Swimmer 1, a new low-copy-number LINE family in teleost genomes with sequence similarity to mammalian L1.
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Animals↗
Biomedical subjects
B J Turner
Publications and source records attributed to B J Turner.
Profile of Medicare beneficiaries with AIDS: application of an AIDS casefinding algorithm.
This profile of Medicare beneficiaries with acquired immunodeficiency syndrome (AIDS) was developed by applying a casefinding algorithm to virtually all Medicare claims from 1991-93. The algorithm identified more than 37,000 beneficiaries with AIDS, approximately 21,000 of whom were living at the end of 1993. These estimates suggest that as many as 12 percent of people living with AIDS at the end of 1993 were covered by Medicare. Medicare expenditures for these beneficiaries averaged more than $2,400 per month and totaled more than $500 million in 1993. These expenditures are likely to rise as more people with AIDS live long enough to qualify for Medicare coverage.
Acquired Immunodeficiency Syndrome↗
Two-part survival models applied to administrative data for determining rate of and predictors for maternal-child transmission of HIV.
In analysing maternal-child HIV transmission from Medicaid claims data, we must deal with follow-up that is sometimes so short that we cannot claim that an apparently uninfected infant is actually uninfected as opposed to not yet exhibiting HIV-associated symptoms. To overcome this, we have been using analyses of 'time-to-diagnosis' of HIV infection to estimate transmission rates and predictors of transmission. Such analyses mix the event of transmission with that of our ability to diagnose HIV infection from coded claims data. We would like to separate these two pieces. Also, due to incomplete follow-up, Kaplan-Meier analyses will underestimate transmission rates. In econometrics and biostatistics there are two-part (mixture) models that can serve the goal of separating transmission from the process of diagnosing HIV infection in the newborn. Farewell describes a model that combines a logistic regression for the yes/no event (in our case, HIV transmission) and a Weibull regression model for the survival analysis portion (in our case, time-to-diagnosis). We use this approach to fit models that have potentially separate covariates for transmission and for time-to-diagnosis. The results allow us to identify predictors of transmission and estimate transmission rates with reduced concern for adequacy of follow-up.
Confidence Intervals↗
Cigarette smoking and maternal-child HIV transmission.
We investigated the association of cigarette smoking with maternal-child HIV transmission, adjusting for illicit drug use, maternal clinical status, and delivery factors. Vital statistics birth data were linked to the New York State Medicaid HIV/AIDS Research Database for HIV-infected women delivering a liveborn singleton from 1988 through 1990. Follow-up of these children was accomplished by Medicaid data > or = 2 years after birth, and their HIV status was ascertained by a clinically based classification. The adjusted relative risk or hazard (RH) of transmission for maternal factors was determined from Cox models. The overall transmission was 24.5% for the 901 maternal-child pairs. Smokers comprised 40% of women with data on smoking (n = 768); their transmission rate was 31% versus 22% for nonsmokers (p = 0.02). In the entire cohort, the adjusted RH of transmission for smokers was 1.45 (95% confidence interval [CI] 1.07-1.96); among women with advanced HIV, the adjusted RH was even higher (RH = 1.71; 95% CI 1.14-2.58). Users of cocaine (15% of the cohort) or of mixed or unspecified illicit drugs (28%) had higher transmission rates in unadjusted analysis (33%, p = 0.06 and 31%, p = 0.06 respectively); after adjustment for smoking and other maternal factors, neither cocaine (RH = 1.04 (95% CI 0.66-1.63)) nor mixed nor unspecified drug use (RH = 1.13 (95% CI = 0.75-1.70)) was significantly associated with transmission. Our data document an association of cigarette smoking during pregnancy with an increased risk of maternal-child HIV transmission that can be added to the growing list of complications caused by cigarette smoking.
Adolescent↗
Clinic services for persons with AIDS. Experience in a high-prevalence state.
