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PubMed2000

Stimulant treatment in Maryland public schools.

OBJECTIVE: A statewide school survey was performed to provide naturalistic data on the prevalence of medication administered to Maryland public school students for the treatment of attention deficit hyperactivity disorder (ADHD) to clarify the concern of some state legislators about stimulant treatment for youths. METHODS: In April 1998, school nurses supervised a survey of all Maryland public school students medicated during school hours for ADHD. The data collected on these students included: type of medication administered, gender, school level, race/ethnicity, special education and Section 504 status, and the specialist of the prescriber. RESULTS: Of the 816 465 students surveyed, 20 050 (2. 46%) received methylphenidate and 3721 (0.46%) received other medications for ADHD. Other major findings were: 1) methylphenidate constituted 84% of all the medication administered for ADHD; 2) the male:female ratio of the medication's recipients was 3.5:1 and 4.3:1 in elementary and secondary school, respectively; 3) black and Hispanic students received methylphenidate at approximately half the rate of their white counterparts; 4) 45% of all students receiving methylphenidate had special education status and an additional 8% had Section 504 status; and 5) nurse practitioners were the prescribers of 3% of the methylphenidate prescribed to Maryland students. CONCLUSIONS: This large, population-based, point prevalence study of medication administered to students for ADHD adds new and updated findings on prevalence variations, rates for minority and special education/Section 504 students, and specialty prescriber rates.

Adolescent↗
PubMedDate not supplied

Incidence rates of Lyme disease in Maryland: 1993 through 1996.

The incidence rate per 100,000 population by gender and age group was calculated for the 24 Maryland jurisdictions using 1,392 cases reported to the Lyme Disease Registry during 1993 to 1996. The overall incidence rate for the state was 7.0 cases per 100,000 inhabitants. Males (incidence rate = 7.7) were 1.2 times more affected than females (incidence rate = 6.2) (p < 0.001). The bimodal overall age distribution shows a peak in the 10 to 19 age category (incidence rate = 8.5) and in the 50 to 59 age group (incidence rate = 8.9), and in the 20 to 29 age group (incidence rate = 3.9). The incidence rate by jurisdiction ranged from 0.7 in Allegany County from Western Maryland to 88.3 in Kent County on the Upper Eastern Shore. Results from this study show that counties from the Upper Eastern Shore region had the highest specific incidence rate by age group/gender/jurisdiction while counties from Western Maryland had the lowest specific incidence rates and have not reported Lyme disease patients younger than 10 or older than 59 years of age. This difference might be explained primarily by the kind of outdoor activities in which the different age groups are involved and the relative abundance of Ixodes scapularis infected with the etiologic agent of Lyme disease, Borrelia burgdorferi, in these two regions.

Adolescent↗
PubMed1999

Family planning training in Maryland family practice and obstetrics/gynecology residency programs.

OBJECTIVE: To examine the extent of family planning and abortion training in Maryland family practice (FP) and obstetrics/gynecology (OB) residency training programs. METHODS: All final-year residents in every FP and OB residency training program in Maryland were asked in 1998 how many cases (0, 1-10, > 10) of ten methods of contraception and abortion they had managed. RESULTS: Seventy-five percent (55) of the 73 residents responded. Fifty percent of FP residents had never inserted an intrauterine device (IUD), 43% had never inserted an implant (Nor-plant), 37% had never prescribed emergency contraceptive pills, and 30% had never fitted a diaphragm. Ninety-seven percent of FP residents had no experience with elective termination of pregnancy, and 83% had no experience with sterilization. Twenty percent of OB residents had never inserted an IUD, 16% had never inserted implants or prescribed emergency contraceptive pills, 20% had never fitted a diaphragm, and 36% had no experience in elective termination of pregnancy. Not one FP resident had inserted or fitted more than ten IUDs, implants, diaphragms, or cervical caps. Except for oral and injectable contraception, the majority of OB residents had not managed more than ten cases of any other reversible contraceptive method: 80% had not inserted more than ten IUDs, 72% had not inserted more than ten implants, 88% had not fitted more than ten diaphragms, and 100% had not fitted more than ten cervical caps. CONCLUSION: These survey results indicate a need for more formal instruction in most contraceptive methods for OB and FP residency programs in Maryland. This study concurs with previous national studies showing deficits in family planning training.

