bluuebunny/crossref_metadata_2025 huggingface dataset:
The Antithrombotic versus Calcium Antagonistic Effects of Polyethylene Glycol Grafted Bovine Pericardium
Authors: Vasudev Sindhu C. , Chandy Thomas , Sharma Chandra P.
Published: January 2017

Cardiovascular calcification, the formation of calcium phosphate deposits in cardiovascular tissue, is a common end stage phenomenon affecting a wide variety of bioprosthesis. This study proposes a novel approach of reducing pericardial calcification and thrombosis via coupling polyethylene glycols (PEG) to glutaraldehyde treated bovine pericardium via acetal linkages. The calcification of the PEG modified tissue and the control pericardium (extracted and glutaraldehyde treated) was investigated by in vivo rat subcutaneous implantation models and by in vitro meta stable calcium phosphate solutions. Scanning electron microscopy showed that calcification primarily involved the surface of collagen fibrils and the intrafibrillar spaces. However, the grafting of pericardium with PEG-20,000 had dramatically modified the surface and subsequently inhibited the deposits of calcium. Further, the modified tissue had also reduced the platelet surface attachment. Such a reduced calcification of PEG modified tissues can be explained by decrease of free aldehyde groups, a space filling effect and therefore improved biostability and synergistic blood compatible effects of PEG after coupling to the tissues. This simple method can be a useful anticalcification treatment for implantable tissue valves.
Wide Variability in Caloric Density of Expressed Human Milk Can Lead to Major Underestimation or Overestimation of Nutrient Content
Authors: Sauer Charles W. , Boutin Mallory A. , Kim Jae H.
Published: January 2017

Background:

Very-low-birth-weight infants continue to face significant difficulties with postnatal growth. Human milk is the optimal form of nutrition for infants but may exhibit variation in nutrient content.

Objective:

This study aimed to perform macronutrient analysis on expressed human milk from mothers whose babies are hospitalized in the neonatal intensive care unit.

Methods:

Up to five human milk samples per participant were analyzed for protein, carbohydrate, and fat content using reference chemical analyses (Kjeldahl for protein, high pressure liquid chromatography for carbohydrates, and Mojonnier for fat). Calorie content was calculated.

Results:

A total of 64 samples from 24 participants was analyzed. Wide variability was found in calorie, protein, carbohydrate, and fat composition. The authors found an average of 17.9 kcal/ounce, with only 34% of samples falling within 10% of the expected caloric density.

Conclusion:

The assumption that human milk contains 20 kcal/ounce is no longer supported based on this study. This supports promoting an individualized nutrition strategy as a crucial aspect to optimal nutrition.
A Critical Review of Instruments Measuring Breastfeeding Attitudes, Knowledge, and Social Support
Authors: Casal Corrine S. , Lei Ann , Young Sera L. , Tuthill Emily L.
Published: January 2017

Background:

Breastfeeding provides beneficial health outcomes for infants and their mothers, and increasing its practice is a national priority in many countries. Despite increasing support to exclusively breastfeed, the prevalence at 6 months remains low. Breastfeeding behavior is influenced by a myriad of determinants, including breastfeeding attitudes, knowledge, and social support. Effective measurement of these determinants is critical to provide optimal support for women throughout the breastfeeding period. However, there are a multitude of available instruments measuring these constructs, which makes identification of an appropriate instrument challenging.

Research aim:

Our aim was to identify and critically examine the existing instruments measuring breastfeeding attitudes, knowledge, and social support.

Methods:

A total of 16 instruments was identified. Each instrument’s purpose, theoretical underpinnings, and validity were analyzed.

Results:

An overview, validation and adaptation for use in other settings was assessed for each instrument. Depth of reporting and validation testing differed greatly between instruments.

Conclusion:

Content, construct, and predictive validity were present for most but not all scales. When selecting and adapting instruments, attention should be paid to domains within the scale, number of items, and adaptation.
Antidepressant Use in Late Gestation and Breastfeeding Rates at Discharge from Hospital
Authors: Leggett Catherine , Costi Lynn , Morrison Janna L. , Clifton Vicki L. , Grzeskowiak Luke E.
Published: January 2017

Background:

Few studies have investigated breastfeeding outcomes among women exposed to antidepressants.

Research aim:

This study aimed to evaluate the association between antidepressant use in late gestation and maternal psychiatric illness on breastfeeding rates at discharge from hospital.

Methods:

The authors conducted a retrospective cohort study of 32,662 women delivering live-born singletons between January 2001 and December 2008. Electronic hospital records were used to obtain data on antidepressant exposure during late gestation and whether mothers were breastfeeding at discharge from hospital following delivery.

Results:

Five hundred seventy-five women received a dispensing for an antidepressant in late gestation (exposed), 1,552 did not receive a dispensing for an antidepressant but had a reported psychiatric illness (disease comparison), and 30,535 served as nonexposed controls. Exposed women were significantly less likely to be breastfeeding their infants at discharge from hospital compared with nonexposed women, adjusted odds ratio ( AOR) = 0.63, 95% confidence interval (CI) [0.50-0.80], but no statistically significant difference was observed when compared with women in the disease comparison group, AOR = 0.83, 95% CI [0.65-1.07]. In stratified analyses, compared with women in the disease comparison group, exposed women were significantly less likely to be breastfeeding their infants at discharge from hospital if their neonate was delivered at term, AOR = 0.73, 95% CI [0.55-0.98], but not preterm, AOR = 1.24, 95% CI [0.66-2.32].

