bluuebunny/crossref_metadata_2025 huggingface dataset:
Microbiologic Changes Following Administration of Locally Delivered Doxycycline in Smokers: A 15‐Month Follow‐Up
Authors: Shaddox Luciana M. , Andia Denise Carleto , Casati Marcio Zaffalon , Nociti Francisco Humberto , Sallum Enilson Antonio , Gollwitzer Jennifer , Walker Clay B.
Published: October 2007

Background: Additional clinical benefits have been reported with the use of locally delivered antimicrobials in the treatment of smokers; however, long‐term changes in the subgingival microbiota following the use of these drugs in smokers have not been documented. The aim of this study was to evaluate long‐term microbiologic changes following locally delivered doxycycline in the treatment of smokers.

Methods: Sixteen smokers with chronic periodontitis presenting a minimum of four pockets (probing depth ≥5 mm) were selected. Patients were assigned randomly to receive scaling and root planing (SRP) or SRP and local doxycycline (SRP‐D). Patients were treated at baseline and 12 months. Subgingival plaque samples were collected at baseline; 3, 6, and 12 months; and 45 and 90 days following retreatment. Polymerase chain reaction and DNA–DNA hybridization analyses were performed to detect the presence of selected periodontal pathogens.

Results: The reduction in the number of sites positive for Porphyromonas gingivalis and Tannerella forsythia (previously T. forsythensis) was statistically significant for SRP‐D at 3 months (68% and 41.3%, respectively) and for SRP at 6 months (75% and 52%, respectively) following treatment. The SRP group showed a greater frequency of P. gingivalis than the SRP‐D group at 3 months (58% and 25%, respectively). There also was a greater reduction in the frequency of P. gingivalis at 3 months following retreatment with SRP‐D compared to SRP (47% and 8%, respectively).

Conclusion: In smokers, adjunctive local doxycycline resulted in a greater reduction in the frequency of P. gingivalis following initial and supportive therapy compared to conventional treatment.
Commentary: Prognosis Revisited: A System for Assigning Periodontal Prognosis
Authors: Kwok Vivien , Caton Jack G.
Published: October 2007

Prognosis is an integral part of the periodontal practice because it directly influences treatment planning. However, there is limited direct evidence in the literature regarding the assignment of periodontal prognosis. There are several important concepts to consider in developing a system of periodontal prognosis. Traditional systems are based on tooth loss and may have limited use for patient management. On the other hand, prognosis can be based on stability of the periodontal supporting apparatus, which is influenced by more evidence‐based factors and may be more useful for patient management. Other important concepts include the timing of the projection (short and long term) and the consideration of individual teeth versus the overall dentition. Historically, several authors have formulated and investigated their own prognostication systems. Results were variable, but they generally showed that systems based on tooth loss were unpredictable over the long term. Therefore, the purpose of this report is to review relevant literature and propose a new periodontal prognostication system.
Serious Psychological Distress Among Parenting and Nonparenting Adults
Authors: Herman-Stahl Mindy , Ashley Olivia Silber , Penne Michael A. , Bauman Karl E. , Weitzenkamp David , Aldridge Molly , Gfroerer Joseph C.
Published: October 2007

Objectives. We compared the prevalence of serious psychological distress among parenting adults with the prevalence among nonparenting adults and the sociodemographic correlates of serious psychological distress between these 2 populations.

Methods. We drew data from 14240 parenting adults and 19224 nonparenting adults who responded to the 2002 National Survey on Drug Use and Health. We used logistic regression procedures in our analysis.

Results. An estimated 8.9% of parenting adults had serious psychological distress in the prior year compared with 12.0% of nonparenting adults of similar age. In both groups, the adjusted odds of having serious psychological distress were higher among adults who were women, younger (between the ages of 18 and 44 years), low income, or receiving Medicaid. We found some differences in the correlates of serious psychological distress between parenting adults and nonparenting adults. The odds of having serious psychological distress were lower among parenting adults after we controlled for demographic characteristics.

Conclusions. Serious psychological distress is fairly prevalent among parenting adults, and high-risk sociodemographic groups of parenting adults should be targeted to ensure access to coordination of services.
Relationships Between Skin Color, Income, and Blood Pressure Among African Americans in the CARDIA Study
Authors: Sweet Elizabeth , McDade Thomas W. , Kiefe Catarina I. , Liu Kiang
Published: October 2007

Objectives. We explored how income and skin color interact to influence the blood pressure of African American adults enrolled in the longitudinal Coronary Artery Risk Development in Young Adults (CARDIA) Study.

Methods. Data were derived from 1893 African American CARDIA year-15 participants who had undergone skin reflectance assessments at year 7. We adjusted for age, gender, body mass index, smoking status, and use of antihypertensive medication to examine whether year-15 self-reported family incomes, in interaction with skin reflectance, predicted blood pressure levels.

Results. Mean systolic and diastolic blood pressure levels were 117.1 (±16.07) and 76.9 (±12.5) mm Hg, respectively. After adjustment, the interaction between skin reflectance and income was significantly associated with systolic blood pressure (P< .01). Among lighter-skinned African Americans, systolic pressure decreased as income increased (b= −1.15, P<.001); among those with darker skin, systolic blood pressure increased with increasing income (b=0.10, P=.75).

