Efectividad de las intervenciones estructurales para la promoción del uso del preservativo en adolescentes y jóvenes: revisión sistemática / Effectiveness of structural interventions to promote condom use in adolescents and young people: Systematic Review

RESUMEN Objetivo Evaluar la efectividad de las intervenciones de tipo estructural o multicomponente dirigidas al incremento del uso del preservativo en adolescentes y jóvenes, identificar las estrategias que conforman las intervenciones evaluadas y reconocer los modelos teóricos que sustentan dichas intervenciones. Metodología Diseño: revisión sistemática de la literatura. Fuente de datos: se consultaron las bases de datos MEDLINE vía OVID, Embase y CENTRAL para buscar estudios sobre intervenciones dirigidas al incremento del uso del preservativo en adolescentes y jóvenes. Selección de estudios: se seleccionaron un total de 7 investigaciones primarias donde se evaluaba el efecto de una intervención estructural o multicomponente para incrementar el uso del preservativo en adolescentes y jóvenes. La calidad de los estudios fue evaluada usando la herramienta para valoración de riesgo de sesgos de Cochrane. Resultados Cinco investigaciones mostraron cambios en los porcentajes del uso del preservativo con valores entre 53 % y el 68 %. Las intervenciones planteadas orientaban sus acciones más a nivel individual con estrategias como: educación sobre salud sexual, consejería en salud reproductiva, conocimientos acerca del preservativo, conocimientos acerca de las ITS/VIH. A nivel organizacional y del entorno iban dirigidas a la provisión de preservativos. Los modelos teóricos planteados en los estudios están centrados en la conducta humana, comportamiento del individuo y el aprendizaje social. Discusión Las intervenciones de tipo estructural que tienen como fin el incremento del uso del preservativo en adolescentes y jóvenes parecen mostrar cambios significativos a nivel individual, pero se desconocen los posibles cambios generados a nivel de la organización y del entorno.(AU)

ABSTRACT Objective Evaluate the effectiveness of structural or multicomponent interventions aimed at increasing the use of condoms in adolescents and young adults, identifying the strategies that form the interventions evaluated, and recognizing the theoretical models that support these interventions. Methodology Design: Systematic review of literature. Data source: MEDLINE databases were consulted via OVID, Embase, and CENTRAL in order to search for studies on interventions aimed at increasing the use of condoms in adolescents and young adults. Selection of studies: A total of 7 primary investigations were selected, in which the effect of a structured or multicomponent intervention to increase the use of condoms in adolescents and young adults was evaluated. The quality of the studies was evaluated using the Cochrane bias risk assessment. Results Five investigations show changes in the percentages of condom use with values between 53% and 68%. The interventions targeted guided their actions more at individual level with strategies such as sexual health education, reproductive health counseling, knowledge about the condom, knowledge about STIs / HIV, than at organizational and environ-mental levels, which were aimed at the provision of condoms. The theoretical models proposed in the studies are focused on human behavior, individual behavior, and social learning. Conclusion Structural interventions that aim to increase the use of condoms in adolescents and young adults seem to show significant changes at individual level, but possible changes generated at both organization and environment levels are unknown.(AU)

[Effectiveness of structural interventions to promote condom use in adolescents and young people: Systematic Review]. / Efectividad de las intervenciones estructurales para la promoción del uso del preservativo en adolescentes y jóvenes: revisión sistemática.

OBJECTIVE: Evaluate the effectiveness of structural or multicomponent interventions aimed at increasing the use of condoms in adolescents and young adults, identifying the strategies that form the interventions evaluated, and recognizing the theoretical models that support these interventions. METHODOLOGY: Design: Systematic review of literature. Data source: MEDLINE databases were consulted via OVID, Embase, and CENTRAL in order to search for studies on interventions aimed at increasing the use of condoms in adolescents and young adults. Selection of studies: A total of 7 primary investigations were selected, in which the effect of a structured or multicomponent intervention to increase the use of condoms in adolescents and young adults was evaluated. The quality of the studies was evaluated using the Cochrane bias risk assessment. RESULTS: Five investigations show changes in the percentages of condom use with values between 53% and 68%. The interventions targeted guided their actions more at individual level with strategies such as sexual health education, reproductive health counseling, knowledge about the condom, knowledge about STIs / HIV, than at organizational and environ-mental levels, which were aimed at the provision of condoms. The theoretical models proposed in the studies are focused on human behavior, individual behavior, and social learning. CONCLUSION: Structural interventions that aim to increase the use of condoms in adolescents and young adults seem to show significant changes at individual level, but possible changes generated at both organization and environment levels are unknown.

