bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient outcome as a measure of quality of nursing home care.
Authors: Linn M W , Gurel L , Linn B S
Published: November 2008

One thousand males transferred from a general medical hospital into 40 community nursing homes were classified by their physicians as to expectations of outcome within six months and measured on physical functioning at the time of their transfer. They were followed up six months later and retested on functional status. Subjects were classified on follow-up as improved, the same deteriorated, or dead. They were also classified as discharged from the nursing home, still in the home, or readmitted to the hospital. Nursing homes were measured every six months on structural variables. Outcomes of the patients were related to the nursing home characteristics by multivariate analysis of variance, controlling for expected outcome, age, and diagnoses of cancer and chronic brain disease. Homes with more RN hours per patient were associated with patients being alive, improved, and discharged from the home. Better ratings on meal services were related to being alive and improved. A higher professional staff-to-patient ratio, better medical records, and more services were related to being discharged from the nursing home.
Peer sex education training and evaluation.
Authors: Zapka J M , Mazur R M
Published: November 2008

Human sexuality has been recognized as an important developmental, emotional, and medical concern on the college campus. The Peer Sex Education Program at the University of Massachusetts/Amherst has been developed as a model for the use of trained students in an educational, referral, and counseling role. This paper describes the program and outlines the methodology used in the documentation and evaluation of various program aspects. Aspects described include the program's rationale and background, the recruiting process, roles and responsibilities, training and supervision models, community development, and delivery of service. Categories of documentation and evaluation considered include effort, performance, adequacy of performance, efficiency, and process. These are related to consumer acceptance and satisfaction, outcome measures of knowledge, attitude, and behavior, effectiveness of referral and other functions, and effect of program on the peer educators' growth and development. The allocation of energy and resources between program development, service delivery and evaluation needs is highlighted.
Studies of ambulance patients with ischemic heart disease. 11. Selection of patients for ambulance telemetry.
Authors: Pozen M W , Fried D D , Voigt G G
Published: November 2008

One hundred eighty-two of 1,928 patients (9.4 per cent) transported by ambulance during a six-month period in Baltimore had ECGs transmitted. Review of the remaining 1,746 records by two cardiologists indicated that an additional 113 patients should have had their ECGs transmitted because of life-threatening conditions. Of patients with acute ischemic heart disease, 47 had ECG monitoring and 24 did not. There were 22 per cent more Killip 111/1V patients with a 19 per cent higher mortality at three months among the "non-transmitted" patients as compared to the "transmitted" patients, controlling for all other relevant variables. Critical presentations inappropriately affect ambulance staffs' selection of patients for monitoring.
Affecting the supply of rural physicians.
Authors: Cooper J K , Heald K , Samuels M
Published: November 2008

A model describing physician supply and distribution is described. Two surveys obtained information to examine elements of the model. The first survey identified a group of primary care physicians that had considered rural locations but ultimately selected an urban location. This sub-group, 29 per cent of the primary care supply pool, received a follow-up survey to provide more information about how they made their choice. About one-half of them finally chose on the basis of factors other than metropolitan/non-metropolitan considerations. For this half, some of the factors that entered into the decision were the availability of physician specialists, nearby hospital facilities, and access to medical school programs. Such factors could be affected by future policy decisions, but the cost is unknown. Even if such policy decisions were made, and appropriate programs instituted, the results would probably not solve the problem of disproportionate physician distribution. The most likely-to-succeed approach to increasing the number of rural physicians remains that of increasing the number of entrants to medical school with a rural background.
Evaluation of the localization auditory screening test in children 6-18 months of age.
Authors: Tillis C H , Grimm W A
Published: November 2008

The present paper is a report of a project to develop an automated auditory screening test for infants six to 18 months of age. The first year of the project was devoted to developing equipment and test procedures; the second year was concerned with testing the effectiveness of the equipment and procedures on an actual population of six to 18 month old infants. Two-hundred and fifty infants were screened auditorily as part of a county health department child development clinic. The pass/fail results of the screening test were evaluated in terms of physical and developmental examination following the screening and by means of a case review of the child's previous history. The results indicate that the procedure under investigation can be used to differentiate the normal hearing infant from the infant with possible hearing problems. It is shown by the test environment in which this study was conducted that the procedure reported can be successfully incorporated into a public health program, i.e., child development clinics or EPSDT programs.
Environmental health and safety concerns and energy conservation practices in academic institutions and hospitals.
Authors: DeRoos R L
Published: November 2008

