bluuebunny/crossref_metadata_2025 huggingface dataset:
Population-based study of unintentional injury incidence and impact during childhood.
Authors: Rivara F P , Calonge N , Thompson R S
Published: November 2008

We report a prospective study of medically treated unintentional injuries ascertained in an HMO population of children and adolescents 19 years of age and younger over a one-year period. The overall rate of medically treated injuries was 247 per 1,000, 147/1,000 for those treated in the clinic, and 100/1,000 for those treated in the emergency room (ER). Overall, 2.5 percent of patients were hospitalized. The highest rates of injury were for falls (60 per 1,000), recreational activities (57 per 1,000) and competitive sports (49 per 1,000). The site of care varied little by injury diagnosis or etiology, with the exception that sprains/strains, fractures, and injuries due to play and sports were more commonly treated in the clinic. The impact of trauma on activity was considerable, with 55.9 percent of injuries resulting in restricted activity, 10.6 percent in greater than or equal to 2 days of school missed, and 6.7 percent in greater than or equal to 2 days spent in bed.
Comprehensive health care for high-risk adolescents: an evaluation study.
Authors: Earls F , Robins L N , Stiffman A R , Powell J
Published: November 2008

This study was designed to evaluate the effectiveness of a large scale program to improve health care for high-risk adolescents. Seven clinics, funded to provide comprehensive primary care to adolescents, were compared to three non-funded clinics. The majority of the 2,788 adolescent patients sampled in these clinics were female (78 percent) and Black (71 percent). Each patient was initially interviewed at the time of a clinic visit and reinterviewed 12 months later; their medical records were systematically reviewed. As expected, the funded clinics detected and treated a wider range of medical and behavioral problems than the comparison clinics, a finding that was based on the self-reports of patients and confirmed by documentation in the medical records. However, improvements in life-style and in specific medical outcomes were not observed. To build on the limited success of this program, efforts are needed to encourage more males to receive care and to develop more specific interventions for patients in this age group.
Risk factors associated with participation in the Ontario, Canada doctors' strike.
Authors: Kravitz R L , Shapiro M F , Linn L S , Froelicher E S
Published: November 2008

To identify factors associated with participation in the 1986 Ontario, Canada doctors' strike, we surveyed 1,028 physicians; 69 percent responded, of whom 42 percent participated in the strike. Risk factors for participation included income greater than $135,000, being a surgeon or gynecologist, having previously "opted out" of the Ontario Health Insurance Plan, being professionally dissatisfied, being politically conservative, favoring political activism by physicians, holding a positive view of the social consequences of extrabilling, and perceiving family, associates, patients and the public to favor the strike. Eighty percent of strikers, but 32 percent of non-strikers, met criteria we established for four strike-prone groups: the "economically rational," the "ideologically committed," the "professionally disaffected," and the "socially malleable." Respondents belonging to one or more of these groups were much more likely to have participated in the strike (64 percent vs 17 percent). Strategies to deal with physician militancy should address the multiplicity of motives that appeared to have influenced doctors in Ontario.
Catholicism and fertility in Puerto Rico.
Authors: Herold J M , Westoff C F , Warren C W , Seltzer J
Published: November 2008

This paper examines the association between fertility and religious affiliation among Puerto Ricans. Bongaarts' proximate determinants framework is used to compare religious categories on behaviors that directly affect fertility. We found no difference in recent fertility between Catholics and non-Catholics in Puerto Rico (total fertility rate = 2.5). We also found Catholics and non-Catholics to be similar on age at first marriage (23.3 and 23.4 years, respectively), contraceptive use (71 percent and 69 percent of married women currently contracepting), and breast-feeding practices (mean duration of breast-feeding of 4.4 and 4.3 months). Differences were observed between less committed and more committed Catholics in total fertility rate, age at first marriage, and contraceptive use, but these differences were not large and were in the opposite direction from the expected. Our findings support the theory of convergence of Catholic and non-Catholic fertility for the US. Our discrepancy with findings from the National Survey of Family Growth is evidence of the cultural diversity in the US Hispanic population and indicates the importance of disaggregating by ethnicity or national origin when studying this population.
Effects of a geriatric nurse practitioner on process and outcome of nursing home care.
Authors: Kane R L , Garrard J , Skay C L , Radosevich D M , Buchanan J L , McDermott S M , Arnold S B , Kepferle L
Published: November 2008

We compared measures of quality of care and health services utilization in 30 nursing homes employing geriatric nurse practitioners with those in 30 matched control homes. Information for this analysis came from reviews of samples of patient records drawn at comparable periods before and after the geriatric NPs were employed. The measures of geriatric nurse practitioner impact were based on comparisons of changes from pre-NP to post-NP periods. Separate analyses were done for newly admitted and long-stay residents; a subgroup of homes judged to be best case examples was analyzed separately as well as the whole sample. Favorable changes were seen in two out of eight activity of daily living (ADL) measures: five of 18 nursing therapies; two of six drug therapies; six of eight tracers. There was some reduction in hospital admissions and total days in geriatric NP homes. Overall measures of medical attention showed a mixed pattern with some evidence of geriatric NP care substituted for physician care. These findings suggest that the geriatric NP has a useful role in nursing home care.
Major trauma in geriatric patients.
Authors: Champion H R , Copes W S , Buyer D , Flanagan M E , Bain L , Sacco W J
Published: November 2008

