bluuebunny/crossref_metadata_2025 huggingface dataset:
Intestinal parasites among North Carolina migrant farmworkers.
Authors: Ciesielski S D , Seed J R , Ortiz J C , Metts J
Published: November 2008

OBJECTIVES. The public health significance of intestinal parasitism among migrant farmworkers has been poorly defined. We report a three-part study in which we attempted to provide population-based estimates and identify risk factors for infection. METHODS. Parasite prevalence and incidence were estimated from two cross-sectional studies and a longitudinal study. We used questionnaires and clinical measurements such as hematocrits to examine risk factors and health effects. RESULTS. In the 1987 convenience sample (n = 265), parasite prevalence ranged from 28% among the US born to 86% among the Central American born, with no significant difference between the prevalence of pathogens among US-born (14%) and Mexican-born (24%) subjects (P = .12, chi 2 test). High prevalences were also found in the 1988 random sample. An annual incidence of 9.5% (n = 74) was demonstrated in 1988. Symptoms such as abdominal pain were associated with infection, and lower hematocrits were associated with hookworm infection (P = .02, t test). CONCLUSIONS. Infection with intestinal parasites appears to be an occupational hazard of farmwork, necessitating improved working and living conditions and greater clinical awareness.
PHLIS: an electronic system for reporting public health data from remote sites.
Authors: Bean N H , Martin S M , Bradford H
Published: November 2008

Disease surveillance conducted by the Centers for Disease Control (CDC) in conjunction with state health departments provides databases of information to public health workers. These databases' utility is limited by the lag time from occurrence of disease events until records are available for analysis. We developed the Public Health Laboratory Information System (PHLIS), a PC-based electronic reporting system for entering, editing, and analyzing data locally and for transmitting data electronically to other state or federal offices. Advantages of PHLIS include reduction in paper handling, decrease in lag time between disease incident and availability of information for analysis, ability to rapidly examine data for clusters of disease, downloadable summary tables, data editing at site of input, data analysis capability, increased interaction among participants, and current data for responses to inquiries. PHLIS is available without cost and is transportable to other agencies, states, or countries.
Causes of death among persons reported with AIDS.
Authors: Chu S Y , Buehler J W , Lieb L , Beckett G , Conti L , Costa S , Dahan B , Danila R , Fordyce E J , Hirozawa A
Published: November 2008

OBJECTIVES. This study describes causes of death in persons with acquired immunodeficiency syndrome (AIDS) and assesses the completeness of reporting of human immunodeficiency virus (HIV) infection or AIDS on death certificates of persons with AIDS. METHODS. AIDS case reports were linked with death certificates in 11 local/state health departments; underlying and associated causes of death were available for 32,513 persons with AIDS who died. RESULTS. HIV/AIDS was designated as the underlying cause of death for 46% of persons with AIDS who died between 1983 and 1986 and 81% of persons with AIDS who died since 1987 (the year specific coding procedures were implemented for HIV/AIDS). Most other underlying causes of death were conditions within the AIDS case definition (notably Pneumocystis carinii pneumonia), pneumonia, infections outside the AIDS case definition, and drug abuse. Unintentional injuries, suicide, and homicide were less common. HIV/AIDS was listed as underlying or associated on 88% of death certificates from 1987 to 1989; reporting varied primarily by HIV exposure category and time between diagnosis and death. CONCLUSIONS. Physicians and other health care professionals should realize their critical role in accurately documenting HIV-related mortality on death certificates. Such data can ultimately influence the allocation of health care resources for HIV-infected individuals.
HIV-related knowledge and precautions among Michigan nurses.
Authors: Schillo B A , Reischl T M
Published: November 2008

OBJECTIVES. The present study examined human immunodeficiency virus (HIV)-related knowledge and precautionary behaviors in a large random sample of registered nurses in all regions of the state of Michigan, allowing for comparisons among nurses in a wide range of occupational experiences, exposures, and backgrounds related to HIV. METHODS. A random sample of all registered nurses living in Michigan completed surveys in the fall of 1989. RESULTS. Although nearly all respondents indicated a high level of knowledge of known viable routes of HIV transmission, many respondents also reported misconceptions about several unverified nonviable routes of HIV transmission. Of the respondents who were involved in situations with potential risk of exposure to HIV, many failed to consistently use the universal precautions recommended by the Centers for Disease Control and Prevention. The respondents also reported significant barriers in applying infection control procedures. CONCLUSIONS. The findings of the present study support the need for continued and intensified efforts to ensure that nurses have the knowledge necessary to provide quality care, are aware of the risk of potential exposures to HIV, and are engaging in appropriate precautionary behaviors.
Risk due to inactivity in physically capable older adults.
Authors: Simonsick E M , Lafferty M E , Phillips C L , Mendes de Leon C F , Kasl S V , Seeman T E , Fillenbaum G , Hebert P , Lemke J H
Published: November 2008

