bluuebunny/crossref_metadata_2025 huggingface dataset:
The completeness of AIDS case reporting, 1988: a multisite collaborative surveillance project.
Authors: Rosenblum L , Buehler J W , Morgan M W , Costa S , Hidalgo J , Holmes R , Lieb L , Shields A , Whyte B M
Published: November 2008

OBJECTIVES. The purpose of this study was to evaluate the completeness of acquired immunodeficiency syndrome (AIDS) case reporting. METHODS. Statewide or hospital-specific 1988 medical records were linked with AIDS surveillance in six sites. Medical records were reviewed for persons who had diagnoses suggesting human immunodeficiency virus (HIV) infection or AIDS but were not reported to AIDS surveillance by September 1989. RESULTS. Among 4500 hospitalized persons diagnosed with AIDS through 1988 in the six sites, completeness of reporting was 92% (95% CI = 89%, 96%; range across sites = 89% to 97%). Completeness of reporting was high in males (92%), females (95%), Whites (95%), Blacks (90%), Hispanics (92%), men reporting sexual contact with men (92%), persons reporting injecting-drug use (91%), and persons exposed to HIV through heterosexual contact (99%). In Medicaid enrollees (two states), completeness of reporting was 99% (95% CI = 95%, 99%) in inpatients and 90% (95% CI = 79%, 90%) in outpatients. Of previously reported persons with AIDS, 82% were reported within 5 months of diagnosis. CONCLUSIONS. Completeness of AIDS reporting was high, overall and in each major demographic and HIV exposure group. These results demonstrate that current surveillance data in these six sites provide timely and accurate information regarding persons with AIDS.
Disability in occupations in a national sample.
Authors: Leigh J P , Fries J F
Published: November 2008

OBJECTIVES. We sought to develop lists of jobs whose members reported high and low levels of functional disability. METHODS. Samples of women (n = 6096) and men (n = 3653) were drawn from the National Health and Nutrition Examination Survey I Epidemiological Follow-up. Disability was measured with a modified Stanford Health Assessment Questionnaire. We analyzed women and men separately, and we calculated average disability indices within longest-held occupations while adjusting for age, age-squared, married spouse present, and education. We minimized attrition bias with an econometric technique. RESULTS. From highest to lowest association with disability, the female broad occupations ranking was as follows: farming, no occupation, laborers, service, technicians, operatives, crafts workers, transportation operators, professionals, sales workers, administrative support, and managers. The male broad occupations ranking was as follows: no occupation, farming, operatives, crafts workers, service, technicians, manager, administrative support, sales, and professionals. The highest levels of disability for women and men occurred among nonconstruction laborers, farm workers, twisting machine operators, servants, machinery maintenance workers, mining machine operators, and bus drivers. CONCLUSIONS. Our results suggest that, in understanding levels of functional disability, occupational safety and health play a larger role than is generally assumed.
Risk reduction in sexual behavior: a condom giveaway program in a drug abuse treatment clinic.
Authors: Calsyn D A , Meinecke C , Saxon A J , Stanton V
Published: November 2008

Just before and 4 months after initiation of a condom giveaway program, a questionnaire regarding sexual behavior and condom acquisition was administered to 103 men attending an outpatient drug abuse treatment clinic. Jars filled with a variety of condoms were placed in every clinic room. Condom taking varied as a function of room. Sixty percent of the subjects reported taking condoms. At follow-up, clients reported increases in condom possession and in use of condoms for vaginal intercourse.
The progression of untreated HIV-1 infection prior to AIDS.
Authors: Hoover D R , Saah A , Bacellar H , Murphy R , Visscher B , Metz S , Anderson R , Kaslow R A
Published: November 2008

Using a case-control study of untreated men, we investigated the physical, mental, and economic effects of human immunodeficiency virus (HIV-1) infection prior to the diagnosis of acquired immunodeficiency syndrome (AIDS). Beginning 2 to 2.5 years prior to AIDS, case subjects reported more of 12 HIV-1 related symptoms and during the year prior to AIDS, at least 30.6 extra days of these symptoms than did control subjects. Within the 6 months preceding AIDS, case subjects' unemployment rose to 9% (P < or = .05) and depression to 34.2% (P < or = .001). At 6 to 12 months and within 6 months before AIDS, 17.1% and 31.5%, respectively, were anemic, while 37.7% and 64.7% had CD4+ counts less than 200 x 10(6)/L. Diagnosing AIDS at CD4+ counts less than 200 x 10(6)/L could significantly reduce pre-AIDS morbidity. Other implications of these findings are discussed.
Predictors of shelter use among low-income families: psychiatric history, substance abuse, and victimization.
Authors: Weitzman B C , Knickman J R , Shinn M
Published: November 2008

For poor housed and homeless families in New York City, NY, we examined the degree to which psychiatric and substance-abuse problems and victimization placed the families at elevated risk of requiring emergency housing, and we documented the prevalence of such problems. These problems were infrequently reported by both groups. However, past mental hospitalization, treatment in a detoxification center, childhood sexual abuse, and adult physical abuse were associated with increased risk of homelessness.
Cumulative trauma disorders of the hand and wrist in the auto industry.
Authors: Nelson N A , Park R M , Silverstein M A , Mirer F E
Published: November 2008

