bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of Restricting Opening Hours on Alcohol-Related Violence
Authors: Duailibi Sergio , Ponicki William , Grube Joel , Pinsky Ilana , Laranjeira Ronaldo , Raw Martin 
Published: October 2007

Objective. We investigated whether limiting the hours of alcoholic beverage sales in bars had an effect on homicides and violence against women in the Brazilian city of Diadema. The policy to restrict alcohol sales was introduced in July 2002 and prohibited on-premises alcohol sales after 11 pm. Methods. We analyzed data on homicides (1995 to 2005) and violence against women (2000 to 2005) from the Diadema (population 360 000) police archives using log-linear regression analyses. Results. The new restriction on drinking hours led to a decrease of almost 9 murders a month. Assaults against women also decreased, but this effect was not significant in models in which we controlled for underlying trends. Conclusions. Introducing restrictions on opening hours resulted in a significant decrease in murders, which confirmed what we know from the literature: restricting access to alcohol can reduce alcohol-related problems. Our results give no support to the converse view, that increasing availability will somehow reduce problems.
The Veterans Health Administration and Military Sexual Trauma
Authors: Kimerling Rachel , Gima Kristian , Smith Mark W. , Street Amy , Frayne Susan 
Published: October 2007

Objectives. We examined the utility of the Veterans Health Administration (VHA) universal screening program for military sexual violence. Methods. We analyzed VHA administrative data for 185 880 women and 4139888 men who were veteran outpatients and were treated in VHA health care settings nationwide during 2003. Results. Screening was completed for 70% of patients. Positive screens were associated with greater odds of virtually all categories of mental health comorbidities, including posttraumatic stress disorder (adjusted odds ratio [AOR]=8.83; 99% confidence interval [CI] = 8.34, 9.35 for women; AOR = 3.00; 99% CI = 2.89, 3.12 for men). Associations with medical comorbidities (e.g., chronic pulmonary disease, liver disease, and for women, weight conditions) were also observed. Significant gender differences emerged. Conclusions. The VHA policies regarding military sexual trauma represent a uniquely comprehensive health care response to sexual trauma. Results attest to the feasibility of universal screening, which yields clinically significant information with particular relevance to mental health and behavioral health treatment. Women’s health literature regarding sexual trauma will be particularly important to inform health care services for both male and female veterans.
Comparing Diabetes Prevalence Between African Americans and Whites of Similar Socioeconomic Status
Authors: Signorello Lisa B. , Schlundt David G. , Cohen Sarah S. , Steinwandel Mark D. , Buchowski Maciej S. , McLaughlin Joseph K. , Hargreaves Margaret K. , Blot William J. 
Published: October 2007

Objectives. We investigated whether racial disparities in the prevalence of type 2 diabetes exist beyond what may be attributable to differences in socioeconomic status (SES) and other modifiable risk factors. Methods. We analyzed data from 34331 African American and 9491 White adults aged 40 to 79 years recruited into the ongoing Southern Community Cohort Study. Participants were enrolled at community health centers and had similar socioeconomic circumstances and risk factor profiles. We used logistic regression to estimate the association between race and prevalence of self-reported diabetes after taking into account age, SES, health insurance coverage, body mass index, physical activity, and hypertension. Results. Multivariate analyses accounting for several diabetes risk factors did not provide strong support for higher diabetes prevalence rates among African Americans than among Whites (men: odds ratio [OR]=1.07; 95% confidence interval [CI]=0.95, 1.20); women: OR=1.13, 95% CI=1.04, 1.22). Conclusions. Our findings suggest that major differences in diabetes prevalence between African Americans and Whites may simply reflect differences in established risk factors for the disease, such as SES, that typically vary according to race.
Concurrent Sexual Partnerships Among Men in the United States
Authors: Adimora Adaora A. , Schoenbach Victor J. , Doherty Irene A. 
Published: October 2007

