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- Factors associated with the use and quality of antenatal care in Nepal: a population-based study using the demographic and health survey data. [Journal Article]
- BMC Pregnancy Childbirth 2014; 14(1):94.
Good quality antenatal care (ANC) reduces maternal and neonatal mortality and improves health outcomes, particularly in low-income countries. Quality of ANC is measured by three dimensions: number of visits, timing of initiation of care and inclusion of all recommended components of care. Although some studies report on predictors of the first two indicators, no studies on the third indicator, which measures quality of ANC received, have been conducted in Nepal. Nepal follows the World Health Organization's recommendations of initiation of ANC within the first four months of pregnancy and at least four ANC visits during the course of an uncomplicated pregnancy. This study aimed to identify factors associated with 1) attendance at four or more ANC visits and 2) receipt of good quality ANC.Data from Nepal Demographic and Health Survey 2011 were analysed for 4,079 mothers. Good quality ANC was defined as that which included all seven recommended components: blood pressure measurement; urine tests for detecting bacteriuria and proteinuria; blood tests for syphilis and anaemia; and provision of iron supplementation, intestinal parasite drugs, tetanus toxoid injections and health education.Half the women had four or more ANC visits and 85% had at least one visit. Health education, iron supplementation, blood pressure measurement and tetanus toxoid were the more commonly received components of ANC. Older age, higher parity, and higher levels of education and household economic status of the women were predictors of both attendance at four or more visits and receipt of good quality ANC. Women who did not smoke, had a say in decision-making, whose husbands had higher levels of education and were involved in occupations other than agriculture were more likely to attend four or more visits. Other predictors of women's receipt of good quality ANC were receiving their ANC from a skilled provider, in a hospital, living in an urban area and being exposed to general media.Continued efforts at improving access to quality ANC in Nepal are required. In the short term, less educated women from socioeconomically disadvantaged households require targeting. Long-term improvements require a focus on improving female education.
- High Risk for HIV Following Syphilis Diagnosis Among Men in Florida, 2000-2011. [Journal Article]
- Public Health Rep 2014 Mar; 129(2):164-9.
Multiple interventions have been shown to reduce the risk of HIV acquisition, including preexposure prophylaxis with antiretroviral medications, but high costs require targeting interventions to people at the highest risk. We identified the risk of HIV following a syphilis diagnosis for men in Florida.We analyzed surveillance records of 13- to 59-year-old men in Florida who were reported as having syphilis from January 1, 2000, to December 31, 2009. We excluded men who had HIV infection reported before their syphilis diagnosis (and within 60 days after), then searched the database to see if the remaining men were reported as having HIV infection by December 31, 2011.Of the 9,512 men with syphilis we followed, 1,323 were subsequently diagnosed as having HIV infection 60-3,753 days after their syphilis diagnosis. The risk of a subsequent diagnosis of HIV infection was 3.6% in the first year after syphilis was diagnosed and reached 17.5% 10 years after a syphilis diagnosis. The risk of HIV was higher for non-Hispanic white men (3.4% per year) than for non-Hispanic black men (1.8% per year). The likelihood of developing HIV was slightly lower for men diagnosed with syphilis in 2000 and 2001 compared with subsequent years. Of men diagnosed with syphilis in 2003, 21.5% were reported as having a new HIV diagnosis by December 31, 2011.Men who acquire syphilis are at very high risk of HIV infection.
- Seroprevalence of Hepatitis B Virus among Adults at High Risk for HIV Transmission Two Decades after Implementation of Nationwide Hepatitis B Virus Vaccination Program in Taiwan. [Journal Article]
- PLoS One 2014; 9(2):e90194.