Surveillance for cumulative trauma disorders (CTDs) of the hand and wrist was carried out in five US automotive plants from 1985 to 1986, using Occupational Safety and Health Administration (OSHA) Form 200 injury and illness logs and medical insurance claims. Results using both record sources indicated that hand and wrist disorders may be more common in foundries than in other types of automotive plants. Similarly, in assembly plants, employees in certain departments appeared to be at higher risk for CTDs. Although our results are based on small numbers of cases, they suggest plants and departments that might be targeted for more detailed investigation.
A quality-of-life method for estimating the value of avoided morbidity.
Authors: French M T , Mauskopf J A
Published: November 2008

We developed a quality-of-life method for valuing changes in health status. Our model determines changes in health attributes for different illnesses and then estimates the dollar value of the corresponding welfare losses. We used our quality-of-life approach to estimate willingness to pay to avoid asthma, a headache, a cough, bronchitis, and arthritis. Estimates derived using our method are similar to those obtained from more expensive and restrictive traditional methods.
Antihypertensive treatment and US trends in stroke mortality, 1962 to 1980.
Authors: Casper M , Wing S , Strogatz D , Davis C E , Tyroler H A
Published: November 2008

OBJECTIVES. This study examines the association between increases in antihypertensive pharmacotherapy and declines in stroke mortality among 96 US groups stratified by race, sex, age, metropolitan status, and region from 1962 to 1980. METHODS. Data on the prevalence of controlled hypertension and socioeconomic profiles were obtained from three successive national health surveys. Stroke mortality rates were calculated using data from the National Center for Health Statistics and the Bureau of the Census. The association between controlled hypertension trends and stroke mortality declines was assessed with weighted regression. RESULTS. Prior to 1972, there was no association between trends in controlled hypertension and stroke mortality declines (beta = 0.04, P = .69). After 1972, groups with larger increases in controlled hypertension experienced slower rates of decline in stroke mortality (beta = 0.16, P = .003). Faster rates of decline were modestly but consistently related to improvements in socioeconomic indicators only for the post-1972 period. CONCLUSIONS. These results do not support the hypothesis that increased antihypertensive pharmacotherapy has been the primary determinant of recent declines in stroke mortality. Additional studies should address the association between declining stroke mortality and trends in socioeconomic resources, dietary patterns, and cigarette smoking.
Correlates of nonadherence to hypertension treatment in an inner-city minority population.
Authors: Shea S , Misra D , Ehrlich M H , Field L , Francis C K
Published: November 2008

OBJECTIVE. Adherence to treatment is a key factor in achieving blood pressure control among hypertensives. We examined correlates of nonadherence to hypertension treatment in an inner-city minority population. METHODS. Subjects (n = 202) were interviewed as part of a case-control study of severe, uncontrolled hypertension conducted in two New York City hospitals in 1989-91. All subjects were African American or Hispanic. Self-reported nonadherence to drug treatment for hypertension was measured using a five-item scale, and the sample was dichotomized as more (n = 87) or less (n = 115) adherent. Multiple logistic regression analysis was used to adjust for demographic and other covariates. RESULTS. Nonadherence was associated with having blood pressure checked in an emergency room (adjusted odds ratio [OR] = 7.9; 95% confidence interval [CI] = 1.75, 35.77; P < .01), lack of a primary care physician (adjusted OR = 2.9; 95% CI = 1.37, 6.02; P < .01), current smoking (adjusted OR = 2.4; 95% CI = 1.10, 5.22; P = .03), and younger age (adjusted OR = 1.03, 95% CI = 1.00, 1.06; P = .03). CONCLUSIONS. Changing the locus of care for hypertension from emergency rooms to primary care physicians may improve adherence to hypertension treatment in minority populations.
Correlates of obesity in young black and white women: the CARDIA Study.
Authors: Burke G L , Savage P J , Manolio T A , Sprafka J M , Wagenknecht L E , Sidney S , Perkins L L , Liu K , Jacobs D R
Published: November 2008

OBJECTIVES. Although differences in obesity between Blacks and Whites are well documented in adult women, less information is available on potential correlates of these differences, especially in young adults. METHODS. The association between behavioral and demographic factors and body size was assessed in 2801 Black and White women aged 18 to 30 years. RESULTS. Black women had significantly higher age-adjusted mean body mass index and subscapular skinfold thickness than did White women. Obesity had different associations with age and education across racial groups. A positive relationship between age and obesity was seen in Black women but not in White women, whereas a negative association between education and body size was noted only in White women. Potential contributing factors to the increased prevalence of obesity in Black women include a more sedentary lifestyle, higher energy intake, earlier menarche, and earlier age at first childbirth. CONCLUSIONS. The difference in obesity across race could not be explained completely by these factors, since within virtually all strata, Black women had higher body mass indexes. Further investigation is needed to develop interventional strategies to prevent or reduce excess levels of obesity in Black women.
The mortality of lead smelter workers: an update.
Authors: Steenland K , Selevan S , Landrigan P
Published: November 2008

