Seroprevalence of rubella among women of childbearing age in Switzerland

A seroepidemiological study was carried out in Switzerland to define the population susceptible to rubella among women of childbearing age. IgG antibodies to rubella virus were determined in 9,046 women giving birth between 1 August 1990 and 30 September 1991 in 23 of 26 Swiss cantons. These sera represented 10–20 % of the yearly total number of births in each Swiss canton. Anti-rubella IgG was measured by an automated enzyme-linked fluorescent assay for use with a commercial system (Vidas Rub IgG, bio-Mérieux, France). Before the study population was screened, the commercial system was compared to the traditional hemagglutination-inhibition (HAI) test using 500 consecutive samples from parturient women. The sensitivity was 97.7 %, the specificity was 100 %, and agreement between the two tests was 97.8 %. The discrepancies corresponded to very low titres of antibodies as measured by HAL The seroprevalence of rubella nationwide in women of childbearing age in Switzerland was 94.3 %. The seroprevalence was higher (96.5 %) in the 5,677 women of Swiss nationality than in the 3,090 women of a different nationality (90.4%) (p<0.001). In Swiss women the seroprevalence of rubella did not increase significantly with age and was identical in primiparous and in multiparous women, thus indicating that women of childbearing age are probably not sufficiently immunised.     

Alcohol dependency and affective illness among women of childbearing age

Summary The objectives of the study were to identify variables that predicted duration of an episode of alcoholism among women and to examine risk factors for women having comorbid alcoholism with affective illness when compared to women who had an affective disorder only. We selected a cohort of women of childbearing age (n = 231) from computerized medical records. The women were contacted five years after their initial emergency visit and asked to participate in a follow-up study. Each RDC episode of illness and its duration were plotted on a longitudinal time-line graph. The only multivariate predictor of duration of an episode of alcoholism was comorbidity with a mood disorder. We compared women who had alcoholism comorbid with affective illness to women with affective illness only. Women with both disorders were 36 times more likely to have a history of illness with their first psychiatric episode before the age of 15 compared to women with an affective disorder only. The findings suggest a dual liability for alcoholism and an affective illness among women with young children.     

Predictors of infant mortality among college-educated black and white women, Davidson County, Tennessee, 1990-1994.

Strategies to reduce US infant mortality rates often focus on the black-white disparity in rates. Linked Infant Birth and Death Files for Davidson County, Tennessee, from 1990 through 1994 were used to determine infant outcomes for infants born to college-educated white and black women. Risks for adverse outcomes were identified by comparing infant deaths to live births using logistic regression analyses. The following variables entered the logistic model process: maternal and paternal age; race and education; nativity status; maternal risk factors; interpregnancy interval; parity; infant gender; tobacco or alcohol use; number of prenatal visits; trimester in which prenatal care began; marital status; gestational age; and birthweight. After adjustment for the effects of the other variables, a gestational age < 28 completed weeks of gestation was the most significant independent predictor of infant death. Black race was not identified as a significant predictor of infant mortality. Regardless of race, a decrease in infant mortality rates among college-educated women in this country depends on the prevention of preterm births. Strategies to diagnose early preterm labor must proceed from a comprehensive maternal care program for all women. Open channels of communication between patient and provider will form the cornerstone for preterm prevention-intervention programs. Analysis of state and local infant mortality data may identify regional differences in infant mortality rates and differences in risk factors associated with adverse infant outcomes.     

