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Azadehrah M, Azadehrah M, Zeinali F, Nokhostin F. Prevalence of Trichomonas Infection in Relation to Human Papillomavirus (HPV) in Pap Smear Samples of Female Patients Referred to Shahid Sadoughi Hospital, Yazd (Iran). Cureus 2024; 16:e57701. [PMID: 38711704 PMCID: PMC11070897 DOI: 10.7759/cureus.57701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 04/05/2024] [Indexed: 05/08/2024] Open
Abstract
Objectives Human papillomavirus (HPV) and Trichomonas vaginalis (TV) infections have been proposed as risk factors for cervical cancer. This study has been conducted with the aim of investigating the prevalence of TV and its relationship with HPV in women who underwent Pap smear testing as part of cancer screenings. Materials and methods The sampling of liquid-based cervical tissue was conducted among 500 women referred to the women's clinic of Shahid Sadoughi Hospital in Yazd, Iran. The studied samples were examined for Pap smear tests and microscopic identification of TV, as well as HPV-DNA detection and the determination of high-risk and low-risk HPV types by the polymerase chain reaction (PCR) method. The results were analyzed using the IBM SPSS Statistics for Windows, Version 24 (Released 2016; IBM Corp., Armonk, New York) software. Results The individuals included in the study were 16-72 years old. The prevalence rate of TV infection in this population was found to be 29.2%, and the frequency rate of HPV was reported to be approximately 19.4%, with high-risk HPV, including HPV-56, having the highest frequency. The Pap smear test results were reported as abnormal in 20.2%, and a significant correlation was observed between HPV infection and an abnormal Pap smear test (P < 0.05). In addition, a notable correlation was detected between TV infection and high-risk and low-risk HPV (P < 0.05). Conclusion According to the significant relationship found between the two pathogens, TV and HPV, in the abnormal Pap smear test results, TV infection can be considered a risk factor for HPV infection, as well as uterine lesions and cancer.
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Affiliation(s)
- Malihe Azadehrah
- Cancer Research Center, Golestan University of Medical Sciences, Gorgan, IRN
| | - Mahboobeh Azadehrah
- Cancer Research Center, Golestan University of Medical Sciences, Gorgan, IRN
| | - Fatemeh Zeinali
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, IRN
| | - Fahimeh Nokhostin
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, IRN
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Petre I, Sirbu DT, Petrita R, Toma AD, Peta E, Dimcevici-Poesina F. Real‑world study of Cerviron ® vaginal ovules in the treatment of cervical lesions of various etiologies. Biomed Rep 2023; 19:54. [PMID: 37546352 PMCID: PMC10398350 DOI: 10.3892/br.2023.1618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/15/2023] [Indexed: 08/08/2023] Open
Abstract
Cervical lesions can be caused by pathogens, hormonal changes or by cervical injury. The recommended treatment in all cases is excision. Local re-epithelialization therapy should be initiated preoperatively and postoperatively. The present study assessed the post-market performance and tolerability of Cerviron® ovules in the treatment and management of cervical lesions postoperatively. The study population included 345 participants aged 20-70 years with either a cervical lesion under treatment or with recent surgical removal of a cervical lesion. The degree of re-epithelialization of the cervical mucosa was improved in 73.17% of the patients evaluated during routine colposcopy exams and 92.73% of patients recorded no bleeding. When adding Cerviron® either as monotherapy or in association with other antimicrobials in postoperative care of the cervical ectropion, improved postoperative outcomes such as reduced post-interventional bleeding and a superior quality of healing were observed. The study and its details are registered in www.clinicaltrials.gov under ID NCT05668806.
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Affiliation(s)
- Izabella Petre
- Discipline of Obstetrics and Gynecology XII, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
- University Clinic of Obstetrics and Gynecology, Emergency Clinic Hospital ‘Pius Brinzeu’, 300226 Timisoara, Romania
| | | | - Ramona Petrita
- Biometrics Unit, MDX Research, 300633 Timisoara, Romania
| | - Andreea-Denisa Toma
- Pharmacy Unit of Municipal Hospital ‘Dr Karl Diel’ Jimbolia, 305400 Jimbolia, Romania
| | - Ema Peta
- Quality Assurance, Perfect Care Distribution SRL, 011158 Bucharest, Romania
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Rodrigues R, Vieira-Baptista P, Catalão C, Borrego MJ, Sousa C, Vale N. Chlamydial and Gonococcal Genital Infections: A Narrative Review. J Pers Med 2023; 13:1170. [PMID: 37511783 PMCID: PMC10381338 DOI: 10.3390/jpm13071170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Sexually transmitted infections (STIs) constitute one of the leading causes of disease burden worldwide, leading to considerable morbidity, mortality, health expenditures, and stigma. Of note are the most common bacterial STIs, chlamydial and gonococcal infections, whose etiological agents are Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), respectively. Despite being usually asymptomatic, in some cases these infections can be associated with long-term severe complications, such as pelvic inflammatory disease, chronic pelvic pain, infertility, ectopic pregnancy, and increased risk of other STIs acquisition. As the symptoms, when present, are usually similar in both infections, and in most of the cases these infections co-occur, the dual-test strategy, searching for both pathogens, should be preferred. In line with this, herein we focus on the main aspects of CT and NG infections, the clinical symptoms as well as the appropriate state-of-the-art diagnostic tests and treatment. Cost-effective strategies for controlling CT and NG infections worldwide are addressed. The treatment for both infections is based on antibiotics. However, the continuing global rise in the incidence of these infections, concomitantly with the increased risk of antibiotics resistance, leads to difficulties in their control, particularly in the case of NG infections. We also discuss the potential mechanism of tumorigenesis related to CT infections. The molecular bases of CT and NG infections are addressed, as they should provide clues for control or eradication, through the development of new drugs and/or effective vaccines against these pathogens.
