bluuebunny/crossref_metadata_2025 huggingface dataset:
Mortality of intravenous drug users in Rome: a cohort study.
Authors: Perucci C A , Davoli M , Rapiti E , Abeni D D , Forastiere F
Published: November 2008

A historical cohort study was carried out in Rome to examine overall and cause-specific mortality among intravenous drug users (IVDUs). A total of 4200 IVDUs (3411 men and 789 women) enrolled in methadone treatment centers between 1980 and 1988 were studied. There were 239 deaths during the follow-up period. The overall SMR was 10.10 in the entire cohort (95% confidence interval, 8.86-11.47), 9.30 in males and 18.07 in females. A large excess of mortality in both sexes was found for infectious, circulatory, respiratory, and digestive diseases as well as for violence, overdose, AIDS, and unknown or ill-defined causes. Tumors and suicide were excessive only in males. Deaths due to drug overdose, violence or trauma, and cirrhosis accounted for 63.6%, AIDS for 7.1%, endocarditis and other bacterial infections for 7.1%, and neoplasms for 3.8% of total mortality. These findings document serious health consequences of drug abuse in Italy.
Timeliness of national reporting of communicable diseases: the experience of the National Electronic Telecommunications System for Surveillance.
Authors: Birkhead G , Chorba T L , Root S , Klaucke D N , Gibbs N J
Published: November 2008

The timeliness of reporting four nationally notifiable diseases was examined using data reported via the National Electronic Telecommunications System for Surveillance. Timeliness of reporting varied by disease (bacterial meningitis: median 20 days; salmonellosis: median 22 days; shigellosis: median 23 days; and hepatitis A: median 33 days) and by state. These findings indicate a need to standardize surveillance definitions and to account for reporting differences between states in interpreting regional disease trends or detecting multistate disease outbreaks.
The association between congenital syphilis and cocaine/crack use in New York City: a case-control study.
Authors: Greenberg M S , Singh T , Htoo M , Schultz S
Published: November 2008

From 1987 to 1989, an epidemic of congenital syphilis was observed in New York City. A case-control study was done to assess the association between various maternal risk factors and congenital syphilis. Independent of the effect of other factors, the odds of being exposed to cocaine were 3.9 times greater among cases than controls (95% confidence interval, 2.8-5.3). This study suggests that the epidemic of congenital syphilis may be related to the increase in cocaine/crack use among delivering mothers.
Human papillomavirus, gonorrhea, syphilis, and cervical dysplasia in jailed women.
Authors: Bickell N A , Vermund S H , Holmes M , Safyer S , Burk R D
Published: November 2008

We assessed the prevalence of human papillomavirus (HPV) by cervicovaginal lavage and Southern blot and inquired about behavioral risk factors for cervical disease and sexually transmitted diseases by interview in 114 female detainees at a large New York City jail. Of the women screened, 8% had abnormal Pap smears, 35% had HPV, 7% had gonorrhea, and 22% had serologic syphilis. Given the high rates of HPV infection and cervical cytology, Pap smears should be a routine intake procedure for incarcerated women.
Immunoglobulins and growth parameters at birth of infants born to HIV seropositive and seronegative women.
Authors: Butz A , Hutton N , Larson E
Published: November 2008

Health characteristics of neonates born to human immunodeficiency virus (HIV) seropositive (n = 63) and HIV seronegative (n = 57) women were compared. No significant differences were found between the two infant groups for sociodemographic characteristics, mode of delivery, Apgar scores, gestational age, growth parameters, or immunoglobulin levels. Furthermore, no differences were detected in a subgroup of infants later confirmed to have HIV infection (class P-2). Maternal HIV infection does not appear to affect newborn health characteristics.
Cancer incidence in the Puerto Rican-born population of Long Island, New York.
Authors: Polednak A P
Published: November 2008

BACKGROUND. There are apparently no published data on cancer incidence in the Puerto Rican-born populations of the northeastern United States. METHODS. Standardized incidence ratios (SIRs) were calculated for 1980 through 1986 for the Puerto Rican-born population in Long Island (New York). RESULTS. Significantly reduced SIRs were found for males (SIR = 0.77) but not for females (SIR = 0.91), using expected numbers derived from incidence rates for all areas in the Surveillance, Epidemiology and End Results (SEER) Program (excluding Puerto Rico). Using incidence rates for Puerto Rico to obtain expected numbers, there was evidence for the retention of elevated SIRs for stomach cancer (both sexes) and for significantly elevated SIRs for lung cancer (both sexes), colon-rectum cancer (females), prostate cancer, and breast and uterine corpus cancer. Using rates for SEER areas, the SIRs for lung cancer approached 1.00, in contrast to other US Puerto Rican-born populations. CONCLUSION. The data indicate the need for surveys on smoking and other health-related behaviors in the population studied and provide further evidence for heterogeneity in cancer patterns in US Puerto Rican-born populations.
Smoking, social support, and hassles in an urban African-American community.
Authors: Romano P S , Bloom J , Syme S L
Published: November 2008

