Showing papers in "American Journal of Public Health in 1970"

Interpretation and uses of medical statistics

Abstract: It has long been the contention of this reviewer that the traditional required biostatistics course in medical schools, schools of public health, or like institutions, is suitable only for statisticians and those concerned with research. In general, for other students reinforcement of arithmetic ability results in little lasting understanding of statistical concepts. This slim volume, expressing what is really needed, can form the basis of an appropriate alternative for these others. The authors say, "It is designed to aid graduates and undergraduates to understand the scope, logic and techniques of approach of statistical method as applied to medicine and allied subjects." They have indeed accomplished their purpose. One cannot learn from this text how to compute a variance or a correlation coefficient, nor is one shown how to set up a chi-square computation or an analysis of variance. However, without the travail that turns off most students, one can learn what statistics is all about and in considerably less time than the usual text. Important definitions are woven into the narrative unobtrusively but emphatically for understanding. Regular summaries review major points. Personal predilections may suggest greater emphasis on some points or disagreement with the manner of expressing specific ideas, but the essence is there for elaboration by an instructor. An adequate index is provided, but a serious deficiency is the complete absence of any references. Readers should be guided to more extended discussions of particular points. Nevertheless, this exposition, directed primarily at comprehension, fills a major gap in statistical literature. CARL L. ERHARDT

Pasteurella multocida infections. II. Pasteurella multocida infection in man unrelated to animal bite.

Abstract: ONE hundred and seventeen cases of infection with Pasteurella multocida unrelated to animal bite were reported in the medical literature to 1965. Of these, 72 were complete case histories, with 35 involving the respiratory tract,127 18 the central nervous system (CNS) 12,28-40 8 sites in the abdomen,41-45 6 septicemias,45-51 1 conjunctivitis,52 and 4 pyomyositis.53 The most frequent clinical diagnoses were meningitis, empyema, and bronchiectasis. There was brief mention of 42 additional infections of the respiratory tract, 21,52.54.55 2 of the gastrointestinal tract,21'52 and 1 isolation from the purulent drainage of an infected gouty joint.21 Among the isolates, 77 of the 117 were from infections of the respiratory tract. The paucity of reports suggests that P. multocida is an infrequent cause of disease in man. However, these infections are not reportable and, therefore, only cases of unusual interest may have been published. This report summarizes the epidemiologic data gathered on 136 cases of P. multocida infection unrelated to animal bite which occurred in the United States from May, 1965, through March, 1968.

Factors affecting diffusion of innovations among health professionals.

Abstract: YOUNG has stated that "the ultimate objective of most health education activities is to change individual, group, community, or societal behavior."' While the health educator has traditionally emphasized the health beliefs and practices of the lay public, both the changing nature of health needs and the continuing appearance of research findings relevant to developing practices and procedures to meet these needs argue for an increased concern with attempts to influence the attitudes and behaviors of health professionals. Public health has long been interested in insuring the speedy application of medical and scientific knowledge. The imposing time lag between disclosure of new public health knowledge and its utilization by health professionals deprives many citizens of the benefits of medical research.2 Health educators assist in narrowing the gap when they engage in activities directed at professionals: continuing education programs for medical and allied health personnel; training programs for health workers (from screening technicians to nursing home employees) ; technical assistance and consultation services in agencies such as schools and health departments; and even dissemination among themselves of new knowledge and techniques from health education theory and research.3 The success of these influence attempts depends on something more than the transmission of technical facts; availability of information concerning the existence, efficacy, and acquisition of new programs or procedures is clearly not in itself a sufficient condition for acceptance by the health professional. In the field of public health, one key element in the application of scientific advances to the community is the role and behavior of the official health agency. Health agencies can speed up or delay the bringing of new procedures and programs to their clients. This paper summarizes some major results of an extensive research project that traced the patterns by which public health programs diffused (spread) among health departments within each of three states. A major study objective was identification of factors facilitating or inhibiting adoption of new programs by an important group of health professionalsadministrators of local health depart-

Salmonella excretion in joy-riding pigs.

