Shareware Overload Trio 2/Shareware Overload Trio Volume 2 (Chestnut CD-ROM).ISO/dir26/hicn757.zip/HICN757.TXT

Text File | 1994-12-06 | 60KB | 1,151 lines

HICNet Medical News Digest      Thu, 01 Dec 1994        Volume 07 :
Issue 57

Today's Topics:

  News from the Editor
  [MMWR 5 Nov 94] The Great American Smokeout
  [MMWR] Attitudes towards Smoking Policies in Eight States
  [MMWR] Cigarette Smoking Among Women of Reproductive Age
  [MMWR] Continuing Diabetes Care
  [MMWR 11 Nov 94] Imported Plague
  [MMWR] Erythromycin-Resistant Bordetella pertussis
  [MMWR] Prevalence of Self-Report Epilepsy

             +------------------------------------------------+
             !                                                !
             !              Health Info-Com Network           !
             !                Medical Newsletter              !
             +------------------------------------------------+
                        Editor: David Dodell, D.M.D.
   10250 North 92nd Street, Suite 210, Scottsdale, Arizona 85258-4599
USA
                        Telephone [phone]
                           FAX [phone]
                         Internet: [e-mail]
                           Bitnet: ATW1H@ASUACAD

                                 Mosaic WWW
*Asia/Pacific:
 http://biomed.nus.sg/MEDNEWS/welcome.html
*Americas:
 http://cancer.med.upenn.edu:3000/
*Europe:

http:/www.dmu.ac.uk/0/departments/pharmacy/archive/www/MEDNEWS/welcome
.html

Compilation Copyright 1994 by David Dodell,  D.M.D.  All  rights
Reserved.
License  is  hereby  granted  to republish on electronic media for
which no
fees are charged,  so long as the text of this copyright notice and
license
are attached intact to any and all republished portion or portions.

The Health Info-Com Network Newsletter is  distributed  biweekly.
Articles
on  a medical nature are welcomed.  If you have an article,  please
contact
the editor for information on how to submit it.  If you are
interested  in
joining the automated distribution system, please contact the editor.

                             Associate Editors:

E. Loren Buhle, Jr. Ph.D. Dept. of Radiation Oncology, Univ of
Pennsylvania

       Tom Whalen, M.D., Robert Wood Johnson Medical School at Camden

        Douglas B. Hanson, Ph.D., Forsyth Dental Center, Boston, MA

             Lawrence Lee Miller, B.S. Biological Sciences, UCI

            Dr K C Lun, National University Hospital, Singapore

             W. Scott Erdley, MS, RN, SUNY@UB School of Nursing

      Jack E. Cross, B.S Health Care Admin, 882 Medical Trng Grp, USAF

  Albert Shar, Ph.D. CIO, Associate Prof, Univ of Penn School of
Medicine

  Martin I. Herman, M.D., LeBonheur Children's Medical Center, Memphis
TN

 Stephen Cristol, M.D. MPH, Dept of Ophthalmology, Emory Univ,
Atlanta, GA

                  Subscription Requests = [e-mail]
              anonymous ftp = vm1.nodak.edu; directory HICNEWS
               FAX Delivery = Contact Editor for information


----------------------------------------------------------------------

Date: Thu, 01 Dec 94 06:25:25 MST
From: [e-mail] (HICNet Medical News)
To: hicnews
Subject: News from the Editor
Message-ID: <[e-mail]>

I have been a little overwelmed lately, thereby causing the tardiness
of
this issue.

I've also converted the machine I compose the newsletter on to IBM's
OS/2 Warp.  Very nice operating system, but it caused a little
incompatibility with my scanner hardware.  I have resolved this
problem,
so articles will be flowing again within a short time.

David Dodell, DMD
Editor



------------------------------

Date: Thu, 01 Dec 94 06:27:47 MST
From: [e-mail] (HICNet Medical News)
To: hicnews
Subject: [MMWR 5 Nov 94] The Great American Smokeout
Message-ID: <[e-mail]>

        The Great American Smokeout, November 17, 1994

     Since 1977, the American Cancer Society (ACS) has sponsored
the Great American Smokeout to foster community-based activities
that encourage cigarette smokers to stop smoking for at least 24
hours. These activities include distributing materials to schools,
hospitals, businesses, and other organizations that discourage
tobacco use; encouraging restaurants and other businesses to be
smoke-free for the day; and promoting media coverage of special
events at the national and community level.
     During the 1993 Great American Smokeout, an estimated 2.4
million (6%) smokers reported quitting, and 6.0 million (15%)
reported reducing the number of cigarettes smoked on that day (1).
In addition, approximately 1.6 million (4%) smokers quit smoking
for 1-10 days after the Smokeout (1). Approximately 10.7 million
packs of cigarettes were not smoked, resulting in an estimated
$18.1 million not spent on cigarettes (1-3).
     This year, the Great American Smokeout will be on Thursday,
November 17. The goal of the Smokeout is to promote and encourage
smoking cessation by helping smokers realize that if they can quit
for 1 day, they can quit permanently. Information is available from
local chapters of the ACS; for telephone numbers of these local
chapters, telephone [phone] or [phone].

Reported by: American Cancer Society, Atlanta. Office on Smoking
and Health, National Center for Chronic Disease Prevention and
Health Promotion, CDC.

References
1. Lieberman Research, Inc. The 1993 Great American Smokeout study.
Atlanta: American Cancer Society, 1993.
2. CDC. Cigarette smoking among adults--United States, 1992, and
changes in the definition of current cigarette smoking. MMWR
1994;43:342-6.
3. The Tobacco Institute. The tax burden on tobacco: historical
compilation, 1993. Washington, DC: The Tobacco Institute, 1994.



------------------------------

Date: Thu, 01 Dec 94 06:28:51 MST
From: [e-mail] (HICNet Medical News)
To: hicnews
Subject: [MMWR] Attitudes towards Smoking Policies in Eight States
Message-ID: <[e-mail]>

 Attitudes Toward Smoking Policies in Eight States -- United States,
1993

     Legislation regulating smoking has at least two functions: to
protect nonsmokers from the adverse health effects of environmental
tobacco smoke and to prevent young persons from smoking (1). To
characterize public attitudes toward such legislation, the National
Cancer Institute (NCI) and the American Cancer Society used the
Behavioral Risk Factor Surveillance System (BRFSS) to survey
persons in eight states* during July-August 1993 as part of the
American Stop Smoking Intervention Study for Cancer Prevention (2).
This report summarizes the survey findings.
     BRFSS provides state-specific estimates of the prevalence of
selected risk behaviors to be used for planning, implementing, and
evaluating public health programs. Each month, state health
departments use survey sampling and random-digit-dialing techniques
(3) to conduct telephone interviews with adults aged greater than
or equal to 18 years. During July-August 1993, a total of 20
questions were added to BRFSS in the eight states to assess support
for policies related to cigarette smoking (4). To estimate the
state population prevalences (5), data were weighted to the age-,
race-, and sex-specific population counts from the most current
census (or intercensal estimate) in each state and for the
respondent's probability of selection. SUDAAN (6) was used to
calculate the 95% confidence intervals for the prevalence
estimates. For this study, sample sizes ranged from 252 to 431 per
state; state-specific response rates for completed interviews
ranged from 63.6% to 93.3%. Current smokers were defined as persons
who had smoked at least 100 cigarettes and who reported being a
smoker at the time of the interview.

