We conducted a case-control study to determine the relative and attributable risk of HIV seropositivity for bacillary-positive (smear and/or culture) pulmonary tuberculosis in Haiti. There were 274 patients with tuberculosis and an equal number of control subjects. Antibodies to HIV were present in 67 (24%) patients and eight (3%) control subjects. Odds ratios suggested that the risk of pulmonary tuberculosis was 15.7 times as great (95% confidence interval, 4.8 to 5.0; p less than 0.05) in patients 20 to 39 yr of age who were HIV-seropositive than in HIV-seronegative patients. In contrast, the relative risk in those 40 to 59 yr of age was elevated (3.0 times), though not significantly (lower 95% confidence interval, 0.8). In the 20- to 39-yr age group, 31% of tuberculosis was attributable to HIV infection (95% confidence interval between 23 and 39%). HIV-seropositive and HIV-seronegative patients did not differ with respect to sputum smear positivity. HIV-seronegative patients were twice as likely to be infected with resistant organisms, though this was not significant. We conclude that HIV infection is a major risk factor for pulmonary tuberculosis in young adult residents of Haiti. This, together with the fact that similar proportions of HIV-seropositive and HIV-seronegative patients were potentially infectious, suggests that without vigorous counteraction tuberculosis will become a greater problem for Haiti.
Primary cutaneous anaplastic large cell lymphoma (PC-ALCL) is a rare, aggressive neoplasm that frequently relapses and requires the use of multiple treatment modalities. PC-ALCL most commonly presents in patients around the age of 60 and clinically manifests as red, single or sometimes grouped nodular lesions in the skin that tend to ulcerate over time. Although cases are limited to the skin, the extracutaneous spread has been occasionally reported. The diagnosis of PC-ALCL is made through excisional biopsy and subsequent immunohistochemical confirmation. Management of PC-ALCL is dependent on the extent of disease, and most patients can be effectively managed with surgical excision and/or radiation. If relapse occurs, systemic therapy including combination chemotherapy is considered. We present the case of a 43-year-old female who presented to an outpatient clinic with multiple suspicious, red, nodular lesions to her left elbow and right upper back. The further evaluation led to the diagnosis of a stage 4E, ALK-negative, CD30-positive PC-ALCL with recurrence after resection. This case highlights the diagnosis and management of PC-ALCL with systemic involvement that did not respond to initial radiotherapy.
Although various studies have investigated the effect of behavioral interventions on body weight, few have reported community interventions for peri-and post-menopausal women. Consequently, questions remain concerning the effectiveness of weight loss interventions for this group of women. The objective of this study was to provide an educational program to improve diet and physical activity levels to promote behavior changes that will improve overall health. A pilot study of obese peri-and post-menopausal African-American women was conducted to assess an educational intervention. Pre and post-tests questionnaires were given to assess eating habits and physical activity and to measure body mass index (BMI) as well as waist circumference. Each participant completed an eight-week behavior modification intervention program designed to increase physical activity levels and encourage healthy dietary choices. A paired-samples t-tests established that after the intervention there were large improvements in diet and exercise as well as small improvements in BMI and waist circumference. The educational intervention was associated with large improvements in diet and exercise and small improvements in BMI and waist circumference. A community setting is a viable option in promoting and improving health behaviors.
The Medicare Annual Wellness Visit (AWV), which includes comprehensive preventative assessments and screenings, is associated with improved preventative services, including vaccination and cancer screenings. However, the AWV alone does not promote whole-person care. Integrating the AWV within an Age-Friendly Health System (AFHS) contextualizes AWV services within a comprehensive geriatric care framework that integrates the “4Ms” (mentation, medication, mobility, and what matters). This study describes and evaluates quality improvement initiatives to improve the completion of AWV within two different AFHS-recognized health systems (an academic university clinic and a Federally Qualified Health Center). The results from this evaluation present opportunities that other health systems can consider for leveraging electronic health records (EHRs) and enabling services to complete AWVs within a 4Ms framework. The implementation results also suggest an adaptation of the 4Ms assessment schedule for patients with complex chronic conditions who may suffer from multiple comorbidities and cognitive impairment.
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