bluuebunny/crossref_metadata_2025 huggingface dataset:
Hearing loss and the high speed dental handpiece.
Authors: Zubick H H , Tolentino A T , Boffa J
Published: November 2008

A pure tone air conduction audiometric evaluation was administered to 137 dentists and 80 physicians. The physicians were found to have better hearing threshold levels, notably in the 4000HZ center frequency range. The left ear of right handed dentists showed a greater loss of hearing ostensibly related to proximity to the noise source. Dental specialists showed a loss pattern similar to those of the general dentists. The findings suggest that there may be a cause and effect relationship between hearing loss and use of the highspeed dental handpiece.
Attitudes toward drinking conveyed in studio greeting cards.
Authors: Finn P
Published: November 2008

Analysis of 129 studio cards containing alcohol-related subject matter revealed themes which suggest that getting drunk is a natural and desirable concomitant of celebrations and that drunkenness is humorous, enjoyable, and harmless. It is proposed that the depiction of intoxication in these cards as pleasurable and risk-free may legitimate and reinforce tolerant attitudes toward alcohol abuse and thereby contribute to their entrenchment and pervasiveness in the face of recent public education prevention campaigns.
Epidemiology of alcohol abuse in military and civilian populations.
Authors: Polich J M
Published: November 2008

Results from a random sample survey of US Air Force personnel show that 4.6 per cent exhibit alcohol dependence, indicated by symptoms of withdrawal and impaired control over drinking. An additional 9.3 per cent can be identified as nondependent alcohol abusers, indicated by serious adverse effects of drinking (such as arrest, accident, hospitalization, or significant work impairment) or by heavy alcohol consumption (over 150 ml of ethanol daily). Compared with data from supervisors and official records, survey results did not understate alcohol-related problems. Survey reports of alcohol consumption did underestimate alcoholic beverage sales by about 20 per cent, but adjustments for this discrepancy increased the prevalence rate by less than one percentage point. Rates of serious alcohol abuse among representative samples of males in the U.S. Army, Navy, Air Force, and civilian populations were also compared. Although the rates were higher in the military than among civilians, most of the difference was associated with the higher-risk demographic characteristics of military personnel, who are more likely than civilians to be young unmarried males. Results indicate that the rate of alcohol abuse in the military is about the same as in civilian groups with comparable demographic characteristics.
The Framingham Disability Study: II. Physical disability among the aging.
Authors: Jette A M , Branch L G
Published: November 2008

The Framingham Disability Study (FDS), a recent component of the Heart Disease Epidemiological Study in Framingham, Massachusetts, was designed to investigate the nature and magnitude of disability among non-institutionalized elderly. From September 1976 through November 1978, 2,654 individuals aged 55 to 84 years from the original Framingham cohort were interviewed in person or by telephone (94 per cent of the potential participant pool). The findings support the well known relationship between physical disability and age. The magnitude of disability, however, is not as great as conventional wisdom might suggest. This paper presents the physical disability prevalence findings and compares these results to earlier epidemiological investigations of disability in the elderly.
Incidence of congenital anomalies among white and black live births with long-term follow-up.
Authors: Christianson R E , van den Berg B J , Milkovich L , Oechsli F W
Published: November 2008

The incidence of congenital anomalies at birth and accumulated to five years is presented for live-born children in a large prospective study. Congenital anomalies are not all diagnosable at birth; our data demonstrate that the incidence rate increases approximately three-and-one-halffold for Blacks and approximately fivefold for Whites between six days of age and five years of age. The incidence of congenital anomalies at birth was higher among Black children than White children, but there were no notable differences between the groups in incidence accumulated to age five years. At five years, the incidence rate of severe and moderate (but not trivial) congenital anomalies amounted to 15 per cent; for severe congenital anomalies, 4 per cent. Severe congenital anomalies diagnosed through age five years were observed to have a much higher incidence among children who weighted 2500 gm or less at birth than among those who were heavier.
Do prescriptions adversely affect doctor-patient interactions?
Authors: Wartman S A , Morlock L L , Malitz F E , Palm E
Published: November 2008

The purpose of this study was to assess the impact of the prescription on the doctor-patient interaction. Data were collected during ongoing quality assessment studies at a prepaid group practice of about 19,000 enrollees. Adult patients and their providers completed forms on all visits to the Department of Medicine and Urgent Care Center during a two-week period. A 50 percent random sample of patients was interviewed by telephone one week after the index visit. Patients who did not receive prescriptions reported more satisfaction with the communicative aspects of their visits to physicians than patients who did receive prescriptions. We suggest that prescriptions may hinder patient satisfaction with the doctor-patient interaction by substituting for other, more "meaningful" communication between patient and provider.
The contribution of school health education to community health promotion: what can we reasonably expect?
Authors: Bartlett E E
Published: November 2008

