bluuebunny/crossref_metadata_2025 huggingface dataset:
A ten-year experience in control of poliomyelitis through a combination of live and killed vaccines in two developing areas.
Authors: Tulchinsky T , Abed Y , Shaheen S , Toubassi N , Sever Y , Schoenbaum M , Handsher R
Published: November 2008

We describe a successful program of poliomyelitis control using a combination of killed and live polio vaccines over a 10-year period in two developing areas, the West Bank and Gaza, adjacent to a relatively developed country, Israel. During the 1970s, immunization using live trivalent oral polio vaccine (OPV) in these areas covered more than 90 percent of the infant population. Nevertheless, the incidence of paralytic polio continued to be high, with many cases occurring in fully or partially immunized persons. It was thought that this could be due to interference with OPV take by other enteroviruses present in the environment due to poor sanitary conditions in these areas. A new policy combining five doses of OPV with two doses of inactivated polio vaccine (IPV) was adopted and implemented in 1978. In the 10 years since then, immunization coverage of infants increased to an estimated 95 percent and paralytic poliomyelitis has been controlled, despite exposure to wild poliovirus from neighboring countries including an outbreak in Israel in 1988. This experience suggests that wide coverage using the combination of IPV and OPV is an effective vaccination policy that may make eradication of polio possible even in developing areas.
Gastrointestinal effects of water reuse for public park irrigation.
Authors: Durand R , Schwebach G
Published: November 2008

To investigate the gastrointestinal effects of employing recycled water as an irrigation source for urban public parks, we studied subjects active in parks irrigated with potable water, nonpotable water of wastewater origin, and nonpotable water of runoff origin. Wet grass conditions during activity and elevated densities of common indicator bacteria, but not exposure to nonpotable irrigation water per se, were found associated with an increased rate of gastrointestinal illness.
Deaths from all causes in non-smokers who lived with smokers.
Authors: Sandler D P , Comstock G W , Helsing K J , Shore D L
Published: November 2008

Mortality associated with passive smoking was evaluated in a 12-year study of 27,891 White adult smokers and 19,035 never smokers identified in 1963. Death rates were calculated using an estimate of the person-years at risk. Adjusted for age, marital status, education, and quality of housing, the estimated relative risks of death from all causes were 1.17 (approximate 95% confidence interval 1.01, 1.36) for men and 1.15 (1.06, 1.24) for women with passive exposure. These relative risks were similar to those for ex-smokers and for pipe or cigar smokers. Risks increased slightly with level of exposure. The relative risk from passive smoking was greatest for men under age 50 (RR = 2.09, 1.31-3.34). Risks from passive smoking were slightly elevated for several causes among men and women, and may be broader than those previously reported. On the other hand, these small nonspecific increases in death rates may reflect other characteristics of passive smokers that increase mortality.
Nicotine intake in young smokers: longitudinal study of saliva cotinine concentrations.
Authors: McNeill A D , Jarvis M J , Stapleton J A , West R J , Bryant A
Published: November 2008

Smoking habits and smoke intake were studied over three consecutive years in 197 girls, initially aged 11 to 14 years. Saliva cotinine concentrations in girls who were smokers throughout the three years increased over each year of the study, the greatest increase occurring during movement from occasional to daily smoking. Cigarette consumption also increased over the two years. For a group of continuing daily smokers (n = 23), inhalation of smoke per cigarette as indexed by the ratio of cotinine concentration to average daily cigarette consumption did not change over time. Cotinine concentrations in 16 girls who were smoking on a daily basis within a year of starting to smoke suggested the early development of inhalation. Our findings suggest that young smokers learn to inhale cigarette smoke very early in their smoking careers, that further increases in smoke intake mainly reflect increased cigarette consumption, and that the pharmacological effects of nicotine are already important in reinforcing their smoking.
A randomized trial of a serialized self-help smoking cessation program for pregnant women in an HMO.
Authors: Ershoff D H , Mullen P D , Quinn V P
Published: November 2008

We report the results of a population-based randomized clinical trial that tested the effectiveness of a prenatal self-help smoking cessation program. The intervention consisted predominantly of printed materials received through the mail. The population (n = 242) consisted of a socioeconomically and ethnically diverse group of pregnant women enrolled in a large health maintenance organization (HMO) who reported they were smoking at the time of their first prenatal visit. Biochemical confirmation of continuous abstinence achieved prior to the 20th completed week of pregnancy and lasting through delivery revealed 22.2 per cent of the women in the eight-week serialized program quit versus 8.6 per cent of controls with usual care. The adjusted odds ratio was 2.80 (95 per cent CI = 1.17, 6.69). We conclude that a low-cost prenatal self-help intervention can significantly affect the public health problem of smoking during pregnancy and its associated risks for maternal and child health.
Cigarette smoking among San Francisco Hispanics: the role of acculturation and gender.
Authors: Marin G , Perez-Stable E J , Marin B V
Published: November 2008

