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PubMed2005

[A questionnaire survey of mental health and welfare in city health centers prior to the partial amendment of the mental health and welfare law going into effect].

OBJECTIVE: The situation of mental health of health centers in cities prior to the partial amendment of the Mental Health and Welfare Law going into effect was investigated to provide data relevant to mental health and welfare in cities. METHOD: 81 health centers were recruited from designated, core, and ordinance-designated cities as well as the 23 sections of Tokyo City, and were supplied into questionnaires by mail. RESULTS: Less than 10 percent of the health centers had played a central role in establishing rehabilitation facilities. Regarding active support, small community-based workshops were most commonly subsidized. Only 13.3% of the health centers in Tokyo City provided support for daily life training facilities, while 60% had rehabilitation facilities. Seventy percent provided in-home services. More specifically, in contrast to the 64.7% of health centers in the designated cities which provided home-helper services, the figure was only 10.0% in ordinance-designated cities. Regarding the 2000 social adaptation training program, this was put into effect by less than half of the health centers in Tokyo City. No patients were admitted to rehabilitation facilities through 28.6% of the health centers, or underwent the consultation for rehabilitation facilities at 37.1%. Participation in care manager training sessions was low in Tokyo City but high in the other areas. Applicants for the health and welfare handbook and medical expense assistance for people with mental disorders were interviewed in 40.0% of Tokyo City's health centers and in over 70% of the others. There were problems with counter application in 50% of health centers in the core cities but not many in the remainder. More than 70% of health centers in the designated cities and Tokyo put the transfer system based on Article 34 of the law into effect but the percentages were lower for core and ordinance-designated cities. Patients were transferred at 34.2% of the health centers where the transfer system was enacted. Most of the designated cities and Tokyo established a council for mental health and welfare. However, this was the case for only 21.4% of the core cities and many of the ordinance-designated cities did not even consider this matter. Many health centers answered that welfare policy had advanced with the partial amendment. CONCLUSION: The study revealed major gaps among health centers and specific problems with different background types.

Community Health Centers↗
PubMed2006

Levels of lead in urban soils from selected cities in a central region of the Philippines.

