Showing papers in "Public Health Reports in 1967"

Preventive actions in dental disease, tuberculosis, and cancer.

Abstract: IF ONLY a minor percentage of the public consistently takes advantage of available preventive health measures, questions might well be raised about the effectiveness of current efforts in health education. But if it is found that certain subgroups in the population consistently follow preventive health recommendations, then a systematic study of these subgroups in relation to persons that fail to take preventive action might reveal the factors that facilitate or inhibit preventive behavior. Firm data on the preventive behavior of the population should prove useful for planning and practice in preventive medicine. Unfortunately, the imposing list of studies of health behavior in the literature do nolt provide definitive knowledge about preventive behavior (1). The vast majority have focused on what might be termed "illness behavior"; that is, behavior following the appearance of visible symptoms. Neither has research revealed the extent to which persons relatively free of symptoms voluntarily undertake actions to prevent or detect possible disease. The few studies of preventive behavior (2-4) are of limited value since they were performed, for the most part, on relatively small samples or in highly restricted geographic regions. Moreover, most of the studies obtained measures at only one point in time, thus precluding the analysis of behavioral consistency over time. In addition, such studies usually dealt with responses to a single health condition, which eliminated the possibility of assessing the consistency of behavior across several health conditions.

Measuring end results of rehabilitation of patients with stroke.

Abstract: REHABILITATION is that part of medical care which aims primarily to relieve the disability produced by disease and to restore the person to a place in society. The basic defect to be corrected by physical medicine and rehabilitation is disability, which prevents performance of the person's usual functions. However, we have no generally accepted measure of disability. Consequently, rehabilitation workers have been slow to convince other health personnel that their methods are effective (1). Disability usually entails physical, mental, and socioeconomic problems, and for this reason complex measures which assess two or all three aspects have been attempted. Since 1955 the State of Maryland's three chronic disease hospitals have used a scoring method to evaluate the performance of independent movement by long-term patients. This disability score, usually called the Barthel index (2) and occasionally the Maryland disability index (3), assigns 0, 5, 10, or 15 points to performing each of 10 activities of daily living. The sum of these scores is 100 points when all activities are carried out skillfully and independently (table 1). The Barthel index is an empirical score developed by a physical therapist and physiatrist. It provides a simple method for evaluating the physical functioning of a disabled patient at a given time and for assessing change in physical function. The physical therapist and physiatrist discussed with nurses and physicians the physical, mental, and social importance of each activity to the patient and its importance in reducing the need for care. They decided not to refine scores for specific functions to values of less than 5 points. However, instructions were standardized to clarify the criterion of performance for each score and to improve repeatability (2). Patients scoring 100 points could have abilities ranging from barely being able to perform the activities of daily living to being able to earn a salary in skilled employment. Therefore patients can continue to improve after scoring 100 points. Similarly, the patient scoring 0 can emerge from a coma and be conscious though helpless in bed without a change in his score. Although abilities of patients with scores at either end of the scale can vary considerably, the functioning of patients with identical intermediate scores differs less. The lower the patient's score, the more severe is his physical impairment; a rise in score indicates an improvement in his physical functioning. The purpose of the analyses described in this paper is to assess the validity of the Barthel index. (Data for this study were made available by the staff of the Montebello State Hospital, Baltimore, Md.) The 1,223 patients in this study all had at least one cerebrovascular accident before their Dr. Wylie is associate professor of public health administration at the Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md.

Improved medical care statistics and the health services system.

Abstract: THE NOTION that a physician suggest to a group of statisticians what they should do may seem strange, but it is not new. The precedent was set by the physician who founded the field of vital statistics, William Farr. How¬ ever, Farr did not ask the first important ques¬ tion in vital statistics. When the English Gov¬ ernment introduced the Registration Bill in 1839, it was proposed to record only the event of death. Edwin Chadwick, the lawyer who founded the public health movement, saw that this exercise was without redeeming social, scientific, or medical merit, and he insisted that the record also indicate the cause of death so that physicians could know how to direct ef¬ forts at improving the health of the people (1). When it comes to medical care, however, stat¬ isticians, lawyers, and physicians have to acknowledge the perceptiveness, courage, and perseverance of a nurse. Florence Nightingale roundly condemned the hospital statistics available in her time and asserted that it was virtually impossible to deduce anything from them with respect to the relative merits of dif¬ ferent hospitals. In general, the charge is still

Expressed willingness of smokers to try 10 smoking withdrawal methods.

