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PubMed2002

Maryland dental hygienists' views of oral cancer prevention and early detection.

PURPOSE: The purpose of this qualitative study was to obtain in-depth information on dental hygienists' awareness and opinions of oral cancer, oral cancer examinations, and related factors. These findings were intended to supplement a previous statewide survey of Maryland dental hygienists on the subject. METHODS: A professional focus group moderator conducted two focus groups in Maryland. Two types of focus groups were used--one face-to-face focus group session with 10 dental hygienists in the Baltimore area and one telephone focus group among 7 dental hygienists who practiced on the Eastern Shore. Criterion-purposeful sampling and qualitative content analysis were used. RESULTS: Six major themes emerged from the focus groups: dental hygienists' lack of awareness of Maryland's oral cancer statistics, level of training to provide oral cancer examinations, provision of oral cancer examinations and barriers for not providing them, reactions to Maryland surveys of dental hygienists and dentists, assessment of oral cancer risk factors, and interest in additional training. CONCLUSIONS: The focus groups provided in-depth information about why oral cancer examinations are or are not provided on a routine basis, as well as ideas for providing updates on oral cancer prevention and early detection for dental hygienists. Moreover, some participants recommended that updates on how to conduct an oral cancer examination be a requirement, as updates on infection control are now.

Attitude of Health Personnel↗
PubMedDate not supplied

Maryland dentists' attitudes regarding tobacco issues.

Due to increased national interest in tobacco intervention roles for oral health professionals, a survey of Maryland dentists' attitudes toward tobacco issues was conducted. A convenience sample of 700 members of the Maryland State Dental Association was drawn from the total membership list (N = 2200). A 30% response rate was obtained. Subjects were mailed a twelve-item questionnaire that elicited primarily attitudinal information. Results revealed that 54.3% of the subjects never smoked, 39% formerly smoked and 6.1% currently smoke. Smoking behavior was associated with numerous attitudinal variables including dentistry's role in promoting tobacco-use cessation. Relatively few of the respondents were aware of federal initiatives regarding the oral health professions' roles in intervention. Less than half viewed tobacco-use cessation interventions as a practice builder, yet 82.1% believe cessation advice is the dentist's responsibility. Respondents' interest in obtaining free training in tobacco-use interventions was positive and was significantly related to several attitudinal variables. Dentists in Maryland appear to appreciate their role in tobacco-use interventions at both the clinical and community levels. However, they exhibit ambivalence regarding the economic value of office interventions and the need for formalized training. Maryland dentists also need to be apprised of federal initiatives concerning tobacco use interventions.

Attitude of Health Personnel↗
PubMed1995

Smoking behavior, workplace policies, and public opinion regarding smoking restrictions in Maryland.

The Maryland Occupational Safety and Health (MOSH) advisory board recently proposed a smoking ban in most Maryland workplaces, including bars and restaurants, unless smoking is restricted to a separately ventilated area where nonsmoking workers cannot be required to enter. Results from the 1992-1993 Current Population Survey strongly suggest that there is broad support among Maryland residents for such restrictions and that the MOSH rules would merely extend an already widespread practice in the state. Efforts by the tobacco industry to gain an injunction against the proposed MOSH regulations would not appear to be supported by a clear majority of Maryland residents.

Adult↗
PubMed1994

Maryland physicians' survey on Lyme disease.

In a survey of 252 physicians practicing in Maryland, 170 responders diagnosed 142 cases of Lyme disease (LB) during 1990 and 1991. About 80% of the cases were diagnosed by primary care physicians. The most common clinical finding, erythema migrans (EM), was reported in half the cases and arthritis was reported in a quarter. Only 22.2% had a history of a tick bite; serological tests were ordered in a third of the cases. EM was treated with oral antibiotics for 10-21 days. Most physicians treated Lyme arthritis with the same therapy, although some used intravenous ceftriaxone. The most commonly used treatment for neurologic or cardiac complications was intravenous ceftriaxone. These preliminary data suggest that LB may be diagnosed by Maryland physicians more frequently than syphilis and tuberculosis. The data also indicate LB is a much larger problem in Maryland than suggested by official reports to the Centers for Disease Control. The clinical characteristics of the illness and the antibiotics prescribed for it in Maryland are similar to those reported in northeastern states.

