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PubMed1996

Regional differences in alcohol and fatal injury: a comparison of data from two county coroners.

OBJECTIVE: While alcohol has been found to be associated with fatal injury, this association may vary in different regions of the United States where drinking patterns and problems are known to vary. The purpose of this study was to analyze alcohol in injury fatalities in a "dry" area of the country (Hinds County, Miss.) compared to a "wet" area (Contra Costa County, Calif.). METHOD: Data on all unnatural causes of death during a 1-year period among those 18 years and older were abstracted from county coroner records in Hinds County, Miss. (n = 222) and Contra Costa County, Calif. (n = 304). RESULTS: Across all causes of death, those in Hinds County were more likely to be alcohol-involved (57%) compared to those in Contra Costa (40%). Those in Hinds County were twice as likely as those in Contra Costa to have died from homicide (32% vs 17%), but the proportion of homicides which was alcohol positive did not differ between the two regions (51% vs 46%). Using logistic regression, gender (male) and region (South) were predictive of a positive blood alcohol concentration across all causes of fatality combined. Age (younger) and ethnicity (black) were predictive of homicide. Ethnicity (non-black), a negative blood alcohol concentration and a positive drug screen were predictive of suicide, while age (younger), ethnicity (non-black), a positive blood alcohol concentration and a negative drug screen were predictive of motor vehicle accidents. CONCLUSIONS: These data suggest that regional variations in alcohol's association with fatal injury do exist, and vary by demographic characteristics and cause of death. In addition, areas of the country that have relatively low rates of per capita consumption may have higher rates of alcohol-related injury fatalities than areas with greater per capita consumption.

Accidents, Traffic↗
PubMed2005

Primary care, social inequalities, and all-cause, heart disease, and cancer mortality in US counties, 1990.

OBJECTIVES: We tested the association between the availability of primary care and income inequality on several categories of mortality in US counties. METHODS: We used cross-sectional analysis of data from counties (n=3081) in 1990, including analysis of variance and multivariate ordinary least squares regression. Independent variables included primary care resources, income inequality, and sociodemographics. RESULTS: Counties with higher availability of primary care resources experienced between 2% and 3% lower mortality than counties with less primary care. Counties with high income inequality experienced between 11% and 13% higher mortality than counties with less inequality. CONCLUSIONS: Primary care resources may partially moderate the effects of income inequality on health outcomes at the county level.

Adult↗
PubMed2002

Income inequality and mortality in US counties: does minority racial concentration matter?

UNLABELLED: This study examined (1) the relationship between income inequality and mortality among all counties in the contiguous United States to ascertain whether the relationships found for states and metropolitan areas extend to smaller geographic units and (2) the influence of minority racial concentration on the inequality-mortality linkage. METHODS: This county-level ecologic analysis used data from the Compressed Mortality Files and the US Census. Weighted least squares regression models of age-, sex-, and race-adjusted county mortality rates were estimated to examine the additive and interactive effects of income inequality and minority racial concentration. RESULTS: Higher income inequality at the county level was significantly associated with higher total mortality. Higher minority racial concentration also was significantly related to higher mortality and interacted with income inequality. CONCLUSIONS: The relationship between income inequality and mortality is robust for counties in the United States. Minority concentration interacts with income inequality, resulting in higher mortality in counties with low inequality and a high percentage of Blacks than in counties with high inequality and a high percentage of Blacks.

Black or African American↗
PubMedDate not supplied

Multiple genotypes of St. Louis encephalitis virus (Flaviviridae: Flavivirus) circulate in Harris County, Texas.

St. Louis encephalitis (SLE) is endemic in Harris County, Texas. The disease is a public health concern in Houston, the largest city in Harris County, and in the state. Consequently, intensive surveillance for SLE virus in local mosquito populations is carried out by the Harris County Mosquito Control Division each year. In this study, we examined genetic variation among SLE isolates obtained during routine virus surveillance over a 13-year time period (1986-1999). St. Louis encephalitis virus isolates were tested for genetic variation using reverse transcription-polymerase chain reaction followed by single-strand conformation polymorphism (SSCP). The results indicated that multiple genotypes of the virus circulate in Harris County. During several years, the genotypes were restricted in their location, i.e., each general area within the county had a specific genotype of the virus. In other years, the various genotypes were widely distributed throughout the county. The presence of multiple distinct genotypes suggests that viruses with different biological characteristics may be circulating in Harris County, and that discrete foci of SLE virus activity occur simultaneously.

