Volume 3, Number 8 March 11, 1990
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Editor: David Dodell, D.M.D.
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T A B L E O F C O N T E N T S
1. Medical News
Medical News for Week Ending March 11, 1990 ........................... 1
2. Center for Disease Control Reports
[MMWR 03-01-90] Mercury Exposure from Interior Latex Paint .......... 7
Imported Denque ....................................................... 10
State Tobacco-Use Prevention and Control Plans ........................ 12
[MMWR 03-08-90] Publicly Funded HIV Counseling and Testing ............ 14
Acute Schistosomiasis in U.S. Travelers Returning from Africa ........ 17
Low Birthweight ....................................................... 20
3. Dental News
Dental News from the National Institute of Dental Research ............ 23
4. Columns
Diabetes Highlights ................................................... 26
5. Articles
AIDS and Perinatology ................................................. 29
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Medical News
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Medical News for Week Ending March 11, 1990
Copyright 1990: USA TODAY/Gannett National Information Network
Reproduced with Permission
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March 5, 1990
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AIDS DRUG TO BE MADE AVAILABLE:
The AIDS drug AZT received government approval for use on infected people
without severe illness, causing more insurers to cover the treatment. Eric
Engstrom of the National AIDS Network, Washington, D.C., feels people do not
seek help because they want to keep AIDS treatment or testing off their
medical and insurance records as long as possible. (From the USA TODAY News
section.)
HEALTH INSTRUCTION FOR KIDS:
Health instruction needs to include several different types of instruction
to be successful, according to Jan McCarthy, Professor of Early Childhood
Education at Indiana State University. Instruction should: begin during
preschool years; be developmentally appropriate and hands-on; integrate with
other subject areas in curriculum; educate teachers and involve parents.
C-SECTION RATE DOWN:
Blue Cross and Blue Shield of Kansas announced nine months ago an effort to
reduce the number of C-sections being performed. The rate has dropped to 26.1
percent from 28.3 percent last spring. The drop represents a total of 82
Caesarean section operations at an estimated savings of nearly $150,000.
Estimated savings over the next 5 years: $1 million.
FEWER PEOPLE GO TO HOSPITALS:
Fewer people entered hospitals in 1987 than in the previous year, but those
who did paid more money, according to an annual survey of hospital charges.
The average daily hospital charge jumped 16 percent over the previous year,
according to the survey by Equicor and Hospital Corp. of America.
WEIGHT LIFTING AND DIABETES:
A new study by the University of Maryland and Johns Hopkins University
shows pumping iron may improve glucose tolerance. Three groups were studied:
one group did strength training; one group took up jogging; and one group got
no exercise. Both groups with exercise lowered insulin levels and saw
significant improvements in glucose tolerance, while the nonexercisers saw no
changes.
BRAN HELPS REVERSE COLON POLYPS:
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Volume 3, Number 8 March 11, 1990
A study by New York Hospital, Cornell Medical Center in New York City shows
adding wheat bran to the diet may shrink precancerous polyps. Two groups were
studied: one group ate a high-fiber cereal; the other was given a low-fiber
cereal. Both groups ate 2 servings a day for 4 years. The high-fiber group
showed a shrink in size and number of polyps, the low-fiber group showed no
change.
THINNESS MAY BE INHERITED:
Researchers at Duke University re-analyzed data from a Danish study of 100
adult adoptees. Their heights and weights were compared with those of their
biological and adopted parents. For thin adoptees, more biological than
adoptive parents were thin. While average or overweight adoptees showed no
difference from either set of parents.
CARE OF HIV PATIENTS:
The American Medical Association is sponsoring its second annual "AMA HIV
Conference: Counseling, Testing and Early Care" June 18-19, at the Westin St.
Francis Hotel, San Francisco, Calif. Registration or information: AMA
Registration Services, 535 N. Dearborn, Chicago, Ill., 60610.
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March 6, 1990
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NEW STUDY OF THE PILL:
The National Institute of Child Health & Human Development requested a new
study on birth control pills. To be addressed: Whether pre- and postmenopausal
breast cancer increases among all women who have ever used birth control pills
and if subgroups are at greater risk. The Institute of Medicine is reviewing
the questions and plans to complete the study by late 1990.
AGE, OBESITY AND SNORING:
A study in Archives of Internal Medicine shows older and heavier Hispanic-
Americans snore more. Researchers also found that cigarette-smoking Hispanics
snore more frequently than nonsmokers. The University of New Mexico School of
Medicine studied 1,222 people and found: men snored two times more than women;
31 percent of men and 17 percent of women snored loudly often or always.
NEGLIGENCE KILLS THOUSANDS:
Negligence kills thousands of people in New York hospitals each year and
injures more, reports researchers from Harvard University. Out of 2.7 million
patients hospitalized in New York in 1984, the researchers estimate that 3.7
percent - nearly 99,000 patients -experienced injury because of their medical
treatment. One-quarter of those were considered the result of negligence.
CDC RELEASES NEW AIDS FIGURE:
The AIDS problem continues, with a possible 57,000 new cases this year and
a half-million new cases possible by the end of 1993, reports the Centers for
Disease Control. More than 80,000 Americans are infected each year with the
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Volume 3, Number 8 March 11, 1990
AIDS-causing human immunodeficiency virus. The projected 1990 AIDS cases
represent a 14 percent increase over the 1989 estimated total.
INFANT DEATHS MAY INCREASE:
Infant mortality reduction in United States has stalled, and infant deaths
could increase sharply if health trends are not reversed. Smoking, alcohol
consumption and drug use by pregnant women are significant causes of the
problem, reports the National Commission to Prevent Infant Mortality.
Solution: provide greater prenatal and pediatric care to pregnant women and
young children.
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March 7, 1990
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KIDS WATCH BETTER TV ALONE:
A study in the American Journal of Diseases of Children reports kids watch
more educational television when they are alone, as opposed to having parents
monitor the channels they watch. Researchers studied 66 parents of kids ages
3 to 6 and found kids watched 21.4 hours of TV a week and 76 percent regularly
watched PBS. As kids grow older, their TV watching habits declined.
SPONGES LEFT IN PATIENTS:
Leaving surgical sponges in abdominal surgery patients is a continuing
problem, reports the Archives of Surgery. Reports estimate the incidence of
foreign bodies left in patients is one per 1,000 to 1,500 laparotomies. Half
of the sponges went undiscovered for 5 or more years. The number of incidents
could be higher due to the reluctance to report this complication.
TOOLS CAUSE VASCULAR PROBLEMS:
The Archives of Internal Medicine reports vibration from industrial
pneumatic tools is a common cause of vascular problems in workers, including
the cold-weather induced Raynaud's phenomenon. This disorder causes blood
vessels in the fingers and toes to contract causing digits to turn white.
Machines that can cause this: rock drills, jack hammers and grinders.
INFANTS SHOULD NOT USE PILLOWS:
The federal Consumer Product Safety Commission warned parents no to let
infants sleep on pillows or cushions filled with plastic foam beads. In the
last 2 years, at least 10 infants, all 3 months old or younger, have died from
such pillows. The agency did not identify the products or manufacturers
pending negotiations or a recall. (From the USA TODAY Life section.)
SMOKING HARMS UNBORN CHILD:
Researchers at the University of North Carolina, Chapel Hill, report women
who smoke during the first trimester of pregnancy place their unborn child at
risk for cleft lip with or without cleft palate. Affecting one in every 700
births, this birth defect is one of the five most common malformations in the
United States.
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Volume 3, Number 8 March 11, 1990
HIGH CHOLESTEROL IN KIDS:
Researchers at the Cleveland Clinic Foundation studied 6,500 kids, 3-to 16-
years old, and found 1 in 5 had high-blood-cholesterol levels (above 185 in
kids). Half of the kids tested with high cholesterol levels had no family
history of heart disease or high cholesterol. For tips on controlling a
child's cholesterol levels, the child's doctor should be consulted.
BRACES HELP FIGHT BACTERIA:
Putting teeth in their proper place helps avert future cavities. Braces may
also reduce gum disease. Bacteria does not like oxygen, so treating the
misalignment of teeth disrupts bad bacteria's environment, reports researchers
at the University of Pennsylvania School of Dental Medicine.
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March 8, 1990
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DEATHS ARE PREVENTABLE:
Half the nation's deaths can be blamed on nine chronic illnesses that are
considered preventable, reports the Centers for Disease Control in Atlanta.
The diseases: stroke, heart disease, diabetes, obstructive lung disease, lung
cancer, breast cancer, cervical cancer, colorectal cancer and cirrhosis of the
liver. Almost all causes of these diseases can be regulated by the
individual.
FRENCH PILL CALLED SAFE:
The French "abortion pill" is a safe and effective way to terminate early
pregnancies, a study confirms. The pill, called RU 486, blocks the action of a
pregnancy hormone and induces a menstrual cycle. It's taken with a second
drug, prostaglandin.
SMOKING AND BODY FAT:
The National Institute on Aging released a study showing cigarette smoking
produces a dangerous redistribution of body fat around the waist, which is
associated with coronary heart disease. Smokers who quit smoking often gain
weight around the hips, which has a relatively harmless effect on health.