Evaluative studies of outcomes of traditional school health education programs have shown that they are very effective in increasing knowledge, somewhat effective in improving attitudes, and, with few notable exceptions, generally ineffective in changing health practices. This paper discusses the previous reviews of the literature of outcomes of school health education programs, and discusses the constraints inherent in school-based activities; an emphasis on cognitive learning, lecture-oriented teaching methods, inadequate pupil assessment procedures, a captive audience, competing subject areas, competing behavioral influences, behavior change attempts directed at ingrained health habits, inadequate coordination with community resources, and lack of consensus regarding educational goals. The paper then examines several recent successful school health education programs emphasizing non-traditional approaches in self-initiated care, pregnancy prevention, smoking prevention, and nutrition. It is concluded that school-based health education programs have three important roles in community health promotion: 1. the provision of a fundamental understanding of health and disease concepts to large segments of the population; 2. the reinforcement of positive health attitudes; and 3. the alteration of concurrent health behaviors for significant health problems. Although school health education may be helpful in enhancing decision-making and social interaction skills, little empirical evidence exists at this time to support this conclusion.
The influence of patient-practitioner agreement on outcome of care.
Authors: Starfield B , Wray C , Hess K , Gross R , Birk P S , D'Lugoff B C
Published: November 2008

A previous study suggested that patient-practitioner agreement and follow-up in ambulatory care facilitates problem resolution as judged by patients. In this study in another medical practice, practitioner-patient agreement on what problems required follow-up was associated with greater problem resolution as judged by the practitioners regardless of the severity of the problems. In this study, patients did not judge problems mentioned only by themselves to be less improved than problems mentioned by both them and their practitioners. However, in this study more of the problems mentioned only by patients were mentioned in the note of the visit contained in the medical record. Patients expected less and reported less improvements of problems that were neither mentioned by the practitioner nor written in the medical record than was the case for problems listed both by patients and practitioners. The findings of this study confirm those of the previous study in suggesting that practitioner-patient agreement about problems is associated with greater expectations for improvement and with better outcome as perceived by patients. In addition, they indicate that practitioners also report better outcome under the same circumstances.
Polychlorinated biphenyl contamination of nursing mothers' milk in Michigan.
Authors: Wickizer T M , Brilliant L B , Copeland R , Tilden R
Published: November 2008

The problem of environmental contamination by toxic substances and human exposure to these substances has attracted increased attention in recent years. Particular concern has centered on polychlorinated biphenyls (PCBs), which have become widespread environmental pollutants as well as contaminants of the human population. This paper reports data from a study of PCB contamination of nursing mothers' breast milk in Michigan. During 1977 and 1978, breast milk samples of 1,057 nursing mothers residing in Michigan were tested for PCB residues. All of the 1,057 samples collected from 68 of the state's 83 counties contained PCB residues ranging from trace amounts to 5,100 parts per million (fat weight basis). The mean level was 1,496 parts per million (ppm), with 49.5 per cent of the samples having PCB levels of 1-2 ppm, 17.4 per cent had 2-3 ppm, and 6.14 per cent had more than 3 ppm. There was no consistent trend in the level of PCB contamination over the 24 months of monitoring. The mean PCB level for the eighth quarter of monitoring was slightly higher than for the first quarter. The public health significance of PCB contamination in human populations and its effects on breast-fed for eight months by a woman with the average PCB level in this sample would have an estimated body burden of approximately 0.89 ppm of PCBs. The implications of PCB contamination of human milk with regard to current breast-feeding practices are discussed and several precautionary measures are recommended.
Mental health primary prevention: the role of parent mutual support groups.
Authors: Kagey J R , Vivace J , Lutz W
Published: November 2008

A primary prevention program was developed to provide supportive services for parents of newborns. Ninety-eight parents responded to a survey intended to evaluate what the groups provided and to describe characteristics of parents who attended the groups. Parents evaluated the groups as effective in providing social contact, supporting the parenting role, feeling less alone, understanding children's development, and increasing child-caring skills. The parents did not evaluate the groups as helping to improve a relationship with their spouse.
Patient recovery from type A botulism: morbidity assessment following a large outbreak.
Authors: Mann J M , Martin S , Hoffman R , Marrazzo S
Published: November 2008

A large outbreak of foodborne botulism provided an opportunity to study the recovery from type A botulism in a group of 27 patients. Patients were interviewed either nine or 13 months after the outbreak, and a written questionnaire was mailed at 24 months, to obtain information on each patient's symptom complex and on subsequent symptom resolution. Recovery from symptoms of botulism was slow. Patients reported that resolution of 50 per cent of their original symptoms occurred by an average of 5 months. Thirteen of 14 patients contacted 13 months after onset of botulism reported some persistent symptoms. This study, although limited to interview data, strengthens the concept of a prolonged recovery phase in botulism, as previously suggested in individual case reports. Physicians and other health workers caring for patients with botulism should anticipate physical and psychological problems resulting from a lengthy and difficult convalescent period.
Low measles incidence: association with enforcement of school immunization laws.
Authors: Robbins K B , Brandling-Bennett D , Hinman A R
Published: November 2008

