bluuebunny/crossref_metadata_2025 huggingface dataset:
AIDS deaths shift from hospital to home. AIDS Mortality Project Group.
Authors: Kelly J J , Chu S Y , Buehler J W
Published: November 2008

OBJECTIVE. This study monitors trends in place of death among persons with acquired immunodeficiency syndrome (AIDS) as a measure of health care usage patterns and terminal health care among persons infected with human immunodeficiency virus (HIV). METHODS. Sixteen health departments collected death certificates for 55,186 persons with AIDS whose deaths occurred through 1991. Place of death was categorized as hospital, residence, hospice or nursing home, and other. RESULTS. The percentage of AIDS deaths at hospital facilities decreased from 92% in 1983 to 57% in 1991. In 1988, 23% of deaths occurred at home or in hospices and nursing homes. This trend was more evident among men, Whites, and men who had sex with men; less so among persons with other modes of exposure; and not at all among injecting drug users and children with perinatally acquired AIDS. Place of death varied by geographic location, with the greatest percentage of hospital deaths in the Northeast (91%) and the greatest percentage of at-home deaths in the West (27%). CONCLUSIONS. The percentage of AIDS deaths at home or in hospices and nursing homes has increased since 1983. These trends may reflect changes in hospital use for end-stage HIV infection. Decreasing hospitalization and increasing outpatient services and home care will decrease costs and may allow HIV-infected persons improved social support.
HIV infection in hospitalized patients and Medicaid enrollees: the accuracy of medical record coding.
Authors: Rosenblum L , Buehler J W , Morgan M W , Costa S , Hidalgo J , Holmes R , Lieb L , Shields A , Whyte B
Published: November 2008

To evaluate the accuracy of computerized medical-record coding for human immunodeficiency virus (HIV), medical charts were reviewed in six sites. In 7601 hospital and 867 Medicaid records with a listed diagnosis of HIV, the predictive value for HIV was 91% or higher. HIV was identified in 34% of 1155 Medicaid records listing immune disorder or illness in the acquired immunodeficiency syndrome (AIDS) surveillance definition (without an HIV code). In hospital and Medicaid records, AIDS was identified both in records listing AIDS and records listing HIV without AIDS. HIV codes on hospital and Medicaid records were highly predictive for HIV; undercoding of HIV occurred in Medicaid records.
Subjective knowledge of AIDS and use of HIV testing.
Authors: Phillips K A
Published: November 2008

Increasing knowledge is an important goal of human immunodeficiency virus (HIV) prevention strategies, although increased knowledge may not be associated with increased preventive behaviors. This study examines the association of (1) objective and subjective acquired immunodeficiency syndrome (AIDS) knowledge, and (2) both objective and subjective AIDS knowledge with HIV testing use. Data are from the 1988 National Health Interview Survey. Objective and subjective knowledge were only moderately correlated. In regression analyses, higher subjective knowledge was significantly associated with higher testing use, but objective knowledge was not. The results are relevant to other preventive behaviors for which knowledge is an important factor.
Preventing tap water scalds: do consumers change their preset thermostats.
Authors: Webne S L , Kaplan B J
Published: November 2008

One goal of the regulatory approach to tap water scald prevention is the installation of hot water heaters at thermostat settings considered safe. In this strategy, it is assumed that consumers will not change preset thermostat settings, an assumption evaluated in a study of 62 families. It was found that 60% of the sample did not change their preset thermostats. Surprisingly, some of those families (27%) who did not increase their settings still had unsafe (> 54 degrees C) water temperatures.
AIDS and the limits of control: public health orders, quarantine, and recalcitrant behavior.
Authors: Bayer R , Fairchild-Carrino A
Published: November 2008

We undertook a survey to document the extent to which public health powers have been used to warn or restrict individuals infected with human immunodeficiency virus (HIV) whose behavior poses a risk of transmission to others. In the period from 1981 through 1990, 24 state health departments either had no mechanism for receiving reports about individuals whose behavior posed a risk of HIV transmission or took no action if they had received such reports. In states that had developed programs for dealing with such individuals, the most common response was the use of cease and desist orders. As of 1992, 10 instances of quarantine had been reported, almost all of which involved relatively brief periods of isolation. Whatever justification exists for using public health authority to confront individuals whose behavior poses a risk of HIV transmission to others, it is clear that the central focus of HIV prevention efforts must remain education, counseling, voluntary testing and partner notification, drug abuse treatment, and needle exchange programs.
Adult health: a legitimate concern for developing countries.
Authors: Phillips M , Feachem R G , Murray C J , Over M , Kjellstrom T
Published: November 2008

Adults, defined here as people between 15 and 59 years of age, in developing countries have a high risk of premature death and suffer from frequent morbidity and high rates of chronic impairment. Their ill health imposes a major burden on health services and large negative consequences on families, communities, and societies. This paper describes the level and impact of adult mortality and morbidity, and highlights some of its characteristics and causes, which in some cases contradict commonly held beliefs. It concludes that "adult health" is a legitimate public health concern for developing countries that is not being addressed. An agenda for remedial research and action is proposed.
A developing country's university oriented toward strengthening health systems: challenges and results.
Authors: Bryant J H , Marsh D R , Khan K S , D'Souza R , Husein K , Aslam A , Qureshi A F , deWit V , Harnar R M
Published: November 2008

