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PubMed1998

[Frequency of admissions to neonatal care units of 1994 birth cohorts in Funen and Frederiksborg Counties].

The frequency of admission to neonatal intensive care units is higher in Denmark than in the UK. The organization of the paediatric departments varies from county to county in Denmark. To investigate possible differences due to the organization, the records for all hospitalized newborns in a one year period in two counties (FR and FU) were studied. The rate of prematurity was higher in county FU than in FR, but, surprisingly, the admission rate was lowest in county FU. For full term infants the highest admission rate was found in county FR, where more infants were treated with nasal continuous positive airway pressure compared to FU. Short admissions were more common in FR. The on-call paediatrician is a senior doctor in FU, whereas it is a junior doctor in FR, and this could be a possible explanation for the differences between the two counties.

Denmark↗
PubMed1994

A population-based study of the association of medical manpower with county trauma death rates in the United States.

OBJECTIVE: To determine the association between measures of medical manpower available to treat trauma patients and county trauma death rates in the United States. The primary hypothesis was that greater availability of medical manpower to treat trauma injury would be associated with lower trauma death rates. SUMMARY BACKGROUND DATA: When viewed from the standpoint of the number of productive years of life lost, trauma has a greater effect on health care and lost productivity in the United States than any disease. Allocation of health care manpower to treat injuries seems logical, but studies have not been done to determine its efficacy. The effect of medical manpower and hospital resource allocation on the outcome of injury in the United States has not been fully explored or adequately evaluated. METHODS: Data on trauma deaths in the United States were obtained from the National Center for Health Statistics. Data on the number of surgeons and emergency medicine physicians were obtained from the American Hospital Association and the American Medical Association. Data on physicians who have participated in the American College of Surgeons (ACS) Advanced Trauma Life Support Course (ATLS) were obtained from the ACS. Membership information for the American Association for Surgery of Trauma (AAST) was obtained from that organization. Demographic data were obtained from the United States Census Bureau. Multivariate stepwise linear regression and cluster analysis were used to model the county trauma death rates in the United States. The Statistical Analysis System (Cary, NC) for statistical analysis was used. RESULTS: Bivariate and multivariate analyses showed that a variety of medical manpower measures and demographic factors were associated with county trauma death rates in the United States. As in other studies, measures of low population density and high levels of poverty were found to be strongly associated with increased trauma death rates. After accounting for these variables, using multivariate analysis and cluster analysis, an increase in the following medical manpower measures were associated with decreased county trauma death rates: number of board-certified general surgeons, number of board-certified emergency medicine physicians, number of AAST members, and number of ATLS-trained physicians. CONCLUSIONS: This study confirms previous work that showed a strong relation among measures of poverty, rural setting, and increased county trauma death rates. It also found that counties with more board-certified surgeons per capita and with more surgeons with an increased interest (AAST membership) or increased training (ATLS) in trauma care have lower per-capita trauma death rates.(ABSTRACT TRUNCATED AT 400 WORDS)

Black or African American↗
PubMed2003

Quality assurance with regard to outcome and use of medical resources for patients hospitalized with acute chest pain: a comparison between a city university hospital and a county hospital.

This study aimed to test the hypothesis that there is a difference in mortality between patients hospitalized with acute chest pain in a university hospital and those hospitalized in a county hospital, and to describe differences in characteristics and use of medical resources in these two settings. All patients hospitalized at Sahlgrenska University Hospital in Göteborg (with a catchment population of 706 inhabitants/km(2)) and Uddevalla County Hospital (with a catchment population of 34 inhabitants/km(2)) with symptoms of acute chest pain during a registration period of 6 months were included in the study. A total of 1592 patients in the city hospital and 822 in the county hospital fulfilled the given criteria for inclusion. Patients in the urban area differed from those in the rural area in that they had a lower prevalence of previous angina pectoris and hypertension and a higher prevalence of previous cancer, previous percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) and current smoking. On admission to hospital, patients in the urban area less frequently showed clinical signs of congestive heart failure and acute ischaemia on the electrocardiogram (ECG) but more frequently had a pathological ECG without signs of ischaemia and more frequently had a heart rate >100 beats/min. The use of medical resources differed between the two hospitals. Revascularization was more frequent in the city hospital and the use of -blockers in the county hospital. The overall 30 day mortality was 4.7% in the urban area and 4.3% in the rural area (P=0.74). When correcting for differences at baseline, the risk ratio for death in the county hospital versus the city hospital was 0.84 (95% confidence interval 0.51-1.40, P=0.53). In conclusion, among patients hospitalized with acute chest pain in a city university and a county hospital the mortality during the subsequent 30 days did not differ. However, there were differences in terms of the use of medical resources and in previous history, chronic medication prior to hospital admission and status on admission between the two cohorts.

