HIV infection of women in African countries

BACKGROUND: The increase in human immunodeficiency virus infection among women of childbearing age increases the potential risk for vertical transmission of infection to their newborns. AIM: This paper discusses literature reviewed on human immunodeficiency virus infection of women in Africa with reference to Ghana, West Africa. The paper provides an epidemiological overview of human immunodeficiency virus infection of women in Ghana and Africa and the potential risk for vertical transmission and associated contributing factors. Literature reviewed was retrieved from the Cumulative Index of Nursing and Allied Health Literature and United States National Library of Medicine databases. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Findings from the review of literature suggest that human immunodeficiency virus infection of African women is a major public health problem which must be addressed and considered a priority in the next decade. Leadership in African countries including nurses and policy-makers will have to do more to make a difference to the epidemic. Measures to reduce transmission of human immunodeficiency virus are discussed.     

湖州市门诊妇女HPV感染亚型的基因芯片检测及分析

目的了解湖州市门诊妇女人乳头瘤病毒（HPV）感染状况和感染型别,为宫颈癌的防治提供理论依据。方法对414例湖州市门诊妇女宫颈分泌物应用基因芯片技术进行18种高危型和5种低危型HPV亚型检测。结果414例妇女中共检出HPV阳性97例,占23.43%,其中单一感染76例,占18.35%;双重感染17例,占4.11%;三重及以上感染4例,占0.97%。97例阳性患者中有高危型HPV感染的为80例,占HPV总阳性人数的82.47%。阳性患者中高危型以16、18、33为主,检出率分别为4.35%、2.17%、2.17%;低危型以6、11型为主,检出率分别为1.69%和1.45%。结论湖州市门诊妇女HPV感染有相当比例,且高危型HPV感染率在总阳性患者中所占比例较高。因此,对门诊妇女有必要进行HPV感染筛查,及早发现高危人群,并进行随访和相应治疗,以降低宫颈癌的发病风险。     

Influenza complicating pregnancy

Influenza is a highly contagious acute respiratory infection that is of major clinical importance both in Japan and worldwide. This infection usually is not life-threatening in otherwise healthy adults, but pregnant women do not tolerate serious pulmonary involvement. In previous reports of influenza pandemics, pregnant women have experienced increased risk of morbidity and mortality compared to non-pregnant women. In addition, mothers with severe respiratory infections may have an increased risk of preterm labor. Vaccination against influenza is recommended for all women who will be pregnant during the influenza season to prevent the occurrence of influenza and the development of pneumonia. There is no firm evidence that maternal infection is associated with an increased risk of spontaneous abortion, stillbirth, or congenital anomalies. However, an infant delivered to an acutely infected patient may develop neonatal influenza as a result of close personal contact with its mother.     

Role of women in prevention and control of AIDS

Women in India and AIDS prevention and control are discussed in terms of vulnerability, victimization, required knowledge, reproductive impact, care and prevention after birth, and the demands of the prevailing situation. A WHO world estimate is that 3 million women of childbearing age are infected with HIV out of 8-10 million. Indian women are vulnerable because of their reduced status and lack of power in private and marital life. Also, pregnant women receive blood transfusions, which may be inadequately screened, for anemia. The use of oral contraceptives with estrogen reduces immunity. The use of IUDs may cause inflammation or injury which provides a point of entry for HIV into the bloodstream. Prostitution is an outlet for lack of money, education, and skills, and places women at risk. The transmission from men to women is higher than the reverse. Every women should know their risks and modes of transmission. Women need to know that the risk of fetal infection from an HIV-positive mother is 20-40%, and that the risk is highest if HIV infection occurs or AIDS symptoms occur during pregnancy. Infant mortality from HIV may occur within the 1st several years. The following needs to be understood about reproduction and HIV: the risk of infection is very high when impregnated by an HIV male partner, and if children are desired, artificial insemination should be the preferred method. The reverse holds true, because penetrative sex without a condom allows transmission of the virus. The best option is for avoidance of childbearing if a partner has HIV. Abortion should be provided. Women need to develop the skills in language and confidence to negotiate safer sex, should be particular about choosing a loyal partner, and protect themselves by urging male condom use. The mode of transmission to babies is not from cuddling or handling. Breast feeding carries a meager risk of transmission, and should be continued if HIV infection occurs; the baby should be immunized. All health workers should receive training in order to provide support and care to mother and child in a private and confidential manner. Traditional healers have a role in providing advice on AIDS and condoms, spiritual support, and in changing behavior. Peer counseling is an important strategy for teenagers. There is a great need from society,husbands, and family to change the views of women and sex and to support women. Testing and screening of pregnant women in whom HIV infection is suspected is recommended.     

