bluuebunny/crossref_metadata_2025 huggingface dataset:
Laboratory evaluation and assistance efforts: mailed, on-site and blind proficiency testing surveys conducted by the Centers for Disease Control.
Authors: Boone D J , Hansen H J , Hearn T L , Lewis D S , Dudley D
Published: November 2008

During the last three years, the Centers for Disease Control (CDC) has conducted: 1) on-site surveys in which trained personnel visited laboratories that had experienced performance problems in the quarterly mailed proficiency testing (PT) program, reviewing the laboratories' analytical procedures by using carefully referenced samples to determine sources of errors and providing assistance in correcting them; 2) special assistance surveys in which carefully referenced samples were mailed to laboratories that had performed unsatisfactorily in routine mailed PT surveys and then telephone consultations were conducted to correct the problems; and 3) blind surveys in which carefully referenced samples were sent through normal patient sample acquisition routes to assess the actual day-to-day performance capability of the laboratories. Results suggest that on-site surveys by trained laboratory surveyors and special mailed assistance surveys can be very effective in identifying the source of analytical errors in laboratories previously found, through mailed PT surveys, to have performance problems. Blind-survey results indicate that good performance in mailed PT does not necessarily imply good laboratory performance with routine patient specimens. Although difficult to conduct, blind surveys should be conducted whenever the logistics can be worked out by contractors for laboratory services, clinicians using laboratory services, and the laboratories themselves to assure the continuation of quality service.
Mandatory PKU screening: the other side of the looking glass.
Authors: Annas G J
Published: November 2008

The challenge that PKU screening programs face is to be effective without sacrificing individual liberty. Most states have assumed that this is impossible, and have enacted mandatory PKU screening tests. It now appears that in fact voluntary screening for PKU can be effective. Accordingly, it seems appropriate to reexamine existing mandatory screening statutes to determine if we can replace government coercion with voluntary informed consent. Focus should be placed on the proper role of the government in screening, and on improving the consent process, and not on those few couples who withhold consent.
Cost-effectiveness of community-based long-term care: current findings of Georgia's alternative health services project.
Authors: Skellie F A , Mobley G M , Coan R E
Published: November 2008

A study of the cost-effectiveness of community-based, long-term care was conducted with voluntary enrollees eligible for Medicaid reimbursed nursing home care. One year after enrollment, average longevity was greater for the 575 clients in the experiment group, but average Medicaid plus Medicare costs for this group were higher than for the 172 clients in the control group. Among those more at risk of entering a nursing home, costs for persons in the experimental group were somewhat lower than for those in the control group. The results suggest that community-based services targeted to those most at risk of institutionalization may be cost-effective.
Occupational risk for laryngeal cancer.
Authors: Flanders W D , Rothman K J
Published: November 2008

In a case-control analysis, we studied the effects of type of employment on laryngeal cancer risk using the interview data from the Third National Cancer Survey. Effects were measured relative to the risk for those employed in a group of arbitrarily defined industries and occupations with low risk. We excluded females and controlled for age, tobacco use, alcohol use, and race in the analysis. We found ratio estimates above 3.0 for workers in the railroad industry and the lumber industry; and for sheetmetal workers, grinding wheel operators, and automobile mechanics.
An independent analysis of the National Cancer Institute study on non-nutritive sweeteners and bladder cancer.
Authors: Walker A M , Dreyer N A , Friedlander E , Loughlin J , Rothman K J , Kohn H I
Published: November 2008

We evaluated the possible relation between use of non-nutritive sweeteners and bladder cancer using data obtained from the National Cancer Institute Bladder Cancer Study under the Freedom of Information Act. In the general study group, there was no evidence for an association between non-nutritive sweeteners and bladder cancer. Control for a variety of factors through multivariate techniques diminished the plausibility of earlier interpretations of these data, which had raised the possibility that certain subgroups of users or non-nutritive sweeteners might be at an increased risk for bladder cancer. We found that the putative effects of non-nutritive sweeteners were not consistent among subgroups with similar baseline risk, did not display consistent dose-response trends, and were subject to considerable sampling error. We concluded that the data provided little evidence that non-nutritive sweeteners increase risk for bladder cancer among subgroups of users, and that definitive evidence on this question is beyond the reach of conventional research.
Giardia prevalence among 1-to-3-year-old children in two Washington State counties.
Authors: Harter L , Frost F , Jakubowski W
Published: November 2008

A survey of intestinal parasites was conducted in two Washington counties. Giardia prevalence among 518 children surveyed was 7.1 per cent and was unrelated to the source of domestic drinking water (surface or well), day care center attendance, or parental occupation. Identified risk factors for Giardia infection include a history of drinking untreated surface water and having two or more siblings between the ages of 3 and 10 years. Of 47 family members of Giardia positive children, 10 (21.3 per cent) were Giardia positive.
Spermicide use and Down's syndrome.
Authors: Rothman K J
Published: November 2008

