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J Warszawski

Publications and source records attributed to J Warszawski.

14 recordsLinked to original sources
PubMed2001

Long-term evaluation of the beneficial effect of subtotal splenectomy for management of hereditary spherocytosis.

Clinical manifestations of hereditary spherocytosis (HS) can be abrogated by splenectomy. However, concerns exist regarding exposure of patients to a lifelong risk for overwhelming infections and, to a lesser extent, to vascular complications after total splenectomy. In the search for alternative treatment modalities, we assessed, in a previous pilot study, the potential usefulness of subtotal splenectomy in a small population of patients. During a mean follow-up period of 3.5 years, subtotal splenectomy was shown to be effective in decreasing the hemolytic rate, while maintaining the phagocytic function of the spleen. In the current study, we evaluated the clinical and biologic features of 40 patients with HS who underwent subtotal splenectomy and were monitored for periods ranging from 1 to 14 years. The beneficial effect of subtotal splenectomy included a sustained decrease in hemolytic rate and a continued maintenance of phagocytic function of the splenic remnant. However, mild-to-moderate hemolysis was persistent and accounted for secondary gallstone formation and aplastic crisis in a small subset of patients. Surprisingly, regrowth of the remnant spleen did not seem to have a major impact on the beneficial outcomes of these individuals. Our results suggest that subtotal splenectomy appears to be a reasonable treatment option for management of patients with HS, especially young children.

Adolescent↗
PubMed1999

Criteria for selective screening of cervical Chlamydia trachomatis infection in women attending private gynecology practices.

OBJECTIVE: To develop a screening strategy for Chlamydia trachomatis in private gynecology practices. STUDY DESIGN: Forty-six gynecologists in the greater Paris area systematically screened all consecutive female attenders during one week. Endocervical swabs were tested by enzyme immunoassay, and, if positive, was further confirmed by direct fluorescent antibody test. RESULTS: Overall (out of 1893 women tested), the chlamydia prevalence was 0.8% (95% confidence interval: 0.32-1.2%). Among women younger than 21 years, the prevalence was 5.2% (95%, CI 0.8-9.6). Having had a new sexual partner in the last year was associated with chlamydial infection, independent of age. However, half of the infected women had not had a new partner. CONCLUSION: Even in this low risk population, the prevalence was high among young women. Most of these infections would probably not have been detected. We developed a strategy which would have detected 81% of chlamydia positive women by testing only one third of the patients.

Adult↗
PubMed1998

Gender difference in persistent at-risk sexual behavior after a diagnosed sexually transmitted disease. ACSF-Investigators.

BACKGROUND AND OBJECTIVES: There are few data on sexual behavior after an episode of sexually transmitted disease (STD). GOALS: To examine association between a history of STD and subsequent at-risk sexual behavior in the general population. STUDY DESIGN: In the French National Survey of Sexual Behavior, current sexual behavior was compared between heterosexuals who reported an STD in the 4 years prior to the last year and those who reported no STD (n = 2517). RESULTS: Reporting of STD was associated with a high rate of past multiple partnership among both sexes, but was associated with current at-risk behavior in men only. Men with a previous history of STD were 2.8 times (95% confidence interval [CI]: 1.4-5.6) more likely to report high-risk unprotected sex as a current behavior. No such association was observed in women (adjusted odds ratio [OR]: 1.0; 95% CI: 0.5-2.0). Conversely, in women, a previous episode of STD was significantly associated with reporting of behavior changes (adjusted OR: 3.4; 95% CI: 1.6-7.1). CONCLUSION: A self-reported history of STD is a marker of current high-risk sexual behavior among heterosexual men that could be used to target prevention programs. In contrast, it may be associated in women with subsequent adoption of STD and HIV risk reduction strategies.

Adult↗
PubMed1998

Ser752 mutation to Pro or Ala in the beta3 integrin subunit differentially affects the kinetics of cell spreading to von Willebrand factor and fibrinogen.

