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James Bethel

Publications and source records attributed to James Bethel.

13 recordsLinked to original sources
PubMed2006

The scope and impact of treatment of latent tuberculosis infection in the United States and Canada.

RATIONALE: The scope of treatment of latent tuberculosis infection (LTBI) in the United States and Canada is unknown. Identifying the types of clinics that administer such treatment and patients who receive it could guide resource utilization and improve treatment initiation and completion. OBJECTIVES: Estimate the number of persons started on LTBI treatment; describe the types of clinics that treat LTBI. METHODS: The Tuberculosis Epidemiologic Studies Consortium, consisting of 19 United States and 2 Canadian sites, conducted a survey among clinics that initiated LTBI treatment for>or=10 patients in 2002. RESULTS: Study catchment areas from the 19 United States sites represented 8.6% of the United States population and 12.7% of all tuberculosis cases in 2000. An estimated 37,857 patients started LTBI treatment during 2002 at 244 clinics surveyed. Of these treatment starts, 29,970 (79%) occurred at general public health clinics; immigrant/refugee clinics (2,409; 6.4%) and correctional/detention facilities (2,325; 6.1%) were the next most common sites. Based on these data, United States tuberculosis case rates, and United States population data, the estimated total number of LTBI treatment starts in the United States was 291,000-433,000. When the 37,145 persons who initiated LTBI treatment in the United States were extrapolated to the entire United States population, with a 5% lifetime risk of tuberculosis without treatment, and 20-60% treatment effectiveness, approximately 4,000-11,000 tuberculosis cases were prevented in the United States. CONCLUSIONS: LTBI treatment is initiated among a substantial number of persons in the United States and Canada, primarily in the public sector. Treatment of LTBI can significantly decrease the tuberculosis burden.

Adolescent↗
PubMed2005

The impact of male-to-male sexual experience on risk profiles of blood donors.

BACKGROUND: Men who have had sex with men (MSM) since 1977 are permanently deferred from donating blood. Excluding only men who engaged in male-to-male sex within either the prior 12 months or 5 years has been proposed. Little is known about infectious disease risks of MSM who donate blood. STUDY DESIGN AND METHODS: Weighted analyses of data from an anonymous mail survey of blood donors were conducted to examine the characteristics of men reporting male-to-male sex during specified time periods. RESULTS: Of the 25,168 male respondents, 569 (2.4%) reported male-to-male sex, 280 (1.2%) since 1977. Compared to donors who did not report male-to-male sex, the prevalence of reactive screening test results was higher among donors who reported the practice within the past 5 years (< or =12 months odds ratio [OR] 5.3, 95% confidence interval [CI] 2.6-10.4; >12 months to 5 years, OR 7.1, 95% CI 1.2-41.7); however, no significant difference was found for donors who last practiced male-to-male sex more than 5 years ago (>5 years-after 1977, OR 1.4, 95% CI 0.7-2.6; 1977 or earlier, OR 1.6, 95% CI 0.7-3.7). The prevalence of unreported deferrable risks (UDRs) other than male-to-male sex was significantly higher for all donors who reported male-to-male sex with ORs ranging from 3.1 to 18.9 (p < or = 0.01). CONCLUSIONS: No evidence was found to support changing current policy to permit donations from men who practiced male-to-male sex within the past 5 years. For donors with a more remote history of male-to-male sex, the findings were equivocal. A better understanding of the association between male-to-male sex and other UDRs appears needed.

Blood Banks↗
PubMed2005

Association of selected phenotypic markers of lymphocyte activation and differentiation with perinatal human immunodeficiency virus transmission and infant infection.

