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PubMed1983

Impact of regionalization. The Orange County experience.

Prior to the designation of a trauma system in Orange County, Calif, 73% of the in-hospital non-CNS deaths secondary to motor vehicular trauma were judged by the autopsy method to have been preventable. In June 1980, a regional system of trauma care with designated trauma centers was established in Orange County. We used the autopsy method to evaluate the first year's experience with this new system and compared the results with previous studies in Orange County for 1974, San Francisco County in 1974, and Orange County in 1978-1979. The results indicate a severe reduction in the number of deaths judged preventable. In addition, a more aggressive approach to the traumatized patient was noted as indicated by an increased percentage of patients who received appropriate surgical intervention.

Adult↗
PubMed2001

Determination of county-level prostate carcinoma incidence and detection rates with Medicare claims data.

BACKGROUND: To the authors' knowledge, national-level population-based data regarding prostate carcinoma incidence and detection currently are not available. The availability of such data could identify those regions with a disproportionately high cancer incidence as well as the population-level association between prostate carcinoma detection and incidence. METHODS: Inpatient, hospital outpatient, and physician/supplier Medicare claims from 1997 were used to identify incident cases of prostate carcinoma in men age > or = 65 years and to calculate state and county-level incidence rates. The 1991 and 1997 claims data were used to determine small area rates of prostate-specific antigen (PSA) testing and prostate biopsy and to determine their correlation with incidence. RESULTS: The calculated incidence rates for 1997 were 890 per 100,000 and 1196 per 100,000, respectively, in white males and African-American males and varied substantially between counties (i.e., 25--75th percentile, 676--1124 per 100,000). Rates of PSA and prostate biopsy increased markedly from 1991 to 1997 in both white men (1580 per 100,000 to 24,286 per 100,000) and African-American men (1277 per 100,000 to 15,190 per 100,000), and considerable variation in detection between counties was observed. Counties that had higher rates of prostate biopsy also had higher age-adjusted incidence rates, and county-level PSA testing was found to be associated with incidence in African-American patients, but not in white patients. 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. In addition, claims provide otherwise unavailable national data concerning cancer detection.

Aged↗
PubMed2003

Late detection of breast and colorectal cancer in Minnesota counties: an application of spatial smoothing and clustering.

Cancers detected at a later disease stage are associated with significantly higher mortality risk. Lack of uniformity in county-level cancer detection rates is thus of substantial interest to state health departments and other public health professionals. In this paper, we perform several spatial analyses of breast and colorectal cancer detection data for Minnesota counties for 1995-1997. We look for outliers and clusters in the late detection rates using a number of techniques: (i). applying various mapping schemes, (ii). smoothing the data using Bayesian methods implemented via Markov chain Monte Carlo, and (iii). applying maximum likelihood techniques to test for the presence of clusters and to identify the most likely clustersOur results suggest a fairly uniform spatial pattern in both sets of detection rates. Spatially smoothed rates did not reveal clusters of counties with significantly higher late detection risk, nor were county-level covariates (such as income, education, and race) particularly helpful in explaining the rates. However, our spatial clustering approach (using the scan statistic) did produce statistically significant clusters of counties which may indicate differences of practical importance for public health.

Bayes Theorem↗
PubMed1993

Methods for analysing county-level mortality rates.

The identification of counties burdened by exceptionally high rates of mortality is a fundamental step in the development of state-based intervention and prevention strategies. However, the estimation of rates from small geographic areas presents special problems, especially for rare events. This paper compares the use of crude and age-standardized rates to the use of Poisson regression models and empirical Bayes models for analysing county-level mortality rates. The results demonstrate both practical and heuristic advantages of the empirical Bayes models. Age-standardized rates adjust for differences in age structure among countries but are vulnerable to extreme variability in county age-specific rates. In our example--an analysis of diabetes mortality rates--Poisson regression did not improve the variability of estimated county-level rates. Adjusted empirical Bayes estimates dramatically shrink the observed rates while preserving some separation of the counties with extreme rates. Also, empirical Bayes estimates of rates for countries with no observed deaths are shrunk close to the prior mean.

