bluuebunny/crossref_metadata_2025 huggingface dataset:
Language of interview: relevance for research of southwest Hispanics.
Authors: Kirkman-Liff B , Mondragón D
Published: November 2008

BACKGROUND. This paper reports the results of a survey investigating health status, access, satisfaction with care, and barriers to care in Arizona. The major focus is on the association between language of interview and the dependent measures; interviews were conducted in English and Spanish. METHODS. The differences between groups were tested using chi-square statistics for each independent categorical variable; the significance of all the independent variables on each of the dependent variables was tested simultaneously using maximum likelihood logistical regression models. RESULTS. Language of interview for Hispanic children was a significant variable, more important than ethnicity itself, in determining health status, access, satisfaction with care, and barriers to care; language of interview for Hispanic adults was not a significant measure, but neither was ethnicity. Instead, income affected access to care for adults. CONCLUSIONS. This pattern of results suggests that in the southwestern United States, studies on health status and access to care that use only ethnicity and do not include language of interview may fail to identify populations of Hispanic children who are remarkably more vulnerable. Public health research of Hispanic populations can be more instrumental toward policy improvement if it increases its specificity with this heterogeneous group. Analysis of language of interview has a low cost and a high benefit toward this specification.
Effects of budgeting on health care services in Dutch hospitals.
Authors: Casparie A F , Hoogendoorn D
Published: November 2008

BACKGROUND. In 1983 hospital budgeting was introduced in the Netherlands. We studied the effect of the enactment of budgeting on the efficiency and effectiveness of health care. METHODS. In four different age groups, the admission rate, length of stay, type and number of surgical inpatient procedures, and hospital mortality were measured in all short-term hospitals from 1977 through 1988. Data were standardized by age and sex. RESULTS. For the total population, the hospital admission rate and the operation rate decreased after 1982. However, for the subgroup of patients beyond the age of 65 both rates are still on the rise, but the increase in the admission rate for elderly patients has slowed significantly since 1983. The tendency toward a shorter length of stay, together with the diminished admission rates, led to a 22% decrease in standardized hospital days between 1982 and 1988. The severity of the operations increased. Most operations performed on elderly patients were aimed at improving the quality of their lives rather than lengthening their life expectancy. The hospital mortality rate decreased in all age groups. CONCLUSIONS. The findings suggest that modern medicine in the Netherlands has become more efficient and more effective. Better health care for older patients was achieved within the same budget. The tendency toward more efficiency by hospitals has been reinforced since 1983.
Dogs as sentinels for Lyme disease in Massachusetts.
Authors: Lindenmayer J M , Marshall D , Onderdonk A B
Published: November 2008

BACKGROUND. An investigation of the relationship between incident human cases of Lyme disease and seroprevalence of antibodies to B. burgdorferi in dogs was undertaken in order to determine whether dogs might serve as sentinels for Lyme disease. METHODS. 3011 canine serum samples were analyzed by ELISA for antibody to B. burgdorferi. Records of incident human cases of Lyme disease were obtained from the Massachusetts Department of Public Health. RESULTS. Regression analyses of the relationship between the log10 (mean incidence in people 1985-1989) and canine seroprevalence from July 1988-August 1989 revealed that canine seroprevalence was highly predictive of incidence (R2 = 0.86, p less than .0001). A logistic regression model that incorporates the altitude of the town where each dog was resident, the date of sampling, and information on each dog's age, sex, and breed adequately explained the risk of canine seropositivity. Dogs resident at altitudes less than 200 feet, of sporting or large mixed breeds, and greater than two years of age were five times, four times, and almost three times more likely, respectively, to exhibit seropositivity than were other dogs. CONCLUSIONS. Estimates of the prevalence of antibody to B. burgdorferi in dog populations offers a sensitive, reliable, and convenient measure of the potential risk to people of B. burgdorferi in the environment. Risk factors for canine seropositivity may directly or indirectly illuminate certain aspects of the epidemiology of human Lyme disease.
Injury prevention awareness in an urban Native American population.
Authors: Hsu J S , Williams S D
Published: November 2008

The injury-related mortality rate for Native American children between the ages of 1 and 4 years is nearly three times that of the same age group in the general population. To assess injury prevention awareness in urban Native American families, we administered 39 age-appropriate questions from the Framingham Safety Survey to 50 Native American families and 100 other families and developed an answer scoring system to analyze and compare survey responses. Survey responses revealed that Native American families are less likely to keep small objects, household products, and medicines out of the reach of their children and to possess and understand the use of ipecac. Although urban Native-American families appear to be less aware of ingestion prevention practices than other urban families, these and other deficiencies in injury prevention awareness are more likely the result of factors related to their low-income status than to culturally based practices.
AIDS surveillance among American Indians and Alaska natives.
Authors: Metler R , Conway G A , Stehr-Green J
Published: November 2008

