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Biomedical subjects

N Hessol

Publications and source records attributed to N Hessol.

9 recordsLinked to original sources
PubMed1999

The relative value of CD4 cell count and quantitative HIV-1 RNA in predicting survival in HIV-1-infected women: results of the women's interagency HIV study.

OBJECTIVES: To determine factors associated with survival and to assess the relative strength of CD4 cell count and HIV-1 RNA in predicting survival in a cohort of HIV-1-infected women. DESIGN: Prospective cohort, enrolled during 1994-1995, with median follow-up of 29 months RESULTS: Of 1769 HIV-infected women 252 died. In multivariate analyses, lower CD4 cell count, higher quantitative plasma HIV-1 RNA, and the presence of a self-reported AIDS-defining (Class C) condition were significantly associated with shorter survival: the relative hazard (RH) of dying was 1.17, 3.27, and 8.46, respectively for women with baseline CD4 cell count of 200-349, 50-199, and < 50 x 10(6) cells/l, compared with women with CD4 cell count of > or = 350 x 10(6) cells/l. Compared with women with HIV-1 RNA levels of < 4000 copies/ml plasma, the RH of dying for women with baseline quantitative HIV-1 RNA measurements of 4000-20,000, 20,000-100,000, 100,000-500,000 and > 500,000 copies/ml, was 2.19, 2.17, 3.16, and 7.25, respectively. CD4 cell count had as strong a prognostic value as HIV-1 RNA level, particularly among participants with more advanced immunodeficiency. When the analysis was adjusted to eliminate the distortion created by having disproportionately sized strata of the categorized variables, the relative hazard of death associated with CD4 cell count became even larger in comparison with that for HIV-1 RNA. Eliminating from the analysis all follow-up time during which participants could have received highly active antiretroviral therapy did not change these findings. Age was not a predictor of survival after adjustment for covariates. CONCLUSIONS: CD4 cell count and HIV-1 RNA had similar prognostic value in this cohort of HIV-1-infected women. Even in the presence of a low viral burden, a substantially decreased CD4 cell count remained a strong predictor of mortality.

CD4 Lymphocyte Count↗
PubMed1997

Does vaginal cuff closure decrease the infectious morbidity associated with abdominal hysterectomy?

BACKGROUND: Infectious morbidity after total abdominal hysterectomy includes fever (31%) and antibiotic administration (45%). Whether vaginal cuff closure reduces postoperative infectious morbidity remains unresolved. STUDY DESIGN: We reviewed the records of 172 consecutive abdominal hysterectomies for nonmalignant disease performed at an inner-city hospital. We identified potential risk factors for infectious morbidity by univariate analysis and determined adjusted odds ratios by multiple logistic regression analysis. RESULTS: The open vaginal cuff technique was associated with an increased risk of wound infection. Use of prophylactic antibiotics was associated with a decreased risk of febrile morbidity and a decreased risk of prolonged hospitalization. Body weight in the heaviest quartile was associated with increased risk of wound infection, increased risk of prolonged hospitalization, and decreased risk of postoperative vaginal cuff granulation tissue. Older age was associated with an increased risk of prolonged hospitalization. CONCLUSIONS: Closure of the vaginal cuff and use of prophylactic antibiotics at total abdominal hysterectomy were associated with decreased infectious morbidity in a high-risk population.

Antibiotic Prophylaxis↗
PubMed1993

Factors associated with human immunodeficiency virus seroconversion in homosexual men in three San Francisco cohort studies, 1984-1989.

A total of 83 HIV seroconversions occurred between 1984 and 1989 in three San Francisco cohorts of homosexual and bisexual men. A nested case-control analysis was performed to assess the risk of seroconversion associated with sexual practices. Strong associations were found with total number of intercourse partners and receptive anal intercourse. Weaker, but significant associations were found with receptive oral intercourse. Individuals reporting condom use with some partners were more likely to become infected than those reporting no condom use. Some of this difference was due to increased numbers of sexual partners among those reporting some condom use, but the association remained significant in multivariate analyses. This observation indicates there is some unmeasured risk associated with those using condoms, such as more HIV seropositive partners.

Cohort Studies↗
PubMed1988

Estimating AIDS infection rates in the San Francisco cohort.

