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PubMed2000

Heroin overdose deaths--Multnomah County, Oregon, 1993-1999.

In the United States, heroin use is increasing and was implicated in 3805 deaths in 1993 (1). Multnomah County is Oregon's most populous county (1998 estimated population: 641,900); three fourths of county residents live in Portland. In 1999, in response to community concerns, the Multnomah County Health Department analyzed medical examiner (ME) data for 1993-1999 and interviewed heroin users to characterize heroin overdose deaths (HODDs) in the county. This report summarizes the findings of these studies, which indicate that HODDs in the county more than doubled from 1993 to 1999 (from 46 to 111), and that interviews with users helped identify possible public health interventions.

Adult↗
PubMed2001

Increased incidence of colorectal cancer in the split-dalmatia county: epidemiological study.

AIM: To investigate the incidence of colorectal cancer in the Split-Dalmatia County in the 1981-1998 period, and compare it with the incidence in the Republic of Croatia. METHODS: The data were obtained using case records and registries of all hospitals and Public Health Institute in the County and the Croatian Cancer Registry. Age-standardized incidence per 100,000 was calculated from the number of patients with colorectal cancer and the number of inhabitants. RESULTS: There were 2,454 new cases of colorectal cancer (1,383 men and 1,071 women) in the Split-Dalmatia County in 1981-1998. Colon cancer was diagnosed in 55% of the cases. Age-standardized incidence rates for colorectal carcinoma per 100,000 population were 11.4 (men 14.8, women 9.0) in 1981, and 63.5 (men 93.1, women 42.5) in 1998. The total incidence increased from 16.1 (colon cancer 7.9, rectal cancer 8.2) in 1981-1985 period to 52.8 (colon cancer 30.5, rectal cancer 22.3) in 1994-1998 period, or approximately 3.3 times. The colorectal cancer incidence rate in the Split-Dalmatia County increased from 16.2 in 1985 to 46.4 in 1995, and in whole Croatia from 32.4 in 1985 to 37.8 in 1995. CONCLUSION: There was a great increase in the reported incidence of colorectal cancer in the Split-Dalmatia County in the 1981-1998 period. The relative increase of incidence in the colorectal cancer was much greater in the Split-Dalmatia County than in Croatia as a whole. These changes call for preventive and screening measures for colorectal carcinoma.

Adult↗
PubMed2001

Implementation of forensic DNA analysis on casework evidence at the Palm Beach County Sheriff's Office Crime Laboratory: historical perspective.

Palm Beach County is the largest of the 64 counties in the state of Florida, USA, with most of the area uninhabited and the population concentrated near the coastal region. The Serology/DNA Section of the Palm Beach County Sheriff's Office (PBSO) Crime Laboratory serves a community of approximately one million residents, and an additional million tourists visit Palm Beach County every year. In addition to the unincorporated county regions, there are thirty-four city police agencies, the Florida State Highway Patrol, several university security agencies, the local Federal Bureau of Investigation, and the county Medical Examiners Office that all use the PBSO Serology/DNA Laboratory for the analysis of casework evidence. The purpose of this manuscript is to provide laboratories that are in the process of initiating DNA analysis on casework with practical information regarding the decision-making processes that occurred during the development of the DNA testing program at PBSO. Many of the concerns addressed in the early 1990's are still a guide to the development of a quality forensic DNA analysis program in the year 2001. Issues, such as personnel, laboratory space, internal standard operating procedures, implementation of DNA analysis on casework evidence, and building a relationship with law enforcement personnel are discussed.

Clinical Laboratory Techniques↗
PubMed2001

Health-related quality of life--Los Angeles County, California, 1999.

The overall goals of the national health objectives for 2010 are to increase the quality and years of healthy life and eliminate health disparities in the U.S. population. To assess progress in achieving these goals, the Behavioral Risk Factor Surveillance System (BRFSS) includes a core set of four health-related quality of life (HRQOL) questions that have been used since 1993 to track adults' perceptions of their physical and mental health and level of function. Data on HRQOL have been reported nationwide and by state but typically not at the county or community level. This report summarizes findings of the 1999-2000 Los Angeles County Health Survey (LACHS) on HRQOL in the county's adult population and describes variations in HRQOL across population groups in the county. The findings have been published in a county health report and are being used by public health officials to highlight the significant disparities in HRQOL across demographic and socioeconomic populations in Los Angeles County and to guide program planning and resource allocation decisions.

