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PubMed1996

The cause-specific prevalence of visual impairment in an urban population. The Baltimore Eye Survey.

BACKGROUND: Whereas population-based data on the causes of bilateral blindness have been reported, little information is available on the distribution of causes of central vision loss less severe than the criteria used to define legal blindness. This visual impairment is responsible for a high proportion of eye care service use and results in important reductions in functional status. METHODS: Data from the Baltimore Eye Survey were used to estimate the cause-specific prevalence of visual impairment (best-corrected visual acuity worse than 20/40 but better than 20/200) among black and white residents of east Baltimore who were 40 years of age or older. Eligible subjects underwent a screening examination at a neighborhood location and, for those whose best-corrected visual acuity was less than 20/30, a definitive ophthalmologic examination at the Wilmer Eye Institute. RESULTS: The prevalence of visual impairment was 2.7% in whites and 3.3% in blacks; the age-adjusted relative prevalence (B/W) was 1.75 (P = 0.01). The leading causes of visual impaired eyes were cataract (35.8%), age-related macular degeneration (14.2%), diabetic retinopathy (6.6%), glaucoma (4.7%), and other retinal disorders (7.3%). Cataract, diabetic retinopathy, and glaucoma were more common as a cause of visual impairment among blacks, whereas macular degeneration was more frequent among whites. More than 50% of all subjects had the potential for improvement in vision with appropriate surgical intervention. CONCLUSION: Visual impairment is a prevalent condition among inner city adults 40 years of age or older. The distribution of causes suggests that improvements in the visual health of the population could be achieved with more effective delivery of efficacious ophthalmologic care.

Adult↗
PubMed2004

Relationships between pediatric asthma and socioeconomic/urban variables in Baltimore, Maryland.

Spatial relationships between clinical data for pediatric asthmatics (hospital and emergency department utilization rates), and socioeconomic and urban characteristics in Baltimore City were analyzed with the aim of identifying factors that contribute to increased asthma rates. Socioeconomic variables and urban characteristics derived from satellite data explained 95% of the spatial variation in hospital rates. The proportion of families headed by a single female was the most important variable accounting for 89% of the spatial variation. Evidence suggests that the high rates of hospital admissions and emergency department (ED) visits may partially be due to the difficulty of single parents with limited resources managing their child's asthma condition properly. This knowledge can be used for education towards mitigating ED and hospital events in Baltimore City.

Asthma↗
PubMed1999

Sadness in older persons: 13-year follow-up of a community sample in Baltimore, Maryland.

BACKGROUND: Our prior psychometric work suggested that older adults interviewed in 1981 in a community survey were less likely than younger adults to report dysphoria. We hypothesized that this would also be true of older adults interviewed 13 years later. METHODS: This study is a population-based 13-year follow-up survey of community-dwelling adults living in East Baltimore in 1981. Subjects were the continuing participants of the Baltimore Epidemiologic Catchment Area Program. After excluding 269 adults who were 65 years of age and older at initial interview in 1981, 1651 adults remained (347 aged 65 years and older and 1304 who were 30-64 years-old at follow-up). We applied structural equations with a measurement model for dichotomous data (the MIMIC -- multiple indicators, multiple causes -- model) to compare symptoms between adults who were 65 years and older at follow-up with younger adults, in relation to the nine symptom groups comprising the diagnostic criteria for major depression, adjusting for several potentially influential characteristics (namely, gender, self-reported ethnicity, educational attainment, cognitive impairment, marital status and employment). RESULTS: Older adults were less likely to endorse sadness as evidenced by a direct effect coefficient of -0.335 (95% Confidence Interval -0.643, -0.027). After adjusting for several potentially influential characteristics, the direct effect of age was substantially unchanged (-0.298 (95% CI -0.602, 0.006)). CONCLUSIONS: Older adults in 1994, like older adults in 1981, were less likely to endorse sadness than younger persons. This finding suggests, but does not prove, that the observed age difference in reporting depression does not reflect a cohort effect.

