bluuebunny/crossref_metadata_2025 huggingface dataset:
Sexual Harassment of Female Nurses in a Hospital in Turkey
Authors: Kisa A. , Dziegielewski S. F.
Published: January 2017

Sexual harassment has been identified as a universal factor that can affect nursing performance and work productivity in any type of health care facility. Few studies in the area of sexual harassment have been conducted in developing countries, and this is the first study of its type to be conducted in the country of Turkey. The general purpose of this study is to examine whether the problem of sexual harassment truly is ‘universal’ and to begin to address whether it exists among female nurses in Turkey. Translated surveys were distributed to selected nurses in Ankara, Turkey, asking about their experiences of sexual harassment during their nursing practice. With a response rate of 58% ( n = 229), 75% of the respondents reported having been sexually harassed during their nursing practice. The most commonly reported forms of sexual harassment included sexual teasing, jokes, remarks or questions and pressure for dates. Harassment by physicians (44%), by patients (34%), by relatives of patients (14%) and others (9%) were noted. Further, a significant relationship was found between sexual harassment of nurses who work in inpatient or outpatient clinics. In general, these findings suggest that sexual harassment of female nurses remains a disturbing problem in this developing country. Based on the findings, implications for policy and further study are suggested.
A Review of Organizational Performance Assessment in Health Care
Authors: Leggat S. G. , Narine L. , Lemieux-Charles L. , Barnsley J. , Baker G. R. , Sicotte C. , Champagne F. , Bilodeau H.
Published: January 2017

As health care organizations look for ways to ensure cost-effective, high quality service delivery while still meeting patient needs, organizational performance assessment (OPA) is useful in focusing improvement efforts. In addition, organizational performance assessment is essential for ongoing management decision-making, operational effectiveness and strategy formulation. In this paper, the roles and impact of OPA models in use in health care are reviewed, and areas of potential abuse, such as myopia, tunnel vision and gaming, are identified. The review shows that most existing OPA models were developed primarily as sources of information for purchasers or consumers, or to enable providers to identify areas for improvement. However, there was little conclusive evidence evaluating their impact. This review of existing OPA models enabled the establishment of principles for the development, implementation and prevention of abuse of OPA specific to health care. The OPA models currently in use in health care may provide managers with false confidence in their ability to monitor organizational performance. To further enhance the field of OPA, areas for future research are identified.
Managing Health Services: How Administrative Data and Population-Based Analyses Can Focus the Agenda
Authors: Roos N. P. , Black C. , Roos L. L. , Frohlich N. , DeCoster C. , Mustard C. , Brownell M. , Shanahan M. , Fergusson P. , Toll F. , Carriere K. C. , Burchill C. , Fransoo R. , MacWilliam L. , Bogdanovic B. , Friesen D.
Published: January 2017

University-based researchers in Manitoba, Canada, have used administrative data routinely collected as part of the national health insurance plan to design an integrated database and population-based health information system. This information system is proving useful to policymakers for providing answers to such questions as: which populations need more physician services? Which need fewer? Are high-risk populations poorly served or do they have poor health outcomes despite being well served? Does high utilization represent overuse or utilization related to high need?

More specifically, this system provides decision-makers with the capability to make critical comparisons across regions and subregions of residents' health status, socioeconomic risk characteristics, and use of hospitals, nursing homes, and physicians. The system permits analyses of demographic changes, expenditure patterns, and hospital performance in relation to the population served. The integrated database has also facilitated outcomes research across hospitals and counties, utilization review within a single hospital, and longitudinal research on health reform. A particularly interesting application to planning physician supply and distribution is discussed. The discussion highlights the strengths of integrated population-based information in analyzing the health care system and raising important questions about the relationship between health care and health.
Barriers to Evidence-Based Care in Nursing: Historical Legacies and Conflicting Cultures
Authors: Hicks C.
Published: January 2017

The British National Health Service (NHS) has witnessed many fundamental changes over the last decade, one of the most significant of which is the imperative for health-care professionals to ensure that their clinical practice can be supported by research evidence. This move from intuition and historical ritual to scientific justification has not been fully successful in either the medical or non-medical professions, with the result that a great deal of research has been sponsored at both the national and local levels to investigate the reasons underlying the research/practice divide. Within nursing the problem has been particularly exacerbated by its ideological framework, the culture and tradition of the profession itself and the recent reforms that were intended to raise its professional status and autonomy. This paper considers the impact of nursing traditions and stereotypes and the bureaucratic structures of the NHS on the introduction of evidence-based nursing care. It is suggested that the essential nature of nursing, its legacy and philosophy, together with the health service's hidden agendas, have conspired to keep nursing in a subordinated, quasi-professional role as one means by which the workforce can be controlled. Because the nursing profession has colluded with this, albeit inadvertently, it now needs to re-establish its complementary functions, in order to salvage its position and truly establish nursing as a profession in its own right.
Business Planning Health-Check Questionnaire: A Survey of First, Second, Third and Fourth Wave NHS Trusts
Authors: Bennett A. R. , Banks J. M.
Published: January 2017

