bluuebunny/crossref_metadata_2025 huggingface dataset:
A lasting public health response to an outbreak of HIV infection in a Scottish prison?
Authors: Goldberg David , Taylor Avril , McGregor James , Davis Barbara , Wrench John , Gruer Laurence
Published: October 2002

Between April and June 1993, 8 cases of acute clinical hepatitis B infection and 2 seroconversions to HIV infection were detected among drug injecting inmates of HM Prison Glenochil in Scotland. To prevent the further spread of infection, an initiative which involved counselling and voluntary attributable HIV testing was conducted over a 10-day period commencing at the end of June. A team of 18 counsellors and phlebotomists was brought together rapidly as part of a unique organizational exercise in the field of public health. Fourteen cases of HIV infection were identified of which 13 were almost certainly infected in Glenochil. Following the exercise, a range of harm reduction measures for injecting prisoners was introduced; these included the availability of hepatitis B vaccine, provision of bleach tablets which could be used to clean injecting equipment, a methadone detoxification programme, increased training for prison officers and improved access to drug and harm minimization counselling for inmates. By mid-1996 all these measures had been sustained and several could be found in many other prisons throughout Scotland. Follow-up investigations showed no evidence of epidemic spread of HIV during the 12 months after the initiative. While the frequency of injecting and needle/syringe sharing may have decreased over the last 3 years, these activities are still being reported and it is highly likely that transmissions of bloodborne infections, in paticular hepatitis C, continue to occur. The surveillance and prevention of infections associated with injecting drug use in the prison setting remain a high public health priority.
Seroprevalence of four sexually transmitted diseases in a semi-urban population of Gabon
Authors: Bertherat E , Georges-Courbot M C , Nabias R , Georges A J , Renaut A
Published: October 2002

Using the cluster-sampling method, the authors estimated the seroprevalence of 4 sexually transmitted diseases (STDs) among the sexually active general population in a city of 30,000 inhabitants in the east of Gabon. The seroprevalences were 2% for HIV-1, 13.8% for hepatitis B, 8.6% for Treponema pallidum and 59.6% for Chlamydia trachomatis. The seroprevalences of hepatitis B and chlamydia were stable over time and similar to those registered in other countries of central Africa. On the other hand, the seroprevalence of T. pallidum is notably low in comparison with these countries and seems to be decreasing. The seroprevalence of HIV-1 is also low but has doubled in 8 years in the city. Immigrant women from west Africa were a high-risk group for STDs but more generally, cohabiting was a risk factor for women.
Rapid HIV testing with same-day results: a field trial in Uganda
Authors: Kassler William J , Alwano-Edyegu Mary Grace , Marum Elizabeth , Biryahwaho Benon , Kataaha Peter , Dillon Beth
Published: October 2002

Rapid, on-site HIV testing with same-day results may improve services and increase the number of clients who learn their serostatus in developing countries. To validate test performance under field conditions and assess the change in the proportion of clients who learn their serostatus, we conducted a field trial using the Capillus HIV-1/HIV-2 assay (Cambridge Diagnostics) at the AIDS Information Centre counselling and testing sites in Uganda. Compared to the standard 2-EIA testing algorithm, the sensitivity of Capillus was 99.6% (95% CI; 98.5%, 99.9%), the specificity was 98.8% (95% CI; 98.1%, 99.3%), the positive predictive value was 96.5% (95% CI; 94.5%, 97.8%), and the negative predictive value was 99.9% (95% CI; 99.5%, 100%). It took less than 5 min to perform a single test, and results were returned to clients in less than an hour, during which time clients were counselled. This resulted in a 27% increase in the proportion of clients who learned their serostatus and received counselling. We conclude that simple, rapid HIV tests can be performed accurately on-site within the time frame of a clinic visit, increasing the number of clients who learn their serostatus and receive post-test counselling.
Risk factors for concordant HIV infection in heterosexual couples in Trinidad
Authors: Gourville E M De , Mabey D , Quigley M , Jack N , Mahabir B
Published: October 2002

Summary: Risk factors for HIV infection in partners of HIV-seropositive index cases were investigated in a cross-sectional survey. Between September 1992 and April 1994 a total of 251 HIV-infected persons and 76 of their sexual partners were interviewed at the main sexually transmitted diseases (STDs) clinic in Trinidad. All participants gave signed consent and responded to a questionnaire. Sixty-four couples had risks for HIV infection through heterosexual intercourse only. However, many recruited sex partners (57/64) reported heterosexual intercourse with persons in addition to the index cases. Overall HIV concordance (both index case and partner HIV infected) was 45% in the couples. HIV concordance was not found to be related to the sexual practices within the studied unions nor to the clinical status of the index case. After allowing for confounding factors there was an increased risk for HIV concordance in couples in unions for 3.48; 95% CI 0.89-13.69, P =0.055), and in those in which sex partners had a past history of genital sores (adjusted for prostitution: OR 4.50; 95% CI 1.01-20.4). Interventions targeted at reducing high-risk sexual behaviour, prostitution and cocaine use could be beneficial in reducing the spread of STDs and HIV in Trinidad. 1 year (adjusted OR
Co-trimoxazole desensitization in HIV-seropositive patients
Authors: Theodore C M , Holmes D , Rodgers M , Mclean K A
Published: October 2002

