A survey of physicians who studied public health during medical school.

Introduction: The need for more physicians trained in prevention, research methods, and management has been argued by many leaders in medical education. Columbia University attempts to address this need by providing medical students with a variety of options for studying public health.

Methods: A survey of Columbia's medical graduates who had taken elective courses in public health explored the reasons they began their studies, why some did not continue, their assessment of the value of public health courses, and their careers after graduation.

Cyclosporin analogs inhibit in vitro growth of Cryptosporidium parvum.

Cyclosporine and nonimmunosuppressive cyclosporin (CS) analogs were demonstrated to be potent inhibitors of the growth of the intracellular parasite Cryptosporidium parvum in short-term (48-h) in vitro cultures. Fifty-percent inhibitory concentrations (IC50s) were 0.4 microM for SDZ 033-243, 1.

A comparative analysis of quality of life data from a Southwest Oncology Group randomized trial of advanced colorectal cancer.

Longitudinal quality of life measurements from an advanced-stage cancer clinical trial are analysed using a variety of methods, and the results compared. The methods used require different assumptions about the mechanism that produces the missing data. They include analyses that require the data to be missing completely at random; fixed-effects models and weighted generalized estimating equations, which require missing at random data; and a fully parametric approach where the outcomes and the missingness mechanism are jointly modelled, allowing non-ignorable missing data.

Psychiatric illness and family stigma.

Considerable research has documented the stigmatization of people with mental illnesses and its negative consequences. Recently it has been shown that stigma may also seriously affect families of psychiatric patients, but little empirical research has addressed this problem. We examine perceptions of and reactions to stigma among 156 parents and spouses of a population-based sample of first-admission psychiatric patients.

Ribosomal RNA gene organization in Cryptosporidium parvum.

The cytoplasmic ribosomal RNA (rRNA) genes of the Apicomplexan protozoan parasite Cryptosporidium parvum have been analyzed with respect to size, copy number, organization and structure. The small and large subunit rRNAs are 1.7 and 3.

A prospective evaluation of the relationship between reasons for drinking and DSM-IV alcohol-use disorders.

Previous research has demonstrated an association between self-reported reasons for drinking and alcohol consumption. The most consistent relationships have been demonstrated between alcohol consumption and drinking for positive affect enhancement and coping with negative affect. However, most of the results have been from cross-sectional research designs that have not controlled for diagnostic status.

Why perinatal mortality cannot be a proxy for maternal mortality.

In recent years, the perinatal mortality rate (PNMR) has been proposed as a proxy measure of maternal mortality, because perinatal deaths are more frequent and potentially more easily measured. This report assesses evidence for an association between these two statistics. This study, based upon data from Matlab, Bangladesh, shows that the maternal mortality ratio (MMR) and the PNMR do not vary together over time, and that the PNMR does not reliably indicate either the magnitude or the direction of change in the MMR from year to year.

Recreational and occupational physical activities and risk of breast cancer.

Physical activity has been hypothesized to reduce breast cancer risk, but an inverse association has not been consistently reported. In this review, we critically evaluate for coherence, validity, and bias the epidemiologic studies on recreational or occupational physical activity, discuss the biologic plausibility of the association, and identify areas for future research. Results from seven of nine studies suggest that higher levels of occupational physical activity may be associated with a reduction in risk, at least among a subgroup of women.

Defining and measuring sexual orientation: a review.

How to define and identify sexual orientations for the purpose of constructing representative samples of homosexuals, bisexuals, and heterosexuals is unclear and confusing to researchers. Different definitions and measures have been proposed and used to develop samples since the 1860s when sexual orientations first gained widespread research interest. Unfortunately, the definitions and measurement tools used since then result in the selection of divergent and incomparable samples.

Lessons for program design from the PMM projects.

The Prevention of Maternal Mortality (PMM) Network designed and tested projects for reducing maternal deaths. The focus was on improving the availability, quality and utilization of emergency obstetric care (EmOC) for women with serious complications. Teams' projects included interventions in health facilities (to improve skills and services and reduce delays in treatment) and in communities (to address lack of transport, funds and information concerning obstetric complications).

The strategic model for the PMM Network.

The projects of the PMM Network are based on a strategic model that focuses sharply on the interval between the obvious onset of a serious obstetric complication and the provision of emergency obstetric care (EmOC). The reason for this is that most of these complications cannot be predicted or prevented, but they can be successfully treated. The implications of this model for program design are profound.

The conceptual framework of the PMM Network.

Understanding the determinants of maternal mortality is a complex task, in part because maternal deaths are influenced by many different categories of events or conditions. Biology, economics, culture, demography and the distribution and effectiveness of health services all contribute. Conceptual frameworks have made important contributions to our understanding of the determinants of other, equally complex events, such as fertility and child survival.

