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 2,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The underlying purpose of all epidemiological research is ultimately to use inferences in order to prevent disease and promote health and well-being. Effective skills in translating results into appropriate policy, programs, and interventions are inherently tricky, and often politically controversial. Generally they are not taught to epidemiologists formally, even though they are a traditionally part of public health practice. To move from findings to policy change requires that the informed and committed epidemiologist should known how to: (1) organize affected parties to negotiate successfully with government and industry; (2) activate populations at risk to protect their health (3) communicate responsibly with lay persons about their health risks so as to encourage effective activism; (4) collaborate with other professionals to achieve disease prevention and health promotion goals. The paper presents and discusses four case studies to illustrate these strategies: (1) the grass-roots social action that was the response of the community to the environmental contamination at Love Canal, New York; (2) mobilization of recognized leaders within the gay community to disseminate HIV risk reduction techniques; (3) collaboration with an existing voluntary organization interested in community empowerment through health promotion in a Chicago slum by using existing hospital, emergency room admissions, and local motor vehicle accident data; (4) a self-help group, MADD (mothers against drunk driving) which fought to change public policy to limit and decrease drunk driving. In addition, the importance of multidisciplinary collaboration and responsible communication with the public is emphasized. Factors that limit the ability of the epidemiologist to move into public health action are discussed, including who owns the research findings, what is the degree of scientific uncertainty, and the cost-benefit balance of taking affirmative public action. Putting epidemiological knowledge to good use should be an integral part of an epidemiologist's repertoire.
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PMID:After epidemiological research: what next? Community action for health promotion. 770 45

We have recorded 8 patients presenting a Hodgkin's disease associated with Castleman's disease. Four men and 4 women with a 44 years mean age (15-60), presented as a solitary mass (2/7) or as a multicentric tumoral disease (5/7). One of our patients was HIV. Histological studies showed typical features of Castleman's disease. Nodular sclerosing Hodgkin's disease with numerous lacunar cells were present in 3 cases, interfollicular Hodgkin's disease in 4 cases and nodular paragranuloma in one case. Hodgkins' and Reed Sternberg cells were positive for CD15 (4/7), CD30 (5/7), EMA (3/6) and LMP-1 (4/5). In situ hybridization on tissue sections demonstrate presence of EBV DNA in one case and EBER1-RNA in 2 of 4 cases. The difficulty in making the diagnosis of Hodgkin's disease the relation between both diseases, and the role of IL-6 are discussed.
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PMID:[Association of Castleman's disease and Hodgkin's disease. Eight cases and review of the literature]. 785 13

This study reports the findings of a case study of the health services planning council established in the Oakland, California, eligible metropolitan area (the Oakland EMA) under Title I of the Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (the CARE Act). We gathered primary data through observation of planning council meetings, examination of documentary evidence, and in-depth interviews with key participants. An important finding of this study was the inconsistency observed between the rational, linear planning model embedded in the CARE Act legislation and the politicized, emergent, and, at times, chaotic planning process actually observed in the Oakland EMA. The primary reasons for this inconsistency included confusion among council members about the planning council's responsibilities and authority, as well as its relationship with the local health department; limitations on administrative support at the local level; reluctance of program administrators at the federal level to provide advice concerning development of the council; allegations of conflict of interest among members of the council; pre-existing societal tensions and divisions; concerns about the representativeness of the council's membership; competition among providers of services for funding; conflicting demands for services by persons affected by HIV disease; disagreements between the council and providers of services over policies and procedures for administering the services contracts; and concerns about the council's involvement in the selection of specific agencies for funding, its lapses in compliance with rules of order, and its failure to accurately record minutes of all of its meetings. Despite the challenges faced by the Oakland planning council, it was able to meet its Title I obligations, which resulted in significant increases in the availability of medical and social services for persons affected by HIV disease. However, dealing with the confusion and conflicts described above consumed a considerable amount of the planning council's time and energy and eventually required a complete reorganization of the council to assure its stability and the legitimacy of the Title I program at the local level. Medical Subject Headings (MeSH): health planning councils; health planning organizations; health care coalitions; organization and administration; organizational innovation; models, organizational.
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PMID:Challenges faced by the HIV health services planning council in Oakland, California, 1991-1994. 887 1