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Affiliation(s)
- Rafaela Rodrigues
- OncoPharma Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Molecular Diagnostics Laboratory, Unilabs Portugal, Centro Empresarial Lionesa Porto, Rua Lionesa, 4465-671 Leça do Balio, Portugal
| | - Pedro Vieira-Baptista
- Department of Gynecology-Obstetrics and Pediatrics, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Lower Genital Tract Unit, Centro Hospitalar de São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Carlos Catalão
- Roche Sistemas de Diagnósticos, Estrada Nacional, 2720-413 Amadora, Portugal
| | - Maria José Borrego
- Laboratório Nacional de Referência das Infeções Sexualmente Transmissíveis, Instituto Nacional de Saúde Dr. Ricardo Jorge, Avenida Padre Cruz, 1649-016 Lisboa, Portugal
| | - Carlos Sousa
- Molecular Diagnostics Laboratory, Unilabs Portugal, Centro Empresarial Lionesa Porto, Rua Lionesa, 4465-671 Leça do Balio, Portugal
| | - Nuno Vale
- OncoPharma Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Community Medicine, Health Information and Decision (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
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Jiang TT, Han Y, Cao NX, Yin YP, Chen XS. Knowledge on Chlamydia trachomatis and Acceptance to Testing for It Among Young Students in China. Sex Transm Dis 2023; 50:236-240. [PMID: 36729091 DOI: 10.1097/olq.0000000000001756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Actively screening for Chlamydia trachomatis (CT) is important for young people because of a high prevalence of asymptomatic infection in this population. This study aimed to investigate knowledge on CT and preference to the screening services for CT among young students in China. METHODS From June to July 2022, a web-based questionnaire survey was conducted to collect information on sociodemographic characteristics, sexual behaviors, knowledge of CT, previous testing for CT, and preference to platform of testing for CT among Chinese young students. An online home-based self-sampling test (HBSST) service was offered free of charge if the participant was willing to be tested for CT. Statistical analyses included descriptive analysis, χ 2 test, and multivariable logistic regression. RESULTS Of 520 participants, 419 (80.6%) were aged between 16 and 24 years, 235 (45.2%) reported having sexual experience in the past, and 27 (5.2%) being tested before for CT. Slightly higher than 10% (57/520) of students were knowledgeable about CT. About one-third (36.9%) expressed their willingness to have a testing for CT but majority of them (63.1%) preferred to a free testing. Having sexual experience was significantly associated with the willingness to take the HBSST service (adjusted odds ratio, 2.96; 95% confidence interval, 1.92-4.58). A total of 139 (26.7%) participants requested the HBSST service online and 43.2% (60/139) returned the specimen for testing, in which 2 positives (3.3%) were found. CONCLUSIONS The knowledge on CT and the previous uptake or current willingness to have a testing for CT was low among Chinese young students.