Environmental Tobacco Smoke
     Respondents were given a list of public locations and asked
whether, for each setting, smoking should be allowed in all areas
(do not restrict), allowed in some areas (restrict), or not allowed
at all (ban). Public opinion about whether to restrict or ban
smoking varied across settings (Table 1): support was greater for
banning smoking in fast-food restaurants (range: 42.5%-63.0%) and
at indoor sporting events (55.4%-66.9%) than in sit-down
restaurants (39.5%-50.6%) and indoor malls (33.4%-56.5%). Overall,
smokers were less likely than nonsmokers to support banning smoking
in the different locations.

Preventing Teenagers from Smoking
     Respondents were given a list of five strategies that might
prevent teenagers from smoking and asked whether they believed the
strategies were not at all effective, somewhat effective, or very
effective. Each of the strategies was believed to be effective
(i.e., somewhat or very) by most respondents (Table 2): in
particular, 65.3%-77.8% of respondents believed that banning all
smoking inside and outside school property would be an effective
strategy. Most respondents (79.1%-89.6%) favored a ban on smoking
inside school buildings that applies to students, visitors, and
teachers; 66.2%-85.1% of respondents favored a ban on the use of
any tobacco product (including cigarettes, cigars, pipes, and
chewing tobacco) at school-sponsored events (e.g., football games
and field trips).
     Banning all cigarette advertising was considered to be an
effective strategy in reducing smoking among teenagers by 54.3%-
71.9% of respondents (Table 2). In addition, 49.8%-66.5% of
respondents believed that tobacco advertising influences persons to
buy tobacco products. The proportion of respondents who supported
a ban on advertising tobacco products at sports stadiums and arenas
ranged from 67.7% to 78.2%, and the proportion who supported a ban
on advertising tobacco products on billboards ranged from 62.6% to
77.2%.
     High proportions of respondents believed in the effectiveness
of selected measures to limit teenager's access to tobacco
products, including stronger enforcement of laws prohibiting the
sale of cigarettes to minors (77.1% to 85.5%), banning all
cigarette vending machines (69.3% to 79.3%), and increasing the
price of a pack of cigarettes (55.4% to 67.7%) (Table 2). Most
respondents (54.1% to 68.8%) favored increasing the tax on a pack
of cigarettes $1 per pack; however, many (47.9% to 66.1%) believed
that such an increase would be unfair to cigarette smokers. Belief
in the effectiveness of teenage access restrictions was high among
both smokers (41.8% to 79.3%) and nonsmokers (60.2% to 88.4%).

Reported by the following BRFSS coordinators: D Hargrove-Roberson,
MSW, Louisiana; J Jackson-Thompson, PhD, Missouri; G Boeselager,
MS, New Jersey; E Capwell, PhD, Ohio; N Hann, MPH, Oklahoma; M
Lane, MPH, South Carolina; R Diamond, MPH, Texas; K Holm, MPH,
Washington. Surveillance Program, National Cancer Institute,
National Institutes of Health. Div of Chronic Disease Control and
Community Intervention, Office of Surveillance and Analysis, and
Office on Smoking and Health, National Center for Chronic Disease
Prevention and Health Promotion, CDC.

Editorial Note: The findings in this report are consistent with
previous studies that have documented public support for regulating
tobacco use in public places (2). For example, in 1987, 72% of
adults in seven Minnesota communities favored prohibiting smoking
in public buildings (7). In 1989, findings from a survey conducted
for the NCI Community Intervention Trial for Smoking Cessation
(COMMIT) (8) indicated that among persons in 10 communities, 62%-
100% supported restricting or banning smoking in selected
locations. Most favored restricting smoking in five locations
(bars, restaurants, bowling alleys, private worksites, and
government buildings) and banning it in three other locations
(indoor sports arenas, hospitals, and doctors' offices).
     These findings also confirm increasing support for banning
smoking in restaurants (9). For example, 16.2% to 32.3% of
respondents in the COMMIT study (8) favored banning smoking in
restaurants, compared with 39.5% to 63.0% of BRFSS respondents. In
addition, the BRFSS findings distinguish between fast-food and
sit-down restaurants. Support for banning smoking in fast-food
restaurants was stronger than support for banning smoking in
sit-down restaurants, possibly because of the perception that
fast-food restaurants tend to cater to and be frequented by
children and adolescents (2).
     Previous studies (2) have documented high levels of support
for measures to prevent teenagers from smoking (7,10). The BRFSS
findings indicate widespread belief in the effectiveness of such
measures and suggest broad support for banning the use of any
tobacco product at school-sponsored events. Finally, the BRFSS
findings indicate support for recommendations issued by the
Institute of Medicine (2), which include the need to 1) adopt and
enforce tobacco-free policies in all public locations, especially
those that cater to and are frequented by children and youths; 2)
adopt tobacco-free policies that apply to persons attending events
sponsored by organizations involved with youths; 3) restrict the
advertising and promotion of tobacco products; and 4) increase the
excise tax on cigarettes.

References
1. Pederson LL, Bull SB, Ashley MJ, Lefcoe NM. A population survey
on legislative measures to restrict smoking in Ontario: 3 variables
related to attitudes of smokers and nonsmokers. Am J Prev Med
1989;5:313-22.
2. Institute of Medicine. Growing up tobacco free: preventing
nicotine addiction in children and youths. Washington, DC: National
Academy Press, 1994.
3. Waksburg J. Sampling methods for random digit dialing. J Am Stat
Assoc 1978;73:40-6.
4. Remington PL, Smith MY, Williamson DF, Anda RF, Gentry EM,
Hogelin GC. Design, characteristics, and usefulness of state-based
behavioral risk factor surveillance, 1981-1987. Pub Health Rep
1988;103:366-75.
5. Siegel PZ, Brackbill RM, Frazier EL, et al. Behavioral risk
factor surveillance, 1986-1990. In: CDC surveillance summaries
(December). MMWR 1991;40(no. SS-4):1-23.
6. Shah BV. Software for Survey Data Analysis (SUDAAN) version 5.5
[Software documentation]. Research Triangle Park, North Carolina:
Research Triangle Institute, 1991.
7. Forster JL, McBride C, Jeffery R, Schmid TL, Pirie PL. Support
for restrictive tobacco policies among residents of selected
Minnesota communities. Am J Health Promot 1991;6:99-104.
8. CDC. Public attitudes regarding limits on public smoking and
regulation of tobacco sales and advertising--10 U.S. communities,
1989. MMWR 1991;40:344-5,351-3.
9. CDC. Preventing tobacco use among young people--a report of the
Surgeon General. Atlanta: US Department of Health and Human
Services, Public Health Service, CDC, 1994.
10. Marcus SE, Emont SL, Corcoran RD, et al. Public attitudes about
cigarette smoking: results from the 1990 Smoking Activity Volunteer
Executed Survey. Pub Health Rep 1994;109:125-34.
* Louisiana, Missouri, New Jersey, Ohio, Oklahoma, South Carolina,
Texas, and Washington.



