Evidence on delay in sexual initiation, multiple partnerships and condom use among young people: review of Caribbean HIV behavioural studies.

OBJECTIVE: To develop a Caribbean regional profile of youth sexual behaviour associated with risk of HIV. DESIGN AND METHODS: A review of sexual behaviour surveys with youth aged 15-24 years was conducted as part of the Pan American Health Organization (PAHO) HIV Caribbean Office's Review and Gender Analysis of Caribbean HIV Behavioural and Seroprevalence Studies. Studies with internationally recommended indicators were prioritized. Studies were sought via database searches and contact with researchers and National AIDS Programmes. RESULTS: Inter-country comparisons and longitudinal analyses were limited by lack of uniformity in study age groups and indicators. Data were sufficient to identify the following among 15-24-year olds: .More males than females report sexual intercourse before the age of 15 years. .More than half of sexually active youth report sex before age 16 years. .First sexual encounter is usually with someone older, with age differences larger for females. .More males than females report multiple partnerships, with 20%-76% of males reporting this in the past year. .Condom use varies widely, with no clear pattern by gender. CONCLUSION: There are substantial levels of early sexual initiation, intergenerational sex among females and multiple partnerships among males, while condom use is inconsistent. Efforts to promote delay in sexual initiation, partner reduction and consistent condom use should be supplemented with initiatives against harmful gender norms, child abuse and transactional sex and skills to negotiate safe sex. Standardization of survey methods to facilitate cross-study comparisons should continue and encompass additional risk factors such as transactional sex, gender-based violence, drug use and HIV treatment adherence.

Adherence to antiretroviral therapy by people accessing services from non-governmental HIV support organisations in three Caribbean countries.

OBJECTIVE: To identify factors associated with antiretroviral therapy (ART) adherence in order to guide the development of strategies to improve the situation. DESIGN AND METHODS: A cross-sectional survey was conducted with people living with HIV (PLHIV) who receive services from non-governmental organisations affiliated to the Caribbean Regional Network of People Living with HIV/AIDS (CRN+) in Antigua and Barbuda, Grenada and Trinidad and Tobago. PLHIV from CRN+, traced potential participants, administered informed consent procedures and carried out structured interviews. The main outcome measure was 95% to 100% adherence over the previous seven days. Multiple logistic regression was conducted to identify associations with demographic characteristics, psychological status, health and support service use, sexual behaviour and substance abuse. RESULTS: Of 394 respondents, 69.5% were currently taking ART. Of these, 70.1% took 95% to 100% of their prescribed pills. One in 20 took more pills than prescribed, all of whom were prescribed fewer or equal to the median pill number. Factors independently associated with adherence were use of a counselling service (OR 3.20; 95% CI 1.55, 6.61), revelation of HIV status without consent (OR 2.31; 95% CI 1.13, 4.74), alcohol consumption (OR 0.47; 95% CI 0.23, 0.96) and side effects (OR 0.32; 95% CI 0.15, 0.68). Drug resistance to ART was reported by 6% of users. CONCLUSION: Improvements in ART adherence may be achieved by counselling, focussed attention to alcohol users and developing drugs with reduced side effects. Such measures are critical to maintain PLHIV quality of life gains and prevent the proliferation of drug resistant HIV strains.

Factors associated with condom use: economic security and positive prevention among people living with HIV/AIDS in the Caribbean.

In the Caribbean region, an estimated 1.1% of the population aged 15-49 is living with HIV. We aimed to measure factors associated with condom use, the primary form of positive prevention in the Caribbean, among people living with HIV (PLHIV) in its major agency advocating on behalf of PLHIV (the Caribbean Regional Network of People Living with HIV/AIDS, or CRN +). Condom use at last sex was selected for analysis from a broad-ranging cross-sectional survey (n=394) among PLHIV who were members of or received services from CRN+ in Antigua and Barbuda, Grenada, Trinidad and Tobago. PLHIV from CRN+ traced potential participants, administered informed consent procedures and carried out structured interviews. Fifty-four percent of respondents reported using a condom the last time they had sex. Condom use was positively associated with partner being HIV negative, disclosure of HIV status, alcohol use, economic security, education level and being employed. Multivariate logistic regression found independent associations between condom use and economic security (p=0.031; odds ratio (OR) for "enough" income 5.06; 95% CI 1.47-17.39), partner being HIV negative (p=0.036; OR 2.85; 95% CI 1.28-6.33) and being married (p=0.043; OR 2.86; 95% CI 1.03-7.91). Seventy-three percent of respondents reported inadequate family income, 26% reported an HIV-negative partner and 9% were married. Condom use appears to be motivated by protection of HIV-negative partners and spouses. Low socioeconomic status is associated with the overall percentage using condoms. Restriction to members of CRN+ limits generalisability of the findings. Nevertheless, the findings support the view that programmes for the socioeconomic empowerment of PLHIV are needed to slow the Caribbean HIV epidemic. Expectations for protection of different types of partners should be further explored in order to develop culturally appropriate interventions with couples.

