bluuebunny/crossref_metadata_2025 huggingface dataset:
On-center vs off-center dental care for Job Corps members: cost and utilization.
Authors: Avery K T , Moore J E , Berry B L
Published: November 2008

While Job Corps Centers vary in size, location, and administrative structure, they are subject to uniform requirements for health services, established by federal regulation and must make individual decisions about whether to furnish dental care on-site or by some alternative arrangement in the community. Analysis of cost and utilization data indicated that expenditures for on-site dental care are greater than for off-center care. However, on-center care results in more dental visits and a lower cost/visit. These observations hold even for the smallest size centers.
The role of the cranial CT scan in municipal hospitals.
Authors: Sterman A B , Schaumburg H H
Published: November 2008

House officer predictions of lesions and CT scan diagnosis were compared for accuracy in a municipal and community hospital setting. The input of the CT scan into initial patient care was also evaluated. In the municipal hospital, house officers made fewer most-correct diagnoses, and the CT scan more often established the correct diagnosis (P less than .03) and altered therapy (P less than .02). Results suggest that municipal hospital patients could benefit from accessible CT scanners.
Problems of case finding and data collection in ambulatory care settings.
Authors: Neuhaus E , Lyons T F , Payne B C
Published: November 2008

The experience gained in a four-year ambulatory care study suggests that major problems of patient care data collection include: 1) Difficulties in obtaining listings of patients by diagnosis/condition that accurately reflect the actual practice experience; 2) Inaccurate coding or identification of the reason for patient visits; and 3) Inability to find the medical record within the system. Data presented here suggest there are certain regularities in completion rates characteristic of research sites and of diagnostic categories.
Drug product selection: the Florida experience.
Authors: Vuturo G J , Krischer J P , McCormick W C
Published: November 2008

Drug product selection, the act of selecting and dispensing a lower cost generically equivalent product to that prescribed, is made possible in 46 states through recently enacted legislation. Florida's legislation is unique in that it requires pharmacists to product select under certain circumstances. This study reports on the results of a review of the Florida experience approximately one year after enactment of its drug product selection legislation. Nearly 132,000 prescriptions were sampled from 60 pharmacies during a four-month study period. This represents one per cent of all new prescriptions in the state and a three per cent sample of community pharmacies. Study results indicate that drug product selection on the average saves the consumer $1.92 per prescription. Further, under the provisions of this law the majority of cost savings (average reductions in acquisition costs between prescribed and dispensed products) are being passed along as savings to the consumer. During the four-month study period this amounted to a total prescription cost savings of nearly $425,000. Drug product selection occurs in approximately two per cent of all new prescriptions which compares favorably with results reported from other states but also suggests that additional savings can be realized under such legislation.
The reaction of the dental profession to changes in the 1970s.
Authors: Waldman H B
Published: November 2008

This paper explores the changing realities of dentistry in the 1970s: the development of denturism; the maldistribution of dental practitioners; the growth and activities of expanded function auxiliaries; the intrusion of the Federal Trade Commission into professional issues resulting in advertising, supermarket and franchise dentistry; and the effect of prepayment plans. These realities are considered in terms of their impact on the profession and the efforts by the individual practitioner and his representative organizations to come to terms with them.
A longitudinal investigation of physician's assistants' perceptions as members of a health care team: a preliminary study.
Authors: Engel G V
Published: November 2008

The perceptions of a cohort of 124 Physician's Assistants (PA) were assessed by responses to questionnaires employing the semantic differential. Profiles at beginning and end of training and as a health worker on the job suggest that other members of the health team are viewed favorably and that PAs' self perceptions may change over time to become more like their perception of nurses and less like their perception of physicians.
Long-term outcome of smoking cessation workshops.
Authors: Evans D , Lane D S
Published: November 2008

Three hundred seventy-two (63%) of 590 enrollees in nine smoking cessation workshops held over a five-year period responded to a follow-up survey. Outcome data were collected retrospectively for six-month intervals from workshop to follow-up. Forty nine per cent of all enrollees graduated, and 56% of the respondents quit smoking during the program. Nonsmoking rates declined to an average of 25% by the first year post-workshop and remained relatively stable thereafter for periods up to five years.
Monitoring ambulatory care: impact of a surveillance program on clinical practice patterns in New York City.
Authors: Paris M , McNamara J , Schwartz M
Published: November 2008

Administrative records of the Title XIX (Medicaid) Program of New York City were reviewed to determine the impact of a surveillance system introduced to monitor physician billing. Billing patterns of the physicians subject to program sanctions, as well as the larger universe of all participating New York City physicians, showed changes coincident with the introduction of the surveillance program: utilization of x-rays, lab tests, injections, and first visit billing decreased.
Demographic trends of tubal sterilization in the United States 1970-75.
Authors: Layde P M , Fleming D , Greenspan J R , Smith J C , Ory H W
Published: November 2008