Contraceptive Devices, Female↗
PubMed1992

Rates of avoidable hospitalization by insurance status in Massachusetts and Maryland.

OBJECTIVE: To determine whether uninsured and Medicaid patients have higher rates of avoidable hospitalizations than do insured patients. DESIGN: We used 1987 computerized hospital discharge data to select a cross-sectional sample of hospitalized patients. Population estimates from the Current Population Survey were used to estimate rates of admission, standardized for age and sex. SETTING: Nonfederal acute care hospitals in Massachusetts and Maryland. PATIENTS: All patients under 65 years of age who were uninsured, privately insured, or insured by Medicaid. Hospitalizations for obstetric and psychiatric conditions were excluded. MAIN OUTCOME MEASURES: Relative risk of admission for 12 avoidable hospital conditions (AHCs) identified by a physician panel. RESULTS: Uninsured and Medicaid patients were more likely than insured patients to be hospitalized for AHCs. Rates for uninsured patients were significantly greater than for privately insured patients in Massachusetts for 10 of 12 individual AHCs, and in Maryland for five of 12 AHCs. After adjustment for baseline utilization, the results were statistically significant for 10 of 12 AHCs in Massachusetts and seven of 12 AHCs in Maryland. For Medicaid patients, rates were significantly greater than for privately insured patients for all AHCs in each state before adjustment, and for nine of 12 and seven of 12 AHCs in each state, respectively, after adjustment for baseline utilization. CONCLUSION: Our findings suggest that patients who are uninsured or who have Medicaid coverage have higher rates of hospitalization for conditions that can often be treated out of hospital or avoided altogether. Our approach is potentially useful for routine monitoring of access and quality of care for selected groups of patients.

Adult↗
PubMed2003

A geospatial study of the potential of two exotic species of mosquitoes to impact the epidemiology of West Nile virus in Maryland.

We used geospatial techniques to study the potential impact of 2 exotic mosquitoes, Aedes albopictus and Ochlerotatus japonicus japonicus, on the epidemiology of West Nile virus in Maryland. These 2 species have established populations in Maryland over the past 15 years. Larvae of both mosquito species are found in natural and artificial water-holding cavities and containers, particularly water in tires. Therefore, we used locations of licensed tire dealers and of tire dumps scheduled for clean up as an index for potential sources of mosquito vectors. This index was expected to underestimate the actual population of source habitats. West Nile virus activity in Maryland during 1999, 2000, and 2001 was indicated by the presence of dead, infected birds, particularly American crows and other corvids; infected pools of mosquitoes; and human and horse infections. Adult females of both mosquito species are aggressive, opportunistic feeders that have been observed to take blood meals from avian and mammalian hosts. Susceptible vertebrate hosts, particularly birds, are ubiquitously distributed throughout the developed areas of the state. This analysis demonstrated a spatial convergence of the virus, the exotic mosquito vectors, and susceptible hosts. This conjunction indicated that these 2 mosquito species have a high potential to serve as bridge vectors and thus, impact the epidemiology of West Nile virus under favorable environmental and climatic conditions. Positive mosquito pools were collected from only the Baltimore-Washington metropolitan corridor, suggesting a newly created enzootic focus for this virus. Land-cover analysis of the sites where virus activity had been detected showed predominantly developed land uses. Analyses of the environmental justice aspects (social, economic, and housing characteristics) of block groups with human West Nile fever cases or with positive mosquito pools were equivocal. Human cases seemed to occur in developed block groups with lower income levels.

Aedes↗
PubMedDate not supplied

Survey of Oral Health Status of Maryland Schoolchildren, 2000--2001.