We conducted a phone survey of 1,669 San Francisco Hispanics ages 15 to 64 years. The age-adjusted overall smoking prevalence was 25.4 per cent (95% CI = 23.3, 27.5) with more men (32.4 per cent) smoking than women (16.8 per cent). Age-adjusted smoking rates were higher among the less acculturated males (37.5 vs 26.7 per cent) and among the more acculturated females (22.6 vs 13.6 per cent). The more acculturated, however, smoked a greater number of cigarettes per day independent of gender. Community-based smoking cessation interventions, adapted to local conditions, may have a greater potential for success among Hispanics.
Accuracy of recalled smoking data.
Authors: Krall E A , Valadian I , Dwyer J T , Gardner J
Published: November 2008

Validity of recalled cigarette data was assessed among 87 middle-aged adults by comparing recall to longitudinal records. Agreement on smoking status and amount smoked 20 years ago occurred for 87 per cent and 71 per cent of subjects, respectively. Corresponding proportions for 32-year recall were 84 per cent and 55 per cent. Gender did not influence recall accuracy. Ex-smokers tended to make the most errors. Accuracy of recalled smoking information 20 years ago was comparable to that of alcohol status and consumption frequency category.
Patient literacy and the readability of smoking education literature.
Authors: Meade C D , Byrd J C
Published: November 2008

This study was designed to determine if primary care clinic patients read at a level congruent to the reading grade level of available smoking literature. Reading estimates of smoking education literature (N = 49) ranged from grade 3 to college level (median = 9.5). Reading skills of 258 smoking patients were estimated by reported years of schooling (median = 10), and by scores on the Wide-Range Achievement Test (median = 6). A serious disparity existed between the reading estimates of smoking education literature and the literacy skills of patients in our sample.
Age of initiation and switching patterns between smokeless tobacco and cigarettes among college students in the United States.
Authors: Glover E D , Laflin M , Edwards S W
Published: November 2008

A stratified, random, multi-stage, cluster sample of physical activity classes among 72 colleges and universities throughout the United States yielded 5,894 usable responses (males = 2,888); (females = 3,006). Twenty-three per cent of the students who began smoking before the age of 10 were current smokers, while 61 per cent of those who began using smokeless tobacco before the age of 10 were current smokeless tobacco users. College students were more likely to switch from smokeless tobacco to cigarettes than from smoking cigarettes to smokeless tobacco.
The sociologic context of occupational health in South Africa.
Authors: Myers J E , Macun I
Published: November 2008

The early history of the occupational health system in South Africa is outlined up to the early 1970s which mark a political and social transition in the society. Relevant demographic and social data are provided, and the roles and mutual relations of capital, labor, state, and academic sectors are discussed. During the past 15 years there has been heightened occupational health activity. Major legislative activity has included several commissions, the promulgation of new laws and regulations governing the workplace, and deregulatory measures in a contradictory mix. Conflictual relations between social forces are illustrated by two examples involving the introduction of safety representatives in the workplace, and compensation for occupational lung disease. The implications of wider political and economic realities are analyzed, and current and probable future trends in the evolution of the occupational health system are identified.
Survival experience of aged hip fracture patients.
Authors: Magaziner J , Simonsick E M , Kashner T M , Hebel J R , Kenzora J E
Published: November 2008

Hip fracture has long been considered a major threat to survival in aged populations. This report describes the survival experience of 814 aged, community dwelling hip fracture patients treated in seven Baltimore hospitals between 1984 and 1986: 4.3 per cent died during hospitalization; 8.2, 12.6, and 17.4 per cent died within three, six, and 12 months after fracture, respectively. The mortality rate for the entire population approaches expected mortality approximately six months post-fracture, but varies by age and sex. The most important factors predicting mortality are presence of serious concomitant illness and marked delirium (in the absence of dementia) at the time of hospital admission. The authors suggest that medical factors that may contribute to patient disorientation be investigated and treated, when possible, in an effort to improve the survival status of hip fracture patients.
Preventing alcohol-impaired driving through community self-regulation training.
Authors: Worden J K , Flynn B S , Merrill D G , Waller J A , Haugh L D
Published: November 2008

A community education program was designed to train the individual drinker to self-regulate his or her blood-alcohol concentration (BAC) below a level of impairment (.05 g/dl or 11 mmol/L). Drink calculators (cardboard wheels and wallet cards) were disseminated to customers of bars and licensed beverage outlets; bartenders and counter clerks were trained to demonstrate use of the calculators and demonstrations were presented in television spots. Program components were evaluated in three matched Vermont communities, one receiving the full community education program, one receiving the TV spots only, and one serving as control. After six months of intervention, a roadside survey of nighttime drivers (N = 892) indicated 5.3 per cent fewer drivers with BACs above 0.05 g/dl in the community program group and 1.0 per cent fewer in the TV-only group compared to the control group; however, substantially fewer drivers were found above .00 BAC in either program community than in the control. Drivers reporting heavy drinking and youthful drivers both indicated higher utilization of the materials than did other drivers. Although limited in scale and duration, this study suggests that a community education program can be effective in preventing alcohol-impaired driving.
Incidence, causes and severity of injuries in Aquitaine, France: a community-based study of hospital admissions and deaths.
Authors: Tiret L , Garros B , Maurette P , Nicaud V , Thicoipe M , Hatton F , Erny P
Published: November 2008

