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1.
Toxicol Lett ; 317: 120-129, 2019 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-31580884

RESUMO

PEGylation is considered a safe mechanism to enhance the pharmacokinetics (PK) and pharmacodynamics (PD) of biotherapeutics. Previous studies using PEGylation as a PK enhancement tool have reported benign PEG-related vacuolation in multiple tissues. This paper establishes a threshold for PEG burden beyond which there are alterations in tissue architecture that could potentially lead to dysfunction. As part of the nonclinical safety assessment of Compound A, a 12 kDa protein conjugated to a 40 kDa branched PEG molecule, monkeys were dosed subcutaneously twice weekly for 3 months at protein doses resulting in weekly PEG doses of 8, 24, 120, or 160 mg/kg. Consistent with previous reports with PEGylated biomolecules, Compound A administration resulted in intracellular vacuoles attributed to the PEG moiety in macrophages in numerous tissues and epithelial cells in the choroid plexus and kidney. Vacuolation occurred at all doses with dose-dependent severity and no evidence of recovery up to 2 months after dosing cessation. The vacuolation was considered nonadverse at PEG doses ≤120 mg/kg/week. However, at 160 mg/kg/week PEG, the vacuolation in choroid plexus, pituitary gland, kidney, and choroid of the eye was considered adverse due to significant alterations of tissue architecture that raised concern for the possibility of compromised tissue function. To our knowledge, this is the first report of potentially adverse cellular consequences of PEG accumulation in tissues other than kidney. Furthermore, the lack of reversibility of vacuolation coupled with the lack of a biomarker for intracellular PEG accumulation highlights a potential risk that should be weighed against the benefits of PK/PD enhancement for long-term administration of PEGylated compounds at high doses.


Assuntos
Células Epiteliais/efeitos dos fármacos , Macrófagos/efeitos dos fármacos , Polietilenoglicóis/toxicidade , Proteínas/toxicidade , Vacúolos/efeitos dos fármacos , Animais , Relação Dose-Resposta a Droga , Esquema de Medicação , Composição de Medicamentos , Células Epiteliais/patologia , Feminino , Injeções Subcutâneas , Macaca fascicularis , Macrófagos/patologia , Masculino , Polietilenoglicóis/administração & dosagem , Proteínas/administração & dosagem , Medição de Risco , Fatores de Tempo , Vacúolos/patologia
2.
Cancer Epidemiol Biomarkers Prev ; 28(11): 1825-1834, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31488413

RESUMO

BACKGROUND: Vaccination against human papillomaviruses (HPV) prevents HPV infections and, consequently, cervical lesions. However, the effect of vaccination on HPV transmission within couples is unknown. METHODS: We used data from HITCH, a prospective cohort study of heterosexual couples (women ages 18-24 years) in Montreal, 2005 to 2013. Vaccination history was self-reported. Genital samples were tested for HPV DNA by PCR (linear array). Type-specific viral loads were quantified using real-time PCR. OR and HR were estimated using multilevel mixed-effects logistic regression and a parametric model for interval- censored survival-time data, respectively. Differences in viral loads were evaluated using the Friedman ANOVA test. RESULTS: Among 497 couples, 12, 16, and 35 women received 1, 2, or 3 vaccination doses at baseline, respectively. Median age at vaccination was 18 years. Most women (92.1%) had their first coitus before vaccination. At baseline, partner concordance of persistent HPV6/11/16/18 infections was lower in vaccinated than unvaccinated women [adjusted OR = 0.10; 95% confidence interval (CI), 0.01-0.65] but not for non α7/α9/α10-HPV types (adjusted OR = 1.00; 95% CI, 0.44-2.29). Incidence of persistent α7/α9/α10 HPV types in women was inversely associated with vaccination status at baseline (adjusted HR = 0.12; 95% CI, 0.03-0.47). Likewise, male partners of vaccinated women had a lower incidence of α7/α9/α10 HPV infections (adjusted OR = 0.22; 95% CI, 0.05-0.95). Vaccinated women with HPV 6/11/16/18 infections had lower viral loads (P = 0.001) relative to unvaccinated women. CONCLUSIONS: Vaccination of sexually active women significantly reduced transmission of α7/α9/α10 HPV types in heterosexual couples. IMPACT: These results underscore and quantify the positive effect of HPV vaccination on HPV transmission within heterosexual couples.

