PubMed Health⌕ Search

Biomedical subjects

A B Williams

Publications and source records attributed to A B Williams.

16 recordsLinked to original sources
PubMed1992

Methadone maintenance treatment and HIV type 1 seroconversion among injecting drug users.

This study examined whether methadone maintenance treatment decreases drug injection enough to significantly limit HIV-1 transmission among injection drug users (IDU). When HIV-1 seroconversion status among prospectively followed methadone maintenance clients was analyzed by treatment retention, 1/56 (2%) of those who remained continuously in treatment seroconverted while 8/42 (19%) of those whose methadone treatment was interrupted seroconverted. When controlled for length of follow up, the difference in seroconversion rate was not statistically significant. Subjects in continuous treatment had a seroconversion rate of 0.7 per 100 person years (95% Confidence Interval [CI] = 0.1, 5.3) and those with interrupted treatment a rate of 4.3 per 100 person years (95% CI = 2.2, 8.6). Subjects in continuous treatment reported less needle sharing (p less than 0.0002), fewer needle sharing partners (p less than 0.002), fewer sexual partners (p less than 0.03), and were more likely to be women (p less than 0.01). These data indicate the need for larger studies to evaluate both client and drug treatment program characteristics which might concomitantly increase treatment retention and decrease HIV-1 risk.

Adult↗
PubMed1992

The epidemiology, clinical manifestations and health-maintenance needs of women infected with HIV.

The growing epidemic of HIV infection poses a serious threat to women's health in the United States and abroad. In the United States, HIV disproportionately affects African-American and Hispanic-American woman. Primary care providers will be faced with an increasing need to provide counseling and clinical services to these women. It is not yet clear whether gender affects the natural history of HIV infection; differences in survival rates may reflect lack of access to care rather than true biologic differences. Opportunistic infections among women with HIV infection are similar to those found among men with AIDS who use injection drugs. Unique expressions of HIV disease associated with women's reproductive tracts include persistent vaginal candidiasis, human papillomavirus infections and cervical dysplasia. Women with HIV infection should receive thorough gynecologic screening, including Pap smears, every six months. Women who know they are HIV positive may choose to become pregnant; these clients require extensive prenatal care and state-of-the-art HIV management.

HIV Infections↗
PubMed1992

Women in the HIV epidemic.

In the United States, the majority of women with HIV/AIDS are women whose lives have been touched by injection drug use--their own or that of their sexual partners. The pattern of opportunistic infections in women is more similar to that of injection drug users than that of homosexual men. Specific complications associated with a woman's reproductive tract include persistent Candida vaginitis, human papillomavirus infections, cervical dysplasias, and, possibly, pelvic inflammatory disease. Childbearing decisions for women with HIV infection are complex and culturally mediated. Meeting the challenge of providing high quality services to women with HIV infection requires major changes in the service delivery system.

Female↗
PubMed1992

Women and the AIDS epidemic: no longer hidden.

1. Women acquire HIV infection along one of three routes: parenteral, sexual, or vertical (perinatal). The HIV/AIDS epidemic among women in the US is growing primarily through parenteral and heterosexual exposures, which are tightly linked to social issues of substance abuse. 2. The majority of AIDS clinical trial participants have been white men. Differences in male and female physiology, hormonal influences on drug pharmacokinetics, and the social context of disease may render protocols ineffective or even harmful for women. 3. To respond effectively to the AIDS epidemic among women in the US, major public health issues, such as access to care, availability of family planning and drug treatment services, and racial discrimination, must be addressed.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Women at risk: an AIDS educational needs assessment.

In order to acquire the information nurses need to develop education and support programs for women at risk for Acquired Immunodeficiency Syndrome (AIDS), a qualitative needs assessment of women at risk was conducted. Interviews were conducted with 21 women who were at risk for AIDS through their own injection drug use or as the heterosexual partners of injection drug users. Results were analyzed using the variables of the Health Belief Model, including the concept of self-efficacy. The perception of AIDS as a serious and a personal health threat motivated these women to practice both "safe sex" and "safe drug use." However, they did not always believe that recommended health behaviors would be effective; and they noted significant costs associated with these behaviors. In addition, the impact of AIDS was seen to be a heightening of the isolation and mistrust which were characteristic of the injection drug using community before the epidemic. AIDS programs for women at risk should facilitate discussion of social and community issues and should emphasize hope rather than fear.

Acquired Immunodeficiency Syndrome↗
PubMed1989

A new algorithm for use in computer identification.

