Predictors of chlamydial infection and gonorrhea among patients seen by private practitioners.

OBJECTIVE: To identify the predictors of chlamydial infection and gonorrhea among patients tested by general practitioners. DESIGN: Prospective study. SETTING: General private practice, family planning and abortion clinic, adolescent clinic, sexually transmitted disease (STD) clinic and community health clinic in downtown Montreal. PATIENTS: The 2856 patients were included because of symptoms compatible with an STD, a history of sexual contact with a person known or suspected to have chlamydial infection, a history of a nonexclusive sexual relationship or presentation for an abortion. MEASURES: Patient information was obtained by the attending physician on a standard form. Enzyme immunoassay (EIA) for Chlamydia trachomatis and culture for Neisseria gonorrhoeae were performed on cervical (female) or urethral (male) samples. Stepwise logistic regression was used to identify the predictors of infection. RESULTS: The EIA results were positive in 11.1% of the cases and the culture results in 2.3%. Among the males chlamydial infection was independently associated with low age (odds ratio [OR] = 0.88 per year), heterosexuality (OR = 4.99), urethral discharge (OR = 3.74) and the absence of a history of gonorrhea (OR = 0.51). Gonorrhea was associated with urethral discharge (OR = 24.3) and homosexuality (OR = 3.68). Among the females chlamydial infection was associated with low age (OR = 0.79 per year), a history of sexual contact with a person known to have chlamydial infection (OR = 2.30), multiple sexual partners in the previous 12 months (OR = 1.60) and a reason for the test other than screening purposes (OR = 0.60). Gonorrhea was associated with a reason other than screening (OR = 0.24) and low age (OR = 0.74 per year). Among the patients tested for screening purposes age was the only significant predictor of chlamydial infection (OR = 0.79 per year), and the prevalence of gonorrhea was 0.4%. The actual rate of chlamydial infection was 11.8% among the patients younger than 25 years, 5.7% among those 25 to 34 years and 0.6% among those over 34. CONCLUSIONS: Age alone can be used as a criterion to screen for chlamydial infection among asymptomatic patients without a history of sexual contact with a person known or suspected to have such infection and with a history of a nonexclusive relationship. The prevalence in our population justifies screening people up to 34 years of age.     

Prevalence of chlamydial genital infection and associated risk factors in adolescent females at an urban reproductive health care center in Croatia

The study was undertaken to determine the prevalence of chlamydial genital infection in sexually active, urban adolescent females 15-19 years; to identify behavioral, demographic, and clinical factors associated with chlamydial infections; and to develop criteria for potential screening strategies. 500 adolescent women, median age 17.7 years, who visited gynecological outpatient clinic in Children's Hospital Zagreb for different reasons were enrolled in this study. Gynecological exam, colposcopy, detection of chlamydial infection by the rapid direct immunoassay of endocervical swab (Clearview Chlamydia-Unipath), endocervical cytological examination--Papanicolaou smear, and questionnaire to obtain demographic, social, behavioral and presence of symptoms data were performed. Positive Chlamydia trachomatis test were found in 16.4% of participants, cytologic cervical abnormalities--cervical intraepithelial neoplasia (CIN I-CIN III) were found in 25.2% and cytological signs of Human papilloma virus were found in 11.4%. Stepwise multivariate logistic regression analysis identified five factors associated with infection: the age of menarche < or =13 years, > or =4 lifetime sexual partners, non-use of contraception (rare or never), cervical friability, and abnormal Papanicolaou test. Urban adolescent sexually active women are at high risk for chlamydial infection and other sexually transmitted diseases including HIV infection. Association between chlamydial genital infection and risk-taking sexual and contraceptive behavior was found. Routine Chlamydia trachomatis testing for this population is recommended as well as implementation of school based sexual health education because of their risk-taking sexual behavior.     

