Telling partners about chlamydia: how acceptable are the new technologies?

BACKGROUND Partner notification is accepted as a vital component in the control of chlamydia. However, in reality, many sexual partners of individuals diagnosed with chlamydia are never informed of their risk. The newer technologies of email and SMS have been used as a means of improving partner notification rates. This study explored the use and acceptability of different partner notification methods to help inform the development of strategies and resources to increase the number of partners notified. METHODS Semi-structured telephone interviews were conducted with 40 people who were recently diagnosed with chlamydia from three sexual health centres and two general practices across three Australian jurisdictions. RESULTS Most participants chose to contact their partners either in person (56%) or by phone (44%). Only 17% chose email or SMS. Participants viewed face-to-face as the "gold standard" in partner notification because it demonstrated caring, respect and courage. Telephone contact, while considered insensitive by some, was often valued because it was quick, convenient and less confronting. Email was often seen as less personal while SMS was generally considered the least acceptable method for telling partners. There was also concern that emails and SMS could be misunderstood, not taken seriously or shown to others. Despite these, email and SMS were seen to be appropriate and useful in some circumstances. Letters, both from the patients or from their doctor, were viewed more favourably but were seldom used. CONCLUSION These findings suggest that many people diagnosed with chlamydia are reluctant to use the new technologies for partner notification, except in specific circumstances, and our efforts in developing partner notification resources may best be focused on giving patients the skills and confidence for personal interaction.The study was funded by the Australian Federal Government Department of Health and Ageing Chlamydia Pilot Program of Targeted Grants

Better than nothing? Patient-delivered partner therapy and partner notification for chlamydia: the views of Australian general practitioners

BACKGROUND Genital chlamydia is the most commonly notified sexually transmissible infection (STI) in Australia and worldwide and can have serious reproductive health outcomes. Partner notification, testing and treatment are important facets of chlamydia control. Traditional methods of partner notification are not reaching enough partners to effectively control transmission of chlamydia. Patient-delivered partner therapy (PDPT) has been shown to improve the treatment of sexual partners. In Australia, General Practitioners (GPs) are responsible for the bulk of chlamydia testing, diagnosis, treatment and follow up. This study aimed to determine the views and practices of Australian general practitioners (GPs) in relation to partner notification and PDPT for chlamydia and explored GPs' perceptions of their patients' barriers to notifying partners of a chlamydia diagnosis. METHODS In-depth, semi-structured telephone interviews were conducted with 40 general practitioners (GPs) from rural, regional and urban Australia from November 2006 to March 2007. Topics covered: GPs' current practice and views about partner notification, perceived barriers and useful supports, previous use of and views regarding PDPT.Transcripts were imported into NVivo7 and subjected to thematic analysis. Data saturation was reached after 32 interviews had been completed. RESULTS Perceived barriers to patients telling partners (patient referral) included: stigma; age and cultural background; casual or long-term relationship, ongoing relationship or not. Barriers to GPs undertaking partner notification (provider referral) included: lack of time and staff; lack of contact details; uncertainty about the legality of contacting partners and whether this constitutes breach of patient confidentiality; and feeling both personally uncomfortable and inadequately trained to contact someone who is not their patient. GPs were divided on the use of PDPT--many felt concerned that it is not best clinical practice but many also felt that it is better than nothing.GPs identified the following factors which they considered would facilitate partner notification: clear clinical guidelines; a legal framework around partner notification; a formal chlamydia screening program; financial incentives; education and practical support for health professionals, and raising awareness of chlamydia in the community, in particular amongst young people. CONCLUSIONS GPs reported some partners do not seek medical treatment even after they are notified of being a sexual contact of a patient with chlamydia. More routine use of PDPT may help address this issue however GPs in this study had negative attitudes to the use of PDPT. Appropriate guidelines and legislation may make the use of PDPT more acceptable to Australian GPs.The Australian Federal Government Department of Health and Ageing Chlamydia Pilot Program of Targeted Grants funded the study

Through the looking glass: public and professional perspectives on patient-centred professionalism in modern-day community pharmacy