Although there are many energy conservation practices which are now being applied in hospitals and academic institutions, there well be additional pressures for even further reductions in such energy use in the near future. In many instances, these reductions in energy use can be done within existing standards and do not endanger the health of persons who reside within these institutions. However, this paper highlights the fact that over-eager attempts at energy reduction may result in adverse effects on patients, students, staff, research programs, or the general public. For this reason, it is important for persons making decisions regarding energy conservation practices to be aware of these potential adverse effects and design energy conservation programs accordingly.
Efficacy of screening for cervical cancer: a review.
Authors: Guzick D S
Published: November 2008

Cytologic screening for cervical cancer currently enjoys wide acceptance, but there remains controversy in the literature concerning its efficacy in prolonging life. On the basis of a literature review, several conclusions are reached: 1) Cervical screening can identify women who are at greater-than-average risk of developing invasive cervical cancer by detecting asymptomatic lesions that would frequently progress to invasion if left untreated; 2) Therapy based on confirmed positive smears can reduce the incidence and mortality rates of invasive cervical cancer, as shown by declining rates in many centers that had constant or increasing rates before screening began, lower rates for geographic areas and occupational groups having less screening, and lower rates among screened women than unscreened women; and 3) Attempts to estimate the amount of life prolongation attributable to cervical screening have not yet yielded reliable figures, because of difficulties with the models or data used. However, in view of the available evidence, it is suggested that incomplete data should not prevent a vigorous continuation of screening where it is already extensive, and an escalation where it is not.
The Woodlawn mental health studies: tracking children and families for long-term follow-up.
Authors: Agrawal K C , Kellam S G , Klein Z E , Turner J
Published: November 2008

Elementary school children in a large public urban school system (Chicago) can be tracked into adolescence, together with their families, by using student numbers established by the Chicago Public Schools. This paper reports on the linkage between a psychiatric follow-up study and the data bank of the Chicago Public Schools. The authors were able to find information about the location and grade placement of 87% of an urban ghetto neighborhood's first grade children after a seven to ten-year lapse in contact. The children about whom information was found did not differ from those missing in the early measures of their school achievement and psychological wellbeing. However, first grade measures of school success of failure did relate to grade placement of children ten years later, as did first grade ratings of bizarreness.
Audience interest in mass media messages about lung disease in Vermont.
Authors: Worden J K , Sweeney R R , Waller J A
Published: November 2008

This study pretested audience interest in 25 potential message concepts to be used in a mass media campaign designed to change knowledge, attitudes, and behavior regarding lung disease. A group of 150 respondents reflecting specific target audiences (smokers, older persons, etc.) rated each concept on the basis of a two-sentence description using Haskins' 0--100 scale. Results indicated that older persons were most interested in message concepts suggesting ways to deal with various lung disease symptoms, and smokers showed highest interest in concepts offering positive and straightforward advice on how to quit smoking, rather than concepts that were negative, cute, or satirical in approach. Recommendations based on audience interest were made for the design of future lung disease media campaigns.
Educational benefits of the United States school feeding program: a critical review of the literature.
Authors: Pollitt E , Gersovitz M , Gargiulo M
Published: November 2008

In the Child Nutrition Act of 1966 it was stated that educational progress was an objective of the United States School Feeding programs. In spite of this fact no serious attempt has ever been made to evaluate whether this objective has been met; the few evaluations that have been conducted lack scientific rigor. As a whole the studies fail to provide a strong basis from which to make valid inferences regarding the long-term effects of the feeding program on school achievement and adaptation. Studies that have focused on the short-term effects of hunger or morning feeding suggest that the provision of breakfast may both benefit the student emotionally and enhance his capacity to work on school type tasks.
Consumer-based boards of health centers: structural problems in achieving effective control.
Authors: Paap W R
Published: November 2008

The fact that consumers have problems in utilizing their formal power as board members is usually attributed to individual deficiencies or cultural differences. The position argued here is that such views need to be questioned and amended. Thus, the ties between a health center and the larger health care system, the relations of consumers to their community environments, and the internal organization of health centers are examined as structural factors which limit the effectiveness of consumer board members.Despite the magnitude and durability of such factors, suggestions are made for increasing the effectiveness of consumer-based boards.
A decade of international change in abortion law: 1967-1977.
Authors: Cook R J , Dickens B M
Published: November 2008

Modern thinking on abortion, reflected in recent legal developments around the world, has turned from concentration upon criminality in favor of female and family well-being. New laws enacted during the last decade are coming to focus upon conditions of health and social welfare of women and their existing families as indications for lawful termination of pregnancy. Regulations governing the delivery of services may be restrictive, however, so as to limit in practice access to means of safe, legal abortion made available in theory. Requirements may be imposed that only medical personnel with unduly high qualifications perform procedures, or that they be undertaken only in institutions meeting standards higher than similar health care requires. Approval procedures may be established involving second medical opinions or committees to monitor observance of the law, which may delay abortions and therefore increase their hazards. Parental and spousal consent requirements may exist in addition with the same effects, or to veto a pregnant female's request. Regulations may be employed more positively, however, to encourage contraceptive practice. A disappointment with legislative reform is that it may fail to improve circumstances if public resources are not applied to achieve the supply of services newly rendered legitimate, and illegal practice may persist.
Manpower planning for nurse personnel.
Authors: Keaveny T J , Hayden R L
Published: November 2008

