General United States Population Research Articles

Incidence and Mortality Trends of Liver Cancer among Puerto Ricans, US Hispanics and Non-Hispanic US Population

Purpose: Hepatocellular carcinoma incidence rates vary greatly among different ethnic groups. Most of the information regarding the epidemiology of liver cancer in Hispanics is based on evaluation of databases in which there is negligible representation of island Puerto Ricans. The aim of this study was to assess the trends in the incidence and mortality rates of liver cancer in Puerto Ricans, United States (US) Hispanics and the US general population. Methods: We analyzed the databases of the Puerto Rico (PR) Cancer Registry, the US SEER 11, and the PR and US Vital Statistics for all cases of liver cancer diagnosed in the period 1992–2001. A trend analysis of the age-standardized liver cancer incidence/mortality rates (per 100,000) was performed using the direct method (Standard World Population 1960) from 1992–2001. Annual percent change (APC) was estimated with the Poisson model using as predictor year of diagnosis. Results: During the study period, Puerto Ricans and US Hispanics (US-H) showed the highest incidence and mortality trends for liver cancer. The incidence of liver cancer remained stable for Puerto Ricans (APC = 0.06%) yet rapidly increased in the US general population (APC = 4.0%) and US-H (APC = 3.73%). The incidence of liver cancer is increasing in all groups and sexes, except among Puerto Rican females who showed a decreasing incidence trend (APC = -1.99%). Puerto Ricans had the highest mortality rates from liver cancer for both sexes and across all age groups, despite exhibiting a decreasing trend during the study period (APC = -1.68). An increasing mortality trend was evident for both US (APC = 1.08) and US-H (APC = 1.14). Conclusion: Both US Hispanics and Puerto Ricans are disproportionately affected by liver cancer having a higher incidence and mortality rates, respectively, in comparison to the US general population. Further studies should explore the reasons for these ethnic disparities.

Shifting Breast Cancer Trends in the United States

United States breast cancer incidence rates declined during the years 1999 to 2003, and then reached a plateau. These recent trends are impressive and may indicate an end to decades of increasing incidence. To put emerging incidence trends into a broader context, we examined age incidence patterns (frequency and rates) during five decades. We used age density plots, two-component mixture models, and age-period-cohort (APC) models to analyze changes in the United States breast cancer population over time. The National Cancer Institute's Connecticut Historical Database and Surveillance, Epidemiology, and End Results program collected 600,000+ in situ and invasive female breast cancers during the years 1950 to 2003. Before widespread screening mammography in the early 1980s, breast cancer age-at-onset distributions were bimodal, with dominant peak frequency (or mode) near age 50 years and smaller mode near age 70 years. With widespread screening mammography, bimodal age distributions shifted to predominant older ages at diagnosis. From 2000 to 2003, the bimodal age distribution returned to dominant younger ages at onset, similar to patterns before mammography screening. APC models confirmed statistically significant calendar-period (screening) effects before and after 1983 to 1987. Breast cancer in the general United States population has a bimodal age at onset distribution, with modal ages near 50 and 70 years. Amid a background of previously increasing and recently decreasing incidence rates, breast cancer populations shifted from younger to older ages at diagnosis, and then back again. These dynamic fluctuations between early-onset and late-onset breast cancer types probably reflect a complex interaction between age-related biologic, risk factor, and screening phenomena.

Incidence of cytomegalovirus infection among the general population and pregnant women in the United States

