PubMed Health⌕ Search

Biomedical subjects

Geoffrey R Swain

Publications and source records attributed to Geoffrey R Swain.

12 recordsLinked to original sources
PubMed2006

Development of a computer-based risk-reduction counseling intervention: acceptability and preferences among low-income patients at an urban sexually transmitted infection clinic.

In preparation for the development of an individually tailored, multimedia, computerized sexually transmitted infection (STI)/HIV-risk reduction intervention software application for use in publicly funded STI clinics, we conducted a waiting-room survey among 583 inner-city patients (67% male; 79% African American; mean age = 30.3) at an STI clinic in Milwaukee, Wisconsin regarding their computer experience and opinions related to a computerized approach to HIV/STI-risk reduction counseling. A substantial minority of respondents indicated they would prefer having either a combined computerized and human counseling intervention (30%) or preferred a computerized intervention alone (13%). Perceived benefits of computerized counseling included impartiality of the response, privacy, accuracy of the information, convenience, and being able to control the dissemination of information. Perceived disadvantages included lack of human contact, inability to obtain necessary information, technical problems, threats to privacy, and failure to take information from a computer seriously. Despite their limited economic resources, participants reported relatively high levels of computer experience overall and a willingness to use an individually tailored computerized risk-reduction counseling approach. We discuss how participants' responses were used to inform the development of such an intervention.

Adolescent↗
PubMed2006

Geographic distribution of human blastomycosis cases in Milwaukee, Wisconsin, USA: association with urban watersheds.

Most studies of endemic blastomycosis and outbreaks have involved rural areas. Case homesites in rural Northern Wisconsin have been associated with waterways and sand soils. ARC-GIS was used to geocode addresses and to observe geographic features of homesites from 45 State-mandated reports of human blastomycosis in urban Milwaukee County, Southeastern Wisconsin 2000-2004. Each case property was directly observed, and houses and duplexes (N = 38) were compared with 151 same-street control homesites. Categorical data was analyzed using a chi-square or Fisher's exact test; continuous variables by Kruskal-Wallis test. One case cluster was seen on Milwaukee's North side where the estimated annual incidence was 2.8/100,000 compared to 0.96/100,000 for the entire county. Cases were less common in the most urbanized watersheds (0.49/100,000/yr) versus Lake Michigan shores (0.85) versus remaining three open watersheds (1.4) [P<0.01]. Case homesites averaged 1067 m to waterways and none were on sand soils. (Comparison is made to a Northern Wisconsin community where case homesites averaged 354 m to waterways, 24/25 were on sand soils and annual incidence was 74/100,000.) No unique features of case homesites were identified in Milwaukee County. In this urban area of Wisconsin, relatively low incidence rates may be explained, in part, by lower density of inland waterways and lack of sand soils, however, blastomycosis cases appear to be associated with open watersheds.

Blastomyces↗
PubMed2005

Evidence of a brief surge in safer sex practices after HIV testing among a sample of high-risk men and women.

OBJECTIVES: We investigated the association between recent HIV testing and safer sex among clients of a publicly funded sexually transmitted disease (STD) clinic. METHODS: Of 401 men and women who were anonymously assessed on sexual risk, HIV testing, STD history, motivations for behavior change, and exposure to HIV prevention education, we studied 292 sexually active respondents who reported previous testing for HIV. Outcome measures included condom use at last intercourse and frequent (at least "most of the time") condom use during the past 3 months. Logistic regression was used to examine the association between each outcome and length of time since HIV testing, controlling for other putative predictors of condom use. RESULTS: The sample consisted mainly of African-American (79%) heterosexual (95%) men and women, almost half (44%) of whom were less than 26 years old. Regression analyses indicated that recent HIV testing was significantly associated with safer sex. Prevalence of condom use at last intercourse was highest among respondents who received an HIV test <3 months before the survey, whereas frequent condom use during the past 3 months peaked among clients who had been tested 3 to 5 months before assessment. CONCLUSIONS: The occurrence of a brief "surge" in safer sex among recent HIV counseling and testing clients, regardless of serostatus, suggests that these individuals may be particularly amenable to additional interventions designed to achieve longer term reductions in risky behaviors.

