bluuebunny/crossref_metadata_2025 huggingface dataset:
The relationship between elevated blood pressure and obesity in Black children.
Authors: Lynds B G , Seyler S K , Morgan B M
Published: November 2008

Blood pressures, heights and weights were measured in 1,692 elementary school black children. Elevated blood pressure (EBP) was defined as a systolic or diastolic reading above the 90th percentile for age, and weights were categorized into five classes based on weight for height norms. Systolic EBP children, whether boys or girls, were three times as likely to be obese as black children in the total population, and a similar relationship held for diastolic EBP children.
The influence of maternal age, birth order and socioeconomic status on infant mortality in Chile.
Authors: Cabrera R
Published: November 2008

In Chile between 1969 and 1974 the birth rate declined by 10 per cent and the infant mortality rate by 18.6 per cent. In 1974 there were proportionately fewer births at high birth order than in 1969. Such births carry significantly higher risk to the infant in both the neonatal and postneonatal period of life. Comparison of data from urban areas of high and low socioeconomic status yield similar findings.
A preliminary survey of the association of Pseudomonas aeruginosa with commercial whirlpool bath waters.
Authors: Kush B J , Hoadley A W
Published: November 2008

Conditions in commercial whirlpool baths were investigated and populations of Pseudomonas aeruginosa surveyed. Conditions generally favored growth, and P. aeruginosa was demonstrated in 62.5 per cent of 24 samples of bath waters surveyed. Serotype 11, implicated in outbreaks of skin rash among bathers at whirlpool baths, was demonstrated most frequently, being isolated from 30 per cent of the 24 survey samples, and from 70 per cent of 20 additional samples from a single bath sampled on two days.
A comparison between carboxyhemoglobin and serum thiocyanate determinations as indicators of cigarette smoking.
Authors: Cohen J D , Bartsch G E
Published: November 2008

Cigarette smoking histories were compared to carboxyhemoglobin and serum thiocyanate concentrations obtained from 426 smokers and 191 non-smokers. The mean levels of both carboxyhemoglobin and serum thiocyanate wefe significantly higher among cigarette smokers and correlated with number of cigarettes smoked per day. The specificity of both procedures was 81 per cent, and serum thiocyanate had a higher sensitivity (93 per cent vs. 83 per cent), making it potentially more suitable for use as an index of cigarette smoking.
The immunization status of children in an HMO.
Authors: Pope C R
Published: November 2008

The immunization status of children within a well established Health Maintenance Organization is compared to data from 1973 and 1977 national surveys. The 1977 HMO data derive from a mail questionnaire survey and the 1973 data from the medical records. The HMO children are at less risk of diphtheria, pertussis, tetanus, polio, and measles while the opposite was true for rubella and mumps. The latter findings are related to earlier HMO policy, now modified.
The health of Mexican Americans: evidence from the human population laboratory studies.
Authors: Roberts R E , Lee E S
Published: November 2008

Data are presented from sample surveys conducted in 1974 (N = 3,119) and 1975 (N = 657) in Alameda County, California, by the Human Population Laboratory. Mexican Americans are compared to Anglos and Blacks on selected health status indicators; chronic conditions, disability, symptoms and a summary measure, the Physical Health Spectrum. Comparisons of crude percentages indicate that, compared to Anglos, Blacks report having more chronic conditions, more disability and more symptoms, while Chicanos generally report fewer health problems than these two groups. Controlling for the effects of age, sex, education, family income, marital status, and perceived health reduces the Anglo/Black differentials in reported health problems, primarily by reducing the rates for Blacks. However, even after adjustment the prevalence rates for Blacks remain higher. After controlling for the effects of the six covariates, the rates for Chicanos remain essentially unchanged in both samples, e.g., lower than the other groups. Results of binary regression analysis indicate that the two most powerful predictors of health status in both samples are age/sex and perceived health. Ethnicity overall is not a good predictor of health status, accounting for 1 per cent or less of the explained variance. Socioeconomic status, while predicting slightly better than ethnicity, still accounts for less than 2% of the variance in health status.
A study of antipsychotic drug use in nursing homes: epidemiologic evidence suggesting misuse.
Authors: Ray W A , Federspiel C F , Schaffner W
Published: November 2008

We reviewed 384,326 prescriptions for 5,902 Medicaid patients residing continuously for one year in 173 Tennessee nursing homes. Of these patients, 43 per cent received antipsychotic drugs; 9 per cent were chronic recipients (received at least 365 daily doses per year). Of the 1,580 physicians who cared for these patients, 42 per cent prescribed antipsychotic medication. Physicians with large nursing home practices (10 or more patients) prescribed 81 per cent of the total antipsychotic medication, and were usually family practitioners (78 per cent) and in rural practice (47 per cent). As nursing home practice size increased, doctors prescribed more drug per patient (p less than .001). Wide variation in antipsychotic drug use occurred among nursing homes; the chronic recipient rate ranged from 0 to 46 per cent. More drug was given per patient in larger homes (r = .18, p less than .05). Typically, one physician (the "dominant" physician) provided care for the majority of a nursing home's patients. The proportion of a home's patients seen by the dominant physician was correlated with the chronic recipient rate (r = .17, p less than .05). These findings provide epidemiologic evidence suggesting misuse of antipsychotic drugs in nursing homes. They illustrate the need for investigations of techniques for patient management in nursing homes which rely less upon psychtropic drugs.
Expanded home-based care for the impaired elderly: solution or pipe dream?
Authors: Dunlop B D
Published: November 2008

