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PubMed1990

Fibrinogen Baltimore I: polymerization defect associated with a gamma 292Gly----Val (GGC----GTC) mutation.

Fibrinogen Baltimore I is one of the very first congenital abnormal fibrinogens reported over several decades ago; however, the molecular defect of this dysfibrinogen has eluded identification. In fact, several reports misidentified the functional defect of Baltimore I, which has impaired fibrin monomer polymerization. Reversed-phase high-performance liquid chromatography analysis of lysyl endopeptidase digest of the purified Baltimore I gamma-chain showed an abnormal peptide not found in the co-existing normal gamma-chain of this heterozygote. Amino acid sequencing of this peptide indicated that gamma-chain Gly292 is replaced by valine. This observation was confirmed, and the genetic defect was determined by direct nucleotide sequencing of a polymerase chain reaction product containing codon gamma 292, which is mutated: GGC----GTC. The molecular defect of Fibrinogen Baltimore I lies in a region of the gamma-chain required for fibrin polymerization, suggesting that the integrity of gamma Gly292 is critical for fibrin assembly.

Adult↗
PubMed1990

Polymerization defect of fibrinogen Baltimore III due to a gamma Asn308----Ile mutation.

Fibrinogen Baltimore III, a congenital abnormal fibrinogen with impaired fibrin monomer polymerization, displays a normal gamma-chain and a gamma-variant that has an apparently lower relative molecular weight (mol wt) than normal on sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Reverse phase high-performance liquid chromatography (HPLC) analysis of the lysyl endopeptidase digest of the purified gamma-chains of fibrinogen Baltimore III revealed the presence of a peptide that is not found in the digest of the normal fibrinogen gamma-chain. Amino acid sequence analysis of this peptide indicated that the gamma-chain residue 308, asparagine, is replaced by isoleucine. Concanavalin A bound both normal and variant gamma-chains of fibrinogen Baltimore III, indicating that the carbohydrate moiety is not altered and is not responsible for the increase in electrophoretic mobility of the Baltimore III gamma-chain. This study suggests that the integrity of gamma Asn308 is critical for fibrin monomer polymerization, since alteration to either a basic (fibrinogen Kyoto I, Asn----Lys) or hydrophobic (Asn----Ile) residue results in significantly delayed polymerization of fibrinogen to fibrin.

Amino Acid Sequence↗
PubMed1990

Blindness and visual impairment in an American urban population. The Baltimore Eye Survey.

Data on the prevalence of blindness and visual impairment in multiracial urban populations of the United States are not readily available. The Baltimore Eye Survey was designed to address this lack of information and provide estimates of prevalence in age-race subgroups that had not been well studied in the past. A population-based sample of 5300 blacks and whites from east Baltimore, Md, received an ophthalmologic screening examination that included detailed visual acuity measurements. Blacks had, on average, a twofold excess prevalence of blindness and visual impairment than whites, irrespective of definition. Rates rose dramatically with age for all definitions of vision loss, but there was no difference in prevalence by sex. More than 50% of subjects improved their presenting vision after refractive correction, with 7.5% improving three or more lines. Rates in Baltimore are as high or higher than those reported from previous studies. National projections indicate that greater than 3 million persons are visually impaired, 890,000 of whom are bilaterally blind by US definitions.

Adult↗
PubMedDate not supplied

A cluster of hypoplastic left heart malformation in Baltimore, Maryland.

