bluuebunny/crossref_metadata_2025 huggingface dataset:
Directly observed therapy for tuberculosis in rural South Africa, 1991 through 1994.
Authors: Wilkinson D , Davies G R , Connolly C
Published: November 2008

OBJECTIVES. This paper describes an audit of a community-based tuberculosis treatment program involving directly observed therapy in South Africa. METHODS. A program audit of 2473 consecutive tuberculosis patients in Hlabisa Health District, KwaZulu/Natal, South Africa, was conducted between 1991 and 1994. RESULTS. Monthly admissions increased from 34 per month in 1991 to 66 in 1994. Of 2186 patients managed in Hlabisa, 1903 (87%) received directly observed therapy. Of those receiving directly observed therapy, 1034 (55%) were supervised by volunteers; 743 (72%) of these were supervised by storekeepers. Among those patients managed locally, 1679 (85%) of 1967 surviving patients completed treatment. Completion rates for patients supervised by health workers and non-health workers were the same. Completion fell from a high of 90% in 1992 to 78% in 1994. Mortality increased from 5% in 1991 to 10% in 1994. CONCLUSIONS. Community-based directly observed therapy that uses an intermittent drug regime and volunteers as supervisors can achieve high treatment completion rates for tuberculosis, even in resource-poor settings.
Is genital mycosis associated with HIV risk behaviors among heterosexuals? ACSF Investigators. Analyse des comportements sexuels en France.
Authors: Warszawski J , Meyer L , Bajos N
Published: November 2008

OBJECTIVES. This study examined in both sexes whether genital mycosis is as strongly associated with human immunodeficiency virus (HIV) sexual risk behavior as are other sexually transmitted diseases. METHODS. Heterosexuals in the French National Survey of Sexual Behavior who reported a history of either mycosis or another sexually transmitted disease in the previous 5 years were compared with heterosexuals who reported no such disease. Odds ratios were adjusted for age, education, place of residence, and number of sexual partners. RESULTS. Among men, mycosis and other sexually transmitted diseases showed similar associations with age and number of sexual partners. Among women, mycosis was also associated with a high number of sexual partners, albeit to a lesser extent than other sexually transmitted diseases. Lifetime experience of heterosexual anal penetration was reported significantly more often by men with a history of mycosis. CONCLUSION. These results suggest that most male mycosis is sexually acquired and constitutes a self-reported indicator as good as other sexually transmitted diseases for high risk. Female mycosis may help define an intermediate HIV risk group.
The Mpowerment Project: a community-level HIV prevention intervention for young gay men.
Authors: Kegeles S M , Hays R B , Coates T J
Published: November 2008

OBJECTIVES. Since young gay men are engaging in alarmingly high rates of unsafe sex and few seek help for changing risky behaviors, community-level programs to prevent infection with the human immunodeficiency virus (HIV) among them are urgently needed. METHODS. We developed and implemented a community-level HIV prevention program in a midsized Oregon community. The peer-led program had three components: out-reach, small groups, and a publicity campaign. Independently from the prevention program, a cohort of young gay men (n = 300) was surveyed in this and in a similar comparison community pre- and postintervention. RESULTS. Following intervention, the proportion of men engaging in any unprotected anal intercourse decreased from 41.0% to 30.0% (-27% from baseline), decreased from 20.2% to 11.1% (-45% from baseline) with nonprimary partners, and decreased from 58.9% to 44.7% (-24% from baseline) with boyfriends. No significant changes occurred in the comparison community over the same period. CONCLUSIONS. This prevention approach effectively led to HIV risk reduction. To reach risk-taking young gay men, HIV prevention activities must be embedded in social activities and community life.
Directly observed therapy for tuberculosis: the Harlem Hospital experience, 1993.
Authors: el-Sadr W , Medard F , Berthaud V , Barthaud V
Published: November 2008

OBJECTIVES. A directly observed therapy program was established at Harlem Hospital, New York, NY, in 1993 to promote high tuberculosis treatment completion rates. METHODS. The Harlem program used an on-site surrogate family model. Treatment completion rate, visit adherence rate, human immuno-deficiency virus seroprevalence, and time to sputum culture conversion were assessed. RESULTS. Out of 145 enrolled patients with suspected and confirmed tuberculosis, 95 (92 confirmed and 3 suspected) continued treatment. The visit adherence rate was 91.1 +/- 7.9%, with one patient (1%) lost to follow-up. CONCLUSION. High rates of treatment completion and visit adherence were achieved because of unique program characteristics. Thus, directly observed therapy is advocated as a means of ensuring treatment completion.
Mass human exposure to rabies in New Hampshire: exposures, treatment, and cost.
Authors: Noah D L , Smith M G , Gotthardt J C , Krebs J W , Green D , Childs J E
Published: November 2008