BACKGROUND, AIMS, AND SCOPE: Lead (Pb) is a naturally occurring element that poses environmental hazards when present at elevated concentration. It is being released into the environment because of industrial uses and from the combustion of fossil fuels. Hence, Pb is ubiquitous throughout global ecosystems. The existence of potentially harmful concentrations of Pb in the environment must be given full attention. Emissions from vehicles are major source of environmental contamination by Pb. Thus, it becomes imperative that concentrations of Pb and other hazardous materials in the environment not only in the Philippines, but elsewhere in the world be adequately examined in order that development of regulations and standards to minimize risk associated with these materials in urban areas is continued. The objectives of this study were: (1) to determine the levels of Pb in soil from selected urbanized cities in central region of the Philippines; (2) to identify areas with soil Pb concentration values that exceed estimated natural concentrations and allowable limits; and (3) to determine the possible sources that contribute to elevated soil Pb concentration (if any) in the study area. METHODS: This study was limited to the determination of Pb levels in soils of selected urbanized cities located in central region in the Philippines, namely: Site 1--Tarlac City in Tarlac; Site 2--Cabanatuan City in Nueva Ecija; Site 3--Malolos City in Bulacan; Site 4--San Fernando City in Pampanga; Site 5--Balanga City in Bataan; and Site 6--Olongapo City in Zambales. Soil samples were collected from areas along major thoroughfares regularly traversed by tricycles, passenger jeepneys, cars, vans, trucks, buses, and other motor vehicles. Soil samples were collected from five sampling sites in each of the study areas. Samples from the selected sampling sites were obtained approximately 2 to 3 meters from the road. Analysis of the soil samples for Pb content was conducted using an atomic absorption spectrophotometer. This study was conducted from 2003 to 2004. Since this study assumed that vehicular emission is the major source of Pb contamination in urban soil, other information which the researchers deemed to have bearing on the study were obtained such as relative quantity of each gasoline type disposed of in each city within a given period and volume of traffic in each sampling site. A survey questionnaire for gasoline station managers was prepared to determine the relative quantity of each fuel type (diesel, regular gasoline, premium gasoline, and unleaded gasoline) disposed of or sold within a given period in each study area. RESULTS AND DISCUSSION: Analysis of soil samples for Pb content showed the presence of Pb in all the soil samples collected from the 30 sampling sites in the six cities at varying concentrations ranging from 1.5 to 251 mg kg(-1). Elevated levels of Pb in soil (i.e. greater than 25 mg kg(-1) Pb) were detected in five out of the six cities investigated. Site 4 recorded the highest Pb concentration (73.9 +/- 94.4 mg kg(-1)), followed by Site 6 (56.3 +/- 17.1 mg kg(-1)), Site 3 (52.0 +/- 33.1 mg kg(-1)), Site 5 (39.3 +/- 19.0 mg kg(-1)), and Site 2 (38.4 +/- 33.2 mg kg(-1)). Soil Pb concentration in Site 1 (16.8 +/- 12.2 mg kg(-1)) was found to be within the estimated natural concentration range of 5 to 25 mg kg(-1). Site 1 registered the least Pb concentration. Nonetheless, the average Pb concentration in the soil samples from the six cities studied were all found to be below the maximum tolerable limit according to World Health Organization (WHO) standards. The high Pb concentration in Site 4 may be attributed mainly to vehicular emission. Although Site 4 only ranked 3rd in total volume of vehicles, it has the greatest number of Type B and Type C vehicles combined. Included in these categories are diesel trucks, buses, and jeepneys which are considered the largest contributors of TSP (total suspended particles) and PM10 (particulate matter less than 10 microns) emissions. CONCLUSION: Only one (San Juan in Site 4) of the thirty sampling sites recorded a Pb concentration beyond the WHO permissible limit of 100 mg kg(-1). San Juan in Site 4 had a Pb concentration of >250 mg kg(-1). On the average, elevated Pb concentration was evident in the soil samples from San Fernando, Olongapo, Malolos, Balanga, and Cabanatuan. The average soil Pb concentrations in these cities exceeded the maximum estimated natural soil Pb concentration of 25 mg kg(-1). Average soil Pb concentration in Site 1 (16.8 mg kg(-1)) was well within the estimated natural concentration range of 5 to 25 mg kg(-1). Data gathered from the study areas showed that elevated levels of Pb in soil were due primarily to vehicular emissions and partly to igneous activity. RECOMMENDATION AND OUTLOOK: The findings of this study presented a preliminary survey on the extent of Pb contamination of soils in urban cities in central region of Philippines Island. With this kind of information on hand, government should develop a comprehensive environmental management strategy to address vehicular air pollution in urban areas, which shows as one of the most pressing environmental problems in the country. Basic to this is the continuous monitoring of Pb levels and other pollutants in air, soil, and water. Further studies should be conducted to monitor soil Pb levels in the six cities studied particularly in areas with elevated Pb concentration. The potential for harm from Pb exposure cannot be understated. Of particular concern are children who are more predisposed to Pb toxicity than adults. Phytoremediation of Pb-contaminated sites is strongly recommended to reduce Pb concentration in soil. Several studies have confirmed that plants are capable of absorbing extra Pb from soil and that some plants, grass species in particular, and can naturally absorb far more Pb than others.

Cities↗
PubMed1991

Healthy cities: the Indiana model of community development in public health.

While the Institute of Medicine's Report on The Future of Public Health provokes debate on public health issues in the United States, the Healthy Cities movement is one approach to addressing many of these issues. Healthy Cities Indiana began in 1988 and adapts the European and Canadian healthy cities experience within the sociopolitical context of Indiana and the United States. Six Indiana cities are collaborating with Indiana University School of Nursing and the Indiana Public Health Association in a process of urban health promotion. The overall healthy cities process is presented including: city commitment, formation of healthy city committee, community leadership development, city action, provision of data-based information to policy makers, and action research and evaluation. Each step in the healthy cities process is described, highlighting examples from the Indiana experience, including an analysis of selected data describing the cities. The facilitators of a healthy city provide support to city leaders in other cities interested in becoming involved in the healthy cities process. Implications of healthy cities for health educators and other health professionals are suggested.

Community Participation↗
PubMed1999

Cardiovascular mortality of Chinese in New York City.