Of 54 federal immunization project areas in the United States, 13 areas with low measles incidence rates in 1977 and 1978 and 10 with high measles incidence rates were compared for differences in surveillance systems, demography, vaccine utilization, school immunization laws, and immunity levels. There was no significant difference between the low incidence and high incidence group for any examined parameter of demographic characteristics, vaccine utilization, or surveillance systems. However, in the low incidence group, school immunization laws were found to be more comprehensive and more strictly enforced with a statewide policy of exclusion from school of noncompliant students. Furthermore, immunization levels were similar for two-year-olds in both groups but were significantly higher for school entrants in the low incidence group. In all public health efforts to control or eliminate measles, priority should be given to establishing and strictly enforcing comprehensive school immunization laws.
Female laundry and dry cleaning workers in Wisconsin: a mortality analysis.
Authors: Katz R M , Jowett D
Published: November 2008

The mortality patterns of 671 female laundry and dry cleaning workers for the period 1963--1977 were analyzed, using Wisconsin death certificate data. Results fail to show an overall increase in malignant neoplasms, but elevated risk was found for cancers of the kidney and genitals (unspecified), along with a smaller excess of bladder and skin cancer and lymphosarcoma.
Black attrition in physician assistant training programs.
Authors: Weiner T , Schneller E S
Published: November 2008

We report on correlates of attrition for Blacks and Whites in physician's assistant training programs. The data reveal an unusually high rate of attrition for Blacks (65 per cent) and, in particular, for Black males (59 per cent). This latter group, regardless of educational background and other potential predicators of educational success, encounters significant difficulty in the educational process. An understanding of this attrition phenomenon is useful for designing admissions policies which identify a larger percentage of low risk recruits to health professions education.
Low-cost health delivery systems: lessons from Nicaragua.
Authors: Heiby J R
Published: November 2008

In 1976 the Ministry of Health of Nicaragua began a low cost program to deliver simple health services in rural areas through trained traditional birth attendants or "parteras." After two years the program had prepared 768 parteras in a five-day training course. Parteras were equipped with a kit that included oral rehydration salts, an antihelminthic, multi-vitamins with iron, aspirin, contraceptives, and obstetrical equipment. The difficulties encountered in implementing this limited set of simple health services illustrate a number of potential obstacles to the achievement of universal, comprehensive primary health care in less developed countries. The most prominent difficulties involved elements of the health service delivery system itself: supervision, the collection and use of management information, training, partera selection, and logistics. The experience also provided examples of issues in the design of delivery systems that require specific applied research.
Job satisfaction in the practice of clinical pharmacy.
Authors: Rauch T M
Published: November 2008

Two groups of pharmacists (n = 69) assigned to 35 US Army Medical Treatment Facilities were surveyed to assess job satisfaction. Pharmacists providing patient care were significantly more satisfied on intrinsic job satisfaction measures than pharmacists not providing patient care. On the other hand, no significant difference in satisfaction was found between pharmacy groups on extrinsic job satisfaction measures. The results are discussed relative to intrinsic and extrinsic sources of job satisfaction and patient care.
The cost-effectiveness of telephone vs clinic counseling for hypertensive patients: a pilot study.
Authors: Bertera E M , Bertera R L
Published: November 2008

The cost-effectiveness of counseling by telephone and by clinic visit contacts were compared in 40 hypertensive patients each of whom received counseling and reinforcement every three weeks for six months regarding diet, exercise, smoking, and coping with stress. Blood pressure declined significantly in both counseling groups (N: 10 each) but not in a control group (N: 20). The cost per patient under control was $82 for the clinic counseling and $39 for the telephone counseling strategy, suggesting that telephone counseling was a cost-effective technique.
Newborn diagnosis of abnormal hemoglobins from a large municipal hospital in Los Angeles.
Authors: Ewing N , Powars D , Hilburn J , Schroeder W A
Published: November 2008

Cord blood samples from 29,611 infants born in Los Angeles over a 71/2 year period were examined for hemoglobinopathies. Among 4,134 Black newborns, the frequency of sickle cell anemia (SS) was 0.3 per cent, of sickle cell trait (AS) 8 per cent, and of Hb-C trait (AC) 2 per cent. Of 17,781 Spanish surnamed (Mexican) newborns, 0.5 per cent had sickle cell trait, and 0.1 per cent had Hb-C trait. Of the 5,541 Caucasian infants, 0.7 per cent had sickle cell trait, and 0.15 per cent had Hb-C trait. Twenty-three Black children with major hemoglobinopathies included 16 with sickle cell anemia, two with hemoglobin C disease (CC), and five with SC disease.
Job decision latitude, job demands, and cardiovascular disease: a prospective study of Swedish men.
Authors: Karasek R , Baker D , Marxer F , Ahlbom A , Theorell T
Published: November 2008

