bluuebunny/crossref_metadata_2025 huggingface dataset:
The pleasures and perils of prophetic advocacy: Henry E. Sigerist and the politics of medical reform.
Authors: Fee E
Published: November 2008

Henry E. Sigerist, an internationally renowned medical historian, played a surprisingly important and visible role in American medical politics in the 1930s and 1940s. Born in Paris of Swiss parents, he was professor in Leipzig, Germany, before coming to the United States in 1932 as professor of the history of medicine at Johns Hopkins University. Once in America. Sigerist became deeply involved in medical politics and the campaign for national health insurance. He argued that individualized medical practice was outdated and should gradually be superseded by state-run and state-financed health services. National health insurance was but one step in this historical progression. Sigerist thus lent the weight of history itself to the cause of medical care reform. The charming and erudite Sigerist was welcomed by the leaders of academic medicine in America. Soon, he emerged as a spokesman of the left wing of the medical profession, an effective and popular speaker and an impassioned advocate of socialized medicine. This paper traces Sigerist's political ideas and activities, and his contributions toward medical care reform in the United States.
Cocaine use and characteristics of young adult users from 1987 to 1992: the CARDIA Study. Coronary Artery Risk Development in Young Adults.
Authors: Braun B L , Murray D , Hannan P , Sidney S , Le C
Published: November 2008

OBJECTIVES: This study examined the relationship of sociodemographic factors and use of substances other than cocaine to cocaine use from 1987 to 1992 in a cohort of Black and White men and women 20 to 32 years of age. METHODS: Data were collected as part of the Coronary Artery Risk Development in Young Adults study. Self-reported cocaine use was analyzed through chi-square tests and repeated measures analyses of variance to determine the bivariate and multivariate relationships of sociodemographics and substance use behaviors to cocaine use over the 5-year period. RESULTS: Cocaine use declined in Whites but remained stable in Blacks from 1987 to 1992. Cross-sectional results showed that use was related to being Black, male and in the older half of the cohort, single, and unemployed; it was also related to higher levels of other substance use in 1987 and 1992. Over time, the magnitude and strength of the relationship were consistent for each variable except for increased odds of cocaine use among the unemployed and Blacks in 1992. CONCLUSIONS: Sociodemographic characteristics and substance use behavior consistently identify individuals at risk for cocaine use. As a result, intervention programs should be targeted at these high-risk groups.
Healthy behaviors among women in the United States and Ontario: the effect on use of preventive care.
Authors: Hofer T P , Katz S J
Published: November 2008

OBJECTIVES: This study examined how several healthy behaviors among women in Ontario and the United States explained (1) the use of preventive health services, (2) differences in use between socioeconomic groups, and (3) differences in use between the two health systems. METHODS: 1990 data on women from the Ontario Health Survey (n = 22,985) and the US National Health Interview Survey (n = 19,092) were analyzed. A woman who avoided smoking and obesity, used seatbelts, and regularly engaged in aerobic exercise was defined as having a healthy lifestyle. Women were considered screened if they reported a mammogram or a breast exam within the previous year or a Pap smear within 2 years. RESULTS: A healthy lifestyle was more common in the United States than Canada among more highly educated groups (odds ratio [OR] = 1.40; 95% confidence interval [CI] = 1.22, 1.60 for college educated) but less common in the United States for those with less than a high school education (OR = 0.52; 95% CI = 0.40, 0.67). Each additional unhealthy behavior decreased the odds of having undergone a mammogram in the previous year by 20%. However, adjusting for the number of unhealthy behaviors did not substantially change the relationship between socioeconomic status and use of preventive services. CONCLUSIONS: The number of healthy behaviors is an important measure of demand for preventive health services. This measure varies across country and socioeconomic group.
The long-term effects of a cardiovascular disease prevention trial: the Stanford Five-City Project.
Authors: Winkleby M A , Taylor C B , Jatulis D , Fortmann S P
Published: November 2008

OBJECTIVES: This study examined long-term effects of a health-education intervention trial to reduce the risk of cardiovascular disease. METHODS: Surveys were conducted in California in two treatment and two control cities at baseline (1979/1980), after the 6-year intervention (1985/1986), and 3 years later at follow-up (1989/1990). Net treatment/control differences in risk-factor change were assessed for women and men 25 to 74 years of age. RESULTS: Blood pressure improvements observed in all cities from baseline to the end of the intervention were maintained during the follow-up in treatment but not control cities. Cholesterol levels continued to decline in all cities during follow-up. Smoking rates leveled out or increased slightly in treatment cities and continued to decline in control cities but did not yield significant net differences. Both coronary heart disease and all-cause mortality risk scores were maintained or continued to improve in treatment cities while leveling out or rebounding in control cities. CONCLUSIONS: These findings suggest that community-based cardiovascular disease prevention trials can have sustained effects. However, the modest net differences in risk factors suggest the need for new designs and interventions that will accelerate positive risk-factor change.
The School Enrollment-Based Health Insurance program: socioeconomic factors in enrollees' use of health services.
Authors: Shenkman E , Pendergast J , Reiss J , Walther E , Bucciarelli R , Freedman S
Published: November 2008

