Reducing sexual transmission of HIV from those who know they are infected: the need for personal and collective responsibility.
Explore the source record for details and available documents.
Behavior Therapy↗
Biomedical subjects
G Marks
Publications and source records attributed to G Marks.
Differences between asthma exacerbations and poor asthma control.
BACKGROUND: Increased variation in peak expiratory flow (PEF) is characteristic of poorly controlled asthma, and measurement of diurnal variability of PEF has been recommended for assessment of asthma severity, including during exacerbations. We aimed to test whether asthma exacerbations had the same PEF characteristics as poor asthma control. METHODS: Electronic PEF records from 43 patients with initially poorly controlled asthma were examined for all exacerbations that occurred after PEF reached a plateau with inhaled corticosteroid treatment. Diurnal variability of PEF was compared during exacerbations, run-in (poor asthma control), and the period of stable asthma before each exacerbation. FINDINGS: Diurnal variability was 21.3% during poor asthma control and improved to 5.3% (stable asthma) with inhaled corticosteroid treatment. 40 exacerbations occurred in 26 patients over 2-16 months; 38 (95%) of exacerbations were associated with symptoms of clinical respiratory infection. During exacerbations, consecutive PEF values fell linearly over several days then improved linearly. However, diurnal variability during exacerbations (7.7%) was not significantly higher than during stable asthma (5.4%, p=0.1). PEF data were consistent with impaired response to inhaled beta2-agonist during exacerbations but not during poorly controlled asthma. INTERPRETATION: Asthmatics remain vulnerable to exacerbations during clinical respiratory infections, even after asthma is brought under control. Calculation of diurnal variability may fail to detect important changes in lung function. PEF variation is strikingly different during exacerbations compared with poor asthma control, suggesting differences in beta2-adrenoceptor function between these conditions.
Adolescent↗
Methods and effectiveness of environmental control.
In recent years the role of allergen exposure and atopy, and the interaction between them in the clinical expression of allergic disease, has been examined in a quantitative manner in epidemiologic studies. Such analyses suggest that avoidance of exposure to domestic allergens is a critical element in integrated strategies for both the prevention and the management of asthma. The promise of primary intervention in high-risk infants, as shown in the Isle of White study, has been confirmed in a recent study in Japan, and at least 4 similar trials are in progress. Applying these principles to the management of symptoms in patients with chronic asthma has proved more difficult, and it is likely that many earlier studies were poorly designed to test the hypothesis that allergen avoidance was clinically useful. Recent studies with patients moved to high altitudes during seasonal reductions in mite exposure and randomized controlled interventions in houses have all shown improvements in clinical manifestations of asthma. These recent trials have also demonstrated something that was less certain-that massive reductions in domestic allergen exposure can be achieved and that people will adopt the significant changes to their domestic environment and lifestyles if the risks and benefits are known. In the future, it seems likely that better study designs, as well as improvements in methods to monitor exposure and clinical outcomes, will provide further support for the role of allergen avoidance in the prevention and management of asthma.
Allergens↗
Age and risk of HIV infection in men who have sex with men.
Explore the source record for details and available documents.
Adolescent↗
Preventive counseling of HIV-positive men and self-disclosure of serostatus to sex partners: new opportunities for prevention.
This study examined whether preventive counseling of HIV-positive men (N = 255) was associated with self-disclosure of serostatus to sex partners. Men who reported being counseled at posttest and at their current HIV clinic to disclose their serostatus to partners were more likely to have done so than men counseled only at posttest, only at the HIV clinic, or not counseled at either site. Disclosure increased with the number of times counseled at the HIV clinic. These patterns held for HIV-negative partners, but not for HIV-positive or HIV-unknown partners. Disclosure to HIV-negative partners was associated with safer sexual practices. The findings suggest that counseling interventions for HIV-positive men, when delivered by multiple sources, may provide an effective means of increasing disclosure to sexual partners.
Adult↗
Is acculturation associated with sexual risk behaviours? An investigation of HIV-positive Latino men and women.