This paper reports the results of a study of injuries conducted during a one-year period within a defined geographic population of 2.7 million persons (Aquitaine, France). Cases were defined as unintentional or intentional injuries, either resulting in immediate death before reaching hospital or requiring hospital admission. During the one-year period, 1,181 deaths were registered and 8,190 hospital admissions occurred during the sample periods. The three leading causes of injury were falls (40 per cent), traffic accidents (27 per cent), and poisonings (15 per cent). The overall incidence of injuries was 136 per 10,000 person years. Incidence by sex and age was assessed for the main external causes. The ratios of nonfatal to fatal cases were calculated by sex and age and by external cause. The origin of the injury was suicide in 14 per cent of cases and assault or homicide in 3 per cent. The severity of injuries, assessed using an automatic computation of the Injury Severity Score (ISS), ranged from 1 to 66 with a mean of 6.9. Substantial variations of ISS were observed according to external cause. At the 8th day following admission, 31 per cent of hospital-treated patients were still hospitalized and 0.8 per cent had died in hospital. The outcome correlated well with the ISS.
Driver age and crash involvement.
Authors: Williams A F , Carsten O
Published: November 2008

The youngest and oldest drivers have the highest crash risk, but the problem lies predominantly in the youngest age groups because elderly drivers have low exposure. The elderly driver problem will increase gradually as their share of the population increases but will remain relatively small. The bulk of the problem will continue to reside among drivers younger than age 65, particularly the youngest drivers.
Unintentional deaths from carbon monoxide in motor vehicle exhaust: West Virginia.
Authors: Baron R C , Backer R C , Sopher I M
Published: November 2008

We investigated the circumstances of unintended carbon monoxide deaths from motor vehicle exhaust. Of 64 episodes involving 82 deaths investigated by the West Virginia Office of the Chief Medical Examiner, 1978-84, 50 occurred outdoors in older vehicles with defective exhaust systems and 14 occurred in enclosed or semi-enclosed home garages. Blood alcohol was detected in 50 (68 per cent) of 74 victims tested; 34 had blood alcohol concentrations greater than or equal to 0.10 g/dl. We suggest increasing public awareness of the hazards of motor vehicle exhaust and enforcing vehicle inspection regulations.
A methodology for targeting hospital cases for quality of care record reviews.
Authors: Hannan E L , Bernard H R , O'Donnell J F , Kilburn H
Published: November 2008

We tested the efficacy of selected case characteristics in targeting quality of care problems for medical record review. The case characteristics, all of which apply to patients who die in a hospital, consist primarily of procedures and DRGs (diagnosis-related groups) for which death rarely occurs, and a set of complications of surgical care. All characteristics are obtainable from combinations of the principal and secondary diagnoses and procedures in the case, and are available from discharge abstracts. The presence of a quality of care problem is confirmed through a review of the medical record by a nurse and two or more physicians. A logistic regression model that controls for various patient and hospital variables is used as a measure of each of the proposed case characteristics. The results indicate that most of the characteristics are associated with higher percentages of quality of care problems than cases chosen at random, and that the methodology has promise as a tool for targeting cases for medical record review.
Preventing AIDS and other STDs through condom promotion: a patient education intervention.
Authors: Solomon M Z , DeJong W
Published: November 2008

We report on two studies that assessed the impact of a soap-opera style videotape on inner-city STD (sexually transmitted disease) patients' knowledge about and attitudes toward condom use, and willingness to redeem coupons for free condoms. Subjects in the first study who viewed the videotape (and participated in a brief oral recall session) had higher knowledge scores and more accepting attitudes than subjects who did not (knowledge test means of 11.1 versus 7.9, attitude index means of 13.0 versus 11.3). The intervention was most effective among those who were relatively poorly educated and, to a lesser extent, among those who reported less frequent use of condoms and fewer sex partners. In the second study, intervention group subjects were more likely than control group subjects to redeem coupons. Both groups exhibited a high level of interest in the free condoms. We argue that education and accessibility to free condoms can increase condom use and that health care providers have a vital role in promoting this form of STD prevention.
Outbreaks of hepatitis A among illicit drug users, Oklahoma, 1984-87.
Authors: Harkess J , Gildon B , Istre G R
Published: November 2008

Transmission of hepatitis A has been described in many settings, although few outbreaks have been reported among illicit drug users. We report six unrelated outbreaks of hepatitis A among users of marijuana and intravenously administered methamphetamine. Although the exact mode of transmission could not be determined, practices associated with illicit drug use may have facilitated transmission of hepatitis A. These outbreaks and other recent information indicate that illicit drug users may be at increased risk of acquiring hepatitis A infection.
Mumps in the US Army 1980-86: should recruits be immunized?
Authors: Arday D R , Kanjarpane D D , Kelley P W
Published: November 2008

