HICNet Medical News Digest      Thu, 23 Jun 1994        Volume 07 : Issue 28

Today's Topics:

  [MMWR 17 Jun 94] Update: Coccidioidomycosis
  [MMWR] Head Injuries Associated with Motorcycle Use
  Hanford Radiation Exposure
  NIAID Recommend Continuing but Not Expanding HIV Vaccine Study
  Courses Available in Pharmocokinetics
  Conference on Alzheimer Disease
  AIDS Daily News Summary

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       Tom Whalen, M.D., Robert Wood Johnson Medical School at Camden

        Douglas B. Hanson, Ph.D., Forsyth Dental Center, Boston, MA

             Lawrence Lee Miller, B.S. Biological Sciences, UCI

            Dr K C Lun, National University Hospital, Singapore

             W. Scott Erdley, MS, RN, SUNY@UB School of Nursing

      Jack E. Cross, B.S Health Care Admin, 882 Medical Trng Grp, USAF

  Albert Shar, Ph.D. CIO, Associate Prof, Univ of Penn School of Medicine

  Martin I. Herman, M.D., LeBonheur Children's Medical Center, Memphis TN

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Date: Thu, 23 Jun 94 05:52:18 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: [MMWR 17 Jun 94] Update: Coccidioidomycosis
Message-ID: <VXiDoc1w165w@stat.com>

       Update: Coccidioidomycosis -- California, 1991-1993

     Coccidioidomycosis is an infection caused by the fungus
Coccidioides immitis, which resides in the soil in some areas of
Arizona, California, Nevada, New Mexico, Texas, and Utah. Infection
can occur when airborne, infective arthroconidia are inhaled.
Symptomatic coccidioidomycosis, which occurs in approximately 40%
of all infections, has a wide clinical spectrum, including mild
influenza-like illness, severe pneumonia, and disseminated disease.
Beginning in 1991, the number of cases of coccidioidomycosis
reported annually to the California Department of Health Services
(CDHS) increased dramatically (1) (Figure 1). This report
summarizes the occurrence of coccidioidomycosis in California
during 1991-1993.
     In 1991, 1200 cases of coccidioidomycosis were reported to
CDHS, compared with an annual average of 428 reported cases during
1981-1990. The number of reported cases continued to increase
during 1992 (4516 cases) but declined during 1993 (4137 cases).
During 1991-1993, most (70%) cases in California were reported from
Kern County in the San Joaquin Valley, where the incidence of
coccidioidomycosis is high; in contrast, during 1981-1990, Kern
County accounted for 52% of all cases. Coccidioidomycosis
surveillance data are reported to CDHS by the counties as weekly
case counts only.

Reported by: BA Jinadu, MD, G Welch, R Talbot, PhD, Kern County
Health Dept; J Caldwell, PharmD, R Johnson, MD, D Blume, PhD, H
Einstein, MD, T Larwood, MD, M Hargrave, Bakersfield; RJ Jackson,
MD, SB Werner, MD, P Duffey, PhD, GW Rutherford, III, MD, State
Epidemiologist, California Dept of Health Svcs; T Kirkland, MD, San
Diego; D Pappagianis, MD, Davis; F Swatek, PhD, Long Beach,
California. DM Dixon, PhD, National Institute of Allergy and
Infectious Disease, National Institutes of Health. Div of Bacterial
and Mycotic Diseases, National Center for Infectious Diseases, CDC.

Editorial Note: The public health impact of coccidioidomycosis in
California during 1991-1993 was substantial. For example, based on
a review of medical records in Kern County alone,
coccidioidomycosis accounted for approximately $45 million in
direct costs of hospitalization and outpatient care during that
period (J. Caldwell, Pharm.D., Kern Medical Center, personal
communication, 1994).
     Factors potentially associated with the ongoing outbreak of
coccidioidomycosis in California include weather conditions (e.g.,
protracted drought followed by heavy rains) conducive to the growth
and spread of C. immitis, activities that disturb the soil and
facilitate airborne spread of the organism, and a large and
increasing population of susceptible persons. These factors
illustrate the association between environmental and demographic
factors and the emergence of some infectious diseases (2,3).
     During 1991-1993 and previously, the number of
coccidioidomycosis cases probably has been underreported. In Kern
County, unlike other counties in California, the local health
department is the diagnostic laboratory for virtually all
coccidioidomycosis serologic tests from suspected cases in the
county and ensures that they are reported to CDHS. Although actual
rates of coccidioidomycosis are probably higher in Kern County than
in other California counties, the link between the diagnostic
laboratory and case reporting in the county enhances
coccidioidomycosis surveillance when compared with areas that rely
primarily on health-care providers to report new cases.
     At least two major barriers constrain the prevention of
coccidioidomycosis. First, although measures to reduce exposure by
minimizing dust in areas where coccidioidomycosis is endemic can
lower incidence rates and may reduce severity of disease in persons
who become infected, exposures to contaminated dust cannot be
totally prevented (4). Second, although recovery from infection
usually confers lasting protection against reinfection, suggesting
a potential role for vaccination, efforts to develop a
coccidioidomycosis vaccine for humans have been unsuccessful (5).
Further efforts to develop vaccines can employ current genetic and
biochemical methods.
     In November 1993, CDHS and the Kern County Health Department
convened a national meeting of experts to consider public health
strategies for controlling and preventing coccidioidomycosis.
Participants concluded that 1) surveillance is generally inadequate
to assess the public health burden of coccidioidomycosis in the
southwestern United States and that the approach used in Kern
County (e.g., linking diagnostic testing to case reporting) enables
more complete assessment of the public health impact of this
disease; 2) despite a historical understanding of the epidemiology
of coccidioidomycosis (4,6-8), efforts should be intensified to
better characterize environmental, behavioral, and host risk
factors for acquiring infection and developing disease; 3) although
several serologic tests for the diagnosis of coccidioidomycosis
(e.g., complement fixation and tube precipitin) are well
characterized and perform well, the sensitivity, specificity, and
reproducibility of enzyme immunoassay and other newer diagnostic
tests need to be better defined (9); and 4) development of a
vaccine may be the most effective strategy for preventing
coccidioidomycosis.

