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Background/aims: To study the susceptibility of Fusarium and Aspergillus isolated from keratitis to amoxicillin, cefazolin, chloramphenicol, moxifloxacin, tobramycin and benzalkonium chloride (BAK). Methods: 10 isolates of Fusarium and 10 isolates of Aspergi/lus from cases of fungal keratitis at Aravind Eye Hospital in South India were tested using microbroth dilution for susceptibility to amoxicitlin, cefazolin, chloramphenicol, moxifloxacin, tobramycin and BAK. The minimum inhibitory concentration (MIC) median and 90th percentile were determined. Results: BAK had the lowest MIC for both Fusarium and Aspergillus. Chioramphenicol had activity against both Fusarium and Aspergillus, while moxifloxacin and tobramycin had activity against Fusarium but not Aspergillus. Conclusions: The susceptibility of Fusarium to tobramycin, moxifloxacin, chloramphenicol and BAK and of Aspergillus to chloramphenicol and BAK may explain anecdotal reports of fungal ulcers that improved with antibiotic treatment alone. While some of the MICs of antibiotics and BAK are lower than the typically prescribed concentrations, they are not in the range of antifungal agents such as voriconazole, natamycin and amphotericin B. Antibiotics may, however, have a modest effect on Fusarium and Aspergillus when used as initial treatment prior to identification of the pathological organism. [ABSTRACT FROM AUTHOR]

Background/objectives: Sex work has been seen as both a health and a social problem. However, there is a paucity of evidence on the longer term impact on health. We explored the health and career paths over a period of 15 years among women who have worked in the sex industry.Design: A longitudinal study of sex workers recruited between 1986 and 1993 and followed for 15 years. Outcome data were obtained through interview, clinic records, or third parties.Setting: Clinic and community settings in London.Participants: We obtained outcome data on 130 (37%) of the original cohort of 354 women, with a combined follow up of 1247 years.Main Outcome Measures: Vital status, most recent occupation, duration of sex work, sexually transmitted infections (STI), major health problems.Results: The majority (73/124, 59%) were still in the sex industry and had sold sex for a mean of 13.6 years. There were six deaths, a mortality of 4.8 per 1000 person years. Surviving women had a high cumulative risk (110 of 118, 93%) of STI. Past gonorrhoea was associated with pelvic inflammatory disease (RR 2.28, 95% CI 1.12 to 4.66) and infertility (RR 10.9, 95% CI 1.5 to 77.3). Other outcomes included mental health problems (38 of 97, 40%) and addiction (46 of 72, 64%). There were no significant differences in health outcomes between women who were still in the sex industry and those who had stopped. There was a high level of occupational mobility, and 31 women (of 84, 37%) had completed vocational or higher education, including eight to postgraduate level.Conclusions: Sex work is associated with excess mortality and morbidity including the sequelae of STI, mental health problems, and substance misuse. The relation between these health problems and sex work is complex. [ABSTRACT FROM AUTHOR]

Objectives: To assess whether a previously established low sexually transmitted infection/HIV risk in prostitutes in London has been sustained, and to measure other occupational risks, including mortality.Design: 9 year prospective study in west London.Subjects: 402 prostitutes recruited from 1985 to 1991, 320 were followed up for 675 person years to 1994.Main Outcome Measures: Condom use in commercial and non-commercial sex; viral and bacterial sexually transmitted infection at initial and follow up visits; death.Results: Condom use increased significantly from 1986 to 1993 and protected the majority of commercial sexual contacts. Baseline prevalence: HIV 1.3%, hepatitis C 6.7%, hepatitis B 6.6%, syphilis 2.3%, HTLV-I/II 0.4%, gonorrhoea 3.0%, chlamydia 8.2%, genital herpes 16.8%. Incidence (per 100 person years): HIV 0.2, hepatitis C 0.3, gonorrhoea 5.6, chlamydia 12.6, genital herpes 6.5. Viral infections were associated with injecting drug use and non-British nationality; bacterial infections were associated with numbers of non-commercial partners but not with sexual contacts at work. Four women died during the course of the study; two had AIDS, two were murdered. This mortality of 5.93 per 1000 person years was 12 times the expected rate for women of a similar age.Conclusions: This study shows that it is possible to have a larger number of sexual partners and remain free from sexually transmitted infections provided that condoms are used consistently: there has been a sustained increase in condom use in the sex industry. None the less, prostitutes are at increased risk of sexually transmitted infections, primarily through non-commercial sexual partnerships. Infectious diseases are only one of the risks facing prostitutes, as illustrated by the mortality from violence as well as from HIV infection. [ABSTRACT FROM AUTHOR]

