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Margaret McLaughlin appointed chief nursing officer, USPHS.
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USPH Dental Health Center to be enlarged.
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Equipment lists and suggested layouts in new USPHS dietary planning guide.
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HIV clinical conference call series available from USPHS.
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Telephone information services from USPHS.
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Cost effectiveness of human immunodeficiency virus postexposure prophylaxis for healthcare workers.
OBJECTIVE: The United States Public Health Service (USPHS) published recommendations for human immunodeficiency virus (HIV) postexposure prophylaxis (PEP) of healthcare workers in May 1998. The aim of this study was to analyse the cost effectiveness of the USPHS PEP guidelines. DESIGN AND SETTING: This was a modelling study in the setting of the US healthcare system in 1989. The analysis was performed from the societal perspective; however, only HIV healthcare costs were considered and health-related losses of productivity were not included. METHODS: A decision tree incorporating a Markov model was created for 4 PEP strategies: the current USPHS recommendations, triple drug therapy, zidovudine monotherapy or no prophylaxis. A probabilistic sensitivity analysis using a Monte Carlo simulation was performed. Confidence intervals (CIs) around cost-effectiveness estimates were estimated by a bootstrapping method. RESULTS: The costs (in 1997 US dollars) per quality-adjusted life-year (QALY) save by each strategy were as follows: monotherapy $US688 (95% CI: $US624 to $US750); USPHS recommendations $US5211 (95% CI: $US5126 to $US5293); and triple drug therapy $US8827 (95% CI: $US8715 to $US8940). The marginal cost per year of life saved was: USPHS recommendations $US81 987 (95% CI: $US80 437 to $US83 689); triple drug therapy $US970 451 (95% CI: $US924 786 to $US 1 014 429). Sensitivity testing showed that estimates of the probability of seroconversion for each category of exposure were most influential, but did not change the order of strategies in the baseline analysis. With the prolonged HIV stage durations and increased costs associated with recent innovations in HIV therapy, the marginal cost effectiveness of the USPHS PEP strategy was decreased to $US62 497/QALY saved. All 3 intervention strategies were cost effective compared with no postexposure prophylaxis. CONCLUSIONS: Current USPHS PEP recommendations are marginally cost effective compared with monotherapy, but the additional efficacy of triple drug therapy for all risk categories is rewarded by only a small reduction in HIV infections at great expense. For the foreseeable future, assuming innovations in therapy that employ expensive drug combinations earlier in the HIV disease course to extend life expectancy and the increasing prevalence of HIV drug resistance, our model supports the use of the USPHS PEP guidelines.
Injuries and illnesses treated at the World Trade Center, 14 September-20 November 2001.
INTRODUCTION: In response to the 11 September 2001 terrorist attacks on the World Trade Center (WTC), the United States Public Health Service (USPHS) deployed Disaster Medical Assistance Teams (DMATs) and the Commissioned Corps to provide on-site, primary medical care to anyone who presented. Patients included rescue and recovery workers, other responders, and some members of the general public. OBJECTIVE: A descriptive analysis of WTC-USPHS patient records was conducted in order to better understand the short-term impact of the WTC site on the safety and health of individuals who were at or near the site from 14 September-20 November 2001. METHODS: The Patient Treatment Record forms that were completed for each patient visit to these USPHS stations over the 10-week deployment period were reviewed. RESULTS: Patient visits numbered 9,349, with visits peaking during Week 2 (21-27 September). More than one-quarter of the visits were due to traumatic injuries not including eye injuries (n = 2,716; 29%). Respiratory problems comprised more than one-fifth of the complaints (n = 2,011; 22%). Eye problems were the third most frequent complaint (n = 1,120; 12%). With respect to the triage class, the majority of visits fell into the lowest category of severity (n = 6,237; 67%). CONCLUSION: USPHS visits probably were skewed to milder complaints when compared to analyses of employer medical department reports or hospital cases; however, given the close proximity of the USPHS stations to the damage, analysis of the USPHS forms provides a more complete picture of the safety and health impact on those who were at or near the WTC site.
Direct and indirect evaluation of posterior composite restorations at three years.
The purpose of this study was to compare the use of direct (USPHS) and indirect (M-L) systems of evaluating the occlusal wear of posterior composite restorations. Additionally, this study has utilized the USPHS method to compare the in vivo performance of posterior resin composite restorations made from four different visible-light-cured materials. Of the 202 restorations placed for this randomized clinical trial, only those restorations that were scored by both direct and indirect evaluation systems were included in these comparisons. Restorations were evaluated by two calibrated examiners from baseline to 36 months. While there were some differences noted among the four materials, the majority (99%) of the restorations evaluated in this study received "alpha" or "bravo" scores for all USPHS parameters, indicating acceptable in vivo performance. The results of this study also indicate that there was a consistent relationship between the direct (USPHS) and indirect (M-L scale) scoring systems. For those restorations that changed anatomic form scores, the mean wear at the alfa/bravo transition was 100 +/- 80 microns. By the 24-month recall examination, the use of the USPHS evaluation system category of anatomic form enabled examiners to differentiate restorations and materials that had experienced little occlusal wear from those that had experienced greater amounts of wear.