To determine cardiovascular disease mortality among Chinese migrants in New York City and compare it to both that of residents in China and whites in New York City, mortality records for 1988 through 1992 for New York City and the 1990 US census data for New York City were linked. Age-specific death rates for urban China, reported by the World Health Organization, were used for comparison. The results show that male and female Chinese residents in New York City had lower mortality rates for all causes and total cardiovascular disease than did either New York City whites or Chinese in China. Coronary heart disease deaths among New York City Chinese were intermediate between Chinese in China (lowest) and New York City whites (highest). Stroke death rates for New York City Chinese were substantially lower than those in China and, in general, were similar to those for New York City whites. However, New York City Chinese had higher death rates for hemorrhagic stroke and lower for atherosclerotic stroke than did New York City whites. In conclusion, cardiovascular mortality rates among Chinese migrants in New York City fall below those of both Chinese in China and whites in New York City.

Adult↗
PubMed1991

No-smoking laws in the United States. An analysis of state and city actions to limit smoking in public places and workplaces.

OBJECTIVE: To assess the prevalence, content, and growth of state and city laws restricting smoking in public places and workplaces in the United States and to identify factors associated with their passage. DESIGN: A mailed survey of city clerks in US cities with a population of 25,000 or greater (N = 980) and review of existing data sources confirmed the status of smoking restrictions in 902 (92%) of the cities in the sample. State laws were identified by contacting each state's Legislative Reference Bureau (100% response). Content of laws was coded using previously developed categories. MAIN OUTCOME MEASURES: Prevalence, comprehensiveness, and cumulative incidence of no-smoking laws in states and in cities with a population of 25,000 or greater. RESULTS: By July 1989, 44 states and 500 (51%) of the cities in our sample had adopted some smoking restriction, but content varied widely. While 42% of cities limited smoking in government buildings, 27% in public places, 24% in restaurants, and 18% in private workplaces, only 17% of cities and 20% of states had comprehensive laws restricting smoking in all four of these sites. The number of city no-smoking laws increased tenfold from 1980 to 1989. City no-smoking laws were independently associated with population size, geography, state tobacco production, and adult smoking prevalence. Laws were more common in larger cities, Western cities, and states with fewer adult smokers. Laws were less common in tobacco-producing states and in the South. CONCLUSIONS: No-smoking laws are more widespread than previously appreciated, especially at the local level, reflecting a rapid pace of city government action in the 1980s. Nonetheless, comprehensive laws, which are most likely to provide meaningful protection from environmental tobacco smoke exposure, remain uncommon and represent a major gap in smoking control policy. Laws are most needed in smaller and non-Western cities and in states that produce tobacco and have a higher proportion of smokers.

Humans↗
PubMed2001

[Analysis on the relationship between use of health check ups and medical care by elderly patients. A study on urban cities with high health check-up rates].

The aim of this study was to evaluate the influence of health examination provided by municipalities in Japan on the use of medical care by elderly patients aged 70 and above. The study was carried out to compare health indicators of cities with high and low usage rates for health check ups over 14 years. The indicators of health service utilization included mean bed days, mean inpatient fees, and mean outpatient fees in 1983, 1988, 1993 and 1996. The data for these indicators were collected from all 12 Japanese cities, where more than 50% of the target population had annual health check-ups in 1983, 1986, 1989 and 1992, as the subjects of high rate cities. All other 134 cities belonging to the same prefectures with the 12 cities were included as the control low rate cities. The correlation coefficients for all the 146 cities showed that usage rates of health check ups had an inverse relationship with mean bed days and mean inpatient fees for the elderly population in all the fiscal years 1983, 1988, 1993 and 1996. In nine out of the ten prefectures, mean bed days and mean inpatient fees were lower in the high rate cities as compared to the low rate cities for all the fiscal years compared. The bed days in the 12 high rate cities were 72% of those in 134 low rate cities in 1983, and the percentages were 66%, 72%, and 78% in 1988, 1993 and 1996 respectively. No remarkable differences in mean outpatient fees were observed between the high and low rate cities. The differences in use of medical care by inpatients suggest that providing preventive health services would decrease the demand by the elderly and result in a more efficient use of health resources.

Aged↗
PubMed2006

Ageing of the baby boomer generation: how demographic change will impact on city and rural GP and nursing workforce.

