bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of nursing home admission in a biracial population.
Authors: Salive M E , Collins K S , Foley D J , George L K
Published: November 2008

Racial differences in predictors of institutionalization were studied in a biracial North Carolina cohort (n = 4074). During 3 years of follow-up, 8.5% of Whites and 6.4% of African Americans were admitted to nursing homes. African Americans were one half as likely as Whites to be institutionalized after adjustment for other risk factors. Among Whites, impaired activities of daily living and cognition were the strongest predictors; among African Americans, impaired instrumental activities of daily living and prior history of nursing home use were strongest. Racial differences in nursing home use were not explained by financial and social support or physical and cognitive impairment.
Firearms and health: the right to be armed with accurate information about the Second Amendment.
Authors: Vernick J S , Teret S P
Published: November 2008

An organized campaign by groups such as the National Rifle Association has sought to convince policymakers and others that the Second Amendment to the US Constitution grants an unfettered right to individuals to possess any firearm, free from federal or state regulation. Although advocates may debate the meaning that should be given to the Second Amendment, under the American legal system the meaning of any particular constitutional provision is determined by the controlling precedent of Supreme Court cases. Two cases, Presser v Illinois and United States v Miller, remain the Supreme Court's latest word on the meaning of the Second Amendment. In Presser, the Court held that the Second Amendment is applicable only to federal, not state, laws. In Miller and subsequent federal cases, any Second Amendment "right" to bear arms is closely linked to the preservation of state militias, upholding a variety of federal gun legislation. Unless the Supreme Court modifies or reverses its Presser and Miller decisions, health advocates should understand that the Second Amendment poses no obstacle to even broad gun control legislation.
The effects of intrauterine cocaine exposure in newborns.
Authors: Bateman D A , Ng S K , Hansen C A , Heagarty M C
Published: November 2008

OBJECTIVES. We sought to determine the effects of intrauterine cocaine exposure in newborns, in an inner-city population in which cocaine use during pregnancy was common. METHODS. During a 1-year period, 12.8% (361 of 2810) of all live singleton infants at Harlem Hospital in New York were identified as cocaine exposed, either by universal urine toxicologic screening or by maternal history. Cocaine-exposed infants were compared with a control group of 387 infants not known to be exposed to cocaine or other illicit drugs. RESULTS. Low birthweight (< 2500 g) was more common among cocaine-exposed infants (31% vs 10%), as was preterm birth (< 37 completed weeks of gestation) (32% vs 14%). In multivariate analyses controlled for demographic and life-style factors and duration of gestation, cocaine was associated with decreased birthweight (154 g), length (1.02 cm), head circumference (0.69 cm), and duration of gestation (0.74 weeks). The birthweight deficits were larger for infants born to mothers who used cocaine in combination with other drugs (195 g) and for infants born to mothers who specifically admitted using crack (200 g). CONCLUSIONS. Intrauterine cocaine exposure is linked with fetal growth retardation and shortened gestation in this population.
Left-handedness and mortality.
Authors: Salive M E , Guralnik J M , Glynn R J
Published: November 2008

We examined mortality associated with handedness in two ways. A simulation using national data suggests that lower mean age at death among left-handed persons, previously offered as evidence of higher mortality, can be explained exclusively by the age distribution of laterality. Second, empiric evidence from a 6-year cohort study of 3774 older adults from East Boston, Massachusetts, demonstrates that left-handedness is not associated with mortality (relative odds = 1.04, 95% confidence interval = 0.79, 1.36).
The nitrate contamination of private well water in Iowa.
Authors: Kross B C , Hallberg G R , Bruner D R , Cherryholmes K , Johnson J K
Published: November 2008

The State-Wide Rural Well-Water Survey was conducted between April 1988 and June 1989. About 18% of Iowa's private, rural drinking-water wells contain nitrate above the recommended health advisory level (levels of NO3-N greater than 10 mg/L); 37% of the wells have levels greater than 3 mg/L, typically considered indicative of anthropogenic pollution. Thirty-five percent of wells less than 15 m deep exceed the health advisory level, and the mean concentration of nitrate-nitrogen for these wells exceeds 10 mg/L. Depth of well is the best predictor of well-water contamination. Individually, NO3-N levels of more than 10 mg/L occurred alone in about 4% of the private wells statewide; pesticides were present alone in about 5%. Total coliform positives occurred alone at 27% of the sites. In a cumulative sense, these three contaminants were detected in nearly 55% of rural private water supplies.
Mental health service use by the elderly in nursing homes.
Authors: Burns B J , Wagner H R , Taube J E , Magaziner J , Permutt T , Landerman L R
Published: November 2008