OBJECTIVES. This study assessed the rabies exposure and treatment that at least 665 persons in Concord, NH, received as a result of one proven rabid pet-store kitten in October 1994. METHODS. All treatment recipients were interviewed by person or phone. RESULTS. The median age of the treatment recipients was 14 years; 58% were female. The most common exposures were low risk (e.g., picking up, petting, nuzzling, or being scratched by a potentially rabid kitten). Local reactions to vaccine or immune globulin were reported by 76.5% of recipients, while 48.8% reported at least one systemic reaction. Cost for the biologicals was estimated at more than $1.1 million. CONCLUSIONS. Because of the inadequacy of pet store records, the inconsistent application of treatment guidelines, and other factors, many people received postexposure treatment as a result of contacts that were unlikely to transmit rabies. The rates of local and systemic adverse reactions experienced were consistent with previous reports.
Death rates among patients hospitalized with community-acquired pneumonia: a reexamination with data from three states.
Authors: Markowitz J S , Pashko S , Gutterman E M , Linde-Zwirble W T , Newbold R
Published: November 2008

OBJECTIVES. Death rates for community-acquired pneumonia based on relatively small-scale, published studies tend to exceed 15% to 20%. This study reexamined these estimates by using very large, population-based databases. METHODS. Death rates from 1993 associated with community-acquired pneumonia were reexamined with hospital discharge data from all of Washington, Illinois, and Florida. RESULTS. These death rates were substantially lower (7.0%, 8.1%, and 9.7%, respectively) than what appears in the literature. Significant risk factors for dying were being 65 years of age or older (odds ratio [OR] = 2.9), being positive for human immunodeficiency virus (OR = 2.9), and having a high severity of illness (OR = 7.1). CONCLUSION. Sampling bias associated with selection for hospital admissions explain the discrepancy between previous and this study's results.
A meningococcal vaccination campaign on a university campus: vaccination rates and factors in nonparticipation.
Authors: Roberts C L , Roome A , Algert C S , Walsh S J , Kurland M , Lawless K , Cartter M L
Published: November 2008

OBJECTIVES. This study was undertaken to determine an accurate vaccination rate and identify factors influencing nonvaccination in a meningococcal vaccination campaign on a Connecticut university campus in May 1993. METHODS. Vaccination and student data were merged to determine demographic factors associated with nonvaccination. A case-control study examined reasons for nonvaccination. RESULTS. The estimated vaccination rate for students returning to the campus was 93%. Lower rates occurred among older students, students living off campus, graduate and nondegree students, and married students. Perceived poor access to the vaccination center was the strongest predictor of nonvaccination. CONCLUSIONS. Higher vaccination rates may be achieved by specifically targeting students who live off campus and by providing multiple vaccination sites with extended hours.
New York inmates' HIV risk behaviors: the implications for prevention policy and programs.
Authors: Mahon N
Published: November 2008

OBJECTIVES: The median incidence rate of acquired immunodeficiency syndrome (AIDS) among prisoners is 7 times higher than for the general population. Yet high-risk sexual activity and drug use in US correctional facilities remain unexamined. This study explores inmate perceptions of high-risk behavior in New York state prisons and New York City jails and seeks to generate hypotheses to inform policies and future research. METHODS: Participants were 22 former New York state prisoners and 28 current New York City inmates. Participants attended one of six focus groups and completed an anonymous questionnaire. Audiotapes of the groups were transcribed and evaluated. RESULTS: A range of consensual and nonconsensual sexual activity occurs among inmates and between inmates and staff. Without official access to latex barriers, prisoners use ineffective makeshift devices, like rubber gloves and used plastic wrap, in attempts to practice safer sex. Prisoners also shoot drugs intravenously with used syringes and pieces of pens and light bulbs. CONCLUSIONS: The absence of harm-reduction devices behind bars may create a greater risk of HIV transmission there than in the community. Officials should consider distributing risk-reduction devices to prisoners through anonymous methods.
Increased blood lead and decreased calcium levels during pregnancy: a prospective study of Swedish women living near a smelter.
Authors: Lagerkvist B J , Ekesrydh S , Englyst V , Nordberg G F , Söderberg H A , Wiklund D E
Published: November 2008

OBJECTIVES: The purpose of this study was to monitor blood lead in a northern Swedish cohort of mothers and children during pregnancy and at birth. METHODS: Blood lead was analyzed during pregnancy and in the umbilical cords of 290 women living near a smelter and in 194 control subjects. RESULTS: During pregnancy, there were statistically significant overall increases in blood lead concentrations by 20% and 15% in the smelter and reference areas, respectively. Mean maternal blood lead concentrations at delivery were 0.15 mumol/L (3.11 micrograms/dL) in the smelter area and 0.13 mumol/L (2.69 micrograms/dL) in the control area. Umbilical cord blood lead levels were 80% to 87% of the maternal levels. Blood lead levels were influenced by place of residence, employment at the smelter, smoking, and wine consumption. Maternal serum calcium levels decreased during pregnancy and were significantly lower than those of the newborns. CONCLUSIONS: An increase in blood lead concentrations was found during pregnancy, despite increased blood volume and unchanged or decreasing environmental lead levels. The mobilization of lead from bone during pregnancy may explain the increase.
Passive smoking, active smoking, and education: their relationship to weight history in women in Geneva.
Authors: Bernstein M , Morabia A , Héritier S , Katchatrian N
Published: November 2008