Conclusions. The protective gradient of income on systolic blood pressure seen among African Americans with lighter skin is not observed to the same degree among those with darker skin. Psychosocial stressors, including racial discrimination, may play a role in this relationship.
Health Status, Health Care Use, Medication Use, and Medication Adherence Among Homeless and Housed People Living With HIV/AIDS
Authors: Kidder Daniel P. , Wolitski Richard J. , Campsmith Michael L. , Nakamura Glenn V.
Published: October 2007

Objectives. We sought to compare health status, health care use, HIV anti-retroviral medication use, and HIV medication adherence among homeless and housed people with HIV/AIDS.

Methods. Data were obtained from a cross-sectional, multisite behavioral survey of adults (N=7925) recently reported to be HIV positive.

Results. At the time interviews were conducted, 304 respondents (4%) were homeless. Self-ratings of mental, physical, and overall health revealed that the health status of homeless respondents was poorer than that of housed respondents. Also, homeless respondents were more likely to be uninsured, to have visited an emergency department, and to have been admitted to a hospital. Homeless respondents had lower CD4 counts, were less likely to have taken HIV anti-retroviral medications, and were less adherent to their medication regimen. Homeless respondents needed more HIV social and medical services, but nearly all respondents in both groups had received needed services. Housing status remained a significant predictor of health and medication outcomes after we controlled for potential confounding variables.

Conclusions. Homeless people with HIV/AIDS are at increased risk of negative health outcomes, and housing is a potentially important mechanism for improving the health of this vulnerable group.
WAR & Military Mental Health
Authors: Pols Hans , Oak Stephanie
Published: October 2007

Involvement in warfare can have dramatic consequences for the mental health and well-being of military personnel. During the 20th century, US military psychiatrists tried to deal with these consequences while contributing to the military goal of preserving manpower and reducing the debilitating impact of psychiatric syndromes by implementing screening programs to detect factors that predispose individuals to mental disorders, providing early intervention strategies for acute war-related syndromes, and treating long-term psychiatric disability after deployment.

The success of screening has proven disappointing, the effects of treatment near the front lines are unclear, and the results of treatment for chronic postwar syndromes are mixed.

After the Persian Gulf War, a number of military physicians made innovative proposals for a population-based approach, anchored in primary care instead of specialty-based care. This approach appears to hold the most promise for the future.
The Effect of Restricting Opening Hours on Alcohol-Related Violence
Authors: Duailibi Sergio , Ponicki William , Grube Joel , Pinsky Ilana , Laranjeira Ronaldo , Raw Martin
Published: October 2007

Objective. We investigated whether limiting the hours of alcoholic beverage sales in bars had an effect on homicides and violence against women in the Brazilian city of Diadema. The policy to restrict alcohol sales was introduced in July 2002 and prohibited on-premises alcohol sales after 11 pm.

Methods. We analyzed data on homicides (1995 to 2005) and violence against women (2000 to 2005) from the Diadema (population 360 000) police archives using log-linear regression analyses.

Results. The new restriction on drinking hours led to a decrease of almost 9 murders a month. Assaults against women also decreased, but this effect was not significant in models in which we controlled for underlying trends.

Conclusions. Introducing restrictions on opening hours resulted in a significant decrease in murders, which confirmed what we know from the literature: restricting access to alcohol can reduce alcohol-related problems. Our results give no support to the converse view, that increasing availability will somehow reduce problems.
The Veterans Health Administration and Military Sexual Trauma
Authors: Kimerling Rachel , Gima Kristian , Smith Mark W. , Street Amy , Frayne Susan
Published: October 2007

Objectives. We examined the utility of the Veterans Health Administration (VHA) universal screening program for military sexual violence.

Methods. We analyzed VHA administrative data for 185 880 women and 4139888 men who were veteran outpatients and were treated in VHA health care settings nationwide during 2003.

Results. Screening was completed for 70% of patients. Positive screens were associated with greater odds of virtually all categories of mental health comorbidities, including posttraumatic stress disorder (adjusted odds ratio [AOR]=8.83; 99% confidence interval [CI] = 8.34, 9.35 for women; AOR = 3.00; 99% CI = 2.89, 3.12 for men). Associations with medical comorbidities (e.g., chronic pulmonary disease, liver disease, and for women, weight conditions) were also observed. Significant gender differences emerged.

Conclusions. The VHA policies regarding military sexual trauma represent a uniquely comprehensive health care response to sexual trauma. Results attest to the feasibility of universal screening, which yields clinically significant information with particular relevance to mental health and behavioral health treatment. Women’s health literature regarding sexual trauma will be particularly important to inform health care services for both male and female veterans.
Comparing Diabetes Prevalence Between African Americans and Whites of Similar Socioeconomic Status
Authors: Signorello Lisa B. , Schlundt David G. , Cohen Sarah S. , Steinwandel Mark D. , Buchowski Maciej S. , McLaughlin Joseph K. , Hargreaves Margaret K. , Blot William J.
Published: October 2007

Objectives. We investigated whether racial disparities in the prevalence of type 2 diabetes exist beyond what may be attributable to differences in socioeconomic status (SES) and other modifiable risk factors.

Methods. We analyzed data from 34331 African American and 9491 White adults aged 40 to 79 years recruited into the ongoing Southern Community Cohort Study. Participants were enrolled at community health centers and had similar socioeconomic circumstances and risk factor profiles. We used logistic regression to estimate the association between race and prevalence of self-reported diabetes after taking into account age, SES, health insurance coverage, body mass index, physical activity, and hypertension.

Results. Multivariate analyses accounting for several diabetes risk factors did not provide strong support for higher diabetes prevalence rates among African Americans than among Whites (men: odds ratio [OR]=1.07; 95% confidence interval [CI]=0.95, 1.20); women: OR=1.13, 95% CI=1.04, 1.22).

