The prevalence of high blood cholesterol levels among adults in the United States

Using the National Cholesterol Education Program's Guidelines for the Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults and the most recent nationally representative serum total cholesterol and lipoprotein data for adults (ages 20 to 74 years) from the second National Health and Nutrition Examination Survey (1976 to 1980), it is estimated that 41% of adults should have lipoprotein analysis after an initial measurement of serum total cholesterol. Furthermore, it is estimated that 88% of those who need lipoprotein analysis, or 36% of all adults aged 20 to 74 years, are candidates for medical advice and intervention for high blood cholesterol levels. We estimate, based on 1986 population data, that approximately 40 million Americans between the ages of 20 and 59 years are candidates for medical advice and intervention. An additional 24 million Americans aged 60 years and older are candidates. Overall, we estimate that about 60 million Americans aged 20 years and older are candidates for medical advice and intervention for high levels of blood cholesterol, although a less intensive approach might be appropriate for elderly patients.     

Birth cohort analysis of prevalence of cigarette smoking among Hispanics in the United States

To investigate historical trends of cigarette smoking among Mexican-Americans, Cuban-Americans, and Puerto Rican-Americans, we conducted a birth cohort analysis of smoking prevalence by using smoking histories of 8286 adults and adolescents from the 1982-1983 Hispanic Health and Nutrition Examination Survey. We constructed smoking prevalence curves for men and women among successive ten-year birth cohorts. Birth cohort-specific prevalence rates were higher for men than for women. Rates, however, decreased among successive cohorts of men. Conversely, rates increased among successive cohorts of Cuban-American and Puerto Rican-American women. For example, peak rates among the 1911 through 1920 cohorts were 26% (Cuban-American women) and 25% (Puerto Rican-American women) compared with peak rates of 43% and 52%, respectively, among comparable groups from 1951 through 1960. These results demonstrate that despite a reduction of cigarette smoking among successive cohorts of Hispanic men, Hispanic women have made little progress or have actually increased their cigarette smoking.     

Sexual dysfunction in the United States: prevalence and predictors

CONTEXT: While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. OBJECTIVE: To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. DESIGN: Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. PARTICIPANTS: A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. MAIN OUTCOME MEASURES: Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. RESULTS: Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall well-being. CONCLUSIONS: The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.     

Tuberculosis among Indochinese refugees in the United States

Surveys of state tuberculosis control programs revealed that of the 262,602 Indochinese refugees who entered the United States in 1979 and 1980, approximately 1.5% either had tuberculosis at the time of entry or developed it by the end of 1980; another 18% were placed on preventive therapy. The refugees comprised 5.3% of the nationally counted cases during the two-year period. Age- and sex-specific incidence rates among Indochinese refugees were 30 to 200 times higher than those for other persons in the United States. For refugees who arrived in 1979, the incidence of tuberculosis during 1980 (231 per 100,000) was only one third the incidence during 1979 (719 per 100,000). For refugees who entered the United States in 1980, the incidence during 1980 was 480 per 100,000. Bacteriologic confirmation of the diagnosis was reported for only 26% of refugees, compared with 79% of other patients with tuberculosis in the United States, suggesting overdiagnosis of tuberculosis among refugees. However, age-specific rates of bacteriologically positive tuberculosis were still 14 to 70 times higher for refugees than for the United States as a whole.     

