bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Incidence of Hospital Utilization for Poisoning and other Injury Types
Authors: Spiller Henry A. , Singleton Michael D.
Published: July 2017

Objectives.

We investigated the incidence of hospital utilization for injuries and compared poisoning with other forms of injury. Previous studies have suggested poison control centers reduce health-care costs by decreasing hospital utilization.

Methods.

We conducted a one-year retrospective study involving patients treated for injuries at acute-care hospitals in Kentucky in 2008. We also compared inpatient discharges with discharges directly from the emergency department (ED) to determine hospitalization rates. The primary data sources were the Kentucky Hospital Billing database and the Kentucky Regional Poison Control Center (KRPCC) database.

Results.

In 2008, there were 377,642 hospital encounters for injuries in Kentucky. The most common mechanisms of injury were falls, struck by/against, motor vehicle traffic crashes, and overexertion. Three causes of injury were greater than one standard deviation above the mean in percentage of inpatient admissions: poisoning (41.3%), firearms (38.4%), and drowning (22.4%). During this same year, KRPCC reported 46,258 poisonings, with 76.5% of patients managed outside of a health-care facility, 11.4% of patients treated and released from the ED, 7.1% of patients admitted to inpatient care, 2.3% of patients admitted to psychiatric care, and 2.7% lost to follow-up.

Conclusions.

Three causes of injury had the greatest percentage of patients admitted for inpatient medical care—poisoning, firearms, and drowning—suggesting a high level of severity in these injuries presenting to the ED. We believe availability and use of a poison control center reduced hospital utilization for poisoning primarily by managing a large number of low-severity patients outside of the hospital system.
Use of Hospital Discharge Data to Evaluate Notifiable Disease Reporting to Colorado's Electronic Disease Reporting System
Authors: Boehmer Tegan K. , Patnaik Jennifer L. , Burnite Steven J. , Ghosh Tista S. , Gershman Ken , Vogt Richard L.
Published: July 2017

Objective.

Notifiable disease surveillance systems are critical for communicable disease control, and accurate and timely reporting of hospitalized patients who represent the most severe cases is important. A local health department in metropolitan Denver used inpatient hospital discharge (IHD) data to evaluate the sensitivity, timeliness, and data quality of reporting eight notifiable diseases to the Colorado Electronic Disease Reporting System (CEDRS).

Methods.

Using IHD data, we detected hospitalized patients admitted from 2003 through 2005 with a discharge diagnosis associated with one of eight notifiable diseases. Initially, we compared all cases identified through IHD diagnoses fields with cases reported to CEDRS. Second, we chose four diseases and conducted medical record review to confirm the IHD diagnoses before comparison with CEDRS cases.

Results.

Relying on IHD diagnoses only, shigellosis, salmonellosis, and Neisseria meningitidis invasive disease had high sensitivity (≥90%) and timeliness (≥75%); legionellosis, pertussis, and West Nile virus infection were intermediate; and hepatitis A and Haemophilus influenzae ( H. influenzae) invasive disease had low sensitivity (≤25%) and timeliness (≤33%). Medical record review improved the sensitivity to ≥90% and timeliness to ≥80% for H. influenza invasive disease, legionellosis, and pertussis; however, hepatitis A retained suboptimal sensitivity (67%) and timeliness (25%).

Conclusions.

Hospital discharge data are useful for evaluating notifiable disease surveillance systems. Limitations encountered by using discharge diagnoses alone can be overcome by conducting medical record review. Public health agencies should conduct periodic surveillance system evaluations among hospitalized patients and reinforce notifiable disease reporting among the people responsible for this activity.
Breast and Cervical Cancer Screening Patterns among American Indian Women at IHS Clinics in Montana and Wyoming
Authors: Wilson Robin Taylor , Giroux Jennifer , Kasicky Kathryn Rita , Fatupaito Bethany Hemlock , Wood Eric C. , Crichlow Renee , Rhodes Neil A. Sun , Tingueley Jennifer , Walling Andrea , Langwell Kathryn , Cobb Nathaniel
Published: July 2017

Objectives.

We investigated factors associated with primary and secondary breast and cervical cancer screening among American Indian (AI) women receiving care from the Indian Health Service (IHS) in Montana and Wyoming.

Methods.

Rates of primary screening (i.e., screening without evidence of a prior abnormal) and secondary screening during a three-year period (2004–2006) were determined in an age- and clinic-stratified random sample of 1,094 women at six IHS units through medical record review.

Results.

Three-year mammography prevalence rates among AI women aged ≥45 years were 37.7% (95% confidence interval [CI] 34.1, 41.3) for primary and 58.7% (95% CI 43.9, 73.5) for secondary screening. Among women aged ≥18 years, three-year Pap test prevalence rates were 37.8% (95% CI 34.9, 40.6) for primary and 53.2% (95% CI 46.0, 60.4) for secondary screening. Primary mammography screening was positively associated with number of visits and receiving care at an IHS hospital (both p<0.001). Primary Pap test screening was inversely associated with age and positively associated with the number of patient visits (both p<0.001). Secondary mammography screening was inversely associated with driving distance to an IHS facility ( p=0.035).

Conclusion.