------------------------------

Date: Thu, 01 Dec 94 06:29:54 MST
From: [e-mail] (HICNet Medical News)
To: hicnews
Subject: [MMWR] Cigarette Smoking Among Women of Reproductive Age
Message-ID: <[e-mail]>

              Health Objectives for the Nation
         Cigarette Smoking Among Women of Reproductive Age
                   -- United States, 1987-1992

     Women who smoke cigarettes are at increased risk for lung
cancer, chronic obstructive pulmonary disease, and complications of
oral contraceptive use. During pregnancy, cigarette smoking
increases the risks for a low birthweight infant and infant
mortality. A national health objective for the year 2000 is to
reduce cigarette smoking among women of reproductive age (i.e., 18-
44 years) to a prevalence of no more than 12% (objective 3.4h) (1).
This goal is substantially lower than the estimated baseline
prevalence of 29% measured by CDC's 1987 National Health Interview
Survey (NHIS). To characterize recent trends in cigarette smoking
and monitor progress toward the year 2000 objective, data from the
NHIS for 1987 through 1992 were analyzed for women aged 18-44
years.
     The NHIS is an ongoing household survey conducted annually
among a nationally representative sample (n=120,000) of the
civilian, noninstitutionalized U.S. population. Information about
tobacco use was collected through personal interviews with an adult
(aged greater than or equal to 18 years) randomly selected from
each surveyed household (n=40,000).* Each year during 1987-1992,
the sample sizes for the target study group that was asked
tobacco-use questions (i.e., women aged 18-44 years) ranged from
3717 to 13,809. Respondents were asked if they ever smoked 100
cigarettes during their lifetimes and whether they currently smoked
(2). Annual prevalence estimates and 95% confidence intervals (CIs)
were calculated using SUDAAN (3). Data were weighted to provide
national estimates.
     During 1987-1992, the prevalence of cigarette smoking among
reproductive-aged women in the United States declined 3.7%, from
29.6% in 1987 to 26.9% in 1992 (Table 1). The prevalence declined
substantially from 1987 (29.6%) to 1990 (25.6%) but increased
slightly from 1991 (26.7%) to 1992 (26.9%). In 1992, an estimated
14.3 million U.S. women aged 18-44 years were smokers.
     Smoking prevalence was inversely related to level of education
and was consistently highest among women with less than a high
school education (Table 1). Among women with less than a high
school education, smoking prevalence decreased from 46.5% in 1987
to 40.6% in 1990; in 1992, the rate (40.2%) remained unchanged. For
women with 16 or more years of education, smoking prevalence
declined from 14.2% in 1987 to 10.5% in 1990; however, in 1992, the
rate increased to 12.5%.
     During 1987-1992, smoking prevalence rates varied by race.
During 1987-1990, race-specific declines in smoking prevalence
occurred among both black and white women (Table 1). For black
women, the rate declined from 31.2% in 1987 to 22.8% in 1990, but
increased significantly to 28.1% in 1991 before declining to 22.6%
in 1992. For white women, the rate declined from 30.0% in 1987 to
26.5% in 1990, then increased to 27.1% in 1991 and 28.6% in 1992.
     Among women aged 18-24 years, smoking prevalence among black
women declined dramatically during 1987-1992, from 21.8% to 5.9%.
In comparison, among white women, the prevalence was unchanged,
27.8% and 27.2% in 1987 and 1992, respectively.

Reported by: Div of Health Interview Statistics, National Center
for Health Statistics; Epidemiology Br, Office on Smoking and
Health, National Center for Chronic Disease Prevention and Health
Promotion, CDC.

Editorial Note: In 1965 (the first year the NHIS was used to
monitor tobacco use), 33% of U.S. women were cigarette smokers (4).
Since then, however, the health risks of cigarette smoking have

·
been widely publicized, and the prevalence of cigarette smoking
among women has declined gradually. During 1974-1985, smoking
prevalence among women decreased at a rate of 0.3% per year, one
third the rate for men (5). While smoking rates declined among
women, death rates for lung cancer increased; in 1987, lung cancer
surpassed breast cancer as the leading cause of cancer death among
U.S. women. By 1990, 25.6% of women aged 18-44 years were current
smokers.
     Two important findings in this report regarding cigarette
smoking by women during 1987-1992 are that 1) rates of cigarette
smoking for young black women declined substantially during this
period, and 2) after a 25-year decline, rates among women of other
races and older women of reproductive age stopped declining in
1990. An important factor probably associated with the decline in
smoking among younger black females was the decrease in rates of
smoking reported by black female high school seniors during 1985-
1989 (6). In addition, cigarette smoking has been suggested to have
less functional value for black women (i.e., they may be less
likely to use smoking for weight control or social acceptability)
(7). However, reasons for the increase in smoking among black women
aged 18-44 years in 1991 only have not been determined. At least
two factors have been suggested to account for the reduction or
termination of declines in cigarette smoking among women of
reproductive age: first, tobacco companies used advertising
campaigns (8) and other approaches to target women, and second, the
increase in rates of smoking initiation by young adolescent females
during the early 1970s resulted in a greater number of adult women
smokers (9).
     Although the mean education level** of Hispanic women in this
study was lower when compared with non-Hispanic women, the
prevalence of cigarette smoking was significantly lower among
Hispanic women, possibly reflecting the effect of potential
cultural differences that decrease the social acceptability of
smoking among Hispanic women. The findings in this report also
indicate that, during 1987-1992, smoking rates were significantly
higher for women living below the poverty level than those living
at or above the poverty level. This inverse association between
income and smoking prevalence also has been documented for men and
reflects correlations with education level.
     Comprehensive strategies to discourage tobacco use by women
and to achieve the year 2000 national health objective should
include four basic components: research, outreach, education, and
advocacy. Research efforts should focus on the disparate
race-specific trends in smoking by race and translation of
successes in efforts to reduce smoking among other groups. Outreach
should especially be directed toward providing interventions for
the high proportion of women smokers with less than a high school
education. Education campaigns that employ paid antismoking
advertising have been implemented successfully in California and
may be adapted for use in other locations in the United States
(10). Examples of measures to strengthen advocacy of
tobacco-control policies include increases in the excise taxes on
tobacco products and enforcement of laws that restrict access to
tobacco products by minors.

