bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk assessment and control of waterborne giardiasis.
Authors: Rose J B , Haas C N , Regli S
Published: November 2008

BACKGROUND: Waterborne giardiasis has been increasing in the United States with 95 outbreaks reported over the last 25 years. The Safe Drinking Water Act has mandated control of this pathogen. METHODS: A risk assessment model was developed to estimate risk of infection after exposure to treated waters containing varying levels of Giardia cysts. The model was defined by a dose-response curve developed from human feeding studies for Giardia and assumed 2L of water consumption per day. Data on concentrations and distribution of the organism in source waters were used to assess exposure after varying reductions achieved through treatment. RESULTS: In surveys reporting prevalence and levels of Giardia cyst contamination, average levels of cysts in surface waters ranged from 0.33 to 104/100L; from pristine watersheds (protected from all human activity) 0.6 to 5/100L. Yearly risks were 4.8 x 10(-3) for systems using polluted waters and 1.3 x 10(-4) for pristine waters with a 10(-3) treatment reduction. CONCLUSION: Public Health officials will need to work with the water industry to ensure a risk of less than 1/10,000 for source waters with 0.7 to 70 cysts per 100 liters through treatment achieving reduction of 10(-3) to 10(-5), respectively, of Giardia cysts.
Effectiveness of source documents for identifying fatal occupational injuries: a synthesis of studies.
Authors: Stout N , Bell C
Published: November 2008

BACKGROUND: The complete and accurate identification of fatal occupational injuries among the US work force is an important first step in developing work injury prevention efforts. Numerous sources of information, such as death certificates, Workers' Compensation files, Occupational Safety and Health Administration (OSHA) files, medical examiner records, state health and labor department reports, and various combinations of these, have been used to identify cases of work-related fatal injuries. Recent studies have questioned the effectiveness of these sources for identifying such cases. METHODS: At least 10 studies have used multiple sources to define the universe of fatal work injuries within a state and to determine the capture rates, or proportion of the universe identified, by each source. Results of these studies, which are not all available in published literature, are summarized here in a format that allows researchers to readily compare the ascertainment capabilities of the sources. RESULTS: The overall average capture rates of sources were as follows: death certificates, 81%; medical examiner records, 61%; Workers' Compensation reports, 57%; and OSHA reports 32%. Variations by state and value added through the use of multiple sources are presented and discussed. CONCLUSIONS: This meta-analysis of 10 state-based studies summarizes the effectiveness of various source documents for capturing cases of fatal occupational injuries to help researchers make informed decisions when designing occupational injury surveillance systems.
Occupational carpal tunnel syndrome in Washington State, 1984-1988.
Authors: Franklin G M , Haug J , Heyer N , Checkoway H , Peck N
Published: November 2008

BACKGROUND: There are no published population-based studies of occupational carpal tunnel syndrome (OCTS) using a strict case definition. Most studies are either industry specific or present patient self-report of symptoms. METHODS: We conducted a population-based incidence study of OCTS using the Washington State Workers' Compensation database. Incident OCTS claims were identified with paid bills for physician reported ICD codes 354.0 and 354.1. RESULTS: There were 7,926 incident OCTS claims identified for the years 1984-1988, which yields an industry-wide incidence rate of 1.74 claims/1,000 FTEs. The mean age (37.4 years) and female/male ratio (1.2:1) in this population differ from those reported in nonoccupational carpal tunnel studies (mean age, 51 years; female/male ratio, 3:1). The female-specific OCTS incidence rate increased significantly during the study period. The highest industry specific OCTS rates were found in the food processing, carpentry, egg production, wood products, and logging industries. CONCLUSION: Demographic differences and industry-specific rates consistent with workplace exposures suggest that OCTS is distinct from CTS occurring in nonoccupational settings. Workers' compensation data proved useful in identifying high risk industries.
Lead exposure in outdoor firearm instructors.
Authors: Tripathi R K , Sherertz P C , Llewellyn G C , Armstrong C W
Published: November 2008

This study was conducted to determine lead exposure of firearm instructors at an outdoor firing range, while cadets were firing nonjacketed and jacketed lead ammunitions. The breathing zone air for lead exceeded the Occupational Safety and Health Administration standard of 50 micrograms/m3 for two instructors during firing exercises using nonjacketed bullets. The use of totally copper-jacketed bullets reduced the breathing zone lead levels by 92 percent for instructor #1 and by 96 percent for instructor #2; subsequent blood lead levels showed a significant decline in both instructors.
Non-Hodgkin's lymphoma in a cohort of Vietnam veterans.
Authors: O'Brien T R , Decouflé P , Boyle C A
Published: November 2008