The US Army's experience with mumps hospitalizations was examined for the years 1980 through 1986. One hundred fifty-two cases among active duty Army soldiers were identified. Mumps rates declined from 3.85 per 100,000 active duty soldiers per year in 1980 to 1.28 in 1985, but an outbreak during 1986 caused rates to jump to 6.65. Attack rates were found to decline dramatically with increasing age or length of military service, with 74 per cent of cases occurring in soldiers with three years or less of service. Rates for Blacks and Whites were similar, but were higher for other minorities. Complications reported were mild. A cost-benefit analysis, assuming all recruits were to be vaccinated, estimated average annual vaccination program costs of $286,789; this figure exceeds average annual reported hospitalized mumps disease costs of $61,525 by a factor of 4.7. Mumps attack rates would have to reach at least 15.0 per 100,000 per year before savings would equal recruit vaccination costs. Failure to show that a vaccine program would be cost-saving may be due to limitations in identifying cases or to the requirement that all recruits be immunized regardless of prior immune status. It is likely that a program to immunize susceptible individuals alone would show benefit.
Recurrent outbreaks of giardiasis in a child day care center, Wisconsin.
Authors: Steketee R W , Reid S , Cheng T , Stoebig J S , Harrington R G , Davis J P
Published: November 2008

In the 19-month period September 1983-March 1985, three outbreaks of giardiasis occurred in one large child day care center. Control measures instituted during each outbreak included case finding; pharmacologic treatment and follow-up testing of stool specimens for cases of giardia infection in day care children and staff, and their household contacts; facilitating and stressing personal and environmental hygiene, including altering diapering practices and teaching appropriate hand washing techniques. In the first, second, and third outbreaks, overall attack rates (stool analysis positive for Giardia lamblia) were determined for those persons with greater than or equal to 2 stool specimens submitted; attack rates in children were 47, 17, and 37 per cent, respectively; for tested staff, the rates were 35, 13, and 9 per cent; and for tested household contacts were 18, 9, and 5 per cent. Attack rates were highest for ambulatory diapered children, children attending the day care center greater than or equal to 40 hours per week, and children who were infected with G. lamblia in the most recent previous outbreak. Despite extensive efforts to identify cases, a cure rate of greater than 90 per cent in treated cases, and improvements in personal and environmental hygiene practices, G. lamblia infections recurred in outbreak proportions.
Sexual behavior changes and HIV antibody in a cohort of New York City gay men.
Authors: Martin J L , Garcia M A , Beatrice S T
Published: November 2008

A sample of 357 gay/bisexual men, ages 20 to 65, were interviewed in 1985 regarding their sexual patterns over the course of the AIDS (acquired immunodeficiency syndrome) epidemic. Within four months after the interview, men were tested for antibody to HIV (human immunodeficiency virus) and 36 per cent were found positive. Cessation of receptive anal intercourse was associated with HIV negative antibody status, (OR greater than 3.0). Reducing the number of sexual partners, becoming monogamous, or eliminating other forms of sexual contact were not related to risk of HIV.
The Hawaii Chlamydia Network Project: a successful program incorporating close intra-agency cooperation.
Authors: Katz A R
Published: November 2008

The Hawaii State Department of Health's Chlamydia Network Project screened 272 asymptomatic females for chlamydia; 20 (7.4 per cent) were found to be positive. When interviewed, 75 per cent (15/20) of the cases gave information such that their sexual partner(s) could be located. Ninety per cent (14/16) of the locatable partners were brought to examination within seven days. Keys to success were the training of family planning clinic staff in STD (sexually transmitted disease) control methods, and close intra-agency cooperation.
Tuberculosis surveillance in a state prison system.
Authors: Spencer S S , Morton A R
Published: November 2008

After four inmates at two New Mexico prisons converted their tuberculosis skin tests, a mass screening program was carried out at all the State's adult correctional facilities (2,240 inmates). Previously unknown converters were found with a disproportionally high per cent of converters (6.8 per cent and 6.3 per cent) and reactors (14.4 per cent and 12.2 per cent) at the first two prisons. No index cases were found. State policy has been revised to include two-stage skin testing of new inmates, annual testing thereafter, and screening of all new correctional staff.
Uncompensated emergency care in hospital markets in Los Angeles County.
Authors: Melnick G A , Mann J , Golan I
Published: November 2008

A survey of hospital emergency rooms in Los Angeles County was conducted in March 1987. Analysis of the distribution of uninsured emergency care patients revealed that private hospitals play a significant frontline role in terms of entry into the hospital system for patients who are unable to pay--almost one-half of such patients were treated in the emergency rooms of private hospitals. Hospitals serving markets in which a higher proportion of residents had incomes below the poverty level provided a greater share of uncompensated emergency room services.
Television viewing and obesity in adult males.
Authors: Tucker L A , Friedman G M
Published: November 2008

We estimated the extent to which time spent watching television is associated with obesity and super-obesity among 6,138 employed adult males. After adjustment for age, smoking status, length of work week, measured physical fitness, and reported weekly hours of exercise, people who viewed TV more than three hours/day were twice as likely to be obese as those who viewed less than 1 hour/day. Those who viewed for 1 to 2 hours daily had a relative risk of 1.60 (1.21, 2.11). Physical fitness consistently confounded the associations between TV viewing and obesity/super-obesity, but the other control variables did not do so.
Survey of cause-of-death query criteria used by state vital statistics programs in the US and the efficacy of the criteria used by the Oregon Vital Statistics Program.
Authors: Hopkins D D , Grant-Worley J A , Bollinger T L
Published: November 2008

