bluuebunny/crossref_metadata_2025 huggingface dataset:
Emergency department patient 'dumping': an analysis of interhospital transfers to the Regional Medical Center at Memphis, Tennessee.
Authors: Kellermann A L , Hackman B B
Published: November 2008

To study the extent and nature of transfers of emergency department (ED) patients because of inability to pay, we audited all telephone requests and actual patient transfers from private hospital EDs and their affiliated free-standing emergency centers to the ED of the Regional Medical Center at Memphis (the Med), a publicly subsidized hospital, between June 1 and August 31, 1986. Transfers to the Med's "special care" centers were assumed to represent tertiary care referrals and were excluded. During the 92-day study interval, ED physicians at the Med handled 190 telephone requests for transfer. Requesting physicians explicitly identified "no money" or "no insurance" as the primary reason for transfer in 89 per cent of 164 cases in which these data were recorded. Thirty-seven per cent of requests were refused; half were too unstable or required an intensive care unit (ICU) bed when none were available. One hundred forty-six transfers (55 per cent) arrived without prior telephone authorization, most by private automobile. Almost all transferred patients (91 per cent) were sent for primarily economic reasons. One out of four was found to be unstable on arrival by explicit clinical criteria. Eighty-two patients transferred for economic reasons (34 per cent) required emergency hospitalization and accounted for 564 bed days during a period of extreme inpatient crowding. Three patients died prior to discharge. Two had been transferred for primarily economic reasons.
International developments in abortion laws: 1977-88.
Authors: Cook R J , Dickens B M
Published: November 2008

During the period between 1977 and the first quarter of 1988, 35 countries liberalized their abortion laws and four countries limited grounds for the procedure. Most legislation has extended abortion eligibility through traditional indications such as danger to maternal health or fetal handicap, but a number of other indications have been created such as adolescence, advanced maternal age, family circumstances, and AIDS or HIV infection. A number of countries have redesigned their abortion laws as part of a comprehensive package to facilitate access to and delivery of contraception, voluntary sterilization, and abortion services. Abortion litigation has increased and stimulated the liberalization of abortion provisions and the support of women's autonomous choice within the law. In Canada, the entire criminal prohibition of abortion was held unconstitutional for violating women's integrity and security. In contrast, Latin American and other constitutional developments may limit legal abortion to instances of danger to women's lives.
Ethnic differences in female overweight: data from the 1985 National Health Interview Survey.
Authors: Dawson D A
Published: November 2008

Ethnic differences in female overweight were analyzed using data from the 1985 National Health Interview Survey. The sample consisted of approximately 17,000 women, ages 18 and over. After adjusting for age and poverty status, there were clear differences in the proportions of women 20 per cent or more overweight among Black, Hispanic and other White women (35, 26 and 20 per cent, respectively). Black women were less likely than White women to perceive themselves as overweight when categorized by actual weight relative to ideal weight; however, within categories of weight relative to other women of the same ethnic group, all women not Hispanic were equally likely to consider themselves overweight. There was no difference by ethnicity in the proportion of women trying to lose weight among those who perceived themselves as overweight. These findings have implications for programs designed to modify weight, since they suggest that women use ethnic-specific standards in assessing overweight.
Incidence of tooth loss among elderly Iowans.
Authors: Hunt R J , Hand J S , Kohout F J , Beck J D
Published: November 2008

This study investigated the 18-month incidence of tooth loss in a random sample of 451 dentate noninstitutionalized Iowans aged 65 and older residing in two rural counties. They had a mean of 19.0 teeth at baseline and lost an average of 0.4 teeth during the subsequent 18 months. Twenty-one per cent of the population lost at least one tooth. Four people had all their teeth extracted. Of the teeth present at baseline, 1.9 per cent subsequently were extracted. The highest incidence of tooth loss occurred among mandibular molars (3.7 per cent), followed by maxillary premolars and canines (3.1 per cent each). The best predictors of tooth loss were previous coronal and root caries.
More frequent diagnosis of acute myocardial infarction among Navajo Indians.
Authors: Klain M , Coulehan J L , Arena V C , Janett R
Published: November 2008

In an earlier study, we failed to confirm a clinical impression that the incidence of acute myocardial infarction (AMI) was increasing in Navajo men. Extending our data collection an additional three years, through 1986, we observed that the attack rate in men more than doubled and there was a gradual increase among women. Most Navajos who sustain AMI are hypertensive (51 per cent), diabetic (50 per cent) or both (31 per cent), but few smoke cigarettes.
Drinking water source, diarrheal morbidity, and child growth in villages with both traditional and improved water supplies in rural Lesotho, southern Africa.
Authors: Esrey S A , Habicht J P , Latham M C , Sisler D G , Casella G
Published: November 2008