To assess the human immunodeficiency virus epidemic among American Indians and Alaska Natives (AI/AN), we examined acquired immunodeficiency syndrome (AIDS) case and seroprevalence data through December 1990. While AI/AN had a low 1990 reported AIDS case rate (4.0/100,000), the increase in diagnosed cases adjusted for reporting delays from 1989 to 1990 was higher (23.1%) among AI/AN than any other racial/ethnic group. Seroprevalence data for military applicants have documented higher rates for AI/AN than for either Whites or Asian/Pacific Islanders.
Hearing loss and hearing aid use in Hispanic adults: results from the Hispanic Health and Nutrition Examination Survey.
Authors: Lee D J , Carlson D L , Lee H M , Ray L A , Markides K S
Published: November 2008

Data from the Hispanic Health and Nutrition Examination Survey were employed to investigate the prevalence of hearing loss and hearing aid use in Mexican-American, Cuban-American, and Puerto Rican adults. Hearing loss was 6 to 14 times more prevalent in older (ages 54 to 74) vs younger (ages 20 through 34) subjects. Cuban Americans and Mexican Americans tended to have a similar prevalence of hearing loss, whereas Puerto Ricans had markedly lower rates. Mexican-American men had higher rates of hearing loss than Mexican-American women. The prevalence of hearing aid use among hearing-impaired individuals ranged from 2% to 11%. Implications for future research are discussed.
Interpersonal violence-related injuries in an African-American community in Philadelphia.
Authors: Wishner A R , Schwarz D F , Grisso J A , Holmes J H , Sutton R L
Published: November 2008

Violence has been recognized as a significant health problem. This study describes fatal and nonfatal interpersonal violence-related injury events over 1 year in an indigent African-American community in Philadelphia. Information on injuries was collected from emergency rooms, the Office of the Medical Examiner, and death certificate files. For persons aged 15 through 49 years, violence-related injury rates surpassed any other injury type. The overall violence-related injury rate was 28.7 per thousand population. Interpersonal violence-related injuries were important for the 0- to 4-year age group (9.19 injuries per 1000 population), and continued as a major cause of morbidity through age 59 (12.08 injuries per 1000 population). For more than half of the events, information from the emergency room chart was sufficient only to categorize the incident as a "fight" or that it was intentional; no further classification was possible.
Physical activity and hypertension in black adults: the Pitt County Study.
Authors: Ainsworth B E , Keenan N L , Strogatz D S , Garrett J M , James S A
Published: November 2008

The relation of physical activity to hypertension was examined in 1751 Black adults in Pitt County, NC. More women (65%) than men (44%) were classified as sedentary. Sedentary behavior was not associated with the prevalence of hypertension in men, but was associated with a 31% increase in prevalence for women (sedentary-26.2%; active-20.0%; P less than .01). The association in women was independent of other risk factors for hypertension.
Geographic variation in relative fees under Medicare.
Authors: Escarce J J
Published: November 2008

Little is known about geographic variation in Medicare's relative fee structure. Using 1986 Part B Medicare claims data, ratios among physician fees for surgical procedures belonging to small families of closely related procedures, excluding outliers, were found to vary up to twofold. Under Medicare's current system of physician payment, physicians in different areas face different financial incentives for performing one procedure in preference to possible alternatives. Changes in incentives under a resource-based Medicare fee schedule will be more pervasive than previously recognized.
Injury-related medical care utilization in a problem drinking population.
Authors: Blose J O , Holder H D
Published: November 2008

BACKGROUND. Population-based data on the overall risk of injury among problem drinkers are extremely limited. METHODS. We conducted an eight-year study of injury-related medical care utilization for a group of problem drinkers (n = 3 729) enrolled in the health insurance plan of a large manufacturing firm with plants in a number of midwestern states. A comparison non-problem drinking cohort matched on age, gender, and number of years of enrollment with the same company plan was also utilized. RESULTS. Problem drinkers utilized injury-related medical care at a rate 1.6 times that of the comparison group and experienced injury-related medical care costs which were three times as high. Increased risks were found for both men and women and for all ages studied. CONCLUSIONS. This study is one of the few to examine the overall incidence of fatal and non-fatal injuries among a large population of problem drinkers and provides evidence that higher medical care costs are associated with chronic alcohol use.
HIV infection, genital ulcer disease, and crack cocaine use among patients attending a clinic for sexually transmitted diseases.
Authors: Chirgwin K , DeHovitz J A , Dillon S , McCormack W M
Published: November 2008

