Patient-led partner notification for syphilis: Strategies used by women accessing antenatal care in urban Bolivia

Maternal syphilis adversely affects close to one million pregnancies worldwide every year with consequences that may include spontaneous abortion, stillbirth, neonatal death, premature birth, neurological impairment and bone deformities of the neonate. In Bolivia, the maternal syphilis rate has been estimated at 4.3% among women with live births and 26% among women with stillbirths. Partner notification is critical to the prevention of maternal re-infection and vertical transmission of syphilis. Patient-led partner notification, also known as patient referral, is the recommended starting point for partner notification programs in resource poor settings because it requires less infrastructure and provider involvement. Though patient referral requires a higher level of engagement on the part of individuals, few studies have examined, in depth, the process of patient-led notification. Further, we found no studies of this type conducted in Bolivia, a country where culturally acceptable and appropriate interventions are needed to control maternal syphilis. This study examined partner notification, for the first time, from the perspective of women accessing treatment for maternal syphilis in Bolivia. Semi-structured interviews were conducted with 18 women who had attempted or planned to attempt notifying their partner. The interview guide was designed to investigate the experience of patient-led partner notification for syphilis with particular emphasis on the strengths and capacities of the participants. Accordingly, we applied an existing theoretical model for individual empowerment in the analysis of the interviews with the participants. This emphasis on the positive, solution-finding capacities of the participants allowed us to investigate the ways in which participants took control over an aspect of concern to their health. More studies are needed which examine successful patient-led strategies for partner notification and their connections with long-term health outcomes.     

C. trachomatis and N. gonorrhoeae surveillance in New Zealand: comparison of laboratory and clinic data

Objectives : To determine the extent to which clinic‐based sexually transmitted infection (STI) surveillance under‐represents the number of laboratory‐confirmed cases of Chlamydia trachomatis and Neisseria gonorrhoeae in the Waikato and Bay of Plenty regions of New Zealand; and to estimate incidence rates for these two infections. Methods : Data on C. trachomatis and N. gonorrhoeae were collected from diagnostic laboratories in the study regions for the year 2000, and compared with routine clinic‐based STI surveillance data. Results : Most laboratory‐confirmed C. trachomatis (65.5%) and N. gonorrhoeae (55.7%) infections were diagnosed by healthcare providers outside the clinic‐based STI surveillance system. The estimated incidence rate for C. trachomatis was 501 per 100,000, and 50 per 100,000 for N. gonorrhoeae. Conclusions and implications : Laboratory surveillance of C. trachomatis and N. gonorrhoeae provides a more complete picture of disease burden. Given the high infection rates reported, developing a national strategy for the management of STIs should be a public health priority in New Zealand.     

Recall of LCx Neisseria gonorrhoeae assay and implications for laboratory testing for N. gonorrhoeae and Chlamydia trachomatis

On July 18, 2002, Abbott Laboratories (Abbott Park, IL) initiated a voluntary recall of its LCx Neisseria gonorrhoeae Assay (List Numbers 8A48-81 and 8A48-82) because, during routine quality assurance testing, several reagent lots failed to meet the analytical sensitivity described in the product insert. The cause of the failure is under investigation by the company. Abbott Laboratories has sent a letter to its customers informing them of this recall and the specific reagent lot numbers not meeting the analytical sensitivity.     

Drake Chemical Workers' Health Registry Study: I. Notification and medical surveillance of a group of workers at high risk of developing bladder cancer

A medical surveillance program and epidemiologic study of 408 former workers of the Drake Chemical Company (now a Superfund waste site) was established in 1986. The Drake Health Registry Study was initiated because these workers had probable past exposures to beta-naphthylamine (BNA), a potent bladder carcinogen. The registry is widely viewed as a model for notification of workers at high risk of disease due to past occupational exposures. By the 40th month, 90% of the 366 living workers had been notified of the existence of the registry; 262 had been enrolled in the annual or semi-annual screening for bladder cancer. Among these, 27 persons have had abnormal screening results indicating moderate to high risk of bladder cancer and have been made eligible for further diagnostic tests. While no invasive bladder tumors were found among 18 persons completing the extended diagnostic evaluation, two diagnoses of moderate to severe dysplasia have been made. The registry has also identified three living and three deceased cases of bladder cancer in the cohort; a mortality analysis showed a 20- to 30-fold excess of bladder cancer. An incidence projection, based on the six identified cases, reveals that between six and ten new bladder cancer cases are likely to occur among the Drake cohort over the next 20 year period.     