3.
Can Fam Physician ; 65(8): 539-542, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31413021

RESUMO

OBJECTIVE: To describe the Greig Health Record for Young Adults (GHRYA), an evidence-based, peer-reviewed, endorsed guide that can assist providers with age-appropriate screening and counseling. SOURCES OF INFORMATION: A literature search was performed by the librarian from the Department of Family and Community Medicine at the University of Toronto in Ontario. PubMed, MEDLINE, the Cochrane Database of Systematic Reviews, and Google Scholar were searched using the terms young adults, emerging adults, preventive services, prevention, screening, and health promotion. Additional searches were performed using the terms mental health, substance use, addictions, sexual health, bullying, abuse, nutrition, sleep, injury prevention, and physical fitness. A total of 521 articles were identified. Articles retained for review were those relevant to young adults and were population studies, guidelines, and systematic reviews. MAIN MESSAGE: Recently, there has been a recognition of the unique health care needs of the 18- to 24-year-old age group. Emerging adults have higher risks of health issues including mental illness, substance use, sexually transmitted infections, and risk-taking behaviour. Providing preventive care requires an age-specific approach, especially as contact with health care providers is often infrequent and episodic. Primary care providers who are less familiar with the preventive care needs of young adults can use the GHRYA to guide their interactions with these patients. This new tool is an easy-to-access guide to evidence-based recommendations to be used when patients present to the office or an urgent-care setting and a ready-to-hand place to record prevention strategies when delivered. The tool includes a checklist and 4 pages of resources and recommendations. CONCLUSION: The GHRYA is a peer-reviewed, endorsed guide to the provision of prevention and screening for young adults, which provides an approach to patient care but also evidence-based resources.

5.
J Infect Dis ; 220(7): 1152-1161, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31063542

RESUMO

BACKGROUND: We studied the association between human papillomavirus (HPV) viral load (VL) and HPV concordance. METHODS: The HITCH cohort study included young, heterosexual, recently formed, sexually active couples. Questionnaires and genital samples were collected at 0 and 4 months. Samples were tested for HPV DNA by polymerase chain reaction (PCR; Linear Array). VLs of HPV6/11/16/18/31/42/51 were quantified using type-specific real-time PCR. Correlations between VL and type-specific HPV prevalence and incidence were evaluated using multilevel, mixed-effects linear/logistic regression models. RESULTS: We included 492 couples. VLs were higher in penile than vaginal samples. VL at subsequent visits correlated significantly within men (r, 0.373), within women (r, 0.193), and within couples (r range: 0.303-0.328). Men with high VL had more type-specific persistent HPV infections (odds ratio [OR], 4.6 [95% confidence interval {CI}, 2.0-10.5]). High VL in men was associated with prevalent (OR, 5.3 [95% CI, 2.5-11.2]) and incident (OR, 6.7 [95% CI, 1.5-30.7]) type-specific HPV infections in their partner. Women's VL was associated with type-specific HPV prevalence in their partner at the same (OR, 5.9) and subsequent (OR, 4.7) visit. CONCLUSIONS: Persistent HPV infections have limited VL fluctuations. VL between sex partners are correlated and seem predictive of transmission episodes.

