Heidi M. Bauer

Bio: Heidi M. Bauer is an academic researcher from California Health and Human Services Agency. The author has contributed to research in topics: Population & Sexually transmitted disease. The author has an hindex of 31, co-authored 54 publications receiving 6658 citations. Previous affiliations of Heidi M. Bauer include Cetus Corporation & University of California, San Francisco.

Epidemiologic Evidence Showing That Human Papillomavirus Infection Causes Most Cervical Intraepithelial Neoplasia

Abstract: Given improvements in human papillomavirus (HPV) testing that have revealed a strong link between sexual activity history and cervical HPV infection the authors conducted a large case-control study of HPV and cervical intraepithelial neoplasia (CIN) to evaluate whether sexual behavior and the other established risk factors for CIN influence risk primarily via HPV infection. The authors studied 500 women with CIN and 500 control subjects receiving cytologic screening at Kaiser Permanente a large prepaid health plan in Portland Oregon. The established epidemiologic risk factors for CIN were assessed by telephone interview. The authors performed HPV testing of cervicovaginal lavage specimens by gene amplification using polymerase chain reaction with a consensus primer to target the L1 gene region of HPV. Unconditional logistic regression analysis was used to estimate relative risk of CIN and to adjust the epidemiologic associations for HPV test results to demonstrate whether the associations were mediated by HPV. The case subjects demonstrated the typical epidemiologic profile of CIN: they had more sex partners more cigarette smoking earlier ages at first sexual intercourse and lower socioeconomic status. Statistical adjustment for HPV infection substantially reduced the size of each of these case-control differences. 76% of cases could be attributed to HPV infection; the results of cytologic review suggested that the true percentage was even higher. Once HPV infection was taken into account an association of parity with risk of CIN was observed in both HPV-negative and HPV-positive women. The data show that the great majority of all grades of CIN can be attributed to HPV infection particularly with the cancer-associated types of HPV. In light of this conclusion the investigation of the natural history of HPV has preventive as well as etiologic importance. (authors)

Genital human papillomavirus infection in female university students as determined by a PCR-based method.

Abstract: The presence of genital human papillomavirus (HPV) was determined at cervical and vulvar sites using two methods, the Food and Drug Administration-approved ViraPap test and polymerase chain reaction (PCR) DNA amplification technology, in 467 women presenting to a university health service for a routine annual gynecologic examination. The PCR system afforded the sensitive detection of a broad spectrum of genital HPV types. Using PCR, we found that 46% of the study population was infected with HPV; the ViraPap test showed a prevalence of 11% infected. PCR analyses demonstrated that 69% of the HPV-positive women were infected at both genital sites. Subsequent HPV-type determination showed that 33% of the study population had HPV types 6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, or other previously isolated types, and 13% had yet unidentified types. Almost all (92%) of the women diagnosed by Papanicolaou smear with condylomatous atypia or dysplasia (n = 12) were HPV positive. The PCR method proved to be an informative and rapid way to detect HPV in large numbers of clinical samples. Our results demonstrate that genital HPV infection is common among sexually active young women.

Screening and Intervention for Intimate Partner Abuse: Practices and Attitudes of Primary Care Physicians

Abstract: ContextAlthough practice guidelines encouraging the screening of patients for intimate partner abuse have been available for several years, it is unclear how well and in which circumstances physicians adhere to them.ObjectiveTo describe the practices and perceptions of primary care physicians regarding intimate partner abuse screening and interventions.Design, Setting, and ParticipantsCross-sectional survey of a stratified probability sample of 900 physicians practicing family medicine, general internal medicine, and obstetrics/gynecology in California. After meeting exclusion criteria, 582 were eligible for participation in the study.Main Outcome MeasureReported abuse screening practices in a variety of clinic settings, based on a 24-item questionnaire, with responses compared by physician sex, practice setting, and intimate partner abuse training.ResultsSurveys were completed by 400 (69%) of the 582 eligible physicians, including 149 family physicians, 115 internists, and 136 obstetrician/gynecologists. Data were weighted to estimate the practices of primary care physicians in California. An estimated majority (79%; 95% confidence interval [CI], 75%-83%) of these primary care physicians routinely screen injured patients for intimate partner abuse. However, estimated routine screening was less common for new patient visits (10%; 95% CI, 7%-13%), periodic checkups (9%; 95% CI, 6%-12%), and prenatal care (11%; 95% CI, 7%-15%). Neither physician sex nor recent intimate partner abuse training had significant effects on reported new patient screening practices. Obstetrician/gynecologists (17%) and physicians practicing in public clinic settings (37%) were more likely to screen new patients. Internists (6%) and physicians practicing in health maintenance organizations (1%) were least likely to screen new patients. Commonly reported routine interventions included relaying concern for safety (91%), referral to shelters (79%) and counseling (88%), and documentation in the medical chart (89%). Commonly cited barriers to identification and referral included the patients' fear of retaliation (82%) and police involvement (55%), lack of patient disclosure (78%) and follow-up (52%), and cultural differences (56%).ConclusionsThese findings suggest that primary care physicians are missing opportunities to screen patients for intimate partner abuse in a variety of clinical situations. Further studies are needed to identify effective intervention strategies and improve adherence to intimate partner abuse practice guidelines.

