Biomedical subjects

J M Dayton

Publications and source records attributed to J M Dayton.

3 recordsLinked to original sources

PubMed2000

Global dimensions of the AIDS epidemic: implications for prevention and care.

The appropriate balance of HIV prevention and care activities depends on the specific epidemiology of HIV, including the stage of the epidemic; information about the cost-effectiveness of specific prevention interventions and treatment regimens; and the level of public resources available. In all countries, it is far less costly to prevent HIV than to treat people with AIDS. Once prevention needs are met, governments facing a severe epidemic who have additional resources should consider cost-effective treatment for people living with AIDS. The epidemiology of HIV provides two clear messages for prevention. First, it is imperative to act early in the epidemic, when HIV spreads exponentially. Viral load is highest during the first few months of infection, so that early in the epidemic a large proportion of those infected may be highly infectious. Second, it is crucial to target interventions initially to those with the highest-risk behavior. This will have the greatest impact on the number of new HIV infections prevented, as individuals with large numbers of sexual and needle-sharing partners who do not use condoms or clean injecting equipment are those most likely to become infected and then spread HIV. Changing the behavior of these individuals, even if only a relatively few members of society, is essential to curbing the epidemic.

Acquired Immunodeficiency Syndrome↗

PubMed2000

Effectiveness of HIV prevention interventions in developing countries.

OBJECTIVE: To review the effectiveness of projects and programs in developing countries that aim to reduce sexual transmission of HIV infection or transmission related to injection drug use. DESIGN: We identified 34 published studies undertaken in 18 developing countries that met rigorous inclusion criteria. These criteria included the length of follow-up, use of statistical analysis, the inclusion of a comparison group, and type of outcomes measured. RESULTS: We found that behavioral change interventions are effective when targeted to populations at high risk, particularly female sex workers and their clients. Few studies have evaluated harm reduction interventions in injecting drug users (IDUs). Evidence on the effectiveness of voluntary counseling and testing programs was promising, and VCT was most effective when directed at discordant couples. Treatment of sexually transmitted diseases (STD) appears highly effective in reducing HIV/STD transmission, particularly in the earlier stages of the epidemic. CONCLUSIONS: This review demonstrates that HIV prevention interventions can be effective in changing risk behaviors and preventing transmission in low and middle-income countries. When the appropriate mix of interventions is applied, they can lead to significant reductions in the prevalence of HIV at the national level. Additional research is needed to identify effective interventions, particularly in men who have sex with men, youth, IDUs and HIV-infected persons. Structural and environmental interventions show great promise, although more evaluation is needed.

Developing Countries↗

PubMed1995

The importance of bone biopsy in managing renal osteodystrophy.

A case is presented in which bone biopsy results helped to resolve not only difficult issues in the clinical management of the patient's renal osteodystrophy but also disruptive psychosocial problems surrounding her clinical course. The outcome was a satisfactory resolution based on rational medical treatment and directed supportive care. The presentation highlights important principles in the procurement, processing, and interpretation of the bone biopsy, while also addressing the importance of accurate diagnosis in facilitating the overall long-term management by the entire renal team.

Aged↗