bluuebunny/crossref_metadata_2025 huggingface dataset:
Targeted HIV screening at a Los Angeles prenatal/family planning health center.
Authors: Fehrs L J , Hill D , Kerndt P R , Rose T P , Henneman C
Published: November 2008

In 1988, the Los Angeles County Health Department conducted a blinded human immunodeficiency virus (HIV) seroprevalence study at a public prenatal (PN) and family planning (FP) center serving mostly Hispanic women in order to determine seroprevalence and to evaluate the center's targeted HIV screening program. Four women (0.13 percent) tested positive (3/1801 PN and 1/1167 FP). Three reported no risk factors; one reported a history of syphilis since 1978. Voluntary HIV testing was selectively offered to women who reported risk factors for HIV infection. Only 14 percent (96/685) of clients offered testing chose to do it: 28 percent (14/50) of clients classified as being at highest risk of infection, and 27 percent (16/59) of women who judged themselves to have some chance of being exposed to HIV. None of the four women who tested positive by blinded testing chose testing. While few women at this center were infected with HIV, higher risk women were not persuaded to be tested through a targeted screening program. Blinded HIV seroprevalence studies provide a tool for both tracking infection in a population and evaluating screening programs.
HIV infection in an Ethiopian prison.
Authors: Kebede Y , Pickering J , McDonald J C , Wotton K , Zewde D
Published: November 2008

HIV-1 antibody was detected in 6.0 percent of prisoners in an Ethiopian prison. HIV-1 seropositivity was strongly associated with positive VDRL status (RR = 3.7) and recent admission to prison (RR = 3.5). Seropositive prisoners were more likely to have prostitute contacts. No correlation was found between seropositivity and number of sexual contacts, long-term sex partners, or dental extractions. HIV-1 infection in this area may be of recent origin and the high prevalence may reflect rates in the surrounding community.
The donation and sale of blood by intravenous drug users.
Authors: Chitwood D D , Page J B , Comerford M , Inciardi J A , McCoy C B , Trapido E , Lai S H
Published: November 2008

In spite of efforts to dissuade intravenous drug users (IVDUs) from donating or selling blood, some continue to do so. As part of a longitudinal study, 915 IVDUs in South Florida were interviewed concerning their history of donation or sale of blood and tested for antibodies to HIV-1 and HTLV-I/II. Approximately 17 percent had either donated or sold blood during 1985 through 1988; most contributors (80.4 percent) sold to commercial blood services. IVDUs who had donated/sold blood were more likely to be male and not in drug treatment than were those who had not contributed blood. IVDUs not in treatment at the time of interview were more likely than IVDUs in treatment to have sold blood. Of those who had donated/sold blood since 1985, 19.6 percent subsequently tested positive for antibodies to HIV-1 and 5.7 percent were positive for antibodies to HTLV-I/II. Increased effort is required to screen prospective donors and sellers, particularly at commercial blood banks.
Use of a medical center's computerized health care database for notifiable disease surveillance.
Authors: Watkins M , Lapham S , Hoy W
Published: November 2008

The sensitivity of a medical center's inpatient and outpatient database to detect notifiable diseases was examined. Only 53 percent of inpatient and 7 percent of outpatient laboratory-confirmed cases of shigellosis, salmonellosis, giardiasis, and hepatitis were identified by an automated search for matching diagnosis codes. Reasons for lack of sensitivity include nonavailability of laboratory results at the time of diagnosis assignment, use of a standardized encounter form with limited preselected diagnosis codes, and pre-emptying of the infectious disease diagnosis by other diagnoses.
Determinants of late stage diagnosis of breast and cervical cancer: the impact of age, race, social class, and hospital type.
Authors: Mandelblatt J , Andrews H , Kerner J , Zauber A , Burnett W
Published: November 2008

Previous studies of the relationship between cancer stage, age, and race have not controlled for social class and health care setting. Logistic regression analyses, using information from the New York State Tumor Registry and area-level social class indicators, demonstrated that, in New York City, older Black, lower class women in public hospitals were 3.75 and 2.54 times more likely to have late stage breast or cervical cancer, respectively, than were younger White, high social class women in non-public hospitals.
Drake Chemical Workers' Health Registry: coping with community tension over toxic exposures.
Authors: Leviton L C , Marsh G M , Talbott E , Pavlock D , Callahan C
Published: November 2008

BACKGROUND: Programs to communicate health risk information and to protect the health of groups exposed to toxic substances need to tailor interventions to the political, economic, and cultural situation of the at-risk group. In particular, such programs must often cope with exceptional community tension and conflict over these exposures. METHODS: This article uses interviews and written materials to document and describe the state of affairs that led up to community tension over an occupational exposure to a bladder carcinogen. The article describes the planning and design of a program to provide medical surveillance to workers, which also alleviated community concern. RESULTS: The Drake Chemical Workers' Health Registry coped successfully with community conflict and obtained a high participation rate. CONCLUSIONS: General recommendations include the following: avoid identification with extraneous agendas; know the community and maintain communication; and match the intervention to the evolution of the community conflict.
Asthmatic responses to airborne acid aerosols.
Authors: Ostro B D , Lipsett M J , Wiener M B , Selner J C
Published: November 2008