OBJECTIVES: The School Enrollment-Based Health Insurance program is designed to reduce financial barriers to children's health care use. This study sought to determine if any socioeconomic measures differed between enrollees with at least one health care encounter and those with no encounters. METHODS: Logistic regression was used to assess the impact of various predictors on the odds that a child would use health care services. RESULTS: Children receiving free insurance premiums were less likely to use health care than those receiving partial subsidy. African-American and Hispanic children were less likely than Whites to use health care. Age, sex, and months enrolled also influenced the likelihood of health care use. CONCLUSIONS: Financial and non-financial factors must be considered when developing children's health care programs.
Assessing mothers' attitudes about the physician's role in child health promotion.
Authors: Cheng T L , Savageau J A , Bigelow C , Charney E , Kumar S , DeWitt T G
Published: November 2008

OBJECTIVE: This study assessed maternal attitudes about the physician's role in child health promotion. METHODS: Home interviews were conducted with 200 Massachusetts mothers (with one child age 2 to 3 years) enrolled in a health maintenance organization. RESULTS: Mothers chose growth and nutrition, physical development, and illness as the most important topics and felt that providers have the ability to prevent problems and to help. Psychosocial and safety issues were less important, although mothers felt susceptible to these issues and believed they greatly affected children's health. CONCLUSIONS: On all issues, mothers believed physicians were more effective in helping families after, not before, problems arose. The Health Belief Model provided insight into attitudes and possible interventions.
An education program for parents of children with asthma: differences in attendance between smoking and nonsmoking parents.
Authors: Fish L , Wilson S R , Latini D M , Starr N J
Published: November 2008

We studied smoking status in relation to parental attendance at an asthma education program for child patients of a health maintenance organization. Nonattendance rates were 24%, 42%, and 78% in nonsmoking, one-smoker, and two-or-more-smoker families, respectively, and 33% overall. Only the number of smokers (odds ratio [OR] = 3.1; 95% confidence interval [CI] = 1.8, 5.3) and perceived adverse impact of asthma on the family (OR = 0.4; 95% CI = 0.2, 0.9) were retained in a multivariate model that correctly classified 73% of families; demographic characteristics, frequency of asthma symptoms, and health care use were rejected. There was a tendency for smoking parents to deny that their child had asthma (17% among families with two or more smokers; 9% among nonsmoking families). Asthma education programs may fail to involve parents who smoke.
Temporarily detained: tuberculous alcoholics in Seattle, 1949 through 1960.
Authors: Lerner B H
Published: November 2008

Repeatedly noncompliant tuberculosis patients (who are often homeless or substance users) are once again being forcibly detained. Health officials intend that confinement be used only when "less restrictive alternatives" have failed. Past programs of detention can inform current efforts. In 1949, Seattle's Firland Sanatorium established a locked ward. Although initially intended only for active public health threats, the ward was eventually used to maintain order among Firland's alcoholic patients. That is, the staff detained alcoholics--regardless of their infectivity or compliance with medications--for breaking sanatorium rules. In this manner, maintaining institutional order became a legitimate reason for invoking public health powers. Although new detention regulations strive to protect patients' civil liberties, attention must also be paid to the day-to-day implementation of coercive measures. When public health language is used to justify administrative or institutional requirements, disadvantaged patients may be stigmatized.
Addressing the epidemiologic transition in the former Soviet Union: strategies for health system and public health reform in Russia.
Authors: Tulchinsky T H , Varavikova E A
Published: November 2008

OBJECTIVES. This paper reviews Russia's health crisis, financing, and organization and public health reform needs. METHODS. The structure, policy, supply of services, and health status indicators of Russia's health system are examined. RESULTS. Longevity is declining; mortality rates from cardiovascular diseases and trauma are high and rising; maternal and infant mortality are high. Vaccine-preventable diseases have reappeared in epidemic form. Nutrition status is problematic. CONCLUSIONS. The crisis relates to Russia's economic transition, but it also goes deep into the former Soviet health system. The epidemiologic transition from a predominance of infectious to noninfectious diseases was addressed by increasing the quantity of services. The health system lacked mechanisms for epidemiologic or economic analysis and accountability to the public. Policy and funding favored hospitals over ambulatory care and individual routine checkups over community-oriented preventive approaches. Reform since 1991 has centered on national health insurance and decentralized management of services. A national health strategy to address fundamental public health problems is recommended.
Does religious observance promote health? mortality in secular vs religious kibbutzim in Israel.
Authors: Kark J D , Shemi G , Friedlander Y , Martin O , Manor O , Blondheim S H
Published: November 2008