This cross-sectional study of 226 HIV-positive Latino men and women sampled and assessed at an outpatient HIV clinic in Los Angeles examined the associations among acculturation, use of a substance before sex, and unsafe sexual behaviour. As acculturation increased, men and women were increasingly likely to have engaged in unsafe sex in the most recent sexual encounter since testing seropositive. In men, the association was partially mediated by use of a substance (primarily alcohol) in the three hours before the sexual encounter; in women, the association was not mediated by drug use. The findings underscore the need for culturally sensitive, secondary prevention programmes for HIV-positive persons.
Acculturation↗
Use of rectal cancer position as a prognostic indicator.
The hypothesis of this study was that the position of rectal cancer within the circumference of the rectum influences mortality. Tumor position was prospectively documented in 181 patients with rectal carcinoma by two examiners. The results were analyzed for correlation to survival using the Lifetest model and for multivariate correlation using the Cox regression model. An anterior tumor location was present in 43 patients and was found to have a significantly higher survival rate than other positions. Two-thirds of anterior tumors were of pathologically favorable Dukes' stages. Fifty-five patients had posterior tumors with decreased survival rates, two-thirds of which were of unfavorable stages. Circumferential position in 61 patients was most predictive of poorer outcome, with a relative risk of death being increased by 4.6 times (P = 0.014) and a 5-year survival rate of 68.8 per cent; 85 per cent of these tumors were of pathologically unfavorable stages. The 5-year survival rate for the whole group, which included 181 patients with all histopathological stages except those with distant metastases at presentation, was 78.5 per cent. This ranking of survival rates was found to be consistent in each category with the postoperatively determined Dukes' stage, which carried a prognostic significance of P = 0.0001. We conclude that tumor position is a significant indicator of prognosis available before surgery for rectal cancer.
Adenocarcinoma↗
Functional decline in the elderly: evidence for direct and stress-buffering protective effects of social interactions and physical activity.
Advances in medical technology and improvements in health behavior have greatly increased the proportion of Americans who survive into old age. Consequently, identifying environmental and behavioral factors that enhance or protect the health and functional capacity of older adults is an important goal. This study investigated the extent to which social interactions and physical activity can protect older adults from the declines in functional ability that typically occur with age and the extent to which they buffer the negative effects of widowhood on physical functioning. Data were from the Longitudinal Study of Aging, a six-year follow-up of over 7,000 respondents in the 1984 National Health Interview Survey. Using individual growth curve models which examine the effects of predictor variables on change over time, this study investigated how physical activity, social interactions, and widowhood are related to the rate of change in functional health over a six-year period. Results suggested that physical activity and social interactions each exerted independent effects on functional decline. In addition, physical activity and social interactions buffered the effects of widowhood on functional decline, especially in men who died before the end of the study. Results suggest a need for health promotion programs to encourage both physical and social activities in the elderly.
Activities of Daily Living↗
Guidelines for conducting economic outcomes studies for endoscopic procedures.
Explore the source record for details and available documents.
Costs and Cost Analysis↗
Distress and coping among women with HIV infection: preliminary findings from a multiethnic sample.
In a multiethnic sample of 53 women with HIV/AIDS, nearly 40% reported clinically significant levels of depression symptomatology and anxiety. Compared to a nonpatient norm, distress levels were higher among the Latina, African-American, and white women who made up the HIV sample. Prayer and rediscovery of self were their most frequent coping responses, suggesting that clinicians working with HIV/AIDS populations not overlook the importance of spiritual faith and practices in adapting to HIV infection.
Adaptation, Psychological↗
Alcohol, tobacco and recreational drug use and the risk of non-Hodgkin's lymphoma.
A population based case-control study was conducted to determine whether risk of non-Hodgkin's lymphoma (NHL) in the absence of HIV infection is related to the previous use of tobacco, alcohol or recreational drugs. A total of 378 residents of Los Angeles County who were diagnosed with high- or intermediate-grade NHL were compared with individually age-, race- and sex-matched neighbourhood control subjects with regard to history of use of tobacco products, alcohol and ten specific recreational drugs. Risk of NHL among women decreased with increased consumption of alcoholic beverages (trend P = 0.03), with risk 50% lower among those consuming five or more drinks per week than among non-drinkers. Cocaine, amphetamines, Quaaludes and lysergic acid diethylamide (LSD) were each associated with a significantly increased risk of NHL in men with risk greater among those with more frequent use of these drugs. Confounding factors could not be excluded in these findings. The use of multiple types of drugs was also associated with a significantly increased risk of NHL in men (trend P = 0.005) with risk greatest among those using five or more types of drugs (odds ratio = 5.8, 95% confidence limits = 1.2-28.4); among these drugs, cocaine use appeared to account for the elevated risk of NHL among men based on multivariable analyses.
