David E. Harris

Mortality impact of an integrated community cardiovascular health program

BACKGROUND Preventing cardiovascular disease through community interventions makes theoretical sense but has been difficult to demonstrate. We set out to determine whether a community cardiovascular health program had an impact on mortality. DESIGN Program evaluation plus ecologic observational analysis of program encounters and mortality rates with external comparisons. SETTING Franklin County and two comparison counties in rural Maine. PARTICIPANTS Program encountered >50% of regional adults, broadly distributed by site, gender, and age. INTERVENTIONS From 1974 to 1994, a community program, integrated with primary medical care and staffed by professional nurses, provided education, screening, counseling, referral, tracking, and follow-up for cardiovascular risk factors. MAIN OUTCOME MEASURES Age-adjusted mortality rates (total, heart, coronary, cerebrovascular, cancer) for three counties and Maine, plus annual program encounters. RESULTS Relative to Maine, the Franklin heart disease death rate was 0.97 at baseline (1960-1969; 95% confidence interval, 0.91 to 1.03), 0.91 during the program (0.85 to 0.97), 0.83 during the 11 years of program growth (0.78 to 0.88), but 1.0 during the 10 years of decreasing encounters. Franklins total death rate was 1.01 at baseline, 0.95 during the program (0.92 to 0.98), and 0.90 during program growth (0.86 to 0. 94). Results were similar for coronary disease, stroke, and cancer. Relative death rates did not fall in either comparison county. Nurse-client encounters totaled 120,280 over 21 years. Relative to Maine, heart disease death rates correlated inversely with program encounters (r = -0.53) but not with unemployment or physician supply. CONCLUSIONS Integrated with primary medical care, a comprehensive, nurse-mediated community cardiovascular health program in rural Maine has been associated with significant time-dependent and dose-dependent reductions in cardiovascular and total mortality.

Location of Food Stores Near Schools Does Not Predict the Weight Status of Maine High School Students.

OBJECTIVE To examine the relationship between stores selling calorie-dense food near schools and student obesity risk, with the hypothesis that high availability predicts increased risk. METHODS Mail surveys determined height, weight, and calorie-dense food consumption for 552 students at 11 Maine high schools. Driving distance from all food stores within 2 km (1.24 miles) of schools (or the closest store) was computed, and the impact of food store density and proximity to schools on student body mass index was determined by logistic regression. RESULTS Ten schools had ≥ 1 store selling soda, and 8 schools had ≥1 fast-food restaurant within 1 km (0.62 miles). There were no significant relationships between the proximity or density of food stores around schools and student obesity risk. Students obtained sugar-sweetened beverages in many locations including at school. CONCLUSIONS AND IMPLICATIONS Unhealthful food choices are ubiquitous. Consequently, stores selling these food items near schools have no significant affect on student obesity.

Seal bounties in Maine and Massachusetts, 1888 to 1962.

Abstract Maine and Massachusetts paid bounties on seals during the 19th and 20th centuries. To determine the number of seals killed for bounty, we examined historical records of bounty claims, and used geographic information systems and multiple linear regression to find predictors of places where large numbers of bounties were paid. We found records of 24,831 bounties paid in Maine (1891–1945) and 15,690 in Massachusetts (1888–1962). Considering possible fraud, missing data, and seals struck and lost, this suggests that 72,284 to 135,498 seals were killed in the bounty hunt, probably enough to account for regional declines in seal populations. Larger numbers of bounties were paid where there were more seals and a higher human population.

Cardiac rehabilitation with nurse care management and telephonic interactions at a community hospital: program evaluation of participation and lipid outcomes.

Cardiac rehabilitation (CR) can help patients with heart disease control some risk factors, limit new coronary artery lesions, and decrease death rates. However, participation rates in CR are low. Using a descriptive design, we evaluated a modified CR program in which nurse care managers used telephonic communication with patients in their homes by comparing it to a traditional CR program in a hospital setting. Using multivariate analysis we compared the patient cohorts eligible for each of the programs, and program participants to the nonparticipants for each program. Compared to traditional CR, the modified CR program with nurse care management was associated with significantly improved participation rates (11% vs. 22%) and the apparent overcoming of several well-described barriers to CR participation (distance from the hospital and domestic isolation). Risk factor management, including testing of serum lipids and achieving goals for lipid reduction, for participants in both CR programs was superior to risk factor management for nonparticipants.