Abstract: A VARIETY of smoking withdrawal techniques have been tried in the United States and elsewhere. The ones most widely used to date are distribution of information (lectures and films), medication, nicotine substitutes, and scare communications. Group therapy, individual counseling, hypnosis, and behavior conditioning have also been employed, but to a lesser extent because they are relatively expensive and can be administered only by trained personnel after intensive planning. In smoking withdrawal clinics, persons may undergo a variety of procedures, including medication, interviews, counseling, and so forth. Interagency councils have been formed at State and local levels to plan antismoking campaigns on a larger scale (1). In San Diego and Syracuse mass smoking control programs involving the entire community are now underway (2). Innumerable physicians and dentists have urged their patients to stop smoking but have often been at a loss to tell them how, and countless books, patented gimmicks, sleep records, and the like on how to stop smoking have been marketed. Many of these programs fail because smokers are unwilling to participate in them. For example, a group of researchers in Philadelphia announced through all three daily newspapers and seven radio stations that a smoking clinic would be available to the public (3). Out of a metropolitan population of 4 million persons, only 135 responded, I11 attended a meeting, and 37 decided to participate. Of these, 24 finished the sessions offered. Other researchers have encountered similar results, although the Roswell Park Clinic, Buffalo, N.Y., has attracted 1,472 smokers over a period of 3 years (4). Furthermore, for our Smoking Control Research Project, sponsored jointly by the Institute of Social and Personal Relations, Berkeley, and the Permanente Medical Group-Kaiser Foundation Health Plan, Walnut Creek, Calif., we sought to recruit about 300 smokers and had to turn away 200 surplus volunteers (5, 6). The difficulty of attracting smokers into programs such as these raises the question of which methods should be offered to those who wish to attempt giving up cigarettes. The answer should Dr. Schwartz is project director and Dr. Dubitzky is research psychologist for the Smoking Control Research Project. Dr. Schwartz is also lecturer in social welfare, University of California, Berkeley. The study is sponsored jointly by the Institute of Social and Personal Relations, Berkeley, and the Permanente Medical Group-Kaiser Foundation Health Plan, Walnut Creek, Calif. Dr. Neil E. Anderson is medical director, and Dr. Frederick A. Pellegrin is consultant for the project; they represent the Permanente Medical Group on the project committee. This project is supported by Cancer Demonstration Grant No. 05-15-D67 from the Division of Chronic Diseases, Public Health Service.

Oral clefts in the American Indian.

Abstract: ORAL CLEFTS vary considerably in incidence among the races (1-3). Among the major racial groups the highest frequencies seem to occur among the Mongoloids. Miller (4) reported rates for cleft lip and cleft palate in Indians of British Columbia almost identical to those for the Japanese. However, Tretsven (5) reported considerably higher rates for Indians born in Montana. This study, part of a larger program concerned with congenital malformations among American Indians, was undertaken to determine the frequency of occurrence of cleft lip and cleft palate among American Indians born in Public Health Service hospitals.

A public health home nursing program for outpatients with heart diseases.

Abstract: DURING the past 10 to 15 years, home care programs have been developed in hospitals and health departments across the country. The primary objective of most programs has been to provide medical and nursing care to patients in their own homes a,fter hospitalization. Indeed, this type of program has become so common that the term "home care" today virtually implies that there has been preceding hospitalization. In the past 2 or 3 years, several home care programs have be-en started which are aimed at patients who are ambulatory and who may never have been hospitalized. The primary objective of these home care programs is to keep patients out of the hospital as long as possible by providing anticipatory medical and nursing services at home. In January 1964 an anticipatory home care program was begun at St. Luke's Hospital Center in New York City for a group of elderly patients with chronic congestive heart failure who received their medical care in the outpatient clinics of the hospital. The aim of this program was to determine if the hospital admission rate of these patients could be reduced by adding public healt,h nursing followup at home to the regular routine of outpatient department c,are. 'The results of this program provide information about the medical care of congestive heart failure, organization of community health services, and role of public health nurses in programs of this kind.

Measurement of discontinuity of psychiatric inpatient care.

Abstract: CONTINUITY of psychiatric care is often said to have special virtue. WVhat is meant by such continuity, however, needs clarification. For example, a recent publication of the National Institute of Mental Health (1) relative to community mental health centers contains these statements: "Since the elements of the center need not be under one roof, nor even under ia single sponsorship, the administration of the various components must be done in such a manner that the goal of smooth continuity of care is achieved." "In some community centers, such as Colorado's Fort Logan State Hospital, emphasis is placed on maintaining continuity of therapists." "Since the object is to provide a -complete circle of treatment for patients at the community level . . . The third idea-"to provide a complete circle of treatment"-has a somber sound, and the first two suggest restless bedfellows. The present study, in an effort to define and quantify continuity of care, at least in a negative way, determines lack of early continuity of care among inpatients new to mental hospitalsin other words, determines the frequency of 'discontinuity of care. Two measures are used. One is the rate at which all persons newly admitted to psychiatric inpatient care had a second inpatient experience in a psychiatric facility other than the facility of initial entry. The second is confined to those patients who had another admission. The first measure gives an estimate of the risk of discontinuity of psychiatric inpatient care, while the second describes the pattern of discontinuity when it occurs. Clearly, even if a patient resumes treatment in the same hospital, there are definitions of discontinuity of care with which the regimen might conform. For example, in the same hospital the second episode might involve different caretaking personnel and a different immediate physical environment. It is presumed here, however, that a different hospital does commonly result in some type of discontinuity and that the measures proposed provide minimum estimates of its frequency. Quantitative studies by others bearing directly on continuity or discontinuity of psychiatric inpatient care were not found.