OBJECTIVES. Mortality studies of lead workers have shown excesses of nonmalignant renal disease and cerebrovascular disease. Animal studies and one human study have shown excess kidney cancer. We have updated a mortality study of male lead smelter workers (n = 1990). METHODS. An analysis was conducted using standard life table techniques. The updated analysis added 11 years of follow-up and 363 new deaths. RESULTS. The original study had found elevated but nonsignificant risks for kidney cancer, stroke, and nonmalignant renal disease, probably attributable to lead exposure. Deaths from accidents and nonmalignant respiratory disease were significantly elevated, but probably not as a result of lead exposure. In the updated study, no new deaths from nonmalignant renal disease occurred (9 observed, standardized mortality ratio = 1.21). Three more deaths from kidney cancer were observed, yielding a standardized mortality ratio of 1.93 (9 observed, 95% CI = 0.88, 3.67), which increased for those who had worked in areas with the highest lead exposure (8 observed, standardized mortality ratio = 2.39, 95% CI = 1.03, 4.71). Cerebrovascular disease remained elevated for those with more than 20 years of exposure (26 observed, standardized mortality ratio = 1.41, 95% CI = 0.92, 2.07). CONCLUSIONS. This cohort with high lead exposure showed a diminishing excess of death from nonmalignant renal disease, a continued excess from kidney cancer, and an excess of cerebrovascular disease only in those with longest exposure to lead.
The social impact of dental problems and visits.
Authors: Gift H C , Reisine S T , Larach D C
Published: November 2008

OBJECTIVES. The purpose of this analysis was to assess selected social consequences of maintaining oral health and treating oral diseases. The associations among socioeconomic and demographic factors with time lost from work or school and reductions in normal activities are explored. METHODS. Data were gathered as part of the 1989 National Health Interview Survey from 50,000 US households (117,000 individuals), representing 240 million persons. The oral health care supplement was analyzed using the software SUDAAN to produce standard errors for estimates based on complex multistage sample designs. RESULTS. Because of dental visits or problems, 148,000 hours of work were lost per 100,000 workers, 117,000 hours of school were lost per 100,000 school-age children, and 17,000 activity days beyond work and school time were restricted per 100,000 individuals in 1989. Exploratory analyses suggest that sociodemographic groups have different patterns of such time loss and of reduced normal activities. CONCLUSIONS. Overall, there is low social impact individually from dental visits and oral conditions. At the societal level, however, such problems and treatments among disadvantaged groups appear to have a greater impact.
Prevention: the cost-effectiveness of the California Diabetes and Pregnancy Program.
Authors: Scheffler R M , Feuchtbaum L B , Phibbs C S
Published: November 2008

BACKGROUND: The California Diabetes and Pregnancy Program is a new preventive approach to improving pregnancy outcomes through intensive diabetes management preconception and early in pregnancy. METHODS. Hospital charges and length of stay data were collected on 102 program enrollees and 218 control cases. Ninety program enrollees and 90 control cases were matched on mother's age. White's classification, and race. Regression models controlled for these variables in addition to MediCal status, birth weight, and enrollment in the program. RESULTS. Hospital charges were about 30% less for program participants and days in the hospital were roughly 25% less. The program effects were larger for women that enrolled before 8 weeks gestation. More serious diabetics were also found to have larger reductions in charges and days. CONCLUSION. After adjusting for inflation and differences in charges across hospitals, $5.19 is saved for every dollar spent on the program.
Maternal smoking and the risk of polyhydramnios.
Authors: Myhra W , Davis M , Mueller B A , Hickok D
Published: November 2008

BACKGROUND. Washington State birth certificates were used to conduct a population-based case-control study to assess the possible association of maternal smoking with polyhydramnios. METHODS. All singleton births complicated by polyhydramnios (n = 557) were identified from the vital records for the years 1984 to 1987. For comparison, 1671 records were randomly selected for the same years from singleton births uncomplicated by polyhydramnios. RESULTS. Women who reportedly smoked prenatally were found to be at increased risk for polyhydramnios (relative risk [RR] = 1.7, 95% confidence interval [CI] = 1.5-2.1, adjusted for marital status, maternal age, and parity). When women with conditions known to be associated with polyhydramnios were excluded, the risk for those who smoked prenatally remained elevated (RR = 1.8, 95% CI = 1.1-2.3). CONCLUSION. Overdistention of the uterus from polyhydramnios may cause a variety of pregnancy complications. The observed association of smoking with polyhydramnios may be a further indication for public health interventions aimed at preventing smoking during pregnancy.
A cost-effectiveness analysis of three staffing models for the delivery of low-risk prenatal care.
Authors: Graveley E A , Littlefield J H
Published: November 2008

BACKGROUND. Health care costs are increasing at more than twice the rate of inflation, thus, public officials are seeking safe and economic methods to deliver quality prenatal care to poor pregnant women. This study was undertaken to determine the relationship between the cost and effectiveness of three prenatal clinic staffing models: physician based, mixed staffing, and clinical nurse specialist with physicians available for consultation. METHODS. Maternal and neonatal physiological outcome data were obtained from the hospital clinical records of 156 women attending these clinics. The women were then interviewed concerning their satisfaction with their prenatal care clinic. The financial officer from each clinic provided data on the clinic staffing costs and hours of service. RESULTS. There were no differences in outcomes for the maternal-neonatal physiological variables, although newborn admission to the Neonatal Intensive Care Unit (NICU) approached significance among the clinics. The clinic staffed by clinical nurse specialists had the greatest client satisfaction and the lowest cost per visit. CONCLUSIONS. The use of clinical nurse specialists might substantially reduce the cost of providing prenatal care while maintaining quality, and might thereby save valuable resources.
Nonclinical factors associated with surgery received for treatment of early-stage breast cancer.
Authors: Satariano E R , Swanson G M , Moll P P
Published: November 2008

