Assessing feasibility and acceptability of a brief intervention for risky alcohol consumption in sexual health clinic attendees: a randomised controlled trial.

OBJECTIVES: To assess the feasibility and acceptability of screening attendees at a sexual health clinic (SHC) for alcohol misuse, and delivering a brief intervention (BI). To explore the effect of this BI on drinking and sexual behaviour. METHODS: A consecutive sample of consenting SHC attendees aged ≥16 years were screened using Alcohol Use Disorders Identification Test Consumption (AUDIT-C). Men scoring ≥5 and women scoring ≥4 were invited to complete the full AUDIT, alcohol diary and baseline questionnaire. INTERVENTIONS: Participants were randomised to receive BI by a trained sexual health professional or a standard alcohol leaflet (usual care, UC). All were followed up for changes in alcohol and sexual behaviour at 6 weeks and 6 months. A fidelity check and staff focus group were undertaken. RESULTS: Of 664 participants screened, 215 (32%) were eligible for randomisation and 207 were included in the final analysis: 103 (BI) and 104 (UC). Follow-up rates were 54% and 47% at 6 weeks and 6 months, respectively. Both groups reduced alcohol consumption though the degree of change did not differ between them. There was some evidence of positive changes in sexual health risk in both groups. BI was delivered as intended, adding 5 minutes to the consultation, and staff feedback was positive. CONCLUSIONS: Alcohol misuse was common in SHC attendees. Systematic assessment and BI for alcohol misuse was feasible and acceptable to staff and patients. Identification and provision of standard information alone appeared to influence drinking and sexual behaviour. TRIAL REGISTRATION NUMBER: ISRCTN19452424.

Recovery of Arcobacter spp. from nonlivestock species.

The genus Arcobacter encompasses campylobacter-like organisms that grow in air at 25 degrees C. Arcobacter has been detected or isolated from clinically healthy livestock as well as aborted fetuses and has been presumptively identified as either Campylobacter or Leptospira, based on its growth in selective semisolid media. Because reports from nonlivestock species are limited, this study examined nine presumptive isolates of Arcobacter spp. from an alpaca (Vicugna pacos), black rhinoceros (Diceros bicornis), white rhinoceros (Ceratotherium simum), gorilla (Troglodytes gorilla), gazelle (Eudorcas thomsoni), rhea (Rhea americana), and aborted equine fetuses. Seven of these nine phenotypically identified isolates of Arcobacter were confirmed by a multiplex polymerase chain reaction assay. The remaining two isolates were subsequently identified as Arcobacter skirrowii (Case 5) and Campylobacter jejuni (Case 6) by sequence analysis of a 527-base pair fragment of the 16S rRNA gene. Together, these cases underscore the challenges to a clinical laboratory of identifying Arcobacter in cases which mimic vibrionic abortion or leptospirosis.

Evaluation of immunoturbidimetric specific protein methods using the Architect ci8200: comparison with immunonephelometry.

BACKGROUND: Specific proteins have traditionally been analyzed using methodologies such as immunonephelometry on specialized analyzers. It is now possible to perform specific protein testing on clinical chemistry analyzers using immunoturbidimetry. Performance characteristics of turbidimetric assays for eight common specific proteins were evaluated against a nephelometric method. METHODS: The Abbott Architect ci8200 and the Beckman Immage were used to perform IgA, IgG, IgM, C3, C4, haptoglobin, and transferrin testing. Abbott, Sentinel and Roche reagents were used to perform CRP testing on the ci8200. The specific protein assays were evaluated for precision, linearity, limit of detection, functional sensitivity, method comparison, prozone, and workflow. RESULTS: Total precision for the immunoturbidimetric assays was consistently better than 2% CV and linear throughout the dynamic range of the assays (recovery +/- 10% of target values). The limits of detection, functional sensitivities, and accuracy (as determined by performance against target values for proficiency testing samples and reference materials) are suitable for clinical purposes. Method comparison, as determined by correlation coefficients, and performance against proficiency testing samples, demonstrated good agreement between the turbidimetric and nephelometric tests. Both the turbidimetric and nephelometric assays provided reliable results under conditions of antigen excess. Specific protein test requests could be consolidated within our routine chemistry workload without impacting analytical test throughput. CONCLUSIONS: As demonstrated by their performance characteristics, the Architect ci8200 immunoturbidimetric specific protein assays are suitable for routine use and correlate well with representative immunonephelometric assays on the Beckman Immage analyzer. The ability to perform specific protein analyses on an integrated clinical chemistry/immunoassay system can allow for consolidation of testing on a single platform, resulting in improved laboratory operations efficiency.

UK national audit of sexual health care for people with HIV infection: case-notes audit.

