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Biomedical subjects

J Moye

Publications and source records attributed to J Moye.

47 records · Page 3Linked to original sources
PubMed1994

Tuberculosis in human immunodeficiency virus-exposed or -infected United States children.

This study was designed to provide a preliminary assessment of the occurrence of tuberculosis exposure, infection and disease within a national sample of infants and children with human immunodeficiency virus (HIV) exposure or infection, and to determine the prevalence of Mycobacterium tuberculosis isolates resistant both to isoniazid and rifampin in these patients or their adult source contacts. A retrospective questionnaire survey was conducted of infants and children with HIV exposure or infection evaluated by pediatric HIV referral centers in the United States comprising the pediatric units or subunits of the Pediatric Acquired Immunodeficiency Syndrome Clinical Trials Group (PACTG). Seventy of 72 sites during a mean period of 5 (range, 1 to 12) years participated in this study and had provided care for 14,038 patients. There were 75 cumulative total cases of tuberculosis disease seen since each site was established. Therapy for asymptomatic infection was given to another 40 children and for tuberculosis exposure to 71 children. Annualized case rates were 478/100,000 for sites established in 1990 to 1992, 117/100,000 for 1988 to 1989, 63/100,000 for 1986 to 1987 and 58/100,000 for 1981 to 1985 (P = 0.05, Spearman's p test for trend). By comparison, the 1992 age-specific tuberculosis case rate for all U.S. children < 5 years was 5.5/100,000. Twenty percent of isolates from PACTG patients and 15% of isolates from adult source contacts were resistant to isoniazid and rifampin.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Anxiety in acutely bereaved prepubertal children.

Anxiety symptoms present immediately following parental death and approximately 8 weeks following the death were evaluated in 38 prepubertal children. Comparison groups included 38 hospitalized depressed children and 19 normal children. Bereaved children and parents were administered the Grief Interview and all were administered standard diagnostic interviews (DICA-C/P). While no bereaved children met DSM-III-R criteria for any anxiety disorder, anxiety regarding other family members dying was reported in 55% of bereaved children immediately after death and in 63% approximately 8 weeks later. When DSM-III-R anxiety symptoms were assessed, bereaved children did not report significantly more anxiety symptoms in the approximate 8-week interval post-parental death than normal comparison children, and had significantly fewer anxiety symptoms than depressed children (p < 0.0001). Bereaved children who had the most anxiety symptoms were also likely to have a depressive disorder (p < 0.002). Age and sex of child, sex of surviving parent, anticipation of death, and family history of anxiety or depressive disorders were not significantly associated with increased anxiety.

Adaptation, Psychological↗
PubMed1993

Depression in Alzheimer patients: discrepancies between patient and caregiver reports.

Estimates of the prevalence of depression in dementia patients vary widely. One problem in accurate identification of such depression is determining whether to rely on demented patients' reports or second-party caregivers' reports of symptoms. To further explore this problem, 31 outpatients with probable Alzheimer disease and their 31 caregivers were interviewed separately with depressive symptom questionnaires. Caregivers reported more depressive symptoms in dementia patients than patients reported for themselves. Correlations between caregivers' and patients' reports of individual symptoms ranged between -0.23 to 0.76, with lowest correlations found for intrapsychic distress, cognitive impairment, and hallucinations. Patients' responses were not necessarily affected by stereotypic responding or severity of impairment, but patients appeared to under-report symptomatology. Caregivers' responses were associated with the extent of contact with the patients, familial relationship, and sources of information used to determine patients' mood but were not correlated with caregivers' depression or ratings of how they would feel if they were "in the patient's shoes."

Aged↗
PubMed1993

Intravenous immune globulin for the prevention of infections in children with symptomatic human immunodeficiency virus infection.

