bluuebunny/crossref_metadata_2025 huggingface dataset:
The implementation of model standards in local health departments.
Authors: Weiler P , Boggess J , Eastman E , Pomer B
Published: November 2008

Four local health departments in California tested a process of state/local negotiations for the purpose of implementing model standards in community preventive health services. The standards, which covered five program areas, had been developed by a collaborative work group of representatives from the United States Conference of City Health Officers, the National Association of County Health Officials, the Association of State and Territorial Health Officials, the American Public Health Association, and the US Department of Health, Education, and Welfare. Evaluation of the project indicates that the success of the negotiation transactions and results varied, both among local health departments and program areas. A number of factors have been identified as influencing the negotiations, including the availability of baseline data, the extent to which individual programs are currently affected by required standards of performance, and health department attitude toward the project. The future utility of this model is considered within the broader context of changes now occurring in the financing and organization of public health within the United States. Project findings suggest that the Model Standards negotiations could provide state and local levels of government with a valuable management tool for determining health care priorities and generating objective programmatic data for budget justification.
Assessing methods for measuring compliance with a fat-controlled diet.
Authors: Hyman M D , Insull W , Palmer R H , O'Brien J , Gordon L , Levine B
Published: November 2008

This study assessed the relative validity of the following non-laboratory measures of compliance with a fat-controlled diet by hypercholesterolemic males: quantitative and qualitative measures of compliance derived from three-day food records and structured interviews, and summary ratings by nutritionists and interviewers. The quantitative measures of consumption referred to: saturated fat, linoleic acid, polyunsaturated fat, P/S ratio and cholesterol. The non-laboratory measures were assessed using the following two laboratory measures as criteria of validity: serum cholesterol concentration and the proportion of linoleic acid among the fatty acids of the serum cholesteryl esters. The results showed that, with respect to quantitative measures, the food record and interview manifested approximately equal validity, with the former marginally more valid. However, under certain conditions qualitative measures, such as patients' self-ratings, were about as valid as the more rigorous and expensive quantitative measures. Characteristics of the patient influenced the validity of the various measures. Validity was enhanced by the simultaneous use of certain combinations of measures.
A National Study on Professional Preparation in Patient Education
Authors: Pigg R. Morgan
Published: November 2008

During the 1980-81 academic year, 249 academic institutions were surveyed concerning professional preparation in patient education. Various degrees of involvement were reported by 39 institutions. Findings indicate that such programs are relatively new, and enrollment in degree programs and courses is limited. Placement of program graduates was termed excellent; especially in public hospitals, private hospitals, and clinics. Part-time teaching faculty are utilized extensively, while some faculty lack either formal preparation or clinical experience in patient education. (Am J Public Health 1982; 72:180-182.)
Induced abortion and spontaneous fetal loss in subsequent pregnancies.
Authors: Chung C S , Smith R G , Steinhoff P G , Mi M P
Published: November 2008

The effect of induced abortion on spontaneous pregnancy loss in subsequent pregnancies was studied based on 3,416 pairs of matched data in a follow-up investigation. Pregnancy outcome was examined also in relation to abortion procedure, gestation length at time of abortion, and number of previous abortions. In general there was no significant association between prior induced abortion and risks of pregnancy loss with the relative risks of 1.10, 0.88, and 0.81 for the first to third trimester respectively. A slight increase of first-trimester spontaneous loss was noted with the D&C/Suction procedure and early induced abortion (less than 9 weeks). The D&C procedure was associated with non-significant increase of second-trimester loss with the relative risk of 1.59.
Traditional and Emerging Forms of Dental Practice: Another View
Authors: Bailit Howard L.
Published: November 2008

Rovin and Nash suggest that alternate dental delivery systems are more competitive and will eventually capture a large share of the dental market presently held by traditional practices. The potential advantages of alternate delivery systems, mainly advertising and capitation payment, have not received careful evaluation. It is therefore premature to conclude that alternate delivery systems are structurally more competitive. (Am J Public Health 1982; 72:662-664.)
Pressures on the dental care system in the United States.
Authors: Wotman S , Goldman H
Published: November 2008

A number of significant pressures are creating tensions in the dental profession and the dental care delivery system. These pressures may be categorized in five major areas: 1) regulation and deregulation pressures involve changes in the state dental practice acts, court decisions concerning antitrust and advertising, and the inclusion of consumers on State professional regulatory boards; 2) cost of services includes factors involving the out-of-pocket cost of dental care and the growth of dental insurance; 3) dentist-related factors include the increased number of dentists and the indebtedness of dental graduates; 4) the pressures of changes in the American populations include the decline in population growth and the increase in proportion of elderly people; 5) changes in the distribution of dental care are based on new epidemiologic data concerning dental caries and progress in the prevention of periodontal disease. Many of these pressures are inducing competition in the dental care system. It is clear that the dental care system is in the process of change as it responds to these complex pressures.
Trends in utilization of prenatal cytogenetic diagnosis by New York State residents in 1979 and 1980.
Authors: Hook E B , Schreinemachers D M
Published: November 2008

