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PubMed1995

AIDS among the homeless of Boston: a cohort study.

We wanted to compare demographics, risk behaviors, AIDS-defining diagnoses, and survival between homeless and housed persons with AIDS in Boston from 1983 to 1991. Our retrospective cohort study used chart review to identify homeless AIDS cases and data from the Massachusetts AIDS Surveillance Program for comparison of homeless and nonhomeless cases. Seventy-two homeless and 1,536 nonhomeless Boston residents were reported to have AIDS between Jan. 1, 1983, and July 1, 1991. Homeless persons with AIDS were more likely to be African American or Latino (81 vs. 39%, p < 0.0001) and have i.v. drug use as a risk behavior (75 vs. 19%, p < 0.0001). The AIDS-defining diagnoses among the homeless were more commonly disseminated Mycobacterium tuberculosis (9 vs. 2%, p < 0.0001) and esophageal candidiasis (17 vs. 9%, p < 0.01). These differences were not seen when the populations were stratified by i.v. drug use. No significant difference in survival between the homeless and nonhomeless cohorts was found. Homeless individuals with human immunodeficiency virus are significantly different than housed persons, and at greater risk of invasive opportunistic infections. Appropriate clinical strategies can be developed to provide needed care to homeless persons with HIV.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Preterm delivery in Boston before and after September 11th, 2001.

BACKGROUND: We hypothesized that stress induced by the terrorist attacks of September 11, 2001 might shorten pregnancy. To test this hypothesis, we compared gestational duration and risk of preterm delivery among women who were pregnant on September 11 with women who had delivered before that date. STUDY DESIGN: We conducted a matched cohort study among pregnant women enrolled in the Boston-based cohort study Project Viva between 1999 and 2001. Each of 606 participants, pregnant on September 11, 2001, was matched to 1 or 2 participants who delivered before that date. RESULTS: Compared with women who delivered before September 11th, women who were pregnant on September 11th had mean gestation length that was 0.13 weeks longer (95% confidence interval = -0.05 to 0.30) and an odds ratio for preterm delivery before 37 weeks' gestation of 0.60 (0.36 to 0.98). Only women exposed in the first trimester had longer gestation. CONCLUSIONS: Contrary to expectation, Boston-area women who were pregnant on September 11th had a lower risk of preterm delivery than women who delivered before that date. Although the interpretation of this finding is difficult, it is clear that the acute psychologic stress documented nationwide after the terrorist attacks did not increase the risk of preterm delivery in this population at some distance from the attacks.

Adult↗
PubMed2005

Predictors of indoor exposure to mouse allergen in urban and suburban homes in Boston.

BACKGROUND: Mouse allergen exposure is prevalent among urban children with asthma. Little is known about mouse allergen exposure in children at risk for the development of allergic diseases. AIMS OF THE STUDY: To assess indoor mouse allergen exposure in early life among children with parental history of asthma or allergies. METHODS: Prospective birth cohort study of 498 children with a history of allergy or asthma in at least one parent living in metropolitan Boston. RESULTS: Of the 498 participating children, 357 (71.7%) resided outside the city of Boston and 439 (90.7%) lived in households with incomes > 30,000 dollars. Mouse allergen was detected in 42% of the homes of study participants. In a multivariate analysis adjusting for sex, income, and endotoxin, black race [odds ratio (OR) = 3.0; 95% confidence interval (CI) = 1.3-6.6, P = 0.009], signs of mice in the home at age 2-3 months (OR = 3.0; 95% CI = 1.6-5.6, P = 0.0006), and kitchen cockroach allergen levels > or = 0.05 to < 2 U/g (OR = 1.8; 95% CI = 1.1-3.2, P = 0.02) were associated with detectable mouse allergen in the kitchen. In this model, living in a single detached house was inversely associated with detectable kitchen mouse allergen levels (OR = 0.4; 95% CI = 0.2-0.6, P = 0.0001). CONCLUSION: Infants with a parental history of asthma or allergies are commonly exposed to mouse allergen in their homes. Among infants at high risk for atopy, predictors of increased mouse allergen levels included black race, reported mice exposure, and moderate levels of cockroach allergen.

