bluuebunny/crossref_metadata_2025 huggingface dataset:
Inadequate utilization of routine electronic RBC counts to identify beta thalassemia carriers.
Authors: Shalev O , Yehezkel E , Rachmilewitz E A
Published: November 2008

We investigated physician awareness of the diagnosis of beta thalassemia minor as suggested by RBC indices obtained from routine electronic counts; and, the knowledge of the carriers of their genetic trait. Out of 17,000 counts, 324 were compatible with the diagnosis of beta thalassemia minor, but, only 175 (54 per cent) were identified by physicians as possibly thalassemic and in 47 of these (27 per cent) was the diagnosis verified. Twenty-four of 39 interviewed patients in whom the diagnosis of beta thalassemia minor was established knew about their carrier state.
Blood alcohol measurements in the emergency department: who needs them?
Authors: Simel D L , Feussner J R
Published: November 2008

We surveyed North Carolina emergency physicians to determine current medical practices regarding the use of blood alcohol concentrations using a hypothetical scenario. Most physicians (88 per cent) would not have obtained blood alcohol concentrations in a patient who had alcohol on his breath but was coherent and cooperative. For marginally impaired patients, more liberal use of blood alcohol concentrations and explicit instructions to avoid driving while impaired might improve patient care and promote highway safety.
Prescribing of noncontraceptive estrogens and progestins in the United States, 1974-86.
Authors: Hemminki E , Kennedy D L , Baum C , McKinlay S M
Published: November 2008

This paper describes changes in the prescribing of noncontraceptive estrogens and progestins, using data from pharmaceutical marketing surveys. The number of estrogen prescriptions decreased from 1975 to 1980, and then increased through 1986. Progestin use has increased since 1982; concomitant use of estrogens and progestins increased over time and was common in 1986. The trends suggest that the use of estrogens, particularly the combined use of estrogens and progestins, will continue to increase.
Decreased incidence of hip fracture in Hispanics, Asians, and blacks: California Hospital Discharge Data.
Authors: Silverman S L , Madison R E
Published: November 2008

We examined the incidence of hip fracture in Non-Hispanic White, Hispanic, Black, and Asian Americans for the years 1983 and 1984 using a data base which contains a summary of all hospitalizations for the State of California. We found a consistently lower risk for hip fracture after age 60 in Hispanic, Black, and Asian American females than in White females who were not Hispanic. Overall age-adjusted hip fracture rates in Hispanic, Black, and Asian females were 49.7, 57.3, and 85.4, respectively, and 140.7/100,000 in White females who were not Hispanic. These differences were not found in males, although Whites (not Hispanic) had the highest incidence of hip fractures among males.
Selection of elderly controls using random digit dialing.
Authors: Olsen G W , Mandel J S
Published: November 2008

The experience of identifying and soliciting elderly male controls, using a nonclustered random digit dialing procedure in a case-control study, is presented. For elderly controls (ages 65-84) 3.5 times more residential telephone numbers were required than for controls encompassing a much broader age range (ages 40-84). This is a function of the proportion of elderly in the population and their lower response to telephone identification. Elderly controls, age 70 and older, also had lower participation rates.
Patterns of sexual behavior and condom use in a cohort of homosexual men.
Authors: Schechter M T , Craib K J , Willoughby B , Douglas B , McLeod W A , Maynard M , Constance P , O'Shaughnessy M
Published: November 2008

To measure the magnitude of risk reduction within a cohort of homosexual men, questionnaire responses in April 1984-March 1985 were compared to those in October 1986-September 1987. A total of 361 subjects were eligible (231 seronegative, 130 seropositive). The annual number of sex partners declined significantly from a median of 8.0 to 5.0 with no difference between the serologic groups. The number of subjects reporting no receptive anal intercourse increased as did condom use during anal receptive intercourse. More seronegatives than seropositives subjects reported no condom use during receptive anal intercourse with regular partners (45.7 per cent versus 23.4 per cent), and with casual partners (14.9 per cent versus 1.5% percent). Among subjects with the most casual sexual contact at the second visit, 33.3 per cent of seronegatives and 29.2 per cent of seropositives did not report usual condom use during receptive anal intercourse with casual partners. Although we have documented marked risk reductions, safe sex practices are still not universal, and a few individuals continue to put themselves at extremely high risk.
Fractures and lifestyle: effect of cigarette smoking, alcohol intake, and relative weight on the risk of hip and forearm fractures in middle-aged women.
Authors: Hemenway D , Colditz G A , Willett W C , Stampfer M J , Speizer F E
Published: November 2008

Cigarette smoking, alcohol consumption and low relative weight are often cited as risk factors for osteoporosis. In a prospective cohort study of 96,508 middle-aged nurses 35 to 59 years of age we found that smoking was not a risk factor for hip and forearm fracture. Women who drank more than 15 grams of alcohol per day and whose relative weight was less than 21 kg/m2 were at increased risk of fractures, but these risk factors were not independent. Only the combination of alcohol intake and thinness substantially increased the likelihood of fracture. The low weight women consuming more than one drink per day comprised but 4 per cent of our population of middle-class women and sustained 6 per cent of the fractures.
Use of a leukocyte esterase dipstick to detect Chlamydia trachomatis and Neisseria gonorrhoeae urethritis in asymptomatic adolescent male detainees.
Authors: O'Brien S F , Bell T A , Farrow J A
Published: November 2008