Our results are consistent with other surveys among AI women, which report that Healthy People 2010 goals for breast (90%) and cervical (70%) cancer screening have not been met. Improvements in breast and cervical cancer screening among AI women attending IHS facilities are needed.
Changing Trends in Viral Hepatitis-Associated Hospitalizations in the American Indian/Alaska Native Population, 1995–2007
Authors: Byrd Kathy K. , Redd John T. , Holman Robert C. , Haberling Dana L. , Cheek James E.
Published: July 2017

Objective.

We described the changing epidemiology of viral hepatitis among the American Indian/Alaska Native (AI/AN) population that uses Indian Health Service (IHS) health care.

Methods.

We used hospital discharge data from the IHS National Patient Information Reporting System to determine rates of hepatitis A-, B-, and C-associated hospitalization among AI/ANs using IHS health care from 1995–2007 and summary periods 1995–1997 and 2005–2007.

Results.

Hepatitis A-associated hospitalization rates among AI/AN people decreased from 4.9 per 100,000 population during 1995–1997 to 0.8 per 100,000 population during 2005–2007 (risk ratio [RR] = 0.2, 95% confidence interval [CI] 0.1, 0.2). While there was no significant change in the overall hepatitis B-associated hospitalization rate between time periods, the average annual rate in people aged 45–64 years increased by 109% (RR=2.1, 95% CI 1.4, 3.2). Between the two time periods, the hepatitis C-associated hospitalization rate rose from 13.0 to 55.0 per 100,000 population (RR=4.2, 95% CI 3.8, 4.7), an increase of 323%. The hepatitis C-associated hospitalization rate was highest among people aged 45–64 years, males, and those in the Alaska region.

Conclusions.

Hepatitis A has decreased to near-eradication levels among the AI/AN population using IHS health care. Hepatitis C-associated hospitalizations increased significantly; however, there was no significant change in hepatitis B-associated hospitalizations. Emphasis should be placed on continued universal childhood and adolescent hepatitis B vaccination and improved vaccination of high-risk adults. Prevention and education efforts should focus on decreasing hepatitis C risk behaviors and identifying people with hepatitis C infection so they may be referred for treatment.
Smoke-Free Laws, Gender, and Reduction in Hospitalizations for Acute Myocardial Infarction
Authors: Hahn Ellen J. , Rayens Mary Kay , Burkhart Patricia V. , Moser Debra K.
Published: July 2017

Objective.

We examined gender differences in the incidence of acute myocardial infarction (AMI) after the passage of a smoke-free law in Lexington, Kentucky. The initial legislation had exemptions not covering manufacturing facilities and government buildings, which may have put men at greater risk for AMI.

Methods.

We examined the effect of Lexington's smoke-free public places law on hospitalizations for AMI (i.e., heart attack) among men and women 40 months prior to and 32 months after enactment of the law. We used the statewide administrative database (Comp Data) for all hospital billing records for the four health-care systems in Lexington-Fayette County. Cases were included in the analysis if ( 1) the patient was ≥35 years of age; ( 2) the patient had a primary discharge diagnosis of AMI, with an International Classification of Diseases, Ninth Revision code in the range of 410.00 to 410.99; and ( 3) the date of service was between January 1, 2001, and December 31, 2006.

Results.

Among women, AMI hospitalizations declined 23% after the law took effect. The rate of AMI events among men did not change significantly. There was an overrepresentation of women in the hospitality industry and a disproportionate number of men working in manufacturing facilities and government worksites not mandated by the law.

Conclusions.

We found gender differences in the reduction of AMI hospitalizations following implementation of a smoke-free law that covered only some sectors of the workforce. Enacting smoke-free laws that cover all places of employment and strengthening existing partial laws may extend protection against AMIs to female and male workers.
Wild Mushroom Exposures in Florida, 2003–2007
Authors: Kintziger Kristina W. , Mulay Prakash , Watkins Sharon , Schauben Jay , Weisman Richard , Lewis-Younger Cynthia , Blackmore Carina
Published: July 2017

Objective.

Exposure to wild mushrooms can lead to serious illness and death. However, there is little information on the epidemiology of mushroom exposures nationwide, as there is no specific surveillance for this outcome. We described mushroom exposures in Florida using available data sources.

Methods.

We performed a population-based study of mushroom exposure calls to the Florida Poison Information Center Network (FPICN) and cases of mushroom poisoning reported in hospital inpatient and emergency department (ED) data from 2003 through 2007.

Results.

There were 1,538 unduplicated mushroom exposures reported during this period, including 1,355 exposure calls and 428 poisoning cases. Most exposures reported to FPICN occurred in children ≤6 years of age (45%) and males (64%), and most were unintentional ingestions (60%). Many exposures resulted in no effect (35%), although 21% reported mild symptoms that resolved rapidly, 23% reported prolonged/systemic (moderate) symptoms, and 1% reported life-threatening effects. Most calls occurred when in or en route to a health-care facility (43%). More than 71% of poisonings identified in hospital records were managed in an ED, and most occurred in young adults 16–25 years of age (49%), children ≤6 years of age (21%), adults >25 years of age (21%), and males (70%). No deaths were reported.

Conclusions.