Animals↗
PubMed2001

Serosurveys for West Nile virus infection--New York and Connecticut counties, 2000.

In 2000, 21 persons were reported with acute illness attributed to West Nile virus (WNV) infection; 19 were hospitalized with encephalitis or meningitis. Of the 21, 10 resided in the Staten Island borough (Richmond County) of New York City. Other ill persons resided in nine other counties--Kings (Brooklyn), New York (Manhattan), and Queens counties in New York; Hudson, Passaic, Monmouth, Morris, and Bergen counties in New Jersey; and Fairfield County in Connecticut. Because ill persons represent only a fraction of the persons who are infected, many more persons probably were infected in 2000. To determine the prevalence of recently acquired WNV infection and associated risk factors for infection, random household cluster serosurveys were conducted in Staten Island and portions of Fairfield County, Connecticut, and Suffolk County, New York, during October-November 2000. All three areas had intense WNV epizootics as determined by avian mortality and mosquito surveillance systems. This report summarizes the preliminary results of this survey and indicates that in areas with intense epizootic WNV activity, asymptomatic or mildly symptomatic human infections can occur.

Adolescent↗
PubMed2001

The long-term effects of Medicaid managed care on obstetrics care in three California counties.

OBJECTIVE: To evaluate the long-term effects of Medicaid managed care (MMC) on obstetric service use and program costs in California. DATA SOURCES/STUDY SETTING: Longitudinal administrative data on Medi-Cal enrollment and claims and encounters related to pregnancy and delivery services were gathered from three counties--two long-standing MMC counties and one traditional fee-for-service Medicaid county--in California between 1987 and 1992. STUDY DESIGN: We studied Aid to Families with Dependent Children (AFDC) beneficiaries with live singleton vaginal deliveries with associated hospital stays of 14 days or less. Effects of managed care were examined with respect to prenatal visits, length of stay for delivery, maternal postpartum readmission rates, and total program expenditures. Multivariate analyses examined how the relative effect of managed care on service use and program expenditures in each MMC county evolves over time in comparison to fee-for-service. We controlled for length of Medi-Cal enrollment prior to delivery, data censoring, and individual characteristics such as race and age. PRINCIPAL FINDINGS: Prenatal care use is consistently lower in the MMC counties, although all three counties' prenatal care provision is well below the national standard. Drastic increases in one-day-stay deliveries were found: up to almost 50 percent of deliveries in MMC counties were one-day stays. Program cost savings associated with MMC enrollment are unambiguous. CONCLUSIONS: MMC cost savings might have come at the expense of reduced provision of prenatal care and shorter delivery length of stay. Future studies should verify any possible causal link and the effects on maternal and infant health outcomes.

Aid to Families with Dependent Children↗
PubMed2001

Breast conservation: trends in a major southern metropolitan area compared with surrounding rural counties.

Despite randomized prospective studies and National Institutes of Health recommendations, surgeons especially in the southern United States have been slow to adopt breast conservation surgery (BCS). Data were analyzed regarding 3,349 cases of stage 0, I, and II breast cancer (1991-1998) from Charlotte-Mecklenburg County, NC; 1057 cases from six surrounding rural counties (1995-1997); and 90,398 cases (1995) from the National Cancer Data Base. During 1995 through 1997 Charlotte-Mecklenburg County had statistically significantly higher rates of BCS compared with six surrounding rural counties for stage I (59% and 42% respectively, P = 0.001) and stage II (37% and 19%, respectively, P = 0.001) breast cancer. The BCS rates in Charlotte-Mecklenburg County (1991-1998) showed the following: Stage 0 rate increased from 17 per cent in 1991 to 78 per cent in 1998 (P = 0.001), stage I rate increased from 31 per cent in 1991 to 65 per cent in 1998 (P = 0.001), and stage II rate increased from 18 per cent in 1991 to 42 per cent in 1998 (P = 0.001). BCS rates for early-stage breast cancer in Charlotte-Mecklenburg County have increased over the last 8 years and now equal national rates; however, patients in surrounding rural counties are not receiving BCS as frequently. There is a need for more widespread education of surgeons, other health care providers, and the general public to increase the use of BCS.