A survey of the 52 vital statistics registration areas in the United States revealed that at least 23 did not fulfill the minimum cause-of-death query guidelines recommended by the National Center for Health Statistics. The Oregon Center for Health Statistics is one of only a few that query certifying physicians at a comprehensive level. During August 1986-July 1987, a total of 2,453 of 23,238 death certificates were returned to the certifiers for additional information, not including those returned in a tobacco use study. More than one-half (56.1 per cent) resulted in new and more specific underlying cause-of-death data. Only 5.2 per cent of the queries were unanswered. One probable result of Oregon's program is that the state has the highest percentage of liver cirrhosis and disease deaths attributed to alcohol abuse in the United States. Nationally, 41.7 per cent of all liver disease and cirrhosis deaths in 1984 were listed as due to alcohol compared to 82.4 per cent in Oregon. The state's total liver cirrhosis and disease death rate (12.0 per 100,000 population) is only marginally higher than the United States rate (11.6). The query program also serves to locate maternal deaths that would otherwise not be reported, as well as to provide more accurate cause-of-death statistics in general.
Fatal violence among spouses in the United States, 1976-85.
Authors: Mercy J A , Saltzman L E
Published: November 2008

In this paper we examine patterns and trends in homicides between marriage partners in the United States for 1976 through 1985 using data from the Federal Bureau of Investigation's Supplemental Homicide Reports (FBI-SHR). We identified 16,595 spouse homicides accounting for 8.8 per cent of all homicides reported to the FBI-SHR during this 10-year period. The rate of spouse homicide for this 10-year period was 1.6 per 100,000 married persons. The risk of being killed by one's spouse was 1.3 times greater for wives than for husbands. Black husbands were at greater risk of spouse homicide victimization than Black wives or White spouses of either sex. The risk of victimization was greater for spouses in interracial than in intraracial marriages and increased as age differences between spouses increased. From 1976 through 1985, the risk of spouse homicide declined by more than 45.0 per cent for both Black husbands and wives but remained relatively stable for White husbands and wives. Demographic patterns in the risk of spouse homicide were similar to those reported for nonfatal spouse abuse suggesting that the causes of spouse homicide and nonfatal spouse abuse may be similar.
The effect of occupational, marital and parental roles on mortality: the Alameda County Study.
Authors: Kotler P , Wingard D L
Published: November 2008

This study investigated the impact of combining marital, parental, and occupational roles upon 18-year risk of mortality from all causes. The respondents were 3,700 participants in the Human Population Laboratory cohort ages 35-64 who completed a comprehensive health and psychosocial questionnaire in 1965 and were followed for mortality status through 1982. Employment status and type of employment were not found to predict mortality risk among women. Contrary to the multiple roles hypothesis, there was virtually no impact upon mortality of increasing numbers of children among employed women, except possibly among single working parents. The major impact of children was felt by housewives who had significantly elevated risks when a child was present in the home or when they had four or more children. Neither the number of children nor the presence of a child in the home affected mortality risk of men. Controlling for a variety of factors thought to be related to mortality in a logistic regression analysis did not change the foregoing relation.
Exposure to occupational hazards among Hispanics, blacks and non-Hispanic whites in California.
Authors: Robinson J C
Published: November 2008

Relative risks of exposure to each of six types of occupational injuries and illnesses for Hispanic and Black workers compared to Whites who are not Hispanic were calculated using 1986 California data. Among males, Hispanics faced relative risks of exposure to all hazards adjusted for education and years of work experience of 1.33 (95% CI 1.22, 1.45), while Blacks faced relative risks of 1.17 (1.0, 1.37). Among females, adjusted relative risks were 1.19 (1.09, 1.29) for Hispanics and 1.31 (1.15, 1.50) for Blacks.
Increasing response rates in physicians' mail surveys: an experimental study.
Authors: Maheux B , Legault C , Lambert J
Published: November 2008

It is becoming increasingly difficult to obtain high response rates in physicians' mail surveys. In 1983-84, we tested the effectiveness of two techniques among 604 Quebec physicians who had not responded to an initial letter. A handwritten thank you note at the bottom of the letter accompanying the questionnaire and a more personalized mailout package increased response rates by 40.7 per cent and 53.1 per cent, respectively, compared to control groups.
Use of clinic versus private family planning care by low-income women: access, cost, and patient satisfaction.
Authors: Radecki S E , Bernstein G S
Published: November 2008

