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PubMed2001

Carrier screening for cystic fibrosis among Maryland obstetricians before and after the 1997 NIH Consensus Conference.

The 1997 National Institutes of Health (NIH) Consensus Conference on Cystic Fibrosis (CF) testing recommended that carrier screening be offered to all pregnant women and couples planning a pregnancy. We surveyed 492 Maryland Ob-Gyns before and after the consensus conference to: (1) assess whether obstetricians changed their practice regarding CF carrier testing, and (2) identify the factors associated with changing practice patterns, including awareness of the statement, and knowledge about CF. Fifty-six percent (275) responded to the first mail questionnaire and 107 obstetricians responded to both questionnaires. In 1998, only 18% of respondents to the second questionnaire were familiar with the NIH statement, but 43% reported discussing testing with patients with no family history, a significant increase from 1997, when only 20% reported discussing testing. Less than one-third correctly answered six multiple-choice knowledge questions about CF and carrier testing. In multivariate analysis, knowledge and familiarity with the NIH consensus statement were not associated with beginning to discuss CF carrier testing after the CF conference with their patients without a family history.

Adult↗
PubMed1991

Prediagnostic serum levels of carotenoids and vitamin E as related to subsequent cancer in Washington County, Maryland.

In 1974 and 1975, serum specimens were collected from 25,802 volunteers in Washington County, Maryland. The serum was kept frozen at -73 degrees C until the time of assay. Prediagnostic samples from 436 cancer cases and 765 matched control subjects have been assayed. Nine sites have been studied: colon, rectum, pancreas, lung, melanoma, basal cell of skin, breast, prostate, and bladder. Serum beta-carotene levels showed a strong protective association with lung cancer, suggestive protective associations with melanoma and bladder cancer, and a suggestive but nonprotective association with rectal cancer. Serum vitamin E levels had a protective association with lung cancer; none of the other sites showed impressive associations. Low levels of serum lycopene were strongly associated with pancreatic cancer and less strongly associated with cancer of the bladder and rectum.

Adult↗
PubMed1992

Cancer of the pancreas and drinking water: a population-based case-control study in Washington County, Maryland.

A case-control study was done to assess a potential association between drinking water and pancreatic cancer in Washington County, Maryland. Cases of pancreatic cancer occurring from 1975 through 1989 were identified from the cancer registry. Controls were selected from the private 1975 census of Washington County. There were 101 cases and 206 controls. Chlorinated municipal water was used as a source of drinking water by 79% of cases and 63% of controls, yielding a significant odds ratio of 2.2. Adjustment for age and smoking had almost no effect on the risk, although both age and smoking were independently associated with an increased risk of pancreatic cancer. Although these findings must be interpreted with caution because of limitations in exposure assessment, these results have implications for the prevention of pancreatic cancer because chlorination of water is so widely practiced.

Adult↗
PubMed2001

Cancer incidence after childhood nasopharyngeal radium irradiation: a follow-up study in Washington County, Maryland.

A population from a hearing clinic in Washington County, Maryland, in 1943-1960 was followed to assess the risk of developing neoplasms from radium treatment of the nasopharynx for adenoid hypertrophy. Of the 2,925 subjects who attended the clinic, 904 received radium treatment. A nonconcurrent prospective study compared the cancer incidence among the irradiated persons with that among persons with other treatments. Seven brain tumor cases (three malignant and four benign) were identified in the irradiated group versus none in the nonirradiated group (relative risk = 14.8, 95% confidence interval: 0.76, 286.3). A nonsignificant excess risk of thyroid cancer was detected in the irradiated group based on two cases in the exposed group and one case in the nonexposed group (relative risk = 4.2, 95% confidence interval: 0.38, 46.6). Decreased risks of breast cancer, female genital cancers, and prostate cancer were observed among the irradiated individuals, although these deficits were not statistically significant individually. The decreased risk of sex hormone-related cancers in the irradiated group suggests possible radiation damage to the pituitary, with consequent reduction in pituitary hormone output and alterations in sexual and other hormonal development in early life. This hypothesis needs further evaluation.

Adenoids↗
PubMed2003

Longitudinal evaluation of an educational intervention for preventing tick bites in an area with endemic lyme disease in Baltimore County, Maryland.