A connection has been suggested between use of vaginal spermicides and the occurrence of Down's syndrome among offspring born to women who used these contraceptive agents. This hypothesis was evaluated with data from a case-control study of congenital heart disease, which included among the subjects 16 infants with Down's syndrome. The estimated ratio of the proportion of Down's syndrome births among spermicide users to the proportion in non-users was 3.6, with a 90 per cent confidence interval of 1.2 to 9.0, thus providing a tentative confirmation of the hypothesis.
Recent trends in coronary risk factors in the USSR.
Authors: Cooper R , Schatzkin A
Published: November 2008

The soviet Union has experienced an increase in the incidence of coronary heart disease over the last 15 years sufficient to result in an overall deterioration in the health of adults. The distribution of coronary risk factors, and the secular trends in diet and cigarette consumption, provide a potential explanation for the upsurge in death rates. The animal fat content of the Soviet diet has been steadily enriched since the 1950s and cigarette production increased 72 per cent from 1959 to 1980. The post-Stalin orientation of the Soviet economy toward a policy of motivating the work force primarily through the provision of consumer goods, in a pattern comparable to western capitalist countries, appear to have laid the basis for these developments. Given the central control of Soviet society, the negative impact of current economic policy on the public health could be viewed as paradoxical. Our analysis suggests that the paradox is only apparent, however, and that the basis for the widespread occurrence of coronary heart disease is similar in the Soviet Union and western societies.
Stress and smoking in hospital nurses.
Authors: Tagliacozzo R , Vaughn S
Published: November 2008

The smoking behavior of hospital nurses and the association between work-related stress and smoking were studied by means of a questionnaire mailed to the entire direct patient care nursing staff at the University of Michigan Hospital. Prevalence of smoking was considerably lower than in the US nurse population surveyed in 1975 and in the general female population of the same age range surveyed in 1978. Significantly higher scores were obtained for smokers than for non-smokers on scales concerning the physical and emotional stress of the job and the dissatisfaction with its rewards. The results supported more weakly the association of smoking with the perception of stress induced by role ambiguity, by nurse-doctor conflict, and by conflict between nurses. Some personal and situational variables were found to interact with perception of stress and smoking.
Severity of illness and the relationship between intensive care and survival.
Authors: Scheffler R M , Knaus W A , Wagner D P , Zimmerman J E
Published: November 2008

Currently about 15 per cent of hospital costs are attributed to intensive care. Research using statistical models has not adequately demonstrated that therapy in intensive care units (ICUs) is associated with reductions in the probability of death. In a study of 613 consecutive admissions to a multidisciplinary ICU, we reevaluate the relationship between ICU care and survival using a new acute physiology scoring system to control for the severity of illness of the patient population. When our severity of illness index was employed, we found a statistically significant and nonlinear relationship between the use of intensive medical care and the probability of survival. This statistical relationship produced a U-shaped curve with three distinct segments. The first segment exhibited an overall decrease in the probability of death with increasing therapy (275 admissions); the second segment, a fairly stable survival rate (281 admissions). Only in the third segment, where there were 57 admissions, did we find an overall increase in the probability of death as utilization of therapy increased. These findings suggest that quantitative measurement of severity of illness, when used in clinical studies, could produce improved insights into the relationship between therapy and health outcomes.
A comparative study of hospice services in the United States.
Authors: Buckingham R W , Lupu D
Published: November 2008

In order to document the implementation of the hospice concept in the United States, 24 hospices, in operation at least one year and serving at least 100 patients, were selected from the National Hospice Organization roster to participate in a survey of organization, staffing, funding, services and population served. All of the hospices offered both home care and bereavement programs but only 41.7 per cent provided an inpatient program. Ten of the hospices were institutionally based, usually in a hospital. Inpatient services were associated with institutional affliations. The average profile of patients admitted to hospice was a 60-year-old White (89 per cent), female (54.3 per cent) cancer patient (94.5 per cent) whose spouse was primary care giver (63.8 per cent). Hospices provided a wide variety of both medical and social services provided by volunteers as well as paid staff. It appears that two divergent types of hospices are developing: 1) independent, heavily volunteer hospices with a variety of professional staff delivering a wide array of social/psychological services with unstable funding; and 2) institutionally based hospices providing both inpatient and home care, greater variety of medical/nursing services, less variety of social/psychological services, using fewer types of volunteers and paid staff, and not experiencing funding problems.
Gastrointestinal illness on passenger cruise ships, 1975-1978.
Authors: Dannenberg A L , Yashuk J C , Feldman R A
Published: November 2008

Following investigations in 1972-1973 of outbreaks of enteric disease on cruise ships using American ports, a surveillance system was established which required that 24 hours before arrival in port, each ship report the number of persons with diarrheal illness seen by the ship's physician during the cruise. The reported data were found to be reliable; they established a baseline incidence for diarrhea on cruise ships. A significantly high portion of enteric disease outbreaks occurred on vessels that did not pass routine annual or semiannual sanitation inspections. The cruise ship sanitation program, developed with the cooperation of the cruise ship industry and the Centers for Disease Control, appears to have been successful in reducing the overall rate of cruise ship associated outbreaks of enteric illness.
Incidence of Colles' fracture in a North American community.
Authors: Owen R A , Melton L J , Johnson K A , Ilstrup D M , Riggs B L
Published: November 2008

