HICNet Medical News Digest Thu, 23 Jun 1994 Volume 07 : Issue 28 Today's Topics: [MMWR 17 Jun 94] Update: Coccidioidomycosis [MMWR] Head Injuries Associated with Motorcycle Use Hanford Radiation Exposure NIAID Recommend Continuing but Not Expanding HIV Vaccine Study Courses Available in Pharmocokinetics Conference on Alzheimer Disease AIDS Daily News Summary +------------------------------------------------+ ! ! ! Health Info-Com Network ! ! Medical Newsletter ! +------------------------------------------------+ Editor: David Dodell, D.M.D. 10250 North 92nd Street, Suite 210, Scottsdale, Arizona 85258-4599 USA Telephone +1 (602) 860-1121 FAX +1 (602) 451-1165 Internet: mednews@stat.com Bitnet: ATW1H@ASUACAD Compilation Copyright 1994 by David Dodell, D.M.D. All rights Reserved. License is hereby granted to republish on electronic media for which no fees are charged, so long as the text of this copyright notice and license are attached intact to any and all republished portion or portions. The Health Info-Com Network Newsletter is distributed biweekly. Articles on a medical nature are welcomed. If you have an article, please contact the editor for information on how to submit it. If you are interested in joining the automated distribution system, please contact the editor. Associate Editors: E. Loren Buhle, Jr. Ph.D. Dept. of Radiation Oncology, Univ of Pennsylvania Tom Whalen, M.D., Robert Wood Johnson Medical School at Camden Douglas B. Hanson, Ph.D., Forsyth Dental Center, Boston, MA Lawrence Lee Miller, B.S. Biological Sciences, UCI Dr K C Lun, National University Hospital, Singapore W. Scott Erdley, MS, RN, SUNY@UB School of Nursing Jack E. Cross, B.S Health Care Admin, 882 Medical Trng Grp, USAF Albert Shar, Ph.D. CIO, Associate Prof, Univ of Penn School of Medicine Martin I. Herman, M.D., LeBonheur Children's Medical Center, Memphis TN Stephen Cristol, M.D., Dept of Ophthalmology, Emory Univ, Atlanta, GA Subscription Requests = mednews@stat.com anonymous ftp = vm1.nodak.edu; directory HICNEWS FAX Delivery = Contact Editor for information ---------------------------------------------------------------------- Date: Thu, 23 Jun 94 05:52:18 MST From: mednews (HICNet Medical News) To: hicnews Subject: [MMWR 17 Jun 94] Update: Coccidioidomycosis Message-ID: Update: Coccidioidomycosis -- California, 1991-1993 Coccidioidomycosis is an infection caused by the fungus Coccidioides immitis, which resides in the soil in some areas of Arizona, California, Nevada, New Mexico, Texas, and Utah. Infection can occur when airborne, infective arthroconidia are inhaled. Symptomatic coccidioidomycosis, which occurs in approximately 40% of all infections, has a wide clinical spectrum, including mild influenza-like illness, severe pneumonia, and disseminated disease. Beginning in 1991, the number of cases of coccidioidomycosis reported annually to the California Department of Health Services (CDHS) increased dramatically (1) (Figure 1). This report summarizes the occurrence of coccidioidomycosis in California during 1991-1993. In 1991, 1200 cases of coccidioidomycosis were reported to CDHS, compared with an annual average of 428 reported cases during 1981-1990. The number of reported cases continued to increase during 1992 (4516 cases) but declined during 1993 (4137 cases). During 1991-1993, most (70%) cases in California were reported from Kern County in the San Joaquin Valley, where the incidence of coccidioidomycosis is high; in contrast, during 1981-1990, Kern County accounted for 52% of all cases. Coccidioidomycosis surveillance data are reported to CDHS by the counties as weekly case counts only. Reported by: BA Jinadu, MD, G Welch, R Talbot, PhD, Kern County Health Dept; J Caldwell, PharmD, R Johnson, MD, D Blume, PhD, H Einstein, MD, T Larwood, MD, M Hargrave, Bakersfield; RJ Jackson, MD, SB Werner, MD, P Duffey, PhD, GW Rutherford, III, MD, State Epidemiologist, California Dept of Health Svcs; T Kirkland, MD, San Diego; D Pappagianis, MD, Davis; F Swatek, PhD, Long Beach, California. DM Dixon, PhD, National Institute of Allergy and Infectious Disease, National Institutes of Health. Div of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, CDC. Editorial Note: The public health impact of coccidioidomycosis in California during 1991-1993 was substantial. For example, based on a review of medical records in Kern County alone, coccidioidomycosis accounted for approximately $45 million in direct costs of hospitalization and outpatient care during that period (J. Caldwell, Pharm.D., Kern Medical Center, personal communication, 1994). Factors potentially associated with the ongoing outbreak of coccidioidomycosis in California include weather conditions (e.g., protracted drought followed by heavy rains) conducive to the growth and spread of C. immitis, activities that disturb the soil and facilitate airborne spread of the organism, and a large and increasing population of susceptible persons. These factors illustrate the association between environmental and demographic factors and the emergence of some infectious diseases (2,3). During 1991-1993 and previously, the number of coccidioidomycosis cases probably has been underreported. In Kern County, unlike other counties in California, the local health department is the diagnostic laboratory for virtually all coccidioidomycosis serologic tests from suspected cases in the county and ensures that they are reported to CDHS. Although actual rates of coccidioidomycosis are probably higher in Kern County than in other California counties, the link between the diagnostic laboratory and case reporting in the county enhances coccidioidomycosis surveillance when compared with areas that rely primarily on health-care providers to report new cases. At least two major barriers constrain the prevention of coccidioidomycosis. First, although measures to reduce exposure by minimizing dust in areas where coccidioidomycosis is endemic can lower incidence rates and may reduce severity of disease in persons who become infected, exposures to contaminated dust cannot be totally prevented (4). Second, although recovery from infection usually confers lasting protection against reinfection, suggesting a potential role for vaccination, efforts to develop a coccidioidomycosis vaccine for humans have been unsuccessful (5). Further efforts to develop vaccines can employ current genetic and biochemical methods. In November 1993, CDHS and the