Combined, these data were useful for describing mushroom exposures. Most exposures occurred in males and in young children (≤6 years of age) and young adults (16–25 years of age), with 78% resulting in contact with a health-care facility. Education should target parents of young children—especially during summer, when mushrooms are more abundant—and young adults who are likely experimenting with mushrooms for their potential hallucinogenic properties.
Veterinary Public Health Capacity in the United States: Opportunities for Improvement
Authors: Jarman Dwayne W. , Liang Jennifer L. , Luce Richard R. , Wright Jennifer G. , Stennies Gail M. , Bisgard Kristine M.
Published: July 2017

Objectives.

In 2006, the Association of American Veterinary Medical Colleges reported that the shortage (≥1,500) of public health veterinarians is expected to increase tenfold by 2020. In 2008, the Centers for Disease Control and Prevention (CDC) Preventive Medicine Fellows conducted a pilot project among CDC veterinarians to identify national veterinary public health workforce concerns and potential policy strategies.

Methods.

Fellows surveyed a convenience sample (19/91) of public health veterinarians at CDC to identify veterinary workforce recruitment and retention problems faced by federal agencies; responses were categorized into themes. A focus group (20/91) of staff veterinarians subsequently prioritized the categorized themes from least to most important. Participants identified activities to address the three recruitment concerns with the highest combined weight.

Results.

Participants identified the following three highest prioritized problems faced by federal agencies when recruiting veterinarians to public health: ( 1) lack of awareness of veterinarians' contributions to public health practice, ( 2) competitive salaries, and ( 3) employment and training opportunities. Similarly, key concerns identified regarding retention of public health practice veterinarians included: ( 1) lack of recognition of veterinary qualifications, ( 2) competitive salaries, and ( 3) seamless integration of veterinary and human public health.

Conclusions.

Findings identified multiple barriers that can affect recruitment and retention of veterinarians engaged in public health practice. Next steps should include replicating project efforts among a national sample of public health veterinarians. A committed and determined long-term effort might be required to sustain initiatives and policy proposals to increase U.S. veterinary public health capacity.
Identifying the Impact of Social Determinants of Health on Disease Rates Using Correlation Analysis of Area-Based Summary Information
Authors: Song Ruiguang , Hall H. Irene , Harrison Kathleen McDavid , Sharpe Tanya Telfair , Lin Lillian S. , Dean Hazel D.
Published: July 2017

Objectives.

We developed a statistical tool that brings together standard, accessible, and well-understood analytic approaches and uses area-based information and other publicly available data to identify social determinants of health (SDH) that significantly affect the morbidity of a specific disease.

Methods.

We specified AIDS as the disease of interest and used data from the American Community Survey and the National HIV Surveillance System. Morbidity and socioeconomic variables in the two data systems were linked through geographic areas that can be identified in both systems. Correlation and partial correlation coefficients were used to measure the impact of socioeconomic factors on AIDS diagnosis rates in certain geographic areas.

Results.

We developed an easily explained approach that can be used by a data analyst with access to publicly available datasets and standard statistical software to identify the impact of SDH. We found that the AIDS diagnosis rate was highly correlated with the distribution of race/ethnicity, population density, and marital status in an area. The impact of poverty, education level, and unemployment depended on other SDH variables.

Conclusions.

Area-based measures of socioeconomic variables can be used to identify risk factors associated with a disease of interest. When correlation analysis is used to identify risk factors, potential confounding from other variables must be taken into account.
Changing Disparities in Invasive Pneumococcal Disease by Socioeconomic Status and Race/Ethnicity in Connecticut, 1998–2008
Authors: Soto Kristen , Petit Susan , Hadler James L.
Published: July 2017

Objectives.

We compared invasive pneumococcal disease (IPD) incidence by race/ethnicity and neighborhood poverty level and assessed their relative utility to describe disparities in IPD in 1998–1999 and again in 2007–2008, after introduction of the 7-valent pneumococcal conjugate vaccine (PCV7).

Methods.

We conducted laboratory surveillance for pneumococcal isolates from sterile body sites and serotyped the isolates. Home address was geocoded to the census-tract level. Census-tract data on the percentage of people below poverty were grouped into three categories. The difference in the magnitude of incidence by race/ethnicity and by census-tract socioeconomic status (SES) (high poverty minus low poverty) was compared for 1998–1999 and 2007–2008 for PCV7 and non-PCV7 serotypes.

Results.

In 1998–1999, incidence difference (all per 100,000 population) for PCV7 serotypes for black people compared with white people was 14.3 and by poverty level was 13.9. The highest rate was among white people in high-poverty tracts (77.3). By 2007–2008, there were only slight differences between rates for black and white people (0.7) and SES (1.4). In 1998–1999, the incidence difference for non-PCV7 serotypes was 4.7 between black and white people and 6.0 by SES. By 2007–2008, the differences were 11.6 and 11.7, respectively. Among those living in the highest-poverty tracts, white people had the highest rate (42.9).

Conclusions.

