Search

IntroductionWhether intramuscular depot medroxyprogesterone acetate (DMPA-IM) and norethisterone enanthate (NET-EN) have a differential impact on the incidence of sexually transmitted infection (STI) remains unclear. In the Vaginal and Oral Interventions to Control the Epidemic (VOICE) trial, HIV-1 acquisition was higher for DMPA-IM users vs. NET-EN users. We compared DMPA-IM and NET-EN users with regard to chlamydia, gonorrhea, trichomoniasis, syphilis, and herpes simplex virus type 2 (HSV-2) infection.Materials and methodsProspective data were analyzed from VOICE, a randomized trial of HIV-1 chemoprophylaxis. Participants were evaluated annually and as indicated for chlamydia, gonorrhea, trichomoniasis, and syphilis. Stored specimens were tested for HSV-2. Proportional hazards models compared the risk of STI between DMPA-IM and NET-EN users.ResultsAmong 2,911 injectable contraception users in South Africa, 1,800 (61.8%) used DMPA-IM and 1,111 used NET-EN (38.2%). DMPA-IM and NET-EN users did not differ in baseline chlamydia: 15.1 vs. 14.3%, p= 0.54; gonorrhea: 3.4 vs. 3.7%, p= 0.70; trichomoniasis: 5.7 vs.5.0%, p= 0.40; or syphilis: 1.5 vs. 0.7%, p= 0.08; but differed for baseline HSV-2: (51.3 vs. 38.6%, p < 0.001). Four hundred forty-eight incident chlamydia, 103 gonorrhea, 150 trichomonas, 17 syphilis, and 48 HSV-2 infections were detected over 2,742, 2,742, 2,783, 2,945, and 756 person-years (py), respectively (chlamydia 16.3/100 py; gonorrhea 3.8/100 py; trichomoniasis 5.4/100 py; syphilis 0.6/100 py; HSV-2 6.4/100 py). Comparing DMPA-IM with NET-EN users, no difference was noted in the incidence of chlamydia, gonorrhea, trichomoniasis, syphilis, or HSV2 infections, including when adjusted for confounders [chlamydia (aHR 1.03, 95% CI 0.85-1.25), gonorrhea (aHR 0.88, 95% CI 0.60-1.31), trichomoniasis (aHR 1.07, 95% CI 0.74-1.54), syphilis (aHR 0.41, 95% CI 0.15-1.10), and HSV-2 (aHR 0.83, 95% CI 0.45-1.54, p= 0.56)].DiscussionAmong South African participants enrolled in VOICE, DMPA-IM and NETEN users differed in prevalence of HSV-2 at baseline but did not differ in the incidence of chlamydia, gonorrhea, trichomoniasis, syphilis, or HSV-2 infection. Differential HIV-1 acquisition, previously demonstrated in this cohort, does not appear to be explained by differential STI acquisition. However, the high incidence of multiple STIs reinforces the need to accelerate access to comprehensive sexual and reproductive health services.

There is an increasing call for curricula in health care to facilitate interprofessional client-centred evidence-based decision making through a reflective and reflexive framework. This discussion paper proposes that adoption of the World Health Organisation, International Classification of Functioning, Disability and Health (ICF) as a framework for curricula of health professionals promotes the necessary paradigm shift needed to legitimise a broad evidence base as the foundation of interprofessional dialogue. Client function is seen as the product of an open system incorporating the individual, social and environmental influences on behaviour, with the role of the professional being to acknowledge the context of individual behaviour through an understanding of individual's functioning in their environment. It is concluded that client focused practice and an iterative process of clinical reasoning based on a broad evidence base that conceptualises health care as the maintenance and promotion of health across the lifespan requires a re-conceptualising of health. The emerging concept shifts the primary emphasis of health care away from post-diagnosis tertiary care towards clients who maintain a life-long independence in the community.

Used focus groups and individual interviews to explore the experiences of physical therapy students undergoing several assessments of their reflection and whether faculty have similar perceptions of those assessments. Found that students had a number of concerns about the assessment of reflection, some of which were shared by faculty. Concluded that reflection is better left unassessed. (EV)

Copyright of Functional Ecology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Research has been conducted on the vitamin A deficiency among HIV-infected and -uninfected women in Kenya. The relationship between serum vitamin A concentration and HIV-1 status, disease state and acute phase response markers has been investigated and the details are reported.

The health care setting presents particular risks from manual handling and it is known that training in manual handling techniques is ineffective in reducing these risks when used as a stand-alone measure. The 'Manual Handling Operations Regulations 1992' requires employers to consider hazardous manual handling, advising the use of an ergonomics approach. However, it is not known how well-equipped non-ergonomists in the health care setting are to deal with this approach. Therefore, the ability of non-ergonomists to make manual handling risk assessments, with or without additional training, and to implement changes to the work environment was investigated. Twenty-five pairs of subjects from a broad cross section of departments in a busy teaching hospital were studied; training and a guide book were provided for one of each pair and the guide book only for the other. Subjects then independently prioritised three tasks in their department and undertook a full assessment of a specified task. All work was repeated by an ergonomist and the subjects' assessments were scored in comparison with the ergonomist. Each department was followed up after six months to assess progress with implementing recommendations. Trends in the data indicated that both groups appeared able to identify hazards though not necessarily to prioritise the tasks. The trained group tended to score better in assessments although wide variation existed within both groups and inter-group differences were not significant at the 5% level. Approximately half of staff assessments were considered 'adequate' to 'very good', in comparison with the ergonomist. Implementation of assessment recommendations ranged from nil to almost full compliance. Incomplete implementation seemed to be related to an apparent confusion in some departments over who was responsible for making changes, a lack of finances for changes and overstretched managers having other priorities. Keywords: Non-ergonomists; Manual handling; Risk assessment