Kern County Health Department convened a national meeting of experts to consider public health strategies for controlling and preventing coccidioidomycosis. Participants concluded that 1) surveillance is generally inadequate to assess the public health burden of coccidioidomycosis in the southwestern United States and that the approach used in Kern County (e.g., linking diagnostic testing to case reporting) enables more complete assessment of the public health impact of this disease; 2) despite a historical understanding of the epidemiology of coccidioidomycosis (4,6-8), efforts should be intensified to better characterize environmental, behavioral, and host risk factors for acquiring infection and developing disease; 3) although several serologic tests for the diagnosis of coccidioidomycosis (e.g., complement fixation and tube precipitin) are well characterized and perform well, the sensitivity, specificity, and reproducibility of enzyme immunoassay and other newer diagnostic tests need to be better defined (9); and 4) development of a vaccine may be the most effective strategy for preventing coccidioidomycosis. References 1. CDC. Coccidioidomycosis--United States, 1991-1992. MMWR 1993;42:21-4. 2. Institute of Medicine. Factors in emergence. In: Lederberg J, Shope RE, Oaks SC, eds. Emerging infections: microbial threats to health in the United States. Washington, DC: National Academy Press, 1992:34-112. 3. CDC. Addressing emerging infectious disease threats to health: a prevention strategy for the United States. Atlanta: US Department of Health and Human Services, Public Health Service, 1994. 4. Smith CE, Beard RR, Rosenberger HG, Whiting EG. Effect of season and dust control on coccidioidomycosis. JAMA 1946;132:833-8. 5. Pappagianis D, Valley Fever Vaccine Study Group. Evaluation of the protective efficacy of the killed Coccidioides immitis spherule vaccine in humans. Am Rev Respir Dis 1993;148:656-60. 6. Pappagianis D. Epidemiology of coccidioidomycosis. Curr Top Med Mycol 1988;2:199-238. 7. Smith CE, Beard RR, Whiting EG, Rosenberger HG. Varieties of coccidioidal infection in relation to the epidemiology and control of the diseases. Am J Public Health 1946;36:1394-402. 8. Smith CE. Epidemiology of acute coccidioidomycosis with erythema nodosum ("San Joaquin" or "Valley Fever"). Am J Public Health 1940;30:600-11. 9. Pappagianis D, Zimmer BL. Serology of coccidioidomycosis. Clin Microbiol Rev 1990;3:247-68. ------------------------------ Date: Thu, 23 Jun 94 05:53:20 MST From: mednews (HICNet Medical News) To: hicnews Subject: [MMWR] Head Injuries Associated with Motorcycle Use Message-ID: Head Injuries Associated with Motorcycle Use -- Wisconsin, 1991 From 1989 through 1991, a total of 9913 persons in the United States died as a result of crashes while operating or riding motorcycles (1). Although use of motorcycle helmets is an effective means for preventing crash-related fatal injuries (2), 25 states and the District of Columbia have not yet enacted laws requiring the universal use of motorcycle helmets (1). This report describes a study by the University of Wisconsin and the Wisconsin Department of Transportation in which linked police reports and hospital discharge records for 1991 were used to assess the risk for head injury for motorcyclists in motor-vehicle crashes, the initial inpatient hospital charges for motorcyclists with head injuries resulting from crashes, and the reduction in injuries and fatalities associated with universal helmet use. For this report, motorcyclists were defined as persons who were operating or riding as a passenger on a motorcycle. Wisconsin was one of seven states funded under the Crash Outcome Data Evaluation Systems project of the National Highway Traffic Safety Administration to generate linked statewide data systems. Because personal identifiers were not available, Police Accident Reports from the Wisconsin Department of Transportation and inpatient discharge records for acute-care hospitals from the state's Office of the Commissioner of Insurance were linked through a probabilistic method (which calculates the likelihood that a police report and a discharge record represent the same person) using date of the event--the crash or the hospital admission--and the motorcyclist's birth date, sex, and zip code of residence. Secondary linking variables were the county of the event, the health service area of the event, the injury, and whether the person was transported by ambulance from the crash. Uncertain matches were reviewed manually using additional corroborating information, such as International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) external cause of injury codes and consistency with known patterns of trauma referral and injury resulting from motor-vehicle crashes. Approximately 7% of the matches made by computer between police reports and hospital records were incorrect. Based on ICD-9-CM diagnostic codes in the discharge record, head injuries were classified into three mutually exclusive categories: 1) brain injury, defined as any diagnosis of intracranial injury with or without skull fracture, intracranial hemorrhage following injury, or loss of consciousness for 1 hour or more; 2) skull fracture with no intracranial injury; and 3) concussion with only brief (less than 1 hour) or no loss of consciousness. Of the 3184 motorcyclists involved in police-reported crashes in Wisconsin in 1991, 2015 (63.3%) were unhelmeted and 994 (31.2%) were helmeted at the time of the crash. Helmet use was unknown for 175 (5.5%), four of whom were fatally injured; of 32 who were hospitalized, 13 incurred head injuries. Of those motorcyclists for whom helmet status was known, 545 were hospitalized and 74 died, including 55 who were unhelmeted and 19 who were helmeted. Of the 545 hospitalized, 187 (34.3%) had sustained a head injury (Table 1). Overall, unhelmeted motorcyclists involved in police-reported crashes were more than twice as likely to be hospitalized for a head injury (153 [7.6%]) than were helmeted riders (34 [3.4%]). Brain injury occurred among 97 (4.8%) of those who were unhelmeted and 17 (1.7%) of those who were helmeted (rate ratio [RR]=2.9, 95% confidence interval [CI]=1.7-4.9); the rate for skull fracture among unhelmeted riders (0.9%) was 4.5 times (95% CI=1.0-19.2) that among helmeted riders (0.2%). The rate for concussions among unhelmeted motorcyclists involved in crashes (1.9%) was