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Peer Reviewed

Title: Presentation and survival of patients with AIDS-related Kaposi's sarcoma in Jos, Nigeria.
Author: Agaba PA; Sule HM; Ojoh RO; Hassan Z; Apena L; Mu'azu MA; Badung B; Agbaji OO; Idoko JA; Kanki P
Source: International Journal of STD and AIDS. 2009 Jun;20(6):410-3.
Abstract: AIDS-related Kaposi's sarcoma (AIDS-KS) remains a significant cause of morbidity and mortality. We describe the pattern of presentation and survival in Jos, Nigeria. We identified 48 HIV-positive patients with AIDS-KS and matched them for age and sex with an equal number of HIV-positive patients without AIDS-KS. We compared their clinical, immunological, virological characteristics and survival. They were similar in age and body mass index profile but patients with AIDS-KS had more tuberculosis co-infection (P, 0.02), lower median CD4 count (P, 0.003) and higher mortality (P, 0.002). Surprisingly, patients with AIDS-KS had lower levels of median viral load (29,347 copies/mL) compared with controls (80,533 copies/mL). We recommend specific AIDS-KS therapy in addition to highly active antiretroviral therapy in order to improve survival.
Language: English
Keywords:
NIGERIA | RESEARCH REPORT | PERSONS LIVING WITH HIV/AIDS | AIDS | SIGNS AND SYMPTOMS | ANTIRETROVIRAL THERAPY | LIFE EXPECTANCY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | HIV Infections | Viral Diseases | Diseases | HIV | Length of Life | Mortality | Population Dynamics | Demographic Factors | Population
Document Number: 342440

Title: Prevalence of Candida species and potential risk factors for vulvovaginal candidiasis in Aligarh, India.
Author: Ahmad A; Khan AU
Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2009 May;144(1):68-71.
Abstract: OBJECTIVES: The objectives were to determine the frequency of Candida species in women of different age groups as well as to suggest the criteria for the diagnosis of vulvovaginal candidiasis (VVC). STUDY DESIGN: A prospective study of vulvovaginal candidiasis was carried out using laboratory diagnosis, with the estimation of vaginal pH and the direct microscopic and biochemical examination of vaginal discharge/secretions. Vaginal cultures for Candida species were collected from 1050 women with vulvovaginal symptoms. RESULTS: Out of 1050 women, 215 (20.47%) were positive for Candida species. Of 215 women, 172 (80%) had pH within the normal range and 167 (77.67%) were showing yeast cells and mycelia on direct microscopic examination. Candida albicans accounted for 46.9% of cases, Candida glabrata 36.7%, Candida parapsilosis 10.2%, Candida tropicalis 2.8%, Candida krusei 1.4%, and Candida kiefer 1.9%. The frequency of culture positivity was related to pregnancy (P<0.001), an increase in parity (P<0.001), and use of oral contraceptives (P<0.001) and antibiotics (P<0.001). The most common signs and symptoms in 215 women with positive cultures were pruritus with or without vaginal discharge and vaginal erythema. CONCLUSION: Our study suggests that vulvovaginal candidiasis can only be diagnosed by using clinical criteria in correlation with vulvovaginal symptoms and Candida cultures.
Language: English
Keywords:
INDIA | RESEARCH REPORT | PROSPECTIVE STUDIES | CLIENTS | CANDIDIASIS | RISK FACTORS | PREVALENCE | LABORATORY EXAMINATIONS AND DIAGNOSES | SIGNS AND SYMPTOMS | PRURITUS | VAGINITIS | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Bacterial and Fungal Diseases | Infections | Diseases | Health | Measurement | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Dermatitis | Vaginal Abnormalities
Document Number: 342002

Peer Reviewed

Title: Prevalence of tuberculosis, HIV and respiratory symptoms in two Zambian communities: implications for tuberculosis control in the era of HIV.
Author: Ayles H; Schaap A; Nota A; Sismanidis C; Tembwe R; De Haas P; Muyoyeta M; Beyers N
Author: Peter Godfrey-Faussett for the ZAMSTAR Study Team
Source: PloS One. 2009;4(5):e5602.
Abstract: BACKGROUND: The Stop TB Partnership target for tuberculosis is to have reduced the prevalence of tuberculosis by 50% comparing 2015 to 1990. This target is challenging as few prevalence surveys have been conducted, especially in high burden tuberculosis and HIV countries. Current tuberculosis control strategies in high HIV prevalent settings are therefore based on limited epidemiological evidence and more evidence is needed from community-based surveys to inform improved policy formulation. METHODS AND FINDINGS: 8044 adults were sampled from 2 sub-districts (wards) in Lusaka province, Zambia. Questionnaires were used to screen for symptoms, respiratory samples were obtained for culture and oral secretions collected for HIV testing. 79 individuals were found to have Mycobacterium tuberculosis in their sputum, giving an adjusted overall prevalence of tuberculosis of 870/100,000 (95% CI 570-1160/100,000). The adjusted overall prevalence of HIV was 28.61% (95% CI 26.04-31.19). HIV- infection was significantly associated with prevalent tuberculosis (Adj OR 2.3, 95% CI 1.42-3.74) and the population attributable fraction of HIV for prevalent tuberculosis was 36%. Symptoms such as prolonged cough (adj OR 12.72, 95% CI 7.05-22.94) and fever (Adj OR 2.04, 95%CI 1.23-3.39), were associated with prevalent tuberculosis, but 8 (10%) individuals with prevalent tuberculosis denied having any symptoms at all and only 34 (43%) would have been classified as a TB suspect by current guidelines. CONCLUSIONS: Undiagnosed tuberculosis is a challenge for tuberculosis control and new approaches are needed if we are to reach international targets. Epidemiological studies can inform screening algorithms for both detection and prevention of active tuberculosis.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | SAMPLING STUDIES | ADULTS | TUBERCULOSIS | HIV INFECTIONS | RESPIRATORY INSUFFICIENCY | PREVALENCE | SCREENING | SIGNS AND SYMPTOMS | LABORATORY EXAMINATIONS AND DIAGNOSES | PREVENTION AND CONTROL | ANTIBIOTICS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Infections | Diseases | Viral Diseases | Pulmonary Effects | Physiology | Biology | Measurement | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs | Treatment
Document Number: 342445

