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PubMedDate not supplied

A community approach to addressing excess breast and cervical cancer mortality among women of African descent in Boston.

In 2000, the REACH Boston 2010 Breast and Cervical Cancer Coalition conducted a community needs assessment and found several factors that may have contributed to disproportionately high breast and cervical cancer mortality among black women: (a) Focus group participants reported that many women in their communities had limited awareness about risk factors for cancer as well as about screening. (b) Black women experienced barriers to care related to the cultural competence of providers and of institutions. (c) Black women were not receiving adequate follow-up for abnormal mammograms and Pap smears. The Coalition's Community Action Plan to address disparities includes a model primary care service for black women; scholarships to increase the number of black mammogram technologists; primary care provider and radiology technologist training about disparities and cultural competence; and education to increase awareness among black women and to increase leadership and advocacy skills.

Adult↗
PubMed1998

Risk factors for death in homeless adults in Boston.

BACKGROUND: Homeless individuals experience high mortality rates. Males, whites, and substance abusers are more likely to die, but other high-risk characteristics are unknown. OBJECTIVE: To identify demographic and clinical factors associated with an increased risk of death in homeless individuals. METHODS: We conducted a case-control study of 558 adults who were seen by a health care program for the homeless in Boston, Mass, and who died in 1988 to 1993. Age-matched paired controls were selected from among individuals seen by the program who were alive at the end of 1993. Predictive data were obtained by blinded review of medical records. Odds ratios (ORs) for death were calculated using logistic regression analysis models. RESULTS: In a multivariate analysis, the strongest risk factors for death were acquired immunodeficiency syndrome (OR, 55.8), symptomatic human immunodeficiency virus infection (OR, 17.7), asymptomatic human immunodeficiency virus infection (OR, 4.1), renal disease (OR, 18.4), a history of cold-related injury (OR, 8.0), liver disease (OR, 3.8), and arrhythmia (OR, 3.3). A history of substance abuse involving injection drugs (OR, 1.6) or alcohol (OR, 1.5) also increased the risk of mortality. Nonfluency in English was associated with a decreased risk of death (OR, 0.4). CONCLUSIONS: In a group of adults seen by a health care program for the homeless, specific medical illnesses were associated with the greatest risk of death. Substance abuse alone was less strongly associated with death. Interventions to reduce mortality among the homeless should focus on individuals with high-risk characteristics.

Adult↗
PubMed1990

Tympanoplasty in children. The Boston Children's Hospital experience.

Considerable controversy surrounds the subject of tympanoplasty in children. Conflicting opinions about the indications, patient selection, timing, and technique of surgery are supported by various published series of cases. The records of 64 consecutive tympanoplasty procedures performed at the Boston (Mass) Children's Hospital over a recent 6-year period were reviewed. The study was limited to cases of repair of uncomplicated perforation of pars tensa that did not require ossiculoplasty or mastoidectomy. Surgery was successful in 73% of cases. A number of factors that are postulated to affect the outcome of surgery have been analyzed to assess their utility in selecting successful surgical candidates. Only patient age at the time of surgery was found to have statistical significance. We conclude that tympanoplasty for repair of perforation is warranted for children 8 years of age and older.

Age Factors↗
PubMed1988

The African connection. Cotton Mather and the Boston smallpox epidemic of 1721-1722.

The contributions of black Americans to early American culture have still not been fully explored or given the attention deserved. A case in point is the significant contributions African slaves made to 18th-century American folk medicine. A review of the events incident to the smallpox epidemic in Boston in 1721 will illustrate the degree to which some reputable men of science depended on the testimony and experience of Africans in dealing with a particularly dread disease.

Africa↗
PubMed2002

Occupational injuries among Boston bicycle messengers.

BACKGROUND: Urban bicycle couriers may have a high incidence of injuries. Most messengers work as contractors and hence their injuries are not well documented. METHODS: To quantify injury rates and severity among urban bicycle couriers a convenience sample of 113 couriers in the city of Boston completed a two-page self-administered survey. RESULTS: Most working couriers have suffered at least one injury resulting either in days lost from work (70%) and in visits to a health-care professional or hospital (55%). The annual incidence rate for injuries resulting in days away from work was 47/100-bike couriers. Bone fractures accounted for the most days lost from work, followed by dislocations, sprains, and strains. Collisions and avoiding collisions with motor vehicles, including being "doored," and collisions with pedestrians accounted for the majority (66%) of events leading to injury. Twenty-four percent of messengers reported wearing a helmet on a regular basis, and 32% have health insurance. CONCLUSIONS: Urban bicycle messengers are a poorly documented, largely unstudied workforce who suffer a very high rate of occupational injury.

Accidents, Occupational↗
PubMed2004

Achieve Boston: a citywide innovation in professional development.