Contemporary trauma to the elderly, its severity and associated mortality and morbidity in 111 United States and Canadian trauma centers are described. Three-thousand eight-hundred thirty-three (3,833) trauma patients age 65 years or older are compared to 42,944 injured patients under age 65. Although both groups had equivalent measures of injury severity, the older group had higher case fatality and complication rates and longer hospital stays. The results raise important questions regarding the triage, acute care, accurate prediction of outcome, and hospital reimbursement for the elderly injured patient, with implications for care evaluation, quality assurance, and the long-term viability of trauma centers and systems of care.
Chronic stressors and maternal depression: implications for prevention.
Authors: Orr S T , James S A , Burns B J , Thompson B
Published: November 2008

We report on the use of an instrument to measure exposure to stressors among 149 women presenting with their children for pediatric care at an urban primary care center. Overall, 38.3 percent of the women had significant levels of depressive symptoms; 71.4 percent of those in the "high stress" group had an adjusted prevalence odds ratio of 5.00 [95% CI = 2.12, 11.82]. We conclude that screening in the pediatric office is feasible for identifying women at high risk of becoming depressed.
Development of a standard questionnaire for occupational health research.
Authors: Ehrenberg R L , Sniezek J E
Published: November 2008

Direct surveys of groups of workers can provide valuable occupational health surveillance data, but this requires consistent collection of data. As part of efforts to improve the standardization of such methodology, NIOSH is developing a standard occupational health questionnaire. This questionnaire will be designed to collect demographic and occupational history information in addition to information about the presence of a spectrum of work-related conditions. The questionnaire will have a modular structure and will consist of a core questionnaire and a series of condition-specific modules.
The role of occupational health clinics in surveillance of occupational disease.
Authors: Welch L
Published: November 2008

Academic occupational health centers can support state-based occupational disease surveillance by playing a role in case identification and management, physician education, workplace investigation, and surveillance case criteria development. The existing centers can also serve as models for developing new clinics. As plans for developing surveillance continue, the role of these centers should be explicitly defined, and they should be included in helping to develop mechanisms for reporting. In all these ways, the centers can significantly enhance the development of a national surveillance system for occupational disease.
The utility of multiple strategies for understanding complex behaviors.
Authors: Adler N E , Kegeles S M , Irwin C E
Published: November 2008

Nickerson's critique of our brief report on changes in knowledge, attitudes and use of condoms among adolescents over a year's time mistakenly interprets the paper as examining an attitude/behavior discrepancy. A number of her criticisms follow from this mistaken interpretation. We agree with some of her general points but identify several errors in her analysis and note areas of disagreement about strategies for studying complex behaviors.
Global health, national development, and the role of government.
Authors: Roemer M I , Roemer R
Published: November 2008

In spite of extreme differences in health status between the more developed and less developed countries, trends of infant mortality and life expectancy show substantial improvements in both types of country between 1950 and 1980. These improvements may be attributed to three types of change: 1) socio-economic development with decolonization, increased industrialization, growth of gross domestic product, urbanization, the gains of women, and enhanced education; 2) cross-national influences due to greater international trade, the spread of technology, and widespread affirmation of human rights; and 3) national health system development through expanded governmental health programs. Further improvements will depend on greater strength in public sector health services rather than private sector services which aggravate inequities.
Consistent pattern of elevated symptoms in air-conditioned office buildings: a reanalysis of epidemiologic studies.
Authors: Mendell M J , Smith A H
Published: November 2008

Published studies of the relation between type of building ventilation system and work-related symptom prevalence in office workers have been contradictory. A reanalysis was performed of six studies meeting specific eligibility criteria, combining published data with unpublished information obtained from study authors. Five eligible studies were from the United Kingdom, and one was from Denmark. Standardized categories of building ventilation type were created to allow comparison of effects across studies. Within each study, prevalence odds ratios (PORs) were calculated for symptoms in each ventilation category relative to a baseline category of naturally ventilated buildings. Air-conditioned buildings were consistently associated with increased prevalence of work-related headache (POR = 1.3-3.1), lethargy (POR = 1.4-5.1), and upper respiratory/mucus membrane symptoms (POR = 1.3-4.8). Humidification was not a necessary factor for the higher symptom prevalence associated with air-conditioning. Mechanical ventilation without air-conditioning was not associated with higher symptom prevalence. The consistent associations found between type of building ventilation and reported symptom prevalence have potentially important public health and economic implications.
The association of corneal arcus with coronary heart disease and cardiovascular disease mortality in the Lipid Research Clinics Mortality Follow-up Study.
Authors: Chambless L E , Fuchs F D , Linn S , Kritchevsky S B , Larosa J C , Segal P , Rifkind B M
Published: November 2008

