bluuebunny/crossref_metadata_2025 huggingface dataset:
Traumatic fracture of the stapes suprastructure following minor head injury
Authors: Singh Shomeshwar , Salib Rami J. , Oates John
Published: October 2002

Abstract Traumatic fracture of the stapes occurs rarely following head injury. Ossiculardislocation is more commonly encountered. When present, stapes fractures are usually associated with an underlying temporal bone fracture. A higher incidence has been reported in childhood, possibly because of the greater flexibility of the skull in this age group. This report highlights the fact that these fractures can be associated with a relatively minor head injury. This possibility should be kept in mind when evaluating patients, especially children, who have a persistent conductive deafness of more than 30 dB with an intact tympanic membrane following any form of head injury. An exploratory tympanotomy with appropriate ossicular reconstruction, as described in this case, can yield excellent results.
Middle-ear reconstruction: a review of 150 cases
Authors: Khan Ikramullah , Jan Amir M. , Shahzad Farrukh
Published: October 2002

This study is based on a retrospective analysis of 150 cases of tympanoplasty and ossicular chain reconstruction as a one-stage procedure. It was conducted at the Federal Government Services Hospital, Islamabad from 1983 to 1999. Temporalis fascia was used for myringoplasty and a sculptured autologous incus to bridge the malleus to stapes head and malleus to footplate gap. These interpositions have produced stable ossicular assemblies and provided satisfactory post-operative hearing gains. One hundred and twenty-six (84 per cent) patients achieved a healed tympanic membrane three months post-operatively. One year post-operatively, 121 (81 per cent) patients had an intact tympanic membrane and at five years 119 (79 per cent) had an intact tympanic membrane. The success rate was based on an intact tympanic membrane and an air-bone gapof less than 30 dB one-year post-operation. Accordingly, the overall success rate was 80 per cent (120 cases). Hearing gains in cases with an absent stapes arch were poorer than in cases with an intact arch. Early (one to three months) post-operative complications included tympanic membrane perforation, lateralization of the graft and persistence of infection. Late (one to five years) complications included the appearance of an anterior perforation and retraction and thinning of the tympanic membrane.
Day to day use and service-related issues with the bone-anchored hearing aid: the Entific Medical Systems questionnaire
Authors: Dutt Sunil N. , McDermott Ann-Louise , Jelbert Anwen , Reid Andrew P. , Proops David W.
Published: October 2002

Over a 12-year period, the Birmingham implantation otology unit has implanted more than 300 patients with bone-anchored hearing aids (BAHA).

The Entific Medical Systems questionnaire was administered to these patients to evaluate the day to day use of the BAHA, professional needs, after-care, wear and tear concerns and service related issues. Data analysis revealed that most patients used their BAHA for more than eight hours a day (90 per cent of BAHA users) and every day of the week (93 per cent of BAHA users). A high degree of satisfaction was expressed as regards sound amplification, listening to radio or television news, listening to music, speech perception in quiet conditions, during conversation with one person in noisy surroundings and conversation with family at home. Some degree of difficulty was expressed with the use of the BAHA during conversation with two or more people in noisy surroundings. A slow process of perceptual acclimatization was noticed with the majority of the patients. The majority of patients were pleased with the service as regards care of the wound, BAHA nursing clinics, device repairs and other service-related issues.
A solitary huge neurofibroma of the soft palate
Authors: Sinha R. , Paul R. , Sen I. , Sikdar B.
Published: October 2002

Neurofibroma of the soft palate, an extremely rare tumour, is probably not yet reported in the literature. We report the first case of an isolated neurofibroma of the soft palate not associated with von Recklinghausen’s disease (VRD), which is also, probably, the first reported case of neurofibroma of the soft palate. The tumour was completely removed from the soft palate after performing tracheostomy, necessitated due to difficulties in intubation.
Group-A streptococcal meningitis in an adult, secondary to purulent otitis media
Authors: Cohen-Kerem Raanan , Lavon Haim
Published: October 2002

Group A streptococcal meningitis is rarely encountered today, although group A streptococcal severe infections are on the increase. We present here a case of an adult male with bacterial meningitis as a complication of otitis media induced by Group A Streptococcus. The approach to diagnosis and treatment considerations are discussed.
Masked pseudomonal skull base osteomyelitis presenting with a bilateral Xth cranial nerve palsy
Authors: Rowlands R. G. , Lekakis G. K. , Hinton A. E.
Published: October 2002

Skull base osteomyelitis classically presents as a complication of severe external otitis, middle ear, mastoid or sinus infection and can lead to multiple lower cranial nerve palsies when the jugular foramen is involved as a consequence of widespread involvement of the skull base. Bilateral skull base osteomyelitis is a recognized phenomenon, but has not previously been reported secondary to pseudomonal infection in the absence of a clinically obvious focus of infection. We report the case of a 77-year-old diabetic patient who presented with dysphonia and dysphagia and had a bilateral Xth cranial nerve palsy. No focus of infection was evident on presentation. Subsequent radiological investigation confirmed the diagnosis of bilateral skull base osteomyelitis.
Muscle-sparing approach to the peroneal nerve of the rabbit
Authors: Schmitz H. Cristina , Beer G. M.
Published: October 2002

