A chemomechanical polymer that functions in blood plasma with high glucose selectivity.
Explore the source record for details and available documents.
Blood Glucose↗
Biomedical subjects
Robert L Cook
Publications and source records attributed to Robert L Cook.
Depression, stress, and social support as predictors of high-risk sexual behaviors and STIs in young women.
A total of 403 women (aged 14-25 years) were surveyed to determine the association of psychosocial variables with risky sexual behaviors and sexually transmitted infections (STIs). Depression, stress, and low social support were associated with high-risk sexual behaviors and past STIs. When comparing adolescent women (aged 14-19) to young women (aged 20-25), the adolescents had stronger associations with the outcome variables.
Adolescent↗
Women's satisfaction with an intravaginal Lactobacillus capsule for the treatment of bacterial vaginosis.
OBJECTIVE: To assess women's satisfaction with a vaginal capsule containing human-derived, H(2)O(2)-producing Lactobacillus crispatus at completion of a randomized, placebo-controlled study for treatment of bacterial vaginosis (BV). METHODS: Women aged 14-35 years with BV were randomized to Lactobacillus or placebo intravaginal capsule twice daily for 3 days monthly for 3 months. Attitudes were assessed with a standardized scale at the final follow-up visit, and associations of satisfaction with clinical and gram stain cure of BV were determined. RESULTS: Four hundred twenty-four women were randomized at enrollment, and 232 (55%) provided data on satisfaction at the final visit. Overall, satisfaction with the capsule was high and was independent of subjects' race, age, and prior history of BV. Report of satisfaction with the capsule, belief that it contained healthy bacteria, and belief that its use improved vaginal health were directly related to clinical cure and to improved Nugent score. Except for women who had BV at the final follow-up visit, most subjects believed that the capsule contained healthy bacteria independent of any outcome reflecting cure. Willingness to use the capsule again was not significantly related to whether subjects experienced clinical cure or normalization of Nugent score at either visit. Adverse effects were rare and were largely related to a perceived difference in vaginal discharge. CONCLUSIONS: Satisfaction with an intravaginal capsule and positive beliefs about its use for BV treatment were prevalent, especially among women with a clinical and microbiological response to BV therapy. However, most women expressed willingness to use the product again regardless of clinical response. Acceptability of and interest in alternative BV treatments, such as L. crispatus intravaginal applications, are high.
Administration, Intravaginal↗
Women's experiences with emergency contraception in an internal medicine practice.
BACKGROUND: Emergency contraceptive pills (ECPs) are effective for preventing unintended pregnancy. Whether patients in primary care settings receive physician counseling regarding ECPs has not been evaluated. METHODS: We conducted a cross-sectional telephone survey of reproductive-age women who sought care at a university-based general internal medicine clinic regarding receipt of physician counseling about ECPs, knowledge and experiences with ECPs, and attitudes toward using ECPs. RESULTS: One hundred forty-nine women aged 18-45 completed the survey. Eighty percent of respondents (n = 119) were at risk for unintended pregnancy. Although all women in the sample had seen an internist in the previous 12 months, only 10% had received physician counseling about ECPs. There was little difference in the proportion of women who received counseling about ECPs comparing those who received care from an obstetrician/gynecologist and an internist with women who received care from an internist alone (13% vs. 8%, p = 0.529). Receipt of ECP counseling was not associated with the consistency of current contraceptive use. No women who were married or over the age of 40 were counseled about ECPs. The majority of participants (92%) had heard of ECPs, although most (54%) had learned about them through the media. Fifty-four percent of women would be likely to use ECPs to prevent unintended pregnancy. CONCLUSIONS: Only a fraction of women seeing internists for their primary care are receiving counseling about ECPs, irrespective of receiving care from an obstetrician/gynecologist. As primary care physicians, internists should determine risk for unintended pregnancy, assess patients' knowledge and attitudes toward ECPs, and provide counseling about this effective therapy.
Adult↗
Intoxication before intercourse and risky sexual behavior in male veterans with and without human immunodeficiency virus infection.
