ABSTRACT
For people living with HIV, lack of adherence to antiretroviral therapy (ART) is a serious problem and frequently results in HIV disease progression. Reasons for non-adherence include concomitant psychosocial health conditions - also known as syndemic conditions - such symptoms of depression or posttraumatic stress disorder (PTSD), past physical or sexual abuse, intimate partner violence (IPV), stimulant use, and binge drinking. The aim of this study was to investigate the association between syndemic conditions and medication adherence. The sample included 281 older men living with HIV who have sex with men (MSM). The study period was December 2012-July 2016. We observed the following syndemic conditions significantly decreased medication adherence: symptoms of depression (p = .008), PTSD (p = .002), and stimulant use (p < .0001). Past physical or sexual abuse, IPV, and binge drinking were not significantly associated with decreased medication adherence. The findings suggest that syndemic conditions may impact medication adherence in older MSM living with HIV.
Subject(s)
Anti-HIV Agents/therapeutic use , Depression/psychology , HIV Infections/drug therapy , Homosexuality, Male/statistics & numerical data , Medication Adherence/statistics & numerical data , Sexual Behavior/psychology , Substance-Related Disorders/psychology , Aged , Cross-Sectional Studies , Depression/epidemiology , HIV Infections/psychology , Homosexuality, Male/psychology , Humans , Male , Medication Adherence/psychology , Middle Aged , Sexual and Gender Minorities , Substance-Related Disorders/epidemiology , Syndemic , Unsafe SexABSTRACT
OBJECTIVE: To assess risk factors for macrosomic infant birth among Latina women. STUDY DESIGN: Prospective study of Latina women recruited during pregnancy from prenatal clinic at San Francisco General Hospital. Information was obtained through a structured interview and review of medical records. RESULT: A total of 11% of women delivered macrosomic infants (birth weight >4000 g). In unadjusted analyses, significant risk factors for macrosomia included older maternal age, increasing gravidity, previous history of macrosomic birth and pre-pregnancy overweight. After adjusting for confounders using multivariate analyses, older mothers (10-year increments) had an elevated risk of macrosomia (odds ratio (OR) 2.59; 95% confidence interval (CI) 1.28 to 5.24). CONCLUSION: Efforts to reduce macrosomia in Latina women should focus on older mothers.
Subject(s)
Fetal Macrosomia , Maternal Age , Adult , Female , Hispanic or Latino , Hospitals, Public , Humans , Odds Ratio , Overweight , Parity , Pregnancy , Prospective Studies , Risk Factors , Young AdultABSTRACT
Evidence regarding the effect of tuberculosis (TB) disease on progression of human immunodeficiency virus (HIV) disease is inconclusive. The authors estimated the effect of time-varying incident TB on time to acquired immunodeficiency syndrome (AIDS)-related mortality using a joint marginal structural Cox model. Between 1995 and 2002, 1,412 HIV type 1 (HIV-1)-infected women enrolled in the Women's Interagency HIV Study were followed for a median of 6 years. Twenty-nine women incurred incident TB, and 222 died of AIDS-related causes. Accounting for age, CD4 cell count, HIV-1 RNA level, serum albumin level, and non-TB AIDS at study entry, as well as for time-varying CD4 cell count, CD4 cell count nadir, HIV-1 RNA level, peak HIV-1 RNA level, serum albumin level, HIV-related symptoms, non-TB AIDS, anti-Pneumocystis jiroveci prophylaxis, antiretroviral therapy, and household income, the hazard ratio for AIDS-related death comparing time after incident TB with time before incident TB was 4.0 (95% confidence interval (CI): 1.2, 14). The effect of incident TB on mortality was similar among highly active antiretroviral therapy (HAART)-exposed women (hazard ratio = 4.3, 95% CI: 0.9, 22) and non-HAART-exposed women (hazard ratio = 3.9, 95% CI: 0.9, 17; interaction p = 0.91). Although results were imprecise because few women incurred TB, irrespective of HAART exposure, incident TB increases the hazard of AIDS-related death among HIV-infected women.