This study examined the growth and morbidity rates of young children in relation to exclusive and non-exclusive use of improved water supplies in rural Lesotho, southern Africa. Data were collected for 247 children 60 months of age and under between July 1984 and February 1985 in 10 villages that had an improved water supply at least one year prior to investigation. Children whose families relied exclusively on the new water supply for their drinking and cooking needs grew 0.438 cm and 235 g more in six months than children whose families supplemented the new water supply with the use of contaminated traditional water for drinking and cooking. The difference in growth was greater among children over 12 months of age at the start of the evaluation than among infants. This may be explained partly by lower rates for Giardia lamblia, the most commonly identified pathogen in stools in older children. Among infants, similar rates of Campylobacter, the most commonly isolated pathogen among infants, may have prevented larger differences. Results suggest that improved drinking water supplies can benefit preschool children's health after infancy, but only if they are functioning and utilized exclusively for drinking and cooking purposes.
Sunlight and other risk factors for cataracts: an epidemiologic study.
Authors: Collman G W , Shore D L , Shy C M , Checkoway H , Luria A S
Published: November 2008

A case control study was conducted in North Carolina to explore the relation between individual exposure to sunlight and the risk of cataracts. One hundred thirteen cases and 161 controls aged 40-69 at diagnosis were studied. Sunlight exposure was inferred from interview data on residency and time spent in the sun, combined with solar radiation data from the National Climatic Data Center. Sunlight exposure was very slightly related to all types of opacities combined. Although the numbers of cases with each type of opacity was small, the risk of cataracts was slightly increased in medium and high exposure categories for persons having cortical or posterior subcapsular opacities only, but not nuclear sclerotic changes. Persons with dark brown or hazel eyes are at increased risk. An unexpected finding was that persons who reported using tranquilizers for six months were at increased risk.
The value of water supply and sanitation in development: an assessment.
Authors: Okun D A
Published: November 2008

The attractiveness of oral rehydration therapy (ORT), a new and simple ministration that averts many child deaths from diarrhea among children, is diverting attention among donor agencies from the importance of water supply and sanitation (WS&S) in developing nations. The principal factor that led to the adoption of ORT is its apparent low cost per diarrheal death averted in children when compared with WS&S. However, WS&S provides many more benefits that are essential to sustaining the lives saved by ORT and vital to maintaining and enhancing the lives of adults and children. Among many other benefits WS&S prevents spread of the causes of diarrhea, controls many other water- and sanitation-related diseases, releases women from the heavy and time-consuming burden of carrying water from distant sources, and improves the quality of life in the community. Cost comparisons between WS&S and ORT are misleading. WS&S is a long-term investment in preventive health while ORT is a response to an immediate life-threatening situation. WS&S interventions eliminate unsanitary conditions leading to illness and death while ORT has no effect on the causes of diarrheal morbidity. The costs of WS&S are not high: $5 to $10 per capita annually. Without WS&S and hygiene education ORT programs are not likely to effect long-term improvement in child health status. ORT and WS&S programs are complementary; one should not displace the other.
Wife's level of education and husband's risk of primary cardiac arrest.
Authors: Strogatz D S , Siscovick D S , Weiss N S , Rennert G
Published: November 2008

Data from a case-control study were analyzed to examine wife's education and risk of primary cardiac arrest in the husband. Men whose wives had more than 12 years of education had 80 per cent the rate of men with less educated wives (odds ratio = 0.8, 95% confidence interval = 0.5, 1.3), after adjustment for risk factors. There was no evidence of a status incongruity effect. These data are inconsistent with reports of positive associations between wife's education and coronary heart disease.
Behavioral aspects of cigarette smoking among industrial college men of Shanghai, China.
Authors: Li V C , Hu J H , Zhou M L , Zheng J B
Published: November 2008

A questionnaire survey was conducted among 7,665 students and staff in the factory-operated industrial colleges in Shanghai, China. Response rate was 95.7 per cent. The proportion of smokers among the men was 50.5 per cent; only 0.33 per cent of the women reported they were smokers. Male smokers began smoking upon entering the work force, where social interaction encourages cigarette smoking. Seventy per cent of the male smokers smoked fewer than 10 cigarettes per day. Only 4.3 per cent perceived themselves as very addicted; 3.4 per cent reported they had no confidence in their ability to control the amount they smoke. The Chinese smokers are more likely to succeed in giving up cigarette smoking for at least one day, as well as for longer periods, compared to US smokers. The number of cigarettes smoked may be related to the individual's purchasing power. For China, strategic timeliness in legislative action and education is urgently needed to combat the high prevalence of cigarette smoking in males, at extremely high risk.
Drug abuse discharges from non-federal short-stay hospitals.
Authors: Gfroerer J C , Adams E H , Moien M
Published: November 2008

