Confronting antimicrobial resistance: a shared goal of family physicians and the CDC.
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Biomedical subjects
Publications and source records attributed to D P Drotman.
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Nitrite inhalants are commonly abused substances in the US and Europe. "Nitrite inhalants and AIDS" was a popular topic in the early 1980s when the cause of AIDS was not known. With the discovery of HIV, concern about nitrite use wained. However, nitrite inhalant use is associated with behavioral relapse and HIV transmission among gay men, with decreased lymphocyte counts and natural killer cell activity in laboratory studies, and remains a candidate "cofactor" in the pathogenesis of AIDS-related Karposi sarcoma. Discouraging nitrite use continues to be a worthwhile public health goal. Participants recommend specific research efforts.
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OBJECTIVE: To determine the risk for bleeding injuries in professional football and to estimate the risk for transmission of the human immunodeficiency virus (HIV) through such injuries. DESIGN: A prospective, observational study. PARTICIPANTS: Professional football players from 11 teams of the National Football League were observed during 155 regular season games from September through December 1992. MEASUREMENTS: The frequencies of bleeding injuries were calculated in association with environmental and athletic factors. Using this information, HIV prevalence, and data on transmission of HIV in other circumstances, the risk for transmission of HIV during football games was estimated. RESULTS: 575 bleeding injuries (average, 3.7 per game for each team) involving 538 players (average, 3.5 players on each team per game) were observed. Approximately 88% of the bleeding injuries were abrasions; the remainder were lacerations. Bleeding injuries were markedly more frequent during games played on artificial surfaces, during games played in domed stadiums, and on teams with a final win/loss percentage of 0.500 or lower. Using data on the prevalence of HIV among college men and rates of HIV transmission in the health care setting, the risk for HIV transmission to each player was estimated to be less than 1 per 85 million game contacts. CONCLUSIONS: Although injuries occur in professional football competitions, bleeding injuries, especially lacerations, occur infrequently. We estimate that the risk for HIV transmission during such competition is extremely remote. The role of artificial playing surfaces on the incidence or severity of bleeding injuries should be investigated.
Publicity about human immunodeficiency virus (HIV) infection in athletes has focused attention on the potential for transmission of blood-borne pathogens during sports and athletic competitions. Existing information suggests that the potential risk for such transmission is extremely low and that the principal risks athletes have for acquiring HIV and hepatitis B virus are related to off-the-field activities. Therefore, efforts to prevent transmission of blood-borne pathogens among athletes should emphasize prevention in off-the-field settings. We summarize technical and other information about this issue, and provide recommendations for the education of sports participants, for infection control in athletic settings, and for training of coaches and officials.
We reviewed 12 epidemiologic studies conducted among gay men with AIDS to examine the role of potential 'cofactors' in the development of KS. Aspects of the studies reviewed include basic study design, wording of the questionnaires, and published results comparing KS patients with those who developed opportunistic infections indicative of AIDS. The studies included questions about sociodemographics, medical history, use of drugs, travel, and sexual behaviors. Patients were invited to provide blood and/or other specimens for laboratory analysis. The results of the review of epidemiologic studies are inconclusive. Nitrite inhalant use was a variable often associated with KS (five studies). The differences in outcomes of these studies may reflect differences in study designs, sample sizes, timing, quality, and content of interviews regarding nitrites, sexual behaviours and other potential cofactors. Epidemiologic study with careful consideration to content of questionnaires and laboratory testing may yet reveal the causes or cofactors for this tumor.
Kaposi's sarcoma (KS) remains the most commonly diagnosed cancer in AIDS patients. Neither the cause nor a cure for AIDS-related KS is known. KS serves as a striking example of how epidemiologists seek the cause of any disease. Epidemiologic analysis of reported KS cases is revealing but not definitive. The leading hypotheses for the cause of AIDS-related KS are an as-yet-unidentified sexually transmitted infectious agent and exposure to inhalant alkyl nitrites, often called poppers. Epidemiology suggests that persons can reduce their risk of KS by avoiding nitrite inhalants and changing behavior to reduce the risk of sexually transmitted infections.
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Kaposi's sarcoma (KS), the most common cancer in patients with acquired immunodeficiency syndrome (AIDS), occurs predominantly in homosexual men. However, the percentage of homosexual AIDS patients with KS has declined during the past 6 years. This and other findings suggest that one or more cofactors associated with the homosexual lifestyle, rather than a special viral strain, probably influence the development of KS in patients infected with the human immunodeficiency virus (HIV). Possible reasons for the decline include changes in homosexual behaviors, leading to the practice of safer sexual techniques, and a decrease in use of nitrite inhalants. Identification of the KS-AIDS cofactor(s) could be invaluable to developing prevention and treatment strategies.
We review epidemiologic studies aimed at identifying the cause(s) or cofactors for AIDS-related Kaposi's sarcoma (KS). The epidemiology of AIDS-related KS in the United States differs from that of other forms of KS. One important feature of the epidemiology of AIDS-related KS is that its occurrence by race is strikingly disproportional. We believe this maldistribution can shed light on recent discussions concerning the cause of AIDS-related KS, and we propose further studies to elucidate the etiology of AIDS-related KS.
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