OBJECTIVES. This study examined the association between recreational physical activity among physically capable older adults and functional status, incidence of selected chronic conditions, and mortality over 3 and 6 years. METHODS. Data are from three sites of the Established Populations for Epidemiologic Studies of the Elderly. RESULTS. A high level of recreational physical activity reduced the likelihood of mortality over both 3 and 6 years. Moderate to high activity reduced the risk of physical impairments over 3 years; this effect diminishes after 6 years. A consistent relationship between activity and new myocardial infarction or stroke or the incidence of diabetes or angina was not found after 3 or 6 years. CONCLUSIONS. Findings suggest that physical activity offers benefits to physically capable older adults, primarily in reducing the risk of functional decline and mortality. Future work must use more objective and quantifiable measures of activity and assess changes in activity levels over time.
Increase in unprotected anogenital intercourse among homosexual men.
Authors: de Wit J B , van den Hoek J A , Sandfort T G , van Griensven G J
Published: November 2008

Results are presented from two sources, data of which indicate an increase in high-risk sexual behaviors for human immunodeficiency virus infection among homosexual men. The number of cases of gonorrhea among homosexual and bisexual visitors to municipal sexually transmitted disease clinics in Amsterdam, The Netherlands, is increasing. An increase was also observed in unprotected anogenital intercourse among homosexual participants in the Amsterdam cohort. These findings indicate that a rebound in the behavior change process among homosexual men is occurring. Furthermore, longitudinal behavioral data show that lapse and relapse into unsafe sex are prevalent in the Amsterdam cohort.
HIV infection in the Women's Jail, Orange County, California, 1985 through 1991.
Authors: Gellert G A , Maxwell R M , Higgins K V , Pendergast T , Wilker N
Published: November 2008

The incidence and prevalence of human immunodeficiency virus (HIV) infection among injection drug users, prostitutes, and other women seeking confidential testing in the Orange County Women's Jail were assessed from 1985 to 1991. A total of 4616 voluntary tests were completed on 3051 women, and 865 women were tested repeatedly. Eighty-two women tested positively, a ratio of 1.8 positives per 100 tests or 2.7% of all persons tested. Cumulative HIV prevalence increased from 2.5% to 2.7% between 1985 and 1991, increased by age, and showed racial differences. Of women with multiple tests, 29 seroconverted. Incidence declined from 5.7 to 1.4 cases per 100 person-years of observation between 1985 and 1991. The overall rate of seroconversion was 1.6 per 100 person-years of observation.
Behavioral outcomes of AIDS educational interventions for drug users in short-term treatment.
Authors: McCusker J , Stoddard A M , Zapka J G , Lewis B F
Published: November 2008

This paper reports the behavioral outcomes of informational vs enhanced small-group educational interventions for drug users among 407 subjects in a short-term drug treatment program. Logistic regression was used to analyze drug use and sexual behaviors at the final follow-up visit. Among lower risk subjects, the enhanced intervention was more effective in reducing injection practices that produced risks in terms of human immunodeficiency virus infection; among those at highest risk, the informational interventions were more effective. The enhanced intervention was more effective than the informational interventions in reducing cocaine use at follow-up. No differential intervention effect on sexual risk behaviors was found.
Understanding AIDS: historical interpretations and the limits of biomedical individualism.
Authors: Fee E , Krieger N
Published: November 2008

The popular and scientific understanding of acquired immunodeficiency syndrome (AIDS) in the United States has been shaped by successive historical constructions or paradigms of disease. In the first paradigm, AIDS was conceived of as a "gay plague," by analogy with the sudden, devastating epidemics of the past. In the second, AIDS was normalized as a chronic disease to be managed medically over the long term. By examining and extending critiques of both paradigms, it is possible to discern the emergence of an alternative paradigm of AIDS as a collective chronic infectious disease and persistent pandemic. Each of these constructions of AIDS incorporates distinct views of the etiology, prevention, pathology, and treatment of disease; each tacitly promotes different conceptions of the proper allocation of individual and social responsibility for AIDS. This paper focuses on individualistic vs collective, and biomedical vs social and historical, understandings of disease. It analyzes the use of individualism as methodology and as ideology, criticizes some basic assumptions of the biomedical model, and discusses alternative strategies for scientific research, health policy, and disease prevention.
Water cost and availability: key determinants of family hygiene in a Peruvian shantytown.
Authors: Gilman R H , Marquis G S , Ventura G , Campos M , Spira W , Diaz F
Published: November 2008

