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Biomedical subjects

D H Freeman

Publications and source records attributed to D H Freeman.

At least 37 records · Page 2Linked to original sources
PubMed1995

Childhood lead poisoning in Massachusetts communities: its association with sociodemographic and housing characteristics.

OBJECTIVES: The purpose of the study was to examine the relationship between communities' sociodemographic and housing characteristics and incidence of lead poisoning. METHODS: This was a population-based correlational study of 238,275 Massachusetts children from birth through 4 years of age who were screened for lead poisoning in 1991-1992. A logistic regression model was developed with the community as the unit of analysis, the case identification rate for lead poisoning (newly identified children with venous blood lead > or = 25 micrograms/dL per 1000 children) as the dependent variable, and US census variables as independent variables. RESULTS: A significant independent relationship with the community case identification rate of lead poisoning was found for seven variables: median per capita income, percentage of housing built before 1950, percentage of the population who were Black, percentage of children screened, and a "poverty index." Rates of iron deficiency and percentage of Hispanics were not associated with the case identification rate of lead poisoning. CONCLUSIONS: Massachusetts communities' incidence of lead poisoning is correlated with sociodemographic and housing characteristics. In states similar to Massachusetts and without screening data, this model may help target screening programs.

Black or African American↗
PubMed1994

A clinical trial of antioxidant vitamins to prevent colorectal adenoma. Polyp Prevention Study Group.

BACKGROUND: People who consume a diet high in vegetables and fruits have a lower risk of cancer of the large bowel. Antioxidant vitamins, which are present in vegetables and fruits, have been associated with a diminished risk of cancers at various anatomical sites. We conducted a randomized, controlled clinical trial to test the efficacy of beta carotene and vitamins C and E in preventing colorectal adenoma, a precursor of invasive cancer. METHODS: We randomly assigned 864 patients, using a two-by-two factorial design, to four treatment groups, which received placebo; beta carotene (25 mg daily); vitamin C (1 g daily) and vitamin E (400 mg daily); or the beta carotene plus vitamins C and E. In order to identify new adenomas, we performed complete colonoscopic examinations in the patients one year and four years after they entered the study. The primary end points for analyses were new adenomas identified after the first of these two follow-up examinations. RESULTS: Patients adhered well to the prescribed regimen, and 751 completed the four-year clinical trial. There was no evidence that either beta carotene or vitamins C and E reduced the incidence of adenomas; the relative risk for beta carotene was 1.01 (95 percent confidence interval, 0.85 to 1.20); for vitamins C and E, it was 1.08 (95 percent confidence interval, 0.91 to 1.29). Neither treatment appeared to be effective in any subgroup of patients or in the prevention of any subtype of polyp defined by size or location. CONCLUSIONS: The lack of efficacy of these vitamins argues against the use of supplemental beta carotene and vitamins C and E to prevent colorectal cancer. Although our data do not prove definitively that these antioxidants have no anticancer effect, other dietary factors may make more important contributions to the reduction in the risk of cancer associated with a diet high in vegetables and fruits.

Adenomatous Polyps↗
PubMed1994

Aryepiglottic fold width in patients with epiglottitis: where should measurements be obtained?

PURPOSE: To determine the best site for measurement or assessment of the aryepiglottic folds and determine whether evaluation of the lower portion of the folds is useful. MATERIALS AND METHODS: The lateral neck radiographs from 38 children with epiglottitis were retrospectively reviewed and compared with findings in 100 patients with croup and 100 control patients. In all patients, the fold thickness was measured at three levels: at the midpoint (site 1), just behind the epiglottis (site 2), and at the base, just above the false vocal cords (site 3). RESULTS: Full-thickness measurements obtained at sites 1 and 2 were statistically significant predictors of epiglottitis (sensitivity, 94.74%; specificity, at least 96.50%) in comparison with those obtained in patients with croup and control patients. CONCLUSION: The best site for width assessment is the upper half of the folds. Measurement at the base, where the folds overlie the arytenoid cartilage, is not nearly as accurate and should be avoided.

Child↗
PubMed1994

HIV infection, risk behaviors, and depressive symptoms among Puerto Rican sex workers.

This paper examines the association of depressive symptoms with human immunodeficiency virus (HIV) infection and risk behaviors among 127 sex workers. Data were obtained by a structured interview and blood specimens tested for HIV. Findings showed a high prevalence rate of depressive symptoms for all sex workers regardless of HIV infection status. Results of a logistic regression analysis indicated that the use of injected drugs and engaging in unprotected intercourse with clients were strongly associated with a high level of depressive symptoms.

Adolescent↗
PubMed1994

HIV/AIDS risk perception, HIV risk behaviors, and HIV seropositivity among injection drug users in Puerto Rico.

