bluuebunny/crossref_metadata_2025 huggingface dataset:
Low-level air pollution and hospital admissions for cardiac and cerebrovascular diseases in Helsinki.
Authors: Pönkä A , Virtanen M
Published: November 2008

OBJECTIVES: This study investigated whether low concentrations of ambient air pollutants are associated with hospital admissions for ischemic cardiac and cerebrovascular diseases. METHODS: Associations between daily concentrations of sulfur dioxide, nitric oxide, nitrogen dioxide, ozone, and particulates and daily hospital admissions due to ischemic cardiac and cerebrovascular diseases were studied in Helsinki, Finland, 1987 through 1989. The regression analyses controlled for weather, day of the week, season, long-term trends, and influenza epidemics. RESULTS: Admissions via emergency rooms due to ischemic cardiac diseases (n = 7005) were significantly associated with the prevailing levels of nitric oxide and ozone, and those due to cerebrovascular diseases (n = 3737) were associated with nitrogen dioxide; these levels were only moderate. Long-term transient myocardial ischemic attacks were related to particulates, and short-term ischemic attacks were related to nitrogen dioxide. CONCLUSIONS: Symptoms of ischemic cardiac and cerebrovascular diseases may be provoked by pollutants in concentrations lower than those given as guidelines in many countries and lower than previously shown.
Neurodegenerative diseases: occupational occurrence and potential risk factors, 1982 through 1991.
Authors: Schulte P A , Burnett C A , Boeniger M F , Johnson J
Published: November 2008

OBJECTIVES: To identify potential occupational risk factors, this study examined the occupational occurrence of various neurodegenerative diseases. METHODS: Death certificates from 27 states in the National Occupational Mortality Surveillance System were evaluated for 1982 to 1991. Proportionate mortality ratios were calculated by occupation for presenile dementia, Alzheimer's disease, Parkinson's disease, and motor neuron disease. RESULTS: Excess mortality was observed for all four categories in the following occupational categories: teachers; medical personnel; machinists and machine operators; scientists; writers/designers/entertainers; and support and clerical workers. Clusters of three neurodegenerative diseases were also found in occupations involving pesticides, solvents, and electromagnetic fields and in legal, library, social, and religious work. Early death from motor neuron disease was found for firefighters, janitors, military personnel, teachers, excavation machine operators, and veterinarians, among others. CONCLUSIONS: Neurodegenerative disease occurs more frequently in some occupations than in others, and this distribution, which may indicate occupational risk factors, should be further investigated.
Lowering state legal blood alcohol limits to 0.08%: the effect on fatal motor vehicle crashes.
Authors: Hingson R , Heeren T , Winter M
Published: November 2008

OBJECTIVES: This study was undertaken to determine whether reductions in alcohol-related fatal crashes following adoption of 0.08% legal blood alcohol limits were independent of general regional trends. METHODS: The first five states that lowered legal blood alcohol limits to 0.08% were paired with five nearby states that retained a 0.10% legal standard. Within each pair, comparisons were made for the maximum equal available number of pre- and postlaw years. RESULTS: States adopting 0.08% laws experienced 16% and 18% relative postlaw declines in the proportions of fatal crashes involving fatally injured drivers whose blood alcohol levels were 0.08% or higher and 0.15% or higher. CONCLUSIONS: It all states adopted 0.08% legal blood alcohol limits, at least 500 to 600 fewer fatal crashes would occur annually.
Water and turf: fluoridation and the 20th-century fate of waterworks engineers.
Authors: Hunt E
Published: November 2008

Once central figures in American public health, waterworks engineers are no longer involved in many decisions made about the public water supplies. This paper argues that the profession's response to the early fluoridation movement of the 1940s and 1950s marked a change in the relationship between waterworks engineers and the other constitutive groups in public health and contributed to the disenfranchisement of the waterworks profession. Sensing a potentially divisive issue, two leaders of the profession, Abel Wolman and Linn Enslow, took steps they hoped would prevent a rift within the profession and allow waterworks engineering to continue its association with the wider public health community. Although the leaders saw the fluoridation issue differently, neither encouraged the profession to consider it openly or to take up the broader question of what limits, if any, should be placed on treating water supplies to meet human needs. Instead, they opted to locate authority for fluoridation outside the waterworks profession with dentists, doctors, and public health administrators. As a result, waterworks engineers conceded a great deal of the status and prestige associated with decision-making roles in community health issues and have largely faded from view.
Hospital nurses' occupational exposure to blood: prospective, retrospective, and institutional reports.
Authors: Aiken L H , Sloane D M , Klocinski J L
Published: November 2008

