Where do people go for treatment of sexually transmitted diseases?

CONTEXT: Major public health resources are devoted to the prevention of sexually transmitted diseases (STDs) through public STD clinics. However, little is known about where people actually receive treatment for STDs. METHODS: As part of the National Health and Social Life Survey, household interviews were performed from February to September 1992 with 3,432 persons aged 18-59. Weighted population estimates and multinomial response methods were used to describe the prevalence of self-reported STDs and patterns of treatment utilization by persons who ever had a bacterial or viral STD. RESULTS: An estimated two million STDs were self-reported in the previous year, and 22 million 18-59-year-olds self-reported lifetime STDs. Bacterial STDs (gonorrhea, chlamydia, nongonococcal urethritis, pelvic inflammatory disease and syphilis) were more common than viral STDs (genital herpes, genital warts, hepatitis and HIV). Genital warts were the most commonly reported STD in the past year, while gonorrhea was the most common ever-reported STD. Almost half of all respondents who had ever had an STD had gone to a private practice for treatment (49%); in comparison, only 5% of respondents had sought treatment at an STD clinic. Respondents with a bacterial STD were seven times more likely to report going to an STD clinic than were respondents with a viral STD--except for chlamydia, which was more likely to be treated at family planning clinics. Men were significantly more likely than women to go to an STD clinic. Young, poor or black respondents were all more likely to use a family planning clinic for STD treatment than older, relatively wealthy or white respondents. Age, sexual history and geographic location did not predict particular types of treatment-seeking. CONCLUSIONS: The health care utilization patterns for STD treatment in the United States are complex. Specific disease diagnosis, gender, race and income status all affect where people will seek treatment. These factors need to be taken into account when STD prevention strategies are being developed.     

How much uncompensated care do doctors provide?

The magnitude of provider uncompensated care has become an important public policy issue. Yet existing measures of uncompensated care are flawed because they compare uninsured payments to list prices, not to the prices actually paid by the insured. We address this issue using a novel source of data from a vendor that processes financial data for almost 4000 physicians. We measure uncompensated care as the net amount that physicians lose by lower payments from the uninsured than from the insured. Our best estimate is that physicians provide negative uncompensated care to the uninsured, earning more on uninsured patients than on insured patients with comparable treatments. Even our most conservative estimates suggest that uncompensated care amounts to only 0.8% of revenues, or at most $3.2 billion nationally. These results highlight the important distinction between charges and payments, and point to the need for a re-definition of uncompensated care in the health sector going forward.     

The fight against sexually transmitted diseases in Ivory Coast: what strategies can we use in the face of HIV/AIDS?

In the AIDS era, sexually transmitted diseases (STDs) have become a major health problem in developing countries, particularly in Africa. Delays in the diagnosis and treatment of such infections may result in complications, many of which primarily affect women. Epidemiological studies in Abidjan have shown that more than 10% of the pregnant women attending antenatal clinics present STDs potentially serious for their own health or that of their infants (gonorrhea, chlamydia infection, genital ulcers or active syphilis). There is evidence that STDs increase the transmission of HIV and that improving the syndromic management of STDs reduces the incidence of HIV infection. This provides a strong argument in favor of controlling STDs in areas of high HIV prevalence. In Ivory Coast, as in other African countries, a STD control program has been integrated into the AIDS control program since 1992, as recommended by the World Health Organization. During the first six years of the STD program, considerable progress was made in some areas, but not without difficulty. Simple syndrome-based decision trees have been adopted for the management of STDs in primary health care. Clinical studies have shown these therapeutic algorithms to be effective. At the same time, effective and affordable drugs for treating STDs were added to the list of essential drugs in Ivory Coast, after an international invitation to tender. The entire staff of the public health sector in Abidjan has been trained in syndromic STD management. Training is now being extended to other parts of Ivory Coast, including the private health sector and, in particular, private nurses. The surveillance of syndromic STDs, mainly genital ulcers in both sexes and urethral discharge in men, facilitates monitoring and evaluation of the STD program, following health care activities and adapting orders for drugs for treating STDs to real needs. In the near future, some parts of the STD program will be strengthened, particularly the management of sexual partners of STD patients and reduction of the cost of STD treatment for pregnant women.     

