bluuebunny/crossref_metadata_2025 huggingface dataset:
Entry into primary care and continuity: the effects of access.
Authors: Forrest C B , Starfield B
Published: November 2008

OBJECTIVES: This study examined the relationship between access and use of primary care physicians as sources of first contact and continuity with the medical system. METHODS: Data from the 1987 National Medical expenditure Survey were used to examine the effects of access on use of primary care physicians as sources of first contact for new episodes of care (by logistic regression) and as sources of continuity for all ambulatory visits (by multi-variate linear regression). RESULTS: No after-hours care, longer office waits, and longer travel times reduced the chances of a first-contact visit with a primary care physician for acute health problems. Longer appointment waits, no insurance, and no after-hours care were associated with lower levels of continuity. Generalists provided more first-contact care than specialists acting as primary care physicians, largely because of their more accessible practices. CONCLUSIONS: These data provide support for the linkage between access and care seeking with primary care physicians.
Increasing social variation in birth outcomes in the Czech Republic after 1989.
Authors: Koupilová I , Bobák M , Holĉík J , Pikhart H , Leon D A
Published: November 2008

OBJECTIVES: This study investigated social variation in birth outcome in the Czech Republic after the political changes of 1989. METHODS: Routinely collected records on singleton live births in 1989, 1990, and 1991 (n = 380,633) and 1994, 1995, and 1996 (n = 286,907) were individually linked to death records. RESULTS: Mean birthweight fell from 3,323 g to 3,292 g (P < .001) between 1989 and 1991 and then increased to 3,353 g by 1996. The gap in mean birthweight between mothers with a primary education and those with a university education, adjusted for age, parity, and sex of infants, widened from 182 g (95% confidence interval [CI] = 169, 19) in 1989 to 256 g (95% CI = 240, 272) in 1996. Similar trends were found for preterm births. Postneonatal mortality declined most among the better educated and the married. The odds ratio for postneonatal death for infants of mothers with a primary (vs university) education, adjusted for birthweight, increased from 1.99 (95% CI = 1.52, 2.60) in 1989 through 1991 to 2.39 (95% CI = 1.55, 3.70) in 1994 through 1995. CONCLUSIONS: Despite general improvement in the indices of fetal growth and infant survival in the most recent years, social variation in birth outcome in the Czech Republic has increased.
Foster care children and family homelessness.
Authors: Zlotnick C , Kronstadt D , Klee L
Published: November 2008

OBJECTIVES: This study examined the association between family homelessness and children's placement in foster care. METHODS: The prevalence of homelessness in a random sample of 195 young foster children was examined. RESULTS: Almost half of the birth parents of the foster children had experienced homelessness. Those children were more likely than other foster children to have siblings in foster care and to be place with nonrelatives. CONCLUSIONS: An extremely high prevalence of family homelessness was found among children in foster care. Policy implications of the association between family homelessness and placement into foster care are discussed.
Reactions of adult and teenaged smokers to the Massachusetts tobacco tax.
Authors: Biener L , Aseltine R H , Cohen B , Anderka M
Published: November 2008

OBJECTIVES: This study assessed smokers' reactions to a 25 cents cigarette tax imposed in Massachusetts. METHODS: A statewide telephone survey of 1783 adult smokers and 216 teenaged smokers was conducted. RESULTS: Among adult smokers, 3.5% reported that they had stopped smoking, owing in part to the price increase; 35% had considered quitting and 19% had attempted to cut the cost of smoking by switching to cheaper brands or cutting down. Among teenagers, 21% had considered quitting and 26% had cut costs. Low-income smokers were more responsive to the price increase than more affluent smokers. CONCLUSIONS: A modest and temporary price increase promoted quitting among adult smokers and reduced cigarette consumption among low-income teenagers.
The impact of economic sanctions on health and human rights in Haiti, 1991-1994.
Authors: Gibbons E , Garfield R
Published: November 2008

OBJECTIVES: This report examines the impact of an economic embargo from 1991 to 1994 on health, well-being, and human rights in Haiti. METHODS: Data from surveillance systems for nutrition, reportable diseases, and hospital diagnoses were combined with survey data and interviews with affected women, governmental representatives, diplomats, and staff of nongovernmental organizations. RESULTS: Changes included declining income, rising unemployment, poorer nutrition, declining infant mortality, rising mortality among 1- to 4-year-olds, decreased attention to children's well-being and education, and family breakdown. Survival strategies among poor Haitians included changed dietary habits, informal-sector economic activity, moving in with relatives, selling domestic goods, increased informal unions among couples, decreased school attendance, and indentured servitude among children. CONCLUSIONS: The implementation of economic sanctions in Haiti resulted in extensive violations of rights; the impact was greatest on the most disadvantaged Haitians. Many Haitian and international supporters of democracy were unaware of the extensive negative impact that sanctions could have. The impact continues now, 5 years after sanctions ended. Modified policies reduced some of the burden of sanctions, and international assistance prevented what otherwise might have become a humanitarian disaster during sanctions.
Economic sanctions as human rights violations: reconciling political and public health imperatives.
Authors: Marks S P
Published: November 2008

