bluuebunny/crossref_metadata_2025 huggingface dataset:
The strange career of managed competition: from military failure to medical success?
Authors: Waitzkin H
Published: November 2008

Managed competition remains untested as the basis of a national health program. However, key principles of managed competition first emerged in the military. For this study, published works on systems analysis and the planning-programming-budgeting system (PPBS), developed by Alain Enthoven and colleagues at the US Department of Defense during the 1960s, were compared with published presentations of managed competition. The influence of PPBS waned after it generated controversy and opposition. PPBS and managed competition represent similar managerial strategies of policy reform. Although the origin of managed competition in failed military policy does not ensure failure in the medical arena, this history also does not augur success.
Medicaid physician payment reform: using the Medicare Fee Schedule for Medicaid payments.
Authors: Reisinger A L , Colby D C , Schwartz A
Published: November 2008

OBJECTIVES. The purpose of this article is to provide estimates of the costs of basing Medicaid physician payment levels on the new resource-based Medicare Fee Schedule. Two possible policy options are considered: setting all Medicaid physician fees at the Medicare Fee Schedule level and setting only office visit fees at the new Medicare levels. METHODS. Data on Medicaid physician fees, use patterns, and the Medicare Fee Schedule are used to develop state-level estimates of expenditure changes under each option. RESULTS. Setting Medicaid rates at the Medicare Fee Schedule level could increase expenditures by $3.2 to $4.1 billion nationally; the other option would result in substantially lower increases in expenditures. Because of the current variations in Medicaid physician fees and in the breadth of eligibility across states, the cost of adopting the Medicare Fee Schedule varies considerably among states. CONCLUSIONS. Adopting the new Medicare Fee Schedule for Medicaid payments, proposed by policy-makers as a way to increase access to appropriate medical care, could double physician expenditures in some states. Adoption of more limited versions of the fee schedule might achieve some access gains at lower costs.
The prevalence and correlates of fear of falling in elderly persons living in the community.
Authors: Arfken C L , Lach H W , Birge S J , Miller J P
Published: November 2008

OBJECTIVES. Fear of falling has been recognized as a potentially debilitating consequence of falling in elderly persons. However, the prevalence and the correlates of this fear are unknown. METHODS. Prevalence of fear of falling was calculated from the 1-year follow-up of an age- and gender-stratified random sample of community-dwelling elderly persons. Cross-sectional associations of fear of falling with quality of life, frailty, and falling were assessed. RESULTS. The prevalence of fear increased with age and was greater in women. After adjustment for age and gender, being moderately fearful of falling was associated with decreased satisfaction with life, increased frailty and depressed mood, and recent experience with falls. Being very fearful of falling was associated with all of the above plus decreased mobility and social activities. CONCLUSIONS. Fear of falling is common in elderly persons and is associated with decreased quality of life, increased frailty, and recent experience with falls.
Low-income neighborhoods and the risk of severe pediatric injury: a small-area analysis in northern Manhattan.
Authors: Durkin M S , Davidson L L , Kuhn L , O'Connor P , Barlow B
Published: November 2008

OBJECTIVES. The purpose of this study was to investigate the relationship between socioeconomic disadvantage and the incidence of severe childhood injury. METHODS. Small-area analysis was used to examine socioeconomic risk factors for pediatric injury resulting in hospitalization or death in Northern Manhattan, New York, NY, during a 9-year period (1983 through 1991). RESULTS. The average annual incidence of all causes of severe pediatric injury was 72.5 per 10,000 children; the case-fatality rate was 2.6%. Census tract proportions of low-income households, single-parent families, non-high school graduates, and unemployment were significant predictors of risk for both unintentional and intentional injury. Among the socioeconomic factors considered, low income was the single most important predictor of all injuries; other socioeconomic variables were not independent contributors once income was included in the model. Compared with children living in areas with few low-income households, children in areas with predominantly low-income households were more than twice as likely to receive injuries from all causes and four and one half times as likely to receive assault injuries. The effect of neighborhood income disparities on injury risk persisted after race was controlled. CONCLUSIONS. These results illuminate the impact of socioeconomic disparities on child health and point to the need for injury prevention efforts targeting low-income neighborhoods.
Child and adolescent drownings in Harris County, Texas, 1983 through 1990.
Authors: Warneke C L , Cooper S P
Published: November 2008

OBJECTIVES. This study described childhood drowning rates and circumstances in Harris County, a large metropolitan area in Texas, and compared case ascertainment between data sources. METHODS. Drowning rates among Harris County residents newborn through 19 years of age were calculated from death certificate data (1983 through 1989), and local childhood drowning hazards were described on the basis of medical examiner data (1983 through 1990). Cases from both sources were compared to determine sensitivity of sources. RESULTS. The drowning rate among Harris County residents newborn through 19 years of age was 3.8 per 100,000 person-years. The drowning rates among Blacks and Hispanics exceeded that of Whites by 56% and 19%, respectively. The majority of the 196 unintentional drownings occurred in swimming pools. Half of the pool drownings occurred in apartment pools and 33% in private home pools. The medical examiner logbook identified a slightly higher number of drownings than did death certificates. International Classification of Diseases external cause of death codes were of limited use in describing drowning circumstances. CONCLUSIONS. Childhood drowning hazards not previously reported were identified, specifically hazards in apartment pools and those among Hispanic children.
Characteristics of adolescent work injuries reported to the Minnesota Department of Labor and Industry.
Authors: Parker D L , Carl W R , French L R , Martin F B
Published: November 2008