BackgroundCytomegalovirus (CMV) is a common opportunistic infection among HIV-infected individuals, a major source of serious complications among organ-transplant recipients, and a leading cause of hearing loss, vision loss, and mental retardation among congenitally infected children. Women infected for the first time during pregnancy are especially likely to transmit CMV to their fetuses. More children suffer serious disabilities caused by congenital CMV than by several better-known childhood maladies such as Down syndrome or fetal alcohol syndromeMethodsUsing CMV seroprevalence data from the nationally representative Third National Health and Nutrition Examination Survey, we estimated CMV incidence among the general United States population and among pregnant women. We employed catalytic models that used age-specific CMV seroprevalences as cumulative markers of past infections in order to derive estimates of three basic parameters: the force of infection, the basic reproductive rate, and the average age of infection. Our main focus was the force of infection, an instantaneous per capita rate of acquisition of infection that approximates the incidence of infection in the seronegative population.ResultsAmong the United States population ages 12–49 the force of infection was 1.6 infections per 100 susceptible persons per year (95% confidence interval: 1.2, 2.4). The associated basic reproductive rate of 1.7 indicates that, on average, an infected person transmits CMV to nearly two susceptible people. The average age of CMV infection was 28.6 years. Force of infection was significantly higher among non-Hispanic Blacks (5.7) and Mexican Americans (5.1) than among non-Hispanic Whites (1.4). Force of infection was significantly higher in the low household income group (3.5) than in the middle (2.1) and upper (1.5) household income groups. Based on these CMV incidence estimates, approximately 27,000 new CMV infections occur among seronegative pregnant women in the United States each year.ConclusionThese thousands of CMV infections in pregnant women, along with the sharp racial/ethnic disparities in CMV incidence, are compelling reasons for accelerating research on vaccines and other interventions for preventing congenital CMV disease. Nevertheless, the relatively low force of infection provides encouraging evidence that modestly effective vaccines and rates of vaccination could significantly reduce CMV transmission.

Schizophrenia and psychotic symptoms in families of two American Indian tribes.

BackgroundThe risk of schizophrenia is thought to be higher in population isolates that have recently been exposed to major and accelerated cultural change, accompanied by ensuing socio-environmental stressors/triggers, than in dominant, mainstream societies. We investigated the prevalence and phenomenology of schizophrenia in 329 females and 253 males of a Southwestern American Indian tribe, and in 194 females and 137 males of a Plains American Indian tribe. These tribal groups were evaluated as part of a broader program of gene-environment investigations of alcoholism and other psychiatric disorders.MethodsSemi-structured psychiatric interviews were conducted to allow diagnoses utilizing standardized psychiatric diagnostic criteria, and to limit cultural biases. Study participants were recruited from the community on the basis of membership in pedigrees, and not by convenience. After independent raters evaluated the interviews blindly, DSM-III-R diagnoses were assigned by a consensus of experts well-versed in the local cultures.ResultsFive of the 582 Southwestern American Indian respondents (prevalence = 8.6 per 1000), and one of the 331 interviewed Plains American Indians (prevalence = 3.02 per 1000) had a lifetime diagnosis of schizophrenia. The lifetime prevalence rates of schizophrenia within these two distinct American Indian tribal groups is consistent with lifetime expectancy rates reported for the general United States population and most isolate and homogeneous populations for which prevalence rates of schizophrenia are available. While we were unable to factor in the potential modifying effect that mortality rates of schizophrenia-suffering tribal members may have had on the overall tribal rates, the incidence of schizophrenia among the living was well within the normative range.ConclusionThe occurrence of schizophrenia among members of these two tribal population groups is consistent with prevalence rates reported for population isolates and in the general population. Vulnerabilities to early onset alcohol and drug use disorders do not lend convincing support to a diathesis-stressor model with these stressors, commonly reported with these tribes. Nearly one-fifth of the respondents reported experiencing psychotic-like symptoms, reaffirming the need to examine sociocultural factors actively before making positive diagnoses of psychosis or schizophrenia.

Kidney Function and Sarcopenia in the United States General Population: NHANES III

Background/Aims: It is not known whether sarcopenia is associated with levels of kidney function in community-dwelling adults. Methods: Subjects were adult Third National Health and Nutrition Examination Survey participants in whom bioimpedance was performed (n = 13,770). Class I sarcopenia was defined as a skeletal mass index of 1–2 standard deviations below and class II sarcopenia as <2 standard deviations below young adult values. Results: A monotonic association existed between increasing sarcopenia prevalence and declining glomerular filtration rate: ≧90 ml/min/1.73 m², 22.8% class I, 3.8% class II sarcopenia; 60–89 ml/min/1.73 m², 33.6% class I, 5.3% class II sarcopenia, and <60 ml/min/1.73 m², 50.7% class I, 9.4% class II sarcopenia (p < 0.0001). This association dissipated when adjustment was made for older age and more comorbidity. Multivariate associations (p < 0.05) of sarcopenia and chronic kidney disease included: older age; low income-to-poverty ratio; overweight; lack of exercise; low carbohydrate, fat and protein intake; hypercalcemia; low 25-hydroxy-vitamin D₃; higher diastolic blood pressure, and insulin resistance. Conclusion: Sarcopenia is common in community-dwelling adults with chronic kidney disease. Although causality cannot be assumed, several associations may be susceptible to intervention.