This paper reports the results of primary research which was carried out in July 1995 with respect to business planning within first, second, third and fourth wave National Health Service (NHS) Trusts. The purpose of the research was to examine current practice in these Trusts in three areas – namely, the levels of responsibility for business planning in general, the business planning processes applied by these Trusts, and the tools and techniques used by business planning managers in the compilation of business plans. The research, based on a 37.5% response rate, concludes that, as a general rule, business planning in first, second, third and fourth wave NHS Trusts tends to be a board-level activity, where senior managers have a job title which reflects this function. Secondly, the research shows that by far the greatest challenge for Trusts lies in the external marketplace. In areas such as patient needs forecasting, competitive (Trust) intelligence, purchaser and general practice fundholder requirements, data are difficult to acquire. Finally, the evidence suggests that there is a significant gap between what is regarded as business planning practice in the NHS and what is actually applied as best practice. The report concludes that business planning in the NHS Trusts sampled appears to be an art rather than a science, and that many assumptions made by business planning managers are founded on qualitative information rather than on specific, measurable data derived from the external and internal market.
Service Quality Attributes of Maternity Care Services: The Prospective Consumer's Perspective
Authors: Calleja A. , Gauci S.P.
Published: January 2017

The application of the repertory grid technique made it possible to capture the mental categorization by which maternity care services are judged. Conceptualization of the expectation standard, defined as estimates of anticipated performance, led to the identification of 14 attributes. These include: reliability, responsiveness, competence, access, courtesy, communication, credibility, security, relationship, tangibles, control, cost, naturalness and quality. The definitions made use of the prospective consumer's own verbal labels. In addition, it was found that maternity care services were not perceived as one continuous process. Three distinct categorizations were identified, that is: before, during, and after the birth of the baby. This suggests that prospective consumers employ the service quality attributes, according to one of the above.
Change in Stress Outcomes following an Industrial Dispute in the Ambulance Service: A Longitudinal Study
Authors: Young K. M. , Cooper C. L.
Published: January 2017

A longitudinal study to assess change in the symptoms of strain following an industrial dispute was carried out in a North of England ambulance service. A cohort of ambulance staff was surveyed over three stages: during the dispute; during the process of reorganizing the service; and during the implementation of a new operating structure. Dependent variables included measure of job satisfaction and mental and physical health. Independent variables included measures of the type A behaviour pattern, locus of control, source of perceived pressure and coping techniques. The results failed to support the main hypothesis as the symptoms of strain measured did not show any reduction after the dispute. Job dissatisfaction increased in the aftermath of the dispute and remained poor during the implementation of change. Symptoms of mental and physical ill-health showed no reduction following the dispute but symptoms of mental ill-health increased as organizational change was implemented. The high level of ‘externality’ shown by ambulance staff partially accounted for both these increases. It is proposed that the manner in which the aftermath of the dispute and ensuing organizational change were managed gave an increasingly limited scope for influence.
Shared Care for High-Dependency Patients: Mental Illness, Neurological Disorders and Terminal Care—A Review
Authors: Walker Z. , McKinnon M. , Townsend J.
Published: January 2017

Changes in the structure of health services in the UK have increased the need to identify and formalize shared responsibilities between primary and secondary care for patients with chronic conditions. There are well-established schemes for the management of patients with some chronic diseases but very little for other high-dependency groups. This review examines the extent of systematic and shared care for some of the less well served groups: these are mental illness, neurological disorders and terminal care. Examples of good practice are highlighted.
Severity of Illness and Profitability: A Patient Level Analysis
Authors: Carpenter C. E. , Rosko M. D. , Louis D. Z. , Yuen E. J.
Published: January 2017

Crafting a payment mechanism for hospitals that provides for the legitimate operating needs of efficient institutions is an enduring health policy dilemma. The Prospective Payment System used by Medicare and some other payers in the US has been criticized for not adjusting for differences in severity of illness within diagnosis-related groups (DRGs). Previous studies have examined the relationship between profitability and severity of illness at the hospital level. This study examines the relationships between severity of illness and cost, revenue, and profit at the patient level. Two measures of severity (disease stage and number of unrelated diseases) were significant predictors of cost per case, and often had better predictive power than DRGs. In most instances, payers did not compensate adequately for severity so that higher values for the severity variables resulted in financial losses for the hospital.
Risk Perception and Counselling among HIV-Positive Women in São Paulo, Brazil
Authors: Ventura-Filipe E M , Bugamelli L E , Leme B , Santos N J S , Garcia S , Paiva V , Hearst N
Published: January 2017

This study of HIV-positive women at a clinic for HIV/AIDS in São Paulo examined their risk perception for HIV before they had learned of their diagnosis and their experiences with pre- and post-test counselling. A sample of 148 women was interviewed regarding demographics, HIV risk factors and risk perception, pre- and post-test counselling, and sexual and reproductive conduct. The majority (77%) had been infected by their partners—37% by an injecting drug user partner. More than half (53%) did not perceive themselves at risk before learning of their HIV status and, of 68 who had perceived themselves at risk, 29% did so only after their partners became ill. The majority (64%) did not receive any kind of pre-test counselling. Post-test counselling was reported by 83% but 14% reported being mishandled by a physician in the process. Findings suggest the importance of prevention efforts to reduce women's barriers to learning about HIV status and the necessity of improving the quality of pre- and post-test counselling.
Cover up or Cool it? Sexual Intercourse during Therapy for Bacterial Sexually Transmitted Infections — A Discussion of Evidence for Efficacy of Condom Use Preventing Transmission during an Acute Bacterial STI
Authors: Lee John D , Clarke Janette
Published: January 2017