Helminth infections among rural schoolchildren in Southern Ethiopia: A cross-sectional multilevel and zero-inflated regression model

Although the prevalence of helminths infection among schoolchildren is known, there has been little progress in the application of count model for modelling the risk factors of helminths egg. Only a few studies applied multilevel analysis to explore the variation in helminths prevalence across schools and classes. This study aimed to assess the prevalence, intensity of helminths infection, and identify risk factors at the individual-, household-, and school-level among schoolchildren in Southern Ethiopia. Using multistage random sampling, we recruited 864 students in the Wonago District. We applied multilevel-logistic and zero-inflated negative binomial regression models (ZINB). Risk factors were concentrated at the individual level; school-level and class-level variables explained less than 5% of the variance. The overall helminths prevalence was 56% (479/850); Trichuris trichiura prevalence was 42.4% (360/850); and Ascaris lumbricoides prevalence was 18.7% (159/850). The rate of any helminths increased among thin children (AOR: 1.73 [95% CI: (1.04, 2.90]), anemic (AOR: 1.45 [95% CI: 1.04, 2.03]), mothers who had no formal education (AOR: 2.08 [95% CI: 1.25, 3.47]), and those in households using open containers for water storage (AOR: 2.06 [95% CI: 1.07, 3.99]). In the ZINB model, A. lumbricoides infection intensity increased with increasing age (AOR: 1.08 [95% CI: 1.01, 1.16]) and unclean fingernails (AOR: 1.47 [95% CI: 1.07, 2.03]). Handwashing with soap (AOR: 0.68 [95% CI: 0.48, 0.95]), de-worming treatment [AOR: 0.57 (95% CI: 0.33, 0.98)], and using water from protected sources [AOR: 0.46 (95% CI: 0.28, 0.77)] were found to be protective against helminths infection. After controlling for clustering effects at the school and class levels and accounting for excess zeros in fecal egg counts, we found an association between helminths infection and the following variables: age, thinness, anemia, unclean fingernails, handwashing, de-worming treatment, mother’s education, household water source, and water storage protection. Improving hygiene behavior, providing safe water at school and home, and strengthening de-worming programs is required to improve the health of schoolchildren in rural Gedeo.     

Prevalence and Risk Factors of Restless Legs Syndrome among Chinese Adults in a Rural Community of Shanghai in China

Aims

The primary objective of this study was to investigate the prevalence and risk factors of restless legs syndrome (RLS) in an adult Chinese population living in a rural community. We also aimed to determine the predictive diagnostic value of the 4-item screening questionnaire for RLS in this population.

Methods

This study was designed as a 2-phase survey. In phase 1 we performed a face-to-face interview of eligible individuals living in a rural community in Shanghai using a 4-item screening questionnaire. In phase 2, sleep specialists performed a phone interview of the individuals who screened positive to diagnosis RLS.

Results

Forty-one RLS cases were confirmed among 2941 eligible individuals 18 years of age or older in the study community. The prevalence of RLS was 1.4% (95% confidence interval (CI) =1.0-1.9%), with a significantly higher rate observed in females (1.9% [95%CI =1.3-2.7%]) than that in males (0.9% [95%CI =0.5-1.5%], p=0.019). The prevalence rate increased significantly with age, from 0.2% (95% CI =0.08-0.6%) in those 18-39 years old to 4.1% (95% CI =2.1-7.9%) in those ≥70 years old (p<0.001). The multivariate logistic regression analysis indicated that gastritis, anemia and hypertension were risk factors for RLS. The sensitivity and specificity of the 4-item screening questionnaire used in this study were 63.4% and 97.5%, respectively.

Conclusion

RLS prevalence is relatively low among Chinese adults living in rural Shanghai. Furthermore, population-based studies with a larger sample size and a longitudinal follow-up may help to determine the risk factors of RLS and potential interventions for RLS.     

Cardiovascular risk factors in a small urban community in central Croatia

The aim of this study was to determine in Karlovac (southern part of central Croatia) the most important risk factors for coronary heart diseases in men and women according to age < or = 59 and > or = 60 on the basis of their prevalence in 558 non-coronary patients and 442 symptomatic coronary patients. In younger male coronary patients (< or = 59 years of age) in relation to the control study, the statistically significant more frequent risk factors were hypercholesterolemia (p < 0.001), smoking (p < 0.01) and diabetes (p < 0.01). In older male patients (> or = 60 years of age) there was no statistically significant difference in a single risk factor. In younger female coronary patients, the statistically significant more frequent risk factors were hypercholesterolemia (p < 0.001) and diabetes (p < 0.001) and in older female patients diabetes (p < 0.05). This population sample showed higher prevalence of cardiovascular risk factors in younger coronary patients. The most frequent risk factors were diabetes, hypercholesterolemia and smoking. The difference is slighter in older coronary patients where it is diabetes, which is the most important for women.     