To study nerve degeneration and regeneration the peroneal nerve of the rabbit is a rewarding experimental model. The access to the nerve should be as atraumatic as possible and no muscular tissue should be incised or transected in order to lower postoperative morbidity and enhance the welfare of the animals. Given such conditions it is not possible to expose the undistributed proximal and central parts of the peroneal nerve from the intervertebral notch to its passage through the lateral head of the gastrocnemius muscle by a single approach, but rather a two-level incision is required. Such an approach to the peroneal nerve was carried out on 24 New Zealand White rabbits. The amount of postoperative pain was estimated by the rabbits social and feeding behaviour. The observed overall impairment was impressively low. This approach has been shown to be beneficial for the animals, and is atraumatic and should be strongly recommended.
Psammomys obesus and the albino rat-two different models of nutritional insulin resistance, representing two different types of human populations
Authors: Kalman R. , Ziv E. , Shafrir E. , Bar-On H. , Perez R.
Published: October 2002

Animal models for insulin resistance and type 2 diabetes are required for the study of the mechanism of these phenomena and for a better understanding of diabetes complications in human populations. Type 2 diabetes is a syndrome that affects 5-10% of the adult population. Hyperinsulinaemia, hypertriglyceridaemia, decreased high-density lipoprotein (HDL) cholesterol levels, obesity and hypertension, all form a cluster of risk factors that increase the risk of coronary artery disease, and are known as insulin resistance syndrome or syndrome X. The gerbil, Psammomys obesus is characterized by primary insulin resistance and is a well-defined model for dietary induced type 2 diabetes. Weanling Psammomys and Albino rats were held individually for several weeks on high energy (HE) and low energy (LE) diets in order to determine the development of metabolic changes leading to diabetes. Feeding Psammomys on HE diet resulted in hyperglycaemia (303 ± 40 mg/dl), hyperinsulinaemia (194 ± 31 µU/ml) and a moderate elevation in body weight, obesity and plasma triglycerides. Albino rats on HE diet demonstrated an elevation in plasma insulin (30 ± 4 µU/ml), hypertriglyceridaemia (170 µ 11 mg/dl), an elevation in body weight and obesity, but maintained normoglycaemia (98 µ 6 mg/dl). Psammomys represent a model that is similar to human populations, with primary insulin resistance expressed in young age, which leads to a high percentage of adult type 2 diabetes. Examples for such populations are the Pima Indians, Australian Aborigines and many other Third World populations. The results indicate that the metabolism of Psammomys is well adapted towards life in a low energy environment, where Psammomys takes advantage of its capacity for a constant accumulation of adipose tissue that will serve for maintenance and breeding in periods of scarcity. This metabolism known as 'thrifty metabolism', is compromised at a high nutrient intake.
Airborne contaminants in conventional laboratory rabbit rooms
Authors: Kaliste E. , Linnainmaa M. , Meklin T. , Nevalainen A.
Published: October 2002

Besides the well known allergens, several other risk factors may exist for health in a laboratory animal unit. The exposure to these factors may be significant in animal units with poor general or local ventilation systems. Moreover, means to prevent the distribution of airborne contaminants may be limited in animal units housing rabbits or other bigger laboratory animals. Airborne contaminants in conventional laboratory rabbit rooms were sought to evaluate the occupational exposure of animal care personnel. Concentrations of airborne dust, bacteria, fungi, ammonia and endotoxins were measured during 2 days in three phases: before working activities began, during them and afterwards. Both stationary and some personal samples were taken. All of the contaminants sought were found in the rabbit room air. When compared to reported levels in farm animal production areas, the concentrations measured were generally low. However, moderate or high levels of airborne bacteria and fungi were found occasionally during work routines. Airborne contaminants should be considered as a potential occupational health risk for persons working with laboratory animals.
Endocrine stress response in jugular-vein cannulated rats upon multiple exposure to either diethyl-ether, halothane/O2/N2O or sham anaesthesia
Authors: de Haan M. , van Herck H. , Tolboom J. B. T. M. , Beynen A. C. , Remie R.
Published: October 2002

