bluuebunny/crossref_metadata_2025 huggingface dataset:
Symptoms of depression among blacks and whites.
Authors: Jones-Webb R J , Snowden L R
Published: November 2008

OBJECTIVES. We sought to examine relationships between sociodemographic indicators of risk and depression symptoms within the Black and White populations. METHODS. In a national probability sample, differences in sex, age, marital status, religion, social class, employment status, urbanicity, and region were evaluated against a Center for Epidemiological Studies Depression Scale score of 16 or greater. Risk factors were identified within the two populations and compared between them. RESULTS. For both races, females were at greater risk for depression than males, and respondents who were formerly married or separated were at greater risk than those who were currently married. Major differences in patterns of risk were also found between the races. Blacks who were 30 to 39 years of age, belonged to non-Western religious groups, and lived in the West were at greater risk than comparable Whites. Blacks who were widowed, members of the middle and lower-middle class, and unemployed were at less risk. CONCLUSIONS. Similarities and differences in patterns of risk were evident. The nature of the differences suggests important divergence in sociocultural and economic experience.
Workplace smoking policies in New Jersey businesses.
Authors: Lewit E M , Botsko M , Shapiro S
Published: November 2008

A New Jersey law enacted in 1985 requires smoking policies for work sites with 50 or more employees. In 1988, we surveyed a sample of New Jersey businesses to determine their smoking policies. Eighty-three percent of respondents with 50 or more employees reported implementing restrictive smoking policies. Of respondents with 2 to 49 employees, 35% had implemented policies. Our findings identify some of the factors other than a legal mandate that lead employers to restrict smoking in the workplace.
Patterns of drug use among Cuban-American, African-American, and white non-Hispanic boys.
Authors: Vega W A , Gil A G , Zimmerman R S
Published: November 2008

This study examined initiation into drug use during grade school years in a sample of Cuban-American, Black, and White non-Hispanic students in the greater Miami, Fla, area. Findings indicate that first use of alcohol occurs in fifth grade and cigarettes in sixth grade for all subgroups except White non-Hispanics, who peak in the fifth grade. White non-Hispanics had the highest life-time levels of alcohol and cigarette use. Foreign-born Cuban Americans had a lower lifetime prevalence of alcohol and cigarette use than US-born Cuban Americans. Higher acculturation level was related to first use of alcohol. One important implication of this study is that alcohol interventions should begin no later than third grade and smoking interventions no later than fourth grade.
Male transvestite prostitutes and HIV risk.
Authors: Elifson K W , Boles J , Posey E , Sweat M , Darrow W , Elsea W
Published: November 2008

Human immunodeficiency virus (HIV)-1, syphilis, and hepatitis B prevalence and associated risk factors were assessed among male transvestite prostitutes. Structured street-level interviews were conducted with 53 respondents in Atlanta, Ga, from July 1990 through July 1991. Test results from serum samples revealed that 68% were seropositive for HIV-1, 81% had seromarkers for syphilis, and 80% had seromarkers for hepatitis B. Univariate logistic regression analysis indicated that seromarkers for syphilis and Black race were the primary factors associated with HIV-1 infection. The results show that transvestite prostitutes are a heterogenous population and distinct from nontransvestite prostitutes; specific outreach is thus needed. Targeted interventions should address the sexual and drug-use-related HIV risk behaviors of transvestite prostitutes.
The physical activity of fifth-grade students during physical education classes.
Authors: Simons-Morton B G , Taylor W C , Snider S A , Huang I W
Published: November 2008

One hundred fifty-seven fifth-grade students in 20 of the 355 elementary schools in one Texas county were systematically observed during physical education classes. On average, the students spent 8.5% of class time in moderate to vigorous physical activity, 23.3% in minimal activity, and 68.1% in sedentary activity. None of the schools averaged 20% of class time in moderate to vigorous physical activity. The levels of physical activity observed are substantially lower than the levels called for in national health objectives.
The effect of fish oil supplements on blood pressure.
Authors: Lofgren R P , Wilt T J , Nichol K L , Crespin L , Pluhar R , Eckfeldt J
Published: November 2008

We conducted a double-blind, placebo-controlled crossover study to determine the effects of fish oil supplementation on blood pressure in middle-aged men. Subjects were randomly assigned to consume either 20 g of fish oil or safflower oil for 12 weeks and then consume the other oil for an additional 12 weeks after a 4-week washout period. We found no significant changes from the pretreatment value in systolic or diastolic blood pressure with the use of fish oil supplements. In addition, there were no significant differences in the posttreatment blood pressures comparing the fish and safflower oil phases of the study.
Commentary: primary care--medical students' unpopular choice.
Authors: Petersdorf R G
Published: November 2008

