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Biomedical subjects

P A Simon

Publications and source records attributed to P A Simon.

At least 19 recordsLinked to original sources
PubMed2001

Comparison of AIDS progression and survival in persons with pulmonary versus extrapulmonary tuberculosis in Los Angeles.

The objective of this research was to compare the demographics, acquired immune deficiency syndrome (AIDS) progression, and survival in persons with AIDS with pulmonary tuberculosis (PTB) versus extrapulmonary tuberculosis (EPTB), because there are limited population-based data on this topic. A population-based longitudinal study with 3 years of follow-up was performed. Data were collected every 6 months from medical records of persons with AIDS and TB treated at private and public medical facilities throughout Los Angeles County (LAC). Participants included a population-based sample of 216 persons with AIDS and PTB and 166 persons with AIDS and EPTB (including 113 persons with both PTB and EPTB), with an AIDS diagnosis reported in 1993. Compared to persons with AIDS with PTB, persons with AIDS and EPTB were 2.2 times more likely to be Latino than white (95% confidence intervals [CIs]: 1.2, 4.0) and 1.7 times more likely to be foreign-born (95% CIs: 1.1, 2.5). Compared to persons with AIDS with PTB, persons with AIDS and EPTB had similar antiretroviral and PCP prophylaxis use; lower CD4 counts at time of AIDS diagnosis (p = 0.0004); no differences in CD4 counts over the total follow-up period (p = 0.4); higher rates of total opportunistic infections (OIs) (incidence density ratio [IDR] = 2.0; 95% CIs: 1.6, 2.4); and comparable survival curves (p = 0.07). Persons with AIDS and EPTB had a more complicated medical course with lower CD4 counts at time of AIDS diagnosis and more OIs over the follow-up period than persons with AIDS and PTB, however the survival profiles for the two groups were comparable.

AIDS-Related Opportunistic Infections↗
PubMed2001

Meeting the data needs of a local health department: the Los Angeles County Health Survey.

Monitoring the health status of populations is a core function of all public health agencies but is particularly important at the municipal and community levels, where population health data increasingly are used to drive public health decision making and community health improvement efforts. Unfortunately, most local health jurisdictions lack important data for developing population health profiles, such as data on chronic disease prevalence, quality-of-life measures, functional status, and self-perceptions of health status. In addition, data on important determinants of health, including health behaviors and access to health care services, are rarely available locally. These data frequently are collected in national and state surveys (e.g., the National Health Interview Survey and the Behavioral Risk Factor Surveillance System) and provide critical information to assess progress toward achieving state and national health objectives. The surveys rarely serve local data needs, however, because of insufficient sample size and lack of flexibility to address local health issues. To address gaps in local health data, in 1997 the Los Angeles County Department of Health Services inaugurated the Los Angeles County Health Survey.

Community Health Planning↗
PubMed1999

High-risk sexual behavior in Los Angeles: who receives testing for HIV?

No recent population-based data on HIV testing in people with high-risk sexual behavior are available. We sought predictors of testing using data from the 1997 Los Angeles County Health Survey, a random-digit telephone survey of 8004 county households. An estimated 2.3 million (35.5%) adults were tested for HIV in the past 2 years and approximately 370,000 (5.6%) engaged in high-risk sexual behavior (defined as having > or =2 partners in the past 12 months and not always using condoms). Among high-risk persons, an estimated 46% of heterosexual men, 56% of heterosexual women, and 72% of men who had sex with men (MSM) were tested for HIV. In a multivariable model of high-risk people, both heterosexual men (odds ratio [OR], 0.31; 95% confidence interval [CI], 0.16-0.61) and women (OR, 0.41; 95% CI, 0.19-0.87) had significantly lower proportions of testing than MSM. Although African Americans and Hispanics had significantly higher testing proportions than whites overall among all county residents, those reporting high-risk sexual behavior did not test at higher proportions. We conclude that the proportion of adults with high-risk sexual behavior tested for HIV is higher than almost a decade ago. However, testing among this group remains suboptimal. Future public health campaigns should intensify efforts to encourage HIV testing among this population.

