Increasing yield of pharyngeal Chlamydia trachomatis among male gay and bisexual clinic attendees in Sydney: an observational study

Sexual Health ◽  
2017 ◽  
Vol 14 (3) ◽  
pp. 282 ◽  
Author(s):  
Sian Louise Goddard ◽  
Preethi Rajagopal ◽  
David James Templeton
Keyword(s):  
Chlamydia Trachomatis ◽  
Observational Study ◽  
Confidence Interval ◽  
Sexual Health ◽  
Odds Ratio ◽  
Temporal Trends ◽  
Health Clinic ◽  
And Bisexual ◽  
Ongoing Surveillance ◽  
Anogenital Infection

Background The aim of the present study was to describe the temporal trends in Chlamydia trachomatis (CT) testing yield among gay and bisexual male (GBM) sexual health clinic attendees in Sydney. Methods: All CT testing occasions among GBM from January 2011 to December 2014 were reviewed. Yield was defined as the proportion of testing occasions where CT was detected. Results: In all, 2917 GBM were tested on 5445 occasions. CT was detected on 439 (8.1%; 95% confidence interval (CI) 7.4–8.8%) occasions. Pharyngeal, urethral and anorectal CT were detected on 74 (1.4%; 95% CI 1.1–1.7%), 109 (2.0%; 95% CI 1.7–2.4%) and 333 (6.1%; 95% CI 5.5–6.8%) occasions respectively. Over the study period, there was a significant increase in pharyngeal CT yield (from 0.70% to 1.6%; odds ratio (OR) 1.25; 95% CI 1.01–1.55; Ptrend = 0.043), which remained borderline significant (OR 1.22; 95% CI 0.99–1.52; P = 0.067) when adjusted for age. There was no change in yield of either urethral or anorectal infections. Almost half the pharyngeal CT (n = 35; 47.3%) occurred without concurrent anogenital infection. Excluding those who would have received anti-chlamydial treatment for another reason, 27.0% of pharyngeal and 4.6% of all CT infections would not have been treated without pharyngeal testing. Conclusions: A recent temporal increase was observed in the yield of pharyngeal CT without a concurrent increase in anogenital yield. Ongoing surveillance is warranted to inform testing guidelines for GBM.

Prevalence and predictors of lymphogranuloma venereum among men who have sex with men at a Sydney metropolitan sexual health clinic

Sexual Health ◽  
2013 ◽  
Vol 10 (2) ◽  
pp. 190 ◽  
Author(s):  
David J. Templeton ◽  
Nicola Sharp ◽  
Sophie Gryllis ◽  
Catherine C. O'Connor ◽  
Sally M. Dubedat
Keyword(s):  
Chlamydia Trachomatis ◽  
Confidence Interval ◽  
Sexual Health ◽  
Lymphogranuloma Venereum ◽  
Health Clinic ◽  
Hiv Positive ◽  
Sex With Men

During an 18-month period to June 2012, 1732 anal chlamydia (Chlamydia trachomatis) tests were performed among men who have sex with men (MSM) at RPA Sexual Health in Sydney’s inner west. Positive anal chlamydia samples were subsequently tested for lymphogranuloma venereum (LGV). Seventy-five (4.3%) anal samples were positive for chlamydia among 67 men during the study period. Anal symptoms were reported for 16 out of 75 (21.3%) of anal chlamydia episodes overall. Three episodes of LGV (all serovar L2b) were identified, all three of whom reported anal symptoms (100%, 95% confidence interval (CI): 29.2–100%). In contrast, only 13/72 (18.1%, 95% CI: 10.0–28.9%) of those with non-LGV anal chlamydia reported anal symptoms. LGV was not identified in any of 59 episodes of asymptomatic anal chlamydia (0%, 95% CI: 0–6.1%). Of those with LGV, two were known to be HIV-positive and one subsequently seroconverted to HIV within a year of the LGV diagnosis. Our findings suggest that routine LGV testing among MSM is not warranted, except among those with anal symptoms.