An analysis of inpatient drug abuse cases was done using the National Hospital Discharge Survey (NHDS). An estimated two million discharges with a drug abuse diagnosis occurred in non-federal short-stay hospitals during 1979-85, a figure which is believed to be an underestimate. Compared to other hospital inpatients, drug abuse inpatients are more likely to be male, ages 15-44, and other than White race. Increases in hospital use for drug abuse treatment were found to have occurred between 1979 and 1985, with discharge rates per 10,000 population increasing from 3.1 to 6.0 for drug dependence and from 3.8 to 7.7 for nondependent drug abuse. Concurrent increases in availability of hospital-based inpatient drug and alcohol treatment programs and insurance coverage for drug abuse treatment were found to have occurred during the same period.
Prevention of lower extremity stress fractures: a controlled trial of a shock absorbent insole.
Authors: Gardner L I , Dziados J E , Jones B H , Brundage J F , Harris J M , Sullivan R , Gill P
Published: November 2008

A prospective controlled trial was carried out to determine the usefulness of a viscoelastic polymer insole in prevention of stress fractures and stress reactions of the lower extremities. The subjects were 3,025 US Marine recruits who were followed for 12 weeks of training at Parris Island, South Carolina. Polymer and standard mesh insoles were systematically distributed in boots that were issued to members of odd and even numbered platoons. The most important finding was that an elastic polymer insole with good shock absorbency properties did not prevent stress reactions of bone during a 12-week period of vigorous physical training. To control for the confounding effects of running in running shoes, which occurred for about one and one-half hours per week for the first five weeks, we also examined the association of age of shoes and cost of shoes with injury incidence. A slight trend of increasing stress injuries by increasing age of shoes was observed. However, this trend did not account for the similarity of rates in the two insole groups. In addition, we observed a strong trend of decreasing stress injury rate by history of increasing physical activity, as well as a higher stress injury rate in White compared to Black recruits. The results of the trial were not altered after controlling for these factors. This prospective study confirms previous clinical reports of the association of stress fractures with physical activity history. The clinical application of a shock absorbing insole as a preventive for lower extremity stress reactions is not supported in these uniformly trained recruits. The findings are relevant to civilian populations.
Evidence and scientific research.
Authors: Goodman S N , Royall R
Published: November 2008

This commentary reviews the arguments for and against the use of p-values put forward in the Journal and other forums, and shows that they are all missing both a measure and concept of "evidence." The mathematics and logic of evidential theory are presented, with the log-likelihood ratio used as the measure of evidence. The profoundly different philosophy behind evidential methods (as compared to traditional ones) is presented, as well as a comparative example showing the difference between the two approaches. The reasons why we mistakenly ascribe evidential meaning to p-values and related measures are discussed. Unfamiliarity with the technology and philosophy of evidence is seen as the main reason why certain arguments about p-values persist, and why they are frequently contradictory and confusing.
The accuracy of industry data from death certificates for workplace homicide victims.
Authors: Davis H
Published: November 2008

This study compared death certificate data on usual industry for workplace homicide victims in five urban Texas counties, with medical examiners' data on the industries where victims were working when injured. The overall positive predictive value of the death certificate data was 72 per cent. Death certificate data on usual industry underestimated the number of victims working in high-risk industries when injured, partly because of victims whose usual industry was recorded as student, housewife, or military personnel.
Problems with surveillance methods for alcoholism: differences in coding systems among federal, state, and private agencies.
Authors: Westermeyer J
Published: November 2008

Social indicator systems can serve as a social accounting method to guide public policy on alcoholism, utilizing data which are routinely collected at public expense. An attempt to develop an alcoholism social indicator system for Minnesota demonstrated many differences in the coding schemes used by various state agencies and institutions. These findings have relevance to other social indicator systems being developed to assess public policies regarding the people's health.
Epidemic giardiasis caused by a contaminated public water supply.
Authors: Kent G P , Greenspan J R , Herndon J L , Mofenson L M , Harris J A , Eng T R , Waskin H A
Published: November 2008

In the period November 1, 1985 to January 31, 1986, 703 cases of giardiasis were reported in Pittsfield, Massachusetts (population 50,265). The community obtained its water from two main reservoirs (A and B) and an auxiliary reservoir (C). Potable water was chlorinated but not filtered. The incidence of illness peaked approximately two weeks after the city began obtaining a major portion of its water from reservoir C, which had not been used for three years. The attack rate of giardiasis for residents of areas supplied by reservoir C was 14.3/1000, compared with 7.0/1000 in areas that received no water from reservoir C. A case-control study showed that persons with giardiasis were more likely to be older and to have drunk more municipal water than household controls. A community telephone survey indicated that over 3,800 people could have had diarrhea that might have been caused by Giardia, and 95 per cent of households were either using alternate sources of drinking water or boiling municipal water. Environmental studies identified Giardia cysts in the water of reservoir C. Cysts were also detected in the two other reservoirs supplying the city, but at lower concentrations. This investigation highlights the risk of giardiasis associated with unfiltered surface water systems.
Selecting patients when resources are limited: a study of US medical directors of kidney dialysis and transplantation facilities.
Authors: Kilner J F
Published: November 2008