In a 30-year period, 1,137 adult residents of Rochester, Minnesota experienced 1235 Colles' fractures. Fracture incidence among women increased over sixfold between ages 35-39 and 60-64 and then leveled off. Male rates were lower in every age group and did not rise as dramatically. Fractures associated with moderate trauma were responsible for the increased incidence with age and the excess among women. Overall, Rochester rates were 30 per cent or more greater than those reported from communities in other countries (Am J Public Health 1982; 72:605-607.).
Traditional and emerging forms of dental practice. Cost, accessibility, and quality factors.
Authors: Rovin S , Nash J
Published: November 2008

The traditional and predominant manner of delivering dental care is through a fee-for-service, private practice system. A number of alternative dental care delivery systems have emerged and are being tested, and others are just emerging. These systems include department store practices, hospital dental services, health maintenance organizations, the independent practice of dental hygiene, and denturism. Although it is too soon to draw final conclusions about the efficacy and effectiveness of these systems, we examine them for their potential to compete with and change the way dental care is currently delivered. Using the parameters of cost, accessibility, and quality, we compare these systems to traditional dental practice. Some of these emerging forms clearly have the potential to complete favorably with traditional practice. Other seem less likely to alter the existing system substantially. The system which can best control costs, increase accessibility, and enhance quality will gain the competitive edge.
Increasing efficiency in evaluation research: the use of sequential analysis.
Authors: Howe H L
Published: November 2008

This paper describes Wald's sequential analysis and briefly reviews the history of its applied use. Two public health applications are presented as examples of how the method helped overcome two common problems associated with evaluation research. In one case, the sequential technique reduced dramatically the workload in an evaluation project where hospital records were being reviewed. In the second case, prompt feedback of data to a breast screening program was facilitated by the sequential method allowing program administrators to refocus their efforts on problem areas before the end of the funding period. On the average, Wald's sequential method results in a savings of 50 per cent in observations as compared to classical sampling procedures. The sample sizes will always terminate with a finite number and will rarely exceed three times the average sample size for any single sample.
Addict death rates during a four-year posttreatment follow-up.
Authors: Joe G W , Lehman W , Simpson D D
Published: November 2008

Mortality rates were examined among 3,324 Black and White daily opioid drug users for a four-year period following treatment in community-based agencies located across the United States. A total of 179 of these addicts died during this follow-up period, yielding a death rate of 15.2 per 1,000 person-years at risk. When adjusted for age, addict death rates were found to be three to 14 times higher than those in the general US population. Life table analysis was also used to examine these rates in relation to client demographic, background, and treatment variables obtained prospectively, both prior to and during treatment. Age, alcohol use, and criminal history were positively associated with higher death rates. With regard to causes of death, age proved to be the only significant predictor; older addicts (over 30) had the highest percentages of deaths due to "natural" causes, while over three-fourths of the deaths among younger addicts were drug related or involved violence.
Rubella susceptibility in inner-city adolescents: the effect of a school immunization law.
Authors: Nelson D B , Layde M M , Chatton T B
Published: November 2008

In order to improve the immune status of girls in our medical clinic, we conducted a prospective sero-survey to identify susceptibles and developed a system for vaccinating non-immune girls. Over an 18-month period, 481 inner-city adolescents were screened. Susceptibility rate defined by a titer less than 1:8 was 12 per cent and did not differ significantly with regard to age or race. Nine months into the study period, the State of Wisconsin enacted a "no immunization-no school" law. The susceptibility rate dropped from 22 per cent prior to the enactment of the law, to 5 per cent after. Of the 60 girls identified as susceptible, 54 (90 per cent) kept their follow up appointments for vaccinations. Enforced state immunization laws appear to be effective in lowering rubella susceptibility.
Attitudes and health promoting behavior of medical and law students.
Authors: Coe R M , Miller D K , Wolff M , Prendergast J M , Pepper M
Published: November 2008

An entering class of medical students is compared with an entering class of law students on attitudes toward self-responsibility for health and reported health behaviors. Students' health behavior patterns are contrasted with those of practicing physicians and lawyers. Data were collected by self-administered questionnaires. Results indicated that medical students were stronger on self-responsibility and also reported more often engaging in health promoting behavior than law students. The same pattern of differences was reported for practicing physicians and lawyers.
Differences in trends of postneonatal mortality by birthweight in upstate New York, 1968-1979.
Authors: Zdeb M S
Published: November 2008