Use of private physicians versus public family planning facilities by poverty level and near poverty level women was examined by means of a sample survey conducted in low-income areas of Los Angeles County. Utilization differed by race/ethnicity, with Hispanics more likely to go to federally subsidized family planning clinics (primarily county-run), Whites and Blacks to private physicians. Private family planning offers easier access, greater convenience, and higher satisfaction, albeit at almost double the cost. Clinic usage is influenced by lack of a regular source of medical care and lack of insurance coverage more than poverty level per se. Clinic patients report greater patient education regarding contraceptive methods, but less general medical care during clinic visits. They are more likely than private patients to express a desire for a different source of family planning care.
Is early natural menopause a biologic marker of health and aging?
Authors: Snowdon D A , Kane R L , Beeson W L , Burke G L , Sprafka J M , Potter J , Iso H , Jacobs D R , Phillips R L
Published: November 2008

The relation between age at natural menopause and all-cause mortality was investigated in a sample of 5,287 White women, ages 55 to 100 years, naturally-postmenopausal, Seventh-day Adventists who had completed mailed questionnaires in 1976. The age-adjusted odds ratio of death during 1976-82 in women with natural menopause before age 40 was 1.95 (95% confidence interval = 1.24, 3.07), compared to the reference group of women reporting natural menopause at ages 50 to 54. Corresponding odds ratios of death were 1.39 (95% CI = 1.06, 1.81) for natural menopause at ages 40 to 44, and 1.03 (95% CI = 0.84, 1.25) for natural menopause at ages 45 to 49. Among 3,166 White, 55- to 100-year-old, surgically-postmenopausal, Adventist women, there was no relation between age at surgical menopause and mortality. Logistic regression analyses indicated that findings from this study were apparently not due to confounding by smoking, over- or underweight, reproductive history, or replacement estrogen use.
The relation of body fat distribution, as assessed by six girth measurements, to diabetes mellitus in women.
Authors: Freedman D S , Rimm A A
Published: November 2008

Independently of the amount of adipose tissue, certain patterns of fat distribution increase the risk of non-insulin-dependent diabetes. Although the ratio of waist to hip (WHR) circumferences has been consistently related to diabetes mellitus, it is possible that only two measures do not completely characterize fat topography. The current study, therefore, examines the cross-sectional relation of six girths (waist, hip, neck, bust, wrist, and ankle) to diabetes mellitus in 43,595 women. As compared with non-diabetics, Quetelet index (kg/m2) and all circumferences were elevated among diabetics. Stratified analyses showed that WHR, and waist, neck, and bust girths were consistently related to diabetes independently of the degree of overweight. As estimated from a logistic regression model that simultaneously controlled for age and all anthropometric variables, the prevalence of diabetes mellitus was positively related to Quetelet index, and to the waist, bust, and neck girths, with odds ratios (ORs) ranging from 1.4 to 2.6. However, diabetes was inversely related to hip (OR = 0.61) and ankle (OR = 0.73) girths; p less than 0.005 for each association. Although cross-sectional in nature, these results suggest that an adverse body fat distribution is not limited to the abdominal region, but that a relative preponderance of adipose tissue in various regions of the upper body is associated with diabetes mellitus in women.
The acceptance and completion of mammography by older black women.
Authors: Burack R C , Liang J
Published: November 2008

We assessed the relation of patient characteristics, knowledge and beliefs to the utilization of mammography in an inner-city setting by 187 Black women over the age of 50. Thirty per cent of those who were offered mammography initially declined the offer and 40 per cent were subsequently unable to complete the procedure. Patient interviews were used to derive 27 potential knowledge and health belief predictor scales. In multiple regression analysis, two health belief scales and two knowledge scales accounted for 15 per cent of the observed variance in the model of acceptance. The strongest predictor of subsequent completion was initial acceptance. The presence of breast symptoms and two health belief scales together with initial acceptance accounted for 26 per cent of variance in the model of completion. These results suggest that the successful accomplishment of mammography requires coordinated efforts at the level of the provider, patient, and setting. Health beliefs may influence the patient's behavior in this process, but their effect appears to be modest.
Mechanical restraints on the medical wards: are protective devices safe?
Authors: Lofgren R P , MacPherson D S , Granieri R , Myllenbeck S , Sprafka J M
Published: November 2008

We prospectively identified 102 mechanically restrained hospital patients and determined their hospital course. The cohort was elderly, cognitively impaired with multiple chronic diseases. The in-hospital mortality was 21 percent. Nosocomial infection developed in 12 percent and new pressure sores in 22 percent. Prolonged use of restraints (greater than 4 days) was the strongest independent predictor of nosocomial infection (relative risk 1.8, 95% CI = 1.2, 2.8) and new pressure sores (RR 1.4, 95% CI = 1.1, 1.8) as determined by multiple logistic regression analysis. Patients placed in mechanical restraints for longer than four days experience frequent morbid events and should be monitored carefully.
Physical activity and risk of cancer in the NHANES I population.
Authors: Albanes D , Blair A , Taylor P R
Published: November 2008

