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PubMedDate not supplied

The growth of London schoolchildren 1904-1966: an analysis of secular trend and intra-county variation.

Height and weight were measured on 299,303 children involved in eleven London County Council Surveys dating from 1904 to 1966. This paper describes the historical background to these surveys, the secular trend towards increasing heights and weights and a decreasing age at menarche, and the variation of height and weight between parts of the county. All the surveys were cross-sectional, but that of 1966 included yearly velocity data on 13,806 children. Means for height and weight by age and sex were adjusted to the exact half year to allow comparison of all surveys. Menarcheal age was determined by probit analysis on status quo data in 1954, 1959 and 1966. Intra-county comparisons were based on the Divisional Index of the nine Area Health Divisions of the County. The results indicate an end to the positive secular trend for height and weight at about the same time as the previously reported end to a decreasing age of menarch in London girls. Intra-county comparisons indicated different rates of secular trend within different areas favouring those children who were the smallest and lighest in 1949. The end of the secular trend is thought to be due to genetic factors and intra-county changes to improve environmental conditions.

Adolescent↗
PubMed2003

Air pollution and daily mortality in two U.S. counties: season-specific analyses and exposure-response relationships.

I used generalized additive models to analyze the time series of daily total nonaccidental deaths and deaths due to vascular disease over the period 1987-1995 in two major metropolitan areas, Cook County, Illinois, and Los Angeles County, California, in the United States. In both counties I had monitoring information on PM(10), CO, SO(2), NO(2), and O(3). In Los Angeles, monitoring information on PM(2.5) was available as well. In addition to full-year analyses, I performed season-specific analyses. I present the results of both single- and multipollutant analyses. Although components of air pollution were associated with total nonaccidental and vascular disease mortality in both counties, the results indicate considerable heterogeneity of these associations in the two locations and also from season to season. In Los Angeles County, the gases, particularly CO and SO(2) but not ozone, were more strongly associated with mortality than was particulate matter, which exhibited only weak and inconsistent associations with both mortality endpoints. Both PM(10) and the gases were associated with total and vascular disease mortality in Cook County. The association of the gases with both mortality endpoints appeared to be stronger and more robust than that of PM(10). Exposure-response analyses using flexible smoothers showed significant departures from linearity, particularly for PM effects.

Air Pollutants↗
PubMed2002

A comparison of Campylobacter jejuni enteritis incidence rates in high- and low-poultry-density counties: Michigan 1992-1999.

To compare the incidence of Campylobacter jejuni enteritis in high- and low-poultry-density counties in Michigan between the years 1992 and 1999, an ecological study was conducted in the state of Michigan. A log-linear model was used to compare yearly, seasonal, age, and gender-specific incidence rates between county groupings. Counties with a high poultry density had a higher overall incidence of C. jejuni enteritis, particularly among children and young adults, compared with counties with low poultry density. The findings suggest that living in high-poultry-density counties is associated with higher odds for C. jejuni enteritis. This may be due to occupational exposure among poultry workers in these counties, but the findings in children suggest that indirect or environmental exposures may also play a role. Future studies should be conducted to investigate these issues.

Adolescent↗
PubMed1984

Bladder cancer mortality in New Jersey counties, and relationship with selected environmental variables.

Age-adjusted mortality rates for bladder cancer were calculated for the 21 New Jersey (NJ) counties (USA) during the period 1968-1977, and compared with the period 1950-1969, with the Surveillance, Epidemiology and End Results (SEER) survey and with cancer mortality in the US 1973-1977. The county rates were also correlated with: the rates of low birth weight, birth defects, infant mortality; chemical waste disposal sites; annual per capital income; per cent of the population working in the chemical industries; density of population and urbanization indices of 21 NJ counties. Age-adjusted bladder cancer mortality rates in 95% of NJ counties were higher than national and SEER area rates. The overall NJ State rates for four subgroup populations were highly significantly (p less than 0.001) greater than the national rates. There was a statistically significant correlation between bladder and lung cancer mortality among females in 21 NJ counties which may suggest a common risk factor--namely cigarette smoking. There was no such correlation between bladder and lung cancer mortality among males. There was a statistically significant association between bladder cancer mortality in individual counties and the percentage of the adult population working in the chemical industries.

Adolescent↗
PubMed1998

Precancerous lesions in two counties of China with contrasting gastric cancer risk.