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Jiang TT, Cao NX, Shi MQ, Jia TJ, Zhou Q, Liu JW, Zhang J, Zhang Y, Yin YP, Chen XS. Using pooled urogenital, anorectal and oropharyngeal specimens to detect Chlamydia trachomatis and Neisseria gonorrhoeae among men who have sex with men in China: a multisite diagnostic accuracy study. BMJ Open 2023; 13:e069876. [PMID: 36878660 PMCID: PMC9990619 DOI: 10.1136/bmjopen-2022-069876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVES Screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) at both urogenital and extragenital sites has been recommended in many countries. Testing of the infections using pooled specimens from urogenital and extragenital sites offer the opportunity to shorten the testing time and reduce the testing cost. Ex-ante pooling is placing the original single-site specimens in a tube with transport media, while ex-post pooling is making a pool of the transport media from both anorectal and oropharyngeal specimens and the urine. This study aimed to conduct a multisite performance evaluation of two pool-specimen approaches (ex-ante and ex-post) in detection of CT and NG using the Cobas 4800 platform among men who have sex with men (MSM) in China. DESIGN Diagnostic accuracy study. SETTING, PARTICIPANTS AND OUTCOME MEASURES Participants were recruited from MSM communities at six cities in China. Two oropharyngeal and anorectal swabs collected by clinical staff and 20 mL first-void urine collected by the participant himself were used for evaluating sensitivity and specificity. RESULTS A total of 1311 specimens were collected from 437 participants in six cities. The sensitivities of ex-ante pooling approach as compared with single-specimen approach (reference standard) were 98.7% (95% CI, 92.7% to 100.0%) for detection of CT and 89.7% (95% CI, 75.8% to 97.1%) for NG, and the specificities were 99.5% (95% CI, 98.0% to 99.9%) and 98.7% (95% CI, 97.1% to 99.6%), respectively. The sensitivities of ex-post pooling approach were 98.7% (95% CI, 92.7% to 100.0%) for CT and 100.0% (95% CI, 91.0% to 100.0%) for NG, and the specificities were 100.0% (95% CI, 99.0% to 100.0%) and 100.0% (95% CI, 99.1% to 100.0%), respectively. CONCLUSIONS The ex-ante and ex-post pooling approaches show good sensitivity and specificity in detecting urogenital and extragenital CT and/or NG, indicating that these approaches can be used in epidemiological surveillance and clinical management of CT and NG infections, particularly among MSM population.
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Affiliation(s)
- Ting-Ting Jiang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Ning-Xiao Cao
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Mei-Qin Shi
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Tian-Jian Jia
- Department of Outpatient, Wuxi Center for Disease Control and Prevention, Wuxi, China
| | - Qian Zhou
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Jing-Wei Liu
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Jin Zhang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Yan Zhang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Yue-Ping Yin
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Xiang-Sheng Chen
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
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Golshiri P, Mohaghegh N, Shamsaee S, Boroumandfar Z. Using education based on the health belief model to modifications in performance of behaviors related to sexually transmitted infections in vulnerable women. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:50. [PMID: 37113406 PMCID: PMC10127466 DOI: 10.4103/jehp.jehp_1291_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 06/07/2022] [Indexed: 06/19/2023]
Abstract
BACKGROUND Sexually transmitted infections (STIs) have always been considered as a health problem in the world. Also, vulnerable women (addicts, jail breakers, and prostitutes) are at the highest risk. According to the World Health Organization's (WHO) approach, the only effective way to prevent and control this disease is public health education, and high-risk and vulnerable groups should be prioritized in educational programs. The aim of the study was to investigate the effect of health belief model (HBM)-based education on changing the behaviors related to STIs in vulnerable women. MATERIALS AND METHODS The present study is an intervention (field trial) study in vulnerable women. Convenience sampling method was used in this study and the sample size was determined to be 84 subjects. Through tossing a coin, the social support center was selected as the intervention group and the drop-in center as the control group. Quantitative data analysis was performed, and descriptive and inferential statistical methods were used. RESULTS The mean scores of perceived threat, perceived benefits, perceived barriers, and perceived self-efficacy and changes in performance between the three measurement stages, as well as changes in the scores of perceived threat, perceived benefits, perceived barriers, and perceived self-efficacy over three measurement times were significantly different between the two groups (interaction) (P < 0.001). The mean score of performance 3 months after the intervention was significantly higher than before the intervention (P = 0.001). CONCLUSIONS The present study confirmed the effectiveness of the HBM in promoting behavioral modifiers that lead to STIs. Therefore, educational interventions with emphasis on understanding the threats, benefits, barriers, and self-efficacy and, ultimately, performance improvement in relation to STIs are recommended.