A technique is described which can be applied to manpower planning for nurse personnel at a state or regional level. An iterative process explores the implications of alternative planning policy decision strategies intended to balance manpower supply and requirements. Impacts of the following policy alternatives are estimated: scale of operations of education institutions; interstate migration patterns; labor force participation rates; and job design of licensed practical nurse (LPN) and registered nurse (RN) positions.
A longitudinal study of military performance subsequent to civilian drug use.
Authors: Rothberg J M , Chloupek R J
Published: November 2008

This study evaluates the military performance of soldiers who were identified by the Army's urine screening program as having used drugs at the time they reported for active duty. The study used prospectively defined cohorts of large size (over 1,600 urinalysis positive and over 2,400 urinalysis negative entering males) and used longitudinal outcome measures drawn from existing medical and personnel files. The major findings are that the urinalysis positive individuals were significantly more likely not to complete their tour of duty, were more likely to be hospitalized, and had more bed-days per hospitalization than their urinalysis negative fellow soldiers. In terms of cohorts entering the Army, however, minimal improvement in outcome was found by considering an entirely drug-free cohort (obtained by omitting the urinalysis positive individuals) compared to a random cohort which contained positives at the then current prevalence of 2 per cent.
Voluntary coordination as a strategy of plan implementation for health systems agencies.
Authors: Berry D E , Candia G R
Published: November 2008

Health planning agencies are faced with the difficult mission of guiding change within a large complex social system whose power is dispersed. Initial short- and long-range plans have been established as frameworks, and now the major focus is implementation. Regulation (non-voluntary coordination) and voluntary coordination are the major means of implementation. Voluntary coordination is a significant strategy for consideration by Health Systems Agencies (HSAs). It may interact with regulation as a competitor, substitute, or complement. Because of limited regulatory powers, HSAs are dependent upon voluntary coordination as a major means of influencing behavior. Conflict, a major feature of voluntary coordination, has the potential of being used as a constructive means for dialogue; negotiation and bargaining may become positive approaches to arriving at decisions. Legitimized community authority is the primary source of authority in a strategy dominated by voluntary coordination as contrasted to state or federal mandates in a regulatory strategy. Knowledge of the environment within which the HSA operates will assist HSA staff and board to arrive at rational and realistic decisions.
Hazards in the hospital: educating the workforce through its union.
Authors: Brown M P
Published: November 2008

The hospital workforce is exposed to many occupational hazards of which most hospital workers are unaware. The author and another health educator, both employed with the California State Department of Health, conducted occupational health and safety educational sessions for the membership of a hospital workers' union. These sessions taught nonprofessional workers how to recognize hospital hazards, how to eliminate or minimize these hazards, and informed workers of their legal rights under the California Occupational Safety and Health Act. We first had to convince the union health and safety officer that we had skills and information which would be of benefit to the union. Once that hurdle was crossed, we encountered some difficulty conducting an adequate needs assessment and including the target population in the planning of the educationals. Two series of educational sessions for rank-and-file members were conducted and were enthusiastically received by those attending, with a request for more sessions.
Cohort maternal mortality: New York, 1917-1972.
Authors: Tu E J
Published: November 2008

Data on New York State maternal mortality, 1917-1972, are analyzed and show that the cohort patterns of age-specific maternal mortality are mainly a reflection of the pattern of period declines in age-specific maternal mortality.
The psychological effects of differential treatment of a high risk sample in a randomized clinical trial.
Authors: Benfari R C , McIntyre K , Eaker E , Blumberg S , Paul O
Published: November 2008

A study was carried out using 616 participants in a randomized clinical trial at the Harvard MRFIT (Multiple Risk Factor Intervention Trial) Clinical Center, to test if there were differences in the psychological dimensions of anxiety, depression, and functional heart symptoms in groups given different levels of treatment in a CHD (Coronary Heart Disease) Intervention Program. A theoretical framework was given to justify a number of hypotheses as to the induction of adverse psychological effects. At the end of two years in the MRFIT Program there were no significant differences between the special intervention group (SI) and the usual care group (UC) in the selected psychological variables.
A survey of mental health service coverage within health maintenance organizations.
Authors: Levin B L , Glasser J H
Published: November 2008