Benefits assumed by those calling for massive expansion of home health care to include preventive, health-supportive services for the dependent aged--reduced institutionalization, reduced stress among family caregivers, and enhanced life-satisfaction for the dependent elderly--have been the objects of inadequate research and reflection. Advocates are unable to specify exactly what kind of person could benefit or who would seek to use such services. The little evidence that exists suggests that these benefits may be realized only partially and/or only among select segments of the population affected. A significantly reduced rate of institutionalization appears especially questionable. Only for a relatively small group, those mildly impaired persons without close kin (who now sometimes end up in lower level nursing homes or domiciliary care homes due to absence of this resource), does expansion of long-term maintenance services appear at this point to hold such potential. Local experiments with expanded home-based programs suggest that there may be a number of factors which could limit demand for such services. Carefully designed research to address these issues is needed.
Evaluation of utilization of laboratory tests in a hospital emergency room.
Authors: Bloomgarden Z , Sidel V W
Published: November 2008

Visits to a metropolitan teaching hospital emergency room were evaluated for laboratory test utilizaion and quality of care of chart review. Of 630 tests, 197 (32 per cent), clustered in 44 out of 476 (9 per cent) patient visits, were considered unnecessary. The number of tests per visit showed a strong negative correlation with the necessity of tests and with the quality of care. Results suggest the usefulness of identifying a subgroup of patients with excessive tests and implementing measures to alter testing behavior for this subgroup.
Childhood hypertension and academic standing in the Philippines.
Authors: Micozzi M S
Published: November 2008

A blood pressure study on 1,078 school children, grades one through six, conducted in Mindanao, Philippines, showed an inverse association between the prevalence of systolic hypertension and the level of academic achievement, significant at p less than 0.05 in grades 4--6, and p = 0.06 in grades 1--3.
Epidemiology of otitis media: a community study.
Authors: Biles R W , Buffler P A , O'Donell A A
Published: November 2008

A community study of the incidence of clinically diagnosed otitis media and middle ear effusions was undertaken in the City of Galveston, Texas, based on a random sample of records of patients aged 0-8 years receiving medical care from four major sources during 1975. No overall sex or ethnic differences were observed in association with otitis media. Thirty-five per cent of the sample had at least one episode of otitis media during 1975 and, of these, one-third had two or more episodes, yielding a conservative annual incidence rate of 55.1 per cent for this age group. The overall age-specific incidence pattern indicated the highest rates for the 0-2 year age group (71 to 114 episodes per 100 children) with a steady decline in risk with increasing age. Infants who received an initial diagnosis within the first 12 months of life experienced significantly more episodes of otitis during a two-year period than did children who received an initial diagnosis after one year of age. Seasonal patterns of otitis media were comparable with those reported in other studies. Analysis by birth month of children who experienced repeated episodes of otitis indicated an increased number of children born in the late summer and fall.
Pilot study of smoking, alcohol and drug abuse prevention.
Authors: McAlister A , Perry C , Killen J , Slinkard L A , Maccoby N
Published: November 2008

A longitudinal pilot study gathered data on the onset and prevention of smoking, alcohol, and drug abuse among 526 students from two junior-high-schools in California. Over two school years, students who were trained to resist social pressures toward tobacco, alcohol, and drug use began smoking at less than one-half the rate of those who did not receive special training. Frequent alcohol and marijuana use was also less prevalent among the students who received such training.
Modifying smoking behavior of teenagers: a school-based intervention.
Authors: Perry C , Killen J , Telch M , Slinkard L A , Danaher B G
Published: November 2008

Tenth grade health classes in three high schools received a special program focusing on the immediate physiological effects of cigarette smoking and the social cues influencing adoption of the smoking habit, and classes in two control schools received standard information on the long-term effects of smoking. Only subjects in the special program reported a decrease in smoking from pre to post-test; they also scored higher than controls on a knowledge test. Carbon monoxide levels were significantly lower for subjects in the special group at post-test.
Preventing tap water burns.
Authors: Baptiste M S , Feck G
Published: November 2008

Based on a 1974-1975 survey of hospital records in upstate New York, we estimate that 347 tap water burns will require inpatient treatment annually, with children and the elderly at increased risk. The number and severity of burns from tap water makes them an important prevention priority. Reducing the temperature of household hot water supplies could be a practical and effective prevention measure.
Teaching and research on women's health issues in Schools of Public Health.
Authors: Oakley D
Published: November 2008

