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Biomedical subjects

R B Rothenberg

Publications and source records attributed to R B Rothenberg.

53 records · Page 3Linked to original sources
PubMed1976

Efficacy of selected diagnostic tests for sexually transmitted diseases.

Direct urethral and cervical smears for gonorrhea in women are useful because of their high specificity. Male rectal smears are less efficacious. Direct tests for candidiasis and trichomoniasis are also specific, but less sensitive than generally thought. Most tests exhibit only moderate month-to-month variability. No association between infection with trichomonads and gonococci was demonstrated. The gonococcal tests all perform best under conditions of high prevalence, such as those that obtain in venereal disease clinics in the United States.

Candidiasis↗
PubMedDate not supplied

Public health surveillance for chronic conditions: a scientific basis for decisions.

In this paper we investigate the important contribution of multiple public health surveillance systems to policy in chronic disease control and prevention. We show that, typically, surveillance for chronic diseases relies on multiple data sources, often created for another purpose. We also define the concept of burden for chronic conditions based on data from multiple sources. An example from a state illustrates a model for combining data for use in policy development. These applications illustrate the central role of statistical methods in ensuring the appropriate use of data from multiple surveillance systems.

Cardiovascular Diseases↗
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Delivering breast and cervical cancer screening services to underserved women: Part I. Literature review and telephone survey.

Although breast and cervical cancer screening procedures have been shown to reduce morbidity and mortality, many women are not using these services. These women are likely to be older, of ethnic or racial minority, of low socioeconomic status, less educated, underinsured, or living in rural locations. Many breast and cervical cancer screening programs employ strategies to increase use. In order to identify and assess those strategies, we reviewed the literature and completed a telephone survey, altogether assessing 61 programs. Our study identified several strategies and found that not all strategies work for all women. Management systems directed to both patients and providers consistently are effective for most underserved women. Community-based outreach and integration of preventive services at the primary health care (PHC) site are effective strategies for both African American and Hispanic women. Use of mass media has been successful when targeted toward Hispanic women, but not when targeted toward African American women. Mobile units and integration of preventive services at PHC sites are effective strategies for elderly women. In many cases, a combination of strategies may be effective. Programs should employ strategies best suited to their target populations.

Adult↗
PubMedDate not supplied

Delivering breast and cervical cancer screening services to underserved women: Part II. Implications for policy.

Many breast and cervical cancer screening (BCCS) programs for underserved women employ strategies to increase the use of preventive services. In Phase I of a two-phase study, strategies were identified and assessed. In Phase II, we further assess strategies previously identified and comment on policy implications. Site visits were conducted at BCCS programs that had used one successful strategy identified during Phase I, provided services to underserved women, and were located in different geographic regions. The federally funded National Breast and Cervical Cancer Early Detection Programs (NBCCEDP) were also considered for site visits. Interviews were completed and available data were reviewed. A descriptive and qualitative analysis was completed. Programs visited were found to be increasing the use of BCCS services for the defined target populations. Some programs focused on outreach and recruitment. Other programs focused on clinical preventive services with little emphasis on outreach and recruitment. Management information systems were used by most programs. We found that there continues to be a large number of women not receiving BCCS services. Some programs have had to limit outreach and recruitment because the clinical preventive services offered are at capacity. Programs need to have a balanced approach to providing services from the outset. Existing programs may need to establish partnerships to provide comprehensive BCCS services to underserved women. Because the unmet need (women who have not received BCCS services) exceeds available clinical preventive services, it is a challenge to know how to best use available resources.

Adult↗
PubMedDate not supplied

Strategic planning system for control of venereal disease: record keeping in a clinic for treatment of sexually transmitted diseases.

A manual data processing system and a computer-based system that was integrated into the operations of a clinic for treatment of sexually transmitted diseases were developed. The automated system can generate routine management reports and cross-tabulate data for special studies. It is flexible and adaptable to other localities but is not a panacea for clinical problems.

Centers for Disease Control and Prevention, U.S.↗
PubMedDate not supplied

Analysis of routine data describing morbidity from gonorrhea.

A system was developed for the collection, coding, and processing of data from routine reports describing morbidity caused by gonorrhea. These data are coded centrally, and tables that provide information about the age, sex, race, source of care, and geographic and temporal distributions of the population affected by gonorrhea are generated. Applications of the system are described; these include study of distribution of the disease, trends in utilization of facilities, seasonal trends in incidence of the disease, and several features of recidivism in the Denver (Colorado) metropolitan area. This system has potential as a tool for evaluation of disease control efforts in any standard metropolitan statistical area.