We examined the incidence of non-Hodgkin's lymphoma (NHL) in a cohort of 18,313 United States Army veterans from the Vietnam era. Diagnoses were confirmed through a review of hospital records. Among veterans who had died after discharge or who had participated in a telephone interview (8,170 Vietnam veterans and 7,564 non-Vietnam veterans), seven Vietnam veterans and one non-Vietnam veteran had developed non-Hodgkin's lymphoma (p = 0.07). As none of the NHL cases had military job titles which suggest that they were occupationally exposed to herbicides while in Vietnam, the reasons for the excess are unclear.
Endemic giardiasis and municipal water supply.
Authors: Fraser G G , Cooke K R
Published: November 2008

To test the hypothesis that endemic giardiasis may be transmitted by unfiltered municipal water supplies, the incidence of laboratory-confirmed giardiasis was studied in a natural experiment due to the arrangement of the public water supply of Dunedin, New Zealand. The incidence rate ratio was 3.3 (90% CI = 1.1, 10.1) for the population receiving unfiltered (microstrained) water relative to that using sand filtered water. In a parallel case-control study of incident cases, the odds ratio for giardiasis and unfiltered (microstrained) water supply was 1.8 (90% CI = 0.5, 6.9).
The microbiologic quality of drinking water in North Carolina migrant labor camps.
Authors: Ciesielski S , Handzel T , Sobsey M
Published: November 2008

A two-year study of the microbiological quality of drinking water in 27 randomly selected North Carolina migrant labor camps yielded total and fecal coliform prevalences of 44 percent and 26 percent, respectively in 1988 and similar but higher prevalences in 1989. Preoccupancy testing by county sanitarians had found virtually no total coliform contamination. These findings suggest that a potential source of contamination existed and that current testing protocols which rely on preoccupancy testing may be inadequate.
Agricultural machine-related deaths.
Authors: Etherton J R , Myers J R , Jensen R C , Russell J C , Braddee R W
Published: November 2008

Analysis of 1980-1985 death certificate data for the United States indicated that an average of 369 occupational deaths per year involved agricultural machinery as the external cause of death. Out of all agricultural machine-related deaths, tractors accounted for 69 percent. Over half of these tractor-related deaths were rollovers. There is a need for public health programs to affect greater use of rollover protective structures (ROPS) on farm tractors.
How blind is blind review?
Authors: Yankauer A
Published: November 2008

BACKGROUND: No representative surveys of scientific opinion about blind review have been published, and there is very little information on the success of the blinding process. The American Journal of Public Health has practiced blind review since 1977. METHODS: In 1989 to 1990 312 of its reviewers were asked to identify author and institution in the manuscript they reviewed, to provide clues to such identification, to express their opinion concerning blind review, and to offer reasons for their opinion. RESULTS: Reviewers claimed to be able to identify author and/or institution in 47% of the 614 chances offered; identification was incorrect 16% of the time, overall identification correct 39% of the time. Self-referencing was the clue to identification in 62%, personal knowledge in 38% of the cases. If only personal knowledge cases are considered, blinding was successful 83% of the time. Blinding was favored by 75% of the reviewers with most asserting it eliminated bias. Reasons given for opposing blind review included the following: blinding not possible, identification will not influence judgment, and its obverse, identification assists judgment. CONCLUSIONS: For the American Journal of Public Health blinding is usually, but not always, successful; and the majority of its reviewers favor current policy. Until more definitive data are in, reviewer preference, which differs from journal to journal, seems the most legitimate guide to journal policy on blind review.
Patterns of mental health utilization among island Puerto Rican poor.
Authors: Alegría M , Robles R , Freeman D H , Vera M , Jiménez A L , Ríos C , Ríos R
Published: November 2008

BACKGROUND: This paper describes utilization of mental health services by poor Puerto Ricans living on the island. It examines the utilization rates, within health sectors, and settings for the provision of mental health services. METHODS: Data are based on an islandwide probability sample of 18- to 64-year-old respondents living in low socioeconomic areas. We assessed need with the Psychiatric Symptom and Dysfunction Scales. RESULTS: Approximately one-third of our study population (31.5%) met criteria for need. Of these, only 32% had received any mental health care in the past year. Need was significantly associated with use of physical or mental health services for mental health problems. We found those who needed services to be five times more likely than those who did not need services to have used one or both sectors of care at least once in the past year. Among the first group 21.8% used the physical health sector to deal with mental health problems in contrast with 17.9% who sought care in the mental health sector. In the physical health sector, subjects used the public and private settings equally. In the mental health sector, 70% of subjects used the public setting. CONCLUSIONS: This suggests the nonpsychiatric physician as a main provider for mental health treatment.
A prospective study of hospitalization with gallstone disease among women: role of dietary factors, fasting period, and dieting.
Authors: Sichieri R , Everhart J E , Roth H
Published: November 2008