Seroprevalence of and risk factors for HIV-1 infection in injection drug users in Montreal and Toronto: a collaborative study.

OBJECTIVE: To determine the prevalence of antibodies to HIV-1 and risk factors for HIV-1 infection among injection drug users. DESIGN: Questionnaire survey. A venous blood sample was taken for HIV-1 antibody testing. SETTING: Montreal and Toronto. PARTICIPANTS: A total of 810 subjects who had used injection drugs in the previous 6 months recruited mainly from treatment centres and from the street in Montreal (425 subjects) and from treatment centres in Toronto (385 subjects) between September 1988 and September 1990. The overall participation rate was 82%. OUTCOME MEASURES: HIV-1 seropositivity, sociodemographic and behavioural risk factors for HIV-1 infection. RESULTS: The overall seroprevalence rate of HIV-1 infection was 4.8% (95% confidence limits [CL] 3.5 and 6.5). In Montreal the rate was 8.2% (95% CL 6.0 and 11.2), and in Toronto 1.0% (95% CL 0.4 and 2.6) (p < 0.001). Seropositive subjects were significantly older (p = 0.041) and were more likely to have a history of imprisonment (p = 0.006) than seronegative subjects. In univariate analysis seropositivity was associated with the following behaviours: more frequent cocaine use (p < 0.001), injecting drugs in "shooting galleries" (p = 0.002), sharing equipment with a person known to be HIV-1 seropositive (p = 0.006), "booting" fresh blood (p = 0.004), homosexual or bisexual orientation (p = 0.006), engaging in prostitution (p < 0.001) and, for men, number of male sexual partners in the previous 6 months (p = 0.007). In multivariate analysis the determinants of HIV-1 seropositivity were Montreal as the city of recruitment (odds ratio [OR] 6.7, 95% CL 2.32 and 19.42), engaging in prostitution (OR 2.13, 95% CL 1.01 and 4.75), a history of imprisonment (OR 3.51, 95% CL 1.33 and 9.29) and sharing equipment with a person known to be HIV-1 seropositive (OR 4.43, 95% CL 1.43 and 13.74). CONCLUSIONS: Our findings show that HIV-1 is circulating among injection drug users in Montreal and Toronto and that both drug use and sexual behaviours are implicated in the transmission of infection in the populations studied. Adapted preventive programs should be developed to prevent further spread of HIV-1 infection in this population.     

Population-based study on the prevalence of and risk factors for human papillomavirus infection in Qujing of Yunnan province, Southwest China

ABSTRACT: BACKGROUND: Human papillomavirus (HPV) infection causes cervical cancer and premalignant lesions of the cervix. Prevalence of HPV infection and HPV genotypes vary among different regions. However there is no data on the prevalence of HPV infection and HPV genotypes from southwest China. This study was undertaken to determine the prevalence of and risk factors for HR-HPV infection in Qujing of Yunnan province, southwest China to provide comprehensive baseline data for future screening strategies. Methods: A sample of 5936 women was chosen by the multi-stage stratified cluster sampling method with selection probabilities proportional to size (PPS). An epidemiological questionnaire was conducted via a face-to-face interview and cervical specimens were taken for HPV DNA testing by Digene Hybrid Capture 2 (HC2) test. HPV Genotyping Reverse Hybridization Test was used for HPV genotyping. Proportions were compared by Chi-squared tests, and logistic regression was utilized to evaluate risk factors. Results: The median age was 38 years and the inter-quartile range was from 31 years to 47 years. 97.3% of the study population was Han nationality. Overall prevalence of HR-HPV infection was 8.3% (494/5936) and bimodal age distribution of HPV infection was observed. The five most prevalent HR-HPV genotypes were HPV-16(3.4%), HPV-56(1.7%), HPV-58(1.4%), HPV-33(1.2%) and HPV-52(0.88%). Multiple HPV infections were identified in 50.5% (208/412) of the positive genotyping specimens. Multivariate logistic regression model indicated that parity (OR=1.35, 95% CI: 1.18-1.53, p<0.0001) was a risk factor for HR-HPV infection, and age of 50-65 years (OR=0.60, 95% CI: 0.45-0.80, p=0.0005), being married or in stable relationship (OR=0.55, 95% CI: 0.31-0.96, p=0.035) were protective factors. Conclusions: This study provided baseline data on HR-HPV prevalence in the general female population in Qujing of Yunnan province, southwest China. The finding of multiple HPV infections and bimodal age distribution revealed that HPV screening is necessary for perimenopausal women in future.     