In the absence of vaccine, IPD incidence is higher among people living in higher-poverty census tracts and among black people. Emerging serotypes also follow this trend. Differences in neighborhood poverty levels reveal disparities in rates of IPD as large as those seen by race/ethnicity and could be used to routinely describe disparities and target prevention.
Setting an Agenda for Advancing Young Worker Safety in the U.S. and Canada
Authors: Runyan Carol W. , Lewko John , Rauscher Kimberly
Published: July 2017

Scholars and practitioners from multiple perspectives, including developmental science, sociology, business, medicine, and public health, have considered the implications of employment for young people. We summarize a series of meetings designed to synthesize information from these perspectives and derive recommendations to guide research, practice, and policy with a focus on young worker safety and health. During the first three meetings, participants from the United States and Canada considered invited white papers addressing developmental issues, public health data and findings, as well as programmatic advances and evaluation needs. At the final meeting, the participants recommended both research and policy directions to advance understanding and improve young worker safety.
Using Disability-Adjusted Life Years to Assess the Burden of Disease and Injury in Rhode Island
Authors: Jiang Yongwen , Hesser Jana Earl
Published: July 2017

Objectives.

Disability-adjusted life years (DALYs) measure the burden of disease and injury in a population. We tested the feasibility of calculating DALYs to assess the burden of disease and injury in Rhode Island (RI).

Methods.

We computed DALYs for the 2008 RI population using methods developed by the World Health Organization, Harvard University, and the World Bank. DALYs are a composite measure that sum years of life lost (YLLs) due to premature mortality with years lived with disability (YLDs). We calculated crude mortality, YLLs, YLDs, and DALYs for 90 major health conditions for RI and stratified them by gender and age. Calculations for YLLs and YLDs were based on five-year averages. We compared our results with U.S. and Los Angeles County, California, estimates.

Results.

A DALYs ranking produces a different picture of RI's disease and injury burden than does mortality-based ranking. Of 90 major health conditions assessed for RI, six of the top 10 causes for mortality and DALYs were the same, but were ranked differently: ischemic heart disease, cerebrovascular disease, Alzheimer dementia and other dementias, trachea/bronchus/lung cancer, chronic obstructive pulmonary disease, and diabetes mellitus. These six conditions accounted for 59% of deaths but only 35% of DALYs. Causes and rank orders for DALYs differed between males and females and among age groups.

Conclusions.

Including nonfatal health conditions in an assessment of population health provides a different picture than traditional mortality-based assessments. This study demonstrates the feasibility and constraints of using DALYs to assess the burden of disease and injury at the state level.
Patient and Clinician Ethical Perspectives on the 2006 Centers for Disease Control and Prevention HIV Testing Methods
Authors: Merchant Roland C. , Waxman Michael J. , Maher Julie G. , Clark Melissa A. , Celada M. Teresa , Liu Tao , Simmons Emma M. , Beckwith Curt G. , Mayer Kenneth H.
Published: July 2017

Objectives.

CDC 2006 recommendations for new HIV testing methods in U.S. health-care settings (opt-out approach, general medical consent, and optional prevention counseling) have been the subject of a public ethical debate. Ethical concerns might limit their implementation and affect expanded HIV screening efforts. We compared clinicians' and patients' perspectives on the ethical concerns raised about, justifications provided in support of, and preferences for the 2006 CDC-recommended HIV testing methods for the U.S. health-care setting, in contrast with the 2001 CDC-recommended HIV testing methods (opt-in approach, specific written consent, and mandatory prevention counseling).

Methods.

We conducted a non-inferiority trial and survey of 249 clinicians and random samples of 1,013 of their patients at three emergency departments and three ambulatory care clinics at university-affiliated hospitals in Rhode Island from June to December 2007.

Results.

Clinicians found the 2006 CDC HIV testing methods to be more ethically concerning than the 2001 testing methods (i.e., ethically inferior), while patients had few ethical concerns. In regard to ethical justifications cited for the 2006 CDC HIV testing methods, clinicians were more supportive of the ethical justifications cited for using an opt-out approach and general medical consent, while patients were more supportive of the justifications for optional HIV prevention counseling. Clinicians showed a relatively greater preference for the opt-out approach and use of general medical consent, while patients had a relatively greater preference for optional HIV prevention counseling.

Conclusions.

Clinicians and their patients hold divergent ethical perspectives on CDC's 2006 HIV testing methods. The results indicate an opportunity to review not only these but also future HIV testing recommendations, as well as how they are presented for implementation.
Fatalities of Pedestrians, Bicycle Riders, and motorists Due to Distracted driving motor Vehicle Crashes in the U.S., 2005–2010
Authors: Stimpson Jim P. , Wilson Fernando A. , Muelleman Robert L.
Published: July 2017

Objective.

Distracted driving is an increasingly deadly threat to road safety. This study documents trends in and characteristics of pedestrian, bicycle rider, and other victim deaths caused by distracted drivers on U.S. public roads.

Methods.

We obtained data from the Fatality Analysis Reporting System database from 2005 to 2010 on every crash that resulted in at least one fatality within 30 days occurring on public roads in the U.S. Following the definition used by the National Highway Traffic Safety Administration, we identified distracted driving based on whether police investigators determined that a driver had been using a technological device, including a cell phone, onboard navigation system, computer, fax machine, two-way radio, or head-up display, or had been engaged in inattentive or careless activities.

Results.

The rate of fatalities per 10 billion vehicle miles traveled increased from 116.1 in 2005 to 168.6 in 2010 for pedestrians and from 18.7 in 2005 to 24.6 in 2010 for bicyclists. Pedestrian victims of distracted driving crashes were disproportionately male, 25–64 years of age, and non-Hispanic white. They were also more likely to die at nighttime, be struck by a distracted driver outside of a marked crosswalk, and be in a metro location. Bicycling victims of distracted crashes were disproportionately male, non-Hispanic white, and struck by a distracted driver outside of a crosswalk. Compared with pedestrians, bicyclists were less likely to be hit in early morning.