Objective: To compare partner notification practice and outcomes at a provincial and a metropolitan clinic.Design: Prospective study, following standardisation of partner notification policy.Settings: Sheffield Department of Genitourinary Medicine, Royal Hallamshire Hospital and Jefferiss Wing Centre for Sexual Health, St Mary's Hospital, London.Subjects: Consecutive patients with culture positive gonorrhoea between October 1994 and March 1996 who were interviewed by a health adviser.Results: In Sheffield, 235 cases reported 659 outstanding contacts, of whom 129 (20%) were subsequently screened, and 65 (50%) had gonorrhoea. At St Mary's 510 cases reported 2176 outstanding contacts, of whom 98 (5%) were known to have been screened, and 53 (54%) had gonorrhoea. Patient or provider referral agreements appeared more productive in Sheffield, where 60% resulted in contact attendance, compared with 13% at St Mary's. Provider referral was used more frequently in Sheffield, for 44% of referrals, compared with 1% at St Mary's. Multivariate analysis showed that partner notification was less effective for casual and short term (< 7 days) partnerships in both centres, and for homosexual men at St Mary's.Conclusion: Partner notification outcomes were better in the provincial setting where contact attendance could be recorded more reliably and provider referral was used more extensively. The high proportion of contacts who remained untraced in both settings indicates the need for complementary screening and prevention initiatives. [ABSTRACT FROM AUTHOR]

Somatostatin has been shown to have negative inotropic and chronotopic effects and to restore sinus rhythm in some cases of cardiac arrhythmia. Using acid extracts, regions of human heart were examined by radioimmunoassay to determine their somatostatin content. Mean (SD) concentrations of 4.1 (0.8) pmol/g and 2.9 (0.8) pmol/g were found in atrioventricular node and right atria respectively and were significantly higher than in other heart regions. Using fresh heart tissue from guinea pigs, somatostatin was localised to cardiac nerves by immunocytochemistry. Nerves containing somatostatin were most abundant in the atria, where the concentrations measured by radioimmunoassay were 7.6 (1.0) and 2.6 (0.4) pmol/g for right and left atria respectively. Somatostatin contained in cardiac nerves may have a physiological role in the cardiac conduction system. [ABSTRACT FROM PUBLISHER]

Fixed torque devices were used to measure joint mobility at three sites in 364 adolescents including 39 families with at least two siblings. Increasing age and being male were associated with reduced laxity, and a strong effect of family was observed in the 39 sibling sets studies. The population included 47 Asians whose mobility was similar to that of the non-Asians, though the female/male difference was apparently greater in the former group. None of the above conclusions apply to index finger hyperextension, and it is apparent that genetic and constitutional factors only affect mobility at some sites. Such observations could lead to a review of current scoring systems for clinical hypermobility. [ABSTRACT FROM PUBLISHER]

Fixed torque measuring devices were used to measure the range of movement at three sites in 364 normal adolescents and young adults. The results confirm the findings of less reproducible measurement techniques that joint mobility at a particular site follows a Gaussian distribution with a wide range in a normal population. In addition, apart from very few individuals, mobility at one site could not predict mobility elsewhere. It seems likely that the degree of connective tissue laxity generally is of lesser importance than local factors in determining the range of joint mobility at a given site in normal individuals. [ABSTRACT FROM PUBLISHER]

