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.

Partner notification of chlamydia infection in primary care: randomised controlled trial and analysis of resource use

OBJECTIVE: To evaluate the effectiveness of a practice nurse led strategy to improve the notification and treatment of partners of people with chlamydia infection. DESIGN: Randomised controlled trial. SETTING: 27 general practices in the Bristol and Birmingham areas. PARTICIPANTS: 140 men and women with chlamydia (index cases) diagnosed by screening of a home collected urine sample or vulval swab specimen. INTERVENTIONS: Partner notification at the general practice immediately after diagnosis by trained practice nurses, with telephone follow up by a health adviser; or referral to a specialist health adviser at a genitourinary medicine clinic. MAIN OUTCOME MEASURES: Primary outcome was the proportion of index cases with at least one treated sexual partner. Specified secondary outcomes included the number of sexual contacts elicited during a sexual history, positive test result for chlamydia six weeks after treatment, and the cost of each strategy in 2003 sterling prices. RESULTS: 65.3% (47/72) of participants receiving practice nurse led partner notification had at least one partner treated compared with 52.9% (39/68) of those referred to a genitourinary medicine clinic (risk difference 12.4%, 95% confidence interval -1.8% to 26.5%). Of 68 participants referred to the clinic, 21 (31%) did not attend. The costs per index case were 32.55 pounds sterling for the practice nurse led strategy and 32.62 pounds sterling for the specialist referral strategy. CONCLUSION: Practice based partner notification by trained nurses with telephone follow up by health advisers is at least as effective as referral to a specialist health adviser at a genitourinary medicine clinic, and costs the same. Trial registration Clinical trials: NCT00112255.

Does population screening for Chlamydia trachomatis raise anxiety among those tested? Findings from a population based chlamydia screening study

BACKGROUND: The advent of urine testing for Chlamydia trachomatis has raised the possibility of large-scale screening for this sexually transmitted infection, which is now the most common in the United Kingdom. The purpose of this study was to investigate the effect of an invitation to be screened for chlamydia and of receiving a negative result on levels of anxiety, depression and self-esteem. METHODS: 19,773 men and women aged 16 to 39 years, selected at random from 27 general practices in two large city areas (Bristol and Birmingham) were invited by post to send home-collected urine samples or vulvo-vaginal swabs for chlamydia testing. Questionnaires enquiring about anxiety, depression and self-esteem were sent to random samples of those offered screening: one month before the dispatch of invitations; when participants returned samples; and after receiving a negative result. RESULTS: Home screening was associated with an overall reduction in anxiety scores. An invitation to participate did not increase anxiety levels. Anxiety scores in men were lower after receiving the invitation than at baseline. Amongst women anxiety was reduced after receipt of negative test results. Neither depression nor self-esteem scores were affected by screening. CONCLUSION: Postal screening for chlamydia does not appear to have a negative impact on overall psychological well-being and can lead to a decrease in anxiety levels among respondents. There is, however, a clear difference between men and women in when this reduction occurs.

Epidemiological, social, diagnostic and economic evaluation of population screening for genital chlamydial infection