OBJECTIVES: This study was undertaken to determine the relationship of education and tobacco smoke to lifetime weight history in women. METHODS: Information on passive smoking, active smoking, and weight history was collected from 928 women aged 29 to 74 years selected from the general population of Geneva, Switzerland. Multivariate analysis of variance was performed for weight, weight at age 20, and weight changes since age 20. RESULTS: Education was inversely related to weight at age 20, current weight, and weight gain since age 20. The least educated group had a current weight of 4 kg more than the most educated group. Differences across smoking categories were small: passive smokers had the highest current weight (63.4 kg) and former active smokers had the lowest (60.4 kg). Weight gain since age 20 tended to be smaller in former and current active smokers (5.5 to 7.2 kg) than in passive smokers (8.3 to 10.4 kg) and those never exposed (9.1 kg). CONCLUSIONS: In this sample, education was an important predictor of women's current weight and weight history. Passive and active smoking had little long-term effect on weight.
Cancer risk and residential proximity to cranberry cultivation in Massachusetts.
Authors: Aschengrau A , Ozonoff D , Coogan P , Vezina R , Heeren T , Zhang Y
Published: November 2008

OBJECTIVES: This study evaluated the relationship between cancer risk and residential proximity to cranberry cultivation. METHODS: A population-based case-control study was conducted. Cases, diagnosed during 1983 through 1986 among residents of the Upper Cape Cod area of Massachusetts, involved incident cancers of the lung (n = 252), breast (n = 265), colon-rectum (n = 326), bladder (n = 63), kidney (n = 35), pancreas (n = 37), and brain (n = 37), along with leukemia (n = 35). Control subjects were randomly selected from among telephone subscribers (n = 184), Medicare beneficiaries (n = 464), and deceased individuals (n = 723). RESULTS: No meaningful increases in risk were seen for any of the cancer sites except for the brain. When latency was considered, subjects who had ever lived within 2600 ft (780 m) of a cranberry bog had a twofold increased risk of brain cancer overall (95% confidence interval [CI] = 0.8, 4.9) and a 6.7-fold increased risk of astrocytoma (95% CI = 1.6, 27.8). CONCLUSIONS: Residential proximity to cranberry bog cultivation was not associated with seven of the eight cancers investigated; however, an association was observed with brain cancer, particularly astrocytoma. Larger, more detailed studies are necessary to elucidate this relationship.
The impact of the economic crisis and the US embargo on health in Cuba.
Authors: Garfield R , Santana S
Published: November 2008

OBJECTIVES: This paper examines the combined effects of a severe economic decline since 1989 and a tightening of the US embargo in 1992 on health and health care in Cuba. METHODS: Data from surveillance systems for nutrition, reportable diseases, and hospital diagnoses were reviewed. These sources were supplemented with utilization data from the national health system and interviews with health leaders. RESULTS: Changes in Cuba include declining nutritional levels, rising rates of infectious diseases and violent death, and a deteriorating public health infrastructure. But despite these threats, mortality levels for children and women remain low. Instead, much of the health impact of the economic decline of Cuba has fallen on adult men and the elderly. CONCLUSIONS: To be consistent with international humanitarian law, embargoes must not impede access to essential humanitarian goods. Yet this embargo has raised the cost of medical supplies and food Rationing, universal access to primary health services, a highly educated population, and preferential access to scarce goods for women and children help protect most Cubans from what otherwise might have been a health disaster.
Adaptive responses among Dutch elderly: the impact of eight chronic medical conditions on health-related quality of life.
Authors: Kempen G I , Ormel J , Brilman E I , Relyveld J
Published: November 2008

OBJECTIVES: This study analyzed the impact of eight common chronic medical conditions on functional, social, and affective domains of health-related quality of life among community-based Dutch elderly (n = 5279). METHODS: Health-related quality of life was measured with six domains of the MOS Short-Form General Health Survey. The impact of the selected chronic conditions on health-related quality of life was analyzed by means of Student's t tests, analyses of variance, and multiple regression analyses. RESULTS: Compared with other domains of health-related quality of life, mental health was the least affected by chronic medical conditions. Back problems and rheumatoid arthritis/other joint complaints accounted for relatively high proportions of the variance in health-related quality of life (from 35.5% to 68.3%), except for health perceptions (22.6%), indicating that health-related quality of life is most affected by these two conditions. CONCLUSIONS: Subjective well-being is by far the domain least affected by chronic medical conditions, while physical functioning and health perceptions are most affected. Back problems and rheumatoid arthritis/other joint complaints affect health-related quality of life strongly.
Physical activity in a multiethnic population of third graders in four states.
Authors: Simons-Morton B G , McKenzie T J , Stone E , Mitchell P , Osganian V , Strikmiller P K , Ehlinger S , Cribb P , Nader P R
Published: November 2008