Adult↗
PubMed2000

Baltimore's consumer ombudsman and assistance program: an emerging public health service in Medicaid Managed Care.

OBJECTIVES: To present Baltimore City Health Department's (BCHD) experience in developing and operating an ombudsprogram for Maryland's Medicaid Managed Care HealthChoice Program as an innovative public health response to its MCH Title V assurance functions. METHODS: This paper presents a case study that 1) describes Baltimore City's Consumer Ombudsman and Assistance Program (COAP) in terms of development, function, structure, and resources; 2) provides a summary of its first 30 months' experiences, both quantitatively and qualitatively; and 3) describes COAP's successes, value, and limitations with respect to its three essential roles--a) conflict resolution for individuals, b) education for consumers, providers and advocates, and c) catalyst for quality improvement. OUTCOMES: Over 1300 cases (involving enrollment, access, billing, and treatment issues) were referred to COAP by the State's Complaint Resolution Section during the first 2 1/2 years of HealthChoice. Ombudsman interventions resulted in conflict resolution for enrollees using a continuum of education, mediation and advocacy, and in generating systematic data for systems change through collaboration with state and community public health, managed care organization, provider, consumer, and advocacy officials and groups. CONCLUSIONS: Public health ombudsprograms can effectively assist and educate enrollees; and provide concurrent, or real-time, information for consumer, provider, health plan, and advocacy groups, as well as public policymakers and legislators to better inform systems improvement and innovation. The community-based ombudsman role is an effective mechanism to ensure appropriate care for MCH populations and others with special needs. Such efforts can be funded by federal/state Medicaid administrative funds and are a sound investment in assuring access to comprehensive care for vulnerable populations.

Adolescent↗
PubMed1998

Attacking poverty and improving health: a report on the WHO/State of Maryland International Health Congress, Baltimore, September 1997.

An international meeting, 'Investment Strategies for Healthy Urban Communities', in Baltimore in September 1997 called on the the business community, city authorities and the health professions to reduce poverty and its adverse health consequences, especially in urban areas, in both the industrialized and developing world. In addition to issuing the Baltimore Charter on partnership for a healthy urban future, the meeting had two main outcomes: the innovative concept of Business for Health, championed by progressive business leaders from Australia, Europe and the United States, to promote business principles to reduce poverty, create enterprises and improve people's health, especially in developing countries; and the establishment by health professionals of an information network between cities and countries on poverty and ill-health. Two follow-up meetings in London in December 1997 resulted in an action plan to create networks of health professional groups and representatives of the business community.

Baltimore↗
PubMed1991

Racial differences in the cause-specific prevalence of blindness in east Baltimore.

BACKGROUND: Bilateral blindness unrelated to simple refractive error is twice as prevalent among blacks as among whites, although the difference narrows among the elderly. The reasons for this race- and age-related pattern are uncertain. METHODS AND RESULTS: A randomly selected, stratified, multistage cluster sample of 2395 blacks and 2913 whites 40 years of age and older in East Baltimore underwent detailed ophthalmic examinations by a single team. We identified 64 subjects who were blind in both eyes. The leading causes of blindness were unoperated senile cataract (accounting for blindness in 27 of the total of 128 eyes), primary open-angle glaucoma (17 eyes), and age-related macular degeneration (16 eyes). Together, these three disorders accounted for 47 percent of all blindness in this sample. Unoperated cataract accounted for 27 percent of all blindness among blacks, among whom it was four times more common than among whites; whites were almost 50 percent more likely than blacks to have undergone cataract extraction before the age of 80 (P less than 0.002). Primary open-angle glaucoma accounted for 19 percent of all blindness among blacks; it was six times as frequent among blacks as among whites and began 10 years earlier, on average. By contrast, age-related macular degeneration resulting in blindness was limited to whites, among whom it was the leading cause of blindness (prevalence, 2.7 per 1000; 95 percent confidence interval, 1.2 to 5.4); it affected 3 percent of all white subjects 80 years of age or older. CONCLUSIONS: The pattern of blindness in urban Baltimore appears to be different among blacks and whites. Whites are far more likely to have age-related macular degeneration, and blacks to have primary open-angle glaucoma. The high rate of unoperated cataracts among younger blacks and among elderly subjects of both races suggests that health services are underused. Half of all blindness in this urban population is probably preventable or reversible.