It is estimated that 35.3 per cent of pregnant New York State women age 35 or over underwent cytogenetic diagnosis in 1980 as compared to 28.7 per cent in 1979. Rates varied sharply by county. In several small counties far from genetic centers, no 1980 cytogenetic diagnostic studies were reported in women 35 or over while in New York City the rate was 41 per cent. In one county with an active genetic center the rate appears to have plateaued at 30 per cent.
The relationship between hip fracture and water fluoridation: an analysis of national data.
Authors: Madans J , Kleinman J C , Cornoni-Huntley J
Published: November 2008

Data from the 1973-1977 National Health Interview Surveys were used to determine whether water fluoridation prevents hip fractures related to osteoporosis. No protective effect was found for fluoride levels of 0.7 ppm, the level recommended for the prevention of dental caries. There are some indications that higher concentrations of fluoride might have a protective effect for groups with a high incidence of osteoporosis. However, no determination of the actual levels needed or the possible adverse effects of high water fluoride levels could be made.
Alcohol Use and Cognitive Loss among Employed Men and Women
Authors: Parker Douglas A. , Parker Elizabeth S. , Brody Jacob A. , Schoenberg Ronald
Published: November 2008

A representative sample of 1,367 employed men and women in Detroit responded to questions about their drinking practices and then completed a cognitive test which measures abstraction abilities. Abstraction, tested while respondents were sober, decreased significantly as reported quantity of alcohol usually consumed per drinking occasion increased. (Am J Public Health 1983; 73:521-526.)
Four years' experience with home birth by licensed midwives in Arizona.
Authors: Sullivan D A , Beeman R
Published: November 2008

In 1978, Arizona began licensing lay midwives under regulations designed to maintain adequate standards of care for women desiring a home birth. During four years of this program, 3 per cent of home birth clients were hospitalized for complications and another 15 per cent received postnatal outpatient care, primarily for second degree lacerations. Five per cent of the newborns required medical care after delivery; half of these were hospitalized. Complications declined over the period due to increased experience, close supervision, and continuing education.
The Seattle evaluation of computerized drug profiles: effects on prescribing practices and resource use.
Authors: Koepsell T D , Gurtel A L , Diehr P H , Temkin N R , Helfand K H , Gleser M A , Tompkins R K
Published: November 2008

Since 1979, all outpatient pharmacy transactions at the US Public Health Service Hospital in Seattle have been captured in a computer system which generates a profile of each patient's active and previously used drugs. We conducted a controlled trial in which patients were allocated to profile or no-profile groups while the computer continued to collect data on everyone. In all, 41,572 clinic visits made by 6,186 patients were studied. The incidence of preventable drug-drug interactions and redundancies was very low and was unaffected by profiles. For unclear reasons, prescription of two interacting drugs on the same visit was significantly more common for patients with profiles. The duration of drug-drug interaction episodes was significantly shorter for profile group patients, perhaps due to earlier detection of the error on subsequent visits. Profiles had no effect on prescribing volume or coordination of drug refill and visit schedules, but profile group patients made about 5 per cent fewer clinic visits than those in the no-profile group. In this setting, it appears that the prescribing of interacting or redundant drugs is more often due to inadequate provider knowledge than to inaccessible patient-specific drug data. Prevention of such errors would thus require a more active educational or monitoring program.
Health expectancy in Canada, late 1970s: demographic, regional, and social dimensions.
Authors: Wilkins R , Adams O B
Published: November 2008

Based on estimates of activity restriction from the Canada Health Survey, institutional data on long-term care, and survival data from vital statistics, we have calculated an index of health expectancy (life expectancy in each state of health), and a summary of these indices which we have called quality-adjusted life expectancy. At birth, expected years of long-term institutionalization were 0.8 for men and 1.5 for women. Expected years of activity restriction not involving long-term institutionalization were 10.8 for men and 14.0 for women; 3.0 of the expected years of activity restriction for men and 1.3 of these years for women were in the most severe category of restriction (unable to do major activity). For both sexes together, quality-adjusted life expectancy was 1.4 years greater in Ontario and the Prairies than in the Atlantic region, 3.2 years greater in Canada's three largest cities than in rural areas and small towns, and 7.7 years greater among persons from high-income families than among persons from low-income families.
Perinatal outcomes among Medicaid recipients in California.
Authors: Norris F D , Williams R L
Published: November 2008

