Vulvovaginal-swab or first-catch urine specimen to detect Chlamydia trachomatis in women in a community setting?

Screening for chlamydia in women is widely recommended. We evaluated the performance of two nucleic acid amplification tests for detecting Chlamydia trachomatis in self-collected vulvovaginal-swab and first-catch urine specimens from women in a community setting and a strategy for optimizing the sensitivity of an amplified enzyme immunoassay on vulvovaginal-swab specimens. We tested 2,745 paired vulvovaginal-swab and urine specimens by PCR (Roche Cobas) or strand displacement amplification (SDA; Becton Dickinson). There were 146 women infected with chlamydia. The assays detected 97.3% (95% confidence interval [CI], 93.1 to 99.2%) of infected patients with vulvovaginal-swab specimens and 91.8% (86.1 to 95.7%) with urine specimens. We tested 2,749 vulvovaginal-swab specimens with both a nucleic acid amplification test and a polymer conjugate-enhanced enzyme immunoassay with negative-gray-zone testing. The relative sensitivities obtained after retesting specimens in the negative gray zone were 74.3% (95% CI, 62.8 to 83.8%) with PCR and 58.3% (95% CI, 46.1 to 69.8%) with SDA. In community settings, both vulvovaginal-swab and first-catch urine specimens from women are suitable substrates for nucleic acid amplification tests, but enzyme immunoassays, even after negative-gray-zone testing, should not be used in screening programs.

Hepatitis C in a sample of pregnant women in Switzerland: seroprevalence and socio-demographic factors

PRINCIPLES: The aim of this study was to determine the prevalence of hepatitis C (HCV) infection in a sample of pregnant women living in Switzerland in 1990-1991, in order to complement existing data in various populations. METHODS: Blood samples were collected from women from consecutive births in obstetric wards in public hospitals of 23 Swiss cantons over a one-year period. They were tested, among other things, for the presence of hepatitis C virus antibodies (anti-HCV). Statistical analyses were done to explore the association of demographic variables with anti-HCV. RESULTS: The study included a total of 9,057 women of whom 64 tested positive for anti-HCV, resulting in a crude prevalence of 0.71%. Prevalence varied by age and was highest in the 25-29-year age-group (0.90%). 43/5,685 Swiss women were HCV seropositive (0.76%) compared with 21/3,372 non-Swiss women (0.62%). Stratified analysis showed a significant association between anti-HCV and anti-HBc antibody positivity in Swiss (adjusted OR [aOR] 23, 95% CI 12-43) and non-Swiss nationals (aOR 3.3, 95% CI 1.3-8.3). CONCLUSIONS: The prevalence of anti-HCV antibodies in the early 1990s was <1% in this sample of pregnant women in Switzerland and was associated with age, nationality and the presence of anti-HBc antibodies, a marker of exposure to hepatitis B virus. These results are in accordance with those from other published European studies. If an effective intervention to prevent vertical transmission becomes available, information on the current prevalence of HCV in pregnant women would be needed in order to assess how screening recommendations should be modified.

Real-time quantitative PCR to determine chlamydial load in men and women in a community setting

We used a PCR method to quantify the loads of Chlamydia trachomatis organisms in self-collected urine and vulvovaginal swab (VVS) samples from 93 women and 30 men participating in the Chlamydia Screening Studies Project, a community-based study of individuals not seeking health care. For women, self-collected VVS had a higher mean chlamydial load (10,405 organisms/ml; 95% confidence interval [95% CI], 5,167 to 21,163 organisms/ml) than did first-void urines (FVU) (503 organisms/ml; 95% CI, 250 to 1,022 organisms/ml; P < 0.001). Chlamydial loads in female and male self-collected FVU specimens were similar (P = 0.634). The mean chlamydial load in FVU specimens decreased with increasing age in females and males. There was no strong statistical evidence of differences in chlamydial load in repeat male and female FVU specimens taken when patients attended for treatment a median of 23.5 (range, 14 to 62) and 28 (range, 13 to 132) days later, respectively, or in VVS taken a median of 35 (range, 14 to 217) days later. In this study, chlamydial load values for infected persons in the community who were not seeking treatment were lower than those published in other studies involving symptomatic patients attending clinical settings. This might have implications for estimates of the infectiousness of chlamydia. The results of this study provide a scientific rationale for preferring VVS to FVU specimens from women.

