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1.
Sex Transm Dis ; 28(2): 117-23, 2001 Feb.
Article in English | MEDLINE | ID: mdl-11234786

ABSTRACT

BACKGROUND: Sequelae of genital Chlamydia trachomatis infection in women are more strongly linked to repeat infections than to initial ones, and persistent or subsequent infections foster continued transmission. OBJECTIVE: To identify factors associated with persistent and recurrent chlamydial infection in young women that might influence prevention strategies. METHODS: Teenage and young adult women with uncomplicated C trachomatis infection attending reproductive health, sexually transmitted disease, and adolescent medicine clinics in five US cities were recruited to a cohort study. Persistent or recurrent chlamydial infection was detected by ligase chain reaction (LCR) testing of urine 1 month and 4 months after treatment. RESULTS: Among 1,194 women treated for chlamydial infection, 792 (66.4%) returned for the first follow-up visit, 50 (6.3 %) of whom had positive LCR results. At that visit, women who resumed sex since treatment were more likely to have chlamydial infection (relative risk [RR], 2.0; 95% CI, 1.03-3.9), as were those who did not complete treatment (RR, 3.4; 95% CI, 1.6-7.3). Among women who tested negative for C trachomatis at the first follow-up visit, 36 (7.1%) of 505 had positive results by LCR at the second follow-up visit. Reinfection at this visit was not clearly associated with having a new sex partner or other sexual behavior risks; new infection was likely due to resumption of sex with untreated partners. Overall, 13.4% of women had persistent infection or became reinfected after a median of 4.3 months, a rate of 33 infections per 1,000 person months. CONCLUSIONS: Persistent or recurrent infection is very common in young women with chlamydial infection. Improved strategies are needed to assure treatment of women's male sex partners. Rescreening, or retesting of women for chlamydial infection a few months after treatment, also is recommended as a routine chlamydia prevention strategy.


Subject(s)
Chlamydia Infections/epidemiology , Chlamydia Infections/prevention & control , Chlamydia trachomatis/isolation & purification , Sexual Partners , Adolescent , Adult , Chlamydia Infections/therapy , Cohort Studies , Female , Humans , Ligase Chain Reaction/methods , Prospective Studies , Recurrence , Risk Factors , United States/epidemiology , Urinalysis
2.
Eval Health Prof ; 24(4): 363-84, 2001 Dec.
Article in English | MEDLINE | ID: mdl-11817197

ABSTRACT

Project RESPECT was a multisite randomized trial comparing three clinic-based interventions' ability to increase condom use and prevent infection with HIV and sexually transmitted diseases. Because Project RESPECT had guiding concepts that determined the content of the sessions, the authors investigated how the intervention operated using these theoretical variables. Growth curve analysis and structural equation modeling estimated the correlation between intentions toward condom use and self-reports of condom use and isolated the treatment effects on mediating variables--attitudes, self-efficacy, and social norms--that predict intentions. The correlations between intentions and behavior exceeded .70 for both genders, justifying the emphasis on intentions. Project RESPECT was effective through changing attitudes and self-efficacy for females in both counseling interventions. For males, only enhanced counseling had significant effects on these two mediator variables.


Subject(s)
Health Knowledge, Attitudes, Practice , Models, Psychological , Safe Sex , Sexually Transmitted Diseases/prevention & control , Analysis of Variance , Female , HIV Infections/prevention & control , Humans , Male , Motivation , Time Factors , United States
3.
Health Psychol ; 19(5): 458-68, 2000 Sep.
Article in English | MEDLINE | ID: mdl-11007154

ABSTRACT

To study the structure of beliefs about condom use outcomes, the authors derived and tested 4 psychosocial hypothetical models: (a) a 2-factor model of the personal and social outcomes of condom use; (b) a 2-factor model of the pros and cons of the behavior; (c) a 3-factor model (i.e., physical, self-evaluative, and social) of outcome expectancies; and (d) a thematic 4-factor model of the protection, self-concept, pleasure, and interaction implications of the behavior. All 4 models were studied with a confirmatory factor analysis approach in a multisite study of 4,638 participants, and the thematic solution was consistently the most plausible. Self-concept and pleasure were most strongly associated with attitudes toward using condoms, intentions to use condoms, and actual condom use, whereas protection and interaction generally had little influence.