OBJECTIVES. This study assessed the association of Jewish religious observance with mortality by comparing religious and secular kibbutzim. These collectives are highly similar in social structure and economic function and are cohesive and supportive communities. METHODS. In a 16-year (1970 through 1985) historical prospective study of mortality in 11 religious and 11 matched secular kibbutzim in Israel, 268 deaths occurred among 3900 men and women 35 years of age and older during 41347 person-years of observation. RESULTS. Mortality was considerably higher in secular kibbutzim. Cox proportional hazards analysis was used to adjust for age and the matched design; rate ratios were 1.67 (95% confidence interval [CI]=1.17, 2.39) for men, 2.67 (95% CI=1.55, 4.60) for women, and 1.93 (95% CI=1.44, 2.59) overall. Kaplan-Meier survival analysis of birth cohorts confirmed the association. The lower mortality in religious kibbutzim was consistent for all major causes of death. CONCLUSIONS. Belonging to a religious collective was associated with a strong protective effect not attributable to confounding by sociodemographic factors. Elucidation of mechanisms mediating this effect may provide etiologic insights and leads for intervention.
Intrauterine growth retardation and premature delivery: the influence of maternal smoking and psychosocial factors.
Authors: Nordentoft M , Lou H C , Hansen D , Nim J , Pryds O , Rubin P , Hemmingsen R
Published: November 2008

OBJECTIVES. This study investigated the influence of psychosocial stress, maternal schooling, social support, psychological well-being, alcohol, and smoking on intrauterine growth retardation and premature delivery. METHODS. At a Copenhagen university hospital, 2432 pregnant women completed a questionnaire on general health, psychosocial stressors, and sociodemographic characteristics. RESULTS. In 212 cases (8.7%) the women delivered prematurely. Preterm delivery as associated with psychosocial stress (adjusted odds ratio [OR]=1.14 for each 1-point increase on the psychosocial stressor 5-point scale and 1.92 for the whole scale) and poor school education (adjusted OR=2.62 for 7-9 years of schooling, 1.91 for 10 years, and 1.0 for 11-13 years). In 152 cases (6.3%), infants had a birthweight below the 10th percentile. Intrauterine growth retardation was associated with smoking, daily drinking, school education, and social network variables. In a multiple logistic regression model, intrauterine growth retardation was associated with smoking habits (adjusted OR=2.40 for 0-9 cigarettes daily, 2.68 for 10-15 daily, and 2.88 for more than 15 daily). CONCLUSIONS. Psychosocial stressors and limited duration of schooling appeared to influence preterm delivery. Smoking habits influenced intrauterine growth retardation.
The first year of hyperinflation in the former Soviet Union: nutritional deprivation among elderly pensioners, 1992.
Authors: Rush D , Welch K
Published: November 2008

OBJECTIVES. Hyperinflation began in early 1992 in the former Soviet Union. This paper describes factors associated with nutritional status that year among elderly pensioners. METHODS. Approximately 300 pensioners were selected randomly in each of eight cities. Surveys of diet, weight, health status, and social and economic conditions were done between June and December 1992. This paper reports on 2281 completed questionnaires. RESULTS. Half the pensioners reported that they had lost 5 or more kilograms in the prior 6 months; 57% did not have enough money to buy food, and 39% needed medicines they could not afford. Forty percent consumed less than a half kilogram of meat, 50% consumed less than a half kilogram of fruit, a third consumed less than a liter of milk, and a third consumed less than 2 kg of bread per week. Weight loss was strongly associated with not having enough money to buy food, and inability to afford medication, and consumption of fewer than three meals a day. Concurrent with these conditions, there was a large increase in mortality in Russia. CONCLUSIONS. The results of these surveys suggest that many elderly pensioners were experiencing severe nutritional deprivation in the latter half of 1992.
Separation between HIV-positive women and their children: the French prospective study, 1986 through 1993.
Authors: Blanche S , Mayaux M J , Veber F , Landreau A , Courpotin C , Vilmer E , Ciraru-Vigneron N , Flock C , Tricoire J , Noseda G , Retbi J M , Rouzioux C
Published: November 2008

OBJECTIVES. We studied the risk and circumstances of separation (due to either maternal death or drug use) between women infected by human immunodeficiency virus (HIV) type 1 and their children. METHODS. This analysis was based on the French Prospective Study of Infants Born to HIV-seropositive Women (1986 through 1993). Data recorded at each follow-up visit included the mother's effective presence with the child and the child's care after separation. RESULTS. A child's cumulative risk of long-term or permanent separation from his or her mother was 37% at 60 months. Maternal drug use was associated with an added risk during the child's first years (adjusted relative risk [RR]=3.4, 95% confidence interval [CI]=2.3, 5.0). The risk among drug users was even higher when the mother used injection drugs during pregnancy (adjusted RR=2.9, 95% CI=1.9, 4.3). Risk of early separation related to drug use tended to diminish since survey initiation. After separation, 57% of the children were placed through child welfare services and 43% were cared for by relatives. CONCLUSIONS. In the French Prospective Study, 2% to 3% of HIV-infected children were separated each year from their mothers as a result of the mothers death from acquired immunodeficiency syndrome (AIDS). Separations related to drug use have decreased over the years, and the family is becoming the most frequent carer after separation.
Long-term back problems and physical work exposures in the 1990 Ontario Health Survey.
Authors: Liira J P , Shannon H S , Chambers L W , Haines T A
Published: November 2008