BACKGROUND. Despite public health efforts, the prevalence of smoking among African Americans remains high. The determinants of smoking behavior in this population must be elucidated so that interventions can be better targeted and more effective. METHODS. As part of a prospective community intervention trial to reduce cancer mortality, we conducted a random household survey of 1137 African-American adults in San Francisco and Oakland between November 1985 and July 1986. The survey instrument included questions about social network characteristics, instrumental and emotional aspects of social support, smoking behavior, and stressors. RESULTS. The overall prevalence of smoking (41.9%) was higher than that reported in national surveys. Logistic models revealed that persons reporting high levels of stress, represented by an abbreviated hassles index, were more likely to smoke than those reporting less stress. Women with poor social networks were more likely to smoke (odds ratio = 3.1) than women with optimal networks; however, this relationship did not hold among men. Indeed, men lacking emotional support from friends or family were less likely to smoke (odds ratio = 0.5) than men receiving such support. No interaction between social support and hassles was observed. CONCLUSIONS. Stressful environments may contribute to high-risk smoking behavior among urban African Americans.
Income, race, and surgery in Maryland.
Authors: Gittelsohn A M , Halpern J , Sanchez R L
Published: November 2008

BACKGROUND. We describe common surgical and medical hospital admission rates for Maryland residents, exploring systematic effects of race and income. METHODS. The data comprise Maryland hospital discharges and population estimates for 1985 to 1987. Patient income is the race-specific median family income of residence zip code. Logistic regression is used to measure incidence by race, income, and residence for surgical and medical reasons for admission. RESULTS. Population rates for discretionary orthopedic, vascular, and laryngologic surgery tend to increase with community income levels. Coronary and carotid artery surgery rates are two to three times higher among Whites. The more discretionary the procedure, the lower is the relative incidence among Blacks. By contrast, admission rates for most medical reasons decline with increasing income levels and are elevated among Blacks. The affluent receive coronary artery procedures whereas the poor are hospitalized for coronary artery disease. CONCLUSIONS. Blacks and the poor appear to have higher illness burdens requiring hospital care. Discretionary surgeries have a White predominance and increase with income; medical admissions have a Black predominance and decline with income. Race and community income level are important factors in differential hospital utilization rates.
National health objectives for the year 2000: the demographic impact of health promotion and disease prevention.
Authors: Stoto M A , Durch J S
Published: November 2008

BACKGROUND. The national objectives in Healthy People 2000, drafted by health professionals aware of currently available public health interventions, represent a wealth of information about near-term future mortality and morbidity. METHODS. Life table methods were used to calculate the impact of projected changes in mortality and activity limitation rates on life expectancy and expected disability years. RESULTS. Meeting the mortality objectives would increase life expectancy at birth by 1.5 to 2.1 years, raising life expectancy to 76.6 to 77.2 years. In addition, meeting the target for disability from chronic conditions would increase the number of years of life without activity limitations from 66.8 years to 69.3-69.7 years. If the targets for coronary heart disease and unintentional injury were changed to reflect recent trends, a greater improvement in life expectancy at birth would be achieved: from 1.8 to 2.7 years to 76.9 to 77.8 years. CONCLUSION. Meeting the targets would have an important demographic impact. Including changes in the coronary heart disease and injuries targets, life expectancy in the year 2000 would be above the middle of the ranges used in current Census Bureau projections.
A 5-year follow-up study of 117 battered women.
Authors: Bergman B , Brismar B
Published: November 2008

This paper reports register data concerning somatic and psychiatric hospital care on 117 battered women who were identified in a surgical emergency department and offered a treatment program. Data were collected during a period of 10 years before to 5 years after the battering in question. It was concluded that the battered woman seeks hospital care much more than the average woman of the same age. It is, however, not only traumatic injuries that bring her to the hospital, but also medical, gynecological, psychiatric, and unspecified disorders and suicide attempts. In this study it was hypothesized that this overuse of hospital care reflects the situation at home characterized by ongoing battering and other psychosocial problems. During the 5 years following the battering, the women did not show any signs of reducing their use of hospital care. It is alarming that this high use of medical care continues over years, and doctors should consider battering as one possible explanation for this phenomenon.
Age- and sex-specific cycles in United States suicides, 1973 to 1985.
Authors: McCleary R , Chew K S , Hellsten J J , Flynn-Bransford M
Published: November 2008

Total US suicides peak on the first day of each week, in the first week of each month, and in the late spring of each year. Although these cycles are assumed to characterize all US suicides, analyses by age and sex show that the cycles occur only in a few subpopulations. Day-of-the-week effects are found almost exclusively in middle-aged suicides; day-of-the-month effects are found almost exclusively in elderly male suicides; and month-of-the-year effects asre found almost exclusively in teenaged and elderly suicides.
From health-based to technology-based standards for hazardous air pollutants.
Authors: Robinson J C , Pease W S
Published: November 2008

The Clean Air Act Amendments of 1990 represent a major shift in regulatory emphasis for toxic air pollutants. Recognizing the immediate public health benefits that can be gained from the application of currently available and affordable control technologies, Congress has abandoned its insistence that health risks should be the only consideration in establishing emissions standards. Previously excluded concerns about economic costs and technological feasibility will now determine the initial level of pollution control required of toxic air pollution sources. In exchange for reducing the stringency of emissions limits, the newly amended act extends the scope of regulation by listing 189 toxic substances that must be controlled over the next decade. This exchange of regulatory depth for breadth occurs against a history of reluctance by the Environmental Protection Agency to implement the original health-protective language of the Clean Air Act. It mirrors earlier compromises under the Clean Water Act and the Occupational Safety and Health Act.
Health for all: a public health vision.
Authors: McBeath W H
Published: November 2008