OBJECTIVES. This study was conducted to determine whether poor hygiene practices are owing to difficulty in getting enough water and/or to ignorance of sanitary principles. METHODS. In a water-scarce shantytown in Lima, Peru, we observed in 12-hour periods over 3 consecutive days the amount of water and soap used for personal and domestic activities in 53 families and the frequency with which direct fecal contamination of hands was interrupted by washing. We also surveyed women in a similar shantytown concerning their knowledge of hygiene to ascertain whether noncompliance was owing to ignorance. RESULTS. Three hundred fecal contamination events were registered, of which only 38 (13%) were interrupted by hand washing within 15 minutes. The mean 12-hour per capita amount of water and soap used by the families was low. More than 80% of the water stored by these families had fecal coliforms. Yet the level of knowledge concerning the importance of hand washing and other hygienic practices was high. CONCLUSIONS. In water-scarce areas, sanitary education programs probably will not change hygiene practices. In these areas, an adequate supply of water is essential for good hygiene.
Young men's risk behaviors for HIV infection and sexually transmitted diseases, 1988 through 1991.
Authors: Ku L , Sonenstein F L , Pleck J H
Published: November 2008

OBJECTIVES. This paper analyzes age- and period-related changes in risk behaviors for human immunodeficiency virus (HIV) infection and sexually transmitted diseases among young men in the United States between 1988 and 1991. METHODS. Data were from the 1988 and 1991 waves of the National Survey of Adolescent Males. The 1988 survey was a nationally representative survey of 1880 males aged 15 through 19 years. The 1991 survey was a longitudinal follow-up of 1676 males aged 17 through 22 years. RESULTS. As they aged, the young men increased their levels of sexual activity and decreased their condom use. Period-related changes between 1988 and 1991 were examined by comparing similar cohorts of 17.5- through 19-year-old men: there were signs that sexual activity and intravenous drug injection increased, but condom use did not change significantly. In 1991 51% of the young men said they were occasionally "high" during sex, a state that is related to reduced condom use. CONCLUSIONS. Early progress in fostering safer behaviors among young men slowed and possibly stopped as the nation entered the 1990s. Prevention efforts need to be renewed and should focus on older youth and young adults.
Anthropometry and childhood mortality in northwest and southwest Uganda.
Authors: Vella V , Tomkins A , Borghesi A , Migliori G B , Ndiku J , Adriko B C
Published: November 2008

Two longitudinal studies were carried out in northwest and southwest Uganda to examine the relationship between anthropometry and childhood mortality. Although the prevalence of malnutrition was significantly different between the two geographic areas, the relative risk for mortality associated with low levels of anthropometry was similar. When the anthropometric parameters were compared among each other, mid-upper arm circumference was found to be the most powerful predictor of mortality. The findings of this study confirm that mid-upper arm circumference is the indicator of choice to identify children at higher risk of death.
Safety behavior among Iowa junior high and high school students.
Authors: Schootman M , Fuortes L J , Zwerling C , Albanese M A , Watson C A
Published: November 2008

The goal of this study was to determine demographic factors associated with reported safety behavior by studying 2250 Iowa junior high and high school students via a self-administered questionnaire. Students attending rural schools used front seat belts and helmets less frequently than urban students. Seat belt and helmet use and swim safety decreased dramatically with age. Occurrences of driving or riding while drunk or high increased with age. Boys were less likely than girls to wear back seat belts and moped helmets and to check water depth before diving. Possession of a driver's license was not independently associated with any of the safety behaviors.
Hormone replacement therapy: the need for reconsideration.
Authors: Rosenberg L
Published: November 2008

Millions of menopausal women are taking hormone supplements. Observational studies suggest that unopposed estrogens reduce the risk of cardiovascular disease and fractures and increase the risk of endometrial cancer and, possibly, breast cancer. In the absence of information from randomized trials, how much of the apparent beneficial effect on heart disease is due to the tendency of healthier women to use these drugs is unknown. The effect on the cardiovascular system of estrogen taken with a progestin is unknown, and this regimen may increase the risk of breast cancer. An approach to health and illness that focuses on a single cause or preventive and on single organ systems is severely limited. Alternative ways to improve cardiovascular and skeletal health that do not increase the risk of cancer are available. A reconsideration of the appropriate use of hormone supplements is needed.
Salmonella enteritidis infections in France and the United States: characterization by a deterministic model.
Authors: Watier L , Richardson S , Hubert B
Published: November 2008

OBJECTIVES. Epidemiological surveillance can be used to identify problems, suggest hypotheses, and assess the effectiveness of preventive actions. These objectives are pursued in the analysis of the dynamic evolution of Salmonella enteritidis infections. In this analysis, development of the epidemic in France and the United States is compared. METHODS. This analysis is based on the formulation of a simple deterministic compartmental model, in which human contact with contaminated food is expressed in terms of a baseline transmission rate. RESULTS. In France, the baseline transmission rate, stable up until 1986, is multiplied by 2.3 in 1987 and by 4.1 in 1988. There is no evidence of a slowdown of the linear rate of increase. In the Middle Atlantic region of the United States, the linear increase of the epidemic is similar to that observed in France. From 1990 a potential effect of the preventive measures is observed. CONCLUSIONS. The pattern of increase of the baseline transmission rate is similar in France and in the Middle Atlantic region of the United States. However, preventive measures, used in both areas, appeared more effective in the United States.
Cat scratch disease in the United States: an analysis of three national databases.
Authors: Jackson L A , Perkins B A , Wenger J D
Published: November 2008

