Rifampin preventive therapy for tuberculosis infection: experience with 157 adolescents.

For persons infected with Mycobacterium tuberculosis resistant to isoniazid (INH), rifampin is recommended for the prevention of active disease. However, the adverse effects and acceptability of this preventive therapy are largely uncharacterized. We prospectively followed 157 high-school students exposed to, and probably infected with, M. tuberculosis strains resistant to INH. All 157 students were prescribed preventive therapy with rifampin (10 mg/kg up to 600 mg daily) for 24 wk. While receiving therapy, 41 (26%) reported one or more adverse effects; of these, 18 had therapy interrupted temporarily, two permanently. Four (2.5%) had alanine aminotransferase elevations greater than two times the upper limit of normal (range, 91 to 161 U/L); of these, one had therapy permanently stopped. Six (3.8%) self-discontinued therapy. No student was found to have active disease during the 2 yr of the study (exact 95% upper confidence limit, 2.2). We assumed that without preventive therapy, seven cases of tuberculosis would have occurred during these 2 yr. Therefore, we estimated that rifampin had a minimum protective effect of 56%. In conclusion, preventive therapy with rifampin was well tolerated and well accepted, and it appears effective in preventing active tuberculosis.

AIDS and prehospital personnel: knowledge and prevention of occupational exposure.

OBJECTIVES: Prehospital personnel, including law enforcement officers, paramedics, and fire-fighters, may be exposed to the human immunodeficiency virus (HIV) while working. This study of prehospital personnel sought to determine: 1) their knowledge of the acquired immune syndrome (AIDS) and HIV transmission; 2) the extent of AIDS training received; 3) self-assessment of risk for HIV infection; and 4) precautions adopted to reduce occupational risk of exposure to HIV. METHODS: A survey was administered to pre-hospital personnel in a large Southern California jurisdiction. The response rate was 41% (n = 1,756) in 10 city and county departments where respondents were employed. Law enforcement officers (44%), firefighters (44%), and paramedics (12%) comprised the sample. RESULTS: Respondents had accurate knowledge about AIDS, but incorrect perceptions about HIV transmission. A minority believed that HIV could be contracted from casual contact. Training relating to AIDS was not frequent. Preventive practices were infrequent in the work setting, with precautions used less than 50% of the time on eight of 10 measures. One-third of these prehospital personnel assessed their risk for HIV infection as medium to high, largely attributable to fear of occupational exposure. CONCLUSIONS: Improved educational programs regarding HIV/AIDS are needed for prehospital personnel to increase the use of preventive occupational practices in the field.

HIV/AIDS knowledge and high risk sexual practices among southern California Vietnamese.

OBJECTIVES: Vietnamese immigration to the U.S. since the conclusion of the Vietnam war has been substantial and in Orange County, CA, Vietnamese Americans comprise 3% of the population (the largest community in the US). Our objective was to collect data on the HIV/AIDS knowledge, attitudes and self-reported high risk behaviours within this community. METHODS: A survey instrument was administered anonymously in Vietnamese to 532 respondents in their homes. Individuals from three population strata were randomly sampled: men 18 to 35 years old (N = 193); men 36 to 45 years old (N = 137); and women 18 to 35 years old (N = 202). Data were gathered on: (1) degree of acculturation; (2) knowledge and attitudes towards HIV/AIDS; and (3) self-reported sexual and other high risk practices. RESULTS: Survey data indicated that 38% of respondents were very worried about themselves and 83% were worried about a family member getting AIDS. Knowledge about actual modes of HIV transmission was generally accurate, but a substantial minority still believed that HIV can be transmitted through casual contact, and 68% from needles used in hospitals. Women demonstrated less accurate knowledge than men on five key items. Quarantine of the HIV infected was agreed to by 45%. Twenty-nine percent did not believe that the epidemic would affect them personally, and 49% stated that they did not have enough information about AIDS to protect themselves. Regarding sexual practices, 31% reported never having had sex. Of the others, 8% had two or more sexual partners in the prior 12 months. No same sex behaviour was reported. Six percent of men had visited a female prostitute; of these, 24% had visited 2 or more in the prior 12 months; half of encounters in this time period were outside the US. Substantial percentages of sexually active, unmarried respondents indicated that they never use (17-40%) or only sometimes use (10-32%) condoms. Less than 1% had used injection drugs. CONCLUSIONS: Education should be targeted at the Vietnamese community of southern California to improve knowledge that HIV cannot be contracted through casual contact, to convey information about methods for self-protection, and to reduce high risk sexual practices such as unprotected sex, sex with multiple partners and sex with prostitutes.