The feasibility of comparative quality assessment studies in immunocytochemistry was examined. The reactions of three CD15 antibodies--anti-Leu M1, DM1, and Tü9--were examined in paraffin wax sections in Hodgkin's disease under a variety of different fixation and pre-treatment conditions, using four immunochemical detection techniques. All three antibodies stained Reed-Sternberg cells, but DM1 could be used at slightly higher dilutions to achieve comparable results. Tissue fixed in formol sublimate showed the most intense staining reactions, and formol saline and neutral buffered formalin gave relatively poor results. Although neuraminidase pre-treatment improved staining, its routine use is probably contraindicated by its high cost. Trypsinisation has some value for sections of tissue fixed in formol saline and neutral buffered formalin. The avidin-biotin complex technique produced the best results, but indirect immunoperoxidase produced acceptable results, is technically easier to perform, and is less expensive. It is concluded that information regarding variations in techniques and commercially available reagents, which may be of use in routine diagnostic histopathology, can be obtained by comparative quality assessment studies of this type. [ABSTRACT FROM PUBLISHER]

The timing of immunisations for preterm infants is controversial. Because of the statement by the British Paediatric Association/Joint Committee on Vaccination and Immunisation Liaison group that immunisations should normally begin three months after the date of birth, the records of all infants born in 1984 and currently (June 1986) resident in the London Borough of Newham were studied to find out if this recommendation was being implemented. Subjects were divided into groups by birth weight and where possible by gestational age. Cumulative uptakes by age of any component of the first and third triple immunisations, and of the pertussis component, were plotted separately. Comparison of uptake of the first course showed a considerable initial delay for infants weighing less than 2000 g at birth compared with heavier babies, but by 18 months the coverage was almost identical. This difference was not evident for the third course. A similar delay was apparent when infants of 37 weeks' gestation or less were compared with babies born at full term, though recording of gestational age was incomplete. Final overall uptake was poor for all groups. Differences among groups in numbers consenting were not an important factor. Informing those responsible for giving the immunisations of these findings has stimulated their interest in improving practice by implementing the recommendations. [ABSTRACT FROM AUTHOR]

The organisation, premises, and staffing of three child health clinics of different types in an inner city area have been studied and related to information on immunisation derived from their computerised child register and other returns, together with some simple estimates of cost. Differences were found between overall uptake of different antigens, consent rate, compliance after consent had been given, and the median age at immunisation for children allocated to each clinic. Thus consent to pertussis immunisation varied from 90% in one clinic to 69% in the other two. In the clinic with the high consent rate, however, only 66% of those whose parents had consented actually received all three doses compared with 82% and 85% in the other clinics. The median age of immunisation also showed pronounced differences between the clinics--314, 351, and 375 days, respectively, for the third dose of the triple course. There were differences in characteristics of the clientele served by each clinic and in staffing and facilities, which led to differences in costs, as well as contributing towards the variable patterns of uptake. We suggest that indicators such as these, largely available from the child health computer system, are used systematically to identify ways of improving uptake and increasing cost effectiveness. [ABSTRACT FROM AUTHOR]

Four cases of anterior ischaemic optic neuropathy occurred in children with accelerated hypertension. The cause may have been a sudden relative fall in arterial pressure which reduced the perfusion of the optic disc, whose circulation was compromised by long-standing hypertensive vascular disease. [ABSTRACT FROM PUBLISHER]

Ninety four neurologists in the United Kingdom, China, and West Germany responded to two structured questionnaires. The first assessed the diagnostic weighting assigned to a number of symptoms, signs, and clinical investigations ascertained from classical descriptions and case notes of patients with motor neuron disease (MND). The second tested the likelihood and consistency of diagnosis in a series of case summaries representing the clinical data of 10 patients with clinically and pathologically documented motor neuron disease. There was a wide measure of agreement concerning the common clinical features of the disease, especially regarding fasciculation of the tongue, fasciculation associated with weakness seen in more than one limb, and dysphagia. In the case summaries, however, there was clear variation in the ranked likelihood of the diagnosis of MND and in the consistency of diagnostic behaviour in the different groups of neurologists. These findings support the need for internationally agreed criteria in the diagnosis of MND. Any such criteria will need to be tested against a standardised data set to establish their validity. [ABSTRACT FROM AUTHOR]