It is important to document the current status of health outcomes among the medically needy so as to establish baselines to gauge the impact of future program changes. We studied the birth characteristics and perinatal outcomes of women covered by Medicaid in California versus those who were not covered in 1968 and in 1978. Our findings show a high degree of equity and a trend of improvement in perinatal mortality among Medicaid beneficiaries. The results suggest that needy women who are not yet covered by public financing may have a greater risk of adverse pregnancy outcomes. It would thus seem prudent to carefully monitor the impact of any future reductions in public health care expenditures.
Factors associated with adolescent use of family planning clinics.
Authors: Shea J A , Herceg-Baron R , Furstenberg F F
Published: November 2008

Clinic records were reviewed for a sample of 498 adolescent family planning clients to document clinic use patterns. For a subsample of 359 adolescents, relationships are explored between clinic use and contraceptive use, demographic characteristics, social relationships, and contraceptive attitudes. The average adolescent was observed for 15 months and made 3.5 visits to the clinic. Twenty-two per cent of the adolescents never returned after an initial visit. Revisits tended to occur in three-month intervals. In the first six months, the probability of making the first revisit was .70; the probability of a second revisit was .45. Adolescents whose visit patterns deviated from the routine clinic protocols were more likely to be inconsistent contraceptive users. The single significant correlate of regular clinic use was the adolescents' satisfaction with their contraceptive methods. Service providers should ensure that adolescents select a suitable contraceptive method and closely follow adolescents whose clinic use patterns deviate from standard protocols.
Nurse-midwifery practice in the United States, 1982.
Authors: Adams C J
Published: November 2008

During 1982 the American College of Nurse-Midwives conducted a national survey of certified nurse-midwives residing in the United States. About 68 per cent of the 1,584 respondents (response rate 76 per cent) were practicing nurse-midwifery. Most of them were providing prenatal and family planning care. The 937 participants who were conducting deliveries reported that they conducted about 1.8 per cent of the estimated 3,704,000 deliveries which took place in the United States during 1982.
Social policy implications of physician shortage areas in Missouri.
Authors: Hicks L L
Published: November 2008

A model is used to identify counties in Missouri in which the supply of physician services is inadequate to serve the resident population. In the model, a formula is used to assess the gap between the physician services available in a county and the visits which would be required to serve the residents. Incorporated in the model are adjustments for the age and specialty of the physicians and the age and sex of the population. The model is applied to 1976 and 1981 data in order to analyze the changes which have occurred within the state during that time. The results show that in spite of a 34 per cent increase in the number of physicians practicing in Missouri between 1976 and 1981, 24 of the 115 counties in the state experienced a decrease in their ability to serve their resident populations adequately. Of these 24 counties, 23 had populations of less than 25,000 and 12 had populations of less than 10,000. A factor magnifying the underservice problem is the sharp increase in the proportion of older physicians located in small, rural counties. In 1981, 47 per cent of the primary care physicians located in counties with less than 10,000 people were aged 60 and over, compared to 34 per cent in 1976. This portends major problems in the future in obtaining replacements.
Practice characteristics of male and female physician assistants.
Authors: Oliver D R , Carter R D , Conboy J E
Published: November 2008

In a national survey of 3,294 non-military responding physician assistants, sociodemographic and practice characteristics of male and female physician assistants were compared. Differences by specialty, practice setting, size of community, and hours of work were generally similar in nature, but smaller in magnitude, than those reported for physicians, and may not be of practical significance.
Patient attitudes toward physician consent in epidemiologic research.
Authors: Boring C C , Brockman E , Causey N , Gregory H R , Greenberg R S
Published: November 2008

Attitudes of patients toward the necessity of physician consent in epidemiologic studies were assessed. Questionnaires were mailed to women with breast, endometrial and ovarian cancers who had previously participated in a personal interview study (N = 692). Of respondents (N = 514), only 2 per cent would have preferred their physician to have withheld approval, and half considered physician permission necessary. Thirty-five per cent reported that their doctor talked to them about the study prior to the interview. Implications of including physician consent in study protocols are discussed.
Utility of drug leaflets for elderly consumers.
Authors: Morris L A , Olins N J
Published: November 2008

A mail survey of 1,650 elderly consumers evaluated prescription drug leaflets for antihypertensives, tranquilizers, and arthritis medicines. Of those who said they received the leaflet, 95 per cent read it, 76 per cent kept it, and 56 per cent discussed it with another person. Respondents taking antihypertensive medicine were more apt to keep the leaflet and say they learned new information from it. Those taking tranquilizers were less likely to say the leaflet made them feel better about using the drug.
The dimensions of health outcomes: a cross-validated examination of health status measurement.
Authors: Brown J H , Kazis L E , Spitz P W , Gertman P , Fries J F , Meenan R F
Published: November 2008

Two independently developed patient outcome measurement instruments were administered to forty-eight subjects with rheumatoid arthritis using a random cross-over design. The independent estimates of physical disability and pain are highly correlated. Each instrument displayed highly significant relationships with global health, providing evidence for convergent validity. The results demonstrate that health status is composed of at least three major dimensions: physical disability, psychological disability, and pain.
Animal bites as an occupational hazard among animal control officers.
Authors: Mann J M , Rollag O J , Hull H F , Montes J M
Published: November 2008

