A Battery of Easily Accessible, Simple Tools for the Assessment of Concussion in Children.

OBJECTIVE: To determine whether a non-proprietary, novel testing battery can identify recently concussed children within 8 weeks of injury. STUDY DESIGN: In total, 568 clinic outpatients aged 10-18 years were sorted into 3 groups: 316 had never been concussed, 162 had ever been concussed before 8 weeks earlier, and 90 had been recently concussed within 8 weeks. At initial and any subsequent visits, a neurologic examination and 4 procedures were performed: Stick Drop, Wall Ball, Sharpened Modified Romberg (SMR), and Animal Naming. Analysis included inter-group and intra-person performance differences using a series of t tests on the Stick Drop, Wall Ball, SMR, and Animal Naming. RESULTS: The recently concussed group performed worse (P < .01 for all) on Stick Drop, total Wall Ball bounces and drops, and SMR compared with never-concussed and ever-concussed groups. This effect for Stick Drop, SMR, and Wall Ball but not Animal Naming persisted beyond the 4 weeks commonly stated to define recovery. Of 59 recently concussed subjects who returned for ≥1 visit, there were improvements in Stick Drop average (P = .004) and maxima (P = .02) as well as SMR (P = .01) but not Animal Naming between initial and subsequent visits. CONCLUSIONS: This novel, rapid testing battery distinguished groups of children ages 10-18 years who had and had not experienced a recent concussion. A view that physical concussion symptoms resolve within a month of injury may be incomplete. Deployment of this readily available, inexpensive and non-proprietary battery should be compared with other tools and studied further in serial assessments.

Broaching the Topic of HIV Self-testing with Potential Sexual Partners Among Men and Transgender Women Who Have Sex with Men in New York and Puerto Rico.

Men who have sex with men (MSM) and transgender women (TGW) are highly affected by HIV and need novel prevention strategies. Using HIV self-testing (HIVST) kits to screen sexual partners may represent a viable risk-reduction alternative; however, more research is needed on effective strategies for broaching HIVST with partners. In the ISUM study, 136 MSM and TGW were given ten HIVST kits for self- and partner-testing. After 3 months, they returned for a follow-up assessment; thirty participants were also selected for in-depth interviews about their experiences initiating HIVST with partners. Most found proposing HIVST to a diverse array of partners relatively easy. They employed strategies such as joint testing and integrating HIVST into larger discussions about protection and sexual health, with moderate success. Nonetheless, real or anticipated negative partner reactions were a significant barrier. Future research can inform best practices for safely and successfully broaching HIVST with sexual partners.

RESUMEN: Los hombres que tienen sexo con hombres (HSH) y las mujeres tránsgenero (MTG) están muy afectados por el VIH y necesitan estrategias innovadoras de prevención. El uso del autotest de VIH (HIVST) para testear a parejas sexuales podría ser una alternativa viable de reducir el riesgo; sin embargo, se necesitan más investigaciones sobre estrategias eficaces para abordar el tema de usar el HIVST con parejas. En el estudio ISUM, 136 HSH y MTG fueron provistos de diez HIVST para testear a sí mismo y a parejas. Después de tres meses, volvieron para una evaluación de seguimiento; treinta participantes también fueron seleccionados para una entrevista en profundidad sobres sus experiencias abordando el tema del uso del HIVST con parejas. La mayoría encontró que proponer HIVST a una gran variedad de parejas fue relativamente fácil. Emplearon estrategias como hacerse la prueba juntos y integrar HIVST en una conversación más amplia sobre la protección y la salud sexual, con leve éxito. No obstante, las reacciones negativas de parejas, ya sean reales o anticipadas, representaron una barrera importante. Las investigaciones futuras pueden informar las mejores prácticas para abordar el tema de HIVST con parejas sexuales de manera segura y exitosa.

Transgender Women's Experiences Using a Home HIV-Testing Kit for Partner-Testing.

