bluuebunny/crossref_metadata_2025 huggingface dataset:
Onset of fertility-related events during adolescence: a prospective comparison of Mexican American and non-Hispanic white females.
Authors: Aneshensel C S , Becerra R M , Fielder E P , Schuler R H
Published: November 2008

Ethnic differences in the first occurrence of fertility-related events are assessed for non-Hispanic White and Mexican American female adolescents. A community-based sample of 1,023 females ages 13 to 19 years was interviewed in 1984-85; 874 (85.4 percent) were reinterviewed approximately two years later. Mexico-born Mexican Americans have the lowest rate of early sexual intercourse, but the highest rate of early births because they are most likely to become pregnant if sexually active, and most likely to have a birth if pregnant. Non-Hispanic Whites have the highest rate of early sexual intercourse, but the lowest rate of early births because pregnant non-Hispanic Whites terminate pregnancies most often. US-born Mexican Americans are intermediate between the other two groups. Delays in the onset of sexual activity among Mexican Americans are not converted into corresponding delays in first pregnancies and births. Early marriage among Mexico-born Mexican Americans, however, accounts for much of the ethnic difference in early fertility.
Prior condom use and the risk of tubal pregnancy.
Authors: Li D K , Daling J R , Stergachis A S , Chu J , Weiss N S
Published: November 2008

The relationship between prior condom use and tubal pregnancy was assessed in a population-based case-control study at Group Health Cooperative of Puget Sound during 1981-86. We interviewed 227 women with a tubal pregnancy who had no clinical indication of infertility and no history of sterilization and 674 similarly defined controls who were matched to the cases on age and county of residence. A history of condom use for more than one year was associated with a decreased risk of subsequent tubal pregnancy (RR = 0.74, 95% CI = 0.44, 1.26) adjusted for the effects of age, current use of contraceptive methods, educational level, and age at first intercourse. The effect was more pronounced when condoms had been used during five-year periods with more than one partner (RR = 0.38, 95% CI = 0.15, 1.0) than during five-year periods with one partner (RR = 0.89, 95% CI = 0.45, 1.76). Condom use for less than one year was unrelated to risk of ectopic pregnancy. Since the use of condoms offers protection against sexually transmitted diseases, one or more of which are likely to be causally related to tubal pregnancy, the observed negative association plausibly represents a protective influence of long-term condom use on the occurrence of tubal pregnancy.
Age and human immunodeficiency virus infection in persons with hemophilia in California.
Authors: Holman R C , Gomperts E D , Jason J M , Abildgaard C F , Zelasky M T , Evatt B L
Published: November 2008

Thirteen hemophilia centers provide comprehensive care to approximately 90 percent of persons with hemophilia in California. For 1987, these centers reported patient human immunodeficiency virus (HIV) antibody status, age group, level of clotting factor deficiency, and hemophilia type on 1,438 persons with hemophilia A and B; HIV serologic status was known for 860 persons (59.8 percent) of whom 537 (62.4 percent) were HIV-antibody-positive. The HIV positivity rate increased with age after taking into account hemophilia type, clotting factor level and treatment center type. The three-year cumulative incidence of reported AIDS (acquired immunodeficiency syndrome) cases based on the number of HIV positive patients, was 11.6 percent. The cumulative incidence rate was 14.6 percent (54 of 370) for those patients over 20 years of age and 4.8 percent (8 of 167) for those under 21 years of age. Although a comparable distribution of the date of diagnoses of AIDS was seen by age group, there appeared to be a bimodal distribution in the rate of AIDS among the age groups, with the 6-12-year-olds and the 21 and older age groups showing higher incidence rates.
The infrastructure of religious communities: a neglected resource for care of people with AIDS.
Authors: Shelp E E , DuBose E R , Sunderland R H
Published: November 2008

The AIDS Interfaith Council of Houston, sponsored by the Foundation for Interfaith Research and Ministry, recruits, trains, and coordinates volunteers for home-based care for adults and children with AIDS (acquired immunodeficiency syndrome). The program provides compassionate, non-judgmental care for the sick and respite support for the primary care provider. Care is provided by highly motivated, trained volunteers. The respite care team model also represents a support system to complement medical management and other health care services for people with AIDS. With the expanding number of cases and the growing preference for clients to remain at home, such a model will become increasingly important as people continue to live longer with AIDS.
Maintenance of safer sexual behaviors and predictors of risky sex: the San Francisco Men's Health Study.
Authors: Ekstrand M L , Coates T J
Published: November 2008

This paper describes the sexual behavior changes made by 686 gay and bisexual men in San Francisco between 1984 and 1988, focusing on the individual maintenance of this behavior change over time. There were drastic reductions in insertive and receptive unprotective anal intercourse over time and the vast majority of subjects were able to maintain these changes for at least 12 months prior to the last interview. A total of 12 percent of participants admitted to relapsing to unprotected receptive anal intercourse following initial behavior change; 10 percent reported engaging in unprotected receptive anal sex during every year of the study period. Men were more likely to practice unprotected anal intercourse in 1988 if at baseline they were younger, practiced unprotected anal intercourse, reported more sex partners, did not have a close friend or lover with AIDS, and engaged in fewer other health-related behaviors.
Longitudinal predictors of reductions in unprotected anal intercourse among gay men in San Francisco: the AIDS Behavioral Research Project.
Authors: McKusick L , Coates T J , Morin S F , Pollack L , Hoff C
Published: November 2008

