bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Occurrence of Rare Cancers in U.S. Adults, 1995–2004
Authors: Greenlee Robert T. , Goodman Marc T. , Lynch Charles F. , Platz Charles E. , Havener Lori A. , Howe Holly L. 
Published: July 2017

Objective. Rare cancers have been traditionally understudied, reducing the progress of research and hindering decisions for patients, physicians, and policy makers. We evaluated the descriptive epidemiology of rare cancers using a large, representative, population-based dataset from cancer registries in the United States. Methods. We analyzed more than 9 million adult cancers diagnosed from 1995 to 2004 in 39 states and two metropolitan areas using the Cancer in North America (CINA) dataset, which covers approximately 80% of the U.S. population. We applied an accepted cancer classification scheme and a published definition of rare (i.e., fewer than 15 cases per 100,000 per year). We calculated age-adjusted incidence rates and rare/non-rare incidence rate ratios using SEER*Stat software, with analyses stratified by gender, age, race/ethnicity, and histology. Results. Sixty of 71 cancer types were rare, accounting for 25% of all adult tumors. Rare cancers occurred with greater relative frequency among those who were younger, nonwhite, and of Hispanic ethnicity than among their older, white, or non-Hispanic counterparts. Conclusions. Collectively, rare tumors account for a sizable portion of adult cancers, and disproportionately affect some demographic groups. Maturing population-based cancer surveillance data can be an important source for research on rare cancers, potentially leading to a greater understanding of these cancers and eventually to improved treatment, control, and prevention.
Estimates of State-Level Health-Care Expenditures Associated with Disability
Authors: Anderson Wayne L. , Armour Brian S. , Finkelstein Eric A. , Wiener Joshua M. 
Published: July 2017

Objectives. We estimated state-level disability-associated health-care expenditures (DAHE) for the U.S. adult population. Methods. We used a two-part model to estimate DAHE for the noninstitutionalized U.S. civilian adult population using data from the 2002–2003 Medical Expenditure Panel Survey and state-level data from the Behavioral Risk Factor Surveillance System. Administrative data for people in institutions were added to generate estimates for the total adult noninstitutionalized population. Individual-level data on total health-care expenditures along with demographic, socioeconomic, geographic, and payer characteristics were used in the models. Results. The DAHE for all U.S. adults totaled $397.8 billion in 2006, with state expenditures ranging from $598 million in Wyoming to $40.1 billion in New York. Of the national total, the DAHE were $118.9 billion for the Medicare population, $161.1 billion for Medicaid recipients, and $117.8 billion for the privately insured and uninsured populations. For the total U.S. adult population, 26.7% of health-care expenditures were associated with disability, with proportions by state ranging from 16.9% in Hawaii to 32.8% in New York. This proportion varied greatly by payer, with 38.1% for Medicare expenditures, 68.7% for Medicaid expenditures, and 12.5% for nonpublic health-care expenditures associated with disability. Conclusions. DAHE vary greatly by state and are borne largely by the public sector, and particularly by Medicaid. Policy makers need to consider initiatives that will help reduce the prevalence of disabilities and disability-related health disparities, as well as improve the lives of people with disabilities.
Increasing Poisoning Mortality Rates in the United States, 1999–2006
Authors: Bohnert Amy S.B. , Fudalej Sylwia , Ilgen Mark A. 
Published: July 2017

Objectives. Poisoning mortality rates have increased dramatically in the United States since the 1970s. This trend has been mainly attributed to an increase in accidental medication overdose deaths. The aim of this study was to analyze recent trends in poisoning mortality among U.S. adults using the most recently available data, and to examine gender and age as risk factors. Methods. Data on injury-based mortality for the entire U.S. were obtained from the Web-based Injury Statistics Query and Reporting System (WISQARS™) for 1999–2006. We analyzed poisoning mortality rates by age group, gender, and intent. We modeled time trends in poisoning mortality using Poisson regression. Results. Although intentional and undetermined poisoning mortality rates remained relatively stable, accidental poisoning mortality rates increased 108.5% between 1999 and 2006, and were significantly higher in each successive year (incidence rate ratio = 1.12 per year increase). Unintentional poisoning mortality rates were higher in men than in women; however, the increase in rate overtime was higher in women than in men. The unintentional poisoning mortality rate was highest in individuals aged 40–49 years across all years studied, but we observed large increases in the rate for individuals aged 15–29 and 50–59 years during the study period. Conclusions. Despite recently raised awareness, rates of unintentional poisoning mortality in the U.S. continued to rise in 2006. Men are at increased risk, but this disparity has decreased over time.
A Comparative Analysis of Health-Related Quality of Life for Residents of U.S. Counties with and without Coal Mining
Authors: Zullig Keith J. , Hendryx Michael 
Published: July 2017

