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Biomedical subjects

J Giesecke

Publications and source records attributed to J Giesecke.

At least 55 records · Page 3Linked to original sources
PubMed1998

An evaluation of partner notification for HIV infection in genitourinary medicine clinics in England.

OBJECTIVE: To evaluate the feasibility and effectiveness of a standardized HIV partner notification programme within genitourinary medicine clinics in England. DESIGN: A prospective survey of HIV partner notification activity over a 12-month period. SETTING: Nineteen genitourinary medicine clinics in England. PATIENTS AND PARTICIPANTS: A total of 501 eligible HIV-positive patients (either newly diagnosed or with whom partner notification had not been undertaken previously) seen during the study period. MAIN OUTCOME MEASURES: The numbers of partners named by patients, and the number of contacts notified, counselled and HIV-tested. RESULTS: Information on overall partner notification activity was obtained by reviewing available medical records of 471 patients; 353 (75%) had discussed partner notification with a health-care worker during the study period and 197 (42%) had undertaken partner notification. Detailed information on outcomes was obtained for only 70 patients who named 158 contacts as being at risk of acquiring HIV. Although 71 (45%) contacts were eventually notified, only 28 were subsequently seen in participating clinics. Almost all contacts (n = 27) requested HIV counselling and testing, and five were diagnosed HIV-positive. Patient referral was the most popular notification method chosen. CONCLUSIONS: This study illustrates some of the practical difficulties that limit HIV partner notification within genitourinary medicine clinics. These include health-care workers' misgivings about undertaking partner notification, insufficient locating information to identify contacts, and migration of newly diagnosed patients, which prevents continuity and completion of notification. Nevertheless, HIV partner notification uncovered previously undiagnosed HIV infections. Further work needs to be undertaken in staff training and policy implementation if higher rates of partner notification and outcome measurements are to be achieved.

Adolescent↗
PubMed1998

Epidemiological explanation of an outbreak of gastro-enteritis in Sweden in the absence of detailed microbiological information.

Waterborne gastroenteritis outbreaks have often gone undetected or been incompletely defined in terms of source and extent. Methods which allow detection or clarification of such events are therefore useful. We describe the methods used to detect and investigate such an outbreak. In autumn 1996 high school absence rates and the rate of parents absent from work to care for sick children suggested a health problem in a Swedish town which had a history of unexplained outbreaks of gastrointestinal disease. A systematic sample of 300 households was surveyed by post. Respondents represented 10% of the total population of the town. Questions concerning symptoms and exposures were included. The same questionnaire was used in a nearby town as a control. Sixty four percent of respondents reported an acute gastrointestinal illness during a two month period. Diarrhoea (90%) and abdominal pain (88%) were the most frequent symptoms among the sick. Two percent of those sick sought medical care. Exposures associated with disease were being a member of a large household, young age, and consumption of water from the community water supply. Attack rate showed a dose response relationship with increasing frequency of water consumption. The peak incidence of gastrointestinal illness occurred shortly after raw water quality control data had shown a rise in indicator bacteria. Further analysis, dividing those infected into groups according to when they became ill and whether they were the first member of their household to fall ill, supported the hypothesis of primary cases being infected from the water supply with some secondary person to person spread.

Disease Outbreaks↗
PubMed1998

Risk factors for infection with Helicobacter pylori--a study of children in rural Ethiopia.

The public health impact of Helicobacter pylori (HP) infection is gradually becoming obvious, the bacterium now being implicated as an aetiologic agent in a variety of gastric diseases. Transmission routes still remain unknown, although single risk factors, such as domestic crowding (especially bed-sharing) in childhood and low parental socioeconomic status, have been pointed out in studies from developed countries. In an attempt to study the risk factors in a developing country, we performed a case control study of 242 randomly selected children aged 2-4 y in Butajira rural area in Ethiopia. Blood samples were drawn and a questionnaire administered. The total prevalence of IgG antibody to HP among the children in the region was 48% (116/242). Several risk factors such as: crowding, water, animals, sanitation, etc. correlated strongly to seropositivity in a univariate analysis. After controlling for possible confounding, independent predictors of seropositivity were: living in town (OR = 2.15, p = 0.001), increasing age (OR = 1.71, p = 0.060), and being a Muslim (OR = 1.54, p = 0.005). It could not be excluded that a bad water supply in town could explain the difference in seroprevalence between town and village. These results indicate that, in developing countries, factors relating to community and religion might be as important risk factors for infection with HP in children as characteristics of the family or the home.