Congenital cardiovascular malformations (CCVMs) of the left side of the heart show familial recurrence of various forms of obstructive malformations, including hypoplastic left heart (HLH), interrupted aortic arch, coarctation of the aorta, and aortic stenosis. In a previous population-based study in the Baltimore-Washington region, these malformations were associated with parental reports of occupational or leisure solvent exposure, overt diabetes, and family history of CCVM in first-degree relatives. Spatial analysis in this well-characterized study population may augment self-reported data by revealing additional associations with potential environmental risk factors. We used spatial analysis to identify clusters of HLH as a group. The study population included all live-born cases of hypoplastic left heart syndrome diagnosed in the first year of life between 1981 and 1989 and a random sample of unaffected infant controls matched by year and hospital of birth. The nested case-control cohort in this spatial analysis included 77 HLH cases and 1894 controls in Maryland and the District of Columbia. Nonparametric and regression analyses included personal variables from the interview data set as well as spatial variables. A region of Baltimore was identified that contained HLH at twice the expected frequency based on the distribution of population younger than 5 years of age. The region included 30 of 77 geocoded cases of HLH in the cohort and is significant by spatial scanning at p = 0.056. Within this region, male cases of HLH were disproportionately present compared to females. This cluster is in a region of Baltimore with industrial release of solvents, dioxin, and polychlorinated biphenyls in air. Outside the cluster, HLH is associated with family history of CCVM in a first-degree relative, maternal exposure to miscellaneous solvents, paternal anesthesia, maternal art painting, aspirin ingestion, and maternal diabetes. Inside the cluster, father's painting and exposure to sympathomimetic drugs were associated risk factors. Spatial analysis of HLH cases delineated an urban region with increased prevalence of this left heart malformation. Within this region, excess male cases of HLH occurred, and industrial release to air of solvents, dioxin, and polychlorinated biphenyl compounds was documented. We propose that both genetic and environmental factors contribute to the phenotype of HLH.

Air Pollution↗
PubMed2006

Volunteering: a physical activity intervention for older adults--The Experience Corps program in Baltimore.

There is compelling evidence supporting the benefits of increased regular physical activity in older adults. The Experience Corps program in Baltimore MD was designed in part as a community based approach to increasing physical activity that would also appeal to older adults who have historically not utilized health promotion programs. The Baltimore Experience Corps program places older volunteers in public elementary schools for 15 h a week in roles designed to improve the academic outcomes of children and, simultaneously, increase the physical, cognitive and social activity of volunteers. This paper reports on the change in physical activity levels among older adults associated with participation in the Baltimore Experience Corps. In a pilot randomized controlled evaluation, older adults were randomly assigned to Experience Corps (EC participants) or a waiting list control group. Ages ranged from 59-86 years, 96% were African American, 94% were women, and 84% had annual incomes less than $15,000. EC participants were required to serve >/=15 h a week. At follow-up after 4-8 months, an analysis of 113 randomized volunteers revealed 53% of the EC participants were more active than the previous year by self-report, as compared to 23% of the controls (p<0.01). When adjusted for age, gender and education, there was a trend toward increased physical activity in the EC participants as calculated by a kilocalorie per week increase of 40%, versus a 16% decrease in the controls (p=0.49). EC participants who reported "low activity" at baseline experienced an average 110% increase in their physical activity at follow-up. Among the controls who were in the "low activity" group at baseline, there was, on average, only a 12% increase in physical activity (p=0.03). Among those who were previously active, there was no significant difference (p=0.30). The pilot results suggest that a high intensity volunteer program that is designed as a health promotion intervention can lead, in the short-term, to significant improvements in the level of physical activity of previously inactive older adult volunteers.

Black or African American↗
PubMed1997

The Baltimore City Health Department program of directly observed therapy for tuberculosis.

To address the vexing problem of treatment completion for tuberculosis patients, the Baltimore City Health Department (BCHD) in 1981 implemented a community outreach strategy employing directly observed therapy (DOT). By 1995, the incidence of tuberculosis in Baltimore had declined 61.7%. This BCHD program has reduced the need for patient incentives by providing nearly 90% of all DOT at either the patient's home, workplace or school; or drug treatment facility, city jail, or nursing home. Today, the proportion of all TB cases in Baltimore receiving DOT through the program approaches 90%, treatment completion rates exceed 90%, sputum-conversion rates among DOT-managed cases are nearly double the rates of privately treated cases, and drug resistant organisms remain rare (0.57% of all isolates, 1989-1993). This article describes the interworkings of this community-based program.