One hundred-and-two full-time animal control officers (ACOs) in New Mexico were surveyed to learn about animal bite risks in this little-studied occupational group. The overall bite rate was 2.57 per working-year (175-500 times population-based rate estimates). A "high risk" ACO subset (seven officers involved in 67 per cent of bite incidents) was discovered. Evaluation of animal bite data can contribute to prevention of occupational injuries among the estimated 10,000 full-time ACOs in this country.
The young adult chronic psychiatric patient in an era of deinstitutionalization.
Authors: Bachrach L L
Published: November 2008

Assessments of the consequences of deinstitutionalization tend to focus primarily on observable changes in psychiatric services. Equally critical, and less often noted, are changes in the target population of deinstitutionalization that have accrued as the result of new service initiatives and changing loci of care. Young adult chronic psychiatric patients, a newly emerging service entity, throw into bold relief the problems associated with delivering care to a changing patient population.
Low-sodium, high-potassium diet: feasibility and acceptability in a normotensive population.
Authors: Jeffery R W , Pirie P L , Elmer P J , Bjornson-Benson W M , Mullenbach V A , Kurth C L , Johnson S L
Published: November 2008

Sixty-nine normotensive volunteers participated in an eight-week study to test the feasibility and acceptability of two low-sodium (less than 70 mEq), high-potassium (greater than 100 mEq) diets. The diet groups differed only in the use of KCl salt substitute. Both dietary groups were able to reduce sodium and increase potassium intake compared to the control group. Urine sodium excretion decreased in the diet groups but no change was observed in potassium. Potassium chloride salt substitute was not used as recommended, suggesting its unacceptability.
Peer pressure and risk-taking behaviors in children.
Authors: Lewis C E , Lewis M A
Published: November 2008

We asked 771 children in grades 5-8 about the dares or challenges they received from other children. A pilot study established categories for classification of the actions proposed ("What did they try to get you to do?"); the techniques utilized ("How did they try to get you to do that?"); and children's responses ("What did you say or do?"). Peer pressure was reported most frequently by 8th grade students. About 50 per cent of the dares encouraged problem behaviors that placed the children (or others) at risk for personal injury, or the potential development of habits hazardous to their health. With increasing age, more occurred in the school environment and fewer involved risk of personal injury. Among 7th and 8th graders, more boys were dared to perform acts of violence, and more girls were challenged to be sexually active.
Hospital-sponsored primary care: I. Organizational and financial effects.
Authors: Shortell S M , Wickizer T M , Wheeler J R
Published: November 2008

Findings are presented from a seven-year (1976-83) evaluation of the Community Hospital Program (CHP), a national demonstration program sponsored by the Robert Wood Johnson Foundation to assist 54 community hospitals in improving the organization of access to primary care. Upon grant expiration, 66 per cent of hospital-sponsored group practices continued under some form of hospital sponsorship; over 90 per cent developed or were planning to develop spin-off programs; and new physicians were recruited and retained in the community. About 9 per cent of hospital admissions were accounted for by group physicians and grantee hospitals experienced a greater annual increase in their market share of admissions than competing hospitals in the area. While only three of the groups generated sufficient revenue to cover expenses during the grant period, 21 additional groups broke even during the first post-grant year. Productivity and cost per visit compared favorably with most other forms of care. Hospitalization rates from the hospital-sponsored practices were somewhat lower than those for other forms of care. Medical director leadership and involvement and the organization design of the practice were among several key factors associated with higher performing practices. The ability of such joint hospital-physician ventures to meet the needs of the poor and elderly in a time of Medicare and Medicaid cutbacks is discussed along with suggestions for targeting future initiatives in primary care.
Playground equipment injuries in a large, urban school district.
Authors: Boyce W T , Sobolewski S , Sprunger L W , Schaefer C
Published: November 2008

We studied the epidemiologic features of playground equipment-related injuries occurring in a large, urban school district over a two-year period. Nurses in each of the district's 68 elementary schools completed self-coded reporting forms on all injuries meeting standardized criteria. A total of 511 equipment-related injuries were reported, an incidence of 8.9 injuries per 1,000 student-years. One-fourth of the injuries were severe, and climbing equipment was disproportionately represented among playground equipment associated with injuries. Extreme variability was found among school-specific rates of equipment injury, with schools at the two extremes separated by as much as a 40-fold difference in incidence. Two school characteristics--smaller student enrollments and the presence of alternative educational programs--were significantly associated with higher equipment-related injury rates.
The influence of client-provider relationships on teenage women's subsequent use of contraception.
Authors: Nathanson C A , Becker M H
Published: November 2008

