Knowledge about vaccines and willingness to participate in preventive HIV vaccine trials: a population-based study, Rakai, Uganda

The purpose of the study was to assess knowledge and beliefs regarding vaccines and willingness to participate in HIV vaccine trials. A baseline survey assessed knowledge and attitudes toward vaccination and potential HIV vaccines among 14,177 participants aged 15-49 years, in a population cohort. Willingness to participate in HIV-preventive vaccine trials was assessed during a follow-up survey 10 months later after providing community education on HIV vaccines. Knowledge of the preventive utility of vaccines was high (71%), but higher in men than women (P<0.001), and increased with education levels (P<0.001). Vaccines were considered appropriate for children and women (99 and 88%, respectively), but not for adult men (28%). Participants felt that adolescents were the most appropriate subjects for HIV preventive vaccine trials (93.7%) but also thought that HIV-positive persons were eligible for trials (60.2%), and only 20% thought a preventive vaccine could help control HIV. HIV vaccine awareness increased from 68% at baseline to 81% at follow-up (P<0.001). Willingness to participate in HIV-preventive vaccine trials was 77%. Vaccine knowledge and willingness to participate in trials are high in this population. However, there still is need for education on the potential role of preventive HIV vaccines in the control of the epidemic and the importance of vaccination for men, especially in the context of an HIV vaccine.     

HIV knowledge and risk factors among men who have sex with men in Ho Chi Minh City,Vietnam

OBJECTIVES: To describe health risk behavior, knowledge, and attitudes about HIV/AIDS and its prevention in men who have sex with men (MSM) in Ho Chi Minh City (HCMC), Vietnam. METHODS: A cross-sectional survey of 219 MSM using a standardized questionnaire. RESULTS: Men who have sex with men were easy to locate and willing to answer detailed questions about their sexual behavior. Self-identified sexual orientation was 67% homosexual, 31% bisexual, and 1.4% heterosexual. High-risk sexual behavior was common. The mean number of sexual partners was 3.3 in the previous month and 14.8 in the previous year. Only 32% used condoms during their last intercourse, and only 40% used a condom when their last intercourse included anal sex. Eighty-one percent reported sex with nonregular male partners, and 22% also had sex with women in the past year. Drug use other than alcohol was rare. Most correctly identified high-risk sexual behavior and body fluids that could transmit HIV; however, only about half knew that someone who appeared healthy could transmit HIV or that there was no cure for AIDS. Self-rated risk for HIV was very low, and fewer than one third believed that homosexuals in Vietnam are at increased risk for HIV. CONCLUSION: Men who have sex with men in HCMC are at high risk for HIV. Knowledge about HIV transmission and prevention could be improved. Education and interventions specifically aimed at MSM are needed, because education targeted at the general population may not reach MSM or influence their behavior.     

High-risk sexual behavior in Los Angeles: who receives testing for HIV?

No recent population-based data on HIV testing in people with high-risk sexual behavior are available. We sought predictors of testing using data from the 1997 Los Angeles County Health Survey, a random-digit telephone survey of 8004 county households. An estimated 2.3 million (35.5%) adults were tested for HIV in the past 2 years and approximately 370,000 (5.6%) engaged in high-risk sexual behavior (defined as having > or =2 partners in the past 12 months and not always using condoms). Among high-risk persons, an estimated 46% of heterosexual men, 56% of heterosexual women, and 72% of men who had sex with men (MSM) were tested for HIV. In a multivariable model of high-risk people, both heterosexual men (odds ratio [OR], 0.31; 95% confidence interval [CI], 0.16-0.61) and women (OR, 0.41; 95% CI, 0.19-0.87) had significantly lower proportions of testing than MSM. Although African Americans and Hispanics had significantly higher testing proportions than whites overall among all county residents, those reporting high-risk sexual behavior did not test at higher proportions. We conclude that the proportion of adults with high-risk sexual behavior tested for HIV is higher than almost a decade ago. However, testing among this group remains suboptimal. Future public health campaigns should intensify efforts to encourage HIV testing among this population.     

