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Biomedical subjects

L F Novick

Publications and source records attributed to L F Novick.

At least 55 records · Page 3Linked to original sources
PubMed1981

Asbestos in Vermont schools: findings of a statewide on-site investigation.

Materials containing asbestos were found in 75 per cent of 336 Vermont Schools constructed or renovated between 1946 and 1974, with two-fifths of the materials in student exposure areas. Findings from visits to all schools contrasted with an earlier investigation relying on self-reporting. Of 105 schools with student exposure disclosed by the current survey, only eight had been identified in the earlier effort. Ceiling tiles, previously not believed to contain substantial asbestos material, constituted a source of student exposure in 36 schools.

Asbestos↗
PubMed1980

Deinstitutionalized mentally retarded hepatitis-B surface antigen carriers in public school classes: a descriptive study.

Twenty-seven of 33 formerly institutionalized retarded HBsAg carriers exhibited behaviors which might facilitate viral transmission in classrooms where they had been placed with retarded susceptibles. Classroom conditions included lack of handwashing facilities and frequent failure to inform staff of the presence of such carriers in their classes. A serological survey of classroom contacts showed that 91% of never-institutionalized students, 86% of staff, and 18% of formerly-institutionalized students had no antibody to HBsAg. Caution should be taken to protect teachers and students from infection with hepatitis-B in such classrooms.

Adolescent↗
PubMed1980

Mentally retarded hepatitis-B surface antigen carriers in NYC public school classes: a public health dilemma.

The placement of retarded children who have been institutionalized and are asymptomatic hepatitis-B surface antigen carriers into public school classes for the retarded has caused controversy and presented the New York City Health Department with an unusual medical-ethical dilemma. In this situation, the cost of interfering with deinstitutionalization, an important social advance, must be balanced against the benefit of controlling the unquantified but real risk of transmitting a potentially serious disease. The Health Department guidelines for managing this problem recommended serological surveillance, promotion of classroom hygiene where possible, and teaching of carriers in classes separate from their susceptible peers. A federal court disallowed the cohorting provisions of these guidelines. Changing policies and practices towards the mentally retarded, such as deinstitutionalization, raise important public health issues which will have to be faced by the involved communities.

Carrier State↗
PubMed1978

A study of 128 deaths in New York City correctional facilities (1971-1976): implications for prisoner health care.

During a 5 1/2 year period, January, 1971 through July, 1976, 128 deaths occurred in New York City. The epidemiology of prisoner deaths including suicide was examined in a large incarcerated population. Each death was categorized according to the International Classification of Diseases. The mean age of the prisoner death was 34 years. Only 3 deaths occurred among females. Ethnic distribution of these deaths was similar to the prison population. Deaths of prisoners fell into 2 categories: external causes (suicide, accidents, homicide, legal intervention) and nonviolent causes. External causes accounted for 71 deaths. The leading cause of death was suicide, accounting for 52 deaths. Suicides occurred in all time periods of incarceration. The highest rate was in the 35 to 44 year age group. History of drug or alcohol abuse was reported by 69 per cent of the suicides. One-third of the prisoners committing suicides had histories of previous attempts or previous mental hospitalizations. Except for 2 individuals, the method was hanging. For the most part, prisoners at risk for suicide exhibited a common pattern and were identifiable. During the last 2 1/2 years of the study period, deaths were reviewed by a prisoner death committee. Deficiencies of care in deaths of nonviolent causation were categorized as "provider," "corrections," or "system." The most common deficiency in care was delay in hospitalization of prisoners requiring care.

Adolescent↗
PubMed1977

Health status of the New York City prison population.

During a two-week period in June 1975, all 1,420 prisoners admitted to New York City Correctional Facilities were studied to determine the prevalence of current and past health conditions. Information was obtained from a standard admission health examination. Almost three-quarters of the male and female prisoners were 30 years or less. Of the study population, 57 per cent were black, 24 per cent were Hispanic and 17 per cent were white. Forty-one per cent reported a history of illicit drug use. More than one-quarter of the prisoners reported a present illness and three-fifths received at least one diagnosis. Commonly diagnosed conditions included drug abuse, psychiatric disorder, trauma, and alcohol abuse. Seven per cent of male prisoners had a previous psychiatric hospitalization. On examination, new trauma was noted in 10 per cent of the male population. In addition to these findings, a history of seizure disorder was reported in 4 per cent of the male population. Health services within prisons must be able to manage the most pressing problems in this population-substance abuse and psychiatric disorder and provide care for the range of conditions that is similar to that found in the general population for this age group.