Age Factors↗
PubMedDate not supplied

Gonorrhea as a social disease.

Gonococcal infection in Colorado Springs, Colorado, is concentrated in about 1% of the population. The social groups at risk are characterized as young, nonwhite, heterosexual, and connected to the military. They exhibit residential proximity by clustering in "core" census tracts; 51% of cases were in four tracts. They demonstrate residential stability and close social association at preferred sites for nighttime leisure activity (six major sites out of 300 available). Social aggregation is further demonstrated by the length of social contact prior to sexual contact (45% had known each other for over two months), the neighborhood nature of sexual choices, and the grouping of sexually connected individuals in lots (six lots contained 20% of cases). The force of infectivity, measured in person-days of potential spread of gonorrhea by infected contacts, provides a quantitative assessment of the important of identifiable social groups in the transmission of gonorrhea.

Colorado↗
PubMedDate not supplied

Disease transmission by heterosexual men with gonorrhea: an empiric estimate.

In Colorado Springs, Colorado, between January and June 1981, approximately 400 cases of gonorrhea in heterosexual men generated approximately 200 "spread" cases in women. The ratio of spread cases to index cases (0.5) is an empiric measure of the reproductive rate for the disease, i.e., the rate at which an infected person replaces himself. Although a reproductive rate of less than one theoretically should produce extinction of the disease, the rate derived from these data is shown to be a weighted average of the rates in symptomatic men (0.31), subsymptomatic men (0.79), and asymptomatic men (1.30). Approximately 35% of gonorrhea transmitted by men may be attributed to the asymptomatic group, which constitutes 10-15% of the infected population. If the observations in this community are applied to the nation as a whole, we estimate that approximately 1.7 million cases of gonorrhea occurred in 1981, as compared with the 990,864 cases actually occurred in 1981, as compared with the 990,864 cases actually reported. This estimate is close to those usually quoted but differs in gender composition. Whereas the observed male-to-female ratio is 1.48:1, the predicted ratio, based on estimates of reproductive rates in subgroups, is 0.8. This analysis supports the theoretical notion that the endemicity of gonorrhea is maintained by heightened transmission within small groups, and it suggests that underdetection is more important than underreporting in the assessment of the "true" incidence of this infection.

Colorado↗
PubMedDate not supplied

Temporal and social aspects of gonorrhea transmission: the force of infectivity.

Theoretical consideration of the epidemiology of sexually transmitted diseases (STD) suggests that the key determinants of transmission dynamics are the duration of infectiousness and the extent to which subgroups in the population interact sexually. We used two empirical correlates to represent these concepts: (1) the force of infectivity, calculated by summing all the days of potential infectivity (the time between last sexual exposure and treatment of the contact) generated by a given case, and then summing the days for all cases within a given subgroup; (2) self-selection, representing the observed probability that members of a given subgroup select sexual partners from within their own group. Using data gathered in Colorado Springs, Colorado, we estimated that a single group i.e., black, male, heterosexual, military personnel residing in the core areas, generated 27% of the force of infectivity. Subgroups that select greater than 50% of their sexual partners from outside their sociodemographic boundaries generated a rate for the force of infectivity that was 4.5 times higher than the rate for self-selectors. These findings confirm the core group theory and suggest strategies for control of STD.

Adult↗
PubMedDate not supplied

Syphilis control. The historic context and epidemiologic basis for interrupting sexual transmission of Treponema pallidum.

Syphilis control has been the prototypic sexually transmitted disease (STD) public health program of the 20th century. However, the disease remains nearly as much an epidemiologic enigma as it did in the early 1900s. This article examines the historic and epidemiologic bases for syphilis control, using unpublished data to supplement a recent model of STD transmission. The authors recommend building on such traditional individually oriented strategies as case finding, partner notification, and presumptive treatment as a basis for future community-oriented, population-based strategies including (but not limited to) selective mass treatment in high-prevalence populations. Using epidemiologic information to target population-level interventions will be the paradigm for syphilis control in the 20th century.

Communicable Disease Control↗
PubMedDate not supplied

The community ecology of diabetes patient classification and practice characteristics.

