J. (1994), "RSsultats d long tenne de la prothdse totale du genou", Livre des rdsulmds des communications particulieres, 69eme Rdunion annuelle de la SOFCOT
3 Aubnot J . H . (1987), "Evaluation fonctionnelle des rdsultats de la chirurgie du genou ", Cahier d"enselgnement de la SOFCOT, Confdrences d'enseignement, 219-232,
4 Smith AJ, Wood DJ. Li MG (2008), "Total knee replacement with and without patellar resurfacing A prospective randomised trial using the Profix total knee system" J Bone Joint Surg (Br) 90B, 4 3 - 9 ,
5 Hooper J, Rothwell A, Frampton C (2009), 'The low contact stress mobile bearing total knee replacement' a prospective study with a minimum follow up of 10 years", J Bone Joint Surg (Br)' 91B, 58 - 63
6 Kim YH, Kim JS, Yoon SH (2007), "Alignment and
orientation of the component in total knee replacement witl and without navigation support' a prospective randomisec study".89B, 471-6.
7, Park KK, Chang CB, Kang YG, Seong SC, Kim TK (2007). "Correlation of maximum flexion with clinica outcome after total knee replacement in Asian patients'j Bone Joint Surg (Br), 89B, 604 - 9.
8. Campbell DG, Duncan WW, Ashworth M, Mintz A, Stiriing J, Wakefield L, Stevenson TM (2006). "Patellar resurfacing in total knee replacement: A ten years prospective study". J Bone Joint Surg (Br), 88B, 734 - 9
9 Gandhi R, Tsvetkov D, Davey JR, Mohamed NN (2008), "Survival and clinical function of cemented and cementless prostheses in total knee replacement, a meta analysis", J Bone Joint Surg (Br). 916, 889 - 95
THUC TRANG HANH VI NGUY CO LAY N H I I M HIV VA MOT Sti YEU Td LIlN QUAN
or PHU Nijr MAI DAM TAI BAI T A M QUAT LAM VA THJNH LONG, TINH N A M DJNH, N A M 2011 T R A N T H | L V - Bg Tii nguyin vi Moi tnrdng PHAM T R ( D U N G - Bg/ hgc Y te cdng c^ng
T6M TAT
Nghiin cuv md ti dt ngang dwgc tiin hinh t$i hai bii tim Quit Lim vi Thjnh Long, tinh Nam Djnh, nim 2011 nhim dinh gii dc hinh vl nguy ca liy nhiim HIV vi mdt s6 yeu ti liin quan d nhdm phu nO- mai dim (PNMD) Ket qua nghiin cuv cho thay: Cd 6,6% khich hing cd nhu ciu QHTD theo dwdng miing/hiu mdn, ty le sw dung bao cao su (BCS) trong Ian quan hi tinh due (QHTD) gan diy nhat li 74,1% vdi khich I?, 54,1% vdi khich quen vi 73,9% vdi ching/ban trai, 1,1% PNMD da timg si> dung ma tuy. ty 1$ PNMD mic STIs li 73%.
gan 14% PNMD cd kiin thuc khdng rfgf vi HIV. Cic yiu ti lien quan tdi hinh vi su- dung BCS khi QHTD d nhdm PNMD bao gom: Trinh dd hgc vin (TDHV), tin twdng ban tinh khdng si> dung ma tuy, sd lucmg b^n tinh tmng thing cao (trin 50 ngudi), loai hinh ho^t dgng, nghe ndi vi tinh due an toin (TDAT) vi liem chlch an toin (TCAT), kiin thuc phdng ching HIV/AIDS.
Tir khda: Hinh vi nguy ca. HIV/AIDS, phu nO- mai dim.
SUMMARY
Status of risks and some factors related to HIV infection among female sex workers in Quat Lam and Thinh Long beach. Nam Dinh provice, 2011
The cnDss-sectional descriptive study was conducted in Quat Lam and Thinh Long beach. Nam Dinh province.
2011 to assess the risks of behavior and some factors related to prevent HIV/AIDS among female sex woritera (FSWs). Research results shows that 6.6% clients of FSWs need to have sex by mouth or anal The rate of FSVt/s use condoms for the last having sex with new clients is 74.1%, with old clients is 54.1% and 73.9%
with husband or boyfriends, 1.1% of FSWs had ever used dnjgs, 73% of FSWs had sexual transmisted infection, neariy 14% of FSWs had not convct answer about HIV tmnsmission routes. Mainly factors related to not using condoms when having sex in FSWs- Low
education, believed that their partner do not use drugs, more than 50 partners in each month, kind of work, listening about safe sex and safe injection drugs, knowledge in preventing HIV/AIDS.