OBJECTIVES. The purpose of the study was to provide descriptive data and incidence data on adolescent work-related injuries and to determine whether such injuries are underreported to the Minnesota Department of Labor and Industry. METHODS. The study consisted of a 1-year survey of 534 adolescent work-related injuries reported to the Department of Labor and Industry and a cross-sectional survey of 3312 public high school students from throughout Minnesota. The high school survey used an abbreviated questionnaire with a subset of items from the Department of Labor and Industry survey. RESULTS. Ninety-six percent of the injuries were strains and sprains, cuts and lacerations, burns, bruises and contusions, and fractures. There were 11 hospitalizations; 4 were for burns that occurred during work in restaurants. Eighty workers (15%) reported permanent impairment as a result of their injuries. It was estimated that there were 2268 reportable injuries to working adolescents in Minnesota during the study year. CONCLUSIONS. The most common serious injuries were injuries to the lower back and burns. The demographic characteristics of adolescents whose injuries were reported to the Department of Labor and Industry were similar to those of injured adolescent workers identified through the high school survey. The results suggest that there is substantial underreporting of adolescent work injuries.
Factors that influence clinicians' assessment and management of family violence.
Authors: Tilden V P , Schmidt T A , Limandri B J , Chiodo G T , Garland M J , Loveless P A
Published: November 2008

OBJECTIVES. High rates of family violence and low rates of detection, report, and therapeutic intervention by health professionals are well documented. This study was undertaken to determine what factors influence clinicians' decision making about identifying abuse and intervening with victims. METHODS. Survey data about clinicians' experiences with and attitudes toward family violence were gathered by mailed questionnaire from a random sample of practicing clinicians in six disciplines (n = 1521). RESULTS. Data showed similarities within and wide differences among three groups of subjects: dentists/dental hygienists, nurses/physicians, and psychologists/social workers. Overall, a third of subjects reported having received no educational content on child, spouse, or elder abuse in their professional training programs. Subjects with education on the topic more commonly suspected abuse in their patients than those without; among all subjects, spouse abuse was suspected more often than child abuse while elder abuse was suspected infrequently. Significant numbers of subjects did not view themselves as responsible for dealing with problems of family violence. Subjects indicated low confidence in and low compliance with mandatory reporting laws. CONCLUSIONS. There is a need for educators to expand curricula on family violence and for legislators to reexamine mandatory reporting laws.
The sexual assault of women at work in Washington State, 1980 to 1989.
Authors: Alexander B H , Franklin G M , Wolf M E
Published: November 2008

Sexual assault in the workplace and the related factors have not been well studied. Workers' compensation claims data were used to describe work-related sexual assaults in Washington State between 1980 and 1989. Sixty-three cases of work-related rape were identified during this study period. The occupations of the rape victims were similar to occupations identified as high risk for other intentional injuries, and the rape incidents were characterized by isolation from the public and from coworkers. Estimates of industry-specific rates are presented. The identification, evaluation, and prevention of sexual assault and other workplace violence are discussed.
Preventing occupational illness and injury: nurse practitioners as primary care providers.
Authors: Lipscomb J , Burgel B , McGill L W , Blanc P
Published: November 2008

Nurse practitioners with master's degrees were surveyed to assess the type and volume of occupational health services provided by primary care as compared with occupational health practitioners and the knowledge base in occupational health in these two groups. Thirty-six percent of 224 nonoccupational health nurse practitioners reported caseloads with 10% or more occupationally related chief complaints; 21% reported treating work-related injury or illness at least once per week. By contrast, a large percentage of nonoccupational health practitioners failed the knowledge-based exam. Large-scale prevention of occupational illness and injury warrants that primary care providers receive training in occupational health.
Occupational injury deaths of 16- and 17-year-olds in the United States.
Authors: Castillo D N , Landen D D , Layne L A
Published: November 2008

Data from the National Traumatic Occupational Fatalities surveillance system were used to analyze occupational injury deaths of civilian 16- and 17-year-olds during 1980 through 1989. There were 670 deaths; the rate was 5.11 per 100,000 full-time equivalent workers. The leading causes of death were incidents involving motor vehicles and machines, electrocution, and homicide. Workers 16 and 17 years old appear to be at greater risk than adults for occupational death by electrocution, suffocation, drowning, poisoning, and natural and environmental factors. Improved enforcement of and compliance with federal child labor laws, evaluation of the appropriateness of currently permitted activities, and education are encouraged.
Head injuries incurred by children and young adults during informal recreation.
Authors: Baker S P , Fowler C , Li G , Warner M , Dannenberg A L
Published: November 2008

