Fetal intestinal perforation and meconium peritonitis associated with maternal autoimmune hepatitis.

Autoimmune hepatitis (AIH) in pregnancy can affect both fetal and maternal outcomes. Little is known regarding the fetal outcomes of AIH in pregnancy. The major risks include spontaneous abortions, fetal mortality, perinatal mortality and prematurity. Two common drugs used in the management of AIH, azathioprine and prednisone, may also be associated with adverse fetal outcomes. We present the case of perinatal focal intestinal perforation with a meconium pseudocyst in a preterm infant of a mother with autoimmune hepatitis on azathioprine and methylprednisone.

Effects of physical activity on exercise tests and respiratory function.

BACKGROUND: Exercise is an important component of pulmonary rehabilitation for patients with chronic lung disease. OBJECTIVE: To explore the role of physical activity in maintaining cardiac and respiratory function in healthy people. METHODS: Cardiorespiratory fitness was measured by a maximal treadmill test (MTT), and respiratory function was tested by spirometry. The cross sectional study included data from 24 536 healthy persons who were examined at the Cooper Clinic between 1971 and 1995; the longitudinal study included data from 5707 healthy persons who had an initial visit between 1971 and 1995 and a subsequent visit during the next five years. All participants were aged 25-55 years and completed a cardiorespiratory test and a medical questionnaire. RESULTS: In the cross sectional study, after controlling for covariates, being active and not being a recent smoker were associated with better cardiorespiratory fitness and respiratory function in both men and women. In the follow up study, persons who remained or became active had better MTT than persons who remained or became sedentary. Men who remained active had higher forced expiratory volume in one second (FEV(1)) and forced vital capacity (FVC) than the other groups. Smoking was related to lower cardiorespiratory fitness and respiratory function. CONCLUSIONS: Physical activity and non-smoking or smoking cessation is associated with maintenance of cardiorespiratory fitness. Change in physical activity habits is associated with change in cardiorespiratory fitness, but respiratory function contributed little to this association during a five year follow up.

Current indications for open stone surgery in Singapore.

A 3-year retrospective study (January 1995 to December 1997) of all treatment modalities for urinary stone disease done in the Department of Urology, Singapore General Hospital was documented, and open stone surgery identified. Patient's characteristics, stone burden, surgical factors, indications and outcome were reviewed for each patient. Of the 2651 procedures performed for urinary stone disease, the majority had extracorporeal shockwave lithotripsy [78% (n = 2075)], while 11% (n = 298) had percutaneous nephrostolithotomy and 9% (n = 228) ureteroscopy. Open stone surgery rate was 2% (n = 50) which included 16 anatrophic nephrolithotomies, 5 pyelolithotomies, 18 ureterolithotomies and 11 nephrectomies. There were 28 males and 22 females varying in age from 26 to 63 years (mean 48 years). The most common indications for open stone surgery were complex stone burden [38% (n = 19)], failure of minimally invasive modalities [16% (n = 8)], non-functioning kidneys [20% (n = 10)], concurrent open surgery [8% (n = 4)], co-morbid medical condition [4% (n = 2)], patient preference for open procedure [8% (n = 4)], anatomic abnormality [4% (n = 2)] and obesity [2% (n = 1)]. Stone free rate of 90% was achieved, morbidity of 8% (n = 4) mostly wound infections and a pneumothorax. Majority of patients with urinary tract calculi can be treated with less invasive modalities. Complex stone burden, failure of less invasive modalities, non-functioning kidney, concurrent open surgery, co-morbid medical problems, patients' preference, anatomic abnormality and obesity are factors to be considered in a small cohort of patients who may still benefit from treatment using open surgical technique.

Association between exercise and HIV disease progression in a cohort of homosexual men.

