bluuebunny/crossref_metadata_2025 huggingface dataset:
Sexual behavior and exposure to HIV infection: estimates from a general-population risk index.
Authors: Campostrini S , McQueen D V
Published: November 2008

OBJECTIVES. The spread of the human immunodeficiency virus (HIV) in the general population has been a much debated topic in the mass media. The aim of this study was to create an approach to estimating the risk of exposure to HIV resulting from sexual behaviors. METHODS. A theoretical estimate was applied to data obtained from a large-scale risk factor survey carried out in Britain. An HIV infection-exposure risk index was constructed by ranking different sex-related categorizations derived from variables in the survey. RESULTS. The risk index involved a Delphi-based assessment of self-reported behavioral factors associated with HIV exposure and subsequent transmission. Roughly 85% of the adult population aged 18 to 50 were estimated to be at some risk for behavioral exposure to HIV virus with regard to reported sexual behavior. Over time, those who could be considered at no risk have declined as a proportion of the population. CONCLUSIONS. The estimates appear to refute commonplace assertions that exposure to HIV through sexual behavior is not a problem for general populations.
Changes in energy intakes during pregnancy and lactation in a national sample of US women.
Authors: Murphy S P , Abrams B F
Published: November 2008

Increases in energy intakes during pregnancy and lactation were evaluated by examining dietary data for 458 pregnant women who participated in the Continuing Surveys of Food Intakes by Individuals conducted in 1985 and 1986. Energy intakes were well below recommendations during all reproductive states; however, increases during pregnancy approximated recommendations, while increases during lactation were low. Postpartum non-lactating intakes did not return to prepregnancy levels for Black women or women with lower incomes.
The quality of the new birth certificate data: a validation study in North Carolina.
Authors: Buescher P A , Taylor K P , Davis M H , Bowling J M
Published: November 2008

A random sample of 395 December 1989 North Carolina birth certificates and the corresponding maternal hospital medical records were examined to validate selected items. Reporting was very accurate for birth-weight, Apgar score, and method of delivery; fair to good for tobacco use, prenatal care, weight gain during pregnancy, obstetrical procedures, and events of labor and delivery; and poor for medical history and alcohol use. This study suggests that many of the new birth certificate items will support valid aggregate analyses for maternal and child health research and evaluation.
Mandating vitamin K prophylaxis for newborns in New York State.
Authors: Tulchinsky T H , Patton M M , Randolph L A , Meyer M R , Linden J V
Published: November 2008

New York State's infant deaths and hospitalizations attributed to hemorrhagic disease of the newborn and other neonatal hemorrhagic conditions were reviewed. In 65% of 34 deaths reviewed, vitamin K was not documented as given or was given only after the onset of hemorrhage. Vitamin K was not included in standing orders in any of 22 hospitals contacted. As a result of this review, vitamin K prophylaxis was made a mandatory newborn care procedure in the State Public Health Code.
Fatal car fires from rear-end crashes: the effects of fuel tank placement before and after regulation.
Authors: Robertson L S
Published: November 2008

A federal standard for fuel tank integrity in cars was applied to 1977 and subsequent models. National data indicate that fatalities per 10,000 occupants in rear-end crashes of small cars, where fire was the most harmful event, were reduced by approximately 57% if the fuel tank was located behind the rear axle and 77% if the tank was situated directly above or in front of the rear axle.
The tobacco industry, state politics, and tobacco education in California.
Authors: Begay M E , Traynor M , Glantz S A
Published: November 2008

OBJECTIVES. Proposition 99 added 25 cents to the California state cigarette tax and mandated that 20% of the new revenues be spent on tobacco education and prevention programs. This paper examines the implementation of these programs and the tobacco industry's response to Proposition 99. METHODS. Political expenditure data for twelve tobacco firms and associations were gathered from California's Fair Political Practices Commission and secretary of state's Political Reform Division. Tobacco education expenditure data were collected from Governor's Budgets and the Department of Finance. RESULTS. Since Proposition 99 passed, tobacco industry political expenditures in California have risen 10-fold, from $790,050 in the 1985-1986 election to $7,615,091 in the 1991-1992 election. The tobacco industry is contributing more heavily to the California legislature than to Congress. A statistical analysis of data on campaign contributions indicates that California legislators' policy-making is influenced by campaign contributions from the tobacco industry. Since fiscal year 1989-1990, the state has ignored the voters' mandate and spent only 14.7% of the new revenues to tobacco education. Medical care programs received more money than permitted by the voters. CONCLUSIONS. The tobacco industry has become politically active in California following the passage of Proposition 99. One result may be that the state has underfunded tobacco education by $174.7 million through the 1993-1994 fiscal year. The estimated redirection of funds to medical care would essentially eliminate the tobacco education campaign by the year 2000.
Work-site cardiovascular risk reduction: a randomized trial of health risk assessment, education, counseling, and incentives.
Authors: Gomel M , Oldenburg B , Simpson J M , Owen N
Published: November 2008