The main objective of this study was to assess the endocrine stress response to multiple anaesthesia followed by sham anaesthesia in order to detect any memory effects. For this purpose, jugular-vein cannulated rats were subjected to either sham, diethyl-ether or halothane/O2/N2O anaesthesia, and their plasma ACTH, corticosterone, glucose, adrenaline and noradrenaline levels measured. The study had three separate experiments, each consisting of a control and treatment group. In two experiments, the rats were exposed to high or low concentrations (40-15%) of diethyl ether, using either a jar containing cotton soaked in diethyl ether or a vaporizer. In the third experiment, rats were exposed to halothane/O2/N2O. Control animals underwent sham anaesthesia. Blood samples were taken 6 min before and at 5, 15 and 55 min after starting the exposure ( t = 0 min). For each variable, the dt5 (level at t = 5 min minus that at t = -6 min) and the cumulative levels over the one-hour period as determined by the area under the curve (AUC) were calculated. Further, the peak levels (Cmax) were determined. The mean time needed to induce anaesthesia was 68, 121 and 55 s for exposure to high and low concentrations of diethyl ether and to halothane/O2/N2O, respectively. Increased noradrenaline and adrenaline dt5 levels were observed only after the first exposure to the high concentration of diethyl ether. Multiple anaesthesia sessions using either diethyl ether or halothane/O2/N2O did not clearly influence adrenaline and noradrenaline levels. Diethyl ether induced a sharp rise in plasma ACTH and glucose levels, irrespective of the concentration used. The response of the ACTH and glucose was similar for single and multiple exposure. An increased response of ACTH, corticosterone and glucose to sham anaesthesia following multiple induction of anaesthesia was observed for the high concentration of diethyl ether only. Halothane/O2/N2O raised plasma glucose without differences between single and multiple anaesthesia sessions. Upon sham anaesthesia following multiple exposures to halothane/O2/N2O, glucose levels were significantly increased. This study indicates that repeated anaesthesia in rats can elicit an increased stress response during subsequent handling and change of environment.
Intravenous tolerability of an acid vehicle in Sprague Dawley rats and beagle dogs after daily slow bolus injection and infusion for one hour during 14 days
Authors: Ploemen Jan-Peter H. T. M. , van Esch Eric , Oshodi Rotimi , de Hoog Saskia C. M. , Frieling Wilbert J. A. M. , Kaijser Gerry
Published: October 2002

To assess the tolerability of an acid vehicle to be used in toxicology studies, a low pH aqueous solution containing 16.4 mg/ml of citric acid, 4.2 mg/ml of disodium phosphate, 25 mg/ml of mannitol, adjusted with phosphoric acid/NaOH 1 M to pH 3 was daily administered intravenously to rats and dogs for 14 consecutive days. The dosing regimen consisted of a slow intravenous bolus injection given over 30 s (0.75 and 0.625 ml/kg, for rats and dogs, respectively) followed by intravenous infusion for one hour (3.75 and 2.75 ml/kg/h, for rats and dogs, respectively). In rats, the dose was administered via the lateral tail vein. In dogs, the intravenous bolus dose was administered via the vena cephalica, vena saphena or vena jugularis, whilst the infusion dose was given into the vena cephalica or vena saphena. In rats, administration of the vehicle was associated with clinical signs (occasional mild vocalization and agitation) which were considered to be due to local irritation during the dosing procedure. Nevertheless, only mild histopathological changes at the injection site were found, while no relevant clinical chemistry changes were found in this species. However, the vehicle caused significant vascular damage with thrombus formation in the dog. It is therefore concluded that this vehicle is suitable for 2-week rat toxicity studies, if carefully applied. The vehicle with its present regimen should not be used in dogs, in view of the prohibitive findings.
Serum α2-macroglobulin and cytokine measurements in an acute inflammation model in rats
Authors: Jinbo T. , Sakamoto T. , Yamamoto S.
Published: October 2002

An enzyme-linked immunosorbent assay (ELISA) for rat α2-macroglobulin (α2M) using a monoclonal antibody was developed, and used to measure α2M in sera from rats injected intramuscularly with turpentine oil as an inflammatory agent. The mean concentration of α2M gradually increased and peaked 2 days after the turpentine oil injection. The peak α2M concentration ranged from 2362–8472 µg/ml (mean 4531 µg/ml), which was 50–290 times higher than the pre-dosing levels of 23–61 µg/ml. In addition, interleukins (IL)-1, IL-2, IL-4, IL-6, IL-8, IL-10, and interferon (IFN)-γ were measured using commercial ELISA reagent kits. IL-6 and IL-8 increased and peaked 12 h after turpentine oil injection, the levels being 5–51 times and 2–38 times the pre-dosing ones, respectively. The concentrations of IL-1, IL-2, IL-4, IL-10 and IFN-γ in rats injected with turpentine oil did not change.
Human–animal interactions and animal welfare in conventionally and pen-housed rats
Authors: Augustsson H. , Lindberg L. , Höglund A. U. , Dahlborn K.
Published: October 2002

The main aim of the present study was to explore the significance of large group/greater pen housing (PH) versus standard Makrolon caging (ST) in three behaviour tests related to human-animal interactions in the adult male laboratory rat. The rats' perception of human interaction was tested in three behavioural tests, of which two reflected common practical procedures, capture and restraint, whereas the third was a human approach test in a Y-maze. The rats' anticipatory reactions to handling and the reactions to restraint did not differ between groups, but the ST rats approached a human hand more quickly than did the PH rats ( P < 0.01). Although food intake did not differ, ST rats gained more weight ( P < 0.01) and had higher total cholesterol values ( P < 0.01) than PH rats. In conclusion, this study shows that housing rats in large groups in an enriched environment did not influence their anticipatory reaction to handling in normal handling situations. However, as the PH rats tended to have a longer approach latency than ST rats in the Y-maze there might be underlying differences in appraisal that are not detected in practical situations. In addition, the PH rats weighed less and had lower total cholesterol values than ST rats and their urine corticosterone values were higher. These effects are suggested to be due to higher physical activity in the PH rats, and the implications of this on the animal as a model is discussed.
Murine models of chronic Pseudomonas aeruginosa lung infection
Authors: van Heeckeren A. M. , Schluchter M. D.
Published: October 2002

