bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of HIV infection on mortality and accuracy of AIDS reporting on death certificates.
Authors: Hessol N A , Buchbinder S P , Colbert D , Scheer S , Underwood R , Barnhart J L , O'Malley P M , Doll L S , Lifson A R
Published: November 2008

To assess the impact of HIV infection on mortality and the accuracy of AIDS reporting on death certificates, we analyzed data from 6704 homosexual and bisexual men in the San Francisco City Clinic cohort. Identification of AIDS cases and deaths in the cohort was determined through multiple sources, including the national AIDS surveillance registry and the National Death Index. Through 1990, 1518 deaths had been reported in the cohort and 1292 death certificates obtained. Of the 1292 death certificates, 1162 were for known AIDS cases, but 9% of the AIDS cases did not have HIV infection or AIDS noted on the death certificate. Only 0.7% of the decedents had AIDS listed as a cause of death and had not been reported to AIDS surveillance. AIDS and HIV infection was the leading cause of death in the cohort, with the highest proportionate mortality ratio (85%) and standardized mortality ratio (153 in 1987), and the largest number of years of potential life lost (32,008 years). The devastating impact of HIV infection on mortality is increasing and will require continued efforts to prevent and treat HIV infection.
The validity of self-reported HIV antibody test results.
Authors: McCusker J , Stoddard A M , McCarthy E
Published: November 2008

Three hundred twenty-six participants in a multisite study were initially tested for human immunodeficiency virus (HIV) antibody and later interviewed; 228 were recent drug injectors and 38 were HIV positive. Later, 264 (81%) correctly reported their test results, 9 (3%) gave incorrect results, and 53 (16%) said either that they had not been tested or that they did not know the results. The predictive values of positive and negative self-reports were 90% and 98%, respectively (P less than .01).
Ineffectiveness of AIDS education and HIV antibody testing in reducing high-risk behaviors among injection drug users.
Authors: Calsyn D A , Saxon A J , Freeman G , Whittaker S
Published: November 2008

The effectiveness of education in reducing high-risk human immunodeficiency virus (HIV) transmission behaviors was examined in 313 injection drug users. Involvement in high-risk behaviors was assessed via structured interview at study entry and 4 months following the intervention. Subjects were randomly assigned to (1) AIDS education, (2) AIDS education with optional HIV antibody testing, or (3) a wait list. The sample as a whole decreased its involvement in high-risk behaviors, but there were no significant differences as a function of experimental group assignment.
The inpatient AIDS unit: a preliminary empirical investigation of access, economic, and outcome issues.
Authors: Fahs M C , Fulop G , Strain J , Sacks H S , Muller C , Cleary P D , Schmeidler J , Turner B
Published: November 2008

An AIDS unit model ("cluster beds") and a general inpatient placement model ("scatter beds") in a major teaching hospital were compared to determine whether they differed on several dimensions of care. After controlling for severity of illness, (the major predictor of admission to the AIDS unit), length of stay, charges, and inpatient mortality rates did not differ between the two settings. Equal proportions of White, Hispanic, male, and privately insured patients were found in both settings. Nursing staff turnover rates were comparable to those of other sites. However, the data raise new issues regarding access to AIDS units for older, Black, and female patients.
What is the dentist's occupational risk of becoming infected with hepatitis B or the human immunodeficiency virus?
Authors: Capilouto E I , Weinstein M C , Hemenway D , Cotton D
Published: November 2008

Surveys have shown that dentists are reluctant to treat persons infected with the human immunodeficiency virus (HIV). However, dentists are much more willing to treat patients with infectious hepatitis B virus (HBV). This study shows that the annual cumulative risk of infection from routine treatment of patients whose seropositivity is undisclosed is 57 times greater from HBV than from HIV, and that the risk of dying from HBV infection is 1.7 times greater than the risk of HIV infection, for which mortality is almost certain.
Legal needle buying in St. Louis.
Authors: Compton W M , Cottler L B , Decker S H , Mager D , Stringfellow R
Published: November 2008

This study sought to determine if and why barriers to the over-the-counter purchase of syringes in the St. Louis metropolitan area might exist, given that no ordinance prohibits such a sale there. Two male research assistants (one African American, one White) approached 33 of the area's pharmacies to buy syringes. In 14 of those pharmacies, either the purchase was refused or the minimum number of syringes that could be bought was so large (at least 100) that the sale was not practical. Racial bias in rates of refusal and implications for prohibiting or restricting legal availability of syringes are discussed.
Characteristics related to elderly persons' not eating for 1 or more days: implications for meal programs.
Authors: Frongillo E A , Rauschenbach B S , Roe D A , Williamson D F
Published: November 2008