BACKGROUND: Dietary risk factors for the development of gallstones have not been clearly established. We analyzed data from a population-based prospective study to determine dietary risk factors for hospitalization with gallstone disease. METHODS: We evaluated the role of dietary constituents, fasting, and dieting on subsequent hospitalization with gallstone disease among 4,730 women, ages 25 to 74 years, who participated in the first follow-up of the first National Health and Nutrition Examination Survey. Baseline dietary variables were established through a 24-hour dietary recall and a medical history. Proportional hazards models were used to calculate the effects of dietary variables while controlling for baseline risk factors. RESULTS: After an average of 10 years follow-up, gallstone disease was confirmed by hospital records among 216 women who denied gallstone disease at the baseline examination. The hazard rate of hospitalization with gallstone disease increased with increasing overnight fasting period and with dieting. Intake of fiber showed a small protective effect. The effect of energy intake was significant only among women younger than age 50 years at baseline. Results were not affected by adjustment for known risk factors for gallstone disease or other dietary factors. CONCLUSION: A long overnight fasting period, dieting, and low fiber intake may increase the risk of hospitalization with gallstone disease.
Cervical cancer screening: who is not screened and why?
Authors: Harlan L C , Bernstein A B , Kessler L G
Published: November 2008

BACKGROUND: The decline in death rates from cervical cancer in the United States has been widely attributed to the use of Papanicolaou (Pap) smears for early detection of cervical cancer. METHODS: Pap smear screening rates, beliefs about appropriate screening intervals and factors affecting screening were examined using 1987 National Health Interview Survey data. RESULTS: Results indicate that through age 69, Blacks are screened at similar or higher rates than Whites. Hispanics, particularly those speaking only or mostly Spanish, are least likely to have received a Pap smear within the last three years. Of women who had never heard of or never had a Pap smear, nearly 80 percent reported contact with a medical practitioner in the past two years, while more than 90 percent reported a contact in the past five years. Overall, the most frequently reported reason for not having a recent Pap smear was procrastinating or not believing it was necessary. CONCLUSIONS: Thus, in developing screening programs, Hispanics, particularly Spanish speakers, must be targeted. In addition, educational programs should target unscreened women who forego the test due to underestimating its importance, procrastination, or because their medical care provider did not suggest the procedure. Women must be intensively educated that Pap smears should be scheduled routinely to detect asymptomatic cervical cancer.
Sustained effects of an educational program to reduce sales of cigarettes to minors.
Authors: Altman D G , Rasenick-Douss L , Foster V , Tye J B
Published: November 2008

We report 1-year follow-up data from a sample of stores participating in a 6-month community-wide educational effort to reduce cigarette sales to minors in Santa Clara County, California. The proportion of over-the-counter sales to minors at the 1-year follow-up illustrated that although statistically significant reductions were maintained 6 months after the intervention ended, recidivism occurred. Suggestions for achieving long-term reductions in sales to minors are offered.
The impact of time in treatment on the employment and earnings of drug abusers.
Authors: French M T , Zarkin G A , Hubbard R L , Rachal J V
Published: November 2008

We use data from a longitudinal survey to estimate the effects of time in drug abuse treatment on post-treatment weeks worked and earnings for 2,420 clients in three treatment modalities. The regression analysis shows that time in treatment had a positive and statistically significant impact on these labor market outcomes, but the effects were small for all modalities. Although residential clients experienced the largest relative changes in weeks worked and real earnings, a benefit-cost calculation suggests that additional residential treatment cannot be justified from earnings improvements alone. These results may indicate a need for more employment services while in treatment.
Controlled trial of Giardia lamblia: control strategies in day care centers.
Authors: Bartlett A V , Englender S J , Jarvis B A , Ludwig L , Carlson J F , Topping J P
Published: November 2008

BACKGROUND: Strategies for control of Giardia lamblia in day care differ in numbers of children treated and in costs to parents and day care operators. The effectiveness of these strategies has not been systematically evaluated. METHODS: We conducted a prospective randomized controlled trial comparing three strategies for control of Giardia in infant-toddler day care centers: Group 1, exclusion and treatment of symptomatic and asymptomatic infected children; Group 2, exclusion and treatment of symptomatic infection only; Group 3, exclusion and treatment of symptomatic infection, treatment of asymptomatic infection in the center. The study included 31 day care centers with 4180 child-months of observation. Giardia prevalence was determined before intervention and 1, 2, 4, and 6 months later; new infants and toddlers were tested on admission. RESULTS: Initial Giardia prevalences were 18% to 22% in the three groups. Giardia was identified in 10.5% of 676 new infants and toddlers entering study day care centers during the 6-month follow-up. Giardia prevalences by intervention group were 8%, 12%, and 7% at 1 month, and 7%, 8%, and 8% at 6 months. CONCLUSIONS: The stricter intervention resulted in greater cost in terms of child day care and parents' work days lost, but did not result in significantly better control of Giardia infections in this day care environment.
Source of bias in prenatal care utilization indices: implications for evaluating the Medicaid expansion.
Authors: Alexander G R , Tompkins M E , Petersen D J , Weiss J
Published: November 2008