OBJECTIVES. This study reports an efficacy trial of four work-site health promotion programs. It was predicted that strategies making use of behavioral counseling would produce a greater reduction in cardiovascular disease risk factors than screening and educational strategies. METHODS. Twenty-eight work sites were randomly allocated to a health risk assessment, risk factor education, behavioral counseling, or behavioral counseling plus incentives intervention. Participants were assessed before the intervention and at 3, 6, and 12 months. RESULTS. Compared with the average of the health risk assessment and risk factor education conditions, there were significantly higher validated continuous smoking cessation rates and smaller increases in body mass index and estimated percentage of body fat in the two behavioral counseling conditions. The behavioral counseling condition was associated with a greater reduction in mean blood pressure than was the behavioral counseling plus incentives condition. On average among all groups, there was a short-term increase in aerobic capacity followed by a return to baseline levels. CONCLUSIONS. Work-site interventions that use behavioral approaches can produce lasting changes in some cardiovascular risk factors and, if implemented routinely, can have a significant public health impact.
The long-term prevention of tobacco use among junior high school students: classroom and telephone interventions.
Authors: Elder J P , Wildey M , de Moor C , Sallis J F , Eckhardt L , Edwards C , Erickson A , Golbeck A , Hovell M , Johnston D
Published: November 2008

OBJECTIVES. The purpose of this study was to implement and evaluate the effectiveness of a long-term tobacco use prevention program for junior high school students that used college undergraduate change agents and telephone boosters. METHODS. A psychosocial intervention combining refusal skills training, contingency management, and other tobacco use prevention methodologies such as telephone and mail boosters was implemented in 11 junior high schools in San Diego County, California. Eleven other junior high schools served as controls. Of the 2668 participants, 57% were White/non-Hispanic, 24% were Hispanic, and 19% were of other racial/ethnic groups. College undergraduates served as change agents for both the classroom and booster interventions, the latter of which was delivered in the third (ninth-grade) year of the program. RESULTS. At the end of the third year, the prevalence of tobacco use within the past month was 14.2% among the intervention students and 22.5% among the controls, yielding an odds ratio of 0.71 for analysis at the school level. CONCLUSIONS. Both college undergraduate change agents and direct one-to-one telephone interventions appear to provide cost-effective tobacco-related behavior modification.
Age patterns of smoking in US black and white women of childbearing age.
Authors: Geronimus A T , Neidert L J , Bound J
Published: November 2008

OBJECTIVES. The purpose of the study was to describe age patterns of smoking among Black and White women of reproductive age, with cohort membership controlled for. METHOD. Data from the 1987 National Health Interview Survey Cancer Supplement, weighted to be nationally representative, were used to calculate the fractions of women who were ever smokers, quitters, and current smokers by age and race. Summary distributions of age patterns of smoking behaviors by race were estimated; proportional hazard models were used to avoid confounding of age and cohort. RESULTS. White women begin smoking at younger ages than do Blacks but are more likely to quit and to do so at young ages. Rates of current smoking converge between Blacks and Whites by age 25, and may cross over by 30. Education-standardized results show larger Black-White differentials in ever smoking and smaller differences in quitting. CONCLUSIONS. Our findings confirm that women's age patterns of smoking vary by race. Age x race interactions should be considered in smoking research and anti-tobacco interventions. For Black women, delayed initiation and failure to quit call for increased emphasis on interventions tailored to adults. These findings have possible implications for understanding Black-White differences in low birthweight, child health, and women's health.
Tobacco use: a modifiable risk factor for dental disease among the elderly.
Authors: Jette A M , Feldman H A , Tennstedt S L
Published: November 2008

OBJECTIVES. Because the public health literature contains few analytic studies of modifiable behavioral risk factors for dental disease among older community-dwelling populations, the New England Elders Dental Study was undertaken as an epidemiologic study of the oral health status of a representative sample of older adults living within the six New England states. METHODS. Five dentists conducted comprehensive in-home oral health examinations on 1156 community-dwelling adults aged 70 and older to determine whether lifetime use of tobacco products was a significant risk factor for tooth loss, caries, and periodontal disease. RESULTS. Among New England elders, tobacco use was more common among men (18.1%) than women (7.9%), with a combined rate of 12.3%. Further, 64.7% of men and 36.6% of women were previous tobacco users. Years of exposure to tobacco products was a statistically significant risk factor for tooth loss, coronal and root caries, and periodontal disease, regardless of other social and behavioral factors. CONCLUSIONS. Lifelong tobacco use is a modifiable risk factor for poor dental health among older adults. Dental practitioners need to intervene with all their adult patients to discourage use of tobacco products for oral as well as general preventive health care.
Smoking control in restaurants: the effectiveness of self-regulation in Australia.
Authors: Schofield M J , Considine R , Boyle C A , Sanson-Fisher R
Published: November 2008

