The relationship of absolute poverty and bone mineral density in postmenopausal Iranian women

Summary Objective:  It is increasingly recognized that socioeconomic inequalities play an important role in bone health, with significantly higher fracture rates being reported in lower income groups. But the relationship between absolute poverty and bone mineral density (BMD) and/or osteoporosis has not been investigated. Methods:  A total of 1135 postmenopausal women under absolute poverty lines who received financial support from the Imam Khomeini Relief Foundation (IKRF) and 406 randomly selected healthy postmenopausal women were screened for osteoporosis using BMD testing. Results:  At all BMD sites, women under the absolute poverty lines had the lowest mean BMD values (p < 0.0001). According to the WHO criteria, 252 subjects under absolute poverty lines (22.4%) and 35 healthy postmenopausal women from the general population (8.7%) were considered osteoporotic (p < 0.0001). After adjustment for lifestyle factors for osteoporosis in logistic regression models, absolute poverty was associated with the age-adjusted prevalence of femoral neck osteoporosis and lumbar osteoporosis [OR = 2.50 (CI, 1.38–4.51; p = 0.002); OR = 2.40 (CI, 1.56–3.70; p < 0.0001), respectively]. Conclusion:  Postmenopausal women under the absolute poverty lines had lower BMDs at all skeletal sites, independent of established osteoporosis risk factors. Submitted: 13 February 2008; Revised: 03 June 2008; Accepted: 09 June 2008     

Knowledge and attitude towards HIV/AIDS among Iranian students

Background  

Young people are of particular importance in state policies against Acquired Immunodeficiency Syndrome (AIDS). We intended to assess the knowledge and attitude of high school students regarding AIDS in Iran.     

Frequency of Mycobacterium tuberculosis infection among Iranian patients with HIV/AIDS by PPD test

Persons infected with the Human Immunodeficiency Virus (HIV) are particularly susceptible to tuberculosis, either by latent infection reactivation or by a primary infection with rapid progression to active disease. This study was done to determine the frequency of tuberculosis infection among Iranian patients with HIV/AIDS. A total of 262 HIV/AIDS patients attending all three HIV/AIDS health care centers of Tehran, Iran were enrolled in this study. A detailed history and physical examination were obtained from all HIV patients suspected of having pulmonary M. tuberculosis. A positive PPD skin test was used as a diagnostic parameter for probability of TB infection. Out of 262 HIV/AIDS patients, a total of 63 (24%) were shown to have the tuberculosis infection based on a positive PPD skin test. Of the patients with positive PPD skin test, 22 (35%) had pulmonary Tuberculosis, 2 (3.2%) had extrapulmonary tuberculosis, and 39 (53%) had no evidence of M. tuberculosis infection (latent infection). Also 8 (12.7%) had history of long term residence in a foreign country, 32 (50.8%) were exposed to an index case, and 9 (14.3%) had past history of pulmonary tuberculosis, while only 33.3% had clinical manifestations of TB (active disease). There was no resistant case of tuberculosis. Our study showed that near 24% of Iranian patients with HIV/AIDS were infected with M. tuberculosis. This finding denotes the need to improve the diagnostic and preventive measures, and also prompt treatment of this type of infection in the HIV infected individuals.     

Predictors of bone mineral density in patients with eating disorders

OBJECTIVE: The objective of this study was to examine potential clinical predictors of bone density in patients with eating disorders. METHOD: We studied 137 women with anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified (NOS) after admission to the hospital. Clinical data of patients were collected by clinical interview and standardized questionnaires. Bone mineral density of the lumbar spine was measured by dual energy x-ray absorptiometry. RESULTS: Lumbar bone density was significantly correlated to present and past minimum weight even after correction for height and age. Other factors did not reach significance. CONCLUSION: Normalized present and past weight is the best predictor of lumbar bone density in patients with eating disorders. Factors like reduced caloric intake, binge eating, vomiting, menstrual status, and use of estrogen, laxatives, and nicotine seem to have no independent effect on bone density in this group of patients.     

