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Biomedical subjects

Shrikant I Bangdiwala

Publications and source records attributed to Shrikant I Bangdiwala.

At least 19 recordsLinked to original sources
PubMed2026

Rationale, design, and experiences from the vanguard phase of the bariatric surgery for the reduction of cardiovascular events (BRAVE) trial.

BACKGROUND: Observational studies suggest that metabolic/bariatric surgery (MBS) reduces mortality and major adverse cardiovascular events in patients with obesity, but adequately powered randomized trials (RCTs) are lacking. The Bariatric Surgery for the Reduction of Cardiovascular Events (BRAVE) trial was designed to address this evidence gap. METHODS: BRAVE is an investigator-initiated, multi-center, open-label RCT with blinded endpoint adjudication comparing MBS vs guideline-based medical weight management (MWM) in adults with obesity and high-risk cardiovascular disease (CVD). Eligible participants have a body-mass index ≥35 kg/m² or ≥30 kg/m² with type 2 diabetes or age >55 years, and prior myocardial infarction (MI), coronary intervention, heart failure (HF), atrial fibrillation (AF) with elevated CHA₂DS₂-VASc score, cerebrovascular disease, or peripheral arterial disease. Participants are randomized 1:1 to MBS (sleeve gastrectomy, Roux-en-Y gastric bypass, or duodenal switch) or MWM, which includes dietary, behavioral, and pharmacologic therapies. The primary outcome is the composite of all-cause death, MI, stroke, HF events, coronary revascularization, AF hospitalization, and renal events. A vanguard phase of 200 participants was implemented to optimize recruitment and logistics. RESULTS: As of October 2025, 2,514 individuals have been screened from 17 centers in Canada, Brazil, Italy and Spain, with 444 entered MBS work-up, and 200 have been randomized. The randomized cohort (mean age 59.8 years; 37% female; mean BMI 44.0 kg m⁻²) has high burden of hypertension (82%), diabetes (45%), coronary artery disease (44%), HF (39%), and AF (48%). Recruitment barriers were identified and addressed through targeted education and enhanced patient engagement. CONCLUSIONS: BRAVE is the first large RCT evaluating whether MBS safely reduces major cardiovascular events compared with medical therapy in high-risk patients with obesity. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05531474.

Humans↗
PubMed2026

Putting Globus Into Context: Prevalence, Characteristics, and Overlap With Other Disorders of Gut-Brain Interaction.

OBJECTIVE: Globus is characterized by the sensation of a lump in the throat without dysphagia or underlying structural abnormality or major motility disorder. Reported prevalences vary considerably across studies. Globus has been linked to both heartburn and affective disorders. This study aims to determine the global prevalence of globus, its association with heartburn, overlap with disorders of gut-brain interaction (DGBI) and psychosocial disorders, and its impact on health-related quality of life (HRQOL). METHODS: Internet surveys from the Rome Foundation Global Epidemiology study were used (N = 54,127). Rome IV criteria were used to identify globus and concurrent DGBI. Heartburn was defined as symptoms ≥ 2-3 days/week. Psychosocial co-morbidity and somatic symptom severity were assessed with PHQ-4 and PHQ-15, and HRQOL by PROMIS-10. RESULTS: The global prevalence of globus according to Rome IV criteria was 0.75%, representing 12.8% of esophageal DGBI and 1.86% of all DGBI. Prevalence was highest in Western Europe (0.94%) and Asia (0.90%), and lowest in the Middle East (0.31%). Globus was slightly more common in females (55.4%), and most affected individuals were aged between 40 and 64 years (46.6%). Coexisting heartburn was reported in 17.4% of cases, esophageal DGBI in 9.1%, and non-esophageal DGBI in 49.0%. Anxiety and/or depression was present in 60.5%. CONCLUSION: Global prevalence of globus is 0.75%, with a slight female predominance, and is most prevalent below 65 years. Overlap with non-esophageal DGBI was greater than with heartburn symptoms or esophageal DGBI, and most patients had anxiety and/or depressive symptoms.

Humans↗
PubMed2006

A survey on patient educational needs in irritable bowel syndrome and attitudes toward participation in clinical research.