The association between specific job characteristics and subsequent cardiovascular disease was tested using a large random sample of the male working Swedish population. The prospective development of coronary heart disease (CHD) symptoms and signs was analyzed using a multivariate logistic regression technique. Additionally, a case-controlled study was used to analyze all cardiovascular-cerebrovascular (CHD-CVD) deaths during a six-year follow-up. The indicator of CHD symptoms and signs was validated in a six-year prospective study of CHD deaths (standardized mortality ratio 5.0; p less than or equal to .001). A hectic and psychologically demanding job increases the risk of developing CHD symptoms and signs (standardized odds ratio 1.29, p less than 0.25) and premature CHD-CVD death (relative risk 4.0, p less than .01). Low decision latitude-expressed as low intellectual discretion and low personal schedule freedom-is also associated with increased risk of cardiovascular disease. Low intellectual discretion predicts the development of CHD symptoms and signs (SOR 1.44, p less than .01), while low personal schedule freedom among the majority of workers with the minimum statutory education increases the risk of CHD-CVD death (RR 6.6, p less than .0002). The associations exist after controlling for age, education, smoking, and overweight.
A multiple cause of death analysis of hypertension-related mortality in North Carolina, 1968-1977.
Authors: Wing S , Manton K G
Published: November 2008

In this paper, records of all medical conditions on death certificates are used to evaluate hypertension-related mortality in North Carolina over the decade 1968-1977. Use of both an inclusive hypertension recode category and multiple cause data resulted in gains in information of over 750 per cent in all four race/sex groups compared to the commonly used underlying cause, hypertensive disease category. Race, sex and age specific 10-year trends in death rates for all mentions of hypertension are analyzed, with comparisons to underlying cause mortality from ischemic heart disease and stroke. Age-adjusted declines of 19 to 24 per cent between 1968 and 1977 were observed for all race/sex groups, although non-White declines occurred mainly at younger ages while White declines (especially White males) occurred mainly at older ages. The non-White excess of hypertension mentions (compared to Whites) increased for males and decreased for females. The decline in hypertension mentions, in spite of the increased awareness of hypertension as a public health problem which would make it more likely to be mentioned on death certificates, suggests that there was a real reduction in the contribution of hypertension to total mortality over the period.
A method for the geographical evaluation of emergency medical service performance.
Authors: Mayer J D
Published: November 2008

Emergency Medical Service (EMS) evaluation is usually conducted on an aggregated, system-wide basis, despite the fact that there is substantial geographical variation in EMS performance. This paper suggests a method for the identification and analysis of geographically disaggregated EMS performance, using Seattle's Medic I program as an example.
Screening for cervical cancer, 1973-1976.
Authors: Hendershot G E
Published: November 2008

Using data from the National Survey of Family Growth, Cycle II, the per cent of women without a Pap test in 1973--76 is shown according to race, residence, and income, updating an earlier report based on 1973 data. Poor women and nonmetropolitan women continued to be significantly less likely than other women to have had a Pap test.
Planning and budgeting in the crippled children's sector through goal programming.
Authors: Joiner C , Drake A E
Published: November 2008

This article describes how the goal programming methodology was applied to a state level Crippled Children's Program. The various organizational goals are incorporated into the programming model to indicate the trade-offs associated with the resource allocation process. Alternative allocations are presented in terms of a "what if" approach to programming.
Colorado court involvement in chemical spill clean-up activities.
Authors: Rice D
Published: November 2008

Judicial involvement was utilized to force the owners of a pesticide formulation plant to decontaminate property that had been covered with toxic pesticides having the potential to contaminate both surface and groundwater supplies in the East Denver metropolitan area. This case represented the first use of the Colorado state court system in dealing with a hazardous waste "spill." In this case, judicial intervention was unsatisfactory because of the delays involved. Other courses of action will be considered in future cases of a similar nature.
Hospitalization for medical-legal and other abortions in the United States 1970-1977.
Authors: Bracken M B , Freeman D H , Hellenbrand K
Published: November 2008

