Agreement in reported sexual partnership dates and implications for measuring concurrency

OBJECTIVES: To describe the reliability of reported dates of first and last sexual exposure, as elicited from sexually transmitted disease/human immunodeficiency virus cases during routine contact investigation, and determine their adequacy for assessing concurrency. METHODS: We used contact tracing data from 5 studies in which both members of 774 dyads were interviewed and named each other as sex partners. We assessed partners' agreement on the dates of first and last exposure as related to precision (to the day, month, or year) of reported dates and demographic and behavioral characteristics of the dyad. We performed simulations that introduced reporting error, based on our observed data, to posited "true" temporal configurations of partnerships to assess the impact of unreliability in reporting on the measurement of concurrency. RESULTS: Thirty-two percent of dyads agreed on the exact date of first sexual exposure, and 36% did so for the date of last sexual exposure. Sixty-four percent agreed within 30 days on the date of first sexual exposure, and 81% did so for the date of last sexual exposure. The reliability of reported dates was positively related to the precision of the reports. Agreement on reported exposure dates was not meaningfully associated with any of the sociodemographic and behavioral variables available. Based on simulations, the positive predictive value of reported dates for estimating concurrency is approximately 80% over a wide range of conditions. CONCLUSIONS: These data suggest that the reliability of reported exposure dates is reasonably good but that estimating concurrency with reported dates is subject to some error. Data designed for the purpose and analyzed with adequate attention to the statistical and epidemiologic issues of assessing concurrency are needed.     

American adolescents: sexual mixing patterns, bridge partners, and concurrency.

BACKGROUND: American adolescents have a high incidence of sexually transmitted infections. Patterns of sexual partner choice influence the transmission of infections in this population. GOAL: To examine patterns of sexual mixing, bridging, and concurrency in American adolescents and the association of these characteristics with condom use. STUDY DESIGN: This project used the AddHEALTH survey data. The survey selected a sample of schools, then conducted in-home interviews with 18,984 students in 1995. A second wave of data collection was conducted 2 years later. The data on sexual relationships collected in the study were analyzed. RESULTS: Respondents ranged in age from 13 to 17 years. Sex partnerships with persons of differing age groups were very common in this population (45% of sexual partnerships). Relationships with persons of different ethnicity were more common among Latinos (42%) than among white (14%) and black (15%) respondents. A large proportion of the sample reported more than two partners (56%). Among these persons, a large proportion reported partners in two different age groups (69%) and ethnic groups (35%) as well as concurrent partners (54%). Condom use was lower among persons with partners in different age groups and among persons with a larger number of partners. CONCLUSIONS: The large number of adolescents who have sexual relationships with persons of different characteristics creates bridges for infections between different groups. Counseling of sexually active adolescents should include discussion on issues of power and communication in these relationships.     

Disclosure of HIV status to sexual partners: predictors and temporal patterns.

BACKGROUND AND OBJECTIVES: Failure to disclose human immunodeficiency virus (HIV) infection to sexual partners interferes with risk reduction. GOAL OF THIS STUDY: The purpose of this study was to identify factors associated with disclosure and failure to disclose HIV infection to sexual partners and to describe condom use with nondisclosure. STUDY DESIGN: A longitudinal survey study of HIV seropositive persons recruited at a public STD clinic. RESULTS: Approximately 76% of the study population (n = 147) reported disclosing their HIV status to their last sex partner at baseline. Predictors of disclosure included consistent condom use and being in a monogamous relationship. Twenty-two percent of those who disclosed at baseline reported nondisclosure during follow-up. Approximately 23% reported not using a condom with a person to whom their status was not disclosed. CONCLUSIONS: These results suggest that ongoing partner notification may be necessary to increase disclosure of HIV status to sex partners over time.     

