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PubMed1997

Testing for interaction between maternal smoking and TGFA genotype among oral cleft cases born in Maryland 1992-1996.

OBJECTIVE: Infants born in Maryland between June 1992 and June 1996 were used in a case-control study of nonsyndromic oral clefts to test for effects of maternal smoking and a polymorphic genetic marker at the transforming growth factor alpha (TGFA) locus, both of which have been reported to be risk factors for these common birth defects. DESIGN AND SETTING: Cases were infants with an oral cleft ascertained through three comprehensive treatment centers, with additional ascertainment through a registry of birth defects maintained by the Maryland Health Department. Controls were healthy infants. Medical history information on infants and mothers were collected, along with DNA samples. PATIENTS, PARTICIPANTS: Among 286 cases contacted (72% ascertainment), there were 192 nonsyndromic isolated oral clefts (106 M; 86 F) available for this case-control study. MAIN OUTCOME MEASURES: The largest group of 149 Caucasian nonsyndromic cases and 86 controls was used to test for association with maternal smoking and genotype at the Taq1 polymorphism in TGFA. RESULTS: While this modest sample had limited statistical power to detect gene-environment interaction, there was a significant marginal increase in risk of having an oral cleft if the mother smoked (odds ratio = 1.75, 95% CI = 1.01 to 3.02). We could not demonstrate statistical interaction between maternal smoking and TGFA genotype in this study, however, and the observed increase in the C2 allele among cases was not statistically significant. CONCLUSIONS: We could not confirm either the reported association between oral clefts and TGFA genotype or its interaction with maternal smoking. However, these data do show an increased risk if the mother smoked during pregnancy, and this effect was greatest among infants with a bilateral cleft and no close family history of clefts.

Alleles↗
PubMed1990

Death in prison: changing mortality patterns among male prisoners in Maryland, 1979-87.

The leading causes of death (rate per 100,000 prisoner-years) in Maryland state prisons for the period 1979-87 were circulatory system disease (59), suicide (40), and homicide and legal intervention (30). Acquired immunodeficiency syndrome (AIDS) became the leading cause of death in 1987. Homicides declined after 1980; drug overdose deaths peaked in 1981 and later disappeared. Male inmates have 39 percent lower all-cause death rates than the general population of Maryland after adjustment for age and race.

Cause of Death↗
PubMed1991

Income, race, and surgery in Maryland.

BACKGROUND: We describe common surgical and medical hospital admission rates for Maryland residents, exploring systematic effects of race and income. METHODS: The data comprise Maryland hospital discharges and population estimates for 1985 to 1987. Patient income is the race-specific median family income of residence zip code. Logistic regression is used to measure incidence by race, income, and residence for surgical and medical reasons for admission. RESULTS: Population rates for discretionary orthopedic, vascular, and laryngologic surgery tend to increase with community income levels. Coronary and carotid artery surgery rates are two to three times higher among Whites. The more discretionary the procedure, the lower is the relative incidence among Blacks. By contrast, admission rates for most medical reasons decline with increasing income levels and are elevated among Blacks. The affluent receive coronary artery procedures whereas the poor are hospitalized for coronary artery disease. CONCLUSIONS: Blacks and the poor appear to have higher illness burdens requiring hospital care. Discretionary surgeries have a White predominance and increase with income; medical admissions have a Black predominance and decline with income. Race and community income level are important factors in differential hospital utilization rates.

Adult↗
PubMed1993

Cervical cancer screening in hospitals: the efficacy of legislation in Maryland.