Data Collection↗
PubMed1993

Oral cancer mortality in Maryland.

Oral cancer mortality is one of the most preventable types of cancer deaths when the lesion is detected early. The survival rate is quite low, however, when oral cancer is diagnosed at an advanced stage. While the Maryland oral cancer incidence rate is lower than the US average, the state ranks fourth in the country for overall age-adjusted oral cancer mortality; Maryland's African-American population has the highest oral cavity and pharyngeal mortality rate. Delayed diagnosis may explain this occurrence since groups at high risk for developing oral cancer, such as the elderly and minority groups, do not have ready access to the Maryland oral health care system. As the elderly annually use physicians' services almost twice as much as they use dentists' services, physicians are encouraged to routinely complete an oral cavity and pharyngeal examination. Inclusion of oral health services into a Maryland health system reform benefits package would also improve routine screening frequency for oral cancer.

Female↗
PubMed1998

Toxic-Pfiesteria--surveillance for human disease in Maryland.

The presence of toxic stages of the dinoflagellate Pfiesteria piscicida and other morphologically related organisms was documented in three estuarine waterways on the lower Eastern Shore of Maryland in 1997. The Maryland Department of Health and Mental Hygiene, working closely with the local health departments, established a surveillance system to collect reports of human illnesses. Maryland's experience has formed the base on which national surveillance criteria for Estuary Associated Syndrome have been developed and regional surveillance protocols have been built. The cooperation of practicing physicians is essential to continued surveillance efforts to further delineate the extent and nature of human health effects following exposures to waters where toxic forms of these dinoflagellates are active. Physicians wishing to report persons who may have Estuary Associated Syndrome should contact their local health department. Persons wanting information or wishing to report finding lesioned fish or a fish kill in progress should call the Maryland Pfiesteria Hotline at 1- 888-584-3110.

Animals↗
PubMed1992

The maryland mammoth allele and rooting both perturb the fate of florally determined apices in Nicotiana tabacum.

The stability of the florally determined state in terminal and axillary buds of two tobacco cultivars was studied. We used Hicks and Hicks Maryland Mammoth, near-isogenic cultivars of Nicotiana tabacum differing at the recessive maryland mammoth locus which confers short-day behavior. The experimental design consisted of growing plants in short-day conditions and subjecting them to three bioassays in long-day conditions: in vitro culture of apices consisting of meristems and three to four leaf primordia; rooting of buds consisting of meristems and 8 to 12 leaves, leaf primordia, and internodes; and release from apical dominance of axillary buds in situ. Cultured terminal and axillary apices expressed floral determination, indicating that meristems can be florally determined. Two lines of evidence indicate that rooting destabilizes an already acquired florally determined state: cultured apices from both axillary and terminal buds produced fewer nodes after excision than homologous buds which were rooted; and a lower percentage of rooted axillary buds from Hicks Maryland Mammoth plants expressed floral determination than did homologous axillary buds grown out in situ in noninductive conditions. Rooted buds from the two genotypes expressed floral determination at different frequencies, but produced abnormal inflorescences at similar frequencies, indicating that roots and the maryland mammoth allele influence common as well as unique processes associated with floral determination.

Alleles↗
PubMed1992

Critical loads and steady-state chemistry for streams in the state of Maryland.

The critical loads to streams, steady-state stream chemistry and catchment chemical weathering rate in 73 catchments has been determined in the state of Maryland, USA. It was calculated with the PROFILE model from chemical limits for biological indicators, soil mineralogy, soil texture, annual average temperature, average soil moisture, net long-term uptake of base cations and nitrogen to the vegetation, annual precipitation and runoff and deposition of sulphur and nitrogen precursors of acid deposition. The results show a full range of critical loads from very low values in the sensitive catchments of western Maryland and the Coastal Plain on the Chesapeake Bay, to insensitive catchments in the Fredrick Valley and Ridge and the Piedmont plain. The critical loads will be used as an input to an integrated regional assessment of the quantitative sensitivity of streams to acid rain, and the assessment of regional stream alkalinity response to different abatement strategies. The mapping of steady-state stream chemistry indicates that streams in Maryland are still acidfying under the present deposition load. Land-use seems to play an important role in maintaining neutral pH in many of the streams of Maryland.

