Reliability of Birth Certificate Data: A Multi-Hospital Comparison to Medical Records Information

Objective: To examine the reliability of birth certificate data and determine if reliability differs between teaching and nonteaching hospitals. Methods: We compared information from birth certificates and medical records in 33,616 women admitted for labor and delivery in 1993–95 to 20 hospitals in Northeast Ohio. Analyses determined the agreement for 36 common data elements, and the sensitivity, specificity, and positive and negative predictive values of birth certificate data, using medical record data as a gold standard. Results: Sensitivity and positive predictive value varied widely (9–100% and 2–100%, respectively), as did agreement, which was almost perfect for measures of prior obstetrical history, delivery type, and infant Apgar score ( = 0.854–0.969) and substantial for several other variables (e.g., tobacco use ( = 0.766), gestational age ( = 0.726), prenatal care ( = 0.671)). However, agreement was only slight to moderate for most maternal risk factors and comorbidities ( = 0.085–0.545) and for several complications of pregnancy and/or labor and delivery ( = 0.285–0.734). Overall agreement was similar in teaching (mean = 0.51) and nonteaching ( = 0.52) hospitals. Although agreement in teaching and nonteaching hospitals varied for some variables, no systematic differences were seen across types of variables. Conclusions: Our findings indicate that the reliability of birth certificate data vary for specific elements. Researchers and health policymakers need to be cognizant of the potential limitations of specific data elements.     

Air-borne B. subtilis enzymes in the detergent industry

Summary Air-borne dust was collected on stationary and portable filters in two factories producing biological detergents. In one factory (Factory A) the detergent base was mixed with enzyme (subtilisin) powder, and the handling of the enzyme was done without effective protection. In the other factory (Factory B) the enzyme was encapsulated in granules before mixing the with detergent base, and the production line was shielded to prevent the spread of dust.Both the amount of air-borne dust and the relative enzyme activity of the dust were greater in Factory A than in Factory B in spite of the considerably larger production of enzyme detergents in the latter factory. The workers studied in Factory A were, on the average, exposed to 5.4 GU (glycine units) per cubic millimetre in their breathing zones, and those studied in Factory B were exposed to enzyme activities about and below 1 GU/m³.Based on exposure measurements and medical examination of the exposed workers, a time-weighted hygienic limit value for subtilisins of 1 GU/m³ is proposed.     

Assertive/leveling communication and empathy in adolescent drug abuse prevention

This paper presents the feelings reported by 5th, 6th, 7th and 8th graders when role playing situations in which they wanted to say no to alcohol/drugs or to talk to a friend who was using. These role plays were part of SAY IT STRAIGHT (SIS) training, which was described in the preceding paper. Youngsters described themselves as feeling good and having high self-respect/esteem only when they said no in an assertive/leveling way. Only youngsters toward whom an assertive/leveling no was addressed described themselves as surprised/shocked and respectful of the person who was saying no. Finally, youngsters reported that the most effective way to convince a friend to quit using and/or get help was to express caring and friendship, and to touch the friend rather than being aggressive/blaming, irrelevant or super-reasonable. This feedback from youngsters opens conceptual issues relevant to some assertiveness training and drug abuse prevention programs.The authors thank Kevin Miller and Antoinette Bradley for their help on the project.This research was supported in part by the Oklahoma Department of Mental Health, Contract # N200073.     

Percutaneous absorption of N,N-dimethylformamide in humans

Summary Skin penetration fo N,N-dimethylformamide (DMF) liquid or vapour was studied in volunteers. Exposure to liquid DMF was performed in two ways: in a dipping experiment, one hand was dipped up to the wrist in DMF for 2–20 min, while in a patch experiment, 2 mmol DMF was applied to the skin and allowed to be absorbed completely. The period of exposure to DMF vapour (50 mg · m^–3) was 4 h. The DMF metabolites N-hydroxymethyl-N-methylformamide (MF), N-hydroxymethylformamide (F), and N-acetyl-S-(N-methylcarbamoyl)cysteine (AMCC) were monitored in the urine. Liquid DMF was absorbed through the skin at a rate of 9.4 mg · cm^–2 · h^–1. Percutaneous absorption of DMF vapour depended strongly on ambient temperature and humidity and accounted for 13%–36% of totally excreted MF. The results suggest that skin absorption of liquid DMF is likely to contribute to occupational exposure substantially more than penetration of DMF vapour. The yield of metabolites after transdermal DMF absorption was only half of that seen after pulmonary absorption. Elimination of MF and F but not that of AMCC was delayed, which supports the contention that AMCC should be used instead of MF as the most suitable biomarker of DMF in cases where percutaneous intake can occur.     

