HRSA's strategies to combat family violence.

This paper discusses the efforts of the Health Resources and Services Administration (HRSA) to work with a broad constituency to combat and ultimately prevent family violence. In partnership with states and communities, HRSA implements programs to strengthen health care infrastructure, support direct community-based service delivery, and educate health care providers. Soliciting and incorporating community input are critical steps in designing innovative training approaches to deal with pressing health concerns, such as the efforts of family violence in a community. This type of collaboration is evident in HRSA's programs such as the Area Health Education Centers, the Geriatric Education Centers, and the AIDS Education and Training Centers. Health care delivery systems and special health interventions must respond to the far-reaching effects of family violence. HRSA is devising a comprehensive strategy to guide program development in violence intervention. This strategy would build on successful models of education, prevention, and service delivery, as well as identification of critical areas for collaboration between community activists, researchers, epidemiologists, health care providers, policymakers, academicians, survivors, philanthropists, representatives from state and local government, and the faith community.

Major infectious diseases causing excess morbidity in the Hispanic population.

Current data indicate that there are a number of infectious diseases, ie, acquired immunodeficiency syndrome/human immunodeficiency virus infections, cysticercosis, hepatitis A, syphilis, tuberculosis, and typhoid fever, among others that cause disproportionately increased morbidity in Hispanics. The greater rate of poverty with its associated socioenvironmental problems, increased barriers to health care, and importation of infectious diseases endemic in the mother country are some of the major reasons that probably account for this disparity in disease burden in Hispanics. This formidable health problem can be addressed by targeting efforts at improving health education of family units and communities, environmental improvements, elimination or reduction of barriers to health care management and disease prevention, and appropriate screening programs. A comprehensive and uniform assessment of the impact of infectious diseases on Hispanics (and other minorities) in this country remains elusive, but is of paramount importance in establishing priorities and effective/efficient strategies to address this issue.

The rapid diagnosis of infectious mononucleosis using an ELISA that detects IgM antibody to a peptide component of Epstein-Barr virus nuclear antigen.

An enzyme-linked immunosorbent assay (ELISA) that detects IgM antibody to a peptide component of the Epstein-Barr virus (EBV) nuclear antigen (EBNA-1) was compared with a conventional rapid heterophil antibody method for the rapid diagnosis of infectious mononucleosis. Discrepancies between the two methods were further analyzed using an indirect immunofluorescence assay to detect antibodies to EBV antigens. We evaluated 298 cases of suspected infectious mononucleosis. The ELISA was very sensitive (98.7%) and able to detect some cases (seven (9%) of 75 confirmed positives) that were negative by the rapid heterophil antibody test, but confirmed by immunofluorescence. However, approximately 17% of all positive tests could not be confirmed by EBV-specific immunofluorescence; thus, the overall positive predictive value was 83%; negative predictive value was 99.5%; and specificity was 93%. The high rate of false-positive tests makes this rapid ELISA unsuitable for the diagnosis of infectious mononucleosis.

Serologic and virologic epidemiology of Epstein-Barr virus: relevance to chronic fatigue syndrome.

Patients considered to have chronic fatigue syndrome (CFS) have been reported to exhibit an increased antibody response to Epstein-Barr virus (EBV) early antigen complex and capsid antigen, findings that suggest some relationship between EBV and CFS. However, the serologic findings have not been totally consistent among different study groups, and the antibody patterns in asymptomatic individuals may be similar. Moreover, patients with symptomatology indicative of CFS do not appear to have an abnormal burden of EBV in body fluids and manifest only a variable, mild degree of EBV-specific cell-mediated responses. The evidence is growing that the serologic findings of an enhanced EBV state in individuals with CFS-like manifestations, as well as the subsequent reports of increased antibody titers to other viruses, reflect a generalized underlying immunologic dysfunction in these patients. Future studies with criteria-defined CFS study groups in which determinations are made of antibody responses to newly identified EBV-associated nuclear antigen components and distinct EBV proteins in addition to specific virologic and immunologic analyses of EBV may be worthwhile as a means of clarifying the association between EBV and CFS.

Cerebrospinal fluid abnormalities in patients without AIDS who are seropositive for the human immunodeficiency virus.

Lumbar punctures were done on 114 consecutive active duty patients referred for evaluation of positive tests for antibodies to the human immunodeficiency virus (HIV). Eighty-eight percent of these patients appeared to have early HIV infections, as evidenced by intact delayed hypersensitivity, T helper lymphocyte counts greater than 400/mm3, and lack of constitutional symptoms. Forty-four (38.6%) of the patients met our criteria for abnormal cerebrospinal fluid (CSF); another 13 (11.4%) had borderline elevations of nucleated cells or protein and could not be definitely classified as having normal or abnormal CSF. No significant differences existed between the patients with normal and abnormal CSF with regard to age; sex; race; serum FTA-Abs; clinical staging; absolute T helper lymphocyte counts; or cytomegalovirus, Toxoplasma, or Epstein-Barr virus serologies. Seventy-two percent of the patients with abnormal CSF had evidence of possible viral infection of the central nervous system (CNS), as evidenced by increased CSF IgG, increased IgG synthesis rates, or the presence of oligoclonal bands. We found that a significant percentage of asymptomatic patients with apparent early HIV infections have abnormal CSF that is possibly due to CNS involvement by HIV.