Conclusion:

While antidepressant use is associated with a reduction in breastfeeding rates, this association appears to be strongly influenced by factors such as underlying maternal psychiatric illness. Overall, these results highlight that these women may benefit from additional education and support to improve breastfeeding rates.
Human Milk Handling and Storage Practices Among Peer Milk-Sharing Mothers
Authors: Reyes-Foster Beatriz M. , Carter Shannon K. , Hinojosa Melanie Sberna
Published: January 2017

Background:

Peer milk sharing, the noncommercial sharing of human milk from one parent or caretaker directly to another for the purposes of feeding a child, appears to be an increasing infant-feeding practice. Although the U.S. Food and Drug Administration has issued a warning against the practice, little is known about how people who share human milk handle and store milk and whether these practices are consistent with clinical safety protocols.

Research aim:

This study aimed to learn about the milk-handling practices of expressed human milk by milk-sharing donors and recipient caretakers. In this article, we explore the degree to which donors and recipients adhere to the Academy of Breastfeeding Medicine clinical recommendations for safe handling and storage.

Methods:

Online surveys were collected from 321 parents engaged in peer milk sharing. Univariate descriptive statistics were used to describe the safe handling and storage procedures for milk donors and recipients. A two-sample t-test was used to compare safety items common to each group. Multivariate ordinary least squares regression analysis was used to examine sociodemographic correlates of milk safety practices within the sample group.

Results:

Findings indicate that respondents engaged in peer milk sharing report predominantly positive safety practices. Multivariate analysis did not reveal any relationship between safety practices and sociodemographic characteristics. The number of safe practices did not differ between donors and recipients.

Conclusion:

Parents and caretakers who participate in peer human milk sharing report engaging in practices that should reduce risk of bacterial contamination of expressed peer shared milk. More research on this particular population is recommended.
“I Had One Job and That Was To Make Milk”
Authors: Bower Katherine , Burnette Tara , Lewis Daniel , Wright Courtney , Kavanagh Katie
Published: January 2017

Background:

For very-low-birth-weight (VLBW) infants, breastfeeding may no longer be an immediate option. Mothers often turn to mechanically expressing their milk with a breast pump to provide their infants human milk.

Research aim:

This study aimed to describe mothers’ experiences expressing milk for their VLBW infants in a level 3 neonatal intensive care unit.

Methods:

Qualitative, phenomenological methods were used to better understand the milk expression experiences of 17 mothers of VLBW infants. In-depth interviews were audio-recorded and transcribed verbatim. Transcripts were analyzed using Colaizzi’s seven-step protocol, and themes were identified to illustrate the lived experience of the mothers.

Results:

Five global themes emerged from interviews with mothers. However, this article focuses on one global theme, “I had one job and that was to make milk,” and the supporting subthemes: (1) “I was heartbroken,” (2) “Pumping is a full-time thing,” and (3) “I literally sacrificed nights.”

Conclusion:

This study provides insight into the complex experience that mothers in the southeastern United States undergo when expressing milk for their VLBW infants.
Knowledge, Representations, Attitudes, and Behaviors of Women Faced With Taking Medications While Breastfeeding
Authors: Spiesser-Robelet Laurence , Brunie Vanida , de Andrade Vincent , Gagnayre Rémi
Published: January 2017

Background:

Breastfeeding is a major public health issue in terms of its benefits to both mothers and infants. Despite recommendations, breastfeeding initiation and duration are low in many industrialized countries. Although human milk is viewed as the most appropriate food for infants, when it is perceived as contaminated, doubts about its quality can lead to negative behaviors concerning breastfeeding. This is especially true when mothers are taking medication.

Research aim:

The aim of this review is to evaluate the data in the literature on the knowledge, representations, attitudes, and behaviors of women with regard to taking medication while breastfeeding. These elements should aid our understanding of how the mothers’ behaviors are constructed in this situation.

Methods:

The authors conducted a scoping review to map and analyze the available data from literature sources regarding breastfeeding mothers’ knowledge, representations, attitudes, and behaviors about medicines. A staged approach to the scoping review was used.

Results:

Eighteen studies met the selection criteria. They described safety behaviors like noninitiation, duration reduction, breastfeeding cessation, and refusal to take medication in order to breastfeed. Most showed a conflict between taking medication and breastfeeding. Because the knowledge, representations, and attitudes behind such behaviors have received very little study, it is difficult to explain how these behaviors are constructed.

Conclusion:

The results of this review confirm the need for a qualitative study to explore the knowledge, representations, and attitudes of breastfeeding women faced with taking medications, so that we can understand their connection with observed behaviors and take appropriate educational action.
Education Attainment and Parity Explain the Relationship Between Maternal Age and Breastfeeding Duration in U.S. Mothers
Authors: Whipps Mackenzie D. M.
Published: January 2017

Background:

Prior research in high-income countries finds that young mothers tend to breastfeed their infants for shorter durations than older mothers; however, there are gaps in our understanding of the processes by which age influences breastfeeding.

