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PubMed1997

The impact of neurologic disease on hospitalizations related to human immunodeficiency virus infection in Maryland, 1991-1992.

OBJECTIVES: To determine the impact of neurologic disease on length of stay and total hospital charges for hospitalizations related to human immunodeficiency virus (HIV) infection. DESIGN: Review of all HIV-related hospitalizations from all acute nonfederal hospitals in Maryland in 1991 and 1992. Neurologic status and HIV disease status were determined by codes from the International Classification of Diseases, Ninth Revision Clinical Modification, in an administrative database. Total hospital charges and length of stay were also included in this database. RESULTS: Of 12 128 HIV-related hospitalizations (6013 patients with the acquired immunodeficiency syndrome [AIDS], 308 HIV-seropositive patients with symptoms without AIDS, and 5807 HIV-seropositive patients without symptoms), neurologic disease occurred in 1013 (8.4%), predominantly in patients with AIDS. In all HIV-seropositive patients, those with primary neurologic disease had a long mean (+/- SD) length of stay (16.4 +/- 16.5 days vs 9.3 +/- 11.3 days; P < .001) and higher mean (+/- SD) total charges ($12,733 +/- $12,009 vs $8069 +/- $11,247; P < .001) than those without neurologic disease. In patients with AIDS, those with primary neurologic disease also had a longer mean (+/- SD) length of stay (17.2 +/- 17.2 days vs 11.7 +/- 12.7 days; P < .001) and higher mean (+/- SD) total charges ($13,430 +/- $12,470 vs $10,794 +/- $13,537; P < .001) than those without neurologic disease. After adjustment for age, sex, race, and stage of HIV infection in all HIV-seropositive patients, our results indicated that neurologic disease increased the length of stay by 3.3 days (95% confidence interval [CI], 2.9-3.8) and total charges by $2552 (95% CI, $2111-$2993). After adjustment for age, sex, and race in discharged patients with AIDS, the results showed that neurologic disease increased length of stay by 2.24 days (95% CI, 0.73-3.77) and total charges by $1512 (95% CI, $40-$2894). CONCLUSION: Neurologic disease increases the length of stay and total hospital charges of HIV-infected patients.

Acquired Immunodeficiency Syndrome↗
PubMed1999

The effect of parental monetary sanctions on the vaccination status of young children: an evaluation of welfare reform in Maryland.

OBJECTIVE: To determine whether financial sanctions to Aid to Families With Dependent Children (AFDC) recipients can be used to improve vaccination coverage of young children. DESIGN: Randomized controlled trial. SETTING: Six AFDC jurisdictions in Maryland. INTERVENTION: Recipients of AFDC were randomized to the experimental or control group of the Primary Prevention Initiative. Families in the experimental group were penalized financially for failing to verify that their children received preventive health care, including vaccinations; control families were not. PARTICIPANTS: Children aged 3 to 24 months from assigned families were randomly selected for the evaluation (911 in the experimental, 864 in the control, and 471 in the baseline groups). MAIN OUTCOME MEASURES: Up-to-date for age for diphtheria and tetanus toxoids and pertussis (DTP), polio, and measles-mumps-rubella (MMR) vaccines; missed opportunities to vaccinate; and number of visits per year. ANALYSIS: Comparisons among baseline and postimplementation years 1 and 2. RESULTS: Vaccination coverage of children was low. Less than 70% of children were up-to-date for age for polio and MMR vaccines; slightly more than 50% were up-to-date for DTP vaccine. Up-to-date rates differed little among baseline, experimental, and control groups. Over time, there was a decrease in missed opportunities, and more children made at least 1 well-child visit; however, neither improvement resulted in a change in vaccination status. CONCLUSIONS: The Primary Prevention Initiative did not contribute to an increase in vaccination coverage among these children. Minimal economic sanctions alone levied against parents should not be expected substantially to affect vaccination rates.

