Demographic impact of the HIV epidemic in Thailand

OBJECTIVE: To assess the impact of the HIV epidemic on the demographic development of the Thai population. METHODS: A deterministic mathematical model was used to predict simultaneously epidemiological and demographic processes. Partial differential equations express the relationships between biological, behavioural and demographic variables. The model allows the evaluation of different sexual mixing patterns, variable transmission probabilities and incubation times. Validity analysis was performed by generating antecedent HIV prevalence patterns among military recruits and pregnant women. RESULTS: On the national level in Thailand we predict that the cumulative number of people in Thailand with HIV infection will exceed 1 million by 1999; the number of deaths from AIDS will be 555000 by the year 2000 but will not reach 1 million until after the year 2014. Without the HIV epidemic the population growth rate was estimated at 1.3% per annum until 1995, after which a decline to 0.9% by 2005 is predicted. The HIV epidemic started to affect the population growth rate by 0.026% per year in 1991, and the difference is predicted to rise to about 0.12% per year during the period 1995-2000, to decline to 0.06% in 2005 and then to disappear. In the mid-1990s HIV affected mainly the 15-35-year-old age group, but over time younger and older age groups have been affected as a result of perinatal transmission, and a decline in fertility as well as ageing of the 15-35-year-old birth cohort. Because of HIV, in 2000 there will be 612000 (1%) fewer people than expected and by 2010, 1140000 fewer (1.6%). We predict that the demographic impact of the HIV epidemic in the northern region will follow the same pattern, but with greater severity. Here, the effect on the population growth rate and the population age distribution is likely to be twice as high as at the national level. CONCLUSIONS: It is estimated that 1 million Thais will be infected with HIV by the year 2000 and an almost equal number will have died of AIDS by the year 2014. Although these numbers seem high, their direct and indirect effects on the demographic structure of the Thai population are small. However, at a regional level, for example in the northern region, the effect of the HIV epidemic may be more severe.     

An epidemiologic summary of the AIDS/HIV epidemic in Minnesota

Health care is seeing a revival of customer service, driven by cost pressure, competition, and a nagging conscience to do the right thing. In some markets, health systems no longer compete on prices. They're already cut to the bone. Service is how they aim to set themselves apart.     

Redefining the growth of the heterosexual HIV/AIDS epidemic in Chicago

A 38-year-old male with bilateral pseudo-internuclear ophthalmoplegia (-INO) in myasthenia that could have been misdiagnosed as INO in multiple sclerosis is reported. He experienced fluctuating symptoms including double vision, imbalance, and tinnitus. His eye movements simulated bilateral INO, with a downshoot in abduction. After thymectomy, his eye movements became normal. From our case and a review of the literature, we propose that ptosis, downshoot, and fatigability are likely to be signs of pseudo-INO in myasthenia, whereas an impaired vertical smooth pursuit is unlikely. Dissociated nystagmus and monocular overshoot might be the results of central compensation.     

Influence of HIV epidemic on the incidence of Kaposi''s sarcoma in Zambian children

BACKGROUND: It has been suggested that suppression of adrenal androgens may provide benefit to patients with metastatic prostate cancer refractory to initial hormonal therapy (e.g., orchiectomy). METHODS: The records of 38 patients with metastatic prostate cancer that had progressed after orchiectomy who were placed subsequently on low dose dexamethasone (DXM) with no other concurrent therapy (36 patients received 0.75 mg twice daily and two received 0.75 mg three times daily) were reviewed. Symptomatic status, prostate specific antigen (PSA) measurements, and available radiographic assessments were recorded. Bone scans were reviewed by an independent, blinded evaluator. RESULTS: Symptomatic improvement was experienced by 24 patients (63%), 20 (83%) of whom also had decreases in PSA. Prostate specific antigen values decreased in 30 patients (79%) with decreases 50% or greater and 80% or greater in 23 (61%) and 13 (34%) patients, respectively. Of the 23 patients with PSA decreases 50% or greater, 8 (35%) had radiographic evidence of disease regression, 5 (22%) were stable, 7 (30%) had disease progression, and 3 (13%) did not have serial radiographic exams. Flutamide was discontinued shortly before DXM treatment for 2 of the 23 patients. CONCLUSIONS: Low dose DXM may produce important symptomatic improvement and decreased PSA levels in the majority of patients with hormone-refractory prostate cancer. In addition, a substantial percentage of those patients with decreases in PSA also will have radiographic evidence of disease regression. These results suggest the need for additional prospective controlled studies of DXM as a therapy for hormone-refractory prostate cancer.     

