Biomedical subjects

J Todd

Publications and source records attributed to J Todd.

At least 73 records · Page 4Linked to original sources

PubMed1997

Correlation of virus load in plasma and lymph node tissue in human immunodeficiency virus infection. INCAS Study Group. Italy, Netherlands, Canada, Australia, and (United) States.

The impact of long-term changes in plasma viremia, produced by effective combination antiretroviral therapy, on human immunodeficiency virus (HIV) burden within tissue reservoirs is unknown. Fifteen patients who had received at least 1 year of therapy with two or three drug combinations of zidovudine, didanosine, and nevirapine had suitable samples of lymph node tissue obtained by ultrasound-guided core needle biopsy. HIV RNA was extracted from homogenized tissue samples and quantitated using a modified branched DNA assay. Results were correlated with antiretroviral treatment effect on the basis of plasma virus load measurements over the preceding 12-18 months. A statistically significant negative correlation was observed between magnitude of treatment effect on plasma viremia and lymph node virus load. These data suggest that combinations of antiretroviral drugs that produce sustained suppression of plasma HIV RNA may also be able to reduce the virus burden in lymphoid tissues.

Biopsy↗

PubMed1997

Indicators of socioeconomic status for adolescents: the WHO Health Behaviour in School-aged Children Survey.

Many indicators of socioeconomic status used for adults are inappropriate for use in research on adolescents. In a school-based survey of 4079 Scottish schoolchildren using a self-completion questionnaire, over 20% of 11-15 year olds were unable to provide a substantive response on father's occupation. In contrast, indicators derived to construct a family affluence scale, which included car ownership, telephone ownership and the child having their own unshared bedroom, resulted in a 98% response rate; and 92% of children responded to a question on their weekly spending money. The intercorrelations between the conventional indicator of father's occupation and each family affluence and spending money were examined, and their associations with a range of health indicators and health behaviour measures compared. Father's occupational status and family affluence were moderately correlated and showed broadly similar patterns of association with the selected health measures although there were also some distinct differences. Child's spending money was only weakly correlated with father's occupation and showed rather different patterns of association with health measures. A case is made for the use of multiple indicators of socioeconomic status in adolescent health surveys, and it is argued that that the family affluence scale provides a useful and easily applied additional indicator to father's occupation or an alternative measure of socioeconomic background where occupational data are unavailable.

Adolescent↗

PubMed1997

Evidence by allelic association-dependent methods for a type 1 diabetes polygene (IDDM6) on chromosome 18q21.

Type 1 diabetes is a common polygenic disease. Fine mapping of polygenes by affected sibpair linkage analysis is not practical and allelic association or linkage disequilibrium mapping will have to be employed to attempt to detect founder chromosomes. Given prior evidence of linkage of the Jk-D18S64 region of chromosome 18q12-q21 to type 1 diabetes, we evaluated the 12 informative microsatellite markers in the region for linkage with disease by the transmission disequilibrium test (TDT) in a UK data set of type 1 diabetic families (n = 195). Increased transmission of allele 4 of marker D18S487 to affected children was detected (P = 0.02). Support for this was extended in a total of 1067 families from four different countries by isolating, and evaluating by the TDT, two novel microsatellites within 70 kb of D18S487. Evidence for linkage and association was P = 5 x 10(-5) and 3 x 10(-4), respectively. There was no evidence for increased transmission of associated alleles to nonaffected siblings. Analysis of an additional 390 families by the TDT did not extend the evidence further, and reduced support in the total 1457 families to P = 0.001 for linkage and P = 0.003 for association. However, evidence for linkage by affected sibpair allele sharing was strong (P = 3.2 x 10(-5)) in the second data set. Heterogeneity in TDT results between data sets was, in part, accounted for by the presence of more than one common disease-associated haplotype (allelic heterogeneity) which confounds the analysis of individual alleles by the TDT. Guidelines for strategies for the mapping of polygenes are suggested with the emphasis on collections of large numbers of families from multiple populations that should be as genetically homogeneous as possible.