This 1978 national survey of all operating Health Maintenance Organizations (HMOs) provided information on the current status of mental health services utilization and service coverage within HMOs. It achieved a 68 per cent response rate. Approximately 90 per cent (108) of the HMOs offered mental health services through basic or supplemental coverage plans; HMO organization characteristics reflected relative heterogeneity; the mean monthly costs for basic health plan coverage (physical and mental health services) were $33.85 (for individuals) and $95.15 (for families); HMOs reported lower physical and mental health hospital utilization and higher ambulatory utilization when compared to more traditional forms of health insurance coverage. The present coverage and uitlization of mental health services within HMOs reflect greater variability of benefits and utilization within HMOs. There is need for further studies of mental health utilization in relation to organizational structure and delivery pattern relationships within HMOs.
Evaluation of drug abuse rehabilitation efforts: a review.
Authors: Quinones M A , Doyle K M , Sheffet A , Louria D B
Published: November 2008

During the 1960s, three modalities of treatment aimed at rehabilitation of the drug abuser (methadone maintenance, outpatient drug free treatment, and the residential therapeutic community) were developed. Large amounts of public and private monies have gone to supporting these modalities; little evaluation as to the efficacy of such rehabilitation efforts has been done. This paper attempts to delineate the evaluative research efforts undertaken in the drug abuse field to date. In addition, the findings of an eight-year evaluation of six drug treatment programs in Newark, NJ are presented. The authors propose a paradigm for quick, effective evaluation of drug and alcohol programs at minimal cost.
Awareness, opinion and behavioral intention of urban women regarding mammography.
Authors: Berkanovic E , Reeder S J
Published: November 2008

A representative sample of women living in metropolitan Los Angeles were asked what they heard and what they believed about mammography and whether they would obtain a mammogram if their doctor advised it. Forty percent of these women said they had not heard of mammography even after the procedure was described. Few of those who had heard of mammography had negative feelings about it. Further, 93 percent of the overall sample said they would obtain a mammogram if their physician recommended it.
A longitudinal evaluation of blood pressure in children.
Authors: Levine R S , Hennekens C H , Klein B , Ferrer P L , Gourley J , Cassady J , Gelband H , Jesse M J
Published: November 2008

Blood pressure levels obtained on two occasions, one year apart, were evaluated among 212 children. An overall correlation of .65 was obtained for systolic pressure and .43 for diastolic pressure. The results suggest that adult levels of correlation are not reached in childhood and that screening programs must consider the relative lability of children's measurements in establishing referral criteria.
Serological markers for hepatitis types A and B among U.S. Arym soldiers, Germany.
Authors: James J J , Smith L
Published: November 2008

Viral hepatitis rates among U.S. Army soldiers in Europe have been found to be two to three times higher than corresponding rates for soldiers stationed in the U.S. Sera from 89 per cent of a representative Army unit with 865 members and a known hepatitis problem were tested for HBsAg, anti-HBs, anti-HBc, and anti-HA. The prevalence of HB markers was 20 per cent, and hepatitis A antibody was present in 25 per cent. A six-month follow-up, conducted on 260 individuals initially negative for all four tests, revealed that 11 of these were now HB seropositive, whereas none had seroconverted to anti-HA positive. The HB virus was the principal agent responsible for hepatitis in the unit surveyed.
Parasitic disease control in a residential facility for the mentally retarded.
Authors: Thacker S B , Simpson S , Gordon T J , Wolfe M , Kimball A M
Published: November 2008

Asymptomatic infection with either Entameba histolytica or Giardia lamblia was found in 61 per cent of the residents of a dormitory in an institution for the mentally retarded; two other dormitories had rates of 20 per cent and 22 per cent. Drug therapy was successfully undertaken in all three dormitories, and environmental improvements were introduced in the heavily infected dormitory. A one-year follow-up showed a reduction in parasitic disease in two dormitories but, in the most heavily infected dormitory, infection had returned to pretreatment levels.
Assessing depression outcomes in group practice clinics.
Authors: Braswell H R , Williamson J W
Published: November 2008

The application of a protocol for the initial assessment of medical care outcomes of geriatric depression management in four multispecialty group practice clinics is described. The clinical findings of this study are limited, but the protocol for the assessment of depression outcomes was found to be feasible, practical and acceptable in all four clinics. The success of the study has positive implications both for improving management of depressed clinic patients and for adapting this quality assurance approach to other health conditions and care settings.
Trends in University Environmental Health Research and Training
Authors: Moeller Dade W. , Pahl Herbert B. , Hammond Paul B.
Published: November 2008

