Health care seeking behaviour for sexually transmitted diseases among commercial sex workers in Morogoro,Tanzania

A qualitative study was conducted in a community of 100 female, self-employed commercial sex workers (CSWs), in Morogoro township, Tanzania. Data was gathered through key informant interviews and open-ended questionnaires. Respondents had extensive experiential knowledge of STDs and HIV/AIDS. They pursued several different avenues in attempting to prevent STDs including eating nutritiously to enhance immunologic status, using condoms, and vaginal washing after each act of intercourse. When they acquired a symptomatic STD, they pursued different avenues of treatment including self-treatment with known herbs, traditional healers (herbalists), injectionists, pharmacies, government hospitals, and private clinics. Almost all CSWs explored all options. Many of the key elements for an effective STD prevention and control program are in place and will be made more effective by training medical personnel, traditional healers, and sex workers themselves. Nous avons effectuéune étude qualitative auprès d'une communautéde 100 femmes travaillant comme prostituées indépendantes dans le township de Morogoro, en Tanzanie. Nous avons rassembléces données au cours d'entretiens avec des informatrices cl es et à l'aide de questionnaires ouverts. Les personnes interrogées ont de vastes connaissances, dérivées de l'expérience, sur les maladies sexuellement transmissibles (MST) et le Sida. Elles utilisent différents types de stratégie pour essayer d'éviter les MST, y compris une alimentation destinée à augmenter la résistance immunologique, l'utilisation de préservatifs et le lavage du vagin après chaque acte sexuel. Lorsque ces femmes attrapent une MST symptomatique, elles essaient différents types de traitement, y compris l'automédication par les plantes médicinales connues, les guérisseurs traditionnels (herboristes), les injections, les pharmacies, les hôpitaux publics et les cliniques privées. Presque toutes les prostituées explorent la totalitédes options disponibles. La plupart des éléments indispensables à la création d'un programme de prévention et de contrôle des MST efficace est déjà en place, et l'effcacitéde ce programme sera encore accrue par la formation du personnel médical, des guérisseurs traditionnels et des prostituées elles-mêmes. En un estudio cualitativo llevado a cabo en una comunidad de 100 trabajadoras sexuales independientes en la ciudad de Morogoro, Tanzania, se obtuvieron datos a través de entrevistas informantes claves, y cuestionarios abiertos. Las entrevistadas mostraron tener amplios conocimientos prácticos sobre enfermedades de transmisión sexual, HIV y sida. Seguían varios métodos diferentes para intentar impedir las enfermedades de transmisión sexual, por ejemplo, comer alimentos nutritivos para aumentar su sistema inmunológico, y utilizar condones y lavados vaginales después de cada relación sexual. Si notaban síntomas de alguna enfermedad de transmisión sexual, seguían tratamientos variados como automedicarse con infusiones conocidas, pedir ayuda a curanderos tradicionales (herbolarios), con inyecciones, en farmacias, hospitales estatales y clínicas privadas. Casi todas las entrevistadas exploraban todas las opciones posibles. Muchos de los elementos clave para lograr una prevención adecuada ya están funcionando, además de un programa de control contra las enfermedades de transmisión sexual que seráz más efica si se educa adecuadamente al personal médico, a los curanderos tradicionales y a las mismas trabajadoras sexuales.     

Factors associated with treatment failure of high-flow nasal cannula among children with bronchiolitis: a single-centre retrospective study

