Addressing the public's concerns about human immunodeficiency virus transmission in health-care settings.

BACKGROUND: The 1990 report of a cluster of patients infected with the human immunodeficiency virus (HIV) associated with a Florida dentist with acquired immunodeficiency syndrome attracted considerable media coverage and legislative attention. A number of polls found that the public favored mandatory HIV-antibody testing of health-care workers. The Centers for Disease Control and Prevention, Atlanta, Ga, conducted a two-phase study to understand how public concerns regarding potential HIV transmission in health-care settings can be addressed by the medical and public health communities. METHODS: Sixteen focus group discussions in nine US cities were conducted to explore the public's perceptions, concerns, and behavioral responses regarding HIV transmission in health-care settings. Using this information, a questionnaire was developed and administered to a nationwide probability telephone sample of 1150 adults. RESULTS: Concern about contracting HIV in health-care settings was highest for emergency department treatment and lowest for treatment by a personal physician. Two factors directly related to patient care, ie, the health-care professional's willingness to discuss acquired immunodeficiency syndrome and the presence of acquired immunodeficiency syndrome educational materials in the waiting room, were considered useful factors for determining potential risk of transmission of HIV in a health-care setting. CONCLUSIONS: Public concern about the potential for HIV transmission in health-care settings remains high. Active steps on the part of health-care professionals, such as providing educational materials and initiating discussions about infection control procedures and about HIV and acquired immunodeficiency syndrome, could likely have positive effects in terms of alleviating these concerns.

Overweight adults in the United States: the behavioral risk factor surveys.

Using data on 19,405 adults from telephone interviews across the US, 1981-1983, we examined the sociodemographic characteristics, health-risk behaviors, body image, and dieting of overweight adults classified by the 1959 Metropolitan Life Insurance tables for weight and height. By self-report, 23% were overweight vs 29% in 1960-62. This modest decline in overweight remained after age-adjusting the 1981-1983 rate to the 1960 population. In 1981-1983, more blacks and Hispanics than whites were overweight [rate ratio (RR) = 1.43]. After adjustment for age and education, more over- than average-weight adults had uncontrolled hypertension, were binge drinking, and had a sedentary lifestyle. Among overweight men and women, 72% and 52%, respectively, were not dieting. Overweight adults acknowledging they were overweight were dieting more often than those without this perception (RR = 1.53). Results are discussed in light of research documenting weight gain and overweight as independent risk factors for cardiovascular disease incidence and mortality.

Using indices to differentiate dimensions of knowledge regarding modes of HIV transmission in the U.S. population, 1987-1989.

The number of HIV-infected individuals is increasing, making it important for the public to understand not only how HIV is transmitted but also the lack of transmission risk associated with casual contact. Using CDC's National Center for Health Statistics National Health Interview Survey, we divided modes of transmission items into two areas of knowledge: "True Transmission" and "False Transmission." Items were recoded with scores from 3 for the most correct response to 0 for the most incorrect response for each of three items related to true and each of eight items related to false transmission. Item and principal components factor analyses yielded two distinct dimensions (true factor loadings from 0.68 to 0.76, false factor loadings from 0.56 to 0.74). Mean scores of 8.3 (range 0-9) and 15.9 for 1987 (range 0-24) for true and false transmission indices, respectively, provide evidence that the population is highly knowledgeable about true modes of transmission but far less so about false modes. Knowledge levels have increased between 1987 and 1989, most meaningfully in the area of false transmission. Use of these indices will facilitate the monitoring over time of differential knowledge, attitudes, and beliefs related to HIV and AIDS.

A comparison of the effects of ipratropium bromide and metaproterenol sulfate in acute exacerbations of COPD.