Acute Disease↗
PubMed2003

Subjective symptoms and well-being 30 months after acute chest pain in a county hospital and a city university hospital in Sweden.

AIM: To compare various health-related aspects of quality of life during long-term follow-up after admission to hospital due to acute chest pain in a city university hospital and a county hospital. METHODS: This was a retrospective survey of all chest pain patients > or = 30 years of age at the Sahlgrenska University Hospital, Göteborg, covering an area with 706 inhabitants per km2 and at Uddevalla County Hospital, Uddevalla, covering an area with 34 inhabitants per km2 over a period of six months. After 30 months all patients alive were approached with a questionnaire in which they were asked about various aspects of health-related quality of life and use of medication. RESULTS: In all, 1,813 patients in the city hospital and 804 patients in the county hospital took part in the survey. The mortality and the overall proportion of patients requiring rehospitalization was similar in the two cohorts. Thirty months after onset of symptoms there was a difference between the two study populations. Patients in the county hospital smoked less frequently (p = 0.004). They tended to have less problems with chest pain at rest (p < 0.05) and dyspnoea at slight physical exercise (p = 0.01). Furthermore, they had less emotional symptoms (p = 0.003) and their state of health caused fewer problems when doing housekeeping (p = 0.008). Differences with regard to emotional symptoms and problems when doing housekeeping were particularly observed among women, whereas smoking habits differed only among men. CONCLUSION: When comparing patients admitted to hospital with acute chest pain in a city university hospital and a county hospital after 30 months some differences appeared. Patients in the county hospital appeared to suffer from less symptoms than patients in the city hospital. This was particularly observed among women. The mechanisms behind these observations are not clear.

Activities of Daily Living↗
PubMed1992

Human immunodeficiency virus-1 seroprevalence among parturients in Los Angeles County public hospitals.

To estimate the prevalence of human immunodeficiency virus type 1 (HIV-1) among parturients in an area with a high cumulative incidence of AIDS, an HIV seroprevalence study was conducted in 1988 in Los Angeles County. Test results were available from 8485 (86.1%) of the 9860 women delivering at four public hospitals. The test results were linked to demographic and medical information available from routinely collected delivery records. Three specimens were HIV-positive, for a seroprevalence of 3.5 per 10,000. The seropositive women were all Latina. The prevalence of HIV among women delivering at all hospitals in Los Angeles County has been shown to be relatively low compared with that of other metropolitan areas with a high number of AIDS cases, such as New York city, but appears to be even lower among women delivering at public hospitals during this time period. This low prevalence is attributed to the predominance of Latinas, who may have lower levels of infection, among public hospital parturients. The relatively low prevalence of HIV among injection drug users in Los Angeles County may contribute to the overall lower prevalence among women in Los Angeles County compared with those in New York city. This study supplements county-specific data obtained from statewide blinded neonatal testing by providing details on HIV seroprevalence among the catchment populations of public hospitals in Los Angeles County.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Population-based study of the adequacy of well-child care services: a rural county's report card.