OBJECTIVES: To investigate epidemiological, social, diagnostic and economic aspects of chlamydia screening in non-genitourinary medicine settings. METHODS: Linked studies around a cross-sectional population-based survey of adult men and women invited to collect urine and (for women) vulvovaginal swab specimens at home and mail these to a laboratory for testing for Chlamydia trachomatis. Specimens were used in laboratory evaluations of an amplified enzyme immunoassay (PCE EIA) and two nucleic acid amplification tests [Cobas polymerase chain reaction (PCR), Becton Dickinson strand displacement amplification (SDA)]. Chlamydia-positive cases and two negative controls completed a risk factor questionnaire. Chlamydia-positive cases were invited into a randomised controlled trial of partner notification strategies. Samples of individuals testing negative completed psychological questionnaires before and after screening. In-depth interviews were conducted at all stages of screening. Chlamydia transmission and cost-effectiveness of screening were investigated in a transmission dynamic model. SETTING AND PARTICIPANTS: General population in the Bristol and Birmingham areas of England. In total, 19,773 women and men aged 16-39 years were randomly selected from 27 general practice lists. RESULTS: Screening invitations reached 73% (14,382/19,773). Uptake (4731 participants), weighted for sampling, was 39.5% (95% CI 37.7, 40.8%) in women and 29.5% (95% CI 28.0, 31.0%) in men aged 16-39 years. Chlamydia prevalence (219 positive results) in 16-24 year olds was 6.2% (95% CI 4.9, 7.8%) in women and 5.3% (95% CI 4.4, 6.3%) in men. The case-control study did not identify any additional factors that would help target screening. Screening did not adversely affect anxiety, depression or self-esteem. Participants welcomed the convenience and privacy of home-sampling. The relative sensitivity of PCR on male urine specimens was 100% (95% CI 89.1, 100%). The combined relative sensitivities of PCR and SDA using female urine and vulvovaginal swabs were 91.8% (86.1, 95.7, 134/146) and 97.3% (93.1, 99.2%, 142/146). A total of 140 people (74% of eligible) participated in the randomised trial. Compared with referral to a genitourinary medicine clinic, partner notification by practice nurses resulted in 12.4% (95% CI -3.7, 28.6%) more patients with at least one partner treated and 22.0% (95% CI 6.1, 37.8%) more patients with all partners treated. The health service and patients costs (2005 prices) of home-based postal chlamydia screening were 21.47 pounds (95% CI 19.91 pounds, 25.99) per screening invitation and 28.56 pounds (95% CI 22.10 pounds, 30.43) per accepted offer. Preliminary modelling found an incremental cost-effectiveness ratio (2003 prices) comparing screening men and women annually to no screening in the base case of 27,000 pounds/major outcome averted at 8 years. If estimated screening uptake and pelvic inflammatory disease incidence were increased, the cost-effectiveness ratio fell to 3700 pounds/major outcome averted. CONCLUSIONS: Proactive screening for chlamydia in women and men using home-collected specimens was feasible and acceptable. Chlamydia prevalence rates in men and women in the general population are similar. Nucleic acid amplification tests can be used on first-catch urine specimens and vulvovaginal swabs. The administrative costs of proactive screening were similar to those for opportunistic screening. Using empirical estimates of screening uptake and incidence of complications, screening was not cost-effective.

Healthcare and patient costs of a proactive chlamydia screening programme: the Chlamydia Screening Studies project

BACKGROUND AND OBJECTIVE: Most economic evaluations of chlamydia screening do not include costs incurred by patients. The objective of this study was to estimate both the health service and private costs of patients who participated in proactive chlamydia screening, using mailed home-collected specimens as part of the Chlamydia Screening Studies project. METHODS: Data were collected on the administrative costs of the screening study, laboratory time and motion studies and patient-cost questionnaire surveys were conducted. The cost for each screening invitation and for each accepted offer was estimated. One-way sensitivity analysis was conducted to explore the effects of variations in patient costs and the number of patients accepting the screening offer. RESULTS: The time and costs of processing urine specimens and vulvo-vaginal swabs from women using two nucleic acid amplification tests were similar. The total cost per screening invitation was 20.37 pounds (95% CI 18.94 pounds to 24.83). This included the National Health Service cost per individual screening invitation 13.55 pounds (95% CI 13.15 pounds to 14.33) and average patient costs of 6.82 pounds (95% CI 5.48 pounds to 10.22). Administrative costs accounted for 50% of the overall cost. CONCLUSIONS: The cost of proactive chlamydia screening is comparable to those of opportunistic screening. Results from this study, which is the first to collect private patient costs associated with a chlamydia screening programme, could be used to inform future policy recommendations and provide unique primary cost data for economic evaluations.

Strategies to increase the use and approval of gender-fair language

When masculine forms are used to refer to men and women, this causes male-biased cognitive representations and behavioral consequences, as numerous studies have shown. This effect can be avoided or reduced with the help of gender-fair language. In this talk, we will present different approaches that aim at influencing people’s use of and attitudes towards gender-fair language. Firstly, we tested the influence of gender-fair input on people’s own use of gender-fair language. Based on Irmen and Linner’s (2005) adaptation of the scenario mapping and focus approach (Sanford & Garrod, 1998), we found that after reading a text with gender-fair forms women produced more gender-fair forms than women who read gender-neutral texts or texts containing masculine generics. Men were not affected. Secondly, we examined reactions to arguments which followed the Elaboration Likelihood Model (Petty &Cacioppo, 1986). We assumed that strong pros and cons would be more effective than weak arguments or control statements. The results indicated that strong pros could convince some, but not all participants, suggesting a complex interplay of diverse factors in reaction to attempts at persuasion. The influence of people’s initial characteristics will be discussed. Currently, we are investigating how self-generated refutations, in addition to arguments, may influence initial attitudes. Based on the resistance appraisal hypothesis (Tormala, 2008), we assume that individuals are encouraged in their initial attitude if they manage to refute strong counter-arguments. The results of our studies will be discussed regarding their practical implications.