BACKGROUND: Male veterans represent a large population at risk for acquiring or transmitting human immunodeficiency virus (HIV) infection. We sought to determine the prevalence of risky sexual behavior among veterans with and without HIV infection and to assess the relationship of intoxication before intercourse and other measures of drug and alcohol use to risky sexual behavior in this population. METHODS: We analyzed baseline data on 1009 HIV-positive (mean age 49 years) and 710 HIV-negative male veterans (mean age 55 years) who were participating in the Veterans Aging Cohort 5-Site Study (VACS 5). Participants completed a written questionnaire that included measures of alcohol and drug use and risky sexual behavior. RESULTS: Compared with HIV-negative veterans, HIV-positive veterans were more likely to report 5 or more sexual partners in the past year (14% vs. 4%, P < 0.01), less likely to report not using a condom at last intercourse (25% vs. 75%, P < 0.01), and similarly likely to report having 2 or more partners and inconsistent condom use (10% vs. 10%). Among sexually active HIV-positive veterans, intoxication before intercourse was significantly associated with having 5 or more sexual partners in the past year (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.1-2.8), inconsistent condom use (OR 1.8, 95% CI 1.2-2.7), and the combined measure of 2 or more partners and inconsistent condom use (OR 1.8, 95% CI 1.1-3.0). Intoxication before intercourse was not significantly associated with these behaviors in HIV-negative veterans, although similar trends were noted. CONCLUSION: Risky sexual behavior was common among male veterans attending outpatient clinics and is more common among HIV-positive veterans who use alcohol and drugs in sexual situations. Asking HIV-positive men a single question about intoxication before intercourse could help to identify men at increased risk of engaging in risky sexual behavior, and specific advice to avoid intoxication in sexual situations could help to reduce risky sexual behavior.
Cohort Studies↗
Alcohol and drug use and related disorders: An underrecognized health issue among adolescents and young adults attending sexually transmitted disease clinics.
OBJECTIVES: The objectives of this study were to describe patterns of alcohol and drug use disorders among young persons attending a public sexually transmitted disease (STD) clinic and to determine their associations with sexual risk behaviors and STDs. STUDY DESIGN: Four hundred forty-eight men and women aged 15 to 24 who were attending an urban STD clinic completed an interviewer-administered questionnaire that assessed a broad range of substance use in general and for alcohol and marijuana use disorders. RESULTS: Overall, 42.9% had an alcohol or marijuana use disorder (51.6% of males and 34.2% of females), whereas 30.6% had a confirmed STD. Participants with a substance use disorder were significantly more likely to have multiple sexual partners (odds ratio [OR] = 2.3; 95% confidence interval [CI] = 1.5-3.4), to be inconsistent condom users (OR = 3.1; 95% CI = 1.5-6.3), and to have an STD (OR = 1.7; 95% CI = 1.1-2.6). CONCLUSIONS: Among young STD clinic attendees, substance use disorders were more common than confirmed STDs. STD clinics may be an appropriate setting to screen for and address substance use disorders in young persons.
Adolescent↗
Systematic review: noninvasive testing for Chlamydia trachomatis and Neisseria gonorrhoeae.
BACKGROUND: Testing of urine samples is noninvasive and could overcome several barriers to screening for chlamydial and gonococcal infections, but most test samples are obtained directly from the cervix or urethra. PURPOSE: To systematically review studies that assessed the sensitivity and specificity of nucleic acid amplification tests for Chlamydia trachomatis and Neisseria gonorrhoeae in urine specimens and to compare test characteristics according to type of assay, site of sample collection, presence of symptoms, disease prevalence, and characteristics of the reference standard. DATA SOURCES: Relevant studies in all languages were identified by searching the MEDLINE database (January 1991 to December 2004) and by hand-searching the references of identified articles and relevant journals. STUDY SELECTION: Studies were selected that evaluated 1 of 3 commercially available nucleic acid amplification tests, included data from tests of both a urine sample and a traditional sample (obtained from the cervix or urethra), and used an appropriate reference standard. DATA EXTRACTION: From 29 eligible studies, 2 investigators independently abstracted data on sample characteristics, reference standard, sensitivity, and specificity. DATA SYNTHESIS: Articles were assessed qualitatively and quantitatively. Summary estimates for men and women were calculated separately for chlamydial and gonococcal infections and were stratified by assay and presence of symptoms. The pooled study specificities of each of the 3 assays exceeded 97% when urine samples were tested, for both chlamydial infection and gonorrhea and in both men and women. The pooled study sensitivities for the polymerase chain reaction, transcription-mediated amplification, and strand displacement amplification assays, respectively, were 83.3%, 92.5%, and 79.9% for chlamydial infections in women; 84.0%, 87.7%, and 93.1% for chlamydial infections in men; and 55.6%, 91.3%, and 84.9% for gonococcal infections in women. The pooled specificity of polymerase chain reaction to gonococcal infections in men was 90.4%. In subgroup analyses, the sensitivity did not vary according to the prevalence of infection or the presence of symptoms but did vary according to the reference standard used. LIMITATIONS: Few published studies present data on the transcription-mediated amplification or strand displacement amplification assays, and few studies report data from asymptomatic patients or low-prevalence groups. CONCLUSIONS: Results of nucleic acid amplification tests for C. trachomatis on urine samples are nearly identical to those obtained on samples collected directly from the cervix or urethra. Although all 3 assays can also be used to test for N. gonorrhoeae, the sensitivity of the polymerase chain reaction assay in women is too low to recommend its routine use to test for gonorrhea in urine specimens.
