bluuebunny/crossref_metadata_2025 huggingface dataset:
Increasing Medicaid child health screenings: the effectiveness of mailed pamphlets, phone calls, and home visits.
Authors: Selby-Harrington M , Sorenson J R , Quade D , Stearns S C , Tesh A S , Donat P L
Published: November 2008

OBJECTIVES. A randomized controlled trial was conducted to test the effectiveness and cost effectiveness of three outreach interventions to promote well-child screening for children on Medicaid. METHODS. In rural North Carolina, a random sample of 2053 families with children due or overdue for screening was stratified according to the presence of a home phone. Families were randomly assigned to receive a mailed pamphlet and letter, a phone call, or a home visit outreach intervention, or the usual (control) method of informing at Medicaid intake. RESULTS. All interventions produced more screenings than the control method, but increases were significant only for families with phones. Among families with phones, a home visit was the most effective intervention but a phone call was the most cost-effective. However, absolute rates of effectiveness were low, and incremental costs per effect were high. CONCLUSIONS. Pamphlets, phone calls, and home visits by nurses were minimally effective for increasing well-child screenings. Alternate outreach methods are needed, especially for families without phones.
Subclinical health effects in a population exposed to excess vitamin D in milk.
Authors: Scanlon K S , Blank S , Sinks T , Lett S , Mueller P , Freedman D S , Serdula M , Falk H
Published: November 2008

To evaluate subclinical health effects of excess vitamin D, a cross-sectional study was conducted of persons consuming milk from a dairy that had overfortified milk for at least 4 years. Milk consumption, sunlight exposure, medical symptoms, serum 25-hydroxyvitamin D (25[OH]D), serum and urinary calcium, and indicators of renal function were measured. Increased milk consumption was associated with increased serum 25(OH)D and urinary calcium. However, the prevalences of elevated serum 25(OH)D and calcium were no greater than expected, and data indicated normal renal function. It was concluded that most persons exposed to excess vitamin D exhibited no measurable adverse subclinical effects.
The effectiveness of alternative planned durations of residential drug abuse treatment.
Authors: McCusker J , Vickers-Lahti M , Stoddard A , Hindin R , Bigelow C , Zorn M , Garfield F , Frost R , Love C , Lewis B
Published: November 2008

Randomized controlled trials were conducted at two residential drug abuse treatment facilities to compare programs that differed in planned duration. One trial compared a 6-month and a 12-month therapeutic community program (n = 184), and the second compared a 3-month and a 6-month relapse prevention program (n = 444). Retention rates over comparable time periods differed minimally by planned treatment duration, and the longer programs had lower completion rates. There was no effect in either trial of planned treatment duration on changes in psychosocial variables between admission and exit or on rates or patterns of drug use at follow-up between 2 and 6 months after exit.
Treating early-stage breast cancer: hospital characteristics associated with breast-conserving surgery.
Authors: Johantgen M E , Coffey R M , Harris D R , Levy H , Clinton J J
Published: November 2008

Despite growing acceptance of the fact that women with early-stage breast cancer have similar outcomes with lumpectomy plus radiation as with mastectomy, many studies have revealed the uneven adoption of such breast-conserving surgery. Discharge data from the Hospital Cost and Utilization Project, representing multiple payers, locations, and hospital types, demonstrate increasing trends in breast-conserving surgery as a proportion of breast cancer surgeries from 1981 to 1987. Women with axillary node involvement were less likely to have a lumpectomy, even though consensus recommendations do not preclude this form of treatment when local metastases are present. Non-White race, urban hospital location, and hospital teaching were associated with an increased likelihood of having breast-conserving surgery.
Rationing health care and the need for credible scarcity: why Americans can't say no.
Authors: Mariner W K
Published: November 2008

With adequate cost containment unlikely in the foreseeable future, health care use will have to be curtailed, ideally with open and explicit criteria for equitably allocating resources or rationing. Yet, consensus on any such criteria appears remote because Americans cannot say no to health care. Americans may refuse to accept rationing for two reasons. The absence of any global limitation on health care resources may encourage patients to believe that health care resources are not scarce and do not need to be rationed. A belief in vitalism--that everyone is morally entitled to unlimited longevity and good health--may discourage setting limits on one's own care. Together, these characteristics may foster the belief that denials of health care services, especially by health insurers, are arbitrary or unfair refusals to pay for existing resources and not a necessary method of rationing scarce resources. If this hypothesis is true, Americans are unlikely to achieve consensus on any equitable allocation of health care unless they face an actual shortage (credible scarcity) of health care resources that makes it necessary to ration care.
Risk factors for HIV and other sexually transmitted diseases and prevention practices among US heterosexual adults: changes from 1990 to 1992.
Authors: Catania J A , Binson D , Dolcini M M , Stall R , Choi K H , Pollack L M , Hudes E S , Canchola J , Phillips K , Moskowitz J T
Published: November 2008