Adult↗
PubMed1976

Assessment of ambulatory care: application of the tracer methodology.

Utilizing a tracer method in the assessment of care was investigated in a large pediatric clinic. A set of tracers were selected and agreement was obtained concerning the relevance of care criteria by at least 80 per cent of the facility physicians. One tracer, iron-deficiency anemia, was studied using two nonphysician abstractors to review a sample of 100 patient records with hemoglobins of 11.0 gm/100 ml or less. Results were compared with an implicit review by a panel of physicians. In 52 patients, the low hemoglobin level was not recognized. Only 25 patients proceeded through the care levels of evaluation, diagnosis, treatment, and follow-up. Poor compliance was found with the approved criteria. Weighted scores of the explicit tracer method were closely related to ratings by the implicit reviewers. Utilizing tracer assessment with nonphysician abstractors demonstrated remediable deficiencies in health care services.

Ambulatory Care↗
PubMed1976

The contractual model for prison health care.

In New York City, the Department of Health is responsible for providing health services to 8 correctional facilities which receive 60,000 admissions annually. A large component of this prison health system is a contract with Montefiore Hospital, a voluntary institution, to provide medical services to the population on Rikers Island, a penal complex. This contractual agreement is unique in that an operating entity, Monefiore Hospital, has agreed to provide a "package" of health services to a defined prisoner population. The City agreed to reimbruse to the Hospital for the three year term of the contract, a total amount not to exceed +11.7 million. Because of delays in renovation of the prison facilities, for the majority of the period of the three year contract, only two prisons were served via the contractual route. Since 1973, the program has provided a range of services including screening of new prisoners, primary, emergency, infirmary and limited speciality care. Major improvements in laboratory and radiology services were implemented. The early experience with this program indicates that in this setting the contractual model possesses a number of distinct advantages over the direct delivery of prison health services. Disadvantages include a significantly higher cost.

Delivery of Health Care↗
PubMed1976

Decentralization in the New York City Department of Health: reorganization of a public health agency.

Since the World War I era there has existed within the New York City Department of Health a basic internal struggle between staff directing the bureaus at the central office and the district health officers operating field health centers throughout the city. Recently, in a five-year period, there was a dramatic reorganization of the Department which markedly affected its orientation and programs. In 1972 a new Commissioner initiated a reorganization of the Department which succeeded in decentralizing field operations in contrast to earlier efforts which had failed to reach this objective. The roles of bureaus and districts were redefined, with the latter receiving budgetary authority, authority to supervise personnel, assignment of health managers, and the implementation of a district cost accounting system. While operational decentralization has occurred, policy setting and resource allocation in response to local needs remain central functions.

Administrative Personnel↗
PubMed1975

Converting child health stations to pediatric treatment centers.

Nineteen child health stations in New York City have added treatment services to their traditional role of well-child supervision with the objective of increasing the access of children livine in underserved areas to integrated preventive and therapeutic care. The conversion process was studied at nine pediatric treatment centers (PTC) in upper Manhattan and the South Bronx. the Department of Health accomplished the conversion by adding full-time pediatricians, on-premises laboratory capability, prepackaged pharmacies, and informal arrangements with local hospitals. The proportion of patient visits at the PTCs for sick care ranged from 11 to 57 per cent and varied with the length of time the unit had been in operation. Personnel cost per visit was $16. Six child health stations were compared before and after conversion to PTCs. Registration increased 5 per cent, visits increased 50 per cent, and personnel cost increased 150 per cent. Review of 600 patient visits revealed that the majority of illness visits were for minor conditions, notably upper respirtory infections. Interviews of 600 parents of three PTCs revealed that approximately one-fourth regarded the PTC as a usual source of care. Increased access and continuity of child health services have been accomplished by these conversions. Adding treatment services to child health stations is a satisfactory alternative to the overcrowded hospital-based pediatric facility.

Adolescent↗
PubMedDate not supplied

Legionella in cooling towers.

