Neuropathology of human immunodeficiency virus infection: a forensic autopsy study in Dar Es Salaam, Tanzania

The objective of this study was to examine the neuropathological changes in the brain of patients infected with human immunodeficiency virus (HIV) in the Tanzanian capital Dar Es Salaam, and investigate whether the prevalence of different forms of HIV-related neuropathology varies from other countries. The subjects were patients with risk factors for HIV infection in whom forensic autopsies were performed between 1997 and 1999. In Dar Es Salaam, forensic autopsy constitutes more than 90% of all autopsies, because hospital autopsy is limited due to socio-cultural and religious reasons. HIV infection was identified in 52 of 143 patients selected from forensic autopsies. Neuropathological findings were observed in 31 of 52 HIV-infected patients; these include lymphocytic meningitis 19, bacterial meningitis 3, tuberculous brain abscess 3, cryptococcal meningitis 3, basal ganglia calcification 3, and toxoplasma encephalitis 1. HIV encephalitis, lymphoma, and cytomegalovirus encephalitis could not be found in this study. Whereas the findings should be interpreted cautiously because of possible autopsy bias and a low percentage of cases examined compared to the total number of HIV-infected patients in Tanzania, our observations provide information on the likely diagnostic possibilities to be considered in the evaluation and management of HIV-infected patients with neurological symptoms in Tanzania. In the face of decreased hospital autopsy, most studies have focused mainly on the end-stage HIV disease; forensic autopsy is a potential source of materials for studies on HIV disease spectrum at different stages.     

Pediatric acquired immune deficiency syndrome (AIDS); health care demonstration projects--HRSA. Notice of availability of funds

The Bureau of Maternal and Child Health and Resources Development (BNCHRD), Health Resources and Services Administration (HRSA) announces that Fiscal Year (FY) 1990 funds are available for grants for Pediatric AIDS Health Care Demonstration Projects, Pediatric AIDS Comprehensive Center Demonstration Projects, and National Issues of High Priority. Projects will be funded to demonstrate strategies and innovative models for intervention in pediatric AIDS and coordinated services for children, youth, and women of childbearing age with Human Immunodeficiency Virus (HIV) infection, AIDS or other related conditions, or those at risk for developing infection and its consequences. Funds were appropriated for this purpose by Public Law 101-166.     

Discrepancy between Mother and Child Perceptions of Their Relationship: II. Consequences for Children Considered within the Context of Maternal Physical Illness

Discrepancies between parent and child perceptions of parenting have been well established. The current study addressed whether discrepancies in one dimension of parenting, the parent-child relationship, are associated with child adjustment difficulties concurrently and longitudinally. In particular, it was hypothesized that greater discrepancies in mother and child perceptions of parenting would be associated with child adjustment difficulties. Furthermore, it was hypothesized that families experiencing a stressor—in this case, maternal infection with the human immunodeficiency virus (HIV)—would experience larger discrepancies than families in which the mother is noninfected and that maternal HIV infection would moderate the association between discrepant views and child adjustment. Participants were 183 African-American women (61 HIV infected; 122 noninfected) and one of their noninfected children. All participants were from the inner-city area of New Orleans. Results indicated that discrepancies in mother and child perceptions of their relationship was associated with mother and child reports of externalizing behavior problems concurrently and longitudinally. In addition, discrepancies were significantly higher in families experiencing maternal HIV infection than in the noninfected group. However, with one exception, maternal HIV status failed to moderate the relationship between discrepancies in perception and child adjustment, indicating that discrepancies play a similar role in both types of families. Clinical implications of the present results are discussed.     

AIDS prevention: legislative options

This article reviews legislative options to prevent the transmission of HIV infection. It distinguishes between pre-exposure measures designed to prevent initial exposure, and post-exposure measures aimed at preventing infected individuals from exposing others. Part I identifies education as the key component of a comprehensive prevention program, and reviews options for pre-exposure education programs designed to avoid or minimize exposure. Part II reviews post-exposure prevention measures, focusing on reporting and contact tracing provisions. Mandatory reporting by name of individuals testing HIV positive and mandatory contact tracing are opposed as counterproductive prevention measures; voluntary partner notification is supported. Part III examines various prevention efforts for settings where there may be either a real or perceived risk of transmission of HIV infection. Part IV sets out conclusions.     

Pathologico-anatomic findings in sudden, unexpected death in children and adults with influenza A infection

Thé following observations resulted from studies on forensic autopsy cases: In 76% of the adults and 55% of the infants the cases of unexpected sudden death without morphologically verifiable causes of death showed virologic evidence of recent influenza-A (H3N2)-infection. The pathologic findings corresponded with the findings in lethal infections with influenza-A viruses. Investigation of cases of sudden and unexpected death should always include virologic serum tests. The demonstration of IgM antibodies against influenza-A virus confirms that there was a recent infection. Death from influenza-A infections occurs also in the interepidemic periods.     