Identification and Assessment Of Known And Novel Human Papillomaviruses by Polymerase Chain Reaction Amplification, Restriction Fragment Length Polymorphisms, Nucleotide Sequence, and Phylogenetic Algorithms

Abstract: The identification and taxonomy of papillomaviruses has become increasingly complex, as approximately 70 human papillomavirus (HPV) types have been described and novel HPV genomes continue to be identified. Methods and corresponding DNA sequence data bases were designed for the reliable identification of mucosal HPV genomes from clinical specimens. HPVs are identified by the amplification of a fragment of the L1 region by consensus primer polymerase chain reaction (PCR) and subsequent hybridization or restriction fragment length polymorphism analysis. L1 PCR fragments may be further characterized by nucleotide sequencing. Conservation of 30 (of 151) predicted amino acids identifies HPV genomic fragments, and nucleotide sequence alignments allow calculation of their phylogenetic relatedness. Sequence differences > 10% from any known HPV type suggest a novel HPV type. Phylogenetic relationships with known HPV types may permit predictions of biology. With these criteria, 10 PCR fragments were identified that would qualify as new genital HPV types after complete genomic isolation.

Determinants of genital human papillomavirus infection in young women.

Abstract: Carcinoma of the cervix has several well-established epidemiologic risk factors, including multiple sexual partners and early age at first intercourse. Human papillomavirus (HPV) infection appears to have an etiologic role in the development of cervical neoplasia, but evidence linking HPV infection to known risk factors for cervical cancer has been inconsistent. The lack of expected correlations may be due to the inaccuracy of HPV assays previously used. A polymerase chain reaction DNA amplification method for the detection of HPV was used to investigate the determinants of genital HPV infection in a cross-sectional sample of 467 women attending a university health service. In contrast to studies using less accurate detection methods, the risk factors for HPV infection found here were consistent with those for cervical neoplasia. The risk of HPV infection was strongly and independently associated with increasing numbers of sexual partners in a lifetime, use of oral contraceptives, younger age, and black race. Age at first intercourse, smoking, and history of a prior sexually transmitted disease were correlated with, but not independently predictive of, HPV infection. These results demonstrate that the key risk factors for cervical carcinoma are strongly associated with genital HPV infection. This correlation suggests that HPV has an etiologic role in cervical neoplasia and reaffirms the sexual route of HPV transmission.

Epidemiologic Classification of Human Papillomavirus Types Associated with Cervical Cancer

Abstract: Background Infection with human papilloma virus (HPV) is the main cause of cervical cancer, but the risk associated with the various HPV types has not been adequately assessed. Methods We pooled data from 11 case–control studies from nine countries involving 1918 women with histologically confirmed squamous-cell cervical cancer and 1928 control women. A common protocol and questionnaire were used. Information on risk factors was obtained by personal interviews, and cervical cells were collected for detection of HPV DNA and typing in a central laboratory by polymerase-chain-reaction–based assays (with MY09/MY11 and GP5+/6+ primers). Results HPV DNA was detected in 1739 of the 1918 patients with cervical cancer (90.7 percent) and in 259 of the 1928 control women (13.4 percent). With the GP5+/6+ primer, HPV DNA was detected in 96.6 percent of the patients and 15.6 percent of the controls. The most common HPV types in patients, in descending order of frequency, were types 16, 18, 45, 31, 33, 52, 58, and 35. A...

The causal relation between human papillomavirus and cervical cancer

Abstract: The causal role of human papillomavirus infections in cervical cancer has been documented beyond reasonable doubt. The association is present in virtually all cervical cancer cases worldwide. It is the right time for medical societies and public health regulators to consider this evidence and to define its preventive and clinical implications. A comprehensive review of key studies and results is presented.

World report on violence and health

Abstract: WHO Violence cuts short the lives of millions of people across the world each year, and damages the lives of millions more. It knows no boundaries of geography, race, age or income. It strikes at children, young people, women and the elderly. It finds its way into homes, schools and the workplace. Men and women everywhere have the right to live their lives and raise their children free from the fear of violence. We must help them enjoy that right by making it clearly understood that violence is preventable, and by working together to identify and address its underlying causes.

Oral and Maxillofacial Pathology

Abstract: 1. Developmental Defects of the Oral and Maxillofacial Region 2. Abnormalities of Teeth 3. Pulpal and Periapical Disease 4. Periodontal Diseases 5. Bacterial Infections 6. Fungal and Protozoal Diseases 7. Viral Infections 8. Physical and Chemical Injuries 9. Allergies and Immunologic Diseases 10. Epithelial Pathology 11. Salivary Gland Pathology 12. Soft Tissue Tumors 13. Hematologic Disorders 14. Bone Pathology 15. Odontogenic Cysts and Tumors 16. Dermatologic Diseases 17. Oral Manifestations of Systemic Diseases 18. Facial Pain and Neuromuscular Diseases 19. Forensic Dentistry Appendix: Differential Diagnosis of Oral and Maxillofacial Diseases Part 1: Mucosal and Soft Tissue Pathology: Color Changes Part 2: Mucosal and Soft Tissue Pathology: Surface Alterations Part 3: Mucosal and Soft Tissue Pathology: Masses or Enlargements Part 4: Radiographic Pathology Part 5: Pathology of Teeth