Summary: Co-trimoxazole (trimethoprim-sulphamethoxazole) is an effective prophylactic agent against Pneumocystis carinii pneumonia (PCP). However, it is associated with a high frequency of adverse reactions in immunocompromised patients which may preclude its use. Fourteen patients with a definite history of adverse reactions to co-trimoxazole on standard PCP prophylactic dosage were selected for desensitization using a regimen of gradual incremental exposure over an 11-day period. Eight (57.1%) were successfully desensitized and have continued on oral co-trimoxazole at maximum 21 months' follow-up. This report demonstrates that oral desensitization as an outpatient procedure is an effective and safe option for both primary and secondary PCP prophylaxis in HIV-seropositive patients with previous adverse drug reactions.
A new recombinant antigen latex agglutination test (Syphilis Fast) for the rapid serological diagnosis of syphilis
Authors: Young H , Moyes A , Mcmillan A
Published: October 2002

We report an assessment of Syphilis Fast, a new latex test that uses a pool of 3 recombinant Treponema pallidum antigens (TpN15, TpN17, and TpN47) for the serodiagnosis of syphilis. Specificity was evaluated by screening 1518 unselected blood specimens in parallel with Syphilis Fast, the Captia SelectSyphG EIA and the Venereal Disease Research Laboratory (VDRL) cardiolipin antigen test while sensitivity was tested using a panel of 99 treponemal sera (treated and untreated) representing various stages of infection and 15 treponemal sera detected on screening. The specificity of Syphilis Fast on initial testing (99.8%) was significantly higher (P 0.02) than that of Captia SelectSyph-G (99.2%) and the VDRL (99.1%): the specificity of Syphilis Fast remained significantly higher (P 0.02) after repeat testing (respective values 99.9%, 99.5% and 99.4%). There was no difference in the sensitivity of Syphilis Fast and Captia SelectSyph-G on initial (93% vs 92.1%) or repeat (95.6% vs 94.7%) testing: both were significantly more sensitive (P 0.001) than the VDRL (46.5% on initial and 43.9% on repeat testing). The sensitivities of the Treponema pallidum haemagglutination test (TPHA) and FTA-abs were 98.2% and 95.6% respectively. Negative reactions in Syphilis Fast and SelectSyph-G were associated with treated infections and correlated with low TPHA titres (80). We conclude that Syphilis Fast is a highly specific, simple and fast screening test with a sensitivity comparable to native antigen treponemal tests and that it merits consideration as a front-line screening test.
Sexually transmitted diseases in Ulaanbaatar, Mongolia
Authors: Schwebke J R , Aira T , Jordan N , Jolly P E , Vermund S H
Published: October 2002

Summary: Although human immunodeficiency virus (HIV) rates are increasing rapidly in Asia, a full understanding of the extent of other sexually transmitted diseases (STDs) in many of these areas is lacking. There have been anecdotes of rising rates of STDs in Mongolia, a country thus far relatively unaffected by HIV. To further the understanding of STDs, a prevalence study was conducted in the STD clinic in Ulaanbaatar, the capital and largest city in Mongolia. Among 260 patients, the prevalence of gonorrhoea, chlamydia and syphilis was 31.1%, 8.1% and 8.6% respectively for males and 10.3%, 9.9% and 6.0% for females. Sixty-seven per cent of females had trichomoniasis and 19.7% of males had non-gonococcal urethritis (NGU). Forty-two per cent of gonococcal isolates had plasmid mediated resistance to penicillin, and chromosomal resistance to penicillin, tetracycline, and ciprofloxacin was documented. No patients were infected with HIV. STDs are a significant problem in Mongolia. Improved control efforts are urgently needed to prevent the emergence of HIV.
Gay men who engage repeatedly in unprotected anal intercourse with casual partners: the Sydney Men and Sexual Health Study
Authors: Ven Paul Van De , Campbell Danielle , Kippax Susan , Knox Stephanie , Prestage Garrett , Crawford June , Kinder Paul , Cooper David
Published: October 2002

Summary: We set out to determine the frequency and correlates of gay men's repeated unprotected anal intercourse with casual partners (UAI-C), defined as UAI-C reported at each of 3 annual interviews. By May 1997, 659 men had completed 3 annual interviews for the Sydney Men and Sexual Health (SMASH) cohort study. For the 3 6-month periods prior to each interview, 127 men reported UAI-C during one period only; 45 reported it during 2 periods; and 20 men reported it during all 3 periods. These 20 men who had repeated UAI-C were compared with 497 men who had anal intercourse with casual partners but did not report on all 3 occasions that they had UAI-C. Logistic regression revealed that repeated UAI-C was associated with HIV-positive status, more casual partners, less favourable attitudes toward condoms and greater recreational drug use. Few gay men have repeated UAI-C but those who do run greater risk of HIV transmission.
Comparison of tampon and urine as self-administered methods of specimen collection in the detection of Chlamydia trachomatis , Neisseria gonorrhoeae and Trichomonas vaginalis in women
Authors: Tabrizi Sepehr N , Paterson Barbara A , Fairley Christopher K , Bowden Francis J , Garland Suzanne M
Published: October 2002

