Journal of urban health : bulletin of the New York Academy of Medicine
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Although public health surveillance system data are widely used to describe the epidemiology of communicable disease, occurrence of hepatitis B and C virus (HBV and HCV, respectively) infections may be misrepresented by under-reporting in injection drug users (IDUs). This study was carried out to examine the relationship between HBV and HCV incidence and case-reporting of hepatitis B and C in Seattle IDUs. Names of participants in a Seattle IDU cohort study who acquired HBV or HCV infection over a 12-month follow-up period were compared to a database of persons with acute hepatitis B and C reported to the health department surveillance unit over the same period. ⋯ Of 113 cohort subjects who acquired HBV or HCV, only 2 (1.5%) cases were reported; both had acute hepatitis B. The upper 95% confidence limit for case-reporting of hepatitis C in the cohort was 5.7%, and for hepatitis B, it was 7.5%. In this study, reporting of acute hepatitis in IDUs was extremely low, raising questions regarding the use of community surveillance data to estimate underlying incidence in that population group.
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Comparative Study
The evolving role and care management approaches of safety-net Medicaid managed care plans.
This article provides new empirical data about the viability and the care management activities of Medicaid managed-care plans sponsored by provider organizations that serve Medicaid and other low-income populations. Using survey and case study methods, we studied these "safety-net" health plans in 1998 and 2000. ⋯ Our study suggests that, with supportive state policies, safety-net plans are capable of remaining viable. Contracting with safety-net plans may not be an efficient mechanism for enabling Medicaid recipients to "enter the mainstream of American health care," but it may provide states with an effective way to manage and coordinate the care of Medicaid recipients, while helping to maintain the health care safety-net for the uninsured.
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When mosquito-borne West Nile virus emerged in the United States in 1999 and triggered pesticide spraying, society was faced with a controversy over an important risk-risk tradeoff-the risks of pesticide exposure versus those of West Nile encephalitis. Effective public communication about risk-risk tradeoffs is important because it can assist individuals and society in investing resources optimally. This study examined how effectively major North American print media in the year 2000 provided information on this risk-risk tradeoff. ⋯ The media were also ineffective in mentioning the efficacy of pesticide spraying or comparing the economic costs of pesticide spraying with those of West Nile encephalitis. We suggest that greater effort in collecting and reporting precise risk information, fostering more active relationships between journalists and scientists/public health professionals, and recognizing biases resulting from preconceptions can help improve reporting by the print media and public health agencies on risk-risk tradeoffs associated with emerging insect-borne infectious diseases. These efforts could help improve public health by improving decision making related to the control of insect-borne diseases.
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In Baltimore, over 1,000 vacant industrial sites persist across its urban landscape, yet little is known about the potential environmental health risks that may undermine future cleanup and redevelopment activities and the health of those in communities near these sites. This study examined the characteristics of urban brownfield properties in southeast Baltimore, Maryland, and screened sites for their potential environmental hazards. In addition, demographic and health data were evaluated to profile the social and health status of those in brownfield communities. ⋯ Moreover, these sites are concentrated in communities in which excess mortality rates due to respiratory disease, cancer, and heart disease exist when compared to the city, state, and national averages. This investigation demonstrated the usefulness of historic archives, real estate records, regulatory files, and national hazard-tracking systems based on standard industrial classification (SIC) to screen brownfield properties for their hazard potential. This analysis provides the foundation for further site monitoring and testing, cleanup and redevelopment priority setting, risk management strategies, and neighborhood planning, and it illustrates the need for increased health surveillance and disease prevention strategies in affected communities.
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We determined if illicit drug use frequency changes after a disaster by comparing drug use frequency in two street-recruited samples of heroin and cocaine users, ages 15-40 years. The users were interviewed between July 11 and November 11 and divided into before- and after-September 11th groups for analysis. The before and after groups were similar in the mean number of days of drug use per month (sniff cocaine 6.8 days vs. 9.4 days, respectively, P =.17; snorted heroin 13.9 vs. 14.0, respectively, P =.96; smoked crack 16.9 vs. 15.6, respectively, P =.96; and smoked marijuana 17.5 vs. 15.3, respectively, P =.36) and in the proportion of daily users: sniffed cocaine 10% versus 17%, respectively (P =.28); snorted heroin 47% versus 40%, respectively (P =.91); smoked crack 33% versus 37%, respectively (P =.68); and smoked marijuana 47% versus 40%, respectively (P =.41). Among street-recruited heroin and cocaine users in Harlem and the Bronx, the frequency of drug use did not increase following the events of September 11, 2001.