Trends in United States ovarian cancer mortality, 1979-1995

The authors have compared the results of scalp reductions with extenders with their earlier results of scalp reductions without extenders. The extenders seem to prevent "stretch-back" and provide 30 to 86% more effectiveness when a second reduction is performed 4 weeks later.     

Abortion patients in 1994-1995: characteristics and contraceptive use

Results of a 1994-1995 national survey of 9,985 abortion patients reveal that women who live with a partner outside marriage or have no religious identification are 3.5-4.0 times as likely as women in the general population to have an abortion. Nonwhites, women aged 18-24, Hispanics, separated and never-married women, and those who have an annual income of less than +15,000 or who are enrolled in Medicaid are 1.6-2.2 times as likely to do so; residents of metropolitan counties have a slightly elevated likelihood of abortion. When age is controlled, women who have had a live birth are more likely to have an abortion than are those who have never had children. Catholics are as likely as women in the general population to have an abortion, while Protestants are only 69% as likely and Evangelical or born-again Christians are only 39% as likely. Since 1987, the proportion of abortions obtained by Hispanic women and the abortion rate among Hispanics relative to that for other ethnic groups have increased. The proportion of abortion patients who had been using a contraceptive during the month they became pregnant rose from 51% in 1987 to 58%. Nonuse is most common among women with low education and income, blacks, Hispanics, unemployed women and those who want more children. The proportion of abortion patients whose pregnancy is attributable to condom failure has increased from 15% to 32%, while the proportions reporting the failure of other barrier methods and spermicides have decreased.     

Trends in ecstasy use in the United States from 1995 to 2001: Comparison with marijuana users and association with other drug use.

This study aims to estimate changes in the prevalence of ecstasy use over time, analyze the overlap of ecstasy use and other drug use, and compare other drug use in ecstasy versus marijuana users. The authors hypothesized that ecstasy users early in the "epidemic" would be polydrug users and that associations between ecstasy and other drug use would diminish as the prevalence of ecstasy use increased. Data were drawn from public use data files from the 1995, 1997, 1999, and 2001 National Household Survey on Drug Abuse. Ecstasy use increased in the U.S. population and the prevalence was greater in younger age groups. Ecstasy users were likely to use a variety of other drugs; however, association of ecstasy use with other drug use was strongest early in the "epidemic," diminishing as the number of new users increased. Later, more drug-naive adolescents and young adults began experimenting with ecstasy. These results can orient prevention strategies that target ecstasy users. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Abortion incidence and services in the United States, 1995-1996

CONTEXT: In the 1980s, the number of abortion providers in the United States began to decline, and more recently, so has the number of abortions performed. Whether the decline in service providers, which was last documented in 1992, is continuing and whether this influences the availability and number of abortions is of public interest. METHODS: In 1997, the Alan Guttmacher Institute conducted its 12th survey of all known abortion providers in the United States. The number and location of abortion providers and abortions were tabulated for 1995 and 1996, and trends were calculated by comparing these data with those from earlier surveys. Limited data were also gathered on types of abortion procedures. RESULTS: Between 1992 and 1996, the number of abortions fell from 1,529,000 to 1,366,000, and the abortion rate decreased from 26 to 23 per 1,000 women aged 15-44. The number of providers fell 14%, to 2,042, with the greatest decline among hospitals and physicians' offices rather than clinics. Eighty-six percent of counties had no known abortion provider, and 32% of women aged 15-44 lived in these counties. Of the country's 320 metropolitan areas, 89 had no known abortion provider, and for an additional 12, fewer than 50 abortions each were reported. Seventy percent of abortions were performed in specialized clinics and only 7% in hospitals. In the first half of 1997, early medical abortions were being offered in about 160 facilities, virtually all of which were also providers of surgical abortions. CONCLUSIONS: While abortion services in some areas of the country have declined since 1992 and many women continue to have limited access to providers, other factors have probably had more influence on the level of abortions performed. Early medical abortion methods are too new to be a measurable factor in abortion access.     