BACKGROUND. Recently there has been a rise in genital ulcer disease (GUD) in urban minority heterosexuals in the United States. The impact of these increased GUD rates on HIV transmission patterns in this population is unknown. METHODS. Sexually transmitted disease (STD) diagnoses were correlated with HIV antibody status and risk factor history in 194 patients who consented to HIV testing at an STD clinic in central Brooklyn. RESULTS. Of 36 HIV-positive patients, 23 (64%) denied HIV risk factors other than heterosexual contact with persons of unknown HIV status. HIV antibody was associated with GUD (odds radio [OR] = 2.72, 95% confidence interval [CI] = 1.20-6.24), multiple concurrent STDs (OR = 2.51, 95% CI = 1.08-5.81), and a history of crack cocaine use (OR = 2.98, 95% CI = inexact-9.61). Crack use was also associated with GUD (OR = 15.15, 95% CI = 3.27-inexact) and multiple simultaneous STDs (OR = 13.87, 95% CI = 4.62-inexact). In a log-linear model analysis, HIV infection was independently associated with GUD and crack use. HIV infection, genital ulcer disease, and crack cocaine use were more common in women than men. CONCLUSIONS. The association between HIV infection and GUD seen here may be secondary to high-risk sexual behavior, which in turn may be partially attributable to crack cocaine use and drug-related prostitution. The high rate of coinfection with HIV and GUD raises a concern about the increased efficiency of sexual transmission of HIV in this population.
Reduction of high-risk sexual behavior among heterosexuals undergoing HIV antibody testing: a randomized clinical trial.
Authors: Wenger N S , Linn L S , Epstein M , Shapiro M F
Published: November 2008

BACKGROUND. We evaluated the effect of HIV antibody testing on sexual behavior and communication with sexual partners about AIDS risk among heterosexual adults at a clinic for sexually transmitted diseases. METHODS. We randomized 186 subjects to receive either AIDS education alone (the control group) or AIDS education, an HIV antibody test, and the test results (the intervention group). These subjects were then followed up 8 weeks later. RESULTS. At follow-up, mean number of sexual partners decreased, but not differently between groups. However, compared with controls, HIV antibody test intervention subjects, all of whom tested negative, questioned their most recent sexual partner more about HIV antibody status (P less than 0.01), worried more about getting AIDS (P less than 0.03), and tended to use a condom more often with their last sexual partner (P = 0.05): 40% of intervention subjects vs 20% of controls used condoms, avoided genital intercourse, or knew their last partner had a negative HIV antibody test (P less than 0.005). CONCLUSION. HIV antibody testing combined with AIDS education increases concern about HIV and, at least in the short term, may promote safer sexual behaviors. Additional strategies will be necessary if behaviors risky for HIV transmission are to be further reduced.
Needle sharing in The Netherlands: an ethnographic analysis.
Authors: Grund J P , Kaplan C D , Adriaans N F
Published: November 2008

BACKGROUND. Needle sharing has been reported to be the main cause of the rapid spread of the human immunodeficiency virus (HIV) among injecting drug users. Risk behaviors such as needle sharing are, however, the end result of complicated interaction patterns in drug user networks, which have their specific rules and rituals, and larger social structures and official drug policy. METHODS. To study these interaction patterns we examined the drug administration rituals of heroin addicts in Rotterdam, The Netherlands. Intensive ethnographic descriptions were collected by participant observation. RESULTS. In less than 10% of the observed self-injections unsafe syringes were used. In 68% of the self-injections new, sterile syringes were used. Needle sharing as a planned sequence was not observed. Sharing was determined primarily by the availability of syringes, experience with the injecting ritual, and drug craving. In all observed needle-sharing events, subjects were aware of the risks involved and undertook efforts to clean the injection equipment. CONCLUSIONS. In contrast to psychological approaches aimed at reducing individual "risk behavior," these findings suggest that HIV prevention can be made more effective if active drug injectors are organized to help themselves and their peers prevent high-risk exchange situations.
Representativeness of deaths identified through the injury-at-work item on the death certificate: implications for surveillance.
Authors: Russell J , Conroy C
Published: November 2008

BACKGROUND. This research investigated the accuracy of the injury-at-work item on the death certificate for surveillance of occupational injury deaths in Oklahoma during 1985 and 1986. METHODS. Representativeness of occupational injury deaths identified by death certificates was assessed by comparing these deaths with all occupational injury deaths identified through death certificates, workers' compensation reports, medical examiner reports, and OSHA records for categories of occupation, industry, and external causes of death. RESULTS. Certain external causes of death (e.g., motor vehicle traffic deaths) and certain occupations (e.g., farming) and industries (agriculture and services) are more often underidentified through death certificates. CONCLUSIONS. The findings of this study support Baker's observation that no single data source contains all deaths or all the data elements necessary to describe occupational injury deaths. Data sources may be combined to improve representativeness through more complete case ascertainment.
The importance of assessing the fit of logistic regression models: a case study.
Authors: Hosmer D W , Taber S , Lemeshow S
Published: November 2008

BACKGROUND. The logistic regression model is being used with increasing frequency in all areas of public health research. In the calendar year 1989, over 30% of the articles published in the American Journal of Public Health employed some form of logistic regression modeling. In spite of this increase, there has been no commensurate increase in the use of commonly available methods for assessing model adequacy. METHODS. We review the current status of the use of logistic regression modeling in the American Journal of Public Health. We present a brief overview of currently available and easily used methods for assessing the adequacy of a fitted logistic regression model. RESULTS. An example is used to demonstrate the methods as well as a few of the adverse consequences of failing to assess the fit of the model. One important adverse consequence illustrated in the example is the inclusion of variables in the model as a result of the influence of one subject. CONCLUSIONS. Failure to address model adequacy may lead to misleading or incorrect inferences. Recommendations are made for the use of methods for assessing model adequacy and for future editorial policy in regard to the review of articles using logistic regression.
Changes in AIDS case reporting after hospital site visits.
Authors: Fife D , McAnaney J , Rahman M A
Published: November 2008