A survey of 157 college and university programs in the United States indicates that, during the ten-year period from 1967 through 1976, the number of people completing graduate programs in environmental health specialties at the master's, doctoral, and post-doctoral levels doubled. In 1974-75, 75 per cent of those completing master's degree programs were in the specialty areas of water pollution, air pollution, and occupational health; 76 per cent of those completing doctoral programs were in water pollution, toxicology, radiation protection, air pollution, and cancer research; and 61 per cent of those completing post-doctoral programs were in cancer research and toxicology. Including those whose current positions could not be ascertained, less than 10 per cent of all graduates accepted employment outside the field of environmental health. Funding for university environmental health research continued to increase throughout this ten-year period. The sources of this funding, however, changed dramatically, with the relative contributions from the U.S. Department of Health, Education, and Welfare decreasing significantly, while those from industry and other federal agencies increased. In contrast, funding for university environmental health training increased significantly between 1966 and 1971, but showed no increase from 1971 to 1975. During this latter period, training support provided by HEW remained essentially constant, that by the Environmental Protection Agency decreased to less than half, while that from the universities approximately tripled. (Am. J. Public Health 69:125-129,1979.)
The Ottawa County project: a report of a tuberculosis screening project in a small mining community.
Authors: Burke R M , Schwartz L P , Snider D E
Published: November 2008

Following a retrospective review of tuberculosis cases reported from Ottawa County, Oklahoma, from 1969 through 1973, a selective tuberculosis screening project was implemented. Screening of a "target group" of the population, 519 former miners, greater than or equal to 50 years of age, resulted in the discovery of abnormal chest X-rays in 182; (103 with silicosis, 36 with silicotuberculosis, 12 with inactive tuberculosis, and 31 with other abnormalities). Eighty-five of these persons had positive tuberculin skin tests. Preventive therapy was recommended for 50, and 36 completed the prescribed course of treatment. Eight new bacteriologically confirmed cases of tuberculosis were found and treated. A large number of persons (1,904) residing in the same area who were not part of the target group were also screened for tuberculosis. This group contained a large number of positive tuberculin reactors but very few were candidates for isoniazid preventive therapy. Thirteen persons in this group had abnormal chest X-rays consistent with inactive tuberculosis but 12 had been identified and given preventive therapy before the project began. These data suggest that selective approaches to screening for tuberculosis in a community which are based on an in-depth retrospective review of the tuberculosis case register can be highly successful.
Longitudinal changes in blood lead level in children and their relationship to season, age, and exposure to paint or plaster.
Authors: McCusker J
Published: November 2008

Children screened for lead poisoning in the Brownsville district of New York City in either summer or winter were followed with blood lead tests for approximately six months to one year from screening to measure longitudinal changes in blood lead level and to identify some determinants of the changes. Only minimal evidence was found of the hypothesized summer rise in blood lead level, while the predominant trend seemed to be for blood lead levels to display statistical regression to the mean. In children found to have low to intermediate blood lead levels (less than 55 microgram/100ml) at screening, variables which were found to predict a rise in blood lead level of 10 microgram/100ml or greater from winter to summer were under age three and/or exposure to paint or plaster.
Canonical correlation analysis: potential for environmental health planning.
Authors: Laessig R E , Duckett E J
Published: November 2008

There is a challenging need to identify the relationships between environmental quality and health status. It may be especially important to be able to isolate key variables which can be consolidated into a few indices of environmental conditions as they are related to health. Such indices might be used to identifying associations among groups of variables, such as specific geographic area. The indices may also provide insights into environmental health relationships which are worthy of further epidemiological investigation. Canonical correlation analysis is a multivariate statistical technique which provides a means of identifying associations among groups of variables, such as health and environmental measures. The technique can produce weighted indices of environmental conditions as they are related to health within a city or region. This paper describes what canonical correlation is, and outlines how it might be used for these purposes. An illustrative application based on data collected for Philadelphia, Pennsylvania is also presented.
The growing demand for midtrimester amniocentesis: a systems approach to forecasting the need for facilities.
Authors: Selle H F , Holmes D W , Ingbar M L
Published: November 2008

A predicted shift in composition of the child-bearing population of the United States to higher maternal ages by year 2000 indicates that the number of chromosomally abnormal offspring of women age 35 and over will increase by 64% while the total number of women increases only 21%. We formulated a conceptual model of a health care system that predicts demand for amniocentesis from prospective patients in any particular region, the number of defective offspring detected, and the future cost of custodial care using any given level of detection effort. It was found that as capacity of clinic facilities and use by women age 35 and over in the area increased, the expenditure for amniocentesis combined with the cost of custodial care for undetected offspring decreased, assuming termination of affected pregnancies. Use of this model will enable health care managers to anticipate need for facilities, and also guide the formulation of social policy in the provision of new health services by enabling them to take into account the predictable effects of these services upon other public services.
Utilization of health care: the Laredo migrant experience.
Authors: Walker G M
Published: November 2008