The animal model of chronic bronchopulmonary infection using agarose beads laden with Pseudomonas aeruginosa is frequently utilized in cystic fibrosis research, though it is challenging to perform it in mice. This paper reports the most successful methods for the creation of this model. Transtracheal insertion of a 22 G 1" over-the-needle intravenous catheter to preferentially inoculate the right mainstem bronchus using tribromoethanol anaesthesia administered i.p. was better for a successful surgical outcome compared, respectively, to the use of a 27 G ½" needle, bilateral inoculation or an anaesthetic cocktail of xylazine, acepromazine and ketamine administered i.p. Bilateral infection was associated with higher mortality, greater weight loss and higher levels of bronchoalveolar cytokine concentration, compared to mice infected primarily in the right lung. Mucoid clinical strain PA M57-15 was preferred since mucoid clinical strain PA 2192 led to comparatively more severe lesions and higher mortality. Using the same operator for a given task reduced the variability inherent in this model, illustrated using outcome measures such as gross lung pathology. The response of mice inoculated with P. aeruginosa-laden agarose beads was characterized by bronchopulmonary inflammation, high production of cytokines, and significant weight loss; whereas the response to infection with free-living bacteria was characterized by pneumonia, lower production of cytokines and weight loss. The use of free P. aeruginosa pre-mixed with sterile agarose beads may be considered as an alternative to the use of P. aeruginosa-laden agarose beads, since the histopathological features were similar, though further characterization is needed to evaluate its utility as an adequate model of cystic fibrosis.
Ward managers' attitudes towards external consultants in Ashworth, a special hospital, 1992-1994
Authors: Richman Joel , Mercer Dave
Published: October 2002

This case study elaborates the aftermath of the Blom-Cooper Inquiry (1992), which forced the special hospital, Ashworth, into a radical 'culture change'. To this end, two groups of external consultants - a management consultancy and a professional task force - were introduced into the hospital. Newly established ward managers were to spearhead the organizational change by bringing social and clinical order to the wards over which the higher management had lost control. Few studies have mapped out the interaction between segments of an organization and expert outsiders. In this study, the interaction of the ward manager to the newly appointed external management consultancy and task force was analysed. It was clear that ward managers rated poorly the efforts of the management consultancy and task force - it was considered that they were not giving value for money. The task force rated slightly more favourably than the management consultancy. The fact that the management consultancy did not have ward credibility in this closed forensic setting was attributed to low prestige. The management consultancy also failed to fulfil the organizational ambitions of ward managers, who wished to be central to the hospital's major decision-making process.
Implementing clinical information systems: a multiple-case study within a US hospital
Authors: Paré Guy
Published: October 2002

The rapid movement of information technologies into health care organizations has raised managerial concern regarding the capability of today's institutions to satisfactorily manage their introduction. Indeed, several health care institutions have consumed huge amounts of money and frustrated countless people in wasted information systems implementation efforts. Unfortunately, there are no easy answers as to why so many health informatics projects are not more successful. The aim of this study is to provide a deeper understanding of clinical information systems implementation. The research reported in this paper focuses on building a theory of the dynamic nature of the implementation process, that is, the how and why of what happened. The general approach taken was inspired by the work of Eisenhardt (1989) on building theories from case study research. We examined the implementation process, use and consequences of three distinct clinical information systems at a large tertiary care teaching hospital. A series of four research propositions reflecting the dynamic nature of the implementation process are offered as each of the three cases are analyzed. Findings add a number of new perspectives and empirical insights to the existing body of knowledge in the fields of IT implementation and medical informatics.
The NHS Plan: nurse satisfaction, commitment and retention strategies
Authors: Newman K. , Maylor U.
Published: October 2002

The NHS Plan envisages a paradigm shift from a centralized, producer-led National Health Service (NHS) to a devolved, patient-centred health care service, fuelled by a substantial investment in human resources, beds, hospitals and infrastructure. The planned net increase of 20 000 nurses by 2004 is examined in the light of findings from a qualitative study of nurse satisfaction, commitment or intention to leave their hospital, nursing or the NHS, involving 124 nurses in four London hospitals. This paper presents nurses' perceptions and rankings of retention strategies and we compare these with the Plan's proposals. Lastly we propose an integrated approach to examining and dealing with the complex issue of nurse recruitment, retention and quality of patient care, based on a conceptual framework, the Nurse Satisfaction, Service Quality and Nurse Retention Chain, which highlights the scope of the challenges confronting the Plan, in both design and implementation of proposals designed to improve working conditions as a foundation for nurse recruitment and retention. Our principal findings are that just 57% of our interviewees may be viewed as 'core loyals' to the profession, 12% are serious in their intention to leave and the remainder may be sensitive to further deterioration in working conditions or a failure to meet expectations on pay. Such findings if realized clearly threaten the Plan's success.
Meeting patient expectations: healthcare professionals and service re-engineering
Authors: Laing Angus
Published: October 2002