References
1. Public Health Service. Healthy people 2000: national health
promotion and disease prevention objectives--full report, with
commentary. Washington, DC: US Department of Health and Human
Services, Public Health Service, 1991; DHHS publication no.
(PHS)91-50212.
2. CDC. Cigarette smoking among adults--United States, 1992, and
changes in the definition of current cigarette smoking. MMWR
1994;43:342-6.
3. Shah BV. Software for Survey Data and Analysis (SUDAAN) version
6.0 [Software documentation]. Research Triangle Park, North
Carolina: Research Triangle Institute, 1991.
4. CDC. Reducing the health consequences of smoking: 25 years of
progress--a report of the Surgeon General. Rockville, Maryland: US
Department of Health and Human Services, Public Health Service,
1989; DHHS publication no. (PHS)89-8411.
5. Fiore MC, Novotny TE, Pierce JP, Hatziandreu EJ, Patel KM, Davis
RM. Trends in cigarette smoking in the United States: the changing
influence of gender and race. JAMA 1989;261:49-55.
6. Bachman JG, Wallace JM, O'Malley PM, Johnston LD, Kurth CL,
Neighbors HW. Racial/ethnic differences in smoking, drinking, and
illicit drug use among American high school seniors, 1976-89. Am J
Public Health 1991;81:372-7.
7. Camp DE, Klesges RC, Relyea G. The relationship between body
weight concerns and adolescent smoking. Health Psychol 1982;12:24-
32.
8. Ernster VL. How tobacco companies target women. In: American
Cancer Society. World smoking and health. Atlanta: American Cancer
Society, 1991:8-11.
9. Gilpin EA, Lee L, Evans M, Pierce J. Smoking initiation rates in
adults and minors: United States, 1944-1988. Am J Epidemiol
1994;140:535-43.
10. Pierce JP, Evans N, Farkas AJ. Tobacco use in California: an
evaluation of the tobacco control program, 1989-1993. La Jolla,
California: University of California, San Diego, 1994.
* Health-topic supplements: Cancer Control and Epidemiology, 1987;
Occupational Health, 1988; Diabetes Risk Factors, 1989; Health
Promotion and Disease Prevention, 1990 and 1991; and Cancer
Control, 1992.
** In this study, the mean number of years of education completed
by Hispanic women was 11.3 years and for non-Hispanic women, 13.1
years.



------------------------------

Date: Thu, 01 Dec 94 06:30:45 MST
From: [e-mail] (HICNet Medical News)
To: hicnews
Subject: [MMWR] Continuing Diabetes Care
Message-ID: <[e-mail]>

           Continuing Diabetes Care -- Rhode Island, 1991

     The annual economic impact of diabetes mellitus in the United
States is an estimated $92 billion (1), primarily reflecting the
treatment of both acute (e.g., diabetic ketoacidosis and
hypoglycemic coma) and chronic (e.g., atherosclerotic
cardiovascular disease, blindness, renal failure, neuropathy, and
amputation of extremities) complications (2). The complications of
diabetes may be prevented or delayed through intensive treatment
(3) and through early detection and treatment of complications
(4,5). To characterize continuing care of diabetes in Rhode Island
in 1991, the Rhode Island Department of Health initiated a Diabetes
Care Survey (DCS) in conjunction with its statewide Health
Interview Survey (HIS) in 1990. This report summarizes the results
of that survey.
     Questions about the frequency of continuing diabetes care were
based on standards published in 1989 that recommend persons using
insulin visit a physician at least quarterly and persons not using
insulin visit a physician at least semiannually. The standards also
recommend examination by an "eye doctor" at least annually for
persons aged 12-30 years with a diagnosis of diabetes of at least
a 5-year duration and for all persons aged greater than or equal to
30 years with diabetes (4). CDC has defined such examinations as
"dilated eye examinations" (5).
     The 1990 HIS used random-digit-dialing to survey 3118
households in Rhode Island; 2588 (83%) persons responded. One adult
(aged greater than or equal to 18 years) respondent in each
household was asked about the sociodemographic characteristics,
health status, and health-related behaviors of all household
members. In 1991, 150 (71%) of 212 adult HIS respondents who
reported having been told by a doctor that they had diabetes in
1990 were recontacted for the DCS and asked about health status and
diabetes care.
     Of the 150 respondents, 89% were aged greater than or equal to
40 years, 52% were aged greater than or equal to 65 years, and 54%
were women. Forty-three percent had not graduated from high school,
and 45% had family incomes at or less than 200% of the poverty
level*. In approximately one third (34%), diabetes had been
diagnosed within the preceding 5 years. Almost all (95%) received
diabetes care from a physician. Almost half (48%) used oral
hypoglycemic agents; 31% used insulin.
     Of the 84 respondents with noninsulin-treated diabetes, nearly
all (99%) had visited a health-care provider at least twice during
the preceding year. Of the 54 respondents with insulin-treated
diabetes, 61% had visited a provider four times during the
preceding year. During the preceding year, 72% of the respondents
who were eligible for a dilated eye examination had received one.
     Respondents aged less than 40 years were less likely to have
visited a health-care provider for regular diabetes care (53%) than
were respondents aged 40-64 years (86%) or greater than or equal to
65 years (95%) (Table 1). Men were less likely than woman to have
had a dilated eye examination during the preceding year (60% versus
84%, respectively).

Reported by: D Goldman, MPH, J Fulton, PhD, D Perry, J Feldman, MD,
Rhode Island Diabetes Control Program, Rhode Island Dept of Health.
Epidemiology and Statistics Br, Div of Diabetes Translation,
National Center for Chronic Disease Prevention and Health
Promotion, CDC.

