Prevalence of shiga-toxigenicEscherichia coliO157:H7 in adult dairy cattle

OBJECTIVE

To describe shiga-toxigenic Escherichia coil O157:H7 (STEC O157:H7) fecal shedding prevalence, seasonal fecal shedding patterns, and site-specific prevalence from the oral cavity, skin, and feces of dairy cattle.

DESIGN

Cross-sectional study.

ANIMALS

Adult dairy cattle from 13 herds in Louisiana.

PROCEDURE

Samples were cultured for STEC O157 by use of sensitive and specific techniques, including selective broth enrichment, immunomagnetic separation, monoclonal antibody-based O:H enzyme immunoassay serotyping, and polymerase chain reaction virulence gene characterization. Point estimates and 95% confidence intervals were calculated for fecal shedding prevalence as well as site-specific prevalence from the oral cavity, skin, and feces. Logistic regression was used to assess seasonal variation and differences at various stages of lactation with respect to fecal shedding of STEC O157 in cattle sampled longitudinally.

RESULTS

Summer prevalence in herds in = 13) was 38.5%, with a cow-level prevalence of 6.5%. Among positive herds, prevalence ranged from 3% to 34.6%. Samples from 3 of 5 herds sampled quarterly over 1 year yielded positive results for STEC O157. In herds with STEC O157, an increase in cow-level prevalence was detected during spring (13.3%) and summer (10.5%), compared with values for fall and winter. Site-specific prevalences of STEC O157:H7 from oral cavity, skin, and fecal samples were 0%, 0.7%, and 25.2%, respectively.

CONCLUSIONS AND CLINICAL RELEVANCE

Our data indicated that STEC O157:H7 was commonly isolated from dairy cows in Louisiana, seasonally shed, and isolated from the skin surface but not the oral cavity of cows.

Human immunodeficiency virus-associated rheumatic disorders in the HAART era

OBJECTIVE

To define the frequency and characteristics of human immunodeficiency virus (HIV)-associated rheumatic manifestations in patients receiving highly active antiretroviral therapy (HAART) referred to a rheumatology clinic.

METHODS

A total of 75 patients with HIV infection receiving HAART were prospectively evaluated for the presence of rheumatic complaints. Diagnosis of HIV infection was performed by ELISA and confirmed by Western blot, and all HIV patients were classified according to the US Centers for Disease Control criteria.

RESULTS

Seventy-five individuals with HIV infection and musculoskeletal manifestations were evaluated: 65 (86%) men and 10 (14%) women. Mean age was 32 +/- 4.5 years (range 21-58). The group included 40 (53%) heterosexuals, 30 (40%) intravenous drugs users, 9 (12%) homosexuals, 3 (4%) who had received blood transfusion, and 2 (2.6%) with unknown risk factors. Septic manifestations were the most common complications seen in 31 (41%) out of 75, and included septic arthritis, cellulitis, osteomyelitis, diskitis, and pyomyositis. Fibromyalgia was present in 13 (17%), seronegative symmetric polyarthritis in 4, oligoarthritis in 4, psoriatic arthritis in 2, carpal tunnel syndrome in 2, and enthesitis in 2. Mutifocal bone non-Hodgkin's lymphoma was present in 7 (9.3%) and Kaposis's sarcoma of bone in 2 (2.6%) patients. Hypertrophic osteoarthropathy in 3 (4%) and aseptic bone necrosis of multiple bones was seen in 3 (4%) patients. Ten patients exhibited only arthralgias. Most patients had moderately elevated erythrocyte sedimentation rate and C-reactive protein. Mean CD4 cell count was 250 mm3 (range 20-450), and mean HIV viral load was 5210 (range 0-75,300) copies/ml.

CONCLUSION

Rheumatic manifestations were highly frequent in HIV patients receiving HAART referred to a rheumatology clinic, although the clinical spectrum differed from the pre-HAART era with septic and malignant complications being the most common manifestations seen.