BACKGROUND: Recent expansions in eligibility for coverage of prenatal care services by the Medicaid program reflect national initiatives to improve pregnancy outcomes. This study investigates the potential impact that completeness of reporting of prenatal care and gestational age variables and strategies to impute missing data may have on evaluations of the Medicaid expansion. METHODS: This study, examining 15 years of vital record data from a single state and comparing 1 year of data from four mid-Atlantic states, selected single live births to resident mothers for analyses. The "day 15" and the "preceding case" methods were used to impute missing gestational age data. RESULTS: Considerable temporal and geographic variation was detected in completeness of reporting of variables used to construct prenatal care indices. After imputing values for cases with missing data, the proportion of cases for which adequacy of prenatal care utilization could not be determined ranged from 3% to 24% among the states investigated. For those cases where gestational age data could be imputed, the distribution of prenatal care utilization was not markedly disparate from those cases with complete reporting of gestational age. CONCLUSIONS: The results indicate that variations in reporting, decisions regarding the treatment of missing data, and the choice of the denominator can alter prenatal care utilization percentages and have implications for evaluations of the impact of the recent Medicaid expansion on prenatal care utilization.
Uncompensated hospital care for pregnancy and childbirth cases.
Authors: Zollinger T W , Saywell R M , Chu D K
Published: November 2008

BACKGROUND: The large number of medically indigent patients in the United States is a major concern to policymakers and may be due to recent increases in the number of uninsured people. The purpose of this study was to identify the factors that affect the amount of unpaid hospital charges for services provided to pregnant women. METHODS: Individual and hospital data were collected on a representative set of 235 pregnancy and childbirth patients with unpaid hospital charges from 28 hospitals in the state of Indiana. RESULTS: Most of these patients did not have insurance coverage (63.8%), yet the majority were employed in the public or private sector (72.3%). Over half (55.5%) of the total uncompensated care amount for this group was from the $1000 to 2499 debt category. The median charge for these patients was $1468, of which the typical hospital was able to collect only 25.5%. CONCLUSIONS: The findings support the belief that any national effort to expand the availability of health insurance coverage to women through increased employment will not totally eliminate the uncompensated care problem. The findings also indicate that rural hospitals face the uncompensated care problem mainly because a significant portion of rural patients are without adequate health insurance coverage.
Effects of paternal occupational exposure on spontaneous abortions.
Authors: Lindbohm M L , Hemminki K , Bonhomme M G , Anttila A , Rantala K , Heikkilä P , Rosenberg M J
Published: November 2008

BACKGROUND: Paternal exposure to mutagenic agents has been suggested to affect pregnancy outcome adversely. METHODS: A nationwide data base of medically diagnosed spontaneous abortions and other pregnancies and national census data was used to evaluate the effects of men's occupational exposures on risk of spontaneous abortion in 99,186 pregnancies in Finland. Census data from the years 1975 and 1980 provided information about the occupation, industry, and socioeconomic status. A job-exposure classification was developed to classify women and their husbands according to possible occupational exposures on the basis of their occupational title and industry. RESULTS: In 10% of the pregnancies, the husband was exposed to one or more of the mutagens, and the rate of spontaneous abortion was unaffected (OR = 1.0). Of the 25 specific mutagenic exposures evaluated, paternal exposure to four (ethylene oxide, rubber chemicals, solvents used in refineries, and solvents used in the manufacturing of rubber products) was associated with an increased relative risk of spontaneous abortion. In addition, the risk of spontaneous abortion was higher among wives of rubber products workers than among unexposed men. CONCLUSIONS: Although there is some biological rationale for the findings of this study, these findings need to be confirmed by studies in which individual exposures can be measured directly.
Serum total cholesterol: HDL cholesterol ratios in US white and black adults by selected demographic and socioeconomic variables (HANES II).
Authors: Linn S , Fulwood R , Carroll M , Brook J G , Johnson C , Kalsbeek W D , Rifkind B M
Published: November 2008

BACKGROUND: Framingham Study findings suggest that total cholesterol (TC):High density lipoprotein cholesterol (HDL-C) ratio is a useful summary of the joint contribution of TC and HDL-C to coronary heart disease (CHD) risk. Information on the distribution of TC:HDL-C in the US population is limited to selected populations and the relationship of the ratio distribution and its correlates has received little attention. METHOD: TC/HDL-C ratios were examined in a representative sample of the United States adult population ages 20 to 74 years, between February 1976 and February 1980 during NHANES II, using stratification and multivariate regression analyses. RESULTS: Age-adjusted mean ratios were higher in men compared with women and were higher in Whites compared with Blacks. White men had the highest TC/HDL-C mean ratios. These relationships remained after stratification by age, education, body mass index, alcohol use, cigarette smoking, and physical activity. Using multivariate analyses, the ratios were positively related to BMI, age, and smoking; and negatively related to female sex, alcohol use, being Black, and physical activity. CONCLUSIONS: Using a ratio reference point of greater than or equal to 4.5 from the Framingham study, at least an estimated 44 million persons ages 25 to 74 years in the US were found to be at higher risk of developing coronary heart disease.
Physicians promoting bicycle helmets for children: a randomized trial.
Authors: Cushman R , James W , Waclawik H
Published: November 2008