Title VII funding to medical schools has not succeeded in correcting the shortage of primary care physicians. Although it is generally true that there is an inverse relationship between the amount of research funds awarded to a school and its success in producing primary care physicians, there are many exceptions. Neither Title VII, the amount of research funding, or Medicare's Direct Medical Education payments has had a substantial effect on the production of primary care physicians. These factors are comparatively insignificant when considered in the light of strong external incentives to specialize. Medical education cannot remedy the specialty imbalance unless the external environment becomes more friendly to generalists.
The cost-effectiveness of rehabilitation in the home: a study of Swedish elderly.
Authors: Melin A L , Håkansson S , Bygren L O
Published: November 2008

OBJECTIVES. To investigate whether care of elderly and disabled patients could be more cost-effective after a short-term hospital stay, we examined the impact of a primary home care intervention program on functional status, use and costs of care after 6 months. METHODS. When clinically ready for discharge from the hospital, chronically ill patients with dependence in one to five functions in personal activities of daily living were randomized to physician-led primary home care with a 24-hour service, and the controls were offered ordinary care. Physical, cognitive, social, and medical functions were assessed in 110 team subjects and 73 controls. Data regarding inpatient days and outpatient visits were collected and converted to costs. RESULTS. Team patients demonstrated better instrumental activities of daily living and outdoor walking and significantly fewer diagnoses and drugs at 6 months. They used less inpatient and more outpatient care compared with the control patients. Significant cost reductions were found in the team group. CONCLUSIONS. This primary home care intervention program is cost-effective, at least for a selection of patients at risk for long-term hospital care.
Depression, anxiety, and social disability show synchrony of change in primary care patients.
Authors: Ormel J , Von Korff M , Van den Brink W , Katon W , Brilman E , Oldehinkel T
Published: November 2008

OBJECTIVES. The purposes of this study were to (1) characterize the social disability associated with the common psychiatric illnesses of primary care patients in terms of role dysfunction (self-care, family role, social role, occupational role) and (2) establish whether severity of psychiatric illness and disability level show synchrony of change. METHODS. A two-stage sample design was employed. In the first stage, 1994 consecutive attenders of 25 general practitioners were screened on psychiatric illness by their physicians and with the General Health Questionnaire. A stratified random sample (n = 285) with differing probabilities was selected for a second-stage interview. Patients with psychiatric symptoms were reinterviewed 1 and 3.5 years later (n = 143). RESULTS. (1) Disability level among patients was increased (moderately for depression, mildly for anxiety) and was associated with severity of psychiatric illness. (2) Most disability was found in occupational and social roles. (3) Change in severity of psychiatric illness was concordant with change in level of disability and was largely invariant across diagnosis (depression, anxiety, mixed anxiety/depression). At follow-up, disability among improved patients had returned to normal levels. CONCLUSIONS. Psychiatric illness in primary care patients is associated with mild to moderate disability, and severity of psychiatric illness and disability show synchrony of change.
Undocumented aliens and uncompensated care: whose responsibility?
Authors: Siddharthan K , Alalasundaram S
Published: November 2008

Undocumented aliens concentrated in metropolitan areas and certain Sunbelt states can financially burden local health agencies and may interfere with access to health care for indigent populations that are legally resident. Data collected from Jackson Memorial Hospital, which provides the bulk of indigent medical services in Dade County, Florida, are used to investigate the problem of providing uncompensated care to undocumented aliens. Policy alternatives concerning immigration issues and reimbursement are discussed.
Health as a human right: an epidemiologist's perspective on the public health.
Authors: Susser M
Published: November 2008

The modern idea of health as a human right is examined, as it evolved from the 18th century, in terms of its origins, its essential content, and 20th-century attempts at implementation. Equity for social groups is seen as a guiding principle. Two attempts at implementation, in Britain and in Cuba, are examined for their effects on equity in health service and in health states. The British National Health Service achieved equity between social classes in services but failed to achieve it in health states (as measured by mortality). Deficiencies in commitment to public health services, it is argued, contributed largely to this failure. The Cuban experiment appears to have moved beyond equity solely in services and toward equity in health states. This success reflects an overall Cuban commitment to the public health. Two important elements of that commitment are, first, continuous evaluation with flexible response and, second, community involvement.
The effects of immune status and race on health service use among people with HIV disease.
Authors: Piette J D , Mor V , Mayer K , Zierler S , Wachtel T
Published: November 2008

OBJECTIVES. The purpose of this study was to examine the relationship between CD4 lymphocyte count and health service use, and to determine whether differences in the rates of service use between Whites and people of color could be identified. METHODS. Medical records for 571 HIV-infected individuals were analyzed. Incidence rates and relative rates across CD4 strata (defined by cell counts) were calculated for inpatient and outpatient events. Rate ratios comparing people of color with Whites were estimated within strata, adjusting for confounding factors using a Mantel-Haenszel pooling procedure. RESULTS. Both inpatient and outpatient service use increased over progressively lower levels of CD4 counts. Within each CD4 stratum and controlling for other factors, White participants had more HIV clinic visits and fewer admissions than people of color. Among participants with fewer than 51 CD4 cells per cubic millimeter, people of color were admitted 20% more often, had 35% more inpatient days per person-year, and had only 74% as many HIV clinic visits as their White counterparts. CONCLUSIONS. These results indicate that CD4 lymphocyte count is strongly associated with increased usage of health services. People of color with HIV disease are more likely than similar Whites to be admitted to the hospital and less likely to use outpatient care.
Changes in sexually transmitted disease rates after HIV testing and posttest counseling, Miami, 1988 to 1989.
Authors: Otten M W , Zaidi A A , Wroten J E , Witte J J , Peterman T A
Published: November 2008