OBJECTIVE: To determine the adequacy of well-child care services using a population-based study. DESIGN: The medical records of all county providers and the immunization records at the local health department were reviewed. A county birth cohort, identified using electronic birth certificates, was compared with those who migrated into the area (hereafter, in-migrants). SETTING: All primary care sites (private, network, etc) in a rural county. PATIENTS: Two-year-old children born between May 31, 1993, and May 30, 1994. MAIN OUTCOME MEASURES: Immunization rates and preventive screenings. RESULTS: A total of 674 medical records were reviewed. Of these, 377 (56%) belonged to a county birth cohort and 297 (44%) were in-migrants. Medical records of 64% of the birth cohort were reviewed. Among all 2-year-olds, 80% received 4 doses of diphtheria and tetanus toxoids and pertussis vaccine; 89%, 3 doses of Haemophilus influenzae type b (Hib); 75%, 4 doses of Hib; 77%, 3 doses of hepatitis B vaccine; 85%, measles-mumps-rubella vaccine; 85%, 3 doses of oral poliovirus vaccine; 17%, varicella live virus vaccine (Varivax). The 4:3:1 rate was 75% at age 2 years. Sixty-eight percent had had 1 hematocrit, 74% had 1 lead screening test, and 43% had 2 lead screening tests. A total of 64% had had 6 well-child visits and 30% had had 9. The mean number of weights and heights measured was 4.8 and 4.5, respectively, at age 1 year and 7.3 and 6.8, respectively, at age 2 years. The birth cohort had notably higher rates of documented immunization and preventive screening than in-migrants. CONCLUSIONS: This study demonstrated immunization coverage at or below the national average, and well-child care service provisions below American Academy of Pediatrics standards at a county level. This study enabled individual primary care sites to assess their well-child care provision and provided a useful baseline for targeting the improvement of well-child care services in the county.

Child Health Services↗
PubMed1996

The impact of the Medicare Influenza Demonstration Project on influenza vaccination in a county in Massachusetts, 1988-1992.

Influenza and related pneumonia continue to cause significant amounts of morbidity and mortality despite the availability of effective vaccines. Two comparable counties in Massachusetts served as project areas of a national trial to see if reimbursement for immunizing Medicare-B eligible recipients against influenza would increase the use of the vaccine and reduce the costs attributed to related morbidity. Providers of health and social services to elders were recruited to participate in one county. A variety of professional and public education campaigns and media were used to promote influenza immunizations. Laboratory-based surveillance was instituted in both counties to assess the extent of circulating virus in each. Vaccine was made available to medical providers in both counties. While the amount of vaccine used in the comparison county increased by 6% from pre-project time (16,000 to 17,000 doses administered), vaccine use increased 219% in the intervention county (21,250 to 46,494 doses administered). In a post-project survey of participating physicians, 88% of 238 respondents reported administering less than 100 doses of influenza vaccine per year prior to the project. By the end of the project, only 32% administered less than 100 in the previous year. This project demonstrated the need for educating both the provider and the public in order to successfully promote immunizations. It was not clear, however, if reimbursement was a more important factor for promoting influenza immunizations than was universal distribution of free vaccine.

Aged↗
PubMed2004

Evaluation of a public health Salmonella surveillance system in King County, Washington.

OBJECTIVES: Salmonella infection is the most common cause of foodborne bacterial outbreaks and deaths in the United States. The effectiveness of Salmonella surveillance for detecting outbreaks depends on timeliness of reporting. We evaluated the public health Salmonella surveillance system in King County, Washington, during an outbreak and at baseline. METHODS: We assessed the timeliness of the Salmonella surveillance system in King County using the Public Health-Seattle & King County Laboratory (County PHL) database from 1998 to 1999. We determined median days for key steps involved in the Salmonella identification and reporting process and the percentage of suspected Salmonella isolates confirmed. Time intervals for key steps during a Salmonella outbreak were compared to baseline surveillance. RESULTS: Of the 652 suspected Salmonella isolates sent to the County PHL from 22 clinical laboratories, 617 (94.6%) were confirmed as Salmonella. Salmonella confirmation rates improved from 1998 to 1999, and 41% of the submitting laboratories, contributing 32.4% of the isolates, had 100% confirmation rates for both years. The median total identification time during the outbreak did not differ significantly from baseline (13 days vs 17 days). The time interval for serotyping contributed most to the total identification time. CONCLUSIONS: King County's Salmonella surveillance system requires more than 2 weeks to confirm and report serotype results for Salmonella isolates. Variation in total identification time depends on serotyping time. A more detailed study of other surveillance systems may identify approaches to decrease total identification time.

Disease Outbreaks↗
PubMed2004

Comparison of small-area analysis techniques for estimating county-level outcomes.