Subject(s)
Attitude to Health , Condoms , Health Behavior , Risk-Taking , Self Concept , Adult , Counseling , Female , HIV Infections/prevention & control , HIV Infections/psychology , Health Knowledge, Attitudes, Practice , Health Surveys , Humans , Male , Philosophy
4.
J Community Health ; 24(3): 201-14, 1999 Jun.
Article in English | MEDLINE | ID: mdl-10399652

ABSTRACT

The effectiveness of HIV antibody counseling and testing as a prevention intervention is limited: persons testing seronegative do not usually change their risk behaviors, some actually increase their risk behaviors, and decreases in risk behaviors are usually short-lived. Referrals to additional prevention and other needed services are therefore recommended, although the extent and determinants of referral provision for persons testing seronegative are unknown. We assessed the prevalence of referrals and the association between risk behaviors and prevention referrals among seronegatives. We reviewed HIV testing and referral data on all persons receiving confidential seronegative test results in San Francisco (SF) in the first 10 months of 1995 (n = 5,595), and gathered more detailed referral information at the municipal STD clinic from November 1995 through May 1996 (n = 747). The overall prevalence of referrals was low: a referral was given to 19.1% of the SF sample and 10.6% of the STD clinic sample; 15.4% of the SF sample and 5.9% of the STD clinic sample received a prevention referral. Injection drug users (IDUs) were the most likely to receive a prevention referral (48.5% of SF IDUs, 36.4% of STD clinic IDUs); men having sex with men and women with high-risk partners were also more likely to get a prevention referral than others. For SF IDUs, unsafe sex and needle sharing were not associated with an increased likelihood of receiving a prevention referral. Opportunities to link high-risk clients from counseling and testing to HIV prevention services are being missed. The referral component of HIV counseling and testing should be improved.


Subject(s)
AIDS Serodiagnosis , Community Networks/statistics & numerical data , HIV Infections/prevention & control , Patient Education as Topic/statistics & numerical data , Preventive Health Services/statistics & numerical data , Referral and Consultation/statistics & numerical data , AIDS Serodiagnosis/psychology , AIDS Serodiagnosis/statistics & numerical data , Adult , Attitude of Health Personnel , Chi-Square Distribution , Community Networks/standards , Female , HIV Infections/psychology , HIV Infections/transmission , Health Care Surveys , Humans , Male , Patient Education as Topic/standards , Referral and Consultation/standards , San Francisco/epidemiology , Sexual Behavior/statistics & numerical data , Substance Abuse, Intravenous/epidemiology
5.
Am J Obstet Gynecol ; 178(5): 987-90, 1998 May.
Article in English | MEDLINE | ID: mdl-9609572

ABSTRACT

OBJECTIVE: We sought to determine potential risk factors for upper genital tract inflammation in women with cervical Neisseria gonorrhoeae, Chlamydia trachomatis, or bacterial vaginosis. STUDY DESIGN: In a case-controlled study we compared 111 women with cervical Neisseria gonorrhoeae, Chlamydia trachomatis, or bacterial vaginosis (the study group) with 24 women who had negative tests for each of these infections (the control group). We evaluated potential risk factors for upper genital tract inflammation by use of bivariate and then logistic regression analysis. RESULTS: We found plasma cell endometritis in 53 of 111 women in the study group and 3 of 24 controls (odds ratio = 6.4, 95% confidence interval 1.7 to 35.0). On logistic regression, the study group women who were in the proliferative phase had increased likelihood of plasma cell endometritis (odds ratio = 4.5, 95% confidence interval 1.6 to 12.4). CONCLUSION: The proliferative phase of the menstrual cycle seems to be the primary risk factor for ascending infection by organisms associated with pelvic inflammatory disease. This may be due to a hormonal effect or to the loss of the cervical barrier during menstruation.


Subject(s)
Cervix Uteri/microbiology , Chlamydia trachomatis/isolation & purification , Endometritis/microbiology , Neisseria gonorrhoeae/isolation & purification , Plasma Cells , Adolescent , Adult , Black People , Case-Control Studies , Chlamydia Infections/complications , Chlamydia Infections/microbiology , Endometritis/epidemiology , Endometritis/pathology , Female , Gonorrhea/complications , Gonorrhea/microbiology , Humans , Menstrual Cycle , Middle Aged , Risk Factors , Therapeutic Irrigation , Vaginosis, Bacterial
6.
J Infect Dis ; 175(6): 1519-22, 1997 Jun.
Article in English | MEDLINE | ID: mdl-9180198