OBJECTIVES. The provision of smoke-free areas in restaurants has been a controversial issue; the restaurant industry largely opts for a self-regulation approach. This study aimed to examine the effectiveness of self-regulation as a strategy in meeting the industry's and customers' perceived needs. METHODS. Restaurateur and customer perspectives on the provision of smoke-free areas in restaurants were examined by survey among 365 restaurateurs and 1327 customers in New South Wales, Australia. RESULTS. Less than 2% of restaurants were totally smoke-free; 22% provided some smoke-free areas. Customers were much more likely than owners to think that smoke-free areas should be provided. Owners appeared to be unaware of customers' views about smoke-free areas in restaurants. CONCLUSIONS. Little evidence was found to support the effectiveness of the self-regulation policy adopted by the restaurant industry. Characteristics of restaurants and owners associated with the provision of smoke-free areas are presented and implications of the findings are discussed.
Occupation as a risk identifier for breast cancer.
Authors: Rubin C H , Burnett C A , Halperin W E , Seligman P J
Published: November 2008

OBJECTIVES. Breast cancer mortality may be reduced if the disease is detected early through targeted screening programs. Current screening guidelines are based solely on a woman's age. Because working populations are accessible for intervention, occupational identification may be a way of helping to define and locate risk groups and target prevention. METHODS. We used a database consisting of 2.9 million occupationally coded death certificates collected from 23 states between 1979 and 1987 to calculate age-adjusted, race-specific proportionate mortality ratios for breast cancer according to occupation. We performed case-control analyses on occupational groups and on stratifications within the teaching profession. RESULTS. We found a number of significant associations between occupation and frequency of breast cancer. For example, white female professional, managerial, and clerical workers all had high proportions of breast cancer death. High rates of breast cancer in teachers were found in both proportionate mortality ratio and case-control analyses. CONCLUSIONS. These findings may serve as in an aid in the effective targeting of work-site health promotion programs. They suggest that occupationally coded mortality data can be a useful adjunct in the difficult task of identifying groups at risk of preventable disease.
Cervical cancer screening in hospitals: the efficacy of legislation in Maryland.
Authors: Klassen A C , Celentano D D , Weisman C S
Published: November 2008

OBJECTIVES. The purpose of the study was to examine the efficacy of a Maryland law requiring Pap testing to be offered during hospital admissions. "In-reach" strategies emphasize cancer screening within existing health care contacts (such as inpatient stays) rather than additional visits solely for screening. METHODS. Data from a 1986 telephone survey of Maryland women were used to examine the effect of hospitalization on self-reported Pap testing in a 3-year period. The effect of hospitalization on screening was examined by age and income to assess whether inpatient screening was more prevalent among certain subgroups of women. RESULTS. For the group as a whole, the odds of Pap screening did not vary with hospitalization. However, among women aged 45 to 54 years with annual household incomes over $20,000, hospitalized women were more likely than nonhospitalized women to report recent Pap tests. For low-income women aged 75 years and older, hospitalization actually decreased the likelihood of reporting Pap tests. CONCLUSIONS. Despite legislation, inpatient cervical cancer screening appears to mirror outpatient patterns, leaving elderly and low-income women unscreened. Methods for increasing inpatient Pap testing for underscreened women are discussed.
The influence of smoking cessation on body weight may be temporary.
Authors: Chen Y , Horne S L , Dosman J A
Published: November 2008

The relationships of bodyweight and body mass index with smoking cessation were examined among 1633 adults in Humboldt, Saskatchewan, Canada. Mean body mass index was highest in ex-smokers and lowest in smokers, and that of non-smokers was intermediate. Body mass index decreased significantly with increasing years after smoking cessation in female ex-smokers after adjusting for age, education, location of work, and physical activity. This trend, however, was not significant in men. The body weight data showed similar results. The prevalence of obesity (body mass index greater than 30 kg/m2) in all subjects showed a decrease with increasing years after smoking cessation.
Factors associated with late smoking initiation in Minnesota women.
Authors: Daly K A , Lund E M , Harty K C , Ersted S A
Published: November 2008

This case-control study investigated factors associated with late initiation (i.e., initiation after the age of 17 years) of smoking among young women. The most significantly elevated odds ratios for late initiation were having a significant other who smoked and having friends who found smoking acceptable at initiation. Peers, especially significant others, played an important role in smoking initiation among young women. Prevention efforts should focus on strategies that reduce the acceptability of smoking in the social environment.
Cotinine concentrations in semen, urine, and blood of smokers and nonsmokers.
Authors: Vine M F , Hulka B S , Margolin B H , Truong Y K , Hu P C , Schramm M M , Griffith J D , McCann M , Everson R B
Published: November 2008