Conclusions.

Distracted drivers are the cause of an increasing share of fatalities found among pedestrians and bicycle riders Policies are needed to protect pedestrians and bicycle riders as they cross intersections or travel on roadways.
Hepatitis B Vaccination Coverage among Health-Care Personnel in the United States
Authors: Byrd Kathy K. , Lu Peng-Jun , Murphy Trudy V.
Published: July 2017

Objectives.

We compared self-reported hepatitis B (HepB) vaccine coverage among health-care personnel (HCP) with HepB vaccine coverage among the general population and determined trends in vaccination coverage among HCP.

Methods.

We used the 2010 National Health Interview Survey (NHIS) to determine the weighted proportion of self-reported ≥1- and ≥3-dose HepB vaccine coverage among HCP aged ≥18 years. We used logistic regression to determine independent predictors of vaccination and performed a trend analysis to determine changes in coverage from 2004 to 2010 using data from the 2004–2010 NHIS.

Results.

Overall, 69.5% (95% confidence interval [CI] 67.2, 71.8) and 63.4% (95% CI 60.8, 65.9) of HCP reported receiving ≥1 and ≥3 doses of HepB vaccine, respectively, compared with 27.1% (95% CI 26.1, 28.1%) and 23.0% (95% CI 22.1, 24.0) among non-HCP Among HCP with direct patient contact, 80.7% (95% CI 78.2, 83.1) and 74.0% (95% CI 71.2, 76.8) received ≥1 and ≥3 HepB vaccine doses, respectively Independent predictors of vaccination included direct patient contact, having more than a high school education, influenza vaccination in the past year, and ever having been tested for HIV. There was no significant change in reported coverage from 2004 through 2010.

Conclusion.

The 2010 HepB vaccine coverage estimate among HCP remained well below the Healthy People 2010 goal of 90%. Efforts to target unvaccinated HCP for preexposure HepB protection should be encouraged.
Determinants of Cervical Cancer Screening among Women with Intellectual Disabilities: Evidence from Medical Records
Authors: Parish Susan L. , Swaine Jamie G. , Son Esther , Luken Karen
Published: July 2017

Objective.

We examined receipt of cervical cancer screening and determinants of screening for women with intellectual disabilities in one Southeastern state.

Methods.

Using medical records data from 2006 through 2010 for community-dwelling women with intellectual disabilities who were 18–65 years of age ( n=163), we employed descriptive and bivariate statistics and a multivariate regression model to examine receipt of cervical cancer screening and the determinants of cervical cancer screening across women's sociodemographic and health-care provider characteristics.

Results.

Of women 18–65 years of age with intellectual disabilities, 55% received a Papanicolaou (Pap) test during 2008–2010, markedly below the Healthy People 2020 targets or rates of Pap test receipt of women without intellectual disabilities Women with intellectual disabilities who lived in residential facilities, those who lived in rural communities, and those who had an obstetrician/gynecologist had higher rates of receipt of care than other women with intellectual disabilities.

Conclusions.

Assertive measures are required to improve the receipt of cervical cancer screening among women with intellectual disabilities. Such measures could include education of women with intellectual disabilities, as well as their paid and family caregivers, and incentives for health-care providers who achieve screening targets.
Assessing the Validity and Reliability of Three Indicators Self-Reported on the Pregnancy Risk Assessment Monitoring System Survey
Authors: Ahluwalia Indu B. , Helms Kristen , Morrow Brian
Published: July 2017

Objectives.

We investigated the reliability and validity of three self-reported indicators from the Pregnancy Risk Assessment Monitoring System (PRAMS) survey.

Methods.

We used 2008 PRAMS ( n=15,646) data from 12 states that had implemented the 2003 revised U.S. Certificate of Live Birth. We estimated reliability by kappa coefficient and validity by sensitivity and specificity using the birth certificate data as the reference for the following: prenatal participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); Medicaid payment for delivery; and breastfeeding initiation. These indicators were examined across several demographic subgroups.

Results.

The reliability was high for all three measures: 0.81 for WIC participation, 0.67 for Medicaid payment of delivery, and 0.72 for breastfeeding initiation. The validity of PRAMS indicators was also high: WIC participation (sensitivity = 90.8%, specificity = 90.6%), Medicaid payment for delivery (sensitivity = 82.4%, specificity = 85.6%), and breastfeeding initiation (sensitivity = 94.3%, specificity = 76.0%). The prevalence estimates were higher on PRAMS than the birth certificate for each of the indicators except Medicaid-paid delivery among non-Hispanic black women. Kappa values within most subgroups remained in the moderate range (0.40–0.80) Sensitivity and specificity values were lower for Hispanic women who responded to the PRAMS survey in Spanish and for breastfeeding initiation among women who delivered very low birthweight and very preterm infants.

Conclusion.

The validity and reliability of the PRAMS data for measures assessed were high Our findings support the use of PRAMS data for epidemiological surveillance, research, and planning.
Prescription Drug Monitoring and Dispensing of Prescription Opioids
Authors: Brady Joanne E. , Wunsch Hannah , DiMaggio Charles , Lang Barbara H. , Giglio James , Li Guohua
Published: July 2017

Objective.