Predictors of unprotected anal intercourse were examined among 508 gay men in San Francisco. The cohort was recruited in 1983-84 at which time 49.8 percent of non-monogamous men (N = 435) and 71.2 percent of monogamous men (N = 73) reported practicing unprotected anal intercourse. Only 12 percent of non-monogamous and 27.4 percent of monogamous men reported these practices in 1988. The non-monogamous men who practiced unprotected anal intercourse in 1984 were more likely to be younger, to report that unprotected anal intercourse was their favorite sexual activity, to be low in perceived efficacy to change sexual behavior, to report that friends were more likely to engage in high-risk behaviors, to have less knowledge of health guidelines, and to be less depressed at that time. Non-monogamous individuals who in 1984 reported that unprotected anal intercourse was their favorite sexual activity were more likely to practice that behavior in 1988. Those who knew their serostatus as positive were less likely to report unprotected anal intercourse in 1988. These data infer that in order to modify AIDS-related high-risk behaviors, community risk-reduction programs be differentially aimed at young persons so as to increase personal efficacy about risk reduction, challenge peer norms, promote antibody testing, and eroticize safer sexual activities.
Sexual histories of heterosexual couples with one HIV-infected partner.
Authors: Padian N S
Published: November 2008

Ninety-eight heterosexual couples enrolled in a HIV transmission study, at least one of whom was HIV-infected, were interviewed about sexual behavior. Although males and females were interviewed separately, there was agreement between them on the number of sexual contacts, the practice or anal intercourse, and condom use. These findings of strong reliability are encouraging, but do not necessarily imply that the data are valid.
Meeting the needs for health services of persons with mental retardation living in the community.
Authors: Minihan P M , Dean D H
Published: November 2008

Adequate health services are critical to the success of efforts to maintain persons with mental retardation in the community, yet information concerning the health status of this population is in short supply. This paper presents the results of a survey of 333 mentally retarded persons randomly selected from a population of 1,333 such individuals living in community settings. Almost two-thirds had chronic conditions requiring medical intervention. The top five conditions in terms of prevalence were neurologic, ophthalmologic, dermatologic, psychiatric-emotional, and orthopedic. The majority of conditions were being managed appropriately in the community health system. A substantial proportion can be managed by primary care physicians with limited specialty involvement. For almost 60 percent of clients with conditions requiring home treatments on an ongoing basis, however, service gaps were identified. Other problems included the reluctance of some providers to accept Medicaid, and the inability of some clients to cooperate with medical examinations.
Apparent underreporting of cigarette consumption among Mexican American smokers.
Authors: Pérez-Stable E J , Marín B V , Marín G , Brody D J , Benowitz N L
Published: November 2008

To determine the accuracy of self-report of cigarette consumption among Mexican American smokers, we compared self-reported cigarette use and serum cotinine concentrations in a sample of 547 participants in the Hispanic Health and Nutrition Examination Survey (HHANES). We defined underreporting of cigarette use as a cotinine to cigarette-per-day ratio of greater than 0.142 microM/l which represented a substantial discrepancy between self-reported consumption and serum cotinine. Of the 98 men and 97 women who reported smoking one to nine cigarettes/day, 20.4 percent and 24.7 percent, respectively, underreported their cigarette consumption. Underreporting was less common among men and women smoking 10 to 19 cigarettes/day (8.3 percent and 10.8 percent, respectively) and 20 or more cigarettes/day (2.2 percent and 2.9 percent, respectively). Comparison of underreporters to other smokers by demographic characteristics within sex and cigarettes/day categories showed no differences. Differences in cotinine metabolism and extremely efficient smoking are alternative explanations that can not be ruled out with these data. We believe, however, that a proportion of Mexican American light smokers may underreport the quantity of cigarettes smoked per day, and may truly be moderate or heavy smokers.
Impact of the human immunodeficiency virus epidemic on mortality trends in young men, United States.
Authors: Buehler J W , Devine O J , Berkelman R L , Chevarley F M
Published: November 2008

Following a long-term decline, death rates in men 25-44 years of age increased from 212 deaths/100,000 in 1983 to 236 deaths/100,000 in 1987. To assess the impact of human immunodeficiency virus (HIV) infections on this trend and to identify causes that are increasing in association with the HIV epidemic, we analyzed national mortality statistics and compared death rates in states with high and low incidence of acquired immunodeficiency syndrome (AIDS). In 1987, there were 10,248 deaths with HIV infection, AIDS, or conditions in the AIDS surveillance definition assigned as the underlying cause, representing 11 percent of deaths for men in this age group compared to less than 1 percent in 1980. In addition, deaths with other underlying causes, such as other infections, drug abuse, and unknown/unspecified causes, had diverging and higher rates in states with high versus low AIDS incidence. In the absence of deaths due to HIV/AIDS and excess deaths due to these associated conditions, we estimate that death rates for men 25-44 years of age would have been 201-209/100,000 in 1987. For 1987, approximately 70-90 percent of HIV-related deaths were reported through national AIDS surveillance. The HIV epidemic has led to a reversal in mortality trends and to increases in various causes of death for young men.
Caffeine-containing beverages, total fluid consumption, and premenstrual syndrome.
Authors: Rossignol A M , Bonnlander H
Published: November 2008