Responding to the HIV epidemic: A national strategy.

Admiral James Watkins (Retired), the chairman of the Presidential Commission on the Human Immunodeficiency Virus Epidemic, discusses the work of the commission, including obstacles to progress the nation faces in attempting to respond to the epidemic and recommendations for improving the nation's response. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Tuberculosis: infection control measures

A 58-year-old man with acute mitral and aortic endocarditis suffered an acute ascending aortic dissection. The patient had a double valve replacement, combined with replacement of the ascending aorta with a Dacron graft and sealing and closure of the proximal and distal aortic segments with surgical glue. Six months after the operation the patient is doing well with normal function of both valve prostheses and aortic vascular graft.     

Tuberculosis control in Bangladesh: success of the DOTS strategy

SETTING: Tuberculosis (TB) has been a major public-health problem in Bangladesh for many decades. National control efforts in the past have not been successful, with less than half of detected cases being cured. In 1993, a project based on the DOTS (directly observed treatment, short-course) strategy was initiated for a population of approximately one million in a rural setting. Following a 78% cure rate in the initial cohort of new smear-positive patients, the project was expanded in phases to cover a rural population of 67 million in 1996. OBJECTIVES: Routine programme data on all new sputum smear-positive patients registered in the TB project since its inception until 1996 were analysed. Case finding results are presented until 1996, as are results of sputum smear conversion after 2 months of treatment in new smear-positive patients for the same cohort of patients. Final treatment outcome results were analysed for new smear-positive patients registered up to 1995. RESULTS: A total of 41,525 patients were registered in the project during the 3-year period. Two-thirds of these were new smear-positive cases and 27% were new smear-negative patients. Sputum smear conversion in 26,151 new smear-positive patients at 2 months was 85%; 5% remained smear-positive, 3% had died and the rest had no sputum examination. Final treatment outcome results in 10,142 new smear-positive patients registered during 1993-1995 showed that 75% were cured, 4% completed treatment but did not have a sputum smear result, 2% remained smear-positive, 6% died, 10% defaulted and 3% were transferred out. CONCLUSION: The DOTS strategy can be successfully implemented in phases in large countries with a high tuberculosis burden. This success is due to decentralizing sputum smear microscopy and treatment delivery services to peripheral health facilities, utilizing the existing primary health care network. High cure rates can be maintained despite rapid expansion of coverage, with proper implementation of the strategy and regular monitoring of reports on case finding, sputum smear conversion and treatment outcome. Case detection needs to be further increased by informing and involving the community in TB control efforts through social mobilization.     

Tuberculosis and its control programme in Japan

The author analyses the factors which brought about the rapid decline of tuberculosis in Japan during the past 30 years. Among the modern measures combating tuberculosis, chemotherapy and the extensive use of BCG vaccination are at the paramount place. As a result of intensive control the problem of tuberculosis has become smaller and smaller and a turning point is reached. The future direction of tuberculosis control is determined by chemoprophylaxis of high risk groups and by symptomatic casefinding combined with selective mass miniature radiography for high risk groups using high technical standards. By means of intensive initial chemotherapy the duration of treatment will be shortened. In 1974 the policy of BCG vaccination was changed; primary vaccination is provided for children in the age of 0 to 3 years, and revaccination at entrance to primary school and in leavers from middle school for tuberculin non-reactors. If the annual risk of infection will continue to decline the primary vaccination age it intended to be raised up to school entrance.     

Tuberculosis and HIV infection. Evaluation of 132 cases

Perioperative blood glucose and insulin levels were measured in children (1-9 years of age) randomly assigned to two groups according to anesthesia technique, general anesthesia (group GA) or general anesthesia combined with regional anesthesia (group RA). Children in the GA group (n = 10) received halothane and opioids, while children of the RA group received epidural anesthesia with bupivacaine (0.25%) and adrenaline combined with halothane anesthesia (n = 10). Children in both groups received 2.5% dextrose in 0.4 N saline administered by volumetric infusion pumps throughout the study period, the infusion rate being adapted to the child's age. Blood samples for glucose and insulin determinations were obtained: at induction, at the end of surgery, and 30, 60 and 120 min after surgery. In response to an identical glucose load, blood glucose levels increased significantly in both groups (P < 0.001), while no differences between groups were observed. Insulin levels did not change significantly postoperatively in the GA group (P = 0.058), while a significant increase was observed in the RA group (P < 0.001). Insulin/blood glucose ratio increased significantly only in the RA group (P < 0.05). The higher insulin secretion in response to glucose infusion in the RA group compared to the GA group may indicate an increased peripheral insulin resistance after regional anesthesia or, more likely, this secretion may be beneficial in contributing to improve postoperative nitrogen balance.     