We examined the clinical and epidemiologic characteristics of diabetic subjects ascertained from five different sources (hospital, private practice, specialist practice, nursing home, and prevalence survey) in a medium-sized upstate New York community. Patients were categorized using the National Diabetes Data Group classification (based on weight and insulin requirement) and using an alternative clinical classification scheme based on age at onset and insulin use. Both classifications demonstrate marked differences in the distribution of diabetic subjects. Those seen in general medical practice reflect the prevalent population and tend to have fewer complications and less insulin requirement. Those seen in specialist practice or in hospital have higher complication frequencies. Thus, the source of patients may determine the epidemiologic picture of the disease, as well as the practitioners' perceptions. Use of the clinical classification scheme helps to identify a subgroup of diabetic subjects--those with onset past the age of 25 yr who use insulin--at greatest risk of complications. Further investigation of high-risk groups is warranted, particularly for the implementation and evaluation of diabetes control programs.

Adolescent↗
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Ischemic heart disease and hypertension: effect of disease coding on epidemiologic assessment.

During the changeover from the eighth to the ninth revision of the "International Classification of Diseases: Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death" (ICD), there were several major alterations of coding for the rubrics Ischemic Heart Disease (IHD) and Hypertension (HBP). As expected, these changes caused major discontinuities for IHD and HPB. These discontinuities were not, however, uniform over sex-race groups. When examined by component ICD codes, the discontinuities were found to vary in both magnitude and direction among the groups. In addition to discontinuity, there was a change in the rate of decline for IHD and HBP after the changeover. This rate of decline varied as well by sex-race group. In general, the decline among blacks was slower than among whites. Earlier studies that assessed IHD mortality have used different groupings of ICD codes to obviate the discontinuity, and researchers have observed a similar differential decline. These results should be viewed with caution because of the potential impact of differential coding on sex-race groups. As preparations are made for ICD-10, special attention should be given to the preservation of epidemiologic continuity to provide better assessment of trends in population subgroups.

Black People↗
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Epilogue. Establishment of the Center for Chronic Disease Prevention and Health Promotion.

The establishment of the Center for Chronic Disease Prevention and Health Promotion (CCDPHP) at the Centers for Disease Control (CDC) following the Conferences on the State of the Art in Quality Control Measures for Diagnostic Cytology Laboratories is briefly discussed. The CCDPHP is expected to play a major role in the CDC's cancer control program, including participation in establishing effective screening programs and assuring the quality of such methodologies as the Papanicolaou test and mammography.

Centers for Disease Control and Prevention, U.S.↗
PubMedDate not supplied

A controlled trial of disease surveillance strategies.

Active surveillance techniques using routine telephone contacts with providers improved the reporting of measles, rubella, salmonellosis, and hepatitis by a factor of 4.6 among private physicians in Monroe County, New York, and increased reporting for these target diseases from all sources by 51 percent. The timeliness of reporting was not improved by active surveillance. Reporting patterns varied by disease and source of report, suggesting the desirability of various approaches to surveillance based on local resources and priorities. Although reporting rates were higher for diseases among persons from census tracts of low socioeconomic status, physicians providing care to persons living in low-income areas responded no differently to active reporting than did those providing care to patients from middle- and high-income areas.

Hepatitis↗
PubMedDate not supplied

A civilian-military partnership to reduce the incidence of gonorrhea.

To reduce the incidence of gonorrhea in the Colorado Springs, Colo., area, casefinding measures (interviewing of patients and tracing of contacts) were conscientiously applied by the local health department, in cooperation with the U.S. Army, to more than 90 percent of reported cases during a 3-year period. Nearly 4,000 cases of gonorrhea--2,127 civilian and 1,811 military--were interviewed; they named 7,399 contacts. A total of 1,141 cases of gonorrhea were newly identified and patients brought to treatment in Colorado Springs as a result. Implementation of these measures was associated with a 12.9 percent overall decline in gonorrhea incidence. This decline was most pronounced in the civilian population (20 percent), while little change in incidence occurred in the military population. The data presented suggest that the orderly application of casefinding epidemiology, allied with other control program initiatives, can interrupt transmission of, and prevent, disease.

Colorado↗
PubMedDate not supplied

Confounding in community interventions.

Evaluations of community intervention projects usually use the community as the unit of analysis and employ a possibly costly cohort approach, which may not achieve sufficient power. The case-control approach, applied extensively in cancer control, may be an inexpensive alternative. Moreover, the case-control approach permits evaluation of potential confounding by factors possibly associated with the intervention. A simulation based on case-control methodology for calculating an intervention program effect (prevented fraction) demonstrates that the threat of confounding, at levels of prevented fractions in the range of 10% to 30%, is modest. Community-based interventions with lower prevented fractions are more susceptible, and their results should be considered with caution. Such boundaries may be of use to investigators in planning and evaluating community-based efforts to reduce risk and control disease.

Case-Control Studies↗