OBJECTIVES. This study sought to provide data on the relationship of work exposures to long-term back problems in a population survey. METHODS. The Ontario Health Survey in 1990 used a representative population sample of the province. It included data on long-term back problems, occupational activity, and physical work exposures. The current study examined relationships between these variables. RESULTS. The prevalence of long-term back problems was 7.8% in working-age adults. It generally increased with age. Long-term back problems were more prevalent in blue-collar occupations and among those not working, as well as among people with less formal education, smokers, and those overweight. Physical work exposures--awkward working position, working with vibrating vehicles or equipment, and bending and lifting--were all associated with a greater risk of back problems. The number of simultaneous physical exposures was monotonically related to increased risk. CONCLUSIONS. Within the limitations of the data and assuming the relationship to be causal, about one quarter of the excess back pain morbidity in the working population could be explained by physical work exposures.
Switching Swiss enrollees from indemnity health insurance to managed care: the effect on health status and stisfaction with care.
Authors: Perneger T V , Etter J F , Rougemont A
Published: November 2008

OBJECTIVES. In 1992, most members of a Swiss indemnity health insurance plan were automatically transferred into a newly created managed care organization. This study examined whether this semivoluntary change affected enrollees' health status and satisfaction with care. METHODS. Three groups of enrollees were compared: 332 plan members who accepted the switch (managed care joiners); 186 plan members who opted to maintain indemnity coverage (non-joiners); and 296 persons continuosly enrolled in another indemnity plan (indemnity plan members). Health status, health related behaviors, and satisfaction with care received in the previous year were surveyed at baseline and 1 year later. RESULTS. Health status remained unchanged in all three groups. Smoking prevalence decreased among managed care joiners but remained constant in the other groups. Satisfaction with insurance coverage increased between baseline and follow-up in managed care joiners, but decreased in nonjoiners and indemnity plan members. The latter groups had higher satisfaction with health care, particularly with continuity of care. CONCLUSIONS. A semivoluntary switch from indemnity health insurance to managed care reduced satisfaction with health care but increased satisfaction with insurance coverage. There were no changes in self-perceived health status.
Access to war weapons and injury prevention activities among children in Croatia.
Authors: Kopjar B , Wiik J , Wickizer T M , Bulajic-Kopjar B , Mujki-Klaric A
Published: November 2008

To investigate the exposure of children in Croatia to war weapons, we surveyed random samples of children (n=986) aged 11 to 16 years and of parents (1469) of children aged 7 to 16 years in April 1994 in four war-affected districts in Croatia. The children's survey indicated that 57% of the boys and 36% of the girls had access to weapons at home, at some other place, or at both. Eighteen percent of the boys and 5% of the girls reported playing with weapons. The parents' survey showed that 68% of the households possessed weapons, with 19% of the children having access to weapons at home. Influenced by preliminary findings of these surveys, the Croatian government modified its national campaign (one partially supported by international aid) to prevent war-related injuries among children. This study demonstrates the feasibility of scientific evaluation of humanitarian aid programs.
Socioeconomic differentials in mortality risk among men screened for the Multiple Risk Factor Intervention Trial: II. Black men.
Authors: Smith G D , Wentworth D , Neaton J D , Stamler R , Stamler J
Published: November 2008

OBJECTIVES: This study examined socioeconomic differentials in risk of death from a number of causes in a large cohort of Black men in the United States. METHODS: For 20 224 Black men screened for the Multiple Risk Factor Intervention Trial between 1973 and 1975, data were collected on median family income of Black households in zip code of residence, age, cigarette smoking, blood pressure, serum cholesterol, previous heart attack, and drug treatment for diabetes. The 2937 deaths that occurred over the 16-year follow-up period were grouped into specific causes and related to median Black family income. RESULTS: There was an inverse association between age-adjusted all-cause mortality and median family income. There was no attenuation of this association over the follow-up period, and the association was similar for the 22 clinical centers carrying out the screening. The gradient was seen for most of the specific causes of death, although the strength of the association varied. Median income was markedly lower for the Black men screened than for the White men, but the relationship between income and all-cause mortality was similar. CONCLUSIONS: Socioeconomic position is an important determinant of mortality risk for Black men. Even though Blacks lived in areas with substantially lower median family income than Whites, the association of income with mortality was similar for Blacks and Whites.
Will uninsured people volunteer for voluntary health insurance? Experience from Washington State.
Authors: Diehr P , Madden C W , Cheadle A , Martin D P , Patrick D L , Skillman S
Published: November 2008

OBJECTIVES: In national and local discussions of health care reform, there is disagreement about whether a national health insurance plan should be mandatory or voluntary. This study describes characteristics of low- income people who were more likely or less likely to be covered by a voluntary plan. METHODS: Survey data were available from an evaluation of Washington State's Basic Health Plan, which offered subsidized health insurance to low-income residents. For those subjects who were eligible and uninsured at baseline, those who joined were compared with those who did not join on a variety of demographic and health-related characteristics. RESULTS: There were substantial differences between those who did and did not join the Basic Health Plan. Those who did not enroll were generally less well-off, with less education, lower income, and worse health. Many had never had health insurance. CONCLUSIONS: If health care reform results in a voluntary plan, additional measures may be needed to ensure that less advantaged citizens have adequate access to health care.
Changes in multiple sexual partnerships, HIV testing, and condom use among US heterosexuals 18 to 49 years of age, 1990 and 1992.
Authors: Choi K H , Catania J A
Published: November 2008