An estimated 2,300,000 women in the United States underwent tubal sterilizations in 1970-1975. During this period the rate of tubal sterilizations per 1,000 women 15-44 years of age rose from 4.7 to 11.7. We studied the influence on sterilization trends of four demographic variables: age, region of residence, race, and marital status. Women 25-34 years of age were twice as likely to be sterilized as older or younger women. Rates were about 40 per cent lower in the West than in the rest of the country. In 1970 rates for non-white women were double those for Whites. Rates for Whites rose faster than those for non-Whites, however, and by 1975 the rates were similar for the 2 races. Non-Whites still tended to be sterilized about one year younger than Whites, and marked regional differences existed in the race-specific rate trends. Rates rose more sharply for previously married women than for currently married women; by 1975 rates for these two groups were similar. Never married women had rates about 1/7 of those of currently married and previously married women. Among the never married, tubal sterilization rates for non-Whites were nine times higher than those for Whites.
The impact of heroin abuse on a regional end-stage renal disease program.
Authors: Zielezny M A , Cunningham E E , Venuto R C
Published: November 2008

The causes for end-stage renal disease (ESRD) in 148 consecutive patients 18-45 years of age were analyzed over a five-year period in the Buffalo-SMSA. Incidence, diagnostic category specific, prevalence, age patterns, and life expectancy are provided by sex, race, and heroin abuse status. A striking correlation between heroin abuse, glomerulonephritis, and ESRD among Blacks was discovered, demonstrating the impact of heroin abuse on both the cost and statistical interpretation of the causes for ESRD.
Life-style and death patterns of the Missouri RLDS church members.
Authors: McEvoy L , Land G
Published: November 2008

Members of the Reorganized Church of Jesus Christ of Latter-Day Saints (RLDS) are dissuaded from the use of tobacco, alcohol, and hot drinks. A well-balanced diet is also stressed. This study compares the 1972-78 mortality experience of the Missouri RLDS with three other population groups. The findings show Missouri RLDS experiencing age-adjusted death rates which are 22.6 percent lower than rates for Missouri non-RLDs whites; 19.6 per cent lower than the non-RLDS of Independence, Missouri; and 14.4 per cent lower than Utah residents. The RLDS display lower death rates than the two Missouri comparison groups for each of seven selected causes-particularly lung cancer, pneumonia/influenza, and violent deaths. Comparisons between the Missouri RLDS and Utah residents show an inconsistent pattern, with Utah residents having non-significantly lower death rates for lung cancer and ischemic heart disease, but with the Missouri RLDS having significantly lower rates for pneumonia/influenza and violent deaths. These inconsistencies are of interest because 72 per cent of Utah's population belong to the Mormon Church which advocates life-styles similar to the RLDS. If these disparate mortality patterns persist under a more direct comparison between the Missouri RLDS and Utah Mormons, they could provide the opportunity to assess the impact of similar life-styles in separate settings.
A prospective study of response error in food history questionnaires: implications for foodborne outbreak investigation.
Authors: Mann J M
Published: November 2008

To explore the problem of response error in food history data, a prospective study examined the validity of food questionnaire data obtained five days after the study meal. Unobtrusive observation of 64 persons selecting two different foods at a buffet-style luncheon were compared with subsequent histories of food consumption. The predictive value of a positive response was 0.73 for one food and 0.82 for the second food. The response error measures obtained were then applied to data from a published foodborne outbreak to illustrate the impact of predictive value positive and predictive value negative levels on the significance of a food-illness association. Public health workers engaged in food questionnaire administration and analysis must consider response error and should explore methods of reducing this problem through attention to both interviewer-respondent interaction and questionnaire design.
A financial analysis of Hodgkin lymphoma staging.
Authors: Corder M P , Lachenbruch P A , Lindle S G , Sisson J H , Johson P S , Kosier J T
Published: November 2008

A clinical algorithm was developed for staging of Hodgkin disease. This represented the treatment logic employed in a specified time period and was used to categorize charges incurred in the staging of 50 consecutive patients who underwent this process at a university hospital. Charges were categorized as: necessary (in concordance with the algorithm), justifiable (a result of care for a separate medical disorder or for consideration of distance), and perceived excess (neither necessary nor justifiable). Thirty per cent of the total charges were identified as perceived excess. Hospitalization accounted for 68 per cent and laboratory charges 22 per cent of the perceived excess charges. Fifty-eight per cent of the patients had a percentage of perceived excess bed charges exceeding 30 per cent of the total. Perceived excess medical hospitalization correlated positively with time from diagnosis to treatment decision. It is recommended that attempts to reduce the expense of Hodgkin lymphoma staging be directed at decreasing hospitalization.
The advent of human diploid cell rabies vaccine: impact on vaccine utilization in New Mexico.
Authors: Mann J M , Hoffman R E , Rollag O J , Bartol L , Burkhart M J
Published: November 2008

