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The growth and development status of homeless children entering shelters in Boston.

In order to characterize the children who enter emergency shelters in Boston, we reviewed the data collected at intake interviews by the pediatric nurse practitioner visiting 10 family shelters and one hotel in Boston as part of the Boston Health Care for the Homeless Project. Families were interviewed soon after their entry into the shelter. Children were weighed and measured, and the Denver Developmental Screening Test (DDST) was administered. From November 1986 to November 1987, 133 families with 213 children were interviewed. Ninety-four percent of the children were in the care of their mothers, and 92 percent were younger than 5 years of age. Sixty-five percent of the families were black, 20 percent were white, and 11 percent were Hispanic. Eighty-nine percent of the families were receiving Aid to Families with Dependent Children benefits, 90 percent were receiving Medicaid benefits, 72 percent were receiving food stamps, and 52 percent were receiving benefits under the Special Supplement Food Program for Women, Infants, and Children. Eighty-five percent of the children were reported to have a regular source of primary pediatric care, and 23 percent were reported to have medical problems. Weight-for-age, weight-for-height, and height-for-age measurements were similar to those reported for national samples of low income children. Ten children (4.7 percent) were found to have abnormal or questionable DDST examinations.

Boston↗

Human immunodeficiency virus infection in hemodialysis patients. Baltimore-Boston Collaborative Study Group.

Patients undergoing chronic hemodialysis receive multiple blood transfusions and, thus, are susceptible to infections transmitted through blood and blood products, including infection with human immunodeficiency virus (HIV). To determine the prevalence of antibody to HIV among patients undergoing chronic hemodialysis in Baltimore and Boston in 1985, we conducted a cross-sectional seroprevalence study. Repeatedly enzyme-linked immunosorbent assay (ELISA)-positive serum samples were tested by Western blot analysis. Among 435 patients in Baltimore, 12 (2.8%) were seropositive by both ELISA and Western blot techniques. Among 90 patients in Boston, three (3.3%) were seropositive. Among 100 frozen serum samples obtained from another Boston hemodialysis population in 1980, only one was seropositive. Many repeatedly ELISA-positive specimens were observed in each of the three groups studied, especially the serum samples that had been stored at -30 degrees C to -70 degrees C for four years. Most were nonspecifically reactive as demonstrated by reactivity with an H9-control ELISA plate. Patients undergoing hemodialysis, many of whom have received frequent transfusions in the past, are at increased risk for prior infection with HIV. Serologic testing for either screening or case-finding purposes must be conducted with great attention to specificity; serum samples frozen for prolonged periods are especially likely to be nonspecifically ELISA positive. These findings have implications concerning case-finding purposes, dialysis procedures, renal transplantation, and seroepidemiologic research.

Acquired Immunodeficiency Syndrome↗

New England College of Optometry's impact on Boston neighborhoods.

BACKGROUND: In the 1960s, the city of Boston developed and implemented an innovative plan creating an urban primary health care system. This bold undertaking was predicated on the maximal utilization of a growing network of multidisciplinary neighborhood health centers. Almost concurrently, the New England College of Optometry (NEWENCO) began a total restructuring of its clinical curriculum. The objectives of this NEWENCO initiative were compatible with those of the city's health care restructuring plan. METHODS: The background, planning, structure, implementation and benefits of this collaborative effort are addressed. RESULTS: The two formed a unique partnership that elevated the quality of care for the residents of Boston's neighborhoods and dramatically improved the training experience for NEWENCO students. CONCLUSIONS: The NEWENCO-City of Boston partnership has improved the quality of health care in the urban neighborhoods and enhanced the clinical training of optometric externs.

Boston↗

The incidence of prenatal syphilis at the Boston City Hospital: a comparison across four decades.