OBJETIVO: Evaluar la efectividad de las intervenciones de tipo estructural o multicomponente dirigidas al incremento del uso del preservativo en adolescentes y jóvenes, identificar las estrategias que conforman las intervenciones evaluadas y reconocer los modelos teóricos que sustentan dichas intervenciones. METODOLOGÍA: Diseño: revisión sistemática de la literatura. Fuente de datos: se consultaron las bases de datos MEDLINE vía OVID, Embase y CENTRAL para buscar estudios sobre intervenciones dirigidas al incremento del uso del preservativo en adolescentes y jóvenes. Selección de estudios: se seleccionaron un total de 7 investigaciones primarias donde se evaluaba el efecto de una intervención estructural o multicomponente para incrementar el uso del preservativo en adolescentes y jóvenes. La calidad de los estudios fue evaluada usando la herramienta para valoración de riesgo de sesgos de Cochrane. RESULTADOS: Cinco investigaciones mostraron cambios en los porcentajes del uso del preservativo con valores entre 53 % y el 68 %. Las intervenciones planteadas orientaban sus acciones más a nivel individual con estrategias como: educación sobre salud sexual, consejería en salud reproductiva, conocimientos acerca del preservativo, conocimientos acerca de las ITS/VIH. A nivel organizacional y del entorno iban dirigidas a la provisión de preservativos. Los modelos teóricos planteados en los estudios están centrados en la conducta humana, comportamiento del individuo y el aprendizaje social. DISCUSIÓN: Las intervenciones de tipo estructural que tienen como fin el incremento del uso del preservativo en adolescentes y jóvenes parecen mostrar cambios significativos a nivel individual, pero se desconocen los posibles cambios generados a nivel de la organización y del entorno.

Inflammatory aortic aneurysm: possible manifestation of IgG4-related sclerosing disease.

In this study, we investigate the hypothesis that IgG4-related autoimmune reaction is involved in the formation of inflammatory aortic aneurysms (IAA). We obtained 23 cases of IAA and 11 cases of atherosclerotic aortic aneurysms (AAA) as control group. We evaluated the expression of IgG4 in both IAA study cases and AAA control cases. In addition, immunohistochemical expression of C-Kit, CD21, CD34, S-100 protein, SMA, vimentin, p53, beta-catenin, and ALK-1, and EBV-LMP1 expression by in situ hybridization were performed only in IAA cases. Of the 23 patients, 20 were males and 3 were females (M: F ratio 6.7:1); age ranged from 43 to 81 years (average 64.3 years). Histologically, all 23 cases of IAA formed a mass that displayed inflammatory myofibroblastic tumor-like features. All lesions stained strongly and diffusely for vimentin and SMA (100%); 17 stained strongly and focally for CD34 (74%); and all were negative for C-Kit, CD21, S-100 protein, p53, beta-catenin, EBV-LMP1, and ALK-1. The numbers of infiltrating IgG4-positive plasma cells in IAA cases exceed that of AAA cases. Score 3 (>50 plasma cells/one 40X field) of IgG4-positive plasma cells was only seen in IAA cases (13/23, 57%), whereas none of the 11 cases of AAA showed score 3 IgG4-positive plasma cells (P=0.0018, Fischer's exact test). Our findings suggest that IAA may be an aortic manifestation of the IgG4-related sclerosing disease. The high number of positive plasma cells, >50 plasma cells/one 40X field is more specific for the IAA than for AAA; however, lesser number can be seen in both IAA and AAA patients.

Pathology of Black Creek Canal virus infection in juvenile hispid cotton rats (Sigmodon hispidus).