INTRODUCTION OBJECTIVE: To compare the impact of ageing on the GP and nursing rural and city workforce. METHOD: Cohort analysis of Australian Bureau of Statistics census data. The data was used to examine the age distribution of the city and rural GP and nursing workforce; patterns of attrition for those 50 years and over; and the impact of changes in working hours. RESULTS: The rural GP and nursing workforce is significantly older than their city counterparts (p<0.001) with the 'baby boomer' generation making up 52% of city GPs but 59% of rural GPs in 2001. While a large proportion of city and rural GPs continued to work past the age of 65 years, rural GPs left the workforce at a significantly younger age than city doctors (p<0.001). Rural nurses are older than their city peers (p<0.001) but retire at an older age than city nurses (p<0.001). In 1986, a significantly higher proportion of rural GPs in all age cohorts worked more than 41 hours per week compared with their city counterparts (p<0.001). By 2001, rural 'generation X' GPs were no more likely to work long hours than those in the city (p<0.001). However, significantly more rural than city 'baby boomers' continued to work long hours. CONCLUSIONS: Rural GPs are retiring faster than city GPs and strategies to attract rural GPs and nurses will be critical to ensure adequate rural health care and that current rural workforce shortage do not worsen.

Adult↗
PubMed1986

New York's role as a center for health care: an analysis of nonresident patients served by New York City hospitals.

Patients who reside outside of New York City have long been an important segment of the patient population at New York City hospitals. Each year, as far back as systematic data are available, approximately 10 percent of all patients at New York City hospitals have been non residents. Increasing competition and changing reimbursement policies compel hospitals in New York City to assess their role in caring for these patients and its economic implications. This report provides a comprehensive assessment of the characteristics of nonresident patients and their significance to the city's hospitals. Using data from all New York City hospitals, the report analyzes the demographics, insurance coverage, and case-mix characteristics of nonresident and resident patients. And, using more detailed data from New York University Medical Center and Columbia-Presbyterian Medical Center, it addresses the financial and reimbursement policy questions posed by the care of nonresident patients. The key findings of the report are as follows: A total of 115,307 nonresidents were hospitalized in New York City in 1982; this figure represents 10.4 percent of all patients in city hospitals. Over 80 percent of nonresident patients come from 14 counties surrounding New York City. Nonresident patients are a crucial component of the patient population at six hospitals that are the principal affiliates of a medical school and the six specialty hospitals. At academic health centers, nonresidents represent 25 percent of all inpatients; at the specialty hospitals, they represent 36 percent. Manhattan hospitals account for 69 percent of all nonresident discharges in the city. Outside of Manhattan, only Montefiore Medical Center and Long Island Jewish Medical Center have substantial numbers of nonresident patients. Among nonresident patients, 75 percent of admissions are scheduled in advance and 72 percent of hospital stays are for surgical procedures. In contrast, among resident patients, only 50 percent of admissions ares scheduled and 52 percent are for surgical procedures. Almost two-thirds of nonresident patients are covered by private insurance, compared to one-third of residents. Nonresident patients require more hospital resources on average than residents do. The average Diagnosis Related Group (DRG) weight, a measure of expected resource intensity, is 22.5 percent higher for nonresidents than for residents. However, nonresidents also come to New York City hospitals for relatively routine care. For example, the most common diagnoses among nonresidents and residents are uncomplicated deliveries and abortions. At New York University Medical Center and Columbia-Presbyterian Medical Center, nonresidents have higher average charges than residents, but the charge differences are much smaller than the DRG weight differences. Thus, within a given DRG, nonresidents consume fewer resources than residents. Under Medicare's Prospective Payment System bases on DRGs, nonresidents appear to be financially attractive to New York hospitals, based on the experience of New York University Medical Center.

Academic Medical Centers↗
PubMed1997

Randomised, controlled, community-level HIV-prevention intervention for sexual-risk behaviour among homosexual men in US cities. Community HIV Prevention Research Collaborative.