BACKGROUND: Gastric cancer (GC) is one of the most common cancers worldwide and shows remarkable geographical variation even within countries such as China. Linqu County in Shandong Province of northeast China has a GC rate that is 15 times higher than that of Cangshan County in Shandong, even though these counties are within 200 miles of each other. METHOD: In order to evaluate the frequency of precancerous gastric lesions in Linqu and Cangshan Counties we examined 3400 adults in Linqu County and 224 adults in Cangshan County. An endoscopic examination with four biopsies was performed in each individual of the two populations. RESULTS: The prevalence of intestinal metaplasia (IM) and dysplasia (DYS) was 30% and 15.1%, respectively, in Linqu compared to 7.9% and 5.6% in Cangshan (P < 0.01). Within these histological categories, advanced grades were found more often in Linqu than in Cangshan. The prevalences of IM and DYS were more common at each biopsy site in Linqu, where the lesions also tended to affect multiple sites. CONCLUSIONS: The findings of this study support the concept that IM and DYS are closely correlated with risks of GC and represent late stages in the multistep process of gastric carcinogenesis.

Adult↗
PubMed1988

An epidemiologic study of sudden death at work in an industrial county, 1979-1982.

The descriptive epidemiology of sudden death at work was studied in an urban, industrial county. County coroner's records were used to identify the 212 deaths that occurred at work among employed white males in Allegheny County, Pennsylvania in 1979-1982. Occupations and industries with increased risks for either sudden natural deaths or fatal injuries at work were identified by comparison with the white male county employed population. Men employed in service occupations had the highest age-adjusted sudden natural death rate at work (27.0 per 100,000). This was 2.5 times as high as the overall county rate. Men employed in the construction industry had the highest age-adjusted rate of fatal injuries at work (24.3 per 100,000). This was 4.4 times as high as the overall county rate. Twenty-five per cent (17/68) of occupational fatalities involved multiple fatalities or injuries. Only 1 per cent (2/144) of natural deaths at work and 7 per cent (5/68) of fatal injuries had blood alcohol levels exceeding 0.1 mg/100 ml, the level of intoxication. Improvements in the prevention and surveillance of sudden deaths that occur at work are suggested. Coroner's records are suggested for use in future surveillance on sudden deaths at work because they identified more sudden deaths at work than death certificates did.

Accidents, Occupational↗
PubMedDate not supplied

Disease reporting from an automated laboratory-based reporting system to a state health department via local county health departments.

OBJECTIVE: The authors assessed the completeness of disease reporting from a managed care organization's automated laboratory-based reporting system to the California Department of Health Services (CDHS) via local public health departments. METHODS: The authors identified all positive laboratory tests for 1997 from the computerized database of Kaiser Permanente Northern California for seven infections for which there are statutory reporting requirements: Campylobacter jejuni, Chlamydia trachomatis, Cryptosporidium parvum, hepatitis A, Neisseria meningitidis, Neisseria gonorrhoeae, and Salmonella (N = 7,331 reports). Cases were then matched by computer query to records of cases reported to CDHS. To determine why cases were not found in CDHS records, a sample of un-matched cases was searched at two county health departments. RESULTS: Overall, 84.5% (95% CI 83.4, 85.6) of the laboratory reports submitted with accompanying demographic information were successfully matched with cases in the CDHS disease surveillance database. Frequency of matching for specific diseases ranged from 79.4% (95% CI 75.6, 83.3) for N. gonorrhoeae to 88.4% (95% CI 85.3, 91.6) for C. jejuni. Reports were more likely to be matched when the county of residence was the same as the county of the health care facility. At the county level, reasons for failure of cases to be forwarded to CDHS included: errors due to manual data entry, failure to forward information from the county of diagnosis to the county of residence, and incorrect disease coding. CONCLUSION: Automated laboratory-based reporting is highly effective, but some data are lost with off-line transfer of information. To optimize surveillance accuracy and completeness, reporting at all levels should be done via direct electronic data transfer.

Animals↗
PubMed1997

Passive surveillance for Kawasaki disease in San Diego County.