Postneonatal mortality among neonatal survivors and the distribution of age at death among infant deaths were examined for births occurring in upstate New York, 1968-1979. Postneonatal mortality rates increased among infants weighing 501-1500 grams. Infants weighing 1501-2000 grams experienced an increase in postneonatal mortality during the mid-1970s, later returning to the level of 1968. Among infants 2001+ grams, postneonatal mortality declined throughout the study period. Among all levels of birthweight, the proportion of infant deaths occurring as postneonatal deaths increased.
Self-rated health: a predictor of mortality among the elderly.
Authors: Mossey J M , Shapiro E
Published: November 2008

Data from the Manitoba Longitudinal Study on Aging (MLSA) were used to test the hypothesis that self-rated health (SRH) is a predictor of mortality independent of "objective health status" (OHS). Subjects were a random sample of non-institutionalized residents of Manitoba aged 65+ in 1971 (n = 3,128). A single item measure of SRH was obtained during a survey conducted in 1971; a baseline measure of OHS was derived from physician and self-reported conditions and health service utilization data. Occurrence and date of death during the years 1971-1977 were known. Analyses of the data revealed that, controlling for OHS, age, sex, life satisfaction, income and urban/rural residence, the risk of early mortality (1971-1973) and late mortality (1974-1977) for persons whose SRH was poor was 2.92 and 2.77 times that of those whose SRH was excellent. This increased risk of death associated with poor self-rated health was greater than that associated with poor OHS, poor life satisfaction, low income and being male. These findings provide empirical support for the long held, but inadequately substantiated, belief that the way a person views his health is importantly related to subsequent health outcomes.
Impact of type A influenza on children: a retrospective study.
Authors: Mullooly J P , Barker W H
Published: November 2008

Excess morbidity was studied during influenza A epidemics (1968-69, 1972-73) among children in a large prepaid group practice program. Excess rates of hospitalization for influenza-related conditions, primarily pneumonia and bronchitis, ranged from 5 per 10,000 (95 per cent confidence limits (CL): 1 to 9) for non-high-risk children to 29 per 10,000 (95 per cent CL: 5 to 53) for children with high-risk conditions. The relative increases in hospitalization rates were greatest for 5-14 year old boys: 278 per cent and 104 per cent increases for high-risk and non-high-risk boys, respectively. The absolute increase was greatest for 0-4 year olds. The excess rate of ambulatory medical care contacts, 2.6 per 100 (95 per cent CL: -1.6 to 6.8 per 100) was not statistically significant. Excess hospitalization rates among 0-14 year olds during epidemics were three to five times larger than those for persons between 15 and 64 years of age but only one-fifth the rate of persons over age 65.
Measuring Severity of Illness: Comparisons Across Institutions
Authors: Horn Susan Dadakis
Published: November 2008

Conventional methods for classifying patients with respect to utilization of health care resources are based almost exclusively on diagnostic criteria. We review a new severity of illness index which is generic to most medical and surgical conditions in a hospital, and which has been found to produce subgroups of patients more homogeneous with respect to hospital resource use (as assessed by total charges, length of stay, routine charges, and laboratory charges) than diagnostic-related groups, staging, and generalized patient management paths. We use the severity of illness groups to compare total charges and length of stay across hospitals. We find that charges and length of stay in an academic teaching hospital are similar to those in community hospitals with and without teaching programs when controlling for severity of illness. (Am J Public Health 1983; 73:25-31.)
Cancer mortality patterns around the San Onofre nuclear power plant, 1960-1978.
Authors: Enstrom J E
Published: November 2008

Because of the recent concern over possible health effects associated with nuclear power plants, cancer mortality patterns in Southern California have been examined for time periods before the San Onofre nuclear power plant began commercial operation in 1968 and since then. This is one of America's older plants and is surrounded by major population centers in Orange, Riverside and San Diego Counties. Infant mortality rates and age-adjusted mortality rates for leukemia, lung cancer, all cancer, and all causes have been calculated and compared for Orange, Riverside, and San Diego Counties, for California, and for the United States during 1960-1978. In addition, childhood leukemia death rates and clusters have been examined in detail in the communities within 25 miles of San Onofre. The cancer and total mortality rates near San Onofre have remained essentially identical to the corresponding rates in California and United States from 1960 to 1978. There have been no significant radiation releases to the population surrounding the San Onofre plant and the cancer rates show no patterns which have been influenced by the presence of the plant. Although no radiogenic health effects would be expected, these results do provide a means of assessing overall mortality trends in the population.
Validity of a Survey Question as a Measure of Visual Acuity Impairment
Authors: Hiller Rita , Krueger Dean E.
Published: November 2008

Survey questions are frequently used to collect data on the prevalence of vision difficulties. The 1971-1972 Health and Nutrition Examination Survey included both a question about “trouble with your vision even when wearing glasses or contact lenses,” and clinical measurement of central distance visual acuity with usual corrective lenses. The question had low sensitivity for impairment of visual acuity, with variation by age and severity of impairment. Sensitivity analyses from other studies are reviewed. (Am J Public Health 1983; 72:93-96.)
The association of alcohol consumption with outcome of pregnancy.
Authors: Marbury M C , Linn S , Monson R , Schoenbaum S , Stubblefield P G , Ryan K J
Published: November 2008