Thirty-two patients presenting with acute exacerbations of chronic obstructive pulmonary disease were entered into the following double-blind, crossover study. First (time 0), patients inhaled either ipratropium bromide (54 micrograms) or metaproterenol sulfate (1.95 mg) via a metered dose inhaler (MDI) attached to a device (Inspirease) (phase 1). After 90 minutes, they inhaled whichever of the two medications they had not received in phase 1. This is referred to as phase 2. Pulmonary function (FEV1 and FVC) was measured at time 0, and at 30, 60, and 90 minutes following phase 1 treatment, and at 30, 60, and 90 minutes following phase 2 treatment (120, 150, and 180 minutes from the start of the study). Arterial blood gas samples (n = 20) were obtained at entry into the study and 30 and 90 minutes after phase 1 medication. The groups did not differ in age, degree of airway obstruction, hypoxemia, or theophylline usage at the start of the study. In phase 1, at 90 minutes, pulmonary function in both groups significantly and similarly improved. For ipratropium, FEV1 improved from 0.62 +/- 0.08 L to 0.88 +/- 0.11 L (p less than 0.01) and for metaproterenol FEV1 improved from 0.69 +/- 0.06 to 0.92 +/- 0.09 L (p less than 0.01). There was no further improvement with phase 2 treatment for either group. Thirty minutes after inhaling ipratropium, there was a small but significant rise in PO2 (5.8 +/- 3.0 mm Hg; p less than 0.05) while metaproterenol inhalation resulted in a 6.2 +/- 1.2 mm Hg decline in PO2 (p less than 0.05). These changes were not sustained at 90 minutes. We concluded that for acute exacerbations of COPD, both ipratropium and metaproterenol are effective medications when administered via an MDI attached to a device (Inspirease). However, ipratropium may be a safer choice as it initially did not cause a decline in blood oxygenation.

A simple, inexpensive apparatus for performance of preparative scale solution phase multiple parallel synthesis of drug analogs. II. Biological evaluation of a retrospective library of quinolone antiinfective agents.

A series of pure fluoroquinolone antiinfective agents was prepared by multiple parallel synthesis using a simple new apparatus. These compounds were evaluated biologically against Gram-positive and Gram-negative microorganisms and against a BCG strain transfected with luciferase in a fluorescence-based antitubercular assay. Activity against relatively fast growing, acid-fast Mycobacterium smegmatis was determined in part by agar-dilution streak assays. Data obtained against Escherichia coli-derived DNA gyrase does not correlate well with whole cell assays against E. coli. These compounds were assayed by a convenient glass-fiber filter binding method modified for high throughput screening. In these analogs, the results with a N-1 cyclopropyl substituent were often inferior to those obtained with a N-1 2',4'-difluorophenyl substituent. None of the new compounds prepared was superior in its antimycobacterial potency to ciprofloxacin or temafloxacin.

Effects of starvation and refeeding on adult male rat diaphragm contractility, fatigue, and fiber types.

The effects of 4.5 days of acute starvation, either alone or followed by refeeding (ad libitum), on diaphragm contractility, fatigue, and fiber types were studied in male rats. Contractility and fatigue resistance indexes were measured in an in vitro costal diaphragm strip preparation with direct stimulation at 37 degrees C. Compared with controls, starvation produced a 28 +/- 1% (P < 0.001) reduction in body weight and an 18 +/- 4% (P < 0.001) reduction in costal diaphragm weight. Twitch and tetanic tensions (normalized for weight or cross-sectional area) were not reduced by starvation. Starvation produced significant increases in fatigue resistance indexes after a 5-Hz stimulation paradigm but not after a 100-Hz paradigm, supporting the hypothesis that fatigue resistance is dependent on the energy demand of a given paradigm. The proportions of type I and type II fibers were similar between diaphragms of starved and control rats, but the cross-sectional area of type II fibers decreased significantly by 18 +/- 7% (P < 0.01). Thus, despite the significant decrease in diaphragm weight after starvation, contractility was preserved and fatigue resistance was increased (low-output paradigm). This is consistent with the decrease in type II fiber area. Refeeding restored all parameters so that there were no longer significant differences in body or diaphragm weight, contractility, fatigue, or fiber types.

Effect of long-term undernutrition on male and female rat diaphragm contractility, fatigue, and fiber types.

The effects of long-term undernutrition (10 wk) on diaphragm contractility, fatigue, and fiber type proportions were studied in male and female rats. Contractility and fatigue resistance indexes were measured in an in vitro diaphragm costal strip preparation by using direct stimulation at 37 degrees C. Undernutrition allowed for continued growth in males and females but with substantial reductions in weight gain. Relative to control rats of the same sex, final weights were significantly lower in undernourished males (74 +/- 3%) than females (90 +/- 5%), but weight gain was not significantly different between undernourished males (58 +/- 5%) and females (60 +/- 3%). Only in males did undernutrition significantly reduce costal diaphragm weight (to 77 +/- 5% of control). Diaphragm forces, normalized for cross-sectional area, were not significantly different from male or female control values. Fatigue resistance indexes (fatigue/baseline force) were increased at all stimulation frequencies in undernourished males but not in undernourished females. Costal diaphragm atrophy, involving types I and II fibers, occurred in undernourished males but not in undernourished females. In conclusion, despite long-term undernutrition reducing weight gain to similar levels in males and females (relative to control), there was excellent preservation of diaphragm weight, function, and structure in females but, although diaphragm atrophy occurred, there was preserved contractility and increased fatigue resistance in males.

