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PubMed1982

Pulmonary function in firefighters: a six-year follow-up in the Boston Fire Department.

Tests of ventilatory capacity, objective cough, and standardized respiratory questionnaires were used in a prospective study to measure the effect of firefighting on pulmonary function in a cohort of 951 white Boston firefighters between 1970-1976. During the six years of follow-up, the mean annual decrements in forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were 36 and 29 ml per year, respectively. At the end of the study in 1976, the mean FEV1 for this group was 98.3% of the level predicted for healthy nonsmoking adults, while the FVC was 97.8%. Current cigarette smoking was associated with an increased prevalence of bronchitis, a loose cough, reduced levels of FEV1 and FVC, and increased longitudinal changes in FEV1 and FVC. The longitudinal changes and current levels of FEV1 and FVC were not correlated with any index of firefighting exposure in active firefighters. Increased use of protective respiratory apparatus and previously described selection effects within the Boston Fire Department appear to be protecting this group of firefighters from long-term effects of smoke exposure as measured by these techniques.

Adult↗

PubMed2005

Aligning systems to create full-service schools: the Boston experience, so far.

Leaders of full-service schools in Boston seek to expand the number and increase the impact of Boston's full-service schools, catalyzing a realignment of public resources and an expansion of private investment. The Full-Service Schools Roundtable, led by a dynamic staff and supported by the mayor and the superintendent of schools, is a steadily growing coalition of educators, public agencies, human service providers, and community leaders. Challenges for the Roundtable are to build the public will to invest in full-service schools; secure leadership from stakeholders; share accountability across sectors so that schools prioritize youth development and health, and service providers share responsibility for school success; and become a political force, championing the strategic realignment of public investments based on child outcomes.

Adolescent↗

PubMed1987

'Mental' in 'Southie': individual, family, and community responses to psychosis in South Boston.

The deinstitutionalization of psychiatric patients is a deeply cultural as well as political task. It entails the sharing of responsibility for human distress with family and community. Consequently, the locus of social control has also shifted from psychiatric and medical expertise to community and legal institutions. Diagnosis and treatment models must be more compatible with lay explanatory models. This paper explores the various meanings of "going 'mental"' and "being 'mental"' in the white, working class, ethnic neighborhood of South Boston. The data are extracted from a study of the impact of deinstitutionalization on a cohort of middle-aged, psychiatric patients discharged from Boston State Hospital in the attempt to return them to community living. Individual, family, and community responses to, and interpretations of, the symptoms of mental distress are discussed. The study indicates that even seriously disturbed individuals are sensitive to cultural meanings and social cues regarding the perception, expression, and content of psychiatric episodes. While madness invariably disenfranchises, it does not necessarily deculturate the individual.

Alcoholism↗

PubMed2006

Mapping and measuring social disparities in premature mortality: the impact of census tract poverty within and across Boston neighborhoods, 1999-2001.

The identification and documentation of health disparities are important functions of public health surveillance. These disparities, typically falling along lines defined by gender, race/ethnicity, and social class, are often made visible in urban settings as geographic disparities in health between neighborhoods. Recognizing that premature mortality is a powerful indicator of disparities in both health status and access to health care that can readily be monitored using routinely available public health surveillance data, we undertook a systematic analysis of spatial variation in premature mortality in Boston (1999-2001) across neighborhoods and sub-neighborhoods in relation to census tract (CT) poverty. Using a multilevel model based framework, we estimated that the incidence of premature mortality was 1.39 times higher (95% credible interval 1.09-1.78) among persons living in the most economically deprived CTs (>/=20% below poverty) compared to those in the least impoverished tracts (<5% below poverty). We present maps of model-based standardized mortality ratios that show substantial within-neighborhood variation in premature mortality and a sizeable decrease in spatial variation after adjustment for CT poverty. Additionally, we present maps of model-based direct standardized rates that can more readily be compared to externally published rates and targets, as well as maps of the population attributable fraction that show that in some of Boston's poorest neighborhoods, the proportion of excess deaths associated with CT poverty reaches 25-30%. We recommend that these methods be incorporated into routine analyses of public health surveillance data to highlight continuing social disparities in premature mortality.