Journal Article↗
PubMed1983

A comparative evaluation of the Maryland NU 6 auditory test.

This study was conducted to determine the performance-intensity functions of the Maryland NU 6 Auditory Test (female voice) with normal-hearing and hearing-impaired persons, to examine equivalency of the four lists, and to compare performance scores on this test with those obtained on the CID W-22 Test and the Maryland CNC Test. Three lists were judged to be equivalent, and there was good test-retest reliability. The test made distinctions among individuals with varying degrees of high-frequency hearing loss. Word recognition scores for the Maryland NU 6 and Maryland CNC Tests were remarkably similar, but differed significantly from those obtained on the W-22 Test.

Adult↗
PubMedDate not supplied

Maryland MIRRORS/II: a connectionist model simulator.

Developing and evaluating connectionist models (also called neural models) is a difficult and time-consuming task. To address this issue, we designed a software system called Maryland MIRRORS/II for the construction of connectionist models in biomedicine and other fields. Maryland MIRRORS/II is distinguished from previous and current related systems by its support of a high-level nonprocedural language, a general-purpose event-handling mechanism, and an indexed library of system resources. These features make Maryland MIRRORS/II a convenient software tool for use in biomedicine. This paper describes Maryland MIRRORS/II and provides a simple example in which it uses error back propagation learning to select the appropriate treatment for a given set of manifestations.

Computer Simulation↗
PubMed1994

Fifteen things you should know about new Maryland laws when making health care decisions.

Recent dramatic changes to Maryland law regarding health care decision making for incapacitated patients will have significant impact on the role of physicians in making these decisions. On October 1, 1993, the newly passed Maryland Health Care Decision Act took effect, and revisions to state guardianship laws were implemented. The laws, which Governor Schaefer approved on May 11, 1993, modify existing statutory language pertaining to the four legal tools available for making health care decisions for a person when he or she becomes incapacitated: (1) living wills, (2) substituted consents for medical procedures, (3) health care power of attorney appointments, and (4) guardianship proceedings. This article summarizes 15 important points in these new or revised Maryland laws on health care decision making.

Advance Directives↗
PubMed2000

Oil and water? Lessons from Maryland's effort to protect safety net providers in moving to Medicaid managed care.

Studies have highlighted the tensions that can arise between Medicaid managed care organizations and safety net providers. This article seeks to identify what other states can learn from Maryland's effort to include protections for safety net providers in its Medicaid managed care program--HealthChoice. Under HealthChoice, traditional provider systems can sponsor managed care organizations, historical providers are assured of having a role, patients can self-refer and have open access to certain public health providers, and capitation rates are risk adjusted through the use of adjusted clinical groups and claims data. The article is based on a week-long site visit to Maryland in fall 1998 that was one part of a seven-state study. Maryland's experience suggests that states have much to gain in the way of "good" public policy by considering the impact of their Medicaid managed care programs on the safety net, but states should not underestimate the challenges involved in balancing the need to protect the safety net with the need to contain costs and minimize the administrative burden on providers. No amount of protection can compensate for a poorly designed or implemented program. As the health care environment continues to change, so may the need for and the types of protections change. It also may be most difficult to guarantee adequate protections to those who need it most--among relatively financially insecure providers that have a limited management infrastructure and that depend heavily on Medicaid and the state for funds to care for the uninsured.

Community Participation↗
PubMed2006

Use of Maryland Biological Stream Survey data to determine effects of agricultural riparian buffers on measures of biological stream health.