Multilevel Factors Influencing Hepatitis B Screening and Vaccination among Vietnamese Americans in Atlanta,Georgia

Chronic hepatitis B virus (HBV) infection may lead to liver cirrhosis, chronic liver disease, and liver cancer. Immunization rates are suboptimal among Asian Americans/Pacific Islanders (AAPIs), who remain disproportionately affected by these illnesses. We investigated socioecological factors affecting HBV prevention among 316 Vietnamese Americans in Atlanta, Georgia. Social and community support of HBV vaccination was associated with screening (OR=1.69, 95% CI [1.21,2.38]), vaccination (OR=1.89, [1.27,2.81]), and intent to vaccinate (OR=1.77, [1.13,2.78]). Misconceptions decreased screening likelihood (OR=0.67, [0.46,0.99]) and vaccination (OR=0.55, [0.35,0.86]). Those able to pay for medical treatment (OR=1.23, [1.01,1.50]) were also more likely immunized, and greater transportation access (OR=1.42, [1.07,1.87]) was associated with greater intention to vaccinate. Multi-level factors facilitated HBV vaccination in this population. Tailored, culturally appropriate communication strategies will positively influence immunization uptake.     

Prévalence de l'infection cervicale à Chlamydia trachomatis dans une population féminine consultant pour contraception.

OBJECTIVES: To determine the prevalence and risk indicators of cervical infection due to Chlamydia trachomatis among female patients consulting for contraception and to evaluate an enzyme immunoassay for the detection of C. trachomatis in this setting. DESIGN: Prevalence study. Endocervical specimens were analysed by means of culture and enzyme immunoassay. C. trachomatis infection was diagnosed through culture. SETTING: A hospital family planning clinic in Trois-Rivières, Que. SUBJECTS: All 533 female patients who consulted for contraception between November 1986 and March 1988. Results of culture were available for 495 patients. MAIN OUTCOME MEASURE: Demographic, epidemiologic and clinical information was collected by means of a standard questionnaire and a gynecologic examination. MAIN RESULTS: The prevalence rate of chlamydial infection was 9% (45/495). Enzyme immunoassay detected 37 (82%) of the infections. The mean age of the patients was 19.8 years, and 98% of the infections were diagnosed in those aged 25 years or less. The variables significantly associated with C. trachomatis infection were having more than one sexual partner in the preceding year (odds ratio [OR] 2.9; 95% confidence limits [CL] 1.7 and 5.0) and having more than one partner in the preceding 3 months (OR 2.3; 95% CL 1.2 and 4.3). These two indicators would have detected 58% and 22% of the infections respectively. CONCLUSIONS: Screening for C. trachomatis infection by means of enzyme immunoassay should be proposed to all female patients aged 25 years or less consulting for contraception in our clinic. Such screening may prove to be an effective preventive measure in other similar clinical settings.     

Household risk factors for Trypanosoma cruzi seropositivity in two geographic regions of Ecuador

Few studies on the relationship between environmental factors and Trypanosoma cruzi transmission have been conducted in Ecuador. We conducted a cross-sectional study of household risk factors for T. cruzi seropositivity in 2 distinct geographical regions of Ecuador. Exposure information was collected via household surveys, and subjects were tested for serological evidence of T. cruzi infection. In total, 3,286 subjects from 997 households were included. In the coastal region, factors associated with seropositivity were living in a house with a palm roof (odds ratio [OR] = 2.63, 95% confidence interval, [1.61. 4.27]), wood walls (OR = 5.75 [2.04, 16.18]), or cane walls (OR = 2.81 11.31, 6.04]), and the presence of firewood in the peridomicile (OR = 2.48 [1.54, 4.01]). Accumulation of trash outside the home was associated with a reduced risk of seropositivity (OR = 0.25 [0.12, 0.51]). In the Andean region, living in a house with adobe walls was the only factor predictive of T. cruzi seropositivity. In conclusion, risk factors for T. cruzi transmission in Ecuador varied by geographic region, probably because of differing behavior of the triatomine vector species in each region. An understanding of the transmission dynamics of T. cruzi in a particular area is necessary for the development of effective Chagas disease control strategies in those areas.     