The beta3 cytoplasmic domain of the alpha v beta3 integrin is essential for intracellular signals required for cytoskeletal rearrangements. Expression of beta3Ser752Pro mutation in heterologous cells profoundly affects cell spreading and beta3 localization into focal contacts. However, the beta3Ser752Ala substitution mostly restores normal integrin functions, suggesting that the presence of Pro is responsible for the receptor's loss of function. To further assess the role of the Ser752 of the beta3 cytoplasmic domain in the cytoskeletal organization of adherent cells, we developed a computer-assisted method of image analysis allowing the automatic classification of spread cells according to the quantitative analysis of their cell morphology. We compared adhesion and spreading to von Willebrand factor (vWF) or fibrinogen (Fg) of cells expressing beta3 wild type, beta3Ser752Pro or beta3Ser752Ala mutated integrin subunit as a chimeric alpha v beta3 receptor. The beta3Ser752Ala substitution did not impair the general ability of cells to spread, but resulted in a delayed and reduced spreading on both vWF and Fg. Moreover, the beta3Ser752Ala mutation produced modifications of the morphology of spread cells, suggesting a disorganization of their cytoskeleton. Attachment studies showed that the beta3Ser752Ala mutation did not modify the capacity of cells to attach to the substrate, indicating no change in the ligand binding affinity of the alpha v beta3 integrin. Furthermore, we identified a slight defect of beta3Ser752Pro cell attachment to vWF and Fg, beside their impairment of spreading. Taken together, these results suggest a role of Ser752 of the beta3 cytoplasmic domain in the optimal cytoskeletal organization of adherent cells.

Alanine↗
PubMed1998

Should condom use be promoted for contraception to prevent transmission of sexual transmitted diseases and AIDS? ACSF Group. French National Survey of Sexual behavior.

BACKGROUND: This study is an exploration of the relationship between the use of oral contraceptive or intrauterine device and condom use. The results should help us better understand how promoting condoms for contraception as compared to sexually transmitted disease prophylaxis might be an effective way of increasing their use in certain populations. METHODS: Women not involved in stable relationships were selected from the French National Survey on Sexual Behaviour using multi-stage probability sampling. We compared frequency of condom use at the last sexual intercourse by women who were using prescribed contraception with that by women who did not. Odds ratios (OR) were adjusted for age, duration of the relationship, education, type of partner and number of partners in the last 12 months. RESULTS: Overall, no difference was found in the frequency of condom use during the last sexual intercourse by women who were using prescribed contraception compared with women who were not. A more frequent use of condoms tended to be associated with the absence of contraception in relationships of less than three months' duration (adjusted OR: 4.5; 95% CI: 0.7-33.3) and for women of 25 to 34 years of age (adjusted OR: 2.4; 95% CI: 0.8-7.1). CONCLUSION: Many factors other than contraceptive practice influence the use of condoms. Nevertheless, our results suggest that reproductive issue should be taken into account in specific subgroups of the population when developing policies to prevent sexual transmission of HIV.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Estimating means and percentages in a complex sampling survey: application to a French national survey on sexual behaviour (ACSF). Analyse des Comportements Sexuels en France.

Two-phase stratification sampling with unequal selection probabilities is a relatively cost-efficient strategy to address problems on a nationwide basis and to perform comparative analyses of specific subgroups. This was the case with the ACSF survey. Specific procedures to estimate the variances of unbiased estimators in complex sampling designs are not included in standard statistical packages and no specialized software is available for two-phase sampling. A detailed synthesis of general basic rules for inference about a target population from a probability sample is first presented. We follow with a standard procedure to estimate means and percentages with their confidence intervals according to the design. Finally, numerical results are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Condom breakage and slippage during heterosexual intercourse: a French national survey. French National Survey on Sexual Behavior Group (ACSF).

OBJECTIVES: This study examined condom failure rates in a representative sample of French men and women. METHODS: Condom users who experienced breakage or slippage were compared with those who reported no difficulties. RESULTS: The rate of breakage at last heterosexual intercourse was 3.4%, and the slippage rate was 1.1%. Significantly associated with breakage and slippage were being age 25 through 34, being sexually active for more than 5 years, condom use for less than 5 years, condom not used for contraception, and sexual intercourse 12 or more times per month. CONCLUSIONS: People who became sexually active before the era of acquired immunodeficiency syndrome, who began condom use in recent years, and who have frequent sex are at increased risk. The low risk observed among experienced condom users below age 25 supports condom promotion to youth.