ObjectivesBronchiolitis is the most common viral lower respiratory tract infection in children under age 2 for which high-flow nasal cannula (HFNC) is increasingly used. Understanding factors associated with HFNC failure is important to identify patients at risk for respiratory deterioration. The objective of this study was to evaluate patient characteristics associated with HFNC failure in bronchiolitis.MethodsA retrospective review of patients aged 0 to 24 months, with bronchiolitis who received HFNC within a single tertiary paediatric intensive care unit, between January 2014 and December 2018 was conducted. HFNC treatment failure was defined as escalation to non-invasive positive pressure or invasive mechanical ventilation. Multivariable regression analysis was used to identify demographic, clinical, and biochemical parameters associated with HFNC failure.ResultsTwo hundred eight patients met inclusion criteria, of which 61 (29.33%) failed HFNC. Risk factors for HFNC failure included younger age (odds ratio [OR] 1.12; 95% confidence interval [CI] 1.03, 1.23; P=0.011) and a Modified Tal score greater than 5 at 4 hours of HFNC therapy (OR 2.81; 95% CI 1.04, 7.64; P=0.042). Duration of HFNC in hours was protective (OR 0.94; 95% CI 0.92, 0.96; P<0.001), such that deterioration is less likely once patients have remained stable on HFNC for a prolonged time.ConclusionThis is the first study exploring predictors of HFNC failure among Canadian children with bronchiolitis. Patient age, HFNC duration, and Modified Tal score were associated with HFNC failure. These factors should be considered when initiating HFNC for bronchiolitis to identify patients at risk for deterioration.     

Diet impacts mortality from cancer: results from the multiethnic cohort study

Purpose

Cancer is the second leading cause of death in the United States and mortality varies by ethnicity. The objective of this study was to examine the association between cancer mortality and dietary intake among a large multiethnic population.

Methods

A prospective cohort design was used to examine cancer mortality among 146,389 participants. Multiethnic cohort study participants represent five ethnic groups: African American, Native Hawaiian, Japanese American, Latino, and Caucasian. Hazard ratios for cancer mortality by intake levels of five food groups and discretionary fat were calculated using Cox proportional hazards models stratified by sex and ethnicity.

Results

There were a total of 2,028 male and 1,464 female fatal cancer cases at the end of follow-up. Among Japanese American men only, there was a significant protective effect seen in those reporting a high grain intake (HR = 0.49, 95 % CI 0.35–0.69); there was no effect of grain consumption in any other ethnic-sex group. There was no evidence that ethnicity modified associations between fruit, vegetable, meat, dairy, or discretionary fat intake and cancer mortality among men. Associations between food group consumption and risk for cancer mortality among women were similar across ethnic groups.

Conclusions

The considerable reduction in cancer risk associated with high grain consumption among a specific ethnic-sex group, Japanese American men, warrants further investigation. Additional research is needed to validate this observation and determine whether this was a chance finding, or possibly due to differential intake of specific grain subtypes, and/or related to a sex-specific cancer type.     

A model of periodontitis in the rat: effect of lipopolysaccharide on bone resorption, osteoclast activity, and local peptidergic innervation

OBJECTIVE: To establish and characterise a rat model of periodontitis that reiterates the features of human disease. METHODS: Periodontal inflammation was induced by a single injection of 10 microg liposaccharide (LPS) (Salmonella typhimurium) in 1 microl saline into rat mandibular gingiva at the buccomesial aspect of the second molar. Animals were killed after 3, 7 and 10 days, mandibles dissected and sectioned for histological and immunocytochemical analysis. RESULTS: LPS injection resulted in a significant gingival and periodontal inflammation with inflammatory infiltrate, apical migration of the junctional epithelium, interdental bone loss, and activation of osteoclasts at the site of injection 7 and 10 days after injection. At 10 days post injection, there was a significant trend for bone loss on both sides of the mandible. Periodontal inflammation was associated with alteration in the levels of calcitonin gene-related peptide-like immunoreactivity in nerve terminals innervating the inflamed gingival papilla. CONCLUSION: Intragingival injection of LPS in the rat provides an easily induced reproducible experimental model of periodontal inflammation that reiterates features of human disease.     

