Determinants of undernutrition among homeless adults.

Factors associated with undernutrition were investigated in a broad community-based sample of 457 homeless adults (344 men and 113 women) who were interviewed and examined in a variety of settings during the summer of 1985. Latent variables representing drug use, alcohol use, a stereotyped homeless appearance, mental illness, poor physical health status, and measured variables of age, sex, income, and number of free food sources were used as predictors of undernutrition. Undernutrition was indicated with three anthropometric measures (weight, triceps skinfold, and upper arm muscle area in the lowest 15th percentile) and one observational measure. Thirty-three percent of the sample was undernourished as defined by at least one of the anthropometric measures. Undernutrition was significantly associated with more drug use, fewer free food sources, less income, and male sex. The findings identify persons at risk for undernutrition and suggest programs to alleviate their hunger, including increased funding for food stamps and other income supports, more free food sources such as shelters and souplines, and drug treatment programs.     

Differential mortality among semiskilled applicants of disability pension

The mortality experience among 4,440 applicants for disability pension has been examined during a period of observation of ten years. All applicants were males and had been member of the Danish Semiskilled Workers' Union. The reference group consists of age matched male members of the same union. The applicants for disability pension experienced a considerable excess mortality when compared with the reference group. The higher mortality risk is still present more than ten years after the application has been settled. The persons who were refused disability pension experienced an elevated mortality, too. In opposition to previous studies it is not found informative to put forward a common estimate of the elevated mortality rate because the group of disability applicants is very heterogeneous concerning their mortality experience; the excess mortality is most elevated among persons granted the high level pension, among the youngest, and during the period closest to the award.     

Determinants of delayed pregnancy testing among adolescents.

BACKGROUND. Pregnant teenagers often prolong the interval between suspecting and confirming that they are pregnant. Prior studies suggest a number of potential determinants for this delay but do not specify which ones are most salient. METHODS. In a cross-sectional survey, 123 pregnant teenagers, 64 of whom maintained their pregnancies and 59 of whom had abortions, completed a short version of the Center for Epidemiologic Studies Depression Scale, the Family APGAR test, and a study-specific questionnaire. RESULTS. Significant bivariate determinants of delayed pregnancy testing included young maternal age, black race, lower educational attainment, lack of pregnancy symptoms, continuing the pregnancy, and denial. Only denial, however, retained a significant net effect on delayed testing (P < .05) when the effects of these six variables were modeled using multiple linear regression. CONCLUSIONS. These results suggest that psychological barriers are the most salient determinants of delayed pregnancy testing among the teenagers surveyed in this study. Some teenagers may not volunteer information about a suspected pregnancy. Providers, therefore, should directly question teenagers about sexual activity and discuss the importance of early testing when pregnancy is suspected. Findings also suggest further research that would increase understanding of adolescent health behavior in pregnancy and identify effective clinical and educational interventions.     

福建口岸2004年赴美移民预防接种情况分析

目的为以后更好的开展赴美移民预防接种工作打下基础。方法对2004年福建国际旅行卫生保健中心赴美移民预防接种情况进行回顾分析。结果2004年共为10999位赴美移民进行了预防接种,其中以中、青年和女性占较大比例。各年龄段的性别构成有差异。共接种30604针次,不良反应占0．26％,开具的禁忌证明中药物过敏居多数。结论做好移民接种工作咨询与评估,提高预防接种技术,加强赴美移民预防接种工作管理,是保障移民预防接种工作不断深入开展的关键和重要措施。     