Female circumcision/female genital mutilation in the United States: legislation and its implications for health providers.

Criminal laws prohibiting female circumcision/female genital mutilation (FC/FGM) have recently been passed in the US Congress and in several state legislatures. The full effect of criminalization on prevention and on the overall well-being of immigrant groups from FC/FGM-practicing countries is currently unknown and will ultimately depend on, among other things, the precise interpretation of the laws by courts and local authorities. Meanwhile, the content of these laws prompt questions about their intended and inadvertent effects on FC/FGM, including: What acts are criminalized under these laws? Will criminalization prevent them? Do the laws have the potential to do more harm than good? The appropriateness of prosecuting FC/ FGM under existing child protection statutes is also raised.

Transformative combinations: women's health and human rights.

From the human rights perspective proposed in this article, a woman's good or ill health reflects more than biology or individual behaviors; it reflects her enjoyment (or lack thereof) of fundamental human rights that enable her to exercise basic power over the course and quality of her life. The "structural" view of health that such a human rights perspective suggests is concerned first with identifying the effects of social, economic, and political relations on women's health and then with promoting "interventions" aimed at transforming the laws, institutions, and structures that deny women's rights and well-being. Yet, traditional human rights law and practice have been limited to narrowly defined abuses by public officials against individuals that fail to capture the most pervasive denials of women's rights, which, though rooted in systematic discrimination, are frequently played out in so-called "private" institutions, primarily within the family.

Human rights and the politics of risk and blame: lessons from the international reproductive health movement.

Recent debates about the "politicization" of public health obscure the ways in which epidemiological concepts of risk are routinely used in the legal and political systems to apportion blame and responsibility for poor health. This article uses the example of reproductive health and rights to argue that new understandings of the connection between socioeconomic conditions and poor health will only generate change when they are reframed into political claims and pressed by social movements. In this connection, human rights language, principles, and practice hold great potential for the US reproductive rights movement, which has sometimes been constrained by the narrow scope of court rulings.

Environment and cancer: who are susceptible?

Acting in concert with individual susceptibility, environmental factors such as smoking, diet, and pollutants play a role in most human cancer. However, new molecular evidence indicates that specific groups-characterized by predisposing genetic traits or ethnicity, the very young, and women-may have heightened risk from certain exposures. This is illustrated by molecular epidemiologic studies of environmental carcinogens such as polycyclic aromatic hydrocarbons and aromatic amines.

Body fat and water changes during pregnancy in women with different body weight and weight gain.

Objective: To determine the fat deposited during pregnancy in women gaining according to recommendations of the Institute of Medicine and the relationship of weight gain to fat gain in women of different starting weights (classified by their body mass index).

Methods: A cohort study of healthy, nonsmoking women, 18-36 years of age, identified during prenatal visits at three hospital clinics and one birthing center in New York City. From a pool of 432 eligible volunteers who signed a consent form, body composition measurements were performed on 200 women at weeks 14 (+/-2) and 37+ of pregnancy, and bone mineral mass was measured at 2-4 weeks postpartum.

Cost-effectiveness of vaccination against pneumococcal bacteremia among elderly people.

Context: Clinical, epidemiologic, and policy considerations support updating the cost-effectiveness of pneumococcal vaccination for elderly people and targeting the evaluation only to prevention of pneumococcal bacteremia.

Objective: To assess the implications for medical costs and health effects of vaccination against pneumococcal bacteremia in elderly people.

Design: Cost-effectiveness analysis of pneumococcal vaccination compared with no vaccination, from a societal perspective.

Controlling tuberculosis in an urban emergency department: a rapid decision instrument for patient isolation.

Objectives: This study examined whether data routinely available in emergency departments could be used to improve isolation decisions for tuberculosis patients.

Methods: In a large emergency department in New York City, we compared the exposure histories of tuberculosis culture-positive and culture-negative patients and used these data to develop a rapid decision instrument to predict culture-positive tuberculosis. The screen used only data that are routinely available to emergency physicians.

Injectable contraceptive discontinuation and subsequent unintended pregnancy among low-income women.

Objectives: This study investigated rates of discontinuation of the recently introduced injectable contraceptive depot medroxyprogesterone acetate (DMPA) and postdiscontinuation rates of unprotected intercourse and unintended pregnancy.

Methods: A sample of 402 low-income, urban, minority women were interviewed when they initiated DMPA use and 12 months later.

Results: The 12-month life-table discontinuation rate was 58%, with half of the discontinuers stopping after only one injection.