6.
Biol Psychiatry Cogn Neurosci Neuroimaging ; 4(12): 1042-1048, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30954442

RESUMO

BACKGROUND: Previously, oxytocin, a neuropeptide implicated in human social cognition and behavior, was shown to improve people's ability to dynamically track another's emotional state ("empathic accuracy") specifically for less socially proficient individuals-i.e., healthy adults who score higher on the Autism Spectrum Quotient (AQ); conversely, oxytocin had no effect on empathic accuracy for more socially proficient individuals, who performed well following oxytocin and placebo. Here, we aimed to replicate this finding and investigate the effects of oxytocin on empathic accuracy in women. To date, women have been seriously underrepresented in human oxytocin research, and it is not known whether the effects observed in male-only samples apply to women. METHODS: In this randomized, double-blind, placebo-controlled, crossover trial, we administered 24 IU intranasal oxytocin (and, on a separate occasion, a matching placebo) to 31 men and 40 women and then measured empathic accuracy. AQ was assessed at baseline (prior to drug administration). RESULTS: Replicating a 2010 study by Bartz et al., oxytocin selectively improved empathic accuracy for men who scored higher on the AQ, whereas oxytocin did not benefit their lower AQ counterparts. Conversely, we found no effect of oxytocin on empathic accuracy for women (regardless of their AQ score). CONCLUSIONS: In addition to speaking to reliability, this research is important given interest in using oxytocin to augment social functioning in some psychiatric disorders marked by social cognitive impairments. More generally, this research adds to our understanding of the biological systems that support human sociality and provides further evidence for the role of oxytocin therein.

7.
Lancet Infect Dis ; 19(3): 317-326, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30745276

RESUMO

BACKGROUND: Hand-to-genital contact is hypothesised to be a transmission mode of human papillomavirus (HPV) of the Alphapapillomavirus genus. We compared the relative importance of hand-to-genital and genital-to-genital HPV transmission between sexual partners. METHODS: In this prospective cohort study, we recruited and followed up female university students aged 18-24 years and their male sexual partners in Montreal, QC, Canada (2005-11). Participants were eligible if they had initiated sexual activity within the past 6 months. Women were examined at clinic visits at baseline and every 4-6 months for up to 24 months. Men had a baseline visit and a single follow-up visit approximately 4 months later. Partners provided hand and genital swab samples, which we tested for DNA of 36 HPV types using PCR. We assessed predictors of incident type-specific HPV detections using Cox proportional hazards models. FINDINGS: Participants were recruited between June 5, 2006, and April 4, 2013. 264 women and 291 men had valid hand samples. The hazard ratio (HR) of incident detection of HPV in genital samples from women was 5·0 (95% CI 1·5-16·4) when her partner was positive for the same HPV type on his hand versus negative, but adjustment for his genital HPV status reduced the HR to 0·5 (0·1-1·8). Similarly, the HR of incident detection of HPV on men's genitals was 17·4 (95% CI 7·9-38·5) when his partner was positive for the same HPV type on her hand versus negative, but adjustment for her genital HPV status reduced the HR to 2·3 (0·9-6·2). Conversely, the HR of type-specific incident detection of HPV in genital samples associated with partner genital HPV positivity was 19·3 (95% CI 11·8-31·8) for women and 28·4 (15·4-52·1) for men after adjustment for their hand HPV status. INTERPRETATION: Clinicians can reassure their patients that HPV transmission is unlikely to occur through hand-to-genital contact. The majority of genital HPV infections are likely to be caused by genital-to-genital sexual transmission. FUNDING: Canadian Institutes for Health Research, National Institutes of Health, Fonds de la Recherche en Santé du Québec, and Merck & Co.