Cotinine levels in the semen, urine, and blood of 88 male smokers and nonsmokers, aged 18 to 35, were analyzed via radioimmunoassay. Detectable cotinine levels were found in all three body fluids, and cotinine levels in all three fluids were highly correlated. Cotinine levels in semen and blood were of similar magnitude; cotinine levels in urine were an order of magnitude or more higher. In all three fluids, cotinine levels increased with an increase in cigarette smoke exposure.
Cancer screening among African-American women: their use of tests and social support.
Authors: Kang S H , Bloom J R , Romano P S
Published: November 2008

This study examined associations between social ties (as measured by the Social Network Index), instrumental and emotional support, and the use of three female cancer screening tests: mammography, cervical smear, and clinical breast examination. Data were taken from a household survey of 670 African-American women living in northern California in 1986. In multiple logistic regression models, Berkman's index was associated with increased use of mammography but not with the use of cervical smear or clinical breast examination. Instrumental and emotional support measures were not significant. These results suggest that social networks may have a role in early cancer detection.
Promoting mammography use through progressive interventions: is it effective?
Authors: King E S , Rimer B K , Seay J , Balshem A , Engstrom P F
Published: November 2008

This study evaluated interventions implemented with women in a health maintenance organization who had not utilized their annual free mammogram referral 45 days (step 2) and 95 days (step 3) after its mailing. The step 2 evaluation compared mammography utilization for women randomly assigned to receive a brief reminder letter or no reminder: 42% of the reminder group vs 28% of the control group obtained mammograms. The step 3 evaluation compared utilization for women randomly assigned to receive a second reminder, a letter suggesting a preventive office visit, or telephone counseling: 29% of those who received telephone counseling, 14% of those who received a letter, and 12% of those who received a second reminder obtained mammograms.
Screening for childhood lead poisoning: a cost-minimization analysis.
Authors: Glotzer D E , Bauchner H , Freedberg K A , Palfrey S
Published: November 2008

Decision analysis was used to compare the costs of three screening strategies for childhood lead poisoning: (1) venipuncture; (2) capillary sample with venipuncture confirmation if the blood lead level is elevated; (3) stratification by risk, with venipuncture for high-risk children and capillary sample for low-risk children. Under baseline conditions, the cost of screening by the venipuncture, stratification, and capillary strategies is $22, $25, and $27, respectively. Venipuncture remains the least expensive strategy unless the cost of venipuncture is more than three times that of capillary sampling. The annual cost of a national lead screening program that uses a single venipuncture sample would be $352 million. Initial screening with a capillary sample would cost $432 million, 23% more than venipuncture.
Self-reported physical activity in a rural county: a New York county health census.
Authors: Eaton C B , Nafziger A N , Strogatz D S , Pearson T A
Published: November 2008

OBJECTIVES. Few studies have described physical activity in rural populations. This study describes the frequency, types, and correlates of physical activity in 29,304 free-living adults in a rural county in New York State. METHODS. Self-reported responses about regular physical activity (maintained long enough to work up a sweat) were analyzed from a private household census of Otsego County with an 86.6% response rate. RESULTS. This survey categorized 46.2% of county residents as sedentary. Walking, the most frequent choice of activity (62% of the women, 36% of the men), increased in frequency with age of respondents whereas cycling, jogging, aerobics, team sports, and swimming (listed in rank order of frequency) generally tended to decrease in frequency with age. Farmers demonstrated an increased amount of "sweat activity" compared with persons in most other occupations. CONCLUSIONS. This descriptive study of physical activity in a rural county shows that sedentary lifestyle is of high prevalence. The high frequency of walking and the gender differences in both the levels and choice of activity suggest that further research and public policy recommendations focus on these issues.
Physicians' recommendations for mammography: do tailored messages make a difference?
Authors: Skinner C S , Strecher V J , Hospers H
Published: November 2008

OBJECTIVES. Message tailoring, based on individual needs and circumstances, is commonly used to enhance face-to-face patient counseling. Only recently has individual tailoring become feasible for printed messages. This study sought to determine whether printed tailored recommendations addressing women's specific screening and risk status and perceptions about breast cancer and mammography are more effective than standardized printed recommendations. METHODS. Computer-assisted telephone interviews were conducted with 435 women, aged 40 to 65 years, who had visited family practice groups within the previous 2 years. Subjects were randomly allocated to receive individually tailored or standardized mammography recommendation letters mailed from physicians to patients' homes. Follow-up interviews were conducted 8 months later. RESULTS. Tailored letter recipients were more likely to remember and to have read more of their letters than standardized version recipients. After controlling for baseline status, tailored letter receipt was associated with more favorable follow-up mammography status for women with incomes below $26,000 and for Black women. CONCLUSIONS. Tailored messages are a more effective medium for physicians' mammography recommendations; tailoring may be especially important for women of low socioeconomic status.
Using census and mortality data to target small areas for breast, colorectal, and cervical cancer screening.
Authors: Andrews H F , Kerner J F , Zauber A G , Mandelblatt J , Pittman J , Struening E
Published: November 2008