In an effort to improve AIDS case reporting, site visits (meetings with hospital staff to encourage reporting) were made to all Philadelphia hospitals. Comparisons of hospitals visited during a 7-week period with hospitals not visited during that period indicated that the site visits were followed by a marked increase in case reports. No similar increase was observed at the comparison hospitals. The increased reporting was accompanied by an increased lag time from diagnosis to report, suggesting that the additional reports at visited hospitals were the result of the identification of previously missed cases rather than a speedup of reporting. Cases reported after the visits were more likely to have white-collar occupations or private medical insurance than were those reported before the visits.
Cardiovascular risk factor levels in ethnic Hawaiians.
Authors: Curb J D , Aluli N E , Kautz J A , Petrovitch H , Knutsen S F , Knutsen R , O'Conner H K , O'Conner W E
Published: November 2008

We report a cardiovascular risk factor survey of "native" Hawaiians 20-59 years old (70 percent, or 257), living on the Hawaiian Homestead lands on the island of Molokai, Hawaii. More than 60 percent of both sexes were overweight. Among males, 42 percent were smokers. The percent of the population with systolic blood pressure greater than 140 mm Hg or a diastolic pressure greater than 90 mm Hg or taking hypertensive medications was 14 percent of those ages 20-39 and 36 percent of those ages 40-59. The percent with serum cholesterol greater than or equal to 6.2 mmol/L ranged from 8 percent of those 20-29 years old to 46 percent in those 50-59 years old. Two percent of those ages 20-29 had a history of diabetes, or 2 + or greater glycosuria by dipstick, as did 23 percent of those ages 50-59. The majority of the known diabetics exhibited glycosuria and elevated glycohemoglobin levels, indicating poor control. Hypertension, although usually known to the participant, was frequently uncontrolled. From these data, it appears that among this group of Hawaiians major risk factors for cardiovascular disease were frequent, while at the same time the levels of awareness and/or control for most of these factors were low.
HIV risk behavior reduction following intervention with key opinion leaders of population: an experimental analysis.
Authors: Kelly J A , St Lawrence J S , Diaz Y E , Stevenson L Y , Hauth A C , Brasfield T L , Kalichman S C , Smith J E , Andrew M E
Published: November 2008

BACKGROUND AND PURPOSE. Peer norms influence the adoption of behavior changes to reduce risk for HIV (human immunodeficiency virus) infection. By experimentally intervening at a community level to modify risk behavior norms, it may be possible to promote generalized reductions in HIV risk practices within a population. METHODS. We trained persons reliably identified as popular opinion leaders among gay men in a small city to serve as behavior change endorsers to their peers. The opinion leaders acquired social skills for making these endorsements and complied in talking frequently with friends and acquaintances. Before and after intervention, we conducted surveys of men patronizing gay clubs in the intervention city and in two matched comparison cities. RESULTS. In the intervention city, the proportion of men who engaged in any unprotected anal intercourse in a two-month period decreased from 36.9 percent to 27.5 percent (-25 percent from baseline), with a reduction from 27.1 percent to 19.0 percent (-30 percent from baseline) for unprotected receptive anal intercourse. Relative to baseline levels, there was a 16 percent increase in condom use during anal intercourse and an 18 percent decrease in the proportion of men with more than one sexual partner. Little or no change was observed among men in the comparison cities over the same period of time. CONCLUSIONS. Interventions that employ peer leaders to endorse change may produce or accelerate population behavior changes to lessen risk for HIV infection.
Motorcycle licensure, ownership, and injury crash involvement.
Authors: Kraus J F , Anderson C , Zador P , Williams A , Arzemanian S , Li W C , Salatka M
Published: November 2008

The interrelationships among motorcycle licensure, ownership, and injury crash involvement were investigated in a sample of 2,723 motorcycle drivers severely or fatally injured in California in 1985-86. Owners of motorcycles in such crashes ("driver-owners") were less likely to have valid licenses than a random sample of motorcycle owners who had not been in crashes (42 vs. 57 percent). Thirty-three percent of the crash-involved drivers had valid motorcycle driver's licenses; 39 percent were operating motorcycles they did not own ("driver-nonowners"). Driver-nonowners were less likely to be validly licensed than driver-owners (20 percent vs. 44 percent). The licensing rate of crash-involved driver-nonowners was 15 percent if the owner was also unlicensed. Rates of valid licensure were lowest among the youngest drivers. Virtually no crash-involved driver-nonowners under age 21 were licensed in cases in which the owner was also young and unlicensed.
Security measures for AIDS and HIV.
Authors: Torres C G , Turner M E , Harkess J R , Istre G R
Published: November 2008