Three months' experience with the newly licensed human diploid cell rabies vaccine in the New Mexico comprehensive consultation-biologics system was reviewed. Comparison with the same period in 1978 and 1979 showed no increase in vaccine utilization despite the advent of this simpler-to-use, safer rabies vaccine. Anti-rabies treatments appear to be minimally influenced by new vaccine technology when a comprehensive consultation system is available to support and guide the private physician.
Impact of a regional infant dispatch center on neonatal mortality.
Authors: Vogt J F , Chan L S , Wu P Y , Hawes W E
Published: November 2008

In 1976, a regional Infant Medical Dispatch Center (IMDC) was implemented in Southern California to improve the lives and well-being of the critically ill newborn infants by expediting location of beds in neonatal intensive care units. Comparison of birth weight-specific neonatal mortality rates among 701-2000 grams neonates before and after the program showed a six-fold improvement in hospitals served by the Center over hospitals not served by the Center during the two-year period. From 1975 to 1977, a 43.7 per cent improvement in neonatal mortality among the 701-2000 grams neonates with hyaline membrane disease was observed in the transported infants served by the Infant Medical Dispatch Center as compared to a 22.9 per cent improvement in the group of transported infants not served by IMDC. Both indicators had consistently shown a marked improvement associated with the IMDC program beyond the improvement of medical sciences over the two years. The data suggest that the improved outcome of the neonates referred by IMDC might be related to the improved efficiency of locating available neonatal intensive care beds.
Height, weight, and triceps skinfold thickness of Michigan children, 1978.
Authors: Sady S P , Moffatt R J , Owen G M
Published: November 2008

Height, weight, and triceps skinfold measurements were made on 258 Michigan males and 225 females, age 2 to 18 years, comprising a representative sample of Michigan children in 1978. Boys of most age groups and younger girls were slightly taller, heavier, and fatter than their US counterparts, studied between 1963 and 1974. Older Michigan girls were slightly shorter but heavier and fatter than their earlier US counterparts.
Frequency of hospitalization among hospital employees and their families.
Authors: Greene S B
Published: November 2008

Using claims data from 443 employee groups in North Carolina, this study examines the acute care hospital utilization rates of hospital employees and their dependents and compares them to employee groups in non-hospital settings. Results show that hospital employee groups account for 28 per cent more hospital days than non-hospital employee groups. The significantly higher rates are due primarily to employee utilization, although hospital employee dependents also showed higher rates of use than would be expected. We hypothesize that the high utilization rates of the hospital employee groups is due to the unusual availability and accessibility of hospital services and an atypical doctor-patient relationship.
Inconsistency in level of care assignment decisions in skilled nursing facilities.
Authors: Greene V L , Monahan D J
Published: November 2008

In Arizona, a non-Medicaid state, we investigated the extent to which unregulated level of care assignments in Skilled Nursing Facilities consistently reflect level and nature of patient impairment. Using Multiple Discriminant Analysis (MDA) to develop optimal prediction functions, approximately 70 per cent of patients could be correctly classified. Factors identified by MDA as discriminating among patients at different levels of care are an Activities of Daily Living (ADL) impairment factor, and a factor defined by confusion, transitory contact with the social environment, and propensity to wander. Results are compared with those of studies using MDA to replicate Multidisciplinary Review Team (MRT) or other expert level of care assignments intended to develop patient classification functions for clinical use. MRT assignments appear to reflect patient impairment characteristics only slightly better than do unregulated institutional assignments, suggesting that such utilization review efforts may result in minimal net gains in appropriateness of placement.
Prospectives on the risks of alternative fuel cycles.
Authors: Johnson D H , Kastenberg W E , Griesmeyer J M
Published: November 2008

A commentary is provided on the uncertainties in the data and in qualifying the phenomena relating to the risks imposed by the various steps involved in the use of coal, oil, natural gas, hydropower, and nuclear fuels for the generation of electricity. Uncertainties appear to be extremely large for hydropower which exhibits both large scale ecological impacts and the potential for high consequence, moderate frequency events at specific sites. Major risk-related uncertainties with the use of nuclear fuels include those surrounding nuclear weapons proliferation and reactor accident frequencies and consequences. Uncertainties for coal and oil include specification of the damage function of air transported sulfates and the effects of atmospheric CO2 buildup, acid rain, and groundwater contamination from mine water runoff. Compounding these problems is the potential impact of the growing global competition for a diminishing supply of oil. In the studies reviewed herein, the assessed risks of the nuclear fuel cycle are no greater than those of the primary alternatives. Prudence suggests that we do not totally reject any particular option at this time on the basis of health effects alone; similarly, no option is an undisputed choice.
Intestinal parasitosis among Southeast Asian immigrants in New Mexico.
Authors: Skeels M R , Nims L J , Mann J M
Published: November 2008