Sexually transmitted diseases: United States, 1995

Over the past two decades, the United States has experienced some dramatic changes in the rates of three "classic" sexually transmitted diseases (STDs) as well as the introduction of a variety of newer and more complex STD organisms. Rates of primary and secondary syphilis increased through the mid-1980s to a record high of 20.3 cases per 100,000 population in 1990. Since then, rates have dropped 69 percent to 6.3, the lowest rate in 35 years. Gonorrhea rates increased steadily between 1950 and 1975, plateaued between 1975 and 1978, before beginning a gradual but quite steady decline. In 1995 the rate of gonorrhea reached a 30-year low of 149.5 per 100,000. Rates of chlamydial infections, however, have increased more than 55 since 1984 as screening programs proliferated and reporting improved. These infections are commonly found in sexually active adolescents and young adults, and for every case detected in men, there are approximately six detected in women. Rates of syphilis (primary and secondary) and gonorrhea are concentrated primarily in southern states, while chlamydial infections appear to be more widespread geographically. Despite the availability of diagnostic tests and effective treatment regimens for many infectious diseases, STDs continue to target certain populations. They disproportionately affect the poor, inner-city residents and minority groups. The consequences of the diseases are many and varied, and risk of sterility, ectopic pregnancy, fetal death and/or blindness are markedly increased among women with STDs. In addition, risk of HIV infection appears to be increased among persons with a history of having an STD.     

Trends in infectious disease hospitalizations in the United States, 1980-1994

BACKGROUND: A recent study concluded that between 1980 and 1992, deaths from infectious diseases increased 58%. This article explores trends in infectious diseases as a cause of hospitalization. METHODS: We analyzed data from the National Hospitalization Discharge Survey for 1980 through 1994 using a previously developed approach to evaluate infectious diseases in data coded according to the International Classification of Diseases, Ninth Revision. RESULTS: Between 1980 and 1994, the rate of hospitalizations in the United States declined approximately 33%; hospitalizations occurred at a rate of 133+/-5 per 1000 US population (35 million+/-1 million discharges) in 1994. The rate of hospitalization for infectious diseases declined less steeply--12% during this interval--resulting in an increased proportion of hospitalizations because of infectious diseases. In 1994, the rate of hospitalizations for infectious diseases was 15.4+/-0.7 per 1000 US population (4.0 million+/-0.2 million discharges). The fatality rate associated with hospitalizations for infectious diseases increased from 1.9%+/-0.1% to 4.0%+/-0.3%, attributable to increased hospitalizations of elderly persons and an increased fatality rate among those younger than 65 years. Among selected categories, hospitalizations for human immunodeficiency virus infections and acquired immunodeficiency syndrome, prosthetic device infections, sepsis, and mycosis increased substantially, and hospitalizations for upper respiratory tract infections, pelvic inflammatory disease, and oral infections declined sharply. Hospitalizations for lower respiratory tract infections constituted 37% of all infectious disease hospitalizations in 1994. CONCLUSIONS: Considering hospitalizations as a dimension of the burden of infectious diseases involves an array of factors: secular trends in hospitalization, changing case management practices, demographic changes, and trends in the variety of infectious diseases themselves. Increases in the proportions of hospitalizations because of infectious diseases during years when hospitalizations for all causes were decreasing reflect an increasing burden of infectious diseases in the United States between 1989 and the mid-1990s.     

One-year experience with subdermal contraceptive implants in the United States

Women who received Norplant contraceptive implants from any of fifteen clinical settings in southeast Texas, U.S.A., were followed for one year to determine their reactions to the method. Of 1,385 who enrolled to receive Norplant implants, 1,253 had implants inserted. Side effects were reported by 78% of those receiving implants and 70% described changes in bleeding patterns. Spotting or irregular bleeding, weight gain and headaches were the conditions reported most frequently. Nine pregnancies were reported during the study period. Six of these, however, existed before the implants were inserted. At the one year anniversary, 143 of women receiving implants had had them removed. Those who discontinued method use were less satisfied, reported more side effects and were more likely to have planned to have another child, thus using the method for spacing, or to have had a change in their marital status while they were using the contraceptive. Providers should counsel patients to focus attention on plans for the future in selecting their contraceptive method. In addition, we recommend, as does the product's distributor, that providers confirm that patients are not pregnant prior to inserting implants.     