Aid to Families with Dependent Children↗
PubMed1990

An efficacy trial of the rhesus rotavirus vaccine in Maryland. The Clinical Study Group.

A double-blind, placebo-controlled trial of oral rhesus rotavirus vaccine at a dose of 10(4) plaque-forming units was performed in 114 young infants in Maryland. Significantly more vaccinees than controls had fever and vomiting during the week after vaccination, but these reactions were mild. Of the vaccinees, 83% had a fourfold or greater rise in neutralizing antibody to rhesus rotavirus vaccine and 69% shed vaccine virus. Seventeen percent of the vaccinees and 24% of controls had rotavirus-positive diarrhea during the 2 years of surveillance. Vaccine efficacy was therefore 29% (95% confidence limits, -31% to +66%). Stools from 12 of 13 episodes containing sufficient antigen to type were serotype 1. We conclude that rhesus rotavirus vaccine was infective, immunogenic, and probably acceptably attenuated but that this serotype 3 vaccine provided little heterotypic protection during serotype 1 outbreaks in the community.

Antibodies, Viral↗
PubMed1989

Epidemiological findings of seasonal changes in mood and behavior. A telephone survey of Montgomery County, Maryland.

Patterns of seasonal changes in mood and behavior in Montgomery County, Maryland, were evaluated in randomly selected household samples by lay interviewers using a telephone version of the Seasonal Pattern Assessment Questionnaire. The method for selecting the sample unit was random-digit dialing. We found that 92% of the survey subjects noticed seasonal changes of mood and behavior to varying degrees. For 27% of the sample seasonal changes were a problem and 4.3% to 10% of subjects, depending on the case-finding definition, rated a degree of seasonal impairment equivalent to that of patients with seasonal affective disorder. The seasonal pattern of "feeling worst" exhibited a bimodal distribution with a greater winter and a substantially lower summer peak (ratio, 4.5:1). Younger women who have a problem with seasonal changes and who feel worse on short days tended to exhibit the highest seasonality scores. It is apparent from our study that seasonal affective disorder represents the extreme end of the spectrum of seasonality that affects a large percentage of the general population. The influence of environmental factors on mood disorders and mood changes in the general population might provide valuable insight into pathogenesis, treatment, and prevention of affective illness.

Adult↗
PubMed1997

Lead levels in Maryland construction workers.

A cross-sectional study of unionized construction workers not currently known to be performing lead work was conducted. Participants completed an interviewer-administered questionnaire obtaining information about demographics, work history, other possible sources of lead exposure and health status (including hypertension, noise-induced hearing loss and renal disease). Blood was then obtained via venipuncture for whole blood lead level, hematocrit and free erythrocyte protoporphyrin determination. Two hundred and sixty-four Maryland construction workers had median whole blood lead determinations of 7 micrograms/dl and mean values of 8.0 micrograms/dl, with a skewed distribution ranging from 2 to 30 micrograms/dl. None were currently engaged in known lead work. Blood lead levels were significantly higher for the 124 who had 'ever' worked in demolition (8.8 micrograms/dl vs. 7.2 micrograms/dl, p = .004), and for the 79 who had ever burned paint and metal and welded on outdoor structures compared to the 48 who had done none of these activities (8.6 micrograms/dl vs. 6.8 micrograms/dl, p = .01). The 58 workers who had ever had workplace lead monitoring performed had higher lead levels (9.7 vs. 7.5 micrograms/dl, p = .003). Blood lead levels increased with age, and cigarette smoking. African Americans (N = 68) had higher lead levels (9.1 vs. 7.5 micrograms/dl, p = .01). There were only two women in the study, one with a lead level of 21 micrograms/dl and one, 7 micrograms/dl. Blood lead levels did not predict either systolic or diastolic blood pressure in this population. However, there was a significant interaction between race and lead as predictors of blood pressure, with blacks demonstrating a trend-significant correlation, and whites showing a nonsignificant but negative association. Demolition and hotwork on outdoor structures are known to cause acute episodes of lead poisoning. They also appear to cause slight but persistent increases in blood lead levels. Future workplace regulation should recognize and seek to maintain the low baseline now apparent even in urban, East Coast, construction workers.