The National Hospital Discharge Survey records for medical-legal, spontaneous, and "other" abortions (ICDA-8 640-641, 643, and 644 respectively) for 1970-1977 were analyzed to investigate the impact of liberalized access to abortion on abortion-related morbidity in the United States. The analysis suggests that in census regions where an increase in medical-legal abortions performed in hospitals occurred over the study period there was an associated decreased likelihood of a "spontaneous" or "other" abortion. The spontaneous and "other" abortion codes appear to have been used synonymously and a small number of each used to classify complications of both illegal and legal abortions performed outside hospitals. There was a significant reduction in length of stay for spontaneous and other abortions between 1970 and 1977. This is suggestive of decreasing severe presenting symptomatology for complicated abortion. The study further suggests that: during 1970-77 illegal abortions were largely replaced by legal procedures; increases in legal abortions beyond those replacing illegal have not resulted in increased rates of hospitalization for complicated abortion; and, the case morbidity rate for legal abortion appears to have declined.
Lung cancer mortality and smoking habits: Mexican-American women.
Authors: Holck S E , Warren C W , Rochat R W , Smith J C
Published: November 2008

Lung cancer mortality was reported to be higher among Mexican-American women as compared with Anglo women from 1950 until 1970; however, smoking habits of Mexican-American women have not been adequately described. This study updates lung cancer mortality data in Texas, describes smoking patterns of 1,255 Mexican-American women from a household survey in the four states bordering Mexico, and compares these findings to a reference group of Anglo women residing in the same area. In 1970, lung cancer mortality rates were similar for Mexican-American and Anglo women in Texas; however, by 1974-1976 Mexican-American women in Texas had a 40 per cent lower rate than Anglo women and by 1979, a 49 per cent lower rate. In our 1979 survey results, Mexican-American women reported lower levels of smoking, both in prevalence and amount smoked, as compared with Anglo women. The lower prevalence was reported for all social and demographic categories examined. The relatively low lung cancer mortality rate is most likely due to relatively low levels of cigarette smoking among Mexican-American women. Based on the trend in lung cancer deaths and our survey findings, we would anticipate a continuing low level of lung cancer mortality among Mexican-American women.
The recent trend in milk feeding among WIC infants.
Authors: Martinez G A , Stahle D A
Published: November 2008

The type of milk fed infants from birth to six months of age was ascertained by quarterly surveys of a national sample of births. WIC (Women, Infants and Children Program) participants were identified from this sample, and trend data indicate that an increased percentage of WIC mothers ae choosing to breastfeed their infants. Infant formula use has declined in the early months of life, but increased at the expense of cow's milk toward the middle of the first year.
Methodological rigor and citation frequency in patient compliance literature.
Authors: Bruer J T
Published: November 2008

An exhaustive bibliography which assesses the methodological rigor of the patient compliance literature, and citation data from the Science Citation Index (SCI) are combined to determine if methodologically rigorous papers are used with greater frequency than substandard articles by compliance investigators. There are low, but statistically significant, correlations between methodological rigor and citation indicators for 138 patient compliance papers published in SCI source journals during 1975 and 1976. The correlation is not strong enough to warrant use of citation measures as indicators of rigor on a paper-by-paper basis. The data do suggest that citation measures might be developed as crude indicators of methodological rigor. There is no evidence that randomized trials are cited more frequently than studies that employ other experimental designs.
Prospects for eliminating racial differences in breast cancer survival rates.
Authors: Shapiro S , Venet W , Strax P , Venet L , Roeser R
Published: November 2008

Results from the randomized trial underway in the Health Insurance Plan of Greater New York to determine the efficacy of periodic screening with mammography and palpation of the breast have been examined to determine the effect of screening on racial differences in breast cancer survival rates. Consistent with experience in general populations, the control group showed a lower five-year survival rate among non-White women with breast cancer than among White women. In the study group, 65 per cent of whom participated in the screening program, there was no differential in the survival rates of the two racial groups. The elimination of the unfavorable status among non-Whites through screening does not appear to be explained by various artifacts explored. Secondary prevention measures may offer the possibility of reducing or closing the gap in breast cancer survival rates between White and non-White women.
Prevention of mental retardation in offspring of hyperphenylalaninemic mothers.
Authors: Cartier L , Clow C L , Lippman-Hand A , Morissette J , Scriver C R
Published: November 2008

Maternal hyperphenylalaninemia constitutes a potential hazard to the fetus for whom the risks of postnatal mental retardation, microcephaly, and congenital malformations are elevated. Preconception and intragestational dietary treatment can apparently improve the outcome of such pregnancies. In the absence of predictive mechanisms for pregnancies at risk and preventive measures involving reproductive counseling and treatment, there could be a rebound in the population frequency of mental retardation related to disorders of phenylalanine metabolism in subsequent generations. We describe a program serving a population of six million that includes screening, diagnosis, treatment, and counseling of the hyperphenylalaninemias. The program has recently added a simple dedicated register for males and females with hyperphenylalaninemia to supplement traditional methods for continuous surveillance of probands. We registered 153 patients: 43 females and 56 males with phenylketonuria, 23 females and 31 males with benign hyperphenylalaninemia, of which 22, 7, 27 and 5, respectively, had reached their 12th birthday in an 1981. Regional centers in the program provided counseling about the consequences of maternal hyperphenylalaninemia and the options to prevent them. No family has rejected the principle or fact of the Register and its goals.
Winter weather and cardiovascular mortality in Minneapolis-St. Paul.
Authors: Baker-Blocker A
Published: November 2008

