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| 2. |
- Boman, Jens, et al.
(författare)
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Genitala klamydiainfektioner : rekommenderad handläggning
- 2011
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Ingår i: Läkartidningen. - : Läkartidningen Förlag AB. - 0023-7205 .- 1652-7518. ; 108:13, s. 730-733
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Tidskriftsartikel (refereegranskat)abstract
- Klamydia är den vanligaste anmälningspliktiga infektionen i Sverige: 37 791 fall rapporterades till Smittskyddsinstitutet år 2009, och 87 procent av de smittade var i åldern 15–29 år.Klamydiainfektion är klassad som allmänfarlig sjukdom enligt smittskyddslagen, vilket bl a innebär att en läkare som misstänker att en patient bär på smitta är skyldig att se till att patienten lämnar prov, och vid positivt provresultat se till att förhållningsregler ges samt att smittskyddsanmälan och smittspårning görs.Provtagning görs vanligen med urinprov hos män och med självtaget vaginalprov hos kvinnor, eventuellt kombinerat med urinprov.Majoriteten av personer med klamydia har subkliniska infektioner men kan ändå få bestående reproduktiva skador och föra smittan vidare. Ungefär var tionde kvinna med obehandlad klamydiainfektion utvecklar klinisk salpingit inom en tolvmånadersperiod. Klamydiaorsakad salpingit ökar risken för utomkvedshavandeskap och nedsatt fertilitet.Okomplicerad genital klamydiainfektion behandlas i Sverige med doxycyklin, vanligen i lägre dosering än i många andra länder. Det är därför viktigt att se till att hela kuren tas enligt anvisningarna och att patienten informeras om att samtidigt intag av vissa läkemedel, spårämnen och födoämnen liksom alkohol kan resultera i suboptimal antibiotikaeffekt.
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| 4. |
- Boman, Jens, 1957-
(författare)
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Prevention of Chlamydia trachomatis infections
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Urogenital chlamydia infection, caused by the bacterium Chlamydia trachomatis (CT), is the most common sexually transmitted bacterial infection in Sweden. In 2008 it was estimated by WHO that there were 105.7 million new cases of CT worldwide, an increase by 4.2 million cases (4.1%) compared to 2005. If untreated, CT infections can progress to serious reproductive health problems, especially in women. These complications include subfertility/infertility, ectopic pregnancy and chronic pain. The CT infection is often asymptomatic and reliable diagnostic methods and contact tracing are important tools for identifying infected individuals. CT infection is classified in the Swedish Communicable Diseases Act as a serious disease; consequently, written reporting and contact tracing are compulsory. Previous or ongoing CT infection is not uncommon in infertile couples, especially in women with tubal factor infertility (TFI). We have tested 244 infertile couples for CT antibodies, and CT IgG positive couples were tested for CT DNA in urine. The prevalence of CT antibodies was higher in infertile men and women, and ongoing CT infection was common. Our results support a role of CT in infertility and underscore the importance of prevention of CT infection. Contact tracing was studied during using questionnaires. A total of 544 questionnaires was sent to tracers in a Swedish county and 534 (98%) were completed. Centralized contact tracing performed by experienced tracers is effective; on average 65% of sexual contacts found by contact tracing are CT-infected. Our data show that it is worthwhile to extend the tracing period beyond 6 months as 30% of reported sexual contacts between months 7-12 were CT-infected. Contact tracing may be performed face-to-face at the clinic or by telephone. Because of the severe consequences of CT infection there is a need for useful methods for both primary and secondary prevention of CT and other sexually transmitted infections (STIs). An important sub-population for CT/STI-prevention is the “core group”, i.e. a subpopulation with high incidence of STIs combined with risky sexual behaviours. This subpopulation contributes particularly to the spread of STIs in the population. Therefore, we have developed and evaluated a brief standardised but flexible manual-based single-session intervention based on motivational interviewing (MI) for the reduction of high risk sexual behaviour. Women (n=105) and men (n=119) at high risk of contracting CT infection were randomly eighter offered brief MI counselling or standard care. Our findings support the effectiveness of brief MI-based counselling in reducing high-risk sexual behaviour and incident CT infection in women (p<0.01) but not in men. Our results suggest that gender aspects need to be considered and that men and women should be treated differently for achieving maximal risk-reduction. Whereas it might be sufficient to include information and motivation when performing risk-reducing counselling on women, counsellors may also add other components, such as behavioural skills and booster sessions, when counselling is performed on men.
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- Carré, Helena, et al.