Increasing Medicaid enrollment among formerly incarcerated adults

ObjectiveTo estimate the incremental associations between the implementation of expanded Medicaid eligibility and prerelease Medicaid enrollment assistance on Medicaid enrollment for recently incarcerated adults.Data Sources/Study SettingData include person‐level merged, longitudinal data from the Wisconsin Department of Corrections and the Wisconsin Medicaid program from 2013 to 2015.Study DesignWe use an interrupted time series design to estimate the association between each of two natural experiments and Medicaid enrollment for recently incarcerated adults. First, in April 2014 the Wisconsin Medicaid program expanded eligibility to include all adults with income at or below 100% of the federal poverty level. Second, in January 2015, the Wisconsin Department of Corrections implemented prerelease Medicaid enrollment assistance at all state correctional facilities.Data Collection/Extraction MethodsWe collected Medicaid enrollment, and state prison administrative and risk assessment data for all nonelderly adults incarcerated by the state who were released between January 2013 and December 2015. The full sample includes 24 235 individuals. Adults with a history of substance use comprise our secondary sample. This sample includes 12 877 individuals. The primary study outcome is Medicaid enrollment within the month of release.Principal FindingsMedicaid enrollment in the month of release from state prison grew from 8 percent of adults at baseline to 36 percent after the eligibility expansion (P‐value < .01) and to 61 percent (P‐value < .01) after the introduction of enrollment assistance. Results were similar for adults with a history of substance use. Black adults were 3.5 percentage points more likely to be enrolled in Medicaid in the month of release than White adults (P‐value < .01).ConclusionsMedicaid eligibility and prerelease enrollment assistance are associated with increased Medicaid enrollment upon release from prison. States should consider these two policies as potential tools for improving access to timely health care as individuals transition from prison to community.     

Determinants of needle sharing among intravenous drug users.

Data from 110 IV-drug abusing persons in methadone maintenance were analyzed to determine the correlates of needle sharing. Sharing was directly related to peer group behavior, attitudes conducive to sharing, economic motivation to share, not owning injection equipment, and fatalism about developing AIDS. Sharers were aware of their AIDS risk. Indicated measures to reduce needle sharing would be positive peer support groups to help resist pressures to share, legal and free access to fresh injection equipment, education on the utility of risk reduction, and increased treatment options for IV cocaine users.     

Determinants of HIV risk among Indian truck drivers.

Although there are very high levels of HIV risk sexual behavior in India, there has been little research on the determinants of this behavior, the psychosocial correlates of condom use, or the potential for effective behavior change interventions. The present research used the information-motivation-behavioral skills model of HIV risk behavior to explore these issues in a sample of Indian truck drivers, a population that comprises an important vector of HIV transmission. This paper presents correlational data on the predictors of HIV risk and preventive behavior in a sample of truck drivers in Chennai, India. The data were collected via detailed individual structured interviews with 300 Indian truck drivers. Results indicated that Indian truck drivers had substantial deficits with respect to HIV prevention information, motivation, and behavioral skills. Consistent with the IMB model, these deficits were often found to be predictive of HIV risk and preventive behavior. The implications of these findings for future intervention are discussed.     

Determinants of lung cancer risk among cadmium-exposed workers.

Workers at a cadmium recovery plant in Globe, Colorado, showed an increased risk of lung cancer, which some investigators have attributed to cadmium exposure. We conducted a cohort mortality analysis of this work force and a case-control analysis of the lung cancer cases within this work force in order to assess the probable causes of the lung cancer excess. The Globe plant began as a lead smelter about 1886, switched to arsenic production in 1920, and became a cadmium metal production facility in 1926. Cadmium, arsenic, and cigarette smoking are three potential lung carcinogens found in this workplace. Industrial hygiene data collected from 1943 onward served as the basis for the National Institute for Occupational Safety and Health (NIOSH)-derived exposure algorithm that assigned cadmium exposure estimates to employees based on their work area in the plant and calendar time. Few exposure data existed for substances other than cadmium. Feedstock ore concentrations were used as a surrogate measure of air arsenic levels. The arsenic content of the fines used as feedstock prior to 1940 was considerably higher than that of the fines used after 1940. Smoking histories had been obtained previously for 45% of the workers. A case-control analysis of the 25 cases of lung cancer known to have occurred among these workers through 1982 was conducted using three controls per case, matched by closest data of hire and age at hire. Potential causal agents for lung cancer included cadmium exposure, cigarette smoking, and arsenic exposure. Exposure variables for each case and control included estimated cumulative cadmium exposure in milligram-years per cubic meter, cigarette smoking history, and plant arsenic exposure status at the time of hire. Estimated cumulative cadmium exposures of cases and controls did not differ overall or within the date-of-hire strata. Cases were more than eight times more likely to have been cigarette smokers than were controls. Lung cancer risk in this workplace was more closely related to the period of hire, not to the cumulative cadmium exposure. The period of hire appears to be a surrogate for arsenic exposure as related to feedstock. The measures used here seem to indicate that exposure to arsenic and cigarette particulates, rather than to cadmium particulates, may have caused the increased rate of lung cancer of these workers.     

Occupational impairment and disability among applicants for Social Security disability benefits in Pennsylvania.

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.