To examine injuries related to playground equipment, children's vehicles, roller skates, and skateboards, 1991 data on emergency room patients younger than 25 years in the Consumer Product Safety Commission's 91 surveillance hospitals were used. Head injury was the primary diagnosis for an estimated 58,480 patients, exceeding the total number of head injuries to bicyclists younger than 25 years. The head injury rate decreased with age. The large number and high rate of head injuries in children involved in a variety of recreational activities suggests the value of multipurpose helmets.
Trans fatty acids: are the effects only marginal?
Authors: Willett W C , Ascherio A
Published: November 2008

In the process of converting vegetable oils into solid fats, a process known as partial hydrogenation, some unsaturated bonds are converted to an unnatural trans position. In humans, trans fatty acids increase low-density lipoprotein cholesterol and decrease high-density lipoprotein cholesterol. In addition, positive associations between intake of trans fatty acids and coronary heart disease have been observed in epidemiological studies. The combined results of metabolic and epidemiological studies provide strong evidence that trans fatty acid intake is causally related to risk of coronary disease. Because the consumption of partially hydrogenated fats is almost universal in the United States, the number of deaths attributable to such fats is likely to be substantial. Federal regulations should require manufacturers to include trans fatty acid content in food labels and should aim to greatly reduce or eliminate the use of partially hydrogenated vegetable fats.
Pap smear and mammogram screening in Mexican-American women: the effects of acculturation.
Authors: Suarez L
Published: November 2008

OBJECTIVES. For Mexican Americans, acculturation is a multidimensional process of adopting attitudes, values, and behavior from the non-Hispanic White culture. This study examines the effects of different dimensions of acculturation on the cancer screening behavior of Mexican-American women. METHODS. Subjects were 450 randomly selected Mexican-American women age 40 years and older living in El Paso, Texas. Personal interviews solicited information on age, income, education, health insurance, Pap smear and mammogram use, and acculturation. Acculturation was measured with five scales that assessed English proficiency, English use, value placed on culture, traditional family attitudes, and social interaction. RESULTS. The 2-year prevalence of Pap smear and mammogram screening increased with each gain in acculturation on English proficiency and use. These associations disappeared when adjusted for age, income, insurance, and education. After adjusting for sociodemographic factors and other acculturation dimensions, a strong traditional Mexican attitude toward family was positively related to mammography use. CONCLUSIONS. Taking advantage of the positive influence of Hispanic familism on cancer screening behavior may increase the effectiveness of cancer control interventions in Mexican Americans.
Self-reports of HIV risk factors by patients at a sexually transmitted disease clinic: audio vs written questionnaires.
Authors: Boekeloo B O , Schiavo L , Rabin D L , Conlon R T , Jordan C S , Mundt D J
Published: November 2008

OBJECTIVES. The purpose of this study was to determine how the method of assessment affects patient report of human immunodeficiency virus (HIV) risks. METHODS. Patients at a sexually transmitted disease clinic randomly received either a written self-administered questionnaire or an audio self-administered questionnaire delivered by cassette player and headset. These questionnaires were followed by face-to-face interviews. RESULTS. Audio questionnaires had fewer missing responses than written questionnaires. Audio questionnaires also identified more unprotected vaginal intercourse and sexual partners suspected or known to have HIV infection or acquired immunodeficiency syndrome than did written questionnaires. Although both the audio and written questionnaires identified more risks than the face-to-face interviews, the difference in the mean number of reported risks between the audio questionnaires and the face-to-face interviews was greater than that between the written questionnaires and the face-to-face interviews. CONCLUSIONS. Audio questionnaires may obtain more complete data and identify more HIV risk than written questionnaires. Research is warranted about whether audio questionnaires overcome barriers to the completion and accuracy of HIV risk surveys. This study emphasizes the need to elucidate the relative strengths and weaknesses of written questionnaires, audio questionnaires, and face-to-face interviews for HIV risk assessment.
HIV vaccine trials: will intravenous drug users enroll?
Authors: Meyers K , Metzger D S , Navaline H , Woody G E , McLellan A T
Published: November 2008

OBJECTIVES. The purpose of this study was to assess the willingness of intravenous drug users to participate in a preventive human immunodeficiency virus (HIV) vaccine efficacy trial. METHODS. Of the 347 intravenous drug users in methadone treatment who were approached for participation, 257 completed a battery of self-administered questionnaires assessing risk behaviors, interest in vaccine trials, and other vaccine-related information. Data from 16 known seropositives and 1 inconsistent responder were dropped from analyses (n = 240). RESULTS. Fifty-two percent of the subjects expressed a willingness to be one of the first individuals to participate in a preventive HIV vaccine efficacy trial. Subjects who had recently shared needles or works and subjects who trusted the government to ensure vaccine safety were both twice as likely to report interest in participation. Twenty-two percent of subjects reported that they would increase needle sharing if vaccinated. Thirty percent did not know what a vaccine was. CONCLUSIONS. These findings suggest that some in-treatment intravenous drug users would volunteer for a preventive HIV vaccine efficacy trial. Education and counseling will be required to ensure that subjects fully understand the trial's purposes, methods, risks and benefits.
Effects of a restricted work-site smoking policy on employees who smoke.
Authors: Brigham J , Gross J , Stitzer M L , Felch L J
Published: November 2008

