bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of particulate air pollution on asthmatics.
Authors: Perry G B , Chai H , Dickey D W , Jones R H , Kinsman R A , Morrill C G , Spector S L , Weiser P C
Published: November 2008

Twenty-four asthmatic subjects in Denver were followed from January through March 1979, a three-month period in which Denver air pollution levels are generally high and variable. Dichotomous, virtual impactor samplers provided daily measurements (micrograms/m3) of inhaled particulate matter (total mass, sulfates, and nitrates) for coarse (2.5--15 micrograms in aerodynamic diameter) and fine fractions (less than 2.5 micrometers). Carbon monoxide, sulfur dioxide, ozone, temperature, and barometric pressure were also measured. Twice daily measurements of each subject's peak expiratory flow rates, use of as-needed aerosolized bronchodilators, and report of airways obstruction symptoms characteristic of asthma were tested for relationships to air pollutants using a random effects model across subjects. During the time actually observed, there were very few days in which high levels of suspended particulates were recorded. Of the environmental variables studied, only fine nitrates were associated with increased symptom reports and increased aerosolized bronchodilator usage.
The association of marijuana use with outcome of pregnancy.
Authors: Linn S , Schoenbaum S C , Monson R R , Rosner R , Stubblefield P C , Ryan K J
Published: November 2008

We analyzed interview and medical record data of 12,424 women to evaluate the relationship between marijuana usage and adverse outcomes of pregnancy. Low birthweight, short gestation, and major malformations occurred more often among offspring of marijuana users. When we used logistic regression to control for demographic characteristics, habits, and medical history data, these relationships were not statistically significant. The odds ratio for the occurrence of major malformations among marijuana users was 1.36, higher than odds ratios for other exogenous variables, and the 95 per cent confidence interval was 0.97-1.91. More data are needed to establish firmly or rule out an association between marijuana usage and major malformations. Until more information is available, women should be advised not to use marijuana during pregnancy.
Dental caries prevalence in children with a diet free of refined sugar.
Authors: Silverstein S J , Knapp J F , Kircos L , Edwards H
Published: November 2008

A study of the caries and dental hygiene status of 73 children living in the Synanon community revealed a mean DMF-S score at 0.53 for the 5-10 year old group and 3.33 for the 11-17 year old group. In spite of poor oral hygiene, 53 per cent of the children were caries-free and none of the children was missing permanent teeth. The children had consumed a diet free of refined carbohydrates for five years and had received optimal fluoride supplementation since birth or joining Synanon.
Prescribed medicines: findings from the National Medical Care Expenditure Survey.
Authors: Rossiter L F
Published: November 2008

In 1977 the National Center for Health Services Research, US Department of Health and Human Services, undertook a survey of 40,000 individuals in the United States, soliciting information on expenditures and sources of payment for health services including prescribed medicines. Differences in the use of prescribed medicines by age, sex, ethnic/racial background, family income, and perceived health status were found across and within therapeutic categories. More than one-fifth of expenditures were for cardiovascular-renal agents. Sources of payment were similar in all but a few therapeutic categories.
Breast self-examination competency: an analysis of self-reported practice and associated characteristics.
Authors: Celentano D D , Holtzman D
Published: November 2008

Of 308 Baltimore, Maryland women surveyed by telephone, 76.3 per cent reported having performed breast self-examination (BSE) during the last year, with only 35 per cent reporting monthly BSE. Four BSE ability scores showed that most women had little knowledge of the proper BSE technique. Utilization factors, socioeconomic status, and knowledge/attitude about cancer were not related to BSE competency. Higher BSE competency scores were related to performing BSE at the recommended interval, having been taught the procedure by a health professional, and perceived confidence in BSE practice were also related to proper performance.
Lead concentrations in inner-city soils as a factor in the child lead problem.
Authors: Mielke H W , Anderson J C , Berry K J , Mielke P W , Chaney R L , Leech M
Published: November 2008

Soil samples were randomly collected from 422 vegetable gardens in a study area centered in downtown Baltimore, Maryland, and having a radius of 48.28 km (30 miles). The levels of lead, four other metals (cadmium, copper, nickel, and zinc), and pH were measured for each location. The application of multi-response permutation procedures, which are compatible with mapping techniques, reveals that lead (as well as cadmium, copper, nickel, and zinc) is concentrated and ubiquitous within the soils of the inner-city area of Metropolitan Baltimore. The probability values that the concentration of metals occurred by chance alone vary from about 10(-15) to 10(-23) depending on the metal considered. Our findings pose environmental and public health issues, especially to children living within the inner-city.
Variations in minimum licensing age and fatal motor vehicle crashes.
Authors: Williams A F , Karpf R S , Zador P L
Published: November 2008