Prevalence and predictors of chlamydia co-infection among patients infected with gonorrhoea at a sexual health clinic in Sydney

Sexual Health ◽  
2012 ◽  
Vol 9 (4) ◽  
pp. 392 ◽  
Author(s):  
David J. Templeton ◽  
Niveditha Manokaran ◽  
Catherine C. O'Connor
Keyword(s):  
Chlamydia Trachomatis ◽  
Confidence Interval ◽  
Neisseria Gonorrhoeae ◽  
Sexual Health ◽  
Medical Records ◽  
Clinic Visit ◽  
Health Clinic ◽  
Gram Stain ◽  
Health Clinics ◽  
Sexual Health Clinics

Anogenital gonorrhoea (Neisseria gonorrhoeae) is commonly diagnosed at sexual health clinics by on-site microscopy. Whether to add anti-chlamydial therapy in such situations is unclear. The medical records of all patients diagnosed with gonorrhoea between May 2005 and April 2010 at RPA Sexual Health were reviewed. Of 165 patients with anogenital gonorrhoea, 27 (16.4%, 95% confidence interval (CI) 11.1–22.9%) were co-infected with chlamydia (Chlamydia trachomatis). Compared with those only infected with anogenital gonorrhoea, there was no correlation of anogenital gonorrhoea–chlamydia co-infection with any demographic, behavioural or clinical variables examined. Anti-chlamydial therapy should be considered for all patients with gram stain diagnosed anogenital gonorrhoea at the initial clinic visit.

The C-project: use of self-collection kits to screen for Chlamydia trachomatis in young people in a community-based health promotion project

Sexual Health ◽  
2009 ◽  
Vol 6 (2) ◽  
pp. 157 ◽  
Author(s):  
Lynne Martin ◽  
Eleanor Freedman ◽  
Leanne Burton ◽  
Scott Rutter ◽  
Vickie Knight ◽  
...  
Keyword(s):  
Chlamydia Trachomatis ◽  
Young People ◽  
Confidence Interval ◽  
Sexual Health ◽  
Odds Ratio ◽  
Online Communication ◽  
Urine Samples ◽  
Raising Awareness ◽  
Positive Rate ◽  
Age Range

Background: The present study aimed to ascertain the acceptability to at-risk young people of self-collected urine samples as a means of testing for Chlamydia trachomatis (chlamydia); to determine the effectiveness of drop-off and outreach collection methods as a means of detecting and treating chlamydia; and to determine the rate of positive chlamydia tests in a sample of the target group. Methods: Participants requested postal testing kits from the project website, the NSW Sexual Health Infoline or at an outreach event and either returned urine samples at selected drop-off locations or directly to the researchers during active outreach events. Results: A total of 413 kits were requested – 196 (47.5%) via email, 204 (49.4%) during outreach events and nine (2.2%) via the NSW Sexual Health Infoline. A total of 195 samples (47.2% of ordered kits) were returned. Participants were less likely to return samples if they had been requested by email (odds ratio = 9.6; 95% confidence interval: 6.0–15.0) or via telephone (odds ratio = 22.0; 95% confidence interval: 2.7–181.0) compared with directly obtaining a kit at an outreach event. The number of specimens positive for chlamydia in the targeted age range was 4, giving a 3.1% positive rate (95% confidence interval: 1.0–8.0). Conclusions: This study identified that free testing kits and online communication worked well as a means of engaging young people and raising awareness of sexual health. However, the requirement to drop-off urine samples at selected locations was not well accepted.

scholarly journals Safety netting in routine primary care consultations: an observational study using video-recorded UK consultations

2019 ◽  
Vol 69 (689) ◽  
pp. e878-e886 ◽  
Author(s):  
Peter J Edwards ◽  
Matthew J Ridd ◽  
Emily Sanderson ◽  
Rebecca K Barnes
Keyword(s):  
Primary Care ◽  
Logistic Regression ◽  
Observational Study ◽  
Confidence Interval ◽  
Treatment Planning ◽  
Odds Ratio ◽  
Adult Patients ◽  
Specific Advice ◽  
The Uk ◽  
Safety Netting

BackgroundSafety-netting advice is information shared with a patient or their carer designed to help them identify the need to seek further medical help if their condition fails to improve, changes, or if they have concerns about their health.AimTo assess when and how safety-netting advice is delivered in routine GP consultations.Design and settingThis was an observational study using 318 recorded GP consultations with adult patients in the UK.MethodA safety-netting coding tool was applied to all consultations. Logistic regression for the presence or absence of safety-netting advice was compared between patient, clinician, and problem variables.ResultsA total of 390 episodes of safety-netting advice were observed in 205/318 (64.5%) consultations for 257/555 (46.3%) problems. Most advice was initiated by the GP (94.9%) and delivered in the treatment planning (52.1%) or closing (31.5%) consultation phases. Specific advice was delivered in almost half (47.2%) of episodes. Safety-netting advice was more likely to be present for problems that were acute (odds ratio [OR] 2.18, 95% confidence interval [CI] = 1.30 to 3.64), assessed first in the consultation (OR 2.94, 95% CI = 1.85 to 4.68) or assessed by GPs aged ≤49 years (OR 2.56, 95% CI = 1.45 to 4.51). Safety-netting advice was documented for only 109/242 (45.0%) problems.ConclusionGPs appear to commonly give safety-netting advice, but the contingencies or actions required on the patient’s part may not always be specific or documented. The likelihood of safety-netting advice being delivered may vary according to characteristics of the problem or the GP. How to assess safety-netting outcomes in terms of patient benefits and harms does warrant further exploration.