Effective treatment of sexually transmitted infections (STIs) such as gonorrhoea and chlamydia needs sexual behaviour modification, in addition to antibiotics, to protect the index patient and their sexual partner from re-infection during treatment. This may mean advice to avoid sex, or to use condoms for intercourse, until all current sexual partners have completed treatment. This article discusses the effectiveness of condoms as re-infection protection during therapy of gonorrhoea and chlamydial infection. Indirect evidence from studies on primary prevention indicates that, although physically, condoms are impermeable to STI pathogens, the risk of failure depends on the experience of the user and the frequency of use. Health care workers may over-estimate the protective value of condoms in this situation. Patients should be made aware of the risk of infection present, even in experienced condom users, if they choose to continue protected sexual intercourse during therapy for acute bacterial STIs.
Emergency Contraception: Who are the Users?
Authors: Fox J , Weerasinghe D , Marks C , Mindel A
Published: January 2017

The objective was to describe the demographic and sexual characteristics of clients attending a Sexual Health Clinic for emergency contraception (EC).

Information about women attending the Parramatta Sexual Health Clinic (PSHC) who received EC between January 1999 and July 2002 was derived from the clinic database. Age-matched controls were randomly selected. Univariate and logistic regression analysis was performed to establish which factors were associated with use of EC.

Two hundred and sixty-seven women requesting EC, and an equal number of controls, were studied. Factors that were independently associated with EC use were being a student, (OR=1.7 [95% CI 1.02–2.69]) and having a regular sexual partner (OR=2.3 [95% CI 1.14–4.73]). Women requiring EC were significantly less likely to have had a sexually transmitted infection (STI) (OR=0.3 [95% CI 0.16–0.60]) or a previous pregnancy (OR=0.2 [95% CI 0.09–0.67]) than controls.

We concluded that users of EC are at low-risk for STIs, but need counselling about safer sex.
Pharmacy Clerks' Prescribing Practices for STD Patients in Porto Alegre, Brazil: Missed Opportunities for Improving STD Control
Authors: Ramos Mauro Cunha , da Silva Rodrigo D Correa , Gobbato Ricardo O , da Rocha Felipe Civeira , de Lucca Giusepe , Vissoky Jacques , Cestari Tania , Filgueiras Absalom
Published: January 2017

STDs are a significant public health problem in Brazil. A primary control strategy is the immediate treatment of symptomatic individuals. When services are unavailable, STD patients seek care in alternative settings. Probably the most frequently used settings are commercial pharmacies, where pharmacy clerks provide treatment, although Brazilian law prohibits selling antibiotics without prescription. Our objective was to evaluate prescribing practices by pharmacy clerks for STDs. We performed a cross-sectional study. Trained medical students visited 62 pharmacies in the city of Porto Alegre during March 2002. These were randomly chosen from a list of 863 registered pharmacies. The students presented to the pharmacy complaining of dysuria and urethral discharge. After obtaining a prescription, or not, they asked for additional instructions to be followed. Immediately after leaving the premises, the instructions were anonymously recorded. Of the 62 pharmacies visited, a clerk in 56 (90.3%, 95% confidence interval [CI]: 80.1%–96.4%) provided a prescription. Most frequently prescribed drugs were ampicillin with probenecide (29/51.8%) and rosoxacin (11/19.6%). Ministry of Health-recommended treatment was not suggested by any of the clerks. Forty-six additional recommendations were given. The use of condoms was the most frequent additional advice (42/46). Prescribing by pharmacy clerks is very prevalent in Porto Alegre. This may represent a lost opportunity for more comprehensive prevention effort (counselling, partner management, and diagnosing other STDs). Additionally, the most frequently prescribed drugs are not recommended by international or national health authorities for treatment of STDs, and none of these drugs covers chlamydia. We conclude that pharmacy clerks are a potentially important source of STD treatment and control but that their practices are in need of vast improvement.
Intrauterine Infection after Delivery: A Marker of HIV-1 Seropositivity among Puerperal Women in Uganda?
Authors: Okong P , Biryahwaho B , Bergstrom S
Published: January 2017

A case controlled study about HIV seroprevalence among women with postpartum endometritis—myometritis (PPEM) matched with two controls. Each was performed in a non-governmental organization hospital in Kampala, Uganda. All participants were offered HIV pre- and post-test counselling. Personal and clinical information was obtained and HIV-1 ELISA tests performed on blood samples and discordant results resolved by Western blot test. HIV-1 seroprevalcnce was significantly higher among women with PPEM than controls, 26 (42.3%) and 26 (21.3%) respectively ( P=0.002). Women with PPEM were two-and-a-half times more likely to be HIV-positive than controls, odds ratio 2.74 (95% CI 1.34–5.65). Single or cohabiting women and low salaried women were also significantly more among PPEM cases than controls. In conclusion, PPEM cases had significantly higher seroprevalence of HIV-1 infection than controls and this needs further elucidation for purposes of management strategies.
Epidemiology of Adult and Adolescent HIV Infection in Israel: A Country of Immigration
Authors: Chemtob D , Grossman Z
Published: January 2017