The effect of differences in the legal minimum licensing age on fatal motor vehicle crashes was studied in New Jersey (age 17), Massachusetts (age 16 1/2), and Connecticut (age 16). New Jersey's 17-year-old licensing law was associated with greatly reduced fatal crash involvement. It is estimated that 65 to 85 per cent reductions in 16 year-old-driver fatal crash involvement can be expected if the licensing age is increased from 16 to 17 without increasing fatal crash rates at older ages.
Underrecording of Infant Homicide in the United States
Authors: Jason Janine , Carpenter Mary M. , Tyler Carl W.
Published: November 2008

Homicide rates for infants dropped suddenly between 1967 and 1969. The abrupt nature of this decline suggested the change was artifactual. Investigation suggests that two classification revisions instituted at this time were causes of this decline: changes in related codes set forth in the Eighth Revision of the International Classification of Diseases, Adapted, and revision of the standard certificate of death in 1968. Infant homicides may have been disproportionately underrecorded after 1968. (Am J Public Health 1983; 73:195-197.)
Contamination of the food chain by polychlorinated biphenyls from a broken transformer.
Authors: Drotman D P , Baxter P J , Liddle J A , Brokopp C D , Skinner M D
Published: November 2008

In 1979, widespread distribution of chicken and egg food products and grease contaminated with polychlorinated biphenyl (PCBs) occurred across the United States and as far away as Canada and Japan. The contamination was traced to an accidental leakage of PCBs from a transformer stored in a hog slaughtering plant in Montana. Breast milk analyses showed the PCB absorption had occurred among egg consumers. The episode illustrates the need for heightened vigilance over the fate of PCBs still in use.
Prevalence and correlates of passive smoking.
Authors: Friedman G D , Petitti D B , Bawol R D
Published: November 2008

The duration per week of exposure to others' tobacco smoke in different locations was tabulated from the questionnaire responses of 37,881 non-smokers and ex-smokers who received multiphasic health checkups in 1979 and 1980. Altogether 63.3 per cent of subjects reported some exposure, 34.5 per cent were exposed at least 10 hours per week, and 15.9 per cent at least 40 hours per week. Duration of exposure per week was weakly correlated with serum thiocyanate level in a small test group. Exposure was strongly related to age with a peak of 78.2 per cent in the twenties decade and an accelerating decline thereafter to 13.9 per cent in those age 80 and over. Sex and race were related to passive smoking only to a relatively small degree. Persons reporting longer exposures were more apt to report greater use of alcohol and marijuana, exposure to occupational hazards, and being currently not married. Lack of college education was most frequent among those denying exposure but was directly related to exposure duration among those reporting some passive smoking. Studies of the health effects of passive smoking should take into account these associated factors. Although the reported passive smoking of married persons was strongly related to their spouses' habits, categorization by spouses' smoking resulted in considerable misclassification.
Beyond the statistics of adolescent smoking.
Authors: Eckert P
Published: November 2008

Statistical studies can identify the demographic characteristics of the adolescent smoking population but cannot reveal how clusters of demographic categories combine in the culture of the community to form salient social categories, or how social processes link these categories to smoking and smoking-related behavior. Because smoking and smoking-related behavior function as a key social symbol, anti-smoking campaigns that are based on an inaccurate understanding of the social context in which smoking occurs can reinforce this behavior. Participant observation in a suburban high school suggests that adolescents begin smoking as part of a complex symbolic process growing out of the process of social differentiation between future members of the working class on the one hand and the middle class on the other. It points out inadequacies in two existing anti-smoking programs in the schools that result from ignoring the social dynamics of smoking.
Traveler's diarrhea at sea: two multi-pathogen outbreaks caused by food eaten on shore visits.
Authors: Berkelman R L , Cohen M L , Yashuk J , Barrett T , Wells J G , Blake P A
Published: November 2008

In 1976 and 1981, two outbreaks of gastrointestinal illness aboard cruise ships occurred within 24 hours following onshore visits to Haiti and Mexico, respectively. Three hundred eighty-six of 600 (64 per cent) and 98 of 260 (38 per cent) passengers became ill following luncheons in Port-au-Prince, Haiti, and Cozumel, Mexico. No increase in illness was observed among those passengers who did not attend the onshore luncheons. In both outbreaks, unrefrigerated seafood dishes served at outdoor buffets were epidemiologically incriminated as the vehicles of transmission. Several species of Vibrion, Salmonella, and toxigenic Escherichia coli were recovered from stool specimens of ill passengers in both outbreaks. In addition, invasive Escherichia coli and Shigella were isolated from stool specimens of ill passengers who ate at the Haitian buffet. Previous investigations of outbreaks of gastrointestinal illness aboard cruise ships have implicated exposures on board as the source and have involved only a single pathogen.
Patterns of vitamin C intake from food and supplements: survey of an adult population in Alameda County, California.
Authors: Shapiro L R , Samuels S , Breslow L , Camacho T
Published: November 2008