Respiratory diphtheria in the United States, 1980 through 1995

OBJECTIVES: The purpose of this study was to describe the epidemiologic, laboratory, and clinical features of respiratory diphtheria cases reported in the United States during 1980 through 1995. METHODS: Respiratory diphtheria cases reported to the Centers for Disease Control and Prevention were reviewed. Cases were defined as physician-diagnosed cases with signs and symptoms compatible with respiratory diphtheria, including the presence of a pseudomembrane without other apparent cause. RESULTS: From 1980 through 1994, 41 respiratory diphtheria cases were reported; none were reported in 1995, and no secondary cases were identified. Nine (22%) case patients were 4 years of age or younger, and 28 (68%) were 15 years of age or older. None of the case patients were up to date with diphtheria vaccination; 4 unvaccinated children died. Seventeen (43%) of 40 case patients had positive culture results. CONCLUSIONS: Available surveillance data suggest that respiratory diphtheria has become a rare disease in the United States. However, importation and circulation of toxigenic strains continue to present a threat and require achieving and maintaining high coverage with diphtheria toxoid-containing vaccines in both children and adults.     

Patterns of psychological test usage in the United States: 1935–1982.

Presents findings from a survey mailed to 10% samples of psychologists in psychiatric hospitals, community mental health centers and community clinics, schools for the mentally impaired, counseling centers, and VA hospitals that assessed the frequency of psychological test usage. The survey sought to update findings from a similar survey conducted in 1969 by B. Lubin et al (1971). Results show that among the most often used projective measures were the Rorschach, TAT, Sentence Completion Test, and Draw-a-Person Test. The MMPI was the most popular objective measure, while the WAIS, WISC, and PPVT were the most frequently used measures of intelligence and conceptual ability. Factors affecting test usage are discussed. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trends in rates of occupational fatal injuries in the United States (1983-92)

Recent advancements in laparoscopic surgery have made laparoscopic splenectomy possible. We retrospectively compared the outcomes of laparoscopic versus open splenectomy in patients with idiopathic thrombocytopenic purpura (ITP) or beta-thalassemia. From July 1993 to July 1997, 52 patients (ITP, 43 cases; beta-thalassemia, 9 cases) underwent either laparoscopic (30 patients, 9 men, 21 women; average age, 36.9 years) or conventional open splenectomy (22 patients, 5 men, 17 women; average age, 34.3 years). The two groups were similar in terms of sex, age, diagnosis, duration of disease, preoperative platelet count, and spleen size. The mean surgical time, estimated amount of blood loss, duration of postoperative recovery, analgesic usage, and complications were compared between the two groups. Laparoscopic splenectomy was successful in 29 (97%) of the 30 patients. The mean surgical time in the laparoscopy group was longer than in the open splenectomy group (190.6 vs 113.9 minutes, p < 0.01). The laparoscopy group had earlier postoperative oral intake (15.2 vs 52.6 hours, p < 0.01), less usage of analgesics (meperidine 50 mg/unit, 1.1 vs 2.8 units, p < 0.01) and a shorter postoperative hospital stay (4.1 vs 6.8 days, p < 0.01). The estimated blood loss, incidence of accessory spleen, surgical complication rate, and recurrence rate of thrombocytopenia were similar in the two groups. Our findings show that laparoscopic splenectomy in patients with ITP or beta-thalassemia is as safe as the open approach. While laparoscopy required a longer surgical time, the recovery period was shorter, analgesic use was less, and physical discomfort was less severe.     

Cesarean delivery rates in 1995 continue to decline in the United States

The anaesthesia management of a 10-year old girl with a fracture to her distal arm is presented, using inhalational anaesthesia with a laryngeal mask and a supplementary axillary plexus block. Due to light anaesthesia the patient vomited during the course of surgery resulting in a severe pulmonary aspiration necessitating four days of mechanical ventilation in the ICU. The safety of the laryngeal mask airway for emergency surgery is discussed.     