Legionellosis (Legionnaires' disease and Pontiac fever) outbreaks have been associated with aerosols ejected from contaminated cooling towers--wet-type heat rejection units (WTHRUs) used to dissipate unwanted heat into the atmosphere. The Vermont Department of Health undertook a program to inventory, inspect, and sample all WTHRUs in Vermont from April 1981 to April 1982. All WTHRUs were sampled for Legionella pneumophila and data were obtained for location, design, construction, and operating characteristics. Of the 184 WTHRUs operating, statistical analyses were performed on those 130 which were sampled for L. pneumophila only once during the study period. Of these, 11 (8.5%) were positive for L. pneumophila. Sources of makeup water and period of operation had significant association with the recovery of L. pneumophila. Five out of 92 towers (5.4%) utilizing surface water sources for cooling were positive for L. pneumophila, in contrast to 6 positive towers of the 38 units (15.8%) which obtained makeup water from ground water sources (p = .054 by chi-square test). Nearly 15% of the 54 units which operated throughout the year were positive, compared to less than 4% of the 76 towers operating seasonally (p = .03 by chi-square test). The mean pH of the cooling water in units where L. pneumophila was recovered (8.3) was significantly higher than the mean pH of 7.9 in units testing negative (p less than .05 by t-test). In addition, the mean log-transformed turbidity of positive towers, 0.03 nephelometric units (ntu), was significantly lower than the mean of log turbidity of negative towers, 0.69 ntu (p less than .02 by t-test).

Air Conditioning↗
PubMedDate not supplied

New York State's two-dose schedule for measles immunization.

In April 1989, New York became the first State in the United States to adopt a two-dose schedule for routine measles immunization. Although a two-dose schedule had been under discussion for the previous 10 years, this policy change was finally prompted in New York State by widespread measles outbreaks in 1989 among college and high school students who had been appropriately vaccinated with a single dose of measles vaccine. These outbreaks affected 21 college and secondary school campuses with 91 cases of measles and led to the administration of 53,093 doses of vaccine at a cost in excess of $859,000 for vaccine alone. In addition, there were major disruptions of intercollegiate athletic and scholastic events and physician and public confusion over the different recommendations for "outbreak" versus "routine" measles immunization. In response, the New York State Department of Health adopted a policy of two doses of measles vaccine required for entrance into kindergarten and college beginning in the fall of 1990. This report describes the data and process that were used in reaching this policy decision.

Adolescent↗
PubMedDate not supplied

HIV seroprevalence in newborns in New York State.

The prevalence of human immunodeficiency virus (HIV) infection was determined in women at the time of childbirth throughout New York State between November 30, 1987, and November 30, 1988. Mandatory blood specimens (276,609) obtained from all newborns were examined for HIV. The overall HIV seroprevalence rate was 0.66% (1816 newborns), with 0.16% in Upstate New York and 1.25% in New York City. Rates for newborns whose mothers were aged 20 to 29 years (1.30%) and 30 to 39 years (1.35%) were significantly higher than rates for those with mothers younger than 20 years of age (0.72%). Rates of seropositivity were higher among blacks (1.8%) and Hispanics (1.3%) than among whites (0.13%). Seropositivity of HIV was higher in zip code areas with high rates of drug use (2.2%) than in the rest of New York City (0.8%). It is estimated that more than 726 HIV-infected children were born in New York State during the 1-year study period, using 40% as the probable proportion of seropositives that will become infected.

Adult↗
PubMedDate not supplied

Establishment of an exposure level to tetrachloroethylene in ambient air in Vermont.

Where environmental contaminants pose potential health hazards, health departments are involved in complex and often controversial situations. Often the rapid formation of a threshold exposure level is required to protect public health. A decision making process was implemented in Vermont when it became necessary to have an interim ambient air exposure level to test for tetrachloroethylene contamination in the water, air, and soil of a community. Contamination of public and private drinking water and ambient air in schools and homes was discovered as a result of uncontrolled waste disposal from an industrial uniform laundry and drycleaning plant. A telephone survey was conducted to determine action taken by the other 49 States regarding emission standards for tetrachloroethylene into ambient air. There were no guidelines in 25 States, and there were guidelines in the remaining 25. Vermont's Commissioner of Health convened a multidisciplinary group of public health professionals to review various approaches to the establishment of an ambient air standard. A decision making action using modified Delphi and nominal group consensus methods set the interim standard at 67 micrograms per cubic meter in ambient air. The drycleaning plant had been closed voluntarily before the standard was established, and the interim standard was used to prevent reopening of the plant through a health order issued by the Vermont Health Department. The standard was also useful for guidance during environmental remediation.

Air Pollutants↗