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Affiliation(s)
- Parastoo Golshiri
- Department of Community and Family Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Negar Mohaghegh
- School of Medicine, Isfahan of Medical University, Isfahan, Iran
| | - Somayeh Shamsaee
- Department of Community and Family Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Boroumandfar
- Reproductive Sciences and Sexual Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Montes-Olivas S, Ozten Y, Homer M, Turner K, Fairley CK, Hocking JS, Tse D, Verschueren van Rees N, Wong WCW, Ong JJ. Evaluating the impact and cost-effectiveness of chlamydia management strategies in Hong Kong: A modeling study. Front Public Health 2022; 10:932096. [PMID: 35968473 PMCID: PMC9363901 DOI: 10.3389/fpubh.2022.932096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives To illustrate the epidemiologic and cost-effectiveness impact of shifting the focus from population-based screening toward a targeted management approach for genital chlamydia infection. Design Modeling study, implementing an individual-based, stochastic, dynamic network model. Setting Hong Kong. Population A hypothetical sample network of 10,000 people with a partnership distribution based on Hong Kong's sexually active population of reproductive age (age 18–49 years). Interventions In this study, we present several scenarios with different implementations of universal vs. targeted screening (based on partner numbers). We also explored the impact of (1) screening only, (2) screening plus expedited partner therapy, and (3) screening plus partner testing. Primary outcome measures Change of chlamydia prevalence before and after implementing the different strategies. The cost-effectiveness analysis reports total direct cost from a health provider perspective, the QALYs gained, and incremental cost-effectiveness ratios (ICER). Results In comparing the effects of universal screening only and targeted screening of the high-risk population, the mean prevalence during the 10th year of intervention was 2.75 ± 0.30% and 2.35 ± 0.21%, respectively (compared with 3.24 ± 0.30% and 3.35 ± 0.21% before the interventions, respectively). The addition of contact tracing to the latter targeted screening scenario reduces the mean prevalence during the 10th year of intervention to 1.48 ± 0.13% (compared with 3.31 ± 0.33% at baseline) in the best-case of testing before treatment and maximal contact-tracing effectiveness (40%). Overall, the most effective scenarios were those for which interventions focused on the high-risk population defined by the number of partners, with contact tracing included. The ICER for targeted screening with contact tracing at 20% and 40% efficiency was $4,634 and $7,219 per QALY gained, respectively (10-year time horizon). Expedited partner therapy did not significantly impact overall chlamydia prevalence and caused overtreatment. Conclusions Our study suggests that targeted screening with strengthened contact tracing efforts is the most cost-effective strategy to reduce the prevalence of chlamydia in Hong Kong.
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Affiliation(s)
- Sandra Montes-Olivas
- Department of Engineering Mathematics, University of Bristol, Bristol, United Kingdom
| | - Yaz Ozten
- Department of Engineering Mathematics, University of Bristol, Bristol, United Kingdom
| | - Martin Homer
- Department of Engineering Mathematics, University of Bristol, Bristol, United Kingdom
| | - Katy Turner
- Bristol Veterinary School, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
| | - Christopher K. Fairley
- Central Clinical School, Faculty of Medicine, Monash University, Melbourne, VIC, Australia
- Alfred Health, Melbourne Sexual Health Center, Melbourne, VIC, Australia
| | - Jane S. Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Desiree Tse
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Nicolas Verschueren van Rees
- Physics Department, University of California, Berkeley, Berkeley, CA, United States
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, United Kingdom
| | - William C. W. Wong
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jason J. Ong
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
- Central Clinical School, Faculty of Medicine, Monash University, Melbourne, VIC, Australia
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- *Correspondence: Jason J. Ong
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Gassowski M, Poethko-Müller C, Schlaud M, Sailer A, Dehmel K, Bremer V, Dudareva S, Jansen K, Baier M, Straube E, Baillot A, Bartsch P, Brüning T, Cremer J, Dallügge-Tamm H, Gröning A, Eicke S, Emrich D, Fritsche G, Gjavotchanoff R, Gohl P, Götzrath M, Meye A, Ehrhard I, Köpke B, Henrich B, Kastilan C, Lehmann S, Märzacker A, Miller B, Mohrmann G, Pache C, Pfüller R, Tiemann C, Wisplinghoff H, Müller T, Aepinus C. Prevalence of Chlamydia trachomatis in the general population in Germany – a triangulation of data from two population-based health surveys and a laboratory sentinel system. BMC Public Health 2022; 22:1107. [PMID: 35659641 PMCID: PMC9164541 DOI: 10.1186/s12889-022-13456-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022] Open
Abstract
Background Chlamydia trachomatis (chlamydia) is a common, frequently asymptomatic, sexually transmitted infection. It can result in severe sequelae, such as ectopic pregnancy and infertility. In Germany, chlamydia is not notifiable. An opportunistic screening program for women < 25 years was introduced in 2008. The aim of this research was to triangulate different data sources to describe the epidemiological situation of chlamydia in Germany and to investigate whether the current target group of the chlamydia screening program aligns with these findings. Methods Urine specimens from participants from population-based health examination surveys of children (2014–17) and adults (2008–11) were tested for chlamydia, using nucleic acid amplification testing. These data were used to generate weighted chlamydia prevalence estimates by age group and sex. Data from a nationwide chlamydia laboratory sentinel system (2014–16) were used to calculate the positive proportion among individuals tested for chlamydia by age, sex and test reason. Results Using data from the population-based surveys, we found a chlamydia prevalence estimate of 2.8% (95% confidence interval (CI) 1.0–7.5%) among all 15- to 17-year-old girls and of 9.6% (95% CI 0.0–23) among those reporting to be sexually active. In adult women, we found the highest prevalence among 18- to 24-year-olds (all: 2.3%; 95% CI 1.0–5.3%; sexually active: 3.1%; 95% CI 1.3–7.0%). In adult men, we found the highest prevalence among 25- to 29-year-olds (all: 3.5%; 95% CI 1.6–7.7%; sexually active: 3.3%; 95% CI 1.3–7.8%). Data from the chlamydia laboratory sentinel showed the highest positive proportion among those opportunistically screened in 19-year-old women (6.1%; 95%- CI 5.9–6.4%), among those screened due to pregnancy in 15-year-old girls (10%; 95% CI 8.5–12%), and among those tested due to symptoms or a positive partner in 19-year-old women (10%; 95% CI 9.8–11%) and 19-year-old men (24%; 95% CI 22–26%). Conclusions Chlamydia seems to mainly affect adolescents and young adults in Germany, with similar overall prevalence in men and women, but with slightly different age distributions. Women at highest risk of chlamydia are covered by the current screening program but given the on-going discussions in high-income countries on cost-effectiveness and benefit-to-harm ratio of these programs, the program-aim needs reconsideration.