BACKGROUND: The educational needs of patients with irritable bowel syndrome (IBS) are poorly understood and rarely studied. AIM: To determine the educational needs of IBS patients, regarding content, presentation format, and expectations from healthcare providers. METHODS: Fifteen functional GI clinic patients were asked open-ended questions to generate items for a questionnaire addressing the study aim. A total of 104 IBS patients received this questionnaire by mail (42 had declined to participate in a prior IBS study). To assess the frequency of endorsements and importance (on a scale of 1-3) of the items, an index was calculated (frequency of endorsements x mean rating per item, first priority scored 3, third priority scored 1). A higher index indicated greater endorsement based on frequency and rating of response. RESULTS: A total of 29 (28%) subjects (22 willing, 7 unwilling to participate previously in questionnaire research) completed the questionnaire (mean age, 42.6 years; SD, 14.2 years; 19 female, 10 male). The overall low response rate is likely related to the population studied; 40.4% of our study subjects have declined participation in prior research. The response rate of those who have previously agreed to participate was 36%. The typical response profile included: interest in learning disease management (index=1.4) and preference for information presented in person by an M.D. (2.4). Choice of presentation media included magazines (1.9), television (1.5), and Web sites (1.2). Doctors' qualities ranked high related to competency (0.8), allocation of sufficient time (0.7), and listening skills (0.4). Preferred incentives for research participation included a thank you note (0.4), summary of trial results (0.3), and monetary incentives (0.6). CONCLUSIONS: This qualitative study will provide pilot data for a national survey on the educational needs of IBS patients, for use in developing effective patient-centered, educational programs.

Adult↗
PubMed2006

Parents' and teachers' concordance with children's self-ratings of suicidality: findings from a high-risk sample.

This study examined concordance between adult and child reports of child suicidality using a sample of 1,046 8-year-old children at risk for, or having experienced, maltreatment. Concordance was low with both caregivers and teachers. For children reporting no suicidality, caregiver-child agreement was associated with few transitions in caregiver and low social withdrawal and aggression, and teacher-child agreement was associated with non-White ethnicity, good academic performance, and low thought problems. For children reporting suicidality, care-giver-child agreement was associated with perceptions of child mental health needs, aggression, and somatic complaints, and teacher-child agreement was associated with thought problems.

Achievement↗
PubMed2005

The dimensions of maltreatment: introduction.

This special issue includes an introduction and seven papers exploring dimensions of maltreatment including type, severity, chronicity, and substantiation status of referrals to CPS, utilizing a subsample of the LONGSCAN studies. Each paper examines one of the dimensions of maltreatment from various perspectives to determine if different conceptualizations of a dimension, examined in isolation, account for different amounts of variation in child outcomes. A final paper assesses the relationship of the combined maltreatment dimensions, including interactions, on a single sample of maltreated children from the LONGSCAN study. This final paper explores the individual contribution of the "best" conceptualizations of the maltreatment dimensions in relation to each other, and to the 10 child outcomes of interest. Implications of the findings from these papers for future research on dimensions of child maltreatment are discussed in two independent commentaries.

Child↗
PubMed2005

Defining maltreatment chronicity: are there differences in child outcomes?

OBJECTIVE: For nearly 25 years researchers have suggested that better taxonomic systems conceptualizing and reliably differentiating among different dimensions of maltreatment are required. This study examines the utility of three different characterizations of one dimension of maltreatment, chronicity, to predict child behavioral and emotional functioning in a sample of maltreated children. A secondary objective of the study is to examine additional parameters of maltreatment inherent in our definitions of chronicity: age at first report to CPS, extent and continuity of maltreatment. METHOD: The study consists of children reported for maltreatment (N=519) from the larger LONGSCAN study cohort. Lifetime maltreatment data were collected from CPS records and coded into two chronicity constructs: "developmental" and "calendar" definitions. Variables for age at first report, frequency, extent and continuity of maltreatment reports also were constructed. Hierarchical regression analyses were utilized to determine the extent to which the various chronicity constructs contributed to the prediction of child outcomes. RESULTS: The most salient definition of chronicity, in terms of its effects on child behavioral and emotional functioning, varied by outcome. The developmental definition was found to have the most balanced sensitivity across outcomes. Among other significant findings, extent and continuity of maltreatment contributed respectively to the prediction of behavior and emotional trauma symptoms. Early age at first report was a predictor of poor daily living skills. CONCLUSION: Chronicity is a complex construct. Findings indicate there are multiple parameters that make up the chronicity construct itself that may be important for understanding child outcomes.