Tuberculosis and HIV infection. Clinical characteristics and diagnosis

The in vitro radiosensitivity of dermal fibroblasts has been found to vary between individuals, and a number of studies have also shown that this parameter correlates with radiation-induced late injuries in clinical radiotherapy. In addition, certain genetic disorders are known to effect radiosensitivity, e.g. normal tissues of patients homozygous or heterozygous for the ataxia teleangiectasia gene show unusual sensitivity to radiation both in vivo and in vitro. Thus, it has been assumed that there is a genetically determined component resulting in a certain intrinsic cellular radiation response in an individual. To study this possible relationship between different cells of a specific patient, we established eight pairs of dermal and tumor fibroblast cultures. The donor patients had either adenocarcinoma of the uterus or squamous cell carcinoma (SCC) of the head and neck. The radiosensitivity of these strains was determined by a 96-well plate clonogenic assay, previously used by us for radiosensitivity testing of cancer cells. From a paired comparison, the values for the cell fraction surviving 2.0 Gy (SF2), of both fibroblast strains, were found to be on the same level in five out of eight cases. In patient 6, the SF2 of tumor fibroblasts was significantly higher than that of dermal fibroblasts (P=0.0014). In two additional cases the tendency was the same, but not statistically significant. As groups, the two types of fibroblasts did not differ from each other, mean SF2 values of 0.24+/-0.07 and 0.21+/-0.05, respectively. The SF2 of tumor fibroblasts from SCC patients proved to be significantly higher than that of the adenocarcinoma patients (P=0.030). These preliminary results indicate that the in vitro radiosensitivity of tumor fibroblasts correlates with normal cell sensitivity in many cases, but not in all. The radiosensitivity of tumor fibroblasts also seems to follow the level of in vitro radiosensitivity determined for the corresponding histological type of tumor cells. Further studies are needed to determine more closely the relationship between the radiosensitivities of tumor cells and tumor fibroblasts, thus evaluating the possibility of testing radiosensitivity from tumor fibroblasts in order to estimate tumor response.     

Tuberculosis control in health care workers: an algorithmic approach

Smooth muscle cells isolated from cecal circular smooth muscle of the guinea pig were used to determine whether thyrotropin-releasing hormone (TRH) can inhibit the contractile response produced by 10(-6) M carbachol by exerting a direct action on muscle cells. In addition, the inhibitory effect of 2',5'-dideoxyadenosine (an inhibitor of adenylate cyclase), phorbol 12-myristate 13-acetate (an inhibitor of particulate guanylate cyclase), 6-anilinoquinoline-5,8-quinone (an inhibitor of nitric oxide synthase) on the TRH-induced relaxation of cecal circular smooth muscle cells was examined. TRH inhibited the contractile response produced by 10(-6) M carbachol in a concentration-dependent manner, with an IC50 value of 4 nM, 2',5'-Dideoxyadenosine and phorbol 12-myristate 13-acetate did not have any significant effect on the TRH-induced relaxation. On the other hand, 6-anilinoquinoline-5,8-quinone and N omega-nitro-L-arginine methyl ester significantly inhibited the relaxation produced by TRH. Our findings show that TRH has a direct inhibitory effect on the isolated cecal circular smooth muscle cells via activation of nitric oxide synthase and soluble guanylate cyclase.     

Tuberculosis control in health care workers: an algorithmic approach

Health care workers have always been at risk for contracting tuberculosis (TB) from patients with active disease. In addition, health care workers who have active TB pose a risk for transmitting TB to patients. As a result, institutions that employ health care professionals must adopt programs to reduce the probability of transmission of TB to their employees or their patients. This article discusses the new guidelines for preventing TB issued by the Centers for Disease Control and Prevention and suggests approaches for adapting the guidelines to the needs of individual institutions. It emphasizes the importance of skin testing for early detection, correct interpretation of the tests, the approaches to determining who should be tested, and the relative frequency with which employees should be tested. It presents algorithms to assist employee health and infection control personnel in screening current and prospective employees, and in responding to positive and negative test results, and the booster effect.