Subject(s)
Antiretroviral Therapy, Highly Active , HIV Infections/mortality , HIV-1 , Tuberculosis/mortality , Adult , Female , HIV Infections/complications , HIV Infections/drug therapy , Humans , Prospective Studies , Tuberculosis/complications , United States/epidemiologyABSTRACT
By linking HIV/AIDS and cancer surveillance data in 12 US regions, breast and reproductive cancer risks with AIDS were compared to those in the general population. Trends in standardized incidence ratios (SIRs) were assessed by CD4 count, AIDS-relative time, and calendar time. Standardized incidence ratios were indirectly adjusted for cancer risk factors using data from AIDS cohort participants and the general population. With AIDS, 313 women developed breast cancer (SIR 0.69, 95% confidence interval (CI) 0.62-0.77), 42 developed ovary cancer (SIR 1.05, 95% CI, 0.75-1.42), and 31 developed uterine corpus cancer (SIR 0.57, 95% CI, 0.39-0.81). Uterine cancer risk was reduced significantly after age 50 (SIR 0.33). Breast cancer risk was reduced significantly both before (SIR 0.71) and after (SIR 0.66) age 50, and was lower for local or regional (SIR 0.54) than distant (SIR 0.89) disease. Breast cancer risk varied little by CD4 count (Ptrend=0.47) or AIDS-relative time (Ptrend=0.14) or after adjustment for established cancer risk factors. However, it increased significantly between 1980 and 2002 (Ptrend=0.003), approaching the risk of the general population. We conclude that the cancer deficit reflected direct or indirect effects of HIV/AIDS and that anti-HIV therapy reduced these effects.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Breast Neoplasms/epidemiology , Ovarian Neoplasms/epidemiology , Uterine Neoplasms/epidemiology , Age Factors , Female , Humans , Incidence , Menopause , Middle Aged , Poisson Distribution , Racial Groups , Registries , Risk , United States/epidemiologyABSTRACT
Even though women and people of color represent an increasing proportion of US acquired immunodeficiency syndrome (AIDS) cases, few research studies include adequate representation of these populations. Here the authors describe recruitment and retention of a diverse group of human immunodeficiency virus (HIV)-infected and at risk HIV-uninfected women in a prospective study operating in six sites across the United States. Methods used to minimize loss to follow-up in this cohort are also described. For the first 10 study visits that occurred during a 5-year period between 1994 and 1999, the retention rate of participants was approximately 82%. In adjusted Cox analysis, factors associated with retention among all women were older age, African-American race, stable housing, HIV-infected serostatus, past experience in studies of HIV/AIDS, and site of enrollment. In an adjusted Cox analysis of HIV-infected women, African-American race, past experience in studies of HIV/AIDS, site of enrollment, and reported use of combination or highly active antiretroviral HIV therapy at the last visit were significantly associated with retention. In adjusted Cox analysis of HIV-uninfected study participants, only the site of enrollment was significantly associated with study retention. These results show that women with and at risk for HIV infection, especially African-American women, can be successfully recruited and retained in prospective studies.
Subject(s)
Black or African American , HIV Infections , Patient Dropouts , Patient Selection , Adult , Age Factors , Cohort Studies , Female , Housing , Humans , Prospective Studies , Risk FactorsABSTRACT
To evaluate cofactors for progression of HIV infection, the authors identified 370 men with well-defined seroconversion dates and cofactor data among participants in the San Francisco City Clinic Cohort (SFCCC). Postseroconversion substance use, sexual behavior, and sexually transmitted diseases were assessed using multivariate proportional hazards models. Weekly use of hallucinogens strongly and independently predicted death (relative hazard [RH], 2.59; 95% confidence interval [CI], 1.56-4.28), as well as diagnosis of AIDS; weekly cocaine use also predicted mortality. Receptive anal intercourse with ejaculation was independently associated with mortality risk (RH, 1.45; 95% CI, 1.02-2.04) and AIDS. The associations of accelerated progression with weekly use of recreational drugs and unprotected receptive anal intercourse need to be confirmed in other prospective cohorts.