This paper describes the relationships of selected dimensions of nurse-client interaction in county health department family planning clinics to the subsequent contraceptive use of the clinic's unmarried teenage clients. The subjects for the study are the clients and professional staff of 78 clinics: 2,900 eligible clients making their first contraceptive visit and 338 clinic staff nurses. Results of interviews demonstrate that client and staff expectations and interactions are significant predictors of adherence to a contraceptive regimen; under circumstances where clients anticipate, and staff employ, authoritative guidance in helping the clients to select a contraceptive method, clinic mean levels of contraceptive use are substantially increased. Overall, 40 per cent of clinic variation in contraceptive compliance is explained by the interaction dimensions and other aspects of clinic organization addressed in this paper. Implications of these results for the structuring of family planning clinic programs directed toward teenage women are briefly considered.
Delegation of expanded functions to dental assistants and hygienists.
Authors: Chapko M K , Milgrom P , Bergner M , Conrad D , Skalabrin N
Published: November 2008

One hundred and twenty-six dental offices in Washington State kept a record of each time an expanded function was performed by the dentist, hygienist, or assistant. There were five two-week recording periods starting in February 1979 and ending in February 1981. Consistent with increasing productivity, dentists most frequently delegate tasks to dental assistants rather than dental hygienists and delegate an individual task consistently if it is delegated at all. For tasks that may be delegated to the assistant, a relationship was found between the per cent of dentists delegating an individual task and the amount of the dentist's time that is freed through delegating that task. From the perspective of quality of care, the per cent of dentists who delegate a task was inversely related to the complexity of the task.
Serologic survey of rotavirus, Norwalk agent and Prototheca wickerhamii in wastewater workers.
Authors: Clark C S , Linnemann C C , Gartside P S , Phair J P , Blacklow N , Zeiss C R
Published: November 2008

Analysis of paired sera from 48 wastewater workers and controls who reported gastrointestinal illness did not reveal any excess of seroconversions to Norwalk agent or to rotavirus. Inexperienced wastewater-exposed workers had higher levels of antibody to Norwalk agent than did experienced and control workers and those with high and medium aerosol exposure had higher titres than those in the low aerosol category. Analysis for Prototheca antibody titres was essentially negative.
Coital and non-coital sexual behaviors of white and black adolescents.
Authors: Smith E A , Udry J R
Published: November 2008

As part of a longitudinal study of young adolescents, data were collected in 1980 on the non-coital and coital sexual experiences of male and female adolescents who ranged in age from 12 to 15 at the time of the initial contact. The follow-up data were collected two years later. Both a Guttman-scale analysis and a longitudinal analysis of these data indicate different sexual patterns between White and Black teens; Whites are more likely than Blacks to engage in a predictable series of non-coital behaviors for a period of time before their first intercourse experience. Of the sexual behaviors studied, the pre-coital experiences of Black teens were less predictable and often involved only necking. These differences in sexual norms offer a partial explanation for the different pregnancy rates between these two groups. They also suggest that sexual and contraceptive education and counseling need to be cognizant of these differences since pre-coital experience may function as both a mechanism to prolong abstinence and to promote a gradual acceptance of one's sexuality.
Physicians' beliefs about the importance of 25 health promoting behaviors.
Authors: Sobal J , Valente C M , Muncie H L , Levine D M , Deforge B R
Published: November 2008

A mail survey of 1,040 primary care physicians in Maryland examined their beliefs about the importance of 25 behaviors for promoting the health of the average person. Physician consensus existed across specialties in rating most health behaviors as very important and few as very unimportant. Eliminating smoking was most important and taking vitamin supplements least important.
A waterborne outbreak of hepatitis A in Meade County, Kentucky.
Authors: Bergeisen G H , Hinds M W , Skaggs J W
Published: November 2008

In November 1982, Meade County, Kentucky health officials noted a sudden increase in the incidence of hepatitis A. Using a standardized interview of 73 cases (68 serologically confirmed), and 85 controls (all negative for antibody to hepatitis A virus), the most important risk factor identified was household use of untreated water from a single spring. A dose-response relationship was found for consumption of unboiled spring water. Water samples taken from the spring during the outbreak were contaminated with fecal coliforms.
Patterns of site-specific displacement in cancer mortality among migrants: the Chinese in the United States.
Authors: King H , Li J Y , Locke F B , Pollack E S , Tu J T
Published: November 2008

Taking advantage of the information gathered for the 1975 National Mortality Survey in China, this paper compares the levels of cancer mortality among foreign-born and United States-born Chinese around 1970 with those of the communities of origin of the majority of Chinese migrants to the US. Age-adjusted rates indicate two distinctive site-specific patterns among US Chinese: a downward trend for cancers of high risk among Guangdong and Hong Kong Chinese (nasopharynx, esophagus, liver, uterus, and perhaps stomach) and an upward trend for those sites of low risk among Chinese in Guangdong and Hong Kong (colon, lung, leukemia, and female breast). Further field studies are needed with emphasis on the birthplace of migrants and environmental changes in host countries.
Medical examination of school entrants: later school problems and absenteeism of attenders and non-attenders.
Authors: Mowat D L , White C
Published: November 2008