Effects of short-term and long-term androgen treatment on the diaphragm in male and female rats.

The effects of short-term (2.5 wk) and long-term (10 wk) testosterone propionate (2.5 mg/day; 5 days/wk) treatment on diaphragm contractility, fatigue resistance, and fiber type proportions were studied in male and female rats. Contractility and fatigue resistance indexes were measured in an in vitro diaphragm costal strip preparation by direct stimulation at 37 degrees C. The fatigue paradigm consisted of 30 trains/min at 5 Hz (50% duty cycle) for 10 min. Fatigue resistance indexes were calculated as postfatigue divided by baseline forces. In females but not males, testosterone treatment produced significant increases in body weight, costal diaphragm weight, and contractility and significant decreases in fatigue resistance indexes. The interaction between testosterone treatment and the duration of treatment was significant, with the increase in contractility (females) being significant after short-term but not long-term treatment. No significant difference in fiber type proportions or areas was observed, regardless of treatment duration or the preexperimental, basal circulating level of androgen.

Gender-specific effects of dexamethasone treatment on rat diaphragm structure and function.

The effects of long-term dexamethasone treatment on diaphragm muscle were studied in female and male rats. Compared with pair-fed control animals, dexamethasone treatment did not significantly affect estrous cycling or peak serum estradiol levels; however, testosterone levels were significantly increased in females and decreased in males. Dexamethasone significantly reduced body and costal diaphragm weights, but to a lesser extent in females than in males. Reductions in diaphragm weight were proportional to reductions in body weight. In females and males, dexamethasone treatment significantly decreased diaphragm fiber (types I and II) cross-sectional area and the relative expression of myosin heavy chain isoform 2B. With the exception of type I fiber atrophy, these changes occurred to a lesser extent in females. Dexamethasone did not significantly affect specific forces. Dexamethasone significantly increased twitch one-half relaxation time and fatigue resistance indexes in males but not in females. In conclusion, the effects of long-term dexamethasone treatment were gender specific, with significantly fewer effects in females, and changes in serum testosterone levels were associated with these findings.

Effects of long-term continuous respiratory resistive loading on rat diaphragm function and structure.

The effects of long-term (24- to 28-wk) continuous respiratory resistive loading on diaphragm mass, contractility, fatigue, and fiber types were studied in male rats. Increased respiratory resistance was produced by extratracheal banding, and results were compared with sham-operated pair-fed controls. At the time the animals were killed, banded tracheal segment internal diameter was reduced by 57% of control values. Diaphragm surface area and muscle mass (normalized for body mass) increased by 19% of control values. Isometric diaphragm contractility and fatigue resistance indexes were measured using an in vitro diaphragm costal strip preparation at 37 degrees C. Twitch and tetanic stimulations were evoked using direct stimulation. Compared with controls, baseline tensions (normalized for diaphragm cross-sectional area) were significantly decreased at low frequencies. Fatigue resistance (endurance) indexes were significantly increased at all frequencies. These findings were consistent with observed increases in number and cross-sectional area of type I (low-tension high-endurance) fibers. We conclude that the diaphragm adapts to chronic long-term resistive loads by sacrificing peak tensions for an increase in endurance capacity.

The Behavioral Risk Factor Surveys: IV. The descriptive epidemiology of exercise.

Telephone interview data from aggregated state surveys showed that about 21 percent of the U.S. adult population expends greater than or equal to 3 kcal/kg-day in vigorous leisure-time exercise. Three kilocalories per kilogram-day is equivalent to the amount commonly recommended to maximally reduce the incidence of coronary heart disease. Approximately 36 percent of the U.S. population reported no vigorous leisure-time exercise. Men, younger persons, and the more highly educated were most likely to expend greater than or equal to 3 kcal/kg-day, but for no subgroup did the rate exceed 30 percent. People who did not smoke, were not obese, and who did wear seat belts are also more likely to expend energy in vigorous leisure-time exercise. The prevalence of alcohol misuse is similar for all exercise categories. The proportion of people who expend greater than or equal to 3 kcal/kg-day is unrelated to self-reported occupational physical effort. Given the established and presumed benefits of physical activity, a substantial portion of the U.S. population would probably benefit from regular, vigorous, leisure-time exercise.

Screening mammography for women 50 years of age and older: practices and trends, 1987.