宁波市鄞州区儿童贫血流行病学调查

目的 调查分析宁波市鄞州区儿童贫血状况及其影响因素,为营养干预措施的制定提供科学依据。 方法 2012年6月-2014年5月在宁波整群抽取鄞州区11个乡镇街道1 650名儿童进行贫血筛查和膳食调查,并对其家庭背景情况进行问卷调查。 结果 1 650名儿童贫血总发病率为7.6%(126/1 650),男性和女性儿童贫血发病率分别是7.9%(69/871)和7.3%(57/779),男女贫血发生率差异无统计学意义(P=0.357);通过对贫血儿童家庭背景的调查,发现贫血与年龄、居住地、看护人的职业和文化程度、家庭的婚姻状况有关:1~6岁阶段儿童贫血发生率明显高于0~1岁和6~12岁两个年龄段儿童;居住在城市儿童贫血发生率明显低于农村和城乡结合部儿童;工作稳定、文化程度高的看护人照顾的儿童贫血发病率相对较低;单亲家庭儿童贫血发病率明显高于双亲家庭。而与性别、同胞个数和母乳喂养时间无关;126例儿童贫血的主要原因是缺铁性贫血和巨幼细胞性贫血;检测贫血儿童外周血血清铁蛋白(SF)、锌原卟啉(ZnPP)、血清叶酸(FA)和维生素B₁₂(VitB₁₂)的浓度,结果提示1~3岁组儿童SF明显低于其他2组;0~1岁组儿童ZnPP浓度正常,但是其他2组明显升高;虽然3组儿童的FA和VitB₁₂浓度均正常,但是6~12岁组儿童FA浓度明显高于其他2组。 结论 本地区儿童的贫血率依然较高,以1~6岁组的儿童发病率最高,且缺铁性贫血和巨幼细胞性贫血是主要原因,有必要同时从多个方面进行干预。      

Prevalence of HPV infection among females in the United States

Context  Human papillomavirus (HPV) infection is estimated to be the most common sexually transmitted infection. Baseline population prevalence data for HPV infection in the United States before widespread availability of a prophylactic HPV vaccine would be useful. Objective  To determine the prevalence of HPV among females in the United States. Design, Setting, and Participants  The National Health and Nutrition Examination Survey (NHANES) uses a representative sample of the US noninstitutionalized civilian population. Females aged 14 to 59 years who were interviewed at home for NHANES 2003-2004 were examined in a mobile examination center and provided a self-collected vaginal swab specimen. Swabs were analyzed for HPV DNA by L1 consensus polymerase chain reaction followed by type-specific hybridization. Demographic and sexual behavior information was obtained from all participants. Main Outcome Measures  HPV prevalence by polymerase chain reaction. Results  The overall HPV prevalence was 26.8% (95% confidence interval [CI], 23.3%-30.9%) among US females aged 14 to 59 years (n = 1921). HPV prevalence was 24.5% (95% CI, 19.6%-30.5%) among females aged 14 to 19 years, 44.8% (95% CI, 36.3%-55.3%) among women aged 20 to 24 years, 27.4% (95% CI, 21.9%-34.2%) among women aged 25 to 29 years, 27.5% (95% CI, 20.8%-36.4%) among women aged 30 to 39 years, 25.2% (95% CI, 19.7%-32.2%) among women aged 40 to 49 years, and 19.6% (95% CI, 14.3%-26.8%) among women aged 50 to 59 years. There was a statistically significant trend for increasing HPV prevalence with each year of age from 14 to 24 years (P<.001), followed by a gradual decline in prevalence through 59 years (P = .06). HPV vaccine types 6 and 11 (low-risk types) and 16 and 18 (high-risk types) were detected in 3.4% of female participants; HPV-6 was detected in 1.3% (95% CI, 0.8%-2.3%), HPV-11 in 0.1% (95% CI, 0.03%-0.3%), HPV-16 in 1.5% (95% CI, 0.9%-2.6%), and HPV-18 in 0.8% (95% CI, 0.4%-1.5%) of female participants. Independent risk factors for HPV detection were age, marital status, and increasing numbers of lifetime and recent sex partners. Conclusions  HPV is common among females in the United States. Our data indicate that the burden of prevalent HPV infection among females was greater than previous estimates and was highest among those aged 20 to 24 years. However, the prevalence of HPV vaccine types was relatively low.      

