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PubMed2002

Measles in suburban Khartoum: an epidemiological and clinical study.

Clinical and epidemiological data were collected from 187 clinically diagnosed measles patients in Haj Yousif area, suburban Khartoum. Laboratory tests confirmed the diagnosis in 141 (75%) of the cases, but demonstrated that in 46 (25%) patients the clinical symptoms were not caused by an acute measles virus (MV) infection. According to their vaccination card, 59% of the laboratory-confirmed measles cases had been vaccinated for measles. Compared with non-measles rash disease cases, confirmed measles cases more often had severe illness (P < 0.0001), were dehydrated (P=0.01) at presentation and less likely to recover without complications [OR 0.19 (95% CI 0.09, 0.39)]. There was no difference in death rate (P=0.20). Underweight [weight-for-age Z score (WAZ) <or= -2 SD] was an independent predictor of recovery with complications [OR 0.4 (95% CI 0.2, 0.99)]. Severe measles cases (those who developed diarrhoea, pneumonia, otitis media, encephalitis or haemorrhagic rash) had similar vaccination rates and time intervals since vaccination as uncomplicated measles cases. Although severe measles had lower WAZ-scores (P=0.004), none of the nutritional parameters studied were predictive of outcome. Mortality was higher in the severe measles group [OR 8.8 (95% CI 1.7, 85.2)]. In 11 of 141 confirmed measles cases serological evidence of a recent infection with another virus was found, most commonly varicella zoster virus and dengue virus; spotted fever and rubella were among the most frequent diagnoses in 17 of 47 cases of the non-measles cases.

Adolescent↗
PubMed2002

Comparison of dietary intakes of micro- and macronutrients in rural, suburban and urban populations in Costa Rica.

OBJECTIVE: To compare, along with behavioural habits, the potential atherogenicity of diets in rural and urban areas in Costa Rica. DESIGN: Subjects were randomly selected from the general population in Costa Rica. A validated food-frequency questionnaire that inquired about dietary intake in the previous year was administered once to each subject. Each subject provided plasma and an adipose tissue biopsy, which were used as biomarkers for carotenoid, tocopherol and/or fatty acid intakes. Each subject also answered another questionnaire on personal profile and household characteristics. SETTING: A dietitian visited all subjects and conducted the interviews at their homes. SUBJECTS: Adult male and female free-living rural, suburban and urban Costa Ricans without a history of physical or mental disability. RESULTS: Subjects in rural areas were significantly (P < 0.05) more active physically, earned less income and had a higher intake of dietary fibre than urban dwellers. Urban residents reported a significantly (P < 0.05) higher consumption of total fat, specifically unsaturated fat mostly from soyabean oil, and had higher plasma and adipose tissue tocopherol and lycopene concentrations. Interestingly, no differences in body mass index were observed. CONCLUSIONS: These data show differences in cardiovascular disease (CVD) risk factors of rural and urban populations in Costa Rica. In rural areas, low socio-economic status and low intake of unsaturated fatty acids appear to be the prevalent CVD risk factors, while in urban areas they were low physical activity, high trans-fatty acids in the diet and adipose tissue, and low dietary fibre intake.

Cardiovascular Diseases↗
PubMed2006

A select annotated bibliography: illegal drug research in rural and suburban areas.

As the diffusion of illegal drugs continues to spread to rural and suburban areas, there is a greater need among illegal drug researchers, law enforcement, and policy makers to gain knowledge from previous work done on what is loosely termed as rural substance abuse research. To help serve that need an annotated bibliography is proffered based on three categories and one method of illegal substance abuse research. These are: drug consumption, drug distribution, drug prices, and ethnography. An exhaustive review of the literature was not undertaken, but rather a focus on research that addresses drug consumption and distribution is put forward.

Humans↗
PubMed2004

Adaptation of health care seeking behavior during childbirth: focus group discussions with women living in the suburban areas of Luanda, Angola.

The aim of this study was to explore how various factors influenced women's decisions regarding place of confinement in Luanda, Angola. Ten focus group discussions were conducted with pregnant and nonpregnant women residing in suburban areas of Luanda and the data were analyzed using the grounded theory technique. Four patterns of action of the main theme, "the molding of women's care-seeking behavior during childbirth," were identified: (I) the "labor process 'on-course' avoiding pattern"; (II) the "labor process 'off-course' avoiding pattern"; (III) the "labor process 'on-course' approaching pattern"; and (IV) the "labor process 'off-course' approaching pattern." Our findings indicate that personal "courage" and social support empowered women and impacted on their preference for home birth, whereas demand for informal user fees and perceived low quality of care influenced women to avoid institutional care during childbirth, sometimes even in spite of complications. Ability to meet demands for informal user fees and knowledge of childbirth influenced women to seek institutional care. The study highlights the need to improve the quality of available maternal health care addressing the implicit educational, attitudinal, and ethical issues.