OBJECTIVES: This study examined nurses risk of exposure to blood resulting from injuries with needles and sharps, the methods of estimating those risks, and the factors affecting risks. METHODS: Nurses on 40 medical units in 20 hospitals in cities with a high incidence of AIDS were studied. Percutaneous injuries were documented for every shift during a 30-day period. These prospective reports were compared with retrospective and institutional reports. Factors affecting the likelihood of injuries were explored. RESULTS: Based on the prospective reports, the rate of injuries to staff nurses was 0.8 per nurse-year. Prospective and retrospective rates were similar, while institutional rates were significantly lower. Factors associated with increased injuries included recapping needles and temporary work assignments. Working in hospitals characterized by professional nurse practice models and taking precautions to avoid blood contact were associated with fewer injuries. CONCLUSIONS: Injuries from needlesticks are more common than institutional reports suggest and do not occur at random. Diminishing the frequency with which nurses recap needles, increasing precautions they take, reducing use of temporary nursing personnel, and implementing organizational changes may lower the odds of nurses being injured.
Correlates of tobacco use among Native American women in western North Carolina.
Authors: Spangler J G , Dignan M B , Michielutte R
Published: November 2008

OBJECTIVES: This study examined correlates of tobacco use among Cherokee women. METHODS: Prevalence rates were analyzed for 614 randomly selected Eastern Band Cherokee women. RESULTS: The prevalence rates for current smokeless tobacco use and smoking were 8% and 39%, respectively. Smokeless tobacco use correlates included lower education and having consulted an Indian healer. Smoking correlates included younger age, alcohol use, no yearly physical exam, separated or divorced marital status, and lack of friends or church participation. CONCLUSIONS: Smoking rates among these women were slightly above national rates. The association of smokeless tobacco use with having consulted an Indian healer may help in understanding Cherokee women's smokeless tobacco use.
Antigovernment sentiment and support for universal access to care: are they incompatible?
Authors: Goldsteen R L , Goldsteen K , Kronenfeld J J , Hann N E
Published: November 2008

OBJECTIVES: Attitudes toward universal access to medical care were examined to determine whether support for it among people opposed to government involvement in health care was modified by three proxy measures of self-interest: being uninsured, in poor health, or a high user of medical care. METHODS: Data on support for universal access, attitudes toward government involvement in health care, and the indicators of self-interest were obtained from a representative sample of adult Oklahomans (n = 1547) surveyed between October 1992 and December 1994. Forced-order multiple regression with interaction terms was the data analysis technique. RESULTS: People opposed to government involvement in health care were found to be less likely to favor universal access to medical care, but poor health, lack of insurance, and high usage of medical care moderated this effect. CONCLUSIONS: The findings support the view that antigovernment sentiment need not foreclose the public option for health policymakers. Other considerations such as self-interest may modify the effect of unfavorable attitudes toward government.
Maternal smoking during pregnancy and limb reduction malformations in Sweden.
Authors: Källén K
Published: November 2008

OBJECTIVE: This study was undertaken to investigate a possible connection between different types of limb reduction defects and maternal smoking during pregnancy. METHODS: With the use of the Swedish health registries, 610 cases of limb reduction malformations were selected from among 1 109 299 infants born between 1983 and 1993 with known smoking exposure in early pregnancy. Confounders such as maternal age and parity were controlled for with the use of the Mantel-Haenszel technique. RESULTS: The odds ratio for any maternal smoking among all cases of limb reductions was 1.26 (95% confidence interval = 1.06, 1.50). The main subgroups of limb reduction defects showed similar odds ratios, but in longitudinal reduction defect, only unilateral cases showed an association with maternal smoking. CONCLUSIONS: This study supports an association between maternal smoking and limb reduction malformations, but further work is needed before a causal inference can be made.
Access to maternity care in rural Washington: its effect on neonatal outcomes and resource use.
Authors: Nesbitt T S , Larson E H , Rosenblatt R A , Hart L G
Published: November 2008

OBJECTIVES: This study sought to ascertain the effects of poor local access to obstetric care on the risks of having a neonate diagnosed as non-normal, a long hospital stay, and/or high hospital charges. METHODS: Washington State birth certificates linked with hospital discharge abstracts of mothers and neonates were used to study 29809 births to residents of rural areas. Births to women from rural areas where more than two thirds of the women left for care were compared with births to women from rural areas where fewer than one third left for care. RESULTS: Poor local access to providers of obstetric care was associated with a significantly greater risk of having a non-normal neonate for both Medicaid and privately insured patients. However, poor local access to care was consistently associated with higher charges and increased hospital length of stay only if the patient was privately insured. CONCLUSIONS: These results indicate that local maternity services may help prevent non-normal births to rural women and, among privately insured women, might decrease use of neonatal resources.
The invisibility of public health: population-level measures in a politics of market individualism.
Authors: Burris S
Published: November 2008

This paper models the prevailing political attack on government as a heuristic, a judgmental strategy that simplifies complex phenomena by applying simple tests to a limited set of relevant data. The heuristic of market individualism offers three tools for analyzing the problems of governing: the supremacy of the free market as a regulatory device, a belief in individual freedom of choice and personal responsibility, and the elevation of individual satisfaction as the chief goal of society. Because public health is inherently concerned with the health of the population rather than individual health, because the market itself is a major source of ill health, and because individual choice is socially mediated, use of the heuristic precludes the recognition of the value of public health work. Although some degree of accommodation to current political realities is a practical necessity, public health advocates must not neglect the task of fashioning radically different alternative visions over the long term.
Age, time, and cohort effects on functional status and self-rated health in elderly men.
Authors: Hoeymans N , Feskens E J , van den Bos G A , Kromhout D
Published: November 2008