Breast Neoplasms↗
PubMed2003

Mammography screening in the county of Fyn. November 1993-December 1999.

This report covers the outcome of the first three invitation rounds of the organised mammography screening programme in the county of Fyn. The programme started in November 1993, and the third invitation round ended on 31 December 1999. The screening takes place either at a special clinic located at University Hospital Odense or in a mobile unit. Women living in and around the city of Odense are examined at the clinic (about 55%), while the rest are examined in the mobile unit. Two-view mammography is used at the first screening. Women with dense breast tissue will continue to have two-view mammography (about 60%), whereas the rest will have singleview mammography at the subsequent screens. All screening images are exposed at the mammography-screening clinic and evaluated with double reading in the clinic. The programme targets women aged 50-69, except those undergoing treatment for breast cancer or going for regular check-ups following breast cancer. Based on the updated population register, the IT-Centre of the county of Fyn issues the invitations. Invited are all women aged 50-69 and living in the county of Fyn when their general practitioners' patients are invited. During the first 3 invitation rounds, 136,079 screening tests were made. Of these, 129,375 tests were made in the women aged 50-69 targeted by the programme. In addition, 6682 screening tests were made in women aged 70 and above, and 22 screening tests were made in women below the age of 50. As a consequence of the mammography screening 2657 assessments were made, 1145 women had surgery, 782 women were diagnosed with invasive breast cancer, and 109 women were diagnosed with ductal carcinoma in situ. A participation rate for the first invitation round was calculated immediately after the end of the round based on the number of participants divided by the number of women invited. This percentage was 88%. Invitation data are, however, not stored. It is therefore not possible now to calculate the participation rates in previous invitation rounds based on the same method. We have therefore chosen to calculate the participation rate as the coverage, i.e. the number of participants divided by the average number of women in the county of Fyn during a given invitation round. Calculated in this way, 84% participated in the first round, 84% in the second round, and 82% in the third round. It should be remembered that these figures do not take into account that some women are not invited because they 1) were undergoing current treatment for breast cancer or going for regular check-ups following breast cancer, or 2) did not participate in the previous round (and never actively informed the programme that they wanted an invitation to the next invitation round), relevant only for the second and third invitation round. For the second and third invitation rounds, the programme only invited women who participated in the previous invitation round, asked the clinic for an invitation, or entered the target population since the last invitation round. Therefore the participation rate in the second invitation round among actually invited women will be close to 94%, as 94% of those participating in the first round came for the second round. For the third invitation round, the participation rate among actually invited women will be close to 96%, as 96% of those participating in the first and second rounds came for the third round. One per cent of the participants in the first invitation round were diagnosed with invasive breast cancer or ductal carcinoma in situ. The detection rate was 0.5% in both the second and third invitation rounds. Ductal carcinoma in situ cases constituted 14% of the detected cases in the first and second rounds, and 10% in the third round. The percentage of invasive breast cancer 10 mm of less was 38%, 31%, and 32%, respectively, and 68%, 74%, and 73%, respectively, were node-negative. The screening programme of the county of Fyn fulfilled all the quality assessment parameters specified by the European guidelines on breast cancer screening, except two. The proportionate interval cancer rate was higher than specified in the guidelines, probably mainly due to the fact that the Fyn programme operates without early recalls. The proportion of stage II+ cancers was higher than specified in the guidelines, which seems, however, to be due to inconsistency between some of the performance indicators in the European guidelines. This analysis of the outcome from the first three invitation rounds of the mammography screening programme in the county of Fyn thus showed that it is a programme of high quality with a favourable profile of the prognostic indicators. The screening programme is hopefully well on its way to reducing breast cancer mortality in the county of Fyn.

Aged↗
PubMed1992

Age distribution and turnover of physicians in nonmetropolitan counties of the United States.