河南省HIV感染者/AIDS患者生存质量评价

目的 了解河南省HIV感染者/AIDS患者生存质量状况及其影响因素,为改善HIV感染者/AIDS患者生存质量提供参考依据.方法 采用世界卫生组织艾滋病生存质量简表对河南省艾滋病高发区112例HIV感染者/AIDS患者生存质量及相关因素进行问卷调查.结果 HIV感染者/AIDS患者生存质量总分为(72.00±10.10)分;HIV感染者/AIDS患者得分除精神支柱/个人信仰领域高于中国常模外(P<0.05),其他领域得分及总评分均低于中国常模,差异有统计学意义(P<0.05);不同抑郁状况(t=-6.31,P=0.00)、相关症状数(t=-2.32,P=0.02)、家庭支持度(t=3.66,P=0.00)HIV感染者/AIDS患者生存质量比较,差异有统计学意义.结论 HIV感染者/AIDS患者的生存质量低于一般人群,对HIV感染者/AIDS患者医疗救助的同时进行心理咨询可以提高其生存质量.     

Assessing the National HIV/AIDS Strategy Evaluation

The report is a useful compilation of data on Australia's HIV/AIDS epidemic and the response to it. The report produces firm evidence for endorsing Australia's success in limiting the spread of HIV by a number of routes. Australia has been successful in preventing iatrogenic spread, spread through commercial sex and spread through injecting drug use. In the latter case however, the hepatitis C epidemic cautions against complacency. The report, unfortunately, does not recognise very serious weaknesses in the evidence it uses as a basis for its endorsement of current efforts against HIV in the male homosexual community and the general heterosexual community. The report recognises failure of current policies in Aboriginal and Torres Strait Islander communities and recognises the threat posed here by HIV but recommends no major policy change. There is some recognition of the limitation of the data, but no recommendation for increased surveillance. The report ignores methods of prevention other than public health education. In my view, there is sufficient evidence to recommend routine neonatal circumcision, at least in Aboriginal and Torres Strait Islander communities. There is a clear need for a more effective approach to STD control, particularly in these communities. ^19,24–28 Adequate STD and HIV control may well require contact tracing and surveillance using traditional public health methods. Measurement of objective indicators of the success of HIV prevention campaigns needs to be improved with more comprehensive collection of data on HIV and STD incidence and condom sales, stratified by relevant covariates. Survey evidence of behavioural change should be collected from those too young to be affected by the selective mortality factor. The international comparisons await a proper statistical study which may be able to identify the elements of an effective approach to AIDS. In future reviews of the effectiveness of Australia's response to AIDS, all methods of limiting the spread of the epidemic should be considered objectively. It is unacceptable for the AIDS program to be declared optimal simply because it accords with current public health ideology.     

深圳市HIV/AIDS患者艾滋病污名和自评症状关联分析

目的了解深圳市HIV/AIDS患者艾滋病污名状况以及和自评症状之间的关系,为艾滋病污名干预提供依据。方法在深圳市内5个区和1个定点治疗医院随机抽取353名HIV/AIDS患者,用Berger-HIV污名量表,SCL-90和社会支持评定量表进行心理学测量,用自行编制问卷进行一般社会人口学信息和患病情况调查。结果深圳市HIV/AIDS患者Berge污名总分均值为(109.41±16.55),关联分析显示Berger污名量表的担心公众歧视、负面自我印象两个维度和SCL-90中的精神病性偏执,以及人际关系敏感因子的相关性较大(R0.400,P0.01)。多因素线性回归模型结果显示社会支持(β=-0.260),疾病类型(HIV或AIDS)(β=-0.111),文化程度(β=0.105)影响艾滋病污名总分差异有统计学意义(P0.05)。结论艾滋病污名的维度(担心公众歧视、负面自我印象)能够激活一系列内在负性情感和认知表达(如怀疑、警惕等精神病性症状和偏执等),负性的情感认知状态可能导致患者负面的行为表达(人际关系敏感、负面印象管理),提示HIV/AIDS患者积极的认知模式和社会支持可能是患者艾滋病污名的有效干预措施。     

老年尘肺患者骨密度及骨代谢指标的临床分析

选取34例老年尘肺患者和30名非尘肺健康体检者进行骨密度和骨代谢生化指标检查。结果显示,与对照组相比,老年尘肺患者的跟骨骨密度T值呈现明显的下降趋势,骨质疏松发生率明显增高(P0.05);老年尘肺患者血清中骨代谢生化指标骨钙素蛋白(BGP)值和人骨碱性磷酸酶(BALP)值明显降低,而血清中骨抗酒石酸酸性磷酸酶(TRACP-5b)值明显升高(P0.05)。提示老年尘肺患者骨质疏松症的发病率可能高于同龄的健康者,应预防因骨质疏松症导致尘肺患者骨折的发生。     