Abstract: AT the APHA Meeting of the EpidemiPkology and Occupational Health Sections in 1965. some of the problems and questions relating to Salmonella excretion in market swine were reviewed and presented.' A number of workers over a period of years observed that when swine were examined on the farm, the Salmonella infection rate, as measured by rectal swabs, was low. However, if swine were similarly examined in holding pens at the slaughterhouse, or by cecal or rectal swabs taken after slaughter, the observed infection rate was often from 30 to 80 per cent.2-6 Proposed explanations of these findings fall into two groups:

An effective weight control program in a public school system.

Abstract: IT iS generally well recognized that obesity constitutes a serious health problem in the U. S. population.'2 In adults, experience with weight reduction is for the most part less than satisfactory owing to the difficulties in modifying firmly established and deeply fixed habits of diet and exercise. Our experience with adolescent obese appears to indicate that a similar situation exists at this age level as well. In many instances, however, important basic differences in root causes distinguish maturity-onset obesity from obesity developed in early life. Whereas in adults the problem of excessive fatness is in the main the result of both excessive caloric intake and inadequate caloric expenditure, in the majority of obese children and adolescents the difficulty is not overeating but extreme physical inactivity.2 The dietary problem, in the latter groups, is not so much an excessive caloric intake as faulty food habits, and a lack of balanced diets with a tendency to overindulge in such special foods as candy, potato chips, and the like. In our judgment, the opportunity for greatest success in the control of obesity lies in tackling the problem in the preadult stage, in obese children and adolescents, when the habits of diet and physical activity are more tractable to modifications and are not yet as firmly established as in adult life. In addition, we believe that the scope of the obesity problem in youngsters is so extensive (12%o to 20%o of the pre-adult population), that reliance cannot be placed on the individual initiative of parents and children to obtain weight control therapy where needed. Furthermore, the cost of such therapy through private medicine is generally too high for all but a limited number of individuals. And, significantly, the eventual serious health consequences of the persistence of obesity into middle adult years make early obesity a national public health problem of communities across the country. The public school system, therefore, affords the most suitable and logical focus for an attack on the problem of weight control in our excessively fat youngsters. The advantages of handling this matter in the public school system are obvious. In this setting, the largest

Trends in "prematurity": United States, 1950-1967.

Abstract: This article addresses trends in the incidence of prematurity in the US in the 1950-67 period. Most notable in this period was a gradual increase in the proportion of low-birth-weight infants among nonwhites while the rate for white infants remained relatively stable. The proportion of such infants increased from 10% to 14% for nonwhite infants between 1950-67 but the incidence among white infants remained at 7%. This divergence in trends was not associated with changes in the distribution of age of mother at time of the infants birth the sex ratio at birth or the proportion of multiple births. Of concern to study investigators was whether changes in the reporting of birth weight and gestation data for the period 1950-67 affected the data. The early data on birth weight and gestation may reflect a statistical artifact and the decline in the study period in the percentage of live births at 36 weeks and a corresponding shift to births at 37-39 weeks further impedes the drawing of definite conclusions regarding trends. Another factor jeopardizing comparability is the increase over the 18-year period in the number of hospital births which is associated with more complete recording of birth weight. On the other hand the data show a trend toward decreases in the number of births in the highest birth weight groups and increases in the lowest groups which is not the pattern one would expect with increased accuracy of reported weights. Unfortunately the national data for the 1950-67 period do not provide information classified according to a socioeconomic index so the extent to which the difference in trend between white and nonwhite infants was due to socioeconomic differentials cannot be determined. New births certificate forms introduced in 1968 will increase the information available for general study. Among the new items are the date of last menstrual period which should improve gestational data and parental education which will provide a socioeconomic indicator.

Suicide attempts in a population pregnant as teen-agers.

