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PubMed1989

Health and mental health problems of homeless men and women in Baltimore.

A study of homeless people in Baltimore, Md, focused on their health and other characteristics, with special emphasis on their needs for services. In the first stage, 298 men and 230 women were randomly selected from the missions, shelters, and jail in Baltimore to respond to a baseline interview that provided extensive sociodemographic and health-related data. In the second stage, a subsample of 203 subjects was randomly selected from the baseline survey respondents to have systematic psychiatric and physical examinations. Data are presented from both stages. Data from the first stage demonstrate, among other things, the high levels of disaffiliation of this population and their heavy involvement in substance abuse. Data from the clinical examinations demonstrate the high prevalence of mental illnesses and other psychiatric disorders and of a wide range of physical disorders and confirm the high prevalence of alcohol abuse disorders. The high rates of comorbidity of these conditions is demonstrated and data are provided on the subjects' needs for mental health and substance abuse services.

Adult↗
PubMed1995

Acquisition and use of needles and syringes by injecting drug users in Baltimore, Maryland.

Our objective was to determine how injection drug users (IDUs) in Baltimore, Maryland obtain and use needles and syringes (NS) for drug injection, before the opening of a needle exchange program (NEP). The method of this study was a cross-sectional structured interview survey in 1992 of active IDUs in a longitudinal study of human immunodeficiency virus (HIV) infection. For 466 IDUs (94.6% black, 83% male), usual sources of NS were "street" dealers (49.6%), pharmacies (29.8%), diabetics (16.3%), friends/neighbors (2.2%), and "shooting galleries" (1.9%). Half (53.5%) reported pharmacy purchase of NS, and 55.6% had diabetic friends/relatives. Twenty-three percent traded drugs, and 5% traded sex for NS. Eighty-eight and two-tenths percent would use a needle exchange program; 24.6% currently own no NS (median owned = 2.2). NS reuse was common (median = three times). Concern about (55.2%) or history of (33.9%) hassle/arrest for NS possession was typical; 81% kept NS at home, and 67% do not carry NS when purchasing drugs. Pharmacy purchasers (versus "street") were less likely to have been jailed, shared NS, or used shooting galleries during the preceding 6 months. In Maryland, although IDUs can legally purchase NS at pharmacist discretion, possession remains illegal; fewer than one-third of IDUs use pharmacies, and most obtain NS from illegal sources. Most IDUs reuse NS, but discard them after several uses. Current patterns of NS acquisition and use in Baltimore are likely to increase HIV transmission. Increased availability and decriminalization of NS possession could decrease the risk of injection-related HIV transmission.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Temporal trends of incident human immunodeficiency virus infection in a cohort of injecting drug users in Baltimore, Md.

OBJECTIVE: To measure the temporal trends in the incidence of infection with human immunodeficiency virus in a cohort of injecting drug users in Baltimore, Md, between 1988 and 1992. DESIGN: Study subjects were screened for antibodies to human immunodeficiency virus by enzyme-linked immunosorbent assay and confirmed with Western blot. They were followed up at 6-month intervals with repeated serologic screening and comprehensive interviews for human immunodeficiency virus risk factors. SETTING: Special study clinic. PARTICIPANTS: A cohort of 2960 participants were recruited and screened between February 1988 and March 1989. Recruitment criteria included an age of 18 years or older, a history of illicit drug injection since 1978, and the absence of the acquired immunodeficiency syndrome; subjects were subsequently tested for human immunodeficiency virus antibodies. Most subjects (85%) were not receiving methadone treatment at baseline and were recruited by word of mouth. MAIN OUTCOME MEASURE: Human immunodeficiency virus seroconversion. RESULTS: Of the 2247 seronegative participants at baseline, 1532 were followed up, and 188 (12.3%) had seroconverted by December 1992. The incidence of human immunodeficiency virus infection over time among users declined somewhat, especially among women; the overall incidence was 1.90 per 100 person-semesters, or 3.80% annually. The incidence, adjusted for gender, was higher in younger (< 35 years) than older (> or = 35 years) subjects (relative incidence, 1.75; 95% confidence interval, 1.29 to 2.38) and in women compared with men, adjusted for age (relative incidence, 1.29; 95% confidence interval, 0.95 to 1.80). The relative incidence among active compared with inactive drug users adjusted for age and gender was 1.58 (95% confidence interval, 1.06 to 2.35). CONCLUSIONS: Although the incidence of human immunodeficiency virus infection in this cohort of injecting drug users in Baltimore declined somewhat during the 4 years of follow-up, especially among women, the persistent annual incidence of nearly 4% during 3 1/2 to 4 1/2 years of observation suggests the need for additional strategies for prevention of infection, especially among those who continue injecting drugs. Newer methods of prevention, such as provision of sterile injection equipment, an effective human immunodeficiency virus vaccine, and wider availability of effective treatment or prevention of drug addiction, are urgently needed in these high-risk populations.

