The Swedish childhood diabetes study — a multivariate analysis of risk determinants for diabetes in different age groups

Summary In a nationwide incident case-referent study stepwise univariate analysis has revealed several risk determinants for childhood diabetes mellitus. In a multivariate analysis we have determined the set of risk determinants that would independently predict childhood Type 1 (insulin-dependent) diabetes. Possible interactions between the risk determinants and differences in risk profiles with different ages at onset were also examined. Reported familial insulin-treated and non-insulin-treated diabetes were significant risk factors in all age groups, as was also a low frequency of milk intake. The frequency of infections and a high intake of foods rich in nitrosamine tended to interact (OR 11.8, p=0.053) indicating a synergistic effect. A Cox regression analysis revealed that stressful life events during the last year was the only variable that tended to affect the age at onset (p=0.055). This indicated that psychological stress may rather precipitate than induce Type 1 diabetes. A short breast-feeding duration (OR=3.81), and an increased body height (OR=3.82) contributed significantly to the predictive model in only the youngest age group (0–4 years). An increased frequency of infections in the year preceding onset (OR=2.15) and no vaccination against measles (OR=3.33) contributed significantly to the model only in the age group 5–9 years. Various nutrients had different impacts on the risk of developing Type 1 diabetes in different age groups. It is concluded that in the genetically susceptible child, risk factors which are associated with eating habits, frequency of infections, vaccination status, growth pattern and severe psychological stress affect the risk of developing diabetes independently of each other. The set of risk determinants varies with the age at onset. A high frequency of infections and a high frequency of nitrosamine-rich food intake seem to have a synergistic effect on the risk of developing diabetes in childhood.     

广东省1995～2001年HIV抗体阳性献血员合并HBV、HCV、梅毒感染状况调查

目的 了解广东省1995～2001年献血员HIV流行的特征及与其他传染病合并感染情况，为制定HIV经血源传播防治策略提供依据。方法 收集1995～2001年广东省HIV抗体阳性献血员资料进行分析，并进行HBV、HCV和梅毒血清学检测。结果 1995～2001年，广东省累计HIV抗体阳性献血员167例，占全省报告HIV感染总数的5．44％(167／3072)，且献血员中HIV抗体阳性人数逐年增长。167例病例中以男性为多(88．02％)；年龄主要集中在20～29岁组(55．09％)；病例送检地区以广州、深圳和东莞为主；其原籍主要是广东省和河南省。128例肌，抗体阳性献血员中抗-HCV、梅毒抗体及HBsAg阳性率分别为79．69％、7．81％及3．13％，HIV／HCV／梅毒、HIV／HBV／HCV、HIV／HBV／梅毒三重感染率分别为7．81％、3．13％及0，未发现四重感染。结论 广东省肌，抗体阳性献血员合并HCV和梅毒感染率高。应加强献血员的筛查及流动人口的管理，以控制HIV,HBV和HCV经献血员向一般人群传播。     

农村居民艾滋病防治知识及高危行为调查研究

目的　通过对农村居民艾滋病 (AIDS)防治知识及高危行为的研究 ,为制定AIDS预防控制措施提供依据。方法　运用横断面调查研究方法 ,通过两阶段人群抽样对其AIDS防治知识及相关行为进行研究。结果　调查对象听说过AIDS的为 6 1.78% ;答对 0～ 3题为 5 6 .91% ,4～ 9题为 38.4 8% ,10～ 13题为 4 .5 5 % ;认为不可能感染艾滋病病毒的为 5 6 .94 % ,不清楚的为 38.38% ,有可能的为 4 .6 8%。 12人有卖血史 ,15人有性病史 ,在有性行为的 886人中 ,7.6 7%有过 1个以上多性伴。结论　农村居民AIDS知识匮乏 ,存在着相关危险行为。所以 ,我省预防AIDS的策略主要是开展健康教育积极推进健康促进 ,改善危险行为 ,提倡安全性行为和推广安全套的使用     

Chronic cryptococcal meningitis in an intravenous drug addict without evidence of infection by HIV-1,2 in southern Italy

Before the emergence of AIDS, extra-pulmonary cryptococcosis was very rare. By contrast, meningeal cryptococcosis is a very common opportunistic infection in AIDS patients. We report an intravenous drug addict with cryptococcal meningitis, who was not infected with HIV and had no apparent predisposing conditions. This case, as those elsewhere described, supports the potential existence of viral agents, other than HIV-1,2, capable of encouraging the occurrence of unusual infections as have emerged during the AIDS pandemic.     

