Diagnostic yield and cost analysis of electrocardiographic screening in Swiss paediatric athletes.

OBJECTIVES: Athletes performing sports on high level are at increased risk for sudden cardiac death. This includes paediatric athletes, even though data on screening strategies in this age group remain scarce. This study aimed to assess electrocardiogram interpretation criteria in paediatric athletes and to evaluate the cost of screening. METHODS: National, multicentre, retrospective, observational study on 891 athletes of paediatric age (<18 years) evaluated by history, physical examination and 12-lead electrocardiogram. The primary outcome measure was abnormal electrocardiogram findings according to the International Recommendations for Electrographic Interpretation in Athletes. The secondary outcome measure was cost of screening. RESULTS: 19 athletes (2.1%) presented abnormal electrocardiogram findings requiring further investigations, mainly abnormal T-wave inversion. These 19 athletes were predominantly males, performing endurance sports with a mean volume of 10 weekly hours for a mean duration of 6 years of training. Further investigations did not identify any relevant pathology. All athletes were cleared for competition with regular follow-up. Total costs of the screening were 108,860 USD (122 USD per athlete). CONCLUSIONS: Our study using the International Recommendations for Electrographic Interpretation in Athletes identified a low count of abnormal findings in paediatric athletes, yet raising substantially the cost of screening. Hence, the utility of electrocardiogram-inclusive screening of paediatric athletes remains to be elucidated by longitudinal data.

Implementing a community-based social marketing project to improve agricultural worker health.

The Together for Agricultural Safety project is a community-based social marketing project working to reduce the adverse health effects of pesticide exposure among fernery and nursery workers in Florida. In 3 years, the collaboration between university and community researchers has embodied many of the principles of community-based research while completing multiple stages of formative data collection required for a social marketing project. This hybrid approach to developing a health intervention for a minority community has been successful in its early stages because the community partners are organized, empowered, and motivated to execute research activities with the assistance of academic partners. However, this work has also been labor intensive and costly. This article describes the lessons learned by project partners and considers the limitations of this approach for agricultural health research.

Generalized radial basis function networks for classification and novelty detection: self-organization of optimal Bayesian decision.

By adding reverse connections from the output layer to the central layer it is shown how a generalized radial basis functions (GRBF) network can self-organize to form a Bayesian classifier, which is also capable of novelty detection. For this purpose, three stochastic sequential learning rules are introduced from biological considerations which pertain to the centers, the shapes, and the widths of the receptive fields of the neurons and allow ajoint optimization of all network parameters. The rules are shown to generate maximum-likelihood estimates of the class-conditional probability density functions of labeled data in terms of multivariate normal mixtures. Upon combination with a hierarchy of deterministic annealing procedures, which implement a multiple-scale approach, the learning process can avoid the convergence problems hampering conventional expectation-maximization algorithms. Using an example from the field of speech recognition, the stages of the learning process and the capabilities of the self-organizing GRBF classifier are illustrated.

An assessment of nicotine dependence among pregnant adolescents.

Studies have reported that between 28 and 62% of pregnant teenagers smoke (Cornelius, Taylor, Geva, & Day, 1995; Trollestrup, Frost, & Starzyk, 1992). Because smoking is prevalent among pregnant teenagers, the purpose of this research is to assess nicotine dependence in this high-risk group. This study analyzed baseline data from a sample of pregnant teen smokers who had volunteered to participate in a smoking cessation study (N = 94). Nicotine dependence was measured by adapting the Fagerstrom Tolerance Questionnaire (FTQ; Prokhorov, Pallonen, Fava, Ding, & Niaura, 1996), and by a 6-item withdrawal symptom scale. The overall FTQ score found among pregnant adolescents was 3.10 (SD = 2.3) compared to the mean overall FTQ score among vocational-technical students of 4.27 (SD = 2.2) (Prokhorov et al., 1996). Duration of smoking in years was significantly correlated with the overall FTQ score (r = 0.43, p < .01). Quantity of smoking, as measured by average number of cigarettes smoked, significantly correlated with overall FTQ scores (r = 0.67, p < .01). Lighter smokers were more likely to have previously attempted to quit, however, among the quit attempters, those who smoked 10+ cigarettes per day reported greater severity of withdrawal symptoms than those who smoked less per day. Prenatal education and smoking cessation programs for pregnant teenagers, and pregnant women in general, need to consider that nicotine dependence is an important issue. Early pregnancy may be an opportune time to intervene among pregnant smokers; incentives may be necessary to attract those women who are the heaviest smokers, and possibly the most dependent on nicotine.

