Asunto(s)
Trazado de Contacto/legislación & jurisprudencia , Revelación , Deber de Advertencia/legislación & jurisprudencia , Infecciones por VIH/transmisión , Educación del Paciente como Asunto/legislación & jurisprudencia , Revelación de la Verdad , Adolescente , Transfusión Sanguínea/legislación & jurisprudencia , California , Niño , Femenino , Humanos , MasculinoRESUMEN
A significant proportion of adolescent girls engaging in risky behaviors will use confidential HIV counseling and testing services that are linked to primary care. Health-care providers play an important role in helping teens address their risk for and concerns about HIV infection by engaging adolescents in repeated discussions about HIV testing.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/psicología , Transmisión de Enfermedad Infecciosa/legislación & jurisprudencia , Síndrome de Inmunodeficiencia Adquirida/transmisión , Miedo , Humanos , Trastornos Fóbicos , Estrés Psicológico , Heridas y Lesiones/sangre , Heridas y Lesiones/virologíaRESUMEN
In October 1989, more than 3 years after the nuclear power plant accident at Chernobyl, in the Ukraine, the Government of the Union of Soviet Socialist Republics requested that the International Atomic Energy Agency (IAEA) evaluate the medical and psychological health of residents living in areas identified as being contaminated with radioactive fallout. The IAEA designed and conducted a collaborative study to examine whether there were any measurable effects of exposure to the low levels of ionizing radiation resulting from the accident. The study, using structured interviews and IAEA laboratory equipment, collected data on more than 1,350 residents of 13 villages. IAEA clinical staff members concluded that they could not identify any health disorders in either the contaminated or nearby (uncontaminated) control villages that could be attributed directly to radiation exposure. The clinical staff, however, did note that the levels of anxiety and stress of the villagers appeared to be disproportionate to the biological significance of the levels of IAEA-measured radio-active contamination. Almost half the adults in all the villages were unsure if they had a radiation-related illness. More than 70 percent of persons in the contaminated villages wanted to move away, and approximately 83 percent believed that the government should relocate them. The IAEA effort indicates that the villagers need to be educated about their actual risks, and they need to understand what types of illnesses are, and are not, associated with exposure to radioactive contamination. Unfortunately, the villagers' needs may exceed the available resources of their local and central governments.
Asunto(s)
Accidentes/psicología , Reactores Nucleares , Traumatismos por Radiación/psicología , Adulto , Niño , Preescolar , Humanos , Agencias Internacionales , Persona de Mediana Edad , Dosis de Radiación , UcraniaRESUMEN
In this longitudinal study of 9,904 clients who were treated at methadone, outpatient drug-free (OPDF), and residential treatment facilities, at intake more than half of all clients reported symptoms of depression or suicide. Females and multiple nonnarcotics users were at highest risk for suicide attempts. Despite a dramatic drop in the level of symptomatology by 4 weeks in treatment, many clients remained suicidal throughout the study period. Suicidal tendencies at both intake and 4 weeks were strongly related to suicidal tendencies at 12 months post-treatment; even more strongly related was the return to weekly or more frequent use of narcotics or nonnarcotics for residential and OPDF clients.
Asunto(s)
Trastorno Depresivo/etiología , Trastornos Relacionados con Sustancias/terapia , Intento de Suicidio/estadística & datos numéricos , Suicidio , Adulto , Terapia Cognitivo-Conductual , Trastorno Depresivo/epidemiología , Femenino , Humanos , Estudios Longitudinales , Masculino , Prevalencia , Centros de Tratamiento de Abuso de Sustancias , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/psicología , Suicidio/estadística & datos numéricos , Intento de Suicidio/psicologíaRESUMEN
The significance of serum IgG and IgA antibodies to cytomegalovirus (CMV) at various stages of human immune deficiency virus (HIV) infection was studied in 175 homosexual men. Sera were obtained from 123 HIV seropositives [41 asymptomatic, 29 with lymphadenopathy associated syndrome (LAS), 22 with AIDS related complex (ARC), and 31 AIDS patients], 17 HIV seroconverters, and 35 HIV asymptomatic seronegatives. The sera were tested blindly for CMV IgA and IgG antibodies using the immunoperoxidase assay (IPA) and CMV infected human embryo cells. Cross-sectional analysis of CMV IgG antibodies at a titer of greater than or equal to 20 showed 87% and 100% prevalence in the HIV seronegative groups and in the HIV seropositive groups, respectively (P less than 0.05). CMV IgG antibodies at a titer of greater than or equal to 80 were present in significantly higher proportions among the HIV seropositive subjects of the various groups as compared with the HIV seronegative homosexual men. However, in the HIV seronegatives who later seroconverted to HIV, a significantly higher prevalence of CMV antibodies (35%) was detected before HIV seroconversion, as compared with the persistently HIV seronegative subjects (14.3%) (P less than 0.05). The HIV seronegatives pre-HIV seroconversion also exhibited a significantly higher geometric mean titer (GMT) of CMV IgG antibodies (62.17 +/- 0.64) as compared with the persistently HIV seronegatives (34.0 +/- 0.6) (P = 0.03). Significantly higher GMTs of CMV IgG antibodies were detected in all the HIV seropositive groups as compared with the persistently HIV seronegative group. CMV IgG antibodies were not detected in the HIV seronegative subjects.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Anticuerpos Antivirales/sangre , Citomegalovirus/inmunología , Infecciones por VIH/microbiología , Adulto , Citomegalovirus/patogenicidad , Infecciones por Citomegalovirus/complicaciones , Infecciones por VIH/complicaciones , Infecciones por VIH/etiología , Seropositividad para VIH/microbiología , Homosexualidad , Humanos , Inmunoglobulina A/metabolismo , Inmunoglobulina G/metabolismo , MasculinoRESUMEN
The Chernobyl Nuclear Power Plant accident, in the Ukrainian Soviet Socialist Republic (SSR), on April 26, 1986, was the first major nuclear power plant accident that resulted in a large-scale fire and subsequent explosions, immediate and delayed deaths of plant operators and emergency service workers, and the radioactive contamination of a significant land area. The release of radioactive material, over a 10-day period, resulted in millions of Soviets, and other Europeans, being exposed to measurable levels of radioactive fallout. Because of the effects of wind and rain, the radioactive nuclide fallout distribution patterns are not well defined, though they appear to be focused in three contiguous Soviet Republics: the Ukrainian SSR, the Byelorussian SSR, and the Russian Soviet Federated Socialist Republic. Further, because of the many radioactive nuclides (krypton, xenon, cesium, iodine, strontium, plutonium) released by the prolonged fires at Chernobyl, the long-term medical, psychological, social, and economic effects will require careful and prolonged study. Specifically, studies on the medical (leukemia, cancers, thyroid disease) and psychological (reactive depressions, post-traumatic stress disorders, family disorganization) consequences of continued low dose radiation exposure in the affected villages and towns need to be conducted so that a coherent, comprehensive, community-oriented plan may evolve that will not cause those already affected any additional harm and confusion.
Asunto(s)
Accidentes/mortalidad , Reactores Nucleares , Accidentes/psicología , Animales , Contaminación Radiactiva de Alimentos , Necesidades y Demandas de Servicios de Salud , Humanos , Morbilidad , Neoplasias Inducidas por Radiación/etiología , Neoplasias Inducidas por Radiación/mortalidad , Ceniza Radiactiva/efectos adversos , Contaminantes Radiactivos/análisis , U.R.S.S. , Ucrania/epidemiologíaAsunto(s)
Síndrome de Inmunodeficiencia Adquirida/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Síndrome de Inmunodeficiencia Adquirida/congénito , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Síndrome de Inmunodeficiencia Adquirida/transmisión , Femenino , Infecciones por VIH/congénito , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Humanos , Cuidado del Lactante , Recién Nacido , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Atención Prenatal , Estados Unidos/epidemiologíaRESUMEN
In a cross-sectional study of 926 subjects from 10 drug treatment programs conducted in 1984 in New Jersey, the seroprevalence of human immunodeficiency virus (HIV) was 35% overall; 30% in whites, 33% in hispanics, and 46% in blacks (p = 0.01 for comparison of blacks to non-blacks). Univariate analysis showed the seroprevalence of HIV was not associated with age or gender, but did correlate with frequency of cocaine or heroin injection (p trend less than 0.001); frequency of needle sharing (p trend = 0.007); and inversely with levels of education (p = 0.05). The prevalence of HIV was also inversely related to the distance of the treatment center from lower Manhattan; being highest for distances of less than 5 miles from lower Manhattan and lowest for distances of 80 miles, with intermediate rates for the intervening distances (p trend less than 0.001). In multivariate analyses, HIV seropositivity was consistently associated with the frequency of needle sharing (p = 0.02) and less than 12 years (high school level) of education (p = 0.02), but not with black race. However, blacks who shared needles less than once a month had a relative risk of 3.2 (95% CI 1.2, 7.7) while non-blacks who shared less than once a month had a relative risk of only 0.9 (95% CI 0.3, 2.4). The risk in non-blacks increased to more than twofold with more frequent needle sharing. When the analysis was stratified by gender and adjusted for needle sharing and geography, a significant twofold increased risk was observed for female (but not male) subjects who had two or more heterosexual partners compared with those who had one partner.