bluuebunny/crossref_metadata_2025 huggingface dataset:
The epidemiology of licit and illicit substance use among high school students in Greece.
Authors: Kokkevi A , Stefanis C
Published: November 2008

Findings on self-reported adolescent licit and illicit substance use are presented based on a nationwide 1984 probability sample of 11,058 Greek adolescent students ages 14-18 years old. Regular smoking and use of alcohol in the 30 days prior to the survey were reported by 22.3 percent and 82.8 percent, respectively. Nearly one-third of the students (30.3 percent) reported lifetime use of psychotropic drugs without prescription, without ever having used any illicit drug. Illicit drug use is less common in Greece than in other European and North American countries with a lifetime prevalence rate of 6 percent. Regular use of tobacco, alcohol, and illicit drugs was more common in males, while unprescribed use of licit psychotropic drugs prevailed in females. Regular smoking, drinking, and illicit drug use were associated with urbanization but not socioeconomic status. Between 1984 and 1988 in an Athenian subsample of schools there was a 20 percent increase in illicit drug use among males. Use of psychotropic drugs without prescription decreased much more than use of tobacco and alcohol.
The impact of HIV-related illness on employment.
Authors: Yelin E H , Greenblatt R M , Hollander H , McMaster J R
Published: November 2008

We used structured telephone interviews to determine the extent of work loss following onset of symptoms, the interval between onset of symptoms and cessation of work, and the risk factors for work loss among 193 persons with symptoms of human immunodeficiency virus (HIV)-related illness attending the AIDS Clinic at the University of California, San Francisco, between October 1, 1988, and September 30, 1989. Estimates of the duration of time between onset of HIV-related symptoms and work loss derive from the life table method of Kaplan and Meier. A Cox proportional hazards model is used to estimate the effect of risk factors on the probability of withdrawing from work in each time interval. Eighty-six percent of the respondents worked prior to onset of the first symptom of HIV-related illness; 40 percent were working at the time of the most recent interview, a mean of 958 days later. The total number of hours worked declined by 59 percent during this time. Kaplan-Meier analysis indicates that 50 percent who worked prior to onset of HIV-related illness stopped working within two years and all had stopped within 10 years after onset of the first symptom.
Public health intervention in a cocaine-related syphilis outbreak.
Authors: Hibbs J R , Gunn R A
Published: November 2008

BACKGROUND. Cocaine users and prostitutes are at high risk for syphilis, but disease control is difficult among these populations. During a cocaine-related syphilis outbreak in Chester, Pennsylvania, in 1989, we conducted a control program at sites where sex and drugs were sold. METHODS. During a 2-week period, investigators recruited persons from these sites for interview, serologic testing, and empiric treatment. RESULTS. Among 136 persons screened, 25 (18%) had early syphilis and 26 others (19%) had recent sexual contact with early syphilis patients. All were treated at initial screening at a cost of $402 and 12 investigator hours per case, compared to $470 and 20 hours per case when treated during routine investigator activities. This program may have contributed to a short-term decline in syphilis incidence in Chester by reducing the period of infectivity of these patients. CONCLUSIONS. Screening and empiric treatment of persons at sites where sex and drugs are sold can be useful in short-term control of cocaine-related syphilis outbreaks.
Bleach programs for preventing AIDS among i.v. drug users: modeling the impact of HIV prevalence.
Authors: Siegel J E , Weinstein M C , Fineberg H V
Published: November 2008

BACKGROUND. The growing importance of drug use as a mode of HIV transmission has led to increased attention to AIDS prevention among intravenous drug users (IVDUs). This analysis examines the effectiveness of bleach distribution, a program to prevent HIV transmission via shared needles. METHODS. We used a Markov model to assess the role of the initial HIV prevalence among drug users in determining the effectiveness of bleach programs. The model incorporates survey data on risk behaviors and published information describing HIV incubation and mortality. It predicts life expectancy for cohorts of IVDUs with and without a bleach program to estimate program effectiveness. RESULTS. We found that bleach programs can produce the greatest life-year savings in areas of low HIV prevalence. In the lowest prevalence scenario (0.02 initial prevalence), initiation of the program resulted in a projected savings of 2.3 life years per HIV-negative drug user, compared with 1.7 and 1.3 years under medium (0.25) and high (0.60) prevalence, respectively. CONCLUSIONS. While bleach programs are beneficial in all groups of IVDUs, these results highlight the advantages of introducing bleach programs early, when prevalence is still comparatively low in a drug-user population.
Utilization of health services in a cohort of intravenous drug users with known HIV-1 serostatus.
Authors: Solomon L , Frank R , Vlahov D , Astemborski J
Published: November 2008

