bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving the life-course development of socially disadvantaged mothers: a randomized trial of nurse home visitation.
Authors: Olds D L , Henderson C R , Tatelbaum R , Chamberlin R
Published: November 2008

We evaluated a comprehensive program of prenatal and postpartum nurse home visitation for socially disadvantaged women bearing first children. Eighty-five per cent of the participating women were either teenagers (less than 19 years at registration), unmarried, or of low socioeconomic status. Women were randomly assigned to either nurse home visitation or comparison services (free transportation for prenatal and well-child care and/or sensory and developmental screening for the child). During the first four years after delivery of their first child, in contrast to their counterparts in the comparison group, nurse-visited White women who had not graduated from high school when they registered in the study returned to school more rapidly; nurse-visited, poor, unmarried White women showed an 82 per cent increase in the number of months they were employed, had 43 per cent fewer subsequent pregnancies, and postponed the birth of second children an average of 12 months longer.
DTP immunization status and tetanus antitoxin titers of Mexican American children ages six months through eleven years.
Authors: Gergen P J , Ezzati T , Russell H
Published: November 2008

Data from the Mexican American portion of the Hispanic Health and Nutrition Examination Survey (HHANES), conducted in 1982-83, were analyzed for the number of diphtheria, tetanus, and pertussis (DTP) immunizations reported for Mexican American children 6 months-11 years of age and for levels of tetanus antitoxin titers in Mexican American children 4-11 years of age. In Mexican American children 6 months-11 years, 98.2 per cent had one or more DTP immunizations reported (95 per cent CI: 97.5, 98.9%); 85.1 per cent had three or more DTP immunizations reported (95 per cent CI: 83.2, 87.0%). The reported immunization coverage in Mexican American children was corroborated by the tetanus antitoxin titers which were above the minimum protective level (greater than or equal to 0.01 IU/ml) in 99.6 per cent of the 4-11 year olds. Using the American Academy of Pediatrics' (AAP) recommendations for the number of DTP immunizations, 61.1 per cent of the children 6 months-11 years of age had the age-appropriate number of immunizations (95 per cent CI: 58.5, 63.7%). AAP immunization completion rates were higher for children who: had a source of care reported (62.1 vs 44.3%; 95% CI of the difference: 7.1, 28.5); had insurance coverage (63.5 vs 56.1%; 95% CI of the difference: 2, 12.8); lived in a standard metropolitan statistical area (SMSA)-not central city as compared to SMSA-central city or not SMSA (66.6 vs 57.1%; 95% CI of the difference: 4.3, 14.7); and had 12 or more completed years of education for the head of the household (65.4 vs 58.3%; 95% CI of the difference: 1.8, 12.4).(ABSTRACT TRUNCATED AT 250 WORDS)
Screening prospective blood donors for AIDS risk factors: will sufficient donors be found?
Authors: Gregorio D I , Linden J V
Published: November 2008

Using data from various sources--we estimate that 14 to 19 per cent of American males 17-75 have personal histories that place them at high risk of transmitting the HIV infection while an additional 2 per cent of adult females may be similarly affected. Because roughly one fourth of either group may already be unsuited to give blood, we estimate that 10-14 per cent of adult males, and 1 per cent of females would be specifically deferred from giving blood because of personal histories of high-risk behavior. Local adjustments in the assumptions underlying these estimates are needed to apply them to given communities.
Next-of-kin attitudes regarding participation in an epidemiologic case-control study.
Authors: Heuser L , Severson R K , Watson T J
Published: November 2008

We assessed next-of-kin's attitudes about participating in an epidemiologic case-control study of adult acute nonlymphocytic leukemia. Responses from a mailed questionnaire indicated that 95 per cent were glad they participated. While 74 per cent benefited, 18.5 per cent were bothered in some way. Results concerning the need to obtain physician permission before contacting next-of-kin were inconclusive; however, 8 of 10 females contacted by the case's physician considered consent necessary.
The stability of health status in rheumatoid arthritis: a five-year study of patients with established disease.
Authors: Meenan R F , Kazis L E , Anderson J J
Published: November 2008

We employed a health status measure to describe the outcomes of rheumatoid arthritis patients over five years. Of the 410 rheumatoid arthritis patients who were originally administered the Arthritis Impact Measurement Scales (AIMS), 299 completed a follow-up five years later. Data were analyzed using nine health status scales, three components of health status, and an overall arthritis impact item. Results for survivors indicated that there were no clinically important deteriorations in any of these measures. In fact, small improvements on most measures were found. The health status changes were similar for patients originally in a clinical trial and for those receiving routine specialty care. Age was found to positively relate to improvements in psychological status and overall arthritis impact, but we were unable to demonstrate any consistent effects of sex, marital status, education, or disease duration. Our results contrast with other studies that have noted major declines over time in the health status of patients with rheumatoid arthritis. Furthermore, level of education was not a major determinant of morbidity in this group. These results suggest that health status in certain patients with rheumatoid arthritis is more stable than previously thought. This has implications for both clinical practice and clinical research in rheumatology.
Effects of the North Carolina Prematurity Prevention Program among public patients delivering at New Hanover Memorial Hospital.
Authors: Covington D L , Carl J , Daley J G , Cushing D , Churchill M P
Published: November 2008

