bluuebunny/crossref_metadata_2025 huggingface dataset:
The national profile of access to medical care: where do we stand?
Authors: Aday L A , Andersen R M
Published: November 2008

This paper presents analyses of recent national survey data on access to medical care. In particular, information on major access indicators and special problems associated with the economic and political climate of the 1980s collected in a 1982 national telephone survey of 6,610 United States adults and children, representing some 4,802 families, is compared with previous national surveys for key population subgroups--by age, place of residence, income, race, insurance coverage, and type of regular source of care. In general, the findings show that favorable progress has been made, but some inequities continue to persist. Some traditionally disadvantaged groups are more likely to have a regular family doctor, private insurance coverage, have been to a doctor, or had certain preventive tests and procedures than was true for them in the past. On the other hand, compared to the more economically and/or socially advantaged groups in 1982, they have still not "caught up" entirely. There also is evidence that they may be hardest hit by the exacerbation of the financial barriers to care that result from unemployment, inflation, and cutbacks in health program eligibility and benefits that have characterized the decade of the 1980s.
Medical self-care education for elders: a controlled trial to evaluate impact.
Authors: Nelson E C , McHugo G , Schnurr P , Devito C , Roberts E , Simmons J , Zubkoff W
Published: November 2008

We conducted a trial to evaluate the impact of medical self-care education on 330 elders whose average age was 71. The test group participated in a 13-session educational intervention with training in clinical medicine, life-style, and use of health services. The comparison group received a two-hour lecture-demonstration. Both groups were assessed pre-intervention, post-intervention, and one year after entry. The results indicate medical self-care instruction: produces substantial improvements, that were sustained for one year, in health knowledge, skills performance, and skills confidence; stimulates many attempts to improve life-style; and generates improvements in life quality. The program had little influence on utilization of medical care or health status.
Absence of menopausal effect on hip fracture occurrence in white females.
Authors: Brody J A , Farmer M E , White L R
Published: November 2008

The rate of hip fracture among White females rises sharply between ages 40 and 44 and then continues at a constant rate of acceleration doubling every five to six years throughout life with no deviation during, or in the years immediately following, menopause. We suggest that the important role of sex hormones and other factors in osteoporosis commences prior to menopause. A premenopause prevention strategy which postpones the onset of the osteoporotic process by five or six years would be expected to reduce the risk of hip fracture by 50 per cent throughout the remainder of a woman's life.
Increase in relevant data after introduction of a problem-oriented record system in primary pediatric care.
Authors: Margolis C Z , Mendelssohn I , Barak N , Beinart T , Goldsmith J R
Published: November 2008

We determined the effect of the problem list and standard data base components of the problem-oriented record (POR) on kibbutz clinic care. We compared quantity and type of data collected and number of problems identified before and after POR implementation at an experimental clinic with the same variables measured at a similar clinic. Family history, prenatal, natal, nutritional, immunization, environment, review of systems, psychosocial and total data collected, as well as number of chronic problems identified, increased significantly after POR implementation.
The incentive plan: an approach for modification of physician behavior.
Authors: Sims P D , Cabral D , Daley W , Alfano L
Published: November 2008

Blue Shield of Massachusetts undertook a one-year study in 1981 to determine if a group of obstetrician/gynecologists could be motivated to reduce average length of stay (ALOS) for normal deliveries, cesarean sections, and hysterectomies. The group decreased ALOS for all three procedures. Additional studies are required to determine what portion of the decrease in ALOS can be attributed to change in physician behavior.
Preventive content of adult primary care: do generalists and subspecialists differ?
Authors: Dietrich A J , Goldberg H
Published: November 2008

We compared preventive care performed by 20 generalists and 20 subspecialists practicing in Santa Clara and San Mateo Counties, California, by auditing charts of adult primary care patients for compliance with recommendations of the Canadian Task Force on the Periodic Health Examination. Generalists and subspecialists both provided 49 per cent of recommended preventive services. The two groups did not differ significantly in performance of any individual service. Performance varied widely within both groups. Of many factors explored, only two were associated with more preventive services: provision of a complete physical examination to the patient, and a physician's belief in the importance of a given service. The "generalist vs. subspecialist" debate assumes that a physician's specialty classification is an important predictor of behavior. For the performance of preventive care, this was not true in our study. Instead, physicians' beliefs and practice habits may be major determinants of the quality of preventive care provided. These exploratory findings needed confirmation in other settings.
Trends in childhood disability.
Authors: Newacheck P W , Budetti P P , McManus P
Published: November 2008