DEPRESSION CAN BE DEBILITATING:
A study conducted by the Rand Corporation of Santa Monica, Calif., shows
that depression can be a debilitating. Researchers studied 22,462 patients
suffering from depression. The study focuses on how the patient functions and
feels. Key finding: Depression is as disabling as chronic medical conditions
in performing daily activities.
HEART DISEASE AND TYPE A PEOPLE:
Hostile individuals - those who are arrogant, argumentative, surly and rude
- double their chances of having coronary heart disease, reports the
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Volume 3, Number 8 March 11, 1990
University of Maryland at Baltimore County and the National Institute on
Aging's Gerontology Research Center. The findings show hostility may be
unhealthy enough to jeopardize your life.
REPRODUCTIVE AGING ALTERED:
Age-related changes may be accelerated or slowed through exposure to
steroid hormones, reports the University of Southern California in Los
Angeles. By studying reproductive aging in mice, oral esteriol was found to
cause irreversible damage to the hypothalamus. An estrogen/progesterone
combination seems to offset the damage to the hypothalamus.
COOKIES CURE STOMACH ACHES:
Researchers at Children's Hospital of Eastern Ontario in Ottawa, Canada
studied 52 children who complained of recurrent stomachaches and found cookies
calmed their tummies. Some kids were given two high-fiber cookies per day;
others received two low-fiber cookies. Results: Kids needed more fiber in
their diets, once they received it their stomachaches subsided.
COFFEE CAN HELP ASTHMATICS:
Caffeine in coffee may work as first aid for asthma in a pinch, reports Dr.
Harold Nelson of the National Jewish Center for Immunology and Respiratory
Medicine. Coffee contains naturally occurring chemicals similar to those found
in asthma medications. Some studies show no correlation, so Nelson suggests
using your medication at all times and only trying coffee in a pinch.
VITAMINS AND CANKER SORES:
A number of studies have found that 15 percent of people who suffer from
canker sores are deficient in certain vitamins, reports Prevention magazine.
Vitamins usually missing: folate, iron or B. Eating foods high in these
vitamins or taking supplements can help, but people who have recurring canker
sores should consult a doctor.
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March 9-11, 1990
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VITAMIN A MAY REVERSE CANCER:
Certain types of skin cancer have responded to experimental oral doses of
vitamin A derivatives known as retinoids, reports Prevention magazine. Basal-
cell carcinoma has responded to both etretinate and isotretinoin in a series
of small studies involving 56 patients. Results: 50 percent of the cancer
lesions showed some response, 9 percent cleared up completely.
MINTS SOOTHE STOMACH:
A strong peppermint candy mint or mug of peppermint tea can help settle
minor stomach discomfort. Oil of peppermint relaxes the muscle that closes the
door from the esophagus to the stomach. This allows excess gas to escape,
relieving the feeling of fullness. Only mints with oil of peppermint will
work.
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Volume 3, Number 8 March 11, 1990
REDUCING FAT CAN BOOST POTENCY:
The same high-fat diet that clogs the arteries leading to the heart can
affect the smaller vessels that lead to the penis. One out of every three men
over 40 will have potency problems at some point and clogged arteries may be
responsible for nearly half of them, says Dr. Harin Padma-Nathan, codirector
of the center for sexual function at the University of Southern California.
GINGER CAN HELP PREVENT NAUSEA:
Researchers at Brigham Young University have found ginger can help
alleviate stomach nausea. In a study of 36 students who were highly
susceptible to motion sickness, students who took gingerroot could withstand
motion without getting sick longer than those who took Dramamine or nothing at
all. Ginger capsules are available in health food stores.
SPICY FOOD BURNS CALORIES:
Researchers from Oxford Polytechnic, in England, report that hot spices may
boost postmeal metabolic rate by as much as 25 percent. Twelve people were fed
766-calorie meals that were identical except for spice content. Result:
Metabolic rates were raised more after the spicy meals and the effect lasted
more than three hours.
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Volume 3, Number 8 March 11, 1990
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Center for Disease Control Reports
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Morbidity and Mortality Weekly Report
Thursday March 1, 1990
Mercury Exposure from Interior Latex Paint -- Michigan
In August 1989, a previously healthy 4-year-old boy in Michigan was
diagnosed with acrodynia, a rare manifestation of childhood mercury poisoning.
Symptoms and signs included leg cramps; rash; itching; excessive perspiration;
rapid heartbeat; intermittent low-grade fevers; irritability; marked
personality change; insomnia; headaches; hypertension; swelling; redness and
peeling of the hands, feet, and nose; weakness of the pectoral and pelvic
girdles; and nerve dysfunction in the lower extremities. A urine mercury level
of 65 ug/L was measured on a 24-hour urine collection. Treatment with
intensive chelation therapy increased his urine mercury excretion 20-fold.
Examination of his mother and two siblings found urine mercury levels greater
than or approximately equal to his; his father had elevated, although lower,
levels. Parents and siblings were asymptomatic, although electromyographic
abnormalities were detected in one sibling.
The Michigan Department of Public Health (MDPH) identified inhalation of
mercury-containing vapors from phenylmercuric acetate contained in latex paint
as the probable route of mercury exposure for the family; 17 gallons of paint
had been applied to the inside of the family's home during the first week of
July. Samples of the paint contained 930-955 ppm mercury; the Environmental
Protection Agency (EPA) limit for mercury as a preservative in interior paint
is 300 ppm. During July, the house was air-conditioned, and the windows were
not opened.
Following 4 months of hospitalization with repeated courses of chelation
therapy and intensive rehabilitation, the patient's symptoms abated except for
residual lower extremity weakness. Although electroneuromyographic
abnormalities persist, he is able to walk and continues to improve.
In October, the Michigan Department of Agriculture prohibited further
sales of the inappropriately formulated paint,* and the MDPH advised persons
not to apply the paint, to thoroughly ventilate freshly painted areas, and to
consult a physician if unexplained health problems occurred. In November, the
MDPH and CDC began an ongoing investigation in selected communities in
southeastern Michigan to assess mercury levels in the air of homes in which
this paint has been applied and in urine samples from persons living in these
homes.
Reported by: R Aronow, MD, Poison Control Center, Children's Hospital,
Detroit; C Cubbage, PhD, Michigan Dept of Agriculture; R Wiener, State Health
Director, B Johnson, MD, J Hesse, J Bedford, PhD, Michigan Dept of Public
Health. Health Studies Br, Div of Environmental Hazards and Health Effects,
Center for Environmental Health and Injury Control, CDC.
Editorial Note: Phenylmercuric acetate is routinely added by some paint
manufacturers to interior latex (water-based) paint as a fungicide and
bactericide to prolong the paint's shelf-life. EPA permits interior latex
paint to contain less than or equal to 300 ppm elemental mercury and exterior
latex paint to contain less than or equal to 2000 ppm. However, neither the
presence nor the concentration of mercury in the paint is required to be
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Volume 3, Number 8 March 11, 1990
labeled on the paint can. Mercury may not lawfully be used in oil-based paint
(1,2).
One case of acrodynia associated with the use of interior latex paint has
been reported previously (3). Acrodynia may occur at urine mercury levels as
low as 50 ug/L (4). Because the Reinsch test, a urine screening for heavy
metals, is not sufficiently sensitive to detect low mercury levels, urine
should be tested for mercury content by cold vapor atomic absorption (5).
Little information is available about background urine mercury levels,
especially in children. Data are largely limited to a 1961 World Health
Organization multicountry survey of adults, which found that 95% of adults had
urine mercury concentrations less than 20 ug/L, and 89%, less than 10 ug/L
(6).
In adults, chronic exposure to mercury vapors can cause nerve-conduction
delays, tremor, insomnia, loss of appetite, and irritability (4,7). In 1965,
mercury vapor exposure from paint may have been the cause of a cluster of
neuromyasthenia cases (with symptoms including headache, weakness, tremor,
unsteady gait, and depression) in workers in an electronics factory (8).
However, the long-term health effects in clinically asymptomatic persons with
elevated urine mercury levels and the potential adverse health effects to
children and fetuses have not been well established.
Because alternative paint preservatives are available, EPA is determining
the distribution of mercury-containing paints and is reviewing the use of
mercury as a paint preservative. To prevent mercury exposure from paint,
proper ventilation should be assured both during and after painting. Cases of
mercury poisoning considered to be associated with interior latex paint should
be reported through state health departments to the Health Studies Branch,
Division of Environmental Hazards and Health Effects, Center for Environmental
Health and Injury Control, CDC; telephone (404) 488-4682.
References
1. Train RE. Decision of the Administrator on the cancellation of pesticides
containing mercury. Environmental Protection Agency, February 17, 1976: FIFRA
dockets no. 246 et al. Fed. Reg. 41 76(1976).
2. Train RE. Decision of the Administrator on reconsideration. Environmental
Protection Agency, May 27, 1976: FIFRA dockets no. 246 et al.
3. Hirschman SZ, Feingold M, Boylen G. Mercury in house paint as a cause of
acrodynia: effect of therapy with N-acetyl-D,L-penicillamine. N Engl J Med
1963;269:889-93.