Managed Care and Prevention of Mental Health and Substance Abuse Problems: Opportunities for Growth Through Collaboration in the New Millennium

Mental health and substance abuse problems impose significant direct and indirect costs on society, yet an increasing number of effective preventive interventions have been identified in the field of behavioral health. Using the Institute of Medicine's Continuum of Care model of prevention, we examine the evolution and future prospects of prevention in the managed care environment. Specific barriers and opportunities for expanding prevention efforts are discussed.     

“In vitro” measurements of spontaneous smooth muscle contractions: A screening method for “invivo” exposure

Conclusion The in vitro recording of spontaneous contractions was selected as a neuromuscular screening method for in vivo exposure to pollutants. The rate of contraction was determined by interval histogram measurements. The method was assessed for effects of age, sex, pH, Ca⁺⁺ concentration, temperature, and circadian rhythm. Male rats were shown to develop a slower rate of contraction with age. The rate of contraction was temperature and pH dependent. An effect was demonstrated for in vivo exposure to Baygon and Carbaryl at a level which did not produce overt symptoms.     

The Effect of Implementing a More Comprehensive Screening for Substance Use Among Pregnant Women in North Carolina

Objectives: Substance use during pregnancy causes significant morbidity and mortality.Screening for substance use provides opportunity for intervention and treatment, but is often overlooked in prenatal care with today's fiscal climate and preconceived ideas about who uses substances. The purpose of this study was to determine the effect of implementing a more comprehensive screening procedure for identifying substance-using pregnant women. Methods: Two hundred randomly selected prenatal patients screened using the old procedure for substance use during pregnancy were compared to 400 randomly selected patients screened after implementation of a new, more detailed screening procedure. The old screening approach included three check-boxes concerning substance use during pregnancy: one for Smoking/alcohol, one for Drug use (any), and one for Drug addiction/alcoholism. The new screening procedure included more detailed questions about the frequency of cigarette, alcohol, and illegal drug use during pregnancy. Results: Compared with the old approach, the new screening protocol increased reporting of smoking/alcohol use from 21% to 72% (relative risk = 2.63, 95% confidence interval = 2.231, 3.108); reporting of any drug use from 12% to 18% (relative risk = 1.07, 95% confidence interval = 1.002, 1.150); and reporting of alcoholism/drug abuse from 0% to 6% (relative risk = 1.06, 95% confidence interval = 1.038,1.090). Conclusions: Our study suggests that more detailed screening using direct questions concerning the amount and frequency of substance use increases reporting of prenatal substance use as compared to screening approaches using only yes/no style check boxes.     

Neurocognitive and Physiological Prerequisites for Prevention of Adolescent Drug Abuse

A number of programs for adolescent substance abuse are reportedly effective for a significant number of subjects; however, there is invariably a substantial subgroup that does not respond favorably. It is critical that underlying mechanisms for these differential effects are identified in order to improve prevention efficacy. Integrity of executive cognitive function (ECF) and its modulation of emotional arousal levels may represent key dimensions of regulatory processes related to risk for substance abuse, and may play a principal role in differential responses to prevention programming. Deficits in ECF and skin conductance responses (SCRs) have been associated with several behavioral disorders, most notably substance abuse, aggression, psychopathy, conduct disorder and attention deficit hyperactivity disorder. Differences in these neurocognitive-emotive processes may also contribute to differential responses to preventive interventions. ECF and physiological responses to cognitive processing (SCRs) implicated in substance abuse were measured in a small pilot study reported herein. Responses of extreme groups of high risk youth who responded favorably and unfavorably to an effective prevention program differed in cognitive and emotional measures, suggesting that they may play a role in variation in intervention outcomes. Further investigation will provide valuable insights for developing preventive interventions.     