This article summarizes and analyzes possible explanations for the near doubling, since 1960, of the proportion of children with limitations of activity due to chronic illness as reported in the National Health Interview Survey (NHIS). We examine several possible explanations for the upward trend in prevalence including: changes in survey design and procedures; changes in awareness of chronic illness on the part of parents and physicians; and changes in the institutionalized population of disabled children. Our analysis indicates that only a small part of the trend can be explained directly by these factors. Further examination of the NHIS data reveals that the types of limitations of activities now reported are less likely to cause frequent confinement in bed; whether this indicates lesser severity or principally different types of chronic conditions is as yet unclear.
Hysterectomy: variations in rates across small areas and across physicians' practices.
Authors: Roos N P
Published: November 2008

This analysis focuses on the practice of hysterectomy across 33 hospital catchment areas of one Canadian province, using claims data from the Manitoba health insurance system. Hysterectomy rates varied five-fold across hospital areas. The availability of hospitals and physicians was unrelated to area rates, and there appeared to be no access barriers in the low-rate areas. High-rate areas were characterized by women who visited large numbers of different physicians and by having larger proportions of French, Polish, and Italian residents (ethnic groups which are largely Catholic in Manitoba). Although women residents of high rate areas made somewhat more visits for gynecologic problems and had many more D&Cs (dilation and curretage of the uterus), it is concluded that this may be due as much to the practice style of physicians treating patients from these areas as to gynecologic need. Residents of high and medium-high rate areas are more likely to have hysterectomy-prone surgeons as their primary physicians. Such physicians appear both more likely to "label" their patients' conditions as gynecologic in origin and more likely to advise surgical intervention (both D&C and hysterectomy) once such conditions are diagnosed. Thus, a combination of patient and physician characteristics may explain much of the variation in small area hysterectomy rates, rather than narrowly defined medical need.
Nosocomial rabies: investigation of contacts of human rabies cases associated with a corneal transplant.
Authors: Anderson L J , Williams L P , Layde J B , Dixon F R , Winkler W G
Published: November 2008

In October 1978 in Boise, Idaho, a woman died of rabies after receiving a corneal transplant from a man, who in retrospect was also found to have died of rabies. Investigation of 203 contacts of these two patients identified 94 who were felt to have had sufficient risk of exposure to justify being given rabies post-exposure prophylaxis. Nurses, physicians, respiratory therapists, and family members were at greatest risk. We discuss the problems encountered in determining risk of exposure for contacts of humans with rabies.
An assessment of occupation and industry data from death certificates and hospital medical records for population-based cancer surveillance.
Authors: Swanson G M , Schwartz A G , Burrows R W
Published: November 2008

This study analyzed 30,194 incident cases and 4,301 death certificates for completeness of occupational reporting. Analysis of data accuracy was based upon a comparison of more than 2,000 death certificates with incident abstracts and 352 death certificates with interview data. Death certificates had a higher proportion with occupation (94.3%) and industry (93.4%) reported than did incident abstracts of hospital medical records (39.0% and 63.5%, respectively). Compared with occupational history data obtained by interview, 76.1% of the death certificates were exact matches for usual occupation and industry.
Epidemiologic investigation of a Yersinia camp outbreak linked to a food handler.
Authors: Morse D L , Shayegani M , Gallo R J
Published: November 2008

In July 1981, an outbreak of gastroenteritis occurred at a summer diet camp. Of the 455 campers and staff, 35 per cent developed an illness characterized by abdominal pain, fever, diarrhea, and/or nausea and vomiting. A total of 53 per cent experienced abdominal pain. Seven persons were hospitalized, five of whom had appendectomies. Yersinia enterocolitica serogroup 0:8 was isolated from 37 (54 per cent) of 69 persons examined, including the camp cook and three assistants. An epidemiologic investigation demonstrated that illness was associated with consumption of reconstituted powdered milk and/or chow mein . Y. enterocolitica serogroup 0:8 was subsequently isolated from milk, the milk dispenser, and leftover chow mein . Information obtained during the investigation suggested that the Yersinia had been introduced by a food handler during food-processing procedures.
Waterborne giardiasis at a mountain resort: evidence for acquired immunity.
Authors: Istre G R , Dunlop T S , Gaspard G B , Hopkins R S
Published: November 2008

In November 1981, an outbreak of waterborne giardiasis occurred at a popular ski resort in Colorado. Stratification of illness by consumption of municipal tap water showed a striking dose-response, with an attack rate of 42 per cent among persons who drank six or more glasses of water per day. Filtered water samples revealed Giardia cysts in specimens both before and after treatment, and several deficiencies were found in the water treatment facility. Residents who had lived in the area greater than 2 years had a lower attack rate for illness than short-term residents.
A pseudo-outbreak of influenza A associated with use of laboratory stock strain.
Authors: Budnick L D , Moll M E , Hull H F , Mann J M , Kendal A P
Published: November 2008