BACKGROUND: Kawasaki disease (KD) is the most common cause of acquired heart disease in children in the United States. Epidemiologic surveillance is conducted to monitor baseline incidence of the disease and to identify epidemics. The aim of this study was to evaluate a passive surveillance system for reporting cases of KD in San Diego County to the local, state and national health authorities. METHODS: We performed a retrospective review of a 2-year period to identify the number of patients who met criteria of the Centers for Disease Control and Prevention for diagnosis of KD and who were successfully reported to the county, state and national databases. RESULTS: The total number of KD patients for 1994 and 1995 was determined by retrospective review of medical record discharge diagnosis codes. Of the 28 San Diego County residents diagnosed with KD in 1994, 24 (86%) met CDC criteria and 15 (63%) of these eligible patients were reported to the county and state health authorities. Of the 41 residents in 1995, 34 (83%) met CDC criteria and 22 (65%) were reported to the above agencies. No patient in either 1994 or 1995 was reported by local or state health authorities to the CDC. CONCLUSION: Passive surveillance for KD in San Diego County resulted in the reporting of approximately two-thirds of the eligible patients at the county and state levels but completely failed to report any documented cases to the CDC. Implementation of a sentinel hospital reporting system should be considered as a preferred alternative to national passive surveillance in the effort to track total numbers of patients and to follow disease trends over time.

California↗
PubMed1999

Assessment of a geographically targeted field intervention on gonorrhea incidence in two New York State counties.

BACKGROUND AND OBJECTIVES: Using study findings that demonstrated the importance of core group members in gonorrhea transmission, in 1984, one New York State county changed its approach toward gonorrhea control by targeting its field intervention activities toward infected persons from a geographic core area. In late 1988, New York State experienced an epidemic increase in the number of syphilis cases. In response, the New York State sexually transmitted disease (STD) control program enacted a Syphilis Initiative, which required the diversion of field staff from gonorrhea to syphilis control activities for a 3-year period. Each of these events held the possibility of impacting gonorrhea incidence in this county. GOAL OF THIS STUDY: To evaluate the impact of core interventions on reducing gonorrhea incidence as compared to traditional nontargeted field intervention methods and to determine the influence on gonorrhea incidence of diverting field activities from gonorrhea to syphilis case finding. STUDY DESIGN: A Poisson regression method was used to estimate gonorrhea incidence for a 22-year period in two similar counties: one county that used core intervention and one that applied traditional case-finding methods. The impact of core intervention was estimated in terms of the reduction in the gonorrhea incidence rate from the preintervention incidence rates. RESULTS: After initiation of the core intervention, the relative risk of gonorrhea decreased by 61%. Between 30 % to 40% of the total reported cases were interviewed for contacts annually during the intervention period. In the control county, the relative risk was reduced by 50% despite a significantly higher percentage of annual case interviews (60%-70%). In addition, a small change in the definition of core (from census tracts encompassing 50% of gonorrhea cases to 30%-35%) during the Syphilis Initiative led to a significant increase (16%) in the relative risk of gonorrhea. CONCLUSION: Targeting partner notification activities toward a geographic core area population appears effective in reducing the risk of gonorrhea, and it was more efficient because the overall percentage of cases interviewed was smaller than in a county using a nontargeted approach. Diversion of staff during a syphilis epidemic, combined with a narrowing of the geographic scope of the core intervention, was associated with an increase in gonorrhea incidence.

Contact Tracing↗
PubMed1987

Colorectal cancer mortality and incidence in Campbell County, Kentucky.

Previous publications have reported an unusually high colon cancer mortality rate for several Kentucky counties. We investigated these high rates by examining incidence of colorectal cancer in one county with a high mortality. The objective was to determine whether the incidence of colorectal cancer was as high as mortality rates indicated and, if so, to look for possible etiologic factors for the high rates. We found the incidence of colon cancer to be significantly higher in Campbell County than expected. While we expected 162 cases of colon cancer, we actually observed 192 (P less than .01). The number of rectal cancers was no higher than expected (52 expected and 62 observed), in agreement with previously reported mortality figures. A geographic plot of cases by home residence showed a significantly higher rate of colon cancer for urban county regions than for rural regions. In fact, the population of rural Campbell County had a colon cancer rate significantly lower than either the county rate or the national rate. Several factors were analyzed to explain these rate differences. The only consistently associated factor was source of residential drinking water.

Adenocarcinoma↗
PubMedDate not supplied

Hispanic health status in Orange County, Florida.