The relationship between corneal arcus (arcus senilis) and mortality from coronary heart disease (CHD) and cardiovascular disease (CVD) is examined in a prospective study of White men (n = 3,930) and women non-hormone users (n = 2,139), ages 30-69, followed for an average of 8.4 years as part of the Lipid Research Clinics Mortality Follow-up Study. After excluding those with clinically manifest CHD at baseline, corneal arcus was strongly associated with CHD and CVD mortality only in hyperlipidemic men ages 30-49 years, for whom the relative risk for CHD and CVD death was 3.7 and 4.0, respectively, after adjusting for age, total cholesterol, HDL cholesterol, and smoking status using a Cox proportional hazards model. Among 30-49 year old males, corneal arcus appears to be a prognostic factor for CHD, independent of its association with hyperlipidemia in this age-group, of about the same magnitude as other common risk factors, underscoring the usefulness of corneal arcus as a prognostic factor to the practicing clinician.
Lyme disease in New Jersey outdoor workers: a statewide survey of seroprevalence and tick exposure.
Authors: Goldstein M D , Schwartz B S , Friedmann C , Maccarillo B , Borbi M , Tuccillo R
Published: November 2008

To evaluate the spread of Lyme disease in New Jersey, we conducted a statewide cross-sectional study of Lyme disease seroprevalence in a high-risk occupational group of outdoor employees. Of the 689 employees who participated in the study, 39 (5.7 percent) were positive for antibody to B. burgdorferi, the causative agent of Lyme disease. Seroprevalence varied markedly by county; unexpectedly high seroprevalence rates were found in several northern counties (Sussex, Hudson, and Hunterdon). Furthermore, some southern counties (Atlantic, Cape May, and Ocean) with large tick populations (as measured by self-reported exposure to ticks) had low seroprevalence rates which were inversely correlated with self-reported preventive practices. These data suggest that lyme disease, as measured by seroprevalence of antibody to B. burgdorferi, may be spreading beyond the southern portion of the state where it had been previously well documented and that preventive behaviors may play an important role in minimizing the risk of the disease.
Evaluating the impact of municipal water fluoridation on the aquatic environment.
Authors: Osterman J W
Published: November 2008

Although highly beneficial for dental health, low concentrations of fluoride in environmental waters may be toxic to several organisms. In an era of heightened public awareness about the environment, this may lead city officials to withhold implementing water fluoridation for environmental reasons. This paper presents a mass balance approach to evaluate this perceived risk. Generally speaking, fluoridated water loss during use, dilution of sewage by rain and ground water infiltrate, fluoride removal during secondary sewage treatment, and diffusion dynamics at effluent outfall combine to eliminate fluoridation-related environmental effects. In Montreal, water fluoridation would raise average aquatic fluoride levels in the waste water plume immediately below effluent outfall by only 0.05-0.09 mg/l. Downstream, these changes would be only 0.02-0.05 mg/l at 1 km, and 0.01-0.03 mg/l at 2 km below outfall. Overall river fluoride concentrations theoretically would be raised by 0.001-0.002 mg/l, a value not measurable by current analytical techniques. All resulting concentrations would be well below those recommended for environmental safety and would not exceed natural levels found elsewhere in Quebec. A literature review did not reveal any examples of municipal water fluoridation causing recommended environmental concentrations to be exceeded, although excesses occurred in several cases of severe industrial water pollution.
Patient, provider and hospital characteristics associated with inappropriate hospitalization.
Authors: Siu A L , Manning W G , Benjamin B
Published: November 2008

To determine the relation between patient and provider characteristics and inappropriate hospital use, we examined adult nonpregnancy hospitalizations from a randomized trial of health insurance conducted in six sites in the United States. Appropriateness of inpatient treatment was based on medical record review; patient characteristics on sociodemographic, economic, and health status; and provider characteristics on descriptors of physician practice and hospital facilities. Twenty-seven percent of admissions attended by physicians licensed for more than 15 years were judged inappropriate, compared to 20 percent for younger physicians. Admissions were more likely to be inappropriate if the patient was female (27 percent compared with 18 percent). Controlling for patient and provider characteristics reduces but does not eliminate the differences in the appropriateness of inpatient care across the study's six sites. Differences in available provider and patient characteristics do not account for geographic differences in inappropriate hospitalization in this study.
Surveillance of occupational lung disease: comparison of hospital discharge data to physician reporting.
Authors: Rosenman K D , Trimbath L , Stanbury M
Published: November 2008

A survey of 762 New Jersey physicians showed that 35% reported seeing patients with either asbestosis, coal worker's pneumoconiosis, occupational asthma or silicosis. Three to four times as many patients with these diagnoses were seen as outpatients as were hospitalized. The implications of these results in using hospital discharge data for occupational disease surveillance are discussed.
Food-borne outbreak of Giardia lamblia.
Authors: Porter J D , Gaffney C , Heymann D , Parkin W
Published: November 2008

