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Recent trends in the vital statistics of the United States continued in 1995, including decreases in the number of births, the birth rate, the age-adjusted death rate, and the infant mortality rate; life expectancy at birth increased to a level equal to the record high of 75.8 years in 1992. Marriages and divorces both decreased. An estimated 3,900,089 infants were born during 1995, a decline of 1% from 1994. The preliminary birth rate for 1995 was 14.8 live births per 1000 total population, a 3% decline, and the lowest recorded in nearly two decades. The fertility rate, which relates births to women in the childbearing ages, declined to 65.6 live births per 1000 women 15 to 44 years old, the lowest rate since 1986. According to preliminary data for 1995, fertility rates declined for all racial groups with the gap narrowing between black and white rates. The fertility rate for black women declined 7% to a historic low level (71.7); the preliminary rate for white women (64.5) dropped just 1%. Fertility rates continue to be highest for Hispanic, especially Mexican-American, women. Preliminary data for 1995 suggest a 2% decline in the rate for Hispanic women to 103.7. The birth rate for teenagers has now decreased for four consecutive years, from a high of 62.1 per 1000 women 15 to 19 years old in 1991 to 56.9 in 1995, an overall decline of 8%. The rate of childbearing by unmarried mothers dropped 4% from 1994 to 1995, from 46.9 births per 1000 unmarried women 15 to 44 years old to 44.9, the first decline in the rate in nearly two decades. The proportion of all births occurring to unmarried women dropped as well in 1995, to 32.0% from 32.6% in 1994. Smoking during pregnancy dropped steadily from 1989 (19.5%) to 1994 (14.6%), a decline of about 25%. Prenatal care utilization continued to improve in 1995 with 81.2% of all mothers receiving care in the first trimester compared with 78.9% in 1993. Preliminary data for 1995 suggests continued improvement to 81.2%. The percent of infants delivered by cesarean delivery declined slightly to 20.8% in 1995. The percent of low birth weight (LBW) infants continued to climb in 1994 rising to 7.3%, from 7.2% in 1993. The proportion of LBW improved slightly among black infants, declining from 13.3% to 13.2% between 1993 and 1994. Preliminary figures for 1995 suggest continued decline in LBW for black infants (13.0%). The multiple birth ratio rose to 25.7 per 1000 births for 1994, an increase of 2% over 1993 and 33% since 1980. Age-adjusted death rates in 1995 were lower for heart disease, malignant neoplasms, accidents, and homicide. Although the total number of human immunodeficiency virus (HIV) infection deaths increased slightly from 42,114 in 1994 to an estimated 42,506 in 1995, the age-adjusted death rate for HIV infection did not increase, which may indicate a leveling off of the steep upward trend in mortality from HIV infection since 1987. Nearly 15,000 children between the ages of 1-14 years died in the United States (US) in 1995. The death rate for children 1 to 4 years old in 1995 was 40.4 per 100,000 population aged 1 to 4 years, 6% lower than the rate of 42.9 in 1994. The 1995 death rate for 5- to 14-year-olds was 22.1, 2% lower than the rate of 22.5 in 1994. Since 1979, death rates have declined by 37% for children 1 to 4 years old, and by 30% for children 5 to 14 years old. For children 1 to 4 years old, the leading cause of death was injuries, which accounted for for an estimated 2277 deaths in 1995, 36% of all deaths in this age group. Injuries were the leading cause of death for 5- to 14-year-olds as well, accounting for an ever higher percentage (41%) of all deaths. In 1995, the preliminary infant mortality rate was 7.5 per 1000live births, 6% lower than 1994, and the lowest ever recorded in the US. The decline occurred for neonatal as well as postneonatal mortality rates, and among white and black infants alike.
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PMID:Annual summary of vital statistics--1995. 971 45

We review the literature showing that positive illusions (i.e., self-aggrandizement, unrealistic optimism, and exaggerated perceptions of control) are common and associated with successful adjustment to stressful events, including conditions of extreme adversity. Using theory and recent data, we offer a basis for integrating positive illusions with the constraints of reality. We explicitly contrast the social psychological model of positive illusions with a personality viewpoint that addresses the question "Do higher levels of positive illusions predict higher levels of adjustment?" These issues are explored in the context of people coping with an array of normal stressful events, as well as those coping with more extreme stressful events, including cancer, heart disease, and HIV infection.
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PMID:Positive illusions and coping with adversity. 895 16