Women have been among the students and the faculty in Schools of Public Health since the early days of academic programs in public health. This report provides data on the recent past and current proportions of students and faculty who are women, and on the current quantity and type of teaching and research on women's health issues in the 22 North American Schools of Public Health. Teaching on these subjects is more widespread than research, but one or both are found in all but three of the schools.
Characteristics of respondents and non-respondents to a mailed questionnaire.
Authors: Barton J , Bain C , Hennekens C H , Rosner B , Belanger C , Roth A , Speizer F E
Published: November 2008

In establishing a cohort of U.S. nurses, an assessment of response bias was made comparing respondents and non-respondents with regard to age, education, state of residence, employment status, field of employment, and major specialty. Overall, the 122,328 respondents (69.7 per cent) and 43,222 non-respondents were quite similar. Together with the reasonable response rate in a homogeneous population, this suggests that estimation of exposure-disease associations is unlikely to be affected by major bias due to non-response.
Health, obesity, and earnings.
Authors: McLean R A , Moon M
Published: November 2008

Published reports and economic theory suggest that a worker's earnings may be affected by his degree of obesity. The purpose of this research was to estimate the size of such an effect. The earnings-obesity hypothesis was tested with data from the National Longitudinal Survey of Mature Men. Results of the test suggest that, for members of that sample, there is no earnings-depressant effect due to obesity.
The underregistration of neonatal deaths: Georgia 1974--77.
Authors: McCarthy B J , Terry J , Rochat R W , Quave S , Tyler C W
Published: November 2008

We reviewed the neonatal outcome of 3,369 infants who weighed less than or equal to 1500 grams and who were born in Georgia during the years 1974--76. We matched 1,465 of these infants with a death certificate registered in the State's Vital Records. Upon review of the hospital records of the remaining infants, we identified 453 infants that died during the neonatal period without a death certificate being registered. Subsequently, we compared the hospital death registries for 1977 in Georgia and death certificates registered in Vital Records during 1977. We identified an additional 236 infants who died without a death certificate being registered. Forty per cent of these infants weighed greater than 1500 grams. Two major procedural errors regarding the filing of death certificates in Georgia at the local level contributed to this 21 per cent underregistratioon of neonatal deaths in 1974--77. The underregistration occurred disproportionately for rural areas, for unmarried mothers, and for Black infants. The reason for underregistration included failure of hospitals and morticians to file death certificates with the county registrars.
Reporting of gonorrhea by private physicians: a behavioral study.
Authors: Rothenberg R , Bross D C , Vernon T M
Published: November 2008

Physicians in the Denver Metropolitan Area were randomly assigned to study groups and exposed to an intervention designed to test current hypotheses concerning the reasons for underreporting of gonorrhea (lack of saliency in the request, patient interference, violation of the physician-patient relationship, insufficient rewards and excessive administrative cost to the reporter). A periodic telephone contact, initiated by the Health Department and requiring only contact between clerical personnel, more than doubled the number of reported cases. The effect was most striking for those who had not previously reported, and for doctors who practiced alone. An estimate of 42 per cent was obtained for the proportion of cases reported, substantially higher than that produced by retrospective surveys based on recall. The impact of undernotification on total morbidity will vary with the preexisting mix of public and private reporting. The telephone reporting system appears to be an inexpensive and effective program tool for determining that impact locally.
Self-reported behavior patterns of patients attending a sexually transmitted disease clinic.
Authors: Kramer M A , Aral S O , Curran J W
Published: November 2008

Records of the sexually transmitted disease (STD) clinic visits of 12,728 patients in Columbus, Ohio were analyzed to better understand the behavior patterns of these patients. Among heterosexual men, a greater proportion of Blacks than Whites reported a previous history of urethritis. After controlling for previous STD among heterosexual men with discharge or dysuria, we found that Black men sought treatment sooner and were more likely to curtail sexual activity than White men after becoming symptomatic with gonorrhea or nongonococcal urethritis.
Hypertension labeling and sense of well-being.
Authors: Bloom J R , Monterossa S
Published: November 2008

Seventy-one individuals were mislabeled on the basis of a prevalence survey (N = 1,031) conducted in low-income community. They were told by a physician that they were hypertensive but were later judged normotensive on the basis of three blood pressure measures. None of these persons was taking antihypertensive medication or under medical care. Compared to the total normotensive sample, the mislabeled group reported more depressive symptoms (P = .005), lower present health (p = .001), and a worsening of their health over the past five years (p = .035). Compared to a control group matched on gender, age, ethnicity, education, and marital status, the mislabeled group reported even more depressive symptoms (p = .005), and lower present health (p = .034). They did not, however, have a worsening of health over the past five years (p = .074). These findings could not be explained by greater utilization of medical care or comorbidity. It is suggested that these findings are a result of people being falsely labeled as hypertensive.
Second consultant opinion for elective orthopedic surgery.
Authors: McCarthy E G , Finkel M L
Published: November 2008