Use of vitamin C in food and pills and its association with health habits and health status were investigated in a random sample of 3,119 adults in Alameda County, California. Vitamin C intakes of nearly 80 per cent of respondents met or exceeded Recommended Daily Dietary Allowances. Fourteen per cent or fewer appeared to have inadequate vitamin C intake. Vitamin C supplements were taken daily by 29 per cent, occasionally by 21 per cent. Most respondents obtained 100 mg or less of vitamin C daily; 2 per cent had more than 2000 mg. Proportionately, more women than men took vitamin C pills daily. Men aged 16 to 44 were the most likely to have neither vitamin C foods nor pills. Persons 45 years and older tended to take vitamin C pills daily, younger persons to take them occasionally. Respondents who did not eat breakfast or who smoked cigarettes had lower vitamin C intakes. People in poor health took more vitamin C than those in good health. Health status may have influenced vitamin C intake rather than vitamin C intake influencing health status.
Does perception of life expectancy reflect health knowledge?
Authors: Hamermesh D S , Hamermesh F W
Published: November 2008

Analysis of original survey data shows White male smokers estimate their longevity as four years less than that of nonsmokers, roughly the actuarial difference. Those who do not exercise perceive the same life expectancy as those who exercise, somewhat inconsistent with available information on mortality. Men with long-lived parents and grandparents expect to live 12-18 years longer than those with short-lived forebears, far longer than studies of actual longevity imply. Men who are more than 15 per cent overweight expect to live four years less, a larger impact than the published actuarial difference.
Knowledge and attitudes of primary health care personnel concerning mental health problems in developing countries.
Authors: Ignacio L L , de Arango M V , Baltazar J , Busnello E D , Climent C E , Elhakim A , Farb M , Guèye M , Harding T W , Ibrahim H H , Murthy R S , Wig N N
Published: November 2008

A semi-structured interview for assessing the knowledge and attitude of health workers concerning mental health problems was applied in seven developing country areas within the context of a World Health Organization coordinated collaborative study. The results indicate a lack of basic mental health training associated with a failure to recognize mental health problems, restricted knowledge concerning psychotropic drug therapy, and an inability to visualize practical forms of mental health care which could be introduced at primary care level. The results were used to design appropriate training programs, and the observations will be repeated to assess the effectiveness of training.
Effects of birth rank, maternal age, birth interval, and sibship size on infant and child mortality: evidence from 18th and 19th century reproductive histories.
Authors: Knodel J , Hermalin A I
Published: November 2008

There has been long-standing interest in the effects of maternal age, birth rank, and birth spacing on infant and child mortality. Contradictory inferences about the role of these factors have arisen on occasion because of the absence of adequate controls, the use of cross-sectional or incomplete reproductive histories, and inattention to the effect of family size goals and birth limitation practices. This study analyzes completed reproductive histories for German village populations in the 18th and 19th centuries, a period when deliberate fertility control was largely absent. Our results confirm previous studies of the association of infant mortality with maternal age, although in the present data these differentials are largely limited to neonatal mortality. They also confirm the importance of birth interval as a factor in infant mortality. Sibship size is positively related to infant mortality even when birth rank is controlled. However, once sibship size is controlled, there are no systematic differences in infant and child mortality by birth order. The mechanisms relating sibship size and mortality are explored.
Self-help smoking cessation and maintenance programs: a comparative study with 12-month follow-up by the American Lung Association.
Authors: Davis A L , Faust R , Ordentlich M
Published: November 2008

One thousand two hundred thirty seven smokers responding to lung association announcements in five geographic areas were randomly assigned to one of four groups and mailed American Lung Association materials: 1) leaflets (L); 2) leaflets plus maintenance manual (L + M); 3) cessation manual (C); and 4) cessation and maintenance manuals (C + M). Five telephone interviews over one year achieved a 95 per cent follow-up completion rate. Nonrespondents as well as exclusive cigar and pipe users were classified as smokers. Twenty per cent quit initially, with 5 per cent continually abstinent in (C + M) at 12 months vs 2 per cent in (L) (p less than .05). Nonsmoking prevalence rates (no tobacco smoking in the past month), on the other hand, gradually increased after six months; at 12 months those with the maintenance component, (L + M) and (C + M), had higher rates (18 per cent) than (L) (12 per cent) or (C) (15 per cent). Leaflets and manual alone were least cost effective. Rising nonsmoking prevalence rates observed in all groups suggest that successful attempts to quit increased over time and that a contributing factor might have been the follow-up method. Although achieving lower quit rates than methods requiring attendance at a course, the self-help intervention has the advantages of greater availability, flexibility, and in some instances lower cost.
Thermotolerant non-fecal source Klebsiella pneumoniae: validity of the fecal coliform test in recreational waters.
Authors: Caplenas N R , Kanarek M S
Published: November 2008

Wisconsin pulp and paper mill processing plants were evaluated for fecal coliform and total Klebsiella (i.e., thermotolerant and thermointolerant) bacterial concentrations. Using the standard fecal coliform test, up to 90 per cent of non-fecal source thermotolerant K. pneumoniae was falsely identified as fecal source bacteria. Since there is a lack of specificity in the currently used standard for fecal coliform evaluation, a more reliable health risk assessment for fecal coliform bacteria is recommended.
Women and divorce: health insurance coverage, utilization, and health care expenditures.
Authors: Berk M L , Taylor A K
Published: November 2008