Peer Reviewed

Title: Sensitivity of paediatric AIDS score vs. WHO case classification in Indian children--a retrospective study.
Author: Banerjee T; Pensi T; Banerjee D
Source: Journal of Tropical Pediatrics. 2009 Apr;55(2):91-6.
Abstract: This study was conducted at the Department of Paediatrics, Dr Ram Manohar Lohia Hospital, to test the statistical significance of existing World Health Organization (WHO) clinical case definition (CCD) for diagnosis of AIDS in areas where diagnostic resources are limited. A total of 360 cases between 18 months and 12 years of age satisfying WHO case definitions of AIDS were included in study group. Our study detected 16.66% (60) of HIV incidence in children visiting the paediatrics outpatient clinic. Twenty percent of cases manifested three major and two minor signs, which had sensitivity of 73.33%; specificity, 90.66% and positive predictive value (PPV), 61.11%. Stepwise logistic analysis identified weight loss, chronic fever >1 month and total lymphocyte count <1500 cells mm(-3) as important predictors. Eighty-six cases (23.89%) showed two major and two minor signs with sensitivity and specificity of 86.66 and 88.66%, respectively. Thus a CCD based on 13 clinical signs/symptoms was proposed for paediatric AIDS with better sensitivity and PPV than the WHO case definition but with almost similar specificity.
Language: English
Keywords:
INDIA | RESEARCH REPORT | RETROSPECTIVE STUDIES | CHILDREN | PERSONS LIVING WITH HIV/AIDS | HIV TESTING | AIDS | LABORATORY PROCEDURES | EXAMINATIONS AND DIAGNOSES | SIGNS AND SYMPTOMS | STANDARDS | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Laboratory Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 331192

5.
Title: Integrating syndromic case management of sexually transmitted diseases into primary healthcare services in Nigeria.
Author: Banwat EB; Egah DZ; Peter J; Barau C; Majang Y; Mafuyai S; Imade GE; Bukbuk DN
Source: Nigerian Journal of Medicine. 2009 Apr-Jun;18(2):215-8.
Abstract: BACKGROUND: Sexually transmitted diseases (STDs) are a huge public health problem; both the aetiological and clinical approaches to management have limitations. WHO has therefore developed an alternative strategy--the syndromic case management approach. This paper reports a training of healthcare providers at the Primary Health Centers aimed at integrating STD care into other services in the PHCs to improve management at the community level. METHODS: Sixteen nurses, from eight PHCs were trained on this new strategy. The training included: identification of STDs, use of flow charts, patient education and counseling, clinic management issues and record keeping and reporting. RESULTS: Over a period of eight weeks post training, about 731 clients were attended to, 451 (61.7%) had signs and symptoms of various STDs (genital discharge, genital ulcer, genital warts and lower abdominal pains). They were treated using the syndromic case approach. About 18.6% (84/451) were males and 81.4% (367/451) were Females. Singles (never married) constituted 32.8% (148/451) while 28.6% were married. About 26.6% and 12.0% were divorced and separated respectively. Age group 20-35 years was at highest risk of infection CONCLUSION: Syndromic case management of STDs can be conveniently integrated into the primary health care delivery system in Nigeria.
Language: English
Keywords:
NIGERIA | RESEARCH REPORT | CLINICAL RESEARCH | NURSES AND NURSING | SEXUALLY TRANSMITTED DISEASES | SIGNS AND SYMPTOMS | TREATMENT | PRIMARY HEALTH CARE | INTEGRATED PROGRAMS | TRAINING ACTIVITIES | EXAMINATIONS AND DIAGNOSES | COUNSELING | PRE-POST TESTS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Health Personnel | Delivery of Health Care | Health | Reproductive Tract Infections | Infections | Diseases | Medical Procedures | Medicine | Health Services | Programs | Organization and Administration | Training Programs | Education | Clinic Activities | Program Activities | Program Evaluation
Document Number: 342684

Peer Reviewed

Title: Peripheral neuropathy in HIV-positive patients at an antiretroviral clinic in Lilongwe, Malawi.
Author: Beadles WI; Jahn A; Weigel R; Clutterbuck D
Source: Tropical Doctor. 2009 Apr;39(2):78-80.
Abstract: Peripheral neuropathy (PN) is common in the setting of antiretroviral (ARV) programmes in resource-limited settings and poses significant challenges in assessment and management. A retrospective analysis was undertaken of prevalence and management of PN in a cohort of 3341 patients on highly active antiretroviral therapy. A first line ARV regimen containing stavudine (D4T) is used for clinically eligible patients. Amitriptyline is prescribed for symptom relief and in cases of persistent or escalating symptoms zidovudine (AZT) is substituted for D4T. Leg pain or numbness was reported in 1173 patients (35%). However, only 428 (13%) were given a diagnosis of PN, 228 (7%) were prescribed amitriptyline and 200 (6%) were switched to AZT. A recent pharmokinetic study in this population showed a high Cmax of D4T with the generic combination triomune (D4T 40 mg). This could account for the high prevalence of PN. The optimum time for switch to a non-D4T containing regimen is unknown.
Language: English
Keywords:
MALAWI | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS | ANTIRETROVIRAL THERAPY | ANTIRETROVIRAL DRUGS | SIDE EFFECTS | NEUROLOGIC EFFECTS | PREVALENCE | SIGNS AND SYMPTOMS | TOXICITY | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | HIV | HIV Infections | Viral Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Physiology | Biology | Measurement
Document Number: 341785

7.
Title: Approach in sexually transmitted diseases.
Author: Belda Junior W; Shiratsu R; Pinto V
Source: Anais Brasileiros de Dermatologia. 2009 Mar-Apr;84(2):151-9.
Abstract: Nowadays, sexually transmitted diseases are one of the most common public health issues. Among its consequences are the possibility of transmission from mother to baby - which may cause miscarriages and congenital disease, male and female infertility, and the increase of HIV infection risk. Therefore, the main goal of these guidelines is to contribute to the improvement of the treatment for sexually transmitted diseases patients by presenting to the medical community how today's science stands on the matter and also what the recommendation for diagnosing and treating a patient are.
Language: EnglishPortuguese
Keywords:
BRAZIL | RECOMMENDATIONS | SEXUALLY TRANSMITTED DISEASES | EXAMINATIONS AND DIAGNOSES | SIGNS AND SYMPTOMS | TREATMENT | CHANCROID | GONORRHEA | South America, Eastern | South America | Latin America | Americas | Developing Countries | Reproductive Tract Infections | Infections | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342656