The main objective of this study was to evaluate whether daily consumption of caffeine-containing beverages is related to the prevalence and severity of premenstrual syndrome apart from any effects of daily total fluid consumption. A secondary objective was to determine whether daily total fluid consumption itself is related to premenstrual syndrome. The study is based on 841 responses to a questionnaire probing menstrual and premenstrual health, and daily fluid consumption, which was mailed to female university students in Oregon. Analysis of the data revealed that consumption of caffeine-containing beverages was strongly related to the prevalence of premenstrual syndrome. Among women with more severe symptoms, the relation between consumption of caffeine-containing beverages and premenstrual syndrome was dose-dependent, with prevalence odds ratios equal to 1.3 for consumers of one cup of a caffeine-containing beverage per day and increasing steadily to 7.0 for consumers of eight to 10 cups per day. The effects were apparent among both caffeine-containing tea/coffee consumers and caffeine-containing soda consumers. The observed effects were only slightly reduced when daily total fluid consumption was controlled. Daily total fluid consumption also was related to the prevalence of premenstrual symptoms although the effects were large only for consumers of 13-19 cups of fluid per day (the largest amount studied).
A population-based descriptive study of housefire deaths in North Carolina.
Authors: Patetta M J , Cole T B
Published: November 2008

We report a population-based study of housefire deaths in North Carolina in 1985 using data obtained from fire investigators and the North Carolina medical examiner system. The crude death rate was 3.2 per 100,000 population; age-specific death rates were highest for ages 75-84 years. Death rates for Whites were one-third as high as death rates for other races. Of those decedents tested for alcohol, 56 percent had blood alcohol levels greater than or equal to 22 mmol/L. Most fatal fires were caused by heating units or cigarettes.
Estimating the full cost of workplace injuries.
Authors: French M T
Published: November 2008

While many studies estimate medical costs and lost wages from workplace injuries, few have estimated pain and suffering costs. This study develops a wage-risk model for railroad workers and estimates the total cost of on-the-job injuries. On average, the total cost of an on-the-job injury to a railroad worker in 1980 was between $19,500 and $22,500. These estimates are substantially higher than the sum of medical costs plus lost wages.
Fatal and severe injury: scooter and moped crashes in California, 1985.
Authors: Salatka M , Arzemanian S , Kraus J F , Anderson C L
Published: November 2008

Fatal and severe injury crashes for scooters and mopeds in California for 1985 were compared with those for motorcycles during the same year. Scooters had more than twice the injury crash rate of mopeds but one-half the rate of motorcycles. Age of injured drivers and crash patterns for scooters, mopeds, and motorcycles varied significantly.
Predictors of vaccination behavior among persons ages 65 years and older.
Authors: Stehr-Green P A , Sprauer M A , Williams W W , Sullivan K M
Published: November 2008

We estimated influenza vaccination coverage of 32 percent among persons 65 years of age and older from the 1987 Behavioral Risk Factor Surveillance System survey. Race other than White, obesity, lack of seatbelt use, and current smoking were associated with decreased likelihood of having been vaccinated. Controlling for these factors, the best predictor of having received influenza vaccination was having had a medical checkup within the last year (Odds Ratio = 2.40, 95% confidence interval = 1.84, 3.14).
Health care utilization barriers among Mexican Americans: evidence from HHANES 1982-84.
Authors: Estrada A L , Treviño F M , Ray L A
Published: November 2008

Data from the Hispanic Health and Nutrition Examination Survey (HHANES) conducted by the National Center for Health Statistics in 1982-1984 were analyzed to document the type of barriers encountered which prevented Mexican Americans from obtaining health care, the sociodemographic subgroups most vulnerable to such barriers, and to examine the combined effects of predisposing, enabling, and need characteristics on these barriers. The findings suggest, in general, that low income groups, younger age groups, the less acculturated, those who lack health insurance coverage, those with functional limitations, and those in poorer perceived health status encounter more barriers than others, and are prevented by these barriers from obtaining health care for themselves.
Utilization of curanderos by Mexican Americans: prevalence and predictors. Findings from HHANES 1982-84.
Authors: Higginbotham J C , Treviño F M , Ray L A
Published: November 2008