PURPOSE: The purpose of this study was to describe dental caries experience in the primary and permanent dentitions of Maryland schoolchildren in kindergarten and third grade, with an emphasis on untreated disease. METHODS: Data came from the Survey of the Oral Health Status of Maryland Schoolchildren, 2000--2001. Outcome variables were measures of dental caries experience for primary and permanent teeth. Dental caries was scored only for lesions that were >0.5 mm, measured with a periodontal probe. Radiographs were not used. Descriptor variables included grade level, gender, race/ethnicity, eligibility for free or reduced meals at school, parent/ guardian education, dental insurance status, and region. The statistical software program SUDAAN was used to produce weighted estimates and account for the complex sampling design. RESULTS: More than 2 in 10 schoolchildren had a history of dental caries. In children with a history of disease, approximately half of the experience was due to untreated decay. Controlling for confounders, disparities in untreated dental caries were significantly associated with region, race/ethnicity, and parent/guardian education. CONCLUSIONS: Success in meeting the dental caries treatment needs in children will require attention to multiple family-level, community-level, and system-level barriers, especially among low socioeconomic status populations. Unless barriers are overcome, dental caries disparities will continue in Maryland.

Age Factors↗
PubMed1992

University of Maryland Medical System: American medicine's first teaching facility reinvents the academic hospital.

The University of Maryland Medical School, established in 1807, focused on bedside teaching. This emphasis has continued and expanded through the growth of University Hospital and, ultimately, the University of Maryland Medical System, such that Maryland can now boast of a superb medical care system providing excellent medical education and research opportunities in a patient care setting.

History, 19th Century↗
PubMedDate not supplied

Survey of dental sealants in Maryland third graders.

The Survey of the Oral Health Status of Maryland Schoolchildren, 2000-2001 was used to describe dental sealant prevalence among third-grade public schoolchildren in Maryland. The presence/absence of dental sealants on permanent molars was scored according to visual criteria. Descriptor variables included gender, race/ethnicity, parent/guardian level of education, and dental insurance status. Overall, less than 25% of third-grade Maryland schoolchildren had dental sealants, including 16% of non-Hispanic black children, 11% of children from families with less than 12 years of education, and 17% of those without dental insurance. Controlling for co-variates, non-Hispanic blacks were 2.2 times as likely to lack dental sealants as their peers, compared with children from families with less than 12 years of education (2.7 times as likely) and those without dental insurance (1.9 times as likely).

Black or African American↗
PubMed2006

Body mass index and up-to-date colorectal cancer screening among Marylanders aged 50 years and older.

INTRODUCTION: Overweight and obese individuals are at increased risk for developing and dying from colorectal cancer. Studies suggest that overweight and obese women are more likely to avoid or delay cancer screening. Our objective was to determine whether overweight or obese adults aged 50 years and older living in Maryland in 2002 were less likely to be up-to-date with colorectal cancer screening than normal and underweight adults. METHODS: The relationship between body mass index and colorectal cancer screening was evaluated based on responses from 3436 participants aged 50 years and older to the Maryland Cancer Survey 2002, a population-based random-digit-dial telephone survey. The survey contains self-reported information on colorectal cancer screening, height, weight, and potential confounders. Logistic regression was performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for age, sex, race, employment, marital status, education, area of residence, and health-care-related variables. RESULTS: Overall, 64.9% of Marylanders aged 50 and older were up-to-date with colorectal cancer screening. Compared with normal and underweight individuals, overweight individuals had similar odds of being up-to-date with colorectal cancer screening (OR, 1.05; 95% CI, 0.83-1.33). Obese individuals had slightly lower odds, but this difference was not statistically significant (OR, 0.84; 95% CI, 0.65-1.09). Recommendation by a health care provider for colorectal cancer screening was strongly associated with up-to-date colorectal cancer screening (OR, 36.7; 95% CI, 28.7-47.0). CONCLUSION: Our study shows no statistically significant association between body mass index levels and up-to-date colorectal cancer screening. We recommend that physicians and other health care providers increase up-to-date colorectal cancer screening rates in the population by referring their patients for appropriate screening.

Aged↗
PubMed1995

Health problems of Maryland's migrant farm laborers.

The health problems of Maryland's agricultural migrant labor force are presented for the information of Maryland's health care providers. Maryland's problems are placed in the context of U.S. and worldwide migrant labor practices.