HIV incidence in the United States, 1978-1999

CONTEXT: HIV incidence measurements, which reflect recent or current transmission, are valuable for monitoring the epidemic and evaluating prevention programs. OBJECTIVES: To summarize HIV incidence patterns and trends in U.S. population groups. DATA SOURCES: Publications in English from 1980 through mid-2000. STUDY SELECTION AND STATISTICAL METHODS: We searched the literature for reports of HIV incidence in the United States. Locally weighted scatterplot smoothing was used to generate smooth curves to estimate trends in incidence. Spearman rank correlation was used to estimate the correlation coefficient between prevalence and incidence. DATA SYNTHESIS: In 74 eligible reports, HIV incidence varied widely (0.002-19.8 per 100 person-years [py]) depending on risk group. Among men who have sex with men (MSM), HIV incidence peaked in the early 1980s (5-20/100 py) and then declined but remained high during the 1990s (2-4/100 py). Among injection drug users (IDUs), incidence decreased since the mid-1980s but differed by geographic area; in the 1990s, incidence remained high in the East (1-3/100 py) but was lower in the West (<0.5/100 py). Throughout the late 1980s and 1990s, incidence was low and stable in broader populations (blood donors: <0.01/100 py; military personnel: 0.01-0.07/100 py). The correlation between HIV incidence and prevalence was strong in populations with a prevalence less than 1% (r = 0.94, p<.0001), moderate in populations with a prevalence from 1% to less than 10% (r = 0.57, p<.0001), and weak in populations with a prevalence at least 10% (r = 0.23, p=.09). CONCLUSIONS: HIV prevention in the United States should continue to focus on MSM and IDUs. HIV incidence measurements should be considered for monitoring HIV transmission in MSM, IDUs, and other populations in which seroprevalence is high.     

HIV incidence estimates among women of childbearing age in the area around Paris, France: no evidence for any effect of age or time

OBJECTIVE: To explore whether there are any age or time effects on the HIV incidence rate among women of childbearing age in the area around Paris (France). DESIGN: Three seroprevalence surveys were conducted among pregnant women in the Paris area (PREVAGEST) during three periods (1990-1991, 1992-1993, 1994-1995); their data were used to derive HIV incidence estimates with Ades and Medley's method. To assess the power of our study, data were also simulated with a demographic model under different assumptions for HIV-incidence rates. RESULTS: No age or time effect was detected on HIV incidence in the Paris area during the period from 1990 to 1995. Analysis of simulated surveys showed that with the sample size of the PREVAGEST surveys, the method was able to detect an age or time effect with a relative risk of about 2.5 between age groups or periods. CONCLUSION: We conclude that the method is applicable to our data. If any existed, age or time effect was quite likely no higher than 2.5. As we previously reported using another method, incidence of HIV infection among women of childbearing age in the Paris area can be estimated at 0.74/1,000 per year (95% confidence interval, 0.62-0.87) from 1990 through 1995.     

Trends in AIDS incidence and survival among racial/ethnic minority men who have sex with men,United States, 1990-1999

OBJECTIVES: We describe trends in AIDS incidence, survival, and deaths among racial/ethnic minority men who have sex with men (MSM). METHODS: We examined AIDS surveillance data for men diagnosed with AIDS from 1990 through 1999, survival trends from 1993 through 1997, and trends in AIDS incidence and deaths from 1996 to 1999, when highly active antiretroviral therapy (HAART) was introduced. RESULTS: The percentage of racial/ethnic minority MSM with AIDS increased from 33% of 26,930 men in 1990 to 54% of 17,162 men in 1999. From 1996 through 1998, declines in AIDS incidence were smallest among black MSM (25%, from 66.2 to 49.5 per 100,000) and Hispanic MSM (29%, from 39.3 to 27.8), compared with white MSM (41%, from 17.9 to 10.5). Declines in deaths of MSM with AIDS were also smallest among black MSM (53%, from 39.7 to 18.6 deaths per 100,000) and Hispanic MSM (61%, 21.6 to 8.4), compared with white MSM (63%, 12.3 to 4.5). Survival improved each year for all racial/ethnic groups but was poorest for black MSM in all years. CONCLUSIONS: Since the introduction of HAART, a combination of factors that include relatively higher infection rates in more recent years and differences in survival following AIDS diagnosis contribute to observed differences in trends in AIDS incidence and deaths among racial/ethnic minority MSM. Increased development of culturally sensitive HIV prevention services, and improved access to testing and care early in the course of disease are needed to further reduce HIV-related morbidity in racial/ethnic minority MSM.     

