bluuebunny/crossref_metadata_2025 huggingface dataset:
A Conceptual Framework for the Analysis of Health Care Organizations' Performance
Authors: Sicotte C. , Champagne F. , Contandriopoulos A. P. , Barnsley J. , Beland F. , Leggat S. G. , Denis J. L. , Bilodeau H. , Langley A. , Bremond M. , Baker G. R.
Published: January 2017

Organizational performance remains an elusive concept despite its importance to health care organizations' (HCOs') management and analysis. This paper uses Parsons' social system action theory to develop a comprehensive theoretically grounded framework by which to overcome the current fragmented approach to HCO performance management. The Parsonian perspective focuses on four fundamental functions that an HCO needs to ensure its survival. Organizational performance is determined by the dynamic equilibrium resulting from the continual interaction of, and interchange among, these four functions. The alignment interchanges allow the creation of bridges between traditional models of organizational performance that are usually used as independent and competing models. The attraction of the Parsonian model lies in its capacity to: (1) embody the various dominant models of organizational performance; (2) present a strong integrative framework in which the complementarity of various HCO performance perspectives are well integrated while their specificity is still well preserved; and (3) enrich the performance concept by making visible several dimensions of HCO performance that are usually neglected. A secondary objective of this paper is to lay the foundation for an integrative process of arbitration among competing indicators and perspectives which is absolutely necessary to make operational the Parsonian model of HCO performance. In this matter, we make reference to the theory of communicative action elaborated by Habermas. It offers, we think, a challenging and refreshing perspective on how to manage HCO performance evaluation processes.
Hospital Response to the Implementation of Prospective Payment
Authors: Trinh H. Q. , Begun J. W.
Published: January 2017

This research examined the competing effects of regulatory intensity (Prospective Payment System) and inertial pressure on US hospitals' cost of medical materials, shifting of services from inpatient to outpatient settings, size of the administrative component, and use of new technology. Among the expected findings, regulatory intensity was associated with reduced medical material costs, less new technology and a greater administrative component. Inertial pressures were associated with higher medical material costs, more new technology and less shifting of services from inpatient to outpatient settings. It was concluded that US hospitals respond to regulatory pressures within the context of strong inertial forces. The stronger the inertial forces, the less dramatic a hospital's response to regulatory pressures is likely to be.
Management of Health System Reform: A View of Changes within New Zealand
Authors: Ritchie D.
Published: January 2017

This paper reports on the context and process of health system reform in New Zealand. The study is based on interviews conducted with 31 managers from three Crown Health Enterprises (publicly funded hospital-based health care organizations). A number of countries with publicly funded health services (e.g. UK, Australia and New Zealand) have sought to shift from the traditional ‘passive’ health management style (using transactional management skills to balance historically-based expenditure budgets) to ‘active’ transformational leadership styles that reflect a stronger ‘private sector’ orientation (requiring active management of resources—including a return on ‘capital’ investment, identification of costs and returns on ‘product lines’, ‘marketing’ a ‘product mix’, reducing non-core activities and overhead costs, and a closer relationship with ‘shareholders’, suppliers and customers/clients). Evidence of activities and processes associated with transformational leadership are identified. Success of the New Zealand health reforms will be determined by the approach the new managers adopt to improve their organization's performance. Transformational leadership has been frequently linked to the successful implementation of significant organizational change in other settings (Kurz et al., 1988; Dunphy and Stace, 1990) but it is too early to assess whether this is applicable in a health care context.
Managerialism in the Health Service: Partnership or Conflict in a Management Development Programme
Authors: Currie G.
Published: January 2017

This paper describes a management development programme in a hospital-based Trust and the differing responses demonstrated by those taking part. In terms of the impact of the programme, a picture emerges of differentiation and fragmentation rather than culture being managed to produce a social glue. Following this, suggestions are made for successful partnerships in the promotion of managerial effectiveness through management development to clinical services managers in the health service.
Cost and Price in the NHS: The Importance of Monetary Value in the Decision-Making Framework – the Case of Purchasing Renal Replacement Therapy
Authors: Moore R. , Marriott N.
Published: January 2017

This paper examines the role of cost, price and health economic evaluation in the National Health Service as demonstrated by reference to renal replacement therapy for patients with end-stage renal failure. In particular, it aims to highlight the problems with monetary value and to illustrate how it may be manipulated by legitimate techniques to produce varying outcome values which may be misleading and thereby distort the healthcare decision-making process. The paper argues for standardization of costing methods and health economic evaluation to enable meaningful intra- and inter-hospital comparisons to be made.
Determinants of Hospital Bad Debt: Multivariate Statistical Analysis
Authors: Kwon Ik-Whan G. , Stoeberl Philipp A. , Martin David , Bae Muean
Published: January 2017

