bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Relationship between Blood Lead Levels and Neurobehavioral Test Performance in NHANES III and Related Occupational Studies
Authors: Krieg Edward F. , Chrislip David W. , Crespo Carlos J. , Brightwell W. Stephen , Ehrenberg Richard L. , Otto David A. 
Published: July 2017

Objectives. The goals of this study were two-fold: ( 1) to assess the relationship between blood lead levels and neurobehavioral test performance in a nationally representative sample of adults from the third National Health and Nutrition Evaluation Survey and ( 2) to analyze the results from previously published studies of occupational lead exposure that used the same neurobehavioral tests as those included in the survey. Methods. Regression models were used to test and estimate the relationships between measurements of blood lead and performance on a simple reaction time, a symbol-digit substitution, and a serial digit learning test in adults aged 20–59 years who participated the survey. Mixed models were used to analyze the data from the occupational studies. Results. The blood lead levels of those participating in the survey ranged from 0.7 to 41.8 μg/dl. The estimated geometric mean was 2.51 μg/dl, and the estimated arithmetic mean was 3.30 μg/dl. In the survey, no statistically significant relationships were found between blood lead concentration and performance on the three neurobehavioral tests when adjusted for covariates. In the occupational studies, the groups exposed to lead consistently performed worse than control groups on the simple reaction time and digit-symbol substitution tests. Conclusions. The results from the survey and the occupational studies do not provide evidence for impairment of neurobehavioral test performance at levels below 25 μg/dl, the concentration that the Centers for Disease Control and Prevention define as elevated in adults. The average blood lead level of the exposed groups in the occupational studies was 41.07 μg/dl, less than 50 μg/dl, the minimum concentration that the Occupational Safety and Health Administration requires for medical removal from the workplace. Given the evidence of impaired neurobehavioral performance in these groups, the 50 μg/dl limit should be reevaluated.
Trends in Total Knee Replacement Surgeries and Implications for Public Health, 1990–2000
Authors: Mehrotra Chetna , Remington Patrick L. , Naimi Timothy S. , Washington William , Miller Richard 
Published: July 2017

Objectives. Total joint replacements are important surgical interventions for treating severe arthritis of weight-bearing joints. The most common indication for total knee replacement (TKR) is osteoarthritis of the knee joint. The goals of this study were to assess the trend in rate of TKR in Wisconsin and to describe the economic impact of these surgical procedures on the health care system. Method. A population-based cross-sectional study of TKR surgeries was conducted among Wisconsin residents aged ⩾45 years. The Wisconsin inpatient hospital discharge data from 1990 through 2000 were used. Rates were age-adjusted to the 2000 U.S. population, and charges for TKR were adjusted for inflation. Results. From 1990 through 2000, the age-adjusted rate for TKR increased by 81.5% (from 162 to 294 per 100,000; p<0.001). The rate increased the most among the youngest age group (45–49 years), rate ratio 5.1 for men, 4.2 for women. The total charges for TKR increased from $69.4 million to $148 million (109.2% inflation-adjusted increase). Medicare received the highest proportion of charges for TKR procedures, but throughout the study period, the proportion of charges covered by private insurance increased by 39%. Conclusions. The rate and costs of TKR procedures among Wisconsin residents increased substantially from 1990 through 2000, especially among younger age groups. Changes in medical practices probably accounted for some of this increase, but these trends also may reflect an increased prevalence of osteoarthritis, which in turn may be related to dramatic increases in the number of individuals who are overweight.
Use of a Prospective Space-Time Scan Statistic to Prioritize Shigellosis Case Investigations in an Urban Jurisdiction
Authors: Jones Roderick C. , Liberatore Monica , Fernandez Julio R. , Gerber Susan I. 
Published: July 2017

Objective. A prospective space-time scan statistic was applied to Chicago's 2002 shigellosis surveillance data to evaluate its utility in objectively describing clusters and assisting in the prioritization of investigations. Methods. The prospective space-time module of SaTScan, a free software available online, was used to identify “live” clusters of disease, meaning cases that were current as of the date of the analysis and strongly associated in place and time. Fifty-two separate space-time analyses were run, one simulation for each week of 2002. Identified clusters were described in terms of space, time, risk factors reported by involved case-patients, and cases' links to venue-associated outbreaks. Results. Twelve live clusters were detected at the p<0.05 significance level: two single-household clusters and 10 community clusters. The community clusters ranged in size from 194 to 367 census tracts (median = 294), and in disease burden from 21 to 41 cases (median = 29). Geographically, all of the community clusters were located in the west-central part of the city and had a temporal span of 28 days. Within the 10 community clusters, 15 different day care centers were identified as potential exposure settings for case-patients or their close contacts. Conclusions. The prospective space-time scan statistic offers local health departments an objective way of describing clusters of shigellosis cases. The method used in this study could help prioritize the assignment and investigation of cases, particularly when overall shigellosis incidence exceeds expected numbers or when an agency's resources are stressed by other events, such as outbreaks.
Income, Housing, and Fire Injuries: A Census Tract Analysis
Authors: Shai Donna 
Published: July 2017