Research aim:

The primary objective of this study was to test the mediating effects of parity and education attainment on the association between maternal age and two breastfeeding outcomes: total duration and duration of exclusive breastfeeding.

Methods:

This study was a secondary data analysis of the IFPS II, a prospective, longitudinal study of ~ 4,900 American mothers. Robust and bias-corrected regression analyses tested the direct effect of age and the indirect effects of age through parity and education for each outcome of interest.

Results:

Parity and education attainment together explain nearly all of the association between maternal age and both measures of breastfeeding duration. The mediating role of education is significantly larger than parity for both outcomes.

Conclusion:

These findings indicate that maternal age primarily indexes parity and education but contributes minimally to breastfeeding duration via a direct effect. The findings have implications for intervention development and targeting strategies.
Workplace Lactation Support in Milwaukee County 5 Years After the Affordable Care Act
Authors: Lennon Tyler , Bakewell Dalvery , Willis Earnestine
Published: January 2017

Background:

Workplace lactation support has become increasingly important because returning to work is associated with discontinuing breastfeeding and women in the workforce are increasing.

Research aim:

This study examined workplace lactation support among Milwaukee County businesses 5 years after implementation of the Affordable Care Act’s Break Time for Nursing Mothers provision.

Methods:

A cross-sectional survey of Milwaukee County businesses was conducted in the summer of 2015 that inquired about workplace policies, lactation spaces, and other lactation resources offered. Business supports were stratified based on employer sizes: large (> 500 employees), medium (50-499 employees), and small (20-49 employees). A lactation amenity score was calculated for each business based on lactation resources available.

Results:

Three hundred surveys were distributed and 71 businesses voluntarily completed the survey. Small employers were excluded from statistical analysis due to fewer responses ( n = 8). Overall, 87.3% ( n = 55) of respondents reported providing access to a multiuser space for lactation and 65.1% ( n = 41) reported providing a designated lactation space. Large employers ( n = 30) were more likely than medium employers ( n = 33) to provide a designated lactation space for breastfeeding or expressing (86.7% vs. 45.5%, p < .001). Large employers’ mean amenity score was significantly higher than that of medium employers (3.37 vs. 2.57, p = .014), and they were also more likely to offer additional supports including access to a lactation consultant, classes, and materials (46.7% vs. 12.1%, p < .01).

Conclusion:

Large employers provide more lactation support than medium employers in Milwaukee County. All employers, regardless of size, need to increase additional lactation support for women in the workplace.
Systematic Review of Evidence for Baby-Friendly Hospital Initiative Step 3
Authors: Wouk Kathryn , Tully Kristin P. , Labbok Miriam H.
Published: January 2017

Background:

The Ten Steps to Successful Breastfeeding outline maternity practices that protect, promote, and support breastfeeding and serve as the foundation for the Baby-Friendly Hospital Initiative.

Research aim:

This systematic review describes interventions related to Step 3 of the Ten Steps, which involves informing pregnant women about the benefits and management of breastfeeding. Our main objective was to determine whether prenatal clinic- or hospital-based breastfeeding education increases breastfeeding initiation, duration, or exclusivity.

Methods:

The electronic databases MEDLINE and CINAHL were searched for peer-reviewed manuscripts published in English between January 1, 2000, and May 5, 2016. Bibliographies of relevant systematic reviews were also screened to identify potential studies.

Results:

Thirty-eight studies were included. The research studies were either randomized controlled trials or quasi-experimental studies conducted in developed or developing countries. Findings suggest that prenatal interventions, delivered alone or in combination with intrapartum and/or postpartum components, are effective at increasing breastfeeding initiation, duration, or exclusivity where they combine both education and interpersonal support and where women’s partners or family are involved. However, varying study quality and lack of standardized assessment of participants’ breastfeeding intentions limited the ability to recommend any single intervention as most effective.

Conclusion:

Future studies should test the strength of maternal breastfeeding intentions, assess the role of family members in influencing breastfeeding outcomes, compare the effectiveness of different health care providers, and include more explicit detail about the time and full cost of different interventions.
The Performance Impact of Context in TQM Implementation: The Nursing Facility Industry
Authors: Weech-Maldonado Robert , Zinn Jacqueline E. , Hamilton Robert D.
Published: January 2017

This study develops a model and empirically assesses how# organizational context mediates the impact of total quality management (TQM) implementation on perceived performance in the nursing facility industry. Outcomes are analysed for financial, human resources and resident-care performance. Contextual factors related to TQM implementation include managerial control, reward systems, organizational structure and the extent of implementation. Duration of TQM implementation is included as a control variable. Benchmarking has a positive impact on financial outcomes, and the extent of TQM implementation and required reporting of quality improvement activity results have a positive impact on both financial and human resources performance. The presence of a Quality Steering Council has a positive impact on financial performance, but only among larger facilities.
Programme Approach to Managing Informed Commissioning
Authors: Miller Paul , Vale Luke
Published: January 2017