OBJECTIVES. Because current Omnibus Budget Reconciliation Act regulations influence the disposition of US nursing home residents who have mental illness, National Nursing Home Survey (1985) data are analyzed for predictors of mental health service use. METHODS. Elderly residents' rates of mental health service use are presented. Logistic regression yielded odds ratios for treatment by both mental health specialists and general practitioners for client and service system variables. RESULTS. Among the two thirds of elderly residents with a mental disorder (including dementia), only 4.5% receive any mental health treatment in a 1-month period. The ratio of specialist to general practitioner care is approximately 1:1. Patients seen by a specialist are likely to be younger (aged 65 to 74); live in the Northeast; and have a diagnosis of schizophrenia (13:1), dementia (3:1), or other mental disorders (5:1). Prior residence in a psychiatric hospital predicts care by both health professional types. Rural location, nonproprietary ownership of the nursing home, and aggressive behavior point to general physician care. CONCLUSIONS. Our findings indicate significant neglect of the mental health needs of older nursing home residents and underscore the importance of monitoring the regulations for screening and treatment of mental disorders under the Omnibus Budget Reconciliation Act.
Expenditures in caring for patients with dementia who live at home.
Authors: Weinberger M , Gold D T , Divine G W , Cowper P A , Hodgson L G , Schreiner P J , George L K
Published: November 2008

OBJECTIVES. Given the national interest in progressive dementia, we estimated expenditures incurred in caring for dementia patients who live at home. METHODS. Primary caregivers of 264 patients from a university-based memory disorders clinic were interviewed at baseline and asked to keep service use diaries for 6 months; 141 caregivers who returned the diaries are the focus of this report. We examined both formal and informal services (distinguished by whether money was exchanged) and associated expenditures. RESULTS. Neither caregivers returning diaries nor their patients differed at baseline from those not returning diaries and their patients. Expenditures incurred over 6 months were extensive for both formal ($6986) and informal ($786) services. Out-of-pocket expenditures were high (e.g., in-home companion or sitter, adult day care, visiting nurse). Multivariable analyses indicated that patients with more severe symptoms of dementia and families with higher incomes reported significantly higher expenditures. CONCLUSIONS. The expense of caring for patients with progressive dementia living at home may be higher than previously estimated and frequently involves expenses paid directly by patients and their families.
Medicare patients' use of overpriced procedures before and after the Omnibus Budget Reconciliation Act of 1987.
Authors: Escarce J J
Published: November 2008

OBJECTIVES. Under the Omnibus Budget Reconciliation Act of 1987, Medicare reduced physician fees for 12 procedures identified as overprices. This paper describes trends in the use of these procedures and other physician services by Medicare patients during the 4-year period surrounding the implementation of the 1987 budget act. METHODS. Medicare physician claims files were used to develop trends in physician-services use from 1986 to 1989. Services were grouped into four categories: overpriced procedures, other surgery, medical care, and ancillary tests. RESULTS. Growth in the volume of overpriced procedures slowed substantially after the 1987 budget act was implemented. Moreover, the reduction in the rate of volume growth for these procedures differed little among specialities or areas. In comparison, the rate of volume growth fell modestly for other surgery, was unchanged for medical care, and increased for ancillary tests. CONCLUSIONS. Increases do not necessarily occur in the volume of surgical procedures whose Medicare fees are reduced. Although the conclusions that may be drawn from a descriptive analysis are limited, these findings suggest that concerns that the resource-based Medicare fee schedule will lead to higher surgery rates may be unwarranted.
Primary care and public emergency department overcrowding.
Authors: Grumbach K , Keane D , Bindman A
Published: November 2008

OBJECTIVES. Our objective was to evaluate whether referral to primary care settings would be clinically appropriate for and acceptable to patients waiting for emergency department care for nonemergency conditions. METHODS. We studied 700 patients waiting for emergency department care at a public hospital. Access to alternative sources of medical care, clinical appropriateness of emergency department use, and patients' willingness to use nonemergency services were measured and compared between patients with and without a regular source of care. RESULTS. Nearly half (45%) of the patients cited access barriers to primary care as their reason for using the emergency department. Only 13% of the patients waiting for care had conditions that were clinically appropriate for emergency department services. Patients with a regular source of care used the emergency department more appropriately than did patients without a regular source of care. Thirty-eight percent of the patients expressed a willingness to trade their emergency department visit for an appointment with a physician within 3 days. CONCLUSIONS. Public emergency departments could refer large numbers of patients to appointments at primary care facilities. This alternative would be viable only if the availability and coordination of primary care services were enhanced for low-income populations.
Treating measles: the appropriateness of admission to a Wisconsin children's hospital.
Authors: Havens P L , Butler J C , Day S E , Mohr B A , Davis J P , Chusid M J
Published: November 2008