COMPARISON OF DNA TRANSFECTION AND MICROCELL-MEDIATED CHROMOSOME TRANSFER FOR DETECTING TRANSFORMING GENES IN HUMAN TUMOR CELL LINES

DNA mediated gene transfection is an important tool for moving and isolating genes from one cell type and putting them into a foreign genetic background. DNA transfection studies have been done routinely in many laboratories to identify and isolate transforming sequences in human tumors and tumor cell lines. A second technique, microcell-mediated chromosome transfer, allows the transfer of small numbers of intact human chromosome from one cell to another. This work was done to compare the efficiency of these two techniques in the transformation of NIH 3T3 mouse fibroblast cells.^ My intent in comparing these two techniques was to see if there was a difference in the transforming capability of DNA which has been purified of all associated protein and RNAs, and that of DNA which is introduced into a cell in its native form, the chromosome. If chromosomal sequences were capable of transforming the 3T3 cells in culture, the method could then be used as a way to isolate the relevant tumorigenic chromosomes from human tumors.^ The study shows, however, that even for those cell lines that contain transforming sequences identified by DNA-mediated gene transfer, those same sequences were unable to transform 3T3 cells when introduced to the cells by somatic fusion of human tumor microcells. I believe that the human transforming sequences in their original genetic conformation are not recognized by the mouse cell as genes which should be expressed; therefore, no noticeable transformation event was selected by this technique. ^

The Olive Tree, Vol. 8 Number 1, 2000

The Summer 2000 issue of The Olive Tree features articles about library projects, collections, technological innovations, and events at Fogler Library, University of Maine.

The identification of child abuse in Harris County in 1998

Characteristics of child abuse cases are not well known. In this study I collected data on 70 child abuse cases that were reported to Children's Protective Services in Harris County in 1998. The purpose of this study was to determine the factors in Harris County that lead to the identification of physical and sexual abuse. In order to answer the questions of who, what, where and when relative to the discovery of abuse I applied the same questionnaire (see Appendix) to each of 35 Sexual Abuse case reports and to each of 35 Physical Abuse/Neglect case reports. Answers to the first four questions were arranged by frequency distribution to show the predominant reporter, the 10 most common indicators, the most common locale, and the most frequent timing. Tables of the age, sex, and ethnicity of the children indicate the identity of those whose victimization was most reported. In addition the relationship between the form questions and the characteristics of the children was explored. A comparison of Sexual Abuse cases with Physical Abuse/Neglect cases was conducted and the results were analyzed and recorded in the Tables. ^ Child maltreatment often has negative short and long term effects on children's mental health and development. Suicide, violence, delinquency, drug and alcohol abuse and other forms of criminality are frequently child abuse related. Early detection and treatment helps to alleviate the myriad mental and physical ailments that untreated victims present as adults. This translates into medical dollar savings. ^ The long term objectives of my research were to reduce the number of undetected and unreported child abuse cases in Harris County by formulating better educational programs and literature for medical professionals and other personnel who are in contact with children. ^

Na 1 Nachlass Max Horkheimer, 645 - "Geschichte und Psychologie", "Preface" und "Vorurteil und Charakter" (p. IX 25a-IX 27.1-4)

"Geschichte und Psychologie" (GS 3, S. 48-69); Photokopie des Drucks aus der Zeitschrift für Sozialforschung, Jahrgang I, 1932; mit handschriftlichen Korrekturen von Gretel Adorno für den Nachdruck (1968), 11 Blatt; "Preface" to Berkeley Adult Study (GS 5, S. 415-420); Veröffentlicht in: Adorno, Theodor W.; Frenkel-Brunswik, Else; Levinson, Daniel J.; Sanford, R. Nevitt: "The Authoritian Personality", New York, 1950, Seote IX- XII. Typoskript, datiert: April 1948, 8 Blatt (siehe auch IX 140, IX 153.3); "Vorurteil und Charakter" (GS 8, Seite 64-76); 1. Aufsatz von Max Horkheimer und Theodor W. Adorno, veröffentlicht in: Frankfurter Hefte; April 1952, Seite 284-291. a) Teilstück, Typsokript, 2 Blatt b) Typoskript mit eigenhändigen und handschriftlichen Korrekturen, 14 Blatt c) Typoskript mit dem Titel: "Vorurteil: Wissenschaftlich untersucht. Der freie und der totalitäre Mensch"; mit handschriftlichen Korrekturen, 5 Blatt d) Typsokript mit demselben Titel, mit eigenhändigen Korrekturen von Max Horkheimer und Theosodr W. Adorno, 6 Blatt; 2. Englische Fassung mit dem Titel: "Prejudice and Personality". a) Typoskript, 14 Blatt b) Typoskript, 14 Blatt; 3. Horkheimer, Max: "Prejudice and Personality. A Paper prepared for the XII th Congress of the International Association of Allied Psychology as a Contribution to the Symposion on: 'The Psychologist ams Scienty'". London, July 19, 1955; 2. überarbeitete Fassung, Typoskript, 7 Blatt; 4. "Vorurteil"; größtenteils identisch mit 1. Typsokript, 10 Blatt (siehe auch IX 28.8);