OBJECTIVES: This study investigated age-related changes in functional status and self-rated health in elderly men, taking into account changes over time and differences between birth cohorts. METHODS: The Zutphen Elderly Study is a longitudinal study of men born in the Netherlands between 1900 and 1920. Functional status and self-rated health were measured in 513 men in 1990, in 381 men in 1993, and in 340 men in 1995. Age, time, and cohort effects were analyzed in a mixed longitudinal model. RESULTS: Longitudinal analyses showed that during 5 years of follow-up, the proportion of men without disabilities decreased from 53% to 39%, whereas the percentage who rated themselves as healthy decreased from 50% to 35%. Cross-sectional analyses confirmed changes in functional status, suggesting an age effect. Time-series analyses confirmed changes in self-rated health, suggesting a time effect. No birth-cohort effects were found. CONCLUSIONS: Functional status deteriorates with age, whereas self-rated health is not related to age in men aged 70 years and older. The observed 5-year decline in self-rated health seemed to be due to a secular trend.
Prescription drug spending: the impact of age and chronic disease status.
Authors: Mueller C , Schur C , O'Connell J
Published: November 2008

OBJECTIVES: The purpose of this study was to examine how pharmaceutical expenditures vary by age and the presence of chronic health problems. METHODS: Data from the 1987 National Medical Expenditure Survey were used to obtain nationally representative estimates of outpatient prescription drug expenditures for the noninstitutionalized population and the fraction of total health expenditures used to purchase medications for age-chronic disease population subgroups. RESULTS: Although the elderly make up 12% of the population, they account for 34% of total pharmaceutical expenditures. Pharmaceutical expenditures are 9% of total expenditures for children, 13% for nonelderly adults, and 23% for the elderly. Among nonelderly adults, approximately one third have at least one chronic condition and account for over two thirds of drug expenditures. Among the elderly, 36% have three or more chronic conditions and account for 57% of drug expenditures for this group; 41% of total drug expenditures are for cardiovascular or renal drugs. CONCLUSIONS: Significant pharmaceutical spending is for treatment of chronic conditions, which subjects insurance coverage to adverse selection and could affect the design of prescription drug benefit packages. Current enrollees in Medicare risk management plans who have drug benefits may face significantly higher out-of-pocket expenses for pharmaceuticals if capitation rates are cut as a means of controlling Medicare program expenditures.
Daytime sleepiness: an epidemiological study of young adults.
Authors: Breslau N , Roth T , Rosenthal L , Andreski P
Published: November 2008

OBJECTIVES: Although excessive daytime sleepiness is associated with increased risks for accidents, decreased productivity, and interpersonal difficulties, information on its epidemiology is scarce. This paper examines correlates of and suspected risk factors for daytime sleepiness from a longitudinal epidemiological study of young adults. METHODS: The sample consisted of 1007 randomly selected young adults from a large health maintenance organization in southeast Michigan. Data were gathered in personal interviews conducted with 97% of the sample 5.5 years after baseline. Information on sleep characteristics in the last 2 weeks, including daytime sleepiness, nocturnal sleep onset, snoring, and hours of sleep, was collected on a self-administered instrument. Psychiatric disorders were measured by the National Institute of Mental Health's Diagnostic Interview Schedule. RESULTS: The average length of nocturnal sleep on weekdays was 6.7 hours. Daytime sleepiness was inversely related to hours of sleep and positively related to the ease of falling asleep at night; it varied significantly by employment and marital status. Snoring was associated with increased daytime sleepiness, as was recent major depression. CONCLUSIONS: Factors that might increase daytime sleepiness among young adults include social factors (being single and being employed full time) and pathological conditions (frequent snoring and major depression).
Thyroxine values from newborn screening of 919 infants born before 29 weeks' gestation.
Authors: Reuss M L , Leviton A , Paneth N , Susser M
Published: November 2008

OBJECTIVES: Severe transient hypothyroxinemia in premature infants is associated with cerebral palsy and mental retardation: this study assessed its prevalence in very premature infants. METHODS: Congenital hypothyroidism screening programs in three states provided thyroxine values for 919 newborn infants younger than 29 weeks who were enrolled in a multicenter study. RESULTS: Thyroxine values were lower than 4.0 micrograms/dL in 21% of survivors and increased each week by 0.6 microgram/dL (95% confidence interval [CI] = 0.4, 0.7). At tests done 1 to 2 days after birth, levels were 2.5 micrograms/dL higher (95% CI = 1.8, 3.3) than at tests done at 8 to 14 days. In New York, levels were 1.0 microgram/dL higher (95% CI = 0.3, 1.6) than elsewhere. The levels of infants who died were 1.3 micrograms/dL lower (95% CI = 0.6, 2.0) than those of survivors. CONCLUSIONS: Severe transient hypothyroxinemia is common in very premature infants and deserves further study.
Dog bite incidence in the city of Pittsburgh: a capture-recapture approach.
Authors: Chang Y F , McMahon J E , Hennon D L , LaPorte R E , Coben J H
Published: November 2008