Adolescent↗

PubMed1997

Evidence for a type 1 diabetes susceptibility locus (IDDM10) on human chromosome 10p11-q11.

A region of linkage to type 1 diabetes has been defined on human chromosome 10p11-q11 (IDDM10; P = 0.0007) using 236 UK and 76 US affected sibpairs and a 1 cM resolution microsatellite marker map. Analysis by the transmission disequilibrium test (TDT) in 1159 families with at least one diabetic child, from the UK, the US, Norway, Sardinia and Italy provided additional support for linkage at D10S193 (P = 0.006, Pc = 0.17). Notably, 5.1 cM distal to D10S193, marker D10S588 also provided positive TDT results (P = 0.009, Pc = 0.25) but the allele under analysis was also preferentially transmitted to nonaffected siblings (P = 0.0008, Pc = 0.02). This allele was positively associated in an independent UK case control study and, importantly, was neutrally transmitted in control CEPH families. These results suggest a type 1 diabetes susceptibility locus on chromosome 10p11-q11 (provisionally designated IDDM10) and demonstrate the necessity of analysis of non affected siblings in disease families, as well as analysis of control families.

Adolescent↗

PubMed1997

The molecular basis of the Kidd blood group polymorphism and its lack of association with type 1 diabetes susceptibility.

The Kidd blood group locus encodes a urea transporter which is expressed on human red cells and in the kidney. This gene is located on chromosome 18q12, and evidence for linkage and association with type 1 diabetes mellitus has been reported. To investigate this further, the genetic basis for the blood group Jk(a)/Jk(b) polymorphism was first determined by sequencing reverse-transcribed reticulocyte RNAs from Jk(a+b-) and Jk(a-b+) donors. The Jk(a)/Jk(b) polymorphism was caused by a transition (G838A), resulting in a Asp280Asn amino acid substitution and an MnlI restriction fragment length polymorphism (RFLP). Using the MnlI RFLP, we found that the Jk(a)/Jk(b) polymorphism was not in linkage disequilibrium with type 1 diabetes in 228 multiplex UK and US families tested.

Adolescent↗

PubMed1997

Male circumcision and susceptibility to HIV infection among men in Tanzania.

BACKGROUND: Evidence from ecological studies and from studies of and sexually transmitted disease (STD) patients in sub-Saharan Africa suggests that there is a protective effect of male circumcision against HIV infection. There are, however, few population-based studies that have controlled adequately for potential confounding factors. METHODS: Data from five population-based studies in north-western Tanzania were used to investigate the association between male circumcision and the risk of HIV infection and STD. The effects of circumcision on HIV prevalence, syphilis (positive Treponema pallidum haemagglutination; TPHA) and self-reported STD were analysed, controlling for a range of demographic and sociocultural variables, and indicators of sexual behaviour. RESULTS: In north-western Tanzania, circumcision was previously restricted to Muslims and specific ethnic groups, but is now more widespread, particularly in urban areas and among more educated men. Assessment of the reliability and validity of self-reported circumcision status showed that these data could be considered fairly accurate, although there was some tendency for circumcision to be over-reported. On univariate analysis, circumcision status was unrelated to HIV prevalence in most studies. After controlling for confounding variables, however, there was a modest but significant reduction of the HIV prevalence among circumcised men [odds ratio (OR), 0.62; 95% confidence interval (CI), 0.48-0.81]. This effect appeared stronger in urban areas (OR, 0.46; 95% CI, 0.32-0.68) and roadside villages (OR, 0.65; 95% CI, 0.42-1.01) than in rural areas and islands (OR, 1.00 and 1.01 respectively). There was no association between circumcision status and syphilis serology (TPHA), but there was a positive association between circumcision and self-reported STD, although this was not significant after adjustment for confounding variables. CONCLUSION: Male circumcision has a protective effect against HIV infection in this population, which may be stronger in urban areas and roadside settlements than in the rural areas. Ethnic group and religious denomination are no longer the sole determinants of male circumcision.