Conclusions. Our findings suggest that major differences in diabetes prevalence between African Americans and Whites may simply reflect differences in established risk factors for the disease, such as SES, that typically vary according to race.
Concurrent Sexual Partnerships Among Men in the United States
Authors: Adimora Adaora A. , Schoenbach Victor J. , Doherty Irene A.
Published: October 2007

Objectives. We sought to determine the prevalence, distribution, and correlates of US men’s involvement in concurrent sexual partnerships, a sexual network pattern that speeds population dissemination of HIV.

Methods. For this analysis, we compared sexual partnership dates of 4928 male respondents in the 2002 National Survey of Family Growth to determine the prevalence of concurrent sexual partnerships and evaluated associations between concurrency and demographic risk characteristics.

Results. Approximately 11% of men had concurrent sexual partnerships during the preceding year. Concurrency was associated with being unmarried (odds ratio [OR] = 4.59; 95% confidence interval [CI] = 2.54, 8.29), non-Hispanic Black (OR=2.56; 95% CI=1.61, 4.07) or Hispanic (OR=2.25; 95% CI=1.32, 3.85) race/ethnicity, and incarceration during the past year (OR=2.10; 95% CI=1.18, 3.74). Men with concurrent sexual partnerships were also more likely to report drug or alcohol intoxication during sexual intercourse (OR=2.10; 95% CI=1.37, 3.21), nonmonogamous female sexual partners (OR=6.11; 95% CI=4.10, 9.11), and history of sexual intercourse with a man (OR = 1.93; 95% CI = 1.09, 3.42), than those without concurrent partnerships.

Conclusions. The higher concurrency prevalence in various groups, dense sexual networks, and mixing between high-risk subpopulations and the general population may be important factors in the US epidemic of heterosexual HIV infection.
An Exploration of Urban and Rural Differences in Lung Cancer Survival Among Medicare Beneficiaries
Authors: Shugarman Lisa R. , Sorbero Melony E.S. , Tian Haijun , Jain Arvind K. , Ashwood J. Scott
Published: October 2007

Objectives. We tested the relationship between urban or rural residence as defined by rural–urban commuting area codes and risk of mortality in a sample of Medicare beneficiaries with lung cancer.

Methods. We used Surveillance, Epidemiology, and End Results data linked with Medicare claims to build proportional hazards models. The models tested hypothesized relationships between individual and community characteristics and overall survival for a cohort of Medicare beneficiaries 65 years and older who were diagnosed with lung cancer between 1995 and 1999 (N=26073).

Results. We found no evidence that lung cancer patients in rural areas have poorer survival than those in urban areas. Rather, individual (Medicaid coverage) and regional (lower census tract–level median income) socioeconomic factors and a smaller supply of subspecialists per 10000 individuals 65 years and older were positively associated with a higher risk of mortality.

Conclusions. Although urban versus rural residence did not directly influence survival, rural residents were more likely to live in poorer areas with a smaller supply of health care providers. Therefore, we still need to be aware of rural beneficiaries’ potential disadvantage when it comes to receiving needed care in a timely fashion.
Performance Measures, Vaccinations, and Pneumonia Rates Among High-Risk Patients in Veterans Administration Health Care
Authors: Jha Ashish K. , Wright Steven M. , Perlin Jonathan B.
Published: October 2007

Objectives. Influenza and pneumococcal vaccinations reduce morbidity, mortality, and health care costs, but their use lags behind goals set by public health experts. We evaluated the effect of a performance measurement program instituted by the Veterans Health Administration in 1995 to improve vaccination rates.

Methods. We used cross-sectional chart-abstracted data to calculate influenza and pneumococcal vaccination rates among eligible patients, and administrative data to calculate pneumonia admission rates. We compared vaccination and hospitalization rates before and after the institution of the performance measurement program with rates outside the Veterans Health Administration.

Results. Influenza and pneumococcal vaccination rates for eligible patients rose from 27% and 28% during 1994 to 1995 to 70% and 85%, respectively, by 2003 (P for trend<.001). Geographic and other variations were substantially reduced. During this time, pneumonia hospitalization rates decreased by 50% among elderly Veterans Health Administration enrollees but increased among Medicare enrollees by 15% (P for differences in trend<.001).

Conclusions. The performance measurement program was associated with increases in vaccination rates, reduced variation, and reduced pneumonia admissions. Health systems instituting similarly effective programs may substantially improve the quality of their clinical health care.
Alcohol Consumption and Posttraumatic Stress After Exposure to Terrorism: Effects of Proximity, Loss, and Psychiatric History
Authors: Hasin Deborah S. , Keyes Katherine M. , Hatzenbuehler Mark L. , Aharonovich Efrat A. , Alderson Donald
Published: October 2007

Objectives. We examined the effects of exposure to or interpersonal loss resulting from a terrorist attack on posttraumatic stress and alcohol consumption after we controlled for psychiatric history assessed before the attack.

Methods. At baseline (1991–1992) and at 1- and 10-year follow-ups, an adult community sample of drinkers living approximately 12 mi (19.2 km) from the World Trade Center were evaluated for alcohol dependence and major depression. Of this group, 82.2% were assessed regarding the impact of the September 11, 2001, attacks, including proximity to the World Trade Center, interpersonal loss, posttraumatic stress, and alcohol consumption.