The objective of this paper is to examine possible organizational reasons for why UK NHS commissioners have not adopted programme budgeting and marginal analysis (PBMA). This is despite increasing evidence of discontent with current commissioning and priority-setting processes, increasing research evidence demonstrating the potential of PBMA and support for the principles of PBMA. Two separate semistructured surveys of the views of commissioning decision-makers on the use of PBMA were carried out at Grampian Health Board and Newcastle & North Tyneside Health Authority. Twenty-nine decision-makers were interviewed. Both surveys found common barriers to implementation of PBMA, described by respondents as ‘institutional inertia’. These were the reactive rather than proactive environment; the fear of ‘unnecessary’ explicitness; an aversion to unilateral innovation in the current NHS environment; and the demand for concrete evaluation evidence. It is concluded that these qualitative surveys have small samples and cannot claim to be representative. It may be significant that many issues were common to both surveys carried out separately in organizations. It is unlikely that NHS commissioning will independently adopt techniques such as PBMA, given the current commissioning environment and organizational structures. Implementation strategies and future research on such commissioning innovations may need to focus on institutions as well as the interventions.
Evaluating Medical Information Systems: Ethnomethodological and Interactionist Approaches
Authors: Greatbatch David , Murphy Elizabeth , Dingwall Robert
Published: January 2017

This paper examines how qualitative research can contribute to the evaluation of medical information systems. Most qualitative studies of the use of medical computer systems adopt either an interactionist or, less commonly, an ethnomethodological perspective. The paper compares and contrasts the two approaches through the detailed discussion of two case studies, one rooted in each tradition. It identifies the implications of using these different analytical approaches and assesses their strengths and weaknessess. The paper argues that the preference for interactionism has led qualitative researchers to overlook important aspects of the social processess which surround the use of computer systems and that, consequently, a shift in emphasis towards ethnomethodological research is necessary. Nonetheless, it concludes by asserting that both strands of qualitative research can illuminate the organizational impact of medical computer systems.
Who Profits from Not-For-Profits: A Reconsideration
Authors: Haddock Cynthia Carter , Arrington Barbara , Skelton Adam
Published: January 2017

‘Who profits from nonprofits?’ asked Herzlinger and Krasker in a recent Harvard Business Review article. Their study examined whether not-for-profit hospitals achieve the intended social goals for which they are subsidised by society. In this paper, we report a reconsideration of Herzlinger and Krasker's question. Using a larger data set and a different statistical method, our findings are at variance with those of Herzlinger and Krasker and in general agreement with their critics.
Going North on a North-Bound Trail: A Model for Achieving Health Management Goals and Objectives
Authors: Eni Godwin O. , Tan Joseph K. H.
Published: January 2017

A basic managerial problem in decision making is to synthesise and priorise information relating to the achievement of organisational goals and objectives.

This paper discusses the role of critical success factors in health services planning as a means for sorting out and specifying relevant information necessary for achieving organisational goals and managerial objectives. The proposed approach enhances existing planning procedures for health care organisations. Within a conceptual framework of the health care system, managerial insights are provided for the realisation of organisational goals via measurable managerial objectives using critical success factors as pointers to success. More importantly, this paper introduces a planning model which incorporates the CSF concept for developing new health care programmes and for evaluating or restructuring existing programmes.
Towards a Formalization of Quality in Health Care Contracts
Authors: Marchment Mike , Hoffmeyer Ullrich
Published: January 2017

The paper explores ways of how measurable indicators of quality of health care might be specified in health care contracts of NHS providers. The paper assesses the likelihood of defining formal outcome-related indicators. If outcome-related indicators are not measurable, then process or input-related quality indicators should be used as a second best choice. These should have certain desirable properties. The paper spells out these properties and points to examples.
Hospital Capital Structure Decisions: Theory and Practice
Authors: Gapenski Louis C.
Published: January 2017

The paper explores capitalisation decisions within the hospital sector. This is done theoretically by examining the appropriateness of capital structure theory of hospitals and also in a real world context of soliciting the views of hospital chief financial officers. The ways in which capital decisions are made is described and the relationship of practice to theoretical models discussed.
Clinicians into Management. The Experience in Context
Authors: Burgoyne John , Lorbiecki Anna
Published: January 2017

This paper interprets the experience of a sample of 60 clinicians becoming involved in formal management, mainly at hospital unit level, in the historical context of changing health service organisation. This includes the introduction of managerialism and the evolution of the NHS into a structured network based around purchaser/provider relationships.

The conclusion is that these clinicians are becoming involved in management, and making the personal and social adjustments necessary for this, but in a way that leaves medical culture, and their allegiance to it, at the present largely intact. This is achieved largely through the organisational mechanism of clinical directorates, which promise to function as professional groups from the clinical point of view and as business units from the managerial perspective.

An argument is put forward, based on a theoretical view compatible with the data from the clinicians' experience, that this mode of medical involvement in management may operate without undue conflict in the longer term if: (a) clinicians accept the degree of local professional regulation that this model applies; and (b) the conflict between medical need and available resource can be dealt with elsewhere in the system without passing it back to hospitals and clinical directorates.