OBJECTIVES. The effects of posttest counseling on acquisition of sexually transmitted diseases in patients at a large urban sexually transmitted disease clinic were studied. METHODS. Comparisons were made of the percentage of patients who had a positive gonorrhea culture (or any sexually transmitted disease) in the 6 months before and after human immunodeficiency virus (HIV) counseling and testing. RESULTS. For 331 patients counseled about a positive HIV test, the percentage with gonorrhea was 6.3 before and 4.5 after posttest counseling (29% decrease). For 666 patients counseled about a negative test, the percentage with gonorrhea was 2.4 before and 5.0 after posttest counseling (106% increase). With any sexually transmitted disease as the outcome, patients who tested positive for HIV had a 12% decrease and patients who tested negative had a 103% increase after counseling. CONCLUSIONS. HIV counseling and testing was associated with a moderate decrease in sexually transmitted diseases among patients who tested positive for the virus, but risk increased for patients who tested negative. This suggests a need to improve posttest counseling in this clinic and to assess the effects of counseling and testing in other clinics.
Chlamydial cervical infection in jailed women.
Authors: Holmes M D , Safyer S M , Bickell N A , Vermund S H , Hanff P A , Phillips R S
Published: November 2008

OBJECTIVES. The prevalence of Chlamydia trachomatis cervical infection in incarcerated adult women has not been reported. To develop a policy for testing and treatment, we determined the prevalence of and risk factors for chlamydial infection in women in a New York City jail. METHODS. Interviews and cervical cultures for C trachomatis were obtained from 101 consenting female inmates. RESULTS. Positive cultures for C trachomatis were found in 27% of the participants. Mucopurulent cervical discharge and education of 8 years or less were two independent risk factors for infection, but only 63% of the infected women had one or both of these factors. If pelvic tenderness were considered as a third factor, an additional 7% of the infected women would have been identified. CONCLUSIONS. The prevalence of chlamydial infection in this population was as high as that in populations for which presumptive treatment is recommended. Although the optimal policy for detection and treatment of chlamydial infection may vary depending on practical considerations, we suggest that women entering correctional facilities should be screened or offered presumptive therapy for C trachomatis infection.
Public reactions to AIDS in the United States: a second decade of stigma.
Authors: Herek G M , Capitanio J P
Published: November 2008

The pervasiveness of stigma in the United States related to the acquired immunodeficiency syndrome (AIDS) was assessed in telephone interviews with a general adult sample (n = 538) and an African-American sample (n = 607). Most respondents manifested at least some stigma. African Americans expressed greater support for policies separating persons with AIDS from others and a stronger desire to avoid these persons, whereas Whites expressed more negative feelings toward them and a greater willingness to blame them for their illness. Regardless of race, men were more likely than women to support policies such as quarantine and to say that they would avoid persons with AIDS.
Changes in HIV rates and sexual behavior among homosexual men, 1984 to 1988/92.
Authors: Silvestre A J , Kingsley L A , Wehman P , Dappen R , Ho M , Rinaldo C R
Published: November 2008

Data were collected from 1614 homosexual and bisexual men in 1984 through 1985 and from 1988 to 1992 in Pittsburgh. Of the men entering the study since 1988, 16% reported engaging in unprotected anal receptive intercourse with more than one partner during the 6 months before their visit. Approximately 7% of the younger men and 18% of the men over 22 years of age in the recent cohort were already infected with the human immunodeficiency virus, the same rates as those described 8 years ago. Aggressive risk-reduction programs are needed in high schools and existing networks in the gay community.
Reported asthma among Puerto Rican, Mexican-American, and Cuban children, 1982 through 1984.
Authors: Carter-Pokras O D , Gergen P J
Published: November 2008

Data from the Hispanic Health and Nutrition Examination Survey (HHANES) (1982 through 1984) and the National Health and Nutrition Examination Survey (NHANES) II (1976 through 1980) were used to examine reported physician-diagnosed asthma among 6-month-old through 11-year-old children. The highest prevalence of active asthma was reported for Puerto Ricans: 11.2% compared with 3.3% for non-Hispanic Whites, 5.9% for non-Hispanic Blacks, 2.7% for Mexican Americans, and 5.2% for Cubans. Health services utilization and severity do not appear to explain the differences between Puerto Ricans and Mexican Americans. Educational programs on asthma should consider focusing on Puerto Ricans.
Complications of BCG vaccinations in rural Haiti.
Authors: Bonnlander H , Rossignol A M
Published: November 2008