Assessing composite resin wear in primary molars: four-year findings.
Many investigators have reported minimal wear of resin restorations in primary molars. Until recently, quantitative wear assessments have not been reported. The purpose of this investigation was (1) to present and contrast data from two 48-month clinical trials wherein quantitative wear assessments were used to evaluate wear of resin restorations in primary molars, and (2) to compare these results with those using the USPHS method of wear assessment. The data were collected from two different clinical trials. One was conducted at the University of California in San Francisco by Tonn and Ryge (TR Trial). The other was conducted at the University of North Carolina at Chapel Hill by Oldenburg, Vann, and Dilley (OVD Trial). The OVD Trial had a sample size of 45 patients with 106 restorations; the TR Trial had 44 patients with 96 restorations. The restorations in both trials were Class I and II restorations in occlusion. They were placed with the experimental light-cured posterior composite resin F-70, later marketed as Ful-Fill. At baseline, six, 12, 24, 36, and 48 months, restorations were evaluated by two evaluators trained in USPHS criteria as well as by a quantitative method of wear assessment, the standard cast technique as described by Leinfelder. Interstudy comparisons were made by Chi-square tests (USPHS evaluations) and ANOVA (quantitative assessments). The results showed that resin restorations in primary molars exhibited progressive wear with time in service. The rate and quantity of wear were very similar to those seen in permanent posterior teeth over 36 months. Findings agree with previous reports that the USPHS evaluation criteria are insensitive in detecting early wear in primary molars.
Medical care for interned enemy aliens: a role for the US Public Health Service in World War II.
During World War II, the US Public Health Service (USPHS) administered health care to 19 000 enemy aliens and Axis merchant seamen interned by the Justice Department through its branch, the Immigration and Naturalization Service (INS). The Geneva Prisoners of War Convention of 1929, which the United States applied to civilian internees, provided guidelines for belligerent nations regarding humanitarian treatment of prisoners of war, including for their health. The INS forged an agreement with the USPHS to meet these guidelines for the German, Italian, and Japanese internees and, in some cases, their families. Chronic shortages and crowded camps continuously challenged USPHS administrators. Nevertheless, the USPHS offered universal access to care and provided treatment often exceeding care received by many American citizens.
[A clinical evaluation of two new materials for restoration of dental wedge-shaped defects].
OBJECTIVE: To evaluate clinically two new materials (Dyract Cem and 3M-Vitremer) for restoration of dental wedge-shaped defects with modified USPHS evaluation criterion. METHODS: 317 teeth with wedge-shaped defects were restored by Dyract Cem and 192 teeth by 3M-Vitremer clinically. The 1 year and 2 year follow-up results were evaluated with modified USPHS evaluation criterion. RESULTS: 1 year successful rate was 91.17% in Dyract Cem group and 81.77% in 3M-Vitremer group, and 2 years successful rates were 88.64% and 80.21% separately. The differences of successful rates between the two groups are significant statistically, but there are no significant differences in main indexes except stain rate when analysed item by item with USPHS evaluation criterion. Successful rates were related with the abrasive degree of the restored teeth. CONCLUSIONS: Both Dyract Cem and 3M-Vitremer have high successful rates and a lot of advantages for restoration of dental wedge-shaped defects. The modified USPHS evaluation criterion is a valuable method for clinical evaluation.
Comparison of direct and indirect methods for analyzing wear of posterior composite restorations.
The vast majority of recent clinical research involving wear analyses of posterior composite resin restorations have used either the direct evaluation method (USPHS) or the indirect cast comparison (Leinfelder) method. However, there has never been any established correlation of the two wear scales. The objective of this study was to determine the amount of wear for the USPHS alfa-bravo transition on the basis of cast comparison data. Clinical wear data were collected over five years by both the direct method and the indirect method. Three materials were used involving a total of 221 restorations in 61 patients. Each restoration was evaluated at baseline, six months, one, two, three, and five years by each method. Then, for those restorations which underwent a transition from an alfa to a bravo clinical rating, the absolute wear at the transition was determined by averaging the indirect ratings just before and just after the transition. The mean wear corresponding to the alfa-bravo transition was 192 +/- 60 microns. Because of the large width of the alfa category up to the alfa-bravo transition, extensive early changes and high initial wear rates cannot be detected by the USPHS system.