Patterns of alcohol consumption were assessed in 12,440 pregnant women interviewed at the time of delivery. Only 92 women (0.7 per cent) reported drinking 14 or more drinks per week, with most consuming fewer than 21 drinks per week. In the crude data, alcohol intake of 14 or more drinks per week was associated with a variety of adverse pregnancy outcomes, including low birthweight, gestational age under 37 weeks, stillbirth, and placenta abruptio. After use of logistic regression to control for confounding by demographic characteristics, smoking, parity and obstetric history, only the association of placenta abruptio with alcohol consumption of 14 or more drinks per week remained statistically significant. With the exception of placenta abruptio, alcohol intake of fewer than 14 drinks per week was not associated with and increased risk of any adverse outcome. No association was seen with congenital malformations at any level of alcohol intake.
On the feasibility of linking census samples to the National Death Index for epidemiologic studies: a progress report.
Authors: Rogot E , Feinleib M , Ockay K A , Schwartz S H , Bilgrad R , Patterson J E
Published: November 2008

To test the feasibility of using large national probability samples provided by the US Census Bureau, a pilot project was initiated to link 230,000 Census-type records to the National Death Index (NDI). Using strict precautions to maintain the complete confidentiality of individual records, the Current Population Survey files of one month in 1973 and one month in 1978 were matched by computer to the 1979 NDI file. The basic question to be addressed was whether deaths so obtained are seriously underestimated when there is no Social Security Number (SSN) in the Census record. The search of the NDI file resulted in 5,542 matches of which about 1,800 appear to be "true positives" representing deaths, the remainder are "false positives." Of the deaths, 80 per cent would still have been detected without SSN in the Census record. The main reasons for missing deaths (false negatives) were discrepancies in the year of birth and in the given name. Assuming certain changes in the NDI matching algorithm, the 80 per cent figure could increase to 85 per cent or higher; however, this could also cause significant increases in the number of false positives. The National Heart, Lung and Blood Institute (NHLBI) and Census Bureau staff are currently developing a probabilistic method to eliminate false positives from the NDI output tape. The results of the pilot study indicate that a larger research project is clearly feasible.
An evaluation of the Social Security Administration master beneficiary record file and the National Death Index in the ascertainment of vital status.
Authors: Wentworth D N , Neaton J D , Rasmussen W L
Published: November 2008

To evaluate the relative utility of the Social Security Administration and National Death Index as sources of mortality data, the vital status of 12,866 participants in the Multiple Risk Factor Intervention Trial was identified from these sources and compared to the known mortality experience. The SSA correctly identified 87.8 per cent of the 409 deaths that occurred between 1974 and 1980. Underreporting of deaths by the SSA occurred for participants with certain demographic characteristics, especially marital status. For the years 1979 and 1980, the period for which the SSA and NDI have comparable data, the SSA correctly identified 93.2 per cent and the NDI correctly identified 98.4 per cent of the 191 known deaths. The NDI matching process resulted in a large number of false positive matches.
Surgeons and operating rooms: underutilized resources.
Authors: Gil A V , Galarza M T , Guerrero R , de Velez G P , Peterson O L , Bloom B L
Published: November 2008

A classification of surgical procedures, based on degree of complexity and the need for facilities and personnel, was applied to all 50,782 surgical interventions performed in the Valle del Cauca, Colombia during 1974. Three-fourths of all operations were of low levels of complexity, and most could be performed on an ambulatory basis with immediate discharge after recovery from anesthesia. Mean numbers of operations per year for surgical specialists and other physicians were 119.7 and 18.1, respectively. The 76 existing operating rooms were utilized only 41.6 per cent of the time. The implications of underutilization of personnel and facilities and low productivity of surgeons are discussed.
Characteristics of joggers among Japanese men in Hawaii.
Authors: Yamamoto L , Yano K , Rhoads G G
Published: November 2008

In a population-based cohort of Japanese American men in Hawaii, the 450 joggers differed from 6,171 nonjoggers in being younger, taller, heavier, and more obese; in having larger vital capacity, higher socioeconomic status, and a higher prevalence of certain electrocardiographic abnormalities; and in being more health conscious as demonstrated by less smoking and a higher frequency of special diets. Blood pressure, serum total cholesterol, hematocrit and high density lipoprotein cholesterol (HDL-C) did not differ significantly between the two groups. Multiple regression analysis showed HDL-C to be inversely related to obesity and cigarettes, and directly related to alcohol consumption but to have no relationship to jogging or age. Temporal analyses suggested that initiation of jogging was followed by a reduction in heart rate, but there was no significant change in other measured parameters. Coronary heart disease (CHD) prevalence was increased in joggers, perhaps because the diagnosis of CHD predisposes to this activity. We conclude that jogging has probably had little impact on the health of this cohort.
Five-year blood pressure control and mortality following health education for hypertensive patients.
Authors: Morisky D E , Levine D M , Green L W , Shapiro S , Russell R P , Smith C R
Published: November 2008