Prevalence of cervical dystonia and spasmodic torticollis in the United States general population

Purpose To examine the prevalence of cervical dystonia (CD) in the US population. Method A survey consisting of relevant demographic and CD-related questions was e-mailed to 2 million people selected from the Shopper's Voice™ database. Results Across a census-weighted sample, 0.280% of 60,062 respondents (79% female, 92% Caucasian) reported a diagnosis of CD and 0.170% reported a diagnosis of ST, indicating possible prevalence of 0.390% of either/both diagnoses. Less than half (42.7%) of those who reported either diagnosis were receiving treatment. Conclusions CD is potentially under-diagnosed and under-treated; approaches to increase awareness of CD and its treatments are needed.

Comparison Between the C-leg® Microprocessor-Controlled Prosthetic Knee and Non-Microprocessor Control Prosthetic Knees

This study investigated energy expenditure and obstacle course negotiation between the C-leg and various non-microprocessor control (NMC) prosthetic knees and compared a quality of life survey (SF-36v2) of use of the C-leg to national norms. Thirteen subjects with unilateral limb loss (12 with trans-femoral and one with a knee disarticulation amputation) participated in the study. The mean age was 46 years, range 30-75. Energy expenditure using both the NMC and C-leg prostheses was measured at self-selected typical and fast walking paces on a motorized treadmill. Subjects were also asked to walk through a standardized walking obstacle course carrying a 4.5 kg (10 lb) basket and with hands free. Finally, the SF-36v2 was completed for subjects while using the C-leg. Statistically significant differences were found in oxygen consumption between prostheses at both typical and fast paces with the C-leg showing decreased values. Use of the C-leg resulted in a statistically significant decrease in the number of steps and time to complete the obstacle course. Scores on a quality of life index for subjects using the C-leg were above the mean for norms for limitation in the use of an arm or leg, equal to the mean for the general United States population for the physical component score and were above this mean for the mental component score. Based on oxygen consumption and obstacle course findings, the C-leg when compared to the NMC prostheses may provide increased functional mobility and ease of performance in the home and community environment. Questionnaire results suggest a minimal quality of life impairment when using a C-leg for this cohort of individuals with amputation.

Compulsive Buying Disorder: A Review of the Evidence

Compulsive buying disorder is characterized by excessive or poorly controlled preoccupations, urges, or behaviors regarding shopping and spending that lead to subjective distress or impaired functioning. Compulsive buying disorder is estimated to have a lifetime prevalence of 5.8% in the United States general adult population. In clinical settings, most individuals with compulsive buying disorder are women (approximately 80%). This gender difference may be artifactual. Compulsive buying disorder is typically chronic or intermittent, with an age of onset in the late teens or early 20s. Comorbid mood and anxiety disorders, substance use disorders, eating disorders, and other disorders of impulse control are common, as are Axis II disorders. The disorder occurs worldwide, mainly in developed countries with market-based economies, and it tends to run in families with mood disorders and substance abuse. There is no standard treatment for compulsive buying disorder, but group cognitive-behavioral models seem promising, and psychopharmacologic treatments are being actively studied. Other treatment options include simplicity circles, 12-step programs, financial counseling, bibliotherapy, marital therapy, and financial counseling. Directions for future research are discussed.

Long-Term Cognitive, Emotional, and Functional Outcomes in Trauma Intensive Care Unit Survivors Without Intracranial Hemorrhage

