Robert L. Cook

Bio: Robert L. Cook is an academic researcher from University of Florida. The author has contributed to research in topics: Medicine & Population. The author has an hindex of 47, co-authored 259 publications receiving 7617 citations. Previous affiliations of Robert L. Cook include McMaster University & Louisiana State University.

Is there an association between alcohol consumption and sexually transmitted diseases? A systematic review.

Abstract: Objective/Goal:The objective of this study was to conduct a systematic review of published literature on the association between problematic alcohol consumption and sexually transmitted diseases (STDs).Design:Using a MEDLINE search (1995–2003) and article references, we identified articles that desc

Systematic review: noninvasive testing for Chlamydia trachomatis and Neisseria gonorrhoeae.

Abstract: Background: Testing of urine samples is noninvasive and could overcome several barriers to screening for chlamydial and gonococcal infections, but most test samples are obtained directly from the cervix or urethra. Purpose: To systematically review studies that assessed the sensitivity and specificity of nucleic acid amplification tests for Chlamydia trachomatis and Neisseria gonorrhoeae in urine specimens and to compare test characteristics according to type of assay, site of sample collection, presence of symptoms, disease prevalence, and characteristics of the reference standard. Data Sources: Relevant studies in all languages were identified by searching the MEDLINE database (January 1991 to December 2004) and by hand-searching the references of identified articles and relevant journals. Study Selection: Studies were selected that evaluated 1 of 3 commercially available nucleic acid amplification tests, included data from tests of both a urine sample and a traditional sample (obtained from the cervix or urethra), and used an appropriate reference standard. Data Extraction: From 29 eligible studies, 2 investigators independently abstracted data on sample characteristics, reference standard, sensitivity, and specificity. Data Synthesis: Articles were assessed qualitatively and quantitatively. Summary estimates for men and women were calculated separately for chlamydial and gonococcal infections and were stratified by assay and presence of symptoms. The pooled study specificities of each of the 3 assays exceeded 97% when urine samples were tested, for both chlamydial infection and gonorrhea and in both men and women. The pooled study sensitivities for the polymerase chain reaction, transcription-mediated amplification, and strand displacement amplification assays, respectively, were 83.3%, 92.5%, and 79.9% for chlamydial infections in women; 84.0%, 87.7%, and 93.1% for chlamydial infections in men; and 55.6%, 91.3%, and 84.9% for gonococcal infections in women. The pooled specificity of polymerase chain reaction to gonococcal infections in men was 90.4%. In subgroup analyses, the sensitivity did not vary according to the prevalence of infection or the presence of symptoms but did vary according to the reference standard used. Limitations: Few published studies present data on the transcription-mediated amplification or strand displacement amplification assays, and few studies report data from asymptomatic patients or low-prevalence groups. Conclusions: Results of nucleic acid amplification tests for C. trachomatis on urine samples are nearly identical to those obtained on samples collected directly from the cervix or urethra. Although all 3 assays can also be used to test for N. gonorrhoeae, the sensitivity of the polymerase chain reaction assay in women is too low to recommend its routine use to test for gonorrhea in urine specimens.

Problem Drinking and Medication Adherence Among Persons with HIV Infection

Abstract: OBJECTIVE: To examine the relation between problem drinking and medication adherence among persons with HIV infection. DESIGN: Cross-sectional survey. SETTING/PARTICIPANTS: Two hundred twelve persons with HIV infection who visited 2 outpatient clinics between December 1997 and February 1998. MEASUREMENTS AND MAIN RESULTS: Nineteen percent of subjects reported problem drinking during the previous month, 14% missed at least 1 dose of medication within the previous 24 hours, and 30% did not take their medications as scheduled during the previous week. Problem drinkers were slightly more likely to report a missed dose (17% vs 12 %, P=.38) and significantly more likely to report taking medicines off schedule (45% vs 26%, P=.02). Among drinking subtypes, taking medications off schedule was significantly associated with both heavy drinking (high quantity/frequency) (adjusted odds ratio [OR], 4.70; 95% confidence interval [95% CI], 1.49 to 14.84; P<.05) and hazardous drinking (adjusted OR, 2.64; 95% CI, 1.07 to 6.53; P<.05). Problem drinkers were more likely to report missing medications because of forgetting (48% vs 35%, P=.10), running out of medications (15% vs 8%, P=.16), and consuming alcohol or drugs (26 % vs 3 %, P<.001). CONCLUSION: Problem drinking is associated with decreased medication adherence, particularly with taking medications off schedule during the previous week. Clinicians should assess for alcohol problems, link alcohol use severity to potential adherence problems, and monitor outcomes in both alcohol consumption and medication adherence.