We examined how social, economic, location, health, and food need characteristics are related to elderly persons' not eating for 1 or more days. The following variables were positively related to not eating: ethnicity, location, receipt of Medicaid, living alone, health problems, mobility, age less than 80 years, cancer, nausea, difficulty swallowing, diarrhea, loss of appetite, and receipt of food from a food pantry. These results have implications for allocating meal program funds, screening clients, and monitoring whether clients eat regularly.
The South Karelia Air Pollution Study: acute health effects of malodorous sulfur air pollutants released by a pulp mill.
Authors: Haahtela T , Marttila O , Vilkka V , Jäppinen P , Jaakkola J J
Published: November 2008

We evaluated the acute health effects of a strong emission of malodorous sulfur compounds released from a pulp mill in South Karelia, Finland. The 24-hour ambient air concentrations of hydrogen sulfide for the two emission days were 35 and 43 micrograms/m3 (maximum 4-hour 135 micrograms/m3). A questionnaire was distributed after the high exposure and later after a low exposure period to 29 households with 75 subjects living in the nearby community. During the high exposure, 63% of the respondents reported experience of at least one symptom compared to 26% during the reference period. Every third participant reported difficulties in breathing. In the 45 subjects responding to both questionnaires more eye, respiratory and neuropsychological symptoms occurred during the exposure compared to the reference period. The strong malodorous emission from a pulp mill caused an alarming amount of adverse effects in the exposed population.
Sources of fiber and fat in diets of US women aged 19 to 50: implications for nutrition education and policy.
Authors: Thompson F E , Sowers M F , Frongillo E A , Parpia B J
Published: November 2008

INTRODUCTION. Many women are not meeting dietary recommendations for fiber and fat intakes. Health educators need to know which foods are major sources of these nutrients. METHODS. This study analyzed the contributions of 27 food groups to fiber, fat, saturated fat, and cholesterol intakes of 2134 women aged 19 to 50 years in USDA's Continuing Survey of Food Intakes by Individuals, the 1985 and 1986 surveys (CSFII 85-86). RESULTS. Major determinants of fiber intake include frequency of use of certain food groups (vegetables, including potatoes, bread, fruit, soups, ready-to-eat cereal) and choice of particular foods within the larger food groups (e.g., whole grain bread, high fiber cereal). Major determinants of total fat, saturated fat, and cholesterol intakes included frequency of use of certain foods (sweet grains, beef, eggs, cheeses/cream, whole milks) and additions to foods (regular salad dressing and butter/margarine). Demographic characteristics were related to various food group consumption parameters. CONCLUSIONS. Information about the relationships between food group and nutrient intake and the effects of household income, race/ethnicity, and region of residence on food group intake indicate opportunities to refine nutritional education programs.
Home apnea monitoring and disruptions in family life: a multidimensional controlled study.
Authors: Ahmann E , Wulff L , Meny R G
Published: November 2008

We used data from telephone interviews and mailed questionnaires to examine 12 aspects of family life among 93 families with infants considered at high risk for sudden infant death syndrome and on home apnea monitors and a matched comparison group with infants not requiring monitoring. Using logistic regression to control confounding variables, we found that case mothers were at an increased risk of poor health, but we found no other significant differences in family life between the two groups.
A cohort study of the impact of perinatal drug use on prematurity in an inner-city population.
Authors: Feldman J G , Minkoff H L , McCalla S , Salwen M
Published: November 2008

Perinatal illicit drug use was determined by anonymously testing the urine of 1111 inner-city parturients. Fourteen percent tested positive, 11.5% for cocaine. As determined by self-report or by positive test results, 17% used drugs. Twenty-eight percent of low birthweights and 20% of premature births in this group were attributable to drug use. Risk of prematurity was reduced by a factor of 2 to 3 with adequate prenatal care. These data suggest an enormous potential for improving perinatal health.
The impact of mailing psychoeducational materials to women with abnormal mammograms.
Authors: Lerman C , Ross E , Boyce A , Gorchov P M , McLaughlin R , Rimer B , Engstrom P
Published: November 2008

A randomized trial was conducted to evaluate the impact of mailed psychoeducational materials on adherence to subsequent annual mammography among women with prior abnormal mammograms. The results showed a 13% increment in adherence among women who received this intervention. This effect was independent of all sociodemographic and medical variables examined. We conclude that mailed psychoeducational materials may be an effective mechanism to improve adherence among women with abnormal mammogram results.
Breast-feeding patterns in a rural village in Giza, Egypt.
Authors: Hakim I A , el-Ashmawy I A
Published: November 2008

In a longitudinal study of infant feeding in rural Giza, Egypt, we found that 68.8% of the recruited mothers initiated early suckling of colostrum, but only 51.2% of the infants were exclusively breast-fed in the first week. Solid foods were introduced much earlier than at the recommended age of 4 to 6 months. Sixty percent of the mothers who participated in the study considered breast-feeding plus regular or irregular complementary feeding to be exclusive breast-feeding.
Newspapers: a source for injury surveillance?
Authors: Rainey D Y , Runyan C W
Published: November 2008