This study reports and discusses responses of 453 medical directors of renal dialysis and transplantation facilities to detailed patient selection questionnaires. The questionnaires examine selection criteria being used today as well as those which would be employed were resources to remain or become scarce relative to need. Selection criteria examined (and the number of directors supporting them when resources are limited) are: qualitative prognosis, psychological stability, likelihood of medical benefit, quantitative prognosis, medical benefit (virtually all); willingness, age (very large majority); unique moral duties, disproportionate resources, environment, progress of science, social value (majority); ability to pay, random selection, constituency (very large minority); sex (virtually none). Qualitative prognosis, quantitative prognosis, medical benefit, ability to pay, and especially age are the criteria employed today whose influence would increase if resources are further limited. Some of the ethical implications of various criteria are discussed.
The quality of care is related to death rates: hospital inpatient management of infants with acute gastroenteritis in Jamaica.
Authors: Walker G J , Ashley D E , Hayes R J
Published: November 2008

The quality of care of random samples of about 40 infants admitted with acute gastroenteritis to each of five hospitals in Jamaica was assessed. Low levels of adherence to consensus care criteria appeared to be correlated with high levels of hospital-specific severity standardized mortality ratios X100 (SSMRs); poor adherence, SSMR 127-230; intermediate adherence, SSMR 95; good adherence, SSMR 14. The main deficiencies in care at certain hospitals were: non-weighing of infants, incomplete physical examination, inadequate estimation of fluid requirements, and irregular recording of fluid intake. To improve the effective care of infants with gastroenteritis, a quality assurance program is required.
State-level pharmaceutical assistance programs for the elderly: a national survey.
Authors: Berry G L , Smyer M A , Lago D
Published: November 2008

In order to put Pennsylvania's Pharmaceutical Assistance Contract for the Elderly (PACE) Program in a national context, a nationwide mail survey and telephone follow-up to each of the 58 State Unit Directors on Aging in the United States and its territories identified 10 programs. The results reported in this article are specific to the seven state-level pharmaceutical assistance programs which were in operation during the fiscal year 1984-85. In general, the programs varied on select program characteristics and on their efforts to address major policy issues. Data from the non-program states indicated support, legislative efforts, and a high interest in fiscal concerns. The findings reflect a lack of program uniformity and have implications for program development and implementation. Suggestions on how to identify the "optimum" or best combination of program and policy options are discussed.
The 1989 revisions of the US Standard Certificates of Live Birth and Death and the US Standard Report of Fetal Death.
Authors: Freedman M A , Gay G A , Brockert J E , Potrzebowski P W , Rothwell C J
Published: November 2008

The US Standard Certificates and Reports are models used by state vital statistics offices to develop documents for the collection of data about vital events. The 1989 revisions incorporate some major modifications to previous versions. Both the Standard Certificate of Live Birth and the Standard Report of Fetal Death utilize a checkbox format to elicit information on medical and other risk factors affecting the pregnancy, complications of labor and/or delivery, obstetric procedures, method of delivery, congenital anomalies, and abnormal conditions of the newborn. Revisions to the Standard Certificate of Death include modifications to the medical certification section and the addition of decedent's educational attainment. Items requesting information about Hispanic origin are added to all of these documents. The rationale behind these changes and their intended use are discussed.
Maternal smoking and low birthweight in the reproductive history of women in Puerto Rico, 1982.
Authors: Becerra J E , Smith J C
Published: November 2008

In 1982, a representative sample of 3,175 women ages 15 to 49 years living in Puerto Rico were interviewed and complete reproductive histories obtained. Births to mothers who started smoking regularly at some time before delivery and who were still smoking at the time of the interview (the exposure definition) were compared with unexposed births. Our analysis of 4,444 single, live births delivered in public and private hospitals from 1946 through 1982 demonstrates that births to smoking women aged 20 and older delivering in public hospitals were 2.5 times more likely to weigh less than 2,500 grams (95% confidence interval (CI) = 1.9, 2.3), and on the average weighed 207 grams less (95% CI = 130, 284) than births to a comparable group of nonsmoking mothers. However, we found no other difference in birthweight between newborns of smoking and nonsmoking women when comparing their births within the same hospital category and age group. The data in this study suggest that the effect of smoking on birthweight among births to Puerto Rican women may be modified by maternal age and by whether the infant was born in a private or public hospital.
Polio immunization policy in the United States: a new challenge for a new generation.
Authors: Salk D
Published: November 2008

The primary reason that live poliovirus vaccine is recommended in the United States today is because it may immunize contacts who have not otherwise chosen to be vaccinated. This policy places contacts at risk of paralysis from an untested, unlicensed "spread virus" vaccine and places infants at risk for an unproven, theoretical benefit to others, not themselves. The licensed killed poliovirus vaccine provides equivalent protection to those vaccinated, with no risk to recipients or contacts. The preceding analysis by Hinman, et al, is an interesting exercise in modeling, but many of their assumptions are open to question. Their sweeping conclusions are not justified by the type of analysis performed, which should yield an overall assessment of a decision environment not a single optimal choice. No measure of perceived social consequence or patient attitude is included, although this is of central importance today. Their report lends an aura of credibility to one conclusion, but this credibility is illusory at best. The major social issue today is not which vaccine to use, but how should polio immunization policy be evaluated.
Decision analysis and polio immunization policy.
Authors: Hinman A R , Koplan J P , Orenstein W A , Brink E W
Published: November 2008