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Infecciones por VIH/epidemiología , Seroprevalencia de VIH , Conducta Sexual , Abuso de Sustancias por Vía Intravenosa , Adulto , Análisis de Varianza , Cocaína , Estudios Transversales , Etnicidad , Femenino , Heroína , Humanos , Masculino , Persona de Mediana Edad , Agujas , New Jersey/epidemiología , Factores de Riesgo , Centros de Tratamiento de Abuso de SustanciasRESUMEN
Seroprevalence of human immunodeficiency virus type 1 (HIV-1) and human T lymphotropic virus types I and II (HTLV-I/II) was determined among 1160 intravenous (iv) drug abusers from five drug treatment or medical centers (Manhattan, Brooklyn, New Jersey, Detroit, and New Orleans). HIV-1 infection ranged from 5% in New Orleans to 48% in New York City. Hispanics and blacks had a significantly higher rate of HIV-1 infection than whites (P less than .01), but within each group rates were similar between males and females and by age stratum. HTLV-I/II seroprevalence increased with age from 3% in the 20-29 year age group to 37% in the group greater than 50 years. New Orleans and Manhattan (24%) had the highest rate, and blacks (19%) had a higher rate than either Hispanics (6.3%) or whites (7.3%). No association between HIV-1 and HTLV-I/II infection was observed except in Manhattan. When compared with iv drug abusers infected only with HIV-1, dually infected subjects had more clinical symptoms related to immune deficiency but a lower prevalence of HIV antigenemia. These data document the frequent occurrence of retroviral infections in iv drug abusers. The contrast between the two classes of virus suggests that HIV-1 is more efficiently transmitted, while the age-dependent rise in HTLV-I/II seroprevalence suggests cumulative exposure of a less-transmissible agent.
Asunto(s)
Infecciones por VIH/epidemiología , VIH-1 , Infecciones por HTLV-I/epidemiología , Infecciones por HTLV-II/epidemiología , Abuso de Sustancias por Vía Intravenosa/complicaciones , Adulto , Negro o Afroamericano , Factores de Edad , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/etnología , Seroprevalencia de VIH , VIH-1/inmunología , Anticuerpos Anti-HTLV-I/sangre , Infecciones por HTLV-I/complicaciones , Infecciones por HTLV-I/etnología , Anticuerpos Anti-HTLV-II/sangre , Infecciones por HTLV-II/complicaciones , Infecciones por HTLV-II/etnología , Hispánicos o Latinos , Humanos , Louisiana/epidemiología , Masculino , Michigan/epidemiología , Persona de Mediana Edad , New Jersey/epidemiología , Ciudad de Nueva York/epidemiología , Prevalencia , Factores Sexuales , Población BlancaRESUMEN
The Public Health Service (PHS) is the second oldest uniformed service of the United States; its tradition commenced with the establishment of the Marine Hospital Service in 1798. Congress, in 1889, established the United States Public Health Service Commissioned Corps under the aegis of the Treasury. The Corps was created as a uniformed nonmilitary service with a distinct uniform, insignia, and with titles, pay, and retirement protocols that corresponded to those of the uniformed military services (the Armed Forces). Initially the health care system of the country, and Commissioned Corps members, were concerned with infectious and vitamin-deficiency diseases; more recently the nation's medical community has focused on cardiovascular diseases, cancer, and AIDS. A comprehensive revitalization of the Commissioned Corps began in April 1987. The intent was to restore the Commissioned Corps to its traditional leadership role as a cadre of mobile, compassionate experts ensuring the nation's health. The revitalization activities have been successful. The Commissioned Corps has approximately 5,500 active duty officers. The Surgeon General directed the development of career tracks for 11 categories of commissioned officers to increase the opportunities for professional development within the PHS and thus increase retention and professional growth. The theme for the 1989 celebration of the centennial of the Commissioned Corps is "a century of service with distinction." A hundred years from now, at the bicentennial of the Commissioned Corps, the current Surgeon General would like it to be said that the Public Health Service has had "two centuries of service with distinction."