ABSTRACT

To determine whether there were core groups of transmitters of gonorrhea and chlamydial infection among 14- to 35-year-olds in San Francisco during 1989-1993, sociodemographic risk factors for repeat gonorrhea and chlamydial infection were examined. During those 5 years, 8613 cases of gonorrhea were reported among males and 3893 among females; the proportions with repeat infection were 17.0% and 19.0%, respectively. There were also 2465 reported cases of chlamydial infection among males and 6996 among females; the proportions with repeat infection were 8.6% and 15.1%, respectively. Multivariate analyses reveal that for males, city planning region 5 was an independent risk factor for both repeat gonorrhea (relative hazard [RH] = 1.22; 95% confidence interval [CI] = 1.05-1.43) and repeat chlamydial infection (RH = 1.78; 95% CI = 1.23-2.57). For females, city planning region 4 was an independent risk factor for repeat gonorrhea (RH = 1.50; 95% CI = 1.12-1.98), and there was no high-risk planning region for repeat chlamydial infection. In San Francisco, there appear to be male and female core transmitters for gonorrhea but there may not be core transmitters for chlamydial infection.


Subject(s)
Chlamydia Infections/epidemiology , Gonorrhea/epidemiology , Adolescent , Adult , Chlamydia Infections/ethnology , Chlamydia Infections/transmission , City Planning , Cluster Analysis , Female , Gonorrhea/ethnology , Gonorrhea/transmission , Humans , Incidence , Male , Risk Factors , San Francisco/epidemiology , Sexual Behavior
7.
Article in English | MEDLINE | ID: mdl-8989209

ABSTRACT

Patient satisfaction is a valuable indicator of the quality of medical care. We assessed the impact of type of health insurance on satisfaction with seven aspects of medical care among 593 HIV-infected men without AIDS, drawn from three sites in San Francisco, California and Denver, Colorado. After adjustment for site of medical care, patient age, race, income, education, and CD4 lymphocyte count, there were few differences in satisfaction between men with fee-for-service and those with managed care insurance. Men with fee-for-service insurance were significantly more satisfied with their interpersonal relations with their clinicians (p = 0.01) but less satisfied with their finances (p = 0.0001) than persons with managed care. Uninsured men were significantly less satisfied with several aspects of care than insured persons. There were no significant differences in satisfaction between men with managed care and those with public insurance. HIV-infected persons who have a choice of insurance should carefully weigh their options, recognizing the implicit trade-offs between types of insurance. Those who choose fee-for-service insurance can expect to be more satisfied with interpersonal relations with their medical providers but less satisfied with financial aspects of their plans. Efforts to address the low satisfaction of uninsured persons are needed.


Subject(s)
HIV Infections/therapy , Insurance, Health/classification , Patient Satisfaction , Adult , Bisexuality , Colorado , Fee-for-Service Plans , Financing, Personal , HIV Infections/psychology , Health Services Accessibility , Homosexuality, Male , Humans , Linear Models , Male , Managed Care Programs , Middle Aged , Physician-Patient Relations , San Francisco , Surveys and Questionnaires
8.
AIDS Care ; 8(4): 433-42, 1996 Aug.
Article in English | MEDLINE | ID: mdl-8863914

ABSTRACT

Depression is a serious, common, and treatable condition among HIV-infected persons. We examined the prevalence and predictors of depression and use of mental health services among 475 HIV-infected men without AIDS. Participants were drawn from three sites in San Francisco and Denver that did not provide ongoing medical care or mental health services. Depression was measured using the Center for Epidemiology Studies Depression scale (CES-D). Overall, 176 men (37.1%) were classified as depressed based on having a CES-D score above the standard cut-off of > or = 16. In logistic regression analysis, persons with HIV-related symptoms (OR = 3.4; 95% CI = 2.0.-5.6), low social support (OR = 2.5; 95% CI = 1.6-3.9), who were unemployed (OR = 1.9; 95% CI = 1.1-3.3), and with CD4 count < 200 cells (OR = 1.9; 95% CI = 1.1-3.3), were significantly more likely to be depressed. Only 40.3% of depressed men had seen a mental health clinician in the previous year and only 6.3% were taking an antidepressant. Among depressed men, in logistic regression analysis, men who were unemployed (OR = 2.4; 95% CI = 1.2-4.7) and those with health insurance (OR = 2.2; 95% CI = 1.1-4.5) were more likely to have received these services. Increased evaluation and treatment of HIV-infected persons for depression is needed.


