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  • 1
    Language: English
    In: The Journal of infectious diseases, 01 January 2010, Vol.201(1), pp.42-51
    Description: Repeated Chlamydia trachomatis infections are common among young sexually active women. The relative frequency of reinfection and antibiotic treatment failure is undefined. Adolescent women enrolled in a longitudinal cohort had behavioral and sexually transmitted infection assessments performed every 3 months, including amplification tests for C. trachomatis, ompA genotyping, and interviews and diary entries to document sex partner-specific coitus and event-specific condom use. Repeated infections were classified as reinfection or treatment failure by use of an algorithm. All infections for which treatment outcomes were known were used to estimate the effectiveness of antibiotic use. We observed 478 episodes of infection among 210 study participants; 176 women remained uninfected. The incidence rate was 34 episodes/100 woman-years. Of the women who were infected, 121 experienced 1 repeated infections, forming 268 episode pairs; 183 pairs had complete data available and were classified using the algorithm. Of the repeated infections, 84.2% were definite, probable, or possible reinfections; 13.7% were probable or possible treatment failures; and 2.2% persisted without documented treatment. For 318 evaluable infections, we estimated 92.2% effectiveness of antibiotic use. Most repeated chlamydial infections in this high-incidence cohort were reinfections, but repeated infections resulting from treatment failures occurred as well. Our results have implications for male screening and partner notification programs and suggest the need for improved antibiotic therapies.
    Keywords: Anti-Bacterial Agents -- Therapeutic Use ; Azithromycin -- Therapeutic Use ; Chlamydia Infections -- Drug Therapy
    ISSN: 00221899
    E-ISSN: 1537-6613
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  • 2
    Language: English
    In: Journal of Adolescent Health, January 2013, Vol.52(1), pp.83-88
    Description: To determine whether depot medroxyprogesterone acetate (DMPA) use is associated with an increased risk of acquisition of sexually transmitted infections (STIs) in a cohort of healthy adolescents, for whom prospective evidence is sparse. Adolescent women aged 14–17 years (n = 342) were recruited from clinical sites in the United States between 1999 and 2005. They returned quarterly for interviews and STI testing. During alternating 3-month periods, participants also completed daily diaries of sexual behaviors and performed weekly vaginal self-obtained swabs to test for STIs. Data collected through 2009 (median follow-up length = 42.2 months) were analyzed. Univariable and multivariable tests of association between STI acquisition during the 3-month diary period and covariates were calculated, using nonlinear mixed-effect logistic regression models to control for repeated measurements. In multivariable analysis, there were no significant associations between DMPA use in the current or previous 3-month period and incidence of , or . The number of total or unprotected sexual events during the diary period was not associated with the risk of STI. Older age was a protective factor for the development of (odds ratio = .85; 95% confidence interval = .76–.96). The only factor significantly associated with an increased risk of contracting all three STIs was a greater number of sexual partners during the diary period (odds ratio, range = 1.91–2.62). In this U.S.-based cohort of adolescent women, we found no evidence that DMPA use was associated with increased STI risk. Efforts to curb STI transmission among adolescents should focus on education about the reduced number of sexual partners.
    Keywords: Adolescent ; Medroxyprogesterone Acetate ; Prospective Studies ; Sexual Behavior ; Sexually Transmitted Diseases ; Medicine ; Social Welfare & Social Work
    ISSN: 1054-139X
    E-ISSN: 1879-1972
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  • 3
    Language: English
    In: Journal of General Internal Medicine, 2011, Vol.26(8), pp.852-857
    Description: Byline: Linda S. Williams (1,2,3), Susan Ofner (4), Zhangsheng Yu (4), Rebecca J. Beyth (5), Laurie Plue (1), Teresa Damush (1,3,4) Keywords: depression; stroke; quality improvement; computerized reminders Abstract: Background Post-stroke depression (PSD) occurs in at least one-third of stroke survivors, is associated with worse functional outcomes and increased mortality, and is frequently underdiagnosed and undertreated. Objective To evaluate the effectiveness of an electronic medical record-based system intervention to improve the proportion of veterans screened and treated for PSD. Design Quasi-experimental study comparing PSD screening and treatment among veterans receiving post-stroke outpatient care one year prior to the intervention (the control group) to those receiving outpatient care during the intervention period (the intervention group) contemporaneous data from non-study sites included to assess temporal trends in depression diagnosis and treatment. Participants Veterans hospitalized for ischemic stroke and/or receiving primary care (PC) or neurology outpatient follow-up within six months post-stroke at two (Veterans Affairs) VA Medical Centers. Interventions We formed clinical improvement teams at both sites. Teams developed PSD screening and treatment reminders and designed tailored implementation strategies for reminder use in PC and neurology clinics. Main Measures Proportion screened for PSD within 6 months post-stroke proportion screening positive for PSD who received an appropriate treatment action within 6 months post-stroke. Key Results In unadjusted analyses, PSD screening was performed within 6 months for 85% of intervention (N=278) vs. 50% of control (N=374) patients (OR 6.2 , p〈0.001), and treatment action was received by 83% of intervention vs. 73% of control patients who screened positive (OR 1.8 p=0.13). After adjusting for intervention, site and number of follow-up visits, intervention patients were more likely to be screened (OR 4.8, p〈0.001) and to receive a treatment action if screened positive (OR 2.45, p=0.05). Analyses of temporal trends in non-study sites revealed no trend toward general increase in PSD detection or treatment. Conclusions Automated depression screening in primary and specialty care can improve detection and treatment of PSD. Author Affiliation: (1) Roudebush VAMC and VA Stroke QUERI, Indianapolis, IN, USA (2) Indiana University, Department of Neurology, 1481 West 10th Street, Indianapolis, IN, 46202, USA (3) Regenstrief Institute, Inc, Indianapolis, IN, USA (4) Indiana University, Department of Medicine, Indianapolis, IN, USA (5) Dept. of Medicine, Division of Internal Medicine, NF/SGVHS GRECC and University of Florida College of Medicine, Gainesville, FL, USA Article History: Registration Date: 22/03/2011 Online Date: 16/04/2011 Article note: Electronic Supplementary Material The online version of this article (doi: 10.1007/s11606-011-1709-6) contains supplementary material, which is available to authorized users.