BACKGROUND: Controlled exposure studies suggest that asthmatics may be more sensitive to the respiratory effects of acidic aerosols than individuals without asthma. This study investigates whether acidic aerosols and other air pollutants are associated with respiratory symptoms in free-living asthmatics. METHODS: Daily concentrations of hydrogen ion (H+), nitric acid, fine particulates, sulfates and nitrates were obtained during an intensive air monitoring effort in Denver, Colorado, in the winter of 1987-88. A panel of 207 asthmatics recorded respiratory symptoms, frequency of medication use, and related information in daily diaries. We used a multiple regression time-series model to analyze which air pollutants, if any, were associated with health outcomes reported by study participants. RESULTS: Airborne H+ was found to be significantly associated with several indicators of asthma status, including moderate or severe cough and shortness of breath. Cough was also associated with fine particulates, and shortness of breath with sulfates. Incorporating the participants' time spent outside and exercise intensity into the daily measure of exposure strengthened the association between these pollutants and asthmatic symptoms. Nitric acid and nitrates were not significantly associated with any respiratory symptom analyzed. CONCLUSIONS: In this population of asthmatics, several outdoor air pollutants, particularly airborne acidity, were associated with daily respiratory symptoms.
A randomized trial to evaluate the risk of gastrointestinal disease due to consumption of drinking water meeting current microbiological standards.
Authors: Payment P , Richardson L , Siemiatycki J , Dewar R , Edwardes M , Franco E
Published: November 2008

BACKGROUND: This project directly and empirically measured the level of gastrointestinal (GI) illness related to the consumption of tapwater prepared from sewage-contaminated surface waters and meeting current water quality criteria. METHODS: A randomized intervention trial was carried out; 299 eligible households were supplied with domestic water filters (reverse-osmosis) that eliminate microbial and chemical contaminants from their water, and 307 households were left with their usual tapwater without a filter. The GI symptomatology was evaluated by means of a family health diary maintained prospectively by all study families over a 15-month period. RESULTS: The estimated annual incidence of GI illness was 0.76 among tapwater drinkers compared with 0.50 among filtered water drinkers (p less than 0.01). These findings were consistently observed in all population subgroups. CONCLUSION: It is estimated that 35% of the reported GI illnesses among the tapwater drinkers were water-related and preventable. Our results raise questions about the adequacy of current standards of drinking water quality to prevent water-borne endemic gastrointestinal illness.
Lyme disease: a proposed ecological index to assess areas of risk in the northeastern United States.
Authors: Schulze T L , Taylor R C , Taylor G C , Bosler E M
Published: November 2008

BACKGROUND: Recent public awareness has resulted in a demand for information about ways to reduce the risk of acquiring Lyme disease. METHODS: Twenty-two school properties and recreational areas within a Lyme disease endemic area of central Monmouth County, New Jersey were evaluated for risk of transmission using an ecological index on the suitability, amount, and access to Ixodes dammini habitat by target human populations and the abundance of infected adult ticks. RESULTS: The characterization of tick habitat accurately predicted the elimination of 11 sites from concern. Of the remaining 11 sites, six were classified high risk and five as moderate risk. On-site tick surveys identified infected I. dammini adults at only four sites (three risk; one moderate risk). CONCLUSIONS: These results indicate that the use of selected ecological parameters provides a cost-effective method to rapidly identify areas at risk for Lyme disease transmission.
Female homicides in United States workplaces, 1980-1985.
Authors: Bell C A
Published: November 2008

BACKGROUND: Women, while noted for low occupational injury mortality rates, are more likely to die as victims of assault than from any other manner of injury at work. METHODS: From the National Traumatic Occupational Fatality surveillance data, 950 women were identified who were fatally assaulted at work. Homicide rates were calculated for the demographic and employment characteristics of these women. Risk ratios among types of lethal injuries were examined. RESULTS: During 1980-1985, the crude six-year workplace homicide rate was 4.0 deaths per million working women: one twentieth the homicide rate of the US female population. Decedents ranged from 16 years (the lowest age included in the data base) to 93 years of age. Working women older than 65 years had the highest age-specific homicide rate, 11.3 per million. Women younger than 20 had the lowest, 2.5 per million per year. Homicide rates for women of races other than White were nearly twice as high as those of Whites. The leading causes of death were gunshot wounds (64 percent), stabbings (19 percent), asphyxiations (7 percent), and blunt force trauma (6 percent). Nearly 43 percent of the deceased women had been employed in retail trade: 8.7 per million employed women annually. CONCLUSIONS: During 1980-1985, only 6 percent of the nation's victims of work-related injury deaths were female: 41 percent of those women were murdered. Homicide is currently the leading manner of traumatic workplace death among women in the United States.
Socioeconomic status and survival from soft-tissue sarcomas: a population-based study in northern Italy.
Authors: Ciccone G , Magnani C , Delsedime L , Vineis P
Published: November 2008