This study describes the measures being taken by AIDS surveillance offices across the country to ensure the security of information regarding patients with AIDS and HIV infection. Security measures were evaluated according to the cumulative number of AIDS cases reported, whether partner notification services were provided, and whether HIV seropositive reporting by name was also required. This study showed that public health departments have taken extra steps to ensure the security of AIDS and HIV data.
Impact of the Minnesota Parental Notification Law on abortion and birth.
Authors: Rogers J L , Boruch R F , Stoms G B , DeMoya D
Published: November 2008

BACKGROUND. The impact of the Minnesota Parental Notification Law on abortion and birth was examined. METHODS. Using linear models, outcome parameters were compared before and after enactment of the law. Time by age group interactions also were examined. RESULTS. The pre-enactment to post-enactment change in the Minnesota abortion rate reflected a greater decline for minors (less than or equal to 17 years old) than for 18-19 year-olds (who were not under the law). An increase in abortion rate occurred for women ages 20-44. The law appeared to have had no impact on birth rate in minors. Following the enactment of the law, the rate of early abortions (less than or equal to 12 weeks) declined among minors more than the rate of late abortions (greater than 12 weeks). This resulted in a pre-enactment to post-enactment increase in the ratio of late-to-early abortions among minors. CONCLUSIONS. These data suggest that parental notification facilitated pregnancy avoidance in 15-17 year-old Minnesota women. Abortion rates declined unexpectedly while birth rates continued to decline in accordance with a long-term trend.
Psychosocial factors in maternal phenylketonuria: prevention of unplanned pregnancies.
Authors: Waisbren S E , Shiloh S , St James P , Levy H L
Published: November 2008

BACKGROUND. Women with phenylketonuria (PKU) not treated prior to conception can have a pregnancy that results in serious fetal damage. In this report, factors associated with preventing unplanned (and hence late treated) pregnancies are described. METHODS. Subjects included 60 phenylketonuric women and two comparison groups composed of female acquaintances and diabetic women. All were interviewed and administered tests of intelligence, general well-being, knowledge, and personality. RESULTS. Thirty-five percent of the sexually active women with PKU used contraception only sporadically. The variables that best predicted reported frequency of birth control use were the extent to which women felt social support to use contraception (r = .64) along with positive attitudes about birth control (r = .66) and knowledge of family planning (r = .43). For the comparison groups, a different pattern of variables predicted contraceptive use, with locus of control figuring most prominently for the diabetics (r = .39) and social support for birth control being most important for the acquaintances (r = .46). CONCLUSIONS. As more girls with PKU enter childbearing ages, there will be an increased need for specific programs that address psychosocial factors in maternal PKU.
Predicting onset and chronicity of women's problem drinking: a five-year longitudinal analysis.
Authors: Wilsnack S C , Klassen A D , Schur B E , Wilsnack R W
Published: November 2008

BACKGROUND. Longitudinal studies of adult drinking have typically excluded or sampled only small numbers of problem drinking women, and have measured a limited range of influences on women's drinking behavior. METHODS. To study the development of women's problem drinking over time, five-year follow-up interviews were conducted with two groups of respondents from a 1981 national survey of women's drinking: 143 problem drinkers and 157 nonproblem drinkers. Regression analyses examined effects of 1981 predictors on six measures of 1986 problem drinking, for problem drinkers and nonproblem drinkers separately. RESULTS. Among 1981 nonproblem drinkers, predictors of onset of problem drinking indicators by 1986 included younger age, cohabiting, and lifetime use of drugs other than alcohol. The most consistent predictor of persistent (chronic) problem drinking was sexual dysfunction; other predictor included being employed part-time or never married, and experiencing recent depression. Divorce or separation predicted lower levels of subsequent alcohol dependance among problem drinkers. CONCLUSIONS. Findings suggest that different personal and social factors predict the onset of problem drinking as compared with its continuation, and point to nontraditional life-style, sexual dysfunction, and role deprivation as potentially important variables.
Gender differences in cigarette smoking and quitting in a cohort of young adults.
Authors: Pirie P L , Murray D M , Luepker R V
Published: November 2008

BACKGROUND. Smoking among young women is associated with a variety of negative health outcomes. Gender specific influences on smoking, quitting and attempting to quit are hypothesized to occur and may have implications for cessation programs. METHODS. Telephone surveys were conducted in a large (n = 6,711) cohort of young men and women (average age 19.2 years) which was first established in 1979 and has been resurveyed several times since then. Questions concerned smoking, successful and unsuccessful attempts to quit, withdrawal symptoms during quit attempts, and concerns about quitting. RESULTS. More women than men reported current smoking (26.5 vs 22.6 percent), but quitting attempts, successful and unsuccessful, were equally common. Withdrawal symptoms were reported equally, except for wanting to eat more than usual and weight gain, both of which were reported more often by women than men. Women smokers reported substantially more concern about weight gain if they quit smoking (57.9 vs 26.3 percent expressing concern). CONCLUSIONS. Targeted programs are needed to address issues of concern to young women smokers, particularly fear of gaining weight.
The UCLA population studies of CORD: X. A cohort study of changes in respiratory function associated with chronic exposure to SOx, NOx, and hydrocarbons.
Authors: Detels R , Tashkin D P , Sayre J W , Rokaw S N , Massey F J , Coulson A H , Wegman D H
Published: November 2008

