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PubMed1991

The linkage of Baltimore's mental health and public health systems.

The Institute of Medicine's The Future of Public Health calls for a strengthening of linkages between public health and mental health, with a view to integrating the functions at the service delivery level. This paper details the history of the mental health/public health interface in Baltimore, Maryland. In 1977, mental health and addiction services were merged into the Department of Health. More recently, in 1988 adult mental health services were split off into a quasi-public corporation. Children's mental health, however, was retained as a distinct service within the Department of Health in order to enhance coordination with other health services for children. Replication of such coordinated-care models is certainly feasible.

Adult↗
PubMed1991

Racial variations in the prevalence of primary open-angle glaucoma. The Baltimore Eye Survey.

OBJECTIVE: --To compare the prevalence of primary open-angle glaucoma between black and white Americans. DESIGN, SETTING, AND PARTICIPANTS: --The design was a population-based prevalence survey of a noninstitutionalized black and white population aged 40 years or older from the eastern and southeastern health districts of Baltimore, Md. A multistage random sampling strategy was used to identify 7104 eligible participants, of whom 5308 (2395 blacks, 2913 whites) received an ophthalmologic screening examination. Those with abnormalities were referred for definitive diagnostic evaluation. MAIN OUTCOME MEASURE: --Primary open-angle glaucoma was defined based on evidence of glaucomatous optic nerve damage, including abnormal visual fields and/or severe optic disc cupping, and was independent of intraocular pressure. MAIN RESULTS: --Age-adjusted prevalence rates for primary open-angle glaucoma were four to five times higher in blacks as compared with whites. Rates among blacks ranged from 1.23% in those aged 40 through 49 years to 11.26% in those 80 years or older, whereas rates for whites ranged from 0.92% to 2.16%, respectively. There was no difference in rates of primary open-angle glaucoma between men and women for either blacks or whites in this population. Based on these data, an estimated 1.6 million persons aged 40 years or older in the United States have primary open-angle glaucoma. CONCLUSIONS: --Black Americans are at higher risk of primary open-angle glaucoma than their white neighbors. This may reflect an underlying genetic susceptibility to this disease and indicates that additional efforts are needed to identify and treat this sight-threatening disorder in high-risk communities.

Adult↗
PubMed1986

The validity of robbery-murder classifications in Baltimore.

The most widely used source of nationwide data on homicide in the United States is the Supplementary Homicide Report (SHR) data compiled by the FBI as part of its Uniform Crime Reporting System. This paper describes a study of the reliability of robbery-murder classifications by the SHR for Baltimore, Maryland during 1983. The research is exploratory, but indicates a high level of inconsistency in the data. Of the 42 cases that were classified as robbery murders by the SHR or the replication study, only 20 were classified that way in both studies. The high level of unreliability can be attributed to three major problems: (1) the SHR codes are mutually exclusive, but many homicides could be placed in several of the categories; (2) there are few systematic rules for classifying ambiguously motivated homicides; and (3) the SHR placed too many cases in the "unknown" category. It appears that the reliability of the coding could be increased substantially with relatively minor changes in the procedures currently used.

Baltimore↗
PubMed1994

Preparations for AIDS vaccine trials. Incident human immunodeficiency virus (HIV) infections in a cohort of injection drug users in Baltimore, Maryland.

In order to prepare for a possible trial of a preventive human immunodeficiency virus (HIV) vaccine in a population of injection drug users (IDUs) we followed a cohort to determine their HIV incidence, compliance with follow-up visits at 3-month intervals (i.e., quarterly) and their attitudes toward HIV vaccine trial participation. A population of 671 HIV-seronegative subjects were recruited from a cohort of IDUs already in follow-up in Baltimore, MD (the ALIVE study). We detected 19 seroconverters in 1677.80 person-quarters of follow-up, an annual incidence of 4.52/100 person-years. Compliance with quarterly follow-up was 93% at 6 months and 89% at 9 months. Although many subjects (n = 104) are not yet due for their 12-month visit, compliance to date has been 76%. The most sensitive risk behaviors associated with HIV seroconversion have been continued injection of illicit drugs and the frequency of drug use. Other reported drug associated risk behaviors, e.g., needle sharing and shooting gallery use, have decreased despite a high HIV incidence; we believe some of the reported reductions in high-risk behavior represent socially desirable responses by the study subjects. Although the difficulties in successfully doing a trial of an HIV vaccine in the population should not be underestimated, our data suggest that such a trial would be feasible.