PURPOSE: To assess the health status of the Hispanic population of Orange County, Florida. METHODS: The methodology utilized secondary data for 66 ethnically identified indicators in a comparative framework applied for a 5-year period (1997-2001). FINDINGS: Orange County Hispanics are younger with lower per capita income than their Florida peers, less likely to be White, and much more likely to be of Puerto Rican origin. Relative to the Hispanic populations in the selected peer counties and statewide, Orange County Hispanics have higher age-adjusted death rates for a majority of disease categories and conditions, such as breast, lung, and prostate cancers; chronic liver disease and cirrhosis; diabetes mellitus; pneumonia and influenza; stroke; acquired immunodeficiency syndrome; motor vehicle accidents; and infant, neonatal, and child mortality. Orange County Hispanics did better in comparison to Orange non-Hispanics, with lower age-adjusted death rates for major causes of death such as heart disease, cancer, and stroke. However, for many indicators, the 5-year trends for Orange County Hispanics are moving in an unfavorable direction in contrast to the trends for non-Hispanics, which are either stable or improving. CONCLUSION: Comparative assessments of Hispanic populations using secondary data enable the development of a comprehensive health status profile. However, this approach is currently constrained by the limited number of ethnically identified indicators and, especially for Hispanics, problems in the accuracy and consistency of the assignment to racial categories and subsequent reporting.

Adolescent↗
PubMed2000

Out-of-area travel from rural and urban counties: a study of ambulatory care sensitive hospitalizations for New York State residents.

Rural patients who are admitted to hospitals outside their residence county or who travel great distances for hospitalization deprive local rural hospitals of revenue. To provide more information about such rural residents, we studied their characteristics compared to those admitted in the same county. Characteristics studied included illness severity, demographics and county resources. To validate the findings and to provide a different analytic approach, characteristics of residents who travel long distances for admission were also studied. We studied admissions for ambulatory care sensitive conditions, as they might be most responsive to policy changes such as increasing recruitment of local primary-care physicians. Hospital discharges during 1994 for 248,656 New York State residents were studied. We constructed multivariate models using logistic regression and ordinary least squares methods. The models were applied to residents in three types of geographic location along an urban-rural continuum. Outside admissions were associated with younger age, higher illness severity and fewer county hospital resources. Same county admissions were associated with nonwhite race, and lack of insurance. Surprisingly, in rural counties, outside admissions were directly associated with increased primary-care providers. Results from the distance model generally supported findings from the outside admission model.

Ambulatory Care↗
PubMed2006

Availability of diagnostic and treatment services for acute stroke in frontier counties in Montana and Northern Wyoming.

CONTEXT: Rapid diagnosis and treatment of ischemic stroke can lead to improved patient outcomes. Hospitals in rural and frontier counties, however, face unique challenges in providing diagnostic and treatment services for acute stroke. PURPOSE: The aim of this study was to assess the availability of key diagnostic technology and programs for acute stroke evaluation and treatment in Montana and northern Wyoming. METHODS: In 2004, hospital medical directors or their designees were mailed a survey about the availability of diagnostic technology, programs, and personnel for acute stroke care. FINDINGS: Fifty-eight of 67 (87%) hospitals responded to the survey. Seventy-nine percent (46/58) of responding hospitals were located in frontier counties, with an average bed size of 18 (11 SD). Of the hospitals in frontier counties, 44% reported emergency medical services prehospital stroke identification programs, 39% had 24-hour computed tomography capability, 44% had an emergency department stroke protocol, and 61% had a recombinant tissue plasminogen activator protocol. Thirty percent of hospitals in frontier counties reported that they met 6-10 of the criteria established by the Brain Attack Coalition to improve acute stroke care compared to 67% of hospitals in the nonfrontier counties. CONCLUSION: A stroke network model could enhance care and improve outcomes for stroke victims in frontier counties.

Acute Disease↗
PubMed2004

Racial segregation and county level intentional injury in Pennsylvania: analysis of hospital discharge data for 1997-1999.

STUDY OBJECTIVE: This study examined whether high levels of racial segregation are associated with high county level intentional injury rates. DESIGN: Multiple linear regression was used to assess the association between county racial segregation (measured by the Gini coefficient) and intentional injury rates. Multicollinearity was assessed with Eigenvalues and condition indices. SETTING: State of Pennsylvania. PATIENTS: County level intentional injury rates for 1995 to 1997 were calculated from hospital discharge data. MAIN RESULTS: After controlling for other known county level risk factors, higher levels of racial segregation in a county were significantly related to higher intentional injury rates. Multicollinearity was not a problem. Population size and density, family stability and median income, together with the percentage male, unemployed, in poverty, divorced men, and high school graduates of the county were controlled. CONCLUSIONS: Racial segregation is an important factor in the rate of intentional injury in a community. These results may be important for municipal and state agencies when developing public policies to prevent violence and promote racial integration.

Adult↗
PubMed1997

Sociodemographic factors and the variation in syphilis rates among US counties, 1984 through 1993: an ecological analysis.