Coverage and uptake of systematic postal screening for genital Chlamydia trachomatis and prevalence of infection in the United Kingdom general population: cross sectional study

Objective To measure the coverage and uptake of systematic postal screening for genital Chlamydia trachomatis and the prevalence of infection in the general population in the United Kingdom. To investigate factors associated with these measures.Design Cross sectional survey of people randomly selected from general practice registers. Invitation to provide a specimen collected at home.Setting England.Participants 19 773 men and women aged 16-39 years invited to participate in screening.Main outcome measures Coverage and uptake of screening; prevalence of chlamydia.Results Coverage of chlamydia screening was 73% and was lower in areas with a higher proportion of non-white residents. Uptake in 16-24 year olds was 31.5% and was lower in men, younger adults, and practices in disadvantaged areas. Overall prevalence of chlamydia was 2.8% (95%confidence interval 2.2% to 3.4%) in men and 3.6% (3.1% to 4.9%) in women, but it was higher in people younger than 25 years (men 5.1%; 4.0% to 6.3%; women 6.2%; 5.2% to 7.8%). Prevalence was higher in the subgroup of younger women who were harder to engage in screening. The strongest determinant of chlamydial infection was having one or more new sexual partners in the past year.Conclusions Postal chlamydia screening was feasible, but coverage was incomplete and uptake was modest. Lower coverage of postal screening in areas with more non-white residents along with poorer uptake in more deprived areas and among women at higher risk of infection could mean that screening leads to wider inequalities in sexual health.     

T cell cytokines and the risk of blood stream infection in extremely low birth weight infants

Cytokines mediate the host immune response to infectious micro-organisms. The objective of this study was to determine whether immune regulatory interleukins (IL-4, IL-5, IL-6, and IL-10) and inflammatory cytokines (Interferon-γ [INF-γ], tumor necrosis factor-β [TNF-β], IL-2, and IL-17) are associated with an increased risk of developing blood stream bacterial/fungal infection (BSI) in extremely low birth weight (ELBW) infants. ELBW infants from 17 NICHD Neonatal Research Network centers without early onset sepsis were studied. Cytokines were measured from blood on days 1, 3, 7, 14, and 21 after birth. 996 ELBW infants contributed a minimum of 4080 unique measurements for each cytokine during the five sampling periods. Infants with BSI had lower levels of the inflammatory cytokines IL-17 (p=0.01), and higher levels of the regulatory cytokines, IL-6 (p=0.01) and IL-10 (p<0.001). Higher levels of regulatory cytokines relative to pro-inflammatory cytokines were associated with increased risk of BSI even after adjusting for confounding variables. In ELBW infants, the ratio of immune regulatory cytokines to inflammatory cytokines was associated with development of BSI. Altered maturation of regulatory and inflammatory cytokines may increase the risk of serious infection in this population.     

Endocervical Chlamydia trachomatis infection in Canadian adolescents.

The highest prevalence rate of sexually transmitted chlamydial infection is among adolescent girls. To determine the rate among predominantly asymptomatic girls who were seen at a pediatric gynecology unit and to identify those at high risk we screened 541 such patients from Jan. 1 to Dec. 31, 1986, by means of direct fluorescent antibody testing; 422 (78.0%) were asymptomatic. The most common reason for presentation was a request for contraceptive advice (the reason for 59.2% of the patients). Of the 446 patients (82.4%) who were sexually active 66 (14.7%) had evidence of chlamydial infection; none of the 93 sexually inactive patients were infected. Neisseria gonorrhoeae was isolated from eight (1.5%) of the patients. The risk factors that correlated with chlamydial infection were abnormal vaginal discharge, abdominopelvic pain and an abnormal Papanicolaou test result. Because of the high morbidity rate associated with genital chlamydial infection and the high prevalence rate among adolescent girls, most of whom are asymptomatic, all sexually active teenagers should be screened.     

Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders,bipolar disorder and major depressive disorder: a systematic review and meta‐analysis

Metabolic syndrome (MetS) and its components are highly predictive of cardiovascular diseases. The primary aim of this systematic review and meta‐analysis was to assess the prevalence of MetS and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder, comparing subjects with different disorders and taking into account demographic variables and psychotropic medication use. The secondary aim was to compare the MetS prevalence in persons with any of the selected disorders versus matched general population controls. The pooled MetS prevalence in people with severe mental illness was 32.6% (95% CI: 30.8%‐34.4%; N = 198; n = 52,678). Relative risk meta‐analyses established that there was no significant difference in MetS prevalence in studies directly comparing schizophrenia versus bipolar disorder, and in those directly comparing bipolar disorder versus major depressive disorder. Only two studies directly compared people with schizophrenia and major depressive disorder, precluding meta‐analytic calculations. Older age and a higher body mass index were significant moderators in the final demographic regression model (z = ?3.6, p = 0.0003, r² = 0.19). People treated with all individual antipsychotic medications had a significantly (p<0.001) higher MetS risk compared to antipsychotic‐naïve participants. MetS risk was significantly higher with clozapine and olanzapine (except vs. clozapine) than other antipsychotics, and significantly lower with aripiprazole than other antipsychotics (except vs. amisulpride). Compared with matched general population controls, people with severe mental illness had a significantly increased risk for MetS (RR = 1.58; 95% CI: 1.35‐1.86; p<0.001) and all its components, except for hypertension (p = 0.07). These data suggest that the risk for MetS is similarly elevated in the diagnostic subgroups of severe mental illness. Routine screening and multidisciplinary management of medical and behavioral conditions is needed in these patients. Risks of individual antipsychotics should be considered when making treatment choices.     

Prevalence and intensity of infections of Ascaris lumbricoides and Trichuris trichiura and associated socio-demographic variables in four rural Honduran communities

Between January and March 1998, a cross-sectional survey was carried out in four rural communities in Honduras, Central America. We examined the prevalence and intensity of Ascaris lumbricoides and Trichuris trichiura infections among 240 fecal specimens, and the association between selected socio-demographic variables and infection for 62 households. The overall prevalence of A. lumbricoides and T. trichiura was 45% (95% CI 39.0-51.9) and 38% (95% CI 31.8-44.4) respectively. The most intense infections for Ascaris and Trichuris were found in children aged 2-12 years old. By univariate analysis variables associated with infections of A. lumbricoides were: number of children 2-5 years old (p=0.001), level of formal education of respondents (p=0.01), reported site of defecation of children in households (p=0.02), households with children who had a recent history of diarrhea (p=0.002), and the location of households (p=0.03). Variables associated with both A. lumbricoides and T. trichiura infection included: number of children 6-14 years old (p=0.01, p=0.04, respectively), ownership of a latrine (p=0.04, p=0.03, respectively) and coinfection with either helminth (p=0.001, p=0.001, respectively). By multivariate analysis the number of children 2-5 years living in the household, (p=0.01, odds ratio (OR)=22.2), children with a recent history of diarrhea (p=0.0, OR=39.8), and infection of household members with T. trichiura (p=0.02, OR=16.0) were associated with A. lumbricoides infection. The number of children 6-14 years old in the household was associated with both A. lumbricoides and T. trichiura infection (p=0.04, p=0.01, OR=19.2, OR=5.2, respectively).     

Chlamydial cervicitis: testing the practice guidelines for presumptive diagnosis

OBJECTIVE: To test the recommendation from the Canadian guidelines for sexually transmitted diseases (STDs) that mucopurulent endocervical discharge and 10 or more polymorphonuclear leukocytes (PMNs) per high-power field of a Gram-stained endocervical smear or, when Gram staining is not possible, the presence of endocervical discharge and one of edema, erythema or induced mucosal bleeding of the cervix can be considered diagnostic for chlamydial cervicitis. METHODS: A total of 596 consecutive women attending 2 family planning clinics for routine care underwent vaginal speculum examination and were tested for Chlamydia trachomatis and Neisseria gonorrhoeae. PMN counts from Gram-stained endocervical smears and the presence or absence of putative indicators of chlamydial infection were recorded. RESULTS: The prevalence of chlamydial cervicitis was 6.2% (37/596), and no women tested positive for N. gonorrhoeae. Presumptive diagnosis of chlamydial cervicitis based on the guidelines criteria of mucopurulent endocervical discharge and 10 or more PMN per high-power microscopic field had a sensitivity and specificity of 18.9% and 97.0% respectively, a positive predictive value of 29.2% and a positive likelihood ratio (LR) of 6.2 (p = 0.003). Presumptive diagnosis based on endocervical discharge with edema, erythema or induced mucosal bleeding of the cervix had a sensitivity and specificity of 43.2% and 80.0% respectively, a positive predictive value of 12.5% and a positive LR of 2.2 (p = 0.002). In the presence of bacterial vaginosis or vaginitis, the LR for the criteria of mucopurulent endocervical discharge and 10 or more PMN per high-power field was 5.4 (p = 0.04), whereas the LR was 4.3 (p = 0.10) if bacterial vaginosis and vaginitis were absent. CONCLUSIONS: In this setting, the practice of making a presumptive diagnosis of chlamydial cervicitis on the basis of the criteria given in the Canadian STD guidelines was not supported.     