OBJECTIVES. Current knowledge of the epidemiology of cat scratch disease is based primarily on information from case series. We used three national databases to obtain more representative data to determine the incidence and demographics of cat scratch disease. METHODS. Records coded with the diagnosis of cat scratch disease from two hospital discharge databases and an ambulatory care database were analyzed. Costs of diagnostic tests and hospitalization were obtained from a sample of providers and published data. RESULTS. The incidence of patients discharged from hospitals with a diagnosis of cat scratch disease was between 0.77 and 0.86 per 100,000 population per year. Fifty-five percent of the case patients were 18 years of age or younger. Males accounted for 60% of cases. Incidence varied by season; approximately 60% of case patients were discharged in the months September through January. The estimated incidence of disease in ambulatory patients was 9.3 per 100,000 population per year. On the basis of these rates, we estimated the annual health care cost of the disease to be more than $12 million. CONCLUSIONS. The rates and seasonality of cat scratch disease found in this study were consistent with previous reports. Adults represented a higher percentage of the total than reported in previous case series, suggesting that the disease may affect more adults than previously recognized.
Estimates of the US health impact of influenza.
Authors: Sullivan K M , Monto A S , Longini I M
Published: November 2008

OBJECTIVES. Data from the Tecumseh Community Health Study were used to estimate excess morbidity owing to influenza, and results were compared with estimates made previously using different methodology for an Institute of Medicine report. METHODS. Study participants from Tecumseh, Michigan, were classified as infected or noninfected based on laboratory results. The excess numbers of respiratory illnesses, respiratory illness days, and bed and restricted activity days experienced by the infected compared with the noninfected were estimated. RESULTS. The number of excess influenza-related respiratory illnesses was lower than that estimated in the Institute of Medicine report, in which all illnesses of certain characteristics occurring during an influenza season were attributed to influenza. It is now estimated that the US population under 20 years of age experiences a yearly average of 13.8 to 16.0 million influenza-related excess respiratory illnesses; for older individuals, the yearly estimate is 4.1 to 4.4 million excess illnesses. CONCLUSIONS. For public health purposes, estimates of excess morbidity as well as of total morbidity associated with influenza should be used in setting health priorities.
Multiethnic variations in the pregnancy outcomes of military dependents.
Authors: Alexander G R , Baruffi G , Mor J M , Kieffer E C , Hulsey T C
Published: November 2008

OBJECTIVES. We examined the pregnancy outcomes of three ethnic groups: African-American Blacks, non-Hispanic Whites, and Filipinos. In an attempt to reduce ethnic dissimilarities in parental employment and access to health care, this investigation compared the single-live-birth outcomes of married, adult women who resided in the state of Hawaii and who indicated that their spouse was on active-duty status in the US military. METHODS. The data for this study were obtained from the 1979-1989 Hawaii vital-record file that provides linked live birth-infant death information. Multiple logistic regression was used to calculate odds ratios for the independent effects of maternal factors on low birthweight and neonatal mortality. RESULTS. Significant differences in maternal age, maternal education, paternal education, parity, hospital of delivery, and use of prenatal care were observed among the ethnic groups. The results of a logistic regression analysis of low birthweight indicated significantly higher risks for Filipinos and Blacks compared with Whites. For very low birthweight, only an increased risk for Blacks was observed. No ethnic differences in neonatal mortality were found. CONCLUSIONS. This investigation revealed more comparable infant mortality experiences among the ethnic groups in spite of persistent birthweight differences.
Home health clients: characteristics, outcomes of care, and nursing interventions.
Authors: Martin K S , Scheet N J , Stegman M R
Published: November 2008

OBJECTIVES. The purpose of the study was to provide descriptive data about the characteristics of home health clients, the services that nurses provide, and the outcomes of those services. Such data have been sparse. METHODS. This study examined 2403 home health clients served by four agencies in Nebraska, New Jersey, and Wisconsin. Demographic, health history, and clinical data were analyzed. The Omaha System was used as the model for describing and measuring data specific to clients' health-related problems, nursing interventions, and outcomes of care. RESULTS. The median age of home health clients was 68.6 years. Nurses conducted 70% of all home visits, identified 9107 client problems, and provided over 96,000 interventions. Between admission and dismissal, clients improved by at least 0.52 point on three 5-point problem-specific outcome subscales (Knowledge, Behavior, and Status). CONCLUSIONS. These data show important characteristics of home health clients in a large national sample. They also support the usefulness of the Omaha System in describing and quantifying nursing practice in the community health setting. The magnitude of positive client change between admission and dismissal suggests that community health services do make a difference.
Nemesis revisited: tuberculosis infection in a New York City men's shelter.
Authors: Paul E A , Lebowitz S M , Moore R E , Hoven C W , Bennett B A , Chen A
Published: November 2008