Adult↗
PubMed2005

Experimental components analysis of brief theory-based HIV/AIDS risk-reduction counseling for sexually transmitted infection patients.

An experimental components analysis of brief HIV risk-reduction counseling based on the information-motivation-behavioral skills (IMB) model was conducted with 432 men and 193 women receiving sexually transmitted infection (STI) clinic services. Following baseline assessments, participants were randomly assigned to 1 of 4 90-min risk-reduction counseling sessions that deconstructed the IMB model within a full factorial design. Participants were followed for 9 months, with STI diagnoses monitored over 12 months. Men who received the full IMB session evidenced relatively greater use of risk-reduction behavioral skills and relatively lower rates of unprotected intercourse over 6-months follow-up and had fewer new STIs. For women, however, the motivational counseling demonstrated the most positive outcomes. Results suggest that brief single-exposure HIV prevention counseling can reduce HIV transmission risks.

Acquired Immunodeficiency Syndrome↗
PubMed2004

The detection of monkeypox in humans in the Western Hemisphere.

BACKGROUND: During May and June 2003, an outbreak of febrile illness with vesiculopustular eruptions occurred among persons in the midwestern United States who had had contact with ill pet prairie dogs obtained through a common distributor. Zoonotic transmission of a bacterial or viral pathogen was suspected. METHODS: We reviewed medical records, conducted interviews and examinations, and collected blood and tissue samples for analysis from 11 patients and one prairie dog. Histopathological and electron-microscopical examinations, microbiologic cultures, and molecular assays were performed to identify the etiologic agent. RESULTS: The initial Wisconsin cases evaluated in this outbreak occurred in five males and six females ranging in age from 3 to 43 years. All patients reported having direct contact with ill prairie dogs before experiencing a febrile illness with skin eruptions. We found immunohistochemical or ultrastructural evidence of poxvirus infection in skin-lesion tissue from four patients. Monkeypox virus was recovered in cell cultures of seven samples from patients and from the prairie dog. The virus was identified by detection of monkeypox-specific DNA sequences in tissues or isolates from six patients and the prairie dog. Epidemiologic investigation suggested that the prairie dogs had been exposed to at least one species of rodent recently imported into the United States from West Africa. CONCLUSIONS: Our investigation documents the isolation and identification of monkeypox virus from humans in the Western Hemisphere. Infection of humans was associated with direct contact with ill prairie dogs that were being kept or sold as pets.

Adolescent↗
PubMed2004

A comparison of HIV/AIDS knowledge and attitudes of STD clinic clients in St. Petersburg, Russia and Milwaukee, Wi, USA.

Over the last decade, Russia has experienced alarming increases in rates of HIV and other sexually transmitted diseases (STDs). Most empirically validated HIV-prevention studies have been conducted in the United States or other developed nations and it is unclear the extent to which these techniques may be useful in the different conditions found in Eastern Europe. The present study compared HIV/AIDS knowledge, attitudes toward condoms, perceived vulnerability to HIV, and attitudes towards HIV testing in samples of 400 Russian and 401 American STD clinic patients. Participants in both samples exhibited knowledge deficits. Overall, Russians had less accurate HIV transmission knowledge, fewer sources of HIV-relevant information, and lower perceived vulnerability to HIV/AIDS. In both countries, a desire to be tested for HIV was related to perceived vulnerability to the disease. American participants were more likely to indicate that they planned to be tested (or re-tested) for HIV in the future (88%) relative to Russian participants (40%). Americans also were more likely to have been tested in the past. Results suggest that interventions designed to work with STD clinic patients are urgently needed but that appropriate intervention strategies may differ from one country to the other, reflecting the more advanced state of the HIV epidemic in the United States vs. the emerging epidemic in Russia.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Decision analysis: point-of-care Chlamydia testing vs. laboratory-based methods.