Twelve per cent of the 847 women who delivered in one hospital prior to implementation of the North Carolina Prematurity Prevention Program had low-birthweight births compared with 9.5 per cent of the 748 women who delivered during the program. Controlling for known risk factors, both low- and very-low birthweight births among Whites (Odds Ratio 2.0 and 3.7 respectively) and very-low-birthweight births among Blacks (OR 2.9) were reduced.
Racial/ethnic differences in the risk of AIDS in the United States.
Authors: Selik R M , Castro K G , Pappaioanou M
Published: November 2008

We analyzed the variation in the risk of AIDS in US Blacks, Hispanics, and other racial/ethnic groups relative to that in Whites (non-Hispanic) by geographic area and mode of acquiring HIV infection, based on data reported between June 1, 1981 and January 18, 1988 to the Centers for Disease Control and 1980 US census data. Relative risks (RRs) in Blacks and Hispanics were highest in the northeast region, and higher in suburbs than in central cities of metropolitan areas. RRs in Blacks and Hispanics were greatest for AIDS directly or indirectly associated with intravenous-drug abuse by heterosexuals (range: 5.7-26.9) and were also high for AIDS associated with male bisexuality (range: 2.5-4.8), suggesting that these behaviors may be more prevalent in Blacks and Hispanics than in Whites. Prevention strategies should take into account these racial/ethnic differences.
Prevalence of cardiovascular disease risk factors in blacks and whites: the Minnesota Heart Survey.
Authors: Sprafka J M , Folsom A R , Burke G L , Edlavitch S A
Published: November 2008

Two cross-sectional surveys were conducted in 1985 and 1986 to measure the prevalence of coronary heart disease (CHD) risk factors in Blacks and Whites. A home interview was followed by a survey center visit. Participation rates were 78 per cent and 90 per cent for the home interview and 65 per cent and 68 per cent for the survey center visit. Adjusted for age and education, systolic and diastolic blood pressure was 3 to 4 mmHg higher in Blacks. Hypertension was more prevalent in Blacks than Whites (44 per cent vs 28 per cent); serum total cholesterol was approximately 0.4 mmol/l lower in Black than White men and 0.08 mmol/l lower in Black than White women. Among men, more Blacks than Whites were current cigarette smokers (44 per cent vs 30 per cent); however, White smokers smoked more cigarettes per day (26 vs 17). Similar differences were noted for women, although the prevalence and quantity of cigarette consumption was less than men. The excess prevalence of these CHD risk factors in Blacks, especially among women, may explain their elevated CHD and stroke mortality rates in the Twin Cities.
Impact of HIV antibody testing on changes in sexual behavior among homosexual men in The Netherlands.
Authors: van Griensven G J , de Vroome E M , Tielman R A , Goudsmit J , van der Noordaa J , de Wolf F , Coutinho R A
Published: November 2008

Between October 1984 and May 1986, 746 homosexual men, living in and around Amsterdam, The Netherlands, were surveyed at three consecutive six months periods regarding their sexual behavior. At the start of the study all subjects, of whom 234 (31 per cent) were HIV-Ab seropositive, were informed about their HIV antibody status. Seropositives initially reported more sexual partners than seronegatives; they also showed a greater reduction in the number of sexual partners and the number of partners with whom all forms of sexual practices were performed than did seronegatives. In both groups subjects were more likely to terminate orogenital intercourse than anogenital intercourse and masturbation.
Changes in the distribution of physicians in rural areas of Minnesota, 1965-85.
Authors: Dennis T
Published: November 2008

The purpose of this study was to assess changes in the physician-population ratio in non-SMSA Minnesota counties between 1965 and 1985 using county specific data published by the American Medical Association. The physician-population ratio actually decreased by 2 per cent for primary care physicians and by 11 per cent for family practitioners in the non-SMSA counties. The large increase in the number of physicians in Minnesota has not translated into improved access to primary care physicians in Minnesota's rural areas.
Nurse administration of sleep medication: a comparison of registered nurses and licensed practical nurses.
Authors: Robers P A , Moore T S , Svarstad B L
Published: November 2008

This study examines differences in the administration of PRN (pro re nata or give "as needed") sleep medication between licensed practical nurses and registered nurses working in long-term care facilities. Work characteristics, characteristics of the residents cared for, and the extent of orders and administration of PRN sleep medications were similar in the two groups. No significant differences in the administration of PRN sleep medication were found.
Hunting firearm injuries, North Carolina.
Authors: Cole T B , Patetta M J
Published: November 2008

To determine the percentage of unintentional firearm-related injuries associated with hunting and to identify risk factors, we conducted a retrospective, descriptive survey of all hunting firearm injuries identified by two North Carolina surveillance systems. Almost one-third of unintentional shooting deaths are hunting-related, and young hunters appear to be at greatest risk of injury. Safety instruction and wearing highly visible clothing should be encouraged; controlled studies should test the effectiveness of these preventive measures.
Smokeless tobacco use and attitudes toward smokeless tobacco among Native Americans and other adolescents in the northwest.
Authors: Hall R L , Dexter D
Published: November 2008