Dr. Salk's comments on our paper fall into four major categories: our use of the techniques of decision analysis, the assumptions we used, the fact that we did not include individual and social values in the model, and the way in which vaccine policies are developed in the United States. We believe that the methods were used correctly, that the assumptions we used are defensible, and that our conclusions were both appropriate and appropriately worded. We explicitly did not include individual and social values since we were addressing the scientific and epidemiologic issues rather than ethical and moral issues. Vaccine policy development in the United States is carried out in public forums with opportunity for presentation of all sides of an issue.
Pathogenic micro-organisms and helminths in sewage products, Arabian Gulf, country of Bahrain.
Authors: Amin O M
Published: November 2008

Fecal and sludge samples from the Arabian Gulf country of Bahrain contained poliomyelitis and coxackie viruses, coliform bacteria, Escherichia coli, Salmonella spp., Shigella sonni, fecal streptococci, Balantidium coli, Ascaris lumbricoides and Hymenolepis nana eggs, and Strongyloides stercoralis. Sludge produced in the central sewage treatment plant is used for agricultural purposes and poses a threat to public health. Recommendations to reduce the potential health hazards are made.
Prevention of AIDS and HIV infection: needs and priorities for epidemiologic research.
Authors: Allen J R , Curran J W
Published: November 2008

By the end of 1987, almost 50,000 cases of acquired immunodeficiency syndrome (AIDS) will have been reported in the United States. Although the primary epidemiology of the disease has been described, much work remains to be done to complete our understanding of the dynamics of transmission and infection with the causative virus, human immunodeficiency virus (HIV). At the state and local level, the highest priorities for epidemiologic research are to understand better the precise populations at risk of prevalent and incident HIV infection, and to use this information to direct and monitor specific prevention programs that are likely to be effective for the populations at risk. These parallel efforts-sophisticated investigative epidemiologic research and applied epidemiologic and serosurveillance studies-must be expanded rapidly and continued for the forseeable future if we are to accomplish the goal of preventing further spread of HIV.
Geographic distribution of human immunodeficiency virus markers in parenteral drug abusers.
Authors: Lange W R , Snyder F R , Lozovsky D , Kaistha V , Kaczaniuk M A , Jaffe J H
Published: November 2008

Drug abuse treatment programs in six regions of the United States collaborated in a study aimed at monitoring trends in the seroprevalence of human immunodeficiency virus (HIV) antibodies. The wide disparities in HIV seroprevalence in the face of similarities in drug using behavior have important implications for prevention. In the New York City area (Harlem, Brooklyn), 61 per cent of samples (N = 280) obtained in late 1986 were positive, up from 50 per cent of samples (N = 585) in early 1985. In Baltimore, Maryland, 29 per cent of samples (N = 184) representing 11 programs were positive. In contrast, samples from programs distant from the Northeast corridor had far lower rates: Denver, Colorado 5 per cent (N = 100); San Antonio, Texas 2 per cent (N = 106); Southern California, 1.5 per cent (N = 413); and Tampa, Florida, 0 per cent (N = 102). Contrary to expectations, there was no corresponding difference in reported lifetime needle sharing experiences, which ranged from 70 per cent in New York to 99 per cent in San Antonio. HIV seropositivity was associated only with geographic location and ethnicity; however, because needle sharing is practiced by parenteral drug abusers in areas where seroprevalence is still relatively low, these areas are potentially vulnerable to the same catastrophic spread seen in the Northeast. A window of opportunity exists where prompt, vigorous, and aggressive efforts at prevention could have major impact.
Concerns of medical and pediatric house officers about acquiring AIDS from their patients.
Authors: Link R N , Feingold A R , Charap M H , Freeman K , Shelov S P
Published: November 2008

To assess the degree of house officers' concerns about acquiring AIDS (acquired immunodeficiency syndrome) from their patients, we surveyed 263 medical and pediatric interns and residents in four housestaff training programs affiliated with seven New York City hospitals with large AIDS patient populations; 258 questionnaires (98 per cent) were returned. Thirty-six per cent of medical and 17 per cent of pediatric house officers reported percutaneous exposures to needles contaminated with blood of AIDS patients. Forty-eight per cent of medical and 30 per cent of pediatric house officers reported a moderate to major concern about acquiring AIDS from their patients. Greater concern about personal risk was noted in those house officers who were earlier in their residency training, who reported having treated a greater number of AIDS patients, and who were in medicine rather than pediatrics programs. Twenty-five per cent of all respondents reported that they would not continue to care for AIDS patients if given a choice. The results demonstrate a substantial degree of concern about acquiring AIDS among house officers caring for AIDS patients and suggest the need for housestaff program administrators for formally address these concerns.
Effects of HIV antibody test knowledge on subsequent sexual behaviors in a cohort of homosexually active men.
Authors: McCusker J , Stoddard A M , Mayer K H , Zapka J , Morrison C , Saltzman S P
Published: November 2008

