Cigarette smoking in Wisconsin: the influence of race, ethnicity, and socioeconomics.

A disparate burden of cigarette use has been demonstrated among demographic subgroups both in the United States and Wisconsin. We examined patterns of adult current smoking prevalence in Wisconsin by race, Hispanic ethnicity, household income, and education to assess whether differences exist among these subgroups. This analysis revealed a strong graded relationship between household income, education, and smoking prevalence, consistent among non-Hispanic whites and blacks, though not Hispanics. Respondents with less than a high school education had significantly higher smoking prevalence rates (41%) than those with a college degree or more (13%). Smoking prevalence rates did not significantly differ between the race and ethnicity subgroups overall, or by gender and education, although they differed in some age and income subgroups. Possible explanations for the socioeconomic gradient include differences in tobacco product marketing practices, indoor workplace smoking policies, and access to health information, resources, and consistent, high-quality health care.

Progress in reducing per capita cigarette sales in Wisconsin, 1985-1999.

Over the past several decades, initiatives have been undertaken both on a national and state level to reduce cigarette smoking and its resultant health consequences. We compared trends in per capita cigarette sales in Wisconsin versus other states from 1985-1999. During this time period, per capita cigarette sales declined 21% in Wisconsin, versus 26% in the United States. Although the average per capita sales in Wisconsin were less than sales in the United States in both 1985 (107 versus 122 packs per capita) and 1999 (84 versus 90 packs per capita), Wisconsin's sales have declined at a slower rate, narrowing the gap between Wisconsin and US sales. Other states, such as California and Massachusetts, with large statewide tobacco control programs had rates of decline in cigarette sales over twice the Wisconsin decline from 1985-1999. In 1985, only 10 states had lower per capita sales than Wisconsin. By 1999, 24 states had lower rates, indicating greater relative progress in reducing sales in other states. Possible explanations for the greater decline in per capita cigarette sales in other states include differences in tobacco control programs, tobacco excise tax increases, and other tobacco policy initiatives.

Health assessment of U.S. military personnel deployed to Bosnia-Herzegovina for operation joint endeavor.

In anticipation of U.S. forces deploying to Bosnia-Herzegovina, plans were established to conduct medical surveillance of all military service members. This surveillance would provide the Department of Defense with an overview of the hospitalization and outpatient morbidity experience of U.S. forces. Standardized collection of medical data from all U.S. camps using 14 diagnostic categories based on International Classification of Diseases, 9th Revision, codes began in March 1996. Special assessments for hantavirus and tick-borne encephalitis (TBE) infection risk were also conducted. The average disease and nonbattle injury rate for U.S. forces was 7.1 per 100 soldiers per week. Injuries accounted for 28% of medical visits, whereas undefined/other visits accounted for 33%. The majority of remaining visits were for respiratory (14%), dermatologic (10%), and gastrointestinal (6%) complaints. There was one confirmed and one suspected case of hemorrhagic fever with renal syndrome; only 0.1% of individuals (2 of 1,913) tested seroconverted to hantavirus during deployment. No cases of TBE were reported, and the overall low seroconversion rate (0.42%, 4 seroconversions among 959 unimmunized personnel) reflected a very low risk of infection with TBE-related viruses. Operation Joint Endeavor and follow-on Operations Joint Guard and Joint Forge have been extremely healthy deployments.

Identified spouse abuse as a risk factor for child abuse.