OBJECTIVES: This research assessed the amount of daily physical activity in a multiethnic sample of US third-grade students. METHODS: Physical activity interviews were conducted with 2410 third graders from 96 schools in four states. Blood pressure, cholesterol, body mass index, timed run for distance, physical-activity self-efficacy, and perceived support for physical activity were also assessed. RESULTS: Students reported a daily average of 89.9 minutes of moderate to vigorous physical activity, 34.7 minutes of vigorous activity, and 120.4 minutes of sedentary behavior; however, 36.6% obtained less than 60 minutes of moderate to vigorous physical activity daily, and 12.8% reported less than 30 minutes. Boys reported more physical and sedentary activity than girls; White children reported more activity than Black or Hispanic children; California children reported the most activity and Louisiana children the least. Geographic location, male gender, lower cholesterol, higher perceived efficacy in physical activity, and higher social support were associated with more physical activity. CONCLUSIONS: Average reported activity met the Year 2000 objectives; however, many students reported less than recommended amounts of activity. These findings support the need for health promotion programs that increase the number of physically active children.
The validity of self-reports of smoking: analyses by race/ethnicity in a school sample of urban adolescents.
Authors: Wills T A , Cleary S D
Published: November 2008

OBJECTIVES: This research compared the validity of self-reports of cigarette smoking for African-American, Hispanic, and White respondents. Previous research has raised a question about the validity of self-report for African Americans. METHODS: A self-report of cigarette smoking was obtained together with a measure of carbon monoxide from expired air. Convergence between self-reported smoking and the biochemical measure was analyzed separately for three ethnic groups at 7th grade, 8th grade, 9th grade, and 10th grade. RESULTS: Analyses indicated that the validity of self-reports of smoking was generally comparable across ethnic groups. Sensitivity and specificity were comparable with data reported in recent meta-analyses. Though sensitivity was slightly lower for minority adolescents than for White adolescents, prevalence rates corrected for group differences in sensitivity showed significantly lower smoking rates for African-American and Hispanic adolescents than for White adolescents. CONCLUSIONS: The lower smoking rates reported for African-American adolescents are real and are not substantially a consequence of reporting artifacts.
Sex trading and psychological distress among women recruited from the streets of Harlem.
Authors: el-Bassel N , Schilling R F , Irwin K L , Faruque S , Gilbert L , Von Bargen J , Serrano Y , Edlin B R
Published: November 2008

OBJECTIVES: This study examines the relationship between sex trading and psychological distress and the implications of that relationship for prevention of human immunodeficiency virus among a sample of young women recruited from the streets of Harlem. METHODS: Interviews were conducted with 346 predominantly drug-using women, aged 18 to 29 years, of whom 176 had exchanged sex for money or drugs in the previous 30 days and were categorized as "sex traders." Psychological distress was measured by using the Brief Symptom Inventory. RESULTS: Sex traders scored significantly higher than non-sex traders on the General Severity Index and on eight of the nine subscales of the Brief Symptom Inventory. Multivariate analysis indicated that after adjustments were made for age; ethnicity; pregnancy; recent rape; perceived risk for acquired immunodeficiency syndrome; current, regular crack use; and current, regular alcohol use, sex traders scored 0.240 units higher on the General Severity Index than non-sex traders. CONCLUSIONS: Poor mental health and drug dependence may under-mine the motivation and ability of these sex traders to adopt safer sex behavior. Therefore, interventions need to be integrated with mental health services and drug treatment to reduce risk behavior in this population.
Determinants of US local health department expenditures, 1992 through 1993.
Authors: Gordon R L , Gerzoff R B , Richards T B
Published: November 2008

OBJECTIVES: This study examined local health department expenditures and their relationship to several departmental characteristics, including the size of the population in the department's jurisdiction. METHODS: Local health department characteristics were obtained from a 1992/93 nationwide mail survey and modeled by means of multiple linear regression. RESULTS: Great variability existed in the per capita expenditures of local health departments, and approximately 70% of the variability was accounted for by differences in jurisdiction population size. Additional characteristics of the health departments explained another 11%. The average unadjusted per capita expenditure by local health departments nationwide was $26. CONCLUSIONS: Local health department expenditures that support essential public health services average a dime a day per person.
Health insurance coverage among foreign-born US residents: the impact of race, ethnicity, and length of residence.
Authors: Thamer M , Richard C , Casebeer A W , Ray N F
Published: November 2008

OBJECTIVES: This study examined the health insurance status of the US foreign-born population and the influence of race, ethnicity, and length of residence on health insurance status. METHODS: Data were obtained from the 1989 and 1990 National Health Interview Surveys, including the Insurance and Family Resource Supplements. RESULTS: In 1989 and 1990, the foreign-born population was twice as likely as the US-born population to be uninsured (26.2% vs 13.0%). The highest rate of uninsured status, 40.8%, was found among foreign-born Hispanics. Persons who had lived in the United States for less than 15 years were 1.5 to 4.7 times more likely to be uninsured than were US-born Whites. CONCLUSIONS: Foreign-born US residents-especially Hispanics and persons residing in the United States for less than 15 years-are vulnerable to not having health insurance, which may limit their access to medical services. The administrative criteria for public programs may explain the high rates of uninsured status among recent immigrants. Recently enacted federal legislation could substantially increase the number of uninsured among the US foreign-born population, with profound public health implications.
State variations in Medicare expenditures.
Authors: Kane R L , Friedman B
Published: November 2008