How much protein do parenteral amino acid mixtures provide?

It is commonly assumed that the weight of the amino acids in a parenteral amino acid mixture equals the amount of protein they provide. This assumption ignores the fact that the molecular weight of free amino acids is 18 mass units greater than when they are protein bound. The actual amount of protein substrate provided by commonly used free amino acid mixtures was determined by analyzing the amino acid composition of 3 commonly used parenteral amino acid solutions and the proteins that would be formed from them, and comparing the results with similar data from 3 nutritionally important proteins. After correction for hydration status, the ratio of essential amino acid mass to total mass of the amino acid mixtures was similar to albumin, myosin, and actin. However, all of the amino acid mixtures provided 17% less protein and energy than is now widely assumed. Current parenteral nutrition guidelines recommend 0.8-1.5 g mixed amino acids/kg normal weight per day, on the assumption that they are equivalent to formed proteins, but they are not equivalent. Clinicians who aim to provide 0.8-1.5 g protein/kg must administer 1.0-1.8 g mixed amino acids/kg.     

How much do doctors know about consent and capacity?

To assess knowledge of capacity issues across different medical specialties we conducted a cross-sectional survey with a structured questionnaire at academic meetings, lectures and conferences. Of 190 individuals who received the questionnaire 129 (68%) responded-35 general practitioners, 31 psychiatrists, 29 old-age physicians [corrected] and 34 final year medical students. Correct answers on capacity to consent to or refuse medical treatment were given by 58% of the psychiatrists, 34% of the geriatricians, 20% of the general practitioners and 15% of the students. 15% of all respondents wrongly believed that a competent adult could lawfully be treated against his or her will, with no obvious differences by specialty. As judged by this survey, issues of capacity and consent deserve more attention in both undergraduate and postgraduate medical education.     

How much do Nepalese mothers know about child development?

Parental knowledge on child development is important for maximal developmental potential. This study was conducted to assess mothers’ knowledge on child development in Nepal. The Caregivers Knowledge of Child Development Inventory (CKCDI) was used to interview mothers. Total of 1272 mothers were interviewed. Out of the total CKCDI score of 40, mean score (SD) obtained by mothers was 20 (4.8). Mothers’ knowledge on the developmental milestone composite was better than stimulation composite with scores of 11.14 (3.09) and 8.9 (3.17), respectively (p?<?.005). Few mothers (38%) identified the correct ages of developmental milestones. Although most of the mothers knew about teaching their children to count or name colors, few knew when to start to read with children. With low level of knowledge on child development among Nepalese mothers, early childhood development programmes should be considered integrated with other health care programmes targeting young children and families.     

How much do medical students know about infection control?

Changes in undergraduate medical training mean that students have direct patient contact from an early stage of their training. This study aimed to assess the knowledge of third-year medical students at the University of Birmingham Medical School, UK on infection control policy and procedures. A semi-structured questionnaire was distributed to medical students. Out of 322 students, 156 returned completed questionnaires (48%). Results showed that 58% of medical students did not know the correct indications for using alcoholic hand gel, 35% did not know the correct use of gloves, and 50% did not know the exclusion period after an episode of diarrhoea and vomiting. Sixty-four percent of medical students reported formal teaching on hand hygiene, 12% reported informal teaching, 19% reported both types of teaching and 5% reported no hand hygiene teaching at all. Forty-nine percent of medical students thought that there was insufficient emphasis on infection control in their course. These results raised concerns about medical students' knowledge about infection control. The University is currently reviewing the need for a more structured model for the teaching and assessment of infection control.     

How much vitamin D3 do the elderly need?