A study commissioned by the Philadelphia EMA HIV Commission shows that many people have a poor understanding about HIV transmission and treatment. The survey of 1,069 people found that lack of knowledge of HIV was greater among African-Americans and Latinos, who were also less likely to know their CD4 counts or viral load, and who were less likely to use combination treatments. Many HIV-positive people do not comprehend the need to start medical treatment early. The commission advises the Philadelphia Health Department to disperse more HIV treatment information among communities of color.
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PMID:Study finds poor knowledge about HIV. 1136 36

A recent study conducted by the Philadelphia EMA Commission, an advisory board to the Philadelphia Health Department, shows that personal lack of knowledge about HIV/AIDS may prevent individuals, particularly people of color, from seeking treatment. One third of the respondents did not feel they needed to be seen by a doctor, 10 percent did not know their T-cell counts, and 33 percent did not know their viral load. Only 56 percent of African Americans and Latinos take protease inhibitors compared with 71 percent of Caucasians. The statistics confirm that lack of information is a barrier to effective treatment and significantly affects many HIV-positive individuals.
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PMID:Many HIV+ people don't understand their disease or treatment options. National Minority AIDS Council. 1136 82

Plasmablastic lymphoma is a relatively new entity that is considered to be a diffuse large B-cell lymphoma with an unique immunophenotype and a predilection for the oral cavity. We present a 50 year-old HIV-positive, bisexual, white male with a CD4 count 300/mm(3) and a viral HIV-RNA polymerase chain reaction (PCR) load of 237 copies/ml, who developed a painful, purple-red mass in the edentulous area of the maxillary right first molar. Erythematous gingival enlargements of the interdental papillae were seen in three of the dental quadrants. In addition, the patient was being managed with antiretroviral therapy and liposomal doxorubicin for recurrent cutaneous Kaposi's sarcoma (KS). Although oral KS was suspected, the gingival lesions were biopsied because they were refractory to chemotherapy and a lymphoma could not be excluded. Histopathologic examination revealed a lymphoid malignant neoplasm, consistent with a plasmablastic lymphoma. Immunoreactivity with vs38c, CD79a, kappa light chain, and IgG was readily identified in tumor cells; while only focal cells expressed CD20 and LCA (CD45RB). CD56, CD3, lambda light chain, and EMA were non-reactive. EBV was detected in the tumor by Southern hybridization, PCR amplification, in situ hybridization for EBER-1 DNA, and immunohistochemistry for latent membrane protein-1. The same tumor was negative for HHV-8 by PCR. Recognition of plasmablastic lymphoma is important, because it represents an HIV-associated malignancy that predominantly involves the oral cavity, may mimic KS and has a poor prognosis.
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PMID:Plasmablastic lymphoma: an HIV-associated entity with primary oral manifestations. 1175 27

Neoplasms of unknown origin present a difficult diagnostic dilemma, particularly if they are very poorly differentiated. Adenocarcinomas, squamous cell carcinomas, melanomas, lymphomas, and sarcomas can all be very difficult to diagnose if the light microscopic cytomorphology is sufficiently undifferentiated. Electron microscopy (EM) can either demonstrate differentiation or narrow the range of differential diagnoses. The authors report the case of a 64-year-old male who has been HIV positive for several years and was found to have expansile lytic lesions in several ribs and a thumb fracture associated with a soft tissue mass which was biopsied. The tumor was composed of very pleomorphic malignant cells without specific differentiation. The malignant cells stained positive for pancytokeratin (AE 1/3), EMA, CEA, CK20, and CK7. Rare cells had mucicarmine-positive intracytoplasmic droplets. They were negative for S-100, calretinin, CD45, MART-1, and vimentin. EM revealed intracytoplasmic lumina with long microvilli and many well-formed desmosomal junctions. The diagnosis was initially very broad. Immunohistochemistry narrowed the diagnosis to carcinoma, but EM alone was able to narrow the diagnosis to poorly differentiated adenocarcinoma. In a neoplasm of unknown origin, EM can either narrow the differential significantly or, in the case of limited material, provide information that otherwise may not be attainable.
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PMID:Desmosomes and microvilli mean a lot: diagnosis of neoplasms of unknown origin using electron microscopy. 1277 6