Adolescent↗

PubMed1997

Sexual behaviour patterns and other risk factors for HIV infection in rural Tanzania: a case-control study.

OBJECTIVE: To examine the association between HIV infection and patterns of sexual behaviour and other risk factors in a rural Tanzanian population in a case-control study, nested within a randomized trial of improved sexually transmitted disease treatment. METHODS: All HIV-positive patients from the baseline survey of the randomized trial were eligible as cases. Cases (n = 338) and controls (a random sample of one in eight HIV-negative persons; n = 1078) were interviewed about risk factors for HIV infection using a structured questionnaire. RESULTS: A significantly higher HIV prevalence was found among men and women not currently employed in farming [men: odds ratio (OR), 2.08; women: OR, 3.65], women who had travelled (OR, 3.27), educated women (OR, 4.51), and widowed/ divorced people compared with those currently married (men: OR, 3.10; women: OR, 3.54). Two spouse-related factors were significantly associated with HIV, even after adjustment for the sexual behaviour of the index case: HIV was more prevalent in men with younger spouses (P = 0.020 for trend) and in women married to men currently employed in manual work, office work or business (OR, 2.20). In women only, blood transfusions were associated with a higher HIV prevalence (OR, 2.40), but only a small population attributable fraction (4%). There was an increased HIV prevalence associated with increasing numbers of injections. Reported number of lifetime sexual partners was significantly associated with HIV infection (women: OR, 7.33 if > or = 10 lifetime partners compared with < or = 1; men: OR, 4.35 for > or = 50 compared with < or = 1). After adjustment for confounders, male circumcision was associated with a lower HIV prevalence (OR, 0.65; P = 0.11). CONCLUSIONS: In these rural communities, many HIV infections occur through sexual transmission. Some people are at high risk of HIV infection through large numbers of sex partners, whereas some are at risk through their spouse or regular partner. The role of circumcision in HIV transmission is unclear. Commercial sex seems to play a negligible role in HIV transmission in these communities. Our results confirm marked heterogeneity in HIV risk, indicating the scope for risk reduction strategies.

Adolescent↗

PubMed1997

Male circumcision and susceptibility to HIV infection among men in Tanzania.

BACKGROUND: Evidence from ecological studies and from studies of and sexually transmitted disease (STD) patients in sub-Saharan Africa suggests that there is a protective effect of male circumcision against HIV infection. There are, however, few population-based studies that have controlled adequately for potential confounding factors. METHODS: Data from the five population-based studies in north-western Tanzania were used to investigate the association between male circumcision and the risk of HIV infection and STD. The effects of circumcision on HIV prevalence, syphilis (positive Treponema pallidum haemagglutination; TPHA) and self-reported STD were analysed, controlling for a range of demographic and sociocultural variables, and indicators of sexual behaviour. RESULTS: In north-western Tanzania, circumcision was previously restricted to Muslims and specific ethnic groups, but is now more widespread, particularly in urban ares and among more educated men. Assessment of the reliability and validity of self-reported circumcision status showed that these data could be considered fairly accurate, although there was some tendency for circumcision to be over-reported. On univariate analysis, circumcision status was unrelated to HIV prevalence in most studies. After controlling for confounding variables, however, there was a modest but significant reduction of the HIV prevalence among circumcised men [odds ratio (OR), 0.62; 95% confidence interval (CI), 0.48-.81]. This effect appeared stronger in urban areas (OR, 0.46; 95% CI, 0.32-0.68) and roadside villages (OR, 0.65; 95% CI, 0.42-1.01) than in rural areas and islands (OR, 1.00 and 1.01 respectively). There was no association between circumcision status and syphilis serology (TPHA), but there was a positive association between circumcision and self-reported STD, although this was not significant after adjustment for confounding variables. CONCLUSION: Male circumcision has a protective effect against HIV infection in this population, which may be stronger in urban areas and roadside settlements than in the rural areas. Ethnic group and religious denomination are no longer the sole determinants of male circumcision.

