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PubMedDate not supplied

School-based clinics: the Baltimore experience.

Adolescents are at risk for a wide range of problems necessitating creative approaches to the delivery of health care. Baltimore City has responded to this challenge by opening seven school-based clinics (SBCs) that provide comprehensive health and social services to adolescents. This article summarizes the history of SBCs, the range of services, and the role of community involvement. A major focus of this article is the independent role of the nurse practitioner as clinical expert and educator.

Adolescent↗
PubMedDate not supplied

Cholesterol as a risk factor for coronary heart disease in elderly men. The Baltimore Longitudinal Study of Aging.

In order to explore the relationship of cholesterol to coronary heart disease (CHD), defined as angina pectoris, myocardial infarction, and sudden coronary death, in older men, a group of 1052 men, participants in the Baltimore Longitudinal Study on Aging, were examined. Subjects were stratified into three age groups, 28 to 64, 65 to 74, and 75 to 97 years old. In all three age groups, cholesterol was a significant risk factor for CHD. In the oldest age group (n = 250), the relationship between cholesterol and risk was linear (P = .003) as opposed to younger age groups where the relationship was exponential. This study extends the age range in which hypercholesterolemia has been shown to be associated with CHD to include the 75- to 97-year range.

Adult↗
PubMed2005

Population-based study of police-reported sexual assault in Baltimore, Maryland.

OBJECTIVE: To document the population-based incidence of sexual assault in Baltimore, Md, victims' alcohol/drug use, and pre-event circumstances. METHODS: Between 1997 and 1999, the city's sexual assault treatment center treated 1,038 victims (age>or=13 years). Data were extracted from forensic narratives. Analysis was restricted to frequency tables and bar graphs. Incidence was calculated based on 1998 population figures. RESULTS: The incidence of sexual assault among females aged 13 years or older was 117 per 100,000. Seventy percent of patients were less than 30 years old. Fifty-three percent tested positive for alcohol/drugs. Two thirds sustained physical or genital injury; 30% sustained both. The most common pre-event circumstances were walking/being followed (27%) and visiting a friend's home (24%). CONCLUSION: This study revealed a high prevalence of physical/genital injury, supporting the call for an injury severity scale for sexual assault and for increased substance abuse counseling and educational/health resources to mitigate sexual assault and offer meaningful response when such crimes occur.

Adolescent↗
PubMed2006

Neighborhoods and obesity in older adults: the Baltimore Memory Study.

BACKGROUND: Obesity has reached epidemic proportions. Although its causes are not well understood, its increasing prevalence is not likely to be due to genetic factors or underlying biology. This has led to interest in the role of environmental factors, although few studies have focused on the role of the social environment. This study investigated whether neighborhood psychosocial hazards independent of individual risk factors were associated with increased odds of obesity. METHODS: Baseline data were analyzed in 2005 from a cohort study of 1140 randomly selected community-dwelling men and women aged 50 to 70 years from 65 contiguous neighborhoods in Baltimore MD. Body mass index (BMI in kilograms/meters squared) was calculated from measured height and weight at baseline (2001-2002). People with a BMI of 30 and higher were considered obese. Multilevel logistic regression was used to examine associations between a 12-item scale of neighborhood psychosocial hazards and the odds of obesity. RESULTS: Thirty-eight percent of the cohort were obese. Residents of neighborhoods in the highest quartile of the Neighborhood Psychosocial Hazards scale were nearly twice as likely to be obese compared to residents in the least-hazardous neighborhoods (53% vs 27%). After adjustment for age, gender, race/ethnicity, education, household wealth, alcohol consumption, tobacco use, self-reported physical activity, and dietary intake, living in more hazardous neighborhoods was associated with a graded increase in the odds of obesity. This association was partially mediated by physical activity. CONCLUSIONS: Even after controlling for a large set of demographic, behavioral, and socioeconomic individual-level risk factors, living in a neighborhood with greater psychosocial hazards was independently associated with obesity.