Subject(s)
Bisexuality , HIV Infections/mortality , Homosexuality, Male , Sexually Transmitted Diseases/complications , Substance-Related Disorders/complications , Adult , Cohort Studies , Disease Progression , HIV Infections/complications , HIV Seropositivity/complications , HIV Seropositivity/diagnosis , HIV Seropositivity/mortality , Humans , Male , Middle Aged , Proportional Hazards Models , Prospective Studies , Sexual Behavior , Sexually Transmitted Diseases/mortality , Substance-Related Disorders/mortalityABSTRACT
To investigate the validity of self-reported acquired immunodeficiency syndrome (AIDS) among women enrolled in a prospective study of human immunodeficiency virus (HIV) infection, the authors compared the self-reported occurrence of AIDS-specific diagnoses with AIDS diagnoses documented by county AIDS surveillance registries. Also examined was the association between participant characteristics and the validity of self-reports. Among the 339 HIV-infected participants in the Northern California Women's Interagency HIV Study between October 1994 and September 1998, 217 reported having been given a diagnosis of AIDS. Of these 217 women, 157 (72%) were listed in the registry as having AIDS. Among the specific AIDS-related conditions reported by three or more women, the sensitivity was highest for tuberculosis (100%), CD4 cell count less than 200 (84%), Mycobacterium avium complex (73%), and Pneumocystis carinii pneumonia (69%), and the positive predictive value was highest for CD4 cell count less than 200 (75%). Among all reported AIDS diagnoses, the kappa statistic was highest for cryptococcosis (0.67) and CD4 cell count less than 200 (0.57). The only statistically significant participant characteristic associated with inaccurate reporting of an AIDS diagnosis was being a current cigarette smoker (adjusted odds ratio = 2.57, 95% confidence interval: 1.17, 5.64). Overall, self-reporting of any AIDS-related condition is fairly accurate, but there is great variability in the accuracy of specific conditions.
Subject(s)
AIDS-Related Opportunistic Infections/epidemiology , Acquired Immunodeficiency Syndrome/epidemiology , Self Disclosure , Adult , California/epidemiology , Educational Status , Female , Humans , Income , Logistic Models , Middle Aged , Prospective Studies , Registries , Reproducibility of Results , SmokingABSTRACT
OBJECTIVE: We attempted to determine the prevalence and predictors of skin disease in a cohort of women with and at risk for HIV infection. METHODS: We analyzed baseline data from a multicenter longitudinal study of HIV infection in women. RESULTS: A total of 2018 HIV-infected women and 557 HIV-uninfected women were included in this analysis. Skin abnormalities were reported more frequently among HIV-infected than uninfected women (63% vs 44%, respectively; odds ratio [OR] 2.10; 95% confidence interval [95% CI], 1.74-2.54). Infected women were also more likely to have more than 2 skin diagnoses (OR, 3.27; 95% CI, 1.31-8.16). Folliculitis, seborrheic dermatitis, herpes zoster, and onychomycosis were more common among HIV-infected women (P < .05). Independent predictors of abnormal findings on skin examination in the infected women were African American race (OR, 1.38; 95% CI, 1.07-1.77), injection drug use (OR, 2.74; 95% CI, 2.11-3.57), CD4(+) count less than 50 (OR, 1.68; 95% CI, 1.17-2.42), and high viral loads (100,000-499,999 = OR, 1.77; 95% CI, 1.32-2.37; > 499,999 = OR, 2.15; 95% CI, 1.42-3.27). CONCLUSION: HIV infection was associated with a greater number of skin abnormalities and with specific dermatologic diagnoses. Skin abnormalities were also more common among women with CD4(+) cell depletion or higher viral load.