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Khowaja K, Syed WW, Singh M, Taheri S, Chagoury O, Al-Thani D, Aupetit M. A Participatory Design Approach to Develop Visualization of Wearable Actigraphy Data for Health Care Professionals: Case Study in Qatar. JMIR Hum Factors 2022; 9:e25880. [PMID: 35394442 PMCID: PMC9034423 DOI: 10.2196/25880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/12/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background Several tools have been developed for health care professionals to monitor the physical activity of their patients, but most of these tools have been considering only the needs of users in North American and European countries and applicable for only specific analytic tasks. To our knowledge, no research study has utilized the participatory design (PD) approach in the Middle East region to develop such tools, involving all the stakeholders in the product development phases, and no clear use cases have been derived from such studies that could serve future development in the field. Objective This study aims to develop an interactive visualization tool (ActiVis) to support local health care professionals in monitoring the physical activity of their patients measured through wearable sensors, with the overall objective of improving the health of the Qatari population. Methods We used PD and user-centered design methodologies to develop ActiVis, including persona development, brainwriting, and heuristic walkthrough as part of user evaluation workshops; and use cases, heuristic walkthrough, interface walkthrough, and survey as part of expert evaluation sessions. Results We derived and validated 6 data analysis use cases targeted at specific health care professionals from a collaborative design workshop and an expert user study. These use cases led to improving the design of the ActiVis tool to support the monitoring of patients’ physical activity by nurses and family doctors. The ActiVis research prototype (RP) compared favorably with the Fitbit Dashboard, showing the importance of design tools specific to end users’ needs rather than relying on repurposing existing tools designed for other types of users. The use cases we derived happen to be culturally agnostic, despite our assumption that the local Muslim and Arabic culture could impact the design of such visualization tools. At last, taking a step back, we reflect on running collaborative design sessions in a multicultural environment and oil-based economy. Conclusions Beyond the development of the ActiVis tool, this study can serve other visualization and human–computer interaction designers in the region to prepare their design projects and encourage health care professionals to engage with designers and engineers to improve the tools they use for supporting their daily routine. The development of the ActiVis tool for nurses, and other visualization tools specific to family doctors and clinician researchers, is still ongoing and we plan to integrate them into an operational platform for health care professionals in Qatar in the near future.
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Affiliation(s)
- Kamran Khowaja
- Information and Computing Technology Division, College of Science and Engineering, Hamad Bin Khalifa University, Education City, Qatar.,Department of Computer Science, Shaheed Zulfikar Ali Bhutto Institute of Science and Technology, Hyderabad, Pakistan
| | - Wafa Waheeda Syed
- Social Computing, Qatar Computing Research Institute, Hamad Bin Khalifa University, Education City, Qatar
| | - Meghna Singh
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Shahrad Taheri
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar.,Department of Medicine, Weill Cornell Medicine, New York, NY, United States.,National Obesity Treatment Center, Qatar Metabolic Institute, Doha, Qatar
| | - Odette Chagoury
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar.,Department of Medicine, Weill Cornell Medicine, New York, NY, United States.,National Obesity Treatment Center, Qatar Metabolic Institute, Doha, Qatar
| | - Dena Al-Thani
- Information and Computing Technology Division, College of Science and Engineering, Hamad Bin Khalifa University, Education City, Qatar
| | - Michaël Aupetit
- Social Computing, Qatar Computing Research Institute, Hamad Bin Khalifa University, Education City, Qatar
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Wenang S, Kurniawan M, Lelle RJ, Inayati I, Rismawati I. Neisseria gonorrhoeae Cases at AMC Muhammadiyah Hospital Indonesia: The Importance of Screening and Health Service Improvement to Prevent its Transmission and Complications. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Gonorrhoeae is a type of sexually transmitted disease (STD) caused by the Neisseria gonorrhoeae (NG) bacteria. It is a commonly reported bacterial STD with rising cases in men and women in Indonesia. Gonorrhoeae is commonly asymptomatic. Therefore, the disease is often left undiagnosed, untreated, and causes further complications.