This paper assesses the factors related to self perception of developing AIDS among a group of 1,568 Puerto Rican injection drug users (IDUs). Incarceration history, years of drug injection, sharing needles, renting and borrowing needles, sharing rinse water or cooker, and having an IDU sex partner yielded a moderate association with HIV/AIDS risk perception. Use of sterile needles, shooting drugs alone, having had previous treatment episodes, and all the variables related to health status were also moderately associated with HIV/AIDS risk perception. A logistic regression model based on backwards elimination procedure, which included statistically significant variables in the bivariate analyses, yielded the variables living with children, sex with an IDU partner, shooting drugs alone, perception of health, having had a sexually transmitted disease, and results of HIV testing as statistically significant (p < 0.05).

Acquired Immunodeficiency Syndrome↗
PubMed1993

The periodic health examination provided to asymptomatic older women: an assessment using standardized patients.

OBJECTIVES: To describe physical examination and cancer prevention services provided by primary care physicians in response to the request for a "checkup" by an asymptomatic 55-year-old woman seeking to establish ongoing care; to assess the effects of two interventions (education and office organization) intended to improve these services; and to assess the feasibility of using "standardized" patients to evaluate physician responses to such a request. SETTING: Northern New England. PARTICIPANTS: Fifty-nine primary care physicians who were accepting new patients and were participating in a study of early detection and prevention of cancer. DESIGN: Cross sectional; observations of patient visits. INTERVENTIONS: Actresses trained to portray a specific patient role ("standardized" or "simulated" patients) visited each physician once. Physicians were blinded to the simulated patients' true identities. MEASUREMENTS: Actresses reported the components of the general physical examination and the cancer-related "checkup." Most interactions were audiotaped. RESULTS: Fourteen physical examination components were measured, ranging from assessment of vibratory sense (5%) to measurement of blood pressure (98%). Provision of 10 services recommended by the National Cancer Institute to standardized patients included 16% being advised to reduce dietary fat; 53% to do monthly breast self-examination; 74% to quit smoking; and 89% to obtain a mammogram. Physicians spent from 5 to 60 minutes with the patients. Two physicians did not charge, whereas others charged from $24 to $108. Study group assignment was not associated with statistical differences in provider performance. Two standardized patients (3%) were detected by physicians. Audiotapes were used to verify the actresses' ability to replicate their scenario (consistently repeat their performance) and to verify physician performance. CONCLUSIONS: Physician responses to an identical patient request varied widely in terms of time spent with the patient, the services provided, and the cost of the visit. Using standardized patients is a feasible method for assessing physician performance of the periodic health examination while controlling for case mix.

Adult↗
PubMed1993

Reduced risk of large-bowel adenomas among aspirin users. The Polyp Prevention Study Group.

BACKGROUND: Epidemiological studies have indicated that aspirin consumption can lower the risk of large-bowel cancer. These studies are not entirely consistent, however, and their interpretation has been complicated by the possibility that cancer symptoms may have led patients to avoid aspirin or that aspirin may have influenced cancer diagnosis and treatment. PURPOSE: Our purpose was to determine the effect of aspirin on risk of large-bowel neoplasms in a study in which aspirin use would not be expected to affect tumor detection and tumor-related symptoms would not likely influence aspirin use. A less complicated assessment of the relationship between aspirin and large-bowel tumors should thus be possible. METHODS: We studied 793 patients enrolled in a clinical trial of nutrient supplements to prevent large-bowel adenomas. Unlike invasive cancers, adenomas usually do not cause symptoms or detectable gastrointestinal bleeding; thus, adenomas are unlikely to influence aspirin use. Each patient had at least one large-bowel adenoma diagnosed and removed shortly before study entry and had been judged to be free of further tumors by colonoscopy. Use of aspirin was assessed by responses on questionnaires administered 6 and 12 months after enrollment. We performed complete colonoscopies on all patients 1 year after they entered the study and removed all polyps. RESULTS: Patients who reported taking aspirin on both questionnaires (consistent users) had a lower risk of new adenomas at their 1-year follow-up colonoscopy (odds ratio = 0.52; 95% confidence interval = 0.31-0.89) compared with patients who did not report using aspirin on either of the questionnaires. The apparent protective effect of consistent aspirin use was present among both men and women and did not appear to be influenced by the number of prior adenomas. CONCLUSIONS: These data further support the hypothesis that aspirin has an antineoplastic effect in the large bowel. Nevertheless, the question of whether aspirin should be used to prevent large-bowel tumors would be best answered by a randomized controlled clinical trial specifically designed to address this issue.

Adenoma↗
PubMed1993

Rural-urban child psychopathology in a Northeastern U.S. state: 1986-1989.