Adaptation, Psychological↗
PubMed2005

A prospective assessment of bowel habit in irritable bowel syndrome in women: defining an alternator.

BACKGROUND & AIMS: Irritable bowel syndrome (IBS) is subtyped as IBS with diarrhea (IBS-D) or IBS with constipation (IBS-C) based on Rome II guidelines. The remaining group is considered as having mixed IBS (IBS-M). There is no standard definition of an alternator (IBS-A), in which bowel habit changes over time. Our aim was to use Rome II criteria to prospectively assess change in bowel habit for more than 1 year to understand IBS-A. METHODS: Female patients (n=317) with IBS entering a National Institutes of Health treatment trial were studied at baseline with questionnaires and 2-week daily diary cards of pain and stool frequency and consistency. Studies were repeated at the end of treatment (3 months) and at four 3-month intervals for one more year. Algorithms to classify subjects into IBS-D, IBS-C, and IBS-M groups used diary card information and modified Rome II definitions. Changes in bowel habit at 3-month intervals were then assessed using these surrogate diary card measures. RESULTS: At baseline, 36% had IBS-D, 31% IBS-M, and 34% IBS-C. Except for stool frequency, there were no differences between groups. While the proportion of subjects in each subgroup remained the same over the year, most individuals (more than 75%) changed to either of the other 2 subtypes at least once. IBS-M was the least stable (50% changed out by 12 weeks). Patients were more likely to transition between IBS-M and IBS-C than between IBS-D and IBS-M. Notably, only 29% switched between the IBS-D and IBS-C subtypes over the year. CONCLUSIONS: While the proportion of subjects in each of the IBS subtypes stays the same, individuals commonly transition between subtypes, particularly between IBS-M and IBS-C. We recommend that IBS-A be defined as at least one change between IBS-D and IBS-C by Rome II criteria over a 1-year period.

Adult↗
PubMed2005

Racial and ethnic disparities in influenza vaccination among elderly adults.

OBJECTIVES: To examine whether access to care factors account for racial/ethnic disparities in influenza vaccination among elderly adults in the United States. DESIGN: Indicators of access to care (predisposing, enabling, environmental/system, and health need) derived from Andersen's behavioral model were identified in the National Health Interview Survey questionnaire. The relationship of these indicators to influenza vaccination and race/ethnicity was assessed with multiple logistic regression models. MAIN RESULTS: Significant differences in vaccination were observed between non-Hispanic (NH) whites (66%) and Hispanics (50%, P<.001) and between NH whites (66%) and NH blacks (46%, P<.001). Controlling for predisposing and enabling access to care indicators, education, marital status, regular source of care, and number of doctor visits, reduced the prevalence odds ratios (POR) comparing Hispanics to non-Hispanic whites from 1.89 to 1.27. For NH blacks, controlling for access to care indicators changed the POR only from 2.24 (95% CI, 1.9 to 2.7) to 1.93 (95% CI, 1.6 to 2.4). CONCLUSIONS: This study confirmed the existence of sizable racial/ethnic differences in influenza vaccination among elderly adults. These disparities were only partially explained by differences in indicators of access to care, especially among non-Hispanic blacks for whom large disparities remained. Factors not available in the National Health Interview Survey, such as patient attitudes and provider performance, should be investigated as possible explanations for the racial/ethnic disparity in influenza vaccination among non-Hispanic blacks.

Aged↗
PubMed2005

Clinical response to tricyclic antidepressants in functional bowel disorders is not related to dosage.

BACKGROUND: As shown in the per protocol analysis of a recent randomized, controlled trial, when tolerated, Desipramine (DES) is effective over placebo (PLA) in treating moderate-to-severe functional bowel disorders (FBD). Clinical experience suggests that the benefit from tricyclic antidepressants (TCA) in FBD can be achieved at doses lower than those used to treat major depression. Within psychiatry, when using higher dosage of TCAs, plasma levels can be used to adjust daily dosage to optimize a treatment response. However, in FBD, it is not known whether plasma levels at the lower dosage are similarly related to a clinical response. AIM: To determine in treating FBD, whether DES blood levels or dose taken can predict a clinical response. METHODS: As part of a study of 12 wk of antidepressant and psychological treatment in 431 patients with FBD at UNC and U of Toronto, we studied those participants who completed treatment (per protocol analysis) taking DES (N = 97, dose 50-150 mg/day) or pill placebo (PLA) (N = 55 1-3 pills/day). The primary outcome measure was defined as a composite score (Satisfaction with Treatment, McGill Pain Questionnaire, Global Well-being, and IBS-QOL). The composite score was correlated with: (i) DES plasma levels at week 6, and (ii) number of pills taken over the duration of the 12-wk treatment period. In addition, we also compared DES dose with DES plasma levels. RESULTS: There was a modest correlation between mean DES dose at weeks 5 and 6 and DES blood level at week 6 (R = 0.2 p < 0.07). However, there were no significant correlations between the composite score either with DES dose or with DES blood levels. CONCLUSIONS: Detectable blood levels of DES are associated with a clinical response in FBD. However, with dosages up to 150 mg, there is no relationship between total dose or plasma level and the clinical response.