OBJECTIVE: To examine the incidence and epidemiologic correlates of congenital syphilis at an inner-city Boston hospital, and draw comparisons with the situation at the same hospital 40 years ago. DESIGN: Chart review and comparison with data collected in 1951. SETTING: Maternity and pediatric services at Boston City Hospital. METHODS: A study conducted in 1951 on the maternity service of Boston City Hospital in which demographic data were collected on all women admitted in labor over a 5-month period was replicated. Serologic testing for syphilis was carried out on these women, and the demographic and medical correlates of positive maternal syphilis serology were examined. This study was repeated exactly 40 years later, using the cord blood screening for syphilis done routinely at delivery and a review of prenatal records. RESULTS: From a group made up largely of married white women in 1951, the study population shifted in 1991 to a group made up mostly of minority women, with 75% unmarried. In 1951, 24 patients were diagnosed with syphilis either before or during the pregnancy, giving a prevalence rate of 2.4%. In 1991, 25 of 647 women were diagnosed with syphilis, for a prevalence rate of 3.9%. The women with positive cord blood serologies had a higher rate of other sexually transmitted diseases and substance abuse. No symptomatic cases of congenital syphilis were seen in 1951 or in 1991, although at least 11 of the 26 infants born to mothers with positive serologies in 1991 received intravenous penicillin therapy. CONCLUSIONS: The continued prevalence of diagnosed syphilis in women at delivery reflects an inner-city epidemic of congenital syphilis that is tied to substance abuse, human immunodeficiency virus, and changing social patterns, as well to older problems of serologic screening, prenatal care, treatment failures, and maternal reinfection. It is essential that screening programs be maintained and improved in this high-risk population, and that infants born to mothers with positive serologies receive full and adequate treatment if there is any doubt at all about their infection status.

Adult↗

Planning for emergency medical services in Boston.

The results of a survey of 10,200 visits to 11 Boston hospital emergency rooms during a 9-day period in March 1972 are presented. The survey was designed to provide data on emergency room use to permit more informed planning by public agencies concerned with improving areawide emergency medical services. The 11 institutions surveyed provided virtually all of the emergency medical services in the city of Boston. A majority are teaching hospitals affiliated with one or more of the three medical schools in the area. Of the 11 hospitals, 3 accounted for 60% of all emergency room visits. Survey data were extracted from emergency room log sheets and hospital medical records of individual patients. Information collected included the residence pattern of patients within the geographic area, the patient mix by degree of urgency based on presenting complaints, mode of transportation to the hospital, and age and sex of the patients. Only 15 percent of the 10,200 visits were true emergencies. Fifty-seven percent were classified as urgant and 28% nonurgent. The mix among the 11 hospitals ranged from 7 to 22 percent in the emergency category, and 11 to 61 percent in the nonurgent classification. Trauma accounted for 19 percent of all admissions, with 3 percent attributed to fractures and 4 percent to head injuries. Fifty-six percent of the emergency cases required the services of an internist or pediatrician, 38 percent a surgeon, and 1 percent an obstetrician. The highest utilization rate--27 per 1,000 population--was recorded for the under 5 age group. Although the 65 and older age group had the lowest utilization rate of 6 per 1,000, this group had the highest rate of visits classified as emergencies. Children under 5 accounted for the highest proportion of nonurgent visits. The survey revealed that 30 percent of all hospital admissions were from the emergency room. One in four emergency patients lived outside the city of Boston. A neighborhood health center and a hospital general practice unit reduced hospital emergency room workloads appreciably, even when they were open only during daytime hours. Eighty-eight percent of all patients arranged for their own transportation, usually by private automobile. Of those arriving by ambulance, only 35 percent were classified as emergencies. The survey data reinforce the conclusion that major planning efforts should be concentrated on the management of the nonemergency patient. The data also emphasize the need for a single agency to be responsible for overall planning for emergency medical services on an area wide basis.

Adolescent↗

Effect of a Soft Boston Orthosis on pulmonary mechanics in severe cerebral palsy.