Adolescent↗
PubMed1998

Mental health and substance abuse treatment services for dually diagnosed clients: results of a statewide survey of county administrators.

Finding are presented from a survey of administrators of county departments of mental health and alcohol and drug programs in California regarding services for individuals with co-occurring mental and substance abuse disorders. A total of 47 counties responded (84% response rate). The survey findings indicate that collaboration across county mental health and alcohol and drug services primarily occurs through information sharing, coordination of services, and joint projects. Fewer than one-half of the counties responding provide integrated programs, and the most frequently provided services are outpatient counseling and case management. Administrators cited historical differences between the two service systems and societal stigma as the greatest barriers to service delivery. Two opposing strategies for state action were suggested, either establishing specific funding set-asides or blending funding for services. Counties varied widely in their ability to estimate unmet service needs. Implications for policy development related to the dually diagnosed are discussed.

Adult↗
PubMed2000

Black-white differences in sentinel causes of death: counties in large metropolitan areas.

The black/white ratio of death rates (before 65 years of age) in 1994-1996 for a group of "sentinel" causes, regarded as preventable by medical treatment and as useful in assessing overall quality of health care, was examined for 60 US counties located in large metropolitan areas. Counties with the highest black/white death rate ratios (>3.5) and the highest death rates for blacks included the District of Columbia; Essex (Newark), New Jersey; Cook (Chicago), Illinois; Wayne (Detroit), Michigan; and Dade (Miami), Florida. In these five counties, in contrast to the US, the death rate from the sentinel causes for blacks had not declined from 1979-1981 to 1994-1996. The findings suggest that racial inequities in health care may be unusually great in certain counties in large metropolitan areas, and that further studies are needed to explain the variation among counties in the black-white ratio of mortality from the sentinel causes.

Black or African American↗
PubMed2006

Hospital utilization for injection drug use-related soft tissue infections in urban versus rural counties in California.

Drug related-soft tissue infections (DR-STIs) are a significant source of hospital utilization in inner-city urban areas where injection drug use is common but the magnitude of hospital utilization for DR-STIs outside of inner-city urban areas is not known. We described the magnitude and characteristics of hospital utilization for DR-STIs in urban versus rural counties in California. All discharges from all nonfederal hospitals in California in 2000 with ICD-9 codes for a soft tissue infection and for drug dependence/abuse were abstracted from the California Office of Statewide Health Planning and Development discharge database. There were 4,152 DR-STI discharges in 2000 from hospitals in 49 of California's 58 counties. Residents of 12 large metropolitan counties accounted for 3,598 discharges (87% of total). The majority of DR-STI discharges were from urban safety net hospitals with county indigent programs and Medicaid as the expected payment source and opiate related discharge diagnoses. Hospital utilization for DR-STIs in California is highest in large urban metropolitan counties, although DR-STI discharges are widespread. Increased access to harm reduction services and drug treatment may reduce government health care expenditures by preventing unnecessary hospital utilization for DR-STIs.

Adolescent↗
PubMed1994

Suicides in California (1968-1977): absence of seasonality in Los Angeles and Sacramento counties.

Since the turn of the century, there have been numerous publications on the seasonality of suicide. Rarely has the duration of sunlight exposure or any other weather parameter been quantitated in studies of suicide seasonality. To explore the relationships between sunlight and suicide, we examined California weather and suicide data from 1968 to 1977. Los Angeles County and Sacramento County were well-suited to the investigation, as complete data were available for these large population centers. There was no evidence of seasonality to suicides in L.A. County or Sacramento, despite a pronounced seasonality to weather. To investigate the acute temporal effects of weather on suicides, all occurrences of 10 successive above- or below-average sunshine days were identified. Suicides of for intervals of 5 days were then compared by Mann-Whitney analyses for 25 days after the selected intervals. For L.A. County, there were no significant findings. For Sacramento County, however, there was evidence for sunlight inhibition of suicides at days 21-25 after the above-average sunshine. Suicides after 10 days of below-average sunshine were increased as much as 70% about the 10-year average. Further replication studies with larger data sets are needed for an adequate examination of the correspondences of suicide data and weather measurements.