Antibodies, Bacterial↗
PubMed1998

Potential exposure to SV40 in polio vaccines used in Sweden during 1957: no impact on cancer incidence rates 1960 to 1993.

U.S. polio vaccines produced during the 1950s were potentially contaminated by simian virus 40 (SV40). Recently DNA from SV40 has been detected in brain ependymoma, pleural mesothelioma and osteosarcoma. In 1957, when national polio vaccination was started in Sweden, vaccine potentially contaminated with SV40 was given to approximately 700,000 individuals, mainly pre-school and school children born between 1946 and 1953. From 1958, a Swedish inactivated polio vaccine was exclusively used, which has been claimed to be free of SV40. We explored cancer incidence rates in the cohorts exposed to the potentially contaminated polio vaccines in Sweden. The Swedish Cancer Registry provided annual cancer incidence rates in five-year age groups for the years 1960-93. Cancer incidence in cohorts maximally exposed was followed during this period, and the incidence when these cohorts reached a specific age was compared to the incidence when unexposed cohorts reached the same age. For osteosarcoma and brain ependymoma overall age-standardised incidence rates were essentially unchanged between 1960 and 1993, and age specific rates were similar in the exposed and unexposed male and female cohorts. During the same period, overall age standardised incidence rates in males of brain cancers increased from 9.0 to 13.1 and of pleural mesotheliomas from 0.2 to 2.1 per 100,000. None of these increased rates was associated with the exposed cohorts. The use of potentially SV40 contaminated inactivated polio vaccines in Sweden has not been shown to be associated with increased cancer incidence. However, the exposed cohorts have not yet reached the age of increased risk of brain cancer or mesothelioma.

Adolescent↗
PubMed1997

Dynamics of the HIV-1 subtype distribution in the Swedish HIV-1 epidemic during the period 1980 to 1993.

We have investigated the distribution of the major subtypes, or clades (A to E), in the Swedish human immunodeficiency virus type 1 (HIV-1) epidemic between the years 1980 to 1993, using gp120 V3 domain serotyping and genotyping. Until 1984 the Swedish HIV-1 epidemic was almost exclusively caused by HIV-1 subtype B. During the late 1980s and the early 1990s an increase in nonsubtype B infections (mainly subtypes A and C) was observed. Nonsubtype B infections constituted approximately 30% of the newly diagnosed HIV-1 cases in 1993. In the analyzed material we also noted a substantial increase in the proportion of HIV-1 infections caused by heterosexual transmission. The present data suggest that the subtype distribution in the Swedish HIV-1 epidemic may well continue to change with time, which may have implications for preventive research and vaccine development strategies.

DNA, Viral↗
PubMed1997

Longer survival after HIV infection for injecting drug users than for homosexual men: implications for immunology.

BACKGROUND: Comparisons of progression in HIV-1 infection between injecting drug users (IDU) and homosexual men have been inconclusive due to the short follow-up periods, often with less well-defined starting points and endpoints. In addition, comparisons of survival after injection have been to some extent obscured by higher non-AIDS mortality in IDU. METHOD: In a retrospective cohort study, homo-/bisexual men and IDU were followed, with dates of seroconversion defined within +/- 1 year by a previously negative HIV antibody test. Endpoints were CD4 cell count below 200 x 10(6)/l, AIDS and death from AIDS. RESULTS: Sixty-three homo-/bisexual men and 125 IDU fulfilled the entry criteria, with no significant differences in age at or date for seroconversion. Mean follow-up times were 6.7 and 7.0 years, respectively. The homo-/bisexual group had a significantly accelerated progression rate to all three endpoints: time to CD4 cell count below 200 x 10(6)/l (P = 0.002), to AIDS (P = 0.0003), and to death from AIDS (P < 0.0001). Adjusting for age and sex only made marginal alterations. Ten years after infection, 54% of homosexual men had developed an AIDS-defining condition and 51% had died from AIDS, whereas the corresponding precentages in the IDU group were 26 and 15, respectively. There was, however, no difference in overall mortality due to almost constant, non HIV-related, yearly mortality of some 4% in IDU. CONCLUSIONS: In our cohort there was a highly significant difference in disease progression and death from AIDS between homo-/bisexual men and IDU. This difference was proposed to be due to the transmission route determining the initial immune response and suggested that this route may have played a more important role than virus variability of the subsequent prognosis.