Results of an intestinal parasite survey of 776 Southeast Asian immigrants in New Mexico are presented. Parasites were found in 71.8 per cent of the patients; 44.3 per cent were multiply infected. Twenty different parasites were identified, some of which are not common in the United States.
Concurrent evaluation of epidemic St. Louis encephalitis: are you on the upward or downward side of the curve?
Authors: Powell K E , Blakey D L
Published: November 2008

Laboratory confirmation of reported cases of St. Louis encephalitis (SLE) lags 2-4 weeks behind onset of illness. A review of our experience in Mississippi in 1975 and 1976 suggests that plotting the number of reported suspects greater than or equal to 50 years of age by date of onset and adjusting for reporting delays can help determine when the peak of the epidemic has passed. This method circumvents the obligatory delay of serologic tests, minimizes the bias of publicity and intensive surveillance, and may avoid promoting control procedure which are expensive, dangerous, and of uncertain efficacy.
The surgical role of family physicians.
Authors: Mainen M W
Published: November 2008

A sample of Board-certified family physicians was surveyed regarding their role in providing operative surgical care. Twenty-one per cent reported operating and 40 per cent assisting at surgery. The percentage operating was 10 per cent in the East and 29 per cent in the West, while assisting was 22 per cent in the East and 57 per cent in the West. The frequency with which family doctors functioned as surgical operators was found to be inversely related to the perceived number of surgeons practicing in the local community, ranging from 16 per cent in communities where respondents perceived many surgeons to 56 per cent in communities with no surgeons. An interaction effect between geography and the relative number of surgeons in the local community appeared to influence whether the family physician functioned as operator or assistant. There was no independent relationship between community population size and operating by family physicians. The study suggests that the surgical role of the family physician develops in response to his local practice setting, and that the role cannot be defined from data averaged on a national scale.
Simplified method for Chlamydia trachomatis isolation using multi-well plate.
Authors: Hayashi H , Sheth P K
Published: November 2008

To simplify Chlamydia trachomatis isolation, we employed a 24-well tissue culture plate, thereby eliminating tedious steps and material in the conventional vial method. Parallel studies indicated that the vial and plate methods were equally sensitive for Chlamydia isolation. The time for culturing McCoy cells was reduced from 72 to four hours allowing us to inoculate specimens the same day. The potential hazard of handling coverslips which might contain infected cells was avoided.
On the distribution of underlying causes of death.
Authors: Gittelsohn A M
Published: November 2008

The feasibility of applying surveillance techniques to large health data sets is being explored through study of a national mortality data base encompassing 21 million United States death records for the period 1968--1978. Through the development of efficient file structures and information recovery techniques, it is possible to pose a series of questions and follow-up questions of the entire data set within budgetary constraints. Initial screening of the mortality data base reveals that major changes have occurred over the 11 years with marked declines for diseases of cardiovascular, respiratory, digestive and renal systems, and maternal and perinatal mortality. There is a tendency for increased usage of non-specific terminology. The occurrence of unlikely and unusual causes in the data set is documented and reasons for their inclusion discussed in terms of underlying cause of death logic. Problems in the study of geographic distributions of cause specific mortality are outlined with illustrations of the dispersion of standardized mortality ratios for major causes of death over areas of the country. Clusters of high mortality areas require interpretation in terms of underlying dispersion and possible reporting artifacts arising out of geographic differentials in diagnostic labeling practice.
Physician shortage in Kentucky, 1930-1980.
Authors: Johnson T P , Cooper J K
Published: November 2008

Changes in the number and locations of Kentucky counties with a shortage of physicians (using current federal definitions of medical underservice) were examined for the decennial years 1930 to 1980. The number of counties with a physician shortage were found to have increased from four per cent in 1930 to 20 per cent in 1970 and 1980. The per cent of population in physician shortage counties was also found to have increased between 1930 and 1970, but to have declined slightly by 1980. Differences in the average population-to-physician ratios of Appalachian and non-Appalachian counties were significant for every year except 1980.
Access to generic drugs in the 1950s: the politics of a social problem.
Authors: Facchinetti N J , Dickson W M
Published: November 2008

From the published literature of the 1950s, the social history of anti-substitution law is analyzed in terms of sociological theory on the construction of social problems. The analysis reveals how the substitution of generic drugs for prescribed brands came to be recognized as a social problem in need of remedial legislation. The most influential party in the process was the brand-drug industry which centered the debate on matters of public health and professionalism instead of industrial profitability. The industry was able to form a coalition of interests and establish the saliency and legitimacy of the problem, even though there was no objective evidence to establish brand substitution as a hazard to health. The case fits well into the theory of social problem construction. Other issues in health care, particularly drug issues can be studied from this same perspective.
Race-specific patterns of abortion use by American teenagers.
Authors: Ezzard N V , Cates W , Kramer D G , Tietze C
Published: November 2008