Adolescent↗

PubMed2006

Challenges of conducting community-based participatory research in Boston's neighborhoods to reduce disparities in asthma.

Boston is one of the preeminent health care and research centers in the world, but for much of its urban core, these resources are largely out of reach. Community Based Participatory Research (CBPR) provides a model with the potential to bridge the gaps between its research prominence and the health of its residents. We report here two case studies of major research projects that were partnerships between universities in Boston and community based organizations and city agencies. The Healthy Public Housing Initiative (HPHI) and the Asthma Center on Community Environment and Social Stress (ACCESS) are projects that provide numerous lessons about the potential and challenges of conducting CBPR. Ensuring that the projects were true partnerships emerged as key issues in both, especially with respect to funding mechanisms and distribution of resources, although the nature of the challenges differed substantially in the two projects. We note that both academic and community partners may harbor stereotypes about the other and that generalizations about broad populations, academics or community members, may not apply well to everyone. Aligning objectives and expectations emerged as another key lesson. In HPHI, tension between service delivery and research was both a source of conflict and a source of creative development that led to divergent but interesting outcomes. In ACCESS, the tensions revolved more around community capacity building while attempting to build and maintain a large cohort for epidemiological investigations. We conclude that open and frank discussion and a transparent process upfront about project direction, finances, expectations, and other dimensions are necessary but not sufficient to address the inherent challenges in CBPR, and that even so, there are likely to be differences in perspective in such partnerships that require honest negotiation throughout the process of the project.

Asthma↗

PubMed2005

Emergency contraception knowledge among women in a Boston community.

This study assesses the baseline knowledge of emergency contraception (EC) in a Boston neighborhood. A written survey was distributed to women aged 18-44 years in the Boston neighborhood of Jamaica Plain. Of the 188 participants, 82% have heard of EC. Knowledge disparities by race/ethnicity groups were seen, with only 51% of Latina women and 75% of Black women having heard of EC compared with 99% of White women (p < .0001 and p = .002, respectively). Of the entire cohort, 39% knew that EC works by preventing pregnancy, 48% knew that it should be taken within 72-120 h of unprotected intercourse and 44% knew that it is only available by prescription in Massachusetts. Only 25% of women have ever discussed EC with a health care provider, and only 12% have ever received an advance prescription. A community education campaign aimed at reproductive-age women, health care providers and pharmacists has been tailored to address these knowledge deficits.

Adolescent↗

PubMed1987

Are hospital services rationed in New Haven or over-utilised in Boston?

The populations of New Haven and Boston are demographically similar and receive most of their hospital care in university hospitals, but in 1982 their expenditures per head for inpatient care were $451 and $889, respectively. The 685,400 residents of Boston incurred about $300 million more in hospital expenditures and used 739 more beds than they would have if the use rates for New Haven residents had applied. Most of the extra beds were invested in higher admission rates for medical conditions in which the decision to admit can be discretionary. The overall rates for major surgery were equal, but rates for some individual operations varied widely. These findings indicate that academic standards of care are compatible with widely varying patterns of practice and that medical care costs are not necessarily high in communities served largely by university hospitals. They also emphasise the need for increased attention to the outcome and cost implications of differences in practice styles.

Adolescent↗

PubMed1998

Outdoor tobacco advertising in six Boston neighborhoods. Evaluating youth exposure.