8.
JMIR Res Protoc ; 8(1): e11284, 2019 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-30650383

RESUMO

BACKGROUND: Human papillomavirus (HPV) epidemiological research has generally been individual based, typically focusing on women, with couple-based research mostly consisting of cross-sectional assessment of prevalent HPV infection in both partners. OBJECTIVE: The HPV Infection and Transmission among Couples through Heterosexual activity (HITCH) study was set up to investigate the transmissibility of HPV among young, recently formed couples in Montreal, Canada. This paper provides an overview of the HITCH cohort study design and procedures as well as a narrative summary of the most important findings. METHODS: HITCH is a longitudinal investigation of HPV transmission in recently formed heterosexual partnerships initiated within 6-month pre-enrollment, a time at which considerable transmission is believed to occur. A total of 549 newly formed dyads were recruited (2005-2011) from postsecondary institutions, including 502 young women and their male partners. An additional 46 males were enrolled at follow-up, as some women enrolled a subsequent partner at follow-up. Women aged 18-24 years were followed for 24 months for acquisition of HPV types not present at enrollment, whereas men returned for a single follow-up visit at month 4, for a sum total of 3361 clinic visits. The last follow-up visit occurred in January 2014. Extensive sociodemographic, sexual behavioral, and medical history data were collected every 2-4 months using computer-assisted, self-administered questionnaires. Furthermore, participants provided genital, blood, oral, and hand specimens for HPV assessment. RESULTS: Although in its early analysis stage, HITCH has produced important publications. Findings from HITCH have increased the available knowledge about the natural history of HPV transmission and its determinants, provided further evidence regarding oral-oral and oral-genital routes of HPV transmission, and supplied empirically valid epidemiological parameters of HPV transmission to assist mathematical modelers in health economic assessments. In addition, HITCH data were made available to several multistudy collaborations evaluating new HPV detection assays and evidence for-or-against HPV type replacement following the introduction of HPV vaccination. CONCLUSIONS: HITCH will continue to offer a unique resource for research on HPV transmission. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/11284.

9.
Clin Child Psychol Psychiatry ; 24(2): 193-198, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30369254

RESUMO

Gender diverse people are individuals who define their gender as different from the sex they were assigned as birth. This incongruence leads to a sense of discomfort within oneself, which according to the DSM-V is called gender dysphoria. The combination of dysphoria, ongoing stress, as outlined in the Minority Stress Theory (Meyer, 2003, Dohrenwend, 2000) and the stigma related to living in a society which traditionally defines gender as binary and rejects the notion of gender as fluid, is associated with psycho-social, mental, and physical health problems. Gender diverse children and young people require support from health practitioner to assist them not only in transitioning, if this is what they choose, but also to manage ongoing and preventive health care in a system which is not always welcoming and frequently hostile to them. In 2012 the United Nations General Assembly called for universal health coverage as a goal in the post-2015 Millennium Development Goal Framework. One step in attaining this goal is universal health access which is not currently being met for gender diverse individuals. Hence, we need to work together, with those that we serve, to develop appropriate, sensitive and accessible health care for all.


Assuntos
Disforia de Gênero/terapia , Acesso aos Serviços de Saúde , Minorias Sexuais e de Gênero , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Adulto Jovem
10.
J Obstet Gynaecol Can ; 40(4): 440-446, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29102218

RESUMO

BACKGROUND: Uptake of HPV vaccination among university students remains low despite risky sexual practices and increased prevalence of high-risk HPV genotypes. The study objective was to determine the level of knowledge related to HPV and cervical cancer among university students and to subsequently develop a targeted education and vaccination campaign to increase uptake. METHODS: Phase I was a pilot project in which participants were recruited as part of Cervical Cancer Awareness Week 2015 at two universities, one site immediately offering vaccination and the other not. A self-administered questionnaire was used to collect demographic information from participants and evaluate their baseline knowledge related to HPV and the risks of cervical cancer, in addition to determining barriers to vaccination and future willingness to be vaccinated. Data was compiled and analyzed using descriptive statistics of means and percentages. In phase II, which followed 1 year after, a targeted education and vaccination campaign was designed based on lessons learned from phase I, and vaccination uptake was reevaluated after 1 year. RESULTS: In phase I, 56 participants responded to a questionnaire related to HPV knowledge and cervical cancer. Among these, 29 students were vaccinated in a 2-day resident-run clinic. Overall, 63% felt they were not at risk of cervical cancer, though 88% knew HPV was the cause of cervical cancer. The three barriers identified to previous vaccination were lack of access to a doctor or a nurse (25%), financial reasons (25%), and low self-perceived risk (7%). There was a 50% three-dose completion rate in phase I. Based on this information, the education campaign in phase II was expanded in the subsequent year through social media, email communication, information booths, and individual solicitation. A total of 151 students were approached for individual solicitation and education. Among these, 64 students were vaccinated on site, including five men. Most importantly, there were 18 walk-ins resulting directly from the education initiatives and person-to-person solicitation. Subsequently, in 2016, 502 students were vaccinated at the McGill student health clinic and 455 at Concordia University. CONCLUSION: HPV vaccination rates in university students are readily increased through educational campaigns, of which person-to-person solicitation proved to be the most fruitful in this study. Identifying barriers to vaccination can guide future initiatives to maximize impact.


