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[Prevention of coronary atherosclerosis. (III). Prevalence of risk factors among civil servants of Mexico City, Federal District].

The prevalence of risk factors in civil servants living in Mexico City was investigated prospectively in 1942 individuals. Risk factors tended to increase with age and in some cases were related to sex. Hypertension was found to be as high as fifteen percent in the older age groups despite the fact that the critical limit was 160/95 in all decades. Hypercholesterolemia was found to be close to the rates reported in the so-called developed countries. Diabetes mellitus varied between 1 and 14%. Obesity and hypertrygliceridemia were also common findings and related. Smoking was independent of sex. Prevalence of the association between the major risk factors are presented. These data, are in agreement with the death causes among civil servants and indicate that preventive programs for ischemic heart disease are needed in civil servants in Mexico City.

Adult↗

The prediction of violent behavior during short-term civil commitment.

The predictive validity of the clinical judgment of dangerousness in the context of short-term civil commitment was studied prospectively by comparing the behavioral scale ratings of both verbal and physical aggression between 37 persons committed on the basis of "danger to others" versus 31 persons committed on other grounds. No statistically significant difference was found between these two groups of detainees with regard to the levels of aggression measured during their approximately three-day detention. This finding is in agreement with abundant previous research which documents the inability of psychiatrists to accurately predict future dangerousness, prompting the author to suggest that the "dangerousness" criterion for civil commitment be rejected. Although society is unlikely to resurrect the broadly defined "in need of treatment" criterion because of its historically demonstrated ever present potential for abuse, the author suggests an alternative criterion for civil commitment which, in perhaps a more well-defined and more practical way, would allow the state to maintain its doctrine of parens patriae toward mental patients.

Adult↗

Civil monetary penalties--weapon against fraud or instrument of health policy?

Most physicians are aware of the highly publicized aspects of government health care regulation, including attempts at mandatory physician assignment and recoupment of services deemed medically unnecessary. There is less awareness of the potential pitfalls of civil monetary penalties, as many physicians believe they are primarily applicable to false claim allegations. However, the use of civil monetary penalties is increasing as Congress creates new bases of liability. This development leads to the question: Are civil monetary penalties a weapon against fraud or an instrument of federal policy?

Crime↗

A laboratory study of predation by damselfly nymphs, Enallagma civile, upon mosquito larvae, Culex tarsalis.

The nymph of the damselfly, Enallagma civile, feeds on the larvae of the mosquito Culex tarsalis amongst a variety of other small aquatic invertebrates. Average daily consumption of 3rd instar Cx. tarsalis larvae by the last nymphal stage of E. civile was 6.06 larvae (range 4.64-8.67). Experiments in which density of prey (mosquito larvae) and predators (E. civile nymphs) were varied, showed that more prey was consumed as prey density increased. However, fewer prey were consumed at higher predator densities; mutual interferences among predators at higher predator densities was suspected.

Animals↗

The international standardization of the medical certification of civil aircrew.

The extremely heterogeneous nature of the various peoples and states of today's world makes the development of a satisfactory set of medical standards for the certification of civil aircrew extremely difficult. This difficulty is compounded by the varying roles aviation plays in different parts of the world. Essential to the understanding of this difficulty is a comprehension of the concept of the sovereignty of nations. Emphasis on aviation medical standards is affected by the variation in health care priorities seen amongst the worldwide community of nations. Annex 1 to the Convention on International Civil Aviation sets regulations and recommendations for aircrew licensure. The capability of the International Civil Aviation Organization (ICAO) to enforce regulations is restricted by the same factors which restrict the power of any supernational organization. Nonetheless ICAO remains the most effective means available for achieving the diplomatic consensus so essential to the development of international standards.

Aerospace Medicine↗

Screening services in civil commitment of the mentally ill: an attempt to balance individual liberties with needs for treatment.