IgE and atopy in perinatally HIV-infected children

Elevated serum immunoglobulin E (IgE) and increased prevalence of atopy is reported in patients infected with human immunodeficiency virus (HIV). The elevated serum IgE may be attributed to polyclonal stimulation of B cells or IgE production against allergens, viruses, fungi and bacteria. This study investigates the prevalence of atopy in perinatally HIV-infected children, and the relationships between serum IgE (and other serum immunoglobulins) with atopy, CD4+ cell count and HIV-disease stage. Serum immunoglobulin levels, epicutaneous skin test for common aeroallergens, clinical Centers for Disease Control and Prevention (CDC) classification, CD4+ cell counts and allergy history were extracted from the charts of perinatally HIV-infected children on highly active antiretroviral therapy. The prevalence of atopy (52%) and the pattern of aeroallergen sensitivity were comparable with the US pediatric population. Serum IgE levels did not correlate with clinical disease stage. However, in non-atopic patients, serum IgE levels increased with disease progression (p = 0.02). There was an inverse relationship between the prevalence of elevated serum IgE levels and atopy with progression of disease (p = 0.019). Serum IgE did not correlate with atopy, CD4+ cell count, or duration of HIV infection or levels of serum immunoglobulins. This is the first study to show no increased prevalence of atopy in perinatally HIV-infected children compared with the general population. In advanced stages of HIV, elevated serum IgE may be specific for antigens other than those known as allergens.     

Describing the health-related quality of life impact of HIV infection: Findings from a study using the HIV Overview of Problems—Evaluation System (HOPES)

This study aimed to describe the results of findings from data collected with an HIV-specific health-related quality of life tool, and to examine the relationship between clinical and biological factors and health-related quality of life (HRQL). Data were collected as a cross-sectional, patient-completed assessment of health-related quality of life. Laboratory data were abstracted from the medical chart. Patients (n=318) with HIV infection including asymptomatic (37%), ARC (20%), AIDS (25%), and AIDS with cancer (18%) were receiving health services at one of the medical centres serving HIV-infected patients in the Los Angeles community, including UCLA, community physicians, Veterans Affairs Medical Centers, and a county hospital. Additional data were contributed by the Johns Hopkins University Medical Center CMV Retinitis Clinic. Symptomatic patients and patients with the lowest CD4 counts reported poorer HRQL than asymptomatic patients and patients with higher CD4 counts. However, medical and demographic variables explained only 35% of the variability of HRQL ratings in this sample of HIV-infected patients. While clinical status and Karnofsky performance status may be used to estimate the impact of HIV infection on HRQL, they are not a substitute for independent assessment of HRQL by the patient.This research was funded in part by the UCLA AIDS Clinical Research Center and CARES Consultants. To obtain more information about the HOPES, please contact the second author at CARES Consultants, 2210 Wilshire Blvd, Suite 359, Santa Monica CA 90403     

Demand patterns for HIV-tests in general practice: Information collected by sentinel networks in 5 European countries

This study describes a p. year international data collection on the demand pattern for HIV-antibody tests in general practice recorded by 6 sentinel networks in 5 European countries. The purpose of the recording was to evaluate the use of HIV-antibody testing by general practitioners and the demand for testing among the general population. Sentinel networks of general practitioners are a possible and available instrument for monitoring the perception of the HIV-test, and indirectly of the threat of the HIV-epidemic by the public and by the general practitioners (GPs). Differences were found between the countries in the frequency of testing, the person asking the test and the reason for testing. Possible explanatory factors, such as differences in the routine testing of specific groups, differences in the training and in the role of the GP, differences in the characteristics of prevention policy, are discussed. The European comparison also offers the opportunity to reflect on common medical practice in dealing with demands for HIV-tests.     

Evidence for reliability, validity and usefulness of the Medical Outcomes Study HIV Health Survey (MOS-HIV)

The Medical Outcomes Study HIV Health Survey (MOS-HIV) is a brief, comprehensive measure of health-related quality of life (HRQoL) used extensively in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). The 35-item questionnaire includes ten dimensions (health perceptions, pain, physical, role, social and cognitive functioning, mental health, energy, health distress and quality of life (QoL)) and takes approximately 5 minutes to complete. Subscales are scored on a 0–100 scale (a higher score indicates better health) and physical and mental health summary scores can be generated. The MOS-HIV has been shown to be internally consistent, correlate with concurrent measures of health, discriminate between distinct groups, predict future outcomes and be responsive to changes over time. Limited experience suggests acceptable reliability and validity in women, injecting drug users and African–American and lower socioeconomic status patients. The MOS-HIV is available in 14 languages and has been included as a secondary outcome measure in numerous clinical trials for all stages of disease. In several studies it has detected significant differences between treatments; in some cases concordant with conventional end-points and, in others, discordant. The interpretation of scores is facilitated by an explanation in terms meaningful to the intended audience. Research is needed to compare the MOS-HIV to other strategies for HRQoL assessment in early HIV disease.     

温州市艾滋病流行特征及流行趋势分析

目的 分析温州市1985～2000年HIV／AIDS流行现状及影响因素，为采取有效控制措施提供依据。方法 分析全市的艾滋病监测及实验室资料。结果 1985年发现首例HIV抗体阳性，至2000年底累计发现感染者124例，发病27例，死亡16例。感染者以青壮年为主，男女比例为3．28：1，静脉推注吸毒和性接触是主要传播途径。结论 预计今后几年温州市高危人群中HIV感染者将大幅度增长，必须采取有效措施预防和控制艾滋病。