California↗
PubMed1994

Alcohol use among primary care patients: comparing an HMO with county clinics and the general population.

A probability sample of all patients seen in the four health maintenance organization (HMO) primary care clinics in one Northern California county (N = 314) are compared to patients from all five of the county-operated primary care clinics in the same county (N = 394) and to the general population of the county (N = 3069) on demographic characteristics, drinking patterns and alcohol-related problems. The HMO clinic patients were less likely to report frequent, heavy drinking, drunkenness or alcohol-related problems during the last year compared to those in the county clinics sample, and they were also less likely to report heavy and problem drinking compared to those in the general population. These data suggest problem drinking may not be over-represented in primary care practice in general, but rather may be more closely associated with characteristics of clientele served by a primary care practice than with those characteristics associated with a need for medical attention.

Adolescent↗
PubMed2006

US state- and county-level social capital in relation to obesity and physical inactivity: a multilevel, multivariable analysis.

Although social capital has been linked to a variety of health outcomes, its association with obesity has yet to be elucidated. This study explored the relations between social capital measured at the US state and county levels and individual obesity and leisure-time physical inactivity. Individual-level data were drawn from the 2001 Behavioral Risk Factor Surveillance System survey, while data from other surveys and administrative sources were used to construct contextual measures. Two state-level social capital scales were derived from 10 indicators and two county-level scales from five indicators. In 2-level analyses of over 167,000 adults nested within 48 states plus the District of Columbia, residence in a state above the median on one or both state social capital scales (vs. neither scale) was associated with lower relative odds of obesity and physical inactivity, controlling for individual-level covariables and state-level estimates of mean household income, the Gini coefficient, and the percentage of Black residents. In 3-level analyses, the adjusted odds ratio (OR) for physical inactivity associated with residence in a county above the median on one or both county social capital scales was significantly below 1, while the association with obesity was not significant. Significantly weaker inverse ORs for the relations between state- and county-level social capital and obesity were observed among American Indians/Alaska Natives compared to Whites. Meanwhile, little support was found for mediation by social capital of the associations of urban sprawl and income inequality with obesity or physical inactivity. Overall, this study provides some evidence for the promotion of social capital as a potential strategy for addressing the burgeoning obesity epidemic.

Adult↗
PubMed2006

Prevalence of shiga toxin-encoding bacteria and shiga toxin-producing Escherichia coli isolates from dairy farms and county fairs.

Shiga toxin-encoding bacteria (STB) and shiga toxin-producing Escherichia coli (STEC) were detected and isolated from dairy cattle and their farm environment and from manure piles at Minnesota (MN) county fairs from 2001 to 2002. A total of 2,540 samples were collected from 28 dairy cattle farms (8 organic and 20 conventional), 17 calf pens (5 organic and 12 conventional), and 12 county fairs. STB were detected from 71 (3.2%) of 2208 fecal samples with 20 (71.4%) of 28 dairy farms having at least one positive animal sample. In samples collected from conventional farms, 41 (2.3%) of 1750 fecal samples were STB-positive and 13 (65%) of 20 farms had at least one positive animal. Thirty (6.6%) of 458 fecal samples from organic farms were STB-positive and 7 (87.5%) of 8 farms had at least one positive animal. STB was detected from 31 (17.4%) of 178 samples and 7 (58.3%) out of 12 manure piles at county fairs. A total of 43 STEC isolates were recovered and belonged to 26 different serotypes (19 O and 18 H types). Among STEC, 60.5% possessed only stx1, 30.2% stx2, and 9.3% both stx1 and stx2. The genes eae and hlyA were detected in more than 50% of the STEC isolates. STB can be found on most dairy cattle farms including organic and conventional herds and county fairs. The presence of these potentially pathogenic bacteria in county fairs may pose a risk to the public who have contact with cattle or their environment.