Reye's syndrome. A review from the forensic viewpoint

Reye's syndrome, encephalopathy and fatty change in the liver and other viscera, typically occurs suddenly in infants and children recovering from a viral illness, particularly influenza or varicella. Its rapid clinical course may suggest a drug-related insult and the differential diagnosis includes a variety of toxins. There are grounds for suspicion that exogenous substances--including aspirin--may be cofactors with recent viral illness in the syndrome's pathogenesis. For these reasons, medical examiners may be called upon to rule the diagnosis in or out, to assess the possibility of direct toxic injury, or to document presence or absence of possible cofactors. With these tasks in mind, this review summarizes the diagnostic, pathologic, and laboratory findings of Reye's syndrome and considers the roles of viral infection, heritable predispositions, and exogenous toxins in its causation. It singles out salicylate treatment for special considerations as a possible cofactor, and concludes with a suggested approach to the forensic medical investigation of possible cases of Reye's syndrome.     

Partner Abuse and HIV Infection: Implications for Psychosocial Adjustment in African American Women

A prospective study of the effects of partner abuse among HIV-infected and noninfected African American women (N = 137) revealed that there were both concurrent and longitudinal effects of abuse on several indices of psychosocial adjustment. Specifically, higher levels of both verbal and physical abuse were found among the HIV-infected group. In addition, the effects of abuse on suicidal ideation were significantly stronger among the HIV-infected group (n = 53) than among their demographically similar noninfected counterparts (n = 84), resulting in significant HIV status by partner abuse interactions. The findings of this study advance our understanding of intimate relationships with regard to partner abuse by examining a group of women at high-risk for abuse, yet understudied in both the HIV/AIDS and relationship literatures.     

Barcelona 2002: law, ethics, and human rights. Juggling individual and collective concerns with respect to HIV/AIDS policies

Efforts to prevent the spread of HIV infection sometimes give rise to tensions between individual and collective rights. This article, based on a presentation by Nelson Varas-Díaz (abstract TuOrG1171), explores these tensions in the context of the laws and policies of eight Latin American countries: Costa Rica, Dominican Republic, Ecuador, Guatemala, Honduras, Nicaragua, Panama, and Puerto Rico. The article describes five elements of the response to HIV/AIDS in which tensions between individual and collective rights have surfaced: the participation of people living with HIV/AIDS on national commissions; the ability of HIV-positive persons to access antiretroviral medications; HIV-antibody testing practices; the confidentiality of health information; and the rights and duties of people living with HIV/AIDS. The article concludes that the success of programs designed to prevent the spread of HIV infection depends on the ability of societies and governments to balance the tensions between individual and collective rights.     

Hiding children to avoid ARV treatment

In the last issue, we reported on the case of a Montréal woman with HIV who lost custody of her two HIV-positive children after refusing to consent to their treatment with antiretroviral therapy.     

Single Types of Family Violence Victimization and Externalizing Behaviors Among Children and Adolescents

Prior research has provided substantial evidence that child maltreatment and exposure to physical intimate partner violence (IPV) are associated with increased externalizing behavior problems among children and adolescents. However, little is known about the effects of exposure to psychological IPV and exposure to the physical abuse of a sibling. Using a total sample (N = 2,572) and subsample (n = 441) of children ages 3–18 years old, the purpose of this study was to assess whether cumulative types of family violence lead to higher mean externalizing behavior scores and to examine the effects of single types of indirect and direct family violence on children’s mean externalizing behavior scores. Results confirmed that children who experienced any type of family violence victimization had higher mean externalizing behavior scores compared to children with no history of family violence; however, few differences in externalizing behavior scores were found as the number of family violence types increased. Children who experienced indirect types of family violence (e.g., exposure to the physical abuse of a sibling) had higher externalizing behavior scores than children who experienced direct maltreatment (e.g., child physical abuse). Findings from this study suggest that researchers and service providers should adopt a broader conceptualization of family violence victimization and increase the amount of services provided to children who are indirectly victimized.     

Advisory committee; Pediatric Advisory Committee; establishment. Final Rule

The Food and Drug Administration (FDA) is announcing the establishment of a Pediatric Advisory Committee in the Office of the Commissioner. Elsewhere in this issue of the Federal Register, FDA is publishing a document requesting nominations for the membership on this committee. This document adds the Pediatric Advisory Committee to the agency's list of standing advisory committees in 21 CFR 14.100.     

Asymptomatic HIV as a disability under the Americans with Disability Act

The Americans with Disability Act (ADA) does not state whether it prohibits discrimination against individuals who are infected with HIV but asymptomatic. Some courts have held that the language of the ADA is unambiguous and does not cover asymptomatic HIV as a disability because the virus is not an "impairment" that substantially limits a "major life activity." Other courts have looked behind the statutory language and found that Congress intended to protect asymptomatic individuals with HIV because the virus impairs one's ability to procreate and/or engage in sexual relations. This Comment argues that asymptomatic individuals with HIV are indeed protected under the ADA, but that the analytic framework thus far employed by the courts is flawed. Asymptomatic HIV is a protected disability not because it is independently debilitating, but because the prejudices and fears of other may prevent HIV-infected persons from fully participating in society. The ADA was enacted to prevent exactly this type of discrimination.     