In 1973, three groups of randomly selected migrant labor families resident in Laredo, Texas were enrolled in a prepaid health insurance study. A study was implemented to determine the kinds and costs of medical care used by Mexican American migrant labor families in their homebase and travel areas where financial barriers to care were eliminated or reduced. At the end of three years it was found that the study population used ambulatory services about one-half as much as the general U.S. population while hospital use approached regional norms. The differences between homebase and out-of-area use are highlighted, and the reported failure to use any public facilities outside of Laredo is discussed.
A clinical epidemiologic study of hyperphenylalaninemia.
Authors: Wrona R M
Published: November 2008

Thirty-nine cases of hyperphenylalaninemia from four diagnostic-treatment centers in Ohio were investigated in a retrospective cohort analysis. None of the centers is included in the PKU Collaborative Study. Epidemiologic analysis showed that early treatment is effective and that degree of dietary control (within limits) does not affect the probability of retardation or borderline retardation. Regression analysis supported the critical period hypothesis rather than the maximum concentration theory. Exposure to serum phenylalanine of 23--27 mg./dl. corresponds to 50 per cent probability retardation. The clinical epidemiologic approach offers an alternative methodology for designing collaborative studies.
Cesarean section, fetal monitoring, and perinatal mortality in California.
Authors: Williams R L , Hawes W E
Published: November 2008

The rate of cesarean section in California has been growing at a compound rate of about 10 per cent per annum since 1969, coinciding with the advent of fetal monitoring. It is of interest, therefore, to study the distribution and efficacy of obstetric interventions. Information derived from the 1977 California birth cohort and a survey questionnaire was used to study the factors associated with the rate of cesarean section in 323 hospitals. Significant positive correlations were observed between the cesarean rate (CSR) and hospital factors indicative of a high degree of technology, including the proportion of labors electronically monitored. Significant negative correlations were observed between the CSR and hospital-specific variables suggestive of socioeconomically underprivileged patient populations. Other factors being constant, hospitals characterized by prepayment health care financing also had lower CSRs. A standaridized mortality ratio (SMR) based on 2.3 million births in the 1970--1976 cohorts was used to adjust the 1977 hospital specific perinatal mortality rates for birth weight, gestational age, sex, race, and plurality. The results show that hospitals which intervene technologically in a large proportion of births have lower risk adjusted perinatal mortality rates.
An evaluation of efforts to educate mothers about child development in pediatric office practices.
Authors: Chamberlin R W , Szumowski E K , Zastowny T R
Published: November 2008

The efforts expended by pediatricians in a variety of private practice settings to educate mothers of first-born children about child behavior and development were examined in relation to various outcome measures of mother and child functioning over a time period of one-and-a-half years. Mothers learned more about child development in group settings than in solo practice settings, but differences between medical groups with and without nurse practitioners were not significant. Mothers receiving care from pediatricians who made at least a moderate effort to teach, learned more about child development, described more use of positive contact with their children, and felt they were helped more in their childrearing efforts than did mothers receiving care from pediatricians who made little effort to teach. However, there were no significant differences in measures of the child's developmental status related to physician teaching input, and mothers exposed to higher levels of teaching input reported more behavioral problems with their children. The most important predictor of the child's developmental status at 18 months of age was the amount of positive contact between mother and child at one year. It is suggested that the effects of changing the frequency of well-child visits on the mothers' interaction patterns with their children and on their feelings of being supported by the physician be ascertained before making recommendations about the optimal number of such visits.
Measles in a partially immunized community.
Authors: Wintermeyer L , Myers M G
Published: November 2008

During the investigation of a measles outbreak in a rural community, a spectrum of illness was observed which ranged in severity from a brief febrile illness to one characteristic of typical measles. Unimmunized children were more apt to develop measles (p less than 0.001) than were immunized children. However, a proportion of both the immunized and unimmunized children developed a milder, "measles-associated," illness. Employing a logistic model, it was demonstrated that the probability of developing either measles or "measles-associated" illness decreased with increasing age at immunization but was not affected by the interval since immunization.
Identifying biohazards in university research.
Authors: Dreesen D W
Published: November 2008