In November 1982, when influenza type A(H3N2) viruses were spreading in the United States, influenza A(H1N1) viruses were reportedly isolated from 10 hospitalized patients in New Mexico, only two of whom had influenza-like illnesses. Reference stock influenza A/Fort Monmouth (FM)/1/47(H1N1) virus had been used to prepare fluorescent antibody test slides in the laboratory reporting the isolates. After investigation, it was concluded that the isolates from the patients' cultures were a result of laboratory contamination. When an unexpected cluster of unusual virus isolates is reported, the possibility of laboratory contamination should be considered.
Predicting changes in perceived health status.
Authors: Goldstein M S , Siegel J M , Boyer R
Published: November 2008

Panel data from the Los Angeles Health Survey (N = 903) were used to examine variables associated with changes in perceived health status over a one-year period. Our findings replicate previous research showing that perceived health status is associated with variations in chronic illness, disability, and the utilization of health services. However, we found that neither positive nor negative changes in perceived health status were related to any indicator of health beliefs or practices or physical health status. The data suggest that single item measures of perceived health status may reflect the individual's sense of long-standing chronic illness.
Outbreak of illness due to volatilized asphalt coming from a malfunctioning fluorescent lighting fixture.
Authors: Tavris D R , Field L , Brumback C L
Published: November 2008

We investigated an outbreak of headache, eye irritation, sore throat, nasal congestion, and nausea in an office complex, ongoing for three months and regularly resolved upon leaving the building. Investigation suggested that the etiology of the illness was malfunctioning fluorescent light ballasts , which overheated and resulted in melting and volatilization of contained asphalt . Correction of the problem resulted in almost complete disappearance of symptoms within two weeks.
Patterns of drug use from adolescence to young adulthood: II. Sequences of progression.
Authors: Yamaguchi K , Kandel D B
Published: November 2008

Major pathways of progression among legal, illegal, and medically prescribed psychoactive drugs from adolescence to young adulthood are described. The data are based on a follow-up cohort of former adolescents representative of high school students in grades 10 and 11 in New York State who were reinterviewed nine years later at ages 24-25. Various models of progression are tested for their goodness of fit. The patterns formerly observed in adolescence involving progression from one class of legal drug (either alcohol or cigarettes) to marijuana to the use of other illicit drugs appear in the transitional period into young adult, with an additional stage, that of prescribed psychoactive drugs. Some differences appear between men and women, with cigarettes more important for women than for men in the total progression.
Health services, health manpower, and universities in relation to health for all: an historical and future perspective.
Authors: Bryant J H
Published: November 2008

The World Health Organization's goal of Health for All by the Year 2000 (HFA) has become a major force in national and international health policies. This paper deals with some of the historical roots of HFA and describes ways in which the major components of the health sector--health services, manpower, and universities--have evolved and should evolve in the future if they are to support the idea of HFA. One conclusion is that the changes called for in relation to HFA are not simply incremental extensions of previous values, structures, and functions. Rather a radical break with the past is often required. To expect otherwise is to misunderstand how fundamentally the concepts of HFA differ from values that have governed the health sector in the past. A second conclusion is that recent decades have seen a remarkable progression of new ideas and changes in the health sector, so much so that the changes called for by HFA are not so improbable as one might otherwise think.
Changing patterns of lung cancer among socio-cultural groups in New York City.
Authors: Rosenwaike I
Published: November 2008

Mortality statistics for New York City were used to examine lung cancer trends and differentials among Whites in three major religious groups. The percentage of deaths attributed to lung cancer increased among all groups of females and among all categories of males except those under age 45. The relatively low lung cancer levels among Jewish men observed in earlier studies have continued and are consistent with patterns of smoking reported for socio-cultural groups. Mortality from lung cancer among Jewish women was still relatively higher than for other women at some age groups.
Needs assessment under the Maternal and Child Health Services Block Grant: Massachusetts.
Authors: Guyer B , Schor L , Messenger K P , Prenney B , Evans F
Published: November 2008

The Massachusetts maternal and child health (MCH) agency has developed a needs assessment process which includes four components: a statistical measure of need based on indirect, proxy health and social indicators; clinical standards for services to be provided; an advisory process which guides decision making and involves constituency groups; and a management system for implementing funds distribution, namely open competitive bidding in response to a Request for Proposals. In Fiscal Years 1982 and 1983, the process was applied statewide in the distribution of primary prenatal (MIC) and pediatric (C&Y) care services and lead poisoning prevention projects. Both processes resulted in clearer definitions of services to be provided under contract to the state as well as redistribution of funds to serve localities that had previously received no resources. Although the needs assessment process does not provide a direct measure of unmet need in a complex system of private and public services, it can be used to advocate for increased MCH funding and guide the distribution of new MCH service dollars.
Italian occupational health: concepts, conflicts, implications.
Authors: Reich M R , Goldman R H
Published: November 2008