The approach of a millennial passage invites public health to a review of past performance and a preview of future prospects toward assuring a healthy public. Since the 1974 Canadian Lalonde report, the best national plans for health progress have emphasized disease prevention and health promotion. WHO's multinational Health for All by the Year 2000 promotes basic health services essential to leading a socially and economically productive life. Healthy People 2000, the latest US guide, establishes three goals: increase healthy life span, reduce health disparities, and achieve universal access to preventive services. Its objectives can be used to excite public understanding, equip program development, evaluate progress, and encourage public accountability for health initiatives. Needed is federal leadership in defining requisite action and securing necessary resources. Elsewhere a "new public health" emphasizes community life-style and multisectoral "healthy public policy." In the United States, a national health program is needed to achieve equity in access to personal health care. Even more essential is equitable sharing in basic health determinants in society--nutritious food, basic education, safe water, decent housing, secure employment, adequate income, and peace. Vital to such a future is able and active leadership now from governments and public health professionals.
Occupational health and safety in Brazil.
Authors: Frumkin H , Câmara V de M
Published: November 2008

BACKGROUND. Brazil is the world's fifth largest and sixth most populous nation. Its economy is varied, with strong manufacturing, agriculture, mining, and service sectors. Therefore, a wide variety of workplace hazards confronts its work force. This paper describes Brazil's occupational safety and health regulatory scheme, workers' compensation system, plant-level practices, training, and data collection. METHODS. We reviewed and analyzed Brazilian regulatory legislation and government and non-governmental organization (NGO) activity in occupational safety and health, as well as the structure and function of the workers' compensation system. We also reviewed available data on injuries and diseases from major sources, including the now-defunct Instituto Nacional do Previdencia Social (INPS) and the workers' compensation scheme, Seguro de Acidente de Trabalho (SAT). RESULTS. The incidence of workplace injuries has decreased in recent years and is now reported to be about 5 per 100 workers per year. The case fatality rate has been constant at about 5 fatalities per 1000 injuries. Less than 6% of reported injuries are classified as "diseases." Brazil's rates are comparable to those of Mexico and Zimbabwe, and two to four times higher than in most industrialized countries. CONCLUSIONS. Brazil has a high incidence of occupational injuries and diseases; these injuries and diseases are underreported; there is a large informal sector at special risk; and Brazil illustrates the disparity that exists in many countries between legislation on the books and legislation that is actually implemented.
HIV infection and risk behaviors among intravenous drug users in low seroprevalence areas in the Midwest.
Authors: Siegal H A , Carlson R G , Falck R , Li L , Forney M A , Rapp R C , Baumgartner K , Myers W , Nelson M
Published: November 2008

We studied behavioral factors that place intravenous drug users at risk for the acquisition and transmission of the human immunodeficiency virus (HIV) in a sample of 855 individuals not in drug treatment, living in central and southwestern Ohio. The HIV seropositivity rate for the sample was 1.5%. Three factors were significantly related to HIV infection: homeless shelter residence (odds ratio [OR] = 7.7, 95% confidence interval (CI) = 3.0-20.0), travel to northeastern HIV hyperendemic areas (OR = 5.2, 95% CI = 1.8-15.4), and recent male homosexual or bisexual behavior (OR = 11.2, 95% CI = 2.9-43.9).
Frequency and thoroughness of STD/HIV risk assessment by physicians in a high-risk metropolitan area.
Authors: Boekeloo B O , Marx E S , Kral A H , Coughlin S C , Bowman M , Rabin D L
Published: November 2008

The US Preventive Services Task Force recommends that all primary care physicians assess the sexually transmitted disease/human immunodeficiency virus (STD/HIV) risk of all adolescent and adult patients. To determine whether factors amenable to change through continuing medical education are associated with frequent and thorough STD/HIV risk assessment, a telephone survey of primary care physicians in the Washington, DC metropolitan area was conducted (n = 961). Thirty-seven percent of physicians reported regularly asking new adult patients about their sexual practices; 60% asked new adolescent patients. STD/HIV risk questioning was associated with physicians' confidence in their ability to help prevent HIV, comfort with discussing patients' sexual practices, and perception of a large STD/HIV problem in their practice. These findings suggest that continuing medical education should target improvement in physicians' sexual practice questioning skills.
The impact of vitamin A supplementation on morbidity: a randomized community intervention trial.
Authors: Abdeljaber M H , Monto A S , Tilden R L , Schork M A , Tarwotjo I
Published: November 2008

A randomized community trial investigated the impact of vitamin A supplementation on symptoms of respiratory and enteric infections among Indonesian children aged 1 to 5 years. A sample of 450 villages had been randomized into 229 villages that received vitamin A distribution and 221 that were observed as controls. The prevalence rates of cough, fever, and diarrhea were reduced in the treatment villages compared with the control villages by 8%, 5%, and 11%, respectively, but the reduction was not statistically significant. These results indicate that vitamin A supplements did not produce a substantial reduction in these symptoms, in spite of a reported reduction in all-cause mortality.
Occupational injuries and illnesses among Washington State agricultural workers.
Authors: Demers P , Rosenstock L
Published: November 2008

