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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Research and development in contraception has only limited interest in women over 35 years old, so we know little about safety, side effects, and effectiveness of contraceptives in this age group. In addition, clinical trials use healthy women which further limits our knowledge about contraceptives in women who have cardiovascular problems, diabetes, and liver conditions. Research does indicate, however, that women with high blood pressure should not take oral contraceptives (OCs) after the age of 35. It also shows that healthy and nonobese women over 35 who do not smoke and have no family history of cardiovascular disease before age 45 can take OCs with 30 mcg of ethinyl estradiol. Practitioners should provide these women with balanced and up-to-date information on the link between OCs and breast cancer and their apparent protective effect against endometrial cancer. The pregnancy rate for 35-39 year old married women using the diaphragm for at least 5 months stands at 1.1/100 women years. Contrary to popular belief, barrier methods can be harmful, e.g., urinary tract infections are more frequent in women who use the diaphragm than in those who do not. Women older than 35 should consider the condom because of its ability to reduce the risk of acquiring HIV or sexually transmitted diseases. Considerable research exists on women over 35 who use copper releasing IUDs. These IUDs are safe in women who do not have heavy menstrual bleeding. The levonorgestrel releasing IUDs are well tolerated in women over 35 since they reduce the amount and duration of menstrual bleeding. Besides users of these IUDs are less likely to have pelvic inflammatory disease and endometritis than those using copper releasing IUDs. Older women in developing countries often undergo hysterectomy for contraceptive purposes and because of heavy bleeding. Tubal ligation is a significant family planning method for older women in developing countries.
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PMID:Contraception after thirty-five. 131 37

Progestins counteract the positive effect of the estrogen component in oral contraceptives (OCs) on cholesterol levels thus increasing the risk of atherosclerosis. Low androgenic potency progestins do not have a negative effect, however. Other research indicates that the lower the estrogen dose in OCs the lower the risk of deep vein and superficial thrombosis. OC users, especially low dose OC users, with no other risk factors (e.g. smoking and hypertension) are not at increased risk of cardiovascular disease. Some research demonstrates elevated risk of stroke in OC users, however. Elevated cholesterol, obesity, diabetes and other factors further increases the risk of stroke. Combined OCs protect against endometrial and ovarian cancer and this effect increases with use and continues after use. Moreover OC users are not at increased risk of pituitary adenoma. Results of some studies shows an increased risk of cervical cancer, but other only demonstrates a slight increase. So far research does not indicate the following to increase breast cancer risk among OC users: early age at 1st OC use, formulation, family history, and history of benign breast disease. There is an increased risk for liver tumors in OC users, nevertheless it is rare. OCs do not raise the risk of diabetes or gallbladder disease. High dose formulations increases the risk of high blood pressure, but not so with low dose formulations. OC use does not impair, fertility, but delayed conception often occurs. Most research demonstrates no increase in pelvic inflammatory disease in OC users. OCs do not cause congenital malformations. Combined OC use is contraindicated for breast feeding mothers, but progestin only OCs can be used with no advance effects. Results of 1 study demonstrates an increase in HIV infection in OC users, but another study has opposite results. The article concludes with recommended clinical management practices.
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PMID:Reassessment of the metabolic effects of oral contraceptives. 185 68

The facilitator is a new profession developed first in Oxfordshire in 1982 for the purpose of promoting prevention in primary health care. There are at present more than 100 facilitators in Britain and some in Holland, most of them working on prevention of cardiovascular disease, but recently some also in connection with the HIV-epidemic. In brief, the task of the facilitator is to bridge the gap or establish a new channel of communication between the general practitioner and his coworkers on the one side and the specialized health service on the other. The paper describes the tasks and working methods of the facilitator in some detail, particularly with respect to prevention of HIV-infection and control and care of HIV-positive and AIDS-sick patients in general practice. A trial project involving facilitators is planned in Oslo.
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PMID:[The health consultant. A new profession]. 232 Dec 35