Using data for 1975 to 1985 from the Area Resource File (ARF), net number changes in different age groups of physicians practicing in nonmetropolitan counties are examined. Small net increases are seen in the higher age groups in most county size categories but the most striking change is large increases in the age groups up to age 44. Family practitioners show a net decline in all county size categories for ages 45-54, but these are offset by increases in medical specialists. In counties of less than 25,000 population, the rate of turnover of physicians over the 1983-1988 period was 25 percent; physicians exiting these counties had a mean age of 52.3 years. The data indicate that aging of physicians in rural counties should not affect maintenance of current supply in the short run, but that increasing the physician-to-population ratio in areas with less adequate supply will be difficult, particularly if the rate of increase of younger physicians in nonmetropolitan counties does not continue.

Adult↗
PubMed1992

[Screening for uterine cervix cancer in Storstrøm, Vestsjaelland and Bornholm counties during 1979-1989].

We studied the use of Pap smears in three counties in Denmark, where the screening activity has been organized in different ways. The county of Storstrøm had an organized screening programme in 1979-82. Women aged 30-50 years were invited personally, and 91% participated. The same response rate is seen in the county of Bornholm today, where women aged 25-54 years are invited. No invitations are sent in the counties of Storstøm and Vestsjaelland today, and only 66%-69% of the 30-50 year old women are screened. The Danish National Board of Health recommends commencement of screening at the age of 23 years. However, 53%-57% of the women aged 15-22 years are screened in Storstrøm and Vestsjaelland counties today. The percentages of women screened in the older age groups are, on the other hand, low. Only 10%-17% of women aged 60-75 years were screened in 1985-89. The Danish National Board of Health recommends that women aged 23-75 years should be screened once every third year and that positive, atypical and unqualified smears should be followed-up. The county of Bornholm has an organized screening programme, but 21% of the Pap smears are nevertheless used outside the national recommendations. The county of Vestsjaelland has no organized screening programme and 42% of the Pap smear are used outside the national recommendations. It would be possible to screen a considerably higher percentage of the women aged 23-75 years if the screening activity was well organized.

Adult↗
PubMed2006

Predicting density of Ixodes pacificus nymphs in dense woodlands in Mendocino County, California, based on geographic information systems and remote sensing versus field-derived data.

Ixodes pacificus nymphs are the primary vectors to humans of Borrelia burgdorferi, the etiologic agent of Lyme disease, in California. We used a supervised classification model, based on remote sensing (RS) data from multi-seasonal Landsat TM 5 images, to identify the key habitat in Mendocino County where humans are exposed to I. pacificus nymphs (woodlands carpeted with leaf litter). The model, based on the normalized difference vegetation index (NDVI), brightness, and wetness, separated the nymphal risk habitat (52.6% of the county) from other habitat types with > 93% user and producer accuracies. Next, we determined the density of questing nymphs in 62 woodland-leaf areas located throughout Mendocino County and created forward-stepwise regression models explaining the variation in nymphal density based on traits attainable by a lay-person in the field (e.g., tree species present, deer signs; r(2) = 0.43, P < 0.0001), or geographic information systems (GIS)/RS-based environmental data (r(2) = 0.50, P < 0.0001). The GIS/RS model, using July NDVI, November greenness, a coastal influence category, May solar insolation, November hours of sunlight, and dominant hydrologic grouping as input variables, was 22% more accurate in predicting nymphal density at 16 validation sites (r(2) = 0.72) than the field-derived data model (r(2) = 0.50). The habitat classification and GIS/RS models were combined to create a continuous nymphal density surface for the entirety of Mendocino County. This risk surface showed that 11.9% of the county was classified as habitat posing at least moderate risk of human exposure to nymphs (> 6.4 nymphs per 100 m(2)). Furthermore, high-risk areas (> 10.5 nymphs per 100 m(2); 1.7% of the county) tended to cluster in the central interior and most heavily populated region of Mendocino County, but were rare in the proximity of coastal population centers.

Animals↗
PubMed2006

[Evaluation on birth defects surveillance system in four counties of Shanxi province, China].

