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Biomedical subjects

R L Berkelman

Publications and source records attributed to R L Berkelman.

At least 37 records · Page 2Linked to original sources
PubMed1990

Impact of the human immunodeficiency virus epidemic on mortality in women of reproductive age, United States.

To assess the effect of the human immunodeficiency virus (HIV) on mortality in US women 15 to 44 years of age and to identify associated causes of death, we examined final (1980 through 1987) and provisional (1988) national mortality statistics. Between 1985 and 1988, the death rate for HIV/acquired immunodeficiency syndrome (AIDS) quadrupled (0.6 per 100,000 to 2.5 per 100,000), and by 1987, HIV/AIDS had become one of the 10 leading causes of death. In 1988, the death rate for black women (10.3 per 100,000) was nine times the rate for white women (1.2 per 100,000). The majority of deaths in both black and white women occurred in women 25 to 34 years of age, for whom HIV-related deaths accounted for 11% and 3% of all deaths in 1988, respectively. Among 1157 death certificates that included any mention of HIV/AIDS in 1987, other leading diagnoses included drug abuse (27%), Pneumocystis carinii pneumonia (20%), other pneumonias (14%), septicemia (10%), other infections not in the AIDS surveillance definition (7%), nephritis (6%), liver diseases (4%), and anemias (4%). If current mortality trends continue, HIV/AIDS can be expected to become one of the five leading causes of death by 1991 in women of reproductive age. Because women infected with HIV are the major source of infection for infants, these trends in AIDS mortality in women forecast the impact of HIV on mortality in children as well.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Kaposi's sarcoma among persons with AIDS: a sexually transmitted infection?

In the United States Kaposi's sarcoma is at least 20,000 times more common in persons with acquired immunodeficiency syndrome (AIDS) than in the general population and 300 times more common than in other immunosuppressed groups. Among persons with the acquired immunodeficiency syndrome (AIDS) reported to Centers for Disease Control by March 31, 1989, 15% (13,616) had Kaposi's sarcoma. Kaposi's sarcoma was commoner among those who had acquired the human immunodeficiency virus (HIV) by sexual contact than parenterally, the percentage with Kaposi's sarcoma ranging from 1% in men with haemophilia to 21% in homosexual or bisexual men. Women were more likely to have Kaposi's sarcoma if their partners were bisexual men rather than intravenous drug users. Kaposi's sarcoma risk was not consistently related to age or race but varied across the United States, being greatest in the areas that were the initial foci of the AIDS epidemic. Thus Kaposi's sarcoma in persons with AIDS may be caused by an as yet unidentified infectious agent, transmitted mainly by sexual contact.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Public health surveillance of non-infectious chronic diseases: the potential to detect rapid changes in disease burden.

The usefulness of surveillance in relating chronic disease trends to recent changes in risk exposures is often questioned on the grounds that these trends respond slowly, reflecting long periods between aetiological exposures and clinical onset of disease. We challenge this preconception on the basis of a review of several important risk factors and diseases: alcohol and liver cirrhosis; tobacco and stroke, cardiovascular disease, and lung cancer; and oestrogens and endometrial cancer. Data from cohort, cross-sectional, and modelling studies demonstrate that the time between removal of exposures and the onset of decline in morbidity or mortality is not defined by the time between initial exposure and disease occurrence. Rather, the pattern of lifetime exposures (with recent exposures often having a dominant effect), the dynamics of the disease process, and the segment of the population with reduced exposures determine how soon the decline begins.

Chronic Disease↗
PubMed1990

Epidemiology of reported cases of AIDS in lesbians, United States 1980-89.

National surveillance data for reported cases of acquired immunodeficiency syndrome (AIDS) were used to assess demographic characteristics and behavioral risk factors in lesbians. From June 1, 1980 through September 30, 1989, 79 women with AIDS reported sex relations only with a female partner; most of these women (95 percent) were intravenous drug users. Prevention of human immunodeficiency virus (HIV) infection in the lesbian community will require efforts to prevent and reduce intravenous drug use.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Impact of the human immunodeficiency virus epidemic on mortality trends in young men, United States.