BACKGROUND AND PURPOSE: Differential prognosis among cancer patients according to socioeconomic status (SES) has been reported. We analyzed survival from soft tissue sarcomas (STS) according to different SES indicators. METHODS: We followed up all the adult patients with a new diagnosis of STS occurring between 1.1.1981 and 31.12.1983 in an area of Northern Italy (N = 86). RESULTS: The overall three-year survival rate was 57 percent. After adjustment for confounders, both low education and blue collar jobs were negatively associated with survival. CONCLUSIONS: The results suggest that patients of low SES have a poorer prognosis for STS.
Pesticide poisoning surveillance through regional poison control centers.
Authors: Olson D K , Sax L , Gunderson P , Sioris L
Published: November 2008

The purpose of this study is to describe pesticide exposure in the population of callers to Minnesota Regional Poison Centers. Case files from 1988 reporting pesticide exposure to humans were identified in cooperation with the Minnesota Center for Health Statistics. Data analysis was conducted by computer using SAS statistical package. Of the 1,428 case files indicating pesticide as the primary substance of exposure to Minnesota residents, a mean age of 5 years (range, one month to 85 years) was identified; 50 percent of all cases were below age 3 years. Males accounted for 1.3 times as many cases as females. Insecticide was identified in the largest percentage of case files (74 percent) followed by herbicide (12 percent), rodenticide (11 percent) and fungicide-nonmedicinal (3 percent). Ingestion was the most common route of exposure; 85 percent of all calls originated from a residence. While insecticides are still the most common types of pesticide call, herbicide has surpassed insecticide in production and sales in the US. In this study, herbicide type exposure calls present a much different picture than other pesticide types. The usefulness of poison control centers for examination of pesticide poisoning is explored. Since reporting occurs coincidental with the exposure and its associated symptoms, each pesticide poisoning report could potentially serve as a true sentinel health event.
Soft plastic bread packaging: lead content and reuse by families.
Authors: Weisel C , Demak M , Marcus S , Goldstein B D
Published: November 2008

The presence of lead in labels painted on soft plastic bread packaging was evaluated. Lead was detected on the outside of 17 of 18 soft plastic bread bags that were analyzed, with an average of 26 +/- 6 mg per bag with lead. Of 106 families questioned, 16 percent of respondents reported turning the bags inside out before reusing for food storage, thus putting food in contact with the lead paint. We estimate that a weak acid, such as vinegar, could readily leach 100 micrograms of lead from a painted plastic bag within 10 minutes. Further, lead and other metals painted on food packaging of any type becomes part of the municipal waste stream subject to incineration and to land-filling. The use of lead in packaging presents an unnecessary risk to public health.
Salmonella egg survey in Hawaii: evidence for routine bacterial surveillance.
Authors: Ching-Lee M R , Katz A R , Sasaki D M , Minette H P
Published: November 2008

One hundred and six dozen eggs, representing 12 brands, were purchased from Oahu supermarkets and cultured for Salmonella using standard FDA (Food and Drug Administration) microbiological techniques. Two enrichment incubation temperatures were used to improve culture sensitivity. Ten cartons (9.4 percent) of the 106 dozen samples had shells positive for Salmonella. Seven of the 10 were traced to a single egg processor. Inspection of the facility led to the discovery of malfunctioning equipment used in the egg washing and sanitation process.
A cross-sectional study of pulmonary function in autobody repair workers.
Authors: Parker D L , Waller K , Himrich B , Martinez A , Martin F
Published: November 2008

This study evaluated pulmonary function in workers from 39 autobody repair shops. Based on 152 White male workers with known smoking status, the mean percent predicted FEV1, FVC, and FEV1/FVC were 93.6, 96.8, and 96.6, respectively. Twenty-three percent of workers had a FEV1/FVC ratio less than the fifth percentile. Isocyanate levels ranged from nondetectable to 0.06 parts per million (STEL = 0.02 ppm). No shop had an adequate respiratory protection program. We concluded that there was an increase in abnormal pulmonary function in autobody workers. Three recommendations were made to shop owners: functional paint booths should be maintained, respiratory protection programs should be developed, and isocyanate-free paints should be used.
The United Mine Workers of American and the recognition of occupational respiratory diseases, 1902-1968.
Authors: Derickson A
Published: November 2008

This study examines the early efforts of the United Mine Workers of America to illuminate the problem of occupational respiratory diseases in the coal fields. The union used the hearings of the US Anthracite Coal Strike Commission of 1902-3 to draw public attention to "miners' asthma." In 1915, it began to agitate for the provision of workers' compensation benefits for victims of this disorder. Throughout the 1950s and 1960s, the union's Welfare and Retirement Fund disseminated information on advances in understanding chronic pulmonary diseases of mining. In particular, the miners' fund promoted the British conceptualization of a distinctive coal workers' pneumoconiosis. At the same time, the staff of the union health plan pressed the US Public Health Service and the Pennsylvania Department of Health to investigate the prevalence of occupational respiratory diseases among bituminous miners. Taken together, these endeavors contributed significantly to growing recognition of the severity and extent of this important public health problem and thus helped lay the foundation for the Federal Coal Mine Health and Safety Act of 1969.
The silence: the asbestos industry and early occupational cancer research--a case study.
Authors: Lilienfeld D E
Published: November 2008