A survey of 1,180 sixth, ninth, and eleventh graders in three school districts in the State of Washington found that 34 per cent of male Native Americans, 24 per cent of female Native Americans, 20 per cent of male non-natives and 4 per cent of female non-natives are current users of smokeless tobacco products. In all areas and groups, the best predictor of whether an adolescent is a user is the use pattern of friends.
Patterns of mental health utilization over time in a fee-for-service population.
Authors: McGuire T G , Fairbank A
Published: November 2008

This paper examines the multi-year patterns of ambulatory mental health care in a population of individuals continuously eligible to receive care in a fee-for-service setting. Among the 14,000 individuals eligible for all three years, 14 per cent used outpatient mental health services during at least one of the three years. Almost 70 per cent of the individuals with some use in 1980 used services during 1981 or 1982. The heaviest use of outpatient mental health and other physician services is among the persons using services in all three years. Our data are compared with three years of data reported by Kessler in an HMO (health maintenance organization) setting. The probability that a non-user becomes a user in roughly the same in the fee-for-service and HMO populations, but the probability of continuing use in the next year is much less in the HMO. This finding, that the "HMO effect" on mental health care is primarily on the visits per user rather than on the number of users, is consistent with other research.
Associations between alcoholic beverage consumption and hospitalization, 1983 National Health Interview Survey.
Authors: Longnecker M P , MacMahon B
Published: November 2008

Data collected in the Alcohol Supplement and core 1983 National Health Interview Survey were used to examine associations between alcoholic beverage consumption and hospitalization. Hospitalizations in acute care facilities (excluding hospitalizations for delivery) in the past 12 months, were treated as dichotomous (any vs none) and examined in relation to alcohol consumption in a logistic regression model adjusting for age, race, income, and smoking. Findings are based on 17,600 individuals meeting inclusion criteria. The adjusted odds ratio of having one or more hospitalization for current drinkers relative to life-long abstainers in females was 0.67 (95 per cent confidence interval 0.57-0.79) and in males was 0.74 (0.57-0.96). U-shaped relationships between level of current alcohol intake and odds of hospitalization were found. While some causes of hospitalization are clearly increased among drinkers, the overall acute care hospitalization experience of moderate drinkers appears to be favorable.
Smoking prevalence in a cohort of adolescents, including absentees, dropouts, and transfers.
Authors: Pirie P L , Murray D M , Luepker R V
Published: November 2008

This study reports daily smoking rates among older adolescents obtained by a unique follow-up of a cohort originally identified in the seventh grade. Those no longer in their original school districts were located and interviewed by telephone. Smoking rates among dropouts exceeded 70 per cent in all age-sex groups. Smoking rates among transfers were as high as those among absentees. Including these subgroups raised smoking prevalence rates among older adolescents substantially.
Monitoring the diffusion of a technology: coronary artery bypass surgery in Ontario.
Authors: Anderson G M , Lomas J
Published: November 2008

Technology assessment involves not only examining technologies before they are released but also their diffusion into practice once they have been released. In this study we show how basic analysis of a large administrative data set, combined with a review of evidence on effectiveness, can be used as the first step in technology assessment. We analyze the use of coronary artery bypass surgery (CABS) in the province of Ontario, Canada. The annual number of procedures increased 52 per cent over a seven-year period between 1979 and 1985. Large increases in CABS rates in the over-65 population accounted for more than half of this increase in procedures. Increased rates of surgery in the over-65 population are unlikely to be caused by increased prevalence of coronary artery disease and may be the result of a change in clinical attitude toward the use of CABS. This change is discussed in the context of the evidence on the effectiveness and cost-effectiveness of CABS. We conclude that there is a need to carefully monitor and evaluate the use of technologies especially in the elderly.
A prospective study of incident comprehensive medical home care use among the elderly.
Authors: Branch L G , Wetle T T , Scherr P A , Cook N R , Evans D A , Hebert L E , Masland E N , Keough M E , Taylor J O
Published: November 2008

This prospective study directly examines, in a defined community population, the extent to which a wide array of characteristics predict utilization of an important long-term care (LTC) service--medical home care--over a two-year interval among the cohort of 3,706 people aged 65 or older. The overall age-sex adjusted rate of two-year incident home care use was 3.2 per cent. For both men and women, the rates among the aged 85 or older group were approximately 12 times the rates of those aged 65 to 74. The multivariate predictors of incident home care, adjusted for age and sex, were five: receiving help with at least one activity of daily living (ADL), being dependent in Rosow-Breslau functional health areas, being homebound, more errors in mental status items, and no involvement with social groups. The dominance of indicators of frailty in physical function and cognitive function are consistent with the predictors of another group of LTC clients, those who subsequently enter nursing homes. However, in the present study the ratios of medical home care use were similar for those living alone and for those living with others in the multivariate model, suggesting the possibility of differences between home care and institutional LTC clients.
Do regional variations in prevalence of cryptosporidiosis occur? The central Ohio experience.
Authors: Hamoudi A C , Qualman S J , Marcon M J , Hribar M , McClung H J , Murray R D , Cannon H J
Published: November 2008