Estimates from the 1977 National Medical Care Expenditure Survey suggest that divorced women are twice as likely as married women to be uninsured, and also more likely to depend on Medicaid assistance. Divorced women use slightly more health services than married women, but also appear to have somewhat poorer health status.
Feeling bad: exploring sources of distress among pre-adolescent children.
Authors: Lewis C E , Siegel J M , Lewis M A
Published: November 2008

Previous studies of stress in childhood have used instruments containing items describing events/conditions thought by adults to be stressful for children. In interviews with 5th- and 6th-grade children, we asked them to describe circumstances that would make or had made them feel bad, nervous, or worried. After pretesting this children's list of items, we administered it to 2,480 5th graders. Subjects ranked how bad they would/did feel if each item happened and, also, how often each had occurred. Children also self-rated their mental health status. There were significant associations between children's ratings of mental health and "Feel Bad" scores. Girls rates most items significantly higher (more bad) than boys. While there were some sex and racial differences in ratings, the rank orders of items by different subgroups were highly correlated. Factor analysis revealed three dimensions, containing items related to: 1) anxieties surrounding conflict with parents; 2) self-image and peer-group relationship; and 3) geographic mobility. Only five or six of the 20 items represent discrete events (changing schools); the rest represent chronic role strains (being left out of a group, being pressured to get good grades). The consequences of these strains are yet to be determined.
The Edgecombe County High Blood Pressure Control Program: I. Correlates of uncontrolled hypertension at baseline.
Authors: Wagner E H , James S A , Beresford S A , Strogatz D S , Grimson R C , Kleinbaum D G , Williams C A , Cutchin L M , Ibrahim M A
Published: November 2008

To guide the planning of a multifacetted hypertension control program in Edgecombe County, North Carolina, a baseline survey of a stratified (by township) random sample of 1,000 households was conducted. All adults (greater than or equal to 18 years) were interviewed and had their blood pressures (BP) measured. Five hundred thirty-nine individuals, 27 per cent of the survey population, had diastolic BP greater than or equal to 90 mm Hg or were receiving anti-hypertensive drug therapy. The 539 hypertensives were divided into seven subgroups reflecting successive stages in the control of hypertension based on the awareness, treatment, and control of their hypertension. Unaware hypertensives were further subdivided into three groups according to the recency of their last BP check, and those aware but untreated were subdivided by whether they had previously received treatment. The seven subgroups of hypertensives were compared, separately for women and men, with respect to sociodemographic characteristics, health behaviors, and health status. In general, the progression from undetected hypertension to treatment and control appeared to be associated with being older, female, and White. This progression was further associated with greater educational levels and higher family incomes among women and increasing self-reported morbidity among men. The implications for intervention of these and other described associations are discussed.
Endemic Campylobacter jejuni infection in Colorado: identified risk factors.
Authors: Hopkins R S , Olmsted R , Istre G R
Published: November 2008

A study of persons with laboratory-confirmed sporadic Campylobacter jejuni infection and of controls matched for age and sex in Colorado in the summer of 1981 yielded odds ratio estimates significantly greater than 1 for the following risk factors: drinking raw water (10.74), drinking raw milk (6.93), eating undercooked chicken (2.77), and living in a household with a cat (3.21).
A prospective study of functional status among community elders.
Authors: Branch L G , Katz S , Kniepmann K , Papsidero J A
Published: November 2008

A six-year prospective study provides estimates of functional status (independent, dependent, nursing home resident, or deceased) according to age, gender, and previous functional status for Caucasian elders initially living in the community. Half the cohort had sustained independence for the six years; of those dependent at the beginning, one-fourth to one-third regained independent function within 15 months, and one-fifth regained self-sufficiency within five years.
Are body mass indices interchangeable in measuring obesity-disease associations?
Authors: Lee J , Kolonel L N
Published: November 2008

We examined data on body weight and height from 55 male and 26 female lung cancer cases and up to 10 sex-ethnicity-age matched controls per case from a large prospective cohort. All four body mass indices (W/H, W/H2, W/Hp) were highly intercorrelated. Conditional logistic regression, using each index as the exposure variable, yielded odds ratios for lung cancer with magnitude and dose-response gradient that were somewhat different among the four indices. These results suggest that the body mass indices are not necessarily interchangeable in measuring obesity-disease associations.
Intradermal immunization with human diploid cell rabies vaccine: serological and clinical responses of immunized persons to intradermal booster vaccination.
Authors: Burridge M J , Sumner J W , Baer G M
Published: November 2008

