Bacterial vaginosis diagnosed by analysis of first-void-urine specimens.

Bacterial vaginosis (BV) is traditionally diagnosed using vaginal samples. The aim of this study was to investigate whether BV can be diagnosed from first-void urine (FVU). Self-collected vaginal smears, vaginal swabs, and FVU were obtained from 176 women. BV was diagnosed by Nugent's criteria. The FVU and vaginal swabs were analyzed by quantitative PCRs (qPCRs) for selected vaginal bacteria (Atopobium vaginae, Prevotella spp., Gardnerella vaginalis, bacterial vaginosis-associated bacterium 2, Eggerthella-like bacterium, "Leptotrichia amnionii," Megasphaera type 1), and all had an area under the receiver operating characteristic (ROC) curve of >85%, suggesting good prediction of BV according to the Nugent score. All seven bacteria in FVU were significantly associated with BV in univariate analysis. An accurate diagnosis of BV from urine was obtained in this population by a combination of qPCRs for Megasphaera type 1 and Prevotella spp. The same two bacteria remained significantly associated with BV in a multivariate model after adjusting for the other five species. There was no statistically significant difference between the sensitivities and specificities of BV diagnosis by molecular methods performed on swabs and FVU samples. A linear regression analysis showed good agreement between bacterial loads from swabs and FVU, but Prevotella spp. could be detected in high numbers in a few FVU samples without being present in swabs. This method will allow diagnosis of BV in studies where only urine has been collected and where detection of BV is considered relevant.

Vaginal microbiome in women from Greenland assessed by microscopy and quantitative PCR.

BACKGROUND: Bacterial vaginosis (BV) is a common condition, although its aetiology remains unexplained. The aim of this study was to analyse the composition of vaginal microbiota in women from Greenland to provide a quantitative description and improve the understanding of BV. METHODS: Self-collected vaginal smears and swabs were obtained from 177 women. The vaginal smears were graded for BV according to Nugent's criteria. The vaginal swab samples were analysed by 19 quantitative PCRs (qPCRs) for selected vaginal bacteria and by PCR for four sexually transmitted infections (STIs). RESULTS: STIs were common: Mycoplasma genitalium 12%, Chlamydia trachomatis 7%, Neisseria gonorrhoeae 1%, and Trichomonas vaginalis 0.5%. BV was found in 45% of women, but was not associated with individual STIs. Seven of the 19 vaginal bacteria (Atopobium vaginae, Prevotella spp., Gardnerella vaginalis, BVAB2, Eggerthella-like bacterium, Leptotrichia amnionii, and Megasphaera type 1) had areas under the receiver operating characteristic (ROC) curve > 85%, suggesting they are good predictors of BV according to Nugent. Prevotella spp. had the highest odds ratio for BV (OR 437; 95% CI 82-2779) in univariate analysis considering only specimens with a bacterial load above the threshold determined by ROC curve analysis as positive, as well as the highest adjusted odds ratio in multivariate logistic regression analysis (OR 4.4; 95% CI 1.4-13.5). BV could be subdivided into clusters dominated by a single or a few species together. CONCLUSIONS: BV by Nugent score was highly prevalent. Two of seven key species (Prevotella spp. and A. vaginae) remained significantly associated with BV in a multivariate model after adjusting for other bacterial species. G. vaginalis and Prevotella spp. defined the majority of BV clusters.

Simplified contrast ultrasound accurately reveals muscle perfusion deficits and reflects collateralization in PAD.