This paper examines Italy's worker-based model for occupational health, especially its key concepts and its relation to social conflict. It briefly reviews the history of three approaches to occupational health in Italy: university-based, industry-based, and government-based. It then analyzes the worker-based approach, which emerged in the late 1960s and early 1970s as worker groups and trade unions mobilized around new concepts of occupational health. Five key concepts are discussed: the workers' homogeneous group; workers' subjectivity; the use of contract language; the development of local occupational health institutions; and the use of occupational hazard risk maps. The analysis illustrates how the social processes of mobilization and institutionalization affected the ideas and structures of Italian occupational health. Worker mobilization in Italy produced ideological changes in the nation's occupational health system, institutional changes in universities and governments, and legislative changes at national and local levels. The institutionalization of reforms, however, created new conflicts and problems and tended to restrict worker participation and promote expert intervention. The paper concludes with a brief outline of the history of occupational health approaches in the United States and then discusses the implications of the five Italian concepts for US occupational health policy.
Industry invites regulation: the passage of the Pure Food and Drug Act of 1906.
Authors: Barkan I D
Published: November 2008

Ending its 27-year stranglehold on proposals for federal pure food and drug legislation, Congress passed the Pure Food and Drug Act and its companion bill, the Meat Inspection Act, on June 30, 1906. An unprecedented convergence of consumer, scientific, and industrial support in 1906 prompted such action; most industries even planned for it, hoping regulation would restore the competitiveness of their products on weak foreign and domestic markets. The ways in which these interests converged, and the reasons therefore, suggest a change in their relationships to each other and with the federal government as America headed into the twentieth century.
A simple language-based acculturation scale for Mexican Americans: validation and application to health care research.
Authors: Deyo R A , Diehl A K , Hazuda H , Stern M P
Published: November 2008

A simple scale for quantifying English use among Mexican Americans was constructed from four brief questions which proved to have excellent scaling characteristics by Guttman Scalogram Analysis in two independent data sets. Construct validity was established by significant associations of the scale with ethnicity, place of birth, generation within the United States, and type of neighborhood. Highly significant associations were found between scale scores and use of oral contraceptives, parity, "fatalism" regarding health, and attitudes toward folk healers. These associations remained significant (though weak) after controlling for education and family income. The language scale thus appears to be reliable and valid, to be capable of distinguishing meaningful subsets among the Mexican American population, and to be applicable to health care investigation.
Child abuse incidence and reporting by hospitals: significance of severity, class, and race.
Authors: Hampton R L , Newberger E H
Published: November 2008

Estimates from the National Study of the Incidence and Severity of Child Abuse and Neglect suggest that hospitals recognized over 77,000 cases of child abuse between May 3, 1979, and April 30, 1980. Compared to other agencies in the sample, hospitals identified children who were younger, Black, lived in urban areas, and had more serious injuries. Hospitals failed to report to child protection agencies almost half of the cases that met the study's definition of abuse. Discriminant analysis revealed that income, mother's role in abuse, emotional abuse, race, maternal employment, and sexual abuse distinguished the reported from the unreported cases. Disproportionate numbers of unreported cases were victims of emotional abuse and came from families of higher income. Their mothers were more often White and more often alleged to be responsible for the injuries.
Genital herpes: does knowledge lead to action?
Authors: Aral S O , Cates W , Jenkins W C
Published: November 2008

We analyzed data from a national telephone survey to determine whether awareness of the herpes epidemic led to changes in sexual behavior. Of those surveyed, 67 per cent heard about herpes only within the last two years. More importantly, 45 per cent of individuals perceiving themselves to be at risk stated they had changed their behavior as a result of this perception. Among those never married, 60 per cent stated they were willing to modify their lives to avoid genital herpes.
Prevalence and trends in oral contraceptive use in premenopausal females ages 12-54 years, United States, 1971-80.
Authors: Russell-Briefel R , Ezzati T , Perlman J
Published: November 2008

Data from the second National Health and Nutrition Examination Survey (NHANES II) were analyzed to estimate the prevalence of oral contraceptive use in the United States, 1976-80. The overall unadjusted prevalence of oral contraceptive use was 16.7 per cent for premenopausal females ages 12-54 years (19.2 per cent for ages 15-44 years). Approximately 8.7 million females (95 per cent confidence interval, 6.9-10.5 million) were oral contraceptive users at the midpoint of NHANES II (March 1978). Comparison to the NHANES I, conducted in 1971-74, indicated a stable number of overall oral contraceptive users in the US population during the 1970s, with shifts in certain age groups: oral contraceptive use increased for females ages 12-19 years and decreased for females ages 20-49 years. The overall age-adjusted prevalences indicated a 2 per cent (95 per cent CI, 0.2-3.8 per cent) decline in oral contraceptive use from the early to the late 1970s. The NHANES provides comparative data and supports findings from another national survey showing a decrease in the per cent of females using oral contraceptives during 1973-82. Trends in oral contraceptive use are also presented by race, poverty level, rural-urban residence, marital status, and education level.
Epidemiologic evaluation of screening for risk factors: application to genetic screening.
Authors: Khoury M J , Newill C A , Chase G A
Published: November 2008