Subject(s)
HIV Infections/complications , Skin Diseases/complications , Skin Diseases/epidemiology , Adolescent , Adult , Cohort Studies , Female , Humans , Longitudinal Studies , Middle Aged , Prevalence , United States/epidemiology , Viral Load , Women's HealthABSTRACT
PURPOSE: To determine if there is a perinatal advantage for birth outcomes among Mexican-origin Latina (Latina) women compared to white non-Hispanic (white) women, after adjusting for maternal, paternal, and infant factors. METHODS: 1,439,583 births from the 1990-1993 California linked birth and infant death certificate data sets were analyzed for the risk of low birth weight infants and infant mortality. RESULTS: Latina women had a statistically higher unadjusted risk of low birth weight infants and infant mortality compared to white women. After adjusting for potential confounders, Latina women had a similar risk of low birth weight infants and a lower risk of infant mortality relative to white women. In multivariate analyses, the most significant risk factor for low infant birth weight was young gestational age (OR = 82.91 for gestational age 1-230 days and OR = 10.62 for gestational age 231-258 days) and the most significant risk factor for infant mortality was low birth weight (OR = 53.99 for infant birth weight <500 grams and OR = 9.27 for infant birth weight 500-2499 grams). CONCLUSION: There was some evidence of a perinatal advantage for Latina women, when compared to white women and after adjusting for numerous potential confounders. To further reduce the risk of low birth weight infants and infant mortality, additional research is needed for etiologic clues beyond race/ethnicity and other traditional risk factors.
Subject(s)
Hispanic or Latino , Infant Mortality , Infant, Low Birth Weight , Adolescent , Adult , Birth Certificates , California/epidemiology , Epidemiologic Studies , Female , Humans , Infant, Newborn , Male , Mexico/ethnology , Pregnancy , Pregnancy Outcome , Risk Factors , White PeopleABSTRACT
We evaluated factors associated with incident self-reported AIDS diagnoses among HIV-infected women in the Women's Interagency HIV Study (WIHS). Baseline information included age, race/ethnicity, HIV risk category, site of enrollment, years of education, cigarette smoking, CD4 cell count, and HIV viral load. Baseline and follow-up data on self-reported AIDS were analyzed using chi-square, Kaplan-Meier, and Cox proportional hazard models. Among the 1397 HIV-infected women who reported being free of clinical AIDS at baseline, 335 women (24%) reported an incident AIDS diagnosis during follow-up. In stratified Kaplan-Meier analyses, the development of self-reported AIDS was significantly associated with baseline CD4 cell count and viral load (p<0.01). In multivariate Cox proportional hazard analyses, women were statistically more likely to report AIDS if they had CD4 cell counts below 195 cells/mm3 (p<0.01), HIV RNA >4000 copies/ml (p<0.01), were current smokers (p<0.01), and had "no identifiable risk" for acquisition of HIV (p = 0.03). Self-reports of a clinical AIDS diagnosis may not always be accurate, but laboratory markers of HIV disease indicate that those women who self-report such diagnoses have greater immunodeficiency and a higher viral load when compared with those who report no AIDS-defining diagnoses.
Subject(s)
Acquired Immunodeficiency Syndrome/epidemiology , HIV Infections/epidemiology , Women's Health , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/transmission , Adolescent , Adult , Age Factors , Educational Status , Ethnicity , Female , HIV Infections/complications , HIV Infections/transmission , Humans , Incidence , Middle Aged , RNA, Viral/blood , Racial Groups , Risk Factors , Smoking , United States/epidemiology , Viral LoadABSTRACT
OBJECTIVE: Interpregnancy intervals are associated with the risk of low birth weight (LBW) infants, but the association between interpregnancy interval and prematurity is unknown. Our objective was to determine whether interpregnancy intervals were associated with the risk of premature infants and to define the degree of risk according to interpregnancy interval. METHODS: We analyzed 289,842 singleton infants born to parous Mexican-origin Hispanic and non-Hispanic white women in the United States who resided in the same county and delivered between January 1, 1991 and September 30, 1991. Interpregnancy interval was defined as the number of months between the previous live birth and conception of the index pregnancy. Multivariate logistic regression analysis was used to estimate odds ratios and 95% confidence intervals for the risk of interpregnancy interval on very premature (23-32 weeks), moderately premature (33-37 weeks), and term gestation (38-42 weeks). RESULTS: Nearly 37% of women had interpregnancy intervals less than 18 months, 45.5% of women had intervals of 18-59 months, and 17.6% of women had intervals over 59 months. After adjusting for confounding variables, women with intervals less than 18 months were 14-47% more likely to have very premature and moderately premature infants than women with intervals of 18-59 months. Women with intervals over 59 months were 12-45% more likely to have very premature and moderately premature infants than women with intervals of 18-59 months. CONCLUSION: Women with interpregnancy intervals from 18-59 months had the lowest risk of very premature and moderately premature infants. Further study is needed to define the mechanisms through which interpregnancy interval influences pregnancy outcome.