CASE STUDIES for Dentistry: development of a tool to author interactive, multimedia, computer-based patient simulations

Computer-based patient simulations have been used to enhance the dental curriculum since the 1980s. This article describes the development of CASE STUDIES for Dentistry (CSD), a patient case simulation building template, developed at Virginia Commonwealth University, with which authors who have no programming expertise can create realistic, effective, interactive multimedia patient simulations by entering their own information and images into a straightforward, fill in the blanks interface. This program was written with Authorware, by Macromedia Inc. Design considerations included emphasis on information collection and analysis, synthesis of collected information, hypothesis proposal and testing, diagnosis, and treatment planning. The program consists of easily accessible interfaces for both authors and students. Authors build simulated patients using typed-in text and their own images. Faculty can build computer-based simulated patients so that students can immediately practice what they learn in class within a simulated doctor-patient relationship. CSD allows building simulations ranging from simple to complex patients in multiple disciplines. Robust feedback and other features allow students to learn both process and content in a self-directed, interactive environment.     

Overnight-stay patients in a day surgery unit to overcome shortage of inpatient beds

A dedicated 23-h stay list was organised at the Addenbrooke's Hospital day surgery unit for elective cases in oral and maxillofacial surgery of minor or moderate severity that would normally be done as inpatients. The patients were selected by the two consultant oral and maxillofacial surgeons and the operations were done by a consultant surgeon (L.C.) and a consultant anaesthetist. Over a 14 month trial period 137 patients were admitted to our 23-h stay lists. One hundred and twenty seven of whom were operated on and stayed overnight, nine went home the same day, and one patient stayed beyond the 23-h limit as he was admitted to the medical ward after a grand mal seizure. The operations were for neoplastic, traumatic, salivary gland and jaw lesions. The reasons for using the overnight-stay facilities varied from social reasons to the need to monitor the airway. The fact that the theatre slots and overnight beds were guaranteed, and that the admissions were booked at outpatient consultation led to few cancellations by patients. This process reduced the inpatient waiting list and released the main operating theatre for major oral and maxillofacial operation, particularly for cancer.     

Starvation ketoacidosis in pregnancy

Starvation ketosis outside pregnancy is rare and infrequently causes a severe acidosis. Placental production of hormones, including glucagon and human placental lactogen, leads to the insulin resistance that is seen in pregnancy, which in turn increases susceptibility to ketosis particularly in the third trimester. Starvation ketoacidosis in pregnancy has been reported and is usually precipitated by a period of severe vomiting. Ketoacidosis is likely to have important implications for fetal survival as ketoacidosis in women with type 1 diabetes mellitus is associated with intrauterine death.     

Venous thromboembolism in ovarian cancer: incidence,risk factors and impact on survival

Objectives

Ovarian cancer has a higher incidence of venous thromboembolism (VTE) than other cancers. Clear cell cancers carry the highest risk at 11–27%. The aim of this study was to identify the predisposing factors for VTE in a population of ovarian cancer patients and to determine the influence of VTE on overall survival.

Study design

VTE events were identified from hospital and general practice/community care records for all patients with ovarian cancer who were diagnosed and treated in a tertiary cancer center between 2006 and 2010.

Results

The overall incidence of VTE was 9.7% (33) in 344 patients. Sixteen (48%) had pulmonary embolism. Six (18%) presented with VTE. Five (15%) had VTE diagnosed during pre-treatment routine CT scanning. Eleven (33%) developed VTE following surgery and eleven (33%) developed VTE during chemotherapy. Risk factors associated with the occurrence of VTE were BMI ≥ 30 (p < 0.01), clear cell carcinoma (p < 0.05), advanced stage (p < 0.01), high grade (p < 0.01) and CA125 > 500 IU/ml (p < 0.001). The occurrence of VTE was associated with decreased overall survival time (p < 0.001).

Conclusion

The incidence of VTE is high in ovarian cancer especially in the clear cell subtype. VTE adversely affects survival in ovarian cancer. Obesity, high grade and stage of cancer, clear cell subtype and high CA 125 level should be incorporated into protocols of VTE prophylaxis in women with ovarian cancer.