OBJECTIVES: Syphilis in the United States is focally distributed, with high incidence rates in the South and in metropolitan areas nationwide. In this study an ecological analysis, using the county as the unit of analysis, was performed to generate hypotheses about community-level determinants of syphilis rates. METHODS: Bivariate rank correlations and multivariate, backward stepwise elimination linear regressions were performed. Mean annual incidence of primary- and secondary-stage syphilis in a county was the dependent variable, and county sociodemographic characteristics (from census data) were the independent variables. RESULTS: In the multivariate regression model, sociodemographic characteristics accounted for 71% of the variation in syphilis rates among counties. With other factors accounted for, the most highly correlated characteristics were percentage non-Hispanic Black population, county location in the South, percentage of the population that was urban, percentage Hispanic population, and percentage of births to women younger than 20 years. CONCLUSIONS: Most of the variation in syphilis rates among counties is accounted for by sociodemographic characteristics. Identification and remediation of modifiable health determinants for which these factors are markers are needed to improve the health status of these populations.

Adolescent↗
PubMed2005

[Spatial analysis of mortality caused by malignant tumors, especially by digestive system tumors, using empirical Bayes estimates in Fejér County, Hungary].

General practitioners in the vicinity of Lake Velencei in Fejér County, Hungary, have reported an unusual pattern of recent cancer mortality. Our aim was to clarify whether the presumed mortality cluster is epidemiologically justified; whether it is restricted to the locations in question or also appears elsewhere in the county; and if it is associated with some particular disease group. County mortality from malignancies of the digestive system, other malignancies, and all other causes for the period 1994 to 1999 was analyzed in 15- to 64-year-old men and women, using conventional standardized mortality ratios and empirical Bayes estimates. A continuous surface was interpolated from settlement level data for mortality maps. A mortality cluster from men's digestive cancers is apparent north and east of Lake Velencei and also elsewhere in the county. Differences from the country average in the frequency of males' deaths from other malignancies are fairly limited. A number of problematic areas in men's mortality from other causes are identifiable, including some of the settlements under the primary focus. Women's digestive tract cancer mortality in the area of the men's cluster near Lake Velencei is below the national average. There are almost no differences from the country level in women's deaths from other malignancies. Female mortality from all other causes shows remarkable elevations in the south of the county. Our results suggest the possible role of geographically localized exposures. Men's high mortality from digestive tract cancers is a problem affecting a considerable area of the county, necessitating further investigation. Continued search for causes is also warranted by some estimates of exceptionally high death rates in women from causes other than malignancies.

Adolescent↗
PubMed2000

Davison County I-3 pilot project for childhood immunizations in children under two years of age.

In 1995, a Davison County Immunization Subcommittee was organized to implement the Infant Immunization Initiative (I-3). The goal of the subcommittee was to improve the immunization rate in the county. Prior to the study, the immunization rate for Davison County was at 40% for children under the two years of age. Davison County had the lowest immunization rate in the state of South Dakota. At the conclusion of the study, 96% of children in Davison County were immunized by their second birthday according to recommendations of the Advisory Committee on Immunization Practices (ACIP), the American Academy of Family Physicians (AAFP), and the American Academy of Pediatrics (AAP). Davison County surpassed President Clinton's goal of 90% immunization rate for children under two years of age.

Child, Preschool↗
PubMed1999

Minority politics in the house of medicine: the physicians forum and the New York County Medical Society, 1938-1965.

The late 1930s challenged laissez-faire medicine. Recognition of serious inadequacies in the distribution of medical services stirred activists who questioned fee-for-service delivery and posited a national health program, including health insurance. The AMA and its components--state and county medical societies--counterattacked, mobilizing money and their powerful political arsenal to fight government intrusion in private medicine. The Physicians Forum, initially under the leadership of Ernst P. Boas, emerged as a formidable element within the New York County Medical Society (the largest component of the AMA). The Forum provoked discussion of medical indigence and economics, upsetting the Society leadership with independent candidate slates and telling the public that doctors spoke with more than one voice. For 25 years, the Physicians Forum altered the dynamics of the Medical Society of the County of New York. While the Forum effort to institutionalize minority opinion in the councils of medicine failed, the interchange between County regulars and Forum insurgents broadened the medical reform agenda and moved the County Society in directions that historically it had avoided. Although medical economics formed an unbridgeable chasm between County regulars and rebels, Forum members demonstrated that medicine was not monolithic, that "majority opinion [was not] ... unanimous opinion," and that doctors must speak to issues of medical and social policy.

American Medical Association↗