In November 1990, a screening was conducted to determine the point prevalence of tuberculosis infection in a volunteer sample of homeless men (n = 161) living in a congregate shelter in New York City. Of those for whom we have results (n = 134), 79% were positive for tuberculosis. The mean length of shelter stay from date of shelter entry was 31.8 months and was significantly associated with the tuberculosis infection rate. The findings suggest that crowded living conditions and the presence of a stable resident pool in crowded congregate shelters may be associated with transmission of tuberculosis infection.
Inappropriate Halsted mastectomy and patient volume in Italian hospitals.
Authors: Grilli R , Mainini F , Penna A , Bertolini G , Scorpiglione N , Torri V , Liberati A
Published: November 2008

To study whether Halsted mastectomy was used only when properly indicated, a prospective survey was undertaken on the process of care of 985 breast cancer patients seen consecutively at 62 general hospitals in Northern and Central Italy. Overall, 79% of Halsted mastectomies were performed inappropriately. The procedure was less likely to be performed on more educated patients and, other factors considered, on those seen at hospitals with larger volume. We conclude that the measurement of utilization of a surgical procedure for which only a few appropriate indications exist may help identify important relationships between hospital characteristics and quality of surgical care.
The Behavioral Risk Factor Surveillance System questionnaire: its reliability in a statewide sample.
Authors: Stein A D , Lederman R I , Shea S
Published: November 2008

The reliability of the Behavioral Risk Factor Surveillance System questionnaire was assessed in a random sample of adults (n = 122) and a separate sample of Black and Hispanic adults (n = 200) in Massachusetts. The questionnaire was administered twice, 21 to 44 days apart, by telephone (210 completed reinterviews, 65% response rate for second administration). There were no statistically significant differences in the distribution of demographic or risk factor variables across administrations. Individual-level reliability (kappa for categorical variables, correlation for continuous variables) for demographic characteristics was more than 0.80 for White respondents and more than 0.60 for Black and Hispanic respondents. Employment and income were reported less consistently than other variables. Reliability coefficients for behavioral risk factors were generally above 0.70. Exceptions were variables with extreme distributions. These data support the use of the Behavioral Risk Factor Surveillance System questionnaire for surveillance and research.
Bringing care to the people: Lillian Wald's legacy to public health nursing.
Authors: Buhler-Wilkerson K
Published: November 2008

Lillian Wald invented public health nursing in 1893, making this year the field's centennial. One of nursing's visionaries, Wald secured reforms in health, industry, education, recreation, and housing. This historical inquiry examines three of Wald's critical experiments, each of which illuminates the past of public health nursing and its contemporary dilemmas: invention of public health nursing itself, establishment of a nationwide system of insurance payments for home-based care, and creation of a national public health nursing service.
The dissemination of smoking cessation methods for pregnant women: achieving the year 2000 objectives.
Authors: Windsor R A , Li C Q , Lowe J B , Perkins L L , Ershoff D , Glynn T
Published: November 2008

The smoking prevalence rate among adult women and pregnant women has decreased only 0.3 to 0.5% per year since 1969. Without a nationwide dissemination of efficacious smoking cessation methods based on these trends, by the year 2000 the smoking prevalence among pregnant women will be approximately 18%. This estimate is well above the US Department of Health and Human Services Year 2000 Objective of 10%. The US dissemination of tested smoking cessation methods could help an additional 12,900 to 155,000 pregnant smokers annually and 600,000 to 1,481,000 cumulatively to quit smoking during the 1990s. Dissemination could help achieve 31 to 78% of the Year 2000 Objectives for pregnancy smoking prevalence. (With dissemination, at best a 15% smoking prevalence during pregnancy, rather than the 10% objective, is likely to be observed.) Our results confirm a well-documented need for a national campaign to disseminate smoking cessation methods.
Socioeconomic status and prediction of ventricular fibrillation survival.
Authors: Hallstrom A , Boutin P , Cobb L , Johnson E
Published: November 2008

OBJECTIVES. The association between socioeconomic status and cardiac arrest is less well known than some other associations with cardiac arrest. We used property tax assessments as a measure of socioeconomic status in a study of victims of out-of-hospital cardiac arrest found in ventricular fibrillation. METHODS. We studied patients attended by the Seattle Fire Department's emergency medical services system between May 1986 and August 1988. During the period studied, 356 episodes met the study criteria; 114 (32%) of these patients survived without major neurologic deficit. Residential property tax assessments were available for 253 of the patients. RESULTS. After adjustments were made for age, witnessed collapse, bystander-initiated cardiopulmonary resuscitation, time from call to paramedic arrival, activity, location of collapse, and chronic morbidity, an association of survival with greater assessed value per living unit was observed. An increase of $50,000 in value per unit was associated with a 1.6-fold increase in survival rate. CONCLUSIONS. Not only are persons in the lower socioeconomic strata at greater risk for cardiac mortality, but they are also less likely to survive an episode of out-of-hospital cardiac arrest.
Smoking and suicide among nurses.
Authors: Hemenway D , Solnick S J , Colditz G A
Published: November 2008