We screened 2,780 consecutive stool specimens submitted for routine ova and parasite examination to assess the prevalence of cryptosporidiosis in a pediatric patient population in central Ohio. The stools were prepared by formalin-ethyl acetate concentration followed by cold Kinyoun acid-fast stain of the sediment. In addition, 912 consecutive intestinal biopsies were monitored for the presence of the parasite. Cryptosporidium oocysts were found in only 0.3 per cent of stool specimens (seven specimens from three patients) and in none of the intestinal biopsies. Due to this low prevalence of cryptosporidiosis, we conclude that routine screening of stool specimens for Cryptosporidium sp. is unnecessary in our patient population. Screening should be targeted to immune compromised patients and patients with persistent diarrhea and no apparent etiology. Our study also supports the concept that there are geographic variations in the prevalence of cryptosporidiosis.
The rising long-term trend in occupational injury rates.
Authors: Robinson J C
Published: November 2008

Establishment survey data for the United States as a whole and workers' compensation data for the State of California were used to document long-term trends in occupational injury and acute illness rates. After declining throughout the first half of the century, national rates of disabling injuries in manufacturing, construction, and the trade sector have risen sharply in recent decades. Injury rates in mining show no strong trend either up or down since 1960. Increases over recent years have been especially pronounced for strains and sprains, cuts, lacerations and punctures, bone fractures, and acute illnesses. Injury rates in the manufacturing sector are strongly influenced by general economic conditions--rising sharply with business upsurges and declining during recessions. Increases in the rate of unemployment, which decrease worker and labor union bargaining power, are associated with increases in injury rates within manufacturing.
Live or inactivated poliomyelitis vaccine: an analysis of benefits and risks.
Authors: Hinman A R , Koplan J P , Orenstein W A , Brink E W , Nkowane B M
Published: November 2008

Using decision analysis we evaluated the benefits and risks of continued primary reliance on oral poliomyelitis vaccine (OPV) compared to use of inactivated poliovirus vaccine (IPV). We followed a hypothetical cohort of 3.5 million children from birth to age 30 assuming 95 per cent coverage with 98 per cent effective vaccine. Primary reliance on IPV would result in more cases of paralytic poliomyelitis as well as more susceptibles remaining in the population than would be expected with continuing OPV use (74.1 vs 10.0 cases and 5.9 per cent vs 1.1 per cent susceptibles, respectively). However, with OPV use, most cases of paralysis seen would be associated with the vaccine. Our analysis supports a continuation of current US policy placing primary reliance on OPV but the conclusion is heavily dependent on assumptions of risk of exposure to wild virus in the United States. Major declines in risk of exposure to wild virus could alter the balance significantly.
Day care center illness: policy and practice in North Carolina.
Authors: Landis S E , Earp J A
Published: November 2008

We surveyed 62 North Carolina day care centers (DCCs) to determine their policies for excluding children. We found that the addition of a temperature of 100-101 degrees F to each of eight symptoms was associated with an increase in the percentage of DCCs choosing "immediate pick-up." Non-profit centers were more likely to send children home (70 per cent) than for-profit centers (48 per cent). Centers with and without written illness policies did not differ in their management of sick children.
Pit and fissure sealant use in private practice: influence of state practice acts.
Authors: Cohen L , Romberg E , LaBelle A
Published: November 2008

To study the influence of the delegation of sealant procedures to auxiliaries on sealant use, we queried a national sample of general dentists and pedodontists. A large percentage (34-58 per cent) of both groups were unaware or mistaken in their perception of the legality of delegating sealants. Although perception of legality to delegate was associated with increased sealant use, a large percentage (33-59 per cent) of both groups did not delegate even when it was perceived legal to do so.
Investigation of possible health effects of community exposure to fermenting wood chips.
Authors: Birkhead G , Vogt R L , Hudson P J
Published: November 2008

We conducted a case-control study of emergency room (ER) patients to evaluate whether asthma is caused by living near a wood-chip fueled power plant that released wood-chip fermentation products. Only eight (29 per cent) of 28 asthma patients seen in the ER during an 11-week period lived within 1.5 miles of the plant compared with 18 (34 per cent) of 54 control patients matched for severity of diagnosis and seen during the same period (Mantel-Haenszel odds ratio controlling for age = 0.96).
AIDS and behavioral change to reduce risk: a review.
Authors: Becker M H , Joseph J G
Published: November 2008

Published reports describing behavioral changes in response to the threat of AIDS (acquired immunodeficiency syndrome) are reviewed. These studies demonstrate rapid, profound, but expectably incomplete alterations in the behavior of both homosexual/bisexual males and intravenous drug users. This is true in the highest risk metropolitan areas such as New York City and in areas with lower AIDS incidence. Risk reduction is occurring more frequently through the modification of sexual or drug-use behavior than through its elimination. In contrast to aggregate data, longitudinal descriptions of individual behavior demonstrate considerable instability or recidivism. Behavioral change in the potentially vulnerable heterosexual adolescent and young adult populations is less common, as is risk reduction among urban minorities. Reports of AIDS-related knowledge and attitudes generally parallel the pattern of behavioral changes. Nonetheless, few studies investigate the relationship of knowledge and attitudes to risk reduction. Future studies should provide much-needed information about the determinants as well as the magnitude of behavioral changes required to reduce the further spread of AIDS.
Prostitutes and AIDS: a health department priority?
Authors: Rosenberg M J , Weiner J M
Published: November 2008

