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PubMed2002

Maternal morbidity and pregnancy outcome in a cohort of mothers transferred out of perinatal centres during a national census.

OBJECTIVE: To record the maternal morbidity and pregnancy outcome in this cohort. DESIGN: Retrospective data collection from a prospectively defined cohort. SETTING: The 37 largest perinatal centres in the UK. POPULATION: 258 in utero transfers recorded during a three-month census (1/4/99-30/6/99). METHODS: A questionnaire regarding the outcome of each mother was sent to the perinatal centre and receiving hospital. RESULTS: Data were returned on 242/258 (94%) mothers. Fifty-eight percent were transferred out of their perinatal centre in preterm labour and 38% had coexisting disease necessitating early delivery. The median gestational age at transfer was 32 weeks (range 23-41). Sixty-one percent delivered at the receiving hospital; 12% were transferred on to a third hospital and 29% ultimately returned to deliver at the original perinatal centre. Fifty-two percent of mothers received postnatal care in hospitals other than those defined as a major perinatal centre. One mother delivered during transfer and a further nine within one hour of arrival. One mother received intensive care after delivery and later died, a further 7% required high dependency care postnatally. Data were available on 273/333 (82%) babies. The median gestational age at delivery was 34 weeks (range 24-41). Six infants were stillborn and 187/264 (71%) infants were admitted to a neonatal unit. CONCLUSIONS: This study has documented the maternal morbidity, potential risks and pregnancy outcome of a cohort of mothers transferred out of the largest perinatal centres in the UK because of a shortage of neonatal cots. A national standard for the delivery of high risk perinatal services is needed to uphold good clinical practice guidelines in the care of high risk mothers and their infants.

Bed Occupancy↗
PubMed2005

Prevalence of Parkinson's disease in Sydney.

OBJECTIVE: To examine the prevalence of Parkinson's disease (PD) in Bankstown, Sydney, using the same methodology as a previous study in Randwick, Sydney, Australia (1998-1999). PARTICIPANTS AND METHODS: Twenty census districts (CDs) for the Bankstown local government area were randomly selected. Research personnel door-knocked every household within the CDs to locate people aged > or =55 years. A structured questionnaire (containing four screening questions for PD) was administered to those agreeing to participate. Screened positive participants were invited to come for a clinical examination. This is a continuation of the previous study and data have been combined. RESULTS: Combining data for Bankstown and Randwick gave 1028 participants; crude prevalence, 780 per 100,000 (CI: 546-1077). In Bankstown, there were 501 participants aged > or =55 years (response rate 70%); 135 were screened positive with 101 (74.8%) agreeing to a clinical examination. The prevalence of PD in the Bankstown community was 3.4% (17 of 501) (95% CI: 1.98-5.43) for those aged > or =55 years; crude prevalence 776 per 100,000 (CI: 452-1241). CONCLUSION: The combined results of two Sydney studies appear to indicate that Sydney has one of the highest prevalence estimates of PD in developed countries.

Aged↗
PubMed1990

Alcoholism among Taiwan aborigines defined by the Chinese Diagnostic Interview Schedule: a comparison with alcoholism among Chinese.

The prevalence of alcoholism was reported to be 0.1% in an aboriginal study on Taiwan using the census survey method in the 1950s. This study adopted a modified Chinese Diagnostic Interview Schedule to determine the prevalence of DSM-III-defined alcohol abuse (AA) and alcohol dependence (AD) in the Atayal, Paiwan and Yami ethnic groups of Taiwan aborigines. Stratified random sampling was used. The sample sizes of Atayal, Paiwan and Yami were 793, 656 and 106 respectively. The prevalence rates of DSM-III-defined AA and AD were 11.6%, 11.4% and 14.2%; and 9.0%, 8.1% and 6.4% respectively. No significant difference was found between the 3 ethnic groups. These prevalence figures are significantly higher than those for Chinese. In this comparative analysis, 2 distinct etiological hypotheses are proposed for the AA and the AD.

Alcoholism↗
PubMed2006

EMTs and GPs: what do we think of each other?