To gain insight into corporate activities regarding the identification of occupational carcinogens earlier in this century, the actions of one industry, the asbestos industry, were reviewed. This industry, in concert with many of its insurers, systematically developed and then suppressed information on the carcinogenicity of asbestos. The development of warnings for those exposed to the asbestos was delayed. As a result, millions of workers were exposed to the carcinogen and hundreds of thousands died. These events are placed into the context of similar activities in other industries during this time.
Tobacco industry scientific advisors: serving society or selling cigarettes?
Authors: Warner K E
Published: November 2008

According to industry documents, the tobacco industry has executed a "brilliantly conceived" strategy to "creat[e] doubt" in the public's mind about whether cigarette smoking is in fact a serious cause of disease. A component of this strategy has been the funding of scientific research "into the gaps in knowledge in the smoking controversy." Grant review and selection are performed by a group of independent scientists. Knowledgeable observers believe that the existence of this research funding program in general, and the Scientific Advisory Board in particular, is intended by the industry to reinforce doubts in the public mind about the severity of the hazards posed by smoking. Because the Advisory Board has never taken a public stance against the industry's position that the causal relationship between smoking and disease remains unproven, I polled these scientists to determine whether they believed that smoking is a cause of lung cancer. Despite repeated opportunities, only four of 13 board members responded, all affirmatively; two others have expressed their judgment that smoking causes lung cancer in their professional publications. Thus, over half of the Board members, and the Board as a whole, have not gone on record as rejecting the industry's "party line." It might be hoped that the American scientists would follow the lead of the members of a similar body of scientists in Australia who have taken a strong and public stand against the industry position that smoking is not an established cause of disease.
Health behaviors, risk factors, and health indicators associated with cigarette use in Mexican Americans: results from the Hispanic HANES.
Authors: Lee D J , Markides K S
Published: November 2008

BACKGROUND: Cigarette smokers often engage in other, potentially deleterious, health behaviors. Such behaviors have not been well documented in Mexican American smokers. METHODS: Data from the Southwestern sample of the Hispanic Health and Nutrition Examination Survey (HHANES) were employed to investigate differences in health behaviors, risk factors and health indicators between cigarette smokers and nonsmokers among Mexican Americans. Differences between those smoking less than 10 and 10 or more cigarettes per day were also examined by age group and gender. RESULTS: Positive associations between smoking status and heavy coffee and alcohol consumption were found across gender and age groups. Less consistent was the finding that smokers weighed less than nonsmokers. Lower systolic and diastolic blood pressures in middle-aged smokers, and higher levels of depressive symptomatology among smoking women were found. Those smoking 10 or more cigarettes per day were more likely to report heavy coffee consumption, with younger men reporting greater activity limitation due to poor health. Middle-aged men and women in the 10+ category were generally in better health than lighter smokers. CONCLUSIONS: Modest associations between cigarette smoking, health behaviors and risk factors found in other studies were confirmed in this Mexican American population. Few significant associations between smoking and health status were noted.
Risk factors for suicide attempts among Navajo adolescents.
Authors: Grossman D C , Milligan B C , Deyo R A
Published: November 2008

BACKGROUND: Rates of adolescent suicide in the United States are highest among Native Americans but little is known about risk factors for suicide attempts in this population. METHODS: To identify risk factors for self-reported suicide attempts by Navajo adolescents, we analyzed the 1988 Indian Health Service Adolescent Health Survey that was administered to 7,254 students in grades 6 through 12 on the Navajo reservation. The responses of students reporting a past suicide attempt were compared to others. RESULTS: Nearly 15 percent (N = 971) reported a previous suicide attempt; over half of those admitted to more than one attempt. Controlling for age, a logistic regression model revealed the following associations with suicide attempts: a history of mental health problems (OR = 3.2); alienation from family and community (OR = 3.2); having a friend who attempted suicide (OR = 2.8); weekly consumption of hard liquor (OR = 2.7); a family history of a suicide or attempt (OR = 2.3); poor self-perception of health (OR = 2.2); a history of physical abuse (OR = 1.9); female gender (OR = 1.7); and sexual abuse (OR = 1.5). CONCLUSIONS: Efforts to prevent adolescent suicide attempts in this population should target individuals with those risk factors of the highest risk and prevalence of exposure.
Does cigarette smoking have an independent effect on coronary heart disease incidence in the elderly?
Authors: Benfante R , Reed D , Frank J
Published: November 2008