OBJECTIVE: To evaluate the reliability of the birth defects surveillance system in four counties with high prevalence of birth defects (Pingding, Xiyang, Taigu and Zezhou counties) in Shanxi province, China. METHODS: One township was selected from each county as study site. The health workers chosen from township or village level were trained to visit families on the outcomes of each pregnancy who gave birth during year 2003 in the study site. The number of births and cases collected in the study were compared with that from the surveillance system. The number of births reported by surveillance system in four counties was also compared with the data from the local government. The criteria of evaluation were: 1) number of the missing report of births should < or = 5%, 2) the number of missing report on major external birth defects cases should < or = 10%. Researchers from the Peking University were responsible for examining the quality of surveillance in some terminal units of surveillance system. RESULTS: The numbers of births reported in the study and from the surveillance system for four-township were 1043 and 997, respectively. 46 births were missing and the rate of misreporting for births was 4.4%. The numbers of birth defects cases reported in the study and from the surveillance system were 30 and 29, respectively. 1 case of birth defect as missed, and rate of misreporting for birth defects cases was 3.3%. The total number of births reported from surveillance was similar to that in the study in four counties, with a difference of 1.2%. Birth registry data was rather readable and special health workers responsible for surveillance work were present in all the terminal units of the surveillance system. CONCLUSION: The misreporting of births and cases existed in the birth defects surveillance system of the four counties in Shanxi province, but were lower than the allowable criteria. The surveillance units had better registration, reporting and administration of births and birth defect cases. Hence, the quality of the data from the surveillance system in these four counties was reliable.

Birth Certificates↗
PubMed1991

The emerging profile of dental manpower in Oklahoma. 2. Tulsa county.

This is the second report of a three part study. Part I focused upon the dental manpower profile of Oklahoma County between the years 1972-1989. Part II emphasizes the dental manpower profile of Tulsa County. Part III, will be inclusive of the dental manpower profile of all other Oklahoma counties. In all phases of the study, data has been assessed for general practitioners, specialists, full-time general practice dental faculty, full-time specialist dental faculty, and public health dentists. The demographic data analyzed in Part I, revealed an increasing average of the dentists from 45.33 years of age in 1972 advancing to 48.83 years of age in 1989 for Oklahoma County. The data presented in Part II documents that in Tulsa County there was an increase in age from 45.68 in 1972 to 50.60 in 1989. Trends in location of dental school education, demonstrated that the University of Oklahoma College of Dentistry is currently the primary resource for the dental manpower pool in Tulsa and Oklahoma Counties. Changes in the dental manpower pool indicate a downward turn in the percentage of dentists choosing to locate in either Tulsa or Oklahoma County.

Dentistry↗
PubMed1991

Dental needs assessment survey: three Florida counties.

Dental needs assessment surveys were completed in three Florida counties (1987 - Lee County), (1988 - Pasco County) and (1989 - St. Lucie County). The data collected were then compared with the results from the national caries prevalence surveys in 1979-80 and 1986-87, by individual county and with the combined three-county total. Visual tactile examinations were done using the Radlike criteria for the DMFS index and the WHO Treatment Needs Index. Schools were selected based on the percent of students enrolled in the free or reduced lunch program and by geographic distribution. Although there were age group differences within individual counties, the combined data showed every age group except the seven year olds at a lower DMFS mean level than the data from the 1986-87 national survey for Region IV. The differences range from -.20 surfaces in 8-year-olds to -.57 surfaces in 13-year-olds. None of the differences were statistically significant from the national surveys. This indicates that these small scale surveys are a reliable method for needs assessment.

Adolescent↗
PubMedDate not supplied

A survey of health needs of older adults in northwest Johnson County, Iowa.

In 1975, the 1972 survey by the DuPage County, Illinois, Health Department (Managan et al. 1974) was replicated in an eight-township area of Johnson County, Iowa, to compare and document areas of nursing needs for the nursing division of a rural health center and to determine if the Illinois findings were generalizable to a setting which included both similarities and differences. The DuPage County population was urban, while the Johnson County population had a strong farm background and the majority of the subjects still resided on a farm. The DuPage County sample of 1,466 represented approximately 5 percent of the elderly population. The sample size in the Johnson County study was only 82; however, it represented approximately 10 percent of the elderly in the eight townships of the study area. The method of interviewing in the resident's homes was replicated as was DuPage's method of statistical analysis. Comparison of data from the two counties showed striking similarities in all parameters: health condition, physical functioning accessibility of medical care, social isolation, and service needs. Both studies found need for additional health services. A multiple disciplinary service approach to health needs would assist the elderly to remain in their own homes longer and to improve the quality of their lives. In the Iowa study, four questions to determine satisfaction with present living facilities and with adequacy of income for needed medical and dental costs were added. When these answers were compared to two previous Iowa studies, findings were similar.

