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Risk factors for syphilis in young women attending a family health program in Vitória, Brazil
Miranda, Angélica Espinosa;Figueiredo, Nínive Camilo;Pinto, Valdir Monteiro;Page, Kimberly;Talhari, Sinésio;
Anais Brasileiros de Dermatologia , 2012, DOI: 10.1590/S0365-05962012000100009
Abstract: background: the high prevalence of stds among women indicates the need to implement approaching techniques, case detection and prevention of new cases. objectives: to describe the frequency of risk factors for syphilis and assess attitudes towards sexual risk in a population of young women in vitória, es. methods: cross-sectional, population-based study, performed in vitória. interviews were held and vdrl and mha-tp were investigated in blood samples. results: among the 904 eligible women (18-29 years) sampled from the family health program (fhp), 11 were diagnosed with syphilis, a prevalence of 1.2% (ci95% 0.5-1.9). median age was 23 years (interquartile range 20-26 years); 65.7% of participants were in high school or college and 85.4% lived with their family or sexual partner. factors associated with syphilis included: lower educational level (<8 years of schooling) [adjusted odds ratio aor=4.3 (ci 95% 1.01-17.99)]; >1 lifetime sexual partners [(aor) =6.50 (ci95% 1.37-30.82)], and history of a previously diagnosed std [aor=10.3 (ci95% 2.37-44.33)]. two thirds (67.7%) of the women surveyed agreed that it is not easy to tell their sexual partner they do not want to have sex without condoms; 52.3% thought it is difficult to use condoms in all sexual intercourses, and 36.2% said they cannot do anything if their partner refuses to use condoms. conclusions: using the fhp as an approach to perform routine vdrl can contribute to decreasing the vulnerability of these women and help control congenital syphilis.
Cervical human papillomavirus infection among young women engaged in sex work in Phnom Penh, Cambodia: prevalence, genotypes, risk factors and association with HIV infection
Couture Marie-Claude,Page Kimberly,Stein Ellen S,Sansothy Neth
BMC Infectious Diseases , 2012, DOI: 10.1186/1471-2334-12-166
Abstract: Background Although cervical cancer is the leading cancer in Cambodia, most women receive no routine screening for cervical cancer and few treatment options exist. Moreover, nothing is known regarding the prevalence of cervical HPV or the genotypes present among women in the country. Young sexually active women, especially those with multiple sex partners are at highest risk of HPV infection. We examine the prevalence and genotypes of cervical HPV, as well as the associated risk factors among young women engaged in sex work in Phnom Penh, Cambodia. Methods We conducted a cross-sectional study among 220 young women (15–29 years) engaged in sex work in different venues including brothels or entertainment establishments, and on a freelance basis in streets, parks and private apartments. Cervical specimens were collected using standard cytobrush technique. HPV DNA was tested for by polymerase chain reaction (PCR) and genotyping using type-specific probes for 29 individual HPV types, as well as for a mixture of 10 less common HPV types. All participants were also screened for HIV status using blood samples. Multivariate logistic regression analyses were conducted to assess risk factors for any or multiple HPV infection. Results The prevalence of cervical HPV 41.1%. HPV 51 and 70 were the most common (5.0%), followed by 16 (4.6%), 71 (4.1%) and 81 (3.7%). Thirty-six women (16.4%) were infected with multiple genotypes and 23.3% were infected with at least one oncogenic HPV type. In multivariate analyses, having HIV infection and a higher number of sexual partners were associated with cervical HPV infection. Risk factors for infection with multiple genotypes included working as freelance female sex workers (FSW) or in brothels, recent binge use of drugs, high number of sexual partners, and HIV infection. Conclusions This is the first Cambodian study on cervical HPV prevalence and genotypes. We found that HPV infection was common among young FSW, especially among women infected with HIV. These results underscore the urgent need for accessible cervical cancer screening and treatment, as well as for a prophylactic vaccine that covers the HPV subtypes present in Cambodia.
Marcadores sorológicos do vírus da hepatite B em mulheres jovens atendidas pelo Programa de Saúde da Família em Vitória, Estado do Espírito Santo, 2006
Figueiredo, Nínive Camillo de;Page-Shafer, Kimberly;Pereira, Fausto Edmundo Lima;Miranda, Angélica Espinosa;
Revista da Sociedade Brasileira de Medicina Tropical , 2008, DOI: 10.1590/S0037-86822008000600009
Abstract: the aim of this study was to determine the frequencies of serological markers for hepatitis b and risk factors associated with hbv infection among young women living in vitória, espírito santo, where vaccination for newborns and adolescents started in 1994 and 2000, respectively. this was a population-based study performed by sampling in three health regions of vitória in 2006. interviews were held and hbsag, anti-hbc and anti-hbs were investigated. out of 1,200 women selected, 1,029 (85.7%) were enrolled. the median age was 23 years (interquartile range: 20-26 years) and 93.2% had had more than four years of schooling. forty-three women (4.2%; 95%ci 2.97%-5.43%) were positive for anti-hbc total, and nine, for hbsag (0.9%; 95%ci 0.4%-1.6%)]. there were 466 positive anti-hbs tests (45.3%; 95%ci 42.2%-48.4%), of which 427 were negative for anti-hbc and hbsag. monthly income of up to four minimum monthly salaries was the only variable independently associated with positive anti-hbc tests (or = 2.6: 95%ci 1.06-6.29). these data show low prevalence of the hepatitis b virus and its better-known risk factors. the prevalence of positive anti-hbs tests with negative anti-hbc and hbsag tests reflects the vaccine coverage in the municipality in this group (43.7%). it was not possible to determine any significant risk factors for hepatitis b virus acquisition among this population.