BACKGROUND: The Food and Drug Administration (FDA), in its 1996 regulations to restrict certain forms of cigarette advertising likely to appeal to adolescents, prohibited outdoor tobacco advertising within 1,000 feet of schools and playgrounds. No published studies have determined the density of outdoor tobacco advertising within the FDA's prescribed 1,000-foot buffer zone around schools. OBJECTIVE: To determine the prevalence, type, and proximity to public schools of all stationary, outdoor tobacco advertising in six Boston neighborhoods. DESIGN: A cross-sectional field survey conducted in six Boston neighborhoods with varying ethnic, cultural, and socioeconomic characteristics. The main outcome measure was advertising density within buffer zones around public schools. RESULTS: Youth in the six neighborhoods are heavily exposed to stationary, outdoor cigarette advertising. This exposure is intense in areas close to public schools, and more intense in neighborhoods with more children, with significant Black and Hispanic/Latino populations, and with low socioeconomic status. Advertising strategies employed by the tobacco industry are in line with accepted professional marketing practice that targets adolescents for other products. CONCLUSIONS: Given the pervasive nature of the outdoor tobacco advertising we observed in the present study, it appears that the only way to protect youth from exposure is by eliminating it from the community.

Adolescent↗

PubMed1997

Marital structure of the Italian community of Boston, Massachusetts, 1880-1920.

The marital structure of Italians living in Boston, Massachusetts, in the period 1880-1920 was studied in order to explore the integration process in the urban context. The study analyses endogamy and inbreeding, using data on 15,579 marriages from the parish books of the three Italian parishes of Boston. Endogamic rates are very high and increased in time, ranging from 93.9% to 97.3%. This correlated with the growth of the Italian community and the decline of the biased sex ratio. One parish, Our Lady of Pompeii in the South End, displays lower endogamic rates because of the reduced and scattered population attending it. The rate of consanguineous (2.33%) and isonymous (6.38%) marriages, and the coefficients of inbreeding, alpha (0.98 x 10(-3)) and Ft (0.0159), are similar to those of north Italian populations, and lower than those for south and insular Italy. The parish of Our Lady of Pompeii shows consistently higher values than the other two parishes. Marriages between first and second cousins are the main cause of the above values in each parish. Consanguineous marriages and inbreeding increased over time, from the 1890s, and this is in general agreement, although slightly delayed, with the Italian trend.

Acculturation↗

PubMed2005

Platinum group element concentrations and osmium isotopic composition in urban airborne particles from Boston, Massachusetts.

Platinum, Pd, Rh, and Os were found to occur at elevated concentrations in airborne particles (PM10) collected at urban sites in Boston, MA. Average Pt, Pd, Rh, and Os concentrations were 6.9 +/- 1.9, 8.1 +/- 1.8, 1.50 +/- 0.50, and 0.068 (-0.068 + 0.070) pg m(-3), respectively. Elevated Pt, Pd, and Rh concentrations are attributed to automobile catalysts, which use Pt, Pd, and Rh for the removal of pollutants from engine exhaust gas. An automobile catalyst source is supported by significant correlations between these elements and by a Pt/Rh similar to that in catalysts. Elevated Os concentrations are also believed to be the result of emission from automobile catalysts in which Os occurs as an impurity. The isotopic composition of Os (187Os/ 188Os) ranged from 0.30 to 2.90, indicating large variations in Os sources. Osmium has a predominantly anthropogenic origin at concentrations > 0.1 pg m(-3), whereas natural sources are more important at lower Os concentrations. Osmium isotopic composition also indicates that Pt, Pd, and Rh in Boston air are of almost exclusive anthropogenic origin, with a relatively small natural contribution. Our results indicate that scavenging by rain plays a major role in the atmospheric residence time and environmental fate of PGE.

Air Pollutants↗

PubMed2001

The Boston experience.

In April 2000, three nurses from Chesterfield (UK) were successful in an application for a travel scholarship. The scholarship was to examine emergency nurse practitioner (ENP) schemes in Boston USA after completion of my dissertation based on the same subject, in the course of which the broad span of ENP work had become obvious to me. Leading up to the trip overseas, we discussed specific objectives we hoped to meet but we did not expect the range of experiences we were exposed to within this busy city. It became apparent while in Boston, that we should avoid becoming too focused otherwise we might miss valuable information or experiences which would benefit practice back in the UK. Six of the most striking issues, which impressed all three of us, are covered in this paper. These are then reflected back to UK practice in an attempt to discover whether these experiences can benefit our own profession. Subjects covered include: student training; ENP training and role parameters; physician assistants; primary care and the effect of information technology on the emergency care culture.