Study 1 examined the reliability of the ratings assigned to the performance of five sign-and-symptom items drawn from tests of motor impairment in Parkinson's disease. Patients with Parkinson's disease of varying severity performed gait, rising from chair, and hand function items. Video recordings of these performances were rated by a large sample of experienced and inexperienced neurologists and by psychology undergraduates, using a four point scale. Inter-rater reliability was moderately high, being higher for gait than hand function items. Clinical experience proved to have no systematic effect on ratings or their reliability. The idiosyncrasy of particular performances was a major source of unreliable ratings. Study 2 examined the intercorrelation of several standard rating scales, comprised of sign-and-symptom items as well as activities of daily living. The correlation between scales was high, ranging from 0.70 to 0.83, despite considerable differences in item composition. Inter-item correlations showed that the internal cohesion of the tests was high, especially for the self-care scale. Regression analysis showed that the relationship between the scales could be efficiently captured by a small selection of test items, allowing the construction of a much briefer test. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To describe and assess measures to control sexually transmitted diseases (STDs) among sex workers and their partners. METHODS: A review of medical, historical and social literature, focusing on selected cases. RESULTS: Measures to control disease in sex workers today are often prompted by concerns about HIV transmission. However, the literature shows that prostitution varies from one place and time to another, together with the risk of sexually transmitted disease. A broad social definition of prostitution rather than a narrow reference to levels of sexual activity is important for effective disease control, as an understanding of the relation between social disadvantage and sexual activity enables the provision of occupational services that sex workers actually want and use. Social prejudice and legal sanctions cause some sex workers and their partners to avoid even the most appropriate and accessible specialist services. Therefore targeted programmes can only complement, and not replace, general measures to control STDs, which are developed for other social groups or the local population as a whole. CONCLUSIONS: Sex workers and sex work differ from one place to another and so a single model for STD control is inappropriate. None the less, occupational health risks suggest a general need for specialist services. Where these do not compound the disadvantages that sex workers already suffer, medical services are likely to offer significant benefits in prevention, early diagnosis, and treatment of STDs. As the stigma of prostitution leads many people to remain invisible to services, a general health infrastructure and anti-discriminatory measures will be equally important to effective disease control. [ABSTRACT FROM PUBLISHER]

To explore the role played by beta adrenoreceptor mediated pathways on human upper gut function a series of studies were conducted into the effects of beta adrenoreceptor agonists and antagonists on orocaecal and duodenocaecal transit and on antral and duodenal motor activity. Under control conditions orocaecal transit was consistent within individuals (mean coefficient of variation (18.0%) but varied widely between individuals (median transit 63 minutes, range 33-164). Prior administration of the non-selective beta adrenergic antagonist propranolol consistently hastened orocaecal transit (median transit 51:25-93, v control p < 0.005). The selective beta-1 antagonist, atenolol, also hastened transit (median transit 50:35-93 minutes, v control p < 0.01). The magnitude of an individual's response to beta blockade correlated closely with the orocaecal transit (Tau = 0.54, p < 0.01). Duodenocaecal transit was also hastened by propranolol from control values of 66:45-107 minutes to 50:16-62 minutes, p < 0.025). In contrast neither duodenal nor antral motility were consistently altered by beta blockade. The beta adrenoreceptor agonist, isoprenaline, delayed both orocaecal transient (97:55-178 minutes, v control p < 0.005) and also duodenocaecal transit (160:45-215 minutes, v 73:40-133) (p < 0.025). Isoprenaline also reduced antral motility by an effect which appeared to occur predominantly through a reduction in contraction amplitude (from a median amplitude of 27:5.39 mm Hg to 14:3-24 mm Hg, p < 0.03) rather than an effect on the interval between contractions. No effect on either amplitude or frequency of duodenal motor activity was observed. A beta adrenoreceptor mediated pathway thus appears to exert a biologically relevant effect on gut function not only under conditions of sympathetic stimulation, but also at rest when a basal beta adrenergic tone appears to influence the speed of nutrient transit through the human upper gut. [ABSTRACT FROM PUBLISHER]