护士性健康照护素养量表的编制与信效度检验

目的:编制评价我国护士性健康照护素养量表,并检验其信度与效度。方法:以简单随机抽样对258名护士进行问卷调查,并采用探索性因子分析与验证性因素以简单随机抽样分析对量表进行检验。结果:性健康照护素养量表共17个条目,经探索性因子分析产生3个公因子(因子1为性健康照护知识;因子2为性健康照护态度;因子3为性健康照护效能),累计贡献率为55.334%。各条目内容效度指数(ICVI)为0.896~0.922,量表内容效度指数(S-CVI)为0.920;而验证性因子分析表明(χ~2=163.218,df=115,P0.001,GFI=0.948,AGFI=0.988,NFI=0.916,NNFI=0.925,CFI=0.941,RFI=0.903)。总量表的Cronbach’sα系数为0.862,重测信度为0.888。结论:护士性健康照护素养量表具有较好的信、效度,可做为评价护士性健康照护素养的现状。     

Discordance in monogamy beliefs, sexual concurrency, and condom use among young adult substance-involved couples: implications for risk of sexually transmitted infections

OBJECTIVES AND GOAL: The objectives of this study were to examine the association between individual and partnership characteristics with condom use, sexual concurrency, and discordance in monogamy perceptions among out-of-treatment, young adult, drug-involved couples to gain a better understanding of how discordance in monogamy beliefs may influence HIV/sexually transmitted infection risk. STUDY DESIGN: Data were collected from 94 predominantly black heavy alcohol and/or drug users (AOD) and their steady partners recruited through street outreach in Durham, North Carolina, and a methadone clinic in Raleigh, North Carolina. RESULTS: One third was wrong about partners' monogamy intentions. Greater lifetime number of substances, longer relationship duration, and at least weekly relationship conflict were associated with inconsistent condom use, and discordant monogamy beliefs were associated with consistent condom use. CONCLUSIONS: Many individuals misperceive their partners' monogamy intentions, although this misperception may be reflective of greater HIV/sexually transmitted infection protection. Interventions for couples should focus on strategies appropriate for committed long-term relationships, including increasing awareness of partner risk behavior, negotiating safety, and conflict resolution skills.     

The spectrum of histopathologic patterns secondary to the topical application of EMLA® on vulvar epithelium: clinicopathological correlation in three cases

EMLA^® (eutectic mixture of local anesthetics, 2.5% each of lidocaine and prilocaine in an oil and water emulsion) is used as a topical anesthetic. We report three cases of EMLA^®‐induced histopathologic changes on the vulvar epithelium. While there are some similar histopathologic features to those reported in extragenital skin, we describe additional findings on vulvar epithelium, which, to our knowledge, have not been reported previously. The patients presented with clinical signs suggestive of lichen sclerosus or erosive lichen planus (LP), but were all confirmed histopathologically as LP. The biopsy was taken after 15 min of EMLA^® application and intradermal injection of 1% lidocaine. Blistering prior to intradermal lidocaine and the biopsy procedure was observed in two patients. The histopathologic changes observed in the epithelium included pallor of the upper epidermis, mild spongiosis, intraepidermal subcorneal and suprabasal acantholysis, congestion of the papillary dermal capillaries and extravasated erythrocytes. Basophilic granules were present, but rare, while the necrosis with multifocal clefting was more marked than in extragenital skin. It is important to be aware of these changes occurring on genital mucosa; these may occur in the absence of clinical signs and may obscure the primary underlying pathology, thus representing a diagnostic pitfall.     

Development and psychometric evaluation of a sexual health care knowledge scale for oncology nurses

ObjectiveThe purpose of this study was to develop a sexual health care knowledge scale for oncology nurses and to evaluate its psychometric properties using Rasch analysis and the known-groups technique.BackgroundAlthough sexual oncology has become a popular topic and sexual health care is now promoted, there has been a lack of instruments supported by psychometric evaluations to measure nurses’ knowledge of sexual health issues.MethodsThe initial 72 items were compiled to form the Sexual Health Care Scale – Knowledge (SHCS-K) for oncology nurses using a literature review and analysis of existing research tools. After a specialist panel verified content validity, the questionnaire was shortened to 58 items. The data were analyzed using a Rasch model to investigate the items with respect to unidimensionality of fit and difficulty and reliability distribution. Discriminant validity was examined using the known-groups technique.ResultsTwo items did not fit with the Rasch model. Person and item separation-index ratios were 3.33 and 9.45, respectively, which confirmed that the SHCS-K functioned well. The reliability was good, at 0.99. Significant differences in marital status, levels of education, and participation in SHC training were observed between groups. The final version of the questionnaire consisted of 55 items, with a total score range of 0–55.ConclusionsThe SHCS-K was found to be a valid and reliable measure for evaluating levels of sexual health care knowledge among this sample of oncology nurses.     