Recently, public and private efforts have been mounted to promote screening mammography. To assess recent trends in the percentage of women 50 years of age and older who have had a screening mammogram, we analyzed data from interviews from women from 33 states who participated in the 1987 Behavioral Risk Factor Surveillance System. Our study group included 8,402 women 50 years of age and older who had visited a physician for a routine checkup in the last year; among these 8,402 women, only 29% reported having had a screening mammogram in the past year. However, of the women in the study group, the percentage who had a screening mammogram in the last year showed a relative increase of 38% during 1987, from 24% for women interviewed in the first quarter of 1987 to 33% for women interviewed in the fourth quarter. However, not all groups of patients benefited equally from the observed trend--the absolute and relative increases in the percentage of women screened were lowest for women who were older, less educated, in low-income groups, and who had poor personal health practices. Although the percentage of women 50 years of age and older who reported being screened increased dramatically during 1987, special efforts are needed to reach the patient groups that are being left behind in the trend toward increased use of screening mammograms.

The behavioral risk factor surveys: I. State-specific prevalence estimates of behavioral risk factors.

The prevalence of most behavioral risk factors varies substantially among states. The prevalence of current cigarette smoking ranges from 22 percent to 38 percent. Estimates of alcohol use show geographic clustering, with lower rates in the southeastern states. The prevalence of sedentary lifestyle, uncontrolled hypertension, overweight, and seatbelt use differs markedly among states. These findings represent an initial step toward the analysis of state-specific baseline risk-factor data for use in developing state programs aimed at reducing the leading causes of death in the United States.

The behavioral risk factor surveys: III. Chronic heavy alcohol use in the United States.

Results of adult telephone interview data from aggregated state surveys show significant chronic alcohol use (two or more drinks per day) by 8.7 percent of the U.S. population. Rates are higher in men than in women (13.8 percent versus 4.0 percent, and higher in whites than in blacks (9.1 percent versus 4.5 percent). Women 25-44 years of age have significantly lower rates (2.9 percent) than women 18-24 (5.7 percent) or women 45-64 (4.6 percent). Also, rates are higher in heavy smokers (over one pack per day) than nonsmokers (22.4 percent versus 5.9 percent), among nonusers of seatbelts than users of seatbelts (10.5 percent versus 6.2 percent), and in those who reported driving after having had "too much" to drink than in those who did not (32.3 percent versus 7.5 percent). Overweight women (2.7 percent) and those who eat in response to stress (3.1 percent) have lower rates of chronic heavy alcohol use than those without these risk factors. Alcohol-related morbidity contributes substantially to the loss of productive life. We conclude that examining alcohol consumption in the light of other lifestyle behaviors would help in the design of effective prevention programs based on multiple risk factor interventions.

The behavioral risk factor surveys: II. Design, methods, and estimates from combined state data.

Behavioral risk factor (BRF) telephone surveys were conducted by 28 states and the District of Columbia from April 1981 through October 1983 to obtain baseline prevalence estimates for risk factors associated with the leading causes of death among adults. A supplemental survey was conducted to cover the remaining states (except Hawaii) in order to provide individual states with national-level data for comparison purposes. The complex sampling designs and variable sampling rates among state surveys required the computation of sample weights before estimates on a national level could be made. Estimates from the combined individual surveys are similar to those obtained from more expensive in-person interviews. The BRF national prevalence estimate of chronic heavier drinking is 8.7 percent, equivalent to the 1979 National Institute on Alcoholism and Alcohol Abuse (NIAAA) estimate of 9 percent. The BRF estimate of 31.5 percent for current smokers compares closely with the 32.6 percent estimated by the 1980 Health Interview Survey. Despite recognized technical limitations, this type of telephone survey can be a practical and affordable source of information both for initially gathering prevalence data and for monitoring trends in the prevalence of behavioral risk factors of public health concern.

Monitoring the exposure of "America Responds to AIDS" PSA campaign.

The "America Responds to AIDS" campaign is the focal point of an integrated mass communications system for AIDS education and information dissemination developed by the National AIDS Information and Education Program of the Centers for Disease Control. Television and radio public service announcements are an integral part of the campaign. One measure of their success is the extent to which they are aired on both national and local levels. Since 1987, the total dollar value for air time donated to the "America Responds to AIDS" campaign is more than $65 million, representing 47 percent of all donations of air time for AIDS public service announcements. These results suggest that the campaign has been successful in reaching a large proportion of the public.

Design, characteristics, and usefulness of state-based behavioral risk factor surveillance: 1981-87.

