RESUMO
To determine whether a single dose of intravenously administered immune globulin (IVIG) decreases late-onset sepsis in premature infants, we prospectively entered 753 neonates with birth weight 500 to 2000 gm, gestation < or = 34 weeks, and age < or = 12 hours into a multicenter, double-blind, controlled trial. Infants were randomly selected to receive a single intravenous infusion, 10 ml/kg, of either IVIG (500 mg/kg) or albumin (5 mg/kg) and were observed for 8 weeks for infection. Maternal and neonatal risk factors for infection did not differ between groups. Although serum IgG values before infusion were related to gestation (R = 0.62), the change in serum IgG or half-life of IgG after IVIG infusion was not (R < or = 0.09). The serum IgG concentration was increased (p < 0.05) in IVIG-treated patients for 8 weeks. There were 88 episodes of late-onset sepsis in 79 neonates (10.5%). Causative organisms included the following: Staphylococcus epidermidis (37 episodes), Enterococcus (9), Staphylococcus aureus (7), Candida (6), Escherichia coli (6), and multiple organisms (11). Sepsis, death, and death as a result of infection were unaffected by treatment. We conclude that a single infusion of IVIG, 500 mg/kg, shortly after birth was not effective prophylaxis for late-onset infection in premature neonates. Future studies of late-onset sepsis prophylaxis should consider IVIG with known pathogen-specific antibody concentrations against organisms causing these infections, in particular S. epidermidis.
Assuntos
Albuminas/uso terapêutico , Bacteriemia/prevenção & controle , Imunoglobulinas Intravenosas/uso terapêutico , Doenças do Prematuro/prevenção & controle , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Imunoglobulina G/sangue , Imunoglobulina G/efeitos dos fármacos , Recém-Nascido , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/microbiologia , Infusões Intravenosas , Masculino , Fatores de Risco , Fatores de TempoRESUMO
The objectives of the study were to determine knowledge levels regarding AIDS and its modes of transmission, and to describe sexual behaviour of Montrealers of Haitian origin. A serial cross-sectional study was conducted in three phases between 1987 and 1990. A questionnaire was administered in a face-to-face interview with the exception of the section concerning sexual practices which was self-administered for those respondents who were literate in French. The study was conducted among 775 men and women residing in the metropolitan Montreal region. These individuals were aged 15 to 39, were born in Haiti or had at least one parent born in Haiti. Knowledge levels were high except for misconceptions about HIV transmission through casual contact and mosquito bites. There was a significant association between high risk sexual behaviour and marital status with the odds of having had multiple partners significantly raised for previously married individuals (OR = 5.96, 95% CI = 3.09; 11.50). High risk behaviour was also associated with being under 25 years of age (OR = 2.83, 95% CI = 1.40; 5.74), knowing someone with HIV/AIDS (OR = 1.88, 95% CI = 1.05; 3.37), being male (OR = 6.81, 95% CI = 3.99; 11.60) and earlier year of interview. Montrealers of Haitian origin, with their specific AIDS-related socio-cultural characteristics, constitute a community which is intermediate between their country of origin, Haiti, and their host country, Canada.
Assuntos
Síndrome da Imunodeficiência Adquirida/psicologia , Etnicidade , Conhecimentos, Atitudes e Prática em Saúde , Síndrome da Imunodeficiência Adquirida/transmissão , Adolescente , Adulto , Intervalos de Confiança , Estudos Transversais , Demografia , Emigração e Imigração , Feminino , Haiti/etnologia , Humanos , Masculino , Razão de Chances , Quebeque , Comportamento Sexual/etnologia , Parceiros Sexuais , Inquéritos e QuestionáriosRESUMO
PIP: A new dipstick test will enable health workers in remote Third World communities to screen blood for human immunodeficiency virus (HIV) and monitor the spread of HIV infection. The test, developed by the Program for Appropriate Technology in Health (PATH), works without electricity, instrumentation, or cold chain and is locally manufacturable. Results are available in 20 minutes, and the cost is 25 cents per sample. Antibodies to both HIV-1 and HIV-2 are detectable. In the test, a plastic dipstick shaped like a comb with 8 test strips is dipped into blood samples, rinsed, and soaked in a reagent solution. The appearance of a red dot on a dipstick tooth indicates a positive finding. Field trials in Uganda, Kenya, Brazil, China, Indonesia, India, and Thailand indicate the dipstick is as reliable as screening tests already on the market; the false-positive rate was under 2%. India and Indonesia are already manufacturing the new test, and Kenya, Uganda, Cameroon, China, and Thailand have expressed interest. The low cost of the dipstick may enable its use in seroprevalence surveys in previously unstudied regions of the Third World. Such a survey was just conducted among a randomly selected group of pregnant women from across Haiti. Blood samples from simple finger pricks collected on filter paper yielded highly reliable results.^ieng
Assuntos