Gaps in vaccine financing for underinsured children in the United States

Context  The number of new vaccines recommended for children and adolescents has nearly doubled during the past 5 years, and the cost of fully vaccinating a child has increased dramatically in the past decade. Anecdotal reports from state policy makers and clinicians suggest that new gaps have arisen in financial coverage of vaccines for children who are underinsured (ie, have private insurance that does not cover all recommended vaccines). In 2000, approximately 14% of children were underinsured for vaccines in the United States. Objectives  To describe variation among states in the provision of new vaccines to underinsured children and to identify barriers to state purchase and distribution of new vaccines. Design, Setting, and Participants  A 2-phase mixed-methods study of state immunization program managers in the United States. The first phase included 1-hour qualitative telephone interviews conducted from November to December 2005 with 9 program managers chosen to represent different state vaccine financing policies. The second phase incorporated findings from phase 1 to develop a national telephone and paper-based survey of state immunization program managers that was conducted from January to June 2006. Main Outcome Measures  Percentage of states in which underinsured children are unable to receive publicly purchased vaccines in the private or public sectors. Results  Immunization program managers from 48 states (96%) participated in the study. Underinsured children were not eligible to receive publicly purchased meningococcal conjugate or pneumococcal conjugate vaccines in the private sector in 70% and 50% of states, respectively, or in the public sector in 40% and 17% of states, respectively. Due to limited financing for new vaccines, 10 states changed their policies for provision of publicly purchased vaccines between 2004 and early 2006 to restrict access to selected new vaccines for underinsured children. The most commonly cited barriers to implementation in underinsured children were lack of sufficient federal and state funding to purchase vaccines. Conclusions  The current vaccine financing system has resulted in gaps for underinsured children in the United States, many of whom are now unable to receive publicly purchased vaccines in either the private or public sectors. Additional strategies are needed to ensure financial coverage for all vaccines, particularly new vaccines, among this vulnerable population.      

Prevalence of HIV infection among intravenous drug users in the United States

We reviewed 92 published and unpublished studies of the prevalence of infection with the human immunodeficiency virus (HIV) among intravenous drug users (IVDUs) in the United States. Human immunodeficiency virus seroprevalence among IVDUs in drug treatment programs in the United States ranged from 0% to 65%. Seroprevalence was highest in the Northeast (10% to 65%) and Puerto Rico (45% to 59%); lower in the South Atlantic (7% to 29%) and in the metropolitan areas of Atlanta, Ga (10%), Detroit, Mich (7% to 13%), and San Francisco, Calif (7% to 13%); and 5% or less in other areas of the West, the Midwest, and the South. Among IVDUs seen in drug treatment programs, risk of infection was not associated with gender or age but was associated with black and Hispanic ethnicity, male homosexual orientation, and certain intravenous drug-use practices. Cross-sectional and cohort studies indicated increases in seroprevalence of between 0% and 14% per year among IVDUs in treatment. We estimated that between 61,000 and 398,000 IVDUs in the United States were infected with human immunodeficiency virus, or 5% to 33% of the IVDU population. High rates of infection among IVDUs in treatment in the Northeast indicate the potential for rapid spread in regions where rates are currently low. An urgent need exists to monitor human immunodeficiency virus infection levels and trends more widely and to develop effective programs to reduce the further spread of human immunodeficiency virus infection among IVDUs.     

美国的美洲印第安人和阿拉斯加本地居民克罗伊茨费尔特-雅各布病的发病情况

采用美国多方面死因数据及来自美国国家健康部门的医疗信息，评估美洲印第安人及阿拉斯加本地居民人群中克罗伊茨费尔特-雅各布病（CJD）的发病情况。1981-2002年间，共证实12例患者死于CJD，平均每年的年龄校正死亡率为0．47／100万，该比率显著低于白人，但与美籍非洲人相似。     

Efficacy of whole-cell pertussis vaccine in preschool children in the United States.

OBJECTIVE--To evaluate the efficacy of currently used whole-cell pertussis vaccines. DESIGN--Active surveillance to detect pertussis cases in Baltimore, Md, Denver, Colo, and Milwaukee, Wis, and investigation of secondary attack rates in 347 household contacts, aged 1 through 4 years, to estimate vaccine efficacy. OUTCOME MEASURE--Vaccine efficacy was estimated using different case definitions for pertussis. RESULTS--Vaccine efficacy was 64%, 81%, and 95% for case definitions of mild cough, paroxysmal cough, and severe clinical illness, respectively. Requiring laboratory confirmation increased efficacy to 95% to 98% for culture-positive children and to 77% to 95% for culture- or serology-confirmed cases, depending on disease severity. Vaccine efficacy for typical paroxysmal cough increased from 44% for one diphtheria, tetanus, and pertussis vaccine dose to 80% for four or more doses. CONCLUSIONS--The trend toward increasing vaccine efficacy with different case definitions may be due to improved efficacy in preventing severe illness and to case definitions that are more specific for pertussis. Whole-cell pertussis vaccine was highly effective in preventing pertussis in preschool children exposed to infection within their households. Direct side-by-side efficacy studies of whole-cell vaccine and the recently licensed acellular vaccine will be necessary to assure that comparable protection is afforded by the new vaccines if they are to be used for immunization of infants.     

