Role of gender in sexual behaviours and response to education in sexually transmitted infections in 17-year-old adolescents

Background: The values we develop in our youth will follow us through life. To study the behavior of young people do not learn us how young people's future will be, but can give us knowledge about how the future can be. Nearly all sexually transmitted diseases is increasing in our country today, many sexually transmitted diseases increase the risk of infertility in both men and women and is certified by the Swedish Communicable Diseases Act as a danger to society. The reasons for the increase in sexually transmitted diseases is not fully understood. Probably it depends on several factors. Virtually every country in the world has more STDs than Sweden. We know that young people today are traveling more than ever and thus bring home communicable diseases. Immigration and tourism will also affect to our country. In many countries tracking partners to infected patients are not mandatory as in Sweden. Today's young people postpone their family formation, which means that many "have time" for more partners than previous generations. A change of attitude to a more permissive approach to sexual contacts without love and relations is also seen in both sexes and contribute to this development. This is for the young woman a revolutionary change. The availability of pornography is unlimited, which may contribute to sexual risk behavior. The HIV / AIDS Campaign during the 80s and 90s when HIV / AIDS became known meant more condom use and more restrictive sex. HIV is in many countries in the world, a major threat to population health. Young people need information and knowledge. They need forums where attitudes and behavior in sexual issues and sexually transmitted diseases are discussed. The aim of the study was to examine gender differences in high school students with respect to sexual risk behavior, and young people's perception of the effect of education on sexually transmitted infections (STIs). The study also aimed to examine differences between students in the academic program compared to vocational programs. Methods: Students invited to participate were in the second year in high school (about 17 years old) and were from two municipalities in southwestern Sweden. After a 60-minute lesson in sex and relationships they were offered to answer a questionnaire about sexual experiences, sexual risk behavior and the effect of education on sexually transmitted diseases. Results: Boys took less responsibility for STI prevention than girls. In addition, boys were less influenced by STI education than girls. The girls had more experience of homosexuality than men. Conclusions and implications for the practitioner: Boys take less responsibility for STI prevention compared to girls. When planning the STI education, it is important to consider gender, traditions and different learning styles. If STI education does not reach the boys, the prevalence of these infections will continue to increase

Estimating predictive value of tests without having a Gold Standard: the concept of Etiologic Predictive Value (EPV)

Background: Patients with infectious diseases often require the use of microbiologic diagnostic tests. Predictive value of tests are used to describe the usefulness of a diagnostic test in a specific setting. Sometimes an acceptable Gold standard is lacking making it difficult to evaluate the usefulness of a new diagnostic test. Aims Of Study/project: Describe how predictive value of tests can be calculated despite the absence of an acceptable Gold Standard. Also to describe how to account for asymptomatic carriers. Methods: Mathematical derivation shows that information from a healthy control population can, for most scenarios, be used to calculate predictive value of tests despite the absence of a Gold Standard. Results: Rules for how the usefulness of diagnostic tests can be estimated in the absence of a Gold Standard. The new statistical method considers the influence asymptomatic carriers will have on the diagnostic process. These rules are especially suited for evaluating microbiologic diagnostic tests but can be used also in other scenarios. Conclusions/ Recommendations: The existing Gold Standard should always be challenged when evaluating a new diagnostic test. Etiologic Predictive Value offers an alternative to comparing the new test with a conventional Gold Standard

Role of gender in sexual behaviours and response to education in sexually transmitted infections in 17-year-old adolescents

