High prevalence of sexually transmitted infections among female sex workers in the eastern highlands province of Papua New Guinea: correlates and recommendations

BACKGROUND: More than 200 female sex workers (FSWs) participating in commercial sex along the Highlands Highway of Papua New Guinea were identified in a previous survey. This has implications for the spread of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) to areas and population groups serviced by the road. GOAL: The goal of this study was to estimate the prevalence of gonorrhea, chlamydia, syphilis, trichomoniasis, and HIV among FSWs in Goroka and Kainantu in the Eastern Highlands Province (EHP) and to identify correlates that could be considered in intervention and control. STUDY: Self-identified FSWs recruited through the Goroka Sex Workers Peer-Mediated Programme were invited to participate. All consenting FSWs underwent pretest counseling and provided sociodemographic and behavioral data using a structured questionnaire. The women were also asked to self-collect vaginal specimens and to provide peripheral blood to detect the respective STIs and HIV. RESULTS: Results were available for 211 FSWs. None of the women were positive for HIV. The overall estimated rates for gonorrhea, chlamydia, syphilis, and trichomoniasis were 21%, 19%, 24%, and 51%, respectively. Seventy-four percent were positive for at least 1 STI and 43% had multiple STI infections. High-risk sexual behaviors were found to be common among the women, including low and inconsistent use of condoms, with most of them attributing this to unavailability, dislike by or familiarity with clients, and being drunk and/or high on marijuana. CONCLUSIONS: STIs are prevalent among FSWs in Goroka and Kainantu in the EHP and are maintained by widespread high-risk sexual behaviors, including low use of condoms. Implications for their spread through the highway warrants increased efforts in intervention. Apart from a need to promote condom acceptance, distribution, and use, other high-risk sexual behavior and correlates identified in this study provide important considerations for intervention and control in this population.     

Electrophysiologic effects of placing cochlear implant electrodes in a perimodiolar position in young children

OBJECTIVE: The purpose of this study was to intraoperatively record the electrically evoked auditory brainstem response (EABR) before and after placement of the electrode positioning system (EPS) (CII Bionic Ear with HiFocus I cochlear implant electrode array) as well as before and after stylet removal (Nucleus Contour cochlear implant electrode array). It was hypothesized that physiologic changes would occur after perimodiolar positioning of the electrode array and these changes would be evident from the EABR recordings. STUDY DESIGN: Consecutive young (11-36 month old) pediatric cochlear implant recipients (n = 17) had intraoperative EABRs recorded from three intracochlear electrodes that represented apical, medial, and basal locations. Wave V amplitudes and thresholds were studied relative to electrode location and pre- versus postperimodiolar positioning. These evoked potential measures were analyzed for statistical significance. SETTING: Tertiary referral children's hospital/medical college. RESULTS: Wave V thresholds of the EABR were lower, and amplitudes were larger after perimodiolar positioning, although the changes were dependent on electrode location and implant design. Statistically significant decreases in EABR wave V threshold and increases in suprathreshold wave V amplitude were found for the basal electrode for the CII Bionic Ear HiFocus I and for the apical electrode for the Nucleus Contour. CONCLUSIONS: Placement of either the CII Bionic Ear HiFocus I or Nucleus Contour cochlear implant electrode array in the perimodiolar position in young children resulted in less electrical current necessary to stimulate the auditory system. Changes in electrophysiologic thresholds and amplitudes, measured with EABR, indicate that the electrode array is placed closer to the modiolus with both electrode designs.     