OBJECTIVE: To profile characteristics of clinics caring for persons with advanced HIV infection. DESIGN AND SETTING: Survey of clinic directors in New York State. PARTICIPANTS: Newly diagnosed Medicaid-enrolled AIDS patients in New York state in federal fiscal years 1987-1992 (n = 6,184) managed by 62 HIV specialty, 53 hospital-based general medicine/primary care, 36 community-based primary care, and 28 other clinics. MEASUREMENTS AND MAIN RESULTS: Telephone survey about clinic hours, emphasis on HIV, staffing, procedures, and directors' rating of care. Estimates of the number of newly diagnosed, Medicaid-enrolled AIDS patients treated in surveyed clinics were obtained from claims data. We found that community-based clinics were significantly more likely to have longer hours, a physician on call, or to accommodate unscheduled care than were hospital-based general medicine/ primary care or other types of clinics. Compared with HIV specialty clinics, general medicine/primary care clinics were less likely to have HIV-specific care attributes such as a director of HIV care (98% vs 72%), multidisciplinary conferences on HIV care (83% vs 32%), or a standard initial HIV workup (90% vs 70%). Of general medicine/primary care clinics, most (83%) were staffed by residents and fellows compared with only 68% of HIV or 25% of community-based clinics (p < .001). General medicine/primary care clinics were less likely than community-based clinics to perform Pap smears (75% vs 94%) or to have case managers on payroll (21% vs 81%). CONCLUSIONS: In this sample of clinics, hospital-based general medicine/primary care clinics managing the care of Medicaid enrollees with AIDS appeared to have more limited hours and availability of specific services than HIV specialty or community-based clinics.
Ambulatory Care Facilities↗
Attitudes toward health-care, HIV infection, and perinatal transmission interventions in a cohort of inner-city, pregnant women.
The objective of this article is to explore attitudes of an inner-city, pregnant cohort about general and HIV-related prenatal care. Responses to an interview at initial prenatal care enrollment were compared using Chi-square and Fisher's exact tests. Of 75 women, drug users (51%) were more likely to say that they would defer initiating prenatal care (P = 0.03) and to minimize the risk of drug or alcohol use to the fetus (P = 0.04). Most (85%) viewed pregnancy as inappropriate for HIV infected women and primarily drug users (P = 0.06) would abort if HIV infected. Over half thought HIV transmission occurred most times or always. Only 20% had heard of a drug to reduce this risk, but 95% would take such a therapy. These inner-city, pregnant women disapproved of pregnancy if HIV infected and thought the risk of transmission was high. They knew little of how to reduce this risk but nearly all would accept a drug to prevent transmission.
Adolescent↗
Prevention of vertical HIV transmission with zidovudine: projected impact of HIV testing and prenatal care.
We sought to estimate the impact of maternal HIV testing and prenatal care on the potential to reduce vertical transmission through zidovudine (AZT) use by HIV-infected mothers. We evaluated the prepartum maternal HIV diagnosis rate, prenatal care, disease stage, and vertical transmission rate (from a two-part mixture model) using New York State Medicaid and vital statistics data for HIV-infected mothers and their singletons in 1985-90. We used published data to estimate the effect of AZT on vertical transmission and expert input to define other parameters for the model. Our HIV-infected (N = 1514) had a vertical transmission rate of 27.0%. HIV was diagnosed prepartum for 39.5% of women in 1990. Transmission would have been 22.2% if AZT had been taken only by the subset of women diagnosed prepartum with HIV and receiving prenatal care by 34 weeks gestation (86.7%). Transmission would have dropped to 11.2% if all women had been diagnosed prepartum with HIV and received adequate prenatal care. The observed deficiencies in prenatal care and maternal HIV diagnosis rates in this Medicaid population-based cohort must be addressed to realize the promise of AZT to reduce vertical transmission.
Adult↗
HIV-1 infection in a population-based twin sample.