1 Department of Microbiology, The Royal Women's Hospital, Victoria, 2 Menzies School of Health Research, Rocklands Drive, Tiwi, 3 Department of Epidemiology and Preventive Medicine, Alfred Hospital, Monash University, Prahran, Victoria and 4 AIDS/STD Unit, Centre for Disease Control, Territory Health Services, Darwin, Australia Summary: Self-administered sampling techniques for the detection of sexually transmitted diseases (STDs) are particularly useful due to their ease of collection and better patient compliance. Urine specimens, and recently tampons, have been described as methods of specimen collection for the detection of some STDs in women. In this study, 660 women had both first-void urine (FVU) and tampon specimens analysed by polymerase chain reaction (PCR) for the detection of Chlamydia trachomatis , Neisseria gonorrhoeae and Trichomonas vaginalis . Overall 6.5%, 10.1% and 17.9% of urine samples were positive whereas 7%, 21.2% and 22% of tampon specimens were positive for C. trachomatis , N. gonorrhoeae and T. vaginalis respectively. Tampon-collected specimens tested by PCR were more sensitive than urine specimens for the detection of N. gonorrhoeae and T. vaginalis ( P 0.001) and equally sensitive for the detection of C. trachomatis ( P =0.45). <
HIV associated eosinophilic folliculitis in a Chinese woman: a case report and a survey in Hong Kong
Authors: Ho M H , Chong L Y , Ho T T Y
Published: October 2002

This is the first survey of eosinophilic folliculitis EF in patients infected with the human immunodeficiency virus HIV in Hong Kong. The present report provides the local data on HIV associated eosinophilic folliculitis HIV EF and includes the first Chinese, heterosexual female patient with this condition. This is a retrospective study on all HIV positive patients n =451 attending the outpatient clinic of the AIDS Unit in Hong Kong. Patients diagnosed as having EF with histological support were included for analysis. The data were presented by descriptive method. Three patients were identified, all of them had skin biopsies done which confirmed the diagnosis; including the female case. Recognition of HIV EF is important because it is indicative of significant immunosuppression with risk of opportunistic infection. We concluded that HIV EF is no longer an exclusive male disease in homosexual patients only. We expect more female patients or heterosexual subjects who are HIV positive developing this disease in the future.
Does penis size influence condom slippage and breakage?
Authors: Smith Anthony M A , Jolley Damien , Hocking Jane , Benton Kim , Gerofi John
Published: October 2002

This study examined the effect of penis dimensions on the probability of complete condom slippage and condom breakage in actual use. Men were recruited through advertising, used the condoms supplied and completed a diary sheet for each condom used. A total of 3658 condoms were used by 184 men of which 1.34 broke and 2.05 slipped off. No significant effect was demonstrated for penile dimensions on the probability of complete condom slippage. However, condom breakage was strongly associated with penile circumference. These findings suggest that condom manufacturers may need to increase the range of condom sizes available, or some aspects of their performance, in order to ensure that condoms meet the needs of all men without unduly exposing them to risk.
Quantification of Chlamydia trachomatis in cervical and urine specimens from women attending a genitourinary medicine clinic: implications for screening strategies
Authors: Thomas B J , Pierpoint T , Robinson D Taylor , Renton A M
Published: October 2002

Population screening and intervention programmes can reduce the prevalence and incidence of infection with Chlamydia trachomatis , especially if sensitive molecular diagnostic tests are used. However, diagnostic tests that perform well on genitourinary medicine GUM clinic populations may be less useful for screening, particularly if the majority of infected subjects are asymptomatic and their samples contain fewer organisms. We have compared the extent of low organism load in cervical and urine samples from symptomatic and asymptomatic chlamydia positive women, by using a direct fluorescent antibody staining method and counting the chlamydial elementary bodies EBs . We have investigated the ability of an enzyme immunoassay EIA; MicroTrak and a DNA amplification ligase chain reaction; LCR assay to detect low numbers of organisms in cervical samples and the ability of the LCR assay to detect low numbers of organisms in urine. A low organism load 10 EBs was seen by direct fluorescent antibody DFA staining in about 30 of cervical samples and in about 75 of urines from chlamydia positive women; the proportions in symptomatic women were not significantly different from those in asymptomatic women. The EIA identified only 16 of cervical samples that contained 10 EBs by DFA staining; the LCR identified 100 of cervical samples and 93 of urine samples that contained 10 EBs by DFA staining. The findings suggest that the ability of chlamydial diagnostic tests to identify positive women should be similar among patients attending a GUM clinic and those taking part in a population screening programme, and that sensitive molecular assays such as the LCR should identify subjects with a low organism load in both groups.
Who do we see? A study of GP referral patterns
Authors: Edwards Sarah , Carne Chris
Published: October 2002

The aim of this study was to assess which patients are referred from general practice, in order to target areas in which our service could be improved. An anonymous postal questionnaire was sent to 433 local general practitioners GPs , 72.3 313 of whom replied. The majority of GPs indicated that they would always send patients with a diagnosis of either gonorrhoea or syphilis to the department, while most would send less than 50 of patients with Chlamydia trachomatis infection. Viral infections i.e. warts and herpes were referred more frequently than chlamydia. Referral of trichomoniasis was uncommon, as was advice about contacts in all conditions except gonorrhoea and syphilis.
Vulvovaginal candidiasis in female sex workers
Authors: Otero L , Palacio V , Carreno F , Mendez F J , Vazquez F
Published: October 2002