Keywords: Risks, HIV infection, female sex workers DAT V A N Dt
Dgi djch HIV/AIDS dang Id v l n d l y t l vd xd h^i nghidm trpng tren todn d u . Tuy nhien d|ch HIV d Viet Nam hi#n v l n dang trong giai dogn tgp trung vdi ty ip hi§n nhiSm cao trong cde nhdm tiem d i c h ma tiiy (TCMT) (23,3%), phy nO mgi ddm (PNMD) (3,2%)[2].
Ddy se Id m i i da dpa tiem tdng Idy tnjyen d j d tir quin t h i d nguy ea cac ra d n g ding ddn cy ndi ehung nlu khdng d bi$n phdp phdng, ching HIV/AIDS kip thdi.
Bdi t i m Thjnh Long vd Quit Id hai khu du Ijch kha n l i tilng eiia tinh Nam Djnh. Trong nhtrng ndm qua eiing vdi sy phdt t n l n kinh t l - xd hit hai khu du lieh nay dd vd dang thu hiit r i t nhilu khdch d i n tham quan, nghi mdt. Nhilu djch vy vui ehai, giai tri dupe hinh thdnh v^
phdt triln, tir dd Idm phdt sinh t | ngn xd h i i nhy ma tiiy, mgi ddm, k6o theo sy Idy tnjyen cua dgi d j d HIV/AIDS, Vi vdy mit nghiin ciru sdu v l hdnh vi nguy ca cOa PNMD vd d c y l u t i lidn quan Idm Ian truyin HIV t^
Nam Djnh vdo thdi diem ndy Id r i t d n thiet, do vgy chiing t i i tiln hdnh nghidn ciru "Thye trgng hdnh vi nguy ca Idy nhilm HIV vd m i t s i y l u t l lien quan d Phy nif mgi dam tgi bdi t i m Quit Ldm vd Thjnh Long, tinh Nam Djnh, ndm 2011". K i t qud ciia nghidn cd-u se cung dp thdng tin v l nguy ca Idy nhilm HIV vd truyen bpnh cua nhdm ndy. Idm ca sd d o vi§e xdy dyng vd cung c i cdc hogt dpng can thi§p phdng ehing HIV/AIDS tgi iJja phyang, gdp phln Idm gi^m sy Idy tnjyin HIV trong d n g ding tgi tinh Nam Djnh.
D 6 | TU'P'NG VA PHU'aNG P H A P NGHIEN CLfU 1. Dja dilm, d6i tu^ng nghiin ci>u
- Dja dilm: Bai t i m Quit Ldm va Thjnh Long fi|l
Nam Djnh. ^,
22 Y HOC THVC HANH (810)-S6 3/2012
- Doi typng nghien ciru: Phy nu- mgi ddm, 270 phieu dieu tra do dy dn Word Bank (WB) thye hipn thdng 9 ndm 2010 tgi Nam Djnh.
2. Phyang phap nghien cifu
- Thiet k l nghien ciru: Nghien CLKU m i ta d t ngang c i phdn tich, dinh lypng k i t hpp vdi d|nh tinh.
+ Nghien cii'u dinh luang' Tiln hdnh thu thdp vd phdn tich thdng tin tCr bp s i lldu dilu tra g i c oCia Dya dn WB.
+ Nghidn cifu dinh tinh: Su- dyng ky thudt phdng v l n sdu vdi muc tieu thu thdp thing tin nhIm b i sung, ly" gidi them cho kit qua nghien eifu dinh lapng thdng qua vipc phan tieh ede yeu t i gdp phln thiic dly, d n trd viic thyc hipn hanh vi nguy ea Idy nhilm HIV eiia PNMD.
Cd mau vd phuang phdp chpn mlu.
+ Nghien ciru ^ n h lypng: Chpn m l u todn b i (270 phieu phdng v l n cua Dy dn WB da thyc hiin dypc daa vdo mlu nghidn eicu).
