Assessing Health Consumerism on the Web: A Demographic Profile of Information-Seeking Behaviors

The growing diversity of the online health information community is increasingly cited as a limiting factor related to the potential of the Internet as an effective health communication channel and information resource. Public-access Internet portals and decreasing costs of personal computers have created a consensus that unequal access to information, or a “Digital Divide,” presents a like problem specific to health care consumers. Access to information, however, is an essential part of the consumer-centric framework outlined in the recently proposed U.S. National Health Information Infrastructure (NHII) and Health Architecture initiatives. To date little research has been done to differentiate the types of health information sought on the Web by different subgroups, linking user characteristics and health-seeking behaviors. Data from a study of consumer Web search activity in a post-intervention era serves as a natural experiment, and can identify whether a “digitally underserved group” persists in the United States. Such an environment would serve to exclude traditionally underserved groups from the benefits of the planned national heath information infrastructure. This exploratory technology assessment study seeks to differentiate and delineate specific behaviors, or lack of desired behaviors, across targeted health care subgroups. Doing so allows the design of more effective strategies to promote the use of the Web as a health education and health promotion tool, under the envisioned shared decision-making, consumer-centric health information model.     

Effects of zidovudine therapy in minority and other subpopulations with early HIV infection

OBJECTIVE--The purpose of this study was to determine whether the beneficial effects of zidovudine seen overall in two recently completed placebo-controlled clinical trials are also apparent in blacks, Hispanics, women, and intravenous drug users. DESIGN--Two double-blind placebo-controlled randomized clinical trials, protocols 016 and 019, conducted by the AIDS Clinical Trials Group. SETTING--University-based referral centers. PARTICIPANTS--Two thousand forty-eight persons with asymptomatic or mildly symptomatic human immunodeficiency virus infection were analyzed. Of these, 155 were black, 190 were Hispanic, 144 were women, and 221 were intravenous drug users. All randomized subjects were included in the analysis. INTERVENTION--Participants in the AIDS Clinical Trials Group protocol 016 were assigned to receive a placebo or a 1200-mg daily dose of zidovudine. Participants in the AIDS Clinical Trials Group protocol 019 were assigned to receive a placebo, a 500-mg daily dose of zidovudine, or a 1500-mg daily dose of zidovudine. MAIN OUTCOME MEASURE--Progression to AIDS. RESULTS--The rates of progression to AIDS in subjects receiving zidovudine were significantly lower than those in subjects receiving a placebo among blacks (P = .03), whites (relative risk [RR] = 2.3, 95% confidence interval [CI] = 1.5 to 3.6, P less than .0001), Hispanics (RR = 4.4, CI = 1.2 to 16.8, P = .02), non-Hispanics (RR = 2.3, CI = 1.5 to 3.6, P = .0002), men (RR = 2.5, CI = 1.6 to 3.8, P less than .0001), and non-intravenous drug users (RR = 2.5, CI = 1.6 to 4.0, P less than .0001). The rates of disease progression for subjects receiving zidovudine were not statistically different from those receiving placebo for women (RR = 3.3, CI = 0.3 to 36.3, P = .31) or for intravenous drug users (RR = 2.0, CI = 0.7 to 6.2, P = .21); however, in both instances the estimated RRs were similar to those for men and non-intravenous drug users. CONCLUSIONS.-Although the two studies used for this analysis were not specifically designed to assess the effects of zidovudine in each separate subpopulation, the data suggest that the beneficial effects of zidovudine reported for the entire study population also apply to the subpopulations of blacks, Hispanics, women, and intravenous drug users.     

Selected measures of health status for Mexican-American, mainland Puerto Rican, and Cuban-American children

The 1987 National Vital Statistics System and the Hispanic Health and Nutrition Examination Survey (1982 through 1984) were used to assess the health status of Mexican-American, mainland Puerto Rican, and Cuban-American children by examining the prevalences of pregnancy outcomes and chronic medical conditions. The low-birth-weight rate among Hispanics (7.0%) compared favorably with that of non-Hispanic whites (7.1%) despite the greater poverty and lower levels of education among Hispanics. When examined by Hispanic subgroup, however, significant differences were present, with mainland Puerto Ricans having the highest prevalences of low-birth-weight infants. Premature births were more common among all three Hispanic subgroups than among non-Hispanic whites. Mexican-American and Cuban-American children had a similar prevalence of (3.9% and 2.5%, respectively) chronic medical conditions compared with non-Hispanic white children; Puerto Rican children had a higher prevalence of chronic medical conditions (6.2%). When assessed by these health status indicators, Hispanic children seem to have a health status similar to non-Hispanic white children. However, mainland Puerto Rican children seem at greater risk for poor health, reflecting the US Hispanic population's heterogeneity. Health programs targeted at US Hispanics should appropriately consider these group differences.     