Children who were scheduled for medical examination before entering school were followed in school one or two years later. Non-attenders had a two-fold risk of repeating grades, special class placement, referral for speech/language problems, teacher-reported learning or behavior problems, failure of vision or hearing screening, and transfer between schools. Absenteeism was also significantly more common. Children not brought in for preventive health care are at greater risk than others for difficulties in school.
Neurologic dysfunction from exposure to 2-t-butylazo-2-hydroxy-5-methylhexane (BHMH): a new occupational neuropathy.
Authors: Horan J M , Kurt T L , Landrigan P J , Melius J M , Singal M
Published: November 2008

Seven cases of subacute central and peripheral neurologic dysfunction developed in 18 workers employed in the manufacture of reinforced plastic bathtubs. Cases were characterized by weight loss, dizziness, paresthesias, muscle weakness, incontinence, memory loss, and loss of peripheral, color, and night vision. Neuropathies began distally, involved both sensory and motor function, and were associated with prolonged sensory latency, muscle fibrillation, and reduced numbers of functioning motor units. One patient developed posterior lenticular cataracts. Slow improvement occurred on removal from exposure, but residual neuropathies persisted for as long as two years. Epidemiologic investigation disclosed that the first case developed approximately two weeks after introduction of a new plastic foaming agent, 2-t-butylazo-2-hydroxy-5-methylhexane (BHMH). All cases occurred in workers exposed directly to BHMH. No new cases developed after use of BHMH was discontinued. A survey of the firm which produced BHMH and of 68 user firms found two additional clusters of mild neuropathy which may have been caused by BHMH. BHMH was withdrawn from distribution following discovery of these cases. Subsequently, BHMH has been shown in rats to be a potent neurotoxin. Adequate premarket testing could have averted this outbreak.
Psychoneuroses among Mexican Americans and other whites: prevalence and caseness.
Authors: Vega W A , Kolody B , Warheit G
Published: November 2008

This paper reports the findings from an epidemiological survey conducted in California using the Health Opinion Survey (HOS), a measure of psychoneuroticism, as well as other scales and inventories. Uncontrolled results indicate that Mexican Americans have higher symptom and case levels, but that these differences are found primarily among marginally acculturated and immigrant respondents. HOS caseness levels were 15.4 for Spanish-speaking Mexican Americans, 6.6 for English-speaking Mexican Americans, and 5.5 for other Whites. Joint effects of ethnicity for sex, age, education, and marital status were substantial, however there were differences in caseness between Spanish-speaking Mexican Americans, English-speaking Mexican Americans, and other Whites on four measures of psychological distress. The results indicate the importance of acculturation-related factors, including educational attainment, language preference, and nativity for predicting symptomatology among Mexican Americans.
An evaluation of subsidized rural primary care programs: IV. Impact of the rural hospital on clinic self-sufficiency.
Authors: McLaughlin C P , Ricketts T C , Freund D A , Sheps C G
Published: November 2008

Subsidized rural clinics and providers have long depended on the rural hospital for the care of some of their patients; the hospital has also been a source of revenue for these providers and programs. We studied a representative national sample of 116 subsidized rural clinics, focusing on the impact on rural clinic costs and revenues of the use of the hospital by the clinics' providers. Both clinic costs and revenue are reduced by the use of the hospital by rural practice providers, but costs are lowered to a greater extent than revenues, thereby enhancing the financial self-sufficiency of the subsidized clinic. The cost savings affect all aspects of clinic operation, but especially laboratory costs, community services costs, and administrative costs. The dependence of these rural clinics on the hospital indicates that the condition of subsidized rural clinics would be worsened by decreased availability of hospital services.
The immediate and subsequent outcomes of nursing home care.
Authors: Lewis M A , Kane R L , Cretin S , Clark V
Published: November 2008

To determine the relationship between admission status and subsequent outcomes, 563 patients discharged during 1980 from 24 nursing homes were followed through 1982. Only 28 per cent of patients were discharged to their homes. Reconstructed life histories of 529 discharges for the two-year follow-up revealed only 38 persons (7.2 per cent) were alive and at home; of these, 36 had been initially discharged to their homes. Four hundred and one persons (75.8 per cent) were dead. Mental orientation, urinary continence, functional status, hip fracture, and diagnoses associated with dementia were found to be significant predictors of outcome status after discharge and at follow-up. Social support had only a modest effect on the former outcomes.
Fragile X syndrome: a public health concern.
Authors: Trusler S , Beatty-DeSana J
Published: November 2008