In order to evaluate the effects of cigarette smoking on coronary heart disease (CHD) in elderly persons in the Honolulu Heart Program, 1,394 men between ages 65 and 74 were followed during an average 12-year period for new cases of nonfatal myocardial infarction and fatal CHD. Incidence rates increased progressively in individuals classified at baseline as never, former, and current smokers, respectively. The absolute excess risk associated with cigarette smoking was nearly twice as high in elderly compared with middle-aged men.
Staff involvement and special follow-up time increase physicians' counseling about smoking cessation: a controlled trial.
Authors: Duncan C , Stein M J , Cummings S R
Published: November 2008

We compared the counseling behaviors of two groups of health maintenance organization physicians: one group received training about smoking cessation counseling; the other group received the same training plus staff support and appointment time specially designated for follow-up of smokers. We interviewed patients after their office visits to measure smoking counseling. The group receiving staff support and designated follow-up time counseled more and made more follow-up appointments about smoking.
Television viewing and obesity in adult females.
Authors: Tucker L A , Bagwell M
Published: November 2008

We measured the relation between time spent watching television per week and obesity in 4,771 adult females. After controlling for age, education, cigarette smoking, length of work week, and weekly duration of exercise, females who reported three to four hours of TV viewing per day showed almost twice the prevalence of obesity (body fat greater than 30 percent), and those who reported more than four hours of TV watching per day showed more than double the prevalence of obesity, compared to the reference group (less than 1 hr/day). Part of the TV/obesity association was a function of differences in exercise duration among the four TV viewing categories.
Characteristics of a random sample of emergency food program users in New York: II. Soup kitchens.
Authors: Bowering J , Clancy K L , Poppendieck J
Published: November 2008

A random sample of soup kitchen clients in New York City was studied and specific comparisons made on various parameters including homelessness. Compared with the general population of low income persons, soup kitchen users were overwhelmingly male, disproportionately African-American, and more likely to live alone. The homeless (41 percent of the sample) were less likely to receive food stamps or free food, or to use food pantries. Fewer of them received Medicaid or had health insurance. Forty-seven percent had no income in contrast to 29 percent of the total sample.
The use of direct mail to increase clinician knowledge: an intervention study.
Authors: Sadowsky D , Kunzel C
Published: November 2008

A probability sample of American general practitioner dentists, 40 years of age or older, in solo private practice, was the target of two direct mail interventions offered at two different times, to test whether knowledge regarding prophylaxis of patients at risk for infective endocarditis could be improved. Tests of knowledge were responses in a mail questionnaire to clinical vignettes, designed to elicit the content of antibiotic regimens used for patients at risk. The research design enabled detection of (1) the effect of the interventions; (2) the differences in their effect; (3) the attenuation of their effect; and (4) the effect of time. Where baseline knowledge was low, it was improved and did not rapidly disappear. Both mail interventions were equally effective, in most instances, and there was no attenuation of the interventions' effect and no effect of time on the control groups' knowledge over a 4 1/2 month period. The results suggest that it is possible to improve clinicians' knowledge of expert recommendations through direct mail intervention.
Occupational injuries among North Carolina migrant farmworkers.
Authors: Ciesielski S , Hall S P , Sweeney M
Published: November 2008

A population-based cross-sectional study of occupational injuries among a random sample of 287 migrant farmworkers demonstrated frequent obstacles to health care; 65% (11/17) of the more seriously injured subjects did not receive prompt care or never received care. Subjects not receiving prompt care were twice as likely to have incomplete recovery. Employers covered medical expenses for only 5/13 (38%) of the injured workers, and only 3/15 were compensated for lost work. This study indicates that comprehensive Workers' Compensation coverage is urgently needed in North Carolina.
Characteristics of maternal employment during pregnancy: effects on low birthweight.
Authors: Peoples-Sheps M D , Siegel E , Suchindran C M , Origasa H , Ware A , Barakat A
Published: November 2008

BACKGROUND: Although maternal employment is considered a risk factor for low birthweight (LBW), the manner in which employment might affect birthweight is poorly understood. In this analysis, selected characteristics of employment during pregnancy were examined for effects on pregnancy outcomes. METHODS: Work characteristics included the number of hours per week, physical activities, and environmental conditions. The outcomes of interest were fetal growth retardation (less than 2500 grams at term) and preterm delivery (less than 37 weeks). The study population consisted of 2711 non-Black, married mothers who participated in the 1980 National Natality Survey (NNS). The NNS data were merged with data from the 1977 revision of The Dictionary of Occupational Titles (DOT) from which measures of occupational physical activities and environmental exposures were obtained. Logistic regression was used in the analysis. RESULTS: Those who worked 40 or more hours per week were more likely than women who worked fewer hours to have a low birthweight delivery at greater than or equal to 37 weeks. No physical or environmental characterics of work were associated with low birthweight or preterm delivery. CONCLUSIONS: Non-Black married American women may face a risk of delivering low-birthweight babies at or near term only if they work 40 or more hours each week. However, the lack of risk associated with other characteristics of work may be a function of measurement error in the DOT data source or of low levels of exposure in the analysis population.
The health hazards of saunas and spas and how to minimize them.
Authors: Press E
Published: November 2008