Data from the Southwest sample of the Hispanic Health and Nutrition Examination Survey (HHANES) were analyzed to examine whether the use of a curandero or other folk medicine practitioner hindered, enhanced, or did not affect the utilization of western health care services by Mexican Americans. Findings revealed that only 4.2 percent of the HHANES sample persons between the ages of 18-74 years reported consulting a curandero, herbalista, or other folk medicine practitioner within the 12 months prior to the survey. Income, self-perceived health status, the language of the interview, and dissatisfaction with modern medical care recently received independently predicted curandero utilization (adjusted OR 2.01 and 1.66, respectively). Low income and self-perceived health status were less strongly related to curandero utilization.
Alcohol consumption patterns among Mexican American mothers and among children from single- and dual-headed households: findings from HHANES 1982-84.
Authors: Stroup-Benham C A , Treviño F M , Treviño D B
Published: November 2008

Data from the southwestern United States sample of the Hispanic Health and Nutrition Examination Survey were employed to compare the patterns of alcohol use among Mexican American mothers and children in female-headed households with use patterns among mothers and children in couple-headed households. Single female heads of household drank more alcoholic beverages on more days than females from dual-headed households. As a whole, the children of single heads of household still living at home did not demonstrate significantly different drinking patterns from their dual-headed household counterparts. While male children of single-headed households drank more days and total drinks than their dual-headed household counterparts, female children of dual-headed households drank more days and total drinks than female children from single-headed households.
Patterns of cigarette smoking among Hispanics in the United States: results from HHANES 1982-84.
Authors: Haynes S G , Harvey C , Montes H , Nickens H , Cohen B H
Published: November 2008

In the 1982-84 Hispanic Health and Nutrition Examination Survey, the prevalence of cigarette smoking was examined among Mexican Americans, Puerto Ricans, and Cuban Americans in the United States. Among 20-74 years olds, the age-adjusted smoking rates for Mexican American, Puerto Rican, and Cuban American men were high--42.5, 39.8, and 41.6 percent, respectively. Quite striking among Cuban American men was the high smoking rate among 20-34 year olds (50.1 percent), the highest smoking rate in the three Hispanic groups compared. The age-adjusted smoking rates for Mexican American, Puerto Rican, and Cuban American women were much lower than those for men-23.8, 30.3, and 24.4 percent, respectively. Both Puerto Rican and Cuban American men were more likely to be heavy smokers (52.3 and 64.1 percent, respectively, smoking a pack or more a day) as compared to the Mexican Americans (33.8 percent smoking a pack or more a day). The pattern was the same for women, with Mexican American women being lighter smokers (18.8 percent smoking a pack or more a day) as compared to heavy smoking among Puerto Rican and Cuban American women (35.1 and 48.6 percent, respectively, smoking a pack or more a day). Given the health hazards of smoking, future research and intervention are required for those groups with high exposure to cigarette smoking.
Acculturation and marijuana and cocaine use: findings from HHANES 1982-84.
Authors: Amaro H , Whitaker R , Coffman G , Heeren T
Published: November 2008

We examined the relation between acculturation and illicit drug use among Hispanics in the United States employing data from the 1982-84 Hispanic Health and Nutrition Evaluation Survey (HHANES). Across all Hispanic groups, acculturation into US society, as reflected in English language use, was associated with higher rates of illicit drug use even after sociodemographic variables such as gender, age, income, and education were considered. Significant interactions between language and education indicated that the predominant use of English was more strongly associated with marijuana and cocaine use among Mexican Americans and Puerto Ricans of lower educational attainment than among those of higher educational attainment. Significant interactions between language use and other factors such as sex, marital status, and place of birth were also associated with marijuana and cocaine use. These results suggest that the experience of acculturation, especially as it relates to drug use, is closely tied to the social and economic context in which an individual lives.
The prevalence of total tooth loss, dental caries, and periodontal disease among Mexican Americans, Cuban Americans, and Puerto Ricans: findings from HHANES 1982-1984.
Authors: Ismail A I , Szpunar S M
Published: November 2008

This paper describes the prevalence of total tooth loss, dental caries, and periodontal disease in 2,226 Puerto Ricans, 1,192 Cuban Americans, and 5,983 Mexican Americans, ages five to 74 years, who were examined during the 1982-84 Hispanic Health and Nutrition Examination Survey (HHANES). The prevalence of total tooth loss was 2.60, 6.10, and 2.80 percent among Mexican Americans, Cuban Americans, and Puerto Ricans, respectively. After adjusting for the confounding effects of age, sex, income, and education status, no statistically significant differences were found in the mean number of decayed teeth among the three groups of Hispanics. Puerto Rican children had an average of 2.09 filled teeth compared with an average of 1.39 and 1.43 filled teeth for Mexican Americans and Cuban Americans, respectively. In adults, Puerto Ricans and Cuban Americans had at least 40 percent higher mean number of filled teeth than Mexican Americans. Cuban American and Puerto Rican adults had about twice as many missing teeth as Mexican Americans. The pit-and-fissure tooth surfaces in children accounted for the majority of sites affected by caries. All Hispanics had a higher prevalence of gingivitis than American adults as estimated during the 1985-86 National Institute of Dental Research (NIDR) survey of American adults. Puerto Ricans had the highest level of periodontal disease and the highest Debris Index scores among the Hispanic groups.
Disease control priorities in developing countries: health policy responses to epidemiological change.
Authors: Jamison D T , Mosley W H
Published: November 2008