Subject(s)
Depression/epidemiology , HIV Infections/psychology , Health Services Accessibility , Mental Health Services/statistics & numerical data , Analysis of Variance , Colorado/epidemiology , Cross-Sectional Studies , HIV Seropositivity , Homosexuality, Male/psychology , Humans , Logistic Models , Male , San Francisco/epidemiology , Social Class , Social Support
9.
Am J Public Health ; 85(11): 1546-8, 1995 Nov.
Article in English | MEDLINE | ID: mdl-7485669

ABSTRACT

This paper examines the effect of socioeconomic position on the differences in the 3-year rates (1990 to 1992) of reported cases of gonorrhea and chlamydia between Black and White adolescents, aged 12 to 20 years, residing in San Francisco. The crude relative risks for Blacks were 23.4 (95% confidence interval [CI] = 20.4, 27.8) for gonorrhea and 9.3 (95% CI = 8.3, 10.3) for chlamydia. Adjusting for poverty and occupational status, the relative risks were 28.7 (95% CI = 22.5, 36.1) for gonorrhea and 8.9 (95% CI = 7.4, 10.6) for chlamydia. This study demonstrates that factors other than poverty and occupational status account for the racial/ethnic differences in the rates of gonorrhea and chlamydia among adolescents in San Francisco.


Subject(s)
Black or African American , Chlamydia Infections/ethnology , Gonorrhea/ethnology , Social Class , White People , Adolescent , Adult , Child , Employment , Female , Humans , Male , Poisson Distribution , Poverty , Risk , San Francisco/epidemiology
10.
Am J Epidemiol ; 142(3): 314-22, 1995 Aug 01.
Article in English | MEDLINE | ID: mdl-7631635

ABSTRACT

The authors analyzed temporal trends in human immunodeficiency virus (HIV) infection among men and women who visited the San Francisco municipal sexually transmitted disease clinic between 1989 and 1992, using blinded HIV seroprevalence data. Temporal changes in sexual behavior were evaluated by abstracting self-reported information on sexual behaviors from a random sample of charts of men who visited the clinic between 1990 and 1992. From 1989 to 1992, HIV seropositivity declined from 2.0% to 1.0% among women (p = 0.06) and from 18.9% to 12.0% (p < 0.001) among men. The percentage of patients who reported having anal intercourse in the previous year did not change significantly during the study period. The percentage of male patients who reported having vaginal intercourse during the previous year decreased from 82.9% to 78.6% (p < 0.05), and the percentage of male patients who reported engaging in receptive oral sex during the previous year increased from 24.0% to 41.6% (p < 0.001). The percentage of male patients who reported that they always used condoms increased from 31.8% to 49.2% for anal sex, from 8.7% to 19.5% for vaginal sex, and from 1.4% to 6.3% for oral sex (p < 0.05). Among patients visiting the sexually transmitted disease clinic, there was a steady and significant decline in HIV seroprevalence. The decline in HIV seroprevalence was accompanied by a significant trend toward safer sexual practices. However, by the end of the study period, less than half of the patients reported using condoms all of the time, which suggests that there is a need to expand behavioral interventions to focus on high-risk persons.


Subject(s)
HIV Seroprevalence/trends , Sexual Behavior/statistics & numerical data , Adult , Ambulatory Care Facilities , Chi-Square Distribution , Condoms/statistics & numerical data , Condoms/trends , Female , Humans , Logistic Models , Male , Middle Aged , Risk Factors , San Francisco/epidemiology , Surveys and Questionnaires
11.
Antimicrob Agents Chemother ; 37(8): 1670-3, 1993 Aug.
Article in English | MEDLINE | ID: mdl-8215281

ABSTRACT

Although women bear the brunt of gonococcal infection-related morbidity, few large studies of gonorrhea treatment in women have been conducted. In a multicenter, double-blind, placebo-controlled trial, 181 evaluable women with uncomplicated gonorrhea were treated with ciprofloxacin (250 mg orally; 94 women) or ceftriaxone (250 mg intramuscularly; 87 women). Twenty-four percent of the participants were infected with antibiotic-resistant Neisseria gonorrhoeae. Cervical gonorrhea was cured in 100% (93 of 93) of the women treated with ciprofloxacin and 99% (83 of 84) receiving ceftriaxone. All pharyngeal (n = 5) or rectal (n = 20) infections treated with ciprofloxacin were cured, as were ceftriaxone-treated patients with pharyngeal (n = 6) or rectal (n = 21) infection. Geometric mean MICs (range) for 248 pretreatment isolates were: penicillin, 0.28 (0.015 to 8.0); tetracycline, 0.46 (0.06 to 4); ciprofloxacin, 0.003 (0.002 to 0.015); and ceftriaxone, 0.004 (0.001 to 0.125) microgram/ml. Both drugs were well tolerated. Despite the high prevalence of antibiotic-resistant gonococci in these populations, 250 mg of oral ciprofloxacin was as effective as an injection of ceftriaxone.