Baltimore↗
PubMed2006

Prevalence of overweight among Baltimore City schoolchildren and its associations with nutrition and physical activity.

OBJECTIVE: To determine the prevalence of overweight and at-risk-for-overweight in schoolchildren from Baltimore City. RESEARCH METHODS AND PROCEDURES: Ten schools within city limits were randomly selected from each tertile of income, using eligibility for free school lunch as a proxy. A total of 209 third grade students from eight public schools in Baltimore City were surveyed in May 2000. Anthropometric data including height, weight, subscapular and triceps skinfold thickness, and percentage body weight from bioelectrical impedance were collected. Nutrition-related knowledge, attitudes, and behaviors were assessed using a validated questionnaire. Physical activity was assessed by questionnaire. RESULTS: Based on International Obesity Taskforce reference values for BMI-for-age, 20.7% of girls and 17.2% of boys were overweight (BMI > 95th percentile) and 15.3% of girls and 14.1% of boys were at-risk-for-overweight (BMI between the 85th and 95th percentiles). The prevalence of overweight and at-risk-for-overweight did not vary by self-reported physical activity levels or by nutrition-related knowledge and behaviors. DISCUSSION: The high prevalence of overweight and at-risk-for-overweight in this sample of inner-city children from Baltimore City highlights a need for targeted preventive and treatment interventions.

Baltimore↗
PubMed2001

Interorganizational relationships among HIV/AIDS service organizations in Baltimore: a network analysis.

A wide variety of organizations has become involved in providing medical and social services to people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Although there is much interest among policymakers, service providers, and clients in coordination among HIV/AIDS service organizations, few studies have used network analytic tools to examine existing systems of HIV-related care. In an effort to fill this gap, this study used network analysis methods to describe several aspects of the interorganizational relationships among 30 HIV/AIDS service agencies in Baltimore, Maryland. Client referrals to other organizations, client referrals from other organizations, exchange of information about shared clients, formal written linkage agreements for client referrals, and joint programs were each examined as a distinct type of network tie, with each the basis of a separate network among these 30 organizations. All of the networks except the one based on joint programs were relatively well connected, with most organizations either directly or indirectly linked. Most of the interorganizational collaboration occurred on a rather ad hoc basis for the purposes of meeting the more immediate needs presented by clients. Highly structured coordination involving substantial investment of resources and ongoing interagency activities appeared to be less common. The findings from this study also suggest that the providers in Baltimore tend to work directly with others as client needs arise rather than negotiating through "clearinghouse" types of organizations. Of the 30 HIV/AIDS service organizations, 5 were highly central in at least four of the five different types of networks. These five organizations--each having a critical role in the continuum of care--may be considered the most central core of the HIV/AIDS service delivery network in Baltimore. These organizations tend to be those that have been created specifically to provide HIV-related services or that specialize in HIV/AIDS care. This research can help policymakers understand how an HIV-related service delivery network may function and delineate key features of a network. In all communities, this type of assessment is critical to designing interventions to promote collaboration that are feasible within the context of existing interorganizational relationships. This type of data also has implications for informing activities to build the capacity of HIV/AIDS service organizations.

Acquired Immunodeficiency Syndrome↗
PubMed1999

The geography of sexual partnerships in Baltimore: applications of core theory dynamics using a geographic information system.