On the other hand it is possible that conflict will increase if the consequences of management control systems and objectives percolate down through the management hierarchy and cross into the medical domain, via clinical directorates.
Evidence of HTLV-I Infection in Singapore Prostitutes
Authors: Sng E H , Thirumoorthy T , Levin A , Alexander S , Sng I , Blattner W
Published: January 2017

Sera obtained in 1987 from 63 male and 632 female Singapore prostitutes were screened for antibody to human T-cell leukaemia virus (HTLV)-I with a particle agglutination test. Of the 3 males and 4 females who were positive one had antibody to HTLV-I core and envelope antigen on Western Blot. Two subjects had presumptive antibody to HTLV-I core antigen and a third subject had such antibody on a repeat specimen in 1989. These sera were negative for HIV-1 antibody. There is evidence of infection with HTLV-I or a variant virus in this population. The infection is likely to have been sexually transmitted.
Evaluation on HIV Serology and Immune-Stimulation on Patients in Tanzania
Authors: Hengster P , Schmutzhard E , Fuchs D , Hofbauer J , Wachter H , Dierich M P
Published: January 2017

Antibodies against human immunodeficiency virus, other infectious agents and neopterin levels were determined in 253 patients in a rural area of North-West Tanzania. Seroprevalence for HIV was 3.2%. In one case serology was positive for HIV-1 and HIV-2 antibodies and questions whether there was a real double infection or a cross reaction not only concerning core region proteins but also transmembrane protein. The specificity in the diagnosis of HIV-infection is markedly increased with newer serological methods using recombinant peptides but did not improve sensitivity on African sera.

Neopterin was determined as a sensitive indirect marker for the activation of T-cells and is therefore correlated with the susceptibility of HIV infection and with progression of disease. High seroprevalence rates for various infectious agents were determined and may explain the high rate of elevated neopterin levels in 80% of the Africans. Neopterin levels were even higher in HIV patients. Viral p24 antigen was found only in two persons, one of whom had no antibodies detectable.
Hepatitis C among Risk Groups for HIV and Hepatitis B
Authors: Vanderschueren S , Van Renterghem L , Plum J , Verhofstede C , Mak R , Vincke J
Published: January 2017

In order to obtain more information on sexual transmission of hepatitis C (HCV) we compared different high-risk groups for HIV and hepatitis B to see if they were seropositive for HCV. A high seroprevalence (38/81) of hepatitis C (HCV) was found among intravenous drug users. Nursing staff ( n = 35) and patients of a dialysis unit ( n = 57) had a low prevalence of anti-HCV antibodies (0% and 5%, respectively). Serology laboratory technicians also had a very low prevalence (0% out of 29). Among prostitutes ( n = 114), healthy homosexual men ( n = 132) and HIV-infected homosexual men ( n = 31), we found a remarkably low seroprevalence of HCV (3.5%, 0.8% and 0.0% respectively).

These data support the view that parenteral exposure to the virus is the most important way of acquiring the infection and that neither heterosexual nor homosexual promiscuity are associated with a high risk of transmission of hepatitis C.
Manifestations of Anogenital HPV Infection in the Male Partners of Women with Anogenital Warts and/or Abnormal Cervical Smears
Authors: Law Carmella , Merianos Angela , Thompson Carol , Rose Barbara , Cossart Yvonne , Grace Julienne
Published: January 2017

The prevalence and manifestations of anogenital human papillomavirus (HPV) infection in 154 men, all of whom were the sexual partners of women with either overt anogenital warts or cervical HPV-related abnormalities, were assessed using clinical, histopathological and molecular criteria. Detailed examination of the anogenital region using a colposcope was supplemented by the use of 5% acetic acid to detect possible foci of subclinical HPV infection. Biopsies of warts and aceto-white lesions were examined histopathologically and by HPV DNA hybridization using radiolabelled HPV 6/11 and 16/18 DNA probes. More than two-thirds of the men had clinical indications of genital HPV infection: 37% had apparent macroscopic warts, almost invariably in combination with aceto-white lesions; while 34% had aceto-white lesions only. The overwhelming majority of these lesions (92%) were located on the penis only. However, only 49% of the macroscopic and 29% of the aceto-white lesions showed histological features consistent with a conclusive diagnosis of HPV infection; while the corresponding figures for HPV DNA positivity were 72% and 56% respectively. Current HPV infection was strongly associated with a past history of anogenital warts, but there was little or no correlation between the manifestions of HPV infection in the male and female sexual partners.
Gonorrhoea and Urogenital Chlamydial Infection in Female Prostitutes in Tegucigalpa, Honduras
Authors: Venegas Vilma Susana , Villafranca Patricia , Madrid Juan Paz , Cosenza Humberto , Bygdeman Solgun
Published: January 2017