Results. In regression models, interpersonal loss and past major depression, but not proximity to the World Trade Center, predicted posttraumatic stress symptoms. Proximity and past alcohol dependence, but not interpersonal loss, predicted high levels of post–September 11 alcohol consumption. Past alcohol dependence did not modify the proximity–drinking relationship, and past major depression did not modify the loss–posttraumatic stress relationship.

Conclusions. Participants’ responses to September 11 were specific to their type of exposure and not predetermined by their psychiatric history. A better understanding of responses to traumatic events should assist more-effective prevention and intervention efforts.
Factors Associated With Patients Who Leave Acute-Care Hospitals Against Medical Advice
Authors: Ibrahim Said A. , Kwoh C. Kent , Krishnan Eswar
Published: October 2007

Objectives. We examined hospital- and patient-related factors associated with discharge against medical advice (termed self-discharge) after emergency admission to acute-care hospitals.

Methods. We analyzed data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project using logistic regression models to assess the relationship between self-discharge and a set of patient and hospital characteristics.

Results. Of 3 039 050 discharges in the sample, 43 678 were against medical advice (1.44%). In multivariable modeling, predictors of self-discharge included having Medicaid insurance (adjusted odds ratio [AOR]=3.32; 95% confidence interval [CI]=3.22, 3.42), having Medicare insurance (AOR=1.64; 95% CI=1.59, 1.70), urban location (AOR=1.66; 95% CI=1.61, 1.72), medium (AOR=1.25; 95% CI=1.20, 1.29) or large (AOR=1.08, 95% CI=1.05, 1.12) hospital (defined by the number of beds), shorter hospital stay (OR=0.84; 95% CI=0.84, 0.85), and African American race (AOR=1.10; 95% CI=1.07, 1.14). Teaching hospitals had fewer self-discharges (AOR=0.90; 95% CI=0.88, 0.92). Other predictors of discharge against medical advice included age, gender, and income.

Conclusions. Approximately 1 in 70 hospital discharges in the United States are against medical advice. Both hospital and patient characteristics were associated with these decisions.
Prevalence of Substance Use Disorders Among African Americans and Caribbean Blacks in the National Survey of American Life
Authors: Broman Clifford L. , Neighbors Harold W. , Delva Jorge , Torres Myriam , Jackson James S.
Published: October 2007

Objectives. We sought to estimate the prevalence of substance disorders for African Americans and Caribbean Blacks in the United States using data from the National Survey of American Life.

Methods. A national household probability sample of noninstitutionalized African Americans (n=3570) and Caribbean Blacks (n=1621) was obtained between February 2001 and June 2003 using a slightly modified version of the Composite International Diagnostic Interview.

Results. Overall differences in prevalence of substance disorders between the ethnic groups were not significant. Prevalence rates of substance disorders among African Americans exceeded that of Caribbean Blacks among women, those aged 45 to 59 years, and those who were divorced. African Americans in major metropolitan areas had higher prevalence rates, and those in the South had lower ones, compared with those living in other areas. Overall, first-generation Caribbean Blacks were significantly less likely, but second-generation more likely, than were African Americans to meet criteria for overall substance disorders.

Conclusions. Failure to distinguish between African Americans and Caribbean Blacks masks important differences in substance use patterns among the Black population in the United States.
Health Services Use Among Gulf War Veterans and Gulf War–Era Nondeployed Veterans: A Large Population-Based Survey
Authors: Helmer Drew A. , Flanagan Mindy E. , Woolson Robert F. , Doebbeling Bradley N.
Published: October 2007

We sought to analyze the self-reported hospitalization, emergency department visits, and outpatient visits of Persian Gulf War (deployed; n=1896) and Persian Gulf War–era (nondeployed; n=1799) military personnel 5 years postconflict to determine whether these groups had different rates of health care use. Compared with personnel who had not been deployed, personnel who had been deployed were more likely to have visited an emergency department (25% vs 21%; odds ratio [OR]=1.24; 95% confidence interval [CI] = 1.06, 1.51]). Among these groups, the National Guard and Reserve personnel were more likely to have been hospitalized than were the regular military personnel (OR= 1.65; 95% CI=1.21, 2.26).
Racial/Ethnic Differences in the Development of Disability Among Older Adults
Authors: Dunlop Dorothy D. , Song Jing , Manheim Larry M. , Daviglus Martha L. , Chang Rowland W.
Published: October 2007

Objectives. We investigated differences in the development of disability in activities of daily living among non-Hispanic Whites, African Americans, Hispanics interviewed in Spanish, and Hispanics interviewed in English.

Methods. We estimated 6-year risk for disability development among 8161 participants 65 years or older and free of baseline disability. We evaluated mediating factors amenable to clinical and public health intervention on racial/ethnic difference.

Results. The risk for developing disability among Hispanics interviewed in English was similar to that among Whites (hazard ratio [HR]=0.99; 95% confidence interval [CI] = 0.6, 1.4) but was substantially higher among African Americans (HR=1.6; 95% CI=1.3, 1.9) and Hispanics interviewed in Spanish (HR=1.8; 95% CI=1.4, 2.1). Adjustment for demographics, health, and socioeconomic status reduced a large portion of those disparities (African American adjusted HR=1.1, Spanish-interviewed Hispanic adjusted HR=1.2).