The relation between intrarectal volume and pressure during increasing rectal distension by a latex balloon were studied on repeated occasions in 10 healthy adult volunteers to define variations within and between individuals. A wide intersubject variation in the maximum tolerable volume (58-908 ml) and pressure (12.2-108.8 cm H2O) at this end point was seen, and these two values were correlated (r = 0.78). Intrasubject variation in maximum tolerable volume also occurred which was related to study order and progressively reduced with repeated study. In 26 unselected patients with pain predominant irritable bowel syndrome similar intersubject variation was noted and virtually all patients data fell within the calculated 95% confidence limits of the normal individuals. Differentiation between patients and normal subjects was not possible from knowledge of rectal responses. These noticeable inter- and intrasubject variations in rectal responses to distension need to be considered whenever similar techniques are proposed for use in the study of rectal disease or of rectal response to treatment. [ABSTRACT FROM PUBLISHER]

A series of three experiments were performed on healthy adult volunteers to investigate the possible role played by beta-adrenoreceptor mediated pathways in the disturbance of human upper intestinal motor function by hand immersion in cold water. In the first experiment, (an extended pilot study on one individual), orocaecal transit of a standard meal was measured on 36 occasions with and without cold water stimulation and with and without a series of alpha and beta blocking drugs. Cold water stimulation consistently delayed transit in this individual, an effect which was attenuated by prior beta-blockade. In a double blind trial of the effect of beta-blocker atenolol v placebo on transit in nine individuals, a consistent reduction in the cold water induced transit delay was observed (p less than 0.01) independent of any direct effect of beta-blockade. In the third experiment seven individuals underwent repeated studies of antroduodenal pressure activity comparing the effects of cold and warm water stimulation with and without beta blockade to determine whether the observed transit effect could be related to an action on gastrointestinal motility. Cold water stimulation reduced antroduodenal motility, but no consistent effects of previous beta blockade were noted. These studies indicate the presence of a beta-adrenoreceptor mediated pathway in the cold water induced delay of orocaecal transit but not in the inhibition of gastroduodenal motility. Further studies are indicated to determine the site and mode of action of this transit effect more precisely. [ABSTRACT FROM PUBLISHER]

Because severe constipation is a disorder largely confined to young women, the possibility that menstrually related factors contribute to disturbed gastrointestinal motor function has been raised. It has also been reported that normal menstruating women show changes in upper gut transit between the follicular and luteal phases of the menstrual cycle and that patients with constipation show prolonged transit. We therefore studied relationships between symptom severity and orocaecal transit during the menstrual cycle in a group of 14 constipated women and a series of control groups comprising seven normal menstruating women, five postmenopausal women, and eight normal men, to determine whether phases of the menstrual cycle were associated with alteration in symptoms or transit. A regular menstrual cycle was reported by 13 of the 14 patients (range 26-30 days) and by all the menstruating female volunteers. Seven patients noted variation in constipation during the menstrual cycle, in all cases this comprised an improvement in symptoms just before or during menstruation. No consistent relationship between symptom severity and follicular or luteal phase was noted. Repeated orocaecal transit measurements in the four study groups showed no consistent differences (greater than 0.05) between groups or during the menstrual cycle (mean change weeks 1-4, -10 +/- 20 min). These findings are inconsistent with the hypothesis of a progesterone related effect upon orocaecal transit in either normal or constipated women. [ABSTRACT FROM PUBLISHER]