Access to health care for Hispanics

The conventional population paradigm in the United States has distinguished between the white majority and the sizable and easily identified black minority. Until recently, much less attention has been paid to Hispanics (or Latinos), currently 20 million in number, who the Census Bureau projects will increase to 31 million persons of a total population of 283 million by the year 2010. In the next two decades Hispanics will account for one of every three net additions to the US population. The analysis that follows considers the critical factors that collectively will determine the access of Hispanics to the health care system and illuminates the changes that, if introduced, will contribute to its improvement. These issues include the homogeneity or heterogeneity of the Hispanic population; the extent to which socioeconomic status adversely affects Hispanics' access to health care; the influence of demographic and epidemiological factors on their needs for care; the role of neighborhood factors in determining their access to the health and medical infrastructures; the paucity of Hispanic health professionals; and finally, the major reform proposals currently on the nation's health agenda as they relate to the issue of improved access to care for Hispanics.     

Use of continuous quality improvement to increase use of process measures in patients undergoing coronary artery bypass graft surgery: a randomized controlled trial

Context  A rigorous evaluation of continuous quality improvement (CQI) in medical practice has not been carried out on a national scale. Objective  To test whether low-intensity CQI interventions can be used to speed the national adoption of 2 coronary artery bypass graft (CABG) surgery process-of-care measures: preoperative -blockade therapy and internal mammary artery (IMA) grafting in patients 75 years or older. Design, Setting, and Participants  Three hundred fifty-nine academic and nonacademic hospitals (treating 267 917 patients using CABG surgery) participating in the Society of Thoracic Surgeons National Cardiac Database between January 2000 and July 2002 were randomized to a control arm or to 1 of 2 groups that used CQI interventions designed to increase use of the process-of-care measures. Intervention  Each intervention group received measure-specific information, including a call to action to a physician leader; educational products; and periodic longitudinal, nationally benchmarked, site-specific feedback. Main Outcome Measure  Differential incorporation of the targeted care processes into practice at the intervention sites vs the control sites, assessed by measuring preintervention (January-December 2000)/postintervention (January 2001-July 2002) site differences and by using a hierarchical patient-level analysis. Results  From January 2000 to July 2002, use of both process measures increased nationally (-blockade, 60.0%-65.6%; IMA grafting, 76.2%-82.8%). Use of -blockade increased significantly more at -blockade intervention sites (7.3% [SD, 12.8%]) vs control sites (3.6% [SD, 11.5%]) in the preintervention/postintervention (P = .04) and hierarchical analyses (P<.001). Use of IMA grafting also tended to increase at IMA intervention sites (8.7% [SD, 17.5%]) vs control sites (5.4% [SD,15.8%]) (P = .20 and P = .11 for preintervention/postintervention and hierarchical analyses, respectively). Both interventions tended to have more impact at lower-volume CABG sites (for interaction: P = .04 for -blockade; P = .02 for IMA grafting). Conclusions  A multifaceted, physician-led, low-intensity CQI effort can improve the adoption of care processes into national practice within the context of a medical specialty society infrastructure.      

Esterified estrogens and conjugated equine estrogens and the risk of venous thrombosis