+ Nghien ciru dinh tinh
Thyc hi§n 12 cupc phdng v l n sdu. Theo md s i ghi chip tren philu dieu tra dinh lypng dd dypc dy dn WB thyc hiin nhd dieu tra vien, giao dye vien ding ding (GDVDD) lien hp Igi vdi nhCfng PNMD dype eho Id cd hdnh nguy nguy ea lay nhilm HIV cao han de tiln hdnh phdng van. Tradng hpp nao khdng lien hp Igi dypc se nhd GDVDD lya ehpn d i i tapng khde cung d hdnh vi nguy ca lay nhiem HIV cao de phdng van
- Phuang phdp thu thdp so lipu. Phong v l n sdu doi typng PNMD va chpn Ipc thdng tin tir 270 philu dieu tra do dy an WB dd thyc hipn.
- Phyang phap xy ly so lipu: Nhdp ligu bing phln mIm Epi Info 3.1, xir ly" vd phdn tich ket qua bing phan mIm SPSS 16,0, O i l vdi Nghien ciru dinh tinh se tiln hdnh ghi ehdp, ma hda thdng tin, phdn tieh trich dan theo chu de.
K^TQUAVABANLUAN I.SLFdyng BCS khi QHTD.
Ty le su dyng BCS trong Ian QHTD gin nhlt cua PNMD cao nhat vdi k h d d Ig (74,1%). thap han vdi chingftign trai (73,9%) .vd thIp nhat vdi khdch quen (54,1%) Ty Id sy dyng BCS trong nhdm MDNH cao han MDDP. Dieu ndy d the ly giai la do MDNH thydng tre dpp han, trinh dp hpc v l n cao han vd hau hit hp chua Idp gia dinh d i n h vi t h i hp d y lhi>c giir gin han nen ty ip diing BCS cao han nhdm MDDP[2][4]. Khdng tin tydng bgn tinh, sp d thai ngodi 9 muin Id nguyen nhan khiln PNMD SU" dyng BCS vdi ehing/ban trai nhieu han.
Bang 1: Ty 10 sir dyng BCS trong l i n QHTD gin day nhat cua PNMD
KhSch h i n g
Khach la
K h i c h quen
Ch6ng/ban traj
SO dung BCS
Cfi Khfing
C(i Khong
C6 Kh6ng
Chung
(%)
200 (74.1)
70 (25,9)
145 (54,1)
123 (45.9)
86 (73,9)
31 (26,1)
M13BP
(%)
10 (38,5)
16 (61,5)
3 (11.5)
23 (88.5)
6 (50)
6 (50)
MDNH
(%)
190 (77.9)
54 (22.1)
142 (58,7) 100 (41,3) 82 (76,6)
24 (23,4)
Ty Ip PNMD dd tirng sCf dyng ma tuy (1,1%), trong dd MDDP (7,7,%) vd MDNH (0,4%) Phdng v l n sdu d c chj cho thIy nguydn nhdn nghiin ma tiiy thydng Id do bgn b i , bgn tinh (ehing/bgn trai, khdch hdng) rii rd, Idi kdo Ngypc Igi nhCfng chj khdng su dyng ma tiiy vl hp cho ring nghidn ma tuy se t i n kdm tiln bge, chu qudn bilt se dull vi$e vd qudn trpng id d c chj d i u nhdn thac dupe tdc hgi ciia thuoc "Chai thule hgi ngudi lim, n i u minh I m y l u hp thIy da xanh xao, g i y qud khdch khdng di vdi minh" (TH12-DP), "Em thIy m i y dira bgn cOng chai thule nhanh xuing lim, diing mdt thdi gian gid vd x l u di nhiiu lim khdch nhin eOng sp" (TH4-NH),
2. Tinh trgng sir dyng ma tuy ciia PNMD Bang 2: Ty Id PNMD dd tirng sy dyng ma tuy Sir dijng ma
tiiy C6 Khfing
T4nq Chung
{%) 3 (1,1) 267 (98,9)
270 MDDP
(%)
2 (7,7) 24 (92,3)26 MDNH
(%)
1 (0,4) 243 (99,6)244 3. Cdc b$nh Idy truyin qua du-dng tinh dye (STIs) vd m i t sd nguy c a khdc.
Bilu do 1: Bilu hlgn NTLTQDTD trong 12 thdng qua eua PNMD
Bilu do 1 eho thay cd tdi 73% PNMD \xa Idi cd bieu hipn mdc STIs trong 12 thdng qua (ra khi hu/ehay mii/huylt trlng bit thydng). STIs Id y i u t i ding Idy nhilm vdi HIV, ty Ip mac STIs trong nhdm PNMD eao kit hap vdi ty Ip sir dyng BCS chaa cao hay su dyng BCS chua diing d e h edng Idm tang nguy ea nhilm HIV cho PNMD[1][3]. Kit qua phdng van sau cho thay PNMD cdn ggp phai mpt so nguy ca khi hdnh nghi n h y tinh trgng cydng bdc khdng tra tien, cy&ng birc QHTD khdng an todn (khdng diing BCS) dan din nguy ca Idy nhiem bpnh vd d thai ngoai y muon.