Factors associated with frovatriptan response in patients with migraine: A prospective, observational study

Cephalalgia ◽  
2015 ◽  
Vol 36 (5) ◽  
pp. 493-498 ◽  
Author(s):  
Jong-Geun Seo ◽  
Sung-Pa Park
Keyword(s):  
Major Depressive Disorder ◽  
Risk Factor ◽  
Observational Study ◽  
Confidence Interval ◽  
Depressive Disorder ◽  
Odds Ratio ◽  
Prospective Observational Study ◽  
Major Depressive ◽  
Factors Associated ◽  
Headache Clinic

Background Almost one-third of patients with migraine do not adequately respond to triptans. We examined factors contributing to frovatriptan response in patients with migraine. Methods We enrolled new patients with migraine who consecutively visited our headache clinic. Eligible patients were instructed to take 2.5 mg of frovatriptan as soon as possible after migraine attack. The responsiveness was determined by whether headache was relieved or absent within 4 hours after the intake of frovatriptan. We assessed frovatriptan to be efficacious when headache responded to its administration in at least one of two successive migraine attacks and inefficacious when headache was not relieved in either attack. We included demographic, clinical and psychiatric variables in the analysis of factors associated with frovatriptan response. Results Of 128 eligible patients, 28 (21.9%) experienced frovatriptan inefficacy. In 24 patients with current major depressive disorder, 12 (50.0%) had frovatriptan inefficacy. Only current major depressive disorder was identified as a risk factor for inefficacy (odds ratio = 5.500, 95% confidence interval 2.103–14.382, p = 0.001). Conclusions Depression may be a risk factor of frovatriptan inefficacy in patients with migraine, even though half of patients with major depressive disorder respond to frovatriptan.

scholarly journals Organisational Determinants and Consequences of Diagnostic Discrepancy in Emergency Departments: A National Study of Consecutive Episodes Between 2008-2016

2020 ◽  
Author(s):  
Line Stjernholm Tipsmark ◽  
Børge Obel ◽  
Tommy Andersson ◽  
Rikke Søgaard
Keyword(s):  
Emergency Department ◽  
Hip Fracture ◽  
Observational Study ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Healthcare Sector ◽  
National Study ◽  
Common Phenomenon ◽  
Mixed Effect ◽  
Mixed Effect Models

Abstract Background Diagnostic discrepancy (DD) is a common phenomenon in healthcare, but little is known about its organisational determinants and consequences. Thus, the aim of the study was to evaluate this among selected emergency department (ED) patients. Method We conducted an observational study including all consecutive ED patients (hip fracture or erysipelas) in the Danish healthcare sector admitted between 2008 and 2016. DD was defined as a discrepancy between discharge and admission diagnoses. Episode and department statistics were retrieved from Danish registers. We conducted a survey among all Danish EDs (m=21) to inform organisational determinants. To estimate the results while adjusting for episode- and department-level heterogeneity, we used mixed effect models of ED organisational determinants and 30-day readmission, 30-day mortality and episode costs (2018-DKK) of DDs. ResultsDD was observed in 2,308 (3.3%) of 69,928 hip fracture episodes and 3,206 (8.5%) of 37,558 erysipelas episodes. The main organisational determinant of DD was senior physicians being employed at the ED (hip fracture: odds ratio (OR) 2.74, 95% confidence interval (CI) 2.15-3.51; erysipelas: OR 3.29, 95% CI 2.65-4.07). However, 24-hour presence of senior physicians (hip fracture) and availability of external senior physicians (both groups) were negatively associated with DD. DD was associated with increased 30-day readmission (hip fracture, mean 9.45% vs 13.76%, OR 1.46, 95% CI 1.28-1.66, p<0.001) and episode costs (hip fracture, 61,681 DKK vs 109,860 DKK, log cost 0.58, 95% CI 0.53-0.63, p<0.001; erysipelas, mean 20,818 DKK vs 56,329 DKK, log cost 0.97, 95% CI 0.92-1.02, p<0.001) compared with episodes without DD. Conclusion DD affects outcomes, and particular organisational characteristics seem to be associated with DD. Yet, the complexity of organisations and settings warrant further studies into these associations.