Adolescent↗
Disclosing HIV status and sexual orientation to employers.
Seropositive gay and bisexual men who reveal their sexual orientation or HIV/AIDS status to their employer risk discriminatory reprisals. However, non-disclosure may limit potential social, emotional, and tangible support. Among our sample of 389 seropositive gay and bisexual men employed in the US, 52% were 'out' to their employer and 35% had disclosed their serostatus to him or her. Among gay men, employer awareness of their sexual orientation was related to their being European American (vs Latino or African American), being HIV-seropositive for more than 4 years, and having a gay or bisexual employer. Disclosure of HIV infection in the total sample was related to being European American, HIV-seropositive for more than 4 years, symptomatic (vs asymptomatic), 'out' at work, and having a gay or bisexual employer. Men who had informed their employers of their HIV status reported consequences that were substantially more positive than those anticipated by men who had not disclosed. Policy and research implications for improving the work environment for gay and bisexual men living with HIV are considered.
Attitude to Health↗
[Results of the local excision of rectal cancer after high-dose radiotherapy associated or not to chemotherapy].
Local excision of rectal cancer in low-risk patients is appealing but it provides limited control of the disease. Postoperative radiation therapy may improve results. The Authors report on their experience with preoperative high dose radiation therapy for rectal cancer patients; more recently, chemoradiation was used. Local excision is advised only for those patients with minimal or no residual disease. The results obtained in 34 cases are encouraging; moreover, a better control of the disease seems to be offered combining chemo- and radiotherapy.
Adult↗
Prognostic significance of tumor fixation of rectal carcinoma. Implications for adjunctive radiation therapy.
BACKGROUND: This study was conducted to assess the prognostic significance of adjunctive radiation in the surgical management of rectal carcinoma patients with tumor fixation. METHODS: Two hundred and ninety-seven patients with a histologic diagnosis of adenocarcinoma of the rectum were treated with high dose preoperative radiation ( > or = 45 Gray [Gy]) followed by surgical resection of the tumor (Group A). One hundred and seventy-four patients underwent initial curative surgery (Group B) followed by selective postoperative radiation (45-50 Gy) for those with pathologic T3, T4, or N+ (B2, C) cancers (N = 143). The two patient groups were compared by presenting clinical stage of the disease to assess the prognostic significance of tumor fixation on results of adjunctive therapy. Follow-up ranged from 24 months to 180 months. RESULTS: The 5-year actuarial survival of Groups A and B was similar, 69% and 61% respectively. Survival was significantly better for Group A patients with fixed cancer (57% vs. 33%, P = 0.003). Survival was also better for patients in Group A with tumors located in the distal rectum (70% vs. 56%, P = 0.02). The local recurrence rate for patients with tumors located in the distal rectum was 17% for Group A and 19% for Group B (P = 0.74). The local recurrence rate for fixed cancers was 23% and 50% for Group A and Group B respectively (P = 0.0009). The incidence of small bowel complications (Grade 3 or 4) was lower for patients undergoing preoperative radiation compared with patients treated with postoperative radiation, (4% vs. 13%, P < 0.05). CONCLUSIONS: When special considerations of sphincter-preserving surgery are not an issue, mobile rectal carcinoma may be effectively treated with surgery and selective postoperative radiation. However, fixed tumors, especially those located in the distal rectum, are better treated with high dose preoperative radiation.
Adenocarcinoma↗
Induction of antigen-specific T and B cell immunity in colon carcinoma patients by anti-idiotypic antibody.