Rabies antibody titers ranged from 0-9.3 IU/mL in 117 human volunteers one year after intradermal vaccination with one or two doses of human diploid cell rabies vaccine (HDCV). At that time, each volunteer received one 0.1-mL booster dose of HDCV intradermally. All 117 volunteers showed good anamnestic responses, with antibody titers rising to 0.5-54.3 IU/mL within seven days of booster injection. Vaccine safety was good; only minor reactions were experienced, all of which resolved spontaneously.
Evaluation of the effects of the North Carolina Improved Pregnancy Outcome Project: implications for state-level decision-making.
Authors: Peoples M D , Grimson R C , Daughtry G L
Published: November 2008

This study was designed to assess the effects of the North Carolina Improved Pregnancy Outcome (IPO) Project on use of prenatal care and incidence of low birthweight among its primarily Black registrants . Weighted least squares and stratified analysis procedures were used to scrutinize vital statistics data for subpopulation effects. IPO services were received by 51.7 per cent of Black women in the counties served by the project. For all Black registrants , the risk of receiving less than adequate prenatal care was 55.1 per cent of that of the comparison group. For Black teenage registrants , the risk was even less: 37.2 per cent of that of the comparison group. Nevertheless, no corresponding effects on the incidence of low birthweight could be detected. The evaluation methods used in this study can be applied to programs for mothers and infants in other locales to generate useful and practical information for state-level decision-making.
An empiric study of ecological inference.
Authors: Connor M J , Gillings D
Published: November 2008

Aggregate-level (macro) data are sometimes used when examining health care issues. Although they may be more accessible than individual (micro) observations, their interpretation is subject to ecological bias which in most cases is not measurable. This paper examines the implications of using aggregate-level data by conducting two separate analyses (micro and macro). Using as a database hospital episodes of care for the North Carolina Medicare aged population, regression models are developed from an examination of geographic grouping effects to explore the impact of extended care services, skilled nursing facility, and home health agency care on acute care hospital days. Specific problems encountered are: variable definition, collinearity , variance reduction, dilution of effect, spurious correlation, and observation influence. Stronger collinear (correlation among independent variables) relations occur at the macro-level than at the micro-level and spurious macro-correlations result from model specification and definition of interaction effects.
Pitfalls in measuring the health status of Mexican Americans: comparative validity of the English and Spanish Sickness Impact Profile.
Authors: Deyo R A
Published: November 2008

We tested a Spanish translation of the Sickness Impact Profile (SIP) in a clinical study of low back pain, which included non-Hispanic patients (Group I), Mexican Americans who used the English SIP (Group II), and Mexican Americans who used the Spanish SIP (Group III). The reliability and clinical validity of responses by these three groups were compared. Internal consistency of responses by all three groups was excellent ( Cronbach 's alpha for the overall SIP = .93 - .95). When construct validity was tested by correlating SIP scores with several clinical measures of disease severity, however, important differences emerged. Group I responses appeared to be highly valid, while group III responses did not; Group II responses appeared reasonably valid, but intermediate between the other groups. These differences appear unlikely to be due to clinical differences, interviewing, or translational problems and seem to parallel the groups' levels of "acculturation." It may be that certain aspects of acculturation, including familiarity with questionnaire research, critically affect the validity of responses to this questionnaire.
Patterns of drug use from adolescence to young adulthood: III. Predictors of progression.
Authors: Yamaguchi K , Kandel D B
Published: November 2008

Possible linkages of influence among classes of drugs in the observed sequential progression from adolescence to young adulthood are investigated through event history analyses. Three stages are examined: initiation to marijuana, to the use of other illicit drugs, and to prescribed psychoactive drugs. The data are based on a follow-up cohort of former adolescents representative of high school students in grade 10 and 11 in New York State who were reinterviewed nine years later at ages 24-25. The sequential order between alcohol and/or cigarettes and marijuana reflects not only the effect of the use of legal drugs on marijuana initiation, but also age effects on onset of these drugs, controlling for individual characteristics measured in adolescence; marijuana use by one's friends in adolescence is an additional important predictor of marijuana initiation. Prior use of marijuana is necessary for progression to other illicit drugs. Multiple factors are involved in the progression to prescribed drugs, with adolescent depressive symptomatology and use of other illicit drugs important for both sexes, and maternal use of psychoactive drugs, dropping out of school, and prior use of marijuana of additional importance for women. Although licit drugs influence initiation into marijuana independently of age effects, it is especially for the progression from marijuana to other illicit drugs that the earlier drug is associated with the progression to a higher stage drug.
Foreign medical graduates in the 1980s: trends in specialization.
Authors: Mick S S , Worobey J L
Published: November 2008