Adolescent↗

PubMed1997

HIV-associated adult mortality in a rural Tanzanian population.

OBJECTIVE: To measure HIV-associated adult mortality in a rural population in Tanzania. To record the signs and symptoms associated with deaths of HIV-positive adults. DESIGN: Prospective cohort study conducted in the context of a randomized controlled trial to evaluate the impact of a sexually transmitted disease treatment programme. METHODS: A cohort consisting of a random sample of 12501 adults aged 15-54 years was recruited from 12 rural communities in Mwanza region, Tanzania in 1991/1992. Baseline HIV prevalence was 4.0%. The cohort was followed up after 2 years to record mortality according to baseline HIV status. A verbal autopsy questionnaire was administered for each of the deaths reported. RESULTS: A total of 196 deaths were recorded, of which 73 (37%) occurred in HIV-positive individuals. Mortality rates per 1000 person-years were 6.0 in HIV-negatives and 93.5 in HIV-positives. The age-adjusted mortality rate ratio was 15.68 (95% confidence interval, 11.18-21.03). The proportion of adult deaths attributed to HIV infection was 35% overall and 53% in those aged 20-29 years. Verbal autopsies showed that HIV-positive deaths were significantly associated with fever, rash, weight loss, anaemia, cough, chest pain, abdominal pain and headache, but the specificity of individual symptoms was low. The World Health Organization clinical case definition of AIDS was satisfied for only 13 deaths, of which seven were HIV-positive at baseline. Only seven respondents reported that the death was associated with HIV or AIDS. CONCLUSIONS: This study confirms the strong association of HIV infection and mortality in rural Africa, with an annual death rate in adult seropositives of over 9%. In this rural population with a relatively low HIV prevalence of 4%, HIV has increased overall adult mortality by more than 50%. Signs and symptoms associated with HIV deaths were non-specific, and the population seemed largely unaware of the contribution of HIV to mortality, an important obstacle to prevention efforts.

Adolescent↗

PubMed1997

Improved treatment services significantly reduce the prevalence of sexually transmitted diseases in rural Tanzania: results of a randomized controlled trial.

OBJECTIVE: To evaluate the impact of improved case management for sexually transmitted diseases (STD) at the primary health care level on the incidence and prevalence of STD. DESIGN: Community-randomized controlled trial. SETTING: Mwanza region, Tanzania. SUBJECTS: A random cohort of about 1000 adults aged 15-54 years from each of 12 communities, in six matched pairs. One member of each pair was assigned at random to receive the intervention, and the others served as a comparison community. This cohort was surveyed at baseline and at follow-up 2 years later. About 100 antenatal clinic attenders were also studied in each community on two occasions: the first shortly after the implementation of the intervention, and the second approximately 1 year later. INTERVENTION: Improved services were established for the management of STD, using the syndromic approach, in rural health units. RESULTS: A total of 12,534 individuals were enrolled in the cohort study, of whom 8844 (71%) were seen again 2 years later. The prevalence of serological syphilis (rapid plasma reagin titre > or = 1:8, Treponema pallidum haemagglutinin assay positive) was 6.2% in both intervention and comparison communities at baseline. At follow-up it was 5.0% in the intervention community and 7.0% in the comparison community [adjusted relative risk (RR), 0.71; 95% confidence interval (CI), 0.54-0.93; P < 0.02]. The prevalence of urethritis in males did not differ significantly between intervention and comparison groups at follow-up, but the prevalence of symptomatic urethritis was reduced by about 50% (adjusted RR, 0.51; 95% CI, 0.24-1.10; P = 0.08). There was no significant difference between the groups in the incidence of self-reported STD symptoms over the last year of the follow-up period, or in the prevalence of any STD in antenatal clinic attenders. CONCLUSION: The reduction in HIV incidence previously reported in this intervention study can be attributed to a reduction in the duration, and hence the prevalence of symptomatic STD.

Adolescent↗

PubMed1997

Sexual transmission of hepatitis B in Mwanza, Tanzania.