In Israel, the caseload and main modes of transmission have changed dramatically since 1991 after mass immigration from countries with generalized HIV epidemics. The previous annual average (of 60 new cases) has almost quadrupled, and 68% are among heterosexuals (compared with 11.6% before). We verified all HIV/AIDS cases ever documented, redefined (according to UNAIOS/WHO definitions) and analysed those aged 13+. Between 1980–2000, HIV and AIDS were diagnosed, respectively, in 2204 and 682 adults and adolescents (cumulative HIV infection rate=61/100000). Of these, 65.2% are male (mean age 35.0 years old; 5D=11.0), 31.5% female (mean age 31.4 years old; SD= 10.5) (and 3.3%, sex unknown). The main modes of HIV transmission were heterosexual (45%), MSM (16.9%) and IDUs (11.5%). Prevention measures must be strengthened, if the currently low-level of HIV epidemic among the Israeli general population is to be sustained.
Clinical and Laboratory Study of First Episode Genital Herpes in Singapore
Authors: Cheong W K , Thirumoorthy T , Doraisingham S , Ling A E
Published: January 2017

A prospective study of the epidemiology, clinical aspects and laboratory features of first episode genital herpes was carried out in Middle Road Hospital, Singapore between June 1986 and December 1987. A total of 68 patients were studied. There were more women than men in the study population with a female to male ratio of 7.5 to 1. The peak incidence of first episode genital herpes was between 20 and 29 years of age.

Specimens from 63 patients yielded positive culture for herpes simplex virus (HSV). HSV-1 was isolated from 21 patients (30.9%), HSV-2 from 41 patients (60.3%) and untyped HSV from one patient (1.5%). True primary genital herpes was diagnosed in 43 patients (68.3%) using a test for complement fixing antibodies to HSV. HSV-1 was found to be the causative agent in 18 (41.9%) of the true primary infections, HSV-2 in 24 (55.8%) and untyped HSV in one (2.3%). In comparison, HSV-1 was isolated in only 2 (10%) of the 20 patients with non-primary first episode genital herpes; HSV-2 was found in 13 patients (65%) and the culture was negative in 5 (25%).
Efficacy of Chemical and/or Surgical Therapy against Condylomata Acuminata: A Retrospective Evaluation
Authors: von Krogh Geo , Wikström Arne
Published: January 2017

In order to estimate treatment resistance of condylomas, standardized records of 230 males aged 17–80 years (mean 27) attending at an STD clinic were analysed retrospectively. Anal warts occurred in 38 (17%) men; in 19 (50%) intra-anal warts were extensive enough to require further referral to the Department of Surgery. Urinary meatal warts occurred in 30 men; 9 of them (30%) were referred to the Department of Urology. The remaining 202 (88%) men were treated in the STD clinic with simple surgery and/or home-treatment with 0.5% podophyllotoxin-ethanol twice a day for one or more 3 day sessions. After a follow-up of at least one year, 46 (23%) patients still had condylomas. However, 77 (49%) of the remaining 156 men were cured after a single therapeutic session, and after 1–4 sessions the cumulative cure rate was 77%.
Factors Associated with the Detection of Entamoeba Histolytica in Homosexual Men
Authors: Law Carmella L H , Walker John , Qassim Mohamed H
Published: January 2017

In a study of bowel parasites in 128 Australian homosexual men attending a sexually transmitted diseases (STD) clinic, Entamoeba histolytica was detected in 37%, Giardia intestinalis in 3% and at least one protozoan in 81% of the group. There was no evidence of pathogenicity of E. histolytica, nor was there any association between the detection of E. histolytica and sexual practices, gastrointestinal symptoms, proctitis, human immunodeficiency virus antibody result or T-cell subset values. However it was noted that those subjects with an elevated IgM > 4 g/l were more likely to harbour E. histolytica trophozoites than those with a level below 4 g/l (OR 6.54, 95% CI 1.3–32.8). Travel to South-East Asia, India, China, Africa, South America or the Pacific islands in the previous 3 years emerged also as an independent factor (OR 2.70, 95% CI 1.12–6.53) associated with detection of E. histolytica.
Treatment of Acute Gonococcal Infections in Bangkok with a Dose Range of the New Cephalosporin, Cefodizime
Authors: Chitwarakorn A , Wongba C , Dagrosa E E , Schinzel B
Published: January 2017

In this randomized dose range study conducted in Bangkok, 326 patients with presumed acute uncomplicated gonorrhoea were treated with a single intramuscular dose of either 0.25 g, 0.5 g, or 1.0 g of a new aminothiazole cephalosporin, cefodizime. One hundred and eighty men and 110 women were evaluable for efficacy. Pathogens were eliminated in all but 4 of these patients resulting in a cure rate of 99%, irrespective of dose, sex, or multiplicity of infected sites. A high percentage of the 290 strains of Neisseria gonorrhoeae isolated from the evaluable patients showed resistance to penicillin, and 40% were penicillinase producing (PPNG). The minimum inhibitory concentration of cefodizime for 90% of the PPNG strains was <0.04 mg/l. No clinically relevant adverse drug reactions were reported. This study demonstrates that a single 0.25 g dose of cefodizime is effective against both PPNG and non-PPNG strains in a geographic region characterized by high endemic antibiotic resistance.
Risk Factors for Chlamydia Trachomatis Infection in 6810 Young Women Attending Family Planning Clinics
Authors: Ramstedt Kristina , Forssman Lars , Giesecke Johan , Granath Fredrik
Published: January 2017

Screening programmes are important for the control of Chlamydia trachomatis (Ct) infection, a disease spread mainly by asymptomatic carriers. Risk factors for Ct infection were assessed in 6810 consecutive asymptomatic young women seeking contraceptive advice. All women filled in a questionnaire and were offered Ct testing.