higher than that for helmeted riders (1.5%) (RR=1.3; 95% CI=0.7-2.3). Total initial* inpatient hospital charges for the 97 unhelmeted motorcyclists with brain injuries was $2,396,366-- compared with $333,619 for the 17 helmeted motorcyclists with brain injuries (Table 1). Average initial hospital charges for unhelmeted motorcyclists with brain injuries were $24,705, compared with $19,624 for helmeted motorcyclists with brain injuries. Although some crashes will be so severe that a motorcycle helmet will not prevent brain injury or death, the proportion of injuries that could have been prevented if a motorcycle helmet had been worn by all riders was estimated for each category of head injury and death (3). These estimates assume that if unhelmeted motorcyclists wore helmets and experienced a similar distribution of outcomes as helmeted motorcyclists, then universal helmet use by all motorcyclists in Wisconsin during 1991 potentially would have prevented 60 brain injuries, 13 skull fractures with no intra- cranial injury, and eight concussions. In addition, universal helmet use potentially would have prevented 14 (18.9%) deaths. Reported by: TA Karlson, PhD, CA Quade, Center for Health Systems Research and Analysis, Univ of Wisconsin, Madison; Wisconsin Dept of Transportation. Div of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC. Editorial Note: Motorcycle helmets are designed to protect users against injury to the brain and other head injuries. The findings in this report indicate that the use of motorcycle helmets lowers the rate of head injury. Although helmet use is approximately 99% in states with universal requirements, use is substantially less in states with laws that apply only to subgroups of the population (4). For example, in Wisconsin, where the law applies only to riders aged less than 19 years, observed helmet use is 42% for all motorcycle riders (5). The findings in this report are subject to at least four limitations. First, incorrectly matched police reports and hospital records diminish the measure of the protective effect of helmets. Second, some motorcycle crashes in Wisconsin may not have been reported to police--in particular, crashes occurring in areas adjacent to other states for which medical treatment may have been obtained in those states. Third, this study evaluated only hospitalized motorcycle riders; the differences in injury rates and health-care costs for unhelmeted riders compared with helmeted riders probably would have been greater if data from emergency departments and long-term--care facilities had been available and analyzed. Skull fractures and concussions are usually associated with complete recovery, but more severe injuries to the brain can result in lifelong disability (6). Fourth, this study did not control for injuries other than head injuries. In a Washington study that controlled for severity of injuries other than head injury, motorcycle helmets were effective in limiting the occurrence of head injury, the need for and duration of mechanical ventilation, the length of intensive-care stay, and the need for rehabilitation (7). Previous studies indicate that unhelmeted riders who are injured are more likely be admitted to a hospital as an inpatient, be permanently impaired, and require ambulance service, neurosurgery, intensive care, rehabilitation, and long-term care (4). Although the source of payment for hospitalization was not analyzed in this report, findings from previous reports indicate that public monies underwrite 25%-50% of the costs associated with motorcycle crashes (4). State-specific data on the costs for hospitalizations--initial, long-term, and public--for unhelmeted riders may assist state legislators in making informed decisions regarding the passage and retention of these laws. This report illustrates how linked data can help provide information on the potential health-care costs associated with public policies intended to prevent motor-vehicle--related injuries. Linkage of existing data systems can assist in the characterization of motorcycle and other motor-vehicle--crash events, injury severity, and cost for non-fatal injuries. Probabilistic linkage allows large files to be linked rapidly, potentially providing information about persons involved in crashes and the severity of their injuries, the treatment they received, and charges for treatment; this information could be linked with data on the public costs of injuries associated with risk-taking behavior (e.g., drinking and driving), nonuse of safety belts and motorcycle helmets, and speeding. The Wisconsin Department of Transportation is using information from linked data about medical outcomes and the costs of crash-related injuries resulting from motorcycle and other motor-vehicle crashes to plan interventions and evaluate their impact. References 1. National Highway Traffic Safety Administration. Fatal Accident Reporting System, 1991; a review of information on fatal traffic crashes in the United States. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 1992. 2. Wilson D. The effectiveness of motorcycle helmets in preventing fatalities. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 1989; National Highway Traffic Safety Administration Technical Report DOT no. HS-807-416. 3. CDC. A framework for assessing the effectiveness of disease and injury prevention. MMWR 1992;41(no. RR-3). 4. US Government Accounting Office. Motorcycle helmet laws save lives and reduce costs to society. Washington, DC: Government Accounting Office, 1990; report no. GAO/RCED-91-170, 1991. 5. Wisconsin Office of Transportation Safety. Motorcycle helmet use in Wisconsin, 1993. Madison, Wisconsin: Wisconsin Department of Transportation, Office of Transportation Safety, 1994. 6. Kraus JF, Rock A, Hemyari P. Brain injuries among infants, children, adolescents, and young adults. Am J Dis Child 1990;144:684-91. 