Crack cocaine, disease progression, and mortality in a multicenter cohort of HIV-1 positive women

Abstract: Recent research suggests that cocaine may directly affect the pathobiology of HIV by causing immune alterations in different lymphocytes such as helper T cells (CD4), suppressor/cytotoxic T cells (CD8), and natural killer (NK) cells.1 Studies show that cocaine interferes with the body’s ability to defend against infection by inhibiting the effector functions of neutrophils and macrophages, and by suppressing cytokine production, decreasing operation of important immune responses.2 Cocaine also enhances the replication of HIV in vitro.3 Cells from chronic cocaine users more readily support HIV replication and development of AIDS-defining opportunistic infections than cells from nonusers, suggesting a direct role for cocaine in the acquisition and progression of AIDS.2 Recently, cocaine has been shown to cause membrane permeability facilitating endothelial transmigration of infected dendritic cells across the blood brain barrier to the central nervous system.4 There is also evidence of cocaine-mediated alteration of immune responses and host resistance due to disturbances in the balance of Th1 pro-inflammatory versus Th2 anti-inflammatory cytokines and lipid bioeffectors.3 Epidemiologic research confirms that crack users are at high risk for HIV infection and progression.5-6 In a prospective study of HIV-seropositive drug users, crack use was significantly associated with progression to AIDS.7 A study of HIV-positive current and former drug users found that active cocaine use was the strongest predictor of failure to maintain viral suppression; 13% of active users maintained suppression vs. 46% of non-users.8 In a prospective cohort study, compared with nonusers and former users, active cocaine and heroin users experienced smaller median reductions in HIV-1 RNA and smaller median increases in CD4 from baseline, controlling for antiretroviral exposure, adherence, and socio-demographic factors.9 Compared to nonusers, the risk of AIDS-related opportunistic conditions was greater for persistent users and intermittent users during periods of active use, with no difference during periods of abstinence.10 Mixed results characterize studies of drug users in exclusively female U.S. cohorts. In a multi-center cohort of HIV-positive women, injection drug use was not associated with progression to AIDS.11 Another large multi-site cohort study found that hard drug use (i.e., cocaine, heroin, methadone, or injecting drugs) was significantly associated with AIDS-defining illnesses, but not with change in CD4, HIV-RNA, or mortality.12 In a third multi-site cohort of HIV+ women, non-injection drug use was associated with time to AIDS-defining event but not with AIDS-related mortality.13 While suggestive, these studies and others focusing on injection drug use do not uniformly demonstrate a link between illicit drug use and HIV-1 disease progression.14-17 Possible reasons include: diverse definitions of illness progression; failure to differentiate between active and nonactive users; and lack of distinction between mortality due to AIDS versus non-AIDS causes.17 Other reasons include lack of controls for highly active antiretroviral therapy (HAART) use and adherence, and inadequate follow-up periods. We addressed all of these issues by examining patterns of crack use and their association with four distinct measures of HIV/AIDS disease progression in a multi-center cohort over an eight-and-one-half-year period during the HAART era.