The motor responses of the small intestine to intraluminal distension were studied proximal and distal to an inflatable balloon in 13 normal volunteers. During fasting, distension rapidly induced a persistent localised inhibition of distal contractile activity with a small proximal increase. Proximally, phase III activity was unaffected during distension but its propagation across and appearance below the balloon was inhibited. Upon deflating the balloon a normal motor pattern rapidly returned. Similar changes were observed during distension in the fed state. The changes in the motor pattern resemble those of the intrinsically mediated 'peristaltic reflex', studied in animals, and suggest that in man the response to balloon distension may also be mediated through an intrinsic mechanism. A patient with a visceral neuropathy, studied in a similar manner, had no inhibition of distal motor activity during distension, suggesting a functional defect of the enteric nerves. Further observations of the motor responses to distension in similar patients seem indicated to determine the usefulness of this technique for evaluating enteric nervous system function when an abnormality is suspected. [ABSTRACT FROM PUBLISHER]

Oesophageal motor responses to intraluminal distension were studied manometrically in 16 healthy volunteers and in nine patients with disordered swallowing, who had prolonged oesophageal clearance without structural abnormality. In the normal subjects distension was associated with an increased number of secondary contractions above the balloon, decrease of all contractile activity below the balloon and was accompanied by an aborally propulsive force which occurred independently of the perception of discomfort. Cholinergic blockade abolished the proximal distension induced contractile response, but did not affect primary peristalsis. Despite normal sensory thresholds, proximal excitatory responses to distension were absent in six and distal inhibition was absent in seven patients. These results show that the normal human oesophagus responds to distension with a proximal enhancement of propulsive motor activity, mediated through a cholinergic pathway. This may be defective in some patients with disordered oesophageal transit. Investigation of the motor responses to intraluminal distension may thus be a useful adjunct to standard manometry for studying patients with suspected oesophageal clearance dysfunction and might allow identification of disordered enteric nervous control. [ABSTRACT FROM PUBLISHER]

Objectives: To describe major changes in the London sex industry between 1985 and 2002 and assess the implications for sexually transmitted infection (STI) risk. Method: A descriptive study comparing women who first attended a sex work clinic between 1996 and 2002 and those first attending from 1985 to 1992; a nested case-control study. 1050 female sex workers took part. The setting was a specialist clinical service for sex workers based in a London genitourinary medicine (GUM) clinic, and fieldwork in west London. The main outcome measures were reported condom use and prevalent STI. Results: Over the period of the study there was a significant increase in the proportion of sex workers not born in the United Kingdom (from 25% to 63%, p < 0.001), and women entered sex work at an older age (median 24 years compared with 20 years, p < 0.001). Condom use increased (with the exception of oral sex). There was a significant decline in the proportion of participants reporting a previous STI (32% compared with 80%, p < 0.001) and the prevalence of acute STI declined from 25% to 8% (p < 0.001). Acute STI was associated with younger age, younger age at first sex work, being new to sex work, and inconsistent condom use. In a multivariate analysis unprotected sex with clients was the only significant risk. Conclusion: Major restructuring of the sex industry, including the shift to a primarily migrant workforce, has been associated with a steep decline in acute STI, undermining popular assumptions that migrant sex workers are central to the ongoing STI epidemic. We attribute the decline in acute STI to an increase in safer sex. [ABSTRACT FROM AUTHOR]

A randomised cross-over trial was conducted to see if wet suits increase swimming speed--a question which has been fiercely debated in the fat-growing endurance sport of Triathlon. Sixteen swimmers volunteered to undertake two 30 minute swims, one with and one without a wet suit. With wet suits the subjects swam an average of 24.9 lengths of a 66 m pool. Without wet suits they swam 23.2 lengths. A 95% confidence interval for the difference is from 0.8 to 2.6 lengths (p less than 0.001). This result suggests that regulations about the use of wet suits must be agreed internationally to ensure equal competition whilst promoting the health and safety aspects of sport. [ABSTRACT FROM AUTHOR]

An abstract of the article "Are post-treatment follow-up visits at 1 and 2 months necessary in patients treated for early syphilis?" by S. Day and K. Gedel is presented.