Newspapers have not been extensively evaluated as an injury surveillance source. We compared clippings with medical examiner records for 45 residential fire deaths and 58 drownings of children to assess extent, completeness, and accuracy of newspaper coverage. Newspapers covered 96% of the fire fatalities and 78% of the drownings and contained more information than medical examiner records on several factors, including fire cause and smoke detector presence, pool fences, warning signs, and supervision of children.
Response comparability of family and staff proxies for nursing home residents.
Authors: Tennstedt S L , Skinner K M , Sullivan L M , McKinlay J B
Published: November 2008

Response comparability on a wide variety of factual and judgmental information regarding nursing home residents was assessed for two proxy groups: family and staff. Family proxies had the most information. Family and staff proxies are not interchangeable. A general lack of response comparability suggests that proxies for nursing home residents should be selected in relation to the type of data needed and the time period of interest.
Use of community-based mental health programs by HMOs: evidence from a Medicaid demonstration.
Authors: Christianson J B , Lurie N , Finch M , Moscovice I S , Hartley D
Published: November 2008

BACKGROUND. Proposals to enroll Medicaid beneficiaries in health maintenance organizations (HMOs) have raised concerns that community-based mental health treatment programs would be adversely affected. METHODS. In Hennepin County (Minnesota) 35% of Medicaid beneficiaries were randomly assigned to prepaid plans. Random samples of individuals with severe mental illness with selected from the prepaid enrollees and from beneficiaries remaining with traditional Medicaid. The two groups were compared with respect to their use of community treatment programs and the write-off (the proportion of patient charges for which payment was not received) experienced by those programs for members of the study sample. RESULTS. There was no strong evidence that Medicaid beneficiaries with severe mental illness who were randomly assigned to prepaid plans used community-based mental health treatment programs differently than did other Medicaid beneficiaries. However, write-offs were consistently higher for enrollees in prepaid plans. CONCLUSIONS. In the short run, the use of community-based mental health treatment programs need not be affected by enrollment of Medicaid beneficiaries in prepaid plans, providing that Medicaid program administrators take steps to minimize the disruption of ongoing treatment, offer beneficiaries a choice among prepaid plans, and encourage community treatment programs to contract with plans to serve beneficiaries.
Improving referral compliance after public cholesterol screening.
Authors: Maiman L A , Hildreth N G , Cox C , Greenland P
Published: November 2008

BACKGROUND. Noncompliance with referral to a physician for retesting and diagnosis is a concern in public cholesterol screening. METHODS. Participants (n = 2109) were referred by a health professional or lay communicator and randomly assigned to a coupon offer, referral reminder letter, or control group. A questionnaire was completed at screening, and a telephone interview was conducted 5 months later. RESULTS. Physician visit rates showed no professional or lay differences. For "no history" subjects, the behavioral interventions were effective compared with controls (coupon = 60.7% and reminder = 57.7% vs control = 46.1%). With professional counseling, only the coupon was effective; for lay counseling, both coupon and reminder yielded higher visit rates. Adjusted for sociodemographics, heart disease risk factors, and health perceptions, the intervention effects remained (professional-coupon offer: odds ratio [OR] = 1.94, 95% confidence interval [CI] = 1.21, 3.09; professional-reminder letter: OR = 1.04, 95% CI = 0.67, 1.63; lay-coupon offer: OR = 2.52, 95% CI = 1.52, 4.18; and lay-reminder letter: OR = 3.10, 95% CI = 1.83, 5.22). CONCLUSIONS. For unaware participants, lay counselors and referral follow-up efforts tailored to specific cholesterol risk groups are indicated.
Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease.
Authors: Winkleby M A , Jatulis D E , Frank E , Fortmann S P
Published: November 2008

BACKGROUND. Socioeconomic status (SES) is usually measured by determining education, income, occupation, or a composite of these dimensions. Although education is the most commonly used measure of SES in epidemiological studies, no investigators in the United States have conducted an empirical analysis quantifying the relative impact of each separate dimension of SES on risk factors for disease. METHODS. Using data on 2380 participants from the Stanford Five-City Project (85% White, non-Hispanic), we examined the independent contribution of education, income, and occupation to a set of cardiovascular disease risk factors (cigarette smoking, systolic and diastolic blood pressure, and total and high-density lipoprotein cholesterol). RESULTS. The relationship between these SES measures and risk factors was strongest and most consistent for education, showing higher risk associated with lower levels of education. Using a forward selection model that allowed for inclusion of all three SES measures after adjustment for age and time of survey, education was the only measure that was significantly associated with the risk factors (P less than .05). CONCLUSION. If economics or time dictate that a single parameter of SES be chosen and if the research hypothesis does not dictate otherwise, higher education may be the best SES predictor of good health.
The second Chicago televised smoking cessation program: a 24-month follow-up.
Authors: Warnecke R B , Langenberg P , Wong S C , Flay B R , Cook T D
Published: November 2008