OBJECTIVE: To examine factors associated with perinatal HIV-1 transmission among twins. METHODS: We identified twins delivered by a population-based cohort of HIV-infected mothers on New York State Medicaid. Tested algorithms were applied to Medicaid files to identify HIV infection in mothers and twins. The HIV transmission rate 3 years after delivery was assessed from Kaplan-Meier curves. Proportional hazards models with adjustment for twin clustering were used to determine the relative hazard (RH) of transmission. RESULTS: In 35 twin pairs, transmission was 20.5%. The risk of transmission was increased significantly for advanced maternal HIV infection (rh = 10.8, 95% confidence interval 2.11, 54.9). We found no association of birth order with twin HIV status. CONCLUSIONS: These data suggest that maternal stage of disease plays a greater role in vertical HIV transmission than birth order. To prevent maternal-child HIV transmission, reducing maternal viral load is likely to have a greater impact than modifying delivery factors.
Adult↗
Association of maternal HIV infection with low birth weight.
We evaluated factors associated with low birth weight (LBW) in an HIV-infected cohort (n = 772) and a general sample (n = 2,377) of women delivering a live singleton in federal fiscal years 1989 and 1990 while enrolled in New York State Medicaid. The association of LBW and HIV infection was studied in logistic models, controlling for illicit drug use, demographic characteristics, adequacy of prenatal care, and medical risk factors. Overall, 29% of the HIV-infected women had a LBW infant compared to 9.3% of the general sample (p < 0.001). The adjusted odds of LBW for HIV-infected women were twofold higher than for uninfected women [odds ratio (OR) = 2.04 and 95% confidence interval (Cl) = 1.54, 2.69]. Odds of LBW were also increased for illicit drug users (OR = 2.16; 95% CI = 1.59, 2.94), cigarette smokers (OR = 1.81; 95% CI = 1.37, 2.39), and African-American versus non-Hispanic white women (OR = 1.89; 95% CI = 1.31, 2.72). Lower odds appeared for women with adequate prenatal care (OR = 0.54; 95% CI = 0.42, 0.68). Among only women with full-term deliveries, the association of HIV with LBW remained strong as we found nearly threefold greater odds of LBW for HIV-infected women. This study indicates that HIV-infected women have an increased risk of bearing a L.BW infant, even after adjusting for the effects of drug use, health care delivery, and other social and medical risk factors.
Adolescent↗
Race, sex, drug use, and human immunodeficiency virus disease.
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Acquired Immunodeficiency Syndrome↗
Health care of children and adults with acquired immunodeficiency syndrome. A population-based analysis.
OBJECTIVES: To compare the use of medical services by pediatric and adult patients with acquired immunodeficiency syndrome (AIDS) in the 6 months before and after the diagnosis of AIDS when demand for care is often high and to study the influence of human immunodeficiency virus specialty care on survival of pediatric patients. DESIGN: Retrospective analysis of Medicaid files. SETTING: New York State Medicaid Program. PATIENTS: A cohort identified as having AIDS from 1985 through 1990 and enrolled on Medicaid from birth or 1 year or more before diagnosis. Because of differing prognoses, 3 groups were studied by age at the time that AIDS was diagnosed: infants younger than 6 months, children aged 6 months to 12 years, and adults aged 13 to 60 years. MAIN OUTCOME MEASURES: Frequencies of any service use and, among users, monthly rates of services. From Cox proportional hazards models, the adjusted hazard of death for human immunodeficiency virus specialty ambulatory care. RESULTS: Nearly all infants (n = 122) were hospitalized before and after the diagnosis of AIDS was made--the most of all groups. After diagnosis, only 81% of older children (n = 612) were hospitalized vs 93% of infants and 90% of adults (n = 5602). Hospitalized children had a median of only 3.3 inpatient days per month vs 12.3 and 7.8 inpatient days for infants and adults, respectively. Of older children, 45% used the emergency department vs 33% of adults. Human immunodeficiency virus specialty care for infants and children was associated with a 40% lower risk of death after the diagnosis of AIDS. CONCLUSIONS: In this AIDS cohort, infants had the greatest use of inpatient care, and older children used the emergency department more than adults. The finding of improved survival for infants and children with human immunodeficiency virus specialty care warrants further study in more recent years.