Subject(s)
Birth Intervals , Infant, Premature , Adolescent , Adult , Confounding Factors, Epidemiologic , Female , Hispanic or Latino , Humans , Infant, Newborn , Logistic Models , Male , Pregnancy , Retrospective Studies , Risk Factors , Socioeconomic FactorsABSTRACT
OBJECTIVES: To identify factors associated with the use of medical services, and to test a model of access to care, among HIV-infected women. METHODS: A cross-sectional telephone survey was administered to 213 HIV-infected women. Outcomes were having a primary care provider, and use of primary care and emergency health services. Predictors included characteristics of the population-at-risk and of the health care system. RESULTS: Ninety-three percent of respondents had a primary care provider. Linear regression found age >45 years (p = .002), perceiving greater barriers to getting to a clinic (p = .04) and greater benefits from medications (p = .03), lack of problems with appointment times (p = .02), having AIDS (p = .01), shorter appointment waiting times (p = .0003), and greater cost of travel to care (p = .001) were associated with a greater number of primary care visits. Thirty-seven percent missed at least 1 primary care appointment. In logistic regression, lack of insurance (odds ratio [OR] = 2.76), current injection drug use (OR = 2.89) and difficulty remembering appointments (OR = 2.36) were associated with having missed any appointments. CONCLUSIONS: Characteristics of the population-at-risk and of the health care system both make important contributions to primary care service use.
Subject(s)
HIV Infections/therapy , Health Services Accessibility , Primary Health Care/statistics & numerical data , Adult , Ambulatory Care , California , Cross-Sectional Studies , Data Collection , Emergency Medical Services/statistics & numerical data , Female , Humans , Middle Aged , Outcome Assessment, Health CareABSTRACT
BACKGROUND: Rates of low-birth-weight (LBW) infants are similar between Latina and white women, an epidemiologic paradox. However, few studies have analyzed the relationship between ethnicity, Latino subgroup, confounding variables, and LBW. METHODS: We analyzed 395070 singleton livebirths to Latina and non-Latina white women in California during 1992. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the risks due to Latino ethnicity and Latino subgroup for very LBW (VLBW, 500-1499 g) and moderately LBW (MLBW, 1500-2499 g) outcomes. RESULTS: Latina and white women had similar unadjusted rates of VLBW (0.7% vs. 0.6%) and MLBW infants (3.7% vs. 3.4%). After adjusting for maternal age, education, birthplace, marital status, parity, tobacco use, use of prenatal care, infant sex, and gestational age, there was no difference in the odds of VLBW infants between Latina and white women (OR, 0.93 [95% CI, 0.81-1.071). Latina women had minimally elevated odds of MLBW infants (OR, 1.06 [95% CI, 1.01-1.11]) compared with white women. By Latino subgroup, there was no difference in the adjusted odds of VLBW infants among Central and South American, Cuban, Mexican, Puerto Rican, and white women. The adjusted odds of MLBW infants were elevated among Central and South American (OR, 1.14 [95% CI, 1.05-1.25]) and Puerto Rican women (OR, 1.41 [95% CI, 1.12-1.78]), relative to white women. CONCLUSIONS: The epidemiologic paradox of LBW in Latinos is valid. New conceptual models are needed to identify Latina women who are at risk for adverse pregnancy outcomes.