Adolescent↗
PubMed1988

Integrated Academic Information Management Systems (IAIMS). Part II. Planning and implementing integrated information services. Integration and outreach: Integrated Academic Information Management Systems (IAIMS) at Maryland.

The University of Maryland Campus for the Professions is now realizing the first benefits of integrated academic information management systems (IAIMS). With the support of the National Library of Medicine, the information Resources Management Division has joined with the Health Sciences Library to plan and to implement change. Within the information utility concept, networked data communications and end-user computing function as the means to integration. Plans call for new 370-based software to extend system capabilities. Mechanisms for outreach ensure that the potential of integration is realized. These mechanisms include technology assisted learning centers, informatics program development, special programs (geriatrics, hypertension pilot), and new applications (conferencing system, voice mail, videodisc development, interinstitutional resource sharing).

Academic Medical Centers↗
PubMed1990

Association of nonmelanoma skin cancer and actinic keratosis with cumulative solar ultraviolet exposure in Maryland watermen.

To establish the relationship between ultraviolet-B radiation and squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and actinic keratosis (AK), a cross-sectional prevalence survey was performed in a sample of 808 white, male watermen 30 years of age and older residing in the Eastern Shore of Maryland. A measure of personal cumulative ultraviolet-B exposure was determined for each subject from data collected through interviews and field and laboratory measurements. A personal interview elicited skin type, medication history, and other factors. Clinical diagnoses and histologic confirmation were done for current and previously removed skin tumors. The ratio of subjects with SCC to subjects with BCC was approximately 1:1; however, the ratio of BCC to SCC was 1.25:1 because BCC cases were more prone to multiple lesions. Watermen with SCC or AK but not BCC had higher average annual ultraviolet-B doses than age-matched controls. This was particularly marked in watermen younger than 60 years of age. Logistic regression showed that an older age, childhood freckling, and blue eyes significantly increased the risk of the development of all three types of skin tumor. Ease of sunburning was associated with BCC and AK, but not with SCC. Watermen in the upper quartile of cumulative ultraviolet-B exposure had a 2.5 times higher risk for the development of SCC when compared with the lower 3 quartiles. This suggests that high levels of ultraviolet-B exposure are important in SCC occurrence. The risk of AK developing was 1.5 times higher for those whose cumulative ultraviolet-B exposure exceeded the median. The relationship of BCC to cumulative ultraviolet-B exposure was not clear and this suggests that different etiologic mechanisms operate for SCC and BCC.

Adult↗
PubMed1994

Report from the Maryland Epidemiology Schizophrenia Linkage Study: no evidence for linkage between schizophrenia and a number of candidate and other genomic regions using a complex dominant model.

Our collaborative group has undertaken a linkage study of schizophrenia, using a systematic sample of patients admitted to Maryland hospitals. An initial sample of 39 families, each having two or more affecteds, was available for genotyping candidate genes, candidate regions, and highly polymorphic markers randomly distributed throughout the genome. We used a single complex dominant model (with a disease gene frequency of 0.005 and age-dependent penetrance for affected phenotype: for under 35, penetrance = .45; for 35 and older, penetrance = .85). We report here 130 markers, which met the exclusion criteria of LOD score < -2.00 at theta > 0.01 in at least 10 informative families, and no evidence for heterogeneity. We also report here markers that were tested as candidates for linkage to the schizophrenic phenotype. They were selected based on the following criteria: a) proximity to reported chromosomal rearrangements (both 5q and 11q), b) suggestions of linkage from other families (5q), or c) presence of a candidate gene (5q, 11q, 3q: Dopamine receptors 1, 2, and 3, respectively). We also tested for mutations of codon 717 in exon 17 of the amyloid precursor protein (APP) gene and were unable to detect the C to T substitution in our schizophrenic group.