Studies on seeds. IV. Lipid composition of bean cotyledon vesicles.

Lipid content has been determined for two types of lipid-rich vesicles isolated from bush bean cotyledon at 24 hr of germination. The larger, nonassociating vesicles are four to six times richer in triglyceride than the smaller vesicles which associate strongly among themselves, as well as with smooth membranes in the cell. The larger vesicles contain about 640 micromoles of phospholipid per gram of protein, while the smaller vesicles have only one-half to two-thirds as much phospholipid per gram of protein. The ratio of individual phospholipids in both kinds of vesicles is close to 20% phosphatidylethanolamine, 60% phosphatidylcholine, and 20% phosphatidylinositol. The fatty acid composition of all phospholipids is similar, and quite different from that of triglyceride, which contains twice as much linolenic acid and less than one-fourth as much palmitic acid. Pea cotyledon has quantitatively the same lipid content as bean cotyledon.

Evidence that the pars intermedia and pars nervosa of the pituitary do not secrete functionally significant quantities of ACTH.

We have compared the capacity to secrete ACTH in response to stress or adrenalectomy in control rats and in those with total hypophysectomy (H), adenohypophysectomy (AH) with preservation of the intermediate and the neural lobes, neurohypophysectomy (NH) with removal of the pars nervosa and all or part of the pars intermedia with preservation of the adenohypophysis, or incomplete adenohypophysectomy (IAH) in which a portion of the adenohypophysis and all of the pars intermedia and pars nervosa were left intact. Plasma ACTH measured with an N-terminal antibody that reacts on an equimolar basis with ACTH and alpha-MSH but not with other known pituitary hormones was elevated after ether or tourniquet stress in all except the H group. Three weeks after adrenalectomy there was an elevated basal plasma ACTH and an augmented ACTH response to stress in intact and IAH but not in AH rats. When a more specific alpha11-24 ACTH antibody was used there was a high plasma ACTH after ether stress in the IAH, NH, and intact groups but not in the AH or H groups. Adrenal weight and plasma corticosterone after tourniquet or ether stress were indistinguishable in the AH and H groups and were much higher and nearly identical in the intact, NH and IAH groups. We conclude that only the adenohypophysis secretes functionally significant amounts of ACTH. Plasma ACTH detected by the N-terminal antibody in the AH group is probably related to alpha-MSH or similar peptides and is incapable of maintaining adrenal weight or stimulating corticosterone secretion.

Nyctohemeral and sex-related variations in plasma thyrotropin, thyroxine and triiodothyronine.

TSH, T4, and T3 were measured by radioimmunoassay in plasma samples obtained from 77 young adult male and 114 female rats fed a Purina high-iodine diet and maintained in an isolated room, 2-4/cage, at 24 +/- 1 C with light from 0600-1800 h. In one experiment, 7 male and 7 female rats were decapitated every 3 h for 30 consecutive h and trunk blood was collected. There was a clear nyctohemeral rhythm of plasma TSH in both sexes characterized by a zenith at 1200 h and a nadir between 1800 and 2100 h. The plasma TSH cycle was approximately 180 degrees out of phase and negatively correlated (P less than .05) with that of plasma corticosterone (B) in both sexes. Although glucocorticoids have been reported to suppress TSH secretion, there was no causal relationship between plasma B and TSH in our experiments since the TSH cycles were normal in chronically adrenalectomized rats. Normal TSH cyclicity was not observed in severely iodine-deficient rats with extremely high plasma TSH levels although the nyctohemeral B rhythm was normal. Plasma TSH was approximately twice as high in males as in females (overall mean +/- SE: M = 149 +/- 11, F = 81 +/- 7 muU/ml, p less than 0.001). There was no significant difference (P greater than 0.05) in plasma TSH at different stages of the estrous cycle. Plasma T4 was slightly, but significantly, higher in males than females (overall mean +/- SE: M = 6.4 +/- 0.1, F = 6.0 +/- 0.1 mug/100 ml; P less than 0.001), while T3 was higher in females than in males (overall mean +/- SE: M = 69.5 +/- 1.7, F = 80.3 +/- 2.1 ng/100 ml; P less than 0.001). No significant nyctohemeral rhythm was observed in plasma T4 or T3 in either sex. These observations indicate that: 1) There is a nyctohemeral rhythm of plasma TSH which is independent of plasma B fluctuations and not associated with proportional changes in plasma thyroid hormones. 2) A sustained high rate of TSH secretion abolishes the normal nyctohemeral plasma TSH rhythm. 3) There are significant differences in plasma concentrations of TSH, T4, and T3 between male and female rats.