In Washington state 29,451 workers' compensation claims were filed by farm workers between 1982 and 1986. Five percent of claimants were under 18 years of age, including 1.3% under the age of 16. Agricultural workers were found to be at higher risk than other workers in the state for fatal injury (relative risk [RR] = 2.5, 95% confidence interval [CI] = 1.7-3.7), sprains and strains (RR = 1.4, CI = 1.3-1.4), fractures (RR = 2.3, CI = 2.2-2.4), dislocations (RR = 1.9, CI = 1.7-2.2), concussions (RR = 1.9, CI = 1.6-2.3), amputations (RR = 2.5, CI = 2.0-3.1), dermatitis (RR = 4.3, CI = 4.0-4.7), systemic poisoning (RR = 3.4, CI = 3.1-3.7), respiratory disease (RR = 1.7, CI = 1.0-2.9), and tendonitis (RR = 1.2, CI = 1.1-1.4).
Epidemiology and the law: courts and confidence intervals.
Authors: Christoffel T , Teret S P
Published: November 2008

Beginning with the swine flu litigation of the early 1980s, epidemiological evidence has played an increasingly prominent role in helping the nation's courts deal with alleged causal connections between plaintiffs' diseases or other harm and exposure to specific noxious agents (such as asbestos, toxic waste, radiation, and pharmaceuticals). Judicial reliance on epidemiology has high-lighted the contrast between the nature of scientific proof and of legal proof. Epidemiologists need to recognize and understand the growing involvement of their profession in complex tort litigation.
Alcohol use and abuse in random samples of physicians and medical students.
Authors: McAuliffe W E , Rohman M , Breer P , Wyshak G , Santangelo S , Magnuson E
Published: November 2008

BACKGROUND. This study sought to resolve conflicting views about whether physicians are especially prone to alcohol abuse. METHODS. Using an anonymous, mailed questionnaire on substance use, we surveyed 500 physicians, 510 pharmacists, and 974 of their students. The physicians and pharmacists were selected randomly from the state society's membership lists, and students selected were from local school lists. Follow-up surveys were sent to nonresponders at two-week intervals. RESULTS. The physicians and medical students did not drink especially heavily and were no more vulnerable to alcoholism than were their counterparts in pharmacy and other professions. Physicians differed from pharmacists in their style of drinking (greater frequency, smaller quantity), but not in total amount of alcohol consumed. Drinking habits among physicians were not associated with medical specialty or type of practice, but were positively related to gender (males drank more than females) and to age (older doctors were more apt to qualify as heavy drinkers than were younger doctors). CONCLUSIONS. Physicians were no more likely to abuse substances nonmedically than were other professionals. Any group in which alcohol use is nearly universal incurs a risk of abuse and impairment that cannot be ignored.
Responsible alcohol service: a study of server, manager, and environmental impact.
Authors: Howard-Pitney B , Johnson M D , Altman D G , Hopkins R , Hammond N
Published: November 2008

A responsible alcohol-service training program was evaluated for its impact on changing beliefs, knowledge, and behavior in 97 servers and 43 managers and on changing establishment policies that encourage safer drinking environments. The training program had a significant impact on changing the beliefs and knowledge of both servers and managers. Observation 4 to 6 weeks after training showed no effects on server behavior, but there was a tendency toward more establishment policies compared with controls.
Effects of a worksite nonsmoking policy: evidence for increased cessation.
Authors: Sorsensen G , Rigotti N , Rosen A , Pinney J , Prible R
Published: November 2008

A random sample of employees was surveyed 20 months after a non-smoking policy was implemented at the New England Telephone Company in 1986. Overall, 21 percent of respondents who were smoking at the time they heard about the policy had quit smoking; 42 percent of quitters said they stopped smoking because of the policy. Cessation was highest among those who reported less smoke in their work area, but was not related to participation in cessation programs. This study suggests that worksite nonsmoking policies may have favorable effects on smoking cessation.
An evaluation of the use of the Statewide Planning and Research Cooperative System of New York State as a resource planning tool for HIV infection.
Authors: Kaufman G I , DiFerdinando G T , Gottesman S E
Published: November 2008

Hospital discharge records of patients with Pneumocystis carinii pneumonia (PCP) in New York State were studied to determine whether cases of human immunodeficiency virus (HIV) infection were identified. We estimate that as many as 13 percent of hospitalizations of patients with PCP in 1987 and 10 percent of those in 1988 were not appropriately identified as HIV related. Identification of PCP as HIV related was a function of a hospital's volume of PCP admissions.
Intake of tapwater and total water by pregnant and lactating women.
Authors: Ershow A G , Brown L M , Cantor K P
Published: November 2008