Bacterial meningitis in the United States in 1995. Active Surveillance Team

BACKGROUND: Before the introduction of the conjugate vaccines, Haemophilus influenzae type b was the major cause of bacterial meningitis in the United States, and meningitis was primarily a disease of infants and young children. We describe the epidemiologic features of bacterial meningitis five years after the H. influenzae type b conjugate vaccines were licensed for routine immunization of infants. METHODS: Data were collected from active, population-based surveillance for culture-confirmed meningitis and other invasive bacterial disease during 1995 in laboratories serving all the acute care hospitals in 22 counties of four states (total population, more than 10 million). The rates were compared with those for 1986 obtained by similar surveillance. RESULTS: On the basis of 248 cases of bacterial meningitis in the surveillance areas, the rates of meningitis (per 100,000) for the major pathogens in 1995 were Streptococcus pneumoniae, 1.1; Neisseria meningitidis, 0.6; group B streptococcus, 0.3; Listeria monocytogenes, 0.2; and H. influenzae, 0.2. Group B streptococcus was the predominant pathogen among newborns, N. meningitidis among children 2 to 18 years old, and S. pneumoniae among adults. Pneumococcal meningitis had the highest case fatality rate (21 percent) and in 36 percent of cases was caused by organisms that were not susceptible to penicillin. From these data, we estimate that 5755 cases of bacterial meningitis were caused by these five pathogens in the United States in 1995, as compared with 12,920 cases in 1986, a reduction of 55 percent. The median age of persons with bacterial meningitis increased greatly, from 15 months in 1986 to 25 years in 1995, largely as a result of a 94 percent reduction in the number of cases of H. influenzae meningitis. CONCLUSIONS: Because of the vaccine-related decline in meningitis due to H. influenzae type b, bacterial meningitis in the United States is now a disease predominantly of adults rather than of infants and young children.     

Modeled Areal Evaporation Trends over the Conterminous United States

Long-term (1961–1990) areal evapotranspiration (AE) has been modeled with the help of 210 stations of the Solar and Meteorological Surface Observation Network within the conterminous United States. Modeled AE, averaged over all stations, has shown an overall increase of about 2–3% in the period 1961–1990, both on an annual basis and over the warm season (May–September). The rate of increase has differed among three geographic regions: the eastern, central, and western United States, with the largest modeled increase found in the east, followed by the central part of the United States. In the western part of the continent, modeled AE has, in fact, stayed constant. Of these trends, only the ones over the eastern part of the conterminous United States are statistically significant.     

Clusters of marijuana use in the United States

In this study, the authors test for and estimate the clustering of marijuana use within United States neighborhoods, making use of data from annual nationally representative household sample surveys conducted during the period 1990-1995. A recently developed statistical method, alternating logistic regression, was used to quantify the clustering of marijuana users in neighborhoods. The resulting estimates of pairwise odds ratios ranged from 1.3 (95% confidence interval 1.22-1.42) for the lifetime history of marijuana use to 2.0 (95% confidence interval 1.6-2.6) for recent sharing of marijuana from one person to another. Exploratory analysis showed a slight decrease of clustering effects after adjustment for individual-level covariates: age, sex, race, education, annual family income, and history of tobacco use. Nevertheless, the main factors that account for clustering remain to be determined. Alternating logistic regression provided useful estimates of marijuana use clustering and can be used to estimate clustering of the other drug-related behavior, including sharing of needle injection equipment and other human immunodeficiency virus risk behaviors. As a form of multilevel analysis, the alternating logistic regression can accommodate shared, community-level characteristics that might influence drug taking (e.g., collective efficacy), as well as individual-level covariates, such as age and sex.     

Trends in HIV incidence among young adults in the United States

CONTEXT: Behaviors that result in potential exposure to human immunodeficiency virus (HIV) usually begin in adolescence or young adulthood, but trends in HIV incidence in young people remain unclear. OBJECTIVE: To estimate trends in HIV incidence in teenagers and young adults. DESIGN AND SETTING: Back-calculation of past HIV incidence in persons born between 1960 and 1974 using US national acquired immunodeficiency syndrome (AIDS) incidence data and estimates of the distribution of times between HIV infection and AIDS. MAIN OUTCOME MEASURES: Incidence and prevalence of HIV in 1988 and 1993 in persons aged 20 and 25 years, respectively, in each of those years. RESULTS: As of January 1993, about 22000 men and 11000 women aged 18 to 22 years were living with HIV infection in the United States. Homosexual contact was the leading route of infection among young men. Heterosexual contact was the leading route of infection among young women. The HIV incidence attributed to homosexual contact or injection drug use decreased among persons aged 20 and 25 years between 1988 and 1993, but HIV incidence attributed to heterosexual contact was stable or increasing. Notably, in men aged 20 and 25 years, HIV prevalence declined by about 50% in white men but was relatively stable in black and Hispanic men. In contrast, HIV prevalence in women aged 20 and 25 years rose by 36% and 45%, respectively, because of increasing heterosexual transmission. Overall, HIV prevalence in persons aged 20 and 25 years declined by only 14% between 1988 and 1993. CONCLUSIONS: In young persons, HIV incidence in homosexual men and injection drug users was slowing by 1993; this favorable trend was offset by increasing heterosexual transmission, especially in minorities.