The authors attempted to determine whether a targeted educational intervention in an area with endemic Lyme disease could increase knowledge, positive attitudes, and reported behaviors related to tick bite prevention and consequently decrease tick bites, as measured by a biomarker of tick bites. Between April and September of 1999, 317 subjects in Baltimore County, Maryland, were randomized to receive either tick-related or general health-related educational materials bimonthly through the mail. At each of three clinic visits, participants completed a self-administered questionnaire and provided a serum sample. Anti-recombinant tick calreticulin antibody (ARTCA), measured in ng/ micro l, was used as a biomarker of tick bites. Linear and logistic regression analyses were used to determine 1) whether the educational intervention was associated with a change in knowledge, attitudes, and behaviors (KAB) and 2) whether change in KAB predicted change in ARTCA levels. Proportions of desired responses increased significantly among intervention subjects versus the comparison group on KAB measures related to examining the body for ticks and insect repellent use. Levels of ARTCA were low among all study subjects. Only six of 37 models exhibited a significant relation between change in a KAB variable and change in ARTCA levels over time. The behavioral intervention was associated with an increase in the KAB measures in the intervention group, but this change was not associated with change in ARTCA levels.

Adolescent↗
PubMed2004

Fruit, vegetable, and antioxidant intake and all-cause, cancer, and cardiovascular disease mortality in a community-dwelling population in Washington County, Maryland.

Higher intake of fruits, vegetables, and antioxidants may help protect against oxidative damage, thus lowering cancer and cardiovascular disease risk. This Washington County, Maryland, prospective study examined the association of fruit, vegetable, and antioxidant intake with all-cause, cancer, and cardiovascular disease death. CLUE participants who donated a blood sample in 1974 and 1989 and completed a food frequency questionnaire in 1989 (N = 6,151) were included in the analysis. Participants were followed to date of death or January 1, 2002. Compared with those in the bottom fifth, participants in the highest fifth of fruit and vegetable intake had a lower risk of all-cause (cases = 910; hazard ratio (HR) = 0.63, 95% confidence interval (CI): 0.51, 0.78; p-trend = 0.0004), cancer (cases = 307; HR = 0.65, 95% CI: 0.45, 0.93; p-trend = 0.08), and cardiovascular disease (cases = 225; HR = 0.76, 95% CI: 0.54, 1.06; p-trend = 0.15) mortality. Higher intake of cruciferous vegetables was associated with lower risk of all-cause mortality (HR = 0.74, 95% CI: 0.60, 0.91; p-trend = 0.04). No statistically significant associations were observed between dietary vitamin C, vitamin E, and beta-carotene intake and mortality. Overall, greater intake of fruits and vegetables was associated with lower risk of all-cause, cancer, and cardiovascular disease death. These findings support the general health recommendation to consume multiple servings of fruits and vegetables (5-9/day).

Adult↗
PubMed2005

The effect of trihalomethane and haloacetic acid exposure on fetal growth in a Maryland county.

As water flows from treatment plants to the tap, chlorine, used to disinfect surface water meant for residential use, reacts with residual organic and inorganic matter, creating chlorine disinfection by-products. In recent years, these by-products have been scrutinized as a potential reproductive and developmental hazard. This study examined whether exposure to the four total trihalomethanes or the five haloacetic acids (two major subgroups of chlorine disinfection by-products) was related to an increased risk of intrauterine growth retardation in four regions of a Maryland county from 1998 to 2002. Maternal exposure to each by-product was evaluated for each trimester as well as over the entire pregnancy. The authors were not able to demonstrate any consistent, statistically significant effect on intrauterine growth retardation associated with any of the chlorine disinfection by-products, nor did they find any indication of a dose-response relation. However, they did find some potential for a slightly elevated risk of intrauterine growth retardation during the second and third trimesters for both total trihalomethanes and five haloacetic acids when comparing increasing quintiles of exposure to constituents of total trihalomethanes and five haloacetic acids.

Adolescent↗
PubMed2005

Predictors of functional impairment in residents of assisted-living facilities: the Maryland Assisted Living study.