OBJECTIVES. The Aga Khan University in Karachi has a mission to educate leaders and to contribute to the development of health systems for Pakistan amid challenges of scarcity and complexity. METHODS. Its key activities are (1) to design and test urban and rural health system prototypes, (2) to develop faculty in medical and nursing postgraduate community health sciences programs, and (3) to design and implement community-based undergraduate medical and nursing curricula. RESULTS. The university has developed equity-based, cost-effective primary health care prototypes in Karachi slums. With government counterparts it has tested village-, facility-, and district-level interventions in a poor rural district. Federal policymakers have taken models from each for widespread replication. The university is training 49 medical and 19 nursing faculty for postgraduate programs in community health sciences. Most faculty retain institutional leadership positions, including teaching community-based, problem-solving, community health sciences as 20% of the medical and nursing undergraduate curriculum. CONCLUSIONS. The mission and experience of the Aga Khan University in population-based health systems design and health sciences education can guide universities in both developing and developed countries.
Physicians who have practiced in both the United States and Canada compare the systems.
Authors: Hayes G J , Hayes S C , Dykstra T
Published: November 2008

OBJECTIVES. The aim of this study was to examine the US and Canadian systems from the unique perspective of physicians who have practiced in both Canada and the United States. METHODS. Questionnaires were sent to 355 Canadian physicians who graduated from US medical schools and 347 US physicians who graduated from Canadian medical schools. RESULTS. The overall response rate was 59% (65% of US-graduated Canadian physicians and 54% of Canadian-graduated US physicians). Thirty-six percent of the respondents were "dual experience" physicians; that is, they had practiced medicine in both countries after completing their medical training. Physicians who left Canada were more likely than those who left the United States to indicate dissatisfaction with the health care system as a reason for leaving. Respondents expressed greater professional satisfaction with their current country of practice, but overall, dual-experience physicians in the United States favored that system only slightly more than the Canadian system, whereas those in Canada rated the Canadian system significantly better than the US system. CONCLUSIONS. The comparatively weak rating of the US system by dual-experience physicians underlines the need for health care reform.
The effects of a natural disaster on child behavior: evidence for posttraumatic stress.
Authors: Durkin M S , Khan N , Davidson L L , Zaman S S , Stein Z A
Published: November 2008

OBJECTIVES. A prospective study of children examined both before and after a flood disaster in Bangladesh is used to test the hypothesis that stressful events play a causal role in the development of behavioral disorders in children. METHODS. Six months before the disaster, structured measures of selected behavioral problems were made during an epidemiological study of disability among 2- to 9-year-old children. Five months after the disaster, a representative sample of 162 surviving children was reevaluated. RESULTS. Between the pre- and postflood assessments, the prevalence of aggressive behavior increased from zero to nearly 10%, and 45 of the 134 children who had bladder control before the flood (34%) developed enuresis. CONCLUSIONS. These results help define what may be considered symptoms of posttraumatic distress in childhood; they also contribute to mounting evidence of the need to develop and evaluate interventions aimed at ameliorating the behavioral and psychological consequences of children's exposure to extreme and traumatic situations.
An epidemic of pesticide poisoning in Nicaragua: implications for prevention in developing countries.
Authors: McConnell R , Hruska A J
Published: November 2008

OBJECTIVES. The purpose of this study was to demonstrate the usefulness of the Northwestern Nicaraguan Ministry of Health surveillance system for detecting pesticide poisonings. METHODS. Cases were reported to the regional department of epidemiology through daily telephone reports and through monthly consolidated reports from each of the 18 health centers of the National Health Service. Reporting forms were also distributed to the four area hospitals. RESULTS. During June and July 1987, an epidemic of 548 pesticide poisoning was detected in northwestern Nicaragua. Seventy-seven percent of the poisonings were caused by carbofuran or methamidophos. Of the work-related cases (91% of reported poisonings), more than 80% occurred among maize farmers and on small to medium land holdings (fewer than 140 hectares). Nineteen percent of the work-related cases involved children under 16 years of age. CONCLUSIONS. Unsafe working conditions such as manual application of pesticides and the use of backpack sprayers, the introduction of a hazardous powdered formulation of carbofuran highly restricted in the developed world, and agricultural subsidies that encouraged the use of hazardous pesticides all contributed to the epidemic.
Fatal occupational injury rates: Quebec, 1981 through 1988.
Authors: Rossignol M , Pineault M
Published: November 2008