PIP: This study assessed nicotine dependence among pregnant adolescent smokers in order to enhance the efficacy of smoking-cessation programs. This study analyzed baseline data from a sample of 94 pregnant teen smokers who had volunteered to participate in a smoking cessation study. Nicotine dependence was measured by adapting Fagerstrom Tolerance Questionnaire (FTQ), and by a 6-item withdrawal symptom scale. The overall FTQ score found among pregnant adolescents was 3.10 (SD = 2.3) compared to the mean overall FTQ score among vocational-technical students of 4.27 (SD = 2.2). Duration of smoking in years was significantly correlated with the overall FTQ score. Quantity of smoking, as measured by average number of cigarettes smoked, significantly correlated with overall FTQ scores. Lighter smokers were more likely to have previously attempted to quit. However, among the attempters to quit, those who smoked 10+ cigarettes per day reported greater severity of withdrawal symptoms than those who smoked fewer per day. Prenatal education and smoking cessation programs for pregnant teenagers, and pregnant women in general, need to consider that nicotine dependence is an important issue. Early pregnancy may be an opportune time to intervene among pregnant smokers; incentives may be necessary to attract those women who are heaviest smokers, and possibly the most dependent on nicotine.

Consideration of factors prior to implementing a smoking cessation program.

This small feasibility study evaluated access, recruitment, and retention of pregnant African-American teens for a subsequent smoking cessation intervention program. A clinic and a school site were selected to assess these factors. Only the school site proved successful. Strengths of the school site included: structure and routine for students, a comfortable and familiar setting, recruitment by school personnel who had a relationship with students, and full support by administrators and staff.

The changing pattern of interracial marriage.

Recent studies have demonstrated an increased occurrence of interracial marriages in the United States, indicating important shifts in intergroup relations. The effectiveness of traditional theoretical approaches in explaining who marries whom, however, remains problematic. Recently, exchange explanations (which have typically assumed that the black partner in the union exchanges educational and economic accomplishments for the higher "status" of the white spouse) have been replaced by progressive theories emphasizing a trend away from ascriptive and toward achievement norms. We extend this approach by predicting an economic and educational gap between spouses in interracial marriages when compared with racially homogamous marriages. Using the 1980 and 1990 Public Use Microdata Sample, we find continuing evidence that racial barriers in mate selection are weakening. Further, people who intermarry, regardless of race or gender, tend to have higher educational and economic status than those in homogamous marriages. There is still limited support for the kinds of social exchanges between spouses that were implied in earlier sociological theories. We conclude that (1) socioeconomic differentials are not always consistent with the exchange perspective and (2) that recent trends are not systematically eroding these socioeconomic differentials in mate selection.

The interactive effects of race and ethnicity and mother's residence on the adequacy of prenatal care.

Adequate prenatal care is known to reduce the risks of low birth weight and neonatal death, yet nearly one quarter of all women giving birth in the United States receive delayed, inadequate or no prenatal care. This suboptimal use of prenatal care has contributed to rates of low birth weight and neonatal mortality higher than those in most other industrialized nations. This paper examines the relationships among race/ethnicity, residence, maternal sociodemographic and medical risk characteristics, and use of prenatal care in the United States. Using data from the National Maternal and Infant Health Survey, this study found important differences in prenatal care use by race/ethnicity and residence, as well as interactive effects of these variables. Single marital status, nonmetropolitan residence, poverty, low level of education, and no insurance were more strongly associated with inadequate prenatal care for whites and Hispanics than for blacks. Nonmetropolitan residents were more likely to receive inadequate care, regardless of race/ethnicity or sociodemographic characteristics. Predicted probabilities of prenatal care use by race/ethnicity and residence showed that, regardless of risk, nonmetropolitan Hispanic women had the highest probability of obtaining inadequate prenatal care. Results highlight the continued importance of race/ethnicity and rural residence in determining prenatal care use and the need to design interventions targeted to these populations.