BACKGROUND: Ireland's health services are undergoing dramatic reorganisation. The establishment of general practitioner (GP) out of hours cooperatives and the integration of current ambulance services into a national ambulance service are among the issues that will impact on prehospital care of emergencies. The study aimed to explore the perceptions of GPs and emergency medical technicians (EMTs) of their own and each other's roles in the context of such reforms. METHODS: A census of all GPs (511) and EMTs (301) in three of Ireland's eight health board regions was undertaken. A questionnaire containing 31 statements asked respondents to indicate their agreement (or lack of it) in areas such as general relationships, care, and training, roles in emergencies and future developments. RESULTS: Of the personnel contacted, 72% of GPs and 75% of EMTs responded. They report excellent working relationships, agree that the ambulance service is of high quality, and that GPs are willing to provide care in emergencies. However, working links are less satisfactory for EMTs, who report a far higher perception of GP use of emergency ambulances than reported by GPs. Both groups are interested in innovative future links. DISCUSSION: Convergence between the professional groups in different geographic areas and between the disciplines across the areas is striking. They include areas of satisfaction and dissatisfaction. The need for improved liaison between the disciplines is clear.

Attitude of Health Personnel↗
PubMed2005

Urban area disadvantage and physical activity: a multilevel study in Melbourne, Australia.

OBJECTIVE: To estimate variation between small areas in the levels of walking, cycling, jogging, and swimming and overall physical activity and the importance of area level socioeconomic disadvantage in predicting physical activity participation. METHODS: All census collector districts (CCDs) in the 20 innermost local government areas in metropolitan Melbourne, Australia, were identified and ranked by the percentage of low income households (<400 dollars/week) living in the CCD. Fifty CCDs were randomly selected from the least, middle, and most disadvantaged septiles of the ranked CCDs and 2349 residents (58.7% participation rate) participated in a cross sectional postal survey about physical activity. Multilevel logistic regression (adjusted for extrabinomial variation) was used to estimate area level variation in walking, cycling, jogging, and swimming and in overall physical activity participation, and the importance of area level socioeconomic disadvantage in predicting physical activity participation. RESULTS: There were significant variations between CCDs in all activities and in overall physical participation in age and sex adjusted models; however, after adjustment for individual SES (income, occupation, education) and area level socioeconomic disadvantage, significant differences remained only for walking (p = 0.004), cycling (p = 0.003), and swimming (p = 0.024). Living in the most socioeconomically disadvantaged areas was associated with a decreased likelihood of jogging and of having overall physical activity levels that were sufficiently active for health; these effects remained after adjustment for individual socioeconomic status (sufficiently active: OR 0.70, 95% CI 0.55 to 0.90 and jogging: OR = 0.69, 95% CI 0.51 to 0.94). CONCLUSION: These research findings support the need to focus on improving local environments to increase physical activity participation.

Adolescent↗
PubMed1977

Social area analysis in community medicine.

There is an acknowledged need for better information to guide resource allocation and service planning in the health services. Despite the recognition of the important role of socioeconomic factors, difficulties with the appropriate presentation of daya have so far proved insuperable. Social area analysis (SAA), which is a generic name for a number of methods employing census and other data to classify small areas into similar socioeconomic groups, is an approach which quantifies data in a useful fashion and has important applications in medical, epidemiological and health services research. Most previous British exercises in SAA have been in the field of town planning. The potentialities of the approach for community medicine are evaluated, by the use of information from two existing studies. This is shown to discriminate more effectively than does existing health information between hypotheses concerning geographical variations in mortality, and it provides adequate explanations for urban area differentials in infant mortality, the uptake of vaccination, and the incidence of infectious disease. Specific applications of SAA in health planning and research are discussed.

Community Health Services↗
PubMed2000

Persistence of tropical ataxic neuropathy in a Nigerian community.

