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Biomedical subjects

G Weissman

Publications and source records attributed to G Weissman.

At least 19 recordsLinked to original sources

The relationship of unsafe sexual behavior and the characteristics of sexual partners of HIV infected and HIV uninfected adolescent females.

PURPOSE: To compare characteristics of sexual relationships in HIV infected and HIV uninfected female adolescents and their association with condom use. METHODS: HIV infected and uninfected subjects, aged 13-19 years, were enrolled in a prospective HIV study from 15 sites in 13 U.S. cities. Baseline data on demographic information, substance use, sexual behavior, partner information, and condom use were collected through direct and computer-assisted interviews from currently sexually active females. Univariate, multiple logistic regression, and repeated measures analyses were employed. RESULTS: Data from 153 HIV infected and 90 HIV uninfected female subjects showed, on average, that current partners were 4-6 years older. In multivariate analysis, HIV infected subjects were older (OR = 1.37; 95% CI: 1.04-1.81), had more lifetime partners (OR = 2.23; 95% CI: 1.03-4.82), initiated consensual vaginal sex earlier (OR = .74; 95% CI:.58-.95), perceived partner to also be HIV infected (OR = 7.46; 95% CI: 3.2-17.4), and had less unprotected sex (OR = .27; 95% CI:.16-.45). Length of relationship was associated with more unprotected sex for both HIV infected and uninfected subjects (OR = 2.59, 95% CI: 1.27-5.27, OR = 4.13; 95% CI: 1.31-13.05, respectively). Mean partner age difference was greater among HIV infected than for HIV uninfected (OR = 1.06; 95%CI: 1.01-1.12); this greater age difference for HIV infected females was associated with less protection (OR = 1.09; 95% CI: 1.03-1.15). HIV disclosure influenced condom use: without disclosure, less condom use was reported (OR = 6.8; 95% CI: 2.29-20.24) controlling for perception that partner was also HIV infected (OR = 1.1; 95% CI: 1.02-1.21). CONCLUSIONS: Because age differential influenced reported condom use, more research, particularly qualitative, is needed into the dynamics of these relationships. Prevention efforts must address partners, particularly older ones.

Adolescent↗

Health-related service utilization and HIV risk behaviors among HIV infected injection drug users and crack smokers.

This study was designed to assess utilization of health-related services and HIV risk related behaviors by HIV infected drug users one year prior to and two years following the availability of Ryan White Title I funding. Using a cross-sectional design, a total of 777 drug injectors and crack smokers from five US cities were surveyed, over three waves of data collection, about their use of drug treatment, medical services, housing, mental health, and case management and about their sex and drug-related risk behaviors. For all service categories and in each wave, including the year prior to Title I funding, HIV risk behaviors were lower among those who used health-related services, with the exception of housing. Use of services did not increase significantly following the disbursement of Title I funds except for housing and case management. These findings suggest that it may be necessary to increase the attractiveness of health-related services, not just funding for services, for HIV infected substance abusers.

Adult↗

Reiter's syndrome among Asian shipboard immigrants: the case of The Golden Venture.

OBJECTIVE: To assess the incidence of Reiter's syndrome aboard The Golden Venture, a ship carrying illegal immigrants from China to the United States. METHODS: After identification of an index case, we conducted telephone interviews with medical staff at immigrant detention centers in Pennsylvania, New York, and Virginia. When a potential case was identified at one facility, we performed a site inspection, reviewing the medical records of all detainees and performing histories and physicals on all those with joint and/or ocular complaints. RESULTS: We identified two patients, both HLA B27 positive, with Reiter's syndrome. The observed incidence (0.87%) approximated the predicted incidence but may have underestimated the actual incidence. We review the history of shipboard Reiter's syndrome, and discuss the pathogenic roles of HLA B27 and particular infectious agents. CONCLUSION: Continued transportation of illegal immigrants from China and other parts of the world is likely to result in occasional clusters of Reiter's syndrome. Physicians treating immigrant populations should remain aware of the possibility of reactive arthritis.

Adult↗

HRSA's strategies to combat family violence.

This paper discusses the efforts of the Health Resources and Services Administration (HRSA) to work with a broad constituency to combat and ultimately prevent family violence. In partnership with states and communities, HRSA implements programs to strengthen health care infrastructure, support direct community-based service delivery, and educate health care providers. Soliciting and incorporating community input are critical steps in designing innovative training approaches to deal with pressing health concerns, such as the efforts of family violence in a community. This type of collaboration is evident in HRSA's programs such as the Area Health Education Centers, the Geriatric Education Centers, and the AIDS Education and Training Centers. Health care delivery systems and special health interventions must respond to the far-reaching effects of family violence. HRSA is devising a comprehensive strategy to guide program development in violence intervention. This strategy would build on successful models of education, prevention, and service delivery, as well as identification of critical areas for collaboration between community activists, researchers, epidemiologists, health care providers, policymakers, academicians, survivors, philanthropists, representatives from state and local government, and the faith community.