4. Clarkson TW, Friberg L, Nordberg GF, Sager PR, eds. Biological monitoring
of toxic metals. New York: Plenum Press, 1988.
5. Foulds DM, Copeland KC, Franks RC. Mercury poisoning and acrodynia
(Letter). Am J Dis Child 1987;141:124-5.
6. Friberg L, Vostal J, eds. Mercury in the environment: an epidemiological
and toxicological appraisal. Cleveland, Ohio: CRC Press, 1972.
7. Rosenman KD, Valciukas JA, Glickman L, Meyers BR, Cinotti A. Sensitive
indicators of inorganic mercury toxicity. Arch Environ Health 1986;41:208-15.
8. Miller G, Chamberlin R, McCormack WM. An outbreak of neuromyasthenia in a
Health InfoCom Network News Page 8
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Kentucky factory--the possible role of a brief exposure to organic mercury. Am
J Epidemiol 1967;86:756-64.
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Volume 3, Number 8 March 11, 1990
Imported Dengue -- United States, 1988
In 1988, 124 cases of imported dengue-like illness (i.e., dengue-like
illness following apparent exposure outside the United States) were reported
to CDC from 36 states and the District of Columbia (Table 1). Twenty-seven
cases (from 17 states) were serologically or virologically confirmed as
dengue, 72 were serologically negative for dengue, and the etiology of 25
remains undetermined because of lack of a convalescent serum sample.
Travel histories of the 27 persons with confirmed dengue indicated that 12
infections had been acquired in Asia, nine in the Caribbean, two in Africa,
one in Central America, and one in Oceania; for two, travel histories were
unknown (Table 1). Dengue serotypes were identified in five cases, two by
virus isolation and three serologically by plaque reduction neutralization
test.
Sixteen (59%) of the confirmed cases were in males. Age was reported for
25 persons and ranged from 3 to 66 years (mean: 33 years). Most patients had
symptoms consistent with classic dengue fever (e.g., fever, muscle and joint
pain, headache, and rash), although several patients had marked
thrombocytopenia and/or severe symptoms. Four of the 27 patients were
hospitalized: a 3-year-old male Asian immigrant with thrombocytopenia,
epistaxis, oliguria, hypotension, and hyponatremia who required intravenous-
fluid therapy and platelet transfusions; a 40-year-old black male with
thrombocytopenia, weakness, and hemorrhagic rash; a 13-year-old male Asian
immigrant with thrombocytopenia, swollen legs, microhematuria, and lethargy;
and a 37-year-old Asian male with thrombocytopenia, palatal petechiae, and
severe myalgias. Gastrointestinal bleeding was reported in two additional
patients.
Reported by: State and territorial health departments. Dengue Br, Div of
Vector-Borne Infectious Diseases, Center for Infectious Diseases, CDC.
Editorial Note: Illness associated with imported dengue cases in 1988 appeared
to be more severe than illness reported in 1987, when only one of 18 confirmed
cases was reported to have had hemorrhagic manifestations (1). Two of the four
persons hospitalized in 1988 were immigrant Asian children, who are part of a
high-risk group for dengue hemorrhagic fever. U.S. citizens traveling abroad
rarely acquire this severe form of dengue fever even when traveling to high-
risk areas (2).
Because Aedes aegypti (the principal mosquito vector of dengue) and Ae.
albopictus (another potential mosquito vector of dengue) are present in the
continental United States (3), the potential exists for indigenous
transmission of dengue in most southeastern and central states. In 1988, Texas
was the only state with Ae. aegypti to report a confirmed imported case of
dengue; however, imported cases were reported from five states (Hawaii,
Illinois, Ohio, Texas, and Virginia) where Ae. albopictus is found. Public
health officials and clinicians should consider the diagnosis of dengue in any
patient with an acute febrile illness and a history of recent travel to
tropical areas. Suspected dengue should be reported and serum samples sent
for confirmation to CDC through state and territorial health departments.
References
1. CDC. Imported dengue--United States, 1987. MMWR 1989;38:463-5.
2. Halstead SB. Dengue haemorrhagic fever: a public health problem and field
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Volume 3, Number 8 March 11, 1990
for research. Bull WHO 1980;58:1-21.
3. CDC. Update: Aedes albopictus infestation--United States, Mexico. MMWR
1989;38:440,445-6.
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Volume 3, Number 8 March 11, 1990
State Tobacco-Use Prevention and Control Plans
In October 1989, the Association of State and Territorial Health Officials
(ASTHO) surveyed health agencies in all 50 states and the District of Columbia
to assess activities related to control of tobacco use. The survey focused on
the extent to which planning efforts met criteria listed in Guide to Public
Health Practice: State Health Agency Tobacco Prevention and Control Plans
(1).* Respondents submitted copies of existing plans for tobacco-use
prevention and control. This report summarizes the analysis of specific plans
to control tobacco use (free-standing plans) or plans that form a discrete
section on tobacco-use-control in a more general health-planning document.
Plans were evaluated in terms of the following components: 1) involvement
of a tobacco-and-health coalition or advisory group comprising representatives
from both the private and public sectors; 2) inclusion of an analysis of
state-specific tobacco-use behavior; 3) presentation of detailed objectives
and specific strategies for reducing tobacco use in the state; 4) presence of
an outline of a specific workplan identifying individuals and organizations
responsible for implementing the plan; 5) description of outcome evaluation
measures, including tobacco-use surveillance systems; 6) description of
process evaluation measures of program/plan activities (e.g., integrity of
programs and models); and 7) presence of state funding for reducing tobacco
use (Table 1).
As of December 31, 1989, 12 states (Colorado, Massachusetts, Michigan,
Minnesota, Nebraska, New Jersey, North Dakota, Oregon, Pennsylvania, Utah,
Vermont, and Virginia) had published plans for tobacco-use prevention and
control (Table 1). Minnesota published the first plan in 1984, and five states
(Colorado, Michigan, New Jersey, Vermont, and Virginia) published their plans
during 1989. Alabama, Connecticut, Idaho, Illinois, Indiana, and Rhode Island
reported that smoking prevention was included in their general plans for
health service. Colorado, North Dakota, and Utah have plans as part of the
Rocky Mountain Tobacco-Free Challenge, an eight-state effort to reduce the
prevalences of tobacco use and chronic diseases associated with tobacco use
(2).
All the state plans addressed the seven critical components of planning as
well as high-risk populations, health care, smoking cessation issues, worksite
policies, public education activities, and school and adolescent program
strategies. Nine of the 12 states with plans funded activities for tobacco-use
prevention and cessation. Workplans to implement listed objectives and
process measures were the most frequently omitted critical elements.
Of the nine plans that included state-specific assessment of tobacco-use
behavior, six assessed adolescent smoking prevalence, and eight assessed adult
smoking prevalence (Table 2). Seven states included an economic analysis,
including tax data or other economic issues. Four states included state
legislation and policies in their plans, and three included using state/local
resources for tobacco-use prevention and control.
Reported by: KM Marconi, PhD, JW Colborn, MS, National Cancer Institute,
National Institutes of Health. Program Svcs Activity, Office on Smoking and
Health, Center for Chronic Disease Prevention and Health Promotion, CDC.
Editorial Note: Elements essential to the control of tobacco use include
comprehensive planning, evaluation, funding, and community support. The ASTHO
survey provides baseline information for measuring progress in these areas
during the 1990s. This information will be particularly important in 1993,
when the National Cancer Institute and the American Cancer Society will
Health InfoCom Network News Page 12
Volume 3, Number 8 March 11, 1990
sponsor the American Stop Smoking Intervention Study (ASSIST) (3). This
multistate effort will provide funding, coordination, training, and evaluation
for tobacco-use prevention and control in 20 geographic areas (which could
include entire states or large metropolitan areas) through 1998.
One indication of the growth in state-based tobacco-use-control activities
is the number of states that reported developing plans to address this
problem. Ten additional states (Arkansas, Delaware, Maine, Missouri, New
Mexico, Ohio, Rhode Island, Texas, West Virginia, and Wisconsin) are expecting
to publish plans.
Tobacco use is a public health problem that may be approached at the state
level through community involvement. A conference on the Public Health
Practice of Tobacco Prevention and Control on March 8 and 9, 1990, in Houston
will address these issues. This conference will provide state-based tobacco-
control specialists a forum for information exchange and technical assistance
on a wide range of tobacco-control activities. These activities will direct
the national efforts toward a smoke-free society by the year 2000. Further
information on the conference is available from ASTHO at (703) 556-9222 or CDC
at (301) 443-1575.
References
1. Association of State and Territorial Health Officials/National Cancer
Institute. Guide to public health practice: state health agency tobacco
prevention and control plans. McLean, Virginia: Association of State and
Territorial Health Officials, 1989.
2. CDC. State-based chronic disease control: the Rocky Mountain Tobacco-Free
Challenge. MMWR 1989;38:749-52.
3. CDC. Trends in lung cancer incidence--United States, 1973-1986. MMWR
1989;38:505-6, 511-3.