OBJECTIVES: The purpose of the study was to examine the efficacy of a Maryland law requiring Pap testing to be offered during hospital admissions. "In-reach" strategies emphasize cancer screening within existing health care contacts (such as inpatient stays) rather than additional visits solely for screening. METHODS: Data from a 1986 telephone survey of Maryland women were used to examine the effect of hospitalization on self-reported Pap testing in a 3-year period. The effect of hospitalization on screening was examined by age and income to assess whether inpatient screening was more prevalent among certain subgroups of women. RESULTS: For the group as a whole, the odds of Pap screening did not vary with hospitalization. However, among women aged 45 to 54 years with annual household incomes over $20,000, hospitalized women were more likely than nonhospitalized women to report recent Pap tests. For low-income women aged 75 years and older, hospitalization actually decreased the likelihood of reporting Pap tests. CONCLUSIONS: Despite legislation, inpatient cervical cancer screening appears to mirror outpatient patterns, leaving elderly and low-income women unscreened. Methods for increasing inpatient Pap testing for underscreened women are discussed.

Aged↗
PubMed1998

Final results of the Maryland WIC 5-A-Day Promotion Program.

OBJECTIVES: This National Cancer Institute-funded study sought to increase fruit and vegetable consumption among women served by the WIC program in Maryland. METHODS: Over a 2-year period, a multifaceted intervention program using a randomized crossover design sought to increase fruit and vegetable consumption at 16 WIC program sites in Baltimore City and 6 Maryland counties. Participants were surveyed at baseline, 2 months postintervention, and 1 year later. RESULTS: Two months postintervention, mean daily consumption had increased by 0.56 +/- 0.11 servings in intervention participants and 0.13 +/- 0.07 servings in control participants (P = .002). Intervention participants also showed greater changes in stages of change, knowledge, attitudes, and self-efficacy. Changes in consumption were closely related to number of nutrition sessions attended, baseline stage of change, race, and education. One year later, mean consumption had increased by an additional 0.27 servings in both intervention and control participants. CONCLUSIONS: Dietary changes to prevent cancer can be achieved and sustained in this hard-to-reach, low-income population. However, many obstacles must be overcome to achieve such changes.

Adolescent↗
PubMed2002

Autopsy study of motorcyclist fatalities: the effect of the 1992 Maryland motorcycle helmet use law.

OBJECTIVES: This study sought to determine the impact of Maryland's all-rider motorcycle helmet law (enacted on October 1, 1992) on preventing deaths and traumatic brain injuries among motorcyclists. METHODS: Statewide motorcyclist fatalities occurring during seasonally comparable 33-month periods immediately preceding and following enactment of the law were compared. RESULTS: The motorcyclist fatality rate dropped from 10.3 per 10 000 registered motorcycles prelaw to 4.5 postlaw despite almost identical numbers of registered motorcycles. Motorcyclists wearing helmets had a lower risk of traumatic brain injury than those not wearing helmets (odds ratio = 0.31, 95% confidence interval = 0.14, 0.68). CONCLUSIONS: Maryland's controversial motorcycle helmet law appears to be an effective public health policy and may be responsible for saving many lives.

Accidents, Traffic↗
PubMed2001

Outcomes assessment of the Center for Government and Corporate Veterinary Medicine at the Virginia-Maryland Regional College of Veterinary Medicine.

INTRODUCTION: The objective of this study was to evaluate the effectiveness and usefulness of the Virginia-Maryland Regional College of Veterinary Medicine's Center for Government and Corporate Veterinary Medicine (CGCVM or Center) as a national resource. METHODOLOGY: Questionnaires were mailed to graduates of the Virginia-Maryland Regional College of Veterinary Medicine (VMRCVM) from the classes of 1993 through 1997, as well as to graduates of other veterinary schools in the United States and Canada in the classes of 1994 through 1997 who had completed externships with the Center. Agencies and corporations that had hosted student clerkships in the 1997/1998 academic year and Deans of each veterinary school that has utilized the Center for student clerkships were also surveyed by mail. CONCLUSION: The results indicate that the Center for Government and Corporate Veterinary Medicine is a valuable national resource for veterinary students interested in public practice veterinary medicine and for veterinarians already in the work force seeking career advancement and/or career redirection.

Clinical Clerkship↗
PubMed2026

Investigation of Mycobacterium abscessus Cluster in Hospital, Maryland, USA, 2024.