Objectives. We compared health-related quality of life (HRQOL) in mining and non-mining counties in and out of Appalachia using the 2006 Behavioral Risk Factor Surveillance System (BRFSS) survey. Methods. Dependent variables included self-rated health, the number of poor physical and mental health days, the number of activity limitation days (in the last 30 days), and the Centers for Disease Control and Prevention Healthy Days Index. Independent variables included the presence of coal mining, Appalachian region residence, metropolitan status, primary care physician supply, and BRFSS behavioral (e.g., smoking, body mass index, and alcohol consumption) and demographic (e.g., age, gender, race, and income) variables. We compared dependent variables across a four-category variable: Appalachia (yes/no) and coal mining (yes/no). We used SUDAAN® Multilog and multiple linear regression models with post-hoc least-squares means to test for Appalachian coal-mining effects after adjusting for covariates. Results. Residents of coal-mining counties inside and outside of Appalachia reported significantly fewer healthy days for both physical and mental health, and poorer self-rated health ( p<0.0005) when compared with referent U.S. non-coal-mining counties, but disparities were greatest for people residing in Appalachian coal-mining areas. Furthermore, results remained consistent in separate analyses by gender and age. Conclusions. Coal-mining areas are characterized by greater socioeconomic disadvantage, riskier health behaviors, and environmental degradation that are associated with reduced HRQOL.
Trends of Elevated PTSD Risk in Firefighters Exposed to the World Trade Center Disaster: 2001–2005
Authors: Berninger Amy , Webber Mayris P. , Cohen Hillel W. , Gustave Jackson , Lee Roy , Niles Justin K. , Chiu Sydney , Zeig-Owens Rachel , Soo Jackie , Kelly Kerry , Prezant David J. 
Published: July 2017

Objectives. We identified trends in the prevalence of elevated posttraumatic stress disorder (PTSD) risk as determined by the Fire Department of the City of New York (FDNY)-modified PTSD Checklist in World Trade Center (WTC)-exposed firefighters. We also examined trends in relation to WTC exposure, social support, change in recreational activities, and functional health. Methods. We analyzed 16,826 questionnaires from 10,074 firefighters in yearly intervals, from September 12, 2001, to September 11, 2005. Results. The prevalence of elevated PTSD risk increased over time, from 9.8% in year 1 to 10.6% in year 4 ( p<0.0001). Earliest arrival at the WTC site (odds ratio [OR] = 6.0; 95% confidence interval [CI] 4.4, 8.3), prolonged work at the site (OR=2.0; 95% CI 1.8, 2.3), providing supervision without previous supervisory experience (OR=4.1; 95% CI 2.8, 6.1), and retirement due to a WTC-related disability (OR=1.3; 95% CI 1.1, 1.5) were associated with ever having elevated PTSD risk. Difficulty functioning at home was strongly associated with elevated PTSD risk (ORs ranged from 17.0 [95% CI 14.5, 20.0] in year 1 to 26.7 [95% CI 20.3, 35.2] in year 3), as was difficulty functioning at work (ORs ranged from 12.1 [95% CI 10.2, 14.2] in year 1 to 23.0 [95% CI 14.6, 36.3] in year 2). Conclusions. Elevated PTSD risk was associated with exposure to the WTC site as well as functional impairment, and remained largely unabated during the first four years of the study. Screening for elevated PTSD risk may be useful in identifying those who could benefit from interventions during long-term follow-up, as well as in the immediate aftermath of disasters.
Disparities in Maternal Hypertension and Pregnancy Outcomes: Evidence from North Carolina, 1994–2003
Authors: Miranda Marie Lynn , Swamy Geeta K. , Edwards Sharon , Maxson Pamela , Gelfand Alan , James Sherman 
Published: July 2017