Following a long-term decline, death rates in men 25-44 years of age increased from 212 deaths/100,000 in 1983 to 236 deaths/100,000 in 1987. To assess the impact of human immunodeficiency virus (HIV) infections on this trend and to identify causes that are increasing in association with the HIV epidemic, we analyzed national mortality statistics and compared death rates in states with high and low incidence of acquired immunodeficiency syndrome (AIDS). In 1987, there were 10,248 deaths with HIV infection, AIDS, or conditions in the AIDS surveillance definition assigned as the underlying cause, representing 11 percent of deaths for men in this age group compared to less than 1 percent in 1980. In addition, deaths with other underlying causes, such as other infections, drug abuse, and unknown/unspecified causes, had diverging and higher rates in states with high versus low AIDS incidence. In the absence of deaths due to HIV/AIDS and excess deaths due to these associated conditions, we estimate that death rates for men 25-44 years of age would have been 201-209/100,000 in 1987. For 1987, approximately 70-90 percent of HIV-related deaths were reported through national AIDS surveillance. The HIV epidemic has led to a reversal in mortality trends and to increases in various causes of death for young men.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Impact of the 1987 revision of the case definition of acquired immune deficiency syndrome in the United States.

To measure the impact of the 1987 expansion of the definition of acquired immune deficiency syndrome on the number and characteristics of cases in the United States, we reviewed the 28,920 cases diagnosed since the revision and reported through 1988. The proportion meeting only new criteria was 28% overall, with a range of 0 to 82% in different states and territories. This proportion was 26% in the last quarter of 1987 and increased to 31% in the last quarter of 1988. It was higher in heterosexual intravenous drug abusers (IVDAs) (43%) and lower in homosexual male non-IVDAs (21%) than in other groups. The new criteria, but not earlier (pre-1985) criteria, generally require a positive test for human immunodeficiency virus (HIV) infection; however, use of HIV testing varies among states, as demonstrated by differences in the percentage of pre-1985-criteria cases with a reported HIV test (39 to greater than 95%). The revision has changed the distribution of characteristics of cases (e.g., heterosexual IVDAs composed 18% of cases meeting old criteria, 35% of cases meeting only new criteria, and 23% of all cases). Interpretation of trends in both the number and characteristics of cases should take into account the variable impact of the revision on reporting.

AIDS Serodiagnosis↗
PubMed1990

Acquired immunodeficiency syndrome and extrapulmonary tuberculosis in the United States.

Of 48,712 acquired immunodeficiency syndrome (AIDS) cases reported to the Centers for Disease Control from October 1987 through March 1989, 1239 (2.5%) were diagnosed with extrapulmonary tuberculosis. Extrapulmonary tuberculosis was diagnosed in 1013 (2.3%) of the US-born persons with AIDS, compared with 26 (8%) of the Mexican-born, 82 (13%) of the Haitian-born, and 4 (1%) of the Cuban-born. Patients with AIDS with and without extrapulmonary tuberculosis were similar in age, except that extrapulmonary tuberculosis was relatively rare in patients with AIDS under the age 10. Compared with white homosexual/bisexual men, black race (odds ratio, 2.7), intravenous drug use (odds ratio, 2.0), heterosexual AIDS transmission category (odds ratio, 1.9), and Hispanic ethnicity (odds ratio, 1.6) were independently associated with extrapulmonary tuberculosis. In 1988, extrapulmonary tuberculosis in persons known to be human immunodeficiency virus seropositive represented 21% of national extrapulmonary tuberculosis morbidity.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Mandatory reporting of infectious diseases by clinicians.