We abstracted records of 369 patients whose recommendations for elective orthopedic surgery were not confirmed by a second opinion consultant. Six months or more after the initial recommendation for surgery, 82 per cent had not had the operation performed, irrespective of the diagnosis and the characteristics of the physician recommending surgery. Reasons for consultant non-confirmation included: use of a cast, brace, or corrective footwear preferable (26.3 per cent), symptoms not severe enough (18.4 per cent), and physical therapy/exercises preferable (17.8 per cent).
Relative mortality of unbelted infant passengers and belted non-infant passengers in air accidents with survivors.
Authors: Fife D , Rosner B , McKibben W
Published: November 2008

Aircraft accidents with survivors were examined to determine the relative risk of mortality for unrestrained infant passengers vs seat-belted adult passengers. The crude relative risk was estimated to be 7.1, based on US data, and 7.4, based on worldwide data. More refined estimates allow for possible effect of seat location and for differences in lethality between crashes. Using such estimates, unbelted infant passengers have relative risk of 5.9 based on US data and 9.6 based on worldwide data. The injury experience of restrained vs unrestrained automobile passengers suggests that observed excess risk to infant air passengers may be related to the absence of a mechanical restraint system. Recommendations for a mechanical restraint system are made and the cost and benefits of implementing these recommendations in the US are discussed.
A comparison of medical record with billing diagnostic information associated with ambulatory medical care.
Authors: Studney D R , Hakstian A R
Published: November 2008

The degree of similarity between diagnostic information furnished with claims and that simultaneously entered into the medical record was estimated for 1,215 private office visits in British Columbia, Canada. For each visit, claim card and chart diagnoses were compared by having three independent internists (blinded to source and type of the data) make judgments about each diagnostic pair. The judges were highly consistent internally and their judgments were stable over time. In 40 per cent of cases chart and claims data were judged dissimilar, and in 38 per cent of cases claims data were judged more valuable as a reflection of the primary problem treated. The degree of judged similarity of chart and claims data correlated significantly and negatively with physician workload, income, and judges' preference for the billing card diagnosis. We conclude that in using claims data to determine the content of ambulatory visits, independent validation of such data may be important.
Accuracy of cancer death certificates and its effect on cancer mortality statistics.
Authors: Percy C , Stanek E , Gloeckler L
Published: November 2008

A study to determine the accuracy of cancer mortality data was done using cancer deaths occurring during 1970 and 1971 in eight of the nine areas included in the Third National Cancer Survey (TNCS). Death certificates with an underlying cause of death of cancer were compared to the hospital diagnosis for 48,826 resident cases of single primary cancers. The underlying cause of death as coded on the death certificate was found to be accurate for about 65 per cent of the cancer deaths in this study. Misclassification problems occurred for colorectal cancer, the second leading cause of death from cancer. Colon cancer was overreported and rectal cancer was under-reported on death certificates. Other misclassification problems were found for cancers of the uterus, brain, and buccal cavity including most of its sub-sites. Physicians tended to report a non-specific site of cancer on the death certificate rather than the specific site identified by the hospital diagnosis.
Accuracy of information on smoking habits provided on self-administered research questionnaires.
Authors: Petitti D B , Friedman G D , Kahn W
Published: November 2008

In the setting of a prepaid medical care plan, self-administered questionnaires were an accurate source of information on smoking habits and the standard against which the physiologic measures of smoking, serum thiocyanate, and expired carbon monoxide, must be judged. Questionnaire responses were internally consistent and highly reproducible. In contrast, the physiologic measures had low overall sensitivity as tests of current tobacco exposure (0.72). Their sensitivity was improved by utilizing the self-reported information.
Public awareness and knowledge about the risks of drinking during pregnancy in Multnomah County, Oregon.
Authors: Little R E , Grathwohl H L , Streissguth A P , McIntyre C
Published: November 2008

Public awareness of the risks of drinking during pregnancy was assessed in a Northwestern metropolitan county. Ninety per cent of respondents stated spontaneously that drinking might be harmful, and one-fourth of this group felt pregnant women should customarily abstain from alcohol. The balance of those who considered drinking harmful felt an average of more than three drinks was safe for daily use. Thus awareness of risk does not necessarily result in recommendation of low-risk behavior.
Surgical fertility regulation among women on the Navajo Indian reservation, 1972-1978.
Authors: Temkin-Greener H , Kunitz S J , Broudy D , Haffner M
Published: November 2008