Minority donation in the United States

Background and Objective  In the United States, approximately 15 million whole blood products are collected each year from 10 million volunteer donors. African Americans are underrepresented in the donor pool. In 2008, 7% of white versus 4% of African American and Hispanics adults donated in the previous year. The donor rates vary by region in the United States: 77–93% for whites, 1–16% for African Americans and 1–13% for Hispanics. In the Atlanta metropolitan area whose donor pool is 77% white, 16% African American and 4% Hispanic, the blood donor rate (number of blood donors per population) was 11/1000 population for whites, 6/1000 for African Americans and 3/1000 population for Hispanics; and the blood donation rate (number of units donated by population over the total population) was 77 donations/1000 population for whites, 22/1000 population for African Americans and 10/1000 population for Hispanics. Thus, African Americans and Hispanics represent half of the donors as whites when adjusted for their percentage of the population and more strikingly donate a significantly fewer number of units per each donor. Materials and Methods  Literature on reasons for racial/ethnic differences in donation rates and methods to address these differences was reviewed. Results  The reasons for these differences are multifactorial. First, although 41% of the total US population is estimated to be eligible to donate, African Americans and Hispanics have lower eligibility rates (whites 46%, African Americans 36%, and Hispanics 41%). Second, donor deferral rates are higher for minorities: whites 11%, African Americans 18%, Hispanics 14% and Asians 16%. Deferral is most commonly secondary to temporary deferral reasons such as low hemoglobin level, yet donors are less likely to return once deferred, and thus deferral affects donor and donation rates. Third, minorities may have different motivators and barriers. The most cited motivators to blood donation are more convenient place and times, and being asked; and the most cited barriers are fear of catching a disease and feeling faint/dizzy, and not have time or knowing where to donate. Racial differences in motivating factors identified include African Americans are more likely than whites to donate to receive an item/gift and be tested for infectious disease, and if assured that donating is safe. Notably, these motivators are not the primary cited motivators. African Americans compared with whites more commonly cite fear, difficulty finding veins and not knowing where to donate as deterrents. In addition, African Americans have distrust in the healthcare system, which is correlated with lower donation rates. Fourth, different racial/ethnic groups may have different preferred marketing strategies, including methods of contact, as well as culturally specific motivators for behavioural change. Conclusion  Thus, with an improved understanding of these differences as well as accurate tools to measure the outcomes, culturally targeted recruitment programs can be developed to increase donation rates.     

Tools to Measure Health Literacy among US African Americans and Hispanics/Latinos with Type 2 Diabetes: A Scoping Review of the Literature

ObjectiveTo provide an overview of the health literacy tools that have been validated in samples of African Americans and Hispanics/Latinos with type 2 diabetes, growing segments of the US population.MethodsFollowing PRISMA guidelines, three electronic databases were searched. The following inclusion criteria were used: peer-reviewed research; examined validity of a health literacy tool; and included US African American and/or Hispanic/Latino adults with type 2 diabetes.ResultsSixteen studies were selected; none exclusively included African Americans while 3 exclusively included Hispanics/Latinos in the sample. Seventeen health literacy tools were identified. Among African Americans, 2 health literacy screeners, 2 diabetes knowledge, and 3 numeracy tools have been validated. Among Hispanics/Latinos, 1 health literacy screener, 1 diabetes knowledge, and 1 numeracy tool have been validated. However, cross-cultural adaptation principles were rarely considered in the development and validation of these tools.ConclusionIn those with type 2 diabetes, future studies should investigate the validity of health literacy screeners among English-speaking Hispanics/Latinos and general health literacy tools among African Americans and Hispanics/Latinos. Evidence on the validity of diabetes knowledge and numeracy tools was mixed across studies.Practice implicationsFindings can inform the selection of culturally-appropriate health literacy tools in clinical and research settings.     