University and college biosafety programs are usually modeled after those of the National Institutes of Health, concentrating entirely on microbial agents. The University of Georgia has expanded its program to include six specific types of biohazards: 1) recombinant DNA; 2) human pathogens; 3) oncogenic viruses; 4) cell cultures; 5) venomous vertebrates and invertebrates; and 6) plant and animal pathogens and the movement into the state of non-indigenous plants and animals. Biohazard questionnaires and checklists are used to assure total involvement and efficient implementation.
High prevalence of cervical dysplasia in STD clinic patients warrants routine cytologic screening.
Authors: Briggs R M , Holmes K K , Kiviat N , Barker E , Eschenbach D A , DeJong R
Published: November 2008

The results of routine cervical cytology screening at a Planned Parenthood Center (PPC) clinic were compared to those at a nearby sexually transmitted diseases (STD) clinic in Seattle. Cervical cytologic findings were consistent with cervical intraepithelial neoplasia (CIN), grades 1 (mild dysplasia), 2 (moderate dysplasia), or 3 (severe dysplasia to carcinoma in situ) in 502 (5.9 per cent) of 8,504 PPC patients and 87 (11.4 per cent) of 764 STD patients (p = .001). This rate for STD patients is five times that reported for the general population. Sixty-three PPC patients and 31 STD patients with screening smears consistent with CIN 1 or 2 underwent further prospective study by us, including repeated cytologic and colposcopic examinations. Thirty-seven (59 per cent) of 63 PPC patients and 26 (84 per cent) of 31 STD patients (p = .02) had at least on additional smear or colposcopy consistent with CIN and were advised to undergo cervical biopsy. Among those who underwent recommended biopsy, CIN was confirmed histologically in 15 (50 per cent) of 30 PPC patients and 11 (61 per cent) of 18 STD patients. Thus, the proportion of patients who had screening cytologic findings consistent with CIN, the proportion with persistent cytologic or colposcopic findings consistent with CIN on retesting, and the proportion of those biopsied who had histologically confirmed CIN, all were higher for STD than for PPC patients. There is a serious need for cytologic screening in STD clinics throughout the nation.
Nutrition and cognitive development among rural Guatemalan children.
Authors: Freeman H E , Klein R E , Townsend J W , Lechtig A
Published: November 2008

Women and children from four Guatemalan villages participated in a voluntary food supplementation program for seven years. In two of the villages, they received a vitamin and mineral fortified, high-protein calorie supplement. In the other two villages, the vitamin-mineral fortified supplement contained no protein and a relatively small number of calories. Cognitive tests were administered regularly to children ages three to seven, and anthropometric measures obtained. In addition, measures of families' social milieu were collected at several points in time. Using multiple regression analysis, we find that both nutritional and social environmental measures are related to various dimensions of cognitive competence. The results suggest that nutritional intake, independent of social factors, affects cognitive development. There is also some evidence that the children who receive the high-protein calorie supplement (and whose mothers received it during pregnancy and lactation) are more likely to score high in cognitive performance. Our results, while not diminishing social environmental explanations of differences in cognitive function, suggest benefits from nutrition intervention programs in rural areas of lesser-developed countries.
Use and reported effectiveness of Tel-Med: a telephone health information system.
Authors: Diseker R A , Michielutte R , Morrison V
Published: November 2008

In January 1977, a Telephone Information System (Tel-Med) was begun in Winston-Salem, North Carolina. A survey was conducted to determine how Tel-Med was meeting the community's need for health information and to see if program objectives were being met. Respondents in 3,005 randomly selected households were interviewed by telephone to determine user characteristics, user motivation, action taken, knowledge and information gained, and system improvements. A key finding indicated that larger percentages of adults with lower income and educational levels were not aware of the service than were the adults in upper income and educational levels. However, income and education are not related to use of Tel-Med among individuals who know of this service. This finding suggests that the poorer and lesser educated would use Tel-Med in a way similar to that of their more fortunate peers if efforts were made to inform them of the service.
Use of automated record linkage to measure patient fertility after family planning service.
Authors: Burnettt C A , Tyler C W , Schoenbucher A K , Terry J S
Published: November 2008

Record linkage was used to identify births in 1974 to patients who had received contraceptive services from public family planning clinics in metropolitan Atlanta. The record linkage methodology is described. Results indicated that patient educational level, age, contraceptive choice, and race were the factors most associated with subsequent patient fertility. Black teenage patients experienced the highest fertility. Patients age 20 years and over with some education beyond high school experienced approximately one-third the fertility of less-educated patients. The program effectiveness of the IUD and the Pill was substantially better than that of foam and condoms. Excluding teenagers, the program effectiveness of the IUD was better than the Pill. Changes in family planning services for high-risk patients may help them achieve their fertility control objectives. Linking family planning clinic records to official birth records as described in this study can help determine clinic success in meeting patient objectives. Other applications of record linkage are discussed briefly.
Health stability and change: a study of urban black youth.
Authors: Brunswick A F
Published: November 2008