BACKGROUND: Community-level interventions may be helpful in population-focused HIV prevention. If members of populations at risk of HIV infection who are popular with other members can be engaged to advocate the benefits of behaviour change to peers, decreases in risk behaviour may be possible. We assessed a community-level intervention to lower the risk of HIV infection, focusing on men patronising gay bars in eight small US cities. METHODS: We used a randomised community-level field design. Four cities received the intervention and four control cities did not. Participants were men from each city who went to gay bars. Men completed surveys about their sexual behaviour on entering the bars during 3-night periods at baseline and at 1-year follow-up. In the control cities, HIV educational materials were placed in the bars. In the intervention cities, we recruited popular homosexual men in the community and trained them to spread behaviour-change endorsements and recommendations to their peers through conversation. FINDINGS: Population-level of risk behaviour decreased significantly in the intervention cities compared with the control cities at 1-year follow-up, after exclusion of surveys completed by transients and men with exclusive sexual partners in a city-level analysis, in the intervention cities we found a reduction in the mean frequency of unprotected anal intercourse during the previous 2 months (baseline 1.68 occasions; follow-up 0.59: p = 0.04) and an increase in the mean percentage of occasions of anal intercourse protected by condoms (baseline 44.7%; follow-up 66.8%, p = 0.02). Increased numbers of condoms taken from dispensers in intervention-city bars corroborated risk-behaviour self-reports. INTERPRETATION: Popular and well-liked members of a community who systematically endorse and recommend risk-reduction behaviour can influence the sexual-risk practices of others in their social networks. Natural styles of communication, such as conversations, brought about population-level changes in risk behaviour.

Adult↗
PubMed2002

Dietary patterns among children aged 6-7 y in four Spanish cities with widely differing cardiovascular mortality.

OBJECTIVE: Classic cardiovascular risk factors, such as smoking, arterial hypertension and hypercholesterolaemia, cannot explain a substantial part of the geographic differences in cardiovascular mortality. Anthropometric and nutritional factors in early stages of life may contribute to adult cardiovascular disease. Therefore, this work examines certain anthropometric variables and diet among children aged 6-7 y, living in four Spanish cities with widely differing ischaemic heart disease (IHD) mortality. DESIGN AND SETTING: Cross-sectional anthropometric and dietary survey in four cities in Spain. SUBJECTS: A total of 1112 children (50.1% males, 49.9% females) attending public and private schools in Cadiz and Murcia, cities with a relatively high IHD mortality, and Madrid and Orense, cities with a relatively low IHD mortality. A standardized method was used to measure anthropometric variables, and a food-frequency questionnaire completed by subjects' mothers, to measure diet. OUTCOME MEASURES: Body mass index (BMI), overweight (BMI>17.6 kg/m(2)), obesity (BMI>20.1 kg/m(2)) and intake of food and nutrients. RESULTS: Children in the four cities showed a high prevalence of overweight (range across cities, 28.9-34.5%) and obesity (8.5-15.7%). They also had a moderately hypercaloric diet (range, 2078-2218 kcal/day), marked by an excessive intake of lipids (45.0-47.3% kcal), particularly saturated fats (16.6-16.9% kcal), proteins (17.0-17.3% kcal), sugars (20.0-21.9% kcal) and cholesterol (161.6-182.9 mg/1000 kcal/day), and a low intake of complex carbohydrates (17.5-18.1% kcal) and fibre (19.6-19.9 g/day). Compared with children in the two low-IHD-mortality cities, those in the two high-IHD-mortality cities had a greater BMI (mean difference, 0.61 kg/m(2); P=0.0001) and ponderal index (0.58 kg/m(3); P=0.0001) and a higher intake of energy (104 kcal/day; P=0.007), cholesterol (16.00 mg/1000 kcal/day; P=0.0001) and sodium (321 mg/day; P=0.0001). Inter-city differences in anthropometric variables remained after adjustment for birthweight. CONCLUSIONS: Intake of fats, especially saturated fats, and cholesterol should be reduced among Spanish children. It could contribute to a needed reduction of the high prevalence of overweight and obesity in children. If the differences in anthropometric variables and diet between children from the cities with high and low coronary mortality are maintained in future or continue into adulthood, this could contribute to consolidate or even increase the IHD mortality gradient across cities. The finding that differences in anthropometric variables are independent of birthweight suggests that the childhood, rather than intrauterine environment, is involved in the development of such differences. SPONSORSHIP: This study was partly funded by grants from the International Olive Oil Board (Consejo Oleícola Internacional), Comunidad Autónoma de Madrid, Fundación Pedro Barrié de la Maza, and Fundación Eugenio Rodríguez Pascual.

Anthropometry↗
PubMed1996

Ultrasonographically assessed maximum carotid artery wall thickness in Mexico City residents and Mexican Americans living in San Antonio, Texas. Association with diabetes and cardiovascular risk factors.