Objectives. We sought to determine the prevalence, distribution, and correlates of US men’s involvement in concurrent sexual partnerships, a sexual network pattern that speeds population dissemination of HIV. Methods. For this analysis, we compared sexual partnership dates of 4928 male respondents in the 2002 National Survey of Family Growth to determine the prevalence of concurrent sexual partnerships and evaluated associations between concurrency and demographic risk characteristics. Results. Approximately 11% of men had concurrent sexual partnerships during the preceding year. Concurrency was associated with being unmarried (odds ratio [OR] = 4.59; 95% confidence interval [CI] = 2.54, 8.29), non-Hispanic Black (OR=2.56; 95% CI=1.61, 4.07) or Hispanic (OR=2.25; 95% CI=1.32, 3.85) race/ethnicity, and incarceration during the past year (OR=2.10; 95% CI=1.18, 3.74). Men with concurrent sexual partnerships were also more likely to report drug or alcohol intoxication during sexual intercourse (OR=2.10; 95% CI=1.37, 3.21), nonmonogamous female sexual partners (OR=6.11; 95% CI=4.10, 9.11), and history of sexual intercourse with a man (OR = 1.93; 95% CI = 1.09, 3.42), than those without concurrent partnerships. Conclusions. The higher concurrency prevalence in various groups, dense sexual networks, and mixing between high-risk subpopulations and the general population may be important factors in the US epidemic of heterosexual HIV infection.
An Exploration of Urban and Rural Differences in Lung Cancer Survival Among Medicare Beneficiaries
Authors: Shugarman Lisa R. , Sorbero Melony E.S. , Tian Haijun , Jain Arvind K. , Ashwood J. Scott 
Published: October 2007

Objectives. We tested the relationship between urban or rural residence as defined by rural–urban commuting area codes and risk of mortality in a sample of Medicare beneficiaries with lung cancer. Methods. We used Surveillance, Epidemiology, and End Results data linked with Medicare claims to build proportional hazards models. The models tested hypothesized relationships between individual and community characteristics and overall survival for a cohort of Medicare beneficiaries 65 years and older who were diagnosed with lung cancer between 1995 and 1999 (N=26073). Results. We found no evidence that lung cancer patients in rural areas have poorer survival than those in urban areas. Rather, individual (Medicaid coverage) and regional (lower census tract–level median income) socioeconomic factors and a smaller supply of subspecialists per 10000 individuals 65 years and older were positively associated with a higher risk of mortality. Conclusions. Although urban versus rural residence did not directly influence survival, rural residents were more likely to live in poorer areas with a smaller supply of health care providers. Therefore, we still need to be aware of rural beneficiaries’ potential disadvantage when it comes to receiving needed care in a timely fashion.
Performance Measures, Vaccinations, and Pneumonia Rates Among High-Risk Patients in Veterans Administration Health Care
Authors: Jha Ashish K. , Wright Steven M. , Perlin Jonathan B. 
Published: October 2007

Objectives. Influenza and pneumococcal vaccinations reduce morbidity, mortality, and health care costs, but their use lags behind goals set by public health experts. We evaluated the effect of a performance measurement program instituted by the Veterans Health Administration in 1995 to improve vaccination rates. Methods. We used cross-sectional chart-abstracted data to calculate influenza and pneumococcal vaccination rates among eligible patients, and administrative data to calculate pneumonia admission rates. We compared vaccination and hospitalization rates before and after the institution of the performance measurement program with rates outside the Veterans Health Administration. Results. Influenza and pneumococcal vaccination rates for eligible patients rose from 27% and 28% during 1994 to 1995 to 70% and 85%, respectively, by 2003 (P for trend<.001). Geographic and other variations were substantially reduced. During this time, pneumonia hospitalization rates decreased by 50% among elderly Veterans Health Administration enrollees but increased among Medicare enrollees by 15% (P for differences in trend<.001). Conclusions. The performance measurement program was associated with increases in vaccination rates, reduced variation, and reduced pneumonia admissions. Health systems instituting similarly effective programs may substantially improve the quality of their clinical health care.
Alcohol Consumption and Posttraumatic Stress After Exposure to Terrorism: Effects of Proximity, Loss, and Psychiatric History
Authors: Hasin Deborah S. , Keyes Katherine M. , Hatzenbuehler Mark L. , Aharonovich Efrat A. , Alderson Donald 
Published: October 2007