OBJECTIVES. As smoking decreases in the population, the remaining smoking population will change, and cessation initiatives will have to incorporate strategies designed for these smokers. METHODS. To study patterns of response to a cessation intervention composed of 20 televised segments and the American Lung Association Freedom from Smoking in 20 Days manual, this study compared cessation rates over 24 months in a cohort of smokers who registered for a cessation program with those in a cohort selected from the smoking population at large. RESULTS. At post intervention, multiple point prevalence of cessation among participants, adjusted for baseline smoking, was 14% among registrants and 6% in the population; at 24 months the adjusted rates were 6% and 2%, respectively. Heavy smokers benefited more than light smokers, and there was a consistent dose-response relationship between extent of exposure to the intervention and cessation. CONCLUSION. The effects of the intervention were strongest for those who read the manual and watched the programs daily. Manual use was important, and those who did not read it did not appear to benefit. Compared to the population and given full participation, heavy smokers benefited more than lighter smokers.
Drug use and suicide ideation and behavior among North Carolina public school students.
Authors: Felts W M , Chernier T , Barnes R
Published: November 2008

We used data from 3064 respondents to the 1990 North Carolina Youth Risk Behavior Survey to examine the relationship between adolescent drug use and suicide ideation and behavior. Principal components analysis followed by varimax rotation was performed separately on the drug use and suicide items. Correlation coefficients computed between the two sets of factor scores and comparison of mean drug use factor scores revealed that drug use, particularly of crack/cocaine, was related to increased suicide ideation and behavior.
Delay in ambulance dispatch to road accidents.
Authors: Brodsky H
Published: November 2008

When a road accident occurs, the police communications officer, or 911 operator, generally receives the first call. If the caller reports injuries, the emergency medical services dispatcher is notified immediately; but if the caller is uncertain of injuries, the operator may wait. Most often an ambulance is not needed. However, in nearly 20% of fatal road accidents in Missouri, waiting for confirmation of need resulted in a delay of 5 minutes or more in the dispatch of an ambulance.
Race, belief in destiny, and seat belt usage: a pilot study.
Authors: Colón I
Published: November 2008

A survey of 1063 individuals found that when belief in destiny was statistically controlled, differences in seat belt use by race disappeared. Thus, racial differences in seat belt use are statistically accounted for and might be explained by belief in destiny. Efforts to increase seat belt use should target minority groups rather than include them in broadbrush programs. Further, these efforts should take into account this important difference in motivation.
A neonatal hepatitis B surveillance and vaccination program: New York City, 1987 to 1988.
Authors: Henning K J , Pollack D M , Friedman S M
Published: November 2008

From July 1987 to June 1988, 1030 pregnant women with hepatitis B were reported to a New York City surveillance program. Among 832 infants under follow-up, the coverage rates for combined hepatitis B immune globulin and vaccine doses 1, 2, and 3 were 84%, 77%, and 59%, respectively. Infants covered by Medicaid and uninsured Black and Hispanic infants were significantly less likely to be completely vaccinated. An estimated 160 cases of chronic hepatitis B infection were prevented among infants enrolled in the program. Strategies are needed to improve vaccine coverage among hard-to-reach groups.
Rotating shift work, sleep, and accidents related to sleepiness in hospital nurses.
Authors: Gold D R , Rogacz S , Bock N , Tosteson T D , Baum T M , Speizer F E , Czeisler C A
Published: November 2008

A hospital-based survey on shift work, sleep, and accidents was carried out among 635 Massachusetts nurses. In comparison to nurses who worked only day/evening shifts, rotators had more sleep/wake cycle disruption and nodded off more at work. Rotators had twice the odds of nodding off while driving to or from work and twice the odds of a reported accident or error related to sleepiness. Application of circadian principles to the design of hospital work schedules may result in improved health and safety for nurses and patients.
Birthweight distributions in Mexico City and among US Southwest Mexican Americans: the effect of altitude.
Authors: Notzon F C , Bobadilla J L , Coria I
Published: November 2008

In this study birthweight distributions for Mexican Americans and Mexico City were compared. Sharp differences in the two distributions were nearly eliminated by controlling for altitude. The small remaining excess in low birthweight in Mexico City appears to be due to a slight overrepresentation of tertiary hospital deliveries, and possibly to a greater prevalence of pathological conditions. The results are consistent with the favorable low birthweight rate reported for Mexican Americans and illustrate the need to adjust for altitude in studies of low birthweight.
Discrepancies between self-reported smoking and carboxyhemoglobin: an analysis of the second national health and nutrition survey.
Authors: Klesges L M , Klesges R C , Cigrang J A
Published: November 2008

Environmental, self-report, and demographic factors mediated the relationship between self-reported cigarette smoking and carboxyhemoglobin among 2114 smokers and 3918 nonsmokers. Self-reported nonsmokers with carboxyhemoglobin levels between 2% and 3% were more likely to be self-reported ex-smokers, to live in a larger community, and to be younger, less educated, and male than were self-reported nonsmokers with carboxyhemoglobin levels of less than 2%. Self-reported nonsmokers with strong evidence of cigarette consumption (carboxyhemoglobin level greater than 3%) were more likely to be self-reported ex-smokers, younger, less educated, and non-White than were nonsmokers with carboxyhemoglobin levels of less than 2%.
The President's Committee on Health Education: a 20-year retrospective on its politics and policy impact.
Authors: Guinta M A , Allegrante J P
Published: November 2008