References
1. CDC. Coccidioidomycosis--United States, 1991-1992. MMWR
1993;42:21-4.
2. Institute of Medicine. Factors in emergence. In: Lederberg J,
Shope RE, Oaks SC, eds. Emerging infections: microbial threats to
health in the United States. Washington, DC: National Academy
Press, 1992:34-112.
3. CDC. Addressing emerging infectious disease threats to health:
a prevention strategy for the United States. Atlanta: US Department
of Health and Human Services, Public Health Service, 1994.
4. Smith CE, Beard RR, Rosenberger HG, Whiting EG. Effect of season
and dust control on coccidioidomycosis. JAMA 1946;132:833-8.
5. Pappagianis D, Valley Fever Vaccine Study Group. Evaluation of
the protective efficacy of the killed Coccidioides immitis spherule
vaccine in humans. Am Rev Respir Dis 1993;148:656-60.
6. Pappagianis D. Epidemiology of coccidioidomycosis. Curr Top Med
Mycol 1988;2:199-238.
7. Smith CE, Beard RR, Whiting EG, Rosenberger HG. Varieties of
coccidioidal infection in relation to the epidemiology and control
of the diseases. Am J Public Health 1946;36:1394-402.
8. Smith CE. Epidemiology of acute coccidioidomycosis with erythema
nodosum ("San Joaquin" or "Valley Fever"). Am J Public Health
1940;30:600-11.
9. Pappagianis D, Zimmer BL. Serology of coccidioidomycosis. Clin
Microbiol Rev 1990;3:247-68.



------------------------------

Date: Thu, 23 Jun 94 05:53:20 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: [MMWR] Head Injuries Associated with Motorcycle Use
Message-ID: <LZiDoc2w165w@stat.com>

         Head Injuries Associated with Motorcycle Use --
                         Wisconsin, 1991

     From 1989 through 1991, a total of 9913 persons in the United
States died as a result of crashes while operating or riding
motorcycles (1). Although use of motorcycle helmets is an effective
means for preventing crash-related fatal injuries (2), 25 states
and the District of Columbia have not yet enacted laws requiring
the universal use of motorcycle helmets (1). This report describes
a study by the University of Wisconsin and the Wisconsin Department
of Transportation in which linked police reports and hospital
discharge records for 1991 were used to assess the risk for head
injury for motorcyclists in motor-vehicle crashes, the initial
inpatient hospital charges for motorcyclists with head injuries
resulting from crashes, and the reduction in injuries and
fatalities associated with universal helmet use.
     For this report, motorcyclists were defined as persons who
were operating or riding as a passenger on a motorcycle. Wisconsin
was one of seven states funded under the Crash Outcome Data
Evaluation Systems project of the National Highway Traffic Safety
Administration to generate linked statewide data systems. Because
personal identifiers were not available, Police Accident Reports
from the Wisconsin Department of Transportation and inpatient
discharge records for acute-care hospitals from the state's Office
of the Commissioner of Insurance were linked through a
probabilistic method (which calculates the likelihood that a police
report and a discharge record represent the same person) using date
of the event--the crash or the hospital admission--and the
motorcyclist's birth date, sex, and zip code of residence.
Secondary linking variables were the county of the event, the
health service area of the event, the injury, and whether the
person was transported by ambulance from the crash. Uncertain
matches were reviewed manually using additional corroborating
information, such as International Classification of Diseases,
Ninth Revision, Clinical Modification (ICD-9-CM) external cause of
injury codes and consistency with known patterns of trauma referral
and injury resulting from motor-vehicle crashes. Approximately 7%
of the matches made by computer between police reports and hospital
records were incorrect.
     Based on ICD-9-CM diagnostic codes in the discharge record,
head injuries were classified into three mutually exclusive
categories: 1) brain injury, defined as any diagnosis of
intracranial injury with or without skull fracture, intracranial
hemorrhage following injury, or loss of consciousness for 1 hour or
more; 2) skull fracture with no intracranial injury; and 3)
concussion with only brief (less than 1 hour) or no loss of
consciousness.
     Of the 3184 motorcyclists involved in police-reported crashes
in Wisconsin in 1991, 2015 (63.3%) were unhelmeted and 994 (31.2%)
were helmeted at the time of the crash. Helmet use was unknown for
175 (5.5%), four of whom were fatally injured; of 32 who were
hospitalized, 13 incurred head injuries. Of those motorcyclists for
whom helmet status was known, 545 were hospitalized and 74 died,
including 55 who were unhelmeted and 19 who were helmeted. Of the
545 hospitalized, 187 (34.3%) had sustained a head injury (Table
1). Overall, unhelmeted motorcyclists involved in police-reported
crashes were more than twice as likely to be hospitalized for a
head injury (153 [7.6%]) than were helmeted riders (34 [3.4%]).
Brain injury occurred among 97 (4.8%) of those who were unhelmeted
and 17 (1.7%) of those who were helmeted (rate ratio [RR]=2.9, 95%
confidence interval [CI]=1.7-4.9); the rate for skull fracture
among unhelmeted riders (0.9%) was 4.5 times (95% CI=1.0-19.2) that
among helmeted riders (0.2%). The rate for concussions among
unhelmeted motorcyclists involved in crashes (1.9%) was higher than
that for helmeted riders (1.5%) (RR=1.3; 95% CI=0.7-2.3).
     Total initial* inpatient hospital charges for the 97
unhelmeted motorcyclists with brain injuries was $2,396,366--
compared with $333,619 for the 17 helmeted motorcyclists with brain
injuries (Table 1). Average initial hospital charges for unhelmeted
motorcyclists with brain injuries were $24,705, compared with
$19,624 for helmeted motorcyclists with brain injuries.
     Although some crashes will be so severe that a motorcycle
helmet will not prevent brain injury or death, the proportion of
injuries that could have been prevented if a motorcycle helmet had
been worn by all riders was estimated for each category of head
injury and death (3). These estimates assume that if unhelmeted
motorcyclists wore helmets and experienced a similar distribution
of outcomes as helmeted motorcyclists, then universal helmet use by
all motorcyclists in Wisconsin during 1991 potentially would have
prevented 60 brain injuries, 13 skull fractures with no intra-
cranial injury, and eight concussions. In addition, universal
helmet use potentially would have prevented 14 (18.9%) deaths.