Adult↗
PubMed2004

How menopause affects the lives of women in suburban Chandigarh, India.

OBJECTIVE: To ascertain the effect of menopause on the lives of women in suburban Chandigarh. METHOD: An integrated qualitative and quantitative study was performed in a low socioeconomic area of Chandigarh city, India. Women aged 40-60 years were enlisted and interviewed. RESULTS: Of the 725 enlisted women, 298 (41%) had attained menopause, 47 (6.5%) were in transition and 43 (5.9%) had undergone hysterectomy. The transition phase lasted for 1-12 months in 48.7% of cases and for 1 year or more in 20.8% of cases. No transitional changes were reported by 30.5% of women. A change in menstrual pattern was the hallmark of this phase and included delayed periods (37.6%), heavy bleeding (13%), scanty periods (7%) or a mixed pattern (11.7%). The majority of women interviewed (76%) did not experience any tension on attainment of menopause. Diminished acuity of vision was the most commonly reported menopausal symptom. Hot flushes were reported by 17.1% of women. Most women (94%) welcomed menopause. Use of hormone replacement therapy was not reported by anyone. CONCLUSION: Although north Indian women experienced various symptoms at menopause, they largely ignored these, while welcoming the freedom from menstruation-related worries.

Adult↗
PubMed2003

Red light violations at rural and suburban signalized intersections in Jordan.

This case study investigated red light violations at rural and suburban signalized intersections in Jordan. Field observations were conducted at 15 signalized intersections located in different Jordanian regions: Amman, Irbid, and Zarqa. The results showed that, out of a total of 1,190 drivers who had a chance for violation, 153 (12.9%) drivers ran red lights. It was found that older drivers have less tendency for running red lights. Based on vehicle type, the analysis showed that truck drivers had the highest violation rate followed by small vehicles and then buses. The Y-shaped intersection had a higher percentage of violations as compared to the T- and cruciform-shaped intersections. The percentage of red light violations was found to be directly proportional to the subjects approach speed and inversely proportional to the conflicting traffic volumes.

Acceleration↗
PubMed2005

Inpatient management of asthma in the Chicago suburbs: the Suburban Asthma Management Initiative (SAMI).

BACKGROUND: Assessment of inpatient asthma management has generally been limited to urban settings, including Chicago, which is known for its high asthma morbidity and mortality. Previously published data have been based on survey methodology. The Suburban Asthma Consortium (SAC) sought to obtain patient-based data unique to the Chicago suburbs to improve asthma care in those areas. OBJECTIVE: To evaluate current inpatient asthma management based on the 1997 National Asthma Education and Prevention Program (NAEPP). DESIGN: Retrospective chart review of all hospitalized patients 3-65 years bearing asthma-related ICD-9 codes for fiscal year 2002 in community, nonteaching hospitals in Chicago suburbs. RESULTS: Nine hundred two cases were submitted from seven hospitals. The majority ( > or = 75%) received inhaled bronchodilators, systemic steroids, oxygen and pulse oximetry. Antibiotic use (67%), chest radiography (85%), complete blood count (77%), and electrolytes (59%) appeared excessive in view of NAEPP recommendations. Peak flow monitoring (PFM) was recorded on admission in 45% of patients 5 years old and older; 52% had PFM during hospitalization. Thirty-eight percent of patients were taking ICS prior to admission; of those not on ICS, only 12% were newly diagnosed asthmatics. Overall, 51% of patients were discharged with ICS. Patients were more likely to receive ICS at discharge if they had required intensive care (ICU), had been on ICS prior to admission, were referred to an asthma specialist while hospitalized, or were insured. Patients with Medicare/Medicaid (MC/MA) had more repeat emergency visits and hospitalizations, longer lengths of stay, and received less ICS at discharge. Depending on the parameter, 41% or less patients received discharge planning education and were not more likely to have received education if in the ICU. Results ranged significantly between hospitals for most parameters (p < 0.05 or less). CONCLUSION: Study subjects received appropriate acute therapy and oxygen monitoring, but there was a divergence from NAEPP recommendations regarding PFM, ICS use, antibiotics, and laboratory evaluation. Patients receiving MC/MA experienced higher morbidity and received less ICS. Discharge asthma education was suboptimal for most hospitals. Most parameters demonstrated significantly wide practice variations between hospitals. Peak flow monitoring and patient education findings differed significantly from those in survey-conducted studies.