Context  Clinical trial evidence indicates that estrogen therapy with or without progestins increases venous thrombotic risk. The findings from these trials, which used oral conjugated equine estrogens, may not be generalizable to other estrogen compounds. Objective  To compare risk of venous thrombosis among esterified estrogen users, conjugated equine estrogen users, and nonusers. Design, Setting, and Participants  This population-based, case-control study was conducted at a large health maintenance organization in Washington State. Cases were perimenopausal and postmenopausal women aged 30 to 89 years who sustained a first venous thrombosis between January 1995 and December 2001 and controls were matched on age, hypertension status, and calendar year. Main Outcome Measure  Risk of first venous thrombosis in relation to current use of esterified or conjugated equine estrogens, with or without concomitant progestin. Current use was defined as use at thrombotic event for cases and a comparable reference date for controls. Results  Five hundred eighty-six incident venous thrombosis cases and 2268 controls were identified. Compared with women not currently using hormones, current users of esterified estrogen had no increase in venous thrombotic risk (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.69-1.22). In contrast, women currently taking conjugated equine estrogen had an elevated risk (OR, 1.65; 95% CI, 1.24-2.19). When analyses were restricted to estrogen users, current users of conjugated equine estrogen had a higher risk than current users of esterified estrogen (OR, 1.78; 95% CI, 1.11-2.84). Among conjugated equine estrogen users, increasing daily dose was associated with increased risk (trend P value   = .02). Among all estrogen users, concomitant progestin use was associated with increased risk compared with use of estrogen alone (OR, 1.60; 95% CI, 1.13-2.26). Conclusion  Our finding that conjugated equine estrogen but not esterified estrogen was associated with venous thrombotic risk needs to be replicated and may have implications for the choice of hormones in perimenopausal and postmenopausal women.      

孕产妇母婴健康信息辨别能力及其影响因素研究

背景　当前母婴健康信息呈爆炸式增长，但质量监管滞后，孕产妇对健康信息的辨别成为一大挑战。目的　探讨孕产妇母婴健康信息辨别能力及其影响因素。方法　选取2016年11月-2017年8月在山西省儿童医院、山西博爱医院和太原市晋源区金胜镇卫生院就诊的孕产妇实施调查。自行设计调查问卷，内容包括人口统计学信息、主动获取母婴健康信息频次、互联网信息的影响、是否具备基础性母婴健康知识/信息、有无在孕妇学校学习、健康信息获取途径、健康信息辨别能力、母婴健康信息人际交流网等。采用多因素Logistic回归分析探究孕产妇母婴健康信息辨别能力的影响因素。结果　共发放问卷1 100份，回收有效问卷858份，有效回收率为78.00%。345例（40.21%）孕产妇自感辨别母婴健康信息有困难。多因素Logistic回归分析结果显示，健康意识强〔OR=1.354，95%CI（1.015，1.805）〕、主动获取母婴健康信息〔OR=1.364，95%CI（1.073，1.733）〕、具备基础性母婴健康知识/信息〔OR=1.523，95%CI（1.106，2.097）〕、母婴健康信息交流网规模大〔OR=1.461，95%CI（1.092，1.955）〕的孕产妇健康信息辨别能力更强（P<0.05）。互联网信息的影响会降低孕产妇的母婴健康信息辨别能力〔OR=0.509，95%CI（0.340，0.762），P<0.05〕。结论　孕产妇的母婴健康信息辨别能力有很大的提升空间。加强母婴保健基础性知识/信息的宣传教育、孕产妇健康意识和信息获取动机的培养，鼓励孕产妇寻求广泛而专业的社会支持，强化对健康信息质量的监管，有利于提升孕产妇母婴健康信息辨别能力。     

Interactive effects of exercise and sleep on frailty severity in community-dwelling older adults: a cross-sectional study

Objectives: This study examined the effects of the interaction between exercise and sleep on frailty severity in community-dwelling older adults.Materials and Methods: This was a cross-sectional study. Data were collected in July 2019. In total, 2021 adults participated who responded to a questionnaire. Among them, 672 participants (317 men and 355 women) with valid responses were included in the analysis. Ordinal logistic regression analysis was performed to examine the association between frailty severity and the interaction between exercise and sleep. The dependent variable represents three different levels of frailty. The independent variables included basic information and interaction between exercise and sleep.Results: The results of ordinal logistic regression analysis (odds ratio [OR]) showed that the period from the start of exercise (OR=0.96), age (OR=1.00 for participants in their 60 s, OR=1.65 for those in their 70s, and OR=3.13 for those aged >80 years), poor subjective health perception (OR=2.12), poor quality of sleep (OR=1.88), stress (OR=1.62), and exercise–sleep interaction (OR=1.00 based on good-exercise–good-sleep interaction, OR=3.09 poor-exercise–good-sleep interaction, and OR=3.50 poor-exercise–poor-sleep interaction) significantly contributed to the model. The Nagelkerke coefficient of determination adjusted for degrees-of-freedom (R²), which represents the contribution rate of the regression equation, was 0.334.Conclusions: Our results suggest that a combination of good exercise and good sleep is needed to prevent frailty progression in community-dwelling older adults.     