The President's Committee on Health Education was created by Richard M. Nixon in September 1971 and submitted its final report in September 1973. The committee resulted from the convergence of (1) a perceived national domestic policy need in response to escalating medical costs, (2) Nixon's personal and political ambitions, and (3) the dynamic political context of the late 1960s and early 1970s. Its work led to both private and public initiatives designed to influence the public's health through education; its findings and recommendations also laid the foundation for the National Consumer Health Information and Health Promotion Act of 1976 and thus contributed significantly to the development of subsequent national policy in health promotion and disease prevention. This paper places the work and contributions of the committee into historical perspective by analyzing the committee's origins and methods and the underlying politics that shaped its work and final report. The impact of the President's Committee is traced from the emergence of health education in the early 1970s as a potentially cost-effective alternative to medical care to the pivotal role health education now plays in health promotion and disease prevention efforts.
Health and the environment in the 1990s.
Authors: Doll R
Published: November 2008

Expectation of life at birth provides a simple measure of the state of health of a country. Differences in the expectation are examined in the United States over time and between males and females and Whites and non-Whites, and worldwide between market and nonmarket developed countries, and between developed and developing countries. The principal factors responsible for the trends and the current differences are changes in the social and physical environment, in personal behavior, and in medical care, and their relative importance is assessed. It is concluded that, at present, the principal environmental hazards worldwide are those associated with poverty of individuals within the market economies and of communities in the developing countries and that in the future, they will be the effects of overpopulation and the production of greenhouse gases.
Use of hair coloring products and the risk of lymphoma, multiple myeloma, and chronic lymphocytic leukemia.
Authors: Zahm S H , Weisenburger D D , Babbitt P A , Saal R C , Vaught J B , Blair A
Published: November 2008

OBJECTIVES. Hair coloring products are widely used and contain components that are mutagenic and carcinogenic. An association between occupational exposure to hair coloring products and hematopoietic cancers has been reported, but the risk for these cancers among users has not been carefully evaluated. METHODS. We conducted a population-based, case-control study with telephone interviews from 385 with telephone interviews from 385 non-Hodgkin's lymphoma cases, 70 Hodgkin's disease cases, 72 multiple myeloma cases, 56 chronic lymphocytic leukemia cases, and 1432 controls. RESULTS. Among women, use was associated with odds ratios of 1.5 for non-Hodgkin's lymphoma, 1.7 for Hodgkin's disease, 1.8 for multiple myeloma, and 1.0 for chronic lymphocytic leukemia. Risk was higher for permanent hair coloring products than for semi- or nonpermanent products, particularly for dark colors. Long duration and early age of first use tended to increase risk, but the patterns were inconsistent. Use was much less common in men and did not significantly increase risk. CONCLUSIONS. The use of hair coloring products appears to increase the risk of non-Hodgkin's lymphoma. Multiple myeloma and Hodgkin's disease were also associated, although based on far fewer subjects. If these results represent a causal association, use of hair coloring products would account for 35% of non-Hodgkin's lymphoma cases in exposed women and 20% in all women.
The Roseto effect: a 50-year comparison of mortality rates.
Authors: Egolf B , Lasker J , Wolf S , Potvin L
Published: November 2008

OBJECTIVES. Earlier studies found striking differences in mortality from myocardial infarction between Roseto, a homogeneous Italian-American community in Pennsylvania, and other nearby towns between 1955 and 1965. These differences disappeared as Roseto became more "Americanized" in the 1960s. The present study extended the comparison over a longer period of time to test the hypothesis that the findings from this period were not due to random fluctuations in small communities. METHODS. We examined death certificates for Roseto and Bangor from 1935 to 1985. Age-standardized death rates and mortality ratios were computed for each decade. RESULTS. Rosetans had a lower mortality rate from myocardial infarction over the course of the first 30 years, but it rose to the level of Bangor's following a period of erosion of traditionally cohesive family and community relationships. This mortality-rate increase involved mainly younger Rosetan men and elderly women. CONCLUSIONS. The data confirmed the existence of consistent mortality differences between Roseto and Bangor during a time when there were many indicators of greater social solidarity and homogeneity in Roseto.
Job strain and mortality in elderly men: social network, support, and influence as buffers.
Authors: Falk A , Hanson B S , Isacsson S O , Ostergren P O
Published: November 2008

The aim was to investigate whether job strain affects mortality in a representative population of elderly men, and whether social network and social support outside the workplace can buffer the negative health effects of job strain. A higher relative mortality risk (RR) was found among men exposed to job strain (RR = 1.7). The combination of exposure to job strain and seven different measures of weak social network and social support was associated with a further increased RR ranging from 2.1 to 4.6.
Use of cardiovascular disease medications and mortality in people with older onset diabetes.
Authors: Klein B E , Moss S E , Klein R
Published: November 2008