Since 1981, the Centers for Disease Control has collaborated with State health departments and the District of Columbia to conduct random digit-dialed telephone surveys of adults concerning their health practices and behaviors. This State-based surveillance system, which yields data needed in planning, initiating, and supporting health promotion and disease prevention programs, is described in this paper. Standard methods and questionnaires were used to assess the prevalence of personal health practices and behaviors related to the leading causes of death, including seatbelt use, high blood pressure control, physical activity, weight control, cigarette smoking, alcohol use, drinking and driving, and preventive health practices. Between 1981 and 1983, 29 States (includes the District of Columbia) conducted one-time telephone surveys. Beginning in 1984, most States began collecting data continuously throughout the year, completing approximately 100 interviews per month (range 50-250), with an average of 1,200 completed interviews per year (range 600-3,000). The raw data were weighted to the age, race, and sex distribution for each State from the 1980 census data. This weighting accounts for the underrepresentation of men, whites, and younger persons (18-24 years) in the telephone surveys and, for many health practices, provides prevalence estimates comparable with estimates obtained from household surveys. Nearly all (86 percent) of the States distributed selected survey results to other State agencies, local health departments, voluntary organizations, hospitals, universities, State legislators, and the press. The majority (60 percent) of States used information from the surveys to set State health objectives, prepare State health planning documents, and plan a variety of programs concerning antismoking, the prevention of chronic diseases, and health promotion. Further, nearly two-thirds (65 percent) used results to support legislation, primarily related to the use of tobacco and seatbelts. Most of the States (84 percent) reported that alternative sources for such data (prevalence of behavioral risk factors) were unavailable. Currently in 1988, over 40 State health departments are conducting telephone surveys as part of the Behavioral Risk Factor Surveillance System. This system has proved to be (a) flexible--it provides data on emerging public health problems, such as smokeless tobacco use and AIDS, (b) timely--it provides results within a few months after the data are collected, and (c) affordable--it operates at a fraction of the cost of comparable statewide in-person surveys. The system enables State public health agencies to continue to plan,initiate, and guide statewide health promotion and disease prevention programs and monitor their progress over time.

Drinking-driving and health lifestyle in the United States: Behavioral Risk Factors Surveys.

National patterns of self-reported drinking-driving were examined using aggregated Behavioral Risk Factor Survey data. Drinking-driving is reported by 6.1% of U.S. adults, is almost three times more prevalent among men than women and is most prevalent in 18-24-year-old men (15.4%). Sociodemographic characteristics of self-reported drinking drivers correspond with those characteristics based on alcohol-associated motor vehicle accident and arrest data. Heavy smokers and those who fail to use seatbelts are more likely to drink and drive than those without these health-risk behaviors. Men reporting stress in interpersonal relationships are more likely to drink and drive. Individuals who drink or smoke in response to stress are more likely to drink and drive than those who exercise in response to stress. The concurrent practice of drinking-driving with lack of seatbelt use, use of alcohol in response to stress and smoking probably contributes substantially to the risk of accident and serious injury among drinking drivers and has implications for both prevention and treatment programs.

Alcohol use and health behavior lifestyles among U.S. women: the behavioral risk factor surveys.

Alcohol use is a complex behavior, occurring in the context of an overall health lifestyle. We used data from a nationally representative telephone survey (N = 12,467 women) to examine associations between binge drinking, chronic drinking, and other health behaviors. Certain health-risk behaviors (e.g., smoking, drunk driving, and seatbelt nonuse) tend to cluster with alcohol misuse. These may act synergistically, thus augmenting the negative health effects of alcohol misuse. Conversely, some health behaviors (e.g., eating or exercising, particularly in response to stress) are negatively associated with alcohol misuse and may serve similar functions for some women. Finally, binge drinking occurs more frequently among women who may have relatively restrictive eating behaviors and higher levels of interpersonal stress. Our findings suggest that alcohol prevention and treatment programs should address sociodemographic and health lifestyle factors that initially predispose an individual to engage in health-risk behaviors and should recognize the interdependent patterns of behaviors associated with alcohol misuse. This approach will help prevent substitutions, recurrence, or induction of detrimental behaviors and will identify potentially negative interactions between existing concurrent health-risk behaviors.

Selecting a systematic approach for educating hospitalized cancer patients.

Establishing cancer patient education programs for hospitalized cancer patients may follow a six-stage process that includes planning and strategy selection, selecting channels and materials, developing materials and pretesting, implementation, assessing effectiveness, and obtaining feedback to refine the program. The extent to which each of the stages is followed depends upon which stages are appropriate for the program and the consensus of hospital management.