Between 1972 and 1978, as legal abortion became more widely available nationally, abortion rates (abortions per 1,000 women) and ratios (abortions per 1,000 live births) increased for all American teenagers; from 1972 to 1975, the rates and ratios for teenagers for Black and other races increased faster than those for White teenagers. For all seven years, abortion rates were higher for teenagers of Black and other races than for white teenagers. This reflected both higher proportions of sexually active teenagers of Black and other races and a greater risk of pregnancy in these teenagers compared with White teenagers. Race-specific differences in legal abortion ratios narrowed during the seven-year interval, as did differences in alternative outcomes of teenage premarital pregnancies (term births, illegal abortions).
Never-pregnant adolescents and family planning programs: contraception, continuation, and pregnancy risk.
Authors: Freeman E W , Rickels K , Mudd E B , Huggins G R
Published: November 2008

Four hundred urban Black teenagers enrolling in a family planning program before pregnancies occurred were followed for one year to assess factors influencing continuation of contraceptive use. Over half the follow-up respondents claimed to always use contraception. Program discontinuers were less likely to use contraception, but nearly half had no sex activity when contacted at follow-up. Sex frequency reported in the sample was low. Background factors of age, grade, and household were associated with contraceptive use and with pregnancy. Girls who had pregnancies were significantly more likely to live in a single-parent household, to have sex more frequently, and to have stated at enrollment that they wanted their first child before age 20. A majority of the sample, nearly all of whom obtained oral contraception, did not know at the one year follow-up how to use any alternative methods for preventing conception, hence many would again be at risk of pregnancy when sex activity resumed.
Trends and patterns in characteristics of local health administrators.
Authors: Rohrer H H , Dellaportas G
Published: November 2008

A survey of 1251 local health departments in 1980-81 (response rate 54 per cent) revealed that 74 per cent of those responding were healed by males, 96 per cent by Whites, 16 per cent by directors 60 or over. Forty per cent of the directors were physicians, a substantially lower percentage than that reported a decade ago. Physicians and males were most prevalent in large departments. Two-thirds of the smallest departments were headed by women, usually nurses.
An outbreak of foodborne hepatitis A: the value of serologic testing and matched case-control analysis.
Authors: Gustafson T L , Hutcheson R H , Fricker R S , Schaffner W
Published: November 2008

In April 1981, an outbreak of hepatitis A occurred among state legislators in Tennessee. Although the number of cases was small, we traced the source to a food handler who served cold meats and cheese. This investigation demonstrates the value of rapid serologic testing using a radioimmunoassay technique and matched case-control analysis to identify small foodborne outbreaks of hepatitis A.
Predictors of effectiveness among public health nutritionists.
Authors: Sims L S , Kohli M
Published: November 2008

This study investigated how public health nutrition directors and practitioners each rated the effectiveness of their professional performance. We examined the specific factors which were predictive of each set of effectiveness ratings. Eleven directors supplied the names and addresses of 226 practitioners, each of whom was mailed a questionnaire. The response rate to the mailing was 84 per cent. Director ratings of practitioners were not significantly related to the self-ratings. Results of multiple regression analysis revealed that the directors had based their evaluation on more "external" criteria, such as age, being a Registered Dietitian, and possessing an extroverted personality. In contrast, the nutritionists' self-ratings were based on more introspective qualities, including self-perceived innovativeness, and the number of competencies which they felt they were currently performing well. The roles of work environment, nature of supervision, and type of educational preparation need to be assessed in future research.
Effects of the Islamic Revolution in Iran on medical education: the Shiraz University School of Medicine.
Authors: Ronaghy H A , Simon H J
Published: November 2008

Some consequences of the Islamic Revolution in Iran on medical education were studied utilizing the Shiraz University School of Medicine. Of the 173 full-time faculty employed in 1978, 108 (63 per cent) had left the university by the end of 1982, and 81 (47 per cent) had left the country, aggravating the chronic shortage of medical personnel in Iran. Steps taken by the Iranian authorities to counteract these trends have not proven effective.
The role of community volunteers in health interventions: a hypertension screening and follow-up program.
Authors: Cooke C J , Meyers A
Published: November 2008

Volunteers from a resident health committee in an apartment complex community carried out door-to-door blood pressure screening of residents. Their results were compared with those from a community where a resident health committee conducted central site screenings and with those of a community where nonresident researchers manned a central screening site. Door-to-door screening by community volunteers was significantly more effective than the two central site screening methods which did not differ from each other. Follow-up measures increased the number of hypertensives who reported seeking treatment by 100 per cent.
Smoking Cessation in a Prospective Study of Healthy Adult Males: Effects of Age, Time Period, and Amount Smoked
Authors: Garvey Arthur J. , Bossé Raymond , Glynn Robert J. , Rosner Bernard
Published: November 2008