BACKGROUND. Despite theoretically higher requirements for water due to physiologic demands of pregnancy and lactation, little is known of actual ranges of intake in pregnant and lactating women. METHODS. Population-based estimates of total water and tapwater intake in women of reproductive age were derived using data from the 1977-78 USDA Nationwide Food Consumption Survey. Three-day average intakes were calculated for 188 pregnant women, 77 lactating women, and 6,201 non-pregnant, non-lactating control women. RESULTS. Total water intake (mean +/- SD) was 1,940 +/- 686 g/day (median 1,835) for control women, 2,076 +/- 743 g/day (median 1,928) for pregnant women and 2,242 +/- 658 g/day (median 2,164) for lactating women. Tapwater intake was 1,157 +/- 635 g/day (median 1,065) for control women, 1,189 +/- 699 g/day (median 1,063) for pregnant women, and 1,310 +/- 591 g/day (median 1,330) for lactating women. Total water intake was equal to or greater than 3,000 g/day among 7 percent of control women, 11 percent of pregnant women, and 13 percent of lactating women. Tapwater intake was equal to or greater than 2,000 g/day among 10 percent of control women, 15 percent of pregnant women, and 8 percent of lactating women. CONCLUSIONS. These results should be useful in estimating amounts of nutrients and toxic substances that women of reproductive age obtain through the water supply.
Regression-adjusted small area estimates of functional dependency in the noninstitutionalized American population age 65 and over.
Authors: Elston J M , Koch G G , Weissert W G
Published: November 2008

Health planning efforts for the population age 65 and over have been hampered continually by the lack of reliable estimates of the noninstitutionalized long-term care population. Until recently national estimates were virtually nonexistent, and reliable small area estimates remain unavailable. However, with the recent publication of several national surveys and the 1990 Census, synthetic estimates can be made for states and counties by using multivariate methods to model functional dependency at the national level, and then applying the predicted probabilities to corresponding state and county data. Using the 1984 National Health Interview Survey's Supplement on Aging and the 1986 Area Health Resources File System, we have produced log-linear regression models that include demographic and contextual variables as predictors of functional dependency among the noninstitutionalized population age 65 and over. Age, sex, race, and the percent of the 65 and over population who reside in poverty were found to be significant predictors of functional dependency. Applying these models to 1986 Medicare Enrollment Statistics, regression-adjusted synthetic estimates of two levels of functional dependency were produced for all states and--as examples of how the rates can be used to produce additional synthetic estimates--the largest county in each state. We also produced point estimates and standard errors for the national prevalence of functional dependency among the noninstitutionalized population age 65 and over.
Dioxins and dibenzofurans in adipose tissue of US Vietnam veterans and controls.
Authors: Kang H K , Watanabe K K , Breen J , Remmers J , Conomos M G , Stanley J , Flicker M
Published: November 2008

The primary reason for concern about the adverse effects of exposure to Agent Orange is attributable to its toxic contaminant, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) or dioxin. We studied adipose tissues from 36 Vietnam veterans, a similar group of 79 non-Vietnam veterans, and 80 civilians; the tissue specimens were selected from the 8,000 archived tissues collected from the non-institutionalized general population by the US Environmental Protection Agency. The geometric mean (+/- standard deviation) dioxin levels in adipose tissue for Vietnam veterans, non-Vietnam veterans, and civilian controls were 11.7 (+/- 1.7), 10.9 (+/- 1.7), and 12.4 (+/- 1.9) parts per trillion on a lipid weight basis, respectively. The mean levels for these groups were not significantly different from each other with or without adjustment for age of individuals, body mass index, and specimen collection year. In addition, none of the surrogate measures of Agent Orange exposure such as military branch, service within specific geographic region, military occupation, and troop location in relation to recorded Agent Orange spray was associated with the dioxin levels in adipose tissue of Vietnam veterans. Our results suggest that heavy exposure to Agent Orange or dioxin for most US troops was unlikely.
A measles outbreak at a college with a prematriculation immunization requirement.
Authors: Hersh B S , Markowitz L E , Hoffman R E , Hoff D R , Doran M J , Fleishman J C , Preblud S R , Orenstein W A
Published: November 2008

BACKGROUND. In early 1988 an outbreak of 84 measles cases occurred at a college in Colorado in which over 98 percent of students had documentation of adequate measles immunity (physician diagnosed measles, receipt of live measles vaccine on or after the first birthday, or serologic evidence of immunity) due to an immunization requirement in effect since 1986. METHODS. To examine potential risk factors for measles vaccine failure, we conducted a retrospective cohort study among students living in campus dormitories using student health service vaccination records. RESULTS. Overall, 70 (83 percent) cases had been vaccinated at greater than or equal to 12 months of age. Students living in campus dormitories were at increased risk for measles compared to students living off-campus (RR = 3.0, 95% CI = 2.0, 4.7). Students vaccinated at 12-14 months of age were at increased risk compared to those vaccinated at greater than or equal to 15 months (RR = 3.1, 95% CI = 1.7, 5.7). Time since vaccination was not a risk factor for vaccine failure. Measles vaccine effectiveness was calculated to be 94% (95% CI = 86, 98) for vaccination at greater than or equal to 15 months. CONCLUSIONS. As in secondary schools, measles outbreaks can occur among highly vaccinated college populations. Implementation of recent recommendations to require two doses of measles vaccine for college entrants should help reduce measles outbreaks in college populations.
Assessment of drug abuser treatment needs in Rhode Island.
Authors: McAuliffe W E , Breer P , Ahmadifar N W , Spino C
Published: November 2008