Class III Obesity Continues to Rise in African-American Women

BACKGROUND

The Behavior Risk Factor Surveillance System (BRFSS) survey, a random telephone survey of the United States, found a rising prevalence of Class III obesity, body mass index (BMI) >40 kg/m(2). African-American women were largely responsible for this increase. The prevalence of Class III obesity in African-American women in the BRFSS during the year 2000 was 6%, identical to the Pennington Biomedical Research Center (PBRC) database during the same year. The PBRC Database might predict the trend in class III obesity in the years 2000-2002.

METHODS

The PBRC is an academic research center in Baton Rouge, that maintains a database with information collected by telephone regarding BMI and race, for subjects responding to solicitations to participate in clinical trials. This database contains 7787 subjects entered from 1995 through 2002, of which 1820 were African-American women and 3006 were Caucasian women. The prevalence of Class III obesity was plotted for women of these 2 racial groups and compared with the year 2000 prevalence in the BRFSS.

RESULTS

The prevalence of Class III obesity in African-American women increased from 0.5% in 1995 to 6% in 2000 (identical to the BRFSS) and to 7.5% in 2002. The prevalence of Class III obesity in Caucasian women remained about 3%.

CONCLUSION

The prevalence of Class III obesity continues to rise in African-American women, a group with greater need and less access to obesity surgery, the only effective treatment, than Caucasian women, an inequality deserving of public policy attention.

Estimating HIV Incidence and Detection Rates From Surveillance Data

BACKGROUND

Markov models that incorporate HIV test information can increase precision in estimates of new infections and permit the estimation of detection rates. The purpose of this study was to assess the functioning of a Markov model for estimating new HIV infections and HIV detection rates in Louisiana using surveillance data.

METHODS

We expanded a discrete-time Markov model by accounting for the change in AIDS case definition made by the Centers for Disease Control and Prevention in 1993. The model was applied to quarterly HIV/AIDS surveillance data reported in Louisiana from 1981 to 1996 for various exposure and demographic subgroups. When modeling subgroups defined by exposure categories, we adjusted for the high proportion of missing exposure information among recent cases. We ascertained sensitivity to changes in various model assumptions.

RESULTS

The model was able to produce results consistent with other sources of information in the state. Estimates of new infections indicated a transition of the HIV epidemic in Louisiana from (1) predominantly white men and men who have sex with men to (2) women, blacks, and high-risk heterosexuals. The model estimated that 61% of all HIV/AIDS cases were detected and reported by 1996, yet half of all HIV/non-AIDS cases were yet to be detected. Sensitivity analyses demonstrated that the model was robust to several uncertainties.

CONCLUSIONS

In general, the methodology provided a useful and flexible alternative for estimating infection and detection trends using data from a U.S. surveillance program. Its use for estimating current infection will need further exploration to address assumptions related to newer treatments.

West Nile virus infection in nonhuman primate breeding colony, concurrent with human epidemic, southern Louisiana

During the summer of 2002, an epidemic of West Nile meningoencephalitis occurred in southern Louisiana. Following the outbreak, blood samples were collected from 1,692 captive rhesus monkeys (Macaca mulatta), pigtail macaques (M. nemestrina), and baboons (Papio spp.) that were permanently housed outdoors at a nonhuman primate breeding facility in St. Tammany Parish, Louisiana. The serum samples were examined for antibodies to West Nile virus (WNV). Overall, 36% of the captive nonhuman primates had WNV antibodies; comparison of these samples with banked serum samples from previous blood collections indicated that the animals were infected subclinically from February to August 2002. WNV activity was demonstrated in surveillance at the nonhuman primate-breeding colony and in the neighboring community during this same period. The high infection rate in this captive nonhuman primate population illustrates the intensity of WNV transmission that can occur silently in nature among other susceptible vertebrates during epidemic periods.