Adolescent↗
PubMed2005

Energy costs of physical activities in children and adolescents.

PURPOSE: The primary aim was to determine the energy expenditure (EE: kcal.kg(-1).h(-1)) in terms of caloric cost and metabolic equivalents of activities commonly performed by children and adolescents. Secondary aims were to determine at what age and pubertal developmental stage values approach those of adults. METHODS: In this descriptive study, 295 volunteer youth 8-18 yr of age completed 18 common physical activities (including rest) while EE was measured continuously with a portable metabolic system. Three sets of activities were assigned in random order for each subject. Activities ranged from television viewing and video game play to running and rope skipping. Pubertal development was estimated from a self-report questionnaire. RESULTS: At rest, VO(2) and EE were highest in the youngest children and decreased with advancing age and higher pubertal stage in both genders. The age-adjusted and puberty-adjusted energy expenditure values were generally lower than the compendium MET values for sedentary and moderate activities but were more varied for high-intensity activities. However, the ratio of activity EE to REE was comparable in children and adults. CONCLUSIONS: Energy expenditure per kilogram of body mass at rest or during exercise is greater in children than adults and varies with pubertal status, thus using the definition of a MET in the compendium of physical activities without adjustment is inadequate for energy estimation in children, until a child reaches Tanner Stage 5. However, the ratio of activity EE to resting EE in children appears to be similar or slightly less than in the compendium, suggesting that the compendium MET increments used with our adjusted EE values more closely approximate the true EE of activities in children than present adult norms.

Adolescent↗
PubMed2005

Epidemiologic features of the physical and sexual maltreatment of children in the Carolinas.

CONTEXT: Child maltreatment remains a significant public health and social problem in the United States. Incidence data rely on substantiated reports of maltreatment known to official social service agencies. OBJECTIVE: The objective of this study was to describe the epidemiologic features of child physical and sexual abuse, on the basis of maternal self-reports. DESIGN, SETTING, AND PARTICIPANTS: Computer-assisted, anonymous, cross-sectional, telephone surveys (N = 1435) were conducted with mothers of children 0 to 17 years of age in North and South Carolina. Mothers were asked about potentially abusive behaviors used by either themselves or their husbands or partners in the context of other disciplinary practices. They were also asked about their knowledge of any sexual victimization their children might have experienced. MAIN OUTCOME MEASURES: The incidence of physical and sexual maltreatment determined through maternal reports. RESULTS: Use of harsh physical discipline, equivalent to physical abuse, occurred with an incidence of 4.3%. Shaking of very young children as a means of discipline occurred among 2.6% of children <2 years of age. Mothers reported more frequent physical discipline of their children, including shaking, for themselves than for fathers or father figures. Nearly 11 of 1000 children were reported by their mothers as having been sexually victimized within the past year. The incidence of physical abuse determined with maternal self-reports was 40 times greater than that of official child physical abuse reports, and the sexual abuse incidence was 15 times greater. For every 1 child who sustains a serious injury as a result of shaking, an estimated 150 children may be shaken and go undetected. There was no statistically significant difference in the overall rates of physical or sexual maltreatment between the 2 states. CONCLUSIONS: Official statistics underestimate the burden of child maltreatment. Supplemental data obtained with alternative strategies can assist policymakers and planners in addressing needs and services within communities and states. These data support the need for continued interventions to prevent maltreatment.

Adolescent↗
PubMed2004

Perceptions of physicians and patients with organic and functional gastrointestinal diagnoses.