Subject(s)
Hispanic or Latino/statistics & numerical data , Infant, Low Birth Weight , Adolescent , Adult , California/epidemiology , Cross-Sectional Studies , Female , Humans , Incidence , Infant, Newborn , Male , Models, Statistical , Odds Ratio , Pregnancy , White PeopleABSTRACT
BACKGROUND: Although immigrants to the United States are usually ethnic minorities and socioeconomically disadvantaged, foreign-born women generally have lower rates of low birth weight infants than do US-born women. OBJECTIVE: To measure the relationship between maternal birthplace, ethnicity, and low birth weight infants. DESIGN: Retrospective cohort study of birth certificate data. SETTING: California, 1992. SUBJECTS: Singleton infants (n = 497 868) born to Asian, black, Latina, and white women. MAIN OUTCOME MEASURES: Very low birth weight (500-1499 g), moderately low birth weight (1500-2499 g), and normal birth weight (2500-4000 g, reference category). RESULTS: Foreign-born Latina women generally had less favorable maternal characteristics than US-born Latinas, yet foreign-born Latina women were less likely to have moderately low birth weight infants (odds ratio, 0.91; 95% confidence interval, 0.86-0.96) than US-born Latinas after adjusting for maternal age, education, marital status, parity, tobacco use, use of prenatal care, and gestational age. While foreign-born Asian women generally had a less favorable profile of maternal characteristics than US-born Asians, there was no statistically significant difference in the odds of very low birth weight or moderately low birth weight infants between foreign- and US-born Asian women. Foreign-born black women had more favorable maternal characteristics than US-born women, but there was no significant nativity difference in very low birth weight or moderately low birth weight between foreign- and US-born black women after adjusting for maternal and infant factors. CONCLUSIONS: The relationship between maternal birthplace and low birth weight varies by ethnicity. Further study is needed to understand the favorable pregnancy outcomes of foreign-born Latina women.
Subject(s)
Emigration and Immigration , Ethnicity , Infant, Low Birth Weight , Infant, Very Low Birth Weight , Pregnancy Outcome/ethnology , Adolescent , Adult , Birth Weight , California/epidemiology , Cohort Studies , Cross-Cultural Comparison , Female , Humans , Infant, Newborn , Parity , Pregnancy , Retrospective StudiesABSTRACT
OBJECTIVE: To determine whether racial differences in risk of low birth weight infants among black and white parents can be attributed to differences in demographic, behavioral, medical, and socioeconomic factors. METHODS: We analyzed 203,815 singleton births from the 1992 California birth certificate data set for the risk of very low birth weight (500-1499 g) and moderately low birth weight (1500-2499 g) infants. Additional study variables included maternal (race, age, education, marital status, parity, obstetric history, tobacco use, medical complications, medical insurance, and use of prenatal care), paternal (race, age, and education), infant (gestational age and gender), and community (median household income from the 1990 US Census) characteristics. RESULTS: For both very low and moderately low birth weight infants, the unadjusted risk associated with parental race showed a gradient of risk, from highest to lowest, for black mother/black father, black mother/white father, white mother/black father, and white mother/white father parents. After adjusting for other risk factors, the odds ratio associated with black mother/black father parents was reduced from 3.37 to 1.73 for very low birth weight infants and from 2.51 to 1.60 for moderately low birth weight infants, but both remained elevated. Interracial parents no longer had an elevated risk of very low birth weight infants and white mother/black father parents no longer had an elevated risk of moderately low birth weight, compared with white parents. CONCLUSION: After controlling for parental, infant, and community factors, most but not all of the increased risk of low birth weight infants associated with black parental race was explained.