Infection with human immunodeficiency virus (HIV) causes a progressive immunodeficiency, often manifested in adults by the development of infections with relatively rare, opportunistic organisms. However, in HIV-infected children, recurrent serious infections with common encapsulated bacteria, as well as recurrent minor bacterial and viral infections, may be early and frequent manifestations of HIV disease. The use of i.v. immune globulin (IVIG) has been shown to prevent infections in patients with primary immunodeficiency and in uncontrolled studies of HIV-infected children. This article reviews the problem of and immunologic predisposition for recurrent infections in pediatric HIV infection and reports on the use of IVIG for prophylaxis. Updated analysis from the National Institute of Child Health and Human Development IVIG Clinical Trial, a multicenter, double-blind, placebo-controlled trial of the safety and efficacy of IVIG for the prevention of infections in children with symptomatic HIV infection, is presented. Between March 1988 and January 1991, 376 children with clinical or immunologic evidence of HIV disease who were randomized to receive IVIG or albumin placebo were enrolled in this trial. In children with an entry CD4+ count of 200/mm3 or higher, IVIG significantly increased the time free from serious bacterial infections and significantly decreased the rates of minor bacterial infections and viral infections.

AIDS-Related Opportunistic Infections↗
PubMed1993

Effect of intravenous immunoglobulin (IVIG) on CD4+ lymphocyte decline in HIV-infected children in a clinical trial of IVIG infection prophylaxis. The National Institute of Child Health and Human Development Intravenous Immunoglobulin Clinical Trial Study Group.

Our objective was to evaluate the effect of intravenous immunoglobulin (IVIG) on absolute CD4+ lymphocyte count (CD4+ count) trends in human immunodeficiency virus- (HIV) infected children enrolled in a trial of IVIG for infection prophylaxis. To that end, we conducted a randomized, double-blind, outpatient trial comparing subjects treated with 400 mg per kilogram of IVIG every 28 days with those given 0.1% albumin placebo. CD4+ counts were measured at entry and every 12 weeks. Twenty-eight clinical centers in mainland United States and Puerto Rico participated. Previous reports showed IVIG efficacy for infection prophylaxis in 313 patients with entry CD4+ counts of > or = 0.20 x 10(9)/L (> or = 200/mm3). Two hundred and seventy-seven (89%) of these 313 children had three or more CD4+ counts measured during the trial and were included in evaluation of CD4+ count trends. Rates of CD4+ count decline, as measured by regression slopes, were compared between IVIG and placebo groups using generalized linear models, comparing unadjusted, age-adjusted, and standardized age-adjusted data. Potential covariate effects were assessed by modeling change in CD4+ count in terms of log change between successive measurements. Age-adjusted slope analysis showed slowing of CD4+ count decline by 13.5 cells/mm3 per month in IVIG compared with placebo recipients (95% confidence interval, 3.1-23.9, p = 0.012). Modeling log change between measurements documented a beneficial effect of IVIG that was cumulative over time and independent of other therapies. Occurrence of serious bacterial infection in the interval before CD4+ count measurement or death was independently associated with more rapid CD4+ count decline (p = 0.01 and p = 0.008, respectively). Zidovudine therapy was associated with a transient increase in CD4+ count. Benefits of IVIG include slowing of CD4+ count decline as well as previously reported reductions in serious and minor bacterial and viral infections in subjects with entry CD4+ counts of > or = 0.20 x 10(9)/L. This finding provides corroboration for the hypothesis that immunologic mechanisms contribute to the pathogenesis of CD4+ decline in HIV infection.

Age Factors↗
PubMed1992

Health screening and random recruitment for cognitive aging research.

A survey of 197 cognitive aging studies revealed infrequent use of structured health assessments and random recruitment. In this study, a health screening questionnarie developed to identify subjects with medical problems that might impair cognition was administered to 315 adults aged 60 and older who were recruited by random digit dialing. On the basis of self-reported medical problems, 35% of the subjects were excluded. Those excluded were older (p less than .001) and tended to be male but did not differ in education from those who passed the screening. Subjects who passed the screening and decided to participate in a neuropsychological research project were younger (p less than .001), better educated (p less than .001), and more likely to be male (p less than .001) than nonparticipants. These findings suggest that careful assessment, selection, and description of subjects is needed to aid interpretation of cognitive aging research. Further attention to health status is needed to aid interpretation of cognitive aging research. Although random recruitment of the elderly is feasible, obtaining representative samples may require stratification on demographic variables.

Aged↗
PubMed1992

Perinatally acquired human immunodeficiency virus infection: extent of clinical recognition in a population-based cohort. Massachusetts Pediatric HIV Surveillance Working Group.