Although the issue of uncompensated care (bad debt plus charity care) has been actively debated in the public arena, there has been little discussion of the bad debt issue alone. This issue is important since issues of bad debt, charity care and uncompensated care are significantly different from each other. Based on 1992 State of Missouri data, the results of our study indicate that more efficient hospitals (measured by occupancy rate), hospitals with more patients covered by prospective payment systems (measured by Medicare discharges), and for-profit hospitals incurred significantly less bad debt cost than other hospitals. However, the difference in bad debt between for-profit hospitals and not-for-profit hospitals is dissipated when using a multivariate statistical model. In addition, this study also reveals that hospitals which provide more charity care have the lowest bad debt costs. Policy implications are also discussed.
The Critical Success Factor Approach to Strategic Alignment: Seeking a Trail from a Health Organization's Goals to its Management Information Infrastructure
Authors: Tan J. K. H.
Published: January 2017

The critical success factor (CSF) approach is a technique that will aid health administrators, planners and managers to identify, specify and sort among the most relevant and critical factors determining an organization's survival and success. Following a top-down management perspective, this paper discusses the CSF methodology as a strategic information management process comprising several important phases: (i) understanding the external factors such as the organization's industry, market and environment; (ii) achieving strong support and championship from top management; (iii) encouraging the proactive involvement of management and staff in generic CSF identification; (iv) educating and directing the participation of staff members in CSF verification and further refinement of generic CSFs into specific CSFs; and (v) aggregating, prioritizing and translating activity-related CSFs into organizational information requirements for the design of the organization's management information infrastructure. The implementation of this CSF approach is illustrated in the context of a British Columbia community hospital, with insights provided into key issues for future health researchers and practitioners.
Mycoplasma Species in Rapid and Slow HIV Progressors
Authors: Ainsworth J G , Hourshid S , Easterbrook P J , Gilroy C B , Weber J N , Taylor-Robinson D
Published: January 2017

We determined the relationship between the presence of Mycoplasma fermentans and Mycoplasma penetrans and the rate of progression of HIV-associated disease in a nested case-control study based on a cohort of 159 HIV-infected patients with different rates of disease progression. Study participants were divided into 3 progression groups: non-progressors who had been HIV-1 seropositive for at least 9 years and had remained asymptomatic with a CD4 cell count of >500/mm3; slow progressors who had been HIV-1 seropositive for at least 9 years and whose CD4 cell count had fallen below 500 cells, and who had developed symptomatic disease or AIDS; and rapid progressors who had developed AIDS within 5 years of HIV infection. Peripheral blood mononuclear cells (PBMCs) were collected at enrolment and examined by mycoplasma polymerase chain reaction (PCR) assays. Three (7%) of 46 non-progressors, 3 (3%) of 86 slow progressors, and 2 (7%) of 27 rapid progressors were M. fermentans positive. The PBMCs from 91 subjects were tested for M. penetrans DNA and none was positive. The small proportion of M. fermentans-positive patients indicates that the mycoplasma cannot be important in the development of AIDS in the large majority of patients. Furthermore, no association was found between its presence and more rapid HIV disease progression.
Asymptomatic Penile HPV Infection: A Prospective Study
Authors: Wikström A , Popescu C , Forslund O
Published: January 2017

The occurrence of human papillomavirus (HPV) among males was analysed with the polymerase chain reaction (PCR) method. Penile brush samples were taken once from 147 males attending for a control or for HPV non-related reasons, and consecutive samples were collected from 88 males re-attending the clinic. Of the males attending once, 13% (19/147) were HPV DNA positive and among the re-attenders 14% (12/88) were initially positive as compared with 33% (29/88) who were positive at least at one visit. Totally, 22 different HPV types were detected of which HPV 16 was most common, found in 6.4% (15/235), followed by HPV 42 found in 3.8% (9/235). Among 14 HPV-positive males with at least one follow-up, 7 had persistent infections with at least one HPV type, and transient HPV types were observed in 9; but in 5 of them new types appeared at follow-up. Among sexually-active males subclinical/latent HPV infection is common and repeated sampling increases its prevalence.
A Survey of Patients with Chlamydia Trachomatis Infection: Sexual Behaviour and Perceptions about Contact Tracing
Authors: Tydén T , Ramstedt K
Published: January 2017

The aim of this study was to evaluate how patients with Chlamydia trachomatis infection perceived the legal enforcement of partner notification and to seek their views on legislation impinging on their own sexual behaviour. The investigation was performed at STD clinics in Stockholm, Sweden in 1997. Consecutive patients ( n=192) answered a questionnaire about sexual behaviour and contact tracing. More men (40%) than women (21%) had had sexual intercourse during the past 6 months with an occasional partner. The mean number (6 months prior to this) was 2.3 partners (1–15) for men and 2.2 partners (1–21) for women. Eighteen per cent admitted to having avoided disclosing the name of their partner(s). Ninety per cent considered it beneficial that chlamydial infection was regulated and that a named partner could be forced to undergo STD testing. Partly based on this report, the government has recommended police enforcement to be removed from the legislation as a tool for contact tracing in chlamydial infections.
Evaluation of a Drama-in-Education Programme to Increase AIDS Awareness in South African High Schools: A Randomized Community Intervention Trial
Authors: Harvey Brian , Stuart James , Swan Tony
Published: January 2017

