hicn medical newsletter part cut here hicnet medical newsletter page volume number april gonorrhea colorado source mmwr date apr the number of reported cases of gonorrhea in colorado increased from to after declining steadily during the s in comparison in the united states reported cases of gonorrhea in continued an overall decreasing trend this report summarizes an analysis of the increase in gonorrhea in colorado in and characterizes trends in the occurrence of this disease from through in cases of gonorrhea were reported to the colorado department of health cdh compared with cases reported in during reported cases increased and among females and males respectively table similar increases occurred among blacks whites and hispanics and respectively however the number of reported cases with race not specified increased from to and constituted of all reported cases in although the largest proportional increases by age groups occurred among persons aged years and greater than or equal to years these age groups accounted for only of all reported cases in persons in the year age group accounted for the largest number of reported cases of gonorrhea during and the highest age group specific rate per reported cases of gonorrhea increased in the five county denver metropolitan area population but decreased elsewhere in the state table half the cases of gonorrhea in the denver metropolitan area occurred in of the census tracts these represent neighborhoods considered by sexually transmitted diseases stds acquired immunodeficiency syndrome aids field staff to be the focus of gang and drug activity when compared with the number of gonorrhea cases diagnosed among men in the denver metro health clinic dmhc the primary public std clinic in the denver metropolitan area increased in and the number of visits by males to the clinic increased concurrently the number of cases diagnosed among women increased by among self identified heterosexual men the number of gonorrhea cases diagnosed at dmhc increased and comprised of all cases diagnosed in males while the number of cases diagnosed among self identified homosexual men remained low and in and respectively four selected laboratories in the metropolitan denver area i e hmo university hospital nonprofit family planning and commercial were contacted to determine whether gonorrhea culture positivity rates increased gonorrhea culture positivity rates in three of four laboratories contacted increased from to while the rate was virtually unchanged in the fourth i e nonprofit family planning from through reported cases of gonorrhea among whites and hispanics in colorado decreased in comparison reported cases among blacks hicnet medical newsletter page volume number april increased since figure during the population in colorado increased for blacks for hispanics and for whites in the gonorrhea rate for blacks per persons was times that for whites per and times that for hispanics per table among black females reported cases of gonorrhea increased from through in the year age group among black males cases increased from through in both the and year age groups reported by ka gershman md jm finn ne spencer msph std aids program re hoffman md state epidemiologist colorado dept of health jm douglas md denver dept of health and hospitals surveillance and information systems br div of sexually transmitted diseases and hiv prevention national center for prevention svcs cdc editorial note the increase in reported gonorrhea cases in colorado in may represent an overall increase in the occurrence of this disease or more complete reporting stimulated by visitations to laboratories by cdh surveillance staff during the increases in confirmed gonorrhea cases at dmhc and in culture positivity rates in three of four laboratories suggest a real increase in gonorrhea rather than a reporting artifact however the stable culture positivity rate in the nonprofit family planning laboratory which serves a network of clinics statewide indicates that the gonorrhea increase did not uniformly affect all segments of the population one possible explanation for the increased occurrence of gonorrhea in colorado may be gang and drug related sexual behavior as implicated in a recent outbreak of drug resistant gonorrhea and other stds in colorado springs although the high morbidity census tracts in the denver metropolitan area coincide with areas of gang and drug activity this hypothesis requires further assessment to examine the possible role of drug use implicated previously as a factor contributing to the national increase in syphilis the cdh std aids program is collecting information from all persons in whom gonorrhea is diagnosed regarding drug use exchange of sex for money or drugs and gang affiliation the gonorrhea rate for blacks in colorado substantially exceeds the national health objective for the year per objective a race is likely a risk marker rather than a risk factor for gonorrhea and other stds risk markers may be useful for identifying groups at greatest risk for stds and for targeting prevention efforts moreover race specific variation in std rates may reflect differences in factors such as socioeconomic status access to medical care and high risk behaviors in response to the increased occurrence of gonorrhea in colorado interventions initiated by the cdh std aids program include targeting partner notification in the denver metropolitan area to persons in groups at increased risk e g year old black females and year old black males implementing a media campaign e g public service radio hicnet medical newsletter page volume number april announcements signs on city buses newspaper advertisements and posters in schools and clinics to promote awareness of std risk and prevention targeted primarily at high risk groups and developing teams of peer educators to perform educational outreach in high risk neighborhoods the educational interventions are being developed and implemented with the assistance of members of the target groups and with input from a forum of community leaders and health care providers references cdc table ii cases of selected notifiable diseases united states weeks ending december and december nd week