4. Kiln thiFC v l HIV, STIs cua PNMD.
Bang 3' Kiln thuc phdng Idy nhiem HIV cua PNMD Ki^n thCrc
Dgt
• Khflng dgt Tflnq
Chung
(%)
234 (86,7)
36 (13,3)
270 MDDP
(%)
25 (96,2)1 (3,8)
26 MDNH
(%)
209 (85,7)
35 (14,3)
244 Kien thuc v l phdng, ching HIV dype danh gid dya trin ede khia cgnh nhy: Hinh thu-c chin dodn, nguyen nhdn lay nhilm, hdu qud, bi|n phdp phdng ngira. Dilm tinh theo thang diem tir 0-9 vd dupe phan thanh hai logi dgt vd khdng dgt vdi diem phdn d i a tgi vi tri phan vj 75%. Kit qua phdn tich cho thIy cd tdi 86,7% PNMD cd kiln thirc v l HIV dgt trong dd ty Ip dgt d MDDP (96,2%), MDNH (85,7%). Da so PNMD ke dypc ten m i t vdi bilu
Y HOC THU'C H A N H (810) - s6 3/2012
hiin m i c STIs nhu: Dau byng dudi (39,3%), chdy mu/huylt tring/khi hu b i t thydng (34,8%), ngua b i ph§n sinh dye (11,1%), tiiu tidn dau bult (7%). dau rdt b i ph$n sinh dye (2,2%). lodt siii b i phdn sinh dye (2,2%). bilu hipn tn§u chirng khde nhy dau khi QHTD (3,3%),
5. M$t sd mdi lien quan
K i t qud phdn tieh eho thIy d mit s i m i i liin quan cd y nghTa thing kS nhy sau: Trinh d i hpe v l n , nghe ndi v l TDAT vd TCAT, logi hinh hogt ding, sy sSn d BCS vd kiln thiKC v l HIV d lidn quan tdi hdnh vi sO- dyng BCS khi QHTD vdi d e logi bgn tinh eiia PNMD, M i l s i nghidn ciru khdc cOng eho kit qud tuang ty [1] [2] [5],
Bdng 4 M i i lidn quan giO'a mit s i y l u t l vdi hdnh vi sir dyng BCS trong l i n QHTD g i n ddy nhlt cua PNMD
Bi^n sA Trinh (30 hgc vdn
s C 4 p 1
> C d p 1 Tirng nghe nfli v6 TDAT
Khfinq nqhe C6 nqhe Tunq nqhe n6l v6 TCAT
Khflng nghe C6 nqhe Logi hinh hogt d^nq
MDDP MDNH NghT khdch I g c f l s i r
dunq ma tuy khflng
C6 S^n cd BCS noi Idm
vi$c Khflng
0 6 Kifin thuc ve HIV
Khflnq dat D^l
S u d g Khflnq 45 16 36 34 42 22 16 54
56 14
14 56 23 47
q B C S Cd 44 156 48 152 84 116
10 190
75 125
11 189 13 167
OR, P, KTC 95%
OR=1t,96, KTC (6,24; 22.93),
P<0,001 OR=3,35, KTC
(1,89,5,92), P<0,001 OR=3,01,KTC
(1,69,5,36), P<0.001 OR=5,63. KTC
(2.41, 13,11).
P<0,001 OR=6,66, KTC
(3,47; 12,79), P<0,001 OR=4,29, KTC
(1,84; 9.99), P<0,001 OR=7.03, KTC
(3,32; 14.92), P<0,001 KET LUAN vA KHUYEN NGHI I . K l t l u ^ n
Hdnh vi nguy ca Idy nhilm HIV a nhdm PNMD bao gim. Ty 1$ su dyng BCS khi QHTD vdi cde logi bgn tinh chua cao. QHTD dydng miing/hdu mdn (6,6%), sir dyng ma tiiy (1,1%), m i c STIs (73%).
- Ty l i PNMD cd kiin thire dgt vd HIV (86,7%).