Subject(s)
Ceftriaxone/therapeutic use , Ciprofloxacin/therapeutic use , Gonorrhea/drug therapy , Neisseria gonorrhoeae , Adolescent , Adult , Ceftriaxone/adverse effects , Ciprofloxacin/adverse effects , Double-Blind Method , Drug Administration Schedule , Female , Follow-Up Studies , Humans , Injections, Intramuscular , Microbial Sensitivity Tests , Middle Aged , Neisseria gonorrhoeae/drug effects , Prospective Studies
12.
J Infect Dis ; 167(5): 1106-11, 1993 May.
Article in English | MEDLINE | ID: mdl-8098052

ABSTRACT

Restriction fragment length polymorphism (RFLP) and plasmid analyses were used to evaluate an outbreak of Haemophilus ducreyi in San Francisco. Fifty-four cases of culture-confirmed chancroid occurred between May 1989 and May 1991. Of these, 46 (96%) were in men and 35 (65%) were in blacks; the median age of patients was 34 years. Among the 32 isolates submitted for RFLP and plasmid analyses, six different HindIII RFLP patterns were identified. Two RFLP types were found in patients who had recently traveled to Los Angeles, Korea, or El Salvador. Four RFLP types appeared to be acquired locally and were more common among blacks (P = .002), in patients with a history of a sexually transmitted disease (P = .01), and in those who used drugs or exchanged drugs or money for sex (P = .08). The use of RFLP analysis confirmed that this outbreak was associated with multiple strains of H. ducreyi and allowed for the identification of risk factors for locally acquired chancroid.


Subject(s)
Chancroid/epidemiology , Disease Outbreaks , Haemophilus ducreyi/genetics , Adolescent , Adult , Aged , Chancroid/microbiology , Chancroid/physiopathology , Demography , Female , Humans , Male , Middle Aged , Plasmids , Polymorphism, Restriction Fragment Length , Retrospective Studies , San Francisco/epidemiology
13.
Am J Epidemiol ; 137(6): 600-8, 1993 Mar 15.
Article in English | MEDLINE | ID: mdl-8470661

ABSTRACT

To compare the seroprevalence of and risk factors for human immunodeficiency virus infection (HIV) among patients attending a public sexually transmitted disease clinic, the authors conducted both voluntary and blinded seroprevalence surveys between June 1989 and August 1990. For the voluntary survey, every twenty-fifth patient attending the clinic for a new problem was invited to receive anonymous testing for HIV antibody. For the blinded survey, sera obtained for syphilis serologies from 2,297 (86%) of the 2,682 patients attending the clinic for a new problem were tested for HIV antibody after all personal identifiers were removed. Of the 946 eligible patients, 631 (66.7%) agreed to participate in the voluntary survey. Black men were significantly less likely to participate than other men and women (p < 0.0001). The prevalence of HIV antibody was 25% greater in the blinded survey than in the voluntary survey (15.2% and 11.4%, respectively, p < 0.05). This difference was due primarily to black homosexual/bisexual men, who had a 12.7-fold greater risk of HIV infection in the blinded survey than in the voluntary survey. These results suggest that blinded seroprevalence surveys may provide a better prevalence estimate of HIV infection than voluntary surveys. The greater risk for HIV infection observed among homosexual and bisexual black men, who were tested only in the blinded serosurvey, suggests that efforts to increase voluntary testing for HIV infection in this group should be developed.