Health systems in developing countries are facing major challenges in the 1990s and beyond because of a growing epidemiological diversity as a consequence of rapid economic development and declining fertility. The infectious and parasitic diseases of childhood must remain a priority at the same time the chronic diseases among adults are emerging as a serious problem. Health policymakers must engage in undertaking an epidemiological and economic analysis of the major disease problems, evaluating the cost-effectiveness of alternative intervention strategies; designing health care delivery systems; and, choosing what governments can do through persuasion, taxation, regulation, and provision of services. The World Bank has commissioned studies of over two dozen diseases in developing countries which have confirmed the priority of child survival interventions and revealed that interventions for many neglected and emerging adult health problems have comparable cost-effectiveness. Most developing countries lack information about most major diseases among adults, reflecting lack of national capacities in epidemiological and economic analyses, health technology assessment, and environmental monitoring and control. There is a critical need for national and international investment in capacity building and essential national health research to build the base for health policies.
Why do child mortality rates fall? An analysis of the Nicaraguan experience.
Authors: Sandiford P , Morales P , Gorter A , Coyle E , Smith G D
Published: November 2008

A comprehensive review of available sources of mortality data was undertaken to document the changes that have occurred in infant mortality in Nicaragua over the last three decades. It was found that a rapid fall in infant mortality commenced in the early 1970s and has continued steadily since. Trends in several different factors which might have led to this breakthrough were examined including: income, nutrition, breastfeeding practices, maternal education, immunizations, access to health services, provision of water supplies and sanitation, and anti-malarial programs. Of these, improved access to health services appears to have been the most important factor. At a time when the number of hospital beds per capita was dropping, increasing numbers of health care professionals, particularly nurses, were becoming available to staff primary health care facilities built in the 1960s. These were provided at least partly in response to the growing political turmoil enveloping the nation at that time. Certain Nicaraguan cultural attributes may have added to the impact of the reforms. Efforts in the field of public health made since the 1979 insurrection appear to have maintained the decline in child mortality.
AIDS-related knowledge, sexual behavior, and condom use among men and women in Kinshasa, Zaire.
Authors: Bertrand J T , Makani B , Hassig S E , Niwembo K L , Djunghu B , Muanda M , Chirhamolekwa C
Published: November 2008

This study was conducted in 1988 among a random sample of 6,625 men and women of reproductive age in all 24 administrative zones of Kinshasa, the capital city of Zaire, to determine existing levels of knowledge regarding AIDS (acquired immunodeficiency syndrome), sexual behavior, knowledge and use of condoms in marital and extramarital relations; perceived risk of AIDS, and attitudes toward testing for the human immunodeficiency virus (HIV). Awareness of AIDS is almost universal, and the vast majority know the four main modes of transmission. Almost half believed in transmission by mosquitoes and in a vaccine or cure for AIDS. The majority of male respondents knew of condoms, but negative attitudes toward condom use are widespread, and few respondents perceived them to play a central role in combatting AIDS.
The course of the HIV epidemic among intravenous drug users in Amsterdam, The Netherlands.
Authors: van Haastrecht H J , van den Hoek J A , Bardoux C , Leentvaar-Kuypers A , Coutinho R A
Published: November 2008

To determine if behavioral changes in intravenous drug users in Amsterdam have retarded the HIV (human immunodeficiency virus) epidemic in this group in recent years, we report that: HIV-antibody seroprevalence in annual samples of injectors has been constant over the years 1986-89; HIV-antibody incidence in a cohort of injectors appears to have decreased from 1986 to 1987 and stabilized after that until 1989; acute hepatitis B incidence in all drug users in Amsterdam declined rapidly between 1985-89. It is concluded that changes in drug use behavior so far appear to have resulted in a stabilization of the epidemic among injectors, at a level with a still disturbingly high incidence rate of 5-6 per 100 person-years.
Predictors of successful aging: a twelve-year study of Manitoba elderly.
Authors: Roos N P , Havens B
Published: November 2008

In Manitoba, Canada, a representative cohort of elderly individuals ages 65 to 84 (n = 3,573) were interviewed in 1971 and the survivors of this cohort were reinterviewed in 1983. This analysis assesses the determinants of successful aging--whether or not an individual will live to an advanced age, continue to function well at home, and remain mentally alert. Over 100 separate indicators of demographic and socio-economic status, social supports, health and mental status in 1971 were available as potential predictors of successful aging. Indicators of access to health care over the period 1970-82 and indicators of diseases over this period were also available as predictors. Those who aged successfully were shown to have greater satisfaction with life in 1983 and to have made fewer demands on the health care system than those who aged less well. Despite the large number of potential predictors of successful aging which were examined, only age, four measures of health status, two measures of mental status, and not having one's spouse die or enter a nursing home were shown to be predictive of successful aging.
Does maternal tobacco smoking modify the effect of alcohol on fetal growth?
Authors: Olsen J , Pereira A da C , Olsen S F
Published: November 2008