Objectives. This study investigates the social and demographic correlates of nonfatal structural fire injury rates for the civilian population for Philadelphia census tracts during 1993–2001. Methods. The author analyzed 1,563 fire injuries by census tract using the 1990 census (STF 3) and unpublished data from the Office of the Fire Marshal of the Philadelphia Fire Department. Injury rates were calculated per 1,000 residents of a given census tract. Multiple regression was used to determine significant variables in predicting fire injuries in a given census tract over a nine-year period and interaction effects between two of these variables—age of housing and income. Results. Multiple regression analysis indicates that older housing (prior to 1940), low income, the prevalence of vacant houses, and the ability to speak English have significant independent effects on fire injury rates in Philadelphia. In addition, the results show a significant interaction between older housing and low income. Conclusions. Given the finding of very high rates of fire injuries in census tracts that are both low income and have older housing, fire prevention units can take preventative measures. Fire protection devices, especially smoke alarms, should be distributed in the neighborhoods most at risk. Multiple occupancy dwellings should have sprinkler systems and fire extinguishers. Laws concerning the maintenance of older rental housing need to be strictly enforced. Vacant houses should be effectively boarded up or renovated for residential use. Fire prevention material should be distributed in a number of languages to meet local needs.
The Role of Reported Primary Race on Health Measures for Multiple Race Respondents in the National Health Interview Survey
Authors: Parker Jennifer D. 
Published: July 2017

Objectives. As data for multiple race groups have only recently been collected and tabulated, the current understanding of the health of multiple race groups is not well developed. In the National Health Interview Survey (NHIS), survey respondents who report more than one race are asked to identify a primary race. This report compares selected health and demographic measures by the response to the primary race question and compares estimates for specific primary race groups to corresponding estimates for single race groups. Methods. Using 1997–2003 NHIS data, several demographic and health measures were compared by reported primary race within the four largest multiple race groups. Then estimates by primary race for these four multiple race groups were compared to those for their single race counterparts. Results. There were few statistically significant associations between reported primary race and health or demographic variables within the four multiple race groups. This lack of association may be due to the small number of multiple race respondents (which results in large standard errors) rather than similarity of point estimates among the subgroups. A greater number of differences between estimates for single race groups and for multiple race respondents who reported the same single race as their primary race were identified. Conclusions. The apparent lack of association between primary race within a multiple race group and health outcomes suggests that tabulating multiple race responses by primary race is unnecessary for valid health estimates for multiple race groups, at least with available statistical power. However, differences between single race and primary race estimates within a multiple race group suggest that inferences for multiple race respondents using single race estimates may be imprecise for some outcomes.
Behavioral Health in Multiracial Adolescents: The Role of Hispanic/Latino Ethnicity
Authors: Whaley Arthur L. , Francis Kimberly 
Published: July 2017

Objectives. The purpose of the present study was twofold: ( 1) to determine whether adolescents who self-identify as multiracial have more adverse health behaviors than their monoracial counterparts, and ( 2) to examine whether the health behaviors of adolescents who are multiracial and Hispanic are more similar to those who identify as monoracial Hispanic or those who are multiracial and non-Hispanic. Methods. Secondary analyses of data in a subsample from the Youth Risk Behavior Survey of 3,704 (27.2%) adolescents who identified as Hispanic/Latino only, multiracial Hispanic, or multiracial non-Hispanic were conducted. Regression analyses were conducted using SUDAAN for the complex sampling to test for differences in health behaviors (i.e., smoking, exercise, substance abuse, and suicide risk) among the three ethnicity/race groups. Results. Each health behavior scale yielded significant between-group differences according to ethnic/racial identity: Hispanic/Latino adolescents scored significantly lower than both multiracial groups on the measure of cigarette smoking, lower than multiracial Hispanic adolescents on the substance abuse scale, and lower than multiracial non-Hispanic adolescents on the measure of exercise. The multiracial Hispanic group was also at marginally increased risk for suicide compared to the Hispanic/Latino group. Conclusions. The results support the hypothesis that multiracial Hispanic adolescents have more behavioral health problems than monoracial Hispanic adolescents. The second hypothesis—that multiracial Hispanic adolescents are more similar to multiracial non-Hispanic adolescents—was also supported. The implications of these findings for the classification of Hispanic adolescents in terms of ethnicity and race in relation to health behaviors are discussed.
Patterns of Intimate Partner Violence and Their Associations with Physical Health, Psychological Distress, and Substance Use
Authors: Carbone-López Kristin , Kruttschnitt Candace , Macmillan Ross 
Published: July 2017