A central theme underpinning the reform of healthcare systems in western economies since the 1980s has been the emphasis on reorienting service provision around the patient. Healthcare organizations have been forced to re-appraise the design of the service delivery process, specifically the service encounter, to take account of these changing patient expectations. This reorientation of healthcare services around the patient has fundamental implications for healthcare professionals, specifically challenging the dominance of service professionals in the design and delivery of health services. Utilizing a qualitative methodological framework, this paper explores the responses of healthcare professionals to service redesign initiatives implemented in acute NHS hospitals in Scotland and considers the implications of such professional responses for the development of patient-focused service delivery. Within this, it specifically examines evolving professional perspectives on the place of a service user focus in a publicly funded healthcare system, professional attitudes towards private sector managerial practices, and the dynamics of changing professional behaviour.
Duration of heart disease visits by elderly patients: productivity versus quality
Authors: Rohrer J. E. , Xu K. T. , Bickley L.
Published: October 2002

A balance should be reached between physician productivity and clinical quality, since the first comes at the expense of the second. The study described here used the National Ambulatory Medical Care Survey (NAMCS) to demonstrate that visit length for elderly heart disease patients is related to both appropriate (i.e. clinical) patient differences and to less justifiable factors. Both demand management and managerial control strategies should be considered.
Going underground and going after women: trends in sexual risk behaviour among gold miners in South Africa
Authors: Meekers Dominique
Published: October 2002

This paper examines trends in risk behaviour among South African gold miners, a population with an estimated HIV prevalence of 10-20%. The study is based on a 1995 and 1997 survey of a random sample gold miners in the town of Welkom, South Africa. The results show that the percentage of miners who perceived they were likely to contract HIV increased from 33% in 1995 to 35% in 1997 (P < 0.01). The percentage who had 4 or more partners in the past year decreased from 25% to 13% (P < 0.01), and the percentage whose last sexual partner was their spouse increased from 56% to 70% (P < 0.01). Condom use in last intercourse with a spouse increased from 18% to 26% (P < 0.05). Condom use with other partners was considerably higher (67%), but did not increase significantly from 1995. The most likely contributors to this behaviour change were the AIDS awareness programmes implemented by the mining industry and the behaviour change communications of a condom social marketing campaign targeted at miners and commercial sex workers in the mining community.
Chlamydia trachomatis PCR (Cobas Amplicor) in women: endocervical specimen transported in a specimen of urine versus endocervical and urethral specimens in 2-SP medium versus urine specimen only
Authors: Airell Å , Ottosson L , Bygdeman S M , Carlberg H , Lidbrink P , Rudén A -K , Elfgren K
Published: October 2002

The sensitivity of Roche Cobas Amplicor Chlamydia trachomatis polymerase chain reaction (PCR) including the internal control (IC) programme to identify inhibition, was investigated on 3 different samples from women: (1) swab samples from the urethra and the cervix pooled in 2-SP transport medium, (2) swab sample from the cervix transported in a urine sample from the same patient, and (3) urine sample alone. Out of the 2412 patients, 193 (8.0%) were chlamydia positive and in 14 of these the results showed discrepancies between sampling methods. The sensitivity of PCR on urethra/cervix, urine/cervix and urine was 98.4% (190/193), 97.9% (189/193) and 93.3% (180/193) respectively. The higher sensitivity of PCR on urethra/cervix and urine/cervix as compared with urine alone was statistically significant. Without the IC, the sensitivity of PCR on urethra/ cervix, urine/cervix and urine would have been 95.9% (185/193), 94.8% (183/193) and 90.7% (175/193) respectively. Factors influencing the rate of inhibition were also studied.
Using a national guideline: an audit of the management of gonorrhoea in Newcastle upon Tyne
Authors: Watson P G
Published: October 2002

The management of cases of gonorrhoea in the Genitourinary Medicine Department (GUM) of Newcastle upon Tyne in 1999 was audited. The sensitivity of microscopy in diagnosis was 90.4% for male urethral gonorrhoea and 26.6% for female genital gonorrhoea. The sensitivity of laboratory culture was 98.5%. Screening for Chlamydia trachomatis co-infection or treating for presumed coinfection was done in 98% of cases of gonorrhoea and the rates of co-infection were 36.4% in women and 8% in men. Effective first-line therapy was given to 95.4% of cases of genital gonorrhoea. Re-attendance for tests of cure within one month of treatment was achieved in 68.2%. Discussion of partner notification was documented in 94.3% of cases of genital gonorrhoea. In 65% of cases of gonorrhoea, there was documented attendance of sexual partners. The value of a national guideline with auditable targets is discussed.
Behavioural surveillance of sexually-related risk behaviours for the cross-border traveller population in Hong Kong: the evaluation of the overall effectiveness of relevant prevention programmes by comparing the results of two surveillance surveys
Authors: Lau Joseph T F , Wong Wing S
Published: October 2002

The present study reports the results of 2 surveys of the first behavioural surveillance system (BSS) set up to monitor sexually-related risk behaviours practised by Hong Kong-China cross-border travellers. The 2 studies interviewed 1263 and 1448 male adult Hong Kong residents in 1997 and 1998 respectively. About one-third of the respondents had had sexual intercourse with a commercial sex worker (CSW) in the past 6 months; about 20% had had sexual intercourse with a CSW or a non-regular sex partner in a single trip; about 35-40% of the CSW clients had not used a condom during the intercourse and about 20% of the respondents reported that they had contracted STD. When the results of the 2 surveys were compared, no significant changes in the outcomes of the surveillance indicators were detected; instead, some unfavourable changes in terms of condom use were observed. The effectiveness of the relevant prevention programmes in Hong Kong is not evident.
Herpes simplex virus type 2 in prisoners, New South Wales, Australia
Authors: Butler T , Donovan B , Taylor J , Cunningham A L , Mindel A , Levy M , Kaldor J
Published: October 2002