We tested 91 asymptomatic adolescent male detainees in a short-stay detention facility in Seattle, Washington for the presence of leukocyte esterase in first-catch urine and for Chlamydia trachomatis and Neisseria gonorrhoeae infection. C. trachomatis was isolated from 10 subjects (11 per cent) and N. gonorrhoeae from five (5 per cent). Dipsticks detected leukocyte esterase in the urine of all 15 subjects with either infection and of 13 subjects with neither infection. Detection of leukocyte esterase was 100 per cent sensitive, 83 per cent specific, and 54 per cent predictive for the presence of either organism.
Effective and ineffective use of fear in health promotion campaigns.
Authors: Soames Job R F
Published: November 2008

Health promotion campaigns are typically designed to elicit fear, yet the use of fear is often ineffective in achieving the desired behavior change. Campaigns which attempt to use fear as part of a punishment procedure are unlikely to succeed. Consistent with established principles of learning, fear is most likely to be effective if the campaign allows for the desired behavior to be reinforced by a reduction in the level of fear. This entails five requirements: 1) fear onset should occur before the desired behavior is offered; 2) the event upon which the fear is based should appear to be likely; 3) a specific desired behavior should be offered as part of the campaign; 4) the level of fear elicited should only be such that the desired behavior offered is sufficient to substantially reduce the fear; 5) fear offset should occur as a reinforcer for the desired behavior, confirming its effectiveness. Under some circumstances it may be difficult to ensure that these requirements are met. In general, a positive reinforcement approach may prove to be more effective than the use of fear.
Tobacco advertisements in physicians' offices: a pilot study of physician attitudes.
Authors: Radovsky L , Barry P P
Published: November 2008

A pilot study evaluated the feasibility of a campaign to eliminate magazines advertising cigarettes from doctors' office waiting rooms. Only six of 51 waiting rooms visited did not contain cigarette ads. Only 25 per cent of physicians interviewed would participate in a subscription-cancellation campaign; they expressed doubt that this would influence patients' smoking behavior. This suggests that such a campaign will fail unless it is possible to change physicians' beliefs in its effectiveness.
Suicides in Alaska: firearms and alcohol.
Authors: Hlady W G , Middaugh J P
Published: November 2008

A manual review of death certificates and autopsy records identified 195 suicides in Alaska during 1983-84. Native males, 20-24 years old, had the highest rate of suicide (257 per 100,000 person-years). Gunshot wounds caused 76 per cent of all suicide deaths; 79 per cent of Native and 48 per cent of White suicides had detectable levels of blood alcohol. Suicide by firearms was weakly associated with blood alcohol levels above 100 mg/dl (odds ratio 1.3, 95 per cent confidence interval 1.11-1.47).
Spermicide use and pregnancy outcome.
Authors: Strobino B , Kline J , Warburton D
Published: November 2008

The relation between periconceptional vaginal spermicide use and sex ratio at birth, birthweight, and the frequency of congenital anomalies was examined in a cohort of 2,712 New York City obstetric patients, 149 of whom (5.5 per cent) became pregnant while using spermicides or had used spermicides before and after conception. Periconceptional spermicide use was not associated with any important variation in the expected sex ratio at birth, nor with major or minor congenital anomalies. Exposure to spermicides in the periconceptional period, defined dichotomously as present or absent, was not associated with decreased birthweight in male or female infants. There was a slight decrease in birthweight among female infants with increasing duration of postconceptional spermicide use; an estimated 7.4 grams decrease with each day of use. The size of the effect and its selectivity by sex suggest a chance finding.
A comparison of women in and out of a prematurity prevention project in a North Carolina perinatal care region.
Authors: Buescher P A , Meis P J , Ernest J M , Moore M L , Michielutte R , Sharp P
Published: November 2008

We assessed a prematurity prevention project in a North Carolina region with 21,000 annual births in terms of its impact on low birthweight. Project records were matched to birth certificates in order to compare characteristics of women in and out of the program who received prenatal care from private providers. A logistic regression analysis, in which the effects of race, marital status, age, and other risk factors for low birthweight were statistically controlled, showed that women not in the project were 1.32 times (95% Confidence Interval 1.14, 1.54) as likely as project participants to have a birth under 2500 grams. The relative risk for non-participants for a birth under 1500 grams was 1.87 (95% CI 1.25, 2.80). Strengths and limitations of the study are discussed. The results are consistent with previous work examining the etiologies of low birthweight in private versus public patients.
Food choices and the cancer guidelines.
Authors: Patterson B H , Block G
Published: November 2008

