Dose of progestin in postmenopausal-combined hormone therapy and risk of endometrial cancer

OBJECTIVE

We studied the impact of progestin dose on this risk. The pattern and number of days per month that progestin is given in postmenopausal combined hormone therapy appears to affect endometrial cancer risk. We assessed the impact of progestin dose on this risk.

STUDY DESIGN

A population-based, case-control study included 647 cases with endometrial cancer and 1209 controls.

RESULTS

Among users of estrogen with medroxyprogesterone acetate (MPA) 10 to 24 days/month, women who took >100 mg/month had an endometrial cancer risk that was equal to that of hormone nonusers (95% CI 0.6-1.7). The corresponding relative risk was 0.8 (95% CI 0.5-1.5) in those who used a lower monthly MPA dose for 10 to 24 days/month. Among users of a continuous combined hormone regimen, the risk of endometrial cancer was low relative to hormone nonusers, regardless of MPA dose.

CONCLUSION

Among the combined hormone regimens most commonly used by postmenopausal women today, MPA monthly dose bears little or no relation to endometrial cancer risk.

The Canadian Paediatric Surveillance Program: Beyond collecting numbers

Traditionally, anecdotal data and retrospective case reports have been used for insight into the natural history, epidemiology and case management of rare diseases. This lack of information has often resulted in delayed recognition and diagnosis of rare diseases, increasing the risk of complications or death of children. Furthermore, the study of rare condiions has been hampered by the need to generate sufficient numbers to enable meaningful analysis and interpretation, a need that requires data collection from a large population. The Canadian Paediatric Surveillance Program (CPSP) was established in 1996 to contribute to the improvement of the health of children and youth by national surveillance and research into uncommon paediatric diseases and conditions. The CPSP provides the mechanism to enable the prospective collection of national epidemiological data on such diseases and conditions. After five years, has the CPSP risen to meet expectations? Is it based on scientific evidence? The CPSP has revealed itself to be a very sensitive surveillance tool, providing invaluable longitudinal, epidemiological information for public health decision-makers. The present paper reviews how the different communicable diseases on the CPSP monthly reporting form stand the test of the 1998 priority criteria for diseases under national surveillance set by Canada's Advisory Committee on Epidemiology.

Urine testing for Chlamydia trachomatis and hassle-free follow-up is acceptable to street youth

OBJECTIVE

To evaluate whether street youth would use a sexually transmitted disease (STD) screening program involving non-nominal, noninvasive testing of urine for Chlamydia trachomatis with hassle-free follow-up and partner self-notification.

DESIGN

Cross-sectional pilot study in six centres frequented by street youth 13 to 25 years of age in the Regional Municipality of Ottawa-Carleton.

INTERVENTIONS

A structured, non-nominal face-to-face interview using an 88-item questionnaire was administered by a trained research assistant. Immediate feedback was provided to participants about specific individual risk reduction strategies for high risk life styles. Each street youth provided a urine sample that was tested non-nominally for C trachomatis by polymerase chain reaction (PCR). A single dose of azithromycin therapy was provided to participants who tested positive, each of whom was requested to encourage recent sexual partners to come forward for testing and treatment.

RESULTS

One hundred and sixty-three street youth were recruited (98 males and 65 females [male to female ratio 1.5:1]) over the four months of the study. The mean ages of participants were males 18.3+/-2.50 years and females 16.7+/-2.02 years. Ninety-two per cent (146) of all participants were sexually active and 99% of the sexually active youth (145 of 146) submitted urine samples. Urine samples were positive in 12 (8.2%) participants (seven males, five females), all of whom were asymptomatic. All those who tested positive were recruited from a single site (site specific rate 13.6%). Overall, only 25% of those tested returned spontaneously for test results; however, nine of 12 participants with positive results were treated due to investigator vigilance in locating the youth. Street youth partner self-notification resulted in five additional street youth requesting testing and treatment.

CONCLUSIONS

Street youth participated in a STD testing program when a street friendly program and noninvasive methods were used. Although more expensive, urine PCR testing increased program acceptance by street youth compared with previous local results. Detection of C trachomatis was high in this hard-to-reach population. There is a need to address further the problem of poor return rates for results and treatment, as well as low rates of partner notification.