BACKGROUND: Simplified contrast-enhanced ultrasound (CEUS) can be used to evaluate muscle perfusion in peripheral arterial disease (PAD). Here, we report its diagnostic accuracy for detecting symptomatic PAD. Additionally, we hypothesize that the extent of collateral formation is reflected by CEUS. METHODS: Ultrasound contrast agent was injected into an antecubital vein of 58 control subjects and 52 symptomatic PAD patients and its appearance in the calf muscle was evaluated. Interreader variability was tested using 118 raw data films. Arterial collateralization of PAD patients was assessed by angiographic imaging. RESULTS: PAD patients showed a significantly longer median time to peak intensity (TTP, 36.9s) than control subjects (19.4s, p<0.001) with longer TTPs in advanced PAD stages. The area under the receiver operating characteristic curve was 0.942 and the mean TTP difference between two blinded readers was 0.28s. A TTP cut off at 30.5s was associated with 91% positive predictive value. PAD patients with good collateralization showed a significantly shorter TTP (34.1s) than patients with poor collateralization (44.0 s, p=0.008) but not a higher ankle-brachial index (ABI). CONCLUSIONS: CEUS accurately displays perfusion deficits of the calf muscle in symptomatic PAD patients. The degree of arterial collateralization is reflected by CEUS and not by ABI.

Psychological and social predictors of changes in fruit and vegetable consumption over 12 months following behavioral and nutrition education counseling.

This study assessed psychological and social factors predicting 12-month changes in fruit and vegetable consumption achieved by 271 men and women from a low-income population randomized to brief behavioral and nutrition education counseling. Greater increases in fruit and vegetable intake were achieved in the behavioral than in the nutrition education condition (1.49 vs. 0.87 portions per day, p=.021). Increases were predicted by baseline social support for dietary change but not by baseline psychological measures. However, short-term (8-week) changes in dietary self-efficacy, encouragement, anticipated regret, perceived benefits, and knowledge of recommended intake predicted 12-month changes in fruit and vegetable consumption independently of gender, age, ethnicity, income, and baseline intake. These factors accounted for 51% of the superiority of behavioral counseling over nutrition education.

Psychological factors associated with fruit and vegetable intake and with biomarkers in adults from a low-income neighborhood.

Fruit and vegetable consumption is below recommended levels in the population, paricularly in low-income groups. This study assessed factors associated with self-reported intake and 2 biomarkers (potassium excretion and plasma vitamin C) in 271 adults living in a low-income neighborhood. Attitudinal barriers to change were negatively related to reported intake and to potassium excretion. Poor knowledge of recommended consumption was associated with low reported intake, low potassium excetion, and low plasma vitamin C concentration. Self-efficacy was related to reported intake but not to biomarkers. The authors conclude that several of the psychological factors associated with self-reported intake were also related to biomarkers in this population and that these may therfore be particularly appropriate targets for intervention.

Behavioural counselling to increase consumption of fruit and vegetables in low income adults: randomised trial.

OBJECTIVE: To measure the effect of brief behavioural counselling in general practice on patients' consumption of fruit and vegetables in adults from a low income population. DESIGN: Parallel group randomised controlled trial. SETTING: Primary health centre in a deprived, ethnically mixed inner city area. PARTICIPANTS: 271 patients aged 18-70 years without serious illness. INTERVENTION: Brief individual behavioural counselling based on the stage of change model; time matched nutrition education counselling. MAIN OUTCOME MEASURES: Self reported number of portions of fruit and vegetables eaten per day, plasma beta carotene, alpha tocopherol, and ascorbic acid concentrations, and 24 hour urinary potassium excretion. Assessment at baseline, eight weeks, and 12 months. RESULTS: Consumption of fruit and vegetables increased from baseline to 12 months by 1.5 and 0.9 portions per day in the behavioural and nutrition groups (mean difference 0.6 portions, 95% confidence interval 0.1 to 1.1). The proportion of participants eating five or more portions a day increased by 42% and 27% in the two groups (mean difference 15%, 3% to 28%). Plasma beta carotene and alpha tocopherol concentrations increased in both groups, but the rise in beta carotene was greater in the behavioural group (mean difference 0.16 micromol/l, 0.001 micromol/l to 1.34 micromol/l). There were no changes in plasma ascorbic acid concentrations or urinary potassium excretion. Differences were maintained when analysis was restricted to the 177 participants with incomes < or = pound 400 (596, $640) a week. CONCLUSIONS: Brief individual counselling in primary care can elicit sustained increases in consumption of fruit and vegetables in low income adults in the general population.