Trauma patients without intracranial hemorrhage or focal neurologic deficits are typically considered low risk for lasting neuropsychological and emotional deficits, and such sequela may be overlooked, especially in those with skull fractures and concussions. We undertook this study to determine the prevalence of and risk factors for persistent cognitive impairment and emotional and functional difficulties in a sample of adult trauma intensive care unit survivors without intracranial hemorrhage. We queried the Vanderbilt University Trauma Registry for all patients admitted during 2003 with an Injury Severity Score >25 and a head computed tomography scan showing no intracranial hemorrhage. Of the 97 patients identified, 58 were evaluated, in person between 12 to 24 months after hospital discharge, with a comprehensive battery of cognitive, emotional, and functional instruments. The Informant Questionnaire of Cognitive Decline in the Elderly-Short Form (IQCODE-SF) was used to evaluate for pre-existing cognitive deficits in patients suspected of having cognitive impairment before their trauma. A total of 33 (57%) patients were determined to have cognitive impairment, which was most pronounced in the domains of attention and executive functioning/verbal fluency. Of these patients, one (3%) was determined by the IQCODE-SF to be cognitively impaired before trauma intensive care unit hospitalization. Of the 58 patients studied, 21 (36.2%) had a concussion or skull fracture and 37 (63.8%) had neither. Cognitive impairment was significantly more likely to occur in patients who sustained a concussion or skull fracture than in trauma patients who did not (81% versus 43%; p = 0.006). Patients reported significant depressive symptoms (56%), significant symptoms of posttraumatic stress disorder (38%), and significant symptoms of anxiety (29%). Quality of life scores were lower than in the general United States population and employment difficulties were widespread. A total of 34% of patients reported being unemployed at follow-up, and cognitive impairment was more common among these patients compared with patients in the workforce (p = 0.03). Neither cognitive impairment nor emotional dysfunction was associated with age, sex, race, Injury Severity Score, blood loss, ventilatory days, or intramedullary nailing of long-bone fractures. The majority of trauma survivors without intracranial hemorrhage display persistent cognitive impairment, which is nearly twice as likely in those with skull fractures or concussions. This cognitive impairment was associated with functional defects, poor quality of life, and an inability to return to work. Future research must delineate modifiable risk factors for these poor outcomes, especially in patients with skull fractures and concussions, to help improve long-term cognitive and functional status.

Policy challenges in American Indian/Alaska Native health professions education

Disparities exist in the numbers of American Indians and Alaska Natives (AI/ANs) in the health professions as compared with the general United States (US) population. Numerous factors contribute to this disparity, including inequities in education, healthcare and economic development opportunities. The basis for inequality is rooted in the policy arena. Issues in health professions education blend the arenas of health policy and education policy. Although AI/ANs have a birth right to healthcare and to education programs as a result of treaties signed between the US and tribal governments, these programs are severely under funded. To understand the disparities in health professions education for AI/ANs today, it is important to understand the history of US federal Indian policy over the last two centuries. Following a history of removal, assimilation, reorganization and termination, the current phase of federal Indian policy is tribal self-determination. As a result, opportunities exist to reduce disparities in the number of AI/AN health professionals and in health disparities. AI/AN tribes have the opportunity to work in partnership to coordinate health, education, social and economic development policy to increase the numbers of AI/AN health professionals. Tribes can also make it a priority to coordinate political advocacy efforts to improve funding for AI/AN health and education programs.

Dietary Magnesium Intake and Risk of Incident Hypertension Among Middle-Aged and Older US Women in a 10-Year Follow-Up Study

To assess the hypothesis that magnesium intake is beneficial in the primary prevention of hypertension, 28,349 female United States health professionals aged > or =45 years participating in the Women's Health Study (WHS), who initially reported normal blood pressure (systolic blood pressure <140 mm Hg, diastolic blood pressure <90 mm Hg, no history of hypertension or antihypertensive medications), were prospectively studied. A semi-quantitative food frequency questionnaire was used to estimate magnesium intake. During a median follow-up of 9.8 years, 8,544 women developed incident hypertension. After adjustment for age and randomized treatment, magnesium intake was inversely associated with the risk for developing hypertension; women in the highest quintile (median 434 mg/day) had a decreased risk for hypertension (relative risk 0.87, 95% confidence interval [CI] 0.81 to 0.93, p for trend <0.0001) compared with those in the lowest quintile (median 256 mg/day). This inverse association was attenuated but remained significant after further adjustment for known risk factors. In the fully adjusted model, the relative risks were 1.00 (95% CI 0.95 to 1.10), 1.02 (95% CI 0.95 to 1.10), 0.96 (95% CI 0.89 to 1.03), and 0.93 (95% CI 0.86 to 1.02) (p for trend = 0.03). Similar associations were observed for women who never smoked and reported no history of high cholesterol or diabetes at baseline. In conclusion, the results suggest that higher intake of dietary magnesium may have a modest effect on the development of hypertension in women.

