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Richard Rothenberg

Publications and source records attributed to Richard Rothenberg.

At least 19 recordsLinked to original sources
PubMed2007

Early syphilis among men in Connecticut: epidemiologic and spatial patterns.

OBJECTIVE: The objective of this study was to describe the epidemiology of early syphilis among men in Connecticut, a moderate-prevalence region, in 2004. STUDY DESIGN: The authors conducted a cross-sectional analysis of health department data. RESULTS: Fifty-five cases were reported from 25 different towns. A majority of cases (82%) were reported among men who have sex with men, and 22% reported coinfection with HIV. Spatial analysis indicated moderate clustering of cases. Approximately half of 197 reported sex partners were not from Connecticut, including 28% from New York City and 20% from other states/countries. The median distance between partners was 48 km (30 miles). Twenty-three percent of syphilis cases had both local and nonlocal partners. CONCLUSIONS: The current epidemiology of early syphilis in Connecticut is consistent with national trends. However, the dispersal of cases throughout the state and the high proportion of reported sex partners residing outside of Connecticut suggest that this state is not a core area of endemic transmission.

Adult↗
PubMed2006

Antibiotic resistance in long-term acute care hospitals: the perfect storm.

OBJECTIVE: To examine bacterial antibiotic resistance and antibiotic use patterns in long-term acute care hospitals (LTACHs) and to evaluate effects of antibiotic use and other hospital-level variables on the prevalence of antibiotic resistance. DESIGN: Multihospital ecologic study. METHODS: Antibiograms, antibiotic purchasing data, and demographic variables from 2002 and 2003 were obtained from 45 LTACHs. Multivariable regression models were constructed, controlling for other hospital-level variables, to evaluate the effects of antibiotic use on resistance for selected pathogens. Results of active surveillance in 2003 at one LTACH were available. RESULTS: Among LTACHs, median prevalences of resistance for several antimicrobial-organism pairs were greater than the 90th percentile value for National Nosocomial Infections Surveillance system (NNIS) medical intensive care units (ICUs). The median prevalence of methicillin resistance among Staphylococcus aureus isolates was 84%. More than 60% of patients in one LTACH were infected or colonized with methicillin-resistant S. aureus and/or vancomycin-resistant Enterococcus at the time of admission. Antibiotic consumption in LTACHs was comparable to consumption in NNIS medical ICUs. In multivariable logistic regression modeling, the only significant association between antibiotic use and the prevalence of antibiotic resistance was for carbapenems and imipenem resistance among Pseudomonas aeruginosa isolates (odds ratio, 11.88 [95% confidence interval, 1.42-99.13]; P=.02). CONCLUSIONS: The prevalence of antibiotic resistance among bacteria recovered from patients in LTACHs is extremely high. Although antibiotic use in LTACHs likely contributes to resistance prevalence for some antimicrobial-organism pairs, for the majority of such pairs, other variables, such as prior colonization with and horizontal transmission of antimicrobial-resistant pathogens, may be more important determinants. Further research on antibiotic resistance in LTACHs is needed, particularly with respect to determining optimal infection control practices in this environment.

Anti-Bacterial Agents↗
PubMed2005

Potential for medical transmission of HIV in Ethiopia.

The potential medical transmission of HIV through unsafe medical injections was evaluated in 16 rural health institutions in Ethiopia. Most institutions reported re-using disposable needle/syringes, and 12% of observed injections were given with used, disposable syringes prepared for re-use. Analysis of used needle flushes showed no HIV RNA; however, the sensitivity of our method was limited. Despite the re-use of disposable needles, medical injection practices are not likely to contribute significantly to HIV transmission in this region.

Adolescent↗
PubMed2005

Social and geographic distance in HIV risk.

OBJECTIVE: The objective of this study was to examine the relationship between social distance (measured as the geodesic, or shortest distance, between 2 people in a connected network) and geographic distance (measured as the actual distance between them in kilometers [km]). STUDY: We used data from a study of 595 persons at risk for HIV and their sexual and drug-using partners (total N = 8920 unique individuals) conducted in Colorado Springs, Colorado, from 1988 to 1992--a longitudinal cohort study that ascertained sociodemographic, clinical, behavioral, and network information about participants. We used place of residence as the geographic marker and calculated distance between people grouped by various characteristics of interest. RESULTS: Fifty-two percent of all dyads were separated by a distance of 4 km or less. The closest pairs were persons who both shared needles and had sexual contact (mean = 3.2 km), and HIV-positive persons and their contacts (mean = 2.9). The most distant pairs were prostitutes and their paying partners (mean = 6.1 km). In a connected subset of 348 respondents, almost half the persons were between 3 and 6 steps from each other in the social network and were separated by a distance of 2 to 8 km. Using block group centroids, the mean distance between all persons in Colorado Springs was 12.4 km compared with a mean distance of 5.4 km between all dyads in this study (P <0.0001). The subgroup of HIV-positive people and their contacts was drawn in real space on a map of Colorado Springs and revealed tight clustering of this group in the downtown area. CONCLUSION: The association of social and geographic distance in an urban group of people at risk for HIV provides demonstration of the importance of geographic clustering in the potential transmission of HIV. The proximity of persons connected within a network, but not necessarily known to each other, suggests that a high probability of partner selection from within the group may be an important factor in maintenance of HIV endemicity.