Of the 5785 who consented to testing, 425 (7.3%) were Ct culture positive. Four variables were significantly related to increased risk of being infected: age 18–23 years, duration of present relationship < 1 year, non-use of condoms, and a history of not having had a previous genital infection.

It is not possible to devise screening criteria that would effectively identify women at high risk. Therefore a screening programme should be targeted at all sexually active young people. However, if after some years the programme succeeds in lowering general Ct prevalence, these factors may be important when selecting patients for Ct testing.
Sexual Behaviour Related to the Spread of Sexually Transmitted Diseases—A Population-Based Survey
Authors: Giesecke Johan , Scalia-Tomba Gianpaolo , Göthberg Mari , Tüll Peet
Published: January 2017

Behavioural patterns pertinent to the spread of sexually transmitted diseases (STD) were assessed in a random sample population study in Sweden. From a sample of 1150 individuals aged 16–31 years, 768 (68%) completed a questionnaire on past and present sexual contacts. Response rate was highest in youngest and oldest age groups. Median age at first intercourse was 16.4 years for women and 17.1 years for men; the woman's partner at first intercourse was a median of 2 years older; men chose partners of the same age for first intercourse. The time to second partner was a median of 2 years; number of lifetime partners increased with one new partner for 2.5 years. Condoms were more frequently used in younger age groups. In all age groups, 5–10% of individuals reported a high-risk behaviour for the spread of STDs.
Prevalence of HIV-2 Infection in a Family Planning Clinic in Lisbon
Authors: Victorino Rui M M , Guerreiro D , Lourenço M Helena , Ferreira M O Santos , Teles L Cunha
Published: January 2017

A significant proportion (10%) of notified AIDS cases in Portugal are due to HIV-2 infection as a result of the close connections of Portugal with Western African Countries (ex-Portuguese colonies) where there is a high HIV-2 seroprevalence.

We conducted a seroepidemiological study of HIV-1 and HIV-2 infection in 1400 women attending family planning and antenatal clinics in a health centre in Lisbon with the objective of analysing whether there was evidence of HIV-2 spread in this population. The seroprevalence for HIV, as determined by ELISA and confirmed by Western Blot, was 0.42% (6 cases) and 50% of these were of HIV-2 infection. Analysis of the epidemiological inquiries reveals that out of the 6 seropositive cases, only one was a drug addict (HIV-1) and another a western African black woman (HIV-2). The other 4 cases (2 HIV-2 and 2 HIV-1) were white Portuguese women with no history of travelling to Africa or previous blood transfusions, and the only risk factor was a history of multiple sexual partners (in 3 out of 4).
Heterosexual Partnership Characteristics of University Women
Authors: Lindblade K , Foxman B , Koopman J S
Published: January 2017

In order to assess the individual risk of acquiring sexually transmitted diseases (STDs), both characteristics of the partnership and the individual should be considered. Partnership characteristics have been used as risk markers for STD transmission but their distribution has not been well described. Using a self-administered questionnaire, we collected information on the partnership characteristics of the 4 most recent sexual partners of the members of 9 university women's social organizations at the University of Michigan. Respondents were asked to report the setting of the first meeting of partners, the length of the presexual relationship, condom use at the first sexual encounter and the total number of sexual encounters within that partnership. We graphically analyse changes in these partnership characteristics with respect to partnership order. As the number of sexual partners increased the women in this population were more likely to report partnership characteristics associated with an increased risk of acquiring an STD. In addition, partnership characteristics varied with the order of the partnership, implying that no single partnership is representative of all others.
The Determination of Amines in the Vaginal Secretions of Women in Health and Disease
Authors: Jones B M , Al-Fattani M , Gooch Hilary
Published: January 2017

The presence of amines in vaginal fluid is thought to be an important contributory factor in the pathogenesis of bacterial vaginosis (BV). As part of on-going work investigating the aetiology of this infection, two separate studies were performed in which gas chromatography was used to measure and compare the amines present in the vaginal secretions of normal women, a group infected with BV and some having other sexually transmitted diseases. The amines studied were methylamine, isobutylamine, putrescine, cadaverine and phenylethylamine. The results of the studies were contrary to expectations, in that they showed an overall similarity in both normal women and in those with BV and other vaginal infections. These findings now bring in to question the validity of amines being a reliable focus, either in the diagnosis of BV, or in investigations into the aetiology of the disease.
High Cumulative Incidence of Genital Herpes Amongst HIV-1 Seropositive Heterosexuals in South London
Authors: O'Farrell Nigel , Tovey Stuart J
Published: January 2017