Fatalities assessed by the Orange County child death review team, 1989 to 1991.

Interagency child death review teams have emerged in response to the increasing awareness of severe violence perpetrated against children in the United States. Child death review involves a systematic, multidisciplinary, and multiagency process to coordinate data and resources from the coroner, law enforcement, the courts, child protective services, and health care providers. The Orange County, CA team reviews all coroner's cases (unattended death or questionable cause of death) for children 12 years old and younger. This paper describes the interagency review in Orange County and provides data on the demographics of cases reviewed by the team (N = 637) compared to unreviewed deaths (N = 1,463) for the period 1989 to 1991. Trends were analyzed to assess differences in: (1) age distribution; (2) gender; (3) ethnicity; (4) cause of death (non-SIDS natural; non-natural including traffic deaths, SIDS, other injuries; homicide; and undetermined); and (5) cause of death by age, gender, and ethnicity. Implications of the data for other jurisdictions with child death review teams are discussed.

Targeted HIV seroprevalence among Vietnamese in southern California.

OBJECTIVE: The prevalence of HIV among southern California Vietnamese is unknown. We collected seroprevalence data on targeted Vietnamese in Orange County, California who may be at risk for HIV infection. METHODS: The assumption of elevated risk was based on rates of infection reported among other U.S. groups. Vietnamese (N = 874) from six county sites were tested during 1992: (1) attendees at county HIV/STD clinics and (2) IDU program; (3) male inmates of the county jail and (4) of a juvenile detention centre; (5) males in a driving under the influence of alcohol (DUI) remedial program; and (6) patients for nonpregnancy-related syphilis screening. RESULTS: The number of cases detected and risk factors were: (1) county HIV/STD clinics--5/223 (2.3%), all men who had sex with men; (2) men's jail--1/122 (0.8%), risk factors unknown; (3) juvenile hall--1/145 (0.7%), risk factors unknown; (4) IDU program--0/33; (5) syphilis screening--0/284; and (6) DUI program--0/67. CONCLUSIONS: HIV infection exists among southern California Vietnamese, and men who have sex with men appear to be at a risk for HIV infection similar to others practicing high risk behaviors in the U.S. population. Preventive education needs to be targeted explicitly at these individuals.

A national survey of public health officers' interactions with the media.

OBJECTIVES: To assess the perceptions, practices, and needs of state and local health officers with respect to professional interactions with the media. DESIGN: A survey of 759 public health officers (56 state and 703 local) on jurisdiction demographics, frequency of media interactions, agency process for media contacts, provision and need for media training, and character of media relations. PARTICIPANTS: Fifty-two state health officers and 568 US local health officers responded, for a survey response rate of 82%. RESULTS: Media reporting was perceived as accurate 52% to 73% of the time, although reporters were seen as needing improved technical and scientific knowledge. Media were used frequently as a component of health education. State health jurisdictions were more likely than local jurisdictions to have a media protocol and designated media contact, to internally review media releases, to interact regularly with media, and to provide staff training on media relations. Media interaction time comprised print media (63%), television (19%), and ratio (17%). One third of the health officers found media relations adversarial, but most held a positive overall view of the media. Favorable evaluation of the media was associated with high frequency of media contact, high perceived accuracy of reporting, and presence of an institutional media protocol. CONCLUSIONS: While health officers evaluated media favorably, problem areas were identified where mutual education could improve the accuracy and value of media reporting on health issues. Training capacity for both professions should be developed to increase the effectiveness of public health in media relations.

AIDS knowledge, occupational precautions, and public education activities among law enforcement officers and first responders.

A survey on AIDS was administered within a large, southern California jurisdiction to law enforcement officers and first responders (paramedics, firefighters). Respondents had accurate knowledge about AIDS but several incorrect perceptions about HIV transmission; a substantial proportion believed that HIV could be contracted from casual contact. AIDS training was not frequent. Self-assessment of HIV risk was medium to high risk in one-third of respondents, and was largely attributable to fear of occupational exposure. Appropriate precautionary professional practices were adopted at low frequencies, with respondents adopting preventive measures less than 50% of the time on 7 of 10 measures. Seventeen percent reportedly received requests for HIV/AIDS education from members of the public, which is incongruous with law enforcement officers' and first responders' demonstrated level of knowledge about HIV transmission. It was concluded that improved educational programs on HIV/AIDS are needed for law enforcement officers and first responders to increase the use of occupational precautions in the field, and to improve the accuracy of public AIDS education activities conducted by these professionals.

