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New York City's fiscal crisis of 1975 was the result of many years of deficit spending to support a variety of expanded services and generous union contracts. These deficits were covered for years by the issuance of city short-term notes and long-term bonds. Eventually, the city's mounting debt of $14 billion led to its inability to sell its notes and bonds. In order to deal with the possibility of the city's financial collapse, the governor of New York State and the state legislature created the Emergency Financial Control Board (EFCB), whose purpose was to manage the city's budget and cost reduction plans. They also created the Municipal Assistance Corporation (MAC) responsible for fiscal oversight and the sale of specially issued bonds. Both agencies eventually played major roles in preventing the city's financial collapse. In an effort to address the costly 5,000 excess acute care hospital beds in the city, the governor and his advisors proposed the creation of a Health Czar (HC). The purpose of this position was to shift responsibility for hospital closures and downsizing from the state government to a para-governmental individual. While there was early support for this proposal by some print media, opposition soon arose because of the flawed structure of the proposal. Also, many initially opposed it because it included the city's public health agency, the New York City Department of Health (NYCDOH), which did not have any responsibility for hospitals. The HC proposal eventually lost broad support because it bypassed legally established processes for the oversight of hospitals. It also almost uniquely focused on the public hospital system, and in so doing gave a pass to the voluntary hospitals and their excess bed capacities. The proposal eventually lost the support of the then mayor when the governor publicly supported a rival candidate in an upcoming election. The election success of yet a third candidate opposed to the proposal resulted in its eventual abandonment by the governor. [ABSTRACT FROM AUTHOR]

Dr Morris Greenberg was an eminent American epidemiologist who served with the New York City Department of Health for a 40 year period, from 1920 until his passing in 1960. In 1946, he became Director of the department's Bureau of Preventable Diseases. In this role, he set very high standards for outbreak and epidemic investigations joined with a commitment to scholarly research and collaboration with the city's medical centers. He received his medical degree from Columbia University College of Physicians and Surgeons and then interned at Bellevue Hospital in New York City. He later trained in pediatrics in Vienna, Austria and received a Master of Science in Public Health degree from Columbia University School of Public Health. In 1942, he became a member of the teaching staff at the School of Public Health. During his years with the New York City Department of Health he led efforts to control outbreaks of smallpox and rickettsialpox, and initiated important studies of poliomyelitis, hepatitis, trichinosis, congenital cardiac anomalies in children, and the embryopathic effects of rubella in pregnancy. Dr. Greenberg's outbreak and epidemic investigations were popularized by The New Yorker writer, Berton Roueché, whose most widely read book remains, Eleven Blue Men and other Narratives of Medical Detection. The book's title is based on Greenberg's investigation of accidental sodium nitrite poisoning among eleven elderly men in Manhattan who as a result, became cyanotic. A pioneer in epidemiology and the prevention and control of communicable disease, Greenberg established very high performance standards for the discipline before there was a Center for Disease Control and Prevention and an Epidemic Intelligence Service in the United States. [ABSTRACT FROM AUTHOR]

Establishing the role of heredity in type 2 diabetes mellitus (type 2 DM) is challenging. While type 2 DM frequently displays a pattern of familial aggregation, many other risk factors are responsible for the clinical expression of the disease. This paper reviews a number of the early twentieth-century studies of inheritance patterns for type 2 DM and presents in detail the history of Josephine Foniciello Imperato (Maria Giuseppa Foniciello) who died from the disease in New York City at the age of 52 years on 14 November 1921, ten months before commercial insulin became available. [ABSTRACT FROM AUTHOR]