Smoking and drinking habits were registered by a self-administered questionnaire in 36th week of gestation in 11,698 pregnant women, more than 80 percent of all such women in two Danish cities 1984-87. Alcohol consumption of 120 g/week or more was associated with a greater reduction in the average birthweight in the babies of smokers than of non-smokers (about 40 grams for the non-smokers and about 200 grams for the smokers). This is particularly striking considering that the average birthweight for smokers is lower than for non-smokers. A birthweight difference of more than 500 grams was found between babies of mothers who neither smoked nor drank and mothers who smoked and drank heavily. Our data suggest that women's smoking habits should be taken into consideration when giving pregnant women advice about drinking.
Admission and mid-stay MedisGroups scores as predictors of death within 30 days of hospital admission.
Authors: Iezzoni L I , Ash A S , Coffman G , Moskowitz M A
Published: November 2008

We examined the ability of MedisGroups, a severity measure based on clinical data abstracted from the medical record, to predict mortality 30 days following admission. MedisGroups measures severity both on admission and approximately one week into the hospital stay. The data base was a random sample of 20,985 admissions of Medicare beneficiaries with one of six conditions from 833 hospitals in seven states between January 1985 and May 1986. In all six conditions, higher admission and mid-stay severity scores were generally associated with higher risk of death. Across the six conditions, the R-squared values for predicting death using admission scores ranged from 0.01 to 0.16; R-squared values using mid-stay scores ranged from 0.03 to 0.34; and R-squared values from combining admission and mid-stay scores ranged from 0.05 to 0.41. Admission MedisGroups score was thus only modestly predictive of 30-day mortality. While the mid-stay score was more powerful, it may not be an appropriate severity adjuster to screen for quality using hospital mortality rates because it could be influenced by substandard care.
Trends in the content and use of oral contraceptives in the United States, 1964-88.
Authors: Gerstman B B , Gross T P , Kennedy D L , Bennett R C , Tomita D K , Stadel B V
Published: November 2008

Drug marketing and physician survey data were used to examine trends in the use and hormonal content of oral contraceptives in the United States between 1964 and 1988. Retail prescriptions for oral contraceptives peaked at approximately 68 million in 1973 and have remained between 50 million and 60 million since 1981. Despite this relative consistency in the number of prescriptions, physician "mentions" of oral contraceptives have increased by approximately 75 percent. This increase may reflect closer monitoring of women on oral contraceptives. Use of multiphasic formulations has steadily risen, accounting for 37 percent of the oral contraceptive prescriptions in 1988. Mean estrogen and progestin doses in all types of formulations have steadily declined. A change in the type of estrogen and progestin used in preparations has coincided with this decline in dose. The association between age and use of high-dose formulations seen in the past was no longer evident in 1988. The data demonstrate that oral contraceptive formulations in wide use today differ in hormone content from those of the past, when most of the major studies addressing the risks associated with oral contraceptive use were completed. There is therefore a need to determine the risks and long-term effects associated with these newer formulations.
A routine tool for detection and assessment of epidemics of influenza-like syndromes in France.
Authors: Costagliola D , Flahault A , Galinec D , Garnerin P , Menares J , Valleron A J
Published: November 2008

A regression model for the nonepidemic level of influenza-like syndrome has been estimated from the 55,200 cases collected between October 1984 and August 1988 using the French Communicable Diseases Computer Network. The start of a major epidemic in 1988-89 was detected early. The size of the epidemic, for the entire country, was estimated at approximately 4.3 million cases. The excess cost of sick-leave, among those of working age, was estimated at $86 million.
Antibiotic use among children in an urban Brazilian slum: a risk factor for diarrhea?
Authors: Schorling J B , De Souza M A , Guerrant R L
Published: November 2008

Among a cohort of children in a poor urban setting in Brazil, the relative risk for the occurrence of a new episode of diarrhea in the two weeks following antibiotic use vs all other weeks was 1.44 (95% confidence interval (CI) = 1.33, 2.45). Among children ever [corrected] exposed to antibiotics, the odds ratio was 1.34 (95% CI = 0.84, 2.16) after stratifying by individual child and controlling for previous diarrhea. Further research is needed to confirm whether antibiotics are a risk factor for diarrhea in such settings.
Diverging gonorrhea and syphilis trends in the 1980s: are they real?
Authors: Gershman K A , Rolfs R T
Published: November 2008

BACKGROUND. The purpose of this study was to evaluate whether the divergence in national trends of gonorrhea and syphilis from 1986 to 1989 in the United States was real and if overall trends masked a contemporaneous increase in both diseases in a core group. METHODS. We analyzed the following: (1) reported cases of gonorrhea and primary and secondary syphilis in the United States for the years 1981 to 1989, (2) gonorrhea screening results from six states for the years 1985 to 1989, and (3) reported cases of gonorrhea and primary and secondary syphilis by census tract for the years 1986 to 1989 in one city. RESULTS. The incidence of gonorrhea decreased 22% in the United States from 1986 to 1989 while the incidence of primary and secondary syphilis increased 59%. Among Blacks, syphilis incidence increased 100% and gonorrhea incidence decreased 13%; among Whites and Hispanics, the incidence of both diseases decreased. Results from gonorrhea screening among females in six states agree with gonorrhea incidence trends in those areas. Race-specific and census tract analyses of data from a number of metropolitan areas where overall rates diverged did not demonstrate a group in which the incidence of both diseases increased. CONCLUSIONS. We conclude that diverging trends of gonorrhea and syphilis from 1986 to 1989 are real and emphasize differences in the epidemiologic characteristics of these two sexually transmitted diseases.
Inpatient morbidity among HIV-infected male soldiers prior to their diagnosis of HIV infection.
Authors: Renzullo P O , McNeil J G , Gardner L I , Brundage J F
Published: November 2008