Peer Reviewed

Title: HIV infection, malnutrition, and invasive bacterial infection among children with severe malaria.
Author: Berkley JA; Bejon P; Mwangi T; Gwer S; Maitland K; Williams TN; Mohammed S; Osier F; Kinyanjui S; Fegan G; Lowe BS; English M; Peshu N; Marsh K; Newton CR
Source: Clinical Infectious Diseases. 2009 Aug 1;49(3):336-43.
Abstract: BACKGROUND: Human immunodeficiency virus (HIV) infection, malnutrition, and invasive bacterial infection (IBI) are reported among children with severe malaria. However, it is unclear whether their cooccurrence with falciparum parasitization and severe disease happens by chance or by association among children in areas where malaria is endemic. METHODS: We examined 3068 consecutive children admitted to a Kenyan district hospital with clinical features of severe malaria and 592 control subjects from the community. We performed multivariable regression analysis, with each case weighted for its probability of being due to falciparum malaria, using estimates of the fraction of severe disease attributable to malaria at different parasite densities derived from cross-sectional parasitological surveys of healthy children from the same community. RESULTS: HIV infection was present in 133 (12%) of 1071 consecutive parasitemic admitted children (95% confidence interval [CI], 11%-15%). Parasite densities were higher in HIV-infected children. The odds ratio for admission associated with HIV infection for admission with true severe falciparum malaria was 9.6 (95% CI, 4.9-19); however, this effect was restricted to children aged 1 year. Malnutrition was present in 507 (25%) of 2048 consecutive parasitemic admitted children (95% CI, 23%-27%). The odd ratio associated with malnutrition for admission with true severe falciparum malaria was 4.0 (95% CI, 2.9-5.5). IBI was detected in 127 (6%) of 2048 consecutive parasitemic admitted children (95% CI, 5.2%-7.3%). All 3 comorbidities were associated with increased case fatality. CONCLUSIONS: HIV, malnutrition and IBI are biologically associated with severe disease due to falciparum malaria rather than being simply alternative diagnoses in co-incidentally parasitized children in an endemic area.
Language: English
Keywords:
KENYA | RESEARCH REPORT | CONTROL GROUPS | MULTIVARIATE ANALYSIS | CHILDREN | MALARIA | SIGNS AND SYMPTOMS | HIV INFECTIONS | MALNUTRITION | BACTERIAL AND FUNGAL DISEASES | CASE FATALITY RATE | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Data Analysis | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Parasitic Diseases | Diseases | Viral Diseases | Nutrition Disorders | Infections | Death Rate | Mortality | Population Dynamics
Document Number: 342633

10.
Title: Increased risk for severe malaria in HIV-1-infected adults, Zambia.
Author: Chalwe V; Van geertruyden JP; Mukwamataba D; Menten J; Kamalamba J; Mulenga M; D'Alessandro U
Source: Emerging Infectious Diseases. 2009 May;15(5):749; quiz 858.
Abstract: To determine whether HIV-1 infection and HIV-1-related immunosuppression were risk factors for severe malaria in adults with some immunity to malaria, we conducted a case-control study in Luanshya, Zambia, during December 2005-March 2007. For each case-patient with severe malaria, we selected 2 matched controls (an adult with uncomplicated malaria and an adult without signs of disease). HIV-1 infection was present in 93% of case-patients, in 52% of controls with uncomplicated malaria, and in 45% of asymptomatic controls. HIV-1 infection was a highly significant risk factor for adults with severe malaria compared with controls with uncomplicated malaria (odds ratio [OR] 12.6, 95% confidence interval [CI] 2.0-78.8, p = 0.0005) and asymptomatic controls (OR 16.6, 95% CI 2.5-111.5, p = 0.0005). Persons with severe malaria were more likely to have a CD4 count <350/microL than were asymptomatic controls (OR 23.0, 95% CI 3.35-158.00, p<0.0001).
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | CONTROL GROUPS | CLIENTS | ADULTS | PERSONS LIVING WITH HIV/AIDS | IMMUNOLOGICAL EFFECTS | MALARIA | RISK FACTORS | ANTIMALARIAL DRUGS | SIGNS AND SYMPTOMS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Program Activities | Programs | Organization and Administration | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Immunity | Immune System | Physiology | Biology | Parasitic Diseases | Health
Document Number: 341944

11.
Title: [Actinomycosis of the caecum simulating carcinoma in a patient with a long-term intrauterine device]
Author: Colovic R; Grubor N; Micev M; Latincic S; Matic S; Colovic N
Source: Srpski Arhiv Za Celokupno Lekarstvo. 2009 May-Jun;137(5-6):285-7.
Abstract: INTRODUCTION: Actinomycosis of the caecum is a rare, but most frequently an abdominally localized disease. It often simulates inflammatory malignancy, rarely a periappendicular abscess or Chron's disease and is only exceptionally the cause of intestinal obstruction or bleeding. CASE OUTLINE: The authors present a 35-year-old woman with an intrauterine device which remained inserted for over three years, causing the development of pain, fever, vaginal secretion and bleeding that continued even after the device was removed. Ultrasonography showed a tumorous mass of irregular form located close to the uterus, which after a few months developed into a colliquation filled with pus requiring incision. Bacteriological examination failed to show actinomycosis. Due to the tumorous lesions involving the terminal ileum, appendix, caecum, ascending colon and omentum, a right hemicolectomy was performed. Based on histolopathological findings of the resected sample the diagnosis of actinomycosis was made. Therefore, after surgery the patient began treatment with antibiotics resulting in full recovery. CONCLUSION: Although rare, actinomycosis of the caecum should be taken into consideration in the differential diagnosis of tumorous lesions of the caecoascending part of the colon, particularly if the tumour is associated with inflammation.
Language: Serbian
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | WOMEN | CLIENTS | IUD COMPLICATIONS | BLEEDING | PAIN | SIGNS AND SYMPTOMS | SURGERY | TREATMENT | Developed Countries | North America | Americas | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | IUD | Contraceptive Methods | Contraception | Family Planning | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342607

12.

Title: Cerebral venous and sinus thrombosis in women.
Author: Coutinho JM; Ferro JM; Canhao P; Barinagarrementeria F; Cantu C; Bousser MG; Stam J
Source: Stroke. 2009 Jul;40(7):2356-61.
Abstract: BACKGROUND AND PURPOSE: Little is known about the gender-specific manifestations of cerebral venous and sinus thrombosis, a disease that is much more common in women than men. METHODS: We used data of the International Study on Cerebral Vein and Dural sinus Thrombosis (ISCVT), a multicenter prospective observational study, to analyze gender-specific differences in clinical presentation, etiology, and outcome of cerebral venous thrombosis. RESULTS: Four hundred sixty-five of a total of 624 patients were women (75%). Women were significantly younger, had less often a chronic onset of symptoms, and had more often headache at presentation. There were no gender differences in ancillary investigations or treatment. A gender-specific risk factor (oral contraceptives, pregnancy, puerperium, and hormonal replacement therapy) was present in 65% of women. Women had a better prognosis than men (complete recovery 81% versus 71%l P=0.01), which was entirely due to a better outcome in female patients with gender-specific risk factors. Women without gender-specific risk factors are similar to men in clinical presentation, risk factor profile, and outcome. Logistic regression analysis confirmed that the absence of gender-specific risk factors is a strong and independent predictor of poor outcome in women with sinus thrombosis (OR, 3.7; CI, 1.9 to 7.4). CONCLUSIONS: Our study identified important differences between women and men in presentation, course, and risk factors of cerebral venous and sinus thrombosis and showed that women with a gender-specific risk factor have a much better prognosis than other patients.
Language: English
Keywords:
GLOBAL | RESEARCH REPORT | PROSPECTIVE STUDIES | STATISTICAL REGRESSION | CLIENTS | WOMEN | CEREBROVASCULAR EFFECTS | THROMBOSIS | RISK FACTORS | SEX FACTORS | SIGNS AND SYMPTOMS | Studies | Research Methodology | Data Analysis | Program Activities | Programs | Organization and Administration | Demographic Factors | Population | Physiology | Biology | Thromboembolism | Embolism | Vascular Diseases | Diseases | Health | Population Characteristics
Document Number: 342314

13.