OBJECTIVES: The goal of this study was to develop and validate quantitative models for estimating cancer incidence in small areas. METHODS. The outcome for each cancer site was the incidence of disease that had reached a late stage at the time of diagnosis. Two sets of predictors were used: (1) census-based demographic variables and (2) census-based demographic variables together with the cancer-specific mortality rate. RESULTS. The best models accounted for a substantial percentage of between area variability in late-stage rates for cancer of the breast (46%), cervix (61%), and colon/rectum (58%). A validation procedure indicated that correct identification of small areas with high rates of late-stage disease was two to three times more likely when model-based estimates were used than when areas were selected at random. CONCLUSIONS. Additional testing is needed to establish the generality of the geographic targeting methodology developed in this paper. However, there are strong indications that small-area estimation models will be useful in many regions where planners wish to target cancer screening programs on a geographic basis.
Changes in the use of screening mammography: evidence from the 1987 and 1990 National Health Interview Surveys.
Authors: Breen N , Kessler L
Published: November 2008

OBJECTIVES: Mammography rates reported by women in the National Health Interview Surveys of 1990 and 1987 are examined. Why this screening modality is not more frequently used is explored. METHODS. Data from the 1987 and 1990 National Health Interview Surveys, conducted by the National Center for Health Statistics, are cross-tabulated and compared. RESULTS. In 1987, approximately 17% of women over 40 years of age reported having had a screening mammogram in the previous year. In 1990, the rate doubled. Race declined in importance; income and education remained strong, positive predictors of screening. CONCLUSIONS. Despite this dramatic increase, two thirds of women are not having screening mammograms. Use was not higher primarily because women did not realize that screening mammography tests for breast cancer in asymptomatic women. Primary care physicians are the main source of health education for screening mammography. The data suggest that public health programs to promote screening mammography should especially target primary care physicians and women with low incomes and education. Likewise, health care providers should ensure that their patients are referred to facilities that deliver high-quality mammography at low cost to make the procedure more accessible.
Infant feeding policies in maternity wards and their effect on breast-feeding success: an analytical overview.
Authors: Pérez-Escamilla R , Pollitt E , Lönnerdal B , Dewey K G
Published: November 2008

OBJECTIVES. The purpose of this review is to examine the plausibility of a causal relationship between maternity ward practices and lactation success. METHODS. Studies were located with MEDLINE, from our personal files, and by contacting researchers working in this field. Of the 65 studies originally reviewed, 18 met our inclusion criteria (i.e., hospital-based intervention, experimental design with randomization procedures, or quasi-experimental design with adequate documentation). RESULTS. Meta-analysis indicated that commercial discharge packs had an adverse effect on lactation performance. The impact of early mother-infant contact on lactation success was unclear. Rooming-in and breast-feeding guidance in a rooming-in context had a beneficial impact on breast-feeding among primiparae. Breast-feeding on demand was positively associated with lactation success. In-hospital formula supplementation of 48 mL per day was not associated with poor breast-feeding performance. CONCLUSIONS. Hospital-based breast-feeding interventions can have a beneficial effect on lactation success, particularly among primiparous women.
Correlates of high-density lipoprotein cholesterol in black and white women.
Authors: Heath G W , Macera C A , Croft J B , Mace M L , Gillette T , Wheeler F C
Published: November 2008

The relationships of high-density lipoprotein (HDL) cholesterol with body composition, leisure-time physical activity, cigarette smoking, and education were examined in a community-based sample of 480 Black and 1337 White women. Univariate and multivariate analyses indicated inverse associations of HDL with body mass index and waist-to-hip ratio in both groups, and with cigarette smoking and low educational attainment among White women only. Since correlates of HDL cholesterol differ for Black and White women, further investigation of the differences in these correlates is warranted.
Developing leaders vs training administrators in the health services.
Authors: Legnini M W
Published: November 2008

In these difficult times, health care institutions need leaders, not simply managers. Leaders' breadth of skills and perspective come from understanding the values involved in health care delivery; managers know the right way to do things, but leaders know which are the right things to do. Schools of public health are moving away from their potential contribution to leadership development in health services administration. The result is a lack of accountability to the community. Leadership skills and an examination of values should be part of health services administration programs in schools of public health, which should see their mission as helping to identify and train leaders, not simply technical specialists in management.
Changes in positions of authority held by US physicians: a fresh look at existing data.
Authors: Osberg J S
Published: November 2008

Some experts contend that physicians have lost positions of authority in the past 40 years. Others argue the opposite, yet neither side bases its arguments on empirical data. This study examined longitudinal variables measuring authority positions held by physicians. Data on the relative position of physicians in medical schools show that medical doctors held 65.6% of the sampled positions in 1970 vs 72.8% in 1990. Yet, in the wider society and within the nonmedical school portion of the health sector, other data indicate that physicians occupy a smaller proportion of authority positions.
Consequences of the North American Free Trade Agreement for health services: a perspective from Mexico.
Authors: Frenk J , Gómez-Dantés O , Cruz C , Chacón F , Hernández P , Freeman P
Published: November 2008