This paper presents five consultation workshops with 29 community pharmacists, stakeholders and patients that examined "patient-centred professionalism" in terms of pharmacists' working day and environment. The concept is ill-defined in both medical and pharmacy literature and the study aimed to clarify the situated nature of the term for patients and health professionals across settings. Workshops were supported by bio-photographic datasets of "in-situ" practice and Nominal Group Work. The thematic content analyses led to the following aspects: building caring relationships; managing external forces; the effects of space and environment, and different roles and expectations. The study reveals how patient-centred professionalism cannot be defined in any singular or stationary sense, but should be seen as a "moveable feast", best understood through everyday examples of practice and interaction, in relation to whose experience is being expressed, and whose needs considered. The phrase is being mobilised by a whole set of interests and stakeholders to reshape practice, the effect of which remains both uncertain and contested. Whilst patients prioritise a quick and efficient dispensing service from knowledgeable pharmacists, pharmacists rail against increasing public demands and overtly formalised consultations that take them away from the dispensary where the defining aspects of their professionalism lie. URN: urn:nbn:de:0114-fqs100177Unser Beitrag stellt die Ergebnisse aus insgesamt fünf Workshops mit 29 Apotheker/innen, Patient/innen und weiteren Akteuren vor, die sich mit "Patient/innen-zentrierter Versorgung" in der Alltagsarbeit und -umgebung von Apotheker/innen befassten. Dieses Konzept ist in der relevanten Literatur nur ungenügend definiert, und ein Ziel der Studie war, dessen situativen Charakter für Patient/innen und im Gesundheitssystem Tätige zu präzisieren. In den Workshops kamen Fotografien aus der Alltagspraxis und spezifische Gruppenarbeitsverfahren zum Einsatz. Im Beitrag werden nach einer Information über die Teilnehmenden die Ergebnisse der thematischen Inhaltsanalyse zusammengefasst, die die folgenden Schwerpunkte erbrachte: Aufbau von Beziehungen mit Patient/innen, Umgang mit externen Einflussgrößen, (räumliche) Umgebungseffekte und Unterschiedlichkeit von Rollen und Erwartungen. Die Ergebnisse zeigen, dass "Patient/innen-zentrierte Versorgung" nicht in einer singulären oder statischen Weise definiert werden kann, sondern am besten nachvollziehbar ist entlang von Beispielen aus der Alltagspraxis und von Alltagsinteraktionen, abhängig davon, wessen Erfahrungen ausgedrückt und wessen Bedürfnisse im Fokus stehen sollen. Dieses Verständnis trifft für eine Vielzahl an Interessen und Akteuren zu, um Praxis zu rekonzeptualisieren, die zugleich auch fragil und strittig ist: Während Patient/innen möglichst schnelle und effektive Dienstleistungen von sachkundigen Apotheker/innen erwarten, wenden diese sich gegen wachsende öffentliche Ansprüche und zunehmend formalisierte Beratungen, die sie von der Art von Arbeit entfernen, die Kern ihrer professionellen Identität ist. URN: urn:nbn:de:0114-fqs100177Este documento presenta cinco talleres de consulta con 29 farmacéuticos comunitarios, los promotores y los pacientes que examinaron "el profesionalismo centrado en el paciente" en términos de jornada de trabajo de los farmacéuticos y el medio ambiente. El concepto está mal definido, tanto en la literatura médica y farmacéutica, y el estudio tuvo como objetivo aclarar la naturaleza situada del término en los pacientes y en los profesionales de la salud en diferentes contextos. Los talleres fueron apoyados por conjuntos de datos bio-fotográficas de la práctica "in-situ" y el Grupo Nominal de Trabajo. El análisis de contenido temático c a los siguientes aspectos: creación de relaciones afectuosas; gestión de fuerzas externas; los efectos del espacio y el medio ambiente, y roles y expectativas diferentes. El estudio revela cómo el profesionalismo centrado en el paciente no puede definirse en un sentido singular o estacional, pero debe ser visto como “fiesta ambulante”, mejor entendida a través de ejemplos de la vida diaria y la interacción, en relación con cuya experiencia se expresa, y cuyas necesidades considera. La frase está siendo movilizada por un juego entero de intereses y de los promotores para reformar la práctica, el efecto del cual sigue siendo incierto y puesto en debate. Mientras los pacientes priorizan un servicio de distribución rápido y eficiente de parte de farmacéuticos bien informados, los farmacéuticos critican severamente las crecientes demandas públicas y abiertamente formalizan consultas que se los llevan lejos del dispensario donde radican los aspectos de definición de su profesionalismo. URN: urn:nbn:de:0114-fqs10017