The purpose of this study was to assess the effect of inoculum dose on the pathogenesis of Black Creek Canal virus (BCCV) infection in the hispid cotton rat (Sigmodon hispidus), the principal host of BCCV. No sign of illness was observed in any of the 52 juvenile hispid cotton rats inoculated with 3.1, 1.1, -0.9, or -2.9 log(10) median infectious doses(VeroE6) (ID(50-VeroE6)) of BCCV and euthanized on day 9, 18, 27, or 54 postinoculation (PI). Analysis of virus assay and serological data indicated that inoculum dose could significantly affect the pathogenesis of BCCV infection in juvenile hispid cotton rats. For example, the six animals inoculated with 3.1 or 1.1 log(10) ID(50-VeroE6) and euthanized on day 54 PI were virus positive and antibody positive, whereas the six animals inoculated with -0.9 or -2.9 log(10) ID(50-VeroE6) and euthanized on day 54 PI were virus positive but antibody negative. Microscopic examination of tissues from the animals inoculated with 3.1 or 1.1 log(10) ID(50-VeroE6) revealed diffuse, subacute pneumonitis in the lungs of all the animals euthanized on day 18 PI or thereafter, and indicated that the severity of pneumonitis was dependent upon inoculum dose as well as duration of infection (i.e., amount of time elapsed since inoculation).

In utero drugs of abuse exposure testing for newborn twins.

This report describes testing of a case of in utero drugs of abuse exposure in which discordant results were seen between urine and meconium, and between twin meconium samples. The discordance between urine and meconium could be explained by the differences in detection window, threshold concentration and screening technology, and the discordance between dizygotic twin meconium samples could be explained by the differences in drug diffusion and placental and fetal biotransformation of drugs. The meconium sample of one twin screened negative for benzodiazepines was reported positive in the confirmation assay with higher sensitivity and a lower cut-off concentration. Negative screening results of drugs of abuse should be interpreted with caution, taking into account matrix type, reactivity of drugs in the assay and cut-off concentration. If screening results are inconsistent with each other or with the clinical scenario, confirmation testing using more sensitive and specific methods with lower cut-offs is warranted.

Cytodiagnosis in the autopsy suite: a tool for improving autopsy quality and resident education.

CONTEXT: Despite several publications attesting to its accuracy and value, cytology is rarely used for preliminary autopsy diagnosis in the United States. Postmortem cytodiagnosis has the potential to increase the accuracy and specificity of the provisional and final autopsy diagnoses, increase resident interest in cytodiagnostic techniques, and direct pathologists to request pertinent special studies, such as microbial cultures and special stains. OBJECTIVE: To assess and illustrate the value of cytodiagnostic techniques for improving autopsy quality assurance and resident education. DESIGN: Eighty-five samples were evaluated from 49 nonconsecutive autopsies. Sixty-five focal lesions were sampled by direct scraping. Diffuse lung consolidation was sampled by fine-needle aspiration (20 samples). Smears and cytocentrifuge preparations of fine-needle aspirations were routinely stained by both Papanicolaou and Romanowski methods. Cytologic diagnoses were compared with final autopsy diagnoses, and both cytology and pertinent histology were reviewed. RESULTS: Clinical or radiographic antemortem site-specific diagnoses had been made in 28 (33%) of the 85 samples. A definite diagnosis was made by postmortem cytology in 68 (80%) of 85 samples, and these diagnoses could contribute to provisional autopsy diagnosis in 46 instances (68%). Resident and faculty enthusiasm for the use of cytology in the autopsy suite has increased during the 7 years following the study. Case examples illustrating the benefits of postmortem cytology are provided. CONCLUSIONS: Postmortem cytology benefits both autopsy quality and resident education.

Pathologic features of Mycobacterium kansasii infection in patients with acquired immunodeficiency syndrome.