AIDS Serodiagnosis↗
PubMed1999

Prevalence of unprotected sex among men with AIDS in Los Angeles County, California 1995-1997.

OBJECTIVE: To determine the prevalence of unprotected sex among men with AIDS in Los Angeles County. DESIGN: Cross-sectional study. METHODS: All men aged > or = 18 years who were newly reported to the local health department with AIDS and completed a standardized interview between January 1995 and June 1997 were included in the study. Men were classified as having unprotected sex if they reported one or more sex partners during the past year with whom they had vaginal or anal sex and did not always use a condom. RESULTS: Of 617 men interviewed, 29% reported unprotected sex in the past year. The prevalence of unprotected sex was highest among men < 30 years of age (43%) and those who had first learned of their HIV-positive status < 12 months prior to interview (44%). In all, 323 (52%) men reported one or more male sex partners in the past year. Of these, 22% reported unprotected insertive anal sex and 27% unprotected receptive anal sex. One or more female partners in the past year was reported by 131 (21%) men. Of these, 53% reported unprotected vaginal sex and 18% unprotected anal sex. CONCLUSIONS: The findings highlight the importance of early HIV detection efforts, coupled with targeted and sustained HIV prevention services for those who test positive, to prevent ongoing transmission of the virus.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Failure to learn human immunodeficiency virus test results in Los Angeles public sexually transmitted disease clinics.

BACKGROUND: Early human immunodeficiency virus (HIV) defection is essential for initiating treatment and partner-notification activities. Sexually transmitted disease (STD) clinic attendees are at high risk for infection and should be made aware of their HIV status. GOAL: To determine the characteristics associated with not receiving an HIV test result in an STD clinic setting. STUDY DESIGN: Confidential HIV testing was offered to 6,705 persons attending four public STD clinics in Los Angeles who submitted blood for syphilis serology and were tested for HIV antibody in an unlinked HIV serosurvey. Human immunodeficiency virus test results and return status were anonymously linked to other risk information. RESULTS: Only one-third of attendees were tested and given their results. Those testing HIV positive in the anonymous survey and those requesting HIV testing were most likely to receive a test result (i.e., 41% and 49%, respectively). Those solely requesting an STD examination, repeat testers, and African-Americans were least likely to receive a result (i.e., 32%, 30%, and 26%, respectively). CONCLUSIONS: Most STD clinic patients fail to receive an HIV test result. Other strategies, such as rapid HIV testing, are needed to increase participation and receipt of HIV test results in this high-risk population.

Ambulatory Care Facilities↗
PubMed1997

Self-directed work teams: application to a drug information center.

OBJECTIVE: To describe the transition of a drug information center from a traditionally managed center to a self-directed work team responsible for service, education, research, and drug use policy development. SUMMARY: To adapt to economic, educational, and technologic changes, traditional management structures in healthcare organizations are being reassessed. In some instances, a team approach (using self-directed work teams [SDWTs]) is being implemented. SDWTs have the potential to provide a number of benefits to an organization, including reduced costs and greater employee motivation. The University of Illinois at Chicago Drug Information Center had functioned under a traditional management structure. For economic and professional reasons, the management structure of the center was changed to an SDWT, prompting a reevaluation of the mission and activities of the center. DISCUSSION: Although still in transition, the center's change to a team structure has proven to be positive. The nature of the SDWT requires greater involvement by team members in all aspects of the center's operation, adding to the experience of team members. The team structure also allows for greater freedom to pursue projects of personal interest to individual team members. A number of issues still need to be resolved, such as performance-based compensation and peer- and self-evaluations. CONCLUSIONS: SDWTs can provide many benefits. The successful implementation of an SDWT, however, has a number of requirements, the most important of which are a commitment from management and effective communication among team members and with management.