The effects of mindfulness-based stress reduction (MBSR) program in Iranian HIV/AIDS patients: a pilot study

Psychological or behavioral interventions that attenuate the effects of stress may be useful in promoting immunocompetence and delaying HIV disease progression and CD4 count level. Mindfulness-Based Stress Reduction (MBSR) is a behavioral intervention that has as its foundation the practice of insight-oriented (or mindfulness) meditation. In this study, we examined the effects of MBSR upon psychological, physical status and CD4 count of HIV/AIDS infected patients registered at the Positive Club of Imam Khomeini Hospital in 2007. Using a pilot study, we evaluated the effectiveness of a psychological intervention (8-week) that was based on training in mindfulness at the Positive Club of Imam Khomeini Hospital in 2007. Eight 2-hour sessions weekly and a day-long retreat were planned for a group of 10 participants with HIV. We investigated the long-term effects of this approach on psychological and physical status of patients by SCL-90-R and MSCL questionnaires and CD4 count after MBSR and in 3, 6, 9 and 12-month follow-ups. We studied six HIV positive patients. The mean age was 35 +/- 7.7 yrs. There was no significant difference in MSCL scores after MBSR and in 3, 6, 9 and 12 months compared to those before MBSR (P>0.05). There was a significant difference in SCL-90-R score after MBSR compared with before (P=0.05). Nevertheless, in 3, 6, 9 and 12 months no significant differences were seen in SCL-90-R scores relative to those before MBSR (P>0.05). The means of CD4 count, before and after MBSR, and in 3, 6, 9 and 12 months were 549 +/- 173.6, 640.2 +/- 189.4, 655.3 +/- 183.4, 638 +/- 167.4, 619.3 +/- 163.2, and 595.2 +/- 165.6, respectively. There was a significant difference in CD4 counts in comparison with those before MBSR (P<0.05). In our study, MBSR had positive effects on psychological status and CD4 count. However, more studies with large sample size are necessary.     

HIV/AIDS患者感染结核病早期诊断方法研究

目的评价痰涂片、线性探针、改良罗氏培养与药敏试验、血清结核抗体、PPD皮肤试验等方法在HIV/AIDS中早期诊断结核病的优缺点,为基层一线医护工作者提供参考依据。方法选择HIV/TB双重感染患者346例、350例单纯结核病采用成组设计的病例对照研究,分别用5种方法开展检测,比较两组患者的阳性检出率、敏感度、特异度以及检出时间周期等,以及在HIV/TB组中不同的CD4细胞计数人群的5种方法受影响情况,用统计学方法评价何种方法更适合基层卫生机构的工作。结果 5种检测方法中阳性检出率为线性探针检查最高,检出率最低的是痰涂片;检出周期最长的是痰培养(需要近个月的培养才能得到结果),检出周期最快的是血清结核抗体和痰涂片(当天就可以得到结果),结性探针方法在24 h左右可以得到检测结果;线性探针敏感度为61.56%、特异度为100.00%,而且其检测水平不受HIV/TB患者不同CD4细胞水平的影响,是各种检测方法中最理想的方法。结论从稳定性、敏感度以及检出结果周期等综合考虑,线性探针技术是当前县一级卫生机构对HIV/AIDS中早期诊断结核病的适宜技术,虽然需要特殊设备和环境,操作技术和防污染措施要求严格,必须下大力气去推广应用,从疾病防控的角度力求突破。     

艾滋病患者血流感染的研究

血流感染(BSI)对艾滋病患者的预后有重要意义,即使在HAART时代,BSI在艾滋病患者的死亡原因中仍排在前三位.国外有较多针对艾滋病患者BSI的研究,而国内这方面的研究较少.此文就艾滋病患者BSI的发病率、病原体、诊断、预后和防治等问题作了综述.     