Acquired Immunodeficiency Syndrome↗
Estimation of survival after AIDS diagnosis: CD4 T lymphocyte count versus clinical severity.
We compared the relative contribution to estimating survival after AIDS diagnosis of a clinical severity measure, the Severity Index for Adults with AIDS (SIAA), and laboratory values at AIDS diagnosis that are often used prognostically. Three SIAA categories were defined from the first AIDS-defining condition and the most severe complication within 3 months. We studied 421 Italian patients surviving > or = 3 months after AIDS diagnosis. Survival curves for laboratory measures grouped by quartile showed poorest survival for CD4 count <100/microliter, hemoglobin <8 g/dl, total lymphocyte count <400/microliter, and albumin <3 g/dl. Adjusting for demographics and zidovudine therapy, the estimated hazard of death was 2.4 (95% CI, 1.6-3.5) for CD4 counts <100/microliter versus higher counts and 4.9 (95% CI, 3.0- 7.8) for the most versus the least severe SIAA category. SIAA offered greater prognostic discrimination than CD4 count at AIDS diagnosis.
AIDS Serodiagnosis↗
The role of functional status in predicting inpatient mortality with AIDS: a comparison with current predictors.
To assess the independent prognostic role of functional status, as reflected by a measure of an inpatient's global requirement for nursing assistance with basic activities of daily living (Global ADL), we compared Global ADL with three validated AIDS mortality predictors: the Clinical AIDS Prognostic Staging (CAPS); the Severity Classification System for AIDS Hospitalization--version 2 (SCAH-2); and CD4 cell count. Our study sample consisted of 1392 patients with AIDS and a hospital stay of 3 or more days at one of 20 hospitals in 11 U.S. cities with high AIDS incidence. Data were collected from September 1990 through December 1991. Two percent of patients refused participation, and 26% were eliminated due to incomplete data collection, leaving an analytic sample of 1003 patients. Only 30% of patients had a CD4 count measured at any time during hospitalization. Cox regression was used to measure the hazard of inpatient mortality adjusted for length of stay. Overall mortality was 12%. Mortality rates for patients in Global ADL stages I-IV were 3%, 8%, 19%, and 51%, respectively (p < 0.0001). Global ADL more effectively discriminated mortality than CAPS (p < 0.001), SCAH-2 (p < 0.001), or CD4 count (p < 0.001). Global ADL also added independent information in analyses adjusted for both CAPS and SCAH-2: a single stage increase of Global ADL demonstrated a 1.9-fold increased hazard of death (CI: 1.6, 2.3). SCAH-2, assigned at discharge, was not strongly correlated with admission predictors (Global ADL: r = 0.17; CI: 0.11, 0.23 or CAPS: r = 0.03, CI: 0.02, 0.17). We conclude that Global ADL, alone or in tandem with other severity systems, provides an excellent severity adjustment for inpatient mortality with AIDS. Finally, CD4 cell counts were not routinely available and were not as predictive as Global ADL in the patients for whom both were available.
Acquired Immunodeficiency Syndrome↗
The severity classification system for acquired immunodeficiency syndrome hospitalizations. Association with survival after discharge and inpatient resource use.
The Severity Classification for AIDS Hospitalizations (SCAH) was applied to a longitudinal person-based data set of Maryland adult residents diagnosed with acquired immunodeficiency syndrome (AIDS) between 1983 and 1989 to predict long-term survival. In contrast to other AIDS severity measures, SCAH can be applied to administrative data bases for analyses of large populations. Although SCAH was created to predict inpatient mortality using cross-sectional hospital discharge data, the models used in this study show SCAH stage at first AIDS hospitalization to predict long-term survival in persons with AIDS, even after adjusting for sociodemographic and treatment variables. Additional models in the study show SCAH stage at first hospitalization has a strong association with inpatient length of stay and associated charges, making it useful for health care resource planning.