HIV partner-testing (PT) may represent a unique and empowering HIV prevention strategy for groups that face structural and institutional barriers to HIV testing and care, including transgender women. We report on in-depth interviews (IDIs) with N = 10 transgender women who used HIV self-test kits for three months to screen potential sexual partners in a randomized controlled trial (iSUM; "I'll Show You Mine") that took place in New York City and San Juan, Puerto Rico. Participants were assigned to intervention (supplied with 10 self-test kits immediately) or control groups (received 6 test kits after 3 months). We conducted IDIs with the first N = 10 transgender women to enroll in the intervention group after three months in the study (after participants used kits with partners) to understand their experiences. Themes discussed in IDIs included: partners' reaction to HIV testing, participants' reactions to partners' test results or refusal to test, partners' own reaction to their test results, and decision-making around test use. Data were independently analyzed by two coders. Overwhelmingly, participants' experiences with PT was positive. Participants reported kits were convenient and acceptable to most partners. Transgender women felt that PT could pose additional risk for them; one woman experienced violence related to kit use. Furthermore, the availability of kits appeared to encourage participants and their partners to think about their HIV status and, in some cases, modify sexual behavior. Work suggests that HIV PT could be a viable risk-reduction strategy for transgender women.

Then We Looked at His Results: Men Who Have Sex With Men from New York City and Puerto Rico Report Their Sexual Partner's Reactions to Receiving Reactive HIV Self-Test Results.

Secondary distribution of HIV self-tests to sexual partners is acceptable but concerns remain about reactions if a partner tests HIV-positive. We report on 14 participants whose sexual partners tested HIV-positive during the "I'll Show You Mine" Study, a randomized controlled trial (N = 272) of HIV self- and partner-testing among men who have sex with men (MSM) and transgender women (TGW). All 14 were MSM and racial/ethnic minorities, mean age was 36.6 years; 86% were gay-identified. Twenty-four partners tested positive; about half were new partners. Six participants had multiple partners test positive. During in-depth interviews with 10 of these participants, they reported their partners' reactions ranged from tearful and worried among those whose result was unexpected, to resignation among those who suspected a positive result, to nonchalance among partners who participants concluded knew of their HIV infection. After testing, some HIV-positive partners disclosed prior knowledge of their status. No partner reacted violently. Participants typically comforted their partners and encouraged confirmatory testing. Four participants had anal intercourse with partners who tested positive. Participants and partners were able to effectively handle situations in which the partner tested HIV-positive.

Few Aggressive or Violent Incidents are Associated with the Use of HIV Self-tests to Screen Sexual Partners Among Key Populations.

Men who have sex with men and transgender women who had multiple sexual partners in the prior 3 months participated in ISUM, a randomized, controlled trial of self- and partner-testing in New York City and San Juan, PR. Only 2% of screened participants were ineligible to enroll due to anticipating they would find it very hard to avoid or handle violence. The intervention group received free rapid HIV self-test kits. During the trial, 114 (88%) of intervention participants who were assessed at follow-up used self-tests with at least one potential partner. Only 6% of participants who asked a partner in person to test reported that at least one of their partners got physically violent, some in the context of sex work. In total, 16 (2%) partners reacted violently. Post-trial, only one participant reported finding it very hard to handle violence, and none found it very hard to avoid potential violence.

Use of Rapid HIV Self-Test to Screen Potential Sexual Partners: Results of the ISUM Study.

ISUM ("I'll show you mine") was a randomized controlled trial in which 272 transgender women and men who have sex with men in New York, NY (NYC) and San Juan, Puerto Rico (SJU) were assigned to an intervention group (n = 136), in which they had access to free HIV self-testing (ST) kits, or to a control group (n = 136). The trial aimed to determine whether the intervention group would use ST to screen sexual partners and have fewer condomless anal intercourse (CAI) occasions with serodiscordant or unknown status partners than the control group. The intervention group had on average 10 (32%) fewer CAI occasions; though clinically relevant, this difference fell short of statistical significance (p = .08). In NYC (n = 166) intervention participants had significantly fewer CAI occasions, whereas in SJU (n = 106) they reported non-significantly more CAI occasions. Two devastating hurricanes hit SJU during the study and may have impacted results in unmeasured ways.

Use of HIV Self-Testing Kits to Screen Clients Among Transgender Female Sex Workers in New York and Puerto Rico.

Transgender female sex workers (TFSW) are highly affected by HIV, with a global prevalence of 27%. HIV self-testing (HIVST) to screen sexual partners has helped men who have sex with men and female sex workers make informed sexual decisions and avoid HIV exposure. This is the first report on TFSW's experiences screening clients using HIVST. Ten TFSW were each given ten HIVST kits and returned after 3 months to complete an online questionnaire and undergo an interview. Eight of them reported using HIVST with potential partners. Among fifty potential partners who were asked in person to test, 42 (84%) were clients. Thirty-four out of fifty (68%) accepted and 16 (32%) refused. Very few violent incidents occurred, and participants felt empowered by offering HIVST to others. Nevertheless, HIVST market cost was prohibitive for future use. HIVST use with clients could be feasible for TFSW if the cost were lowered or subsidized.