(författare)
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Asking about condom use : a key to individualized care when screening for chlamydia
- 2011
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Ingår i: International Journal of STD and AIDS (London). - : Sage Publications. - 0956-4624 .- 1758-1052. ; 22:8, s. 436-441
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Tidskriftsartikel (refereegranskat)abstract
- Chlamydia trachomatis (CT) infection has been a target for both selective and national screening programmes, and Sweden has an opportunistic approach. A national plan of action states that risk groups should be identified and offered risk reduction counselling. Patients attending a drop-in sexually transmitted infection (STI) clinic reception at the University Hospital, Umeå, Sweden, were invited to complete a questionnaire regarding sociodemographic characteristics, symptoms and sexual risk behaviour; all had a CT test taken. A total of 1305 patients were included, 58% men, mean age 27.8 years. CT prevalence was 11%; 51% of those with CT were ≥ 25 years old. Only 5% used a condom during the entire sexual intercourse with their last new/temporary partner. Sexually active inconsistent condom users comprised 62% of the study population and contributed to 81% of the chlamydia infections. Asking whether a condom was used could quickly triage patients into groups with a 'higher risk' (none or inconsistent use of condoms and at least one new/temporary partners), and 'lower risk' (with more consistent condom use, although not always accurate) allowing for individualized care and counselling when screening for chlamydia. Evaluating whether a condom was used throughout the sexual intercourse did not add any useful information.
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| 7. |
- Christianson, Monica, et al.
(författare)
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'Let men into the pregnancy' : men's perceptions about being tested for Chlamydia and HIV during pregnancy
- 2013
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Ingår i: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 29:4, s. 351-358
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate how to prevent transmission of HIV and Chlamydia trachomatis (CT) by exploring whether screening of men during pregnancy may be an innovative way to reach men, to increase detection, and to avoid the present gendered responsibility.DESIGN: An explorative research strategy with in-depth interviews and an analysis informed by grounded theory principles was used.SETTING: The northern part of Sweden.PARTICIPANTS: Twenty men/becoming fathers in their twenties and early thirties were offered CT and HIV testing and were interviewed about their perceptions about being tested during pregnancy.FINDINGS: Six categories emerged that concerned the men's risk perceptions, reasons for not testing men, benefits and negative consequences associated with being tested, incentive measures for reaching men and the optional time for testing men during pregnancy. The majority of the men perceived their own risk for having CT or HIV to be close to zero, trusted their stable partner, and did not see men as transmitters. They did not understand how men could play a role in CT or HIV transmission or how these infections could negatively affect the child. However, few informants could see any logical reasons for excluding men from testing and the majority was positive towards screening men during the pregnancy.KEY CONCLUSIONS: Men's sexual health and behaviour on social and biological grounds will affect the health of women and their children during pregnancy and childbirth. As long as expectant fathers do not count in this 'triad', there is a risk that CT and HIV infections in adults and infants will continue to be an unsolved problem.IMPLICATIONS FOR PRACTICE: Knowledge from this research can contribute to influencing the attitudes among health-care providers positively, and inspiring policy changes.
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| 8. |
- Helldin, Jan Olof, et al.
(författare)
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Viltet i samhället
- 2010
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Ingår i: Vilt, människa, samhälle. - 9789147094189 ; , s. 135-168
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Bokkapitel (populärvet., debatt m.m.)
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| 9. |
- Joly, Florence, et al.
(författare)
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Decreased hypersensitivity reactions with carboplatin-pegylated liposomal doxorubicin compared to carboplatin-paclitaxel combination : analysis from the GCIG CALYPSO relapsing ovarian cancer trial
- 2011
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Ingår i: Gynecologic Oncology. - New York : Elsevier BV. - 0090-8258 .- 1095-6859. ; 122:2, s. 226-232
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe and analyze observed hypersensitivity reactions (HSR) from the randomized, multicenter phase III CALYPSO trial that evaluated the efficacy and safety of the combination of carboplatin and pegylated liposomal doxorubicin (CD) compared with standard carboplatin–paclitaxel (CP) in patients with platinum-sensitive relapsed ovarian cancer (ROC). Methods: HSR documented within case report forms and SAE reports were specifically analyzed. Analyses were based on the population with allergy of any grade and for grade > 2 allergy. Results: Overall 976 patients were recruited to this phase III trial, with toxicity data available for 466 and 502 on the CD and CP arms, respectively. There was a 15.5% HSR rate associated with CD (2.4% grade > 2) versus 33.1% with CP (8.8% grade > 2), p < 0.001. HSRs occurred more often during first cycle in the CD (46%) arm than in the CP arm (16%). Multivariate predictors of allergy were chemotherapy regimen and age; patients randomized to CD and patients ≥ 70 years old on CP had less allergy. Few patients (< 6%) stopped treatment due to allergy. Allergy rates were higher in patients who did not receive prior supportive treatment; however there was no relationship between allergy and the type of carboplatin product received, or response rate. Conclusions: Use of PLD with carboplatin instead of paclitaxel and older age were the only 2 factors predicting a low rate of HSRs in patients with ROC. CD has previously demonstrated superior progression-free survival and therapeutic index than CP. Taken together these data support the use of CD as a safe and effective therapeutic option for platinum-sensitive ROC.
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