Aged↗
PubMed2004

Are partners available for post-abortion contraceptive counseling? A pilot study in a Baltimore City clinic.

About half of the 1.2 million abortions each year in the United States are repeat abortions. While most abortion providers counsel women about contraception, one reason for the high repeat rate could be failure to take into account the social context of the women--in particular, the male partner. To assess whether there might be a window of opportunity for a contraceptive intervention that includes the male partner at the time of the abortion, we undertook a pilot study at an urban abortion clinic to examine the role of the male partner among women receiving abortions. Between May 2001 and August 2002, two questionnaires were administered to 109 women receiving abortions in a Baltimore City clinic. On the procedure day, women were more likely to be accompanied by a male partner upon arrival (30%) or when leaving (34%) than by any other individual. The majority of women receiving abortions reported that their partners played positive decision-making and support roles throughout the abortion process. A significant proportion of couples could be available for contraceptive counseling following an abortion, providing rationale for couples' post-abortion contraceptive counseling for women whose partners are already actively and positively involved in the abortion process. Such an intervention may help to reduce repeat abortions.

Abortion, Induced↗
PubMed2005

Longitudinal predictors of injection cessation and subsequent relapse among a cohort of injection drug users in Baltimore, MD, 1988-2000.

OBJECTIVE: To determine predictors of injection drug use cessation and subsequent relapse among a cohort of injection drug users (IDUs). METHODS: IDUs in Baltimore, MD were recruited through community outreach in 1988-1989. Among IDUs with at least three follow-up visits, parametric survival models for time to injection cessation (>or=6 months) and subsequent relapse were constructed. RESULTS: Of 1327 IDUs, 94.8% were African American, 77.2% were male, median age was 34 years, and 37.7% were HIV-infected. Among 936 (70.5%) subjects who ceased injection, median time from baseline to cessation was 4.0 years. Three-quarters subsequently resumed injection drug use, among whom median time to relapse was 1.0 year. Factors independently associated with a shorter time to cessation were: age <30 years, stable housing, HIV seropositivity, methadone maintenance treatment, detoxification, abstinence from cigarettes and alcohol, injecting less than daily, not injecting heroin and cocaine together, and not having an IDU sex partner. Factors independently associated with shorter time to injection relapse were male gender, homelessness, HIV seropositivity, use of alcohol, cigarettes, non-injection cocaine, sexual abstinence and having a longer time to the first cessation. CONCLUSIONS: This study provides strong support for targeting cessation efforts among young IDUs and severely dependent, unstably housed, and HIV-infected individuals.

Adult↗
PubMed2005

Places of social poverty and service dependency of people with intellectual disabilities: a case study in Baltimore, Maryland.

In the United States, post-asylum geographies of people with intellectual disabilities implicate the condition of service dependency in their social impoverishment, here defined as "isolation from the community and lack of real friendships and relationships" (The importance of income. The Self-Determination National Program Office of the Institute on Disability, University of New Hampshire, Concord, 1998, p. 2). Social historical geographies of people with intellectual disabilities, both general and local to Baltimore, Maryland, contextualize how one voluntary service organization re/created service dependency and social poverty of people with intellectual disabilities through residential location decisions.

Baltimore↗
PubMed2006

Testing the Paleolithic-human-warfare hypothesis of blood-injection phobia in the Baltimore ECA Follow-up Study--towards a more etiologically-based conceptualization for DSM-V.