Domestic Violence↗

Appropriate response to pneumococcal vaccine in celiac sprue.

Hyposplenism as a complication of celiac sprue confers an increased risk of pneumococcal sepsis, but such patients do not routinely receive pneumococcal vaccine despite reports of overwhelming pneumococcal sepsis. Because antibody response in these patients has not been previously assessed, we measured pre- and postvaccination levels in 10 patients with documented sprue. All demonstrated appropriate acute antibody responses to a polyvalent pneumococcal vaccine. Vaccination of all patients with celiac sprue seems appropriate.

Adult↗

Creating an agenda for research and evaluation: HIV service delivery, the Ryan White CARE Act, and beyond.

HRSA, AHCPR and NCAP convened a working meeting in November 1992, to discuss creation of a national agenda for research and evaluation on HIV service delivery systems that are cost-effective, responsive to the needs of the diverse populations affected by the epidemic, and reflective of the lessons learned so far. In this article, the interests and goals of the conveners are described, the meeting's process and outcomes are discussed, and the nine key study areas that were identified and chosen by the meeting participants are presented. It is hoped that this article will stimulate further interest among private and public funders and among the research community in fostering the implementation of HIV service delivery-related research and evaluation studies. If this is accomplished, decision-makers will be better enabled to make informed and responsive policy decisions.

Delivery of Health Care↗

Implications of flow cytometry in malignant conditions of the stomach.

UNLABELLED: Aneuploidy, abnormal nuclear DNA content, has been demonstrated in most malignant processes, including gastric malignancies. Utilizing flow cytometry on endoscopic biopsies, we have attempted to characterize the prevalence of aneuploidy and to investigate the prognostic implications of gastric biopsy DNA content with regard to survival. DNA aneuploidy was detected in 71% of specimens revealing malignancy by histologic evaluation. When aneuploidy was demonstrated, 63% of the specimens proved to be positive for malignancy (positive predictive value). However, the absence of aneuploidy had a negative predictive value for malignancy of 93%. Patients with diploid adenocarcinomas had a median survival of 32 months, compared to a median survival of 4 months in the group with DNA aneuploidy. CONCLUSIONS: 1) The prevalence of aneuploidy in endoscopically obtained specimens compares favorably with other previously reported series. 2) The presence of aneuploidy in gastric malignancies appears to correlate with decreased survival and may be helpful in making therapeutic decisions.

Adenocarcinoma↗

Evaluation of colonic neoplasia by flow cytometry of endoscopic biopsies.

Colonoscopy is a valuable and frequently used method in the evaluation of colonic neoplasia. Flow cytometry is a technique that can be used to diagnose malignancy. In this study, flow cytometry was used to evaluate colonoscopic biopsies taken from patients with suspected colonic neoplasia. Nineteen colonic biopsies were obtained and evaluated by this technique. Aneuploidy was demonstrated in six patients with carcinoma of the colon. In addition, abnormal DNA histograms were noted in two premalignant conditions (colonic adenoma and inflammatory bowel disease). The results show that flow cytometry can be applied to colonic biopsies and suggest that it may be of use in the diagnosis of malignant and premalignant conditions of the colon.

Adenoma↗

Women living with drug abuse and HIV disease: drug abuse treatment access and secondary prevention issues.

In collaboration with the National Institute on Drug Abuse, the Health Resources and Services Administration is conducting a multisite, longitudinal study on issues of service needs, service utilization, and access to care for drug abusers with HIV. This article discusses access to drug abuse treatment and HIV secondary prevention for 116 women interviewed during the study's first year in five U.S. cities. Using interview data from 115 service providers in those same cities, it also discusses drug abuse treatment availability and barriers to service expansion for drug users with HIV. Study findings indicate that there are highly significant gaps between the drug abuse treatment services these women feel they need and those they have been able to receive; these were particularly pronounced for drug detoxification and residential and outpatient drug-free treatment. Women who used crack cocaine or injection drugs had particularly high levels of need for residential and outpatient drug abuse treatment, while women who use crack were found to have significantly less experience with the drug abuse treatment system than IDUs. HIV secondary prevention was also found to be a critical need for these women, many of whom were engaging in behaviors that place them at risk for reinfection, infection with other diseases, and transmission to others. Providers indicated that lack of funding was the major barrier to expanding services for this population; other barriers, such as lack of ancillary services and transportation, were also noted. Two positive findings were that many drug abuse treatment agencies in these cities provide a wide range of ancillary services and that many different kinds of agencies offer drug abuse treatment services.

Adolescent↗