OBJECTIVE. A large number of children with measles were hospitalized at a children's hospital during a metropolitan measles outbreak. In this study we addressed the appropriateness of those admissions. METHODS. Charts of all 634 patients with a diagnosis of measles who were treated between August 1989 and April 1990 were reviewed. Determination of the appropriateness of hospital admission was based on severity of illness and presence of severe complications of measles. RESULTS. Of 564 patients with clinical measles or serologic evidence of recent infection, 252 were inpatients (median age 1.5 years) and 312 were outpatients (median age 2.1 years). Fifty-nine (23.4%) of the inpatients had been inappropriately admitted. Inpatients were significantly more likely than outpatients to have physiologic instability or a clinical complication. Children 15 months of age or younger were more likely to be hospitalized, as were children evaluated in the first 3 months of the outbreak period, even if admission was not appropriate on the basis of physiologic instability or complications. CONCLUSIONS. Younger patients with measles and patients evaluated earlier in the epidemic were more likely to be admitted to the hospital even when admission was inappropriate as assessed by degree of physiologic instability or presence of complications.
A work-site nutrition intervention: its effects on the consumption of cancer-related nutrients.
Authors: Hebert J R , Harris D R , Sorensen G , Stoddard A M , Hunt M K , Morris D H
Published: November 2008

OBJECTIVES. In a work-site nutrition intervention targeting fat and fiber, we examined the intervention's effect on specific nutrients implicated in carcinogenesis, including trace metals, vitamins, and categories of fatty acids. The rationale was based on the association observed in a variety of epidemiologic studies between these nutrients and epithelial cancers. METHODS. Data were taken from eight control companies and five intervention companies that fully implemented the Treatwell intervention. Analyses of variance were used preserving the study's nested design. RESULTS. Significant intervention-related associations were observed for increased total vitamin A and carotene. Marginal intervention effects were observed for relative decreases in the percentage of calories from both saturated and monounsaturated fatty acids, a relatively smaller increase in the percentage of calories from polyunsaturated fatty acids, and an increase in the consumption of vitamin B6. CONCLUSIONS. Results indicate a broader effect of the intervention than on fat and fiber only. Increased intake of carotene, the single most important of these other nutrients, is plausibly related to a variety of epithelial cancers.
The Healthy Worker Project: a work-site intervention for weight control and smoking cessation.
Authors: Jeffery R W , Forster J L , French S A , Kelder S H , Lando H A , McGovern P G , Jacobs D R , Baxter J E
Published: November 2008

OBJECTIVES. A randomized trial was conducted to evaluate the effectiveness of a work-site health promotion program in reducing obesity and the prevalence of cigarette smoking. METHODS. Thirty-two work sites were randomized to treatment or no treatment for 2 years. Treatment consisted of health education classes combined with a payroll-based incentive system. Evaluation was based on cohort and cross-sectional surveys. RESULTS. Of 10,000 total employees in treatment work sites, 2041 and 270 participated in weight control and smoking cessation programs, respectively. Weight losses averaged 4.8 lbs, and 43% of smoking participants quit. Net 2-year reductions in smoking prevalence in treatment vs control work sites were 4.0% and 2.1% in cross-sectional and cohort surveys, respectively. No treatment effect was found for weight. Treatment effects for smoking prevalence and weight were both positively correlated with participation rates in the intervention programs (r = .45 for smoking and r = .55 for weight). CONCLUSIONS. This work-site health promotion program was effective in reducing smoking prevalence at a cost that is believed to make the investment worthwhile.
The initial impact of a workplace lead-poisoning prevention project.
Authors: Bellows J , Rudolph L
Published: November 2008

The California Department of Health Services began an occupational lead poisoning prevention project in cooperation with 275 radiator service companies. The agency developed and marketed resources to facilitate companies' own efforts, tracked the progress of each company, and urged the companies to conduct blood lead testing. Testing by participating employers increased from 9% to 95%, and 10 times as many companies with likely overexposures were identified as had been reported to the state's lead registry in the previous year. The success of this project indicates that the model should be applied more extensively.
Is access to home health care a problem in rural areas?
Authors: Kenney G M
Published: November 2008

In 1987, urban Medicare beneficiaries were 13.7% more likely than their rural counterparts to use Medicare home health care services. Regression analysis shows that rural use rates, particularly those in sparsely populated areas, fall short of those in urban areas, other things being equal. Rural areas have lower Medicare ceilings, proportionately fewer visiting nurse associations, and lower availability of auxiliary services. These factors combined account for 82% of the difference between rural and urban use rates.
Commentary: condoms and HIV/STD prevention--clarifying the message.
Authors: Roper W L , Peterson H B , Curran J W
Published: November 2008

In the United States and throughout the world, the majority of human immunodeficiency virus (HIV) infections are sexually transmitted. an estimated 12 million other sexually transmitted diseases occur annually in the United States. Avoiding sexual intercourse altogether or restricting sex to partners known to be uninfected will prevent infection; this needs to be promoted as the most effective strategy. Studies show that correct and consistent use of latex condoms is highly effective in preventing sexually transmitted HIV infection and other sexually transmitted diseases. The effectiveness of condoms depends on individual behavior leading to correct and consistent use. Further studies are needed to maximize the use and effectiveness of condoms for those who choose to be sexually active as well as to develop and evaluate other methods, particularly those more under the control of women. In the interim, our prevention message should be clear: When used correctly and consistently, condoms are highly effective; when used otherwise, they are not.
AIDS trends among Hispanics in the United States.
Authors: Diaz T , Buehler J W , Castro K G , Ward J W
Published: November 2008