Social Networks,Sexual Networks and HIV Risk in Men Who Have Sex with Men

Worldwide, men who have sex with men (MSM) remain one of the most HIV-vulnerable community populations. A global public health priority is developing new methods of reaching MSM, understanding HIV transmission patterns, and intervening to reduce their risk. Increased attention is being given to the role that MSM networks play in HIV epidemiology. This review of MSM network research studies demonstrates that: (1) Members of the same social network often share similar norms, attitudes, and HIV risk behavior levels; (2) Network interventions are feasible and powerful for reducing unprotected sex and potentially for increasing HIV testing uptake; (3) HIV vulnerability among African American MSM increases when an individual enters a high-risk sexual network characterized by high density and racial homogeneity; and (4) Networks are primary sources of social support for MSM, particularly for those living with HIV, with greater support predicting higher care uptake and adherence.     

Men who have sex with men: estimated population sizes and mortality rates by race/ethnicity, Miami-Dade County, Florida

BACKGROUND: Estimated numbers of men who have sex with men (MSM) by race/ethnicity and mortality rates among such MSM with HIV/AIDS are unavailable. This hampers efficient targeting of HIV/AIDS prevention and care resources. METHODS: An existing estimation methodology was adapted to develop MSM population estimates by race/ethnicity for Miami-Dade County, Florida. We ascertained and characterized deaths that occurred during 2003 to 2005 among MSM HIV/AIDS cases, matching HIV/AIDS surveillance and vital statistics registries. We calculated estimated average annual racial/ethnic-specific mortality rates and rate ratios (RRs) among MSM HIV/AIDS cases. RESULTS: An estimated 63,020 men aged > or =18 years in the county are MSM (7.5% of all men aged > or =18 years; point estimate). Among 754 MSM HIV/AIDS deaths, point-estimate mortality rates per 100,000 MSM were higher for blacks (733.5) than for whites (229.2) (P < 0.01) and Hispanics (360.5) (P < 0.01). The best estimate of the black/white MSM mortality RR among HIV/AIDS cases was 3.20:1 (P < 0.01); for Hispanic/white MSM, it was 1.57:1 (P < 0.01). Sensitivity analyses suggested the estimates were reasonably robust to biases that we examined. CONCLUSIONS: Black and Hispanic MSM were more likely to die with HIV/AIDS than white MSM. Plausible racial/ethnic-specific MSM population and mortality rate estimates can inform effective HIV/AIDS prevention efforts and program planning.     

Incarceration, African Americans and HIV: advancing a research agenda

Incarceration is a crisis among African Americans, and the prevalence of HIV/AIDS in incarcerated men and women is 3-5 times that of the general population. We explore the potential implications of the widespread incarceration of African Americans on HIV risk and HIV outcomes in: 1) the current and formerly incarcerated, 2) their sexual partners, and 3) the communities impacted by incarceration. We set forth a research agenda for understanding and ameliorating the negative impacts incarceration and conclude that the African-American population's ability to successfully address the HIV/AIDS epidemic requires a coordinated and evidence-based response to the challenge of effectively preventing, managing and treating HIV in populations affected by incarceration.     

HIV/AIDS behind bars: an avenue for culturally sensitive interventions.

The prevalence of HIV infection and the incidence of AIDS are higher among prison inmates compared to the general population. Although African Americans and Hispanics constitute approximately 13% and 12.5% of the population, respectively, they are over-represented among the prison population. The current trend in the adult/adolescent AIDS cases among African Americans and Hispanics outpaces that of the white population. The sociodemographic data of HIV/AIDS looks similar to the sociodemographics of U.S. prisons. This suggests that there may be a link between HIV transmission in prison and the current AIDS epidemic in the community. In addition, this high incidence is also a reflection of the high-risk lifestyle of the incarcerated population. High-risk behavior common among the incarcerated and inner city minority communities includes injection drug use, sharing of drugs and drug paraphernalia, and multiple sex partners. HIV transmission risk-reduction efforts such as mandatory screening of inmates, preventive HIV/AIDS education, and appropriate and adequate therapeutic management are essential to curtail the epidemic. However, any HIV/AIDS reduction program for minority communities must include culturally sensitive interventions.     