OBJECTIVES: The purpose of this study was to estimate the number of dog bite injuries occurring in the city of Pittsburgh in 1993. METHODS: The capture-recapture method was used, along with long-linear modeling. Three sources were used to identify victims hospital reports, animal control reports, and police/victim reports. RESULTS: In 1993, 790 dog bites were reported. The capture-recapture method estimated that there were 1388 unreported dog bites, with an estimated incidence rate of 58.9 per 10,000. CONCLUSIONS: Dog bite is a common our preventable injury. To improve surveillance, the focus should be on educating the general public about the serious consequences of dog bite injuries.
Eugenics and public health in American history.
Authors: Pernick M S
Published: November 2008

Supporters of eugenics, the powerful early 20th-century movement for improving human heredity, often attacked that era's dramatic improvements in public health and medicine for preserving the lives of people they considered hereditarily unfit. Eugenics and public health also battled over whether heredity played a significant role in infectious diseases. However, American public health and eugenics had much in common as well. Eugenic methods often were modeled on the infection control techniques of public health. The goals, values, and concepts of disease of these two movements also often overlapped. This paper sketches some of the key similarities and differences between eugenics and public health in the United States, and it examines how their relationship was shaped by the interaction of science and culture. The results demonstrate that eugenics was not an isolated movement whose significance is confined to the histories of genetics and pseudoscience, but was instead an important and cautionary part of past public health and a general medical history as well.
Shifting categories of the social harms associated with alcohol: examples from late medieval and early modern England.
Authors: Warner J
Published: November 2008

This paper offers a historical perspective on our own attempts to define the social harms associated with the abuse of alcohol. Challenging the notion that categories are necessarily objective and constant, it instead emphasizes the extent to which even harms that are visible and thus susceptible to measurement are in fact socially constructed. English sources from the preindustrial era revealed six broad categories of social harms associated with the abuse of alcohol. Four of the categories consisted of visible harms in the form of income lost, domestic violence, brawling, and accidents, all of which are still recognized as social harms associated with the abuse of alcohol. The other two categories, reversal of the established moral order and susceptibility to trickery, were of an essentially intrinsic or subjective nature and have since dropped from the lexicon of social harms.
Taking the cure to the poor: patients' responses to New York City's tuberculosis program, 1894 to 1918.
Authors: Abel E K
Published: November 2008

Drawing on the case files of a major charitable agency, this paper explores how poor people experienced New York City's pioneering program of tuberculosis control. Although the program provided enormous benefits, poor New Yorkers often had pressing concerns that took priority over eradicating tuberculosis. Moreover, the program imposed extreme hardships even as it promised liberation from a terrible scourge. Poor people did not protest collectively, but many individually resisted. They delayed seeking diagnosis, disobeyed the advice promulgated by the Department of Health, attended clinics irregularly, and either refused to enroll in hospitals, sanatoria, and preventoria or fled soon after arrival.
The House of Falk: the paranoid style in American health politics.
Authors: Derickson A
Published: November 2008

The onset of the Cold War had a blighting effect on the campaign for a national health insurance program in the United States. In the highly charged atmosphere of the late 1940s, proponents of social insurance spent considerable time and energy denying that they were agents of foreign powers. In one widely promoted conspiratorial formulation, some on the right traced the origins of subversion not only to Moscow but also to Geneva, Switzerland, home of the International Labor Organization. In the fractiously partisan context of the period, conservative political leaders amplified concerns over disloyal bureaucrats' manipulating the levers of legislative politics as well as the design of health policy. One federal official in particular, I. S. Falk, became the object of outright demonization. The paranoid attacks took their toll on the drive to extend social protection. The reformers' difficulties suggest the limitations of heavy dependence on bureaucratic expertise in the pursuit of health security.
Race, foster care, and the politics of abandonment in New York City.
Authors: Rosner D , Markowitz G
Published: November 2008

Following the end of the Great Depression of the 1930s, the sectarian system of foster care services in New York City practiced open discrimination. African-American children were generally segregated in a small number of overcrowded and understaffed all-Black institutions. As the African-American migration to the city accelerated in the years following the outbreak of World War II, a small group of psychologists, jurists, philanthropists, and social workers began a systematic challenge to this system. This paper explores the role of racism in shaping New York's foster care system and the experience of African-American children who were forced to depend on services originally organized to serve Whites. It also looks at the ways race affected the way children were typed--as mentally ill, delinquent, or even criminal--in response to the structural realities of a system that sorted children into separate types of institutions according to race. The paper also provides the background for understanding the landmark challenge to segregation of children in sectarian and public institutions represented by Wilder v Sugarman.
The federal government's use of Title VI and Medicare to racially integrate hospitals in the United States, 1963 through 1967.
Authors: Reynolds P P
Published: November 2008