Conclusions. Higher risks for developing disability among older African Americans, and Hispanics interviewed in Spanish compared with Whites were largely attenuated by health and socioeconomic differences. Language- and culture-specific programs to increase physical activity and promote weight maintenance may reduce rates of disability in activities of daily living and reduce racial/ethnic disparities in disability.
Lack of Health Coverage Among US Veterans From 1987 to 2004
Authors: Himmelstein David U. , Lasser Karen E. , McCormick Danny , Bor David H. , Boyd J. Wesley , Woolhandler Steffie
Published: October 2007

Objectives. Veterans Administration health care enrollment is restricted to veterans with service-connected problems and those who are poor. We sought to determine how many veterans were uninsured, trends in veterans’ coverage, and whether uninsured veterans lacked access to medical care.

Methods. We analyzed annual data from 2 federal surveys, the Current Population Survey for the years 1988 to 2005 and the National Health Interview Survey for 2002 to 2004.

Results. Nearly 1.8 million veterans were uninsured and not receiving Veterans Administration care in 2004. The proportion of working-age veterans lacking coverage peaked in 1993 at 14.2%, fell to 9.9% in 2000, and rose steadily to 12.7% in 2004. Uninsured veterans had substantial access problems; 51.4% had no usual source of care (vs 8.9% of insured veterans), and 26.5% reported failing to get needed care because of the cost (vs 4.3% of insured veterans).

Conclusions. Many US veterans are uninsured and lack adequate access to health care. Expanded funding for veterans’ care is urgently needed; only national health insurance could guarantee coverage to both veterans and their family members.
Cognitive Function and Dental Care Utilization Among Community-Dwelling Older Adults
Authors: Wu Bei , Plassman Brenda L. , Liang Jersey , Wei Liang
Published: October 2007

Objectives. We sought to investigate the relationship between varying levels of cognitive function and dental care utilization.

Methods. Using data obtained from the National Health and Nutrition Examination Survey (1999–2002), we performed weighted descriptive and multivariate logistic regression analyses on 1984 individuals with at least 1 tooth and who were 60 years and older.

Results. Multivariate analyses suggested that level of cognitive function was associated with dental care utilization. At a higher level of cognitive functioning, individuals were more likely to have had more frequent dental visits. In addition, a higher level of socioeconomic status, healthy lifestyle, and worse self-rated oral health–related symptoms were more likely to indicate a higher frequency of dental care utilization. By contrast, poorer oral health status as determined by clinical examinations was negatively associated with frequency of dental visits.

Conclusions. The results suggest that community-dwelling older adults with low cognitive function are at risk for less frequent use of dental care. Oral health serves as a mediating factor between cognitive function and dental care utilization. There is a great need to improve oral health awareness and education among older adults, caregivers, and health care professionals.
Prevalence of HIV Infection Among Inpatients and Outpatients in Department of Veterans Affairs Health Care Systems: Implications for Screening Programs for HIV
Authors: Owens Douglas K. , Sundaram Vandana , Lazzeroni Laura C. , Douglass Lena R. , Sanders Gillian D. , Taylor Kathie , VanGroningen Ronald , Shadle Vera M. , McWhorter Valerie C. , Agoncillo Teodora , Haren Noreen , Nyland Jill , Tempio Patricia , Khayr Walid , Dietzen Dennis J. , Jensen Peter , Simberkoff Michael S. , Bozzette Samuel A. , Holodniy Mark
Published: October 2007

Objectives. We sought to determine the prevalence of HIV in both inpatient and outpatient settings in 6 Department of Veterans Affairs (VA) health care sites.

Methods. We collected demographic data and data on comorbid conditions and then conducted blinded, anonymous HIV testing. We conducted a multivariate analysis to determine predictors of HIV infection.

Results. We tested 4500 outpatient blood specimens and 4205 inpatient blood specimens; 326 (3.7%) patients tested positive for HIV. Inpatient HIV prevalence ranged from 1.2% to 6.9%; outpatient HIV prevalence ranged from 0.9% to 8.9%. Having a history of hepatitis B or C infection, a sexually transmitted disease, or pneumonia also predicted HIV infection. The prevalence of previously undocumented HIV infection varied from 0.1% to 2.8% among outpatients and from 0.0% to 1.7% among inpatients.

Conclusions. The prevalence of undocumented HIV infection was sufficiently high for routine voluntary screening to be cost effective in each of the 6 sites we evaluated. Many VA health care systems should consider expanded routine voluntary HIV screening.
Use of Preventive Care by Elderly Male Veterans Receiving Care Through the Veterans Health Administration, Medicare Fee-for-Service, and Medicare HMO Plans
Authors: Keyhani Salomeh , Ross Joseph S. , Hebert Paul , Dellenbaugh Cornelia , Penrod Joan D. , Siu Albert L.
Published: October 2007

Objectives. We compared use of preventive care among veterans receiving care through the Veterans Health Administration (VHA), Medicare fee-for-service (FFS) plans, and Medicare health maintenance organizations (HMOs).

Methods. Using both the Costs and Use, and Access to Care files of the Medicare Current Beneficiary Survey (2000–2003), we performed a cross-sectional analysis examining self-reported use of influenza vaccination, pneumococcal vaccination, serum cholesterol screening, and serum prostate-specific antigen measurement among male veterans 65 years or older. Veterans’ care was categorized as received through VHA, Medicare FFS, Medicare HMOs, VHA and Medicare FFS, or VHA and Medicare HMOs.

Results. Veterans receiving care through VHA reported 10% greater use of influenza vaccination (P<.05), 14% greater use of pneumococcal vaccination (P<.01), a nonsignificant 6% greater use of serum cholesterol screening (P=.1), and 15% greater use of prostate cancer screening (P<.01) than did veterans receiving care through Medicare HMOs. Veterans receiving care through Medicare FFS reported less use of all 4 preventive measures (P<.01) than did veterans receiving care through Medicare HMOs.