BACKGROUND: Since many health data are unavailable at the county level, policymakers sometimes rely on state-level datasets to understand the health needs of their communities. This can be accomplished using small-area estimation techniques. However, it is unknown which small- area technique produces the most valid and precise results. METHODS: The reliability and accuracy of three methods used in small-area analyses were examined, including the synthetic method, spatial smoothing, and regression. To do this, severe work disability measures were first validated by comparing the 2000 Behavioral Risk Factor Surveillance System (BRFSS) and Census 2000 measures (used as the gold standard). The three small-area analysis methods were then applied to 2000 BRFSS data to examine how well each technique predicted county-level disability prevalence. RESULTS: The regression method produces the most valid and precise estimates of county-level disability prevalence over a large number of counties when a single year of data is used. CONCLUSIONS: Local health departments and policymakers who need to track trends in behavioral risk factors and health status within their counties should utilize the regression method unless their county is large enough for direct estimation of the outcome of interest.

Adolescent↗
PubMed2006

County and organizational predictors of depression symptoms among low-income nursing assistants in the USA.

Low-wage workers represent an ever-increasing proportion of the US workforce. A wide spectrum of firms demand low-wage workers, yet just 10 industries account for 70% of all low-paying jobs. The bulk of these jobs are in the services and retail sales industries. In health services, 60% of all workers are low-paid, with nursing aides, orderlies, personal attendants, and home care aides earning an average hourly wage of just 7.97 US dollars--a wage that keeps many of these workers hovering near or below the poverty line. Nursing assistants also tend to work in hazardous and grueling conditions. Work conditions are an important determinant of psychological well-being and mental disorders, particularly depression, in the workplace have important consequences for quality of life, worker productivity, and the utilization and cost of health care. In empirical studies of low-wage workers, county-level variables are of theoretical significance. Multilevel studies have recently provided evidence of a link between county-level variables and poor mental health among low-wage workers. To date, however, no studies have simultaneously considered the effect of county-and workplace-level variables. This study uses a repeated measures design and multilevel modeling to simultaneously test the effect of county-, organizational-, workplace-, and individual-level variables on depression symptoms among low-income nursing assistants employed in US nursing homes. We find that age and emotional strain have a statistically significant association with depression symptoms in this population, yet when controlling for county-level variables of poverty, the organizational-level variables used were no longer statistically significant predictors of depression symptoms. This study also contributes to current research methodology in the field of occupational health by using a cross-classified multilevel model to explicitly account for all variations in this three-level data structure, modeling and testing cross-classifications between nursing homes and counties of residence.

Adult↗
PubMed1998

County drift: a type of geographic mobility of chronic psychiatric patients.

This study describes "County Drift," the tendency of chronic psychiatric patients to move from outlying counties to the central county containing the psychiatric hospital. Changes of residence of repeat visitors to a Psychiatric Emergency Service were examined to substantiate that a higher proportion (34.2%) moved to the central county than the reverse (5.3%). An analysis comparing patients who moved to the central county with those who did not showed that patients already connected to treatment and with schizophrenic/psychotic, disorders remained in their home counties. Patients presenting complications reflected by secondary diagnoses of personality or substance use disorders were more likely to relocate to the area of the psychiatric facility.

Adult↗
PubMed2002

Use of Medicare claims data to measure county-level variation in breast carcinoma incidence and mammography rates.

BACKGROUND: National-level population-based data about breast carcinoma incidence and its association with screening mammography are currently not available. METHODS: Inpatient, hospital outpatient and physician/supplier Medicare claims were used to identify incident cases of breast carcinoma in women > or = 65 years from 1996 to 1997 and calculate county-level incidence rates. The 1994-1995 claims data were used to determine county-level rates of mammography, and determine the correlation with incidence. RESULTS: The median 2-year incidence rate for women > or = 65 was 979/100,000, and substantial variation in incidence between counties was observed. (i.e. 25th percentile 789/100,000, 75th percentile 1186/100,000). Two-year county-level mammography rates also varied among counties (i.e. 25th percentile 30.5%, 75th percentile 40.9%) and were higher in white women than in black women (median 36.8 and 26.3%, respectively). Counties with higher rates of mammography also had higher age-adjusted incidence rates. CONCLUSIONS: Medicare claims may provide an alternative source of population-based data, particularly for areas in which registry data are not readily available, or are of limited scope. The data highlight the geographic variation in incidence and screening rates that may be useful for targeted interventions, and also suggest that mammography remains in a growth phase.