Background: The values we develop in our youth will follow us through life. To study the behavior of young people do not learn us how young people's future will be, but can give us knowledge about how the future can be. Nearly all sexually transmitted diseases is increasing in our country today, many sexually transmitted diseases increase the risk of infertility in both men and women and is certified by the Swedish Communicable Diseases Act as a danger to society. The reasons for the increase in sexually transmitted diseases is not fully understood. Probably it depends on several factors. Virtually every country in the world has more STDs than Sweden. We know that young people today are traveling more than ever and thus bring home communicable diseases. Immigration and tourism will also affect to our country. In many countries tracking partners to infected patients are not mandatory as in Sweden. Today's young people postpone their family formation, which means that many "have time" for more partners than previous generations. A change of attitude to a more permissive approach to sexual contacts without love and relations is also seen in both sexes and contribute to this development. This is for the young woman a revolutionary change. The availability of pornography is unlimited, which may contribute to sexual risk behavior. The HIV / AIDS Campaign during the 80s and 90s when HIV / AIDS became known meant more condom use and more restrictive sex. HIV is in many countries in the world, a major threat to population health. Young people need information and knowledge. They need forums where attitudes and behavior in sexual issues and sexually transmitted diseases are discussed. The aim of the study was to examine gender differences in high school students with respect to sexual risk behavior, and young people's perception of the effect of education on sexually transmitted infections (STIs). The study also aimed to examine differences between students in the academic program compared to vocational programs. Methods: Students invited to participate were in the second year in high school (about 17 years old) and were from two municipalities in southwestern Sweden. After a 60-minute lesson in sex and relationships they were offered to answer a questionnaire about sexual experiences, sexual risk behavior and the effect of education on sexually transmitted diseases. Results: Boys took less responsibility for STI prevention than girls. In addition, boys were less influenced by STI education than girls. The girls had more experience of homosexuality than men. Conclusions and implications for the practitioner: Boys take less responsibility for STI prevention compared to girls. When planning the STI education, it is important to consider gender, traditions and different learning styles. If STI education does not reach the boys, the prevalence of these infections will continue to increase

Making it out of hospital alive: the art of open abdomen management – a pilot study

Purpose: In the management of patients with an open abdomen (OA), failure of fascial closure, decreased GCS, and presence of acute renal failure have been identified as having a significant effect on in-hospital mortality. The aim of this study is to develop a probability nomogram in order to predict the likelihood of in-hospital mortality amongst patients being managed with an OA. Methodology: All patients admitted to the Cairns Hospital from 1999 to 2015 that were managed with an OA were identified. Statistical analysis was performed using multivariate logistic regression methods using 54 prognostic factors in regards to in-hospital mortality. Results: A total of 133 patients were managed with an OA. 31 (23%) patients died in-hospital. Four prognostic factors were found to significantly contribute to in-hospital mortality. These included APACHE III score (odds ratio (OR) 1.29), presence of one or more cardiac risk factors (OR 5.00), normal pulse rate (50-80 beats per minute; OR 0.19) and the use of enteral feeding (OR 0.25). Probability nomograms were developed in order to demonstrate a patient's likelihood of in-hospital mortality, as well as identify specific aspects that may improve their overall outcome. Internal validation using receiver operator curve analysis showed an area under the curve of 0.825. Conclusion: Four prognostic factors were identified in regards to in-hospital mortality in patients being managed with an OA. The use of these probability nomograms will not only aid in predicting the likelihood of in-hospital mortality, but also show aspects which can be targeted in order to improve their overall outcome

Making it out of hospital alive: the art of open abdomen management – a pilot study

Purpose: In the management of patients with an open abdomen (OA), failure of fascial closure, decreased GCS, and presence of acute renal failure have been identified as having a significant effect on in-hospital mortality. The aim of this study is to develop a probability nomogram in order to predict the likelihood of in-hospital mortality amongst patients being managed with an OA. Methodology: All patients admitted to the Cairns Hospital from 1999 to 2015 that were managed with an OA were identified. Statistical analysis was performed using multivariate logistic regression methods using 54 prognostic factors in regards to in-hospital mortality. Results: A total of 133 patients were managed with an OA. 31 (23%) patients died in-hospital. Four prognostic factors were found to significantly contribute to in-hospital mortality. These included APACHE III score (odds ratio (OR) 1.29), presence of one or more cardiac risk factors (OR 5.00), normal pulse rate (50-80 beats per minute; OR 0.19) and the use of enteral feeding (OR 0.25). Probability nomograms were developed in order to demonstrate a patient's likelihood of in-hospital mortality, as well as identify specific aspects that may improve their overall outcome. Internal validation using receiver operator curve analysis showed an area under the curve of 0.825. Conclusion: Four prognostic factors were identified in regards to in-hospital mortality in patients being managed with an OA. The use of these probability nomograms will not only aid in predicting the likelihood of in-hospital mortality, but also show aspects which can be targeted in order to improve their overall outcome