OBJECTIVES. The purposes of the study were to assess the potential impact of the North American Free Trade Agreement (NAFTA) on medical care in Mexico and to identify internal measures Mexico could take to increase the benefits and minimize the risks of free trade. METHODS. The dual nature of the health sector is examined; the Mexican, Canadian, and US health care systems are compared; and modes and consequences of international exchange of health services are analyzed. RESULTS. Four issues require immediate attention: accreditation of health care facilities, licensing and certification of professionals, technology assessment, and financial equity. CONCLUSIONS. NAFTA offers opportunities for positive developments in Mexico, provided risks can be anticipated and preventive measures can be taken to avoid negative impacts on the health system. Medical services, like other elements of the Mexican economy, must be modernized to respond to the demands of global competition. The Mexican National Academy of Medicine has recommended to the Mexican government (1) internal strengthening of the Mexican health care system to improve its ability to respond to the new conditions created by NAFTA and (2) a gradual process to facilitate equitable and mutually beneficial interactions among the three countries.
Comparing hospitals that perform coronary artery bypass surgery: the effect of outcome measures and data sources.
Authors: Hartz A J , Kuhn E M
Published: November 2008

OBJECTIVES. The relative quality of hospital care often is judged by comparing risk-adjusted rates of adverse outcomes. This study evaluated whether hospital quality comparisons are affected by the choice of outcome and the use of administrative data instead of clinical data. METHODS. The data were collected from 2687 coronary artery bypass surgery patients from 17 hospitals. All patients were on Medicare. For 10 hospitals with 94 to 713 patients, risk-adjusted outcomes for death, major complications, and any complications were derived from a clinically rich database and an administrative database. RESULTS. The correlations between adjusted hospital rankings derived from the clinical and administrative databases were not significant: .48 for mortality, .21 for major complications, and -.14 for any complication. When only the clinical database was used, the correlation between risk-adjusted hospital rankings for mortality and major complications was .77 (P < .01) and the correlation between major complications and any complication was -.45. CONCLUSIONS. These results suggest assessing quality of care by the use of administrative data may not be adequate and that quality assessment by the use of clinical data may depend greatly on the outcome chosen.
Rates, patterns, causes, and costs of hospitalization of nursing home residents: a population-based study.
Authors: Barker W H , Zimmer J G , Hall W J , Ruff B C , Freundlich C B , Eggert G M
Published: November 2008

OBJECTIVES. Hospitalization of nursing home residents is a growing, poorly defined problem. The purposes of this study were to define rates, patterns, costs, and outcomes of hospitalizations from nursing homes and to consider implications for reducing this problem as part of health care reform. METHODS. Communitywide nursing home utilization review and hospital discharge data were used to define retrospectively a cohort of 2120 patients newly admitted to nursing homes; these patients were followed for 2 years to identify all hospitalizations. Resident characteristics were analyzed for predictors of hospitalization. Charges and outcomes were compared with hospitalization of community-dwelling elders. RESULTS. Hospitalization rates were strikingly higher for intermediate vs skilled levels of care (566 and 346 per 1000 resident years, respectively). Approximately 40% of all hospitalizations occurred within 3 months of admission. No strong predictors were identified. Length of stay, charges, and mortality rates were higher than for hospitalizations from the community. CONCLUSIONS. Hospitalizations from nursing homes are not easily predicted but may in large part be prevented through health care reforms that integrate acute and longterm care.
HIV infection among women in prison: an assessment of risk factors using a nonnominal methodology.
Authors: Hankins C A , Gendron S , Handley M A , Richard C , Tung M T , O'Shaughnessy M
Published: November 2008

The relative contributions of needle use practices and sexual behaviors to human immunodeficiency virus (HIV) antibody seropositivity among 394 women incarcerated in Quebec were determined by risk factor assessment and serology with a nonnominal methodology. HIV positivity was found in 6.9% (95% confidence interval [CI] = 4.6, 9.9) of all participants and in 13% (95% CI = 8.6, 18.6) of women with a history of injection drug use. HIV seropositivity among women with a history of injection drug use was predicted by sexual or needle contact with a seropositive person, self-reported genital herpes, and having had a regular sexual partner who injected drugs, but it was not predicted by prostitution. Nonnominal testing is an ethical alternative to mandatory and anonymous unlinked testing among correctional populations.
Risk factors for acute non-A, non-B hepatitis and their relationship to antibodies for hepatitis C virus: a case-control study.
Authors: Mele A , Sagliocca L , Manzillo G , Converti F , Amoroso P , Stazi M A , Ferrigno L , Rapicetta M , Franco E , Adamo B
Published: November 2008