Can we improve trauma mortality in a state with a voluntary trauma system.

BACKGROUND: Arizona has no organized statewide trauma system. We looked at the 1997 and the 1998 Uniform Hospital Discharge Data Set (UHDDS) for the State of Arizona, and examined the trauma mortality data at both trauma hospitals and nontrauma hospitals. METHODS: All qualifying mortalities based on hospital data from 1997 through 1998 were reviewed for the State of Arizona. Trauma deaths from 32 nontrauma hospitals were examined and compared with that of 7 level 1 trauma centers within the state. RESULTS: In this time period, there were 375 qualified mortalities from nontrauma centers and 761 qualified mortalities from level 1 trauma facilities. Only 29 (8%) of nontrauma hospital deaths were found to be due to motor vehicle accidents. Only 8 (4%) mortalities at nontrauma centers were due to firearms. CONCLUSION: The data suggest that patients are arriving at the appropriate facility for definitive care despite the absence of a formal statewide trauma system.

Management guidelines for hypotensive pelvic fracture patients.

Pelvic fractures are common in blunt trauma patients and are often associated with other system injuries. Most studies describe the type of pelvic fractures and classify them by the forces creating the injury. Mortality from these fractures is due most often to other system injuries or to hemorrhage. Mortality ranges from 5 to 20 per cent depending on complexity and number of systems injured. We studied 692 cases of pelvic fractures and analyzed the seriously ill patients. They were identified by blood pressure (BP) less than 90 systolic on presentation to the trauma room and having a complex pelvic fracture. The management of these patients was by a protocol used by a group of eight trauma surgeons. This group of 75 hypotensive pelvic fracture patients were analyzed to identify significant factors in their management that predicted mortality. Patients with base excess (BE) values < or =-5 were significantly more likely to die (P<0.05). Patients with BP < or =90 on leaving the trauma room had a significantly higher mortality (P<0.01). Injury Severity Score predicted mortality and can be useful as a tool for quality assurance and process improvement. The early operative intervention to fix associated fractures within 24 hours was not detrimental to patient outcome. Overall mortality in this very sick population was 14.7 per cent. Emergent angiography was used successfully on 14 patients. Seven patients died of continued bleeding. The most important management guidelines for these seriously injured, complex patients are: 1) resuscitate with BE used as a monitor; 2) keep patient blood volume as close to normal as possible; 3) use BP, BE, and ISS to evaluate management of these patients.

Absence of nyctohemeral variation in stress-induced ACTH secretion in the rat.

Changes in plasma ACTH concentrations were measured in the adult male rat following a stressor in order to ascertain if there is a nyctohemeral variation in ACTH secretion following stress. The immuno-reactive ACTH concentrations obtained following a 2.5-min hind-leg tourniquet at 0400 or 1600 hours in pentobarbital-anesthetized animals were compared to those obtained in anesthetized and unanesthetized, unstressed controls. Neither absolute nor increment change in plasma ACTH concentrations following morning or afternoon tourniquet stress were significantly different after either 20 or 40 min anesthesia. Moreover, plasma ACTH concentrations from unstressed, unanesthetized rats showed a slight but significant difference (p smaller than 0.05) at 0400 hours [118 plus or minus 18 pg/ml (mean plus or minus SE)] compared to 1600 hours (64 plus or minus 12 pg/ml) indicating a reversal of the expected ACTH rhythm. Plasma corticosterone concentrations in these same rats showed the predicted lower-morning and higher-afternoon corticosterone pattern suggesting a possible nyctohemeral difference in the adrenal sensitivity to circulating levels of ACTH.