Biomedical subjects

R M Klevens

Publications and source records attributed to R M Klevens.

26 records · Page 2Linked to original sources

PubMed1997

Impact of laboratory-initiated reporting of CD4+ T lymphocytes on U.S. AIDS surveillance.

This study was conducted to measure the impact of laboratory-initiated reporting of CD4+ results on reporting of AIDS in the United States. States were categorized by whether CD4+ reporting was required; we compared the number and percentage of AIDS cases reported based on immunologic criteria, controlling for whether states also required HIV infection reporting. We observed cases reported in 1994 with CD4+ values and the delay between diagnosis and report by CD4+ and HIV-reporting status. From 1992 to 1994, states with CD4+ reporting had a greater proportionate increase in reported AIDS cases (98%) than states without CD4+ reporting (55%; p < 0.0001). From 1993 to 1994, the eight states with both CD4+ and HIV reporting had a higher increase in cases meeting immunologic criteria (7%) than the 13 states with only HIV reporting (< 1%), the three states with only CD4+ reporting (< 1%), and the 16 states with neither form of laboratory reporting (4%). Of 1987 definition cases reported in 1994, the percentage reported with CD4+ values was lower in states without either CD4+ or HIV reporting (79%) than in states with both CD4+ and HIV reporting (83%), only HIV reporting (84%), or only CD4+ reporting (88%). The percentage of AIDS cases reported within 3 months of diagnosis was lower in states without laboratory reporting (40%) than in states with CD4+ reporting (45%, p = 0.001). CD4+ reporting may enable states to report AIDS cases earlier in the course of HIV disease, permitting early targeting of health care and social services.

Acquired Immunodeficiency Syndrome↗

PubMed1997

Assessing the generalizability of smoking studies.

We used data from the 1986 Adult Use of Tobacco Survey, 10 studies of self-quitters and seven studies of treatment seekers, to illustrate how subpopulations of smokers might differ; e.g. treatment seekers vs. self-quitters and research volunteers vs. smokers in the general population. Smoking researchers may wish to use our results to determine whether their sample is similar to the population of interest.

Adult↗

PubMed1996

Characteristics of women with AIDS and invasive cervical cancer.

OBJECTIVE: To characterize women reported with AIDS and invasive cervical cancer in the first year of the expanded AIDS surveillance case definition. METHODS: Using X2 testing and logistic regression, we compared women with invasive cervical cancer with those having other AIDS-defining illnesses. RESULTS: Of the 16,794 women 13 years old or older and reported with AIDS in 1993, 217 (1.3%) had invasive cervical cancer and 9113 (54.3%) had other opportunistic illnesses; the remaining 7464 (44.4%) had no opportunistic illnesses and were reported based on immunologic criteria. Women with invasive cervical cancer were more likely to have had AIDS diagnosed before 1993 (73 and 56%, respectively; P < .01), to be younger (median age 33 and 35 years; P < .001), to be white (31 and 21%; P < .01), and to reside in the south (41 and 34%; P < .05). Among women reported with CD4+ counts, the median value was higher in 149 women with invasive cervical cancer than in the 5993 with other opportunistic illnesses (153 and 50 cells/microL, respectively). Women with invasive cervical cancer were more likely to report injection drug use (57 and 48%; P < .05). In multivariate analysis, Hispanic women were 0.6 times less likely to be reported with invasive cervical cancer than were white women (P < .05). Among women infected through injecting drug use, black women were 0.5 times less likely to be reported with invasive cervical cancer (P < .001). CONCLUSION: Hispanic and black women infected with HIV were less likely to be reported with invasive cervical cancer, a finding that may be associated with inadequate access to health care services. Women with invasive cervical cancer were less severely immunosuppressed than women with other AIDS opportunistic illnesses.

Acquired Immunodeficiency Syndrome↗

PubMed1995

Tuberculosis in health care workers at a hospital with an outbreak of multidrug-resistant Mycobacterium tuberculosis.

OBJECTIVE: Investigate reports of tuberculosis in health care workers employed at a hospital with an outbreak of multidrug-resistant Mycobacterium tuberculosis. DESIGN: Case series of tuberculosis in health care workers, January 1, 1989, through May 31, 1992. Antimicrobial susceptibility testing and restriction fragment length polymorphism analysis of M tuberculosis isolates. Longitudinal analysis of cumulative tuberculin skin test surveillance data. Assessment of infection control. The patients consisted of 361 health care workers who had either serial tuberculin skin tests or tuberculosis. RESULTS: Six health care workers, the largest number linked to one multidrug-resistant tuberculosis outbreak, had disease due to M tuberculosis that matched the outbreak strain from hospitalized patients. The two who were seropositive for human immunodeficiency virus died, one of tuberculous meningitis and the other of multiple causes including tuberculosis. The estimated risk of a skin test conversion was positively associated with time and increased by a factor of 8.3 (1979 to 1992). In 1992 the annual risk for workers in the lowest exposure occupational group was 2.4%. In comparison, nurses and housekeepers had relative risks of 8.0 (95% confidence interval, 3.2 to 20.3) and 9.4 (95% confidence interval, 2.7 to 32.3), respectively. Laboratory workers had a relative risk of 4.2 (95% confidence interval, 1.1 to 15.5). Tuberculosis admissions increased, but the hospital had inadequate ventilation to isolate tuberculosis patients effectively. There were lapses in infection control practices. CONCLUSIONS: Health care workers who were exposed during a hospital outbreak of multidrug-resistant tuberculosis had occupationally acquired active disease. The human immunodeficiency virus-infected health care workers with tuberculosis had severe disease and died. The risk of skin test conversion increased during the study period, and higher exposure occupations had elevated risk. Effective infection control is essential to prevent the transmission of tuberculosis to health care workers.