The impact of economic sanctions on civilians has frequently been studied by public health specialists and specialized agencies of the United Nations (UN). This commentary explores some of the difficulties of the claim that sanctions constitute violations of human rights. The deprivation suffered by civilian populations under sanctions regimes often are violations of economic, social, and cultural human rights; however, the attribution of responsibility for those violations to the "senders" of sanctions (the UN Security Council or the US government, for example) is difficult to sustain, particularly in light of the efforts made by these entities to provide for humanitarian exemptions and humanitarian aid. A more productive approach to avoiding civilian harm is to prefer, as a matter of policy, arms embargoes, severing of communications, and international criminal prosecutions over trade embargoes. Promising recommendations have been formulated regarding "smart sanctions," which target regimes rather than people, and "positive sanctions" in the form of incentives. Health and human rights professionals have specific and important tasks in implementing such a restructured approach to sanctions.
The risks for late adolescence of early adolescent marijuana use.
Authors: Brook J S , Balka E B , Whiteman M
Published: November 2008

OBJECTIVES: The purpose of this study was to assess the relation of early adolescent marijuana use to late adolescent problem behaviors, drug-related attitudes, drug problems, and sibling and peer problem behavior. METHODS: African American (n = 627) and Puerto Rican (n = 555) youths completed questionnaires in their classrooms initially and were individually interviewed 5 years later. Logistic regression analysis estimated increases in the risk of behaviors or attitudes in late adolescence associated with more frequent marijuana use in early adolescence. RESULTS: Early adolescent marijuana use increased the risk in late adolescence of not graduating from high school; delinquency; having multiple sexual partners; not always using condoms; perceiving drugs as not harmful; having problems with cigarettes, alcohol, and marijuana; and having more friends who exhibit deviant behavior. These relations were maintained with controls for age, sex, ethnicity, and, when available, earlier psychosocial measures. CONCLUSIONS: Early adolescent marijuana use is related to later adolescent problems that limit the acquisition of skills necessary for employment and heighten the risks of contracting HIV and abusing legal and illegal substances. Hence, assessments of and treatments for adolescent marijuana use need to be incorporated in clinical practice.
Which adults do underaged youth ask for cigarettes?
Authors: Ribisl K M , Norman G J , Howard-Pitney B , Howard K A
Published: November 2008

OBJECTIVES: This study identified adults' demographic and smoking behavior characteristics that are related to being asked to provide tobacco to a minor. METHODS: Telephone interviews were conducted with 6352 California adults. Predictors included age, sex, household income, and smoking status. RESULTS: Only 10.1% of California adults had been asked to provide tobacco to a minor in the previous year. Fewer than 3% of individuals 55 years and older had been asked to provide tobacco, but among younger smokers 59.0% of 18- and 19-year-olds and 39.3% of 20- to 24-year-olds had been approached. CONCLUSIONS: Interventions to reduce the social availability of tobacco are needed.
Prevalence of and factors associated with hormone replacement therapy counseling: results from the 1994 National Health Interview Survey.
Authors: Zhang P , Tao G , Anderson L A
Published: November 2008

OBJECTIVES: This study estimated the prevalence of and the factors associated with hormone replacement therapy (HRT) counseling. METHODS: We analyzed the responses of 3170 women, aged 40 to 60 years, from the 1994 National Health Interview Survey. RESULTS: The prevalence of HRT counseling was 43.6%. Women were more likely to report having received HRT counseling if they were White, older, more educated, had had a hysterectomy, had experienced menopausal symptoms, and had a regular source of care. CONCLUSIONS: More attention should be directed at counseling non-White women and women with less formal education. Reducing the barriers to having a regular source of care appears to increase the likelihood of receiving HRT counseling.
Achieving a public health recommendation for preventing neural tube defects with folic acid.
Authors: Werler M M , Louik C , Mitchell A A
Published: November 2008

OBJECTIVES: This study examined 3 approaches to achieving the public health recommendation that all women of child-bearing age ingest 0.40 mg of folic acid per day to reduce the occurrence of neural tube defects (NTDs). METHODS: A total of 1136 mothers of infants with major malformations from the Boston and Philadelphia areas, whose pregnancies began from 1993 to 1995, were interviewed within 6 months of delivery about vitamin supplementation, dietary intakes, and other factors. RESULTS: Seventy-one percent of the 1136 women in the study did not take folic acid--containing supplements daily before conception, but the proportion decreased over the years of the study. Women not taking supplements consumed an average of 0.25 mg of naturally occurring folates daily. On the basis of dietary intakes reported by women not taking folic acid supplements, a simulation of cereal grain fortification with folic acid at the level required by the US Food and Drug Administration showed that an average of only 0.13 mg of folic acid would be ingested daily. CONCLUSIONS: With consumption of folic acid only through dietary intake, sizeable portions of the childbearing population would receive less than the level of folic acid recommended for preventing NTDs. Even with food fortification, women of childbearing age should be advised to take folic acid--containing supplements on a daily basis.
Evidence for decline in disability and improved health among persons aged 55 to 70 years: the Framingham Heart Study.
Authors: Allaire S H , LaValley M P , Evans S R , O'Connor G T , Kelly-Hayes M , Meenan R F , Levy D , Felson D T
Published: November 2008

