Biomedical subjects

Brian W C Forsyth

Publications and source records attributed to Brian W C Forsyth.

4 recordsLinked to original sources

PubMed2004

Rapid HIV testing of women in labor: too long a delay.

For HIV-infected women who have not received antiretroviral treatment or transmission prophylaxis in pregnancy, starting antiretrovirals in labor or soon after birth can still decrease the risk of perinatal transmission. There is, therefore, potential benefit in conducting rapid HIV testing in labor, but hospitals are seldom prepared to conduct such testing. We compared protocols for rapid HIV testing at 2 hospitals to determine what proportion of women had results back early enough to intervene if results had been positive. Hospital A initially used HIV enzyme-linked immunosorbent assays (ELISAs) and changed to using rapid tests (eg, Single Use Diagnostic System [SUDS]); hospital B used only the SUDS. With use of the SUDS in hospital A, results were reported more quickly than with the ELISA protocol in the same hospital (P < 0.0001). Comparing use of the SUDS in the 2 hospitals, test results were available more quickly in hospital A than hospital B (P < 0.05), which resulted in hospital A having more results reported prior to delivery (64% vs. 38%, P < 0.05) and within 12 hours postdelivery (94% vs. 73%, P < 0.05). If HIV testing in labor is to have its maximum effect on decreasing the risk of perinatal HIV transmission, hospitals need to institute rapid HIV testing, but protocols must ensure that results are available as quickly as possible.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Pediatricians' training and identification and management of psychosocial problems.

This study evaluated the association of pediatrician training on the identification and management of current and ongoing emotional or behavioral problems among children ages 4-8 years in 19 practices in south-central Connecticut. Pediatricians with advanced training in psychosocial issues were more likely to identify children's psychosocial problems and use multiple management strategies compared with pediatricians with no specialized training. Although pediatricians with moderate training in psychosocial issues were more likely to identify psychosocial problems compared with pediatricians with no training, there was no relationship between moderate training and management of psychosocial problems. These results suggest that identification and management of young children's psychosocial problems demands advanced training and support the American Academy of Pediatrics' call for more extensive training.

Adult↗

PubMed2003

Analyzing multiply matched cohort studies with two different comparison groups: application to pregnancy rates among HIV+ women.

We develop a new statistical method to analyze multiply matched cohort studies with two different comparison groups. We employ a linear-logistic model to describe the underlying log-odds ratios and use a conditional likelihood approach to conduct inference. Under the assumption of homogeneous log-odds ratios, we provide methods to construct both asymptotic and exact confidence regions of the two log-odds ratios in a simple case. We propose a score test to evaluate the assumption of homogeneous log-odds ratios across strata. While our methods are general, we develop them around a specific application, namely, the study of pregnancy rates in HIV-infected women. Our analyses suggest that HIV infection is associated with a decrease in pregnancy rates and that this decrease in fertility becomes significant after accounting for illicit drug use.

Biometry↗

PubMed2002

Pregnancy and birth rates among HIV-infected women in the United States: the confounding effects of illicit drug use.

OBJECTIVE: To determine the effect of HIV infection on pregnancy and birth rates and assess the potentially confounding effect of illicit drug use. DESIGN: A retrospective record review of matched cohorts examining pregnancy outcomes for HIV-positive women and two HIV-negative comparison groups (one matched by drug use). METHODS: Ninety HIV-positive women who gave birth in a US city between 1989 and 1993 were matched to HIV-negative women by race, age, parity and date of index birth (group 1, N = 180) and also by the type of illicit drug used (group 2, N = 90). Data were abstracted on tubal ligations and pregnancies occurring before April 1996. RESULTS: A total of 63% of HIV-positive women used cocaine during the index pregnancy and 26% also used opiates. HIV-positive women had fewer tubal ligations than group 1 (38.9% versus 51.1%, P = 0.058), but there was no difference when matching included drug use (38.9% in group 2). HIV infection was associated with a decrease in the number of pregnancies; this decrease was most marked when matching included drug use (18.0 versus 32.1 pregnancies per 100 woman-years,P < 0.01). There were no significant differences in spontaneous or therapeutic terminations. Poisson regression analysis demonstrated that HIV infection and older age were associated with fewer pregnancies, and cocaine use with an increased pregnancy rate. CONCLUSION: This study confirms that HIV infection is associated with a decrease in the number of pregnancies, but also illustrates the confounding effects of illicit drug use among women in the United States.

Adult↗