Explicit discrimination against minorities existed in the 1960s in hospital patient admissions and physician and nurse staff appointments. With passage of the Civil Rights Act of 1964, along with Medicare legislation in 1965, civil rights advocates within the federal government had both a legislative mandate to guarantee equal access to programs funded by the federal government in Title VI and a federal program that affected every hospital in the country in Medicare. This study was conducted to determine the extent to which the Medicare hospital certification program was a major determinant in the racial integration of hospitals throughout the United States. In-depth interviews were conducted with individuals involved in hospital and health care policy in the 1950s and 1960s. Other primary resources include archival and personal manuscripts, government documents, newspapers, and periodicals.
Leprosy and tuberculosis: the epidemiological consequences of cross-immunity.
Authors: Lietman T , Porco T , Blower S
Published: November 2008

OBJECTIVES: This study tested the hypothesis, first proposed by Chaussinand, that individual-level immunity acquired from exposure to tuberculosis may have contributed to the disappearance of leprosy from western Europe. METHODS: The epidemiological consequences of cross-immunity were assessed by the formulation of a mathematical model of the transmission dynamics of tuberculosis and leprosy. RESULTS: The conditions under which Mycobacterium tuberculosis could have eradicated Mycobacterium leprae were derived in terms of the basic reproductive rates of the two infections and the degree of cross-immunity. CONCLUSIONS: If the degree of cross-immunity between two diseases within an individual is known, then the epidemiological consequences of this cross-immunity can be assessed with transmission modeling. The results of this analysis, in combination with previous estimates of the basic reproductive rate of tuberculosis and degree of cross-immunity, imply that tuberculosis could have contributed to the decline of leprosy if the basic reproductive rate of leprosy was low.
Sociodemographic factors and the variation in syphilis rates among US counties, 1984 through 1993: an ecological analysis.
Authors: Kilmarx P H , Zaidi A A , Thomas J C , Nakashima A K , St Louis M E , Flock M L , Peterman T A
Published: November 2008

OBJECTIVES: Syphilis in the United States is focally distributed, with high incidence rates in the South and in metropolitan areas nationwide. In this study an ecological analysis, using the county as the unit of analysis, was performed to generate hypotheses about community-level determinants of syphilis rates. METHODS: Bivariate rank correlations and multivariate, backward stepwise elimination linear regressions were performed. Mean annual incidence of primary- and secondary-stage syphilis in a county was the dependent variable, and county sociodemographic characteristics (from census data) were the independent variables. RESULTS: In the multivariate regression model, sociodemographic characteristics accounted for 71% of the variation in syphilis rates among counties. With other factors accounted for, the most highly correlated characteristics were percentage non-Hispanic Black population, county location in the South, percentage of the population that was urban, percentage Hispanic population, and percentage of births to women younger than 20 years. CONCLUSIONS: Most of the variation in syphilis rates among counties is accounted for by sociodemographic characteristics. Identification and remediation of modifiable health determinants for which these factors are markers are needed to improve the health status of these populations.
Active and passive surveillance for communicable diseases in child care facilities, Seattle-King County, Washington.
Authors: MacDonald J K , Boase J , Stewart L K , Alexander E R , Solomon S L , Cordell R L
Published: November 2008

OBJECTIVES: The purpose of this study was to develop and evaluate models for public health surveillance of illnesses among children in out-of-home child care facilities. METHODS: Between July 1992 and March 1994, 200 Seattle-King County child care facilities participated in active or enhanced passive surveillance, or both. Reporting was based on easily recognized signs, symptoms, and sentinel events. Published criteria were used in evaluating surveillance effectiveness, and notifiable disease reporting of participating and nonparticipating facilities was compared. RESULTS: Neither surveillance model was well accepted by child care providers. Enhanced passive and active surveillance had comparable sensitivity. Reporting delays and the large amount of time needed for data entry led to problems with timeliness, especially in terms of written reporting during active surveillance. CONCLUSIONS: Widespread active public health surveillance in child care facilities is not feasible for most local health departments. Improvements in public health surveillance in child care settings will depend on acceptability to providers.
Can physicians treat tuberculosis? Report on a national survey of physician practices.
Authors: Sumartojo E M , Geiter L J , Miller B , Hale B E
Published: November 2008

OBJECTIVES: Researchers examined physicians' treatment strategies for tuberculosis to determine whether they would follow recommendations of the Centers for Disease Control and Prevention and the American Thoracic Society. METHODS: A national survey sampled 1772 physicians. Analyses tested correlates of recommended treatment regimens. RESULTS: Among respondents, 59.4% described a recommended regimen. Specialists; physicians aware of professional publications, treatment recommendations, and reporting requirements; and those having more than 50% of patients in nursing homes were more likely to describe recommended regimens. Physicians who had been in practice longer, relied on personal experience, or had more than 50% of patients receiving Medicaid were less likely to describe recommended regimens. CONCLUSIONS: Physicians who treat tuberculosis require training and support. Policymakers should consider who should treat tuberculosis and how recommended practice should be ensured.
Incidence of tuberculosis infection among New York State prison employees.
Authors: Steenland K , Levine A J , Sieber K , Schulte P , Aziz D
Published: November 2008