BACKGROUND: The rapidly increasing number of spas, hot tubs, and saunas intensifies the potentials for deaths from hyperthermia and drowning. METHODS: I analyzed 54 such deaths reported to me by 55 medical examiners and coroners in the United States and 104 deaths reported to the US Consumer Product Safety Commission (CPSC). RESULTS: Only seven of the 158 deaths analyzed occurred in saunas. All of the remaining deaths occurred in spas, jacuzzis, or hot tubs, which were far more numerous. The chief risk factors identified were alcohol ingestion, heart disease, seizure disorders, and cocaine ingestion (alone or in combination with alcohol ingestion). These factors accounted for 71 or 44.7% of the 159 fatalities. Of these risk factors, alcohol represented 38%; heart disease, 31%; seizure disorders, 17%; and cocaine ingestion, alone or in combination with alcohol, 14%. Sixty-one of the 151 spa-associated deaths occurred in children under 12 years of age. Accidental drownings from uncovered or improperly covered spas and, to a lesser extent, entrapment by suction, were the chief causes of childhood drownings. CONCLUSIONS: Children and older persons who have heart disease or seizure disorders or who use alcohol or cocaine are especially vulnerable. Recommended preventive measures include shortening the time of exposure, lowering the temperature, establishing safety standards for covers and for baffles for suction outlets, and using warning notices.
Risk factors for childhood homicides in Ohio: a birth certificate-based case-control study.
Authors: Winpisinger K A , Hopkins R S , Indian R W , Hostetler J R
Published: November 2008

Death certificate of children less than 8 years of age who were killed between 1979 and 1986 were linked to their Ohio birth certificates and compared with those of Ohio children born in 1983 (controls). Having an unmarried mother increased risk of homicide almost fivefold (odds ratio 4.87). Having a teenage mother, a mother who had not graduated from high-school, and being of Black race or low birthweight each increased the risk by approximately threefold. Increases in the proportion of children born to unmarried mothers may contribute to increases in childhood homicide rates.
Costs and benefits of implementing child survival services at a private mining company in Peru.
Authors: Foreit K G , Haustein D , Winterhalter M , La Mata E
Published: November 2008

Costs and savings of child health services were studied in a private mining company in Peru. Despite considerable outlays for medical services, few children under age 5 were vaccinated, and half of their illnesses went untreated. Children who were attended at the company clinic usually received unnecessary medication. As a result of the study, the company hired additional staff to provide integrated maternal-child preventive health care and family planning and contracted for intensive training and periodic on-site supervision. In less than 2 years, vaccination coverage reached 75%, and virtually all children under age 1 were enrolled in growth monitoring. Prescriptions were reduced by 24%, including a 67% drop in antimicrobials. The cost of the new services was $13,200 for the first 2 years. Approximately $6800 has been saved in pharmaceuticals prescribed for respiratory infection and diarrhea. Recently, two more mines adopted maternal and child health and family planning services. It is hoped that cost-benefit arguments will encourage other companies to incorporate aggressive child survival measures into their health plans.
Service needs of severely disturbed children.
Authors: Trupin E W , Forsyth-Stephens A , Low B P
Published: November 2008

BACKGROUND: As one piece of a statewide Children's Mental Health System Analysis conducted in Washington State, the specific service needs of severely emotionally disturbed children were investigated. METHODS: The primary case-workers of 3398 children under the care of the state responded to a survey of the child's treatment history, social and clinical condition, and service needs. Service need data on the 2455 children in the sample who were classifiable as severely emotionally disturbed were examined using log linear analysis. RESULTS: School- and home-based services were frequently reported needs of school-aged children. Adolescent children were reported to be in need of services which prepare them for adulthood. Services endorsed for female children tended to focus on assistance to family members, therapy, and protection, whereas services endorsed for male children focused on home removal, substance abuse treatment, and preparation for employment. CONCLUSIONS: Severely emotionally disturbed children are in need of a variety of nontraditional mental health services. Significant differences in the needs of male versus female children, and of differently aged children, are present that have serious implications for service system development.
Attitudes toward abortion among parents of children with cystic fibrosis.
Authors: Wertz D C , Rosenfield J M , Janes S R , Erbe R W
Published: November 2008

BACKGROUND: DNA prenatal diagnosis for cystic fibrosis (CF) has been available for parents of affected children since late 1985. METHODS: Using anonymous questionnaires, we surveyed 395 parents of children with CF at 12 New England CF centers with regard to 12 maternal or family situations and 11 fetal characteristics; 271 (68%) responded. RESULTS: The majority supported legal abortion in the first trimester for all 23 situations; 58% would abort for severe mental retardation (MR), 40% would abort for a genetic disorder leading to death before age five years, 41% for a child bedridden for life, 35% for moderate MR, 20% for CF and 17% for a severe incurable disorder starting at age 40 years. Few would abort for a disorder starting at age 60 years, for genetic susceptibility to alcoholism or for sex selection. Variables most strongly related to abortion for CF were attitudes of spouse, respondent's siblings, and CF doctor toward abortion for CF as well as infrequent attendance at religious services. CONCLUSIONS: Prenatal diagnosis may not reduce substantially the number of CF births to parents of CF children because most do not accept abortion for CF.
Infant diet and salmonellosis.
Authors: Haddock R L , Cousens S N , Guzman C C
Published: November 2008