This study was designed to test for the fragile X syndrome [fra(X)] in institutionalized male patients with nonspecific mental retardation, referral patients, and relatives of fra(X) patients. Thirty-one of 91 (34.0 per cent) subjects tested were positive for the fra(X) chromosome; relatives had the largest percentage of positives. The data reflect the value of this test for detecting families having potential carriers who can benefit from genetic counseling.
WIC prenatal participation and its relationship to newborn Medicaid costs in Missouri: a cost/benefit analysis.
Authors: Schramm W F
Published: November 2008

The primary purpose of this study was to determine if WIC prenatal participation is associated with a reduction in Medicaid costs within 30 days after birth, and, if so, whether the reduction in Medicaid costs is greater than the WIC costs for these women. This evaluation of WIC was performed using 7,628 Missouri Medicaid records matched with their corresponding 1980 birth records. This file was then divided into a WIC group containing 1,883 records and a non-WIC comparison group of 5,745 records. WIC participation was found to be associated with the reduction in Medicaid newborn costs of about $100 per participant (95 per cent confidence interval $43,153); mother's Medicaid costs were not affected. For every dollar spent on WIC, about 83 in Medicaid costs within 30 days of birth were apparently saved according to the results of this study (95 per cent confidence interval $.40, $1.30). Reductions in low birthweight rates and NICU admission rates among WIC infants provided two possible reasons for the reduced Medicaid costs associated with WIC food supplementation. As WIC food costs increased, both mean birthweight and newborn Medicaid savings also increased. Because of possible inconsistencies in the data, similar studies are needed in other states.
An exploration of somatization among Asian refugees and immigrants in primary care.
Authors: Lin E H , Carter W B , Kleinman A M
Published: November 2008

The clinical records of Chinese, Filipino, Vietnamese, Laotian, and Mien patients in primary care were reviewed to determine the prevalence of somatization, its associated patient characteristics, and the manifested illness behavior. Patients in this study were generally poor, unemployed, and spoke little English. Somatization accounted for 35 per cent of illness visits. These visits were also more costly. Refugees had a higher rate of somatization (42.7 per cent) than immigrants (27.1 per cent). Although sociodemographic characteristics did not strongly differentiate patients with somatization from others, ethnicity and indicators of decreased resources such as large households with low income, households headed by single women, or a limited English proficiency were associated with somatization in certain ethnic groups. Somatization is thus an important health problem among Asian refugees and immigrants.
Newborn screening for hemoglobinopathies: the benefit beyond the target.
Authors: Grover R , Newman S , Wethers D , Anyane-Yeboa K , Pass K
Published: November 2008

As a result of New York State's Newborn Screening Program 4,565 neonates with trait hemoglobinopathies were identified and 3,200 families were notified of the results of testing their infants in New York City in 1982. Of the 1,531 families (2,190 parents) tested and counseled, 22 parents were diagnosed with sickle cell disease and 39 couples were found to be at-risk for having a child with sickle cell disease. Amniocentesis was performed in 14 of the 28 at-risk pregnant women and three of the four affected pregnancies were terminated. MCH-331001-01 to 04
Trends in the hospitalization for acute childhood asthma, 1970-84.
Authors: Halfon N , Newacheck P W
Published: November 2008

Data from the 1970 through 1984 National Hospital Discharge Surveys indicate that the rate of hospitalization for children under 15 years old with asthma has increased at least 145 per cent while the average length of stay for children with asthma decreased by 26 per cent from 5 days in 1970 to 3.6 days in 1984. Over an analogous period (1970 to 1980), data from the National Health Interview Survey indicate that the prevalence of childhood asthma has increased by approximately 28 per cent for children 6 to 16 years of age. Several potential explanations for the hospital trend are discussed, including changes in the disease classification and information system, criteria for admission, organizational factors, changes in therapy, and changes in morbidity.
Ethnic differences in preterm and very preterm delivery.
Authors: Shiono P H , Klebanoff M A
Published: November 2008

Ethnic differences in preterm (less than 37 weeks) and very preterm (less than 33 weeks) delivery were evaluated in a prospective cohort of 28,330 women. Blacks had the highest rate of preterm and very preterm delivery, followed by Mexican-Americans, Asians, and Whites. Adjustment for maternal age, education, marital status, employment, parity, number of previous spontaneous or induced abortions, smoking and drinking during pregnancy, infant sex, and gestational age at initiation of prenatal care resulted in the following odds ratios for preterm delivery: 1.79 (1.55-2.08) for Blacks, 1.40 (1.19-1.63) for Mexican-Americans, 1.40 (1.16-1.69) for Asians, and 1.00 for Whites. The corresponding odds ratios for very preterm delivery were 2.35 (1.72-3.22) for Blacks, 1.31 (0.88-1.94) for Mexican-Americans, 1.10 (0.67-1.83) for Asians, and 1.00 for Whites. Exclusion of cases of premature rupture of membranes, placenta previa, and abruptio placenta did not explain the large ethnic differences. Although Whites and Mexican-Americans had similar birthweight distributions, Mexican-Americans had an increased risk for preterm delivery. Fifty-five per cent of low birthweight babies in Kaiser were preterm and this fraction did not vary substantially by ethnic group.
Decline in the incidence of carcinoma in situ of the cervix.
Authors: Chow W H , Greenberg R S , Liff J M
Published: November 2008