Lead-210 in tobacco and cigarette smoke.

Abstract: M ANY recent investigations of cigarette smoke have been concerned with concentrations of polonium-210 and the radiation dose to the lungs of smokers who inhale it (1, 2). To ascertain if further insult to the lungs occurs, a study of the levels of other radionuclides, specifically lead-210 in cigarette smoke, was undertaken at the Northeastern Radiological Health Laboratory, Public Health Service. Limited data by Holtzman and Ilcewicz have indicated a transfer of lead-210 in the smoke (3), and stable lead in tobacco smoke has been reported also by Cogbill and Hobbs (4). Increased exposure of the lung to lead-210 may result because the nuclide has a longer effective half-life with subsequent daughter ingrowth. Calculations of the amount of lead-210 deposited in the lung, a critical organ, were based on the concentrations of lead-210 found in the smoke of various brands of cigarettes tested at this laboratory.

Salmonella excretion by turtles.

Abstract: THE PET turtle as a potential source of salmonellosis has been pointed out (1, 2). The evidence is clear-cut-a pet turtle is brought into a home and within a few days one or more persons handling the turtle becomes ill. Upon investigation, the same Salmonella serotype is recovered from the patient and the turtle. Quite commonly, however, a turtle is in the home for several months before any person becomes ill. One wonders in such instances whether the turtle had the organism when it was brought into the home or whether it was infected from some source after it arrived. To supply a logical basis for evaluation of these points, we attempted to determine if naturally infected pet turtles would have salmonellae in the feces for prolonged periods of time. As an adjunct to the study, we tried to quantitate the levels of Salmonella contamination in the typical environment of a pet turtle.

An emergency medical service system--analysis of workload.

Abstract: The objective of this study is to determine the nature and distribution of emergencies and the workload of the emergency medical services system Staff members of the Injury Control Program were assigned to the San Francisco Health Department of accumulate reports on emergency patients treated by the city's emergency medical service Reports on ambulance and non-ambulance patients included site, time, circumstances, personal and emergency data, state of consciousness, prior aid, discharge and disposition, provisional diagnosis, treatment and condition Judgement was made on the urgency for treatment and use of the ambulance In 1964 the population served by the medical services system included 753,000 residents and 199,000 transients The total cost of operation to the city and county was about $1,100,000 per year There was 18,350 reports on ambulance patients and 39,470 on non-ambulance patients A 20% sample was used The proportion of white emergency patients was nearly equal to the proportion of white persons, Negroes 14 times greater, Indians 4 times and Orientals who constitute 79% of the population were only 33% of the emergency cases The percentage of total ambulance cases involving persons 35-84 years was from 1 to 26 greater than their representation; in non-ambulance cases ages 1-44 were greater, 45-84 less More than 66% suffered accidental injury The ratio of injury to disease was highest for the weekend About 30% of all emergencies occurred between midnight and noon Calls and admissions peaked at 4 pm to 6 pm Average number of ambulance runs per day was 43 43% cite the street or highway as place of emergency, 35% cite the home 90% of the patients were conscious In 67% of the emergencies time spent at the scene was 15 minutes or more Of the 7,671 patients for which information was reported, 87 were judged to have needed an ambulance About 80% of all patients were discharged in 15 minutes The accumulation of information provides input data for developing computer simulation studies on distribution of the workload in the emergency hospital and in other parts of an emergency medical service system /MW/

Pool drownings and their prevention.

Abstract: MERICANS are bringing the bathing beach into their communities and backyards. Twenty years ago, of an estimated 10,800 swimming pools of permanent inground construction in the United States, 2,500-less than 25 percent-were connected with homes or private residences (1). By 1966, when permanent pools of all classifications had increased to more than 700,000, more than 500,000 of these were home pools. Permanent pools are now estimated to be increasing by upwards of 50,000 each year. The following data (2) show the growth of pools in various categories over the past 20 years:

A public health program for sexually assaulted females.

Abstract: A 21/2 -year-old girl was taken to a local hospital after she was attacked in her home by an unknown man. She suffered deep vaginal tears. She was given a sedative and transferred to the municipal general hospital where she was examined, treated, and discharged. Her parents were instructed to give her sitz baths and to apply a vaginal cream. Four months after the incident, the child had recovered physically.