Adult↗
PubMed1993

Partners in community health: the Baltimore City Health Department, the Johns Hopkins School of Hygiene and Public Health, and the Eastern Health District, 1932-1992.

The Eastern Health District of Baltimore was established in 1932 as an early partnership between the Baltimore City Health Department and the Johns Hopkins School of Hygiene and Public Health. Although its heydey occurred in the thirties and forties, for 51 years the district has provided data for researchers studying community health problems; learning opportunities for students in medicine, nursing, and public health administration; and a wide array of clinical and public health services to urban residents. The Eastern Health District concept has been copied worldwide, and although the partnership between the health department and the school of public health has changed over the years, some collaborative activities continue the tradition of research and service provision.

Baltimore↗
PubMed1996

The contribution of missed opportunities to childhood underimmunization in Baltimore.

OBJECTIVE: To determine the community-wide incidence of missed opportunities to vaccinate, to describe the clinical settings in which they occur, and to estimate the impact of missed opportunities on immunization coverage. DESIGN AND METHODS: We abstracted outpatient medical records from a random, community-based sample of 2-year-old children whose residence was inner-city Baltimore. The date of each vaccine and the date, diagnoses, and temperature at each visit were collected for 502 children at 98 different provider sites. MAIN OUTCOME MEASURES: Missed opportunities to vaccinate and up-to-date vaccination status. RESULTS: By 24 months of age, 75% of the children had at least one missed opportunity and only 55% were up-to-date for the 4:3:1 series. Missed opportunities occurred at more than one third of eligible visits for each vaccine, including > 20% of preventative care visits. Diagnoses commonly associated with missed opportunities were "well child," otitis media, upper respiratory infection, gastroenteritis, skin infection, and resolving illness. If no missed opportunities had occurred, 73% of the children would have been up-to-date by 24 months. CONCLUSIONS: Missed opportunities occurred commonly at providers serving inner-city children in Baltimore and represent a major factor in underimmunization. Reduction of missed opportunities by accurate screening at all visits and adherence to the contraindication guidelines is a provider-based, low-cost method to increase immunization coverage.

Baltimore↗
PubMed1987

Characterization of chromosomes with hybrid genes for Hb Lepore-Washington, Hb Lepore-Baltimore, Hb P-Nilotic, and Hb Kenya.

This study concerns the characterization of chromosomes with hybrid genes for Hb Lepore-Washington (44 chromosomes), for Hb Lepore-Baltimore (5 chromosomes), for Hb P-Nilotic (8 chromosomes), and for Hb Kenya (7 chromosomes) by determining a relatively large number of restriction enzyme polymorphism. Two, and possibly three, different Hb Lepore-Washington chromosomes were identified by specific haplotypes, while the haplotype of the Hb Lepore-Baltimore chromosome had its own characteristic pattern. A likely conclusion is that the crossovers leading to the formation of these chromosomes have occurred as independent events within the populations. Chromosomes with the delta beta-Lepore-Washington hybrid gene maintained specific characteristics (such as increased Hb F levels in heterozygotes, and high or low G gamma values in this Hb F) which have been observed in normal individuals with chromosomes having comparable haplotypes. Only one haplotype was observed for each of the chromosomes carrying either the beta delta-P-Nilotic hybrid gene or the A gamma beta hybrid gene of Hb Kenya.