Head injury is the leading cause of death and serious morbidity in bicycle accidents. There is good evidence to recommend helmets, yet few children wear them. We evaluated helmet promotion in a randomized trial targeting children presenting to primary care settings for routine ambulatory care. The intervention consisted of physician counseling and take-home pamphlets. The study involved 339 families, 167 in the intervention group and 172 in the control group. In a follow-up telephone call, 2 to 3 weeks later, only 7.2% of the intervention group had purchased helmets, compared with 7.0% of the control group (chi 2 = 0.0056, P = .94). During the latter half of the study, bicycle safety received considerable media attention in Ottawa, and the provincial medical society sponsored a $5 discount campaign. Therefore both groups were subject to community "co-intervention." Nonetheless, we were surprised that physician counseling made no additional impact. Our results and the success of certain community programs suggest that physicians interested in helmet promotion would do better to participate in the design and implementation of multidisciplinary campaigns.
A comparison of breast-feeding data from the National Surveys of Family Growth and the Ross Laboratories Mothers Surveys.
Authors: Ryan A S , Pratt W F , Wysong J L , Lewandowski G , McNally J W , Krieger F W
Published: November 2008

This study compares rates of breast feeding reported in the National Surveys of Family Growth with those from the Ross Laboratories Mothers Surveys. Both surveys have documented rates of breast feeding over the last 30 or more years. Despite differences in survey methodology, both surveys document similar long-term trends in breast feeding. The similarities of rates in breast feeding also are evident across several maternal sociodemographic characteristics. We conclude that both surveys produce reliable and useful estimates of breast feeding.
Measles vaccination coverage among Latino children aged 12 to 59 months in Los Angeles County: a household survey.
Authors: Ewert D P , Thomas J C , Chun L Y , Enguidanos R C , Waterman S H
Published: November 2008

A high rate of measles transmission has occurred in Los Angeles County since 1987. To determine measles vaccination coverage among Latino preschoolers, the group at highest risk of measles during this period, a cluster survey was conducted among Latino households with children aged 12 to 59 months. Of 279 children enrolled, 240 (86%, 95% confidence interval = 81% to 91%) reportedly had received the measles vaccine. Measles vaccination coverage among Latino preschoolers in Los Angeles County is insufficient to halt measles transmission within this subpopulation.
Analysis of US child care safety regulations.
Authors: Runyan C W , Gray D E , Kotch J B , Kreuter M W
Published: November 2008

BACKGROUND: With 1.9 million US children cared for in organized group child care, the safety of these children is a public health concern. In the absence of federal policy, each state has developed its own day care safety regulations. METHODS: After creating a set of 36 criteria from three sets of national guidelines, we assessed the safety regulations of 45 states. With a mailed survey of state day care regulatory personnel, we examined the processes of formulating and implementing safety policy in 47 states. RESULTS: For 24 of the 36 items, more than half the states' regulations were below the criteria or failed to mention the topic. Most notable is the inattention to playground safety, choking hazards, and firearms. CONCLUSION: The uneven quality of regulations may be a reflection of a regulatory process that is fragmented, with many different groups sharing authority and with limited involvement of injury prevention specialists.
Adult foster care for the elderly in Oregon: a mainstream alternative to nursing homes?
Authors: Kane R A , Kane R L , Illston L H , Nyman J A , Finch M D
Published: November 2008

BACKGROUND. In Oregon, adult foster care (AFC) homes, which are private residences where a live-in manager cares for one to five disabled residents, have been covered by Medicaid since 1981 and seem to offer a mainstream alternative to nursing homes. They house almost 6000 older people, two thirds of which pay privately. METHODS. In a cross-sectional study, we interviewed 400 AFC and 400 nursing home residents. Data analyses included descriptive cross-tabulations; hierarchial loglinear models for judging the effects of care setting and payment status on resident characteristics; and logit analyses for predicting care setting and payment status within care settings. RESULTS. On average, nursing home residents were more physically and cognitively impaired than AFC residents, but there was considerable overlap in patterns of frailty in the two settings. Medicaid AFC residents were less disabled than privately paying AFC residents. AFC residents reported more social activity, even when we controlled for disability status. AFC residents and their families were more likely to value privacy and homelike settings when choosing a care setting, whereas nursing home residents were more likely to value rehabilitation and organized activity programs. CONCLUSIONS. Both AFC and nursing homes are viable components of a long-term care repertoire. The greater disability levels of private-pay AFC residents refutes the criticisms that disabled Medicaid residents were being inappropriately channeled to AFC.
Is coronary-care-unit admission restricted for elderly patients? A multicenter study.
Authors: Fleming C , D'Agostino R B , Selker H P
Published: November 2008