In the United States, per-capita opioid dispensing has increased concurrently with analgesic-related mortality and morbidity since the 1990s. To deter diversion and abuse of controlled substances, most states have implemented electronic prescription drug monitoring programs (PDMPs). We evaluated the impact of state PDMPs on opioid dispensing.

Methods.

We acquired data on opioids dispensed in a given quarter of the year for each state and the District of Columbia from 1999 to 2008 from the Automation of Reports and Consolidated Orders System and converted them to morphine milligram equivalents (MMEs). We used multivariable linear regression modeling with generalized estimating equations to assess the effect of state PDMPs on per-capita dispensing of MMEs.

Results.

The annual MMEs dispensed per capita increased progressively until 2007 before stabilizing. Adjusting for temporal trends and demographic characteristics, implementation of state PDMPs was associated with a 3% decrease in MMEs dispensed per capita ( p=0.68). The impact of PDMPs on MMEs dispensed per capita varied markedly by state, from a 66% decrease in Colorado to a 61% increase in Connecticut.

Conclusions.

Implementation of state PDMPs up to 2008 did not show a significant impact on per-capita opioids dispensed. To control the diversion and abuse of prescription drugs, state PDMPs may need to improve their usability, implement requirements for committee oversight of the PDMP, and increase data sharing with neighboring states.
Assessment of State- and Territorial-Level Preparedness Capacity for Serving Deaf and Hard-of-Hearing Populations in Disasters
Authors: Ivey Susan L. , Tseng Winston , Dahrouge Donna , Engelman Alina , Neuhauser Linda , Huang Debbie , Gurung Sidhanta
Published: July 2017

Objectives.

Substantial evidence exists that emergency preparedness and response efforts are not effectively reaching populations with functional and access needs, especially barriers related to literacy, language, culture, or disabilities. More than 36 million Americans are Deaf or hard of hearing (Deaf/HH). These groups experienced higher risks of injury, death, and property loss in recent disasters than the general public. We conducted a participatory research study to examine national recommendations on preparedness communication for the Deaf/HH.

Methods.

We assessed whether previous recommendations regarding the Deaf/HH have been incorporated into state- and territorial-level emergency operations plans (EOPs), interviewed state- and territorial-level preparedness directors about capacity to serve the Deaf/HH, and proposed strategies to benefit Deaf/HH populations during emergencies. We analyzed 55 EOPs and 50 key informant (KI) interviews with state directors.

Results.

Fifty-five percent of EOPs mentioned vulnerable populations; however, only 31% specifically mentioned Deaf/HH populations in their plan. Study findings indicated significant relationships among the following factors: a state-level KI's familiarity with communication issues for the Deaf/HH, making relay calls (i.e., calls to services to relay communication between Deaf and hearing people), and whether the KI's department provides trainings about serving Deaf/HH populations in emergencies. We found significant associations between a state's percentage of Deaf/HH individuals and a KI's familiarity with Deaf/HH communication issues and provision by government of any disability services to Deaf/HH populations in emergencies. Further, we found significant relationships between KIs attending training on serving the Deaf/HH and familiarity with Deaf/HH communication issues, including how to make relay calls.

Conclusion.

This study provides new knowledge that can help emergency agencies improve their preparedness training, planning, and capacity to serve Deaf/HH populations in emergencies.
High Risk for HIV following Syphilis Diagnosis among Men in Florida, 2000–2011
Authors: Peterman Thomas A. , Newman Daniel R. , Maddox Lorene , Schmitt Karla , Shiver Stacy
Published: July 2017

Objective.

Multiple interventions have been shown to reduce the risk of HIV acquisition, including preexposure prophylaxis with antiretroviral medications, but high costs require targeting interventions to people at the highest risk. We identified the risk of HIV following a syphilis diagnosis for men in Florida.

Methods.

We analyzed surveillance records of 13- to 59-year-old men in Florida who were reported as having syphilis from January 1, 2000, to December 31, 2009. We excluded men who had HIV infection reported before their syphilis diagnosis (and within 60 days after), then searched the database to see if the remaining men were reported as having HIV infection by December 31, 2011.

Results.

Of the 9,512 men with syphilis we followed, 1,323 were subsequently diagnosed as having HIV infection 60–3,753 days after their syphilis diagnosis. The risk of a subsequent diagnosis of HIV infection was 3.6% in the first year after syphilis was diagnosed and reached 17.5% 10 years after a syphilis diagnosis. The risk of HIV was higher for non-Hispanic white men (3.4% per year) than for non-Hispanic black men (1.8% per year). The likelihood of developing HIV was slightly lower for men diagnosed with syphilis in 2000 and 2001 compared with subsequent years. Of men diagnosed with syphilis in 2003, 21.5% were reported as having a new HIV diagnosis by December 31, 2011.

Conclusion.

Men who acquire syphilis are at very high risk of HIV infection.
Timely HIV Diagnosis and HIV/TB Comanagement among California Patients in 2008
Authors: Kong Darryl , Watt James P. , Marks Suzanne M. , Flood Jennifer M.
Published: July 2017

Objective.

National guidelines highlight the roles of early HIV diagnosis and effective comanagement for HIV and tuberculosis (TB) to prevent mortality and morbidity from HIV-related TB. We assessed HIV diagnosis timing and HIV/TB comanagement for California HIV/TB patients.