Current evidence suggests a strong positive correlation between cigarette consumption and depression; this study examined the relationship between cigarettes and suicide. Over 100,000 predominantly White, middle-aged, female registered nurses were followed via biannual questionnaires from 1976 through 1988. Respondents smoking 1 through 24 cigarettes per day had twice the risk and those smoking 25 or more cigarettes four times the risk of committing suicide, compared with those who had never smoked. Although no information on causation was available, this paper links cigarettes to another major health problem.
A stop-smoking telephone help line that nobody called.
Authors: Glasgow R E , Lando H , Hollis J , McRae S G , La Chance P A
Published: November 2008

The purpose of this study was to evaluate the reach of a smoker's hotline that provided a variety of services to over 2100 health maintenance organization members. Formative evaluation procedures identified topics of concern, and repeated promotions advertised the service via multiple channels. Excluding a special giveaway promotion, an average of less than three calls per month were made during the 33 months of operation. To be cost-effective, smoker's hotlines should be offered to large populations and should be consistently and intensively publicized.
Benjamin Rush's educational campaign against hard drinking.
Authors: Katcher B S
Published: November 2008

More than 200 years ago, during a period of unprecedented production and consumption of distilled alcoholic beverages in the United States, Benjamin Rush launched a health education campaign that warned the public about the hazards of such beverages. He corrected erroneous notions about their presumed beneficial effects and accurately described more than a dozen alcohol-related health problems. Although the temperance movement has had a tumultuous history in the United States, the origin and long-standing tradition of temperance as a health promotion activity needs to be recognized.
Mental health services and outcome-driven health care.
Authors: Fogel B
Published: November 2008

Mental disorders and mental symptoms often go untreated in both chronic care and primary care settings. However, they covary with functional disability. They are likely to impair social and occupational function in medical outpatients and to cause excess instrumental and cognitive disability in frail older persons. In both groups, they are frequent and often remediable. The costs of untreated mental disorders are often shifted to caregivers and to society in general. To ensure adequate mental health care requires a reorientation of medical care toward optimizing function and well-being as well as longevity. Such a reorientation will necessarily entail more attention to treatable mental disorders. Research is needed to (1) develop firm knowledge on which to base integrated medical and mental health treatment and (2) evaluate the potential economic benefits of combined care. Incentives must be changed if such a paradigm of care is to prosper.
The effect of federal grants on medical schools' production of primary care physicians.
Authors: Rosenblatt R A , Whitcomb M E , Cullen T J , Lishner D M , Hart L G
Published: November 2008

OBJECTIVES. Title VII of the Health Professions Educational Assistance Act of 1976 was created to encourage the production of primary care physicians. This study explored recent trends in the proportion of US medical school graduates entering primary care in relationship to Title VII funding. METHODS. The American Medical Association Physician Masterfile was used to determine the specialty choice of all students graduating from American medical schools between 1960 and 1985. RESULTS. The proportion of graduates entering primary care rose from 19.7% in 1967 to 31.1% in 1976 and remained stable for the subsequent decade. The increase occurred before implementation of Title VII. Rural, state-owned medical schools with departments of family medicine tend to produce a greater proportion of primary care physicians than urban private schools without family medicine departments. CONCLUSIONS. The values of American medical schools and the reward structure of American medical practice favor the production of specialists over primary care physicians. Although Title VII helped to encourage and sustain the development of primary care educational programs at both the medical student and graduate levels, an increase in the proportion of primary care physicians will require fundamental changes.
The underrecognition of HIV infection in women in an inner-city emergency room.
Authors: Schoenbaum E E , Webber M P
Published: November 2008

OBJECTIVES. This study analyzed the recognition of human immunodeficiency virus (HIV) infection and associated factors in women and men attending an emergency room in the Bronx, New York, NY. METHODS. From April 16, 1989, to May 5, 1989, the emergency room records of 2102 consecutive patients 13 years of age or older were reviewed and, for 856 patients undergoing venipuncture, linked anonymously to results of HIV antibody tested in excess blood. RESULTS. HIV seroprevalence was 7.8% in women and 14.6% in men. Among seropositive women, 5.0% had acquired immunodeficiency syndrome (AIDS), compared with 26.0% of men. Excluding patients with AIDS, HIV infection was recognized in 13.2% of women and 27.0% of men. HIV infection was recognized only in women aged 25 through 44 years. In men, recognition occurred in all age groups. Clinical presentation did not distinguish the seropositive from seronegative women. Risk assessments were recorded less frequently for women (11.2%) than men (15.9%). For 92.5% of persons with any behavioral risk assessment, injecting drug use was the only behavior assessed. CONCLUSIONS. HIV infection is underrecognized in women, in part, because of a lower prevalence of AIDS. Universal HIV risk assessment, which includes heterosexual behaviors, may help increase recognition of HIV in women and opportunities for early intervention.
The underreporting of cocaine-related trauma: drug abuse warning network reports vs hospital toxicology tests.
Authors: Brookoff D , Campbell E A , Shaw L M
Published: November 2008