Between 1978 and 1980 a cohort of approximately 6700 homosexual and bisexual men were recruited from the San Francisco City Clinic to participate in studies of sexually transmitted hepatitis B. Testing frozen blood specimens collected at intervals from these patients provides a means of tracking the spread of the AIDS virus since 1978. The rate of spread of HIV was estimated by fitting different survival curves to interval-censored serological data using maximum likelihood techniques. The curves were compared using the Akaike Information Criterion (AIC) to select that which best describes the data. The best was found to be a log-logistic model, which suggested that between 1978 and 1981 the virus spread rapidly, infecting 44% of the then uninfected cohort members. More recently the rate of spread has declined, with an additional 32% of the cohort becoming infected between 1981 and 1987.

Acquired Immunodeficiency Syndrome↗
PubMed1984

The incidence of acute brain injury and serious impairment in a defined population.

Studies on the incidence and epidemiologic features of brain injury and the immediate medical outcomes are few, and published results have serious methodological inconsistencies which prohibit comparisons. This study provides incidence rates of brain injury among the residents of San Diego, California. Cases had clinical confirmation and onset of injury occurred during 1981. The 3358 cases identified represent a rate of 180/100,000 with males having a 2.2 times higher rate than females. Rates were highest for males aged 15-24 years and, for both genders, those over age 70. Forty-eight per cent of all cases were from transport-related causes, followed by falls (21%) and assaults (12%). Over 11% were dead-on-arrival, and 16% were classified as having moderate or severe brain damage on admission to a hospital. Age- and sex-specific incidence rates varied according to external cause of injury. For example, for most subcategories of motor vehicle crashes and for assaults, the incidence rate was highest among males aged 15-24, while for brain injuries from falls or firearms, highest incidence rates were observed in older age groups. Almost 7% of all cases discharged alive from an acute care hospital had significant neurologic sequelae. The impact of brain injury is discussed as a major unresolved public health problem.

Accidents, Traffic↗
PubMedDate not supplied

Commonly used diagnostic criteria for pelvic inflammatory disease have poor sensitivity for plasma cell endometritis.

BACKGROUND: The majority of women with tubal damage do not have a history of acute pelvic inflammatory disease. The prevalence of upper genital tract inflammation was evaluated in women deemed not to have pelvic inflammatory disease by common diagnostic criteria. GOAL OF THIS STUDY: To compare clinical signs and laboratory tests used to diagnose pelvic inflammatory disease with endometrial biopsy histopathology. STUDY DESIGN: Endometrial biopsy and commonly used physical and laboratory tests were performed on 52 women with pelvic tenderness, 51 with vaginosis or cervicitis, and 22 control subjects who had no evidence of infection with Neisseria gonorrhoeae or Chlamydia trachomatis and who tested negative for bacterial vaginosis using vaginal swab Gram's stain. RESULTS: Thirty-six of 52 patients (69%) with pelvic tenderness, compared with 22 of 51 patients (43%) with vaginosis or cervicitis and two of 22 control subjects (9%), had plasma cell endometritis. The Centers for Disease Control and Prevention minimal diagnostic criteria for pelvic inflammatory disease had a sensitivity of 33% for plasma cell endometritis. CONCLUSIONS: The clinical diagnosis of pelvic inflammatory disease using published criteria correlates poorly with plasma cell endometritis.

Adolescent↗
PubMedDate not supplied

A randomized comparison of Worksite-sponsored smoking cessation programs.

This worksite study assesses the relative effectiveness of three smoking cessation programs. Computerized medical files indicated that 29% of 13,171 employees were current smokers. Of smokers responding to a worksite-wide survey, 79% indicated interest in a smoking cessation program; 402 smokers agreed to participate and were randomly allocated, within their preference for a group or self-help approach, to the three different programs. Overall, 11% of smokers participated, an excellent rate for a large worksite. Participants were followed for 12 months (91% follow-up). Smokers in the group preference had better short-term results than did those following the self-help approach. The Multiple Component Program had 61% who quit, the Relapse Prevention Program had 37%, and the American Cancer Society Quitter's Guide had 12%. Long-term quit rates ranged from 16% to 26%; all groups exceeded the usual spontaneous quit rate of 5%.

Adult↗