Adult↗
PubMed2004

Rapid assessment of the needs and health status of older adults after Hurricane Charley--Charlotte, DeSoto, and Hardee Counties, Florida, August 27-31, 2004.

On August 13, 2004, Hurricane Charley, a Category 4 storm with sustained winds of 145 mph, made landfall at a Gulf of Mexico barrier island in Florida, resulting in an estimated 31 deaths statewide and extensive property damage in Charlotte, DeSoto, and Hardee counties. The Florida Department of Health (FLDOH) requested that CDC conduct a rapid needs assessment of older adults (i.e., aged >/=60 years) because this vulnerable age group constitutes a substantial proportion of the population in the most severely affected counties (Charlotte County [43% older adult residents of 141,627 total population], DeSoto County [24% of 32,209], and Hardee County [18% of 36,938]). This report summarizes the findings and recommendations from three rapid needs assessments in these Florida counties. Older adult residents experienced disruptions in both quality-of-life status and medical care for preexisting conditions (e.g., cardiovascular disease, diabetes, and physical disabilities). On the basis of these findings, recommendations were provided to FLDOH for immediate use in deploying resources for response to Hurricane Charley and in planning responses to future disasters.

Aged↗
PubMed2006

[A registry study of hospital admissions of children with asthma and bronchitis in different counties].

INTRODUCTION: In Denmark, asthma is the most widespread chronic childhood disease, imposing great demands on the health services. Considerable variations exist among Danish counties with respect to the percentage of asthmatic children treated by general practitioners and paediatric specialists, which makes it relevant to investigate whether there are differences among Danish counties in admission and readmission rates to hospitals in relation to the capacity of the outpatient clinics. MATERIALS AND METHODS: We performed a cross-sectional study using county-level aggregated data derived from the National Hospital Register and from StatBank Denmark documenting hospital admissions and visits to outpatient clinics in 2001 of children aged 0-4 years and 5-14 years with asthma or bronchitis. The chi2-test was used to calculate the differences by county. RESULTS: The results showed statistically significant differences among the counties in hospital admission rates, readmission rates and number of visits to outpatient clinics. DISCUSSION: The differences among counties in admission rates and number of visits to outpatient clinics indicate that there are considerable variations in the amount of specialist resources being allocated to management of childhood asthma. No study results are available about where asthmatic children are treated most advantageously, which makes further research relevant in view of the large differences in use of resources.

Adolescent↗
PubMed2006

Progress in pediatric asthma surveillance I: the application of health care use data in Alameda County, California.

INTRODUCTION: The ability to conduct community-level asthma surveillance is increasingly crucial for public health programming and child health advocacy. We explored the potential and limitations of health care use records from both public and private sources for asthma surveillance in a California county. METHODS: We combined administrative patient record data from Kaiser Permanente of Northern California and Medi-Cal (the California Medicaid program) for Alameda County residents during 2001. We assessed the resulting data set for completeness, population representation, consistency with external data, and internal indicator consistency. RESULTS: Our resulting data set included records for 226,383 children younger than 18 years. Completeness of Medicaid data was affected by managed care market share, reducing our usable data set size to 176,789, approximately equal to one of every two children in the county or one of every 3 person-months. External data documenting hospitalization rates due to asthma were poorly correlated with hospitalization rates (r = 0.2120, P = .20) but highly correlated with emergency department visits (r = 0.8607, P <.001) in the resulting data set. High internal consistency of indicators suggested that the data set represented a broad spectrum of health care access and quality of care congruent with clinical aspects of the disease. CONCLUSION: The utility of these data is affected by logistical and administrative factors, including the health care payment structure and the market shares of care providers. These factors can be expected to similarly affect the utility of this approach in other counties. Our ability to generate county-level health statistics for comparison with other locations was limited, although the data set appeared well suited for within-county geographic analysis. In light of these findings, these data have the potential to expand the local health surveillance capacity of communities.

Adolescent↗
PubMedDate not supplied

[Epidemiologic characteristic of hepatitis B in the Splitsko-Dalmatinska County].