Chromosome Mapping↗
PubMed1987

Hemoglobin J-Baltimore (beta 16(A13)Gly----Asp): interference with the assay of HbA1c.

Three independent cases of Hemoglobin J-Baltimore(beta 16(A13)Gly----Asp) were detected through the assay of HbA1c in diabetic patients. Using chromatography on Bio-Rex 70 resin, one large peak replaced the usually well resolved peaks of HbA1a + b and HbA1c. The species that overlapped the latter fractions was identified as HbJ1c. HbJ-Baltimore itself was identified using HPLC of the beta-chain tryptic peptides. This observation emphasizes the errors that hemoglobin variants may introduce in the assay of HbA1c.

Adult↗
PubMed2004

Depressive disorder as a long-term antecedent risk factor for incident back pain: a 13-year follow-up study from the Baltimore Epidemiological Catchment Area sample.

BACKGROUND: The co-occurrence of affective distress and back pain is well documented but the relationship between them is less certain. This study examines the relationship between lifetime occurrence of depressive disorder and incident back pain reported over a 13-year period. METHOD: The Baltimore Epidemiologic Catchment Area Study is a prospective study of a household-residing cohort, selected probabilistically from East Baltimore in 1981. Between 1982-3 (wave 2) and again between 1993-6 (wave 3), a follow-up study of the original cohort was conducted. Questions on depressive disorder and back pain were drawn from the Diagnostic Interview Schedule. Logistic regression analyses were used to evaluate whether depressive disorder acts as a risk factor for incident back pain. RESULTS: In cross-sectional analyses, lifetime occurrence of depressive disorder was a significant correlate of lifetime prevalence of back pain at wave 1 (OR = 1.6, P = 0.01). During the 13-year follow-up, across three data collection points, there was an increase in the risk for incident back pain when depressive disorder was present at baseline (OR = 1.9, 95% CI 1.03, 3.4). However, during the short-term follow-up period of 1 year, between baseline and wave 2, depressive disorder at baseline was unrelated to first-ever reports of back pain. Lifetime depressive disorder in both waves 1 (baseline) and 2 (1 year later) was associated with a more than three times greater risk for a first-ever report of back pain during the 12 to 13 year follow-up period, in comparison to those who did not have depressive disorder at waves 1 or 2 (OR = 3.4, 95% CI 1.4, 7.8). Back pain at wave 1 was not significantly associated with an increased risk for depression in the longitudinal analysis (OR = 0.8, 95% CI 0.5, 1.4). CONCLUSIONS: Depressive disorder appears to be a risk factor for incident back pain independent of other characteristics often associated with back pain. Back pain is not a short-term consequence of depressive disorder but emerges over periods longer than 1 year. Moreover, in this study the alternative pathway of back pain as a risk factor for depressive disorder could not be supported.

Back Pain↗
PubMedDate not supplied

Particulate matter and heart rate variability among elderly retirees: the Baltimore 1998 PM study.