BACKGROUND: Hepatitis B virus (HBV) is endemic and poses a grave public health problem in Africa where it is mainly transmitted from mother to baby or during childhood. Sexual transmission has also been suggested to play a role in East Africa, but this has never been properly demonstrated. Additional preventive strategies may be proposed if sexual transmission of HBV occurred in this region where HIV and other STDs are highly prevalent. GOALS: To determine the prevalence of markers for hepatitis B virus (HBV)and other sexually transmitted diseases (STD) in routine blood samples taken from three populations in Mwanza, Tanzania, and to use the data collected to look at the association between hepatitis B and other STDs, including human immunodeficiency virus (HIV). STUDY DESIGN: Routine blood samples were collected from 1,025 patients attending a clinic for STDs, 253 voluntary blood donors from secondary schools, and 952 blood donors who gave blood in a hospital specifically for a relative who needed a blood transfusion. All samples were tested for HIV by double enzyme-linked immunosorbent assay (ELISA), and for syphilis using the Treponema pallidum hemagglutination (TPHA) and rapid plasma reagin (RPR) tests. Two markers for HBV were examined by the double ELISA method, the presence of the anti-hepatitis B core antigen (anti-HBc) and the hepatitis B surface antigen (HBsAg). RESULTS: There were high prevalences of HBV, syphilis, and HIV in relative donors and STD patients. Although HBV markers were more prevalent in men of increasing ages, syphilis and HIV markers were more prevalent in young women. Evidence of past infection with HBV (presence of anti-HBc) was associated with serologic markers of recent treponemal infection (both TPHA and RPR positive) in both sexes (men odds ratio [OR] = 1.91, P < 0.011; women OR = 2.34, P < 0.02) and with HIV in men (OR = 1.93, P < 0.003). Current infection with HBV (presence of HBsAg) was associated with recent syphilis in men (OR = 2.13, P < 0.006). In STD patients, current infection with HBV was associated with Trichomonas vaginalis in women (OR = 3.57, P < 0.002) and recent syphilis in men (OR = 3.46, P < 0.001). There was no further association between HBV markers and any other STD pathogen or any particular STD syndrome, nor was there any association between current HBV infection and HIV in both sexes. The population attributable fraction for sexual acquisition of hepatitis B is estimated at 7.2% in men and 3.0% in women, based on the association between hepatitis B and syphilis. CONCLUSIONS: These findings suggest that sexual acquisition of hepatitis B occurs at low levels in Mwanza, and that HBV can be prevented through enhancement of the current HIV/STD control activities, in addition to improved vaccination strategies.

Adolescent↗

PubMed1997

STD rapid assessment in Rwandan refugee camps in Tanzania.

OBJECTIVE: To obtain baseline information on sexually transmitted diseases (STDs) in the Rwandan refugees camps in Tanzania, prior to establishment of STD services. SETTING: The largest camps of Rwandan refugees in the Ngara District of Tanzania (estimated population 300,000). The study was carried out in 8 days in August 1994. SUBJECTS AND METHODS: A rapid assessment technique was used to measure STD prevalences among: (i) 100 antenatal clinic attenders (ANC); (ii) 239 men from outpatient clinics (OPD); and (iii) 289 men from the community. Interviews (by questionnaire) and genital examination were performed for all participants; sampling for females included genital swabs for the the diagnosis of Neisseria gonorrhoeae (NG), Candida albicans (CA), Trichomonas vaginalis (TV), bacterial vaginosis (BV) and a blood sample for syphilis serology. Men provided urine samples which were screened for leucocytes using the leucocyte esterase (LE) dipstick; urethral swabs for Gram stain were taken from men with a reactive LE test and from those with symptoms or signs of urethritis. OPD males provided a blood sample for syphilis serology. RESULTS: All groups reported frequent experience with STDs and engaging in risky sexual behaviour prior to the survey. During the establishment of the camps, sexual activity was reportedly low. Over 50% of ANC attenders were infected with agents causing vaginitis (TV/BV/CA) and 3% were infected with NG. The prevalence of active syphilis was 4%. In the male outpatients, the prevalence of urethritis was 2.6% and of serological syphilis was 6.1%. Among males in the community, the prevalence of urethritis was 2.9% (the majority being asymptomatic infections). We noted frequent over-reporting of STD symptoms, unconfirmed clinically or biologically. CONCLUSIONS: STD case detection and management should be improved by training health workers in using the WHO syndromic approach, and through IEC campaigns encouraging attendance at clinics. Rapid epidemiological methods provide quick and useful information at low cost in refugee camps.