OBJECTIVES: This study examined variations in Medicare expenditures across states. METHODS: 1992 data on average Medicare expenditures per enrollee, users of services per 1000 enrollees, service use per user, and payment per unit of service were compared across states for various services. Weighted least squares regression analysis was employed to examine total Medicare expenditures per enrollee by state. RESULTS: Variation in Medicare expenditures across states is driven more by average number of service users per 1000 enrollees and average service units per user than by average payment per service unit. Medicare expenditures per enrollee by state are primarily a function of Medicare HMO penetration rate (P = .000), urban area (P = .001), hospital bed supply (P = .005), elderly mortality rate (P = .012), Medicare physician assignment rate (P = .026), percentage of primary care practitioners (P = .042), and interactions between urban elderly and percentage of primary care physicians (P = .005) and Black elderly and nursing home bed supply (P = .012). CONCLUSIONS: Before sweeping Medicare cuts are undertaken or excessive reliance on managed care occurs, attention should be focused on the current disproportionate distribution of expenditures across states.
Excess mortality attributable to hip fracture in white women aged 70 years and older.
Authors: Magaziner J , Lydick E , Hawkes W , Fox K M , Zimmerman S I , Epstein R S , Hebel J R
Published: November 2008

OBJECTIVE: The purpose of this study was to estimate the excess mortality attributable to hip fracture. METHODS: The 6-year survival rate of community-dwelling White female hip fracture patients aged 70 years and older entering one of seven hospitals from 1984 to 1986 (n = 578) was compared with that of White female respondents aged 70 years and older interviewed in 1984 for the Longitudinal Study on Aging (n = 3773). RESULTS: After age, education, comorbidity, and functional impairment were controlled, the mortality differential between the two groups accumulated to an excess among hip fracture patients of 9 deaths per 100 women 5 years postfracture. Among those with three or more functional impairments or one or more comorbidities, the excess was 7 deaths per 100: the effect of the fracture had disappeared in these groups by 4 years. In contrast, those with two or fewer impairments and those with no comorbidities had a continuing trend of increased mortality, with an excess of 14 deaths per 100 by 5 years. CONCLUSIONS: There is an immediate increase in mortality following a hip fracture in medically ill and functionally impaired patients, whereas among those with no comorbidities and few impairments, there is a gradual increase in mortality that continues for 5 years postfracture.
The effects of planned duration of residential drug abuse treatment on recovery and HIV risk behavior.
Authors: McCusker J , Bigelow C , Frost R , Garfield F , Hindin R , Vickers-Lahti M , Lewis B
Published: November 2008

OBJECTIVE: This study assessed the effects of planned duration of residential drug abuse treatment on recovery from drug use and on human immunodeficiency virus (HIV) risk behaviors. METHODS: Two concurrent randomized controlled trials of programs differing in planned duration were conducted: 6-month vs 12-month versions of a traditional therapeutic community program, and 3-month vs 6-month versions of a modified therapeutic community incorporating a relapse prevention and health education program. Outcomes, measured at least 16.5 months after admission, included time from admission to first drug use; severity of drug, alcohol, legal, and employment problems; and risky drug injection and sexual behaviors. RESULTS: Among 539 clients (86% of those enrolled), there were no significant effects of planned duration of treatment upon Addiction Severity Index scores or HIV risk behavior. In the relapse prevention program, clients randomized to the 6-month program had a longer time to first drug use than those in the 3-month program (hazard ratio = 0.74; 95% confidence interval = 0.58, 0.93). Employment problems at follow-up were significantly less severe among clients treated in the therapeutic community than among those in the relapse prevention program. CONCLUSIONS: No overall benefit of extending treatment beyond 6 months was found.
The changing distribution of HIV infection: HIV surveillance in Lazio, Italy, 1985 through 1994. Lazio HIV Surveillance Collaborative Group.
Authors: Brancato G , Perucci C A , Abeni D D , Sangalli M , Ippolito G , Arcà M
Published: November 2008

OBJECTIVES: This study sought to describe the human immunodeficiency virus (HIV) surveillance system in Lazio, Italy, and to analyze exposure patterns and time trends of HIV serodiagnoses from January 1985 to December 1994. METHODS: A linkage procedure made it possible to identify newly diagnosed HIV cases. Anonymous information was collected on demographic and exposure factors for each individual. RESULTS: Of 35,425 reports, 13,660 were newly diagnosed HIV cases, 70.9% of them in men. The proportion of women increased at the beginning of the study period (the male:female ratio declined from 3.5 in 1985 to 2.6 in 1986) and then remained stable. The proportion of subjects reporting heterosexual exposure, in men and women, respectively, increased from 1.5% and 2.0% in 1985 to 21.2% and 60.8% in 1994. Starting in 1992, heterosexual contact has become the main transmission route for women. CONCLUSIONS: A changing pattern in the HIV epidemic is emerging, with a shift in the incidence of HIV diagnosis from "core" high-risk groups (drug injectors) to the large low-risk population (the general population) exposed through heterosexual transmission. This is probably occurring in other areas (e.g., large urban centers in the United States) with a similar epidemiological situation.
Improving publicly funded substance abuse treatment: the value of case management.
Authors: Shwartz M , Baker G , Mulvey K P , Plough A
Published: November 2008