Constructing Grounded Theory: A Practical Guide through Qualitative Analysis

Abstract: การวจยเชงคณภาพ เปนเครองมอสำคญอยางหนงสำหรบทำความเขาใจสงคมและพฤตกรรมมนษย การวจยแบบการสรางทฤษฎจากขอมล กเปนหนงในหลายระเบยบวธการวจยเชงคณภาพทกำลงไดรบความสนใจ และเปนทนยมเพมสงขนเรอยๆ จากนกวชาการ และนกวจยในสาขาสงคมศาสตร และศาสตรอนๆ เชน พฤตกรรมศาสตร สงคมวทยา สาธารณสขศาสตร พยาบาลศาสตร จตวทยาสงคม ศกษาศาสตร รฐศาสตร และสารสนเทศศกษา ดงนน หนงสอเรอง “ConstructingGrounded Theory: A Practical Guide through Qualitative Analysis” หรอ “การสรางทฤษฎจากขอมล:แนวทางการปฏบตผานการวเคราะหเชงคณภาพ” จะชวยใหผอานมความรความเขาใจถงพฒนาการของปฏบตการวจยแบบสรางทฤษฎจากขอมล ตลอดจนแนวทาง และกระบวนการปฏบตการวจยอยางเปนระบบ จงเปนหนงสอทควรคาแกการอานโดยเฉพาะนกวจยรนใหม เพอเปนแนวทางในการนำความรความเขาใจไประยกตในงานวจยของตน อกทงนกวจยผเชยวชาญสามารถอานเพอขยายมโนทศนดานวจยใหกวางขวางขน

Guidelines for the use of antiretroviral agents in HIV-infected adults and adolescents

Abstract: SUMMARY The availability of an increasing number of antiretroviral agents and the rapid evolution of new information has introduced extraordinary complexity into the treatment of HIV-infected persons. In 1996, the Department of Health and Human Services and the Henry J. Kaiser Family Foundation convened the Panel on Clinical Practices for the Treatment of HIV to develop guidelines for the clinical management of HIV-infected adults and adolescents. This report recommends that care should be supervised by an expert, and makes recommendations for laboratory monitoring including plasma HIV RNA, CD4 cell counts and HIV drug resistance testing. The report also provides guidelines for antiretroviral therapy, including when to start treatment, what drugs to initiate, when to change therapy, and therapeutic options when changing therapy. Special considerations are provided for adolescents and pregnant women. As with treatment of other chronic conditions, therapeutic decisions require a mutual understanding between the patient and the health care provider regarding the benefits and risks of treatment. Antiretroviral regimens are complex, have major side effects, pose difficulty with adherence, and carry serious potential consequences from the development of viral resistance due to non-adherence to the drug regimen or suboptimal levels of antiretroviral agents. Patient education and involvement in therapeutic

Synthetic molecular motors and mechanical machines.

Abstract: The widespread use of controlled molecular-level motion in key natural processes suggests that great rewards could come from bridging the gap between the present generation of synthetic molecular systems, which by and large rely upon electronic and chemical effects to carry out their functions, and the machines of the macroscopic world, which utilize the synchronized movements of smaller parts to perform specific tasks. This is a scientific area of great contemporary interest and extraordinary recent growth, yet the notion of molecular-level machines dates back to a time when the ideas surrounding the statistical nature of matter and the laws of thermodynamics were first being formulated. Here we outline the exciting successes in taming molecular-level movement thus far, the underlying principles that all experimental designs must follow, and the early progress made towards utilizing synthetic molecular structures to perform tasks using mechanical motion. We also highlight some of the issues and challenges that still need to be overcome.

Quick assessment of literacy in primary care: the newest vital sign.

Abstract: PURPOSE Current health literacy screening instruments for health care settings are either too long for routine use or available only in English. Our objective was to develop a quick and accurate screening test for limited literacy available in Eng- lish and Spanish. METHODS We administered candidate items for the new instrument and also the Test of Functional Health Literacy in Adults (TOFHLA) to English-speaking and Spanish-speaking primary care patients. We measured internal consistency with Cronbach's and assessed criterion validity by measuring correlations with TOFHLA scores. Using TOFLHA scores 0.76 in English and 0.69 in Spanish) and correlates with the TOFHLA. Area under the ROC curve is 0.88 for English and 0.72 for Spanish ver- sions. Patients with more than 4 correct responses are unlikely to have low literacy, whereas fewer than 4 correct answers indicate the possibility of limited literacy. CONCLUSION NVS is suitable for use as a quick screening test for limited literacy in primary health care settings.