Measurements of carotid artery wall thickness are often used as a surrogate for atherosclerosis. However, few studies have performed these measurements in populations of Mexican origin. Since Mexicans in Mexico City consume high-carbohydrate diets and have carbohydrate-induced dyslipidemia (high triglyceride and low HDL cholesterol levels) compared with Mexican Americans living in San Antonio, Tex, we questioned whether they also had more atherosclerosis than San Antonio Mexican Americans. Mean maximum intimal-medial thickness (IMT) of the common (CCA) and internal (ICA) carotid arteries were measured in 867 subjects aged 35 to 64 years (40% men) in two Mexican-origin populations, one from San Antonio (n = 202) and the other from Mexico City (n = 665). IMT's in the two cities were compared, and their associations with cardiovascular risk factors were analyzed. Older age, male sex, high levels of total cholesterol, low levels of HDL cholesterol, and high systolic blood pressure were positively associated with both CCA IMT and ICA IMT. Cigarette smoking was significantly associated with ICA IMT. CCA and ICA IMTs in diabetic subjects were thicker than in nondiabetic subjects in both men and women (all P < = .05). CCA IMT was thicker in the San Antonio than the Mexico City subjects after adjustment for cardiovascular risk factors (0.81 versus 0.76 mm in men and 0.77 versus 0.71 mm in women; P < .001 for city difference). San Antonio men also had thicker ICA IMT than their counterparts in Mexico City (0.88 versus 0.83 mm), but the reverse was true for women (0.73 versus 0.77 mm; interaction between sex and city, P < .05). Our results indicate that men had higher carotid IMTs than women. CCA IMT was thicker in San Antonio Mexican Americans than in Mexico City residents. The differences in ICA IMTs between San Antonio and Mexico City were inconsistent. Thus, since Mexico City residents consume high-carbohydrate diets, the data do not support an atherogenic effect of such diets. The interaction between sex and city on ICA IMT deserves further study.

Cardiovascular Diseases↗
PubMed1988

Aneurysmal subarachnoid hemorrhage in Izumo City and Shimane Prefecture of Japan. Incidence.

During the 5-year period from 1980 to 1984, the incidence of subarachnoid hemorrhage due only to rupture of aneurysms was investigated in Izumo City, a small city with a population of 79,026. Additionally, to ascertain the relation of incidence to the size of the geographic area and/or population, a similar analysis was made on a larger area of Shimane Prefecture, including Izumo City, with a total population of 789,712. During this 5-year period, a total of 83 patients with aneurysmal subarachnoid hemorrhage were hospitalized in Izumo City, 548 patients in Shimane Prefecture. Ruptured aneurysms were confirmed in 77 cases (93%) in Izumo City and 466 cases (85%) in Shimane Prefecture. The crude annual incidences of aneurysmal subarachnoid hemorrhage for Izumo City and Shimane Prefecture were 21.0 and 13.9 per 100,000 population for all ages, and the age-adjusted annual incidences (adjusted to the 1980 population of Japan) were 18.3 and 11.0 per 100,000 for all ages, respectively. For both Izumo City and Shimane Prefecture, the age-specific annual incidences peaked at the ages of 50-69 years, and the highest incidence was 92.3 per 100,000 men from Izumo City in the eighth decade of life. The annual incidence of subarachnoid hemorrhage for Izumo City is the highest reported to date. If a wider area, such as Shimane Prefecture, were studied many patients in poor condition, particularly elderly patients, would be missed. To determine accurately the incidence of aneurysmal subarachnoid hemorrhage, it thus might be better to conduct the study in a small city such as Izumo City.

Adult↗
PubMed2005

The influence of a large city on some soil properties and metals content.

Urban soils differ from the rural ones by the fact that they are more strongly influenced by anthropogenic activities. This influence is often reflected by a high degree of contamination. To investigate the influence a large city can have on its soils and on the surrounding ones, samples within the city of Torino, Italy were compared with a set of surrounding soils developed from the same alluvial parent material. City-country trends were investigated by spatially managing the samples. Results show that the city plays a key role in concentrating some pollutants, such as Pb, Zn, and Cu within its borders. Lead is the element most enriched in the city, presenting a pollution index of 7.5 calculated comparing the two sets of samples. Ni and Cr appear to have a strong natural contribution. The spatial distributions for Pb, Cu and Zn present an abrupt division between urban and rural samples. Unexpectedly, the transport of pollutants from the city to the surrounding areas seems to be limited as no city-country trends with distance are identified. The pH and the sand fraction result also influenced by the city, showing high values. The investigation of possible city-country distance trends has shown to be effective in evaluating the impact a city can have on its soils and on the transport and deposition of contaminants on the surrounding ones.