AIDS-Related Opportunistic Infections↗

PubMed1994

Cigarette smoking: an independent risk factor for impotence?

The authors sought to determine whether current cigarette smoking was associated with impotence among middle-aged men. This is a secondary analysis of a cross-sectional survey of 4,462 US Army Vietnam-era veterans aged 31-49 years who took part in the Vietnam Experience Study in 1985-1986. The main outcome measurement was the odds ratio for reported impotence, which was calculated by comparing current smokers with nonsmokers while controlling for multiple confounders. The study sample consisted of 1,162 never smokers, 1,292 former smokers, and 2,008 current smokers. The prevalence of impotence was 2.2% among never smokers, 2.0% among former smokers, and 3.7% among current smokers (p = 0.005). The unadjusted odds ratio (OR) of the association between smoking and reported impotence was 1.8 (95% confidence interval (CI) 1.2-2.6). The association held even after adjustments were made for confounders, including vascular disease, psychiatric disease, hormonal factors, substance abuse, marital status, race, and age (OR = 1.5, 95% CI 1.0-2.2). Neither years smoked nor cigarettes smoked daily were significant predictors of impotence in current smokers. The authors concluded that, among the men in this study, a higher percentage of cigarette smokers reported impotence than did nonsmokers. This observation could not be totally explained by comorbidity factors related to smoking.

Adult↗

PubMedDate not supplied

Predictors of tobacco sales to minors.

BACKGROUND: Our purpose was to determine which characteristics of buyers, stores, and store clerks predicted successful tobacco sales to minors. METHODS: Seventeen minors visited randomly selected retail outlets in the Austin, Texas, area and attempted to purchase tobacco products. We used logistic regression modeling to determine independent predictors of successful purchase attempts. RESULTS: Overall, 101 of 165 attempts (61.2%) were successful. Although legally required, only 25.3% of stores posted warning signs about underage purchase of tobacco, and stores with signs were no less likely to sell to minors than stores without signs. Successful attempts were more common from vendors in metropolitan locations and from vendors with no alcohol products. Only 8.1% of attempts succeeded when buyers were questioned (usually about age), compared with 95.6% of attempts when no questions were asked (P < 0.001). The best predictor of a successful purchase attempt was failure to question buyers (adjusted odds ratio = 1,850; P < 0.001). CONCLUSIONS: Warning signs had no effect on vendors' compliance with the state minors' access law, and failure to question minors about their age substantially increased the odds of a successful purchase. Laws prohibiting tobacco sales to minors should be enforced by requiring vendors to obtain proof of buyers' ages for persons who appear to be < 30 years of age.

Adolescent↗

PubMedDate not supplied

Special contribution: transforming a neighborhood health center into a community-oriented primary care practice.

We describe a community-oriented primary care (COPC) preventive medicine residency. Through the residency, medical, nursing, dental, and other health professionals work as fellows to combine clinical and public health skills in primary care practices. We describe the steps that fellows used to begin transforming one community health center into a COPC practice, and we highlight the activities of one specific environmental cleanliness project as an example. COPC activities have laid the foundation for further advances in developing a professional partnership between the center and the community it serves.

Boston↗

PubMedDate not supplied

The association between veteran status and cigarette-smoking behaviors.

Although the prevalence of smoking has decreased since 1980 among active duty military personnel, it remains higher than among the adult civilian population; among military veterans, the prevalence of smoking has not been well described. The objectives of this study were to describe patterns of cigarette smoking behaviors among United States veterans and nonveterans and to examine the association between military veteran status and cigarette smoking. We analyzed data from a cross-sectional survey from a national probability sample of the civilian, noninstitutionalized adult population (National Health Interview Survey supplements). We estimated the prevalence of ever, current, and former smoking, as well as crude and adjusted odds ratios (AORs) of each outcome measure among veterans and nonveterans, by gender. The prevalence of ever smoking was 74.2% (+/- 0.7%) among veterans and 48.4% (+/- 0.5%) among nonveterans; current smoking prevalence was 33.9% (+/- 1.0%) among veterans and 27.7% (+/- 0.5%) among nonveterans. Among those who had not initiated smoking before the age of 18 years, veterans were more likely than nonveterans to report ever smoking (AOR = 1.8 for men and 1.9 for women) and current smoking (AOR = 1.9 for both men and women). After statistical adjustment, no difference was seen in cessation behavior. We concluded that the prevalence of ever and current smoking was higher among U.S. military veterans. The association was the strongest among veterans who had not initiated smoking before the age of 18 years. These findings are consistent with the hypothesis that military service is a risk factor for cigarette smoking, and they support the military's current prevention and cessation efforts.

Adult↗