OBJECTIVE. The purpose of this study was to assess whether cocaine-related trauma is underreported to the US Federal Drug Abuse Warning Network (DAWN). METHODS. We compared DAWN reports filed by an urban emergency department with the department's toxicology results for patients treated for major trauma. DAWN regulations in effect during the study period required the reporting of all patients treated for injury who used drugs or who tested positive for drugs of abuse. RESULTS. Of 520 patients treated for major trauma, 217 (42%) were tested for a variety of drugs. Of these, 82 (38%) tested positive for cocaine. Of the 102 patients injured in motor vehicle accidents, 20 (20%) tested positive for cocaine. Of the 59 patients injured in motor vehicle accidents who were under age 40, 18 (30%) tested positive for cocaine. Of 100 victims of violent assault, 57 tested positive for cocaine. During the time period studied, DAWN recorded 48 hospital visits associated with cocaine, none involving trauma or injury. CONCLUSIONS. Cocaine-related trauma was unreported to DAWN despite the hospital's compliance with the system's guidelines. The pattern of DAWN reports from other institutions suggests that underreporting of cocaine-related injury is widespread.
California adults with elevated blood lead levels, 1987 through 1990.
Authors: Maizlish N , Rudolph L
Published: November 2008

OBJECTIVES. Follow-up of California blood lead registry reports, 95% of which are of occupationally exposed adults, can guide interventions at specific high-risk work sites and measure the impact of targeted, industry-specific interventions. METHODS. A protocol was implemented to follow up the most severe case reports (> or = 2.90 mumol/L) and establish a statistical database for descriptive analysis. RESULTS. From 1987 through 1990, the California Department of Health Services received 17,951 reports for 4069 civilian, noninstitutionalized adults employed by at least 328 companies. Of 232 incident case subjects with severe lead toxicity (> or = 2.90 mumol/L), 182 were successfully traced and interviewed. Index case subjects were mostly male (95%) and disproportionately Hispanic (46%); 35% lived with children aged 7 or younger, and 10% had been hospitalized. Ninety-four percent involved overexposures at work sites that lacked medical removal (50%), ventilation (36%), appropriate respirators (62%), training (64%), clothing changes (45%), or showering (60%). CONCLUSIONS. Well-known risk factors for occupational lead poisoning clustered at the work sites of index case subjects. Despite standards of the Occupational Safety and Health Administration, lead overexposure in California adults remains a significant public and occupational health concern.
The smoking habits of Minnesota physicians.
Authors: Hensrud D D , Sprafka J M
Published: November 2008

The prevalence of smoking among physicians has gradually declined over the past 25 years. Few recent studies have examined specific smoking habits. Of 393 physicians in the Minnesota Medical Association who responded to a survey (response rate of 83%), 9% reported smoking any form of tobacco. The prevalence of cigarette smoking was 4.9%, while 5.1% smoked a pipe and 2.1% smoked cigars. The prevalence estimates of current and former smokers were greater among men than women and among older than younger physicians. Cigarette and overall smoking prevalence among physicians continues to be well below levels reported for the general population.
Commentary: the new female condom--item 1 on a women's AIDS prevention agenda.
Authors: Gollub E L , Stein Z A
Published: November 2008

A US Food and Drug Administration (FDA) advisory panel has recommended that the female condom Reality be approved for contraception and acquired immunodeficiency syndrome (AIDS) prevention. Final FDA approval will mark the first official recognition of a woman-controlled method for protection against sexually transmitted disease. A female condom allows women to use just one method to respond to the twin anxieties of AIDS and unwanted pregnancy. In those couples in which the man refuses to wear a male condom, the availability of a female condom makes protection possible for the first time. Although the female condom has some advantages over the male condom--greater comfort for some women and men and nonreliance on male arousal--general population experience with the device is needed to achieve regular widespread use and hence effectiveness at population levels. The FDA still lags behind in responding to women's needs for information on AIDS and sexually transmitted disease.
A method for identifying persons at high risk for sexually transmitted infections: opportunity for targeting intervention.
Authors: Richert C A , Peterman T A , Zaidi A A , Ransom R L , Wroten J E , Witte J J
Published: November 2008

OBJECTIVES. The purpose of this study was to develop a method to identify persons at high risk for acquiring new sexually transmitted infections. METHODS. Computerized medical records from sexually transmitted disease clinics in Dade County, Florida, were used to conduct a retrospective cohort study. For all patients who visited in 1987, risk factors were identified for returning to the clinics within a year with a new sexually transmitted infection. Predictor variables were derived from the index visit and any visits in the year prior to the index visit. Logistic regression was used to develop a model that was applied to all patients who attended in 1989. RESULTS. Of 24,439 patients attending in 1987, 18.5% returned within a year with a new infection. Return rates were highest for 15- to 19-year-old Black males (31.8%). The highest odds ratios for returning were a diagnosis or treatment for an infection in the previous year and a diagnosis or treatment for infection at the index visit. The patients predicted to be at highest risk had a 39% return rate. There were as many new infections among the 2893 patients at highest risk as there were among the 13,326 patients at lowest risk. CONCLUSIONS. We developed a model that identifies persons at very high risk for sexually transmitted infection. These persons should be targeted for intensive intervention to reduce their risk.
Using a passive alcohol sensor to detect legally intoxicated drivers.
Authors: Foss R D , Voas R B , Beirness D J
Published: November 2008