Self-reported Antiretroviral Therapy in Injection Drug Users

Context.— The US Public Health Service and the International AIDS Society–USA recently published recommendations for antiretroviral therapy (ART) for persons infected with human immunodeficiency virus (HIV); however, anecdotal evidence suggests that HIV-infected injection drug users (IDUs) may not be receiving optimal care as defined by the recommendations. Objective.— To assess ART use in HIV-infected IDUs. Design.— A cross-sectional survey of self-reported ART use between July 1996 and June 1997 in IDUs. Setting.— A community-based clinic affiliated with Johns Hopkins University, Baltimore, Md. Participants.— A total of 404 HIV-infected IDUs with CD4⁺ cell counts less than 0.50x10⁹/L recruited into a longitudinal study in 1988 and 1989. Main Outcome Measure.— Self-reported ART use was assessed: no current therapy, monotherapy, or combination therapy with or without a protease inhibitor. Results.— One half (199/404 [49%]) of patients reported no recent ART. A total of 14% (58/404) had monotherapy, 23% (90/404) were receiving combination therapy without a protease inhibitor, and 14% (57/404) had triple-combination therapy with a protease inhibitor. A multivariate analysis of factors associated with ART showed that care continuity and recent HIV-related outpatient visit (odds ratio [OR], 4.30; 95% confidence interval [CI], 2.36-7.81 and OR, 2.84; 95% CI, 1.66-4.88, respectively), CD4⁺ cell count of less than 0.20x10⁹ (OR, 2.41; 95% CI, 1.51-3.84), no current drug use and being in drug treatment (OR, 2.16; 95% CI, 1.34-3.47; OR, 2.12; 95% CI, 1.23-3.66, respectively), and unemployment (OR, 2.31; 95% CI, 1.21-4.40) were associated with reporting ART use. In other analysis, less likely to receive protease inhibitors were current drug injectors (OR, 0.5; 95% CI, 0.3-1.0) and those recently incarcerated (OR, 0.2; 95% CI, 0.03-0.9), but patients with acquired immunodeficiency syndrome were more likely to receive protease inhibitors (OR, 2.0; 95% CI, 0.9-4.6). Protease inhibitor use doubled (P<.01) from July and December 1996 to January and June 1997 (7.7% and 14.8%, respectively). Conclusions.— Those IDUs infected with HIV who were not receiving ART tended to be active drug users without clinical disease who have less contact with health care providers. Although we do not have information on clinical judgment regarding treatment decisions or whether persons were prescribed therapy not taken, the proportion of subjects reporting receiving ART suggests that strategies for improving treatment in this population are indicated. Expanding simultaneous treatment services for HIV infection and substance abuse would enhance the response to these related epidemics.      

Analysis of cases of harm associated with use of health information on the internet

Anthony G. Crocco, MD,FRCPC; Miguel Villasis-Keever, MD,MSc; Alejandro R. Jadad, MD,FRCPC

JAMA. 2002;287:2869-2871.

Context  There is concern about the potential harm associated with the use of poor quality health information on the Internet. To date, there have been no systematic attempts to examine reported cases of such harm.

Methods  We conducted a systematic review of the peer-reviewed literature, to evaluate the number and characteristics of reported cases of harm associated with the use of health information obtained on the Internet. Using a refined strategy, we searched MEDLINE (from 1966 to February 2001), CINAHL (from 1982 to March 2001), HealthStar (from 1975 to December 2000), PsycINFO (from 1967 to March 2001), and EMBASE (from 1980 to March 2001). This was complemented with searches of reference lists. Two authors separately reviewed the abstracts to identify articles that describe at least 1 case of harm associated with the use of health information found on the Internet. Articles of any format and in any language deemed possibly relevant by either researcher were obtained and reviewed by both researchers.

Results  The search yielded 1512 abstracts. Of these 186 papers were reviewed in full text. Of these, 3 articles satisfied the selection criteria. One article described 2 cases in which improper Internet searches led to emotional harm. The second article described dogs being poisoned because of misinformation obtained on the Internet. The third article described hepatorenal failure in an oncology patient who obtained misinformation about the use of medication on the Internet.

Conclusions  Despite the popularity of publications warning of the potential harm associated with using health information from the Internet, our search found few reported cases of harm. This may be due to an actual low risk for harm associated with the use of information available on the Internet, to underreporting of cases, or to bias.

