Recruitment of minority students to U.S. epidemiology degree programs. The American College of Epidemiology Committee on Minority Affairs.

PURPOSE: African-, Hispanic-, and Native Americans are underrepresented in the field of epidemiology including degree programs. As part of the assessment component of its mandate, the American College of Epidemiology Committee on Minority Affairs conducted a survey of minority recruitment activities of U.S. epidemiology degree programs. METHODS: The survey, containing questions related to marketing activities, institution infrastructure, financial support, academic offerings, and receptive/supportive environment, was mailed to all programs identified in Episource as offering epidemiology degrees. Separate responses were requested concerning activities at the department and school levels. RESULTS: Fifty-two completed questionnaires were received (response rate of 79%). All but two institutions had at least one activity conducted by either the department or the school. However, all activities were more common at the school- than at the department-level. Indeed, some activities [a written minority student recruitment plan (6% of departments and 52% of schools), personnel with minority recruitment responsibilities (4% of departments and 73% of schools)] were almost exclusively school-sponsored. Although marketing-type activities were the most common minority recruitment tool used by departments, only 21% made visits to minority schools, 17% visited other colleges specifically to recruit minorities, and 12% produced materials targeted to ethnic/racial minorities. Six percent of the departments and 19% of the schools offered financial support (grants, fellowships, scholarships) to almost all underrepresented minority students. CONCLUSIONS: Even though individual epidemiology degree programs may not see a need for general recruitment activities in order to maintain the size of their applicant pool, minority-specific recruitment activities should be undertaken to enhance and diversify that pool. We recommend that epidemiology departments develop, adopt, and implement comprehensive written plans for the recruitment of underrepresented minority students into their programs.

Racial and ethnic distribution of faculty, students, and fellows in US epidemiology degree programs, 1992. Committee on Minority Affairs of the American College of Epidemiology.

The American College of Epidemiology Committee on Minority Affairs assessed the racial/ethnic distribution of faculty, students, and postdoctoral fellows in epidemiology degree programs in the United States in 1992. Fifty-six programs in schools of public health, medicine, or veterinary medicine completed a one-page anonymous questionnaire (85% response rate). Of 711 faculty members (median of 8 per program), 46 (6%) were minorities (US black, Hispanic, or Asian/Pacific Islander). Of 2142 students (1206 masters, 862 doctoral, 74 postdoctoral: median of 17 per program), 293 (14% of all students; 17% of US citizen students) were minorities. In the 46 doctoral programs, there were 36 black students (in 20 doctoral programs), 15 Hispanic students (in 9 programs), and no Native Americans. There were three minority postdoctoral fellows, all blacks (4% of all postdoctoral fellows). Determined, consistent, and sustained efforts will be required to boost the representation of blacks, Hispanics, and Native Americans in epidemiology.

Time series analysis of syphilis surveillance data.

To manage a public health programme effectively it is necessary to set objectives and priorities according to the resources available. To utilize available resources optimally in a disease control programme we should both estimate the present and predict the future magnitude of the health problem. The CDC has an effective programme to control syphilis, a sexually transmitted disease. To keep track of control activities, CDC receives the number of syphilis cases from all states every three months. Primary and secondary syphilis cases declined from an all time high of 106,539 cases in 1947 to 6399 cases in 1956. Since then, syphilis cases increased to 27,921 in 1986. Congenital syphilis cases declined from 17,600 in 1941 to 239 in 1983, but increased to 408 in 1986. We built time series models for primary and secondary syphilis cases in men and women and congenital syphilis cases in children under one year of age. These models were used to forecast syphilis cases in all three categories. This analysis suggests that no change in the trend of male syphilis cases has occurred, but syphilis cases in women and congenital syphilis cases in children under one year of age during 1987 have increased.

Therapy of uncomplicated gonorrhea due to antibiotic-resistant Neisseria gonorrhoeae.