scholarly journals Persistence of child marriage in rural Bangladesh and impact on maternal and perinatal health: findings from a health and demographic surveillance system

2021 ◽  
Author(s):  
Kyu Han Lee ◽  
Atique I. Chowdhury ◽  
Qazi S. Rahman ◽  
Solveig A. Cunningham ◽  
Shahana Parveen ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Perinatal Mortality ◽  
Adolescent Girls ◽  
Odds Ratio ◽  
Surveillance System ◽  
Perinatal Death ◽  
Temporal Trends ◽  
Demographic Surveillance System ◽  
Child Marriage ◽  
First Marriage

ABSTRACTObjectivesTo describe temporal trends in child marriage between 1990 and 2019 in a rural sub-district of Bangladesh and characterize relationships between age, time to pregnancy, complications during delivery, and perinatal mortality.DesignHealth and demographic surveillance system.SettingBaliakandi sub-district, Bangladesh.Participants56,155 female residents.Main outcome measuresAnnual proportion of marriages to female residents under 18 years of age, time between first marriage and pregnancy, proportion of births with complications during delivery, and odds of perinatal mortality.ResultsBetween 1990 and 2010, the proportion of marriages to female residents under 18 years of age decreased from 71% to 57%. Most notably, marriages to females aged 10 to 12 years dropped from 22% of all marriages to 3%. In 2019, 53% of all marriages were to females under 18 years. The estimated time between first marriage and pregnancy did not differ by female age at marriage. By 365 days after marriage, the cumulative incidence of pregnancy was approximately 50% for each age group. Adolescent girls were more likely to experience complications during delivery with at least one complication reported for 36% of mothers aged 13 to 15 years, 32% of mothers aged 16 to 17 years, and 23% of mothers aged 18 to 34 years (χ2 test, P<0.001). Compared to adults, births among females aged 13 to 15 years were more likely to result in stillbirths (odds ratio 2.23, 95% confidence interval 1.19 to 4.16) and births among females 16-17 years were more likely to result in early neonatal deaths (odds ratio 1.57, 95% confidence interval 1.01 to 2.42).ConclusionsChild marriage persists in Baliakandi. Over half of all marriages were to child brides and only minor reductions were seen over the past decade. Pregnancies were common among adolescent girls with no evidence of delayed pregnancy after marriage. Compared to adults, adolescents were more likely to experience complications during delivery and perinatal death. Preventing child marriage has substantial social and health benefits for girls and, by doing so, will also contribute to Bangladesh’s commitment to reduce child mortality.

Pregnancy Intendedness and the Use of Periconceptional Folic Acid

PEDIATRICS ◽  
2003 ◽  
Vol 111 (Supplement_1) ◽  
pp. 1142-1145 ◽  
Author(s):  
Kenneth D. Rosenberg ◽  
Jill M. Gelow ◽  
Alfredo P. Sandoval
Keyword(s):  
Folic Acid ◽  
Confidence Interval ◽  
Older Women ◽  
Adolescent Mothers ◽  
Low Income ◽  
Odds Ratio ◽  
Response Rate ◽  
Pregnancy Risk ◽  
Pregnancy Intendedness ◽  
Ongoing Surveillance

Objective. Periconceptional use of folic acid can prevent birth defects, including at least 50% of neural tube defects. This study used an ongoing surveillance system to explore the association between pregnancy intendedness and women taking periconceptional folic acid. Methods. Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) surveys a stratified random sample of women after a live birth. In 1998–1999, 1867 women completed the survey (64.0% response rate); responses were weighted for nonresponse. Women were asked whether they took folic acid most days in the month before becoming pregnant. Results. Overall, 33.2% of women took folic acid most days in the month before becoming pregnant, and 39.9% said that their pregnancy was unintended. Adolescent mothers were less likely to take periconceptional folic acid (9.2%) and more likely to report unintended pregnancy (62.0%) than older women. Overall, women who said that their pregnancy was intended were more likely to report that they had taken periconceptional folic acid (odds ratio: 4.75; 95% confidence interval: 3.16–7.14); after controlling for maternal age and income the odds ratio was 3.70 (95% confidence interval: 2.38–5.56). Conclusions. Women whose pregnancies were intended were more likely to have been taking periconceptional folic acid than women whose pregnancies were unintended. The importance of fertile women’s taking daily multivitamins that contain 400 μg (0.4 mg) of folic acid should be stressed among women who are not contemplating pregnancy, especially adolescents and low-income women.

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