Three health education interventions for urban poor hypertensive patients were introduced sequentially in a randomized factorial design: 1) an exit interview to increase understanding of and compliance with the prescribed regimen; 2) a home visit to encourage a family member to provide support for the patient's regimen; and 3) invitations to small group sessions to increase the patient's confidence and ability to manage his/her problem. Previous evaluation of the initial two-year experience demonstrated a positive effect of the educational program on compliance with the medical treatment and blood pressure control. Data accumulated over an additional three years, including mortality analysis, are now presented. The study group consisted of the same cohort of 400 ambulatory hypertensive outpatients in the eight experimental and control groups. The five-year analysis shows a continuing positive effect on appointment keeping, weight control, and blood pressure control. All-cause life table mortality rate was 57.3 per cent less for the experimental group compared to the control group (12.9/100 vs 30.2/100, p less than .05), while the hypertension-related mortality rate was 53.2 per cent less (8.9/100 vs 19.0/100, p less than .01). The results from this longitudinal study provide evidence to encourage health practitioners to utilize such educational programs in the long-term management and control of high blood pressure.
Byssinosis: a role for public health in the face of scientific uncertainty.
Authors: Wegman D H , Levenstein C , Greaves I A
Published: November 2008

Byssinosis, a lung disease caused by cotton dust, has been the subject of recent controversy. Debates over the nature of the disease, possible interactions with cigarette smoking, and the proposed reevaluation of the cotton dust standard by the Occupational Safety and Health Administration have tended to overlook the plight of affected workers and to obscure the most effective means for preventing the disease. The present lack of definitive information is no reason for inaction, nor for depriving disabled workers of adequate financial compensation. In this respect, byssinosis is no different from other public health hazards for which action must often be taken on the basis of incomplete evidence.
Identifying and tracing a population at risk: the DESAD Project experience.
Authors: Nash S , Tilley B C , Kurland L T , Gundersen J , Barnes A B , Labarthe D , Donohew P S , Kovacs L
Published: November 2008

In recent years, medical record review has been used to alert patients who have received drugs or treatments that have newly discovered side-effects. The experience of the national cooperative Diethylstilbestrol-Adenosis (DESAD) Project in identifying and notifying women exposed in utero to diethylstilbestrol (DES) shows this to be a difficult task. In order to identify 4,830 exposed women, 221,245 charts were reviewed. Detailed tracing data for one of the centers participating in the DESAD Project indicated that only 85 per cent of the 690 DES-exposed women identified at that center could be notified of exposure. The DESAD Project experience has led to recommendations for standardized prenatal records and drug lists, long-term storage of medical records, new legal guidelines, and improved recording of follow-up information, taking into account issues of privacy.
Lake Michigan fish consumption as a source of polychlorinated biphenyls in human cord serum, maternal serum, and milk.
Authors: Schwartz P M , Jacobson S W , Fein G , Jacobson J L , Price H A
Published: November 2008

Reported consumption of Lake Michigan sport fish was examined in relation to the levels of polychlorinated biphenyls (PCBs) in biological samples provided by a sample of maternity patients. Fish consumption was correlated with PCB levels in maternal serum and milk but not in cord serum. PCB levels in serum increased with age, but were unrelated to social class, parity, or weight. Women who breast fed consumed as much fish as women who did not and their maternal and cord sera PCB levels were similar.
Supply, workload and utilization: a population-based analysis of surgery in rural Manitoba.
Authors: Roos L L
Published: November 2008

This paper explores the relationships among physician supply, workload (output per physician), and utilization (physician services per capita) in rural Manitoba. Surgery taking place within a patient's home area and that taking place outside this area are discussed. Longitudinal and cross-sectional analyses are compared. Although the average surgeon does more surgical procedures than does the average general practitioner, the number of procedures performed varies greatly within each specialty. Individual physician workloads remained fairly stable over time when a surgically active physician moved into an area, while population utilization increased 17 per cent. When such physicians left an area, the surgical workloads of the physicians increased significantly (18.7 per cent) while population utilization stayed essentially the same. Both physician workload and surgical utilization in control areas increased gradually (between 6 and 7 per cent) over the period studied. Several models of physician behavior were investigated using data on individual procedures as well as overall figures. A model emphasizing the importance of physician discretion appeared to provide the best fit with the data.
Caring for Southeast Asian refugee patients in the USA.
Authors: Muecke M A
Published: November 2008

This paper concerns care of refugees from Southeast Asia who speak little English and are relatively unfamiliar with the formal health care system in the United States. It aims to demystify the behaviors of refugee patients and to support health practitioners who are attempting to care for them. Western medicine is discussed in terms of the expectations that refugees tend to hold of it, and of the conflicts with Southeast Asian beliefs and practices which it presents. Despite language differences, health care agents can increase the effectiveness of their communication with persons from Southeast Asia, primarily by allowing for their viewpoints. Topics discussed are: the first encounter with a refugee patient; use of interpreters; obtaining informed consent; "the passive obedient" patient; the "non-compliant" patient; body image; sources of social support for healing; use of medications; traditional self-care practices; and death and depression.
Passenger car size and driver seat belt use.
Authors: O'Neill B , Williams A F , Karpf R S
Published: November 2008