The present study examined effects on smoking cessation of three variables—chronological age, time period, and amount smoked—in 637 healthy male smokers aged 22-69 at baseline. Subjects were followed from 1962-1975 using life table procedures. Age was not significantly related to quitting rates (p = .150). The amount smoked effect approached significance (p = .096) with rates of quitting progressively lower at higher consumption levels. Powerful time-period effects were found (p = .008). Incidence rates of quitting increased from 1962-1970, after which a marked decline occurred. (Am J Public Health 1983; 73:446-450.)
The physician visit patterns of chiropractic users: health-seeking behavior of the elderly in Manitoba, Canada.
Authors: Shapiro E
Published: November 2008

To assess the effect of chiropractic use on overall health care utilization patterns, the volume and pattern of ambulatory physician visits by elderly persons having contact with chiropractors are compared with those having contact with physicians only. This analysis is based on data representative of the Canadian Province of Manitoba's entire elderly population; they are drawn from interviews and from claims filed routinely as part of Manitoba's universally insured health care services. The results show that chiropractic services do not substitute for physician services among the elderly in a province which fully insures medical services and a limited number of chiropractic visits. The data suggest that, under these conditions, some elderly chiropractic users consume more physician services than other elderly of equal health status, in addition to visiting chiropractors.
Smoking and carcinoma in situ of the uterine cervix.
Authors: Lyon J L , Gardner J W , West D W , Stanish W M , Hebertson R M
Published: November 2008

We carried out a case-control study of 217 cases of in situ carcinoma of the uterine cervix and 243 controls chosen from the general population of Utah. We found a relative risk of 3.0 for cigarette smoking after controlling for sexual and socioeconomic risk factors. The smoking association was strongest in the youngest age group (ages 20-29), reaching seventeenfold, and was weaker in the older age groups. These data suggest that cigarette smoking may be an independent risk factor for cancer of the uterine cervix, after considering sexual behavior and other well-established risk factors.
Third-trimester induced abortion in Georgia, 1979 and 1980.
Authors: Spitz A M , Lee N C , Grimes D A , Schoenbucher A K , Lavoie M
Published: November 2008

We reviewed 86 third-trimester induced abortions reported to the Georgia Department of Human Resources in 1979 and 1980. Only three of the 78 with adequate data were classified correctly. Fetal deaths in utero accounted for 67.4 per cent of reported cases and first- or second-trimester abortions 18.6 per cent. The true rate of induced abortions performed in the third trimester was 4.3 per 100,000 legal abortions. Diagnosed anencephaly accounted for two out of the three valid third-trimester induced abortions performed.
Tick testing as a method of controlling Rocky Mountain spotted fever.
Authors: Sacks J J , Pinner T A , Parker R L
Published: November 2008

In South Carolina, 1974-1980, only two matches were found between 536 Rocky Mountain spotted fever (RMSF) cases and 965 individuals who submitted ticks that tested rickettsial antigen positive. In neither case did the positive test prevent RMSF. Tick rickettsial positivity rates varied inversely with human RMSF attack rates in different geographic areas. A physician survey established it as unlikely that RMSF occurred in positive tick submitters (PTS), and that although not recommended, 34 per cent of asymptomatic PTS received prophylactic treatment. Only 18 per cent of positive ticks were engorged. Tick testing appears ineffective in preventing RMSF.
Epidemiologic features of Reye syndrome seen in southwestern Pennsylvania 1970-80.
Authors: Ruben F , Streiff E , Neal M , Lehberger L , Hreha M , Michaels R
Published: November 2008

In 11 years of surveillance in southwestern Pennsylvania there were 97 cases of Reye syndrome. Peak incidence was in February and March, corresponding to periods of influenza A and B activity. Mean age of cases was 7.9 years; 57 per cent were female. Case fatality declined from 55 per cent in 1970-75 to 16 per cent in 1976-80 (p less than .001). Influenza was associated with 45 per cent of cases, varicella 19 per cent; the remaining 36 per cent of cases did not occur during periods of influenza activity. Reye syndrome occurred significantly more frequently in suburban and rural areas than in central city (p less than .01), more frequently among White persons than Blacks (p less than .01), and more frequently in counties where the total population under 17 years was less than 25,000 (p less than .01).
The effect of public controversy on occupational health problems: byssinosis.
Authors: Bronstein J M
Published: November 2008

The effect of the byssinosis controversy on surveillance programs in the cotton textile industry is reviewed. The federally regulated format for industry medical surveillance guarantees neither automatic reduction of cotton dust exposure for high-risk workers nor wage rate retention for workers who are transferred to less dusty job sites. The absence of universal guidelines for worker management, combined with doubt over the severity and prevalence of byssinosis, encourages employers to evaluate medical surveillance programs primarily on the basis of their economic impact. When employers use the programs to control their losses, the potential costs of worker participation are increased. Comparisons with medical surveillance programs in the coal industry suggest that health benefits to workers can be guaranteed in the context of disputes over occupational diseases if industry, labor, and government agencies all participate in program design and operation.
A methodological note on location-allocation models.
Authors: Scarpaci J L
Published: November 2008