This study investigated an outbreak of axillary lymphadenitis and abscesses after Bacillus Calmette-Guérin vaccination among rural Haitian children treated at the Hospital Albert Schweitzer from January 1986 through March 1991. Seventy-seven cases of vaccine-related complications were identified, all among children immunized before the age of 1 year. The proportions of children with complications were 0.017% for 1986 through 1989, 0.91% for 1990, and 2.2% for January through March 1991.
Diagnostic x-ray exposure and lens opacities: the Beaver Dam Eye Study.
Authors: Klein B E , Klein R , Linton K L , Franke T
Published: November 2008

The Beaver Dam Eye Study is a population-based study of common age-related eye diseases. During the standardized medical history, the 4926 subjects were asked whether they had ever had a chest x-ray, computerized axial tomography (CAT) scan of the head, other x-rays of the head, x-rays of the abdomen, or other diagnostic x-rays. The eye examination included photographs of the lenses of the eyes, which were subsequently graded according to protocol. Nuclear sclerosis and posterior subcapsular opacity were significantly associated with CAT scans. If these relationships are causal, it would highlight the importance of minimizing such exposure to the lens of the eye.
Cardiovascular disease risk factors: improvements in knowledge and behavior in the 1980s.
Authors: Frank E , Winkleby M , Fortmann S P , Farquhar J W
Published: November 2008

This study surveyed 4158 adults residing in two control cities of the Stanford Five-City Project. Analysis of five cross-sectional surveys (conducted in 1979 through 1990) demonstrated improvements in respondents' general cardiovascular disease risk factor knowledge and behaviors. Cholesterol-related knowledge and behavior showed particularly marked improvements.
Forging the future: the public health imperative.
Authors: Allukian M
Published: November 2008

During the 1980s, national policy promoted military expenditures and downsized domestic programs. These priorities, along with tax reform and deregulation, created a "domestic gulf crisis" with a new wave of vulnerable populations--poor children, the homeless, the elderly, and the uninsured. Our lack of a national health program compounds the problem. The 1990s will be a decade of change and challenge. To forge a healthier and stronger future for our nation, we must implement five public health imperatives: (1) We must have a national health program that is universal, comprehensive, and prevention-oriented, with built-in assurances for quality, efficiency, and a strong public health infrastructure. (2) We must have a comprehensive national health education and promotion program for all schoolchildren. (3) Women must have freedom of choice. (4) Prevention and public health must become one of our country's highest health priorities. (5) The federal government must increase its leadership, commitments, and resources to reach the goals set forth in Healthy Communities 2000 and Healthy People 2000.
An injury prevention program in an urban African-American community.
Authors: Schwarz D F , Grisso J A , Miles C , Holmes J H , Sutton R L
Published: November 2008

OBJECTIVES. Injury is a major US public health problem, particularly in urban minority communities. This paper evaluates the impact of the Safe Block Project, a comprehensive injury prevention trial, on home hazards and injury prevention knowledge in a poor urban African-American community. METHODS. Nine census tracts in the community were allocated to either the intervention area or the control area. The intervention, carried out by trained community outreach workers, consisted of (1) home modification for simple prevention measures, (2) home inspection accompanied by information about home hazards, and (3) education about selected injury prevention practices. Approximately 12 months after the intervention, random samples of control and intervention homes were assessed for home hazards and injury prevention knowledge. RESULTS. A significantly larger proportion of intervention homes than control homes had functioning smoke detectors, syrup of ipecac, safely stored medications, and reduced electrical and tripping hazards. No consistent differences were observed between control and intervention homes on home hazards requiring major effort to correct. CONCLUSIONS. There was a distinct difference between control and intervention homes with respect to safety knowledge and home hazards requiring minimal to moderate effort to correct. The Safe Block Project could serve as a model for future urban injury prevention efforts.
The fluoridation of drinking water and hip fracture hospitalization rates in two Canadian communities.
Authors: Suarez-Almazor M E , Flowerdew G , Saunders L D , Soskolne C L , Russell A S
Published: November 2008

OBJECTIVES. The purpose of this study was to compare hip fracture hospitalization rates between a fluoridated and a non-fluoridated community in Alberta, Canada: Edmonton, which has had fluoridated drinking water since 1967, and Calgary, which considered fluoridation in 1991 but is currently revising this decision. METHODS. Case subjects were all individuals aged 45 years or older residing in Edmonton or Calgary who were admitted to hospitals in Alberta between January 1, 1981, and December 31, 1987, and who had a discharge diagnosis of hip fracture. Edmonton rates were compared with Calgary rates, with adjustment for age and sex using the Edmonton population as a standard. RESULTS. The hip fracture hospitalization rate for Edmonton from 1981 through 1987 was 2.77 per 1000 person-years. The age-sex standardized rate for Calgary was 2.78 per 1000 person-years. No statistically significant difference was observed in the overall rate, and only minor differences were observed within age and sex subgroups, with the Edmonton rates being higher in males. CONCLUSIONS. These findings suggest that fluoridation of drinking water has no impact, neither beneficial nor deleterious, on the risk of hip fracture.
Abnormal chest x-rays in intravenous drug users: implications for tuberculosis screening programs.
Authors: Bellin E , Fletcher D , Safyer S
Published: November 2008