AIDS Vaccines↗
PubMed1994

Immunization coverage and its relationship to preventive health care visits among inner-city children in Baltimore.

OBJECTIVE: To provide empirical data on immunization coverage and the receipt of preventive health care to inform policy makers' efforts to improve childhood immunization. DESIGN AND METHODS: We surveyed a random sample drawn from a birth cohort of 557 2-year-old children living in the inner-city of Baltimore. Complete information on all their preventive health care visits and immunization status was obtained from medical record audits of their health care providers. MAIN OUTCOME MEASURES: Age-appropriate immunizations and preventive health care visits. RESULTS: By 3 months of age, nearly 80% made an age-appropriate preventive health visit, but by 7 months of age, less than 40% had a preventive visit that was age-appropriate. In the second year of life, 75% made a preventive health visit between their 12- and 17-month birthdays. The corresponding age-appropriate immunization levels were 71% for DTP1, 39% for DTP3, and 53% for measles-mumps-rubella vaccine. Infants who received their DTP1 on-time were twice as likely to be up-to-date by 24 months of age. CONCLUSIONS: Our analyses focus attention on the performance of the primary health care system, especially during the first 6 months of life. Many young infants are underimmunized despite having age-appropriate preventive visits, health insurance coverage through Medicaid, and providers who receive free vaccine from public agencies. Measles vaccination coverage could be improved by initiating measles-mumps-rubella vaccine vaccination, routinely, at 12 months among high risk populations.

Baltimore↗
PubMed1994

Epidemiologic observations on infection with Rochalimaea species among cats living in Baltimore, Md.

Cats from several sources in Baltimore, Md, were tested for seropositivity to Rochalimaea henselae and R quintana. Co-infection with Toxoplasma gondii or feline immunodeficiency virus was assessed as a risk factor for infection with Rochalimaea spp. Of 592 cats tested, 87 (14.7%) were seropositive for one or both Rochalimaea spp, although titers to R henselae were significantly higher than those to R quintana. Prevalence of seropositivity increased significantly with cat age and weight and was associated with seropositivity to T gondii but was not associated with gender. Prevalence of seropositivity was similar (12.5 to 14.4%) among groups of cats with some history of human contact but was higher among feral cats (44.4%). Whether cats are reservoirs or mechanical vectors of Rochalimaea spp that can cause diseases in people is still uncertain, but these findings indicated widespread infection of cats and suggested possible modes of transmission for Rochalimaea spp among cats.

Age Factors↗
PubMed1993

Automated suprathreshold screening for glaucoma: the Baltimore Eye Survey.

PURPOSE: To evaluate automated suprathreshold perimetric screening for glaucoma in a population-based survey of ocular disorders in east Baltimore, Maryland. METHODS: A population-based sample of persons > or = 40 years of age residing in 16 clusters was selected for an ocular screening examination that included automated suprathreshold testing with the Full Field 120 program of the Humphrey Field Analyzer. Subjects who failed the test underwent manual testing to confirm the defect. Subjects were referred for definitive examination by an ophthalmologist if they had an abnormal field, visual acuity worse than 20/30, intraocular pressure > 21 mm Hg, optic disc damage, a history of glaucoma, or shallow angles. The sensitivity and specificity of the automated visual field testing for identifying glaucoma was estimated and compared with other methods to screen for glaucoma. RESULTS: Of 5,341 subjects > or = 40 years of age who underwent a screening eye examination at neighborhood centers, 4,735 (89%) completed the automated field test. The median test time was 7.25 minutes per eye. Screening test results were abnormal in one or both eyes in 1,234 (26%) of the subjects. Kinetic perimetry was performed on 95% of these subjects, and defects were confirmed for 448 (36%) of them. Hence, 9.5% of the 4,735 subjects who completed the automated test were referred for definitive examination because the defect on automated perimetry was confirmed on manual testing. For a specificity of 90%, the sensitivity of the screening visual field test to detect glaucoma was 52% for 17 or more relative or absolute defects, higher than that of intraocular pressure at 39% for a cut-off of 20.5 mm Hg, vertical cup-to-disc ratio at 45% for a cut-off of 0.53, narrowest remaining rim width at 42% for a cut-off of 0.16, and was comparable to a combination of these and other nonfield parameters. CONCLUSION: Suprathreshold testing performed better than nonperimetry-based screening tests for glaucoma. However, a number of logistical weaknesses of this visual field screening method were identified.