OBJECTIVE: Gonorrhea has a focused geographic distribution characterized by high incidence rates in defined "core" areas and decreased incidence as the radial distance from the central core increases. Dense cor group transmission has long been hypothesized. METHODS: We have previously mapped sexually transmitted disease (STD) rates in Baltimore census tracts using STD morbidity data interfaced with a geographic information system. Core areas were defined using a standard definition based on gonorrhea distribution. We studied spatial distance patterns between sexual partners, using the residential addresses of 572 individuals, representing 286 dyad partnerships recruited as part of an epidemiology and behavioral study. To determine if partners lived closer together than would be expected, a modified bootstrap algorithm using Monte Carlo models was developed to compare the distances between partners' residences and all other possible residences. RESULTS: Two distinct (east and west) core areas were previously identified. Compared with randomly selected Baltimore addresses, partners tended to reside closer to one another than would be expected by chance (z = -1.8), with a median distance of 1.7 kilometers. Within the core areas, women resided a median of 547 meters from their partner, and men resided a median of 339 meters from their reported partners. When all partnerships were considered, the median distance was 1,699 meters. Of the 500 simulation models, the minimum median distance was 4,889 meters. CONCLUSIONS: Partners of patients in core areas in Baltimore live remarkably close to one another, and the partner selection patterns in general indicate nonrandom distribution. Geographic information system-determined patterns of STD patients residing in hyperendemic census tracts support the core theory of disease transmission. In these areas, targeted geographically based interventions may be warranted.

Adult↗
PubMed1993

Needs assessment for reducing infant mortality in Baltimore City: the Healthy Start Program.

Needs assessments are essential for policy formulation and the appropriate design of intervention programs. Recent nationwide data show that among large metropolitan areas of the United States, Baltimore has one of the highest infant mortality rates and ranks in the worst top 10 for blacks and the top 5 for whites for most indicators of poor pregnancy outcome. In this paper, we present the methods and results of a needs assessment that used multiple sources of routinely collected data and was conducted for the purpose of identifying intervention factors contributing to infant mortality in Baltimore City. This needs assessment was used by the Baltimore City Health Department to successfully secure funding for the federal Healthy Start Infant Mortality Prevention Initiative. We present the results of the analyses, along with some of the proposed interventions that resulted from the needs assessment. We also discuss the limitations of this type of needs assessment as well as suggestions for future needs assessments for the design of interventions to improve perinatal health.

Black or African American↗
PubMed2006

Science for life: a conversation with Nobel laureate David Baltimore. Interview by Barbara J Culliton.

As a man with equal interests in science and science policy, David Baltimore has been at the forefront of many of the important debates that have shaped science since the 1970s. Very much engaged in the initial discussions about the use of recombinant DNA technology, Baltimore had a front-row seat as the biotechnology industry developed. He was also a major player in the decision that resulted in funding of the Human Genome Project by the National Institutes of Health (NIH). Baltimore discusses biotechnology, science education, and the need for a strong dialogue among scientists and scholars in the health policy community.

Biotechnology↗
PubMed2000

Errors in the treatment of tuberculosis in Baltimore.

BACKGROUND: Incomplete or incorrect antibiotic therapy, especially in the initial phase of antituberculosis (anti-TB) treatment, is a major cause of acquired drug resistance and treatment failure. We determined the extent of errors in anti-TB treatment regimens by way of nonadherence to recommended treatment protocols among patients with TB in Baltimore, MD, a city with declining rates of disease. An error was defined as using too few drugs or the wrong drugs, giving inadequate doses of drugs, or prescribing an inadequate duration of treatment. METHODS: We reviewed the records of all patients with culture-positive, pulmonary TB reported in the city of Baltimore from January 1, 1994, to December 31, 1995. We determined demographic information, initial anti-TB regimen, doses and duration of therapy, history or presence of resistance to anti-TB drugs, injecting-drug or alcohol abuse, HIV status, and whether treatment was given by a private physician or by the Tuberculosis Clinic of the Baltimore City Health Department (BCHD). RESULTS: Of the 110 cases of active pulmonary TB, 17 cases (15.4%) had errors in treatment for control of their current disease. Thirteen of 34 privately treated patients (38%) had some error in their initial anti-TB regimen, compared with 4 of 76 patients (5.2%) treated by the Tuberculosis Clinic of the BCHD (p < 0.0001). Patients were otherwise similar as determined by age, sex, HIV status, drug-resistance characteristics, and injecting-drug use, regardless of whether they had erroneous anti-TB regimens. CONCLUSION: In a low-prevalence area, private physicians make frequent errors in prescribing anti-TB therapy. Additional educational resources for physicians and increased use of expert consultation may contribute to improved TB control.