A study of vital statistics data from five Minneapolis-St. Paul winters indicates cardiovascular mortality is influenced by winter temperatures and snow. Although air temperature was not statistically implicated in triggering cardiovascular mortality in four of the five study winters, during the winter of 1976-77, about 15 per cent of the variance in daily cardiovascular mortality could be attributed to fluctuations in the daily minimum air temperature. Snow influenced mortality on the day of occurrence as well as the two days following a snowfall. There appear to be some differences in the ability of winter weather to influence mortality from acute myocardial infarction (ICD 410) and old myocardial infarction (ICD 412). The variance in daily ICD 410 mortality attributable to the influence of snow is somewhat less than that in daily ICD 412 mortality. The greatest variance in daily ICD 412 mortality that could be ascribed to snow occurred during the winter of 1974-75, and was 13 per cent. It is likely that rain intermixed with snow may also trigger increased mortality from cardiovascular disease. A combination of rain and snow can produce dramatic increased in mortality from ICD 410. Study of mortality data from five winters indicates that snow is somewhat more important in triggering deaths from heart disease than is air temperature.
Nutritional anemias in the English-speaking Caribbean: a review of the literature.
Authors: Johnson A A , Latham M C , Roe D A
Published: November 2008

A review of the published literature on nutritional anemias in the English-speaking Caribbean was carried out. Published articles on the subject are few in number and are concentrated in the larger islands such as Jamaica and Trinidad. Nutritional anemias are most prevalent among women of childbearing age. Iron and folate deficiencies and, to a much lesser extent, protein deficiency resulting from insufficient dietary intakes of these nutrients are the major nutritional factors contributing to this anemia.
A comprehensive rabies control program in Alaska.
Authors: Middaugh J , Ritter D
Published: November 2008

In 1975 the State of Alaska initiated a comprehensive Rabies Control Program. Lay vaccinators trained and certified by the state provided animal vaccination in rural areas. From 1975 through 1980, 182 persons received post-exposure rabies prophylaxis with Human Rabies Immune Globulin (HRIG) plus Duck Embryo Vaccine (DEV), or Human Diploid Cell Vaccine (HDCV), while 2,569 persons initially thought to have been exposed were not treated after consultation, at a cost saving of approximately $3,220,241.
Caffeine consumption and benign breast disease: a case-control comparison.
Authors: Marshall J , Graham S , Swanson M
Published: November 2008

In this case-control comparison of 323 women with benign breast disease and 1,458 controls, no differences were noted in the coffee and tea consumption patterns of the cases and controls. These findings do not support the recent suggestion of Minton, et al, that methylxanthine ingestion is causally related to benign breast disease or breast cancer.
A political economic theory of the dental care market.
Authors: Lipscomb J , Douglass C W
Published: November 2008

A theory of the dental care market is introduced which proposes that the vertically integrated (local/state/national) structure of the profession services as an organizational vehicle both for intra-professional debate and for developing provider-oriented dental care policy. We suggest that a special relationship exists between professionalism and professional regulation. Such regulation has functioned simultaneously to limit competition and to foster a prized consumption commodity for providers: professionalism and professional esteem. The organized pursuit of this commodity inherently dampens competition. Professionalism itself plays a crucial role in: 1) securing for organized dentistry a form of state regulation in which the providers themselves are the principal decision-makers; and 2) influencing provider and consumer market behavior in several significant respects, the net result being the formation of maintenance of a type of "leadership cartel" in the local market. Thus, a political-economic theory of the dental care market formally acknowledges professionalism as valued by established dentists and recent graduates as a central determining influence. Traditional models of pure competition and monopoly emerge as special, extreme cases of the general theory. Hypotheses are offered regarding consumer and provider behavior, market dynamics, and health policy and regulation.
The effect of immediate access to a computerized medical record on physician test ordering: a controlled clinical trial in the emergency room.
Authors: Wilson G A , McDonald C J , McCabe G P
Published: November 2008