Secondary analysis of data collected by the American Medical Association and the Graduate Medical Education National Advisory Committee (GMENAC) suggests that measures to diminish the flow of alien Foreign Medical Graduates (FMGs) into the United States have been less effective than planned. Declining trends in the proportion of FMG house officers in the mid- to late-1970s have recently stabilized around 19 per cent. There has also been a dramatic increase in the number of US citizen Foreign Medical Graduates ( USFMGs ) in house officer positions. A pattern of alien FMG and USFMG house officer specialization correlates with specialties designated by the GMENAC as shortage areas by 1990 (r = -.49, p less than .05). Despite the GMENAC prediction of a surplus of physicians by 1990, differential selection of alien FMGs and USFMGs into shortage specialties may assure their substantial future presence in the US health care system.
Formaldehyde vapor in mobile homes: a cross sectional survey of concentrations and irritant effects.
Authors: Hanrahan L P , Dally K A , Anderson H A , Kanarek M S , Rankin J
Published: November 2008

Sixty-five Wisconsin mobile home households volunteered for an assessment of indoor formaldehyde gas. Sixty-one teenage and adult occupants completed health questionnaires. Formaldehyde concentrations ranged from less than 0.10 to 0.80 ppm, with the risk of ocular discomfort showing a positive dose-response relationship.
Consensus methods: characteristics and guidelines for use.
Authors: Fink A , Kosecoff J , Chassin M , Brook R H
Published: November 2008

Consensus methods are being used increasingly to solve problems in medicine and health. Their main purpose is to define levels of agreement on controversial subjects. Advocates suggest that, when properly employed, consensus strategies can create structured environments in which experts are given the best available information, allowing their solutions to problems to be more justifiable and credible than otherwise. This paper surveys the characteristics of several major methods (Delphi, Nominal Group, and models developed by the National Institutes of Health and Glaser) and provides guidelines for those who want to use the techniques. Among the concerns these guidelines address are selecting problems, choosing members for consensus panels, specifying acceptable levels of agreement, properly using empirical data, obtaining professional and political support, and disseminating results.
Infant formula promotion and infant-feeding practices, Bicol region, Philippines.
Authors: Griffin C C , Popkin B M , Spicer D S
Published: November 2008

A 1978 household survey and a 1981 survey of stores and health facilities document the availability of breast milk substitutes, promotion of infant food and formula through the medical sector, and the effects of such promotion on the infant-feeding practices of mothers in the Bicol region of the Philippines. Breast milk substitutes were universally available in the region. Infant food and formula companies were active in the modern medical sector with promotional efforts that included distributing free formula samples, providing pamphlets and posters, and organizing professional meetings. Industry activities had mixed effects on health professionals' knowledge of breast-feeding and attitudes towards the practice. Activities of multinationals tended not to affect mothers' breast-feeding behavior directly but increased the probability of their introducing breast milk substitutes within the first six months, and thus in practicing a program of mixed feeding.
Emergency CPR instruction via telephone.
Authors: Eisenberg M S , Hallstrom A P , Carter W B , Cummins R O , Bergner L , Pierce J
Published: November 2008

We initiated a program of telephone CPR (cardiopulmonary resuscitation) instruction provided by emergency dispatchers to increase the percentage of bystander-initiated CPR for out-of-hospital cardiac arrest. Cardiac arrests in King County, Washington were studied for 20 months before and after the telephone CPR program began. Bystander-initiated CPR increased from 86 of 191 (45 per cent) cardiac arrests before the program to 143 of 255 (56 per cent) cardiac arrests after the program. During the after period, 58 patients received CPR as a result of telephone instruction, 12 of whom were discharged. We estimate that four lives may have been saved by the program. A review of hospital records revealed no excess morbidity in the group of patients receiving dispatcher-assisted CPR.
The teaching of occupational health in United States medical schools: five-year follow-up of an initial survey.
Authors: Levy B S
Published: November 2008

A survey of 111 of the 127 United States medical schools revealed that 73 (66 per cent) specifically taught occupational health during the 1982-83 academic year, compared to 50 per cent in 1977-78. Occupational health was a required part of the curriculum in 54 per cent of the schools compared to 30 per cent in 1977-78. However, the median required curriculum time for occupational health was four hours during both academic years. Increased attention needs to be given to occupational health in medical school curricula.
Non-fatal suicidal and life-threatening behavior among 13- to 17-year old adolescents seeking emergency medical care.
Authors: Deykin E Y , Perlow R , McNamarra J
Published: November 2008

In suicidal behavior emergency room admissions of 13- to 17-year olds at the Brockton Hospital (Massachusetts), females predominated over males by almost two to one. For subclassification of life-threatening behaviors, frequency was about the same for males and females, but for suicide attempts and suicide gestures, female frequency was two to four times that of males. Repeat episodes of self-inflicted injury were more common among females. The type of the initial episode was a powerful predictor of a repeat occurrence.
Public health nursing: in sickness or in health?
Authors: Buhler-Wilkerson K
Published: November 2008