Mortality follow-up for a cohort defined in 1980 with diabetes diagnosed at 30 years of age or older has been completed through 1988. History of medication use was obtained during the initial evaluation. There were 605 (44.2%) confirmed deaths; heart disease was the underlying cause in 49.9% of the deaths. Use of loop diuretics was associated with an odds ratio of death of 1.8 (95% CI = 1.4, 2.2). Although a causal relationship cannot be inferred, it is reasonable to suggest that blood chemistries be monitored regularly in persons on these drugs since electrolyte imbalance may be related to death.
Race and sex differences in mortality following fracture of the hip.
Authors: Jacobsen S J , Goldberg J , Miles T P , Brody J A , Stiers W , Rimm A A
Published: November 2008

This paper describes the all-cause mortality experience, following a fracture of the hip, of 712,027 persons covered by the Medicare program from 1984 through 1987. White women experienced the lowest mortality rate (17.2 per 1000 person-months), followed by Black women (22.9 per 1000 person-months), Black men (33.5 per 1000 person-months), and White men (33.7 per 1000 person-months). The observed race-sex differences in survival were found at all ages and regardless of the number of comorbid conditions listed with the discharge diagnosis. While these data demonstrate marked race-sex differences in survival following hip fracture, the cause of these differences is not immediately apparent and demands further investigation.
HIV prevention and the two faces of partner notification.
Authors: Bayer R , Toomey K E
Published: November 2008

In the cases of medical patients with sexually transmitted diseases (particularly those with the human immunodeficiency virus), two distinct approaches exist to notifying sexual and/or needle-sharing partners of possible risk. Each approach has its own history (including unique practical problems of implementation) and provokes its own ethical dilemmas. The first approach--the moral "duty to warn"--arose out of clinical situations in which a physician knew the identity of a person deemed to be at risk. The second approach--that of contact tracing--emerged from sexually transmitted disease control programs in which the clinician typically did not know the identity of those who might have been exposed. Confusion between the two approaches has led many to mistake processes that are fundamentally voluntary as mandatory and those that respect confidentiality as invasive of privacy. In the context of the AIDS epidemic and the vicissitudes of the two approaches, we describe the complex problems of partner notification and underscore the ethical and political contexts within which policy decisions have been made.
Creating a healthy public.
Authors: Keck C W
Published: November 2008

Significant change in thought and action will be required for our health system to become capable of serving all citizens effectively. Reliance on market forces and political expediency to shape health policy has focused attention inappropriately on finding ways to pay for illness care rather than maximizing health status. This misdirection of thought and effort has led many of us to search for ways to assure that health policy decisions are consistently based on both science and an ethic of humane concern. Courageous and disciplined local leadership will be needed to motivate policymakers to focus on the task of creating a healthy public. Linkage of academicians and practitioners with the public in a manner than empowers communities to assess and prioritize their own health problems could foster a strong community-based demand for ethical and humane decision making. Constituent demand for improved health status could provide the support politicians need if they are to legislate a national health program that emphasizes health promotion and disease prevention as well as illness care.
Determinants of passive smoking in children in Edinburgh, Scotland.
Authors: Jarvis M J , Strachan D P , Feyerabend C
Published: November 2008

OBJECTIVES. Using saliva cotinine as a quantitative marker, we examined the contribution of factors other than parental smoking to children's passive exposure to tobacco smoke. METHODS. Saliva specimens from a random sample of 734 7-year-old schoolchildren in Edinburgh, Scotland, were analyzed for cotinine. Their parents completed a questionnaire covering smoking habits and conditions in the home. RESULTS. A number of independent predictors of cotinine were identified in addition to the main one of smoking by household members. These predictors included home ownership, social class, day of the week, season of the year, number of parents present, crowding in the home, the number of children in the household, and sex. Cotinine was higher in children from less advantaged backgrounds, during winter, on Mondays, in girls, and when fewer other children were present. The effects were similar between children from nonsmoking and smoking homes. CONCLUSIONS. Questionnaire measures of parental smoking are insufficient to fully characterize young children's exposure to passive smoking. Because socioeconomic variables contribute to measured exposure, passive-smoking studies that treat class as a confounder and control for it may be overcontrolling.
How women's adopted low-fat diets affect their husbands.
Authors: Shattuck A L , White E , Kristal A R
Published: November 2008

OBJECTIVES. One way of promoting a reduction in dietary fat intake is by changing the diet of family members. This study investigated the long-term effects of a low-fat dietary intervention on husbands of women who participated in the Women's Health Trial (WHT). METHODS. An average of 12 months after the end of the WHT, a randomly selected sample of participants' husbands was sent dietary and health questionnaires as part of a follow-up study of the maintenance of the low-fat diet among WHT participants. RESULTS. We found an absolute difference in fat intake between groups of 4 percentage points (32.9% energy from fat among intervention husbands [n = 188] vs 36.9% among control husbands [n = 180]). The wife's attitude and fat intake were among the most important predictors of her husband's fat intake, indicating that the effect of the WHT intervention on the husbands of participants was more likely due to their acceptance of lower-fat foods being served at home than to overt actions by the men. CONCLUSIONS. Our results suggest that a dietary intervention aimed at women can have an effect on their husbands and may be a cost-effective approach to healthy dietary change for both women and men.
Weight loss attempts in adults: goals, duration, and rate of weight loss.
Authors: Williamson D F , Serdula M K , Anda R F , Levy A , Byers T
Published: November 2008