Air Pollution, Indoor↗
PubMed2004

Adults only: the prevalence of tobacco promotions in bars and clubs in the Boston area.

OBJECTIVE: To document the nature and prevalence of tobacco promotions in bars and clubs in a major US city. DESIGN: We conducted systematic observations in a representative sample of 38 establishments in the Boston area, half of which had been advertised in a tobacco company ad. We also observed seven events in six additional clubs hosting Camel Casbah promotions. Telephone interviews were later completed with club managers. MAIN OUTCOME MEASURE: Use of branded give-away items, distribution of free cigarette samples, managers' reports of costs and benefits of hosting promotions. RESULTS: The majority of the 38 clubs were observed to use bar paraphernalia including matchbooks with tobacco brand logos, regardless of their history of appearing in tobacco sponsored ads. Free cigarette samples were not observed at any of the sampled clubs, but were a feature of every Casbah event. Managers of clubs in the advertised group were somewhat more likely to report having hosted promotions, but 44% of managers of non-advertised clubs indicated that tobacco promotions had occurred in their establishments in the past. Approximately one third of club managers viewed public links with a tobacco company as a negative feature of hosting promotions. CONCLUSIONS: Based on managers' reports, tobacco promotions occurred in more than 50% of the Boston area entertainment venues frequented by young adults. Cigarette companies should be required to inform the attorney general of plans to conduct promotions in adult-only venues to facilitate monitoring of compliance with the Master Settlement Agreement. The negative health and business consequences of hosting promotions should be communicated to bar owners.

Adult↗
PubMed2005

A nursing PhD specialty in health policy: University of Massachusetts Boston.

This article describes the Nursing PhD Program specialty in health policy conceived and developed at the University of Massachusetts Boston. The rationale for a specialty in health policy is that nurses have valuable knowledge and a unique perspective of the health care system. Nurses belong to the largest group of health care providers and are the providers that spend the most time with patients. The nursing profession has a responsibility to help assure members of society have access to safe and effective quality health care. As a group, nurses need to be politically savvy to translate their knowledge and perspective to benefit society. Nurses need to direct their attention to understanding issues and policy arguments and to contribute to policy discussion with reasoned arguments and objectivity. The PhD program at the University of Massachusetts Boston prepares nurses as policy analysts, researchers, and educators who will positively contribute to the health of society.

Boston↗
PubMed2006

Air pollution in Boston bars before and after a smoking ban.

BACKGROUND: We quantified the air quality benefits of a smoke-free workplace law in Boston Massachusetts, U.S.A., by measuring air pollution from secondhand smoke (SHS) in 7 pubs before and after the law, comparing actual ventilation practices to engineering society (ASHRAE) recommendations, and assessing SHS levels using health and comfort indices. METHODS: We performed real-time measurements of respirable particle (RSP) air pollution and particulate polycyclic aromatic hydrocarbons (PPAH), in 7 pubs and outdoors in a model-based design yielding air exchange rates for RSP removal. We also assessed ventilation rates from carbon dioxide concentrations. We compared RSP air pollution to the federal Air Quality Index (AQI) and the National Ambient Air Quality Standard (NAAQS) to assess health risks, and assessed odor and irritation levels using published SHS-RSP thresholds. RESULTS: Pre-smoking-ban RSP levels in 6 pubs (one pub with a non-SHS air quality problem was excluded) averaged 179 microg/m3, 23 times higher than post-ban levels, which averaged 7.7 microg/m3, exceeding the NAAQS for fine particle pollution (PM2.5) by nearly 4-fold. Pre-smoking ban levels of fine particle air pollution in all 7 of the pubs were in the Unhealthy to Hazardous range of the AQI. In the same 6 pubs, pre-ban indoor carcinogenic PPAH averaged 61.7 ng/m3, nearly 10 times higher than post-ban levels of 6.32 ng/m3. Post-ban particulate air pollution levels were in the Good AQI range, except for 1 venue with a defective gas-fired deep-fat fryer, while post-ban carcinogen levels in all 7 pubs were lower than outdoors. CONCLUSION: During smoking, although pub ventilation rates per occupant were within ASHRAE design parameters for the control of carbon dioxide levels for the number of occupants present, they failed to control SHS carcinogens or RSP. Nonsmokers' SHS odor and irritation sensory thresholds were massively exceeded. Post-ban air pollution measurements showed 90% to 95% reductions in PPAH and RSP respectively, differing little from outdoor concentrations. Ventilation failed to control SHS, leading to increased risk of the diseases of air pollution for nonsmoking workers and patrons. Boston's smoking ban eliminated this risk.