     

成人经皮动脉导管未闭封堵术后主动脉瓣关闭不全的临床分析

目的 分析成人经皮动脉导管未闭(patent ductus arteriosus,PDA)封堵术后发生主动脉瓣关闭不全(aortic regurgitation,AR)的风险、临床相关因素及转归.方法 入选101例PDA成年患者,分析PDA封堵术后26例(25.74％)新发生AR或AR程度加重患者的基本临床特征、PDA特征、封堵情况及转归,利用logistic回归模型分析发生AR的危险因素.结果 26例新发生AR或AR程度加重患者与未发生AR患者比较,平均肺动脉压[(46.2±20.7)vs (31.4±17.5)mmHg,1 mmHg=0.133 kPa]、左心室舒张末期内径[(5.2±0.2)vs (4.2±0.4)cm]、PDA大小[(14.0±6.4) vs (9.0±3.5) cm]、术前有轻度AR患者发生率38.46％(10/26) vs 18.67％(14/75)]差异均有统计学意义(P＜0.05).Logistic回归分析提示左心室舒张末期内径(OR=33.541,95％ CI:5.883～191.235,P=0.000)和PDA大小(OR=7.512,95％ CI:1.976～28.564,P=0.003)是AR的独立危险因素.随访期间,26例AR患者中有22例(84.62％) AR愈合,1例于术后第30个月死于进行性加重的AR及心力衰竭.结论 左心室舒张末期内径和PDA大小是成人经皮PDA封堵术后发生AR的独立危险因素.大多数AR患者的转归良好.     

Tracing a syphilis outbreak through cyberspace

CONTEXT: A recent outbreak of syphilis among users of an Internet chat room challenged traditional methods of partner notification and community education because locating information on sexual partners was limited to screen names and privacy concerns precluded identifying sexual partners through the Internet service provider. OBJECTIVES: To determine the association of Internet use and acquisition of syphilis and to describe innovative methods of partner notification in cyberspace. DESIGN, SETTING, AND PATIENTS: Outbreak investigation conducted at the San Francisco (Calif) Department of Public Health (SFDPH) in June-August 1999 of 7 cases of early syphilis among gay men linked to an online chat room; case-control study of 6 gay men with syphilis reported to SFDPH in July-August 1999 (cases) and 32 gay men without syphilis who presented to a city clinic in April-July 1999 (controls). MAIN OUTCOME MEASURES: Association of syphilis infection with Internet use, Internet use among cases vs controls, and partner notification methods and partner evaluation indexes. RESULTS: During the outbreak, cases were significantly more likely than controls to have met their sexual partners through use of the Internet (67% vs 19%; odds ratio, 8.7; P =.03). We notified and confirmed testing for 42% of named partners; the mean number of sexual partners medically evaluated per index case was 5.9. CONCLUSIONS: In this study, meeting sexual partners through the Internet was associated with acquisition of syphilis among gay men. Public health efforts must continually adapt disease control procedures to new venues, carefully weighing the rights to privacy vs the need to protect public health. JAMA. 2000;284:447-449     

河南省公众对结核病互联网信息的需求分析

目的 分析河南省公众对结核病互联网信息的需求,为开展结核病健康教育工作提供科学依据。方法 采用多阶段分层随机抽样方法,抽取6个调查点。采用统一问卷对调查点15岁及以上居民进行面对面询问式调查。调查内容包括调查对象一般情况和结核病互联网信息的需求。使用SPSS15.0 软件分析资料,应用χ2 检验和Logistic回归分析,P<0.05 为差异有统计学意义。结果 有16.7%（177/1 057）的调查对象对互联网有需求;“城市”人群（23.5%）、“流动人口”（27.0%）、 “15~19岁年龄组”（57.1%）、“大专及以上”（32.5%）、“在校学生”（50.0%）及 “以往接受过结核病健康教育”（19.1%）对结核病互联网信息的需求最大;“年龄组”（OR=0.948）和 “文化程度”（OR=1.513）是公众对结核病互联网信息需求的主要影响因素;公众喜欢的互联网咨询方式为“搜索引擎”（29.04%）、“医学专业人员在线咨询”（27.81%）和“到医学专业的网站查看”（21.95%）;公众偏好的互联网知识形式是“文字+图片”（36.90%）、“文字+视频”（32.73%）。结论 低年龄组和高文化程度的公众对结核病互联网信息的需求更大,公众喜欢以“搜索引擎”、“医学专业人员在线咨询”的方式得到图文并茂的结核病互联网信息。     