OBJECTIVES. This study evaluated the biological and subjective consequences observed in individual smokers after implementation of a workplace smoking-restriction policy. METHODS. Employees were evaluated for 4 weeks before and 4 weeks after their workplace became smoke-free (n = 34). A comparison group of smokers whose work-site smoking was unrestricted served as controls (n = 33). Daily exposure to tobacco constituents and withdrawal effects were measured. RESULTS. Smokers at the restricted site had verified smoking reduction (mean = four cigarettes per day) and significantly reduced nicotine and carbon monoxide during the work shift. There were increases in ratings of some common withdrawal symptoms (cravings/urges, concentration difficulties, increased eating, depression). No evidence of compensatory smoking during nonwork hours was found. Overall tobacco exposure, as measured in saliva cotinine, showed a nonsignificant 15% decline. CONCLUSIONS. Workplace smoking restriction markedly altered smoking patterns (i.e., reduced daytime smoking) and reduced cotinine levels to an amount consistent with cigarette reduction. Thus, work-site smoking restriction may promote meaningful, albeit limited, reductions in tobacco exposure and consequent health risks.
The use of vitamin supplements and the risk of cataract among US male physicians.
Authors: Seddon J M , Christen W G , Manson J E , LaMotte F S , Glynn R J , Buring J E , Hennekens C H
Published: November 2008

OBJECTIVES. The purpose of this study was to examine prospectively the association between reported use of vitamin supplements and risk of cataract and cataract extraction. METHODS. The study population consisted of 17,744 participants in the Physicians' Health Study, a randomized trial of aspirin therapy and beta-carotene among US male physicians 40 to 84 years of age in 1982 who did not report cataract at baseline and provided complete information about vitamin supplementation and other risk factors for cataract. Self-reports of cataract and cataract extraction were confirmed by medical record review. RESULTS. During 60 months of follow-up, there were 370 incident cataracts and 109 cataract extractions. In comparison with physicians who did not use any supplements, those who took only multivitamins had a relative risk of cataract of 0.73 after adjustment for other risk factors. For cataract extraction, the corresponding relative risk was 0.79. Use of vitamin C and/or E supplements alone was not associated with a reduced risk of cataract, but the size of this subgroup was small. CONCLUSIONS. These data suggest that men who took multivitamin supplements tended to experience a decreased risk of cataract and support the need for rigorous testing of this hypothesis in large-scale randomized trials in men and women.
Overweight schoolchildren in New York State: prevalence and characteristics.
Authors: Wolfe W S , Campbell C C , Frongillo E A , Haas J D , Melnik T A
Published: November 2008

OBJECTIVES. Childhood overweight is an increasing public health concern. This study was undertaken to determine the prevalence of overweight in elementary school children in New York State and to identify characteristics associated with child fatness. METHODS. Weight, height, triceps skinfold, midarm circumference, and a 24-hour dietary recall were taken on 1797 second- and fifth-grade students from 51 randomly selected schools in New York State outside of New York City. Parents completed a brief questionnaire. RESULTS. In comparison with 1974 and 1980 national reference data, up to twice the expected percentages of children had values above the 85th, 90th, and 95th percentiles for body mass index, triceps skinfold, and arm fat area. Regression analyses suggested that children who tended to be fatter were members of low socioeconomic status, two-parent (but not single-parent) households; those with few or no siblings; those who ate school lunch; and those who skipped breakfast. CONCLUSIONS. The findings suggest that overweight is a problem among many elementary school children in New York State and that sociodemographic characteristics may be useful for targeting preventive efforts.
5-A-DAY: dietary behavior and the fruit and vegetable intake of Latino children.
Authors: Basch C E , Zybert P , Shea S
Published: November 2008

OBJECTIVES. The purpose of the study was to examine children's intake of fruits and vegetables in relation to the recent national "5-A-DAY" campaign. METHODS. Four 24-hour dietary recalls per child collected from 205 mothers of 4- to 5-year-old urban Latino children were used to analyze average 5-A-DAY fruit and vegetable consumption and examine associations between 5-A-DAY consumption, nutrient intakes, and eating patterns. RESULTS. The reported mean servings per day of fruits and vegetables, as defined by 5-A-DAY criteria, were 1.8 and 1.0, respectively, with only 6.8% (n = 14) of the children averaging five or more servings per day. Fruit juice accounted for 36% of 5-A-DAY servings. There were significant linear trends in intake of vitamins A and C, potassium, iron, cholesterol, protein, and fiber across quintiles of 5-A-DAY intake. There were no differences among quintiles in intake of saturated or total fat or in servings from most non-5-A-DAY food groups. CONCLUSIONS. Latino children's intake of fruits and vegetables falls far short of current recommendations. Fruit juice accounted for a disproportionate amount of 5-A-DAY intake in this population. Sensible 5-A-DAY interventions should take into consideration the existing eating patterns of the target population.
The logic in ecological: I. The logic of analysis.
Authors: Susser M
Published: November 2008