We studied the relation between self-reported physical activity and cancer in the first National Health and Nutrition Examination Survey (NHANES I) cohort, originally examined between 1971-75, and followed prospectively through the Epidemiologic Follow-up Study (NHEFS), conducted between 1982-84. Among 5,138 men and 7,407 women 25-74 years old, for nonrecreational activity we observed increased risk of cancer among inactive individuals compared to very active persons (for men, relative risk [RR] 1.8, 95% confidence interval [CI] = 1.4, 2.4; for women RR 1.3, 95% CI = 1.0, 1.8). These findings were unchanged after adjustment for cigarette smoking, body mass index (BMI), and other potential confounders. Sites which demonstrated stronger inactivity-cancer associations included colorectum (RR 1.6, 95% CI = 0.7, 3.5) and lung (RR 1.6; 95% CI = 1.2, 3.5) among men, and breast (post-menopausal) (RR 1.7; 95% CI = 0.8, 2.9) and cervix (RR 5.2; 95% CI = 1.4, 14.5) among women, although these findings for women were based on relatively few cases. The association between inactivity and cancer was greater among persons of moderate (or lower) BMI, those cases occurring three or more years after baseline, and, in women, those more than 60 years old. In contrast, recreational exercise showed little relation to cancer, with the exception of prostate cancer. The results suggest that inactive individuals are at increased risk of cancer.
HIV testing in prisoners: is mandatory testing mandatory?
Authors: Andrus J K , Fleming D W , Knox C , McAlister R O , Skeels M R , Conrad R E , Horan J M , Foster L R
Published: November 2008

We studied 977 newly incarcerated Oregon inmates to compare voluntary versus mandatory human immunodeficiency virus antibody (HIVAb) testing in the prison setting. All inmates were offered HIVAb counseling and testing. Blood drawn for routine syphilis serology from those who declined this offer was also tested for HIVAb after personal identifiers had been removed. Only 1.2 percent (12) prisoners were HIV positive. However, 62.5 percent (611) inmates were at risk for HIV infection by being an intravenous drug user, a male homosexual, or hepatitis B core antibody (HBcAb) positive. The ratio of at-risk, as yet uninfected inmates to those already HIV infected was 53 to 1. Two-thirds of all inmates including those at-risk chose to receive counseling and testing. In areas where most at-risk inmates are not yet infected, it may be more appropriate for HIV prevention activities in prison to focus on voluntary programs that emphasize education and counseling rather than mandatory programs that emphasize testing.
Emergency room use and primary care case management: evidence from four Medicaid demonstration programs.
Authors: Hurley R E , Freund D A , Taylor D E
Published: November 2008

Claims-based utilization data collected in four Medicaid demonstration programs are used to examine the impact of primary care case management on patterns of reliance on the emergency room as a source of services. The experience of stratified random samples of AFDC (Aid to Families with Dependent Children) adults and children in the demonstration programs is compared with that of equivalent samples from comparison groups in traditional Medicaid programs. Data were analyzed in multivariate models controlling for person characteristics in a pre/post, demonstration/comparison design. Results indicated large reductions in the proportion of persons with at least one emergency room visit ranging from 27 to 37 per cent for children and 30 to 45 per cent for adults. Use levels for persons with at least one ER visit are less substantially affected. The findings suggest that gatekeeping designs can alter patterns of enrollee use with respect to the emergency room and some discussion of these implications is presented.
Determinants of community-based coverage: periodic vitamin A supplementation. Aceh Study Group.
Authors: Tarwotjo I , West K P , Mele L , Nur S , Nendrawati H , Kraushaar D , Tilden R L
Published: November 2008

Factors related to preschool child receipt of vitamin A during the first year of a semi-annual vitamin A capsule delivery program were investigated in 229 villages in Aceh, Indonesia. Coverage was higher in villages which were more rural and less economically developed. Highest performance was achieved by village distributors who represented the local status quo in this rural area (farmers, or non-farmers with minimum education) rather than more upwardly mobile, highly educated residents. Household or child-level characteristics were not associated with coverage. This information may be useful for planning direct service programs in the community.
Accidental ingestions of oral prescription drugs: a multicenter survey.
Authors: Jacobson B J , Rock A R , Cohn M S , Litovitz T
Published: November 2008

Accidental ingestion of oral prescription drugs by children under age five continues to be a public health problem. A telephone survey of 1,866 ingestion incidents reported to nine poison control centers was conducted in the spring of 1986. Accidental ingestion occurred most often with a two-year-old child (42 per cent) in their own home (82 per cent). Thirty-five per cent of the toxic drugs ingested at home belonged to someone other than the immediate family, most often a grandparent. Toxic drugs were more often out of their usual storage location and in non-child-resistant prescription packaging, a nonprescription container, or in no container. Twenty-two per cent of all child-resistant packages were non-functional. Overall, at least 61 per cent of all medications had no child-resistant barrier at the time of ingestion. Accessible storage locations such as the kitchen counter, table top, or top of a dresser or bedside table greatly increased the risk of accidental ingestion. These results suggest the need for effective child-resistant packaging that is easier for all adults to use.
Containing mental health treatment costs through program design: a Massachusetts study.
Authors: Dickey B , Binner P R , Leff S , Uyeda M K , Schlesinger M J , Gudeman J E
Published: November 2008