Changes in the rates of induced abortions, bilateral tubal ligations, and hysterectomies on the Navajo Indian Reservation have been examined for the years 1972-1978. While the incidence of abortions and tubal sterilizations is still considerably lower among Navajo women than among the total United States population of women, it has risen, especially among those in the prime of the reproductive cycle, i.e., ages 20-34. The rate of hysterectomy has not changed substantially. Regression analyses performed on the data indicate that the utilization of surgery for fertility regulation in women on the Navajo Reservation, unlike other surgical procedures, is not affected by access to hospitals which provide surgery. Rather measures of involvement in the wage work economy are of primary importance. Those areas of the Reservation having the highest levels of such involvement exhibit the highest rates of such surgery.
Does visiting the school health room teach appropriate or inappropriate use of health services.
Authors: Nader P R , Brink S G
Published: November 2008

This study examines the school health room visiting behavior, over two school years, of a random sample (N = 671) of urban children, grades K-5. Excluding eight students who visited regularly for medication (and who alone accounted for 25 per cent of all visits), 94 per cent of the students made at least one visit. Girls visited more frequently than boys (5.1 visits/year vs 4.1 visits/year). Girls were more likely to be in the frequent visitor group (P = 0.01); to have presented five or more different complaints (P = 0.02); and to have visited for stomachache (P less than or equal to 0.001). These sex differences were observed as early as first grade. Almost 58 per cent of the variance in visiting in the second year was predicted by frequency of visiting in the first. These data raise questions about the influence of the school in either reinforcing or modifying the health services utilization behavior of individuals.
Disability trends in the United States population 1966-76: analysis of reported causes.
Authors: Colvez A , Blanchet M
Published: November 2008

According to data published by the United States National Center for Health Statistics, disability reported among the US population has increased substantially during the years 1966 to 1976. Among younger age groups, the increase in activity limitation involves visual and hearing impairments as well as asthma. In the middle age group (45-64), four causes increased in both sexes (diabetes, musculoskeletal disorders, hypertension, and diseases of the circulatory system other than hypertension and heart conditions); one cause affected men only (heart conditions) and one women only (malignant neoplasms). In the 65 and over age group, diabetes and circulatory diseases (excluding heart conditions and hypertension) increased significantly. Although the US population increased by 10 per cent, the number of persons permanently limited in their activities because of health conditions increased by 37 per cent with a much larger proportion of those disabled claiming to be unable to carry on their main activity. Changes in health survey procedures and changes in standards used by respondents to rate their health status are not believed to account for these findings. Factors which could have contributed to this trend include environmental deterioration and improved social benefits easing retirement and providing better access to the health care system. Planning agencies need to recognize the relationships of the health care system to disability as well as to mortality.
Mistreatment of the elderly in the domestic setting: an exploratory study.
Authors: Hickey T , Douglass R L
Published: November 2008

Professionals and practitioners (N = 228) involved in providing services to the elderly were interviewed regarding their experiences with the mistreatment of older people by their families. Semi-structured questions dealt with: case identification and follow-up procedures; perceptions of etiological factors; and descriptive typologies from illustrative case histories. Findings indicated that domestic mistreatment of the elderly was familiar to most professionals interviewed, to the extent that 60 per cent of the respondents dealt with such cases on a weekly basis. Among the 10 professional groups interviewed, there was little variation in their experiences with neglect; police officers, lawyers, community mental health and aging services workers had greater exposure to cases of physical abuse. Intentional mistreatment was typically viewed as a consequence of inadequacies in the caretaker, while unintentional cases were related to the victims' isolation. Most respondents indicated that there were no established procedures for dealing with, or following-up mistreatment cases, and over one-half reported that nothing was done. Differences in perception of the etiology of domestic mistreatment of the elderly were closely related to the occupational perspectives of the various respondent groups. Although incidence rates could not be established, 89 illustrative cases of domestic mistreatment of the elderly were indicative of the severity of the occurrences and the absence of appropriate interventions.
Smoking and epidemic influenza-like illness in female military recruits: a brief survey.
Authors: Kark J D , Lebiush M
Published: November 2008

An outbreak of influenza-like disease caused illness among 48 per cent of 173 female military recruits, 35 per cent of whom smoked cigarettes. The risk of influenza-like illness was greater in smokers (60.0 per cent) than in nonsmokers (41.6 per cent), with a risk ratio of 1.44 (95 per cent CL 1.03-2.01). Among those ill, a significantly greater proportion of smokers visited the clinic than nonsmokers. This could have been due to more severe illness among smokers, or to a greater tendency to visit the physician. The proportion of influenza-like disease attributable to smoking in this population was 13 per cent.
Neonatal Mortality by the Day of the Week in the 1974-75 Arkansas Live Birth Cohort
Authors: Mangold William D.
Published: November 2008

This study is an analysis of daily variations in neonatal mortality among 66,049 live births in the 1974-75 Arkansas live birth cohort. Weekends and holidays in general, and Sundays in particular, were found to have the fewest number of deliveries. Variations in deliveries by the day of the week were attributed to obstetric practices. Births weighing less than 2500 gms. were over-represented among weekend deliveries as were infants experiencing a birth-related injury. Neonatal mortality was found to be higher among weekend deliveries with a Sunday rate that was 27 per cent above the weekly average. Separate analysis by race and birth weight revealed the weekend peak to be more pronounced among non-whites. Analysis of daily variations by cause of death showed that Sundays exceeded the overall average for seven of the eight cause of death categories examined. (Am J Public Health 1981;71:601-605.)
Hospitalization of medicaid children: analysis of small area variations in admission rates.
Authors: Connell F A , Day R W , LoGerfo J P
Published: November 2008

