Asunto(s)
Instituciones Privadas de Salud/organización & administración , Viviendas para Ancianos/organización & administración , Innovación Organizacional , Anciano , Financiación del Capital , Instituciones Privadas de Salud/economía , Viviendas para Ancianos/economía , Humanos , Renta , Estados UnidosRESUMEN
BACKGROUND: In the United States, an increasing proportion of women infected with the human immunodeficiency virus (HIV) live in nonmetropolitan areas. Little is known, however, about the risk factors for HIV transmission in women outside large cities. METHODS: We interviewed and tested 1082 (99.8 percent) of 1084 consecutive pregnant women who registered for prenatal care at a public health clinic in western Palm Beach County, Florida. This rural agricultural area of about 36,000 people is known to have a high prevalence of HIV infection. RESULTS: The seroprevalence of HIV was 5.1 percent (52 of 1011 women). Black women who were neither Haitian nor Hispanic had the highest rate of infection (8.3 percent [48 of 575]). Only 4 of 1009 women (0.4 percent) reported ever injecting drugs, and the 4 were HIV-seronegative; however, 14 of 43 users of "crack" cocaine (33 percent) had HIV infection. At prenatal registration, 131 of 983 women (13 percent) tested positive for gonorrhea, chlamydial infection, or syphilis. By multivariate logistic-regression analysis, HIV infection was found to be independently associated with having used crack cocaine (odds ratio, 3.3; P < 0.001), having had more than two sexual partners (odds ratio, 4.6; P < 0.001), being black but neither Hispanic nor Haitian (odds ratio, 11; P < 0.001), having had sexual intercourse with a high-risk partner (odds ratio, 5.6; P < 0.001), and testing positive for syphilis (odds ratio, 3.1; P = 0.015). Nevertheless, 11 of the 52 HIV-infected women (21 percent) reported a total of only two to five sexual partners and no known high-risk partners, had never used crack cocaine, and had no positive tests for sexually transmitted disease. CONCLUSIONS: In the rural community we studied, most of the women with HIV infection acquired it through heterosexual contact. The increasing seroprevalence of HIV and the increasing incidence of syphilis and use of crack cocaine mean that other women may be at similar risk of acquiring heterosexually transmitted HIV infection.
Asunto(s)
Infecciones por VIH/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Conducta Sexual , Adulto , Cocaína Crack , Femenino , Florida/epidemiología , Infecciones por VIH/transmisión , Humanos , Embarazo , Grupos Raciales , Análisis de Regresión , Factores de Riesgo , Población Rural , Enfermedades de Transmisión Sexual/complicaciones , Trastornos Relacionados con Sustancias/complicacionesRESUMEN
Since 1935 the State health agency has provided insulin to medically indigent diabetics in Florida. During 1980, data were collected on 9,429 recipients regarding their age, race, sex, height, weight, and type and dosage of insulin. The mean age was 55 years; 47 percent were white and 52 percent were black. Seventy-two percent of the recipients were females and 28 percent were males. The utilization rate was much greater for blacks than for whites in all age-sex groups. Seventy-two percent of the estimated number of insulin-requiring black females used insulin supplied by the health agency, compared with 9 percent of insulin-requiring white females in the State. For black males, the proportion was 37 percent and for the white males, it was 5 percent. Obesity was defined as a Body Mass Index (BMI) of greater than 25 for females and greater than 27 for males. The mean BMIs were 30.9 for females and 27.7 for males. In all age groups, women were more obese than men, and blacks were more obese than whites except for the oldest age group, those 65 and older. The mean total daily dosage of insulin was 46 units, and 95 percent of recipients used NPH or Lente insulin. Insulin dosage per kilogram of body weight showed some decrease as weight increased. The authors concluded that the Florida program reaches a significant proportion of its target population.