Self-reported overweight and obesity are not associated with concern about enough food among adults in New York and Louisiana

BACKGROUND

A causal relationship between hunger and obesity has been postulated. Two cross-sectional studies have found evidence to suggest an association between obesity and food insecurity among adult women, and a third study suggests an association between underweight and food insecurity among men. The purpose of this study was to investigate the association between concern about enough food and obesity in an adult population at the state level.

METHODS

A cross-sectional analysis was conducted using 1999 data from the Behavioral Risk Factor Surveillance System (BRFSS), Social Context Module (n = 3,945).

RESULTS

An 8.0% prevalence of concern about enough food was found in Louisiana, and an 11.8% prevalence was found in New York, and was positively associated with morbid obesity, RR = 2.20 (95% CI = 1.24, 3.90) and RR = 2.23 (95% CI = 1.30, 3.84), respectively. However, this association became nonsignificant after controlling for education, income, race/ethnicity, marital status, and general health.

CONCLUSION

A very strong apparent relationship between concern about enough food and obesity could be entirely accounted for by the influences of socioeconomic variables. This emphasizes the need for longitudinal research studies using precise measures of weight, height, and food security.

A review of varicella vaccine and Louisiana vaccination requirements

In order to decrease the burden of disease from varicella and increase varicella vaccination rates nationally, all states were advised by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention in May 1999 to institute vaccination requirements or documented evidence of natural infection for all children entering elementary school and daycare facilities. Beginning September 1, 2003, Louisiana law requires varicella vaccination or a history of varicella disease prior to entry to school and daycare. In light of these new state requirements, this article discusses the epidemiology of varicella and addresses a number of concerns about the varicella vaccine. The four main issues addressed via a literature review are (1) the perception of varicella as a benign childhood disease, (2) concerns about vaccine efficacy and safety, (3) concerns about waning immunity, and (4) concerns about shifting burden of disease. The article also reviews varicella vaccination recommendations and encourages vaccination of all children in accordance with new state requirements.

The effect of race and gender on invasive treatment for cardiovascular disease

The purpose of this study was to investigate racial and gender differences in the utilization of invasive procedures for cardiovascular treatment. Medical records data of 3015 patients were abstracted from a Medical System Database from 1999 to 2001. Logit models were used to estimate the adjusted odds in the utilization, referral, and acceptance of invasive procedures, while controllingfor confounders (age, race, sex, comorbidity, disease severity, payer type, marital status and family history) simultaneously. When considering utilization of invasive procedures, the adjusted odds were lower for African-Americans compared to Caucasians. There was a statistically significant difference (p < .05) in Coronary Artery Bypass Graft (CABG) utilization between African Americans and Caucasians. African Americans were less likely than Caucasians to receive a CABG. Although not statistically significant, African-Americans were less likely than Caucasians to receive a cardiac catheterization and Percutaneous Transluminal Coronary Angioplasty (PTCA). Findings failed to yield a statistical significance for gender disparities regarding invasive procedure utilizations.

Self-Reported Health of Residents of the Mississippi Delta

The rural Lower Mississippi Delta of Arkansas, Louisiana, and Mississippi has a large economically and socially disadvantaged population at high risk for health problems. Their health status is poorly understood as they are not well represented in national health surveys. A random-digit-dialing telephone survey was conducted in 2000, with 2,236 respondents representing residents of 36 counties along the Mississippi River. Self-reported chronic conditions, health status, and obesity (derived from weight and height) were compared with the nationally representative Continuing Survey of Food Intake of Individuals. High cholesterol, diabetes, and hypertension were significantly higher than in the national sample. Obesity was strikingly higher in Delta children (27.9% versus 16.2%) of all ages and in Delta adults (33.9% versus 17.3%). Controlling for age, income, and gender, African Americans were at particular risk for obesity, hypertension, and diabetes. A public health crisis appears to exist in the Delta given the high prevalence health problems.