Adult↗
PubMedDate not supplied

Comparison of contraceptive implant adopters and pill users in a family planning clinic in Baltimore.

All 133 women who began using the Norplant contraceptive implant between August and December of 1991 at a Planned Parenthood clinic in Baltimore were compared with a sample of 112 women who obtained prescriptions for the pill at the same clinic during the same time period. A multivariate analysis found that women of Medicaid are significantly more likely than those who are self-paying to select the implant rather than the pill. Similarly, compared with women who have had no children, those who have had two or more are also significantly more likely to choose the implant. However, adolescents and women who have had an abortion are no more likely than other women to select the implant.

Adolescent↗
PubMedDate not supplied

Psychological research in the Baltimore Longitudinal Study of Aging.

The Baltimore Longitudinal Study of Aging (BLSA) is an ongoing multidisciplinary study of biomedical and psychosocial aging. Over 1000 men and women are currently active, returning to the Gerontology Research Center every 2 years for a 2.5-day visit. Longitudinal studies of cognitive functioning have shown a variety of patterns of age changes in vigilance, problem solving, divergent thinking abilities, and visual memory. Studies of personality traits have shown stability in both mean levels and individual differences. Future BLSA research will add neuroimaging studies to link personality and cognition to the structure and function of the aging brain.

Adolescent↗
PubMed1993

Prevalence of human immunodeficiency virus-1 infection in a Baltimore acute care hospital.

In conjunction with the Centers for Disease Control and Prevention's (CDC's) national Sentinel Hospital Surveillance System for HIV (human immunodeficiency virus) Infection, we conducted unlinked (anonymous) testing of a systematically selected sample of blood specimens for HIV-1 antibodies to assess the HIV-1 infection level in an urban hospital's catchment population. We excluded specimens from patients with admitting diagnoses often associated with HIV infection. Of the 5,350 specimens tested between April 1988 and October 1989, 106 (2%) were HIV-1 seropositive. HIV-1 seroprevalence in female patients was 1%, and in male patients, 3%. Those 25-44 years of age showed the highest seroprevalence (3.7% in all patients: 6.6% in male patients, 1.1% in female patients). These results demonstrate a high HIV-1 infection level in this patient population and suggest Baltimore hospitals should evaluate the impact and costs of developing routine HIV counseling and testing programs for their patients.

AIDS Serodiagnosis↗
PubMed1993

Maternal and child health services in the Baltimore City Health Department, 1900-1992.

Maternal and Child Health Services in the Baltimore City Health Department, founded in 1934 and 1919, respectively, grew out of concern for maternal and infant death. Increasingly, services have focused on prevention and on building individual health by strengthening the family. The authors identify changing patterns of health care and the health department's continuing role in assuring high quality care and developing guidelines for cost-effective management.

Adult↗
PubMed1996

Scopolamine poisoning among heroin users--New York City, Newark, Philadelphia, and Baltimore, 1995 and 1996.

Heroin is mixed ("cut") frequently with other substances primarily to increase its weight for retail sale (e.g., mannitol and starch) and to add pharmacologic effects (e.g., dextromethorphan and lidocaine). During 1995 and 1996, health departments and poison-control centers in New York City (NYC); Newark, New Jersey; Philadelphia; and Baltimore reported at least 325 cases of drug overdoses requiring medical treatment in persons who had used "street drugs" sold as heroin that probably also contained scopolamine, an anticholinergic drug. This report summarizes the clinical and epidemiologic features of these cases, which represent a new type of drug overdose.