Vulvovaginal candidiasis is a frequent inflammatory process in women but it has not been widely studied in female sex workers FSWs . To estimate the frequency of Candida species infection in FSWs and to identify related risk factors and clinical findings, we carried out a retrospective study of 1923 FSWs over 11 years. We also performed a prospective study of 163 consecutive FSWs with a history of candidiasis during a 4 year period. Candida species were isolated in 1967 samples 18.5 of the total . Candida albicans 89.3 was the most frequent species, followed by Candida glabrata 2.7 , Candida parapsilosis 1.2 and Saccharomyces cerevisiae 0.4 . In the prospective study of 163 patients, we found vaginal discharge in 76.1 of cases, soreness in 52.1 and vulval pruritus in 32.5 . We identified 12 patients 7.4 with recurrent vulvovaginal candidiasis. No statistical difference was found between recurrent vulvovaginitis and the use of oral contraceptives, oral sex, tight fitting clothing and synthetic underwear. FSWs have the same prevalence of candidiasis as other groups of women described in published literature. The proportion of albicans and non albicans species does not differ between women with recurrent and non recurrent vulvovaginal candidiasis VVC .
Historical Disclosure of Rape by Women Attending Genitourinary Medicine Clinics
Authors: Horn C K , Scott G R , Bain S S R
Published: October 2002

In a previous internal audit of women attending the department of genitourinary medicine following rape, we noted that data from diagnostic coding seemed to underestimate the problem and that anecdotally, a number of women had been seen with concerns relating to historical assault. We therefore decided to record attendance following rape prospectively.

Between 1 June 1996 and 31 May 1997 staff at the Department of Genitourinary Medicine (GUM) at the Royal Infirmary of Edinburgh completed a data collection form for every female patient aged > 15 years who attended the clinic and spontaneously disclosed a history of rape, either recent or historical.

Seventy-five women attending GUM disclosed a history of rape. Sixty-six per cent were aged <25 years. Thirty women presented more than 12 months after the incidence, of whom 50% presented to the health adviser requesting HIV antibody testing. The incidence of sexually transmitted infections was low and in no case could be specifically attributed to the rape. None of the 38 HIV antibody tests performed were positive.

A number of women present to GUM a long time after an incident of rape, most commonly due to concerns about HIV. They may have endured a great deal of mental anguish before summoning up the courage to seek help. This can have a substantial effect on workload, especially for health advisers.
Chlamydia in a District General Hospital: An Audit of Treatment and Contact Tracing
Authors: White C , Wardropper A G
Published: October 2002

A retrospective case note audit, with reference to the recently published central audit group guidelines, was undertaken to assess females with chlamydial infection attending a district general hospital department of genitourinary medicine. Those diagnosed and referred by other agencies (mainly general practitioners (GPs)) were more often symptomatic and those treated before attending was more likely to need retreating. Contact tracing for current and recent partners was more successful than tracing previous partners. We feel that GPs and other agencies should continue to be encouraged to diagnose chlamydial infection and then to refer for immediate management, to limit re-infection/potential re-infection and the need for retreatment. Contact tracing of casual contacts and previous partners has been of limited success and poses a challenge to meet the standards of the new guidelines.
Epidemiology of Syphilis and Gonorrhoea in Eastern Poland in the Years 1988-1997
Authors: Chodynicka B , Serwin A B , Janczy/lo-Jankowska M , Waugh M A
Published: October 2002

Because of the sexually transmitted diseases (STDs) epidemic in the former Soviet Union and the possibility of a rise in early syphilis and gonorrhoea in the eastern region of Poland it seemed important to calculate the incidence rates for early syphilis and gonorrhoea for 3 border regions (east, west and south) and the central part of the country in the last 10 years. In addition, data were analysed on patients and their sexual partners (from Poland and abroad), and the country where the contact took place obtained from 14 Provincial Skin-VD Out-Patients’ Clinics of eastern Poland. The results from 1988/89 and 1996/97 were compared. It was shown that early syphilis morbidity signi® cantly decreased in western and southern Poland, fell in the central part and rose in the east slightly. Gonorrhoea morbidity signi® cantly decreased in all regions. However, the number of provinces with early syphilis and gonorrhoea incidence rates in the 1990s of the same value or higher than in the 1980s, or of the whole of Poland clearly increased in eastern and central regions. The early syphilis and gonorrhoea morbidity in east Poland in the 1990s in relation to 1980s was marked by significant increase in the percentage of the foreigners treated (12.2 vs 1.8, P≤0.001 for early syphilis, and 10.0 vs 2.3, P≤0.001 for gonorrhoea) and in sexual contacts with foreigners reported by Polish patients (23.7 vs 0.8, P≤0.01 for early syphilis and 17.7 vs 4.3, P≤0.01 for gonorrhoea). Of the foreign contacts reported in 1996/97 by early syphilis and gonorrhoea patients, 60.4% and 82.2%, respectively, were casual. Contact with foreigners took place, mainly, in the former Soviet Union. The study illustrates that there may be a danger of an increase in the incidence of syphilis and gonorrhoea in Poland due to the epidemics in the neighbouring countries.
HIV Infection among Pregnant Women in Bobo-Dioulasso, Burkina Faso: Comparison of Voluntary and Blinded Seroprevalence Estimates
Authors: Meda Nicolas , Zoundi-Guigui Marie-Therese , Van De Perre Philippe , Alary Michel , Ouangré Amadou , Cartoux Michel , Mandelbrot Laurent , Viens Pierre , Dabis François
Published: October 2002