AIDS-Related Opportunistic Infections↗
PubMed1992

School placement for human immunodeficiency virus-infected children: the Baltimore City experience.

Over the past 6 years, the city of Baltimore has successfully implemented a school placement policy for human immunodeficiency virus (HIV)-infected children and children with acquired immunodeficiency syndrome (AIDS). Both policy and specific procedures are based on nationally promulgated guidelines. School placement policy is part of an overall AIDS policy that includes education of students and staff and adoption of universal precautions to prevent transmission of communicable diseases in school. Implementation has been marked by excellent collaboration between the departments of health and education. Important policy components include expedited clinical investigation of each case, an interagency review panel, strict protection of confidentiality, a restricted setting for certain children, a school site visit for each placement, and continued monitoring of the school placement by school nurses. Many HIV-infected students need special educational services and/or school health services. The Baltimore City school placement process has avoided the exaggerated publicity endured by some communities, where media reporting has aggravated community fears and invaded the lives of families with HIV-infected children. Baltimore City has succeeded in ensuring access to education, protecting families' confidentiality, and providing special care for HIV-infected students. Local communities should emphasize national guidelines in designing school placement policies for HIV-infected children. School placement policies work best in the context of a comprehensive policy incorporating AIDS education and care.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Characterization of particulate and gas exposures of sensitive subpopulations living in Baltimore and Boston.

Personal exposures to particulate and gaseous pollutants and corresponding ambient concentrations were measured for 56 subjects living in Baltimore, Maryland, and 43 subjects living in Boston, Massachusetts. The 3 Baltimore cohorts consisted of 20 healthy older adults (seniors), 21 children, and 15 individuals with physician-diagnosed chronic obstructive pulmonary disease (COPD*). The 2 Boston cohorts were 20 healthy seniors and 23 children. All children were 9 to 13 years of age; seniors were 65 years of age or older; and the COPD participants had moderate to severe physician-diagnosed COPD. Personal exposures to particulate matter with aerodynamic diameters less than 2.5 microm (PM2.5), sulfate (SO(4)2-), elemental carbon (EC), ozone (03), nitrogen dioxide (NO2), and sulfur dioxide (SO2) were measured simultaneously for 24 hours/day. All subjects were monitored for 8 to 12 consecutive days. The primary objectives of this study were (1) to characterize the personal particulate and gaseous exposures for individuals sensitive to PM health effects and (2) to assess the appropriateness of exposure assessment strategies for use in PM epidemiologic studies. Personal exposures to multiple pollutants and ambient concentrations were measured for subjects from each cohort from each location. Pollutant data were analyzed using correlation and mixed-model regression analyses. In Baltimore, personal PM2.5 exposures tended to be comparable to (and frequently lower than) corresponding ambient concentrations; in Boston, the personal exposures were frequently higher. Overall, personal exposures to the gaseous pollutants, especially O3 and SO2, were considerably lower than corresponding ambient concentrations because of the lack of indoor sources for these gases and their high removal rate on indoor surfaces. Further, the impact of ambient particles on personal exposure (the infiltration factor) and differences in infiltration factor by city, season, and cohort were investigated. No difference in infiltration factor was found among the cohorts, which suggests that all subjects were exposed to the same fraction of ambient PM2.5 for a given ambient concentration. In addition, the results show significant correlations between ambient PM2.5 concentrations and corresponding personal exposures over time and provide further indication that ambient gaseous pollutant concentrations may be better surrogates for personal PM2.5 exposures, especially personal exposures to PM2.5 of ambient origin, than their respective personal exposures. These results have important implications for PM health effects studies that use regression models including both ambient PM2.5 and gaseous pollutant concentrations as independent variables, because both parameters may be serving as surrogates for PM2.5 exposures.