Conclusions. Receiving care through VHA was associated with greater use of preventive care.
Reducing Avoidable Deaths Among Veterans: Directing Private-Sector Surgical Care to High-Performance Hospitals
Authors: Weeks William B. , West Alan N. , Wallace Amy E. , Lee Richard E. , Goodman David C. , Dimick Justin B. , Bagian James P.
Published: October 2007

Objectives. We quantified older (65 years and older) Veterans Health Administration (VHA) patients’ use of the private sector to obtain 14 surgical procedures and assessed the potential impact of directing that care to high-performance hospitals.

Methods. Using a merged VHA–Medicare inpatient database for 2000 and 2001, we determined where older VHA enrollees obtained 6 cardiovascular surgeries and 8 cancer resections and whether private-sector care was obtained in high- or low-performance hospitals (based on historical performance and determined 2 years in advance of the service year). We then modeled the mortality and travel burden effect of directing private-sector care to high-performance hospitals.

Results. Older veterans obtained most of their procedures in the private sector, but that care was equally distributed across high- and low-performance hospitals. Directing private-sector care to high-performance hospitals could have led to the avoidance of 376 to 584 deaths, most through improved cardiovascular care outcomes. Using historical mortality to define performance would produce better outcomes with lower travel time.

Conclusions. Policy that directs older VHA enrollees’ private-sector care to high-performance hospitals promises to reduce mortality for VHA’s service population and warrants further exploration.
Suicide Mortality Among Individuals Receiving Treatment for Depression in the Veterans Affairs Health System: Associations with Patient and Treatment Setting Characteristics
Authors: Zivin Kara , Kim H. Myra , McCarthy John F. , Austin Karen L. , Hoggatt Katherine J. , Walters Heather , Valenstein Marcia
Published: October 2007

Objectives. We sought to report clinical and demographic factors associated with suicide among depressed veterans in an attempt to determine what characteristics identified depressed veterans at high risk for suicide.

Methods. We used longitudinal, nationally representative data (1999–2004) to determine suicide rates among depressed veterans, estimating time until suicide using Cox proportional hazards regression models.

Results. Of 807694 veterans meeting study criteria, 1683 (0.21%) committed suicide during follow-up. Increased suicide risks were observed among male, younger, and non-Hispanic White patients. Veterans without service-connected disabilities, with inpatient psychiatric hospitalizations in the year prior to their qualifying depression diagnosis, with comorbid substance use, and living in the southern or western United States were also at higher risk. Posttraumatic stress disorder (PTSD) with comorbid depression was associated with lower suicide rates, and younger depressed veterans with PTSD had a higher suicide rate than did older depressed veterans with PTSD.

Conclusions. Unlike the general population, older and younger veterans are more prone to suicide than are middle-aged veterans. Future research should examine the relationship between depression, PTSD, health service use, and suicide risks among veterans.
Evaluation of cisplatin administered with piroxicam in dogs with transitional cell carcinoma of the urinary bladder
Authors: Greene Shawna N. , Lucroy Michael D. , Greenberg Chelsea B. , Bonney Patty L. , Knapp Deborah W.
Published: October 2007

Objective—To evaluate the antitumor activity and toxic effects of a conservative dose of cisplatin administered in combination with piroxicam to dogs with transitional cell carcinoma (TCC) of the urinary bladder.

Design—Clinical trial (nonrandomized, noncontrolled).

Animals—14 client-owned dogs with histologically confirmed TCC of the urinary bladder.

Procedures—Each dog was treated with cisplatin (50 mg/m2, IV, q 21 d [reduced to 40 mg/m2, IV, q 21 d because of toxic effects]) and piroxicam (0.3 mg/kg [0.14 mg/lb], PO, q 24 h). A CBC, serum biochemical analyses, and urinalysis were performed prior to each cisplatin treatment. Tumor staging (determined from thoracic and abdominal radiographic and urinary bladder ultrasonographic findings) was performed before treatment and at 6-week intervals during treatment.

Results—5 dogs received only 1 dose of cisplatin because of the rapid progression of disease (n = 2) or toxic effects (3). With regard to the neoplastic disease among the other 9 dogs, 1 had partial remission, 5 had stable disease, and 3 had progressive disease after 6 weeks of treatment. Median progression-free interval was 78 days (range, 20 to 112 days). Median survival time was 307 days (range, 29 to 929 days). Moderate to severe renal toxicosis and moderate to severe gastrointestinal toxicosis developed in 5 and 8 dogs, respectively.

Conclusions and Clinical Relevance—Because of minimal efficacy and associated renal and gastrointestinal toxicosis, administration of cisplatin (40 to 50 mg/m2) with piroxicam cannot be recommended for treatment of dogs with TCC of the urinary bladder.
Prevalence of and intrinsic risk factors for appendicular osteosarcoma in dogs: 179 cases (1996–2005)
Authors: Rosenberger Julie A. , Pablo Norma V. , Crawford P. Cynda
Published: October 2007

Objective—To determine the prevalence of appendicular osteosarcoma (OSA) in Greyhounds compared with other breeds and identify potential intrinsic risk factors associated with development of OSA.

Design—Retrospective case series.

Animals—179 dogs with primary appendicular OSA.

Procedures—Medical records of dogs in which primary appendicular OSA had been diagnosed between 1996 and 2005 were reviewed. Prevalence and crude odds ratios for OSA were calculated for various breeds by comparison with a reference population of mixedbreed dogs. Age and sex were examined as potential risk factors for the 3 breeds with highest prevalence.

