High rate of HIV seroconversion among patients attending urban sexually transmitted disease clinics.

OBJECTIVE: To study rates of documented HIV seroconversion and syphilis as a cofactor for seroconversion in sexually transmitted disease (STD) clinics. In the main clinic the HIV seroprevalence rate was 12% and most infections had been shown to be acquired by heterosexual contact. METHODS: We analyzed computer records of patients who had at least two HIV-antibody tests between 1 December 1987 and 31 December 1990, at STD clinics in Dade County (Miami), Florida. RESULTS: Of 5164 individuals with two HIV tests, 208 (4.0%) seroconverted. The overall seroconversion rate was 3.1 per 100 person-years. Among blacks, who accounted for 77% of seroconversions, the rate was higher for women (4.8) than for men (2.7). The highest rate was in 15-19-year-old black women (7.1 per 100 person-years). The HIV seroconversion rate was 12.8 for patients with primary or secondary syphilis diagnosed between two HIV tests, 3.1 for patients who acquired syphilis before their first HIV test, and 2.3 for patients who had never had syphilis. Eighteen per cent of all HIV seroconversions were attributable to syphilis acquired in the interval between two HIV tests. CONCLUSIONS: We found high HIV seroconversion rates, especially among black teenagers and black women, in an STD clinic population in which the majority of HIV infections were shown previously to have been acquired heterosexually. Syphilis was a marker for HIV seroconversion and syphilitic ulcers may facilitate HIV transmission. Innovative prevention programs directed towards women and adolescents should be developed and evaluated.

Premature mortality related to HIV infection in California 1981-1993.

The number of years of potential life lost (YPLL) before age 65 was used to compare the effects of HIV on premature mortality versus other causes of death in California from 1981 to 1993. Using California AIDS case surveillance data, YPLL associated with HIV rose from 629 in 1981 to 120,721 in 1989, and is projected to reach 188,000 in 1993 (plausible range, 155,000-285,000). In 1989, HIV ranked fourth in YPLL behind all malignant neoplasms, traffic-related motor vehicle accidents, and all heart diseases. By 1993, if current mortality trends continue, HIV is projected to be the leading single cause of YPLL in California ahead of all malignant neoplasms (184,597 in 1989), motor vehicle-related YPLL (163,038 in 1989), and all heart diseases.

Eradication of poliomyelitis: progress in the People's Republic of China.

China and the other countries of the Western Pacific Region have a goal of eradication of wild poliovirus by the end of 1995. In this report we examine the progress made toward eradication through the end of 1993. We examined the information about poliomyelitis and wild poliovirus based on the acute flaccid paralysis surveillance system. The number of reported poliomyelitis cases decreased from 4623 cases in 1989 and 5065 cases in 1990, which occurred during a large nationwide poliomyelitis epidemic, to 538 cases in 1993. Mass supplemental immunization sessions were conducted during the 1991 to 1992 and 1992 to 1993 winters. After the two rounds of supplemental immunizations in the 1992 to 1993 winter, wild poliovirus was not detected for the subsequent 21 months in 22 contiguous provinces in central and northern China, in which 980 million persons reside. In 1993 wild poliovirus was detected in only 5 provinces in southern China and in 2 provinces in the remote Western region; these provinces have only 14% of the total population in China. China is close to achieving its 1995 poliomyelitis elimination goal. Mass supplemental immunizations in children 0 to 3 years old can rapidly eliminate wild poliovirus from large, very densely populated areas, low income rural areas and remote mountainous areas. There appears to be no technical obstacle, even in the most difficult areas, to achieving global eradication of wild poliovirus by the year 2000.

Inventory and expressive measures of locus control and academic performance: a 5-year outcome study.

Inventory and expressive measures of locus of control were used in a effort to assess their long term potential for predicting academic performance. Thus 45 male graduate students from three diverse major areas and 45 male high ability undergraduates were initially administered Rotter locus of control and Autobiography locus of control scales. Academic data regarding grade point average and baccalaureal or doctoral degree attainment were gathered five years later. The hypotheses were supported to the extent that low to moderate significant correlations were found between the two locus of control scales and subsequent academic performance. The strongest relationships were found between locus of control and graduate degree attainment, with graduate student internals significantly more likely to earn the doctorate within 5-year period than externals. It was speculated that the externals might be a more persistent group, but the internals were more likely to either attain the degree within 5 years, or drop out. And within this study's restricted ability ranges, locus of control personality measures proved to be better predictors of degree attainment than conventional ability scales.

Sex differences on the Personal Orientation Inventory.

Differences on the Personal Orientation Inventory (POI) between 816 male and 408 female entering freshmen were examined. Females scored consistently and significantly more in the purported self-actualizing direction on the POI scales and subscales than males in this study. Special emphasis was placed upon the pattern of significant scale differences in an effort to derive the meaning of such male-female differences for these and other data. One interpretation is that females may be seeking a college education for more self-actualizing purposes than males. It is suggested that the consistency of such differences be further explored and that sex differences on the POI be considered in future studies of self-actualization.

The effect of known risk factors on the excess mortality of black adults in the United States.

We compared the mortality rate ratios, before and after adjustment for different risk factors, of black vs white adults in the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. For persons 35 to 54 years old, the rate ratio of mortality for blacks vs whites decreased from 2.3 (unadjusted) to 1.9 when adjusted simultaneously for six well-established risk factors (smoking, systolic blood pressure, cholesterol level, body-mass index, alcohol intake, and diabetes) and decreased from 1.9 to 1.4 when adjusted for the six risk factors plus family income. Thus, approximately 31% of the excess mortality can be accounted for by six well-established risk factors and a further 38% by family income. This leaves 31% unexplained. Broader social and health system changes and research targeted at the causes of the mortality gap, coupled with increased efforts aimed at modifiable risk factors, may all be needed for egalitarian goals in health to be realized.