AIM: This study aims to describe the incidence and distribution of gonorrhoeae in AMC Muhammadiyah Hospital, Yogyakarta, Indonesia. The importance of screening and health service improvement toward preventing transmission and complications are also discussed.
METHODS: It is a descriptive observational study and aims to identify the percentage of NG in patients with clinical symptoms of STDs. The non-randomized sampling technique was used with 710 respondents. The inclusion criteria were women aged 15-44 years with STD symptoms who underwent vaginal smear examinations for NG, Bacterial Vaginosis (BV), yeast cells-pseudohyphae Candida sp, and were willing to be respondents. The exclusion criteria were women with STDs and HIV. Microscopic characteristics of NG were examined by Gram staining the vaginal swab samples from the respondents.
RESULTS: It was found that 623 (87.7%) out of 710 respondents had NG with clinical symptoms of leukorrhea and itchiness. The vaginal smear results also found bacterial vaginosis and candidiasis.
CONCLUSIONS: Screening and health facilities providing STI-related services are essential to prevent the transmission of gonorrhoeae and reduce the high incidence and severity of gonorrhoeae in reproductive health.
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11
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Dukers-Muijrers NHTM, Evers YJ, Hoebe CJPA, Wolffs PFG, de Vries HJC, Hoenderboom B, van der Sande MAB, Heijne J, Klausner JD, Hocking JS, van Bergen J. Controversies and evidence on Chlamydia testing and treatment in asymptomatic women and men who have sex with men: a narrative review. BMC Infect Dis 2022; 22:255. [PMID: 35287617 PMCID: PMC8922931 DOI: 10.1186/s12879-022-07171-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/03/2022] [Indexed: 11/19/2022] Open
Abstract
Background Chlamydia trachomatis (CT) is the most common bacterial sexually transmitted infection (STI) worldwide. CT is mainly asymptomatic. Test-and-treat strategies are widely implemented to prevent transmission and complications. Strategies are not without controversy in asymptomatic women and men who have sex with men (MSM). Concerns are emerging to test and treat asymptomatic persons for urogenital CT (‘Controversy 1’) and pharyngeal or rectal CT (‘Controversy 2’), whereby testing symptomatic persons is not under debate. Opposed views in CT treatment involve using azithromycin versus doxycycline (‘Controversy 3’). The objective of this review is to provide coverage of these public health and clinical controversies by reviewing the current scientific evidence. Methods A literature search was performed using PubMed for relevant publications between 2018 and September 2021, and iterative retrieval of additional relevant publications. Results Controversy 1. In women, the majority of asymptomatic CT are at the urogenital site, and detections mostly include viable CT. CT easily transmits to a partner and potentially also between the vaginal and rectal areas; the clinical impact of urogenital CT is established, although risks for adverse outcomes are uncertain. Wide-scale testing in asymptomatic women has not resulted in reduced prevalence. In MSM, evidence for the clinical impact of asymptomatic urogenital CT is lacking. Controversy 2. Rectal CT is common in women diagnosed with urogenital CT, but the clinical impact of asymptomatic rectal CT is uncertain. In MSM, rectal CT is common, and most CT infections are at the rectal site, yet the risk of longer term complications is unknown. In both sexes, pharyngeal CT is uncommon and has no documented clinical impact. Controversy 3. In the treatment of rectal CT, doxycycline has superior effectiveness to azithromycin. Evidence has also accumulated on the harms of test-and-treat strategies. Conclusions Current practices vary widely, from widescale test-and-treat approaches to more individual patient- and partner-level case management. Choosing which asymptomatic people to test at what anatomic site, and whether to test or not, requires an urgent (re-)definition of the goals of testing and treating asymptomatic persons. Treatment guidelines are shifting toward universal doxycycline use, and clinical practice now faces the challenge of implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07171-2. Test-and-treat is a key strategy in the control of Chlamydia trachomatis (CT). We discuss recent controversies and present scientific evidence regarding urogenital, rectal, and pharyngeal CT test-and-treat strategies in women and in men who have sex with men (MSM). This should inform best practices for the prevention and management of the most common bacterial sexually transmitted infection (STI) worldwide.