This study assesses the effects of HIV (human immunodeficiency virus) antibody testing on subsequent (one year) sexual behavior among 270 homosexual men at a Boston community health center, 21 per cent of whom were unaware of their test result. Except for the number of steady partners, the levels of all sexual activities of all groups of study participants declined over time. No effects of test awareness of antibody status were found on protective behavior for receptive anogenital contact. Elimination of unprotected insertive anogenital contact (by elimination of the practice or by condom use) was reported somewhat more often among seropositive men who became aware of their test result. Increased negative emotional reactions were reported by HIV seropositive men who were aware of their test result. These results suggest some behavioral impact of HIV antibody test knowledge in this cohort, but may not be generalizable to other populations.
Birthweight-specific infant mortality for native Americans compared with whites, six states, 1980.
Authors: Vanlandingham M J , Buehler J W , Hogue C J , Strauss L T
Published: November 2008

We used data from the National Infant Mortality Surveillance (NIMS) project to compare birthweights and birthweight-specific mortality risks among Native American and White infants. Because race categories in NIMS were limited to White, Black, and all, we studied six states in which greater than 85 per cent of newborns who were neither White nor Black were Native American. In these states, the infant mortality risk (IMR) among Native Americans was 15.3 deaths per 1,000 live births compared with 8.7 deaths among Whites, relative risk (RR) = 1.8 (95% CI = 1.5-2.0). The percentage of Native American infants with less than 2,500 g birthweights was 5.8 per cent versus 5.0 per cent for White infants. Birthweight-specific neonatal mortality risks were similar for the two race groups, but birthweight-specific postneonatal mortality risks (PNMRs) were more than three times as high among Native Americans compared with Whites for infants of greater than or equal to 2,500 g birthweight. PNMRs were elevated for most causes of death and for all categories for maternal age, educational attainment, trimester prenatal care began, and number of previous live births. Leading causes of postneonatal death among Native Americans of greater than or equal to 2,500 g birthweight were sudden infant death syndrome and infections.
Studying patterns of cancer care: how useful is the medical record?
Authors: Feigl P , Glaefke G , Ford L , Diehr P , Chu J
Published: November 2008

Records of hospital inpatients were abstracted for 5,000 newly diagnosed cancer patients admitted in 1982-83 to 17 Comprehensive Cancer Centers and 17 Community Hospital Oncology Programs. Generally available data items (silent record rate less than 5 per cent for the typical institution) included: age, race, sex, dates of hospitalization, zip code of residence, pathological stage, dates of biopsy and surgery, numbers of nodes examined and positive, certain diagnostic procedures, and some radiotherapy descriptors. For other data items, there was enormous variability in completeness and high institution-to-institution variation. Record completeness did not differ consistently between comprehensive and community cancer centers. We conclude that the hospital patient record is useful for tracking the frequency of surgical and related events. However, studies of diagnostic and therapeutic procedures should not rely solely on the hospital medical record due to the high rates of silent records.
Sleep apnea and mortality in an aged cohort.
Authors: Bliwise D L , Bliwise N G , Partinen M , Pursley A M , Dement W C
Published: November 2008

In the aged, sleep may be a vulnerable period for death from cardiovascular causes. Because of its high prevalence in the elderly, sleep apnea has been suggested to be one mechanism contributing to such sleep-related mortality. In this study, a cohort of 198 non-institutionalized elderly individuals (mean age at entry = 66) were followed for periods up to 12 years after initial polysomnography. The mortality ratio for sleep apnea (defined as a Respiratory Disturbance Index of over 10 events per sleep hour) was estimated to be 2.7 (95% CI = .95, 7.47). Multiple regression with the Cox proportional hazards model suggested that cardiovascular death was most clearly associated with age in this cohort. These results raise the possibility that "natural" death during sleep in the elderly may be associated with specific pathophysiological events during sleep.
Patterns of blood donations among individuals at risk for AIDS, 1984.
Authors: Seage G R , Barry M A , Landers S , Silvia A M , Lamb G A
Published: November 2008

Of 978 respondents to an anonymous questionnaire targeted to reach homosexuals in Boston during October 1984, 88 (9 per cent) reported recent blood donation. When compared to non-recent donors, high-risk respondents who were recent blood donors were younger, less open about their sexual preference, and more likely to obtain their information about AIDS (acquired immunodeficiency syndrome) from television and newspapers. These results suggest that particular subgroups of the population at risk for AIDS would benefit from expanded educational programs.
Judging maturity in the courts: the Massachusetts consent statute.
Authors: Yates S , Pliner A J
Published: November 2008