This paper addresses ecological studies in public health research in terms of the logic of their analysis. It makes several distinctions between studies based on ecological and individual units. First, it identifies the variables common to both types of study and those particular to ecological studies. Second, it shows how ecological and individual units combine in two classes: unmixed (purely ecological, purely individual) and mixed. Third, it details how the relationships among and between individual and grouped units (expressed in terms of regression coefficients between independent and dependent variables) yield four coefficients: for all individual members; for all groups; for all individuals within each group; and for all individuals within groups (a weighted average). Equipped with an understanding of the dimensions involved at ecological and individual levels and of the relationships between them, researchers are in a position to exploit the public health potential of the ecological approach.
The ecological effects of individual exposures and nonlinear disease dynamics in populations.
Authors: Koopman J S , Longini I M
Published: November 2008

To describe causally predictive relationships, model parameters and the data used to estimate them must correspond to the social context of causal actions. Causes may act directly upon the individual, during a contact between individuals, or upon a group dynamic. Assuming that outcomes in different individuals are independent puts the causal action directly upon individuals. Analyses making this assumption are thus inappropriate for infectious diseases, for which risk factors alter the outcome of contacts between individuals. Transmission during contact generates nonlinear infection dynamics. These dynamics can so attenuate exposure-infection relationships at the individual level that even risk factors causing the vast majority of infections can be missed by individual-level analyses. On the other hand, these dynamics amplify causal associations between exposure and infection at the ecological level. The amplification and attenuation derive from chains of transmission initiated by exposed individuals but involving unexposed individuals. A study of household exposure to the only vector of dengue in Mexico illustrates the phenomenon. An individual-level analysis demonstrated almost no association between exposure and infection. Ecological analysis, in contrast, demonstrated a strong association. Transmission models that are devoid of any sources of the ecological fallacy are used to illustrate how nonlinear dynamics generate such results.
Urinary biological monitoring markers of anticancer drug exposure in oncology nurses.
Authors: Newman M A , Valanis B G , Schoeny R S , Hee S Q
Published: November 2008

People handling anticancer drugs or their wastes may absorb these potent genotoxic agents. The aim of this study was to determine the utility of some general urinary markers among 24 female oncology nurses handling these drugs in comparison with 25 "unexposed" nurses. The markers were the Salmonella typhimurium reverse and forward mutation assays, total thioethers, and D-glucaric acid. The reverse mutation assay was the most specific and sensitive marker for anti-cancer drug exposure. Use of the marker battery was no great advantage as a screening tool relative to use of the reverse mutation assay alone. Better recording of work practices in nurse work logs would have improved interpretation of results.
The consumption of well-done red meat and the risk of colorectal cancer.
Authors: Muscat J E , Wynder E L
Published: November 2008

Heterocyclic aromatic amines and polycyclic aromatic hydrocarbons are mutagens that are produced in highly cooked meats. A case-control study of 511 patients with colorectal cancer and 500 matched control subjects examined whether consumption of well-done cooked beef is related to the risk of developing large bowel cancer. Approximately 16% of men and women consumed well-done beef, and 50% ate medium-cooked beef. For both sexes, there was no association between consumption of well-done or medium-cooked beef and colorectal cancer. This paper discusses whether questionnaire data accurately reflect dietary intake of heterocyclic aromatic amines and polycyclic aromatic hydrocarbons.
The reproducibility of data from a Food Frequency Questionnaire among low-income Latina mothers and their children.
Authors: Basch C E , Shea S , Zybert P
Published: November 2008

We examined the 3-month and 1-year reproducibility of mothers' and children's dietary intakes of calories and 11 nutrients derived from oral administrations of a food frequency questionnaire to 166 Latina women. One-year correlations generally ranged from 0.40 to 0.55 for both mothers and children. For most nutrients, roughly half the children in the highest (lowest) quartile of intake at baseline were also in the highest (lowest) quartile 1 year later. The food frequency questionnaire has great potential for measuring typical nutrient intakes in these populations.
The resurgence of tuberculosis in New York City: a mixed hierarchically and spatially diffused epidemic.
Authors: Wallace D
Published: November 2008

For New York City from 1978 to 1990, plotting the 3-year running averages of citywide new tuberculosis cases against the middle year yielded an S-shaped curve, with the inflection point at 1983 between early slow and late rapid rise. The inflection in the S curve appears to be associated with hierarchical establishment of secondary epicenters, and the phase of rapid rise in new cases seems to be associated with spatial diffusion from both the primary and secondary epicenters.
The role of state health departments in formulating policy: a survey on the case of AIDS.
Authors: Robins L , Backstrom C
Published: November 2008