Adiposity and age of menarche in Hispanic women

Women with increased adiposity have been shown to have earlier menarche. However, the association between menarche and body fat distribution has been controversial. The present study examined relationships between several anthropometric data and age at menarche in 2,494 women aged 25 to 74 years from the Hispanic Health and Nutrition Examination Survey. Early menarche was similarly related to adiposity as measured by body mass index (BMI), skinfolds representative of central adiposity (subscapular and iliac), and skinfolds representative of peripheral adiposity (triceps and calf). These relationships persisted after controlling for a variety of influences such as socioeconomic status; they were consistent in all three ethnic groups studied, but were significant only in Puerto Rican women. Ratios of central/peripheral skinfold measures were not associated with menarche. These analyses describe the relationship between early maturation and overall adiposity in three distinct Hispanic groups and reject a specific association between menarche and central body fat distribution.     

HIV/AIDS surveillance in the United States, 1981-2001

We review the HIV/AIDS reporting system, including the legal basis for reporting, the methods and infrastructure for reporting, evaluation of the completeness and quality of the data, and analysis and dissemination of reports. Other information systems (e.g., seroprevalence surveys and behavioral surveys) that collect useful information for HIV prevention and care programs are also described. Multiple data collections systems are needed to monitor the HIV/AIDS epidemic in the United States and to collect the information needed to plan, implement, and evaluate prevention and care programs.     

肥胖与育龄期女性生殖功能研究进展

女性生殖功能受众多因素影响,肥胖是引起育龄期女性生殖能力降低的重要因素之一.育龄期肥胖女性可表现为月经紊乱,排卵障碍甚至不孕.肥胖与多囊卵巢综合征互为因果.肥胖影响辅助生殖技术的结局,使自然流产的风险增高,影响到妊娠的结局.避免超重及肥胖,积极控制多余体重,提高肥胖女性生育能力.     

Prevalence of CMV antibodies among women of childbearing age in different social environments in southern Israel

The prevalence rate of IgG antibodies to cytomegalovirus (CMV) was determined in a sample of 567 women of childbearing age in the southern part of Israel by the immunoperoxidase assay to membrane antigen (IPAMA) technique. Urban Jewish women of Afro-Asian origin showed significantly higher rates of seropositivity than urban Jewish women of European-American origin (80% vs 65%, respectively, P less than 0.001), closely resembling the level of CMV seropositivity found in Afro-Asian and European-American countries in the same age and sex population groups. The Bedouin women showed slightly lower rates of CMV seropositivity (75%) than Jewish women of Afro-Asian origin. Particularly high rates of CMV seropositivity were detected in women who live in a kibbutz environment: 96% in women of Afro-Asian origin and 80% in women of Euro-American origin. Multiple discriminant analysis also singles out the kibbutz environment as a major contributor to the variance between the groups tested (P less than 0.003).     

Literacy skills,language use,and online health information seeking among Hispanic adults in the United States

ObjectiveOnline health information is underutilized among Hispanics with low English proficiency in the U.S. This study examines the association between a unique measure of general English literacy, language use, and online health information seeking among Hispanic adults.MethodsData for Hispanics ages 25–65 (N = 700) come from the 2012/2014 Program for International Assessment of Adult Competencies (PIAAC). Binary logistic regression models were used to predict online health information seeking as a function of literacy skill scores (0–500 points) and primary language use (Spanish vs. other).ResultsLiteracy (Odds-Ratio = 1.012, p < 0.001) was a positive predictor, while speaking Spanish at home (Odds-Ratio = 0.352, p < 0.01) was a negative predictor of online health information seeking.ConclusionLiteracy skills and language use appear to be separate contributors of online health information seeking among Hispanic adults.Practice implicationsOnline health information providers should be aware of literacy skills and Spanish language use as barriers to online health information seeking among Hispanics, particularly those who have both limited literacy skills and predominantly Spanish language use.     

HIV incidence trends among white and african-american active duty United States Army personnel (1986-2003)

OBJECTIVE: To analyze HIV incidence rate (IR) trends among white and African-American active duty US Army personnel between 1986 and 2003. METHODS: Joinpoint regression was applied to identify time periods when significant changes in HIV IRs occurred, along with the corresponding annual percentage changes (APCs). RESULTS: African-Americans had a higher IR than white personnel (0.34/1,000 vs. 0.07/1,000; P < 0.001). Among white personnel, 2 significant time periods of changing HIV IRs were found: between 1986 and 1989 (APC = -31.1; P = 0.006) and between 1989 and 2003 (APC = -5.7; P = 0.003). Among African-Americans, a significant decline in HIV IRs was observed only between 1986 and 1991 (APC = -19.4; P < 0.001). This study revealed that the HIV IRs seem to have increased in 2 African-American groups: unmarried personnel and health care professionals. CONCLUSION: This cohort study (1,280 incident HIV infections among 1.5 million persons with 8.4 million person-years of follow-up) provides invaluable information on HIV trends in the United States Army. Despite an overall decline in HIV IRs, certain subpopulation among African-American personnel were observed to have increasing HIV IRs. Future research is needed to identify the current behavioral risk factors associated with HIV infection among US Army personnel.     