OBJECTIVES: This study examined tuberculosis skin test conversions among 24,487 New York State prison employees in 1992. METHODS: Conversions were analyzed by prison and by job category. RESULTS: The conversion rate was 1.9%. Employees in prisons with low and high numbers of prisoner cases had odds ratios for conversion of 1.67 (95% confidence interval [CI] = 1.27, 2.19) and 2.20 (95% CI = 1.69, 2.87), respectively, relative to employees in prisons with no prisoner cases. In prisons with cases, guards and medical personnel had odds ratios of 1.64 (95% CI = 1.11, 2.43) and 2.39 (95% CI = 1.40, 4.08), respectively, relative to employees with little prisoner contact. CONCLUSIONS: In 1992, approximately one third of new infections among New York State prison employees were due to occupational exposure.
Compliance with tuberculosis drug regimens: incentives and enablers offered by public health departments.
Authors: Buchanan R J
Published: November 2008

OBJECTIVES: This research examined incentives implemented by public health departments to encourage tuberculosis patients to comply with tuberculosis drug regimens. METHODS: A questionnaire addressing incentives was mailed to the directors of each state's health department during May 1995. All 50 states and the District of Columbia returned questionnaires. RESULTS: The survey results indicate that public health departments in almost all states are implementing the incentives advocated by tuberculosis experts. CONCLUSIONS: The implementation of these incentives may help to explain why the incidence of tuberculosis resumed its long-term decline in the United States during 1993 after a decade of resurgence.
Maternal acculturation and childhood immunization levels among children in Latino families in Los Angeles.
Authors: Anderson L M , Wood D L , Sherbourne C D
Published: November 2008

OBJECTIVES: This study examined the relationship between acculturation levels of poor Latina women in Los Angeles and their children's immunization status. Receipt of three doses of diphtheriatetanus-pertussis vaccine and two doses of oral polio vaccine by the age of 12 months was considered adequate immunization. METHODS: Household interviews were conducted in East Los Angeles and South Central Los Angeles with mothers (n = 688) about one randomly selected child aged 12 to 36 months. RESULTS: One fourth of the children were inadequately immunized. Less-acculturated mothers were more likely to have adequately immunized children. Inadequate prenatal care, absence of close family members, the child's birth position as other than firstborn, and more than one family relocation during the child's lifetime were associated with inadequate immunization. CONCLUSIONS: The findings challenge the notion that children of recent immigrants bear a higher risk of underimmunization.
Geographic analysis of pertussis infection in an urban area: a tool for health services planning.
Authors: Siegel C , Davidson A , Kafadar K , Norris J M , Todd J , Steiner J
Published: November 2008

OBJECTIVE: This study examined whether incident cases of pertussis cluster in urban census tracts and identified community characteristics that predict high-incidence areas. METHODS: An ecological study design was used. The study population included all persons diagnosed with pertussis from January 1, 1986, through December 31, 1994. Maps of rates were constructed via a geographic information system and clustering was statistically confirmed. Associations between pertussis rates and community characteristics were tested. RESULTS: Mapping and statistical analysis revealed spatial clustering of pertussis. Higher age-adjusted rates of pertussis infection were associated with higher proportions of residents below poverty level. CONCLUSIONS: In urban areas pertussis infection clusters in areas of poverty.
Outbreak of hepatitis A among homosexual men in Sydney.
Authors: Stokes M L , Ferson M J , Young L C
Published: November 2008

OBJECTIVES: This study examined an outbreak of hepatitis A in eastern Sydney during 1991-1992. METHODS: Data were based on cases of hepatitis A in eastern Sydney residents reported from January 1991 to October 1992. RESULTS: Five hundred seventy cases of hepatitis A were reported. Of these, 515 (90%) occurred in male patients, of whom 330 were reported to be homosexual or bisexual. The highest attack rate (71/10,000) occurred in men aged 20 to 29 years of age. CONCLUSIONS: This outbreak affected large numbers of young homosexual men living in the inner eastern suburbs of Sydney. Hepatitis A vaccination should be considered for all susceptible homosexual men. Further research into the use of hepatitis A vaccine as an outbreak control measure is also recommended.
Behavior intentions of the public after bans on smoking in restaurants and bars.
Authors: Biener L , Siegel M
Published: November 2008