A community intervention trial was undertaken in KwaZulu Natal, South Africa to evaluate the effectiveness of a high school drama-in-education programme. Seven pairs of secondary schools were randomized to receive either written information about HIV/AIDS or the drama programme. Questionnaire surveys of knowledge, attitude and behaviour were compared before and 6 months after the interventions. One thousand and eighty students participated in the first survey and 699 in the second. Improvements in knowledge ( P=0.0002) and attitudes ( P<0.00001) about HIV/AIDS were demonstrated in pupils at schools receiving the drama programme when compared to pupils receiving written information alone. These changes were independent of age, gender, school or previous sexual experience. In schools receiving the drama programme, sexually active pupils reported an increase in condom use ( P<0.01). It is important to provide resources to sustain such programmes and to obtain stronger evidence of effect on behaviour by measuring changes in HIV incidence.
Disseminated Penicillium Marneffei in a Patient Infected with Human Immunodeficiency Virus
Authors: Vilar F J , Hunt R , Wilkins E G L , Wilson G , Jones N P
Published: January 2017

A case of a 31-year-old man with systemic Penicillium marneffei infection acquired in Thailand and who developed endophthalmitis is described. This presentation has not previously been reported. He responded to combined treatment with intravenous and intravitreal amphotericin.
The Association of Neoplasms and HIV Infection in the Correctional Setting
Authors: Baillargeon Jacques , Pollock Brad H , Leach Charles T , Gao Shou-Jiang
Published: January 2017

HIV-associated immunosuppression has been linked to an increased risk of a number of cancers, including Kaposi sarcoma (KS), non-Hodgkin's lymphoma (NHL), and invasive cervical cancer. Because prison inmates constitute one of the highest HIV/AIDS prevalent populations in the US, understanding the link between HIV infection and cancer in the correctional setting holds particular public health relevance. The study population consisted of 336,668 Texas Department of Criminal Justice inmates who were incarcerated, for any duration, between 1 January 1999 and 31 December 2001. Inmates diagnosed with HIV infection exhibited elevated rates of KS, NHL, anal cancer, and Hodgkin's disease, after adjusting for age and race. The elevated rates of cancer among HIV-infected individuals, particularly prison inmates, may be mediated, in part, by high-risk behaviours. HIV-associated risk behaviours, including unsafe sexual practices, injection drug use, and prostitution may be associated with cancer-related risk behaviours, such as smoking, excessive alcohol consumption, and poor diet. It will be important for future investigators to examine the association between HIV infection and Cancer risk with sufficiently large study cohorts and appropriate longitudinal designs.
The ‘Bear Trap’: The Colliding Epidemics of Tuberculosis and HIV in Russia
Authors: Drobniewski F A , Atun R , Fedorin I , Bikov A , Coker R
Published: January 2017

In April, 2003 the World Bank approved a long-awaited $150 million loan to the Russian Federation to support tuberculosis (TB) and AIDS control. Although the Russian Federation accounts for a relatively small fraction of the global TB case-load the proportion of cases which are drug-resistant and particularly multidrug-resistant is very high in some regions. HIV incidence, principally associated with intravenous drug abuse, has also increased dramatically and this will impact upon TB control efforts. Federation-wide data are limited but a focus on one region shows something of the confluence of the epidemics of HIV and TB. Approaching 200 cases of HIV-associated TB have occurred in the past two years, and the age structure of the HIV-infected population and that with high rates of TB shows sizeable overlap. The region has high rates of multidrug-resistant TB which are likely to impact considerably on efforts to meet this emerging and complex public health challenge. Insights gained through the examination of this one region can tell us something of the magnitude of the challenge now faced by both the international community and Russia.
Syphilis as a Social Disease: Experience from the Post-Communist Transition Period in Estonia
Authors: Uusküla Anneli , Nygård Jan F , Kibur-Nygård Mari
Published: January 2017

Increased incidence of sexually transmitted diseases (STD) and radical social changes have taken place at the same time in Estonia.

Our aim was to study the trends in syphilis incidence, selected sociodemographic factors and health status indicators during the economic transition.

Associations were estimated by the ordinary least square regression method for change in and actual values of syphilis and tuberculosis incidence rate (IR), percentage of non-ethnic Estonians and urban population, homicides rate, unemployment rate and, birth rate. The analysis was performed by counties at three different time periods.

Syphilis IR significantly correlated with the proportion of non-ethnic Estonians, urban population, tuberculosis IR and birth rate. Change of syphilis IR correlated significantly with concurrent changes in unemployment rate and tuberculosis IR.

Our findings support the theory that syphilis is a social disease, thus emphasizing the importance of social factors in the occurrence of STDs.
Caretakers of AIDS Patients in Rural Tanzania
Authors: Katapa R S
Published: January 2017

Socio-economic characteristics of caretakers of bed-ridden AIDS patients in two rural communities of Rungwe district, Tanzania were sought. The study also explored what caretaking entailed. Data were collected from 60 caretakers between September and November 2002. The proportion of female caretakers was significantly higher than that of male caretakers; the majority of the caretakers were old. The majority of the AIDS patients were family members of the caretakers. The caretakers' households lacked basic needs for the patients. Some of the caretakers sold family assets in order to buy medicines for the patients. Most of the caretakers worked under stress and there was no one to counsel them. Community members offered very little or no support to caretakers and the households were stigmatized. People in the communities knew about HIV/AIDS transmission, but their behaviour did not match their knowledge.
Case Fatality and Health Care Costs in HIV-Infected Patients: Evolution from 1992 to 2000 at Rouen University Hospital, France
Authors: Basuyau F , Josset V , Merle V , Czernichow P
Published: January 2017

