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  • 1
    Language: English
    In: Pediatrics, February 2011, Vol.127(2), pp.e336-44
    Description: We assessed differences in chlamydia screening rates according to race/ethnicity, insurance status, age, and previous sexually transmitted infection (STI) or pregnancy. A retrospective cohort study was performed using electronic medical record and billing data for women 14 to 25 years of age in 2002-2007, assessing differences in the odds of a chlamydia test being performed at that visit. Adjusted odds of a chlamydia test being performed were lower among women 14 to 15 years of age (odds ratio: 0.83 [95% confidence interval: 0.70-1.00]) and 20 to 25 years of age (20-21 years, odds ratio: 0.78 [95% confidence interval: 0.70-0.89]; 22-23 years, odds ratio: 0.76 [95% confidence interval: 0.67-0.87]; 24-25 years, odds ratio: 0.64 [95% confidence interval: 0.57-0.73]), compared with women 18 to 19 years of age. Black women had 3 times increased odds (odds ratio: 2.96 [95% confidence interval: 2.66-3.28]) and Hispanic women nearly 13 times increased odds (odds ratio: 12.89 [95% confidence interval: 10.85-15.30]) of testing, compared with white women. Women with public (odds ratio: 1.74 [95% confidence interval: 1.58-1.91]) and public pending (odds ratio: 6.85 [95% confidence interval: 5.13-9.15]) insurance had increased odds of testing, compared with women with private insurance. After first STI diagnosis, differences according to race/ethnicity persisted but were smaller; after first pregnancy, differences persisted. Despite recommendations to screen all sexually active young women for chlamydia, providers screened women differently according to age, race/ethnicity, and insurance status, although differences were reduced after first STI or pregnancy.
    Keywords: Chlamydia Infections -- Diagnosis ; Health Personnel -- Standards ; Mass Screening -- Methods
    ISSN: 00314005
    E-ISSN: 1098-4275
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  • 2
    Language: English
    In: Disease models & mechanisms, 01 April 2017, Vol.10(4), pp.425-437
    Description: Molecular mechanisms underlying development of acute pneumonitis and/or late fibrosis following thoracic irradiation remain poorly understood. Here, we hypothesize that heterogeneity in disease progression and phenotypic expression of radiation-induced lung disease (RILD) across murine strains presents an opportunity to better elucidate mechanisms driving tissue response toward pneumonitis and/or fibrosis. Distinct differences in disease progression were observed in age- and sex-matched CBA/J, C57L/J and C57BL/6J mice over 1 year after graded doses of whole-thorax lung irradiation (WTLI). Separately, comparison of gene expression profiles in lung tissue 24 h post-exposure demonstrated 〉5000 genes to be differentially expressed (twofold change) between strains with early versus late onset of disease. An immediate divergence in early tissue response between radiation-sensitive and -resistant strains was observed. In pneumonitis-prone C57L/J mice, differentially expressed genes were enriched in proinflammatory pathways, whereas in fibrosis-prone C57BL/6J mice, genes were enriched in pathways involved in purine and pyrimidine synthesis, DNA replication and cell division. At 24 h post-WTLI, different patterns of cellular damage were observed at the ultrastructural level among strains but microscopic damage was not yet evident under light microscopy. These data point toward a fundamental difference in patterns of early pulmonary tissue response to WTLI, consistent with the macroscopic expression of injury manifesting weeks to months after exposure. Understanding the mechanisms underlying development of RILD might lead to more rational selection of therapeutic interventions to mitigate healthy tissue damage.