mmwr cdc gang related outbreak of penicillinase producing neisseria gonorrhoeae and other sexually transmitted diseases colorado springs colorado mmwr cdc relationship of syphilis to drug use and prostitution connecticut and philadelphia pennsylvania mmwr rolfs rt goldberg m sharrar rg risk factors for syphilis cocaine use and prostitution am j public health andrus jk fleming dw harger dr et al partner notification can it control epidemic syphilis ann intern med gershman ka rolfs rt diverging gonorrhea and syphilis trends in the s are they real am j public health public health service healthy people national health promotion and disease prevention objectives full report with commentary washington dc us department of health and human services public health service dhhs publication no phs hicnet medical newsletter page volume number april effectiveness in disease and injury prevention impact of adult safety belt use on restraint use among children less than years of age selected states and source mmwr date apr motor vehicle crashes are the leading cause of death among children and young adults in the united states and account for more than million years of potential life lost before age annually child safety seats and safety belts can substantially reduce this loss from through all states passed legislation requiring the use of child safety seats or safety belts for children although these laws reduce injuries to young children by an estimated motor vehicle crash related injuries remain a major cause of disability and death among u s children while the use of occupant restraints among children decreases inversely with age usage for those aged years aged years and aged years in addition parents who do not use safety belts themselves are less likely to use restraints for their children to characterize the association between adult safety belt use and adult reported consistent use of occupant restraints for the youngest child aged less than years within a household cdc analyzed data obtained from the behavioral risk factor surveillance system brfss during and this report summarizes the findings from this study data were available for respondents aged greater than or equal to years in states that participated in brfss a population based random digit dialed telephone survey and administered a standard injury control and child safety module developed by cdc of these respondents had a child aged less than years in their household each respondent was asked to specify the child s age and the frequency of restraint use for that child the two categories of child restraint and adult safety belt use in this analysis were consistent use i e always buckle up and less than consistent use i e almost always sometimes rarely or never buckle up data were weighted to provide estimates representative of each state software for survey data analysis sudaan was used to calculate point estimates and confidence intervals statistically significant differences were defined by p values of less than each of the states had some type of child restraint law of these six arizona kentucky maine nebraska rhode island and west virginia had no law requiring adults to use safety belts four idaho maryland pennsylvania and washington had a secondary enforcement mandatory safety belt law i e a vehicle had to be stopped for a traffic violation before a citation for nonuse of safety belts could be issued and one state new york had a primary enforcement mandatory safety belt law i e vehicles could be stopped for a safety belt law violation alone in nine states child passenger protection hicnet medical newsletter page volume number april laws included all children aged less than years but the other two states used both age and size of the child as criteria for mandatory restraint use the analysis in this report subgrouped states into those having a law requiring adult safety belt use law states and those without such a law no law states overall of children aged less than years reportedly were not consistently restrained during automobile travel both child restraint use and adult restraint use were significantly higher p less than chi square test in law states than in no law states versus and versus respectively high rates of restraint use for children aged less than or equal to year were reported by both adults indicating consistent and less than consistent safety belt use figure adults with consistent use reported high rates of child occupant restraint use regardless of the child s age range for year olds to for year olds in comparison for adults reporting less than consistent safety belt use the rate of child occupant restraint use declined sharply by the age of the child range for year olds to for year olds when comparing children of consistent adult safety belt users with children of less than consistent adult safety belt users confidence intervals overlap for the two youngest age groups i e aged less than and year reported child occupant restraint use in law states generally exceeded that in no law states regardless of age of child table in addition higher adult educational attainment was significantly associated with increased restraint use for children a factor that has also been associated with increased adult safety belt use reported by national center for injury prevention and control national center for chronic disease prevention and health promotion cdc editorial note the findings in this report are consistent with others indicating that adults who do not use safety belts themselves are less likely to employ occupant restraints for their children because these nonbelted adults are at increased risk of crashing and more likely to exhibit other risk taking behaviors children traveling with them may be at greater risk for motor vehicle injury educational attainment of adult respondents was inversely associated with child restraint use in this report accordingly occupant protection programs should be promoted among parents with low educational attainment because low educational attainment is often associated with low socioeconomic status such programs should be offered to adults through health care facilities that serve low income communities or through