The National Highway Traffic Safety Administration (NHTSA) claims, on the basis of survey results, that seat belt use in small cars is twice as high as in large cars. The agency interprets this as being due in part to perceptions of higher risk by small car occupants. In fact, little is known about the factors motivating belt use, including whether risk perception is important. A reanalysis of the NHTSA data indicates that most of the differences in belt use by car size can be explained by higher use in imported cars, and by geographical differences in belt use in domestic cars.
The Pennsylvania domiciliary care experiment: I. Impact on quality of life.
Authors: Sherwood S , Morris J N
Published: November 2008

This paper reports findings concerning the impact on quality of life of a case management focused program of small board and care facilities serving aging, mental health, and mental retardation adult target populations--the Pennsylvania Domiciliary Care Program. Program participants from the counties in which the Domiciliary Care Program was initiated were matched with persons residing in similar counties without the program who were comparable on a large array of characteristics prior to program initiation. Conducted separately by target group, 10-month follow-up assessments provided the basis for determining impact. In general, the effects were positive, particularly with respect to meeting program quality of life goals (providing needed services, improving living conditions, increasing community integration, and reducing institutional days); the effects were more positive for the aging and mental health than for the mentally retarded target populations.
Premature deaths avoided by the antismoking campaign.
Authors: Warner K E , Murt H A
Published: November 2008

The antismoking campaign has encouraged millions of people to quit smoking cigarettes and millions of others not to initiate the habit. Because quitting smoking, or deciding not to start, reduces one's mortality risks relative to the continuing smoker, we estimate that these consumption impacts resulted in the avoidance of more than 200,000 premature smoking-related deaths during 1964-1978. On average, each of these premature deaths averted translates into 23 additional years of life. Furthermore, campaign-related smoking cessation and non-initiation during the 1964-1978 period will result in the avoidance of many more premature deaths in the coming decades. Although these figures suggest that the antismoking campaign has been successful, tens of millions of Americans continue to smoke and the premature deaths avoided constitute only a small fraction of the 4 million deaths attributable to smoking that occurred during the same years.
Comparison of an Active and Passive Surveillance System of Primary Care Providers for Hepatitis, Measles, Rubella, and Salmonellosis in Vermont
Authors: Vogt Richard L. , LaRue Denise , Klaucke Douglas N. , Jillson David A.
Published: November 2008

Between June 1, 1980 and May 31, 1981, the Vermont Health Department telephoned a randomly chosen half of the state's primary care offices for surveillance reports of hepatitis, measles, rubella, and salmonellosis. No reports were actively solicited from the other half of the primary-care practices in the state. Active-surveillance units made more reports and more complete reports of diseases and had twice the number of reports per patient seen by the practice than did passive-surveillance units. (Am J Public Health 1983; 73:795-797.)
Statistical validation of a severity of illness measure.
Authors: Wagner D P , Knaus W A , Draper E A
Published: November 2008

This paper provides statistical detail on the predictive power of a new severity of illness scale--APACHE (Acute Physiology and Chronic Health Evaluation)--on 833 consecutive medical admissions to an intensive care unit (ICU). In a multivariate logistic regression analysis of routine physiologic and other data obtained within 24 hours of ICU admission, severity of illness and age were significantly (p less than .0001) related to survival. Using the estimated equation to forecast death rates for independent data, APACHE allowed accurate estimates of death rates for groups of patients whose mortality at hospital discharge varied from 3 to 80 per cent. The Acute Physiology Score of APACHE is also strongly and significantly associated with outcome within a number of specific cardiovascular, neurologic, respiratory, and gastrointestinal diagnoses. After multi-institutional validation studies, APACHE could prove useful in a wide range of studies involving acutely ill patients.
Prevalences of anemia and iron deficiency anemia in Black and White women in the United States estimated by two methods.
Authors: Meyers L D , Habicht J P , Johnson C L , Brownie C
Published: November 2008

Prevalences of anemia were estimated by two methods for 742 Black and 3,074 White nonpregnant women of childbearing age drawn from a large probability sample of the United States civilian noninstitutionalized population (NHANES I). One method defines the prevalence of anemia as the proportion of women with hemoglobin levels below a 12 g/dl "cut-off". The second method defines the prevalence of anemia as the proportion of women whose hemoglobin values are shifted downwards relative to a distribution of hemoglobin values of non-anemic women. Estimates produced by both methods suggest a higher prevalence of anemia in Black than in White women. Estimates produced by the "cut-off" method, however, are higher than those from the "distribution" method for both racial groups, probably because the "cut-off" method results in large overestimates in populations where anemia prevalence is low. The "distribution" method is further used to estimate the contribution of iron deficiency to anemia. Essentially all anemia in White women and a high proportion of anemia in Black women is associated with iron deficiency in the US civilian noninstitutionalized population. Iron supplementation trials are needed in order to define the magnitude of the problem accurately and plan appropriate public health programs.
Evaluation of hospital care in one trauma care system.
Authors: Spain D M , Fox R I , Marcus A
Published: November 2008