Screening services are a central feature of New Jersey's new civil commitment law. This law, more commonly referred to as the screening law, exemplifies a nationwide trend in civil commitment legislation, attempting to balance liberty interests and the need to treat the mentally ill. Screening services, designated as the preferred process of entry into involuntary hospitalization, were expected to prevent unnecessary commitment and to provide community mental health services. When deemed necessary, commitment in local general hospitals rather than in state mental hospitals was to occur. This paper reports results of a study of screening centers that were already in operation in New Jersey prior to the implementation of the new law. It assesses the function of screening services and their potential impact on the commitment process in light of the objectives of the law. Data were obtained from in-depth interviews with key informants from the screening centers as well as from their environment, and from statistical reports on hospitalizations in state hospitals, admissions to screening centers, and admissions to psychiatric inpatient units of general hospitals. Analysis suggests that without more resources for alternative community facilities, screening services cannot achieve their objectives and the new reform may not live up to expectations. Shortage of alternatives to hospitalization and lack of incentives to develop and use them appeared to be counterproductive to achieving the objectives of the law. The availability of screening service and psychiatric units in general hospitals for involuntary hospitalization, on one hand, and the lack of alternatives in the community, on the other, may actually lead to inappropriate commitments and an increase in the number of civil commitments. Furthermore, findings indicated that screeners encouraged hospitalization readily even if other, less restrictive environments could have been pursued. Screening centers may become "gate openers" instead of playing their expected role as "gate keepers."

Commitment of Persons with Psychiatric Disorders↗

Public health impact of the 1992 Los Angeles civil unrest.

The Los Angeles civil unrest in April 1992 stunned the nation. The days of violence resulted in 53 deaths, 2,325 reported injuries, more than 600 buildings completely destroyed by fire, and approximately $735 million in total damages. The purpose of this paper is to give an overview of the activities of the Public Health Programs and Services Branch of the Los Angeles County Department of Health Services during and after the civil unrest and to illustrate the types of public health issues and problems that may result from large-scale civil disturbance. Public health agencies and jurisdictions should consider these issues in their disaster planning. Public Health Programs and Services Branch activities were directly affected by the violence and destruction. Women, Infants and Children Program vouchering sites and 20 drug program and alcohol recovery sites were damaged or burned and 15 county health centers closed during the unrest. At least 38 private medical and dental offices and 45 pharmacies were destroyed or damaged. County health authorities offered facilities to house relocated private care providers and filled prescriptions for medications where needed. The environmental health impact required the inspection of 2,827 burned and damaged sites for hazardous waste including asbestos; at 9 percent of the inspected sites, waste required special disposal. More than 1,000 food facilities suffered damage and required inspection before reopening. In the 3 months following the unrest, a 20-percent increase in disposal capacity was authorized at four county landfills to accommodate the disposal of debris. Violence was a public health issue of particular concern. The Centers for Disease Control and Prevention sent a team to study the violence from an epidemiologic perspective. The Federal agency also provided funding for televised children's talk shows dealing with reactions to the violence.

Crime↗

Organization and operation of civil aviation medicine in the Soviet Union.

The United States of America and the Soviet Union formalized an agreement in 1973 wherein periodic exchanges of information in civil aviation take place. During the period Aug. 21-Sept. 9, 1976, the author and an associate visited the Soviet Union as part of the exchange agreement. During the visit, the following information was covered. The civil ceviation medicine program in the Soviet Union involves preflight physical examinations for aircrew members, including flight attendants, quarterly physical examinations on pilots and flight engineers, and a special central hospital for diagnosis and treatment of problem medical cases occurring in aviation personnel. In addition, prophylactoria (special rest facilities) for flight crew are maintained at major airports. Certain other aspects of Soviet civil aviation medicine include preflight examinations on all children, and the provision at each airport of a designated medical emergency facility.

Aerospace Medicine↗

Federal civil-service annuitants and social security, December 1975.