Editorial Note: The control of complications and costs of diabetes
requires that persons with diabetes have access to continuing
medical care for this disease. The findings in this report indicate
that in Rhode Island, most persons with diabetes reported receiving
dilated eye examinations in accordance with current
recommendations. In comparison, other recent assessments indicate
that during 1989, only 49% of adults with diagnosed diabetes in the
United States had dilated eye examinations during the preceding
year (6); in addition, during 1992, 33%-60% of patients with
diabetes who were receiving care at three of the largest health
maintenance organizations in the United States also had received
yearly eye examinations (7 ).
     Since 1979, efforts of the Rhode Island Diabetes Control
Program have been directed toward reducing barriers to care and
ensuring eye examinations for persons with diabetes; the program
has especially focused on persons with low income and those with no
health insurance. Components of the multifaceted campaign to ensure
eye care for persons with diabetes include 1) distribution of
information, including materials developed by the National
Institutes of Health as a part of the National Eye Health Education
Program, through sites (e.g., the offices of primary-care
physicians and podiatrists, clinics, emergency rooms, hospitals,
worksites, pharmacies, and Lions clubs) that promote annual eye
examinations among persons with diabetes; 2) distribution of
national standards for eye care by mail to all primary-care
providers, through presentations to selected medical staff at all
Rhode Island hospitals, and through publication of articles
assessing and promoting diabetic eye care in Rhode Island; and 3)
direct diabetes-care interventions through neighborhood health
centers associated with the Providence Ambulatory Health Care
Foundation.
     The findings in this report also indicate that in Rhode
Island, persons with insulin-treated diabetes visit health-care
providers less frequently than is recommended; persons aged less
than 40 years were least likely to visit providers at regular
intervals. Possible reasons for lack of continuing care in this age
group include lack of health insurance, self-perceived good health,
and short duration of disease--and therefore, fewer complications
(5).
     The Rhode Island Diabetes Control Program and its Diabetes
Professional Advisory Council have used these and other findings to
develop a statewide diabetes control plan. These findings also may
be used as a baseline for evaluating interventions. To facilitate
this process, the advisory council has established a surveillance
committee to develop an overall surveillance plan to be coordinated
with the statewide diabetes control plan.
     Although public health surveillance is integral to the control
of infectious diseases, the role of state-based surveillance is
less well established in the control of diabetes and other chronic
conditions. The Rhode Island DCS is an innovative and useful tool
for the surveillance of diabetes health-care patterns and practices
and may serve as a model for other states with diabetes control
programs.

References
1. American Diabetes Association, Inc. Direct and indirect costs of
diabetes in the United States in 1992. Alexandria, Virginia:
American Diabetes Association, Inc, 1993.
2. Herman WH, Teutsch SM, Geiss LS. Diabetes mellitus. In: Amler W,
Dull HB, eds. Closing the gap: the burden of unnecessary illness.
New York: Oxford University Press, 1987.
3. The Diabetes Control and Complications Trial Research Group. The
effect of intensive treatment of diabetes on the development and
progression of long-term complications in insulin-dependent
diabetes mellitus. New Engl J Med 1993;329:977-86.
4. Committee on Professional Practice. Position statement:
standards of medical care for patients with diabetes mellitus.
Diabetes Care 1989;12:365-8.
5. CDC. The prevention and treatment of complications of diabetes
mellitus. Atlanta: US Department of Health and Human Services,
Public Health Service, CDC, 1991.
6. Brechner RJ, Cowie CC, Howie LJ, Herman WH, Will JC, Harris MI.
Ophthalmic examination among adults with diagnosed diabetes
mellitus. JAMA 1993;270:1714-8.
7. Herman WH, Dasbach EJ. Diabetes, health insurance, and
health-care reform. Diabetes Care 1994;17:611-3.
* Poverty statistics are based on a definition originated by the
Social Security Administration in 1964, subsequently modified by
federal interagency committees in 1969 and 1980, and prescribed by
the Office of Management and Budget as the standard to be used by
federal agencies for statistical purposes.



------------------------------

Date: Thu, 01 Dec 94 06:32:14 MST
From: [e-mail] (HICNet Medical News)
To: hicnews
Subject: [MMWR 11 Nov 94] Imported Plague
Message-ID: <[e-mail]>

       Detection of Notifiable Diseases Through Surveillance
      for Imported Plague -- New York, September-October 1994

     Recent reports of bubonic and pneumonic plague outbreaks in
India (1,2) prompted the New York City Department of Health
(NYCDOH) and the New York State Department of Health (NYSDOH), in
conjunction with CDC, to develop an emergency response plan to
detect and manage suspected cases imported by international air
travel. This report describes the surveillance system implemented
by CDC on September 27 and supplemental efforts by NYC/NYSDOH to
guide and inform physicians about the outbreak, and summarizes
clinical findings for 11 travelers who had symptoms suggestive of
plague.

CDC Surveillance System
     The CDC surveillance protocol included instructions to staff
of international air carriers to notify U.S. quarantine officials
before landing of passengers or crew with illness suggestive of
plague. All passengers arriving on direct flights from India were
provided a plague alert notice that described the symptoms of
plague and urged them to seek medical attention if they developed
a febrile illness within 7 days of disembarkation. Once passengers
were in the United States, the surveillance system relied on
physicians and other hospital staff to report suspected plague
cases to local health departments, which would then notify CDC.

Supplemental Efforts by NYCDOH/NYSDOH
     A primary role of NYCDOH/NYSDOH, in conjunction with CDC, was
to determine whether the clinical presentation of persons with
suspected cases was consistent with plague and to arrange for
immediate hospitalization in facilities with respiratory isolation
rooms. In addition, because of the high volume of air travel from
India (approximately 2000 passengers arrive daily at John F.
Kennedy International Airport on flights from India), NYCDOH/NYSDOH
supplemented CDC's surveillance plan by using two approaches to
disseminate information to heighten awareness of plague, focusing
on emergency department physicians. First, a fact sheet describing
the clinical presentation of plague and emphasizing the need to
assess travel history among patients with suggestive symptoms was
transmitted by fax or electronic mail to emergency department
physicians and infection-control practitioners at 102 hospitals in
New York City and to all acute-care hospitals and county health
departments in the state. Second, a special plague advisory issue
of City Health Information, NYCDOH's bulletin, was distributed to
20,000 physicians in New York City within 2 weeks of CDC's plague
alert. To directly reach persons who recently may have arrived from
India and were at increased risk for plague, leaflets in English
and Hindi describing plague symptoms and urging ill persons to seek
medical attention were distributed by NYCDOH at a heavily attended
Indian cultural fair on October 8 and 9.

Clinical Findings for Travelers
     As of October 27 (when the plague alert was terminated), 10
persons with suspected plague had been reported to NYCDOH and one
to the Albany County Health Department and NYSDOH. None were
confirmed as having plague. Patients ranged in age from 31 to 80
years; six were men. All 11 patients reported having recently been
in India. One suspected case was recognized by an airline crew
member during a flight; two by customs officials in the airport;
and one by airline officials at check-in for a connecting domestic
flight at a different airport. The remaining seven suspected cases
were reported by hospital emergency departments. Nine of the 11
patients were admitted to a hospital isolation unit for observation
while awaiting consultation with CDC and/or confirmatory laboratory
testing.
     Ten patients had clinical presentations that were not
consistent with pneumonic plague. One patient, who developed adult
respiratory distress syndrome and coma, required serologic and
microbiologic testing to rule out plague. The final diagnoses for
10 of the suspected cases were viral syndrome (four patients),
malaria (three), concurrent malaria and dengue (one), and typhoid
and liver disease (one each); one person had no illness.