BACKGROUND. Women diagnosed with early breast cancer have had the opportunity to receive breast-conserving surgical treatment, which reduces the physical and psychological morbidity heretofore associated with breast removal. METHODS. Nonclinical factors associated with women receiving partial mastectomies with radiation (P + R) compared with modified radical mastectomies without radiation (MOR) were examined in 2238 Black and White women diagnosed, in 1985 through 1987, with early-stage breast cancer in the metropolitan Detroit area. RESULTS. Age at diagnosis and size of hospital were the strongest predictors of type of surgery received, with younger women (less than 55 years of age) and women treated in larger hospitals (more than 500 beds) more than twice as likely to receive P + R. Stratifying on race, age at diagnosis remained the strongest predictor for White women, followed by hospital size. Among Black women, hospital size was more strongly associated with surgery received than was age. CONCLUSIONS. Younger women and women undergoing treatment at large hospitals are more likely to receive the breast-conserving P + R. Black women treated in small hospitals appear to be particularly unlikely to receive P + R.
AIDS in bisexual men in the United States: epidemiology and transmission to women.
Authors: Chu S Y , Peterman T A , Doll L S , Buehler J W , Curran J W
Published: November 2008

BACKGROUND. Homosexual and bisexual men with acquired immunodeficiency syndrome (AIDS) differ, and bisexual men play an important role in the sexual transmission of human immunodeficiency virus (HIV) to women. METHODS. To describe AIDS in these groups, we examined AIDS cases reported nationally through June 1990. RESULTS. Among 65 389 men who reported having had sex with men since 1977, 26% were bisexual. More Black (41%) and Hispanic men (31%) than White men (21%) reported bisexual behavior. Bisexual men were twice as likely to report intravenous drug use (20%) as were homosexual men (9%), regardless of race or ethnicity. Among 3555 women with heterosexually acquired AIDS, 11% reported sexual contact with a bisexual man and no other risk factor, although in some states approximately half reported such contact. In 1989, the AIDS rate due to sex with a bisexual man was three and five times higher among Hispanic and Black women, respectively, than among White women. CONCLUSIONS. Differences between bisexual and homosexual men with AIDS and the relative importance of AIDS in women due to sexual contact with bisexual men should be considered in the development of HIV prevention programs.
Workplace compliance with a no-smoking law: a randomized community intervention trial.
Authors: Rigotti N A , Bourne D , Rosen A , Locke J A , Schelling T C
Published: November 2008

BACKGROUND. Compliance with state and local laws restricting smoking in public places and workplaces has not been systematically evaluated. METHODS. We assessed workplace compliance with a comprehensive no-smoking law adopted in Brookline, Mass, and tested whether mailing information to businesses increased awareness of and compliance with the law. We conducted a random sample telephone survey of 299 businesses (87% response rate). Self-reported compliance was validated by direct observations. RESULTS. One year after its adoption, the law was popular with businesses. The prevalence of smoking restrictions, smoking policies, and no-smoking signs was 80%, 59%, and 40%, respectively. One third of businesses banned smoking. Full compliance with the law was low, however, because few businesses posted a copy of their smoking policy as required. The mailing increased employers' awareness of the law. Employers sent the mailing also reported better compliance, but this was not confirmed by direct observations. CONCLUSIONS. The law was popular and contributed to a high prevalence of workplace smoking restrictions. Different interpretations of the law by policymakers and businesses seemed to explain why formal compliance was low. The mailing increased awareness of, but not compliance with, the law.
Medicaid coverage of screening tests for breast and cervical cancer.
Authors: Boss L P , Guckes F H
Published: November 2008

Although most women receive periodic Papanicolaou smear (Pap) those who do not are more likely to be of lower socioeconomic status. Similarly, for the many women who do not receive periodic mammography for early diagnosis of breast cancer, cost has often been cited as a reason. Medicaid provides health benefits to roughly 9.4 million women of the appropriate ages for Pap tests and roughly 3.3 million women of the appropriate ages for mammography. The decision to provide such coverage is made on the state level. Of the 50 states and the District of Columbia, 49 provide some level of coverage for Pap smears, 39 for screening mammography. Knowing the extent of coverage allows public health professionals to take advantage of this funding source to provide services for lower-income women and may help initiate coverage in those states where it is not currently available.
Cesarean section rates in Italy by hospital payment mode: an analysis based on birth certificates.
Authors: Bertollini R , DiLallo D , Spadea T , Perucci C
Published: November 2008

The study, based on birth certificate data from 1985 through 1987, investigated cesarean section (CS) rates in the Lazio region of Italy and their relationship with mode of hospital care payment. Use of abdominal delivery increased from 22.3% in 1985 to 24.3% in 1987. CS rates were highest (34.7%) in private hospitals. A marked variation in the use of CS was associated with mode of hospital care payment independently from other predictors of abdominal delivery.
Smoking-related behavior, beliefs, and social environment of young black women in subsidized public housing in Chicago.
Authors: Manfredi C , Lacey L , Warnecke R , Buis M
Published: November 2008

