Trends in the first ten years of AIDS in New York City. The New York City Department of Health AIDS Surveillance Team.

With over 37,000 cases of acquired immunodeficiency syndrome (AIDS) reported by the end of 1991, New York City had reported nearly 20% of all US cases in the first decade of the AIDS epidemic. This report examines cases diagnosed through 1990 and reported through 1991 to describe rates and trends in the affected subpopulations. Case data were collected by the New York City Department of Health AIDS Surveillance Team, using a format standardized by the federal Centers for Disease Control. Deaths attributable to human immunodeficiency virus (HIV) infection were examined using data provided by the New York City Department of Health Bureau of Vital Statistics. From 1981 through 1990, 37,436 cases of AIDS were diagnosed: 83% in men over the age of 19 years, 15% in women over 19, 2% in children under 13, and less than 1% in teenagers aged 13-19. Cumulative rates in New York City adults were as high as 100 per 10,000 in nine neighborhoods. Predominant trends included a sustained plateau in reported incidence in men who reported having sex with men and a continuing rise in cases in injection drug users and women infected through heterosexual intercourse. HIV-related deaths in men, women, and children were continuing to rise at the end of the decade. During the first decade of the AIDS/HIV epidemic, case surveillance in New York City measured the visible portion of the epidemic and provided important data on subepidemics.

Which newborns in New York City are at risk for special education placement?

In this study of 162 third graders in New York City public schools, we found that slightly over half of the children in special education were males who had Medicaid coverage at birth and mothers with medical conditions or adverse health habits noted on the birth certificate; two thirds of the children with this combination of characteristics actually were placed in special education. These findings suggest that newborns at risk for later learning disabilities can be targeted to receive preventive interventions.

Treatment of homosexual alcoholics in government-funded agencies: provider training and attitudes.

Alcoholism treatment providers in 36 government-funded agencies in New York City were surveyed for information about their training for and attitudes toward the treatment of homosexual patients. The 164 respondents had limited knowledge about how to evaluate and treat homosexual alcoholics and frequently did not discuss sexual orientation with their clients even though they considered it important. The training and supervision of most providers in the treatment of alcoholic homosexual clients was substandard or nonexistent. About half of the providers believed that treatment programs would benefit from having openly gay staff and felt that being openly gay carried little professional risk. Respondents also reported that development of programs for homosexual alcoholics had little priority in their facilities. Many believed that homosexual alcoholics are less likely to seek help and may have more difficulty achieving sobriety.

Birth outcomes for infants of drug abusing mothers.

Birthweight, gestational age, and Apgar scores of drug-exposed infants were compared to those of drug-free infants using data collected from birth certificates. Infants born to abusers of opiates and cocaine as well as opiates and cocaine together were also compared to one another. The presence of adverse neurologic signs, need for intensive care, and length of hospitalization after delivery were compared among different types of drug-exposed infants using data collected in a program for infants at risk for developmental delay. Infants of all drug abusers weighed an average of 423 g less than controls; mean gestational age for infants in the different drug groups ranged from four to ten days less than for controls. Opiate-exposed infants were significantly more likely to show adverse neurologic signs than were those with exposure only to cocaine, and were more likely to need intensive care. Infants of polydrug (cocaine + opiate) abusers fared worse than infants born to abusers of single drugs with respect to birthweight, gestational age, and length of hospital stay. Outcomes for infants of "crack" abusers were worse than those for infants exposed to other forms of cocaine with respect to birthweight and adverse neurologic signs. Our findings suggest that special outreach and follow-up efforts may be needed to facilitate the optimal development of these infants.

A simple approximation for calculating sample sizes for comparing independent proportions.

A simple approximation is provided to the formula for the sample sizes needed to detect a difference between two binomial probabilities with specified significance level and power. The formula for equal sample sizes was derived by Casagrande, Pike and Smith (1978, Biometrics 34 , 483-486) and can be easily generalized to the case of unequal sample sizes. It is shown that over fairly wide ranges of parameter values and ratios of sample sizes, the percentage error which results from using the approximation is no greater than 1%. The approximation is especially useful for the inverse problem of estimating power when the sample sizes are given.

Separation of younger red cells with improved survival in vivo: an approach to chronic transfusion therapy.

Transfusion of donor blood containing predominantly younger red cells with prolonged survival in vivo could significantly reduce the iron overload of patients requiring chronic transfusion. Age-dependent separation of red cells can be obtained by buoyant density centrifugation on isotonic solutions of arabino-galactane. By this technique, rabbit red cells were separated on a single layer of arabino-galactane and the appropriate fraction, after being labeled with (51)Cr, was reinfused into the donor. The survival in vivo was calculated by a mathematical model which corrects for both (51)Cr elution and random loss. There was a significant difference in survival in vivo between the light young red cells and the heavy old red cells. The potential survival in vivo of the 50% lightest red cells was 56 days, compared to 28 days for the heaviest red cells. Arabino-galactane appeared to be devoid of acute toxicity and of strong antigenicity and it did not appear to adhere to the red cell stroma. These data extrapolated to humans indicate that it may be feasible and advantageous to use red cells fractionated by this technique for transfusion. The 50% lightest human red cells can be expected to have a mean survival of 88 days, compared with 60 days for unfractionated blood. Transfusion of young red cells could significantly reduce the iron overload for patients requiring chronic transfusion, by avoiding infusion of the oldest red cells, which contribute equally to iron overload yet offer only transient survival in vivo.

Retention of patients in the New York City methadone maintenance treatment program.

The retention, termination, and readmission of patients admitted to the New York City Methadone Maintenance Program from November 1970 through the end of 1973 were analyzed. Sixty-seven percent of patients remained in continuous treatment for 1 year and 50% for 2 years. The retention of patients admitted in successive years declined. Women had somewhat higher retention than men, as did patients over age 30 compared with those 30 or under; there were no differences among ethnic groups. Termination rates were determined for specific reasons for termination from the program as a function of length of time in treatment and also for calendar trimesters. A sharp increase in the rate of voluntary terminations was noted during the second and third trimesters of 1973. Rates of readmission to the program were obtained, specific for reason for first termination and length of time in initial treatment. One out of five terminated patients was readmitted to the program within 24 months.

Reliability of self-reported age of first drug use: analysis of New York City narcotics register data.

New York City Narcotics Register data were analyzed to determine the consistency of self-reported age of first drug use among multiple reports on a single individual. There were 15,263 individuals with two or more reports between January 1973 and April 1974 which specified age of first drug use. Discrepancies were noted in 68% of cases; in 31% the responses differed by 3 or more years. Even among reports from a single agency, there were discrepancies in 45% of cases. The degree of consistency was only slightly better when the analysis was restricted to subjects 20 years of age and younger. No comparable inconsistency was observed with respect to self-reported year of birth.