Title: Prevalence of Chlamydia trachomatis among women attending gynecology and infertility clinics in Gaza, Palestine.
Author: El Qouqa IA; Shubair ME; Al Jarousha AM; Sharif FA
Source: International Journal of Infectious Diseases. 2009 May;13(3):334-41.
Abstract: BACKGROUND: Chlamydia trachomatis is an obligate intracellular bacterium characterized by a biphasic developmental cycle of replication. The organism is recognized as one of the major causes of sexually transmissible human bacterial infection throughout the world. Since there have been no previous studies dealing with chlamydial diagnosis in Palestine, this study was conducted to determine the prevalence of C. trachomatis infection among women attending gynecology and infertility clinics. METHODS: Endocervical swabs were collected from 109 women, aged 18-52 years (median 29 years), attending gynecology and infertility clinics in Gaza. These specimens were processed using molecular (polymerase chain reaction, PCR) and enzyme immunoassay (EIA; IDEIA PCE Chlamydia) techniques. RESULTS: The results obtained show that the overall prevalence rate of C. trachomatis was 20.2%. The sensitivity was 73% for the EIA, 86% for the MOMP (major outer membrane protein gene)-based PCR, and 100% for the plasmid-based PCR. Meanwhile the specificity was 94% for the EIA, 98% for the plasmid-based PCR, and 100% for the MOMP-based PCR. In multivariate analysis, only cervical discharge was significantly associated with positivity for C. trachomatis (adjusted odds ratio 5.6, 95% confidence interval 2.0-15.5; p=0.001). CONCLUSIONS: The study revealed that a significant proportion of Palestinian women expressed evidence of exposure to C. trachomatis. Women with cervicitis are more likely to have been previously infected or exposed to Chlamydia infection. Furthermore, PCR proved to be superior and more efficient in the diagnosis of C. trachomatis than EIA.
Language: English
Keywords:
GAZA | RESEARCH REPORT | CLINICAL RESEARCH | SAMPLING STUDIES | CLIENTS | WOMEN | CHLAMYDIA | PREVALENCE | INFERTILITY | CERVICAL EFFECTS | LABORATORY PROCEDURES | SIGNS AND SYMPTOMS | Middle East | Developing Countries | Research Methodology | Studies | Program Activities | Programs | Organization and Administration | Demographic Factors | Population | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Measurement | Reproduction | Cervix | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342115

14.

15.

Peer Reviewed

Title: Multiple sexual partnership mediates the association between early sexual debut and sexually transmitted infection among adolescent and young adult males in Nigeria.
Author: Fatusi A; Wang W
Source: European Journal of Contraception and Reproductive Health Care. 2009 Apr;14(2):134-43.
Abstract: The study was cross-sectional analytical in design and involved 1,278 Nigerian males aged 15-24 years. Logistic regression was used in assessing the statistical relationship between early sexual debut (<16 years) and self-reported STIs (history of at least one of three symptoms-painful urination, genital discharge, and genital ulcer/sore within the past 12 months), with demographic factors, sexual behaviors, and psychosocial measures controlled for. The prevalence of self-reported symptoms was 4.2% for genital discharge, 4.1% for painful urination, and 2.0% for genital sore/ulcer. Overall, 6.8% had STI symptoms. At bivariate analysis, early sexual debut (p = 0.021), multiple partners (p < 0.001), concurrent partners (p = 0.002), and sex with casual/commercial partners (p = 0.013) were associated with STIs. At multivariate analysis, early sexual debut (odds ratio [OR] = 2.12, 95% confidence interval [CI] = 1.17-3.84) remained significantly associated with STIs. Multiple sexual partnership (OR = 2.00, 95% CI = 1.13-3.52) was also significantly associated with STIs and is a mediator of the association between early debut and STI.
Language: English
Keywords:
NIGERIA | RESEARCH REPORT | HEALTH SURVEYS | STATISTICAL REGRESSION | ADOLESCENTS, MALE | YOUTH | MULTIPLE PARTNERS | FIRST INTERCOURSE | SEXUALLY TRANSMITTED DISEASES | SIGNS AND SYMPTOMS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Health | Data Analysis | Research Methodology | Adolescents | Age Factors | Population Characteristics | Demographic Factors | Population | Sexual Partners | Sex Behavior | Behavior | Reproductive Tract Infections | Infections | Diseases
Document Number: 341447

16.

Peer Reviewed

Title: Rationing antiretroviral therapy in Africa--treating too few, too late.
Author: Ford N; Mills E; Calmy A
Source: New England Journal of Medicine. 2009 Apr 30;360(18):1808-10.
Abstract: The past 6 years have seen striking advances in access to antiretroviral therapy in Africa. From 2002 onward, the international drive to scale up antiretroviral treatment gained considerable momentum, most notably with the establishment of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, the "3 by 5" Initiative of the World Health Organization (WHO), and the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). The momentum has now begun to wane, with various groups arguing that the focus on AIDS has had its day and that health care funding should now be redirected to other areas, such as maternal and child health and primary care. But before the international community gives up on prioritizing care for patients with HIV infection, we believe that on-the-ground discussions must address not only whether enough has been done to scale up treatment but also whether the treatment that patients are receiving is good enough. The standard approach to HIV treatment in Africa is to wait until people are visibly sick, treat them with effective but poorly tolerated drugs, and then wait until they are sick again before switching regimens. There are several problems with this approach. The first is that too few people are receiving treatment. Second, we are waiting until people are symptomatic before they are treated. Another concern is that in most developing countries, patients are receiving drugs with major tolerability issues. Furthermore, not only should initial treatment begin earlier in developing countries, but when the first-line regimen fails, patients should also be switched earlier to another regimen. The drive to scale up antiretroviral treatment in Africa has encouraged a public health approach that promotes reaching the greatest number of patients with the simplest, most affordable regimens. We would argue that treating people when they are less sick with drugs that are less toxic and providing a simple tool for monitoring adherence and detecting treatment failure would be entirely consistent with this approach and would improve access to care by facilitating the decentralization of services from the hospital level to the clinic. (excerpt)
Language: English
Keywords:
AFRICA | DEVELOPING COUNTRIES | SUMMARY REPORT | HIV INFECTIONS | ANTIRETROVIRAL THERAPY | TREATMENT | TIME FACTORS | SIGNS AND SYMPTOMS | DRUG RESISTANCE | ANTIRETROVIRAL DRUGS | SIDE EFFECTS | HIV TRANSMISSION | HEALTH POLICY | NEEDS ASSESSMENT | Viral Diseases | Diseases | HIV | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics | Demographic Factors | Population | Policy | Political Factors | Sociocultural Factors | Evaluation
Document Number: 341021

17.