To assess the usefulness of screening for risk factors, we derived arithmetic relationships between screening parameters (sensitivity, specificity, and positive predictive value PPV) and risk factor frequency, disease frequency and relative risk. We evaluated these relationships in the special case of genetic markers and disease susceptibility. It can be shown that even in the face of very large relative risks, sensitivity and positive predictive value are affected by the relative magnitude of disease and genetic marker frequencies. When the genetic marker is less frequent than the disease, PPV increases with increasing relative risk but sensitivity remains low. When the genetic marker is more frequent than the disease, sensitivity increases with increasing relative risk but PPV remains low. When marker and disease frequencies are equal, both PPV and sensitivity increase with increasing relative risks, but very high relative risks (greater than 100) have to be obtained for rare diseases. Depending on the goals of the screening program, these relationships can be used to predict the relative magnitudes of false positives (low PPV) and false negatives (low sensitivity). This approach can be generalized to evaluate nongenetic risk factors in screening programs as well.
Self-management education of children with asthma: AIR WISE.
Authors: McNabb W L , Wilson-Pessano S R , Hughes G W , Scamagas P
Published: November 2008

This study was conducted to test the efficacy of AIR WISE, an individually administered asthma self-management program. Subjects were paired and randomly assigned to either an experimental group (N = 7) or a control group (N = 7). The frequency of experimental group emergency visits, analyzed over a 12-month posttreatment period, was substantially less than those of the control group, supporting the hypothesis that AIR WISE is effective in high-utilizer children through improved self-management.
Epidemiology of urinary tract infection: II. Diet, clothing, and urination habits.
Authors: Foxman B , Frerichs R R
Published: November 2008

Although several health habits and behaviors are commonly cited in medical and nursing textbooks as potential causes of urinary tract infection (UTI) in women, few have been studied in a systematic fashion. In a case-control study, we evaluated the associations between UTI and the most commonly mentioned risk factors: urination habits, diet, clothing, and soaps. Because sexual intercourse and diaphragm use increase the risk of UTI, we assessed the effect of health habits and behaviors controlling for these two risk factors. Women with initial UTI were compared with controls with no UTI history; women with a second UTI were compared to those with initial UTI. For the 25 initial cases, 19 secondary cases, and 181 controls enrolled in the study from a university health service, we found using tampons and drinking soft drinks to be moderately associated (RR greater than or equal to 1.4) with both initial and recurrent UTI. Although several other individual habits had only small associations with UTI, several of these behaviors together might substantially increase risk of initial or recurring UTI.
What participants understand about a maternal serum alpha-fetoprotein screening program.
Authors: Faden R R , Chwalow A J , Orel-Crosby E , Holtzman N A , Chase G A , Leonard C O
Published: November 2008

We investigated the knowledge of pregnant women participating in a maternal serum alphafetoprotein (MSAFP) screening program for the detection of neural tube defects (NTDs) in the fetus. Women participating in the screening program scored higher on two knowledge tests than a comparison group of pregnant women who were not offered screening. However, there were substantial gaps in the knowledge base of women in the program, as measured by one of the tests. Women did not misinterpret a negative test result to mean that the test had identified a potential problem with the fetus; instead, there is a suggestion that they tended to interpret a negative result too positively, as an assurance that the baby was healthy in all respects.
Measuring the accuracy of vital status data in cohort studies.
Authors: Fett M J
Published: November 2008

To measure the quality of vital status data in a retrospective cohort study of mortality among former servicemen of the Vietnam Conflict era, test subjects of independently determined vital status were included among study subjects during vital status ascertainment procedures. This allowed for differentiation between vital status "unknown" and incorrect assignment of vital status, and enabled measurement of the quality of both live and deceased vital status data. Four parameters based on sensitivity and specificity were used to express the quality of vital status data. The deceased specificity rate was 100 per cent, the deceased sensitivity rate was 95.7 per cent, the live specificity rate was 98.5 per cent, and the live sensitivity rate was 95.4 per cent. Using models of misclassification, the estimated death rate was found to be most sensitive to changes in the deceased specificity rate, indicating that emphasis should be given to minimizing incorrect ascertainment of truly alive subjects as deceased when developing vital status ascertainment procedures.
Diphtheria in the United States, 1971-81.
Authors: Chen R T , Broome C V , Weinstein R A , Weaver R , Tsai T F
Published: November 2008