The prevalence of gonorrhoea and urogenital chlamydial infection was investigated in female prostitutes in Tegucigalpa, Honduras. Epidemiological data were recorded according to a standardized questionnaire. The median age of the prostitutes was 27 years and the median period of prostitution was 2–4 years. Most of the women (91%) had no occupation other than prostitution and 57% of them had not even completed primary school. In 233 cases when both gonococcal culture and chlamydial antigen detection with a commercial EIA kit were performed the prevalence of gonorrhoea was 25% (59) and that of chlamydial infection 31% (72). Both diseases were recorded in 9%. The women who had been prostitutes for 2 years or longer had gonorrhoea ( P < 0.01) or chlamydial infection ( P < 0.05) less frequently than those who had practised prostitution for a shorter time period. Among 70 different gonococcal isolates from 241 prostitutes, 40 (57%) belonged to serogroup W II/III. Most (83%) of the 30 W I isolates were beta-lactamase producing (PPNG) like 42% of the W II/III isolates. All non-PPNG isolates, except one had decreased susceptibility to benzylpenicillin (MIC ≥0.125 mg/l) and all isolates were susceptible to spectinomycin. Four out of five isolates from the throat were PPNG and the fifth had a benzylpenicillin MIC of 0.5–2.0 mg/l.
Sexually Transmitted Diseases in HIV-1 Seropositive Women at Presentation
Authors: Kell P D , Barton S E , Summerbell C D , Lawrence A G
Published: January 2017

Ninety women who were HIV antibody positive attended the genitourinary medicine clinics of East Riverside up to May 1990. Seventy-five of these women (83%) were examined for co-existent sexually transmitted disease (STD) at presentation. The prevalence of STD in these women was compared to the incidence of STD in all females attending in 1989. Syphilis and chlamydia were found to be significantly more common in women with HIV infection. We feel that a full examination for STD is an important aspect in the management of these women.
Risk of HIV Infection among Dutch Expatriates in Sub-Saharan Africa
Authors: Houweling Hans , Coutinho Roel A
Published: January 2017

In order to study the prevalence of human immunodeficiency virus (HIV) infections and related risk factors, Dutch expatriates returning from sub-Saharan Africa were asked to complete a questionnaire on sexual, occupational and other risk factors, and to donate a sample of blood to test for antibodies against HIV. The 1968 participants were workers of various professions and their family members over 16 years of age posted in sub-Saharan African countries by Dutch governmental, non-governmental and commercial organizations for at least 6 months cumulative time between 1 January 1979 and 1 January 1990.

Antibodies against HIV-1 were found among 4 of 1122 men (0.4%) and 1 of 846 women (0.1%). The woman and 3 of the men had had sexual contact with African partners and had been treated for sexually transmitted diseases, 2 of these 3 men also had an African life partner. One man reported occupational exposure only. Of the 1968 participants 89 men (7.9%) and 18 women (2.1%) lived with an African partner; 344 men (30.7%) and 111 women (13.1%) had heterosexual contact with other African partners. Only 22.3% (men) and 18.6% (women) of casual sexual contacts with African partners were always protected by a condom. Two hundred and thirty-two of 408 (56.9%) (para)medics reported needlesticks. Groups at risk of HIV infection through sexual exposure were identified using logistic regression models.

In conclusion, the observed prevalence of HIV-1 is low. However, unprotected sexual contact with African partners and needlestick accidents were common. This study underscores the continuous need for health education of expatriates on the risks of transmission of HIV in Africa.
Sexual Assault on Men
Authors: Lacey H B , Roberts R
Published: January 2017

Epidemiological data in 13 cases of sexual assault on men who attended a sexual assault referral centre are presented. All the assailants were male. The sexual orientation of the victims was predominantly heterosexual (7 of 13), 3 considered themselves to be homosexual and 3 were confused about their sexual orientation. The average age at the time of assault was 21.6 years. The most common form of assault was anal intercourse which occurred in 8 cases, followed by forced oral penetration which occurred in 6 cases. The proportion of known:unknown assailants (8:5) shows similar characteristics to those seen in female rape, use of weapons and multiple assailants were more common in assault on men. Seven men (54%) developed psychological problems following assault, and this was their main reason for presentation to the centre.
Diagnosing Non-Gonococcal Urethritis: The Gram-Stained Urethral Smear in Perspective
Authors: Terry P M , Holland S , Olden D , O'Connell S
Published: January 2017

The value of microscopy of a Gram-stained urethral smear in the diagnosis of non-gonococcal urethritis and chlamydial urethral infection was assessed in 153 men attending a department of genitourinary medicine. A mean of more than 4 polymorphs in 5 fields (×1000) was considered to be abnormal. In the diagnosis of urethritis, the sensitivity (94%), specificity (91%), positive predictive value (93%) and negative predictive value (93%) were high. In the diagnosis of chlamydial infection, sensitivity (91%) and negative predictive value (96%) were high, but specificity (68%) and positive predictive value (46%) were low. In men with symptoms of genitourinary infection, the sensitivity (96.7%) and negative predictive value (97.4%) of the Gram-stained urethral smear in the diagnosis of chlamydial infection was comparable with modern chlamydial antigen detection tests.
High Prevalence of Human Papillomavirus and Cervical Intraepithelial Neoplasia in a Young Australian STD Population
Authors: McKinnon K J , Ford R M , Hunter J C
Published: January 2017

