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1.
Sex Transm Dis ; 50(8): 536-542, 2023 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-37213194

RESUMO

BACKGROUND: Shifts in public health infrastructure to respond to one emerging health threat may have unanticipated consequences for preexisting diseases. Previous research evaluating the impact of COVID-19 on sexually transmitted infections (STIs) has been conducted nationally, with little exploration of the impact on a granular geospatial level. This ecological study seeks to quantify the association between COVID-19 cases or deaths and chlamydia, gonorrhea, and syphilis cases for all US counties in 2020. METHODS: Separate, adjusted multivariable quasi-Poisson models with robust standard errors modeled the county-level association between 2020 COVID-19 cases and deaths per 100,000 and 2020 chlamydia, gonorrhea, or syphilis cases per 100,000. Models were adjusted for sociodemographic characteristics. RESULTS: Every 1000 additional COVID-19 cases per 100,000 was associated with a 1.80% increase in the average number of chlamydia cases ( P < 0.001) and a 5.00% increase in the average number of gonorrhea cases ( P < 0.001). Every 1000 additional COVID-19 deaths per 100,000 was associated with a 57.9% increase in the average number gonorrhea cases ( P < 0.001) and a 74.2% decrease in the average number of syphilis cases ( P = 0.004). CONCLUSIONS: Higher rates of COVID-19 cases and deaths were associated with increased rates of some STIs at the US county level. The underlying reasons for these associations could not be established by this study. The emergency response to an emerging threat may have unanticipated influence on preexisting diseases that varies by level of governance.


Assuntos
COVID-19 , Infecções por Chlamydia , Gonorreia , Infecções por HIV , Infecções Sexualmente Transmissíveis , Sífilis , Estados Unidos/epidemiologia , Humanos , Gonorreia/epidemiologia , Sífilis/epidemiologia , Infecções por Chlamydia/epidemiologia , COVID-19/epidemiologia , Infecções Sexualmente Transmissíveis/epidemiologia
2.
BMC Geriatr ; 22(1): 828, 2022 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-36307754

RESUMO

BACKGROUND: Among older adults, postoperative urinary tract infection is associated with significant harms including increased risk of hospital readmission and perioperative mortality. While risk of urinary tract infection is known to increase with age, the independent association between frailty and postoperative urinary tract infection is unknown. In this study we used 2014-2018 data from the U.S. National Surgical Quality Improvement Program (NSQIP) to investigate whether frailty is an independent risk factor for postoperative urinary tract infection, controlling for age and other relevant confounders. METHODS: Frailty was assessed using the modified Frailty Index. Postoperative urinary tract infection was defined as any symptomatic urinary tract infection (of the kidneys, ureters, bladder, or urethra) developing within 30 days of the operative procedure. To examine associations between frailty and other specific factors and postoperative urinary tract infection, chi squared tests, students t-tests, and logistic regression modelling were used. RESULTS: Urinary tract infection was identified after 22,356 of 1,724,042 procedures (1.3%). In a multivariable model controlling for age and other patient and surgical characteristics, the relative odds for urinary tract infection increased significantly with increasing frailty score. For example, compared to a frailty score of 0, the relative odds for urinary tract infection for a frailty score of 3 was 1.50 (95% confidence interval 1.41, 1.60). The relative odds associated with the maximum frailty score (5) was 2.50 (95% confidence interval 1.73, 3.61). CONCLUSIONS: Frailty is associated with postoperative urinary tract infection, independent of age. Further research should focus on the underlying mechanisms and strategies to mitigate this risk among frail adults.


Assuntos
Fragilidade , Infecções Urinárias , Humanos , Idoso , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Fragilidade/complicações , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Readmissão do Paciente , Fatores de Risco , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Estudos Retrospectivos
3.
Nat Commun ; 12(1): 6909, 2021 11 25.
Artigo em Inglês | MEDLINE | ID: mdl-34824209

RESUMO

There is an urgent need for innovative methods to reduce transmission of bloodborne pathogens like HIV and HCV among people who inject drugs (PWID). We investigate if PWID who acquire non-pathogenic bloodborne viruses like anelloviruses and pegiviruses might be at greater risk of acquiring a bloodborne pathogen. PWID who later acquire HCV accumulate more non-pathogenic viruses in plasma than matched controls who do not acquire HCV infection. Additionally, phylogenetic analysis of those non-pathogenic virus sequences reveals drug use networks. Here we find first in Baltimore and confirm in San Francisco that the accumulation of non-pathogenic viruses in PWID is a harbinger for subsequent acquisition of pathogenic viruses, knowledge that may guide the prioritization of the public health resources to combat HIV and HCV.