Adult↗
PubMed2006

Young heroin users in Baltimore: a qualitative study.

This study describes the characteristics of 67 young heroin users, interviewed using a semistructured qualitative questionnaire (QQ) as part of a larger study of 18- to 25-year-old heroin users seeking detoxification with buprenorphine at a drug treatment center in Baltimore. This new generation of heroin users has a different demographic profile compared to older heroin users in this area. Our data, supported by data from another clinic and from the Maryland State Alcohol and Drug Abuse Administration, seem to indicate that the younger heroin users in treatment settings are predominantly White, with a high proportion of women, often living in the suburbs. Based on responses to the QQ, all subjects initiated heroin use intranasally, usually in a group setting; 75% had subsequently gone on to use intravenously. The typical young heroin user in Baltimore Metropolitan area appears to be a young White man or woman from a middle/working-class background, with exposure to drug use among close contacts while growing up, experimenting with gateway drugs with peers before proceeding first to intranasal, and then intravenous heroin use, engaging in criminal activities to support the habit, repeatedly seeking help with assistance from family, but failing to sustain abstinence due to continued exposure to drug using peers and a poorly implemented plan of aftercare. Further research should focus on efforts to engage peer groups and families in order to improve treatment outcomes in young heroin users.

Administration, Intranasal↗
PubMedDate not supplied

Outcomes for substance user treatment in women: results from the Baltimore Drug and Alcohol Treatment Outcomes Study.

The Baltimore Drug and Alcohol Treatment Outcomes Study is a large study focusing on a single city. Over 1000 adult male and female substance users entering treatment in 16 publicly funded substance use treatment programs in the City of Baltimore between 1998 and 1999 were evaluated at four time periods (intake, 30 days after treatment, 6 month, and 12 month follow-ups). A comprehensive psychological battery was administered at each assessment interval. In this article, we report on the seven domains (alcohol, drug, medical, legal, employment, family, and psychological) of the addiction severity index (ASI) with the 459 women who participated in the study. Overall, statistically significant differences across time showed improvement as a result of substance user treatment were found in six of the seven ASI domains; no statistically significant effects for time were found for the medical composite scores. Drug and alcohol use among the participants was significantly reduced as early as 30 days after treatment. We discuss these findings in relation to the specific treatment needs of women who are addicted.

Adult↗
PubMed2006

Serologic evidence for Rickettsia typhi and an ehrlichial agent in Norway rats from Baltimore, Maryland, USA.

We screened serum from 90 Norway rats trapped in East Baltimore, Maryland, USA, from April to November 2005 for antibodies against Rickettsia typhi and Ehrlichia chaffeensis. Six rats had positive titers of > or = 1:64 against R. typhi and did not react with R. akari. In addition, four rats had cross-reactive antibodies with titers of > or = 1:64 against Ehrlichia chaffeensis. Sera from these rats also cross-reacted with Anaplasma phagocytophilum or Ehrlichia muris. Our data indicate that the agent of murine typhus and ehrlichial agents are circulating in the Norway rat population in Baltimore.

Animals↗
PubMed2002

Temporal trends in the incidence of human immunodeficiency virus infection and risk behavior among injection drug users in Baltimore, Maryland, 1988-1998.