Asunto(s)
Diabetes Mellitus/tratamiento farmacológico , Insulina/uso terapéutico , Indigencia Médica , Sistemas de Medicación/organización & administración , Administración en Salud Pública , Adulto , Negro o Afroamericano , Anciano , Antropometría , Femenino , Florida , Humanos , Masculino , Persona de Mediana Edad , Factores Sexuales , Estados Unidos , Población BlancaAsunto(s)
Neoplasias , Sistema de Registros , Adulto , Anciano , Recolección de Datos , Florida , Humanos , Persona de Mediana Edad , Neoplasias/epidemiologíaRESUMEN
Ultrastructural defects were demonstrated in nasal and bronchial cilia from a 12-year-old boy with repeated upper and lower respiratory tract infections. Numerous abnormalities were found, including single axonemes surrounded by excess cytoplasmic matrix, compound cilia, intracytoplasmic microtubular doublets, and cilia contained within a periciliary sheath. Dynein arms were missing from the majority of the peripheral microtubular doublets. The most striking abnormality, however, was a disorientation of cilia as judged by the increased variation in the orientation of central microtubules. Because of these ultrastructural abnormalities, it is highly likely that ciliary motility was markedly decreased and that defective mucociliary transport was responsible for chronic and repeated upper respiratory tract infections.
Asunto(s)
Bronquios/ultraestructura , Cilios/ultraestructura , Mucosa Nasal/ultraestructura , Infecciones del Sistema Respiratorio/patología , Niño , Enfermedad Crónica , Cilios/fisiología , Citoplasma/ultraestructura , Dineínas , Humanos , Masculino , Microtúbulos/ultraestructura , Infecciones del Sistema Respiratorio/fisiopatologíaRESUMEN
The effects of specific antibodies in chronic echovirus type 5 (echo 5) encephalitis were investigated in a patient with x-linked hypogammaglobulinemia. Virus was detected in cerebrospinal fluid (CSF) and blood despite treatment with commercial human gammaglobulin that contained low titers of antibodies to echo 5 (0.6 x 10(4) units per injection). Virus disappeared from blood and CSF when plasma containing high concentrations of antibodies (total dose, 1--4 x 10(4) units/kg) was administered intravenously. Maximal inhibition of virus was achieved in culture and in the patient's CSF when the titer of antibody to echo 5 in CSF was greater than or equal to 16 units/ml. Although the patient died, hyperimmune plasma improved the neurologic status and eliminated detectable virus from the blood and CSF.
Asunto(s)
Agammaglobulinemia/complicaciones , Especificidad de Anticuerpos , Encefalitis/inmunología , Enterovirus Humano B/inmunología , Anticuerpos Antivirales/administración & dosificación , Transfusión Sanguínea , Preescolar , Enfermedad Crónica , Encefalitis/complicaciones , Enterovirus Humano B/aislamiento & purificación , Humanos , Interferones/líquido cefalorraquídeo , Masculino , Plasma/trasplante , gammaglobulinas/uso terapéuticoRESUMEN
During the period August 9--13, 1976, 21 of 89 residents of a nursing home in southeastern Florida had sudden onset of fever--temperature greater than 38.1 degrees C (100.6 degrees F) with no accompanying symptoms. Five residents, whose temperatures ranged from 39.4 degrees C (103 degrees F) to 41.3 degrees C (106.4 degrees F), died. No viral or bacterial pathogens were isolated. None of the nursing home's 123 employees and volunteers had similar illness. The air-conditioning system was shut down for repairs from August 9 through August 12, a time when recorded peak temperatures outdoors ranged from 30.6 degrees C (87 degrees F) to 32.2 degrees C (90 degrees F). The only recorded temperature inside the nursing home for that period was 31.7 degrees C (89 degrees F). Laboratory and epidemiologic data were consistent with the theory that the illness was due to hyperpyrexia, secondary to environmental conditions, rather than to an infectious agent. The episode was considered analogous to the nonspecific increased mortality of elderly and chronically ill persons during an urban heat wave. The episode points up the need for prompt recognition and intervention when there is the potential for heat stress in elderly and chronically ill patients. Buildings housing such patients must be designed so that alternative ventilation can be provided when the central air-conditioning system fails.