BACKGROUND. Intravenous drug users (IVDUs) with human immunodeficiency virus (HIV) infection and AIDS often have no health insurance or rely on public programs to finance their health care. We examined the independent contributions of HIV serostatus, clinical symptoms, CD4 cell counts, and health insurance to utilization of health services among 1881 intravenous drug users in Baltimore, Maryland. METHODS. Participants in an ongoing natural history study of HIV were informed of HIV serostatus and seropositives were informed of CD4 cell counts; 6 months later, participants were administered a questionnaire concerning self-reported use of health services, insurance coverage, and HIV-related symptoms. RESULTS. Of 1881 participants, 67% had health insurance (including Medicaid), 48% had at least one outpatient visit, and 12% had at least one inpatient visit within the prior 6 months. The proportion of the study population that was HIV-1 seropositive was 32%. In multivariate analysis, the single most important predictor of health care utilization was the presence of two or more HIV-related clinical symptoms. HIV positive serostatus alone or known low CD4 counts were not significantly associated with use of health care services. CONCLUSIONS. These data suggest that HIV seropositive IVDUs are not receiving recommended preventive care. Additional efforts will be needed to ensure that HIV-seropositive drug users participate in currently recommended protocols for early treatment of asymptomatic HIV-1 infection.
Leptospirosis on Kauai: investigation of a common source waterborne outbreak.
Authors: Katz A R , Manea S J , Sasaki D M
Published: November 2008

During the summer of 1987, a common source waterborne outbreak of leptospirosis occurred on the island of Kauai in the state of Hawaii. Eight leptospirosis cases were identified using the microscopic agglutination test. Methodologic weaknesses in this technique were responsible for the initial missed diagnosis on six of the eight cases. All cases had repeated exposure to the Waimea River. A wide array of animal reservoirs and optimal water conditions may have been factors in this outbreak.
Injuries in working populations: black-white differences.
Authors: Wagener D K , Winn D W
Published: November 2008

BACKGROUND. Although "accidents and adverse effects" mortality is higher among Blacks than Whites, annual injury rates reported in the National Health Interview Survey (NHIS) are lower among Blacks. We evaluated the influence of sociodemographic risk factors on injury rates among working adults. METHODS. NHIS data from 1983 through 1987 for currently working adults were used. Methods were developed to estimate standard errors using data from different sample frames and sample sizes. RESULTS. Working Blacks had fewer reported injuries requiring medical attention or restriction of usual activities than working Whites (22.0 vs 27.0 per 100 persons per year). The difference was pronounced among younger adults in both sexes and among both poor and nonpoor. However, age, sex, and income could not completely explain racial differentials. "At-work" injury rates (36% of all injury episodes) were similar for Blacks and Whites (9.2 vs 9.9 per 100 persons per year), except low-income Blacks and Blacks in service or blue-collar occupations had nonsignificantly smaller at-work injury rates. CONCLUSION. Possible reporting biases could not be completely eliminated. However, available evidence does not rule out a true difference in injury rates by race, highlighting the complexity of understanding the etiology of injuries and, hence, developing public health programs to prevent injuries.
Cardiovascular risk factors among Asian Americans living in northern California.
Authors: Klatsky A L , Armstrong M A
Published: November 2008

BACKGROUND. Recent substantial immigration has created large population subsets of Asian Americans in the United States. Available data about cardiovascular risk factors in these persons are sparse. METHODS. This study examined data among 13,031 persons self-classified as 5951 Chinese, 4211 Filipinos, 1703 Japanese, and 1166 other Asians. Covariates in regression analyses were age, smoking, alcohol, education, and marital status. RESULTS. Chinese men and women had the lowest adjusted mean body mass index. Filipino men and women had the highest prevalence of hypertension. There were no major differences in blood glucose levels. Total cholesterol levels were highest in Japanese men and women. Comparisons of US-born persons and those born in respective countries of origin showed no major cholesterol or glucose differences; more hypertension only in Chinese and other Asian men; higher body mass index in men, but not in women of most ethnicities; and a lower smoking prevalence in men, but a substantially higher one in women. CONCLUSIONS. These data show important ethnic differences in risk factors among Asian Americans and indicate groups that should be targeted for public health efforts concerned with obesity (Asian-American men), hypertension (Filipino-American men and women), hypercholesteremia (all Asian Americans), and smoking cessation (Asian-American women).
Ethnic populations in public mental health: services choice and level of use.
Authors: Hu T W , Snowden L R , Jerrell J M , Nguyen T D
Published: November 2008

BACKGROUND. Barriers to access and use of mental health care by Asians, Blacks, and Hispanic Americans have been a source of concern for many years. Limitations in our knowledge base persist regarding patterns of use in public sector programs of certain services. Using a sample of almost 27,000 persons, this study examined access and level of use by ethnic minority groups of emergency services, inpatient care, individual outpatient visit, and case management. METHODS. Data from the management information systems of San Francisco and Santa Clara counties were analyzed for fiscal year 1987/1988. Multivariate models were evaluated at two stages, reflecting whether or not a service had been used, and if used, the level of use. RESULTS. Asians and Hispanics used less emergency and inpatient but more outpatient care than did Whites; Blacks used more emergency and less outpatient care. CONCLUSIONS. Ethnicity continues to play a role in understanding the utilization of mental health services. Regarding emergency and inpatient care, Asian and Hispanic patterns of use appear relatively favorable, whereas the patterns of Blacks continue to be problematic.
Black-white differences in infant mortality in 38 standard metropolitan statistical areas.
Authors: Polednak A P
Published: November 2008