Anemia Screening in Elective Surgery: Definition, Significance and Patients?? Interests

To the Editor: In their article, Olson et al. (1) concluded that routine assessment of hemoglobin levels for “healthy” patients undergoing low-risk elective surgery should be abandoned. We take issue with their conclusions. Because even mild anemia has been linked to increased morbidity and mortality (2–4), and knowing a patient's hemoglobin level can help caregivers identify and treat both anemia itself and various serious medical conditions associated with anemia, routine assessment of hemoglobin levels should be continued. Olson et al. defined anemia as having a hemoglobin levels ≤9 g/dL, assuming that these levels, even in asymptomatic patients, would indicate anemia that might necessitate therapy. By setting the hemoglobin threshold so low, the authors under-estimated the prevalence of anemia in their patients. The World Health Organization defines anemia as hemoglobin <13 g/dL in men and <12 g/dL in women (5). Data from the National Health and Nutrition Survey suggest a prevalence of 4.4%–5.9% in the general United States population (6). However, the reported incidence of anemia in surgical populations is dramatically increasing. In one study, up to 75% of hospitalized patients older than 65 yr old had anemia (7). Another study found 67% of cancer patients to be anemic, and many were untreated (8). Anemia is an independent predictor of morbidity and mortality (9). It might be argued that the poor outcomes associated with anemia are mostly the result of cases with very low hemoglobin levels. However, even mild anemia has been linked to increased morbidity and mortality in patients undergoing percutaneous coronary intervention (2), in patients with congestive heart failure (3), and in patients with the vicious cycle of cardio-renal-anemia syndrome (4). Numerous studies also show that anemia reduces quality of life and leads to poor performance (8,10). Again, hemoglobin levels between 12 and 9 g/dL have been equally implicated (11). Conversely, normalizing hemoglobin levels helps prevent dementia and improve brain function (12). Lastly, hemoglobin assessment is an inexpensive readily available screening tool for underlying comorbidities. For example, the prevalence of colon cancer varies from 4% to 15% (13) among patients in outpatient settings who present with iron-deficiency anemia. Anemia is a key predictor of reduced renal function (14). Our interest in anemia goes beyond surgical transfusion requirements. Anemia, once considered an innocent bystander, should no longer be left undetected or untreated (9). To manage anemia in elective surgery patients, we recently (15) developed a clinical care pathway calling for measuring a patient's hemoglobin 30 days before surgical procedures. This allows time for diagnosing and treating underlying comorbidities. Simply obtaining a hemoglobin level for those evaluated for low-risk surgery helps identify patients whose anemia may be attributable to silent killers such as colon cancer and helps caregivers decide upon appropriate diagnostic and therapeutic measures. Aryeh Shander, MD Mazyar Javidroozi, MD Department of Anesthesiology & Critical Care Medicine Englewood Hospital & Medical Center Englewood, NJ [email protected] Lawrence T. Goodnough, MD Departments of Pathology and Medicine Stanford University Stanford, CA

Proportionate Mortality Among Current and Former Members of the United Farm Workers of America, AFL-CIO, in California 1973-2000