Changes in sexually transmitted disease rates after HIV testing and posttest counseling, Miami, 1988 to 1989.

OBJECTIVES: The effects of posttest counseling on acquisition of sexually transmitted diseases in patients at a large urban sexually transmitted disease clinic were studied. METHODS: Comparisons were made of the percentage of patients who had a positive gonorrhea culture (or any sexually transmitted disease) in the 6 months before and after human immunodeficiency virus (HIV) counseling and testing. RESULTS: For 331 patients counseled about a positive HIV test, the percentage with gonorrhea was 6.3 before and 4.5 after posttest counseling (29% decrease). For 666 patients counseled about a negative test, the percentage with gonorrhea was 2.4 before and 5.0 after posttest counseling (106% increase). With any sexually transmitted disease as the outcome, patients who tested positive for HIV had a 12% decrease and patients who tested negative had a 103% increase after counseling. CONCLUSIONS: HIV counseling and testing was associated with a moderate decrease in sexually transmitted diseases among patients who tested positive for the virus, but risk increased for patients who tested negative. This suggests a need to improve posttest counseling in this clinic and to assess the effects of counseling and testing in other clinics.

Epidemic poliomyelitis in The Gambia following the control of poliomyelitis as an endemic disease. I. Descriptive findings.

An epidemic of type 1 poliomyelitis involving 305 cases occurred in The Gambia (estimated 1986 population, 768,995) from May through November 1986, following a 6-year period when only five cases were reported. Cases were identified by physician reporting during the epidemic and by a national village-to-village search conducted after the epidemic. The national attack rate was 40 cases per 100,000 people. Cases lived in all parts of the country except the capital, Banjul. The peak month of the epidemic was August (139 cases). The highest attack rate by year of age was in 1-year-old children (394 cases per 100,000 persons), and 75% of cases were 3 years of age or less. A vaccination coverage survey showed that 64% (95% confidence interval 60-68) of 1- to 2-year-old children were vaccinated with at least three doses of trivalent oral polio vaccine at the beginning of the epidemic. Fifty-seven cases became paralyzed more than 2 weeks after a national mass campaign in which 95% of children 1-7 years old were reported to have received a dose of trivalent oral polio vaccine. Experience in The Gambia shows that a several-year period of excellent control of endemic poliomyelitis by a vaccination program can be followed by a major epidemic and that a mass vaccination campaign may be only partially successful in ending the epidemic.

Surveillance for polio eradication in the People's Republic of China.

A case-based virus surveillance system for wild poliovirus in China was developed. By 1993, all 30 provincial immunization units and, by 1994, all 29 provincial laboratories were sending computerized data to the national level. In 1993, a county-level, computerized map was operationalized that permitted visual monitoring of the progress of the polio eradication program every month by county. In 1993, wild poliovirus type 1 was detected in 8 provinces. Wild poliovirus mainly caused clusters of polio cases identified by a surveillance system that detected primarily clinical polio in children <5 years old (1 stool sample was collected on approximately 50% of reported cases). By 1995, the surveillance system had reached certification-like levels (80% of acute flaccid paralysis [AFP] patients with 2 stool specimens and AFP case rate of 1/100,000 children <15 years old). No indigenous wild poliovirus was detected in 1995. This general case-based model can be applied to measles and other important diseases, and may then lead to a more rapid decrease in adverse health outcomes.

Epidemic poliomyelitis in The Gambia following the control of poliomyelitis as an endemic disease. II. Clinical efficacy of trivalent oral polio vaccine.

An epidemic of poliomyelitis caused by poliovirus type 1 occurred in The Gambia from May to November 1986. Descriptive findings and vaccination coverage levels are reported in part I. This article (part II) describes a case-control study to estimate the clinical efficacy of three or more doses of trivalent oral polio vaccine compared with zero doses. "Cases" were 1- to 7-year-old children paralyzed during the epidemic who were diagnosed as having poliomyelitis by designated referral physicians. They were identified by reports from referral physicians during the epidemic and by a nationwide village-to-village search after the epidemic. Up to five controls were randomly selected for each case from among children of the same age and sex living in neighboring households. In a matched analysis of 195 cases and 839 controls, the efficacy of three or more doses of trivalent oral polio vaccine was 72% (95% confidence interval 57-82) when children without vaccination cards were considered unvaccinated. The efficacy of three or more doses in 1- to 2-year-old children, in whom the determination of vaccination status was considered to be more accurate than in older children, was 81% (95% confidence interval 66-90). Vaccine failure was not associated with short intervals between doses. Higher levels of vaccination coverage and efficacy than those achieved in The Gambia may be needed in African countries to prevent the return of poliomyelitis as an epidemic disease after it has been controlled as an endemic disease.

Status of the eradication of indigenous wild poliomyelitis in the People's Republic of China.

A large nationwide outbreak occurred in 1989-1990 in China, in which nearly 10,000 poliomyelitis cases were reported. After two rounds of oral poliovirus vaccine (OPV) supplemental activity in nearly every province in the 1992-1993 winter season, no wild poliovirus was detected in 1993 in 22 provinces in the middle of China that contained 86% of the population. During the first national immunization days (NIDs) conducted in December 1993 and January 1994, 83 million children 0-47 months of age were immunized. In 1994, wild poliovirus was identified in only 6 of 2397 children with stool specimens tested. After a second NID in December 1994 and January 1995, no wild poliovirus was detected in 1995 despite a very high level of virus surveillance. In summary, double-round mass supplemental OPV immunizations in children 0-3 years old in two consecutive winters eliminated wild poliovirus from 23% of the world's population (1.2 billion people).