BACKGROUND. To investigate whether elderly patients are more likely to experience restricted access to high technology medical care, we examined the impact of age on the likelihood of coronary care unit (CCU) admission for patients with acute myocardial infarction. METHODS. As part of a prospective investigation of emergency room triage for patients with suspected cardiac ischemia, we studied 4223 patients presenting to six hospitals. Because CCU admission is the accepted standard of care for acute infarction, we defined nonadmission to the CCU as a restriction of access to care. We used a logistic regression model to control for gender, hospital, and CCU occupancy at the time of admission and examined the relationship between age and CCU nonadmission. RESULTS. Patients 75 years or older with acute myocardial infarction were 2.5 times more likely not to be admitted to the CCU than younger patients (RR 2.5, 95% CI 1.64, 3.85). Coronary unit admission was restricted even when the physician's admitting diagnosis was "myocardial infarction" (RR 7.1, 95% CI 2.1, 25.0) or "rule-out myocardial infarction" (RR 1.5, 95% CI 1.1, 2.1). Observed differences in clinical presentation or severity of illness between older and younger patients did not account for these findings. CONCLUSION. Our findings suggest that physicians may intentionally restrict access to coronary care for elderly patients with acute myocardial infarction.
Comparison of subjective ratings of function with observed functional ability of frail older persons.
Authors: Elam J T , Graney M J , Beaver T , el Derwi D , Applegate W B , Miller S T
Published: November 2008

BACKGROUND. Important clinical decisions often hinge on patients' functional status. Previous studies have shown disagreement among sources of ratings of patients' functional status. This study compared patient self-ratings, family member ratings, and physician ratings of patient function to performance-based functional testing criteria. METHODS. Five activities of daily living of 73 older patients were studied at admission to a rehabilitation unit following discharge from an acute care community hospital. Data were collected from patients, family members, and physicians and were compared with performance-based function testing. RESULTS. Patient ratings were significantly more accurate than physician ratings for walking, transferring, and telephoning. Patients were significantly more accurate than family members for rating walking and telephoning, but patients were not significantly more accurate than family members or physicians for rating eating or dressing. CONCLUSIONS. We conclude that decisions about patients' functional level should be based on performance testing. If performance testing is unavailable, patients' own ratings are most accurate, followed by family ratings. Physicians' ratings are least accurate.
The increasing supply of physicians in US urban and rural areas, 1975 to 1988.
Authors: Frenzen P D
Published: November 2008

BACKGROUND. Despite the rapid growth of the US physician supply since the mid-1970s, it remains unclear whether physicians have spread into the most rural areas of the country. This report examines the urban-rural distribution of physicians between 1975 and 1988. METHODS. A county-based typology of the urban-rural continuum was employed to examine trends in the supply of nonfederal primary care physicians, specialist physicians, and osteopaths. RESULTS. All urban and rural areas gained physicians during the late 1970s and 1980s. The supply of physicians increased most rapidly in metropolitan counties. Within nonmetropolitan areas, urbanized remote counties became more prominent centers of the physician supply. Osteopaths were more likely to locate in the most rural areas than allopaths. The physician supply in all areas also became more specialized over time. CONCLUSIONS. The rapid growth of the US physician supply was associated with the spread of more practitioners into all parts of the country. However, the supply of physicians increased most rapidly in urban areas, widening urban-rural differences in the availability of physicians.
Cause-specific mortality in a population-based study of diabetes.
Authors: Moss S E , Klein R , Klein B E
Published: November 2008

BACKGROUND. Mortality from vascular diseases has been reported to be high in diabetic persons. METHODS. To evaluate mortality from these and other specific causes, we examined cause-specific age-sex standardized mortality ratios in a geographically defined population of younger onset (diagnosed before age 30 and taking insulin, n = 1200) and older onset (diagnosed after age 30, n = 1772) diabetic persons followed for 8.5 years. Cause of death was determined from death certificates. RESULTS. In younger onset persons, age-sex standardized mortality ratios were significantly high (P less than .05) for all causes of death (7.5) as well as for diabetes (191), all heart disease (9.1), ischemic heart disease (10.1), other heart disease (6.3), nephritis and nephrosis (41.2), accidents (2.9), and all other causes (3.2). In older onset persons, age-sex standardized mortality ratios were significantly high for all causes of death (2.0) as well as for diabetes (16.8), all heart disease (2.3), ischemic heart disease (2.3), other heart disease (2.1), stroke (2.0), and pneumonia and influenza (1.7). CONCLUSIONS. Diabetic persons experience very high mortality, especially from vascular diseases, compared to the general population.
Aging and the fitness of fire fighters: the complex issues involved in abolishing mandatory retirement ages.
Authors: Saupe K , Sothmann M , Jasenof D
Published: November 2008