OBJECTIVES. The purpose of the study was to (1) determine the prevalence of significant abnormalities in routine chest x-rays used to screen for pulmonary tuberculosis in intravenous drug users and (2) evaluate the ability of the purified protein derivative skin test to identify persons with such abnormalities. METHODS. We conducted a cross-sectional screening study on 1314 persons admitted to an opiate detoxification unit in an urban jail. Purified protein derivative tuberculin reactivity and the prevalence of abnormalities consistent with tuberculosis on screening chest x-rays were evaluated. The chest x-ray was obtained independent of the skin test. RESULTS. The chest x-rays of 73 of the inmates (5.6%) showed abnormalities consistent with tuberculosis. Tuberculin skin testing missed 17 of 26 chest x-rays (65%) with significant infiltrates. CONCLUSIONS. Purified protein derivative screening is insensitive to chest x-ray abnormalities that require additional diagnostic evaluation for tuberculosis. Routine chest studies should be performed on all intravenous drug users admitted to congregate housing settings.
A proposed classification code for farm and agricultural injuries.
Authors: Murphy D J , Purschwitz M , Mahoney B S , Hoskin A F
Published: November 2008

A fundamental problem with classifying agriculturally related injury is that there is neither a rational nor a comprehensive scheme for grouping incidents into categories describing actual exposures encountered on farms and in agricultural work. Current surveillance systems are unable to differentiate between work that is related to farm production and work that is not, and to include all exposed persons in the surveillance. The proposed Farm and Agricultural Injury Classification Code is a step toward overcoming these problems. When it was applied to previously analyzed fatality data, 40% of cases previously identified as farm production work were reclassified into other categories.
Anergy compromises screening for tuberculosis in high-risk populations.
Authors: Zoloth S R , Safyer S , Rosen J , Michaels D , Alcabes P , Bellin E , Braslow C
Published: November 2008

Anergy may occur in groups at high risk for tuberculosis, compromising tuberculin skin testing. Within New York City's correctional system, anergy prevalence was 25% among opiate users referred to detoxification programs and 3% in the general population. Correlates of anergy were recent weight loss and needle sharing. The high prevalence of anergy among opiate users compromises the utility of tuberculosis screening and suggests the need for routine chest x-rays to detect pulmonary tuberculosis in some high-risk-populations.
Local health officers' views on hazardous waste remediation.
Authors: Greenberg M
Published: November 2008

Hazardous waste sites are a priority for local health officers in New Jersey. However, most officers feel that they are not adequately briefed or consulted by federal and state officials who manage site remediation. Consequently, many local health officers tend to be neutral or negative about federal and state site remediation plans. Consultation with local health officers should be formally built into the site remediation process, and officers should directly approach their state governments to gain access.
The conflict between public health goals and the temperance mentality.
Authors: Peele S
Published: November 2008

OBJECTIVES. The prevailing view today is that alcohol consumption is unambiguously a social and public health problem. This paper presents evidence to balance this view. METHODS. Evidence of beneficial effects of alcohol against coronary artery disease is examined, together with cultural reasons for resistance in the United States to the implications of this evidence. RESULTS. Alcohol use reduces the risk of coronary artery disease--the major cause of heart disease, America's leading killer--even for those at risk for such disease. Moreover, recent research indicates that alcohol continues to reduce risk at the higher levels of drinking measured in general populations. However, with consumption of more than two drinks daily, these gains are increasingly offset by greater mortality from other causes. CONCLUSIONS. Educators, public health commentators, and medical investigators are uneasy about findings of healthful effects of drinking. A cultural preoccupation with alcoholism and the negative effects of drinking works against frank scientific discussions in the United States of the advantages for the cardiovascular system of alcohol consumption. This set has deep roots in American history but is inconsistent with public health goals.
Alcohol-related mortality in California, 1980 to 1989.
Authors: Sutocky J W , Shultz J M , Kizer K W
Published: November 2008

OBJECTIVES. This study sought to examine the impact of alcohol use and misuse on mortality in California during the 1980s. METHODS. Alcohol-Related Disease Impact estimation software and California vital statistics data were used to calculate alcohol-related mortality, mortality rates, and years of potential life lost. Statistical tests were applied to detect significant differences in death rates by sex and race/ethnicity. Time trends in death rates for a subset of alcohol-defined diagnoses were examined using regression analysis. RESULTS. An estimated 6.2% of all deaths for California residents during 1989 were related to alcohol, making it one of the top 10 leading causes of death. Injury diagnoses were major contributors to the total estimated number of alcohol-related deaths and years of potential life lost before age 65. Alcohol-related mortality rates were significantly higher for men and for Blacks. However, age-adjusted death rates for alcohol-defined diagnoses declined significantly from 1980 to 1989. CONCLUSIONS. A structured data-base approach to analyzing mortality data represents an important advance for alcohol research that has implications for policy and program planning. Future refinements and enhancements to the disease impact estimation methodology will add precision to determining how alcohol use and misuse affect public health in California.
Predictors of alcoholism in young Swedish men.
Authors: Andréasson S , Allebeck P , Brandt L
Published: November 2008