Adult↗
PubMed1997

[Estimation methods in a sampling survey].

The objective of this paper is to present a guide for statistical analysis of a sampling survey. Advantages and disadvantages of classical sampling designs are first discussed. A sampling survey was designed to give more precise estimates of parameters which characterize a targeted well-defined population. Simple sampling design often is impossible in large population and rarely is the optimal solution. According to practical and economic constraints, and to available sampling frames, other strategies (stratification, unequal probabilities, several selection steps) may be necessary or more efficient. Fundamental tools to compute estimators and their confidence intervals are presented. The choice of the sampling method determine for each population unit the probability to include it in the final sample. These inclusion probabilities must be known to formulate estimators, ideally unbiased and with low variance. Difficulties arise from calculating the variance, especially for estimators which are not linear functions of the characteristics of interest. In that case, estimation procedures include Taylor linearization. It is always possible to find at least one linear estimator for a total. The total is the key-parameter in sampling theory, most parameters (such as ratios, means, percentages...), being function of unknown totals. Numerical examples are given.

Confidence Intervals↗
PubMed1996

[Epidemiology of sexually transmitted diseases, with the exception of AIDS].

Epidemiologic trends in sexually transmitted diseases strongly vary in the world. The situation is worrying in the developing countries. Both the incidences and prevalences are very high antibiotic resistance is expanding and interactions between sexually transmitted diseases and human immunodeficiency virus contribute to AIDS epidemic. In western Europe, the decline of some sexually transmitted diseases is likely to be linked with successful control programmes and gonorrhea and syphilis now are rare diseases. The USA situation is contrasted. Some inner-city minority population still have high level of gonorrhea and are concerned with resurgence of syphilis and chancroid. Chlamydia trachomatis infections, which are a major, cause of infertility and ectopic pregnancy, have become the most prevalent sexually transmitted disease in industrialized world.

Developing Countries↗
PubMed1996

Factors associated with microsporidial and cryptosporidial diarrhea in HIV infected patients.

Cryptosporidium and microsporidia are increasingly recognized as important agents of chronic diarrhea in human immunodeficiency virus (HIV) infected patients. These protozoa present clinical and biological similarities but coinfection with these two parasites seems uncommon in a population of diarrheic HIV infected patients in the Paris area (France), a comparison study was performed in order to clarify epidemiological differences between these protozoa. From November 1993 to December 1994, 26 microsporidial infected patients were compared to 28 cryptosporidial patients for various factors. Results of a multivariate logistic regression analysis showed that trips to tropical countries remained strongly associated with microsporidic compared with Cryptosporidium adjusted odds ratio [OR] = 4.6, 95% confidence interval [CI] 1.1-19.5). Thus, as compared with cryptosporidiosis, specific epidemiological factors could be associated with microsporidial transmission in tropical countries.

AIDS-Related Opportunistic Infections↗
PubMed1996

Is genital mycosis associated with HIV risk behaviors among heterosexuals? ACSF Investigators. Analyse des comportements sexuels en France.

OBJECTIVES: This study examined in both sexes whether genital mycosis is as strongly associated with human immunodeficiency virus (HIV) sexual risk behavior as are other sexually transmitted diseases. METHODS: Heterosexuals in the French National Survey of Sexual Behavior who reported a history of either mycosis or another sexually transmitted disease in the previous 5 years were compared with heterosexuals who reported no such disease. Odds ratios were adjusted for age, education, place of residence, and number of sexual partners. RESULTS: Among men, mycosis and other sexually transmitted diseases showed similar associations with age and number of sexual partners. Among women, mycosis was also associated with a high number of sexual partners, albeit to a lesser extent than other sexually transmitted diseases. Lifetime experience of heterosexual anal penetration was reported significantly more often by men with a history of mycosis. CONCLUSION: These results suggest that most male mycosis is sexually acquired and constitutes a self-reported indicator as good as other sexually transmitted diseases for high risk. Female mycosis may help define an intermediate HIV risk group.

Adolescent↗