With increasing competition for resources, health departments are faced with the question of whether to target female prostitutes as a high priority component of AIDS prevention strategy. Prostitutes are considered to be a reservoir for transmission of certain sexually transmitted diseases (STDs). However, a variety of studies suggest that human immunodeficiency virus (HIV) infection in prostitutes follows a different pattern than that for STDs: HIV infection in non-drug using prostitutes tends to be low or absent, implying that sexual activity alone does not place them at high risk, while prostitutes who use intravenous drugs are far more likely to be infected with HIV. Emerging data from heterosexual groups similarly suggest a low rate of heterosexual transmission, particularly from women to men. Prostitutes who do not use intravenous drugs probably face their highest risk from steady partners who may be infected with HIV and other STDs and with whom barrier protection is generally not used. Nevertheless, there are good reasons for health departments to place high priority on prevention efforts directed to prostitutes: 1) prostitutes often have other risky behaviors such as drug use; and 2) prostitutes are reachable, being a group which is already in the health care system administered by health departments.
Comparing state-only expenditures for AIDS.
Authors: Rowe M J , Ryan C C
Published: November 2008

The State AIDS Policy Center at the Inter-governmental Health Policy Project (IHPP) at George Washington University surveyed all 50 states to determine state AIDS (acquired immunodeficiency syndrome) expenditures, without Medicaid or federal funds, for fiscal 1984-88. During this period, state-only expenditures increased 15-fold, to $156.3 million. Between fiscal 1986-1988, the distribution of state funding for AIDS patient care and support services doubled from 16 to 35 per cent and the number of states supplementing federal funds for testing and counseling increased from eight to 20. Five states continue to account for the largest AIDS appropriations. Of these, California leads in funding research; New York, Florida, and New Jersey have directed funds to provide care and services to IV (intravenous) drug users, prisoners, and children. The average state expenditure per diagnosed AIDS case is $3,323 and an increasing number of states with relatively low case loads are appropriating funds beyond this level. Across states, AIDS expenditures per person average $.65 and $.21 for education, testing and counseling--below the level recommended by the Institute of Medicine for AIDS prevention activities. Some jurisdictions support AIDS activities indirectly by shifting resources, often from their STD (sexually transmitted disease) programs--this trend deserves continuing review given the rise in STD cases and their relationship to diagnosed AIDS.
State Medicaid coverage of AZT and AIDS-related policies.
Authors: Buchanan R J
Published: November 2008

Medicaid programs are paying for 23 per cent of the health care costs of AIDS patients nationally, and approximately 40 per cent of all AIDS patients will become dependent on Medicaid to pay for their health care. The state Medicaid programs were surveyed by mail for this research in mid 1987 to determine if the states covered AZT (Retrovir), if limits apply to this coverage, if the states have or are developing AIDS-related policies, and if hospice care is a benefit. Forty-four states cover AZT (two additional states cover AZT only during inpatient hospital care), with most Medicaid programs placing some limit on coverage or reimbursement. Most states do not have special Medicaid coverage for AIDS care nor are they developing proposals or policies for this care. However, a number of states are developing or implementing AIDS-related policies through their Medicaid programs. These policies can become models for other Medicaid programs to follow if the incidence of AIDS increases in their states.
Health insurance and AIDS: the status of state regulatory activity.
Authors: Faden R R , Kass N E
Published: November 2008

Information collected by the National Gay Rights Advocates in 1986 and by the authors in the spring of 1987 was used to determine the extent to which the states currently regulate the practices of the health insurance industry specific to acquired immunodeficiency syndrome (AIDS). Of the 10 states reporting the greatest number of AIDS cases, six prohibit insurers form denying coverage to group policy applicants because of human immunodeficiency virus (HIV) infection. These findings refer only to the status of state regulatory activity specific to AIDS.
Hemophilia-associated AIDS in the United States, 1981 to September 1987.
Authors: Stehr-Green J K , Holman R C , Jason J M , Evatt B L
Published: November 2008

Between January 1, 1981 and September 4, 1987, 407 cases of hemophilia-associated acquired immunodeficiency syndrome (AIDS) had been reported to the Centers for Disease Control. The number of cases diagnosed each year nearly doubled, except in 1986, when cases increased only 50 per cent. Demographic characteristics of the patients did not change over time. The majority (74 per cent) had severe hemophilia and 97 per cent received commercially produced concentrated clotting factors. The cumulative incidence of AIDS between 1981 and September 1987 for persons with severe hemophilia A was substantially greater than that for persons with severe hemophilia B (4.2 cases vs 1.9 cases per 100 persons).
Seroprevalence of HIV antibody among individuals entering the Iowa Prison System.
Authors: Glass G E , Hausler W J , Loeffelholz P L , Yesalis C E
Published: November 2008