Chromosome Mapping↗
PubMed1985

The incidence of systemic lupus erythematosus in Baltimore, Maryland, 1970-1977.

The incidence of systemic lupus erythematosus, based on first hospital discharge diagnosis, in Baltimore, Maryland for the years 1970 through 1977 was determined for individual sex-race groups and the total population. Age-specific incidence rates were consistently highest among black females and lowest among white males: rates for white females exceeded those for black males through age 54, but then declined for ages greater than or equal to 55. Mean age at diagnosis was significantly lower for black females versus white females (35.5 versus 41.7 years, P = 0.005) and for all females versus all males (37.2 versus 44.2 years, P = 0.012). There were no temporal trends noted in yearly age-adjusted incidence rates during the 8-year study period. The overall population incidence of systemic lupus erythematosus was 4.6 per 100,000 per year, representing a twofold increase over a comparable study done in New York City 15 years ago.

Adolescent↗
PubMed1990

Eosinophilia-myalgia syndrome due to L-tryptophan ingestion. Report of four cases and review of the Maryland experience.

Eosinophilia-myalgia syndrome (EMS) is a recently described clinical entity that has been ascribed to taking over-the-counter preparations of the amino acid L-tryptophan. We describe 4 patients with EMS, 3 of whom presented with eosinophilic fasciitis, and we review the epidemiology of EMS reported in Maryland and discuss the possible pathophysiology of the disease. EMS should be considered in the differential diagnosis of severe myalgia, eosinophilia, and eosinophilic fasciitis.

Administration, Oral↗
PubMed1989

Availability of schizophrenic patients and their families for genetic linkage studies: findings from the Maryland epidemiology sample.

It has been suggested that collections of affected sib pairs, or their nuclear families, may be an efficient method for screening for genetic linkages in schizophrenia. We present the data collected in five years from 15 hospitals in the state of Maryland in an effort to determine if such a collection scheme will be feasible. Probands in our sample were eligible for inclusion in the sample if they were white, were age 16 years or older, and carried a research diagnosis of schizophrenia. Family data are reported for 258 probands. Using the most stringent category of affected (RDC schizophrenia) revealed ten families with two or more affected sibs. The broadest category of affected (any psychotic disorder or psychiatric hospitalization) identified only 36 families with two or more affected sibs. We conclude that, if schizophrenia is a heterogeneous disorder with decreased penetrance, an effort to collect multiplex nuclear families is unlikely to provide enough data to identify genetic linkage. Alternatively, an effort to seek out and collect larger multiplex, multigenerational families rather than a collection of affected sib pairs may be more efficacious.

Adolescent↗
PubMed2005

Sleep disturbances in the elderly residing in assisted living: findings from the Maryland Assisted Living Study.

INTRODUCTION: A majority of the elderly suffer from some sort of sleep disturbance. Common sleep disturbances are insomnia and excessive daytime sleepiness. There are no published studies on the prevalence of sleep disturbance in the assisted living (AL) setting. OBJECTIVE: To estimate the prevalence, types, and associations of sleep disturbance in a stratified random sample of AL residents, and to explore the effect of sleep disturbance on cognitive and physical functioning, as assessed by the Mini- Mental State Exam (MMSE) and the Psychogeriatric Dependency Rating Scale (PGDRS). METHODS: Participants were 198 randomly selected assisted living residents in 22 Maryland facilities. Participants were rated on an 11-item sleep questionnaire regarding insomnia and daytime sleepiness. RESULTS: Sleep disturbance was present in 69% of residents, insomnia (IN) in 42% and excessive daytime sleepiness (DS) in 34.6%. IN and DS scores were not significantly correlated(r = 0.10, p = 0.19). Use of hypnotics, sedating antidepressants, and depression were associated with insomnia. Depression and poor general medical health were associated with daytime sleepiness. On a cognitive task (Mini Mental State Examination) participants with insomnia only out-performed participants with no sleep disturbance and daytime sleepiness; on a measure of physical function (PsychoGeriatric Dependency Rating Scale- physical domain), participants with insomnia fared better than those with daytime sleepiness only and those with both insomnia and daytime sleepiness. Participants with DS only performed worse on both measures compared to those with no sleep disturbance, those with insomnia only, and those with both insomnia and daytime sleepiness. CONCLUSION: The prevalence of sleep disturbance in AL is similar to that reported in nursing homes. Daytime sleepiness is associated with poorer cognitive and day-to-day functioning, while insomnia is associated with better outcomes. Effective management of DS may lead to improved functioning in the AL residents.