Twenty-four hour dietary recall data from 11,658 adult respondents in the second National Health and Nutrition Examination Survey (NHANES II) (1976-80) were used to examine the American diet in relation to certain of the cancer dietary guidelines from the National Academy of Sciences and the American Cancer Society. The per cent who reported consuming any food in those food groups considered protective was small: cruciferous vegetables (18 per cent); fruits and vegetables high in vitamin A (21 per cent); high fiber breads and cereals (16 per cent). The per cent consuming foods potentially increasing cancer risk was high: red meat (55 per cent); bacon and lunch meats (43 per cent). Proportions of persons eating fruits and vegetables increased with income. Diets were closer to the guidelines for females than males, for Blacks than Whites, and for older than younger Americans.
Usefulness of comprehensive feasibility studies in environmental epidemiology investigations: a case study in Minnesota.
Authors: Bender A P , Williams A N , Sprafka J M , Mandel J S , Straub C P
Published: November 2008

Episodes of public water supply contamination with industrial or agricultural chemicals frequently give rise to public concerns about adverse health effects. These concerns may precipitate epidemiologic or clinical investigations requiring large expenditures of state and federal resources regardless of whether such investigations are justified by scientific criteria. An alternative is a comprehensive feasibility study, utilizing all available information to determine whether large-scale studies are warranted or feasible. At a relatively modest cost, a feasibility study allows health officials to identify information needs and deficiencies, outline potential study options and costs, clearly establish the rationale for a proposed study or, conversely, prevent unwarranted expenditures of public resources. Furthermore, a feasibility study may in itself resolve many community and scientific concerns. This article provides a case study of the usefulness of a formal feasibility study in a situation involving an elevated cancer rate and contaminated municipal water supply wells surrounding a federal superfund site.
The status of cancer cluster investigations undertaken by state health departments.
Authors: Warner S C , Aldrich T E
Published: November 2008

A survey of state health departments indicates the number of cancer cluster reports received is associated with the size of the state, the presence of a population-based tumor registry, and the existence of a centralized system for response. Cancer cluster investigations, have generally been unproductive in terms of etiologic discoveries yet they may have important benefits in terms of public education, allaying public anxiety about environmental concerns and engendering good will toward government agencies.
Hepatitis B screening in a New York City obstetrics service.
Authors: Friedman S M , DeSilva L P , Fox H E , Bernard G
Published: November 2008

A cross-sectional chart review study was performed of hepatitis B virus (HBV) surface antigen screening of 532 women admitted to a New York City hospital obstetrics service from 1984 to 1985. Comparison of serologic results to risk factors for hepatitis B revealed that women born outside the United States and those with a positive test for or history of a sexually transmitted disease were more likely to be infected with HBV. Obstetric clinics with large immigrant populations should consider screening all patients for HBV.
The impact of AIDS on state and local health departments: issues and a few answers.
Authors: Judson F N , Vernon T M
Published: November 2008

Owing to large differences in the incidence of AIDS (acquired immunodeficiency syndrome) and in public health resources and priorities, the impact of AIDS on state and local health departments has been variable. Nonetheless, health departments everywhere are being held responsible for surveillance and control of the HIV (human immunodeficiency virus) epidemic which we believe requires, at minimum, convenient, free HIV testing and counseling; expanded HIV services in sexually transmitted diseases clinics and substance treatment centers; locally oriented AIDS information/education; notification of persons unknowingly exposed to HIV; restrictive measures for HIV-infected persons who, after counseling, persist in exposing others; regulation or closure of public establishments in which HIV transmission is likely to result; and confidential reporting of all HIV test results to public health departments. In Colorado new legislation was passed to require reporting of HIV test results, to provide the reports with near absolute protections against unauthorized disclosure, and to modify quarantine statues to incorporate rights to due process, appeals, and confidentially. States in which there is a legal basis for discrimination against gay men will need to rectify this problem first. There is no evidence that reporting of HIV infections in Colorado has adversely affected the rate at which persons with HIV risk behaviors volunteer to be tested. For Denver and Colorado Departments of Health, more than 70 per cent of the estimated $2,796,000 expended in AIDS activities during 1987 was federal.
AIDS, policy analysis, and the electorate: the role of schools of public health.
Authors: Krieger N , Lashof J C
Published: November 2008

Current debates concerning appropriate policy to combat the epidemic of acquired immunodeficiency syndrome (AIDS) have raised critical questions regarding the role that schools of public health and individual public health professionals should play, if any, in AIDS-related policy analysis and social advocacy. In the summer of 1986, the School of Public Health at the University of California at Berkeley initiated a telegram sent by the Deans of all 23 schools of public health to protest US Department of Justice AIDS policy and, in the subsequent fall, the school expanded its public educational role in an unprecedented manner by initiating and issuing, with California's other three schools of public health, a policy analysis of Proposition 64, the LaRouche AIDS Quarantine Initiative. That analysis exposed the proposition's fallacious claims regarding casual transmission of AIDS and served to educate the electorate on the likely public health impact of this deleterious legislation. Based on these experiences, and in light of ongoing national controversy regarding AIDS, we believe schools of public health have an important role to play in policy analysis, and individual public health professionals have a role to play in social advocacy.
Sexually active adolescents and condoms: changes over one year in knowledge, attitudes and use.
Authors: Kegeles S M , Adler N E , Irwin C E
Published: November 2008