federal programs i e head start that are directed at parents with young children injury prevention programs emphasize restraining young children in addition however efforts must be intensified to protect child occupants as hicnet medical newsletter page volume number april they become older parents especially those with low educational attainment those who do not consistently wear safety belts and those from states that do not have mandatory safety belt use laws should be encouraged to wear safety belts and to protect their children by using approved child safety seats and safety belts finally the increased use of restraints among children may increase their likelihood of using safety belts when they become teenagers the age group characterized by the lowest rate of safety belt use and the highest rate of fatal crashes references cdc childhood injuries in the united states am j dis child partyka sc papers on child restraints effectiveness and use washington dc us department of transportation national highway traffic safety administration report no dot hs guerin d mackinnon d an assessment of the california child passenger restraint requirement am j public health hall w orr b suttles d et al progress report on increasing child restraint usage through local education and distribution programs chapel hill north carolina university of north carolina at chapel hill highway safety research center national highway traffic safety administration occupant protection trends in cities washington dc us department of transportation national highway traffic safety administration wagenaar ac molnar lj margolis lh characteristics of child safety seat users accid anal prev shah bv barnwell bg hunt pn lavange lm software for survey data analysis sudaan version software documentation research triangle park north carolina research triangle institute lund ak voluntary seat belt use among u s drivers geographic socioeconomic and demographic variation accid anal prev margolis lh wagenaar ac molnar lj use and misuse of automobile child restraint devices am j dis child hunter ww stutts jc stewart jr rodgman ea characteristics of seatbelt users and non users in a state with a mandatory use law health education hicnet medical newsletter page volume number april research arizona idaho kentucky maine maryland nebraska new york pennsylvania rhode island washington and west virginia hicnet medical newsletter page volume number april publication of cdc surveillance summaries source mmwr date apr since cdc has published the cdc surveillance summaries under separate cover as part of the mmwr series each report published in the cdc surveillance summaries focuses on public health surveillance surveillance findings are reported for a broad range of risk factors and health conditions summaries for each of the reports published in the most recent march issue of the cdc surveillance summaries are provided below all subscribers to mmwr receive the cdc surveillance summaries as well as the mmwr recommendations and reports as part of their subscriptions surveillance for and comparison of birth defect prevalences in two geographic areas united states problem condition cdc and some states have developed surveillance systems to monitor the birth prevalence of major defects reporting period covered this report covers birth defects surveillance in metropolitan atlanta georgia and selected jurisdictions in california for the years description of system the california birth defects monitoring program and the metropolitan atlanta congenital defects program are two population based surveillance systems that employ similar data collection methods the prevalence estimates for diagnostic categories were based on data for for births in california and births in metropolitan atlanta the prevalences in the two areas were compared adjusting for race sex and maternal age by using poisson regression results regional differences in the prevalence of aortic stenosis fetal alcohol syndrome hip dislocation dysplasia microcephalus obstruction of the kidney ureter and scoliosis lordosis may be attributable to general diagnostic variability however differences in the prevalences of arm hand limb reduction encephalocele spina bifida or trisomy down syndrome are probably not attributable to differences in ascertainment because these defects are relatively easy to diagnose interpretation regional differences in prenatal diagnosis and pregnancy termination may affect prevalences of trisomy and spina bifida however the reason for differences in arm hand reduction is unknown but may be related to variability in environmental exposure heterogeneity in the gene pool or random variation actions taken because of the similarities of these data bases several collaborative studies are being implemented in particular the differences in the birth prevalence of spina bifida and down syndrome will focus attention on the impact of prenatal diagnosis authors jane schulman ph d nancy hicnet medical newsletter page volume number april jensvold m p h gary m shaw dr p h california birth defects monitoring program march of dimes birth defects foundation larry d edmonds m s p h anne b mcclearn division of birth defects and developmental disabilities national center for environmental health cdc influenza united states problem condition cdc monitors the emergence and spread of new influenza virus variants and the impact of influenza on morbidity and mortality annually from october through may reporting period covered this report covers u s influenza surveillance conducted from october through may description of system weekly reports from the vital statistics offices of cities provided an index of influenza s impact on mortality who collaborating laboratories reported weekly identification of influenza viruses weekly morbidity reports were received both from the state and territorial epidemiologists and from sentinel family practice physicians nonsystematic reports of outbreaks and unusual illnesses were received throughout the year results during the influenza season influenza a h n and b viruses were identified in the united states with essentially equal frequency overall although both regional and temporal patterns