The objective of our study was to estimate the prevalence of HIV infection among pregnant women in Bobo-Dioulasso (Burkina Faso) according to 2 survey methods. Unlinked anonymous HIV screening was performed among women attending 2 antenatal clinics. Voluntary and confidential HIV counselling and testing were offered to women attending 2 other antenatal clinics in the same time period, September-October 1996. Voluntary HIV testing was performed in the context of a clinical trial on mother-to-child transmission of HIV (ANRS 049 clinical trial) with an acceptance rate of HIV testing of 93%. The first survey recruited 200 women and the second, 424. The mean age (24.6 years vs 24.8 years) and the mean number of pregnancies (3.1 vs 3.3) of women were comparable, in the 2 studies (P=0.69 and P=0.26, respectively). Prevalence of HIV infection in the blinded survey was estimated at 10.0% (95% confidence interval (CI): 6.4–15.2), while it was 9.4% (95% CI: 6.9–12.7) in the voluntary HIV screening programme. These 2 estimates were not statistically different (P=0.82). In the voluntary screening study, the prevalence of HIV infection was significantly different between age groups 15–24 years and 25–49 years (13.9% vs 4.5%, P < 0.001). In the age group 25–49 years, the prevalence of HIV infection estimated in the blinded study and in the voluntary screening study were significantly different (10.5% vs 4.5%, P=0.04) suggesting a potential participation bias among pregnant women of older age in the voluntary, confidential HIV screening group. In conclusion, for the purpose of HIV surveillance, the most reliable method for HIV prevalence remains the unlinked, anonymous testing.
Encouraging HIV Testing in GUM Clinics—Can we Dispense with the Pre-Test Discussion?
Authors: Munday P E , Mullan H M
Published: October 2002

In a genitourinary medicine (GUM) clinic on the periphery of the London conurbation, HIV testing was promoted during a one-month period by offering testing without preliminary pre-test discussion to patients who assessed themselves to be low risk. The testing rate rose from 5.9% to 10.8% in women and 12.6% to 20% in men. One new HIV-positive patient was identified.
HIV Infection among Women Admitted to the Gynaecology Service of a District Hospital in South Africa
Authors: Wilkinson D , Wilkinson N F , Connolly C
Published: October 2002

Our objective was to determine the prevalence of HIV infection and disease-specific HIV prevalence among women admitted to the gynaecology service of a district hospital in South Africa over a 3-month period in 1997. This was done with the goal of developing HIV education and counselling services in this setting. HIV status was determined among 196 (96%) of 205 consecutive admissions; 82 (42%) tested HIV positive. The HIV-infected women were younger than the HIV uninfected women (mean age 27 vs 33 years, P = 0.001). The disease-specific HIV prevalence was ≥40% among women who had had abortions, pelvic inflammatory disease, or ectopic pregnancy. The length of hospital stay (mean 5.4 days) and mortality (1%) were similar in the 2 groups. Inpatient gynaecology services may be an important setting in Africa, within which to provide HIV education, counselling and care.
Characteristics of HIV-Infected Men with Low Serum Testosterone Levels
Authors: Kopicko J J , Momodu I , Adedokun A , Hoffman M , Clark R A , Kissinger P
Published: October 2002

Low levels of serum testosterone may have negative implications on morbidity in HIV-infected men. The purpose of this study was to determine demographic and clinical characteristics that predict low serum testosterone among men attending our HIV clinic. A cross-sectional study of 587 HIV-positive male patients who presented at the Louisiana State University HIV Outpatient (HOP) Clinic between August 1997 and January 1999 was conducted. Demographic and clinical characteristics were collected and analysed. Of the 587 men studied, 119 (20.3%) had a serum testosterone level below 400ng/dl. Significantly more men with low serum testosterone levels had a presence of opportunistic infection (especially HIV wasting syndrome, oesophageal candidiasis, or dementia), CD4+ cell counts below 200 cells/mm3, or were taking megestrol acetate. Early detection of low serum testosterone will allow for expedient testosterone supplementation therapy, which could improve morbidity and quality of life for HIV-infected men.
The relationship between educational background and decline to death in a sample of Louisiana male AIDS cases
Authors: Sorensen William , Park Hae-Seong , Corson Karen
Published: October 2002