We compared data from two independent, representative samples of the US population to determine whether heterosexual adults 18 to 49 years of age modified their human immunodeficiency virus (HIV) risk behaviors between 1990/91 and 1992. We found little change in multiple sexual partnerships, having a risky partner, and HIV test seeking in the heterosexual population. Overall, consistent condom use significantly increased from 11% in 1990/91 to 20% in 1992, but this increase was limited to selected demographic groups. These results suggest a continuing need for HIV education among heterosexual adults.
The growth in the US uninsured population: trends in Hispanic subgroups, 1977 to 1992.
Authors: Berk M L , Albers L A , Schur C L
Published: November 2008

This paper presents trends in the growth in the US uninsured population, using cross-sectional national estimates from 1977, 1987, 1989, and 1992 and focusing specifically on coverage problems experienced by Hispanic Americans. An examination of the composition of uninsured persons added between 1977 and 1992 shows that almost 40% of the difference is accounted for by persons of Hispanic origin, with those of Mexican origin alone constituting 27%. In addition, the annual average rate of growth in the uninsured Hispanic population between 1977 and 1992 was 9.7%, compared with only 2.3% for the uninsured non-Hispanic population.
The estimated prevalence and incidence of HIV in 96 large US metropolitan areas.
Authors: Holmberg S D
Published: November 2008

OBJECTIVES: This study sought to estimate the size and direction of the human immunodeficiency virus (HIV) epidemic in US metropolitan statistical areas (MSAs) with populations greater than 500,000. METHODS: A "components model" from review of more than 350 documents, several large datasets, and information from 220 public health personnel was used. Data review focused on injection drug users, men who have sex with men, and high-risk heterosexual men and women. RESULTS: In the 96 MSAs, there are, broadly, an estimated 1.5 million injection drug users, 1.7 million gay and bisexual men, and 2.1 million at-risk heterosexuals, and, among them, an estimated 565,000 prevalent and 38,000 incident HIV infections. This implies about 700,000 prevalent and 41,000 new HIV infections yearly in the United States. Roughly half of all estimated new infections are occurring among injection drug users, most of them in northeastern cities, Miami, and San Juan. Gay and bisexual men still represent most prevalent HIV infections, although incidence--except in young and minority gay men--is much lower now than it was a decade ago. Relatively high prevalences of HIV in at-risk heterosexual persons in several cities indicate the potential for an increase in transmission among them. CONCLUSIONS: This review and synthesis outline the comparative epidemiology of HIV in major US cities and identify populations for interventions.
Viral infections in short-term injection drug users: the prevalence of the hepatitis C, hepatitis B, human immunodeficiency, and human T-lymphotropic viruses.
Authors: Garfein R S , Vlahov D , Galai N , Doherty M C , Nelson K E
Published: November 2008

OBJECTIVES: The purpose of this study was to estimate the prevalence and correlates of four blood-borne viral infections among illicit drug injectors with up to 6 years of injecting experience. METHODS: We analyzed data from 716 volunteers recruited in 1988 and 1989. Test results for hepatitis C virus (HCV), hepatitis B virus (HBV), human immunodeficiency virus, type 1 (HIV), and human T-lymphotropic virus types I and II (HTLV) were examined across six sequential cohorts defined by duration of drug injection. RESULTS: Overall, seroprevalence of HCV, HBV, HIV, and HTLV was 76.9%, 65.7%, 20.5% and 1.8%, respectively, and 64.7%, 49.8%, 13.9%, and 0.5%, respectively, among those who had injected for 1 year or less. Among the newest initiates, HCV and HBV were associated with injecting variables, and HIV was associated with sexual variables. CONCLUSIONS: The high rates of HCV, HBV, and HIV infections among short-term injectors emphasizes the need to target both parenteral and sexual risk reduction interventions early. Renewed efforts at primary prevention of substance abuse are indicated.
Clinical and prophylactic trials with assured new treatment for those at greater risk: I. A design proposal.
Authors: Finkelstein M O , Levin B , Robbins H
Published: November 2008

OBJECTIVES: The accepted sine qua non for estimating the difference in efficacy between a new and a standard treatment is a randomized controlled clinical trial. Yet in some situations it is either practically or ethically impossible to conduct such a trial. For example, patients who are desperately ill may decline to participate when they learn they may not receive the new treatment, especially when that treatment is readily available outside the experimental protocol. Likewise, in a prophylactic trial of a promising vaccine, recruitment of persons at greater risk may falter or fail. Our objective is to demonstrate that a rigorous comparison of treatments may still be attainable. METHODS: The features of a controlled clinical or prophylactic trial are reviewed from the perspectives of Food and Drug Administration regulations, ethical considerations, and practical problems. RESULTS: An explicit risk-based allocation method of design and analysis is proposed, one guaranteeing that all subjects at greater risk will receive the new treatment. CONCLUSIONS: Under certain conditions, a risk-based allocation trial can furnish consistent estimates of both standard and experimental treatment effects for those at greater risk while avoiding certain difficulties caused by randomized treatment allocation.
Differences in the misreporting of chronic conditions, by level of education: the effect on inequalities in prevalence rates.
Authors: Mackenbach J P , Looman C W , van der Meer J B
Published: November 2008