The cumulative incidence of sexually transmitted diseases (STD) in a cohort of 51 (35 female, 16 male) HIV-1 seropositive STD clinic attenders who had acquired HIV-1 infection via heterosexual transmission was investigated through a retrospective review of the case notes. The women were followed up for a mean 11.6 months and the men for 18 months. Thirty-one (88%) of the women and 13 (81%) of the men were of sub-Saharan African origin. Approximately half of the subjects were first diagnosed as HIV-1 positive with CD4 counts <200×106/1 and a quarter with CD4 counts <50×106/1. STDs detected in women were: genital herpes 15 (43%), Candida 12 (34%), bacterial vaginosis 9 (25%), and in men: genital herpes 6 (38%), non-gonococcal urethritis 4 (25%). No cases of gonorrhoea were detected. At the time of first diagnosis of genital herpes at the clinic, the mean CD4 count in women was 275×106/1 and in men 285×106/1. Genital herpes was the AIDS defining diagnosis in 3 of the women.

The recognized risk of HIV transmission via genital lesions should be stressed in HIV-1 positive subjects with genital herpes. The incidence of other STD was low—both knowledge of HIV status and safer sex counselling may limit unsafe sexual behaviour and should be evaluated further as a strategy for limiting the spread of HIV-1 infection.
Screening for Tuberculosis in an East London HIV Clinic
Authors: Theodore C M , Forster G E , Goh B T , Barnes N , Hughes D
Published: January 2017

A prospective study was carried out to assess the value of routine skin tuberculin testing and chest radiography in HIV seropositive patients, attending the Genitourinary Medicine (GUM) clinic between July 1991–May 1992. 144 consecutive HIV seropositive patients had tuberculin Tine tests and chest radiographs performed. Ten patients were treated for active tuberculosis (TB) on the basis of abnormal radiography with or without strongly positive (Grade 3/4) skin tuberculin tests. A further 10 patients received prophylaxis on the basis of abnormal chest radiography consistent with previous tuberculous infection or strongly positive tuberculin tests. Active or previous tuberculous infection was found in the UK born Caucasian homosexual population as well as in injecting drug users and patients who were born in areas of high TB prevalence.

Screening for TB in HIV seropositive patients is important both for detecting asymptomatic tuberculous infection and for recognizing patients at risk for reactivation of latent TB. We showed a high pick-up rate with 20 out of 144 patients having treatment as a result of screening.
Concomitant HIV and Mycobacterial Infection in Ireland, 1987–92
Authors: Mundy L M , Lynch M M , Crowley B D , Kelly G , Desmond N M , Mulcahy F M
Published: January 2017

A six-year retrospective review of concomitant HIV and mycobacterial infection in the Republic of Ireland is presented. A total of 42 culture proven mycobacterial infections were seen in 40 different HIV-infected patients. There were 24 infections with Mycobacterium tuberculosis (M.tb) and 18 infections with mycobacteria other than tuberculosis (MOTT), a significantly higher rate of MOTT infections in Ireland compared to a study from 1962–1981. The detection rate for all mycobacterial infections had an annual upward trend with a 4-fold increase between 1987 and 1992. In homosexuals, MOTT infections occurred more frequently than M.tb, while the reverse was true for IVDUs. Twenty per cent of the infections were seen in patients recently incarcerated. Relapse of tuberculosis occurred in 42.9% (3/7) of non-compliant patients, 2 of whom developed rifampin-resistant strains of M.tb. No patient compliant to their regimen had a relapse in disease. The overall survival of patients after diagnosis of M.tb was significantly better than those with MOTT infections, with respective one-year survival rate of 79% and 36% (log rank test, P=0.006).
The Concept and Classification of Antiphospholipid/Cofactor Syndromes
Authors: Alarcón-Segovia D , Cabral AR
Published: January 2017

In 1990, three groups simultaneously reported that putative IgG antibodies to anionic phospholipids were either not directed to phospholipids or at least required β2-grycoprotein-I (β·2-GP-I) for reactivity in vitro. During the same year, our group described a patient with ‘idiopathic’ hemolytic anemia with serum and erythrocyte-bound IgM antibodies to phosphatidylcholine later found to be independent of β2-GP-I for antigen recognition. Lately, the field has been expanded considerably with: (1) the description of other potential antigens such as prothrombin for some lupus anticoagulants, (2) the finding of crossreactivity between some antiphospholipid antibodies (aPL) with thrombomodulin, (3) the presence of serum antibodies to β2-GP-I (anti-β2-GP-I) in patients with SLE and thromboses, (4) the findings that the clinical manifestations of APS in SLE patients associate more strongly with anti-β2-GP-I than with aPL, (5) our finding of a group of SLE patients with the clinical manifestations of APS, with negative serum aPL, but with positive anti-β2-GP-I, (6) the description of a group of patients with the clinical manifestations of APS, without serum aPL, without serological nor clinical evidence of any autoimmune disease, but with IgG anti-β2-GP-I, and (7) the observation that serum anti-phosphatidylethanolamine antibodies detected in some patients with APS require kininogen (alone or complexed with the kininogen-binding protein), prekallikrein and/or factor XI for in vitro reactivity. Thus, there are antibodies that may be considered true aPL; other ‘aPL’ require a protein cofactor for their detection in vitro, at least in the case of β2-GP-I it would appear that their epitope is present on the protein proper not on the phospholipid, hence these are pseudo aPL, and a third group of related anti-cofactor autoantibodies that are directed to the protein in the absence of phospholipid. Clearly, the term ‘antiphospholipid syndrome’ has become obsolete. We propose the term ‘Antiphospholipid/Cofactor Syndromes’ to cull the various syndromes.
β2-Glycoprotein I: Target Antigen for Autoantibodies in the ‘Antiphospholipid Syndrome’
Authors: Kandiah DA , Sheng YH , Krilis SA
Published: January 2017