Baltimore↗
PubMed1996

Hydroxychloroquine use in the Baltimore Lupus Cohort: effects on lipids, glucose and thrombosis.

Hydroxychloroquine is used by 35% of SLE patients enrolled in the Baltimore Lupus Cohort. Eighty per cent of patients who took hydroxychloroquine at cohort entry remain on it six years later. In addition to its role for disease manifestations of lupus, hydroxychloroquine may be indicated for the prevention of disease or treatment-induced complications, including hyperlipidemia, diabetes mellitus, liver function test elevation and thrombosis.

Antirheumatic Agents↗
PubMed1996

Antibodies to Bartonella species in inner-city intravenous drug users in Baltimore, Md.

BACKGROUND: Bartonella quintana has recently been associated with homeless alcoholic men. Both B quintana and Bartonella henselae have been shown to be opportunistic pathogens of people with acquired immunodeficiency syndrome. The reservoirs and modes of transmission of these infections are incompletely known. OBJECTIVES: To examine serum samples that were taken from inner-city intravenous (IV) drug users for antibodies to Bartonella organisms to determine whether there is an urban transmission cycle for Bartonella species and to examine the demographic and behavioral characteristics of IV drug users to identify possible risk factors for infection with any of these agents. MATERIALS AND METHODS: A serologic survey was conducted, using a convenience sample of serum specimens collected during a study of IV drug use and human immunodeficiency virus infection among 630 inner-city residents in Baltimore, Md. A detailed questionnaire was administered at the initial collection of serum, and additional serum collections and questionnaire updates were made at 6-month intervals. The most recent available serum sample was tested for Bartonella antibody titer by using the indirect immunofluorescent antibody test with 3 antigens: Bartonella elizabethae, B henselae, and B quintana. Univariate and multivariate analyses of selected potential demographic and behavioral risk factors were conducted. RESULTS: Antibodies to Bartonella were highly prevalent in this group; more than 37% of all samples reacted with at least 1 antigen. Overall seroprevalence of antibodies to B elizabethae, B henselae, and B quintana was 33%, 11%, and 10%, respectively. Current IV drug use, frequency of injection, and seronegative human immunodeficiency virus status were significantly associated with Bartonella antibody presence, but these associations varied by analysis. There was a significant inverse association of antibody prevalence to B henselae and B quintana by using CD4+ cell counts among human immunodeficiency virus-seropositive individuals. CONCLUSIONS: Intravenous drug users have an elevated prevalence of antibodies to Bartonella organisms and may be at significant risk of becoming infected. Current IV drug use, high frequency of injection, and seronegative human immunodeficiency virus status are significant risk factors for an increased prevalence of Bartonella antibodies. The current natural histories of Bartonella species are rapidly changing, and mechanisms of transmission remain unknown.

Adult↗
PubMed1998

Satellite exchange in the Baltimore Needle Exchange Program.

OBJECTIVE: Our first objective was to develop an index of satellite exchange and then determine whether satellite exchangers (SEs) differed demographically or behaviorally from other injecting drug users (IDUs). Our second objective was to determine the degree that SEs contributed to needle exchange program (NEP) effectiveness. METHODS: We collected data from approximately 5000 Baltimore Needle Exchange Program (BNEP) participants on the number of syringes acquired and returned over the two-year period February 1995 to February 1997. We then conducted one-way ANOVAs and logistic regressions to determine if SEs were different from other IDUs. RESULTS: We classified 9.35% of the IDUs and SEs and showed that SEs reported levels of drug use and risk behavior similar to other BNEP participants. Although SEs represented less than 10% of all BNEP clients, they accounted for more than 64% of all needles distributed by the BNEP. We showed that SEs accessed more wide-ranging drug use networks than non-SE IDUs and thus can act as potential bridges for human immunodeficiency virus (HIV) prevention materials and messages to larger numbers of drug injectors. CONCLUSIONS: SEs can be expressly targeted with specific prevention messages and encouraged to be "ambassadors" for HIV prevention messages. Efforts to curtail the activities of SEs may detract from the effectiveness of NEPs.