Adolescent↗
PubMed1990

[Comparison of 2 series of autopsies observed at Johns-Hopkins Medical Center, Baltimore (JHMI) and at the Neuchâtel Institute of Pathology (INAP)].

We are reporting the first results of a comparative study of 100 consecutive autopsies and their clinical diagnoses, observed at the Johns Hopkins Medical Institutions (JHMI) and at the Institut neuchâtelois d'anatomie pathologique (INAP). The diagnoses of the two series were coded according to the two different systems used currently at the two institutions. The data from Baltimore were automatically classified by a special "key word method" using the categories of the Index Medicus (MeSH = Medical subject headings). We proceeded then to a second recording by SNOMED codes, introduced into the computer system in the same way as we document the autopsy diagnoses in Neuchâtel. The two series could be compared in detail according to topographical, morphological and aetiological parameters. The over-all repartition of the examined cases shows a higher incidence of newborns in Baltimore (23), in Neuchâtel we observed only 7 newborn autopsies. The mean age was inferior in Baltimore (males: 53.5 years for JHMI, 73.1 years for INAP; females: 58.4 years for JHMI, 66.2 years for INAP). The number of diagnoses per autopsy was 31.9 at JHMI, and 50.1 in Neuchâtel. The topographical distribution of clinical and autopsy diagnoses showed a higher frequency of central nervous system lesions in JHMI which might be explained by the activity of a neuropathological division. Findings concerning the morphological categories revealed a higher frequency in JHMI for traumatic abnormalities (7.2% vs 2.5%), malformations (4.3% vs 0.8%), whereas inflammation and fibrosis and degenerative lesions were more often encountered in Neuchâtel. The differences in morphological observations could be attributed to a higher proportion of newborn cases in JHMI with complex malformation syndromes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Characteristics of epidemic hepatitis A in Baltimore City: implications for control measures.

In 1988, a hepatitis A epidemic began in Baltimore, Maryland. A total of 607 cases were reported to the Baltimore City Health Department between the period November 1, 1988, and December 31, 1989. The health department conducted case investigations to identify factors important to the development of control measures. Immunoglobulin was given to appropriate contacts, and an educational campaign was initiated. Of the 607 reported cases, 63% were white and 57% were male. Cases were geographically clustered within 5 of Baltimore's 23 zip codes. Among the 242 adults interviewed, 43% self-reported drug use and 44% were unemployed. Twenty-one percent of the adults and 56% of the children reported contact with either a suspected or confirmed case of hepatitis. Despite control efforts, the epidemic continued through 1990. Barriers to implementing traditional control measures resulted in continuing transmission of hepatitis A in the community.

Adolescent↗
PubMed1993

Health indicators of substance abuse problems in Baltimore.

Selected health indicators were examined for which Baltimore-specific data were available, including substance abuse treatment admissions, AIDS (acquired immunodeficiency syndrome) case reports, and drug-related emergency room visits and deaths. All indicators reflected high levels and increasing rates of substance abuse problems in Baltimore. Drugs of choice most likely to result in adverse effects were heroin, cocaine, and alcohol--often in combination. The African-American population in Baltimore is disproportionately affected by substance abuse. Emerging drug use patterns are examined, and health service and policy issues are discussed.

Adolescent↗
PubMed1993

Geographic distribution of AIDS patients diagnosed at eight Baltimore hospitals.

Since the beginning of the AIDS (acquired immunodeficiency syndrome) epidemic in Baltimore, the university hospitals, particularly Johns Hopkins, have diagnosed and treated a disproportionate share of Baltimore patients. Many Baltimore community hospitals are now treating AIDS patients. These hospitals will have an increasing role in providing primary and secondary care as the epidemic expands.

Acquired Immunodeficiency Syndrome↗