Three conditions render the use of standard methodologies inappropriate in solving location-allocation problems. This paper presents one alternative method for assigning an emergency aircraft to one of three hospitals in northern Chile when standard approaches are not suitable. Graph analyses and the demographic potential measures are used in the case presented. The main advantages of this alternative approach are its computational ease and the use of more than one method.
Resource requirements for evaluating ambulatory health care.
Authors: Thompson M S , Palmer R H , Rothrock J K , Strain R , Brachman L H , Wright E A
Published: November 2008

We implemented the most frequently used form of quality assurance activity: abstracting information on the quality of patient care from medical records and communicating findings to providers in 16 ambulatory care groups. Site providers accepted the evaluation criteria, agreed that deficiencies in care were detected, and, for some medical tasks, effected improvements in care. Direct costs in 1980 dollars for the quality assurance cycle including data system development were $46 per evaluated case. Per-case costs varied considerably among tasks, decreased with larger numbers of cases and as experience grew, and were reduced through computerization. Measured costs were high due to: a demanding research design; our extended accounting of direct, indirect, and induced costs; and the substantial resource requirements of rigorously performed evaluations.
Feasibility of an Extended MPH Degree Program for fully employed practicing health professionals.
Authors: Wainwright R B , Peterson M L , Farrier J M
Published: November 2008

This report describes the first four years of operation of the Extended MPH Degree Program of the University of Washington School of Public Health and Community Medicine and the features that might explain its initial success. The format of the curriculum is radically different from the traditional two-year program of studies leading to the master of public health degree. Over a three-year span of intensive, on-campus courses and seminars, students are able to fulfill all academic and institutional requirements necessary for the MPH degree. Many more applicants have enrolled for the Extended Degree Program than for the regular MPH program. The 94 students who have matriculated into the program are employed mainly in government agencies in eight western states and British Columbia; most have their prior professional training in nursing and medicine with a median of nine years professional experience. The academic performance of these students is comparable to that of regular full-time MPH program students. The administrative, fiscal, and instructional problems raised by such a transformation have been overcome and the demand for the program and our experience to date suggest that extended MPH degree programs are both feasible and desirable.
Current tuberculosis screening practices.
Authors: Snider D E , Anderson H R , Bentley S E
Published: November 2008

Health department officials in all 50 states and 14 major cities responded to a survey questionnaire designed to obtain information about current tuberculosis screening practices. Persons being screened fell into the groups designated as high risk by the American Thoracic Society (ATS) and the Centers for Disease Control (CDC). The methods used for screening were generally those advocated by ATS, CDC, and the Food and Drug Administration (FDA), although chest radiographs continue to be overused. Screening in about one-half of the groups is mandated by law or regulation. There appears to be some confusion about the circumstances in which "two-step" tuberculin testing should be used. Data on the productivity and costs of screening activities were very limited. We encourage those responsible for tuberculosis screening programs to evaluate them, discontinue those which are unproductive, and intensify those which are productive.
Patients' therapeutic preferences in an ambulatory care setting.
Authors: Povar G J , Mantell M , Morris L A
Published: November 2008

One thousand two hundred-fifteen adult outpatients of an urban health maintenance organization completed questionnaires containing four hypothetical clinical situations. Of these patients, 72 per cent preferred a non-drug "home remedy" when given a choice among that and two different drug options. Risk aversion and willingness to accept current discomfort were stronger than demographic variables in predicting this preference. We conclude that patients informed about the risks and benefits of drug and non-drug therapies will prefer the latter if that option is offered.
Screening for chest disease in college students: policies of student health services regarding the use of routine screening chest radiographs and tuberculin skin tests.
Authors: Fager S S , Slap G B , Kitz D S , Eisenberg J M
Published: November 2008

We conducted a survey of college health services to determine their policies regarding the use of screening chest radiographs and tuberculin skin tests. Pre-enrollment chest radiographs are prescribed for all incoming students by 24 per cent of the 531 respondents and for health professions students, foreign students, and intercollegiate athletes only by an additional 20 per cent, 19 per cent, and 6 per cent, respectively. Periodic chest radiography is conducted for all students by 7 per cent of the respondents and for health professions students, foreign students, and intercollegiate athletes only by an additional 22 per cent, 16 per cent, and 8 per cent, respectively. Pre-enrollment tuberculin skin tests are prescribed for all incoming students by 52 per cent of the respondents and for health professions students, foreign students, and intercollegiate athletes only by an additional 48 per cent, 29 per cent, and 9 per cent, respectively. Periodic tuberculin skin testing is conducted for all students by 27 per cent of the respondents and for health professions students, foreign students, and intercollegiate athletes only by an additional 48 per cent, 23 per cent, and 16 per cent, respectively. We estimate from these data that 723,000 incoming students in the United States received screening chest radiographs in 1979 with estimated charges totaling between $7 million and $27 million. There may be 0.05 to 0.33 induced cases of lung cancer, leukemia, thyroid cancer, and female breast cancer over a 20-year period among this group of students exposed to ionizing radiation.
Prescriptive authority for nurse practitioners: a comparative study of professional attitudes.
Authors: Bigbee J L , Lundin S , Corbett J , Collins J
Published: November 2008