OBJECTIVES. The National AIDS Behavioral Survey (1990-1992) of heterosexual adults (18-49 years) measured human immunodeficiency virus (HIV) risk factors, condom use, and HIV antibody testing, with a focus on major "high-risk" cities. METHODS. A longitudinal survey was conducted. RESULTS. There was little reduction in the overall prevalence of HIV risk factors in the national or high-risk cities cohorts over time. Despite this picture of stability, approximately 39% of the population at risk for HIV because of multiple sexual partners turns over annually. There was little change in HIV test-seeking or in consistent condom use with primary sexual partners. Although the majority of at-risk respondents used condoms sporadically or not at all (65%), a significant increase in condom use was found among those reporting multiple sexual partners in both waves, particularly among Black heterosexuals. Data from other surveys and condom sales nationally support the findings. CONCLUSIONS. There is a need for a series of surveys in this area to assess the reliability of the present findings and to monitor the general US population's response to prevention programs.
Risk factors for HIV-1 seroconversion among injection drug users: a case-control study.
Authors: Chitwood D D , Griffin D K , Comerford M , Page J B , Trapido E J , Lai S , McCoy C B
Published: November 2008

OBJECTIVES. A nested case-control study was conducted in Miami, Fla, to determine risk factors associated with human immunodeficiency virus type 1 (HIV-1) seroconversion among injection drug users. METHODS. The study identified 21 incident cases of HIV-1 infection and 76 unmatched controls from two longitudinal cohorts of injection drug users. One cohort consisted of individuals who originally had been recruited from treatment centers; a second cohort was recruited from the "street." Logistic regression analyses that adjusted for age, gender, and race were performed. RESULTS. The final model determined that the primary independent risk factor that best explained the risk for seroconversion was sharing injection equipment in the year prior to conversion; a marginal risk factor was presence of sexually transmitted disease during this same period. CONCLUSIONS. Both an injection component and a sexual component play a role in seroconversion among injection drug users, although the injection component is much stronger.
The risk of domestic violence and women with HIV infection: implications for partner notification, public policy, and the law.
Authors: Rothenberg K H , Paskey S J
Published: November 2008

Partner notification has emerged as an important strategy in the fight against acquired immunodeficiency syndrome (AIDS), and states have now adopted a plethora of laws that encourage or mandate notification, often without the patient's consent. As human immunodeficiency virus (HIV) infection continues to spread among women, the future development of AIDS control strategies and public health laws must be shaped by concern for the safety and autonomy of patients who face a risk of domestic violence. Three distinct recommendations flow from this premise. First, all HIV-infected women should be assessed for the risk of domestic violence and offered appropriate interventions. Second, where a risk of abuse is indicated, partners should never be notified without the patient's consent. State laws that presently permit involuntary notification should be repealed or amended. Third, laws that punish a patient's refusal to notify partners should also be modified or repealed.
Regulating controversial programs for unpopular people: methadone maintenance and syringe exchange programs.
Authors: Des Jarlais D C , Paone D , Friedman S R , Peyser N , Newman R G
Published: November 2008

One third of all cases of the acquired immunodeficiency syndrome (AIDS) in the United States are associated with the injection of illicit drugs. There is mounting evidence for the effectiveness of syringe exchange programs in reducing human immunodeficiency virus (HIV) risk behavior and HIV transmission among injection drug users. Expansion of syringe exchange would require increased public funding and undoubtedly would include government regulation of syringe exchanges. An analogy is drawn with the present system of regulation of methadone maintenance treatment programs and possible regulation of syringe exchange programs. Specific recommendations are offered to reduce the likelihood of repeating the regulatory problems of methadone maintenance treatment in future regulation of syringe exchange programs.
The diversion of mentally ill persons from jails to community-based services: a profile of programs.
Authors: Steadman H J , Morris S M , Dennis D L
Published: November 2008

OBJECTIVES. A major proposal for appropriately treating persons with mental illnesses who have been arrested is to divert them from jail to community-based mental health programs. However, there are few available definitions, guidelines, and principles for developing effective diversion programs. The goal of this research was to determine the number and kinds of jail diversion programs that exist, how they are set up, and which types of programs are effective. METHODS. On the basis of information gathered during a national mail survey (n = 1263) and follow-up telephone survey of 115 responding jails, 18 sites were selected for on-site interviews based on perceived effectiveness and presence of a formal diversion program. RESULTS. Data are presented from a national sample of jail diversion programs (n = 18). Key factors for developing diversion programs and descriptors of effective programs are presented. CONCLUSIONS. It is clear that controlled, longitudinal studies of these programs' effectiveness, using client-based and organizational outcome measures, are badly needed.
Tobacco information in two grade school newsweeklies: a content analysis.
Authors: Balbach E D , Glantz S A
Published: November 2008