The incidence of Kaposi sarcoma among injection drug users with AIDS in the United States

Some studies report increased prevalence of human herpesvirus 8 (HHV-8), the causative agent of Kaposi sarcoma (KS), among injection drug users (IDUs), suggesting that HHV-8 may be transmitted through blood-borne or other exposures common in this population. Since an elevated HHV-8 prevalence in IDUs would likely lead to increased KS incidence, KS incidence was studied in IDUs and non-IDU's with AIDS. AIDS-related KS cases were identified using linked US AIDS and cancer registry data for 25,891 women, 47,782 heterosexual men, and 90,616 men who have sex with men (MSM). KS arose in 7099 persons with AIDS. KS incidence was highest for MSM (5.7 per 100 person-years), substantially lower for heterosexual men (0.7 per 100 person-years), and lowest for women (0.4 per 100 person-years). After adjustment for age, race, registry location, and year of AIDS onset, relative risks for KS associated with injection drug use were 1.3 (95% CI, 0.9-1.8) among women, 1.1 (0.7-1.6) among heterosexual men, and 0.9 (0.8-0.9) among MSM. It is concluded that injection drug use was not associated with an increased risk of AIDS-related KS. Thus, these data suggest that IDUs' risk of acquiring HHV-8, through needle sharing or other behaviors related to injection drug use, is low.     

The dynamics of aging and mortality in the United States, 1900-1988.

The Strehler-Mildvan modification of the Gompertz relationship between aging and mortality provides a dynamic theoretical model for identifying and separating genetic, environmental and competitive influences upon age-related mortality. The initial method of longitudinal Gompertzian analysis, which utilized linear regression, tended to underestimate both genetic and environmental influences upon age-related mortality. A modified method of longitudinal Gompertzian analysis has been applied to mortality due to stomach cancer, cervical cancer and emphysema. This modified method of longitudinal Gompertzian analysis suggests that the genetic influence upon age-related mortality is essentially the same for both men and women. Moreover, application of this modified method suggests that environmental influences upon age-related mortality in the United States have been declining for the past 20 years for men and for the past 45 years for women.     

Rising incidence of hepatocellular carcinoma in the United States

BACKGROUND AND METHODS: Clinical observations have suggested that the number of cases of hepatocellular carcinoma has increased in the United States. We analyzed data from the Surveillance, Epidemiology, and End Results (SEER) data base to determine the age-adjusted incidence of hepatocellular carcinoma from 1976 to 1995, data from the U.S. vital-statistics data base to determine age-adjusted mortality rates from 1981 to 1995, and data from the Department of Veterans Affairs to determine age-adjusted rates of hospitalization for the disease from 1983 to 1997. RESULTS: The incidence of histologically proved hepatocellular carcinoma increased from 1.4 per 100,000 population (95 percent confidence interval, 1.3 to 1.4) for the period from 1976 to 1980 to 2.4 per 100,000 (95 percent confidence interval, 2.3 to 2.4) for the period from 1991 to 1995. Among black men, the incidence was 6.1 per 100,000 for the period from 1991 to 1995, and among white men, it was 2.8 per 100,000. There was a 41 percent increase in the mortality rate from primary liver cancer and a 46 percent increase in the proportion of hospitalizations attributable to this disease during the periods studied. The incidence increased significantly among younger persons (40 to 60 years old) during the period from 1991 to 1995 as compared with earlier periods. CONCLUSIONS: An increase in the number of cases of hepatocellular carcinoma has occurred in the United States over the past two decades. The age-specific incidence of this cancer has progressively shifted toward younger people.