OBJECTIVES. In 1991 the incidence of acquired immunodeficiency syndrome (AIDS) in the United States was 31.6 per 100,000 population among Hispanics and 11.8 per 100,000 among non-Hispanic Whites. The purpose of this study was to further describe the AIDS epidemic among Hispanics by examining differences in risk factors among different Hispanic groups (as defined by birthplace). METHODS. AIDS cases reported to the Centers for Disease Control and Prevention from 1988 through 1991 were reviewed. RESULTS. For men, except for those born in Puerto Rico, the predominant exposure category was male-male sex. The proportion of cases due to injection drug use was 35% among Hispanic men born in the United States, 27% among men born in the Dominican Republic, and 61% among men born in Puerto Rico, but < 10% among other Hispanic men and non-Hispanic White men. For women the predominant exposure category was injection drug use among Hispanics born in the United States (56%) and Puerto Rico (46%) and among non-Hispanic Whites (42%). The proportion of cases associated with injection drug use was significantly lower (< 30%) among other Hispanic women. CONCLUSIONS. AIDS prevention strategies must be geared toward different exposure categories among different Hispanic groups.
Sentinel surveillance for HIV-2 infection in high-risk US populations.
Authors: Onorato I M , O'Brien T R , Schable C A , Spruill C , Holmberg S D
Published: November 2008

OBJECTIVES. We conducted sentinel surveillance in persons practicing behaviors known to transmit retroviruses to determine the US presence and extent of human immunodeficiency virus type 2 (HIV-2). METHODS. Sentinel surveillance for HIV-2 was conducted by testing 31,533 anonymous blood specimens from patients at sexually transmitted disease clinics, injecting drug users at treatment centers, and clients at HIV counseling and testing sites in 14 US cities where West African immigrants often settle. Specimens were tested by HIV-1 and HIV-2 whole virus and synthetic peptide enzyme immunoassay and confirmed by HIV-1 and HIV-2 Western blots. RESULTS. Nearly 10% of 31,533 sera were positive for HIV-1. Two heterosexual Black male sexually transmitted disease patients were infected with HIV-2. One of the HIV-2 positive specimens did not cross-react on HIV-1 enzyme immunoassay screening. One client had antibodies consistent with malarial infection in West Africa; the other, who had syphilis, did not have antibodies to malaria or to any of 20 arboviruses present in Africa. CONCLUSIONS. Clinics serving clients from HIV-2 endemic areas should test persons practicing risk behaviors for both HIV-1 and HIV-2. Sentinel surveillance for HIV-2 serves as an early warning system for the possible spread of this virus in the United States.
American adults' knowledge of HIV testing availability.
Authors: Valdiserri R O , Holtgrave D R , Brackbill R M
Published: November 2008

OBJECTIVES. Understanding client needs, knowledge, and preferences about services is necessary to ensure that human immunodeficiency virus (HIV) counseling and testing programs are accessible. This study addressed knowledge of HIV testing availability. METHODS. To study American adults' knowledge of HIV testing availability, we collected data during 1990 by random digit-dialing telephone surveys of adults residing in 44 states and the District of Columbia. RESULTS. Of the 81,557 persons who responded, almost two thirds identified medical doctors as a source of HIV testing. Fourteen percent identified public sites, and 12% said they didn't know where to go for HIV testing. Persons who were older, less educated, and had lower incomes were less likely to know where they could go for testing. Persons identifying public sites shared some characteristics with others who lacked adequate health care coverage. CONCLUSIONS. Physicians will be increasingly called upon to provide HIV counseling and testing to their patients. This may require additional training to provide effective, individualized, risk-reduction messages about sexual and drug use behaviors. Even when persons have adequate information about availability, sociodemographic characteristics are likely to influence preferences for HIV counseling and testing.
A new approach to combatting iodine deficiency in developing countries: the controlled release of iodine in water by a silicone elastomer.
Authors: Fisch A , Pichard E , Prazuck T , Sebbag R , Torres G , Gernez G , Gentilini M
Published: November 2008

OBJECTIVES. Four hundred million people or more may be exposed to iodine deficiency worldwide, in developing countries in particular. Because of the practical problems with existing methods for the large-scale prevention of iodine deficiency, the authors developed a new approach to collective prophylaxis. METHODS. This approach relies on the controlled diffusion of iodine into water from a silicone elastomer. Silicone matrices installed in a bore well released iodine at a rate sufficient to permit the daily per capita intake of at least 100 micrograms of iodine, the amount recommended by the World Health Organization. The matrices were tested over 1 year in a village in Mali, West Africa, an area in which goiter was highly endemic. The effects on the well water and population were compared with those of a placebo system in a control village. RESULTS. An increase in urinary iodine levels was observed in the treated population, and after 12 months the incidence of goiter had fallen from 53.2% to 29.2%. CONCLUSIONS. This new concept, adaptable to all sources of water supply, may contribute to the eradication of iodine deficiency.
Vitamin and mineral supplement use and mortality in a US cohort.
Authors: Kim I , Williamson D F , Byers T , Koplan J P
Published: November 2008