7. Offner PJ, Rivara FP, Maier RV. The impact of motorcycle helmet use. J Trauma 1992;32:636-42. * Initial hospital charges were used as a proxy for hospital costs, which are only a portion of direct medical costs. Initial hospital charges do not include physician fees, emergency department charges, or costs after discharge for subsequent hospitalizations, long-term care, and rehabilitation. ------------------------------ Date: Thu, 23 Jun 94 05:55:38 MST From: mednews (HICNet Medical News) To: hicnews Subject: Hanford Radiation Exposure Message-ID: From: Hanford Health Information Network Re: Information re: Hanford Radiation Exposure If you lived in Eastern Washington, Northeastern Oregon or the Idaho Panhandle between 1944 through 1972 you may have been exposed to radiation released from the Hanford Nuclear Weaspons Facility. If you are a health care provider, some of your patients may have exposed to radiation. An estimated 740,000 curies of radioactive iodine 131 released between 1944-1972 is believed to represent the greatest health threat, according to the Hanford Environmental Dose Reconstruction Project. The Columbia River was polluted with 22,000,000 curies of radioactive elements, south of Hanford to the mouth of the river and along the coast contaminating Willapa Bay oyster beds. For comparison, Three Mile Island released 15-24 curies of I-131. Hanford Health Information Network(HHIN) prepares and distributes information on both the known and potential health effects of radiation to health care providers and persons who were or may have been exposed to radiation from Hanford Nuclear Facility operations from 1944 to 1972. For more information and free education materials call 1-800-959-7660. Please leave a message with your name, address, phone number and if you would like to be on the mailing list. The HHIN is also developing a curriculum for continuing medical and nursing education which will be available to universities/schools of medicine across the country by fall 1994. We are sponsoring a conference on September 9-11, 1994 in Spokane, Washington titled: Radiation Health Effects and Hanford: A Conference for Concerned Citizens and Health Care Providers. For a brochure contact HHIN Conference, University of Washington School of Medicine, CME, 1325 4th Ave. Suite 2000, Seattle, WA 98101 phone (206)543-1050, FAX (206) 543-3195. Congress established the HHIN to serve the public and provide health care professionals with a range of information on radiation health effects. The HHIN is a collaboration among the state health agencies of Idaho, Oregon and Washington and nine Indian Nations. For those who would like information and live in Washington State contact 1-800-522-4446; in Idaho 1-800-793-6113; in Oregon 1-800-248-4446; and Tribal Members of the three States 1-800-798-0796. National Information Line: 1-800-959-7660. Please do not use e-mail, call our toll free numbers. ------------------------------ Date: Thu, 23 Jun 94 05:56:42 MST From: mednews (HICNet Medical News) To: hicnews Subject: NIAID Recommend Continuing but Not Expanding HIV Vaccine Study Message-ID: <85iDoc4w165w@stat.com> N I A I D N E W S *********************************************** NATIONAL INSTITUTES OF HEALTH National Institute of Allergy and Infectious Diseases June 17, 1994 NIAID Advisors Recommend Continuing But Not Expanding at This Time Ongoing Trials of Two Candidate HIV Vaccines On June 17, 1994, the National Institute of Allergy and Infectious Diseases (NIAID) held a joint meeting in Bethesda, Md., of the NIAID AIDS Research Advisory Committee (ARAC) and the NIAID AIDS Subcommittee of the National Advisory Allergy and Infectious Diseases Council. At the meeting, NIAID solicited a recommendation from the group about whether or not to expand at this time the NIAID's U.S.-based clinical trials of the two gp120 subunit HIV candidate vaccines furthest along in development. Ashley T. Haase, M.D., ARAC chairperson and head of the Department of Microbiology at the University of Minnesota Medical School in Minneapolis, chaired the meeting. After a full day of discussion and deliberation, these advisors recommended that the Institute continue, but not expand, the current vaccine trials of the two gp120 candidates in question and continue the development of other candidates currently under study. The committee members also recommended NIAID proceed with expanded clinical trial evaluation when a vaccine of a different design and/or when other compelling data from current or other studies are available. In recognition of the difference in the dynamics of the epidemic throughout the world, the majority of the advisers also agreed that at the present time this recommendation applies only to studies of these two products in the United States. The discussion and subsequent recommendation to NIAID Director, Anthony S. Fauci, M.D., is part of NIAID's ongoing decision-making process about when to begin its first efficacy trial of preventive HIV vaccines. Because of the clear, overwhelming consensus of the advisors, Dr. Fauci adopted the recommendation. The two vaccines are based on genetically engineered forms of the major HIV surface protein, gp120, from closely related but distinct HIV-1 strains representative of most infections in North America and Europe. The Biocine Company (Emeryville, Calif., a joint venture of Chiron and CIBA-Geigy) makes its vaccine from the SF-2 strain. Genentech, Inc., (South San Francisco) bases its vaccine on the MN strain. At this time, these HIV vaccines are the only ones in an NIAID-sponsored Phase II clinical trial. NIAID began the trial in December 1992. NIAID will evaluate data from new and ongoing HIV vaccine studies before it identifies a suitable candidate vaccine to propose for expanded trials. The Institute estimates that one to three years are needed to get such data. NIAID is committed to the development of a vaccine to prevent HIV infection and disease. This means continuing the Institute's comprehensive basic and applied program of preclinical and clinical work on candidates and concepts currently in earlier stages of development. Additional community preparedness work will also be carried out. The clinical trials conducted through NIAID's vaccine clinical trial networks are part of a broader prevention effort that includes non-vaccine prevention research. NIAID, a component of the National Institutes of Health (NIH), supports research on AIDS, tuberculosis and other infectious diseases as well as allergies and immunology. NIH is an agency of the U.S. Public Health Service, U.S. Department of Health and Human Services. Prepared by: Office of Communications National Institute of Allergy and Infectious Diseases National Institutes of Health Bethesda, MD 20892 Public Health Service U.S. Department of Health and Human Services ------------------------------ Date: Thu, 23 Jun 94 05:58:19 MST From: mednews (HICNet Medical News) To: hicnews Subject: Courses Available