Study of three complementary techniques for measuring cutaneous hydration in vivo in human subjects: NMR spectroscopy, transient thermal transfer and corneometry – application to xerotic skin and cosmetics

Background/aims: The aim of this study was to determine the capability and the analytical quality of three different in vivo, non‐invasive, quantitative methods for measuring skin hydration: two innovative methods that have been used for more than eight years – nuclear magnetic resonance spectroscopy (NMR‐S) and transient thermal transfer (TTT) – and the more widely used and conventional corneometry. Methods: The work presented evaluated the capability and precision, as well as cutaneous exploration depths, of the three methods. Experiments were carried out in vivo following the hydration, in kinetic terms, induced by topic application of reference moisturizing products. Spatio‐temporal efficacy of a lipolotion was also studied by the TTT method. Cases of xerotic skin were studied with TTT and corneometry. Results: The results obtained showed better repeatability and reproducibility with the TTT and NMR‐S methods than with corneometry. NMR‐S is one of the only direct hydration measurement methods. It measures skin hydration down to the outer dermis with high precision. It is indicated for products having an action down to the deep cutaneous layers. By changing thermal power parameters, the TTT method can determine hydration to the outer, middle or deep epidermal layers. It is, therefore, possible to track the penetration of products in various layers of the epidermis. The small size of the probe enables the hydration measurement of skin sites (lips, eyelids) that were not, up to now, measurable with the two other methods. Corneometric investigations are restricted to the surface of the horny layer; measurements are easy and rapid but influenced by the composition of products applied to the skin and their phases: aqueous, oily or ionic. The xerotic skin study highlights the importance of exploration in different layers of the epidermis, as dehydration concerns not only the upper layers of the epidermis but also the medial and deep layers. With the TTT method, it has been possible to highlight the penetration dynamics of a lipolotion with, initially, an increase in the hydration in the outer epidermis, followed 3 h later by a transfer from the outer to the middle epidermis. Conclusion: NMR‐S, TTT and corneometry represent three possible ways to assess skin hydration. Because they explore different cutaneous depths, they are more complementary than competitive. Transient thermal transfer, although a semi‐direct method, is a precise, informative, and innovative solution to evaluate skin hydration at different epidermal depths and sites.     

A comparison of sexual behaviour and risk behaviour for HIV infection between women in three clinical settings.

OBJECTIVE--To compare sexual behaviour and HIV risk behaviour between women in three clinical settings and to investigate the effect of socio-economic status and ethnic origin upon these behaviours. SUBJECTS AND METHODS--A questionnaire was administered to 1,950 women attending clinics for genitourinary medicine (GUM) family planning and termination of pregnancy (TOP), all in inner London. RESULTS--A quarter of women attending the GUM and TOP clinics were not using any regular form of contraception. Differences in the median numbers of sexual partners in the past year (1-2) and over lifetime (4-6) between the three groups were slight. Amongst the women in all three groups: more than half (54.8-64.9%) had had a non-regular partner in the preceding twelve months; fewer than one-fifth (10.4-17.1%) reported always using condoms with their regular partners, and fewer than two-fifths (31.3-39.7%) always used them with their non-regular partners; approximately one in five women (18.6-23.9%) reported one or more major HIV risk behaviours. Some parameters of sexual behaviour were found to be influenced by socio-economic status and/or ethnic origin. CONCLUSIONS--The behaviour of women attending these three clinics is very similar. Women attending clinics for family planning or termination of pregnancy need advice on sexually transmitted diseases and HIV infection, and women attending genitourinary medicine or termination clinics need advice on contraception. Closer integration between disciplines is required to provide a comprehensive sexual health service for women.     

More realistic models of sexually transmitted disease transmission dynamics: sexual partnership networks, pair models, and moment closure

BACKGROUND: Mathematical models of sexually transmitted disease transmission have proven powerful tools for interpreting observed epidemiologic pattern. However, the most commonly used formulation of such models largely fail to capture the effect of partnership concurrency and contact network structure on transmission. GOAL: The development of a compartmental model of partnership formation and dissolution that includes approximations for the influence of the sexual-partner network. STUDY DESIGN: Theoretical analysis of ordinary differential equation models for sexually transmitted disease transmission within sex-partner networks. RESULTS: The approach developed advances earlier pair models, allows for the influence of concurrent sexual partnerships, and illustrates the importance of concurrency to the persistence of diseases with relatively short durations of infectiousness. The authors also illustrate that heterogeneity in risk is possible even in model populations in which all individuals follow the same behavioral rules. CONCLUSION: Deterministic extended pair models offer a powerful approach to modelling sexually transmitted disease transmission that usefully complement computationally intensive microsimulation models.     