This article examines personal and work-related characteristics of a sample of the nearly 1 million Federal civil-service retirees who were receiving annuities based on their own wage records as of December 31, 1975. Employment patterns and subsequent annuities in civil-service careers have been related to corresponding experience in jobs covered under the old-age, survivors, disability, and health insurance (OASDIHI) program. With some exceptions, the review uncovered patterns generally similar to those found in a study of 1967 annuitants. About 2 out of 5 annuitants were entitled to OASDHI cash benefits in 1975. Most of these dual beneficiaries received benefits on the basis of their own OASDHI-covered earnings, but 11 percent were entitled as dependents or survivors of other workers. About two-thirds of the annuitants not currently receiving benefits had some OASDHI-covered employment during their work careers. In general, those with the shortest civil-service careers and lowest annuities were most likely to be entitled to OASDHI cash benefits.

Aged↗

Donaldson revisited: is dangerousness a constitutional requirement for civil commitment?

The Supreme Court decision O'Connor v. Donaldson (1975) has been widely interpreted to assert that dangerousness is a constitutional requirement for civil commitment. This interpretation is a misreading of the decision, which actually addressed the conditions disallowing indefinite, involuntary custodial confinement and not the requirements for an initial commitment. An excessive reliance on dangerousness narrowly construed as a restrictive requirement for civil commitment has distorted the commitment process by emphasizing the state's police power in protecting the public at the expense of its parens patriae responsibility to provide care and treatment for the severely mentally ill. In reality, the Court has been remarkably cautious in addressing the justifications for civil commitment and has allowed room for a broader interpretation of legitimate justifications that would permit greater latitude in the treatment of the severely mentally ill.

Adult↗

U.S. civil rights policy and access to health care by minority Americans: implications for a changing health care system.

The history of health care discrimination as well as ongoing, extensive evidence of racial disparities argue for continued vigilance in the area of health care and civil rights. Under Title VI of the Civil Rights Act of 1964, individuals have challenged de facto discriminatory policies adopted by health entities receiving federal financial assistance. Title VI health litigation is difficult because of complex issues of proof as well as confounding problems of poverty and lack of health insurance that affect both claims and remedies. An analysis of cases brought under the law suggests that discrimination claims within a particular market fare better than those challenging decisions to relocate or alter the market served. This has important implications for claims involving discrimination by managed care organizations. Because the same potential for discrimination exists in the new health system of managed care, although in altered form, data collection and evaluation are warranted.

Civil Rights↗

The medical aspects of civil defense in California.

Medical care for persons injured in atomic bomb attack or other far-reaching enemy action occupies an important place in civil defense plans that have been set up in California. Preparations have been made on the basis of suppositions as to where attacks might occur and estimates of the number of casualties. State and federal funds have been allocated for aid station equipment, antibiotics, plasma, blankets and litters. In the table of organization, use of all physicians, nurses and hospitals in the state is contemplated. Communities at the center of attacks would borrow facilities and medical personnel from areas not directly affected.County medical societies in California have appointed civil defense committees to work out local plans. Each physician has a part in these plans. If he does not know what his assignment is, be ought to get in touch with his county medical society headquarters immediately.

Antibiotics, Antitubercular↗

Urbanization and de-urbanization of the black population before the Civil War.

Pre-Civil War black urbanization is examined using data from federal census records, 1790 to 1860. The black population is found to be as urban as the white population initially, but its urbanization underwent relative decline in the last two decades before the Civil War. Foreshadowing current patterns, the northern black population was heavily concentrated in the largest cities, and the free black population was the most urban of all groups. The timing of black urban decline in the North, as well as regional and size of place differences in that decline, suggest that both competition with immigrants in major eastern seaboard cities and the passage of the Fugitive Slave Law in 1850 contributed to black de-urbanization. For the South, the explanations of black urban decline proposed by Wade, Conrad and Meyer, Goldin, and Bonacich are evaluated, and Bonacich's split labor market theory is judged to be most consistent with the demographic trends.

Black or African American↗

Civil War vascular injuries.