OBJECTIVES. The purpose of the study was to estimate the death rates from occupational injuries in the province of Quebec for the period 1981 through 1988. METHODS. Worker's compensation files were used to ascertain numbers of deaths, which were used as the numerators in figuring the rates (it was estimated that these files reported 83% of the true number of deaths among men). Annual average estimates of the labor force were used as denominators. RESULTS. From 1981 through 1988, compensation was awarded for 1227 fatal work injuries. Among men (96% of the victims), rates declined from 1981 to 1988 (from 12.7 to 8.1 per 100,000); women's rates were stable (< or = 1.0 per 100,000). Compared with men, women had excess mortality from violent acts. Motor vehicle crashes accounted for 36% of all fatal injuries in 1984 and 1985 and declined thereafter. Fatal injury rates in forestry and mining rose to a 1987 maximum of 67.6 per 100,000. The construction sector had the largest number of deaths, despite a decline in rates from 1981 to 1988 (from 27.8 to 15.9 per 100,000). CONCLUSIONS. Except for construction and agriculture, reported fatal occupational injury rates in Quebec were similar to those in the United States. Motor vehicle crashes, falls, violent acts, and farming-related injuries were the most frequent causes of death.
Modern contraception use in Ethiopia: does involving husbands make a difference?
Authors: Terefe A , Larson C P
Published: November 2008

OBJECTIVES. This study was undertaken to determine the relative efficacy of home visitation with and without husband participation on the use of modern contraception in Ethiopia. METHODS. A randomized field trial of a family planning education intervention using home visitation with and without husband participation was conducted in Addis Ababa, Ethiopia, from August 1990 to December 1991 and included a 12-month postintervention follow-up. A total of 266 experimental and 261 control subjects were entered, of whom 91.7% and 88.9%, respectively, were followed through 12 months. RESULTS. A greater proportion of couples in the experimental group were practicing modern contraception at 2 months (25% vs 15%) and 12 months (33% vs 17%) following the home visit intervention. By 12 months following the home visits, experimental subjects were less likely to have defaulted and more likely to have started using modern contraception following an initial delay. CONCLUSIONS. The inclusion of husbands in family planning programs will result in relevant increases in the use of modern contraception. However, there exists an important "sleeper" effect to the education intervention, reflected by a delay of greater than 2 months in the initiation of modern contraception for most couples.
Prescription and nonprescription drug use among black and white community-residing elderly.
Authors: Fillenbaum G G , Hanlon J T , Corder E H , Ziqubu-Page T , Wall W E , Brock D
Published: November 2008

OBJECTIVES. To examine and compare concomitants of prescription and nonprescription drug use of Black and White community-dwelling elderly. METHODS. Information on prescription and nonprescription drug use, demographic and health characteristics, and use of health services was obtained from a probability-based sample of Black (n = 2152) and White (n = 1821) community-resident elderly in the Piedmont area of North Carolina. Descriptive statistics were calculated. Linear regression, in which sample weights and design effects were taken into account, was used for the final models. RESULTS. For prescription drug use, 37% and 32% of the variance was explained for Whites and Blacks, respectively (6% and 5% for nonprescription drugs). Health status and use of medical services were the strongest predictors of prescription drug use for both races (with Medigap insurance also important for Whites and Medicaid important for Blacks). Demographic characteristics and self-assessed health were significant factors in the use of nonprescription drugs. Race independently predicted use of both types of drugs but explained only a small proportion of the variance. CONCLUSIONS. Health status and use of health services are importantly related to prescription drug use. Non-prescription drug use is difficult to explain.
Insurance, income, and access to ambulatory care in King County, Washington.
Authors: Saver B G , Peterfreund N
Published: November 2008

OBJECTIVES. We studied simultaneous effects of income and insurance on access measures in an indigent population, focusing on Medicaid and the marginal effects of increasing income. METHODS. Surveys were distributed in waiting rooms of county clinics and welfare offices. Models examined insurance (private, Medicaid, or none), income (to twice the poverty level), single-parent status, age, gender, and presence of a regular source of care; first-order interactions were evaluated. RESULTS. In terms of ease of access, postponing care, and having a regular source of care, uninsured respondents fared worst and Medicaid recipients were at an intermediate level. However, relative to those with private insurance, Medicaid recipients had four times the odds, and uninsured respondents twice the odds of being denied care. Income had no consistent effect; however, older, poorer people may have greater problems. For preventive services, income was significant, while differences between Medicaid and private insurance were generally not significant. CONCLUSIONS. Except for denial of care, access for indigent people is improved by Medicaid but remains worse than the access of those with private insurance. Income had variable effects, but support for income criteria used for public insurance eligibility was not found.
Cancer incidence among American Indians and Alaska Natives, 1980 through 1987.
Authors: Nutting P A , Freeman W L , Risser D R , Helgerson S D , Paisano R , Hisnanick J , Beaver S K , Peters I , Carney J P , Speers M A
Published: November 2008