Cohorting of infants with respiratory syncytial virus

During two winter periods (1994-1995 and 1995-1996), nasopharyngeal aspirates were obtained from infants and young children with an acute respiratory illness, after initial assessment in an area with six cubicles which serves as an admissions unit. Aspirates were sent for rapid diagnostic testing. Respiratory syncytial virus (RSV) positive patients were cohorted into two six-bedded bays on the paediatric wards. Over the two successive winter periods studied, 347 RSV positive patients were assigned to the cohort. No nosocomial infections were identified during the first winter; in the second, two were identified. Cohorting at admission eased clinical management, with one area used for high-dependency care and cubicles being freed for children with other infectious diseases. Nosocomial infection was minimized.

Canadian street youth: correlates of sexual risk-taking activity

The purpose of this study was to develop a national perspective on the sexual activity of street youth in Canada and to determine the correlates of risky sexual behavior according to street youth's link to the street. Five categories of street youth (sex industry workers, heavy drug and/or alcohol users, young offenders, homeless and unemployed) ages 15 to 20 years were recruited in 1988 from 10 Canadian urban centers to participate in a 45-minute structured interview focusing on knowledge and attitudes regarding sexually transmitted diseases (STD)/human immunodeficiency virus, current sexual practices, sexual and STD history, demographic background, alcohol/drug use and relationship with parents and peers. Data from the survey were also compared with findings from more than 15,000 non-street youth adolescents surveyed in the same year with the use of parallel questionnaires. Of 712 street youth surveyed (391 males, mean age 17.3 years; 321 females, mean age 16.8 years), the majority were sexually active (95% males, 93% females) and 22% reported at least one previous STD (16% males, 30% females). The lowest STD rates were in unemployed males (5%) and the highest (68%) in female sex industry workers. STD/human immunodeficiency virus high risk behaviors were frequent with 47% of males and 41% of females having had at least 10 different partners, 73% of males and 75% of females inconsistently using condoms and 22% of males and 24% of females participating in anal intercourse. Even among sex industry workers more than 40% used condoms inconsistently.(ABSTRACT TRUNCATED AT 250 WORDS)

Hospital response protocols for child sexual abuse and sexually transmitted diseases in children

Hospitals are significant portals of entry to the health care system for children who have been sexually abused. Hospital staff have the opportunity to investigate, intervene in and prevent the cycle of abuse. Accordingly, several Canadian hospitals have standardized responses to meet the needs of the sexually abused child; however, the prevalence of protocols and the degree of standardization across the country have not been documented. A survey of hospitals in Canada indicated that 46% of hospitals that treated children had a response protocol for child sexual abuse and only 17% had a response protocol for sexually transmitted diseases in children. Protocols were more likely to be in place in hospitals that were accredited, specialized in paediatrics, were designated as teaching facilities for medicine, nursing and social work, and had more than 200 beds. In hospitals without protocols, staff were often not convinced of their need or desirability.

High-risk STD/HIV behavior among college students

The current sexually transmitted disease (STD) epidemic in adolescents has led to concern about the potential for spread of the human immunodeficiency virus (HIV). In 1988, a total of 5514 students in first-year community college and university classrooms across Canada were surveyed to assess STD/HIV-related knowledge, attitudes, and risk behavior. The students' mean age was 19.7 years; the male-to-female ratio was 1:1.4. Students knew more about HIV/acquired immunodeficiency syndrome than other STDs. Of the 74.3% of the men and 68.9% of the women who were coitally active, 14.3% of the men and 18.6% of the women had participated in anal intercourse and 5.5% reported a previous STD. Only 24.8% of the men and 15.6% of the women always used a condom during sexual intercourse. Among the 21.3% of the men and 8.6% of the women with 10 or more partners, regular condom use was reported in only 21% and 7.5%, respectively. In this subgroup, anal intercourse was practiced by 26.9% of the men and 34.8% of the women, and previous STD was reported by 10.6% and 24.2%, respectively. Factors associated with not using a condom included number of sexual partners, embarrassment about condom purchase, difficulty discussing condom use with a partner, use of oral contraceptives, insufficient knowledge of HIV/STDs, and the belief that condoms interfere with sexual pleasure. These factors are potentially amenable to change. Effective, behaviorally focused educational programs are needed to improve condom use and reduce STD/HIV risk.