BACKGROUND: The Island of Guam has experienced a high incidence of infant salmonellosis for a number of years (age-specific incidence rate of approximately 3700 cases per 100,000 infants in 1984). Interviews of case parents suggested that the use of high-iron infant formula was associated with this problem. METHODS: A case-control study was conducted to test this hypothesis. Information on feeding practices and a variety of medical and socioeconomic factors was collected for 78 laboratory-confirmed Salmonella-case infants and 167 control infants. RESULTS: Case infants were less likely to have been breast-fed (odds ratio [OR] = 9.15; 95% confidence interval [CI] = 2.71-30.9) and more likely to have been fed infant formula with an iron content of 10 mg/L or greater (OR = 2.96; 95% CI = 1.24-7.08) than were control infants. CONCLUSIONS: Although the precise means by which infants are most commonly exposed to Salmonella bacteria remain obscure, breast-feeding apparently protects against the development of physician-diagnosed clinical salmonellosis, while the feeding of high-iron infant formula has the opposite effect.
The health effects of economic insecurity.
Authors: Catalano R
Published: November 2008

BACKGROUND. Interest in the health and behavioral effects of economic insecurity appears to vary with the performance of the economy. The current recession in the United States and Western Europe and growing unemployment in Eastern Europe make it timely to analytically review the recent research concerned with the health effects of economic contraction. METHODS. The research concerned with the health and behavioral effects of economic insecurity is organized by dependent variable and method. Rules for determining which effects are supported by strong and which by weak evidence are developed and applied to the literature. RESULTS. Evidence for effects on symptoms of psychological distress, seeking help for psychological distress, and nonspecific physiological illness is strong. Evidence for effects on suicide, child abuse, adverse birth outcomes, and heart disease is characterized as weak or sufficiently controversial to warrant skepticism. CONCLUSIONS. The health effects of economic security are undoubtedly mediated by economic policies. Estimating the effect of policy alternatives on the incidence of various outcomes is, however, very difficult given the current state of the research. The effect of rising unemployment on health in Eastern Europe cannot, moreover, be estimated from existing research. Effects estimated from Western economies probably do not generalize to situations in which the meaning of economic insecurity is conditioned by profound social and political reforms.
Epidemiologic studies utilizing surveys: accounting for the sampling design.
Authors: Korn E L , Graubard B I
Published: November 2008

BACKGROUND. Since large-scale health surveys usually have complicated sampling schemes, there is often a question as to whether the sampling design must be considered in the analysis of the data. A recent disagreement concerning the analysis of a body iron stores-cancer association found in the first National Health and Nutrition Examination Survey and its follow-up is used to highlight the issues. METHODS. We explain and illustrate the importance of two aspects of the sampling design: clustering and weighting of observations. The body iron stores-cancer data are reanalyzed by utilizing or ignoring various aspects of the sampling design. Simple formulas are given to describe how using the sampling design of a survey in the analysis will affect the conclusions of that analysis. RESULTS. The different analyses of the body iron stores-cancer data lead to very different conclusions. Application of the simple formulas suggests that utilization of the sample clustering in the analysis is appropriate, but that a standard utilization of the sample weights leads to an uninformative analysis. The recommended analysis incorporates the sampling weights in a nonstandard way and the sample clustering in the standard way. CONCLUSIONS. Which particular aspects of the sampling design to use in the analysis of complex survey data and how to use them depend on certain features of the design. We give some guidelines for when to use the sample clustering and sample weights in the analysis.
Factors influencing the formation of new human coronary lesions: age, blood pressure, and blood cholesterol.
Authors: Mack W J , Blankenhorn D H
Published: November 2008

BACKGROUND. The Cholesterol Lowering Atherosclerosis Study, a controlled angiographic trial, has reported that new native coronary artery lesions are significantly reduced by aggressive blood lipid lowering therapy with colestipol plus niacin. To study factors relevant to primary atherosclerosis prevention, we have conducted an epidemiologic analysis of new native coronary lesion formation in placebo-treated patients. METHODS. Univariate and multivariate logistic regression procedures were used to examine age at entry into the study, number of years since bypass, body weight, diastolic and systolic blood pressure, plasma total cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, non-HDL-cholesterol, and apolipoproteins A-I,B, and C-III. RESULTS. Significant univariate protective factors were older age (P less than .006), reduction of total plasma cholesterol (P less than .040), and systolic (P less than .024) and diastolic (P less than .022) blood pressure. Significant multivariate protective factors were older age (P less than .005) and reduction in systotic blood pressure (P less than .021). Blood pressure effects were not associated with use of specific antihypertensive agents. CONCLUSIONS. These data provide additional support for the control of hypertension and reduction of blood cholesterol level for primary and secondary ischemic heart disease prevention. They also indicate the existence of a population at high risk for early coronary lesion formation and the need for improved means to identify such individuals prior to the onset of clinical manifestations of ischemic heart disease.
A randomized trial of an interim methadone maintenance clinic.
Authors: Yancovitz S R , Des Jarlais D C , Peyser N P , Drew E , Friedmann P , Trigg H L , Robinson J W
Published: November 2008