Sorodiagnóstico da AIDS , Países em Desenvolvimento , Equipamentos e Provisões , Infecções por HIV , Testes Hematológicos , Programas de Rastreamento , População Rural , América , Ásia , Sudeste Asiático , Região do Caribe , Técnicas de Laboratório Clínico , Demografia , Diagnóstico , Doença , Haiti , Índia , Indonésia , América Latina , América do Norte , População , Características da População , VirosesRESUMO
To determine attitudes and beliefs related to AIDS among the population of metropolitan Montreal of Haitian origin, we conducted serial cross-sectional surveys between 1987 and 1990 among a random sample of 777 men and women aged 15 to 39. Data on perceived risk of AIDS and attitudes towards HIV testing were collected in home settings using a combination of face-to-face structured interviews and a self-administered questionnaire. Multivariate analysis was conducted to determine predictors of attitudes towards people with HIV. The fear of being infected with HIV is great in this population. The social representation of illness in this community is very much influenced by religious beliefs. Scores for the five-item scale suggest only moderately favourable attitudes towards persons with HIV compared to Montrealers in general. Attitudes towards persons with AIDS were positively associated with years of schooling and a higher perceived risk of getting infected (p < or = 0.01).
Assuntos
Síndrome da Imunodeficiência Adquirida/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/transmissão , Adolescente , Adulto , Estudos Transversais , Escolaridade , Medo , Feminino , Haiti/etnologia , Humanos , Masculino , Análise Multivariada , Quebeque/epidemiologia , Distribuição Aleatória , Religião e Psicologia , Projetos de Pesquisa , Fatores de Risco , Percepção SocialRESUMO
Newborn infants may have IgG deficiencies that increase their susceptibility to bacterial infection. To determine whether intravenous immune globulin (IVIG) therapy improves survival rates in early-onset sepsis, we prospectively entered 753 neonates (birth weight 500 to 2000 gm, gestation less than or equal to 34 weeks, age less than or equal to 12 hours) into a multicenter, double-blind, controlled trial. Blood culture specimens were obtained and infants randomly assigned to receive 10 ml (per kilogram) intravenously of a selected IVIG (500 mg/kg) or albumin (5 mg/kg) preparation. Maternal and neonatal risk factors were not different between groups. Thirty-one babies (4.2%) had early-onset sepsis; the causative organisms were group B streptococcus (12 babies), Escherichia coli (6), and others (13). Of these 31 neonates, 7 (23%) died. Total serum IgG was higher for 7 days after IVIG therapy than after albumin treatment (p less than 0.05). During these 7 days, 5 (30%) of 17 albumin-treated and none of 14 IVIG-treated patients died (p less than 0.05). The survival rate at 56 days of age, however, was not significantly improved. Group B streptococcus type-specific IgG antibody was significantly increased after IVIG treatment and appeared to be related to the amount of IVIG specific antibody. Infusion-related adverse reactions were less frequent in patients receiving IVIG therapy (0.5%) than in those receiving albumin. The IVIG therapy in neonates with early-onset sepsis, while reducing the early mortality rate, did not significantly affect the overall survival rate. Further studies are necessary to confirm these findings and to determine more effective therapeutic regimens.
Assuntos
Bacteriemia/terapia , Imunoglobulinas Intravenosas/uso terapêutico , Doenças do Prematuro/terapia , Antibacterianos/uso terapêutico , Anticorpos Antibacterianos/sangue , Bacteriemia/imunologia , Bacteriemia/mortalidade , Terapia Combinada , Método Duplo-Cego , Feminino , Humanos , Imunoglobulina G/sangue , Recém-Nascido , Doenças do Prematuro/imunologia , Doenças do Prematuro/mortalidade , Masculino , Estudos Prospectivos , Streptococcus agalactiae/imunologia , Resultado do TratamentoRESUMO
We used interviews of 268 subjects to ascertain knowledge, attitudes, beliefs and practices related to AIDS among Montrealers of Haitian origin, from November 1987 through October 1988. The questions on knowledge included items on general knowledge about the disease (prevention of AIDS, treatment, nature and manifestations of the disease, screening and high-risk groups), and more specific questions about modes of HIV-1 transmission. The average correct answers to questions on general knowledge about AIDS was 81%. The questions on HIV-1 transmission concerned both modes of infection that are scientifically established, and other modes that are not scientifically recognized. The average correct answers to questions on scientifically recognized modes of infection was 94% and the average correct answers for modes of transmission that are not scientifically accepted was 74%. The attitudes and beliefs of Montrealers of Haitian origin toward persons with AIDS was only moderately favourable. Attitudes and beliefs toward condom promotion were very positive. The percentage of subjects reporting male homosexuality or injection drug use was extremely small. 23% of subjects who had experienced sexual intercourse reported that they had two or more partners during the 12 months preceding the survey.
