Defining behavioral methods to prevent sexually transmitted diseases through intervention research.

This article focuses on efforts to use behavioral interventions to prevent STDs. Presented is a history of attempts to prevent and control STDs through behavior change and a summary of the main theoretic approaches to human behavior that have provided the scientific base for behavioral public health interventions. The authors also review the important behavior intervention studies, most of which have addressed chronic disease prevention.

Measles vaccination in pediatric emergency departments during a measles outbreak.

Objective: To determine the proportion of preschool-aged patients attending two inner-city hospital pediatric emergency departments (EDs) who were eligible for measles vaccination, to describe their demographic and clinical characteristics, and to assess the performance of the ED immunization programs that were implemented during a measles outbreak in vaccinating eligible children.

Design: Cross-sectional study.

Setting: Pediatric EDs of two urban hospitals in Chicago, Ill, in 1989.

The epidemiology of multidrug-resistant tuberculosis in the United States.

There has been a significant increase in the number of cases of MDR-TB in the United States. Although cases of MDR-TB have been reported from many areas of the country, the majority of the cases are concentrated in large urban areas. MDR-TB is difficult and expensive to treat.

Prevalence of self-medication with antibiotics among patients attending a clinic for treatment of sexually transmitted diseases.

To ascertain the prevalence of self-medication with antimicrobial agents among patients attending a clinic for treatment of sexually transmitted diseases (STDs), we administered a questionnaire to and collected a urine specimen for antimicrobial testing from 551 patients before treatment. We defined self-medication as an antimicrobial agent taken on the patient's own initiative by self-report during the week before the visit to the clinic or a positive urine assay for antimicrobial agents at the time of the clinic visit. We tested urine for the presence of antimicrobial agents by a disk diffusion method using Sarcina lutea as the test organism.

Preventive services guidelines for primary care clinicians caring for adults and adolescents infected with the human immunodeficiency virus.

Primary care clinicians caring for persons infected with the human immunodeficiency virus greatly contribute to public health efforts to combat the human immunodeficiency virus/acquired immunodeficiency disease epidemic in the United States. Primary care clinicians can assess the prevention needs of persons infected with the human immunodeficiency virus and ensure that needed prevention services are received.

Human immunodeficiency virus counseling, testing, referral, and partner notification services. A cost-benefit analysis.

Background: The Centers for Disease Control and Prevention (Atlanta, Ga) annually provides more than +100 million in funding to states, territories, and cities for the provision of human immunodeficiency virus (HIV) counseling, testing, referral, and partner notification (CTRPN) services. Given the size of this expenditure, it is important to consider the net benefits of this program activity. We compared the economic costs and benefits of publicly funded HIV CTRPN services.

When tuberculosis treatment fails. A social behavioral account of patient adherence.

Several conclusions about measuring adherence can be drawn. Probably the best approach is to use multiple measures, including some combination of urine assays, pill counts, and detailed patient interviews. Careful monitoring of patient behavior early in the regimen will help predict whether adherence is likely to be a problem.

American adults' knowledge of HIV testing availability.

Objectives: Understanding client needs, knowledge, and preferences about services is necessary to ensure that human immunodeficiency virus (HIV) counseling and testing programs are accessible. This study addressed knowledge of HIV testing availability.

Methods: To study American adults' knowledge of HIV testing availability, we collected data during 1990 by random digit-dialing telephone surveys of adults residing in 44 states and the District of Columbia.

A method for identifying persons at high risk for sexually transmitted infections: opportunity for targeting intervention.

Objectives: The purpose of this study was to develop a method to identify persons at high risk for acquiring new sexually transmitted infections.

Methods: Computerized medical records from sexually transmitted disease clinics in Dade County, Florida, were used to conduct a retrospective cohort study. For all patients who visited in 1987, risk factors were identified for returning to the clinics within a year with a new sexually transmitted infection.

Disease prevention programs for racial and ethnic minorities.

Many studies show a dramatic relationship between socioeconomic status and disease incidence. Clear racial and ethnic disparities also exist in the occurrence of diseases such as acquired immunodeficiency syndrome (AIDS), tuberculosis and syphilis. Consequently, to identify true risk factors for diseases when planning prevention programs, the effect of socioeconomic status must be differentiated from that of race or ethnicity.

Successes and failures in vaccine delivery: evaluation of the immunization delivery system in Puerto Rico.