Seroprevalence of hepatitis B virus (HBV) after implementation of universal neonatal HBV vaccination and catch-up vaccination programs remains rarely investigated among the adults who were born in the vaccination era (in or after 1986) and engaged in high-risk sexual behaviors.Between 2006 and 2012, we determined HBV surface antigen ([HBsAg), anti-HBs, and HBV core antibody (anti-HBc), hepatitis C virus antibody (anti-HCV) and rapid plasma reagin titers among HIV-infected men who have sex with men (MSM) born during 1984-1985 (Group I: 244 persons) and those born in or after 1986 (Group II: 523), and HIV-uninfected MSM (Group III: 377) and heterosexuals (Group IV: 217) born in or after 1986. Prevalence and incidence of HBV infection were estimated and multivariate analysis was performed to identify factors associated with HBsAg positivity.Compared with Group I, Groups II-IV had a significantly lower prevalence of HBsAg positivity (7.8% vs 3.7%, 2.4%, and 3.2%, respectively); and the prevalence of anti-HBc positivity was also lower for Groups III and IV (30.3% vs. 19.6%, and 18.0%, respectively), but no difference was observed between Groups I and II (30.3% vs. 26.3%). In multivariate analysis, HBsAg positivity was significantly associated with syphilis (adjusted odds ratio, 2.990; 95% confidence interval, 1.502-5.953) and anti-HCV positivity (adjusted odds ratio, 3.402; 95% confidence interval, 1.091-10.614). In subjects of Group II with all-negative HBV markers at baseline, the incidence rate of HBsAg seroconversion was 0.486 episodes per 100 person-years; and for those who received combination antiretroviral therapy containing lamivudine and/or tenofovir, none developed HBsAg seroconversion during the follow-up.Among the adults who were born in or after 1986 and engaged in high-risk sexual behaviors in Taiwan, neonatal HBV vaccination and catch-up vaccination programs conferred long-term protection against HBsAg seroconversion and HBsAg positivity was associated with syphilis and anti-HCV positivity.
- John Hunter's (1728-1793) account of venereal diseases. [JOURNAL ARTICLE]
- J Med Biogr 2014 Jan 30.
John Hunter's work included description of the nature of digestion, child development, role of the lymphatic system and proof that the maternal and foetal blood supplies are separate. His contribution to the understanding of venereal diseases is reviewed. Hunter's argument of the unitary nature of venereal diseases is examined and the progress he made in diagnosis and management is discussed.
- Maria Polydouri (1902-1930): The Greek poete maudit who died of tuberculosis. [JOURNAL ARTICLE]
- J Med Biogr 2013 Oct 8.
Maria Polydouri was a notable Greek poet. Often likened to the French poètes maudits, her poetry reflected a lyrical charisma and her unsettled life an untimely ending. The passing of both her parents within less than two months when she was aged 18 and her incomplete, desperate affair with the syphilitic poet Kostas Karyotakis, defined her existence. She took up many uncompleted occupations and remained socially committed. It seems that in 1923 she caught tuberculosis that was diagnosed ultimately in 1927 and led to her hospitalization at first in Paris and later in Athens. A progressive and restless spirit until the end, she wrote her best poems while in hospital. Polydouri's final years and death received national attention and marked her out as a Greek literary legend.
- Toward global prevention of sexually transmitted infections (STIs): The need for STI vaccines. [JOURNAL ARTICLE]
- Vaccine 2014 Feb 25.
An estimated 499 million curable sexually transmitted infections (STIs; gonorrhea, chlamydia, syphilis, and trichomoniasis) occurred globally in 2008. In addition, well over 500 million people are estimated to have a viral STI such as herpes simplex virus type 2 (HSV-2) or human papillomavirus (HPV) at any point in time. STIs result in a large global burden of sexual, reproductive, and maternal-child health consequences, including genital symptoms, pregnancy complications, cancer, infertility, and enhanced HIV transmission, as well as important psychosocial consequences and financial costs. STI control strategies based primarily on behavioral primary prevention and STI case management have had clear successes, but gains have not been universal. Current STI control is hampered or threatened by several behavioral, biological, and implementation challenges, including a large proportion of asymptomatic infections, lack of feasible diagnostic tests globally, antimicrobial resistance, repeat infections, and barriers to intervention access, availability, and scale-up. Vaccines against HPV and hepatitis B virus offer a new paradigm for STI control. Challenges to existing STI prevention efforts provide important reasons for working toward additional STI vaccines. We summarize the global epidemiology of STIs and STI-associated complications, examine challenges to existing STI prevention efforts, and discuss the need for new STI vaccines for future prevention efforts.
- HIV Risk and Prevention Behaviors in Men Who Have Sex With Men and Women: A Respondent-Driven Sampling Study in Shenzhen, China. [JOURNAL ARTICLE]
- AIDS Behav 2014 Mar 1.
Men who have sex with men and women (MSMW) may expand the HIV epidemic from men who have sex with men to the female population. From a respondent-driven sampling survey in Shenzhen, China, we quantified the burden of HIV/syphilis and studied patterns of risk and prevention behaviors in 107 MSMW, and compared these with those of 542 men who have sex with men only (MSM-only). HIV prevention behaviors and consistent condom use with male partners did not differ between the two groups. However, HIV risk behaviors were more common among MSMW than MSM-only. Moreover, among MSMW, the HIV prevalence was as high as 6 % and consistent condom use was extremely low with female partners in MSMW. We conclude that there is risk of HIV transmission from MSMW to the female population. Special efforts are needed to convince MSMW they should refrain from HIV risk behaviors.
