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Objective: The primary objective of this study was to determine if there was an increased risk of myocardial infarction (MI) in a high-risk hypertensive diabetic managed care population receiving combination antihypertensive therapy including a dihydropyridine (DHP) calcium channel blocker (CCB)., Methods: A retrospective, population-based, case-control study design was used to determine the risk of MI versus the prescribed antihypertensive drug regimen. During 1997-1999, 6,096 diabetics with hypertension were identified. After exclusions, there were 131.high-risk. study patients who suffered an MI during the study period. These were compared to an equally matched sample. High-risk patients were defined as those with a medical history of previous MI, angina pectoris or ischemic heart disease, or those who had undergone a coronary artery bypass graft and/or angioplasty procedure. Patients were then assigned to Group I cases and controls (DHP use) and Group II cases and controls (no DHP use). Odds ratios (OR) and 95% confidence intervals (CI) were determined for the independent variables and antihypertensive drug regimens. Logistical regression analysis was used to model age, ethnicity, and potential risk factors to identify any differences among calcium channel blockers., Results: After adjusting for age and gender, the OR for an MI in patients on a combination DHP regimen was 0.75 (95% CI, 0.44, 1.29). The OR for other regimens ranged from 0.52 to 1.16, with no significant difference between antihypertensive drug classes. In comparison to nondihydropyridines (NDHPs), the OR for DHPs was 1.38 (95% CI, 0.54, 3.54), but it was determined to not be statistically different ( P=0.5065)., Conclusion: No increase in risk of MI could be determined with the use of a combination antihypertensive regimen including a DHP CCB when compared to other antihypertensive drugs in a matched high-risk population of patients with hypertension and diabetes. Choice of antihypertensive drug regimen may be less important than strategies that focus on achieving optimal disease outcomes to reduce the incidence of MI and hospitalization and lower health care costs in this high-risk population in managed care.

Background: Errors in the classification of male circumcision status could bias studies linking infection to lack of circumcision., Goal: To determine the frequency and factors associated with the reproducibility of reporting circumcision status., Study Design: Secondary analysis of data using logistic regression modeling from a multicenter randomized controlled trial was performed., Results: At follow-up assessment, 15.6% of clinician reports on circumcision status disagreed with baseline reports. Disagreement was more common if both clinicians were women than if both were men (odds ratio [OR], 2.8; 95% CI, 1.9-4.1). As compared with whites reported as circumcised (4%, 19/532 visits), the highest disagreement involved uncircumcised Hispanic (OR, 3.3; 95% CI, 1.7-6.3), white (OR, 12.2; 95% CI, 5.8-25.6), or black (OR, 17.1; 95% CI, 10.4-27.9) men., Conclusions: This is one study among a small number of studies examining the reproducibility of clinician-reported circumcision status by comparing multiple clinical examinations of the same patient. The magnitude of the misclassification discovered could bias results and indicates the need for greater accuracy in reporting circumcision status in future studies.

In 1993, the levels of copper (Cu) in much of Nebraska's drinking water exceeded the U.S. Environmental Protection Agency's (EPA) action level of 1.3 mg/L. To determine the association of copper with gastrointestinal (GI) illness in August 1994 the authors interviewed persons living in households with 1993 Cu levels > 3 mg/L (51 households), 2-3 mg/L (54 households), and < 1.3 mg/L (43 households). Cases were defined as persons who had experienced the rapid onset of vomiting or nausea with abdominal pain during the preceding two weeks. To validate their exposure index, the authors immediately resampled drinking water in the households of 25 cases and 27 controls matched for age. Reassessment in December 1994 of the exposure and case status of the original cohort showed no association between copper in drinking water in 1993 and case status in 1994. The risk of GI illness seemed no greater with Cu > 3 mg/L (RR = 1.03; 95% CI = 0.43, 2.49) or 2-3 mg/L (RR = 0.50; 95% CI = 0.18, 1.41) than with Cu < 1.3 mg/L. The 1993 Cu concentrations could not be reproduced in August 1994; resampling in December 1994 again showed no association between GI illness and Cu exposure (RR > 1.3-2.9 mg/L, < or = 1.3 mg/L = 0.25, 95% CI = 0.10, 0.64, and RR > or = 3.0 mg/L, < or = 1.3 mg/L = 0.36, 95% CI = 0.09, 1.49).