Reported by: B Mojica, MD, R Heffernan, MPH, C Lowe, MFA, S
Matthews, New York City Dept of Health; T Briggs, Albany County
Health Dept, Albany; F Guido, E Wender, MD, Westchester County
Health Dept, Hawthorne; S Kondracki, G Birkhead, MD, D Morse, MD,
State Epidemiologist, New York State Dept of Health. Div of
Quarantine, National Center for Prevention Svcs; Bacterial Zoonoses
Br, Div of Vector-Borne Infectious Diseases, National Center for
Infectious Diseases; Div of Field Epidemiology, Epidemiology
Program Office, CDC.

Editorial Note: This report illustrates the ongoing potential for
importation of emerging infectious diseases into the United States
and the need for prompt reporting of cases to local and state
health departments for an appropriate public health response (3).
The Institute of Medicine has identified international travel and
commerce as a major factor associated with emerging infections (4).
The protocols described in this report--highlighting the close
cooperation between federal, state, and local public health
officials; the medical community; and the airline industry--
represent the coordinated, comprehensive prevention-oriented
response needed to guard against the threat of emerging and
resurgent infections. In addition, the evaluation of suspected
plague cases in New York revealed limitations in recognizing cases
of disease only at the point of disembarkation; in New York,
approximately half of the suspected cases were brought to the
NYCDOH/NYSDOH's attention by local physicians. The importance of
obtaining a travel history when evaluating persons presenting with
fever was underscored by the detection of cases of dengue and
nationally notifiable disease conditions (i.e., malaria and
typhoid) (5).

References
1. CDC. Human plague--India, 1994. MMWR 1994;43:689-91.

·
2. CDC. Update: human plague--India, 1994. MMWR 1994;43:722-3.
3. Berkelman RL, Bryan RT, Osterholm MT, LeDuc JW, Hughes JM.
Infectious disease surveillance: a crumbling foundation. Science
1994;264:368-70.
4. Institute of Medicine. Emerging infections: microbial threats to
health in the United States. Washington, DC: National Academy
Press, 1992.
5. CDC. National notifiable diseases reporting--United States,
1994. MMWR 1994;43:800-1.



------------------------------

Date: Thu, 01 Dec 94 06:33:44 MST
From: [e-mail] (HICNet Medical News)
To: hicnews
Subject: [MMWR] Erythromycin-Resistant Bordetella pertussis
Message-ID: <[e-mail]>

          Erythromycin-Resistant Bordetella pertussis --
             Yuma County, Arizona, May-October 1994

     In 1993, a total of 6586 cases of pertussis was reported in
the United States, including 70 in Arizona. On June 27, 1994, a
case of Bordetella pertussis disease caused by a strain resistant
to erythromycin was reported to the Arizona Department of Health
Services (ADHS) from Yuma County (1990 population: 106,895).
Susceptibility testing at CDC confirmed that the isolate was highly
resistant to erythromycin with a minimum inhibitory concentration
(MIC) greater than 64 ug/mL. The MIC of erythromycin against B.
pertussis usually ranges from 0.02 ug/mL to 0.1 ug/mL, and
resistant isolates have not been previously reported (1). This
report summarizes the case investigation and describes efforts to
enhance surveillance for pertussis in Arizona.

Case Report
     The erythromycin-resistant strain was isolated from a
2-month-old male infant living in Yuma County, Arizona, who had
onset of cough on May 16, 1994. The illness was initially diagnosed
as bronchitis, and treatment with amoxicillin was initiated on May
23. The infant had no history of previous antibiotic therapy, and
the parents reported he had not received pertussis vaccine before
the onset of illness. On May 26, he was hospitalized with severe
paroxysmal cough, inspiratory whoop, posttussive vomiting, and
episodes of cyanosis and apnea. B. pertussis infection was
diagnosed by direct fluorescent antibody (DFA) testing; oral
erythromycin estolate therapy (50 mg per kg body weight per day)
was initiated on May 26 and continued for 12 days. Because of
persistent paroxysmal cough and episodes of cyanosis, apnea, and
bradycardia, on June 8 he was transferred to a pediatric
intensive-care facility.
     Both a DFA test and culture performed on nasopharyngeal
secretions obtained on June 8 confirmed the persistence of
pertussis organisms, and intravenous erythromycin therapy (30
mg/kg/day) was initiated. On June 13, a repeat DFA test and culture
were positive, and the erythromycin dosage was increased to 40
mg/kg/day. Despite sequential oral and parenteral erythromycin
therapy, nasopharyngeal cultures obtained from the infant on June
16 and 20 grew B. pertussis, and his condition remained unchanged.
Susceptibility testing at the hospital laboratory suggested that
the isolate was resistant to erythromycin but sensitive to
trimethoprim-sulfamethoxazole (TMP-SMZ). On June 20, erythromycin
therapy was discontinued, and therapy with TMP-SMZ was initiated;
the infant's condition improved rapidly. A nasopharyngeal culture
obtained on June 25 was negative, and he was discharged from the
hospital on June 29.
     Approximately 2 weeks before the infant's onset of illness,
his 17-year-old mother had developed a spasmodic cough illness
associated with posttussive vomiting. A nasopharyngeal culture
specimen obtained from the mother on June 28 was negative. She had
no history of recently receiving antibiotic treatment.

Enhanced Surveillance for Pertussis
     Because of the case in the 2-month-old infant, in late June,
the Yuma County Department of Public Health enhanced surveillance
to detect pertussis illness and to obtain B. pertussis isolates
from county residents. State and federal public health officials
visited all primary-care providers and health-care facilities in
Yuma County to disseminate culture kits and instructions for
obtaining appropriate culture specimens. In particular, providers
were asked to obtain nasopharyngeal cultures from all Yuma County
residents with an unexplained acute cough illness lasting 7 or more
days. In addition, ADHS mailed letters to approximately 2500
primary-care providers in Arizona to encourage collection of
nasopharyngeal cultures for diagnosis of pertussis. Health
officials in two California counties near Yuma County (Imperial and
San Diego counties) were alerted to the isolation of an
erythromycin-resistant pertussis strain in Yuma County.
     The first person with a culture-confirmed case of B. pertussis
in Yuma County in 1994 had onset on April 9. A total of 18
confirmed cases (eight culture-confirmed and 10 epidemiologically
linked to a culture-confirmed case) and 57 probable cases (defined
as unexplained acute cough for 14 or more days) were identified
during April 30-October 1. During the period of enhanced
surveillance (late June-October 1), a total of 127 nasopharyngeal
culture specimens were obtained from Yuma County residents and sent
to the ADHS laboratory. In addition to the index case, B. pertussis
was isolated from the specimens of seven persons. Of these seven
isolates, one was inadvertently discarded, and the remaining six
were susceptible to erythromycin. In addition, all 22 B. pertussis
strains isolated during June-August from persons in other Arizona
counties and all 13 B. pertussis strains isolated during January-
August from patients in San Diego County were susceptible to
erythromycin.
     ADHS has continued enhanced surveillance and has recommended
that providers in Arizona obtain nasopharyngeal culture specimens
from all persons--regardless of age or vaccination status--with
unexplained acute cough of 14 or more days' duration and at least
one of the following symptoms: paroxysms of cough, inspiratory
whoop, or posttussive vomiting. Health-care providers also have
been urged to report all suspected cases to local health
departments and to send B. pertussis culture specimens to the ADHS
laboratory.
     Preliminary results of studies at CDC suggest that the
mechanism of B. pertussis resistance to erythromycin does not
involve ribosomal riboneucleic acid methylation, which has been
documented in streptococcal and staphylococcal resistance to
erythromycin. Studies are ongoing at CDC to elucidate the mechanism
of B. pertussis resistance to erythromycin.