Spinal braces such as the Soft Boston Orthosis (SBO) help stabilize scoliosis and improve sitting, positioning, and head control in individuals with cerebral palsy. However, their impact on pulmonary mechanics in this population has not been studied. We examined the effect of a Soft Boston Orthosis on the pulmonary mechanics and gas exchange in 12 children and young adults (5-23 years of age) with severe cerebral palsy. Pulmonary resistance, compliance, tidal volume, minute ventilation, work of breathing, oxygen saturation, and end-tidal CO2 tension were measured with the subjects seated both with and without the orthosis and in the supine position without the orthosis. There were no significant differences in the measured parameters when comparing subjects with and without their orthoses in the sitting or in the supine position. As would be expected in individuals with severe cerebral palsy, pulmonary resistance was increased (7.33 cm H2O/L/s) and compliance was decreased (0.12 L/cm H2O) compared to reported normal values. Work of breathing was greatest in the sitting position without the orthosis (1.2 dynes/cm), suggesting that the improved positioning achieved with the orthosis may decrease the work of breathing. We conclude that the application of a Soft Boston Orthosis does not impact negatively on pulmonary mechanics and gas exchange in young people with severe cerebral palsy.

Adolescent↗

Studies of the oxidation states of hemoglobin M Boston and hemoglobin M Saskatoon in blood by EPR spectroscopy.

The extent of the oxidation of Hemoglobin (Hb) M Saskatoon (beta 63His-->Tyr) and Hb M Boston (alpha 58His-->Tyr) in the patient's blood was determined by measurement of the intensity of EPR signals at g perpendicular = 6.0 for the normal subunits, g1 = 6.7 for the mutant subunits of Hb M Saskatoon and g1 = 6.3 for those of Hb M Boston, respectively. The amounts of reduced mutant subunits were estimated from the EPR signal intensities and the amounts of Hb present as mutant Hb in the blood. About 50% and 76% of mutant subunits in Hb M Boston and Hb M Saskatoon remained reduced in the fresh blood. Gentle shaking of the blood at 37 degrees C for 15 hours in air brought about autoxidation of the normal subunits as well as the mutant subunits of the two Hbs M, indicating that the presence of the mutant subunits facilitated autoxidation of the normal subunits. Possible involvement of NADH-metHb reductase in erythrocytes in maintenance of the reduced mutant subunits of Hb M Saskatoon was discussed.

Electron Spin Resonance Spectroscopy↗

Reduction in organic contaminant exposure and resultant hepatic hydropic vacuolation in winter flounder (Pseudopleuronectes americanus) following improved effluent quality and relocation of the Boston sewage outfall into Massachusetts Bay, USA: 1987-2003.

Effluent upgrades for metropolitan Boston have included toxicant reduction, primary and secondary treatment and outfall extension. Between 1992 and 2003 winter flounder at five stations were surveyed annually for liver and muscle burden and chronic hepatic sub-lethal impacts of polynuclear and halogenated aromatic hydrocarbons, and metals. Trends in flounder availability and fin condition were also examined. In 1988 12% of the adult winter flounder in Boston Harbor exhibited hepatic neoplasms and up to 80% had hepatic hydropic vacuolation (HV). Tumor prevalence fell to 0-2% and HV to <50% by 1996. Since then tumors have been absent, while a steady prevalence of HV has persisted, consistent with lower hydrocarbon loading and tissue levels. Contaminants and HV also fell with distance from the Boston outfall. After the outfall extension was activated in 2000, there has been no significant change in flounder liver health at the new outfall site.

Animals↗

Fate of linear alkylbenzenes released to the coastal environment near Boston Harbor.

Linear alkylbenzenes (LABs) were used to assess the fates of hydrophobic organic compounds (HOCs) released to a large urban harbor and the adjoining offshore waters. We found that particulate concentrations of the individual C12 LAB isomers in 1996 summertime surface waters decreased from 1 pM in Boston Harbor to 20-200 fM in coastal Massachusetts and Cape Cod Bays. Levels fell to only a few fM in offshore Gulf of Maine locations. These observations were consistent with municipal wastewater in Boston Harbor as the predominant input followed by dispersal via known circulation patterns in this region. Phase-dependent removal rate coefficients for flushing, vertical scavenging, volatilization, photodegradation, and biodegradation of individual LAB isomers were constrained from literature, field observations, and laboratory experiments and combined with estimates of wastewater release rates into a predictive 3-box model. Vertical scavenging, biodegradation, and flushing were predicted to be the most important fate processes for C12 LABs in the Boston Harbor-MA Bay-Cape Cod Bay flow system with about 1% of the harbor releases "surviving" passage. For HOCs such as the relatively bio-recalcitrant LAB, 6-phenyldodecane, it appears that we are at present able to predict the coastal fate of harbor-introduced HOCs in this system within a factor of 2. Contrary to expectations from biodegradation experiments, the ratio of internal-to-external (I/E) LAB isomers decreased offshore in both water and sediment samples, suggesting we are "missing" an important process affecting LAB fates.