On 9 May 1987, a Soviet-made IL-62M Polish airliner, LOT Flight 5055, crashed, exploded, and burned, killing the crew and 183 passengers. A forensic science team from the Armed Forces Institute of Pathology, comprised of 6 dental officers, 3 forensic pathologists, and 3 medical photographers, worked in concert with the Polish forensic science team. The small number of antemortem records and the extreme fragmentation of the remains presented a new scenario for computer use. Typically, the Computer-Assisted Postmortem Identification (CAPMI) software is used to compare remains against an antemortem database. Results are listed by the number of tooth-to-tooth matches based on restorative or other characteristics or both. The Polish disaster confounded this approach to some degree, however, and suggested a reconsideration of the theory on which the sort is made, that is, that the cases with maximum number of matches to preexisting dental records would be the most likely identification (ID) match. A hypothesis was constructed that, if searches were accomplished for fragments with a minimum number of mismatches, the correct matches would appear higher in the rank order. Six antemortem records (that had all dental information) were sorted against one hundred and twelve postmortem fragmented records. The resulting report was reordered so that records were listed by minimum number of mismatches. There was significant improvement in rank placement for all of the records. Thus it was accepted that in the situation of highly fragmented remains a different sorting based on the number of mismatches is indicated. Programming changes to make this option available have been implemented in the new version of CAPMI.

Accidents, Aviation↗
PubMed1989

Direct surgical treatment of atrioventricular node reentrant tachycardia.

Atrioventricular node reentry tachycardia is a common type of supraventricular tachycardia. Rarely is it incapacitating and refractory to drug therapy, but when it is, the only option in therapy until recently has been atrioventricular node ablation or antitachycardia pacemaker insertion. The purpose of this paper is to review the case histories of four patients in whom we have surgically abolished atrioventricular node reentrant tachycardia while intentionally preserving atrioventricular node conduction. All four patients had atrioventricular node reentrant tachycardia confirmed by electrophysiologic study as diagnosed by established criteria. One patient had a left posterior atrioventricular accessory pathway, in addition to atrioventricular node reentrant tachycardia. All patients underwent intraoperative epicardial and endocardial mapping. Direct surgical dissection of the atrioventricular node node was performed in all four patients during normothermic cardiopulmonary bypass. Early and late postoperative electrophysiologic studies were used to evaluate the success of the surgical dissection. None of the patients had any evidence of dual atrioventricular node pathways or spontaneous or inducible atrioventricular node reentrant tachycardia postoperatively. At last follow-up (15 weeks to 21 months postoperatively), all patients were free from arrhythmias and cardiac medications, all were in normal sinus rhythm, and all had a subjectively improved life-style. This technique of direct surgical dissection of the atrioventricular node during normothermic cardiopulmonary bypass has allowed for complete cure of atrioventricular node reentrant tachycardia, while maintaining normal atrioventricular node function in these four patients.

Adult↗
PubMed1989

Race/ethnicity as a risk factor for HIV-1 infection among Connecticut intravenous drug users.

This cross-sectional study of 341 entrants to drug abuse treatment in four Connecticut cities in 1986-1987 evaluated whether demographic, behavioral, viral serologic, or economic differences explained the disproportionate risk of human immunodeficiency virus type 1 (HIV-1) infection among black and Hispanic intravenous drug users (IVDUs), relative to non-Hispanic white IVDUs. Blacks [odds ratio (OR) = 9.0, 95% confidence interval (CI) = 5.1-15.9] and Hispanics (OR = 4.1, 95% CI = 1.9-8.8) were at increased risk of HIV-1 infection, relative to non-Hispanic whites. Those who lived closer to New York City, injected drugs more frequently, used intravenous drugs for a longer duration, used shooting galleries, had greater numbers of sexual partners, had human cytomegalovirus (CMV) or hepatitis B virus (HBV) antibodies, and had the lowest annual incomes were also at increased risk. However, none of these other factors accounted for the black and Hispanic HIV-1 risk in stratified analysis. Black race, Hispanic ethnicity, proximity to New York City, and number of drug injections in the past year each also remained significant, independent risk factors in a multivariate analysis. The increased HIV-1 risk of nonwhite IVDUs remained unexplained. Behavioral, sociologic, and/or biologic factors not identified in this study may modulate HIV-1 transmission dynamics in IVDUs.

Acquired Immunodeficiency Syndrome↗
PubMed1988

A comparison of oxygen therapy devices used in the postoperative recovery period.