Association of human papillomavirus and Chlamydia infections with incidence cervical neoplasia

Incidence cervical neoplasia is defined as disease that becomes manifest during a given period of observation. Association with preceding genital infections having characteristic cytologic findings would seem to be more likely for incidence than for prevalence cases since the usual long latency period of carcinoma in situ (CIS) could allow resolution of infectious processes. For this reason, it was elected to examine the preceding Papanicolaou smears from patients with tissue-confirmed incidence CIS or invasive epidermoid carcinoma. There were 67 women with biopsy-proven CIS or invasive carcinoma of the uterine cervix identified in the files of the University of New Mexico Cytopathology Laboratory from 1966 to 1982 who had two initial negative smears as well as smears at intervals of three years or less. All cytologic smears prior to tissue diagnosis were rescreened for confirmation of cytologic atypia or its absence as well as for morphologic evidence of human papillomavirus (HPV) or chlamydial infections. Control cases matched for age, gravidity, ethnicity and number of smears were reviewed in an identical manner. Koilocytes indicative of HPV infection were found in 17 index cases (25%) and 5 controls (7%) (p = 0.005). Chlamydial infections were identified in 18 index cases (27%) and in 4 controls (6%) (p = 0.001). The times required for conversion from smear negativity to malignancy were determined for each incidence case. The results showed great variability but suggest that the progression to malignancy is not hastened in women with antecedent HPV or chlamydial infections. Our results indicate that the presence of koilocytes and/or chlamydial inclusions in cervical smears serves to identify a group of women with a significantly increased risk of developing cervical carcinoma, even in the absence of concurrent dysplasia.     

Epidemiology of soil-transmitted helminth infections in Semarang,Central Java,Indonesia

Soil-transmitted helminth (STH) infections are endemic in Indonesia. However, prevalence data for many parts of the country are incomplete. The aim of this study was to determine human STH prevalence and knowledge and practices relating to STH risk behaviour, to provide a current view of the status of STH infection in rural communities in Central Java. A cross-sectional survey of 16 villages was conducted in Semarang, Central Java in 2015. Demographic and household data together with information about knowledge and practices relating to STH and hygiene were elicited through face-to-face interviews. Stool samples were collected and examined using the flotation method. Children (aged 2–12 years) also had their haemoglobin (Hb) levels, height and weight data collected, and BMI estimated. Data were analysed using univariate logistic regression analysis. A total of 6,466 individuals with a mean age of 33.5 years (range: 2–93) from 2,195 households were interviewed. The overall prevalence of STH was 33.8% with Ascaris lumbricoides (roundworm) the predominant nematode identified (prevalence = 26.0%). Hookworm and Trichuris trichiura (whipworm) were found in 7.9% and 1.8% of participants, respectively. Females were at increased odds of infection with A. lumbricoides (adjusted OR 1.14, 95% CI [1.02–1.29], p = 0.02). Adults in age groups 51–60 and over 60 years had the highest odds of being infected with hookworm (adjusted OR 3.01, 95% CI [1.84–4.91], p<0.001 and adjusted OR 3.79, 95% CI [2.30–6.26], p<0.001, respectively) compared to 6–12 year olds. Farmers also had higher odds of being infected with hookworm (adjusted OR 2.36, 95% CI [1.17–4.76], p = 0.02) compared to other occupation categories. Poverty (OR 2.14, 95% CI [1.77–2.58], p<0.001), overcrowding (OR 1.35, 95% CI [1.27–1.44], p<0.001), goat ownership (OR 1.61, 95% CI [1.10–2.41], p = 0.02) and the presence of dry floor space in the home (OR 0.73, 95% CI [0.58–0.91], p = 0.01) were all household factors significantly associated with an increased odds of infection. Infection with STH was not significantly associated with the gastrointestinal illness (p>0.05), BMI or Hb levels; however, one third of all 2–12 year olds surveyed were found to be anaemic (i.e. Hb concentrations below 110g/l or 115g/l for children under 5 and 5 years or older, respectively), with a greater proportion of school-age children at risk. Knowledge and behaviour related to hygiene and gastrointestinal diseases varied widely and were generally not associated with STH infection. The study revealed that STH infection remains endemic in Central Java despite ongoing deworming programs. Current control efforts would benefit from being re-evaluated to determine a more effective way forward.     