A case-control study was carried out comparing 333 case subjects with non-A, non-B hepatitis and 1095 hospital control subjects. Of 333 case subjects, 197 (59%) were positive for hepatitis C antibody (anti-HCV). Excluding blood transfusion and intravenous drug use, surgical intervention and dental therapy were strongly associated with anti-HCV-positive cases: in particular, obstetric and gynecology surgical intervention was found to be strongly associated with HCV positivity (odds ratio [OR] = 32; 95% confidence interval [CI] = 7, 147). Raw shellfish consumption was a risk factor for anti-HCV-negative cases (OR = 2.2; 95% CI = 1.0, 5.1), thus suggesting an enterically transmitted virus in sporadic non-A, non-B hepatitis in Italy.
Gynecologists' sex, clinical beliefs, and hysterectomy rates.
Authors: Bickell N A , Earp J A , Garrett J M , Evans A T
Published: November 2008

This study determined how gynecologists' sex, beliefs, appropriateness ratings, and practice characteristics influence hysterectomy rates in North Carolina. Gynecologists who performed hysterectomies at higher rates were further from training, practiced in areas with fewer gynecologists, and had more patients with abnormal bleeding or cancer. Male gynecologists performed 60% more hysterectomies than female gynecologists, but this may have been because they were further from their training. Appropriateness ratings were affected by gynecologists' attitudes toward surgery, recency of training, and practice case mix, and by patients' expressed desire to avoid surgery, but they did not predict hysterectomy rates. To decrease their chances of undergoing hysterectomy, patients should express their preferences and possibly seek the opinion of more recently trained gynecologists.
National and state spending on specialty alcoholism treatment: 1979 and 1989.
Authors: Huber J H , Pope G C , Dayhoff D A
Published: November 2008

The National Drug and Alcohol Treatment Unit Survey was used to measure changes in specialty alcoholism treatment spending between 1979 and 1989 nationally and by state. National spending more than doubled from $1.6 billion to $3.8 billion in 1989 dollars. Private spending increased more rapidly than public spending, although most clients continue to be publicly funded. Dramatic differences across states in public funding growth were partially explained by differential increases in per capita income and in federal substance abuse block grants. Access to treatment continues to vary widely across the states.
Monitoring childhood immunizations: a Canadian approach.
Authors: Roberts J D , Poffenroth L A , Roos L L , Bebchuk J D , Carter A O
Published: November 2008

In Manitoba, Canada, a centralized, computerized childhood immunization monitoring system serves a population with insured medical coverage; each individual has a unique identification number. All physicians bill a single payer, and specific billing codes are used to identify immunizations given by physicians and by public health nurses. Together with dates of service, this information is used to construct immunizations-to-date and age-at-immunization profiles for individuals and groups. Reminders seeking missing information are built into the system and executed at strategic ages. The quality of input data has been assessed as high. The approach could be used readily by health maintenance organizations in the United States.
The risk of hospitalization for ischemic heart disease among Asian Americans in northern California.
Authors: Klatsky A L , Tekawa I , Armstrong M A , Sidney S
Published: November 2008

To supplement sparse data about ischemic heart disease in Asian Americans, hospitalization risk was prospectively examined in a group of Asian Americans living in Northern California. Analyses used Cox models with ischemic heart disease risk traits as covariables. With Whites as the referent category, relative risks by ethnic group were as follows: Chinese, 0.6 (P = .001); Japanese, 1.0 (P = .97); Filipinos, 1.0 (P = .95); South Asians, 3.7 (P < .001); other Asian Americans, 0.8 (P = .55). Thus, unexplained differences in ischemic heart disease risk exist among Asian-American ethnic groups, with Chinese Americans at lowest risk and persons of South Asian origin at highest risk.
Seat belt use among drinking drivers in Minnesota.
Authors: Foss R D , Beirness D J , Sprattler K
Published: November 2008

OBJECTIVES. Among the reasons cited for recent declines in alcohol-related traffic fatalities is the enactment of seat belt use laws by most states. It is suspected that drinking drivers are less likely to comply with such laws, although evidence on the relationship between belt use and drinking by drivers is sparse and conflicting. The purpose of this study was to examine the relationship of drinking to driver seat belt use. METHODS. Observational, self-report, and chemical breath test data were collected on nighttime drivers in 16 Minnesota communities during September, 1990. RESULTS. Drivers with an illegal blood alcohol concentration (> or = 100 mg/dL) were substantially less likely to be wearing a seat belt (odds ratio [OR] = 2.17). Belt use was also more common among females (OR = 2.02) and before midnight (OR = 1.47). Males who had been drinking were less likely to be belted. Belt use was related to drinking before, but not after, midnight. Belt use was not related to drinking status among college graduates, but it was strongly related to drinking status among those with less education. CONCLUSIONS. The present findings provide further argument for rapid implementation of passive countermeasures (airbags) and for development of creative, carefully focused interventions to target high-risk populations.
A proposed method for assessing the performance of local public health functions and practices.
Authors: Miller C A , Moore K S , Richards T B , Monk J D
Published: November 2008