Two never-smoking cohorts in Southern California, one in Lancaster (N = 2340) exposed only to moderate levels of oxidants and the other in Long Beach (N = 1326) exposed to high levels of SOx, NO2, hydrocarbons and particulates completed spirometry and the single-breath nitrogen test five to six years apart. Forty-seven percent and 45 percent of the participants were retested. Mean results at baseline for those tested and not retested were similar. Loss to follow-up was primarily due to moving (39 percent and 47 percent). Every difference of consequence indicated greater deterioration in lung function in Long Beach. The level of significance of the difference was greatest, even in the youngest age groups, for delta N2(750-1250), suggesting that the earliest site of impairment may occur in the small airways. Greater deterioration in spirometric parameters was observed in every age group in Long Beach females above seven years of age at baseline and in Long Beach males above 15 years of age, suggesting that chronic exposure to the pollutant mix occurring in Long Beach ultimately adversely affects the large airways as well as small airways.
Ascertainment of maternal deaths in New York City.
Authors: Allen M H , Chavkin W , Marinoff J
Published: November 2008

Maternal deaths in New York City are defined as deaths from any cause in a woman while pregnant or within six months of pregnancy termination. Pilot studies seeking to improve maternal death ascertainment found that selected medical examiner reports contributed an additional 10.5 percent of the total maternal deaths, vital statistics review contributed 6.3 percent, linkage of death tapes of women of reproductive age to live birth and fetal death tapes contributed 1.0 percent. Medical examiner cases should be incorporated into surveillance data for accurate ascertainment of pregnancy associated deaths.
Effect of pregnancy during TMI crisis on mothers' mental health and their child's development.
Authors: Houts P S , Tokuhata G K , Bratz J , Bartholomew M J , Sheffer K W
Published: November 2008

Five years after the Three Mile Island nuclear accident, the mental health of women who had been pregnant and living within 10 miles of Three Mile Island at the time of the accident was similar to that of women from the same area who became pregnant after the accident. Ratings of the development of the two groups of children when they were 5 years old were also similar. However, women who were pregnant during the crisis and had been "extremely disturbed" about their pregnancies rated their children's health as poorer than did the women who were pregnant later.
Using a state cancer registry to increase screening behaviors of sisters and daughters of breast cancer patients.
Authors: Houts P S , Wojtkowiak S L , Simmonds M A , Weinberg G B , Heitjan D F
Published: November 2008

The Pennsylvania Cancer Registry was used to contact breast cancer patients and, through them, their adult sisters and daughters. The sisters and daughters were counseled concerning their higher than average risks for breast cancer and their need for mammography and breast self-examination. Results showed a 9 percent increase in mammography and a 10 percent increase in breast self-examination rates for the counseled over control group. Costs were $49 per counseled sister or daughter indicating a need to increase cost effectiveness before implementation is practical.
Health policy: if you don't know where you're going, any road will take you.
Authors: Sultz H
Published: November 2008

It is not surprising that our health care system seems stalled in a developmental time warp, insulated from pressures to change. Everybody knows what should be changed, but changed to what? There is no national health policy that provides the context to redesign the health care system or even plan its incremental improvement. The self-interest ethos of the 1980s allowed decades of health and social advances to be rescinded with hardly a whisper of outrage. The more sophisticated our medical technology became, the more indifferent was the response to the real health needs of our society. Neither a society nor a health care system can survive without virtue or a cause that supersedes individual interests. Our health care cannot progress without an articulated purpose, a common vision expressed as policy that eliminates ambiguity of purpose, ambivalence towards performance standards, conflicts of principles, and contradictions of goals. The challenge calls for great leadership--to define policies that reverse the decline in both the indices of health and the political will to address the public good. To attempt less would allow this country's health care system to go down any road the vagaries of our political process take it.
The yield of cholesterol screening in an urban black community.
Authors: Russell N K , Becker D M , Finney C P , Moses H
Published: November 2008

BACKGROUND: While the distribution of cholesterol levels have been well studied in the general population, little is known about cholesterol and other cardiovascular disease risk factors in screenings held in an urban Black community. This study was designed to determine the yield of cholesterol screening in this community. METHODS: Screening took place in eight community sites. Serum total cholesterol was measured using a rapid capillary technique. Blood pressure was taken according to national guidelines and the average of two to three measurements were used. Standard interviews were used to determine the presence of cardiovascular risk factors by history. RESULTS: Of the 562 individuals screened, 44.9 percent had cholesterol levels requiring referral for follow-up care. Of those with total cholesterol greater than or equal to 6.21 mmol/L, 66.4 percent were previously undetected and more than half also had blood pressure levels greater than or equal to 140/90 mmHg on screening; 45 percent of all participants had blood pressure greater than or equal to 140/90 on screenings. Of those with a history of elevated total cholesterol levels, none had levels below 5.17 mmol/L at the time of screening. CONCLUSIONS: Multiple risk factors are highly prevalent in the urban Black community during cholesterol screening programs. Findings suggest the need for cholesterol programs incorporating blood pressure screening in the urban Black community.
The validity of health risk appraisals for coronary heart disease: results from a randomized field trial.
Authors: Smith K W , McKinlay S M , McKinlay J B
Published: November 2008