OBJECTIVES: This study detected secular change in disability and health among persons aged 55 to 70 years, the life period when increases in disability and morbidity begin and retirement occurs. METHODS: Cross-sectional comparisons were completed with data from similarly aged members of the original (n = 1760) and offspring (n = 1688) cohorts of the Framingham Heart Study, which represent 2 generations. Analyses were conducted by gender and on chronic disease subgroups by logistic regression. RESULTS: There was substantially less disability in the offspring cohort than in the original cohort. Thirty-six percent of offspring men were disabled vs 52% of original cohort men (P = .001); among women, these proportions were 54% vs 72% (P = .001). Fewer offspring perceived their health as fair or poor and fewer had chronic diseases. Offspring were more physically active and less likely to smoke or consume high amounts of alcohol, but their average weight was greater. The secular decline in disability was strongly evident among individuals with chronic diseases. CONCLUSIONS: Our findings depict a secular change toward a less disabled and globally healthier population in the period of life when retirement occurs.
The association between state housing policy and lead poisoning in children.
Authors: Sargent J D , Dalton M , Demidenko E , Simon P , Klein R Z
Published: November 2008

OBJECTIVES: This study examined the effect of an active program of household lead paint hazard abatement, applied over 22 years, on childhood lead poisoning in Massachusetts. METHODS: A small areas analysis was used to compare screening blood lead levels of children in Worcester County, Mass (n = 27,590), with those in Providence County, RI (n = 19,071). Data were collapsed according to census tract. RESULTS: The percentage of children with lead poisoning (blood lead level > or = 20 micrograms/dL [Pe20]) was, on average, 3 times higher in Providence County census tracts (3.2% vs 0.9% in Worcester County census tracts, P < .0001), despite similar percentages of pre-1950s housing in both counties. The ratio of Pe20 in Providence vs Worcester County census tracts was 2.2 (95% confidence interval = 1.8, 2.7), after adjustment for differences in housing, sociodemographic, and screening characteristics. This estimate was robust to alternative regression methods and sensitivity analyses. CONCLUSIONS: Massachusetts policy, which requires lead paint abatement of children's homes and places liability for lead paint poisoning on property owners, may have substantially reduced childhood lead poisoning in that state.
Effects of ignition interlock license restrictions on drivers with multiple alcohol offenses: a randomized trial in Maryland.
Authors: Beck K H , Rauch W J , Baker E A , Williams A F
Published: November 2008

OBJECTIVES: This investigation sought to test the effectiveness of a statewide ignition interlock license restriction program for drivers with multiple alcohol-related traffic offenses. METHODS: A total of 1387 multiple offenders eligible for license reinstatement were randomly assigned to participate in an ignition interlock program (experimental group) or in the conventional postlicensing treatment program (control group). The arrest rates of these 2 groups for alcohol traffic offenses were compared for 1 year during the ignition interlock license restriction program and for 1 year after unrestricted driving privileges were returned. RESULTS: Participation in the interlock program reduced offenders' risk of committing an alcohol traffic violation within the first year by about 65%. The alcohol traffic violation rate during the first year was significantly less for participants in the interlock program (2.4%) than for those in the control group (6.7%). However, there was no statistically significant difference between these groups in the second year, after the interlock license restriction was lifted. CONCLUSIONS: Ignition interlock license restriction programs are effective at reducing recidivism among drivers with multiple alcohol offenses, at least while the restriction is in effect.
Impact of diabetes mellitus on mortality associated with pneumonia and influenza among non-Hispanic black and white US adults.
Authors: Valdez R , Narayan K M , Geiss L S , Engelgau M M
Published: November 2008

OBJECTIVES: This study assessed the impact of diabetes on mortality associated with pneumonia and influenza among non-Hispanic Black and White US adults. METHODS: Data were derived from the National Mortality Followback Survey (1986) and the National Health Interview Survey (1987-1989). RESULTS: Regardless of race, sex, and socioeconomic status, people with diabetes who died at 25 to 64 years of age were more likely to have pneumonia and influenza recorded on the death certificate than people without diabetes who died at comparable ages (odds ratio [OR] = 4.0, 95% confidence interval [CI] = 2.3, 7.7). For those 65 years and older, the risk remained elevated among Whites with diabetes (OR = 2.2, 95% CI = 1.7, 2.7) but not among Blacks with diabetes (OR = 1.0, 95% CI = 0.6, 1.7). It was estimated that about 17,000 (10.3%) of the 167,000 deaths associated with pneumonia and influenza that occurred in 1986 were attributable to diabetes. CONCLUSIONS: The impact of diabetes on deaths associated with pneumonia and influenza is substantial. Targeted immunizations among people with diabetes may reduce unnecessary deaths associated with pneumonia and influenza.
Psychotropic medication use among children in foster care: relationship to severe psychiatric disorders.
Authors: Zima B T , Bussing R , Crecelius G M , Kaufman A , Belin T R
Published: November 2008

