Estimating local chlamydia incidence and prevalence using surveillance data

Background: Understanding patterns of chlamydia prevalence is important for addressing inequalities and planning cost-effective control programs. Population-based surveys are costly; the best data for England come from the Natsal national surveys which are only available once per decade, and are nationally representative but not powered to compare prevalence in different localities. Prevalence estimates at finer spatial and temporal scales are required. Methods: We present a method for estimating local prevalence by modeling the infection, testing and treatment processes. Prior probability distributions for parameters describing natural history and treatment-seeking behavior are informed by the literature or calibrated using national prevalence estimates. By combining them with surveillance data on numbers of chlamydia tests and diagnoses, we obtain estimates of local screening rates, incidence and prevalence. We illustrate the method by application to data from England. Results: Our estimates of national prevalence by age group agree with the Natsal-3 survey. They could be improved by additional information on the number of diagnosed cases that were asymptomatic. There is substantial local-level variation in prevalence, with more infection in deprived areas. Incidence in each sex is strongly correlated with prevalence in the other. Importantly, we find that positivity (the proportion of tests which were positive) does not provide a reliable proxy for prevalence. Conclusion: This approach provides local chlamydia prevalence estimates from surveillance data, which could inform analyses to identify and understand local prevalence patterns and assess local programs. Estimates could be more accurate if surveillance systems recorded additional information, including on symptoms

Developing a Conceptual Framework of Seroadaptive Behaviors in HIV-Diagnosed Men Who Have Sex With Men

Background. Seroadaptive behaviors are strategies employed by men who have sex with men (MSM) to reduce the transmission risk for human immunodeficiency virus (HIV). It has been suggested that they contribute to the increasing diagnoses of sexually transmitted infections in HIV-diagnosed MSM. To understand the context in which the reemerging sexually transmitted infections appear, we developed a social epidemiological model incorporating the multiple factors influencing seroadaptive behaviors. Methods. A literature review of seroadaptive behaviors in HIV-diagnosed MSM was conducted. The literature was synthesized using a social epidemiological perspective. Results. Seroadaptive behaviors are adopted by MSM in high-income countries and are a way for HIV-diagnosed men to manage and enjoy their sexual lives. Influences are apparent at structural, community, interpersonal, and intrapersonal levels. There is little evidence of whether and when the behavior forms part of a premeditated strategy; it seems dependent on the social context and on time since HIV diagnosis. Social rules of HIV disclosure and perception of risk depend on the setting where partners are encountered. Conclusions. Seroadaptive behaviors are strongly context dependent and can reduce or increase transmission risk for different infectious diseases. Further data collection and mathematical modeling can help us explore the specific conditions in more detail

Designing A Module In Entrepreneurship For Product Design Students

Creative problem-solving has been identified as one of the most critical future-proof skillsets we can develop in our society. When educating future designers, entrepreneurship skills are now considered essential; however, designers find it difficult to establish themselves as entrepreneurs. Therefore, graduate designers are increasingly in need of these skills to complement their creative ability. This paper offers information to academic institutions looking to implement entrepreneurship modules in existing design and creative programmes. The paper seeks to understand the entrepreneurship skills required for product design graduates through a case study. Current teaching practice is described, and interviews and co-design sessions with relevant stakeholders are conducted to inform future entrepreneurship education for product design students. From these findings, a module descriptor entitled ‘Entrepreneurship for Designers’ was created for an existing programme and delivered through both practice and theory. This module is intended to provide an understanding of the entrepreneurship process and to offer students the confidence to pursue design-related ventures post-graduation

Understanding Relationships Between Chlamydial Infection, Symptoms, and Testing Behavior

BACKGROUND: Genital chlamydia is the most commonly diagnosed sexually transmitted infection worldwide and can have serious long-term sequelae. Numerous countries invest substantially in testing but evidence for programs’ effectiveness is inconclusive. It is important to understand the effects of testing programs in different groups of people. METHODS: We analyzed data on sexual behavior and chlamydia tests from 16-to 24-year olds in Britain’s third National Survey of Sexual Attitudes and Lifestyles, considering test setting, reason, and result. We conducted descriptive analysis accounting for survey design and nonresponse, and Bayesian analysis using a mathematical model. RESULTS: Most men testing due to symptoms tested in sexual health settings (63%; 95% confidence interval 43%–84%) but most women testing due to symptoms were tested by general practitioners (59%; 43%–76%). Within behavioral groups, positivity of chlamydia screens (tests not prompted by symptoms or partner notification) was similar to population prevalence. Screening rates were higher in women and in those reporting more partners: median (95% credible interval) rates per year in men were 0.30 (0.25–0.36) (0 new partners), 0.45 (0.37–0.54) (1 new partner), and 0.60 (0.50–0.73) (≥2 new partners). In women, they were 0.61 (0.53–0.69) (0 new partners), 0.89 (0.75–1.04) (1 new partner), and 1.2 (1.0–1.4) (≥2 new partners). CONCLUSIONS: Proportion of testing occurring in sexual health is not a proxy for proportion prompted by symptoms. Test positivity depends on a combination of force of infection and screening rate and does not simply reflect prevalence or behavioral risk. The analysis highlights the value of recording testing reason and behavioral characteristics to inform cost-effective control

The price of sex: condom use and the determinants of the price of sex among female sex workers in eastern zimbabwe.