Achieve Boston is a broad-based collaborative effort to improve the overall quality of programs for children and youth by establishing a professional development infrastructure that supports those who work with young people during the out-of-school-time hours.

Adolescent↗
PubMed1994

The impact of soil lead abatement on urban children's blood lead levels: phase II results from the Boston Lead-In-Soil Demonstration Project.

The Boston Lead-In-Soil Demonstration Project was a randomized environmental intervention study of the impact of urban soil lead abatement on children's blood lead levels. Lead-contaminated soil abatement was associated with a modest reduction in children's blood lead levels in both phases of the project; however, the reduction in Phase II was somewhat greater than that in Phase I. The combined results from both phases suggest that a soil lead reduction of 2060 ppm is associated with a 2.25 to 2.70 micrograms/dl decline in blood lead levels. Low levels of soil recontamination 1 to 2 years following abatement indicate that the intervention is persistent, at least over the short-term. Furthermore, the intervention appears to benefit most children since no measurable differences in efficacy were observed for starting blood and soil lead level, race, neighborhood, gender, and many other characteristics. However, soil abatement did appear to be more beneficial to children in the higher socioeconomic classes, with low baseline ferritin levels, and who spent time away from home on a regular basis and lived in nonowner occupied housing, and with adults who had lead-related hobbies and almost always washed their hands before meals. Children who lived in apartments with consistently elevated floor dust lead loading levels derived almost no benefit from the soil abatement. It was not possible to separate the effects of the variables that had a beneficial impact on efficacy because they were closely correlated and the number of subjects was small. We recommend that further research be conducted to identify subgroups of children to whom soil lead abatement might be targeted.

Boston↗
PubMed1987

Health diary study of Japanese residents in Greater Boston: variables related to high incidence of health problems.

This study was conducted to assess the impact of migration on the incidence of illness episodes and health care seeking behavior among Japanese residents in Greater Boston. Subjects were instructed to keep diaries about illnesses experienced and visits to physicians. A total of 62 problems (0.77 per person) occurred over a four-week period with only 9 problems (15 percent) receiving medical consultation. Residents who were in the U.S. for less than one year had the highest rate of perceived stress and the highest incidence of health problems. The number of people available for support to an individual did not correlate with the occurrence of health problems. Surprisingly no emotional or psychological problems were recorded in the diary in spite of explicit encouragement to note such problems. An increased occasion of family get-togethers compared to that in Japan was perceived as stressful by men, but not by women. This contrasts with the perception of children's educational issues as stressful exclusively by women.

Acculturation↗
PubMed1989

Record performances at the Boston Marathon: biometeorological factors.

Air temperature and relative humidity have long been suspected of affecting the performance of marathon runners. Though these factors are important in their extremes, we show that other factors are even more indicative of race performances. Performances of the top 3 finishers in the last 30 Boston Marathons were correlated with hourly meteorological data for each race day. These 90 individual performances were classified as: record breaking performances (31), average performances (35), and unusually slow performances (24). The factors that help predict record breaking and unusually slow performances are: (i) wet bulb temperature, (ii) percent sky cover, and (iii) presence or absence of a light precipitation. Record breaking performances are characterized by a wet bulb temperature of less than 7.8 degrees C, and 100% sky cover. A light drizzle is also conducive to better performances. On the other hand, unusually low performances are accompanied by a wet bulb temperature of greater than 7.8 degrees C, and a sky cover of 50% or less. No light precipitation was recorded on any of the unusually slow race days. A graphic analysis clearly shows these relationships to exist. In addition, a multiple regression analysis confirms the importance of these variables. The authors advise that these are reliable predictors; however, when considering marathon races held in various geographical regions and differing climatic regimes, the exact numerical thresholds used here may not apply.

Boston↗
PubMed2006

Mapping turbidity in the Charles River, Boston using a high-resolution satellite.

The usability of high-resolution satellite imagery for estimating spatial water quality patterns in urban water bodies is evaluated using turbidity in the lower Charles River, Boston as a case study. Water turbidity was surveyed using a boat-mounted optical sensor (YSI) at 5 m spatial resolution, resulting in about 4,000 data points. The ground data were collected coincidently with a satellite imagery acquisition (IKONOS), which consists of multispectral (R, G, B) reflectance at 1 m resolution. The original correlation between the raw ground and satellite data was poor (R2 = 0.05). Ground data were processed by removing points affected by contamination (e.g., sensor encounters a particle floc), which were identified visually. Also, the ground data were corrected for the memory effect introduced by the sensor's protective casing using an analytical model. Satellite data were processed to remove pixels affected by permanent non-water features (e.g., shoreline). In addition, water pixels within a certain buffer distance from permanent non-water features were removed due to contamination by the adjacency effect. To determine the appropriate buffer distance, a procedure that explicitly considers the distance of pixels to the permanent non-water features was applied. Two automatic methods for removing the effect of temporary non-water features (e.g., boats) were investigated, including (1) creating a water-only mask based on an unsupervised classification and (2) removing (filling) all local maxima in reflectance. After the various processing steps, the correlation between the ground and satellite data was significantly better (R2 = 0.70). The correlation was applied to the satellite image to develop a map of turbidity in the lower Charles River, which reveals large-scale patterns in water clarity. However, the adjacency effect prevented the application of this method to near-shore areas, where high-resolution patterns were expected (e.g., outfall plumes).