BACKGROUND. Rhode Island's Division of Substance Abuse asked us to assess the State's drug treatment needs and make recommendations regarding its treatment system for the next three years. METHODS. We used a statewide telephone drug use survey of 5,176 households supplemented by drug-related hospital discharges, Division of Drug Control statistics, and interviews with providers, state officials, and out-of-state experts. Drug abuse was measured with items from the Diagnostic Interview Schedule. Abusers were asked if they were receiving or wanted to receive treatment. RESULTS. Survey responses, used to estimate the unmet need for drug treatment, indicated a need to triple drug treatment services. Regression models using survey data indicated that the treatment network was overly centralized in the Providence area. Interviews with state officials, clinicians, and out-of-state experts provided material for recommendations on reimbursement policy, treatment mix, quality assurance, and cost containment. CONCLUSIONS. The RI Department of Health's certificate-of-need program adopted our overall recommendation for tripling the drug treatment system as its guideline in evaluating proposals for new treatment facilities. With State funding of a new adolescent center and expansion of outpatient slots in the private sector, this recommendation has now been fully implemented.
Racial/Ethnic differences in smoking, drinking, and illicit drug use among American high school seniors, 1976-89.
Authors: Bachman J G , Wallace J M , O'Malley P M , Johnston L D , Kurth C L , Neighbors H W
Published: November 2008

BACKGROUND. This paper reports racial/ethnic differences in the use of licit and illicit drugs by high school seniors in the United States. METHODS. The study uses questionnaire data from annual, nationally representative surveys of seniors from 1976 through 1989. Combined sample sizes were 57,620 for 1976-79; 75,772 for 1980-84; and 73,527 for 1985-89. RESULTS. Native American had the highest prevalence rates for cigarettes, alcohol, and most illicit drugs; White students had the next highest rates for most drugs. Asian Americans had the lowest prevalence rates, and Black students had levels nearly as low except for marijuana. Prevalence rates for the Hispanic groups were mostly in the intermediate ranges except for relatively high cocaine use among the males. Trend patterns for most forms of drug use were similar across subgroups, although cigarette use declined more sharply for Black than White seniors, resulting in greater Black-White differences in recent years. CONCLUSIONS. This study, other school-based studies, and general population surveys all show relatively low levels of drug use by most non-White youth, especially Black Americans and Asian Americans. Multivariate analyses indicate that such subgroup differences in high school seniors' drug use are not primarily attributable to family composition, parents' education, region, or urban-rural distinctions.
Elevated nicotine levels in cervical lavages from passive smokers.
Authors: Jones C J , Schiffman M H , Kurman R , Jacob P , Benowitz N L
Published: November 2008

One hundred forty-five nonsmokers found to have normal cytologic diagnoses on routine Pap smears were interviewed regarding environmental exposure to tobacco smoke, and a 3 ml saline lavage of the cervix was collected for measurement of cervical nicotine levels by gas chromatography-mass spectroscopy. Nicotine levels tended to be highest among women exposed to tobacco smoke in the home, intermediate in women exposed only outside the home, and lowest in women recalling no exposure (p = 0.001).
The Nursing Minimum Data Set: abstraction tool for standardized, comparable, essential data.
Authors: Werley H H , Devine E C , Zorn C R , Ryan P , Westra B L
Published: November 2008

The Nursing Minimum Data Set (NMDS) represents the first attempt to standardize the collection of essential nursing data. These minimum core data, used on a regular basis by the majority of nurses in the delivery of care across settings, can provide an accurate description of nursing diagnoses, nursing care, and nursing resources used. Collected on an ongoing basis, a standardized nursing data base will enable nurses to compare data across populations, settings, geographic areas, and time. Public health nurses will be able to evaluate and compare services. The purpose of this article is to discuss briefly the following aspects of the NMDS: background including definition, purposes, and elements; availability and reliability of the data; benefits; implications of the NMDS with emphasis on nursing research; and health policy decision making.
A community-based study of the use of chiropractic services.
Authors: Shekelle P G , Brook R H
Published: November 2008

BACKGROUND: Little population-based information is available on the use of chiropractic services. METHODS: We analyzed data from the RAND Health Insurance Experiment (HIE), a community-based study of the use of health services. Insurance claim forms for all fee-for-service patients who completed the study were examined for all visits coded as being seen by a chiropractor. Services provided and patient-specified symptoms were taken from these forms. Population-based use rates were calculated for each HIE site. Use rates and services were calculated separately for first visits and repeat visits. RESULTS: There were 5,279 persons who contributed 19,021 person-years of exposure during the study; 395 different persons used 7,873 chiropractic services for a visit rate of 41 per 100 person-years and rate of use of 7.5 percent. Forty-two percent of all visits were for pain in the back. Spinal manipulation accounted for 61 percent of all services provided. Compared to non-users, users tended to be White, middle-aged, married, and high school educated. Seven-fold geographic variations in the use of chiropractic services were seen. CONCLUSIONS: Chiropractors deliver a substantial amount of health care to the US population, and there are significant geographic variations in the rate and intensity of use of chiropractic services.
Does increased detection account for the rising incidence of breast cancer?
Authors: Liff J M , Sung J F , Chow W H , Greenberg R S , Flanders W D
Published: November 2008