CONTEXT: There are limited data on the extent to which spouse abuse in a family is a risk factor for child abuse. OBJECTIVE: To estimate the subsequent relative risk of child abuse in families with a report of spouse abuse compared with other families. DESIGN: Cohort study. SETTING: Analysis of a centralized US Army database PARTICIPANTS: Married couples with children with at least one spouse on active duty in the US Army during 1989-95. MAIN OUTCOME MEASURES: The US Army Family Advocacy Program's Central Database was used to identify child and spouse abuse. The exposure was an episode of identified spouse abuse and the main outcome was a substantiated episode of subsequent child abuse. RESULTS: During the study period of an estimated 2,019,949 person years, 14,270 incident child abuse cases were substantiated. Families with an incident case of spouse abuse identified during the study period were twice as likely to have a substantiated report of child abuse compaired with other military families, rate ratio, 2.0, (95% confidence interval [CI] 1.9-2.1). Young parental age had the highest rate ratio, 4.9 (95% CI 4.5-5.3) in the subgroup analysis controlling for rank. Identified spouse abuse was associated with physical abuse of a child, rate ratio 2.4 (95% CI 2.2-2.5), and with sexual abuse of a child, rate ratio 1.5 (95% CI 1.3-1.7). Identified spouse abuse was not associated with child neglect or maltreatment, rate ratio, 1.0 95% CI 0.9-1.1) CONCLUSION: An identified episode of spouse abuse in a family appears to be associated with an increased risk of subsequent child abuse and serves as an independent risk factor. Therefore. care providers should consider the potential risk to children when dealing with spouse abuse.

Wisconsin, July 1999 heat wave: an epidemiologic assessment.

OBJECTIVE: To assess the characteristics of heat-related deaths in Wisconsin during the summer of 1999. METHODS: Review of death certificates indicating heat as an underlying or contributing cause of death. RESULTS: Heat-related illness led to 21 deaths during the summer of 1999 in Wisconsin. The rate of death was highest in the elderly, particularly those aged 65-84 years (2.2/100,000). Heat was the underlying cause for 12 of the 21 deaths. Cardiovascular conditions were the underlying cause in 8 of the deaths, and a contributing cause for another 7. CONCLUSIONS: The elderly, persons taking psychotropic medications, and persons with chronic diseases, particularly cardiovascular conditions, are at increased risk of death from heat during heat waves. Prevention messages and weather advisories during heat emergencies must target these groups. Care givers and medical personnel must be on heightened awareness for the signs and symptoms of heat exhaustion and heat stroke during these periods.

A decade of improvement in areas of chronic disease. Where do we go from here?

The last decade has seen significant progress in reduction of mortality rates from many chronic diseases on both a state and national level. Moreover, in general, Wisconsin has achieved levels below the United States for mortality. However, as suggested by Figures 1 and 2, preventive efforts in stroke and prostate cancer should become high priorities in this state. Additionally, it will be important to monitor the stabilization of death rates due to diabetes. Turning Point, anti-tobacco efforts by the Tobacco Control Board and the Thomas T. Melvin Program, and the upcoming Minority Health Report should reveal additional areas for DHFS and its statewide partners to address in the arena of chronic disease. Programs such as the Wisconsin Diabetes Control Program and the Wisconsin Well Woman Program will also continue to contribute significantly to other community and clinical efforts to control chronic diseases.

Myiasis in humans: an overview and a report of two cases in the Republic of Panama.

This paper on myiasis provides varied references from documented sources as an overall review. A review of two case studies, a primary screwworm (cochliomyia hominivorax) infestation and a human botfly (Dermatobia hominis) infestation, as well as information on approaches to positive intervention and remediation are presented. Human myiasis found in the subtropical and tropical regions of the world is a health threat. As a result of the military's expanding role in medical support to various regions where myiasis is endemic, this paper serves to familiarize health care providers with this condition and to provide guidance when dealing with patients affected by myiasis.

Efficacy of sedation of children with chloral hydrate.

Chloral hydrate has been used extensively to sedate children, but at Brooke Army Medical Center, other drug combinations were becoming increasingly popular due to a perception that chloral hydrate had a high rate of failure, especially with younger or neurologically impaired children. Therefore, 50 children were given the drug before a diagnostic study, and patient data and a sedation score were recorded on a worksheet. Of 50 children, 43 (86%) were "successfully sedated" on the first attempt with no side effects. Children with neurologic disorders had a much greater (27% vs 4%) failure rate than "normal" children. The sedation rate did not significantly differ by age, sex, or initial drug dosage. The study suggest that chloral hydrate is a safe and effective oral sedative but that children with neurologic disorders may need alternative drugs for sedation.