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Query: UMLS:C0021051 (immunodeficiency)
 71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Some nurses are reluctant to care for human immunodeficiency virus (HIV)-infected clients because of fear of contagion and discomfort in caring for people with alternate life-styles. Various federal, state, and local antidiscrimination statutes limit the right of the nurse to refuse to care for people with acquired immunodeficiency syndrome (AIDS) or HIV infection. Other constraints are employment contracts, ethical codes of professional organizations, and regulations of state licensing boards. Nurses have rights as well as responsibilities in caring for AIDS or HIV-infected patients. They also have a professional responsibility to institute measures that minimize the need for litigation and ensure access to health care for everyone.
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PMID:Acquired immunodeficiency syndrome: the nurse's legal duty to serve. 183 93

This study investigates patients' concern about the human immunodeficiency virus transmission from their physician during the course of routine medical care. We examined patients' fear of acquired immunodeficiency syndrome (AIDS), knowledge of human immunodeficiency virus transmission, level of comfort with medical procedures performed by a physician suspected of having AIDS, perceived risk of AIDS transmission in physician-patient interactions, and the desire to be informed of the human immunodeficiency virus status of physicians. Three hundred fifty patients attending a university-based outpatient center in a large midwestern city were surveyed. Findings show that, as fear of AIDS increases, so does reported level of discomfort with procedures conducted by a physician suspected of having AIDS. Fear of AIDS was inversely correlated with knowledge. Patient concerns regarding susceptibility to the human immunodeficiency virus infection in routine care call attention to the need for education about transmission of AIDS in the health care context.
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PMID:Patients' fear of contracting the acquired immunodeficiency syndrome from physicians. 236 47

Sexually active adolescents should use condoms to prevent the transmission of sexually transmitted diseases, including human immunodeficiency virus. This study examined, among male and female adolescents, which beliefs about condoms are associated with intentions to use them if they have coitus in the next year. Teenagers attending adolescent health clinics completed self-administered surveys. Although most adolescents knew that condoms prevent sexually transmitted diseases, an increasing belief in the preventive effects of condoms was not associated with an increased motivation to use them. Instead, other immediate, short-term consequences, such as the ease with which they can be used and discomfort associated with their use, were most strongly associated with adolescents' intentions to use condoms. To encourage condom use, messages from physicians and other health care professionals must focus on adolescents' beliefs that are most likely to encourage or inhibit use of condoms. Health considerations should not be the sole emphasis of such communications if the goal is to increase the use of condoms among sexually active adolescents.
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PMID:Adolescents and condoms. Associations of beliefs with intentions to use. 275 65

The degree and depth to which primary care physicians counsel patients at risk for human immunodeficiency virus (HIV) infection is a major concern. To determine which factors influence whether physicians counsel patients at risk for HIV, primary care physicians's clinical experience, knowledge, attitudes, and preventive counseling advice in hypothetical case scenarios were assessed. Ninety-nine adult primary care physicians in the Washington, D.C., metropolitan area were interviewed by telephone from May through November 1987. Ninety-one physicians had tested or referred patients for HIV antibody tests. However, 58% could not name the ELISA or Western blot as the tests. The most frequent HIV prevention recommendations were using condoms (67.7%), abstaining from sexual activity (36.4%), getting tested for HIV (30.3%), and safe sex (23.2%). Naming the HIV antibody tests was the most significant predictor of preventive counseling advice; other significant predictors included physicians' personal comfort with counseling homosexual patients and various physician practice and demographic characteristics. Previous studies showed that homophobia was the main inhibitor of effective AIDS counseling. These results suggest that physicians' lack of knowledge and general discomfort in counseling patients about sexual risk factors, rather than homophobia alone, are important barriers to preventive counseling about HIV infection.
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PMID:Primary care physicians' assessment and prevention of HIV infection. 276 88