This study examined the Case Summary Questionnaires completed by attorneys representing minors at judicial consent for abortion hearings in Massachusetts and filed with the Women's Bar Association. The 477 Case Summaries filed between December 1981 and June 1985 were analyzed to provide a more systematic account of how the judicial consent statute is applied in the courtroom. After hearings which typically lasted 12 minutes, only nine minors were judged immature. No evidence for a discernible pattern justifying these rulings emerged from an examination of petitioner and court characteristics such as age, length of hearing, number of weeks pregnant, or presiding judge. Further, 11 lawyers privately reported they found their clients immature. In only one instance, however, did the lawyer and judge identify the same adolescent. The findings add to a growing body or research that calls into question the ability of the consent statute to protect the best interest of the minors involved.
Congenital limb reduction defects in the agricultural setting.
Authors: Schwartz D A , LoGerfo J P
Published: November 2008

To ascertain whether parental involvement in agricultural work and residence in an agricultural setting are associated with the development of congenital limb reduction defects, we carried out a case-control study using California birth records from 1982, 1983, and 1984. Cases with limb reduction defects (N = 237) and randomly selected controls (N = 475) were compared regarding parental occupation and maternal county of residence. After adjustment for potential confounders in a multivariate analysis, the estimated relative risk (RR) of parenting a child with a limb reduction defect among parents involved in agricultural work was 0.9 (95 per cent confidence limits = 0.4, 1.7). The RR among mothers who resided in a county of high agricultural productivity as compared with minimal agricultural productivity was 1.7 (95% CL = 1.1, 2.7), while the RR associated with residence in a county with high pesticide use as compared with minimal pesticide use was 1.9 (95% CL = 1.2, 3.1). When we limited the cases to children with limb reduction defects who had at least one additional anomaly (n = 79) and compared them to the control births, the corresponding RRs were 1.6 (95% CL = 0.7, 3.6), for parental involvement in agricultural work, 2.4 (CL = 1.2, 4.7) for county agricultural productivity, and 3.1 (CL = 1.5, 6.5) for county pesticide use.
Short interpregnancy interval and the risk of low birthweight.
Authors: Klebanoff M A
Published: November 2008

The effect of interpregnancy interval on the birthweight of the subsequent child was investigated in a cohort of 5,938 women who registered for two consecutive pregnancies in the Collaborative Perinatal Project. Mean birthweight increased from 3,101 grams for intervals of less than 3 months to 3,193 grams for intervals of 15-17.9 months and remained stable thereafter (p for trend = 0.006). However, women with shorter intervals were younger, lighter weight, and less educated at the beginning of the first pregnancy than were women with longer intervals; the birthweight of their previous child was lower, and they were of marginally lower socioeconomic status. Adjustment for confounders reduced the maximum difference in mean birthweight by interval length from 92 to 39 grams, and blunted the trend for lower birthweights with shorter intervals (p = 0.45). Similarly, adjustment reduced the increased risk of low birthweight among women with the shortest intervals from 52 per cent to 12 per cent. We conclude that a short interpregnancy interval is primarily a marker for a woman who is otherwise at high risk, and that modification of this interval alone may be unlikely to have a major impact on low birthweight.
Physical activity and coronary heart disease in middle-aged and elderly men: the Honolulu Heart Program.
Authors: Donahue R P , Abbott R D , Reed D M , Yano K
Published: November 2008

The relationship of physical activity to the development of definite coronary heart disease was examined separately in middle-aged (45-64 years) and elderly men (65-69 years) participating in the Honolulu Heart Program. After 12 years of follow-up, results indicate that increased levels of physical activity reported at study entry were inversely related to the risk of definite coronary heart disease in both age groups. In particular, among those aged 45 to 64 years, the rate of definite coronary heart disease in men who led active life styles was 30 per cent lower than the rate experienced by those who were less active (relative risk, 0.69; 95% confidence interval, 0.53, 0.88). In those older than 64 years, the rate of definite coronary heart disease in active men was less than half the rate experienced by those who led more sedentary life styles (relative risk, 0.43; 95% CI, 0.19, 0.99). These results continued to hold up when controlling for several cardiovascular risk factors and potentially confounding variables, supporting earlier observations that physical activity is beneficial in middle-age, and further suggesting that benefits may extend to the elderly male population as well.
Public health at the 1984 Summer Olympics: the Los Angeles County experience.
Authors: Weiss B P , Mascola L , Fannin S L
Published: November 2008

During the 1984 Summer Olympic Games, the Los Angeles County Department of Health Services used its active disease surveillance system to monitor disease occurrence and other health concerns. Reports were collected by telephone three times a week from 198 participating facilities including hospitals, prepaid health plans, private physicians, and Olympic sites. Background data were obtained two months preceding the Olympic events. Less illness was recorded during the Olympics than during the same period for the three preceding years.
Prevalence of the misuse of ultra-low-tar cigarettes by blocking filter vents.
Authors: Kozlowski L T , Pope M A , Lux J E
Published: November 2008