BACKGROUND: Vitamin D insufficiency poses a problem in many parts of the world, the elderly being an especially vulnerable group. This insufficiency results from an inadequate amount of sunshine and a low dietary intake of vitamin D. Typically, insufficiency is accompanied with high intact parathyroid hormone, (S-iPTH) concentrations. AIMS OF THE STUDY: We studied how serum 25-hydroxy vitamin D (S-25-OHD) concentrations respond to different doses of vitamin D3 supplementation. Secondly to determine the smallest efficient dose to maintain serum 25-OHD concentration above the insufficiency level. We also studied which dose would be efficient in decreasing S-iPTH concentration in these subjects. SUBJECTS AND METHODS: Forty-nine 65- to 85-year-old women participated. The women were randomly assigned into one of four groups receiving 0 (placebo), 5, 10 or 20 microg of vitamin D3 daily for 12 weeks. Fasting morning blood was drawn at the beginning of the study, and thereafter every second week. Calciotropic variables were assessed from serum and urine samples. RESULTS: The S-25-OHD concentration increased significantly (p < 0.001) in all supplemented groups [5 microg: by 10.9 (8.5) nmol/L, 10 microg: by 14.4 (6.9) nmol/L, 20 microg: by 23.7 (11.9) nmol/L], whereas it decreased in the placebo group by 8.3 (13.2) nmol/L. Equilibrium in S-25-OHD concentration was reached in all groups after 6 weeks of supplementation at 57.7 (8.9) nmol/L, 59.9 (8.9) nmol/L and 70.9 (8.9) nmol/L in the groups with increasing vitamin D supplementation. The dose-response to supplementation decreased with increasing vitamin D status at baseline, r = -0.513, p = 0.002. S-iPTH tended to decrease in those with highest dose response to supplementation. CONCLUSIONS: A clear dose response was noted in S-25-OHD to different doses of vitamin D3. The recommended dietary intake of 15 microg is adequate to maintain the S-25-OHD concentration around 40-55 nmol/L during winter, but if the optimal S-25-OHD is higher than that even higher vitamin D intakes are needed. Interestingly, subjects with lower vitamin D status at baseline responded more efficiently to supplementation than those with more adequate status.     

How much time do patients with diabetes spend on self-care?

INTRODUCTION: Little is reported about how much time patients spend on self-management, a cornerstone of diabetes care. METHODS: We studied a cross-section of 1482 diabetic patients enrolled in 3 northeastern United States managed care plans. Patients were surveyed about how much time they spent on foot care, exercise, and food shopping/preparation (7/00 to 9/01). Logistic regressions modeled which types of patients were likely to spend time, and linear regressions modeled characteristics associated with spending more/less time. RESULTS: Patients (57.9% > or = 55 years; 51.6% women; 36.2% African American; 31.1% on insulin) spent 58 (mean) minutes/day on self-care (interquartile range 19, 84). Many patients skipped individual self-care elements: 37.9% reported no foot care, 37.7% no exercise, and 54.4% no time on food shopping/preparation. One fourth of patients with severe foot neuropathy symptoms spent no time on foot care. Never self-testers were less likely than others to engage in foot care (odds ratio (OR) 0.4 (95% CI 0.3, 0.6), exercise (OR 0.4 (95% CI 0.3, 0.6)), and food shopping/preparation (OR 0.7 (95% CI 0.5, 1.0)), and were likely to spend 30 minutes less total self-care time than frequent self-testers (P <.01). DISCUSSION: Most people spent considerable time engaged in self-care, but many skipped individual tasks, offering clinicians opportunities for collaborative decision making.     

Does coffee protect against liver cirrhosis?

PURPOSE: To evaluate the relation between consumption of coffee and other methylxanthine-containing beverages and liver cirrhosis. METHODS: A hospital-based case-control study of digestive tract and liver diseases was conducted in Greater Milan, Italy, including 101 cases with liver cirrhosis and 1538 controls. RESULTS: Compared with coffee non-drinkers, the multivariate odds ratio (OR) was 0.77 for one cup of coffee per day, 0.57 for two, and 0.29 for three or more. The OR for 40 years of coffee consumption or more was 0.45. Trends in risk were significant for both number of cups and duration of coffee drinking. No significant association was observed with decaffeinated coffee, tea and cola-containing beverages. The relation between coffee consumption and liver cirrhosis was not attributable to confounding and was observed across strata of tobacco, alcohol, and other major covariates of interest. In particular, an inverse relation was observed also in subjects reporting moderate alcohol drinking. CONCLUSIONS: The present study confirms, and further quantifies, the existence of an inverse association between coffee consumption and liver cirrhosis. However, the metabolism of caffeine is impaired in fasting subjects with liver cirrhosis, and the association could be due to a reduction of coffee drinking in subjects with liver cirrhosis.