OBJECTIVE: The research agenda for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) has emphasized the need for a more etiologically-based classification system, especially for stress-induced and fear-circuitry disorders. Testable hypotheses based on threats to survival during particular segments of the human era of evolutionary adaptedness (EEA) may be useful in developing a brain-evolution-based classification for the wide spectrum of disorders ranging from disorders which are mostly overconsolidationally such as PTSD, to fear-circuitry disorders which are mostly innate such as specific phobias. The recently presented Paleolithic-human-warfare hypothesis posits that blood-injection phobia can be traced to a "survival (fitness) enhancing" trait, which evolved in some females of reproductive-age during the millennia of intergroup warfare in the Paleolithic EEA. The study presented here tests the key a priori prediction of this hypothesis-that current blood-injection phobia will have higher prevalence in reproductive-age women than in post-menopausal women. METHOD: The Diagnostic Interview Schedule (version III-R), which included a section on blood and injection phobia, was administered to 1920 subjects in the Baltimore ECA Follow-up Study. RESULTS: Data on BII phobia was available on 1724 subjects (1078 women and 646 males). The prevalence of current blood-injection phobia was 3.3% in women aged 27-49 and 1.1% in women over age 50 (OR 3.05, 95% CI 1.20-7.73). [The corresponding figures for males were 0.8% and 0.7% (OR 1.19, 95% CI 0.20-7.14)]. CONCLUSIONS: This epidemiological study provides one source of support for the Paleolithic-human-warfare (Paleolithic-threat) hypothesis regarding the evolutionary (distal) etiology of bloodletting-related phobia, and may contribute to a more brain-evolution-based re-conceptualization and classification of this fear circuitry-related trait for the DSM-V. In addition, the finding reported here may also stimulate new research directions on more proximal mechanisms which can lead to the development of evidence-based psychopharmacological preventive interventions for this common and sometimes disabling fear-circuitry disorder.

Adult↗
PubMed2005

Contribution of impaired glucose tolerance in subjects with the metabolic syndrome: Baltimore Longitudinal Study of Aging.

BACKGROUND: In addition to fasting plasma glucose (FPG), we examined the contribution of the oral glucose tolerance test (OGTT) in the prevalence of subjects with the metabolic syndrome (MS). METHODS AND RESULTS: Study participants were white adults in the Baltimore Longitudinal Study of Aging who underwent a fasting 2-hour OGTT. In men between the ages of 20 to 39, 40 to 59, 60 to 79, and 80 to 95 years, the prevalence of the MS by Adult Treatment Panel (ATP) III criteria (which excludes OGTT) was 11%, 28%, 32%, and 15%, respectively; whereas in women the prevalence was 5%, 12%, 24%, and 16%, respectively. If the current ATPIII dysglycemia criteria also included a 2-hour postchallenge glucose (2hPG) of 7.8 mmol/L or higher, the prevalence of the MS increased from 25% to 33% in men and from 15% to 21% in women (P<.0001). In study participants with FPG less than 5.6 mmol/L, the prevalence of the MS increased from 16% to 23% in men and from 9% to 13% in women. In men between the ages of 20 to 39, 40 to 59, 60 to 79, and 80 to 95 years and FPG less than 5.6 mmol/L, the prevalence of the MS increased to 15%, 32%, 40%, and 29%, respectively (P<.005 for men between 40 and 95 years of age), with inclusion of an abnormal 2hPG. In women between the ages of 20 to 39, 40 to 59, 60 to 79, and 80 to 95 years and FPG less than 5.6 mmol/L, the prevalence of the MS increased to 7%, 14%, 33%, and 31%, respectively, with inclusion of an abnormal 2hPG (P<.001 for women between 60 and 95 years of age). CONCLUSION: The prevalence of the MS is significantly underestimated when the current ATPIII criteria of FPG 6.1 mmol/L or higher is the only determinant of dysglycemia.

Adult↗
PubMed2005

Calcium channel blockers and risk of AD: the Baltimore Longitudinal Study of Aging.