From January 1 to April 30, 1986, all individuals entering the Iowa prison system were tested for antibody to the human immunodeficiency virus (HIV). Sera were collected on 363 newly incarcerated inmates, 389 inmates returning to prison, and 107 forensic psychiatric patients. Three of the 859 serum samples (0.3 per cent) tested during this study were reactive by ELISA (enzyme-linked immunosorbent assay) testing, but none reactive by the Western blot. Analysis for AIDS risk factors included a high prior IV-drug use rate (22-50 per cent) and a low admitted homosexuality rate in a predominantly young white male population.
Screening blood donors for human immunodeficiency virus antibody: cost-benefit analysis.
Authors: Eisenstaedt R S , Getzen T E
Published: November 2008

The costs and benefits of screening blood donors for antibody to human immunodeficiency virus (HIV) are assessed. Total costs, including testing, discarding processed blood, marginal donor recruiting, notifying and evaluating positive donors, are $36,234,000 annually for 10 million donors in 1986. Screening these donors will prevent 292 cases of transfusion-transmitted acquired immune deficiency syndrome (TT-AIDS), saving the costs of therapy and loss of earnings for total benefits of $43,490,480, a benefit:cost ratio of 1.2:1. Net economic benefits of $0.73 per donor will arise from the program. Calculated benefits will rise as increased numbers of infected recipients are diagnosed with longer follow-up or as partially effective therapy increases the cost of caring for patients with AIDS. Changes in test sensitivity, follow-up procedures, estimated value of life, and testing costs will also alter these projections, but none as dramatically as a change in the overall specificity of the screening process. The cost per case of TT-AIDS prevented, $124,089, and cost per year of life extended, $10,885, are comparable to costs of other screening programs.
Vaginal birth after cesarean (VBAC) in the 1980s.
Authors: Placek P J , Taffel S M
Published: November 2008

The incidence of vaginal birth after cesarean (VBAC) and characteristics of VBAC births are investigated using 1980-85 National Hospital Discharge Survey Data collected by the National Center for Health Statistics. Only 3.4 per cent of mothers with previous cesarean delivery had VBAC in their subsequent 1980 delivery; this increased to 6.6 per cent in 1985. Because VBAC is a relatively infrequent event, 1980-85 data were combined and indicate that in this period 4.9 per cent of mothers with previous cesarean had a vaginal birth in their subsequent delivery. Combined 1980-85 VBAC rates are under 10 per cent for all age, race, marital status, region, hospital size, hospital ownership, and expected source of payment groups. Between 1980 and 1985, over 1.4 million repeat cesareans were performed for mothers having a live birth. Evidence suggests that potentially over 500,000 of these repeat cesareans could have been VBACs (over and above the 74,000 VBACs which occurred). VBAC mothers' mean length of hospital stay is 3.2 days, which compares closely with 3.0 days for other vaginal deliveries, but both contrast sharply with 5.6 days for repeat cesareans and 6.0 days for primary cesareans. Except for the uterine scar from the previous cesarean, VBAC mothers appear to have about the same history and frequency of complications as mothers with other vaginal deliveries. If the 500,000 repeat cesareans had been VBACs, surgical fees and costs for 1.2 million days of hospital stay would have been averted over the 1980-85 period.
Breast self-examination: improving competence and frequency in a classroom setting.
Authors: Dorsay R H , Cuneo W D , Somkin C P , Tekawa I S
Published: November 2008

We conducted a prospective study of 459 women to determine if a one-session class in breast self-examination (BSE) can improve competence and frequency. Women who attended the class were randomly assigned to one of two groups. We assessed three areas of competence of BSE in one group immediately before the class, in the other group immediately after the class, and in both groups at follow-up one year later. Of the 459 women who attended the class, 286 returned for the one-year follow-up. All three areas of competence measured showed significant improvement in the group tested immediately after the class compared with the group tested just before the class. Competence scores at the one-year follow-up remained twice as high as those before the class although there was a decrease in competence from just after the class. Younger women proved more competent in performing BSE than did older women. At one year, participants further reported performing BSE nearly twice as often as before the class. We conclude that competent BSE can be learned and frequency of BSE can be increased from a one-session class.
Promoting breastfeeding at a migrant health center.
Authors: Young S A , Kaufman M
Published: November 2008

A program to promote breastfeeding was introduced at a migrant health center in North Carolina. Strategies for promoting breastfeeding as a feeding method particularly suited to the migrant lifestyle were identified and implemented. Donated layettes were used to encourage attendance of prenatal patients at a class on breastfeeding. Women planning to breastfeed were given cards to alert the delivering hospital of their intention. These hospitals were provided with bilingual flipcharts to use in communicating with non-English speaking patients. Of the 158 women who came to the center for one or more prenatal visits, 101 attended a class or received individual counseling on breastfeeding; during this 13-month period, 52 per cent of 64 women who attended the class were breastfeeding at time of their hospital discharge (Mexican-Americans 60%, Black Americans 44%). In a comparison of similar ethnic distribution, the corresponding rate was 10%.
Repeal of the Massachusetts seat belt law.
Authors: Hingson R , Levenson S M , Heeren T , Mangione T , Rodgers C , Schiavone T , Hertz R P , Schiavonnet T
Published: November 2008