Assuntos
Infecções Transmitidas por Sangue , Plasma , Transtornos Relacionados ao Uso de Substâncias , Viroma , Adulto , Sequência de Aminoácidos , Anelloviridae , Patógenos Transmitidos pelo Sangue , Feminino , Hepatite C/epidemiologia , Humanos , Conhecimento , Masculino , Metagenômica , Filogenia , Saúde Pública , Adulto Jovem
4.
Clin Infect Dis ; 70(4): 615-627, 2020 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-30921452

RESUMO

BACKGROUND: Whether human immunodeficiency virus (HIV) infection impacts gut microbial α-diversity is controversial. We reanalyzed raw 16S ribosomal RNA (rRNA) gene sequences and metadata from published studies to examine α-diversity measures between HIV-uninfected (HIV-) and HIV-infected (HIV+) individuals. METHODS: We conducted a systematic review and individual level meta-analysis by searching Embase, Medline, and Scopus for original research studies (inception to 31 December 2017). Included studies reported 16S rRNA gene sequences of fecal samples from HIV+ patients. Raw sequence reads and metadata were obtained from public databases or from study authors. Raw reads were processed through standardized pipelines with use of a high-resolution taxonomic classifier. The χ2 test, paired t tests, and generalized linear mixed models were used to relate α-diversity measures and clinical metadata. RESULTS: Twenty-two studies were identified with 17 datasets available for analysis, yielding 1032 samples (311 HIV-, 721 HIV+). HIV status was associated with a decrease in measures of α-diversity (P < .001). However, in stratified analysis, HIV status was associated with decreased α-diversity only in women and in men who have sex with women (MSW) but not in men who have sex with men (MSM). In analyses limited to women and MSW, controlling for HIV status, women displayed increased α-diversity compared with MSW. CONCLUSIONS: Our study suggests that HIV status, sexual risk category, and gender impact gut microbial community α-diversity. Future studies should consider MSM status in gut microbiome analyses.


Assuntos
Microbioma Gastrointestinal , Infecções por HIV , Minorias Sexuais e de Gênero , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Homossexualidade Masculina , Humanos , Masculino , RNA Ribossômico 16S/genética
5.
BMJ Open ; 9(3): e023453, 2019 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-30837248

RESUMO

OBJECTIVES: Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) increase the risk of HIV transmission among men who have sex with men (MSM). Diagnosis of NG/CT may provide an efficient entry point for prevention of HIV through the delivery of pre-exposure prophylaxis (PrEP); however, the additional population-level impact of targeting PrEP to MSM diagnosed with NG/CT is unknown. DESIGN: An agent-based simulation model of NG/CT and HIV cocirculation among MSM calibrated against census data, disease surveillance reports and the US National HIV Behavioral Surveillance study. SETTING: Baltimore City, Maryland, USA. INTERVENTIONS: PrEP implementation was modelled under three alternative scenarios: (1) PrEP delivery at NG/CT diagnosis (targeted delivery), (2) PrEP evaluation at NG/CT screening/testing and (3) PrEP evaluation in the general community (untargeted). MAIN OUTCOME: The projected incidence of HIV after 20 years of PrEP delivery under two alternatives: when equal numbers of MSM are (1) screened for PrEP or (2) receive PrEP in each year. RESULTS: Assuming 60% uptake and 60% adherence, targeting PrEP to MSM diagnosed with NG/CT could reduce HIV incidence among MSM in Baltimore City by 12.4% (95% uncertainty range (UR) 10.3% to 14.4%) in 20 years, relative to no PrEP. Expanding the coverage of NG/CT screening (such that individuals experience a 50% annual probability of NG/CT screening and evaluation for PrEP on NG/CT diagnosis) can further increase the impact of targeted PrEP to generate a 22.0% (95% UR 20.1% to 23.9%) reduction in HIV incidence within 20 years. When compared with alternative implementation scenarios, PrEP evaluation at NG/CT diagnosis increased impact of PrEP on HIV incidence by 1.5(95% UR 1.1 to 1.9) times relative to a scenario in which PrEP evaluation happened at the time of NG/CT screening/testing and by 1.6 (95% UR 1.2 to 2.2) times relative to evaluating random MSM from the community. CONCLUSIONS: Targeting MSM infected with NG/CT increases the efficiency and effectiveness of PrEP delivery. If high levels of sexually transmitted infection screening can be achieved at the community level, NG/CT diagnosis may be a highly effective entry point for PrEP initialisation.