in Pharmocokinetics Message-ID: ANNOUNCEMENT ^^^^^^^^^^^^ Summer, 1994 Courses for Scientists, Physicians, Clinical Research Associates and Regulatory Affairs Specialists For the past eight years, Kemic Bioresearch has organized special courses in pharmacokinetics and other biomedical topics for researchers and clinical and regulatory specialists from the pharmaceutical industry and government. These widely acclaimed, three-day courses are presented at various venues throughout North America each year. Courses to be offered this summer on the beautiful Acadia University campus in Nova Scotia include: July 4-6, 1994 "Pharmacokinetics: Essential Theory and Practical Considerations" (to be also presented in Princeton, NJ, December 5-7) July 13-15, 1994 "Clinical Trial Management: Quality Assurance & Performance Strategies..." July 18-20, 1994 "Special Topics in Pharmacokinetics: Data Analysis and Modeling Techniques with Computer Applications" (also to be presented in Princeton, Dec. 7-9) August 1-3, 1994 "Fundamentals of Pharmacology" For further information concerning any of these courses, please contact: Tel: (902) 678-8195 Susan Goodall Fax: (902) 678-2839 Courses Co-ordinator Kemic Bioresearch Labs Email: pmullen@fox.nstn.ns.ca P.O. Box 878 Kentville, Nova Scotia, B4N 4H8 Canada ------------------------------ Date: Thu, 23 Jun 94 05:59:19 MST From: mednews (HICNet Medical News) To: hicnews Subject: Conference on Alzheimer Disease Message-ID: Alzheimer Society of Ottawa-Carleton and the SCO Health Service present a one-day conference: ALZHEIMER DISEASE: Essential partnerships in helping patients and family cope Thursday, SEPTEMBER 29, 1994 --- 8:15 a.m. to 3:45 p.m. Elisabeth Bruyere Health Centre, 43 Bruyere Street, Ottawa, Ontario Who should attend: Families and Professional Caregivrs who care for those with Alzheimer Disease, either in the community or in care facilities. Conference Fee (includes lunch and coffee breaks) * Regular Registration................ $90.00 ** Early bird registration............. $80.00 (received prior to August 2, 1994) *** Family members who are also......... $50.00 Alzheimer Society Members Keynote Speakers: "Meeting the Challenge" Len Fabiano, RN, BA. is author of several books, including "Mother I'm Doing the Best I Can" and "The Tactics of Supportive Therapy: A Cpmprehensive Intervention Program for Effective Caring of the Alzheimer Victim" "Alzheimer Disease - A Ray of Hope" Update on Research and Treatment Dr. Jonathan Willmer, MD, FRCP(C) (Neurology) Dr. Willmer is the Director of the Memory Disorder Clinic, Elisabeth Bruyere Health Centre Concurrent Sessions: 1. "Doing Things on Purpose: Meaningful Activity Programming" Jitka Zgola, Coordinator, Psychogeriatric Community Services and author of "Doing Things" 2. "Managing Difficult Behaviour" Jean Benton, RN, B.Sc., Saint Vincent Hospital, will focus on an "enabling framework" for assessing behavious and planning care. 3. "La maladie d'Alzheimer" (en francais) Louise Cleroux, Unite d'Alzheimer et maladies reliees Monique Thibault, programme Jour de sortie des Infirmieres de l'ordre de Victoria Mathe Charron, IA, B.Sc. (Villa Maguerite) Les differentes approches et suggestions practiques en milieux familial, communautaire et institutionelle. 4. "Making Life Easier" Melanie Macdonald, RN, MEd, MBA St. Vincent Hospital Practical strategies for caregivers to enhance the coping abilities of those with Alzheimer Disease. 5. "Living with and Learning from Loss: A Family Panel" Moderator: Patricia Van Loan, MScEd, MSW (Saint Vincent Hospital) A son, daughter and spouse will discuss their personal experiences as caregivers and how they have coped with losses. The panel will offer practical suggestions as to how professionals can best help family caregivers. For Further Information Contact: Patricia Van Loan Tel. (613) 233-4041, ext. 2109 FAX (613) 782-2785 ------------------------------ Date: Thu, 23 Jun 94 06:00:01 MST From: mednews (HICNet Medical News) To: hicnews Subject: AIDS Daily News Summary Message-ID: AIDS Daily Summary The Centers for Disease Control and Prevention (CDC) National AIDS Clearinghouse makes available the following information as a public service only. Providing this information does not constitute endorsement by the CDC, the CDC Clearinghouse, or any other organization. Reproduction of this text is encouraged; however, copies may not be sold, and the CDC Clearinghouse should be cited as the source of this information. Copyright 1994, Information, Inc., Bethesda, MD ************************************************************** Topics in this issue: - "Thailand Begins AIDS Vaccine Trial" - "HIV Health Workers 'Need Better Protection'" - "Partners of HIV-Infected Men with Hemophilia" - "Self-Reports of HIV Risk Factors by Patients at a Sexually Transmitted Disease Clinic: Audio vs Written Questionnaires" - "Stanford Opens HIV/AIDS Primary Care Clinic" - "Triplex Reports Discovery of Olignucleotide Compounds That Significantly Inhibit HIV-1 Activity" - "Five Best Centers for AIDS Research" - "AIDS Vaccine Research Misleading, Group Alleges" - "HIV Screening in Pregnancy: UK Lags" - "The First Search for the Source" - "Good News and Bad News About AZT" - "Zidovudine for the Prevention of HIV Transmission From Mother to Infant" - "Suppression of HIV Production in Resting Lymphocytes by Combining Didanosine and Hydroxamate Compounds" - "HIV Vaccine Trials: Will Intravenous Drug Users Enroll?" - "AZT Not Linked to Higher Rate of Birth Defects" - "Scientists Joust Over AIDS Research" - "TB Underestimated in HIV Wasting" - "Another HIV Drug" ************************************************************** "Thailand Begins AIDS Vaccine Trial" United Press International (06/06/94) (Utumporn, Pichayaporn) The first in a series of clinical trials in developing nations began on Monday, as the Thai Red Cross began testing a new AIDS vaccine. The 30 HIV-negative volunteers who were inoculated with United Biomedical Inc.'s UBI-1 formula will receive a second vaccination in four weeks, according to Dr. Praphan Phanuphak, director of the agency's Program on AIDS. Doctors will periodically draw blood from trial participants over the next six months, and check their immune systems after eight months, he said. At that point, researchers should know if the vaccine will help develop antibodies. The UBI-1 vaccine has already been tested on about 100 volunteers in the