The purpose of this study was to determine the relationship between educational level and time of decline to AIDS mortality. A total of 1578 death certificates were matched and processed with reported Louisiana male AIDS cases to assess the relation between decline to AIDS mortality with educational background, age, race, and transmission group. A 2 (race)X4 (age group)X2 (transmission group)X3 (educational background) ANOVA was performed. In addition, descriptive statistics were utilized to show patterns of the association. A significant (P<0.05) main effect of educational background on decline to death was found. However, inconsistent educational level effect on mortality was found across different subgroups regarding race and AIDS transmission group. Those with higher educational levels demonstrated least severity of decline to death. Furthermore, a significant 3-way interaction in the well-educated black intravenous drug user (IDU) population suggests a call to expand current models of counselling for this clientele.
Management of Reproductive Tract Infections in Rural Bangladesh
Authors: Ahmed Mohsin U , Mirza Tanjina , Khanum Parveen A , Khan Mehrab A , Ahmed Shameem , Khan Mobarak H
Published: October 2002

This study was undertaken to identify existing reproductive tract infection (RTI) treatment practices of the government family planning (FP) paramedics in rural Bangladesh. It also assessed the knowledge and perceptions of the clients about RTIs as well as the service-seeking behaviour of the clients and their husbands.

Data on paramedic treatment practices were collected by observing paramedic–client interactions at the family welfare centres (FWCs) and satellite clinics (SCs). One hundred clients seeking RTI treatment were observed. The same clients were interviewed at departure from the health-care facility to assess their knowledge and perceptions about RTIs as well as service-seeking behaviour of the clients and their husbands. Twenty-four village practitioners were also interviewed to assess their knowledge on the subject.

Results of the study showed that in the treatment of RTI, paramedics of government FP services commonly: (i) did not do a physical examination, (ii) used a substandard dosage of drugs, and (iii) made no attempt to notify or treat male partners. Thirty-one of the 97 clients reported that their husbands had some kind of genital problem.

It was revealed from the study that as an alternative to the government FP services, the clients and their husbands often seek RTI treatment from the village practitioners though the village practitioners’ knowledge concerning RTI is poor.

Based on the findings of this study, it is recommended that the knowledge and skills of the paramedics and village practitioners for RTI treatment be strengthened. Prevention of RTI through awareness campaigns is essential for the control of RTIs, and especially of STDs.
A Care Package for Managing Female Sexual Assault in Genitourinary Medicine
Authors: Harrison J M , Murphy S M
Published: October 2002

This paper describes the development of a designated in-house service for the management of adult female victims of sexual assault within the Department of Genitourinary Medicine (GUM) at St Mary's Hospital, London. This was set up in 1994 as a need was identified by medical, nursing, psychological and health advising staff for an appropriate streamlined service which would provide comprehensive sexual health screening, psychological support and therapy and adequate medico-legal documentation within the limitations of a busy GUM clinic. A structured package of care consisting of medical and psychological protocols with training for relevant staff and a specialist in-house referral clinic was introduced. Fifty-four patients were seen during the first 17 months of the service, the notes of 48 of these were examined and relevant epidemiological and audit data are presented here. By auditing the quality of documentation before and after the introduction of the protocols specifically looking at the appropriateness and comprehensiveness of the sexually transmitted diseases screen and the medico-legal documentation it was clear that the quality of care to these patients was improved. We present here the development of these protocols, a detailed description of the protocols themselves and the method of their implementation.
Routine Reporting or Sentinel Surveys for HIV/AIDS Surveillance in Resource-Poor Settings: Experience in South Africa, 1991-97
Authors: Stuart James M , Irlam James H , Wilkinson David
Published: October 2002

Information from routine and sentinel surveillance was used to monitor the HIV/AIDS epidemic in KwaZulu-Natal, South Africa between 1991 and 1997. Comparisons were made between data obtained from (1) sentinel surveillance for antenatal HIV infection, pulmonary tuberculosis (PTB), and AIDS in a single health district and (2) province-wide sentinel surveillance for antenatal HIV infection, legally required notification of cases of PTB, and voluntary notification of AIDS cases. HIV prevalence among antenatal clinic attenders in the sentinel district rose rapidly and at similar rates to provincial figures: 4.2% vs 4.8% in 1992 to 25.9% vs 26.9% in 1997. PTB incidence increased four-fold in the sentinel district over the study period, whereas provincial PTB figures from passive surveillance fluctuated widely and showed no clear increase (Chi-square for trend 425.5, P ≤ 0.00001). AIDS incidence in the sentinel district increased dramatically while provincial data from the voluntary reporting system showed a less consistent and much slower rise (Chi-square for trend 9.07, P=0.003). Incidence of AIDS in 1997 was estimated as 437/105 in the sentinel district compared to 32/105 in the provincial figures.