Population-based hospitalization rates were computed and analyzed for AFDC children among 14 small area subdivisions of the State of Washington. Medical-surgical admission rates ranged from 65.3 to 161.7 per 1,000 person-years among the 14 areas. Surgical admission rates were significantly higher in urban areas; medical admission rates were significantly higher in rural areas. The majority of variance in overall rates was accounted for by admissions for four diagnostic categories: gastroenteritis (18-fold differences), lower respiratory infections (15-fold differences), upper respiratory infections (8-fold differences), and ear, nose, and throat (ENT) surgery (6-fold differences). Secondary analysis indicates that these differences in admission rates were not associated with: medical need or demographic factors, epidemic patterns of disease, physician supply, hospital bed supply or occupancy rates, or severity of disease or delay in seeking medical care as reflected by average length of stay. It is possible that the observed variations may reflect either differences in the propensity of local physicians to hospitalize or differences in the use or adequacy of community, ambulatory, and preventive care.
Choosing measures of health status for individuals in general populations.
Authors: Ware J E , Brook R H , Davies A R , Lohr K N
Published: November 2008

This paper offers suggestions to adi the selection of appropriate instruments and data gathering methods for studies that require measures of personal health status applicable in general populations. Before selecting measures, the reason for studying health status must be identified. Next, definitional issues arise when attempting to specify the components of health that are to be studied. Evidence supports restriction of the definition of personal health status to its physical and mental components, rather than including social circumstances as well. In evaluating the suitability of available measures, three features must be considered: 1) practicality in terms of administration, respondent burden, and analysis; 2) reliability in terms of the study design and group or individual comparisons; 3) validity, in terms of providing information about the particular health components of interest to the study. Evaluating validity will be difficult for most available measures; careful attention to item content will be helpful in choosing appropriate measures. Despite problems in development and interpretation, overall health status indicators will prove useful to many studies and should be considered, as should both subjective and objective measures of health status. Given that the reasons to measure health have been identified, the aspects of health to be measured specified, and attention paid to their suitability, appropriate measures may often be found among those now available.
Measuring effectiveness of service aides in infant immunization surveillance program in North Central Texas.
Authors: Moore B J , Morris D W , Burton B , Kilcrease D T
Published: November 2008

The Immunization Division of Texas Public Health Region 5 sought to measure the per cent of referrals taking immunization action as a result of service aide contact. From data collected on newborn-nonresponders during a 12-month period, results show that aides may be credited with influencing 44 percent of the referrals reporting subsequent immunization.
Increasing utilization of a rural cervical cancer detection program.
Authors: Windsor R A , Kronenfeld J J , Cain M G , Cutter G R , Goodson L A , Edwards E
Published: November 2008

The Alabama Department of Public Health established, in 1973, a Cancer Screening Program (CSP). Although 66,000 women have been screened, many rural females had never used the program. After a community health organization education effort was introduced into a target rural county, an examination of CSP new user data for two intervention quarters revealed 345 and 150 per cent increases, respectively, in the pattern of use.
Drinking water sodium and blood pressure in children: a second look.
Authors: Tuthill R W , Calabrese E J
Published: November 2008

A previous study by the current authors demonstrated a statistically significant and clinically important elevation of 3-5 mmHg in mean systolic and diastolic blood pressure in high school sophomores in a community with 108 mg/L of sodium in the water supply when compared to their peers in an appropriately matched community with 8 mg/L of sodium. The current investigation, employing identical techniques but studying third graders in the same two communities, showed similar results. This second look considered dietary intake and urinary excretion of sodium. Since the difference in 24-hour dietary sodium consumption was 300 milligrams between the communities, an intake of one liter of high sodium tap water represented approximately 25 per cent of the difference in total sodium intake between the two communities. These studies suggest that sodium consumption in both drinking water and diet may be contributing to the different blood pressure distributions among the normotensive children in the two communities.
Anemia of pregnancy: evaluation of the effectiveness of routine dietary supplementation program in an Israeli community.
Authors: Palgi A , Levi S , Reshef A
Published: November 2008

Of 514 Israeli women 4-5 months pregnant, 200 who were non-anemic (Hb 11 gm/100 ml or higher) took a daily supplement of ferrous sulfate (100 mg elemental iron). The 160 who remained on this regimen showed, as a group significantly less reduction in hemoglobin levels than 180 non-anemic women who did not wish to take the supplement. Forty of the 200 women either dropped out or were shifted to other treatment regimens because they developed anemia after the fifth month.
Description and evaluation of the smoking cessation component of a multiple risk factor intervention program.
Authors: Malotte C K , Fielding J E , Danaher B G
Published: November 2008