An outbreak of giardiasis occurred following a family party for 25 persons. Nine who had eaten fruit salad became ill, compared with one who had not eaten the salad (Relative Risk = 7.4, 95% CI = 1.4, 169.3). The fruit salad preparer had a diapered child and a pet rabbit at home who were both positive for Giardia lamblia. This outbreak emphasizes the importance of good hygienic practices in food preparation and the possibility of domestic-animal-to-person transmission in Giardia outbreaks.
Are women using postmenopausal estrogens? A community survey.
Authors: Harris R B , Laws A , Reddy V M , King A , Haskell W L
Published: November 2008

Self-reported estrogen and progestin use in a California community was determined in 1986-87 from a telephone survey of postmenopausal women (n = 954) ages 50-65 years. Current use of hormones was reported by 32 percent; 26 percent took estrogens alone while 6 percent used estrogen + progestin. Comparisons pointed to significant social network and medical care utilization differences. Women who used estrogen therapy were younger, thinner, lived in smaller household units, and were less likely to be widowed.
Estimating the mortality cost of AIDS: do estimates of earnings differ?
Authors: Begley C E , Crane M M , Perdue G
Published: November 2008

The future earnings of male Texans dying of AIDS in 1987 were estimated using: national earnings profiles; earnings derived from occupations listed on death certificates; and earnings reported by persons with AIDS who responded to a survey. Mortality cost estimates using the two sources of actual earnings differed by a modest amount in comparison to the estimate using national earnings profiles.
Effects of individually motivating smoking cessation in male blue collar workers.
Authors: Kilburn K H , Warshaw R H
Published: November 2008

Adverse demonstrable health effects linked to the individual's smoking were shown to 2,689 American workers to motivate cessation during routine examinations to detect asbestosis. This intervention was evaluated six to 25 months later by a mailed questionnaire and by telephone to non-responders. Results were compared to yearly quit rates of 2.5 percent to 5 percent for 736 workers who were ex-smokers at the initial examination. Of the 504 men who responded by mail, 29.8 percent had quit smoking, 35.9 percent had cut down from a mean of 28 to 13 cigarettes per day, and 34.3 percent were smoking as before. Subsequent follow-up at one year showed that 25.6 percent remained quit, and that 23 percent of those who cut down had quit, for an overall quit rate of 34 percent. Of 101 non-responders contacted by telephone, 17 percent had quit and 53 percent had reduced smoking. In both samples, those who quit were more likely to have had lower alveolar carbon monoxide (COa) levels, to be older, and to have had asbestosis. Responders by mail were the same age as non-responders but had smoked longer, had higher prevalences of asbestosis, emphysema, chronic bronchitis and higher COa. Demonstration of the adverse personal effects of smoking appear to have contributed to the quit rates or reduced smoking rates in 65 percent of the responding workers.
The association between Type A behavior and change in coronary risk factors among young adults.
Authors: Garrity T F , Kotchen J M , McKean H E , Gurley D , McFadden M
Published: November 2008

The association of Type A/B behavior pattern and changes in blood pressure, total serum cholesterol, serum triglyceride, body mass, and smoking was estimated in a cohort of 375 young Black and White men and women from a rural county in Central Kentucky between 1978-79 and 1985-88. Type A participants experienced significant increases in systolic (2.90 +/- 1.29 mmHg) and diastolic (3.80 +/- 1.17 mmHg) blood pressure and in cigarette smoking (3.26 +/- 0.89 cigarettes per day) over the eight-year follow-up period, but Type B participants experienced no change. Type A and B individuals showed similar changes in total serum cholesterol, serum triglyceride, or body mass. Differences between behavioral types in blood pressure were present for women but not men, and for Blacks but not for Whites. These findings suggest a possible significance of the Type A pattern for the development of cardiovascular risk of young adults.
The Framingham Disability Study: relationship of various coronary heart disease manifestations to disability in older persons living in the community.
Authors: Pinsky J L , Jette A M , Branch L G , Kannel W B , Feinleib M
Published: November 2008

The relation between coronary heart disease and disability was examined in 2,576 community-dwelling women and men ages 55-88 years. These Framingham Study participants were originally recruited in 1948-51 for an examination of cardiovascular disease. Twenty-seven years later, remaining members of the cohort were interviewed to ascertain physical abilities, and a score on a disability scale was assigned. Multivariate logistic analyses examined disability in relation to uncomplicated angina pectoris (AP), complicated AP, and coronary heart disease other than AP, controlling for possible confounders. In younger and older women and men, uncomplicated and complicated AP were associated with disability. Coronary heart disease other than AP was associated with disability only in the younger men. Congestive heart failure predicted disability only in the women. These results suggest that onset of AP should be recognized as a critical point in the development of disability and that AP is a better predictor of disability than is myocardial infarction or coronary insufficiency.
The effects of psychosocial work organization on patterns of cigarette smoking among male chemical plant employees.
Authors: Green K L , Johnson J V
Published: November 2008

We tested the hypothesis that job strain (the combination of high psychological job demands and low work control) is positively associated with smoking prevalence and intensity in a study group of 389 males employed in a chemical plant, using a self-administered questionnaire. In a logistic regression analysis which controlled for a number of sociodemographic factors, job strain was not found to be associated with smoking cessation. However, among smokers, those in higher-strain jobs smoked more heavily than those in lower-strain positions (OR 1.70, 95% CI = 1.10, 2.61) and were more likely to have increased the amount they smoke (OR 3.72, 95% CI = 1.92, 7.17).
Prior cesarean delivery in women with secondary tubal infertility.
Authors: Wolf M E , Daling J R , Voigt L F
Published: November 2008