of predominance shifted over the course of the season throughout the season increases in the indices of influenza morbidity in regions where influenza a h n predominated were similar to increases in regions where influenza b predominated only of identified viruses were influenza a h n but isolations of this subtype increased as the season waned and it subsequently predominated during the season during the season outbreaks in nursing homes were reported in association with influenza b and a h n but not influenza a h n interpretation the alternating temporal and geographic predominance of influenza strains a h n and b during the season emphasizes the importance of continual attention to regional viral strain surveillance since amantadine is effective only for treatment and prophylaxis of influenza a actions taken weekly interim analyses of surveillance data produced throughout the season allow physicians and public health officials to make informed choices regarding appropriate use of amantadine cdc s annual surveillance allows the observed viral variants to be assessed as candidates for inclusion as components in vaccines used in subsequent influenza seasons authors louisa e chapman m d m s p h epidemiology activity office of the director division of viral and rickettsial diseases national center for infectious diseases margaret a tipple m d division of quarantine national center for prevention services cdc suzanne gaventa folger m p h health investigations branch division of health studies agency for toxic substances and disease registry maurice harmon ph d connaught hicnet medical newsletter page volume number april laboratories pasteur mirieux company swiftwater pennsylvania alan p kendal ph d european regional office world health organization copenhagen denmark nancy j cox ph d influenza branch division of viral and rickettsial diseases national center for infectious diseases lawrence b schonberger m d m p h epidemiology activity office of the director division of viral and rickettsial diseases national center for infectious diseases cdc reference cdc cdc surveillance summaries march mmwr no ss hicnet medical newsletter page volume number april clinical research news clinical research news for arizona physicians vol no april tucson arizona published monthly by the office of public affairs at the university of arizona health sciences center copyright the university of arizona high tech assisted reproductive technologies following the birth of the first in vitro fertilization embryo transfer ivf et baby in a host of assisted reproductive technologies have been developed that include ivf et gamete intrafallopian tube transfer gift embryo cryopreservation freezing and gamete micromanipulation together these technologies are referred to as the high tech assisted reproductive technology art procedures ovulation induction sperm insemination and surgery for tubal disease and or pathology still are the mainstays of the therapies available for infertility management however when these fail it almost always is appropriate to proceed with one of the art procedures therefore in addition to a comprehensive basic and general infertility service at the university of arizona center for reproductive endocrinology and infertility there is a program of assisted reproduction that specializes in art procedures this program serves as a tertiary provider for those patients in the state of arizona whose infertility problems cannot be resolved by the traditional therapies the following article on back describes the art procedures available in our center clarifies appropriate applications for each and considers the realistic expectations for their success procedures included are o in vitro o fertilization embryo transfer ivf et gamete intrafallopian tube transfer o gift cryopreservation of human embryos and gamete micromanipulation this article also considers ongoing research in our program that is directed towards improved success of these technologies hicnet medical newsletter page volume number april future areas of research in addition to ongoing research that is directed exclusively toward the management of infertile couples we are developing the technology to assist couples who are at risk for producing embryos with a serious hereditary disease this technology involves biopsying the preimplantation human embryo and then subjecting the biopsied cells to genetic analysis using either dna amplification or fluorescent in situ hybridization there are recent reports of the successful application of dna amplification by other centers for example for diagnosis of the genes for cystic fibrosis and hemophilia we hope to apply and further focus fluorescent in situ hybridization technology for probing the x chromosome the identification of which will provide a scientific basis for counselling patients who exhibit sex linked disorders the considerable clinical application of such technology lies in the fact that it circumvents the need for prenatal diagnosis in addition to the possibility of a subsequent termination of affected fetuses in order to avoid the birth of affected children catherine racowsky ph d associate professor and director of research department of obstetrics and gynecology college of medicine university of arizona tucson arizona applications success rates and advances for the management of infertility the following are the art procedures available at the university of arizona center for reproductive endocrinology and infertility in vitro fertilization embryo transfer is the core art procedure of our assisted reproduction program this procedure involves retrieval of unfertilized eggs from the ovary their insemination in vitro in a dish and the culture of resultant embryos for or days before they are transferred to the patient s uterus all cultures are maintained in an incubator under strictly controlled atmospheric and temperature conditions before being processed for use in insemination semen samples are evaluated in our andrology laboratory using both subjective light microscopy and computer hicnet medical newsletter page volume number april assisted semen analyses to ensure an adequate number of eggs with which to perform ivf et