Toxicity of seleno-L-methionine, seleno-DL-methionine, high selenium wheat, and selenized yeast to mallard ducklings

The toxicity of four chemical forms of selenium (seleno-L-methionine, seleno-DL-methionine, selenized yeast, and high selenium wheat) was compared in day-old mallard ducklings (Anas platyrhynchos). In the first experiment, in which the basal diet was 75% wheat, survival after 2 weeks was lower for ducklings fed 30 g/g selenium as seleno-L-methionine (36%) than for ducklings fed 30 g/g selenium as seleno-DL-methionine (100%) or 30 g/g selenium from high selenium yeast (88%). The concentration of selenium at 2 weeks in the livers of survivors was similar for ducklings fed 15 g/g selenium as seleno-DL-methionine (12 g/g, wet weight), seleno-L-methionine (11 g/g), and high selenium wheat (11 g/g), but was lower when the selenium came from selenized yeast (6.2 g/g). When fed 30 g/g selenium from the various sources, the selenium concentrations in liver were 20 g/g for seleno-DL-methionine, 19 g/g for seleno-L-methionine, and 9.9 g/g for selenized yeast. In a second experiment, in which the basal diet was a commercial duck feed, survival after 2 weeks was 100% in ducklings fed 30 g/g selenium as seleno-DL-methionine, seleno-L-methionine, or selenized yeast. Selenium concentrations in liver were similar for ducklings fed the 30-g/g selenium diets as the DL or L forms of selenomethionine (27 and 25 g/g), but lower for ducklings fed selenized yeast (13 g/g). The greater toxicity of the L form of selenomethionine was probably related to the palatability or nutritional nature of the wheat-based diet used in experiment 1, but the exact reason for the difference between the DL and L forms is unknown. Biologically incorporated selenium, derived from high selenium wheat, was no more toxic than selenium derived from the two purified forms of selenomethionine, and the selenium in selenized yeast was not as toxic as that in the two forms of selenomethionine.     

Assessment of occupational exposure to 4,4′-methylene-bis-(2-chloroaniline) “MOCA” by a new sensitive method for biological monitoring

Summary A new specific and sensitive method for the urinary determination of 4,4-methylene-bis-(2-chloroaniline) (MOCA), a known carcinogen in rats, mice and dogs, has been developed. After a brief study on rats to determine some peculiarities in MOCA urinary excretion, this method was used to assess occupational exposure in French industrial firms. Both the manufacture of MOCA and its use as a curing agent in the production of polyurethane elastomers were surveyed. MOCA excretion levels were distributed from non-detectable (<0.5 g/l) up to 1600 g/l. Concentrations of N-acetyl metabolites, when present, were largely lower than MOCA levels. The results seemed to reflect workers' overall exposure fairly. Preventive measures following analytical determinations often led to an obvious lowering of excretion levels.     

Ein Krankheitsersatzindex: Konstruktion und Validierung

Zusammefassung Häufig taucht in empirischen Forschungsarbeiten, die Gesundheit und/oder Krankheit zum Gegenstand haben, das Problem auf, dass zwar eine grössere Anzahl an Variablen zu gesundheitsrelevanten Fragestellungen vorhanden sind, aber keine Angaben über das Auftreten von Krankheiten. Daher stellt sich die Frage, wie Krankheit substituiert werden kann. Auf Grundlage der Daten des Sozio-Ökonomischen Panels und des Gesundheitssurveys der Deutschen Herz-Kreislauf-Präventions-studie wird eine Lösungsmöglichkeit aufgezeigt. Ein aus den Variablen Arztbesuche, Im Krankenhaus verbrachte Nächte und Vorhandensein einer chronischen Krankheit gebildeter Krankheitsersatzindex korreliert hochsignifikant mit einer Reihe von Krankheiten und Beschwerden, so dass davon ausgegangen werden kann, dass dieser Index diese substituieren kann, wenn in Datensätzen zwar die oben aufgeführten Variablen, aber keine Angaben zu Krankheiten vorhanden sind.

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Summary Empirical research dealing with health and illness often has the problem that the data sets contain a variety of health related variables but no variables about the appearance of diseases and complaints. In order to solve this problem a disease substitution index (DSI) based on data of the German Socio-Economic Panel (GSOEP, 1985) and the national health survey conducted in the framework of the German Cardiovascular Prevention Study (GCP, 1984–1986) was constructed. Consisting of the variables medical attendance, hospital attendance and existence of chronical diseases the DSI shows statistically significant association with a series of diseases and complaints. These findings indicate that the DSI can be used to substitute diseases and/or complaints in datasets with the mentioned variables but no informations about diseases or complaints.