The history of cesarean delivery was evaluated in a population-based case-control study of secondary infertility in King County, Washington. Sixty-one married women diagnosed with secondary infertility due to tubal problems who had a previous viable pregnancy were compared to 343 married women who had a previous viable pregnancy and then had a live birth that was conceived at the same time the infertile women began trying to conceive. The risk of tubal infertility was not substantially elevated in women who had a previous cesarean delivery in the most recent viable pregnancy compared to women with vaginal delivery (odds ratio = 1.2; 95% confidence interval = 0.4, 3.7).
A comparison of homeless, community-wide, and selected distressed samples on the CES-Depression Scale.
Authors: Ritchey F J , La Gory M , Fitzpatrick K M , Mullis J
Published: November 2008

Center for Epidemiological Studies (CES) Depression Scale results for surveys of homeless, community-wide and selected distressed samples are compared. Nearly four times the percentage of homeless fit the criterion for clinical caseness (a score of 16+) compared to the general population (74 to 19 percent). None of the distressed samples exhibited a higher rate except psychiatric patients diagnosed as acutely depressive. High rates of depression have implications for social policies directed toward homelessness.
How valid are mammography self-reports?
Authors: King E S , Rimer B K , Trock B , Balshem A , Engstrom P
Published: November 2008

We compared mammography reports in medical records to self-reports obtained during a 1989 telephone interview survey for a sample of 100 women members of a health maintenance organization (HMO) who indicated they had mammograms within the past year and 100 who said they had not had mammograms within the past year. Of the women reporting they had not had mammograms within the past year, none had mammogram reports in the HMO data center. Of the 100 women reporting they had mammograms within the past year, 94 had confirmatory radiology records.
Incidence of bicycle-related injuries in a defined population.
Authors: Thompson D C , Thompson R S , Rivara F P
Published: November 2008

Population-based incidence rates for head injuries and total injuries resulting from bicycle crashes were calculated in a Seattle, Washington health maintenance organization population. Overall rates were 163 per 100,000 for all injuries and 42/100,000 for head injuries. Individuals between 5 and 14 years of age are at highest risk for bicycle-related injuries. The data are presented for their potential utility in program planning.
Hypertension prevalence and the status of awareness, treatment, and control in the Hispanic Health and Nutrition Examination Survey (HHANES), 1982-84.
Authors: Pappas G , Gergen P J , Carroll M
Published: November 2008

The prevalence rates of hypertension among adult (ages 18-74) Mexican Americans, Cuban Americans, and Puerto Ricans were estimated using data from the 1982-84 Hispanic Health and Nutrition Examination Survey (HHANES). Hypertension is defined as diastolic greater than or equal to 90 mm Hg, or systolic greater than or equal to 140 mm Hg, or currently taking antihypertensive medication. Among Mexican Americans in the Southwestern United States, 16.8 percent of the males and 14.1 percent of the females were found to be hypertensive. Among Cuban Americans in Dade County, Florida 22.8 percent of the males and 15.5 percent of the females were hypertensive. Among Puerto Ricans in the New York City area 15.6 percent of the males and 11.5 percent of the females were hypertensive. The age-adjusted rates are significantly lower than comparable rates for Whites and Blacks as measured in the second National Health and Nutrition Examination Survey (NHANES II), 1976-80. Control of hypertension in the HHANES populations fall short of the 1990 Objectives for the Nation established by the US Public Health Service 60 percent (34 percent controlled Mexican American hypertensives, 27.8 percent controlled Cuban American hypertensives, and 29 percent controlled Puerto Rican hypertensives.
Injury and disability in matched men's and women's intercollegiate sports.
Authors: Lanese R R , Strauss R H , Leizman D J , Rotondi A M
Published: November 2008

Eight matched men's and women's intercollegiate varsity teams were studied prospectively for one academic year to determine the incidence of athletic injury and resulting disability. Sports in which both men and women participated in a comparable manner were chosen: basketball, fencing, gymnastics, swimming, tennis, indoor track, outdoor track, and volleyball. Men (232) and women (150) were injured at comparable rates, 42 percent versus 39 percent. When adjusted for exposure time, seven of the eight sports continued to show similar injury rates. Women gymnasts, however, experienced .82 injuries per 100 person-hours of exposure as compared to .21 injuries for the men (p = .0001). Disability was greater in women gymnasts, 7.44 days per 100 person-hours versus 1.15 days for men (p = .0004). Percent of season lost to injury was also greater for women gymnasts. Types and sites of injury were similar for men and women, with sprains and strains accounting for over half of all injuries. We found no evidence for gender differences in matched sports except for gymnastics, in which technically diverse events may have accounted for the differences observed.
Coding external causes of injury (E-codes) in Maryland hospital discharges 1979-88: a statewide study to explore the uncoded population.
Authors: Marganitt B , MacKenzie E J , Smith G S , Damiano A M
Published: November 2008