Personal interviews were conducted with a representative sample of 536 urban Black youth at two points in their life cycle: first when they were adolescents, aged 12--17, and six to eight years later when they were young adults, aged 18--23. A total of 47 health problems for males, 48 for females, were inquired about each time. Longitudinal analysis was performed to determine the extent of change, the direction of change, and the health problems most subject to change. The number of health problems increased for both sexes, but the increase was significantly greater among males than females. Male and female morbidity count, thus, became nearly equivalent in young adulthood whereas, in adolescence, young women's had exceeded men's. More detailed age analysis revealed that the greatest increase in male's health problems occurred two years behind that for women: for men, between ages 17 and 18; for women between ages 15 and 16. With but few exceptions, the same health problems which dominated in adolescence continued to be most prevalent in young adulthood. Population prevalence rates, however, understate the considerable degree of shift or turnover in individual cases reporting health problems as well as in general health status as measured by the total number of those problems.
Cancer incidence and trihalomethane concentrations in a public drinking water system.
Authors: Carlo G L , Mettlin C J
Published: November 2008

Four thousand two hundred fifty-five cases of esophageal, stomach, colon, rectal, bladder, and pancreatic cancer reported from Erie County, NY between 1973 and 1976 were analyzed in terms of their relationship to type of water source, level of trihalomethane (THM) and various social and economic parameters. Among white males, a significant positive correlation existed between pancreatic cancer incidence rates and THM level. No other significant correlations were observed. This research lends little or no support to the hypothesis that THM levels which meet present standards are related to the incidence of human cancer.
Gaining control: reform, reimbursement and politics in New York's community hospitals, 1890--1915.
Authors: Rosner D
Published: November 2008

This is an historical study of an early twentieth century political struggle regarding hospital reimbursement in New York City. During a period called the "Progressive Era" (1895--1915), administrators in the City's Comptroller's office sought to gain control over small, locally run community hospitals by dismantling the long-standing practice of flat-grant payments to institutions. Central office planners felt that these payments gave too much control to trustees. In its place, the Comptroller initiated a system of per-capita, per-diem reimbursement. Inspectors now judged for the institutions which services and which clients were appropriate for municipal reimbursement. From the perspective of the Comptroller's office, this change was an attempt to put rationality into the system of municipal support for charitable institutions. From the perspective of trustees and community representatives, however, this change was a political attack on the rights of institutions and local communities to control their own fate. Within the context of the larger Progressive Era "good government" movement to centralize decision-making in the hands of experts who believed strongly in the efficiency of larger institutions, it was generally the smallest, most financially troubled community institutions which felt the brunt of these changes.
Evaluation of the costs and benefits of motorcycle helmet laws.
Authors: Muller A
Published: November 2008

Since 1976, 28 states have repealed or significantly amended their motorcycle helmet laws. The change in legislation was not based on an evaluation of the costs and benefits of such laws. This paper attempts such an assessment by comparing the cost of motorcycle helmets with the medical costs averted due to helmet use using data primarily based on motorcycle crashes in Colorado, Oklahoma, and South Dakota. Nationwide, at least $61 million could be saved annually if all motorcyclists were to use helmets. Helmet law repeals have been observed to lead to a 40 to 50 per cent point reduction in helmet use. The associated additional medical care costs substantially exceed cost savings produced by reduced helmet use. It is estimated that helmet law repeals may produce annually between $16 and 18 million of unnecessary medical care expenditures. Several alternatives to increase motorcycle helmet use are briefly discussed. It is concluded that helmet laws are effective in encouraging helmet use among motorcyclists and will prevent unnecessary medical expenditures as well as unnecessary pain and suffering among injured motorcyclists.
Professional encroachment: a comparison of the emergence of denturists in Canada and Oregon.
Authors: Rosenstein D I , Joseph L P , Mackenzie L J , Wyden R
Published: November 2008

In 1978, supporters of denturism in Oregon succeeded in passing an initiative which allows denturists to provide dentures directly to the public. The steps which led to the referendum included three unsuccessful attempts to have the state legislature enact a law legalizing denturism. After capturing broad-based consumer support, the issue was placed on the ballot and passed by an overwhelming margin. Both the denturists and the dentists in Oregon adopted strategies similar to those used in Canada over 20 years ago when the issue was raised in a number of provinces. As was the case in Canada, the denturists prevailed. Denturists stressed the price differential and the issue of freedom of choice. Dentists stressed health and safety issues. The public perceived the dentists' campaign as negative and self-serving. This perception may have contributed to the election results. In order to avoid this tarnished image, dentists must anticipate the public's needs, and formulate strategies to meet such needs.