Peer Reviewed

Title: Sexual behavior and drug consumption among young adults in a shantytown in Lima, Peru.
Author: Galvez-Buccollini JA; DeLea S; Herrera PM; Gilman RH; Paz-Soldan V
Source: BMC Public Health. 2009 Jan 19;9(23):[27] p.
Abstract: Risky sexual behaviors of young adults have received increasing attention during the last decades. However, few studies have focused on the sexual behavior of young adults in shantytowns of Latin America. Specifically, studies on the association between sexual behaviors and other risk factors for sexually transmitted infections (STI) and HIV/AIDS transmission, such as the consumption of illicit drugs or alcohol are scarce in this specific context. The study participants were 393 men and 400 women between 18 and 30 years of age, from a shantytown in Lima, Peru. Data were obtained via survey: one section applied by a trained research assistant, and a self-reporting section. Logistic regression was used to estimate associations between use of any illicit drug, high-risk sexual behaviors and reported STI symptoms, adjusting for alcohol consumption level and various socio-demographic characteristics. Among men, age of sexual debut was lower, number of lifetime sexual partners was higher, and there were higher risk types of sexual partners, compared to women. Though consistent condom use with casual partners was low in both groups, reported condom use at last intercourse was higher among men than women. Also, a lifetime history of illicit drug consumption decreased the probability of condom use at last sexual intercourse by half. Among men, the use of illicit drugs doubled the probability of intercourse with a casual partner during the last year and tripled the probability of reported STI symptoms. Drug consumption is associated with high-risk sexual behaviors and reported STI symptoms in a Lima shantytown after controlling for alcohol consumption level. Development of prevention programs for risky sexual behaviors, considering gender differences, is discussed.
Language: English
Keywords:
PERU | RESEARCH REPORT | OLDER ADULTS | RISK FACTORS | RISK BEHAVIOR | DRUG USE AND ABUSE | ALCOHOL USE AND ABUSE | SEX BEHAVIOR | SEXUALLY TRANSMITTED DISEASES | AIDS | HIV INFECTIONS | CONDOM USE | SIGNS AND SYMPTOMS | South America, Western | South America | Latin America | Americas | Developing Countries | Adults | Age Factors | Population Characteristics | Demographic Factors | Population | Biology | Behavior | Reproductive Tract Infections | Infections | Diseases | Viral Diseases | Risk Reduction Behavior
Document Number: 329532

18.

Peer Reviewed

Title: Association of age at first sex with HIV-1, HSV-2, and other sexual transmitted infections among women in northern Tanzania.
Author: Ghebremichael M; Larsen U; Paintsil E
Source: Sexually Transmitted Diseases. 2009 Sep;36(9):570-576.
Abstract: The authors examined the association between age at first sex and the prevalence of sexually transmitted infections (STIs), including HIV-1 and HSV-2, in women in Moshi urban district, northern Tanzania. A total of 2,019 women aged 20 to 44 were randomly selected in a two-stage sampling, and they provided information on demographics and sexual behaviors. Blood and urine samples were drawn for STI testing. Women who had their first sexual intercourse between ages 18 and 19 (OR = 0.66; 95% CI = 0.50-0.86) or 20+ (OR = 0.46; 95% CI = 0.36-0.60) were less likely to have STIs, including HIV-1 and HSV-2, than were women who had their first intercourse before their 18th birthday. Early age at first sex was associated with having a regular noncohabiting partner, female circumcision, and coercion at first intercourse.
Language: English
Keywords:
TANZANIA | RESEARCH REPORT | SAMPLING STUDIES | WOMEN | FIRST INTERCOURSE | HIV INFECTIONS | SEXUALLY TRANSMITTED DISEASES | INCIDENCE | SIGNS AND SYMPTOMS | LABORATORY EXAMINATIONS AND DIAGNOSES | RISK FACTORS | FEMALE GENITAL CUTTING | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Demographic Factors | Population | Sex Behavior | Behavior | Viral Diseases | Diseases | Reproductive Tract Infections | Infections | Measurement | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Harmful Traditional Practices | Traditional Health Practices | Culture | Sociocultural Factors
Document Number: 339905

19.

20.

Peer Reviewed

Title: Lack of utility of risk score and gynecological examination for screening for sexually transmitted infections in sexually active adolescents.
Author: Guimaraes EM; Guimaraes MD; Vieira MA; Bontempo NM; Seixas MS; Garcia MS; Daud LE; Cortes RL; Alves Mde F
Source: BMC Medicine. 2009;7:8.
Abstract: BACKGROUND: Sexually transmitted infections constitute the main health risk among adolescents. In developing countries the diagnosis and treatment of cervical infections is based on the syndromic approach. In this study we estimated the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae among female adolescents from a Health Sector of the city of Goiania, Brazil, and validated cervicitis diagnosis using World Health Organization/Ministry of Health risk score and gynecological examination. METHODS: A cross-sectional community-based sample of 914 15- to 19-year-old female teenagers was randomly selected and referred to the local Family Health Program. Of these, 472 (51.6%) were sexually active and gynecological examinations were carried out for 427. Endocervical samples were collected to perform the polymerase chain reaction for C. trachomatis and N. gonorrhoeae. Performance of risk score, the presence of mucopurulent discharge, friability, ectopia and pain during cervical maneuver were compared with the presence of C. trachomatis or N. gonorrhoeae or both. RESULTS: The prevalence of C. trachomatis and N. gonorrhoeae was 14.5% and 2.1%, respectively. The risk score had a specificity of 31.9% (95% confidence interval, 21.2 to 44.2) and a positive predictive value of 20.8% (95% confidence interval, 13.5 to 29.7). Friability was the component of the gynecological examination that presented the best performance with a sensitivity of 43.5%, specificity of 81.0%, and 30.6% of positive predictive value. CONCLUSION: The prevalence of infection by C. trachomatis and N. gonorrhoeae was high among these sexually active adolescents. The syndromic approach is clearly inadequate for screening and treating these infections in this population. Therefore, the implantation of other strategies to control these infections among adolescents is urgently required.
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | CROSS SECTIONAL ANALYSIS | ADOLESCENTS, FEMALE | URBAN POPULATION | RISK ASSESSMENT | SEX BEHAVIOR | GYNECOLOGY | CERVICAL EFFECTS | PREVALENCE | CHLAMYDIA | GONORRHEA | SIGNS AND SYMPTOMS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Evaluation | Behavior | Medicine | Health Services | Delivery of Health Care | Health | Cervix | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Measurement | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases
Document Number: 331079

21.