Objectives. The purpose of this work is to formally model patterns of intimate partner violence (IPV) separately for males and females and to assess the unique contributions of different types of violence exposure to health related outcomes. Methods. Using data from the National Violence Against Women Survey—a national probability sample of U.S. men and women—latent class analyses produced a map of the underlying structure of IPV for both males and females that is defined by specific types of violent acts. Multivariable logistic regression analyses assessed the differential physical health, mental health, and substance use consequences of exposure to IPV by gender. Results. Women and men experience similar types of IPV, although the prevalence of the different types of violence is much greater for women than men. Second, exposure to IPV for both women and men is associated with a range of negative health outcomes including increased odds of poor physical health and physical disability, psychological distress and mental illness, and heightened recreational and non-recreational substance use. Finally, there is some evidence that experiences with IPV have stronger and broader associations with negative health outcomes among women, likely reflecting differences in the severity of violence experienced by men and women. Conclusions. More attention to the ways in which interpersonal violence is conceptualized, measured, and screened for is crucial. Specifically, while women have greater exposure to IPV, and subsequently a greater range of health problems, the effects on men should not be ignored.
A Practical Approach to Public Health Surveillance of Violent Deaths Related to Intimate Partner Relationships
Authors: Biroscak Brian J. , Smith Patricia K. , Post Lori A. 
Published: July 2017

Objectives. Articles describing the epidemiology of intimate partner homicide (IPH) have often been positioned as one-time research projects utilizing a single data source for case identification. However, researchers without access to centralized repositories for data pertinent to IPH can ascertain cases by using multiple extant data sources. The authors describe a surveillance system that can serve as a model for state health departments and others seeking to quantify and characterize violent deaths related to intimate partner relationships on an ongoing basis. Methods. Retrospective surveillance was conducted to identify and characterize deaths related to intimate partnerships by linking the following data sources: death certificates, newspaper articles, law enforcement reports, and medical examiners' records. Results. The authors identified at least 34% more IPHs using multiple data sources than would have been recognized solely using Supplementary Homicide Reports—the most frequently cited data source for IPH case ascertainment—and 22% more cases than newspaper data alone would have allowed for. Conclusions. While it was discovered that at least 181 IPHs—and at least 128 other deaths related to intimate partnerships—occurred in Michigan from 1999–2001, this frequency of occurrences is probably conservative. This limitation is due, in part, to the researchers not having access to information from all possible data source contributors. However, in the absence of statewide data systems, the authors demonstrate the utility of using multiple data sources for violent death surveillance to address incomplete case ascertainment.
Changes in Driver Fatality Rates and Vehicle Incompatibility Concurrent with Changes in the Passenger Vehicle Fleet
Authors: Braitman Keli A. , Ferguson Susan A. , Elharam Kamal 
Published: July 2017

Objective. With more sport utility vehicles (SUVs) on the road, public concern has been expressed about their influence on traffic safety. The present study examined changes in the mix of passenger vehicles between 1988 and 2004 and concurrent changes in driver fatality rates and vehicle incompatibility. Method. Vehicle registrations and driver deaths per registered vehicle were examined using data from R.L. Polk and Company and the Fatality Analysis Reporting System. Results. Between 1988 and 2004, SUVs comprised an increasingly larger proportion of registered passenger vehicles (5% of one- to three-year-old vehicles in 1988 vs. 22% in 2004), yet driver deaths per registered vehicle decreased 43% to 47% for all passenger vehicle types. Reductions in driver fatality rates were greater for two-vehicle crashes than for single-vehicle crashes and greater for two-vehicle frontal crashes than for two-vehicle side-impact crashes. Driver death rates declined more on rural roads than on urban roads, and this difference was most pronounced for SUVs. Among cars struck by other vehicles, driver death rates in front-to-front and front-to-side impacts decreased more when the striking vehicle was an SUV than a pickup or car. Conclusions. Factors likely contributing to the overall reductions in fatality rates include advances in occupant protection, increases in average vehicle weight, increased availability of SUVs with car-based designs, and reductions in alcohol-impaired driving. Reductions of driver death rates in two-vehicle collisions between 1988 and 2004 are encouraging, but SUVs and pickups continue to pose a substantially higher risk to drivers of cars than when the striking vehicle is another car.
Development of a Survey Instrument to Measure Connectivity to Evaluate National Public Health Preparedness and Response Performance
Authors: Dorn Barry C. , Savoia Elena , Testa Marcia A. , Stoto Michael A. , Marcus Leonard J. 
Published: July 2017