Aged↗
PubMed1980

Pet ownership in rural Northern California (El Dorado County).

Demographic and economic aspects of pet ownership were studied in 488 households in El Dorado County, California, from May to July 1971. About 60% of households owned dogs or cats, and pet ownership was most prevalent (75%) in two small residential communities in the western end of the county. Among dogs, Poodle and German Shepherd Dog were the most popular breeds; about 36% of the females in the sample were spayed, but only 6% of the males were castrated. Approximately one third of all cats had been neutered. Reported use of veterinary services was higher for dogs (79%) than for cats (53%). The results of the survey indicated pet ownership is most likely to be found in households with children, where the head of household is employed, generally confirming findings from earlier surveys in Yolo, Alameda, and Contra Costa Counties (all in northern California) and later surveys in Champaign County, Illinois, and Garland, Tex. Some community health findings were included for El Dorado County and nearby Yolo County. In these two counties, cancer was reported more frequently by adults without pets (3.9% of those greater than or equal to 65 years old) than by pet owners (1.8% of those greater than or equal to 65 years old). Among children less than 5 years old, "frequent diarrhea" was reported more commonly in homes without pets (9.5% vs 2.6%; P less than 0.01). On the other hand, pet-owning adults, 16 to 64 years of age, living in rural areas or areas with generally lower than average incomes reported "frequent headaches" (21%) more frequently than did adults without pets (17%; P less than 0.025%) who resided in the same areas.

Adolescent↗
PubMedDate not supplied

Trends in cancer mortality rates, Bergen County, New Jersey, 1962-75.

Publication of the "Atlas of Cancer Mortality for U.S. Counties, 1950-1969" caused a great deal of concern in counties shown in the Atlas to have had high cancer mortality rates in relation to the United States as a whole. An analysis was made of temporal trends of cancer mortality in Bergen County, a "high-rate county" in northeastern New Jersey, by calculating age-adjusted cancer mortality rates by sex and site for Bergen County residents for the period 1962-75. Mortality rates and time rates of change in mortality rates were compared to those in the United States as a whole. Male and female rates for respiratory cancer and male rates for all sites combined increased significantly more quickly in the United States than in Bergen County during the study period. The authors discuss these trends and recommended that recent time-specific mortality rates be furnished to county health commissions on a regular basis.

Adolescent↗
PubMed1994

[Trends in drugs-of-abuse in Los Angeles County].

Trends in major drugs-of-abuse, cocaine, heroin/morphine, phencyclidine (PCP), and amphetamines, in Los Angeles County were reported. Death toil of drug abusers in Los Angeles County climbed up high in 1986 due to dramatic increase in cocaine-related deaths. Cocaine-related deaths were responsible for 66.0% (580 cases) of all drugs-of-abuse-related deaths in the first six months of 1988. In the same period, 212, 67, and 20 deaths were related to heroin/morphine, PCP, and amphetamines use, respectively. Emergency room mentions for cocaine in Los Angeles County have greatly been increased since 1982 and recorded 2,331 in the first six months of 1989. Also, heroin/morphine-related emergency room mentions in the County have steadily been increased since 1982 and reached 1,216 in the first six months of 1989. Contrary to these, PCP-related emergency room mentions in the County were decreased from 1,259 in the first six months of 1982 to 630 in those of 1989. There were only 174 emergency room mentions for amphetamines in the County in the first six months of 1989. In 1992, 5,754 patients were admitted to Los Angeles County+University of Southern California Medical Center for treatment of poisoning. Cocaine poisoning, 1,965 cases, was secondly frequent following ethanol poisoning, 2,132 cases. Thirdly and fourthly frequent poisoning were by heroin/morphine, 712 cases, and PCP, 218 cases, respectively. Drug abusers in an age group of 30s were encountered much more frequently at the Medical Center than those in any other age groups, and male dominated greater part of age groups of 30s or more.(ABSTRACT TRUNCATED AT 250 WORDS)

Amphetamines↗