Aged↗
PubMed2007

A comparison of small and large assisted living facilities for the diagnosis and care of dementia: the Maryland Assisted Living Study.

OBJECTIVES: To compare the demographic, clinical, and psychiatric characteristics of residents living in small (< or = 15 beds) and large assisted living (AL) facilities in the United States. METHODS: One hundred and ninety-eight residents in 10 large and 12 small assisted living facilities were comprehensively assessed as part of the Maryland Assisted Living Study (MD-AL). The presence or absence of dementia and psychiatric disturbances and the facilities' recognition and management of these disorders were compared across the two types of AL. Aspects of care delivery were also compared. RESULTS: Small facilities had a higher prevalence of dementia (81%) compared to larger facilities (63%) and the mean Mini-Mental State Examination (MMSE) across all residents in small facilities (mean 13.04) was than in large facilities (mean 19.93)(p = 0.000). Almost all (98%) of the residents of small homes carried a diagnosis of a dementia or other psychiatric diagnosis, compared to 74% of residents in large facilities (p < 0.001). Psychosis in particular was more prevalent in the smaller homes and the mean Neuropsychiatric Inventory score, a measure of neuropsychiatric symptoms, was higher compared to large homes. Falls were more common in larger homes despite a greater number of personal care hours per week. The use of safety devices and restraints was significantly less common in large facilities compared to smaller homes, where 'geri-chair' and bedrails were more often used. CONCLUSIONS: Rates of dementia and psychiatric disorder differ in assisted living facilities depending on size of facility.

Accidental Falls↗
PubMed1995

Prostate cancer and prediagnostic levels of serum vitamin D metabolites (Maryland, United States)

An hypothesis has been forwarded linking prostate cancer to low serum levels of vitamin D metabolites. We sought to test this hypothesis using sera obtained in a large, prospective cohort study. A serum bank in Washington County, Maryland (United States) has stored sera obtained from 20,305 county residents during a blood collection campaign undertaken in August through November 1974. We studied sera obtained from 61 residents who were diagnosed with prostate cancer during the period 1980 through 1992. Each prostate cancer case was matched to two controls on age (+/- 1 yr) and race. Controls had donated blood in the same blood-collection campaign and had not been diagnosed with prostate cancer through 1992. Serum levels of vitamin D metabolites did not differ significantly between cases and controls. Mean 25-hydroxyvitamin D (25-D) levels were 34.3 ng/ml and 33.2 ng/ml, and mean 1,25-dihydroxyvitamin D (1,25-D) levels were 41.0 pg/ml and 40.1 pg/ml, in cases and controls, respectively. No statistically significant trends or differences between cases and controls were found in an analysis by quintile of serum level. We also did not observe the association of vitamin D metabolites with prostate cancer to be strongest among older men with more severe disease, as previously has been reported. In summary, although our study's power was limited, our findings provide little support for the hypothesis that vitamin D metabolite levels are associated strongly with subsequent risk for prostate cancer.

Age Factors↗
PubMed1989

A model: systems management of life threatening injuries in children for the state of Maryland, USA.