OBJECTIVES: The term tropical ataxic neuropathy (TAN) is currently used to describe several neurological syndromes attributed to toxiconutritional causes. However, TAN was initially proposed to describe a specific neurological syndrome seen predominantly among the Ijebu speaking Yorubas in south western Nigeria. In this study, the prevalence of TAN was determined in Ososa, a semiurban community in south western Nigeria described as endemic for TAN in 1969, and its neurological features were compared with Strachan's syndrome, prisoners of war neuropathy, the epidemic neuropathy in Cuba, and konzo. METHODS: A census of Ososa was followed by door to door screening of all subjects aged 10 years and above with a newly designed screening instrument. Subjects who screened positive had a neurological examination, and the diagnosis of TAN was made if any two or more of bilateral optic atrophy, bilateral neurosensory deafness, sensory gait ataxia, or distal symmetric sensory polyneuropathy were present. RESULTS: A total of 4583 inhabitants were registered in the census. Of these, 3428 subjects aged 10 years and above were screened. The diagnosis of TAN was made in 206 of 323 subjects who screened positive for TAN. The prevalence of TAN was 6. 0%, 3.9% in males and 7.7% in females. The highest age specific prevalence was 24% in the 60-69 years age group in women. CONCLUSION: The occurrence of TAN in Ososa continues at a higher prevalence than was reported 30 years ago. Its neurological features and natural history do not resemble those described for Strachan syndrome, epidemic neuropathy in Cuba, or konzo. The increasing consumption of cassava foods linked to its causation makes TAN of public health importance in Nigeria, the most populous African country.

Adolescent↗
PubMed2006

Trends in hospitalization rate, hospital case fatality, and mortality rate of stroke by subtype in Minneapolis-St. Paul, 1980-2002.

BACKGROUND: The stroke mortality rates have been declining in the USA for decades. Less is known about trends in stroke incidence rates, but some studies indicate they have declined. The stroke case fatality has also been declining. Little information exists on trends in stroke subtypes. We examined trends in mortality, hospitalization rate, and hospital case fatality of stroke by subtype in the Minneapolis-St. Paul area from 1980 to 2002. METHODS: We estimated hospitalization rates and case fatality for > or =30-year-olds with data from the Minnesota Hospital Association. We estimated mortality rates with counts from the Minnesota Department of Health. Rates were age adjusted to the US 2000 standard by the direct method using census estimates. We tested for significant trends using linear regression. RESULTS: Total stroke mortality and hospital case fatality both declined by almost 50% over the study period, while the rate of stroke hospitalization was relatively stable. Ischemic stroke hospitalization rates increased, while hospital case fatality and mortality rates decreased. Subarachnoid hemorrhage in-hospital case fatality and mortality rates declined, while the hospitalization rate was stable. Intracerebral hemorrhage hospitalization rates increased minimally, hospital case fatality declined, and the mortality rate was stable. CONCLUSION: These data suggest that declines in total stroke case fatality are contributing most to declining mortality rates in the presence of stable total stroke attack rates.

Adult↗
PubMed2006

Representation of asylum seekers and refugees among psychiatric inpatients in London.

OBJECTIVE: Refugees are at high risk of mental disorders but often complain about a lack of access to appropriate care. The purpose of this study was to assess the representation of refugees among psychiatric inpatients, given that it has been suggested that they use a disproportionate level of care compared with nonrefugees. METHODS: A census of all psychiatric inpatient units in London was used to determine the numbers of inpatients, the numbers of refugees, and measures of need, such as compulsory detention, duration of admission, need for interpreters, and whether inpatient status was appropriate. RESULTS: Of 2,955 psychiatric inpatients, 134 (4.5 percent) were refugees. Refugees' admission rates were similar to or lower than those of nonrefugees. Refugees were more likely to be inappropriately placed, to require interpreters, and to have more complex needs. CONCLUSION: The results of this study suggest that refugees are not overusing London's psychiatric inpatient units but have complex needs that challenge existing service providers.

Adolescent↗
PubMed1996

Community attitudes to mental illness.

BACKGROUND: The baseline findings from a controlled study of the effect of a public education campaign on community attitudes to mental illness are presented. METHOD: A census of attitudes to mental illness was conducted in two areas, prior to the opening of supported houses for the mentally ill. Factor analysis of the Community Attitudes toward the Mentally Ill (CAMI) inventory revealed three components: Fear and Exclusion, Social Control and Goodwill. RESULTS: The only determinant of Fear and Exclusion was having children. The main determinants of Social Control were social class, ethnic origin, age, having suffered mental illness and having children. The main determinant of Goodwill was educational level. The attitude factors were predictive of respondents' behavioural intentions toward the mentally ill. Respondents with children and non-Caucasians were more likely to object to the mentally ill living in their neighbourhood. CONCLUSIONS: Any intervention aimed at changing attitudes to mentally ill people in the community should be targeted at people with children and non-Caucasians, as these groups are more likely to object.