Over a year when public health information regarding AIDS intensified, changes in perceptions and use of condoms in a sample of sexually active adolescents in San Francisco were examined. Although perceptions that condoms prevent sexually transmitted diseases (STDs) and the value and importance placed on avoiding STDs remained high, these were neither reflected in increased intentions to use condoms nor in increased use.
Crash involvement of large trucks by configuration: a case-control study.
Authors: Stein H S , Jones I S
Published: November 2008

For a two-year period, large truck crashes on the interstate system in Washington State were investigated using a case-control method. For each large truck involved in a crash, three trucks were randomly selected for inspection from the traffic stream at the same time and place as the crash but one week later. The effects of truck and driver characteristics on crashes were assessed by comparing their relative frequency among the crash-involved and comparison sample trucks. Double trailer trucks were consistently overinvolved in crashes by a factor of two to three in both single and multiple vehicle crashes. Single unit trucks pulling trailers also were overinvolved. Doubles also had a higher frequency of jackknifing compared to tractor-trailers. The substantial overinvolvement of doubles in crashes was found regardless of driver age, hours of driving, cargo weight, or type of fleet. Younger drivers, long hours of driving, and operating empty trucks were also associated with higher crash involvement.
Estimates of pregnancies and pregnancy rates for the United States, 1976-85.
Authors: Ventura S J , Taffel S M , Mosher W D
Published: November 2008

After increasing by 9 per cent in the period 1976-80 in the United States, pregnancy rates declined by 4 per cent between 1980 and 1984 (from 111.9 to 107.3 pregnancies per 1,000 women aged 15-44 years). Between 1984 and 1985, the rate rose by less than 1 per cent to 108.2. More detailed data by age and race, available only through 1983, indicate that the decline in the 1980-83 period was not shared by all age groups. For example, pregnancy rates continued to increase for women in their thirties, and teenage pregnancy remained substantially the same. In 1983, 61 per cent of all pregnancies ended in live birth, 26 per cent in induced abortion, and 13 per cent in fetal loss. Pregnancy rates in that year were two-thirds higher for women of races other than White than for White women, and pregnancies of other-than-White women were more likely to terminate as an induced abortion or fetal loss. However, White teenagers and teenagers of other races were about equally likely to have their pregnancy end in induced abortion or fetal loss.
Past and present preferred prescribing practices of hormone replacement therapy among Los Angeles gynecologists: possible implications for public health.
Authors: Ross R K , Paganini-Hill A , Roy S , Chao A , Henderson B E
Published: November 2008

Usual prescribing strategies of hormone replacement therapy for postmenopausal women by Los Angeles area gynecologists, both now and 10 years ago, were investigated by a mail survey. Of the 330 gynecologists who responded, estrogen therapy is currently used as a routine by nearly all (95 per cent), for women both with and without a uterus. Over three-fourths of these physicians favor use of 0.625 mg of conjugated equine estrogen. The estrogen is combined with cyclic progestin therapy, usually 10 mg of medroxyprogesterone acetate, by 86 per cent of gynecologists using estrogen for women with a uterus, and by 47 per cent for women without a uterus. Although conjugated equine estrogens were used widely for both groups of patients 10 years ago, a higher dose generally was preferred. Use of progestin therapy was uncommon (less than 20 per cent) for any postmenopausal patients at that time. Although the most common monthly therapeutic regimen for estrogen/progestin therapy is estrogen for days 1-25 and progestin for days 16-25, there is wide variation in prescribing strategies. We present these findings in the context of the probable effects of estrogen/progestin therapy on various chronic disease outcomes.
Incidence of depression and anxiety: the Stirling County Study.
Authors: Murphy J M , Olivier D C , Monson R R , Sobol A M , Leighton A H
Published: November 2008

Prevalence studies in psychiatric epidemiology out-number incidence investigations by a wide margin. This report gives descriptive information about the incidence of depression and anxiety disorders in a general population. Using data gathered in a 16-year follow-up of an adult sample selected as part of the Stirling County Study (Canada), the incidence of these types of disorders was found to be approximately nine cases per 1,000 persons per year. The data suggest that for every man who became ill for the first time with one of these disorders, three women became ill. Incidence tended to be higher among relatively young persons. These incidence rates are consistent with prevalence rates of approximately 10 per cent to 15 per cent for depression and anxiety disorders aggregated together, given an estimated average duration of illness of about 10 years. It is concluded that these incidence rates are fairly realistic in view of evidence that disorders of these types tend to be chronic.
Case shifting and the Medicare Prospective Payment System.
Authors: Sloan F A , Morrisey M A , Valvona J
Published: November 2008