OBJECTIVES: This study sought to describe the level of psychotropic medication use and its relationship to severe psychiatric disorders among school-aged children in foster care. METHODS: Home interviews with 302 foster parents and children aged 6 to 12 years and 266 follow-up clinical evaluations were conducted. RESULTS: Thirteen percent of the children had taken psychotropic medication in the previous year, and 52% of those whose clinical status merited a medication evaluation had not received medication in the previous year. CONCLUSIONS: As the efficacy of psychotropic medication treatment for severe child psychiatric disorders becomes more established, research on the appropriateness of such care can begin.
Effects of a community-based intervention on physical activity: the Pawtucket Heart Health Program.
Authors: Eaton C B , Lapane K L , Garber C E , Gans K M , Lasater T M , Carleton R A
Published: November 2008

OBJECTIVES: The effect of a community-based physical activity program in Pawtucket, RI, was evaluated relative to one in a comparison community. METHODS: Cross-sectional surveys of 7529 residents of Pawtucket, RI, and 7732 residents of the comparison city were conducted at 2-year intervals during 7 years of intervention. RESULTS: There were no differences in self-reported knowledge of the benefits of physical activity, attempts to increase exercise, or prevalence of physical inactivity between Pawtucket and the comparison community. CONCLUSIONS: Future community-based physical activity interventions should attempt to involve a wider range of individuals.
A further analysis of race differences in the National Longitudinal Mortality Study.
Authors: Ng-Mak D S , Dohrenwend B P , Abraido-Lanza A F , Turner J B
Published: November 2008

OBJECTIVES: The purpose of this study was to investigate associations between race and specific causes of mortality among adults 25 years and older in the National Longitudinal Mortality Study. METHODS: Mortality hazard ratios between races during 9 years of follow-up were estimated with Cox proportional hazards models, with control for multiple indicators of socioeconomic status (SES) and SES-relevant variables. RESULTS: Black persons younger than 65 years were at higher risk than others for all-cause and cardiovascular mortality; the strongest effects were observed among persons aged 25 through 44 years. CONCLUSIONS: Race, independent of SES, is related to mortality in American society, but these effects vary by age and disease categories.
Mortality differentials among Israeli men.
Authors: Manor O , Eisenbach Z , Peritz E , Friedlander Y
Published: November 2008

OBJECTIVES: This study examined differentials in mortality among adult Israeli men with respect to ethnic origin, marital status, and several measures of social status. METHODS: Data were based on a linkage of records from a 20% sample of the 1983 census to records of deaths occurring before the end of 1992. The study population included 72,527 men, and the number of deaths was 17,378. RESULTS: Differentials is mortality by origin show that mortality was higher among individuals of North African origin than among those of Asian and European origin. After allowance for several socioeconomic indicators, the excess mortality among North African Jews was eliminated. Substantial and consistent differences in mortality were found according to education, occupation, income, possession of a car, housing, and household amenities. Differentials among the elderly were markedly narrower than those among men younger than 70 years. CONCLUSIONS: Some sectors of Israeli society have higher risks of death than others, including, among the male population, these who are poor, less educated, unmarried, unskilled, out of the labor force, and of North African origin.
The impact of a community-based heart disease prevention program in a low-income, inner-city neighborhood.
Authors: O'Loughlin J L , Paradis G , Gray-Donald K , Renaud L
Published: November 2008

OBJECTIVES: This study evaluated the impact of a 4-year, community-based cardiovascular disease prevention program among adults aged 18 to 65 years living in St-Henri, a low-income, innercity neighborhood in Montreal, Quebec. METHODS: Awareness of and participation in the program were monitored in 3 independent sample telephone surveys. Self-reported behaviors were compared in St-Henri and a nearby comparison community before and after program implementation in both a 3-year repeat independent sample survey and a 5-year longitudinal cohort telephone survey. RESULTS: Awareness of the program reached 37.4%, but participation was low (2%-3%). There were no secular declines in smoking or high-fat diet; physical inactivity increased in both communities. There were no statistically significant program effects detected in the independent sample surveys, although physical inactivity increased more in the comparison community than in St-Henri. In the longitudinal cohort sample, there was a small, statistically significant increase favoring St-Henri in frequency of cholesterol checkups. CONCLUSIONS: Despite careful adaptation of the program to the local social context, there were few community-wide program effects. However, several component interventions showed promise in terms of community penetration and impact.
Tobacco smoking and depressed mood in late childhood and early adolescence.
Authors: Wu L T , Anthony J C
Published: November 2008