Subject(s)
Black or African American , Infant, Low Birth Weight , Socioeconomic Factors , White People , Age Factors , Birth Weight , California , Chi-Square Distribution , Educational Status , Female , Gestational Age , Humans , Income , Infant, Newborn , Insurance, Health , Marital Status , Parity , Prenatal Care , Regression Analysis , Risk FactorsABSTRACT
OBJECTIVE: We sought to determine potential risk factors for upper genital tract inflammation in women with cervical Neisseria gonorrhoeae, Chlamydia trachomatis, or bacterial vaginosis. STUDY DESIGN: In a case-controlled study we compared 111 women with cervical Neisseria gonorrhoeae, Chlamydia trachomatis, or bacterial vaginosis (the study group) with 24 women who had negative tests for each of these infections (the control group). We evaluated potential risk factors for upper genital tract inflammation by use of bivariate and then logistic regression analysis. RESULTS: We found plasma cell endometritis in 53 of 111 women in the study group and 3 of 24 controls (odds ratio = 6.4, 95% confidence interval 1.7 to 35.0). On logistic regression, the study group women who were in the proliferative phase had increased likelihood of plasma cell endometritis (odds ratio = 4.5, 95% confidence interval 1.6 to 12.4). CONCLUSION: The proliferative phase of the menstrual cycle seems to be the primary risk factor for ascending infection by organisms associated with pelvic inflammatory disease. This may be due to a hormonal effect or to the loss of the cervical barrier during menstruation.
Subject(s)
Cervix Uteri/microbiology , Chlamydia trachomatis/isolation & purification , Endometritis/microbiology , Neisseria gonorrhoeae/isolation & purification , Plasma Cells , Adolescent , Adult , Black People , Case-Control Studies , Chlamydia Infections/complications , Chlamydia Infections/microbiology , Endometritis/epidemiology , Endometritis/pathology , Female , Gonorrhea/complications , Gonorrhea/microbiology , Humans , Menstrual Cycle , Middle Aged , Risk Factors , Therapeutic Irrigation , Vaginosis, BacterialABSTRACT
To determine whether there were core groups of transmitters of gonorrhea and chlamydial infection among 14- to 35-year-olds in San Francisco during 1989-1993, sociodemographic risk factors for repeat gonorrhea and chlamydial infection were examined. During those 5 years, 8613 cases of gonorrhea were reported among males and 3893 among females; the proportions with repeat infection were 17.0% and 19.0%, respectively. There were also 2465 reported cases of chlamydial infection among males and 6996 among females; the proportions with repeat infection were 8.6% and 15.1%, respectively. Multivariate analyses reveal that for males, city planning region 5 was an independent risk factor for both repeat gonorrhea (relative hazard [RH] = 1.22; 95% confidence interval [CI] = 1.05-1.43) and repeat chlamydial infection (RH = 1.78; 95% CI = 1.23-2.57). For females, city planning region 4 was an independent risk factor for repeat gonorrhea (RH = 1.50; 95% CI = 1.12-1.98), and there was no high-risk planning region for repeat chlamydial infection. In San Francisco, there appear to be male and female core transmitters for gonorrhea but there may not be core transmitters for chlamydial infection.
Subject(s)
Chlamydia Infections/epidemiology , Gonorrhea/epidemiology , Adolescent , Adult , Chlamydia Infections/ethnology , Chlamydia Infections/transmission , City Planning , Cluster Analysis , Female , Gonorrhea/ethnology , Gonorrhea/transmission , Humans , Incidence , Male , Risk Factors , San Francisco/epidemiology , Sexual BehaviorABSTRACT
To investigate the relation between Asian ethnicity/national origin and low birth weight (< 2,500 g), the authors analyzed singleton live births among 50,044 Asian and 221,866 white women who delivered in California during 1992. Ethnic and subgroup differences in prenatal characteristics and birth weight outcomes were found between Asian and white women and between Asian subgroups. In unadjusted comparisons, very low birth weight (500-1,499 g) was more likely among Filipino women and less likely among Chinese women, relative to whites. Moderately low birth weight (1,500-2,499 g) was more likely among Cambodian, Filipino, Indian, Japanese, Laotian, and Thai women and was less likely among Koreans, relative to whites. In multivariate analyses, Filipino women remained at increased risk of both very low and moderately low birth weight, while Cambodian, Indian, and Laotian women had elevated odds of moderately low birth weight. Chinese women were less likely to have very low birth weight infants than were whites. Utilization of prenatal care was also associated with low birth weight. Perinatal outcomes among Asians vary by national origin, and accepted risk factors that were studied only partially explain this variation.