Mycobacterium abscessus infections are frequently drug resistant and can cause severe disease, particularly among vulnerable populations in healthcare settings. In June 2024, a cluster of M. abscessus infection cases was reported at a hospital in Maryland, USA. An investigation involving hospital infection prevention staff, the Maryland Department of Health, the Centers for Disease Control and Prevention, and the Wadsworth Laboratory of the New York State Department of Health included initiation of mitigation efforts such as tap water use restrictions, point-of-use water filters, hospitalwide water flushing, and staff education regarding sink safety. Whole-genome sequencing of patient and environmental isolates, coupled with epidemiologic data, revealed a strong association (0-24 single-nucleotide polymorphism differences) between environmental and patient samples, indicating that infections were likely a result of patient exposure to M. abscessus. Ensuring initiation of mitigation initiatives likely prevented additional patient infections. Although effective in this investigation, not all mitigation strategies are equal or sustainable.

Humans↗
PubMed1991

The epidemiology of rodent and lagomorph rabies in Maryland, 1981 to 1986.

Records from the Maryland Public Health Department were screened for confirmed rodent and lagomorph rabies between 1981 and 1986. Questionnaires were designed for collection of information about events that led to the exposure of human and/or domestic animals to rabid rodent or lagomorphs. These species comprised 1.2% of all the reported rabies in the state. Woodchucks (Marmota monax) constituted 80.0% of all the reported rodent/lagomorph rabies cases in Maryland. The majority showed aggressive behavior (55.0%). Woodchucks exposed 15 persons (75.0% of all the exposures by rodents/lagomorphs). Domestic animal and human rabies exposure due to rodents and lagomorphs represents a small but significant number of the total exposure to rabid animals.

Aggression↗
PubMed1990

Ambulatory practice variation in Maryland: implications for Medicaid cost management.

Simulation modeling with data from the Maryland Medicaid Management Information System has provided an opportunity to examine policy options and assess their likely impact on savings before program decisions were made. Analysis of a large sample of the Maryland Aid to Families with Dependent Children (AFDC) Medicaid subpopulation confirms that a significant difference in utilization and cost to Medicaid exists between usual sources of care for AFDC clients even after controlling for patient demographics and case-mix differences. Findings indicate that savings from reduced use of hospital outpatient departments may offset increases of as much as 40-50 percent in physician fees under certain assumptions.

Adolescent↗
PubMed2001

Maryland dental hygienists' knowledge and opinions of oral cancer risk factors and diagnostic procedures.

OBJECTIVES: To examine Maryland dental hygienists' (DHs) knowledge of oral cancer risk factors and diagnostic procedures, as well as opinions about the currency and adequacy of their oral cancer knowledge, educational preparation, interest in, and preferred types of, continuing education courses. METHODS: Seven hundred DHs were randomly selected from a registry of 2677 Maryland licensed dental hygienists. A mailed survey instrument provided baseline data on 331 (RR = 60%) DHs. Stratified tabular and logistic analytical techniques were employed (alpha level < or =0.05). RESULTS: Most correctly identified tobacco use (99.7%) and alcohol use (89%) as risk factors; however, 31% incorrectly identified poor oral hygiene as a risk factor. 64% of DHs correctly identified older age as a risk factor, yet only 16% identified that the majority of oral cancers are diagnosed in the 60+ year old age group. Nearly 91% correctly identified the examination procedures of the tongue for oral cancer detection; while only 16% of DHs correctly identified erythroplakia and leukoplakia as the conditions most likely associated with oral cancer. CONCLUSIONS: Gaps in knowledge exist and strongly suggest the need for continuing education courses to clarify risk factors and diagnostic procedures associated with earlier oral cancer detection and prevention.

Adult↗
PubMed2002

Comparing NHANES data in the assessment of hypertension of African-Americans. Awareness, treatment and control of hypertension in an urban Maryland city.