Endometriosis Among Women Exposed to Polybrominated Biphenyls

We examined the association between endometriosis and exposure to polybrominated biphenyls (PBBs) and polychlorinated biphenyls (PCBs) among women inadvertently exposed to PBBs in 1973

Country differences in the diagnosis and management of coronary heart disease : a comparison between the US, the UK and Germany

Background The way patients with coronary heart disease (CHD) are treated is partly determined by non-medical factors. There is a solid body of evidence that patient and physician characteristics influence doctors' management decisions. Relatively little is known about the role of structural issues in the decision making process. This study focuses on the question whether doctors' diagnostic and therapeutic decisions are influenced by the health care system in which they take place. This non-medical determinant of medical decision-making was investigated in an international research project in the US, the UK and Germany. Methods Videotaped patients within an experimental study design were used. Experienced actors played the role of patients with symptoms of CHD. Several alternative versions were taped featuring the same script with patients of different sex, age and social status. The videotapes were shown to 384 randomly selected primary care physicians in the three countries under study. The sample was stratified on gender and duration of professional experience. Physicians were asked how they would diagnose and manage the patient after watching the video vignette using a questionnaire with standardised and open-ended questions. Results Results show only small differences in decision making between British and American physicians in essential aspects of care. About 90% of the UK and US doctors identified CHD as one of the possible diagnoses. Further similarities were found in test ordering and lifestyle advice. Some differences between the US and UK were found in the certainty of the diagnoses, prescribed medications and referral behaviour. There are numerous significant differences between Germany and the other two countries. German physicians would ask fewer questions, they would order fewer tests, prescribe fewer medications and give less lifestyle advice. Conclusion Although all physicians in the three countries under study were presented exactly the same patient, some disparities in the diagnostic and patient management decisions were evident. Since other possible influences on doctors treatment decisions are controlled within the experimental design, characteristics of the health care system seem to be a crucial factor within the decision making process

Clinicopathologic Features of Primary Merkel Cell Carcinoma: A Detailed Descriptive Analysis of a Large Contemporary Cohort

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98776/1/dsu12194.pd

Family history of Alzheimer's disease alters cognition and is modified by medical and genetic factors

In humans, a first-degree family history of dementia (FH) is a well-documented risk factor for Alzheimer's disease (AD); however, the influence of FH on cognition across the lifespan is poorly understood. To address this issue, we developed an internet-based paired-associates learning (PAL) task and tested 59,571 participants between the ages of 18-85. FH was associated with lower PAL performance in both sexes under 65 years old. Modifiers of this effect of FH on PAL performance included age, sex, education, and diabetes. The Apolipoprotein E epsilon 4 allele was also associated with lower PAL scores in FH positive individuals. Here we show, FH is associated with reduced PAL performance four decades before the typical onset of AD; additionally, several heritable and non-heritable modifiers of this effect were identified.Mueller Family Charitable Trust; Arizona Department of Health Services; National Institutes of Health [R01-AG041232, R01-AG049465-05]; Flinn FoundationOpen access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Rare Copy Number Variants in \u3cem\u3eNRXN1\u3c/em\u3e and \u3cem\u3eCNTN6\u3c/em\u3e Increase Risk for Tourette Syndrome

Tourette syndrome (TS) is a model neuropsychiatric disorder thought to arise from abnormal development and/or maintenance of cortico-striato-thalamo-cortical circuits. TS is highly heritable, but its underlying genetic causes are still elusive, and no genome-wide significant loci have been discovered to date. We analyzed a European ancestry sample of 2,434 TS cases and 4,093 ancestry-matched controls for rare (\u3c 1% frequency) copy-number variants (CNVs) using SNP microarray data. We observed an enrichment of global CNV burden that was prominent for large (\u3e 1 Mb), singleton events (OR = 2.28, 95% CI [1.39–3.79], p = 1.2 × 10−3) and known, pathogenic CNVs (OR = 3.03 [1.85–5.07], p = 1.5 × 10−5). We also identified two individual, genome-wide significant loci, each conferring a substantial increase in TS risk (NRXN1 deletions, OR = 20.3, 95% CI [2.6–156.2]; CNTN6 duplications, OR = 10.1, 95% CI [2.3–45.4]). Approximately 1% of TS cases carry one of these CNVs, indicating that rare structural variation contributes significantly to the genetic architecture of TS