The unexpected movement of the HIV epidemic in the Southeastern United States: transmission among college students

BACKGROUND: Approximately 16 million people are enrolled in institutions of higher learning in the United States. However, college students have not been perceived as at high risk for HIV infection. In early 2003, acute HIV infection was diagnosed in 2 men attending college in North Carolina. We describe an epidemiologic investigation of newly diagnosed HIV infection in men attending college in North Carolina. METHODS: We reviewed state surveillance records examining new HIV diagnoses in men 18-30 years old between January 1, 2000 and December 31, 2003, living in 69 North Carolina counties. Risk behavior and demographic information for HIV-infected men enrolled in college were compared with HIV-infected male nonenrollees. RESULTS: Of the 735 records available for review, 84 (11%) were college men. Eighty-seven percent of college men were African American and 92% were men who have sex with men (MSM) or men who have sex with men and women (MSM/W). Compared with noncollege men, college men were more likely to be African American (odds ratio 3.70, 95% CI = 1.86-7.54), to report meeting sex partners at bars or dance clubs (odds ratio 3.01, 95% CI = 1.77-5.10) or on the Internet/chat lines (odds ratio 4.95, 95% CI = 2.53-9.64), or to report use of "ecstasy" or club drugs (odds ratio 4.51, 95% CI = 1.15-15.40). Newly diagnosed HIV infection was found in men in 37 colleges located in North Carolina or surrounding states and a sexual partner network investigation linked 21 colleges, 61 students, and 8 partners of students. CONCLUSION: We describe an epidemic of HIV infection occurring in North Carolina college students, primarily involving African American MSM and MSM/W. College students represent an at-risk, accessible population, which deserves further HIV prevention interventions.     

Are HIV/AIDS conspiracy beliefs a barrier to HIV prevention among African Americans?

OBJECTIVES: This study examined endorsement of HIV/AIDS conspiracy beliefs and their relations to consistent condom use and condom attitudes among African Americans. METHODS: We conducted a telephone survey with a random sample of 500 African Americans aged 15 to 44 years and living in the contiguous United States. RESULTS: A significant proportion of respondents endorsed HIV/AIDS conspiracy beliefs. Among men, stronger conspiracy beliefs were significantly associated with more negative condom attitudes and inconsistent condom use independent of selected sociode-mographic characteristics, partner variables, sexually transmitted disease history, perceived risk, and psychosocial factors. In secondary follow-up analyses, men's attitudes about condom use partially mediated the effects of HIV/AIDS conspiracy beliefs on condom use behavior. CONCLUSIONS: HIV/AIDS conspiracy beliefs are a barrier to HIV prevention among African Americans and may represent a facet of negative attitudes about condoms among black men. To counter such beliefs, government and public health entities need to work toward obtaining the trust of black communities by addressing current discrimination within the health care system as well as by acknowledging the origin of conspiracy beliefs in the context of historical discrimination.     

东莞市男男性行为者艾滋病知识行为调查

目的了解男男性行为者（MSM）艾滋病防治知识掌握情况及高危行为方式,为在该人群中开展艾滋病预防干预工作提供依据。方法在男男性行为者聚集场所进行问卷调查。结果调查对象年龄中位数为29岁,以未婚、高中文化程度、省外流动人口及在东莞居住2年以上者为主;艾滋病知识知晓率为91.75%;74.75%的调查者在过去的6个月中有过同性性行为（其中3.34%的人有过同性商业性行为）,其中51.84%的人每次都使用安全套;39%的人在过去的6个月与女性有过性行为,其中37.82%的人每次都使用安全套;27.25%的人在过去的6个月与男性、女性都有过性行为;7.25%的人在最近一年曾患过性病;10.5%的人HIV抗体筛查结果阳性。结论应采用民间组织宣传干预与VCT检测相结合的模式,加强MSM人群的艾滋病宣传教育工作,推广使用安全套,防止HIV在MSM人群中的传播及经其女性性伴向一般人群传播。     

