No abstract

A levonorgestrel-releasing IUD and the Copper T 380Ag IUD were in randomized comparison for seven years in five clinics. In two other clinics the randomized study was truncated at five years, but use of the Copper T continued. No pregnancies occurred to users of either device in years 6 and 7. Cumulative pregnancy rates were 1.1 per 100 at seven years for the steroid-releasing and 1.4 per 100 for the copper-releasing IUDs. Cumulative rates of PID did not differ between devices. Infection rates appeared to be lowest during the sixth and seventh years of the study. Termination attributable to amenorrhea was the principal contributor to differences in cumulative continuation rates between devices. At the five clinics that carried the comparative study to seven years, cumulative continuation rates were 24.9 per 100 for LNg20 IUD users and 29.4 per 100 for TCu 380Ag users. Women who used either method for periods of five to seven years experienced, on average, marked to mild increases in hemoglobin as compared with levels at admission. The Copper T380 family and the LNg20 IUDs represent the most effective reversible contraceptive methods yet studied in long-term randomized trials.

Spontaneous bacterial peritonitis is the most frequent bacterial infection in patients with cirrhosis. The reported incidence varies between 7% and 30% in hospitalized patients with cirrhosis and ascites, representing one of their main complications. Outcomes in patients with spontaneous bacterial peritonitis are poor since acute kidney injury, acute-on-chronic liver failure, and death occur in as much as 54%, 60%, and 40% of the patients, respectively, at midterm. Early antibiotic treatment of spontaneous bacterial peritonitis is crucial. However, the landscape of microbiological resistance is continuously changing, with an increasing spread of multidrug-resistant organisms that make its current management more challenging. Thus, the selection of the empirical antibiotic treatment should be guided by the severity and location where the infection was acquired, the risk factors for multidrug-resistant organisms, and the available information on the local expected bacteriology. The use of albumin as a complementary therapy for selected high-risk patients with spontaneous bacterial peritonitis is recommended in addition to antibiotics. Even though antibiotic prophylaxis has proven to be effective to prevent spontaneous bacterial peritonitis, a careful selection of high-risk candidates is crucial to avoid antibiotic overuse. In this article we review the pathogenesis, risk factors, and prognosis of spontaneous bacterial peritonitis, as well as the current evidence regarding its treatment and prophylaxis.

Objectives-We sought to determine the association of social-environmental factors with condom use and sexually transmitted infections (STIs) among 420 sex workers participating in an STI/HIV prevention study in Corumbá, Brazil, to inform future intervention efforts.Methods-Participants provided urine samples for polymerase chain reaction testing of chlamydia and gonorrhea and responded to multi-item scales addressing perceived social cohesion, participation in networks, and access to and management of resources. We conducted multivariate log-linear and negative binomial regression analyses of these data.Results-Increased social cohesion was inversely associated with number of unprotected sex acts in the preceding week among women (adjusted incidence rate ratio [IRR]=0.80; P<.01), and there was a marginal association among men (adjusted IRR=0.41; P=.08). Women's increased participation in social networks was associated with a decrease in frequency of unprotected sex acts (adjusted IRR=0.83; P=.04), as was men's access to and management of social and material resources (IRR=0.15; P=.01). Social-environmental factors were not associated with STIs.Conclusions-The social context within which populations negotiate sexual behaviors is associated with condom use. Future efforts to prevent STI/HIV should incorporate strategies to modify the social environment.With growing agreement about the importance of economic, political, and social contexts in shaping sexual behaviors and the course of the HIV epidemic, HIV prevention researchers have escalated calls for implementation of multilevel structural and social interventions that modify social environments and empower communities. [1][2][3][4][5][6][7][8][9] Interventions that seek to create social cohesion, improve access to resources, create networks, ensure community participation, Correspondence should be sent to Sheri A. Lippman, PhD, MPH, Center for Aids Prevention Studies, University of California San Francisco, 50 Beale St., suite 1200, CA, 94105 (LippmanS@globalhealth.ucsf.edu). Reprints can be ordered at http://www.ajph.org by clicking the "Reprints/Eprints" link. Human Participant ProtectionThis study was approved by the Population Council's internal review board, the Committee for the Protection of Human Subjects at the Federal University of Mato Grosso do Sul in Brazil, and the Brazilian National Ethics Committee. All participants provided informed consent in their language of choice (Portuguese or Spanish) before enrollment. NIH Public Access Author ManuscriptAm J Public Health. Author manuscript; available in PMC 2011 April 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript mobilize communities, and otherwise establish human rights are especially important for marginalized groups that experience discrimination and exclusion from public life.Improving social-environmental factors has become an integral element in HIV prevention 2, 5,10,11 and health promotion generally. [12][13][14][15] The United Nations Joint Programme on...