Intermediate vaginal flora is associated with HIV prevalence as strongly as bacterial vaginosis in a cross-sectional study of participants screened for a randomised controlled trial

ABSTRACT CONTEXT AND OBJECTIVE: Bacterial vaginosis occurs frequently in pregnancy and increases susceptibility to sexually transmitted infections (STI). Considering that adolescents are disproportionally affected by STI, the aim of this study was to evaluate the cervicovaginal levels of interleukin (IL)-1 beta, IL-6, IL-8 and bacterial sialidase in pregnant adolescents with bacterial vaginosis. DESIGN AND SETTING: Cross-sectional study at mother and child referral units in Belém, Pará, Brazil. METHODS: Vaginal samples from 168 pregnant adolescents enrolled were tested for trichomoniasis and candidiasis. Their vaginal microbiota was classified according to the Nugent criteria (1991) as normal, intermediate or bacterial vaginosis. Cervical infection due to Chlamydia trachomatisand Neisseria gonorrhoeae was also assessed. Cytokine and sialidase levels were measured, respectively, using enzyme-linked immunosorbent assays and MUAN conversion in cervicovaginal lavages. Forty-eight adolescents (28.6%) were excluded because they tested positive for some of the infections investigated. The remaining 120 adolescents were grouped according to vaginal flora type: normal (n = 68) or bacterial vaginosis (n = 52). Their cytokine and sialidase levels were compared between the groups using the Mann-Whitney test (P < 0.05). RESULTS: The pregnant adolescents with bacterial vaginosis had higher levels of IL-1 beta, IL-6 and IL-8 (P < 0.05). Sialidase was solely detected in 35 adolescents (67.2%) with bacterial vaginosis. CONCLUSIONS: Not only IL-1 beta and sialidase levels, but also IL-6 and IL-8 levels are higher in pregnant adolescents with bacterial vaginosis, thus indicating that this condition elicits a more pronounced inflammatory response in this population, which potentially increases vulnerability to STI acquisition.

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Is bacterial vaginosis associated with cervical intraepithelial neoplasia?

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200303000-00010 ◽

2003 ◽

Vol 13 (2) ◽

pp. 159-163 ◽

Cited By ~ 7

Author(s):

D. C. M. Boyle ◽

S. E. Barton ◽

S. Uthayakumar ◽

P. E. Hay ◽

J. W. Pollock ◽

...

Keyword(s):

Human Papillomavirus ◽

Bacterial Vaginosis ◽

Cervical Intraepithelial Neoplasia ◽

Intraepithelial Neoplasia ◽

Cross Sectional Study ◽

Vaginal Flora ◽

Sectional Study ◽

Cross Sectional ◽

Papilloma Virus ◽

Sexually Transmitted

Previous research has produced conflicting results regarding the association of bacterial vaginosis (BV) and cervical intraepithelial neoplasia (CIN). These studies have been weakened in their conclusions mainly by failure to adequately control for the presence of sexually transmitted infections (STIs). One proposed mechanism suggesting that carcinogenic nitrosamines acting either independently or via human papilloma virus (HPV) has not been fully tested previously. We undertook a prospective, case-controlled, cross-sectional study where the presence of STIs, in particular human papillomavirus (HPV) which is known to be associated with the development of CIN, was controlled for. Women with BV were not found to have CIN more frequently than women with normal vaginal flora and the quantities of nitrosamines produced by women with BV did not differ significantly from women without BV. We thus found that BV is not associated with CIN.

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Effect of early oral clindamycin on late miscarriage and preterm delivery in asymptomatic women with abnormal vaginal flora and bacterial vaginosis: a randomised controlled trial

The Lancet ◽

10.1016/s0140-6736(03)12823-1 ◽

2003 ◽

Vol 361 (9362) ◽

pp. 983-988 ◽

Cited By ~ 226

Author(s):

Austin Ugwumadu ◽

Isaac Manyonda ◽

Fiona Reid ◽

Phillip Hay

Keyword(s):

Randomised Controlled Trial ◽

Bacterial Vaginosis ◽

Preterm Delivery ◽

Controlled Trial ◽

Vaginal Flora ◽

Randomised Controlled ◽

Asymptomatic Women ◽

Abnormal Vaginal Flora ◽

Late Miscarriage

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Role of feasibility and pilot studies in randomised controlled trials: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2018-022233 ◽

2018 ◽

Vol 8 (9) ◽

pp. e022233 ◽

Cited By ~ 27

Author(s):

Amanda Jane Blatch-Jones ◽

Wei Pek ◽

Emma Kirkpatrick ◽

Martin Ashton-Key

Keyword(s):

Feasibility Study ◽

Randomised Controlled Trials ◽

Feasibility Studies ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Group 2 ◽