Air Movements↗
PubMed1993

The risk of childhood injury on Boston's playground equipment and surfaces.

The Childhood Injury Prevention Program of the Boston Department of Health and Hospitals conducted a survey of injury risk in Boston's playgrounds. A standardized checklist was used to assess a 25% sample of public playgrounds for hazards. Climbers accounted for 34% of the hazards observed and had the greatest proportion of significant hazards. The surfacing material in 100% of the playgrounds observed was unsafe. Urban children risk exposure to hazardous playground equipment frequently situated above unsafe surfacing material.

Boston↗
PubMed1997

Causes of death in homeless adults in Boston.

BACKGROUND: Homeless persons have high mortality rates. OBJECTIVE: To ascertain causes of death in a group of homeless persons. DESIGN: Cohort study. PATIENTS: 17,292 adults seen by the Boston Health Care for the Homeless Program from 1988 to 1993. MEASUREMENTS: Cause-specific mortality rates adjusted for race and rate ratios that compare mortality rates in homeless persons with those in the general population of Boston. RESULTS: Homicide was the leading cause of death among men who were 18 to 24 years of age (mortality rate, 242.7 per 100000 person-years; rate ratio, 4.1). The acquired immunodeficiency syndrome was the major cause of death in men (mortality rate, 336.5 per 100000 person-years; rate ratio, 2.0) and women (mortality rate, 116.0 per 100000 person-years; rate ratio, 5.0) who were 25 to 44 years of age. Heart disease and cancer were the leading causes of death in persons who were 45 to 64 years of age. CONCLUSIONS: The most common causes of death among homeless adults who have contact with clinicians vary by age group. Efforts to reduce the rate of death among homeless persons should focus on these causes.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Youth perceptions of comprehensive adolescent health services through the Boston HAPPENS program.

INTRODUCTION: The Boston HAPPENS (HIV Adolescent Provider and Peer Education Network for Services) program is a collaborative network of care made up of 8 organizations that serve youth and provide coordinated care for human immunodeficiency virus (HIV)-positive, homeless, and at-risk youth aged 12 to 24 years. Learning youth perceptions about the program is essential to determine if the program is meeting their needs. METHODS: In this qualitative evaluation, 18 youth served by the network met in 4 focus groups to provide their view of the program. Services within 5 categories were assessed: (a) medical care, (b) mental health and substance abuse care, (c) HIV prevention and care, (d) case management, and (e) allocation of finances. RESULTS: Boston HAPPENS has achieved name recognition and provides many needed services for youth from a wide variety of backgrounds. The youth were comfortable receiving care and were appreciative of the comprehensive services available. They provided suggestions for how mental health services could be offered as one-on-one counseling as part of "wellness care." Young participants also requested more recreational and support opportunities for young people living with HIV. DISCUSSION: Qualitative evaluations such as this give a voice to youth to advocate for services they need. By including youth ideas and perspectives during program development and implementation, services can be more attractive to groups of at-risk youth who historically have been less likely to seek care.