Background. Higher prices for unprotected sex threaten the high levels of condom use that contributed to the decline in Zimbabwe's human immunodeficiency virus (HIV) epidemic. To improve understanding of financial pressures competing against safer sex, we explore factors associated with the price of commercial sex in rural eastern Zimbabwe. Methods. We collected and analyzed cross-sectional data on 311 women, recruited during October–December 2010, who reported that they received payment for their most-recent or second-most-recent sex acts in the past year. Zero-inflated negative binomial models with robust standard errors clustered on female sex worker (FSW) were used to explore social and behavioral determinants of price. Results. The median price of sex was $10 (interquartile range [IQR],$5–$20) per night and$10 (IQR, $5–$15) per act. Amounts paid in cash and commodities did not differ significantly. At the most-recent sex act, more-educated FSWs received 30%–74% higher payments. Client requests for condom use significantly predicted protected sex (P < .01), but clients paid on average 42.9% more for unprotected sex. Conclusions. Within a work environment where clients' preferences determine condom use, FSWs effectively use their individual capital to negotiate the terms of condom use. Strengthening FSWs' preferences for protected sex could help maintain high levels of condom use

The consultation and relational empathy measure: an investigation of its scaling structure.

Purpose: The Consultation and Relational Empathy (CARE) measure is recommended to evaluate the quality of care. However, there is no evidence that it is valid in rehabilitation. Aims were to examine the internal construct (factorial) validity of the CARE in the assessment of the patient-therapist relationship. Method: CARE data were part of an experimental study of acupuncture and different currently used acupuncture placebo controls, including 213 patients (age 66.8, SD 8.3, 58% female) with chronic stable hip or knee pain of mechanical origin, waiting for a joint replacement. CARE was completed two weeks into the study and on completion, two weeks later. Data analysis: Cronbach alpha, factor analysis and Rasch analysis. Results: Internal construct validity was supported (82% of variance explained by the first factor; fit to the Rasch model χ( 2 ) = 18.2, P = 0.57). CARE was unidimensional, had local independence of items, good item fit, absence of Differential Item Functioning and invariance over time. Three percent of people did not complete items 9 & 10. Conclusions: CARE satisfied strict criteria for internal construct validity. An interval scale transformation is available that can be used in clinical practice and research. Further work is required to investigate item non-response and how this may be dealt with in clinical settings. [Box: see text]

The cooperative functions of the EBNA3 Proteins are central to EBV persistence and latency

The Epstein–Barr nuclear antigen 3 (EBNA3) family of proteins, comprising EBNA3A, EBNA3B, and EBNA3C, play pivotal roles in the asymptomatic persistence and life-long latency of Epstein–Barr virus (EBV) in the worldwide human population. EBNA3-mediated transcriptional reprogramming of numerous host cell genes promotes in vitro B cell transformation and EBV persistence in vivo. Despite structural and sequence similarities, and evidence of substantial cooperative activity between the EBNA3 proteins, they perform quite different, often opposing functions. Both EBNA3A and EBNA3C are involved in the repression of important tumour suppressive pathways and are considered oncogenic. In contrast, EBNA3B exhibits tumour suppressive functions. This review focuses on how the EBNA3 proteins achieve the delicate balance required to support EBV persistence and latency, with emphasis on the contribution of the Allday laboratory to the field of EBNA3 biology

The future of pharmacology education: a global outlook

Pharmacology educators play a unique role in higher education, at the intersection of basic biological, and clinical sciences. They teach a on wide range of courses including undergraduate and postgraduate medicine, pharmacy, nursing, dentistry, physiotherapy, osteopathy, veterinary science and biomedical science [1]. Note that this is far from an exhaustive list. Significant changes have taken place in pharmacology education in response to advances in pharmacology, developments in educational approaches and learning technologies, changes in healthcare education delivery, and the massification and internationalization of higher education. These challenge the educator, whose role is increasingly recognized as encompassing teaching, leadership and scholarly activity [2]. The future of pharmacology education depends on our ability to navigate these changes. We argue that there are sets of interrelated knowledge, skill, and attribute competencies that pharmacology educators must master to ultimately enable their students to succeed, discussed in detail in the following sections

Why lose weight? Reasons for seeking weight loss by overweight but otherwise healthy men

OBJECTIVE: To identify the reasons for seeking weight loss in overweight or obese but otherwise healthy men. DESIGN: Interviews, prior to intervention, with subjects who had volunteered to participate in a work-site-based weight loss study. SUBJECTS: Ninety-one overweight=obese male workers. Mean age 41, range 18 – 55 y, mean body mass index (BMI) 31.0, range 26.2 – 41.6 kg=m2. MEASUREMENTS: Anthropometric measurements; body weight and height. Body mass index calculated. A short interview using open questions to determine the individuals reason for seeking weight loss. RESULTS: The message that weight loss is beneficial to health for the overweight was recognized by all subjects regardless of BMI, and was reported as the main factor for attempting weight loss. Improved fitness and effects on appearance and well-being were reported half as often as the primary reason for weight loss. CONCLUSION: Overweight lay members of the public have accepted the health education message that weight loss can improve health. Overweight but otherwise healthy men who responded, of their own accord, to an electronic mail message offering help to lose weight did not regard obesity and overweight as primarily a cosmetic issue. This is still, however, important, especially to younger people