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*Copies are available from the National Cancer Institute, 9000 Rockville Pike,
Building 31, Room 10A24, Bethesda, MD 20892; or the Technical Information
Center, Office on Smoking and Health, Center for Chronic Disease Prevention
and Health Promotion, CDC, 5600 Fishers Lane, Park Building, Room 1-16,
Rockville, MD 20857.
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Volume 3, Number 8 March 11, 1990
Morbidity and Mortality Weekly Report
Thursday March 8, 1990
Publicly Funded HIV Counseling and Testing -- United States, 1985-1989
CDC provides support to 63 human immunodeficiency virus (HIV) prevention
programs through health departments in 50 states, four cities, seven
territories, the District of Columbia, and Puerto Rico. Each calendar
quarter, the 63 programs report to CDC aggregate data regarding the number of
1) pretest counseling sessions, HIV-antibody tests, positive tests, and post-
test counseling sessions, by type of testing site; 2) HIV-antibody tests and
positive tests, by risk exposure category; and 3) HIV-antibody tests and
positive tests, by age group, sex, and race/ethnicity.
From 1985 through 1989,* the programs performed approximately 2.5 million
HIV-antibody tests; 149,639 (6.0%) tests were positive. This report summarizes
demographic, risk, and site type data from the 63 programs from January 1988
through September 1989.Number and Type of Testing Sites
From January 1988 through September 1989, the number of counseling and
testing sites in the 63 programs increased from 1577 to 5013. In 1989, these
included 1297 (25.9%) freestanding HIV counseling and testing sites, 877
(17.5%) sexually transmitted diseases (STD) clinics, 633 (12.6%) family-
planning clinics, 522 (10.4%) other health department sites, 504 (10.1%)
prenatal/obstetric clinics, 443 (8.8%) tuberculosis clinics, 183 (3.7%)
private physicians' offices and clinics, 173 (3.5%) drug-treatment centers,
162 (3.2%) other nonhealth department testing sites, 109 (2.2%) prisons, 29
(0.6%) colleges, and 81 (1.6%) unclassified facilities.Characteristics of
Counseling and Testing Sites
From January 1988 through September 1989, the 63 programs reported
1,403,240 HIV-antibody tests and 64,347 positive tests (Table 1). Of these,
freestanding HIV counseling and testing sites and STD clinics together
accounted for 916,290 (65.3%) of all tests and 44,425 (69.0%) of all positive
tests. Family planning and prenatal/ obstetric clinics accounted for 8.1% of
all reported tests and 1.3% of positive tests. In contrast, drug-treatment
centers and prisons accounted for 5.3% of total tests and 7.1% of positive
tests.Risk Category and Demographic Data
Information on self-reported risk category was available for 1,040,392
reported tests (Table 2). Of these, seropositivity rates were highest for
homosexual/bisexual intravenous-drug users (IVDUs) (17.1%),
homosexual/bisexual males (16.5%), persons with hemophilia (14.0%), and
heterosexual IVDUs (11.6%). These four categories accounted for 24.4% of tests
from persons who reported their risk category and 70.6% of all positive tests
from the same population.
Two groups accounted for 72.9% of tests with a self-reported risk
category: 1) 456,188 (43.9%) were from persons categorized as "heterosexuals
with reported risk" (including heterosexuals whose sex partners are at risk
for or infected with HIV, heterosexuals with multiple sex partners, and
heterosexuals with any other factor considered by local health authorities to
pose a risk for HIV infection); and 2) 302,005 (29.0%) were from persons
classified as "other heterosexual" (primarily heterosexual persons who
correctly or incorrectly reported no history of risk behavior or no partner(s)
at risk for or infected with HIV) (Table 2). These two heterosexual groups had
a combined seropositivity rate of 2.0%, yet accounted for 28.1% of reported
positive tests for persons whose risk category was reported. For the
"heterosexual with reported risk" category, seropositivity rates by reported
partner characteristic were: partner infected with HIV, 11.7% (1455/12,440);
Health InfoCom Network News Page 14
Volume 3, Number 8 March 11, 1990
partner with hemophilia, 5.1% (34/667); IV-drug-using partner, 5.0%
(1792/36,167); and bisexual partner, 4.1% (2312/56,830).
Of 828,847 tests for which some demographic information was given,
race/ethnicity was specified for 754,900 (91.1%). Of tested persons with known
race/ethnicity, seropositivity was highest in Hispanics (8.6%) (Table 3). When
compared to the overall U.S. population, both blacks and Hispanics were
substantially overrepresented among HIV-antibody tests and positive tests.
Males accounted for 459,046 (55.4%) of the 828,847 tests and 30,758
(79.7%) of all positive tests. Seropositivity in males and females was 6.7%
and 2.1%, respectively. Of 735,584 persons for whom age was known, most
(73.1%) tests and most (78.9%) positive tests were from persons aged 20-39
years. Seropositivity rates for persons aged 20-29 and 30-39 years were 3.6%
and 6.0%, respectively.
Reported by: Program Development, Technical Support Section, Program
Operations Br, Div of STD/HIV Prevention, and Office of the Director, Center
for Prevention Svcs, CDC.
Editorial Note: Of all HIV prevention efforts, counseling and testing
activities receive the highest level of resource support from CDC. The data
reported here indicate a large and increasing demand for HIV counseling and
testing in the United States; from January 1988 through September 1989, one in
22 persons seeking publicly funded HIV counseling and testing services were
confirmed to be infected. Knowledge of HIV-infection status and appropriate
counseling can assist persons in initiating changes in behavior that will
reduce the risk of infecting others or of becoming infected (1,2). Positive
behavioral changes can also occur in the large number of persons who elect not
to be tested but who receive risk-reduction counseling. In addition, early
detection of HIV infection and referral (3) can lead to optimal medical
management and partner notification.
Because of duplicate testing, the total number of persons tested and found
to be HIV-antibody positive in U.S. publicly funded settings is not known.**
However, four publicly funded HIV prevention programs that have monitored
repeat tests estimated that 12%-30% (mean: 23%) of HIV-antibody tests and 3%-
18% (mean: 13%) of positive tests represented previously tested persons (CDC,
unpublished data). When these rates are applied to the data reported here, an
estimated 2 million persons have been tested since 1985 through publicly
funded counseling and testing programs, and 123,000-145,000 persons have been
found to be infected.
Many of the estimated 1 million HIV-infected persons in the United States
remain unaware of their infection (4). Of persons who are aware of their HIV
infection, a substantial proportion had their infection identified in publicly
funded counseling and testing programs.
To ensure that persons with undetected HIV infection receive appropriate
counseling and testing, priorities should include increasing the number of
persons, especially those engaging in risk behaviors, who come to the test
sites and the number of persons who receive the full range of counseling and
testing, referral, and partner notification services. Programs should attempt
to maximize the proportion of persons at risk who 1) are offered and receive
pretest counseling; 2) accept and receive HIV-antibody testing; 3) return for
HIV-antibody test results; 4) are offered and receive post-test counseling; 5)
if infected, participate in partner notification; and 6) if infected, are
referred for and receive further medical and prevention services.
References
Health InfoCom Network News Page 15
Volume 3, Number 8 March 11, 1990
1. Cates W Jr, Handsfield HH. HIV counseling and testing: does it work? Am J
Public Health 1988;78:1533-4.
2. Stempel RR, Moss AR. A review of studies of behavioral response to HIV-
antibody testing among gay men (Poster session). V International Conference on
AIDS. Montreal, June 4-9, 1989:730.
3. Francis DP, Anderson RE, Gorman ME, et al. Targeting AIDS prevention and
treatment toward HIV-1-infected persons. JAMA 1989;262:2572-6.
4. CDC. Estimates of HIV prevalence and projected AIDS cases: summary of a
workshop, October 31-November 1, 1989. MMWR 1990;39:110-2,117-9.foots
*Estimated 12-month total for 1989 based on adjustment of data received for
January through September.
**In addition to the tests reported here, a large but unknown number of
persons are tested for HIV antibody in hospitals, outpatient medical
facilities, physicians' offices, blood-donation centers, military facilities,
and other settings.
Health InfoCom Network News Page 16
Volume 3, Number 8 March 11, 1990
Acute Schistosomiasis in U.S. Travelers Returning from Africa
In December 1988 and May 1989, CDC was notified that members of two groups
of travelers who had recently returned to the United States from Botswana and
Cote d'Ivoire, respectively, had experienced illnesses characterized by an
influenza-like syndrome and eosinophilia. Subsequent investigations
documented the occurrence of acute schistosomiasis in each group.
Botswana. From September 14 to October 2, 1988, a group of 16 persons
visited the Okavango Delta region of Botswana. Twelve of 13 travelers who
responded to mailed questionnaires reported contact with fresh water (e.g.,
wading, swimming, bathing, washing, and boating) while in this region. None
reported recent water contact in other geographic areas in which
schistosomiasis was endemic. Within 5 weeks of the expedition, 11 persons had
onset of symptoms that included fatigue, fever, sweats, chills, headache, and
gastrointestinal discomfort. These symptoms lasted 1-30 days (mean: 8 days)
and recurred in five persons 11-20 days (mean: 15 days) after the initial
episode.