Plasmablastic lymphoma (PBL) is a rare and relatively new entity originally described in HIV-infected individuals. This subset of Epstein-Barr-virus (EBV)-related non-Hodgkin lymphomas is now regarded as a distinct clinicopathological category of AIDS-associated lymphomas occurring preferentially in the oral cavity and showing a poor prognosis. We describe for the first time an EBV-associated PBL with an isolated cutaneous distribution on the lower extremities in an HIV-infected heterosexual male and point to the unique clinical, morphological and immunophenotypic characteristics of this lymphoma. The patient presented with fast growing solid and livid nodules on both legs. The large, blastic tumor cells showed the following immunophenotype: CD138+, CD45+, CD20-, CD10-, CD3-, CD30-, bcl-2-, bcl-6-, LMP-1- and EMA-. The proliferation fraction (Mib-1) was >90%. EBV association was demonstrated by in situ hybridization (EBV-encoded RNAs 1/2). Polymerase-chain-reaction-based DNA analysis demonstrated a clonal IgH rearrangement in the absence of a bcl-2/IgH translocation. PBL in HIV patients may occur not only in the oral cavity, but can probably involve any other organs including the skin.
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PMID:Cutaneous plasmablastic lymphoma in an HIV-positive male: an unrecognized cutaneous manifestation. 1511 93

Non-Hodgkin's lymphoma is known to involve the bladder, either primarily or secondary. Anaplastic large cell lymphoma has not been documented at this site before. We report a case of a systemic anaplastic cell lymphoma in a 22-year-old man who presented with multisystemic symptoms and signs, including those suggestive of bladder disease. He was HIV-negative. Biopsy of the bladder showed a high grade lymphoma composed of large cells with nuclei containing prominent nucleoli. The tumor cells expressed CD30, CD45, EMA and ALK-1. A diagnosis of anaplastic large cell lymphoma, of null cell phenotype was made. The lymph node biopsy showed similar features on hematoxylin and eosin section. The patient was put on a regime of CHOP and is disease-free 33 months after diagnosis.
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PMID:Systemic anaplastic large cell lymphoma presenting as a bladder neoplasm. 1516 Sep 69

Plasmablastic lymphoma is an HIV-associated non-Hodgkin's lymphoma that primarily affects the oral cavity and jaws. The purpose of this report is to describe the first case of plasmablastic lymphoma occurring in an HIV-negative, nonimmunocompromised individual, and to review the histopathologic and immunohistochemical phenotype of this lymphoma. Histopathologically, our case exhibited a dense, diffuse lymphocytic infiltrate of noncohesive large lymphocytes with plasmacytoid features. Immunohistochemical analysis revealed positivity for the B-cell marker CD79a, VS38c, Epstein-Barr virus latent membrane protein (LMP), immunoglobulin G (IgG), and lambda light chain restriction. Neoplastic cells were negative for leukocyte common antigen, CD20, CD3, CD10, CD138, Bcl-2, Bcl-6, desmin, actin, EMA, S-100, HMB45, Alk-1, HHV8, IgA, IgM, and cytokeratin. The features of this rare disease are summarized based on a comprehensive review of the epidemiologic, clinical and immunohistochemical findings of previously reported cases.
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PMID:Oral plasmablastic lymphoma in an HIV-negative patient: a case report and review of the literature. 1603 78


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