Adolescent↗
PubMed2003

"Where does the damp come from?" Investigations into the indoor environment and respiratory health in Boston public housing.

The self-reported prevalence of asthma increased by 75% from 1980 to 1994, a trend found to be significant and evident in every region of the country. The increase has been most marked in children 0-14 years of age, and there is evidence that, as with lead poisoning, inner-city and urban populations are most at risk. Attention has turned to the role of indoor environment risk factors, especially in homes and schools. Such factors include moisture and mold growth, pest infestation, dust mites, the building envelope, heating systems, inadequate ventilation, NO2, and environmental tobacco smoke. The Healthy Public Housing Initiative (HPHI) is a Boston-based community-centered research and intervention project designed to engage Boston Housing Authority residents in a collaborative process to improve respiratory health, quality of life, building conditions, and building maintenance in public housing. This article summarizes the significant research findings from four pilot studies in housing developments that lay the foundation for the larger HPHI asthma-related environmental intervention study. The research design for the pilot projects is informed by principles of community-collaborative research. The strengths of this model of research to our work are also discussed.

Adolescent↗
PubMed2004

Linking crime guns: the impact of ballistics imaging technology on the productivity of the Boston Police Department's Ballistics Unit.

Ballistics imaging technology has received national attention as a potent tool for moving the law enforcement response to violent gun criminals forward by linking multiple crime scenes to one firearm. This study examines the impact of ballistics imaging technology on the productivity of the Boston Police Department's Ballistics Unit. Using negative binomial regression models to analyze times series data on ballistics matches, we find that ballistics imaging technology was associated with a more than sixfold increase in the monthly number of ballistics matches made by the Boston Police Department's Ballistics Unit. Cost-effectiveness estimates and qualitative evidence also suggest that ballistics imaging technology allows law enforcement agencies to make hits that would not have been possible using traditional ballistics methods.

Boston↗
PubMed2004

Overcoming historical and institutional distrust: key elements in developing and sustaining the community mobilization against HIV in the Boston Haitian community.

The Metro Boston REACH 2010 HIV Coalition needs to develop innovative processes aimed at overcoming a history of distrust that has led to limited cooperation from the Haitian community. Among the key elements being implemented are the development of a community vision through a community mobilization process; the development of an innovative working group process, in which coalition members worked together to develop and implement culturally and linguistically appropriate HIV prevention curricula; participatory leadership and joint accountability processes, manifested in decision-making approaches, such as the fund allocation system, and in the provision of technical assistance workshops on team building, designed to engender cohesion, skills, and resources sharing among coalition members. The success of this venture is measured through the growing expectation that this coalition could serve as a community planning body for all HIV-related services aimed at reducing HIV infection in the Greater Boston Haitian population.

Adult↗
PubMedDate not supplied

Investigations into the indoor environment and respiratory health in Boston public housing.

The self-reported prevalence of asthma in the United States increased by 75% from 1980 to 1994, a trend found to be significant and evident in every region of the country. The increase was most marked in children from birth to 14 years of age; and growing evidence indicates that, as with lead poisoning, inner-city and urban populations are most at risk. Attention has turned to the role of indoor environmental risk factors, especially in homes and schools. Such factors include moisture and mold growth, pest infestation, dust mites, the building envelope, heating systems, inadequate ventilation, nitrogen dioxide, and environmental tobacco smoke. The Healthy Public Housing Initiative (HPHI) is a Boston-based community-centered research and intervention project designed to engage Boston Housing Authority residents in a collaborative process to improve respiratory health, quality of life, building conditions, and building maintenance in public housing. This article summarizes the significant research findings from four pilot studies in housing developments that laid the foundation for the larger HPHI asthma-related environmental intervention study. The research design for the pilot projects is informed by principles of community-collaborative research. The strengths of this model of research for our work are also discussed.