Parent and teacher symptom reports from two epidemiological surveys of 2,519 Connecticut children were used to study rural-urban differences in childhood psychopathology. Parents and teachers of girls in cities reported elevated total disturbance and social withdrawal. Parents of urban girls also reported higher rates of behavioral disturbance. For boys, urban excesses were primarily observed in emotional disturbance. Rural-urban variation was largely associated with economic and cultural differences between sites and not with urbanization per se. Findings suggest that certain assumptions about rural-urban differences in specific forms of psychopathology, such as delinquency, should be reevaluated.

Anxiety Disorders↗
PubMed1993

Drug abuse and illicit drug use in Puerto Rico.

OBJECTIVES: Based on an epidemiologic field survey of community households in Puerto Rico, this study estimates the frequency of illicit drug use and clinically defined drug abuse and/or dependence syndromes. Results are compared with those from surveys on the United States mainland. Suspected risk factors are studied as well, with a special focus on childhood misbehavior. METHODS: Trained lay interviewers administered a Spanish Diagnostic Interview Schedule to 912 respondents aged 17 to 68 years who were selected by multistage probability sampling of island households. RESULTS: An estimated 8.2% of the population had a history of illicit drug use and 1.2% qualified for a standardized lifetime diagnosis of drug abuse, dependence, or both. An estimated 18.4% of the male drug users and 7.7% of the female drug users met criteria for drug abuse and/or dependence. A history of drug use was related to the diagnoses of alcohol abuse and/or dependence and antisocial personality, but few persons who had used illicit drugs at least once in their lifetime reported a history of receiving treatment for alcohol, drug, or mental health problems. CONCLUSIONS: The data were consistent with a suspected association between level of childhood misbehavior and occurrence of illicit drug use, even after statistical control for potentially confounding variables.

Adolescent↗
PubMed1993

Incarceration history as a risk factor for HIV infection among Puerto Rican injection drug users.

This study assesses factors associated with incarceration history and HIV seropositivity among 1,700 out-of-treatment drug injectors recruited in Puerto Rico between 1989-1990 from health care centers, emergency rooms, copping areas, shooting galleries, bars, billiard rooms and street corners. Analysis links incarceration history with criminal involvement and chronic drug use. After controlling for sociodemographics and previously reported correlates of HIV status, regression analysis shows incarceration history significantly relates to HIV status. The only predictor of incarceration history not related to HIV status was illegal activity as a major source of income. Analysis emphasizes HIV prevention programs within the penal system.

Adult↗
PubMed1993

Human immunodeficiency virus infection and risk behaviors among injection drug users in four Puerto Rican communities.

This study compares the prevalence of human immunodeficiency virus (HIV) infection and HIV risk behaviors among 1,702 injection drug users (IDUs) recruited within four catchment areas in metropolitan San Juan (79.9% male and 20.1% female). To assess the impact of different antecedent variables on intercommunity risk differences, we constructed separate logistic regression models for each one of the catchment areas in the analysis. Old San Juan/Santurce has the highest rate of HIV seropositivity. Furthermore, Old San Juan/Santurce IDUs were more likely to have had incarceration experience, to report using drugs only by injection, and to have been injecting drugs for 16 years or more. Also, this group was more likely to report practicing prostitution and to have been diagnosed with sexually transmitted diseases (STDs) than their peers from the other sites. The need of preventive programs in specific communities within metropolitan urban areas is discussed.

Adult↗
PubMed1993

HIV risk behaviors and HIV seropositivity among young injection drug users.

Although injection drug use (IDU) is the major risk category for HIV infection in Puerto Rico and injection drug users start their drug injection careers very young, there is little information related to drug injection patterns of young IDUs. In this paper we report on factors found to be associated with HIV seropositivity among 255 young IDUs (16-24 years old). Overall, 23.5% subjects were HIV seropositive. Being 22 to 24 years old, having dropped out of school, having a history of incarceration, and having been diagnosed with STDs, and initiating drug use injection before 17 years of age were the factors significantly related to HIV seropositivity. Findings suggest that prevention programs should begin early in the development of youngsters. Special HIV and STD preventive programs for youngsters at risk of leaving school before completing high school should be a priority.

Adolescent↗
PubMed1992

Social support and depressive symptoms in the elderly.

The purpose of this study was to examine the effect of characteristics of social networks and support on depressive symptoms in the elderly. The subjects were 1,962 noninstitutionalized persons 65 years and older from the New Haven Establishment of Populations for Epidemiologic Study of the Elderly in 1982, who were available to give a complete follow-up interview in 1985. Baseline depression, functional disability in 1982, and any change in disability by 1985 were considered as additional influences on 1985 depression, requiring adjustment along with sociodemographic variables. Multiple regression procedures were used to simultaneously examine the variables. Baseline depression, functional disability, and change in functional disability made the largest contribution to explaining the variance in depression. Among the social support and network characteristics, loss of a spouse, adequacy of emotional support, and its change during 1982-1985 made the largest contributions. Other significant characteristics in relative order of magnitude of effect, based on contrast tests, included tangible support adequacy and its change, loss of a confidant between 1982 and 1985, number of children making weekly visits and change in this number by 1985, and the absence of a confidant in both 1982 and 1985. For mental health outcomes, these findings emphasize the need to consider specific dimensions of social support and networks rather than global measures.