We examined the trends in hospital discharge E-coding in Maryland over a 10-year period. The overall proportion of E-coded discharges has increased from 40 percent in 1979 to 55 percent in 1988. E-coding was lower in the severely injured, the elderly, and patients with long hospital stays. Our findings demonstrate that E-code reporting varies because of the limited number of data fields available for coding of discharge diagnoses. Universal, systematic reporting of E-codes in hospital discharge data is essential if these data are to provide critically needed information about nonfatal injuries. Hospital discharge data formats should contain separate fields for E-codes and the use of these codes, we believe, should be mandated.
Benzodiazepine tranquilizers and the risk of accidental injury.
Authors: Oster G , Huse D M , Adams S F , Imbimbo J , Russell M W
Published: November 2008

To determine whether benzodiazepine tranquilizers increase the risk of accidental injury requiring medical attention, we used pharmacy claims submitted to a large third-party payer to identify 4,554 persons who had been prescribed these agents and a matched control group of 13,662 persons who had been prescribed drugs other than benzodiazepines. We then used diagnoses recorded on claims submitted by medical care providers to identify all accident-related care received by these persons during three months before their first-observed prescription for a benzodiazepine or nonbenzodiazepine agent, respectively, and six months subsequently. We found accident-related care was more likely among persons who had been prescribed benzodiazepines; among these persons, the probability of an accident-related medical encounter was higher during months in which a prescription for a benzodiazepine had recently been filled compared to other months; and persons who had filled three or more prescriptions for these agents in the six months following initiation of therapy had a significantly higher risk of an accident-related medical event than those who had filled only one such prescription. Approximately two-fold risks of accident-related care were found, after controlling for age, sex, and prior utilization.
Association of hepatitis B surface antigen and core antibody with acquisition and manifestations of human immunodeficiency virus type 1 (HIV-1) infection.
Authors: Solomon R E , VanRaden M , Kaslow R A , Lyter D , Visscher B , Farzadegan H , Phair J
Published: November 2008

We examined the associations between seropositivity for hepatitis B virus (HBV) with the presence or development of antibodies to human immunodeficiency virus (HIV-1) and with HIV-1 induced T-helper lymphocyte deficiency or acquired immunodeficiency syndrome (AIDS). Serologic data on HBV and HIV-1, cytometric enumeration of CD4+ lymphocytes, clinical events (AIDS by Centers for Disease Control criteria) and hepatitis B vaccination histories were available on 4,498 homosexual participants in the Multicenter AIDS Cohort Study, Men were classified as to previous infection with HBV and prevalent or incident infection with HIV-1. Although there was an association between seropositivity for HBV infection and HIV-1 infection at enrollment (odds ratios anti-HBc 2.6; HBsAg 4.2), the relation between HBV seropositivity and subsequent seroconversion to HIV-1 was weaker (odds ratios 1.3 and 1.6). HIV-1 seroconversion was also associated with a history of certain other sexually transmitted diseases, but predisposing sexual practices did not account for the association between HBV and HIV-1 infection. Seropositivity for HBV infection at entry was not related to initially low or more rapid subsequent decline in T-helper lymphocyte counts and was not associated with an increased incidence of AIDS during 2.5 years of follow-up. History of vaccination against HBV did not appear to decrease susceptibility to HIV-1 infection or to subsequent progression of immunodeficiency. We conclude that prior HBV infection is unlikely to be specifically associated with acquisition of HIV-1 infection and is unrelated to more rapid progression of HIV-1-induced immunodeficiency.
Death in prison: changing mortality patterns among male prisoners in Maryland, 1979-87.
Authors: Salive M E , Smith G S , Brewer T F
Published: November 2008

The leading causes of death (rate per 100,000 prisoner-years) in Maryland state prisons for the period 1979-87 were circulatory system disease (59), suicide (40), and homicide and legal intervention (30). Acquired immunodeficiency syndrome (AIDS) became the leading cause of death in 1987. Homicides declined after 1980; drug overdose deaths peaked in 1981 and later disappeared. Male inmates have 39 percent lower all-cause death rates than the general population of Maryland after adjustment for age and race.
Long-term impact of smoking cessation on the incidence of coronary heart disease.
Authors: Tosteson A N , Weinstein M C , Williams L W , Goldman L
Published: November 2008

Using a simulation model of the US male population, we estimated the long-term impact that future smoking cessation programs would have on the distribution and occurrence of coronary heart disease in males ages 35-84. For interventions that reduce the number of smokers by 25 percent in 1990, the number of men free of coronary heart disease is projected to increase by 416,787 (0.7 percent) in 2015, and the age-standardized absolute incidence to decline by 2.3 percent. Incidence rates and absolute incidences are projected to fall in men under age 65, but absolute incidence would rise in men over age 65, in large part because of the increased number of men who were at risk for coronary heart disease because of a reduction in non-coronary smoking-related mortality. These trends were more marked for greater smoking reductions and were generally unaffected in a variety of analyses using alternative assumptions, which considered smoking as a risk factor in the elderly, a lag-time before benefits from smoking cessation were realized and secular declines in smoking prevalence. Subject to the assumptions of our model, we conclude that smoking reductions will markedly reduce coronary heart disease, especially in younger age groups, and that this benefit will be slightly offset by a small increase in absolute incidence in elderly men.
Prospective payment and the utilization of physical therapy service in the hospitalized elderly.
Authors: Holt P , Winograd C H
Published: November 2008