Antibiotics available to treat uncomplicated anogenital infections due to beta-lactamase-producing Neisseria gonorrhoeae include spectinomycin, ceftriaxone, and clavulanic acid added to aqueous procaine penicillin G or amoxicillin. Important variables in deciding which antibiotic regimen to use include effectiveness against urethral, cervical, pharyngeal, and rectal infections; cost; eradication of coexisting incubating syphilis; adverse effects; efficacy against strains of N. gonorrhoeae with chromosomally mediated resistance to antimicrobial agents; ease of administration; patient acceptance; and the potential for inducing resistance to antimicrobial agents in pathogens other than those causing sexually transmitted diseases. This review outlines the advantages and disadvantages of the various regimens.

Predicting acute pelvic inflammatory disease: a multivariate analysis.

A multivariate logistic regression analysis of patient symptoms and signs and laboratory findings associated with the diagnosis of acute pelvic inflammatory disease was performed with use of data from 628 women who were clinically diagnosed as having the disease for the first time at the University of Lund, Sweden. In 414 women (65.9%) acute pelvic inflammatory disease was laparoscopically confirmed. We developed a mathematical model that correctly predicted 87.0% of the cases of acute pelvic inflammatory disease and had an overall correct classification rate of 75.6%. Variables that were good predictors of acute pelvic inflammatory disease were purulent vaginal discharge, erythrocyte sedimentation rate greater than or equal to 15 mm/hr, positive gonorrhea result, adnexal swelling on bimanual examination, and rectal temperature greater than or equal to 38 degrees C. Furthermore, we developed "mixed model I" and "mixed model II," which combine simple clinical parameters and laparoscopy in varying degrees. In mixed model I the sensitivity, specificity, and overall classification values were 93%, 67.2%, and 84.5%; in mixed model II these values were 100%, 67.2%, and 89.2%. Use of relatively simple and reproducible clinical parameters can identify those women who would most benefit from laparoscopy to diagnose acute pelvic inflammatory disease.

Serological response to syphilis treatment. A new analysis of old data.

One important aspect of the posttreatment evaluation of patients with early syphilis is assessment of serological test results. Using information previously collected from 818 patients in the Early Syphilis Study, we evaluated the seroresponse of people treated for primary or secondary syphilis. We generated curves describing the VDRL titer declines with time. The VDRL titer declined approximately fourfold at three months and eightfold at six months. These observations will allow clinicians to identify treatment failures or reinfections at the earliest possible time during their follow-up.

Gonorrhea in the United States: 1967-1979.

Sex-, race-, and age-specific gonorrhea cases and rates reported by public and private sources were studied. The role of the age, sex, and race composition of the population was used to explain changing trends of morbidity due to gonorrhea. Beginning in 1967, reported cases of gonorrhea in the United States increased at an annual rate of 13% through 1975, with increases in women twice those in men. The group aged 20-24 years had the highest age-specific rates of gonorrhea in both men and women, while the highest percentage increases were observed in the 15-19-year-old age group. Since 1975, numbers of reported cases have stabilized. Decreases in rates of gonorrhea were more pronounced in men than in women. Among all ages, the group aged 20-24 showed the largest decrease for race and sex categories, except for nonwhite women.

Syphilis in the United States: 1967-1979.

Reported data on cases of primary and secondary syphilis in the United States during 1967-1979 were analyzed by age, race, sex, and reporting source. Although the incidence of primary and secondary syphilis fluctuated little in the United States between 1967 and 1979, the ratio of male to female cases increased twofold, from 1.5:1 to 3:1. Cases in men, primarily those aged 25-39 years, reported by public clinics increased from 32% to 56% of the total cases reported; in particular, cases among white males reported by public clinics increased by 351%. The percentage of white men with early syphilis who attended public clinics and who reported at least one male sex partner increased from 38% in 1969 to 70% in 1979. These findings suggest that an essential change occurred in the epidemiology of early syphilis in the United States: white gay men became proportionately more burdened by the disease, and increasing transmission of the disease occurred within this segment of the population in the United States.