OBJECTIVE: To evaluate and compare the performance of several different methods available for detection of Chlamydia trachomatis (Ct) infection, and to explore possible testing and treatment strategies incorporating point-of-care testing versus laboratory-based tests. DESIGN: Prospective trial and decision analysis. SETTING: Large, urban, publicly funded sexually transmitted disease clinic. PARTICIPANTS: 1,384 female patients. METHODS: Each subject was tested for Ct infection by direct fluorescent antibody (DFA, Sanofi/Kallestad, Chaska, MN), optical immunoassay (OIA, Thermo Electron, Point of Care and Rapid Diagnostics, Louisville CO), McCoy cell culture (in-house method), and polymerase chain reaction (microwell PCR, microwell assay, Roche, Branchburg NJ). RESULTS: Performing a rapid in-clinic test on women who did not meet empiric treatment criteria would have increased the overall proportion of infected persons receiving same-day treatment from 48.6% to 79.1% using DFA or 78.4% using OIA. CONCLUSIONS: Use of empiric treatment criteria and same-day point-of-care testing for patients not meeting the empiric treatment threshold appears to be an appropriate, useful, and cost-effective strategy for increasing same-day treatment of Ct infections in this population.

Adolescent↗
PubMedDate not supplied

The public health dashboard: a surveillance model for bioterrorism preparedness.

The City of Milwaukee Health Department piloted a short-term, near real-time syndromic surveillance and communication tool by using an existing secure regional Internet infrastructure. Voluntary, active syndromic case reporting by hospital Emergency Departments was combined with other data streams, including clinical laboratory reports of communicable disease, hospital emergency room diversions, ambulance runs, medical examiner reports of unusual or suspicious deaths, poison control and nursing hotline call volumes, and pharmacy over-the-counter sales. These data were aggregated into a "Surveillance Dashboard" format that was used to communicate community syndromic health trends to hospitals, Emergency Departments, and other providers using a secure Internet technology. Emergency Departments at 8 area hospitals reported a total of 314 cases meeting syndromic criteria from 26,888 patient encounters. Participants were satisfied with data entry and communications. All participating Emergency Departments received e-mail and text pager alerts sent by the Milwaukee Health Department. No unexplained findings or suggestions of an early outbreak were reported through syndrome surveillance for the 4-week duration of the project. Similar surveillance and communications systems could provide multiple benefits to Emergency Department workflow and management, as well as to public health and emergency response.

Bioterrorism↗
PubMedDate not supplied

Three Hundred Sixty Degree Feedback: program implementation in a local health department.

Three Hundred Sixty Degree Feedback systems, while popular in business, have been less commonly implemented in local public health agencies. At the same time, they are effective methods of improving employee morale, work performance, organizational culture, and attainment of desired organizational outcomes. These systems can be purchased "off-the-shelf," or custom applications can be developed for a better fit with unique organizational needs. We describe the City of Milwaukee Health Department's successful experience customizing and implementing a 360-degree feedback system in the context of its ongoing total quality improvement efforts.

Canada↗
PubMedDate not supplied

Local health department and academic partnerships: education beyond the ivy walls.

The National Association of County and City Health Officials (NACCHO) is the national organization representing local health departments. NACCHO supports efforts that protect and improve the health of all people and all communities by promoting national policy, developing resources and programs, seeking health equity, and supporting effective local public health practice and systems.

Cooperative Behavior↗
PubMedDate not supplied

Universal influenza vaccination recommendations: Local health department perspectives.

Modern vaccines-including influenza vaccine-provide a uniquely powerful and cost-effective way to prevent deadly communicable diseases from spreading. Unfortunately, since the last decade of the 20th century, influenza vaccine supply and distribution problems have steadily grown worse in the United States. Supply disruptions such as delayed deliveries or shortages have occurred in 5 of the last 6 years, hindering efforts to combat a disease that every year kills about 36,000 people and sends more than 200,000 to hospital. Universal influenza recommendations may be one means of resolving our nation's recurring influenza vaccine supply and distribution crises.

Humans↗