This study of a subset of women and infants participating in National Institutes of Health Pediatric AIDS Clinical Trials Group protocol 185 evaluated lymphocyte phenotypic markers of immune activation and differentiation to determine their association with the likelihood of human immunodeficiency virus (HIV) transmission from the women to their infants and the potential for early identification and/or prognosis of infection in the infants. Lymphocytes from 215 human immunodeficiency virus type 1 (HIV)-infected women and 192 of their infants were analyzed by flow cytometry with an extended three-color panel of monoclonal antibodies. Women who did not transmit to their infants tended to have higher CD4+ T cells. Most notably, levels of total CD8+ T cells and CD8+ CD38+ cells made significant independent contributions to predicting the risk of mother-to-child transmission. Adjusting for HIV-1 RNA level at entry, a one percentage-point increase in these marker combinations was associated with a nine percent increase in the likelihood of maternal transmission. Total as well as naive CD4+ T cells were significantly higher in uninfected than infected infants. Total CD8+ cells, as well as CD8+ cells positive for HLA-DR+, CD45 RA+ HLA-DR+, and CD28+ HLA-DR+ were elevated in infected infants. Detailed immunophenotyping may be helpful in predicting which pregnant HIV-infected women are at increased risk of transmitting HIV to their infants. Increasing differences in lymphocyte subsets between infected and uninfected infants became apparent as early as six weeks of age. Detailed immunophenotyping may be useful in supporting the diagnosis of HIV infection in infants with perinatal HIV exposure.

Adult↗
PubMed2005

Success or failure.

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Emergency Nursing↗
PubMed2003

Performance characteristics of HIV-1 culture and HIV-1 DNA and RNA amplification assays for early diagnosis of perinatal HIV-1 infection.

A plasma HIV-1 RNA amplification assay (RNA assay), a quantitative peripheral blood mononuclear cell (PBMC) microculture (culture), and a PBMC HIV-1 DNA amplification assay (DNA assay) were compared for diagnosis of HIV-1 infection in infants receiving zidovudine in Pediatric AIDS Clinical Trials Group protocol 185; assays were performed for all 24 infected and 100 uninfected infants. HIV-1 infection was defined as >or=2 positive cultures or positive antibody to HIV-1 at >or=18 months. Cultures were performed at birth and 6 and 24 weeks of age; DNA and RNA assays were performed on cryopreserved specimens. The sensitivity of culture and DNA and RNA assays at birth was 20.8%, 10.5%, and 26.7%, respectively. At older ages, sensitivity typically exceeded 80%, remaining highest for the RNA assay (>85%). Assay specificity was >99%. Positive predictive values exceeded 93% for each assay at each age; negative predictive values were highest (>90%) for the RNA assay. At birth (P < 0.005) and age 6 weeks (P < 0.001), a significantly larger proportion of infected infants were identified by means of the RNA assay than by the other assays. The diagnostic performance of the RNA assay matched or exceeded that of culture and the DNA assay. Given that RNA assays require less blood volume and yield rapid results, our study adds to existing data suggesting that RNA assays may be used for early diagnosis of HIV-1 infection in infants.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Progression of HIV disease among women following delivery.

OBJECTIVE: To assess patterns of HIV disease progression among HIV-1-infected women following delivery. METHODS: Four hundred ninety-seven women enrolled in PACTG 185, a phase 3 trial of passive immunoprophylaxis in addition to zidovudine (ZDV) for the prevention of perinatal transmission, were included. Visits occurred twice during pregnancy; at delivery; and at 12, 26, 48, and 78 weeks postpartum. Repeated-measures linear regression and proportional hazards models were applied. RESULTS: Trial treatment (HIV hyperimmune globulin vs. immune globulin) was not related to postpartum disease progression. Longitudinal analysis of HIV-1 RNA demonstrated stable levels during pregnancy, significantly increased HIV-1 RNA by 12 weeks postpartum even on stable therapy, and a gradual increase thereafter. Changes in CD4+ lymphocyte percentage over 18 months of follow-up were similar for women continuing or stopping ZDV postpartum. Compared with those receiving no therapy, the hazard ratio for AIDS or death among women who received monotherapy postpartum was 0.52 (95% confidence interval [CI]: 0.25-1.04), 0.17 (CI: 0.06-0.49) for women who received combination therapy, and 0.24 (CI: 0.06-1.01) for women who received highly active antiretroviral therapy. CONCLUSIONS: RNA levels increased significantly from delivery to 12 weeks postpartum. Changes in HIV-1 RNA and CD4+ lymphocyte percentage were similar among women continuing or stopping therapy after delivery, and response to antiretroviral therapy was as expected postpartum.

Adult↗
PubMed2003

Blood lead concentration and delayed puberty in girls.