Alcohol and Drug Use Before and During Pregnancy: An Examination of Use Patterns and Predictors of Cessation

Objectives This study examines alcohol and nonmedical drug use before and during pregnancy and identifies the predictors of use cessation before the first prenatal visit. Methods Data analyses were based on the Prenatal Risk Overview (PRO), a structured interview that screens for psychosocial risk factors associated with poor birth outcomes. The study sample includes 1,492 consecutive prenatal care patients from four urban clinics between November 2005 and June 2007. Results Reported alcohol and drug use pre-pregnancy was much higher among U.S.-born women than immigrants, and among unmarried women than married women. American Indians had the highest rates among racial/ethnic groups. Since learning of their pregnancy, 5.6% of patients reported alcohol use and 10.7% reported drug use, reflecting cessation rates of 87.0% for alcohol and 55.6% for drugs. In logistic regression analyses, older age, current smoking, and lack of transportation predicted both alcohol and drug use continuation. Alcohol use continuation was also predicted by pre-pregnancy alcohol use frequency, depression, and physical/sexual abuse by someone other than an intimate partner. Drug use continuation was also predicted by race (higher for American Indians and African Americans), and pre-pregnancy drug use frequency. Conclusions Women who continued to use alcohol or drugs after learning they were pregnant were more frequent users than spontaneous quitters, more likely to smoke cigarettes, and had more psychosocial stressors. Achieving higher rates of cessation may require approaches that simultaneously address substance use and impediments to quitting. Higher continuation rates among some cultural groups require further investigation.     

Gay and Bisexual Adolescent Boys' Sexual Experiences With Men: An Empirical Examination of Psychological Correlates in a Nonclinical Sample

Over the last quarter century the incest model, with its image of helpless victims exploited and traumatized by powerful perpetrators, has come to dominate perceptions of virtually all forms of adult–minor sex. Thus, even willing sexual relations between gay or bisexual adolescent boys and adult men, which differ from father–daughter incest in many important ways, are generally seen by the lay public and professionals as traumatizing and psychologically injurious. This study assessed this common perception by examining a nonclinical, mostly college sample of gay and bisexual men. Of the 129 men in the study, 26 were identified as having had age-discrepant sexual relations (ADSRs) as adolescents between 12 and 17 years of age with adult males. Men with ADSR experiences were as well adjusted as controls in terms of self-esteem and having achieved a positive sexual identity. Reactions to the ADSRs were predominantly positive, and most ADSRs were willingly engaged in. Younger adolescents were just as willing and reacted at least as positively as older adolescents. Data on sexual identity development indicated that ADSRs played no role in creating same-sex sexual interests, contrary to the seduction hypothesis. Findings were inconsistent with the incest model. The incest model has come to act as a procrustean bed, narrowly dictating how adult–minor sexual relations quite different from incest are perceived.     

Sexual Health Education for Adolescent Males Who Are Interested in Sex With Males: An Investigation of Experiences,Preferences, and Needs

Purpose

There is a dearth of research to inform sexual education programs to address sexual health disparities experienced by adolescent males who are interested in sex with males (AMSM). The current study sought to determine where AMSM receive sexual health information, clarify their preferences, and explore relations with sexual behavior.

Context of Risk for HIV and Sexually Transmitted Infections Among Incarcerated Women in the South: Individual,Interpersonal, and Societal Factors

Incarcerated women are disproportionately affected by HIV and sexually transmitted infections (STIs) due to risk factors before, during, and after imprisonment. This study assessed the behavioral, social, and contextual conditions that contribute to continuing sexual risk behaviors among incarcerated women to inform the adaptation of an evidenced-based behavioral intervention for this population. Individual, in-depth interviews were conducted with 25 current and 28 former women prisoners to assess HIV/STI knowledge, perceptions of risk, intimate relationships, and life circumstances. Interviews were independently coded using an iterative process and analyzed using established qualitative analytic methods. Major themes identified in the interviews involved three focal points: individual risk (substance abuse, emotional need, self-worth, perceptions of risk, and safer sex practices); interpersonal risk (partner pressure, betrayal, and violence); and risk environment (economic self-sufficiency and preparation for reentry). These findings highlight the critical components of HIV/STI prevention interventions for incarcerated women.     