Subject(s)
HIV Seroprevalence , HIV-1 , Sexually Transmitted Diseases/epidemiology , Adolescent , Adult , Ambulatory Care Facilities , Epidemiologic Methods , Female , HIV Infections/epidemiology , Humans , Male , Prevalence , San Francisco/epidemiology
14.
Int J Epidemiol ; 21(1): 155-62, 1992 Feb.
Article in English | MEDLINE | ID: mdl-1544747

ABSTRACT

Portions of sub-Saharan Africa are subject to major epidemics of meningococcal meningitis that require early detection and rapid control. We evaluated the usefulness of weekly meningitis rates derived from active surveillance data in Burkina Faso for detecting a meningitis epidemic. By analysing the rates of disease in 40 x 40km2 areas within a study region of Burkina Faso, we found that a threshold of 15 cases/100,000/week averaged over 2 weeks was 72-93% sensitive and 92-100% specific in detecting epidemics exceeding 100 cases/100,000/year. During epidemic periods, the positive predictive value of this threshold approached 100% for detecting local epidemics. Additionally, meningitis incidence was proportional to village size, with villages greater than 8000 having the highest disease rates during a major group A meningococcal epidemic in 1983-1984. Despite the rudimentary nature of surveillance data available in many developing countries, these data can be used to detect the early emergence of meningitis epidemics. Additional studies are needed to determine the relevance of this approach for detecting epidemics.


Subject(s)
Disease Outbreaks/statistics & numerical data , Meningitis, Meningococcal/epidemiology , Burkina Faso/epidemiology , Humans , Incidence , Meningitis, Meningococcal/prevention & control , Population Density , Population Surveillance , Retrospective Studies , Vaccination
15.
Sex Transm Dis ; 19(1): 7-13, 1992.
Article in English | MEDLINE | ID: mdl-1561589

ABSTRACT

In contrast to rates for the United States as a whole, the incidence rate of gonorrhea increased 11% in San Francisco between 1986 and 1988, with substantial increases observed among black adolescents. Reports by health department personnel and police suggested that crack cocaine use, specifically the exchange of sex for drugs, contributed to this increase. To test this hypothesis, the authors conducted a case-control study from August 1988 to October 1988 that compared 68 prospectively identified adolescent gonorrhea patients with 136 neighborhood control patients. Thirty-two percent of the female gonorrhea patients had received money or drugs in exchange for sex, while none of the control patients reported having done so (P = 0.0001). Most of the female patients (89%) who had received money or drugs in exchange for sex had used crack. Crack use was less common among female patients who denied receiving money or drugs in exchange for sex (11%) and among control patients (6%). Crack use and providing money or drugs in exchange for sex were not risk factors for gonorrhea among the male patients, but were reported frequently by both gonorrhea patients and control patients. Not living with parents was a risk factor for male patients (odds ratio 4.9, 95% confidence limit 1.4 to 19.5). For all patients, a history of a sexually transmitted disease appeared to be an independent risk factor for gonorrhea. The conclusion is made that crack-related exchange of sex for money or drugs is a risk factor for gonorrhea among black adolescent girls in San Francisco.(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Black or African American , Crack Cocaine , Gonorrhea/epidemiology , Adolescent , Female , Humans , Male , Risk Factors , San Francisco/epidemiology , Sex Work , Sexual Behavior
16.
Am J Epidemiol ; 135(1): 41-7, 1992 Jan 01.
Article in English | MEDLINE | ID: mdl-1736659

ABSTRACT

Chlamydia trachomatis is the most prevalent sexually transmitted bacterial pathogen. Nevertheless, selective, rather than universal, screening for chlamydia has been recommended, largely because testing is expensive and requires considerable technical expertise. A total of 1,348 women in four family planning clinics in San Francisco, California, were screened from March 1987 to January 1988 to identify criteria for selective screening. Of these, 9.2% had a positive chlamydia test using direct fluorescence. Logistic regression analysis identified five factors associated with infection: age less than 25 years, cervical friability, single marital status, a new sexual partner within the past 3 months, and lack of barrier contraceptive use. No single risk factor or combination of risk factors had both a high sensitivity and a high positive predictive value for infection. While screening all women who were unmarried would detect 93% of those with chlamydia, the positive predictive value of 10.7% was not much higher than the overall prevalence. Conversely, screening all women with cervical friability, which had a positive predictive value of 23.2%, would only detect 11% of those with chlamydia. On the basis of the authors' findings, selective screening should not be used in high prevalence populations in which all women are at risk and should be screened for chlamydia.