Drug Information Services↗
PubMed1996

Reasons for HIV antibody test refusal in a heterosexual sexually transmitted disease clinic population.

OBJECTIVE: To evaluate acceptance of confidential HIV antibody testing and reasons for test refusal among heterosexual clients of Los Angeles County sexually transmitted disease (STD) clinics. METHODS: From January 1993 through June 1994, all blood specimens routinely collected for syphilis serology were tested blindly for HIV antibody at seven STD clinics. Patients were counseled and offered a confidential HIV test. Rate of refusal of confidential testing and primary reason for test refusal were examined by demographic group and HIV serostatus, as determined in the blinded survey, for all heterosexual clients. RESULTS: Of 20,125 persons offered confidential testing, 35.6% refused the test. Test refusal was higher among men (38.7%) than women [31.1%; adjusted odds ratio (OR), 1.4; 95% confidence interval (CI), 1.3-1.4] and among blacks (38.6%) than whites (28.6%; adjusted OR, 1.7; 95% CI, 1.5-2.0). The most common reason for refusal was 'already know my HIV status' (40.6%), followed by 'don't want to know' (23.9%), and 'not at risk' (19.4%). Confidentiality concerns were cited as the primary reason for refusal by 2.2%. Among the 180 (0.9%) persons who tested positive in the blinded survey, 99 (55.0%) refused the confidential test. Of the 44 seropositive persons who refused the confidential test because they "already knew their HIV status', 29 (65.9%) reported their previous test to be negative. CONCLUSIONS: Efforts are needed to increase acceptance of confidential HIV testing in this heterosexual population and should (1) include a client-centered counseling approach that facilitates accurate self-assessment of risk and addresses the misperception that a prior negative test result implies an absence of risk, and (2) highlight the potential benefits of early intervention medical and psychosocial services.

AIDS-Related Opportunistic Infections↗
PubMed1995

Unintentional carbon monoxide poisoning in Colorado, 1986 through 1991.

Unintentional carbon monoxide poisonings were identified through death certificates, by hyperbaric chambers, and by laboratories required to report carboxyhemoglobin levels greater than 12%. From 1986 to 1991, 981 cases were reported, including 174 deaths. Deaths most often resulted from fire-related carbon monoxide intoxication (36.2%), followed by motor vehicle exhaust (34.5%), and furnaces (10.3%). Among nonfatal cases, furnaces were the leading source of carbon monoxide exposure (44.3%), followed by motor vehicle exhaust (22.8%). The importance of furnaces and other home heating devices in carbon monoxide intoxication may be underappreciated if only mortality data are examined. Surveillance of carbon monoxide-related morbidity is a useful adjunct to mortality surveillance in guiding prevention efforts.

Accidents↗
PubMed1995

Late HIV diagnosis.

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AIDS Serodiagnosis↗
PubMed1995

Income and AIDS rates in Los Angeles County.

OBJECTIVE: To examine the relationship between income and AIDS rates in Los Angeles County (LAC) by race/ethnicity. METHODS: 1990 US census data were used to classify LAC postal zones (zip codes) by median household income into low-, middle-, and high-income strata. AIDS rates were calculated for each income stratum based on 15,805 AIDS cases diagnosed from 1987 through 1992 and reported to the county health department. RESULTS: The AIDS rate was highest among residents of low-income areas (252.8 per 100,000), intermediate among residents of middle-income areas (161.2 per 100,000), and lowest among residents of high-income areas (82.0 per 100,000). This trend in rates was present in all racial/ethnic groups examined and was most pronounced among whites (675.1, 226.7, and 88.4 per 100,000, respectively). Residents of low-income areas accounted for 78% of AIDS cases among blacks, 67% among Hispanics, and 47% among whites. CONCLUSIONS: These findings suggest a strong inverse relationship between income and AIDS rates in LAC that is consistent across racial/ethnic groups. Prevention programs and treatment services should be directed most intensively to low-income neighborhoods in this county.

Acquired Immunodeficiency Syndrome↗