    Keywords: Gene Expression Profiling ; Lung Fibrosis ; Murine Strain Differences ; Radiation Pneumonitis ; Disease Progression ; Gene Expression Profiling ; Lung Diseases -- Genetics ; Radiation Injuries -- Genetics
    ISSN: 17548403
    E-ISSN: 1754-8411
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  • 3
    In: Sex Transm Dis, 2001, Vol.28(5), pp.247-251
    Description: BACKGROUND: The temporal pattern of partners and sexual encounters may be key factors in the acquisition and transmission of sexually transmitted diseases (STDs). Behavior among adolescent women is of particular interest because they frequently have the highest prevalence and incidence of infection. GOAL: To examine coital diary data collected during a 7-month longitudinal study of young women at high risk of STDs and to describe their sexual behaviors, with particular attention to issues of partner sequence and overlap. STUDY DESIGN: A 7-month longitudinal study of young women infected with or having a sexual contact infected with Neisseria gonorrhoeae, Chlamydia trachomatis, or Trichomonas vaginalis attending the STD clinic or one of four neighborhood adolescent health clinics. Data were collected at enrollment and at 1, 3, 5, and 7-month follow-up visits. Coital diaries were kept between visits. RESULTS: The average frequency of coital events was 0.94 per week. The median number of sexual partners during the follow-up period was one, and overlapping of partnerships was an uncommon occurrence. The number of days between the last coital event of a current relationship and the first encounter of a new relationship differed for those choosing a new partner (mean, 20.6 days) and those who returned to a previous partner (mean, 7.9 days;P 〈 0.001). CONCLUSION: Although at high risk for STDs, high-risk behavior was not common among the study population. Partner choice and the behavior of these partners may be more important elements than personal high-risk behavior in accounting for the high prevalence of sexually transmitted infections among inner-city adolescent women.
    Keywords: Teenage Girls -- Sexual Behavior ; Sexually Transmitted Diseases -- Research;
    ISSN: 0148-5717
    E-ISSN: 15374521
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  • 4
    Language: English
    In: Infectious diseases in obstetrics and gynecology, December 2005, Vol.13(4), pp.191-6
    Description: To investigate the occurrence of, and risk factors for, pelvic inflammatory disease (PID) occurring during the post-partum year. Demographic and clinical data for women who delivered a term infant with 5-minute Apgar score 〉 or = 8 from 1992 through 1999 at a large urban hospital were extracted from an electronic medical record system. During the study period, 15 206 deliveries occurred among 12 549 women. PID was diagnosed during the post-partum year of 148 (1.0%) deliveries. In univariate analysis, young age, black race, and both pre-delivery history and post-partum diagnosis of chlamydial and gonococcal infection were associated with PID. In multivariate analysis, only young age and a positive test for gonorrhea before delivery or post-partum were independent predictors of PID. Pelvic inflammatory disease was diagnosed during the post-partum year in 1% of women studied. Young maternal age was an important demographic risk factor. Further investigation of post-partum STD acquisition and progression to PID is needed to determine whether women are at increased risk following delivery.
    Keywords: Postpartum Period ; Chlamydia Infections -- Complications ; Gonorrhea -- Complications ; Pelvic Inflammatory Disease -- Epidemiology
    ISSN: 1064-7449
    E-ISSN: 10980997
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  • 5
    Language: English
    In: Annals of the Rheumatic Diseases, 22 March 2007, Vol.66(3), p.394
    Description: To evaluate the risk factors for early radiographic changes of knee osteoarthritis.
    Keywords: BMI, Body Mass Index ; Gee, Generalised Estimating Equations ; Jsn, Joint Space Narrowing ; Jsw, Joint Space Width ; K&L, Kellgren and Lawrence ; Rct, Randomised Controlled Trial ; Womac, Western Ontario and Mcmaster Universities ; Radiology ; Degenerative Joint Disease ; Musculoskeletal Syndromes ; Osteoarthritis ; Clinical Diagnostic Tests ; Radiology (Diagnostics)
    ISSN: 0003-4967
    ISSN: 00034967
    E-ISSN: 1468-2060
    E-ISSN: 14682060
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  • 6
    Language: English
    In: American journal of public health, July 2004, Vol.94(7), pp.1124-6
    Description: We used an electronic medical records system retrospectively to evaluate how frequently, in a public hospital and its clinics, combined gonorrhea/chlamydia tests were accompanied by a syphilis test before and during a syphilis outbreak. Among 70,330 gonorrhea/chlamydia tests (1996-2000), the proportion with a syphilis test increased from 13% (preoutbreak) to 50% (intervention period) for men and from 6% to 13% for nonpregnant women. The increased syphilis testing coincided with a multifaceted public health intervention.