OBJECTIVES. Public health departments have been criticized for not being on the cutting edge of health policy formation in the United States and, in particular, for being ineffective in dealing with acquired immunodeficiency syndrome (AIDS). This study examines the attitudes and influence of public health officials on this problem. METHODS. A survey of state health department officials was supplemented by surveys of state legislature health committee chairs and hospital association directors, as well as by interviews with key AIDS policymakers and observers in six states. RESULTS. Both in their own eyes and in the eyes of legislative leaders and hospital association officials, public health officials were considered to be the principal initiators of public policy on AIDS. CONCLUSIONS. Contrary to the Institute of Medicine's 1988 report, state health departments are leaders in the fight against AIDS at the state level. Moreover, we argue that public health departments should be judged on how effectively they perform functions for which they have primary legal responsibilities, not for other roles for which they have been given neither responsibility nor resources.
Correlates of needle sharing among injection drug users.
Authors: Mandell W , Vlahov D , Latkin C , Oziemkowska M , Cohn S
Published: November 2008

OBJECTIVES. The sharing of contaminated injection equipment is the primary mode of human immunodeficiency virus (HIV) transmission for injection drug users. This study examined demographic factors, life events, and drug use practices that are potential risk factors for sharing injection equipment. METHODS. Between February 1988 and March 1989, 2921 active injection drug users were interviewed and questioned about their backgrounds, life-styles, and patterns of injection drug use. RESULTS. Of 2524 participants who reported injecting drugs within the 6 months prior to study enrollment, 70.4% reported recent needle sharing. A multivariate analysis found needle sharing to be more frequent among those with a history of arrest and lower socioeconomic status, even after accounting for other demographic and drug use variables. In addition, recent needle sharing was higher in male homosexual or bisexual men than in their heterosexual counterparts. CONCLUSIONS. These data suggest that injection drug users have an economic motive to share needles and that the availability of free and legal needles may reduce levels of needle sharing.
Do blacks and whites differ in their use of health care for symptoms of coronary heart disease?
Authors: Crawford S L , McGraw S A , Smith K W , McKinlay J B , Pierson J E
Published: November 2008

OBJECTIVES. The purpose of this study was to identify the role of race in seeking and receipt of care for symptoms of coronary heart disease. METHODS. Data on medical care, sociodemographic characteristics, symptoms, risk factors, income, and insurance were collected in a telephone interview for a random sample of 2030 Black and White adults in inner-city Boston. Rates of care-seeking for symptoms, amounts of delay in seeking care, and rates of receipt of care were compared for Blacks and Whites after adjustment for other characteristics. RESULTS. Before and after adjustment for other factors, Blacks and Whites were equally likely to seek care. Average delay time was shorter for Blacks, particularly Black women. With the exception of a lower rate of referral to cardiologists among Blacks, receipt of care was similar for Blacks and Whites who sought medical attention for symptoms. CONCLUSIONS. In an urban population of Blacks and Whites who were similar in socioeconomic status and access to medical care, there were few racial differences in coronary heart disease-related care patterns.
Acute chest pain in African Americans: factors in the delay in seeking emergency care.
Authors: Ell K , Haywood L J , Sobel E , deGuzman M , Blumfield D , Ning J P
Published: November 2008

OBJECTIVES. African Americans have been shown to have longer delay times than the majority population in seeking care for acute cardiac problems. The purpose of this study was to determine whether socioeconomic factors affect delay times. METHODS. Structured interviews were administered to 254 African Americans admitted to a public hospital and 194 African Americans admitted to a private hospital for suspected acute myocardial infarction. RESULTS. Patient characteristics found by multiple regression analysis to affect decision-making and travel time for care-seeking were structural access to care, persistence of symptoms, degree of incapacitation, consultation with a layperson, consultation with medical professionals, and mode of transportation. CONCLUSIONS. Within-group differences were found to be related to socioeconomic status. Strategies to increase knowledge about heart attack symptoms, improve access to care, and improve the socioeconomic status of at-risk African Americans are indicated.
The adequacy of prenatal care and incidence of low birthweight among the poor in Washington State and British Columbia.
Authors: Katz S J , Armstrong R W , LoGerfo J P
Published: November 2008

OBJECTIVES. The purpose of this study was to examine differences in adequacy of prenatal care and incidence of low birthweight between low-income women with Medicaid in Washington State and low-income women with Canadian provincial health insurance in British Columbia. METHODS. A population-based cross-sectional study was done by using linked birth certificates and claims data. RESULTS. Overall, the adjusted odds ratio for inadequate prenatal care in Washington (comparing women with Medicaid with those with private insurance) was 3.2. However, the risk varied by time of Medicaid enrollment relative to pregnancy (2.0, 1.0, 2.7, 6.3; for women who enrolled prior to pregnancy, during the first trimester, during the second trimester, or during the third trimester, respectively). In British Columbia, the adjusted odds ratio for inadequate care (comparing women receiving a health premium subsidy with those receiving no subsidy) was 1.5 for women receiving a 100% subsidy and 1.2 for women receiving a 95% subsidy. The risk for low birthweight followed a similar trend in both regions, but there was no association with enrollment period in Washington. CONCLUSIONS. Overall, the risk for inadequate prenatal care among poor women was much greater in Washington than in British Columbia. Most of the difference was due to Washington women's delayed enrollment in Medicaid. In both regions, the poor were at similar risk for low birthweight relative to their more affluent counterparts.
Smoking and mortality among residents of a California retirement community.
Authors: Paganini-Hill A , Hsu G
Published: November 2008