Vital prognosis in HIV-infected patients has been improved by new therapies, leading to an increase in treatment and outpatient costs but lower inpatient care costs. The aim of the study was to compare the health care costs between 1992–1996 (first half) and 1996–2000 (second half) in HIV-infected patients at Rouen University Hospital. Hospitalization costs (including inpatient and outpatient care), infectious complication treatment and antiretroviral therapy costs were evaluated from a National Health Insurance viewpoint. Between 1992 and 2000, 1212 patients were admitted at least once. Total expenditure increased between the two periods from €13,660 to €27,567, i.e., a two-fold increase. During the same period, 125 deaths were avoided, and 3602 years of life were gained. The cost of one avoided death was €108,320 and the cost per life-year gained was €3776.
Pseudomonas Orchitis in Puberty
Authors: Rajagopal Ambit S
Published: January 2017

Acute epididymo-orchitis is a common cause of ‘acute scrotum’ in adolescence and young adults, and the common causative pathogens are Chlamydia trachomatis and Neisseria gonorrhoeae. This is a rare case of acute epididymo-orchitis due to Pseudomonas aerugillosa in a pubertal boy with a history of ‘ano-receptive’ intercourse. On Medline search there are no reports of pseudomonas orchitis in this age group.
Clinical Applications of the Polymerase Chain Reaction
Authors: Kitchin P A
Published: January 2017

The polymerase chain reaction (PCR) is a technique that allows a million-fold, or greater, amplification of defined regions of DNA or RNA. It is potentially capable of detecting a single copy of a gene, present only once in 105 eukaryotic cells. This remarkable level of sensitivity has allowed the development of many diagnostic assays for human pathogens and disease states. These include: the detection of viral, bacterial and protozoal agents; diagnosis and genetic analysis of inherited diseases such as β-thalassaemia, sickle cell disease, haemophilia, Tay-Sachs disease and many others; diagnosis and analysis of neoplastic disorders such as, chronic myelogenous leukaemia (CML), acute lymphocytic lymphoma (ALL), follicular lymphomas and various other cancers, including the detection of activated oncogenes; prenatal and pre-implantation diagnosis; and the development of genetic risk prediction.

The PCR can greatly simplify diagnostic processes that were previously difficult to perform, particularly where the initial amounts of biological material were very limited. In other cases, PCR provides the only method available for detection and diagnosis. However, although simple in theory, the PCR technique remains, for routine clinical diagnostic purposes, currently in the domain of the specialist laboratory. This is because of its sensitivity to nucleic acid contamination from other sources that can cause misleading results. Procedures and precautions are being developed to minimize this problem and there is little doubt that, in many instances, the PCR will be the diagnostic method of choice within the next few years.
Sexually Transmitted Diseases in Lesbians
Authors: Edwards Anne , Thin R Nicol
Published: January 2017

The limited published data support the assumption that lesbians are a low risk group for sexually transmitted diseases (STDs). However there are virtually no contemporary data and the older papers do not take into account genital wart virus infection, now the third most prevalent STD in Britain. One of the dangers in assuming that lesbians are a ‘safe group’ for STD and allied disorders is that patients may not attend for regular cervical cytology and could be at risk of developing cervical cancer.

In an unselected series of 27 lesbians attending a genitourinary medicine clinic, the most important findings were a relatively high prevalence of the viral STDs, herpes simplex and human papillomavirus. Additionally, 10 patients had abnormal cytology ranging from inflammation to dyskaryosis.

There is a need for more information about the true prevalence of STDs in this group and evaluation of the risk factors for female-to-female transmission of infections. Lesbians should continue to have regular cervical smears, especially as many have had earlier heterosexual intercourse.
Incidence of Herpes Simplex Virus Type-1 and Type-2 from Patients with Primary (First-Attack) Genital Herpes in Sheffield
Authors: Woolley P D , Kudesia G
Published: January 2017

In a study to determine the herpes simplex virus (HSV) type isolated from patients with primary (first-attack) genital herpes and to identify any clinical or epidemiological features that might influence the reported incidence of any particular viral type, there was almost an equal incidence of HSV-1 and HSV-2 isolated from women (48% versus 52%). In the case of women, the initial clinical diagnosis was correct in 97% with HSV-1 and 95% with HSV-2 infection. Amongst men, HSV-2 was isolated more frequently than HSV-1 (71% versus 29%). However, the initial clinical diagnosis in men was correct in only 53% with HSV-1 and 83% with HSV-2 infection. These results suggest that in primary genital herpes the incidence of HSV-1 and HSV-2 is probably equal, while in men the reported incidence of HSV-1 may be affected by underdiagnosis giving a falsely high incidence of HSV-2 infection.
Screening for Chlamydia Trachomatis Genital Infection in Young Men in Stockholm
Authors: Larsson S , Rudén A-K , Bygdeman S M
Published: January 2017