BACKGROUND: Environmental lead exposure has been linked to alterations in growth and endocrine function. It is not known whether such exposure affects pubertal development. METHODS: We analyzed the relations between blood lead concentration and pubertal development among girls (defined as females 8 to 18 years of age) who were enrolled in a cross-sectional study (the third National Health and Nutrition Examination Survey) in which race was self-reported or proxy-reported: 600 were non-Hispanic white, 805 were non-Hispanic African-American, and 781 were Mexican-American girls. Puberty was measured on the basis of the age at menarche and Tanner stage for pubic-hair and breast development. RESULTS: Geometric mean lead concentrations were less than 3 microg per deciliter (0.144 micromol per liter) in all three groups. As compared with concentrations of 1 microg per deciliter (0.048 micromol per liter), lead concentrations of 3 microg per deciliter were associated with decreased height (P<0.001), after adjustment for age, race, and other factors, but not with body-mass index or weight. Blood lead concentrations of 3 microg per deciliter were associated with significant delays in breast and pubic-hair development in African-American and Mexican-American girls. The delays were most marked among African-American girls; in this group, the delays in reaching Tanner stages 2, 3, 4, and 5 associated with a lead concentration of 3 microg per deciliter as compared with 1 microg per deciliter were 3.8, 5.3, 5.8, and 2.1 months, respectively, for breast development and 4.0, 5.5, 6.0, and 2.2 months, respectively, for pubic-hair development; the associated delay in age at menarche was 3.6 months. In white girls, there were nonsignificant delays in all pubertal measures in association with a lead concentration of 3 microg per deciliter. CONCLUSIONS: These data suggest that environmental exposure to lead may delay growth and pubertal development in girls, although confirmation is warranted in prospective studies.

Adolescent↗
PubMed2003

Attitudes toward blood donation incentives in the United States: implications for donor recruitment.

BACKGROUND: The potential effectiveness of various donation incentive programs may vary by demographics, first-time or repeat status, and collection site. STUDY DESIGN AND METHODS: Attitudes toward future incentives were obtained from a 1998 anonymous survey sent to 92,581 US blood donors. Responses (encouraged, discouraged, no difference) to incentives were compared within demographic groups, donations sites, and between first-time and repeat community whole-blood (WB) donors using chi-square tests and logistic regressions adjusted for sample design. RESULTS: Incentives most likely to encourage donation return among all 45,588 WB respondents were blood credits (61%), cholesterol screening (61%), and prostate-specific antigen (PSA) screening (73% of men). Younger donors (< or = 25 years old) were 4 to 5 times more likely to be encouraged to donate if offered compensatory incentives (tickets to events, discounts or lottery and/or raffle tickets), gifts, or a token of appreciation than were those donors older than 55. This age effect influenced positive attitudes toward incentives in first-time donors and in donors giving at schools, universities, or military sites. Among all donors, up to 7 to 9 percent reported they would be discouraged to return if offered compensatory incentives. CONCLUSIONS: Blood credits and cholesterol and PSA screening would be well received at all donation sites. Gifts, compensatory incentives, and tokens of appreciation appeal more to younger donors. These data may allow blood centers to optimize recruitment by tailoring limited incentive resources more effectively.

Adult↗
PubMed2003

Blood-donor perceptions of health history screening with a computer-assisted self-administered interview.

BACKGROUND: Computer-assisted self-interviewing (CASI) has been shown to promote disclosures of sensitive information. Using CASI to screen blood-donor candidates might encourage reports of deferrable risks without discouraging eligible donors. STUDY DESIGN AND METHODS: In 1998, an anonymous mail survey was sent to donors from eight blood centers. The relationship of donor demographics, donation history, and infectious risks (HIV test-seeking behavior, unreported deferrable risk, or reactive donor-screening test result) on attitudes toward CASI were assessed. RESULTS: Of 92,581 blood donors surveyed, 52,650 (57%) responded; of these, 4713 (7%) had an infectious risk. Among donors with risks, 29 percent felt they would be encouraged to reveal personal data, and 7 percent reported they would be discouraged from donating by CASI. Young, minority, female, and first-time donors were the most likely to report that CASI would encourage personal disclosures. Among donors without risks, 5 percent felt CASI would discourage them from donating. CONCLUSIONS: Although most donors felt their donation practices would not be influenced, CASI might reduce the proportion of donors with infectious risks by fostering personal disclosures and self-deferrals. The potential for CASI to improve donor screening and increase appropriate self-deferrals should be balanced against the possible loss of reluctant safe donors.