OBJECTIVES. The purpose of the study was to assess risk indicators for admission for alcoholism in young men. METHODS. Level of alcohol consumption and background variables were analyzed in a survey of 49,464 Swedish conscripts. Admissions to psychiatric care were registered during a 15-year follow-up. RESULTS. A strong association was found between level of alcohol consumption at conscription and future admission for alcoholism. The strongest risk indicator for admission for alcoholism, however, was "Contacts with police or child care authorities," with an odds ratio of 4.9. CONCLUSIONS. For conscripts reporting moderate alcohol consumption at conscription there was a clear association between an increasing burden of risk indicators and future alcoholism. Among men who already had a high level of alcohol consumption at conscription, additional risk indicators, with the exception of psychological factors, had relatively little impact on future admission for alcoholism. Poor emotional control and early symptoms of mental disorder, however, were instrumental not only in enhancing the risk for high consumption at conscription, but also in enhancing the risk for high consumers to become abusers or addicted.
From beer to crack: developmental patterns of drug involvement.
Authors: Kandel D , Yamaguchi K
Published: November 2008

OBJECTIVES. Prior research has identified developmental stages in drug use in adolescence, from substances that are legal for adults to illicit drugs. The position of crack in patterns of drug involvement remains to be established. METHODS. The analyses are based on a sample (n = 1108) representative of 12th graders attending New York State public and private schools. From reported ages of first use of five classes of drugs (alcoholic beverages, cigarettes, marijuana, cocaine but not crack, crack), alternate models of progression were tested for their goodness of fit through log-linear models. RESULTS. The sequence involves at the earliest stage the use of at least one licit drug, alcohol or cigarettes. Subsequent stages involve marijuana and cocaine; crack is the last drug in the sequence. The results confirm the more important role of alcohol among males and cigarettes among females in the progression into various drug classes. Age of first drug use at a lower stage is a strong predictor of further progression. CONCLUSIONS. The developmental pattern of drug involvement identified in the early 1970s still characterizes adolescent pathways of drug involvement in the late 1980s.
Preschool children at high risk for measles: opportunities to vaccinate.
Authors: Hutchins S S , Gindler J S , Atkinson W L , Mihalek E , Ewert D , LeBaron C E , Swint E B , Hadler S C
Published: November 2008

OBJECTIVES: In 1989 and 1990 the United States experienced a measles epidemic with more than 18,000 and 27,000 reported cases, respectively. Nearly half of all persons with measles were unvaccinated preschool children under 5 years of age. We sought to identify potential sites for vaccine delivery. METHODS. Preschool children with measles were surveyed in five inner cities with measles outbreaks in 1989 to 1990 to assess the children's use of health care services and federal assistance programs before contracting measles. RESULTS. Of 972 case children surveyed, 618 (64%) were eligible for measles vaccination at measles onset. Of those, 93% had previously visited a health care provider (private physician, public clinic, hospital emergency department, or hospital outpatient department) and 65% were enrolled in a federal assistance program (AFDC, WIC, or food stamps). Based on parent-reported reasons for health care visits, in Dallas and New York City, health care providers of 24% of 172 children may have missed at least one opportunity to administer measles vaccine. CONCLUSIONS. Many potential opportunities exist to raise the vaccination coverage of unvaccinated preschool children. These opportunities depend on (1) health care providers taking advantage of all opportunities to vaccinate, and (2) immunization services being linked to federal assistance programs.
Religious advance directives: the convergence of law, religion, medicine, and public health.
Authors: Grodin M A
Published: November 2008

Because of the deep interpersonal significance of decisions made at the end of life, it is not surprising that religion has played an important role in patient and family decision making. Specific religious concerns about death and dying have led to religious advance directives. Advance directives offer a case study of models of interaction between religious communities and secular institutions. This paper examines why such directives have been created and how they may affect health care decisions. An analysis of their strengths and weaknesses concludes that specific religious instructions are unnecessary in written directives and may undermine both the religious and health care goals of patients.
The US temporal and geographic variations of diseases related to Helicobacter pylori.
Authors: Sonnenberg A
Published: November 2008

OBJECTIVES. If Helicobacter pylori plays an important role in the occurrence of three distinct diseases--gastric cancer, gastric ulcer, and duodenal ulcer--their individual epidemiologic behaviors should show a resemblance to one common pattern. METHODS. To test this hypothesis, birth cohort and linear regression analyses were used to study the US temporal and geographic variations, respectively, of mortality from the three diseases. RESULTS. US mortality from gastric ulcer in males and duodenal ulcer in both sexes showed a clear-cut peak of occurrence in subjects born around 1885, whereas gastric cancer declined continuously in all Americans born since 1855. The geographic distributions showed a strong correlation between gastric and duodenal ulcer, as opposed to weak correlations between either ulcer type and gastric cancer. CONCLUSIONS. The similarities in the behavior of the three diseases support the idea that identical risk factors play a crucial role in their occurrence. However, the time lag between the decline in mortality from gastric cancer and the decline in mortality from peptic ulcer and their weak geographic correlations indicate that factors besides H pylori must have influenced their epidemiology.
Underreporting of diabetes on death certificates, King County, Washington.
Authors: Andresen E M , Lee J A , Pecoraro R E , Koepsell T D , Hallstrom A P , Siscovick D S
Published: November 2008