Estimation of sensitivity and specificity of two diagnostics tests for bovine immunodeficiency virus using Bayesian techniques

The validation of assays for bovine immunodeficiency virus (BIV) in cattle is hampered by the absence of a gold standard. Two tests that often are used to detect BIV are the indirect fluorescent-antibody assay (IFA) and the nested-set polymerase chain-reaction assay (PCR). IFA detects an antibody response whereas PCR detects the provirus in white blood cells. Using Bayesian techniques performed simultaneously on animals from two different dairy herds, we estimated the performance of the IFA and PCR assays and infection prevalence. Bayesian techniques also were used to derive posterior distributions of sensitivities, specificities, and prevalences. The Bayesian estimates were IFA sensitivity=60%, IFA specificity=88%, PCR sensitivity=80%, PCR specificity=86%, Herd A prevalence=20%, and Herd B prevalence=71%. Although PCR was the more sensitive assay, substantial misclassification of infection would be expected in epidemiological studies of BIV regardless of which assay was used.

Inter-relationships among childhood BMI, childhood height, and adult obesity: the Bogalusa Heart Study

OBJECTIVE

Although the body mass index (BMI, mass index, kg/m2) is widely used as a surrogate measure of adiposity, it is moderately associated (r approximately 0.3) with height among children. We examined whether the resulting preferential classification of taller children as overweight is appropriate.

DESIGN

Cross-sectional analyses of children (ages, 3-17 y) examined the relation of height to adiposity (as assessed by BMI and skinfold thicknesses) and fasting levels of insulin. Longitudinal analyses examined the relation of childhood height and weight-height indices to adult (mean age, 25 y) levels of adiposity and fasting insulin.

SUBJECTS

Children (n=11,406) and adults (n=2911) who had participated in the Bogalusa Heart Study.

MEASUREMENTS

We constructed three weight-height indices: BMI, W/H3, and W/Hp. The triceps and subscapular skinfolds, as well as fasting levels of insulin, were also measured.

RESULTS

The classification of children as overweight (BMI-for-age > or =95th percentile) varied markedly by height, with a 10-fold difference in the prevalence of overweight across quintiles of height between the ages of 3 and 10 y. Childhood height, however, was also related to skinfold thicknesses and insulin levels, and all associations were modified in a similar manner by age. Furthermore, childhood height was related to adult adiposity, and of the three childhood weight-height indices, BMI showed the strongest associations with adult adiposity.

CONCLUSIONS

Because BMI reflects the positive association between height and adiposity among children, it is a better weight-height index than is either W/H3 or W/Hp.

A staged management diabetes foot program versus standard care: a 1-year cost and utilization comparison in a state public hospital system11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated

OBJECTIVE

To determine whether staged management of foot ulcers reduces health care costs and utilization.

DESIGN

Nonrandomized retrospective study using data from 1998-1999 in the Louisiana public hospital system.

SETTING

Louisiana public hospital system.

PARTICIPANTS

Forty-five patients with diabetes foot ulcer who received staged management foot care and 169 patients with diabetes foot ulcer who received standard foot care.

INTERVENTIONS

Staged management of foot ulcers consisting of devices to offload pressure; self-care education; and, after healing, custom-fabricated orthoses and footwear, and monitored progressive ambulation.

MAIN OUTCOME MEASURES

One-year levels of the number of foot-related inpatient hospitalizations, number of amputation-related hospitalizations, total number of foot-related inpatient days, total charges for foot-related inpatient hospitalizations, all-cause outpatient visits, total charges for all-cause outpatient visits, and combined outpatient and foot-related inpatient charges.

RESULTS

Over the 12-month study period, the staged management group had a lower foot-related hospitalization rate than did the comparison group (.09 admissions per person vs.50 admissions per person, P=.0002); lower foot-related inpatient days (.91d per person vs 3.97d per person, P=.0289); lower foot-related inpatient charges ($1321 per person vs $5411 per person, P=.0151); fewer amputation-related hospitalizations (.04 per person vs.19 per person, P=.0351); fewer emergency department visits (.60 visits per person vs 1.22 visits per person, P=.0043); lower emergency department charges ($104 per person vs $208 per person, P=.0057); and lower total charges ($4776 per person vs $9402 per person, P=.0141). The staged management group had a higher number of outpatient visits (24.91 per person vs 8.04 per person, P<.0001) and higher outpatient charges ($2169 per person vs $1471 per person, P<.0001).