Acquired Immunodeficiency Syndrome↗
Prenatal care and birth outcomes of a cohort of HIV-infected women.
Adequate prenatal care has been linked to improved birth outcomes in general populations but has not been assessed in HIV-infected women. We examined longitudinal claims files and vital statistics records for women in the New York State Medicaid HIV/AIDS data base delivering a singleton from 1985 through 1990. Adequacy of the self-reported number of prenatal visits was assessed by the Kessner index. In logistics models, we estimated the association of prenatal care, illicit drug use, and other maternal characteristics with three outcomes; low birth weight, preterm birth, and small-for-gestational-age. Of 2,254 singletons delivered by this HIV-infected cohort, 28% were low birth weight, 23% were preterm birth, and 20% were small for gestational age. Two-thirds had inadequate prenatal care. Non-drug users had 57 and 26% lower adjusted odds of low birth weight and preterm delivery than drug users. The adjusted odds of low birth weight and preterm birth for women with an adequate number of prenatal visits were, respectively, 48 and 21% lower than for women with inadequate care. Adequate prenatal care was also associated with a 43% reduction in the odds of small-for-gestational-age. An adequate number of prenatal visits by women in this HIV cohort was associated with a significant reduction in all three adverse birth outcomes, but most had inadequate prenatal care. These data support strengthening efforts to bring pregnant, HIV-infected women into care.
Adult↗
Prenatal care of HIV-infected women: analysis of a large New York State cohort.
We examined the effect of methadone treatment, duration of Medicaid enrollment during pregnancy, and other maternal characteristics on receipt of prenatal care by 2,254 women infected with human immunodeficiency virus (HIV) delivering a singleton in New York state from 1985 through 1990. Data were obtained from the New York State Medicaid HIV/AIDS Research Data Base and vital statistics records. Adequacy of the number of prenatal visits reported by the mother on vital statistics records was assessed with use of the Kessner Index, which adjusts for gestational age at delivery. Too few visits were reported by 65% of the study population. Illicit drug users had higher odds of having too few visits [1.64, 95% confidence interval (CI) 1.24-2.17] than methadone-treated women but the odds were similar for non-drug users and methadone-treated women (0.79, 95% CI 0.60-1.25). Women with brief Medicaid enrollment (< or = 25% of pregnancy) had 45% higher odds of having too few visits than did longer enrollees. Treatment for drug addiction and longer Medicaid enrollment during pregnancy may offer important interventions to increase prenatal care of HIV-infected women. Approaches to increase prenatal care of HIV-infected women are especially important given trials showing a reduction in vertical transmission from zidovudine treatment during pregnancy.
Adolescent↗
Knowledge of drugs for myocardial infarction: generalists versus specialists.
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Acquired Immunodeficiency Syndrome↗
Concerted evolution of repetitive DNA sequences in eukaryotes.
A large fraction, sometimes the largest fraction, of a eukaryotic genome consists of repeated DNA sequences. Copy numbers range from several thousand to millions per diploid genome. All classes of repetitive DNA sequences examined to date exhibit apparently general, but little studied, patterns of "concerted evolution." Historically, concerted evolution has been defined as the nonindependent evolution of repetitive DNA sequences, resulting in a sequence similarity of repeating units that is greater within than among species. This intraspecific homogenization of repetitive sequence arrays is said to take place via the poorly understood mechanisms of "molecular drive." The evolutionary population dynamics of molecular drive remains largely unstudied in natural populations, and thus the potential significance of these evolutionary dynamics for population differentiation is unknown. This review attempts to demonstrate the potential importance of the mechanisms responsible for concerted evolution in the differentiation of populations. It contends that any natural grouping that is characterized by reproductive isolation and limited gene flow is capable of exhibiting concerted evolution of repetitive DNA arrays. Such effects are known to occur in protein and RNA-coding repetitive sequences, as well as in so-called "junk DNA," and thus have important implications for the differentiation and discrimination of natural populations.
Amphibians↗