Although the incidence of and mortality from acquired immunodeficiency syndrome have declined recently in the United States, data are needed on the incidence of human immunodeficiency virus (HIV) and risk behaviors among injection drug users (IDUs). The authors studied the temporal trends of HIV incidence and risk behavior, ascertained through semiannual confidential interviews, between 1988 and 1998 in a cohort of 1,532 HIV-seronegative IDUs in Baltimore, Maryland. An additional 338 HIV-negative drug users were recruited in 1994 and were studied by using the same methods. Overall, 277 persons seroconverted to HIV during 8,826.45 person-years of follow-up, an incidence of 3.14 per 100 person-years. The incidence per 100 person-years declined over time from 4.45 in 1988-1990 to 3.35 in 1991-1994 to 1.84 in 1995-1998, a decline of 12% per year. HIV infections were associated with injection of cocaine, more frequent injection, needle sharing, and injection in a shooting galley. Sexual behavior variables associated with HIV incidence included a sexually transmitted infection, male homosexual behavior, and sex with another IDU. These data suggest that high-risk behavior and HIV incidence among IDUs have decreased recently in Baltimore. Nevertheless, additional prevention strategies are needed in these populations.

Adult↗
PubMed2002

Characteristics of injection drug users who utilize tuberculosis services at sites of the Baltimore city needle exchange program.

OBJECTIVE: To describe characteristics of needle-exchange program (NEP) participants who utilized tuberculosis services from an NEP site. METHODS: Between June 1998 and May 1999, tuberculosis services were advertised and offered to Baltimore, Maryland, NEP participants. Demographic and tuberculosis-specific data were collected on participants who self-selected into services. Analyses were based on being tuberculin skin tested, returning for a skin test reading, and testing tuberculin positive. RESULTS: Among 691 contacts with NEP participants, this service performed 296 tuberculin tests, with an 84% return rate for skin test reading. Participants were 32% female, 87% African American, and 11% employed. Higher frequency of NEP visits was positively associated with requesting tuberculosis services and returning for skin test reading. Among those who returned for skin test reading, longer smoking duration and problems getting food in the past year due to a lack of money were associated with a positive test. CONCLUSIONS: Utilization of a tuberculosis service and high return rates can be achieved among NEP participants without formal recruitment strategies. Frequent exchange appears to facilitate return visits for NEP-based tuberculosis screening, which may imply accessibility for frequent exchangers. More extensive health services at sites of the Baltimore NEP appear to be warranted, with particular attention paid to effectiveness for frequent exchangers.

Adult↗
PubMed1998

Geographic epidemiology of gonorrhea in Baltimore, Maryland, using a geographic information system.

The epidemiology of gonorrhea is characterized by geographically defined hyperendemic areas, or "cores." Geographic information system (GIS) technology offers new opportunities to evaluate these patterns. The authors developed a GIS system linked to the disease surveillance database at the Baltimore Health Department and used this system to evaluate the geographic epidemiology of gonorrhea in Baltimore, Maryland, during 1994. There were 7,330 reported cases, of which 87.4% were in persons aged 15-39 years; 56.6% were of the cases were in males; and 60.5% of the cases were reported from the nonsexually transmitted disease (STD) clinic sector. Valid residential addresses were available for 6,831 (93.5%) of cases. In the GIS system, gonorrhea cases were geocoded by reported address using digitized maps, and assigned to census tract. Census tract-specific rates for persons aged 15-39 years were calculated using 1990 census data. Gonorrhea was reported from 196/202 (97%) of census tracts, of which 90 census tracts had >30 cases. For these 90 census tracts, rates were ranked. The core was considered as the top rate quartile, consisting of 13 geographically contiguous census tracts with rates 4,370-6,370 per 100,000; adjacent areas were 19 census tracts in the second quartile (rates: 3,730-4,370 per 100,000). As radial distance from the core areas increased, incidence rates decreased and male/female ratio increased, which is consistent with previous definitions of the core theory of STD transmission. Mapping of cases by provider showed that cases reported from STD clinics had similar geographic distribution to those from the non-STD clinic sector. From an operational perspective, GIS can be effectively integrated with clinical data systems to provide epidemiologic analysis.