Health insurance coverage and utilization of health services by Mexican Americans, mainland Puerto Ricans, and Cuban Americans

This investigation examines data on 13,000 Mexican Americans, Puerto Ricans, and Cuban Americans between 6 months and 74 years of age who were interviewed from 1982 through 1984 in the Hispanic Health and Nutrition Examination Survey. In addition, data from the 1989 Current Population Survey (N = 145,000) conducted by the US Bureau of the Census are presented for the white and black non-Hispanic populations as well as the three Hispanic national origin groups. The study revealed that over one third of the Mexican-American population, one fifth of the Puerto Rican population, and one fourth of the Cuban-American population is uninsured for medical expenditures compared with one fifth of the black, non-Hispanic population and one tenth of the white, non-Hispanic population. Furthermore, compared with Hispanics with private health insurance, uninsured Hispanics are less likely to have a regular source of health care, less likely to have visited a physician in the past year, less likely to have had a routine physical examination, and less likely to rate their health status as excellent or very good.     

Barriers to Use of Free Antiretroviral Therapy in Injection Drug Users

Context.— In British Columbia, human immunodeficiency virus (HIV)–infected persons eligible for antiretroviral therapy may receive it free but the extent to which HIV-infected injection drug users access it is unknown. Objective.— To identify patient and physician characteristics associated with antiretroviral therapy utilization in HIV-infected injection drug users. Design.— Prospective cohort study with record linkage between survey data and data from a provincial HIV/AIDS (acquired immunodeficiency syndrome) drug treatment program. Setting.— British Columbia, where antiretroviral therapies are offered free to all persons with HIV infection with CD4 cell counts less than 0.50x10⁹/L (500/µL) and/or HIV-1 RNA levels higher than 5000 copies/mL. Subjects.— A total of 177 HIV-infected injection drug users eligible for antiretroviral therapy, recruited through the prospective cohort study since May 1996. Main Outcome Measures.— Patient use of antiretroviral drugs through the provincial drug treatment program and physician experience treating HIV infection. Results.— After a median of 11 months after first eligibility, only 71 (40%) of 177 patients had received any antiretroviral drugs, primarily double combinations (47/71 [66%]). Both patient and physician characteristics were associated with use of antiretroviral drugs. After adjusting for CD4 cell count and HIV-1 RNA level at eligibility, odds of not receiving antiretrovirals were increased more than 2-fold for females (odds ratio [OR], 2.53; 95% confidence interval [CI], 1.08-5.93) and 3-fold for those not currently enrolled in drug or alcohol treatment programs (OR, 3.49; 95% CI, 1.45-8.40). Younger drug users were less likely to receive therapy (OR, 0.47/10-y increase; 95% CI, 0.28-0.80). Those with physicians having the least experience treating persons with HIV infection were more than 5 times less likely to receive therapy (OR, 5.55; 95% CI, 2.49-12.37). Conclusions.— Despite free antiretroviral therapy, many HIV-infected injection drug users are not receiving it. Public health efforts should target younger and female drug users, and physicians with less experience treating HIV infection.      

Statin use and incident nuclear cataract

Context  Statins are widely prescribed for their lipid-lowering effects but also have putative antioxidant properties. Oxidative stress is believed to play a role in the development of nuclear cataract, but little is known regarding the relationship of statin use and cataract incidence. Objective  To evaluate the relationship of use of statins and incident cataract in adults in a midwestern community in the United States. Design, Setting, and Participants  The Beaver Dam Eye Study, an observational, longitudinal, population-based study of age-related eye disease in Beaver Dam, Wis. There were 1299 persons who were seen at the third examination in 1998-2000, had gradable photographs in both eyes, and were deemed to be at risk of developing nuclear cataract within 5 years. Main Outcome Measure  Five-year incidence of cataract with respect to statin use. Cataracts were graded from photographs taken through the participant’s dilated pupil. Results  A total of 210 persons developed incident nuclear cataract in the interval from 1998-2000 to 2003-2005. Five-year incidence of nuclear cataract was 12.2% in statin users compared with 17.2% in nonusers (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.36-0.84), controlling for age. When only never smokers without diabetes were assessed, the age-, lipid level–, and sex-adjusted OR was 0.40 (95% CI, 0.18-0.90). Five-year incidence of cortical cataract was 9.9% in statin users and 7.5% in nonusers (OR, 1.28; 95% CI, 0.79-2.08); posterior subcapsular cataract occurred in 3.0% of statin users and 3.4% of nonusers (OR, 0.82; 95% CI, 0.39-1.71). Conclusion  Statin use in a general population appears to be associated with lower risk of nuclear cataract, the most common type of age-related cataract.      