Metastatic adenocarcinoma of the esophagus to the skin: new patterns of tumor recurrence and alternate treatments for palliation

BACKGROUND: Esophageal cancer, particularly adenocarcinoma of the esophagus (ACE), has been steadily increasing in incidence in the United States. In the past, patients usually died rapidly with locoregional disease that leads to inanition and aspiration. However, today when patients with ACE are treated successfully with induction chemotherapy and radiation therapy, followed by surgical excision, ACE usually does not recur locally, but presents with metatastic disease. We present a 62-year-old white male with ACE, which was treated with induction chemotherapy and radiation therapy followed by surgical excision. After approximately 1 year with no evidence of locoregional recurrence, the patient presented with diffuse cutaneous metastatic disease. METHODS: In addition to routine staining immunohistochemical stains for CK(AE1/AE3), CK7, CK 20, EMA, alpha-smooth muscle (SM) actin, S-100 protein, CD34, P53, Bcl-2, c-erbB-2 were performed. RESULTS: The immunohistochemical profile was consistent with an esophageal origin showing positive staining with CK20 and CK7 as well as AE1/AE3 and EMA. In addition, there was marked nuclear expression of p53, as well as membrane expression of c-erb-B2; consistent with progression of the disease and poor response to further cytotoxic therapeutic regimes. CONCLUSIONS: With new therapeutic protocols, we can expect to see more metastatic disease with recurrences of ACE. The histopathologic features and the immunohistochemical profile of the recurrent tumors may be helpful in determining alternate forms of therapy that either alone or in combination could be useful in palliation and delaying progression.     

A simple method for measuring DNA synthesis in epidermis and sebaceous glands and its application in chalone assays

Liquid scintillation counting and autoradiography were used to measure DNA synthesis (3H-TdR uptake and incorporation) by the epidermis and the sebaceous glands in mouse pinna skin. Using this approach it has been possible to show that a chalone-like inhibitor of DNA synthesis acts rapidly to restrict the flow of epidermal G1 cells into S-phase. The point of action within the cell cycle is probably at the G1-S phase 'boundary'. The technique described is sufficiently sensitive to be used for measuring small alterations in DNA synthesis in short-term experiments and for long-term experiments in which the size of the progenitor cell population is altered by systemic or topical administration of compounds influencing DNA synthesis.     

Antimicrobial susceptibility of Neisseria gonorrhoeae isolates from three Caribbean countries: Trinidad, Guyana, and St. Vincent

BACKGROUND: The percentage of Neisseria gonorrhoeae isolates resistant to antimicrobial agents commonly used for treatment is unknown in many Caribbean countries. GOAL: To determine the antimicrobial susceptibility of N gonorrhoeae isolates from Trinidad (144 isolates), Guyana (70 isolates), and St. Vincent (68 isolates) so baseline data can be established for further studies, and to assist in establishing effective treatment guidelines. STUDY DESIGN: Consecutive urethral and endocervical specimens from several clinics were collected and identified as N gonorrhoeae. Isolates of N gonorrhoeae were tested for their susceptibility to penicillin, tetracycline, ceftriaxone, ciprofloxacin, spectinomycin, and azithromycin. The presumptive identification of penicillinase-producing N gonorrhoeae and/or tetracycline-resistant N gonorrhoeae isolates based on MIC was confirmed by plasmid and tetM content analysis. RESULTS: High percentages of penicillin and/or tetracycline resistance were observed in N gonorrhoeae isolates from Guyana (92.9%), St. Vincent (44.1%), and Trinidad (42.4%). Isolates from all three countries were susceptible to ceftriaxone, ciprofloxacin, and spectinomycin. One penicillinase-producing N gonorrhoeae/tetracycline-resistant N gonorrhoeae from Guyana had an MIC of 0.5 microg/l to ciprofloxacin. This and nine other isolates from Guyana also were resistant to azithromycin (defined as MIC > or = 2.0 microg/ml) as well as penicillin and tetracycline. A reduced susceptibility to azithromycin was displayed by 16% of the isolates from St. Vincent and 72% of the isolates from Guyana (MIC, 0.25-1.0 microg/ml). Most penicillinase-producing N gonorrhoeae isolates carried Africa-type plasmids (61/90), with 28 of 90 having Toronto-type plasmids and a single isolate carrying an Asia-type plasmid. The tetM determinant in tetracycline-resistant N gonorrhoeae isolates was predominantly of the Dutch type (68/91). CONCLUSIONS: The high prevalence of N gonorrhoeae isolates from 3 of 21 English- and Dutch-speaking Caricom countries in the Caribbean with either plasmid-mediated or chromosomal resistance to penicillin and tetracycline supports international observations that these drugs should not be used to treat gonococcal infections. The detection of isolates with reduced susceptibility to drugs such as azithromycin, which currently are recommended for treatment in the region, attest to the importance of the continued monitoring of gonococcal antimicrobial susceptibility for the maintenance of effective treatment guidelines.     