OBJECTIVES. This study compared tobacco-related articles from two elementary school publications, Weekly Reader and Scholastic News, published in 1989 through 1994. METHODS. Articles for grades 4 through 6 were evaluated, and the publications were compared with each other. Also, issues of Weekly Reader published after acquisition by K-III, which is owned by the firm that formerly owned RJR Tobacco, were compared with the earlier ones. RESULTS. Weekly Reader was less likely than Scholastic News to mention short-term consequences of smoking (32% vs 64%) or to give a clear "no-use" message (35% vs 79%). Weekly Reader was more likely to give the tobacco industry position (68% vs 32%). Post-K-III issues of Weekly Reader were less likely to provide a clear no-use message than earlier ones (62% vs 24%). CONCLUSIONS. Health professionals need to monitor the health information carried in these publications, which reach between 1 and 2 million students per grade level each week. Although neither publication had perfect tobacco coverage, Scholastic News was significantly better than Weekly Reader.
Emerging diseases and ecosystem instability: new threats to public health.
Authors: Epstein P R
Published: November 2008

Ecologists have begun to describe an environmental distress syndrome, whereby widespread loss of top predators and harsh environmental conditions are encouraging the selection of opportunistic pests and pathogens across a wide taxonomic range of plants and animals. Environmental change and pollutants stress individuals and populations, and this may be reflected in the global resurgence of infectious disease as these stresses cascade through the community assemblages of species. In 1993, the sudden appearance of a virulent, rodent-borne hantavirus in the arid US Southwest accompanied anomalous weather patterns, and a novel Vibrio cholerae variant (O139 Bengal) emerged in Asia where marine ecosystems are experiencing a pandemic of coastal algal blooms, apparently harboring and amplifying the agent. This paper suggests a framework for integrating the surveillance of health outcomes and key reservoir and vector species, with ecological and climatic monitoring.
Seven chronic conditions: their impact on US adults' activity levels and use of medical services.
Authors: Verbrugge L M , Patrick D L
Published: November 2008

OBJECTIVES. This paper analyzes the impact of seven chronic conditions (three nonfatal: arthritis, visual impairment, hearing impairment; four fatal: ischemic heart disease, chronic obstructive pulmonary disease, diabetes mellitus, malignant neoplasms) on US adults aged 18 and older. Impact refers to how readily a condition prompts activity limitations, physician visits, and hospital stays. METHODS. Data come from three national health surveys and vital statistics. For comparability, a single disease classification scheme was applied, and new rates were estimated. Frequency, impact, and prominence of the target conditions are studied via rates, ratios of rates, and ranks, respectively. RESULTS. In young adulthood, the nonfatal conditions prompt limitations less readily than do the fatal ones, but by older ages, arthritis and visual impairment have a limiting impact equivalent to that of fatal conditions. Despite high prevalence and limitations, nonfatal conditions stand well below fatal conditions for health services use. CONCLUSIONS. Although statistics on frequency, impact, and prominence all indicate conditions "importance," they give only weak clues about specific service needs of affected persons. The persistent finding that nonfatal conditions do not receive health services care commensurate with their prevalence and impact reflects long-standing imbalanced attention on fatal conditions in research and medical care.
Take heart: results from the initial phase of a work-site wellness program.
Authors: Glasgow R E , Terborg J R , Hollis J F , Severson H H , Boles S M
Published: November 2008

OBJECTIVES. The purpose of this study was to evaluate the short-term effects of a low-intensity work-site heart disease risk reduction program using a matched pair design with work site as the unit of analysis. METHODS. Twenty-six heterogeneous work sites with between 125 and 750 employees were matched on key organization characteristics and then randomly assigned to early or delayed intervention conditions. Early intervention consisted of an 18-month multifaceted program that featured an employee steering committee and a menu approach to conducting key intervention activities tailored to each site. RESULTS. Cross-sectional and cohort analyses produced consistent results. At the conclusion of the intervention, early and delayed intervention conditions did not differ on changes in smoking rates, dietary intake, or cholesterol levels. There was considerable variability in outcomes among work sites within each condition. CONCLUSIONS. Despite documented implementation of key intervention activities and organization-level changes in terms of perceived support for health promotion, this intervention did not produce short-term improvements beyond secular trends observed in control work sites. Research is needed to understand determinants of variability between work sites.
Fruit and vegetable intake among adults in 16 states: results of a brief telephone survey.
Authors: Serdula M K , Coates R J , Byers T , Simoes E , Mokdad A H , Subar A F
Published: November 2008

A brief food frequency questionnaire was used to assess daily fruit and vegetable consumption among 23,699 adults in 16 US states sampled in a random-digit dialing telephone survey. Men consumed fewer servings per day (3.3) than did women (3.7). Only 20% of the population consumed the recommended 5 or more daily servings. Intakes varied somewhat by state and were lower among the young and the less educated. Efforts are needed to improve fruit and vegetable consumption among all Americans, especially younger adults and those with lower levels of education.
Serial mass-media campaigns to promote physical activity: reinforcing or redundant?
Authors: Owen N , Bauman A , Booth M , Oldenburg B , Magnus P
Published: November 2008