Adolescent↗
PubMed1998

Psychopathology as a predictor of disability: a population-based follow-up study in Baltimore, Maryland.

To determine whether psychopathology is associated with disability as a result of underlying physical illness or whether such psychopathology antedates disability and is an independent determinant of disability, the authors conducted a nested case-control study within the Epidemiologic Catchment Area Follow-up Study in Baltimore, Maryland. From a 1981 random sample of 3,481 persons from Baltimore interviewed for psychopathology, disability, and other comorbidity, 1,920 who were alive in 1993 were traced and were reinterviewed with a similar instrument. Within the study population, 168 new cases of disability were identified as occurring between 1981 and 1993, as measured by the inability to perform activities of daily living. These cases were compared with 1,715 controls who reported no disability. The sociodemographic factors that were significantly related to incident disability in this analysis were age, female gender, and less than a high school education. These comparisons revealed associations of incident disability in activities of daily living with almost all antecedent chronic physical illnesses. Significant age- and gender-adjusted associations were observed between incident disability in activities of daily living and antecedent (in 1981) alcohol abuse and dependence (odds ratio (OR)=2.5, 95% confidence interval (CI) 1.5-4.2), major depressive disorder (OR=4.2, 95% CI 2.2-8.3), and phobia (OR=1.9, 95% CI 1.3-2.8). The adjusted odds ratio for the joint effect of antecedent depression and chronic physical illness on incident disability in activities of daily living was 17.0 (95% CI 6.9-41.7). There was a significant independent effect of antecedent major depression on activities of daily living disability. The effect of psychopathology on incident disability is nonspecific as to type of baseline chronic physical illness. Such a finding has important implications for defining strategies to prevent disability.

Adolescent↗
PubMed1999

Longitudinal change in height of men and women: implications for interpretation of the body mass index: the Baltimore Longitudinal Study of Aging.

Age differences in height derived from cross-sectional studies can be the result of differential secular influences among the age cohorts. To determine the magnitude of height loss that accompanies aging, longitudinal studies are required. The authors studied 2,084 men and women aged 17-94 years enrolled from 1958 to 1993 in the Baltimore Longitudinal Study of Aging, Baltimore, Maryland. On average, men's height was measured nine times during 15 years and women's height five times during 9 years. The rate of decrease in height was greater for women than for men. For both sexes, height loss began at about age 30 years and accelerated with increasing age. Cumulative height loss from age 30 to 70 years averaged about 3 cm for men and 5 cm for women; by age 80 years, it increased to 5 cm for men and 8 cm for women. This degree of height loss would account for an "artifactual" increase in body mass index of approximately 0.7 kg/m2 for men and 1.6 kg/m2 for women by age 70 years that increases to 1.4 and 2.6 kg/m2, respectively, by age 80 years. True height loss with aging must be taken into account when height (or indexes based on height) is used in physiologic or clinical studies.

Adolescent↗
PubMed1991

A population-based evaluation of glaucoma screening: the Baltimore Eye Survey.

The Baltimore Eye Survey was a population-based survey conducted from January 1985 to November 1988 among residents of east Baltimore, Maryland, who were 40 years of age or older. A total of 5,308 black subjects and white subjects received a comprehensive screening examination for glaucoma including tonometry, visual fields, stereoscopic fundus photography, and a detailed medical and ophthalmic history. Based on a definitive examination, a diagnosis of glaucoma of any type was made for 196 persons. Tonometry, cup:disc ratio, and narrowest neuroretinal rim width were evaluated for their ability to correctly classify subjects into diseased or nondiseased states. There were no cutoff values at which these variables provided a reasonable balance of sensitivity and specificity, separately or in combination. Logistic regression models were fit that included demographic and other risk factors. Sensitivities and specificities were calculated for varying cutoff levels on the distribution of predicted probabilities. There was no cutoff for which reasonable sensitivity and specificity were obtained. The authors conclude that the effectiveness of current techniques for glaucoma screening is limited.