OBJECTIVES: Many studies of socio-economic inequalities in the prevalence of chronic conditions rely on self-reports. For chronic nonspecific lung disease, heart disease, and diabetes mellitus, we studied the effects of misreporting on variations in prevalence rates by respondents' level of education. METHODS: In 1991, a health interview survey was conducted in the southeastern Netherlands with 2867 respondents. Respondents' answers were compared with validated diagnostic questionnaires in the same survey and the diagnoses given by the respondents' general practitioners. RESULTS: Misreporting of chronic lung disease, heart disease, and diabetes may be extensive. Depending on the condition and the reference data used, the confirmation fractions ranged between .61 and .96 and the detection fractions between .13 and .93. Misreporting varied by level of education, and although various patterns were observed, the dominant pattern was that of more underreporting among less educated persons. The effects on prevalence rates were to underestimate differences by level of education to a sometimes considerable degree. CONCLUSIONS: Misreporting of chronic conditions differs by respondents' level of education. Health interview survey data underestimate socioeconomic inequalities in the prevalence of chronic conditions.
Tracking community sentinel events: breast cancer mortality and neighborhood risk for advanced-stage tumors in Denver.
Authors: Andres T L , Baron A E , Wright R A , Marine W M
Published: November 2008

OBJECTIVES: The incidence of related sentinel events--breast cancer mortality and neighborhood-specific morbidity for advanced stage at diagnosis--were calculated for women likely to use a community health center in Denver, Colo. METHODS: For the center's service area, neighborhoods (n = 37) were defined by program use. Mortality rates and proportional hazards regression models were estimated for 4189 breast cancer cases recorded between 1979 and 1990. Neighborhood-specific standard morbidity ratios of advanced-stage tumors were based on age-specific rates applied to the entire community. RESULTS: Service area residents were more likely to present with advanced tumors (odds ratio [OR] = 1.4; 95% [CI] = 1.2, 1.5). After adjustment, advanced-stage disease and socioeconomic-demographic status, but not race-ethnicity, contributed significantly to survival. Two neighborhoods (6.5% of the population at risk) with standard morbidity ratios of 2.1 (95% CI = 1.3, 3.4) and 1.7 (95% CI = 1.2, 2.5) accounted for 42% of the excess cases of advanced-stage tumors between 1986 and 1990. CONCLUSIONS: Neighborhood variation in advanced-stage cancer can serve as the basis for efforts to improve access to breast cancer screening.
Adjusting for multiple testing when reporting research results: the Bonferroni vs Holm methods.
Authors: Aickin M , Gensler H
Published: November 2008

Public health researchers are sometimes required to make adjustments for multiple testing in reporting their results, which reduces the apparent significance of effects and thus reduces statistical power. The Bonferroni procedure is the most widely recommended way of doing this, but another procedure, that of Holm, is uniformly better. Researchers may have neglected Holm's procedure because it has been framed in terms of hypothesis test rejection rather than in terms of P values. An adjustment to P values based on Holm's method is presented in order to promote the method's use in public health research.
Cuban epidemic neuropathy, 1991 to 1994: history repeats itself a century after the "amblyopia of the blockade".
Authors: Ordúñez-García P O , Nieto F J , Espinosa-Brito A D , Caballero B
Published: November 2008

The 1991 to 1994 epidemic of neuropathy in Cuba has been one of the more devastating in recent history, affecting more than 50,000 people throughout the entire country with clinical manifestations of optic and peripheral neuropathy. Although the causes are not entirely clear, it seems that a combination of acute nutritional deficiency and the toxic effects of tobacco and possibly other unidentified toxic substances is involved. The epidemic coincided with the acute worsening of the economic situation on the island following political changes in Eastern European countries and a tightening of the US economic embargo. This paper reviews reports of a strikingly similar epidemic known as the "Amblyopia of the Blockade," which occurred in Cuba almost a century ago when the island was undergoing a US naval blockade during the Cuban-Spanish-American war. It discusses the parallelism with the recent epidemic as well as the implications of this historical evidence to clarify further the ultimate causes of these epidemics.
The association between cesarean delivery and breast-feeding outcomes among Mexican women.
Authors: Pérez-Escamilla R , Maulén-Radovan I , Dewey K G
Published: November 2008