Sexual practices in the transmission of hepatitis B virus and prevalence of hepatitis delta virus infection in female prostitutes in the United States.

OBJECTIVE--To evaluate heterosexual transmission of hepatitis B virus (HBV) and the prevalence of hepatitis delta virus (HDV) infection in female prostitutes. DESIGN--Survey. SETTING--Sexually transmitted disease clinics, drug treatment programs, detention centers, and/or outreach efforts in eight areas in the United States. PARTICIPANTS--A total of 1368 female prostitutes 18 years of age or older. OUTCOME MEASURES--Seropositivity for HBV and HDV infection. RESULTS--The overall prevalence of past or present HBV infection was 56%: 74% in women who were injecting-drug users (IDUs), 38% in women reporting no history of injecting-drug use (non-IDUs), 51% in whites, 55% in blacks, and 67% in Hispanics. Of 21 HBV carrier IDUs, 21% had HDV infection; of 18 HBV carrier non-IDUs, 6% had HDV infection. In non-IDUs (49%), risk factors for HBV infection were a history of having penile-anal intercourse (odds ratio [OR], 3.1; 95% confidence limits [CL], 1.3, 7.3) and seropositivity for syphilis and human immunodeficiency virus (HIV) infection. In IDUs, factors associated with an increased risk of infection, in addition to behaviors related to injecting-drug use, were the number of lifetime sexual partners, having sexual partners from groups at high risk for HBV infection, and seropositivity for syphilis and HIV infection; spermicide and/or diaphragm use was associated with a markedly decreased risk of HBV infection among blacks (OR, 0.1; 95% CL, 0.03, 0.4) and Hispanics (OR, 0.2; 95% CL, 0.06, 0.9). CONCLUSION--This is the first study to suggest that having anal intercourse and failing to use vaginal contraceptives may facilitate transmission of HBV to women. Our data support guidelines that recommend hepatitis B vaccination for prostitutes and persons with a history of sexually transmitted diseases or multiple sexual partners.     

Prevalence of marijuana use disorders in the United States: 1991-1992 and 2001-2002

Context  Among illicit substance use disorders, marijuana use disorders are the most prevalent in the population. Yet, information about the prevalence of current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) marijuana use disorders and how prevalence has changed is lacking. Objective  To examine changes in the prevalence of marijuana use, abuse, and dependence in the United States between 1991-1992 and 2001-2002. Design, Setting, and Participants  Face-to-face interviews were conducted in 2 large national surveys conducted 10 years apart: the 1991-1992 National Longitudinal Alcohol Epidemiologic Survey ([NLAES] n = 42 862) and the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions ([NESARC] n = 43 093). Main Outcome Measures  Rates of past year marijuana use, abuse, and dependence. Results  Among the adult US population, the prevalence of marijuana use remained stable at about 4.0% over the past decade. In contrast, the prevalence of DSM-IV marijuana abuse or dependence significantly (P = .01) increased between 1991-1992 (1.2%) and 2001-2002 (1.5%), with the greatest increases observed among young black men and women (P<.001) and young Hispanic men (P = .006). Further, marijuana use disorders among marijuana users significantly increased (P = .002) in the absence of increased frequency and quantity of marijuana use, suggesting that the concomitant increase in potency of delta-9-tetrahydrocannabinol (⁹-THC) may have contributed to the rising rates. Conclusions  Despite the stability in the overall prevalence of marijuana use, more adults in the United States had a marijuana use disorder in 2001-2002 than in 1991-1992. Increases in the prevalence of marijuana use disorders were most notable among young black men and women and young Hispanic men. Although rates of marijuana abuse and dependence did not increase among young white men and women, their rates have remained high. The results of this study underscore the need to develop and implement new prevention and intervention programs targeted at youth, particularly minority youth.