We assessed impacts of the Medicare Prospective Payment System (PPS) during its first two years of operation (1984-85) on 467 hospitals using data from the Commission on Professional and Hospital Activities and from the American Hospital Association. Medicare discharges as a per cent of total discharges remained constant between 1983 and 1985, but the per cent of uninsured patients increased, especially at large public hospitals. The number of Medicare and total discharges per hospital declined. The number of complex diagnosis related groups (DRGs) increased, both for Medicare and non-Medicare. This trend began before the implementation of PPS and affected all types of hospitals. There was also an appreciable increase in case mix types of hospitals. There was also an appreciable increase in case mix severity within specific DRGs during 1980-85. The proportion of total patients received from or transferred to other hospitals rose after 1983, but these increases were very small. The per cent of Medicare patients admitted through the emergency room increased, especially after 1983. By contrast, the share of total non-Medicare admissions through the emergency room (ER) remained stable. Although the growth of the number of uninsured and Medicare patients admitted through the ER predate PPS, they may be influenced by it and warrant further monitoring.
Non-contraceptive estrogen use and the risk of gallstone disease in women.
Authors: Kakar F , Weiss N S , Strite S A
Published: November 2008

We interviewed 102 women, ages 41-74 years who underwent gallstone surgery between January 1979 and September 1980, and 98 controls selected from the membership files of a large prepaid health care plan in Western Washington, about their past use of certain medications, reproductive history, and physical and demographic characteristics. The risk of gallstone disease among women who used estrogens for at least one year prior to diagnosis of their condition, relative to that of other women, was 1.18 (95% CI: 0.65-2.13). Standardization for the effects of age, race, obesity, parity, thiazide use, and history of high blood pressure did not alter appreciably the estimate of relative risk. Among estrogen users, the duration of use was similar in cases and controls. Our findings suggest that if non-contraceptive estrogen use is a risk factor for gallstone disease (requiring surgery) in women, its effect is very small.
Characteristics influencing informed consent on a congenital malformations registry.
Authors: Law C , Robertson M O , Panny S R , Wulff L M
Published: November 2008

Maryland law requires that all babies born with "sentinel birth defects" be reported to the State Department of Health, but mothers may deny consent for further contact. Consent was not strongly related to maternal age, race, or self-reported data on exposures, smoking, and drugs but was much less likely if the infant was dead. Selection bias in congenital malformations research may lead to underrepresentation of lethal defects, but self-reported data appear to be unbiased.
Toxic shock syndrome: incidence and geographic distribution from a hospital medical records reporting system.
Authors: Miday R K , Wilson E R
Published: November 2008

A large database of hospital records maintained by the Commission on Professional and Hospital Activities Professional Activity Study (CPHA-PAS) was used to estimate the temporal incidence and geographic distribution of toxic shock syndrome (TSS). The CPHA-PAS hospital-diagnosed incidence was 3.5 times the reported TSS incidence, with a gradual decrease over the time period 1981-83. Marked differences in the regional occurrence of cases may provide clues to the etiology of this complex disease.
The social and economic correlates of pregnancy resolution among adolescents in New York City, by race and ethnicity: a multivariate analysis.
Authors: Joyce T
Published: November 2008

This study utilizes a data set combining vital records from live birth and induced abortion certificates in New York City in 1984 to examine the correlates of the two outcomes among pregnant adolescents. Four groups totaling 31,207 teenagers were examined: Black non-Latinos (51 per cent), White non-Latinos (17 per cent), Puerto Ricans (25 per cent), and non-Puerto Rican Latinos (8 per cent). Multivariate regressions were fit for each group. Simulations based on the regressions reveal that the proportion of live births plus induced abortions among unmarried 18-year-olds, on Medicaid, with a previous live birth, no previous induced abortions, and nine years of completed schooling was .55 in the case of Puerto Ricans, .34 for non-Puerto Rican Latinos, .60 for Blacks, and .51 for Whites. For nulliparous adolescents of the same age and marital status, with an additional year of schooling, but not on Medicaid, and with a previous induced abortion, the fraction of pregnancies that were terminated rose to .84 in the case of Puerto Ricans, .81 for non-Puerto Rican Latinos, .87 for Blacks, and .96 for Whites. The results suggest that attitudes toward abortion as proxied by previous induced terminations substantially increase the likelihood of aborting as well as narrow the racial and ethnic differences with respect to pregnancy resolution.
Hemorrhage, infection, toxemia, and cardiac disease, 1954-85: causes for their declining role in maternal mortality.
Authors: Sachs B P , Brown D A , Driscoll S G , Schulman E , Acker D , Ransil B J , Jewett J F
Published: November 2008

Hemorrhage, infection, toxemia, and cardiac disease are no longer the leading causes of maternal death. We studied factors causing their decline in incidence using data collected by the Committee on Maternal Welfare of the Massachusetts Medical Society between 1954 and 1985. The dramatic decline in incidence of these conditions in the Commonwealth during the study period appears to have been due to both legislative actions and improvements in medical practice. The legislative actions included licensing of maternity services, blood banks, and legalization of abortion. Cardiac-related mortality has declined due to a reduction in the prevalence of rheumatic heart disease. Changes in clinical practice that stand out were the aggressive control of the hypertensive component of toxemia leading to a reduced incidence of intracranial hemorrhage, the prompt recourse to blood transfusion for hemorrhage, and the use of broad spectrum antibiotics.
Effect of DRGs on three-month readmission rate of geriatric patients with congestive heart failure.
Authors: Rich M W , Freedland K E
Published: November 2008