Objectives. We examined the effects of exposure to or interpersonal loss resulting from a terrorist attack on posttraumatic stress and alcohol consumption after we controlled for psychiatric history assessed before the attack. Methods. At baseline (1991–1992) and at 1- and 10-year follow-ups, an adult community sample of drinkers living approximately 12 mi (19.2 km) from the World Trade Center were evaluated for alcohol dependence and major depression. Of this group, 82.2% were assessed regarding the impact of the September 11, 2001, attacks, including proximity to the World Trade Center, interpersonal loss, posttraumatic stress, and alcohol consumption. Results. In regression models, interpersonal loss and past major depression, but not proximity to the World Trade Center, predicted posttraumatic stress symptoms. Proximity and past alcohol dependence, but not interpersonal loss, predicted high levels of post–September 11 alcohol consumption. Past alcohol dependence did not modify the proximity–drinking relationship, and past major depression did not modify the loss–posttraumatic stress relationship. Conclusions. Participants’ responses to September 11 were specific to their type of exposure and not predetermined by their psychiatric history. A better understanding of responses to traumatic events should assist more-effective prevention and intervention efforts.
Factors Associated With Patients Who Leave Acute-Care Hospitals Against Medical Advice
Authors: Ibrahim Said A. , Kwoh C. Kent , Krishnan Eswar 
Published: October 2007

Objectives. We examined hospital- and patient-related factors associated with discharge against medical advice (termed self-discharge) after emergency admission to acute-care hospitals. Methods. We analyzed data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project using logistic regression models to assess the relationship between self-discharge and a set of patient and hospital characteristics. Results. Of 3 039 050 discharges in the sample, 43 678 were against medical advice (1.44%). In multivariable modeling, predictors of self-discharge included having Medicaid insurance (adjusted odds ratio [AOR]=3.32; 95% confidence interval [CI]=3.22, 3.42), having Medicare insurance (AOR=1.64; 95% CI=1.59, 1.70), urban location (AOR=1.66; 95% CI=1.61, 1.72), medium (AOR=1.25; 95% CI=1.20, 1.29) or large (AOR=1.08, 95% CI=1.05, 1.12) hospital (defined by the number of beds), shorter hospital stay (OR=0.84; 95% CI=0.84, 0.85), and African American race (AOR=1.10; 95% CI=1.07, 1.14). Teaching hospitals had fewer self-discharges (AOR=0.90; 95% CI=0.88, 0.92). Other predictors of discharge against medical advice included age, gender, and income. Conclusions. Approximately 1 in 70 hospital discharges in the United States are against medical advice. Both hospital and patient characteristics were associated with these decisions.
Prevalence of Substance Use Disorders Among African Americans and Caribbean Blacks in the National Survey of American Life
Authors: Broman Clifford L. , Neighbors Harold W. , Delva Jorge , Torres Myriam , Jackson James S. 
Published: October 2007

Objectives. We sought to estimate the prevalence of substance disorders for African Americans and Caribbean Blacks in the United States using data from the National Survey of American Life. Methods. A national household probability sample of noninstitutionalized African Americans (n=3570) and Caribbean Blacks (n=1621) was obtained between February 2001 and June 2003 using a slightly modified version of the Composite International Diagnostic Interview. Results. Overall differences in prevalence of substance disorders between the ethnic groups were not significant. Prevalence rates of substance disorders among African Americans exceeded that of Caribbean Blacks among women, those aged 45 to 59 years, and those who were divorced. African Americans in major metropolitan areas had higher prevalence rates, and those in the South had lower ones, compared with those living in other areas. Overall, first-generation Caribbean Blacks were significantly less likely, but second-generation more likely, than were African Americans to meet criteria for overall substance disorders. Conclusions. Failure to distinguish between African Americans and Caribbean Blacks masks important differences in substance use patterns among the Black population in the United States.
Racial/Ethnic Differences in the Development of Disability Among Older Adults
Authors: Dunlop Dorothy D. , Song Jing , Manheim Larry M. , Daviglus Martha L. , Chang Rowland W. 
Published: October 2007