‘Antiphospholipid’ (aPL) antibodies are of important clinical significance because of their association with thrombosis both arterial and venous, recurrent foetal loss, specific neurological sequelae like seizures and chorea, cardiac valvular abnormalities and thrombocytopenia.1 Traditionally these autoantibodies have been assayed using phospholipid (PL) dependent tests and are classified as lupus anticoagulants (LA) and anticardiolipin (aCL) antibodies based on the method of detection.2 The antibodies thus, had been thought to bind PLs but it has now become clear that the true antigens are PL-binding proteins. The major protein consistently found as the target antigen for these autoantibodies is β2-glycoprotein I (β2-GPI).3 Other candidate PL-binding proteins have also been investigated including prothrombin, protein C and protein S4 but thus far appear to play less important roles in the binding of these antibodies.
Platelets and Antiphospholipid Antibodies
Authors: Machin SJ
Published: January 2017

The involvement of platelets in the antiphospholipid syndrome is complex and the full pathogenic significance is not fully understood. The binding of aPL antibodies to the platelet membrane may result in the thrombopenia and further haemostatic activation.
The Catastrophic Antiphospholipid Syndrome 1996: Acute Multi-Organ Failure Associated with Antiphospholipid Antibodies: A Review of 31 Patients
Authors: Asherson RA , Piette J-C
Published: January 2017

Thirty one patients with antiphospholipid antibodies who developed multi-organ failure (“Catastrophic Antiphospholipid Syndrome”) are reviewed. Thirteen suffered from a ‘Primary’ antiphospholipid syndrome, 13 from defined SLE, 4 from ‘lupus-like’ disease and one from rheumatoid arthritis. In more than one third precipitating factors were evident (e.g. infections, major/minor surgical procedures, oral contraceptives). Death occurred in 60% of patients from a variety of causes (myocardial failure, ARDS, CNS causes or, often a combination). Disseminated Intravascular Coagulation was present in 8 of 31 patients. Plasmapheresis appeared to be useful in several who had not responded to conventional therapy (e.g. IV heparin, steroids, immunosuppression).
Significance of aPL IgG Subclasses
Authors: Sammaritano LR
Published: January 2017

Human immunoglobulin G (IgG) is comprised of four subclasses with distinct structural and biologic properties. Patients with autoimmune disease, in general, show an overall increase in serum IgG as well as skewing in subclass distribution for particular autoantibodies. Antinuclear antibodies and anti-double stranded DNA antibodies, for example, are primarily IgG1 and IgG3. In contrast, anticardiolipin antibodies show a skewing towards presence of IgG2 presence is associated with arterial and venous thrombotic complications. Selective absorption of IgG2 from high titer sera abrogates aCL ELISA binding. Pathogenicity of aCL may be related to IgG2 in an important way. The precise mechanism of action and nature of the inducing stimulus are not yet clear.
Immunomodulation of Experimental APS: Lessons from Murine Models
Authors: Krause I , Blank M , Shoenfeld Y
Published: January 2017

During the last few years several murine models for APS have been described. These include spontaneous occurring disease, or APS induced by immunization with pathogenic autoantibodies. Employing those models, several treatment modalities, in different stages of the disease, were studied. Treatments which showed promising potential for application in patients with APS include immunomodulation with specific anti-idiotypic or anti-CD4 antibodies, treatment with IL-3, high-dose intravenous immunoglobulins, ciprofloxacin or bromocriptine, as well as antithrombotic and anticoagulant treatments using aspirin and/or low-molecular-weight heparin. Bone-marrow transplantation was also found to improve clinical and serological manfestations of the disease. These studies might promote the handling of controlled clinical trials assessing their efficacy in APS patients.
Antibodies against Phospholipids other than Cardiolipin: Potential Roles for Both Phospholipid and Protein
Authors: Rauch J , Janoff AS
Published: January 2017