A 42-year-old patient with hemophilia A developed acute left hypochondrial pain 8 days postnephrolithotomy. A colloidal scan indicated multiple hematomas, and conservative management was given. Postoperatively, recurrent discomfort necessitated splenectomy. Multiple space-occupying lesions were found, and the histology was that of a large, noncleaved lymphoma. Contiguous spread outside of the capsule was evident, but abdominal nodes and liver appeared normal. Chemotherapy was administered, with evidence of tumor response, but refractoriness supervened, and the patient died 4 months after the diagnosis. Space-occupying lesions in a hemophiliac are generally ascribed to hematomas. The exposure of this population to the human immunodeficiency virus (HIV) should raise the consideration of a non-Hodgkin lymphoma in any situation where rapid clinical resolution of a hematoma is not occurring.
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PMID:Intrasplenic lymphoma resembling multiple hematomas in a hemophiliac. 340 37

As part of a statewide survey of experiences related to the acquired immunodeficiency syndrome and competencies of a random sample of primary care physicians in California done in early 1986, we interviewed 1,000 internists, family and general practitioners about their sexual history-taking and counseling practices. Less than 4% have patients complete a history form that includes questions about sexual orientation or practices, and only 10% ask new patients questions specific enough to identify those at high risk of exposure to the human immunodeficiency virus. Internists, women and younger physicians and those expressing little discomfort in dealing with gay men more often took adequate sexual histories and gave appropriate advice. Among those physicians with patients at risk of becoming infected, only half recommended the use of condoms and 60% advised a reduction in the number of partners. More than 15% recommended abstention from sexual intercourse, and 8% suggested these patients should switch to a heterosexual life-style.
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PMID:The sexual history-taking and counseling practices of primary care physicians. 366 Jul 73

More than a decade has passed since the human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS) epidemic began; our failure to develop an effective vaccine and adequate medical treatments indicates that future research and practice must work to prevent the spread of HIV. We review the literature on the current HIV-prevention practices of primary care physicians and highlight opportunities for clinical prevention. Prevention is hindered in four ways: 1) by narrow conceptions of medical care and of the role of the physician; 2) by physicians' discomfort with discussing human sexuality and illicit drug use and their attitudes toward persons with HIV or AIDS; 3) by constraints on time and resources; and 4) by the ambiguity of HIV prevention messages. We suggest strategies to overcome these barriers, including modifications in public policy, health care delivery systems, and medical education. These strategies support a nonhierarchical physician-patient relationship, with attention to culture and values, that will help physicians to identify and work with persons at increased risk for HIV infection.
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PMID:Prevention of HIV infection in primary care: current practices, future possibilities. 757 27

Cholic acid (sodium cholate) exhibits a strong spermicidal and antiviral [anti-human immunodeficiency virus (HIV)-1] activity. The same effects are observed for F-5 Gel, the active mixture of a new contraceptive sponge (Protectaid), which contains sodium cholate together with low concentrations (0.5%) of nonoxynol-9 and benzalkonium chloride. Both cholic acid and the F-5 Gel exerted a dose-dependent, in-vitro inhibitory effect 1) on the activity of HIV-1 associated reverse transcriptase in an acellular system (their 50% inhibitory dose was 7.2 mM and 0.8 x 10 -3 v/v, respectively, and 2) on the potential of HIV-1 to infect human lymphocytes efficiently. In the 3 semen samples examined, sperm motility was instantaneously inhibited by the addition of a 6 mM solution of sodium cholate or of a 1:10 dilution of F-5 Gel. Both cholic acid and F-5 Gel affected in a dose-dependent manner the viability of normal peripheral blood lymphocytes (NPBL) and CEM cells. The Protectaid contraceptive sponge impregnated with F-5 Gel was given to 20 young women aged 19-25 years for a period of 1 year who had chosen this method for both contraception and against sexually transmitted diseases. All women were instructed to insert the sponge within the 12 hours preceding each sexual intercourse and to remove it 4-6 hours afterwards. During 12 months of use with at least 3 intercourse per week, the contraceptive efficacy of the Protectaid vaginal sponge was 100%. Cervical cultures at 6-month intervals showed the presence of Mycoplasma hominis and Candida albicans in 1 and 2 cases, respectively. The combined spermicidal and anti-HIV properties of cholic acid reported and used in the Protectaid sponge offer a new and modern protective method of contraception. At the end of the study, cervical cultures revealed the presence of Escherichia coli and Candida albicans in 1 case each. No slide effects were recorded, and only 1 woman complained of discomfort.
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PMID:Spermicidal and antiviral properties of cholic acid: contraceptive efficacy of a new vaginal sponge (Protectaid) containing sodium cholate. 768 80