Objectives. We investigated differences in the development of disability in activities of daily living among non-Hispanic Whites, African Americans, Hispanics interviewed in Spanish, and Hispanics interviewed in English.Methods. We estimated 6-year risk for disability development among 8161 participants 65 years or older and free of baseline disability. We evaluated mediating factors amenable to clinical and public health intervention on racial/ethnic difference.Results. The risk for developing disability among Hispanics interviewed in English was similar to that among Whites (hazard ratio [HR]=0.99; 95% confidence interval [CI] = 0.6, 1.4) but was substantially higher among African Americans (HR=1.6; 95% CI=1.3, 1.9) and Hispanics interviewed in Spanish (HR=1.8; 95% CI=1.4, 2.1). Adjustment for demographics, health, and socioeconomic status reduced a large portion of those disparities (African American adjusted HR=1.1, Spanish-interviewed Hispanic adjusted HR=1.2).Conclusions. Higher risks for developing disability among older African Americans, and Hispanics interviewed in Spanish compared with Whites were largely attenuated by health and socioeconomic differences. Language- and culture-specific programs to increase physical activity and promote weight maintenance may reduce rates of disability in activities of daily living and reduce racial/ethnic disparities in disability.
Lack of Health Coverage Among US Veterans From 1987 to 2004
Authors: Himmelstein David U. , Lasser Karen E. , McCormick Danny , Bor David H. , Boyd J. Wesley , Woolhandler Steffie 
Published: October 2007

Objectives. Veterans Administration health care enrollment is restricted to veterans with service-connected problems and those who are poor. We sought to determine how many veterans were uninsured, trends in veterans’ coverage, and whether uninsured veterans lacked access to medical care. Methods. We analyzed annual data from 2 federal surveys, the Current Population Survey for the years 1988 to 2005 and the National Health Interview Survey for 2002 to 2004. Results. Nearly 1.8 million veterans were uninsured and not receiving Veterans Administration care in 2004. The proportion of working-age veterans lacking coverage peaked in 1993 at 14.2%, fell to 9.9% in 2000, and rose steadily to 12.7% in 2004. Uninsured veterans had substantial access problems; 51.4% had no usual source of care (vs 8.9% of insured veterans), and 26.5% reported failing to get needed care because of the cost (vs 4.3% of insured veterans). Conclusions. Many US veterans are uninsured and lack adequate access to health care. Expanded funding for veterans’ care is urgently needed; only national health insurance could guarantee coverage to both veterans and their family members.
Cognitive Function and Dental Care Utilization Among Community-Dwelling Older Adults
Authors: Wu Bei , Plassman Brenda L. , Liang Jersey , Wei Liang 
Published: October 2007

Objectives. We sought to investigate the relationship between varying levels of cognitive function and dental care utilization. Methods. Using data obtained from the National Health and Nutrition Examination Survey (1999–2002), we performed weighted descriptive and multivariate logistic regression analyses on 1984 individuals with at least 1 tooth and who were 60 years and older. Results. Multivariate analyses suggested that level of cognitive function was associated with dental care utilization. At a higher level of cognitive functioning, individuals were more likely to have had more frequent dental visits. In addition, a higher level of socioeconomic status, healthy lifestyle, and worse self-rated oral health–related symptoms were more likely to indicate a higher frequency of dental care utilization. By contrast, poorer oral health status as determined by clinical examinations was negatively associated with frequency of dental visits. Conclusions. The results suggest that community-dwelling older adults with low cognitive function are at risk for less frequent use of dental care. Oral health serves as a mediating factor between cognitive function and dental care utilization. There is a great need to improve oral health awareness and education among older adults, caregivers, and health care professionals.
Prevalence of HIV Infection Among Inpatients and Outpatients in Department of Veterans Affairs Health Care Systems: Implications for Screening Programs for HIV
Authors: Owens Douglas K. , Sundaram Vandana , Lazzeroni Laura C. , Douglass Lena R. , Sanders Gillian D. , Taylor Kathie , VanGroningen Ronald , Shadle Vera M. , McWhorter Valerie C. , Agoncillo Teodora , Haren Noreen , Nyland Jill , Tempio Patricia , Khayr Walid , Dietzen Dennis J. , Jensen Peter , Simberkoff Michael S. , Bozzette Samuel A. , Holodniy Mark 
Published: October 2007