After a decade-long resurgence, including a large cutaneous diphtheria outbreak in Washington State, the diphtheria incidence rate in the United States reached its lowest recorded level ever in 1980--two patients (0.01 case per million). Mortality paralleled the decline in incidence rate. Only 143 of the 3,141 US counties reported noncutaneous diphtheria patients during 1971-81; most were located in the West. The highest attack rates were experienced by children less than 15 years old (0.8 case per million) and by American Indians (22.6 cases per million). Persons immunized with three or more doses of diphtheria toxoid had a lower death-to-case ratio (1.3 per cent) than totally unimmunized persons (13.4 per cent). The reasons for the dramatic decline in diphtheria incidence rates are unclear, although it has been postulated that the gene for producing diphtheria toxin may be lost from organisms in highly immunized populations. Significant proportions of the adult and elderly populations are susceptible to diphtheria. Continuation of primary immunization with increased emphasis on the routine use of tetanus and diphtheria toxoids (Td) boosters in adults should ensure that diphtheria will remain largely a scourge of the past.
A priority system model for sanitation management in food service establishments.
Authors: Wodi B E , Mill R A
Published: November 2008

We set out to develop a sanitation management scheme that will enable health regulatory authorities to utilize available personnel more efficiently in the regulation of the food service industry given the current budgetary and manpower constraints. Previous analyses of the Annual Food Service Establishment Sanitation Inspection Summary records from a large County Department of Health for fiscal years 1979, 1980, and 1981 indicated a cut-off point at about two to four visits for a productive follow-up sanitation inspection of food service establishments. Revisits after this point seemed counter-productive. Revisits of up to 13 times in some establishments and a high uninspection rate of others were noted. The above data, the population at risk for each establishment (generated by a prescribed method), and various control criteria were integrated into the model. Application of the model to a sample of 82 food service establishments was successful in ensuring that those operations that pose high risk to patrons are given priority in a sanitation management program while also facilitating the inspection of all food service establishments within a jurisdiction at some point.
Prevalence of dental mottling in school-aged lifetime residents of 16 Texas communities.
Authors: Butler W J , Segreto V , Collins E
Published: November 2008

The severity of dental mottling in 2,592 school-aged, lifetime residents of 16 Texas communities was investigated in 1980-81 to identify factors associated with mottling and to construct a prediction model for the prevalence of mottling. The communities were selected to obtain a wide range of levels of fluoride in the drinking water. The children within each of the communities were contacted through their schools and received a dental examination to assess the severity of mottling. Information on demographic, dental health practice, and other candidate predictor variables was obtained from a questionnaire completed by a parent. A number of water quality measurements were also recorded for each community. White and Spanish-surname children had about the same prevalence of mottling while Blacks had a higher prevalence, odds ratio (OR) = 2.3, 95% confidence interval = 1.4, 3.7. Children from homes which had air conditioning had a lower prevalence of mottling (OR = .6, (0.4, 0.8)). The use of fluoride toothpaste or drops and the number of fluoride treatments were almost identical among those who did and did not develop moderate mottling. In addition to fluoride, total dissolved solids and zinc were water quality variables associated with mottling.
Determinants of medical record access for an epidemiologic study.
Authors: Savitz D A , Grace C
Published: November 2008

Hospital record access is often needed for epidemiologic research. In a recent study, 26 Denver-area hospitals were contacted for permission to review records. The review process, the decision regarding access, and hospital characteristics were analyzed. Hospitals with a review committee, larger hospitals, and those which reached a decision rapidly were most likely to grant access. These results may provide guidance to investigators planning studies requiring review of hospital records.
Epidemiology of human rabies post-exposure prophylaxis at the US Naval Facility, Subic Bay, Philippines.
Authors: Dembert M L , Lawrence W B , Weinberg W G , Granger D D , Sanderson R D , Garst P D , Eighmy J J , Wells T E
Published: November 2008

Data collected during 1984 from an active animal rabies surveillance system and human rabies post-exposure prophylaxis program at the US Naval Hospital, Subic Bay Naval Facility, Philippines revealed that potential rabies exposure, most commonly from dog bites or scratches, was reported for 311 US military and civilian personnel and four Filipino employees working on the facility. Seventy-nine persons (25 per cent) required complete post-exposure prophylaxis. Brain tissue from two captured dogs implicated in attacks was subsequently found to be positive for rabies antigen on fluorescent antibody testing.
The rise in medical care expenditures in Japan, trends in disease patterns: 1977-81.
Authors: Kawamura N , Gotoda Y , Yoshikura H
Published: November 2008

In Japan, the nationwide cost of medical care is increasing rapidly. Analysis of data from the Japanese health insurance system shows that costs are not rising for all diagnoses and that it is diseases requiring hospitalization and expensive medical treatments that have been responsible for the rising cost of medical care.
Smoking behavior among US Latinos: an emerging challenge for public health.
Authors: Marcus A C , Crane L A
Published: November 2008

In this paper we review evidence on smoking and lung cancer among Latinos, including findings from several unpublished studies and technical reports. Recent surveys of smoking behavior in California, Texas, and New Mexico indicate a notable sex difference in smoking among Latinos, with Latino males smoking at least as frequently as White males, while Latino females report smoking rates considerably lower than White females. Our analysis of the 1979 and 1980 National Health Interview Surveys corroborates this finding and also indicates that this pattern holds true for subgroups of the Latino population, including country of origin. Taken together, these findings suggest that among Latino males rates of lung cancer and other cigarette-linked diseases may increase in the near future.
Pattern of alcohol use associated with self-identified problem drinking.
Authors: Sanchez-Craig M , Israel Y
Published: November 2008