Priority health-risk behaviors that contribute to the leading causes of mortality, morbidity, and social problems among youth and adults often are established during youth, extend into adulthood, and are interrelated. The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults: behaviors that contribute to unintentional and intentional injuries, tobacco use, alcohol and other drug use, sexual behaviors, unhealthy dietary behaviors, and physical inactivity. The YRBSS includes both a national school-based survey conducted by CDC and state and local school-based surveys conducted by state and local education agencies. This report summarizes results from the national survey, 35 state surveys, and 16 local surveys conducted among high school students from February through May 1995. In the United States, 72% of all deaths among school-age youth and young adults result from four causes: motor vehicle crashes, other unintentional injuries, homicide, and suicide. Results from the 1995 YRBSS suggest that many high school students practice behaviors that may increase their likelihood of death from these four causes: 21.7% had rarely or never used a safety belt, 38.8% had ridden with a driver who had been drinking alcohol during the 30 days preceding the survey, 20.0% had carried a weapon during the 30 days preceding the survey, 51.6% had drunk alcohol during the 30 days preceding the survey, 25.3% had used marijuana during the 30 days preceding the survey, and 8.7% had attempted suicide during the 12 months preceding the survey. Substantial morbidity and social problems among school-age youth and young adults also result from unintended pregnancies and sexually transmitted diseases, including HIV infection. YRBSS results indicate that in 1995, 53.1% of high school students had experienced sexual intercourse, 45.6% of sexually active students had not used a condom at last sexual intercourse, and 2.0% had ever injected an illegal drug. Among adults, 65% of all deaths result from three causes: heart disease, cancer, and stroke. Most of the risk behaviors associated with these causes of death are initiated during adolescence. In 1995, 34.8% of high school students had smoked cigarettes during the 30 days preceding the survey, 39.5% had eaten more than two servings of foods typically high in fat content during the day preceding the survey, and only 25.4% had attended physical education class daily. YRBSS data are being used nationwide by health and education officials to improve national, state, and local policies and programs designed to reduce risks associated with the leading causes of mortality and morbidity. YRBSS data also are being used to measure progress toward achieving 21 national health objectives and one of eight National Education Goals.
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PMID:Youth risk behavior surveillance--United States, 1995. 898 Dec 66

Records of 133 AIDS patients treated at the Internal Medicine and Cardiology Service of the University Hospital in Brazzaville between January 1986 and December 1995 were analyzed. During the 10 years, 342 patients with AIDS were admitted, of whom 133 (38.9%) had recently developed cardiopathies. Patient ages ranged from 17 to 78 years (average, 35 years). 75 were male and 58 female. Clinical manifestations were often minor or even absent, but patient histories revealed functional symptoms. The patients were generally in an advanced stage of HIV infection. Clinical examination showed myocarditis to be the most frequent condition, with 81 cases (61%). Isolated liquid pericarditis was observed in 47 cases, including 15 with blockage. 25 patients showed mitral insufficiency, 16 tricuspid insufficiency, 2 aortic insufficiency due to infectious endocarditis, and 2 myocardial infarct. In 17 cases the onset was abrupt, with influenza-like symptoms. Standard cardiac radiography demonstrated cardiomegaly in all cases. Only 23 of the 133 electrocardiograms were considered normal. The other 110 showed various anomalies, of which the most frequent and significant was diffuse and concordant inversion of the T waves. Cardiac ultrasound in the 90 patients examined allowed diagnosis of 58 cases of myocarditis, 27 of liquid pericarditis not associated with myocarditis, and 5 of infectious endocarditis. 20 deaths were observed. The condition was stabilized in 85%. The fatality rate for AIDS-related cardiopathy is relatively low, on the order of 15-20%. Early diagnosis allows initiation of treatment, which often reduces patient discomfort.
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PMID:[The heart and AIDS]. 902 16

Invasion of the heart by HIV has become a clinical problem over the last decade. The objective of the present study was to systematically detect the excess HIV-related cardiac lesions in Kinshasa by performing echocardiography. The study population consisted of 166 HIV-infected patients and 166 HIV-seronegative patients with heart disease (control group). 69% of patients were at stage A of HIV infection and 31% were at stage AIDS C3 according to CDC 1993 criteria. A higher incidence of echocardiographic abnormalities was observed in HIV-seropositive subjects (28.3%) than in control subjects (13%) (p = 0.035). Systolic function was very severely impaired at the stage of AIDS (%R = 21,6 +/- 8.7) showing a highly significant difference (p < 0.01) compared to HIV-seropositive patients at stage A (% R = 29.2 +/- 11.9) and control subjects (%R = 28.9 +/- 5). One patient (0.6%) developed Salmonella enteritidis infectious endocarditis. Echocardiography, a noninvasive technique, contributes to the diagnosis of cardiac lesions associated with HIV infection. HIV has a predominant role in the severity of dilatation and alteration of the left ventricular systolic function in black Africans compared to Caucasian populations.
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PMID:[The effect of HIV infection on high incidence of heart diseases in Kinshasa (Zaire). Echocardiographic study]. 913 74