Predictors for future activity limitation in female patients with chronic low back pain

Introduction: Non-specific chronic low back pain (CLBP) have various impact on body functions, activity and participation in daily life and it is a common cause for consulting primary care.The knowledge about various prognostic factors for the recovery for patients with CLBP is still limited. Purpose/Aim: To investigate prognostic factors for future activity limitation in women with CLBP consulting primary care. Materials and Methods: A prospective longitudinal cohort study. Female patients with CLBP consulting primary care were assessed at baseline and re-assessed after two years. Prognostic factors for self-reported activity limitation related to low back pain were analysed by multivariate regression. Results: At the two years 95 % (n=123/130) were followed up. A walk test, self-reported clinical stress symptoms and activity limitation predicted activity limitation at the two -year follow up. Conclusion(s): Physical performance, self-reported clinical stress and activity limitation at baseline was shown to be of prognostic value for future activity limitation in women with CLBP

Does being indigenous make it complex general surgery?

Purpose: Evaluate if being indigenous increases the overall risk of conversion (CONV) from a laparoscopic to open cholecystectomy. No previous study evaluating risk of CONV has analysed an indigenous population. Methodology: In a cross sectional observational study, data was collected from any patient who underwent a laparoscopic cholecystectomy at the Cairns Hospital between 2010-2012. Risk factors relating to patient factors, radiological factors and laboratory factors were considered. Univariate and multivariate logistic regression with the construction of nomograms was performed (accepted in Am J Surg 2015) Results: Of 732 patients, 197 (26.9%) were indigenous. This study has the largest indigenous cohort to date. 40 preoperative risk factors were evaluated. The difference in CONV rate between patients who are indigenous (11%) and non-indigenous (4.7%) was statistically significant (P = 0.0033). However, ethnicity did not remain in the final multivariate model as a direct predictor of risk of CONV Conclusion: Patients who are indigenous had a significantly higher CONV rate compared to patients who are non-indigenous. This was better explained by an increased prevalence of other risk factors and adding as a risk factor does not increase the overall risk of CONV. The nomogram developed to predict CONV can be applied to any patient regardless of their ethnicity

Urine culture doubtful in determining etiology of diffuse symptoms among elderly individuals [Urinodling har tveksamt värde vid beslut om antibiotikabehandling av patienter på äldreboenden]

Background: As many as half of elderly residents at nursing homes have asymptomatic bacteriuria. Thus it’s hard to know if a new symptom is related to findings of bacteria in urine or not. There are different opinions on the possible connection between different non-specific symptoms and urinary tract infections (UTI). Non-specific symptoms in combination with diagnostic uncertainty often lead to antibiotic treatments of uncertain value. Antibiotic overuse increases the prevalence of antibiotic resistant bacteria. Research question: What is the relationship between bacteria in the urine and new or increased fatigue, confusion, restlessness, aggressiveness, not being herself/himself, dysuria, urgency and fever. Methods: In this cross-sectional study symptoms were registered and voided urine specimens collected for urine cultures from 651 elderly residents in 32 nursing homes located in south-western Sweden. Correlation between bacteriuria and presence of a symptom at group level were determined using logistic regression. To estimate the clinical relevance of correlations at group level positive and negative etiological predictive values (EPV) were calculated. EPV takes into account the presence of asymptomatic bacteriuria. Results: In this study 207/651 (32%) of urine cultures were positive. Fatigue, restlessness and confusion were the most common symptoms. Logistic regression indicated some correlations at group level. Aside from Escherichia coli in the urine and not being herself/himself present for at least one month, but less than three months, EPV indicated no clinically useful correlation between any symptoms in this study and findings of bacteriuria. Conclusion: Urine cultures are insufficiently specific when evaluating elderly patients at nursing homes presenting with new or increased restlessness, fatigue, confusion, aggressiveness, dysuria or urgency