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Résumé Dans la rechereche empirique sur la santé et/ou la maladie, il arrive fréquemment que malgré un grand nombre de variables concernant l'état de santé, aucune donnée ne se réfère directement à la maladie même. Comment substituer celle-ci est la question qui se pose. Sur la base de données tirées d'études allemandes socio-économiques et de la prévention cardio-vasculaire, il est proposé ici une solution. Un index de substitution de maladie (ISM) construit avec les variables consultations médicales, nuitées d'hôpital et présence d'une affection chronique montre une forte corrélation avec une série de maladies et malaises spécifiques. On peut en conclure que l'ISM peut se substituer à celles-ci lorsque les données utilisées ne contiennent pas d'indications directes sur les maladies et malaises mais seulement les variables mentionnées plus haut.

     

“Mom” as a Protective Strategy Used by Children in Foster Care

How children use language impacts on their adjustment in foster care. It is important to understand the strategies children use with caregivers to protect themselves. The shortage of literature on how children cope in foster care is concerning because it limits placement workers in their ability to help children in care. This paper examines some of the reasons children take it upon themselves to call their foster caregiver Mom even when they have been discouraged from doing so. The phenomenon of children referring to foster caregivers as Mom is examined in this paper for how this strategy provides protection for children, theoretical explanations for how the use of Mom works, and for the opportunities its use brings.     

Ultraviolet and volatility loss of herbicides

Herbicide 2,4-D formulated as a urea-type polymer was readily destroyed by long-wave uv (356-nm) irradiation, whereas conventional 2,4-D was more resistant. The opposite relationship was noted for polymeric and conventional formulations of dicamba. Polymerized 2,4-D was more resistant to thermal degradation (60°C) than non-polymerized formulations. Ultraviolet degradation of polymerized 2,4-D was eliminated by the incorporation of RYLEX-H and UVINUL D-50, industrial uv absorbers. Exposure of polymeric dicamba to 60°C heat, followed by trapping of the volatile component, indicated that 21 percent was lost by thermal degradation and 46.6 percent by volatilization. Comparable values for non-polymerized dicamba were 37.9 and 60.1 percent.     

Lifestyle patterns concerning sports and physical activity,and perceptions of health

SummaryObjectives To explore the perceptions of health and physical activity, and the associations between these two areas from a theoretical lifestyle perspective.Methods Data was collected by means of a self-administered questionnaire, among 3019 adults attending centres for preventive medicine in France. Correspondence analysis examined the significance of the relationships between perceptions of health and perceptions of sports and physical activity.Results Four pricipal types of subjects emerged from the factor analyses expressing four different lifestyle patterns. Non physically active lifestyle: a feeling of not being healthy, Physically active lifestyle, pleasure/leisure-oriented, Necessarily physically active lifestyle, regardless of health, Physically active lifestyle aimed at stress relief.Conclusions The sociological approach helps tackle sports and physical activity as behaviour patterns but also and especially as a health orientation connected with the socio-economical climate. This approach also gives sports practice back its meaningful cultural dimension.

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ZusammenfassungFragestellung Wie werden Gesundheit und körperliche Aktivitäten und Sport wahrgenommen? Welche Zusammenhänge bestehen zwischen den beiden Parametern in Hinblick auf den Lebensstil?Methoden Die Rohdaten wurden mit Hilfe eines selbst zu beantwortenden Fragebogens gesammelt. Die 3019 Studienteilnehmer sind ausschliesslich Erwachsene, die in einem französischen Vorsorgezentrum während einer freiwilligen Beratungsstunde angesprochen wurden. Der Schwerpunkt der anschliessenden Faktorenanalyse lag in der Suche nach Korrelationen zwischen der Wahrnehmung der Gesundheit und den Eindrücken, die die sportlichen Aktivitäten hinterliessen.Ergebnisse Diese Analyse ermöglicht es, vier Antwortprofile herauszuarbeiten, die letztlich vier verschiedenen Lebensstilen entsprechen: inaktiv, allgemeines Unwohlsein, das sich im klinischen Bereich niederschlägt, aktiv, auf Lustempfindungen orientiert, passiv, fatalistisch, ohne Interesse an Gesundheit, aber gesellschaftsorientiert, aktiv, gesundheitsbewusst, auf Stressabbau orientier.Schlussfolgerungen Aus soziologischer Sicht kann somit die Ausübung körperlicher Aktivitäten einerseits als reines Verhaltensmuster gedeutet werden, andererseits aber auch als gesundheitsorientierte Handlung, eng verknüpft mit den sozioökonomischen Verhältnissen. Sprot an sich erhält somit seine Bedeutung als kulturelle Dimension wieder.