Aged↗
PubMed1992

Improving future preventive care through educational efforts at a women's community screening program.

Cervical cancer mortality continues to be a significant problem in the United States. Pap Test screening programs have been effective in attracting high risk women, but the impact of these programs on subsequent health care has seldom been explored. This follow up study examined the impact of a cervical cancer screening and education program on preventive health behaviors of New Hampshire women in the 24 months following the screening program. A mailed survey was sent to a random sample of 750 women from program participants to evaluate both their recent preventive health care practices and to identify perceived barriers to obtaining preventive health services. Of these, 71.1 percent responded. Survey responses of the original program participants were linked to each subject's previous answers to the same questions asked 24 months earlier. A comparison group was derived by asking follow up study participants to identify a female acquaintance within five years of her age. Seventy-four percent of the comparison group responded. Survey responses of original program participants were then compared to those of the comparison group. Results indicate that women who participated in the original Project received significantly more preventive health care services in the two years since the Project than in the two years prior to it. Women in the comparison group received more Paps and clinical breast examinations than women in the participant group, perhaps because all participants had received a Pap test two years before. Having a regular health care provider was the most significant characteristic associated with obtaining indicated preventive services. An important contribution of community screening programs may be to encourage women to establish a regular source of care.

Adult↗
PubMed1992

A receiver operating characteristic (ROC) curve analysis of a model of mental health services use by Puerto Rican poor.

In this study, the contribution of four distinct domains of the Help Seeking-Decision Making model to predicting the use of mental health services is examined. Using a proposed methodology the authors assess the relevance of this model and its domains to mental services planning. The methodology combines logistic regression analysis and receiver operating characteristic (ROC) curves. Logistic regression analysis allows us to examine the individual variables of the model and generate predictions about use. ROC curves allow us to compare and interpret the relative contribution of a predisposing domain, a physical and mental health domain, an enabling-restrictive domain, and an organizational domain in correctly classifying users and nonusers of mental health services. The physical and mental health domain yielded a Somer's D-statistic of 0.7, which corresponds to an 85% correct classification of randomly selected pairs of users and nonusers. The study findings suggest that comparing ROC curves helps to describe and interpret the domains of the model that are relevant for making predictions about who will or will not use mental health services during a 1-year period.

Adolescent↗
PubMed1991

Cancer staging may have different meanings in academic and community hospitals.

We investigated differences in lung cancer care and outcome between academic and community settings for all lung cancer patients diagnosed during 1973-1976 in New Hampshire and Vermont. Trained abstracters reviewed hospital charts to record personal, diagnostic, and clinical information, and survival was determined for all patients through the end of 1979. Patients diagnosed in university hospital cancer centers underwent more staging procedures and tended to be assigned to a higher stage than similar patients diagnosed in community hospitals. When tumor stage was considered as a covariable in a survival analysis, these patients appeared to have a lower mortality rate both for non-small cell tumors (mortality rate ratio, 95% confidence interval = 0.81, 0.71-0.91) and for small cell tumors (0.71, 0.55-0.91). When functional status rather than tumor stage was used to adjust for disease severity, there was no apparent survival advantage for university patients with non-small cell cancer (0.96, 0.85-1.09) and the lower mortality for small cell cancers (0.76, 0.59-0.97) was attenuated, although still statistically significant. We conclude that inconsistently-collected data on clinical stage can complicate comparisons of prognosis between cancer patients from different types of hospitals and that measures of performance status may be more useful indicators of disease severity in population based studies.

Academic Medical Centers↗
PubMed1991

Characteristic hostility in schizophrenic outpatients.

In this study of 133 schizophrenic outpatients, we assessed characteristic hostility and correlates of hostility over a 6-month period. Results showed that 13 percent of the study group were characteristically violent, 18 percent were characteristically threatening, and another 21 percent were irritable and argumentative. About half (48%) were without hostility. A multiple regression model identified six variables--housing instability, hallucinations or delusions, schizoaffective diagnosis, lack of depression, alcohol use, and bizarre behavior--that together accounted for over 50 percent of the variance in observed characteristic hostility. Hostility also predicted rehospitalization and total inpatient days during 1-year followup. Implications of these findings for assessment and future research are discussed.

Adult↗