In November 1986, the Massachusetts mandatory seat belt use law repealed in a referendum by a 53 per cent to 47 per cent vote. In an anonymous random digit telephone survey of 1,046 adults in Massachusetts in summer 1986, while the law was in effect, 61 per cent of respondents had said they would vote in favor of the law. A post-repeal follow-up of 80 per cent of these persons revealed initial supporters and opponents of the law were equally likely to vote, but 15 per cent of the summer supporters switched their opinions and voted for repeal, compared to only 4 per cent of summer opponents who switched. In addition, a separate survey of 167 households that had refused to answer the summer survey indicated that survey nonrespondents were more likely to vote against the law than for it. Those opposing the law saw it as an infringement on personal liberty and believed it was not effective in reducing injury and death.
Health advertising: prevention for profit.
Authors: Freimuth V S , Hammond S L , Stein J A
Published: November 2008

The National Cancer Institute (NCI) estimates on the basis of current knowledge alone that, at a minimum, 30,000 lives could be saved in the year 2000 if Americans would modify their dietary habits. A recent innovative way of responding to this challenge was the Kellogg Company/NCI All-Bran advertising campaign. This paper will describe the campaign, and its impact on consumers, cereal industry sales, food industry advertising practices, health regulatory policy, and the organizational credibility of both NCI and Kellogg. For the past three years, Kellogg has included NCI's cancer prevention messages in their advertisements for All-Bran cereal and on their bran cereal boxes. This collaborative effort has stimulated considerable controversy over whether the health claims made on the cereal label are in violation of federal food labeling regulations. Meanwhile, research has demonstrated the positive impact of the campaign on consumer's knowledge and behavior regarding fiber as well as on Kellogg's profits. Other manufacturers are anxious to jump on the "branwagon"; however, many unanswered questions remain about this new approach to health advertising.
Cocaine and heroin dependence compared in poly-drug abusers.
Authors: Hasin D S , Grant B F , Endicott J , Harford T C
Published: November 2008

Concerns about cocaine dependence are increasing, in some ways replacing heroin as the focus of highest concern. We compared cocaine and heroin dependence by levels of cocaine and heroin use in poly-drug users. While dependence indicators differed markedly between regular and sporadic users of these drugs, cocaine dependence indicators did not differ from heroin dependence indicators. Implications of the findings are discussed.
Hair dye use and risk of leukemia and lymphoma.
Authors: Cantor K P , Blair A , Everett G , VanLier S , Burmeister L , Dick F R , Gibson R W , Schuman L
Published: November 2008

Data from a population-based case-control study of incident leukemia and non-Hodgkin's lymphoma among adult men in Iowa and Minnesota were used to evaluate risk associated with hair dye use. The relative risk for ever using hair dyes was 1.8 (95% confidence interval [CI] = 1.1-2.7) among leukemia patients, and 2.0 (CI = 1.3-3.0) among cases with non-Hodgkin's lymphoma. There was a suggestion of increased risk with extent of hair dye use. Given the widespread use of hair coloring products, these observations deserve more detailed evaluation in populations where the exposure is relatively common.
Optimum cutoff points for biochemical validation of smoking status.
Authors: Cummings S R , Richard R J
Published: November 2008

Selection of cutoff points for tests to validate smoking cessation should take account of the prevalence of deception. When the prevalence of deception is relatively low, the cutoff points to validate quitting should be relatively high. Many studies have used cutoff points that are too low and may have underestimated cessation rates. We present a method for determining the best cutoff points that takes account of the prevalence of deception.
Hypertensive emergency: case criteria, sociodemographic profile, and previous care of 100 cases.
Authors: Bennett N M , Shea S
Published: November 2008

To study the frequency, cost, sociodemographic profile, and previous care correlates of hospital admissions for hypertensive emergency, we used specific case criteria to identify a series of 100 cases at Presbyterian Hospital in New York City. Approximately 58 cases were admitted per year. Mean length of hospital stay was 11.8 days, 75 per cent of patients received intensive care, and estimated annual hospital charges were $438,828 (1986 dollars). Cases had severe hypertension on admission (mean systolic blood pressure, 229.8 mmHg; mean diastolic blood pressure, 143 mmHg). Two-thirds had clinical evidence of acute arteriolitis. Cases were predominantly young, male, Black or Hispanic, and of lower socioeconomic status. At least 93 per cent of cases were previously diagnosed, and at least 83 per cent were aware of their diagnosis of hypertension. Improved management of chronic hypertension rather than more intensive screening may be a useful strategy to reduce the incidence of hypertensive emergency.
Health professionals and hospital administrators in organ procurement: attitudes, reservations, and their resolutions.
Authors: Prottas J , Batten H L
Published: November 2008