Context: To further investigate mortality among farm workers, a proportionate mortality ratio (PMR) analysis was conducted among the membership of the United Farm Workers of America (UFW), a farm worker labor union, for the years 1973-2000 in the state of California. Purpose: This report compares proportionate mortality for 118 causes of death in the UFW and the general United States population, adjusting for age, sex, race and calendar year of death. In addition, an exploratory analysis was conducted comparing deaths in the UFW to deaths in the California Hispanic population. Methods: A roster of members of the UFW was compared to the death certificate master files of the state of California for the years 1973 to 2000. Matches were detected using automated techniques and visual review. PMR and associated confidence intervals were calculated using the National Institute for Occupational Safety and Health Life Table Analysis System using deaths in the U.S. as the standard. A similar analysis was conducted limiting attention to the time period 1988-2000 and using deaths in the California Hispanic population as the standard. Findings: There were a total of 139,662 members of the union included in the linkage that yielded 3,977 deaths in the time period 1973-2000. Proportionate mortality in the farm workers was significantly elevated for respiratory tuberculosis, malignant neoplasms of the stomach, biliary passages, liver and gallbladder, and uterine cervix, diabetes mellitus, cerebrovascular disease, cirrhosis of the liver, and “other diseases of the digestive system.” Transportation injuries including motor vehicles deaths, deaths from machine injuries, unintentional poisonings and assault and homicide were significantly elevated as well. Farm workers were at significantly lower risk of death from HIV-related disease, malignant neoplasms of the esophagus, intestine, pancreas, lung, urinary bladder, melanoma, and brain, all cancer deaths, “other diseases of the nervous system,” ischemic heart disease, conductive disorder, “other diseases of the heart,” emphysema, “other respiratory diseases,” and symptoms and ill-defined conditions. These results were similar when using California Hispanic deaths as the standard for the years 1988-2000. There was still excess proportionate mortality from tuberculosis, cerebrovascular disease and unintentional injuries among the UFW members and lowered mortality from HIV related deaths, all cancer deaths combined and diseases of the heart. Conclusions: These results include some unique findings in regard to both excess and deficits of mortality that may be explained by the Hispanic ethnicity and recent immigration of the cohort.

Prevalence of Active Hepatitis C Virus Infection in Patients with Systemic Lupus Erythematosus

Hepatitis C virus (HCV) infection is associated with various autoimmune disorders and can mimic systemic lupus erythematosus (SLE) clinically and serologically. There are few reports of prevalence of HCV infection in patients with SLE. The aim of this study was to determine the prevalence of HCV viremia by polymerase chain reaction (PCR) in patients with SLE. We tested sera from 40 consecutive patients with SLE collected from 1993 to 2000. All of the patients had HCV viral load measured by PCR. The results were compared with the prevalence of HCV viremia in a control group of blood donors in our geographic area as well as in United States general population. HCV was detected in 4 of 40 patients (10%). The prevalence of HCV in our area blood donors is 130 cases per 100,000 persons (0.13%; P<0.0001). The prevalence of HCV infection in the United States general population, screened by PCR, is 1330 cases per 100,000 people (1.33%; P=0.002). The prevalence of HCV infection was significantly higher in our SLE patients than in our area blood donors. The frequency of HCV infection was also higher than that of the United States general population. Our observations support those of other investigators who have reported an increased prevalence of HCV infection in SLE patients. Further detailed investigation of this association may help in understanding the pathogenesis of SLE. HCV infection should be tested when the diagnosis of SLE is considered.

Personal Health Habits of American Cardiologists

This study surveyed all cardiologists in a large coalition of cardiology groups. A 1-page, 25-item anonymous questionnaire containing 3 sections (demographics, medical history, and current medications and supplements) was used. Data from returned questionnaires were analyzed and compared with those in national databases. Eight hundred surveys were sent, and complete data were available for analysis on 471 (59%). The average age of the participants was 48.6 years; 7.1% were women. The average body mass index (BMI) was 25 kg/m(2), and 8% were obese (BMI > or =30 kg/m(2)); 1.3% were active smokers; 89% exercised > or =1 time/week; and 72% had > or =1 alcoholic drink/week. Red wine was the most frequently consumed alcoholic beverage. Associated cardiovascular risks included dyslipidemia (28%), hypertension (14%), and diabetes mellitus (0.6%). Four percent had experienced coronary events. Compared with matched cohorts from the United States (US) population, cardiologists reported lower rates of hypertension, dyslipidemia, and diabetes mellitus, and the rates of smoking and obesity were 1/18 and 1/3 those of the US population, respectively. Aspirin and statins were each taken daily by about 1/3 of the participants. A cardiologist with dyslipidemia was 5 times as likely to be treated and a cardiologist with hypertension was almost twice as likely to be treated as an American adult man with either of these disorders, respectively. In conclusion, cardiologists appear to follow healthier lifestyles than the general adult US population.