Epidemiologic characteristics of hepatitis B virus (HBV) infection in the Split-Dalmatia County and in Croatia as a whole from January 1, 1994 till December 31, 2003 were analyzed. The mean number of hepatitis B cases was 28 (morbidity rate 6.03 per thousand) in the Split-Dalmatia County and 208 (morbidity rate 4.68 per thousand) in Croatia. Over the last five years, there was a marked decrease in the incidence of hepatits B in the Split-Dalmatia County (morbidity rate 1.55 per thousand), whereas its incidence at the national level showed a stable pattern (morbidity rate 4.49 per thousand). In the Split-Dalmatia County, the majority of patients (57.51%) were aged 15-29, which could be attributed to risky sexual contacts and intravenous drug use. The male to female ratio was 2.1(188:93). There was no major incidence fluctuation according to months of year. The hepatitis B mortality rate was 0.24% (5/2079) in Croatia as a whole, whereas no case of HBV lethality was recorded in the Split-Dalmatia County. The significant decrease in the hepatitis B morbidity rate in the Split-Dalmatia County most probably resulted from the comprehensive measures of prevention, especially vaccination, the early introduction of the needle exchange program (1955-1996).

Adolescent↗
PubMed1991

Estimating county percentages of people without health insurance.

County data on the percentage of people without health insurance are seldom available, although state program planning requires such information. As part of an evaluation of Washington's Basic Health Plan (BHP), we conducted a telephone survey in nine Washington counties to estimate the percentage of people under the age of 65 who were uninsured. We used regression analysis to estimate the percentage uninsured in a county as a function of the percentage unemployed. Two validation approaches yielded very good results, suggesting that the equation could be used to estimate the percentage uninsured in unsurveyed counties. The variation ranged from 15% to 23% uninsured in the 9 surveyed counties, and was estimated to range from 9% to 35% among the state's 39 counties. With proper caution, estimates based on this equation can probably be used in other states if better data are unavailable.

Data Collection↗
PubMed1989

Relationship between 17 Venezuelan counties estimated through communality of surnames.

The coefficients of relationship and the Euclidean distances between 17 Venezuelan counties were estimated based on the frequency distribution of surnames obtained from the 1984 Venezuelan register of electors. In general, the coefficients of relationship between counties within the same state were higher than those between counties from different states. Euclidean distances exhibited the opposite relationship. Spearman's correlation coefficients for 136 pairs of counties were estimated between geographic and Euclidean distances (r = 0.41), geographic distance and coefficient of relationship (r = -0.44) and between Euclidean distance and coefficient of relationship (r = -0.48). The effect of partial geographic isolation on the frequency distribution of surnames is shown in the State of Falcón, where an isthmus separates two counties of the peninsula from two others on the mainland, and in Mérida, where the Venezuelan Andes separates three counties from the rest of the country. Our results suggest that Euclidean distances are less influenced by common surnames than the coefficients of relationship. They also indicate that in Venezuela a high proportion of the population has remained sedentary until recently, and this gives rise to the focal distribution of some surnames.

Demography↗
PubMedDate not supplied

Family planning clinic services in U.S. counties, 1983.

Organized family planning clinics are a major source of contraceptive services for low-income women, who are less likely than higher income women to be using a contraceptive method. A 1983 study estimated that 9.5 million U.S. women with family incomes below 150 percent of poverty were at risk of unintended pregnancy, and identified a network of 5,106 clinics providing them with services. Seventy-six percent of all counties in the United States have organized clinics that offer family planning services; almost all of those without services are nonmetropolitan counties. An estimated 52 percent of low-income women at risk of unintended pregnancy were served by organized family planning clinics in 1983, while the rest either went unserved or sought care elsewhere. Ten percent of low-income women not served by clinics live in counties that have no family planning clinics, but 67 percent live in counties where existing clinics reach fewer than half of potential low-income patients. More sites may be needed, particularly in counties without clinics, to effectively serve low-income women at risk of unintended pregnancy. However, since the majority of unserved women live in counties where at least one clinic exists, coverage might be improved through increased accessibility and outreach.

Community Health Centers↗
PubMed1983

U.S. Supreme Court decision in Jefferson County Pharmaceutical Association v. Abbott Laboratories et al.