The prevention of hepatitis B with vaccine. Report of the centers for disease control multi-center efficacy trial among homosexual men.

A randomized, double-blind, vaccine/placebo trial of the Merck 20-micrograms hepatitis B virus (HBV) vaccine was done among 1402 homosexual men attending venereal disease clinics in five American cities. Vaccination was followed by only minimal side effects. Two doses of vaccine induced antibody in 80% of vaccine recipients. A booster dose 6 months after the first dose induced antibody in 85% of recipients and markedly increased the proportion of recipients who produced high antibody titers. The incidence of HBV events was markedly less in the vaccine recipients compared to that in the placebo recipients (p = 0.0004). Between month 3 and 15 after the first dose, 56 more significant HBV events (hepatitis, or hepatitis B surface antigen positive, or both) occurred in the placebo group while only 11 occurred in the vaccine group. Ten of the 11 HBV events in the vaccine recipients occurred in hypo- or nonresponders to the vaccine. This vaccine appears to be safe, immunogenic, and efficacious in preventing infection with hepatitis B virus.

Effect of menstrual cycle and method of contraception on recovery of Neisseria gonorrhoeae.

We examined the records of 5,287 women who were names as sexual contacts of men who had gonococcal urethritis in the National Gonorrhea Therapy Monitoring Study. Neisseria gonorrhoeae was recovered from endocervical cultures from 3,247 (61.4%) of the women. Participants who were seen during the first five days of the menstrual cycle were slightly more likely to have a positive culture (64.9%) than women who were seen on days 6 through 10 (61.3%), days 11 through 15 (60.0%), days 16 through 20 (59.8%), days 21 through 25 (60.4%), or after day 25 (61.2%). Similar data were obtained for 1,489 untreated women who presented because a recent screening culture contained N gonorrhoeae. Neisseria gonorrhoeae was isolated from pretreatment cultures from 231 (79.7%) of 290 such women who were examined during the first five days of their menstrual cycle and from 884 (73.7%) of 1,199 women who were examined later in the cycle. Method of contraception had no statistically significant influence on the recovery of N gonorrhoeae.

A trial of minocycline given after exposure to prevent gonorrhea.

In a prospective evaluation of antibiotic prophylaxis against gonorrhea, 1080 men were given 200 mg of oral minocycline or placebo after sexual intercourse with prostitutes in a Far Eastern port. Later, at sea, gonococcal infection was detected in 57 of 565 men given placebo and 24 of 515 men given minocycline (P less than 0.001). Minocycline prophylaxis completely prevented infection by gonococci susceptible to 0.75 microgram or less of tetracycline per milliliter, reduced the risk of infection or prolonged the incubation period in men exposed to gonococci susceptible to 1.0 to 2.0 micrograms per milliliter, but did not prevent infection or prolong incubation in men exposed to gonococci resistant to 2.0 micrograms. Minocycline did not increase the proportion of asymptomatic infections. Minocycline prophylaxis would probably have limited effectiveness as a public-health measure because of the tendency to select resistant gonococci.

Pharmacokinetic determinants of penicillin cure of gonococcal urethritis.

In a 1964 study of the pharmacokinetic determinants of penicillin cure of gonococcal urethritis, 45 male prisoner volunteers were experimentally infected with strains of Neisseria gonorrhoeae having known in vitro penicillin susceptibility. After developing urethritis, subjects received intramuscular penicillin G and had serum samples obtained serially to determine penicillin concentration. Using a multiple regression technique, we studied patient-associated parameters and parameters of the serum penicillin curves to determine the best predictors of treatment results. Cure was best predicted by the time the serum penicillin concentration remained above three to four times the penicillin minimum inhibitory concentration of the infecting strain (probability of correct classification, >0.80). Those cured had serum penicillin concentrations which remained in this range for means of 7 to 10 h. Our findings confirm principles of antimicrobial therapy derived from animal models and may have application in studying therapy of gonorrhea and other infectious diseases.