1. The American College of Cardiology acknowledges the continuum of changing societal, medical and economic perspectives affecting traditional medical ethics. Primacy of patient responsibility remains paramount to the cardiovascular specialist who at the same time should participate in the development of broader societal programs. 2. Medical decisions should be freely and jointly formulated by the patient and the cardiovascular specialist with appropriate sensitivity to such matters as mental competence, pertinent medical information and standards of care, sufficient time for contemplation, informed consent, patient right of refusal, physician right to refuse to provide inappropriate care and the right of patient, physician or third party payer to seek consultation or additional opinions. 3. The cardiovascular specialist should make a special effort to clarify and document patient preferences regarding end-of-life treatment through some form of advance directive. 4. The cardiovascular specialist bears a moral obligation to provide medical care to any patient who is HIV positive or has AIDS. 5. A conflict of interest occurs when a cardiovascular specialist places personal or financial interest ahead of the welfare and health of a patient. Professional accountability should be established through local or regional peer review. 6. The American College of Cardiology encourages and supports a renewed dedication to the principles of medical ethics, particularly in the field of cardiovascular disease. Cardiovascular specialists are encouraged to participate in the promulgation of medical ethics by teaching and by example, individually and with others.
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PMID:Ethics in cardiovascular medicine. Task Force II: The relation of cardiovascular specialists to patients, other physicians and physician-owned organizations. 235 84

Heart disease and stroke have been the first and third leading causes of death, respectively, in the United States for many years, and the importance of primary and secondary prevention in reducing morbidity and mortality from these two disease entities has been well established. Additional confirmatory information continues to accumulate, but it is accepted that hypertension, smoking, and serum lipids are important risk factors in coronary heart disease and stroke. Although this discussion deals primarily with cardiovascular disease, many of the issues related to prevention and medical education are generic and are equally relevant to the prevention of other diseases, including HIV infection. Moreover, the way in which medical education approaches preventive cardiology is likely to be similar to the way in which prevention issues are approached in general.
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PMID:Perspectives on prevention and medical education for the 1990s. 238 7

The Office of Minority Health (OMH) was established in December 1985 in response to recommendations developed by the Secretary's Task Force on Black and Minority Health. Originally, OMH's mission emphasized six health problems identified by the Task Force as priority areas: cancer, cardiovascular disease and stroke; chemical dependency; diabetes; homicide, suicide, and unintentional injuries; and infant mortality and low birth weight. OMH added HIV infection to the six health priority areas after epidemiologic data showed that the representation of blacks and Hispanics was disproportionately high among persons reported with AIDS. Strategies to eliminate or reduce high-risk behaviors associated with HIV infection need to mobilize racial and ethnic minority communities and rebuild social networks in order to foster sustained behavioral changes. OMH created the Minority HIV Education/Prevention Grant Program to demonstrate the effectiveness of strategies to expand the activities of minority community-based and national organizations involved in HIV education and prevention, as well as to encourage innovative approaches to address appropriately the diversities within and among minority populations. In 1988, grants totaling $1.4 million were awarded to four national and 23 community-based minority organizations. Project workers conduct information, education, and prevention interventions directed to specific groups within racial and ethnic minority communities. Interventions include education and prevention training, information activities, developing educational materials, and providing technical assistance. Project innovations include conducting HIV education and prevention training for families at home, presenting a play produced and performed by local teenagers, and developing a workshop and a manual to help minority service organizations to recruit and train volunteer staff members. Working with minority community-based and national organizations is an essential component of effective strategies for preventing HIV infection among racial and ethnic minorities. OMH's Minority HIV Education/Prevention Grant Program encourages minority groups to participate as partners in Federal, State, and local HIV prevention efforts.
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PMID:PHS grants for minority group HIV infection education and prevention efforts. 251 87

Palliative care arose out of the change from acute to chronic causes of death and the emphasis of health care on improving quality of life. In the United Kingdom, specialist palliative care is provided mainly for cancer patients through hospices and support teams, which have grown rapidly in the last 30 years. Single sites and more recently several units have demonstrated their effectiveness, acceptability and efficiency. However, the majority of people who die will not receive these services but will receive much of their care in hospital, nursing home and community settings. The growing numbers of people who are likely to die from HIV/AIDS and the growing numbers of older people make it important that palliative care becomes more integrated with hospital, community and general practitioner services. Palliative care should become a gradually increasing part of care from diagnosis to death, rather than being concerned only with the terminal phase. A palliative care component and appropriate standards could be included in the needs assessment and the contracts for many hospital and community services. In research on new treatments, particularly for cancer and HIV/AIDS, palliative aspects should be measured along with survival and the usually fairly basic estimates of quality of life. Hospices, and in particular support teams and day care, require further evaluation if they are to extend their role to providing care for the younger people with HIV/AIDS and the older people who are dying from chronic diseases such as cardiovascular disease.
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PMID:Palliative care: a review of past changes and future trends. 768 24