HIV infection in the Women's Jail, Orange County, California, 1985 through 1991.

The incidence and prevalence of human immunodeficiency virus (HIV) infection among injection drug users, prostitutes, and other women seeking confidential testing in the Orange County Women's Jail were assessed from 1985 to 1991. A total of 4616 voluntary tests were completed on 3051 women, and 865 women were tested repeatedly. Eighty-two women tested positively, a ratio of 1.8 positives per 100 tests or 2.7% of all persons tested. Cumulative HIV prevalence increased from 2.5% to 2.7% between 1985 and 1991, increased by age, and showed racial differences. Of women with multiple tests, 29 seroconverted. Incidence declined from 5.7 to 1.4 cases per 100 person-years of observation between 1985 and 1991. The overall rate of seroconversion was 1.6 per 100 person-years of observation.

Lead poisoning among low-income children in Orange County, California. A need for regionally differentiated policy.

OBJECTIVE: To estimate the prevalence of elevated lead levels among children in Orange County, California, and to evaluate the appropriateness of a universal pediatric blood lead screening policy in this community. DESIGN: Venous blood lead testing was conducted and results were analyzed according to seven blood lead strata ranging from less than 0.50 mumol/L (10 micrograms/dL) to 3.35 mumol/L (70 micrograms/dL) or higher. A cost analysis of the lead-testing program in Orange County was conducted. SETTING: Children meeting poverty eligibility criteria and attending the Child Health and Disability Prevention Program, the state's implementation of the federal Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services program. PARTICIPANTS: A total of 5115 Orange County children between 12 and 72 months of age using EPSDT services from March through December 1992. MAIN OUTCOME MEASURES: Blood lead levels and associated costs of the testing program stratified by level of blood lead elevation. RESULTS: Blood lead levels of 0.50 mumol/L (10 micrograms/dL) or higher were found in 371 children (7.25%; 95% confidence interval, 6.66% to 7.85%), but only six children (0.12%; 95% confidence interval, 0.04% to 0.20%) had elevations greater than 1.20 mumol/L (25 micrograms/dL). Five children (83.3%) had histories of lead consumption unrelated to ingestion of lead-containing paint but related to the use of lead-containing folk remedies and cooking utensils. Costs for detection of children with blood levels elevated to 0.50 mumol/L (10 micrograms/dL) or higher was $310 per child and for levels of 1.20 mumol/L (25 micrograms/dL) or higher was $19,139 per child. CONCLUSIONS: These data suggest that lead poisoning is not a major public health problem among Orange County children and detection of infrequent cases would involve a high cost per child. In jurisdictions with newer housing, initial screening for a history of possible lead exposure alone may offer reasonable efficacy that is cost-effective. The scope of lead-testing programs should be determined according to local needs and conditions.

Survival of breast cancer patients receiving adjunctive psychosocial support therapy: a 10-year follow-up study.

PURPOSE: The impact of an adjunctive psychosocial support program on length of survival with breast cancer was evaluated in a retrospective cohort study. The duration of observation of survival was extended 10 years beyond a previous study of the same cohort of patients. PATIENTS AND METHODS: One hundred two nonparticipants were individually matched to 34 participants on major prognostic factors. Both groups were monitored from the date of cancer diagnosis (1971 through 1980) until March 1991. The support program consisted of weekly cancer peer support and family therapy, individual counseling, and use of positive mental imagery. Survival analysis controlled for the effects of other major prognostic factors in the outcome of breast cancer. RESULTS: The mean +/- SD survival time from date of cancer diagnosis to last date of follow-up was 96.0 +/- 53.2 months in the participant group compared with 85.1 +/- 63.4 months in the nonparticipant group, a nonsignificant difference (P = .1). Median survival was 84.0 months for participants (95% confidence interval [CI], 59 to 133) and 66.0 months for nonparticipants (95% CI, 48 to 105). A second analysis restricted nonparticipants to those who had a survival time > or = that of the matched case at time of entry into the support program. Survival increased to a mean of 101.1 months (median, 105.0; 95% CI, 71 to 132) for nonparticipants and remained unchanged for participants, also a statistically nonsignificant difference (P = .9). CONCLUSION: While the program may have beneficial effects on quality of life, this study does not indicate a significant favorable impact on survival with breast cancer or that the program is serving as a social locus for the gathering of exceptional survivors.