We studied the effect, in a university teaching hospital, of the prospective payment system (PPS) on utilization of physical therapy (PT), a non-reimbursable service; subjects were hospitalized patients aged 75 or older with non-PT-related diagnoses (myocardial infarction, pneumonia, congestive heart failure, and colectomy) and PT-related diagnoses (cerebrovascular accident and hip fracture). The proportion of patients referred for PT increased from 68 percent pre-PPS to 85 percent post-PPS for those with PT-related diagnoses and from 13 percent pre-PPS to 19 percent post-PPS for those with non-PT-related diagnoses. The mean number of sessions of PT decreased slightly for both groups: from 8.5 to 7.6 sessions for those with PT-related diagnoses and from 5.2 to 4.5 for those with non-PT-related diagnoses. In patients with PT-related diagnoses whose ambulatory status worsened during hospitalization, referrals for PT increased from 76 percent pre-PPS to 98 percent post-PPS. Referrals of comparable patients with non-PT-related diagnoses did not increase. Changes in provider education and efforts to reduce length of stay may account for these findings.
Prevalence of chronic bronchitis among US Hispanics from the Hispanic Health and Nutrition Examination Survey, 1982-84.
Authors: Bang K M , Gergen P J , Carroll M
Published: November 2008

In the Hispanic Health and Nutrition Examination Survey (HHANES), Puerto Ricans had a higher age-adjusted prevalence of self-reported chronic bronchitis (2.9 percent, 95% CI = 2.2, 3.6) than Mexican Americans (1.7 percent, 95% CI = 1.3, 2.1) or Cubans (1.7 percent, 95% CI = 0.9, 2.5). The prevalence of chronic bronchitis was at least 2 times higher in smokers as compared to nonsmokers among Puerto Ricans and Cubans, but not for Mexican Americans.
Dental office practices for tobacco users: independent practice and HMO clinics.
Authors: Severson H H , Eakin E G , Stevens V J , Lichtenstein E
Published: November 2008

Surveys of independent dental practitioners and health maintenance organization (HMO) dentists and their adult male patients in Oregon found that cessation information and advice was being given to tobacco-using patients, especially smokeless tobacco users, and that the tobacco users surveyed expressed interest in obtaining help to quit. Oral health providers expressed an interest in further training in how to help their tobacco-using patients to quit.
Behavioral change in longitudinal studies: adoption of condom use by homosexual/bisexual men.
Authors: Joseph J G , Adib S M , Koopman J S , Ostrow D G
Published: November 2008

We compared reporting serial cross-sectional prevalence of sexual behavior over time, to reporting individual patterns of behavioral change in a cohort of homosexual men at a six-month interval. Aggregate prevalence rates underestimated the magnitude of change to safer practices, and failed to provide information on relapse to less safe practices. We conclude that it is important to report data based on individual fluctuations in behavior for the evaluation of change over time.
Seat belt use in cars with air bags.
Authors: Williams A F , Wells J K , Lund A K
Published: November 2008

Seat belt use was observed in 1,628 cars with air bags and manual belts and 34,223 cars with manual seat belts only. Sixty-six percent of drivers in cars with air bags wore seat belts compared to 63 percent of drivers in cars with manual belts only. The study found no evidence for the speculation that drivers with air bags will reduce their seat belt use because they believe an air bag alone provides sufficient protection.
Fecal contamination of shanty town toddlers in households with non-corralled poultry, Lima, Peru.
Authors: Marquis G S , Ventura G , Gilman R H , Porras E , Miranda E , Carbajal L , Pentafiel M
Published: November 2008

We used direct observer techniques to measure the frequency with which toddler-aged children were contaminated by poultry feces in homes in a peri-urban shanty town in Lima, Peru. The mean number of fowl was 5.4 (SD 3.1), with 10.0 (SD 10.7) poultry defecations per 12 hours. Toddlers' hand contact with poultry feces occurred a mean of 2.9 (SD 3.0) times/12 hours. A mean of 3.9 (SD 4.6) feces-to-mouth episodes per household/12 hours occurred both by direct hand-to-mouth contamination and indirectly by handling soiled objects which were then placed in the mouth. There was a strong correlation between feces-to-hand contamination and feces-to-mouth contamination (r = 0.94). There was also an association between feces-to-mouth contamination and the number of stools deposited in the house (r = 0.66). For each additional chicken stool deposited during the day, there was an average increase of 0.27 in feces-to-mouth episodes. We collected feces from 68 infected chickens and found viable Campylobacter jejuni for up to 48 hours after deposition. Yet, a survey of 108 families demonstrated that free-roaming poultry were often not thought of as a health risk for children. An intervention program to reduce oral-fecal contamination should emphasize that all poultry be corralled and not allowed access into the house.
Work-related psychosocial stress and risk of preterm, low birthweight delivery.
Authors: Homer C J , James S A , Siegel E
Published: November 2008