Adolescent↗
PubMed1995

Small area variations in health care delivery in Maryland.

OBJECTIVE: Our purpose is a descriptive analysis of variations in hospital use among small areas of Maryland. DATA SOURCE: The data are Maryland patient discharge records from acute care hospitals for 1985-1987 and small area population estimates by age, gender, race, and income. FINDINGS: The common finding was excess geographic variability among Maryland's 115 areas. The hypothesis of uniform rates was rejected for most DRGs, including low-variation mastectomy and hernia repair. Clustering of high-use rates occurred in neighboring areas for orthopedic, vascular, and elective procedures. Admission rates for most nondiscretionary procedures and medical DRGs were reduced in affluent areas while discretionary surgery increased with income level. Elective procedures had extreme variation and were related to income. Coronary artery disease rates declined with income while coronary artery procedure rates increased, indicating that access and patient selection were factors in the use of coronary bypass and angioplasty. CONCLUSIONS: The issue is not the ubiquitous variation among small areas but its extent and identification of geographic patterns. Hospital use is related to demography, morbidity, medical resources, access, selection for care, and physician practice patterns. Heterogeneity of these factors ensures that uniform delivery of health care rarely holds. There is little evidence that incidence of surgical disease is the main source of variation in use of discretionary surgery. Rather, variations reflect differing medical opinion on appropriate use. Without evaluation, excessive use cannot be distinguished from underservice. Morbidity explains the variability of nondiscretionary surgery and conditions related to lifestyle. Access plays an important role for discretionary surgery. Geographic analysis can identify variation and relate incidence to socioeconomic and specific local effects. Hospital data do not permit direct assessment of appropriate care. Understanding the reasons for variation requires information beyond incidence data. The challenge is to identify and explain small area variations or to fix them.

Catchment Area, Health↗
PubMed1994

Redefining boundaries in the financing and care of diabetes: the Maryland experience.

The story of the development of the Maryland Medicaid Diabetes Care Program is narrated in this policy case study. Maryland Medicaid, a funding authority willing to assume a proactive role, decided to promote health care system changes expected to improve the health status of its recipients with diabetes. A state Medicaid budget crisis presented opportunities for financing new and expanded preventive services for those with this chronic disease. Specifically recounted is how Maryland Medicaid redefined its financing boundaries in an effort to overcome finance-induced fragmentation in diabetes health care delivery. The difficulties encountered by a single payer in moving unilaterally to alter health care practices are discussed. Two commentaries follow.

Diabetes Mellitus↗
PubMed1976

The early history of optometry in Maryland.

The progress of optometry in Maryland began with the passage of the first optometry law in 1914. Following its passage by the Maryland Legislature, the Maryland Optometric Association embarked on a plan to develop the profession by sponsoring (1) educational programs, (2) the gradual elimination of store-front practices, (3) the adoption of a code of ethics, and (4) establishing free eye clinics throughout the state. Optometry's steady climb toward professional status also resulted in the introduction of new optical instruments and techniques of refraction. The American Academy of Optometry and the educational courses of the Optometric Extension Program are credited for the impetus to professionalize optometry.

History, 20th Century↗
PubMed1996

Identification of childhood vaccine providers in Maryland.

The purpose of the study was to compare the utility of an American Medical Association (AMA)-derived list and a Maryland State Department of Health and Mental Hygiene (state)-derived list of potential childhood vaccine providers (CVPs) in identifying true childhood vaccine providers for the Vaccines for Children (VFC) program in Maryland. A telephone survey of a sample of physicians from the two lists was used to determine their status as providers of routine vaccinations to children. Results showed a significant difference between the two lists. The state-derived list was composed of an estimated 60.7% CVPs, whereas the AMA-derived list was composed of an estimated 36.7% CVPs. Using the capture-recapture method, it was estimated that there are about 2077 CVPs in Maryland. Based on this figure, the state-derived list would have identified 71.7% of the state's CVPs, and the AMA-derived list would have identified 59.4%. Using the AMA-derived list would have required contacting approximately 1800 extra providers to identify the additional 350 CVPs (16.8%) not identified in the state-derived list. Accurate, up-to-date lists of providers that include pertinent practice characteristics would enhance the ability to contact specific providers for VFC program enrollment and for other clinical and public health purposes.