Abstract: PREGNANCY, childbearing, and motherhood are normal biological events rather than disease processes, but even in the mature married woman they disturb the usual pattern of social life. For the teen-age girl, particularly if unmarried, pregnancy and the events which follow are especially likely to cause difficulty for the individual, those immediately associated with her, and society. Other authors1-3 have reviewed some of the problems associated with teenage pregnancies, such as disrupted education, welfare dependency, and increased fertility. A review of the medical records of 105 pregnant females 17 years of age or younger admitted to the Yale-New Haven Hospital for delivery during 1959 and 1960 suggested an additional potential difficulty -the possibility of suicide-threatened, attempted, or actually committed. This study revealed that 14 of the young mothers were known to have made subsequently one or more self-destructive attempts or threats serious enough to require care or to be reported to a physician at the hospital. The study population received its obstetrical care in the period before the emphasis on programs for teen-age mothers. Some were patients of private physicians, but the majority were seen by obstetrical residents, medical students, and staff physicians in the general obstetrical clinic.4 As a group they were offered no special social services, although in individual cases the need was so obvious that a social worker was assigned. They were excluded from school when their condition became apparent and limited educational alternatives were provided.5 Today in New Haven, and in many other cities throughout the United States, such girls are being offered programs that include unified medical care, augmented social services, and special educationafl provisions. It is hoped these programs will make a significant difference in the life of these young mothers and their children. Some reports are already indicating lower rates of medical complications among mothers and infants8 and decreases in early school terminations.1 Studies now under way may show that the attention being

Consumer participation in OEO-assisted neighborhood health centers.

Abstract: A the nation sought to address the problems of poverty in the midsixties the Office of Economic Opportunity (OEO) was established as an action agency to redress the imbalance in national priorities. The War on Poverty was to be fought under many service banners-jobs, education, legal assistance, and health. Each of these, however, was to be pursued under a more general operational flag-community organization. While in many areas community participation has become an organizational goal without service objectives, each service program-Head Start, Legal Services, Health-was to assure consumer participation. There has always been discussionin OEO and elsewhere-among those interested in community organization. One school of thought has attempted to gather community residents together over issues of conflict and confrontation. In such programs, the issues may be real or imagined, but in either case they are used to arouse community interest, if not indignation. The principal work of such organization is to confront the power structure external to the community and to protest inequities. The other school-call it the service orientation-tries to identify real needs in communities and, together with the community residents, organize into a meaningful structure which meets their basic needs. This may be seen most generally in the service-based community organization such as Head Start, Health, Legal Services. The difference in this theory of community organization is that, if successful, it will bring antipolitical groups together in a situation where compromise-political or otherwise-will help both parties (sides) to achieve what they want. The end effect of the first school of thought, where there is an attempt to gather the community together over issues of conflict, can be and frequently is the establishment of a group calling for control that has nothing to control. Whereas, when the effect of organization can be put into community avenues to direct and control some of the factors that affect people's lives-family, education, legal and personal rights, health care, and housing-consumer participa-

Gestational interval from vital records.

Abstract: Information concerning the time of in-utero development of the newborn was first sought in this country through official registration procedures approximately 30 years ago. In 1939 the National Office of Vital Statistics (NOVS) through the Standard Certificate for Live Birth provided for inclusion of "number months of pregnancy" as an addition to the statements required at registration. At approximately this same time the District of Columbia introduced a supplementary confidential section to its birth registration form including "period of gestation -- weeks" as one of the 47 items of medical information requested "for use of the Health Department." Neither NOVS nor the District of Columbia published any early report of the results of these drives. The next revision of the Standard Certificate for Live Birth in 1949 introduced the supplementary confidential section on the national scene with "length of pregnancy -- weeks" as one of three items in this new section. Thus weeks replaced months as the measure of time to be used. Much revision of birth certificates at state and city levels resulted from this recommendation of NOVS with the result that information concerning "length of pregnancy" was required in 1950 by 40 states and each of the three city jurisdictions. However five of the states did not require the interval to be recorded in weeks as had been recommended and thus the time unit of months remained officially acceptable in some parts of the nation. (excerpt)