Results—Breed period prevalence of OSA was highest for Greyhounds (21/339 [6.2%]), followed by Rottweilers (51/969 [5.3%]) and Great Danes (13/297 [4.4%]); all 21 Greyhounds with OSA were identified as having retired from racing. Sex was not identified as a risk factor for OSA in these breeds, but in all 3 breeds, risk of OSA increased with age. Greyhounds were significantly older at the time of OSA diagnosis (mean, 9.9 years) than were Rottweilers (8.3 years) and Great Danes (7.8 years). Rottweilers and Great Danes were more likely to have OSA involving the forelimbs than the hind limbs. The most frequent lesion sites for all 3 breeds were the proximal end of the humerus and distal end of the radius. The proximal end of the femur was also a common site for the Greyhounds.

Conclusions and Clinical Relevance—Results of the present study suggested that Greyhounds, Rottweilers, and Great Danes had an increased risk of developing OSA, compared with mixed-breed dogs.
Diagnostic imaging findings and endocrine test results in dogs with pituitary-dependent hyperadrenocorticism that did or did not have neurologic abnormalities: 157 cases (1989–2005)
Authors: Wood Farica D. , Pollard Rachel E. , Uerling Megan R. , Feldman Edward C.
Published: October 2007

Objective—To compare imaging findings in dogs with pituitary-dependent hyperadrenocorticism (PDH) that did or did not have neurologic abnormalities.

Design—Retrospective case series.

Animals—157 dogs with PDH that did (n = 73) or did not (84) have neurologic abnormalities.

Procedures—Medical records were reviewed for the presence and nature of clinical signs of CNS disease, and computed tomographic and magnetic resonance images were reviewed for evidence of a pituitary tumor.

Results—60 of the 84 (71%) dogs without neurologic abnormalities and 48 of the 73 (66%) dogs with neurologic abnormalities had a detectable pituitary tumor. However, 17 of the 84 (20%) dogs without neurologic abnormalities had a pituitary macrotumor (ie, a tumor ≥ 10 mm in height), and 41 of the 73 (56%) dogs with neurologic abnormalities did not have a detectable pituitary tumor or had a pituitary microtumor. Vague signs of CNS dysfunction (ie, lethargy, inappetence, and mental dullness) were more specific for detection of pituitary macrotumors than were CNS-specific signs (ie, seizure or blindness).

Conclusions and Clinical Relevance—Results suggested that there was no apparent relationship between a pituitary tumor and development of neurologic abnormalities in dogs with PDH. In addition, neurologic abnormalities in dogs with pituitary macrotumors were often vague (ie, lethargy, inappetence, and mental dullness).
Effect of hyperimmunization with an Escherichia coli J5 bacterin in adult lactating dairy cows
Authors: Erskine Ronald J. , VanDyk Elizabeth J. , Bartlett Paul C. , Burton Jeanne L. , Boyle Michael C.
Published: October 2007

Objective—To determine the effect of hyperimmunization with an Escherichia coli J5 bacterin on serum IgG2 concentration, incidence of clinical mastitis, and rate of survival to the end of the lactation period (ie, day 305) in adult lactating dairy cattle.

Design—Randomized controlled trial.

Animals—1,012 Holstein cows in their second lactation and greater.

Procedures—All cows were given 3 doses of the J5 bacterin; cows in the hyperimmunization group were given an additional 3 doses during the first 3 months of lactation. Blood was collected from a small sample of cows to determine anti-J5 IgG2 concentrations.

Results—Cows in the hyperimmunization group had higher mean serum anti-J5 IgG2 concentrations than did control cows 28 days after administration of the fourth, fifth, and sixth doses of the J5 bacterin. However, mean serum anti-J5 concentrations during the subsequent lactation were not significantly different between groups. The proportions of cows that developed clinical mastitis were not significantly different between groups. However, control cows were more likely to have severe clinical mastitis than were cows in the hyperimmunization group. The percentage of control cows that remained in the herd to day 305 was significantly lower than the percentage of cows in the hyperimmunization group that did.

Conclusions and Clinical Relevance—Results suggested that hyperimmunization of mature lactating dairy cattle was associated with increased serum anti-J5 IgG2 concentrations and decreased incidence of severe clinical mastitis, but did not alter survival rate of cows that developed severe clinical mastitis.
Fatal gastrointestinal parasitism in goats: 31 cases (2001–2006)
Authors: Valentine Beth A. , Cebra Christopher K. , Taylor George H.
Published: October 2007

Objective—To evaluate signalment, history, clinical and pathologic findings, and seasonal weather patterns in association with fatal gastrointestinal parasitism in goats.

Design—Retrospective case series.

Animals—152 goats that were > 1 day of age.

Procedures—Characteristics including age and counts of coccidia oocysts and trichostrongyle ova (eggs) per gram of feces (EPG) in goats that died because of gastrointestinal parasitism and goats that died because of other causes were compared. Weather data and annual incidence of caprine fatal gastrointestinal parasitism were investigated.