OBJECTIVES: This study assessed the potential effect of smoke-free policies on bar and restaurant patronage. METHODS: Random-digit dialing techniques were used in surveying a representative sample of Massachusetts adults (n = 2356) by telephone. RESULTS: Approximately 61% of the respondents predicted no change in their use of restaurants in response to smoke-free policies, 30% predicted increased use, and 8% predicted decreased use. In turn, 69% of the respondents predicted no change in their patronage of bars, while 20% predicted increased use and 11% predicted decreased use. CONCLUSIONS: These results suggest that smoke-free policies are likely to increase overall patronage of bars and restaurants.
Physician assisted suicide and the Supreme Court: putting the constitutional claim to rest.
Authors: Mariner W K
Published: November 2008

Like the debate about many controversial questions of ethics and medical care in America, public debate about physician assisted suicide became focused on questions of constitutional law. On June 26, 1997, the United States Supreme Court unanimously rejected any constitutional right of terminally ill patients to physician assisted suicide. An analysis of the Court's reasoning reveals that its decisions resolved only a narrow constitutional question that affects relatively few people--mentally competent, terminally ill patients who wish to hasten their imminent deaths by having a physician prescribe medication that they intend to use to commit suicide. Although suicide is not a crime, states remain free to prohibit assisted suicide. One consequence of the Court's decisions may be renewed debate on state laws. A more productive result would be to address the broader public health concerns that gave rise to support for physician assisted suicide--inadequate care for the terminally ill and prevention of suicide.
Hamburger-associated Escherichia coli O157:H7 infection in Las Vegas: a hidden epidemic.
Authors: Cieslak P R , Noble S J , Maxson D J , Empey L C , Ravenholt O , Legarza G , Tuttle J , Doyle M P , Barrett T J , Wells J G , McNamara A M , Griffin P M
Published: November 2008

OBJECTIVES: This study sought to determine whether a multistate fast food hamburger-associated outbreak of Escherichia coli O157:H7 infection involved Las Vegas residents as well and, if so, why public health officials had not detected it. METHODS: A matched case-control study was conducted among persons with bloody diarrhea and their healthy meal companions. Hamburger production, distribution, and cooking methods were reviewed. Unused hamburger patties were cultured, and E. coli O157:H7 isolates were characterized. Local laboratory stool culture practices were reviewed. RESULTS: Fifty-eight cases of bloody diarrhea were identified. Illness was associated with eating regular hamburgers (matched odds ratio [OR] = 9.0, 95% confidence interval [CI] = 1.02,433.4), but 25% of ill persons reported eating only jumbo hamburgers. Regular and jumbo hamburger patties yielded E. coli O157:H7 indistinguishable from the lone clinical isolate. No local laboratory cultured routinely for E. coli O157:H7 until after the outbreak. CONCLUSIONS: A large outbreak of E. coli O157:H7 infections escaped timely notice in Las Vegas because local laboratories did not culture for this pathogen. Health officials should encourage laboratories to screen at least all bloody stools on sorbitol-MacConkey medium.
Infectious disease mortality among infants in the United States, 1983 through 1987.
Authors: Read J S , Troendle J F , Klebanoff M A
Published: November 2008

OBJECTIVE: The purpose of this study was to determine the relative importance of infectious disease as a cause of infant mortality in the United States and to identify characteristics at birth associated with subsequent infectious disease mortality. METHODS: Birth and infant death certificate data from the National Center for Health Statistics (NCHS) 1983 through 1987 Linked Birth/ Infant Death Data Sets were analyzed. RESULTS: Infection was the underlying cause of death for over 16000 infants, representing the fourth leading cause of mortality in this cohort. Almost 90% of infectious disease deaths during infancy were due to noncongenital infections, and the majority of these deaths occurred during the postneonatal period. Low birthweight, preterm birth, and male gender were independently associated with postneonatal mortality due to noncongenital infection. CONCLUSIONS: NCHS should revise its classification system for causes of infant mortality to incorporate an "Infectious Diseases" category. Future research should be directed toward clarifying the low birthweight-infectious disease mortality relationship and determining the degree to which infection-related infant deaths might be prevented by existing vaccines or improved access to health care.
Drug use disorders and treatment contact among homeless adults in Alameda County, California.
Authors: Robertson M J , Zlotnick C , Westerfelt A
Published: November 2008

OBJECTIVES: This study estimates the extent and distribution of specific drug problems among homeless adults. METHODS: A countywide probability sample of 564 homeless adults received structured interviews that included a standardized assessment of substance use disorders. RESULTS: Two thirds of the sample (69.1%) had a lifetime history of a substance use disorder (including abuse of or dependence on alcohol [52.6%] or drugs [52.2%]); half had a current (52.4%) substance use disorder (including alcohol [38.8%] or drugs [31.3%]). Current drug disorders were higher among respondents who were younger, homeless longer, or sampled from the city of Oakland, Calif. Alcohol use disorders were higher among men than among women; surprisingly, drug use disorders were not. CONCLUSION: Rates of current drug use disorders for homeless adults were more than eight times higher than general population estimates. However, estimates of drug problems among homeless adults vary as a function of case ascertainment and sampling strategy. Estimates based only on samples from urban areas may overestimate drug problems among the area's larger homeless populations.
Racial and ethnic disparities in the use of cardiovascular procedures: associations with type of health insurance.
Authors: Carlisle D M , Leake B D , Shapiro M F
Published: November 2008