Urine culture after treatment of uncomplicated cystitis in women

The follow-up urine culture for urinary tract infection (UTI) is widely recommended, but it is done relatively infrequently in everyday practice. We thought an investigation of its effectiveness was warranted. The study population consisted of 141 women with a culture-proven symptomatic lower UTI. Of these, 56.7% (80) had a follow-up culture and 43.3% (61) did not. The two groups were found to be comparable in important parameters of risk for urinary tract infection and its complications. The relative risk of a subsequent symptomatic UTI was 0.5 for women who did not obtain a follow-up urine culture (95% confidence interval = 0.2 to 1.5). The follow-up urine culture in asymptomatic, healthy women may be unjustified.     

Seroprevalence of human immunodeficiency virus infection in a prenatal population at high risk for HIV infection

To determine the seroprevalence of human immunodeficiency virus infection in prenatal patients at high risk for HIV infection we tested 513 women from December 1985 through July 1987 at an inner-city hospital in Atlanta, Georgia. Demographic and HIV risk information was collected from all seropositive women. Twenty-nine (6%) of the 513 women tested were positive for HIV on enzyme-linked immunosorbent assay and Western blot analysis. Twenty-six (90%) of seropositive women gave a history of intravenous drug use. Two (7%) had sexual partners known to have AIDS or AIDS-related complex (ARC), and one (3%) was Haitian. Seropositive women were at remarkable risk for other sexually transmitted diseases. The majority of pregnancies ended in term births. This serosurvey defines an obstetric population with a high seroprevalence, and has stimulated us to institute routine voluntary antepartum screening for HIV.     

Risk factors for sternal wound infection in men versus women.

BACKGROUND: Differences between men and women in complication rates after cardiac surgery have been reported. The rate of one of the most severe postoperative complications, sternal wound infection, has not been compared between the sexes. OBJECTIVE: To compare the frequencies of 21 risk factors for sternal wound infection between men and women. METHODS: Records of 306 patients who had cardiac surgery between 1989 and 1999 at 3 different hospitals in the southwestern and southeastern United States were reviewed for 21 risk factors. Of the 306 patients, 115 (25 women and 90 men) had experienced a sternal wound infection and 191 randomly selected patients (52 women and 139 men) had not. RESULTS: Three risk factors occurred at significantly different rates in men and women. Smoking and use of a single internal mammary artery for grafting were more common in men than women. Women were older than men at the time of cardiac surgery. Logistic regression analyses showed that the 3 dichotomous risk factors (use of single internal mammary artery for grafting, smoking, age > 70 years) that univariate analysis indicated were significantly related to sex could also be used to predict infection group. CONCLUSIONS: This study contributes to the awareness of the possible differences between men and women in the risk of sternal wound infection developing after cardiac surgery. Although 3 risk factors occurred at significantly different rates in men and women, further research is needed to determine the effects that these differences in risk factors may have on the occurrence of sternal wound infection in men and women.     

舟山群岛地区5412例妇女高危型人乳头状瘤病毒感染现状及其与宫颈病变关系研究

目的 调查舟山群岛地区妇女高危型人乳头状瘤病毒(high risk human papilloma virus,HR-HPV)感染现状及其与宫颈病变的关系。 方法 2008年7月至2011年10月,采用第二代杂交捕获(HC-Ⅱ)检测技术对5412例妇女进行HR-HPV病毒负荷量检测,对HR-HPV阳性感染者行阴道镜下宫颈活组织细胞病理学分析。结合人口学及流行病学资料进行危险因素分析。 结果 舟山地区妇女HR-HPV阳性感染率为20.01%(1083/5412),并随年龄增长呈下降趋势(PPP结论 舟山地区妇女HR-HPV感染阳性率及HR-HPV阳性者宫颈病变检出率均较高,有必要通过开展广泛的HR-HPV筛查和阳性者定期随访,及时发现宫颈病变。     

USPSTF recommendations for STI screening

Since 2000, the U.S. Preventive Services Task Force (USPSTF) has issued eight clinical recommendation statements on screening for sexually transmitted infections. This article, written on behalf of the USPSTF, is an overview of these recommendations. The USPSTF recommends that women at increased risk of infection be screened for chlamydia, gonorrhea, human immunodeficiency virus, and syphilis. Men at increased risk should be screened for human immunodeficiency virus and syphilis. All pregnant women should be screened for hepatitis B, human immunodeficiency virus, and syphilis; pregnant women at increased risk also should be screened for chlamydia and gonorrhea. Nonpregnant women and men not at increased risk do not require routine screening for sexually transmitted infections. Engaging in high-risk sexual behavior places persons at increased risk of sexually transmitted infections. The USPSTF recommends that all sexually active women younger than 25 years be considered at increased risk of chlamydia and gonorrhea. Because not all communities present equal risk of sexually transmitted infections, the USPSTF encourages physicians to consider expanding or limiting the routine sexually transmitted infection screening they provide based on the community and populations they serve.     