Depressive symptoms and antidepressant use in a random community sample of ethnically diverse, urban elder persons

BACKGROUND: There are limited data on depressive symptoms and antidepressant use in ethnically diverse, urban elderly. METHODS: Analysis of depressive symptom and antidepressant use data from an epidemiological survey of dementia in an ethnically diverse, urban, elderly community. RESULTS: 21.5% (N=566) reported clinically significant depressive symptoms. Severity was inversely associated with socioeconomic status. 7.5% (N=194) reported antidepressant medication use. Multiple logistic regression analysis adjusting for severity and other covariates showed that men and African Americans had nearly half the odds of using antidepressants. Antidepressant use was more frequent among Hispanics, those with more severe depression and more medical illness. LIMITATIONS: Combined sample; CES-D not validated in Hispanics and inner-city African Americans; depressive symptoms assessed at one time-point; lack of complete income data; geographically restricted. CONCLUSIONS: In this elder sample, taking into account depressive symptom severity and other confounds, antidepressant use is nearly half as likely among men and African Americans.     

Differences in attitudes toward organ donation among African Americans and whites in the United States.

The availability of organs within the African-American population has been an on-going issue. Historically, African Americans donate organs at a much lower rate than whites. Thus, this study was designed to compare general attitudes between African Americans, whites, and other minorities concerning the issue of organ donation and to identify the factors that hamper African Americans from becoming organ donors. We conducted a 12-question survey of 249 African Americans, 492 whites, and a category of others defining themselves as 71 Asians, 23 Hispanics, 22 Native Americans, and 35 unknowns for a total sample of 892. Samples were taken from six United States cities. Thirty-eight percent of African Americans stated they would not donate organs, compared to 10% of whites. When asked why not, African Americans stated "personal reasons" followed by "if I am an organ donor I won't get the necessary medical attention" as their top choices. Whites chose "religious reasons" followed by "organs may be taken before I am dead" as their top choices. African Americans were more concerned with getting proper medical treatment as opposed to whites, who worried their organs might be taken before their death. Regarding family discussion pertaining to organ donation, 66% of African Americans stated no discussion. Whites had a 46% rate for no family discussion. Regarding trust of doctors, 46% of African Americans expressed lack of trust for doctors, with 23% of whites expressing lack of trust for doctors. The results of this study point to the areas that must be given more focus by African-American health care providers and educators.     

Determinants of enrollment in a preventive HIV vaccine trial: hypothetical versus actual willingness and barriers to participation

OBJECTIVE: To compare hypothetical and actual willingness to enroll in a preventive HIV vaccine trial and identify factors affecting enrollment. METHODS: Participants previously enrolled in an HIV vaccine preparedness study (VPS) in 8 US cities were invited to be screened for a phase 2 HIV vaccine trial. Demographic and risk characteristics of those enrolling, ineligible, and refusing enrollment were compared using the chi2 or Fisher exact test. Multivariable logistic models were used to identify independent predictors of refusal. RESULTS: Of 2531 high-risk HIV-uninfected former VPS participants contacted for the vaccine trial, 13% enrolled, 34% were ineligible, and 53% refused enrollment. Only 20% of those stating hypothetical willingness during the VPS actually enrolled in this vaccine trial. In multivariate analysis, refusal was higher among African Americans and lower in persons >40 years of age, those attending college, and those with > or =5 partners in the prior 6 months. All racial ethnic groups cited concerns about vaccine-induced seropositivity; African Americans also cited mistrust of government and safety concerns as barriers to enrollment. CONCLUSIONS: Steps can be taken to minimize potential social harms and to mobilize diverse communities to enroll in trials. Statements of hypothetical willingness to participate in future trials may overestimate true enrollment.     