OBJECTIVES: This study builds on previous observations about a suspected causal association linking tobacco smoking with depression. With prospective data, the study sheds new light on the temporal sequencing of tobacco smoking and depressed mood in late childhood and early adolescence. METHODS: The epidemiologic sample that was studied consisted of 1731 youths (aged 8-9 to 13-14 years) attending public schools in a mid-Atlantic metropolitan area, who were assessed at least twice from 1989 to 1994. A survival analysis was used to examine the temporal relationship from antecedent tobacco smoking to subsequent onset of depressed mood, as well as from antecedent depressed mood to subsequent initiation of tobacco use. RESULTS: Tobacco smoking signaled a modestly increased risk for the subsequent onset of depressed mood, but antecedent depressed mood was not associated with a later risk of starting to smoke tobacco cigarettes. CONCLUSIONS: This evidence is consistent with a possible causal link from tobacco smoking to later depressed mood in late childhood and early adolescence, but not vice versa.
Differences in program implementation between nurses and paraprofessionals providing home visits during pregnancy and infancy: a randomized trial.
Authors: Korfmacher J , O'Brien R , Hiatt S , Olds D
Published: November 2008

OBJECTIVES: This study examined differences between nurses and paraprofessionals in implementation of a home visiting program for low-income, first-time parents during pregnancy and the first 2 years of the child's life. METHODS: Mothers were randomly assigned to either a nurse-visited (n = 236) or a paraprofessional-visited (n = 244) condition. Nurse- and paraprofessional-visited families were compared on number and length of visits, topics covered, number of program dropouts, and relationship with home visitor. RESULTS: On average, nurses completed more visits than paraprofessionals (28 vs 23; P < .001) and spent a greater proportion of time on physical health issues during pregnancy (38% vs 27%; P < .001) and on parenting issues during infancy (46% vs 32%; P < .001). Paraprofessionals conducted visits that lasted longer and spent a greater proportion of time on environmental health and safety issues (15% vs 7% pregnancy; 15% vs 8% infancy; P < .001). While home visitors were viewed equally positively by mothers, nurses had fewer dropouts than did paraprofessionals (38% vs 48%; P = .04). More paraprofessional-visited families than nurse-visited families experienced staff turnover. CONCLUSIONS: Nurses and paraprofessionals, even when using the same model, provide home visiting services in different ways.
Mortality from infectious diseases in Israel, 1979-1992, based on revised ICD-9 codes: implications for international comparisons.
Authors: Shohat T , Harari G , Green M S
Published: November 2008

OBJECTIVES: This study examined trends in infectious disease mortality rates in Israel between 1979 and 1992, using a traditional and a revised set of International Classification of Diseases, Ninth Revision (ICD-9) codes. METHODS: A revised scheme of ICD-9 codes was used to compute mortality rates from infectious diseases for the period 1979 through 1992 by sex and for different age categories. RESULTS: Age-adjusted infectious disease mortality rates based on the revised ICD-9 codes were 3 times higher than those based on traditional codes. Between 1979 and 1992, age-adjusted mortality rates declined more under the revised method than under the traditional method (20% vs 1.7%). CONCLUSIONS: The revised set of ICD-9 codes allows a more comprehensive view of the burden of infectious diseases on public health.
The association between switching hand preference and the declining prevalence of left-handedness with age.
Authors: Galobardes B , Bernstein M S , Morabia A
Published: November 2008

OBJECTIVES: This study determined the prevalence of left-handedness and of switching hand preference among innately left-handed subjects. METHODS: Subjects of Swiss nationality (n = 1692), participating in a population-based survey in Geneva, Switzerland, completed a questionnaire on innate hand preference and current hand preference for writing. RESULTS: From 35 to 44 years of age to 65 to 74 years of age, the prevalence of innate left-handedness declined from 11.9% to 6.2% (trend P = .007). In these same age groups, the proportion of innately left-handed subjects who switched to the right hand for writing increased from 26.6% to 88.9% (trend P = .0001). CONCLUSIONS: Across generations, we found an increase in the prevalence of switching hand preference among innately left-handed subjects. This phenomenon could be explained by social and parental pressure to use the right hand.
Cigarette smoking among gay and bisexual men.
Authors: Stall R D , Greenwood G L , Acree M , Paul J , Coates T J
Published: November 2008

OBJECTIVES: This study measured the prevalence of cigarette smoking among gay men and identified associations with smoking. METHODS: Household-based (n = 696) and bar-based (n = 1897) sampling procedures yielded 2593 gay male participants from Portland, Ore, and Tucson, Ariz, in the spring of 1992. RESULTS: Forty-eight percent of the combined sample reported current smoking, a rate far above prevalence estimates for men in Arizona (z = 14.11, P < .001) or Oregon (z = 24.24, P < .001). Significant associations with smoking included heavy drinking, frequent gay bar attendance, greater AIDS-related losses, HIV seropositivity, lower health rating than members of same age cohort, lower educational attainment, and lower income. CONCLUSIONS: Rates of cigarette smoking are very high among gay men. Tobacco prevention and cessation campaigns should be designed to reach the gay male community.
Long-term trends in childhood infectious disease mortality rates.
Authors: DiLiberti J H , Jackson C R
Published: November 2008