The Black-White difference in infant mortality rates for 1982 through 1986 in 38 large US standard metropolitan statistical areas (SMSAs) varied by a factor of almost seven. In multiple regression analyses the most important predictor of the Black-White difference in the 38 SMSAs was an index of Black-White residential dissimilarity (or "segregation index"), independent of Black-White differences in median family income and poverty prevalence. Certain SMSAs in California had relatively low segregation indexes and small Black-White differences in infant mortality, despite considerable Black-White differences in poverty prevalence. The explanations for the apparent effect of residential segregation should be explored.
Comparison of smoking habits of blacks and whites in a case-control study.
Authors: Kabat G C , Morabia A , Wynder E L
Published: November 2008

Information from Blacks and Whites interviewed in a case-control study of tobacco-related diseases was analyzed to identify explanatory factors for racial differences in smoking habits. Blacks were three times more likely to be light vs heavy smokers. This association did not differ according to such variables as cigarette preference, degree of inhalation, or quitting. The association of race and light smoking was present in both current and ex-smokers. Sociodemographic or smoking-related characteristics do not appear to explain racial differences in smoking habits. Future studies should focus on cultural factors influencing smoking behavior.
Mammography in a health maintenance organization.
Authors: Hansen J P , Knapp P A , Newcomb P A
Published: November 2008

The charts of a random sample of 496 women, aged 51 and older, in a staff model health maintenance organization (HMO) were retrospectively audited for mammography frequency over an 8-year period. Of the 496 women, 306 (61.7%) had at least one mammogram. For the 422 women who had been members of the HMO for at least 2 years, 196 (46.4%) had mammography within the previous 18 months.
The Tuskegee Syphilis Study, 1932 to 1972: implications for HIV education and AIDS risk education programs in the black community.
Authors: Thomas S B , Quinn S C
Published: November 2008

The Tuskegee study of untreated syphilis in the Negro male is the longest nontherapeutic experiment on human beings in medical history. The strategies used to recruit and retain participants were quite similar to those being advocated for HIV/AIDS prevention programs today. Almost 60 years after the study began, there remains a trail of distrust and suspicion that hampers HIV education efforts in Black communities. The AIDS epidemic has exposed the Tuskegee study as a historical marker for the legitimate discontent of Blacks with the public health system. The belief that AIDS is a form of genocide is rooted in a social context in which Black Americans, faced with persistent inequality, believe in conspiracy theories about Whites against Blacks. These theories range from the belief that the government promotes drug abuse in Black communities to the belief that HIV is a manmade weapon of racial warfare. An open and honest discussion of the Tuskegee Syphilis Study can facilitate the process of rebuilding trust between the Black community and public health authorities. This dialogue can contribute to the development of HIV education programs that are scientifically sound, culturally sensitive, and ethnically acceptable.
The New York Needle Trial: the politics of public health in the age of AIDS.
Authors: Anderson W
Published: November 2008

During the past 5 years, the exchange of sterile needles and syringes for dirty injecting equipment has gained increasing acceptance outside the United States as a potential means of reducing the transmission of the human immunodeficiency virus (HIV) among intravenous drug users. This article describes the controversy over attempts to establish a needle and syringe exchange scheme in New York City between 1985 and 1991. The response to a health crisis is used as an indicator of patterns of social and institutional practice. Advocates of needle exchanges had reached a stalemate with the promoters of law enforcement, and the strategic reformulation of the policy problem in terms of the research process seemed to offer a solution. The article discusses the practical limitations on designing and carrying out a controversial health promotion policy; the use (under constraint) of a restrictive research process to constitute--rather than simply to guide or monitor--public policy; and the potential ethical hazards of health professionals' seeking a polemical recourse to the clinical trial. The efforts to establish a needle exchange in New York thus illustrate more general problems for AIDS prevention.
Lessons from London: the British are reforming their national health service.
Authors: Vall-Spinosa A
Published: November 2008

In an effort to keep abreast of the changing needs of a more affluent society and to ensure better value for money, the British are reforming their National Health Service. They are promoting competition and entrepreneurship, and directing funding to follow a patient rather than flowing directly to institutions. British physicians are resisting these changes. The United States, in the middle of a health care crisis of its own, can learn a great deal from Britain, especially in the area of controlling expenditures. The low cost of the National Health Service can be attributed to four major factors: (1) It is general practitioner driven and no patient accesses a specialist or hospital directly. (2) Hospitals, which employ all the specialists and supply most of the technology, operate on very tight, cash-limited budgets. (3) Administrative costs are very low. (4) The expense of malpractice is not (yet) a major concern. Changes occurring in both countries foretell a future wherein our health care systems may look very much alike.
Behavior changes after notification of HIV infection.
Authors: Cleary P D , Van Devanter N , Rogers T F , Singer E , Shipton-Levy R , Steilen M , Stuart A , Avorn J , Pindyck J
Published: November 2008