Exposure risks and tetanus immunization in women of family owned farms. Implications for occupational and environmental health nursing.

A sampling pool of 4,808 farms in 10 parishes across southeast Louisiana was used to examine the risk factors of farm women who engage in activities putting them at risk for tetanus and to examine the circumstances related to vaccination. Data were collected, via stratified random sampling, in summer 1998 resulting in 657 completed interviews. Only 53.6% of women were current with a tetanus booster, having received their immunization within the past 10 years. Just as many women received tetanus vaccination following an injury or accident as for prevention. As women aged, they were less likely to be compliant. In the South, a number of environmental factors contribute to the risk for tetanus exposure and infection. These risk factors were examined in light of compliance with tetanus booster compliance. Increasing awareness of risk is essential because although tetanus is uncommon, the death rate from tetanus is greater than 30%.     

Sense of Coherence in Minority Women at Risk for HIV Infection

Abstract It is theorized that persons with strong sense of coherence are likely to define an event as less stressful and be able to manage a problem more successfully than those with weak sense of coherence. The study investigated the relationship among coherence and personal and environmental concerns, appraisal of threat, emotional distress, and high-risk behaviors in minority women at risk for human immunodeficiency (HIV) infection. As predicted, a significant negative relationship was seen between level of coherence and concerns. Moreover, women strong in coherence reported less negative appraisals of threat, less emotional distress, and fewer high-risk behaviors than those with weak coherence. Results of tests of a path model investigating the impact of coherence and appraisal on distress and risk revealed coherence to be significantly and negatively associated with appraisal, distress, and risk, both directly and indirectly through its association with appraisal. The path model accounted for 45% of the variance in distress, 10% of the variance in appraisal, and 4% of risk behavior. Continuing investigation of factors such as coherence that can lessen the seriousness of environmental stressors is imperative as it relates to women at risk for HIV infection.     

某地区女性泌尿生殖道感染患者人乳头瘤病毒感染现状调查

目的 研究该地区女性泌尿生殖道感染患者人乳头瘤病毒(HPV)感染状况及HPV阳性患者HPV基因型分布状况,确定该地区HPV感染的优势型别.方法 采用基因芯片技术对591例女性泌尿生殖道感染患者进行HPV检测.结果 检出HPV阳性者288例,检出率为48.73%;低危型感染116例,占40.28%,高危型141例,占48.96%,混合型感染31例,占10.76%;低危型感染以HPV6、11型为主,分别占48.28%、42.24%;高危型感染以HPV16型为主,占43.26%.HPV易感年龄阶段为20～＜40岁,占所有感染者的63.54%.结论 该地区女性泌尿生殖道感染患者HPV感染率较高,以高危型感染为主,且存在与低危型混合感染的可能.     

Antibody to Rmp (outer membrane protein 3) increases susceptibility to gonococcal infection.

The severe adverse effects of gonococcal infection on human fertility suggests that Neisseria gonorrhoeae would exert powerful selection for the development of a protective immune response in humans. N. gonorrhoeae is an obligate human pathogen and must persist in humans to survive. Since it is an ecologically successful organism, it must have evolved strategies to evade any human immune response it elicits. In a longitudinal study among 243 women working as prostitutes and experiencing frequent gonococcal infection, younger women, women with HIV infection, and women with antibody to the gonococcal outer membrane protein 3 (Rmp) were at increased risk of infection (adjusted odds ratio 3.4, CI95% 1.1-10.4, P < 0.05). Rmp is highly conserved in N. gonorrhoeae and the blocking of mucosal defences may be one of its functions. As similar proteins occur in many gram negative mucosal pathogens, the enhancing effect of such proteins may be a general strategy whereby bacteria evade human immune responses.     