Boston↗

PubMed1985

Diet and 20-year mortality from coronary heart disease. The Ireland-Boston Diet-Heart Study.

In a prospective epidemiologic study of 1001 middle-aged men, we examined the relation between dietary information collected approximately 20 years ago and subsequent mortality from coronary heart disease. The men were initially enrolled in three cohorts: one of men born and living in Ireland, another of those born in Ireland who had emigrated to Boston, and the third of those born in the Boston area of Irish immigrants. There were no differences in mortality from coronary heart disease among the three cohorts. In within-population analyses, those who died of coronary heart disease had higher Keys (P = 0.06) and modified Hegsted (P = 0.02) dietary scores than did those who did not (a high score indicates a high intake of saturated fatty acids and cholesterol and a relatively low intake of polyunsaturated fatty acids). These associations were significant (P = 0.03 for the Keys and P = 0.04 for the modified Hegsted scores) after adjustment for other risk factors for coronary heart disease. Fiber intake (P = 0.04) and a vegetable-foods score, which rose with increased intake of fiber, vegetable protein, and starch (P = 0.02), were lower among those who died from coronary heart disease, though not significantly so after adjustment for other risk factors. A higher Keys score carried an increased risk of coronary heart disease (relative risk, 1.60), and a higher fiber intake carried a decreased risk (relative risk, 0.57). Overall, these results tend to support the hypothesis that diet is related, albeit weakly, to the development of coronary heart disease.

Adult↗

PubMed1973

Structure of hemoglobin M Boston, a variant with a five-coordinated ferric heme.

X-ray analysis of the natural valency hybrid alpha(2) (+M Boston)beta(2) (deoxy) shows that the ferric iron atoms in the abnormal alpha subunits are bonded to the phenolate side chains of the tyrosines that have replaced the distal histidines; the iron atoms are displaced to the distal side of the porphyrin ring and are not bonded to the proximal histidines. The resulting changes in tertiary structure of the alpha subunits stabilize the hemoglobin tetramer in the quaternary deoxy structure, which lowers the oxygen affinity of the normal beta subunits and causes cyanosis. The strength of the bond from the ferric iron to the phenolate oxygen appears to be the main factor responsible for the many abnormal properties of hemoglobin M Boston.

Adult↗

PubMedDate not supplied

Levels of lead in blood and bone of women giving birth in a Boston hospital.

Blood lead levels declined among Americans aged 1-74 y between the years 1976 and 1991 (National Health and Examination Survey [NHANES III]). In 1990, umbilical cord blood lead levels were surveyed among 223 women who gave birth in a Boston hospital obstetrical service. In a survey conducted 10 y earlier, women had a mean umbilical cord blood lead level of 6.56 micrograms/dl (standard deviation = 3.19). In another subgroup of 41 women who were 1-4 wk postpartum, bone lead levels were surveyed with a K-x-ray fluorescence instrument and by analysis of venous blood lead levels. In 1990, umbilical cord blood lead levels were very low (i.e., mean and median of 1.19 [standard deviation = 1.32] and 1.0 micrograms/dl, respectively. In the subgroup of postpartum women, lead levels in cortical bone (i.e., tibia) and trabecular bone (i.e., patella) were also low (i.e., tibia mean and median of 4.5 [standard deviation = 4.0] and 4 micrograms/g bone mineral, respectively); patella mean and median of 5.8 [standard deviation = 4.5] and 5 micrograms/g, respectively). Maternal age was the only factor associated (i.e., borderline [p=.076]) with bone lead. Umbilical cord blood lead levels among women served by this Boston hospital from 1980 to 1990 declined dramatically, thus paralleling the National Health and Examination Survey. Bone lead levels were also low, but lead remains a reproductive hazard to women in select high-risk groups.