BACKGROUND AND AIMS: We studied patient after-hours telephone calls to gastrointestinal (GI) fellows at a university program to determine requests made, physicians' responses, and perceptions of patients and physicians to these requests. METHODS: During a 4-month period, 4 GI fellows taking call were asked about reasons for patient-initiated after-hours telephone calls, actions taken, and their perceptions about the nature of the request, the illness impact, and their role in the care administered. Patients were telephoned within 1 week and asked the same questions about their perceptions of the call. RESULTS: Patients (N = 102) made 103 telephone calls, averaging 8.7 minutes, for symptoms (56%), procedure-related concerns (19%), and medications (18%). Physicians usually referred the patient to the clinic or emergency room (40%) or provided discussion and reassurance (36%). Patients' perceptions differed from physicians' perceptions: patients believed their problems to be more severe and more disabling and requests were more reasonable than perceived by the physician. Furthermore, their interactions with physicians (physician helpfulness, satisfaction with the recommendation, and likeability of the physician) were more positive than believed by physicians. Physicians believed phone calls from patients with functional disorders were less serious and less reasonable, that these patients were less disabled, and also that these patients were less liked than patients with an organic diagnosis. CONCLUSIONS: In this study, physicians carried a lower perception of the importance of telephone requests, the impact of the disorder, and their perceived helpfulness to patients than did patients making these requests. Physician perceptions were significantly lower for all these factors for patients with functional GI diagnoses. Additional studies are needed to understand the reasons for differing perceptions between physicians and patients.

Adolescent↗
PubMed2004

The world studies of abuse in the family environment (WorldSAFE): a model of a multi-national study of family violence.

The World Studies of Abuse in the Family Environment (WorldSAFE) designed and implemented a study of family violence--intimate partner violence and child abuse and neglect--using standardized methods to cover over 12,000 women in eighteen communities within five lesser-developed countries. The rationale, process and methods for developing the population-based survey are described. Standardized methods included common training of investigators and field staff, sampling strategies, eligibility criteria, instruments, data collection methods, operational definitions, analysis strategies and data management. Special features of the WorldSAFE model are described--namely an ecological conceptual framework, an extensive and broad-based dissemination strategy, and community advisory boards. The World Studies of Abuse in the Family Environment (WorldSAFE) Steering Committee and principal investigators are as follows: Bhopal (India): Gandhi Medical College, S.S. Bhambal (MD) and A.K. Upadhyaya (MD). Chapel Hill (USA): University of North Carolina at Chapel Hill, Shrikant Bangdiwala (PhD); Wanda Hunter (MPH); Desmond K. Runyan (MD, DrPH); and Laura S. Sadowski (MD, MPH). Chennai (India): Chennai Medical College, Saradha Suresh (MD) and Shuba Kumar (PhD). Delhi (India): All India Institute of Medical Sciences, R.M. Pandey (PhD). Ismailia (Egypt): Suez Canal University Faculty of Medicine, Fatma Hassan (MD, PhD). Lucknow (India): King George's Medical College, M.K. Mitra (MD) and R.C. Ahuja (MD). Manila (the Philippines): University of the Philippines School of Medicine, Laurie Ramiro (PhD); M. Lourdes Amarillo (MS); Bernadette Madrid (MD). Nagpur (India): Government Medical College, Dipty Jain (MD). São Paulo (Brazil): Escola Paulista de Medicina, Isabel Bordin (MD) and Christine Silvestre De Paula. Temuco (Chile): Universidad de La Frontera, Sergio R. Muñoz (PhD) and Beatriz Vizcarra. Thiruvananthapuram (India) formerly Trivandrum: Government Medical College, M.K.C. Nair (MD) and Rajamohanan Pillai (MD). Vellore (India): Christian Medical College, L. Jeyaseelan (PhD) and Abraham Peedicayil (MD).

Brazil↗
PubMed2004

Intimate partner violence and the role of socioeconomic indicators in WorldSAFE communities in Chile, Egypt, India and the Philippines.