Our objectives were to determine the prevalence of, and risk factors for, herpes simplex virus type 2 (HSV-2) antibodies in male and female prisoners. A cross-sectional random sample was used consisting of 789 prisoners (657 males and 132 females) from 27 correctional centres across New South Wales (NSW), stratified by sex, age and Aboriginality. Participants were questioned about demographics and behavioural risk factors and were screened for serum antibody to HSV-2. The overall prevalence of HSV-2 antibodies was higher in females (58%) than males (21%), and in Aborigines (34%) compared with non-Aborigines (24%). HSV-2 prevalence increased with the number of sexual partners. Few prisoners (1%) reported a previous diagnosis of genital herpes. Independent risk factors for the presence of HSV-2 antibodies were increasing age and Aboriginality for men, and higher reported number of lifetime sexual partners and the presence of hepatitis C antibodies for women. HSV-2 infection is common in prison inmates. There is a need to incorporate information about STDs, including HSV-2, into education programmes for inmates.
Epidemiology of syphilis in Bulgaria, 1990–1998
Authors: Dencheva R , Spirov G , Gilina K , Niagolova D , Pehlivanov G , Tsankov N
Published: October 2002

There have been great political, social and economic changes in Bulgaria since 1990 with higher incidences of syphilis when compared with the previously controlled morbidity of syphilis. There has been a 7-fold increase in 1998 compared with 1990. The male/female ratio remained the same 1.2:1. A higher number of cases was reported in cities than in villages and small towns, 80.68% in 1990; 73.4% in 1998. The number of employed patients with syphilis has decreased during the years - from 75.5% in 1990 to 44% in 1998, with a corresponding increase in syphilis in the unemployed. The age group at highest risk is 20-24 years, 28.7% in 1991; 24% in 1998. The least affected group are those older than 55 - the incidence being 6.34% in 1990; 2.6% in 1997 and 4% in 1998. The prevalence of the different stages of early infection remained the same. The incidence of congenital syphilis increased from 1 in 1990 and 1991 to 21 in 1996, 29 in 1997 and 35 in 1998.
High prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium in female commercial sex workers in Japan
Authors: Tsunoe Hiroaki , Tanaka Masatoshi , Nakayama Hiroshi , Sano Masatoshi , Nakamura Genichi , Shin Takeshi , Kanayama Akiko , Kobayashi Intetsu , Mochida Osamu , Kumazawa Joichi , Naito Seiji
Published: October 2002

Our objectives were to explore the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium in Japanese female commercial sex workers (CSWs), in comparison with pregnant women as controls. A high-risk group of 174 female CSWs and 90 asymptomatic pregnant women were enrolled in this study. Detection of C. trachomatis, N. gonorrhoeae, and M. genitalium on the endocervix of the women was performed mainly by using polymerase chain reaction (PCR)-based assays. The prevalence rates of C. trachomatis, N. gonorrhoeae, and M. genitalium were 19.0%, 32.8%, and 12.6%, respectively, in the CSWs, compared with 5.6%, 0%, and 1.1% respectively, in the pregnant women. These results suggest a high prevalence of C. trachomatis , N. gonorrhoeae, and M. genitalium in Japanese CSWs. We conclude that continued close monitoring of the prevalence of C. trachomatis, N. gonorrhoeae, and M. genitalium infection in CSWs is important for preventing the dissemination of these microorganisms, and that further investigation of M. genitalium as a sexually transmitted pathogen in women is needed.
Factors associated with female condom use among HIV-seropositive women
Authors: Kalichman Seth C , Rompa David , Cage Marjorie
Published: October 2002

Female condoms are an effective option for preventing sexually transmitted diseases (STDs), including HIV transmission. Little is known, however, about female condom use in women living with HIV/AIDS. Ninety HIV-positive women completed measures of demographic characteristics, exposure and use of female condoms, attitudes toward female and male condoms, sexual behaviours, and substance use. Most women (77%) had been exposed to female condoms, however only 30% reported lifetime use, 16% reported recent use, and only 6% of the sample used female condoms as much or more than they used male condoms. The only factors consistently associated with female condom use were positive attitudes toward female condoms. Women who recently used female condoms were also more likely to have multiple male sex partners and reported fewer unprotected intercourse occasions. Female condoms are therefore used by a small number of HIV-infected women, particularly those with more than one male sex partner. Female condom use may be enhanced by removing barriers to their use, increasing cooperation of male partners, and enhancing proficiency of use.
An acceptability study of female-controlled methods of protection against HIV and STDs in south-western Uganda
Authors: Pool R , Whitworth J A G , Green G , Mbonye A K , Harrison S , Wilkinson J , Hart G J
Published: October 2002