PURPOSE: To study the relationship between exercise and human immunodeficiency virus (HIV) disease progression. METHODS: 415 individuals (156 HIV positive, 259 HIV negative), from a cohort study of 851 homosexual men from New York City, 1985-1991. By 1991, 68 of the 156 persons developed Acquired Immune Deficiency Syndrome (AIDS) and 49 died with AIDS. Exercise was defined as self-report of exercising 3-4 times/week or daily at entry; less was considered nonexercise. CD4 lymphocyte decline was constructed for each subject by modeling log CD4 count against time in days. The association between exercise and progression to AIDS and death with AIDS, adjusting for baseline CD4 count, was determined using Cox model. Linear regression was used to model CD4 decline with exercise for HIV positive and HIV negative groups separately, adjusting for initial CD4 count. RESULTS: Having exercised was associated with slower progression to AIDS at 1 year (HR = 0.68, 90% confidence interval (CI): 0.4-1.17); hazard ratios (HR) at 2, 3, and 4 years were 0.96, 1.18, and 1.36, respectively. Having exercised was also associated with slower progression to death with AIDS at 1 year (HR = 0.37, 90% CI: 0.14-0.94) with hazard ratios at 2, 3, and 4 years of 0.68, 0.98, and 1.27, respectively, suggesting a protective effect close to the time exercise was assessed, but an increased risk after 2 years. Exercising 3-4 times/week had a more protective effect than daily exercise. Exercisers in the HIV positive group showed an increase in CD4 count during a year by a factor of 1.07. CONCLUSION: Moderate physical activity may slow HIV disease progression.

Congener-specific analysis of PCBs in human milk from Kazakhstan.

We have characterized the spectrum of PCB contaminants in human milk samples from 95 women in Kazakhstan using GC/MS congener specific analysis. In these samples, 12 PCBs comprised 83% of total PCB concentration, and were similar to the major PCBs reported in other published human milk studies. By summing concentration levels of 80 PCB congeners in the Kazakhstan samples, a mean total PCB concentration of 368 ng/g fat was obtained. This is lower than levels reported in human milk samples from Western Europe. Six indicator PCBs were summed in Kazakh milk samples; their aggregate value was similar to literature values published for human milk from the former Soviet Union. Using WHO's recent TEF scheme, the mean sum of PCDD/F, coplanar PCB, mono-ortho PCB, and di-ortho PCB TEQ is 42 pg TEQ/g fat.

Epidemiology of HIV and AIDS among Asian and Pacific Islander Americans.

As of June 1997 the Centers for Disease Control and Prevention reported 4,370 AIDS cases among Asian and Pacific Islander Americans (APIs) in the U.S. It also reported that the rate of new AIDS cases among APIs men who have sex with men (MSM) per 100,000 population increased by 55% from 1989 (4.0) to 1995 (6.2). Focusing on the relatively low numbers of APIs with AIDS in the U.S. has resulted in complacency among API communities and government officials, despite reports of increased seroprevalence and exponential growth in diagnosed AIDS cases. However, because of the geographic and social isolation of many Asian and Pacific Islander American communities, the effect of HIV is magnified once it takes hold. The low numbers of reported AIDS cases among API and the perception of them as the "model minority" has reinforced their denial of AIDS as a threat. Data collection and surveillance tools must be modified to accurately capture the range of HIV-related and social issues that affect Asian/Pacific Islander communities in the United States. Notwithstanding sample limitations, ethnic-specific data are needed to identify HIV trends in each of the Asian Pacific Islander American communities, which can inform prevention and intervention programs.

Asian and Pacific Islander American HIV community-based organizations: a nationwide survey.

A national survey was conducted to (a) ascertain the status of HIV prevention among community-based organizations targeting APIs in the United States, (b) define technical assistance needs among these organizations, and (c) determine their involvement in the HIV community planning process. Of the 80 surveys sent out, 49 (61%) completed responses were received. Filipinos, Chinese, Vietnamese, Cambodians, and multiracials were the subpopulations targeted the most often, and, not surprising, Tagalog, Cantonese, Mandarin, Vietnamese, Cambodian, Korean and Japanese were the Asian languages most widely in use. Gay men, bisexual men, and youth were targeted most frequently by HIV prevention efforts. Of all the largest ethnic subpopulations, Asian Indian is the only group with no community-based organization that exclusively targets them for HIV prevention. More than 95% of respondents reported conducting some type of evaluation; the size of the budget and organization often determined the evaluation strategies used. Program development, staff development, and program evaluation were the most frequently reported areas of technical assistance requested. A majority of the respondents (79%) reported being involved with the HIV prevention community planning process where APIs were represented on state/local community planning groups, they did not rate the performance of the community planning process highly. We recommend providing technical assistance in fund-raising, program evaluation, and participation in the HIV community planning process.