BACKGROUND. To learn more about how people who did not volunteer for testing react to information about HIV infection, we assessed short-term behavior changes in HIV-positive blood donors. METHODS. Blood donors who were notified at the New York Blood Center that they were HIV positive were asked to participate in a study. A nurse elicited a medical history, performed a limited medical examination, and asked participants to complete a questionnaire that included questions about drug use, sexual behavior, and psychological characteristics. Participants were asked to return in 2 weeks to complete another questionnaire. RESULTS. Many fewer men and women reported engaging in unsafe sexual behaviors in the 2 weeks preceding the follow-up visit than had reported such behaviors prior to notification. These changes were greater than those other investigators have reported, but about 40% of the participants still reported unsafe sexual activity at the follow-up interview. CONCLUSIONS. To make nonvolunteer screening programs for HIV infection more effective in reducing the spread of HIV infection, we need to learn more about how to help people change their high-risk behaviors.
Knowledge about AIDS and HIV in the US adult population: influence of the local incidence of AIDS.
Authors: McCaig L F , Hardy A M , Winn D M
Published: November 2008

BACKGROUND. Accurate information about acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) is important for prevention. This study determined whether AIDS knowledge varied among populations residing in areas with a low, medium, or high incidence of AIDS. METHODS. Respondents to the 1988 National Health Interview Survey of AIDS Knowledge and Attitudes, which is based on a nationally representative sample of 29,659 adults, were rated on their knowledge about modes of HIV transmission, general knowledge about AIDS, and misperceptions about HIV transmission through casual contact. RESULTS. Persons 50 years of age or older, Blacks, Hispanics, and persons with less than a high school education had lower knowledge scores and higher misperception scores. Residents of the high-incidence area had more misperceptions than those who lived in the medium- or low-incidence areas. Sociodemographic determinants of scores were important factors overall and within each AIDS incidence area. CONCLUSIONS. These data suggest that the ability of educational messages to reach and be absorbed by individuals nationwide is less dependent on whether they live in an area with a high incidence of AIDS and more dependent on other demographic variables. New and continued efforts are needed to improve knowledge in older persons, minorities, and the less educated in all parts of the country.
HIV instruction, HIV knowledge, and drug injection among high school students in the United States.
Authors: Holtzman D , Anderson J E , Kann L , Arday S L , Truman B I , Kolbe L J
Published: November 2008

BACKGROUND. The prevalence of HIV-related behaviors and determinants of these behaviors among adolescents in the United States have not been well studied. METHODS. To determine the prevalence of HIV-related drug behaviors and to assess the effects of HIV-related school-based instruction and HIV knowledge on these behaviors, data were analyzed from a 39-item, self-administered questionnaire completed by a probability sample of all students in grades 9 through 12 in the United States. RESULTS. Usable responses were obtained from 8098 students. Of these, 2.7% (95% confidence interval [CI] = 2.3-3.2) and 1.7% (95% CI = 1.3-2.1) reported injecting illicit drugs ever and during the past year, respectively. Corresponding prevalences of needle sharing were 0.8% (95% CI = 0.5-1.1) and 0.5% (95% CI = 0.3-0.7). Regression analysis revealed that students with higher knowledge scores were less likely and males more likely to have ever injected drugs. HIV knowledge was similarly associated with other outcome measures of drug-injection behavior. Although HIV instruction did not directly influence drug-injection behavior independently of demographic characteristics, it was positively associated with HIV knowledge. CONCLUSIONS. While these results do not establish a causal relationship, they suggest that HIV knowledge and school-based instruction may play a role in maintaining low levels of drug-injection behavior among high school students.
An evaluation of the impact of maternity care coordination on Medicaid birth outcomes in North Carolina.
Authors: Buescher P A , Roth M S , Williams D , Goforth C M
Published: November 2008

BACKGROUND. Care coordination is an important component of the enhanced prenatal care services provided under the recent expansions of the Medicaid program. The effect of maternity care coordination services on birth outcomes in North Carolina was assessed by comparing women on Medicaid who did and did not receive these services. METHODS. Health program data files, including Medicaid claims paid for maternity care coordination, were linked to 1988 and 1989 live birth certificates. Simple comparisons of percentages and rates were supplemented by a logistic regression analysis. RESULTS. Among women on Medicaid who did not receive maternity care coordination services, the low birth weight rate was 21% higher, the very low birth weight rate was 62% higher, and the infant mortality rate was 23% higher than among women on Medicaid who did receive such services. It was estimated that, for each $1.00 spent on maternity care coordination, Medicaid saved $2.02 in medical costs for newborns up to 60 days of age. Among the women who did receive maternity care coordination, those receiving it for 3 or more months had better outcomes than those receiving it for less than 3 months. CONCLUSIONS: These results suggest that maternity care coordination can be effective in reducing low birth weight, infant mortality, and newborn medical care costs among babies born to women in poverty.
Overcoming denial and increasing the intention to use condoms through the induction of hypocrisy.
Authors: Aronson E , Fried C , Stone J
Published: November 2008

Feelings of hypocrisy were induced in college students to increase condom use. Hypocrisy was created by making subjects mindful of their past failure to use condoms and then having them persuade others about the importance of condoms for AIDS prevention. The induction of hypocrisy decreased denial and led to greater intent to improve condom use relative to the control conditions. The implications of these findings for AIDS prevention are discussed.
Patterns of breast and cervical cancer screening at three public health centers in an inner-city urban area.
Authors: Whitman S , Ansell D , Lacey L , Chen E H , Ebie N , Dell J , Phillips C W
Published: November 2008