HARP SEAL RECORDS FROM THE SOUTHERN GULF OF MAINE: 1997 – 2001

Abstract Harp seals (Phoca groenlandica) whelp on the North Atlantic pack ice in early spring, move north in the summer and then, historically, return as far south as Nova Scotia in the fall. Because recent reports document increased sightings in the northern Gulf of Maine, we reviewed records of harp seal sightings between Kittery and Rockland, Maine to determine if this increase is also occurring in the southern Gulf. From 1997 to 2001 we found 357 confirmed reports of harp seal sightings. Most (85%) occurred in the first quarter of the year and almost all (96%) were juveniles. The total sightings for 2001 (N=238) greatly exceeded the number in any other year. The weight and health status of the seals sighted in 2001 was no different from those of previous study years. Thus, harp seals are sighted in substantial numbers in both the southern and northern Gulf of Maine. The reason for this general increase, as well as the reason for the spike in 2001, is unknown.

The Impact of Maternal Obesity and Excessive Gestational Weight Gain on Maternal and Infant Outcomes in Maine: Analysis of Pregnancy Risk Assessment Monitoring System Results from 2000 to 2010

The objective of this study is to understand the relationships between prepregnancy obesity and excessive gestational weight gain (GWG) and adverse maternal and fetal outcomes. Pregnancy risk assessment monitoring system (PRAMS) data from Maine for 2000–2010 were used to determine associations between demographic, socioeconomic, and health behavioral variables and maternal and infant outcomes. Multivariate logistic regression analysis was performed on the independent variables of age, race, smoking, previous live births, marital status, education, BMI, income, rurality, alcohol use, and GWG. Dependent variables included maternal hypertension, premature birth, birth weight, infant admission to the intensive care unit (ICU), and length of hospital stay of the infant. Excessive prepregnancy BMI and excessive GWG independently predicted maternal hypertension. A high prepregnancy BMI increased the risk of the infant being born prematurely, having a longer hospital stay, and having an excessive birth weight. Excessive GWG predicted a longer infant hospital stay and excessive birth weight. A low pregnancy BMI and a lower than recommended GWG were also associated with poor outcomes: prematurity, low birth weight, and an increased risk of the infant admitted to ICU. These findings support the importance of preconception care that promotes achievement of a healthy weight to enhance optimal reproductive outcomes.

HOODED SEAL (CYSTOPHORA CRISTATA) RECORDS FROM THE SOUTHERN GULF OF MAINE

Abstract Hooded seals (Cystophora cristata) whelp on the North Atlantic pack ice in early spring and then historically distribute as far south as Nova Scotia. Recent reports document increased sightings in the northern Gulf of Maine. To determine the number of sightings in the southern Gulf of Maine, we reviewed records of stranded hooded seals between Kittery and Rockland, Maine, for 1997–1999 and found 84 confirmed reports. The 1998 totals (43), exceeded those in 1997 (20) or 1999 (21). Most sightings occurred during the winter months, with six in the summer/fall of 1999. Thus, hooded seals are sighted in substantial numbers in both the southern and northern Gulf of Maine.

GIS-based Analysis of Ice-breeding Seal Strandings in the Gulf of Maine

Abstract Phoca groenlandica (harp seals) and Cystophora cristata (hooded seals), two species of ice-breeding seals, are being sighted more frequently onshore in the Gulf of Maine since 1990, but little is known about their behavior in this ecosystem. We obtained records of 904 ice-breeding seal stranding locations in the Gulf of Maine between 1996 and 2002 from NOAA Fisheries and used a geographic information system (GIS) to conduct group-wise comparisons by species (using non-parametric techniques), and to determine the predictors of high seal-stranding density (using ordinal logistic regression analysis). Compared to harp seals, hooded seals stranded closer to deep water, farther north, and near different intertidal shoreline types. Predictors of high seal-stranding density included being closer to an offshore basin, deep water, public land, and areas of lower human population. These results may reflect seal behavior and reporting bias.

Long Term Observations of a Harbor Seal Haul-Out Site in a Protected Cove in Casco Bay, Gulf of Maine.

Abstract We counted the numbers of seals hauled out at low tide on two near-shore ledges in a protected cove in Casco Bay, Gulf of Maine a minimum of 12 times per month, for four years starting in August 1997. The highest mean monthly counts were in August (molting season) and the lowest in either January or February. Counts during pupping season (May and June) were lower than during April or July. As no mother-pup pairs were observed, these ledges are molting but not pupping ledges. Time-series analysis revealed no overall trend in the number of seals present, but did show a decreasing trend in the fraction of days each month that seals were present. Further observations are needed to determine if this trend is continuing and if it is present in other locations on the Maine coast.

11-Year Trends in Pregnancy-Related Health Indicators in Maine, 2000–2010

The objective of this study is to understand health and demographic trends among mothers and infants in Maine relative to the goals of Healthy People 2020. Pregnancy risk assessment monitoring system (PRAMS) data from Maine for 2000–2010 were used to determine yearly values of pregnancy-related variables. Means (for continuous variables) and percentages (for categorical variables) were calculated using the survey procedures in SAS. Linear trend analysis was applied with study year as the independent variable. The slope and significance of the trend were then calculated. Over the study period, new mothers in Maine became better educated but the fraction of households with incomes <