The 1977 New York City blackout began at 9:36 p.m. on 13 July and lasted some 25 h until 10:39 p.m. on 14 July. The New York City Department of Health rapidly set up a Blackout Contingency Plan, established priorities, and mobilized its staff to address remedial interventions. Top priorities included water supplies, sewage disposal, perishable food supplies, hospital and emergency room services, solid waste disposal, beach contamination with untreated sewage , and assisting those on electrically powered home life support systems. The 1977 blackout occurred during an extended heat wave. An analysis of total deaths and deaths due to pulmonary and cardiovascular/renal diseases by day correlated with temperatures. However, there was no direct correlation with the blackout itself, in part perhaps because of the confounding influence of high temperatures. The increase of deaths on very hot days outside of the blackout period lends strong support to the relationship between increased deaths and high ambient temperatures. The 1977 New York City blackout was distinguished from those of 1965 and 2003 by violence, arson, and looting that occurred in several areas. These acts resulted in 204 civilian injuries, 436 police injuries, 80 firefighter injuries, and 1037 fires. The violence, arson, and looting caused extensive long-term physical and functional damage to certain areas of two boroughs of the city, Brooklyn and the Bronx. Although the New York City Department of Health had not previously established a disaster preparedness plan, its professionals quickly rose to the occasion because they were able to draw upon vast public health practice experience and ingenuity. [ABSTRACT FROM AUTHOR]

The information contained in pathology reports of radical prostatectomy specimens is critically important to treating physicians for selecting adjuvant therapy, evaluating therapy, estimating prognosis, and analyzing outcomes. This information is also of importance to patients and their families. In recent years, the Cancer Committee of the College of American Pathologists and the Association of Directors of Anatomic and Surgical Pathology developed suggested protocols for reporting the findings on radical prostatectomy specimens. The objectives of this study were to assess radical prostatectomy-specimen reports by using quality indicators derived from existing suggested protocols and to thereby assist pathologists in improving the quality of their reports on such specimens. A retrospective chart review of 554 cases for the second 6-month period of 1996 focused on 10 quality indicators: submission of a frozen section; location of the adenocarcinoma; proportion of the specimen involved by adenocarcinoma; perineural involvement; vascular involvement; seminal vesicle involvement; periprostatic fat status; number of nodes submitted; status of nodes; and prostate intraepithelial neoplasia (PIN). The findings of this study were shared with the pathology departments in all hospitals in New York State. In addition, the 113 hospitals from which the 554 cases were drawn were given their institution-specific data. Teleconferences were held with the 37 hospitals that accounted for 72.4% of all cases. These conferences included directors of pathology and laboratories and focused on the aggregate statewide findings. The presence of quality indicators in reports varied from a mean of 14.8% (periprostatic fat) to a mean of 85.91% (seminal vesicle involvement). For all hospitals, 4 indicators (proportion of the specimen involved by adenocarcinoma, vascular involvement, periprostatic fat status, and PIN) were included in fewer than 50% of cases. These 4 quality indicators and an additional 3 others (submission of a frozen section, perineural involvement, and the number of nodes submitted) were included in fewer than 70% of cases. Only 3 indicators (location of the adenocarcinoma, seminal vesicle involvement, and the status of nodes) were found in more than 70% of cases. Although the mean level of quality indicator inclusion ranged from 14.8% to 85.9% for all cases examined, the absolute range for any individual indicator was 0% to 100%. Thus, some hospitals included a given indicator 100% of the time; others never included it. This pattern held true for all 10 indicators. High-volume hospitals (10 or more cases) performed significantly better than low-volume hospitals (14 cases) on 5 indicators (P < .05), and better, but not significantly so, for an additional 2 indicators. Overall, the mean inclusion levels for all 10 indicators were 10% higher for high-volume hospitals compared with low-volume and medium-volume hospitals (5-9 cases). This study demonstrated wide variations in the inclusion of quality indicators by pathologists in their radical prostatectomy-pathology reports. Whereas some hospitals always include given indicators, others never mentioned them. These marked disparities point to the need for standardized reporting for radical prostatectomy specimens. [ABSTRACT FROM PUBLISHER]

In 1947, a smallpox outbreak occurred in New York City with a total of twelve cases and two deaths. In order to contain this outbreak, the New York City Department of Health launched a mass immunization campaign that over a period of some 60 days vaccinated 6.35 million people. This article examines in detail the epidemiology of this outbreak and the measures employed to contain it. In 1976, a swine influenza strain was isolated among a few recruits at a US Army training camp at Fort Dix, New Jersey. It was concluded at the time that this virus possibly represented a re-appearance of the 1918 influenza pandemic influenza strain. As a result, a mass national immunization program was launched by the federal government. From its inception, the program encountered a myriad of challenges ranging from doubts that it was even necessary to the development of Guillain-Barré paralysis among some vaccine recipients. This paper examines the planning for and implementation of the swine flu immunization program in New York City. It also compares it to the smallpox vaccination program of 1947. Despite equivalent financial and personnel resources, leadership and organizational skills, the 1976 program only immunized approximately a tenth of the number of New York City residents vaccinated in 1947. The reasons for these marked differences in outcomes are discussed in detail. [ABSTRACT FROM AUTHOR]