Smoking cessation decreases mortality among the elderly. Participants in the Leisure World Cohort Study initiated in 1981 were followed until death or January 1, 1991. The 8869 women and 4999 men (median age = 73 years at initial survey) contributed 105,952 person-years of follow-up; 4002 had died. All-cause mortality rates were highest among current smokers; compared with never smokers the age-adjusted relative risks (and 95% confidence intervals) were 1.67 (1.46, 1.92) for women and 1.95 (1.66, 2.30) for men. Current smokers had increased risks of coronary heart disease, other cardiovascular disease, and cancer. Risk of death from smoking-related cancers continued to be high among former smokers, although lower than the risk among current smokers. Relative risks of mortality from cancer and cardiovascular disease increased with the number of cigarettes smoked per day and with a decreasing number of years since cessation of smoking.
Popular films do not reflect current tobacco use.
Authors: Hazan A R , Lipton H L , Glantz S A
Published: November 2008

This study examined trends in tobacco use in a random sample of 2 of the 20 top-grossing US films each year from 1960 through 1990 (62 films). The overall rate of tobacco use did not change. Films continue to portray smokers as successful, attractive White males. Smoking groups became larger, smoking alone declined, hostility and stress reduction were increasingly associated with smoking, and smoking by minor characters increased. Although smoking among elite characters fell, it remained nearly three times as prevalent as in actual population data during the 3 decades. Events involving young people more than doubled. Films do not accurately represent smoking in the United States.
Building bridges between schools of public health and public health practice.
Authors: Handler A , Schieve L A , Ippoliti P , Gordon A K , Turnock B J
Published: November 2008

A 1988 Institute of Medicine report, The Future of Public Health, characterized the current public health system as fragmented, particularly with regard to relationships between public health agencies and academic institutions. As one response to the report, the Health Resources and Services Administration established the Center for the Development of Public Health Practice at the University of Illinois to advance linkages between schools of public health and public health agencies. Surveys of schools of public health and of state health agencies were conducted in 1992 to collect baseline data on the practice links between the two. Responses reveal that there is a substantial amount of informal collaboration between them. Formalization of collaborative activities between schools and agencies is beginning to occur and is expected to expand owing to increased focus on public health practice at schools of public health.
Estimating the number of HIV-infected injection drug users in Bangkok: a capture--recapture method.
Authors: Mastro T D , Kitayaporn D , Weniger B G , Vanichseni S , Laosunthorn V , Uneklabh T , Uneklabh C , Choopanya K , Limpakarnjanarat K
Published: November 2008

OBJECTIVES. The purpose of the study was to estimate the number of injection drug users infected with the human immunodeficiency virus (HIV) in Bangkok to allow planning for health services for this population. METHODS. A two-sample capture-recapture method was used. The first capture listed all persons on methadone treatment for opiate addiction from April 17 through May 17, 1991, at 18 facilities in Bangkok. The second capture involved urine testing of persons held at 72 Bangkok police stations from June 3 through September 30, 1991. Persons whose urine tests were positive for opiate metabolites or methadone were included on the second list. RESULTS. The first capture comprised 4064 persons and the recapture 1540 persons. There were 171 persons included on both lists, yielding an estimate of 36,600 opiate users in Bangkok. Existing data indicate that 89% of opiate users in Bangkok inject drugs and that about one third are infected with HIV, yielding an estimate of approximately 12,000 HIV-infected injection drug users in Bangkok in 1991. CONCLUSIONS. During the 1990s the number of cases of acquired immunodeficiency syndrome (AIDS) and other HIV-related diseases, including tuberculosis, in the population of HIV-infected injection drug users in Bangkok will increase dramatically, placing new demands on existing health care facilities. The capture-recapture method may be useful in estimating difficult-to-count populations, including injection drug users.
Work-related traumatic brain injury in Washington State, 1988 through 1990.
Authors: Heyer N J , Franklin G M
Published: November 2008

OBJECTIVES. Brain trauma is a major cause of disability in the United States, especially among young adults. Work-related brain trauma cases represent a subpopulation that may be amenable to intervention efforts, but largely because of unavailability of data, this group has not previously been studied. METHODS. Washington State workers' compensation data were used to identify brain trauma cases and to describe incidence rates with respect to age, gender, and industrial classification. Cause of injury was evaluated for industrial classifications with numerous cases. RESULTS. Washington State workers experienced 301 brain traumas over a 3-year period (9.4/100,000 full-time equivalent workers per year). One third of all traumatic brain injury claims were concentrated among seven industrial classifications. Cause of injury was highly correlated with specific industrial classifications. CONCLUSIONS. This study demonstrates the usefulness of diagnosis-related group codes to identify cases of traumatic brain injury. These injuries are concentrated among a few industries, with a dominant specific cause for each industry. This suggests that intervention methods may be efficiently introduced to reduce traumatic brain injuries in the workplace.
Low birthweight at term and the timing of fetal exposure to maternal smoking.
Authors: Lieberman E , Gremy I , Lang J M , Cohen A P
Published: November 2008