Polyclonal goat anti-idiotypic Abs directed against anti-human gastrointestinal carcinoma mAb GA733 were administered to 13 colon cancer patients who had their primary tumor and lymph node metastases removed before immunotherapy. Patients received four s.c. doses (0.5 to 8 mg each) of alum-precipitated anti-idiotypic Ab. Seven of the 13 patients produced anti-anti-Ids that bound specifically to the GA733 epitope on tumor cells and shared idiotopes with mAb GA733. In four of the seven responding patients, anti-Id therapy specifically modulated T cell responses. In two patients who did not demonstrate GA733 Ag/anti-Id-reactive T cells before therapy, anti-Id administration induced CD4+, MHC class II-dependent T cells that specifically proliferated in culture in response to stimulation with either anti-Id or GA733 Ag. In two other patients who did demonstrate Ag/anti-Id-reactive T cells before therapy, anti-Id administration transiently induced lymphocytes that suppressed the proliferative responses of cultured pretherapy lymphocytes to stimulation with anti-Id or GA733 Ag. Nine of the 13 treated patients showed no evidence of disease after 39 to 86 mo of observation. Five of these patients developed Ag-specific Ab3 and one had, in addition, a T cell response.
Adult↗
Women's self-disclosure of HIV infection: rates, reasons, and reactions.
A survey of 65 ethnically diverse women at 2 outpatient HIV clinics revealed relatively low rates of disclosure of HIV-positive serostatus to extended family members, somewhat higher rates for immediate family members, and highest rates for lovers and friends. Spanish-speaking Latinas were less likely to disclose their serostatus or to discuss HIV-related worries with others than English-speaking Latinas, African Americans, and Anglo Americans. Reasons for disclosure and nondisclosure varied by target. In general, targets reacted positively to disclosure. Implications for clinicians treating women with HIV infection are discussed.
Adolescent↗
Culturally sanctioned secrets? Latino men's nondisclosure of HIV infection to family, friends, and lovers.
Spanish-speaking Latino men (n = 107) were more likely than English-speaking Latinos (n = 85) and Whites (n = 206) to withhold their HIV-positive serostatus and their gay or bisexual orientation from significant others, especially family members. Similar effects were observed when Latinos were divided by birthplace and when analyses controlled for sociodemographic and medical factors. Reasons for revealing or concealing an HIV diagnosis varied across targets. Although both Latinos and Whites were more likely to withhold their diagnosis from their parents to prevent worrying them than to avoid personal rejection, this tendency was somewhat stronger among Latinos. Our findings suggest that some traditional values may deter Latinos from seeking HIV-related social support in times of need.
Acculturation↗
Self-disclosure of HIV infection among men who vary in time since seropositive diagnosis and symptomatic status.
OBJECTIVE: To assess self-disclosure of HIV-positive serostatus to family, friends, and intimate lovers among asymptomatic and symptomatic men who varied in length of time since HIV-seropositive diagnosis. Additionally, the study assessed the anticipated and actual interpersonal consequences of disclosure. METHODS: A multiethnic sample of 684 men with HIV/AIDS completed self-administered questionnaires at two HIV-outpatient clinics in Los Angeles. The cross-sectional analysis stratified the men by time since testing HIV-seropositive and symptomatic status. Disclosure to six significant others (intimate lover, close friend, mother, father, sister, brother) was examined in univariate and multivariate analyses. RESULTS: Men recently diagnosed HIV-seropositive (within 2-4 months) were more likely to have informed intimate lovers and friends than family members; disclosure to father was extremely low. Disclosure was generally lower among asymptomatic than symptomatic men; 21% of asymptomatic men who had tested HIV-seropositive in the previous year had not informed any of the six significant others considered in the study. Disclosure rates were higher among men diagnosed less recently. The interpersonal reactions of those informed were more favorable than the reactions non-disclosers anticipated; however, both actual and anticipated reactions were generally supportive. CONCLUSION: Many asymptomatic men inform few or no significant others of their HIV infection in the first few months after HIV diagnosis. Given the generally supportive reactions reported, HIV-seropositive men should be encouraged, when appropriate, to inform family, friends, and intimate lovers of their serostatus.
Acquired Immunodeficiency Syndrome↗