OBJECTIVES: Although attempted weight loss is common, little is known about the goals and durations of weight loss attempts and the rates of achieved weight loss in the general population. METHODS. Data were collected by telephone in 1989 from adults aged 18 years and older in 39 states and the District of Columbia. Analyses were carried out separately for the 6758 men and 14,915 women who reported currently trying to lose weight. RESULTS. Approximately 25% of the men respondents and 40% of the women respondents reported that they were currently trying to lose weight. Among men, a higher percentage of Hispanics (31%) than of Whites (25%) or Blacks (23%) reported trying to lose weight. Among women, however, there were no ethnic differences in prevalence. The average man wanted to lose 30 pounds and to weigh 178 pounds; the average woman wanted to lose 31 pounds and to weigh 133 pounds. Black women wanted to lose an average of 8 pounds more than did White women, but Black women's goal weight was 10 pounds heavier. The average rate of achieved weight loss was 1.4 pounds per week for men and 1.1 pounds per week for women; these averages, however, may reflect only the experience of those most successful at losing weight. CONCLUSIONS. Attempted weight loss is a common behavior, regardless of age, gender, or ethnicity, and weight loss goals are substantial; however, obesity remains a major public health problem in the United States.
Predictors of smoking cessation and relapse in older adults.
Authors: Salive M E , Cornoni-Huntley J , LaCroix A Z , Ostfeld A M , Wallace R B , Hennekens C H
Published: November 2008

We examined longitudinal changes in smoking behavior among older adults in three community cohorts of the Established Populations for Epidemiologic Studies of the Elderly. Smoking prevalence declined from 15% at baseline to 9% during 6 years of follow-up. Annual smoking cessation and relapse rates were 10% and less than 1%, respectively. Interval diagnosis of myocardial infarction, stroke, or cancer increased subsequent smoking cessation but not relapse. Although smoking cessation around diagnosis is increased, primary prevention could yield greater benefits.
The Tobacco Institute's "It's the Law" campaign: has it halted illegal sales of tobacco to children?
Authors: DiFranza J R , Brown L J
Published: November 2008

A survey of tobacco retailers was conducted to evaluate the efficacy of the Tobacco Institute's "It's the Law" program, which has the goal of eliminating the illegal sale of tobacco to minors. Only 4.5% (7) of the 156 retailers surveyed were participating in the "It's the Law" program. Eighty-six percent of the retailers who were participating in the program were willing to illegally sell cigarettes to children, compared with 88% (131/149) of the retailers who were not participating.
Homosexual and bisexual men's perceptions of discrimination in health services.
Authors: Kass N E , Faden R R , Fox R , Dudley J
Published: November 2008

Questionnaires were distributed to homosexual and bisexual male participants in the Multicenter AIDS Cohort Study and to homosexual and bisexual male patients with acquired immunodeficiency syndrome (AIDS) to determine whether the men believed they had been refused medical or dental treatment because of their sexual orientation or a condition related to the human immunodeficiency virus (HIV). Men with AIDS were significantly more likely (18%) to report being refused treatment by a doctor or dentist on the basis of a known or suspected HIV-related condition than were men who were seropositive (5%) or seronegative (1%). Significantly more respondents reported refusal of dental care than of medical care.
Clinical research, prophylaxis, therapy, and care for HIV disease in Africa.
Authors: De Cock K M , Lucas S B , Lucas S , Agness J , Kadio A , Gayle H D
Published: November 2008

By the end of the century, citizens of resource-poor countries will constitute 90% of the world's human immunodeficiency virus (HIV)-infected people. Clinical management of such persons in developing countries has been neglected; most AIDS research has concentrated on epidemiology, and donor agencies have generally invested in the prevention of HIV infection. The heavy burden of HIV disease in Africa requires that care for AIDS be addressed, and prevention and care should be seen as interrelated. Prevention and treatment of tuberculosis, the commonest severe infection in persons with AIDS in Africa, illustrate this interrelationship. We outline priorities for applied research on the management of HIV disease in a resource-poor environment, and discuss prophylaxis, therapy for opportunistic diseases, terminal care, and use of antiretroviral therapy. Research should define the standard of care that can realistically be demanded for HIV disease in a resource-poor environment. Research and public health programs for AIDS in developing countries must address AIDS care and attempt to reduce the widening gap between interventions available for HIV-infected persons in different parts of the world.
HIV-1 seroprevalence and risk behaviors in an urban African-American community cohort.
Authors: Brunswick A F , Aidala A , Dobkin J , Howard J , Titus S P , Banaszak-Holl J
Published: November 2008