OBJECTIVES: This study examined the impact of cesarean section delivery on the initiation and duration of breast-feeding in the 1987 Mexican Demographic and Health Survey. METHODS: The subsample (n = 2517) was restricted to women whose delivery of their last-born children (aged 5 years and younger) was attended by a physician. Multivariate logistic regression was used to examine the association between cesarean section and likelihood of either not initiating breast-feeding or doing so for less than 1 month. Among women who breast-fed for 1 month or more, multivariate survival analysis was used to examine the relationship between cesarean section and breast-feeding duration. RESULTS: Cesarean section was a risk factor for not initiating breast-feeding (odds ratio [OR] = 0.64, 95% confidence interval [CI] = 0.50, 0.82) and for breast feeding for less than 1 month (OR = 0.58, 95% CI = 0.37, 0.91) but was unrelated to breast-feeding duration among women who breast-fed for 1 month or more (OR = 0.97, 95% CI = 0.86, 1.11). CONCLUSIONS: It is desirable to provide additional breast-feeding support during the early postpartum period to women who deliver via cesarean sections.
Risk factors for hazardous substance releases that result in injuries and evacuations: data from 9 states.
Authors: Hall H I , Haugh G S , Price-Green P A , Dhara V R , Kaye W E
Published: November 2008

This study was undertaken to determine risk factors associated with hazardous substance releases (at fixed facilities or during transport) that have public health consequences. Data from nine states with surveillance systems for such releases and their consequences were analyzed. Risk factors were determined for releases resulting in (1) injuries or (2) evacuations. Both outcomes were more likely to occur as a result of facility releases (odds ratio [OR] = 1.89, 95% confidence interval [CI] = 1.44, 2.47, for injuries; OR = 3.29, 95% CI = 2.28, 4.74, for evacuations). Releases of ammonia, chlorine, and acids resulted in injuries and evacuations more frequently than releases of other substances.
Liability for managed care decisions: the Employee Retirement Income Security Act (ERISA) and the uneven playing field.
Authors: Mariner W K
Published: November 2008

As managed care organizations expand their programs of quality assurance and physician evaluation, more medical malpractice lawsuits may be brought against managed care organizations on the ground that, like hospitals, they are legally responsible for negligent corporate acts that injure patients. However, the federal Employee Retirement Income Security Act (ERISA) shields managed care organizations from liability when they are part of an employee group health plan governed by ERISA. Unlike patients with other types of insurance, patients in ERISA health plans do not have a malpractice remedy for a managed care organization's negligence. A few federal appeals courts recently recognized that ERISA plans can be vicariously liable for their physicians' medical malpractice, but only if the physician is the plan's employee or agent. Yet ERISA still prohibits negligence claims against ERISA health plans for injuries resulting from denial of plan benefits, failure to use qualified physicians, utilization review, or improper plan administration. Current managed care operations do not neatly distinguish between administering benefits and controlling quality of care. Neither should the law. ERISA should be amended to provide employees with the same remedies that patients in non-ERISA plans enjoy.
The regionalization of perinatal care in Wales and Washington State.
Authors: Rosenblatt R A , Macfarlane A , Dawson A J , Cartlidge P H , Larson E H , Hart L G
Published: November 2008

OBJECTIVES. The purpose of this study was to compare perinatal regionalization and neonatal mortality in Wales and Washington State. METHODS. The 28 hospitals in Wales and the 80 hospitals in Washington State that offered maternity services and the 218,326 births that occurred in these hospitals in 1989 and 1990 were studied. Surveys were used to identify the neonatal technology and the referral policies of each hospital, and linked data from birth and death certificates were used to examine birthweight-specific neonatal mortality rates for all babies born in these hospitals. RESULTS. Welsh district general hospitals (broadly equivalent to Level II perinatal centers in the United States) have more sophisticated neonatal technology than their Washington State counterparts and appear less likely to refer small or preterm babies to regional or subregional centers. Neonatal mortality rates were quite similar in the two settings. CONCLUSIONS. Perinatal care in Wales appears to be less regionalized than in a similar region in the United States. The relative lack of perinatal regionalization in Wales may contribute to duplication and underutilization of expensive neonatal technologies. National health care systems do not, in and of themselves, lead to optimal regionalization of services.
Hospitalizations for injury in New Zealand: prior injury as a risk factor for assaultive injury.
Authors: Dowd M D , Langley J , Koepsell T , Soderberg R , Rivara F P
Published: November 2008

OBJECTIVES. This study sought to determine the degree to which injury hospitalization, especially for assaultive injury, is a risk for subsequent hospitalization due to assault. METHODS. A New Zealand hospitalization database was used to perform a retrospective cohort study. Exposure was defined as an injury hospitalization, stratified into assaultive and nonassaultive mechanisms. Hospitalizations for an assault during a 12-month follow-up period were measured. RESULTS. Individuals with a prior nonassaultive injury were 3.2 times more likely to be admitted for an assault than those with no injury admission (95% confidence interval [CI] = 2.7, 3.9). The relative risk associated with a prior assault was 39.5 (95% CI = 35.8, 43.5), and the subsequent admission rate did not vary significantly by sex, race, or marital or employment status. Among those readmitted for an assault, 70% were readmitted within 30 days of the initial hospitalization. CONCLUSIONS. Prior injury is a risk for serious assault, and the risk is even greater if the injury is due to assault. Risk of readmission for assault is largely independent of demographic factors and greatest within 30 days of the initial assault.
Persons with dual diagnoses of substance abuse and major mental illness: their excess costs of psychiatric care.
Authors: Dickey B , Azeni H
Published: November 2008