Methods.

We reviewed and analyzed public health charts for California HIV/TB patients reported during 2008. HIV diagnoses fewer than three months before TB diagnosis were considered new HIV diagnoses. We determined the proportion of patients with new HIV diagnoses, risk factors for new HIV diagnoses, and proportion of patients receiving recommended CD4 cell count measurements, supervised TB therapy, and antiretroviral therapy (ART).

Results.

Of 130 HIV/TB patients, 51% had new HIV diagnoses. Foreign-born patients were more likely than U.S.-born patients to have new HIV diagnoses. Supervised TB therapy and CD4 cell count measurements followed national recommendations for 91% and 74% of patients, respectively. At least 73% of patients started ART before completing TB therapy. Compared with patients who had previous HIV diagnoses, patients with new HIV diagnoses started ART later and had lower CD4 cell counts and higher viral loads at TB diagnosis.

Conclusions.

Although most HIV/TB patients received the recommended treatment, half had new HIV diagnoses. Compared with patients who had previous HIV diagnoses, patients with new HIV diagnoses had greater immunosuppression at TB diagnosis. A new diagnosis indicates that HIV could have been diagnosed earlier and ART or treatment for latent TB infection could have been initiated to prevent TB development.
Recursive formulae for the solution of simultaneous parabolic differential equations
Authors: Greenfield Paul F.
Published: July 2017

Recursive formulae have been developed for the solu tion of the algebraic equations which result when an implicit finite difference scheme is applied to two simultaneous parabolic differential equations. The resulting formulae require fewer mathematical operations than either elimination or iteration methods.
Two Simulation Tools for Testing ATM Resource Allocation Strategies
Authors: Bolla Raffaele , Dalal'Ah Ahmad , Davoli Franco , Marchese Mario
Published: July 2017

Two event-driven simulation tools aimed at testing access control and routing mechanisms in an Asynchronous Transfer Mode (ATM) environment are presented. The first one is dedicated to the behavioural description of an ATM Virtual Circuit (VC) switch. The purpose is to test resource allocation and Call Admission Control (CAC) strategies, so only the relevant events for this objective are considered and some important functions (e.g., the switching element) for a complete description of an ATM switch are not explicitly modeled. The second simulator has been designed to test routing strategies for an ATM network. In such a case, a higher level of abstraction than in the previous one is necessary and, again, only the meaningful events to the aim are taken into account. Some resource allocation, CAC, and routing schemes are also reported, along with the description of the simulation tools. Several simulation results are discussed, in order to assess their performance.
High-Density Cotton in American Mills
Authors: Campbell Malcolm E.
Published: July 2017

Interest in the use of high-dercsity cotton has recently been stimulated by two factors: first, the necessity for diverting to domestic use the large quantity of cotton which had been originally packed in high-density bales for export; and second, the possibility that it would be necessary to compress to high density a large proportion of the crop for shipment within the country in order to conserve shipping space.

Textile Research Institute, Inc., has investigated the various aspects of the subject, including the feasibility of using high-density cotton in American mills,, the effect of high-density compression on spinning quality, and other factors.

The results of this investigation are embodied in a fifteen page report of which the following is a summary. This report has been issued to all members of the Insti tute. Non-members may obtain copies at the price of one dollar per copy by writing to the Institute.
Environmental Impacts of Tourism on U.S. National Parks
Authors: Wang Chih-Yung , Miko Paul S.
Published: July 2017

The purpose of this study was to identify perceived tourism impacts on the natural environment within national parks. Responses from 44 of 51 U.S. national park superintendents to a mailed survey questionnaire indicated that 24 parks had water quality problems, 27 had air quality problems, 37 had vegetation (flora) or wildlife (fauna) problems, and 22 had coastline/shoreline problems relating to tourism. Implications for travel research and policies concerning the development and promotion of park tourism are discussed.
The Characteristics and Satisfaction of Mainland Chinese Visitors to Hong Kong
Authors: Qu Hailin , Li Isabella
Published: July 2017

The purpose of this study was to identify the characteristics, travel patterns and destination selection attributes, and perceptions and satisfaction level of mainland Chinese visitors traveling to Hong Kong. A systematic sampling approach was employed, and a self-administered and closed-ended questionnaire was used to survey a sample of 275 mainland Chinese visitors. It was found that the majority of the mainland Chinese visitors were male, married, between the ages of 26 and 45, and white-collar workers. Generally speaking, visitors were quite satisfied with all aspects of their journey to Hong Kong, except for the price.
Factors Influencing Membership in a Tourism Promotion Authority
Authors: Donnelly Maureen P. , Vaske Jerry J.
Published: July 2017

This study examined factors that influence business membership in a new voluntary statewide tourism promotion organization. Three types of factors were considered: the characteristics of the business, beliefs about tourism and statewide tourism promotion, and the perceived benefits/costs of membership. Data were obtained from telephone surveys of current members and nonmembers of the Colorado Travel and Tourism Authority (CTTA). Results from a predictive model indicated that three tourism beliefs and three of the benefits/costs variables differentiated current members from nonmembers. For the model examining the likelihood of a nonmember becoming a CTTA member, two of the belief statements about tourism, two of the perceived benefits/costs variables, and one business characteristic (years of operation) were significant. The implications of these findings for increasing membership in the CTTA are discussed.
The Tomatis Method with Severely Autistic Boys: Individual Case Studies of Behavioral Changes
Authors: Neysmith-Roy Joan M.
Published: July 2017