Reported by: TA Karlson, PhD, CA Quade, Center for Health Systems
Research and Analysis, Univ of Wisconsin, Madison; Wisconsin Dept
of Transportation. Div of Unintentional Injury Prevention, National
Center for Injury Prevention and Control, CDC.

Editorial Note: Motorcycle helmets are designed to protect users
against injury to the brain and other head injuries. The findings
in this report indicate that the use of motorcycle helmets lowers
the rate of head injury. Although helmet use is approximately 99%
in states with universal requirements, use is substantially less in
states with laws that apply only to subgroups of the population
(4). For example, in Wisconsin, where the law applies only to
riders aged less than 19 years, observed helmet use is 42% for all
motorcycle riders (5).
     The findings in this report are subject to at least four
limitations. First, incorrectly matched police reports and hospital
records diminish the measure of the protective effect of helmets.
Second, some motorcycle crashes in Wisconsin may not have been
reported to police--in particular, crashes occurring in areas
adjacent to other states for which medical treatment may have been
obtained in those states. Third, this study evaluated only
hospitalized motorcycle riders; the differences in injury rates and
health-care costs for unhelmeted riders compared with helmeted
riders probably would have been greater if data from emergency
departments and long-term--care facilities had been available and
analyzed. Skull fractures and concussions are usually associated
with complete recovery, but more severe injuries to the brain can
result in lifelong disability (6). Fourth, this study did not
control for injuries other than head injuries. In a Washington
study that controlled for severity of injuries other than head
injury, motorcycle helmets were effective in limiting the
occurrence of head injury, the need for and duration of mechanical
ventilation, the length of intensive-care stay, and the need for
rehabilitation (7). Previous studies indicate that unhelmeted
riders who are injured are more likely be admitted to a hospital as
an inpatient, be permanently impaired, and require ambulance
service, neurosurgery, intensive care, rehabilitation, and
long-term care (4).
     Although the source of payment for hospitalization was not
analyzed in this report, findings from previous reports indicate
that public monies underwrite 25%-50% of the costs associated with
motorcycle crashes (4). State-specific data on the costs for
hospitalizations--initial, long-term, and public--for unhelmeted
riders may assist state legislators in making informed decisions
regarding the passage and retention of these laws.
     This report illustrates how linked data can help provide
information on the potential health-care costs associated with
public policies intended to prevent motor-vehicle--related
injuries. Linkage of existing data systems can assist in the
characterization of motorcycle and other motor-vehicle--crash
events, injury severity, and cost for non-fatal injuries.
Probabilistic linkage allows large files to be linked rapidly,
potentially providing information about persons involved in crashes
and the severity of their injuries, the treatment they received,
and charges for treatment; this information could be linked with
data on the public costs of injuries associated with risk-taking
behavior (e.g., drinking and driving), nonuse of safety belts and
motorcycle helmets, and speeding. The Wisconsin Department of
Transportation is using information from linked data about medical
outcomes and the costs of crash-related injuries resulting from
motorcycle and other motor-vehicle crashes to plan interventions
and evaluate their impact.

References
1. National Highway Traffic Safety Administration. Fatal Accident
Reporting System, 1991; a review of information on fatal traffic
crashes in the United States. Washington, DC: US Department of
Transportation, National Highway Traffic Safety Administration,
1992.
2. Wilson D. The effectiveness of motorcycle helmets in preventing
fatalities. Washington, DC: US Department of Transportation,
National Highway Traffic Safety Administration, 1989; National
Highway Traffic Safety Administration Technical Report DOT no.
HS-807-416.
3. CDC. A framework for assessing the effectiveness of disease and
injury prevention. MMWR 1992;41(no. RR-3).
4. US Government Accounting Office. Motorcycle helmet laws save
lives and reduce costs to society. Washington, DC: Government
Accounting Office, 1990; report no. GAO/RCED-91-170, 1991.
5. Wisconsin Office of Transportation Safety. Motorcycle helmet use
in Wisconsin, 1993. Madison, Wisconsin: Wisconsin Department of
Transportation, Office of Transportation Safety, 1994.
6. Kraus JF, Rock A, Hemyari P. Brain injuries among infants,
children, adolescents, and young adults. Am J Dis Child
1990;144:684-91.
7. Offner PJ, Rivara FP, Maier RV. The impact of motorcycle helmet
use. J Trauma 1992;32:636-42.

* Initial hospital charges were used as a proxy for hospital costs,
which are only a portion of direct medical costs. Initial hospital
charges do not include physician fees, emergency department
charges, or costs after discharge for subsequent hospitalizations,
long-term care, and rehabilitation.



------------------------------

Date: Thu, 23 Jun 94 05:55:38 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: Hanford Radiation Exposure
Message-ID: <F4iDoc3w165w@stat.com>

From:  Hanford Health Information Network
Re:  Information re: Hanford Radiation Exposure

If you lived in Eastern Washington, Northeastern Oregon or the
Idaho Panhandle between 1944 through 1972 you may have been
exposed to radiation released from the Hanford Nuclear Weaspons Facility.