Changes associated with two serial, nationwide, mass-media-based campaigns to promote physical activity conducted by the National Heart Foundation of Australia in 1990 and 1991 were examined. Surveys conducted before and after each campaign found statistically significant differences in message awareness (46% vs 71% in 1990; 63% vs 74% in 1991). In 1990, there were significant increases in walking, particularly among older people, and in intentions to exercise. No such changes were apparent in 1991. In the case of these two campaigns, conducted 1 year apart, the second may have been redundant.
Home pesticide use and childhood cancer: a case-control study.
Authors: Leiss J K , Savitz D A
Published: November 2008

The association between childhood cancer and home pesticide use was examined in a case-control study of children under 15 years of age. Parents of 252 children diagnosed with cancer in the Denver area between 1976 and 1983 and of 222 control subjects were interviewed regarding use of home pest extermination, yard treatment, and pest strips. The strongest associations were found for yard treatments and soft tissue sarcomas (odds ratios [ORs] around 4.0) and for use of pest strips and leukemias (ORs between 1.7 and 3.0). These results suggest that use of home pesticides may be associated with some types of childhood cancer.
The limits of thresholds: silica and the politics of science, 1935 to 1990.
Authors: Markowitz G , Rosner D
Published: November 2008

Since the 1930s threshold limit values have been presented as an objectively established measure of US industrial safety. However, there have been important questions raised regarding the adequacy of these thresholds for protecting workers from silicosis. This paper explores the historical debates over silica threshold limit values and the intense political negotiation that accompanied their establishment. In the 1930s and early 1940s, a coalition of business, public health, insurance, and political interests formed in response to a widely perceived "silicosis crisis." Part of the resulting program aimed at containing the crisis was the establishment of threshold limit values. Yet silicosis cases continued to be documented. By the 1960s these cases had become the basis for a number of revisions to the thresholds. In the 1970s, following a National Institute for Occupational Safety and Health recommendation to lower the threshold limit value for silica and to eliminate sand as an abrasive in blasting, industry fought attempts to make the existing values more stringent. This paper traces the process by which threshold limit values became part of a compromise between the health of workers and the economic interests of industry.
Health and social characteristics and children's cognitive functioning: results from a national cohort.
Authors: Kramer R A , Allen L , Gergen P J
Published: November 2008

OBJECTIVES. The purpose of this study was to examine the associations between cognitive functioning in children and sociodemographic, family, and health characteristics. METHODS. Data from phase 1 of the third National Health and Nutrition Examination Survey were used to evaluate performance on standardized cognitive tests in a representative sample of 2531 children 6 to 16 years of age. Multivariate analyses were used to assess independent associations between covariates and test performance. RESULTS. Lower income, minority status, and lower education of an adult reference person (one of the persons in the household who owned or rented the home) were independently associated with poorer performance on all cognitive subtests. To a lesser degree, general health status, history of birth complications, and sex also were independent predictors of performance for some of the subtests. CONCLUSIONS. These findings illustrate disparities in cognitive functioning across sociodemographic and health characteristics of children in the US population. They suggest the need for public health policies to take a multifaceted approach to optimizing childhood environments in order to overcome the effects of socioeconomic and minority status.
The risk of assaultive violence and alcohol availability in Los Angeles County.
Authors: Scribner R A , MacKinnon D P , Dwyer J H
Published: November 2008

OBJECTIVES. Although there is considerable evidence that alcohol consumption facilitates assaultive violence, the extent to which alcohol outlets in a community influence assaultive violence remains controversial. METHODS. To assess the geographic association between city-specific rates of assaultive violence and alcohol-outlet density, an ecologic analysis of the 74 larger cities in Los Angeles County was conducted for the 1990 reporting year. RESULTS. Sociodemographic factors alone accounted for 70% (R2 = .70) of the variance in the rate of assaultive violence in a multiple regression model. Adding the variable for alcohol-outlet density to the model yielded a significant positive slope. The magnitude of this relation indicates that in a typical Los Angeles County city (50,000 residents, 100 outlets, 570 offenses per year), one outlet was associated with 3.4 additional assaultive violence offenses in 1990. CONCLUSIONS. These findings indicate that higher levels of alcohol-outlet density are geographically associated with higher rates of assaultive violence. This association is independent of measured confounders, including city-level measures of unemployment, ethnic/racial makeup, income, age structure, city size, household size, and female-headed households.
Care denied: US residents who are unable to obtain needed medical services.
Authors: Himmelstein D U , Woolhandler S
Published: November 2008