In an effort to examine breast and cervical cancer screening patterns among poor African-American urban women, medical records were abstracted at three public health centers located in the inner city of Chicago. The proportions of eligible women at these three centers who received Pap smears, breast examinations, and mammograms were computed. These proportions were notably low and differed significantly among the three centers. Because the literature is now suggesting that an appropriate sequence best defines adequate screening, sequences of screenings were also determined and were found to be lacking. All of these screening histories fall far below the screening objectives set by the National Cancer Institute for the year 2000. This information suggests that interventions are needed that will help health centers serving poor women to deliver more frequent cancer screening.
Effects on serum lipids of adding instant oats to usual American diets.
Authors: Van Horn L , Moag-Stahlberg A , Liu K A , Ballew C , Ruth K , Hughes R , Stamler J
Published: November 2008

This study was designed as a test of the serum lipid response and dietary adaptation to recommended daily inclusion of instant oats in an otherwise regular diet. Hypercholesterolemic adults were randomly assigned to a control or intervention group. Participants in the intervention group were given packages of instant oats and requested to eat two servings per day (approximately two ounces dry weight), substituting the oats for other carbohydrate foods in order to maintain baseline calorie intake and keep weight stable. Serum lipids were measured in blood collected by venipuncture at baseline, four weeks, and eight weeks. Baseline mean total cholesterol (TC) levels were 6.56 mmol/L and 6.39 mmol/L for intervention and control groups, respectively. After eight weeks, mean serum total cholesterol of the intervention group was lower by -0.40 mmol/L, and mean net difference in TC between the two groups was 0.32 mmol/L (95% CI: 0.09, 0.54). Low-density lipoprotein-cholesterol was similarly reduced with mean net difference of 0.25 mmol/L (95% CI: 0.02, 0.48) between the two groups. Mean soluble fiber intake increased along with slight self-imposed reductions in mean total fat, saturated fat, and dietary cholesterol intake in the intervention group. Neither group changed mean body weight. Daily inclusion of two ounces of oats appeared to facilitate reduction of serum total cholesterol and LDL-C in these hyperlipidemic individuals.
Validation of a surveillance case definition of carpal tunnel syndrome.
Authors: Katz J N , Larson M G , Fossel A H , Liang M H
Published: November 2008

The National Institute for Occupational Safety and Health (NIOSH) has proposed a surveillance case definition for work-related carpal tunnel syndrome (CTS). The case definition requires the presence of median nerve symptoms; one or more occupational risk factors; and objective evidence of CTS including one of three physical examination findings or nerve conduction tests diagnostic of CTS. We evaluated the performance of the NIOSH case definition, restricting our analysis to cases in which physical examination findings served as the objective criterion. Nerve conduction studies were used as the gold standard. Seventy-eight workers were studied; 38 percent had CTS. The NIOSH case definition had sensitivity of 0.67 (95% CI = 0.57, 0.77), specificity of 0.58 (95% CI = 0.47, 0.69), and positive and negative predictive values of 0.50 (95% CI = 0.39, 0.61) and 0.74 (95% CI = 0.64, 0.84), respectively. Overall 38 percent of subjects were classified incorrectly. In a sample with a prevalence of 15 percent, as might be encountered in high risk workplaces, the positive predictive value would be 0.22. In conclusion, when physical examination findings serve as the objective criterion the performance of the case definition is modest reflecting the limited diagnostic value of its component tests and indicating that effective screening for CTS awaits improved diagnostic techniques.
Behavioral, health and psychosocial factors and risk for HIV infection among sexually active homosexual men: the Multicenter AIDS Cohort Study.
Authors: Penkower L , Dew M A , Kingsley L , Becker J T , Satz P , Schaerf F W , Sheridan K
Published: November 2008

We examined whether 644 homosexual men who engaged in receptive anal intercourse were at particularly elevated risk for seroconversion if they also possessed specific behavioral, health or psychosocial vulnerability characteristics. Of 11 potential factors examined, heavy drinking, moderate to heavy drug use, and younger age were significantly related to seroconversion. These variables were also associated with an increased number of sexual partners, anonymous sex, and failure to use condoms.
Increased risk of ectopic pregnancy with maternal cigarette smoking.
Authors: Coste J , Job-Spira N , Fernandez H
Published: November 2008

As part of a case-control study of ectopic pregnancy, we evaluated the potential etiologic role of cigarette smoking. Maternal cigarette smoking at the time of conception was associated with an increased risk of ectopic pregnancy with a dose-response relationship (adjusted odds ratios: 1.30 to 2.49). On the other hand, partner's smoking was not associated with ectopic pregnancy. The study provides a supplementary argument towards a causal effect of smoking in the development of ectopic pregnancy.
Are people more health conscious? A longitudinal study of one community.
Authors: Niknian M , Lefebvre R C , Carleton R A
Published: November 2008