OBJECTIVES. Vitamin and mineral supplementation is a common practice in the United States, yet little is known about the long-term health effects of regular supplement use. METHODS. To examine the relationship between reported use of supplements and mortality, we analyzed data from US adults 25 to 74 years of age who were examined in the First National Health and Nutrition Examination Survey (1971 to 1975), with vital status determined through 1987. RESULTS. At baseline, 22.5% of the cohort reported using supplements regularly and 10.0% reported irregular use. The risk of mortality for regular supplement users was similar to that for nonusers. No consistent mortality benefits or risks of supplement use were found across a number of population subgroups. The risk for those who reported supplement use at both the baseline and a follow-up interview approximately 10 years later was similar to the risk for those who reported not using supplements at either interview. CONCLUSIONS. We found no evidence of increased longevity among vitamin and mineral supplement users in the United States. Considering the wide use of supplements in the general population, the cost-effectiveness and the safety of supplement use need to be better defined.
Activating communities for health promotion: a process evaluation method.
Authors: Wickizer T M , Von Korff M , Cheadle A , Maeser J , Wagner E H , Pearson D , Beery W , Psaty B M
Published: November 2008

OBJECTIVES. To date, evaluations of community-based prevention programs have focused on assessing outcomes, not the process of organizing communities for health promotion. An approach was developed to analyze community organization efforts aimed at advancing community health objectives. These organizational processes are referred to as community activation. METHODS. Information was gathered from 762 informants through a key informant survey conducted in 28 western communities. The data collected included informant ratings of community activation and information about interorganizational activities analyzed through network analytic techniques. RESULTS. Activation levels, as measured by informant ratings, varied across communities. Program coordination, as measured by network analysis, occurred, on average, approximately 30% of the time. Higher income communities tended to be more activated than lower income communities. CONCLUSIONS. There is a widely recognized need for improved information about health-related community organization activities. It appears possible to gather such information through key informant surveys and to develop measures of community organization status that can be used in the evaluation of community health promotion programs.
The dual epidemics of tuberculosis and AIDS: ethical and policy issues in screening and treatment.
Authors: Bayer R , Dubler N N , Landesman S
Published: November 2008

As the recent increase in cases of tuberculosis is addressed, there is a danger that the need for increased protection of the public health will create a climate in which the rights of individuals with tuberculosis and human immunodeficiency virus (HIV) infection may be disregarded. This paper considers ethical and policy issues in the control of tuberculosis. The authors conclude that mandatory HIV testing is not critical to effective tuberculosis control, and that although individuals infected with HIV are at increased risk for developing tuberculosis, exclusionary employment practices are not justified. Because failure to complete the course of tuberculosis treatment increases the prospect that drug-resistant strains will develop, it is crucial to require all those who commence treatment to complete their therapy. To ensure the completion of treatment, special attention must be paid to the needs of the homeless, drug users, and those with psychiatric impairments. In addition, all tuberculosis patients should begin their posthospital care under direct observation. Patients who fail to complete treatment despite efforts to encourage and facilitate their cooperation should be subject to confinement after a hearing with full due process protections.
Automobile driver fatalities in frontal impacts: air bags compared with manual belts.
Authors: Zador P L , Ciccone M A
Published: November 2008

OBJECTIVES. The effectiveness of air bags was estimated in this study by comparing driver fatalities in frontal crashes with driver fatalities in nonfrontal crashes, for cars with air bags and manual belts and cars with manual belts only. METHODS. Fatal Accident Reporting System data for drivers fatally injured during 1985 to 1991 in 1985 to 1991 model year cars that were equipped with air bags in or before model year 1991 were analyzed. RESULTS. Driver fatalities in frontal crashes in air bag cars were 28% lower than those in comparable cars with manual belts only. This percentage was used for estimating the overall fatality reduction in air bag cars. The reduction was greater in large cars (50%) than in midsize cars (19%) or in small cars (14%). Air bags reduced driver fatalities in frontal crashes involving ejection by about 9%. Fatalities in frontal crashes among drivers who were reportedly using manual belts at the time of the crash were reduced by about 15%. The comparable reduction among drivers who were reportedly not using manual belts was 31%. CONCLUSION. It was estimated that air bags reduced the total number of all driver fatalities by about 19%.
Bicycle helmet laws and educational campaigns: an evaluation of strategies to increase children's helmet use.
Authors: Dannenberg A L , Gielen A C , Beilenson P L , Wilson M H , Joffe A
Published: November 2008