OBJECTIVES: This study assessed long-term trends in US childhood infectious disease mortality rates (CIDMR). METHODS: We calculated age-adjusted and age group-specific US CIDMR (1968-1996) by using data from the Compressed Mortality File (1968-1992, 1996) and Multiple Cause of Death Files (1993-1995) of the National Center for Health Statistics and English data for historical comparison (1861-1964). RESULTS: US CIDMR declined continuously from 1968 to 1996, although the rate of decline slowed after 1974. Respiratory and central nervous system categories declined most; HIV-related deaths offset these declines somewhat. CONCLUSIONS: CIDMR declined nearly 200-fold between 1861 and 1996, but no substantive improvement occurred after 1986.
Preventable inpatient time: adequacy of electronic patient information systems.
Authors: Katz D L , Mazhari R , Kalus R , Nawaz H
Published: November 2008

OBJECTIVES: This study assessed hospital electronic patient information systems (EPIS) for inclusion of variables associated with avoidable and extended hospitalization (preventable inpatient time). METHODS: We searched MEDLINE and HealthSTAR databases to identify predictors of preventable inpatient time. We then audited the admissions process and the handwritten medical record at 1 hospital, and the EPIS at all hospitals, affiliated with the Yale University School of Medicine for inclusion of the predictors. RESULTS: Whereas the written medical record included all 58 predictors, the EPIS of the 10 hospitals surveyed included an average of only 38% of the predictors. CONCLUSIONS: The conventional approach to information gathering during hospital admission is highly inefficient. Revising EPIS to include predictors of preventable inpatient time could enhance efficiency and quality, while reducing costs, of hospital care.
Who should be offered prenatal diagnosis? The 35-year-old question.
Authors: Kuppermann M , Goldberg J D , Nease R F , Washington A E
Published: November 2008

Prenatal diagnosis of chromosomal disorders is generally offered to women who will be 35 years or older at the time of delivery or who have been determined via serum screening to be at risk similar to that of a woman older than 35 years. This age threshold was based on 4 major rationales that reflect considerations of resources and effectiveness. In this paper, we explore the current screening recommendations and consider new information that calls the 35-years threshold into question. We conclude that guidelines regarding use of prenatal diagnosis account for the preferences of the individual patient as well as for individual risk.
The role of state policies and programs in buffering the effects of poverty on children's immunization receipt.
Authors: Mayer M L , Clark S J , Konrad T R , Freeman V A , Slifkin R T
Published: November 2008

OBJECTIVES: This study assessed the influence of public policies on the immunization status of 2-year old children in the United States. METHODS: Up-to-dateness for the primary immunization series was assessed in a national sample of 8100 children from the 1988 National Maternal and Infant Health Survey and its 1991 Longitudinal Follow-Up. RESULTS: Documented immunization rates of this sample were 33% for poor children and 44% for others. More widespread Medicated coverage was associated with greater likelihood of up-to-dateness among poor children. Up-to-dateness was more likely for poor children with public rather than private sources of routine pediatric care, but all children living in states where most immunizations were delivered in the public sector were less likely to be up to date. Poor children in state with partial vaccine replacement programs were less likely to be up to date than those in free-market purchase states. CONCLUSIONS: While state policies can enhance immunization delivery for poor children, heavy reliance on public sector immunization does not ensure timely receipt of vaccines. Public- and private-sector collaboration is necessary to protect children from vaccine-preventable diseases.
The impact of physician bonuses, enhanced fees, and feedback on childhood immunization coverage rates.
Authors: Fairbrother G , Hanson K L , Friedman S , Butts G C
Published: November 2008

OBJECTIVES: The purpose of this study was to examine the effects on immunization coverage of 3 incentives for physicians--a cash bonus for practice--wide increases, enhanced fee for service, and feedback. METHODS: Incentives were applied at 4-month intervals over 1 year among 60 inner-city office-based pediatricians. At each interval, charts of 50 randomly selected children between 3 and 35 months of age were reviewed per physician. RESULTS: The percentage of children who were up to date for diphtheria, tetanus, and pertussis and Haemophilus influenzae type b; polio; and measles-mumps-rubella immunization in the study's bonus group improved by 25.3 percentage points (P < .01). No significant changes occurred in the other groups. However, percentage of immunizations received outside the participating practice also increased significantly in the bonus group (P < .01). Levels of missed opportunities to immunize were high in all groups and did not change over time. Physicians' knowledge of contraindications was low. CONCLUSIONS: Bonuses sharply and rapidly increased immunization cover-age in medical records. However, much of the increase was the result of better documentation. A bonus is a powerful incentive, but more structure or education may be necessary to achieve the desired results.
The effectiveness of the Reach for Health Community Youth Service learning program in reducing early and unprotected sex among urban middle school students.
Authors: O'Donnell L , Stueve A , San Doval A , Duran R , Haber D , Atnafou R , Johnson N , Grant U , Murray H , Juhn G , Tang J , Piessens P
Published: November 2008