Secular changes in cardiovascular health awareness, knowledge and behavior were observed in four biennial cross-sectional surveys and a cohort survey in a New England community. These changes are not related to more health promotion activities in the social milieu of respondents, but are more likely due to national mass media health campaigns, the effects of which may influence outcomes of community-based cardiovascular disease prevention studies.
Sexual risk behaviors, AIDS knowledge, and beliefs about AIDS among runaways.
Authors: Rotheram-Borus M J , Koopman C
Published: November 2008

Sexual risk behaviors, knowledge of acquired immunodeficiency syndrome (AIDS), and beliefs about AIDS prevention were examined among 126 runaways. In the previous 3 months, 65 percent of youths had been sexually active. Among the sexually active runaways, males reported a median of 2.7 partners and females reported 1.3 partners, and only 18 percent reported consistent condom use. Runaways demonstrated moderately high AIDS knowledge and beliefs endorsing AIDS prevention. Condom use and abstinence were directly related to beliefs about preventing AIDS.
Discharges against medical advice at regional acute care hospitals.
Authors: Smith D B , Telles J L
Published: November 2008

Data from 67 acute care hospitals in the Philadelphia metropolitan area indicate that there were 7,613 discharges against medical advice (AMA) in fiscal year 1987, or 1.20 percent of all discharges that year. Diagnosis-related group (DRG), type of insurance, and sex had independent effects on the rate of AMA discharges. Urban community hospitals had the highest percent of AMA discharges. Previous studies, done in teaching facilities, may have underestimated the rate of AMA discharges.
Survival trends of people with AIDS in Washington State.
Authors: Lafferty W E , Glidden D , Hopkins S G
Published: November 2008

Survival rates of 609 cases of acquired immunodeficiency syndrome (AIDS) in Washington State diagnosed between 1982 and 1987 according to pre-1987 AIDS surveillance definition were analyzed. People with a primary diagnosis of Kaposi's sarcoma survived longer than those with Pneumocystis carinii pneumonia. Both groups survived longer than those with other diagnoses. Median survival increased from 11.3, to 12.5, to 20.8 months for cases diagnosed in or before 1985, during 1986, and during 1987, respectively.
Race and weight change in US women: the roles of socioeconomic and marital status.
Authors: Kahn H S , Williamson D F , Stevens J A
Published: November 2008

BACKGROUND. The prevalence of overweight among Black women in the US is higher than among White women, but the causes are unknown. METHODS. We examined the weight change for 514 Black and 2,770 White women who entered the first Health and Nutrtion Examination Survey (1971-75) at ages 25-44 years and were weighed again a decade later. We used multivariate analyses to estimate the weight-change effectgs associated with race, family income, education, and marital change. RESULTS. After multiple adjustments, Black race, education below college level, and becoming married during the follow-up interval were each independently associated with an increased mean weight change. Using multivariate logistic analyses, Black race was not independently associated with an increased risk of major weight gain (change greater than or equal to +13 kg), but it was associated with a reduced likelihood of major weight loss (change less than or equal to -7 kg) (odds ratio - 0.64 [95% CI -0.41, 0.97])]. Very low family income was independently associated with the likelihood of both major weight gain (OR - 1.71 [95% CI - 1.15, 2.55]) and major weight loss (OR - 1.86 [95% CI - 1.18, 2.95]). CONCLUSIONS. Amont US women, Black race is independently associated with a reduced likelihood of major weight loss, but not with major weight gain. Women at greatest risk of weight gain are those with education below college level, those entering marriage, and those with very low family income.
Cost-effectiveness of alpha-1 antitrypsin replacement therapy in treatment of congenital chronic obstructive pulmonary disease.
Authors: Hay J W , Robin E D
Published: November 2008

BACKGROUND: Alpha 1-antitrypsin (AAT) replacement therapy is an expensive intervention ($20,000-$30,000 per patient annually) which may slow or arrest the progression of chronic obstructive pulmonary disease (COPD) in AAT-deficient patients. While FDA-approved, therapy efficacy is unknown. The costs and benefits of AAT replacement therapy were evaluated for patients with congenital COPD. METHODS: Epidemiological and disease cost data were taken from published sources. A discrete-time model of disease stage probability transition was developed to calculate the present-value expected cost of disease treatment, under a range of possible therapy efficacy and other parameter values. RESULTS: At an efficacy of 70 percent, the cost per life year saved with AAT replacement therapy would be between $28,000 and $72,000 (1990 US dollars), depending on patient age, sex, and smoking status. At 30 percent efficacy, the cost per life year saved range would be between $50,000 and $128,000. A controlled efficacy study would cost $53 million or less, if the true efficacy were 50 percent or better. CONCLUSIONS: With efficacy of 30 percent or higher, therapy cost-effectiveness would be comparable to other widely used medical interventions. The economic assessment methodology was used to evaluate both the therapeutic innovation and the value of additional clinical research.
Morbidity and disability in older persons in the years prior to death.
Authors: Guralnik J M , LaCroix A Z , Branch L G , Kasl S V , Wallace R B
Published: November 2008