Temporal trends in the incidence of carcinoma in situ of the uterine cervix were evaluated in metropolitan Atlanta between 1975 and 1983. The average annual age-adjusted incidence rates per 100,000 women decreased from 61.5 in 1975-77 to 40.1 in 1981-83 for Whites and from 118.3 to 51.8 for Blacks during the same time periods. The relative declines were uniform across all age groups and exceeded the corresponding reductions in the incidence of invasive cervical carcinoma.
A comparative study of hospital fetal death records and Washington State fetal death certificates.
Authors: Harter L , Starzyk P , Frost F
Published: November 2008

Hospital fetal death records were compared with Washington State fetal death certificates to ascertain the completeness of reporting. Washington State law requires reporting of all fetal deaths of 20 or more weeks gestation. For 16 hospitals reporting 603 fetal deaths, an additional 49 fetal deaths were identified in the mother's charts. The study documents underreporting, especially in the gestational ages closet to the 20-week age limitation where 71 per cent of the 48 unreported cases were 20 to 27 weeks gestation.
Birthweight and gestational age: mothers' estimates compared with state and hospital records.
Authors: Little R E
Published: November 2008

Birthweight and gestational age estimates made by research subjects were compared with values obtained from birth certificates and hospital records. Ninety-one per cent of mothers' estimates of their infant's birthweight and 88 per cent of their estimates of infant gestational age agreed with the delivery record. When the same mothers estimated their own and their husband's birthweight, only 44 per cent were in agreement with birth certificate values; however, 78 per cent were in agreement with the pounds portion of the weight. Agreement of mothers' estimates of her own and her husband's gestational age with birth certificates was no better than chance.
Geographic variation in the onset of decline of ischemic heart disease mortality in the United States.
Authors: Wing S , Hayes C , Heiss G , John E , Knowles M , Riggan W , Tyroler H A
Published: November 2008

This report examines geographic variation in the onset of the decline of ischemic heart disease (IHD) mortality in white males aged 35-74 during the period 1968-78. Using a quadratic regression model, State Economic Areas (SEAs) were classified as experiencing onset of the decline in 1968 or earlier, 1969-72, or 1973 or later. In the United States as a whole, approximately one-third of SEAs experienced a late onset of the decline (after 1968). Metropolitan SEAs were in advance of non-metropolitan, and the Northeast and Pacific states showed earlier onset than the South and midsections of the country. The acceleration of the national decline after 1972 appears to be due to declines in areas in which rates had been increasing or in plateau until that time. Evidence about geographic variation in the onset of decline may provide clues about social and environmental factors responsible for the decline.
Did low birthweight among US blacks really increase?
Authors: David R J
Published: November 2008

The low birthweight (LBW) rate among reported United States non-White births increased 32 per cent from 1950 to 1967. States with large increments in non-White LBW rates over the period 1950-67 ("rising LBW states") were compared to states with more stable LBW rates. Paradoxically, states with the most deterioration in LBW rates had the most improvement in LBW risk factors (low income, mothers under age 20 or over age 35, birth order over four). In 1950, at least 9.7 per cent of non-White births in rising LBW states went unreported, and underreporting was biased, with out-of-hospital LBW births who die young least likely to be reported. From 1950 to 1967, non-White out-of-hospital births for the US declined from 42 per cent to 7 per cent, and yearly values for per cent of non-White births in hospital and LBW rates were highly correlated (r = .98). These data suggest that the observed rise in non-White LBW rates from 1950 to 1967 was due in large part to systematic underreporting of LBW births among non-White out-of-hospital deliveries in the 1950s. This underreporting essentially ceased when hospital delivery for non-Whites became nearly universal in the late 1950s and 1960s.
Characteristics of hazardous material spills from reporting systems in California.
Authors: Shaw G M , Windham G C , Leonard A , Neutra R R
Published: November 2008

Data on hazardous material releases that occurred between January 1, 1982 and September 30, 1983 in California were obtained from the California Highway Patrol (CHP) and the US Department of Transportation (DOT). The majority of incidents involved highway transport of hazardous materials, although some information was available on air, rail, and stationary facility releases. Vehicle accidents and failure of or damage to the container were the most frequent causes of releases. Proportionately more hazardous materials incidents occurred in early summer than at other times of the year, during weekdays, and daytime hours. The largest proportions of incidents involved the chemical categories of corrosives and fuels. Reported exposures and injuries to response personnel and other people at the scene were relatively few; no fatalities were reported. Few incidents were reported in both data sources, suggesting that the examination of only one data source would yield a gross underestimate of the total number of hazardous materials incidents in California. The lack of available denominator data limits the interpretation of the findings.