Mixed-Method Evaluation of Social Media-Based Tools and Traditional Strategies to Recruit High-Risk and Hard-to-Reach Populations into an HIV Prevention Intervention Study.

Men who have sex with men and transgender women are hard-to-reach populations for research. Social media-based tools may overcome certain barriers in accessing these groups and are being tested in an ongoing study exploring HIV home-test kit use to reduce risk behavior. We analyzed pre-screening responses about how volunteers learned about the study (n = 896) and demographic data from eligible participants who came for an initial study visit (n = 216) to determine the strengths and weaknesses of recruitment strategies. Social media-based strategies resulted in the highest number of individuals screened (n = 444, 26% eligible). Dating sites/apps reached large numbers of eligible participants. White-Hispanics and African-Americans were more likely to be recruited through personal contacts; community events successfully reached Hispanic volunteers. Incorporating recruitment queries into pre-screening forms can help modify recruitment strategies for greater efficacy and efficiency. Findings suggest that recruitment strategies need to be tailored to reach specific target populations.

Bumble Foot: A Rare Presentation of a Fusobacterium varium Infection of the Heel Pad in a Healthy Female.

Fusobacterium infection is common in herd animals and caged birds; the infection is typically referred to as "bumble foot" or "foot rot." These are opportunistic anaerobic bacteria that cause abscesses in the feet of animals that have developed inflammation in the foot pad secondary to the terrain. In humans, F. varium is known to cause abscesses associated with the oropharynx and gastrointestinal tract, also known as Lemierre's disease. The present study reports the case of a rare presentation of a F. varium soft tissue infection of the heel pad in a healthy young female with no associated oropharynx or gastrointestinal abscesses. Therefore, her presentation and disease course were similar to that described in herd animals. The patient was treated with 3 weeks of intravenous antibiotics, incision and drainage, and a gracilis free flap to the weightbearing surface of the right heel.

Sports celebrities and public health: Diego Maradona's influence on drug use prevention.

Exposure to a sports celebrity through media and sporting events can have important influences on a public health issue associated with that celebrity. The battle against drug use by Argentinean soccer icon Diego Maradona has provoked concerns about drug abuse and prevention in Argentina, particularly among young people. The present study analyzes how two forms of involvement with Maradona affected the public's concern and perceptions of drug use after Maradona's drug-related health crisis in 2004. Results indicate that those who had a greater degree of parasocial interaction with Maradona were more likely to have an increased awareness of drug abuse, a greater personal concern about drug abuse, abstained from drug use, and more strongly support drug abuse prevention programs. In contrast, identification with Maradona had a mitigating effect on drug use prevention. Implications of these findings regarding the influence of sports celebrities on substance abuse are discussed.

Dance reveals symmetry especially in young men.

Dance is believed to be important in the courtship of a variety of species, including humans, but nothing is known about what dance reveals about the underlying phenotypic--or genotypic--quality of the dancer. One measure of quality in evolutionary studies is the degree of bodily symmetry (fluctuating asymmetry, FA), because it measures developmental stability. Does dance quality reveal FA to the observer and is the effect stronger for male dancers than female? To answer these questions, we chose a population that has been measured twice for FA since 1996 (ref. 9) in a society (Jamaican) in which dancing is important in the lives of both sexes. Motion-capture cameras created controlled stimuli (in the form of videos) that isolated dance movements from all other aspects of visual appearance (including FA), and the same population evaluated these videos for dancing ability. Here we report that there are strong positive associations between symmetry and dancing ability, and these associations were stronger in men than in women. In addition, women rate dances by symmetrical men relatively more positively than do men, and more-symmetrical men value symmetry in women dancers more than do less-symmetrical men. In summary, dance in Jamaica seems to show evidence of sexual selection and to reveal important information about the dancer.