Autoantibodies to phospholipids other than cardiolipin have received less attention, to date, than anti-cardiolipin antibodies. This review focuses on these antibodies and potential roles for both phospholipid and protein in their reactivity. We review data in the literature indicating that antibodies to phosphatidylethanolamine and some lupus anticoagulant antibodies recognize phospholipid-binding proteins in association with phospholipid. Kininogens appear to be involved in the binding of antibodies to phosphatidylethanolamine, while phosphatidylserine-binding proteins, such as prothrombin and annexin V, have been implicated in lupus anticoagulant antibody recognition. These proteins bind to phospholipids that normally reside in the inner monolayer of the cell membrane, suggesting that exposure of these lipids is necessary for protein binding and antibody recognition to occur. In contrast, other autoantibodies, in particular those reactive with erythrocytes, appear to be directed at phospholipids that normally occur in the outer membrane leaflet, such as phosphatidylcholine. In summary, there is clearly accumulating evidence that antibodies to phospholipids other than cardiolipin recognize epitopes on phospholipid-binding proteins. It is not clear whether recognition of these epitopes is due to an increase in antigen density or a change in the protein or phospholipid structure, but it is likely that both protein and phospholipid structure play an important role in the in vivo interactions of these antibodies.
William Osier and Basil Gildersleeve on Plato's Eryximachus
Authors: Bryan Charles S , Wise Brian K , Briggs Ward W
Published: January 2017

Basil Lanneau Gildersleeve was a colleague of Sir William Osier at the Johns Hopkins University. Gildersleeve was a classicist who praised Osier in public but who also took him to task for his high opinion of Eryximachus, a character in Plato's Symposium. The present paper reviews this dispute between two colleagues and explores its origins.
What was the Cause of Nietzsche's Dementia?
Authors: Sax Leonard
Published: January 2017

Many scholars have argued that Nietzsche's dementia was caused by syphilis. A careful review of the evidence suggests that this consensus is probably incorrect. The syphilis hypothesis is not compatible with most of the evidence available. Other hypotheses — such as slowly growing right-sided retro-orbital meningioma — provide a more plausible fit to the evidence.
Dr John Andree, MD (Rheims) LRCP, Founding Physician of the London Hospital
Authors: Gibbs Denis
Published: January 2017

The contributions of the Huguenot physician John Andree to the founding of the London Hospital in 1740, and to the development of the new voluntary hospital in its early years, are assessed in the context of his own special interests. These included his promotion of the merits of Tilbury water, his observations on epilepsy and his criticism of the use of hemlock for the treatment of cancer.
The Treatment of a Dictator
Authors: Wade Owen
Published: January 2017

In 1973 Mr Richard Hughes, who was working on the third novel of his trilogy on the rise of the Nazi Party and Adolf Hitler, came to see me regarding a document, some 300 pages long, on the medical treatment given by Dr Theodore Morell to Hitler. The document had been obtained at the Nuremberg war trials. My original report to Hughes on the content of this document is reproduced here.
Dr Arthur Wakefield on Mount Everest in 1922: ‘This has not been by any Manner of Means a Picnic”
Authors: Bayne Ronald
Published: January 2017

In 1922 Dr Arthur Wakefield, a general practitioner from Cumbria, reached the North Col of Mt Everest at 23,000 feet as a member of the first British team to attempt the summit. As well as being a climber, he provided medical care to his comrades, who included George Leigh Mallory and George Finch. Yet, in their accounts of the expedition, several climbers portrayed him as a nervous old man and a “complete passenger”. However, his letters home and a small daily diary suggest he was a wise and caring physician. His motivation for joining this expedition at the age of 46 was somewhat different from that of his companions.
John Coakley Lettsom's Welsh Connections
Authors: James D Geraint
Published: January 2017

John Coakley Lettsom (1744–1815), the Quaker physician, lived and worked in London but two of his daughters married brothers of the Elliot family, from Carmarthenshire. His wife was a member of the Miers family, who also had connections with Wales. This paper traces these connections.
The Flight and the Downfall of the Demon: Creativity and Illness in Vrubel's Life
Authors: Lerner Vladimir , Wiztum Eliezer
Published: January 2017

The life of Mikhail Vrubel (1856–1910), the Russian painter, combined remarkable artistic accomplishments with severe psychopathology. We have attempted to examine the influence of the changes in the artist's emotional state on the creative process. The contradictions that abound in the descriptions of Vrubel's character and conduct should, in all likelihood, be attributed not only to the complexity of his personality but also to the effect of psychopathology on his behaviour. We believe that Vrubel suffered from mood disorder, complicated by syphilis.
A Waning Comet: John Sheldon, FRS (1752–1808)
Authors: Cameron Alick
Published: January 2017

John Sheldon, an eccentric surgeon-anatomist, of considerable brilliance, was the first Englishman to ascend in a balloon. He became insane in 1787, after which he moved from London. He re-established himself at Exeter and was elected surgeon to the hospital in 1797.
Sir Hugh Cairns KBE MD FRCS (1896–1952): Neurosurgeon
Authors: Schurr Peter H
Published: January 2017

The pioneers of neurosurgery in nineteenth century Britain, such as Macewen and Horsley, were hampered by insufficient knowledge of neurology and neurophysiology, inadequate anaesthesia, and an underdeveloped surgical technique. By the early years of this century, however, advances had taken place which were seized upon by Harvey Cushing, the American who became the father of modern neurological surgery. Three people were the pillars upon which British neurosurgery has stood: if Norman Dott was the best technician among them and Sir Geoffrey Jefferson the most genial and philosophical, it was Sir Hugh Cairns (Figure 1) who was the greatest teacher1. Cairns had an attractive personality combined with infinite drive and dedication. He allowed nothing to stand in his way if he felt that what he was doing was right. He was a man who inspired his colleagues with respect and devotion and who served his patients and the institutions with which he worked with incredible energy and determination.