The effect of the recent U.S. Supreme Court antitrust decision in Jefferson County Pharmaceutical Association v. Abbott Laboratories et al. on state and local health-care institutions is examined. In Jefferson County, the Court ruled that state and county government hospitals are not exempt from the price discrimination prohibitions of the Robinson-Patman Antidiscrimination Act when they engage in commercial activities in competition with private retail businesses. The Jefferson County decision forces state and county governments to determine which of their activities are commercial and which are traditional governmental functions that would be exempt from antitrust legislation. However, the Portland case findings relating to purchases for a hospital's own use and the traditional Robinson-Patman discounts are still available. Despite closer antitrust scrutiny, hospital pharmacists in state and county government hospitals should be able to provide cost-effective outpatient and ambulatory-care services.

Drug Industry↗
PubMed1995

The epidemic of gang-related homicides in Los Angeles County from 1979 through 1994.

OBJECTIVE: To determine trends in gang homicides and the population at greatest risk for homicide by reviewing all gang-related homicides in Los Angeles County, California, from January 1979 to December 1994. DESIGN: Homicide files of the Los Angeles Police Department and the Los Angeles County Sheriff's Department from 1979 to 1994 involving violent street gang activity were reviewed. Gang files were reviewed for demographic data, weapons used, homicides by drive-by shootings, and times and geographic areas of occurrence. SETTING: Los Angeles County from January 1, 1979, to December 31, 1994. MAIN OUTCOME MEASURES: Age, race, and sex of gang-related homicide victims; frequency of weapon use; and the change in gang-related homicide rates during the study period. RESULTS: A total of 7288 gang-related homicides occurred in Los Angeles County from 1979 through 1994; 5541 of these homicides occurred in Los Angeles Police Department and Los Angeles County Sheriff's Department jurisdictions. During the study period, the proportion of all homicides that were gang related increased from 18.1% to 43.0% (P < .001). Of the 5541 gang-related homicide victims, 4580 (85.6%) were aged 15 to 34 years, 93.3% were African American or Hispanic, 5157 (93.2%) were male, 3559 (64.2%) were gang members, and 1408 (25.4%) occurred during drive-by shootings. Firearms were used in an increasing proportion of homicides, from 71.4% in 1979 to 94.5% in 1994. Homicides by semiautomatic handguns dramatically increased during the study period. Gang-related homicide rates for African-American males aged 15 to 19 years increased from 60.50 per 100,000 population per year in 1979 to 1981 to 192.41 per 100,000 population per year in 1989 to 1991. CONCLUSIONS: Gang-related homicides in Los Angeles County have reached epidemic proportions and are a major public health problem. To prevent gang violence, the root causes of violent street gang formation must be alleviated, the cycle of violent street gang involvement must be broken, and access to firearms must be limited.

Adolescent↗
PubMed1994

Risky driving behaviors among teenagers--Gwinnett County, Georgia, 1993.

In the United States in 1991, approximately 6000 persons aged 16-20 years died from motor-vehicle crashes (MVCs)--twice as many as from any other cause of death among persons in this age group. During 1991, approximately 3000 crashes in Gwinnett County, Georgia (1990 population: 352,910) (26% of all crashes in Gwinnett County), involved at least one teenage driver (Gwinnett County Department of Transportation, unpublished data, 1992). Risky driving behaviors are among the risk factors for teenage MVC death and injury. To better characterize these risk factors, the Georgia Department of Human Resources, the Gwinnett County Board of Health, the community-based Gwinnett County Teen Traffic Tragedies Task Force, and CDC conducted a case-control study of MVCs among teenage drivers in Gwinnett County during 1993. This report summarizes the results of that study.

Accidents, Traffic↗
PubMed1993

Prohibition revisited: county alcohol control consequences.

This study examined measures of alcohol abuse consequences in wet vs dry counties in Kentucky. Data were gathered from all counties of the state for the year 1988. Dry counties had less alcohol-related auto accidents and DUI arrests. Other alcohol-related variables, such as cirrhosis mortality, were not significantly different between wet and dry counties. When demographic variables were also considered, it was determined that the advantage enjoyed by dry counties remained. Findings indicate that county-level alcohol prohibition is effective in promoting the public's health, by improving highway safety.

Accidents, Traffic↗
PubMedDate not supplied

Tuberculosis in San Diego county: a border community perspective.