CONCLUSIONS

A staged management diabetes foot program significantly reduced emergency department and hospital utilization and charges in a statewide public hospital system.

Childhood cardiovascular risk factors and carotid vascular changes in adulthood: the Bogalusa Heart Study

CONTEXT

Carotid artery intima-media thickness (IMT) is associated with cardiovascular risk factors and is recognized as an important predictive measure of clinical coronary atherosclerosis events in middle-aged and elderly populations. However, information on the association of carotid IMT in young adults with different risk factors measured in childhood, adulthood, or as a cumulative burden of each of the risk factors measured serially from childhood to adulthood is limited.

OBJECTIVE

To examine the association between carotid IMT in young adults and traditional cardiovascular risk factors measured since childhood.

DESIGN, SETTING, AND PARTICIPANTS

A cohort study of 486 adults aged 25 to 37 years from a semirural black and white community in Bogalusa, La (71% white, 39% men), who had at least 3 measurements of traditional risk factors since childhood, conducted between September 1973 and December 1996.

MAIN OUTCOME MEASURE

Association of carotid IMT with risk factors, including systolic blood pressure, lipoprotein levels, and body mass index.

RESULTS

Male vs female (0.757 mm vs 0.719 mm) and black vs white (0.760 mm vs 0.723 mm) participants had increased carotid IMT (P<.001 for both). In multivariable analyses, significant predictors for being in top vs lower 3 quartiles of carotid IMT in young adults were childhood measures of low-density lipoprotein cholesterol (LDL-C) level (odds ratio [OR], 1.42, corresponding to 1-SD change specific for age, race, and sex; 95% confidence interval [CI], 1.14-1.78) and body mass index (BMI; OR, 1.25; 95% CI, 1.01-1.54); adulthood measures of LDL-C level (OR, 1.46; 95% CI, 1.16-1.82), high-density lipoprotein cholesterol (HDL-C) level (OR, 0.67; 95% CI, 0.51-0.88), and systolic blood pressure (OR, 1.36; 95% CI, 1.08-1.72); and long-term cumulative burden of LDL-C (OR, 1.58; 95% CI, 1.24-2.01) and HDL-C (OR, 0.75; 95% CI, 0.58-0.97) levels measured serially from childhood to adulthood. An increasing trend in carotid IMT across quartiles of LDL-C level measured in childhood was observed, with a mean value of 0.761 mm (95% CI, 0.743-0.780 mm) for those at the top quartile vs 0.724 mm (95% CI, 0.715-0.734 mm) for those in the lower 3 quartiles (P<.001).

CONCLUSIONS

Childhood measures of LDL-C level and BMI predict carotid IMT in young adults. The prevention implications of these findings remains to be explored.

Trichomonas vaginalis Among HIV-Infected Women

BACKGROUND AND OBJECTIVES

Trichomonas vaginalis (Tv) is a common sexually transmitted disease (STD) among HIV-infected populations. The relationship between Tv and immune status and HIV viral load as affected by protease inhibitor (PI) use has not been well examined.

GOAL

The goals were to evaluate the association between Tv and both immune status and PI use among HIV-infected women, and to characterize factors associated with Tv among HIV-infected women.

STUDY DESIGN

We used a retrospective cohort study conducted between 1990 and 2000.

RESULTS

Of 1578 women, the majority was under 35 years, black (AA), and infected heterosexually or with unidentified risk. Thirty percent (30.2%) had Tv at least once, and 36.9% had at least one subsequent positive test; Tv was more common than chlamydia, gonorrhea, genital warts, or syphilis. After adjusting for follow-up time, young age, AA race, substance use, and other sexually transmitted diseases (STDs) were associated with initial Tv infection, but pregnancy, immune status, and PI use were not associated. After adjusting for follow-up time, having other STDs was associated with and pregnancy was protective of subsequent Tv positivity, but immune status and PI use were not associated; neither were age, race, or substance use.