Alkylation↗

Boston brace in the treatment of idiopathic scoliosis.

In a retrospective follow-up study of 64 patients with adolescent idiopathic scoliosis, the initial correction of Boston brace with straight lumbar profile strongly predicted good treatment results at follow-up (mean, 4.8 years). If the initial correction was > 50%, the curve was permanently reduced with an average of 7.2 degrees. The average initial correction was 62%. This initial brace effect was preserved in another comparable group of 60 patients treated with a Boston brace with 15 degrees lumbar lordosis. It is concluded that the Boston brace is effective in the conservative treatment of idiopathic scoliosis, and the corrective ability seemingly does not deteriorate with a change in the brace design from 0 to 15 degrees lordosis.

Adolescent↗

Cigarette advertising on taxicabs in Boston, Massachusetts (USA).

OBJECTIVE: To examine the frequency of tobacco advertisements on taxicabs within Boston, Massachusetts (USA). DESIGN: At seven locations throughout Boston, an observer counted all taxicabs over 30-minute periods in December 1995. MAIN OUTCOME MEASURES: Confirmed sightings of taxicabs with cigarette advertisements were recorded with information collected on the cigarette brand and taxicab company. RESULTS: A total of 314 taxicabs were observed over 210 minutes of observation time, including 127 (40.4%) with cigarette advertisements. Taxicabs with cigarette advertisements were seen once every 1.65 minutes on average, with Marlboro as the most frequently advertised brand (69 of 127 advertisements, 54.3%). Less affluent locations were serviced by greater proportions of taxicabs carrying cigarette advertisements compared with more affluent locations (odds ratio = 2.08, 95% confidence interval = 1.18-3.68). CONCLUSIONS: Taxicabs represent a major form of exposure to cigarette advertising in Boston.

Advertising↗

Patterns of service use and costs in model day hospital-in programs in Boston and Tucson.

Patterns of service use and costs in two similar model day hospital-inn programs for psychiatric patients in publicly funded hospitals in Boston and Tucson are compared. Implementation of the programs resulted in cost savings at both sites, although mean annual costs per patient were much lower in Tucson than in Boston. Compared with patients at the Boston site, patients in Tucson had more admissions but shorter stays and fewer days in the program during a 12-month follow-up period. Site-specific differences in the programs, in local practice patterns, and in state mental health funding levels may have influenced cost differences.

Arizona↗

Prediction of Boston Naming Test performance from vocabulary scores: preliminary guidelines for interpretation.

Patients with limited education or underdeveloped vocabulary skills may perform below the normal range on the Boston Naming Test when compared to the original published norms, even in the absence of brain damage. To reduce the frequency of false positive dysnomic classifications of patients with limited vocabulary skills, we developed a score adjustment to account for the significant shared variance between scores on this test and the WAIS-R Vocabulary subtest. Vocabulary significantly predicted performance on the Boston Naming Test (r = .65, p < .0001) in a sample of 62 outpatients who had no objective evidence of brain damage. Linear regression was used to derive expected performance on the Boston Naming Test from Vocabulary scaled scores. Relative to the original published norms, scores based on the Vocabulary subtest cut-offs produced fewer false positives and more accurately classified group membership for patients with and without objectively verified brain damage. These performance predictions are offered as tentative guidelines to assist clinicians in evaluating the presence of naming deficits by controlling for the variance associated with knowledge of vocabulary.

Adolescent↗

Compound heterozygosity for Hb Lepore-Boston and Hb Neapolis (Dhonburi) [beta 126(H4)Val-->Gly] in a patient from Naples, Italy.