We reviewed the three-month hospital readmission rates of 410 patients ages 70 years or older discharged alive with a first time diagnosis of congestive heart failure during the period January 1983-June 1986. The mean age was 79.8 years, 59.5 per cent were women. Mean length of initial hospital stay decreased from 10.8 days in 1983 to 7.8 days in 1986. One hundred-nineteen patients (29 per cent) were rehospitalized at least once within three months of initial discharge. The readmission rates by year were: 1983, 40.0 per cent; 1984, 27.5 per cent; 1985, 21.4 per cent; 1986, 23.2 per cent. During this same interval, the percentage of patients referred for home health care services increased from 3.3 per cent in 1983 to 13.0 per cent in 1984, 5.8 per cent in 1985, and 12.5 per cent in 1986. Thus, decreased length of hospital stay was associated with a parallel decline in early readmission rate and increased utilization of home health care services. Although this study has important methodologic limitations, the data suggest that shorter hospital stays under the DRG system are not necessarily associated with an increased rate of early rehospitalization.
The impact of political violence on health and health services in Cape Town, South Africa, 1986: methodological problems and preliminary results.
Authors: Yach D
Published: November 2008

Cape Town, South Africa experienced an upsurge in the level of political violence from May to July of 1986. To determine the impact of the political violence on health and health services, selected routinely available information was analyzed, a community survey was conducted of 1,540 randomly selected households in high, medium, and low impact areas (defined using police and community reports), and a survey of 162 nurses (75 per cent response rate) working in clinic and maternity services in Cape Town's townships was undertaken. Methodological problems were encountered in relation to sampling, interviewer allocation to areas, and access to routinely available information. Nevertheless, a consistent picture emerged from the studies that: demonstrated the impact of political violence on attendance at routine health service facilities (for hypertension, tuberculosis, immunizations, antenatal and postnatal services); highlighted the disruptions caused to basic services in high impact areas (water, street lighting, sanitation and transport); documented the problems experienced by nurses in performing their usual services and by patients obtaining access to their services; showed that high impact areas had three times higher rates of gunshot wounds than low impact areas during the period.
Poverty, race, and hospitalization for childhood asthma.
Authors: Wissow L S , Gittelsohn A M , Szklo M , Starfield B , Mussman M
Published: November 2008

This study uses Maryland hospital discharge data for the period 1979-82 to determine whether Black children are more likely to be hospitalized for asthma and whether this difference persists after adjustment for poverty. The average annual asthma discharge rate was 1.95/1000 children aged 1-19; 3.75/1000 for Black children, and 1.25/1000 for White. Medicaid-enrolled children of both races had increased discharge rates for asthma compared to those whose care was paid for by other sources: 5.68/1000 vs 2.99/1000 for Blacks, and 3.10/1000 vs 1.11/1000 for Whites. When ecologic analyses were performed, populations of Black and White children had nearly equal asthma discharge rates after adjustment for poverty. The statewide adjusted rate was 2.70/1000 (95% CL = 1.93, 3.78) for Black children and 2.10/1000 (1.66, 2.66) for White children. Among Maryland counties and health planning districts, variation in asthma discharge rates was not associated with the supply of hospital beds or the population to primary-care physician ratio. We conclude that Black children are at increased risk of hospitalization for asthma, but that some or all of this increase is related to poverty rather than to race.
Fatal pedestrian injuries to young children: a different pattern of injury.
Authors: Brison R J , Wicklund K , Mueller B A
Published: November 2008

All pedestrian vehicle collision fatalities to children less than five years of age in Washington State were evaluated for a five-year period using State death certificates, coroners' reports, and police records. Although the majority of pedestrian fatalities to older children have been shown to be due to "dart-outs" into traffic with the child being struck by an oncoming car, pedestrian fatality incident for children less than five tended to occur when the child was backed over in the home driveway by the family van or light truck driven by a parent. Prevention of pedestrian injuries in this age group requires strategies aimed at safeguarding the driveway and reassessing the safety of light trucks and vans as family vehicles.
An overview of Japanese occupational health.
Authors: Reich M R , Frumkin H
Published: November 2008

This paper provides an overview of Japanese occupational health and evaluates the current situation from three perspectives. Major occupational health hazards are assessed using four sources of data, showing patterns similar to those found in other advanced industrial societies. Institutional structures for occupational health policy are then examined, illustrating strengths and weaknesses of the Japanese legal and administrative systems. Trade union activities are presented, indicating the constraints of enterprise unions, and the tendency for a greater orientation toward compensation than prevention. Significant occupational health problems persist among marginal workers in Japan, including women and various minority groups. The analysis demonstrates a record for occupational health in Japan considerably more mixed than the conventional view.
The choice of weapons in firearm suicides.
Authors: Wintemute G J , Teret S P , Kraus J F , Wright M W
Published: November 2008