Reported by: S Lewis, MPH, Public Health Nursing Staff, Yuma County
Dept of Public Health, Yuma; B Erickson, PhD, G Cage, MS, G Harter,
State Public Health Laboratory; C Kioski, MPH, S Barefoot, L
Carmody, MA, H Houser, L Sands, DO, State Epidemiologist, Arizona
Dept of Health Svcs; M Saubolle, PhD, Good Samaritan Regional
Medical Center, K Lewis, MD, S Barbour, MD, M Rudinsky, MD,
Children's Hospital, Phoenix. Hospital Infections Program, and Div
of Bacterial and Mycotic Diseases, National Center for Infectious
Diseases; National Immunization Program, CDC.

Editorial Note: Erythromycin is the drug of choice for treating
persons with B. pertussis disease and for postexposure prophylaxis
of all household members and other close contacts as recommended by
the Advisory Committee on Immunization Practices (2-6). For adults
who are susceptible to pertussis because of a decrease in
vaccine-induced immunity or for infants who are too young to be
adequately vaccinated and are at risk for severe disease,
erythromycin prophylaxis and treatment are the primary control
measures.
     Because of the limited number of isolates subjected to
susceptibility testing (n=41), the proportion of resistant strains
of B. pertussis cannot be estimated accurately for Yuma County or
other areas in the region. However, the absence of additional
erythromycin-resistant strains in Arizona and San Diego County,
California, suggests that antimicrobial resistance is not
widespread. Ongoing surveillance and collection of B. pertussis
isolates should assist in more accurate assessment of the extent of
transmission of the resistant strain in the area.
     Failure of erythromycin to eradicate B. pertussis has been
associated with poor absorption of some preparations of the
antibiotic (4,7). Among the three esterified oral erythromycin
formulations (estolate, ethylsuccinate, and stearate), erythro-
mycin estolate has superior bioavailability and achieves higher
concentrations in serum and respiratory secretions. TMP-SMZ is an
alternative for treatment and for chemoprophylaxis, but its
efficacy as a chemoprophylactic agent has not been evaluated (8).
     Nasopharyngeal cultures should be obtained from persons with
pertussis who do not improve with erythromycin therapy. Criteria
for assessing treatment failure are 1) persistence or worsening of
the typical symptoms* of pertussis disease, 2) initiation of
erythromycin therapy within 2 weeks of onset of illness, 3)
completion of erythromycin therapy in the recommended dosage, and
4) verification of patient compliance with therapy. Most persons
who meet these criteria will not be culture-positive for B.
pertussis; however, isolates obtained from patients with
erythromycin therapy failure should be sent to CDC (Pertussis
Laboratory, Childhood Respiratory Diseases Branch, Division of
Bacterial and Mycotic Diseases, National Center for Infectious
Diseases, CDC, Mailstop C-02, 1600 Clifton Road, NE, Atlanta, GA
30333) for further testing. Tests to evaluate antimicrobial
susceptibility of B. pertussis have not been standardized and are
not widely available. In collaboration with ADHS, efforts to
standardize B. pertussis susceptibility testing are ongoing at CDC.
     All health-care providers in the United States are encouraged
to obtain nasopharyngeal cultures from patients in whom pertussis
is suspected. These include persons with unexplained acute cough of
14 or more days' duration and at least one of the following
symptoms: paroxysms of cough, inspiratory whoop, or posttussive
vomiting, regardless of the patient's age or vaccination status.
All probable and confirmed cases of pertussis should be reported
promptly to local or state health departments.

References
1. Hoppe JE, Haug A. Antimicrobial susceptibility of Bordetella
pertussis (Part I). Infection 1988;16(suppl):126-30.
2. ACIP. Diphtheria, tetanus, and pertussis: recommendations for
vaccine use and other preventive measures--recommendations of the
Immunization Practices Advisory Committee (ACIP). MMWR 1991;40(no.
RR-10).
3. American Academy of Pediatrics. Pertussis. In: Peter G, ed. 1994
Red book: report of the Committee on Infectious Diseases. 23rd ed.
Elk Grove Village, Illinois: American Academy of Pediatrics,
1994:355-67.
4. Bass JW. Erythromycin for treatment and prevention of pertussis.
Pediatr Infect Dis 1986;5: 154-7.
5. Sprauer MA, Cochi SL, Zell ER, et al. Prevention of secondary
transmission of pertussis in households with early use of
erythromycin. Am J Dis Child 1992;146:177-81.
6. Steketee RW, Wassilak SGF, Adkins WN Jr, et al. Evidence for a
high attack rate and efficacy of erythromycin prophylaxis in a
pertussis outbreak in a facility for the developmentally disabled.
J Infect Dis 1988;157:434-40.
7. Hoppe JE, the Erythromycin Study Group. Comparison of
erythromycin estolate and erythro-mycin ethylsuccinate for
treatment of pertussis. Pediatr Infect Dis J 1992;11:189-93.
8. Hoppe JE, Halm U, Hagedorn HJ, Kraminer-Hagedorn A. Comparison
of erythromycin ethylsuccinate and co-trimoxazole for treatment of
pertussis. Infection 1989;17:227-31.

*Prolonged paroxysms of cough associated with apnea, cyanosis, or
bradycardia in young infants or prolonged paroxysms of cough
associated with whoop and/or posttussive vomiting in older children
and adults.