The acceptability of oral fluid testing for HIV antibodies. A pilot study in gay bars in a predominantly rural state.

BACKGROUND: One barrier for individuals desiring human immunodeficiency virus (HIV) antibody testing has been the lack of alternatives to blood HIV testing. Oral fluid HIV testing provides another testing option. OBJECTIVES: To evaluate the acceptability of oral fluid testing for HIV antibodies in a gay bar outreach setting. STUDY DESIGN: This pilot study was conducted using the HIV Risk Behavior Survey (HRBS) and OraSure acceptability survey in gay bars in Columbia, South Carolina during July and August, 1997. RESULTS: Of the 118 HRBS participants, 54% agreed to take the oral fluid test with 6% testing positive. A majority (91%) of participants felt comfortable with the oral HIV antibody testing in gay bars. Also, 21.8% of individuals in the OraSure study were tested for the first time. CONCLUSION: This study indicates that oral fluid testing for HIV antibodies in an outreach setting is acceptable and effective in reaching individuals who do not usually access traditional testing sites.

Risk factors for congenital syphilis in infants of women with syphilis in South Carolina.

OBJECTIVES: This study examined risk factors for congenital syphilis in South Carolina. METHODS: Case infants with presumptive and confirmed congenital syphilis were compared with control infants born to women with reactive serologies during pregnancy, allowing investigation of risk factors for congenital rather than acquired transmission of syphilis. Data were collected from congenital syphilis report forms and birth certificates for 186 case infants and 487 controls born from 1991 to 1993. Odds ratios were calculated for maternal risk factors. RESULTS: Significant statistical trends were found for timing of first prenatal visit and number of visits. Other significant factors included rural residence (odds ratio [OR] = 2.0, 95% confidence interval [CI] = 1.4, 2.9) and previous pregnancy loss (OR = 0.3, 95% CI = 0.2, 0.6). CONCLUSIONS: Prevention of congenital syphilis may be less effective among pregnant women with syphilis in South Carolina who have fewer prenatal care visits. Health care providers need further education on maternal/child syphilis management and techniques for motivating and educating patients.

Correlates of hepatotoxicity and antituberculosis therapy in South Carolina.

This study revealed that 20-30 percent of TB patients who were taking antituberculosis therapy developed elevated liver function tests. Half of the elevation in liver enzyme values occurred within the first two months of treatment. No statistically significant differences between sex, race and liver toxicity was found in this study. The time from initiation of treatment for TB to development of hepatotoxicity was shorter for females and whites. Physicians and public health workers should monitor the liver function tests of TB patients who are taking antituberculosis treatment. Recommendations for monitoring hepatotoxicity vary depending on the age of the patients. For patients less than 35 years old, monthly symptom review for jaundice, acholic stools, fever, anorexia, nausea and vomiting, may be adequate. For older patients, liver function tests are recommended monthly or every one to two months.

Cigarette smoking and tuberculin skin test conversion among incarcerated adults.

INTRODUCTION: The purpose of this case-control study was to determine whether smoking plays a role in tuberculin skin test conversion among the inmate population of South Carolina. RESULTS: The major findings of this study indicate that smokers were more likely to have become tuberculin skin test converters during incarceration than nonsmokers (odds ratio [OR] = 1.78, 95% confidence intervals [CI = 0.98, 3.21). Inmates who smoked 1 to 20 cigarettes per day prior to incarceration (OR = 1.32, 95% CI = 0.76, 2.31), and those who smoked > 20 cigarettes per day prior to incarceration (OR = 1.75, 95% CI = 0.83, 3.71) were more likely to have become converters during incarceration than nonsmokers, suggesting a dose-response effect. Converters were found to have reduced their number of cigarettes smoked per day since incarceration. Those inmates smoking 1 to 10 cigarettes per day (OR = 1.88, 95% CI = 0.96, 3.69), and those who smoked > 10 cigarettes per day since incarceration (OR = 1.87, 95% CI = 0.92, 3.78) were more likely to have become converters than nonsmokers. Interestingly, inmates who smoked for 15 years or less were more likely to have become tuberculin skin test converters than nonsmokers (OR = 1.60, 95% CI = 0.81, 3.16), while those smoking for more than 15 years were more likely to have become converters than nonsmokers while incarcerated (OR = 2.12, 95% CI = 1.03, 4.36). CONCLUSIONS: This suggests that the cumulative effects related to the duration of smoking may be more important than the number of cigarettes smoked with regard to tuberculin skin test conversion. This is consistent with the understanding that long-term exposure to cigarette smoking has an adverse effect on the lung's defense mechanisms, namely mucociliary clearance of potential pathogens, such as Mycobacterium tuberculosis.