or indeed gift follicular development is typically stimulated with gonadotropins perganol metrodin gonadotropin releasing hormone gnrh factrel lutrepulse and or gnrh analogues lupron depo lupron synarel occasionally however ivf et is accomplished with eggs obtained in non stimulated cycles while some programs utilize laparoscopic egg retrieval in the operating room with the patient under general anesthesia we undertake the less costly approach of ultrasound guided retrieval in our infertility unit with the patient sedated couples who resort to ivf et exhibit such pathologies as tubal deficiencies ovulatory dysfunction endometriosis and or mild forms of male factor infertility according to the united states ivf registry the overall success rate for ivf et nationwide has stabilized at about percent per cycle results from our program involving patients who have undergone ivf et cycles reflect a comparable success rate nevertheless the overall incidence of success with this procedure is disconcertingly low and emphasizes the need to address those physiological factors that limit achievement of a higher percentage of pregnancies well recognized predictors of outcome include patient age response to exogenous ovarian stimulation quality of sperm and number of repeated ivf et cycle attempts however among these age is the single most significant determinant of conception therefore it is critical that such patients are referred to an assisted reproduction program at the earliest opportunity following failure of traditional therapies the underlying basis for the negative effect of age on fertility has not been clearly delineated beyond recognition that the number of eggs available for retrieval declines markedly with age fertilization rates significantly decrease in eggs retrieved from patients who are over years and provided the appropriate hormonal background is present age is unrelated to uterine competency to sustain pregnancy ongoing research in our center therefore is investigating physiological changes in the egg that may be impacted by age we have determined that more than percent of eggs that fail to fertilize in vitro are chromosomally abnormal and that a significant proportion of these abnormalities are accountable to patient age currently the only recourse for such patients is to use eggs obtained from a donor our program has initiated recruitment of volunteer egg donors to satisfy the needs of a list of recipients interested in this form of therapy gift this high tech art procedure is performed in the operating room usually with the use of a laparoscope and in contrast to ivf et involves introducing sperm and freshly retrieved eggs into the lumen of the fallopian tube an average of eggs tube under these circumstances fertilization occurs in vivo and if excess eggs are retrieved the remainder undergo ivf with subsequent options for embryo transfer in that cycle or freezing for transfer in a subsequent cycle this art procedure is applied to cases in hicnet medical newsletter page volume number april which there is at least one patent fallopian tube but the couple has such pathologies as ovulatory dysfunction endometriosis male factor infertility and or idiopathic infertility the data reported in the united states ivf registry for through indicate that the overall success rate with gift is higher than that obtained with the ivf et technique range of clinical pregnancies for gift is to percent and for ivf et to percent in view of this fact one might expect more patients to be treated with gift than ivf et however in our program we have taken into account three basic concerns which while substantially reducing the number of gift cycles performed benefit the patient these concerns are the increased costs associated with performing a procedure in the operating room the risks albeit minimal of undergoing general anesthesia and the considerable benefits to be accrued from obtaining direct information on the quality and fertilizability of the eggs and the developmental competency of resultant embryos the increased success with gift undoubtedly reflects the artificial environment provided by the laboratory in the ivf et procedure between january and december we have performed a total of gift cycles with an overall success rate of percent embryo cryopreservation or freezing is applied in our program when embryos result from residual gift eggs or from non transferred ivf embryos this procedure not only provides patients with a subsequent opportunity for success at much reduced costs but also circumvents the legal and ethical issues relating to disposal of supernumerary embryos therefore as stipulated by the american fertility society ethical guidelines for art programs from both a practical and an ethical standpoint all assisted reproduction programs should have the capability of cryopreserving human embrys gamete micromanipulation this art procedure which is still very new is applied to couples who are unaccepting of insemination with donor semen but who have severe male factor infertility less than million sperm ml in combination with fewer than perccent motile sperm and or less than percent sperm with normal morphology we are currently developing the procedure of sub zonal insertion szi which entails injecting sperm under the coating around the egg the barrier normally penetrated by the sperm through enzymatic digestion available data from szi programs world wide indicate that only to percent of szi cycles result in a pregnancy this statistic undoubtedly relates to limitations imposed by abnormalities inherent in the sperm therefore we are currently focusing on the development of improved techniques for the recognition and selection of sperm chosen for manipulation such efforts are unquestionably worthwhile in view of the fact that this technology offers the only realistic opportunity for severe male factor patients to establish conception catherine racowsky ph d hicnet medical newsletter page volume number april associate professor and director of research department of obstetrics and gynecology college of medicine end of part internet david stat com fax bitnet atw h asuacad fidonet amateur packet ax wb tpy wb tpy az usa na