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RésuméObjectifs Etudier les perceptions de la santé et de l'activité physique et sportive, ainsi que les relations entre les deux dans la perspective théorique du style de vie.Méthodes Des données ont été recueillies par questionnaire auto-administré auprès de 3019 adultes consultant un centre de médecine préventive français. Une analyse factorielle des correspondances a permis d'étudier les relations d'affinités entre les perceptions de la santé et celles de l'activité physique et sportive.Résultats Quatre profils de réponses se distinguent par cette analyse factorielle qui font émerger quatre styles de vie: physiquement inactif, le sentiment de ne pas être en bonne santé, physiquement actif, orienté vers le plaisir et les loisirs, physiquement actif au travail sans attention pour la santé et physiquement actif pour lutter contre le stress.Conclusions L'approche sociologique permet d'aborder la pratique physique et sportive, comme un comportement mais aussi et surtout comme une orientation de santé, en relation avec les conditions socio-économiques. Elle redonne ainsi à la pratique sportive sa dimension culturelle signifiante.

     

Comprehensive pediatric primary care vs traditional care in an israeli population: Their influence on pediatric emergency room use and hospitalization

Emergency room (ER) utilization and hospitalization were studied as indicators of the impact of improvements in pediatric primary care services in an Israeli development town, Ofakim, population 12,000. One of the two pediatric services was upgraded in 1976 through the introduction of pediatric faculty, integration of preventive and curative services and conversion of the medical records to a problem-oriented format ( experimental clinic B ). The primary care system remained unchanged in the second clinic ( traditional clinic A ). During 1980, ER utilization by the B clinic population was 9.3/100 compared with 17.6/100 for the A clinic population. Fifty two percent of the B clinic population patients reaching the ER were hospitalized compared with 25% of A clinic patients.The lower ER utilization rate represents a significant saving for the health services, and educational interventions are suggested from the study. Analysis of ER utilization data seems to offer useful information for overall planning and monitoring of ambulatory services for a community.Corresponding author.     

Cardiovascular prevention in the community: the plurisectorial program of the canton of Tessin

Summary It describes the primary prevention of cardiovascular diseases carried out in Tessin (Italian-speaking Switzerland). Every single action is adressed to the entire population, activelyinvolving professional associations (doctors), pharmacists, nurses, shop-keepers, etc.) and making use in particular of the collaboration of the mass-media (daily press, radio, television). The described actions concern the struggle against the cardiovascular risk factors through the daily diffusion of tv advertisements, free measurement of arterial pressure, and the possibility of disposing in the majority of regional restaurants of a Health menu with a low content of saturated fats and cholesterol. In 1984 every citizen of Tessin has been reached by an average of 24 preventive messages.

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Riassunto E' descritto il programma di prevenzione primaria contro le malattie cardiovascolari attuata nel Canton Ticino (Svizzera). Le singole azioni si rivolgono a tutta la popolazione, coinvolgendo attivamente associazioni professionali (medici, farmacisti, infermieri, esercenti, ecc.) e si avvalgono soprattutto della collaborazione dei mass-media (stampa quotidiana, radio, e televisione). Le azioni descritte concernono la lotta ai fattori di rischio cardiovascolari tramite la diffusione quotidiana di spots pubblicitari televisivi, la misurazione gratuita della pressione arteriosa e la possibilità di disporre nel più gran numero di ristoranti del Cantone di un Piatto della Salute con un basso contenuto di grassi saturi e di colesterolo. Ogni abitante del Cantone é stato in media raggiunto nel corso del 1984 da 24 messaggi preventivi.