BACKGROUND: Assisted living is a popular residential option for older individuals, yet little research has been done on people choosing this option. This study examines predictors of functional impairment in assisted living residents in the domains of cognition, mood, and health. METHODS: An experienced team of neuropsychiatrists, nurses, and technicians using a number of cognitive, behavioral, health, and functional status tests and a cross-sectional study design assessed 198 residents of 22 assisted living facilities in Maryland. Data from these evaluations were used in univariate and multiple regression models to identify predictors of functional impairment, operationalized as the sum of the scores on two scales, one measuring impairment in basic activities of daily living and one measuring impairment in instrumental activities of daily living. RESULTS: Greater cognitive impairment, worse depression, and worse medical health were significant independent predictors of functional impairment, together explaining a sizeable portion of the variance (adjusted R2=0.434). None of the demographic variables examined individually, including age and education, was predictive of functional impairment. In an analysis of specific cognitive domains, executive dysfunction, impairment of visuospatial skills, and amnesia were significant predictors of impairment, whereas inattention was not. CONCLUSION: Executive dysfunction, apraxia, memory impairment, depression, and general medical health are all significant predictors of functional impairment in assisted living residents, with executive dysfunction being the strongest. These results may be instrumental in developing a more efficient model of care for residents of assisted living facilities, one based on having accurate predictive models of degree of impairment.

Activities of Daily Living↗
PubMed2006

Correlates of caregiver-rated quality of life in assisted living: the Maryland Assisted Living study.

We used a cross-sectional study to examine the correlates of caregiver-rated quality of life (QOL) in 198 randomly selected residents from a stratified random sample of 22 assisted living facilities in central Maryland. We measured QOL by using the Alzheimer's Disease-Related Quality of Life Questionnaire. In general, despite cognitive impairment, residents in assisted living were rated as having a high QOL. In a multivariate regression, we found that nonmood neuropsychiatric symptoms were the strongest correlate of QOL, explaining 37% of the variance. Depressive symptoms, functional dependence, marital status, and cognition also contributed to the model, but only minimally. Because of the strong association of neuropsychiatric symptoms with QOL, special attention should be given to their recognition and amelioration.

Activities of Daily Living↗
PubMed1995

Measuring the implementation of health promotion programs: the case of the Breast and Cervical Cancer Program in Maryland.

This paper introduces critically important issues and benefits for measuring the extent and processes of program implementation when conducting and studying health education and health promotion programs. These methods are illustrated with reference to the Breast and Cervical Cancer Program in Maryland. We suggest using a chain of events research paradigm rather than confining community intervention research to the more frequently used experimental model. Combined roles as researchers and technical advisors serve complementary functions of gathering relevant, valid information about implementation and making these data useful to program managers. Measures of implementation should be used to examine the detailed delivery of program components, to assess organizational and environmental processes influencing the extent of implementation and to analytically link variations in program delivery to desired short-term outcomes. Measuring these processes is needed to move implementation research for health promotion programs beyond an anecdotal set of case stories about implementation problems to a fully developed area of research-based knowledge.

Breast Neoplasms↗
PubMedDate not supplied

Therapeutic and toxic drug concentrations in post mortem blood: a six year study in the State of Maryland.

A six-year study of therapeutic and toxic drug concentrations in the blood from medical examiner's cases in the State of Maryland is reported. Statistical means, ranges, and number of cases are presented for three categories of cases; single drug deaths (53 drugs and 5 metabolites), multiple drug deaths (40 drugs and 5 drug metabolites), and non-drug related deaths (49 drugs and 5 metabolites). Results are compared to previous studies from the literature to facilitate, augment, and improve the understanding of the concentrations of drugs consistent with therapy or death.

Amitriptyline↗
PubMed1989

Quantitative carcinogenesis in man: solar ultraviolet B dose dependence of skin cancer in Maryland watermen.

Skin cancer is the most common form of cancer in humans and occurs primarily on sun-exposed areas of the body. In a study of 808 Caucasian Maryland watermen, we examined the prevalence of nonmelanoma skin cancer in relation to age and exposure to solar ultraviolet B (UVB) radiation. For each study subject, the exposure to solar UVB radiation for each year of life after the age of 16 years was calculated. We obtained the data for this analysis by combining a detailed occupational history with laboratory and field measurements. Prevalence of the three major types of nonmelanoma skin neoplasms was analyzed: squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and actinic keratosis (AK). Average annual exposure to UVB radiation was strongly correlated with the prevalence of SCC, but not with the prevalence of BCC or AK. This finding is consistent with dose saturation (plateau in dose-response relationship) for the induction of BCC and AK in humans with high annual exposure to UVB radiation. In addition, two small groups of apparently hypersusceptible individuals were present in the population. One group had SCC despite low annual exposure to UVB radiation, and the other group had multiple skin cancers despite average exposure to UVB radiation.