BACKGROUND: The incidence of breast cancer has been increasing over time in the United States. METHODS: To determine the role of screening in this increase, trends in the incidence of in situ and invasive carcinoma of the breast were evaluated using records of the metropolitan Atlanta SEER program between 1979 and 1986. From a sample of records, evidence of symptoms and mammographic screening prior to diagnosis was recorded. RESULTS: The average annual age-adjusted incidence of invasive disease rose 29 percent among Whites and 41 percent among Blacks. Incidence increased in all age groups. A trend towards earlier detection of invasive disease was found. Asymptomatic tumors accounted for only 40 percent of the increased incidence among whites and 25 percent of the increased incidence among blacks, with mammography as the principal contributing procedure. CONCLUSIONS: These data suggest that increased detection accounts for some but not all of the rising incidence of breast cancer in the United States.
Tracking progress toward national health objectives in the elderly: what do restricted activity days signify?
Authors: Scholes D , LaCroix A Z , Wagner E H , Grothaus L C , Hecht J A
Published: November 2008

Restricted activity days is the measure by which the 1990 health objectives for prevention of functional disability in older adults will be evaluated. Yet its significance in older populations is poorly understood. We evaluated its use as an outcome measure for a randomized trial designed to impact upon physical function in elderly HMO enrollees. As predicted, restricted activity days was more correlated with physical disability measures than with other health status measures. Distributional properties and rates of missing data were shortcomings.
Capacity of US labs to provide TLI in support of early HIV-1 intervention.
Authors: Valdiserri R O , Cross G D , Gerber A R , Schwartz R E , Hearn T L
Published: November 2008

We surveyed laboratories to assess their capacity to perform T-lymphocyte immunophenotyping. Of the 1026 respondents, 279 located in 41 states and the District of Columbia performed this type of testing. Most laboratories were located in hospitals, reported a low weekly test volume, and indicated that it took 6-24 weeks for flow cytometer operators to become proficient. Many laboratories appear to have the capacity to perform additional CD4+ cell testing, but training additional operators may be necessary. The paucity of laboratories performing T-lymphocyte immunophenotyping in the public sector may affect referral patterns from that setting.
Black-white differences in cancer prevention knowledge and behavior.
Authors: Jepson C , Kessler L G , Portnoy B , Gibbs T
Published: November 2008

Data from the 1987 National Health Interview Survey Cancer Control Supplement were used to estimate multivariate logistic regression models of diet change, mammography utilization, stool blood test utilization, and smoking. Predictor variables included race, sex, age, income, dietary concerns, and four knowledge-related variables: education and three measures of cancer prevention knowledge. When knowledge variables were included in the models, race was not a significant predictor of behavior, with one exception: among women, Blacks were found to smoke less than Whites.
Report of an association between race and thyroid stimulating hormone level.
Authors: Schectman J M , Kallenberg G A , Hirsch R P , Shumacher R J
Published: November 2008

We examined the association between race and thyroid stimulating hormone (TSH) level in 809 consecutive Black or White adults tested for mild suspicion of hypothyroidism with a normal TSH result. The mean TSH level of Blacks was 0.4 (SE .053) mU/L lower than that for Whites after age and sex adjustment, race explaining 6.5 percent of the variation in TSH levels. A validation sample yield similar results. This finding supports the possibility that differences in thyroid function and/or regulation may be associated with race.
Association of waist to hip ratio and family history with the prevalence of NIDDM among 25,272 adult, white females.
Authors: Morris R D , Rimm A A
Published: November 2008

The independent association of waist to hip ratio (WHR), relative weight, and family history with the prevalence of non-insulin dependent diabetes mellitus (NIDDM) was investigated in a population of 25,254 White females in the United States and Canada. A multivariate logistic analysis yielded standardized odds ratios of 1.47, 1.46, 1.54, and 1.14 for family history index, WHR, relative weight, and age, respectively.
Cervical papillomavirus infection and cervical dysplasia in Hispanic, Native American, and non-Hispanic white women in New Mexico.
Authors: Becker T M , Wheeler C M , McGough N S , Jordan S W , Dorin M , Miller J
Published: November 2008

BACKGROUND: Human papillomavirus infections of the cervix are found with varying frequencies in different populations worldwide, and have been associated with cervical cytologic abnormalities. METHODS: We studied 1,603 randomly selected Hispanic, Native American, and non-Hispanic White women in New Mexico to determine the prevalence of cervical HPV infection in these ethnic groups, and its association with Pap smear abnormalities, using a new commercial dot-blot hybridization assay. RESULTS: Nine percent of all women screened had evidence of cervical HPV infection (13.7% of non-Hispanic White women, 9.7% of Hispanics, and 6.6% of Native American women). Prevalence was higher in younger women ages 14-19 years than in older age groups. Over half of women with cervical HPV infection (n = 145) had normal Pap smears. The proportion of infected women increased among those with more advanced cytopathologic abnormalities; 5.6 percent with normal Pap smears had cervical HPV vs 66.7 percent with moderate-severe dysplasia. CONCLUSIONS: Cervical HPV infection is common among New Mexico clinic attendees, varies in prevalence among the three major ethnic groups, and is strongly associated with cervical cytopathologic abnormalities.
Urolithiasis in Tennessee: an occupational window into a regional problem.
Authors: Thun M J , Schober S
Published: November 2008