The affirmation of the scientist-practitioner. A look back at Boulder.
In the aftermath of World War II, several influences were paramount in forcing academic psychology to recognize, albeit reluctantly, the coming professionalization of psychology. The federal government, wishing to avoid a repeat of blunders following World War I that led to significant dissatisfaction among veterans, took proactive steps to ensure that mental health needs of the new veterans would be met. The USPHS and the VA were mandated to expand significantly the pool of mental health practitioners, a direction that led not only to the funding of the Boulder conference but also to the development of APA's accreditation program, funded practical and internship arrangements with the VA, and the USPHS grants to academic departments for clinical training. The GI Bill, amended to include payment for graduate education, created tremendous interest in graduate programs in psychology. As a result, psychology programs were inundated with funded applicants, most of whom were interested in the application of psychology to clinical and other applied fields. Graduate psychology departments were mixed in their views of this "blessing." The reality of a separate curriculum for professional training in psychology was a bitter pill for some academic psychologists to swallow. Graduate departments feared that control of their programs would be taken over by external forces and that they would lose their right to determine their own curriculum. Further, they feared the domination of clinical training within their own departments and the effects of such educational emphasis on their traditional experimental programs. The Boulder conference brought together these disparate needs and concerns, although one can argue about how well some points of view were represented with respect to others. It was a time of high anticipation and fear. The conference could easily have ended in failure, with such diverse interests being unable to reach any consensus. There are many letters in the correspondence of committee members that suggest disagreements serious enough to prevent the development of any single model of training. Instead, by most yardsticks that one could apply, the conference succeeded, perhaps beyond the dreams of many of those in attendance who were most invested in a model for professional training. In evaluating the legacy of Boulder, several points are apparent. First, the conference succeeded because 73 individuals were able to agree to some 70 resolutions in 15 days, creating the scientist-practitioner model of professional training. Such consensus was arguably a remarkable achievement. The endorsement of the model by academic units followed with little evident resistance, although it is clear that some Boulder-model programs were developed that bore little resemblance to the model's insistence on significant training in both research and practice. Second, as a response to social and political needs, the conference was clearly a success. The cooperation of the APA, the USPHS, and the VA benefited all three entities. Clinical psychology was given the financial support and backing to advance it as a profession, and the federal government was able to begin the process of securing the personnel needed to address the mental health needs of the nation. The architects of Boulder were clear that their vision of training for professional psychology should be viewed as dynamic and experimental rather than fixed and prescribed. Certainly there are several variants of professional training extant today, yet the overwhelming majority of currently accredited programs in psychology label themselves as "Boulder-model" programs or "scientist-practitioner" programs. Still, new national conferences on professional training in psychology occur with some regularity as participants seek to resolve many of the same concerns debated by those at Boulder. The grand experiment goes on.
Women's health and nutrition research: US governmental concerns.
The US Public Health Service (USPHS) and the National Institutes of Health (NIH) have a major commitment to women's health issues and to women's health research. "To assess the problems of women's health in the context of the lives women in America lead today," the Assistant Secretary for Health, USPHS, appointed a task force whose report published in 1985 identified issues, listed 15 recommendations, and served as a guide for the establishment of groups within each agency to implement the recommendations according to their appropriate responsibilities. NIH established an Advisory Committee on Women's Health Issues which assessed NIH involvement in women's health research, made recommendations for implementation or expansion of this research, including a recommendation that women be included in clinical trails or their exclusion be justified. An Office of Research on Women's Health was created. The NIH announced a Women's Health Initiative (WHI) in the spring of 1991, which will address three of the leading health problems for women: cardiovascular disease, breast and colon cancer, and osteoporosis. The WHI will provide an integrated, multidisciplinary approach through clinical trials, observational studies, and community trials. Clinical trials will evaluate hormone replacement therapy, calcium/vitamin D, and dietary modification of fat/fiber. Community trials will implement known interventions for relevant risk factors. Presented here are USPHS response to the mandate to address women's health issues; data from the US National Center for Health Statistics about the incidence and prevalence of diseases and risk factors in women; details about the WHI clinical trial; and aspects of the WHI applicable to the field of nutrition.
Adult health screening and referral in the emergency department.