OBJECTIVES. This study uses Indian Health Service inpatient data to estimate cancer incidence among American Indians and Alaska Natives. METHODS. Hospital discharge data for 1980 through 1987 were used to identify cases of cancer for 21 sites in women and 18 sites in men. Estimates of incidence were directly standardized to data from the Surveillance, Epidemiology, and End Results Program for the same time frame. RESULTS. Cancers of the gallbladder, kidney, stomach, and cervix show generally high rates among many American Indian and Alaska Native communities, and cancers of the liver and nasopharynx are high in Alaska. Of the relatively common cancers in Whites, American Indians and Alaska Natives experience lower rates for cancers of the breast, uterus, ovaries, prostate, lung, colon, rectum, and urinary bladder and for leukemia and melanoma. Variation among geographic areas and among tribal groups is observed for many important cancer sites. CONCLUSIONS. This study demonstrates significant variations of cancer rates among American Indians and Alaska Natives, with important implications for Indian Health Service cancer control programs. The study also supports the potential use of hospital discharge data for estimating chronic disease among diverse American Indian and Alaska Native communities.
Improving response rates through incentive and follow-up: the effect on a survey of physicians' knowledge of genetics.
Authors: Tambor E S , Chase G A , Faden R R , Geller G , Hofman K J , Holtzman N A
Published: November 2008

OBJECTIVES. This study assessed efforts to increase response rates to a mailed physician survey and examined whether, as a result, nonresponse bias was reduced. METHODS. Randomly selected physicians and geneticists were mailed a questionnaire concerning genetics knowledge and attitudes. In the final but not the pilot survey, a $25 incentive and intensive follow-up were used to increase the response rate. RESULTS. The response rate from physicians in the final survey was 64.8% (n = 1140), compared with 19.6% in the pilot test (n = 69). Sample representatives in sociodemographic and practice characteristics was improved by follow-up. Respondents recruited with more difficulty did not differ on the principal outcome variable, genetics knowledge, except on one subscore. Pilot study and final survey respondents did not differ in knowledge. CONCLUSIONS. Although the effect of increased response rates on the principal outcome variable in this study was minimal, this may not be the case for other studies. Every effort should be made to attain as high a response rate as is practical and to establish that respondents are representative of the population being sampled.
Weapon carrying among inner-city junior high school students: defensive behavior vs aggressive delinquency.
Authors: Webster D W , Gainer P S , Champion H R
Published: November 2008

OBJECTIVES. The purpose of this study was to estimate associations between beliefs and experiences hypothesized to be related to weapon carrying among youths. METHODS. Students in two inner-city junior high schools completed anonymous questionnaires. Logistic regression models were fit for having ever carried a weapon for protection or use in a fight and were stratified by sex and weapon type. RESULTS. Among males, 47% had carried knives and 25% had carried guns. Key risk factors for knife carrying were being threatened with a knife, getting into fights, and disbelief that having a weapon increases the carrier's risk of injury. Gun carrying was associated with having been arrested, knowing more victims of violence, starting fights, and being willing to justify shooting someone. Among females, 37% had carried a knife; knowing many victims of violence and being willing to justify shooting someone predicted knife carrying. CONCLUSIONS. Knife carrying was associated with aggressiveness but did not appear to be related to serious delinquency. Gun carrying within this nonrandom sample appeared to be a component of highly aggressive delinquency rather than a purely defensive behavior.
The authorship and fate of international health papers submitted to the American Journal of Public Health in 1989.
Authors: Koch-Weser D , Yankauer A
Published: November 2008

We reviewed the authorship characteristics, editorial processing, and final fate of 126 papers dealing with data from countries other than the United States and Canada and submitted to the American Journal of Public Health in 1989. The acceptance rate of these international health papers was 22%, similar to that of all papers (25%). Authors from developed countries had higher acceptance rates than authors from developing countries, but the highest acceptance rate (36%) was for international health papers with joint authorship from both developed and developing countries. Of 83 rejected papers, 72% were published in other journals. Of these, 45% were published in journals covered by Index Medicus, a figure similar to that for all papers rejected by the Journal.
Screening for colorectal neoplasia: physicians' adherence to complete diagnostic evaluation.
Authors: Myers R E , Balshem A M , Wolf T A , Ross E A , Millner L
Published: November 2008

This prospective study was done in a health maintenance organization colorectal cancer screening program to determine whether 166 persons found to have abnormal fecal occult blood test results typically underwent complete diagnostic evaluation (i.e., either colonoscopy or barium enema x-ray plus flexible sigmoidoscopy). Chart audit data show that 137 (82%) subjects contacted a physician to discuss follow-up. A complete diagnostic evaluation was recommended to only 52 (38%) patients who talked with a physician. Forty-two (81%) patients who were advised to get a complete diagnostic evaluation actually complied. Significant differences in clinical findings were observed for patients who did and did not have a complete diagnostic evaluation.
Medical technology assessment and practice guidelines: their day in court.
Authors: Anderson G F , Hall M A , Steinberg E P
Published: November 2008

There is the expectation that outcomes research and the promulgation of medical practice guidelines will be able to identify and hopefully reduce the amount of unnecessary or inappropriate medical care through a variety of methods, including utilization review. However, past efforts by public and private insurers to deny claims on the basis of formal technology assessments or practice guidelines have frequently been overturned by the courts for multifarious reasons. This paper examines the court's reluctance to accept a variety of technology assessment methods in coverage policy decisions. The paper reviews the options that have been proposed to restrict judicial involvement in the formulation of coverage policy and then proposes a new option that employs a more precise taxonomy of medical practice assessment.
An outbreak of hepatitis A among health care workers: risk factors for transmission.
Authors: Doebbeling B N , Li N , Wenzel R P
Published: November 2008