Assuntos
Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Infecções por Papillomavirus , Vacinas contra Papillomavirus , Vacinação/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Projetos Piloto , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Neoplasias do Colo do Útero , Vacinação/psicologia , Adulto Jovem
11.
Sex Transm Dis ; 45(1): 28-34, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28876295

RESUMO

BACKGROUND: Y chromosome DNA from male epithelial and sperm cells was detected in vaginal samples after unprotected sex in experimental studies. We assessed the strength of this association in an observational setting to examine the utility of Y chromosome DNA as a biomarker of recent sexual behaviors in epidemiological studies. METHODS: The HPV (human papillomavirus) Infection and Transmission Among Couples Through Heterosexual Activity cohort study enrolled 502 women attending a university or college in Montréal, Canada, and their male partners from 2005 to 2010. Participants completed self-administered questionnaires. We used real-time polymerase chain reaction to test women's baseline vaginal samples for Y chromosome DNA and assessed which sexual behaviors were independent predictors of Y chromosome DNA positivity and quantity with logistic and negative binomial regression. RESULTS: Y chromosome DNA positivity decreased from 77% in women in partnerships reporting vaginal sex 0 to 1 day ago to 13% in women in partnerships reporting last vaginal sex of 15 or more days ago (adjusted odds ratio, 0.09; 95% confidence interval, 0.02-0.36). The mean proportion of exfoliated vaginal sample cells with Y chromosome DNA was much lower for women who reported always using condoms (0.01%) than for women who reported never using condoms (2.07%) (adjusted ratio, 26.8; 95% confidence interval, 8.9-80.5). No association was found with reported oral/digital sex frequency or concurrency of partnerships. CONCLUSIONS: Y chromosome DNA quantity is strongly associated with days since last vaginal sex and lack of condom use in observational settings. Y chromosome DNA quantity may prove useful as a correlate of recent vaginal sex in observational studies lacking data on sexual behavior, such as surveillance studies of human papillomavirus infection prevalence.


Assuntos
Cromossomos Humanos Y/genética , Coito , Preservativos/estatística & dados numéricos , DNA/análise , Heterossexualidade , Infecções por Papillomavirus/transmissão , Parceiros Sexuais , Vagina/metabolismo , Biomarcadores/análise , Canadá , Feminino , Papillomavirus Humano 16/isolamento & purificação , Humanos , Masculino , Razão de Chances , Infecções por Papillomavirus/virologia , Reação em Cadeia da Polimerase , Vigilância da População , Valor Preditivo dos Testes , Prevalência , Fatores de Risco , Inquéritos e Questionários , Vagina/virologia , Adulto Jovem
12.
J Infect Dis ; 216(10): 1210-1218, 2017 12 05.
Artigo em Inglês | MEDLINE | ID: mdl-28968731