CONTEXT: Mycobacterium kansasii is a slow-growing photochromogenic mycobacterium that may infect patients with human immunodeficiency virus (HIV) late in the course of acquired immunodeficiency syndrome (AIDS). The clinical features of pulmonary and extrapulmonary infections have been described in the literature; however, the pathology of infection has not been adequately addressed. OBJECTIVE: This report describes the pathologic features of 12 cases of M kansasii infection in patients with AIDS. DESIGN: The medical records, autopsy protocols, cytologic material, and histologic material from patients with AIDS and concomitant M kansasii infection at a tertiary-care medical center during 1990-2001 were reviewed. RESULTS: Twelve cases were identified, 6 by autopsy, 5 of which were diagnosed postmortem. Four of the 12 cases had cytologic material and 4 cases had histologic biopsies available for review. Pulmonary infection was most common (9/12), and all patients in whom thoracic lymph nodes were assessed showed involvement (7/7). Abdominal infection was less frequent, with only 1 of 6, 2 of 6, and 2 of 6, demonstrating liver, spleen, and abdominal lymph node infection, respectively. Isolated infections without documented pulmonary infection included brain abscess (n = 1), ulnar osteomyelitis (n = 1), and paratracheal mass (n = 1). Cytologic and histologic material showed a wide range of inflammatory reactions, including granulomas with and without necrosis, neutrophilic abscesses, spindle-cell proliferations, and foci of granular eosinophilic necrosis. The M kansasii bacillus was characteristically long, coarsely beaded, and frequently showed folded, bent, or curved ends. Intracellular bacilli were randomly or haphazardly distributed within histiocytes. CONCLUSION: Mycobacterium kansasii infection produces predominantly pulmonary infection in late-stage AIDS with a high incidence of thoracic lymph node involvement and a much lower incidence of dissemination to other sites. Infection is manifest as a wide variety of inflammatory reactions on cytology and histology; however, the characteristic appearance of the bacillus on acid-fast bacilli stain and its intracellular arrangement in histiocytes can allow a presumptive identification.

Infection by Dipylidium caninum in an infant.

Dipylidium caninum, the dog tapeworm, is a cosmopolitan parasite of dogs and cats and occasionally causes human infection in the United States. Diagnosis is made by observing the characteristic rice grain-like proglottids in stool specimens and the pathognomonic egg packets in the gravid uterus in histologic sections of the parasite. There have been few reported cases of human infection with this parasite, and very little information on the pathology of this zoonotic disease is available in the English language. This report of a case of D caninum infection in a 6-month-old infant highlights the diagnostic features of this disease. To our knowledge, this is the first case to be reported in the American pathology literature during the last 36 years (MEDLINE database, 1966-2002).

Maporal viral infection in the Syrian golden hamster: a model of hantavirus pulmonary syndrome.

Hantavirus pulmonary syndrome (HPS) is a severe and often fatal rodent-borne zoonosis. Maporal (MAP) virus is a newly discovered hantavirus that originally was isolated from an arboreal rice rat captured in central Venezuela. The results of this study indicate that MAP virus in the Syrian golden hamster (Mesocricetus auratus) can cause a disease that is clinically and pathologically remarkably similar to HPS. The similarities include the time course of clinical disease, presence of virus-specific IgG at the onset of clinical disease, subacute pneumonitis, rapid onset of diffuse alveolar edema in the absence of necrosis, hepatic-portal triaditis, mononuclear-cellular infiltrate in lung and liver, widespread distribution of hantaviral antigen in endothelial cells of the microvasculature of lung and other tissues, and variable lethality. These similarities suggest that the MAP virus-hamster system is a useful model for studies of the pathogenesis of HPS and for the evaluation of potential therapeutic agents.

Expression of CD4 on peripheral blood granulocytes. a novel finding in a case of myelodysplastic syndrome in association with t(5;12).

Myelodysplastic syndromes (MDS) are associated with cell maturation defects that can manifest as abnormal surface antigen expression. We describe a patient with refractory anemia with excess blasts, who presented with infection and extensive dysplastic features in peripheral blood granulocytes. The granulocytes expressed CD11b, CD13, CD15, CD33, and CD43. The granulocytes also expressed CD4 antigen. Cytogenetic analysis showed a clonal t(5;12)(q33;p13). The patient improved on antibiotics with partial improvement in the dysplastic features. However, shortly after, the patient experienced paravertebral extramedullary blast transformation followed by a leukemia phase of acute monoblastic leukemia. The patient died a few days later. This is the first report describing anomalous expression of CD4 on granulocytes in MDS. Since the breakpoint on chromosome 12 is near the CD4 gene, which is mapped to 12p12, we hypothesize that dysregulation of the CD4 gene may have occurred resulting in its persistent expression on mature and maturing granulocytes.