OBJECTIVES: This study examined whether disparities in the use of cardiovascular procedures exist among African Americans, Latinos, and Asians relative to White patients, within health insurance categories. METHODS: Hospital discharge records (n = 104,952) of Los Angeles Country, California, residents with possible coronary artery disease were analyzed. RESULTS: After adjustment for confounders, lower odds of procedure use were found for African American and Latino patients for most types of insurance. Asians and Pacific Islanders had odds of procedure use similar to those of White patients. Disparities were absent among the privately insured. CONCLUSIONS: Racial and ethnic disparities in procedure rates were evident in all types of insurance except private insurance.
Using a brief household food inventory as an environmental indicator of individual dietary practices.
Authors: Patterson R E , Kristal A R , Shannon J , Hunt J R , White E
Published: November 2008

OBJECTIVES: This study examined whether foods in household pantries are an indicator of house-hold members' diet. METHODS: In a random-digit-dial survey, the presence in the house of 15 high-fat foods was assessed with whoever answered the phone. A randomly selected household member was surveyed about diet-related behaviors (n = 1002). RESULTS: Individuals in the precontemplation stage of dietary change had more high-fat foods in their pantry than those in maintenance (means of 7.4 and 5.8, respectively). Individuals with low-fat pantries had an intake of 32% energy from fat vs 37% for those with high-fat pantries. CONCLUSIONS: Household food inventories are a practical and valid approach to monitoring dietary behaviors in community-based studies.
Carbonated beverage consumption and bone mineral density among older women: the Rancho Bernardo Study.
Authors: Kim S H , Morton D J , Barrett-Connor E L
Published: November 2008

OBJECTIVES: The association between carbonated beverage consumption and bone mineral density was examined in a community-based cohort of older White women. METHODS: One thousand women 44 to 98 years of age had bone mineral density measured at four sites and provided medical and behavioral histories, including type and quantity of carbonated beverages consumed. RESULTS: Bone mineral density levels were not associated with intake of any type of carbonated beverage after adjustment for age, obesity, calcium intake, exercise, and current use of tobacco and alcohol, thiazides, estrogen, or thyroid hormone. CONCLUSIONS: Modest intake of carbonated beverages does not appear to have adverse effects on bone mineral density in older women.
Transmission of Mycobacterium tuberculosis in a California State Prison, 1991.
Authors: Koo D T , Baron R C , Rutherford G W
Published: November 2008

OBJECTIVES: An investigation was conducted to determine whether ongoing transmission of Mycobacterium tuberculosis was occurring in a California state prison. METHOD: Prison pharmacy records were used to identify cases of active tuberculosis (TB). RESULTS: Ten of the 18 cases of active TB treated at the facility during 1991 were diagnosed at the prison that same year (an incidence of 184 per 100,000). Three inmates were infectious for a total of 7 months while imprisoned. The prevalence of TB skin test-positivity among inmates was 30%, and the incidence of new infection attributable to incarceration was 5.9 per 100 inmates per year. CONCLUSIONS: Transmission of M. tuberculosis may be occurring in the California prison system.
Characteristics of automatic or semiautomatic firearm ownership in the United States.
Authors: Hemenway D , Richardson E
Published: November 2008

OBJECTIVES: This study examined ownership patterns of automatic/ semiautomatic firearms in the United States. METHODS: Data were derived from a national random-digit-dialing telephone survey of 800 gun owners. RESULTS: Sixty percent of gun owners reported owning an automatic or semiautomatic firearm. In comparison with other gun owners, owners of automatics or semiautomatics were more likely to be male, live in the South, own a gun for protection, and have a gun for work. They were also more likely to report binge drinking. CONCLUSIONS: Owners of automatic or semiautomatic firearms differ from other gun owners in several respects, including frequency of binge drinking.
Disability in activities of daily living: patterns of change and a hierarchy of disability.
Authors: Dunlop D D , Hughes S L , Manheim L M
Published: November 2008

OBJECTIVES: This paper examines longitudinal data over 6 years to evaluate incidence rates of disability and the pattern of dependency in activities of daily living. METHODS: The Longitudinal Study of Aging (n = 5151) was used to evaluate incidence of disability in activities of daily living; biennial interview data from 1984 through 1990 were used. The median age to disability onset for individual activities was estimated from survival analysis. A prevalent ordering of incident disability was identified from patterns of disability onset within individuals. RESULTS: The progression of incident disability among the elderly supported by longitudinal data, based on both the ordering of median ages to disability onset and patterns of incident disability, was as follows: walking, bathing, transferring, dressing, toileting, feeding. Gender differences were found in disability incidence rates. CONCLUSIONS: This study provides a mathematical picture of physical functioning as people age. These findings, based on longitudinal data, indicate a different hierarchical structure of disability than found in previous reports using cross-sectional data. Furthermore, the study documents gender differences in incident impairment, which indicate that although women outlive men, they spend more time in a disabled state.