This study investigates the relationship between ambient fine particle pollution and impaired cardiac autonomic control in the elderly. Heart rate variability (HRV) among 56 elderly (mean age 82) nonsmoking residents of a retirement center in Baltimore County, Maryland, was monitored for 4 weeks, from July 27 through August 22, 1998. The weather was seasonally mild (63-84 degrees F mean daily temperature) with low to moderate levels of fine particles (PM2.5 < 50 micrograms/m3). Two groups of approximately 30 subjects were examined on alternate days. A spline mixed-effects model revealed a negative relationship between outdoor 24-h average fine particulate matter (PM2.5) and high-frequency (HF) HRV that was consistent with our earlier Baltimore study for all but 2 days. These 2 days were the only days with significant precipitation in combination with elevated PM2.5. They were also unusual in that back-trajectory of their air masses was distinctly different from those on the other study days, emanating from the direction of rural Pennsylvania. Mixed-effects analysis for all 24 study days showed a small negative association of outdoor PM2.5 with HF HRV (-0.03 change in log[HF HRV] for a 10 micrograms/m3 increment in PM2.5) after adjustment for age, sex, cardiovascular status, trend, maximum temperature, average dew point temperature, random subject intercepts, and autocorrelated residuals. After excluding study days 4 and 5, this association was strengthened (-0.07 change in log[HF HRV] for 10 micrograms/m3 PM2.5, 95% CI -0.13 to -0.02) and was similar to that obtained in an earlier study (-0.12 change in log[HF HRV] for a 10 micrograms/m3 increment in outdoor PM2.5, 95% CI -0.24 to -0.00) [Liao D., Cai J., Rosamond W.D., Barnes R.W., Hutchinson R.G., Whitsel E.A., Rautaharju P., and Heiss G. Cardiac autonomic function and incident coronary heart disease: a population-based case-cohort study. The ARIC Study. Atherosclerosis Risk in Communities Study. Am J Epidemiol 1997: 145 (8): 696-706]. Acute (1 to 4 h) previous PM2.5 exposure did not have a stronger impact than the 24-h measure. A distributed lag model incorporating the six preceding 4-h means also did not indicate any effect greater than that observed in the 24-h measure. This study is consistent with earlier findings that exposures to PM2.5 are associated with decreased HRV in the elderly.

Aged↗
PubMed1997

HbC compound heterozygotes [HbC/Hb Riyadh and HbC/Hb N-Baltimore] with opposing effects upon HbC crystallization.

Compound heterozygotes of variant haemoglobins (Hbs) with HbC, with or without novel phenotypic changes, have provided insight into the molecular basis of the interacting haemoglobins and information concerning the role of specific residues in the crystallization of oxy HbC. A high phosphate buffer system has proved useful for studying the effects of variant haemoglobins (naturally co-existing with HbC in the red cell) on the oxy HbC crystallization process and has led us to conclude that beta87 and beta73 are contact sites of the oxy HbC crystal. We now present investigations from two HbC compound heterozygotes which exhibit opposing effects upon HbC crystallization: HbC/Hb N-Baltimore (beta95 Lys-->Glu) and HbC/Hb Riyadh (beta120 Lys-->Asn). The latter inhibits the in vitro crystallization of HbC, explaining the lack of erythrocyte abnormalities (with the exception of microcytosis) in the doubly heterozygous infant. In contrast, Hb N-Baltimore accelerates the crystallization of HbC, contributing to multiple abnormalities in red cell morphology, albeit in the absence of morbidity. We conclude that (1) beta120 and beta95 are additional contact sites in the crystal, and (2) the HbC/Hb Riyadh haemoglobinopathy demonstrates that crystallization may not be required for the generation of the observed microcytosis and increased red cell density in HbC-containing red cells.

Adult↗
PubMed1983

Fibrinogen Baltimore II: congenital hypodysfibrinogenemia with delayed release of fibrinopeptide B and decreased rate of fibrinogen synthesis.

A congenital hypodysfibrinogenemia, fibrinogen Baltimore II, was found in a young asymptomatic Caucasian female. Prothrombin, partial thromboplastin, and euglobulin lysis times were normal, as were platelet function and coagulation factor assays. Subnormal plasma fibrinogen levels were found using chronometric, rate-independent, and immunologic assay methods. Kinetic analysis of fibrinopeptide release revealed a delay in the thrombin-catalyzed release of fibrinopeptide B from the abnormal protein. Proteolysis of fibrinopeptide A by thrombin or Arvin, fibrin monomer polymerization, and fibrin polymer ligation occurred at normal rates. Catabolism of radiolabeled autologous and homologous fibrinogen was also normal, but the fibrinogen synthetic rate was less than half the normal value. Comparison of the coagulation characteristics of fibrinogen Baltimore II with those of other abnormal fibrinogens indicates that it represents a unique example of hypodysfibrinogenemia.