Reporting of cases of communicable disease is important in the planning and evaluation of disease prevention and control programs, in the assurance of appropriate medical therapy, and in the detection of common-source outbreaks. In the United States, the authority to require notification of cases of disease resides in the respective state legislatures. We examined the laws and regulations of health departments of all US jurisdictions to ascertain diseases and conditions currently required to be reported in each state or territory. We present herein the state reporting requirements for infectious diseases and infectious disease-related conditions. To obtain additional information regarding time frames for reporting, agencies to which reports are required, persons required to report, and specific conditions under which reports are required, the reader is referred to the statutes and health department regulations of the respective states.

Communicable Disease Control↗
PubMed1989

Epidemiology of human immunodeficiency virus infection and acquired immunodeficiency syndrome.

As of December 31, 1988, 82,764 cases of acquired immunodeficiency syndrome (AIDS) and more than 46,000 AIDS-related deaths had been reported in the United States. In 1987, AIDS deaths accounted for 9% of the total mortality among men 25 to 34 years of age. Projections suggest that the impact of human immunodeficiency virus (HIV) infection on morbidity and mortality in young adults and children will continue to increase, with an estimated 50,000 cases projected to be diagnosed in 1989. The mean latency period between infection and diagnosis of AIDS is estimated to be more than seven years, and 78% to 100% of persons infected with HIV are predicted to develop AIDS within 15 years of onset of infection. Rates of seroconversions have been decreasing since 1984 among cohorts of homosexual HIV-seronegative men, and the proportion of AIDS cases among homosexual men is decreasing. In contrast, the proportion of AIDS cases attributed to intravenous drug use is increasing, with 33% of AIDS cases reported in 1988 occurring among intravenous drug users, their sex partners, or children of women who are intravenous drug users or sex partners of intravenous drug users. Worldwide, the differences in the epidemiology of HIV infection and AIDS are primarily due to differences in the proportions of the modes of transmission and in the time in which HIV infection was introduced.

Acquired Immunodeficiency Syndrome↗
PubMed1989

The science of public health surveillance.

Improved public health surveillance can lead to earlier implementation of prevention and control measures. Better surveillance data lead to a more rational establishment of priorities. More timely and accurate data facilitate earlier epidemic detection and control. With better surveillance data, the impact of intervention activities and other public health programs can be evaluated more accurately. In this paper we describe how to improve the science of surveillance in terms of data collection, analysis, and dissemination and its application to public health practice. We then discuss the potential benefits and costs of such efforts and suggest methods for evaluating alternative approaches. The argument for science in surveillance, on the other hand, may be subject to excess. Surveillance is not an end unto itself, but rather a tool. This tool should be refined and modified to adapt to the goals of a particular public health program. It is the development of methods to apply creative ideas to surveillance, and the rigorous assessment of the process, that will benefit from the application of scientific principles.

Data Interpretation, Statistical↗
PubMed1986

Assessing the diagnostic accuracy and efficacy of selected antepartum fetal surveillance techniques.

Published studies on the contraction stress test (CST), the nonstress test (NST), and monitoring of fetal movement were reviewed to assess the accuracy and efficacy of these techniques. The false-negativity and false-positivity rates, sensitivity, and specificity of these tests were assessed with use of perinatal mortality and various measures of morbidity as outcomes. Both the CST and the NST generally demonstrated low sensitivity and high rates of false positivity. No randomized controlled trials have been conducted that are of sufficient size to demonstrate whether there is a significant difference in outcome following use of the CST or the NST. A single nonrandomized, controlled trial evaluating fetal-movement monitoring suggested clinical benefit. Direct costs of NSTs and CSTs in the United States were estimated to exceed $200 million per year. Yet the CST and the NST have not been demonstrated to be useful diagnostic tests. The CST, the NST, and fetal-movement monitoring are potentially useful screening tests. However, they require critical evaluation, with large randomized, controlled trials, to determine their efficacy and safety before their further diffusion into obstetrical practice.

Costs and Cost Analysis↗