The Postmodern ‘Turn’ in Social Work: The Challenges of Identity and Equality

Diversity and demands for equality have challenged fixed notions of identity amongst the diverse populations of Europe. This development has prompted discourses about the significance of fluidity and multiplicity in identities that have given prominence to postmodern theories in the profession of social work. A number of social work educators have contributed to the ensuing debates. Walter Lorenz’s work has contributed substantially to developments on this front by:highlighting the dangers of essentialising fixed identities in professional practice, referring to the failure of social workers to live up to professional values and ideals in the Nazi attack on Jews and others who were different from the Aryan norms that Hitler’s regime sought to impose; arguing for racial equality in multicultural Europe; and ensuring that social work theories and practice engaged with innovations in the social sciences more generally to improve the profession’s research, theoretical and practice bases. In this article, I engage with crucial debates that have shaped the profession during the post-war period, honouring Walter Lorenz’s contributions to them in the process.

Theory and Practice: A Matter of Words. Language, Knowledge and Professional Community in Social Work

The relation between theory and practice in social work has always been controversial. Recently, many have underlined how language is crucial in order to capture how knowledge is used in practice. This article introduces a language perspective to the issue, rooted in the ‘strong programme’ in the sociology of knowledge and in Wittgenstein’s late work. According to this perspective, the meaning of categories and concepts corresponds to the use that concrete actors make of them as a result of on-going negotiation processes in specific contexts. Meanings may vary dramatically across social groups moved by different interests and holding different cultures. Accordingly, we may reformulate the issue of theory and practice in terms of the connections between different language games and power relationship between segments of the professional community. In this view, the point is anyway to look at how theoretical language relates to practitioners’ broader frames, and how it is transformed while providing words for making sense of experience.

Turkey. A Generalist Approach in Social Work Education

A global review of social work education reveals considerable similarity among countries as well as significant differences. Historically, programs of social work education are informed by humanistic values and encompass knowledge of social problems, an understanding of individuals and their environment in interaction, and method of intervention into social and human difficulties. At the same time, structure of social work within the educational system and the length of training vary considerably from country to country. There is no serious international standards' setting for social work education, programs, educators and students around the world. Education programs exist at differing levels of education and for differing periods of time. There are no worldwide data on the number and qualifications of teachers of social work, the number and characteristics of social work students, variations in curricula and type of practicum (Hokeenstad and Kendall, 2001; Hokenstad, Midgley, 1998). North American and European models have had a major influence on social work educational programs in most parts of the world, especially developing countries. Still, the amount of western influence on social work education in developing countries is an issue that continues to be discussed (Hockenstad, Khinduka and Midgley, 1992; Frumkin, Lloyd, 2001). The programs in practice in Europe and North America have influenced the implementation of social work education programs. In recent years this influence has had a big part in the acceptance of the generalist approach. It is very important that social work education programs must be planned in accordance with the social structure and the development process of the society. Because of this, information on the social indicators and social welfare services will be given first then social work education will be stressed upon.

Youth and Health as an issue of Research in Social Work - Two examples of current Research

Health issues under aspects pertaining to social work are currently being investigated in our department under two main perspectives. The study of Youth, Health, and Internet is based on experiences with a project of e-mail counseling for youths we have been running in our department for one year so far. Our thesis is that the internet has become an important platform for youngsters in general as well as concerning health issues specifically. So far, however, little is known about the ways youths address their health related problems in the net. We believe that research in this area is badly needed since future concepts of effective health improvement and prevention for youths cannot ignore this medium. Biography and Health is our second focus of investigation, addressing deficiencies in the empirical research of Aaron Antonovsky´s salutogenetic concept that has lately become quite popular in many health discussions. Drawing from biographical methods we are currently investigating the development of the so called "sense of coherence" - the center piece of salutogenesis.

New Initiative on postgraduate developments in social work in Europe

In September 2004 five European Schools for social work started to develop an international doctoral studies program in social work. The initiative came from the Faculty of Social Work Ljubljana and the meeting was held in Ljubljana, Slovenia. The partners designed a mission statement which is now published for the first time.