Two hundred and forty-five women consecutively attending a large city Sexually Transmitted Diseases (STD) Centre had routine cervical screening performed by both the Pap smear and, in addition, a Cervigram. The aim of this study was to determine the prevalence of HPV infection, CIN and cervical cancer in an STD population. The mean age of this group was 26 years with a range from 16 to 53 years. Colposcopy and biopsy revealed a prevalence for human papillomavirus (HPV) of 41%, and 20.4% for cervical intraepithelial neoplasia (CIN). No cases of cervical cancer were detected. The Pap smear detected HPV-associated change in 18% and CIN in 8.2%, therefore generally underestimating the true prevalence of HPV and CIN. Cervicography was positive in 44% of the total group, indicating either HPV-associated change or CIN. Current screening methods are therefore failing to detect significant amounts of HPV-associated change and CIN.
Screening Pregnant Women for Genital Herpes
Authors: Woolley P D , Lacey H B , Helsen K
Published: January 2017

In a prospective study to identify the viral type isolated from women undergoing screening for herpes simplex virus (HSV) during pregnancy using fluoroscine-labelled monoclonal antibodies to HSV-1 and HSV-2, HSV-2 was more likely to be isolated during the third trimester and was the only viral type isolated at term. As the severity of neonatal central nervous system disease is greater with HSV-2 than HSV-1 we recommend that all women with a history of genital herpes should be screened during pregnancy.
Improved Outcome of Pneumocystis Carinii Pneumonia in AIDS Patients: A Multifactorial Treatment Effect
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

Factors determining the outcome of an episode of Pneumocystis carinii pneumonia (PCP) in 149 AIDS patients treated at St Mary's Hospital were identified and their importance on improved survival evaluated between 1984 and 1989. The proportion of fatal episodes of PCP decreased over time. Fatal compared with non-fatal episodes had lower mean alveolar-arterial oxygen gradient (82.5 mmHg vs 53.8 mmHg, P<0.001), mean haemoglobin level (11.2g/dl vs 12.1 g/dl, P=0.01), mean lymphocyte count (0.68 times 109/l vs 0.92 times 109/l, P=0.05) and more coinfections (31% vs 5%, P<0.001). Over time, the most significant change which occurred was a reduction in alveolar-arterial oxygen gradient at time of first presentation with PCP (r=−0.37, P<0.001). Mean alveolar-arterial oxygen gradient declined from 79.9 mmHg in 1984 to 45.3 mmHg in 1989 (r= −0.88, P=0.02), independently of zidovudine therapy or PCP prophylaxis.

Patients were being treated at an earlier stage in their disease course as indicated by their reduced alveolar arterial oxygen gradient. This is due either to earlier patient presentation, earlier medical diagnosis or both. The widespread introduction of zidovudine and PCP prophylaxis may further contribute to improve morbidity and mortality patterns in the future.
Comparison of Four In Situ Hybridization Methods, Based on Digoxigenin- and Biotin-Labelled Probes, in Detecting HPV DNA in Male Condylomata Acuminata
Authors: Lassus J , Niemi K-M , Marjamäki A , Syrjanen S , Kartamaa M , Lehmus A , Krohn K , Ranki A
Published: January 2017

We have compared the efficacy of digoxigenin- and biotin-labelled probes in detecting HPV DNA by in situ hybridization on paraffin-embedded tissue sections of 57 male condyloma-suspect genital lesions. Each biopsy was hybridized with at least three of the following four methods: digoxigenin-labelled HPV DNA probes (Dig-HPV), biotinylated HPV-DNA probes (Bio-HPV), and two commercial methods (ViraType in situ and PathoGene), both based on biotinylated DNA probes. The hybridization products were visualized with colourigenic enzyme substrates.

In most biopsies, the 4 methods gave equal results although cross-hybridization was most often found with the low-stringency ViraType method. Dig-HPV 6/11 probes gave positive results about twice as often as either of the commercial methods. No such difference, however, was found for HPV 16/18 probes.

DNA of any type of HPV 6/11, 16/18 or 31/33/35 or 51 was detected in 28/43 (65%) of lesions showing condyloma acuminatum histology but in none of the 14 biopsies with no histological signs of HPV infection. In HPV-positive condylomata with no cellular atypia. HPV 6/11 was detected in 87% (13/15), and HPV 16/18 in 27% (4/15). In biopsies with cellular atypia, HPV types 6/11 were detected in 62% (8/13), HPV types 16/18 in 46% (6/13), and HPV types 31/33/35 or 51 in 50% (6/12). In about 50% of the biopsies where at least one hybridization method gave a positive result, either one of the commercial methods gave a negative result. Thus, in situ hybridization using digoxigenin-labelled HPV DNA probes is at least as sensitive a method for HPV detection in paraffin embedded biopsy tissue as in situ hybridization using biotin-labelled probes. Combination of in situ hybridization using digoxigenin-labelled HPV DNA probes with in situ hybridization with biotinylated HPV DNA probes may further improve sensitivity of HPV DNA detection in paraffin-embedded biopsy material.
The Value of Tests of Cure following Cervical Chlamydial Infection
Authors: White DJ , Mann CH , Matthews RS , Leeming J G , Clay J C
Published: January 2017

Test of cure (TOC) was performed 2, 4 and 6 weeks after treatment for cervical chlamydia infection with 10–14 days of Deteclo one tablet twice daily, erythromycin 500 mg twice daily or doxycycline 100 mg twice daily. Testing was by chlamydia culture and IDEIA™ (DAKO diagnostics Ltd). Discrepant results were subsequently checked by immunofluorescence (Syva MicroTrak™) of both sets of left over transport media. Two hundred and three patients attended on at least one occasion; 189, 146 and 107 at 2, 4 and 6 weeks respectively. Of these 127, 70 and 34, respectively, denied sexual intercourse or had consistently used condoms.