OBJECTIVES. This study analyzed data on US residents reporting that they were unable to obtain needed care. Inadequately immunized children and women inadequately screened for breast or cervical cancer were also examined. METHODS. Data from the 1987 National Medical Expenditure Survey was analyzed. RESULTS. A total of 6,375,000 (90% confidence interval [CI] = 6,039,000, 6,711,000) people could not get hospitalization, prescription medications, medical equipment/supplies, or emergency, pediatric, mental health, or home care. Although the uninsured were more likely to forego care unavailable, three quarters of those unable to obtain services were insured, and 46% (90% CI = 42.4%, 49.6%) had private coverage. Of those reporting the reason why they failed to obtain care, 65.1% (90% CI = 61.7%, 68.6%) listed high costs or lack of insurance, including 60.7% (90% CI = 57.1%, 64.3%) of the privately insured. More than a third of women had not had a breast examination in the previous 2 years, a fifth had not had a Pap smear within the previous 4 years, and half had never had a mammogram (ages 50-69 only). Of children 2 to 5 years old, 35.1% (90% CI = 31.5%, 35.7%) were inadequately immunized. Medicaid recipients had measures of access to care similar to those of the uninsured. CONCLUSIONS. Many US residents--most of whom have insurance--are unable to obtain needed care, usually because of high costs.
Racial and ethnic differences in the use of invasive cardiac procedures among cardiac patients in Los Angeles County, 1986 through 1988.
Authors: Carlisle D M , Leake B D , Shapiro M F
Published: November 2008

OBJECTIVES. The purpose of the study was to compare use of invasive cardiovascular procedures among Latino, Asian, African-American, and White patients. METHODS. In a cross-sectional study of hospital discharge data, multiple logistic regression was used to model use of coronary artery angiography, bypass graft surgery, and angioplasty among adult Los Angeles County residents discharged from California hospitals between 1986 and 1988 with primary diagnoses consistent with possible ischemic heart disease. RESULTS. After potential demographic, socioeconomic, and clinical confounders, including hospital procedure volume, were controlled, Latinos were less likely than Whites to undergo angiography (odds ratio [OR] = 0.90) and bypass graft surgery (OR = 0.87). African Americans were less likely to receive bypass graft surgery (OR = 0.62) and angioplasty (OR = 0.80). Asians were as likely as Whites to receive each procedure. The impact of adjustment for hospital procedure volume was greater for Latinos and Asians than for African Americans. CONCLUSIONS. Administrative data suggest that disparities in use of invasive cardiovascular procedures are not limited to African Americans. Hospital procedure volume appears to be an important factor related to such disparities. The causes of racial/ethnic differences in reported procedure rates remain unclear.
Obstetrical judgments of viability and perinatal survival of extremely low birthweight infants.
Authors: Reuss M L , Gordon H R
Published: November 2008

OBJECTIVES. The purpose of the study was to determine whether the obstetrical judgment of viability makes a difference to fetal and neonatal survival of extremely low birthweight infants (500-749 g). METHODS. We assessed the effect of the antenatal judgment of viability in a group of 66 infants born weighing from 500 to 749 g. These infants were alive at maternal hospital admission and were subsequently live-born or stillborn between January 1, 1984, and December 31, 1985. We related the antepartum assessment of viability and other factors recorded in the medical record to fetal survival and to postneonatal survival to hospital discharge. RESULTS. The obstetrical judgement of viability was strongly associated with outcome. After birthweight and gestational age were controlled, fetuses considered viable were 18 times more likely to survive (95% confidence interval = 2, 175) than those considered nonviable. CONCLUSIONS. The effects of obstetrical practices on perinatal mortality must be taken into consideration in estimating the survival potential of very small fetuses and in evaluating the relationship between survival and disability.
The professional structure of Soviet medical care: the relationship between personal characteristics, medical education, and occupational setting for Estonian physicians.
Authors: Barr D A
Published: November 2008

OBJECTIVES. Using the Estonian example, this study provides data to describe the ways in which personal, educational, and occupational factors interacted to determine the professional structure of the Soviet health care system. METHODS. The study analyzes data gathered from a survey of 20% of the physicians in Estonia. It measures the frequencies of pertinent personal and occupational factors, and uses multivariate analysis to explore relationships between these factors. RESULTS. Most physicians in Estonia are women and work in urban settings. About half of the physicians work in hospitals, and one third work in large outpatient clinics called polyclinics. About one third work in primary care. Gender affects education, specialty, type of workplace, and administrative duties; nationality affects education and administrative duties. CONCLUSIONS. The Soviet system of health care derived its professional structure from a combination of personal and occupational factors. Those considering options for reform of the health care systems of the newly independent states that once constituted the Soviet Union should appreciate the nature of these structural forces.
Extended coverage for preventive services for the elderly: response and results in a demonstration population.
Authors: German P S , Burton L C , Shapiro S , Steinwachs D M , Tsuji I , Paglia M J , Damiano A M
Published: November 2008

OBJECTIVES. This study was undertaken to test the acceptability of preventive services under Medicare waivers to a community-dwelling population aged 65 and over and to examine the effect of such services on health. METHODS. Medicare beneficiaries and designated primary care providers were sampled, and beneficiaries were screened and surveyed. A total of 4195 individuals were then randomized into intervention or control groups. Those in the intervention group were offered free preventive visits (under waivers) to their physicians. A follow-up survey of the entire group was administered after completion of the intervention. RESULTS. Sixty-three percent of the intervention group made a preventive clinical visit, and about half of them a counseling visit. For men, being married and having a solo practitioner were positively associated with accepting the intervention services, while for women, having had a mammogram, having a confidant, having a high school education, and having a female practitioner were so associated. The intervention group showed a greater health benefit than did the control group and had a significantly lower death rate: 8.3% vs 11.1%. CONCLUSIONS: Older individuals will respond to preventive programs, and such services will result in modest health gains.
Preventive services for the elderly: would coverage affect utilization and costs under Medicare?
Authors: Burton L C , Steinwachs D M , German P S , Shapiro S , Brant L J , Richards T M , Clark R D
Published: November 2008