Stigmatized drug use, sexual partner concurrency, and other sex risk network and behavior characteristics of 18- to 24-year-old youth in a high-risk neighborhood.

BACKGROUND: Sex risks and drug use are related. This relation in youth is described. GOAL: To determine how stigmatized drug use is related to sexual risk behaviors and network characteristics among youth. STUDY DESIGN: In-person interviews were conducted with both a probability household sample (n = 363) and a targeted, street-recruited sample of cocaine, heroin, crack, or injected drug users (n - 165) comprising 18- to 24-year-olds in an inner city neighborhood. Drug use in the preceding 12 months was scaled hierarchically, lowest to highest social stigma, as none, marijuana, noninjected cocaine, noninjected heroin, crack, and injected drugs. RESULTS: Users of the more stigmatized drugs had more sex partners. They were more likely to report a history of concurrent sex partners, sex with someone who also had engaged in sex with a network member, commercial sex work, and unprotected sex. Findings showed crack use and drug injection to be associated more strongly with increased sex risk among women than among men. CONCLUSIONS: Young users of the more stigmatized drugs are at much greater network and behavior risk for sexually transmitted diseases. Drug use prevention, harm reduction interventions, or both may lower this risk.     

A new variant of mastocytosis: report of three cases clinicopathologically mimicking histiocytic and vasculitic disorders

Cutaneous mastocytosis (CM) or urticaria pigmentosa is characterized by abnormal proliferation and accumulation of mast cells. Clinically, CM usually presents as symmetrically distributed red-brown macules or papules that develop weals, erythema and often pruritus on stroking (Darier's sign). The histological hallmark of the disease is an increase in oval to spindle-shaped mast cells in the dermis located around blood vessels and skin appendages. We describe three patients with a new clinicopathological type of CM, which clinically mimics a histiocytic disorder and histologically mimics leucocytoclastic vasculitis (LV). Three infants (two boys and one girl) developed generalized reddish-yellow-brown macules of 3-10 cm with occasional scaling and crusting on the trunk and extremities without further symptoms or organ involvement except variable itching. Histology revealed diffuse and dense dermal infiltrates of eosinophils, neutrophils and nuclear debris with perivascular accentuation, imitating LV. This infiltrate masked large epithelioid cells, positive for macrophage markers, which by special histochemical stains for metachromatic granules turned out to be mast cells. This is the first report of this new variant of CM, which may cause considerable diagnostic difficulties both clinically and histopathologically.     

Clients of indoor commercial sex workers: heterogeneity in patronage patterns and implications for HIV and STI propagation through sexual networks

OBJECTIVES: To determine whether "high-risk" clients occupied important sociometric positions in sexual networks of commercial sex workers and to estimate whether they were more likely to be HIV and STI infected. GOAL: To determine whether a classification of high-risk clients could be validated by network analysis. STUDY DESIGN: We used proxy data on clients collected from a cross-sectional survey of 49 indoor female sex workers. RESULTS: Two types of clients were categorized as high risk, including those who created sexual bridges between sex establishments and those who had sex with most or all the FSW at an establishment. High-risk clients were significantly more central and were more likely to be members of cohesive subgroups than were lower-risk clients. The few known HIV and STI infections were in high-risk clients. CONCLUSIONS: It is possible to identify theoretically high-risk commercial sex clients from the network perspective using simple data collection and categorization approaches.