Preconception sex selection demand and preferences in the United States

Preconception sex selection for nonmedical reasons raises important moral, legal, and social issues. The main concern is based upon the assumption that a widely available service for sex selection will lead to a socially disruptive imbalance of the sexes. For a severe sex ratio distortion to occur, however, at least two conditions have to be met. First, there must be a significant preference for children of a particular sex, and second, there must be a considerable interest in employing sex selection technology. Our objective was to ascertain such demand and preferences among the United States general population. Cross-sectional web-based survey. United States general population. One thousand one hundred ninety-seven men and women aged 18 to 45 years. None. Web-based questionnaire assessing preferences for sex of children and demand for preconception sex selection for nonmedical reasons. Eight percent of respondents would use preconception sex selection technology, 74% were opposed, and 18% were undecided. If the sex selection process was simplified to taking a pill, 18% would be willing to use such a medication, 59% were opposed, and 22% were undecided. In terms of gender choices, 39% of respondents would like their first child to be a son, 19% would like their first child to be a daughter, and 42% had no preference. Overall, 50% wished to have a family with an equal number of boys and girls, 7% with more boys than girls, 6% with more girls than boys, 5% with only boys, 4% with only girls, and 27% had no preference. Preconception sex selection technology via sperm separation is unlikely to be used by the majority of the United States population and is unlikely to have a significant impact on the natural sex ratio.

Longitudinal Model Predicting Mutual Partner Violence Among White, Black, and Hispanic Couples in the United States General Population

Longitudinal Model Predicting Mutual Partner Violence Among White, Black, and Hispanic Couples in the United States General Population

Longitudinal Model Predicting Mutual Partner Violence Among White, Black, and Hispanic Couples in the United States General Population

Longitudinal Model Predicting Mutual Partner Violence Among White, Black, and Hispanic Couples in the United States General Population

Longitudinal Model Predicting Mutual Partner Violence Among White, Black, and Hispanic Couples in the United States General Population

This analysis determines the longitudinal predictors of male-to-female (MFPV) or female-to-male (FMPV) alone and mutual partner violence (MPV) among White, Black, and Hispanic couples. A national sample of couples 18 years of age or older was interviewed in 1995 and again in 2000. Participants constitute a multistage area probability sample representative of married and cohabiting couples from the 48 contiguous United States. Results indicate that most couples reporting violence engage in MPV. After controlling for other factors, Blacks are 3 times more likely to report MPV at follow-up and Hispanics are 9 times more likely to report MFPV. The results indicate that ethnic minorities are at greater risk of MPV. In addition, the predictors of partner violence vary depending on the type of partner violence. These findings highlight the importance of distinguishing different types of partner violence and have important epidemiological and prevention implications.

Incidence and risk factors for the occurrence of non‐AIDS‐defining cancers among human immunodeficiency virus‐infected individuals

The objective of this study was to determine the rates and predictors of non-AIDS-defining cancers (NADCs) among a cohort of human immunodeficiency virus (HIV)-infected individuals. The authors conducted a retrospective study of 4144 HIV-infected individuals who had 26,916 person-years of follow-up and who had open access to medical care at 1 of the United States military HIV clinics during the years 1988-2003. Cancer incidence rates were race specific and were adjusted for age; these were compared with national rates using logistic regression to assess predictors of NADC development. One hundred thirty-three NADCs were diagnosed with a rate of 980 diagnoses per 100,000 person-years. The most frequent NADCs were skin carcinomas (basal cell and squamous cell), Hodgkin disease, and anal carcinoma. The results showed that there were higher rates of melanoma, basal and squamous cell skin carcinomas, anal carcinoma, prostate carcinoma, and Hodgkin disease among the HIV-infected cohort compared with age-adjusted rates for the general United States population. Predictors of NADCs included age older than 40 years (odds ratio [OR], 12.2; P < 0.001), Caucasian/non-Hispanic race (OR, 2.1; P < 0.001), longer duration of HIV infection (OR, 1.2; P < 0.001), and a history of opportunistic infection (OR, 2.5; P < 0.001). The use of highly active antiretroviral therapy (HAART) was associated with lower rates of NADCs (OR, 0.21; P < 0.001). A low CD4 nadir or CD4 count at diagnosis (< 200 cells/mL) was not predictive of NADCs. The most frequent NADCs were primary skin malignancies. Melanoma, basal and squamous cell skin carcinomas, anal carcinoma, prostate carcinoma, and Hodgkin disease occurred at higher rates among HIV-infected individuals. The implementation of screening programs for these malignancies should be considered. Most risk factors for the development of NADCs are nonmodifiable; however, the use of HAART appeared to be beneficial in protecting against the development of malignant disease.