Adult↗
PubMed2004

Prevalence of HIV, syphilis, hepatitis B, and hepatitis C among entrants to Maryland correctional facilities.

Although high prevalence of hepatitis C virus (HCV) in correctional institutions has been established, data are sparse regarding the comorbidities of hepatitis B virus (HBV), HCV, and human immunodeficiency virus (HIV), all of which may complicate the management of HCV. This study sought to estimate the prevalence and correlates associated with HCV prevalence among entrants into the Maryland Division of Correction and the Baltimore City Detention Center. Participants included all newly incarcerated entrants between January 28 and March 28, 2002. Excess sera with identifiers removed from samples drawn for routine syphilis testing were assayed for antibodies to HIV and HCV and for HBV surface antigen and surface and total core antibodies. Separately, all HIV-positive specimens were tested using the serological testing algorithm for recent HIV seroconversion. Of the 1,081 inmates and 2,833 detainees, reactive syphilis serology was noted in 0.6% of the combined population; HIV seroprevalence was 6.6%; HCV prevalence was 29.7%; and 25.2% of detainees and prisoners had antigen or core or surface antibodies to HBV. A multivariate analysis of predictors of HCV positivity indicated that detainees, women, whites, older age groups, those who were HIV seropositive, and individuals with past or present infection with HBV were significantly more likely to be positive for HCV. These data indicate that hepatitis C remains an important public health concern among entrants to jail and prison and is complicated with coinfections that need to be addressed for effective treatment.

Adolescent↗
PubMed2000

Duration of human immunodeficiency virus infection and likelihood of giving birth in a Medicaid population in Maryland.

The objective of this study was to examine the effect of duration of human immunodeficiency virus (HIV) infection on a woman's likelihood of giving birth. Using longitudinal data from the Maryland state Human Immunodeficiency Virus Information System and a retrospective cohort design, the authors compared 1,642 women with acquired immunodeficiency syndrome (AIDS) to 8,443 uninfected women enrolled in the Medicaid program between 1985 and 1995. The decade before AIDS diagnosis was divided into four 2.5-year periods. Proximity to AIDS diagnosis served as a proxy for duration of infection. An extension of the Cox model was used to estimate the relative risk for giving birth, with adjustment for covariates and repeated outcomes. The average number of births per 100 person-years was 6.0 for HIV-infected women and 11.1 for uninfected women (adjusted relative risk = 0.63; 95% confidence interval (CI): 0.57, 0.68). Accounting for duration of infection, the adjusted relative risks for birth among HIV-infected women, as compared with uninfected women, were 0.85 (95% CI: 0.71, 1.03), 0.74 (95% CI: 0.63, 0.86), 0.55 (95% CI: 0.47, 0.64), and 0.45 (95% CI: 0.38, 0.55) for successive 2.5-year periods before AIDS diagnosis. Demographic characteristics, contraception, abortion, fetal loss, or drug use could not fully explain the reductions. These results suggest that HIV-infected women experience a progressive reduction in births years before the onset of AIDS. This may compromise estimation of HIV prevalence and interpretation of time trends from serosurveillance of pregnant women.

Adolescent↗
PubMed1982

Patterns of incidence and trends in diagnostic classification of cerebrovascular disease in Washington County, Maryland, 1969-1971 to 1974-1976.

A study was conducted to provide baseline data on patterns of cerebrovascular disease incidence in the community of Washington County, Maryland, over two time intervals--1969-1971 and 1974-1976--and to evaluate any temporal trends with regard to their possible relation to reported declines in stroke death rates. Among the statistically significant changes in incidence between 1969-1971 and 1974-1976 were a decline in the rate of cerebral thrombosis and a concomitant increase in frequency of cerebrovascular disease-unspecified, most likely a reflection of a change in diagnostic terminology. In addition, the findings of a significant decrease in incidence of cerebral hemorrhage (for all ages over 55 years and both sexes) and a non-significant decrease in incidence rates for all types combined among those in the oldest age category between the two study periods support the role of changing incidence rates in the stroke death rate decline. It is clear, however, that monitoring of this community over a longer period of time will be necessary before the validity of these trends can be established and their causes elucidated. The need for more complete recording of historical data and clinical findings on admission, as well as adherence to standardized diagnostic and classification protocols was underscored by this study.