OBJECTIVES. The purpose of this study was to investigate a nosocomial outbreak of hepatitis A that occurred in the burn treatment center of a referral hospital. METHODS. Retrospective cohort and case-control studies were performed to determine acquisition rates and risk factors for transmission. Adjusted infection rates were calculated by week of exposure. A case-control study was conducted to determine potential mechanisms for nosocomial acquisition. Recently infected health care workers were defined as case patients; exposed, serosusceptible health care workers without infection served as controls. RESULTS. The outbreak of hepatitis A affected 11 health care workers and 1 other burn patient (1 secondary patient case). All 11 health care workers became ill after the admission of a man and his 8-month-old son who developed hepatitis A while in the hospital. The cumulative incidence risk ratio was elevated for health care workers caring for either the infant or the father during the same week of exposure. The case-control study implicated the behavior of eating on the hospital ward as the single most important risk factor for infection. CONCLUSION. Inadequate hand-washing and subsequent oral contamination appear responsible for the outbreak. Hospitals may witness other institutional outbreaks if health care workers regularly eat on the wards.
Patient-to-patient transmission of hepatitis B in a dermatology practice.
Authors: Hlady W G , Hopkins R S , Ogilby T E , Allen S T
Published: November 2008

OBJECTIVE. The purpose of the study was to investigate infection with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) among patients in a dermatology practice. METHODS. Historical cohort, matched case-control, and cross-sectional survey methods were used. RESULTS. The age-specific incidence of reported HBV infection in the practice from 1985 through 1991 was more than 12 times the expected rate. The dermatologist was not an HBV carrier. He practiced neither universal precautions nor sterile surgical technique. Seroprevalence of markers for HBV infection was highest (36.8%) among patients who had had surgery on the same day that HBV was apparently acquired by an index case; seroprevalence was near the expected background level for patients not exposed to index cases. Of HBV-infected patients with known dates of onset, 72% had had surgery during their incubation periods. All of 30 HBV antigen specimens tested were of the same subtype. None of the patients tested, including 74 patients exposed to surgery on the same day as a patient with acquired immunodeficiency syndrome, had evidence of HIV infection. CONCLUSIONS. HBV, but not HIV, was transmitted from patient to patient by the dermatologist's failure to apply either universal precautions or sterile surgical technique.
The health effects of swimming at Sydney beaches. The Sydney Beach Users Study Advisory Group.
Authors: Corbett S J , Rubin G L , Curry G K , Kleinbaum D G
Published: November 2008

OBJECTIVES. The purpose of the study was to determine the health risks of swimming at ocean beaches in Sydney, Australia. METHODS. From people attending 12 Sydney beaches in the period from December 5, 1989 to February 26, 1990, we recruited a cohort of 8413 adults who agreed to participate in this study. Of these, 4424 were excluded either because they had been swimming in the previous 5 days or because they reported a current illness. Of the remainder, 2839 successfully completed a follow-up telephone interview conducted within 10 days after recruitment. We recorded reported respiratory, gastrointestinal, eye, and ear symptoms and fever that occurred within the 10 days between initial interview on the beach and the follow-up interview. RESULTS. A total of 683 participants (24.0%) reported experiencing symptoms in the 10 days following initial interview. Of these, 435 (63.7%) reported respiratory symptoms. Swimmers were almost twice as likely as nonswimmers to report symptoms. There was a linear relationship between water pollution and all reported symptoms with the exception of gastrointestinal complaints. CONCLUSIONS. Swimmers at Sydney ocean beaches are more likely to report respiratory, ear, and eye symptoms than beachgoers who do not swim. The incidence of these symptoms increases slightly with increasing levels of pollution.
The risk of measles, mumps, and varicella among young adults: a serosurvey of US Navy and Marine Corps recruits.
Authors: Struewing J P , Hyams K C , Tueller J E , Gray G C
Published: November 2008

OBJECTIVES. To assess the risk of epidemic transmission and to guide immunization policy, the seroprevalence of antibody to measles, mumps, and varicella was determined in a group of young adults. METHODS. A cross-sectional study of 1533 US Navy and Marine Corps recruits was conducted in June 1989. Antibody status was determined with commercially available enzyme-linked immunosorbent assays. RESULTS. Direct sex and race adjustment to the 15- to 29-year-old US population resulted in seronegativity rates of 17.8% for measles, 12.3% for mumps, and 6.7% for varicella. Measles and mumps seronegativity rates were higher among Whites whereas varicella seronegativity was higher among non-Whites. Recruits enlisting from outside the 50 US states, especially those from island territories, were more likely to lack varicella antibody. The sensitivity of a positive history of vaccination or disease in predicting antibody status was less than 90% for all diseases. CONCLUSIONS. These results suggest a continued potential for epidemics, especially of measles, and the need for mandatory immunization policies. Immigrants to the United States, especially those from island territories, may be a high-risk group that could benefit from varicella vaccination.
Infectious diseases and mortality among US nursing home residents.
Authors: Beck-Sague C , Banerjee S , Jarvis W R
Published: November 2008