A single site pre-post study of seriously mentally ill patients treated in a public mental health system shows that annual treatment costs can be substantially reduced with the use of day hospital treatment. Two cohorts of psychiatric patients--282 consecutive admissions to a traditional public inpatient unit in 1980, and 340 consecutive admissions to a combination of inpatient and day hospital care in 1984--were followed 12 months after admission. The substitution of the day hospital is made possible because the facility provided a dormitory residence for those who could not go home at night. Cost savings per hospital episode are about 31 per cent when the additional costs of day hospital and residence are considered. Cost shifting from inpatient to residential sites is noted, but overall mean annual costs, when all other treatment (including additional admissions), residential and family costs were included, are reduced. Readmission rates did not rise. The generalizability of the findings is limited to public mental health centers and state hospitals.
Stress reduction training changed number of sexual partners but not immune function in men with HIV.
Authors: Coates T J , McKusick L , Kuno R , Stites D P
Published: November 2008

We tested the impact of stress management training on sexual behavior and immune functioning in 64 gay men infected with human immunodeficiency virus (HIV). Subjects randomized to the stress management group met for eight two-hour sessions and one all day retreat to learn systematic relaxation, health behavior change, and stress management skills. Compared to those randomized to a wait list control, treatment subjects reported significantly fewer sexual partners in the prior month at post-test (1.10 vs 2.29 for controls). There were no differences between groups in lymphocyte numbers and function.
Personality risk factors for cocaine abuse.
Authors: Yates W R , Fulton A I , Gabel J M , Brass C T
Published: November 2008

To evaluate the role of personality in cocaine abuse, 59 adults meeting DSM-III criteria for cocaine abuse were compared to similar-aged non-cocaine alcohol abusers and community controls on a DSM-III measure of personality. Cocaine abusers were more likely than non-cocaine alcohol abusers to display narcissistic personality traits (Odds ratio 6.86, 95% CI = 4.52, 15.60). (Am J Public Health 1989; 79:891-892.
Lead absorption in indoor firing range users.
Authors: Valway S E , Martyny J W , Miller J R , Cook M , Mangione E J
Published: November 2008

To determine if users of indoor firing ranges may be at risk from lead exposure, we studied a law enforcement trainee class during three months of firearms instruction. Blood lead levels were obtained before training and at four-week intervals during training. Air lead levels were measured three times during instruction. Blood lead levels rose from a pre-training mean of 0.31 mumol/L to 2.47 mumol/L. Mean air lead levels were above 2,000 micrograms/m3, more than 40 times the Occupational Safety and Health Administration's standard of 50 micrograms/m3. Cumulative exposure to lead and the change in blood lead were positively correlated. Control measures need to be studied to determine their efficacy in decreasing or eliminating this health risk.
Health care for the homeless in a national health program.
Authors: Reuler J B
Published: November 2008

To assess the impact of adoption of a national health program on homeless care in the United States, care for this group in Britain's National Health Service (NHS) was evaluated. Although hospital and medication charges are eliminated, primary care for the homeless lacks central government directive, suffers from overlap of statutory agencies and mechanistic biases, is disproportionately delivered in emergency rooms, and has relied on advocacy by the non-profit sector. Disadvantages of this void in NHS provision are marginalization of the homeless and continuation of a two-class care system. Removal of financial barriers to care by enactment of a national health program in the US would not solve all issues related to delivery of quality care for the homeless unless its structure addressed the special needs of disenfranchised groups.
Use of smokeless tobacco, cigarette smoking, and hypercholesterolemia.
Authors: Tucker L A
Published: November 2008

The primary purpose of this study was to determine the extent to which regular use of smokeless tobacco is associated with hypercholesterolemia (greater than or equal to 6.2 mmol/L) among 2,840 adult males. The confounding effects of age, education, physical fitness, body fatness, and other tobacco use were also examined. After adjustment, smokeless tobacco users were 2.5 times, heavy smokers were 2 times and mild/moderate smokers were 1.5 times more likely to have hypercholesterolemia than non-users of tobacco. Cigarette smokers did not differ significantly from users of smokeless tobacco regarding hypercholesterolemia. Users of smokeless tobacco were younger and less educated compared to non-users of tobacco, while smokers were less educated and less physically fit.
The external costs of a sedentary life-style.
Authors: Keeler E B , Manning W G , Newhouse J P , Sloss E M , Wasserman J
Published: November 2008

Using data from the National Health Interview Survey and the RAND Health Insurance Experiment, we estimated the external costs (costs borne by others) of a sedentary life-style. External costs stem from additional payments received by sedentary individuals from collectively financed programs such as health insurance, sick-leave coverage, disability insurance, and group life insurance. Those with sedentary life-styles incur higher medical costs, but their life expectancy at age 20 is 10 months less so they collect less public and private pensions. The pension costs come late in life, as do some of the medical costs, and so the estimate of the external cost is sensitive to the discount rate used. At a 5 percent rate of discount, the lifetime subsidy from others to those with a sedentary life style is $1,900. Our estimate of the subsidy is also sensitive to the assumed effect of exercise on mortality. The subsidy is a rationale for public support of recreational facilities such as parks and swimming pools and employer support of programs to increase exercise.