We aimed to assess the acceptability of a variety of formulations of female-controlled methods of protection against HIV and STDs among men and women in south-western Uganda. Pilot interviews were carried out with 50 men and 55 women and 25 focus group discussions (FGDs) were held with 138 women and 42 men. The female condom, foaming tablets, sponge, foam, gel and film were demonstrated to 146 women and 35 of their male partners, who then tried out 2 of the products. They were interviewed 7 times during the course of 5 months. At the end experiences were evaluated during a second series of FGDs. Sixty-five (45%) women completed the trial. The main reasons for non-completion were related to geographical mobility. Product preference after the initial demonstration was similar to that at the end of the trial. The most popular formulations were the sponge (25% of the women), foaming tablets (23%), and the female condom (19%). The foam was of medium popularity (16%). The gel (9%) and film (7%) were least popular. Ten per cent of the women and 14% of the men reported products interfering with sexual enjoyment; 24% of the women and 67% of the men said products increased enjoyment. 'Dry sex' is not popular in this area and increased lubrication was an important determinant of acceptability. Age, level of education and location did have some effect on preference. Although secrecy was a dominant theme in the FGDs, 87% of the women had informed their partners by the end of the trial. The products were generally well received. Female control was an important issue for both sexes. Male attitudes were ambivalent because female ownership of products increased women's control. Although they have clear preferences, women appear to accept the products generally and might use a single available product just as readily if choice was limited, as long as it conforms to general cultural preferences, such as those relating to wet/dry sex.
Skrljevo disease-two centuries of history
Authors: Gruber F
Published: October 2002

Skrljevo disease, also called Rijeka (Fiume) or Grobnik disease, by some physicians was first identified in the village of Skrljevo in Croatia in 1790. From texts dating back to the beginning of the 19th century it is clear that it was a nonvenereal (endemic) form of syphilis and represented a great calamity for the local people and a problem for the physicians. The disease was considered by some to be lepra, scurvy, scabies or others. The occurrence of the disease in the region around Rijeka was closely associated with the poor socioeconomic conditions present at that time in the region. It is interesting to note that many of the greatest physicians of the time such as Alibert, Frank, Hebra, Sigmund were acquainted with the disease and dealt with it in their writings. This paper gives a brief chronology of the major political events in the region since that time, underlying the measures used in fighting the disease.
Marriage, monogamy and HIV: a profile of HIV-infected women in south India
Authors: Newmann S , Sarin P , Kumarasamy N , Amalraj E , Rogers M , Madhivanan P , Flanigan T , Cu-Uvin S , McGarvey S , Mayer K , Solomon S
Published: October 2002

A retrospective study was conducted on 134 HIV-infected females evaluated at an HIV/AIDS centre in south India to characterize their socio-demographics, HIV risk factors and initial clinical presentations. The mean age was 29 years; 81% were housewives; 95% were currently or previously married; 89% reported heterosexual sex as their only HIV risk factor; and 88% reported a history of monogamy. The majority were of reproductive age, thus the potential for vertical transmission of HIV and devastating impacts on families is alarming. Nearly half of these women initially presented asymptomatically implying that partner recruitment can enable early HIV detection. Single partner heterosexual sex with their husband was the only HIV risk factor for the majority of women. HIV prevention and intervention strategies need to focus on married, monogamous Indian women whose self-perception of HIV risk may be low, but whose risk is inextricably linked to the behaviour of their husbands.
Factors influencing delay in treatment seeking by first-time attenders at a genitourinary clinic
Authors: Pitts M K , Woolliscroft J , Cannon S , Johnson I , Singh G
Published: October 2002

We examined treatment-seeking behaviours amongst a consecutive sample of 188 first-time attenders at a busy genitourinary (GU) clinic in a general hospital. Participants were interviewed and completed a battery of questionnaires prior to receiving diagnosis or treatment. Delay in treatment seeking was measured in 3 ways: utilization delay, illness behaviour delay and appraisal delay. Appraisal delay and illness behaviour were significantly related, but were unrelated to utilization delay. Substantial delays were reported before seeking treatment, with a median of 30 days elapsing between first noticing symptoms and attending the clinic. Analysis of age groups indicated that the oldest groups - 45 and above were likely to delay longest, on all 3 measures of delay.
Sexual behaviour and infection rates for HIV, blood-borne and sexually transmitted infections among patients attending drug treatment centres in Rio de Janeiro, Brazil
Authors: Bastos F I , Lowndes C M , Derrico M , Castello-Branco L R , Linhares-De-Carvalho M I , Oelemann W
Published: October 2002

A survey was carried out in 2 drug use treatment centres (TCs) in Rio de Janeiro, Brazil, to assess risk behaviours, HIV infection and other sexually transmitted infections/blood-borne infections (STIs/BBIs). Two hundred and twenty-five drug users (195 males and 30 females) were interviewed and clinically examined, and their blood and urine were tested for STIs/BBIs. Prevalences (%) for these infections were as follows - HIV: 0.9, hepatitis B virus (HBV): 14.7, hepatitis C virus (HCV): 5.8, syphilis: 5.3, gonorrhoea/chlamydia (CT/NG): 4.7. In bivariate analyses CT/NG infection was associated with younger age ( P =0.003); current genitourinary symptoms (odds ratio [OR]=6.2) and a mainly illegal source of income (OR= 9.1). Hepatitis C infection was associated with a history of ever having injected any drug (OR=19.6), and with each one of the injected drugs. After multiple logistic regression, lower educational level (adjusted odds ratio [AOR]=3.70) and 'ever having injected drugs' (AOR=3.69) remained as independent risk factors for hepatitis B infection. In conclusion, TCs must implement programmes directed towards the prevention of STIs/BBIs.
Serum lipid levels associated with increased risk for cardiovascular disease is associated with highly active antiretroviral therapy (HAART) in HIV-1 infection
Authors: Koppel Kristina , Bratt Göran , Eriksson Mats , Sandström Eric
Published: October 2002