OBJECTIVES. One of the objectives for the nation for the year 2000 requires that 90% of the population be served by a local health department effectively carrying out the core functions of public health. This study proposes a method whereby determinations can be made of the extent to which a local public health jurisdiction is served by core public health functions, as well as the extent to which the functions are rendered by the health department. METHODS. Fourteen health departments under longitudinal study between 1979 and 1992 were studied. Respondents in each department completed a survey protocol using 81 indicators linked to standard public health functions and practices. Results are presented in graphic form, which provides a visual profile of public health performance for a local jurisdiction. RESULTS. The graphic profiles successfully differentiate one jurisdiction from another, and within each jurisdiction they differentiate the performance levels of different public health practices. The method enables identification of the full range of public health providers. CONCLUSIONS. Current definitions of public health practice have utility for evaluating public health performance. The validity of the proposed method deserves further study.
Tuberculosis risk factors in adults in King County, Washington, 1988 through 1990.
Authors: Buskin S E , Gale J L , Weiss N S , Nolan C M
Published: November 2008

OBJECTIVES. Tuberculosis has become a resurgent public health problem in the United States. Because resources are limited, control programs frequently must target populations at greatest risk. The purpose of the study was to examine risk factors for tuberculosis in adults. METHODS. In King County, Washington State, from 1988 through 1990, the characteristics of patients with tuberculosis were compared with census data, and a case-control study was conducted. Self-administered questionnaires were completed by 151 patients with active tuberculosis and 545 control subjects. RESULTS. Infection with the human immunodeficiency virus, non-White race/ethnicity, and foreign birthplace were each associated with a sixfold or greater increase in risk. Each of the following was associated with at least a doubled risk: history of selected underlying medical conditions; low weight for height; low socioeconomic status; and age 70 years or older. Men had 1.9 times the risk of women, smokers of 20 years' or more duration had 2.6 times the risk of nonsmokers, and heavy alcohol consumers had 2.0 times the risk of nondrinkers. CONCLUSIONS. Intervention targeting easily identified groups may be an effective way to reduce the incidence of tuberculosis.
The determinants of hypertension awareness, treatment, and control in an insured population.
Authors: Stockwell D H , Madhavan S , Cohen H , Gibson G , Alderman M H
Published: November 2008

OBJECTIVES. The purpose of the study was to identify the determinants of awareness, treatment, and control of hypertension in a population with full access to medical care. METHODS. Unionized New York City health care workers (n = 1394) with comprehensive medical insurance were screened for hypertension. Union records documenting all physician visits and prescription medications for the year before screening provided the opportunity to relate patterns of treatment to blood pressure outcomes. RESULTS. Of the 409 employees found to have hypertension, 289 (71%) were aware of their condition and 201 (49%) had been treated, but only 51 (12%) had their blood pressure controlled at the recommended level (< 140/90 mm Hg). In a logistic regression model, the only variable of treatment associated with control was days of antihypertensive medication. The total number of physician visits was not associated with control. CONCLUSIONS. These findings demonstrate that in conventional community settings, even in the absence of financial barriers, treatment for hypertension continues to be characterized by poor outcomes. Improving access to primary care, without changes in the nature of that care, may not substantially improve blood pressure control.
Occupational impairment and disability among applicants for Social Security disability benefits in Pennsylvania.
Authors: Bresnitz E A , Frumkin H , Goldstein L , Neumark D , Hodgson M , Needleman C
Published: November 2008

OBJECTIVE. The study goal was to assess the extent of workplace-related disease and injury among Social Security Disability Insurance applicants. METHODS. A convenience sample of 240 consecutive applicants to the Pennsylvania Bureau of Disability Determination was studied to assess the prevalence of work-related disorders. An applicant had a work-related condition if there was a clear statement of a workplace illness or injury associated with the impairment, or if the applicant had worked at an occupation with a high likelihood of exposures known or suspected to contribute to the condition of interest. RESULTS. Of the 240 applicants, 166 (69%) were awarded disability insurance benefits; a total of 27 (11%) had work-related conditions, including 14 of the 166 (8%) who were found to be disabled. Forty percent of the 27 had a disorder that was musculoskeletal in origin. Of 59 applicants with cancer, 10.2% had some work-related etiological component. Of an estimated 71,680 adult disability insurance applicants in Pennsylvania in 1990, 5134 new insurance beneficiaries had a projected occupationally related disability. CONCLUSIONS. A substantial number of applicants for disability insurance benefits suffer from an impairment caused or exacerbated by prior workplace exposures. These individuals may serve as sentinel events for initiating follow-up surveillance and prevention activities.