Objective. Survey instruments for evaluating public health preparedness have focused on measuring the structure and capacity of local, state, and federal agencies, rather than linkages among structure, process, and outcomes. To focus evaluation on the latter, we evaluated the linkages among individuals, organizations, and systems using the construct of “connectivity” and developed a measurement instrument. Methods. Results from focus groups of emergency preparedness first responders generated 62 items used in the development sample of 187 respondents. Item reduction and factors analyses were conducted to confirm the scale's components. Results. The 62 items were reduced to 28. Five scales explained 70% of the total variance (number of items, percent variance explained, Cronbach's alpha) including connectivity with the system (8, 45%, 0.94), coworkers (7, 7%, 0.91), organization (7, 12%, 0.93), and perceptions (6, 6%, 0.90). Discriminant validity was found to be consistent with the factor structure. Conclusion. We developed a Connectivity Measurement Tool for the public health workforce consisting of a 34-item questionnaire found to be a reliable measure of connectivity with preliminary evidence of construct validity.
Assessment of Missing Immunizations and Immunization-Related Barriers among WIC Populations at the Local Level
Authors: Ghosh Tista S. , Patnaik Jennifer L. , Bennett Anne , Trefren Lynn , Vogt Richard L. 
Published: July 2017

Objective. Low childhood immunization rates have been a challenge in Colorado, an issue that was exacerbated by a diphtheria-tetanus-acellular pertussis (DTaP) vaccine shortage that began in 2001. To combat this shortage, the locally based Tri-County Health Department conducted a study to assess immunization-related barriers among children in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), a population at risk for undervaccination. Methods. This study assessed characteristics and perceptions of WIC mothers in conjunction with their children's immunization status in four clinics. Results. Results indicated poor immunization rates, which improved with assessment and referral. The uninsured were at higher risk for undervaccination. DTaP was the most commonly missing vaccine, and discrepancies existed between the children's perceived and actual immunization status, particularly regarding DTaP. Targeted interventions were initiated as a result of this study. Conclusion. Local health departments should target immunization-related interventions by assessing their own WIC populations to identify unique vaccine-related deficiencies, misperceptions, and high-risk subpopulations.
Fetal Death Certificates as a Source of Surveillance Data for Stillbirths with Birth Defects
Authors: Duke C. Wes , Alverson C.J. , Correa Adolfo 
Published: July 2017

Objective. We assessed fetal death certificates (FDCs) as a source of surveillance for stillbirths with birth defects by linkage with data from the Metropolitan Atlanta Congenital Defects Program (MACDP), a population-based birth defects surveillance system. Methods. Stillbirths with defects in MACDP were identified from 1994 through 2002 and linked to FDCs. Sensitivity of FDCs for capturing stillbirths with defects was estimated, and predictors for a case being reported were assessed. Concordance for selected variables from each data source was evaluated. Results. Two hundred twenty-four of 257 stillbirths with birth defects in MACDP were linked to an FDC (linkage rate 5 87.2%; 95% confidence interval [CI] 82.4, 91.0). Stillbirths of non-Hispanic black and Hispanic/other mothers were more likely to be issued an FDC (odds ratio [OR] 5 5.6 [95% CI 1.9, 17.0] and 14.0 [95% CI 1.7, 114.0], respectively). Cases undergoing autopsy were more likely to be issued an FDC (OR53.2; 95% CI 1.1, 8.7). Performance of an amniocentesis was poorly recorded on FDCs. The sensitivity and positive predictive value of FDCs for selected classes of defects ranged from 10% to 70% and 25% to 93%, respectively. Conclusions. Compared to FDCs, MACDP's active case identification improves the ascertainment of stillbirths with birth defects and the quality of certain recorded data.
Evaluation Findings from the Institute for Public Health and Faith Collaborations
Authors: Kegler Michelle Crozier , Kiser Mimi , Hall Sarah M. 
Published: July 2017

Objective. The Institute for Public Health and Faith Collaborations sought to cultivate boundary leadership to strengthen collaboration across religious and health sectors to address health disparities. This article presents findings from an evaluation of the Institute and its impact on participating teams of faith and public health leaders. Methods. Self-administered surveys were completed by participating team members ( n=243) immediately post-Institute. Semistructured telephone interviews were conducted with at least one health and one faith leader per team six to eight months after the Institute. Results. Significant self-reported improvement occurred for all short-term outcomes assessed, with the largest increases in describing organizational frames and why they are important for community change, and understanding the role of boundary leaders in community systems change. Six months after the Institute, participants spoke of inspiration, team building, and understanding their own leadership strengths as important outcomes. Leadership growth centered on functioning in groups, making a change in their work, a renewed faith in self, and a renewed focus on applying themselves to faith/health work. Top team accomplishments included planning or implementing a program or event, or solidifying or sustaining a collaborative structure. The majority felt they were moving in the right direction to reduce health disparities, but had not yet made an impact. Conclusions. Results suggest the Institute played a role in helping to align faith and health assets in many of the participating teams.