Objectives: To retrospectively audit the management of post-exposure HIV prophylaxis following sexual exposure (PEPSE) against the British Association for Sexual Health and HIV 2004 draft guidance. Methods: A retrospective review of case notes from January 2000 to November 2004. The draft guidelines were not adopted into clinical practice during the study period. Results: 76 patients received PEPSE. 79% (95% Cl 68.08 to 87.46) of PEPSE prescriptions were given for exposures that were in accordance with the guidelines' recommended indications (target 90%). 87% (95% Cl 77.13 to 93.51) of PEPSE was prescribed within 72 hours of risk exposure (target 90%). 91% (95% Cl 81.94 to 96.22) of recipients received a recommended antiretroviral combination. 53% (95% Cl 40.84 to 64.21) of recipients completed the PEPSE course (target 75%). 45% of patients attended for the 3 month follow up HIV test but only 12% (95% CI 5.56 to 21.29) attended for both the 3 month and 6 month HIV test (target 75%). Conclusion: PEPSE is predominantly being prescribed for recommended indications and is dispensed within 72 hours of risk exposure. PEPSE completion rates and attendance for 3 months and 6 months post-exposure HIV testing need improving, perhaps by introducing a PEPSE clinic. [ABSTRACT FROM AUTHOR]

Objectives: To document changes in "crack" cocaine use in the sex industry in London, and to assess health risks associated with the drug.Design: Two serial cross sectional surveys.Subjects: Sex workers interviewed in 1989-9 and 1995-6.Main Outcome Measures: Self reported use of crack cocaine; clinical history of sexually transmitted infection and pregnancy, clinical outcomes.Results: The proportion of women reporting crack use increased significantly from 22/193 (11%) in 1989-91 to 48/143 (34%) in 1995-6. Women in all the main prostitution sectors reported crack use. Crack users had been working in prostitution for longer, were more likely to have worked on the streets, to inject drugs, and to have a partner who injected. Crack use was associated with termination of pregnancy and with hepatitis C infection. The association with hepatitis C was partially explained by confounding with injecting drug use.Conclusions: Crack use is more common and less problematic than clinical presentation suggests. Use has increased over the past decade, and is associated with hepatitis C infection and termination of pregnancy. It is possible that crack use facilitates hepatitis C transmission due to oral lesions from smoking. Crack use can be difficult to identify because of the stigma of being labelled a "crack whore," therefore information on crack might usefully be integrated into general health promotion material on drugs and safer sex. [ABSTRACT FROM AUTHOR]

Background: We hypothesised that changes in the London sex industry will have weakened health and safety norms. Methods: Baseline data were collected on sex workers at St Mary's Hospital and grouped into four time periods: 1985-88; 1989-92; 1993-96; 1997-2000. Results: 1217 new patients were enrolled. The following changes were seen: women were older (median age increased from 25 to 27) less likely to have been born in the UK (declined from 80% to 39%), were older when they began sex work (median age increased from 21 to 24 years), and had been working for less time (median of 3 years declined to 1 year). The proportion working on the streets declined from 22% to 2%, while the proportion working in flats increased from 15% to 35%. Condom use at work rose from 80% to 99% for vaginal and from 50% to 81% for oral sex. Condom use with non-paying partners rose from 11% to 31%. There was a decline in the proportion reporting a past STI from 86% to 31%, and in the prevalence of most STI at first visit chlamydia declined from 8.2% to 3.9%, and gonorrhoea from 3% to 1%. The only increase was in hepatitis B core antibody from 6.6% to 10.1%. Discussion: We have documented significant changes in the London sex industry but these have not been associated with increased risk behaviour or risk of STI. This finding is all the more surprising given increasing migration from higher prevalence areas and increasing STI in the UK. [ABSTRACT FROM AUTHOR]

Assesses the risks of infection of prostitute women with HIV in London, England. Role of prostitute women in models of heterosexual transmission of HIV; Debates on public health initiatives; Performance of a cohort analysis.