化疗对乳腺癌患者骨密度的影响

目的探讨化疗（药物治疗）对乳腺癌患者骨密度的影响及可能的机制。方法68例乳腺癌患者（绝经前28例,绝经后40例）和50例正常对照。乳腺癌患者术后均常规化疗。其中绝经前患者化疗结束后按月经状况分为：A组16例,化疗结束后继续行经;B组12例,化疗结束后停经。所有研究对象均测量基线骨密度（BMD）;用双能X线吸收测定仪（DEXA）测量腰椎和左髋部位的BMD,分别比较肿瘤组化疗前、后,A组与B组化疗结束后BMD的变化。结果肿瘤组化疗后腰椎和左髋部位的BMD比化疗前均显著降低（P〈0．05）;B组化疗结束后较A组化疗结束后腰椎和左髋部位的BMD均有明显降低（P〈0．05）。结论化疗导致乳腺癌患者骨量早期丢失。对于绝经前的患者,卵巢功能衰竭是引妒骨量丢失最重要的原因。     

Epidemiological profile of elderly HIV/AIDS patients

The present study is the result of an experience in the hospital Correia Pican?o in Recife, Pernambuco Federal State, a reference hospital for HIV patients. The objective of this investigation is to supply the discrepancy of information on elderly carriers of HIV. This is a quantitative, transversal and retrospective research. A diagram form was used to organize the data collected from 46 medical records. Results showed that there was an increase on the number of women, especially married women, heterosexuals, and elderly infected by HIV. The study also showed an increase on the number of infections through sexual contact and the predominance of carriers who were undereducated. It was also observed that the medical records were incomplete. The conclusion was that preventive education programs have to be elaborated in order to reach the population in general, including the elderly.     

HIV/AIDS患者的心理需求调查

目的 了解HIV／AIDS患者的心理需求。方法 对我国4个省111例HIV／AIDS进行流行病学问卷调查和个人深入访谈。结果 大部分感染者都表现出对结果的不相信，在知道感染后大部分感染者都选择不告诉其他人。对于是否愿意和其他感染者进行交流。在因吸毒和血液途径的感染者中均有较高的比例，分别是75．56％和87．10％，而且其中94．29％和100％的人将面对面交流作为首选。结论 HIV／AIDS患者承受的心理压力巨大，应采取有效措施加以改善。     

Depot medroxyprogesterone and bone mineral density

OBJECTIVE: To investigate depot medroxyprogesterone (DMPA)-associated bone loss in a general practice setting. DESIGN: Forty-eight patients from a single practice who had used DMPA for contraception for more than 2 years. All patients had a serum oestradiol and if the serum level was <52 pmol/l or >52 pmol/l with menopausal symptoms, bone mineral densitometry (BMD) measurements were made at the lumbar spine (LS) and femoral neck (FN) using dual-energy x-ray absorptiometry (DEXA). Thirty-two patients had bone densitometry, of whom 27 had a serum oestradiol <52 pmol/l and five >52 pmol/l associated with menopausal symptoms. Of the remaining 16 patients, nine patients had a serum oestradiol <52 pmol/l but did not have a BMD as they moved away (five women) or switched to another contraceptive (four women). RESULTS: BMD results showed a significantly reduced bone mass at both sites with mean Z score LS -0.84 (95% CI -1.17 to -0.52) and FN -0.32 (95% CI -0.62 to -0.02). Eighteen women (56% of 32 women) had either osteopenia (15 cases) (T score < -1.0) or osteoporosis (three cases) (T score < -2.5) at the LS. There were trends to an association of a family history of height loss or tobacco smoking (current or past) for LS and FN Z scores that did not quite achieve significance. There was also a trend to lower body weight in those with a possible family history of osteoporosis or who were smokers and an inverse correlation of weight with BMD at the FN (p < 0.05) and a non-significant inverse correlation at the LS. CONCLUSION: The present results demonstrate that a low bone mass should be considered in patients with prolonged DMPA usage especially if they have risk factors for osteoporosis.     

Evaluation of an intensive HIV/AIDS counselling course in Zimbabwe

The anticipated increase in the number of people with HIV infection and AIDS in Zimbabwe, together with those who have associated worries, will place extra demands upon clinical and counselling services in the coming decade. To meet these demands, a wide range of health care staff will have to acquire specialist counselling skills. For this reason, an intensive 2 day HIV/AIDS counselling training course was run at the Family Counselling Unit, Harare, in February 1989. The structure, content and evaluation of the course are presented here. Overall, the course was positively evaluated by the 38 trainees. However, a number of trainees were critical about some of the teaching methods and the degree of emphasis given to some of the objectives. Our experiences may help others in establishing HIV/AIDS counselling courses elsewhere.