OBJECTIVES. The passage of a mandatory bicycle helmet law for children in Howard County, Maryland, provided an opportunity to compare legislation and education as strategies to increase helmet use. METHODS. In 1991, a survey was mailed to fourth-, seventh-, and ninth-grade students attending a stratified sample of public schools in Howard County and in two similar suburban/rural counties without helmet laws. RESULTS. Of 7217 students surveyed, 3494 responded (48.4%). Self-reported helmet use in Howard County rose from 11% to 37% after the law and accompanying educational campaign went into effect. Helmet use changed from 8% to 13% in Montgomery County, where educational efforts were undertaken, and from 7% to 11% in Baltimore County, where helmet promotion activities were minimal. Predictors of helmet use included having friends who wore helmets, believing helmet laws are good, being in fourth grade, living in Howard County, and using seatbelts regularly. CONCLUSIONS. Legislation combined with education appears to increase bicycle helmet use substantially more than does education alone. The Howard County law may be considered a successful model of a strategy to increase children's helmet use.
Occupational injury deaths in Alaska's fishing industry, 1980 through 1988.
Authors: Schnitzer P G , Landen D D , Russell J C
Published: November 2008

OBJECTIVES. Studies from other countries have identified fishing as a hazardous industry, but little is known about occupational injury mortality related to fishing in the United States. Alaska was chosen for this study because approximately 45,000 people annually participate in Alaska's fishing industry and fishing is thought to be a major contributor to occupational injury mortality in the state. METHODS. Work-related injury deaths in Alaska's fishing industry were identified by means of death certificates and US Coast Guard mortality data. Fatality rates were calculated by using average annual fishing industry employment estimates. RESULTS. The 5-year average annual fishing-related fatality rate was 414.6 per 100,000 fishermen. The majority of the decedents were Caucasian men who drowned while fishing. CONCLUSIONS. This study emphasizes that fishing is a dangerous industry in Alaska and demonstrates the benefit of using multiple data sources to identify fishing-related deaths in the state.
Hip fracture rates in Hong Kong and the United States, 1988 through 1989.
Authors: Ho S C , Bacon W E , Harris T , Looker A , Maggi S
Published: November 2008

OBJECTIVES. Prior studies have suggested that hip fracture rates are substantially lower in Asian countries than in the United States. However, comparisons have been limited by unavailability of recent data, differences in case definition, lack of data from similar time periods, and small sample sizes. This study sought to examine trends by age and sex, with separate statistics for those aged 85 or older. METHODS. Hospital discharge data were used to obtain hip fracture incidence in Hong Kong and the United States from 1988 through 1989. RESULTS. Within each population, women had higher hip fracture rates than men. Fracture rates in the United States were significantly higher for both sexes than rates in Hong Kong. For persons over the age of 80, rates of hip fracture among White US males exceeded those for Hong Kong women. Inclusion of transferred cases in hip fracture rates minimized differences between the countries. CONCLUSIONS. Despite increasing hip fracture rates in Hong Kong, those rates are still substantially lower than the rates in the United States. Identifying factors responsible for this variation may prove useful in the search for preventive strategies.
Factors affecting gay and bisexual men's decisions and intentions to seek HIV testing.
Authors: Myers T , Orr K W , Locker D , Jackson E A
Published: November 2008

OBJECTIVES. This paper describes the relationships of sociodemographic, attitudinal, and behavioral variables to (1) decision to be tested, (2) expressed intention to be tested, and (3) reasons for not being tested for the human immunodeficiency virus (HIV) antibody. METHODS. A sample of 1295 men completed an anonymous questionnaire in gay-identified venues. Factor analysis was used to group reasons for not being tested and logistic and multiple linear regression were used to model the dependent variables. RESULTS. Fifty-three percent of the respondents had been tested, of whom 26% tested positive. Metropolitan residence and anal intercourse most strongly correlated with previous test-seeking. Previous test experience correlated most strongly with intention to be tested. Reasons for not being tested fell into three groups: (1) desire for anonymity, (2) self-perceived health, and (3) no benefit and denial. The odds were lower for gay men than bisexuals and men who did not participate in anal intercourse to express a desire for anonymity. CONCLUSIONS. Public health agencies should be prepared to individualize testing policies and education to deal with specific concerns and fears. Improving access to the test by removing some of the current psychological and physical barriers will enhance its medical and public health value.
Pregnancy and contraception use among urban Rwandan women after HIV testing and counseling.
Authors: Allen S , Serufilira A , Gruber V , Kegeles S , Van de Perre P , Carael M , Coates T J
Published: November 2008

OBJECTIVES. This study examined hormonal contraceptive use and pregnancy in urban Rwandan women, following human immunodeficiency virus (HIV) antibody testing and counseling. METHODS. A sample of 1458 childbearing urban Rwandan women aged 18 to 35 years was tested and followed for 2 years. RESULTS. At enrollment, 17% of 998 HIV-negative women and 11% of 460 HIV-positive women were pregnant, and 17% vs 23%, respectively, were using hormonal contraceptives. One year later, half of the HIV-positive and one third of the HIV-negative hormonal-contraceptive users had discontinued use. The 2-year incidence of pregnancy was 43% in HIV-positive and 58% in HIV-negative women. HIV-positive women with fewer than four children were more likely to become pregnant than those with four or more; this association persisted in multivariate analyses but was not noted among HIV-negative women. At the end of the study, over 40% of non-users said that they would use hormonal contraception if it was provided at the study clinic, but 40% of HIV-positive women desired more children. CONCLUSIONS. Research is needed to identify the practical and psychosocial obstacles to effective long-term contraception among HIV-positive women. HIV counseling programs must specifically address the issue of childbearing.
Treatment for glaucoma: adherence by the elderly.
Authors: Gurwitz J H , Glynn R J , Monane M , Everitt D E , Gilden D , Smith N , Avorn J
Published: November 2008