BACKGROUND: Urinary tract stones (stones) are believed to be unusually common in the southeastern United States but neither the incidence of nor the risk factors for stones are known. METHODS: In three well-defined occupational populations in eastern Tennessee, we assessed the prevalence, incidence, and cumulative incidence of stones and measured biochemical risk factors for lithogenesis. RESULTS: The age-adjusted prevalence of stones was 18.5 percent in Tennessee compared to 7.7 percent among White males in US NHANES (prevalence ratio 2.4, 95% CI 1.7, 3.3). The cumulative incidence (risk) was 27.8 percent by age 65, higher than in any other reported population. Risk factors were age, a family history, and urinary saturation with calcium-oxalate (COAX). Persons with a positive family history and the highest measured CAOX index had a predicted lifetime risk of 88.8 percent. Biochemical factors affecting lithogenesis were hypercalciuria, hyperoxaluria, and low urine volume. CONCLUSION: Future research should characterize the geographic boundaries of a southeastern "stone-belt" and explore genetic and dietary hypotheses that might explain it.
The influence of three mass media campaigns on variables related to adolescent cigarette smoking: results of a field experiment.
Authors: Bauman K E , LaPrelle J , Brown J D , Koch G G , Padgett C A
Published: November 2008

BACKGROUND: This paper reports findings from a field experiment that evaluated mass media campaigns designed to prevent cigarette smoking by adolescents. METHODS: The campaigns featured radio and television messages on expected consequences of smoking and a component to stimulate personal encouragement of peers not to smoke. Six Standard Metropolitan Statistical Areas in the Southeast United States received campaigns and four served as controls. Adolescents and mothers provided pretest and posttest data in their homes. RESULTS AND CONCLUSIONS: The radio campaign had a modest influence on the expected consequences of smoking and friend approval of smoking, the more expensive campaigns involving television were not more effective than those with radio alone, the peer-involvement component was not effective, and any potential smoking effects could not be detected.
Comparison of two growth charts in Lesotho: health workers' ability to understand and use them for action.
Authors: Ruel M T , Pelletier D L , Habicht J P , Mason J B , Chobokoane C S , Maruping A P
Published: November 2008

BACKGROUND: Two growth monitoring charts widely used for growth monitoring in Africa (the Road-to-Health (RTH) and the Growth Surveillance (GS] were compared in order to assist the Government of Lesotho to decide on an appropriate national growth chart. METHODS: Thirty-four health workers were taught and tested on the RTH during a first week of training and on the GS during a second week (the RTH-GS group), while the order was reversed for another 25 trainees (the GS-RTH group). The health workers were trained and tested on their ability not only to use and interpret the two charts, but also to make the right decisions about specific actions to be taken when growth faltering occurs. RESULTS: There was no difference between scores to the RTH and GS charts after one week of training. After the second week of training, the scores to the RTH chart improved and became better than those to the GS chart. The scores to the GS test did not increase with previous knowledge of the RTH chart. CONCLUSIONS: For this reason and others discussed in the paper, the RTH chart was recommended for nationwide use in Lesotho. The adoption of this recommendation was facilitated by the close involvement in this research of public and private agencies responsible for growth monitoring in Lesotho.
HIV-1 prevalence in selected Tijuana sub-populations.
Authors: Güereña-Burgueño F , Benenson A S , Sepúlveda-Amor J
Published: November 2008

To assess the prevalence of HIV-1 (human immunodeficiency virus) infection among high-risk populations in Tijuana, Mexico, HIV-1 antibody status was determined and information on risk behavior was obtained from 1,069 individuals in three high-risk groups. The prevalence of HIV-1 among 415 prostitutes was 0.5 percent; 410 prisoners, 1.2 percent; 233 homosexual/bisexual men, 11.6 percent; and 106 intravenous drug abusers, 1.9 percent. The potential for spread of HIV-1 exists in Tijuana despite the current relatively low seroprevalence of HIV-1.
Physical activity on the job and cancer in Missouri.
Authors: Brownson R C , Chang J C , Davis J R , Smith C A
Published: November 2008

We conducted a series of case-control studies to investigate the risks of 16 cancer types in relation to occupational physical activity. These studies were based on Missouri Cancer Registry data for 17,147 White male cancer patients registered between 1984 and 1989. Colon cancer risk was increased for both the moderate (odds ratio (OR) = 1.1; 95% confidence interval (CI) = 1.0, 1.3) and low (OR = 1.2; 95% CI = 1.0, 1.5) activity levels. Similar elevations were observed for prostate cancer at the moderate (OR = 1.1; 95% CI = 1.0, 1.3) and low (OR = 1.5; 95% CI = 1.2, 1.8) levels of activity, and for cancer of the testis at the low activity level (OR = 2.2; 95% CI = 1.3, 3.7). An opposite trend (p less than 0.01) was noted for lung cancer, which showed decreased risk at the moderate (OR = 0.9; 95% CI = 0.8, 1.0) and low (OR = 0.8; 95% CI = 0.6, 0.9) activity levels. These associations suggest that further study of the relationship between physical activity and site-specific cancer risk is warranted.