Our objective was to evaluate human immunodeficiency virus (HIV) risk-factor assessment and counseling behavior in 86 medical house staff and to ascertain the effect of question format (closed versus open) on reported physician behaviors. We designed a cross-sectional survey using a self-report questionnaire; we received 78 returns of 86 questionnaires (91% response) from one-year and three-year medical housestaff at two general medical clinics in a university-affiliated Bronx municipal hospital. House staff reported assessing sexual behavior (51%) and intravenous drug use (81%) in new patients significantly less often than they assessed smoking (95%) or alcohol use (94%). Counseling to reduce the risk of HIV transmission among all patients occurred even less frequently (41%, all P < .05). Question format (closed versus open) significantly affected response rate; respondents to closed-format questions reported far more behaviors performed. Intravenous drug users (IVDUs) received more frequent advice than general clinic patients about reducing HIV transmission (85% versus 41%), but house staff may ignore sexual risks in IVDUs. Resident confidence that IVDUs would change sexual or drug risk behavior was equally low, 1.5 on a 4-point scale. They reported greater discomfort discussing sexuality than drug use (2.4 versus 1.7; 4-point scale, P = .003). Discomfort discussing sexuality inversely associated with sexual history-taking in multi-variate analysis. Greater involvement with HIV positive patients and fewer perceived barriers to counseling were also associated with more assessment or counseling about risks for HIV transmission. These results suggest that enhancing house staff assessment and counseling efforts to reduce risks for HIV transmission requires interventions that foster involvement with HIV positive patients, emphasize the importance of sexual transmission in IVDUs, facilitate competence in discussing sexual behavior, and address provider belief that IVDUs will not change risk behaviors. Results also demonstrate a significant effect of question format on reported physician behavior.
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PMID:Preventing HIV transmission: behavior and attitudes of medical house staff in a high-prevalence area. 825 20

Interest in umbilical cord blood as an alternate source of hematopoietic stem cells is growing rapidly. Umbilical cord blood offers the clinician a source of hematopoietic stem cells that is rarely contaminated by latent viruses and is readily available. Moreover, the collection of umbilical cord blood poses no risk to the donor; there is no need for general anesthesia or blood replacement, and the procedure causes no discomfort. Whether cord blood lymphocytes are as likely to cause GVHD as lymphocytes from older individuals is unknown. Current clinical experience would suggest that the incidence may be low. Few of the patients transplanted with umbilical cord blood thus far have developed clinically significant GVHD, including recipients of HLA-disparate grafts. These results and associated laboratory findings pose intriguing possibilities for the future of umbilical cord blood stem cells in the setting of unrelated transplantation. With the marked incidence of grade 2-4 acute GVHD that is currently observed after unrelated bone marrow transplantation, a reduction in incidence or severity would be a major advancement in this field. In the setting of autologous trans-plantation, there are other intriguing possibilities; for example, cord blood may be an optimal source of pluripotential stem cells for gene therapy. The large-scale collection and storage of cord blood stem cells has become a reality. Pilot programs for the banking of unrelated umbilical cord blood have already begun in the United States and Europe. Not only is there the potential for reducing the time from search initiation to the time of donor stem cell acquisition but also there is the potential for reducing the risks associated with unrelated bone marrow transplantation. There is also the hope of remedying the shortage of donors from ethnic and racial backgrounds that are currently underrepresented in most unrelated donor programs. Even with the creation of such banks, it should not be forgotten that the collection of umbilical cord bloods should at least be considered when a child with leukemia, lymphoma, neuroblastoma, marrow failure syndrome, immunodeficiency state, or inborn error of metabolism has a mother who is pregnant. The clinical results to date in small recipients would suggest that it is at least as good as bone marrow; but additional patients and more time will be needed to finalize this conclusion.
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PMID:Allogeneic umbilical cord blood transplantation. 907 4


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