PIP: The authors used interviews from 268 patients to ascertain knowledge, attitudes, beliefs, and practices related to AIDS among Montrealers of Haitian origin. Interviews were conducted between November 1987-October 1988 and questions queried general knowledge about the disease (prevention of AIDS, treatment, nature, and manifestations of the disease, screening, high-risk groups), and more specific questions on the modes of HIV-1 transmission. The average % of correct answers on general knowledge about AIDS was about 81%. The questions on HIV-1 transmission concerned both modes of infection that are scientifically established, and other modes that are not. The average % of correct answers to questions on scientifically recognized modes of infection was 94% and for those answers on those which are not scientifically accepted was 74%. The attitudes and beliefs of these Montrealers towards those with AIDS was only moderately favorable. Attitudes and beliefs toward condom promotion were, on the other hand, very positive. The % of subjects reporting male homosexuality or injection drug use was extremely small. 23% of subjects who had experienced sexual intercourse reported that they had 2 or more partners in the 12 months preceding the survey. (author's)
Assuntos
Síndrome da Imunodeficiência Adquirida/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Síndrome da Imunodeficiência Adquirida/etiologia , Síndrome da Imunodeficiência Adquirida/transmissão , Adolescente , Adulto , Dispositivos Anticoncepcionais Masculinos/estatística & dados numéricos , Feminino , Haiti/etnologia , Humanos , Masculino , Quebeque , Fatores de Risco , Parceiros Sexuais , Inquéritos e QuestionáriosRESUMO
Since Canada's first AIDS case was reported in 1978, a total of 1 775 cases have been recorded. Most of these (90 percent) have occurred in three provinces (Ontario, Quebec, and British Columbia); most (89 percent) have occurred among adults 24 to 49 years old; and most (95 percent) of these adult cases have occurred in males. Nationwide, 82 percent of those afflicted have been homosexual of bisexual men, 5 percent have been immigrants from endemic regions, and 4.6 percent have been recipients of blood or blood products. However, the distribution differs in the different provinces-especially in Quebec, where a substantial share of all cases (17 percent) have occurred among immingrants from endemic regions. Regarding levels of HIV infection, information is limited. The authors estimate that roughly 30 000 Canadians were probably infected as of early 1988, but the true number could be as low as 10 000 or as high as 50 000. HIV tests are available free of charge to any Canadian who requests them. At present, a system of voluntary testing of individuals for personal or clinical reasons, combined with anonymous screening of populations for epidemiologic purposes, comprises the HIV testing program in Canada. In seven of Canada's 10 provinces, HIV seropositivity is reportable to public health authorities. One of these provinces conducts a contact tracing programs based on traditional sexually
Assuntos
Epidemiologia , Síndrome da Imunodeficiência Adquirida/diagnóstico , Síndrome da Imunodeficiência Adquirida/epidemiologia , CanadáRESUMO
Since Canada's first AIDS case was reported in 1978, a total of 1 775 cases have been recorded. Most of these (90 percent) have occurred in three provinces (Ontario, Quebec, and British Columbia); most (89 percent) have occurred among adults 24 to 49 years old; and most (95 percent) of these adult cases have occurred in males. Nationwide, 82 percent of those afflicted have been homosexual of bisexual men, 5 percent have been immigrants from endemic regions, and 4.6 percent have been recipients of blood or blood products. However, the distribution differs in the different provinces-especially in Quebec, where a substantial share of all cases (17 percent) have occurred among immingrants from endemic regions. Regarding levels of HIV infection, information is limited. The authors estimate that roughly 30 000 Canadians were probably infected as of early 1988, but the true number could be as low as 10 000 or as high as 50 000. HIV tests are available free of charge to any Canadian who requests them. At present, a system of voluntary testing of individuals for personal or clinical reasons, combined with anonymous screening of populations for epidemiologic purposes, comprises the HIV testing program in Canada. In seven of Canada's 10 provinces, HIV seropositivity is reportable to public health authorities. One of these provinces conducts a contact tracing programs based on traditional sexually