.

Sexually transmitted disease symptom management behaviours among female sex workers in Tashkent, Uzbekistan.

The objective of this cross-sectional study was to assess prevalence and correlates of self-treatment of sexually transmitted diseases (STD) among female sex workers (FSW) in Tashkent, Uzbekistan. Enrolled FSW completed a self-administered questionnaire, HIV serologic testing and optional pelvic examination. STD diagnosis was based on physical examination and/or microscopic findings. Of 448 women, 337 (75.0%) accepted examination; of these, 316 (93.8%) received at least one STD-related diagnosis. Nearly half (45.4%) reported prior STD self-treatment, which was associated with HIV infection (age-adjusted odds ratio [AOR] = 3.20, 95% confidence interval [CI] = 1.45-7.53) and condom knowledge (AOR = 2.10, 95% CI = 1.16-3.80). For those with history of STD, immediate resumption of sex work before completing treatment was common (87.0%). STD self-treatment is common among FSW in Tashkent, particularly women with HIV infection. Confidential venues for STD care and condom utilization programmes targeted to FSW and their clients are needed to prevent STD in this setting.

Prevalence and correlates of risky sexual behaviors among injection drug users in Tashkent, Uzbekistan.

The objective of this paper is to describe prevalence and correlates of sexual risk behaviors among injection drug users (IDUs) in Tashkent, Uzbekistan. Participants in this cross-sectional study completed a questionnaire detailing sociodemographic, medical and drug and sexual risk behaviors and HIV antibody testing. Of 701 IDUs surveyed, only 20.5% reported consistent condom use, which was more likely for women. Prior sexually-transmitted infection (STI) diagnosis was reported by 36.2% of participants and was associated with early (

Manual vacuum aspiration for second-trimester pregnancy termination.

OBJECTIVES: To compare manual and electric vacuum aspiration for surgical abortions between 14 and 18 weeks of pregnancy. METHODS: A consecutive case series of pregnant women presenting to Johns Hopkins Bayview Medical Center for abortion. There were 73 women in the manual vacuum aspiration group and 37 women in the electric vacuum aspiration group. Dilatation and evacuation was performed using manual or electric vacuum aspiration according to protocol. Procedure time was assessed with the t-test. RESULTS: In all cases, abortion was performed with initial vacuum. Group sizes were sufficient to detect a 20% difference in mean procedure time with 80% power (calculated with two separate S.D.s for procedure time). There was no significant difference in procedure time between the two groups. CONCLUSIONS: Manual vacuum aspiration can be safely and effectively used in second-trimester abortion procedures and should be more widely investigated for this purpose.

Emergency department screening for asymptomatic sexually transmitted infections.

OBJECTIVES: This study assessed the prevalence and correlates of asymptomatic genital tract infection with Neisseria gonorrhoeae and Chlamydia trachomatis among emergency department patients. METHODS: Individuals seeking emergency department evaluation for nongenitourinary complaints provided urine samples for N gonorrhoeae and C trachomatis testing by ligase chain reaction and completed a sociodemographic and behavioral questionnaire. RESULTS: Asymptomatic N gonorrhoeae or C trachomatis was found in 9.7% of persons tested. Correlates of C trachomatis infection included younger age, residence in high-morbidity zip code areas, previous history of N gonorrhoeae or C trachomatis, and number of sex partners in the past year. CONCLUSIONS: Urine-based screening of asymptomatic emergency department patients detected significant numbers of N gonorrhoeae and C trachomatis infections. Targeted screening programs may contribute to community-level prevention and control of sexually transmitted infections.

Chlamydia trachomatis and febrile complications of postpartum tubal ligation.

OBJECTIVE: Our goal was to determine whether chlamydia-infected women have a higher rate of febrile complications after postpartum tubal ligation. STUDY DESIGN: Cross-sectional analysis of 1447 women tested for chlamydial infection within 2 weeks of delivery and who underwent postpartum tubal ligation was performed. Subjects were identified with the Regenstrief Institute for Health Care database. Infected subjects were compared with uninfected subjects for incidence of fever not explained by nongynecologic sources. RESULTS: Women infected with Chlamydia trachomatis at delivery were more likely to experience febrile postoperative complications after tubal ligation (p < 0.0001, relative risk 9.5, 95% confidence interval 4.5 to 20.1). CONCLUSION: Women undergoing postpartum tuba ligation may benefit from prompt diagnosis and preoperative treatment of chlamydial infection.

PIP: A cross-sectional analysis of 1447 US women who underwent postpartum tubal ligation and were tested for Chlamydia trachomatis within 2 weeks of delivery revealed a significant (p 0.0001) increased risk (odds ratio, 9.5; 95% confidence interval, 4.5-20.1) of febrile postoperative complications in untreated chlamydia-positive women. A total of 36 women (2.5%) tested positive for chlamydia at delivery. Of the 41 women with febrile complications (defined as fever equal to or above 38.0 C for more than 24 hours with no evidence of pneumonia, urinary tract infection, or nonreproductive infection) after tubal ligation, 8 (22%) were chlamydia-positive. Of note was the finding that 30% of chlamydia-negative women with febrile complications had a sexually transmitted disease history, predominantly chlamydia. Although previous studies have linked chlamydial infection with salpingitis, postabortion endometritis, tubal infertility, and ectopic pregnancy, this is the first to identify an association with febrile morbidity after postpartum tubal ligation. It cannot be ascertained whether the increased febrile complication rate is caused by chlamydia or concomitant conditions; nonetheless, use of rapid diagnostic tests in women intending to undergo postpartum tubal ligation and prompt treatment of chlamydial infections detected are recommended.

Retroperitoneal leiomyosarcoma: eight cases and a literature review.

Leiomyosarcoma, a rare malignancy of smooth muscle, may arise from the retroperitoneum and present with the same vague symptoms as a malignancy of the pelvic organs. The purpose of this paper is to review eight cases of retroperitoneal leiomyosarcoma and to illustrate the presenting symptoms, prognostic indicators, and outcomes of patients seen at Indiana University Medical Center between 1989 and 1994. Patients in this study were white females who presented between the ages of 46 and 73 (mean age of 61.4) with nonspecific presenting symptoms of weight loss and back pain (37.5% for each). Tumor size (mean diameter of 14.6 cm in the range 4 to 35 cm), tumor extension, and the presence of distant metastases were of greater prognostic significance than tumor grade (7/8 were grade II, 1/8 was grade I). Surgical resection improved long-term prognosis; three of five patients undergoing resection are alive with no evidence of disease compared to zero of three treated nonsurgically. Due to location and vague presenting symptoms, this tumor continues to have a bleak prognosis and further evaluation and innovative treatment are required before a reasonable cure rate may be expected.