OBJECTIVES. This study was undertaken to determine whether adding a benefit for preventive services to older Medicare beneficiaries would affect utilization and costs under Medicare. METHODS. The demonstration used an experimental design, enrolling 4195 older, community-dwelling Medicare recipients. Medicare claims data for the 2 years in which the preventive visits occurred were compared for the intervention (n = 2105) and control (n = 2090) groups. Monthly allowable charges for Part A and Part B services and number of hospital discharges and ambulatory visits were compared. RESULTS. There were no significant differences in the charges between the groups owing to the intervention, although total charges were somewhat lower for the intervention group even when the cost of the intervention was included. Charges for both groups rose significantly as would be expected for an aging population. A companion paper describes a modest health benefit. CONCLUSIONS. There appears to be a modest health benefit with no negative cost impact. This finding gives an early quantitative basis for the discussion of whether to extend Medicare benefits to include a general preventive visit from a primary care clinician.
The changing epidemiology of invasive bacterial infections in Massachusetts children, 1984 through 1991.
Authors: Loughlin A M , Marchant C D , Lett S M
Published: November 2008

Coincident with the licensure of Haemophilus influenzae b conjugate vaccines from 1987 to 1990, the incidence of meningitis and other invasive infections caused by H influenzae type b declined in Massachusetts children by 87% and 91%, respectively. By 1991, Neisseria meningitidis had replaced H influenzae b as the leading cause of bacterial meningitis, accounting for 57% of cases. During the period 1984 through 1991, serogroup C displaced sero-group B as the most common cause of N meningitidis disease. Streptococcus pneumoniae caused 92% of nonmeningitis invasive disease, with sero-groups 14, 6, 19, 18, 4, 23, and 9 causing 94.5% of infections. These findings have implications for the development of additional polysaccharide-protein conjugate vaccines for the prevention of childhood infections.
The effect of US children's access to care on medical attention for injuries.
Authors: Overpeck M D , Kotch J B
Published: November 2008

This analysis examined the effect of access to care on nonfatal medically attended injury rates for US children in 1988. Rates of medically attended injury were about the same for children with health insurance and Medicaid, after adjustment for other characteristics. However, lack of medical care coverage (health insurance or Medicaid) had the effect of decreasing the rates of both total and serious medically attended injury compared with the rates for children with coverage. For children without coverage, as many as 30% of total injuries and 40% of serious injuries may not have been attended in 1988.
State legislative strategies to improve the supply and distribution of generalist physicians, 1985 to 1992.
Authors: Rivo M L , Henderson T M , Jackson D M
Published: November 2008

State laws enacted between 1985 and 1992 were reviewed to examine state involvement in influencing the supply and distribution of generalist physicians. Forty-seven states enacted 238 relevant laws during this period. In 1991 and 1992, 36 states enacted 98 laws, as compared with 1985 and 1986, when 8 states enacted 12 laws. Legislation addressed planning and oversight; financial incentives to institutions, students, and residents; and strategies to enhance the practice environment. A new strategy is to link funding to measureable outcomes, such as the career choices of a state medical school's graduates. Few states devoted resources to evaluate their efforts.
Epidemiology and quantitative risk assessment: a bridge from science to policy.
Authors: Hertz-Picciotto I
Published: November 2008

Quantitative risk assessment provides formalized scientific input to regulatory agencies that set occupational and environmental standards for potentially toxic exposures. Current practice relies heavily on statistical extrapolation from high-dose animal studies. Human data obviate the need for interspecies extrapolation and reduce the range of high-to-low dose extrapolation. This paper proposes a framework for classifying individual epidemiologic studies as to their adequacy for use in dose-response extrapolation. The framework considers five criteria: (1) a stable positive association with an adverse health outcome; (2) high overall study quality; (3) no substantial confounding; (4) quantitative exposure assessment for individuals; (5) evidence of a dose-response relationship. With these criteria, studies can be categorized as (1) suitable to serve as a basis for extrapolation; (2) inadequate to be the basis for direct extrapolation but appropriate to use for evaluating the plausibility of animal-derived risk estimates; or (3) useful only for hazard identification, not for dose-response assessment. Methods for using studies in the first two categories are briefly described. The emphasis is not on establishing rigid rules, but rather on ensuring a consistent, reliable process that makes optimum use of available data.
Home hazards and falls in the elderly: the role of health and functional status.
Authors: Northridge M E , Nevitt M C , Kelsey J L , Link B
Published: November 2008