Adolescent↗

PubMed1997

Geographic analysis of pertussis infection in an urban area: a tool for health services planning.

OBJECTIVE: This study examined whether incident cases of pertussis cluster in urban census tracts and identified community characteristics that predict high-incidence areas. METHODS: An ecological study design was used. The study population included all persons diagnosed with pertussis from January 1, 1986, through December 31, 1994. Maps of rates were constructed via a geographic information system and clustering was statistically confirmed. Associations between pertussis rates and community characteristics were tested. RESULTS: Mapping and statistical analysis revealed spatial clustering of pertussis. Higher age-adjusted rates of pertussis infection were associated with higher proportions of residents below poverty level. CONCLUSIONS: In urban areas pertussis infection clusters in areas of poverty.

Age Distribution↗

PubMed1997

Evaluation of the introduction of the Groshong central venous catheter into the oncology/haematology department of a district general hospital.

Technological advances in the medical management of oncological and haematological malignancies have seen the introduction of long-term central venous access as common practice in this setting. The result of this has been an influx of a variety of lines onto the market, thus creating a minefield of choice for the practitioner. As a newly appointed Macmillan clinical nurse specialist for oncology and haematology to a unit with no established policy regarding the use of central venous catheters, the author was presented with an opportunity to introduce the most advanced line into clinical practice. In this centre the decision was made to introduce this line for a number of reasons, not only for the benefits associated with enhanced patient safety but also because of the educational and supportive role Bard Access Limited had offered. When instigating change and development it was of paramount importance that all members of the health care team were well educated regarding the use and maintenance of these lines to ensure success. This paper aims to share our experience of the Groshong line and includes a detailed audit of each line placed in a 12-month period. The information collated includes details regarding insertion method, infection rates, episodes of thrombosis and numbers of catheters removed due to malfunction.

Catheterization, Central Venous↗

PubMed1996

Asymptomatic gonorrhoea and chlamydial infection in rural Tanzanian men.

OBJECTIVE: To measure the prevalence of urethritis due to Neisseria gonorrhoeae and Chlamydial infection trachomatis in rural Tanzanian men DESIGN: About 500 men aged 15-54 years were selected from each of 12 rural communities by random cluster sampling; interviewed concerning past or present symptoms of sexually transmitted diseases; and asked to provide a first catch urine specimen, which was tested for pyuria with a leucocyte esterase dipstick test. Subjects with symptoms or with a positive result on testing were examined, and urethral swabs were taken for detection of N gonorrhoeae by gram stain and of C trachomatis by antigen detection immunoassay. SETTING: Mwanza region, north western Tanzania. SUBJECTS: 5876 men aged 15-54 years. MAIN OUTCOME MEASURES: Prevalence of urethral symptoms, observed urethral discharge, pyuria, urethritis ( > 4 pus cells per high power field on urethral smear), N gonorrhoeae infection (intracellular gram negative diplococci), and C trachomatis infection (IDEIA antigen detection assay). RESULTS: 1618 (28%) subjects reported ever having a urethral discharge. Current discharge was reported by 149 (2.5%) and observed on examination in 207 (3.5%). Gonorrhoea was found in 128 subjects (2.2%) and chlamydial infection in 39 (0.7%). Only 24 of 158 infected subjects complained of urethral discharge at the time of interview (15%). CONCLUSION: Infection with N gonorrhoeae and C trachomatis is commonly asymptomatic among men in this rural African population. This has important implications for the design of control programmes for sexually transmitted disease.