We investigated whether work-related psychologic stress--defined as work characterized by both high psychologic demands and limited control over the response to these demands--increases a woman's risk of delivering a preterm, low birthweight infant. We studied 786 employed pregnant women included in the National Longitudinal Survey of Labor Market Experience, Youth Cohort (NLSY), a nationally representative sample of 12,686 young adults. Data concerning work status, job title, and other factors affecting pregnancy outcome were obtained from the NLSY. Assessment of job experience was based on job title, using an established catalogue of occupation characteristics. After accounting for the physical exertion entailed in a job, occupational psychologic stress as measured by job title was not associated with preterm, low birthweight delivery for the sample as a whole (Relative risk = 1.16, 95% confidence interval .45, 2.95). For those women who did not want to remain in the work force, work-related stress increased their risk of experiencing this outcome (RR = 8.1, 95% CI 1.5, 50.2). Personal motivation toward work, as well as the physical effort of work, should be considered in evaluating the impact of a job's psychologic characteristics on pregnancy outcome.
Epidemiologic assessment of screening tests for antibody to human T lymphotropic virus type I (HTLV-I).
Authors: Khabbaz R F , Hartley T M , Lairmore M D , Kaplan J E
Published: November 2008

We tested 196 sera from a human T lymphotropic virus type I (HTLV-I) risk group (prostitute women) with two commercial "research" enzyme-linked immunoabsorbent assays (EIA) for HTLV-I antibodies. All tested sera were characterized by HTLV-I Western immunoblots and by HTLV-I radioimmunoprecipitation assays. The estimated sensitivities of the EIA tests were 93.8 percent and 100 percent, and the specificities were 98.8 percent and 95.8 percent, respectively, using recommended criteria for seropositivity (requiring reactivity to both gag p24 and env gp46 or gp61/68). Calculated negative predictive values remained excellent (greater than 99.9 percent and 100 percent, respectively) at lower seroprevalence rates but the positive predictive values were only 7.3 percent and 2.3 percent when calculated for a seroprevalence rate of 0.1 percent. These results emphasize the importance and need for additional HTLV-I supplementary serologic testing when screening populations with low HTLV-I seroprevalence rates.
Soviet health care and perestroika.
Authors: Schultz D S , Rafferty M P
Published: November 2008

Health and health care in the Soviet Union are drawing special attention during these first years of perestroika, Mikhail Gorbachev's reform of Soviet political and economic life. This report briefly describes the current state of Soviet health and medical care, Gorbachev's plans for reform, and the prospects for success. In recent years the Soviet Union has experienced a rising infant mortality rate and declining life expectancy. The health care system has been increasingly criticized for its uncaring providers, low quality of care, and unequal access. The proposed measures will increase by 50 percent the state's contribution to health care financing, encourage private medicine on a small scale, and begin experimentation with capitation financing. It seems unlikely that the government will be able to finance its share of planned health improvements, or that private medicine, constrained by the government's tight control, will contribute much in the near term. Recovery of the Soviet economy in general as well as the ability of health care institutions to gain access to Western materials will largely determine the success of reform of the Soviet health care system.
Comparison of two methodologies to measure agricultural occupational fatalities.
Authors: Murphy D J , Seltzer B L , Yesalis C E
Published: November 2008

Agricultural occupational fatalities in Pennsylvania for the years 1985-87 were followed up. Supplemental data concerning the occupation of the deceased and circumstances of the fatal accident were obtained from a family member. The number of fatalities designated as agriculturally and occupationally related by the National Traumatic Occupational Fatality (NTOF) system was compared with the number of fatalities identified by using alternative criteria for classification of agriculturally and occupationally related fatalities. There may be nearly a 30 percent error in the NTOF method resulting in a 20 percent undercount.
Workplace health hazards: analysis of hotline calls over a six-year period.
Authors: Quint J , Handley M , Cummings K
Published: November 2008

Between 1981-1986 a state-based occupational health telephone hotline received more than 8,000 inquiries on over 3,000 hazardous agents. Major caller groups were employees (37%), employers (20%), health care providers, primarily physicians (19%), government agencies (12%), and labor unions (6%). Employees were the fastest growing caller group. Callers inquired about general health hazards of chemicals (65%), the relation of symptoms to work (22%), and risks to pregnancy (13%).
Retirement and primary cardiac arrest in males.
Authors: Siscovick D S , Strogatz D S , Weiss N S , Rennert G
Published: November 2008

We investigated the association between retirement and primary cardiac arrest (PCA) in 126 male cases and controls, 25-75 years of age, without prior heart disease or comorbidity. After adjustment for age alone, retirement was not associated with an increased risk of PCA, (OR = 1.1; 95% confidence intervals = 0.5, 2.4). This lack of association was not uniform across age strata, however. In 10 of 19 discordant pairs 60 or more years of age, the control subject had been retired; in all seven discordant pairs under 60, the case had been retired (lower 95% CI of the relative risk = 1.9).