United States, China, and Australia, and has also been approved by the World Health Organization for Rwanda, Uganda, and Brazil, in addition to Thailand. "HIV Health Workers 'Need Better Protection'" Nature (05/19/94) Vol. 369, No. 6477, P. 173 (Butler, Declan) A group of French researchers, doctors, and healthcare providers have formed Union pour la Protection des Soignants et de leurs Patients, an association seeking to reduce the risks of HIV infection to healthcare workers through hospital accidents. In particular, the association wants health authorities to require hospitals to introduce precautions against accidental HIV transmission. Self-sheathing needles, for example, could reduce needleprick accidents by two-thirds, according to Francis Cheilan, the group's president. He notes that although similar precautions were issued by the ministry of health two years ago, only a handful of hospitals have introduced safer procedures. Part of the problem, says Cheilan, is that authorities are not convinced of the risks, even though an estimated 30 French healthcare workers have contracted HIV through work accidents. The association claims that the true figure is closer to 300, and will continue to incline as more HIV-positive patients are diagnosed. The association is also campaigning for specific legislation allowing healthcare workers to claim adequate compensation. Currently, workers contaminated by HIV on the job come under legislation that covers general work accidents, which entitles them only to an invalidity pension--about one-third of salary. "Partners of HIV-Infected Men with Hemophilia" Focus (05/94) Vol. 8, No. 6, P. 8 (Klimes, I.; Catalan, J.; Garrod, A. et al.) No differences were observed in the psychological status of female partners of HIV-negative hemophiliac men and HIV-positive hemophiliac men, according to a study. Partners of the 17 HIV-positive and 19 HIV-negative hemophiliacs were comparable in terms of age, employment status, and social class, and all were confirmed to be HIV-negative. Despite being forced to cope with their husband's psychological state, changes in the sexual relationships, and concerns about contracting HIV, 78 percent of the partners of seropositive men said that their relationship, in general, remained unchanged since their partners first underwent HIV testing. When compared to women in the general community, however, partners of hemophiliac men--regardless of HIV status--were found to have twice the number of psychological symptoms. The heightened level of psychological distress among these women suggests that living with and managing hemophilia is more stressful and of more immediate concern than the challenge of living with asymptomatic HIV disease. "Self-Reports of HIV Risk Factors by Patients at a Sexually Transmitted Disease Clinic: Audio vs Written Questionnaires" American Journal of Public Health (05/94) Vol. 84, No. 5, P. 754 (Boekeloo, Bradley O.; Schiavo, Laura; Rabin, David et al.) Measurement error in assessing HIV risk can lead to misinterpretation of research, undetected patient risk, and weakened efforts to protect the blood supply. For most HIV risk factors, self-reporting is typically the only acceptable method of assessment, usually through written questionnaires or face-to-face interviews. Although neither method has been deemed superior, there has been some concern that there is greater measurement error in face-to-face interviews, as opposed to pencil-and-paper surveys. Written questionnaires, however, may be difficult for some subjects to read and complete. A self-administered questionnaire completed through audiocassette player and headset may overcome some of the sources of measurement error associated with the other two methods. To determine how method of assessment affects patient self-reporting about HIV, patients received either a written self-administered questionnaire, or one that was administered through the tape and headset. Boekeloo et al. found that audio questionnaires not only had fewer missed responses than written questionnaires, but they also identified more unprotected vaginal intercourse and partners known or thought to be HIV-infected. They conclude that audio questionnaires may obtain more complete data and identify more HIV risk than written questionnaires, and research needs to be done to determine whether this method overcomes barriers to completion and accuracy of HIV risk surveys. "Stanford Opens HIV/AIDS Primary Care Clinic" Business Wire (06/06/94) California's Stanford Hospital will provide specialized primary care for HIV/AIDS patients with the opening of The Stanford Positive Care Clinic. According to the clinic's director, Dr. Andrew Zolopa, the goal of the new facility is to provide HIV-infected patients--at all stages--with comprehensive health care, as well as access to the most current drug and vaccine research trials. The clinic will also provide the peninsula's HIV/AIDS patients with access to all levels of care at a single location, dispensed by specially trained staff members. "Triplex Reports Discovery of Olignucleotide Compounds That Significantly Inhibit HIV-1 Activity" Business Wire (06/06/94) Scientists at Triplex Pharmaceutical Corp. have discovered a series of compounds, called guanine-thymine olignucleotides (GTOs), which seem to inhibit HIV production through a unique nucleic acid protein interaction. The compounds suppressed HIV p24 production for more than one week after being removed from an HIV-infected culture media, according to Triplex President and CEO Dr. James M. Chubb. The GTOs may prevent viral-specific transcription, thus potentially slowing or even halting disease progression, added Dr. Robert F. Rando, an assistant director at Triplex. Rando said the company is currently focusing on defining the mechanisms of action of the GTOs, and working to characterize the GTOs' long-term suppression of HIV. "Five Best Centers for AIDS Research" Advocate (05/17/94) No. 655, P. 20 A survey of medical school deans and senior faculty members lists the five best centers for AIDS research as the University of California at Los Angeles, the University of California at San Francisco, Harvard University, Johns Hopkins University, and the University of Washington. The study was conducted by U.S. News & World Report. "AIDS Vaccine Research Misleading, Group Alleges" Washington Post (06/08/94) P. A11 (Schwartz, John) Public Citizen's Health