To evaluate the effectiveness of the trauma care system in the Hudson Valley Emergency Medical Services (EMS) Region, (with no designated regional trauma care center) 421 consecutive trauma autopsy reports for 1979-80 were analyzed. Of the 421 trauma patients, 194 died at the scene (DAS), most from vehicular accidents. The remaining 227 patients were triaged into the EMS system. Ninety-five were dead on arrival (DOA) at medical facilities; of 132 (31 per cent) who arrived alive at hospitals, 35 died in emergency rooms and 97 died later as inpatients. Nearly 60 per cent of the deaths involved brain injuries. A panel of five physician-evaluators examined the pathologist's analysis of those deaths considered to have been possibly preventable and concluded that 10 deaths (7.6 per cent) of in-hospital cases were preventable. The study showed the need for primary prevention of accidents to decrease the number of victims (46 per cent) who died at the scene and those (23 per cent) who were dead on arrival at hospitals.
Polybrominated biphenyls and fetal mortality in Michigan.
Authors: Humble C G , Speizer F E
Published: November 2008

The contamination of the Michigan food supply by polybrominated biphenyls (PBBs) in the mid-1970s appears to have had little or no impact on fetal mortality. Comparison of fetal death rates among residents of Lower Peninsula counties with a high percentage of quarantined farms and among residents of Upper Peninsula counties with no quarantined farms reveals no important differences in rates or trends after the contamination. Since counts of early spontaneous abortions are lacking, a complete assessment of the possible impact on reproductive outcome cannot be made.
Polychlorinated biphenyls: influence on birthweight and gestation.
Authors: Taylor P R , Lawrence C E , Hwang H L , Paulson A S
Published: November 2008

Fifty-one infants born to women employed at two capacitor manufacturing facilities with a history of high exposure to polychlorinated biphenyls (PCBs) had a mean birthweight of 153 grams less than that of 337 infants born to women who had worked in low-exposure areas (90 per cent confidence interval, -286 to -20 g); mean gestational age was 6.6 days shorter in the high-exposure infants (90 per cent CI, -10.3 to -2.9 days). After adjusting for gestational age, the difference in birthweight was markedly reduced, indicating that the observed reduction in birthweight was due mainly to shortening of gestational age in the high-exposure group.
Insurance incentives and seat belt use.
Authors: Robertson L S
Published: November 2008

In 1983, Nationwide Insurance Company increased compensation payments for its clients injured or killed in a motor vehicle crash while using a seat belt. A survey of belt use was undertaken in the month after all those so insured had been informed of the change. Belt use by drivers insured by Nationwide was not significantly different from that of drivers insured by other companies. The incentive appears to have had no apparent effect on belt use.
Exposure-related hypothermia mortality in the United States, 1970-79.
Authors: Rango N
Published: November 2008

This study describes exposure-related hypothermia deaths in the United States from 1970 to 1979. Mortality risk from hypothermia increases with age; at all ages, non-White men are at highest risk and White women at lowest risk. Counts of deaths from hypothermia based on information from death certificate data may be understated. Effective social intervention to prevent hypothermia mortality and morbidity requires better public health surveillance and intensive case-finding.
A survey of patient sources of prescription drug information.
Authors: Morris L A , Grossman R , Barkdoll G L , Gordon E , Soviero C
Published: November 2008

A national telephone survey of 1,104 adults who had recently obtained a new prescription was undertaken to determine the nature and amount of drug information obtained. Sixty percent stated that physicians provided directions for use information with the pharmacy reported as about half as active. Only 3 to 6 per cent said they asked the physician or pharmacist for information. However, one in six respondents said they looked up the prescription in a drug reference book such as the Physicians Desk Reference.
Campylobacter enteritis associated with undercooked barbecued chicken.
Authors: Istre G R , Blaser M J , Shillam P , Hopkins R S
Published: November 2008

An outbreak of Campylobacter enteritis occurred in 1982 among 11 of 15 members and friends of an extended family gathering in Colorado. Median onset for illness, characterized by diarrhea, abdominal cramps, fever and headache, was four days after the party. Illness was associated with eating undercooked chicken. Two ill persons had stool specimens positive for C. jejuni. Eight of ten ill persons tested had Immunoglobulin-M-specific indirect fluorescent antibody (IFA) titers to C. jejuni greater than or equal to 32. IFA titers to C. jejuni peaked within three weeks of exposure and decreased to control levels within three months after exposure. Inadequate cooking of poultry may increase the risk of these infections.