The Relationship Between Black Race,Maternal Infection and NEC in the Preterm Infant

Higher rates of necrotizing enterocolitis (NEC) in black preterm infants have been attributed to the higher rates of preterm delivery in this population. The focus however has been on preterm infant risk factors with minimal investigation into the contribution of antepartum differences among black women and how they may contribute to poorer outcomes in the black preterm infant. Retrospective cohort controlled study design examined the relationship between maternal infection, preterm infant infection, race and NEC. Black women were found to experience an increased number of maternal infections when compared to white and Hispanic women. Of the black mothers who experienced infection during pregnancy their preterm infants had a more cycles of antibiotic administration than white and Hispanic infants. Preterm infants who experienced increased exposure to antibiotics had higher risk for necrotizing enterocolitis.     

浙江省温州地区部分体检女性人乳头状瘤病毒基因型的分布

目的 了解浙江省温州地区健康体检女性人乳头状瘤病毒（HPV）感染情况、基因分型及其年龄分布状况，为宫颈癌防治提供参考依据。方法 选择2014年6月至2016年5月在温州医科大学附属第二医院体检中心进行体检的4 089名妇女作为研究对象，根据年龄分为5组，采用流式荧光杂交技术对宫颈脱落细胞标本进行HPV基因分型检测，并对HPV感染率、基因亚型和年龄分布等进行统计分析。结果 4 089名妇女中共检出HPV阳性763例，总感染率为18.66%（763/4 089）。共检出27种亚型，单一亚型感染596例（14.58%，596/4 089），多重感染167例（4.08%，167/1 089），多重感染中以二重感染最常见（78.44%，131/167）。共检出高危型感染575例（14.06%，575/4 089），低危型感染257例（6.29%，257/4 089），高低危型混合感染69例（1.69%，69/4 089）。高危型中52型感染率最高，达18.87%（144/575），其次为53型（9.96%，76/575）、16型（8.91%，68/575）和58型（8.13%，62/575）；低危型感染率前3名分别为81型（7.73%，59/257）、61型（6.16%，47/257）和55型（5.77%，44/257）。不同年龄组HPV总感染率、多重感染率、高危型感染率差异均有统计学意义（2=18.882、19.517、21.113，均P0.01），随着年龄增长，HPV感染率有逐渐增加的趋势，其中59岁及以上年龄组总感染率、多重感染率和高危型感染率均高于其他年龄组。结论 浙江省温州地区HPV感染具有明显的亚型和年龄分布特异性。     

Toxoplasmosis in pregnancy: an emerging concern for family physicians.

Toxoplasmosis is usually asymptomatic in pregnant women but poses a risk of severe effects on the fetus. One to eight of every 1,000 pregnant women become infected, and the infection is transmitted to the fetus in approximately 40 percent of these cases. The risk of transmission rises with increasing gestational age at the time of initial infection. Congenital infection with toxoplasmosis may lead to serious sequelae, such as blindness, mental retardation, neurologic deficits and deafness. Prevention of morbidity from toxoplasmosis depends on prevention of the infection in pregnant women, plus early recognition and aggressive treatment of maternal infections.     

New developments in the diagnosis of maternal and congenital CMV infection

Recent advances in the screening of pregnant women with Cytomegalovirus (CMV) IgM, CMV IgG and CMV IgG avidity serologic tests, has led to a more accurate diagnosis of CMV infection. When serologic screening is performed early in gestation, it is possible to identify those women at risk of intrauterine transmission of the virus, i.e., those women with a primary CMV infection, who should be enrolled in prenatal diagnosis. The use of quantitative PCR on amniotic fluid from pregnant women at 21-22 weeks of gestation in prenatal diagnosis is an effective diagnostic tool to distinguish between CMV infection and CMV disease in the fetus and newborn. Quantitative PCR on peripheral blood leukocytes from CMV infected newborns can be used to monitor viral load, especially during treatment with ganciclovir. These advances in serology and quantitative virology should lead to more accurate diagnosis of maternal and congenital CMV infection.     

Congenital rubella syndrome

Rubella (German measles) is a common viral infection in children and adults. It is usually a mild disease with few complications and resultant sequelae. Maternal infection with rubella, however, can cause severe congenital defects, known as congenital rubella syndrome. Although the incidence of rubella has declined, about 15 percent of women of childbearing age remain at risk for rubella. About one third of fetuses are infected from maternal rubella infection. The risk of fetal damage is directly related to the occurrence of the maternal infection with greater risk present in the first trimester of pregnancy. The most important area of primary health care delivery by the nurse clinician is prevention. Routine rubella serologic testing and immunization, if required, of women of childbearing age is essential to the elimination of congenital rubella syndrome.