Although hypertension is a well-recognized risk factor for stroke, heart failure, and renal failure, particularly among African-Americans, many with high blood pressure are unaware of its presence. Those who are cognizant of their high blood pressure are often not treated at appropriate levels, as recommended by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). In 1999, we participated in a blood pressure screening at the Wicomico County, Maryland Health Fair, whose primary focus was the Health and Wellness of African-Americans. Wicomico County is located on the Eastern Shore of Maryland. Our participation in the health fair screening of a predominantly African-American population afforded us the opportunity to update data from the National Health and Nutrition Examination Survey (NHANES) and determine if JNC VI guidelines were being met, especially among the diabetic population. Since the NHANES data is now over five years old, we felt that our study would be of interest to physicians working with patients who have hypertension. Our findings compared to the NHANES II last published in 1994. We were looking for any improvement in the detection and treatment of hypertension. Data analysis found a slight increase in the awareness and treatment of hypertensives, but a decrease in the number of patients who were able to manage their illness. This was particularly true among diabetics who were at high risk for hypertension.

Adolescent↗
PubMedDate not supplied

Oral health status of preschool children attending Head Start in Maryland, 2000.

PURPOSE: The objective of this study was to determine the oral health status of preschool children attending Head Start Centers in Maryland. METHODS: Clinical caries examinations were conducted on 482 children between ages 3-5 from 37 Maryland Head Start Centers in 2000. Additionally, 560 questionnaires were completed by their caretakers regarding their child's access to care, potential caries risk factors and history of toothaches. RESULTS: The overall prevalence of untreated decay was 52%, with a higher prevalence found in rural than urban centers (64% vs 48%). For all children, the mean decayed, filled surfaces (dfs) was 3.64, while the mean decayed surfaces (ds) was 2.90. For those who had caries experience, the dfs was 6.67 and the ds was 5.32. The percentage of children with caries increased by age from 43% for three-year-olds to 62% for four-year-olds. Of those children with caries experience, 17% had complained of a toothache and 9% reportedly cried because of a toothache. CONCLUSIONS: Of significance in this study were the findings that: caries is highly prevalent in this underserved preschool population; pain due to dental caries is not uncommon; and there is little utilization of dental care despite federally mandated and Head Start and Medicaid requirements.

Analysis of Variance↗
PubMed2003

Control of Ixodes scapularis (Acari: Ixodidae) with topical self-application of permethrin by white-tailed deer inhabiting NASA, Beltsville, Maryland.

We report the first successful area-wide reduction of Ixodes scapularis by using minimal amounts of permethrin self-applied by free-ranging white-tailed deer in as little as 3 y of nearly continuous treatment. The study to control all active stages of L. scapularis Say was initiated in April 1995, at the Goddard Space Flight Center, National Aeronautics and Space Administration (NASA), Beltsville, Maryland (treated location), and the Patuxent Wildlife Research Center, Laurel, Maryland (non-treated location). The locations had similar flora and fauna, and pre-treatment sampling (April to October 1995) of deer, plots, and mice for I. scapularis indicated nearly similar tick populations at both locations. After pre-treatment sampling, 4 deer '4-poster' stations were placed at NASA, while the control area received none. Ten percent permethrin, supplied to 4 roller covers on each station, was passively transferred to the head, neck, and ears of free-ranging deer feeding at the stations. This treatment resulted in elimination of adult I. scapularis on sampled deer (100% control) by the 2nd y of treatment and reductions of immature tick stages on mice. During the 3rd y of treatment, adult, nymphal, and larval questing ticks were reduced by 91-100% from sampled plots, and nymphal and larval ticks were reduced by 70-95% on sampled mice.

Administration, Topical↗
PubMed2002

BK virus nephropathy diagnosis and treatment: experience at the University of Maryland Renal Transplant Program.