The School of Public Health at the State University of New York, Downstate Medical Center has sponsored a 6-8 week global health elective for fourth year medical students since 1980. The purpose of this elective is to provide students with an opportunity to observe the health care and public health delivery systems in low-income countries, provide medical service and have a cross-cultural experience. Over the course of the past 35 years, 388 students have participated in this global health elective in more than 41 low-income countries. The most popular sites include the Dominican Republic, Guatemala, India, Kenya and Thailand. Overall, interest in this elective has persisted throughout the course of time, sometimes temporarily increasing or decreasing with outside factors, such as the events of 11 September 2001 and the outbreak of Severe Acute Respiratory Syndrome in Asia. Recent annual applications for this elective have been as high as 44 out of a class of 200 students. Over the past 10 years, annual acceptance rates have varied, ranging from a low of 32 % in 2007-2008 to a high of 74 % in 2010-2011 and 2013-2014. Careful screening, including a written application, review of academic records and personal interviews has resulted in the selection of highly mature, adaptable and dedicated students who have performed well at overseas sites. Student rated satisfaction levels with this elective are almost universally high, with most rating it the best experience of their medical school years. Students undergo extensive preparation prior to their travel overseas, including a review of individual health and safety issues, travel and lodging, and the nature of the host country culture, health care system and assignment site. Downstate medical students are especially experienced in cross-cultural understanding because of the unusual diversity of the patient population in Brooklyn, and the diversity of local hospital staff and the medical school class. The Alumni Fund of the College of Medicine has steadfastly supported this elective with both a philosophical commitment and financial grants to help defray costs since the very early years. The Dr. Michael and Lona B. Kennéy Endowment, the Joshua H. Weiner endowment, and the LSK Foundation have also provided financial support for this elective. Throughout the course of this elective, overseas preceptors have willingly given of their time and institutional resources to make these experiences available and meaningful for our students. [ABSTRACT FROM AUTHOR]

The State University of New York (SUNY), Downstate Medical Center initiated a Master of Public Health (MPH) degree program in July 2001 following planning efforts that began in 1995. Twelve students entered the program in June 2002, and currently some 110 MPH students and 12 Doctor of Public Health (DrPH) students are enrolled. This article describes the long and complex process of transforming the original MPH degree program, with its single focus on urban and immigrant health, with a student enrollment of 12 and 8 full-time faculty, into a school of public health with a large student enrollment of 122 students, 25 full-time faculty, five MPH degree tracks, and four DrPH degree tracks. The process of establishing the SUNY Downstate School of Public Health in 2009 from its inception as an MPH program in 2001 spanned a period of 8 years. This process was guided by a commitment to two basic principles. The first was to maintain the original 2005 program accreditation by the Council on Education for Public Health (CEPH). The second was to sequentially secure accreditation for all subsequent four MPH and four DrPH degree tracks through CEPH's procedure of substantive change approval. This policy assured continuous national CEPH accreditation of the original Urban and Immigrant Health MPH degree track and all added degree programs. The 5-year period following the initial CEPH accreditation of the MPH program in 2005 was one of intense development during which all of the essential elements for CEPH accreditation of a school of public health were put into place. This rapid development was made possible by the vision and full support of Downstate's president, John C. LaRosa, MD, FACP, and the dedicated efforts of many. This included the students, faculty, staff, and administrators of the School of Public Health, the school's Community Advisory Group, several external advisors, and many in the medical center's Central Administration, College of Medicine, School of Graduate Studies, College of Nursing, College of Health Related Professions, and the University Hospital of Brooklyn. From the very beginning of the planning phase for an MPH program and through the ultimate accreditation of the School of Public Health in 2010, broad participation was solicited from all major units in the medical center. Thus, the MPH program became a center-wide initiative and not merely that of the College of Medicine's Department of Preventive Medicine and Community Health. This broad participation has been continuously maintained through the involvement of leaders of other medical center academic units and the University Hospital of Brooklyn in the program's and then the school's standing and ad hoc committees, and in other activities as well. Similarly, community representation has been maintained, some through formal linkages relevant to the practical field experiences required of all students. In October 2010, the Board of Councilors of CEPH accredited the SUNY Downstate School of Public Health for a 5-year period through 31 December 2015. The accreditation of the school was a major milestone for Downstate, Brooklyn, and New York City. The SUNY Downstate School of Public Health is the first CEPH accredited school of public health in the history of Brooklyn, and only the second such school in New York City. It is also the first CEPH accredited school of public health at a publicly supported university in New York City. The school has already had a major impact on improving the health and well-being of the people of Brooklyn through its numerous collaborative community-based health promotion and disease prevention programs. [ABSTRACT FROM AUTHOR]