The purpose of this study was to investigate the prevalence of genital chlamydial infection in male military recruits in Stockholm, Sweden. Two hundred and thirty-eight men who admitted to sexual experience were included in the study. One hundred and five (44%) of these 238 men consented to a specimen being taken for chlamydial culture. Eleven (10%) of these 105 men had a positive chlamydial culture. All 11 men were 17–18 years old and 10 were asymptomatic. In order to decrease the prevalence of chlamydial infection, screening of young men is as essential as screening of women.
Sexually Transmitted Diseases among Patients Seeking HIV Antibody Test for AIDS
Authors: Mohanty K C
Published: January 2017

A total of 489 patients who had blood tests for antibodies to the human immunodeficiency virus (HIV) were given medical advice for sexually transmitted disease (STD) screening. Of 378 patients who had STD screening, STDs were found to be present in 47%. Among various STDs, non-specific urethritis (NSU) in men and chlamydial genital infection in women were found to be common. When the prevalence of these two diseases were compared with those of a control group the difference was significant.
Screening Colposcopy in Genitourinary Medicine
Authors: Nathan P M , Moss T R
Published: January 2017

A prospective study of new female patients attending the Genitourinary Medicine Department in Doncaster was carried out to look at the value of colposcopic examination at their first attendance. Of the 100 randomized patients studied 41 showed evidence of colposcopically detected cervical abnormality. Twenty-seven patients had colposcopically directed biopsies. These showed evidence of cervical intraepithelial neoplasia (3 cases), flat condyloma (16 cases), exophytic wart (2 cases), chronic inflammation (2 cases) and normal epithelium (4 cases). Colposcopic cervical abnormalities were significantly associated, with a history of anogenital warts, sexual contact with anogenital warts and the presence of anogenital warts at presentation. Despite this, less than half the group showing colposcopic abnormalities had an association with anogenital warts. Demonstration of cervical abnormalities by colposcopy resulted in a greater patient compliance during follow-up. Screening or primary colposcopy may be incorporated into a genitourinary screen at the first visit. The procedure is both acceptable and beneficial to the patient, facilitating the detection of a range of cervical disease and enhancing the doctor–patient relationship.
Prevalence of Occult Human Papillomavirus Infection, Determined by Cytology and DNA Hybridization, in Heterosexual Men Attending a Genitourinary Medicine Clinic
Authors: Mandal D , Haye K R , Ray T K , Goorney B P , Stanbridge C M , Corbitt G
Published: January 2017

One hundred and five heterosexual men without evidence of clinical anogenital warts and attending a genitourinary medicine clinic were studied. Three separate specimens for cytology were taken from (i) the distal urethra including the perimeatal area, (ii) the penile shaft and glans penis including the sub-preputial area, and (iii) from the anorectal area using a proctoscope. Pooled specimens of exfoliated cells from these sites were also taken for the detection of human papillomavirus (HPV) by DNA hybridization. Twenty-eight (27%) of the men had cytological evidence suggestive of HPV infection. HPV genome was detected in 21 (20%) of the men by DNA hybridization and 95% of them were carrying HPV 16 genotype either alone or in combination with other genotypes. A total of 42 (40%) of patients had evidence of occult HPV infection using cytology and/or DNA hybridization techniques collectively. None of the epidemiological risk factors were significantly associated with occult HPV infection in this study. The significance of this high incidence of sexually transmissible HPV genomes, mostly HPV16 in the anogenital area of heterosexual men attending genitourinary medicine clinics requires further study.
Distribution of HIV and Acute Hepatitis B Infection among Drug Injectors in Glasgow
Authors: Gruer L D , Peedle M , Carrington D , Clements G B , Follett E A
Published: January 2017

This study compared the distributions of known human immunodeficiency virus (HIV) and acute hepatitis B virus (HBV) infection among drug injectors in Glasgow over a 3.5 year period. Data were obtained from all relevant laboratory request forms submitted to Glasgow's 3 virology laboratories during the period 1 January 1986 to 30 June 1989. The overall prevalence of HIV among those tested was 3.7% (66/1786). There were 125 cases of acute HBV infection. The male:female ratios for HIV and acute HBV were 1:1 and 2:1, respectively. Thirty-four per cent of persons with HIV were aged under 21 years compared with 53% with acute HBV. Three out of 10 areas of the city accounted for 92% of HIV infection but only 66% of acute HBV infection. HIV infection was not detected among drug injectors in 4 areas of the city but at least 2 cases of acute HBV infection were recorded in all 10 areas. The geographical and age distribution of acute HBV infection in Glasgow suggests that the potential for future spread of HIV among drug injectors remains considerable.
Evaluation of an Enzyme Immunoassay (Chlamydiazyme) with Confirmatory Test for the Detection of Chlamydial Antigen in Urine from Men
Authors: Mumtaz G , Ridgway G L , Clark S , Allason-Jones E
Published: January 2017