住院儿童贫血转归影响因素研究

目的 探讨住院患儿贫血转归的影响因素。方法 通过住院病历记录和自拟调查问卷分析787例住院贫血儿童。用SAS8．1统计软件包对所有资料进行单因素和多因素非条件Logistic回归分析。结果 住院患儿贫血的转归：787例贫血患儿出院时贫血的转归：41例（5．21％）患儿痊愈，535例（67．98％）患儿好转，211例（26．81％）患儿未愈；单因素与多因素非条件Logistic逐步回归分析结果：母孕期健康状况、患儿居住地、就诊原因、住院是否及时、贫血程度、原发病转归和是否输血与住院患儿贫血的转归有关。结论 原发病转归、是否输血、住院是否及时、贫血程度等与住院儿童贫血的转归有关，其中原发病好转或治愈和输血是住院儿童贫血好转或治愈的保护性因素。     

Prevalence of chlamydial and gonococcal infections among young adults in the United States

Context  Chlamydial and gonococcal infections are important causes of pelvic inflammatory disease, ectopic pregnancy, and infertility. Although screening for Chlamydia trachomatis is widely recommended among young adult women, little information is available regarding the prevalence of chlamydial and gonococcal infections in the general young adult population. Objective  To determine the prevalence of chlamydial and gonoccoccal infections in a nationally representative sample of young adults living in the United States. Design, Setting, and Participants  Cross-sectional analyses of a prospective cohort study of a nationally representative sample of 14 322 young adults aged 18 to 26 years. In-home interviews were conducted across the United States for Wave III of The National Longitudinal Study of Adolescent Health (Add Health) from April 2, 2001, to May 9, 2002. This study sample represented 66.3% of the original 18 924 participants in Wave I of Add Health. First-void urine specimens using ligase chain reaction assay were available for 12 548 (87.6%) of the Wave III participants. Main Outcome Measures  Prevalences of chlamydial and gonococcal infections in the general young adult population, and by age, self-reported race/ethnicity, and geographic region of current residence. Results  Overall prevalence of chlamydial infection was 4.19% (95% confidence interval [CI], 3.48%-4.90%). Women (4.74%; 95% CI, 3.93%-5.71%) were more likely to be infected than men (3.67%; 95% CI, 2.93%-4.58%; prevalence ratio, 1.29; 95% CI, 1.03-1.63). The prevalence of chlamydial infection was highest among black women (13.95%; 95% CI, 11.25%-17.18%) and black men (11.12%; 95% CI, 8.51%-14.42%); lowest prevalences were among Asian men (1.14%; 95% CI, 0.40%-3.21%), white men (1.38%; 95% CI, 0.93%-2.03%), and white women (2.52%; 95% CI, 1.90%-3.34%). Prevalence of chlamydial infection was highest in the south (5.39%; 95% CI, 4.24%-6.83%) and lowest in the northeast (2.39%; 95% CI, 1.56%-3.65%). Overall prevalence of gonorrhea was 0.43% (95% CI, 0.29%-0.63%). Among black men and women, the prevalence was 2.13% (95% CI, 1.46%-3.10%) and among white young adults, 0.10% (95% CI, 0.03%-0.27%). Prevalence of coinfection with both chlamydial and gonococcal infections was 0.030% (95% CI, 0.18%-0.49%). Conclusions  The prevalence of chlamydial infection is high among young adults in the United States. Substantial racial/ethnic disparities are present in the prevalence of both chlamydial and gonococcal infections.