Aged↗
PubMed2003

Prevalence and processing of child sexual abuse: a multi-data-set analysis of urban and rural counties.

This study investigated how contextual factors affect the processing of child sexual abuse cases, from reporting to sentencing. We analyzed three types of data: (a) data compiled by the Pennsylvania Coalition Against Rape from monthly reports by all rape crisis centers in the state; (b) data from the Pennsylvania Office of Children, Youth, and Families; and (c) sentencing data from the Pennsylvania Commission on Sentencing. Results indicated that aggregate rates of reporting, substantiation, and sentencing were affected by county levels of expenditure. In addition, reporting and substantiation were affected by county-level factors, such that rural counties, counties with a higher percentage of individuals living below the poverty level, counties with higher expenditures, and counties with a higher percentage of stranger assaults had higher rates of child sexual abuse reporting.

Child↗
PubMed2003

Population-density and county-level variation in breast cancer mortality rates among white women residing in the Northeastern and Southern United States.

OBJECTIVE: We assessed the contribution of variation in risk factor prevalence to population-density and county-level variation in breast cancer mortality rates. METHODS: In 1995 we collected risk factor information in a telephone interview of a random digit dialed sample of: (1) 1241 women from counties in the upper and lower tertiles of population density as of 1970 in the Northeast and South of the United States (Design A); (2) 2492 women from counties in the upper and lower tertiles of 1970-1979 breast cancer mortality rates in the four populations from Design A, and; (3) 276 women in Nassau County in New York State. We calculated 1990-94 mortality ratios (MRs) adjusted for breast cancer risk factors. RESULTS: The high/low population-density fully-adjusted MRs in women > or = 55 years were 1.01 (95% CI 0.9-1.2) and 1.00 (95% CI 0.8-1.2). The fully-adjusted MRs for high versus low mortality counties ranged from 0.95 (95% CI 0.8-1.2) to 1.29 (95% CI 1.0-1.6) in women > or = 55 years. CONCLUSIONS: Differences in risk factor prevalence explained higher rates in high-density versus low-density areas in older women. Modest elevations in the adjusted high/low breast cancer MRs among older women in certain groups of counties may reflect unidentified risk factors but more likely are due to chance.

Adult↗
PubMed1999

Iron status of middle-aged women in five counties of rural China.

OBJECTIVE: To determine the relationships of dietary iron sources, other dietary factors, and lifestyle to iron status among premenopausal and recently postmenopausal Chinese women with widely varying regional dietary patterns. DESIGN: Cross-sectional. Subjects were interviewed, blood samples were drawn, and dietary intakes were measured by a 3-day dietary survey for subjects in the five survey counties. SETTING: Rural China. SUBJECTS: About 80 randomly selected subjects per county among women aged 32 66 y. MAIN OUTCOME MEASURES: Blood hemoglobin, plasma ferritin, and plasma iron. RESULTS: Total iron intake was relatively high (15-29 mg/d) compared to developed counties. Heme iron intake was negligible in two of the study counties. Overall levels of iron deficiency anemia were relatively low in these generally iron-stressed women. There was no clear statistical relationship between iron intake and physiological iron status. Although several measures of dietary intake (heme iron, dietary calcium, animal protein) were correlated with several measures of iron status before adjusting for survey county, only dietary animal protein was significantly positively correlated with plasma ferritin after adjusting for the possibly confounding factor of the survey county (r= 0.15, P = 0.009). Intakes of potential inhibitors of iron absorption, such as tea, even in very high amounts, were not correlated to iron status. Plasma ferritin was positively correlated with plasma retinol (P = 0.024) and cholesterol (P = 0.007). Systemic inflammatory response, as indicated by high plasma C-reactive protein levels, was shown to be raised in a group of subjects with apparently contradictory high levels of ferritin and low levels of hemoglobin (P = 0.03). CONCLUSIONS: Iron nutriture in these areas of rural China seemed more related to physiological factors such as inflammatory response, menses, plasma vitamin A and cholesterol, than to dietary factors.