Conversion of painful hemiarthroplasty to total shoulder arthroplasty: long-term results

The purpose of this study was to evaluate the outcome after conversion of painful hemiarthroplasty to total shoulder arthroplasty (TSA). Sixteen consecutive patients who underwent revision TSA for failed humeral head replacement (HHR) at our institution from 1988 to 2000 were evaluated. The mean interval from the time of HHR to revision TSA was 3.5 years (range, 11 months to 10.5 years). At a mean 5.5-year follow-up (range, 2-14 months), the results were excellent in 3 of 15 (20%), satisfactory in 5 of 15 (33%), and unsatisfactory in 7 of 15 (47%). The mean American Shoulder and Elbow Surgeons score was 73.6 (range, 46.7-95) out of a possible 100. The mean visual analog pain score was 2.4 (range, 0-6) out of 10. Evidence of posterior glenoid erosion was found in 64% (7/11) of these patients. On the basis of the complexity of the surgery and the 47% unsatisfactory rate, we conclude that revision of a failed HHR to a TSA is a salvage procedure whose results are inferior to those of primary TSA.     

Survey of Internet web sites on circumcision

Information on circumcision is available on the Internet, which is available for parents to review. The purpose of this study is to sample and summarize the Internet's informational content on circumcision. One hundred web sites were identified using the Google search engine on February 15, 2003. The informational content of each site was reviewed and tabulated. Seventy-three of the 100 web sites were appropriate for review. Ten agreed with recommending circumcision, 4 agreed under limited circumstances, 37 recommended against circumcision, and 4 recommended against circumcision under limited circumstances. Eighteen did not take a stance for or against. Thirteen agreed that circumcision reduces the risk of urinary tract infection, and 16 disagreed with this. Fifteen agreed that circumcision reduces the risk of penile cancer and 14 disagreed with this. Fifty-one percent of web sites surveyed were against circumcision, 14% of the web sites surveyed recommended circumcision, and 25% of surveyed web sites had no opinion.     

Steady-state free precession MR imaging: improved myocardial tag persistence and signal-to-noise ratio for analysis of myocardial motion

Tagging with balanced steady-state free-precession (SSFP) magnetic resonance (MR) imaging by using a steady-state storage scheme for myocardial motion analysis was evaluated. Signal-to-noise ratio (SNR), blood-tissue contrast, and tag persistence in volunteers and phantoms showed improved performance of SSFP imaging with tagging compared with that of radiofrequency spoiled gradient-echo (SPGR) MR imaging with tagging. Choice of flip angle with SSFP imaging involved a trade-off among SNR, blood-tissue contrast, and tag persistence. Increased SNR and tag persistence can be achieved simultaneously with SSFP imaging compared with SPGR tagging methods. As a result, the proposed technique may be useful for analysis of diastolic ventricular function.     

Selection of a substance use disorder diagnostic instrument by the National Drug Abuse Treatment Clinical Trials Network

Several instruments for diagnosing substance use disorders (SUD) have been developed, but to date none has emerged as the standard for community-based clinical studies. To select the most suitable SUD diagnostic instrument for its clinical trials, the National Drug Abuse Treatment Clinical Trials Network (CTN) implemented a procedure in which 36 university-based addiction researchers and 62 community-based addiction treatment providers evaluated and ranked five widely recognized diagnostic instruments: (1) the SUD section of the Structured Clinical Interview for DSM-IV (SCID); (2) the SUD section of the Composite International Diagnostic Interview, 2nd ed. (CIDI-2); (3) the SUD section of the Diagnostic Interview Schedule for DSM-IV Diagnosis (DIS-IV); (4) the Diagnostic Statistical Manual-IV Checklist (DSM-IV Checklist); and (5) the Substance Dependence Severity Scale (SDSS). To assist the evaluation and ranking process, key characteristics of each instrument were presented in tabular and narrative formats. Participants ranked each instrument from 1 (most preferred) to 5 (least preferred). The SCID received the best overall mean score (2.24) followed by the CIDI-2 (2.59), DIS (2.94), DSM Checklist (3.40) and the SDSS (3.83). After discussing the pragmatic and scientific advantages and disadvantages of each instrument, the CTN Steering Committee selected the CIDI-2. The selection of the CIDI-2 standardizes the collection of diagnostic data and provides a common diagnostic tool for practitioners and clinical researchers in the CTN. Implications for practice/research collaboration and initiatives are explored.