This study was undertaken to determine the importance of riparian buffers to stream ecology in agricultural areas. The original Maryland Biological Stream Survey (MBSS) data set was partitioned to represent agricultural sites in Maryland's Coastal Plain and Piedmont regions. ANOVA, multiple linear regression (MLR), and CART regression tree models were developed using riparian and site catchment landscape characteristics. MBSS data were both stratified by physiographic region and analyzed as a combined data set. All models indicated that land management at the site was not the controlling factor for fish IBIs (FIBI) at that site and, hence, using FIBI to evaluate site-scale factors would not be a prudent procedure. Measures of instream habitat and location in the stream network were the dominant explanatory factors for FIBI models. Both CART and MLR models indicated that forest buffers were influential on benthic IBIs (BIBI). Explanatory variables reflected instream conditions, adjacent landscape influence, and chemistry in the Coastal Plains sites, all of which are relatively site specific. However, for Piedmont sites, hydrologic factors were important, in addition to adjacent landscape influence, and chemistry. Both Coastal Plain and Piedmont CART models identified several hydrologic factors, emphasizing the dominant control of hydrology on the physical habitat index (PHI). Riparian buffers were a secondary influence on PHI in the Coastal Plain, but not in the Piedmont. Between 40% and 70% of the variation in FIBI, BIBI, and PHI was explained by the "easily obtainable" variables available from the MBSS data set. While these are empirical results specific to Maryland, the general findings are of use to other locations where the establishment of forest buffers is considered as an aquatic ecosystem restoration measure.

Agriculture↗
PubMed2006

The effect of a medicaid managed care program on patterns of psychiatric readmission among adolescents: evidence from Maryland.

This study evaluates the effect of Maryland's Medicaid managed care program on patterns of psychiatric readmission for adolescents. Rates and frequency of readmissions are compared before (FY 1997) and after (FY 1998) the implementation of Maryland's Medicaid managed care program. Medicaid claims files were reviewed for 881 adolescents consecutively admitted to three major Maryland psychiatric hospitals between July 1, 1996 and June 30, 1998. Adolescents admitted after the managed care reforms were more likely to experience multiple readmissions. The 1-year cumulative rate of readmission pre- and postmanaged care was 33% and 38%, respectively; the highest risk period fell within the first 15-30 days postdischarge. The high rate of early readmissions raises concern about the quality of care and the adequacy of community-based services. Findings also suggest that youths with serious emotional disturbances who are high users of inpatient care may be adversely affected by the managed care reforms.

Adolescent↗
PubMed1996

Lyme disease surveillance in Maryland, 1992.

The incidence of Lyme disease (LD) reported to the Maryland Department of Health and Mental Hygiene during 1992 was 6.5/100,000 population, ranging from 29.3 cases/100,000 on the Eastern Shore (74.4% of all cases) to no cases in the mountains of western Maryland. Among the 317 reported patients, 44.4% gave a history of tick exposure and 78.9% had positive serologic test results. For the 187 (59.0%) patients meeting the Centers for Disease Control and Prevention (CDC) surveillance case definition, erythema migrans (EM) occurred in 69.5%, with arthritic (26.7%), neurologic (13.4%), and cardiac (2.1%) manifestations being less frequent. Patients not meeting the surveillance case definition were significantly more likely to have influenza-like symptoms, a smaller rash, and arthralgia. Patients meeting the CDC criteria were more likely to have an onset during the major transmission season in the summer (odds ratio (OR): 2.1; confidence interval (CI): 1.2 to 3.6) since this was the time when most (115/130) patients with EM were detected. Positive serologic results were more likely (OR: 2.2; CI: 1.2 to 4.2) in those not meeting the case definition. The treatment given to patients thought to have LD was almost always that recommended in the literature and there was no difference between treatment prescribed for patients meeting and those not meeting the case definition. These data show that physicians in Maryland are treating many patients for LD who are clinically diagnosed as having LD (e.g., febrile patients with flulike symptoms, patients with arthralgias or erythematous rashes < 5 cm in size) and who have positive serologic test results but who do not meet the CDC surveillance case definition. These patients and the large number of unreported patients being seen and treated for LD or tick bites must be added to the overall burden of LD in the state.

Adolescent↗
PubMed2006

Oral cancer exams among cigarette smokers in Maryland.