Survey data indicate that young Black female smokers living in public housing are heavier smokers and have weaker motivation to quit, health beliefs and social environment less conducive to cessation, and less knowledge of where to get help to quit than other young Black female smokers in metropolitan Chicago. Compared with White women, the latter, other Black women smoke fewer cigarettes daily and have a stronger desire to quit and more concern about health reasons for quitting, but have a weaker belief in the risk of lung cancer from smoking, greater concern about quitting difficulties, and less knowledge of where to get help to quit. Low education, not race, is associated with higher smoking prevalence and less social pressure to quit or support for quitting.
Smoking initiation and cessation in relation to body fat distribution based on data from a study of Swedish women.
Authors: Lissner L , Bengtsson C , Lapidus L , Björkelund C
Published: November 2008

In a representative sample of Swedish women, smokers were significantly less obese than nonsmokers. However, a smoker was likely to have significantly more upper-body fat than a nonsmoker of similar body mass index. Women who quit smoking experienced less upper-body fat deposition than would be expected by their accompanying weight gain, suggesting that weight gained as a consequence of smoking cessation is not preferentially deposited in the region associated with increased cardiovascular risk.
Surveillance of occupational lead exposure in New Jersey: 1986 to 1989.
Authors: Tepper A
Published: November 2008

Between January 1986 and June 1989, 1916 New Jersey workers were identified through a surveillance system for occupational lead exposure. The average annual proportion of workers with a blood lead level above 2.42 mumol/L was 12%. Industries with the highest proportion of workers with blood lead levels above 2.42 mumol/L were special trade construction (35%) and industries dealing with scrap and waste materials (27%).
Provider compliance with recommended dietary fluoride supplement protocol.
Authors: Levy S M , Muchow G
Published: November 2008

Proper dosage of dietary fluoride supplements is important for children without access to optimally fluoridated water to balance dental caries prevention and risks of dental fluorosis. Subsequent to water fluoride assay, compliance by physicians and dentists with the recommended dietary fluoride supplement dosage schedule was determined for 446 children. Approximately one third of child patients and 42% of siblings did not receive the recommended supplement dosage.
Condom use in multi-ethnic neighborhoods of San Francisco: the population-based AMEN (AIDS in Multi-Ethnic Neighborhoods) Study.
Authors: Catania J A , Coates T J , Kegeles S , Fullilove M T , Peterson J , Marin B , Siegel D , Hulley S
Published: November 2008

We examined the prevalence and correlates of condom use in a community-based sample of unmarried heterosexual and gay/bisexual Whites, Blacks, and Hispanics (aged 20 to 44 years) in San Francisco (n = 1229). Only 9% of heterosexual males reported always using condoms, and fewer of those with multiple sexual partners (6%) reported always using condoms compared with those in monogamous relationships (12%). Much higher proportions of gay/bisexual men reported always using condoms (48%). Racial differences in condom use were observed only among women. Sexual communication and the sexual enjoyment value of condoms were consistent correlates of condom use across gender and sexual orientation, while other condom-related beliefs were significant predictors of condom use only for men. In general, condom promotion programs should build sexual communication skills, teach people how to enhance enjoyment with condoms, and reduce psychological barriers to condom acquisition and use.
Childhood chronic illness: prevalence, severity, and impact.
Authors: Newacheck P W , Taylor W R
Published: November 2008

BACKGROUND. Using data from the 1988 National Health Interview Survey, this article presents national estimates of the prevalence and impact of childhood chronic conditions. METHODS. Proxy responses to a checklist of child health conditions administered for 17,110 children under 18 years of age were used. Conditions were classified as chronic if they were first noticed more than 3 months prior to the interview or if they were the type that would ordinarily be of extended duration, such as arthritis. RESULTS. An estimated 31% of children were affected by chronic conditions. Among these children, highly prevalent conditions included respiratory allergies 9.7 per 100, repeated ear infections 8.3 per 100 and asthma 4.3 per 100. These children can be divided into three groups: 66% with mild conditions that result in little or no bother or activity limitation; 29% with conditions of moderate severity that result in some bother or limitation of activity, but not both; and 5% with severe conditions that cause frequent bother and limitation of activity. The 5% with severe conditions accounted for 19% of physician contacts and 33% of hospital days related to chronic illness. CONCLUSIONS. Childhood chronic conditions have highly variable impacts on children's activities and use of health care.
Birth weight and perinatal mortality: the effect of gestational age.
Authors: Wilcox A J , Skjaerven R
Published: November 2008