Adult↗
PubMed1987

The role of contraceptive use in cervical cancer: the Maryland Cervical Cancer Case-Control Study.

Recent evidence on the importance of sexual history and sexually transmissible agents in cervical cancer has been reported. Case-control studies have frequently demonstrated increased risk of cervical cancer for women using oral contraceptives, while laboratory results have shown that vaginal spermicides inactivate various sexually transmissible agents. To determine the role of contraceptive use in cervical cancer, 153 cases of Maryland women with invasive cervical cancer and age, race, and residence-matched controls were interviewed in 1985, focusing on sexual history, health care utilization patterns, screening history, contraceptive use, and smoking. Overall, lifetime use of contraceptives was protective of cervical cancer (odds ratio (OR) = 0.38, 95% confidence interval (CI) = 0.2-0.7). Use of oral contraceptives (OR = 0.48), diaphragm (OR = 0.29), and vaginal spermicides (OR = 0.28) were more frequent in controls than cases. After adjustment for behavioral factors (age at first intercourse, smoking, gaps in Papanicolaou smear testing, and obstetrician-gynecologist visits), use of vaginal spermicides remained significant (OR = 0.30), although use of oral contraceptives and barrier methods of contraception failed to remain significant. The effectiveness of vaginal spermicides in preventing cervical cancer may be due to their antiviral action.

Adult↗
PubMedDate not supplied

Assessing the evidence submitted in the development of a workplace smoking regulation: the case of Maryland.

OBJECTIVE: This study compared the characteristics of the basic science, biomedical, and socioeconomic literature submitted in 1993-1994 by supporters and opponents of the proposed workplace regulation of tobacco smoke developed by the Maryland Occupational Safety and Health (MOSH) Advisory Board. METHODS: The authors retrospectively analyzed 544 written publications submitted to the MOSH Advisory Board regarding the proposed workplace regulation of tobacco smoke. Outcome measures included the type and year of publication and, for journal articles, the journal's peer review policy and impact factor. RESULTS: Supporters of regulation submitted fewer documents (n = 164) than opponents (n = 380). Supporters of regulation submitted a lower proportion of conference proceedings and a higher proportion of government reports. The publications submitted to the regulators by the supporters of regulation were more recently published than the materials submitted by opponents. Journal articles represented more than half of the publications submitted; most were peer-reviewed. Supporters of regulation submitted articles from journals with higher impact factors (median impact factor 2.78) than did opponents of regulation (median 1.66; p = 0.0005), and articles that were published more recently (median year of publication 1990) than those submitted by opponents (median 1989; p = 0.0001). CONCLUSIONS: Public health advocates should highlight the scientific evidence base that supports tobacco control regulations. Public health advocates should encourage and support regulatory officials' use of the criteria of peer review, impact factor, and date of publication to prioritize their review of submitted documents in order to base policy on the best available evidence.

Air Pollution, Indoor↗
PubMed1994

The investigation of fatal falls and jumps from heights in Maryland (1987-1992).

This study is a retrospective analysis of 139 cases of falls and/or jumps from heights, examined at the Office of the Chief Medical Examiner for the State of Maryland during the 6-year period from 1987 through 1992. A total of 56 individuals (40%) committed suicide by jumping from heights and 72 (52%) fell accidentally. Of the 72 accidental falls, 36 (50%) were work related. Two cases involved victims of homicide and the causes in nine cases remain undetermined. Of the 139 cases examined, 89 individuals (64%) fell or jumped from buildings, 29 (21%) from bridges, 15 (11%) from ladders, and 6 (4%) from trees or electric poles. Of the 29 individuals who fell or jumped from bridges, 14 went into water. Falls and jumps most often involved whites (78%) and males (82%). Their ages ranged from 4 to 83 years, with the majority in their 20s and 30s. Of the 124 people who fell or jumped from heights and landed on the ground, the head was the most frequently injured body region (70%), followed by the chest (66%), the abdomen (48%), extremities (28%), and the neck (19%). Of the 124 victims who landed on the ground, 63 sustained lethal injuries involving multiple organs. In contrast with ground impacts, water impact injuries were much less severe. Five of the 14 victims who jumped from bridges into water were relatively uninjured and died from drowning even though they jumped from heights of 100-200 feet (30-60 m).(ABSTRACT TRUNCATED AT 250 WORDS)

Accidental Falls↗