Data collected in the 1985 National Nursing Home Survey were analyzed to identify risk factors for infections and mortality and to explore their relationship in US nursing homes. An infection was recorded in 166,609 (14%) discharges. Risk of pneumonia was found to be higher among bedbound patients (54.5 vs 13.1 per 100 discharges); urinary tract and other infections were most frequent among residents with indwelling catheters (6.6 vs 1.0 per 100 discharges). Residents with pneumonia were more likely than those with other infections to die (35% vs 28%), or be discharged to hospitals if alive (94% vs 66%). Thus, immobility and catheterization were associated with infections in US nursing homes, and pneumonia was found to contribute to mortality.
The impact of a public health nurse intervention on influenza vaccine acceptance.
Authors: Black M E , Ploeg J , Walter S D , Hutchinson B G , Scott E A , Chambers L W
Published: November 2008

Public health clients in an Ontario community 65 years of age or older were randomly allocated to receive an intervention by a public health nurse during a home visit promoting either influenza immunization or safety measures. There was no statistically significant differences in influenza immunization rates between these two groups (56.1% vs 56.6%). Men were significantly more likely to receive immunization.
Neonatal tetanus in Peru: risk assessment with modified enzyme-linked immunosorbent assay and toxoid skin test.
Authors: Vernacchio L , Madico G , Verastegui M , Diaz F , Collins T S , Gilman R H
Published: November 2008

We used a modified enzyme-linked immunosorbent assay (ELISA) to investigate tetanus immunity in 232 pregnant Peruvian women. One hundred forty-two (61.2%) had protective antitoxin titers (> or = 0.01 IU/mL). Protective titers correlated positively with the number of toxoid doses reported during the current pregnancy. A majority of women reporting no toxoid doses during the current pregnancy had at least one prenatal health care visit. We evaluated a toxoid skin test in 44 of the subjects, but it correlated poorly with the ELISA. The modified ELISA is a useful in vitro method for studying tetanus immunity in the developing world.
Acculturation and gender differences in sexual attitudes and behaviors:Hispanic vs non-Hispanic white unmarried adults.
Authors: Marín B V , Tschann J M , Gómez C A , Kegeles S M
Published: November 2008

Understanding how acculturation and gender affect Hispanics' sexual behavior is needed to prevent infection with the human immunodeficiency virus. We examined differences in and correlates of condom use among 398 Hispanics and 540 non-Hispanic Whites in San Francisco who were part of a random probability sample of unmarried adults. Hispanic women reported fewer sexual partners than all other groups. Condom use was low in all groups, but Spanish-speaking Hispanic women reported lower condom use than White women. Hispanics, generally, had poorer attitudes toward condoms and were less likely than non-Hispanic Whites to believe they could avoid acquired immunodeficiency syndrome. Hispanics need targeted prevention interventions.
Aggression, substance use, and suicidal behaviors in high school students.
Authors: Garrison C Z , McKeown R E , Valois R F , Vincent M L
Published: November 2008

OBJECTIVES. We sought to analyze the frequency and correlates of suicidal behaviors in a community sample of adolescents. METHODS. Information concerning suicidal thoughts and acts, aggressive behaviors, substance use and physical recklessness were collected with the 70-item self-report Youth Risk Behavior Survey from a statewide sample of 3764 South Carolina public high school students. RESULTS. Seventy-five percent of students reported no suicidal behaviors, 11% reported serious suicidal thoughts, 6.4% reported specific suicidal plans, 5.9% reported attempts not requiring medical care, and 1.6% reported attempts requiring medical care. All types of suicidal behaviors occurred more frequently in females than males. Odds ratios for aggressive behaviors and cigarette use were elevated across all categories of suicide behaviors, increasing in magnitude with severity of reported suicidal behavior. Substance use was associated with some but not all categories of suicidal behaviors. The relationships were most pronounced with the use of potentially more dangerous drugs. CONCLUSIONS. The results suggest that suicidal behaviors are not infrequent occurrences among adolescents and that they often coexist with other high-risk behaviors. Interventions designed to reduce suicidal behaviors should simultaneously address coexisting high-risk behaviors.
Risk factors for early adolescent drug use in four ethnic and racial groups.
Authors: Vega W A , Zimmerman R S , Warheit G J , Apospori E , Gil A G
Published: November 2008

OBJECTIVES. It is widely believed that risk factors identified in previous epidemiologic studies accurately predict adolescent drug use. Comparative studies are needed to determine how risk factors vary in prevalence, distribution, sensitivity, and pattern across the major US ethnic/racial groups. METHODS. Baseline questionnaire data from a 3-year epidemiologic study of early adolescent development and drug use were used to conduct bivariate and multivariate risk factor analyses. Respondents (n = 6760) were sixth- and seventh-grade Cuban, other Hispanic, Black, and White non-Hispanic boys in the 48 middle schools of the greater Miami (Dade County) area. RESULTS. Findings indicate 5% lifetime illicit drug use, 4% lifetime inhalant use, 37% lifetime alcohol use, and 21% lifetime tobacco use, with important intergroup differences. Monotonic relationships were found between 10 risk factors and alcohol and illicit drug use. Individual risk factors were distributed disproportionately, and sensitivity and patterning of risk factors varied widely by ethnic/racial subsample. CONCLUSIONS. While the cumulative prevalence of risk factors bears a monotonic relationship to drug use, ethnic/racial differences in risk factor profiles, especially for Blacks, suggest differential predictive value based on cultural differences.
Drug abuse and illicit drug use in Puerto Rico.
Authors: Canino G , Anthony J C , Freeman D H , Shrout P , Rubio-Stipec M
Published: November 2008