OBJECTIVES. We examined whether a passive alcohol sensor could be used for mass screening of motorists to accurately and quickly detect drivers whose blood alcohol concentration exceeded a variety of levels often established as per se evidence of legal intoxication. METHODS. In a voluntary roadside survey, 1181 late-night drivers in Minnesota were interviewed. Breath measurements were taken with both a passive alcohol sensor and an evidentiary quality portable breath-test device. RESULTS. Measurements could be taken much more easily and quickly with the passive sensor, whose readings correlated very strongly (r = .87) with the evidentiary device. Moreover, for criterion blood alcohol concentration levels ranging from 100 mg/dL to 20 mg/dL, a large proportion of motorists could be accurately identified as being above or below the criterion, with relatively few false-negative or false-positive identifications. CONCLUSIONS. The use of passive alcohol sensors at sobriety checkpoints should allow motorists to be processed very quickly with minimal inconvenience. At the same time, detection of legally intoxicated motorists will probably be substantially increased and the general deterrent value of per se alcohol-impaired driving laws enhanced.
Prevalence of HIV infection among psychiatric patients in a New York City men's shelter.
Authors: Susser E , Valencia E , Conover S
Published: November 2008

We report on the prevalence of human immunodeficiency virus (HIV) infection among psychiatric patients in a New York City shelter for homeless men. We reviewed the records of all 90 men discharged from the shelter psychiatry program to community housing over a 2-year period. HIV serostatus was recorded for 62 of the 90 men. Of these 62, 12 (19.4%) were positive. There were 28 men whose serostatus was not recorded. Data on the HIV risk behaviors of these 28 men suggested that seroprevalence could have been similarly high among them. The results indicate an urgent need to develop and apply preventive interventions for HIV in this population.
The alcohol warning label and adolescents: the first year.
Authors: MacKinnon D P , Pentz M A , Stacy A W
Published: November 2008

Awareness of the alcohol labeling law and exposure to, beliefs about, and memory for the government-mandated alcohol warning label were measured in a sample of adolescents immediately before the label was required to appear (in the fall of 1989) and 1 year after the label was required. After the label was required, there were increases in awareness, exposure, and recognition memory, but there were not substantial changes in alcohol use or beliefs about the risks written on the warning.
A proposal for the mandatory inclusion of helmets with new children's bicycles.
Authors: Dannenberg A L , Vernick J S
Published: November 2008

To reduce bicycle-related head injuries in children, we propose new regulations be established that mandate the inclusion of approved helmets with the sale of all new children's bicycles. Currently, purchasing a helmet is a separate economic decision that acts as a barrier to helmet ownership and use. The inclusion of a helmet with the bicycle would markedly increase helmet ownership. The increased demand would reduce the manufacturing cost per helmet, so the cost of the bicycle with the helmet would be lower than the current retail price of the two separately. This proposal could potentially be implemented by federal or state legislation, a Consumer Product Safety Commission regulation, or voluntary adoption of a practice or standard by bicycle manufacturers. Increased helmet ownership is necessary but not sufficient to raise helmet use rates. The increased ownership generated by this proposal, complemented by enhanced educational, promotional, and legal interventions, is probably the most practical and cost-effective public health strategy available to increase helmet usage and prevent bicycle-related head injuries in children.
Racial misclassification of American Indians: its effect on injury rates in Oregon, 1989 through 1990.
Authors: Sugarman J R , Soderberg R , Gordon J E , Rivara F P
Published: November 2008

OBJECTIVES. We assessed the extent to which injury rates among American Indians in Oregon are underestimated owing to misclassification of race in a surveillance system. METHODS. The Oregon Injury Registry, a population-based surveillance system, was linked with the Indian Health Service patient registration file from Oregon, and injury rates for American Indians were calculated before and after correcting for racial misclassification. RESULTS. In 1989 and 1990, 301 persons in the Oregon registry were coded as American Indian. An additional 89 injured persons who were coded as a race other than American Indian in the registry were listed as American Indian in the Indian Health Service records. The age-adjusted annual injury rate for health service-registered American Indians was 6.9/1000, 68% higher than the rate calculated before data linkage. American Indian ancestry, female sex, and residence in metropolitan counties were associated with a higher likelihood of concordant racial classification in both data sets. CONCLUSION. Injury rates among American Indians in an Oregon surveillance system are substantially underestimated owing to racial misclassification. Linkage of disease registries and vital records with Indian Health Service records in other states may improve health-related data regarding American Indians.