INTRODUCTION: The United States Public Health Service (USPHS) recommends using all available patient encounters to provide preventive healthcare to patients. Many studies have demonstrated the importance of performing preventive care in the emergency department (ED). These studies have used the ED as a location for patient identification and treatment, rather than as a referral site. The primary objective of this study was to identify and refer patients with unmet healthcare needs seen in the Emergency Department. A secondary objective was to determine if the patient would accept health referrals and follow-up with a doctor or clinic. METHODS: Age and gender-specific algorithms were developed from the USPHS Clinicians' Book of Preventative Health, Second Edition. A convenience sample of patients who presented to the emergency department was asked to participate in the study to obtain 50 subjects in each age and gender grouping. After one week the patients were followed up by telephone, and after one month the computer database was queried to confirm that an appointment had been made with a doctor or clinic as recommended. RESULTS: Three hundred and twelve patients in the Emergency Department were enrolled in the study. The demographic profile of the patients surveyed consisted of 152 (48.7%) African Americans, 81 (26.0%) Hispanics, and 12 (3.8%) Caucasians. Of those enrolled, 59.9% had a primary care physician, and 78.2% had insurance coverage. The study revealed that 28.8% of the subjects did not need a referral, 51.3% needed 1 to 3 referrals, and 19.9% needed 4 to 8 referrals. The most common needs were for tetanus immunizations (41.2%) and stool for occult blood (41.0%); the least common was for Pap smears (2.6%) and blood pressure (2.0%). Most patients accepted the referrals (88.3%), but only a fourth of those (22.6%) reported making a follow-up appointment. The appointment was confirmed in the computer system in 39.6% of the cases. The highest rate of follow-up was for prostate screening (41.4%); the least was for drug abuse (0.0%). CONCLUSION: Most of the patients in this study were found to have unmet healthcare needs. Many of the patients were given referrals and followed up with the clinic or physician for the healthcare problems identified. This study reinforces the value of the USPHS guideline to use all available patient encounters for preventive healthcare.
Marginal adaptation of Cerec 3 CAD/CAM composite crowns using two different finish line preparation designs.
PURPOSE: The purpose of this study was to compare marginal discrepancies of Cerec 3 CAD/CAM composite crowns, fabricated on human prepared teeth with two different finish line designs, chamfer and shoulder. MATERIALS AND METHODS: Sixteen human molar teeth were used to prepare full crowns. Eight teeth were prepared with a 1-mm-wide chamfer finish line and the other eight with a 1.2- to 1.5-mm circumferential shoulder. Cerec 3 crowns were fabricated from optical impressions using Paradigm MZ100 composite polymer. Marginal adaptation was evaluated in two ways: (1) using modified United States Public Health Service (USPHS) criteria to evaluate eight preselected sites on each crown margin, and (2) using scanning electron microscopy (SEM) to measure marginal gaps on all four axial walls with 15 measurements on each wall (60 measurements per crown). An evaluation of the number of acceptable crowns, determined by having all measured sites per tooth with margin gap size less than 100 microm, as a function of finish line design was also conducted. RESULTS: In both chamfer and shoulder groups, there were only two crowns (out of eight) with clinically acceptable ratings for all eight measurement sites according to USPHS criteria. Fisher's chi-square analysis showed that there was no statistically significant difference in marginal adaptability as a function of finish line design ( p>0.05). With SEM imaging, overall mean marginal gaps for the chamfer group were 65.9+/-38.7 microm (range 35.0 to 130.0 microm), and for the shoulder group were 46.0+/-9.2 microm (range 26.3 to 55.6 microm); this difference was not found to be statistically significant ( p>0.05). While crown assessment based on mean marginal discrepancy measurements indicated that both the chamfer and shoulder groups were considered clinically acceptable (<100 microm); crown acceptability based on all measurement sites being less than 100 mum indicated that in the chamfer and shoulder groups there were four and three acceptable crowns out of eight, respectively. The Fisher's chi-square test indicated no statistically significant difference between the groups ( p>0.05). An agreement rate of 81.2% was calculated between the two evaluation methods, modified USPHS criteria and SEM measurements. CONCLUSIONS: Based on mean marginal discrepancy measurements, the typical marginal assessment technique, Cerec 3 Paradigm MZ100 crown restorations appear to have acceptable marginal adaptability (mean discrepancies <100 microm). Thus, the evidence from this investigation would suggest that the finish line preparation design had no effect on marginal adaptation for Cerec 3 composite crowns.
Assessment of appearance match by visual observation and clinical colorimetry.
Judgments of appearance matching by means of the visual criteria established by the United States Public Health Service (USPHS) and by means of an extended visual rating scale were determined for composite resin veneer restorations and their comparison teeth. Using a colorimeter of 45 degrees/0 degrees geometry and the CIELAB color order system we used the color of the restorations and comparison teeth to calculate a color difference for every visual rating. Statistically significant relationships were found between each of the two visual rating systems and the color differences. The average CIELAB color difference of those ratings judged a match by the USPHS criteria was found to be 3.7. However, the overlap in ranges of the color differences for those comparisons rated matches and mismatches indicates the importance of other factors in appearance matching, such as translucency and the effects of other surrounding visual stimuli. The extended visual rating scale offers no advantages to the more broadly defined criteria established by the USPHS.