We performed a randomized clinical trial of the effect of immediately printed summaries of a computerized medical record on physician test ordering rates in an Emergency Room setting. The computerized medical record contained medication history, the results of most diagnostic studies, an outpatient problem list, and inpatient and emergency room diagnoses. Physicians were presented with a printed summary of the patient's computerized record for study but not for control encounters. All other patient information was equally available to both kinds of encounters. All results were provided for one period of the study, designated T1. Due to a program error, summaries were printed without recent data during a period of the study, designated T2. Two-thirds of the visits were cared for by internists, one-third by surgeons. During T1, internists ordered an average of 3.2 tests, costing $34.91 for control visits, and 2.7 tests, costing $29.94 for study control visits (p less than .026). Surgeons also ordered fewer tests during study visits as compared to controls (1.32 vs 1.54) but the differences were not statistically significant. There was no significant effect on either medical or surgical test ordering during time period T2.
A study of carboxyhaemoglobin levels of cigarette and sheesha smokers in Saudi Arabia.
Authors: Zahran F , Yousef A A , Baig M H
Published: November 2008

A single carboxyhaemoglobin (COHb) estimation of late evening blood sample among non-smokers, cigarette smokers, and sheesha smokers was evaluated among Saudis. The COHb level in smokers of 15 to 40 cigarettes a day ranged between 0.7 and 10.3 with a mean value of 6.1 +/- 2.58 COHb. Values among sheesha smokers ranged between 6.5 and 13.9 with a mean value of 8.8 +/- 1.83, significantly higher than those of cigarette smokers (P less than 0.001) for a given degree of exposure to tobacco smoke.
Excess mortality from traffic accidents among elderly pedestrians living in the inner city.
Authors: Allard R
Published: November 2008

Age-specific death rates for pedestrian-car accidents among the populations living in four contiguous areas of a large city, one being the downtown area and the others gradually more removed from it, were compared. The rates are highest downtown and decrease progressively in the outlying areas, the absolute differences between areas being largest above age 65. These data suggest that pedestrian accident prevention efforts should take into account the specific needs of the elderly living in the inner city.
The persistence of depressive symptomatology among prepaid group practice enrollees: an exploratory study.
Authors: Hankin J R , Locke B Z
Published: November 2008

This exploratory study examines the persistence of depressive symptomatology as measured by the Center for Epidemiological Studies Depressive Scale (CES-D). Over as 12-month period, half of the group of 309 prepaid group practice enrollees reporting depressive symptoms at the beginning of the interval also had high scores on the CES-D at the end of the interval. Sociodemographic characteristics did not predict persistence of depression. Persistence of depression was positively associated with initially reporting cognitive and affective types of depressive symptoms, the presence of physical illness, the seeking of psychiatric treatment, and the receipt of psychotropic drug prescriptions.
Hospitalizations for measles, 1970-78.
Authors: Nolan T F , Goodman R A , Patriarca P A , Hinman A R
Published: November 2008

The National Hospital Discharge Survey of the National Center for Health Statistics was analyzed for measles hospitalizations. From 1970-1978 there were an estimated 52,301 hospitalizations for measles, or approximately 5,800 per year. The median patient age was three years, and the median length of stay was four days. Forty-one per cent of the discharges listed respiratory complications, 10 per cent listed otitis media, and 3 per cent listed neurologic complications. Based on this analysis, hospitalizations for measles accounted for 314,063 hospital days during the period 1970-1978.
Data requirements to measure progress on the objectives for the nation in health promotion and disease prevention.
Authors: Green L W , Wilson R W , Bauer K G
Published: November 2008

The Reagan Administration has adopted the policy guidelines developed over the previous few years in the disease prevention and health promotion initiative of the Carter Administration. Broad national consensus had been sought in the formulation of 226 measurable objectives for the decade. We classify the prevention objectives according to their position in an implied causal chain: 1) improved programs, 2) increased public and professional awareness, 3) reduced risk factors, and 4) improved health status. Prior to 1980, the data systems and periodic surveys sponsored by federal agencies and national organizations covered only four of the 42 objectives in the public and professional awareness category, whereas at least half of the objectives in each of the other three categories were covered by available national data sources, mostly federal. Sample surveys are needed to measure the majority of the currently unmeasured objectives in all four categories. Private and state health interview surveys are needed to supplement the federal capacity, especially in the face of federal cutbacks in survey capacity.
Referrals from an emergency room to primary care practices at an urban hospital.
Authors: Straus J H , Orr S T , Charney E
Published: November 2008

Three hundred ninety-eight patients treated in the emergency room for non-urgent complaints who stated that they had no regular source of primary medical care were referred to one of several medical care centers in the area. Overall, 34 per cent of such patients complied with the referral. Correlates of compliance were: age (very young and very old), patient-perceived health status, medically determined need for follow-up care, and having an appointment made by the emergency room provider. Another group of 500 successfully referred patients became excellent users of the primary care office, complying with requested health maintenance and follow-up visits. However, emergency room utilization by the successfully referred patients did not decrease more than among referred patients who did not enroll in the primary care source.
Evaluating the impact of physician peer review: factors associated with successful PSROs.
Authors: Adler N E , Milstein A
Published: November 2008