Title: Neurological disorders in HIV-infected children in India.
Author: Gupta S; Shah DM; Shah I
Source: Annals of Tropical Paediatrics. 2009 Sep;29(3):177-81.
Abstract: There are few studies of HIV-related neurological disorders from centres in low-income countries where facilities are available for detailed investigation. METHODS: Records of all patients attending the paediatric HIV outpatient department at B. J. Wadia Hospital for Children, Mumbai between April 2000 and March 2008 were reviewed. Of 668 HIV-infected patients, 48 (7.2%) had neurological manifestations and are included in this study. RESULTS: Twenty-six (54.2%) children had HIV encephalopathy. Other causes of neurological manifestations include febrile convulsion in five (10.4%), bacterial meningitis in three (6.3%), epilepsy in two (4.2%), tuberculous meningitis and progressive multi-focal encephalopathy in two (4.2%) each and toxoplasmosis, vasculitis, acute demyelinating encephalomyelitis, anti-phospholipid antibody syndrome, Down's syndrome, birth asphyxia, herpes simplex encephalopathy and mitochondrial encephalopathy in one (2.1%) each. Mean (SD) age at presentation was 4.36 (3.38) years with a range of 2 months to 15 years. The common subtle neurological manifestations were abnormal deep tendon reflexes and extensor plantar reflexes. The common symptomatic manifestations were delayed milestones in 21 children (43.8%) and seizures in 19 (39.6%). Seizures were more common in males (54%) than in females (25%) (p=0.038). In children <5 years, delayed milestones was the most common manifestation while focal neurological deficits were more common in older children. Of the 13 children who received HAART, nine (60.23%) improved. CONCLUSION: Early diagnosis of neurological disorders in HIV-infected children is important for appropriate investigation and management, especially the introduction of HAART.
Language: English
Keywords:
INDIA | RESEARCH REPORT | RECORDS | CHILDREN | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | NEUROLOGIC EFFECTS | MENINGITIS | TUBERCULOSIS | SIGNS AND SYMPTOMS | EXAMINATIONS AND DIAGNOSES | TREATMENT | MANAGEMENT | ANTIRETROVIRAL THERAPY | Asia, Southern | Asia | Developing Countries | Information Processing | Information | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Physiology | Biology | Central Nervous System Effects | Central Nervous System | Infections | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Organization and Administration | HIV
Document Number: 342530

22.

Title: Domestic violence against women during pregnancy: the case of Palestinian refugees attending an antenatal clinic in Lebanon.
Author: Hammoury N; Khawaja M; Mahfoud Z; Afifi RA; Madi H
Source: Journal of Women's Health. 2009 Mar;18(3):337-45.
Abstract: OBJECTIVES: To determine the factors associated with domestic violence against pregnant Palestinian refugee women residing in Lebanon and currently using the United Nation Relief and Work Agency's (UNRWA) primary healthcare services. METHODS: This was a cross-sectional study conducted at a polyclinic of primary healthcare of the UNRWA in South Lebanon during the years 2005-2006. The sample was 351 pregnant women who were 15-42 years of age and not accompanied by their husbands or relatives. All women were invited by the midwife to participate in the study during their visit to the clinic for their first checkup or during a follow-up visit. The Abuse Assessment Screen instrument was used to screen for past and recent history of physical and emotional abuse among the participants. RESULTS: Domestic violence was significantly associated with education, gestational age, fear of husband or someone else in the house, and unintended pregnancy. The odds of abuse for women with an elementary or lower education were 6.86 (95% CI 1.2-38.1) and for women with an intermediate or secondary education 6.84 (95% CI 1.4-33.3) compared with women with a university education. The odds of abuse during pregnancy for women whose husbands did not desire their pregnancy were 3.80 (95% CI 1.5-9.7) compared with other women. CONCLUSIONS: Domestic violence against women in Lebanon was associated with educational level, gestational age, fear of husband or someone else in the house, and unintended pregnancy.
Language: English
Keywords:
LEBANON | RESEARCH REPORT | PREVALENCE | PREGNANT WOMEN | REFUGEES | ANTENATAL CARE | VIOLENCE AGAINST WOMEN | PHYSICAL ABUSE | SIGNS AND SYMPTOMS | EDUCATIONAL STATUS | FEAR | PREGNANCY, UNPLANNED | Middle East | Developing Countries | Measurement | Research Methodology | Population Characteristics | Demographic Factors | Population | Migrants | Migration | Population Dynamics | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Domestic Violence | Crime | Social Problems | Sociocultural Factors | Violence | Behavior | Diseases | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Emotions | Psychological Factors | Reproductive Behavior | Fertility
Document Number: 341353

23.

Title: Hormonal contraceptive regimens in the perimenopause.
Author: Hardman SM; Gebbie AE
Source: Maturitas. 2009 Jun 11;
Abstract: Perimenopausal women have low fertility but still need contraception if they are sexually active. They often have co-existing menstrual problems and menopausal symptoms. No method of contraception is contraindicated by age alone. In addition to highly effective contraception, hormonal methods offer non-contraceptive benefits which can improve quality of life for perimenopausal women. Combined hormonal oral contraception has been available for many decades. The combined vaginal ring and transdermal patch are newer methods offering alternative delivery systems but similar risk profiles to oral preparations. New combinations containing naturally occurring estrogens in place of the synthetic hormone ethinylestradiol are now available and, in theory, could be safer. The progestogen-only methods have an excellent safety profile and have a range of delivery systems and dosages to suit all. Concerns regarding loss of bone mineral density with the injectable depot medroxyprogesterone acetate continue but to date there is no evidence that this translates into higher fracture risk. Effective use of any method of contraception is strongly dependent on good counselling and support from healthcare professionals. Risks should be explained in absolute terms for each individual woman, enabling her to make an informed choice on evidence-based medicine and not influenced by ill-informed media publicity.
Language: English
Keywords:
UNITED KINGDOM | CRITIQUE | MENOPAUSE | AGE FACTORS | SIGNS AND SYMPTOMS | HORMONES | CONTRACEPTIVE METHODS | CONTRACEPTIVE SAFETY | RISK FACTORS | MENSTRUATION DISORDERS | Developed Countries | Europe, Western | Europe | Reproduction | Population Characteristics | Demographic Factors | Population | Diseases | Endocrine System | Physiology | Biology | Contraception | Family Planning | Safety | Public Health | Health
Document Number: 341711

24.