We report on the firearms used in 235 suicides in Sacramento County, California, during 1983-85. Handguns were used in 69 per cent of firearm suicides--65 per cent for males, 88 per cent for females--and in all such deaths among women ages 35 and older. We tested the hypothesis that the choice of firearms by persons committing suicide at home would passively reflect the reported prevalence of firearms by type in households in the region. Handguns were used more frequently (rate ratio 2.00; 95% CI = 1.68, 2.39), and rifles and shotguns less frequently than expected.
A survey of measured levels and dietary sources of selected organochlorine pesticide residues and metabolites in human sera from a rural population.
Authors: Stehr-Green P A , Farrar J A , Burse V W , Royce W G , Wohlleb J C
Published: November 2008

We measured serum levels of 11 pesticide residues and metabolites in 85 rural-dwelling persons. In general, the serum levels increased with age, with males having slightly higher levels than females. Consumption of eggs from home-raised hens contributed substantially to increased serum concentrations of trans-nonachlor, heptachlor epoxide, and oxychlordane; consumption of home-grown root vegetables likewise contributed to increased serum concentrations of trans-nonachlor and oxychlordane. Health risks, if any, that may be attributable to these "background" levels of exposure remain to be fully characterized in this, and all other, affected populations.
Determination of immune status to measles, rubella, and varicella-zoster viruses among medical students: assessment of historical information.
Authors: Murray D L , Lynch M A
Published: November 2008

We examined the serological susceptibility of entering medical students to measles, rubella, and varicella-zoster (VZV) viruses over a four-year period. Serological results were then compared to historical information to ascertain whether undocumented histories of disease or vaccination could be used to identify students who may not need serological testing. For measles, historical information was of no benefit in predicting immunity. For VZV and, to a greater extent, rubella, a higher seropositive rate was seen in students claiming a positive history.
A procedure for linking psychosocial job characteristics data to health surveys.
Authors: Schwartz J E , Pieper C F , Karasek R A
Published: November 2008

A system is presented for linking information about psychosocial characteristics of job situations to national health surveys. Job information can be imputed to individuals on surveys that contain three-digit US Census occupation codes. Occupational mean scores on psychosocial job characteristics-control over task situation (decision latitude), psychological work load, physical exertion, and other measures-for the linkage system are derived from US national surveys of working conditions (Quality of Employment Surveys 1969, 1972, and 1977). This paper discusses a new method for reducing the biases in multivariate analyses that are likely to arise when utilizing linkage systems based on mean scores. Such biases are reduced by modifying the linkage system to adjust imputed individual scores for demographic factors such as age, education, race, marital status and, implicitly, sex (since men and women have separate linkage data bases). Statistics on the linkage system's efficiency and reliability are reported. All dimensions have high inter-survey reproducibility. Despite their psychosocial nature, decision latitude and physical exertion can be more efficiently imputed with the linkage system than earnings (a non-psychosocial job characteristic). The linkage system presented here is a useful tool for initial epidemiological studies of the consequences of psychosocial job characteristics and constitutes the methodological basis for the subsequent paper.
Socioenvironmental characteristics associated with the onset of decline of ischemic heart disease mortality in the United States.
Authors: Wing S , Casper M , Riggan W , Hayes C , Tyroler H A
Published: November 2008

The relation of community socioenvironmental characteristics to timing of the onset of decline of ischemic heart disease (IHD) mortality was investigated among the 507 State Economic Areas of the continental United States. Onset of decline was measured using data for White men aged 35-74 and classified as early (1968 or before) vs late (after 1968). Ten socioenvironmental characteristics derived from US Census Bureau data were strongly related to onset of decline. Areas with the poorest socioenvironmental conditions were two to 10 times more likely to experience late onset than those areas with the highest levels. We found that income-related characteristics could account for most of the difference in onset of decline of IHD between metropolitan and non-metropolitan places. We conclude that community socioenvironmental characteristics provide the context for changes in risk factors and medical care.
Morbidity and use of ambulatory care services among poor and nonpoor children.
Authors: Newacheck P W , Starfield B
Published: November 2008

Using data from the Child Health Supplement to the 1981 National Health Interview Survey, illness and use of physician services are compared for children under 18 years old in three family income groups. The results indicate that although annual prevalence of many health problems does not differ greatly by income level, disability as measured by bed days is greater among low income children. A substantial minority of children from all socioeconomic levels are afflicted by multiple health problems. The impact of multiple conditions, as measured by days spent ill in bed, appears much greater for children from low income families. Use of physician services was found to be similar for children of all socioeconomic levels when no significant health problems were present, but low income children with health problems used fewer physician visits on an adjusted basis than their higher income counterparts.
Service use and costs for Medicare beneficiaries in risk-based HMOs and CMPs: some interim results from the National Medicare Competition Evaluation.
Authors: Rossiter L F , Nelson L M , Adamache K W
Published: November 2008