Primary care physicians and barriers to providing care to persons with HIV/AIDS.

Primary care physicians play an increasingly important role in the care of persons with HIV/AIDS due to the rising number and changing geographic distribution of persons infected with HIV/AIDS. The study explored the relationship between barriers to health services and the experience and willingness of primary care physicians to care for persons with HIV/AIDS. The study was based on a random survey of primary care physicians in South Carolina. The results indicate that although primary care physicians' willingness to treat persons with HIV/AIDS is significantly associated with many self-reported barriers (i.e., financial, structural, knowledge, and attitudinal), their HIV/AID care experience was most significantly correlated with self-reported knowledge that overrides financial and structural barriers. The results emphasize the importance of programs and policy initiatives aimed at enhancing the primary care physicians' knowledge level and improving their attitudes related to HIV/AIDS.

Blood pressure in Hispanic women: the role of diet, acculturation, and physical activity.

The role of diet, acculturation, and physical activity on systolic and diastolic blood pressure was examined among 1,420 Mexican American, 388 Cuban American, and 542 Puerto Rican women who responded to the Hispanic Health and Nutrition Examination Survey collected in 1982-4. Dietary intake measures included sodium, potassium, calcium, magnesium, fiber, ethanol, and total kilocalories as estimated from 24-hour recall data. Serum sodium/potassium ratio was included as a measure of metabolic function. Acculturation was measured using language preference, speaking, reading and writing. Physical activity included recreational and non-recreational activities. Other correlates included age, education, and body composition. Final models indicated that age and body composition were significantly associated with blood pressure across all three Hispanic subgroups. Among Mexican-American women, acculturation had an impact on both systolic and diastolic blood pressure that was independent of diet, body composition, and physical activity. Furthermore, the dietary intake of specific nutrients such as sodium and potassium did not appear to be as important as the way the individual metabolized those nutrients, as indicated by the serum sodium/potassium ratio. The strong association of body mass index with both systolic and diastolic blood pressure among all three ethnic groups reinforces the need to maintain an appropriate body weight.

Survival after AIDS diagnosis in South Carolina, 1982-1992.

The results of this study demonstrate that age, ethnicity, and AIDS-defining diagnosis are important predictors of survival time after AIDS diagnosis, and should be considered when planning treatment and services for people with AIDS. Future studies in states with large rural populations will be helpful in further understanding the natural history of the disease in areas outside the nation's major population centers. These could improve on the results of the present study by actively following up all cases to determine mortality status, collecting detailed clinical information on AIDS-defining diagnoses (with dates), collecting information on treatment of HIV infection and associated opportunistic infections, and evaluating service utilization. Monitoring survival trends over time remains an effective tool in evaluating the success of current efforts to provide treatment and services to people with AIDS.

Analysis of breast milk to assess exposure to chlorinated contaminants in Kazakstan: PCBs and organochlorine pesticides in southern Kazakstan.

Organochlorine pesticides (OC) and polychlorinated biphenyls (PCBs) were measured in samples of breast milk taken from 92 donors representative of regional populations in southern Kazakstan. The World Health Organization protocol for assessing levels of chlorinated contaminants in breast milk was followed. The most prevalent OC residues were beta-hexachlorocyclohexane (beta-HCH), p,p'-DDE, p,p'-DDT, hexachlorobenzene, and alpha-HCH. The measured levels of beta-HCH were among the highest reported in the published literature. Data from Aralsk, near the Aral Sea, indicated continuing DDT exposure. Overall PCB-toxic equivalent levels (22 pg/g fat) were similar to those reported in industrialized European countries. PCBs were highest in Atyrau in the Caspian oilfields.

Rural physicians: a survey analysis of HIV/AIDS patient management.

