Showing papers in "American Journal of Public Health in 1965"

Vascular Disease of the Brain—Epidemiologic Aspects: The Framingham Study

Abstract: The epidemiologic features of thrombotic brain infarction in comparison to myocardial infarction both presumed manifestations of atherosclerosis were studied over a 12-year period in 5106 men and women aged 30-62. All were examined prior to the study and found to be free of both coronary heart disease and vascular disease of the brain. In the 12-year period 167 myocardial infarctions and 57 thrombotic brain infarctions occurred. A marked male predominance was noted in myocardial infarction but no predominance of either sex was noted in thrombotic infarction of the brain. In men only the incidence of brain infarction lagged 20 years behind that of myocardial infarction. Thrombotic brain infarction was much more common accounting for 63% of all "stroke" events than either subarachnoid hemorrhage and embolus to the brain or the most lethal type hemorrhage into the brain which occurred only 4% of the time. The incidence of both myocardial and thrombotic brain infarction increased with age. High risk factors included elevated blood pressure or serum cholesterol electrocardiographic abnormalities excessive smoking and a low vital energy. Generally the factors which predisposed to the development of the 1 disease also predisposed to the development of the other. Persons with any 2 of the high risk factors were usually susceptible. Obesity was not a risk factor in either disease.

The association of alcohol and tobacco with cancer of the mouth and pharynx.

Abstract: THE association of smoking with cancer of the mouth and pharynx has been demonstrated by a number of studies.1-9 Vincent and Marchetta8 found, in a series of 106 cases of oral and pharyngeal cancer, an association with the use of both tobacco and alcohol. Wynder, Bross and Feldman5 reported that, for a series of 659 cases, cancer of the mouth and pharynx was apparently associated independently with both alcohol consumption and smoking. Keller'0 found, in a series of 2,177 cases of lip, oral, and pharyngeal cancers, a strong association of cancer of the floor of the mouth and liver cirrhosis. No association was found between any of these cancers and syphilis, diabetes mellitus, or arteriosclerosis; an association of tongue cancer and alcoholism was rejected. The present study was undertaken to investigate further the relation of cancer of the mouth and pharynx to the use of tobacco and alcohol, and to liver cirrhosis, syphilis, and diabetes mellitus.

Continuing importance of laboratory-acquired infections.

Abstract: NSTANCES of laboratory-acquired infecI tion have been recognized for many years. These cases are likely to be reported in the literature when some unusual agent or set of circumstances is involved and periodically there have been reviews summarizing cases due to a particular agent or group of agents. In an attempt to obtain a more accurate measure of the extent of the problem a survey of laboratories in the United States was conducted in 1950 which disclosed almost twice as many unreported cases as published cases occurring during the previous 20 years.1 Since that time, in spite of increased awareness of the hazards and the increased emphasis on safety devices and measures, laboratory infections have continued to occur. Changes in the kinds of agents involved and in the circumstances resulting in infection to some extent reflect recent trends in areas of research and interest in certain agents. The purpose of this report is to present a summary of the laboratory infections which have come to our attention since 1950 in order to obtain a picture of the current extent of this continuing problem. Comparison of Recent and Previous Data

Occupational diseases. a guide to their recognition

Abstract: Occupational diseases are discussed in terms of occupational health hazards as a n1eans to recognition of the disease. The text covers routes of entry and modes of action, chemical hazards, physical hazards, biological hazards, dcrn1atoses, airway diseases, plant and wood hazards, chen1ical carcinogens, pesticides, sources of consultation, and a 1ist of references.

Social-psychological factors influencing the use of community health resources.