RESUMO

Background: Detection of human papillomavirus (HPV) DNA in genital samples may not always represent true infections but may be depositions from infected sexual partners. We examined whether sexual risk factors and a biomarker (Y chromosome DNA) were associated with genital HPV partner concordance and estimated the fraction of HPV detections potentially attributable to partner deposition. Methods: The HITCH study enrolled young women attending a university or college in Montréal, Canada, and their male partners, from 2005 to 2010. We tested baseline genital samples for Y chromosome DNA and HPV DNA using polymerase chain reaction. Results: Type-specific HPV concordance was 42.4% in partnerships where at least one partner was HPV DNA positive. Y chromosome DNA predicted type-specific HPV concordance in univariate analyses, but in multivariable models the independent predictors of concordance were days since last vaginal sex (26.5% higher concordance 0-1 vs 8-14 days after last vaginal sex) and condom use (22.6% higher concordance in never vs always users). We estimated that 14.1% (95% confidence interval [CI], 6.3-21.9%) of HPV DNA detections in genital samples were attributable to vaginal sex in the past week. Conclusions: A substantial proportion of HPV DNA detections may be depositions due to recent unprotected vaginal sex.


Assuntos
Alphapapillomavirus/genética , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/virologia , Comportamento Sexual , Parceiros Sexuais , Adolescente , Adulto , Alphapapillomavirus/classificação , Biomarcadores , Canadá/epidemiologia , Cromossomos Humanos Y , DNA Viral , Feminino , Humanos , Masculino , Infecções por Papillomavirus/transmissão , Vigilância da População , Prevalência , Fatores de Risco , Vagina/virologia , Adulto Jovem
13.
Sex Transm Dis ; 44(6): 329-337, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28499281

RESUMO

BACKGROUND: Assortative sexual mixing, the tendency for individuals to choose partners with similar characteristics to themselves, may be an important contributor to the unequal distribution of sexually transmitted infections in populations. We analyzed the tendency for assortative mixing on demographic and sexual behaviors characteristics in newly formed young adults dating partnerships. METHODS: Women aged 18 to 24 years and their male sexual partners of no more than 6 months were recruited during 2005 to 2010 at universities in Montreal, Canada. New dating partners were also prospectively recruited during the 2-year follow-up. We used Spearman and Newman coefficients to examine correlations between partners' demographic characteristics and sexual behaviors, and multivariable logistic modeling to determine which characteristics were assortative. RESULTS: Participants in 502 recruited partnerships were assortative on age (Spearman P = 0.60), smoking behavior (P = 0.43), ethnicity (Newman coefficient=0.39), lifetime number of sexual partners (P = 0.36), sex partner acquisition rates (P = 0.22), gap length between partnerships (P = 0.20), and on whether they had concurrent partners (P = 0.33). Partners were assortative on number of lifetime partners, sexual partner acquisition rates, concurrency, and gap length between partnerships even after adjustment for demographic characteristics. Reported condom use was correlated between initial and subsequently recruited partners (P = 0.35). There was little correlation between the frequencies of vaginal/oral/digital/anal sex between subsequent partnerships. CONCLUSIONS: Dating partnerships were substantially assortative on various sexual behaviors as well as demographic characteristics. Though not a representative population sample, our recruitment of relatively new partnerships reduces survivor bias inherent to cross-sectional surveys where stable long-term partnerships are more likely to be sampled.


Assuntos
Grupos Étnicos/estatística & dados numéricos , Heterossexualidade , Infecções por Papillomavirus/transmissão , Parceiros Sexuais , Canadá/epidemiologia , Preservativos/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Relações Interpessoais , Masculino , Grupo Associado , Satisfação Pessoal , Estudos Prospectivos , Parceiros Sexuais/psicologia , Comportamento Social , Adulto Jovem
14.
J Innov Health Inform ; 23(1): 171, 2016 04 18.
Artigo em Inglês | MEDLINE | ID: mdl-27348486