First catch urine specimens from 312 male patients were examined for the presence of chlamydial antigen by an enzyme immunoassay (Chlamydiazyme). Positive results were repeated and confirmed using a blocking assay. In addition, urethral swabs were examined by cell culture for Chlamydia trachomatis. Discrepant results were further analysed by direct immunofluorescence (IF) of the spun urine deposit. Paired specimens were positive from 26 subjects, and negative from 276 subjects. Eight paired specimens were urethral culture positive, and urine EIA negative. Two specimens, urine EIA positive but urethral culture negative, were positive on direct IF. The sensitivity, specificity, predictive value of a positive result, and predictive value of a negative result for urine EIA against cell culture and/or direct IF were 77.8%, 100%, 100% and 97.2% respectively.
Is Bacterial Vaginosis a Sexually Transmitted Disease?
Authors: Larsson P-G , Platz-Christensen J-J , Sundström E
Published: January 2017

The sexual behaviour of 400 women with and 400 women without bacterial vaginosis from a health screening programme was investigated by a questionnaire to see if women with bacterial vaginosis had similar behaviours to women considered at risk for STDs. These patients were randomly selected from computer records. Eight hundred questionnaires were distributed and 641 women answered. The age of first sexual intercourse was lower among women with bacterial vaginosis (17.8 years) than those without (18.6 years; P < 0.001). Number of lifetime sexual partners was higher among women with bacterial vaginosis ( P < 0.001). Women with bacterial vaginosis smoked or had smoked more often. These results indicate that women with bacterial vaginosis have similar sexual behaviour to those at risk for STDs.
Value of Examining the Sexual Partners of Women Suffering from Initial Genital Herpes
Authors: Woolley P D
Published: January 2017

In a retrospective clinical audit of patient records to determine the value of examining the sexual partners of women with initial genital herpes, it was evident that only the regular partners attended for screening.

Twenty-six per cent of women with initial genital herpes and 19% of male partners had some form of other lower genital tract infection. Of 164 male partners of women with initial genital herpes, 30 (18.3%) also suffered from initial genital herpes at the same time, 22 (13.4%) gave a history of, or had signs consistent with, recurrent genital herpes, and 3 (1.8%) asymptomatic male partners without a previous history of genital ulceration had herpes simplex virus isolated from the urethra on routine screening.
Significance of Barteroides Ureolyticus in the Lower Genital Tract
Authors: Woolley P D , Kinghorn G R , Bennett K W , Eley A
Published: January 2017

In a study to determine the significance of Bacteroides ureolyticus in the lower urogenital tract using a new selective and differential medium, this organism was isolated from 30.1% of asymptomatic men, 37.8% of men with genital warts, and 26.3% of men with non-gonococcal urethritis. Using the same selective medium B. ureolyticus was isolated from 49% of women attending the same genitourinary clinic with symptoms of vaginal discharge and/or pruritis vulvae, 44.1% of asymptomatic women, and 50% of asymptomatic women attending a local family planning clinic. Furthermore, this organism was isolated from 27.1% of women whose vaginal specimens isolated commensal organisms only, 43.2% with C. albicans, 59.4% with U. urealyticum, 74.4% with M. hominis, and 76.8% with G. vaginalis.

On testing with the API ATB 32A test strips, 86% of the positive isolates of B. ureolyticus from the female genital tract were indistinguishable from those isolated from the male genital tract indicating that this organism is common to the lower genital tract of both sexes. These results indicate that B. ureolyticus is a commensal in the lower genital tract.
Balanitis (Balanoposthitis) in Patients Attending a Department of Genitourinary Medicine
Authors: Abdullah A N , Drake S M , Wade A A H , Walzman M
Published: January 2017

Eighty-six patients with balanitis/balanoposthitis who presented at the department of genitourinary medicine in Coventry between October 1989 and August 1990 were investigated. While 34 (41%) cases had no specific aetiological factor Candida spp. accounted for 26 cases (30%), and group B beta haemolytic streptococci for 11 cases (13%) (one patient, a diabetic, was culture positive for both Candida spp. and group B beta haemolytic streptococci). The remaining 14 patients had other miscellaneous causes of balanitis/balanoposthitis.
The Prevalence of Hairy Leukoplakia in HIV Seropositive and HIV Seronegative Immunocompromised Patients
Authors: Ramael M , Colebunders R , Colpaert C , Goeman J , Schrijvers D , Lachenal M , Vandenbruaene M , Blot K , Van Marck E
Published: January 2017

The prevalence of hairy leukoplakia was determined among 176 symptomatic HIV seropositive patients seen at the outpatient department of the Institute of Tropical Medicine in Antwerp, Belgium. Moreover, systematic tongue biopsies were performed during postmortem examination of 21 patients with AIDS, 100 HIV seronegative immunocompromised patients with haematologic or other malignancies and 100 HIV seronegative non-immunocompromised patients who died at the University Hospital Antwerp.