Cities↗
PubMed2001

Interpreting sexual behaviour data: validity issues in the multicentre study on factors determining the differential spread of HIV in four African cities.

BACKGROUND: The main conclusion of the multicentre study on factors determining the differential spread of HIV in four African cities was that differences in sexual behaviour could not, by themselves, explain the differences in HIV prevalence between the four cities. The present paper examines three potential sources of bias that could invalidate this conclusion: (1) changes in sexual behaviour since the start of the HIV epidemics; (2) bias due to the low response rates of men; and (3) bias in reported sexual behaviour. METHODS: To assess whether there have been any changes in sexual behaviour over time, selected parameters of sexual behaviour were compared between different age groups in the four cities. The maximum likely extent of bias due to non-participation of men in Yaoundé, Kisumu and Ndola was assessed with a simulation exercise, in which records of non-participants were replaced with records of 'low activity men' in Yaoundé and 'high activity men' in Kisumu and Ndola. To assess the validity of the sexual behaviour data, internal validity checks were carried out: comparing biological data on sexually transmitted infections with reports; comparing reports of spouses; and comparing numbers of sex partners reported by men and women. A fourth method consisted of comparing the findings of the multicentre study with an external source, Demographic and Health Surveys (DHS). RESULTS: There were differences in sexual behaviour between the younger and the older age groups in all four cities but there was no evidence of a shift towards safer sexual behaviour in the high HIV prevalence cities. After simulating results for male non-participants in Yaoundé, Kisumu and Ndola, the median lifetime number of sex partners was similar in Yaoundé, Kisumu and Ndola. By testing for various sexually transmitted infections among men and women aged 15-24 years who reported that they had never had sexual intercourse, we could establish that, in all four cities, at least 1-9% of men and 6-18% of women had misreported their sexual activity. The number of non-spousal partners in the past 12 months reported by men was two to three times higher than the number reported by women, as has been found in other studies. The most consistent differences between our survey and the DHS were found in the numbers of non-spousal partners in the past 12 months reported by never-married men and women. In all four cities, participants reported more non-spousal partners in the DHS than in our survey. CONCLUSIONS: In all four cities, we found evidence that men as well as women misreported their sexual behaviour, but overall it seems that under-reporting of sexual activity was not more common or more serious in the two high HIV prevalence cities than in the two low HIV prevalence cities. We believe that the main conclusions of the multicentre study still hold.

Adolescent↗
PubMedDate not supplied

Exposure to New York City as a risk factor for heart attack mortality.

OBJECTIVE: If New York City (NYC) residents' unusually high rate of ischemic heart disease (IHD) results from chronic exposure to that city, there might also be an effect of acute exposure among visitors to NYC. We explored this possibility and also whether IHD is reduced among NYC residents dying away from the city. METHODS: Using all US death certificates for 1985-1994, we examined (correcting for age, race, and sex) IHD deaths in three groups: NYC residents who died in the city, non-NYC residents visiting the city, and NYC residents traveling out of the city. RESULTS: IHD deaths among NYC residents dying in the city were 155% of the expected proportion (p < .0001). Among visitors to the city, such deaths were 134% of the expected proportion (p < .0001). The proportion of IHD deaths among NYC residents dying out of the city was only 80% of the expected value (p <.0001). These effects are not due to nearby commuters, recent immigrants, local classification practices, or socioeconomic status, and they do not appear in other US cities. CONCLUSIONS: With both chronic and acute effects of exposure to NYC, these data are consistent with the hypothesis that the stress of NYC is linked to the high rate of IHD.

Environmental Exposure↗
PubMed1999

International and US medical graduates in US cities.

OBJECTIVES: This study examines the comparative distributions of postresident international medical graduates (IMGs) and US medical graduates (USMGs) in high and low poverty areas of US cities. Existing research has established that IMGs are more likely than USMGs to practice in urban areas, yet there is the question whether IMGs locate more frequently than USMGs in urban poverty areas. METHODS: Data from the 1997 AMA Physician Masterfile and 1990 US Census were merged to classify physicians' practices into low- and high-poverty areas in selected cities. RESULTS: In 14 cities with populations of 2.5 million or more, IMGs were located in a statistically significant disproportion in poverty areas of 7 cities. Of 36 cities with populations of 1,000,000 to 2,499,999, there were 5 cities that had significant IMG disproportions in poverty areas. Of a random sample of 27 cities with populations of 250,000 to 999,999, there were 2 cities that had significant IMG disproportions. Many cities in all three size categories had a large proportionate IMG complement of the total physician workforce located within high-poverty areas. CONCLUSIONS: IMGs were found in disproportionate numbers in poverty areas in a number of US cities, especially the very largest ones. These findings are discussed in light of the current debate about a physician surplus and initiatives to reduce the number of IMGs in residency training.