Primary care physicians in South Carolina were asked about their knowledge, attitudes, beliefs, and services provided to HIV/AIDS patients. The study focused on conditions under which physicians would provide additional services in an effort to develop more effective state policies regarding HIV/AIDS. There was a 66 percent (597/900) response rate. This analysis focuses on a group of 338 physicians that identified themselves as rural (nonurban) physicians. Of the rural physicians responding, 42 percent had not treated a case of HIV/AIDS during the last year and 52 percent had seen only 1 to 9 patients. They identified lack of specialty back-up support, likelihood of losing patients, legal and ethical issues, and lack of community services as the primary barriers to service. Gaps in rural physician knowledge included when to refer HIV/AIDS cases to specialists and information on legal and ethical issues. They, like their urban colleagues, would provide additional services to HIV/AIDS patients with specialty back-up (57 percent), better community and social services support (54 percent), additional training (48 percent), and limited liability (47 percent). The authors conclude that policy changes addressing these areas in the broader contexts of rural health issues would expand access to care for persons with HIV infection in rural states.

[ Dietary intake of fluorine through of tea prepared by the traditional method in Senegal]. / L'apport de fluor dans l'alimentation par le thé préparé selon la méthode traditionnelle au Sénégal.

The consumption of tea in Senegal is known and called "trois normaux". The use of Thea sinensis as drink many times per day with a lot of sugar, may cause some public health problems. In the aim to face that situation, we have analysed the fluor level in the available tea samples in the senegalese market in respect of the ways of the preparation. The fluor level has been analysed by ionometric specific electrode. The concentrations were from 3.8 to 6.1 mg/l in the infusion and from 11.1 mg/l in the decoction. These results showed that the tea plant contain a high concentration of fluoride. In addition, the level of fluoride may be higher, when the water drink itself is rich in fluoride.

AIDS-related knowledge and attitudes of social workers in South Carolina.

This study examines the association between knowledge of acquired immune deficiency syndrome (AIDS) and skill among social workers in South Carolina and attitudes toward people with human immunodeficiency virus (HIV) and AIDS. A stratified random sampling method was used to obtain a representative sample of social workers in South Carolina. Findings show that AIDS-related knowledge and skill were significantly associated with improving the general attitudes of social workers toward HIV/AIDS clients. In addition to knowledge and skill-related measures, other significant covariates of attitudes include levels of contact with HIV/AIDS clients and sensitivity to minorities. As with previous studies, demographic variables such as age and gender were not found to be significantly related to variations in attitudes toward HIV/AIDS clients. Furthermore, locality of practice and supervisory position did not significantly correlate with attitudes. The implications of these findings for social services agencies are discussed.

Incentives for physicians to treat HIV-seropositive patients: results of a statewide survey.

We asked primary care physicians in South Carolina about their knowledge, attitudes, and beliefs regarding patients with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) and the services they provide for these patients. In support of an effort to develop more effective state policies regarding HIV/AIDS, the survey focused on conditions under which physicians would provide additional services for such patients; 597 of 900 physicians (66%) responded. Among responding physicians, 40% had not seen a patient with HIV infection/AIDS during the past year and 50% had seen only one to nine. Respondents identified lack of specialty backup support, insufficient clinical knowledge, and lack of available community services as the major barriers to providing care for these patients. Gaps in their knowledge included state and federal policies, available community resources, and clinical issues. Respondents said they would provide additional services if they had specialty backup (54%), better community and social support services (50%), additional training (46%), and limited liability (44%). We concluded that policy changes in these areas could expand access to care for HIV/AIDS patients in South Carolina.

Tuberculosis and AIDS in South Carolina: a case-control study.

The epidemiologic features of tuberculosis patients with AIDS or HIV infection in this study do not appear to be different from those reported from previous studies. Tuberculosis patients with AIDS or HIV positive antibody in South Carolina are predominantly black males who live in the urban areas and are 25 to 44 years old. They have more extrapulmonary sites and more anergic reactions to tuberculin tests. Physicians and other public health workers should be aware of the abnormal clinical and laboratory manifestations of tuberculosis patients with AIDS and HIV infection. It is also imperative for tuberculosis control programs to offer counseling and HIV antibody testing to tuberculosis patients.