Adult↗
PubMed1990

Utilization pattern of clinical nurse specialists in the Baltimore-Washington area.

In the present cost containment environment, hospitals often change their employment patterns. Nurses in advanced practice roles are particularly vulnerable to reassignment. In order to determine if the employment of Clinical Nurse Specialists (CNSs) in the Baltimore-Washington area had decreased and to determine what specialty areas employed the most CNSs, a survey of all area hospitals was conducted. The nursing departments of all 88 hospitals were contacted by phone with 40 of them (45%) agreeing to provide data. Seventeen institutions reported employing a total of 119 CNSs. Of these, only 12 required a Master's degree for nurses to hold that position. As expected, larger institutions employed more CNSs. This role appears to be stable, with only two institutions having eliminated CNS positions recently and five reporting plans to add such positions in the near future. Most CNSs reported either directly or indirectly to the Director of Nursing. Those in positions funded by another source reported to personnel in the funding department or agency. Almost all CNSs had clinical titles, and Psychiatric, Oncology, Medical and/or Surgical, Pediatrics or Critical Care were the most prevalent specialties mentioned. The CNS role is a viable role in the Baltimore-Washington area even in this time of cost containment. Most CNSs are identified with their area of clinical specialization.

Baltimore↗
PubMedDate not supplied

Recruitment of older women: lessons learned from the Baltimore Hip Studies.

OBJECTIVES: This study used a qualitative approach in which participants were asked to write about their experiences in recruiting older women into either one of two exercise intervention studies that are part of the Baltimore Hip Studies. The sample included 8 researcher nurses all women, White, and 42-53 years of age. BACKGROUND: Older adults, particularly older women, are less likely to participate in research studies when compared to their younger counterparts. The purpose of this study was to explore the techniques successfully used by research nurses in the Baltimore Hip Studies to recruit older women after hip fracture into exercise intervention studies. METHOD: Data analysis was performed using basic content analysis (Crabtree & Miller, 1992; Miles & Huberman, 1984) "in vivo" coding (Dowd, 1991), or "grounded" coding (Glaser & Strauss, 1967), which involves using the informants' own words to capture a particular idea. RESULTS: A total of 16 codes were identified and reduced to nine themes. Seven themes focused on techniques that facilitated recruitment: (a) caring for individuals; (b) emphasizing benefits; (c) eliciting support from others; (d) being an expert; (e) using role models; (f) using good timing; and (g) giving good first impressions. The remaining two themes identified barriers to recruitment: (a) time commitment and (b) lack of support. DISCUSSION: Based on these themes, specific recruitment techniques are recommended. Ongoing research, however, is needed to establish the most effective recruitment procedures with older women.

Adult↗
PubMedDate not supplied

The relationships between sexual behavior, alcohol use, and personal network characteristics among injecting drug users in Baltimore, Maryland.

BACKGROUND AND OBJECTIVES: Studies on the relationship between alcohol consumption and HIV-related risk behaviors report inconclusive and contradictory results. GOAL OF THIS STUDY: This study sought to examine the relationship between drug and alcohol use, personal network characteristics, and sexual risk behaviors. STUDY DESIGN: A sample of 290 injecting drug users in Baltimore, Maryland, were interviewed. RESULTS: More than half the males and 28% of the females reported multiple partners within the prior 6 months, and 33% of the males reported exchanging money or drugs for sex. For males, heavy drinking was significantly associated with multiple partners, exchanging money or drugs for sex, and casual sex. The personal network characteristics of size and density, as measured by the percentage of network members who knew each other, were associated with sexual risk behaviors. CONCLUSION: These results indicate that among injecting drug users in Baltimore, heavy drinkers, and those with larger, lower density personal networks have increased levels of sexual risk behaviors.

Adult↗