OBJECTIVES: To describe the epidemiology of active disease caused by Mycobacterium tuberculosis in San Diego County from 1989 to 1993 and to identify the specific subgroups for whom the impact of the disease was most pronounced. METHOD: The authors reviewed all 1860 reports of verified tuberculosis (TB) cases included in the surveillance database maintained by the San Diego County Health Department's TB Control Program. Data were analyzed by age, gender, ethnicity, nativity, HIV co-infection, major site of infection, and drug resistance. RESULTS: Between 1989 and 1993. San Diego County witnessed a greater increase (77.7%) in the number of incident TB cases than the state of California as a whole (22.8%) or the United States (9.9%). The local resurgence of TB was reflected in increasing case counts among specific subpopulations--immigrants from countries with high endemic rates of TB (62.5% of the new cases), U.S.-born members of minority groups, the elderly, and young adult males. CONCLUSIONS: Tuberculosis cases in San Diego County have increased each year since 1989, with certain population subgroups exhibiting more dramatic increases in case rates than those reported nationally. San Diego County is one of the principal entry points for the western United States and a popular travel destination. These factors have led to a dramatic increase in the incidence of TB in the county. A range of tailored surveillance, treatment, and control strategies--some of which have already been implemented--will be needed to control the spread of the disease.

Adolescent↗
PubMedDate not supplied

Agricultural safety efforts by county health departments in Wisconsin.

OBJECTIVE: The authors sought to improve the agriculture safety prevention efforts of county health departments in Wisconsin by examining current programs, staffs' perceptions of the farm safety problem, and the need for new resources. METHODS: A survey instrument was completed by a professional staff member of the local health department in each of Wisconsin's 69 counties. RESULTS: Usable responses were obtained from 84% of the counties. Forty-five percent of the responding staff members conducted some agricultural safety and health programs, most often health screenings or group meetings conducted collaboratively with county agricultural Extension agents. There were no major differences in county demographics or other service provision variables between staff members who conducted programs and those who did not. Staff members perceived the largest barriers to better safety as lack of staff time and difficulty getting farmers to attend safety programs. Most failed to place more emphasis on training agricultural workers to permanently correct hazards than on training them to work safely around hazards. However, the staff members ranked safety inspection checklists as the most needed new material and ranked Extension agents and farmers as the most appropriate people to conduct inspections using such checklists. CONCLUSION: County public health professionals want more staff time and new materials to increase the effectiveness of their agricultural safety efforts. Encouraging agricultural workers and family members to identify and correct hazards would be a more effective use of staff time than training people to work safely around hazards.

Adult↗
PubMed1994

Breast cancer in a county hospital population: impact of breast screening on stage of presentation.

BACKGROUND: Indigent patients in a county hospital setting typically present with breast cancer at a later stage than do patients in the private sector. In the early 1980s, 50% of all breast cancers diagnosed in our county hospital were stages III and IV. This contrasted markedly with the findings of an American College of Surgeons study, which showed < 15% of breast cancers diagnosed as stages III and IV. METHODS: Recognizing this disparity, we instituted a breast screening project in the county teaching hospital targeted at women who routinely received medical care in the county hospital clinics. Between 1985 and 1992, 14,567 mammograms were performed. RESULTS: Two hundred eighty-nine breast biopsies were performed and 76 cancers were identified (26%). Ninety-five patients advised to have surgical consultation for biopsy declined further evaluation. The stage distribution of cancers diagnosed was as follows: stage 0, 20%; stage I, 43%; stage II, 28%; stage III, 8%; and stage IV, 1%. This compares favorably with National Cancer Data Base statistics for 1988. In contrast, symptomatic nonscreened patients diagnosed at the county hospital in 1992 presented at a significantly more advanced stage: stage 0, 1%; stage I, 14%; stage II, 45%; stage III, 26%; and stage IV, 13%. CONCLUSIONS: Mammographic screening has lowered the stage of cancers diagnosed in the screened indigent population. However, a significant percentage of patients are presenting to our hospital with stage III and IV disease. Problems identified in the screening project included noncompliance with recommendations for follow-up of abnormal studies and noncompliance with appointments. In order to broaden the impact of our breast screening project, we have instituted outreach programs with community-based clinics and the American Cancer Society.

Adult↗