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Affiliation(s)
- Nicole H T M Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, PO Box 33, 6400 AA, Heerlen, The Netherlands. .,Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
| | - Ymke J Evers
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, PO Box 33, 6400 AA, Heerlen, The Netherlands.,Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, PO Box 33, 6400 AA, Heerlen, The Netherlands.,Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Petra F G Wolffs
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Henry J C de Vries
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Department of Infectious Diseases, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands.,Department of Dermatology, Amsterdam Infection & Immunity Institute (AII), Amsterdam University Medical Center (UMC), Amsterdam, The Netherlands
| | - Bernice Hoenderboom
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Institute for Public Health Genomics, Genetics & Cell Biology, Maastricht University, Faculty of Health and Medicine and Life Sciences, Maastricht, The Netherlands
| | - Marianne A B van der Sande
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Global Health, Julius Centre for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Janneke Heijne
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Jeffrey D Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Jan van Bergen
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,STI AIDS Netherlands, Amsterdam, The Netherlands
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12
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Greydanus DE, Cabral MD, Patel DR. Pelvic inflammatory disease in the adolescent and young adult: An update. Dis Mon 2021; 68:101287. [PMID: 34521505 DOI: 10.1016/j.disamonth.2021.101287] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract that is typically polymicrobial with classic core involvement of Neisseria gonorrhoeae and/or Chlamydia trachomatis, though other endogenous flora from the vagino-cervical areas can be involved as well. It is often a sexually transmitted disease but other etiologic routes are also noted. A variety of risk factors have been identified including adolescence, young adulthood, adolescent cervical ectropion, multiple sexual partners, immature immune system, history of previous PID, risky contraceptive practices and others. An early diagnosis and prompt treatment are necessary to reduce risks of PID complications such as chronic pelvic pain, ectopic pregnancy and infertility. Current management principles of PID are also reviewed. It is important for clinicians to screen sexually active females for common sexually transmitted infections such as Chlamydia trachomatis and provide safer sex education to their adolescent and young adult patients. Clinicians should provide comprehensive management to persons with PID and utilize established guidelines such as those from the US Centers for Disease Control and Prevention (CDC).
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Affiliation(s)
- Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
| | - Maria Demma Cabral
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
| | - Dilip R Patel
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
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13
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Moore A, Traversy G, Reynolds DL, Riva JJ, Thériault G, Wilson BJ, Subnath M, Thombs BD. Recommandation relative au dépistage de la chlamydia et de la gonorrhée en soins primaires chez les personnes non connues comme appartenant à un groupe à risque. CMAJ 2021; 193:E573-E584. [PMID: 33875467 PMCID: PMC8084558 DOI: 10.1503/cmaj.201967-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Ainsley Moore
- Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Agence de la santé publique du Canada ( Subnath, Traversy), Ottawa, Ont.; Département de médecine familiale et communautaire (Reynolds), Université de Toronto, Toronto, Ont.; Département de médecine familiale (Riva), Université McMaster, Hamilton, Ont.; Faculté de médecine (Thériault), Université McGill, Montréal, Qc; Division de santé communautaire et humanités (Wilson), Université Memorial, T.-N.-L.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qc
| | - Gregory Traversy
- Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Agence de la santé publique du Canada ( Subnath, Traversy), Ottawa, Ont.; Département de médecine familiale et communautaire (Reynolds), Université de Toronto, Toronto, Ont.; Département de médecine familiale (Riva), Université McMaster, Hamilton, Ont.; Faculté de médecine (Thériault), Université McGill, Montréal, Qc; Division de santé communautaire et humanités (Wilson), Université Memorial, T.-N.-L.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qc
| | - Donna L Reynolds
- Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Agence de la santé publique du Canada ( Subnath, Traversy), Ottawa, Ont.; Département de médecine familiale et communautaire (Reynolds), Université de Toronto, Toronto, Ont.; Département de médecine familiale (Riva), Université McMaster, Hamilton, Ont.; Faculté de médecine (Thériault), Université McGill, Montréal, Qc; Division de santé communautaire et humanités (Wilson), Université Memorial, T.-N.-L.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qc
| | - John J Riva
- Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Agence de la santé publique du Canada ( Subnath, Traversy), Ottawa, Ont.; Département de médecine familiale et communautaire (Reynolds), Université de Toronto, Toronto, Ont.; Département de médecine familiale (Riva), Université McMaster, Hamilton, Ont.; Faculté de médecine (Thériault), Université McGill, Montréal, Qc; Division de santé communautaire et humanités (Wilson), Université Memorial, T.-N.-L.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qc
| | - Guylène Thériault
- Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Agence de la santé publique du Canada ( Subnath, Traversy), Ottawa, Ont.; Département de médecine familiale et communautaire (Reynolds), Université de Toronto, Toronto, Ont.; Département de médecine familiale (Riva), Université McMaster, Hamilton, Ont.; Faculté de médecine (Thériault), Université McGill, Montréal, Qc; Division de santé communautaire et humanités (Wilson), Université Memorial, T.-N.-L.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qc