Prevalence and Predictors of Insufficient Plasma Vitamin C in a Subtropical Region and Its Associations with Risk Factors of Cardiovascular Diseases: A Retrospective Cross-Sectional Study

Background: to evaluate the prevalence and predictors of insufficient plasma vitamin C among adults in a subtropical region and its associations with cardiovascular disease risk factors including dyslipidemia and lipid-independent markers, namely homocysteine, high-sensitivity C-reactive protein (hs-CRP) and lipoprotein(a). Methods: Data of this retrospective cross-sectional study were extracted from electronic medical database of a Medical Center. Based on plasma vitamin C status, subjects were split into two groups—subjects with sufficient and insufficient plasma vitamin C levels (<50 µmol/L, ≤8.8 mg/L). Results: Prevalence of insufficient plasma vitamin C in 3899 adults was 39%. Multivariate logistic regression identified male gender, high body mass index, age 20–39, and winter/spring as independent predictors of insufficient vitamin C among all subjects. Greater proportions of subjects with insufficient plasma vitamin C had lower high-density lipoprotein cholesterol levels and elevated levels of triglyceride, homocysteine and hs-CRP (all p < 0.001). There were no differences in total cholesterol, low-density lipoprotein cholesterol and lipoprotein(a) between groups. Conclusions: There was a high prevalence of insufficient plasma vitamin C in the subtropical region, which indicates that insufficient plasma vitamin C remains a public health issue. Further study is needed to confirm these findings and to determine the underlying mechanisms.     

Condom Use at First Intercourse with a New Partner in Female Adolescents and Young Adults: The Role of Cognitive Planning and Motives for Having Sex

This study examined the extent to which cognitive planning and motives for sex can explain condom use at first intercourse with young females' most recent partner. A total of 133 female adolescents completed a questionnaire on cognitive planning (i.e., mentally preparing oneself for discussing condom use and for managing condoms), motives for having sex (i.e., having sex to express love, to experience pleasure, to enhance mood, and to please others), and condom use at this particular occasion. Logistic regression analyses showed that condom use was positively related to cognitive planning with respect to discussing condom use and negatively related to the motive for having sex to enhance mood. Cognitive planning for the management of condoms did not have a significant overall effect on condom use, but it did appear to be very effective for those adolescents who had a low score on the motive for having sex to express love. It thus appears useful to strengthen the skills of adolescents to discuss the use of condoms. Furthermore, stressing the negative affective consequences of unsafe sex may be particularly effective for those who are inclined to have sex to enhance mood, while encouraging adolescents to make plans for the management of condoms is likely to positively affect the use of condoms among those who are not primarily motivated to express love by having sex.     

Psychological Risk Factors for the Development of Restrictive and Bulimic Eating Behaviors: A Polish and Vietnamese Comparison

The aim of this paper is to identify psychological factors which are culture specific or common predictors for restrictive and bulimic behaviors towards eating for young women raised in different cultures. The study included 661 young women from Poland (n = 233) and Vietnam (n = 428). Subjects filled-in the Eating Disorders Inventory (EDI-3) and the Multidimensional Body-Self Relations Questionnaire-Appearance Scales (MBSRQ-AS), and body measurements were collected to calculate anthropometric indices. Women form Vietnam were less satisfied with their appearance than were their Polish peers, but Vietnamese showed a lower level of preoccupation with being overweight and fear of obesity. Intercultural differences indicate that Vietnamese women show greater intensities for psychological variables, connected with restrictive and bulimic eating behaviors, verified in the research model: low self-esteem, personal alienation, interpersonal insecurity, interpersonal alienation, emotional dysregulation, interoceptive deficits, perfectionism and asceticism, and anxiety.     