The correlation between diverticulosis and redundant colon

Purpose: Diverticulosis and redundant colon are colonic conditions for which underlying pathophysiology, management and prevention are poorly understood. Historical papers suggest an inverse relationship of these two conditions. However, no further attempt has been made to validate this relationship. This study set out to assess the correlation between diverticulosis and colonic redundancy. Methodology: The presence of redundant colon and diverticulosis were noted during colonoscopy. Multivariate binary logistic regression was per-formed with the aim of developing a probability nomogram. Multivariate logistic regression was performed with redundant colon as the dependent variable and diverticulosis, age and gender as independent variables. Nagelkerke R2 and a receiver operator curve with area under curve were calculated to assess goodness off it and internally validate the multivariate model. Results: The probability of redundant colon was increased by female gender odds ratio (OR) 8.4 (95% CI 2.7-26, p=0.00020) and increasing age OR 1.7 (95% CI 1.1-2.6, p=0.017). Paradoxically, diverticulosis strongly reduced the probability of redundant colon with OR of 0.12 (95% CI 0.42-0.32, p=0.000039). The Nagelkerke R2 for the multivariate model was 0.29and area under the curve at ROC analysis was 0.81 (CI 95% 0.73-0.90 p-value 3.1x10-8). Conclusions: This study found an inverse correlation between redundant colon and diverticulosis, supporting the historical suggestion that the two conditions rarely occur concurrently. The underlying principle for this relationship remains to be found. However, it may contribute to the understanding of the aetiology and pathophysiology of these colonic condition

Urine culture doubtful in determining etiology of diffuse symptoms among elderly individuals [Urinodling har tveksamt värde vid beslut om antibiotikabehandling av patienter på äldreboenden]

Background: As many as half of elderly residents at nursing homes have asymptomatic bacteriuria. Thus it’s hard to know if a new symptom is related to findings of bacteria in urine or not. There are different opinions on the possible connection between different non-specific symptoms and urinary tract infections (UTI). Non-specific symptoms in combination with diagnostic uncertainty often lead to antibiotic treatments of uncertain value. Antibiotic overuse increases the prevalence of antibiotic resistant bacteria. Research question: What is the relationship between bacteria in the urine and new or increased fatigue, confusion, restlessness, aggressiveness, not being herself/himself, dysuria, urgency and fever. Methods: In this cross-sectional study symptoms were registered and voided urine specimens collected for urine cultures from 651 elderly residents in 32 nursing homes located in south-western Sweden. Correlation between bacteriuria and presence of a symptom at group level were determined using logistic regression. To estimate the clinical relevance of correlations at group level positive and negative etiological predictive values (EPV) were calculated. EPV takes into account the presence of asymptomatic bacteriuria. Results: In this study 207/651 (32%) of urine cultures were positive. Fatigue, restlessness and confusion were the most common symptoms. Logistic regression indicated some correlations at group level. Aside from Escherichia coli in the urine and not being herself/himself present for at least one month, but less than three months, EPV indicated no clinically useful correlation between any symptoms in this study and findings of bacteriuria. Conclusion: Urine cultures are insufficiently specific when evaluating elderly patients at nursing homes presenting with new or increased restlessness, fatigue, confusion, aggressiveness, dysuria or urgency