Data Collection↗
PubMed2006

Suicide mortality in South Africa: a city-level comparison across socio-demographic groups.

BACKGROUND: South Africa offers a valuable study environment to assess the impact of political and social changes on health. Increasing urbanisation has led to a focus on city development and its effect on its residents. The study assesses whether sex- and race-specific suicide rates differ across six of South Africa's major cities. Regional differences may reflect varying contextual and individual underlying mechanisms. Those need to be understood for appropriately targeted prevention efforts. METHODS: Suicide mortality data (n=4,946) for the six cities between 2001 and 2003 were used to assess whether there are differences in rates for age-standardised race and sex groups across cities and whether these differences are constant across cities. The overall age-standardised rates for the six cities was 25.3/100,000 for men and 5.6/100,000 for women. RESULTS: Suicide rates are most often highest among whites and men, but both the magnitude and distribution of suicide vary considerably for different race and sex groups within and across cities. There is a strong association between the method of suicide used and the city. CONCLUSIONS: Despite some common trends in the suicide profile across South African cities, city does matter for the magnitude and distribution of suicide mortality across race and sex groups and for the method of suicide used. The need for locally based suicide research investigating possible reasons for these differences is highlighted.

Adult↗
PubMedDate not supplied

Ecology of cycloheximide-resistant fungi in field soils receiving raw city wastewater or normal irrigation water.

The effect of raw city wastewater irrigation on biodiversity and population densities of a cycloheximide-resistant (CH) fungal community was studied in 13 field soils receiving either raw city wastewater or normal irrigation, and in raw city wastewater in the Nablus area, using the hair baiting technique (HBT) and a surface soil dilution plating (SSDP) technique. Three of these fields [one had been receiving raw city wastewater for more than ten years and was designated a heavily polluted field, and the other 2 were cultivated for the first time and were either irrigated with raw city wastewater (newly polluted field) or normal irrigation water (nonpolluted)], were sampled 4-7 times over a 9-month period. The other ten fields, which had been under raw city wastewater irrigation for more than 10 years, were sampled only once. Fifty-seven CH-resistant species belonging to 18 genera were recovered, of which 49 species were recovered from soil habitats and 28 species from raw city wastewater. The HBT had shown to be more efficient in the isolation of pathogenic and potentially pathogenic fungi including dermatophytes. A higher percentage of this group of fungi was recovered from the three main field soils studied using HBT (70% of all isolates), than the SSDP (35.5%); no dermatophytes were recovered by the SSDP method. Two dermatophytes (Microsporum gypseum, and Trichophyton ajelloi), and five more fungi (Arthroderma cuniculi, A. curreyi, Chrysosporium keratinophilum, C. tropicum, C. pannorum), were recovered from these habitats. Wastewater irrigation seemed to have affected the fungal population densities, with the highest population densities being found in the heavily polluted field soil, while lower population densities were found in the nonpolluted field soil. Increases in organic matter were also observed as a result of sewage effluent irrigation. However, basic similarities in the biodiversity of CH-resistant fungal communities existed in nonpolluted and polluted field soils, and raw city wastewater. Comparable numbers of fungal species were recovered from the three main field soils. The species most commonly found in those habitats included: Alternaria alternata, Aspergillus candidus, Geotrichum candidum, and Paecilomyces lilacinus. Field soils receiving either raw city wastewater or normal irrigation water, were found to be rich in pathogenic and potentially pathogenic CH-resistant fungi, including dermatophytes, with raw city wastewater yielding the highest percentage (81%), followed by the newly wastewater irrigated field (77.7%), the nonpolluted field (67%), and the heavily polluted field (63.4%) Hygienic measures should therefore be taken to control the spread of these fungi in the environment of human communities, and to avoid mycotic infections among farmers.

Agriculture↗