Objectives. To better understand disparities in pregnancy outcomes, we analyzed data from North Carolina to determine how the pattern of maternal hypertensive disorders differs among non-Hispanic white (NHW), non-Hispanic black (NHB), and Hispanic women across the range of maternal ages. In addition, we explored whether rates of poor birth outcomes, including low birthweight (LBW) and preterm birth (PTB), among hypertensive women differed by race. Methods. We restricted our analyses to births occurring between 1994 and 2003, constructing six five-year maternal age categories: 15–19 years, 20–24 years, 25–29 years, 30–34 years, 35–39 years, and 40–44 years. We used logistic regression to determine the relative contribution of race and age to incidence of maternal hypertension. All analyses controlled for the standard covariates of maternal education, marital status, and tobacco use. To assess the impact of maternal hypertension on birth outcomes, we limited the dataset to women with any hypertensive disorder and used linear regression to determine how particular race-age combinations affected outcomes. We also used logistic regression to find out how particular race-age combinations affected the likelihood of LBW and PTB. Results. The risk of hypertension differed by race, with NHB women exhibiting the highest risk and Hispanic women the lowest risk. Further, rates of hypertension increased with age. Among hypertensive women, pregnancy outcomes differed by race and age, with NHB women having the poorest outcomes (i.e., LBW and PTB) and age exhibiting a dose-response relationship in PTB and very PTB. Conclusions. Patterns of maternal hypertension and subsequent outcomes are important contributors to persistent disparities in pregnancy outcomes.
Costs of HIV Prevention among Out-of-Treatment Drug-Using Women: Results of a Randomized Controlled Trial
Authors: Ruger Jennifer Prah , Ben Abdallah Arbi , Cottler Linda 
Published: July 2017

Objectives. We developed a micro-costing methodology to estimate the real resource costs consumed by delivery of the National Institute on Drug Abuse (NIDA) Cooperative Agreement Standard Intervention (SI) for human immunodeficiency virus (HIV) prevention, plus two enhanced modules, in a three-arm randomized controlled trial (RCT) among drug-using women. To our knowledge, this is the first micro-costing study of the SI and enhanced modules and the first of its kind targeting drug-using women. Methods. We conducted a micro-costing study alongside a three-arm RCT to estimate costs of ( 1) the modified NIDA SI; ( 2) the SI and a well woman exam (SI+WWE); and ( 3) the SI, WWE, and four educational sessions (SI+WWE+4ES) to prevent HIV and sexually transmitted diseases in at-risk, drug-using women in St. Louis, Missouri. Results. The cost of the SI that all 501 participants received was approximately $227 per person. The additional costs for the WWE and 4ES were approximately $145 and $942 per person, respectively. Total program costs for the SI ( n=501) were $113,869; additional costs for the SI+WWE ( n=342) were $49,403 and for the SI+WWE+4ES ( n=170) were $160,189. The main cost component for the SI (64% of total costs) was testing costs, whereas building and facilities costs were the main cost component for the SI+WWE+4ES (75% of total costs). Conclusions. This study provides accurate estimates of the real costs for standard and enhanced HIV interventions for policy makers seeking to implement targeted HIV-prevention programs with scarce resources.
A Longitudinal Study of the Impact of an Emergency Preparedness Curriculum
Authors: Hoeppner Mary M. , Olson Debra K. , Larson Susan C. 
Published: July 2017

Objective. We conducted a longitudinal study to evaluate the impact of a curriculum designed to develop competency in emergency preparedness among public health professionals. Methods. At six and 12 months following completion of one or more courses in the areas of emergency preparedness, response, and recovery, or in food protection, course participants were contacted and asked to identify if their participation allowed them to develop targeted competencies, identify important knowledge or skills they had acquired, provide examples of application of learning, and describe the impact of changes. Over five years, 36 sets of data were collected. Results. The response rate of those who responded at either six or 12 months, or for both time periods, was 63%. At both six and 12 months, those who responded agreed that the learning activity helped them develop the competency associated with it in the curriculum plan. Respondents described multiple applications of learning and reported the development of reflective and systems-thinking abilities. Conclusions. The results provide compelling evidence that learners do develop competencies that impact their work activities as a result of competency-based educational programming and are able to apply these competencies in their work and organizational activities.
Chlamydia Positivity in Women Screened in Family Planning Clinics: Racial/Ethnic Differences and Trends in the Northwest U.S., 1997–2006
Authors: Fine David , Thomas Katherine K. , Nakatsukasa-Ono Wendy , Marrazzo Jeanne 
Published: July 2017