Complete blood counts done for six persons found peripheral eosinophilia
(range: 10%-57%; normal: 0-4%). Of fecal specimens from 11 persons, nine
contained small numbers of Schistosoma eggs having characteristics of both S.
mansoni and S. rod haini. Urine samples from three persons were negative for
ova of S. haematobium. Fifteen travelers submitted serum specimens, and all
were positive for antibodies to Schistosoma sp. The one member of the group
who did not submit a serum sample reportedly had S. mansoni ova in a stool
specimen.
Persons with positive fecal and/or serologic specimens were treated with a
single oral dose of praziquantel (40 mg/kg). All symptoms resolved after
treatment, and no serious adverse reactions to therapy were reported. Twelve
of the 13 travelers who completed questionnaires were aware of the risks of
acquiring malaria and diarrheal illness in this region; seven reported having
been advised about the risks for schistosomiasis.
Cote d'Ivoire. From March 1 to April 15, 1989, eight persons traveled to a
remote rural area of western Cote d'Ivoire. During their visit, seven members
of this group were briefly in contact (bathing, wading, and/or swimming) with
fresh river water. None had recently traveled to other areas in which
schistosomiasis was endemic.
All seven persons reported transient pruritus immediately after their
exposures. Two to 4 weeks later, six of these seven persons developed symptoms
including fever, chills, fatigue, headache, and gastrointestinal discomfort.
Initial symptoms lasted 2-25 days (mean: 12 days) but recurred within 1-4
weeks in all six patients. Four persons required hospitalization, and five
were treated presumptively for malaria. Eosinophilia (range: 15%-48%) occurred
in all patients. Fecal examinations in four persons detected ova of S.
mansoni; egg counts were low and ranged from 16 to 24 eggs per gram of feces.
For all seven persons, urine examinations were negative for Schistosoma ova.
For six persons, serum specimens were positive for antibodies to Schistosoma
sp. All six were successfully treated with praziquantel.
Each of these seven travelers had received pretravel health advice and
were taking malaria prophylaxis. Four were advised about methods for avoiding
diarrheal illness; one was cautioned regarding the potential risks for
schistosomiasis.
Reported by: TW Cummings, MD, San Diego; MN Gropper, MD, Univ of California,
San Fran cisco; JE Galpin, MD, Tarzana; KH Acree, MD, California Dept of
Health Svcs. RS Gutin, MD, L Szczukowski, MD, Denver; RE Hoffman, MD, State
Health InfoCom Network News Page 17
Volume 3, Number 8 March 11, 1990
Epidemiologist, Colorado Dept of Health. M Kohan, MD, Coral Springs; CL
MacLeod, MD, Miami, Florida. KE Droulard, MD, Dept of Pathology, Mercy Medical
Center, Nampa; FR Dixon, MD, State Epidemiologist, Div of Health, Idaho Dept
of Health and Welfare. BL Graham, MD, Jackson, Mississippi. S Wilson, MD, Dept
of Pathology, San Juan Regional Medical Center, Farmington; CM Sewell, DrPH,
State Epidemiologist, New Mexico Health and Environment Dept. S Vogh, MD,
Copenhagen, Denmark. Parasitic Diseases Br, Div of Parasitic Diseases, Center
for Infectious Diseases; Div of Field Svcs, Epidemiology Program Office, CDC.
Editorial Note: The occurrence of these two outbreaks within a 9-month period
and the high infection rates emphasize that schistosomiasis poses a continuing
hazard for persons traveling in areas in which the disease is endemic. Reports
of at least five similar outbreaks among U.S. and European tourists since 1975
have indicated similarly high infection rates (range: 55%-100%; mean: 77%). In
these five outbreaks, symptoms of acute schistosomiasis (Katayama syndrome)
were reported to occur in 40%-93% (mean: 76%) of those infected (1-6). These
symptoms are thought to result from an immunologic response to the maturation
of adult worms and subsequent egg deposition in the vasculature surrounding
the intestines and bladder (7) (Figure 1). Although the clinical outcome in
travelers is usually benign, hospitalization is sometimes necessary, and
manifestations can be severe. For example, in 1984, two U.S. students
developed transverse myelitis and paraplegia after acquiring infection in
Kenya (4).
Early manifestations of acute schistosomiasis are often nonspecific and
may easily be misdiagnosed. The diagnosis should be considered when
eosinophilia is associated with fever, fatigue, headache, and/or
gastrointestinal distress in persons who have been exposed to fresh water in
areas in which schistosomiasis is endemic. Early diagnosis and treatment based
on clinical, epidemiologic, and serologic criteria may be important in
preventing serious sequelae (e.g., transverse myelitis) of acute infection.
Screening stool and urine specimens for ova and parasites is the traditional
method of diagnosis, but signs and symptoms of acute infection can occur
before detectable egg excretion (8). Sensitive and specific serologic tests
have recently been developed that can help establish the diagnosis before
substantial egg deposition or excretion (9). Single-day therapy with
praziquantel (40-60 mg/kg) is effective against all species of schistosomes
(10). Although side effects to treatment have been reported, they are
generally mild and transient (7).
Because there is no practical way to distinguish infected from noninfected
water, all fresh water in schistosomiasis-endemic areas should be considered
suspect. If fresh water contact is unavoidable, bathing water should be heated
to 50 C (122 F) for 5 minutes or treated with iodine or chlorine in a manner
similar to that used for treating drinking water. In addition, water can be
strained with paper filters or allowed to stand for 3 days before use.
Vigorous towel drying and application of rubbing alcohol to exposed skin
immediately after contact with untreated water also may help reduce cercarial
penetration and subsequent infection (3,4).
Schistosomiasis is endemic in 74 countries in Africa, South America, the
Caribbean, and Asia (10). Because travel to these areas is becoming
increasingly popular, health-care providers should be aware of the clinical
manifestations, methods for diagnosis, and appropriate treatment of this
disease. In addition, health and travel professionals should provide more
intensive preventive counseling to persons planning travel to areas endemic
for schistosomiasis.
Health InfoCom Network News Page 18
Volume 3, Number 8 March 11, 1990
References
1. Zuidema PJ. The Katayama syndrome: an outbreak in Dutch tourists to the
Omo National Park, Ethiopia. Trop Geogr Med 1981;33:30-5.
2. CDC. Cercarial dermatitis among bathers in California; Katayama syndrome
among travelers in Ethiopia. MMWR 1982;31:435-8.
3. Istre GR, Fontaine RE, Tarr J, Hopkins RS. Acute schistosomiasis among
Americans rafting the Omo River, Ethiopia. JAMA 1984;251:508-10.
4. CDC. Acute schistosomiasis with transverse myelitis in American students
returning from Kenya. MMWR 1984;33:445-7.
5. Chapman PJC, Wilkinson PR, Davidson RN. Acute schistosomiasis (Katayama
fever) among British air crew. Br Med J 1988;297:1101.
6. Stuiver PC. Acute schistosomiasis in Schistosoma haematobium infection.
In: Steffen R, Lobel HO, Haworth J, Bradley DJ, eds. Travel medicine. Berlin:
Springer-Verlag, 1989:381-3.
7. Nash TE, Cheever AW, Otteson EA, Cook JA. Schistosome infection in humans:
perspectives and recent findings. Ann Intern Med 1982;97:740-54.
8. Hiatt RA, Sotomayor ZR, Sanchez G, Zambrana M, Knight WB. Factors in the
pathogenesis of acute schistosomiasis mansoni. J Infect Dis 1979;139:659-66.
9. Hancock K, Tsang VCW. Development and optimization of the FAST-ELISA for
detecting antibodies to Schistosoma mansoni. J Immunol 1986;92:167-86.
10. World Health Organization. The control of schistosomiasis. Geneva: World
Health Organization, 1985. (WHO technical report series, no. 728).
Health InfoCom Network News Page 19
Volume 3, Number 8 March 11, 1990
Low Birthweight -- United States, 1975-1987
The incidence of low birthweight (LBW) is monitored in the United States
because it is an important indicator of infant morbidity and mortality. This
report highlights findings on trends in LBW in the United States from 1975
through 1987 (the most recent year for which data are available) (1). These
findings are based on analysis of birth certificate data provided by the 50
states and the District of Columbia to CDC's National Center for Health
Statistics. For each birth, data include birthweight and related demographic
and health information for the mother and infant.
From 1975 through 1985, the incidence of LBW ( less than 2500 g ( less
than 5 lbs. 8 oz.)) declined from 73.9 per 1000 live births to 67.5 per 1000,
a 9% decrease (Table 1). However, LBW increased 2.2% from 1985 through 1987.
Moderately low birthweight (MLBW) (1500-2499 g (3 lbs. 4 oz. to 5 lbs. 8 oz.))
declined by 11% from 1975 through 1985 but also increased 2.2% from 1985
through 1987. Very low birthweight (VLBW) ( less than 1500 g ( less than 3
lbs. 4 oz.)) increased by 4% from 1975 through 1985 and increased another 2.5%
from 1985 through 1987. Most of the decline in LBW and MLBW occurred before
1980 (86% and 78%, respectively); all the increase in VLBW occurred after
1980.