Adolescent↗
PubMed1980

Studies of blood pressure in schoolchildren (ages 6--19) and their parents in an integrated suburban school district.

Systolic blood pressure (SBP) and diastolic blood pressure (DBP), along with demographic and anthropometric variables were assessed in a biracial group of schoolchildren and parents in an integrated suburban school district: 682 schoolchildren, ages 6--19, including 268 white males, 236 white females, 85 black males and 93 black females; 362 adults, ages 20--64, including 142 white males, 159 white females, 20 black males and 41 black females. There were no significant black-white SBP or DBP differences in children, while SBP and DBP were higher in adult blacks than whites. Using multiple regression analysis, with BP as the dependent variable, SBP in children was significantly associated with pulse, weight, skinfold thickness, age and height; DBP was significantly associated with age, pulse, weight, and skinfold thickness. Race, sex, and education of the head of household did not significantly enter the multiple regression matrix for children's BP. Respectively, 29% and 22% of the variance of the children's SBP and DBP was accounted for by the measured variables. In adults, SBP was significantly related to weight, race, pulse, and age; DBP was significantly related to weight, race, age, and skinfold thickness. Respectively, 27% and 24% of the variance of the adults' SBP and DBP was accounted for by the measured variables. Covariance adjusted mean SBP and DBP were higher in hypertriglyceridemic than in hypotriglyceridemic children (p = 0.001), and were lower in hyperalpha-lipoproteinemic than hypoalpha-lipoproteinemic children (p less than or equal to 0.03). Children in an integrated school district may have shared behaviors, goals, and environments contributing to shared BP, while differing environmental factors may become amplified with age and life experience and contribute to higher BP in black adults.

Adolescent↗
PubMed1981

The costs of a suburban paramedic program in reducing deaths due to cardiac arrest.

The marginal costs per averted death of a suburban paramedic program are estimated to be approximately $42,000, when program costs are attributed entirely to cardiac arrest cases due to underlying heart disease, and indirect costs attributable to episode-related hospitalization are included, It is suggested that at $42,000 per cardiac arrest death averted the program is cost-beneficial by two criteria. First, it compares favorably with an estimate obtained from the literature of the value to the average individual of saving the life of a myocardial infarction patient. Second, the people of King County passed a cost-commensurate Paramedic Program Property Tax Levy in 1979, revealing their willingness to support the program. Results of the study should be generalized in accordance with the facts that in King County 1) the population density averages approximately 1,300 per square mile; 2) a basic emergency medical system ensures a 4-minute average response time to initiation of cardiopulmonary resuscitation; 3) a citizen-training program in cardiopulmonary resuscitation further reduces average time to initiation of basic life support; and 4) the paramedic program is designed to ensure a 10-minute average time to definitive care.

Catchment Area, Health↗
PubMed1993

Incidence of lead poisoning in young children from inner-city, suburban, and rural communities.

The Centers for Disease Control (CDC) have recently lowered the acceptable blood lead concentration in young children from < or = 25 to < or = 10 micrograms/dl (< or = 1.21 to < or = 0.48 mumol/L). The incidence of lead toxicity with respect to geographical areas and socioeconomic status has not yet been defined. We evaluated the incidence of increased lead concentration in inner-city, suburban, and rural children aged 9 months to 3 years. Seven hundred eighty of the 4,196 studied inner-city samples (18.6%) had lead concentrations > or = 10 micrograms/dl (0.48 mumol/L), of which only 71 (1.6%) had lead values > or = 25 micrograms/dl (1.21 mumol/L). Only 5 of the 212 studied children (2.4%) from suburbia and 7 of the 120 children (5.8%) from rural communities had blood lead concentrations > or = 10 micrograms/dl (0.48 mumol/L). None of these children, however, had a lead concentration > or = 15 micrograms/dl (0.73 mumol/L). In contrast, 276 inner-city subjects (6.6%) had lead values > or = 15 micrograms/dl (0.73 mumol/L). Our data indicate that a correlation exists between geographical location and blood lead concentration in young children. Government health agencies at all levels should prioritize their limited resources for those areas that are most at risk for lead poisoning.

Centers for Disease Control and Prevention, U.S.↗
PubMed2003

Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center.