To estimate the pattern and level of alcohol consumption leading to problem drinking, the drinking histories of 70 early stage problem drinkers were examined. An average consumption of four drinks (54 g/ethanol), on an average of three days/week, was the pattern that best separated the phase when patients were problem free from the phase when their drinking led to problems.
The origins of American psychiatric epidemiology.
Authors: Grob G N
Published: November 2008

Psychiatric epidemiology developed relatively late (as compared with epidemiology generally). Nineteenth century psychiatrists, although avid collectors of statistics, did not use such data in any systematic manner. The impetus for the creation of an epidemiology of mental illness came from the work of late nineteenth century social scientists concerned with understanding individual and social behavior and applying their findings to social problems. Initially they helped to create the modern census, which represented a radical faith that quantitative research, when merged with administrative rationality, could replace politics. During and after the 1920s, the demographic analysis of the institutionalized mentally ill population expanded sharply; by the late 1930s and 1940s psychiatric epidemiologists had begun to study the role of socioenvironmental variables and the incidence of mental illness in the community. Twentieth century psychiatric epidemiologists, however, faced a severe intellectual problem; their work rested on a descriptive rather than an etiological nosology. Consequently, the results of epidemiological studies in psychiatry often differed precisely because of variations in the design of studies and classification systems as well as the subjective observations of the investigators themselves. The ensuing disagreements among those involved in the epidemiologic study of mental illness were a natural consequence.
A controlled evaluation of rural regional perinatal care: impact on mortality and morbidity.
Authors: Siegel E , Gillings D , Campbell S , Guild P
Published: November 2008

The impact of a rural regional perinatal care (RPC) program was assessed by a quasi-experimental, controlled, population-based design. Outcome measures included changes in five-year average fetal and neonatal mortality rates as well as short-term obstetric and newborn morbidity. Declines in fetal and neonatal as well as birthweight specific mortality rates were observed for both pilot and control regions, for both races, and especially for 1501-2500 g infants. However, comparisons of preprogram (1966-74) and postprogram (1975-80) average yearly changes showed no statistically significant differences between regions. While the incidence of prenatal morbidity was the same for both regions, intrapartum and newborn morbidity significantly favored the pilot region. These results were difficult to interpret. Program relevant implications of the findings in relation to rural RPC in North Carolina are discussed. Specific benefits appeared to be associated with the development of two high-risk maternity clinics and a Level II center capability in the pilot region. The importance of community support and public/private sector cooperation in relation to RPC is noted.
Waterborne disease in Colorado: three years' surveillance and 18 outbreaks.
Authors: Hopkins R S , Shillam P , Gaspard B , Eisnach L , Karlin R J
Published: November 2008

The Colorado Department of Health conducted intensive surveillance for waterborne diseases during the three-year period July 1, 1980-June 30, 1983. Eighteen outbreaks of waterborne illness were investigated. Outbreaks involved from 15 to 1,500 ill persons. Giardia lamblia was confirmed or suspected as the agent in nine outbreaks, rotavirus in one, and no agent could be identified in eight. Seventeen outbreaks occurred on surface-water systems; none of these had adequate chemical pretreatment and filtration. Investigation of water systems exhibiting positive coliform results during the first year detected no outbreaks. Activities important to effective surveillance included educational outreach programs to local health agencies, physicians and the public, and the designation of one individual to whom all water-related public complaints and health department inquiries were directed.
The cost and effectiveness of school-based preventive dental care.
Authors: Klein S P , Bohannan H M , Bell R M , Disney J A , Foch C B , Graves R C
Published: November 2008

The National Preventive Dentistry Demonstration Program assessed the cost and effectiveness of various types and combinations of school-based preventive dental care procedures. The program involved 20,052 first, second, and fifth graders from five fluoridated and five nonfluoridated communities. These children were examined at baseline and assigned to one of six treatment regimens. Four years later, 9,566 members of this group were examined again. Analyses of their dental examination data showed that dental health lessons, brushing and flossing, fluoride tablets and mouthrinsing, and professionally applied topical fluorides were not effective in reducing a substantial amount of dental decay, even when all of these procedures were used together. Occlusal sealants prevented one to two carious surfaces in four years. Children who were especially susceptible to decay did not benefit appreciably more from any of the preventive measures than did children in general. Annual direct per capita costs were $23 for sealant or fluoride prophy/gel applications and $3.29 for fluoride mouthrinsing. Communal water fluoridation was reaffirmed as the most cost-effective means of reducing tooth decay in children.
Home refinishing, lead paint, and infant blood lead levels.
Authors: Rabinowitz M , Leviton A , Bellinger D
Published: November 2008