- Cde y l u t i liin quan tdi hdnh vi siV dyng BCS khi QHTD d nhdm PNMD: TDHV thIp, tin tadng bgn tinh khdng sii' dyng ma tuy, s i lupng bgn tinh trong thdng eao (trin 50 ngydi). logi hinh hogt ddng, nghe ndi vi TDAT vd TCAT, kiln thac phdng ching HIV/AIDS.
2. K h u y i n nghj
- D l y mgnh cde hogt ddng truyin thdng: Tuydn truyin rd han v l dydng Idy, dudng khdng idy, vai trd cua TDAT, TCAT trong phdng, ehing HIV eho PNMD vi ehu chya,
- Khuyin khich sy tham gia cua chu nhd hdng, khdch sgn, PNMD vdo mgng lydi CTV, GDVDD, thydng xuyin tdp huln ndng cao kiln thirc, ky ndng phdng ehing HIV cho hp.
- Tdng cydng khd ndng tilp d n cua PNMD vdi cdc ehyang trinh can thi$p gidm tdc hgi: Ta v l n , xdt nghifm HIV ty nguy$n, khdm STIs luu ddng, d p phdt BKT, BCS miln phi.
T A I L l f U THAM K H A O
1. B i Y t l vd V i i n v i sinh djch t l Trung uang (2005 - 2006), Kit qud ehyang trinh gidm sdt kit hpp hdnh vi vd d e ehi s l sinh hpc HIV/AIDS (IBBS) tgi Vigt Nam.
Nhd xult ban Y hpc, Hd N i l .
2. Cye phing, ching HIV/AIDS-BO Y te (2009), 'Mii liin quan giO-a d e nhilm khuin Idy tnjyIn qua dying tinh dye (STIs) vd nhilm HIV/AIDS', Dgc san d a Cgc phdng, chong HlV/AIDS-Bd Y t l , (02), tr.lO- 13.
3. Nguyin Thj Minh Tdm vd d n g sy (2009), "Kiln thiKC, thdi d i vd hdnh vi liin quan d i n HIV/AIDS eua phy nCf mgi ddm tgi 7 tinh/thdnh p h i Vi$t Nam", Cdc cing trinh nghien cu-u khoa hpe v l HIV/AIDS giai dogn 2006- 2010, Tgp chi Y hpc thy^ hdnh. (742+743). tr 658 - 661, Bd Y te xuat ban. Ha Npi.
4 Nguyen Thi Nhu et al (2007), "Clients of female sex workers as a bringing population in Viet Nam', Journal of practical medicine. (742+743), p.351-354.
Published by Ministry of health. Ha Noi.
5. Duong Le Quyen et al (2009), 'Behavioral sun/ey on condom use and HIV voluntary counseling and testing uptake among male clients of female sex workers in 2009 in Viet Nam", Journal of practical medicine. (742+743), p.293-296. Published by Ministry of health. Ha Noi.
KHAO SAT Sir PHU HOP v i KET QUA KHAM DANH GIA SEO BONG SAU M 6 CUT BE CUNG MAC BANG DEN KHE VA B&NG MAY VISANTE OCT
DAO TH| L A M Hl/dNG - B^nh vi^n Mat trung wong
T 6 M TAT
Muc tiiu: khio sit s y phu hgp vi kit qui dinh gii s?o bgng sau md gidcdm bing ky thuit chup cit Idp phan trwdc nhan ciu (Visante OCT) vi bing din khe (Slit-lamp) tren sinh hien vi. Dii twgng: 67 mit cOa 67 NB gidcdm nguyin phit di <Tiiu trj bing PT cSt bi CGM t^i khoa Gidcdm bgnh vi$n MSt trung wong tir thing 1/2010 din thing 8/2010. Phuung phip: Md ti, dt ngang, cd phin tich. Kit qui: 94,1% mit sgo typ I,
100% mit s^o ti'p 11 theo khim nghiim den khe tuwg Ong vdi 84,6% s^o d^ng nang vi 96,6% spo dgng toi Ian theo khim bing miy Visante OCT cd NA <
21mmHg. /Vguvc /gi ty 1$ mit cd NA £ 21 mmHg cao han d nhdm sgo t^p III (42,9%) vi IV (33.3%) tuung Ong vdi nhdm s^o d^ng dgt (25%) vi d^ng v6 bao (52,9%).
Mil liin quan giira 2 phuung phip lam sing vi Wsanfc OCT cd y nghla thing ki vdi p <0.01 (ca Pearson Chi- Square test vi Fisher's Exact test). S y phO hgp d miJc
Y HOC THVC HANH (810) - S6 3/2012
