HIV Prevalence and Testing Trends in Men Who Have Sex with Men

The Centers for Disease Control and Prevention (CDC) has released new data on trends for human immunodeficiencognizedy virus (HIV) testing among men who have sex with men. The report, “HIV Prevalence, Unrec Infection, and HIV Testing Among Men Who Have Sex with Men—Five U.S. Cities, June 2004–April 2005,” was published in the June 24, 2005, issue of Morbidity and Mortality Weekly Report and is available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5424a2.htm.

The CDC analyzed data from five cities participating in the National HIV Behavioral Surveillance system. Of 1,767 men who had one or more male sex partners, 450 (25 percent) tested positive for HIV. Nearly one half of infected men did not know that they were HIV positive. The prevalence of previously undetected infections was highest among nonwhite men younger than 30 years.

Most men with previously undetected infections had been tested before for HIV (84 percent), but fewer than one half had been tested within the previous year (approximately 42 percent). The most common reason given for not being tested was fear of discovering that they were HIV positive. Other reasons included worry that others would find out or that their name would be reported to the government; fear of losing their job, family, or insurance coverage; and fear of needles. Nearly 20 percent of men with previously undetected HIV infections said they had not done anything to put themselves at risk for infection.

The CDC concludes that men who have sex with men should be encouraged to be tested for HIV at least annually, and prevention programs should focus on reaching persons who are unaware of their HIV status, especially in at-risk populations.

CDC Reports on U.S. Heat-Related Mortality

The Centers for Disease Control and Prevention (CDC) has released updated statistics on the rates of hyperthermia and heat-related deaths. The report, “Heat-Related Mortality—Arizona, 1993–2002, and United States, 1979–2002,” was published in the July 1, 2005, issue of Morbidity and Mortality Weekly Report and is available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5425a2.htm.

Continued exposure to ambient heat that is close to body temperature contributes to a significant number of deaths from hyperthermia, especially among older adults (i.e., 65 years or older). From 1979 to 2002, a total of 4,780 deaths were attributed to extreme heat in the United States. The incidence of such deaths was three to seven times greater in Arizona than in the United States overall from 1993 to 2002.

Older adults, children, and persons without access to air conditioning are at increased risk for heat-related illness and death. Persons with chronic mental disorders or cardiopulmonary disease, and persons taking medications that affect salt and water balance (e.g., diuretics, anticholinergics, tranquilizers that impair sweating) also are at greater risk.

Heat exhaustion is the most common form of heat-related illness. Signs of heat exhaustion include intense thirst, heavy sweating, weakness, paleness, anxiety, dizziness, fatigue, headache, nausea, and vomiting. Core body temperature may range from below normal to slightly elevated, and skin may be cool and moist. If left untreated, heat exhaustion can progress to heat stroke, a severe illness defined as a core body temperature of at least 40.6°C (105.1°F) accompanied by hot, dry skin and central nervous system abnormalities such as delirium, convulsions, and coma.

The CDC recommends that public health agencies in areas affected by extreme heat identify susceptible populations and risk behaviors, educate populations at risk, and design and implement location-specific heat response plans.

AHA Scientific Statement on Off-Pump vs. On-Pump Coronary Artery Bypass Grafting

The American Heart Association (AHA) has released a scientific statement on the effectiveness of off-pump versus on-pump coronary artery bypass grafting (CABG) for myocardial revascularization. The Council on Cardiovascular Surgery and Anesthesia collaborated with the Interdisciplinary Working Group on Quality of Care and Outcomes Research to review clinical data from retrospective studies, meta-analyses, and randomized trials that compared the two methods. The full report was published in the May 31, 2005, issue of Circulation.

Off-pump CABG does not use cardiopulmonary bypass or cardioplegia, while standard on-pump CABG involves the use of a heart-lung machine and medication to arrest the heart. On-pump CABG has been the gold standard for managing myocardial revascularization; however, it has been unclear whether outcomes with standard CABG are superior to outcomes with off-pump CABG.

Although the AHA report did not determine that one method was superior to the other, it showed trends that were associated consistently with each.

POSITIVE TRENDS ASSOCIATED WITH OFF-PUMP CABG

• Less bleeding

• Less renal dysfunction

• Less short-term neurocognitive dysfunction, especially with a calcified aorta

• Shorter overall hospitalization

POSITIVE TRENDS ASSOCIATED WITH ON-PUMP CABG

• Less technically demanding

• Shorter learning curve for surgeon

• Better long-term graft patency

• Easier to graft posterior (circumflex) bypass targets

• More bypass grafts constructed

The AHA concludes that patients receiving CABG have excellent outcomes regardless of the method. However, outside factors (e.g., surgeon skill, hospital quality, systems approach) are significant in determining the outcome after coronary revascularization. Further large-scale prospective randomized trials are needed to definitively answer whether one method is more effective than the other. In the meantime, the AHA recommends choosing the method with which the surgeon is most comfortable and most skilled.

Physicians' Use of Electronic Medical Records

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Figure.

Percentage of U.S. health care professionals using electronic medical records from 2001 to 2003.

NCHS Statistics on the Use of Electronic Medical Records

Data from the National Center for Health Statistics (NCHS) on the use of electronic medical records in health care were published in the May 13, 2005, issue of Morbidity and Mortality Weekly Report. The full report is available online at http://www.cdc.gov/nchs/data/ad/ad353.pdf.

According to the NCHS, electronic medical records were used most frequently in the emergency department, followed closely by outpatient departments. Electronic medical records were used less frequently in physician offices. About 73 percent of physicians used the technology for billing patients, 17 percent for maintaining medical records, and 8 percent for ordering prescriptions. The technology was used for automated drug dispensing systems in 40 percent of emergency departments but only in 18 percent of outpatient departments. See the accompanying figure for results by setting.