Public health nursing began in the United States as a small undertaking in which a few wealthy women hired one or two nurses to visit the sick poor in their homes. By 1910, the work of these nurses had expanded to include a variety of preventive programs. While most preventive programs originated with voluntary organizations, such as the visiting nurse societies, they were eventually taken over either by boards of education or health departments. As a consequence of the new division that resulted, sick nursing would increasingly become the sole domain of the voluntary organizations, while the teaching of prevention would become the responsibility of public agencies. By examining the history of public health nursing between 1900-30, this article considers why a movement that might have been significant in delivering comprehensive health care to the American public failed to reach its potential.
Edentulism and oral health problems among elderly rural Iowans: the Iowa 65+ rural health study.
Authors: Hunt R J , Beck J D , Lemke J H , Kohout F J , Wallace R B
Published: November 2008

A household health interview survey of 3,673 noninstitutionalized people aged 65 and over in two rural Iowa counties included questions about loss of teeth, use of dentures, and presence of oral health problems. Edentulism rates were 10-15 per cent lower than those found a decade earlier in national health surveys. A log-linear analysis found that the best demographic predictors of edentulism were education, age, and marital status. Spouses tended to be of similar dentition status, i.e., both edentulous or both dentate. No association was found between the loss of teeth and prevalence of digestive problems. Only 7 per cent of the edentulous people felt they needed to visit a dentist, even though 70 per cent had not seen one for over five years. About 40 per cent had dentures that were over 20 years old, with half of these being over 30 years old. Many dentures were loose and causing soreness in the mouth or difficulty in eating. These elderly people appeared to expect some problems with dentures and oral pain and accepted them without feeling a need to seek treatment.
Incidence of hepatitis B in the penitentiary of New Mexico.
Authors: Hull H F , Lyons L H , Mann J M , Hadler S C , Steece R , Skeels M R
Published: November 2008

A study was conducted to determine the incidence of hepatitis B (HB) in a prison population. Forty-seven per cent of 455 male prisoners had evidence of past HB infection. HB seropositivity was most strongly correlated with: 1) a history of IV drug abuse; 2) age; 3) total time in any prison; and 4) race. During a one-year study period there were no clinical cases of HB in the prison and the seroconversion rate was 0.8 per cent among prisoners still incarcerated.
Physician use by the elderly over an eight-year period.
Authors: Mossey J M , Shapiro E
Published: November 2008

Investigation of ambulatory use of physicians by older persons over an eight-year period reveals that 60 per cent visited physicians with similar frequency for six or more years; 22 per cent regularly made two or less visits and 14 per cent made seven or more visits each year. Analyses reveal cohort effects rather than age effects to be of primary importance in determining an individual's regular pattern of physician use.
Firearm-related fatalities: an epidemiologic assessment of violent death.
Authors: Alexander G R , Massey R M , Gibbs T , Altekruse J M
Published: November 2008

This study examines 1970-78 South Carolina firearm fatalities utilizing vital record data. During this period, 5,808 firearm deaths, classified as accident, homicide, suicide, or undetermined, were reported with an average annual fatality rate of 23.35 deaths per 100,000 estimated population. Firearm fatalities in South Carolina were the sixth leading cause of death in 1975 and accounted for 2.9 per cent of all deaths to residents. A significant period decline in the firearm fatality rate was observed and was attributed mainly to decreases in the non-White rate. In 1978, the fatality rate for non-Whites (18.5) fell below the rate for Whites (19.1) for the first time in the years investigated. Firearm deaths represent a major community health problem and, as such, warrant attention and direct involvement by state and local health professionals.
Prescribing practices among nurse practitioners in adult and family health.
Authors: Batey M V , Holland J M
Published: November 2008

Data derived through log recordings of 89 nurse practitioners (NPs) in adult/family practice on 7,086 prescriptions issued during 890 clinical days were analyzed to describe prescribing practices of NPs who held prescriptive authority from the licensing regulatory boards of five western states. Results showed drug utilization to be similar to physician prescribing data, and intensity of prescribing to be less than that of physicians. The distributions of prescriptions by drug category and in relation to health problems underlying prescriptions are reported. Confidence with prescribing by type of drugs was parallel to incidence of prescriptions within drug category. Physician consultation prior to prescribing occurred with highest incidence for health problems treated with least frequently prescribed drugs. Physician consultation or referral was reported for 14.3 per cent of prescriptions.
Epidemiology of a tuberculosis outbreak in a South Carolina junior high school.
Authors: Sacks J J , Brenner E R , Breeden D C , Anders H M , Parker R L
Published: November 2008

A 13-year-old, female, seventh-grade student (the index patient) was found to have smear-positive, cavitary, pulmonary tuberculosis. Epidemiologic and contact investigation, involving skin testing over 900 people, revealed a 40 per cent tuberculin reactor rate for persons in the junior high school she attended compared to a 2 per cent rate for control schools. Repeat skin testing of initial non-reactors identified an additional 3 per cent of infected school children. School teachers showed a seven-fold increase in the prevalence of positive skin-test reactions following the outbreak. Tuberculin-reactor rates for seventh graders were substantially higher than for eighth graders. The more classes shared with the index patient, the higher the probability of being a reactor. Among students who shared no classes with the index patient, the highest rates of tuberculin reactions were found for those who had entered a classroom immediately after the index patient had left it. Evidence of transmission on the school bus and in the church choir was also suggested. Six secondary cases (three pulmonary) resulted from the outbreak. Identical phage types from the index and secondary patients suggest who had left school during the term proved useful in determining when transmission began. The index case was found to be a missed contact of a previously identified case of tuberculosis. Since household contacts are at high risk for developing active disease, there is a need for meticulous and complete investigation and preventive therapy for all such persons, especially children.
AIDS and sexual behavior reported by gay men in San Francisco.
Authors: McKusick L , Horstman W , Coates T J
Published: November 2008