Cervix Uteri↗
A temporal and dose-response association between alcohol consumption and medication adherence among veterans in care.
BACKGROUND: Previous studies have shown that alcohol consumption is associated with decreased medication adherence, but this association may be confounded by characteristics common among those who drink heavily and those who fail to adhere (e.g., illicit drug use). Our objective was to determine whether there are temporal and dose-response relationships between alcohol consumption and poor adherence. METHODS: We administered telephone interview surveys to participants in the Veterans Aging Cohort Study, an eight-site observational study of HIV+ and matched HIV- veterans in care, to determine whether alcohol consumption on a particular day was associated with nonadherence to prescribed medications on that same day. We used the Time Line Follow Back to measure alcohol consumption and the Time Line Follow Back Modified for Adherence to measure adherence. Individuals were categorized as abstainers (no alcohol in past 30 days), nonbinge drinkers (alcohol in past 30 days but < or =four standard drinks on each day), or binge drinkers (> or =five standard drinks on at least one day). RESULTS: Among 2702 respondents, 1582 (56.6%) were abstainers, 931 (34.5%) were nonbinge drinkers, and 239 (8.9%) were binge drinkers. Abstainers missed medication doses on 2.4% of surveyed days. Nonbinge drinkers missed doses on 3.5% of drinking days, 3.1% of postdrinking days, and 2.1% of nondrinking days (p < 0.001 for trend), and this trend was more pronounced among HIV+ individuals than HIV- individuals. Binge drinkers missed doses on 11.0% of drinking days, 7.0% of postdrinking days, and 4.1% of nondrinking days (p < 0.001 for trend), and this trend was comparably strong for HIV+ and HIV- individuals. CONCLUSIONS: Among veterans in care, self-reported alcohol consumption demonstrates a temporal and dose-response relationship to poor adherence. HIV+ individuals may be particularly sensitive to alcohol consumption.
Alcohol Drinking↗
Is there an association between alcohol consumption and sexually transmitted diseases? A systematic review.
OBJECTIVE/GOAL: The objective of this study was to conduct a systematic review of published literature on the association between problematic alcohol consumption and sexually transmitted diseases (STDs). DESIGN: Using a MEDLINE search (1995-2003) and article references, we identified articles that described measures of alcohol consumption and STDs and presented data on their association. For each eligible study, we classified the alcohol consumption measure as specific (problem drinking) or general, and examined study designs, study populations, STD measures, and results. RESULTS: Of 42 eligible studies, 11 included specific measures of problem drinking, of which 8 found a significant association between alcohol consumption and at least 1 STD. The relationship did not appear to vary according to gender or pattern of alcohol consumption assessed. CONCLUSIONS: The literature supports an overall association between problematic alcohol consumption and STDs, although their causal relationship cannot be determined with certainty from these observational studies. The findings have implications for prevention planners, clinicians, and individual patients at risk of STDs.
Alcohol Drinking↗
Knowledge about sexually transmitted diseases in women among primary care physicians.
