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The National Heart, Lung, and Blood Institute convened an expert panel April 28 to 29, 2008, to identify gaps and recommend research strategies to prevent atrial fibrillation (AF). The panel reviewed the existing basic scientific, epidemiological, and clinical literature about AF and identified opportunities to advance AF prevention research. After discussion, the panel proposed the following recommendations: (1) enhance understanding of the epidemiology of AF in the population by systematically and longitudinally investigating symptomatic and asymptomatic AF in cohort studies; (2) improve detection of AF by evaluating the ability of existing and emerging methods and technologies to detect AF; (3) improve noninvasive modalities for identifying key components of cardiovascular remodeling that promote AF, including genetic, fibrotic, autonomic, structural, and electrical remodeling markers; (4) develop additional animal models reflective of the pathophysiology of human AF; (5) conduct secondary analyses of already-completed clinical trials to enhance knowledge of potentially effective methods to prevent AF and routinely include AF as an outcome in ongoing and future cardiovascular studies; and (6) conduct clinical studies focused on secondary prevention of AF recurrence, which would inform future primary prevention investigations.

GOAL

In San Francisco, coinciding with increases in the western United States, we observed substantial gonorrhea increases among young heterosexuals during 2003-2005. We conducted a case-control study to identify intervention strategies for prevention and control.

STUDY DESIGN

We interviewed case patients with gonorrhea during February-July, 2006 and control subjects at the local Department of Motor Vehicles. We included sexually active heterosexuals aged 15 to 35 years in sex-stratified analyses.

RESULTS

We interviewed 225 persons: 24 male and 28 female case patients and 98 male and 75 female control subjects. In multivariable analysis adjusting for black race and multiple partners among men, black race [adjusted odds ratio (AOR), 5.1; 95% confidence interval (CI), 1.7-15.0], having had multiple partners (AOR, 3.1; 95% CI, 1.1-8.5), having had an anonymous partner (AOR, 6.4; 95% CI, 1.9-21.4), and a long-term partnership (AOR, 0.3; 95% CI, 0.1-0.9) were associated with gonococcal infection. Among women, after adjustment for age, multiple partners, and black race (subject or partner), being black or having a black partner (AOR, 6.9; 95% CI, 2.2-21.8), having had a recently incarcerated partner (AOR, 6.2; 95% CI, 1.0-38.4), or meeting partners on the street (AOR, 19.0; 95% CI, 2.0-179.0) were associated with gonococcal infection.

CONCLUSIONS

Demographic and behavioral factors increase risk for gonorrhea among heterosexuals in San Francisco with partner characteristics being particularly important. Prevention and control efforts are focusing on blacks and incarcerated populations using street-based outreach and expanded screening and treatment.

BACKGROUND

Young adults entering jail are at increased risk for sexually transmitted diseases (STD) such as chlamydia, are released quickly, and are unlikely to be tested for STDs elsewhere. San Francisco jails performed targeted chlamydia screening and treatment since 1996.

GOAL

To determine this program's impact on chlamydia positivity among females attending neighborhood medical clinics.

STUDY DESIGN

During 1997-2004, jail testing density, a measure of the proportion of persons from year 2000 census blocks that were tested in jail, was compared by neighborhood. Chlamydia positivity among females aged 15 to 25 years were compared at 2 clinics serving areas with different jail testing densities.

RESULTS

Of persons offered screening at intake, 89% accepted. A total of 42,952 tests were performed among 23,561 persons in jail (45% black, 73% male). A total of 2765 (6.4%) tests were positive for chlamydia; 81% of chlamydial infections were treated. Jail testing density significantly correlated with neighborhood female chlamydia rates. Mean jail testing density at Clinic S, calculated by using the residence of persons tested for chlamydia, was 7 times greater than that at Clinic O. Chlamydia positivity declined at Clinic S from 16.1% to 7.8% (Ptrend <0.001). No significant change occurred at Clinic O in chlamydia (4.7% in 1997 and 2004, Ptrend = 0.81).

CONCLUSIONS

In San Francisco, screening young adults in jail focused testing on persons from neighborhoods with high chlamydia rates. Jail screening started immediately before chlamydia declines among young females at a clinic serving neighborhoods with high jail testing density. These programs might help reduce community prevalence and racial/ethnic disparities in STDs.