    Keywords: Chlamydia Infections -- Diagnosis ; Disease Outbreaks -- Statistics & Numerical Data ; Gonorrhea -- Diagnosis ; Mass Screening -- Statistics & Numerical Data ; Syphilis -- Diagnosis ; Syphilis Serodiagnosis -- Statistics & Numerical Data
    ISSN: 0090-0036
    E-ISSN: 15410048
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  • 7
    In: Sexually Transmitted Diseases, 2010, Vol.37(4), pp.248-252
    Description: BACKGROUND:: Population-based studies suggest that acquisition of herpes simplex virus 2 (HSV 2) is most common between ages 20 and 29, especially in minority women. We examined HSV 2 infection and viral shedding in a cohort of young women. METHODS:: Women, age 18 to 24 (median 21), who were part of an observational cohort enrolled between ages 14 to 17, had blood obtained for HSV 2 antibody. Intensive diary collections on sexual behavior and genital symptoms and weekly vaginal swabs were obtained at regular intervals. RESULTS:: HSV 2 antibodies were detected in 43 of 127 participants (33.9%), only 4 of whom were previously known to be positive. Factors associated with a positive test included older age, years of sexual activity, and number of lifetime partners. Testing for HSV 2 DNA by polymerase chain reaction on weekly vaginal swabs from a 13-week sampling period for each HSV 2 antibody positive participant showed 32 of 43 (74.4%) were positive at least once. The positive predictive value of pain for viral shedding was poor. CONCLUSIONS:: HSV 2 infection is very common among young adult women, but symptomatic genital herpes is not. Shedding of HSV 2 DNA can be detected in most antibody positive persons. Early intervention strategies will be needed to control HSV 2 infection.
    Keywords: Herpes Simplex ; Risk Factors ; Development and Progression ; Diagnosis ; Herpes Simplex Virus ; Health Aspects ; Medicine;
    ISSN: 0148-5717
    E-ISSN: 15374521
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  • 8
    Language: English
    In: Statistics in Medicine, 1992, Vol.11(5), pp.565-577
    Description: Estimates of transmission probabilities for sexually transmitted diseases historically come from studies of uninfected individuals exposed to those with a high disease prevalence (for example, prostitutes). However, changes in sexual behaviour, much of which relates to concerns about AIDS, has made identification of populations suitable for such studies extremely difficult. This paper presents a method for estimating these probabilities that utilizes a deterministic model and routinely collected data available in many clinics. Variance estimates for the estimators are also derived. Data for chlamydial infection and sensitivity analyses for the input parameters and assumptions illustrate the method.
    Keywords: Chlamydia Trachomatis ; Models, Statistical ; Chlamydia Infections -- Transmission ; Sexually Transmitted Diseases, Bacterial -- Transmission;
    ISSN: 0277-6715
    E-ISSN: 1097-0258
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  • 9
    Language: English
    In: Journal of General Internal Medicine, 1996, Vol.11(12), pp.762-764
    Description: We previously reported a predictive model that identified potentially modifiable risk factors for nonelective readmission to a county hospital. The objectives of this study were to determine if those risk factors were generalizable to a different population. We found that the previously reported risk factors were generalizable, and other potentially modifiable risk factors were identified in this population of veterans. However, further research is needed to establish whether or not the risk factors can be modified and whether or not modification improves outcomes.
    Keywords: patient readmission ; patient discharge ; hospitalization
    ISSN: 0884-8734
    E-ISSN: 1525-1497
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  • 10
    In: Medical Care, 1988, Vol.26(7), pp.699-708
    Description: A multifaceted intervention was hypothesized to increase postdischarge ambulatory contacts and to reduce nonelective readmissions. Patients (N=1,001) discharged from the general medicine service were stratified by risk for nonelective readmission and randomized to the control or intervention group. Intervention patients received phone calls from nurses, mailings of appointment reminders and lists of early warning signs, and prompt rescheduling of visit failures. Patients were followed for 6 months, and the results were computed in units per patient per month. The intervention group had 10.4% more total office contacts (0.53 vs 0.48, P=0.005) than the control group. Although the intervention group had 7.6% fewer nonelective readmission days (0.85 vs 0.92), this was not statistically significant (P=0.5). Patients in the intervention group at high risk (N=181) had 28.1% more office visits (0.73 vs 0.57, P〈0.01) and 31.9% fewer nonelective readmission days (1.13 vs 1.66), but this was also not statistically significant (P=0.06). Thus, the intervention significantly increased postdischarge contacts, primarily in high-risk patients, but failed to reduce the incidence of nonelective readmission days significantly.
    Keywords: Aftercare ; Patient Readmission;
    ISSN: 0025-7079
    E-ISSN: 15371948
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