OBJECTIVES. This study was undertaken to determine whether vigorous and frail older people who identify environmental hazards in their homes have an increased risk for falls. METHODS. A 1-year prospective study was conducted among 266 female and 59 male community-dwelling volunteers aged 60 to 93 years who had fallen at least once during the previous year. Composite measures of home safety and of frailty were derived using principal components analysis. Participants were divided into vigorous and frail groups, and associations between baseline home safety measures and falls at home over the follow-up year were compared between the two groups. RESULTS. Frail individuals were more than twice as likely as vigorous individuals to fall during follow-up (rate ratio [RR] = 2.24; 95% confidence interval [CI] = 1.54, 3.27). In the study group as a whole, falls were not strongly associated with the presence of home hazards. However, when compared with vigorous older persons living with fewer home hazards, vigorous older persons living with more home hazards were more likely to fall. The increased risk for falls among vigorous elderly was limited to falls where home hazards were present. By contrast, living with more home hazards was not associated with increased likelihood of falls among frail older persons. CONCLUSIONS. While frail older persons experience higher overall fall rates, vigorous older persons should not be overlooked in fall prevention projects.
Mortality among Navajo uranium miners.
Authors: Roscoe R J , Deddens J A , Salvan A , Schnorr T M
Published: November 2008

OBJECTIVES. To update mortality risks for Navajo uranium miners, a retrospective cohort mortality study was conducted of 757 Navajos from the cohort of Colorado Plateau uranium miners. METHODS. Vital status was followed from 1960 to 1990. Standardized mortality ratios were estimated, with combined New Mexico and Arizona non-White mortality rates used for comparison. Cox regression models were used to evaluate exposure-response relationships. RESULTS. Elevated standardized mortality ratios were found for lung cancer (3.3), tuberculosis (2.6), and pneumoconioses and other respiratory diseases (2.6). Lowered ratios were found for heart disease (0.6), circulatory disease (0.4), and liver cirrhosis (0.5). The estimated relative risk for a 5-year duration of exposure vs none was 3.7 for lung cancer, 2.1 for pneumoconioses and other respiratory diseases, and 2.0 for tuberculosis. The relative risk for lung cancer was 6.9 for the midrange of cumulative exposure to radon progeny compared with the least exposed. CONCLUSIONS. Findings were consistent with those from previous studies. Twenty-three years after their last exposure to radon progeny, these light-smoking Navajo miners continue to face excess mortality risks from lung cancer and pneumoconioses and other respiratory diseases.
Random-digit dialing for control selection in childhood cancer studies: the geographic proximity and demographics within matched sets.
Authors: Sakkinen P A , Severson R K , Ross J A , Robison L L
Published: November 2008

The purpose of this analysis was to evaluate the degree of matching in 95 individually matched pairs from a case-control study of childhood leukemia that used random-digit dialing to select control subjects. Both geographic proximity (of each case subject to his or her matched control subject) and differences in socioeconomic status were evaluated. The median distance between matched pairs was 3.2 km. There were no significant differences in distance between matched pairs by urban/rural status and geographic location. For studies of childhood cancer drawn from pediatric referral centers, random-digit dialing appears to provide a suitable control group.
The rapid implementation of a statewide emergency health information system during the 1993 Iowa flood.
Authors: O'Carroll P W , Friede A , Noji E K , Lillibridge S R , Fries D J , Atchison C G
Published: November 2008

In the face of disastrous flooding, the Iowa Department of Public Health established the statewide Emergency Computer Communications Network to establish rapid electronic reporting of disaster-related health data, provide e-mail communications among all county health departments, monitor the long-range public health effects of the disaster, and institute a general purpose public health information system in Iowa. Based on software (CDC WONDER/PC) provided by the Centers for Disease Control and Prevention and using standard personal computers and modems, this system has resulted in a 10- to 20-fold increase in surveillance efficiency at the health department, not including time saved by county network participants. It provides a critical disaster assessment capability to the health department but also facilitates the general practice of public health.
Radium-bearing pipe scale deposits: implications for national waterborne radon sampling methods.
Authors: Field R W , Fisher E L , Valentine R L , Kross B C
Published: November 2008

A point-of-use waterborne radon-222 (222Rn) survey of a small Iowa town was performed to determine the cause of unnaturally high waterborne 222Rn concentrations in the municipality. The source of the elevated 222Rn concentrations was a newly discovered reservoir of waterborne 222Rn originating from distribution-system radium-226 (226Ra) adsorbed internal pipe scale deposits. Because the proposed national drinking water regulations for 222Rn require sampling at the origin of the distribution system rather than at the point of use, the proposed scheme for collection of water samples may not represent actual consumer waterborne 222Rn exposure in all cases.
Water chlorination and lipo- and apolipoproteins: the relationship in elderly white women of western Pennsylvania.
Authors: Riley T J , Cauley J A , Murphy P A
Published: November 2008