Adolescent↗
PubMed1996

Community knowledge of mental illness and reaction to mentally ill people.

BACKGROUND: We test the hypothesis that negative attitudes to mentally ill people may be fuelled by a lack of knowledge. METHOD: A census of knowledge of mental illness was conducted in two areas prior to the opening of long-stay supported houses for the mentally ill in each area. Three attitudinal factors (Fear and Exclusion, Social Control and Goodwill) which had been extracted by factor analysis of the Community Attitudes toward the Mentally Ill (CAMI) inventory (see previous paper) were analysed in respect of their associations with knowledge of mental illness. RESULTS: Most respondents (80%) knew of somebody who had a mental illness but a substantial proportion of respondents had little knowledge about mental illness. Social Control showed an association with knowledge of mental illness. Groups who showed more socially controlling attitudes (especially those over 50 years old, those of lower social class, and those of non-Caucasian ethnic origin) had less knowledge about mental illness. Regression analysis revealed that when knowledge was taken into account, age had no effect on Social Control, and the effect of social class and ethnic origin was diminished. Respondents with children, who showed more Fear and Exclusion, were not less knowledgeable about mental illness. CONCLUSIONS: The results support the hypothesis that negative attitudes, especially in older people, are fuelled by a lack of knowledge. Negative attitudes among people with children are not related to a lack of knowledge.

Adolescent↗
PubMed1996

Public education for community care. A new approach.

BACKGROUND: The findings from a controlled study of the effect of a public education campaign on community attitudes to mentally ill people are presented. METHOD: A census of neighbours' attitudes toward mental illness was conducted in two areas before the opening of supported houses for the mentally ill. In one area an educational campaign was conducted. The attitude survey was then repeated in both areas and patients' social contact with neighbours was recorded. RESULTS: Respondents exposed to the didactic component of the campaign showed only a small increase in knowledge about mental illness but there was a lessening of fearful and rejecting attitudes in the experimental area and not in the control area. Neighbours in the experimental area were more likely to make social contact with both staff and patients. It was social contact which was directly associated with improved attitudes rather than education per se. Patients in the experimental area made contact and even friendships with neighbours whereas those in the control area did not. CONCLUSIONS: The public education campaign did not lead to significant change in neighbours' knowledge of mental illness. However, their attitudes improved and patients' social integration was enhanced.

Activities of Daily Living↗
PubMed2001

Survey of patients from an inner-London health authority in medium secure psychiatric care.

BACKGROUND: Underprovision by the National Health Service (NHS) has led to an increase in medium secure psychiatric beds managed by the independent sector. Black people are overrepresented in medium secure care. AIMS: To describe those people from an inner-London health authority occupying all forms of medium secure provision. To compare those in NHS provision with those in the independent sector, and Black patients with White patients. METHOD: A census of those in medium secure care in August 1997. RESULTS: The 90 patients in independent-sector units were similar to the 93 patients in NHS units except that they were more likely to have been referred from general psychiatric services (48% v. 19%) and less likely to have been referred from the criminal justice system or a high-security hospital (37% v. 63%). There were few differences between Black and White patients. CONCLUSIONS: The NHS meets only part of the need for medium secure care of the population of this London health authority. This comparison of the characteristics of Black and White patients does not help to explain why Black people are overrepresented in medium secure settings.

Adolescent↗
PubMed2006

Asthma prevalence among US adults, 1998-2000: role of Puerto Rican ethnicity and behavioral and geographic factors.

OBJECTIVES: We analyzed asthma prevalence among US adults by age, gender, race, Puerto Rican ethnicity, and other demographic, behavioral, health, and geographic variables. We hypothesized that high prevalences would be observed among Puerto Ricans and in the Northeast census region. METHODS: We used data from the 1998 through 2000 US National Health Interview Surveys. Information on lifetime history of asthma and asthma in the past year was collected from 95615 adults. We calculated weighted prevalence estimates and odds ratios from logistic regression. RESULTS: Of US adults, 8.9% had ever been diagnosed with asthma, and 3.4% had experienced an episode in the past 12 months. Asthma diagnosis rates were highest among Puerto Ricans (17.0%) and lowest among Mexican Americans (3.9%); rates were 9.6% and 9.2% among non-Hispanic Blacks and non-Hispanic Whites, respectively. Geographically, asthma prevalence was highest in the West (10.5%) and lowest in the Northeast (8.6%). Puerto Ricans in all regions had high asthma rates. CONCLUSIONS: final logistic regression model included race/ethnicity, obesity, poverty, female gender, and cigarette smoking. Higher asthma rates were confirmed among Puerto Ricans but not in the Northeast region.