BACKGROUND. The strong association between birth weight and perinatal mortality is due both to gestational age and to factors unrelated to gestational age. Conventional analysis obscures these separate contributions to perinatal mortality, and overemphasizes the role of birth weight. An alternative approach is used here to separate gestational age from other factors. METHODS. Data are from 400,000 singleton births in the Norwegian Medical Birth Registry. The method of Wilcox and Russell is used to distinguish the contributions to perinatal mortality made by gestational age and by relative birth weight at each gestational age. RESULTS. Gestational age is a powerful predictor of birth weight and perinatal survival. After these effects of gestational age are controlled for, relative birth weight retains a strong association with survival. CONCLUSIONS. Current public health policies in the United States emphasize the prevention of low birth weight. The present analysis suggests that the prevention of early delivery would benefit babies of all birth weights.
Low birth weight in relation to multiple induced abortions.
Authors: Mandelson M T , Maden C B , Daling J R
Published: November 2008

BACKGROUND. Most studies report that a single induced abortion does not increase risk for delivering a low birth weight infant in a subsequent pregnancy. However, the effect of multiple abortions has not been adequately evaluated. METHODS. This relationship was studied in 6541 White women who delivered their first child between 1984 and 1987. We compared the frequencies of low birth weight (less than 2500 g) among infants born to 1999 women without prior induced abortion and 1999 women with one abortion with the frequencies of low birth weight among infants born to women with two (n = 1850), three (n = 520), and four or more (n = 173) prior induced abortions. RESULTS. After adjustment for confounding variables, we found no linear relationship in risk of low birth weight among women with one (relative risk [RR] = 1.2, 95% confidence interval [CI] = 0.9-1.5), two (RR = 1.5, 95% CI = 1.1-2.0), three (RR = 1.3, 95% CI = 0.8-1.9), or four or more (RR = 1.6, 95% CI = 0.9-2.9) prior induced abortions. CONCLUSIONS. These findings confirm earlier reports of little or no evidence of harmful effects on birth weight by one or by two or more induced abortions. We further report that risk is not significantly elevated even in women with three, four, or more prior terminations of pregnancy when compared with women with one or two abortions.
The Behavioral Risk Factor Survey and the Stanford Five-City Project Survey: a comparison of cardiovascular risk behavior estimates.
Authors: Jackson C , Jatulis D E , Fortmann S P
Published: November 2008

BACKGROUND. Nearly all state health departments collect Behavioral Risk Factor Survey (BRFS) data, and many report using these data in public health planning. Although the BRFS is widely used, little is known about its measurement properties. This study compares the cardiovascular risk behavior estimates of the BRFS with estimates derived from the physiological and interview data of the Stanford Five-City Project Survey (FCPS). METHOD. The BRFS is a random telephone sample of 1588 adults aged 25 to 64; the FCPS is a random household sample of 1512 adults aged 25 to 64. Both samples were drawn from the same four California communities. RESULTS. The surveys produced comparable estimates for measures of current smoking, number of cigarettes smoked per day, rate of ever being told one has high blood pressure, rate of prescription of blood pressure medications, compliance in taking medications, and mean total cholesterol. Significant differences were found for mean body mass index, rates of obesity, and, in particular, rate of controlled hypertension. CONCLUSIONS. These differences indicate that, for some risk variables, the BRFS has limited utility in assessing public health needs and setting public health objectives. A formal validation study is needed to test all the risk behavior estimates measured by this widely used instrument.
Evaluation of an intervention to reduce playground hazards in Atlanta child-care centers.
Authors: Sacks J J , Brantley M D , Holmgreen P , Rochat R W
Published: November 2008

In 1988, we identified playground hazards at 58 child-care centers (CCCs) and intervened by showing the director the hazards and distributing safety information. In 1990, we evaluated the 58 intervention CCCs as well as 71 randomly selected control CCCs. Intervention centers had 9.4 hazards per playground; control centers had 8.0. We conclude that the intervention was ineffective.
Which newborns in New York City are at risk for special education placement?
Authors: Goldberg D , McLaughlin M , Grossi M , Tytun A , Blum S
Published: November 2008

In this study of 162 third graders in New York City public schools, we found that slightly over half of the children in special education were males who had Medicaid coverage at birth and mothers with medical conditions or adverse health habits noted on the birth certificate; two thirds of the children with this combination of characteristics actually were placed in special education. These findings suggest that newborns at risk for later learning disabilities can be targeted to receive preventive interventions.
The lowest birth-weight infants and the US infant mortality rate: NCHS 1983 linked birth/infant death data.
Authors: Overpeck M D , Hoffman H J , Prager K
Published: November 2008

The National Center for Health Statistics Linked Birth and Infant Death Data Set, 1983 birth cohort, shows that infants weighing less than 750 g, comprising only 0.3% of all births, account for 25% of deaths in the first year of life and for 41% of deaths in the first week. If interventions had prevented the death of these very small babies, the infant mortality rate would have been 8.3 per 1000 live births instead of 10.9, and the Black/White mortality differential would have been reduced by 25%.
Performance of the Reflotron in Massachusetts' Model System for Blood Cholesterol Screening Program.
Authors: Havas S , Bishop R , Koumjian L , Reisman J , Wozenski S
Published: November 2008

The precision, accuracy, and durability of the Reflotron were evaluated by the Massachusetts Model Systems for Blood Cholesterol Screening Program. Screenings were conducted in diverse community settings over 16 months. Fingerstick samples from 10,428 individuals were tested. None of the four analyzers met the 1992 standards for precision, although two met the 1992 standards for accuracy. More than 40% of Reflotron values differed from the reference laboratory values by upwards of 5%. More than 16% of individuals were misclassified in terms of their risk category. All four instruments malfunctioned during the project.
Standards for peer evaluation: the hospital quality assurance committee.
Authors: Feldman S E , Roblin D W
Published: November 2008