Adolescent↗
PubMed2003

Behavioral and infectious disease risks in young blood donors: implications for recruitment.

BACKGROUND: Recruitment of young donors is critical to expand the donor base and sustain the blood supply. Nevertheless, there is concern that younger blood donors may have a higher risk profile than their older counterparts. STUDY DESIGN AND METHODS: The prevalence of behavioral risks associated with transfusion-transmissible viral infections and the incidence of viral markers were compared between younger and older donors. Behavioral risks included unreported deferrable risks (UDRs) and HIV test seeking estimated from anonymous donor surveys administered in 1993 and 1998. The incidence of HIV, HCV, or HBV was estimated from donors giving at five US blood centers between 1996 and 2000. RESULTS: Donors younger than 25 years of age were significantly more likely to report a UDR or HIV test seeking than those 25 years or older. ORs comparing donors 18 to 19 and 20 to 24 years of age to those 25 years or older were 2.0 (95% CI, 1.5-2.6) and 1.5 (95% CI, 1.2-1.9) for UDR and 4.5 (95% CI, 3.0-6.9) and 5.5 (95% CI, 4.2-7.1) for test seeking, respectively. Although incidence estimates did not significantly differ between age groups, HIV incidence appeared to be highest in 18- to 19-year-old donors, whereas HBV incidence was highest in 20- to 24-year-old donors. CONCLUSIONS: Donors younger than 25 years of age appeared to have a higher behavioral risk profile than older donors. The message not to donate when a behavioral risk is present or for obtaining HIV tests needs to be reinforced in younger donors.

Adult↗
PubMed2002

Motivations to donate blood: demographic comparisons.

BACKGROUND: Understanding blood donor motivations is crucial to improving effectiveness of donor recruitment and retention programs. STUDY DESIGN AND METHODS: Data from a 1998 survey of 92,581 U.S. blood donors were used to evaluate factors influencing the decision to donate in various demographic groups. Data were weighted to adjust for response and sample design. RESULTS: Of 52,650 respondents, 45,588 gave whole-blood (WB) donations. Among all demographic groups, the major reasons to donate were altruism (75-87%) and awareness of the need for blood (34-43%). Except for first-time donors and those <or=25 years old, blood drive organizers and/or recruiters were more important than family and/or peers in encouraging donors (13-19% vs. 1-8%). Although 59 to 63 percent of donors said they would be encouraged to donate by reminders originating from the blood bank, for some, the contact would have a negative effect and discourage donation. Discouragement would be higher if they were reminded by a telephone call (14%) rather than by a letter or e-mail (4%) or an appeal (2%) from the blood bank. CONCLUSION: WB donations appear to be made primarily for altruistic reasons and in response to appeals for blood. Ways to build on this humanitarianism and take advantage of new communication routes, such as e-mail, need to be developed.

Altruism↗
PubMed2002

Bioelectrical impedance analysis models for prediction of total body water and fat-free mass in healthy and HIV-infected children and adolescents.

BACKGROUND: Bioelectrical impedance analysis (BIA) is an attractive method of measuring pediatric body composition in the field, but the applicability of existing equations to diverse populations has been questioned. OBJECTIVE: The objectives were to evaluate the performance of 13 published pediatric BIA-based predictive equations for total body water (TBW) and fat-free mass (FFM) and to refit the best-performing models. DESIGN: We used TBW by deuterium dilution, FFM by dual-energy X-ray absorptiometry, and BIA-derived variables to evaluate BIA models in a cross-sectional study of 1291 pediatric subjects aged 4-18 y, from several ethnic backgrounds, including 54 children with HIV infection and 627 females. The best-performing models were refitted according to criterion values from this population, cross-validated, and assessed for performance. Additional variables were added to improve the predictive accuracy of the equations. RESULTS: The correlation between predicted and criterion values was high for all models tested, but bias and precision improved with the refitted models. The 95% limits of agreement between predicted and criterion values were 16% and 11% for TBW and FFM, respectively. Bias was significant for some subgroups, and there was greater loss of precision in specific age groups and pubertal stages. The models with additional variables eliminated bias, but the limits of agreement and the loss of precision persisted. CONCLUSION: This study confirms that BIA prediction models may not be appropriate for individual evaluation but are suitable for population studies. Additional variables may be necessary to eliminate bias for specific subgroups.

Adolescent↗