The case-notes of 3210 patients with HIV infection were audited. A sexual history was documented within four weeks before or after initial HIV diagnosis in 69% of cases (regional range 45-84%), and in the six months before attendance during the audit interval in 34% (12-53%). An offer of tests for sexually transmitted infections was documented within four weeks before or after HIV diagnosis in 58% (30-83%), and in the prior six months in 28% (14-47%). Syphilis serology was offered in the previous three months to 45% (14-100%) of cases resident in syphilis outbreak areas and to 25% (7-62%) of other cases. Hepatitis B testing was performed for 98% (95-100%) of cases and for hepatitis C, for 91% (79-100%). Cervical cytology results in the past year were documented for 73% (43-94%) of eligible women. Considerable inter-regional variation in performance exists. Interventions are needed to improve the sexual health care of people with HIV infection.

UK national audit of sexual health care for people with HIV infection: clinic policies.

A national audit of the sexual health care for people with HIV infection (PWHIV) was conducted in genitourinary medicine clinics and other clinics providing care for PWHIV in the UK in the summer of 2006. Data were aggregated by region and clinic, allowing practice to be compared between regions, as well as to national averages and against various guidelines. In this, the first of two papers, clinics were surveyed on their local policies. In total, 126 clinics participated. Only 38 clinics (30%, regional range 0-60%) had written local care pathways on management of sexually transmitted infection in PWHIV, while 73 (58, 20-100%) had unwritten policies. This compares with the national standard that 100% of service providers should be able to provide documentation of local care pathways for sexually transmitted diseases in people with HIV. Clinics should consider creating policies especially where standards are not being met.

A Pasteurella-like bacterium associated with pneumonia in captive megachiropterans.

A novel Pasteurella-like organism was recovered postmortem from lung tissue of two captive Wahlberg's epauleted fruit bats (Epomophorus wahlbergi), with severe, unilateral pneumonia. The bats had been recently shipped and died shortly after release from a 30-day quarantine. One presented with clinical signs of anorexia and lethargy before death; the other died without prior clinical symptoms. The same Pasteurella-like organism was recovered antemortem from subcutaneous abscesses in two captive little golden mantled flying foxes (Pteropus pumilus) housed with additional E. wahlbergi. The organism was also cultured on tracheal wash from one Malaysian flying fox (Pteropus vampyrus) and another E. wahlbergi, both demonstrating clinical signs of pneumonia. All recovered isolates appeared morphologically and biochemically similar to the initial isolates and were further characterized as either a Pasteurella or Actinobacillus organism on the basis of biochemical and cellular fatty acid profiles. Screening of the current collection using pharyngeal swabs isolated this organism from 12 of 15 E. wahlbergi, two of three P. vampyrus, one of 26 island flying foxes (Pteropus hypomelanus), and one of nine Rodrigues fruit bats (Pteropus rodricensis). The organism was not identified in pharyngeal culture from eight Indian flying foxes (Pteropus giganteus), nine Egyptian fruit bats (Rousettus aegypticus), or an additional 16 P. pumilus.

A field investigation of Bacillus anthracis contamination of U.S. Department of Agriculture and other Washington, D.C., buildings during the anthrax attack of October 2001.

In response to a bioterrorism attack in the Washington, D.C., area in October 2001, a mobile laboratory (ML) was set up in the city to conduct rapid molecular tests on environmental samples for the presence of Bacillus anthracis spores and to route samples for further culture analysis. The ML contained class I laminar-flow hoods, a portable autoclave, two portable real-time PCR devices (Ruggedized Advanced Pathogen Identification Device [RAPID]), and miscellaneous supplies and equipment to process samples. Envelopes and swab and air samples collected from 30 locations in the metropolitan area once every three days were subjected to visual examination and DNA extraction, followed by real-time PCR using freeze-dried, fluorescent-probe-based reagents. Surface swabs and air samples were also cultured for B. anthracis at the National Veterinary Service Laboratory (NVSL) in Ames, Iowa. From 24 October 2001 to 15 September 2002, 2,092 pieces of mail were examined, 405 real-time PCR assays were performed (comprising 4,639 samples), and at the NVSL 6,275 samples were subjected to over 18,000 platings. None of the PCR assays on DNA extracted from swab and air samples were positive, but viable spores were cultured from surface swabs taken from six locations in the metropolitan area in October, November, and December 2001 and February, March, and May 2002. DNA extracted from these suspected B. anthracis colonies was positive by real-time and conventional PCRs for the lethal factor, pXO1, and for capA and vrr genes; sequence analysis of the latter amplicons indicated >99% homology with the Ames, vollum, B6273-93, C93022281, and W-21 strains of B. anthracis, suggesting they arose from cross-contamination during the attack through the mail. The RAPID-based PCR analysis provided fast confirmation of suspect colonies from an overnight incubation on agar plates.