Required recertification of physicians has been proposed as a way to improve quality of care. Hospital medical staff quality assurance committees may be more meaningful targets for reform than individual physicians. Review standards are needed to make these committees effective monitors. Increasing regulatory attention to medical staff peer review can be expected.
Cognitive and attitudinal impacts of a university AIDS course: interdisciplinary education as a public health intervention.
Authors: Strauss R P , Corless I B , Luckey J W , van der Horst C M , Dennis B H
Published: November 2008

This paper describes an interdisciplinary, variable credit-bearing university course on acquired immunodeficiency syndrome (AIDS) that enrolled 429 students. Pre- and post-course questionnaires were used to assess knowledge and attitudes relative to AIDS and these were compared to National Health Interview Survey findings. Considerable cognitive and attitudinal changes occurred over the course period. University courses, taught annually, were found to be an efficient mechanism for educating large numbers of future community leaders and professionals about AIDS.
Fear of dying and HIV infection vs hepatitis B infection.
Authors: Schneiderman L J , Kaplan R M
Published: November 2008

Accidental exposure to the blood of hepatitis B patients produced less fear than does accidental exposure today to the human immunodeficiency virus (HIV), even though both have an approximately equal overall risk of death (approximately 1%). Subjects responding to hypothetical insect-exposure and disease-exposure scenarios chose to avoid the HIV-type risk of 1% chance of exposure/100% chance of death. Fear of certain death seems to account for the greater concern about exposure to HIV than to Hepatitis B.
Prevalence of HIV antibodies in transsexual and female prostitutes.
Authors: Modan B , Goldschmidt R , Rubinstein E , Vonsover A , Zinn M , Golan R , Chetrit A , Gottlieb-Stematzky T
Published: November 2008

Human immunodeficiency virus (HIV) prevalence was studied in an unselected group of 216 female and transsexual prostitutes. Subjects were asked about age, biological sex, marital status, children, length of occupation, sexual practices, and drug abuse history. Blood was drawn on site. All 128 females who did not admit to drug abuse were seronegative; 2 of the 52 females (3.8%) who admitted to intravenous drug abuse were seropositive. In contrast, 11.1% of the 36 male transsexuals (including 3 out of 32 non-drug abusers) were seropositive. The results support the notion that vaginal transmission of HIV is less effective than anal transmission.
Risk factors associated with antibodies to leptospires in inner-city residents of Baltimore: a protective role for cats.
Authors: Childs J E , Schwartz B S , Ksiazek T G , Graham R R , LeDuc J W , Glass G E
Published: November 2008

Leptospiral antibody prevalence was 16% in residents of Baltimore. Seropositivity was associated with age, gender, race, and bird ownership, reduced the antibody risk associated with age and race from odds ratios (95% confidence interval) of 3.3 (2.0, 5.5) and 3.3 (1.1, 9.3), respectively, to the baseline level. These data establish the high prevalence of leptospiral antibody in Baltimore and suggest a protective role for cats in reducing the risk of human infection.
The epidemiology of low back pain in an adolescent population.
Authors: Olsen T L , Anderson R L , Dearwater S R , Kriska A M , Cauley J A , Aaron D J , LaPorte R E
Published: November 2008

We assessed the prevalence of low back pain (LBP) in a cohort of 1242 adolescents (aged 11 through 17) currently participating in a 4-year prospective study of medically treated injuries. Overall, 30.4% of the adolescents reported LBP. The impact of LBP in adolescents was considerable, with one third resulting in restricted activity and 7.3% seeking medical attention. Life-table analysis demonstrated that by age 15, the prevalence of LBP increased to 36%. There were few differences by gender or race. These results suggest that LBP in adolescents is a serious public health problem.
Barrier contraceptives and sexually transmitted diseases in women: a comparison of female-dependent methods and condoms.
Authors: Rosenberg M J , Davidson A J , Chen J H , Judson F N , Douglas J M
Published: November 2008

INTRODUCTION. Most efforts at sexually transmitted disease (STD) protection center on condom use, but little is known about how condoms compare with other barrier methods, particularly those controlled by women. METHODS. To evaluate the effect of different barrier contraceptives on the prevalence of STDs and other vaginal infections, we retrospectively studied 5681 visits by women to an urban STD clinic. RESULTS. As compared with women using no contraceptive or with tubal ligations, women using the contraceptive sponge or diaphragm had at least 65% lower rates of infection with Neisseria gonorrhoeae and Trichomonas vaginalis, while condom users had 34% and 30% lower rates, respectively. For Chlamydia trachomatis, the reduction was 13% among sponge users, 72% among diaphragm users, and 3% among condom users, although these differences were not significant. When compared with women using condoms, women using female-dependent methods (sponge or diaphragm) had significantly lower rates of both gonorrhea and trichomoniasis. Vaginal candidiasis was more common among women using diaphragms but not other barrier methods, while rates of bacterial vaginosis were similar among all groups. CONCLUSIONS. Women using the contraceptive sponge or diaphragm experience protection from STDs to a greater extent than those relying on condoms. Female-dependent barrier contraceptives should receive more attention in STD risk-reduction programs.
Pregnancy-induced hypertension in North Carolina, 1988 and 1989.
Authors: Savitz D A , Zhang J
Published: November 2008