Air Pollution, Indoor↗
PubMed1981

Maternal alcohol consumption and newborn assessment: methodology of the Boston City Hospital prospective study.

This paper describes the methods of the Maternal Health and Child Development of Project at the Boston City Hospital which explored the impact of maternal drinking prior to and during pregnancy on fetal development. Between February 1977 and October 1979, of 3222 women who delivered single infants, 1690 were interviewed in hospital after delivery and their babies examined by a pediatrician who was unaware of the interview results. The 1690 mother-infant pairs of whom both interview and exam are available did not systematically differ from the 272 for whom the interview only or 824 for whom the exam only was conducted. Interviews were also collected prenatally in the Boston City Hospital's Women's Clinic, from 470 women whose infants were examined. Maternal and infant characteristics are described. Heavy drinkers were much more likely to smoke cigarettes and to have used psychoactive drugs than lighter drinkers. Heavy drinkers also differed from non-heavy drinkers on several other factors which may influence fetal development.

Adolescent↗
PubMed1994

An integrated system grows in Boston. Interview by Karen Gardner.

After news reports highlighting discussions among the major teaching hospitals in Boston last year, two leading academic medical centers--Massachusetts General Hospital (MGH) and Brigham and Women's Hospital--teamed up to form Partners Healthcare System Inc. Ferdinand Colloredo-Mansfield, the former chairman of MGH and the current co-chair of the new system, spoke recently with TRUSTEE editor Karen Gardner about the integration process now taking place between the two hospitals. Colloredo-Mansfeld, president of Cabot Partners, a real estate investment counseling firm in Boston, has been a trustee of MGH since 1982 and has served as chairman since 1992. He has also been an active participant in the process.

Academic Medical Centers↗
PubMed1997

Responding to domestic violence: a coordinated response by a consortium of teaching hospitals. Domestic Violence Task Force, Conference of Boston Teaching Hospitals.

Increasingly, health care providers are recognizing their role in the struggle against domestic violence. Although individual institutions around the country have developed protocols and programs in conjunction with community providers, there has been no unified health care effort. In May 1995, the Conference of Boston Teaching Hospitals (COBTH)--a collaborative body of the 14 academic hospitals and medical centers in the Boston area--formed the COBTH Domestic Violence Task Force. This task force, chaired by the president of Children's Hospital, represents the first time that hospital administrators and clinical staff have joined forces to deal with this issue. Critical to this effort were (1) the recognition that the hospitals have a responsibility to respond to patients as well as employees who are battered, (2) that in order for this work to move forward and become integrated into hospital systems, the involvement of senior medical staff and management is necessary, (3) that training and education must be ongoing and penetrate all levels of staff, and (4) that this work must be collaborative, with hospital staff working across disciplines and with community service providers. This paper outlines the year-long work of this Committee, including specific objectives and recommendations.

Boston↗
PubMed1997

Outbreak of invasive group A Streptococcus associated with varicella in a childcare center -- Boston, Massachusetts, 1997.

Group A Streptococcus (GAS) causes common childhood diseases such as streptococcal pharyngitis and impetigo and can cause severe, life-threatening invasive disease including streptococcal toxic-shock syndrome and necrotizing fasciitis. Invasive GAS disease occurs when GAS infects a normally sterile site. Clusters of invasive GAS infection previously had not been reported among children in school or childcare centers (CCCs). However, on February 13, 1997, the Boston Public Health Commission received reports of cases of concurrent invasive GAS and varicella infection among two of 14 children in the same CCC classroom. Because of the potential for further spread of invasive disease, the Boston Public Health Commission initiated an investigation of these cases. This report describes the findings of the investigation, including risk factors for infection, and recommended prevention measures. The findings indicate the potential for widespread GAS infection and carriage in CCCs and suggest that, in this outbreak, antecedent use of varicella vaccine would have prevented cases of invasive GAS.

Boston↗