OBJECTIVES: Little is known about sexually transmitted disease (STD) knowledge of primary care providers. The objectives of this study were to determine the knowledge about the management of STDs among primary care physicians and to identify physician characteristics associated with possession of STD knowledge. STUDY: A self-administered questionnaire was mailed to a random sample of 1600 obstetrician/gynecologists, pediatricians, family physicians, and internists practicing in Pennsylvania. Information on physician and patient demographics was gathered, and we assessed knowledge and practice patterns concerning the management of STDs in young women. RESULTS: Physician knowledge regarding the evaluation and management of women with or at risk for STDs was associated with female gender (odds ratio [OR]: 2.1; 95% confidence interval [CI]: 1.4-3.2), age < or =40 (OR: 2.3; 95% CI: 1.4-3.6), and metropolitan practice location (OR: 1.7; 95% CI: 1.1-2.6). Familiarity with the Center for Disease Control and Prevention's (CDC's) STD treatment guidelines was independently associated with STD knowledge (OR: 2.0; 95% CI: 1.2, 3.3). Physicians with good STD knowledge were more likely to report routinely screening at-risk women for Chlamydia trachomatis (OR: 3.9; 95% CI: 2.3-6.8). CONCLUSIONS: Inadequacies in physician knowledge may serve as a barrier to the appropriate diagnosis and treatment of STDs. Interventions to improve STD management practices should include continuing medical education and distribution of CDC's STD treatment guidelines to primary care providers.
Adult↗
Alcohol screening in young persons attending a sexually transmitted disease clinic. Comparison of AUDIT, CRAFFT, and CAGE instruments.
OBJECTIVE: To compare the ability of 3 brief alcohol screens (Alcohol Use Disorders Identification Test [AUDIT], CRAFFT, and CAGE) to identify adolescents and young adults with a current alcohol use disorder (AUD) and to determine whether there are gender-based or race-based differences in screening performance. DESIGN, PARTICIPANTS, AND SETTING: Cross-sectional study of 358 young persons (55% males; 49% blacks; age range, 15-24 years; mean age, 20.6 years) who were attending an urban clinic for sexually transmitted diseases and reported alcohol use during the past year. MEASUREMENTS: Receiver operating characteristic (ROC) curve analysis was used to determine the ability of the 3 screens to discriminate between participants with and without AUDs detected in the Structured Clinical Interview for DSM-IV (SCID). RESULTS: One third (33%) of participants met Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for a current AUD (24% with alcohol abuse and 9% with alcohol dependence). The AUDIT performed best at a cut score of 9 (sensitivity, 0.76; specificity, 0.79), CRAFFT at a cut score of 2 (sensitivity, 0.94; specificity, 0.33), and CAGE at a cut score of 1 (sensitivity, 0.69; specificity, 0.63). The AUDIT had the best overall performance (area under the curve [AUC], 0.84), followed closely by CRAFFT (AUC, 0.79) and then CAGE (AUC, 0.70). Performance of screens did not differ by gender. The AUDIT performed slightly better in whites than blacks, but no race-based differences were observed for the CAGE or CRAFFT. CONCLUSIONS: Clinicians should use the AUDIT or CRAFFT, rather than the CAGE, to screen young persons for AUDs. The AUDIT performs best, but its length may limit its utility in this setting. The CRAFFT is a suitable alternative, with excellent sensitivity and no gender-based or race-based differences.
Adolescent↗
How condom use, number of receptive anal intercourse partners and history of external genital warts predict risk for external anal warts.