If you are a health care provider, some of your patients may have
exposed to radiation.  An estimated 740,000 curies of radioactive iodine
131 released between 1944-1972 is believed to represent the greatest
health threat, according to the Hanford Environmental Dose Reconstruction
Project.  The Columbia River was polluted with 22,000,000 curies
of radioactive elements, south of Hanford to the mouth of the river
and along the coast contaminating Willapa Bay oyster beds.
For comparison, Three Mile Island released 15-24 curies of I-131.

Hanford Health Information Network(HHIN) prepares and distributes
information on both the known and potential health effects of radiation
to health care providers and persons who were or may have been exposed
to radiation from Hanford Nuclear Facility operations from 1944 to 1972.
For more information and free education materials call 1-800-959-7660.
Please leave a message with your name, address, phone number and
if you would like to be on the mailing list.

The HHIN is also developing a curriculum for continuing medical and
nursing education which will be available to universities/schools of
medicine across the country by fall 1994.

We are sponsoring a conference on September 9-11, 1994 in Spokane,
Washington titled:

Radiation Health Effects and Hanford:
 A Conference for Concerned Citizens and Health Care Providers.

For a brochure contact HHIN Conference, University of Washington
School of Medicine, CME, 1325 4th Ave. Suite 2000, Seattle, WA  98101
phone (206)543-1050, FAX (206) 543-3195.

Congress established the HHIN to serve the public and provide health
care professionals with a range of information on radiation health effects.
The HHIN is a collaboration among the state health agencies of Idaho,
Oregon and Washington and nine Indian Nations.

For those who would like information and live
in Washington State contact 1-800-522-4446;
in Idaho 1-800-793-6113;
in Oregon 1-800-248-4446;
and Tribal Members of the three States 1-800-798-0796.

National Information Line: 1-800-959-7660.
Please do not use e-mail, call our toll free numbers.



------------------------------

Date: Thu, 23 Jun 94 05:56:42 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: NIAID Recommend Continuing but Not Expanding HIV Vaccine Study
Message-ID: <85iDoc4w165w@stat.com>

N I A I D   N E W S
***********************************************
NATIONAL INSTITUTES OF HEALTH
National Institute of Allergy and Infectious Diseases
June 17, 1994


            NIAID Advisors Recommend Continuing But Not
              Expanding at This Time Ongoing Trials of
                     Two Candidate HIV Vaccines


      On June 17, 1994, the National Institute of Allergy and
Infectious Diseases (NIAID) held a joint meeting in Bethesda, Md., of
the NIAID AIDS Research Advisory Committee (ARAC) and the
NIAID AIDS Subcommittee of the National Advisory Allergy and
Infectious Diseases Council.  At the meeting, NIAID solicited a
recommendation from the group about whether or not to expand at this
time the NIAID's U.S.-based clinical trials of the two gp120 subunit
HIV candidate vaccines furthest along in development.  Ashley T.
Haase, M.D., ARAC chairperson and head of the Department of
Microbiology at the University of Minnesota Medical School in
Minneapolis, chaired the meeting.

      After a full day of discussion and deliberation, these advisors
recommended that the Institute continue, but not expand, the current
vaccine trials of the two gp120 candidates in question and continue the
development of other candidates currently under study.  The committee
members also recommended NIAID proceed with expanded clinical trial
evaluation when a vaccine of a different design and/or when other
compelling data from current or other studies are available.  In
recognition of the difference in the dynamics of the epidemic throughout
the world, the majority of the advisers also agreed that at the present
time this recommendation applies only to studies of these two products
in the United States.

      The discussion and subsequent recommendation to NIAID
Director, Anthony S. Fauci, M.D., is part of NIAID's ongoing
decision-making process about when to begin its first efficacy trial of
preventive HIV vaccines.  Because of the clear, overwhelming
consensus of the advisors, Dr. Fauci adopted the recommendation.

      The two vaccines are based on genetically engineered forms of
the major HIV surface protein, gp120, from closely related but distinct
HIV-1 strains representative of most infections in North America and
Europe.  The Biocine Company (Emeryville, Calif., a joint venture of
Chiron and CIBA-Geigy) makes its vaccine from the SF-2 strain.
Genentech, Inc., (South San Francisco) bases its vaccine on the MN
strain.  At this time, these HIV vaccines are the only ones in an
NIAID-sponsored Phase II clinical trial.  NIAID began the trial in
December 1992.

      NIAID will evaluate data from new and ongoing HIV vaccine
studies before it identifies a suitable candidate vaccine to propose for
expanded trials. The Institute estimates that one to three years are
needed to get such data.  NIAID is committed to the development of
a vaccine to prevent HIV infection and disease.  This means continuing
the Institute's comprehensive basic and applied program of preclinical
and clinical work on candidates and concepts currently in earlier stages
of development.  Additional community preparedness work will also
be carried out.  The clinical trials conducted through NIAID's vaccine
clinical trial networks are part of a broader prevention effort that
includes non-vaccine prevention research.

      NIAID, a component of the National Institutes of Health (NIH),
supports research on AIDS, tuberculosis and other infectious diseases
as well as allergies and immunology.  NIH is an agency of the U.S.
Public Health Service, U.S. Department of Health and Human Services.

Prepared by:
Office of Communications
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Bethesda, MD 20892

Public Health Service
U.S. Department of Health and Human Services



------------------------------

Date: Thu, 23 Jun 94 05:58:19 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: Courses Available in Pharmocokinetics
Message-ID: <w8iDoc5w165w@stat.com>

                              ANNOUNCEMENT
                              ^^^^^^^^^^^^
      Summer, 1994 Courses for Scientists, Physicians, Clinical Research
                Associates and Regulatory Affairs Specialists

For the past eight years, Kemic Bioresearch has organized special courses
in pharmacokinetics and other biomedical topics for researchers and
clinical and regulatory specialists from the pharmaceutical industry and
government.  These widely acclaimed, three-day courses are presented at
various venues throughout North America each year.