The first case of BK virus allograft nephropathy at the University of Maryland Renal Transplant Program was diagnosed in 1997. Since then more than 100 cases have been identified. The incidence of BKAN has increased from 1% for patients transplanted in 1997 to 5.8% for patients transplanted in 2001. BKAN is an important cause of premature kidney graft loss at the University of Maryland Transplant Program. One-third of the patients diagnosed with BKAN since 1997 have already lost graft function, and a third of the remaining patients have creatinine levels over 3 mg/dl. We could not determine that a specific immunosuppressive drug increased the incidence of BKAN. Older patients had an increased risk of developing the disease. The histological diagnosis of BKAN was made at a mean time of 14.4 months after transplantation (range 1.2-53 months). BKAN occurred in 4.3% of all patients biopsied during the period described. The diagnosis of BK allograft nephropathy was based on a combination of renal biopsy to demonstrate viral cytopathic chages, urine cytology and quantitative viral load in plasma. A threshold of >10,000 copies of BK virus per ml of plasma is proposed as an indication of BKAN. Following diagnosis of BKAN, patients on a single immunosuppressve drug (FK506, CsA, sirolimus or MMF) in addition to prednisone had less graft loss and higher viral clearance in comparison to patients on prednisone and 2 immunosuppressant drugs (FK506, CsA or sirolimus and MMF). There was no difference in the rate of acute allograft rejection among different immunosuppression reduction protocols. Three patients who lost their grafts to BKAN were retransplanted. For these patients there has not yet been evidence of recurrence of BKAN. After reduction of immunosuppression, the course of BKAN in most patients followed one of 2 pathways: 1) Clearance of the infection and disappearance of the viral cytopathic changes in biopsies and urine (20%); 2)Persistence of viral replication with continuous associated tubular damage (70%). Renal transplant patients should be routinely screened with urine cytology. The presence of decoy cells in the urine is an indication for quantitative measurement of viral load in plasma. Patients with any evidence of BK viral reactivation should be followed closely. In patients biopsied early due to persistence of BK virus-infected cells in urine, there is a higher rate of conversion from positive to negative urine cytology after reduction of immunosuppression.

Antiviral Agents↗
PubMedDate not supplied

Self-reported awareness of unrestored dental caries. Survey of the Oral Health Status of Maryland Schoolchildren, 2000--2001.

PURPOSE: The purpose of this study was to assess and compare parental awareness of unrestored dental caries needs in a schoolchildren population according to socioeconomic status. METHODS: Subjective and normative unrestored dental caries data of kindergarten and third-grade children were collected from parental awareness questionnaires and clinical examinations, respectively, used in a 2000--2001 statewide survey of Maryland schoolchildren. Descriptive, bivariate, and multivariate analyses were performed to assess awareness of unrestored dental caries. Parental perceived need also was compared to clinical findings of unrestored dental caries. RESULTS: Actual (clinically assessed) unrestored dental caries (21%) was found to be 2 times the level of self-reported awareness of dental caries (11%). Those most likely to have significantly incorrect awareness of unrestored dental caries were: (1) low-income populations; (2) residents of the Maryland Eastern Shore. Sensitivity was 34% and specificity 96% in comparing self-assessed, unrestored dental caries need with the clinical findings. CONCLUSIONS: An incorrect perceived oral health need is high in poorer populations and may serve as a barrier to their achieving optimal oral health, given that disease prevalence is higher and access to oral health care services is lower in this population group.

Attitude to Health↗
PubMed2005

Legionnaires disease associated with potable water in a hotel--Ocean City, Maryland, October 2003-February 2004.

During October 2003-February 2004, eight cases (seven confirmed cases and one possible) of Legionnaires disease (LD) were identified among guests at a hotel in Ocean City, Maryland. This report summarizes the subsequent investigation conducted by the Worcester County Health Department (WCHD), Maryland Department of Health and Mental Hygiene (DHMH), and CDC, which implicated the potable hot water system of the hotel as the most likely source of infection. The detection of this outbreak underscores the importance of enhanced, state-based surveillance for timely detection of travel-associated LD and implementation of control measures.

Adult↗