Results—Death was attributed to gastrointestinal parasitism in 31 of 152 (20%) goats (median age, 5 months; range, 1 month to 7 years); deaths were attributed to coccidiosis (n = 7 goats; median age, 4 months; median EPG, 2,225), trichostrongylosis (6 goats; median age, 1.25 years; median EPG, 3,700), or dual infection (18 goats; median age, 6.7 months; median EPG, 8,088 coccidia and 5,475 trichostrongyles). Sudden onset of weakness or death was a common historical finding; diarrhea was evident in 15 goats. Common postmortem findings in these goats included cachexia, tissue pallor, poorly formed feces, and mesenteric lymphadenomegaly. Wet weather in spring and summer was associated with increased annual incidence of fatal gastrointestinal parasitism in goats.

Conclusions and Clinical Relevance—Gastrointestinal parasitism is an important cause of death in goats. Clinical signs may not develop until just prior to death, and diagnosis is achieved via parasitologic evaluation of feces and necropsy. Seasonal weather patterns should be considered on an annual basis when designing parasite control programs for goats.
Reports and Notices
Authors: Caratini Sophie , Klute Georg , Claudot-Hawad Hélène
Published: October 2007

Espaces Et Societes Sahelo-Sahariens: Les Configurations De L'alterite Nomade. Une Nouvelle équipe De Recherches Pluridisciplinaires Sur Les Sociétés Nomades: Historique Du Projet Et Travaux En Cours.
Report on the International Conference 'Les sociétés pastorales en Afrique sahélienne: environnement, développement et démocratie' 3-7 November, 1997, Niamey, Niger
Conseiller du prince ou chercheur? Deux enjeux de savoir é ne pas confondre
Instituting Europe: Germany, the Union, and the Legacy of the Short Century
Authors: Werz Michael
Published: October 2007

Recent debates about the future of the European Union have focused

in large part on institutional reforms, the deficit of democratic legitimacy,

and the problem of economic and agrarian policies. As important

as these issues may be, the most crucial question at the moment

is not whether Europe will prevail as a union of nations or as a thoroughly

integrated federal structure. What is of much greater concern

is the fact that political structures and their corresponding political

discourses have lagged far behind the social changes occurring in

European societies. The pivotal transformation of 1989 has not been

grasped intellectually or politically, even though its results are

increasingly visible in both the east and west.
Erich Auerbach's Mimesis as a Meditation on the Shoah
Authors: Richards Earl Jeffrey
Published: October 2007

Within the enormous body of critical writings dedicated to literary

works devoted to the Shoah, the possibility of its very representation

and the problems arising in the potential deformation of memory

are frequent topics. In light of these issues, it might be helpful to

examine a well-known work of literary scholarship, Erich Auerbach’s

Mimesis, The Representation of Reality in Western Literature, written

between May 1942 and April 1945, as a potentially overlooked

example of a highly sublimated allegorical meditation on the contemporary

murder of Europe’s Jews. Auerbach’s classic work, which

explicitly takes literary representation as its central theme, seems to

use carefully and subtly selected examples from western literature as

figures for current events.
Loyal Dissidents and Stasi Poets: Sascha Anderson, Christa Wolf, and the Incomplete Project of GDR Research
Authors: Hell Julia
Published: October 2007

Sascha Anderson, Sascha Anderson (Cologne, 2002)

Jörg Magenau, Christa Wolf. Eine Biographie (Berlin, 2002)

Christa Wolf, Leibhaftig. Erzahlung (Munich, 2002)
Monuments, Travel and Traces: New Directions in German Cultural History
Authors: Neaman Elliot
Published: October 2007

Rudy Koshar, From Monuments to Traces; Artifacts of German Memory 1870-1990 (Berkeley: University of California Press, 2000)

Rudy Koshar, German Travel Cultures (New York/Oxford: Berg, 2000)
Painting History: Two Recent Books on Anselm Kiefer
Authors: Gordon Peter Eli
Published: October 2007

Daniel Arasse, Anselm Kiefer, Mary Whittall, trans. (New York: Harry N. Abrams, 2001)

Lisa Saltzman, Anselm Kiefer and Art after Auschwitz (Cambridge: Cambridge University Press, 1999)
Three Looks at German Foreign Policy before September 11: A Landscape Shifts
Authors: Donfried Karen
Published: October 2007

Wolf-Dieter Eberwein and Karl Kaiser, Germany’s New Foreign Policy: Decision-Making in an Independent World (Hampshire: Palgrave, 2001)

Adrian Hyde-Price, Germany & European Order: Enlarging NATO and the EU (Manchester: Manchester University Press, 2000)

Matthias Kaelberer, Money and Power in Europe: The Political Economy of European Monetary Cooperation (Albany: State University of New York Press, 2001)
The German Model Reconsidered
Authors: Kwon Hyeong-ki
Published: October 2007

The German model of political economy that had been an enviable

alternative to the liberal market until the late 1980s in the literature of

political economy was under serious structural crisis throughout the

1990s, causing serious doubts about its viability. Many neoliberals

and industrial experts in Germany began to doubt whether Germany

was an attractive place for business activity, initiating the Standort

Deutschland debate. Even German Chancellor Gerhard Schröder conceded

“the end of German model.”1 Many political economists and

journalists expected and recommended imitating the American

model of a liberal market. Prominent German newspapers and magazines

such as the Frankfurter Allgemeine Zeitung, Der Spiegel, and Die

Woche ran articles titled “The Discovery of America” and “Jobwunder

in Amerika.” Wolfgang Streeck, one of the main proponents of the

German model, expected the convergence of the German economy

toward an American-led liberal market economy under globalization

because of “a secular exhaustion of the German model.” Streeck

believed that the postwar German model was based on the politics

between labor and capital within a national boundary, but globalization

represents a fluidity of financial and labor markets that extricates

whatever coordination has been nationally accomplished.