Courses to be offered this summer on the beautiful Acadia University
campus in Nova Scotia include:

                               July 4-6, 1994
     "Pharmacokinetics: Essential Theory and Practical Considerations"
          (to be also presented in Princeton, NJ, December 5-7)

                              July 13-15, 1994
 "Clinical Trial Management: Quality Assurance & Performance Strategies..."

                              July 18-20, 1994
 "Special Topics in Pharmacokinetics: Data Analysis and Modeling Techniques
  with Computer Applications" (also to be presented in Princeton, Dec. 7-9)

                              August 1-3, 1994
                       "Fundamentals of Pharmacology"

For further information concerning any of these courses, please contact:
    Tel:   (902) 678-8195                  Susan Goodall
    Fax:   (902) 678-2839                  Courses Co-ordinator
                                           Kemic Bioresearch Labs
    Email: pmullen@fox.nstn.ns.ca          P.O. Box 878
                                           Kentville, Nova Scotia, B4N 4H8
                                           Canada



------------------------------

Date: Thu, 23 Jun 94 05:59:19 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: Conference on Alzheimer Disease
Message-ID: <k0iDoc6w165w@stat.com>

      Alzheimer Society of Ottawa-Carleton and the SCO Health Service
                       present a one-day conference:

                             ALZHEIMER DISEASE:
         Essential partnerships in helping patients and family cope

          Thursday, SEPTEMBER 29, 1994 ---  8:15 a.m. to 3:45 p.m.
    Elisabeth Bruyere Health Centre, 43 Bruyere Street, Ottawa, Ontario

         Who should attend:     Families and Professional Caregivrs
          who care for those with Alzheimer Disease, either in the
                      community or in care facilities.

Conference Fee (includes lunch and coffee breaks)
 *   Regular Registration................ $90.00
 **  Early bird registration............. $80.00
       (received prior to August 2, 1994)
 *** Family members who are also......... $50.00
       Alzheimer Society Members

Keynote Speakers:

"Meeting the Challenge"
Len Fabiano, RN, BA. is author of several books, including
"Mother I'm Doing the Best I Can" and "The Tactics of
Supportive Therapy: A Cpmprehensive Intervention Program for
Effective Caring of the Alzheimer Victim"

"Alzheimer Disease - A Ray of Hope"
Update on Research and Treatment
Dr. Jonathan Willmer, MD, FRCP(C) (Neurology)
Dr. Willmer is the Director of the Memory Disorder Clinic,
Elisabeth Bruyere Health Centre

Concurrent Sessions:

1. "Doing Things on Purpose: Meaningful Activity Programming"
     Jitka Zgola, Coordinator, Psychogeriatric Community
     Services and author of "Doing Things"

2. "Managing Difficult Behaviour"
     Jean Benton, RN, B.Sc., Saint Vincent Hospital, will
     focus on an "enabling framework" for assessing behavious
     and planning care.

3. "La maladie d'Alzheimer" (en francais)
     Louise Cleroux, Unite d'Alzheimer et maladies reliees
     Monique Thibault, programme Jour de sortie des
       Infirmieres de l'ordre de Victoria
     Mathe Charron, IA, B.Sc. (Villa Maguerite)

     Les differentes approches et suggestions practiques en
     milieux familial, communautaire et institutionelle.

4. "Making Life Easier"
     Melanie Macdonald, RN, MEd, MBA St. Vincent Hospital

     Practical strategies for caregivers to enhance the
     coping abilities of those with Alzheimer Disease.

5. "Living with and Learning from Loss: A Family Panel"
     Moderator: Patricia Van Loan, MScEd, MSW (Saint Vincent
       Hospital)

     A son, daughter and spouse will discuss their personal
     experiences as caregivers and how they have coped with
     losses. The panel will offer practical suggestions as to
     how professionals can best help family caregivers.

For Further Information Contact:
Patricia Van Loan    Tel. (613) 233-4041, ext. 2109
                     FAX  (613) 782-2785



------------------------------

Date: Thu, 23 Jun 94 06:00:01 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: AIDS Daily News Summary
Message-ID: <qaJDoc7w165w@stat.com>

                     AIDS Daily Summary

The Centers for Disease Control and Prevention (CDC) National AIDS
Clearinghouse makes available the following information as a public
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Copyright 1994, Information, Inc., Bethesda, MD

     **************************************************************
     Topics in this issue:
     - "Thailand Begins AIDS Vaccine Trial"
     - "HIV Health Workers 'Need Better Protection'"
     - "Partners of HIV-Infected Men with Hemophilia"
     - "Self-Reports of HIV Risk Factors by Patients at a Sexually
        Transmitted Disease Clinic: Audio vs Written Questionnaires"
     - "Stanford Opens HIV/AIDS Primary Care Clinic"
     - "Triplex Reports Discovery of Olignucleotide Compounds That
        Significantly Inhibit HIV-1 Activity"
     - "Five Best Centers for AIDS Research"
     - "AIDS Vaccine Research Misleading, Group Alleges"
     - "HIV Screening in Pregnancy: UK Lags"
     - "The First Search for the Source"
     - "Good News and Bad News About AZT"
     - "Zidovudine for the Prevention of HIV Transmission From Mother to
        Infant"
     - "Suppression of HIV Production in Resting Lymphocytes by
        Combining Didanosine and Hydroxamate Compounds"
     - "HIV Vaccine Trials: Will Intravenous Drug Users Enroll?"
     - "AZT Not Linked to Higher Rate of Birth Defects"
     - "Scientists Joust Over AIDS Research"
     - "TB Underestimated in HIV Wasting"
     - "Another HIV Drug"
     **************************************************************

              "Thailand Begins AIDS Vaccine Trial"
             United Press International (06/06/94)
                    (Utumporn, Pichayaporn)

     The first in a series of clinical trials in developing nations
began on Monday, as the Thai Red Cross began testing a new AIDS
vaccine.  The 30 HIV-negative volunteers who were inoculated with
United Biomedical Inc.'s UBI-1 formula will receive a second
vaccination in four weeks, according to Dr. Praphan Phanuphak,
director of the agency's Program on AIDS.  Doctors will
periodically draw blood from trial participants over the next six
months, and check their immune systems after eight months, he
said.  At that point, researchers should know if the vaccine will
help develop antibodies.  The UBI-1 vaccine has already been
tested on about 100 volunteers in the United States, China, and
Australia, and has also been approved by the World Health
Organization for Rwanda, Uganda, and Brazil, in addition to
Thailand.