我国首例艾滋病抗体阳性死亡病例的进一步病理研究

作者原报告艾滋相关综合征(ARC),经用组化和免疫组化方法,发现肺部有混合性机会感染和淋巴结免疫缺陷病变,应诊断艾滋病(AHDS)。     

A Proposed Scheme for Classifying Pediatric Rib Head Fractures Using Case Examples

Pediatric rib head fractures are typically described as “posterior” or “costovertebral,” terms lacking specificity. To resolve this issue, a scheme was developed to describe the location of rib head fractures observed in a pediatric forensic population. The scheme uses three anatomical landmarks, terminus (tip), tubercle, and costovertebral articular surface to divide the rib head into two subregions, costovertebral and costotransverse. Examples of five cases of infants with rib head fractures are presented using this scheme. Forty‐eight rib head fractures were observed in these infants with the following frequencies: 56% (three infants) at the terminus; 21% (three infants) in the costovertebral subregion; 21% (one infant) at the costovertebral articular facet; and 2% (one infant) in the costotransverse subregion. Due to the small number of cases assessed, statistical analyses could not be performed; however, the data demonstrate the variation in distribution of pediatric rib head fractures.     

Child Fatalities in Dammam: A Call for Child Fatality Reviews in Arab Countries

Identifying children's risk exposure is the first step toward mortality prevention. This retrospective study determined the causes of child fatalities in Dammam, Saudi Arabia. Death reports of children and adolescents from 1999 to 2015 (N = 157) were analyzed. Boys represented most cases (69%) and there were two age peaks (1–5 years and 16–18 years). Accidents (typically immersion) defined the main death circumstance (51%) followed by homicide (25%). Only 33% of cases underwent autopsy, and the most common cause of death was head injury (27%) followed by firearm injury. Only one immersion death underwent autopsy. This study revealed important data about the risk exposure of children in Dammam and emphasizes deficient investigative procedures. Child fatality reviews comprise systematic data collection by multidisciplinary teams to determine the true risks toward children in a community. Such teams do not exist in Arab countries; therefore, strategies should be implemented to initiate them.     

Best Practices for Serving Traumatized Children and Families

This paper highlights the traumatic impact of child abuse and neglect upon children and adolescents who are commonly seen in court systems. In addition to describing prevalence rates of trauma exposure and psychological reactions among traumatized children, it addresses the need for judges and court personnel to work with children and families in a manner that is sensitive to their traumatic experiences and emphasizes the need for these children to receive the very best evidence‐based care available in order to help them more effectively cope and recover from trauma exposure. Cultural issues and model adaptations are covered in relation to the use of evidence‐based practices with children from various cultural and ethnic backgrounds. Specific recommendations are given to help judges and court personnel become better informed about the use of evidence‐based practices for treating child trauma, enabling them to respond more sensitively and appropriately in these cases.     

South Africa: highest court orders government to provide antiretrovirals to prevent mother-to-child transmission

On 5 July 2002, South African treatment activists won a significant victory when the Constitutional Court ordered the South African government to make the antiretroviral drug nevirapine available in public hospitals and clinics for the purposes of preventing mother-to-child transmission of HIV. The Court also ruled the government has a constitutional obligation to implement a program to realize the right of pregnant women and their newborn children to access health services to prevent transmission.     

The Relation Between Intimate Partner Violence, Parenting Stress, and Child Behavior Problems

Parenting characteristics can have a significant influence on how children are affected by family violence. The purpose of this study was to explore the role women’s parenting stress plays in the relationship between exposure to physical and psychological intimate partner violence (IPV) and children’s externalizing and internalizing behavior problems. Data for this study were taken from three waves of the Illinois Families Study. The final sample included 1,653 children from 805 families. Structural equation modeling analyses were conducted across two developmental stages in order to better understand the unique relationships based on child development. For children ages 6–12 years, parenting stress mediated the relationship between exposure to psychological IPV and internalizing behaviors. No direct or indirect pathways between exposure to IPV and children’s behavior problems were found among adolescents ages 13–17. Implications for social service interventions with children and families exposed to violence are included.     

Exemption from federal preemption of state and local cigarette and smokeless tobacco requirements; revocation. Food and Drug Administration, HHS. Final rule

The Food and Drug Administration (FDA) is revoking its regulation governing the exemption from Federal preemption of State and local medical device requirements for the sale and distribution of cigarettes and smokeless tobacco to children and adolescents. This action is being taken in response to the Supreme Court Decision of March 21, 2000, in which the court held that Congress has not given FDA the authority to regulate tobacco products as customarily marketed. On March 31, 2000, FDA removed its regulations restricting the sale and distribution of cigarettes and smokeless tobacco to children and adolescents. Because these regulations are not in effect, the State requirements are not preempted. Therefore, FDA is revoking its regulations exempting the State and local requirements from preemption. This rule is also adding a regulation that was inadvertently removed in a previous document.