Testing for amphetamine-type stimulant (ATS) use to ascertain validity of self-reported ATS use among young female sex workers in Cambodia
Vannda Kab, Jennifer Evans, Neth Sansothy, Ellen Stein, Marie Claude-Couture, Lisa Maher, Kimberly Page, on behalf of the Young Women's Study Collaborative
Addiction Science & Clinical Practice , 2012, DOI: 10.1186/1940-0640-7-11
Abstract: Cross-sectional data from the Young Women's Health Study-2 (YWHS-2), a prospective study of HIV and STS use among young (15 to 29 years) FSW in Phnom Penh, Cambodia, was analyzed. The YWHS-2 assessed socio-demographic characteristics, HIV serology, HIV risk, and ATS use by self-report and urine toxicology testing at each quarterly visit; the 2nd of which provided data for this assessment. Outcomes include sensitivity, specificity, positive- and negative predictive values, overall and stratified by age, sex work setting and HIV status.Among 200 women, prevalence of positive toxicology screening for ATS use was 14% (95% CI: 9.2 - 18.9%) and concurrent prevalence of self-reported ATS was 15.5% (95% CI: 10.4- 20.6%). The sensitivity and specificity of self-report compared to toxicology test result was 89.3% (25/28), and 96.5% (166/172), respectively. The positive predictive value of self-report ATS use was 80.6% (25/31); the negative predictive value was 98.2% (166/169). Some differences in concordance between self-report and urine toxicology results were noted in analyses stratified by age group and type of sex-work setting, but not by HIV status.Results indicate a high prevalence of ATS use among high-risk young women in Phnom Penh, Cambodia and high concordance between self-reports and toxicology testing.
Temporal changes in HCV genotype distribution in three different high risk populations in San Francisco, California
Paulo Dias, Judith A Hahn, Eric Delwart, Brian R Edlin, Jeff Martin, Paula Lum, Jennifer Evans, Alex Kral, Steve Deeks, Michael P Busch, Kimberly Page
BMC Infectious Diseases , 2011, DOI: 10.1186/1471-2334-11-208
Abstract: We assessed HCV GT distribution in 460 patients from three HCV-infected high risk populations in San Francisco, and examined patterns by birth cohort to assess temporal trends. Multiple logistic regression was used to assess factors independently associated with GT 1 infection compared to other GTs (2, 3, and 4).Overall, GT 1 was predominant (72.4%), however younger injection drug users (IDU) had a lower proportion of GT 1 infections (54.7%) compared to older IDU and HIV-infected patients (80.5% and 76.6%, respectively). Analysis by birth cohort showed increasing proportions of non-GT 1 infections associated with year of birth: birth before 1970 was independently associated with higher adjusted odds of GT 1: AOR 2.03 (95% CI: 1.23, 3.34). African-Americans as compared to whites also had higher adjusted odds of GT 1 infection (AOR: 3.37; 95% CI: 1.89, 5.99).Although, HCV GT 1 remains the most prevalent GT, especially among older groups, changes in GT distribution could have significant implications for how HCV might be controlled on a population level and treated on an individual level.Hepatitis C virus (HCV), first identified in 1990, is a single strand RNA virus in the family Flaviviridae. It is prone to high rates of genetic mutation, resulting in evolution to divergent forms and six major genotypes [1]. Each genotype (GT) is further divided into subtypes, based on genetic sequence variability. There are notable clinical differences in responsiveness to interferon-based therapy for treatment of chronic infection by GT, with GTs 1 and 4 being less responsive and requiring longer exposure time to treatment than types 2 and 3 [2-5]. GT has been associated with different patterns in HCV viremia during interferon treatment [6], and antiviral resistance [7,8]. Although some clinical conditions have been noted to differ by HCV GT, including insulin resistance [9], HIV and HIV disease progression [10], little is known regarding how different HCV GTs differ in virulence or
Rectal Duplication Cyst in a 12 year old Female Presenting with Chronic Constipation and Rectal Bleeding: A Case Report  [PDF]
Kimberly Harris, Kishore Vellody
International Journal of Clinical Medicine (IJCM) , 2011, DOI: 10.4236/ijcm.2011.21002
Abstract: Constipation is a common presenting complaint in children. Rectal duplication cysts are rare congenital malformations that need to be considered in patients with chronic constipation that has not responded to typical therapy and in pa-tients presenting with rectal bleeding. It is important to maintain a high index of suspicion when diagnosing this condi-tion as other congenital malformations may be present and rectal duplication cysts have the potential for malignant transformation if they go unrecognized. This case report describes a 12 year old female with chronic constipation and rectal bleeding who was found to have a rectal duplication cyst. It discusses the pathophysiology of the disease and highlights the options available for treatment.