Adult↗
PubMed1996

Traditional risk factors and ischemic stroke in young adults: the Baltimore-Washington Cooperative Young Stroke Study.

OBJECTIVE: To determine the association of hypertension, diabetes, and cigarette smoking with incidence of ischemic stroke in young adults. DESIGN: Case-control study. SETTING: Population-based sample of cases and controls. SUBJECTS: The study included 296 cases of incident ischemic stroke among black and white adults aged 18 to 44 years in central Maryland counties from the Baltimore-Washington Cooperative Young Stroke Study and 1220 black and white adults aged 18 to 44 years from the Maryland Behavioral Risk Factor Survey, a telephone survey of a random sample of the same region, to serve as controls. MAIN OUTCOME MEASURES: Logistic regression models were developed to determine the age-adjusted odds ratios for each risk factor. Population-attributable risk percent were computed based on the odds ratios and prevalence of each risk factor. RESULTS: The age-adjusted odds ratios (95% confidence intervals) for white men (WM), white women (WW), black men (BM), and black women (BW) were as follows: current cigarette smoking: WM, 2.0 (1.1-3.8), WW, 2.1 (1.1-4.3), BM, 3.3 (1.6-6.6), and BW, 2.2 (1.3-3.9); history of diabetes mellitus: WM, 22.9 (5.8-89.6), WW, 6.2 (1.9-20.2), BM, 4.2 (0.8-21.9), and BW, 3.3 (1.4-7.7); and history of hypertension: WM, 1.6 (0.7-3.2), WW, 2.5 (1.1-5.9), BM, 3.8 (1.8-7.9), and BW, 4.2 (2.4-7.5). The population-attributable risk percent (95% confidence intervals) were as follows: current cigarette smoking: WM, 22.6 (3.1-38.2), WW, 17.2 (4.0-34.0), BM, 40.5 (23.1-54.0), and BW, 29.1 (13.5-41.9); history of diabetes mellitus: WM, 19.0 (8.2-28.5), WW, 15.8 (3.8-26.3), BM, 13.2 (5.3-20.4), and BW, 22.1 (12.5-30.7); and history of hypertension: WM, 21.7 (6.2-34.6), WW, 21.3 (5.4-34.5), BM, 53.5 (39.0-64.4), and BW, 50.5 (37.1-61.1). CONCLUSIONS: Hypertension, diabetes mellitus, and current cigarette smoking are important risk factors in a biracial young adult population. Cigarette smoking and hypertension, the 2 most modifiable risk factors, were particularly important risk factors in young blacks.

Adolescent↗
PubMed1991

Relationship between intraocular pressure and primary open angle glaucoma among white and black Americans. The Baltimore Eye Survey.

A detailed ocular examination, including perimetry, was conducted on 5308 black and white subjects aged 40 years and older in a population-based prevalence survey in east Baltimore, Md. Repeated, detailed examinations were carried out on selected subjects. Roughly half of all subjects with optic nerve damage from primary open angle glaucoma, regardless of race, were unaware that they had the condition. The average intraocular pressure (IOP) among black patients with glaucoma who were receiving treatment was virtually identical to that in those black patients who were not receiving treatment (median IOP, 20 mm Hg); treated eyes of white patients had a lower IOP than those eyes of white patients who were not receiving treatment (mean [+/- SD] IOP, 18.69 +/- 3.23 mm Hg vs 24.15 +/- 5.23 mm Hg; P less than .001). The risk of glaucomatous optic nerve damage increased with the height of the screening IOP, particularly at levels of 22 to 29 and 30 mm Hg and above (relative rate compared with IOP of 15 mm Hg or lower, 12.8 and 40.1 mm Hg, respectively). More than half of all glaucomatous eyes had a screening IOP below 21 mm Hg, whether these eyes were receiving treatment or not. The IOP in glaucomatous eyes tended to rise on follow-up, in contrast with nonglaucomatous eyes in which the IOP was as likely to rise as to fall. Results confirmed that IOP is an important factor in glaucoma, but did not support the traditional distinction between "normal" and "elevated" pressure, nor its corollaries, "low-tension" glaucoma and "high-tension" glaucoma.

Black People↗