In the past two years several guidelines for suggested components of emergency medical systems for children have been suggested, and for the first time, specific standards of pediatric trauma care have also been formulated. The American Academy of Pediatrics new Provisional Committee on Emergency Medicine has been charged with the responsibility of developing national standards of emergency care for children and are currently at work on such a landmark document. We have had a functioning statewide system for the management of life threatening injuries in children for the past 10 years. In 1985, 320 children were admitted to our trauma center. The evolution, organization, and current status of the Maryland system is described in this report. Hopefully it may serve as one successful model which could be modified for use in other regions of the country.

Adolescent↗
PubMedDate not supplied

Indoor radon and well water radon in Virginia and Maryland.

The domestic use of radioactive water has long been a cause for concern, but only a few studies have examined prolonged exposure to radionuclide concentrations found in natural settings. This paper reports on the indoor radon concentrations from 1,500 homes in northern Virginia and southern Maryland and well water radon from 700 homes in the same area. Indoor radon concentrations are almost all between 1 and about 40 pCi/L. The winter season shows the highest values with about 40% of the homes over the US EPA action level of 4.0 pCi/L. The summer season shows the lowest values with about 25% of the homes over this level. This seasonal variation is related to home ventilation. Waterborne radon in homes with private well ranges from about 100 pCi/L to about 8,000 pCi/L. In small homes, indoor radon can be significantly increased by outgassing of the home water supply, even at water radon levels of less than 10,000 pCi/L.

Air Pollutants, Radioactive↗
PubMed1994

The relation of reported alcohol ingestion to plasma levels of estrogens and androgens in premenopausal women (Maryland, United States).

We undertook a cross-sectional study in 107 premenopausal women in Maryland (United States) of alcohol intake and hormonal status in order to evaluate whether plasma hormone levels might mediate the reported positive relation between alcohol ingestion and breast cancer risk. Alcohol ingestion was estimated using a drinking pattern questionnaire, a food frequency questionnaire, and seven-day food records. Fasting blood specimens were collected on days 5-7, 12-15, and 21-23 of each participant's menstrual cycle and pooled to create follicular, midcycle, and luteal phase samples, respectively, for analysis. Estrone, estrone sulfate, estradiol, androstenedione, and dehydroepiandrosterone sulfate (DHEAS) in plasma were measured by radioimmunoassay, and sex-hormone binding globulin (SHBG) was measured by an immunoradiometric assay. After adjusting for age, weight, and total energy intake, alcohol ingestion was not associated with plasma estrogens in the follicular, midcycle, or luteal phases of the menstrual cycle, nor with the level of SHBG or DHEAS in plasma averaged from the three phases of the cycle. Alcohol, however, was significantly positively associated with the average level of plasma androstenedione. Based on these cross-sectional findings among premenopausal women, the increased risk of breast cancer related to alcohol ingestion does not appear to be mediated by elevated plasma estrogen levels. Androstenedione, however, may mediate the alcohol/breast cancer-association.

Adult↗
PubMedDate not supplied

The impact of managed care on the substance abuse treatment patterns and outcomes of Medicaid beneficiaries: Maryland's HealthChoice program.

The introduction of Medicaid managed care raises concern that profit motives lead to the undersupply of substance abuse (SA) services. To test effects of the Maryland Medicaid HealthChoice program on SA treatment patterns and outcomes, Medicaid eligibility files were linked to treatment provider records and two study designs were used to estimate program impact: a quasi-experimental design with matched comparison groups and a natural experiment. Patient sociodemographic and clinical characteristics were adjusted using multiple regression. Under managed care, there was a shift from residential, correctional-only, and detoxification-only treatment toward outpatient-only treatment. Among beneficiaries entering treatment, those enrolled in managed care organizations (MCOs) had similar utilization and outcomes to those in Medicaid fee-for-service; those enrolling in MCOs during treatment had longer and more intensive episodes and, as a result, better outcomes. Thus, the study disclosed no empirical evidence that health plans respond to capitation by reducing SA services.

Adolescent↗