We assessed the attitudes of Wyoming physicians, pharmacists, nurses, and nurse practitioners about granting prescriptive authority to nurse practitioners. Support for the issue was mixed, with physicians expressing the strongest disagreement. All groups supported limitation of authority to a specific drug formulary, collaborative regulation, and mandatory certification and continuing education if prescriptive authority is granted to nurse practitioners.
The participation of Hispanics in US schools of Public Health, 1975-79.
Authors: Trevino F M , Montoya M , Juarez R Z
Published: November 2008

Hispanic student and faculty representation at US Schools of Public Health from 1975-1979 was investigated. Findings indicate a substantial underrepresentation of Hispanic students and faculty members at these schools. Hispanic public health graduates were found to be less likely than other graduates to receive an MPH degree or a doctorate. It appears that the University of Puerto Rico graduates one-half of all Hispanic graduates and employs two-thirds of all Hispanic public health faculty.
Evaluation of tuberculosis control programs: some national trends.
Authors: Powell K E , Brown E D , Seggerson J J , Farer L S
Published: November 2008

Increasing numbers of tuberculosis control programs compile information about the number, location, bacteriologic status, and chemotherapy status of tuberculosis patients within their jurisdiction. Reports from these programs show that during the 1970s the prevalence of patients requiring supervision decreased three times faster than the incidence of tuberculosis; this decline occurred because low relapse rates among patients who had received adequate therapy allowed the recommended duration of follow-up after completion of therapy to diminish from lifetime to none. The prevalence of patients hospitalized for tuberculosis decreased four times faster than the incidence of tuberculosis because the duration of hospitalization decreased from many months to a few weeks and because a small proportion of patients were hospitalized. Future declines in these two program aspects are expected to be much smaller and should parallel the decline in morbidity more closely. Other measures of program performance have shown a less favorable trend and suggest an impeded flow of information to the health department from other persons or agencies involved in the care of tuberculosis.
Community health politics: transition of the Seattle USPHS Hospital.
Authors: Hughes R G , Tompkins R K
Published: November 2008

To achieve transition of the Seattle US Public Health Service Hospital from federal to local control, the community overcame large obstacles; the most difficult was federal preference for closing the hospital rather than incurring additional costs essential for transition. The Washington State Congressional Delegation, local officials, hospital staff, patients and numerous community volunteers--individuals and private organizations--worked together to save the hospital and secure federal resources for its transition. Going through the transition influenced the hospital as it developed a new corporate structure, designed new administrative systems, and prepared to operate in a new environment while facing an uncertain future. The hospital has continued to cope with issues arising from transition, such as operating in a competitive context while reaffirming its community service heritage. Despite the difficulties of transition, Seattle preserved a valuable community health resource.
A randomized study of the impact of home health aides on diabetic control and utilization patterns.
Authors: Hopper S V , Miller J P , Birge C , Swift J
Published: November 2008

Home health aides were offered to half of a group of 227 low-income diabetic clinic patients; in the group offered aides, fasting blood sugar (FBS) declined when compared to control group (10.1 mg/dl vs an increase of 5.1 mg/dl), and missed clinic appointments and emergency room use also decreased. The group of 44, who, upon offer of an aide actually accepted one, showed a significant increase in eye clinic appointments as well as the greatest decline in FBS (13.9 mg/dl).
Family planning in a healthy, married population: operationalizing the human rights approach in an Israeli health service setting.
Authors: Block D E , Kurtzman C
Published: November 2008

A community health center in Israel, delivering services to a geographically defined population, attempted to formulate goals for its postpartum family planning service. Taking into account the pronatalist climate in Israel along with the good health status of the population served by this center, it was decided that the community-wide goal of the family planning program was to ensure the rights of couples to decide freely and responsibly on the number and spacing of their children. Specific process and outcome objectives were developed based on helping couples define and clarify their family planning goals, and assisting them to achieve these goals. Preliminary evaluation of the intervention based on the objectives showed that 84.0 per cent of the cohort of women who gave birth in 1980 (n = 212) had specific postpartum planning goals as opposed to 69.0 per cent of women who gave birth in 1977 (n = 242). The percentage of women experiencing unplanned pregnancies during the two years after birth was reduced by 46 per cent in the 1980 cohort (6.1 per cent of the women) as compared with the 1977 cohort (11.2 per cent).