Objectives. We sought to determine the prevalence of HIV in both inpatient and outpatient settings in 6 Department of Veterans Affairs (VA) health care sites. Methods. We collected demographic data and data on comorbid conditions and then conducted blinded, anonymous HIV testing. We conducted a multivariate analysis to determine predictors of HIV infection. Results. We tested 4500 outpatient blood specimens and 4205 inpatient blood specimens; 326 (3.7%) patients tested positive for HIV. Inpatient HIV prevalence ranged from 1.2% to 6.9%; outpatient HIV prevalence ranged from 0.9% to 8.9%. Having a history of hepatitis B or C infection, a sexually transmitted disease, or pneumonia also predicted HIV infection. The prevalence of previously undocumented HIV infection varied from 0.1% to 2.8% among outpatients and from 0.0% to 1.7% among inpatients. Conclusions. The prevalence of undocumented HIV infection was sufficiently high for routine voluntary screening to be cost effective in each of the 6 sites we evaluated. Many VA health care systems should consider expanded routine voluntary HIV screening.
Use of Preventive Care by Elderly Male Veterans Receiving Care Through the Veterans Health Administration, Medicare Fee-for-Service, and Medicare HMO Plans
Authors: Keyhani Salomeh , Ross Joseph S. , Hebert Paul , Dellenbaugh Cornelia , Penrod Joan D. , Siu Albert L. 
Published: October 2007

Objectives. We compared use of preventive care among veterans receiving care through the Veterans Health Administration (VHA), Medicare fee-for-service (FFS) plans, and Medicare health maintenance organizations (HMOs). Methods. Using both the Costs and Use, and Access to Care files of the Medicare Current Beneficiary Survey (2000–2003), we performed a cross-sectional analysis examining self-reported use of influenza vaccination, pneumococcal vaccination, serum cholesterol screening, and serum prostate-specific antigen measurement among male veterans 65 years or older. Veterans’ care was categorized as received through VHA, Medicare FFS, Medicare HMOs, VHA and Medicare FFS, or VHA and Medicare HMOs. Results. Veterans receiving care through VHA reported 10% greater use of influenza vaccination (P<.05), 14% greater use of pneumococcal vaccination (P<.01), a nonsignificant 6% greater use of serum cholesterol screening (P=.1), and 15% greater use of prostate cancer screening (P<.01) than did veterans receiving care through Medicare HMOs. Veterans receiving care through Medicare FFS reported less use of all 4 preventive measures (P<.01) than did veterans receiving care through Medicare HMOs. Conclusions. Receiving care through VHA was associated with greater use of preventive care.
Reducing Avoidable Deaths Among Veterans: Directing Private-Sector Surgical Care to High-Performance Hospitals
Authors: Weeks William B. , West Alan N. , Wallace Amy E. , Lee Richard E. , Goodman David C. , Dimick Justin B. , Bagian James P. 
Published: October 2007

Objectives. We quantified older (65 years and older) Veterans Health Administration (VHA) patients’ use of the private sector to obtain 14 surgical procedures and assessed the potential impact of directing that care to high-performance hospitals. Methods. Using a merged VHA–Medicare inpatient database for 2000 and 2001, we determined where older VHA enrollees obtained 6 cardiovascular surgeries and 8 cancer resections and whether private-sector care was obtained in high- or low-performance hospitals (based on historical performance and determined 2 years in advance of the service year). We then modeled the mortality and travel burden effect of directing private-sector care to high-performance hospitals. Results. Older veterans obtained most of their procedures in the private sector, but that care was equally distributed across high- and low-performance hospitals. Directing private-sector care to high-performance hospitals could have led to the avoidance of 376 to 584 deaths, most through improved cardiovascular care outcomes. Using historical mortality to define performance would produce better outcomes with lower travel time. Conclusions. Policy that directs older VHA enrollees’ private-sector care to high-performance hospitals promises to reduce mortality for VHA’s service population and warrants further exploration.