Randomised Controlled ◽

Pilot Feasibility Study ◽

Group 1

ObjectivesTo assess the value of pilot and feasibility studies to randomised controlled trials (RCTs) funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme. To explore the methodological components of pilot/feasibility studies and how they inform full RCTs.Study designCross-sectional study.SettingBoth groups included NIHR HTA programme funded studies in the period 1 January 2010–31 December 2014 (decision date). Group 1: stand-alone pilot/feasibility studies published in the HTA Journal or accepted for publication. Group 2: all funded RCT applications funded by the HTA programme, including reference to an internal and/or external pilot/feasibility study. The methodological components were assessed using an adapted framework from a previous study.Main outcome measuresThe proportion of stand-alone pilot and feasibility studies which recommended proceeding to full trial and what study elements were assessed. The proportion of ‘HTA funded’ trials which used internal and external pilot and feasibility studies to inform the design of the trial.ResultsGroup 1 identified 15 stand-alone pilot/feasibility studies. Study elements most commonly assessed weretesting recruitment(100% in both groups),feasibility(83%, 100%) andsuggestions for further study/investigation(83%, 100%). Group 2 identified 161 ‘HTA funded’ applications: 59 cited an external pilot/feasibility study wheretesting recruitment(50%, 73%) andfeasibility(42%, 73%) were the most commonly reported study elements: 92 reported an internal pilot/feasibility study wheretesting recruitment(93%, 100%) andfeasibility(44%, 92%) were the most common study elements reported.Conclusions‘HTA funded’ research which includes pilot and feasibility studies assesses a variety of study elements. Pilot and feasibility studies serve an important role when determining the most appropriate trial design. However, how they are reported and in what context requires caution when interpreting the findings and delivering a definitive trial.

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HIV Prevalence and Frequency of Risk Behavior in Injecting Drug Users Entering Treatment and Out of Treatment: A Cross-Sectional Study in Five Italian Cities

Journal of Drug Issues ◽

10.1177/002204269402400312 ◽

1994 ◽

Vol 24 (3) ◽

pp. 527-535 ◽

Cited By ~ 6

Author(s):

Giovanni Rezza ◽

Stefania Salmaso ◽

Damiano Abeni ◽

Giovanna Brancato ◽

Alessandra Anemona ◽

...

Keyword(s):

Risk Behavior ◽

Drug Users ◽

Injecting Drug Users ◽

Cross Sectional Study ◽

Hiv Prevalence ◽

Sectional Study ◽

Cross Sectional ◽

Female Ratio ◽

Outreach Programs ◽

Male To Female

We conducted a study to describe current patterns of drug-related behaviors, and to identify characteristics that may distinguish injecting drug users entering treatment from those out of treatment, in five Italian cities. Overall, 1,180 subjects were recruited — 568 entering treatment and 612 out of treatment. Male to female ratio was 6.6:1. The median age was similar in the two groups. A high proportion of injecting drug users recruited out of treatment had been in treatment at least once. HIV prevalence among injecting drug users entering treatment was not higher than that of those who were out of treatment. Furthermore, a large proportion of injecting drug users who still were out of treatment reported having adopted safe behaviors. The results of the study emphasize the need to implement outreach programs aimed at harm reduction.

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Does occupational distress raise the risk of alcohol use, binge-eating, ill health and sleep problems among medical doctors? A UK cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2018-027362 ◽

2019 ◽

Vol 9 (5) ◽

pp. e027362 ◽

Cited By ~ 9

Author(s):

Asta Medisauskaite ◽

Caroline Kamau

Keyword(s):

Binge Eating ◽

Sleep Problems ◽

Early Recognition ◽

Controlled Trial ◽

Psychiatric Morbidity ◽

Cross Sectional Study ◽

Health Problems ◽

Coping With Stress ◽

Cross Sectional ◽

Randomised Controlled

ObjectivesThis study aims to assess the prevalence of health problems (eg, insomnia, binge-eating, substance use and ill health) among UK doctors and to investigate whether occupational distress increases the risk of health problems.DesignThis study reports the analysis of data collected at the baseline stage of a randomised controlled trial (protocol #NCT02838290).SettingDoctors were invited through medical Royal Colleges, the British Medical Association’s research panel and a random selection of NHS trusts across various UK regions.Participants417 UK doctors with an equivalent split of gender (48% males) and seniority (49% consultants).Main outcomes and measuresOutcomes were sleep problems (eg, insomnia), alcohol/drug use (eg, binge-drinking), ill health (eg, backache) and binge-eating (eg, uncontrollable eating). Predictor variables were occupational distress (psychiatric morbidity, burnout, job effort, work-life imbalance, coping with stress through self-blame or substances) and work factors (workplace and years practising medicine).Results44% of doctors binge-drank and 5% met the criteria for alcohol dependence; 24%–29% experienced negative emotions after overeating and 8% had a binge-eating disorder; 20%–61% had some type of sleep problem and 12% had severe/moderate insomnia; 69% had fatigue and 19%–29% experienced other types of ill health problems. The results show that occupational distress and job factors increase the odds of doctors using substances, having sleep problems, presenting with frequent symptoms of ill health and binge-eating. For example, burnout increased the risk of all types of sleep problems, eg, difficulty falling/staying asleep, insomnia (OR ≥1.344; p≤0.036). Even taking into consideration whether or not a doctor works in a hospital, the risk of health problems still rises when doctors have signs of occupational distress.ConclusionEarly recognition of occupational distress can prevent health problems among UK doctors that can reduce the quality of patient care because of sickness-related absence.

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