     

Preventing a Non-Existent Illness?: Some Issues in the Prevention of “Schizophrenia”

The prevention of schizophrenia has received little attention, not least because it is claimed that its causes are largely unknown. I argue that this pessimistic view is based on acceptance of both the highly problematic concept of schizophrenia and of the assumption that it is a genetic/biological illness. The problems of both the concept and its surrounding assumptions are examined and an alternative model of psychotic behaviour and experience, with very different implications for prevention, is discussed.     

Identification of obstacles for chronic pain patients to return to work: evaluation of a questionnaire

The Obstacles to Return-to-Work Questionnaire (ORQ) was developed and evaluated. A total of 154 patients with chronic musculoskeletal pain and prolonged work disability participated in the study. Factor analyses reduced the ORQ to 55 items grouped into 9 subscales. The subscales were named Depression, Pain intensity, Difficulties at work return, Physical workload and harmfulness, Social support at work, Worry due to sick leave, Work satisfaction, Family situation and support, and Perceived prognosis of work return. The subscales showed satisfactory reliability. In order to determine predictive validity a discriminant analysis was conducted with sick leave 9 months after assessment as the outcome. This analysis indicated that the scales Perceived prognosis of work return, Social support at work, Physical workload and harmfulness, Depression, and Pain intensity could significantly predict sick leave and correctly classified 79% of the patients. The Multidimensional Pain Inventory and the Disability Rating Index could also significantly predict sick leave in this sample and correctly classified as many patients as the ORQ. However, these questionnaires do not include any work-oriented items and they had a lower specificity than the ORQ. This study suggests that patients' perceptions and beliefs about work and returning to work may be a significant hindrance for actual recovery.     

N-alkylvaline levels in globin as a new type of biomarker in risk assessment of alkylating agents

Adducts with the N-terminal valine of erythrocyte globin can serve as individual biomarkers of systemic and cellular exposure to endogenous and exogenous alkylating agents. In contrast to detoxification markers of this kind of mecapturic acids derived from alkylation of glutathione, individual N-alkylations of valine in globin reflect the formally toxifying part of the stress due to alkylating agents transformed into the ultimate toxicant. Thus, in contrast to the traditional methods of biological monitoring this approach enables a better evaluation of systemic exposure to reactive agents, adapted more sensibly to the exposure situation over the whole life span of erythrocytes, and it can serve as a specific biomarker of exposure for the purpose of health surveillance in occupational medicine. An individual evaluation of exposures in comparison with the range of corresponding background levels is discussed from the point of view of supplementary risk assessment in medical surveillance of occupationally exposed persons.Work presented at the 23rd Congress on Occupational and Environmental Health in the Chemical Industry (Medichem 1995) The Chemical Industry as a Global Citizen — Balancing Risks and Benefits, 19–22 September 1995, Massachusetts Institute on Technology, Cambridge, Massachusetts     

Effects of tributyltin on survival,growth, morphometry,and RNA-DNA ratio of larval striped bass,Morone saxatilis

Effects of tributyltin (TBT) on survival, growth, morphometry, and RNA-DNA ratio in larval striped bass(Morone saxatilis) were assessed in three experiments. In Experiment I, 13 day old larvae were exposed to 0, 0.067, 0.766, or 2.284 g TBT/L for 6 days. All larvae exposed to 2.284 /L died by day 5; exposure to 0.766 g/L significantly reduced survival relative to controls (59.8% vs. 81.8%). Significant, concentration-dependent decreases in body depth occurred in larvae exposed to 0.067 and 0.766 g/L. In Experiment II, all 16 day old larvae exposed to 1.498 g/L died by day 6. Survival, weight, and morphometry parameters were not significantly different in larvae exposed to 0, 0.052, or 0.444 g/L for 7 days. In Experiment III, survival was similar in 21 day old larvae exposed to 0, 0.055, 0.218, or 0.514 /L for 7 days. Notochord length and dry weight decreased significantly in larvae exposed to 0.514 g/L. Weight and morphometry parameters were more sensitive indicators of sublethal stress than RNA-DNA ratio. Maximum TBT concentrations reported in Chesapeake Bay marinas are likely to cause increased larval mortality. Longer-term studies are needed to assess effects at <0.050 g/L, which may be more representative of habitat conditions.