    Keywords: depression ; stroke ; quality improvement ; computerized reminders
    ISSN: 0884-8734
    E-ISSN: 1525-1497
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  • 4
    Language: English
    In: Journal of Health Psychology, December 2019, Vol.24(14), pp.1965-1975
    Description: The aim of this study was to determine if adults value health states or are willing to accept risk differently for themselves than for their children or elderly parents. Participants (701) were asked to rate four hypothetical health states for themselves using both the standard gamble and time trade-off methodologies. They then did the same assessments for a real or hypothetical child as well as an elderly parent. Participants were willing to take more risk or trade more years of life to avoid bilateral vision loss and mental impairment for themselves than they were for their children and elderly parents.
    Keywords: Health Assessment ; Utility Values ; Medicine ; Psychology
    ISSN: 1359-1053
    E-ISSN: 1461-7277
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  • 5
    Language: English
    In: Western Journal of Nursing Research, October 2018, Vol.40(10), pp.1452-1468
    Description: Dysmenorrhea is highly prevalent and may increase women’s risk for developing other chronic pain conditions. Although it is highly variable, symptom-based dysmenorrhea phenotypes have not been identified. The aims of the study were to identify symptom-based dysmenorrhea phenotypes and examine their relationships with demographic and clinical characteristics. In a cross-sectional study, 762 women with dysmenorrhea rated severity of 14 dysmenorrhea-related symptoms. Using latent class analysis, we identified three distinctive phenotypes. Women in the “mild localized pain” phenotype (n = 202, 26.51%) had mild abdominal cramps and dull abdominal pain/discomfort. Women in the “severe localized pain” phenotype (n = 412, 54.07%) had severe abdominal cramps. Women in the “multiple severe symptoms” phenotype (n = 148, 19.42%) had severe pain at multiple locations and multiple gastrointestinal symptoms. Race, ethnicity, age, and comorbid chronic pain conditions were significantly associated with phenotypes. Identification of these symptom-based phenotypes provides a foundation for research examining genotype–phenotype associations, etiologic mechanisms, and/or variability in treatment responses.
    Keywords: Dysmenorrhea ; Chronic Pain ; Pelvic Pain ; Menstruation ; Phenotype ; Nursing ; Public Health
    ISSN: 0193-9459
    E-ISSN: 1552-8456
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  • 6
    Language: English
    In: Infection and Immunity, 2012, Vol. 80(1), p.254
    Description: Because epithelial cells are the major cell type productively infected with Chlamydia during genital tract infections, the overall goal of our research was to understand the contribution of infected epithelial cells to the host defense. We previously showed that Toll-like receptor 3 (TLR3) is the critical pattern recognition receptor in oviduct epithelial (OE) cells that is stimulated during Chlamydia infection, resulting in the synthesis of beta interferon (IFN-β). Here, we present data that implicates TLR3 in the expression of a multitude of other innate-inflammatory immune modulators including interleukin-6 (IL-6), CXCL10, CXCL16, and CCL5. We demonstrate that Chlamydia-induced expression of these cytokines is severely disrupted in TLR3-deficient OE cells, whereas Chlamydia replication in the TLR3-deficient cells is more efficient than in wild-type OE cells. Pretreatment of the TLR3-deficient OE cells with 50 U of IFN-β/ml prior to infection diminished Chlamydia replication and restored the ability of Chlamydia infection to induce IL-6, CXCL10, and CCL5 expression in TLR3-deficient OE cells; however, CXCL16 induction was not restored by IFN-β preincubation. Our findings were corroborated in pathway-focused PCR arrays, which demonstrated a multitude of different inflammatory genes that were defectively regulated during Chlamydia infection of the TLR3-deficient OE cells, and we found that some of these genes were induced only when IFN-β was added prior to infection. Our OE cell data implicate TLR3 as an essential inducer of IFN-β and other inflammatory mediators by epithelial cells during Chlamydia infection and highlight the contribution of TLR3 to the inflammatory cytokine response.