The simultaneous presence of two hemoglobin variants has been detected in a 14-month-old patient affected by thalassemia intermedia. The two variants were characterized by a combination of allele-specific amplification methods and mass spectrometric procedures carried out on isolated globins. These were identified as Hb Lepore-Boston and Hb Neapolis (also known as Hb Dhonburi) or beta 126 (H4)Val-->Gly. Hb Lepore-Boston is the most common hybrid variant detected in Campania and several cases of Hb Neapolis which causes a mild hypochromic microcytic anemia have been identified in this region in the last few years. This is the first report of a double heterozygosity involving Hb Lepore-Boston and Hb Neapolis.

Follow-Up Studies↗

Determination of the amounts and oxidation states of hemoglobins M Boston and M Saskatoon in single erythrocytes by infrared microspectroscopy.

The reduced abnormal subunits of two M-type hemoglobins, Boston (His alpha 58-->Tyr) and Saskatoon (His beta 63-->Tyr), have been determined in the presence of normal human hemoglobin A by measurement of C-O stretch bands in infrared spectra of carbon monoxide complexes. Use of an infrared microscope coupled to a Fourier transform infrared spectrometer of high sensitivity permitted measurements to be made on as small a hemoglobin mixture as is contained in a single erythrocyte. The abnormal subunits of both Hbs M exhibit bands near 1970 cm-1 compared with bands near 1951 cm-1 for the normal subunits. The increase in 1970 cm-1 band intensity upon erythrocyte reduction with dithionite provided a measure of the extent of abnormal subunit oxidation; in cell suspensions about 60% of the abnormal subunits of Hb M Boston and 80% for Hb M Saskatoon remained reduced. The amount of Hb present as abnormal Hb averaged about 25% for Hb M Boston cells and about 50% for Hb M Saskatoon cells. However, the ratio of Hb M to Hb A in individual cells varied markedly, with the ratio expected to decrease as the cell ages. These results demonstrate the unique utility of infrared microspectroscopy for the study of differences in abnormal Hb status among individual erythrocytes.

Carboxyhemoglobin↗

The return of Boston exanthem. Echovirus 16 infections in 1974.

Although the "Boston exanthem" has been seen rarely over the past 20 years, in the summer of 1974 we identified ten children, aged 1 week to 7 years with echovirus 16 infections. Seven of the children had rashes, and in four, the illness suggested roseola infantum. Five of these children were neonates, all with illnesses severe enough to mimic sepsis. In addition information obtained on echovirus 16 isolations occurring in 1974 elsewhere in the country showed an additional 27 isolations from eight states. It is postulated that more outbreaks of the Boston exanthem or other echovirus 16 illnesses will appear during the next several years, before the virus again "disappears".

Boston↗

Increase in suicide attempts by drug ingestion. The Boston experience, 1964-1974.

At the Massachusetts General Hospital between 1964 and 1974, there was an estimated 118% increase in emergency ward admissions for drug overdose suicide attempts and an estimated 257% increase in such attempts by individuals in the 20- to 29-year age range. Approximately 67% of overdoses seen in 1972 and 1974 occurred in individuals under age 30. An increase in drug overdose suicide attempts by males was noted. By 1972, males were making approximately as many attempts as females. Based on extrapolations from the Massachusetts General Hospital drug overdose data, and not including an estimate of non-hospital-treated suicide attempts, an estimated annual (1972) suicide attempt rate of 337/100,000 (0.38%) was obtained for Boston. The estimated suicide attempt-completed suicide ratio for the Boston area was 39:1. These estimates should be interpreted as giving an approximate order of magnitude and not as specifying precise rates.

Adolescent↗

The Boston Center for Liver Transplantation (BCLT). Initial experience of a new surgical consortium.

Improved survival following liver transplantation has led to a rapid increase in the number of centers providing this expensive and demanding therapy. In January 1984, four Boston hospitals launched a cooperative program known as the Boston Center for Liver Transplantation (BCLT). From January 1984 through July 1985, 47 liver transplantations were performed in 41 patients ranging in age from 8 months to 60 years. Donor organs were retrieved from 22 states within a 2,500-mile radius. Thirty-five of the 47 procedures were performed by teams consisting of surgeons from at least two BCLT member hospitals. Twelve-month actuarial survival was 54.1% without significant institutional variability. The BCLT has developed into a unique transplant consortium capable of sharing manpower, equipment, and organs without sacrificing quality of care of disrupting preexisting medical services.

Adolescent↗