BACKGROUND. A natural history study of human immunodeficiency virus (HIV) disease was carried out among 1575 HIV-infected US Army men and 6220 demographically similar uninfected soldiers. Inpatient morbidity occurring up to 8 years prior to the date of HIV infection diagnosis among those men who became HIV infected was evaluated for both groups. METHODS. Incidence density rates were calculated for hospital admissions. Poisson regression was used to assess the trend in hospital admissions among those subsequently diagnosed with HIV infection. Prevalence ratios for discharge diagnoses were also calculated. RESULTS. Sixteen diagnoses/diagnosis categories occurred statistically more frequently among subsequently HIV diagnosed individuals than among those who remained uninfected. Among these were hepatitis B and abscess of anal/rectal region (6 to 8 years prior to HIV infection diagnosis); unspecified viral infection, enlarged lymph nodes, syphilis (3 to 5 years prior to HIV infection diagnosis); and diagnoses suggestive of acute retroviral syndrome (1 to 2 years prior to HIV infection diagnosis). CONCLUSIONS. Data such as these may provide useful information to HIV surveillance efforts regarding patterns of morbidity experienced prior to HIV infection as well as to health care providers regarding patients at high risk for becoming infected with HIV.
Risk factors for shooting gallery use and cessation among intravenous drug users.
Authors: Celentano D D , Vlahov D , Cohn S , Anthony J C , Solomon L , Nelson K E
Published: November 2008

BACKGROUND. Shooting galleries, locations where intravenous drug users (IVDUs) can rent or borrow needles and syringes, are a high-risk environment for HIV-1 transmission. This study investigates risk factors for lifetime attendance at shooting galleries and differentiates characteristics of those who continue to frequent shooting galleries and those who have stopped. METHODS. We interviewed 2615 active IVDUs in Baltimore in 1988 and 1989 and determined patterns of IV drug use, sociodemographics, and HIV-1 serostatus as related to persistence vs cessation of shooting gallery use. RESULTS. Over half (52%) of active IVDUs reported ever using a shooting gallery, with 33% reporting use within the prior 3 months. In multivariate analysis, lifetime shooting gallery use was associated with male gender, homosexuality/bisexuality, low socioeconomic status, Black race, and heavier drug involvement. Persistent shooting gallery users were more frequently male, homosexual/bisexual, homeless, less educated, and started IV drug use more recently compared with those who ceased going to shooting galleries. CONCLUSIONS. Shooting gallery attendance may be pragmatic from a sociological and economic perspective, but it carries with it a heightened risk of acquiring HIV-1 infection.
Comparing the predictive accuracy of health risk appraisal: the Centers for Disease Control versus Carter Center program.
Authors: Gazmararian J A , Foxman B , Yen L T , Morgenstern H , Edington D W
Published: November 2008

BACKGROUND. From 1986 to 1987 the Carter Center of Emory University joined with the Centers for Disease Control (CDC) to develop a new, probability-based, adult health risk appraisal (HRA) instrument for the public domain. This new instrument is compared with the CDC HRA version to determine which is a more accurate predictor of mortality. METHODS. We compared predicted mortality risks from the CDC HRA and the Carter Center HRA with the observed mortality among 3135 smokers and never-smoking persons, aged 25 to 60, followed from 1959 to 1979 as part of the Tecumseh Community Health Study. RESULTS. When individuals were classified according to the difference between their actual age and risk age, for the CDC HRA, there was a progressively increasing risk of 10-year mortality as the difference increased. The Carter Center HRA did not show this trend. An analysis using relative operating characteristic curves showed that the mortality risk predictions for both programs were very similar for men and women. However, differences between actual age and risk age for the two programs were not similar for men or women, particularly older men. Therefore, actual age minus risk age for the CDC program was a more accurate predictor of 10-year mortality than was this difference for the Carter Center program. CONCLUSIONS. The results from both types of analyses suggest that the validity of risk ages obtained from the Carter Center version may not be sufficient to justify updating programs for those currently using the CDC instrument.
Self-disclosure of HIV infection to sexual partners.
Authors: Marks G , Richardson J L , Maldonado N
Published: November 2008

Self-disclosure of HIV infection to current sexual partners was examined in 138 seropositive men, mostly lower income Hispanics, from Los Angeles. Forty-five percent had been sexually active since learning their serostatus. Of these, 52% had kept their infection secret from one or more partners. The likelihood of disclosure decreased in direct proportion to the number of partners. Nondisclosure occurred in conjunction with unprotected receptive and insertive anal intercourse. Potential factors promoting nondisclosure are discussed.
The impact of HIV on the usefulness of sputum smears for the diagnosis of tuberculosis.
Authors: Long R , Scalcini M , Manfreda J , Jean-Baptiste M , Hershfield E
Published: November 2008