Hispanic subgroup differences in prenatal care.

Within SES categories in the United States, racial and ethnic minorities generally fare less well on a variety of health-related indicators than do majority groups. Important differences exist within subgroups, however, and at present, these differences are poorly understood. In this paper we address Hispanic subgroup (Cuban American, Mexican American. Puerto Rican, and Central/South American) differences in utilization of prenatal care. Data from the 1986 and 1987 national Linked Birth/Infant Death files are used to assess patterns of prenatal care utilization across subgroups. Using Kotelchuck's Adequacy of Prenatal Care Utilization Index, we find that when controlling for other factors, Cuban American and Puerto Rican women are more likely to obtain adequate care than are Hispanic women of Mexican or Central/South American origin. Other factors important in understanding utilization patterns include marital status, education level, birthplace, and region of the country. We conclude with a discussion of the relatively weak link between prenatal care and birth outcomes and identify important cultural factors that may be important in understanding why this relationship is not stronger.

Smoking among low-income, pregnant women: prevalence rates, cessation interventions, and clinical implications.

Smoking has a significant effect on the major causes of death and disability among women, including coronary heart disease, stroke, cancer, and osteoporosis. When pregnant women smoke, it adversely affects not only them but also the health, development, and functioning of their unborn and young children. Of the general population of pregnant women, between 20 and 45 percent smoke. Furthermore, among low-income and less educated pregnant women, the increase in prevalence of postpartum smoking relapse rates, continued smoking, and initiation of smoking underlies the need for developing effective interventions for prevention and cessation. Although self-help, stop-smoking materials demonstrated success in several trials, interventions used in conjunction with these materials were brief with little follow-up, and did not address the need for continued intervention to help maintain abstinence or cessation after birth. This article reviews the smoking cessation trials that have assessed the effects of various interventions on cessation rates among low-income pregnant women, and describes future research needs for clinic-based smoking interventions for those women and the clinical implications for health professionals.

Managed care is in your future.

Though Texas has been slower than most other large states to move into managed care, it is gaining ground. According to the Texas Health Maintenance Organization Association, 1.2 million Texans were enrolled in HMO plans in January 1990. Three years later, 1.5 million had signed on--a 24 percent increase. State enrollment in other managed care plans, which aren't required to file reports with state regulatory agencies, was estimated to be 6.9 million (41 percent of Texans) in 1991, according to Blue Cross/Blue Shield. While these state enrollment figures are large, the most recent numbers available indicate that Texas hospitals have a long way to go. A 1991 AHA survey found that 259 Texas hospitals (47 percent of those surveyed) do not have contracts with HMOs or PPOs. With changes coming at break-neck speed, how can these hospitals position themselves to survive and prosper in the managed care world? This month, HealthTexas presents three examples of hospitals and health care systems that have successfully made the transition to managed care. Their stories illustrate three very different approaches--developing a network, direct contracting, and establishing a health plan. And, those who have led these ventures offer advice to help other hospitals make the transition a little easier.

The efficacy of postoperative autotransfusion in total joint arthroplasty.

Although postoperative blood salvage is used routinely in orthopaedic surgical procedures, little data exists to evaluate this practice. The purpose of this study was to evaluate the effectiveness of the Solcotrans autotransfusion system following elective total joint arthroplasty. This study compared two groups of patients: 59 patients who used the Solcotrans Orthopaedic Drainage/Reinfusion System and 56 patients who used a standard drainage system. Based on the results of the study, the researchers questioned the clinical efficacy and cost-effectiveness of a postoperative wound drainage/reinfusion system in patients after elective total joint arthroplasty.

Educational and career aspirations of secondary school students in Grenada following the American intervention.

This paper reports a study of educational and occupational aspirations of secondary school students in Grenada following the 1983 American intervention. Questionnaire data were obtained from 729 students attending 7 of the island's 18 secondary schools. A status attainment model containing parental and family characteristics was tested. It was discovered that Grenadian students have exceptionally and unrealistically high aspirations. Although the opportunity structure in Grenada is very limited compared to that in the United States, the island's students have higher levels of aspirations. The status attainment model was not very useful in explaining either educational or occupational aspirations, as the levels of explained variance were less than 5%. The implications of high aspirations and low opportunities for the future of Grenada are discussed.