          "HIV Health Workers 'Need Better Protection'"
          Nature (05/19/94) Vol. 369, No. 6477, P. 173
                       (Butler, Declan)

     A group of French researchers, doctors, and healthcare providers
have formed Union pour la Protection des Soignants et de leurs
Patients, an association seeking to reduce the risks of HIV
infection to healthcare workers through hospital accidents.  In
particular, the association wants health authorities to require
hospitals to introduce precautions against accidental HIV
transmission.  Self-sheathing needles, for example, could reduce
needleprick accidents by two-thirds, according to Francis
Cheilan, the group's president.  He notes that although similar
precautions were issued by the ministry of health two years ago,
only a handful of hospitals have introduced safer procedures.
Part of the problem, says Cheilan, is that authorities are not
convinced of the risks, even though an estimated 30 French
healthcare workers have contracted HIV through work accidents.
The association claims that the true figure is closer to 300, and
will continue to incline as more HIV-positive patients are
diagnosed.  The association is also campaigning for specific
legislation allowing healthcare workers to claim adequate
compensation.  Currently, workers contaminated by HIV on the job
come under legislation that covers general work accidents, which
entitles them only to an invalidity pension--about one-third of
salary.


          "Partners of HIV-Infected Men with Hemophilia"
               Focus (05/94) Vol. 8, No. 6, P. 8
          (Klimes, I.;  Catalan, J.; Garrod, A. et al.)

     No differences were observed in the psychological status of
female partners of HIV-negative hemophiliac men and HIV-positive
hemophiliac men, according to a study.  Partners of the 17
HIV-positive and 19 HIV-negative hemophiliacs were comparable in
terms of age, employment status, and social class, and all were
confirmed to be HIV-negative.  Despite being forced to cope with
their husband's psychological state, changes in the sexual
relationships, and concerns about contracting HIV, 78 percent of
the partners of seropositive men said that their relationship, in
general, remained unchanged since their partners first underwent
HIV testing.  When compared to women in the general community,
however, partners of hemophiliac men--regardless of HIV
status--were found to have twice the number of psychological
symptoms.  The heightened level of psychological distress among
these women suggests that living with and managing hemophilia is
more stressful and of more immediate concern than the challenge
of living with asymptomatic HIV disease.


    "Self-Reports of HIV Risk Factors by Patients at a Sexually
    Transmitted Disease Clinic: Audio vs Written Questionnaires"
  American Journal of Public Health (05/94) Vol. 84, No. 5, P. 754
    (Boekeloo, Bradley O.;  Schiavo, Laura;  Rabin, David et al.)

     Measurement error in assessing HIV risk can lead to
misinterpretation of research, undetected patient risk, and
weakened efforts to protect the blood supply.  For most HIV risk
factors, self-reporting is typically the only acceptable method
of assessment, usually through written questionnaires or
face-to-face interviews.  Although neither method has been deemed
superior, there has been some concern that there is greater
measurement error in face-to-face interviews, as opposed to
pencil-and-paper surveys.  Written questionnaires, however, may
be difficult for some subjects to read and complete.  A
self-administered questionnaire completed through audiocassette
player and headset may overcome some of the sources of
measurement error associated with the other two methods.  To
determine how method of assessment affects patient self-reporting
about HIV, patients received either a written self-administered
questionnaire, or one that was administered through the tape and
headset.  Boekeloo et al. found that audio questionnaires not
only had fewer missed responses than written questionnaires, but
they also identified more unprotected vaginal intercourse and
partners known or thought to be HIV-infected.  They conclude that
audio questionnaires may obtain more complete data and identify
more HIV risk than written questionnaires, and research needs to
be done to determine whether this method overcomes barriers to
completion and accuracy of HIV risk surveys.


         "Stanford Opens HIV/AIDS Primary Care Clinic"
                   Business Wire (06/06/94)

     California's Stanford Hospital will provide specialized primary
care for HIV/AIDS patients with the opening of The Stanford
Positive Care Clinic.  According to the clinic's director, Dr.
Andrew Zolopa, the goal of the new facility is to provide
HIV-infected patients--at all stages--with comprehensive health
care, as well as access to the most current drug and vaccine
research trials.  The clinic will also provide the peninsula's
HIV/AIDS patients with access to all levels of care at a single
location, dispensed by specially trained staff members.


    "Triplex Reports Discovery of Olignucleotide Compounds
          That Significantly Inhibit HIV-1 Activity"
                   Business Wire (06/06/94)

     Scientists at Triplex Pharmaceutical Corp. have discovered a
series of compounds, called guanine-thymine olignucleotides
(GTOs), which seem to inhibit HIV production through a unique
nucleic acid protein interaction.  The compounds suppressed HIV
p24 production for more than one week after being removed from an
HIV-infected culture media, according to Triplex President and
CEO Dr. James M. Chubb.  The GTOs may prevent viral-specific
transcription, thus potentially slowing or even halting disease
progression, added Dr. Robert F. Rando, an assistant director at
Triplex.  Rando said the company is currently focusing on
defining the mechanisms of action of the GTOs, and working to
characterize the GTOs' long-term suppression of HIV.


             "Five Best Centers for AIDS Research"
               Advocate (05/17/94) No. 655, P. 20

     A survey of medical school deans and senior faculty members lists
the five best centers for AIDS research as the University of
California at Los Angeles, the University of California at San
Francisco, Harvard University, Johns Hopkins University, and the
University of Washington.  The study was conducted by U.S. News &
World Report.