Few analytic opportunities have allowed us to evaluate the role that specific sexual acts and male latex condoms play in the acquisition of external anal warts (EAW) using longitudinal data. The acquisition of EAWs occurs from epithelial contact with other HPV-infected surfaces, and hence is dependent upon sexual behaviour. Our objectives were to classify the relative importance of condom use, receptive anal intercourse (RAI) and prior history of EGWs on acquisition of EAWs. The observational Multicenter AIDS Cohort Study followed 2925 men over nine semiannual study visits for behavioural and physical examinations with laboratory testing. The main outcome measure was the occurrence of examiner-diagnosed EAWs in a homosexual population. EAWs were diagnosed among 10% of men studied across 22,157 visits reviewed for this study. Men with history of EGWs were more likely than those previously unaffected to have developed EAWs (cOR = 2.4 (2.0, 2.9)), as were men who reported multiple anoreceptive intercourse partners (e.g., compared with men who reported no RAI partners, men with 1, 2-5, > or = 6 RAI partners had crude risk ratios 1.0 (0.8, 1.3), 1.6 (1.2, 2.1), 3.9 (2.7, 5.8), respectively). These relations persisted after other demographic and sexual risk factors were controlled for in the analyses. Consistent condom usage showed no protective effect for EAWs in our crude or adjusted analyses. Patient education messages should be tailored to reflect our uncertainty about the protective nature of condoms for the development of anal warts, but to continue to assert the protective effects of a limited lifetime number of sexual partners and the heightened risk for wart recurrence once infected.
Anus Diseases↗
Coupling NMR to NOM.
This work itemizes and critically assesses several 1D and multi-dimensional nuclear magnetic resonance (NMR) techniques, in both the liquid (solvent suppression, APT, DEPT, INEPT, COSY, TOCSY, HSQC, HMQC, HMBC, NOESY, ROESY and others) and solid states (DP, SACP, RAMP-CP, CP-TOSS, MQ-DEPT, 2D 1H-13C HETCOR and others), which are relevant to the characterization of natural organic matter (NOM). The pros and cons of many of the discussed techniques are compared in an effort to provide guidance to the most beneficial utilization of these NMR instrumental techniques for researchers interested in gaining insight into various aspects of NOM.
Journal Article↗
Alcohol use disorders among emergency department-treated older adolescents: a new brief screen (RUFT-Cut) using the AUDIT, CAGE, CRAFFT, and RAPS-QF.
BACKGROUND: Early identification of alcohol use disorders (AUD) among emergency department (ED)-treated patients is important for facilitating intervention and further evaluation outside EDs. A number of brief screening instruments have been developed for identifying patients with AUD, but it is not clear whether they are practical and perform well with older adolescents in an ED setting. This study contrasted four brief screening instruments for detecting DSM-IV-defined AUD and tested a newly developed brief screen for use among ED-treated older adolescents. METHODS: The Alcohol Use Disorders Identification Test (AUDIT), the CAGE, the CRAFFT, and a modified RAPS-QF were given to 93 alcohol-using older adolescents (55% men; aged 18-20 years) in an ED. Receiver operator characteristic analyses were used to evaluate the performance of brief screens against the criterion of a lifetime DSM-IV alcohol abuse or dependence diagnosis. RESULTS: Of existing instruments, the AUDIT had the best overall performance in identifying AUD (sensitivity, 82%; specificity, 78%). A new, shorter screening instrument composed of two AUDIT items, two CRAFFT items, and one CAGE item (RUFT-Cut) performed as well as the AUDIT (sensitivity, 82%; specificity, 78%). CONCLUSIONS: Among existing alcohol screening instruments, the AUDIT performed best for identifying ED-treated older adolescents with alcohol use disorders. The RUFT-Cut is a brief screening instrument for AUD that shows promise for identifying ED-treated older adolescents who are in need of intervention or further evaluation. Future research should focus on use of the RUFT-Cut in other settings with larger, more diverse samples of adolescents.
Adolescent↗
High prevalence of sexually transmitted diseases in young women seeking HIV testing in Rio de Janeiro, Brazil.
BACKGROUND AND OBJECTIVES: Few data are available on the prevalence of and risk factors for sexually transmitted diseases (STDs) other than HIV in Brazil. GOAL: The goal of this study was to determine the prevalence of HIV infection and other STDs in Brazilian women who seek HIV testing, investigate risk factors for these infections, and assess feasibility of screening in HIV test clinic settings. STUDY DESIGN: We conducted a cross-sectional study of 200 women, aged 14 to 29 years, who attended an HIV testing site in central Rio de Janeiro. Participants completed a questionnaire and received testing for HIV, syphilis, chlamydia, and gonorrhea. RESULTS: HIV and other STDs were common (HIV 8%, syphilis 6.5%, chlamydial infection 8%, and gonorrhea 9.5%). HIV was significantly associated with lower education and with having an HIV-infected partner. Other STDs were significantly associated with younger age at first intercourse, heavy alcohol consumption, and marijuana use. CONCLUSION: STDs appear to be substantial health problems among young Brazilian women seeking HIV testing. HIV testing sites in Brazil should consider offering screening and treatment for STDs and substance abuse as part of their HIV prevention services.