OBJECTIVES. Previous attempts at obtaining population estimates of human immunodeficiency virus type 1 (HIV-1) seroprevalence have been beset by problems of cooperation bias. As part of the fourth round of study with an urban African-American community cohort, the following investigation was aimed at assessing HIV-1 prevalence and the relative importance of sex and drug injection as risk factors in infection. METHODS. Personal interviews were conducted in the home with 364 respondents, followed by voluntary blood sample collection from 287 of these individuals. RESULTS. Blood assays showed a point prevalence of 8.4% HIV-1 seropositivity in this community cross section, with a higher female-to-male ratio than appears among acquired immunodeficiency syndrome (AIDS) case reports. Most infected persons were unaware and unsuspecting of their infection. CONCLUSIONS. First, findings underscore the need to focus on risk behaviors rather than on risk groups. Second, the smaller than 2:1 ratio of infected men to women suggests that current AIDS case reports seriously underestimate HIV-1 infection among certain cohorts of African-American women. Finally, widespread ignorance of own infected status and inaccurate risk assessment signal the substantial task for community health educators in reaching inner-city African-American men and women at risk.
Are HIV-infected injection drug users taking HIV tests?
Authors: Reardon J , Warren N , Keilch R , Jenssen D , Wise F , Brunner W
Published: November 2008

OBJECTIVES. Knowledge of infection is essential for human immunodeficiency virus-type 1 (HIV-1) treatment initiation and epidemic control. This study evaluates infection knowledge among infected injection drug users and acceptance of confidential testing among injection drug users, particularly those infected with HIV-1. METHODS. A total of 810 injection drug users entering treatment in Contra Costa County, Calif, were examined. Clients were tested with unlinked (blinded) tests and simultaneously counseled and offered voluntary confidential HIV-1 antibody testing. Data on confidential testing acceptance, previous testing, drug use, and demographic information were collected. RESULTS. Of the 810 tested, 105 (13.0%) were infected. The current confidential test was accepted by 507 (62.6%). HIV seroprevalence in the unlinked survey was four times greater than in the voluntary survey (13% and 3.5%, respectively). HIV-1 infection was associated with refusal of a confidential test largely because most infected injection drug users (n = 58; 55.2%) already knew of their infection. Of the 47 injection drug users who were not aware of their infection, 12 (25.5%) accepted the test. Although African-American injection drug users presented with a higher infection rate (37.3%), they were three times less likely to know of their infection. CONCLUSIONS. "In-clinic" HIV-1 testing is highly accepted, and most infected clients in treatment will learn their status. Nevertheless, voluntary testing data are likely to yield considerable underestimates of the true rate of infection among injection drug users.
Partner notification for control of HIV: results after 2 years of a statewide program in Utah.
Authors: Pavia A T , Benyo M , Niler L , Risk I
Published: November 2008

OBJECTIVES. We sought to evaluate the utility of partner notification for control of human immunodeficiency virus (HIV) infection and to identify subgroups in which it may be most effective. METHODS. All persons reported to be HIV-positive during a 2-year period were interviewed. Outcome measures included proportion of index patients cooperating; number of partners named, located, counseled, and tested; number of persons newly testing positive; and costs. RESULTS. Of 308 index patients, 244 (79%) cooperated. They named 890 partners; 499 (70%) of in-state partners were located. Of these, 154 (34%) had previously tested HIV-positive. Of 279 partners tested for the first time, 39 (14%) were HIV-positive. Injecting drug users were significantly more likely to cooperate than persons in other risk groups (93% vs 76%) and named more partners (median 4 vs 1). Women and persons choosing confidential testing were more likely to cooperate and named more partners. The estimated cost of the program was $62,500 per year. CONCLUSIONS. Partner notification identified a group with a high seroprevalence of HIV. It was not successful among populations that may be difficult to reach with other interventions.
Race and survival time with AIDS: a synthesis of the literature.
Authors: Curtis J R , Patrick D L
Published: November 2008

OBJECTIVE. This study summarizes the evidence concerning the association of Black and White race with acquired immunodeficiency syndrome (AIDS) survival time. METHODS. English-language articles measuring survival time with AIDS for Black and White persons were reviewed. Each article was assigned to one of three groups based on the method of subject accrual. RESULTS. Of the nine eligible studies identified, five studies had inclusive methods of accruing study subjects, and four of these five showed decreased survival time among Black persons. In the studies with more restrictive accrual methods, survival time for Blacks was not decreased. CONCLUSIONS. Although the published studies vary in their results, this variation appears to be systematic according to the method of accruing study subjects. If the accrual method serves to minimize socioeconomic differences between Blacks and Whites, there is no difference in survival time by race. However, if a more inclusive method is used, a significant decrease in AIDS survival time is observed among Blacks. This analysis suggests that, in some studies, race may function as a marker for socioeconomic factors and/or access to health care and that AIDS patients in the lowest socioeconomic or access group have significantly shorter survival times.