Adult↗
PubMed2000

Use of a continuous nephelometer to measure personal exposure to particles during the U.S. Environmental Protection Agency Baltimore and Fresno Panel studies.

In population exposure studies, personal exposure to PM is typically measured as a 12- to 24-hr integrated mass concentration. To better understand short-term variation in personal PM exposure, continuous (1-min averaging time) nephelometers were worn by 15 participants as part of two U.S. Environmental Protection Agency (EPA) longitudinal PM exposure studies conducted in Baltimore County, MD, and Fresno, CA. Participants also wore inertial impactor samplers (24-hr integrated filter samples) and recorded their daily activities in 15-min intervals. In Baltimore, the nephelometers correlated well (R2 = 0.66) with the PM2.5 impactors. Time-series plots of personal nephelometer data showed each participant's PM exposure to consist of a series of peaks of relatively short duration. Activities corresponding to a significant instrument response included cooking, outdoor activities, transportation, laundry, cleaning, shopping, gardening, moving between microenvironments, and removing/putting on the instrument. On average, 63-66% of the daily PM exposure occurred indoors at home (about 2/3 of which occurred during waking hours), primarily due to the large amount of time spent in that location (an average of 72-77%). Although not a reference method for measuring mass concentration, the nephelometer did help identify PM sources and the relative contribution of those sources to an individual's personal exposure.

Activities of Daily Living↗
PubMed2000

Weekday/weekend differences in OH reactivity with VOCs and CO in Baltimore, Maryland.

This study compared the first-order frequencies for OH associated with volatile organic compounds (VOCs) and CO (hereafter called OH reactivity with VOCs or CO), the product of the VOC or CO concentration, and their respective kOH value, on an average weekday with that on an average weekend day at a core urban site in Baltimore, MD. The average daytime concentrations were calculated for each of the 55 available Photochemical Assessment Monitoring Station (PAMS) VOCs using data from the Baltimore site. The data were sorted in descending order to highlight the important species based on concentration. The OH reactivity with VOCs was sorted in descending order to identify the important species based on the magnitude of the OH reactivity. A similar process was followed for the OH reactivity with CO. The contribution of the significant species to the weekday/weekend difference in OH reactivity was examined. The OH reactivity with C5H8 was the largest among the OH reactivity with the PAMS' VOCs and was the same on the weekday and weekend. The weekday/weekend difference in OH reactivity with VOCs was entirely due to differences in concentrations of the anthropogenic VOCs. The OH reactivity with VOCs was 11% larger on the weekday. When OH reactivity with CO was included, the OH reactivity was 13% larger on the weekday.

Carbon Monoxide↗
PubMed2001

Geographic, demographic, and seasonal differences in penicillin-resistant Streptococcus pneumoniae in Baltimore.

We examined the epidemiology of invasive penicillin-resistant Streptococcus pneumoniae (PRSP) infections among residents of the Baltimore metropolitan area from 1995 through 1997. During this period, the proportion PRSP cases increased 42%, from 5.7% to 8.1% of cases. PRSP rates were highest among persons aged <5 and > or =65 years, black patients, and urban dwellers. However, the proportion of PRSP cases was higher among white persons (10%) than it was among black persons (5%) and among residents of suburban counties (10%) versus urban counties (6%). PRSP cases were more common in November-April (8%) than they were in May-October (5%), particularly for persons aged > or =65 years (10% vs. 1%). By use of logistic regression, white race, suburban residence, and winter respiratory season were found to be independent predictors of infection with PRSP. The incidence of PRSP is increasing in Baltimore, and the seasonality of PRSP suggests that recent antibiotic use, which is more common in winter months, may rapidly affect the prevalence of resistant pneumococcal infections.

Adolescent↗
PubMed1983

The East Baltimore study: the relationship of lipids and lipoproteins to selected cardiovascular risk factors in an inner city Black adult population.