Research, a consumer health group, yesterday accused a key military researcher of manipulating data to give his research on the controversial gp160 experimental AIDS vaccine a favorable twist. After receiving a letter from Sidney M. Wolfe, the organization's director, Rep. Henry A. Waxman (D-Calif.) said he would reopen an investigation on the researchers, the vaccine, and its manufacturer, Connecticut-based MicroGeneSys. Robert Redfield, chief of the department of retroviral research at the Walter Reed Army Institute of Research, previously admitted that his analysis of the gp160 data was flawed, but was cleared of scientific misconduct charges. "HIV Screening in Pregnancy: UK Lags" Lancet (05/07/94) Vol. 343, No. 8906, P. 1113 (Banatvala, J.E.; Chrystie, I.L.) The results of 1991 HIV testing among pregnant women in London revealed that 1 in 500 women attending certain antenatal clinics were infected, and 75 percent of them did not know or did not inform health care providers that they were infected. It was also becoming increasingly clear that the advantages of knowing the HIV status of a mother and her baby outweighed the potential disadvantages. In light of this information, the Department of Health issued guidelines advising that HIV testing be made available to pregnant women in areas of "known or suspected higher prevalance of HIV infection." In 1991, only 8 of 296 hospital-based antenatal clinics--3 in Scotland and 5 in London--offered HIV tests to all pregnant women. By 1993, one year after the guidelines were released, that number had sunk to 4, although more centers were considering offering the test. The lack of antenatal HIV screening in the U.K. contrasts with other countries. Although testing is available on request in most antenatal clinics in Britain, various factors contribute to the poor response to the Department of Health's recommendations, the first of which is cost. The department took into account money for lab testing, training programs, and counseling, but failed to include the expenses for manpower and space requirements. Another reason is the fact that many staff still believe that HIV testing is not worthwhile. They should be reassured by the results of a multi-center trial of HIV-infected mothers who cut the risk of transmitting the virus to their babies by two-thirds by taking AZT. Nonetheless, the HIV program requires considerably more resources and stands little chance of implementation unless additional funds are forthcoming. "The First Search for the Source" Toronto Globe and Mail (06/08/94) P. A16 (Mickleburgh, Rod) Hospitals in Canada, where more than 1,000 blood transfusion recipients became infected with HIV, announced on Monday that they intend to track down everyone who received the procedure from 1978 to 1985, when the Red Cross began to screen donated blood for the virus. Under the trace-back procedure, when a blood transfusion patient develops HIV, the patient's hospital gives the Red Cross the code numbers of blood units donated to the patient. The Red Cross then tries to contact all of the involved donors to urge them to undergo HIV testing. This method is largely based on protocol developed in 1985, according to Col. Neville Robinson. As administrator of Vancouver's Red Cross Blood Transfusion Center, Robinson led that year's investigation into the source of HIV-contaminated blood that infected two blood transfusion recipients. Operation 300, as it was called, was 150 days spent trying to contact the 301 donors to the first infected patient and the 17 donors linked to the second patient. The detective work meant hours of telephone work at a time when fear of AIDS had gripped the public. "Good News and Bad News About AZT" U.S. News & World Report (05/16/94) Vol. 116, No. 19, P. 88 Recent studies with AZT have brought both triumph and disappointment to the AIDS battle. In a recent trial of AZT in HIV-positive, pregnant women, scientists at the National Institutes of Health calculated that those who took the drug were only one third as likely to transmit the virus to their babies as were those who took a placebo. Another finding, however, suggests that while AZT has demonstrated clear benefit to most patients who are already sick, the common practice of prescribing AZT before a patient exhibits symptoms of disease does not ultimately prolong life. In fact, according to the study, the side effects from taking the drug--including chronic nausea and fatigue--may outweigh its short-term benefits. The finding has left HIV patients in a "catch-22" situation: either to cope with the side effects of taking AZT in order to delay sickness, or to wait before taking the drug, possibly bringing illness on earlier. A panel of experts convened by the National Institutes of Allergy and Infectious Diseases suggests that AZT use be dictated by CD4 levels. Those with counts under 200 should take the drug. Patients with counts between 200 and 500 should consult a physician. And those with CD4 counts over 500--about half the normal level--should not take AZT, says the panel. "Zidovudine for the Prevention of HIV Transmission From Mother to Infant" JAMA (05/25/94) Vol. 271, No. 20, P. 1567 Although preliminary results of a trial of zidovudine to prevent HIV transmission from mothers to their babies showed a 67.5% risk reduction, the findings were subject to at least four limitations. First, the study did not measure the efficacy of zidovudine among women whose T cell counts were below 200. Nor did it assess the efficacy of zidovudine among women who had previously used the drug for extended periods and may have developed zidovudine-resistant strains of HIV. The study also did not evaluate risk in the first trimester of pregnancy. Third, the study failed to assess the independent or relative contributions of the antepartum, intrapartum, or treatment of the infant; therefore, the efficacy and side effects of zidovudine regimens restricted to only one or two of these treatment periods were unknown. Finally, the study has not yet yielded any information about long-term side effects for the infants and mothers treated with zidovudine. "Suppression of HIV Production in Resting Lymphocytes by Combining Didanosine and Hydroxamate Compounds" Lancet (05/21/94) Vol. 343, No. 8908, P. 1292 (Malley, S.D.; Grange, J.M.; Hamedi-Sangsari, F. et al.) Although the currently available AIDS drugs zidovudine, didanosine, and zalcitabine exhibit