OBJECTIVES. The purpose of this study was to determine the extent of nonadherence to treatment for glaucoma among elderly patients. METHODS. This was a retrospective cohort study of 2440 patients older than age 65 who were enrolled in the New Jersey Medicaid Program and who were newly initiated on a topical agent for the treatment of glaucoma. Two patient-specific measures of nonadherence were employed: (1) no filled prescription for any glaucoma medication over a 12-month period after the initiation of therapy and (2) number of days without therapy for glaucoma during this 12-month period. RESULTS. By the first measure, 569 patients (23%) were found to be nonadherent. The mean number of days without therapy during the study year was 112. Factors associated with nonadherence included the use of glaucoma medication requiring more than 2 administrations per day and the presence of multiple other medications in the patient's drug regimen. Patients started on multiple glaucoma medication were more adherent than those started on a single agent. Age and sex were not found to be predictors of nonadherence. CONCLUSIONS. Substantial nonadherence was found to be common in this population. More attention to the issue of nonadherence could result in important benefits in the preservation of sight.
The risk of childhood injury on Boston's playground equipment and surfaces.
Authors: Bond M T , Peck M G
Published: November 2008

The Childhood Injury Prevention Program of the Boston Department of Health and Hospitals conducted a survey of injury risk in Boston's playgrounds. A standardized checklist was used to assess a 25% sample of public playgrounds for hazards. Climbers accounted for 34% of the hazards observed and had the greatest proportion of significant hazards. The surfacing material in 100% of the playgrounds observed was unsafe. Urban children risk exposure to hazardous playground equipment frequently situated above unsafe surfacing material.
Surface-specific fall injury rates on Utah school playgrounds.
Authors: Sosin D M , Keller P , Sacks J J , Kresnow M , van Dyck P C
Published: November 2008

The purpose of this study was to estimate surface-specific rates of fall injuries on school playgrounds. Playground injuries related to falls from climbing equipment and the surfaces involved were identified from injury reports for 1988 to 1990 from 157 Utah elementary schools. Enrollment data and playground inspections were used to estimate student-years spent over each surface. The fall injury rates per 10,000 student-years were asphalt, 44; grass, 12; mats, 16; gravel, 15; and sand, 7. These data did not show that impact-absorbing surfaces reduce fall injuries on playgrounds better than grass. Improved field studies are needed to guide policy decisions for playground surfacing.
Hip fracture incidence before and after the fluoridation of the public water supply, Rochester, Minnesota.
Authors: Jacobsen S J , O'Fallon W M , Melton L J
Published: November 2008

Recent ecological comparison studies have suggested a positive association between fluoridation and hip fracture. Using data from the Rochester Epidemiology Project, we found the incidence of hip fracture for the 10 years before the fluoridation of the Rochester, Minn, public water supply was 484 per 100,000, compared with 450 per 100,000 in the following 10 years. When the effects of calendar time and age were controlled for, the relative risk associated with fluoridation was 0.63. These ecologic trend data suggest that the fluoridation of public water supplies is not associated with an immediate increase in rates of hip fracture. Further studies of this association at the individual level are clearly required before public policy decisions can be made.
New York City's tuberculosis control efforts: the historical limitations of the "war on consumption".
Authors: Lerner B H
Published: November 2008

New York City began America's first campaign to control tuberculosis in 1893, and the disease declined until the 1970s. Throughout the 20th century, New York relied on three control strategies: screening, supervised therapy, and detention of noncompliant persons. Officials consistently identified the persistent foci of tuberculosis to be minorities and the poor, and they concentrated efforts among these populations. Recently, however, in the setting of rising human immunodeficiency virus infection and homelessness, tuberculosis--including multidrug-resistant strains--has returned to New York with a vengeance. Tuberculosis control in the city has been limited by two problems that hamper many public health programs: (1) antituberculosis measures, while appropriately targeting the poor, have been inconsistently funded and poorly coordinated; and (2) efforts have emphasized detection and treatment of individual cases rather than improvement of underlying social conditions. Renewed efforts by New York and other cities must address these limitations.
High-density lipoprotein cholesterol and alcohol consumption in US white and black adults: data from NHANES II.
Authors: Linn S , Carroll M , Johnson C , Fulwood R , Kalsbeek W , Briefel R
Published: November 2008