Hairy leukoplakia was observed in 52 (29.5%) of the outpatients, but only in one (5%) of the AIDS patients in the postmortem study ( P=0.03). An explanation for this difference may be that significantly more AIDS patients who died had received either acyclovir or ganciclovir during the 3 months prior to the postmortem examination than the HIV seropositive outpatients during the 3 months prior to examination. Hairy leukoplakia occurred more often in Caucasian homosexual men with HIV infection (38%) than among heterosexual Africans with HIV infection (17%) ( P=0.06). Hairy leukoplakia was observed in none of the HIV seronegative patients.
Megestrol Acetate Vs Cyproheptadine in the Treatment of Weight Loss Associated with HIV Infection
Authors: Summerbell C D , Youle M , McDonald V , Catalan J , Gazzard B G
Published: January 2017

Two appetite stimulants, megestrol acetate and cyproheptadine were administered in a randomized trial to 14 patients who had no evidence of opportunistic infection or malabsorption but were wasted (had lost more than 5 kg body weight) as a result of human immunodeficiency virus (HIV) infection. Energy intakes were calculated from a 7 day weighed dietary record. Mean energy intakes per kilogramme body weight were similar in both treatment groups (greater than 34 kcal/kg) and were higher than that in well British males. Energy intakes increased by just over 500 kcal during both treatments, but fell to pretreatment levels after therapy. Patients in both treatment groups gained a moderate amount of weight. Megestrol acetate was associated with impotence in 4 patients.

Insufficient calorie intake alone is not a common cause of wasting associated with HIV and the role of appetite stimulants is likely to be limited.
Empirically Treated Pneumocystis Carinii Pneumonia in London, 1983–1989
Authors: Beck E J , French P D , Helbert M H , Robinson D S , Moss F M , Harris J R W , Pinching A J , Mitchell D M
Published: January 2017

For 227 episodes of Pneumocystis carinii pneumonia (PCP) treated at St Mary's between 1983 and 1989, factors predictive of fatal outcome were age, haemoglobin levels, peripheral lymphocyte count and alveolar-arterial oxygen gradient.

Case fatality for the 47 empirically-treated episodes was significantly higher compared with the 180 cytologically proven episodes (55% vs 18%, χ2 = 25.7, P<0.0001). Case fatality for episodes which could not be bronchoscoped was significantly higher compared with bronchoscopy negative cases (66% vs 25%, χ2 = 4.5, P<0.05). Predictive factors for fatal outcome differed significantly for cases which could not be bronchoscoped and cytologically proven cases: haemoglobin level (10.7 g/dl vs 12.0 g/dl, P<0.001), lymphocyte count (0.64 × 109/l vs 0.87×109/l, P=0.05) and oxygen gradient (77.7 mmHg vs 58.9 mmHg, P<0.02). Such differences were not observed between bronchoscopy negative and cytologically proven cases.

Case fatality decreased significantly over time ( b = –0.39, SE=0.14, P<0.05). Total and non-fatal first time episodes displayed an inverse relationship between oxygen gradient and time ( r = −0.22, P<0.006 and r = −0.24, P<0.01, respectively). Mean oxygen gradient of fatal episodes for sequential years increased significantly from 73 mmHg in 1983 to 102 mmHg in 1989 ( r = 0.92, P<0.01). This suggests that medical intervention as well as presentation with less severe disease both contributed to improved case fatality over time.
Efficient Diagnosis of Pneumocystis Carinii Pneumonia
Authors: Smith Don E
Published: January 2017

In patients with HIV infection the diagnosis of PCP is relatively simple when patients present late, with advanced pneumonia. The diagnosis becomes more difficult when patients present with minimal symptoms, are receiving specific prophylactic therapy or have had previous AIDS-related pulmonary diseases. A number of non-invasive tests, such as Gallium scanning, exercise-induced hypoxaemia, DTPA scanning and lung function testing have been developed to improve on the diagnostic value of clinical examination and the chest X-ray. Although each has its own particular advantages and disadvantages, the most efficient means of diagnosing PCP, in patients presenting with respiratory symptoms, is to use these investigations as part of a diagnostic algorithm, thereby maximizing resources and defining relative risks for different types of patients.
Age-Related Increase in Sexual Behaviours and Decrease in Regular Condom Use among Adolescents in Australia
Authors: Dunne M P , Donald M , Lucke J , Nilsson R , Ballard R , Raphael B
Published: January 2017

The prevalence of sexual behaviours was estimated from a survey of 3854 Australian secondary school students. Self-reported prevalence of intercourse increased from 9.9% (age 13 years or less) to 23.9% (age 15) and 51.2% at age 17 and over. Among 932 sexually experienced youth in the final 3 years of secondary school, 26% of males and 18% of females reported having 3 or more partners in the previous year; 89.4% had used a condom at least once, with males (71.8%) reporting more last occasion condom use than females (53.4%). ‘Last occasion’ and ‘usual’, but not lifetime, condom use was significantly lower among older respondents. Although nearly 90% of females in each of 3 age groups reported lifetime condom use, just 27.6% of female students aged 17 or more reported that condoms were always used during intercourse. The decline with age, noted in research with adults and older adolescents, may begin in the middle teens.
Human Immunodeficiency Virus and Treponema Pallidum Infections in Nigerian Patients with Leprosy
Authors: Nwosu C M , Nwosu S N N , Okoye K C
Published: January 2017

Fifty-one patients were selected from 4 leprosaria in eastern Nigeria and were examined for evidence of syphilis. They were screened serologically for treponemal and human immunodeficiency virus (HIV) infections. Information about their sexual behaviour and demographic data were obtained to determine the factors associated with increased risk of contracting sexually transmitted diseases (STD). They were compared with 115 controls.