The relationship between consumption of chlorinated drinking water in the home water supply and serum lipids was examined in 2070 elderly White women. Private springs, cisterns, and wells were considered nonchlorinated and public water sources, chlorinated. Mean serum lipids and lipoproteins were similar in the chlorinated and nonchlorinated groups. Stratification by years of exposure revealed little difference in lipid concentrations. Lifestyle factors--for example, smoking and alcohol consumption--differed by years of exposure. Hence, previous reports of an association between chlorinated drinking water and serum cholesterol levels may reflect inadequate control of other factors differentially distributed across chlorinated exposure groups.
Measuring chemical sensitivity prevalence: a questionnaire for population studies.
Authors: Kipen H M , Hallman W , Kelly-McNeil K , Fiedler N
Published: November 2008

Because no information exists on the prevalence of chemical sensitivity syndromes such as multiple chemical sensitivities, a questionnaire for use in population studies was developed and tested to assess the presence or absence of chemical sensitivity. Seven hundred five individuals attending clinics answered a questionnaire asking whether each of 122 common substances caused symptoms. Results showed that patients with multiple chemical sensitivities and asthma had average total scores that were significantly different from each other and from those of each of the other diagnostic categories. Higher total scores were also reported by female patients. The instrument described here may facilitate meaningful prevalence studies of multiple chemical sensitivities. It will also allow study of chemically induced symptoms in other conditions such as asthma.
Reducing postneonatal mortality in West Virginia: a statewide intervention program targeting risk identified at and after birth.
Authors: Myerberg D Z , Carpenter R G , Myerberg C F , Britton C M , Bailey C W , Fink B E
Published: November 2008

OBJECTIVES. Excessive postneonatal mortality in West Virginia has been associated with inadequate health care. This paper describes two interventions aimed at those infants at greatest risk of dying. METHODS. Two systems of risk-related intervention were simultaneously introduced and funded statewide from 1985 through 1987. Risk status was determined by a multifactorial score at birth or clinical risk factors later. At-risk infants were linked with physicians who provided specified care plans. All infants were followed for 1 year for mortality. RESULTS. Of 4570 infants with a high Sheffield Birth Score, 45%, together with 1003 infants with clinical risk factors, received specified care plans. High-risk infants constituted 7.6% of total resident births. Odds ratios for overall postneonatal mortality and sudden infant death syndrome in high-birth-score infants compared with low-birth-score infants were 6.2 (95% confidence interval [CI] = 4.2, 9.3) and 11.2 (95% CI = 5.4, 23.2), respectively. The relative risks of postneonatal mortality were similarly significant for infants with most clinical risk factors. During the program there was a 21.4% reduction in the trend of yearly standardized mortality ratios, which differed markedly from the trend in surrounding states. The data suggest that 33 lives were saved at a cost of $36,363 per infant. CONCLUSION. Ensuring affordable, available, accessible, and acceptable care for a small group of at-risk infants was associated with a dramatic drop in overall postneonatal mortality in West Virginia.
The costs and effects of a nutritional education program following work-site cholesterol screening.
Authors: Byers T , Mullis R , Anderson J , Dusenbury L , Gorsky R , Kimber C , Krueger K , Kuester S , Mokdad A , Perry G
Published: November 2008

OBJECTIVES. The purpose of this study was to assess the costs and impact of a nutrition education program following a cholesterol screening. METHODS. Forty work-sites were randomly assigned to one of two educational interventions: a "usual" intervention of 5 minutes of counseling, or a "special" intervention of 2 hours of behaviorally based education on dietary changes to lower serum cholesterol. Costs were monitored, and cholesterol levels were retested 6 and 12 months later. RESULTS. The total per-person cost for screening and the educational intervention was about $50. Cholesterol levels differed little between the two intervention groups 6 months after screening, but after 12 months those in the special intervention worksites showed a 6.5% drop in cholesterol, whereas those at the usual intervention worksites showed a drop of only 3.0%. Hence a 3.5% cholesterol reduction was attributable to the special intervention. CONCLUSIONS. A behaviorally based nutrition education program following cholesterol screening can have a meaningful impact on long-term cholesterol levels at a low cost. Nutrition education in work-sites may therefore be a useful way to lower the risk of heart disease in communities.
Evaluating food fortification options: general principles revisited with folic acid.
Authors: Crane N T , Wilson D B , Cook D A , Lewis C J , Yetley E A , Rader J I
Published: November 2008

OBJECTIVES. This article uses folic acid as an example to illustrate some of the complex issues and general principles that emerge when evaluating fortification of the food supply as one possible means to address a public health recommendation. METHODS. Distributions of current daily folate intakes from conventional foods and dietary supplements were estimated. Intakes that might result from fortification of cereal-grain products and ready-to-eat cereals at various levels for eight age-gender groups were also estimated by using the US Department of Agriculture's 1987-1988 Nationwide Food Consumption Survey. RESULTS. The results illustrate that fortification of the US food supply tends to increase folate intakes of consumers at the high end of the intake distribution curves in the general population to a greater extent than it affects consumers at the low end of the intake distribution curves in the target population. CONCLUSIONS. The effectiveness of food fortification options for a target population and the safety for the general population impose conflicting challenges that must be considered concurrently when making decisions about fortifying the US food supply.