Fourteen were positive over the study period by either or both methods of detection. Of 8 culture positive results 3 were negative by IDEIA. Two of these had elementary bodies (EBs) on immunofluorescence of both sets of saved transport media. One had EBs on immunofluorescence of the saved culture transport medium only. None of the 6 IDEIA positive, culture negative patients had immunofluorescent EBs in the IDEIA transport media although one had EBs in the saved culture transport medium. One IDEIA suspicious, culture negative patient had EBs in both sets of saved transport media.

There was no significant difference in the rate of chlamydia detection from patients admitting to or denying unprotected intercourse.

TOC has a low yield in cases of cervical chlamydial infection when there has been careful contact tracing and treatment has been completed. If TOC is performed culture should be used if available and where antigen detection methods are used confirmation should be sought for any positive results.
Factors Associated with Trichomoniasis, Candidiasis and Bacterial Vaginosis
Authors: Hart Gavin
Published: January 2017

Of 6125 women attending an STD clinic from 1988 to 1991, 5365 (88%) were tested for vaginitis of whom 97 (1.8%) had trichomoniasis, 945 (17.6%) had candidiasis, 734 (13.7%) had bacterial vaginosis and 3628 (67.6%) were free of vaginal infection. Dual infections occurred in 49 (0.9%) patients.

Independent predictors for trichomoniasis by multivariate analysis were being pregnant (odds ratio (OR)=2.4), having vaginal discharge or dysuria (OR=4.7), being Aboriginal (OR=4.3), being Asian (OR=5.0), being unemployed (OR=2.1) or tattoed (OR=1.9). Many factors, including use of oral contraception (OR=1.2) and current antibiotic medication (OR=1.5), had a small significant association with candidiasis. Independent predictors for bacterial vaginosis were having multiple sex partners in the past month (OR=1.6), being unmarried (OR=1.5), being unemployed (OR=1.3) being a prostitute (OR=1.5) and not currently using antibiotic medication (OR=2.5).

The epidemiological profiles were consistent with trichomoniasis and bacterial vaginosis being sexually transmitted diseases with epidemiology different from that of gonorrhoea and chlamydia and different from each other, and candidiasis being a disease in which constitutional factors are more important than issues relating to sexual transmission.
Management of Cervical Intraepithelial Neoplasia in Departments of Genitourinary Medicine—A National Survey
Authors: Markos A R , Wade A A H , Walzman M
Published: January 2017

A national survey of the methods used in the diagnosis and treatment of cervical intraepithelial neoplasia (CIN) in the departments of genitourinary medicine (GUM) in the United Kingdom had been conducted through a postal questionnaire. The findings indicate that at present of 157 responders to the questionnaire, 43 (27.3%) take an active part in the management of CIN. The different modes of management and follow-up are presented.
Detection of IgG, IgM and IgA Antibodies in Patients with Uncomplicated Chlamydia Trachomatis Infection: A Comparison between Enzyme Linked Immunofluorescent Assay and Isolation in Cell Culture
Authors: Theunissen J J H , van Heijst B Y M , Chin-A-Lien R A M , Wagenvoort J H T , Stolz E , Michel M F
Published: January 2017

The diagnostic value of serum IgG, IgM and IgA in patients with uncomplicated urogenital Chlamydia trachomatis infection was compared with isolation in cell culture. C. trachomatis specific antibodies were determined with an enzyme linked immunofluorescent assay using elementary bodies from C. trachomatis serotypes E,F,H,I,J and LGV2 as antigens. At least two sera from each patient were tested and cultures were also established on the same day. Excluding the IgM titres in men, significantly more IgG, IgA and IgM and combinations of these antibodies were observed in culture positive patients. The sensitivity with which IgG titres in men or IgG and/or IgM titres in men and women could be determined, was significantly lower using C. trachomatis LGV2 as the only antigen than when all 6 antigens were used. The presence of 10 or more leucocytes in the urine sediment of men correlated positively with an IgG or an IgG and/or IgM titre.
Prevalence of HPV in a Melbourne Female STD Population: Comparison of RNA and DNA Probes in Detecting HPV by Dot Blot Hybridization
Authors: Borg A J , Medley G , Garland S M
Published: January 2017

A total of 377 women, consecutively selected as first attenders to a sexually transmitted diseases clinic in Melbourne, Australia, were examined for overt Condylomata acuminata and were screened for genital HPV DNA types 6, 11, 16, 18, 31, 33 and (35) using 2 dot blot hybridization methods. Overall, there was a 90% positivity correlation between the 2 methods with HPV DNA being detected in 12% of ectocervical samples. Overt warts were found in 15% of the women and HPV DNA was detected at the cervix in 35% with cytology predicting HPV with or without dysplasia in 27%. Thirteen percent had a past history of warts but none on examination and HPV DNA was evident in 16% while 18% had cytological features of HPV. Those with no warts evident and no past history of warts had both HPV DNA and cytological features of HPV in 7%.