OBJECTIVES. This study examined the costs of psychiatric treatment for seriously mentally ill people with comorbid substance abuse as compared with mentally ill people not abusing substances. METHODS. Three different sources of data were used to construct client-level files to compare the patterns of care and expenditures of 16,395 psychiatrically disabled Medicaid beneficiaries with and without substance abuse: Massachusetts Medicaid paid claims; Department of Mental Health state hospital inpatient record files; and community support service client tracking files. RESULTS. Psychiatrically disabled substance abusers had psychiatric treatment costs that were almost 60% higher than those of nonabusers. Most of the cost difference was the result of more acute psychiatric inpatient treatment. CONCLUSIONS. Although the public health and financial costs of high rates of comorbidity are obvious, the solutions to these problems are not. Numerous bureaucratic and social obstacles must be overcome before programs for those with dual diagnoses can be tested for clinical effectiveness.
Alcohol consumption among the elderly in a general population, Erie County, New York.
Authors: Mirand A L , Welte J W
Published: November 2008

OBJECTIVES. Relatively few studies of drinking among the elderly have been completed despite the growing proportional representation of the elderly in the US population. This study sought to estimate the prevalence of and to observe whether active or health-oriented lifestyles are associated with heavy drinking among the elderly. METHODS. Random-digit dialing telephone interviews were conducted with 2325 Erie County, New York, general population residents aged 60 years or older. RESULTS. The prevalence of heavy drinking was 6%. Adjusted analyses showed positive associations between heavy drinking and being male, having suburban residency, and currently using cigarettes. Negative relationships were observed between heavy drinking and socioeconomic status, rural residency, and degree of health orientation. Age and level of active lifestyle were not significant contributors to the model. CONCLUSIONS. Of the studied variables, health orientation offers the greatest opportunity to address heavy drinking among the elderly.
Are smokers with alcohol disorders less likely to quit?
Authors: Breslau N , Peterson E , Schultz L , Andreski P , Chilcoat H
Published: November 2008

OBJECTIVES. This study examined the likelihood of smoking cessation in smokers with a prior history of alcoholism. METHODS. Data came from an epidemiologic study of 1007 young adults, randomly selected from those insured in a large health maintenance organization (HMO) in southeast Michigan. Cox proportional hazards models with time-dependent covariates were used to estimate the hazards ratios of quitting in smokers with current and past alcoholism, with smokers with no history of alcoholism as a reference. Sex, race, and education were controlled. RESULTS. Smokers with active alcoholism in the preceding year were 60% less likely to quit than were smokers with no history of alcoholism. In contrast, smokers whose alcoholism had remitted were at least as likely to quit as smokers with no history of alcoholism. Compared with persistent alcoholism, remission of alcoholism was associated with more than a threefold increase in the likelihood of subsequent smoking cessation. CONCLUSIONS. The findings suggest that discontinuation of alcoholism might increase the potential for successful smoking cessation.
Can physical activity minimize weight gain in women after smoking cessation?
Authors: Kawachi I , Troisi R J , Rotnitzky A G , Coakley E H , Colditz G A
Published: November 2008

OBJECTIVES. The purpose of this study was to examine prospectively whether exercise can modify weight gain after smoking cessation in women. METHODS. Data were analyzed from a 2-year follow-up period (1986-1988) in the Nurses' Health Study, an ongoing cohort of 121,700 US women aged 40 to 75 in 1986. RESULTS. The average weight gain over 2 years was 3.0 kg in the 1474 women who stopped smoking, and 0.6 kg among the 7832 women who continued smoking. Among women smoking 1 to 24 cigarettes per day, those who quit without changing their levels of exercise gained an average of 2.3 kg more (95% confidence interval [CI] = 1.9, 2.6) than women who continued smoking. Women who quit and increased exercise by between 8 to 16 MET-hours (the work metabolic rate divided by the resting metabolic rate) per week gained 1.8 kg (95% CI = 1.0, 2.5), and the excess weight gain was only 1.3 kg (95% CI = 0.7, 1.9) in women who increased exercise by more than 16 MET-hours per week. CONCLUSIONS. Smoking cessation is associated with a net excess weight gain of about 2.4 kg in middle-aged women. However, this weight gain is minimized if smoking cessation is accompanied by a moderate increase in the level of physical activity.
The role of employee flexible spending accounts in health care financing.
Authors: Schweitzer M , Asch D A
Published: November 2008

Employee flexible spending accounts for health care represent one component of the current health care financing system that merits serious reform. These accounts create a system of undesirable incentives, force employees and employers to take complicated gambles, reduce tax revenues, and fail to meet their purported policy objectives. This paper describes shortcomings in these accounts from both a theoretical and an empirical perspective. Some proposed alternatives; including medical spending accounts and zero balance accounts, resolve many of these concerns but not all of them.