In a developing country, 289 patients were examined for active pulmonary mycobacterial disease (sputum smear and culture) and HIV infection (serology) to compare the sensitivity and positive predictive value of sputum smears for diagnosing pulmonary tuberculosis in patients with and without antibodies to HIV. Seventy-nine percent of HIV-seronegative vs 66% of HIV-seropositive patients with positive cultures for Mycobacterium tuberculosis were smear positive (P less than .05), and a positive sputum smear predicted the presence of M. tuberculosis in 90% of HIV seronegative vs 80% of HIV seropositive patients (P less than .05). In our opinion, HIV did not significantly compromise the diagnostic utility of the sputum smear.
Human exposure to rabies from pet wild raccoons in South Carolina and West Virginia, 1987 through 1988.
Authors: Woodruff B A , Jones J L , Eng T R
Published: November 2008

During 1987 and 1988, exposures to eight pet wild raccoons in South Carolina and West Virginia resulted in administration of rabies post-exposure prophylaxis to 19 children and 26 adults. All eight raccoons appeared normal at the time of capture, and three had no signs of illness when sacrificed. The direct medical cost resulting from these exposures was $23,714 ($527 per person). Regulations and public education may help decrease this type of rabies exposure.
Canine seroprevalence and the distribution of Ixodes dammini in an area of emerging Lyme disease.
Authors: Rand P W , Smith R P , Lacombe E H
Published: November 2008

This study evaluates the relative usefulness of canine serosurveys to predict risk of exposure in an area of emerging Lyme disease by comparing the distribution of canine seroprevalence with that of vector ticks. From 16 veterinary clinics throughout the State of Maine, 828 canine sera were obtained during the heartworm-testing months of April and May 1989 and measured for anti-Borrelia antibodies by enzyme-linked immunosorbent assay. In the same year, 1605 ticks, including 585 Ixodes dammini, were collected from pets, humans, small mammals, and deer. Thirty-six dogs were seropositive, 28 of which had not traveled to endemic areas. Eighty-nine percent of all seropositive dogs were from towns within 20 miles (32 km) of the coast; the great majority lived within 5 miles (8 km) of tidewater (odds ratio =4.45, P = .002). Positivity varied from 17% in a southern coastal clinic to 0% in four northern clinics. Of 585 I. dammini identified, all but 5 (99.1%) were also from towns within 20 miles of the coast. Comparison of I. dammini submissions with those of another commonly found tick, Ixodes cookei, corroborated this predominantly coastal distribution. Canine seropositivity generally coincided with this coastal range. These data predicted areas of risk for human Lyme disease, although the prevalence of reported cases remained low.
Situational factors associated with AIDS risk behavior lapses and coping strategies used by gay men who successfully avoid lapses.
Authors: Kelly J A , Kalichman S C , Kauth M R , Kilgore H G , Hood H V , Campos P E , Rao S M , Brasfield T L , St Lawrence J S
Published: November 2008

While most gay men have reduced behavior practices at high risk for HIV infection, there is growing evidence that many also lapse to unsafe sex. This study examined situational factors related to risk behavior lapses as well as coping strategies used by men who successfully resist lapse urges. A convenience sample of 470 men patronizing gay bars or attending social organization meetings in four cities was surveyed. Forty-five percent of men were classified as "lapsers" (those who had had unprotected anal intercourse in the previous 6 months) and 24% were classified as "resisters" (those who successfully resisted urges to engage in this behavior). All provided information concerning the importance of factors related to the most recent occurrence of either unsafe sex or resisting unsafe urges. Most episodes of unsafe sex occurred outside monogamous relationships and with partners of unknown HIV serostatus, although simply inquiring about partner serostatus was relatively common. Lapsers rated affectionate feelings and wishing to please a partner as well as spontaneity of unsafe sex as the most important situational factors surrounding high-risk behavior. Resisters of unsafe sex urges reported active cognitive self-guidance, experience in safe sex, and recall of both AIDS fears and safety benefits as their most important coping strategies. Gay men who continue high-risk behavior may be overrelying on partner reports of negative serostatus. Lapse prevention approaches tailored to situations that create increased risk vulnerability must be developed. Teaching skills already used by men who successfully resist unsafe sex urges might be one approach.
Environmental health and African Americans.
Authors: Walker B
Published: November 2008

As environmental health has taken on immensely increased significance in the prevention of disease, dysfunction, and premature death, its boundaries have been anything but stable. This instability, along with a multitude of demographic, social, and economic currents, have brought into stark relief the increasing demand for scientists who have the skills and knowledge to perform environmental risk assessment and implement effective risk management policies and services. Despite this demand far too few African Americans want, or are prepared, to pursue careers in sciences. This paper describes efforts to address this problem and suggests why such initiatives may not yield the desired results.