To evaluate factors that may affect the timely diagnosis of children with human immunodeficiency virus (HIV) infection, we compared data derived from two population-based pediatric HIV studies. Data from anonymous newborn HIV serosurveys were used to estimate the number of children born to HIV-seropositive mothers. A statewide active surveillance project determined the number of HIV-exposed children who had been clinically recognized. Of 88,732 Massachusetts newborn specimens tested anonymously for HIV antibodies during a 12-month period (November, 1987, to October, 1988), 223 were positive. As of October, 1991, 78 of these children (35%) had been identified by a statewide network of infectious disease physicians. HIV-exposed children born in inner city hospitals were more likely to have come to medical attention than those born in suburban hospitals (47% vs. 17%). Among the 29 children with confirmed HIV infection (13% of 223), the initial evaluation for HIV occurred at an earlier age among children born in inner city hospitals than among children born in other areas. HIV testing practices that rely heavily on risk assessment may result in delayed diagnosis of HIV infection in children whose mothers are not perceived to be at risk.

AIDS Serodiagnosis↗
PubMedDate not supplied

Prophylactic intravenous immunoglobulin in HIV-infected children with CD4+ counts of 0.20 x 10(9)/L or more. Effect on viral, opportunistic, and bacterial infections. The National Institute of Child Health and Human Development Intravenous Immunoglobulin Clinical Trial Study Group.

OBJECTIVE: To evaluate the efficacy of intravenous immunoglobulin (IVIG) for prevention of viral, opportunistic, and minor bacterial infections in children infected with human immunodeficiency virus (HIV). DESIGN: Randomized, double-blind, placebo-controlled, outpatient clinical trial comparing subjects treated with 400 mg of IVIG per kilogram of body weight every 28 days with those given albumin placebo. SETTING: Twenty-eight clinical centers in mainland United States and Puerto Rico. PATIENTS: Three hundred seventy-six children infected with human immunodeficiency virus with clinical or immunologic evidence of HIV disease, 313 of whom had entry CD4+ counts of at least 0.20 x 10(9)/L (greater than or equal to 200/mm3). MAIN OUTCOME MEASURES: The incidence of laboratory-proven and clinically diagnosed viral, opportunistic, and bacterial infections. MAIN RESULTS: Viral infections and minor bacterial infections contributed more frequently to morbidity in children with entry CD4+ counts of at least 0.20 x 10(9)/L (together over five times as frequent) than did serious bacterial infection, the primary outcome measure of the trial. Opportunistic infections occurred at a similar rate as laboratory-proven serious bacterial infections. In this group of children, IVIG was significantly associated with a decrease in the rate of viral infections and minor bacterial infections per 100 patient-years (36.0 vs 54.0 episodes of viral infection per 100 patient-years, IVIG vs placebo, P = .01; and 115.1 vs 159.7 episodes of minor bacterial infection per 100 patient-years, IVIG vs placebo, P = .02), as well as a decrease in the rate of serious bacterial infections per 100 patient-years (26.4 vs 48.2 episodes per 100 patient-years; P = .002). There was no apparent difference in the rate of opportunistic infections between treatment arms. CONCLUSIONS: Beneficial effect of IVIG was seen across multiple infectious outcome measures, with reductions in serious and minor viral and bacterial infections observed in children with entry CD4+ counts of at least 0.20 x 10(9)/L.

Bacterial Infections↗
PubMedDate not supplied

Misdiagnosed HIV infection in pregnant women: implications for clinical care.

Out of nearly 900 women in a research study of human immunodeficiency virus infection in pregnancy, 8 were subsequently found not to be infected. Misdiagnoses could have resulted from (a) laboratory errors or specimen mixups; (b) failure to follow the testing algorithm recommended by the Centers for Disease Control and Prevention to confirm results; (c) women perceiving they were infected by high-risk behavior in the absence of testing, despite the receipt of negative test results, or based on screening results only; or (d) factitious disorder, HIV Munchausen syndrome, or malingering. Because of the potentially devastating impact of an HIV diagnosis and the toxicity of HIV therapies, health care providers should obtain independent confirmation of the diagnosis before initiating treatment or followup for HIV based on patient report or provider referral. Quality test interpretation and counseling must be ensured. Therapeutic interventions may be indicated for persons intentionally and falsely presenting themselves as HIV-infected.

Adult↗