Objectives. We assessed chlamydia trends, individual-level risk factors, and population-level area-based socioeconomic measures (ABSMs) associated with chlamydia infection in women attending U.S. Public Health Service (PHS) Region X Infertility Prevention Project (IPP) family planning (FP) clinics from 1997–2006. We then explored these measures within racial/ethnic subpopulations. Methods. Using data from 667,223 chlamydia tests obtained from women aged 15–24 years screened in 201 FP clinics, we employed a generalized mixed model with logistic link, incorporating clinic and ZIP code as random effects to adjust for risk of chlamydia associated with individual- and population-level (areal) measures for the overall population and for each racial/ethnic subpopulation. Results. Significant racial/ethnic differences in chlamydia persisted after adjusting for individual and aggregate factors. Relatively steep chlamydia gradients were found across racial/ethnic ABSM levels. Compared with white women, infection risk was significantly higher for black (adjusted odds ratio [AOR] = 1.93), American Indian/Alaska Native (AOR=1.62), Asian/Pacific Islander (AOR=1.42), and Hispanic (AOR=1.28) women. The impact of population-level ABSMs on chlamydia varied across racial/ethnic groups and was generally modest. Among white women, there was a significant 4% relative annual increase in predicted chlamydia during the 10-year period 1997–2006. Chlamydia positivity over time did not change for racial/ethnic minority groups after adjusting for individual- and population-level factors. Conclusions. Racial/ethnic differences in chlamydia persisted over time and were not mitigated by adjustment for aggregate socioeconomic position or areal racial/ethnic measures. Changes in project strategies will be needed to address racial/ethnic disparities for chlamydial infection among young female FP clinic clients.
Atrazine Exposure in Public Drinking Water and Preterm Birth
Authors: Rinsky Jessica L. , Hopenhayn Claudia , Golla Vijay , Browning Steve , Bush Heather M. 
Published: July 2017

Objectives. Approximately 13% of all births occur prior to 37 weeks gestation in the U.S. Some established risk factors exist for preterm birth, but the etiology remains largely unknown. Recent studies have suggested an association with environmental exposures. We examined the relationship between preterm birth and exposure to a commonly used herbicide, atrazine, in drinking water. Methods. We reviewed Kentucky birth certificate data for 2004–2006 to collect duration of pregnancy and other individual-level covariates. We assessed existing data sources for atrazine levels in public drinking water for the years 2000–2008, classifying maternal county of residence into three atrazine exposure groups. We used logistic regression to analyze the relationship between atrazine exposure and preterm birth, controlling for maternal age, race/ethnicity, education, smoking, and prenatal care. Results. An increase in the odds of preterm birth was found for women residing in the counties included in the highest atrazine exposure group compared with women residing in counties in the lowest exposure group, while controlling for covariates. Analyses using the three exposure assessment approaches produced odds ratios ranging from 1.20 (95% confidence interval [CI] 1.14, 1.27) to 1.26 (95% CI 1.19, 1.32), for the highest compared with the lowest exposure group. Conclusions. Suboptimal characterization of environmental exposure and variables of interest limited the analytical options of this study. Still, our findings suggest a positive association between atrazine and preterm birth, and illustrate the need for an improved assessment of environmental exposures to accurately address this important public health issue.
Increasing Access to Oral Health Care for People Living with HIV/AIDS in the U.S.: Baseline Evaluation Results of the Innovations in Oral Health Care Initiative
Authors: Fox Jane E. , Tobias Carol R. , Bachman Sara S. , Reznik David A. , Rajabiun Serena , Verdecias Niko 
Published: July 2017