Although LBW declined for both white infants and black infants before
1980, the decline was nearly twice as great for white (9%) as for black
infants (5%) (Table 1). The decline in LBW rates in the first half of the
1980s was less than or equal to 1% for both white infants and black infants.
During the same time, the increase in VLBW was more than twice as great for
black (9%) as for white (4%) infants. From 1985 through 1987, LBW rates
increased by slightly less than 1% for white infants and by 2% for black
infants; the incidence of VLBW for white infants was stable but rose an
additional 3% for black infants (Table 1).
In 1985, 52% and 93% of MLBW and VLBW infants, respectively, were born
preterm ( less than 37 weeks of gestation) (Table 2). From 1981 through 1985,
the rate for full-term LBW infants declined by 7%, but the rate for preterm
LBW infants increased by 2% (1). Thus, the small decline in the overall rate
of LBW in this period is due entirely to the reduction in the rate of full-
term LBW infants.
In 1985, compared with a longer interbirth interval (2-4 years after the
previous live birth), a short interbirth interval (1-1 years after the
previous live birth) was associated with a two-thirds greater likelihood of
LBW and an approximately 80% greater likelihood of VLBW (Table 3).
Reported by: Div of Vital Statistics, National Center for Health Statistics;
Div of Reproductive Health, Center for Chronic Disease Prevention and Health
Promotion, CDC.
Editorial Note: The data in this report underscore the substantial and
persistent difference between black and white infants in the risk for LBW. In
1975, black infants were 2.1 times as likely as white infants to have a
birthweight of less than 2500 g. Because the LBW rate declined slightly more
for white than for black infants from 1975 through 1985, the relative risk for
black infants increased to 2.2 by 1985 and remained at this level through
1987. The relative risk of VLBW for black infants also increased (from 2.6 in
1975 to 2.9 in 1987) (1).
Reasons for the worsening gap between rates for black and white LBW and
VLBW infants are complex. Relatively more black than white mothers are
represented in subgroups at high risk for LBW (i.e., unmarried, less than 20
Health InfoCom Network News Page 20
Volume 3, Number 8 March 11, 1990
years of age, with less than 12 years of education, or with late or no
prenatal care). Within each subgroup, however, black mothers are generally
twice as likely to have LBW infants and two to three times as likely to have
VLBW infants (1). Increased maternal education lowers the risk for LBW for
both black and white infants in high-risk categories; however, the risk for
black infants relative to white infants in LBW incidence actually increases
with added years of completed education (1). At comparable levels of
education, black mothers have a lower average family income than do white
mothers (2). These socioeconomic differences may affect the quality of health
care available to black women.
Other factors related to the higher rates of LBW among black infants
include poorer nutritional status among black mothers, higher rates of
mistimed pregnancies, and higher rates of unwanted births (3). Black women
are generally more likely than white women of similar prepregnancy weight to
gain less than 16 lbs. during their pregnancy, and this lower weight gain is
associated with an increased risk for LBW (4). Anemia is associated with
preterm delivery; an estimated 5.0%-8.3% of preterm deliveries among black
mothers above the preterm deliveries among white mothers is due to excessive
rates of anemia among black women (5,6). Iron supplementation for pregnant
women with borderline or frank anemia should lead to a modest reduction in
preterm delivery and in the relative risk of LBW among black infants (6).
Consistent with the finding that infants born less than 2 years after a
previous child are at greater risk for LBW, infants who are either unwanted or
conceived before the mother is ready to bear another child have a greater risk
for LBW (3). The proportion of LBW attributable to mistimed or unwanted births
among black infants has been estimated at greater than 16% (6). Regardless of
whether this attributable risk is causal or is related to other factors
associated with unplanned pregnancies, the prevention of unintended
pregnancies could substantially reduce the difference in rates of LBW between
blacks and whites (6).
Recent recommendations on improving prenatal care (7) specify that care
should begin before conception and should include pregnancy planning;
involvement of a care coordinator; and comprehensive treatment for all
identified risks, including behavioral and nutritional factors. The provision
of comprehensive, coordinated prenatal care has been associated with reduced
risk for LBW among poor, predominantly black prenatal patients (8).
New information relevant to the etiology of LBW will be available for 1989
from the revised U.S. Certificate of Live Birth for 47 states and the District
of Columbia. The revised certificate includes questions relating to medical
risk factors during pregnancy, such as anemia and cardiac disease, and such
factors as tobacco and alcohol use and weight gain during pregnancy that are
closely associated with birthweight. These data, combined with other
socioeconomic and health data from birth certificates, should help clarify the
reasons for the persistent and large racial differentials in the incidence of
LBW and infant mortality (9).
References
1. Taffel SM. Trends in low birth weight: United States, 1975-85. Vital Health
Stat 1989:21(48); DHHS publication no. (PHS)89-1926.
2. Kleinman JC, Kessel SS. Racial differences in low birth weight. N Engl J
Med 1987;317:749-53.
3. Pamuk ER, Mosher WD. Health aspects of pregnancy and childbirth. Vital
Health InfoCom Network News Page 21
Volume 3, Number 8 March 11, 1990
Health Stat 1988:23(16); DHHS publication no. (PHS)89-1992.
4. Taffel SM. Maternal weight gain and the outcome of pregnancy, United
States, 1980. Vital Health Stat 1986:21(44); DHHS publication no. (PHS)86-
1922.
5. Klebanoff MS, Shiono PH, Berendes HW, Rhoads GG. Facts and artifacts about
anemia and preterm delivery. JAMA 1989;262:511-5.
6. Hogue CJR, Yip R. Preterm delivery: can we lower the black infant's first
hurdle? JAMA 1989;262:548-50.
7. Expert Panel on Content of Prenatal Care. Caring for our future: the
content of prenatal care. Washington, DC: US Department of Health and Human
Services, Public Health Service, 1989.
8. Buescher PA, Smith C, Holliday JL, Levine RH. Source of prenatal care and
infant birth weight: the case of a North Carolina county. Am J Obstet Gynecol
1987;156:204-10.
9. Taffel SM, Ventura SJ, Gay GA. Revised U.S. certificate of birth--new
opportunities for research on birth outcome. Birth 1989;16:188-93.
Health InfoCom Network News Page 22
Volume 3, Number 8 March 11, 1990
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Dental News
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Dental News from the National Institute of Dental Research
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02/21/90
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SAMPLING OF BOOKS AND JOURNAL ARTICLES ON AIDS AND DENTISTRY
AIDS, A GUIDE FOR DENTAL PRACTICE. Barr, C.E.; Marder, M.Z.
Chicago: Quintessence; 1987
AIDS AND THE DENTAL TEAM. Greenspan, D. Chicago: Year Book
Medical Publishers; 1986
Other books and audiovisual materials on AIDS AND DENTISTRY may
be found by searching the National Library of Medicine's MEDLAR
data bases using the following MeSH subject heading:
ACQUIRED IMMUNODEFICIENCY SYNDROME
AIDS (DISEASE)
A sampling of journal articles on AIDS AND DENTISTRY:
Acquired immune deficiency syndrome (AIDS): a review and
recommendations for dental hygienists. Porter, S.R.;
Cawson, R.A.; et al. DENTAL HEALTH. 1985; 24(3): 3-4, 6-7
AIDS and the dental team. Heupert, A.H. Dental Hygiene. July
1978; 61(7): 314-317
AIDS and the oral cavity. The HIV infection: Virology,
etiology, origin, immunology, precautions and clinical
observations in 110 patients. Reichart, P.A.; Gelderblom,
H.R.; et al. INTERNATIONAL JOURNAL OF ORAL AND MAXILLOFACIAL
SURGERY. APR 1987; 16(2): 129-153
AIDS and the oral cavity. Epidemiology and clinical oral
manifestations of human immune deficiency virus infection:
a review. Schidt, M.: Pindborg, J.J. INTERNATIONAL JOURNAL
OF ORAL AND MAXILLOFACIAL SURGERY. Feb 1987; 16(1): 1-14
AIDS: dental implications. Corboy, P.H. JOURNAL OF LAW AND
ETHICS IN DENTISTRY. 1988; 1(1): 7-21
AIDS: what dentists are doing about it. Shapater, D. DENTAL
MANAGEMENT. 1988; 28(3): 32-35
Assisting with infectious patients. Taylor, N. BRITISH DENTAL
SURGERY ASSISTANT. 1988; 47(1): 3,12
Classification of oral lesions associated with HIV infection.
Health InfoCom Network News Page 23
Volume 3, Number 8 March 11, 1990
Pindborg, J.J. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY.
Mar 1989; 67(3): 292-295
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02/09/90
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DHHS NEWS RELEASE ON FLUORIDE
Statement by David G. Hoel, Ph.D., Acting Director, National
Institute of Environmental Health Sciences.
Preliminary data were released February 6, 1990 from a study by this
Department's National Toxicology Program on the possibility of a relationship
between sodium fluoride and cancer in animals.