Human immunodeficiency virus is known to enter the host at parenteral and mucosal sites and consequently an effective vaccine should stimulate immunity at both routes of entry. One approach toward stimulating HIV-specific mucosal and systemic immunity is the use of candidate live oral Salmonella typhi vector vaccine, strain CVD 908, which has been shown to stimulate mucosal and systemic immunity in volunteers. Using recombinant DNA techniques we constructed an expression cassette which comprises the lpp promoter (Plpp) and sequences encoding recombinant gp120 (rgp120). When the Plpp-rgp120 expression cassette is integrated into the chromosome of CVD 908 in the delta aroC allele, high levels of recombinant gp120 expression are observed. It is likely that effective immunity against HIV in humans will require immunization with multiple HIV antigens. Hence, a second expression cassette encoding two additional HIV antigens with vaccine potential, p24 (a HIV-1 gag gene product) and Nef (a putative regulator of HIV-1 gene expression) has been constructed. We plan to integrate the p24-Nef-encoding expression cassette into the aroD locus in the chromosome of CVD 908 delta aroC::rgp120 in a stable manner to produce a CVD 908-HIV vector vaccine that expresses multiple HIV antigens.
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PMID:Expression of human immunodeficiency virus antigens in an attenuated Salmonella typhi vector vaccine. 795 70

A self-administered, confidential survey of respondents' history of selected sexually transmitted disease (STD) was conducted in 1987-88 among adults enrolled in a multicenter study of cardiovascular disease. Respondents (and response rates) included 535 white men (78 percent), 694 white women (89 percent), 262 black men (48 percent), and 472 black women (64 percent), ages 21 to 40 years at the time of the survey. Among those who were heterosexually active, 43 percent of black women, 37 percent of black men, 33 percent of white women, and 21 percent of white men reported ever having had at least one STD in the survey. A history of syphilis or gonorrhea was more commonly reported by blacks than whites; a history of genital herpes, chlamydia, or genital warts was more commonly reported by women than men. Independent risk factors for having had at least one STD in the survey included female sex; use of cocaine, amphetamines, or opiates; and lifetime number of sex partners. The number of sex partners was the most predictive risk factor. Black race was a significant marker for other, unidentified STD risk factors. The data show a high prevalence of a lifetime history of STD among young heterosexual urban U.S. adults with possible implications for the future spread of human immunodeficiency virus infection.
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PMID:Sexually transmitted diseases among young heterosexual urban adults. 826 51

Reduced, oxidized and protein-bound forms of homocysteine (Hcy), cysteine and cysteinylglycine in plasma interact via redox and disulphide exchange reactions, and these aminothiol species comprise a dynamic system referred to as redox thiol status. Notably, in plasma reduced cysteine is the most abundant low molecular weight sulfhydryl compound. Elevation of plasma Hcy (hyperhomocysteinemia) causes changes in redox thiol status. Protein-bound Hcy increases up to a maximum capacity of about 140 micromol/L, and there is a concurrent displacement of protein-bound cysteine. When the Hcy binding approaches saturation, free oxidized and reduced Hcy show a substantial increase. The resulting increase in reduced/total ratio for Hcy causes a parallel change in this ratio for the other aminothiols. These dynamics were observed during both chronic hyperhomocysteinemia (due to cobalamin deficiency or homocystinuria) and acute hyperhomocysteinemia (induced by methionine or Hcy loading). In addition, changes in redox thiol status have been observed in patients with vascular disease (decreased reduced/total ratio for cysteine), renal failure (low reduced/total ratio for aminothiols) or HIV infection (high level of reduced Hcy), which suggest primary imbalance between prooxidant and antioxidant processes in these patients. In conclusion, redox thiol status is a dynamic system which is probably linked to the extracellular antioxidant defence system. This must be taken into account when designing future experimental or epidemiological studies on Hcy and cardiovascular disease.
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PMID:Reduced, oxidized and protein-bound forms of homocysteine and other aminothiols in plasma comprise the redox thiol status--a possible element of the extracellular antioxidant defense system. 864 71


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