The objective of this study was to evaluate immunization delivery and determine reasons for low coverage among preschool-age public clinic attendees in Puerto Rico. In 25 randomly selected clinics, coverage and missed immunization opportunities were assessed in 273 children aged 2 to 59 months, exist interviews were conducted with parents, and providers were interviewed. Two neighborhoods close to the clinics were surveyed to determine parental knowledge about immunizations, and the vaccination status of children in these neighborhoods was assessed.

When, where, and how do immunizations fail?

There are two main reasons for failure of immunizations: (1) failure of the vaccine delivery system to provide potent vaccines properly to persons in need; and (2) failure of the immune response, whether due to inadequacies of the vaccine or factors inherent in the host. The first category is by far the most important worldwide. The major factor contributing to failure of the delivery system is failure to vaccinate; in the developing world this is commonly a result of inadequacy of the vaccine supply.

The multidrug-resistant tuberculosis challenge to public health efforts to control tuberculosis.

After years of steady decline, there has been an unprecedented resurgence of tuberculosis (TB) in the United States and outbreaks of multidrug-resistant tuberculosis (MDR-TB). The authors assess the nature, epidemiology, and implications of MDR-TB; provide suggestions for preventing drug resistance among patients with drug-susceptible TB; and offer recommendations for managing patients with MDR-TB. They outline the National Action Plan to Combat MDR-TB.

Structuring HIV prevention service delivery systems on the basis of social science theory.

In order to identify the optimal configuration of HIV prevention programs, it is necessary to examine different theoretical models of behavior change. Cognitive/decision-making theories of human behavior change are compared to social learning theories vis-a-vis their influence on the structure of service delivery systems. Cognitive/decision-making theories ascribe behavior change to the provision of new information and favor the development of homogeneous interventions providing clients with information about risk behaviors.

The laboratory's role in prevention and control of infectious diseases.

The laboratory is essential for optimal prevention and control of infectious diseases. Its major functions are identification and characterization of infectious agents and development of serological tests. Isolation of the agent and characterization of the immune response can lead to development of some of the most effective prevention tools--vaccines.

Diagnosis and therapy for common sexually transmitted diseases.

During the past decade, as the human immunodeficiency virus (HIV) has appeared, sexually transmitted diseases (STDs) have resurged to epidemic proportions, and STDs have been shown to facilitate transmission of HIV, the diagnosis and treatment of STDs have increased in importance for all clinicians. This article's recommendations for treatment of STDs that might more commonly be seen in a dermatology practice are based on the 1989 Sexually Transmitted Disease Treatment Guidelines of the Centers for Disease Control. Clinicians are encouraged to address actively prevention and treatment of sexual partners, a very important part of the management of STDs.

Pelvic inflammatory disease: trends in hospitalizations and office visits, 1979 through 1988.

Objectives: We attempted to assess trends in pelvic inflammatory disease occurrence and to describe current antibiotic treatment and use of surgical procedures for pelvic inflammatory disease in the United States.

Study Design: Analyses of hospitalizations according to the National Center for Health Statistics, National Hospital Discharge Survey for 1979 to 1988, and of office visits to private physicians from the National Disease and Therapeutic Index for 1979 to 1989 were done.

Results: From 1979 to 1988, a mean of 181,700 women aged 15 to 44 years were hospitalized each year for acute pelvic inflammatory disease (3.

Epidemiology of poliomyelitis in the United States one decade after the last reported case of indigenous wild virus-associated disease.

Poliomyelitis caused by wild poliovirus has been virtually nonexistent in the United States since 1980, and vaccine-associated paralytic poliomyelitis (VAPP) has emerged as the predominant form of the disease. We reviewed national surveillance data on poliomyelitis for 1960-1989 to assess the changing risks of wild-virus, vaccine-associated, and imported paralytic disease; we also sought to characterize the epidemiology of poliomyelitis for the period 1980-1989. The risk of VAPP has remained exceedingly low but stable since the mid-1960s, with approximately 1 case occurring per 2.

A million dollar measles outbreak: epidemiology, risk factors, and a selective revaccination strategy.

Between February 8 and April 4, 1986, an outbreak of measles occurred in the State of Arkansas. A total of 489 suspected measles cases were reported from 53 counties; 86 schools statewide reported suspected measles cases. There were 284 cases confirmed in 18 counties; 23.