Boston↗
PubMed1986

Association of human T lymphotropic virus type III antibodies with sexual and other behaviors in a cohort of homosexual men from Boston with and without generalized lymphadenopathy.

Forty asymptomatic homosexually active men seen at a Boston community health center and 39 men with generalized lymphadenopathy were interviewed and filled out detailed epidemiologic questionnaires. Twenty percent of the asymptomatic men and 92 percent of those with lymphadenopathy had antibodies to human T lymphotropic virus type III (HTLV-III). None of the men have subsequently had the acquired immune deficiency syndrome (AIDS). Seropositivity was associated with receptive anal intercourse and oral exposure to ejaculate, a history of hepatitis B, anal gonorrhea, or intestinal parasites, but no other sexually transmitted diseases, and did not correlate with the use of recreational drugs. More of the seropositive men had multiple partners from New York City. An association with seropositivity was less evident in relation to the numbers of partners from San Francisco or Los Angeles, since the whole cohort generally had fewer contacts with partners from these cities. The data suggest that educational programs among homosexual men attempting to decrease AIDS risk should focus on decreasing the number of partners, receptive anal intercourse, oral exposure to ejaculate and other intimate rectal contact, and sexual contact with men from areas of increased HTLV-III seroprevalence.

Adult↗
PubMed1989

Extracorporeal shock-wave lithotripsy of gallstones: Boston experience with the Dornier MPL 9000 lithotripter.

After the success of shock-wave therapy for fragmentation of renal stones, machines for shock-wave therapy of gallbladder stones were quick to follow. In Munich, gallstones were successfully treated in 174 of 175 patients who were also taking ursodiol to help solubilize the calculous rubble left after treatment. In Boston, of the initial 87 patients accepted, 58 were treated for a single stone (mean diameter 15.7 mm), 16 were treated for 2 stones, and 13 for 3 stones. Although reporting of exact results is not possible before the Food and Drug Administration issues a clearance, it is fair to say that both patients and physicians are generally pleased with the results.

Boston↗
PubMed1995

Restructuring of cardiovascular services at Children's Hospital, Boston, Massachusetts.

BACKGROUND: In recent years there has been growing concern about the turbulence and many uncertainties in the health care environment. The leaders of the Cardiovascular Departments at Children's Hospital in Boston recognized the need to position themselves more effectively for providing quality cardiovascular services in the future. METHODS: A transformational strategy for leadership and organization of cardiovascular services was designed by the physician and nursing leaders of the Cardiovascular Departments. The new Cardiovascular Program included changes in governance administration and clinical operations. RESULTS: A Governance Board was appointed to oversee the fiscal and clinical affairs of the unified Cardiovascular Program. The operating budget was reduced by 10% (2.1 million dollars) over a 2-year period. This goal was achieved with creative restructuring in three areas: (1) personnel, (2) supplies, and (3) ancillary usage. CONCLUSIONS: This organizational innovation is a model for collaborative practice. It is hoped that this new model will allow the faculty and staff to improve upon a tradition of excellence in clinical care and will help in retaining an environment and spirit conducive to the generation of new knowledge.

Boston↗
PubMed1985

Methodological issues in modeling the relationship between low-level lead exposure and infant development: examples from the Boston Lead Study.

This paper addresses several methodological issues relevant to an assessment of the association between low-level lead exposure and early development. In particular, we discuss methods for choosing, from a large pool of candidates, the covariates to control when estimating this association. We examine the issue of confounding and explain why adjusting increased, rather than decreased, the estimate of the association between blood lead level and development at 6 months of age in our sample. A step-by-step description of our strategy for model building is presented. Finally, we demonstrate the robustness of the findings by showing that the magnitude and standard error of the estimated lead effect is not affected appreciably by the method of selecting covariates to be controlled for or by the characterization of lead as a continuous, ordinal, or dichotomous variable. Although these issues arose in the course of analyses of data collected by the Boston lead study (D. Bellinger, H. Needleman, A. Leviton, C. Waternaux, M. Rabinowitz, and M. Nichols (1984), Neurobehav. Tox. Teratol., 6, 387-402), they apply to other current prospective lead studies as well.

Analysis of Variance↗