Is it justifiable to withhold treatment for hepatitis C from illicit-drug users?
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Biomedical subjects
Publications and source records attributed to L D Moore.
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OBJECTIVES: This study sought to determine prevalence of and risk factors for nonfatal recent overdose among street-recruited injection heroin users. METHODS: From August 1998 through July 1999, 1427 heroin injectors were recruited from 6 inner-city neighborhoods in the San Francisco Bay Area, Calif, and interviewed. Factors hypothesized to be associated with recent overdose were analyzed with logistic regression. RESULTS: Of the 1427 participants, 684 (48%) had had an overdose, 466 (33%) had experienced 2 or more overdose events, and 182 (13%) had had a recent overdose. In multiple logistic regression, being younger (adjusted odds ratio [OR] for each year of increasing age = 0.95; 95% confidence interval [CI] = 0.94, 0.97), having been arrested 3 or more times in the past year (adjusted OR = 2.50; 95% CI = 1.61, 3.87), drinking 4 or more alcoholic drinks per day (adjusted OR = 2.05; 95% CI = 1.37, 3.05), and having participated in methadone detoxification during the past year (adjusted OR = 1.47; 95% CI = 1.03, 2.09) were independently associated with recent overdose. Being homeless; identifying as gay, lesbian, bisexual, or transgender; having spent 5 or more years in prison or jail; and having engaged in sex work also were associated with recent overdose. CONCLUSIONS: Targeted interventions that decrease risk for overdose are urgently needed.
Directly observed therapy (DOT) has become a popular strategy in tuberculosis (TB) control. Limited resources to provide DOT makes selection of patients an issue. Studies were done in San Francisco to analyze the socioeconomic and behavioral characteristics of 1992 TB patients--and of those on DOT--and to determine attitudes of indigent San Franciscans toward TB and adherence to TB control measures. The studies show that (1) African American and Latino patients were more likely to be selected for DOT than Asian/Pacific Islanders and whites, regardless of factors associated with adherence behavior, and (2) DOT, delivered in a respectful manner and combined with incentives, was evaluated positively by those with risk factors.
In Shenandoah National Park, O(3) monitoring data were characterized and attempts were made to relate O(3) concentration levels to visible foliar injury observed for five plant species surveyed. Foliar injury for three species increased with elevation. The 24-h monthly mean O(3) concentrations tended to increase with elevation; however, the number of elevated hourly occurrences did not. Although the frequency of high hourly O(3) concentrations did not consistently increase with elevation, O(3) exposures in the park may have been high enough to provoke an effect that may have been enhanced by vegetation sensitivities that differed as a function of altitude.
Eye movements of two patients with Duane's retraction syndrome (type 1) were recorded using high-resolution infrared oculography. Slowed hypometric abduction was found. The dynamics of adducting saccades in the affected hypometric eye were normal, suggesting an absence of functional cocontraction of the medial and lateral rectus muscles. Therefore, narrowing of the palpebral tissue on adduction most likely reflects a reorganization of the central ocular motor pathways.
Theophylline level testing enables the physician to monitor patients on theophylline and maintain benefit vs risk at an optimum ratio. This study consisted of a retrospective chart review of 53 patients who had a total of 103 serum theophylline level determinations (STLDs) over a 12-month period. The study was designed to look at reasons why physicians ordered STLDs and to what extent those results influenced subsequent theophylline prescribing. Findings showed that a large number of STLDs were ordered on asymptomatic patients with no recent dose change or initiation of therapy and no recent hospitalization or emergency room visit. The most common reason for ordering an STLD was presentation with symptoms or signs of asthma and no other recent events. On several occasions when low results were obtained, theophylline dosage was not increased. In some of these cases the patient's clinical presentation may have influenced the decision to maintain the same dosage. Use of erythromycin and smoking status were observed to affect theophylline clearance. Most physicians failed to document time of last theophylline dose, which hindered accurate interpretation of STLDs.
Streptococcus mutans strain GS-5 was grown in a variety of carbon sources in order to achieve different balanced growth rates, ranging from 61 to 383 minutes. The influence of the S. mutans growth rate on mouse phagocyte activity against these bacteria has been evaluated. The percentages of bacteria phagocytized and intracellularly killed by macrophages rose to 60-80% and 85-95% respectively when the doubling time was longer, showing that S. mutans is particularly sensitive to nonspecific immune defence mechanisms when cultured under conditions similar to those of its natural ecosystem.
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In cell-free extracts derived from Streptococcus faecalis, protein synthesis directed by endogenous messenger RNA increases as the culture ages. The increased activity is accompanied by an increase in the percentage of membranebound ribosomes and by a decrease in ribosomal monomers and subunits. These changes progress against a background of structural and compositional modifications in the membrane. Membrane modifications possibly related to endogenously directed protein synthesis in cell-free extracts include: (i) decreased specific activity of a membrane-associated polynucleotide phosphorylase capable of polysome degradation, and (ii) increased concentrations of certain phospholipids.
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