OBJECTIVE: To determine the attributable cost of ventilator-associated pneumonia from a hospital-based cost perspective, after adjusting for potential confounders. DESIGN: Patients admitted between January 19, 1998, and December 31, 1999, were followed prospectively for the occurrence of ventilator-associated pneumonia. Hospital costs were defined by using the hospital cost accounting database. SETTING: The medical and surgical intensive care units at a suburban, tertiary care hospital. PATIENTS: Patients requiring >24 hrs of mechanical ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We measured occurrence of ventilator-associated pneumonia, in-hospital mortality rate, total intensive care unit (ICU) and hospital lengths of stay (LOS), and total hospital cost per patient. Ventilator-associated pneumonia occurred in 127 of 819 patients (15.5%). Compared with uninfected, ventilated patients, patients with ventilator-associated pneumonia had a higher Acute Physiology and Chronic Health Evaluation II score on admission (p <.001) and were more likely to require multiple intubations (p <.001), hemodialysis (p <.001), tracheostomy (p <.001), central venous catheters (p <.001), and corticosteroids (p <.001). Patients with ventilator-associated pneumonia were more likely to be bacteremic during their ICU stay (36 [28%] vs. 22 [3%]; p <.001). Patients with ventilator-associated pneumonia had significantly higher unadjusted ICU LOS (26 vs. 4 days; p <.001), hospital LOS (38 vs. 13 days; p <.001), mortality rate (64 [50%] vs. 237 [34%]; p <.001), and hospital costs (70,568 dollars vs. 21,620 dollars, p <.001). Multiple linear regression, controlling for other factors that may affect costs, estimated the attributable cost of ventilator-associated pneumonia to be 11,897 dollars (95% confidence interval = 5,265 dollars-26,214 dollars; p <.001). CONCLUSIONS: Patients with ventilator-associated pneumonia had significantly longer ICU and hospital LOS, with higher crude hospital cost and mortality rate compared with uninfected patients. After we adjusted for underlying severity of illness, the attributable cost of ventilator-associated pneumonia was approximately 11,897 dollars.

Adolescent↗
PubMed2004

Visual acuity and refractive errors in a suburban Danish population: Inter99 Eye Study.

PURPOSE: The present study was performed as part of an epidemiological study, the Inter99 Eye Study. The aim of the study was to describe refractive errors and visual acuity (VA) in a suburban Danish population. METHODS: The Inter99 Eye Study comprised 970 subjects aged 30-60 years and included a random control group as well as groups at high risk for ischaemic heart disease and diabetes mellitus. The present study presents VAs and refractive data from the control group (n = 502). All subjects completed a detailed questionnaire and underwent a standardized general physical and ophthalmic examination including determination of best corrected VA and subjective refractioning. RESULTS: Visual acuity </= 0.05 was found in one eye of one subject and VA </= 0.3 in 11 eyes of 11 subjects. The main cause of reduced visual function was strabismic amblyopia. Myopia (</= - 0.5 D, spherical equivalent refraction) was present in 33.1% of right eyes of the total population but in 56.8% of subjects with a university degree. CONCLUSIONS: Strabismic amblyopia was a significant cause of unilateral visual impairment. Myopia was approximately twice as frequent in subjects with a university degree as in the remaining study population.

Adult↗
PubMed1998

Depressive disorders among the Chinese elderly in a suburban community.

A community survey of depression among the Chinese > or = 65 years in age was performed in a suburban setting. One hundred and eighty-seven individuals comprised the survey group. Among them, 65 (34.8%) were scored > or = 11 on the Chinese version of the Geriatric Depression Scale. Compared with nondepressed individuals, those with depressive disorders were more likely to be older and with poor family support. Forward stepwise logistic regression analysis identified only age as significantly correlating with geriatric depression scores.

Age Factors↗
PubMed1988

Prevalence and incidence of eating disorders in a suburban area.

There has been no previous epidemiological study on anorexia nervosa (AN) and bulimia (BU) where non-medical care givers have also been included in the case-finding procedure. In this study, psychiatric, somatic, child psychiatric, social and primary care personnel were systematically asked for information on patients. Fifty-one cases of eating disorder (17 AN, 34 BU) according to slightly modified DSM-III criteria were traced in a suburban catchment area of 78,000 inhabitants during a two-year period. This means a two-year prevalence of 66/100,000 (22 AN and 44 BU). For females between 16-24 years the prevalence of AN was 258/100,000; BU: 473/100,000; total 730/100,000 (1/137). There were also 10 "possible cases" where the diagnosis could not be established with certainty, mainly because of insufficient information. If these patients were added, the number of cases would be 61 (or a prevalence of 79/100,000 inhabitants). The one-year incidence for AN was 2.6/100,000 and for BU 3.9. The incidence for AN was 43/100,000 for females 16-24 years old (1/2326). For BU it was 65/100,000 (1/1538). There seems to be no clear social class grouping. Twenty (56%) of the adult patients had been hospitalized for eating disorder during the last six-year period.