------------------------------

Date: Thu, 01 Dec 94 06:36:53 MST
From: [e-mail] (HICNet Medical News)
To: hicnews
Subject: [MMWR] Prevalence of Self-Report Epilepsy
Message-ID: <[e-mail]>

Prevalence of Self-Reported Epilepsy -- United States, 1986-1990

     Epilepsy is a chronic neurologic condition characterized by
abnormal electrical discharges in the brain manifested as two or
more unprovoked seizures (1). Risk factors for epilepsy include
vascular disease, head trauma, congenital or perinatal factors,
central nervous system infections, and neoplasms; however, the
etiology of epilepsy is unknown for approximately three fourths of
cases (2). Epilepsy frequently causes impaired physical,
psychological, and social functioning, which results in substantial
disability, economic loss, and diminished quality of life (3). To
examine the burden of epilepsy in the United States, the prevalence
of self-reported epilepsy was estimated by using data from 1986
through 1990 from the National Health Interview Survey (NHIS) (4).
This report summarizes the results of this analysis.
     The NHIS is a nationally representative household survey of
the U.S. civilian, noninstitutionalized population conducted
annually by CDC. Respondents were asked whether they or any
household family member had epilepsy or repeated seizures,
convulsions, or blackouts during the preceding 12 months.
Self-reported epilepsy was categorized according to the
International Classification of Diseases, Ninth Revision, Clinical
Modification, codes 345.0-345.9. Age-specific and age-adjusted
prevalences for the 12-month period preceding the interview and
associated standard errors were estimated; the direct method was
used to age-adjust the estimates, using the 1980 U.S. resident
population as the standard (5). To increase the stability of the
estimates, data were combined for 1986-1990. Confidence intervals
(CIs) were based on the standard errors of the estimates, taking
into account the survey design.
     During 1986-1990, approximately 1.1 million persons in the
United States annually reported having epilepsy. The overall
prevalence of epilepsy was 4.7 cases per 1000 persons. The
prevalence was lowest (3.1) for persons aged greater than or equal
to 65 years and highest (5.2) for persons aged 15-64 years (Table
1). The prevalence for persons aged less than 15 years was 4.0. The
age-adjusted prevalence was similar for women and men (5.1 and 4.2,
respectively), and the age-specific pattern was consistent for both
sexes. The age- and race-adjusted prevalence of epilepsy was
similar among the regions of the country (4.0 in the West, 4.4 in
the Northeast, 4.9 in the Midwest, and 5.0 in the South)*.
     The age-adjusted prevalence of epilepsy was higher for blacks
(6.7 [95% CI=4.9-8.5]) than whites (4.5 [95% CI=3.9-5.1]).**
Compared with whites, prevalence rates among blacks were especially
higher for persons aged 35-44 years and 45-54 years (prevalence
ratios=3.0 and 2.3, respectively) (Figure 1, page 817). This
pattern was similar for both black males and black females.

Reported by: Statistics Br, Div of Chronic Disease Control and
Community Intervention, National Center for Chronic Disease
Prevention and Health Promotion; National Center for Health
Statistics, CDC.

Editorial Note: The findings in this report indicate that epilepsy
is a common neurologic condition in the United States. However, the
overall age-adjusted prevalence in this report (4.7) is lower than
estimates from previous studies (6.0-7.0), which were based on
rigorous case ascertainment efforts (i.e., record review or
neurologic examination) in more clearly defined local populations
(2,6).
     Epileptic seizures can be classified by etiology or clinical
manifestation. Seizures with a presumptive cause (e.g., head
trauma, stroke, or neoplasm) are classified as symptomatic seizures
or secondary epilepsy; repeated seizures with no presumed cause are
classified as idiopathic epilepsy (7). Symptomatic seizures can be
either acute or temporally remote from the triggering event and can
be prevented by reducing the prevalence of the predisposing event.
However, even if all known risk factors for epilepsy were removed
from the population, approximately 70% of cases would still occur
(2).
     The findings in this report are subject to at least two
limitations. First, estimates are based on self-reported data and
may be subject to reporting bias. For example, because a social
stigma is associated with epilepsy, persons may be reluctant to
report the condition (8). Second, epilepsy manifests itself with
varying seizure frequency throughout life. Persons whose seizures
are controlled with medication or who have not had a recent seizure
may not have reported epilepsy as a medical problem in this survey.
     The higher reported prevalence of epilepsy for blacks than for
whites is consistent with previous reports (6,9). Among blacks, the
higher prevalences in middle-aged groups (i.e., 35-44 years and 45-
54 years) may reflect differences in the epidemiology of epilepsy
in middle life (e.g., trauma and cerebrovascular disease). Because
most previous studies have reported a higher prevalence of epilepsy
among males, the detection of similar prevalences for men and women
in this report warrants further assessment (9).
     Prompt detection and early medical intervention can greatly
improve seizure control and enhance the quality of life for persons
with epilepsy; however, epilepsy remains undiagnosed or
inadequately treated in many persons. To address these issues, CDC
is collaborating with professional and voluntary organizations to
design provider and consumer education materials to improve
awareness, detection, and appropriate treatment of persons with
epilepsy.
     November is National Epilepsy Month. For additional
information about epilepsy management or referral to local
resources, contact the Epilepsy Foundation of America, telephone
[phone] or [phone].

References
1. Adams RD, Victor M. Principles of neurology. 4th ed. New York:
McGraw-Hill, 1989.
2. Hauser WA, Kurland LT. The epidemiology of epilepsy in
Rochester, Minnesota, 1935 through 1967. Epilepsia 1975;16:1-66.
3. Hartshorn JC, Byers VL. Impact of epilepsy on quality of life.
J Neurosci Nurs 1992;24:24-9.
4. NCHS. Current estimates from the National Health Interview
Survey: data from the national health survey, 1989. Hyattsville,
Maryland: US Department of Health and Human Services, Public Health
Service, CDC, 1990; DHHS publication no. (PHS)90-1504. (Vital and
health statistics; series 10, no. 176).
5. Fleiss JL. Statistical methods for rates and proportions. 2nd
ed. New York: John Wiley & Sons, 1981.
6. Haerer AF, Anderson DW, Schoenberg BS. Prevalence and clinical
features of epilepsy in a biracial United States population.
Epilepsia 1986;27:66-75.
7. Commission on Classification and Terminology, International
League Against Epilepsy. Proposal for revised clinical and
electroencephalographic classification of epileptic seizures.
Epilepsia 1981;22:489-501.
8. Jacoby A. Felt versus enacted stigma: a concept revisited--
evidence from a study of people with epilepsy in remission. Soc Sci
Med 1994;38:269-74.
9. Hauser WA, Hesdorffer DC. Epilepsy: frequency, causes and
consequences. New York: Epilepsy Foundation of America, 1990.

*Northeast=Connecticut, Maine, Massachusetts, New Hampshire, New
Jersey, New York, Pennsylvania, Rhode Island, and Vermont;
Midwest=Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota,
Missouri, Nebraska, North Dakota, Ohio, South Dakota, and
Wisconsin; South=Alabama, Arkansas, Delaware, District of Columbia,
Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North
Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and
West Virginia; West=Alaska, Arizona, California, Colorado, Hawaii,
Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and
Wyoming.
**Numbers for races other than black and white were too small for
meaningful analysis.



------------------------------

End of HICNet Medical News Digest V07 Issue #57

·
(continued next message)


 @FROM   :[e-mail]
· (Continued from last message)
***********************************************


---
Editor, HICNet Medical Newsletter
Internet: [e-mail]                 FAX: [phone]
Bitnet  : ATW1H@ASUACAD