RESUMO

BACKGROUND: Personal health records (PHRs) are tools that allow individuals to access, share and manage their health information online. Despite apparent interest, adoption rates remain low. There is a gap in our understanding as to what different populations of users, in particular young adults, might want from such a tool. OBJECTIVE: To describe and interpret the views and expectations of young healthy adults about using an online PHR. METHODS: A qualitative descriptive study was carried out. Four focus groups were conducted with a total of 29 participants (18-34 years old) from a community setting in Montreal, Canada. Interviews were transcribed and analyzed with inductivethematic analysis. RESULTS: With respect to how young adults viewed PHRs, three broad themes were identified: perceived advantages to using a PHR, future PHR users and concerns about PHRs. Three other overarching themes emerged from data analysis in terms of what participants expected from using a PHR: the use of the PHR for preventative health, PHR support to take more control over their health and strategies to make the PHR worthwhile. A conceptual framework of factors influencing expectations of PHR use in this population is proposed. CONCLUSIONS: While young adults view the PHR as beneficial, this is not enough for them to be motivated to actually use a PHR. To foster use, the PHRs need to be perceived as a health prevention tool that helps users to increase control over theirhealth status. More research is needed to understand the expectations and anticipated use of different populations in designing a person-centered tool;the proposedframework provides theoretical basis in this regard.


Assuntos
Registros de Saúde Pessoal , Pesquisa Qualitativa , Adulto , Canadá , Registros Eletrônicos de Saúde , Feminino , Grupos Focais , Humanos , Masculino , Opinião Pública , Adulto Jovem
17.
Acad Med ; 90(5): 660-70, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25406604

RESUMO

PURPOSE: To understand the influence of academic discourses about family medicine on medical students' professional identity construction during undergraduate training. METHOD: The authors used a multiple case study research design involving international medical schools, one each from Canada, France, Spain, and the United Kingdom (UK). The authors completed the fieldwork between 2007 and 2009 by conducting 18 focus groups (with 132 students) and 67 semistructured interviews with educators and by gathering pertinent institutional documents. They carried out discursive thematic analyses of the verbatim transcripts and then performed within- and cross-case analyses. RESULTS: The most striking finding was the diverging responses between those at the UK school and those at the other schools. In the UK case, family medicine was recognized as a prestigious academic discipline; students and faculty praised the knowledge and skills of family physicians, and students more often indicated their intent to pursue family medicine. In the other cases, family medicine was not well regarded by students or faculty. This was expressed overtly or through a paradoxical academic discourse that stressed the importance of family medicine to the health care system while decrying its lack of innovative technology and the large workload-to-income ratio. Students at these schools were less likely to consider family medicine. CONCLUSIONS: These results stress the influence of academic discourses on medical students' ability to identify with the practice of family medicine. Educators must consider processes of professional identity formation during undergraduate medical training as they develop and reform medical education.


Assuntos
Escolha da Profissão , Educação de Graduação em Medicina/métodos , Medicina de Família e Comunidade/educação , Médicos de Família/educação , Faculdades de Medicina/normas , Identificação Social , Estudantes de Medicina/psicologia , Canadá , Grupos Focais , França , Humanos , Estudos Retrospectivos , Espanha , Reino Unido
18.
Cancer Epidemiol Biomarkers Prev ; 23(12): 2959-64, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25392180

RESUMO

We estimated the prevalence of oral human papillomavirus (HPV) and assessed risk factors among young heterosexual men participating in the HPV Infection and Transmission among Couples through Heterosexual Activity (HITCH) study. Oral and genital HPV samples were collected from 222 men and their female partners who were participating in the HITCH study, a longitudinal cohort on HPV transmission among heterosexual couples. Demographic and behavioral data were collected through self-administered computer questionnaires and biologic samples were tested with the Linear Array for HPV. Outcome measures were overall and type-specific prevalence of oral HPV. The prevalence of oral HPV among men was 7.2% and was higher among men who were ever smokers (12.2%), in nonmonogamous relationships (17.9%), or had a partner with oral (28.6%) and/or genital (11.5%) HPV infection. Moreover, prevalence increased with frequency of oral sex among men whose partner who had a genital infection with the same HPV type. Our results provide further evidence that oral HPV may be transmitted through either oral-oral or oral-genital routes.


