The impact of AIDS on state and local health departments: issues and a few answers.

Owing to large differences in the incidence of AIDS (acquired immunodeficiency syndrome) and in public health resources and priorities, the impact of AIDS on state and local health departments has been variable. Nonetheless, health departments everywhere are being held responsible for surveillance and control of the HIV (human immunodeficiency virus) epidemic which we believe requires, at minimum, convenient, free HIV testing and counseling; expanded HIV services in sexually transmitted diseases clinics and substance treatment centers; locally oriented AIDS information/education; notification of persons unknowingly exposed to HIV; restrictive measures for HIV-infected persons who, after counseling, persist in exposing others; regulation or closure of public establishments in which HIV transmission is likely to result; and confidential reporting of all HIV test results to public health departments. In Colorado new legislation was passed to require reporting of HIV test results, to provide the reports with near absolute protections against unauthorized disclosure, and to modify quarantine statues to incorporate rights to due process, appeals, and confidentially. States in which there is a legal basis for discrimination against gay men will need to rectify this problem first. There is no evidence that reporting of HIV infections in Colorado has adversely affected the rate at which persons with HIV risk behaviors volunteer to be tested. For Denver and Colorado Departments of Health, more than 70 per cent of the estimated $2,796,000 expended in AIDS activities during 1987 was federal.     

Changing mortality patterns in Nauruans: an example of epidemiological transition.

An analysis of mortality data for the years 1982-5 was carried out for the Micronesian population (aged 15 years and over) of the central Pacific Island, Nauru. Among males, the most common causes of death were circulatory system disorders (33.3%), accidents (25.2%), and diabetes mellitus (12.1%). The majority of accidents occurred in the 15-34 year age group and involved motor vehicles. Among females, neoplasms (almost all lung and cervix) (22.4%), circulatory system disorders (20.7%), and diabetes mellitus (17.2%) were the most common causes of death. When accidents are excluded, 59.4% of deaths were in persons with diabetes. Compared with Australia, mortality rates in almost all age groups were at least five times higher for males and females for a comparable period. Nauruan life expectancy (39.5 years for men and 48.5 years for women) is one of the lowest in the world. These data confirm the high mortality associated with diabetes mellitus in Nauruans as evidenced in earlier studies. Modernization of this society through the affluence acquired by the mining of phosphate has led to serious public health problems relating to non-communicable diseases so that the mortality trends now mirror those of developed societies.     

Theoretical and practical considerations in the doubly-labelled water (2H2(18)O) method for the measurement of carbon dioxide production rate in man

In the doubly-labelled water (2H2(18)O) method for the measurement of carbon dioxide production rate in man, single exponential disappearance curves for 2H2O and H2(18)O in body water are used; the precision with which the slopes and intercepts of the curves are estimated determines the precision of the estimate of carbon dioxide production rate. In studies with infants, and in computer simulations, the effect of different experimental regimes on the overall precision of the carbon dioxide production estimate was investigated. When the number of data points used was progressively reduced by shortening the total observation period from 7 d (about 3 biological half-lives for the isotopes) to 1 d there was a deleterious effect on precision and in the infants there was an upward bias in the values for carbon dioxide production. When the number of data points was reduced by removing points from the middle of the exponential curves with the maintenance of the 7-d experimental period, precision was also reduced but by less than in the former procedure and there were no consistent trends in the average values for carbon dioxide production.