Peer Reviewed

Title: Community knowledge, attitudes and practices (KAP) on malaria in Swaziland: a country earmarked for malaria elimination.
Author: Hlongwana KW; Mabaso ML; Kunene S; Govender D; Maharaj R
Source: Malaria Journal. 2009;8:29.
Abstract: BACKGROUND: The potential contribution of knowledge, attitudes and practices (KAP) studies to malaria research and control has not received much attention in most southern African countries. This study investigated the local communities' understanding of malaria transmission, recognition of signs and symptoms, perceptions of cause, treatment-seeking patterns, preventive measures and practices in order to inform the country's proposed malaria elimination programme in Swaziland. METHODS: A descriptive cross-sectional survey was undertaken in four Lubombo Spatial Development Initiative (LSDI) sentinel sites in Swaziland. These sentinel sites share borders with Mozambique. A structured questionnaire was administered to 320 randomly selected households. Only one adult person was interviewed per household. The interviewees were the heads of households and in the absence of the heads of households responsible adults above 18 years were interviewed. RESULTS: A substantial number of research participants showed reasonable knowledge of malaria, including correct association between malaria and mosquito bites, its potential fatal consequences and correct treatment practices. Almost 90% (n = 320) of the respondents stated that they would seek treatment within 24 hours of onset of malaria symptoms, with health facilities as their first treatment option. Most people (78%) perceived clinics and vector control practices as central to treating and preventing malaria disease. Indoor residual spraying (IRS) coverage and bed net ownership were 87.2% and 38.8%, respectively. IRS coverage was in agreement with the World Health Organization's (WHO) recommendation of more than 80% within the targeted communities. CONCLUSION: Despite fair knowledge of malaria in Swaziland, there is a need for improving the availability of information through the preferred community channels, such as tinkhundlas (districts), as well as professional health routes. This recommendation emerges along with the documented evidence suggesting that as the level transmission and disease decreases so does the perception about the importance of malaria control activities. Finally, given the relatively moderate ownership of bed net there is a need for future studies to evaluate the distribution of insecticide-treated nets (ITNs) compared with IRS.
Language: English
Keywords:
SWAZILAND | RESEARCH REPORT | KAP SURVEYS | COMMUNITY PARTICIPATION | KNOWLEDGE | PERCEPTION | SIGNS AND SYMPTOMS | MALARIA | MALARIA PREVENTION | TRANSMISSION | NEEDS ASSESSMENT | INFORMATION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Organization and Administration | Sociocultural Factors | Psychological Factors | Behavior | Diseases | Parasitic Diseases | Infections | Evaluation
Document Number: 330813

25.

Peer Reviewed

Title: Side effects from the copper IUD: do they decrease over time?
Author: Hubacher D; Chen PL; Park S
Source: Contraception. 2009 May;79(5):356-62.
Abstract: BACKGROUND: The copper intrauterine device (IUD) can cause side effects in some women; increased uterine bleeding and pain may cause early removal. Because of simplified reporting from previous research, little is known about how side effects might change over time. STUDY DESIGN: This is a secondary analysis of a prospective study of 1947 first-time copper IUD users. Over a 1-year period, we collected detailed information on side effects and looked for trends using generalized mixed-effects regression modeling. RESULTS: During menses, most bleeding and pain side effects were found to decrease over time (p<.05). During intermenstrual intervals, overall spotting and pain complaints remained unchanged, but the number of days with these problems increased (p<.05). Serious side effects that prompted either a clinic visit or IUD removal had varied patterns over time, depending on the type of problem. CONCLUSION: Side effects from the copper IUD can be troubling for both user and clinician. Some problemsimprove over time, while others do not. This information may be helpful in counseling women who are considering IUD use and current users who are contemplating IUD removal due to side effects.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | PROSPECTIVE STUDIES | CLIENTS | WOMEN | IUD, COPPER RELEASING | IUD SIDE EFFECTS | SIGNS AND SYMPTOMS | Developed Countries | North America | Americas | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Demographic Factors | Population | IUD | Contraceptive Methods | Contraception | Family Planning | Diseases
Document Number: 342086

26.
Title: Care seeking for STI symptoms in Pakistan.
Author: Khan AA; Naghma-e-Rehan; Qayyum K; Khan A
Source: JPMA. Journal of the Pakistan Medical Association. 2009 Sep;59(9):628-30.
Abstract: OBJECTIVE: To estimate the frequency of Sexually Transmitted Infections (STIs) among sex workers and drug users in Pakistan. METHODS: Interviews were conducted on 3640 sex workers, injection drug users and truckers about STI symptoms within the past year and currently and the care they sought for them. RESULTS: Nearly half (46%) reported STI symptoms in the past 12 months and 55% went for treatment. Most of the care sought was from the private sector and more by IDUs and female sex workers. Increasing age or having a genital ulcer predicted care seeking. CONCLUSIONS: The results suggest the need to understand the factors determining care seeking among members of high risk groups; and emphasizing the role of the private health care providers in treatment and control of STIs.
Language: English
Keywords:
PAKISTAN | RESEARCH REPORT | INTERVIEWS | SEX WORKERS | WOMEN | IV DRUG USERS | TRUCK DRIVERS | SEXUALLY TRANSMITTED DISEASES | SIGNS AND SYMPTOMS | TREATMENT | Developing Countries | Asia, Southern | Asia | Data Collection | Research Methodology | Sex Behavior | Behavior | Demographic Factors | Population | Drug Use and Abuse | Labor Force | Human Resources | Economic Factors | Reproductive Tract Infections | Infections | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342954

27.