The smoking cessation component of a residential program which attempts to concurrently intervene on several risk factors related to chronic disease is described. Seventy-two per cent of the 43 smokers in the first 13 cohorts were abstinent at discharge. Fifty-five per cent were abstinent at two months. Six-month data for the first nine cohorts show 53 per cent abstinence. Possible advantages and disadvantages of a multiple behavior change program in a residential setting are discussed.
Ethnic differences in hemoglobin distribution of Asian and European Jewish women in Israel, both pregnant and nonpregnant.
Authors: Palgi A
Published: November 2008

Hemoglobin levels of Asian Jewish women both while pregnant and nonpregnant were lower than in their European counterparts by about 0.23 g/100 ml to 0.3 g/100 ml. The groups had similar parity numbers but the Asian women's socioeconomic status was lower. In both the pregnant and nonpregnant, Israeli-born Asian women had higher mean hemoglobin levels than Asian immigrants but lower than Israeli-born Europeans.
The gay report on sexually transmitted diseases.
Authors: Darrow W W , Barrett D , Jay K , Young A
Published: November 2008

Most studies of sexually transmitted diseases in homosexual men have examined prevalence in clinic populations; for comparative purposes, we analyzed data from a survey of 4,329 gay men conducted in 1977. Among 4,212 respondents to the self-administered questionnaire, 66.8 per cent reported previous infection with pediculosis; 38.4 per cent, gonorrhea; 24.1 per cent, nonspecific urethritis; 18.1 per cent, venereal warts; 13.5 per cent, syphilis; 9.7 per cent, hepatitis; and 9.4 per cent, herpes. Number of different lifetime sexual partners best predicted histories of symphilis (r = .249), gonorrhea (r = .402), and the other diseases; frequency of checkups, years as a practicing homosexual, and furtive sexual activities were among the many other significant correlates of venereal infections. Respondents most often sought examinations from private physicians (39.4 per cent); those who visited gay clinics were examined most often and felt most positive about their medical care. Gay men who participated in the survey reported frequent infections with many of the same sexually transmitted diseases often seen in private medical practices, public VD clinics, and gay health centers. Since high rates of disease are related to large numbers of different partners, frequent exposures with anonymous contacts, and anal intercourse, we recommend frequent examinations for those whose life-styles include these characteristics.
Theory and action for health promotion illustrations from the North Karelia Project.
Authors: McAlister A , Puska P , Salonen J T , Tuomilehto J , Koskela K
Published: November 2008

The North Karelia Project in Finland illustrates the fundamental goals of health promotion. Specific activities of the project serve as examples of how concepts from the social and behavioral sciences can be applied to achieve estimated reductions in predicted risk of disease. The results in North Karelia are not conclusive, but they are encouraging, and the investigations conducted there is an essential reference for future research in health promotion and disease prevention.
The effects of family involvement and practitioner home visits on the control of hypertension.
Authors: Earp J A , Ory M G , Strogatz D S
Published: November 2008

The effectiveness of two social support strategies designed to lower hypertensive patients' blood pressure were compared to each other and to a control group (N = 63) receiving routine care in a randomized clinical trial extending over a period of two years. Group 1 (N = 99) received visits and had family members actively participate in their care through home blood pressure monitoring; Group 2 (N = 56) received home visits from nurses and pharmacists. All groups were predominantly Black. After the first year of the trial, the proportion of patients with uncontrolled diastolic blood pressure (greater than or equal to 95mm Hg) had declined significantly for all three groups; no group showed a statistically significant advantage. However, during the last six months of the second year (after visiting had ended), both Groups 1 and 2 demonstrated clear superiority in DBP control over Group 3, achieving borderline statistical significance (p = .07) when multivariable analysis was performed to control for potential confounders. Supplementing routine care with periodic home visits produced an additional 21 per cent of patients with well-controlled DBP, while involving family members plus visits produced a 17 per cent improvement in the percentage of patients with DBP less than 95mm Hg. However, neither support strategy was clearly more effective than the other over time. The efficacy of the interventions is discussed with respect to cost and feasibility of implementation.
Heatlh care in the People's Republic of China: a view from inside the system.
Authors: Henderson G E , Cohen M S
Published: November 2008

During a three-month period, all admissions to an infectious disease ward at a tertiary care hospital in the People's Republic of China were studied. The hospital's catchment area covered a population of almost eight million, 10 per cent urban and 90 per cent rural. Seventy-two per cent of the patients admitted to this facility were city dwellers with illnesses which were significantly less serious in degree than the illnesses encountered among patients transferred from rural facilities. Ease of travel, nature of the disease process, availability of beds, ability to manipulate the referral ladder, and cost of health care may account for these results. Charges for health care in China proved very expensive relative to per capita income. This may be of major consequence to rural persons who are personally liable for some portion of this cost. These results suggest that although referral to tertiary care in China occurs more commonly among rural patients than is the case in other developing nations, access to this care and its cost are significant problems of the present system. During the drive for modernization, a multifactorial approach (including health policy, administrative controls, and patient and physician education) will be essential to avoid deterioration of the rural health system, and the increase financial burden to be expected with the introduction of advanced medical technology.
New dimensions in cause of death statistics.
Authors: Chamblee R F , Evans M C
Published: November 2008