OBJECTIVES. High-density lipoprotein (HDL) cholesterol is known to be positively related to moderate alcohol consumption from studies in selected populations. This study describes the association in a representative sample of the US adult population. METHODS. Stratification and multivariate regression analyses were used to examine HDL cholesterol levels and alcohol consumption. RESULTS. Fewer women than men reported consumption of alcohol at any frequency. Similar percentages of Whites and Blacks reported alcohol consumption. Age-adjusted mean HDL cholesterol levels were higher among alcohol drinkers than among nondrinkers in all sex-race strata. Mean HDL cholesterol levels of Whites and Blacks of both sexes increased consistently with increased frequency of consumption of beer, wine, and liquor. With age, education, body mass index, smoking, and physical activity controlled for, there were higher age-adjusted HDL cholesterol levels with increasing reported quantities of alcohol consumed. Daily or weekly use of alcohol led to an increase of 5.1 mg/dL in mean HDL cholesterol level, whereas consumption of 1 g of alcohol led to an increase of 0.87 mg/dL. CONCLUSION. Even if there is a causal association between alcohol consumption and higher HDL cholesterol levels, it is suggested that efforts to reduce coronary heart disease risks concentrate on the cessation of smoking and weight control.
Alcohol and drug problems among diverse health and social service populations.
Authors: Weisner C , Schmidt L
Published: November 2008

OBJECTIVES. This study responds to clinical and research interest in identifying alcohol- and drug-related problems in health and social service agency populations. These problems are associated with a variety of illnesses and social problems, and community agencies serve important screening functions. METHODS. Indicators of problematic alcohol and drug use are compared across representative samples of clients within a county's alcohol, mental health, and drug treatment systems; hospital emergency rooms; primary health clinics; criminal justice and welfare systems; and general population. RESULTS. Agencies followed a consistent rank ordering in the prevalence of substance abuse indicators. Highest prevalences were found in the populations of behavioral health agencies, including alcohol, drug, and mental health treatment facilities and criminal justice, followed by welfare agencies. General medical agencies served populations with the lowest prevalence and problem severity. CONCLUSION. Health and social service agencies provide significant opportunities for the screening and referral of individuals with problematic alcohol and drug use. Although behavioral agencies have higher potential for referral and intervention, general medical services may be more effective in conducting prevention and early case-finding activities.
Level of education and alcohol abuse and dependence in adulthood: a further inquiry.
Authors: Crum R M , Helzer J E , Anthony J C
Published: November 2008

OBJECTIVES. Prospectively gathered data were used to reexamine and to strengthen previously described observations about education and the risk of alcohol abuse and dependence. The hypothesis was that individuals who dropped out of high school and those who entered college but failed to get a college degree might be at increased risk for an alcohol disorder. METHODS. Study subjects were selected between 1980 and 1984 by taking probability samples of roughly 3000 adult household residents at each of the five Epidemiologic Catchment Area Program survey sites. To assess the occurrence of psychiatric conditions, staff administered the Diagnostic Interview Schedule soon after sampling and again at follow-up, roughly 1 year later. RESULTS. Individuals who had dropped out of high school were 6.34 times more likely to develop alcohol abuse or dependence than were individuals with a college degree. For those who had entered college but failed to achieve a degree, the estimated relative risk was 3.01. To extend these analyses, estimates for annual incidence were calculated, and an exploratory evaluation of interaction is presented. CONCLUSIONS. If these findings can be replicated, they should help identify subgroups at higher risk for the development of alcohol disorders.
Cardiovascular diseases in a Canadian Arctic population.
Authors: Young T K , Moffatt M E , O'Neil J D
Published: November 2008

OBJECTIVES. The purpose of this study was to review cardiovascular mortality, morbidity, and risk factors in the multiethnic population of the Northwest Territories, Canada. METHODS. We analyzed death certificates and hospital records, and used a community health and examination survey. RESULTS. The age-standardized mortality rate for ischemic heart disease (but not for other heart diseases or stroke) among the Northwest Territories population was lower than among the Canadian population. Among the indigenous Inuit/Eskimos and Indians, the age-standardized mortality rate for all circulatory diseases was lower than Canadians. Among Indian women, the rate approached the Canadian rate and exceeded that of Inuit and non-Natives. Compared with residents of Manitoba, Northwest Territories Inuit adults had a higher prevalence of smoking in all age-sex groups. Obesity was prevalent among older Inuit women and hypertension among young Inuit men. Except for women aged 25 to 44, the total cholesterol and triglyceride levels among Inuit were lower than or not different from Manitoba residents. Relatively high levels of high-density lipoprotein were found in older Inuits. CONCLUSIONS. The epidemiologic pattern of cardiovascular diseases in Arctic Canada differs from that among non-Native, southern Canadians. Rapid sociocultural changes may alter the situation, and health agencies must anticipate such transitions and intensify culturally appropriate control programs.
Moderate drinking and coronary heart disease mortality: evidence from NHANES I and the NHANES I Follow-up.
Authors: Coate D
Published: November 2008

Data from the National Health and Nutrition Examination Survey, conducted from 1971 through 1974, and the National Health and Nutrition Examination Survey Follow-up, conducted from 1982 through 1984, were used to test for a beneficial effect of moderate alcohol consumption on coronary heart disease mortality among White men and women. Evidence of such an effect was found for White men; accelerated time-to-failure models showed 3% to 4% longer life spans for moderate drinkers than for nondrinkers or light drinkers.