As the result of the insistence of the Surgeon General during the United States Civil War, there was extensive documentation of injuries to major blood vessels and their resulting complications. The specific treatment of vascular injuries during the Civil War was ligation of the injured vessel or amputation. This was before there was any knowledge of the cause and prevention of infection. Overall, the results were dismal, with a mortality rate of nearly 60% for the more than 1000 soldiers treated by arterial ligation. The most important contribution of these medical reports was to define how the injuries should be diagnosed and managed. Many of the principles that developed as the result of this post-war review are as valid today as they were then. Unfortunately, it seems that many of these lessons have had to be relearned by the surgeons who have participated in each of our subsequent military conflicts.

American Civil War↗

A high prevalence of HIV-1 infection among pregnant women living in a rural district of north Uganda severely affected by civil strife.

This study aims at estimating the recent trends in HIV-1 prevalence and the factors associated with infection among pregnant women in the Gulu District of north Uganda, a rural area severely affected by civil strife. In 2000-2003, a total of 4459 antenatal clinic attendees of Lacor Hospital were anonymously tested for HIV-1 infection. The overall and age-specific prevalence did not show any significant trend over time. The age-standardized prevalence slightly declined, from 12.1% in 2000 to 11.3% in 2003. Increased age [20-24 years: adjusted odds ratio (AOR) 1.63; 95% CI 1.18-2.25; >or=25 years: AOR 2.56; 95% CI 1.91-3.44], residence in urban areas (AOR 1.76; 95% CI 1.41-2.18), being unmarried (AOR 1.60; 95% CI 1.27-2.01), increased age of partner (25-34 years: AOR 1.87; 95% CI 1.29-2.73; >or=35 years: AOR 2.68; 95% CI 1.72-4.16), modern occupation of partner (AOR 1.98; 95% CI 1.53-2.58), and short time of residence at the current address (AOR 1.36; 95% CI 1.05-1.76) were associated with infection. The HIV-1 prevalence in this rural district is high and similar to that observed in urban antenatal clinics, probably reflecting the effect of the last 18 years of civil strife.

Adult↗

Sexual harassment stories: testing a story-mediated model of juror decision-making in civil litigation.

The story model of juror decision-making proposes that jurors use personal experience and information presented at trial to create stories that guide their verdicts. This model has received strong empirical support in studies using criminal cases. The research presented here extends the story model to civil litigation and tests a story-mediated model against an unmediated model of jury decision-making. In Phase 1, content analysis of mock juror responses to 4 realistic sexual harassment cases revealed prototypic plaintiff and defense stories. In Phase 2, these prototypic stories were included as mediators in a model predicting verdicts in 4 additional sexual harassment cases. Mock juror attitudes, experiences, and demographics were assessed, then attorneys presented abbreviated versions of 4 actual sexual harassment cases. Path analyses provided support for the story-mediated model, which added significantly to the amount of variance accounted for in the outcome measures of verdict, commitment to verdict, and confidence times verdict. Implications for sexual harassment and other types of civil cases are discussed.

Adult↗

Modeling civil violence: an agent-based computational approach.

This article presents an agent-based computational model of civil violence. Two variants of the civil violence model are presented. In the first a central authority seeks to suppress decentralized rebellion. In the second a central authority seeks to suppress communal violence between two warring ethnic groups.

Civil Disorders↗

Birth order and civil disobedience: a test of Sulloway's "Born to Rebel" hypothesis.

In Born to Rebel, F. Sulloway (1996) argued that, throughout history, later-borns have been more likely than first-borns to challenge the status quo. The authors tested Sulloway's hypothesis among a group of U.S. college students who had participated in civil disobedience as part of a labor dispute. The authors predicted that there would be a higher percentage of later-borns among those who had been arrested than among a group of their friends who had not participated in civil disobedience or among a control group of students drawn from classes at the college. The findings, in fact, revealed a significant relationship between the number of times the students had been arrested and birth order.

Adult↗