BACKGROUND: Current and former smokers are at increased risk to develop oral cancer. This analysis was performed to determine whether current and former smokers are more likely to undergo an exam for oral cancer than non-smokers. METHODS: The Maryland Cancer Survey performed in 2002 was a population-based random digit dial, statewide survey on cancer screening and risk behaviors, targeting adults aged 40 years and older. The dataset contains self-reported information on oral cancer examinations, current smoking status, and health care access information for 4840 Maryland residents. RESULTS: 2062 (42.6%) of Marylanders aged 40 years and older reported ever having had an oral cancer examination. Dentists and dental hygienists performed 90.9% of the exams. Current and former smokers were no more likely than those who have never smoked to have ever had the examination (adjusted OR = 1.02, 95% CI = 0.85-1.23 and OR = 1.09, 95% CI = 0.94-1.25, respectively). Other predictors associated with having an oral cancer exam included having more than a high school of education, being female, non-black, being in good to excellent health, and having a recent physical exam. Having visited the dentist in the last year had the highest odds of having ever had an oral cancer exam. CONCLUSIONS: Current and former smokers are a high-risk group who need to be targeted for oral cancer exams by dental professionals and primary care physicians.

Adult↗
PubMed2002

Knowledge, attitudes, and behaviors toward skin cancer in Maryland youths.

PURPOSE: To describe the knowledge, attitudes, and practices of 7th-graders in Maryland with respect to sun protection and skin cancer. METHODS: Maryland middle school students ages 10 to 16 years (55% girls, estimated 67% white) from 6 counties completed an in-school questionnaire (n = 2,775) developed by the Coalition for Skin Cancer Prevention in Maryland in 1999 to assess knowledge, attitudes, and behaviors concerning sun exposure and skin cancer. To evaluate for gender and age differences, mean knowledge and attitude scores were compared using Student's t-tests and the prevalence of behaviors were compared using Chi-square tests. Multiple regression was used to model how age, gender, knowledge, and attitudes predicted the likelihood of being sunburned the previous summer. RESULTS: On average, these youths correctly answered 65% of 13 true/false items and 43% of 7 multiple choice items. Approximately one-third (32%) felt a tan looked healthy and 51% felt a tan looked attractive; on the other hand, 36% agreed/strongly agreed that sun protection was "cool." Attitudes toward skin protection became less favorable with age (p-for-trend < .001). When out in the sun the previous summer, 37% rarely or never used sunscreen and 43% never wore a hat. The prevalence of two or more painful sunburns during the past summer was 30%. Less favorable attitudes toward skin protection were associated with a higher likelihood of sunburn (p < .001). The likelihood of sunburn did not differ by gender, even though when compared with boys, girls had significantly higher knowledge scores (p < .01), more favorable attitudes (p < .001), and were significantly more likely to report using sunscreen (p < .001). CONCLUSIONS: A substantial proportion of youths were not protecting themselves adequately from sunlight. The overall low levels of knowledge accentuate the need to incorporate basic knowledge of skin cancer and sun protective behaviors in preventive interventions designed for this population. The results particularly emphasize the need to positively impact attitudes toward sun protective behavior early in life to help curb the epidemic of skin cancer.

Adolescent↗
PubMed2002

Views of oral cancer prevention and early detection: Maryland physicians.

The purpose of this study was to obtain in-depth information on Maryland physicians' knowledge, opinions and practices about oral cancer examinations. The qualitative descriptive study used one focus group conducted in a conference facility and nine one-on-one interviews at private medical offices. A criterion-purposeful sampling was used for selection of participants. Generally, we found low awareness of, and surprise about, Maryland's high oral cancer mortality rates. Physicians were not surprised that they detect more lesions than dentists, although most physicians did not provide oral cancer examinations on a routine basis. Physicians were interested in attending continuing medical education (CME) courses on oral cancer prevention and early detection but only if worked into other CME programs on cancer. They were very interested in having hands-on training on performing an oral cancer examination. These findings will be used to implement educational interventions for Maryland physicians to help increase early detection of oral cancers.

Clinical Competence↗