This study presents an assessment of the cardiorespiratory health and physical fitness of fire fighters of different ages with the aim of addressing several questions currently being debated on a national level. These include how fire fighters differ across age groups in their health and physical fitness, and what would be the impact on the existing work force of implementing minimum fitness standards as an alternative to mandatory retirement ages. Fire fighters aged 20-65 years were found to be similar in their cardiorespiratory health and physical fitness to the sedentary segment of the general population of the same age. Particularly worrisome, however, is the low maximal aerobic capacity (31, 28, 26 ml/kg/min), high percent body fat (26, 29, 30), and high resting blood pressure (136/86, 140/90, 143/93 mm Hg) observed in the 40-45-, 50-55-, and 60-65-year-old fire fighters, respectively. In fact, 66%, 83%, and 93% of the fire fighters in these three age groups, respectively, fall below the lowest published recommendations for maximal aerobic capacity in this profession. These data underscore the need to establish minimum health and physical performance standards for fire fighters and demonstrate the profound impact such minimum standards will have on the existing work force.
Malnutrition in elderly ambulatory medical patients.
Authors: Manson A , Shea S
Published: November 2008

Elderly ambulatory persons may be especially susceptible to malnutrition, particularly those who are poor and socially isolated or have comorbid chronic medical diseases. We found that 98 of 2,986 persons aged 60 years or older attending a hospital-based medical practice between 1979 and 1989 weighed less than 45.4 kg (100 lbs). All but 1 of these subjects met criteria for malnutrition as judged against age-specific norms for weight. Thus the prevalence of malnutrition in this sample was 3.25% (95% CI 2.61, 3.89%). Interviews and physical examinations of a subsample (n = 16) revealed that all 16 subjects either met anthropometric-based criteria for malnutrition or were being treated for malnutrition. Of the 98 subjects who weighed less than 45.4 kg, 62 (63.3%; 95% CI 53.8, 72.8%) had comorbid conditions that could have contributed to malnutrition. Physicians did not record a diagnosis of malnutrition or weight loss in 47.9% of subjects (95% CI 38.0, 57.8%) and did not prescribe a nutrition supplement for 76.5% of subjects (95% CI 68.1, 84.9%). Subjects treated with nutrition supplement were more likely to have cancer. These findings suggest that malnutrition, both with and without concomitant major comorbid disease, is relatively frequent among elderly ambulatory patients and that a specific nutritional diagnosis is not made in many cases. We suggest that weight under 45.4 kg in an elderly person is a useful criterion for identifying elderly patients at nutritional risk.
Development and validation of a simple device to estimate birthweight and screen for low birthweight in developing countries.
Authors: Dusitsin N , Chompootaweep S , Poomsuwan P , Dusitsin K , Sentrakul P , Lumbiganond P
Published: November 2008

Low birthweight (less than 2500 g) is the major factor associated with the death of infants within the first 4 weeks of life. The mean birthweight of newborn babies of a certain geographic area reflects the quality of maternal and child health care service as well as the degree of socioeconomic development of that particular region. Hence, birthweight is being used increasingly as an indicator for health and socioeconomic planning. However, in a developing country such as Thailand, two-fifths of the babies are delivered at home and are not weighed because scales are not available. To solve this problem in rural areas, a circular nomographic chart was developed with which the birthweight can be computed from a newborn baby's chest and mid-arm circumferences. Preliminary trials comparing these charts with standard baby scales showed a high degree of accuracy with sufficient sensitivity and specificity.
Recent trends in the incidence of toxic shock syndrome in northern California.
Authors: Petitti D B , Reingold A L
Published: November 2008

The incidence of toxic shock syndrome in women members of a large prepaid medical care program in Northern California was 1.5 cases per 100,000 in a period after removal of tampons containing polyacrylate rayon and reductions in tampon absorbency. This rate was lower, but not significantly lower, than the rate of 2.2 per 100,000 in the prior interval. It was higher, but not significantly higher, than the rate of 0.4 per 100,000 in the era before "superabsorbent" materials were introduced into tampons. The incidence in men has been stable at about 0.1 cases per 100,000 for the 15-year period from 1972 though 1987.
Newborn seroprevalence study: methods and results.
Authors: Novick L F , Glebatis D M , Stricof R L , MacCubbin P A , Lessner L , Berns D S
Published: November 2008

For the 28-month period, November 30, 1987 through March 31, 1990, 653,117 blood specimens obtained on all newborn infants in New York State for detection of metabolic disorders were also analyzed for HIV serologic status. The overall seroprevalence rate was 0.66 percent: 1.24 percent in New York City and 0.17 percent in New York State exclusive of New York City. Rates of seropositivity were highest in the Bronx (1.72 percent) and Manhattan (1.59 percent). Outside of New York City, HIV seropositivity was concentrated in certain areas. Sixty-four zip codes with two or more seropositives and an HIV seroprevalence rate twice the average outside of New York City contained 65 percent of the HIV seropositives but only 16 percent of the newborns tested. Newborn seropositivity increased with maternal age. In New York City, the seroprevalence rates increased from 0.16 percent (1 in 624) for 14-year-olds to 1.41 percent (1 in 71) for 24-year-olds, a ninefold rise. This survey has provided the impetus for a number of preventive initiatives.
HIV infection among women entering the New York State correctional system.
Authors: Smith P F , Mikl J , Truman B I , Lessner L , Lehman J S , Stevens R W , Lord E A , Broaddus R K , Morse D L
Published: November 2008