In November 1983, we surveyed 655 gay men in San Francisco regarding their sexual practices during the previous month and the same month one year ago. The sample was selected to include men in situations that would lead to high risk of sexual activities related to AIDS (acquired immune deficiency syndrome) transmission (i.e., men frequenting bathhouses and gay bars) as well as men in low-risk situations (those going to neither place and men in primary relationships). The Bath group showed little change in frequency of bathhouse use and in number of sexual partners from that location. The other groups showed substantial reductions in frequency of sexual contacts from bars, baths, T-rooms, or parks. Men in monogamous relationships showed little change in sexual behavior within their relationship. Men in non-monogamous relationships and men not in relationships reported substantial reductions in high-risk sexual activity, but not a corresponding increase in low-risk sexual behavior. Knowledge of health guidelines was quite high, but this knowledge had no relation to sexual behavior. Using sex to release tension, use of sex to express gay identity, and knowledge of persons with AIDS in the advanced stages of disease were related to frequency and type of sexual behavior.
Bathtub-related drownings in the United States, 1979-81.
Authors: Budnick L D , Ross D A
Published: November 2008

We analyzed National Center for Health Statistics data on drownings in bathtubs and Consumer Product Safety Commission data on bathtub-related injuries for the years 1979-80 and 1979-81, respectively. Seven hundred ten persons drowned in bathtubs in 1979 and 1980, for a crude mortality rate of 1.6 per million persons per year. Although there was an excess of deaths in the spring, there was no important seasonal trend. Mortality rates in the Pacific and Mountain states were higher than in other states. Persons at the extremes of age were at greatest risk of death, with mortality rates of 5-6 per million per year. Black males aged 20-64 years had substantially elevated mortality rates compared to White males. The prevalence of personal risk indicators varied with age, with a frequent history of being left unattended among children less than 5 years old, a frequent history of seizures among persons 5-39 years old, a frequent history of alcohol or drug use among persons 40-59 years old, and frequent evidence of having fallen among those at least 60 years old. Bathtubs are potentially dangerous, and the prevention of drownings in them can be approached through a combination of passive and active strategies.
Cigarette smoking, herpes simplex virus type 2 infection, and cervical abnormalities.
Authors: Mayberry R M
Published: November 2008

In a case-control study, we investigated the relation of cigarette smoking and genital herpes virus infection to cervical abnormalities. Although cases and controls differed according to several factors, multiple logistic analyses indicated that age, education, and cigarette smoking were the only independent risk factors for histologically confirmed disease. Relative risk estimates were 1.92 and 3.68 for past and current smokers, respectively. The results indicated that smoking and genital herpes infection did not interact in the risk of cervical abnormality.
Public health aspects of mental health: the last 75 years of the American Journal of Public Health.
Authors: Williams C L , Westermeyer J
Published: November 2008

The American Journal of Public Health has reflected the relationship of public health to the field of mental health over its 75-year history. The earliest volumes of the Journal addressed movements and concerns within public mental health. Quantitative analysis of mental health articles shows wide fluctuations over the last 75 years, probably due to variations in federal funding for mental health research. Topical emphases in the Journal have included social issues and improved mental health, the contributions of epidemiological studies, and technological advances in prevention and treatment.
Referrals by traditional birth attendants in northeast Brazil.
Authors: Janowitz B , Wallace S , Araujo G , Araujo L
Published: November 2008

Between October 1980 and July 1981, 1,878 women were attended by traditional birth attendants (TBAs) at four obstetric units in rural areas surrounding the city of Fortaleza in Northeast Brazil. Of these women, 232 (12.4 per cent) were referred to a hospital in Fortaleza for delivery. The most important indicators for referral to hospital were: presence of an antenatal problem, complication of labor, or malpresentation. Based on record review, 65 referred women with none of these conditions were classified as low risk and 42 women not referred were classified as high risk (at least one such condition present). Of 1,878 deliveries, 32 (17 per 1,000) terminated as fetal deaths, and 12 infants died before discharge from hospital or obstetric unit (six per 1,000). The death rate was much higher for the high-risk cases (156 per 1,000 referrals, 95 for nonreferrals). Although some women may have been inappropriately referred while others who should have been were not referred, the system of referral has allowed TBAs to attend uncomplicated deliveries and to refer women with complications.