Subject(s)
Asian/statistics & numerical data , Birth Weight , Infant, Low Birth Weight , Pregnancy Outcome , Adolescent , Adult , Asia/ethnology , California/epidemiology , Educational Status , Female , Humans , Incidence , Infant, Newborn , Maternal Age , Odds Ratio , Parity , Pregnancy , Prenatal Care/statistics & numerical dataABSTRACT
Several studies have shown that human immunodeficiency virus type 1 (HIV-1) is associated with an increase in the incidence of Kaposi's sarcoma and non-Hodgkin's lymphoma among homosexual men. The role of HIV-1 in increasing the incidence of other malignancies is more controversial. The incidence of non-Kaposi's sarcoma cancer was examined from 1978 to 1990 among 15,565 homosexual men who participated in studies of hepatitis B virus infection in the late 1970s in New York City, New York, and San Francisco, California. The standardized incidence ratio (SIR) for all cancers was 1.6 (95% confidence interval (CI) 1.4-1.8). Excesses were observed for non-Hodgkin's lymphoma (SIR = 12.7; 95% CI 11.0-14.6). Hodgkin's disease (SIR = 2.5; 95% CI 1.5-3.9), and anal cancer (SIR = 24.2 95% CI 13.5-39.9). As seen with non-Hodgkin's lymphoma, a cancer known to be associated with HIV-1. Hodgkin's disease incidence was significantly higher in more recent years compared with earlier years. No cases of Hodgkin's disease were found among HIV-1 antibody-negative men, and Hodgkin's disease was diagnosed near the time of initial acquired immunodeficiency syndrome diagnoses. Anal cancer incidence did not correlate with HIV-1 antibody status and did not tend to occur near the time of AIDS diagnoses. This study confirms the association of non-Hodgkin's lymphoma with HIV-1 infect on and suggests an association between Hodgkin's disease and HIV-1 infection. An excess in anal cancer was observed but did not appear to be associated with HIV-1 infection.
Subject(s)
Homosexuality, Male , Neoplasms/epidemiology , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/epidemiology , Acquired Immunodeficiency Syndrome/mortality , Adult , Anus Neoplasms/complications , Anus Neoplasms/epidemiology , Anus Neoplasms/mortality , HIV-1 , Hodgkin Disease/complications , Hodgkin Disease/epidemiology , Hodgkin Disease/mortality , Humans , Incidence , Lymphoma, Non-Hodgkin/complications , Lymphoma, Non-Hodgkin/epidemiology , Lymphoma, Non-Hodgkin/mortality , Male , Neoplasms/complications , Neoplasms/mortality , New York City/epidemiology , Risk Factors , San Francisco/epidemiologyABSTRACT
BACKGROUND: The Centers for Disease Control and Prevention published recommendations for clinicians on the management of pelvic inflammatory disease, but it is unknown if providers are aware of the guidelines or follow them. GOAL: To compare pelvic inflammatory disease screening, diagnosis, treatment, and reporting practices among primary care physicians with the Centers for Disease Control and Prevention guidelines for pelvic inflammatory disease. STUDY DESIGN: A weighted random sample of California primary care physicians surveyed in November 1992 and January 1993. RESULTS: Of the 1,165 physicians surveyed, 553 (48%) returned completed questionnaires. Among respondents, 302 (55%) reported having treated a case of pelvic inflammatory disease during the last 12 months, and of these, 52% answered that they were unsure of or do not follow the Centers for Disease Control and Prevention guidelines for pelvic inflammatory disease. Pediatricians and those with more years since residency were less likely to deviate from the Centers for Disease Control and Prevention guidelines for pelvic inflammatory disease, and family practitioners were more likely to deviate from the guidelines. CONCLUSIONS: Pelvic inflammatory disease is commonly encountered by primary care physicians in California. Training and experience were important predictors of compliance with the Centers for Disease Control and Prevention recommendations; however, substantial divergence from the guidelines occurs.