Adolescent↗
A comprehensive liquid-state heteronuclear and multidimensional NMR study of Laurentian fulvic acid.
The Boreal forest fulvic acid known as Laurentian fulvic acid (LFA) has been interrogated by state of the art heteronuclear and 2D high resolution NMR techniques. It is shown that one can obtain very highly resolved and informative spectra of a traditionally fractionated material. It was possible to observe a proton coupled system of up to seven bonds in the TOCSY spectrum and 329 peaks in the 1H,13C-HSQC spectrum. It is found that the majority of the nitrogen in this sample is in the form of ammonium cations. From the combination of inverse-gated decoupling, APT, and INEPT 13C spectra of LFA it can be concluded that while the aromatic moieties of LFA are highly unfunctionalized, the carbohydrate moieties are highly functionalized. Proton coupled networks are observed in the TOCSY spectrum between and within the aliphatic, functionalized aliphatic, and heteroatom substituted regions and, to a lesser extent, also between the amine/aromatic and heteroatom substituted regions. The HMBC spectrum confirms that both the aliphatic and heteroatom moieties are highly functionalized with carboxylic and alcoholic functional groups, while the aromatic moieties are very sparsely functionalized with phenolic and carboxylic functionalities. Additionally, specific model molecular structures have been identified which are consistent with experimental evidence and are in full agreement with our previously derived meso-model based on solid-state 13C NMR data. Finally, some of the shortcomings of 2D liquid-state NMR for the characterization of humic materials are addressed.
Benzopyrans↗
Increased prevalence of herpes simplex virus type 2 among adolescent women with alcohol use disorders.
PURPOSE: To determine the relationship between alcohol use disorders (AUDs) and herpes simplex virus type 2 (HSV-2), hepatitis B virus (HBV), and human immunodeficiency virus (HIV) infections among a sample of sexually active adolescents. METHODS: Subjects were 240 sexually active male and female adolescents aged 14 to 21 years (mean 17.5 years) recruited from clinical and community settings in western Pennsylvania between 1991 and 1995; 55% had a lifetime history of AUDs (63 females, 69 males) and 45% did not have a lifetime history of AUDs (57 females, 51 males). Participants provided information about demographic factors and sexual behaviors as well as a serum sample that was assayed for antibodies to HSV-2, HBV, and HIV infections. Multivariate logistic regression was used to determine the independent relationship of AUDs to HSV-2 infections among females. RESULTS: The seroprevalence of HSV-2 infections was 15% among females and 0% among males; the overall prevalence of HBV (1.2%) and HIV (0.4%) infections was very low. Among adolescent females, the seroprevalence of HSV-2 infections was significantly higher among those with an AUD (19%), compared with those without an AUD (10.5%) (adjusted odds ratio 8.1, 95% confidence interval 1.5-44.8, p =.017). CONCLUSIONS: Adolescent women with an AUD appear to be at substantially increased risk of HSV-2 infection. These results highlight the need to address sexually transmitted diseases among adolescents with alcohol problems.
Adolescent↗
Social stigma and negative consequences: factors that influence college students' decisions to seek testing for sexually transmitted infections.
College students often delay or avoid seeking testing for sexually transmitted infections (STIs), even if the services are readily available. We used in-depth, semistructured interviews to survey 41 college students aged 18 to 23 years about factors that influence decisions about STI testing. We grouped statements into 9 themes that represent influences on the decision. The most frequently mentioned factors were negative consequences of testing and perceived vulnerability to infection; other issues that influenced decision making included perceived benefits, perceived severity of diseases, public knowledge and opinion, social norms, provider characteristics, test-site characteristics, and personal considerations. Social stigmas and negative consequences appear to represent significant barriers to college students' being tested, which could increase the risk of spreading infections to others. Clinicians and health educators should raise students' awareness of the need for screening and should work to reduce the barriers to screening, including social stigmas and negative consequences.
Adult↗