Adult↗
PubMed1997

[Traumatic paraplegia. Possibilities of therapy and rehabilitation in a modern treatment center].

After foundation of treatment centres for paraplegics using the concept of comprehensive care by Sir Ludwig Guttmann in 1943, the treatment goal includes the activation of the patient and the integration into society. This is achieved by the immediate admission for surgical treatment of the injured person into a specialized treatment centre which can guarantee all procedures of re-integration. This has to contain a comprehensive medical care including neurourological and physical therapy by using equipment and staff comparable to a hospital of maximum care. Simultaneously, all social and job related steps for integration have to be initiated. The concentration of all therapeutic options in one treatment centre moves the patient into the focus of interest and facilitates a cost-effective and quality oriented work for individual therapy concepts.

Combined Modality Therapy↗
PubMed1996

Utility of an anonymous questionnaire for the identification of a primary transmission route and possible secondary transmission in adults with acute hepatitis B virus infection.

By letting adults with acute hepatitis B virus (HBV) infection answer an anonymous questionnaire covering risks associated with the acquisition and further transmission of HBV infection, we found that a likely relevant transmission route could be identified in most patients. Despite being informed of the diagnosis, 50% of the patients exposed others via sexual contact during their contagious period.

Adult↗
PubMed1996

Age at acquisition of Helicobacter pylori infection: comparison of a high and a low prevalence country.

Helicobacter pylori (HP) is now generally accepted as the main aetiological agent in chronic active gastritis and peptic ulcer. Infection with HP is widespread, but the routes of transmission are still unclear. Several studies have shown increasing prevalence of antibodies against HP with age. In developing countries, age at peak incidence of seroconversion is probably considerably lower than in developed countries. We performed a cross-sectional study to determine the age at maximum incidence of seroconversion to HP in a high-prevalence country (Ethiopia) and in a low-prevalence country (Sweden). Sera from 242 Ethiopian children, aged 2-14 years and from 295 Swedish children aged 1-15 years were analysed using an enzyme linked immunosorbent assay (ELISA) for detecting immunoglobulin G (IgG) antibodies. In Ethiopia, a comparison was made of a local and a reference strain for preparation of the antigen, but there was little difference in outcome. A comparison between antigen prepared from the reference strain and the pooled antigen used in the Swedish study also showed little difference. The sharpest rise in seroprevalence was found in the age range 2-4 years. Among 4-year-olds, some 60% had already seroconverted, and among 12-year-olds almost 100% had done so. In Sweden, the sharpest rise appeared between the ages of 9 and 10 years. Above 10 years of age seroprevalence was around 20%. Infection with HP is acquired in early childhood in Ethiopia, but somewhat later, although still before the teens, in Sweden. To determine properly the risk factors for infection with HP, possible exposure must be assessed around the age of seroconversion, since seropositivity may remain for a long time but environmental factors may have changed since primary infection.

Adolescent↗
PubMed1995

Risk factors for hepatitis A, B and C virus infection among Swedish expatriates.

The influence of different risk factors for viral hepatitis A, B and C, particularly if sexual contact with the indigenous population was related to an increased risk of having hepatitis B virus (HBV) markers, was assessed by multivariate analysis in a logistic regression model in a prospectively enrolled series of 563 adult Swedish expatriates. The most frequently reported recognised risk factors for the acquisition of viral hepatitis (as reported in a self-administered questionnaire) were having received an inoculation during medical or dental treatment, reported by 45% of all subjects, and having had sexual contact with the indigenous population, reported by 35%. Whilst the prevalences of hepatitis A virus (HAV) and hepatitis C virus (HCV) markers in these expatriates were of the same magnitude as previously reported in the general Swedish population, 8% and 0.3%, respectively, the prevalence of markers for a past or present HBV infection was about twice as high (5%). The presence of HBV markers was associated with being a health care professional or having received inoculations during medical or dental treatment in Africa. No significant association was found between having HBV markers and having had sexual contact with the indigenous population.

Adolescent↗