OBJECTIVES: This study evaluated the impact of case management on client retention in treatment and short-term relapse for clients in the publicly funded substance abuse treatment system. METHODS: A retrospective cohort design was used to study clients discharged from the following four modalities in 1993 and 1994: short-term residential (3112 clients), long-term residential (2888 clients), outpatient (7431 clients), and residential detox (7776 clients). Logistic regression models were used to analyze the impact of case management after controlling for baseline characteristics. RESULTS: The odds that case-managed clients reached a length of stay previously identified as associated with more successful treatment were 1.6 (outpatient programs) to 3.6 (short-term residential programs) times higher than the odds for non-case-managed clients. With the exception of outpatient clients, the odds of case-managed clients' being admitted to detox within 90 days after discharge (suggesting relapse) were about two thirds those of non-case-managed clients. The odds of case-managed detox clients' transitioning to post-detox treatment (a good outcome) were 1.7 times higher than the odds for non-case-managed clients. CONCLUSIONS: Case management is a low-cost enhancement that improves short-term outcomes of substance abuse treatment programs.
State smoking prevalence estimates: a comparison of the Behavioral Risk Factor Surveillance System and current population surveys.
Authors: Arday D R , Tomar S L , Nelson D E , Merritt R K , Schooley M W , Mowery P
Published: November 2008

OBJECTIVES: This study examined whether there are systematic differences between the Behavioral Risk Factor Surveillance System (BRFSS) and the Current Population Survey (CPS) for state cigarette smoking prevalence estimates. METHODS: BRFSS telephone survey estimates were compared with estimates from the US Census CPS tobacco-use supplements (the CPS sample frame includes persons in households without telephones). Weighted overall and sex- and race-specific BRFSS and CPS state estimates of adults smoking were analyzed for 1985, 1989, and 1992/1993. RESULTS: Overall estimates of smoking prevalence from the BRFSS were slightly lower than estimates from CPS (median difference: -2.0 percentage points in 1985, -0.7 in 1989, and -1.9 in 1992/1993; P < .05 for all comparisons), but there was variation among states. Differences between BRFSS and CPS estimates were larger among men than among women and larger among Blacks than among Hispanics or Whites; for most states, these differences were not significant. CONCLUSIONS: The BRFSS generally provides state estimates of smoking prevalence similar to those obtained from CPS, and these are appropriate for ongoing state surveillance of smoking prevalence.
Telephone support as an adjunct to transdermal nicotine in smoking cessation.
Authors: Lando H A , Rolnick S , Klevan D , Roski J , Cherney L , Lauger G
Published: November 2008

OBJECTIVES: Transdermal nicotine patches have shown considerable promise in improving smoking cessation outcomes. The present study assessed telephone support as an adjunct to a managed care-based, single-session group orientation smoking cessation program with nicotine patch therapy. METHODS: The unit of randomization was the orientation session (n = 35). Subjects (n = 509) were randomly assigned to a group session without telephone support, the session plus access to a toll-free help line, or the session with telephone help line plus active telephone outreach. RESULTS: Contrary to hypothesis, there were no differences between treatment conditions. Overall abstinence rates were 22% at 6 months and 21% at 1 year. Fewer than 1% of eligible subjects called the toll-free help line. An average of 3.8 of a possible 4 calls were completed in the telephone outreach condition. CONCLUSIONS: Abstinence results obtained in this program were comparable to those obtained with more extensive counseling. However, there was no evidence of benefit from telephone support beyond the initial physician-led group orientation session.
Injury and death associated with hospital bed side-rails: reports to the US Food and Drug Administration from 1985 to 1995.
Authors: Todd J F , Ruhl C E , Gross T P
Published: November 2008

OBJECTIVES: Hospital bed side-rails, while intended for patient protection, can contribute to injury and death. Reports to the Food and Drug Administration (FDA) of hospital bed side-rail entrapment have increased. In this paper entrapment cases are reviewed and the population potentially at risk identified. METHODS: FDA's database was searched for events involving hospital beds from January 1985 to August 1995 and entrapment cases were identified. RESULTS: Of 111 entrapments, 65% were associated with death and 23% with injury. CONCLUSIONS: Advanced age, female sex, low body weight, and cognitive impairment may be associated with increased risk. Preventive measures are detailed.
The contribution of six chronic conditions to the total burden of mobility disability in the Dutch population.
Authors: Picavet H S , van den Bos G A
Published: November 2008

OBJECTIVES: This study assessed the proportions of the burden of mobility disability in the Dutch population that are attributable to musculoskeletal diseases, lung diseases, neurological disorders, heart diseases, diabetes, and cancer. METHODS: National survey data were analyzed with an elimination technique that combines the results of logistic regression analysis and the disease prevalence. RESULTS: Of the total prevalence of disability (20.5%), 33.7% can be attributed to these six chronic conditions. Musculoskeletal disorders account for the major part, whereas the contribution of cancer is very small. CONCLUSIONS: The potential benefits of effective curative or preventive treatments for chronic conditions, in terms of reduction of the disability burden in the population, are limited.
'Call fast, Call 911': a direct mail campaign to reduce patient delay in acute myocardial infarction.
Authors: Meischke H , Dulberg E M , Schaeffer S S , Henwood D K , Larsen M P , Eisenberg M S
Published: November 2008