Peer Reviewed

Title: Knowledge and practice among healthcare providers in rural Vietnam regarding sexually transmitted infections.
Author: Lan PT; Mogren I; Phuc HD; Stalsby Lundborg C
Source: Sexually Transmitted Diseases. 2009 Jul;36(7):452-8.
Abstract: OBJECTIVES: To assess knowledge and reported practice regarding sexually transmitted infections (STI) among healthcare providers in rural Vietnam and to examine background characteristics possibly associated with knowledge and practice. METHODS: A cross-sectional study using a self-completed questionnaire was carried out in 2006 among 465 healthcare providers in rural Vietnam. The questionnaire included questions on providers' characteristics, STI knowledge, and case scenarios of 4 common STI syndromes. Correct answer was scored 1, "do not know" or incorrect answer was scored 0. Linear and logistic regressions were applied. RESULTS: Diseases considered as STI were gonorrhea and syphilis by 83% of the respondents, 70% believed partner treatment necessary for bacterial vaginosis or candidiasis cases. Sharing clothes/food or kissing was commonly mentioned as transmission routes (60%). Median scores of knowledge and reported practice were 29 (range: 0-50) and 2 (range: 0-20), respectively. Among the respondents, 34% had a knowledge score of less than 25 and 78% had a practice score of less than 10. Characteristics predicting higher level of knowledge were being a medical doctor, assistant medical doctor, midwife, or serving STI patients. Characteristics predicting higher level of practice were serving STI patients, being a midwife or female provider, and having participated in STI or reproductive tract infection training courses. Respondents who reported treating STI patients had a higher level of knowledge and reported practice than the others.
Language: English
Keywords:
VIETNAM | RURAL AREAS | RESEARCH REPORT | HEALTH PERSONNEL | SEXUALLY TRANSMITTED DISEASES | KNOWLEDGE | QUESTIONNAIRES | SIGNS AND SYMPTOMS | RISK FACTORS | EDUCATIONAL STATUS | MISINFORMATION | Asia, Southeastern | Asia | Developing Countries | Geographic Factors | Population | Delivery of Health Care | Health | Reproductive Tract Infections | Infections | Diseases | Sociocultural Factors | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Communication
Document Number: 342820

28.

Peer Reviewed

Title: HIV-1 RNA dysregulates the natural TLR response to subclinical endotoxemia in Kenyan female sex-workers.
Author: Lester RT; Yao XD; Ball TB; McKinnon LR; Omange WR; Kaul R; Wachihi C; Jaoko W; Rosenthal KL; Plummer FA
Source: PloS One. 2009;4(5):e5644.
Abstract: BACKGROUND: Subclinical endotoxemia has been reported in HIV-1 infected persons and may drive systemic immune activation and pathogenesis. Proinflammatory responsiveness to endotoxin (LPS) is mediated by Toll-like receptor 4 (TLR4). We therefore examined the association between plasma LPS levels, HIV RNA, and TLR4 expression and cytokine responses in the blood of HIV infected and uninfected participants in a cohort of female sex-workers in Kenya. METHODOLOGY/PRINCIPAL FINDINGS: Ex vivo plasma and peripheral blood mononuclear cells (PBMC) were assessed for LPS and TLR mRNA, respectively. The effects of HIV single stranded RNA, a TLR8 ligand, on TLR4 and LPS signaling were further assessed in short term PBMC culture. Both HIV uninfected and infected subjects frequently had low detectable LPS levels in their plasmas. Significantly increased LPS levels were associated with chronic HIV-1 infection, both treated and untreated, but not with other acute or semi-chronic conditions reported. In HIV-uninfected subjects, TLR4 mRNA expression levels correlated inversely with plasma LPS levels, suggesting chronic endotoxin 'tolerance' in vivo. A similar effect of reduced TLR4 mRNA was seen in short term PBMC culture after stimulation with LPS. Interestingly, the apparent in vivo tolerance effect was diminished in subjects with HIV infection. Additionally, pre-stimulation of PBMC with LPS lead to proinflammatory (TNF-alpha) tolerance to subsequent LPS stimulation; however, pre-treatment of PBMC with HIV single-stranded RNA40, could enhance TLR4-mediated LPS responsiveness in vitro. CONCLUSIONS/SIGNIFICANCE: Thus, dysregulation of endotoxin tolerance by HIV-1 RNA may exacerbate HIV chronic immune activation and pathogenesis.
Language: English
Keywords:
KENYA | RESEARCH REPORT | CLINICAL RESEARCH | SEX WORKERS | WOMEN | HIV INFECTIONS | AIDS | IMMUNOLOGICAL EFFECTS | SIGNS AND SYMPTOMS | LABORATORY PROCEDURES | ANTIRETROVIRAL THERAPY | IMMUNE SYSTEM | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Sex Behavior | Behavior | Demographic Factors | Population | Viral Diseases | Diseases | Immunity | Physiology | Biology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV
Document Number: 342162

29.

Title: Sex, microbial translocation, and the African HIV epidemic [letter]
Author: Lester RT; Jaoko W; Plummer FA; Kaul R
Source: Proceedings of the National Academy of Sciences of the United States of America. 2009 Aug 25;106(34):E89; author reply E90.
Abstract: This letter focuses on HIV-associated bacterial translocation in Africa and highlights the need for further investigation into this phenomenon in order to better define its causes and consequences.
Language: English
Keywords:
AFRICA | CRITIQUE | PERSONS LIVING WITH HIV/AIDS | SIGNS AND SYMPTOMS | SCREENING | HIV TRANSMISSION | HIV TESTING | LABORATORY PROCEDURES | Developing Countries | HIV Infections | Viral Diseases | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Laboratory Examinations and Diagnoses
Document Number: 342959

30.

Peer Reviewed

Title: Psychometric evaluation of the Trauma Symptoms Checklist for Children (TSCC) among children affected by HIV/AIDS in China.
Author: Li X; Fang X; Stanton B; Zhao G; Lin X; Zhao J; Zhang L; Hong Y; Chen X
Source: AIDS Care. 2009 Mar;21(3):261-70.
Abstract: The current study, utilizing the baseline data from a longitudinal assessment of psychosocial needs of children orphaned by HIV/AIDS or living with HIV-infected parents in China, was designed to assess the psychometric properties of the Trauma Symptoms Checklist for Children (TSCC) among children affected by HIV/AIDS in China. The psychometric properties assessed in this study include internal consistency, convergent and discriminant validity, and construct validity. The sample in the current study include 296 double orphans, 459 single orphans, and 466 children living with HIV-infected parents in central China where many residents had been infected with HIV through unhygienic blood collection. The results demonstrate adequate reliability and validity of the TSCC among study population. Children who experienced more traumatic events scored significantly higher on all TSCC clinical scales and subscales than those children who experienced less such events. The Chinese version of the TSCC should provide mental health researchers and practitioners with a reliable and valid assessment instrument in studying posttraumatic distress and related psychological symptomology among children affected by HIV/AIDS in China.
Language: English
Keywords:
CHINA | RESEARCH REPORT | SAMPLING STUDIES | ORPHANS AND VULNERABLE CHILDREN | AIDS | STRESS | SIGNS AND SYMPTOMS | ANGER | ANXIETY DISORDERS | DEPRESSION | TESTING | RELIABILITY | VALIDITY | Asia, Eastern | Asia | Developing Countries | Studies | Research Methodology | Family and Household | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Psychological Factors | Behavior | Emotions | Mental Disorders | Measurement
Document Number: 341831


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