Adolescent↗

PubMed1996

Intravascular adenosine at reperfusion reduces infarct size and neutrophil adherence.

BACKGROUND: Adenosine has been shown to reduce infarct size predominantly during reperfusion by adenosine A2-receptor-mediated processes. This cardioprotection may involve inhibition of events in the vascular compartment, such as adherence-independent and adherence-dependent actions of neutrophils. This study tested the hypothesis that adenosine exerts its cardioprotection during reperfusion by targeting effectors in the vascular compartment. METHODS: Polyadenylic acid (molecular weight, 230,000 daltons) was used as an intravascularly confined adenosine mimetic. In anesthetized New Zealand white rabbits, the left coronary artery was occluded for 30 minutes and reperfused for 120 minutes. RESULTS: Polyadenylic acid (1 mg/kg bolus, 0.5 mg kg-1 h-1) given 5 minutes before reperfusion significantly (p < 0.05) reduced infarct size compared with vehicle (23% +/- 2% versus 37% +/- 2% area at risk). The A1-antagonist KW-3902 had no effect on this polyadenylic acid-induced protection (17% +/- 3%), whereas the A1-A2 antagonist sulfophenytheophylline blocked this infarct size reduction (41% +/- 2%). In vitro adherence of platelet-activating factor-activated neutrophils to thoracic aortic endothelium was significantly diminished by polyadenylic acid (185 +/- 12 neutrophils/mm2 versus 36 +/- 4 neutrophils/mm2 endothelial surface). Sulfophenytheophylline inhibited this effect (280 +/- 6 neutrophils/mm2), whereas KW-3902 did not (31 +/- 7 neutrophils/mm2). CONCLUSIONS: An intravascular adenosine mimetic agent exerts cardioprotection during reperfusion by targeting receptor-mediated mechanisms in the intravascular compartment, possibly involving inhibition of neutrophil-related processes.

Adenosine↗

PubMed1996

Implementing a nationwide insecticide-impregnated bednet programme in The Gambia.

Earlier studies in The Gambia suggested that the use of impregnated bednets might prove to be a useful malaria control strategy. Based on the results of these studies, in 1992 the Government of The Gambia was encouraged to initiate a National Impregnated Bednet Programme (NIBP) as part of the National Malaria Control Programme Strategy. This paper describes the implementation process/procedure of the NIBP. Evaluation results showed that, overall, 83% of the bednets surveyed has been impregnated, and 77% of children under the age of five years and 78% of women of childbearing age were reported to be sleeping under impregnated bednets.

Adolescent↗

PubMed1996

Prognostic value of plasma human immunodeficiency virus type 1 (HIV-1) RNA levels in patients with advanced HIV-1 disease and with little or no prior zidovudine therapy. AIDS Clinical Trials Group Protocol 116A/116B/117 Team.

The association of plasma human immunodeficiency virus type 1 (HIV-1) RNA level at study entry and over time with clinical progression was evaluated in 187 patients from AIDS Clinical Trials Group protocol 116A who had little or no prior zidovudine treatment. Three-fold-higher HIV-1 RNA levels at study entry and 3-fold increases by week 8 were associated with progression (relative hazard [RH], 1.67; 95% confidence limits [CL], 1.20, 2.32; and RH, 1.45; CL, 1.02, 2.05, respectively). Having 3-fold-higher CD4 cell count at entry was independently associated with a 52% reduction in risk for progression (adjusted RH, 0.48; CL, 0.33, 0.70). When stratified by length of prior zidovudine therapy, RNA level was predictive in drug-naive patients (adjusted RH, 1.87; CL, 1.23, 2.85) but not predictive in patients with up to 16 weeks of prior therapy (adjusted RH, 1.11; CL, 0.70, 1.76). Analysis suggests that the acquisition of mutations at HIV-1 reverse transcriptase codons 215 and 74 is associated with subsequent increases in HIV-1 RNA level (relative risk, 7.00; CL, 0.86, 56.90).

Acquired Immunodeficiency Syndrome↗