Human immunodeficiency virus infection is the leading medical problem among prison inmates in several states. In 1988 a blinded seroprevalence study was conducted on 480 New York female prison entrants to determine the prevalence of and risk factors for HIV infection in this population. Ninety (18.8 percent) women were HIV-seropositive. Seroprevalence was highest among women ages 30-39 (25.0 percent) and varied by ethnicity (Hispanics, 29.4 percent; Blacks, 14.4 percent; Whites, 7.1 percent) and residence (New York City, 23.8 percent; Upstate, 5.1 percent). Nearly half (44.9 percent) of the 136 acknowledged intravenous drug users and one-third (33.8 percent) of the 71 women with a positive syphilis serology were HIV-seropositive. There was no difference in fertility histories between seropositive and seronegative women, and two of 21 pregnant women were seropositive. This study led to increased clinical and prevention services for this high-risk population.
Hospitalization of HIV-seropositive newborns with AIDS-related disease within the first year of life.
Authors: Glebatis D M , Novick L F , Stacy A
Published: November 2008

The purpose of this study was to estimate the proportion of HIV-seropositive newborns hospitalized for an AIDS-related diagnosis within 12 months of birth and to characterize these hospitalizations. The number of HIV-seropositive infants born December 1987 through June 1988 was derived from the blinded New York State Newborn HIV Seroprevalence Study. The number of infants who were born in these same months and hospitalized with an ARD within 12 months of birth was obtained from a data base containing information on all hospital discharges in New York State. Comparisons were made on the basis of month of birth. Of infants born during the study period, 995 tested positive for HIV antibody, and 151 infants (15 percent) were hospitalized with an ARD within 12 months of birth. The 151 ARD cases had a total of 240 hospitalizations, accounting for 5,772 patient days. Fifty-six percent of the ARD cases were diagnosed within six months of birth.
HIV seroprevalence surveys: impetus for preventive activities.
Authors: Novick L F
Published: November 2008

Seroprevalence determinations of human immunodeficiency virus are essential for design and implementation of preventive strategies. By demonstrating the severity of HIV infections within communities, New York State surveys have spurred preventive interventions, including information to the public and health care providers and increased counseling and testing of women of reproductive age. In high-prevalence areas the community health workers have been employed in preventive activities. Specific information has been provided to county health departments on zip code areas with high HIV seroprevalence rates. Serosurveys revealed that the magnitude of HIV infection in adolescents is much larger than indicated by case reports. Various seroprevalence studies confirmed higher rates of infection with increasing age and minority status and a strong association with intravenous drug use. Combining data provided by seroprevalence studies in a given community enables planners to assess the extent of infection in that community and in groups important to transmission of the virus.
Evaluating the treatment of sexually transmitted diseases at an urban public hospital outpatient clinic.
Authors: Shekelle P G , Kosecoff J
Published: November 2008

Sexually transmitted diseases occur disproportionately among the poor, are often treated in public hospitals and clinics, and have not been subjected to quality-of-care evaluation. We designed a medical record abstraction system using well-established, specific process-of-care criteria drawn from the medical literature and experts and grouped into three levels of quality: excellent, adequate, and minimal. One hundred seventy-six consecutive patients were identified from the clinic logbook and their medical records abstracted. Deficiencies in history taking, physical examination, laboratory testing, treatment, and public health reporting were identified.
The future of public health.
Authors: Walker B
Published: November 2008

Significant progress has been made in developing the biological, social, and behavioral science base for public health services. But this knowledge will have limited value unless it is transformed into programs and services for the people who need them. The systems and mechanics for this transmutation may not have reached their full potential. Assuring that they do so offers, in the 1990s, a challenge and an opportunity for the public health community.
Occupational risks associated with cigarette smoking: a prospective study.
Authors: Ryan J , Zwerling C , Orav E J
Published: November 2008

BACKGROUND. Studies have indicated that cigarette smokers have more occupational accidents and injuries and use more sick time and health benefits than nonsmokers, thereby producing sizeable costs for employers. However, they usually have not controlled for other possible sources of these costs. We analyzed occupational costs associated with smoking while adjusting for a number of potential confounders. METHODS. We conducted a prospective, controlled study of the association between smoking and employment outcomes in 2537 postal employees, adjusting for age, gender, race, drug use, job category, and exercise habits. RESULTS. For smokers, the relative risk for turnover was 1.01 (95% confidence interval [CI], 0.83-1.21); for accidents 1.29 (CI, 1.07-1.55); for injuries 1.40 (CI, 1.11-1.77); for discipline 1.55 (CI, 1.19-2.02). Their mean absence rate was 5.43% compared with 4.06% for nonsmokers. CONCLUSIONS. Our study shows that cigarette smoking is associated with adverse employment outcomes after controlling for a number of possible confounders. This finding has implications for companies formulating smoking policies and considering the establishment of smoking cessation programs.