INTRODUCTION. Pregnancy-induced hypertension (PIH) is a highly prevalent pregnancy complication with adverse effects on maternal and infant health. Epidemiologic research concerning its etiology is limited. METHODS. Birth records from North Carolina for the period 1988 through 1989 included an indication of the presence of PIH. The risk of PIH was examined in relation to several maternal characteristics and exposures, including reproductive history, demographic characteristics, and tobacco use during pregnancy. Risk ratio estimates, adjusted for confounders, were calculated contrasting PIH among exposed vs unexposed women. RESULTS. The overall risk of PIH was 43.1 per 1000 births, with multiple pregnancies, nulliparity, and advanced maternal age associated with markedly increased risks. Tobacco use was inversely associated with PIH, and Blacks and Whites were at virtually equal risk. CONCLUSIONS. Problems in diagnosis and classification impede research in this area, with birth certificates limited in quality and breadth of information. Nonetheless, several patterns emerged that are worthy of further epidemiologic evaluation using more sophisticated designs.
The transformation of American midwifery: 1975 to 1988.
Authors: Declercq E R
Published: November 2008

BACKGROUND. The use of midwives is a natural solution to the problem of improving access to skilled perinatal services while lowering costs. The number of midwife-attended births has grown from 0.9% of all births in 1975 to 3.4% of all births in 1988. The purpose of the study was to determine how mothers served by midwives and the settings in which they are served have changed in that period. METHODS. The analysis is based on birth certificate data from 1975 to 1988 from the Natality, Marriage and Divorce Statistics Branch of the National Center for Health Statistics, Centers for Disease Control. RESULTS. Almost all of the growth (93.2%) in midwife-attended births from 1975 to 1988 was in hospitals; 87.3% of all births attended by midwives occurred in hospitals. Pronounced differences exist between mothers served by midwives in and outside of hospitals, and there are strong regional patterns in midwife attendance at birth. CONCLUSIONS. Given the positive outcomes associated with midwifery practice, further research into the content of midwifery care is recommended.
Carrier screening for cystic fibrosis: a pilot study of the attitudes of pregnant women.
Authors: Botkin J R , Alemagno S
Published: November 2008

We surveyed the attitudes of a consecutive sample of 306 pregnant Caucasian women toward carrier screening for cystic fibrosis. Of the 214 respondents, 98% said that screening should be offered before pregnancy, and 69% said they would accept carrier screening during pregnancy. Twenty-nine percent of the respondents indicated a willingness to terminate a pregnancy if the fetus were found to have cystic fibrosis. We conclude that carrier screening is of interest to pregnant women, although interest in terminating a pregnancy because of screening results may be limited.
Access to cancer screening services for women.
Authors: Kirkman-Liff B , Kronenfeld J J
Published: November 2008

A major effort in preventive care for women has emphasized the obtaining of Pap smears and mammograms. This paper uses survey data from one state to examine issues of access to Pap smears and mammograms. Poor women receiving health care through a managed-care Medicaid program received these services at the same rate as women with other types of health insurance, while the uninsured were less likely to have had either type of service.
Swimming-associated cryptosporidiosis.
Authors: Sorvillo F J , Fujioka K , Nahlen B , Tormey M P , Kebabjian R , Mascola L
Published: November 2008

In July and August 1988, an outbreak of gastroenteritis affected 44 of 60 (73%) persons from 5 separate swimming groups who had used the same swimming pool in Los Angeles. Cryptosporidium was identified in 5 of 8 (63%) stool specimens, and the clinical picture was consistent with Cryptosporidium infection. Resistance of Cryptosporidium to chlorine, an inadequately maintained pool filtration system, repeated exposure to pool water, and possible continuing pool contamination may have contributed to ongoing transmission. Cryptosporidium should be considered a potential etiologic agent of gastroenteritis associated with recreational water use.
Weight gain prevention and smoking cessation: cautionary findings.
Authors: Hall S M , Tunstall C D , Vila K L , Duffy J
Published: November 2008

OBJECTIVES. Weight gain is a consistent sequela of smoking cessation. A successful intervention might attract smokers who fear weight gain. If the gain causes smoking relapse, such an intervention might reduce smoking relapse risk. METHODS. Using a sample of 158 smokers who completed a 2-week smoking treatment program, we compared an innovative weight gain prevention intervention with both a nonspecific treatment and standard treatment. Subjects were assessed on weight and smoking behavior and followed for 1 year. RESULTS. A disturbing, unexpected finding was that subjects in both the innovative and nonspecific conditions had a higher risk of smoking relapse than did standard treatment subjects. Some differences were observed between abstinent and smoking subjects in weight gain by treatment condition. CONCLUSIONS. Both active interventions may have been so complicated that they detracted from nonsmoking. Also, caloric restriction may increase the reinforcing value of nicotine, a psychoactive drug, thereby increasing smoking relapse risk. The magnitude of weight gain after smoking cessation may not merit interventions that increase smoking risk. Perhaps attitudinal modifications are the most appropriate.