Prevalence of human papillomavirus infection,distribution of viral types and risk factors in cervical samples from human immunodeficiency virus-positive women attending three human immunodeficiency virus-acquired immune deficiency syndrome reference centres in northeastern Brazil

Human immunodeficiency virus (HIV)-positive patients have a greater prevalence of coinfection with human papillomavirus (HPV) is of high oncogenic risk. Indeed, the presence of the virus favours intraepithelial squamous cell lesion progression and may induce cancer. The aim of this study was to evaluate the prevalence of HPV infection, distribution of HPV types and risk factors among HIV-positive patients. Cervical samples from 450 HIV-positive patients were analysed with regard to oncotic cytology, colposcopy and HPV presence and type by means of polymerase chain reaction and sequencing. The results were analysed by comparing demographic data and data relating to HPV and HIV infection. The prevalence of HPV was 47.5%. Among the HPV-positive samples, 59% included viral types of high oncogenic risk. Multivariate analysis showed an association between HPV infection and the presence of cytological alterations (p = 0.003), age greater than or equal to 35 years (p = 0.002), number of partners greater than three (p = 0.002), CD4⁺ lymphocyte count < 200/mm³ (p = 0.041) and alcohol abuse (p = 0.004). Although high-risk HPV was present in the majority of the lesions studied, the low frequency of HPV 16 (3.3%), low occurrence of cervical lesions and preserved immunological state in most of the HIV-positive patients were factors that may explain the low occurrence of precancerous cervical lesions in this population.     

A National Case-Control Study Identifies Human Socio-Economic Status and Activities as Risk Factors for Tick-Borne Encephalitis in Poland

Background

Tick-borne encephalitis (TBE) is endemic to Europe and medically highly significant. This study, focused on Poland, investigated individual risk factors for TBE symptomatic infection.

Methods and Findings

In a nation-wide population-based case-control study, of the 351 TBE cases reported to local health departments in Poland in 2009, 178 were included in the analysis. For controls, of 2704 subjects (matched to cases by age, sex, district of residence) selected at random from the national population register, two were interviewed for each case and a total of 327 were suitable for the analysis. Questionnaires yielded information on potential exposure to ticks during the six weeks (maximum incubation period) preceding disease onset in each case. Independent associations between disease and socio-economic factors and occupational or recreational exposure were assessed by conditional logistic regression, stratified according to residence in known endemic and non-endemic areas. Adjusted population attributable fractions (PAF) were computed for significant variables. In endemic areas, highest TBE risk was associated with spending ≥10 hours/week in mixed forests and harvesting forest foods (adjusted odds ratio 19.19 [95% CI: 1.72–214.32]; PAF 0.127 [0.064–0.193]), being unemployed (11.51 [2.84–46.59]; 0.109 [0.046–0.174]), or employed as a forester (8.96 [1.58–50.77]; 0.053 [0.011–0.100]) or non-specialized worker (5.39 [2.21–13.16]; 0.202 [0.090–0.282]). Other activities (swimming, camping and travel to non-endemic regions) reduced risk. Outside TBE endemic areas, risk was greater for those who spent ≥10 hours/week on recreation in mixed forests (7.18 [1.90–27.08]; 0.191 [0.065–0.304]) and visited known TBE endemic areas (4.65 [0.59–36.50]; 0.058 [−0.007–0.144]), while travel to other non-endemic areas reduced risk.

Conclusions

These socio-economic factors and associated human activities identified as risk factors for symptomatic TBE in Poland are consistent with results from previous correlational studies across eastern Europe, and allow public health interventions to be targeted at particularly vulnerable sections of the population.