OBJECTIVE: To investigate the association between use of calcium channel blockers (CCB), dihydropyridine (DHP) or nondihydropyridine (nonDHP) type CCB and risk of developing Alzheimer's Disease (AD) or mortality. There is evidence suggesting that calcium plays a key role in changes in the brain leading to AD. Previous reports suggest a possible role for CCB in the treatment of AD. However, there are some indications that CCB increase mortality in patients with cardiac disease. METHODS: Subjects were 1092 participants in the Baltimore Longitudinal Study of Aging (BLSA) older than 60 years of age. Data on CCB use was collected prospectively for up to 19 years. Cox proportional hazards regression was used to estimate relative risks (RR) and confidence intervals (CI) of AD and mortality associated with use of CCB or use of only DHP or nonDHP-CCB. Analyses were adjusted for gender, education, smoking, blood pressure and history of heart problems. RESULTS: Use of DHP-CCB was not associated with a significantly reduced risk of AD compared to non-users, although the estimate of the RR was low with DHP-CCB (RR = 0.30, 95% CI = 0.07-1.25, P = 0.10). Use of nonDHP-CCB was not associated with reduced risk of AD and the estimate of the RR risk was close to one (RR = 0.82, 95% CI = 0.37-1.83, P = 0.63). In addition, there was no increase in mortality among users of DHP-CCB (RR = 0.64, 95% CI = 0.32-1.29, P = 0.21) or nonDHP-CCB (RR = 1.10, 95% CI = 0.65-1.87, P = 0.72). CONCLUSION: Users of DHP-CCB and nonDHP-CCB in this study did not have a significantly reduced risk of AD.

Aged↗
PubMed2006

Race and restless legs syndrome symptoms in an adult community sample in east Baltimore.

BACKGROUND & PURPOSE: Due to the relative absence of African-Americans seeking treatment for restless legs syndrome (RLS) in specialty clinics, a lower prevalence of RLS among African-Americans than Caucasians has been suggested. We compared the prevalence of RLS in African-Americans and Caucasians in a biracial community sample as part of Wave IV of the Baltimore Health and Mental Health Study. METHODS: Subjects included 1071 adults [358 African-Americans (35.0%), and 633 Caucasians (61.8%), and 33 others]. Diagnosis of RLS was based on endorsement of RLS symptoms on a seven-item RLS questionnaire during a household interview. Adjusted odds and 95% confidence intervals were calculated based on logistic regression models with diagnosis of RLS as the main outcome variables and African-American race as the main predictor while adjusting for other relevant sociodemographic and/or health-related variables. RESULTS: The prevalence of RLS in this population was 4.1%. The rates were similar for African-Americans (4.7%) and Caucasians (3.8%). After adjustment for age, gender, medical comorbidities, and socioeconomic status, no difference in the prevalence of RLS was found between African-Americans and Caucasians. CONCLUSION: RLS is comparably prevalent among African-American and Caucasian adults in the general population. Barriers affecting access to care settings for African-American RLS patients should be investigated in the future.

Adult↗
PubMed2004

Association of prostate cancer risk with insulin, glucose, and anthropometry in the Baltimore longitudinal study of aging.

OBJECTIVES: To examine the relationship of insulin, glucose, and anthropometry with the subsequent risk of prostate cancer. METHODS: The relative risk of prostate cancer by insulin, glucose, and anthropometric measures was evaluated in 823 male participants (87 patients with prostate cancer in 10,737 person-years of follow-up) of the Baltimore Longitudinal Study of Aging who had at least one fasting plasma insulin measurement, which was prediagnostic for those with prostate cancer. Age-adjusted and multivariate-adjusted relative risks were estimated from Cox proportional hazards regression models. RESULTS: Insulin concentrations were in the normal range (defined as less than 20 microU/mL) for 95.1% of participants. Fasting insulin and glucose levels were unrelated to prostate cancer risk in our overall analysis (P for trend = 0.56 and 0.45, respectively). The relative risk of prostate cancer for the second through fourth quartiles of the waist/hip ratio compared with the lowest quartile was 2.10, 1.96, and 2.06, respectively (P for trend = 0.32). Risk was unrelated to waist circumference and body mass index. CONCLUSIONS: The results of this study do not conclusively support positive associations of markers of insulin and glucose metabolism and obesity with prostate cancer. Additional larger prospective studies with repeated measure of these parameters are warranted to explore these associations further.

Adenocarcinoma↗
PubMed2002

Calcium intake and prostate cancer risk in a long-term aging study: the Baltimore Longitudinal Study of Aging.