Subject(s)
Chlamydia Infections/diagnosis , Chlamydia trachomatis , Genital Diseases, Female/diagnosis , Adolescent , Adult , Ambulatory Care Facilities , Chlamydia Infections/epidemiology , Family Planning Services , Female , Genital Diseases, Female/epidemiology , Humans , Middle Aged , Predictive Value of Tests , Prevalence , Risk Factors , San Francisco , Sensitivity and Specificity
17.
Appl Environ Microbiol ; 54(12): 3122-5, 1988 Dec.
Article in English | MEDLINE | ID: mdl-3223772

ABSTRACT

Infection of hemodialysis patients with nontuberculous mycobacteria (NTM) has been associated with water used in reprocessing hemodialyzers. This study was conducted to determine the prevalence of NTM and other bacteria in water samples collected over a 13-week period from 115 randomly selected dialysis centers in the United States. Total viable counts were determined by membrane filter assays; increased recovery of NTM was obtained by dosing a portion of each water sample with 1% formaldehyde (HCHO) before filtering. NTM were widely distributed and occurred with a high frequency in water supplies in dialysis centers. NTM were detected in water from 95 centers (83%), and 50% of all samples examined contained NTM. The results of this study support recommendations to use 4% HCHO or a chemical germicidal equivalent for disinfecting dialyzers that are to be reused.


Subject(s)
Mycobacterium/isolation & purification , Renal Dialysis/adverse effects , Water Microbiology , Water Supply , Disinfection , Formaldehyde , Mycobacterium Infections/etiology
18.
J Clin Microbiol ; 25(8): 1388-91, 1987 Aug.
Article in English | MEDLINE | ID: mdl-3497943

ABSTRACT

The validity of commercial latex agglutination kits for detection of Haemophilus influenzae type b and Streptococcus pneumoniae antigens in serum and urine specimens was studied. We tested serum and urine specimens from 44 patients with bacteremic pneumonia (23 S. pneumoniae, 13 H. influenzae type b, 11 other) with commercial latex agglutination kits (Directigen, Bactigen) for S. pneumoniae and H. influenzae type b antigens. All specimen samples were randomized and read blindly by two readers. Interreader reproducibility was 100%. The sensitivity and specificity of both kits for H. influenzae type b antigens in serum and urine were greater than 90%. None of the 24 urine samples from S. pneumoniae bacteremic patients were positive by either kit, although 6 ng of type 3 polysaccharide could be detected in spiked urine. Sensitivity for S. pneumoniae antigens in serum was 27% for Directigen and 38% for Bactigen. Specificity for S. pneumoniae antigens in serum was 95% for Directigen and 74% for Bactigen. The results suggest that the kits are useful in diagnosing H. influenzae type b pneumonia. However, the commercially available S. pneumoniae reagents tested appear to have limited utility for diagnosing S. pneumoniae pneumonia because both kits lack sensitivity and Bactigen lacks specificity, as well.


Subject(s)
Antigens, Bacterial/analysis , Haemophilus influenzae/immunology , Pneumonia, Pneumococcal/diagnosis , Pneumonia/diagnosis , Streptococcus pneumoniae/immunology , Acute Disease , Counterimmunoelectrophoresis , Haemophilus Infections/diagnosis , Humans , Latex Fixation Tests , Predictive Value of Tests , Reagent Kits, Diagnostic , Sepsis/diagnosis
19.
Lancet ; 2(8447): 114-8, 1985 Jul 20.
Article in English | MEDLINE | ID: mdl-2862316

ABSTRACT

Sequential case-control studies were used to monitor changes in the clinical protection induced by group A meningococcal polysaccharide vaccine over a 3-year period. Overall, vaccine efficacy declined from 87% 1 year after vaccination to 70% and 54% at 2 and 3 years, respectively. When stratified by age at time of vaccination the data showed that, although vaccine efficacy remained high in children greater than or equal to 4 years of age (vaccine efficacy 85%, 74%, and 67% at 1, 2, and 3 years after vaccination, respectively), it declined dramatically in those less than 4 years of age at time of vaccination (vaccine efficacy 100%, 52%, and 8%, respectively, at 1, 2, and 3 years after vaccination). Thus, a single dose of group A meningococcal vaccine does not yield lasting clinical protection in children less than 4 years of age.


Subject(s)
Bacterial Vaccines , Meningitis, Meningococcal/prevention & control , Polysaccharides, Bacterial/immunology , Adolescent , Age Factors , Child , Child, Preschool , Female , Humans , Infant , Male , Meningitis, Meningococcal/epidemiology , Meningococcal Vaccines , Vaccination
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