Questions have been increasingly raised about the value of performing right heart catheterization. A preliminary analysis done in 1992 revealed significant interhospital variation in the frequency of the procedure among Medicare Part A and Medicaid patients in New York State, and it also suggested that the procedure was being performed routinely in some hospitals. In 1993, IPRO initiated a cooperative health care quality improvement program involving the state's 53 catheterization laboratories. As a result of this educational intervention, the rate of bilateral catheterization among Medicare Part A patients felt from 89/100,000 beneficiaries in 1992 to 65/100,000 in 1996, and the overall percentage of catheterized Medicare patients undergoing bilateral catheterization felt from 30.5% in 1992 to 17.4%. A major question was whether a corresponding decrease had occurred among ambulatory patients (Medicare Part B). To determine the answer, the Medicare Part B database was analyzed for the identical period of time. It was found that the percentage of ambulatory Medicare patients who underwent bilateral catheterization at the 53 laboratories felt from 37.6% in 1992 to 17.0% in 1996, paralleling the decline observed among inpatients. The results of this quality improvement study show that an educational intervention directed at inpatient practice patterns can have a similar impact on outpatient patterns. [ABSTRACT FROM AUTHOR]

Investigates the knowledge, attitudes and behaviors of teenagers in an affluent New York City suburb concerning AIDS. High levels of overall knowledge; Poor knowledge of epidemiology of the disease; AIDS risk factors in this group.

Focuses on the outcome of a third world international health elective for medical students instituted at the Department of Preventive Medicine and Community Health at the State University of New York from 1980 to 1996. Emphasis on public health, preventive medicine and primary care; Breakdown of students according to gender and race; Student satisfaction levels.

Describes the Health Care Quality Improvement Program (HCQIP) of IPRO, a peer review organization in New York State under contract with the Health Care Financing Administration of the U.S. Department of Health and Human Services. Purpose of HCQIP; Components of cooperative projects; Steps in the development of cooperative projects.

Compares the Medicare claims coded for cholecystectomy and those coded for laparoscopic cholecystectomy for a four-year period in New York State. Increase in the number of total cholecystectomy; Reason for the increase; Performance of the procedures in mildly symptomatic and asymptomatic patients; Broadening of indications for gallbladder surgery.

Characterizes the quality of care problems among Medicare and Medicaid inpatients in New York State. Results as a reflection of a peer-review process; Use of focused educational intervention in the improvement of quality of care.

Presents the results of a hospital based case review of all laparoscopic cholecystectomies performed on Medicare and Medicaid patients in New York State in 1991. Island Peer Review Organization's case review of hospital responses; Nature of responses; Findings related to coding; Complications.

An obituary for internal medicine specialist John T. Flynn is presented.

Reviews the exhibition `Nakunte Diarra: Bogolanfini Artist of the Beledougou,' at The Museum at the Fashion Institute of Technology in New York City.

The article reviews the exhibition "African Metal Implements: Weapons, Tools and Regalia" at the Hillwood Art Gallery in New York City from November 4-30, 1984.

The article reviews the exhibition of books at the African-American Institute in New York City from the September 27, 1983-January 7, 1984.