Routine disease notification and voluntary reporting systems are likely to underestimate the impact of the HIV/AIDS epidemic in resource-poor settings. Sentinel surveillance at representative sites should be developed to validate or replace passive surveillance systems.
Mucinase and sialidase activity of the vaginal microflora: implications for the pathogenesis of preterm labour
Authors: Howe L , Wiggins R , Soothill P W , Millar M R , Horner P J , Corfield A P
Published: October 2002

Evidence linking bacterial vaginosis (BV) to chorioamnionitis and spontaneous preterm birth is mounting. Successful treatment of BV could reduce the rate of late miscarriage and preterm birth. Mucinase and sialidase activity have been implicated in the pathogenesis of BV. This study extends the work of previous studies to investigate sialidase, other known mucin degrading enzymes and overall mucin degrading activity in samples of vaginal fluid from women with and without BV. Samples from 31 women were diagnosed for BV, and tested for enzyme activity using established assays. Activity was recorded in all samples. Significant increases in activity were detected in BV samples for sialidase using a mucin (BSM P<0.005) and serum type glycoprotein (AGP P<0.005) substrates, beta-galactosidase (P<0.001), and beta-N-acetylhexosaminidase (P<0.01). No significant increases in BV patients were detected in O-glycanase, proteinase, arylesterase, sulphatase or whole mucinase activities. These results support the hypothesis that certain BV-associated enzymes may detrimentally affect the mucosal barrier, permitting bacteria access to the uterus.
Alcohol use in HIV patients: what we don't know may hurt us
Authors: Petry Nancy M
Published: October 2002

Our objectives are to evaluate the prevalence of and problems associated with alcohol use disorders among HIV patients. We review the literature on alcohol use and HIV. Rates of alcohol use disorders are high among HIV patients. The cooccurrence of alcohol use disorders and HIV may lead to medical and psychiatric complications, difficulties with HIV medication compliance, and poorer treatment outcomes. Additionally, alcohol use is associated with risky sexual behaviours and intravenous drug use, the 2 major modes of HIV transmission. Recommendations for screening and treating alcohol problems in HIV patients are provided.
Inequality in the geographical distribution of general practitioners in England and Wales 1974-1995
Authors: Gravelle Hugh , Sutton Matthew
Published: October 2002

Objectives: To compare geographical inequality in the distribution of general practitioners (GPs), other resources and mortality around 1995 in England and Wales; to measure trends between 1974 and 1995 in inequality of GP distribution; to examine the implications of different need adjustments and inequality measures on the degree of geographic inequality; and to analyse the impact of policies (increased supply, area inducements and entry regulation) on inequality.

Methods: Measurement of relative inequality (decile ratio, Gini coefficient, Atkinson index) and absolute inequality (standard deviation) in the ratio of GPs to need-adjusted population in former Family Practitioner Committee/Family Health Services Authority areas each year from 1974 to 1995; and relative inequality across areas in the distributions of income, other resources and standardised mortality ratios (SMRs) around 1995. Regression of 1995 GP/population ratios on 1974 ratios. Application of equalising net advantages location model to GP distribution.

Results: Inequality in the distribution of GPs in 1995 was less than inequality in other primary care resources, but greater than inequalities in disposable income, SMRs, primary school expenditure, and hospital and community health services expenditure. The decile ratio shows little change between 1974 and 1995. Gini and Atkinson inequality indices indicate some reduction in inequality between 1974 and 1980, but little change thereafter. The standard deviation of need-adjusted provision increased over the period. Areas that had the lowest GP provision in 1974 tended to have the lowest in 1995.

Conclusions: The choice between relative and absolute inequality measures and, to a lesser extent, the method of adjusting for need affect conclusions about the trend in inequality. Both types of measure and most need adjustments suggest that the policies adopted did not lead to a reduction in inequality over the period. Interactions between policies may reduce their overall effectiveness.
Money or your life? The health - wealth trade-off in pharmaceutical regulation
Authors: Maynard Alan , Cookson Richard
Published: October 2002

For decades the development of pharmaceuticals has been regulated by safety, efficacy and quality rules for product registration. In public health care systems, these three 'hurdles' are increasingly being supplemented by a fourth: the mandatory requirement to demonstrate economic efficiency in order to obtain reimbursement. This requirement challenges the wealth creation ethic of industry (money) with the population health ethic of public health and health economics (your life). Despite practical and methodological obstacles to the use of economic evidence in decisions, the logic of this development is evident: in order to maximise improvements in population health, scarce resources must be targeted towards developing and applying technologies that deliver the greatest health gains per unit cost. The impact of this policy change on industry practice and profits will be considerable, and companies that fail to demonstrate the economic efficiency of their products will stumble at the fourth hurdle.
What makes British general practitioners take part in a quality improvement scheme?
Authors: Spooner Andrew , Chapple Alison , Roland Martin
Published: October 2002

Objectives: To understand the reasons for the apparent success of a quality improvement scheme designed to produce widespread changes in chronic disease management in primary care.

Methods: Purposeful sample of 36 primary care staff, managers and specialists. Qualitative analysis of 27 interviews in East Kent Health Authority area, where, over a three-year period, more than three-quarters of general practitioners (GPs) had enrolled in a quality improvement programme which required them to meet challenging chronic disease management targets (PRImary Care Clinical Effectiveness - PRICCE).

Results: Major changes in clinical practice appeared to have taken place as a result of participation in PRICCE. The scheme was significantly dependent on leadership from the health authority and on local professional support. Factors that motivated GPs to take part in the project included: a desire to improve patient care; financial incentives; maintenance of professional autonomy in how to reach the targets; maintenance of professional pride; and peer pressure. Good teamworking was essential to successful completion of the project and often improved as a result of taking part. The scheme included a combination of interventions known to be effective in producing professional behavioural change.