We estimated the reporting of diabetes on death certificates for persons known to have diabetes. Surveillance of 19 hospitals and two paramedic emergency medical services during 12 months in Seattle and King County, Washington, ascertained acute ischemic heart disease events for persons with diabetes and yielded 1235 persons with suspected ischemic heart disease. Mortality was 23.6%, and 41% of death certificates listed diabetes. The reporting of diabetes on the death certificate was not random, and it varied by patient and physician characteristics. Diabetes is strongly linked to fatal ischemic heart disease, but its importance is underrepresented by death certificates for some subgroups.
Racial differences in the elderly's use of medical procedures and diagnostic tests.
Authors: Escarce J J , Epstein K R , Colby D C , Schwartz J S
Published: November 2008

OBJECTIVES. This study sought to examine racial differences in the use of medical procedures and diagnostic tests by elderly Americans. METHODS. We used 1986 physician claims data for a 5% national sample of Medicare enrollees aged 65 years and older to study 32 procedures and tests. For each service, we calculated the age- and sex-adjusted rate of use by race and the corresponding White-Black relative risk. RESULTS. Whites were more likely than Blacks to receive 23 services, and for many of these services, the differences in use were substantial. In contrast, Blacks were more likely than Whites to receive seven services. Whites had a particular advantage in access to higher-technology or newer services. Racial differences in use persisted among elders who had Medicaid in addition to Medicare coverage and increased among rural elders. CONCLUSIONS. There are pervasive racial differences in the use of medical services by elderly Americans that cannot be explained by differences in the prevalence of specific clinical conditions. Financial barriers to care do not fully account for these findings. Race may exacerbate the impact of other barriers to access.
Out-of-hospital cardiac arrest: racial differences in outcome in Seattle.
Authors: Cowie M R , Fahrenbruch C E , Cobb L A , Hallstrom A P
Published: November 2008

OBJECTIVES. Out-of-hospital sudden cardiac arrest is a key area in which to study the dual problem of the poorer health status of minority populations and their poorer access to the health care system. We proposed to examine the relationship between race (Black/White) and survival. METHODS. We determined the incidence and outcome of cardiac arrests in Seattle for which medical assistance was requested. RESULTS. Over a 26-month period, the age-adjusted incidence of out-of-hospital cardiac arrest was twice as great in Blacks than in Whites (3.4 vs 1.6 per 1000 aged 20 and over). The initial resuscitation rate was markedly poorer in the Black victims (17.1% vs 40.7%), and rates of survival to hospital discharge were also lower in Blacks (9.4% vs 17.1%). Both effective initial resuscitation and survival were significantly related to White race following adjustment for other covariates. CONCLUSION. The differences in outcomes were not fully explained by features of the collapse or relevant service factors. Possible explanations include delays in instituting therapy, less bystander-initiated cardiopulmonary resuscitation, poorer levels of health, and differences in the underlying cardiac disorders.
The relationship of Chlamydia trachomatis infection and male infertility.
Authors: Greendale G A , Haas S T , Holbrook K , Walsh B , Schachter J , Phillips R S
Published: November 2008

OBJECTIVES. Infertility affects at least 2 million couples in the United States. One third of infertility is attributed to male causes, but the etiology of most male infertility remains obscure. This study was designed to investigate the relationship between Chlamydia trachomatis and unexplained infertility in men. METHODS. Questionnaires and serum were collected prospectively from 52 case subjects (men from couples with explicitly defined idiopathic infertility) and 79 control subjects (first-time expectant fathers). RESULTS. Case subjects were significantly more likely than control subjects to be seropositive for antibody to C trachomatis at a titer of 1:64 or higher. By test of trend, higher titers were associated with higher odds ratios. Adjustment for age of either partner at initiation of pregnancy attempt, race, income, previous genitourinary symptoms or diagnoses, number of previous sexual partners, and barrier contraceptive use had no significant effect on the estimate of the odds ratio. One half of the men who were antibody positive had no history of genitourinary symptoms. CONCLUSIONS. Our results suggest an association between infection with C trachomatis in men and unexplained infertility and imply that infection is frequently asymptomatic.
The coding of underlying cause of death from fetal death certificates: issues and policy considerations.
Authors: Kirby R S
Published: November 2008