The Health Care Financing Administration (HCFA) initiated the Medicare Competition Demonstration in 1982 in anticipation of congressional intent to establish a national program. Interim results on the 1984 service use and cost experience of the health maintenance organizations (HMOs) and competitive medical plans (CMPs) participating in the demonstrations indicate that Medicare enrollees in the demonstration experienced a median of 1,951 hospital days per 1,000 person years, 57 per cent of the median of 3,432 days per 1,000 in the local markets from which the plans drew enrollment. Independent practice association (IPA) HMOs experienced higher hospital use rates than staff and group model HMOs. These comparisons are not adjusted for various risk factors, the absence of which were likely to favor the demonstration plans. Plans with lower hospital service use were federally qualified and had been operating for more than five years. The median total annual revenue per enrollee across all plans was $2,312, compared to median annual expenses per enrollee of $2,250. The distribution of median annual expenses per enrollee by major category of expense was: institutional expenses ($1,038/enrollee), medical expenses ($720/enrollee), supplemental services expenses ($154/enrollee), and administrative and other expenses ($295/enrollee). Future analysis, using beneficiary-level data, will examine the impact of the demonstration and the nature and extent of evident biased selection and will compare the quality of care in the demonstrations to that in the fee-for-service sector.
Time of exposure and risk of HIV infection in homosexual partners of men with AIDS.
Authors: Osmond D , Bacchetti P , Chaisson R E , Kelly T , Stempel R , Carlson J , Moss A R
Published: November 2008

We interviewed, and tested for HIV antibody, 117 homosexual men who had been regular sexual partners of men who developed acquired immunodeficiency syndrome (AIDS); 85 tested seropositive. Receptive anal intercourse with the index AIDS case and number of different sexual partners with whom subjects were anally receptive were both risk factors. Controlling for the number of partners with whom subjects were anally receptive, we found that the odds ratio of receptive anal intercourse with the case was infinite (95% confidence intervals, 3.3-infinity) if sexual contact continued up to or beyond the time of diagnosis, while the odds ratio was 1.0 (95% CI 0.3-3.2) if contact ceased before the case's AIDS diagnosis. Risk was not associated with the duration or frequency of contact. Our data suggest that the potential for sexual transmission from an HIV-infected person may be greater close to or after the onset of disease.
Hospital charges for people with AIDS in Washington State: utilization of a statewide hospital discharge data base.
Authors: Lafferty W E , Hopkins S G , Honey J , Harwell J D , Shoemaker P C , Kobayashi J M
Published: November 2008

We analyzed Washington State inpatient hospital utilization for 165 AIDS (acquired immunodeficiency syndrome) cases with 344 hospitalizations from July 1984 through December 1985. We found that mean charges per hospitalization were $9,166 and mean length of stay was 13.3 days. In addition, evaluation of two diagnosis-related groups (DRGs 079 and 398) commonly used for AIDS hospitalizations showed that AIDS hospitalizations were substantially more expensive than non-AIDS hospitalizations within the same diagnosis-related group. AIDS-specific diagnosis-related groups may be necessary to achieve a balance between inpatient charges and reimbursements.
History of blood transfusion, tattooing, acupuncture and risk of hepatitis B surface antigenaemia among Chinese men in Singapore.
Authors: Phoon W O , Fong N P , Lee J
Published: November 2008

To determine whether a history of blood transfusion, tattooing, and acupuncture is associated with an increased risk of hepatitis B surface antigenaemia, a study of 6,328 Chinese men between 35 and 65 years of age was undertaken in Singapore. The age-adjusted odds ratios were 1.44 (95% CI: 1.14, 1.83) for blood transfusion, 1.14 (95% CI: 0.80, 1.63) for tattooing, and 0.88 (95% CI: 0.71, 1.11) for acupuncture. Using no history of any of the three percutaneous procedures as reference, the age-adjusted odds ratio for blood transfusion only was 1.40, 95% CI: 1.07, 1.84, and for blood transfusion plus tattooing was 2.59, 95% CI: 1.18, 5.70. The proportion of HBsAg positive cases attributable to blood transfusion and tattooing, as measured by the population attributable risk, are 4.1 and 0.7 per cent, respectively.
Odd man out: a graphical approach to meta-analysis.
Authors: Walker A M , Martin-Moreno J M , Artalejo F R
Published: November 2008

The areas of overlap of confidence intervals from several studies can be used to create summary confidence regions. These summary regions lend themselves to graphical display, have readily derivable statistical properties, and can carry information about the influence both of available studies and of hypothetical future investigations. The case of a region covered by at least N-1 out of N confidence intervals is presented in some detail.
Nuclear education in public health and nursing.
Authors: Winder A E , Stanitis M A
Published: November 2008

Twenty-three public health schools and 492 university schools of nursing were surveyed to gather specific information on educational programs related to nuclear war. Twenty public health schools and 240 nursing schools responded. Nuclear war-related content was most likely to appear in disaster nursing and in environmental health courses. Three schools of public health report that they currently offer elective courses on nuclear war. Innovative curricula included political action projects for nuclear war prevention.