OBJECTIVES. This study was undertaken to evaluate the risk of small-for-gestational-age birth for women who stop smoking or begin to smoke during pregnancy. METHODS. Women with term singleton pregnancies from a hospital-based cohort of 11,177 were classified as (1) nonsmokers; (2) smoked throughout pregnancy; (3) smoked during first trimester only; (4) smoked during first and second trimesters only; and (5) smoked during second and third trimesters or during third trimester only. Risk of small-for-gestational-age birth according to smoking category was estimated and adjusted for confounding factors by logistic regression. RESULTS. Women who stopped smoking by the third trimester were not at increased risk of small-for-gestational-age birth compared with nonsmokers. Women who began smoking during the second or third trimester had an elevated risk of small-for-gestational-age birth (odds ratio [OR] = 1.83; 95% confidence interval [CI] = 1.25, 2.67) similar to that for women who smoked throughout pregnancy (OR = 2.20; 95% CI = 1.90, 2.54). Risk of small-for-gestational-age birth increased with the number of cigarettes smoked during the third trimester. CONCLUSIONS. It is during the third trimester that smoking retards fetal growth, presenting a compelling opportunity for smoking cessation interventions. Programs must emphasize the importance of not resuming smoking late in pregnancy.
Indicators for monitoring the growth of peruvian infants: weight and length gain vs attained weight and length.
Authors: Piwoz E G , Lopez de Romaña G , Creed de Kanashiro H , Black R E , Brown K H
Published: November 2008

OBJECTIVES. To determine appropriate indicators and age intervals for growth monitoring in this population, the relationship between monthly weight and length indicators and nutritional status at 12 months was evaluated among 102 low-income Peruvian infants. METHODS. Cutoffs for defining adequate vs slow growth were obtained from published reference data, and sensitivities and specificities of each indicator were calculated. RESULTS. Low weight gain in early infancy, especially from 1 to 2 months, is useful for predicting low weight at 1 year (sensitivity = 81%, specificity = 65%, 25th percentile cutoff). Use of actual weight at 2 months, however, produces comparable results (sensitivity = 86%, specificity = 57%, 50th percentile cutoff). Monthly length gains were weak predictors of low length for age. Neither weight nor length gains accurately predicted the opposite form of undernutrition. Nonhuman milk consumption before 4 months and poor appetite from 3 to 12 months were related to low early weight gain and subsequent undernutrition. CONCLUSIONS. Growth monitoring programs in this population should enroll infants at birth, monitor actual weight, promote exclusive breast-feeding and delayed introduction of nonhuman milk, and provide specific feeding advice to mothers of infants with frequently depressed appetite.
Ethnic differences in midwife-attended US births.
Authors: Parker J D
Published: November 2008

This study examined US ethnic differences in midwifery care from 1982 through 1989. After adjustment for maternal characteristics, Native American mothers were most likely, and White and Asian mothers were least likely, to obtain midwifery care. For these three groups, midwifery use increased rapidly in the period from 1982 through 1989. Compared with White mothers, Black and Hispanic mothers were more likely to be attended by a midwife; however, their use of midwives increased more slowly. Though the local availability of obstetricians and midwives may determine a woman's choice of care provider, these data suggest that cultural factors also play a role.
Counseling adolescents for smoking prevention: a survey of primary care physicians and dentists.
Authors: Gregorio D I
Published: November 2008

Pediatricians, family practitioners, and dentists were questioned in the spring of 1992 about whether they counseled adolescent patients (10 through 18 years old) not to smoke. Of the 674 questionnaires distributed, 443 (66%) were returned and analyzed. Most practitioners could not estimate cigarette use among their adolescent patients. Prevention counseling occurred infrequently, and least often among younger patients. Physicians were more likely than dentists to counsel adolescents. The data highlight the need for continuing training of primary health care practitioners about the importance of counseling adolescents not to smoke.
An increase in Haemophilus influenzae type B vaccination among preschool-aged children in inner-city Los Angeles, 1990 through 1992.
Authors: Ewert D P , Westman S , Ward B , Bendaña N , Halbert R , Vadheim C M , Ward J I , Mascola L
Published: November 2008

Haemophilus influenzae type b (Hib) vaccination coverage and disease incidence were measured among preschool-aged children residing in inner-city Los Angeles. Among children 1.5 to 14 months of age, vaccination coverage of at least one dose increased from 0% in 1990 to 82% (95% confidence interval [CI] = 73%, 91%) in 1992. Among children 15 to 59 months old, vaccination coverage of at least one Hib dose administered at or after age 15 months increased from 35% (95% CI = 29%, 41%) in 1990 to 63% (95% CI = 56%, 70%) in 1992. Although Hib vaccination has reduced disease incidence in this population, greater use of vaccine can result in further reductions.