Knowledge, perceptions and practices of medical doctors in Jamaica on primary health care and the concept "health for all by the year 2000"

As leaders of health teams, physicians are expected to have firm knowledge, perception and practice of the requirements of the concept of Primary Health Care (PHC) and Health for All by the Year 2000 (HFA-2000), which was declared in 1978. This study, done between December 1995 and February 1996 examinedthe effect of the source of training, geographicallocation, specialty and years in practice on the knowledge, perception and practice of medical doctors regarding primary health care (PHC) and Health for All by Year 2000(HFA2000). Using a cross-sectionalsurvey methods, a sample frame of 1246 registered doctors was taken and the doctors were interviewed with questionaires after exclusion of doctors at the UWI who had undergone a similar study (not practice) in 1994 by Wynter. Twenty years after Alma Ata Declaration, a fair number of doctors are still lacking in the practice of PHC/HFA but their knowledge and perception of PHC/HFA is good. The University of the West Indies-trained doctors had a higher knowledge and perception of PHC/HFA but lower practice level as compared to overseas trained doctors. Specialists had a high knowledge and perception PHA/HFA but a lower practice level as compared to general practitioners. Being located in the urban area was associated with a lower knowledge but a higher perception of PHC/HFA as compared to rural doctors. Geographical location did not influence the practice of PHC/HFA, however, the number of years in practice increased the practice of PHC/HFA. The emphasis on curative-prevention during their training, time, type and nature of patient contact, socio-economic factors and tears of exposure to disease and cure are some of the factors influencing positively or negatively on the knowledge, perception and practice of doctors in Jamaica. A socio-economic framework inclined towards improving a community-oriented medical education (for both undergraduates and practising physicians) would enhance PHC towards the achievement of HFA-2000 and beyond. (AU)

Nova dimensão para o atendimento médico da comunidade

O autor não apresentou resumo

Los elementos esenciales de un programa de control de la sífilis

Conferencia Sanitaria Panamericana, 18. Organización Panamericana de la Salud; 28 set.-8 oct. 1970

OMS. Reunión del Comité Regional, 22. Organización Mundial de la Salud

The essential elements of a syphilis control program

Pan American Sanitary Conference, 18. Pan American Health Organization; Sep.28-Oct.8, 1970

WHO Meeting Regional Committee, 22. World Health Organization

Importancia y características epidemiológicas de las enfermedades venéreas / The inportance and epidemiological characteristics of venereal diseases

This article begins by defining such terms as "real incidence," "reported incidence in morbidity," and "prevalence," the situation in the United States being taken as a reference point. It examines the extent of the problem, the means of assessing it; the increse in venereal diseases, as shown by statistics, both in the region and throughout the world, as well as the consequences of venereal diseases for the family, for society, and for marital relationship, the shortcomings of both the case-reporting and control activities. The chapter on epidemiological characteristics discusses the geographical distribution of the diseases, urban-rural diferentials, mobility, age, sex and socio-economic factors. Although the exact extent of the world problem is not known and defects in case reporting hamper the compilation of reliable statistics, some significant data area available. A comparison of the syphilis and gonorrhea rates per 100,000 population in the Americas, 1959-1962, shows that in 1962 the syphilis rate for North, Middle, and South America were 64, 77 and 48 respectively. Since then there has been a slight increase in North America probably due to intensified case-finding activities. There has been an improved trend in the number of reported cases of gonorrhea in all three regions. Current morbidity data in the United States indicate a somewhat higher syphilis prevalence and venereal

Los elementos esenciales de un programa de control de la sífilis / The essential elements of a syphilis control program

If a syphilis control program is to be successful, it must have the essential elements including delegation of responsibilities

This applies directly to prostitution because if this is a problem in syphilis control, it is recommended that it be controlled by the police department not by the health services

It will also be advisable to aim professional training at private physicians, emphasizing the need for complete case reporting

It is hoped that the above-mentioned essential elements will be helpful in controlling the disease in countries interested in eradicating it(AU)

In the same way, it will be necessary to provide physicians, laboratory technicians, nurses, interviewers and clerical personnel with intensive and continuing training so that the services are maintained at the level the program requires

Another essential element is the national character of the administration and economic support which the program needs to have at all times if it is to be successful. In this regard, special attention must be given to the fundamental aspects of control when the budget available does not make it possible to use other procedures which, although they may be worthwhile, are expensive

Finally, it is advisable to frequently analyze the data obtained in the program in order to evaluate its success or failure, to review measures of the extent and distribution of the problem