Seventy-one patients scheduled to undergo upper or lower abdominal surgical procedures were allocated at random to one of seven treatment groups: in the recovery room they were to receive oxygen via a 40% Ventimask with 10 litres/minute oxygen flow, or via either a Hudson mask or a nasal cannula with 3, 6 or 9 litres/minute oxygen flow. The 40% Ventimask gave the most consistent, satisfactory postoperative values of PaO2 but the much cheaper nasal cannula at 6 or 9 litres/minute was generally adequate in conscious patients. The performance of the intermediately priced Hudson mask was similar to that of the nasal cannula at these flows. The unconscious state was associated with a 45% lower PaO2 than the rousable or awake states. Differences between the treatments with regard to postoperative PaCO2 were small and non-significant. The nasal cannula with 6 litres/minute humidified oxygen flow is recommended for routine treatment, and the Ventimask for unconscious patients.

Abdomen↗
PubMed1988

The control of post-thoracotomy pain. A comparative evaluation of thoracic epidural fentanyl infusions and cryo-analgesia.

This is a comparative study of two methods to relieve postoperative thoracotomy pain. Continuous thoracic epidural infusion of fentanyl produced superior analgesia when compared with cryo-analgesia of the relevant thoracic nerves. Linear analogue pain scores were consistently lower in the epidural group reaching significance (p less than 0.05) at 32 and 40 hours after operation. All 36 patients in the cryo-analgesia group required additional analgesia, while 12 out of the 32 patients in the epidural group did not. This difference was significant at p less than 0.001. Respiratory and cardiovascular measurements were similar in both groups and the only side effect attributable to the epidural fentanyl was itching but this was not a problem.

Analgesia↗
PubMed1986

Public health implications of HIV infection.

Acquired immunodeficiency syndrome is the most extreme of a range of immune abnormalities that have been linked to infection with a recently described retrovirus. From a public health viewpoint, the most important advance to date has been the development of serum tests that detect exposure to this virus. Serologic screening has greatly reduced the risk of infection for transfusion recipients and facilitated surveillance studies and research. False negative tests clearly occur, and prognostic implications of positive antibody tests are not yet well-described. Primary care providers have a major role to play in public education for prevention of this new and frightening epidemic.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Blood glucose homeostasis in rats with a deficiency of liver phosphorylase kinase.

The glycogen storage disorder (gsd/gsd) rat has little or no phosphorylase kinase activity in the liver and is unable to break down liver glycogen on fasting. Nevertheless, gsd/gsd rats do not become hypoglycaemic on fasting. Gsd/gsd rats showed a decreased rate of glucose turnover measured with [6-3H]glucose. Perfused livers from gsd/gsd rats showed decreased rates of gluconeogenesis from lactate and alanine when the results were expressed per gram of liver, but the total glucose produced per liver was normal. Measurement of gluconeogenesis in vivo using [14C]-bicarbonate showed that gsd/gsd rats had a decreased rate of glucose production from substrates that enter the gluconeogenic pathway before pyruvate. We conclude that gsd/gsd rats have adapted to unavailability of liver glycogen by decreasing peripheral uptake of glucose and not by increasing gluconeogenesis.

Animals↗
PubMedDate not supplied

Reproductive concerns of women at risk for HIV infection.

This qualitative, exploratory study investigated knowledge about perinatal transmission of human immunodeficiency virus (HIV) and perceptions of the childbearing role among women at risk for acquired immunodeficiency syndrome (AIDS) through injection drug use. Content analysis was used to analyze the results of 21 face-to-face, semistructured interviews with women who had a personal history of injection drug use or who were the sexual partners of men who injected drugs. Contextual variables influencing women at risk for HIV infection that were identified included fear of HIV antibody testing, a belief that perinatal HIV transmission is inevitable, support for pregnancy termination in the event of HIV-associated pregnancy, a strong desire for children, pride in mothering behavior, and guilt about the possibility of transmitting HIV to unborn children. AIDS education and counseling for these women will be most effective if these variables are considered.

Female↗
PubMedDate not supplied

Epidemic human immunodeficiency virus (HIV) infection among intravenous drug users (IVDU).

Human immunodeficiency virus (HIV) infection is epidemic among intravenous drug users (IVDU), particularly in the northeastern United States. IVDU are playing a critical role in the spread of HIV by infecting their heterosexual partners and children, as well as their needle-sharing partners. The epidemiology of HIV infection among IVDU is reviewed here, including a compilation of seroprevalence data. Relevant determinants of the future spread of HIV among IVDU are discussed, including the major risk factors for HIV seropositivity, the modes of HIV transmission, and aspects of the natural history of HIV infection in IVDU. The public health policy implications of these issues include the need for education of adolescents and the general public about the risks of drug injection and heterosexual intercourse with IVDU, as well as motivation of IVDU to stop injecting, never share injection paraphernalia, or, at least, clean needles effectively.

Acquired Immunodeficiency Syndrome↗