The responses of hospital administrators, directors of nursing, intensive care unit nurses, and neurosurgeons are reported to a range of inquiries designed to measure their commitment to organ procurement and thereby identify impediments limiting their cooperation with organ procurement efforts. Descriptive and multivariate statistical techniques are used to analyze data collected from each group. We find general approval for organ procurement but serious hesitation about dealing with donor families, particularly among physicians. Physician support for donation, moreover, is the strongest predictor of other professionals, attitudes toward donation. Neurosurgeons and intensive care unit nurses who believe organ procurement is a professional responsibility have the fewest reservations about facilitating organ donation.
Giardia transmission in a swimming pool.
Authors: Porter J D , Ragazzoni H P , Buchanon J D , Waskin H A , Juranek D D , Parkin W E
Published: November 2008

In the fall of 1985, an outbreak of giardiasis occurred among several swimming groups at an indoor pool in northeast New Jersey. Nine clinical cases were identified, eight of whom had Giardia positive stool specimens. All were female; seven were adults (greater than 18 years) and two were children. The attack rate was highest (39 per cent, 5/13) for the ladies lap group who had exposure on one day. These cases had no direct contact with children or other risk factors for acquiring Giardia. Infection most likely occurred following the ingestion of swimming pool water contaminated with Giardia cysts. The source of Giardia contamination was a handicapped child who had a fecal accident in the pool. He was a member of a group that swam at the same time as the ladies lap group. A stool survey of the handicapped group showed that of the 20 persons tested, nine were positive for Giardia, including the specimen from this child. Examination of the pool records showed that no chlorine levels had been taken on the day of the fecal accident and that on the following day the chlorine level was zero. This is the second report of Giardia transmission among swimming pool attendees. It emphasizes the need to maintain appropriate chlorine levels in swimming pools and to institute measures to clear pools after a fecal accident.
Long-term weight loss maintenance: assessment of a behavioral and supplemented fasting regimen.
Authors: Hovell M F , Koch A , Hofstetter C R , Sipan C , Faucher P , Dellinger A , Borok G , Forsythe A , Felitti V J
Published: November 2008

This analysis assessed 18-30-month weight loss maintenance following treatment with both behavior modification and supplemented fasting procedures for 400 patients. Fifty-five per cent of the patients who started treatment discontinued prior to completing the program. Patients who completed treatment lost a mean of 83.9 per cent of their excess weight, but regained an average of 59 per cent to 82 per cent of their initial excess weight by 30 months following start of treatment. The combination of behavior modification and supplemented fasting regimens was a successful means of effecting weight loss. However, there appeared to be limited weight loss maintenance. Behavioral epidemiological studies are needed to identify variables responsible for maintenance of weight loss.
Incidence of hypertension in the Framingham Study.
Authors: Dannenberg A L , Garrison R J , Kannel W B
Published: November 2008

Incidence and trends in incidence of definite hypertension were analyzed based on 30 years follow-up of 5,209 subjects in the Framingham Heart Study cohort. Based on pooling of 15 two-year periods, hypertension incidence per biennium increased with age in men from 3.3 per cent at ages 30-39 to 6.2 per cent at ages 70-79, and in women from 1.5 per cent at ages 30-39 to 8.6 per cent at ages 70-79. No consistent trend in incidence rates was evident for either sex from the 1950s through the 1970s. The proportion of hypertensive subjects receiving antihypertensive medication has increased since 1954-58 and exceeded 80 per cent for both men and women ages 60-89 years in 1979-81. Incidence data presented in this report may serve as a baseline for assessing the impact of future public health efforts in the primary prevention of hypertension.
The development of worker-controlled occupational health centers in Canada.
Authors: Yassi A
Published: November 2008

Over the past decade worker-controlled occupational health centers have been established in three Canadian provinces. This development has been a response to the slowness in recognizing occupational medicine in the Canadian medical community, the limited availability and questionable acceptability of existing services, as well as the growth of worker control in occupational health matters generally. The history, funding, organizational structure, personnel, resources, and programs of these worker-controlled centers are outlined, illustrating the extensive programs that can be provided despite small budgets of these operations. Advantages to workers include direct access to resources as well as expert professional advice with the focus on work place hazards. Furthermore, the centers provide for extensive interaction among workers on their common concerns. Disadvantages of the model include restricted access to work places associated with frequent distrust of employers. Employer-based and university-based models are compared to worker-controlled centers, and it is suggested that the latter may influence the pattern of practice of occupational health as well as the ability of workers and their unions to promote improved occupational health and safety conditions.
Elimination of cotinine from body fluids: implications for noninvasive measurement of tobacco smoke exposure.
Authors: Jarvis M J , Russell M A , Benowitz N L , Feyerabend C
Published: November 2008

Cotinine elimination from plasma, saliva, and urine was studied over 11 days in five subjects (three nonsmokers and two occasional smokers). Half-lives for cotinine averaged 16-19 hours in the different body fluids (range 10 to 27 hours between subjects). There was no tendency for the half-life in saliva to be longer than in plasma or urine. We conclude that choice of body fluid for cotinine assay in smoking studies should depend on practical rather than pharmacokinetic considerations.