Na 1 Nachlass Max Horkheimer, 673 - Forschungsprojekte über Antisemitismus, Vorurteil, Autorität: Einzeluntersuchungen (p. IX 139 - IX 140.1-14)

Assignements. Anweisungen zu Einzeluntersuchungen des Antisemitismus-Projekts, 1943 und ohne Datum, 15 Blatt; Zum 'Berkeley Projekt on Antisemitism', 1944-1946; Sitzungsprotokolle und Memoranden der 'Los Angeles Branch of the Berkeley Research Project on Social Discrimination', 19.03.1946 - 11.04.1946, Typoskript, 11 Blatt; Frenkel-Brunswik, Else: 1 Brief mit Unterschrift an Max Horkheimer, ohne Ort, 10.01.1944, 6 Blatt; Interview- und Testprotokolle, Typoskript, 33 Blatt; Horkheimer, Max: 1 Brief an Theodor W. Adorno, ohne Ort, 11.10.1945, 5 Blatt; "Traits of the Authoritatian Character", a) Typoskript, 2 Blatt; b) Typoskript, 2 Blatt; c) Typoskript mit eigenhändigen Korrekturen und Ergänzungen, von Max Horkheimer, 2 Blatt; "Hypothese concerning indirect questions of Berkeley Questionaire". Als Typoskript vervielfältigt, 4 Blatt; Frenkel-Brunswik, Else; Sanford, R. Nevitt: "Some Personality Factors in Anti-Semitism", Sonderdruck aus: The Journal of Psychology, 1945, 20, S. 271-291; Levison, Daniel J.; Sanford, R. Nevitt: "A Scale for the Measurement of Anti-Semitism", Sonderdrucke aus: The Journal of Psychology, 1944,17, S.339-370; "'Unconscious' Facism", Excerpt aus: Propaganda Analysis, No. 7, L938, Typoskript 1 Blatt; Löwenthal, Leo: 1 Brief mit Unterschrift an Max Horkheimer, New York, 31.05.1945; Deutsch, Monroe E.: 2 Briefe mit Unterschrift an Max Horkheimer, Berkeley, 1945; 4 Briefe und Beantwortung von Max Horkheimer, Pacific Palisades, 1945; Lundberg, O.: 5 Briefe von Max Horkheimer, Pacific Palisades, 1945-1946; Sanfort, Nevitt: 1 Brief von Samuel H. Flowerman, ohne Ort, 14.06.1947; Statement for Berkeley Public Opinio Study Group Accounts, 19 Blatt;

Na 1 Nachlass Max Horkheimer, 546 - Korrespondenzen mit Leo Löwenthal (p. VI 18, 215-414)

135 Briefe zwischen Leo Löwenthal und Max Horkheimer; 2 Briefe von Max Horkheimer an S. Flowerman, 1945/1946; 2 Briefe zwischen John Slawson und Max Horkheimer, Februar 1946; 1 Brief von R. Nevitt Sanford an John Slawson, 31.01.1946; 1 Brief von Paul Lazarsfeld an Norbert K. Merton, 04.02.1946; 1 Brief von Paul Lazarsfeld an Theodore Abel, 05.02.1946; 2 Briefe zwischen Max Horkheimer und Dessie E. Kushell, Januar 1946; 3 Briefe von Max Horkheimer an Margaret Nicolson, Januar 1946;

Na 1 Nachlass Max Horkheimer, 557 - Korrespondenzen mit Leo Löwenthal (p. VI 24, 1-230)

139 Briefe zwischen Max Horkheimer und Leo Löwenthal; 5 Briefe zwischen Charles Y. Glock und Max Horkheimer; 2 Briefe von Leo Löwenthal an Frederick Pollock, 1951/1952; 1 Brief von Max Horkheimer an Robert S. Lynd, 08.11.1951; 1 Brief von Max Horkheimer an Nevitt R. Sanford, 21.04.1951; 1 Brief von Max Horkheimer an Herbert Marcuse, 05.03.1951; 1 Brief von Harry J. Krould an Max Horkheimer, 19.02.1951; 1 Brief von Max Horkheimer an Paul Lazarsfeld, 09.02.1951; 1 Brief von Max Horkheimer an Manfred George, 12.08.1952; 1 Brief von Max Horkheimer an Paul Massing, 27.07.1952;