The results showed that positive treponemal tests were more common in those patients living outside the leprosaria ( P<0.05). Age and sex of the patients living inside the leprosaria were not factors associated with treponemal infections. Leprosy appeared to be a factor for T. pallidum infection when compared with the control group ( P < 0.05; OR 476; CI 1.16,19.5). One leprosy patient and one control subject had positive HIV tests and there was no significant association between leprosy and HIV infection.

These findings suggest the possibility of the spread of sexually transmitted diseases amongst the leprosy patient population. The importance with respect to control measures is that leprosy patients living outside leprosaria may constitute a potential reservoir for introducing sexually transmitted diseases into the leprosaria.
A Comparison of AIDS-Defining Events and Subsequent CDC Stage IV Events in IDUs and Gay Men
Authors: Ross J D C , Brettle R , Zhu C , Haydon G , Elton R A
Published: January 2017

The two major risk groups for acquisition of HIV in the UK are gay men and IDUs. Individuals from these risk groups vary in a number of respects in their life-style, which have the potential to affect the course of their HIV disease. This study compares gay men and IDUs from the Lothian Region of Scotland with respect to their AIDS defining diagnosis and subsequent CDC (Centers for Disease Control) stage IV events. Comparisons were made between the two risk groups for their AIDS defining diagnosis by performing chi square tests, Mann-Whitney tests and logistic regression. Subsequent CDC stage IV events were analysed using ordinal logistic regression and Cox regression. 89 IDUs and 56 gay men were included in the analysis. Oesophageal Candida was a commoner AIDS-defining diagnosis in IDUs than gay men and Kaposi's sarcoma was diagnosed more frequently in gay men than IDUs. Subsequently oesophageal Candida was also commoner in IDUs and CMV retinitis was seen more frequently in gay men. The role of prophylaxis and differences in diet are discussed as possible causes of the observed differences in the incidence of oesophageal Candida. The higher incidence of CMV retinitis in gay men probably reflects the high level of sexual acquisition of CMV.
Prevalence and Incidence of Syphilis and its Association with HIV-1 Infection in a Population-Based Study in the Kagera Region of Tanzania
Authors: Killewo J Z J , Sandström A , Råden U Bredberg , Mhalu F S , Biberfeld G , Wall S
Published: January 2017

Population-based prevalence and incidence studies on HIV-1 infection were started in the Kagera region of Tanzania in 1987. The prevalence and incidence of infection with Treponema pallidum was studied to enable development of better strategies for STD control.

Serological diagnosis of a past or treated infection with Troponema pallidum was made by seropositivity only to TPHA testing while active syphilis was diagnosed by seropositivity to both VDRL and TPHA tests. Seroconversion was measured in 1989 by finding TPHA serologically positive individuals during the follow-up period among the initially seronegative study population of 1987.

The overall prevalence of active syphilis in the total sample of adults in the region was found to be 5.9% while that of past syphilis was 13.5%. The association between the prevalence of HIV-1 infection and syphilis of both types was found to be highly significant. However, the association between one pre-existing infection and seroconversion in the other was present but not statistically significant. The overall incidence of syphilis based on seroconversion in a cohort of adults in the region was found to be 11.6 per 1000 person-years at risk.

In view of these findings, syphilis is a significant health problem in the region with a high level of transmission and efforts should be made to control it. Intervention studies should use these base-line data and monitor changes in syphilis incidence which may indicate changes in sexual behaviour. Such indicators could also be useful for evaluating the impact of interventions directed at reducing the transmission of HIV, syphilis and other STDs in the region.
Sentinel Surveillance of HIV-1 Infection in Tamilnadu, India
Authors: Solomon Suniti , Anuradha S , Ganapathy M , Jagadeeswaril
Published: January 2017

The objective was to determine the time trends in the prevalence of HIV infection and to evaluate appropriate preventive intervention in different population groups. Sentinel surveillance of HIV-1 infection by anonymous unlinked technique was carried out in Tamilnadu from December 1989 to March 1993. The sentinel population monitored were attendees of STD clinics, blood donors and antenatal mothers. The results of HIV seropositivity were compared for each 6-month period. During the study period there was 10-fold rise of HIV seropositivity among STD patients (1% to 10%), 2-fold rise among antenatal attendees (0.37% to 0.76%), and 3-fold rise in blood donors (0.24% to 0.72%). There was a steady increase in the incidence of HIV infection among those with high risk bheaviour (STD attendees) as well as in the general population. This information is of value in planning and evaluation of preventive and control programmes in India.
The Antiphospholipid Syndrome
Authors: Hughes GRV
Published: January 2017

The antiphospholipid syndrome, now 13 years old, embraces almost all specialties. After a slow start—possibly because many early descriptions were published largely in the rheumatology literature, the syndrome has become recognised worldwide as a major cause of venous-arterial thrombosis, strokes, valvular disease and recurrent abortion. Its prevalence may soon overtake that of its ‘parent’ disease, Lupus.