Partner-specific sexual behavioral differences between phase 3 HIV vaccine efficacy trial participants and controls: Project VISION

OBJECTIVE: To assess and compare sexual behaviors using partner-specific data between HIV-negative men who have sex with men (MSM) recruited for an HIV vaccine efficacy trial and a control group. METHODS: HIV-negative MSM from an HIV vaccine trial (n = 525) and controls (n = 732) were recruited by similar strategies and interviewed about behaviors with the 3 most recent partners in the past 6 months, obtained by audio computer-assisted self-interview (A-CASI). RESULTS: Vaccine trial participants were more likely than controls to report an HIV-positive partner (24.7% and 14.1%, respectively) or an HIV-positive primary partner (16.1% and 6.8%, respectively) and were less likely to report occasional or single-time partners of unknown HIV status (51.6% and 63.2%, respectively; P < 0.05 for each comparison). Vaccine trial participants more often reported receptive unprotected anal intercourse (UAI) during their last sexual encounter with an HIV-positive partner (adjusted odds ratio [OR] = 2.7, 95% confidence interval [CI]: 1.0 to 7.9). Most believed their HIV-positive partners were receiving antiretroviral treatment (ART), however, and after adjustment for perceived ART use, the association between vaccine study participation and receptive UAI with an HIV-positive partner was not significant. CONCLUSIONS: High-risk sexual behavior was reported by many VAX004 participants and controls. Differences between vaccine trial and control participants in the highest risk per contact behavior, receptive UAI with HIV-positive partners, was partly accounted for by perceived ART use. Partner level data are useful in refining risk assessment, which is important in the evaluation of HIV vaccine and other prevention trials.     

Concurrent partnerships among rural African Americans with recently reported heterosexually transmitted HIV infection

OBJECTIVES: To investigate concurrent sexual partnerships among African Americans in North Carolina with recently reported heterosexually transmitted HIV infection. DESIGN: Population-based case series of persons with newly reported HIV infection. METHODS: Household interviews concerning sexual and other risk behaviors for HIV transmission were conducted among African Americans, 18-59 years old, who had been reported to the state health department within the preceding 6 months as having heterosexually acquired HIV infection. Dates of sexual partnerships were analyzed to identify concurrency among the 3 most recent partnerships. RESULTS: Concurrency prevalence in the past 1 and 5 years, respectively, was 45 and 63% for men and 37 and 58% for women. Most respondents (87%) believed that a recent partner had had a concurrent partnership. Multivariate analysis revealed associations between concurrency and male gender, youth, crack cocaine smoking, and incarceration of a sex partner. CONCLUSIONS: Concurrent partnerships likely accelerate heterosexual HIV transmission among blacks in the rural southeastern United States. Future research should examine the socioeconomic context that supports this network pattern.     

High HIV prevalence and risk behaviors in men who have sex with men in Chennai, India

OBJECTIVE: To estimate HIV and sexually transmitted disease (STD) prevalence and behavioral risk characteristics of men who have sex with men (MSM) in Chennai, India. METHODS: A cross-sectional population-based random sample survey was conducted in 2001. Randomly selected residents of 30 slums in Chennai were interviewed for behavioral risk factors through face-to-face interviews. Sera and urine were examined for syphilis, HIV-1, gonorrhea, and chlamydia. Logistic regression analyses were used to assess associations between MSM status and HIV infection and to identify risk characteristics of MSM. RESULTS: Of 774 men, 46 reported (5.9%) sex with other men. MSM were more likely to be seropositive for HIV (odds ratio [OR] = 8.57; 95% confidence interval [CI]: 1.83, 40.23) and were more likely to have a history of STD (OR = 2.66; 95% CI: 1.18, 6.02) than non-MSM. Men who used illicit drugs in past 3 months (adjusted odds ratio [AOR] = 4.01; 95% CI: 1.92, 8.41), ever exchanged money for sex (AOR = 3.93; 95% CI: 1.97, 7.84), or were ever tested for HIV (AOR = 3.72; 95% CI: 1.34, 10.34) were significantly more likely to report sex with men. CONCLUSIONS: MSM in Chennai slums are at high risk for HIV. HIV prevention strategies aimed at changing unsafe drug and sexual practices should target the general population of men, with specific attention to areas with high rates of MSM.     