| | - Brenda J Wilson
- Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Agence de la santé publique du Canada ( Subnath, Traversy), Ottawa, Ont.; Département de médecine familiale et communautaire (Reynolds), Université de Toronto, Toronto, Ont.; Département de médecine familiale (Riva), Université McMaster, Hamilton, Ont.; Faculté de médecine (Thériault), Université McGill, Montréal, Qc; Division de santé communautaire et humanités (Wilson), Université Memorial, T.-N.-L.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qc
| | - Melissa Subnath
- Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Agence de la santé publique du Canada ( Subnath, Traversy), Ottawa, Ont.; Département de médecine familiale et communautaire (Reynolds), Université de Toronto, Toronto, Ont.; Département de médecine familiale (Riva), Université McMaster, Hamilton, Ont.; Faculté de médecine (Thériault), Université McGill, Montréal, Qc; Division de santé communautaire et humanités (Wilson), Université Memorial, T.-N.-L.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qc
| | - Brett D Thombs
- Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Agence de la santé publique du Canada ( Subnath, Traversy), Ottawa, Ont.; Département de médecine familiale et communautaire (Reynolds), Université de Toronto, Toronto, Ont.; Département de médecine familiale (Riva), Université McMaster, Hamilton, Ont.; Faculté de médecine (Thériault), Université McGill, Montréal, Qc; Division de santé communautaire et humanités (Wilson), Université Memorial, T.-N.-L.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qc
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14
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Moore A, Traversy G, Reynolds DL, Riva JJ, Thériault G, Wilson BJ, Subnath M, Thombs BD. Recommendation on screening for chlamydia and gonorrhea in primary care for individuals not known to be at high risk. CMAJ 2021; 193:E549-E559. [PMID: 33875459 PMCID: PMC8084554 DOI: 10.1503/cmaj.201967] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Ainsley Moore
- Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Public Health Agency of Canada (Subnath, Traversy), Ottawa, Ont.; Department of Family and Community Medicine (Reynolds), University of Toronto, Toronto, Ont.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Faculty of Medicine (Thériault) McGill University, Montréal, Que.; Division of Community Health and Humanities (Wilson), Memorial University, NFLD; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que
| | - Gregory Traversy
- Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Public Health Agency of Canada (Subnath, Traversy), Ottawa, Ont.; Department of Family and Community Medicine (Reynolds), University of Toronto, Toronto, Ont.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Faculty of Medicine (Thériault) McGill University, Montréal, Que.; Division of Community Health and Humanities (Wilson), Memorial University, NFLD; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que
| | - Donna L Reynolds
- Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Public Health Agency of Canada (Subnath, Traversy), Ottawa, Ont.; Department of Family and Community Medicine (Reynolds), University of Toronto, Toronto, Ont.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Faculty of Medicine (Thériault) McGill University, Montréal, Que.; Division of Community Health and Humanities (Wilson), Memorial University, NFLD; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que
| | - John J Riva
- Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Public Health Agency of Canada (Subnath, Traversy), Ottawa, Ont.; Department of Family and Community Medicine (Reynolds), University of Toronto, Toronto, Ont.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Faculty of Medicine (Thériault) McGill University, Montréal, Que.; Division of Community Health and Humanities (Wilson), Memorial University, NFLD; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que
| | - Guylène Thériault
- Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Public Health Agency of Canada (Subnath, Traversy), Ottawa, Ont.; Department of Family and Community Medicine (Reynolds), University of Toronto, Toronto, Ont.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Faculty of Medicine (Thériault) McGill University, Montréal, Que.; Division of Community Health and Humanities (Wilson), Memorial University, NFLD; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que
| | - Brenda J Wilson
- Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Public Health Agency of Canada (Subnath, Traversy), Ottawa, Ont.; Department of Family and Community Medicine (Reynolds), University of Toronto, Toronto, Ont.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Faculty of Medicine (Thériault) McGill University, Montréal, Que.; Division of Community Health and Humanities (Wilson), Memorial University, NFLD; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que
| | - Melissa Subnath
- Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Public Health Agency of Canada (Subnath, Traversy), Ottawa, Ont.; Department of Family and Community Medicine (Reynolds), University of Toronto, Toronto, Ont.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Faculty of Medicine (Thériault) McGill University, Montréal, Que.; Division of Community Health and Humanities (Wilson), Memorial University, NFLD; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que
| | - Brett D Thombs
- Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Public Health Agency of Canada (Subnath, Traversy), Ottawa, Ont.; Department of Family and Community Medicine (Reynolds), University of Toronto, Toronto, Ont.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Faculty of Medicine (Thériault) McGill University, Montréal, Que.; Division of Community Health and Humanities (Wilson), Memorial University, NFLD; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que
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