OBJECTIVES: This study evaluated the effectiveness of a community youth service (CYS) program in reducing sexual risk behaviors among African American and Latino urban young adolescents. METHODS: A total of 1061 students at 2 urban middle schools were surveyed at baseline and 6-month follow-up. Students at one school were randomly assigned by classroom to receive either the Reach for Health CYS program or the Reach for Health classroom curriculum only. Students at the other school served as controls. RESULTS: At follow-up. CYS participants reported significantly less recent sexual activity (P < .05) and scored lower on a sexual activity index than those in the control condition (P < .03). The greatest effect was among eighth graders, who received the most intensive service program (P < .03). The benefit of the curriculum-only intervention appeared greatest among students in special education classes. CONCLUSIONS: Well-organized CYS that couples community involvement with classroom health instruction can have a positive impact on the sexual behaviors of young adolescents at risk for HIV, sexually transmitted diseases, and unintended pregnancy. This study also suggests the importance of including students in special education classes in health education programs.
Interior surface materials in the home and the development of bronchial obstruction in young children in Oslo, Norway.
Authors: Jaakkola J J , Oie L , Nafstad P , Botten G , Samuelsen S O , Magnus P
Published: November 2008

OBJECTIVES: This study assessed the role of polyvinyl chloride (PVC) plastics and textile materials in the home in the development of bronchial obstruction during the first 2 years of life. METHODS: The study was a matched pair case-control study based on a cohort of 3754 newborns in Oslo in 1992 and 1993 who were followed up for 2 years. The case group consisted of 251 children with bronchial obstruction; the control group was matched one-to-one for date of birth. RESULTS: In conditional logistic regression analysis, the risk of bronchial obstruction was related to the presence of PVC flooring (adjusted odds ratio [OR] = 1.89; 95% confidence interval [CI] = 1.14, 3.14) and textile wall materials (adjusted OR = 1.58; 95% CI = 0.98, 2.54). The reference category was wood or parquet flooring and painted walls and ceiling. Further analysis revealed an exposure-response relationship between the assessed amount of PVC and other plasticizer-containing surface materials and the risk of bronchial obstruction. CONCLUSIONS: This study provides new evidence of the role of PVC and textile wall materials in the development of bronchial obstruction in young children.
Measurement of the validity of a preschool vision screening program.
Authors: Robinson B , Bobier W R , Martin E , Bryant L
Published: November 2008

OBJECTIVES: The validity (sensitivity and specificity) of a preschool vision screening program was measured over a 3-year period to determine how well strabismus and significant refractive errors could be detected. METHODS: Public health nurses were trained to administer tests of visual acuity, stereoacuity, and ocular alignment. Failure on any test, visual acuity of 6/9 or less, stereoacuity of less than 100 seconds of arc, or an apparent misalignment of the eyes resulted in referral to an eye care practitioner. An age-matched control was also referred. Analysis of practitioner reports used predefined study-based criteria for ocular abnormalities. RESULTS: More than 1100 children were screened each year. The annually calculated prevalence of vision problems ranged between 10.5% and 13.8%. The estimated sensitivity varied from 60.4% to 70.9% (specificity, 69.6% to 79.9%). The yield indicated that a very high percentage of children with vision problems were identified for the first time. CONCLUSIONS: The validity of this screening is comparable to that of other school screenings. The limitations are predictable. Consideration should be given to replacing visual acuity tests with a rapid, objective measure of refractive error and ocular alignment.
Prevalent urinary incontinence as a correlate of pregnancy, vaginal childbirth, and obstetric techniques.
Authors: Foldspang A , Mommsen S , Djurhuus J C
Published: November 2008

OBJECTIVES: This study examined the association between pregnancy, vaginal childbirth and obstetric techniques, and the prevalence of urinary incontinence among adult women aged 20 to 59 years. METHODS: A cross-sectional survey enrolled a random sample of 6240 women aged 20 to 59 years who were mailed a self-administered questionnaire focusing on urinary incontinence and other health variables. More than 75% of the women responded. The present analysis includes 4345 women who were not pregnant and did not experience a vaginal childbirth during 1994. RESULTS: Multivariate prevalence odds ratios showed increases in relation to urinary incontinence during pregnancy, urinary incontinence immediately after a vaginal childbirth, and age of 30 years or more at the second vaginal childbirth. No multivariate associations were found for forceps delivery or vacuum extraction delivery, episiotomy, or perineal suturing. CONCLUSION: Not only the process of childbirth itself but also processes during pregnancy seem to be strongly associated with prevalent urinary incontinence. Perineal suturing may be associated with prevalent urinary incontinence, whereas other obstetric techniques inspected do not seem to be so.
Errors in gestational age: evidence of bleeding early in pregnancy.
Authors: Gjessing H K , Skjaerven R , Wilcox A J
Published: November 2008

OBJECTIVES: This study explored the extent of errors in gestational age as ascertained by last menstrual period. METHODS: More than 1.5 million birth records (covering the years 1967-1994) from the population-based Medical Birth Registry of Norway were used to study variation in gestational age within strata of birthweight. RESULTS: Within 100-g strata of birthweight, it was found that the observed gestational age distribution could be divided into 3 distinct underlying distributions separated by approximately 4 weeks. This pattern was present through all birthweight strata, from 200 g up to 4700 g. In addition, the apparent misclassification causing a gestational age 4 weeks too short was much more common among low-birthweight births than among heavier births. CONCLUSIONS: The separation of the gestational age distributions by intervals of close to 4 weeks suggests that errors in gestational age measurements are caused by factors related to menstrual bleeding. Furthermore, there is evidence for a strong relation between bleeding at the time of the next menstrual period after conception and low birthweight. This conclusion should be approached with caution because of the retrospective nature of the data.
Acculturation and breast cancer screening among Hispanic women in New York City.
Authors: O'Malley A S , Kerner J , Johnson A E , Mandelblatt J
Published: November 2008