Atrial fibrillation among African Americans, Hispanics and Caucasians: clinical features and outcomes from the AFFIRM trial

The Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study concluded that rate control with anticoagulation was equivalent overall to rhythm control with cardioversion for long-term survival and that anticoagulation reduced the risk of stroke. We compared baseline and follow-up data for three ethnic groups: Caucasians (n=3,599), African Americans (n=265) and Hispanics (n=132). Caucasians were older and more likely male, African Americans were more likely female and hypertensive, and Hispanics had higher prevalence of cardiomyopathy. Survival was better for rate control than rhythm control in Caucasians, equivalent in African Americans and better for rhythm control in Hispanics. Outcomes may be influenced by differential baseline characteristics, but low numbers of African Americans and Hispanics warrant caution in data interpretation. BACKGROUND: The AFFIRM study compared a rate-control strategy to a rhythm-control strategy for the treatment of atrial fibrillation (AF) in patients at high risk for stroke or death. It concluded that the rhythm-control strategy offered no survival advantage, and it also confirmed the value of anticoagulation to prevent complications of AF. Data have not previously been available for specific racial ethnic populations. METHODS: We compared baseline and follow-up data for the patients randomized to rate-control versus rhythm-control in three population groups-Caucasian, African-American and Hispanic. RESULTS: Among 4,060 total patients, 3,599 were Caucasian, 265 were African-American and 132 were Hispanic. At baseline, Caucasians were older and had a higher percentage of males, normal ejection fractions, AF as their only cardiac diagnosis, a prior antiarrhythmic drug failure and less congestive heart failure. African Americans were more likely to be female, had more hypertension and qualified for the study with a first episode of AF, compared to Caucasians. Hispanics had more cardiomyopathy at baseline than Caucasians. Overall survival in Caucasians at five years for the rate-control and rhythm-control groups was 78.9% vs. 76.4%, respectively (p=0.04); for African Americans, 79.0% vs. 69.4% (p=0.22); and for Hispanics, 66.5% vs. 83.9% (p=0.01). Overall, survival was not different between the three populations. However, lower rates of event-free survival were recorded for Hispanics and for African Americans (p=0.0182). CONCLUSIONS: Different survival rates were found for rate-control versus rhythm-control in African-American and Hispanic patients, compared to Caucasian. These findings may be influenced by differences in baseline characteristics, but must be interpreted with caution because of the small sample sizes for African-American and Hispanic participants.     

A survey of the ethnic and racial distribution in orthopedic residency programs in the United States.

This study examined the racial and ethnic composition of orthopedic training programs in the United States. A questionnaire was mailed in January 1995 to chairpersons at 159 orthopedic programs in the United States. Eighty-nine (56%) responses were received. The distribution of orthopedic residents and fellows was as follows: white non-Hispanic, 84.2%; Asian, 6.6%; African American, 3.6%; Native American, 2.2%; Puerto Rican, 1.2%; Mexican American, 0.8%; and other Hispanic, 1%. African Americans and Hispanics were under-represented in orthopedic training programs compared with their numbers in the general population. The percentage of residents in these two minority groups also were below goals established by the Council on Graduate Medical Education and the US Government's Healthy People 2000 report. In contrast, Native Americans and Asians were overrepresented. If racial balance is to be achieved in orthopedics, new incentives must be created to encourage more African Americans and Hispanics to enter orthopedic residency training programs.