Objectives. We provide an overview of the Health Resources and Services Administration HIV/AIDS Bureau's Special Projects of National Significance Innovations in Oral Health Care Initiative, describe the models developed by the 15 demonstration sites and associated evaluation center, and present initial descriptive data about the characteristics of the multisite evaluation study sample. Methods. Baseline data were collected from May 2007–August 2009 for 2,469 adults living with HIV/AIDS who had been without dental care, except for emergency care, for 12 months or longer. Variables included sociodemographic characteristics, HIV status, medical care, history of dental care and oral health symptoms, oral health practices, and physical and mental health quality of life. Descriptive statistics of baseline variables were calculated. Results. The study sample included 2,469 adults who had been HIV-positive for a decade; most were engaged in HIV care. The majority (52.4%) of patients had not seen a dentist in more than two years; 48.2% reported an unmet oral health-care need since testing positive for HIV, and 63.2% rated the health of their teeth and gums as “fair” or “poor.” Conclusions. This study is the largest to examine oral health care among people living with HIV/AIDS in more than a decade. The need for access to oral health care among members of this HIV-positive patient sample is greater than in the general population, following previous trends. Findings from our study reinforce the necessity for continued federal and statewide advocacy and support for oral health programs targeting people living with HIV/AIDS; findings can be extended to other vulnerable populations.
Area-Level Socioeconomic Disadvantage and Severe Pulmonary Tuberculosis: U.S., 2000–2008
Authors: Oren Eyal , Narita Masahiro , Nolan Charles , Mayer Jonathan 
Published: July 2017

Objectives. Lower socioeconomic status (SES) is associated with increased risk of tuberculosis (TB) and diagnostic delays, but the extent to which this association reflects an underlying gradient in advanced status of pulmonary TB is unknown. We conducted a multilevel retrospective cohort analysis examining the relationship between socioeconomic characteristics and pulmonary TB disease status, as measured via sputum smears and chest radiography results. Methods. We included 862 incident TB patients reported in King County, Washington, from 2000–2008. We abstracted patient-level measures from charts and surveillance data. We obtained socioeconomic characteristics of TB patients, as well as those of the areas where TB patients lived, from the 2000 U.S. Census. A socioeconomic position (SEP) index was derived to measure SES. Results. Of those with known results, 814 of 849 patients (96%) displayed abnormal radiography findings. A total of 239 graded patients (39%) had positive smears, 136 (57%) of whom had grades of moderate (3+) or numerous (4+) acid-fast bacilli. In unadjusted analyses, patients living in lower SEP areas did not appear to have higher probabilities of more advanced disease. In multivariate models adjusting for individual demographic and socioeconomic measures, as well as area-based demographic variables, block-group SEP was not significantly associated with more advanced pulmonary disease. Conclusions. Lower SEP was not significantly associated with greater pulmonary disease severity after controlling for individual age, race, sex, and origin, and block-group race, ethnicity, and origin. These findings suggest that the severity of pulmonary TB at diagnosis is not synonymous with delayed diagnosis.
Missed Connections: HIV-Infected People Never in Care
Authors: Bertolli Jeanne , Garland Pamela Morse , Valverde Eduardo E. , Beer Linda , Fagan Jennifer L. , Hart Clyde ,   Never in Care Pilot Project Team
Published: July 2017

Objective. Clinical interventions that lengthen life after HIV infection and significantly reduce transmission could have greater impact if more HIV-diagnosed people received HIV care. We tested a surveillance-based approach to investigating reasons for delayed entry to care. Methods. Health department staff in three states and two cities contacted eligible adults diagnosed with HIV four to 24 months previously who had no reported CD4+ lymphocyte (CD4) or viral load (VL) tests. The staff conducted interviews, performed CD4 and VL testing, and provided referrals to HIV medical care. Reported CD4 and VL tests were prospectively monitored to determine if respondents had entered care after the interview. Results. Surveillance-based follow-up uncovered problems with reporting CD4 and VL tests, resulting in surveillance improvements. However, reporting problems led to misspent effort locating people who were already in care Follow-up proved difficult because contact information in surveillance case records was often outdated or incorrect. Of those reached, 37% were in care and 29% refused participation. Information from 132 people interviewed generated ideas for service improvements, such as emphasizing the benefits of early initiation of HIV care, providing coverage eligibility information soon after diagnosis, and leveraging other medical appointments to provide assistance with linkage to HIV care. Conclusions. Surveillance-based follow-up of HIV-diagnosed individuals not linked to care provided information to improve both surveillance and linkage services, but was inefficient because of difficulties identifying, locating, and recruiting eligible people. Inefficiencies attributable to missing, incomplete, or inaccurate surveillance records are likely to diminish as data quality is improved through ongoing use.