Adolescent↗
PubMedDate not supplied

Case characteristics and trends in pediatric tuberculosis, Maryland, 1986-1993.

OBJECTIVE: To identify case characteristics and trends in the incidence of pediatric tuberculosis (TB) in Maryland during the national resurgence of the disease. METHODS: The authors conducted a retrospective review of the 248 cases of TB in children ages 19 and younger reported to the state registry between 1986 and 1993. RESULTS: The incidence of pediatric TB in Maryland, while showing a downward trend between 1986 and 1993, was characterized by a bimodal pattern, with one peak in children younger than age 5 and another peak in adolescents. Certain case characteristics differed significantly according to age: adolescents with TB were more likely to have positive AFB smears, positive cultures, and cavitary X-rays than children in the 0-4 age group. On the other hand, PPD results did not differ significantly by age. Children with TB came from households in zip code areas for which the median family income was lower and the rate of unemployment was higher than comparable statewide figures. CONCLUSIONS: Study findings indicate that (a) the general decline in adult TB in Maryland was accompanied by a decline among children; (b) age-specific case characteristics continue to be useful in clinical decision making for children with suspected TB; and (c) a state TB registry may prove useful not only in tracking disease trends and monitoring statewide control efforts but also in confirming case characteristics, all of which are important disease control issues in a time of fiscal downsizing.

Adolescent↗
PubMed1996

The Dentists' Well-Being Committee of Maryland.

The Maryland Dentist's Well-Being Committee was formed in 1980 as a standing committee of the Maryland State Dental Association. The committee has assisted many dentists over the years with problems such as stress, alcoholism, drug dependence, psychiatric disorders, medical problems, HIV (human immunodeficiency virus) disease, neurological disorders, and other illnesses that cause impairment. Key elements of the committee include confidentiality, a good working relationship with the Maryland State Board of Dental Examiners, advocacy efforts, and a paid clinical coordinator with special expertise in mental health and addiction treatment.

Confidentiality↗
PubMed2006

Predicting water quality impaired stream segments using landscape-scale data and a regional geostatistical model: a case study in Maryland.

In the United States, probability-based water quality surveys are typically used to meet the requirements of Section 305(b) of the Clean Water Act. The survey design allows an inference to be generated concerning regional stream condition, but it cannot be used to identify water quality impaired stream segments. Therefore, a rapid and cost-efficient method is needed to locate potentially impaired stream segments throughout large areas. We fit a set of geostatistical models to 312 samples of dissolved organic carbon (DOC) collected in 1996 for the Maryland Biological Stream Survey using coarse-scale watershed characteristics. The models were developed using two distance measures, straight-line distance (SLD) and weighted asymmetric hydrologic distance (WAHD). We used the Corrected Spatial Akaike Information Criterion and the mean square prediction error to compare models. The SLD models predicted more variability in DOC than models based on WAHD for every autocovariance model except the spherical model. The SLD model based on the Mariah autocovariance model showed the best fit (r(2) = 0.72). DOC demonstrated a positive relationship with the watershed attributes percent water, percent wetlands, and mean minimum temperature, but was negatively correlated to percent felsic rock type. We used universal kriging to generate predictions and prediction variances for 3083 stream segments throughout Maryland. The model predicted that 90.2% of stream kilometers had DOC values less than 5 mg/l, 6.7% were between 5 and 8 mg/l, and 3.1% of streams produced values greater than 8 mg/l. The geostatistical model generated more accurate DOC predictions than previous models, but did not fit the data equally well throughout the state. Consequently, it may be necessary to develop more than one geostatistical model to predict stream DOC throughout Maryland. Our methodology is an improvement over previous methods because additional field sampling is not necessary, inferences about regional stream condition can be made, and it can be used to locate potentially impaired stream segments. Further, the model results can be displayed visually, which allows results to be presented to a wide variety of audiences easily.

Carbon↗