OBJECTIVE: To investigate the association between prostate cancer and calcium and other nutrients thought to influence the synthesis of 1,25-dihydroxyvitamin D [1,25(OH)2D]. METHODS: We included in the analysis 454 male participants in the Baltimore Longitudinal Study of Aging who were 46 to 92 years old at the time of completion of a food frequency questionnaire. Among them, 69 men were diagnosed with prostate cancer during their lifetime. In 68% of the cases, the food frequency questionnaire was completed after the diagnosis of cancer. Multiple logistic regression analysis was used to calculate the odds ratio and 95% confidence interval of prostate cancer. RESULTS: The median calcium intake was 788 mg/day. The adjusted odds ratio of prostate cancer for the highest tertile compared with the lowest tertile of calcium intake was 0.92 (95% confidence interval 0.48 to 1.77; P(trend) = 0.89). Likewise, no significant trends were found for phosphorus, vitamin D, fructose, or animal protein intake. Dairy products, including milk, were not associated with an increased risk of prostate cancer. The adjusted odds ratio of prostate cancer was 1.26 (95% confidence interval 0.57 to 2.79; P(trend) = 0.73) for men with high dairy intakes compared with those with low dairy intakes. CONCLUSIONS: The results of this study suggest that calcium intake within moderate limits is not associated with a notably increased risk of prostate cancer.

Aged↗
PubMed1998

Baltimore Vision Screening Project. Phase 2.

BACKGROUND: Vision screening in preschool and school age children remains a valuable method of identifying potentially treatable visual abnormalities, as well as refractive errors in the school age population. A major difficulty in conducting these types of programs is the inconsistent follow-up encountered frequently in children identified by the screening program. The Baltimore Vision Screening Project was designed to address the issue of access to care for a group of inner city elementary school students by providing on-site evaluation and treatment. METHODS: A standard vision-screening protocol was administered to prekindergarten and kindergarten students attending an inner city elementary school and access to care provided at the school. Children identified by the screening were examined at the school, and appropriate treatment was prescribed. The second phase of the study details a return to the school 1 year after the initial screening. The purpose of this was to reassess the level of visual morbidity in this population and to evaluate the effects of providing treatment in the previous year. RESULTS: Two hundred eighty-five children were screened during the 1994-1995 school year. Visual morbidity statistics from the follow-up year were similar to those of the previous screening: 5.3% diagnosed with amblyopia, 3.2% with strabismus, and 7.4% with refractive errors. Forty of the 68 children identified, examined, and treated in the previous year still were attending the school during the follow-up investigation. Compliance with recommended treatment was 30% in this group, with only 20% of the students passing the vision screening the following year. CONCLUSIONS: The follow-up screening confirmed the presence of significant visual morbidity in this group of preschool and kindergarten students. Nearly two thirds of the students had not complied with the recommended treatment or spectacle wear or both, despite providing immediate access to this care through the vision-screening program.

Baltimore↗
PubMed1999

Racial differences in the prevalence of age-related macular degeneration: the Baltimore Eye Survey.

OBJECTIVE: To determine the prevalence of age-related macular degeneration (AMD) and signs of age-related maculopathy in a population-based sample of blacks and whites 40 years of age or older from East Baltimore. DESIGN: Cross-sectional population-based study. PARTICIPANTS: A total of 5308 black and white subjects received a screening eye examination that included fundus photography. MAIN OUTCOME MEASURES: Stereoscopic color fundus photographs were graded for the presence and severity of drusen, pigmentary abnormalities, geographic atrophy, and choroidal neovascularization in the macula. RESULTS: Drusen > or = 64 microm were identified in about 20% of individuals in both groups, but large drusen (>125 microm) were more common among older whites (15% for whites versus 9% for blacks over 70). Pigmentary abnormalities were also more common among older whites (7.9% for whites versus 0.4% for blacks over 70). Age-related macular degeneration was more prevalent among whites than blacks. The prevalence of AMD was 2.1 % among whites over 70 years of age. No cases of AMD were detected among 243 black subjects in this age group. Logistic regression adjusting for age, sex and smoking (current, former, or never) detected an odds ratio of 4.4 (95% confidence interval: 1.5-12.4) for whites with AMD compared with blacks. CONCLUSION: Although drusen are common in both blacks and whites over the age of 40, more severe forms of age-related maculopathy and late AMD are more prevalent in older whites.