       "AIDS Vaccine Research Misleading, Group Alleges"
               Washington Post (06/08/94) P. A11
                       (Schwartz, John)

     Public Citizen's Health Research, a consumer health group,
yesterday accused a key military researcher of manipulating data
to give his research on the controversial gp160 experimental AIDS
vaccine a favorable twist.  After receiving a letter from Sidney
M. Wolfe, the organization's director, Rep. Henry A. Waxman
(D-Calif.) said he would reopen an investigation on the
researchers, the vaccine, and its manufacturer, Connecticut-based
MicroGeneSys.  Robert Redfield, chief of the department of
retroviral research at the Walter Reed Army Institute of
Research, previously admitted that his analysis of the gp160 data
was flawed, but was cleared of scientific misconduct charges.


             "HIV Screening in Pregnancy: UK Lags"
         Lancet (05/07/94) Vol. 343, No. 8906, P. 1113
                (Banatvala, J.E.; Chrystie, I.L.)

     The results of 1991 HIV testing among pregnant women in London
revealed that 1 in 500 women attending certain antenatal clinics
were infected, and 75 percent of them did not know or did not
inform health care providers that they were infected.  It was
also becoming increasingly clear that the advantages of knowing
the HIV status of a mother and her baby outweighed the potential
disadvantages.  In light of this information, the Department of
Health issued guidelines advising that HIV testing be made
available to pregnant women in areas of "known or suspected
higher prevalance of HIV infection."  In 1991, only 8 of 296
hospital-based antenatal clinics--3 in Scotland and 5 in
London--offered HIV tests to all pregnant women.  By 1993, one
year after the guidelines were released, that number had sunk to
4, although more centers were considering offering the test.  The
lack of antenatal HIV screening in the U.K. contrasts with other
countries.  Although testing is available on request in most
antenatal clinics in Britain, various factors contribute to the
poor response to the Department of Health's recommendations, the
first of which is cost.  The department took into account money
for lab testing, training programs, and counseling, but failed to
include the expenses for manpower and space requirements.
Another reason is the fact that many staff still believe that HIV
testing is not worthwhile.  They should be reassured by the
results of a multi-center trial of HIV-infected mothers who cut
the risk of transmitting the virus to their babies by two-thirds
by taking AZT.  Nonetheless, the HIV program requires
considerably more resources and stands little chance of
implementation unless additional funds are forthcoming.


           "The First Search for the Source"
       Toronto Globe and Mail (06/08/94) P. A16
                 (Mickleburgh, Rod)

Hospitals in Canada, where more than 1,000 blood transfusion
recipients became infected with HIV, announced on Monday that
they intend to track down everyone who received the procedure
from 1978 to 1985, when the Red Cross began to screen donated
blood for the virus.  Under the trace-back procedure, when a
blood transfusion patient develops HIV, the patient's hospital
gives the Red Cross the code numbers of blood units donated to
the patient.  The Red Cross then tries to contact all of the
involved donors to urge them to undergo HIV testing.  This method
is largely based on protocol developed in 1985, according to Col.
Neville Robinson.  As administrator of Vancouver's Red Cross
Blood Transfusion Center, Robinson led that year's investigation
into the source of HIV-contaminated blood that infected two blood
transfusion recipients.  Operation 300, as it was called, was 150
days spent trying to contact the 301 donors to the first infected
patient and the 17 donors linked to the second patient.  The
detective work meant hours of telephone work at a time when fear
of AIDS had gripped the public.


           "Good News and Bad News About AZT"
  U.S. News & World Report (05/16/94) Vol. 116, No. 19, P. 88

   Recent studies with AZT have brought both triumph and
disappointment to the AIDS battle.  In a recent trial of AZT in
HIV-positive, pregnant women, scientists at the National
Institutes of Health calculated that those who took the drug were
only one third as likely to transmit the virus to their babies as
were those who took a placebo.  Another finding, however,
suggests that while AZT has demonstrated clear benefit to most
patients who are already sick, the common practice of prescribing
AZT before a patient exhibits symptoms of disease does not
ultimately prolong life.  In fact, according to the study, the
side effects from taking the drug--including chronic nausea and
fatigue--may outweigh its short-term benefits.  The finding has
left HIV patients in a "catch-22" situation: either to cope with
the side effects of taking AZT in order to delay sickness, or to
wait before taking the drug, possibly bringing illness on
earlier.  A panel of experts convened by the National Institutes
of Allergy and Infectious Diseases suggests that AZT use be
dictated by CD4 levels.  Those with counts under 200 should take
the drug.  Patients with counts between 200 and 500 should
consult a physician.  And those with CD4 counts over 500--about
half the normal level--should not take AZT, says the panel.


            "Zidovudine for the Prevention of HIV
              Transmission From Mother to Infant"
          JAMA (05/25/94) Vol. 271, No. 20, P. 1567

     Although preliminary results of a trial of zidovudine to prevent
HIV transmission from mothers to their babies showed a 67.5% risk
reduction, the findings were subject to at least four
limitations.  First, the study did not measure the efficacy of
zidovudine among women whose T cell counts were below 200.  Nor
did it assess the efficacy of zidovudine among women who had
previously used the drug for extended periods and may have
developed zidovudine-resistant strains of HIV.  The study also
did not evaluate risk in the first trimester of pregnancy.
Third, the study failed to assess the independent or relative
contributions of  the antepartum, intrapartum, or treatment of
the infant; therefore, the efficacy and side effects of
zidovudine regimens restricted to only one or two of these
treatment periods were unknown.  Finally, the study has not yet
yielded any information about long-term side effects for the
infants and mothers treated with zidovudine.


    "Suppression of HIV Production in Resting Lymphocytes
      by Combining Didanosine and Hydroxamate Compounds"
         Lancet (05/21/94) Vol. 343, No. 8908, P. 1292
   (Malley, S.D.; Grange, J.M.; Hamedi-Sangsari, F. et al.)