Endpoints are a continuing source of controversy in clinical trials of antiretroviral (specifically, anti-HIV) treatments. The most visible disagreement is about the respective roles of morbidity and mortality as endpoints, and laboratory measurements as endpoints. Laboratory measurements have been intensely examined as possible surrogates for clinical outcomes, but the definition of the usual clinical outcome-first occurrence or recurrence of an AIDS-defining condition or death-has received little critical scrutiny. First disease progression has serious weakness as an endpoint, and one should consider alternatives. In this paper, we suggest using rule-based schemes to rank patients' post-randomization histories and then using the ranks as an outcome measure, an extension of the work by Follmann et al. on heart disease. We evaluated six rule-based ranking schemes for antiretroviral trials by applying them to 60 participants in CPCRA 002 and comparing the results to subjective rankings given by five experts. The expert's rankings were in good agreement with each other, and the six rule-based schemes were clearly differentiated by their degree of agreement with the expert's rankings. The ranking scheme most in accord with the experts ranked patients first by seriousness of their most serious AIDS-defining disease, second by the timing of that disease, and the third by the total number of AIDS-defining diseases they experienced. Finally, we used this rule-based rankings to re-analyse CPCRA 002.
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PMID:Rule-based ranking schemes for antiretroviral trials. 917 82

In examining ways to improve female health care access and utilization, the magnitude of health problems must be examined before the design of solutions. Two types of barriers interfere with health care: attitudinal barriers blocking motivation to seek health care services and organizational barriers which block actual use of needed services. The major health problems of women in the United States are heart disease, cancer, stroke, lung-related diseases, intentional injuries, diabetes and HIV/AIDS. Public health has had a greater impact than high technology on the health of our nation. Balancing health care reform, changes in legislation and funding for medical education should help the United States be responsive to the challenge to move from substandard health for many women to superlative health care for all women and their family members.
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PMID:Women's health care for the coming millennium. 937 60

N-acetylcysteine (NAC), the acetylated variant of the amino acid L-cysteine, is an excellent source of sulfhydryl (SH) groups, and is converted in the body into metabolites capable of stimulating glutathione (GSH) synthesis, promoting detoxification, and acting directly as free radical scavengers. Administration of NAC has historically been as a mucolytic agent in a variety of respiratory illnesses; however, it appears to also have beneficial effects in conditions characterized by decreased GSH or oxidative stress, such as HIV infection, cancer, heart disease, and cigarette smoking. An 18-dose oral course of NAC is currently the mainstay of treatment for acetaminophen-induced hepatotoxicity. N-acetylcysteine also appears to have some clinical usefulness as a chelating agent in the treatment of acute heavy metal poisoning, both as an agent capable of protecting the liver and kidney from damage and as an intervention to enhance elimination of the metals.
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PMID:Clinical applications of N-acetylcysteine. 957 47

As more effective therapies have produced longer survival times for human immunodeficiency virus (HIV)-infected patients, new complications of late-stage HIV infection including HIV-related heart disease have emerged. Almost any agent that can cause disseminated infection in patients with acquired immunodeficiency syndrome (AIDS) may involve myocardium, but clinical evidence of cardiac disease is usually overshadowed by manifestations in other organs, primarily the brain and lungs. Cardiac abnormalities are found at autopsy in two-thirds of patients with AIDS, and more than 150 reports of cardiac complications have been published. Cardiac involvement in HIV disease includes pericardial effusion, myocarditis, dilated cardiomyopathy, and/or endocardial involvement at any stage of the disease. This review deals with all the cardiac manifestations of AIDS and serves to highlight two problems and one indication. First of all, there are very few clinical studies. Current knowledge is based almost exclusively on echocardiography and autopsy studies. Observational or clinical trials would be useful. Second, there exists very poor information on the impact of treatment; and epidemiologic and clinicopathologic studies are mandatory for obtaining detailed data concerning the mechanisms of myocardial damage in AIDS. Finally, because cardiac complications are often clinically inapparent or subtle in the initial stages, periodic screening of HIV-positive patients by electrocardiogram and echocardiogram is probably indicated. In addition, AIDS may also provide the opportunity to gain insights into the pathogenesis of little understood cardiac diseases such as lymphocytic myocarditis and dilated cardiomyopathy.
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PMID:Cardiac involvement in acquired immunodeficiency syndrome--a review to push action. The Committee for the Study of Cardiac Involvement in AIDS. 966 54

Heart disease, lung cancer, and HIV infection are among the diseases previously thought to be primarily men's health problems that have been documented in recent years to be serious health problems for women. Researchers have reported that women with heart disease have poorer outcomes and receive less intensive therapy than men. Clinicians and consumers are just beginning to realize that cardiac disease is the #1 cause of death in women -- outpacing breast cancer. In the breast cancer arena, the impact of such genetic links as BRCA1 and BRCA2 is still unclear, as is the issue of screening mammograms for women under the age of 50. Other top issues in women's health include efforts to ban "drive through" deliveries and early postmastectomy discharge, calculation of the high price of prematurity, changes in Pap screening techniques, and continuing efforts to understand the effects of estrogen. This editorial examines the key issues and trends in women's health reported and debated in 1996.
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PMID:Examining Women's Health: 1996-1997. 974 86


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