Stakes and Motivation in Tournaments: Playing When There is Nothing to Play for but Pride
Lionel Page,Katie Page
Economic Analysis and Policy , 2009,
Abstract: Tournaments are an effective means of incentivising participants to ensure an optimal level of effort. However, situations can occur in tournaments where the final outcome of a given competitor does not depend on his/her future performance. Specifically, we study these specific situations in a data set of the group stages of European football club competitions from 1992 to 2009. We identify situations where teams are already sure to finish either first or last at the penultimate stage in the group. We show that such situations affect team performance in the last match, typically decreasing the performance of a team sure to finish first and increasing the performance of a team sure to finish last. The first finding is in line with the economic predictions yet provides interesting implications, namely that the schedule of the match order plays a significant role in the overall performance of the team. The second, counter-intuitive, finding is not well accommodated into the existing economics framework and thus we discuss two alternative explanations, one based on social pressure and the other on pride.
Inexpensive Geophysical Instruments Supporting Groundwater Exploration in Developing Nations  [PDF]
James A. Clark, Richard Page
Journal of Water Resource and Protection (JWARP) , 2011, DOI: 10.4236/jwarp.2011.310087
Abstract: Geophysical methods are often used to aid in exploration for safe and abundant groundwater. In particular resistivity and seismic refraction methods are helpful in determining depth to bedrock and zones of saturation in the subsurface. However the expense of these instruments ($5000 to $20,000) has resulted in their limited use in developing countries. This paper describes how to construct these devices for less than $250 each. The instruments are small, light and robust and are as useful for groundwater exploration as the commercial models for shallow aquifers (less than 35 m deep) where wells can be hand dug, augured or drilled with small portable drill rigs. Data interpretation can be accomplished quickly in the field with free software implemented on a laptop computer. A suite of geophysical instruments and software can therefore be assembled for less than $850. This paper gives the design for these instruments and essential information needed to use them. It is hoped that these inexpensive geophysical instruments can be widely distributed among drillers and aid workers in developing countries, improving the success rate of water wells.
Molecular Targeted Therapy of Hepatocellular Carcinoma  [PDF]
Kimberly Terry, Mehmet Sitki Copur
Journal of Cancer Therapy (JCT) , 2013, DOI: 10.4236/jct.2013.42A052

Hepatocellular carcinoma (HCC) is the fifth most common cancer and the third most common cause of cancer-related mortality worldwide. Despite decades of efforts by many investigators, systemic chemotherapy or hormonal therapy has notoriously failed to show an improvement in survival. With a median survival of 8 months, and 1- and 3-year survival rates of 20% and 5%, respectively, the effective treatment of HCC remains far from satisfactory. Better understanding of the pathogenesis of this disease, identification of molecular targets for therapeutic intervention and availability of promising molecularly targeted therapies may change this dismal picture. In this review we will focus on what is currently known about the molecular pathogenesis of HCC, and explore the currently available and future molecular based therapies targeting these pathways. Future research in this area will maximize clinical benefit while minimizing the toxicity and cost through utilization of novel targeted agents.

Outcome of Cataract Surgery in Patients Treated for Retinopathy of Prematurity  [PDF]
Huy Nguyen, Kimberly G. Yen
Open Journal of Ophthalmology (OJOph) , 2017, DOI: 10.4236/ojoph.2017.74038
Background/Aims: Pediatric patients with treated retinopathy of prematurity (ROP) may develop visually significant cataracts. We report the outcome of cataract surgery in patients who had ROP treatment. Method: Retrospective chart review of 19 eyes from 16 patients who had ROP treatment and subsequent cataract surgery between August, 2002 and March, 2015. Results: Eighteen of 19 eyes received laser treatment for ROP; 1 eye received intravitreal bevacizumab. 5 eyes received lens-sparing pars plana vitrectomy (LSPPV) in addition to laser. Average follow up was 10.1 ± 5.5 years. Average visual acuity improved from 20/324 prior to and 20/110 after cataract surgery (p = 0.06). 13/19 (68%) of the eyes received laser only and developed cataracts an average of 6.2 ± 5.6 years after laser treatment. 5/19 (26%) eyes developed cataracts an average of 6.4 ± 4.2 years after LSPPV and laser. In one eye, a cataract developed after a bevacizumab injection 2.9 years after the injection. Visual axis opacification (VAO) developed in 2/5 (40%) eyes after Ce/PCIOL/PPC-Antvx, 8/10 eyes (80%) after CE/IOL, and in 0/4 eyes after CE/PPC-AntVx. Ocular comorbidities included strabismus, nystagmus, amblyopia, optic atrophy, corneal band keratopathy, and phthisis bulbi. Conclusion: Cataract surgery in patients who have a history of ROP can be complicated by anatomical changes from prematurity and prior vitreoretinal surgeries. Vision improvement is limited by other ocular comorbidities.
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