Conclusions: When managerial vision is aligned to professional values, and combined with a range of interventions known to influence professional behaviour including financial incentives, substantial changes in clinical practice can result. Lessons are drawn for future quality improvement programmes in the National Health Service.
Motives for seeking a second opinion in orthopaedic surgery
Authors: van Dalen Isabelle , Groothoff Johan , Stewart Roy , Spreeuwenberg Peter , Groenewegen Peter , van Horn Jim
Published: October 2002

Objectives: The number of second opinions in orthopaedic surgery is increasing rapidly, yet the grounds on which patients and their doctors decide to seek a second opinion have been little studied. The goal of the study was to identify patient and consultant factors that appeared to contribute to a second opinion being sought.

Methods: Two thousand and seventy-nine consecutive new patients visiting an orthopaedic surgical outpatient clinic in 1996-1997 participated in the study. Patients were self-defined as seeking a second opinion if they had visited at least one other consultant for the same condition within the previous two years. Each of these patients completed a questionnaire before seeing the orthopaedic surgeon; this included details about the physician-patient relationship, reasons for seeking a second opinion and perceived health status. The first-opinion consultants were contacted by mail; their practice characteristics and the motives for seeking a second opinion were also obtained.

Results: Thirty per cent of the study population ( n = 625) had sought a second opinion. Patients sought a second opinion because of disappointment concerning their original treatment, or because they wanted more information about their condition and/or its treatment. First-opinion consultants were usually unaware of these communication issues. Patients' inclination to initiate a second opinion was best predicted by their evaluation of their relationship with their first-opinion consultant. The propensity to initiate referrals for a second opinion varied widely among the first-opinion consultants (10-70%) and was inversely proportional to the size of the group they worked in and their distance from the referral centre.

Conclusions: Patients did not seek a second opinion because they had doubts about the competence of their treating consultant, but because they were dissatisfied about the level of communication or about the results of their treatment. Medical educators should continue to increase their efforts to improve specialists' communication and relationship skills since these seem to generate referrals for second opinions, which occupy clinic space that could be used by other patients.
Guidelines and educational outreach visits from community pharmacists to improve prescribing in general practice: a randomised controlled trial
Authors: Watson Margaret , Gunnell David , Peters Tim , Brookes Sara , Sharp Deborah
Published: October 2002

Objectives: To evaluate the effectiveness of guidelines with or without one-to-one educational outreach visits by community pharmacists in improving general practice prescribing for non-steroidal anti-inflammatory drugs (NSAIDs).

Methods: Cluster randomised trial of 20 general practices within Avon, England. Practices were randomised to three groups: control; mailed guidelines; mailed guidelines plus educational outreach visits. General practitioners (GPs) in the latter group received two one-to-one outreach visits from community pharmacists. Changes in prescribing were measured using outcomes derived from prescribing analysis and cost (PACT) data. The primary outcome measure was change in the volume of prescribing for ibuprofen, diclofenac and naproxen as a percentage of total NSAID prescribing. Six secondary outcomes included other measures of prescribing quality and volume. A cost-benefit analysis was performed.

Results: No significant differences were observed for the primary outcome measure: practices receiving outreach visits prescribed only 2.1% [95% confidence interval (CI): -0.8 to 5.0] more of the three recommended NSAIDs than the control practices did and 1.6% (95% CI: -1.4 to 4.7) more than practices that received guidelines only. Following adjustment for multiple comparisons, only one secondary outcome showed a statistically significant difference between the groups: the proportion of prescribing of the five most frequently used drugs was 2.2% (95% CI: 0.9 to 3.6) higher in the educational outreach group compared with the control group. A net increase in costs was shown with both interventions.

Conclusions: Although good prescribing at baseline in the participating practices limited the capacity for improvement, this trial provides no evidence that guidelines with or without educational outreach visits from community pharmacists lead to substantial improvements in prescribing behaviour.
Factors influencing physicians' assessment of urgency for inpatient surgery
Authors: Arnesen Kjell Erik , Erikssen Jan , Stavem Knut
Published: October 2002

Objectives: To assess to what extent patient, disease and referral characteristics influenced physicians' assessment of urgency of inpatient surgery.

Methods: In total, 452 patients, mean age 50 years, were examined in surgical or gynaecological outpatient clinics in one hospital and referred for inpatient surgery. Data were collected by the examining physician, and the patients were either given a maximal waiting time or the waiting time was not specified. A stepwise logistic regression, with urgency for surgery within four weeks or less as the dependent variable, was used. The results are presented as adjusted odds ratios (OR) with 95% confidence intervals (CI).

Results: Of 452 patients, 181 (40%) were deemed urgent (four weeks or less). In multivariate logistic regression analysis, suspected or verified malignant disease (OR 3.45, 95% CI 2.11 to 5.64), risk of serious deterioration (OR 4.53, 95% CI 2.17 to 9.46), being on sick leave from work (OR 3.97, 95% CI 1.82 to 8.64) and being assessed by a physician undergoing specialist training (OR 1.99, 95% CI 1.24 to 3.21) were significant predictors of being assessed as needing inpatient surgery urgently.

Conclusions: Physicians' judgements, in an informal way, internalize many of the public's concerns for fairness, such as the severity of a condition, the potential for improvement and aversion to inequalities in health. More research is needed to understand the difference in urgency ratings between junior and more experienced physicians.