We measured the blood lead levels of 249 infants semi-annually from birth to two years of age; we sampled the home paint and recorded any recent home refinishing activity. Mean blood lead from birth to age 2 years did not vary systematically with age but did correlate significantly with the amount of lead in the indoor paint (p less than .01). Refinishing activity in homes with high lead paint was associated with elevations of blood lead averaging 69 per cent.
Does a vegetarian diet reduce the occurrence of diabetes?
Authors: Snowdon D A , Phillips R L
Published: November 2008

We propose the hypothesis that a vegetarian diet reduces the risk of developing diabetes. Findings that have generated this hypothesis are from a population of 25,698 adult White Seventh-day Adventists identified in 1960. During 21 years of follow-up, the risk of diabetes as an underlying cause of death in Adventists was approximately one-half the risk for all US Whites. Within the male Adventist population, vegetarians had a substantially lower risk than non-vegetarians of diabetes as an underlying or contributing cause of death. Within both the male and female Adventist populations, the prevalence of self-reported diabetes also was lower in vegetarians than in non-vegetarians. The associations observed between diabetes and meat consumption were apparently not due to confounding by over- or under-weight, other selected dietary factors, or physical activity. All of the associations between meat consumption and diabetes were stronger in males than in females.
Epidemics in Renaissance Florence.
Authors: Morrison A S , Kirshner J , Molho A
Published: November 2008

Epidemics and mortality in 15th and 16th century Florence, Italy, were investigated by use of records of the government-sponsored Dowry Fund. These records contain the date of birth, date of investment, and date of dowry payment or death of 19,000 girls and women. Major epidemics ("plagues") occurred repeatedly. The most severe were in 1430, 1437-38, 1449-50, 1478-79, and 1527-31. Annual death rates of girls enrolled in the Dowry Fund increased by 5 to 10 times in each of these periods. During the last period, at least 20-25 per cent of the population of Florence is likely to have died. Recurrent epidemics accounted for 38 per cent of the total mortality experienced by girls enrolled in the Dowry Fund. The frequency of serious epidemics diminished with the passage of time, and overall mortality declined by about 10 per cent over the 15th and 16th centuries. Epidermic mortality was not consistently related to age. The effects of epidemics were most severe in the summer and autumn. Non-epidemic mortality was also greater in the summer and autumn than in the winter and spring.
Meningitis: describing the community health problem.
Authors: Skoch M G , Walling A D
Published: November 2008

We identified all 391 cases of meningitis hospitalized in a metropolitan community (population 367,094) over a four-year period to assess incidence, morbidity, and mortality. The crude incidence rate was 27 per 100,000 person years; the incidence rate for children under 5 years of age was 174 per 100,000 person years. The case fatality rate was 3 per cent. Bacterial organisms were identified in 33 per cent of all cases, with H. influenzae most commonly observed (53 per cent). Only 16 per cent of hospitalized cases were known to the county health department.
Asbestos disease in family contacts of shipyard workers.
Authors: Kilburn K H , Lilis R , Anderson H A , Boylen C T , Einstein H E , Johnson S J , Warshaw R
Published: November 2008

Radiologic signs of pulmonary asbestos disease were found in 11.3 per cent of 274 wives of shipyard workers who were 20 or more years from initial hiring-on in shipyards in Los Angeles County. Asbestosis was also found in 7.6 per cent of 79 sons and 2.1 per cent of 140 daughters of these workers. The wives, sons, and daughters were without occupational exposure. Comparable radiographic signs were not found in comparison groups. It is probable that asbestos exposure in the household places these family members at risk for mesothelioma and lung cancer.
Methodologic issues in evaluating stop smoking programs.
Authors: Midanik L T , Polen M R , Hunkeler E M , Tekawa I S , Soghikian K
Published: November 2008

Three methodologic issues (definitions of smoking, period of follow-up, composition of study group) were assessed in 426 persons five years after participation in a stop smoking program of a prepaid medical plan. When smoking was defined by measurement interval or by type or amount of tobacco smoked, smoking rates varied only slightly. Little information was gained by extending the follow-up period beyond the first year. However, study group composition (as defined by attendance at program sessions) had a pronounced effect on smoking rates. Those who attended fewer sessions were more likely to smoke during the follow-up period.
Hypertension prevalence among Penobscot Indians of Indian Island, Maine.
Authors: Deprez R D , Miller E , Hart S K
Published: November 2008

Prevalence of hypertension, measured on a random sample of Penobscot Indian adults on reservation in Maine, was 23 per cent. Only 50 per cent of the hypertensive Penobscots were aware of their condition. Among those treated with antihypertensive medications, 56 per cent were controlled. When compared to a statewide sample of Maine adults, the prevalence of hypertension among Penobscots was similar but awareness was significantly lower.