CONCLUSION

Tv is a common STD among HIV-infected women and does not appear to be associated with immune status or PI use. Aggressive screening might represent a means of reducing the incidence and prevalence of Tv.

Complexed PSA performance for prostate cancer detection in an African-American population

OBJECTIVES

Complexed prostate-specific antigen (cPSA) has been shown to improve the differentiation of benign and malignant disease compared with total PSA (tPSA) in studies evaluating predominantly white populations of men. We sought to evaluate the diagnostic performance of cPSA relative to tPSA in a population of African-American men.

METHODS

Consecutive African-American men scheduled for prostate biopsy were enrolled prospectively at the Louisiana State University Medical Center, New Orleans. Serum was collected before the biopsy procedure and tested with the Immuno 1 tPSA and cPSA methods. Receiver operating characteristic curve analysis was performed and the area under the curve was calculated for tPSA and cPSA.

RESULTS

A total of 156 patients were evaluated, 51 (32.7%) of whom were diagnosed with prostate cancer. The median PSA value for men with prostate cancer was 4.96 ng/mL and for those with benign disease was 3.93 ng/mL. The receiver operating characteristic analysis indicated that the area under the curve for cPSA (0.679) was statistically greater than that achieved for tPSA (0.642, P = 0.004). Using cutoff values for cPSA of 2.3 ng/mL and for tPSA of 2.85 ng/mL provided a specificity of 31.4% and 26.7%, respectively, at a sensitivity for prostate cancer detection of 95%. This was not statistically significant (P = 0.18).

CONCLUSIONS

cPSA offers modest improvement in prostate cancer detection compared with tPSA in African-American men, but not at the clinically relevant 95% sensitivity level. Additional work is needed to improve prostate cancer detection in this high-risk cohort of patients.

Initial and repeated screening for gonorrhea during pregnancy

BACKGROUND AND GOAL

Late pregnancy rescreening is advised for at-risk patients, but data supporting this recommendation are lacking. The intent of this study was to determine the value of a late-pregnancy test for gonorrhea after a negative initial test at the beginning of prenatal care.

STUDY DESIGN

A retrospective chart review of clinic records over a 29-month period identified patients with a positive DNA direct assay for gonorrhea either initially or at 34 weeks.

RESULTS

Of 751 women, 38 (5.1%) had gonorrhea diagnosed at their first testing; 19 women (2.5%) were positive only at their second screening. For one patient, both tests were positive.

CONCLUSION

Repeating screening for gonorrhea at 34 weeks in a high-prevalence population is warranted.

A mortality and morbidity study of refinery and petrochemical employees in Louisiana

AIMS

To examine the mortality experience of 4221 employees from 1973 to 1999 and the illness absence patterns for 2203 employees from 1990 to 1999 of a chemical and refinery facility in Louisiana.

METHODS

Mortality and illness absence data were extracted from the Shell Oil Company's health surveillance system (HSS). The standardised mortality ratio was used as a measure of mortality risk. Morbidity frequency and duration of absence were calculated by age, sex, and four health risk factors (cigarette smoking, high blood pressure, hypercholesterolaemia, and obesity).

RESULTS

Male employees experienced a significant deficit in mortality for all causes of death, all cancers, lung cancer, heart disease, and respiratory disease compared with the corresponding US population. Brain cancer was non-significantly increased, with six observed and five expected deaths; mortality from leukaemia was consistently lower than expected. The majority of employees had no illness absences of six days or longer during the 10 year study period. The loss of productivity (in terms of days of absence) was greater for employees with health risk factors. Ever smoking male employees had a 79% increase of heart disease and more than 50% higher rates of respiratory disease and musculoskeletal disorders compared to non-smokers. Smokers were absent 2.9 and 1.6 more days than non-smokers and ex-smokers, respectively.