Abstract: THE purpose of this paper is to exTplore some social-psychological concomitants of the utilization of health services. It would probably be wise at the outset, however, to indicate that the title of this paper-"Social-Psychological Factors Influencing the Use of Community Health Resources"-is somewhat misleading. At least it is misleading to the extent that the focus of these remarks will be on "social-psychological factors" rather than on "community health resources." For the purposes of this paper, it is not important to discuss separately the social-psychological factors found to be associated with the use of various clinics, hospital outpatient services, inpatient care, or even visits to the offices of physicians in private practice. Rather, we shall concentrate on an event common to all medical settings, namely, the social encounter between the patient and the therapist as a significant part of the more general process of response to illness. The term therapist is used here rather than physician to permit generalization of the social relationship to paramedical personnel and healers other than orthodox physicians, e.g., chiropractors, faith healers, and others who, after all, must be included in the community's total health resources. We will return to this point later. First, however, it would seem appropriate to summarize briefly the results of some previous studies in utilization and to indicate some important issues raised by these studies. In general, most of these studies make use of a host of demographic and social factors related to utilization of health resources.1 Such investigations provide a description of trends in utilization and of the variations in important social and demographic factors associated with this use. It has been found, for example, that rates of utilization of health services are greater for females than males, and that use increases with age for both sexes.2 It has been shown that utilization varies directly with social class standing.3 It has been demonstrated that while upper social classes spend more for health services, the amount they spend represents a smaller proportion of their total income than the amount spent by the lower social classes.4 It has been found that owners of various health insurance policies utilize health services more often than people without insurance.5 It is also known that to a certain extent ecology influences the use of various health resources, especially hospitals.6 These studies emphasize the importance of the factors of availability

Social factors in medical deprivation.

Abstract: AN increasing number of studies in the Pfield of public health are documenting the differential distribution of medical care in the United States.1-4 The lower income groups,5 ethnic minorities,6 and rural areas,7 for example, do not share equally in the quantity-and probably quality, although less is known here-of medical services with their more privileged counterparts. Such inequalities present a serious challenge to all health workers and to the nation as a whole. This challenge was highlighted in President Johnson's special message to Congress on health and medical care: "Clearly, too many Americans still are cut off by low income from adequate health services. The linkage between ill-health and poverty in America is still all too plain." Similarly, New York City Commissioner of Health, Dr. George James, has stated that "we have now reached the point in our development where we should accept the concept of equal health opportunity for all of our citizens, whoever they may be and wherever they may be."8 Several explanations have been offered to account for these social differentials in health services. Most common has been the economic one-the upper income groups can afford, and therefore secure, more and better medical care. However, several studies have indicated that cost is not the sole determinant of the amount or quality of medical care.9 In fact, the rapid growth of health insurance plans has, in some cases, increased the utilization of medical services among low income groups to such an extent that an inverse relationship between family income and hospital admissions may result.10 Other explanations have focused upon the social and psychological aspects of the greater incompatibility of lower class clients with treatment sources and even public health philosophy.11 As presently organized and administered, it is argued, preventive and therapeutic medicine are not congenial to the health beliefs and modes of behavior of low income groups, especially ethnic minorities such as Negroes or Puerto Ricans.12 Furthermore, as Anderson and Rosen have pointed out, utilization of the complex medical services that characterize modern medicine calls for a "medically sophisticated population" possessing a degree of knowledge and understanding most likely to be lacking in the less educated segments of society.'3 One consequence of the above forces is the development of a cultural gap be-'

Cancer registration and survival in california

Abstract: versy. However, it is difficult to believe that simply by drafting a more refined, sophisticated version of the original law, the crisis could have been avoided. The Medical Care Insurance Act was the instrument of major social change; it is probable that social conflict was the inevitable result of its enactment. The author deserves much credit for producing a carefully documented, thoughtful study of an historic event in the development of medical care in North America. He has included 75 pages of appendixes which record important correspondence, memoranda, legislation and other documents of great interest to the student of medical care. This book is an important contribution to the literature on medical care and an essential reference for anyone interested in the Saskatchewan Story. M. S. ACKER

Factors associated with breech delivery.

Abstract: largely methodological, and draws on data supplied by the Collaborative Study of Cerebral Palsy, Mental Retardation, and other Neurological and Sensory Disorders of Infancy and Childhood to illustrate the application of technics. The problems dealt with in the collaborative study are complex, so that methods are needed that will disentangle intricate questions; breech delivery, the topic of this report, is merely one of the many problems under study.