BACKGROUND: A large proportion of the disease and disability which affects older persons occurs in the years just prior to death. Little prospective evidence is available which quantifies the burden of morbidity and disability during these years. METHODS: In three community-based cohorts of persons age 65 and older, chronic conditions and disability were evaluated for the three years prior to death in 531 persons who had three annual assessments and then died within one year of the third assessment. Number of chronic conditions, prevalence of disability in activities of daily living (ADLs), and prevalence of disability on a modified Rosow-Breslau scale were determined for these decedents and compared to 8821 members of the cohorts known to have survived. RESULTS: Prevalence rates of disease and disability increased during the follow-up for both decedents and survivors, with decedents generally having higher rates than survivors. Disability rates prior to death, but not the number of diseases, increased with increasing age at death. The odds ratio for disability in ADLs at any of the three assessments for decedents versus survivors ranged from 3.0 to 4.2 in the three communities. In each community the odds ratio for ADL disability was higher in women decedents versus survivors than in men decedents versus survivors. CONCLUSIONS: These results have important implications for disability levels in future older populations in which death is projected to occur at increasingly higher ages.
Alcohol drinking patterns and blood pressure.
Authors: Russell M , Cooper M L , Frone M R , Welte J W
Published: November 2008

BACKGROUND: Although blood pressure tends to increase with average alcohol consumption, little is known about the effects of drinking patterns on blood pressure. Therefore, the effects of average drinks per day and drinking pattern (defined as the independent and interactive effects of quantity and frequency) on blood pressure were compared. METHODS: Data were obtained from a random sample survey of 1,635 household residents in Erie County, New York. Alcohol-blood pressure relationships were examined using multiple regression analyses that controlled for the potentially confounding influence of 13 additional risk factors for elevated blood pressure. RESULTS: Consistent with prior research, a positive relationship was found between average drinks per day and diastolic and systolic blood pressure. Analyses examining the effect of drinking pattern indicated that drinking frequency had a positive effect on both diastolic and systolic blood pressure, whereas drinking quantity did not affect either. Furthermore, there was little evidence that the frequency-by-quantity interaction affected blood pressure. CONCLUSIONS: Low average alcohol intake and low blood pressure were associated with infrequent drinking, rather than with frequent drinking of small amounts of alcohol. Results suggest that the standard practice of averaging alcohol consumption may obscure important effects of drinking frequency on health.
Caffeine consumption during pregnancy and fetal growth.
Authors: Fenster L , Eskenazi B , Windham G C , Swan S H
Published: November 2008

BACKGROUND: The purpose of this study was to examine the association between maternal caffeine consumption and low birthweight, intrauterine growth retardation, and prematurity, adjusting for multiple confounders. METHODS: Data obtained from birth certificates and interviews on 1,230 women with singleton live births were analyzed to evaluate the potential influence of caffeine consumption during the first trimester on fetal growth. RESULTS: The crude odds ratio for intrauterine growth retardation in infants of women reporting heavy caffeine consumption (greater than 300 mg/day) was 3.86 (95% CI = 1.80, 8.40) which decreased to 2.90 (95% CI = 1.23, 6.87) after controlling for confounding factors. The adjusted odds ratio for low birthweight and heavy maternal caffeine consumption was also elevated (OR = 2.05; 95% CI = 0.86, 4.88). Women who reduced their caffeine intake from greater than 300 mg/day to less than that early in pregnancy had lower risks of delivering infants with either intrauterine growth retardation or low birthweight than women who continued to consume that amount. Preterm delivery appeared to be unrelated to caffeine consumption. CONCLUSIONS: Taken together with studies reporting similar findings, these results suggest that heavy caffeine consumption increases the risk for fetal growth retardation.
Bone cancer incidence rates in New York State: time trends and fluoridated drinking water.
Authors: Mahoney M C , Nasca P C , Burnett W S , Melius J M
Published: November 2008

BACKGROUND: Recent animal studies of the potential carcinogenicity of fluoride prompted an examination of bone cancer incidence rates. METHODS: Trends in the incidence of primary bone cancers, including the incidence of osteosarcomas were examined among residents of New York State, exclusive of New York City. Average annual osteosarcoma incidence rates in fluoridated and non-fluoridated areas were also compared. RESULTS: Among persons less than 30 years of age at diagnosis, bone cancer incidence among males demonstrated a significant increase since 1955, while incidence among females has remained unchanged. A significant decrease in bone cancer incidence rates since 1955 was observed among both males and females age 30 years and over at time of diagnosis. Osteosarcoma incidence rates have remained essentially unchanged since 1970, among both younger and older males and females. The average annual age adjusted incidence of osteosarcomas (1976-1987) in areas served by fluoridated water supplies was not found to differ from osteosarcoma incidence rates in non-fluoridated areas. CONCLUSIONS: These data do not support an association between fluoride in drinking water and the occurrence of cancer of the bone.
Neonatal diarrhea at a maternity hospital in Rangoon.
Authors: Aye D T , Bact D , Sack D A , Wachsmuth I K , Kyi D T , Thwe S M
Published: November 2008

Between 1981 and 1986, 1,540 infants born at the Central Women's Hospital in Rangoon were transferred to the Sick Baby Unit because of diarrhea (15.4 per 1,000 live births). Rates among cesarean infants were five times as high as those of infants born vaginally (51.0 and 10.3 per 1000 live births, respectively). One hundred eighty-four of the infants with diarrhea died (case fatality rate = 12 percent). We conclude that neonatal diarrhea is endemic in this large maternity hospital in Burma, and that control efforts should be targeted especially to cesarean and low birthweight infants.
Response of hospitals, skilled nursing facilities, and home health agencies in Oregon to AIDS: reports of nursing executives.
Authors: White C M , Berger M C
Published: November 2008