Adult↗
PubMed2002

Chlamydia trachomatis in older Los Angeles County residents, 1991-1998: implications and recommendations for the detection of sexually transmitted infections in older age groups.

OBJECTIVES: This study examined the incidence and implications of reported chlamydia cases in Los Angeles County residents aged 50 and older. DESIGN: Observational study of passive surveillance data submitted to the Los Angeles County Sexually Transmitted Disease Program. SETTINGS: Private and public health facilities in Los Angeles County. PARTICIPANTS: Los Angeles County residents aged 50 and older. MEASUREMENTS: Chlamydia cases were identified from the Los Angeles County Sexually Transmitted Disease Program passive surveillance system reports received from 1991 to 1998. RESULTS: Between 1991 and 1998, 1,421 cases of chlamydia were reported in persons aged 50 and older in Los Angeles County, accounting for 1% of total chlamydia cases. The average annual incidence rate for this period was 9.3 per 100,000, and appeared relatively stable. The mean age +/- standard deviation was 59.0 +/- 9.2 years, with a range of 50 to 96 years. Rates for older women were 1.1 to 3.0 times higher than in older men, similar to rate ratios for 20- to 35-year-olds. Rates among older African Americans appear to be substantially higher than any other older racial/ethnic group. CONCLUSIONS: Our data show that there are no age barriers for sexually transmitted infections. Although this population is highly unlikely to experience adverse reproductive outcomes, transmission to younger sex partners and contribution to the overall chlamydia epidemic are serious concerns. Surveillance and prevention strategies aimed at older persons will be needed as this population continues to grow.

Aged↗
PubMedDate not supplied

Cancer mortality in U.S. counties with hazardous waste sites and ground water pollution.

Since the late 1950s, more than 750 million tons of toxic chemical wastes have been discarded in an estimated 30,000 to 50,000 hazardous waste sites (HWSs). Uncontrolled discarding of chemical wastes creates the potential for risks to human health. Utilizing the National Priorities Listing (NPL) of hazardous waste sites developed by the United States Environmental Protection Agency (EPA), this study identified 593 waste sites in 339 U.S. counties in 49 states with analytical evidence of contaminated ground drinking water providing a sole source water supply. For each identified county, age-adjusted, site-specific cancer mortality rates for 13 major sites for the decade 1970-1979, for white males and females, were extracted from U.S. Cancer Mortality and Trends 1950-1979. Also, HWS and non-HWS counties that showed excess numbers of deaths were enumerated for each cancer selected. Significant associations (p less than .002) between excess deaths and all HWS counties were shown for cancers of the lung, bladder, esophagus, stomach, large intestine, and rectum for white males; and for cancers of the lung, breast, bladder, stomach, large intestine, and rectum for white females when compared to all non-HWS counties. There were no consistent geographical patterns that suggested a broad distribution of gastrointestinal cancers associated with HWSs throughout the United States, although we did identify a cluster of excess gastrointestinal cancers in counties within states located in EPA Region 3 (Delaware, Maryland, Pennsylvania, Virginia, West Virginia).(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMedDate not supplied

Reduced IL-6 levels among individuals in Hudson County, New Jersey, an area contaminated with chromium.

Hudson County, New Jersey, was a major center for the processing of chromium ore. After processing, some of the ore residue that contained low concentrations of chromium became distributed in population centers throughout the county. There now exists concern in the county about possible health effects from chromium exposure. Our previous research suggested that immune-function assays would make useful biomarkers for chromate exposure in humans. Blood samples were drawn from 46 individuals who lived and/or worked in Hudson County and from 47 controls. Only one of the immune-associated assays performed on these samples showed any statistically significant differences between the Hudson County and control groups. The mean level of IL-6 produced by pokeweed mitogen-stimulated mononuclear cells isolated from the Hudson County group was 64% of the control value--a highly significant decrease (p<.001). There was also a significant correlation between the proliferative responses of the mononuclear cells to pokeweed mitogen and the levels of IL-6 produced by these cells. No differences were detected in the IL-6 responses that resulted from age, gender, or smoking status. The reliability of the IL-6 assay was found to be 90%. To our knowledge, there have been no reports, until now, that describe reduced production of any cytokine in individuals who are exposed to chromate.

Cell Division↗