BACKGROUND: The literature documenting the influence of socioeconomic status (SES) on health and injury does not provide a clear consensus on how to account for socioeconomic indicators in population and health outcome studies across countries. The World Studies of Abuse in the Family Environment (WorldSAFE) consortium conducted a series of population-based, multi-stage probability sampling cross-sectional surveys in selected communities in five countries from 1997 to 2003 that allows for the examination of the relationship of SES with current physical and psychological intimate partner violence (IPV). METHODS: Women aged 15-49 years (n = 3975) from six urban low- and middle-income communities participating the the WorldSAFE consortium were interviewed. Using a standardized instrument, the following SES indicators were collected: dwelling ownership, land ownership, number of rooms in the house along with number of residents, toilet facilities, ownership of 13 specific individual/household items, current work status of the woman and her husband/partner, and years of formal schooling completed by the woman and her husband/partner. A family asset index was constructed using principal coordinate analysis. The outcome variables utilized in this manuscript were current (past 12 months) physical IPV, and current psychological IPV. Basic bivariate associations between the categorical predictors and outcome variables were followed by a multiple logistic regression analysis to investigate the effect of covariates on the study outcomes. RESULTS: The were considerable variability among the six sampled communities with respect to the relationship between socioeconomic indicators and current physical and psychological IPV. In general, the employment status of the woman was related to her experience of intimate partner violence, and her educational level and family's assets index were protective factors. When considered in multiple logistic regression models, the asset index was the only indicator that was consistently significant across communities. CONCLUSION: The derived asset index as an SES indicator was found to be associated with current psychological and physical IPV against women across the sampled six communities in four countries.

Adolescent↗
PubMed2004

Physical intimate partner violence in Chile, Egypt, India and the Philippines.

BACKGROUND: Violence against women is recognized by globally as a serious health and social problem that impedes development. OBJECTIVES: To determine the magnitude of physical intimate partner violence against women in six selected communities from Chile, Egypt, India and the Philippines. DESIGN: Population-based household surveys. SETTINGS: Selected urban communities in Temuco, Chile; Ismailia, Egypt; Lucknow, Trivandrum, and Vellore non-slum areas of India; and in Manila, the Philippines. PARTICIPANTS: Women aged 15-49 years who cared for at least one child younger than 18 years old. The number of participants per community was 442 (Santa Rosa, Chile), 631 (El-Sheik Zayed, Egypt), 506 (Lucknow, India), 700 (Trivandrum, India), 716 (Vellore, India) and 1000 (Paco, the Philippines). MAIN OUTCOME MEASURES: Lifetime and Current physical intimate partner violence (IPV) was measured using standard definitions and four behaviors of actions--namely slap, hit, kick and beat. Three derived variables for severity included: disabling IPV, IPV-related injury requiring health care and multiple severe IPV (presence of hit and kick and beat). RESULTS: Percentages of lifetime and current physical intimate partner violence (IPV) against women in our sample of 3975 were as follows: 24.9 and 3.6 (Santa Rosa), 11.1 and 10.5 (El-Sheik Zayed), 34.6 and 25.3 (Lucknow), 43.1 and 19.6 (Trivandrum) 31.0 and 16.2 (Vellore), and 21.2 and 6.2 (Paco). Multiple severe physical IPV was more common in the three communities within India (9.0%, 5.9% and 8.0% in Trivandrum, Lucknow and Vellore) than the other three communities (Santa Rosa 2.1%; El-Sheik Zayed 2.9% and Paco 1.9%). CONCLUSIONS: Physical IPV was found to be a common phenomenon in all six communities. Overall, patterns of IPV behaviors were similar among the six communities.

Adolescent↗
PubMed2004

Changing profiles of injecting drug users with AIDS in a Hispanic population.

AIMS: To describe and assess the changing trends in socio-demographic, risk, clinical and immunological parameters in male intravenous drug users (IDU) with AIDS. DESIGN, SETTING AND PARTICIPANTS: Baseline description by year of entry of 610 male IDU with AIDS who entered into a cohort study in Bayamón, Puerto Rico, from 1992 to 2000. Study participants were evaluated at in-patient health-care facilities in the University Hospital Ramón Ruiz Arnau or in the ambulatory immunology clinic facilities. FINDINGS: The median age at which subjects entered the study and the proportion of patients with an educational level lower than a high school degree increased from 1992 to 2000. Upward trends were also observed in the practice of injecting non-prescription drugs during the last 12-month period, the practice of needle sharing and the use of a combination of heroin and cocaine ('speedballs'). Higher proportions of subjects were also diagnosed with wasting syndrome and bacterial pneumonia. The median CD4 count recorded at entry decreased over the course of the study. CONCLUSIONS: Puerto Rican male IDU diagnosed with AIDS are arriving at health-care facilities in the latest stages of the disease. Better and early interventions with different health care approaches need to be developed.

Acquired Immunodeficiency Syndrome↗