Research which deals with beliefs and feelings about cancer suggests that cancer is somewhat unique among chronic illnesses with respect to the intensity of negative feelings and stigma attached to this disease. The research results to date fit well in the context of the health belief model and indicate that cancer is extremely high in perceived severity, moderate in perceived susceptibility, and extremely low in perceived benefits of preventive and treatment programs. This paper reports the results of a study which used the semantic differential technique to determine a sample of seventh-grade students' perceptions of cancer in comparison to heart disease, diabetes, and mental illness. The results indicated that children generally view cancer as higher in severity (except for heart disease), higher in susceptibility, and lower in benefits of treatment than the other illnesses. Perceptions did not differ by sex, socio-economic background, or knowledge of cancer. However, in addition to perceiving cancer as being very high in severity and feeling pessimistic about the chances of recovering, black children believe they are personally more susceptible than do white children. In general, this combination of perceptions provides a unique stigma to cancer as a fearsome chronic disease with little hope of cure. The low perceived benefits of treatment presents a barrier to action which has important implications for health education programs.

This study examines the weight-for-height index q = w/h lambda where the parameter lambda is chosen to maximize the correlation of q with triceps skinfold thickness, and thus provide an indirect measure of adiposity. Using a sample of 1668 children ages 5-12 years, we estimate lambda by an iterative procedure in each age/sex category. We find that lambda does not vary simply across the age/sex categories, and that the correlation of q and skinfold thickness is never more than marginally greater than that of the Quetelet index w/h2. We indicate that almost identical properties will be evidenced by the more general two-parameter index w alpha/h beta. Our conclusion is that there is no weight-for-height index generally useful as an indirect measure of adiposity in children.

Effective use of time, money, and personnel in the delivery of health care services to rural areas requires baseline information on the target population with respect to the problem being addressed. Prior to the initiation of an educational program on diabetes and glaucoma, the Public Health Department of Davie County, North Carolina, conducted a survey of county residents to determine knowledge, attitudes, and practices concerning these illnesses. The goals of the survey were to determine (1) basic knowledge with respect to the nature of each illness, symptoms, and high-risk groups, (2) the stigma attached to each illness, and (3) health practices in terms of previous tests for diabetes and glaucoma and whether or not the respondents know where to go for such tests. Information was obtained through a telephone survey of randomly sampled households in Davie County. Results of the survey indicated that the level of knowledge for both diabetes and glaucoma is particularly low with respect to identification of high-risk groups and symptoms, and approximately one-quarter of all respondents felt there was some stigma attached to diabetes and glaucoma. The lowest levels of knowledge were observed in the youngest and oldest respondents, males, the unmarried, and those with low levels of educational attainment. The differences in knowledge by age, marital status, and sex were found to be partially a function of differing levels of educational attainment. These data have provided information useful in the selection of content areas for the programs and in the identification of target populations for special emphasis.

The present study examined the reported sources of information on cancer and the level of cancer knowledge for a sample of black and white adults. Black respondents had significantly less knowledge and the relationship between race and cancer knowledge persisted even when controlling for education, sex, and age. Possible reasons for the observed difference include (a) the tendency for blacks to obtain information on cancer from television and radio, while whites rely more on printed materials, (b) differences in the quality of education received by black and white adults, and (c) a possible lack of motivation on the part of black respondents to acquire knowledge of cancer due to lower access to medical care. Intervention programs designed to provide all blacks with information about cancer should take into account the preferred sources of information, and should be oriented toward reducing the barriers to taking action related to prevention and early detection as well as increasing perceptions of the benefits of taking such action.

Height, weight, and triceps skinfold measurements were made on 1,668 Forsyth County, North Carolina students ages 5-12 during 1978. These data were compared to a representative sample of Michigan children taken during the same year and to their United States counterparts in HANES I (1971-74). The North Carolina children more closely resembled their US counterparts than did the Michigan group, casting doubt on the secular trend toward heavier children suggested by the Michigan researchers. (Am J Public Health 1982; 72:730-733.)

This investigation estimated the extent of noncompliance with follow-up to screening for cervical dysplasia at a public health family planning clinic. Available data also permitted examination of the relationship between selected background characteristics and compliance with follow-up. Noncompliance was defined as failure to respond to notification of an abnormal cervical smear (Class III, IV, or V) by failing either to make a follow-up appointment or to keep such an appointment after it was made. The sample consisted of 177 women with abnormal cervical smears who were screened at the Forsyth County Family Planning Clinic between January 1, 1980, and June 30, 1981. Information on the women's compliance with the request for follow-up was obtained from a file specifically kept for this purpose by the clinic nurse. Background characteristics were obtained by reviewing clinic records. Results indicated that approximately 17% of the sample was noncompliant. Noncompliant patients were more likely to be unmarried, less educated, younger, and to have fewer total health problems than women who returned for follow-up. Logistic regression analysis revealed that the number of health problems and educational attainment were the most important predictors of noncompliance.