OBJECTIVES. Based on an epidemiologic field survey of community households in Puerto Rico, this study estimates the frequency of illicit drug use and clinically defined drug abuse and/or dependence syndromes. Results are compared with those from surveys on the United States mainland. Suspected risk factors are studied as well, with a special focus on childhood misbehavior. METHODS. Trained lay interviewers administered a Spanish Diagnostic Interview Schedule to 912 respondents aged 17 to 68 years who were selected by multistage probability sampling of island households. RESULTS. An estimated 8.2% of the population had a history of illicit drug use and 1.2% qualified for a standardized lifetime diagnosis of drug abuse, dependence, or both. An estimated 18.4% of the male drug users and 7.7% of the female drug users met criteria for drug abuse and/or dependence. A history of drug use was related to the diagnoses of alcohol abuse and/or dependence and antisocial personality, but few persons who had used illicit drugs at least once in their lifetime reported a history of receiving treatment for alcohol, drug, or mental health problems. CONCLUSIONS. The data were consistent with a suspected association between level of childhood misbehavior and occurrence of illicit drug use, even after statistical control for potentially confounding variables.
Health education for pregnant smokers: its behavioral impact and cost benefit.
Authors: Windsor R A , Lowe J B , Perkins L L , Smith-Yoder D , Artz L , Crawford M , Amburgy K , Boyd N R
Published: November 2008

OBJECTIVES. A randomized trial (the Birmingham Trial II) was conducted to evaluate the behavioral impact of health education methods among 814 female smokers at four public health maternity clinics. METHODS. Four hundred patients were randomly assigned to an Experimental (E) Group, and 414 were assigned to a Control (C) Group. Self-reports and saliva cotinine tests confirmed smoking status at the first visit, at midpregnancy, and at end of pregnancy. RESULTS. The E Group exhibited a 14.3% quit rate and the C Group an 8.5% quit rate. A Historical Comparison (C) Group exhibited a 3.0% quit rate. Black E and C Group patients had higher quit rates than White E and C Group patients. A cost-benefit analysis found cost-to-benefit ratios of $1:$6.72 (low estimate) and $1:$17.18 (high estimate) and an estimated savings of $247,296 (low estimate) and $699,240 (high estimate). CONCLUSION. Health education methods are efficacious and cost beneficial for pregnant smokers in public health maternity clinics.
Paternal smoking and birthweight in Shanghai.
Authors: Zhang J , Ratcliffe J M
Published: November 2008

OBJECTIVES. Although maternal active smoking has been established to be associated with fetal growth retardation, evidence of an effect of environmental tobacco smoke exposure on birthweight is still limited and inconclusive. This study addressed the relationship between prenatal environmental tobacco smoke exposure and birthweight and fetal growth retardation in Shanghai, China. METHODS. Data on 1785 full-term live-born normal infants of nonsmoking mothers were used from the Shanghai Birth Defects and Perinatal Death Monitoring conducted between October 1986 and September 1987. Environmental tobacco smoke exposure was defined as exposure to paternal smoking. RESULTS. Infants with environmental tobacco smoking exposure were, on average, 30 g lower in birthweight than nonexposed infants, after adjustment for gestational age, parity, maternal age, and occupation. CONCLUSION. Consistent with previous research, this study suggests that environmental tobacco smoking exposure may have a modestly adverse effect on birthweight.
Cigarette smoking and the risk of diabetes in women.
Authors: Rimm E B , Manson J E , Stampfer M J , Colditz G A , Willett W C , Rosner B , Hennekens C H , Speizer F E
Published: November 2008

OBJECTIVES. Noninsulin-dependent diabetes mellitus, a major risk factor for cardiovascular disease, is prevalent in more than 12 million Americans. A voluminous amount of data demonstrates that cigarette smoking is an important cause of cancer and coronary heart disease. However, the association between cigarette smoking and the risk of diabetes is virtually unexplored, especially in women. METHODS. We examined the association between smoking and the incidence of noninsulin-dependent diabetes mellitus among 114,247 female nurses who were free of diabetes, cardiovascular disease, and cancer in 1976. We collected exposure information and disease status prospectively for 12 years from biennially self-administered questionnaires. RESULTS. Current smokers had an increased risk of diabetes, and we observed a significant dose-response trend for higher risk among heavier smokers. During 1,277,589 person-years of follow-up, 2333 women were clinically diagnosed with diabetes. The relative risk of diabetes, adjusted for obesity and other risk factors, was 1.42 among women who smoked 25 or more cigarettes per day compared with nonsmokers. CONCLUSIONS. These data suggest that cigarette smoking may be an independent, modifiable risk factor for noninsulin-dependent diabetes mellitus.
Self-exempting beliefs about smoking and health: differences between smokers and ex-smokers.
Authors: Chapman S , Wong W L , Smith W
Published: November 2008