BACKGROUND: While health risk appraisals (HRAs) are becoming increasingly popular as tools for health assessment and health education, comparatively little is known about the accuracy of these risk estimates. METHODS: A field trial among 732 randomly selected adults ages 25 to 65 years was conducted to assess the validity of the risk scores produced by four widely used HRAs. RESULTS: Self-reported HRA risk scores for cigarette smoking and relative weight were generally accurate, but correlations between physiological measurements and scores for blood pressure, cholesterol, and physical activity were always lower than .51. Correlations between epidemiologic estimates of the probability of CHD death and HRA total risk scores ranged from .13 to .75; partial correlations adjusting for age, race, and gender ranged from .12 to .47. CONCLUSIONS: The HRAs chosen for the field trial exhibited modest correlations with the CHD mortality risk predicted by the epidemiologic model. Mathematical errors made by respondents completing self-scored instruments and lack of knowledge regarding physiologic status decrease the accuracy of HRA risk estimates.
Clinical and epidemiological features of neurotoxic shellfish poisoning in North Carolina.
Authors: Morris P D , Campbell D S , Taylor T J , Freeman J I
Published: November 2008

BACKGROUND: In October 1987, a red tide due to P. brevis affected the North Carolina coast for the first time. The purpose of our study was to describe the clinical and epidemiological features of neurotoxic shellfish poisoning (NSP), an illness caused by eating shellfish contaminated with the neurotoxins of P. brevis. METHODS: Active surveillance was established for cases of NSP. A descriptive study of the NSP cases was then completed. RESULTS: Forty-eight persons, who had eaten oysters at 20 meals, met the case definition. A variety of gastrointestinal tract and neurological symptoms were reported. The illnesses were generally mild and of short duration, and there were no deaths. Forty-one (85 percent) affected persons lived in five communities located within a 70-kilometer area along the coast. Cases occurred from October 27 to December 9; 27 (56 percent) of the cases occurred before the first closure of affected shellfish waters on November 2. There was a significant increase in the illness attack rate with an increase in the number of oysters eaten. CONCLUSIONS: Routine monitoring of coastal waters for P. brevis is needed to facilitate earlier recognition of red tides, closure of affected areas, and education of the public before substantial exposure to contaminated shellfish occurs.
Effect of hospital utilization review on medical expenditures in selected diagnostic areas: an exploratory study.
Authors: Wickizer T M
Published: November 2008

Quarterly claims data on 43 insured groups were analyzed through multivariate techniques to explore whether the effects of hospital inpatient utilization review vary across selected broad diagnostic areas. Findings suggest that utilization review was associated with decreases in expenditures of approximately 15 percent for diagnoses within the surgical area, a lesser decrease within the mental health area, and still lesser decrease within the medical area. However, these measurements are imprecise both because of the small numbers and the aggregated diagnoses in each category.
Risk communication activities of state health agencies.
Authors: Chess C , Salomone K L , Sandman P M
Published: November 2008

Surveys concerning the risk communication practices and needs of state health agencies were completed by agency commissioners and designated staff of 48 states and territories. These data indicate that agencies are expending more effort on responding to requests for information than on initiating dialogues with interested constituencies or alerting the public to risk. The data also suggest a gap between the stated philosophy and practice of the agencies.
Mass flea outbreak at a child care facility: case report.
Authors: Corpus L D , Corpus K M
Published: November 2008

Cat fleas, Ctenocephalides felis Bouchet, were collected at a Mississippi child care facility after reports of large numbers of adult fleas occurring on children and personnel. One building yielded 161 (99 percent) of the fleas collected. Urticarial lesions due to flea bites occurred on the legs of six children. Flea presence was due to cats occupying the crawl space. Fleas were eradicated by eliminating entry of cats and using residual insecticides throughout the facility.
Impact of work on the quality of life of community-residing young elderly.
Authors: Ruchlin H S , Morris J N
Published: November 2008

Using a random sample of 310 Massachusetts community-residing elderly between the ages of 65 and 74, this study investigates the relationship between employment status and quality of life using a modified version of the Spitzer Uniscale QL index. The odds of reporting the highest quality of life rating, after controlling for socioeconomic and health characteristics, was 3.51:1 for those who worked versus those who did not do so.
Cuba's response to the HIV epidemic.
Authors: Pérez-Stable E J
Published: November 2008