Low socioeconomic status, inner city Black adults, aged 20 to 49 yr (24 males and 45 females), were randomly selected from East Baltimore, MD to study plasma lipid and lipoprotein levels. Several factors known to affect these levels also were examined: dietary intake, alcohol intake, degree of obesity (measured by body mass index), physical activity level, smoking, and hormone use. Compared to women, the men consumed 9.3 more calories/kg body weight (p less than 0.005), 273 mg more cholesterol/day (p less than 0.005), and 7% fewer calories as sucrose (p less than 0.01). The P/S ratio of both their diets was 0.5. The men also had a lower body mass index than the women (23.9 kg/m2 versus 29.0; p less than 0.001). Mean lipid and lipoprotein levels were similar in the men and women. However, the men's total cholesterol (167 mg/dl) and low density lipoprotein cholesterol (94 mg/dl) levels were lower than those of adult Blacks in other studies, while the levels of the East Baltimore women were similar to those in other studies. For women, body mass index and high density lipoprotein cholesterol were negatively correlated (p less than 0.01); triglycerides and oral contraceptive use were positively correlated (p less than 0.01). None of the factors studied explained the relatively low total cholesterol and low density lipoprotein cholesterol levels in these inner city Black adult men.

Adult↗
PubMed1988

Natural history of adenocarcinoma-large cell carcinoma of the lung: conclusions from screening programs in New York and Baltimore.

A mathematical model of the progression kinetics of lung cancer was described and used to shed light on the natural history of adenocarcinoma and large cell carcinoma of lung from data collected in screening studies of male smokers by the Memorial Sloan-Kettering Cancer Center and The Johns Hopkins Medical Institutions. In both programs, estimates of the mean duration of early-stage adenocarcinoma or large cell carcinoma of lung ranged upward from 4 years, and estimates of the probability of detecting it in early-stage disease ranged downward from .16. The probabilities of curing early-stage disease through surgical treatment were found to be at most .52 and .13 in the New York and Baltimore studies, respectively. These estimates led to the conclusion that expected reduction in mortality from adenocarcinoma and large cell carcinoma of lung as due to annual x-ray screening from age 45 to 80 years is not greater than 18% in New York and 5% in Baltimore.

Adenocarcinoma↗
PubMed1981

The East Baltimore study. II. Familial aggregation of plasma lipid levels in juveniles in a black inner-city population.

Familial aggregation of plasma lipid levels among 676 black juveniles, aged less than 20 years and residing in 202 households in East Baltimore, Maryland, was assessed by the intraclass correlation coefficient of residuals from sex-specific cubic regressions on age. Significant aggregation of both plasma cholesterol (r = 0.23, p less than 0.005) and plasma triglyceride (r = 0.27, p less than 0.005) levels were found. In addition, no effect on familial aggregation was found for each of several measures of family structure: number of juvenile household members, closeness in age, all children over 9 years of age, or shared surname. Two methods of classifying juvenile household size were compared. An association between classification method and juvenile household size was demonstrated (p less than 0.005) for the distributions of households and of children. The intraclass correlation coefficients for plasma cholesterol and plasma triglyceride for households classified by number of juveniles were higher than the coefficients for the house grouped by the number of juveniles admitted to the study, when compared for each classification number, 2 through 4. Evidence for an effect on familial aggregation of the socioeconomic status was shown by a comparison of intraclass correlation coefficients from households in East Baltimore with those from white and black households from the Columbia Medical Plan which have higher levels of occupation and education. Higher correlations were shown for the groups with higher socioeconomic status, regardless of race.

Adolescent↗
PubMed1988

Evidence of human infection with a rat-associated Hantavirus in Baltimore, Maryland.

Human sera obtained from two sources in Baltimore were tested for antibodies against a Hantavirus by a variety of techniques. Four persons out of 1,788 had hantaviral antibody as demonstrated by immunofluorescent assay, enzyme-linked immunosorbent assay, and neutralizing assay. Neutralizing antibody titrations against three test viruses indicated that infections were caused by a rat-associated virus. Medical histories of two subjects indicated life-long residence in Baltimore and an absence of foreign travel, implicating a local source of infection.

Adolescent↗