Evidence from tar-stain patterns in 135 cigarette filters discarded in ashtrays in public areas of shopping malls was used to estimate the prevalence of behaviorally blocked air dilution vents in ultra-low-yield cigarettes. Nineteen per cent (+/- 4, standard errors of the mean) of the filters had been blocked extremely, 39 per cent (+/- 5 SEM) had been blocked to some degree, and 42 per cent (+/- 5 SEM) had not been blocked at all. Smokers, health practitioners, and researchers need to be warned of the risks of vent blocking.
Gonorrhea rates: what denominator is most appropriate?
Authors: Aral S O , Schaffer J E , Mosher W D , Cates W
Published: November 2008

We used traditional crude population denominators and four different definitions of sexual activity to calculate progressively more refined gonorrhea rates among reproductive age women. Refining denominators to take sexual activity into account had the largest impact on morbidity rates for young women. Traditional denominators severely underestimate gonorrhea rates in teenagers, and understate the real magnitude of gonorrhea risk among sexually active teenagers.
Perinatal and infant mortality rates and place of birth in Italy, 1980.
Authors: Parazzini F , La Vecchia C
Published: November 2008

In 1980, the ratio of home birth to public hospital perinatal and neonatal mortality rates decreased from Northern to Southern Italy, being inversely related to the proportion of home deliveries and probably reflecting the effect of planned versus unplanned home births. The post neonatal mortality rate in Southern Italy was about four times as high in children born at home (9.5/1,000 live births) than in those delivered in public hospitals (2.6/1,000 live births), probably reflecting differences in the socioeconomic status according to the birthplace selection in various regions.
Physical fitness in children: a survey method based on parental report.
Authors: Murphy J K , Alpert B S , Christman J V , Willey E S
Published: November 2008

In the present study of 213 healthy children, the relation between parental reports of activity level and laboratory-determined physical fitness was examined. Results indicated that parental reports of activity level were associated with fitness for the entire sample. The association was most consistent among White children who resided in a household that was headed by their father.
Why does family homelessness occur? A case-control study.
Authors: Bassuk E L , Rosenberg L
Published: November 2008

We compared 49 homeless female-headed families with 81 housed female-headed families in Boston. Most housed families were living in public or private subsidized housing. In both groups the mothers were poor, currently single, had little work experience, and had been on welfare for long periods. Many of their children had serious developmental and emotional problems. Homeless mothers had more frequently been abused as children and battered as adults and their support networks were fragmented; the housed mothers had female relatives and extended family living nearby whom they saw often. The frequency of drug, alcohol, and serious psychiatric problems was greater among the homeless mothers. The homeless mothers may have been more vulnerable to the current housing shortage because they lacked support in time of need. This, in turn, may have been due to their history of family violence. Psychiatric disabilities may have been another contributing factor in the minority of homeless women. The notion that a "culture of poverty" accounts for homelessness was not supported by the data since the homeless were less likely to have grown up in families on welfare. The data suggest that solutions to family homelessness in the current housing market require an increase in the supply of decent affordable housing, income maintenance, and assistance from social welfare agencies focused on rebuilding supportive relationships.
A cluster of unexplained deaths in a nursing home in Florida.
Authors: Sacks J J , Herndon J L , Lieb S H , Sorhage F E , McCaig L F , Withum D G
Published: November 2008

In the two-week period November 13-27, 1984, 12 patients died in a 54-bed nursing home in Florida; based on previous mortality patterns, 2.5 deaths would have been expected for the whole month. There was no similar increase in deaths in November 1984 and no comparable monthly death rate for any of 69 nursing homes in the same county from 1976-84. Comparison of the 12 deaths in November with 28 deaths that occurred during the previous 10 months and with 31 surviving patients who were continuously present in the nursing home between November 12-28, 1984 revealed that the patients who died in November were more likely to have had onset of the terminal event during the night shift, had a recent visitor, and had an admitting diagnosis of organic brain syndrome. The abrupt increase in the death rate for November 1984 was not associated with a measurable change in population characteristics, an outbreak of infectious disease, or changes in procedures or the environment. Reviews of employee schedules revealed a consistent and strong association between the duty times of two nurses and the onsets of the terminal episode and the times of patient deaths. Continuing epidemiologic surveillance of adverse outcomes in nursing homes is recommended.
Sensitivity and specificity of clinical case definitions for pertussis.
Authors: Patriarca P A , Biellik R J , Sanden G , Burstyn D G , Mitchell P D , Silverman P R , Davis J P , Manclark C R
Published: November 2008

We evaluated the diagnostic performance of 15 clinical case definitions for pertussis in 233 patients who developed acute respiratory illness during community outbreaks in Wisconsin and Delaware. Using results from culture (Regan-Lowe media) and serology (Ig-class-specific ELISA) as diagnostic standards, cough for greater than or equal to 14 days was both sensitive (84 per cent-92 per cent) and specific (63 percent-90 per cent) in identifying patients with pertussis. This definition may be useful in monitoring pertussis outbreaks and for investigating contacts of culture-positive cases.