The two-year study exposed rats and mice to very high doses of sodium fluoride
to determine whether cancers would occur. This standard method enables
scientists to detect rare events. At the highest levels, which greatly exceed
the amount used in the treatment of water, there were some cases of a form of
bone cancer found in the male rats.
These unanalyzed data are essentially the same as those released prematurely
several weeks ago. During the next several weeks the NTP staff will prepare a
detailed analysis of the data. Outside scientists will review the data and
the NTP analysis and present their recommendations at a public meeting in late
April.
Until then, the significance of the test results cannot be determined.
These data resulted from only one study, involving only two species of animals
-- rats and mice -- with only five male rats affected by bone cancer
(osteosarcoma) and a small number of squamous carcinomas, tumors of the oral
cavity, in male and female rats.
In the highest dose, at 79 parts per million, four osteosarcomas were observed
among 80 male rats. At 45 parts per million of sodium fluoride, one
osteosarcoma was observed in a male rat. The test involved only one of
several compounds used in water fluoridation.
In the several hundred pages of pathology data from the test there are also
numerous instances of other kinds of tumors and other lesions in both the
control animals, who received no sodium fluoride, and in the dosed animals.
Some of these may have been due to the age of the rodents in the test.
Within these data tables there are a few statistically positive differences
between the dosed and control animals. Any or all of these differences could
be the result of chance alone. Their relevance is impossible to determine
until the detailed, peer-reviewed analysis of the test is completed.
After 45 years of water fluoridation involving scores of human epidemiological
studies both in the United States and in other countries there has not been
any evidence that shows a relationship between fluoridation and cancer or
other diseases in humans. Moreover, water fluoridation has proven highly
effective in improving the nation's dental health by markedly reducing tooth
Health InfoCom Network News Page 24
Volume 3, Number 8 March 11, 1990
decay.
Fluoride is a natural substance which occurs in some water supplies and foods
which humans and animals have ingested from the beginning of time.
The data must be fully analyzed to determine its significance. Until the
completion of this process, the many benefits of fluoride warrant continuation
of the present policy designed to prevent tooth decay.
The critical matter now is to determine the best scientific judgments
possible. That is what this first step by the National Toxicology Program
toward the fullest possible study is intended to do.
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02/09/90
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AGING AND ORAL HEALTH BROCHURE
The American Association of Dental Schools has a brochure "Function, Aging,
Oral Health -- An Overview of the Dental Issues Affecting the Health of Older
Persons," that is of interest to all dentists who come in contact with elderly
patients in private care, nursing homes or hospitals.
Up to 25 copies are available free of charge from the AADS. For more
information or to request a copy, contact Mercedes Bern-Klug, Director,
Geriatric Education Project, American Association of Dental Schools, l627
Massachusetts, NW, Washington, DC 20036, 202/667-0433.
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Volume 3, Number 8 March 11, 1990
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Columns
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DIABETES HIGHLIGHTS #3
J. Martin Wehlou MD
CompuServe: 72047,2444
Bitnet: WEHLOU@BGERUG51
InterNet: WEHLOU@BGERUG51.BITNET
BBS: 32-91-30.46.25, 1200/2400 8N1
Voice: 32-91-31.67.40
Fax: 32-91-31.33.12
SODIUM-LITHIUM COUNTERTRANSPORT
Sodium-Lithium countertransport in erythrocytes is increased in patients with
IDDM before the onset of nephropathy and is associated with hyperfiltration.
The elevated sodium-lithium countertransport may be an early marker of
diabetic nephropathy. N. Engl. J. Med. 322:500-5, 1990.
DEFECTIVE ANTILIPOLYTIC EFFECT
Poorly controlled IDDM patients are resistant to the antilipolytic effects of
insulin and show impaired stimulation of glucose oxidation during insulin-
induced hypoglycemia. Amelioration of these defects in well-controlled
patients may contribute to the higher risk of hypoglycemia during intensified
insulin therapy. Diabetes 39:134-41, Feb 1990.
DOES HUMAN INSULIN PROVOKE LESS NORADRENALIN, OR DOES IT NOT?
A study in volunteers showed human insulin to cause less noradrenalin response
compared with porcine insulin (see Lancet Oct 21 1989, p 946). However, a
second study under similar, but not identical, conditions contradicts this
result. Lancet #8687; 335:485, Feb 24 1990 [letter].
WATCH OUT FOR YEAST
The source of human insulins from Novo has recently changed from humanised
porcine to totally synthetic, derived from manufacture with yeast. A case is
presented where this change may have caused some grief through increased
bioavailability of the yeast derived formulation. Lancet #8687; 335:485, Feb
24 1990 [letter].
PORTAL VS. SYSTEMIC INSULIN
By rerouting the pancreatic venous drainage to the vena cava in dogs, it was
found that despite differences in systemic insulin concentration, there were
no clear changes in hepatic and extrahepatic carbohydrate metabolism.
Diabetes 39:142-48, Feb 1990.
BRAIN SMARTS
During acute reduction of plasma glucose, the brain maintains a constant rate
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Volume 3, Number 8 March 11, 1990
of glucose metabolism by increasing the fraction of glucose taken up from the
blood. Diabetes 39:175-80, Feb 1990.
IDF-I NOT CAUSE FOR PDR
In a large (682 subjects) population based study, no correlation could be
found between the levels of Insulinlike Growth Factor I (IGF-I) and the
prevalence of Proliferative Diabetic Retinopathy (PDR). Diabetes 39:191-95,
Feb 1990.
CYCLOSPORIN FOR WHOM?
Significant decrements in ICA titers are not useful in monitoring efficacy of
cyclosporin, and determination of ICA and IA status and phenotype (DR3/4) at
diagnosis is of no predictive value for remission in selecting recent-onset
IDDM patients for cyclosporin immunointervention. Diabetes 39:204-10, Feb
1990.
BRAINS, NOT MUSCLE
Impaired muscle glucose clearance accounts for less than 10% of the reduced
systemic glucose clearance in NIDDM subjects. This suggests that muscle
insulin resistance plays only a minor role in the reduced clearance found in
NIDDM in the postabsorptive state and that reduced brain glucose clearance may
be largely responsible. Diabetes 39:211-16, Feb 1990.
FISH OIL (AGAIN)
Cod-liver oil, rich in omega-3 polyunsaturated fatty acids, raises HDL and
lowers LDL cholesterol. The albuminuria in diabetics is diminished by these
fish oils. Fish oils may therefore have a role as an adjunct to diabetic
therapy, but it is too early to predict the long-term effects of such a
treatment. Lancet 335:508-09, March 3, 1990.
PREGNANT DIABETICS NEED FOOD
Reducing caloric intake to around 1200 kcal/day in gestational diabetes does
not significantly lower fasting plasma glucose or significantly improve
glucose tolerance. Moreover, it does cause an increase in ketonuria and
ketonemia. The impact of these changes on the fetus are controversial, but a
cause for concern. A 1600-1800 kcal/day diet may be safer, but needs further
study. Diabetes 39:234-40, Feb 1990.
ALBUMINURIA COMES FIRST
A significant elevation of urinary albumin excretion precedes the increase of
systemic blood pressure by several years in type I diabetes. Diabetes 39:245-
49, Feb 1990.
WHAT AMYLIN DOES
Amylin, found in amyloid deposits in pancreatic islets of type II diabetes, is
present in normal beta-cells and bears a striking homology to calcitonin gene-
related peptide (CGRP). Both amylin and CGRP when infused in rats, cause
insulin resistance. Therefore it may be implicated in the insulin resistance
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Volume 3, Number 8 March 11, 1990
of human type II diabetes. Diabetes 39:260-65, Feb 1990.
DQB-Asp57 TOO GOOD TO BE TRUE
Almost half of a group of IDDM patients studied in Japan did carry an aspartic
acid at position 57 of the DQ beta chain. Therefore, the hypothesis that the
presence of the aspartic acid at this position provides protection against
developing IDDM is not tenable for Japanese patients. Diabetes 39:266-69, Feb
1990.
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UPCOMING EVENTS
------------------------------------------------------------------------------
50th ADA Annual Meeting: 14-19 June 1990, Atlanta, Georgia.
6th Meeting of the International Study Group on Diabetes Treatment with
Implantable Insulin Delivery Devices: 21-24 June 1990, Nice, France.
3rd International symposium on molecular and cellular biology of insulin and
IGFs, 12-14 October 1990, Gainesville, Florida.
51st ADA Annual Meeting: 21-28 June 1991, Washington DC.
14th IDF congress: 23-28 June 1991, Washington DC.
Symposium on Epidemiology of Diabetes and Its Complications, 29 June -1 July
1991, Williamsburg, Virginia.
Health InfoCom Network News Page 28
Volume 3, Number 8 March 11, 1990
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Articles
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AIDS AND PERINATOLOGY
Prepared by Barbara R. Tysinger, M.S.L.S
A sampling of books on AIDS AND PERINATOLOGY
AIDS AND OBSTETRICS AND GYNAECOLOGY. Hudson, C.N.; Sharp, F.
London: Springer-Verlag; 1988.