Adolescent↗
PubMed1993

An injury prevention program in an urban African-American community.

OBJECTIVES: Injury is a major US public health problem, particularly in urban minority communities. This paper evaluates the impact of the Safe Block Project, a comprehensive injury prevention trial, on home hazards and injury prevention knowledge in a poor urban African-American community. METHODS: Nine census tracts in the community were allocated to either the intervention area or the control area. The intervention, carried out by trained community outreach workers, consisted of (1) home modification for simple prevention measures, (2) home inspection accompanied by information about home hazards, and (3) education about selected injury prevention practices. Approximately 12 months after the intervention, random samples of control and intervention homes were assessed for home hazards and injury prevention knowledge. RESULTS: A significantly larger proportion of intervention homes than control homes had functioning smoke detectors, syrup of ipecac, safely stored medications, and reduced electrical and tripping hazards. No consistent differences were observed between control and intervention homes on home hazards requiring major effort to correct. CONCLUSIONS: There was a distinct difference between control and intervention homes with respect to safety knowledge and home hazards requiring minimal to moderate effort to correct. The Safe Block Project could serve as a model for future urban injury prevention efforts.

Accidents, Home↗
PubMed1996

Aiding troubled employees: the prevalence, cost, and characteristics of employee assistance programs in the United States.

OBJECTIVES: Employee assistance programs (EAPs) are job-based programs designed to identify and assist troubled employees. This study determines the prevalence, cost, and characteristics of these programs in the United States by worksite size, industry, and census region. METHODS: A stratified national probability sample of more than 6400 private, nonagricultural US worksites with 50 or more full-time employees was contacted with a computer-assisted telephone interviewing protocol. More than 3200 worksites responded and were eligible, with a response rate of 90%. RESULTS: Approximately 33% of all private, nonagricultural worksites with 50 or more full-time employees currently offer EAP services to their employees, an 8.9% increase over 1985. These programs are more likely to be found in larger worksites and in the communications/utilities/transportation industries. The most popular model is an external provider, and the median annual cost per eligible employee for internal and external programs was $21.83 and $18.09, respectively. CONCLUSIONS: EAPs are becoming a more prevalent point of access to health care for workers with personal problems such as substance abuse, family problems, or emotional distress.

Adult↗
PubMed2004

Geographic location of commercial plasma donation clinics in the United States, 1980-1995.

OBJECTIVE: We examined the location of commercial plasma donation centers in the United States over the period 1980 to 1995 relative to the geographic distribution of risk behaviors associated with transfusion-transmissible infections. METHODS: The census tract locations of commercial source plasma clinics were described by measures of neighborhood social disadvantage and the prevalence of illicit drug use and active local drug economies. RESULTS: Depending on the measure of social environment used, commercial plasma clinics were 5 to 8 times more likely to be located in census tracts designated high-risk than would be expected by chance. CONCLUSIONS: Commercial source plasma clinics were overrepresented in neighborhoods with very active local drug economies. These patterns persisted after the links between human immunodeficiency virus and hepatitis C virus infections and plasma products had been established and may present risks to blood system safety.

Ambulatory Care Facilities↗
PubMedDate not supplied

Quantity and distribution of continuing professional education opportunities among healthcare workers in Ghana.

BACKGROUND: Despite their importance, continuing professional education opportunities have been rarely addressed in literature. This study explains how continuing professional education opportunities among the healthcare workers in Ghana are distributed. METHOD: A census was conducted using a self-administered questionnaire (N = 6,696). Three focus group discussions with a total of 23 healthcare workers were undertaken. RESULTS: The study found that the quantities of continuing professional education opportunities were unequally distributed. The total continuing professional education opportunities were greater than the target of the Ministry of Health but fewer than healthcare workers' demand. Type of occupational group was the major determinant of continuing professional education opportunities. CONCLUSION: To ensure homogeneously appropriate quality of services, continuing professional education opportunities should be equally distributed.

Adult↗