OBJECTIVES: A 10-month direct mail campaign was implemented to increase use of emergency medical services via 911 calls and to reduce prehospital delay for individuals experiencing acute myocardial infarction symptoms. METHODS: This prospective, randomized, controlled trial involved three intervention groups (receiving brochures with informational, emotional, or social messages) and a control group. RESULTS: Intervention effects were not observed except for individuals who had a history of acute myocardial infarction and who were discharged with a diagnosis of acute myocardial infarction; their 911 use was meaningfully higher in each intervention group than in the control group. CONCLUSIONS: The mailings affected only the individuals at greatest risk.
Plasma polychlorinated biphenyl levels in Dutch preschool children either breast-fed or formula-fed during infancy.
Authors: Patandin S , Weisglas-Kuperus N , de Ridder M A , Koopman-Esseboom C , van Staveren W A , van der Paauw C G , Sauer P J
Published: November 2008

OBJECTIVES: This study examined the influence of lactational and in utero exposure to polychlorinated biphenyls (PCBs) on plasma PCB levels in children. METHODS: Plasma PCB levels were measured in 173 children at 3.5 years, of whom 91 were breast-fed and 82 were formula-fed in infancy. RESULTS: Median plasma PCB levels were 3.6 times higher in breast-fed children (0.75 microgram/L) than in their formula-fed peers (0.21 microgram/L). Breast-feeding period and breast-milk PCB levels were important predictors for PCB levels in the breast-fed group. For children in the formula-fed group, PCB levels were significantly related to their material plasma PCB levels. CONCLUSIONS: PCB levels in Dutch preschool children are related to transfer of maternal PCBs; therefore, strategies should be aimed at reducing maternal PCB body burden.
Hepatitis A among schoolchildren in a US-Mexico border community.
Authors: Redlinger T , O'Rourke K , VanDerslice J
Published: November 2008

OBJECTIVES: A cross-sectional study investigated the association of hepatitis A seropositivity with environmental and personal risk factors among children in a United States-Mexico border community. METHODS: Hepatitis A serological markers and a questionnaire identifying risk factors were evaluated for 523 primary school children. RESULTS: Of the children studied, 16.9% tested positive for total antihepatitis A virus. Risk factors included being in the first grade, low maternal educational attainment, living in Mexico for more than 6 months, household crowding, and inadequate excreta disposal systems. CONCLUSIONS: To decrease enteric disease, improvements in excreta disposal infrastructures and educational programs are needed. Hepatitis A vaccine should be administered before school age.
Diabetes in Hawaii: estimating prevalence from insurance claims data.
Authors: Maskarinec G
Published: November 2008

OBJECTIVES: The purpose of this study was to determine the prevalence of diabetes mellitus in Hawaii from insurance claims data. METHODS: Information from two major health plans covering approximately 66% of the state's population was used to estimate prevalence rates by sex, age group, and geographic area. Weighted multiple linear regression was applied to identify predictors of diabetes prevalence. RESULTS: The statewide diabetes prevalence was estimated at 43.8 per 1000 persons. The ethnic composition of the population and rural residence partially explained the geographic variation in diabetes prevalence. CONCLUSIONS: Insurance claims data may be a useful tool for population-based diabetes surveillance.
Under the shadow of Tuskegee: African Americans and health care.
Authors: Gamble V N
Published: November 2008

The Tuskegee Syphilis Study continues to cast its long shadow on the contemporary relationship between African Americans and the biomedical community. Numerous reports have argued that the Tuskegee Syphilis Study is the most important reason why many African Americans distrust the institutions of medicine and public health. Such an interpretation neglects a critical historical point: the mistrust predated public revelations about the Tuskegee study. This paper places the syphilis study within a broader historical and social context to demonstrate that several factors have influenced--and continue to influence--African American's attitudes toward the biomedical community.
Primary HIV infection--a public health opportunity.
Authors: Cates W , Chesney M A , Cohen M S
Published: November 2008

Primary human immunodeficiency virus (HIV) infection should be considered a key target for HIV prevention activities. Mathematical models suggest that the primary HIV infection interval makes a disproportionate contribution to the HIV epidemic, perhaps accounting for as many as half of the existing infections at any point in time. If this is true, primary infection presents a special window of opportunity within which to exert a maximum impact on the spread of HIV. A combination of biological, behavioral, and social factors may account for the influence of primary infection on the HIV epidemic. HIV prevention measures can be focused on each of these factors. Biologically, detecting individuals early in the course of infection and offering treatment can reduce viral load and possibly an individual's infectiousness. Behaviorally, counseling newly infected persons about the importance of adopting safer practices may instill prevention behaviors at a critical time. Socially, using a network approach to notify persons exposed to those with primary infections can dampen the amplification effect of rapid HIV spread through high-risk environments. By focusing prevention efforts on the primary HIV infection interval, public health officials could increase their leverage in slowing the HIV epidemic.
AIDS education in Tanzania: promoting risk reduction among primary school children.
Authors: Klepp K I , Ndeki S S , Leshabari M T , Hannan P J , Lyimo B A
Published: November 2008