Assuntos
Infecções por Chlamydia/diagnóstico , Gonorreia/diagnóstico , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/estatística & dados numéricos , Profilaxia Pré-Exposição , Adolescente , Adulto , Idoso , Infecções por Chlamydia/epidemiologia , Gonorreia/epidemiologia , Infecções por HIV/epidemiologia , Humanos , Incidência , Masculino , Maryland/epidemiologia , Pessoa de Meia-Idade , Modelos Teóricos , Comportamento Sexual , Minorias Sexuais e de Gênero , Adulto Jovem
6.
Int J STD AIDS ; 28(4): 330-344, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27101993

RESUMO

Many individuals remain sexually active into their eighth decade. Surveillance data suggest that rates of sexually transmitted infections in older patients are increasing. We compared demographics, risk behaviors, and predictors of acute infections in patients 50 years and older versus younger patients attending sexually transmitted disease clinics in Baltimore, Maryland. This was a retrospective study from a large electronic database of visits to two urban sexually transmitted disease clinics between 2005 and 2010. Proportions were compared using the Chi square test. Logistic regression was used to assess predictors of acute sexually transmitted infections in older versus younger groups. It was found that patients over 50 were more likely than younger patients to report never using condoms (32.6% [CI 0.31-0.34] versus 24.1% [CI 0.23-0.25]). The overall prevalence of acute sexually transmitted infections was 18.1% (CI 0.17-0.19) in older and 25.8% (CI 0.25-0.27) in younger patients. Older women were more likely to be diagnosed with trichomoniasis (21.5% [CI 18.6-24.5] versus 13.1% [CI 11.5-14.8]). Black race was predictive of having an acute sexually transmitted infections in younger men (OR 2.2 [CI 1.47-3.35]) and women (OR 2.7 [CI 1.34-5.30]) but not in older men (OR 1.2 [CI 0.79-1.73]) or women (OR 1.2 [CI 0.43-3.15]). Older age was associated with a decreased risk of acute STI diagnosis in younger men and older women only, while having had sex for money or drugs in the past month was predictive only in younger women. Reporting symptoms and increasing numbers of sexual partners in the last six months was predictive of acute sexually transmitted infection diagnosis in all age groups. Older patients seeking care at sexually transmitted disease clinics engage in important risk behaviors. Race, a factor predictive of acute sexually transmitted infections in younger patients is not a significant predictor of sexually transmitted infections in older persons.


Assuntos
Infecções Sexualmente Transmissíveis/epidemiologia , Adulto , Baltimore/epidemiologia , Preservativos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Assunção de Riscos , Comportamento Sexual , Parceiros Sexuais , Adulto Jovem
7.
Sex Transm Dis ; 43(8): 519-23, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27419818

RESUMO

Ocular syphilis, a form of neurosyphilis, has been increasingly diagnosed in the United States. This case series summarizes the course of 6 patients recently diagnosed with ocular syphilis, emphasizing the varied sociodemographic factors and the wide range of symptoms and outcomes that are seen in patients with this disease.


Assuntos
Infecções Oculares Bacterianas/diagnóstico , Neurossífilis/diagnóstico , Treponema pallidum/isolamento & purificação , Adulto , Infecções Oculares Bacterianas/microbiologia , Infecções Oculares Bacterianas/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurossífilis/microbiologia , Neurossífilis/patologia , Sorodiagnóstico da Sífilis , Estados Unidos
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