Publications

OBJECTIVE

This study compared the characteristics of the basic science, biomedical, and socioeconomic literature submitted in 1993-1994 by supporters and opponents of the proposed workplace regulation of tobacco smoke developed by the Maryland Occupational Safety and Health (MOSH) Advisory Board.

METHODS

The authors retrospectively analyzed 544 written publications submitted to the MOSH Advisory Board regarding the proposed workplace regulation of tobacco smoke. Outcome measures included the type and year of publication and, for journal articles, the journal's peer review policy and impact factor.

RESULTS

Supporters of regulation submitted fewer documents (n = 164) than opponents (n = 380). Supporters of regulation submitted a lower proportion of conference proceedings and a higher proportion of government reports. The publications submitted to the regulators by the supporters of regulation were more recently published than the materials submitted by opponents. Journal articles represented more than half of the publications submitted; most were peer-reviewed. Supporters of regulation submitted articles from journals with higher impact factors (median impact factor 2.78) than did opponents of regulation (median 1.66; p = 0.0005), and articles that were published more recently (median year of publication 1990) than those submitted by opponents (median 1989; p = 0.0001).

CONCLUSIONS

Public health advocates should highlight the scientific evidence base that supports tobacco control regulations. Public health advocates should encourage and support regulatory officials' use of the criteria of peer review, impact factor, and date of publication to prioritize their review of submitted documents in order to base policy on the best available evidence.

OBJECTIVES

This study examined factors associated with emergency department use among homeless and marginally housed persons.

METHODS

Interviews were conducted with 2578 homeless and marginally housed persons, and factors associated with different patterns of emergency department use were assessed in multivariate models.

RESULTS

Findings showed that 40.4% of respondents had 1 or more emergency department encounters in the previous year; 7.9% exhibited high rates of use (more than 3 visits) and accounted for 54.5% of all visits. Factors associated with high use rates included less stable housing, victimization, arrests, physical and mental illness, and substance abuse. Predisposing and need factors appeared to drive emergency department use.

CONCLUSIONS

Efforts to reduce emergency department use among the homeless should be targeted toward addressing underlying risk factors among those exhibiting high rates of use.

Between March and October 2000, 157 suspected cases of leptospirosis hospitalized with complications of Weil's syndrome and a mortality of 8% were identified in Salvador, Brazil. We conducted a population-based case-control study to identify risk factors for acquisition of leptospirosis in neighborhoods with high endemicity during the rainy season-associated urban epidemic. Sixty-six (65%) of 101 laboratory-confirmed cases and 125 age and sex-matched healthy neighborhood controls were interviewed. Residence in proximity to an open sewer (matched odds ratio [OR] = 5.15, 95% confidence interval [CI] = 1.80-14.74), peri-domiciliary sighting of rats (OR = 4.49, 95% CI = 1.57-12.83), sighting groups of five or more rats (OR = 3.90, 95% CI = 1.35-11.27), and workplace exposure to contaminated environmental sources (OR = 3.71, 95% CI = 1.35-10.17) were found to be independent risk factors for acquiring disease. Some of these risk factors are amenable to focused interventions, which include provision of closed drainage systems for sewage and reduction of rodent populations in the peri-domicilary environment. Environmental control of transmission may help to greatly reduce the incidence of severe leptospirosis.