     Although the currently available AIDS drugs zidovudine,
didanosine, and zalcitabine exhibit strong HIV inhibition in
vitro in long-term dividing cell lines and activated peripheral
blood mononuclear cells, they are only partially effective in
suppressing viral replication in AIDS patients.  Malley et al.
suggest that it is the non-dividing "resting" cells that should
be targeted for antiviral activity, since quiescent peripheral T
lymphocytes may be an important and inducible HIV reservoir in
infected persons.  The researchers evaluated the anti-HIV
activity of the three drugs and found them, alone or in
combination, unable to fully inhibit viral production or protect
the cells from the cytopathic effect of viral replication.  The
drugs were then tested in combination with hydroxamates, known
for their inhibitory effect on ribonucleotide reductase in
replicating cells.  Didanosine in combination with '-hydroxamate
(DAH) or hydroxyurea (HU) yielded a synergistic effect resulting
in complete suppression of viral production, total protection
against the cytopathic effect induced by viral replication, and
non effect on the cells' ability to replicate normally after
treatment.  Trials are slated for May.


       "HIV Vaccine Trials: Will Intravenous Drug Users Enroll?"
   American Journal of Public Health (05/94) Vol. 84, No. 5, P. 761;
         (Meyers, K.;  Metzger, D.S.;  Navaline, H. et al.)

     A number of HIV vaccines are currently in phase I/II clinical
trials, and as this work progresses towards phase III studies, a
relevant practical question emerges.  As of yet, little work has
been done to outline the issues surrounding recruitment and
retention of volunteers for HIV vaccine trials.  Crucial is the
need to determine whether individuals at high risk, particularly
intravenous drug users, will participate.  To assess the
willingness of addicts to participate in vaccine trials, Meyers
et al. analyzed the results of questionnaires completed by 257 IV
drug users.  The subjects were asked about risk behaviors,
interest in vaccine trials, and other vaccine-related
information.  Meyers et al. discovered that 30 percent of the
subjects did not even know what a vaccine was.  Of those that
did, however, 52 percent expressed willingness to be one of the
first to participate in a preventive HIV vaccine trial.
Twenty-two percent, however, said they would probably increase
needle-sharing if they were vaccinated.  The findings suggest
that some in-treatment drug users would enroll for preventive HIV
vaccine efficacy trials, but that education and counseling would
be required to make sure participants fully understand the
trial's purposes, methods, risks, and benefits.


        "AZT Not Linked to Higher Rate of Birth Defects"
             Philadelphia Inquirer (06/10/94) P. D9

     Infants whose mothers took the anti-AIDS drug AZT while pregnant
do not appear to suffer from birth defects as a result, according
to a study by the Centers for Disease Control and Prevention.  Of
the babies born to mothers who took the drug during pregnancy,
only about 2 percent had birth defects.  That rate was not
significantly more than the general population, in which 3
percent of all babies are born deformed.  Furthermore, there was
no pattern among the babies born with defects to suggest that the
deformity was caused by AZT.


             "Scientists Joust Over AIDS Research"
                Baltimore Sun (06/10/94) P. 17A

     Two renowned scientific journals, Science and the Journal of the
American Medical Association, have clashed over the validity of
findings in a published report about an AIDS-related skin cancer.
The dispute revolves around an experimental compound regarded by
leading AIDS researcher Dr. Robert Gallo as promising for the
treatment of Kaposi's sarcoma.  Public debate exploded on
Wednesday when JAMA printed a report by Dr. Marlys H. Witte et
al. of the University of Arizona in Tucson, who attempted, but
failed, to duplicate Gallo's experiments with mice and confirm
some of the key findings.  The researchers say Gallo's work is
flawed by systematic errors and omissions, and that their
challenge of the findings' validity was foiled by another
journal, Science.  Witte et al. had originally submitted their
own report to Science, which had published Gallo's study, but the
journal called the Witte team's experiments "an extraordinary
waste of time and effort" and rejected the paper.  When a second
report including the comments of another researcher, Dr. H.J.
Carroll, was again rejected by Science, the Tucson researchers
decided to air the dispute through JAMA.  Related Story: Chicago
Tribune (06/09) P. 1


               "TB Underestimated in HIV Wasting"
             United Press International (06/11/94)

     HIV wasting syndrome, or slim disease, is caused by tuberculosis
more often than previously thought, according to a British study.
HIV patients who have wasting syndrome shed much of their body
weight, and the condition is especially common in Africa.
Researchers examined the bodies of more than 200 HIV patients in
the Ivory Coast, and found that nearly half of the 93 patients
with wasting syndrome were co-infected with tuberculosis,
although TB treatment was not noted on the patients' medical
records.  The researchers also found that the most severe cases
of wasting syndrome were accompanied by the most severe cases of
tuberculosis.  They concluded that the large volume of TB in the
body suggests that it--and not the intestinal parasite and lack
of food previously attributed--is probably the cause of the
wasting syndrome.  Because TB is treatable in its early stages,
the findings have major implications for African cities.


                 "Another HIV Drug"
    Lancet (05/28/94) Vol. 343, No. 8909, P. 1306
                  (Rowe, Paul M.)

     Stavudine, also known as d4T, is the fourth inhibitor of HIV
reverse transcriptase pushing for accelerated Food and Drug
Administration approval.  Despite the fact that little is known
about the nucleoside analogue's specific indications,
interactions with other drugs, or effects in segments other than
young white males, an advisory committee in May was supportive of
a recommendation for approval.  The drug has been tested on
10,000 subjects, 79 percent of whom are still alive after 18
months.  Another trial compared d4T with zidovudine, and found
d4T to be significantly better at increasing or maintaining CD4
cell levels and decreasing HIV antigen levels.



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End of HICNet Medical News Digest V07 Issue #28
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---
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