Six severely autistic males ranging in age from 4 years to 11 years received the Tomatis Method to assist in alleviating the severity of behaviours contributing to the diagnosis of autism. Ten minute video samples were taken of each boy, under two conditions of play, every time he completed one section of the treatment programme. As measured by the Children's Autism Rating Scale (CARS) all of the boys were severely autistic at the beginning of treatment. Three (50%) of the boys demonstrated positive behavioural changes by the end of the treatment. One boy was no longer considered to be autistic, two boys showed mild symptoms of autism and three boys remained within the severely autistic range. Of particular interest were the changes that occurred in pre-linguistic areas for five of the six boys. These included Adaptation to Change, Listening Response, Non Verbal Communication, Emotional Response and Activity Level. These behaviours are considered prerequisites for successful verbal communication. The children who demonstrated behavioural change were 6 years of age or younger at the beginning of treatment. The author suggests that the Tomatis Method may be helpful in making prelinguistic behaviours manageable and thus help prepare the child to learn basic skills necessary for the development of language and learning.
Psychometric Properties of an Instrument to Measure Resilience in Adults
Authors: Strümpfer D.J.W.
Published: July 2017

A rationale for using a projective approach, in addition to self-reports, is presented. A resilience exercise is described, consisting of 6 sentences describing adverse situations, in response to which participants write projective stories. A scoring scheme for such stories is introduced. 152 adults ( Mage = 34.28, SD = 9.15; Meduc = 14.55, SD = 2.31) working in organizations, completed the exercise and self-report scales. On the basis of initial scoring by two judges, the scoring scheme was revised to clarify some instructions. On a new sample of 20 protocols a 0.87 agreement between two judges was obtained. One judge then re-scored all protocols on the revised manual. A word count per protocol correlated 0.54 ( p < 0.000) with the total score. Scores per story and scores per scoring category, were corrected for word count, using a regression procedure. The 6 stories all loaded on a single resilience factor. Exploratory and confirmatory factor analyses showed a 2-factor model to fit the data best, producing factors which measured abstract and concrete aspects. The total resilience score correlated 0.26 ( p < 0.001) with Antonovsky's Sense of Coherence scale (short form) and 0.21 ( p < 0.01) with Diener's Satisfaction with Life scale.
Altruism, Conflict, and the Migration Decision
Authors: Tcha Moonjoong
Published: July 2017

This paper uses a dynastic model with intergenerational altruism to analyse rural-urban migration during times of high unemployment rates and low expected income, and to explain the higher mobility of young generations. Different dynastic utilities between generations lead to conflicts between generations on migration decisions, and predict the higher mobility of the young generation. In addition, the model explores how the degree of altruism affects the migration decision.
What About the Bell-shaped Relationship Between Primacy and Development?
Authors: Lemelin André , Polèse Mario
Published: July 2017

This paper proposes, estimates, and tests a “no-frills” static two-equation recursive model, where the size of the largest city depends on the level of development in a two-step relationship, with the total urban population intervening as an intermediate variable. The model has the following implications for primacy: (1) contrary to Richardson and Schwartz's (1988) assertion, primacy is indeed related to development, albeit indirectly, but (2) the relationship does not display the bell shape predicted by the El-Shakhs-Mera hypothesis. Instead, primacy as a function of development decreases monotonically at a decreasing rate. Research assistance was provided by Atib Salhi.
Decomposing Sources of Regional Growth with an Input-output Model: A Framework for Policy Analysis
Authors: Siegel Paul B. , Alwang Jeffrey , Johnson Thomas G.
Published: July 2017

Decomposition of an extended input-output model can provide insights into the relationship between a region's changing economic structure and its performance. Standard decomposition techniques are augmented and adapted to generate a conceptual framework for identifying potential sources of regional growth and subsequent impacts of alternative development strategies. The conceptual framework is a heuristic device that also can be used for applied policy analysis. As such, this paper provides a foundation for more elaborate empirical studies in the future.
Variation in U.S. State Income Inequality: 1960-1990
Authors: Levernier William , Rickman Dan S. , Partridge Mark D.
Published: July 2017

This study examines regional trends in state income inequality in the United States. Data for the 48 contiguous states are used to estimate separate cross-sectional equations of state income inequality for I960, 1970, 1980, and 1990. Thus, previous cross-sectional studies of state income inequality are updated with the addition of recent census data. Moreover, the model specified includes variables not previously examined, which reduces the possibility of omitted variable bias and provides a richer policy framework. State characteristics are identified that may explain the convergence of state income inequality both during earlier years and in recent years.
Torticollis in children
Authors: Tom Lawrence W. C. , Rossiter James L. , Sutton Leslie N. , Davidson Richard S. , Potsic William P.
Published: July 2017

Torticollis is a common clincial sign that is found in a variety of disorders. Childhood torticollis differs from the adult form in that congenital types are common and many frequently encountered disorders found in adults are unusual. Pediatric torticollis related to otolaryngologic conditions is reviewed, and three illustrative cases are presented.