Adolescent↗
PubMed1981

Dental knowledge, attitude and behavior in 12-year-old Dutch suburban children.

A questionnaire on dental knowledge, attitude and behavior was presented to Dutch suburban children in the 6th grade (n = 399). The mean age was 12.3 years. The children scored relatively high on knowledge and attitude. Girls scored better on knowledge and attitude than boys. However, the differences were small. Between socioeconomic classes no differences were found in knowledge scores. The attitude of the higher socioeconomic classes was more positive than that of the lower classes. With regard to behavior more than 90% of the children reported that they have their own toothbrush, use toothpaste containing fluoride and visit the dentist every 6 months. Further it was found that 69% eat sweets several times a day, 53% offer sweets in school when they celebrate their birthday, 28% brush their teeth less than twice a day, 45% sometimes forget to brush their teeth and 44% use fluoride tablets. No clear differences in behavior between boys and girls were found. The higher the socioeconomic class of the children the higher the toothbrushing frequency, the more fluoride tablets are used and the lower the sweet consumption frequency. Although almost all children stated that their parents consider toothbrushing important, 24% were not supervised. It is also suggested that effectiveness of dental health education on behavior should not be evaluated in short term studies.

Age Factors↗
PubMed2005

Zygomatic complex fractures in a suburban Nigerian population.

A retrospective analysis of 128 zygomatic complex fractures was undertaken. There were 109 males (85.2%) and 19 females (14.8%), aged 3-74 years (mean +/- SD, 33 +/- 12.6 years). Patients in the third decade of life (38.3%) recorded the highest incidence. Road traffic accidents (74.2%) mainly from automobile (61.7%) and motorcycle (9.4%) involvement were the predominant etiology. While 38.8% of them presented within the first 24 h, males were relatively earlier than their female counterparts, although this was not statistically significant (P > 0.05). Class 3 fractures were the commonest (50%), followed by classes 2 (zygomatic arch) and 4, respectively. Most class 6 fractures (6.3%) resulted from gunshot injuries. There were 116 unilateral (left 63, right 53) and 12 bilateral fractures with the right side of the face recording more zygomatic arch fractures. In addition, statistical significance was observed between etiology, class and type of fracture (P < 0.05). One hundred and twenty-four (136 fractures) patients were available for treatment as four declined. Twelve cases did not require treatment while others were managed by either closed or open reduction under general anesthesia. Gillies' temporal approach was the commonest (57.1%) surgical technique employed. However the unstable nature of the fractures necessitated open reduction and transosseous wiring in 33 cases. The high prevalence of zygomatic complex fractures arising from vehicular accidents reflects the poor status of the road network in rural and suburban Nigerian communities. Hence government should improve on existing infrastructures, decongest the highways and enforce traffic laws amongst road users. In addition, the need to encourage massive investments in safer alternative transport systems is emphasized.

Accidents, Traffic↗
PubMed1996

Mild mental retardation in schoolchildren in a Swedish suburban municipality: prevalence and diagnostic aspects.

The prevalence of mild mental retardation (MMR) (IQ 50-72) was investigated in a Swedish suburban municipality with special demographic characteristics. The study population consisted of the 6397 children aged 9-15 years residing in the municipality on December 31, 1994. A total of 82 children fulfilled psychometric and adaptive criteria of MMR, corresponding to a prevalence of 12.8/1000. The prevalence was higher than that reported in previous Swedish and Finnish studies using similar case-finding methods. This can probably be explained by the lower socioeconomic status in the municipality studied and by the fact that testing is now more acceptable. Nearly 90% of the MMR children had symptoms in their preschool years, mainly motor, speech/language deviations and a relative inability to perform certain tasks. These symptoms also occur in children with minimal brain dysfunction/ deficits in attention, motor control and perception which should be taken into consideration when selecting screening tests.

Adolescent↗
PubMed2001

Rural, urban and suburban comparisons of preventive services in family practice clinics.

Numerous studies have compared health services provided in rural and urban areas, and overall they have found that utilization is lower in rural areas. A significant factor in lower utilization is that rural residents have less access to health services. Much less is known about rural and urban utilization differences once a patient has access to a service provider. This paper focuses on preventive services received when a patient is already in a clinic. Using data from an in-depth qualitative study of 16 family practice clinics in Nebraska, comparisons of physician-specific preventive service rates are made across three geographic categories: rural, urban and suburban. Results from a one-way multivariate analysis of variance show that preventive services rates for nine services examined were as high or higher in rural areas, suggesting that rural health services do not lag for patients with access.

Adolescent↗