BACKGROUND. Interim methadone maintenance has been proposed as a method of providing clinically effective services to heroin addicts waiting for treatment in standard comprehensive methadone maintenance programs. METHODS. A clinic that provided initial medical evaluation, methadone medication, and AIDS education, but did not include formal drug abuse counseling or other social support services was established in New York City. A sample of 301 volunteer subjects recruited from the waiting list for treatment in the Beth Israel methadone program were randomly assigned to immediate entry into the interim clinic or a control group. RESULTS. There were no differences in initial levels of illicit drug use across the experimental and control groups. One-month urinalysis follow-up data showed a significant reduction in heroin use in the experimental group (from 63% positive at intake to 29% positive) with no change in the control group (62% to 60% positive). No significant change was observed in cocaine urinalyses (approximately 70% positive for both groups at intake and follow-up). A higher percentage of the experimental group were in treatment at 16-month follow-up (72% vs 56%). CONCLUSIONS. Limited services interim methadone maintenance can reduce heroin use among persons awaiting entry into comprehensive treatment and increase the percentage entering treatment.
Oral rehydration program evaluation by quality assurance sampling in rural Haiti.
Authors: Pierre-Louis J N
Published: November 2008

An oral rehydration program in rural Haiti was evaluated by quality assurance sampling. The quality assurance sampling method and its application are described. The indicators measured were knowledge of the oral rehydration salts packet, knowledge of preparation of the solution from the packet, oral rehydration therapy use, and knowledge of preparation of the solution from salt and sugar. Coverages of the first two indicators were adequate, coverages of the latter two were inadequate. The method is a useful low-cost approach to evaluation of program coverage.
Impaired and disabled elderly in the community.
Authors: Ford A B , Roy A W , Haug M R , Folmar S J , Jones P K
Published: November 2008

A nine-year representative, longitudinal study of 1,598 urban elderly shows that two to eight times as many impaired or disabled are cared for in the community as in institutions. Younger age, male gender, better income, and living with others, especially children, favor continuing care in the home.
New York State HIV seroprevalence project: goals, windows, and policy consideration.
Authors: Novick L F
Published: November 2008

In the summer of 1987, the New York State Department of Health embarked on an extensive effort to determine the prevalence of trends of HIV infection in the state. Sero-surveillance for antibody to HIV was undertaken by blind testing of available blood samples. Six populations were selected as windows on the epidemic: newborns, homeless adolescents, prisoners, and clients of family planning, STD, and drug treatment clinics. Testing of all newborns in New York State began in December 1987, and all six study windows were operational by June 1988. As of March 1990 blind testing for HIV antibody had been performed on more than 725,000 blood specimens in these six studies. Collectively these seroprevalence activities are providing invaluable information and impetus to preventive actions and public policy.
Comparison of newborn screening records and birth certificates to estimate bias in newborn HIV serosurveys.
Authors: Pass K A , Schedlbauer L M , MacCubbin P A , Glebatis D M
Published: November 2008

Implicit in the New York State Newborn HIV Seroprevalence Study is the assumption that newborns of all New York State residents are tested for human immunodeficiency virus (HIV) antibodies. We examined this assumption by describing that part of the 1988 New York newborn population not tested in the HIV seroprevalence study and assessing any bias contributed by this group. Of the expected total HIV specimens 1.5 percent were never received by the Newborn Screening Program, 0.5 percent were invalid specimens for which no repeat specimen could be obtained, and 1.7 percent were unsuitable or of insufficient quantity to be tested for HIV antibody. Thus 96.3 percent of all 1988 New York newborns were tested for HIV antibody. Black infants from New York City and low-birthweight infants were represented disproportionately among those not tested. Assignment of all untested newborn to HIV-positive status increased the seroprevalence rate 17 percent (0.64 percent to 0.75 percent).
Projection of AIDS incidence in women in New York State.
Authors: Lessner L
Published: November 2008

The results of the Newborn HIV Seroprevalence Study in New York State for 1988 were used to estimate the number of human immunodeficiency virus (HIV)-infected women of childbearing age in 1988. The estimate was accomplished for each of 80 age, racial/ethnic, and geographic strata by dividing the number of seropositive newborns by the 1988 estimated fertility rate. Summing across strata yielded a total of 23,430 infected women age 15 to 44 years in 1988. From this estimate a tree model was used to estimate the number of women infected during 1981-88. Back calculation was used to distribute these infections over time, and the selected incubation distribution was used to estimate future AIDS cases for this population: 8,295 cases by 1993.