Asunto(s)
United States Public Health Service/organización & administración , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Síndrome de Inmunodeficiencia Adquirida/terapia , Adolescente , Preescolar , Control de Enfermedades Transmisibles/métodos , Promoción de la Salud/métodos , Historia del Siglo XIX , Historia del Siglo XX , Humanos , Investigación , Prevención del Hábito de Fumar , Estados Unidos , United States Public Health Service/historiaRESUMEN
A cohort of 2915 HIV-1-seronegative men from the four centers of the Multicenter AIDS Cohort Study (MACS) was followed at 6 month intervals for 24 months to identify men who developed antibodies to HIV-1. Two hundred thirty-two men (8%) seroconverted. The highest attack rate was among men who reported practicing both receptive and insertive anal-genital intercourse. The attack rate among men who reported practicing receptive but not insertive intercourse was 3.6 times higher than among men practicing insertive intercourse although those practicing insertive only reported 38% more different partners. Only two men seroconverted who reported not practicing analgenital intercourse in the 12 month prior to the first antibody-positive visit. Because men were followed every 6 months, one of these men could have been infected within 6 months of the actual development of HIV-1 antibodies. The seroconversion rate was significantly lower among men who reported using condoms with all their partners. The results of this study (a) reaffirm that receptive anal-genital intercourse is the major route of infection among homosexual men of HIV-1, (b) suggest that there is a low risk of HIV-1 infection to the insertive partner in anal-genital intercourse, (c) suggest that infection may rarely occur through sexual activities other than anal-genital intercourse, (d) provide evidence that condoms as currently used by men in the MACS provide significant but not complete protection against HIV-1 infection, and (e) suggest that the number of men in the homosexual community engaging in high-risk behavior is declining.
Asunto(s)
Dispositivos Anticonceptivos Masculinos , Seropositividad para VIH , Conducta Sexual , Bisexualidad , Estudios de Seguimiento , Homosexualidad , Humanos , MasculinoRESUMEN
Drug-abuse treatment may have important direct and indirect effects on restricting the spread of infection with human immunodeficiency virus by decreasing the prevalence of intravenous drug use and by decreasing regular drug use that impairs the immune system. Drug-abuse treatment results in substantial declines in the use of heroin, cocaine, prescription psychotherapeutic drugs, and other drugs in the year after treatment. Declines are closely related to the length of time spent in treatment; treatment duration of greater than or equal to 6 months has a significant impact on drug use after treatment. The potential impact of drug-abuse treatment in combatting the AIDS epidemic is discussed.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/prevención & control , Trastornos Relacionados con Sustancias/rehabilitación , Síndrome de Inmunodeficiencia Adquirida/etiología , Síndrome de Inmunodeficiencia Adquirida/transmisión , Alcoholismo/complicaciones , Alcoholismo/rehabilitación , Cocaína , Dependencia de Heroína/complicaciones , Dependencia de Heroína/rehabilitación , Humanos , Abuso de Marihuana/complicaciones , Abuso de Marihuana/rehabilitación , Metadona/uso terapéutico , Estudios Prospectivos , Psicotrópicos , Análisis de Regresión , Trastornos Relacionados con Sustancias/complicacionesRESUMEN
Selected findings from the Multicenter AIDS Cohort Study (MACS) of homosexual/bisexual men are reviewed. High risk sexual behaviors, the use of drugs/alcohol, condom use, and behavior change are addressed in a public health context. The potential significance of education/behavior modification programs as strategies for public health intervention emerges from these findings. Until there is a realistic timetable for vaccine availability and more effective chemotherapy, the MACS provides the opportunity to continue to study the effects of behavior change on the AIDS epidemic.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Síndrome de Inmunodeficiencia Adquirida/transmisión , Bisexualidad , Estudios de Cohortes , Dispositivos Anticonceptivos Masculinos , Seropositividad para VIH , Homosexualidad , Humanos , Estilo de Vida , Masculino , Estudios Multicéntricos como Asunto , Factores de Riesgo , Conducta SexualRESUMEN
Longitudinal data on four visits scheduled at 6 month intervals were available on a cohort of 1,827 homosexual men who were human immunodeficiency virus (HIV) seropositive at entry. To identify predictors of the rate of decline of CD4 T-lymphocytes, we used an autoregressive model that relates CD4 counts to predictor variables, while adjusting for previous CD4 counts. Significant predictors of steeper decline of CD4 counts were high CD8 count, low hemoglobin, low platelets, high serum IgA, high cytomegalovirus (CMV) antibody, and low HIV antibody. Using the fitted model, a subject with an initial deficit of 314 CD4 cells (median value of study sample) with respect to seronegative subjects and with average values in all other predictors is estimated to lose approximately 53 cells in a 6 month period (95% C.I. = 45-61 cells). Contrasting this estimate to the one obtained with similar methods in intravenous drug users, it is suggested that a faster rate of decline is present among i.v. drug users. This analysis provides evidence that several covariates in addition to previous number of CD4 counts have significant predictive power for estimating the decline in CD4 counts in HIV seropositive subjects.