    Keywords: Immunity, Innate ; Chlamydia Muridarum -- Immunology ; Cytokines -- Metabolism ; Epithelial Cells -- Immunology ; Oviducts -- Immunology ; Toll-Like Receptor 3 -- Immunology;
    ISSN: 1098-5522
    ISSN: 10985522
    ISSN: 00199567
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  • 7
    Language: English
    In: Medicine & Science in Sports & Exercise, 2010, Vol.42, p.650
    ISSN: 0195-9131
    Source: Wolters Kluwer - Ovid (via CrossRef)
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  • 8
    In: Sexually Transmitted Diseases, 2012, Vol.39(10), pp.747-749
    Description: ABSTRACT: Among adolescents, partner changes are associated with STIs, but little is known about the timing. Using daily diaries and weekly STI tests, we describe whether infections occur before or after sex partner change during periods when a young woman changes partners once. Results showed infections occurring both before and after partner changes.
    Keywords: Sexually Transmitted Diseases ; Timing ; Young Women ; Adolescents ; Diaries ; Article;
    ISSN: 0148-5717
    E-ISSN: 15374521
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  • 9
    In: Stroke, 2011, Vol.42(8), pp.2269-2275
    Description: BACKGROUND AND PURPOSE—: Quality of care delivered in the inpatient and ambulatory settings may be correlated within an integrated health system such as the Veterans Health Administration. We examined the correlation between stroke care quality at hospital discharge and within 6 months postdischarge. METHODS—: We conducted a cross-sectional hospital-level correlation analyses of chart-abstracted data for 3467 veterans discharged alive after an acute ischemic stroke from 108 Veterans Health Administration medical centers and 2380 veterans with postdischarge follow-up within 6 months in fiscal year 2007. Four risk-standardized processes of care represented discharge care quality: prescription of antithrombotic and antilipidmic therapy, anticoagulation for atrial fibrillation, and tobacco cessation counseling along with a composite measure of defect-free care. Five risk-standardized intermediate outcomes represented postdischarge care quality: achievement of blood pressure, low-density lipoprotein, international normalized ratio, and glycosylated hemoglobin target levels, and delivery of appropriate treatment for poststroke depression along with a composite measure of achieved outcomes. RESULTS—: Median risk-standardized composite rate of defect-free care at discharge was 79%. Median risk-standardized postdischarge rates of achieving goal were 56% for blood pressure, 36% for low-density lipoprotein, 41% for international normalized ratio, 40% for glycosylated hemoglobin, and 39% for depression management and the median risk-standardized composite 6-month outcome rate was 44%. The hospital composite rate of defect-free care at discharge was correlated with meeting the low-density lipoprotein goal (r=0.31; P=0.007) and depression management (r=0.27; P=0.03) goal but was not correlated with blood pressure, international normalized ratio, glycosylated hemoglobin goals, nor with the composite measure of achieved postdischarge outcomes (probability values 〉0.13). CONCLUSIONS—: Hospital discharge care quality was not consistently correlated with ambulatory care quality.
    Keywords: Medicine;
    ISSN: 0039-2499
    E-ISSN: 15244628
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  • 10
    Language: English
    In: Radiology, January 2013, Vol.266(1), pp.289-94
    Description: To determine whether radiology reports describe clinically significant carotid arterial stenosis in a consistent format that is actionable by ordering clinicians. This study was HIPAA compliant. Informed consent was waived. Institutional review board approval was obtained for this retrospective chart review, which included radiology reports of carotid artery imaging for patients hospitalized with ischemic stroke at 127 Veterans Affairs medical centers in 2006-2007. "Clinically significant results" were defined as results with at least 50% stenosis or at least moderate stenosis, excluding complete occlusion. How often clinically significant results were reported as an exact percentage stenosis (such as 60%), range (such as 50%-69%), or category (such as moderate) was determined. Among results reported as a range, how often the range bracketed clinical thresholds of 50% and 70% (typically used to determine appropriateness of carotid arterial revascularization) was determined. Among 2675 patients, there were 6618 carotid imaging results, of which 1015 (15%) were considered clinically significant. Among 695 clinically significant results at ultrasonography (US), 348 (50%) were described as a range, and another 314 (45%) were reported as an exact percentage stenosis. Among the 348 clinically significant US results reported as a range, 259 (74%) bracketed the thresholds of 50% or 70%. For magnetic resonance angiographic results, 48% (106 of 221) qualitatively described clinically significant results as a category, 38% (84 of 221) as an exact percentage stenosis, and 14% (31 of 221) as a range. In this national health care system, the manner in which clinically significant carotid arterial stenosis was reported varied widely.
    Keywords: Angiography -- Statistics & Numerical Data ; Carotid Stenosis -- Diagnostic Imaging ; Hospitals, Veterans -- Statistics & Numerical Data
    ISSN: 00338419
    E-ISSN: 1527-1315
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