Recently, plans to implement nationwide coding of underlying cause of fetal death have been promulgated. To examine the validity and potential utility of nationwide coding, this paper presents data from a five-state (Wisconsin, Arkansas, Maine, North Carolina, California) analysis of underlying causes of fetal death from vital records for 1985 through 1987. Nosological coding rules varied somewhat from state to state. Underlying causes were grouped into categories; distributions were similar for each state. Many deaths (20.3% to 32.9%) were coded as unspecified conditions. Congenital anomalies accounted for only 6.9% to 10.3% of fetal deaths, including implausible and nonspecific causes. In total, 29.5% to 42.8% of the reports were not valid or useful. To obtain better data, researchers must focus on improving fetal death reporting, which will entail the promotion of comprehensive autopsy, placental and laboratory evaluation, systematic vital records query procedures, and implementation of multiple-cause-of-fetal-death coding.
Should oral contraceptives be available without prescription?
Authors: Trussell J , Stewart F , Potts M , Guest F , Ellertson C
Published: November 2008

In this paper, it is argued that oral contraceptives should be available without prescription. Prescription status entails heavy costs, including the dollar, time, and psychological costs of visiting a physician to obtain a prescription, the financial and human costs of unintended pregnancies that result from the obstacle to access caused by medicalization of oral contraceptives, and administrative costs to the health care system. After a review and evaluation of the reasons for strict medical control of oral contraceptives in the United States, safety concerns anticipated in response to the proposal discussed here are addressed. Also, concerns that prescription status is necessary for efficacious use are evaluated. It is concluded that neither safety nor efficacy considerations justify prescription status for oral contraceptives. Revised package design and patient labeling could allow women to screen themselves for contraindications, to educate themselves about danger signs, and to use oral contraceptives safely and successfully. Several alternatives to providing oral contraceptives by prescription with current package design and labeling and selling them over the counter are suggested; the proposals discussed would make these safe and effective contraceptives easier to obtain and to use.
Factors influencing the practice of vaginal birth after cesarean section.
Authors: Goldman G , Pineault R , Potvin L , Blais R , Bilodeau H
Published: November 2008

OBJECTIVES. Vaginal birth after cesarean has been recommended for most women with previous cesarean sections for the past 10 years. This practice, however, has not yet been generalized because high variations can still be observed among countries, hospitals, and physicians. METHODS. A case-control study involving 635 case patients and 2593 control patients was carried out to determine which characteristics of the physician, the patient, or the hospital were important in the adoption of this practice. RESULTS. The results of the multiple stepwise logistic regression analysis indicate a higher likelihood that women will experience vaginal birth after cesarean if their physicians had cesarean rates under 20%, had less than 5% of their patients considered at risk, and were younger than 54 years old. Vaginal birth after cesarean was also favored by hospitals characterized by a high degree of neonatal and obstetrical specialization, and a patient population with a low level of education. CONCLUSIONS. This policy is still in the developmental stage, as evidenced by the great variability between hospitals and physicians in rates of vaginal birth after cesarean. Further efforts are required for this policy to become the norm.
Race and birthweight in biracial infants.
Authors: Collins J W , David R J
Published: November 2008

OBJECTIVES. The purpose of the study was to determine the role of infant race as a determinant of the Black-White disparity in low birthweight (< 2500 g). METHODS. Univariate analysis and multivariate logistic regression were performed on Illinois vital records from 1982 and 1983 and on 1980 United States census income data. RESULTS. Fourteen percent of the infants born to Black mothers and White fathers were of low birthweight, compared with 9% of infants born to White mothers and Black fathers and 6% of a random sample of White infants. Both groups of biracial infants were more likely to have been born to unmarried mothers and to reside in very low-income (< $10,000 per year) census tracts than were White infants. When all confounding variables were entered into a logistic model, the adjusted odds ratio of low birthweight for biracial infants born to Black mothers and White fathers equaled 1.4. When biracial infants born to White mothers and Black fathers were compared with White infants, the adjusted odds ratio of low birthweight equaled 1.0. CONCLUSIONS. Paternal and consequent infant race does not affect the birthweight distribution of those born to White mothers and Black fathers. Unidentified factors closely related to maternal race underlie the Black-White disparity in infant birthweight.
Vietnamese infant and childhood mortality in relation to the Vietnam War.
Authors: Savitz D A , Thang N M , Swenson I E , Stone E M
Published: November 2008

OBJECTIVES. There is obvious potential for war to adversely affect infant and childhood mortality through direct trauma and disruption of the societal infrastructure. This study examined trends in Vietnam through the period of the war. METHODS. The 1988 Vietnam Demographic and Health Survey collected data on reproductive history and family planning from 4172 women aged 15 through 49 years in 12 selected provinces of Vietnam. The 13,137 births and 737 deaths to children younger than age 6 reported by the respondents were analyzed. RESULTS. For the country as a whole, infant and childhood mortality dropped by 30% to 80% from the prewar period to the wartime period and was stable thereafter. In provinces in which the war was most intense, mortality did not decline from the prewar period to the wartime period but declined after the war, consistent with an adverse effect during the wartime period. CONCLUSIONS. The data are limited by assignment of birth location on the basis of mother's current residence and by inadequate information on areas of war activity. Nonetheless, the data do not indicate a widespread, sizable adverse effect of the war on national infant and childhood mortality in Vietnam but suggest detrimental effects in selected provinces.