The Transition of Social Isolation and Related Psychological Factors in 2 Mild Lockdown Periods During the COVID-19 Pandemic in Japan: Longitudinal Survey Study

BackgroundLockdowns and stay-at-home orders announced internationally for COVID-19 have led to physical and social distancing, with reports of many individuals experiencing social isolation (SI) and loneliness. Although the emergency declaration in Japan was declared as a “mild” lockdown requested by the government without penalties for violations, the lockdown measures, including SI, had several influences on people’s lives and mental health as in other countries. Furthermore, Japan declared a state of emergency multiple times; thus, it is necessary to examine the influence of the transition of SI caused by repeated emergency declarations and the deterioration of mental health associated with these changes.ObjectiveThis study longitudinally investigated the transition of SI and its related factors during the mild lockdown under 2 declared states of emergency in Japan and analyzed psychosocial characteristics by extracting clusters where people with specific transition patterns of SI predominated.MethodsWe collected data on 7893 inhabitants (3694 [46.8%] women, 49.6 [SD 13.7] years old) living in the 7 prefectures where the initial emergency declaration was applied. The investigations took place online in the final phase of the first and second states of emergency: phase 1 (between May 11 and 12, 2020) and phase 2 (between February 24 and 28, 2021). Nonparametric Bayesian coclustering was used to visualize the exhaustive interaction structure between the transition pattern of SI and the psychosocial variables.ResultsThere were no improvements in social networks and loneliness between the 2 phases, although psychological distress significantly improved and depression slightly decreased. Overall, 3868 (49%) of the 7893 participants remained socially isolated through phases 1 and 2, and 947 (12%) were socially isolated in phase 2, even though they were not socially isolated in phase 1. More participants experienced persistent SI in unmarried, childless, and low-household-income groups. The persistent-SI group had fewer cohabitants than other transition pattern groups. The nonparametric Bayesian coclustering results showed that most clusters, including participants without SI throughout phases 1 and 2, had healthy behaviors, more interactions, good relationships, and less loneliness and psychological stress. Furthermore, the cluster in which relationships deteriorated in phase 1 recovered in phase 2. Comparatively, the clusters with SI throughout phases 1 and 2 were divided into clusters with increased loneliness and psychological stress; clusters were close to participants’ average scores in this study. The clusters with increased loneliness and psychological stress were notable for deteriorating relationships and less online interaction.ConclusionsThis study revealed the actual state of transition of SI and related psychological, social, and behavioral factors under repeated declarations of a state of emergency. These results should help construct intervention methods that fit individual characteristics of people in SI during a pandemic.     

Patient-centred interprofessional collaboration in primary care: challenges for clinical,educational and health services research. An EGPRN keynote paper

The theme ‘patient-centred interprofessional collaboration’ of the EGPRN conference in October 2012, captures in just three words important challenges for European primary care and its research agenda. Challenges for future research are formulated, in three domains: clinical, educational and health services research. Transferability of research, based upon advanced computational infrastructure, will facilitate a rapid learning health care system. In educational research, this includes the use of observational and reflexivity methods. Outcomes should be defined in terms of improvement of functional status and social participation rather than in terms of disease-specific outcomes. Partnership with all stakeholders, patients, GPs and their health care colleagues and students, can help in reducing avoidable waste in the production and reporting of research evidence.     

Treatment of Gay Men for Post-Traumatic Stress Disorder Resulting from Social Ostracism and Ridicule: Cognitive Behavior Therapy and Eye Movement Desensitization and Reprocessing Approaches

This report describes the clinical treatment of a sample of four gay men suffering from Post-Traumatic Stress Disorder (PTSD) attributed to their repeated experiences with peer ridicule and ostracism throughout childhood and adolescence, caused by their gender variant appearance and behavior. All of the men in the sample shared the following features: (1) a childhood history of ridicule and ostracism from both peers and adults focused on their gender variant presentation designed to elicit gender norm compliance; (2) a lack of social support networks to assist them in coping with the stress; (3) self-destructive coping responses that began in childhood and continued into adulthood in an attempt to lessen the experience of shame; and (4) symptoms of PTSD. A treatment model utilizing cognitive-behavioral therapy and eye movement desensitization and reprocessing was discussed.