Adult↗
PubMed2003

Accumulation of metals, trace elements and semi-volatile organic compounds on exterior window surfaces in Baltimore.

Organic films have been found to develop on window surfaces [Diamond et al., Environmental Science and Technology 34 (2000a) 2900]. The film contains organic compounds that are in dynamic equilibrium with the gas-phase in air, and organic and inorganic compounds and elements associated with deposited air particles. In this study, the exterior surfaces of windows were sampled in downtown and suburban Baltimore, Maryland. Higher concentrations of PCBs, PAH, metals and trace elements were found at downtown than a suburban site. PCBs in the films at downtown sites were dominated by penta and hexa homologue groups and PAH signatures resembled that of vehicle emissions. Twenty-six metals and trace elements were separated into two groups according to their enrichment factors (EF). Ag, Hg, Se, Sb and Zn had EF > 100, suggesting anthropogenic sources of these metals in the films; whereas Fe, Ca, Co, Cr and others had EF <10, suggesting a crustal origin. An unusual profile dominated by deca- and nona- PCBs and relatively higher concentrations of Ag, Hg and Zn may be attributable to emissions from a medical waste incinerator. Dry deposition fluxes of selected metals on windows were 1.4-94 times higher on windows with than without films, indicating that the film increases the dry deposition of particles and their associated chemicals. This implies that film development, which is associated with elevated VOC and SOC emissions to urban air, will increase film development that will, in turn, increase the accumulation of other atmospherically deposited constituents such as metals.

Air Pollutants↗
PubMed1998

Health and access to care: perspectives of homeless youth in Baltimore City, U.S.A.

Homeless youth suffer from high rates of health problems, yet little is known about their perceptions of or context for their own health issues. In this study, a combination of qualitative techniques from participatory rural appraisal and rapid assessment procedures was used to investigate the perceptions of health needs of shelter-based youth in Baltimore, MD in the U.S.A. The most common youth-identified health problems included STDs, HIV/AIDS, pregnancy, depression, drug use and injuries. These correlate well with more objective health status data for the same youth. The youth spoke of environmental safety threats of violence and victimization by adults, as well as racism and sexism in their lives. Youth reported that trusted adult figures such as grandmothers are important sources of health advice. Many homeless youth from less than ideal family situations remain in contact with and continue to seek advice from parents and other family members. Health interventions with urban street youth need to acknowledge the primacy of the social context for these youth, as well as the reality of violence as a daily health threat.

Adolescent↗
PubMedDate not supplied

The association of depression and problem drinking: analyses from the Baltimore ECA follow-up study. Epidemiologic Catchment Area.

In this study, we hypothesized that there would be an increased risk of greater alcohol consumption among depressed problem drinkers than those without depression in the prior year, and that the strength of this association would be stronger for women. As part of the Epidemiologic Catchment Area (ECA) program, probability samples of area residents were selected and the baseline interview for the Baltimore site was completed in 1981. Between 1993 and 1996, 73% of the survivors (n = 2633) were reinterviewed. For the 334 problem drinkers identified, the occurrence of a depressive episode and level of alcohol consumption for each intervening year between the baseline and follow-up interviews were assessed. Generalized estimating equations (GEE) were used for logistic regression analyses to examine the association between the occurrence of depression in the prior year with transition to higher-level drinking in the subsequent year. The problem drinkers tended to have a bimodal association of transitioning to higher-level drinking; although the strength of the association was greater for men. Future research will need to assess the potential influences on this relationship of other sociodemographic and psychopathologic characteristics, including the effect of treatment for depression or substance use.

Adolescent↗