To describe experience and readiness to provide care for persons with acquired immunodeficiency syndrome (AIDS), responses to a mailed survey from 86 percent of chief nursing executives of the 207 hospitals, skilled nursing facilities (SNFs) and home health agencies (HHAs) in Oregon were summarized. As of January 1989, 44 percent reported having provided care; even in low incidence counties, 64 percent of hospitals had provided care. Adequate resources were reported by 79 percent in hospitals, 26 percent in SNFs, and 69 percent in HHAs.
Adult survivors of childhood sexual abuse and subsequent risk of HIV infection.
Authors: Zierler S , Feingold L , Laufer D , Velentgas P , Kantrowitz-Gordon I , Mayer K
Published: November 2008

BACKGROUND: Epidemiologic description of long-term adverse health effects of childhood sexual abuse is lacking, despite estimates that perhaps 30 percent of adults have experienced sexual assault in childhood. METHODS: In an adult cohort enrolled to investigate causes of transmission of human immunodeficiency virus, we identified current behaviors affecting risk of infection that were associated with a history of early sexual abuse. One hundred and eighty-six individuals provided information on the occurrence of abuse and subsequent sexual and drug using activities. RESULTS: Approximately half of the women and one-fifth of the men reported a history of rape during childhood or adulthood. Twenty-eight percent of the women and 15 percent of the men recalled that they had been sexually assaulted during childhood. People who reported childhood rape compared with people who did not were four times more likely to be working as prostitutes (90 percent confidence interval = 2.0, 8.0). Women were nearly three times more likely to become pregnant before the age of 18 (90% CI = 1.6, 4.1). Men who reported a history of sexual abuse had a twofold increase in prevalence of HIV infection relative to unabused men (90% CI = 1.0, 3.9). CONCLUSIONS: The disturbing prevalence of early sexual abuse and its possible health-related consequences call for prompt and routine investigation of sexual abuse histories. Identification of sexual victimization may be an important component for management of risk factors for human immunodeficiency virus.
A comparison of injury death rates in China and the United States, 1986.
Authors: Li G H , Baker S P
Published: November 2008

BACKGROUND: The importance of injury as a public health problem is not well recognized in many developing countries. Data have recently become available on injury mortality in China. METHOD: We compared Chinese injury data based on a 100 million population segment for 1986 with data for the United States. RESULTS: The age-adjusted death rate from all injuries for China exceeds the rate for the US (69.0 vs 61.3 per 100,000). The US has higher death rates from motor vehicle crashes, fires, and homicide; China has greater mortality from drowning, poisoning, falls, and suicide. Especially noteworthy in China are the high drowning rates among young children and the elderly and the high suicide rates in rural areas among young adults and the elderly. CONCLUSION: Injury is an important public health problem in China, exceeding in many respects the problem in the United States. It is urgent for China to place high priority on injury research and prevention.
Comparison of AIDS knowledge, attitudes, and behaviors among incarcerated adolescents and a public school sample in San Francisco.
Authors: DiClemente R J , Lanier M M , Horan P F , Lodico M
Published: November 2008

Data collected from incarcerated youth (n = 113) and a public school sample (n = 802) demonstrate that both adolescent groups have a high level of AIDS knowledge. Incarcerated youth are less aware of HIV risk-reduction behaviors and report markedly higher rates of HIV risk behaviors. Incarcerated youth are at substantially increased risk of HIV infection relative to their school-based counterparts and should be a primary target of HIV prevention programs.
Hyperendemic urban blastomycosis.
Authors: Manetti A C
Published: November 2008

Within the United States, blastomycosis is primarily endemic in the Mississippi and Ohio River valleys, but reliable figures as to its prevalence and incidence are scarce. A review of pathology department files and medical records from three hospitals in Rockford, Illinois, revealed 32 documented cases of blastomycosis in an eight and one-half year period beginning in March 1981. Twenty-three of these cases were urban since they occurred within the Rockford census tract boundaries--an incidence more than 3.5 times greater than expected in an endemic area. Addresses of patients in 18 of the 23 cases were concentrated at the northeast and southwest ends of the city. Implications are discussed.
Vietnam era and Vietnam combat veterans among the homeless.
Authors: Rosenheck R , Gallup P , Leda C A
Published: November 2008

Of 10,524 homeless veterans assessed in a 43-site VA program, 50 percent served during the Vietnam War era, compared to only 29 percent of all veterans in the general population. This reflects the greater risk of homelessness among men aged 30-44 rather than the impact of Vietnam Era service. The proportion of homeless veterans who served in the Vietnam Theater (44.9 percent), and the proportion exposed to combat fire (40.5 percent) were similar to those of nonhomeless veterans. Homeless combat veterans who are not White were more likely to have psychiatric, alcohol, and medical problems than homeless noncombat Vietnam veterans who are not White.