CONCLUSIONS

Regardless of the comparison population, significantly fewer deaths were seen for all causes combined, all cancers, lung cancer, heart disease, or non-malignant respiratory disease. Illness absence rates and duration were higher among employees with health risk factors.

Prevalence of the Brugada electrocardiographic pattern at the Medical Center of Louisiana in New Orleans

Since 1992 the Brugada syndrome has gained recognition as a cause of ventricular fibrillation. The syndrome was originally described in patients with the diagnostic triad of (1) right bundle branch block, (2) an electrocardiogram (ECG) with persistent ST-segment elevation in leads V1, V2, and V3, and (3) sudden cardiac death. Two different types of ST-segment elevation, coved and saddleback, have been described. All patients originally described had structurally normal hearts. The definition of the Brugada electrocardiogram (originally right bundle branch block and ST-segment elevation in V1, V2, and V3 in characteristic coved or saddleback configuration) has been evolving since the initial description, and not all patients with the Brugada electrocardiogram have the Brugada syndrome. We designed a trial to determine the prevalence in our population at the Medical Center of Louisiana in New Orleans of the Brugada ECG as it was originally defined. ECGs performed in 1997 were examined for changes consistent with the Brugada electrocardiogram. Those ECGs with changes secondary to another identifiable cause were excluded. The amount and type of ST-segment elevation in leads V1, V2, and V3 were recorded for the remaining ECGs. From a total of 55,446 electrocardiograms performed on 27,328 patients, we were able to identify only 18 ECGs with the changes originally described by Brugada, and none of them meet current criteria. Our study suggests that in our patient population the ECG now considered typical of the Brugada syndrome is rare.

Prevalence and correlates of HIV serostatus disclosure

BACKGROUND AND OBJECTIVE

A study of HIV-positive individuals in New Orleans, Louisiana, found that the majority of patients disclosed to their main partners and family members, but less than one fourth disclosed to any casual sex partner. Older age and lower CD4 cell counts were associated with disclosure.

GOAL

The goal was to describe patterns of HIV serostatus disclosure among a diverse sample of patients at an HIV outpatient clinic in New Orleans, Louisiana.

STUDY DESIGN

A convenience sample of HIV-seropositive patients provided information about disclosure of seropositivity, demographics, date of HIV diagnosis, CD4 cell count, mode of HIV acquisition, and sexual activity since HIV diagnosis.

RESULTS

The 269 persons disclosed their HIV status to people in the following categories: main sex partner (74.2%), casual sex partner (24.8%), immediate family member (69.8%), other relative (27.0%), or friend (26.4%). Adolescents were less likely than adults to disclose to a main partner, immediate family member, or a friend. Immunosuppressed persons were more likely than nonimmunosuppressed persons to disclose to a main partner, immediate family member, or another relative.

CONCLUSION

Many HIV-infected individuals delay disclosure until their disease has progressed. Interventions such as partner notification and skill-building to facilitate appropriate HIV disclosure are needed.

Outcomes of coronary artery bypass grafting in patients with a history of illicit drug use

To date, no studies have been conducted on the effects of illicit drug use in patients with ischemic heart disease treated with coronary artery bypass grafting. Our retrospective study suggests that current illicit drug use is a significant predictor of cardiovascular complications in the first 6 months after coronary artery bypass grafting.