AIDS IN CHILDREN, ADOLESCENTS AND HETEROSEXUAL ADULTS: an
interdisciplinary approach to prevention. Schinazi, R.F.;
Nahnias, A.J. New York: Elsevier; 1988.
See: "Legal aspects related to possible measures for the
prevention of perinatal human immunodeficiency virus
infection", Eldridge, F.M., pp. 210-211.
"HIV infection in the newborn and child: specific effects
on the nervous system", Epstein, L.G., pp.241-244.
"Mother and child: practical management issues: medical",
pp. 254-276.
AIDS: principles, practices, and policies. Corless, I.B.;
Pittman-Lindenman, M. New York: Hemisphere Publishing; 1989.
See: "Pediatric AIDS", Grossman, M., pp. 235-240.
MATERNITY AND GYNECOLOGIC CARE: the nurse and the family, 4th
edition. Bobak, I.M.; Jensen, M.D.; et al. St. Louis: Mosby;
1989.
See: "Complications of childbearing: infections: acquired
immune deficiency syndrome", pp. 745-746.
"Complications of childbearing: infections: specific
nursing care plan: postpartum woman with hepatitis B,
possibly AIDS, and A UTI", pp. 747-749.
"Complications of the newborn: infection and drug
dependence: human immunodeficiency virus-acquired immune
deficiency syndrome", pp. 980-982.
VACCINES 89: modern approach to new vaccines including
prevention of AIDS. Lerner, R.A.; et al. Cold Spring Harbor,
N.Y.: Cold Spring Harbor Laboratory; 1989.
See: "Infection of human placental tissue by HIV-1", Maury,
W.; Potts, B.; Rabson, A.B., pp. 133-136.
Other books and audiovisual materials on AIDS AND PERINATOLOGY may be
found by searching MESH subject headings:
Searching by subject:
ACQUIRED IMMUNODEFICIENCY SYNDROME
ACQUIRED IMMUNODEFICIENCY SYNDROME--in infancy &
childhood
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Volume 3, Number 8 March 11, 1990
AIDS (DISEASE)
AIDS (DISEASE) IN CHILDREN
A sampling of journal articles on AIDS AND PERINATOLOGY
Cross-cutting issues: women, minorities, children and AIDS.
PUBLIC HEALTH REPORTS. 1988; 103(Suppl.1): 88-98.
Frozen semen: efficiency in artificial insemination and advantage
in testing for acquired immune deficiency syndrome. Sherman,
J.K. FERTILITY AND STERILITY. 1987; 47(1): 19-21.
Guidelines for the control of perinatally transmitted human
immunodeficiency virus infection and care of infected mothers,
infants, and children. Rutherford, G.W.; et al. WESTERN JOURNAL
OF MEDICINE. 1987; 147(1): 104-108.
HIV in pregnancy. Feinkind, L.; Minkoff, H.L. CLINICS IN
PERINATOLOGY. 1988; 15(2): 189-202.
HIV infection and pregnancy. Dinsmoor, M.J. MEDICAL CLINICS OF
NORTH AMERICA. 1989; 73(3): 701-711.
HIV infection, breastfeeding, and human milkbanking. LANCET.
1988; 2(8603): 143-144.
HIV screening in pregnancy. AMERICAN FAMILY PHYSICIAN. 1988; 37:
93-96.
Human immunodeficiency virus infection in women, I: the effects
of human immunodeficiency virus on pregnancy. Gloeb, D.J.; et
al. AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY. 1988; 159(3):
756-761.
The human right of bonding for warehoused AIDS babies. Meintz,
S.L.; et al. FAMILY & COMMUNITY HEALTH. 1989; 12(2): 60-64.
Impact of the diagnosis of AIDS on hospital care of an infant.
NEONATOLOGY, CLINICAL PEDIATRICS, Special Issue. 1987; 26(1):
30-34.
The infant of the immunodeficiency virus infected mother.
Andiman, W.A. SEMINARS IN PERINATOLOGY. 1989; 13(1): [whole
issue].
Knowledge of HIV antibody status and decisions to continue or
terminate pregnancy among intravenous drug users. Selwyn, P.A.;
et al. JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION. 1989;
261(24): 3567-3571.
The management of children born to human immunodeficiency virus
seropositive women. Mok, J.Y. Q. JOURNAL OF INFECTION. 1989;
18(2): 119-124.
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Volume 3, Number 8 March 11, 1990
Managing the HIV-positive patient and her newborn in a CNM
service. Fekety, S.E. JOURNAL OF NURSE-MIDWIFERY. 1989; 34(5):
253-258.
Perinatal infection with Human Immunodeficiency Virus: specific
antibody responses by the neonate. Pyun, K.H.; et al.
OBSTETRICAL AND GYNECOLOGICAL SURVEY. 1988; 43(5): 281-282.
Perinatal nurses' knowledge and attitudes about AIDS. Prince,
N.A.; et al. JOGNN: JOURNAL OF OBSTETRIC, GYNECOLOGIC AND
NEONATAL NURSING. 1989; 18(5): 363-369.
Perinatal transmission of the human immunodeficiency virus.
Pape, J.W.; et al. BULLETIN OF THE PAN AMERICAN HEALTH
ORGANIZATION. 1989; 23(1-2): 50-61.
Pregnancy-associated deaths due to AIDS in the United States.
Koonin, L.M.; et al. JAMA: JOURNAL OF THE AMERICAN MEDICAL
ASSOCIATION. 1989; 261(9): 1306-1309.
Prevalence of human immunodeficiency virus in a general prenatal
population. Barton, J.J.; et al. AMERICAN JOURNAL OF OBSTETRICS
AND GYNECOLOGY. 1989; 160(6): 1316-1423.
Prospective study of human immunodeficiency virus infection and
pregnancy outcomes in intravenous drug users. Selwyn, P.A.; et
al. JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION. 1989; 261(9):
1289-1294.
Seroprevalence of Human Immunodeficiency Virus among childbearing
women. Hoff, R.; et al. NEW ENGLAND JOURNAL OF MEDICINE. 1988;
318: 525-530.
Short term outcome in babies refused perinatal intensive care.
Sidhu, H.; et al. BRITISH MEDICAL JOURNAL. 1989; 299(6700):
647-649.
Other articles on AIDS AND PERINATOLOGY may be found in various indexing
and abstracting tools available in libraries:
AIDS BIBLIOGRAPHY
ACQUIRED IMMUNODEFICIENCY SYNDROME/transmission
ACQUIRED IMMUNODEFICIENCY SYNDROME/congenital
PREGNANCY COMPLICATIONS, INFECTIOUS
CUMULATIVE INDEX TO NURSING AND ALLIED HEALTH (CINAHL)
ACQUIRED IMMUNODEFICIENCY SYNDROME (1984+)
PERINATAL CARE (1983+)
PERINATAL NURSING (1989+)
PREGNANCY COMPLICATIONS, INFECTIOUS (1983+)
Health InfoCom Network News Page 31
Volume 3, Number 8 March 11, 1990
EXCERPTA MEDICA
SECTION 54. AIDS.
SECTION 10. Obstetrics and Gynecology.
SECTION 7. Pediatrics.
ACQUIRED IMMUNODEFICIENCY SYNDROME
HUMAN IMMUNODEFICIENCY VIRUS
PERINATAL INFECTIONS
PREGNANCY
INDEX MEDICUS
ACQUIRED IMMUNODEFICIENCY SYNDROME (1983+)
ACQUIRED IMMUNODEFICIENCY SYNDROME/transmission
ACQUIRED IMMUNODEFICIENCY SYNDROME/congenital
AIDS-RELATED COMPLEX
HIV
HIV SEROPOSIVITY
PREGNANCY COMPLICATIONS/immunology
PREGNANCY COMPLICATIONS, INFECTIOUS (1964+)
PRENATAL CARE
A sampling of OTHER INFORMATION on AIDS AND PERINATOLOGY
Online databases
INDEX MEDICUS, EXCERPTA MEDICA, and CINAHL can also be
searched as computer databases and you can do your
own search on AIDS and PERINATOLOGY using the
SilverPlatter MEDLINE database where available.
Audiovisual materials
"Chilly dawn: AIDS in children" [audiocassette] AUDIO DIGEST
1987. Family Practice v. 33, no. 23.
"Infants and children with AIDS" [videocassette] Mary Boland
and James Oleske. NCME #517 (1986).
Conferences and Symposia
Listing of relevant conferences and symposia can be found in
each issue of AIDS/HIV RECORD which is published twice each
month.
Additional information on this topic may be found in other issues or
updates of the Health Sciences Library Information Series on AIDS.
WE WELCOME YOUR SUGGESTIONS AND COMMENTS
If you have comments on this bibliography or wish to suggest resources
Health InfoCom Network News Page 32
Volume 3, Number 8 March 11, 1990
or future topics please contact:
Health Sciences Library CB# 7585
University of North Carolina at Chapel Hill
Chapel Hill, NC 27599-7585
(919) 962-0700
(School of Medicine) email id: aids@med.unc.edu
: pwatkins@med.unc.edu
Health InfoCom Network News Page 33