OBJECTIVES: The purpose of this study was to test the effects of an education program in Tanzania designed to reduce children's risk of human immunodeficiency virus (HIV) infection and to improve their tolerance of and care for people with acquired immunodeficiency syndrome (AIDS). METHODS: A randomized controlled community trial including baseline and 12-month follow-up surveys was employed. Public primary schools in the Arusha and Kilimanjaro regions of Tanzania were stratified according to location and randomly assigned to intervention (n = 6) or comparison (n = 12) conditions. Of the 1063 sixth-grade students (average age: 13.6 years) who participated at baseline, 814 participated in the follow-up survey. RESULTS: At follow-up, statistically significant effects favoring the intervention group were observed for exposure to AIDS information and communication, AIDS knowledge, attitudes toward people with AIDS, and subjective norms and behavioral intentions toward having sexual intercourse. A consistent positive but nonsignificant trend was seen for attitudes toward having sexual intercourse and for initiation of sexual intercourse during the previous year (7% vs 17%). CONCLUSIONS: It is feasible and effective to train local teachers and health workers to provide HIV/AIDS education to Tanzanian primary school children.
Nutrient intakes of individuals from food-insufficient households in the United States.
Authors: Rose D , Oliveira V
Published: November 2008

OBJECTIVES: Understanding the nutritional consequences of food insufficiency is important for informed policy-making that addresses the problem of domestic hunger. This study estimated the extent to which individuals from food-insufficient households were likely to have low intakes of energy and 14 other nutrients. METHODS: The diets of pre-schoolers, adult women, and the elderly were analyzed with 24-hour recall data from the 1989 through 1991 Continuing Survey of Food Intake by Individuals. Logistic regression analysis was used to study the association of self-reported household food insufficiency with nutrient intakes below 50% of the recommended daily allowance. RESULTS: For adult women, food insufficiency was significantly associated with low intakes of eight nutrients, including energy, magnesium, and vitamins A, E, C, and B6. Elderly individuals in the food-insufficient group were also more likely to have low intakes of eight nutrients, including protein, calcium, and vitamins A and B6. Household food insufficiency was not significantly associated with low intakes among preschoolers. CONCLUSIONS: The results validate the use of self-reported hunger measures in nutritional surveillance and highlight nutrients of concern for food assistance and nutrition education efforts targeted at individuals from food-insufficient households.
In utero exposure to famine and subsequent fertility: The Dutch Famine Birth Cohort Study.
Authors: Lumey L H , Stein A D
Published: November 2008

OBJECTIVES: We hypothesized that if prenatal caloric restriction due to nutritional deprivation had affected development of the organs responsible for producing and regulating female reproductive hormones, a woman's fertility would be impaired. METHODS: Women born in Amsterdam from August 1, 1944, through April 15, 1946, a period encompassing a severe 5-month famine, were identified (n = 700; 85% response rate). Date of birth and vital status of all offspring were ascertained by home interview between 1987 and 1991. Famine exposure was inferred from the mother's date of birth. RESULTS: Of the study participants, 74 (10.6%) had no children. The remainder reported 1334 off-spring (1294 singletons, 20 pairs of twins), of whom 14 were stillborn and 22 died in the first 7 days of life. There was no detectable effect of famine exposure on age at menarche, the proportion having no children, age at first delivery, or family size. An excess of perinatal deaths occurred among offspring of famine-exposed women, particularly those exposed in their third trimester. CONCLUSIONS: Acute famine exposure in utero appears to have no adverse consequences for a woman's fertility. The excess perinatal mortality in the second generation is unexplained and should be confirmed by other studies.
Racial and ethnic differences in determinants of intrauterine growth retardation and other compromised birth outcomes.
Authors: Frisbie W P , Biegler M , de Turk P , Forbes D , Pullum S G
Published: November 2008

OBJECTIVES: This study examined the extent of variation by race/ethnicity in the prevalence of adverse birth outcomes, whether differentials persisted after other risk factors were controlled for, and whether the direction and magnitude of relationships differed by type of outcome. METHODS: A revised system of measurement was used to estimate multinomial logistic models in a large, nationally representative US data set. RESULTS: Considerable racial/ethnic variation was found across birth outcome categories; differences persisted in the adjusted parameter estimates; and the effects of other risk factors on birth outcomes were similar as to direction, but varied somewhat in magnitude. The odds of compromised birth outcomes were much higher among African Americans than among Mexican Americans and non-Hispanic Whites. CONCLUSIONS: In addition to persistent racial inequality, we found strong adverse effects of both inadequate and "adequate-plus" prenatal care and smoking. Risk of intrauterine growth retardation was higher in the absence of medical insurance, and risk of all adverse birth outcomes was lower among mothers participating in the Special Supplemental Food Program for Women, Infants, and Children.