strong HIV inhibition in vitro in long-term dividing cell lines and activated peripheral blood mononuclear cells, they are only partially effective in suppressing viral replication in AIDS patients. Malley et al. suggest that it is the non-dividing "resting" cells that should be targeted for antiviral activity, since quiescent peripheral T lymphocytes may be an important and inducible HIV reservoir in infected persons. The researchers evaluated the anti-HIV activity of the three drugs and found them, alone or in combination, unable to fully inhibit viral production or protect the cells from the cytopathic effect of viral replication. The drugs were then tested in combination with hydroxamates, known for their inhibitory effect on ribonucleotide reductase in replicating cells. Didanosine in combination with '-hydroxamate (DAH) or hydroxyurea (HU) yielded a synergistic effect resulting in complete suppression of viral production, total protection against the cytopathic effect induced by viral replication, and non effect on the cells' ability to replicate normally after treatment. Trials are slated for May. "HIV Vaccine Trials: Will Intravenous Drug Users Enroll?" American Journal of Public Health (05/94) Vol. 84, No. 5, P. 761; (Meyers, K.; Metzger, D.S.; Navaline, H. et al.) A number of HIV vaccines are currently in phase I/II clinical trials, and as this work progresses towards phase III studies, a relevant practical question emerges. As of yet, little work has been done to outline the issues surrounding recruitment and retention of volunteers for HIV vaccine trials. Crucial is the need to determine whether individuals at high risk, particularly intravenous drug users, will participate. To assess the willingness of addicts to participate in vaccine trials, Meyers et al. analyzed the results of questionnaires completed by 257 IV drug users. The subjects were asked about risk behaviors, interest in vaccine trials, and other vaccine-related information. Meyers et al. discovered that 30 percent of the subjects did not even know what a vaccine was. Of those that did, however, 52 percent expressed willingness to be one of the first to participate in a preventive HIV vaccine trial. Twenty-two percent, however, said they would probably increase needle-sharing if they were vaccinated. The findings suggest that some in-treatment drug users would enroll for preventive HIV vaccine efficacy trials, but that education and counseling would be required to make sure participants fully understand the trial's purposes, methods, risks, and benefits. "AZT Not Linked to Higher Rate of Birth Defects" Philadelphia Inquirer (06/10/94) P. D9 Infants whose mothers took the anti-AIDS drug AZT while pregnant do not appear to suffer from birth defects as a result, according to a study by the Centers for Disease Control and Prevention. Of the babies born to mothers who took the drug during pregnancy, only about 2 percent had birth defects. That rate was not significantly more than the general population, in which 3 percent of all babies are born deformed. Furthermore, there was no pattern among the babies born with defects to suggest that the deformity was caused by AZT. "Scientists Joust Over AIDS Research" Baltimore Sun (06/10/94) P. 17A Two renowned scientific journals, Science and the Journal of the American Medical Association, have clashed over the validity of findings in a published report about an AIDS-related skin cancer. The dispute revolves around an experimental compound regarded by leading AIDS researcher Dr. Robert Gallo as promising for the treatment of Kaposi's sarcoma. Public debate exploded on Wednesday when JAMA printed a report by Dr. Marlys H. Witte et al. of the University of Arizona in Tucson, who attempted, but failed, to duplicate Gallo's experiments with mice and confirm some of the key findings. The researchers say Gallo's work is flawed by systematic errors and omissions, and that their challenge of the findings' validity was foiled by another journal, Science. Witte et al. had originally submitted their own report to Science, which had published Gallo's study, but the journal called the Witte team's experiments "an extraordinary waste of time and effort" and rejected the paper. When a second report including the comments of another researcher, Dr. H.J. Carroll, was again rejected by Science, the Tucson researchers decided to air the dispute through JAMA. Related Story: Chicago Tribune (06/09) P. 1 "TB Underestimated in HIV Wasting" United Press International (06/11/94) HIV wasting syndrome, or slim disease, is caused by tuberculosis more often than previously thought, according to a British study. HIV patients who have wasting syndrome shed much of their body weight, and the condition is especially common in Africa. Researchers examined the bodies of more than 200 HIV patients in the Ivory Coast, and found that nearly half of the 93 patients with wasting syndrome were co-infected with tuberculosis, although TB treatment was not noted on the patients' medical records. The researchers also found that the most severe cases of wasting syndrome were accompanied by the most severe cases of tuberculosis. They concluded that the large volume of TB in the body suggests that it--and not the intestinal parasite and lack of food previously attributed--is probably the cause of the wasting syndrome. Because TB is treatable in its early stages, the findings have major implications for African cities. "Another HIV Drug" Lancet (05/28/94) Vol. 343, No. 8909, P. 1306 (Rowe, Paul M.) Stavudine, also known as d4T, is the fourth inhibitor of HIV reverse transcriptase pushing for accelerated Food and Drug Administration approval. Despite the fact that little is known about the nucleoside analogue's specific indications, interactions with other drugs, or effects in segments other than young white males, an advisory committee in May was supportive of a recommendation for approval. The drug has been tested on 10,000 subjects, 79 percent of whom are still alive after 18 months. Another trial compared d4T with zidovudine, and found d4T to be significantly better at increasing or maintaining CD4 cell levels and decreasing HIV antigen levels. ------------------------------ End of HICNet Medical News Digest V07 Issue #28 *********************************************** --- Editor, HICNet Medical Newsletter Internet: david@stat.com FAX: +1 (602) 451-1165 Bitnet : ATW1H@ASUACAD