A five-component measurement method was developed and applied to the 1981 impact statements of 30 Professional Standards Review Organizations (PSROs) by four blind raters familiar with the PSRO program. High inter-rater reliability (.95) was achieved. Rater's scores for each PSRO were then averaged and regressed against five variables predicted to affect PSRO impact: geographical density of PSROs; PSRO affiliation with a medical society; surgical necessity review; use of data profiles; and pre-existing Medicare hospitalization rates. As a set, the variables accounted for 44 per cent of the variance in PSRO performance (p less than .05). When entered in stepwise regression, geographical density and use of surgical necessity review accounted for the largest share of the variance. The findings are believed to reflect the recency of PSRO motivation to demonstrate significant impact, and the value of surgical necessity review as an indicator of PSRO courage to risk unpleasant backlash from their medical communities.
The prevalence and incidence of juvenile rheumatoid arthritis in an urban Black population.
Authors: Hochberg M C , Linet M S , Sills E M
Published: November 2008

We determined the prevalence and incidence of juvenile rheumatoid arthritis (JRA) in an urban Black population in Baltimore, identifying three cases through review of computerized outpatient encounters and a fourth case by reviewing discharge records at area hospitals. The prevalence of JRA among Blacks, as of December 31, 1980, was estimated as 0.26 per 1,000 (95 per cent confidence interval: 0.07, 0.66), the average annual incidence 6.6 per 100,000 per year (0.8, 23.8) for the years 1979 and 1980. These data suggest that Black race is not associated with significantly increased risk of development of JRA.
The variability of blood pressure measurements in children.
Authors: Osborne R , Mullin C S , Roberson P K
Published: November 2008

This study examined the sources and amount of variation present in the blood pressures of 99 third grade children, using data collected from three repeated measurements made on three separate visits. The results highlight factors to consider when planning or evaluating studies designed to relate children's blood pressure levels to environmental conditions. Factors include variability both between and within children by visit and between observers; periodic restandardization of observers during the course of a study is desirable.
Predictive value of serologic tests.
Authors: Hart G
Published: November 2008

An analysis of serologic tests for treponemal disease performed in Australian aboriginal communities is used to illustrate factors influencing the predictive value positive of serologic tests. Simple extrapolation of predictive value estimates, from prevalence, sensitivity, and specificity data, is complicated by variation of specificity between strata of a population, and the weighting of true positive and false positive results produced by the criteria for selecting individuals for testing. The predictive value positive of a particular test is greatest when it is used for incident cases suspected of having a disease, but lower when the same test is used to screen a whole population unless longitudinal data are available to exclude individuals with past disease. Preferential testing of individuals without active disease may produce very low predictive values. Empirical estimation of the predictive value of tests provides objective guidelines for decision making and enables increased predictability by modification of testing criteria.
Concussion incidences and severity in secondary school varsity football players.
Authors: Gerberich S G , Priest J D , Boen J R , Straub C P , Maxwell R E
Published: November 2008

The head coaches and players of 103 secondary school football teams in Minnesota were asked to respond to mail questionnaires. Information about injury incidence and concomitant health care provision was elicited. Responses from 3,063 players (81 per cent) yielded a total injury rate of 78 injuries/100 players; 19/100 players reported a concussion experience characterized by loss of consciousness and/or loss of awareness. Of the players who experienced a loss of consciousness, 69 per cent were returned to play the same day. Persistent concussion symptoms were reported as long as six to nine months following the end of the season; six cases involved permanent disabilities. Continued use of illegal techniques of butt-blocking and face-tackling by as many as 40 per cent of the players was associated with apparent increased risks of concussions and concussion symptoms. Players with a prior history of loss of consciousness had a risk of loss of consciousness four times that of the player without a prior history.
Worksite smoking cessation programs: a potential for national impact.
Authors: Stachnik T , Stoffelmayr B
Published: November 2008

Data from three pilot studies of small worksite smoking cessation programs demonstrate that programs which appeal to all smokers in an organization, not just those who have stated an interest in achieving cessation, will attract a high per cent of smokers and assist an unusually high per cent of them to achieve and maintain abstinence.
Establishment of Health Maintenance Organizations: A Geographical Analysis
Authors: Cromley Ellen K. , Shannon Gary W.
Published: November 2008

Seven characteristics of 243 Standard Metropolitan Statistical Areas (SMSAs) were subjected to discriminant analysis to determine whether they distinguish SMSAs where at least one health maintenance organization (HMO) was organized between 1972 and 1980 from SMSAs where no HMO developed. The discriminant function correctly classifies 77 per cent of the metropolitan areas considered. Presence of a medical school, regional location, and SMSA population were positively related to HMO establishment. Number of Medicare recipients per 1,000 SMSA residents was not associated with HMO development. (Am J Public Health 1983; 73:184-187.)