OBJECTIVES. The purpose of the present study was to examine the role of self-exempting or cognitive dissonance-reducing beliefs about smoking and health. Such beliefs may hold important implications for the content and targeting of health promotion campaigns. METHODS. A survey of smokers and ex-smokers was conducted in western Sydney, Australia. Six hypotheses were tested. RESULTS. The principal findings were (1) that 27.9% of smokers and 42.1% of ex-smokers agreed that smokers were more likely than non-smokers to get five smoking-related diseases; (2) that for 11 of 14 beliefs tested, more smokers than ex-smokers agreed to a statistically significant degree; (3) that the median number of such beliefs agreed to by smokers was five, compared with three for ex-smokers; (4) that for only 5 of 14 beliefs was agreement expressed by more precontemplative smokers than smokers contemplating or taking action to quit; (5) that more than one in four smokers, despite agreeing that smokers are more likely than non-smokers to get five diseases, nonetheless maintain a set of self-exempting beliefs. CONCLUSIONS. Fewer smokers than ex-smokers accept that smoking causes disease, and smokers also maintain more self-exempting beliefs. Becoming an ex-smoker appears to involve shedding such beliefs in addition to accepting information about the diseases caused by smoking.
Smoking cessation factors among African Americans and whites. COMMIT Research Group.
Authors: Royce J M , Hymowitz N , Corbett K , Hartwell T D , Orlandi M A
Published: November 2008

OBJECTIVES. This study was undertaken to explore smoking patterns and attitudes that influence smoking cessation and relapse among African Americans. METHODS. Baseline data from eight Community Intervention Trial for Smoking Cessation (COMMIT) sites were analyzed. RESULTS. Compared with Whites, African Americans who smoke less than 25 cigarettes per day were 1.6 times more likely to smoke within 10 minutes of awakening (a behavioral indicator of nicotine dependence), adjusting for education, age, and gender (OR = 1.2 for heavier smokers). African Americans reported a stronger desire to quit smoking and reported serious quit attempts in the past year. African Americans favored tobacco restrictions (they were 1.8 times more likely than Whites to view smoking as a serious community problem, 1.7 times more likely to favor restrictions on cigarette vending machines, and 2.1 times more likely to prohibit smoking in their car). African Americans were lighter/moderate, menthol smokers. CONCLUSIONS. African Americans find smoking socially unacceptable and are strongly motivated to quit, but their "wake-up" smoking may indicate high nicotine dependence, making abstinence difficult even for lighter smokers.
Retail stores' compliance with a city no-smoking law.
Authors: Rigotti N A , Stoto M A , Bierer M F , Rosen A , Schelling T
Published: November 2008

OBJECTIVES. Laws restricting smoking in public places and workplaces can protect the public only if they are obeyed. We sought to assess compliance with a Cambridge, Mass, no-smoking ordinance. METHODS. We prospectively observed 174 retail stores 1 month before and 3, 11, and 24 months after the law took effect. At 24 months, we interviewed one employee per store. RESULTS. Full compliance with the law was low; at 24 months, only 4% of stores displayed the mandated sign and were free of smokers and smoke. Fewer than half the stores posted any no-smoking sign. Sign prevalence increased over 2 years (22% to 41%, P < .001), but the frequency of smoke or smokers (13% and 10%, respectively, at baseline) did not change. According to employees interviewed at 24 months, 38% of stores illegally permitted customers or employees to smoke. These stores had more smoke and fewer signs than did stores prohibiting smoking. Compliance was poor in liquor and convenience stores. Employees who had been told how to handle customers' smoking were more likely to enforce the law. CONCLUSIONS. Compliance with a no-smoking law is not guaranteed. For retail stores, compliance may improve if stores adopt no-smoking policies, post signs, and teach employees to enforce the law.
The implications of an epidemiological mistake: a community's response to a perceived excess cancer risk.
Authors: Guidotti T L , Jacobs P
Published: November 2008

OBJECTIVES. The response of community residents to a perceived cancer excess may include changes in attitude, health-related behavior, and property values. In 1986, a cancer agency conducted a study of cancer incidence (1979 to 1983) in two suburbs of Edmonton, Alberta, and reported elevations on the order of 25% over expected for most sites. Reanalysis of these data several months later revealed an error. Correction brought the rates into line with Alberta as a whole and with other communities surrounding Edmonton. METHODS. We used public opinion trends and property value trends (during the period of concern) to study the two communities affected by the allegation of increased cancer risk. RESULTS. A survey of residents found significant differences at the time in health-related behavior and beliefs suggesting increased perception of personal, family, and community risk and modest changes in behavior. Real estate values in one community temporarily lost an average of $4000, or about 5% of total value, compared with a similar, adjacent housing market. CONCLUSIONS. The perception of an elevated cancer risk, in the absence of a true risk, may have a substantial negative effect on the affected community, both psychologically and economically.