Assuntos
Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/virologia , Adolescente , Estudos de Coortes , Humanos , Estudos Longitudinais , Masculino , Papillomaviridae/genética , Prevalência , Fatores de Risco , Comportamento Sexual , Doenças Sexualmente Transmissíveis , Adulto Jovem
19.
BMC Med Educ ; 14: 184, 2014 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-25193544

RESUMO

BACKGROUND: Despite significant differences in terms of medical training and health care context, the phenomenon of medical students' declining interest in family medicine has been well documented in North America and in many other developed countries as well. As part of a research program on family physicians' professional identity formation initiated in 2007, the purpose of the present investigation is to examine in-depth how family physicians construct their professional image in academic contexts; in other words, this study will allow us to identify and understand the processes whereby family physicians with an academic appointment seek to control the ideas others form about them as a professional group, i.e. impression management. METHODS/DESIGN: The methodology consists of a multiple case study embedded in the perspective of institutional theory. Four international cases from Canada, France, Ireland and Spain will be conducted; the "case" is the medical school. Four levels of analysis will be considered: individual family physicians, interpersonal relationships, family physician professional group, and organization (medical school). Individual interviews and focus groups with academic family physicians will constitute the main technique for data generation, which will be complemented with a variety of documentary sources. Discourse techniques, more particularly rhetorical analysis, will be used to analyze the data gathered. Within- and cross-case analysis will then be performed. DISCUSSION: This empirical study is strongly grounded in theory and will contribute to the scant body of literature on family physicians' professional identity formation processes in medical schools. Findings will potentially have important implications for the practice of family medicine, medical education and health and educational policies.


Assuntos
Docentes de Medicina , Papel do Médico/psicologia , Médicos de Família/educação , Médicos de Família/psicologia , Identificação Social , Humanos , Controle Interno-Externo , Entrevista Psicológica , Percepção Social
20.
J Infect Dis ; 210(6): 846-52, 2014 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-24683197

RESUMO

BACKGROUND: We studied features that predict the presence of human papillomavirus (HPV) in a new sexual partnership. METHODS: We analyzed data from the "HPV Infection and Transmission Among Couples Through Heterosexual Activity" (HITCH) Cohort Study of recently formed partnerships ("dyads"). Women aged 18-24 and their male partners were recruited during 2005-2010 in Montreal, Canada. We tested genital swabs for detection of 36 HPV types. We defined HPV in a partnership as the presence of 1 or more HPV types in either or both partners. Using baseline data from 482 dyads, we calculated prevalence ratios to evaluate candidate risk factors. RESULTS: Most women (88%) were unvaccinated. Sixty-seven percent of dyads harbored HPV. For 49% of dyads, both partners were HPV+. HPV was least prevalent in dyads who were in their first vaginal sex relationship (17%) and was virtually ubiquitous in dyads for which both partners had concurrent partners (96%). Dyads that always used condoms with previous partner(s) were 27% (95% confidence interval, 9%-42%) less likely to have HPV. CONCLUSIONS: The finding that condom use limited onward spread to future partners is in support of condom promotion to prevent sexually transmitted infections. Ongoing monitoring of HPV in sexual networks is needed, particularly in populations with suboptimal vaccine coverage.


Assuntos
Infecções por Papillomavirus/transmissão , Adolescente , Adulto , Preservativos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/virologia , Vacinas contra Papillomavirus/uso terapêutico , Prevalência , Quebeque/epidemiologia , Fatores de Risco , Comportamento Sexual/estatística & dados numéricos , Parceiros Sexuais , Adulto Jovem
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