OBJECTIVES: This study investigated whether acculturation was associated with the receipt of clinical breast examinations and mammograms among Colombian, Ecuadorian, Dominican, and Puerto Rican women aged 18 to 74 years in New York City in 1992. METHODS: A bilingual, targeted, random-digit-dialed telephone survey was conducted among 908 Hispanic women from a population-based quota sample. Outcome measures included ever and recent use of clinical breast examinations and mammograms. Multivariate logistic regression models were used to assess the effect of acculturation on screening use. RESULTS: When demographic, socioeconomic, and health system characteristics and cancer attitudes and beliefs were controlled for, women who were more acculturated had significantly higher odds of ever and recently receiving a clinical breast examination (P < or = .01) and of ever (P < or = .01) and recently (P < or = .05) receiving a mammogram than did less acculturated women. For all screening measures, there was a linear increase in the adjusted probability of being screened as a function of acculturation. CONCLUSIONS: Neighborhood and health system interventions to increase screening among Hispanic women should target the less acculturated.
Wife abuse among women of childbearing age in Nicaragua.
Authors: Ellsberg M C , Peña R , Herrera A , Liljestrand J , Winkvist A
Published: November 2008

OBJECTIVES: This study measured the prevalence, frequency, and severity of physical wife abuse and its risk factors in León, Nicaragua. METHODS: A cross-sectional survey was conducted with a representative sample of 488 women 15 to 49 years of age. RESULTS: The lifetime prevalence of spousal violence was 52% among ever-married women (n = 360). Spousal violence was significantly positively associated with poverty, parity, urban residence, and history of violence in the husband's family. No significant associations were found between spousal violence and women's age, education, marital dependency, or occupation. CONCLUSIONS: Wife abuse constitutes a major public health problem in Nicaragua, requiring urgent measures for prevention and treatment for victims.
The influence of race on approaching families for organ donation and their decision to donate.
Authors: Guadagnoli E , McNamara P , Evanisko M J , Beasley C , Callender C O , Poretsky A
Published: November 2008

OBJECTIVES: This study examined whether patients' race was associated with their families' being approached for organ donation and agreeing to donation. METHODS: Logistic regression models were applied to data collected from records at 112 hospitals. RESULTS: The odds that a family of a White patient was approached for donation were nearly twice those for a family of an African American. The odds of donation also differed by race, but the magnitude varied by patient and hospital characteristics. CONCLUSIONS: Much attention directed toward racial disparity in donation has focused on attitudes of the public. The behavior of hospital staff also may be related to differences in rates.
From socialist principles to motorcycle maintenance: the origin and development of the salaried physician model in the Israeli Public Health Services, 1918 to 1998.
Authors: Shvarts S , de Leeuw D L , Granit S , Benbassat J
Published: November 2008

For more than 70 years, physicians in the Israeli health care system have been employed on a fixed salary rather than on a fee-for-service basis. The present report is a brief review of the origin and development of this unique salaried physician model and its effect on the terms of physicians' employment. Archival documents were reviewed. The salaried physician model was introduced to ensure egalitarian health care for patients rather than equal payment for physicians. It was accepted by physicians because it guaranteed their employment and income. However, over the years, the salaried physician model has evolved into a complex wage scale, with multiple fringe benefits that bypass formal agreements in order to reward individual physicians. In addition, the salaried physician model has encouraged illegal private practice, which is viewed today as one of the major problems of the Israeli Public Health Services.
Prevalence and social correlates of cardiovascular disease risk factors in Harlem.
Authors: Diez-Roux A V , Northridge M E , Morabia A , Bassett M T , Shea S
Published: November 2008

OBJECTIVES: This study examined the prevalence, social correlates, and clustering of cardiovascular disease risk factors in a predominantly Black, poor, urban community. METHODS: Associations of risk factor prevalences with sociodemographic variables were examined in a population-based sample of 695 men and women aged 18 to 65 years living in Central Harlem. RESULTS: One third of the men and women were hypertensive, 48% of the men and 41% of the women were smokers, 25% of the men and 49% of the women were overweight, and 23% of the men and 35% of the women reported no leisure-time physical activity over the past month. More than 80% of the men and women had at least 1 of these risk factors, and 9% of the men and 19% of the women had 3 or more risk factors. Income and education were inversely related to hypertension, smoking, and physical inactivity. Having 3 or more risk factors was associated with low income and low education (extreme odds ratio [OR] = 10.2, 95% confidence interval [CI] = 3.0, 34.5 for education; OR = 3.7, CI = 1.6, 8.9 for income) and with a history of unstable work or of homelessness. CONCLUSIONS: Disadvantaged, urban communities are at high risk for cardiovascular disease. These results highlight the importance of socioenvironmental factors in shaping cardiovascular risk.