Cluster Analysis↗
PubMed2004

A simulation to assess the conditions required for high level heterosexual transmission of HIV in Africa.

We used a previously described simple compartment model to simulate the conditions required for heterosexual (penile-vaginal) contact to be responsible for 80% or more of transmission of HIV in Africa. In general, the configurations required substantially exceed reported survey and other data for the number of sexual partners, the transmission probabilities, and the distribution of HIV prevalence in population segments. Though the model does not capture nuances of transmission dynamics, it does offer an approximation of the gap between empirical data and current hypotheses.

Africa↗
PubMed2003

Chlamydia screening in a metropolitan Atlanta primary care clinic.

BACKGROUND: Chlamydia is the most commonly reported infectious disease in the United States, yet many women at risk for chlamydia infection are not being tested. METHODS: We conducted a chlamydia screening study (Phase I) and retrospective medical chart review (Phase II) of 199 women from 16 to 40 years of age attending a primary care clinic in metropolitan Atlanta. RESULTS: Two (1%) of the 199 study participants tested positive for chlamydia during Phase I. Phase II medical chart reviews indicated that only 35% of study participants had been tested for chlamydia at least once in the previous 15 months. Three of these individuals tested positive, yielding a prevalence of 5.6%. All infections occurred in women 30 years of age or younger. CONCLUSION: The results suggest that chlamydia screening is low and that recommended guidelines are not being followed. Strategies are needed to increase the rates of screening and adherence to these guidelines to ensure that chlamydia is detected before complications occur.

Adolescent↗
PubMed2003

Once and future HIV treatment: a comparison of clinic and community groups.

The demographic, risk-taking, psychological, and social network characteristics of HIV+ patients receiving and not receiving antiretroviral therapy were compared to those characteristics in HIV+ and HIV- persons who are not in care. In this cohort study, we enrolled patients from the Grady Infectious Disease Program (IDP) Clinic in Atlanta, GA, defining group membership by their use of antiretroviral therapy at the time of ascertainment. We also enrolled HIV+ and HIV- persons from inner city neighbourhoods of Atlanta. We collected extensive survey information from both groups, as well as clinic and follow-up information from the Clinic groups. We attempted to interview each participant four times over a period of two years. We used scores for Risk, for Social Stress and for Psychological Distress to compare the groups. Persons receiving antiretroviral therapy continued to display risky behaviour and to experience a substantial degree of social stress and psychological distress. HIV+ persons in the community, however, had the most prominent profile for HIV-transmission risk, social stress, and psychological distress and display considerable cross-over in their patterns of risk-taking. Men who have sex with men appear to play a dominant role, through their risk behaviour and network affiliations, in the maintenance of HIV endemicity. Current approaches fail to give sufficient attention to the admixture of risk that occurs in inner city communities. Reaching HIV+ persons with antiretroviral therapy in such communities faces considerable social, structural, and psychological barriers that may be more important than simple adherence to medication.

Age Distribution↗
PubMed2002

The transformation of partner notification.

Since 1996, several traditional epidemiological studies of program efficacy have done little to alter the fixed opinions of promoters or detractors of partner notification. Modeling studies have appeared that confirm the value of the contact-tracing approach in locating and treating persons who may be important in transmission. These provide a theoretical base for a number of empirical studies that have applied social network methods to classical partner-notification approaches, which have demonstrated the dense networks and geographic clustering of persons involved in sexually transmitted disease transmission and have provided justification for focusing efforts on small groups that may be critical to epidemicity or its maintenance. These initial studies would appear to warrant a broad-based inclusion of network concepts into programmatic activities, with careful monitoring and analysis of the impact they have on both the traditional indices of partner notification as well as the larger effect on disease transmission.

Contact Tracing↗