Adolescent↗

PubMedDate not supplied

Estimation of the prevalence of injection drug use in greater Boston in 1993.

This article is a report on different methods of estimation of the number of injection drug users (IDUs) in the Boston standard metropolitan statistical area (SMSA) in 1993. Because the sharing of needles is a means of transmission for HIV, an estimate of the prevalence of injection drug use is essential for acquired immunodeficiency syndrome (AIDS) prevention programs. The data for this study come from the Massachusetts Department of Public Health Bureau of Substance Abuse, the Massachusetts AIDS Surveillance Unit, the Drug Abuse Warning Network (DAWN), the National Household Survey on Drug Abuse: Population Estimates 1993, and the Massachusetts State Police Crime Reporting Unit. The estimates in this study can be assessed with regard to the different time frames that are involved, noting that some estimates are useful only to establish upper or lower bounds. The estimate that best meshes with the findings of this report is that there were between 13,500-16,500 injection drug users in greater Boston and 45,000-60,000 IDUs in Massachusetts in 1993.

Acquired Immunodeficiency Syndrome↗

PubMed1993

Infectious diseases at the Boston City Hospital: the first 60 years.

During the 60 years that followed the opening of the Boston City Hospital in 1864, Boston experienced severe epidemics of diphtheria, scarlatina, and measles. The South Department was created to isolate patients, primarily children, who suffered from those diseases. Smallpox was a serious public health problem, and typhoid fever, pneumonia, and tuberculosis continued to cause high mortality. Diagnoses became more accurate and nursing care improved, although for most diseases treatment was not markedly better. The influenza epidemic in 1918 demonstrated how little could be done for patients. Nonetheless, the reputation of the hospital grew, and it gained increased acceptance in the community as medicine became more scientific.

Boston↗

PubMed1978

Bacteremic superinfections of patients with bacteremia: occurrence, bacteriology, mortality, and duration of hospitalization at Boston City Hospital during 12 selected years between 1935 and 1972.

During the course of hospitalization of 6,414 patients with bacteremic infections identified at Boston City Hospital (Boston, Massachusetts) during 12 selected years between 1935 and 1972, 6.0% developed verified bacteremic superinfections with organisms not isolated or identified in the primary bacteremic infection. Analysis of these cases reemphasizes the increasing occurrence of serious hospital-acquired infections despite the successive introduction and intensive use of a large number of effective antibacterial agents. The bacteremic superinfections, like the primary hospital-acquired bacteremias, increased in incidence over the years, particularly since 1961; they were more frequent and were associated with a higher mortality rate and longer duration of hospital stay in the primary hospital-acquired cases than in the patients in whom bacteremia was considered to be community-acquired. The organisms in superinfections were similar to those in primary hospital-acquired bacteremias. Superinfection was more frequent among the patients who died than among the survivors.

Bacterial Infections↗

PubMed2000

Boston's contributions to the development of orthopaedics in the United States. A brief history.

Since the early part of the nineteenth century, physicians from Boston have had a major impact on orthopaedics in America. Initially, the general surgeons such as John Ball Brown and his son, Buckminster had an impact on orthopaedics, but contributors such as Henry Bigelow and Charles Scudder added greatly to the knowledge and capacity for care. The first orthopaedic ward, Ward I, was located at the Massachusetts General Hospital and began the new era. Surgical treatment by orthopaedists began in the twentieth century with such contributors as Philip Wilson, EA Codman, Robert B. Osgood, Joel Goldthwait, Elliot Brackett, Robert Lovett, and Edward Bradford. These physicians not only treated patients at the Children's, Tufts University, Boston City, the Beth Israel, and the Massachusetts General Hospitals, but assumed the academic responsibilities of a major educational center. More recently the contributors to orthopaedics have included Marius Smith-Petersen, Otto Aufranc, Henry Banks, Edward Cave, Carter Rowe, Joseph Barr, and others who have created a spectacular program for education, research, and clinical care.

Boston↗