This article discusses the limitations of traditional national cause of death statistics. These limitations derive from an attempt to conceptualize a multidimensional phenomenon and reduce down to a unidimensional framework. The article outlines the characteristics of a new multidimensional approach which involves the codification and tabulation of all causes (multiple causes) listed on death certificates. Preliminary data are presented which illustrate that multiple cause of death data do indeed represent a major new dimension to cause of death statistics. These data indicate that most major causes of death are contributory factors in many deaths in which they are not the underlying cause of death. For example, in 1976, diabetes mellitus was the underlying cause of approximately 35,000 deaths but was a contributing factor in another 100,000 deaths. This paper also demonstrates the contribution of multiple cause of death data to identifying patterns of association among diseases and the kinds of injuries resulting from various external causes. Finally, data are presented which depict the use of multiple cause data in evaluating the efficacy of the coding rules used to classify the underlying cause of death.
Irritants in cigarette smoke plumes.
Authors: Ayer H E , Yeager D W
Published: November 2008

Concentrations of the irritants formaldehyde and acrolein in side stream cigarette smoke plumes are up to three orders of magnitude above occupational limits, readily accounting for eye and nasal irritation. "Low-tar" cigarettes appear at least as irritating as other cigarettes. More than half the irritant is associated with the particulate phase of the smoke, permitting deposition throughout the entire respiratory tract and raising the issue of whether formaldehyde in smoke is associated with bronchial cancer.
A Brief Review of the Current Status of Alternatives of Chlorine Disinfection of Water
Authors: Anderson A. C. , Reimers R. S. , DeKernion P.
Published: November 2008

This paper briefly outlines some of the alternative disinfectants being considered in lieu of chlorination. Methods currently in use as well as those in the research stage are included. Each method is assessed with respect to disinfection efficiency and environmental impact. (Am J Public Health 1982; 72:1290-1293.)
Surveillance of sylvatic plaque in Oregon by serotesting carnivores.
Authors: Hopkins D D , Gresbrink R A
Published: November 2008

In Oregon, during 1974-1979, 10.3 per cent of 3.255 statewide blood samples from carnivores were positive for Yersinia pestis. The per cent positive rate and geometric mean positive titer increase monthly from January (6.5 per cent) to June (21.7 per cent), and decline thereafter. Data are presented on how geographic location, species, and time of year affect surveillance results. The correlation of carnivore plague surveillance with human cases in discussed.
The frequency of a Norwalk-like pattern of illness in outbreaks of acute gastroenteritis.
Authors: Kaplan J E , Feldman R , Campbell D S , Lookabaugh C , Gary G W
Published: November 2008

Records of 642 outbreaks of acute gastroenteritis were reviewed to determine the proportion of outbreaks that were clinically and epidemiologically consistent with Norwalk-like virus infection. Using as our criteria stool cultures negative for bacterial pathogens, mean (or median) duration of illness 12-60 hours, vomiting in greater than or equal to 50 per cent of cases, and, if known, mean (or median) incubation period of 24-48 hours, we found that 23 per cent of waterborne outbreaks, 4 per cent of foodborne outbreaks, and 67 per cent, 60 per cent, and 28 per cent of outbreaks in nursing homes, in summer camps, and on cruise ships, respectively, satisfied the criteria for Norwalk-like pattern. Of 54 outbreaks that satisfied the criteria for Norwalk-like pattern, 14 were investigated for virus etiology. Ten of these (71 per cent) yielded serologic evidence of Norwalk-like virus infection. Norwalk-like viruses are probably an important cause of outbreaks of acute gastroenteritis. Investigation for Norwalk virus antibody in outbreaks that are clinically and epidemiologically consistent with Norwalk-like virus infection is likely to yield diagnostically useful results.
Uses of ecologic analysis in epidemiologic research.
Authors: Morgenstern H
Published: November 2008

Despite the widespread use of ecologic analysis in epidemiologic research and health planning, little attention has been given by health scientists and practitioners to the methodological aspects of this approach. This paper reviews the major types of ecologic study designs, the analytic methods appropriate for each, the limitations of ecologic data for making causal inferences and what can be done to minimize these problems, and the relative advantages of ecologic analysis. Numerous examples are provided to illustrate the important principles and methods. A careful distinction is made between ecologic studies that generate or test etiologic hypotheses and those that evaluate the impact of intervention programs or policies (given adequate knowledge of disease etiology). Failure to recognize this difference in the conduct of ecologic studies can lead to results that are not very informative or that are misinterpreted by others.