BACKGROUND: Cuba's response to the human immunodeficiency virus (HIV) epidemic has been to conduct mass testing of the population to ascertain seroprevalence, to enforce mandatory relative quarantine of persons testing positive, and to implement educational interventions using media and school-based programs. METHODS: Interview with the Vice-Minister of Health and review of available data. RESULTS: Reports to date show a very low seroprevalence rate without evidence of a widespread epidemic. Sexual contact with foreign-born persons is the primary risk factor. Possible advantages of Cuba's policy include rapid reduction in the risk of HIV transmission by infected blood products, an opportunity for focused education and secondary prevention, and limitation of new infections. Possible disadvantages include the restriction of individual freedom in those who are not guilty of any illegal act, quarantine of persons with false positive HIV tests, and ongoing transmission because of the incomplete nature of the quarantine. The policy is expensive and may displace other public health priorities. The content of the media-based educational interventions has emphasized rational medical information in unimaginative formats with a limited focus on prevention. CONCLUSIONS: The issue of personal responsibility for behavioral change versus government imposed regulations is at the core of Cuba's HIV policy. The quarantine policy may paradoxically permit most Cubans to feel that they are personally invulnerable to the HIV epidemic.
Effects of an intervention program on AIDS-related drug and needle behavior among intravenous drug users.
Authors: Stephens R C , Feucht T E , Roman S W
Published: November 2008

BACKGROUND: Behaviors which entail high risk for human immunodeficiency virus (HIV) infection among intravenous drug users can be significantly reduced through educational intervention. METHODS: The educational intervention was conducted by a health educator in a one-on-one format and provided information about acquired immunodeficiency syndrome (AIDS) and strategies for reducing the risk of infection. Risk was assessed prior to the intervention and was compared to a follow-up assessment obtained approximately three months later (n = 322). RESULTS: The percentage who reported using drugs intravenously decreased from 92.2 to 70.5, and the percentage who reported sharing syringes dropped from 67.4 to 24.3. Reductions of these and other high-risk behaviors were detected across various demographic subgroups, and analyses show that the impact of the intervention endured for several months. CONCLUSIONS: The findings suggest that intravenous drug users conform to a model of rational choice when confronted with accurate information about the devastating consequences of HIV infection.
Preventing homicide: an evaluation of the efficacy of a Detroit gun ordinance.
Authors: O'Carroll P W , Loftin C , Waller J B , McDowall D , Bukoff A , Scott R O , Mercy J A , Wiersema B
Published: November 2008

BACKGROUND: In November 1986, a Detroit, Michigan city ordinance requiring mandatory jail sentences for illegally carrying a firearm in public was passed to preserve "the public peace, health, safety, and welfare of the people." METHODS: We conducted a set of interrupted time-series analyses to evaluate the impact of the law on the incidence of homicides, hypothesizing that the ordinance, by its nature, would affect only firearm homicides and homicides committed outside (e.g., on the street). RESULTS: The incidence of homicide in general increased after the law was passed, but the increases in non-firearm homicides and homicides committed inside (e.g., in a home) were either statistically significant or approached statistical significance (p = .006 and p = .070, respectively), whereas changes in the incidence of firearm homicides and homicides committed outside were not statistically significant (p = .238 and p = .418, respectively). We also determined that the ordinance was essentially unenforced, apparently because of a critical shortage of jail space. CONCLUSIONS: Our findings are consistent with a model in which the ordinance had a dampening effect on firearm homicides occurring in public in Detroit. The apparent preventive effect evident in the time series analyses may have been due to publicity about the ordinance, whereas the small nature of the effect may have been due to the lack of enforcement.
Benzodiazepine anti-anxiety agents: prevalence and correlates of use in a southern community.
Authors: Swartz M , Landerman R , George L K , Melville M L , Blazer D , Smith K
Published: November 2008

BACKGROUND: Benzodiazepine anti-anxiety agents are the most widely prescribed psychotherapeutic drugs in the United States today. Recent evidence, however, suggests that their use may be decreasing. METHODS: We examine the population prevalence and correlates of use of benzodiazepine anxiolytics at the Duke site of the NIMH-sponsored Epidemiologic Catchment Area project. RESULTS: Bivariate analysis of use patterns for the drugs revealed demographic predictors similar to those reported in previous studies: increased likelihood of use by the elderly, Whites, women, the less educated, and the separated or divorced. Use is also associated with symptoms of psychic distress, negative life events, use of health care services, and diagnoses of affective disorder, agoraphobia with panic, and panic disorder. Age, sex, race, education, and marital status remain associated with non-hypnotic benzodiazepine use in a logistic regression analysis. CONCLUSIONS: Multivariate analyses of these data indicate that when potential confounding factors are controlled, age, sex, race, education, and marital status are significantly related to benzodiazepine anxiolytic use but the effects of sex and education are mediated by intervening variables. Implications of these findings are discussed particularly in relation to high levels of use in the elderly.
Evaluating needle exchange: do distributed needles come back?
Authors: Guydish J , Clark G , Garcia D , Downing M , Case P , Sorensen J L
Published: November 2008

We employed capture-recapture methods as a strategy for evaluating needle exchange. Needles distributed by the exchange at two time periods were marked with color coded bands indicating the date and site of distribution. Half of the marked needles (2,068/4,239) returned within two weeks of distribution, and 61 percent (2,593/4,239) returned during the study period. The rate of return for stationary exchange sites (63 percent) was greater than that for roving/mobile sites (51 percent; chi 2 = 28.6, p less than .001). Of all needles returned, 87 percent (2,248/2,593) returned to the site of original distribution.