The long-term effects of fat metabolism, storage and utilization in HIV-1 infected patients on highly active antiretroviral therapy (HAART) including a protease inhibitor are profound and cause increasing concern. The main importance of these lipid/metabolic disorders lies in their assumed contribution to an increased risk of coronary heart disease (CHD). In the general population increased levels of lipoprotein(a) [Lp(a)] constitute an independent risk factor for CHD by itself as well as in combination with increased levels of cholesterol and low density lipoprotein (LDL)-cholesterol, respectively.

Two hundred and fifty-six patients with 27 ± 7 months HAART and 84 treatment-naive HIV-1 positive patients were screened for cardiovascular risk factors. The subjective perception of fat wasting and/or accumulation in different sites of the body, which was possible to evaluate in 235 patients on HAART and 73 treatment-naive patients, the levels of plasma triglycerides (TG), cholesterol, LDL and high-density lipoproteins (HDL)-cholesterol, LDL/HDL ratio and Lp(a) were measured.

Of the patients on HAART, 42% (98/235) reported abnormal fat distribution as compared with 4% (3/73) of the treatment-naive patients (P < 0.0001). The levels of TG, cholesterol and LDL-cholesterol, but not HDL-cholesterol or Lp(a) were higher (P < 0.0001) in the HAART group as compared with the naive group. Very high Lp(a) levels (>700 mg/l) were more common among HAART patients as compared with naive, 14% (36/256) vs 2% (2/83); P = 0.0022. The Lp(a) levels correlated to the levels of LDL-cholesterol, but not to total cholesterol, HDL-cholesterol or TG, and did not differ between patients with and without subjective perception of abnormal fat distribution.

A significant number of the HAART patients had very high levels of Lp(a) and various combinations of increased lipid values associated with considerably increased risk for CHD. The elevation of Lp(a) did not relate to any other clinical or laboratory parameter than to LDL-cholesterol.
Adenovirus and non-gonococcal urethritis
Authors: Azariah S , Reid M
Published: October 2002

Non-gonococcal urethritis (NGU) is a common problem presenting to sexual health clinics that is usually managed empirically. In many cases the aetiology is never clearly established or further investigated. Adenovirus has been identified in the past as an occasional cause of NGU but little has been written about its clinical presentation. We present a case report of 6 men who were diagnosed with NGU caused by adenovirus infection, along with a review of the relevant literature, with the aim of improving clinical recognition of this pathogen.
Late presentation of HIV infection associated with prolonged survival following AIDS diagnosis—characteristics of individuals
Authors: Hocking Jane S , Rodger Alison J , Rhodes Dennis G , Crofts Nick
Published: October 2002

Individuals who present late with human immunodeficiency virus (HIV) infection do not benefit from advances in drug therapies that delay their progression to acquired immunodeficiency syndrome (AIDS). This paper describes these individuals and their subsequent survival and investigates predictors of late presentation. All AIDS diagnoses from 1992-1998 notified to the Victorian State AIDS Registry were included. Subjects were grouped as individuals diagnosed with AIDS within 8 weeks of a first positive HIV test (late presenters), or individuals for whom there was more than 8 weeks between AIDS diagnosis and first positive HIV test (non-late presenters). Of 1021 AIDS diagnoses notified, 24% were late presenters. Late presentation was associated with increasing age, being bisexual or heterosexual, being born in Asia, southern Europe or South America and being diagnosed at a hospital. Late presenters survived longer following AIDS diagnosis (P <0.0001). This increased survival may indicate a positive response by drug naïve patients to antiretroviral therapies following AIDS diagnosis.
Genital mycoplasmas among pregnant women in Côte d'Ivoire, West Africa: prevalence and risk factors
Authors: Faye-Ketté H , La Ruche G , Ali-Napo L , Dosso M , Messou N , Viho I , Msellati P
Published: October 2002

A cross-sectional study was conducted among pregnant women in Côte d'Ivoire to assess the prevalence and the factors associated with mycoplasma colonization. A positive culture was found in 400 of 551 women (73%); Ureaplasma urealyticum was identified in 22%, Mycoplasma hominis in 20% and both microorganisms in 31%. Mycoplasma colonization was not associated with genital symptoms or signs. Young age, low educational level, antimicrobial chemotherapy before consultation and presence of bacterial vaginosis were factors independently associated with M. hominis colonization. Among women colonized with M. hominis, HIV seroprevalence was 21% in women with high amounts of M. hominis (≥104 colour-changing units per ml) versus 7% in women with lower amounts ( P =0.01). U. urealyticum was found more often in unmarried women and when pregnancy was less than 20 weeks. Mycoplasma colonization is frequent among pregnant women in Abidjan, but their pathogenicity requires further study.