The value of screening for sexually transmitted diseases in an HIV clinic

Because bacterial sexually transmitted diseases (STDs) facilitate HIV transmission, screening for and treatment of STDs among HIV-infected persons should prevent HIV spread to partners. Before screening programs for gonorrhea and Chlamydia infection should be widely established in HIV clinics, it is useful to know the prevalence of these infections. This study analyzed the results of a urine-based screening program for gonorrhea and Chlamydia in a New Orleans HIV clinic and compared the positivity rates to the prevalence in the local community. Among persons screened in the HIV clinic, 1.7% (46/2629) had gonorrhea and 2.1% (56/2629) had Chlamydia infection. Among persons aged 18-29 years, the test positivity for gonorrhea was similar in the HIV clinic to that of persons in sociodemographically similar community samples (3.1 versus 2.4%, adjusted odds ratio 1.6, P = 0.11) and the test positivity for Chlamydia infection was lower (5.4% versus 10.5%, adjusted odds ratio 0.6, P < 0.01). Based on a previously published mathematical model, it was estimated that treatment of all 46 gonorrhea and 56 Chlamydia infections in the HIV clinic may have averted 9 HIV infections among sex partners and saved far more in future medical costs than the cost of the screening. Routine screening for gonorrhea and Chlamydia infection should be considered in HIV clinics.

The prevalence of female-to-male intimate partner violence in an urban emergency department

Female-to-male intimate partner violence (IPV) recently has become a recognized health care issue. We screened a heterosexual male Emergency Department population for IPV using the HITS scale, a four-question survey. Two hundred eighty-two men were enrolled in the study. Basic demographics, along with the answers to the HITS scale, were analyzed. Of the men screened, 29.3% had a positive history of IPV. Men who were positive for IPV were more likely to score higher on questions regarding the frequency of verbal aggression than actual or threatened physical violence. This study reinforces the need to screen both genders for IPV in the Emergency Department.

Surveillance for acute insecticide-related illness associated with mosquito-control efforts--nine states, 1999-2002

Ground and aerial applications of insecticides are used to control populations of adult mosquitoes, which spread such diseases as West Nile virus--related illness, eastern equine encephalitis, and dengue fever. This report summarizes investigations of illnesses associated with exposures to insecticides used during 1999-2002 to control mosquito populations in nine states (Arizona, California, Florida, Louisiana, Michigan, New York, Oregon, Texas, and Washington) (estimated 2000 population: 118 million). The findings indicate that application of certain insecticides posed a low risk for acute, temporary health effects among persons in areas that were sprayed and among workers handling and applying insecticides. To reduce the risk for negative health effects, public health authorities should 1) provide public notice of application times and locations and appropriate advice about preventing exposures, 2) ensure that insecticide handlers and applicators meet state-mandated training and experience requirements to prevent insecticide exposure to themselves and the public, and 3) implement integrated pest management control strategies that emphasize mosquito larval control, reduction of mosquito breeding sites, and judicious use of insecticides to control adult mosquito populations.

Eating patterns and obesity in children. The Bogalusa Heart Study

BACKGROUND

Childhood obesity is a growing public health problem. This study examined the association between eating patterns and overweight status in children who participated in the Bogalusa Heart Study.

METHODS

A single 24-hour dietary recall was collected on a cross-sectional sample of 1562 children aged 10 years (65% Euro-American [EA], 35% African American [AA]) over a 21-year period. Overweight was defined as body mass index greater than the 85th percentile using Centers for Disease Control and Prevention reference standards. Multivariate logistic regression was used to investigate the association between eating patterns and overweight.

RESULTS

Consumption of sweetened beverages (58% soft drinks, 20% fruit flavor drinks, 19% tea, and 3% coffee) (p<0.001); sweets (desserts, candy, and sweetened beverages) (p<0.001); meats (mixed meats, poultry, seafood, eggs, pork, and beef) (p<0.051); and total consumption of low-quality foods (p<0.01) were positively associated with overweight status. Total amount of food consumed, specifically from snacks, was positively associated with overweight status (p<0.05). There was a lack of congruency in the types of eating patterns associated with overweight status across four ethnic-gender groups. The percent variance explained from the eating pattern-overweight models was very small. The interaction of ethnicity and gender was significantly associated with overweight status (p<0.001). The odds of being overweight for EA males were 1.2 times higher than for AA females.

CONCLUSIONS

These results demonstrate that numerous eating patterns were associated with overweight status, yet the odds of being overweight were very small. Additional studies are needed to confirm these findings in a longitudinal sample having multiple days of assessment.