- Hepatitis B Testing and Vaccination among Adults with Sexually Transmitted Infections in a Large Managed Care Organization. [JOURNAL ARTICLE]
- Clin Infect Dis 2014 Feb 25.
Background. Data on viral hepatitis B (HBV) testing and vaccination in primary care settings among persons at sexual risk for HBV infection have been sparse. We examined rates and factors associated with HBV serologic testing and vaccination rates in adults infected with sexually transmitted infections. Methods. We conducted a retrospective cohort study of adults diagnosed with chlamydia, gonorrhea, or syphilis in Kaiser Permanente Southern California in 2008-2011. Eligible adults were identified in electronic medical records (EMR) and were followed-up for HBV serologic tests. The vaccine series initiation was examined in subjects who were tested susceptible. Results. The 90-day hepatitis B surface antigen (HBsAg) testing rate was 28.1% in 15,357 adults. Testing rates increased through the study period (P for trend <0.01). Only 8.8% (1,359/15,357) of patients received both HBsAg and HBsAb tests to determine prior exposure and susceptibility to HBV. There were 116 (10.6%) subjects who were tested susceptible and initiated the vaccine series. In multivariable logistic regression analysis, the odds of receiving testing was inversely associated with female sex, black race, other/unknown race, or having pre-specified chronic comorbidities. In survival analysis, adults aged 25-34 years and≥55 years were more likely to initiate hepatitis B vaccine series compared to 18-24 year olds (25-34 years: hazard ratio[HR]=1.88, 95% CI=1.11-3.19; ≥55 years: HR=2.99 , 95% CI= 1.18-7.61). Conclusions. There are missed opportunities in HBV testing and vaccination in primary care. Implementation of provider decision-making support tools in the EMR system may potentially improve hepatitis B testing and vaccination rates.
- Results from screening immigrants of low-income countries: data from a public primary health care. [Journal Article]
- J Travel Med 2014 Mar; 21(2):92-8.
A total of 3,132 immigrants from low- and middle-income countries were involved in a cross-sectional observational study to screen for infectious diseases among immigrants attending public primary health care (PHC) centers. The study was conducted to clarify the degree of demographic differences and risk predictors of these diseases.Demographic and clinical variables, screening for infectious diseases [hepatitis B and C, human immunodeficiency virus infection, syphilis, and tuberculosis (TB)], and analytical data (anemia, hematuria, and liver function) were recorded from immigrants attending a public PHC unit in Barcelona.Global hepatitis B, including chronic and previous, reached 18.1%; Morocco as the country of origin [odds ratio (OR) 2.1, 95% confidence interval (CI) 1.07-4.14] and gastrointestinal symptoms (OR 1.9, CI 1.18-3.02) were risk factors. Hepatitis C prevalence was 3.3% with elevated hepatic transaminase levels as a risk factor (OR 26.1, CI 8.68-78.37). Positive syphilis was 3.1%; latent and active TB rates were 28.1 and 5.8%, respectively. Concerning TB, we found remarkable differences both among WHO regions of origin (the Eastern Mediterranean region showed the highest rate of active TB, 8%) and the three categories of years of residence in Spain (6.5% for <1 year, 12.8% for 1-5 years, and 10% for >5 years).The data allowed recommendation of a minimal screening of TB in immigrants from low-income countries regardless of the years of residence in Spain, hepatitis C in patients with altered transaminase levels, and hepatitis B in patients with gastrointestinal symptoms and/or from Morocco.
- Solitary cavernous sinus neurosarcoidosis mimicking neurosyphilis. [Journal Article]
- J Korean Neurosurg Soc 2014 Jan; 55(1):61-3.
A differential diagnosis between neurosarcoidosis and neurosyphilis is particularly problematic in patients with a positive serologic result for syphilis. We report here a patient with a solitary cavernous sinus sarcoidosis who had a history of syphilis and showed rapidly progressing cavernous sinus syndrome. A transsphenoidal biopsy was performed and a histopathologic examination revealed a non-caseating granuloma with an asteroid body. His facial pain disappeared after steroid therapy. He received oral prednisolone for one year. A follow-up magnetic resonance imaging of the brain revealed resolution of the mass over the cavernous sinus. Particularly in patients with a history of syphilis, neurosyphilis should be included in a differential diagnosis of neurosarcoidosis.