Animals↗
PubMed1999

Epidemiology of human hookworm infections among adult villagers in Hejiang and Santai Counties, Sichuan Province, China.

Hookworm infection as well as other intestinal nematodiases are endemic to Sichuan Province in China. In order to research the prevalence and intensity of these infections we visited two villages in Hejiang County (southern Sichuan Province) and Santai County (northwestern Sichuan Province) between July and October of 1997. Fecal examinations were performed on adult villagers over the age of 15 years (currently children under this age are dewormed annually with anthelmintic drugs). Among 310 residents of Lugao Village (Hejiang County), 87, 63 and 60% were infected with hookworm, Ascaris or Trichuris, respectively. The prevalence of hookworm determined to rise linearly with age (r = 0.97). High intensity infections with hookworm still occur in this region as 22% of the residents have over 3000 eggs per gram (PEG) of feces as determined by quantitative egg counts. The majority of these individuals harbored mixed infection with Necator americanus and Ancylostoma duodenale, although the former predominated when adult hookworms were collected from 30 village residents treated with pyrantel pamoate. In contrast, among the 334 Xinjian villagers examined (Santai County) the majority harbored predominantly light hookworm infections--66.1% of the residents has less than 400 EPG by quantitative fecal examination and only 3.7% exhibited greater than 3000 EPG. Again, N. americanus was the predominant hookworm seen after worm expulsion. We have round that despite economic development which is occurring in some parts of China, significant hookworm infections and clinical hookworm anemia still exist in areas of Sichuan Province. In Hejiang County we found that the intensity of hookworm infection has actually risen within the last 10 years. Hookworm is a medical problem among the elderly in Sichuan.

Adolescent↗
PubMed1994

Psychosocial factors associated with the use of bicycle helmets among children in counties with and without helmet use laws.

We examined the extent to which psychosocial factors, in addition to the presence of a law, are associated with the use of bicycle helmets. A mailed questionnaire was completed by 3494 children in fourth, seventh, and ninth grades in three Maryland counties: Howard County, which had a law requiring child bicyclists to wear helmets and an educational campaign; Montgomery County, which had an educational campaign but no law; and Baltimore County, which had neither. Overall, 19% of the respondents reported having worn a bicycle helmet on their most recent ride. In a multiple logistic regression, children's use of helmets in all three counties was significantly associated with their beliefs about the social consequences of wearing helmets and the extent to which their friends wear helmets. Significant interactions were also found, suggesting that in the presence of a law, an educational campaign, or both, children's use of helmets was associated more with social concerns than with parental influences or cognitive factors, such as beliefs about the need for helmets or perceptions of risk. To increase helmet use, the issues of stylishness, comfort, and social acceptability of wearing helmets need to be addressed and more widespread adoption of bicycle helmet laws should be encouraged.

Adolescent↗
PubMed1992

Reye's syndrome in Olmsted County, Minnesota: did it exist before 1963?

In this study, our goals were to determine whether Reye's syndrome existed before the first published report of this entity in 1963 and to describe the long-term incidence and trend of this syndrome. Medical and pathologic records and pathologic specimens for Mayo Clinic patients, including those who were residents of Olmsted County, Minnesota, were reviewed through the facilities of the Rochester Epidemiology Project. On review, 12 cases were identified for the period 1920 through 1962; 2 of these cases were in Olmsted County residents. Of the 12 cases identified before 1963, 10 were in patients younger than 5 years of age. In addition to the aforementioned two cases, five others in Olmsted County were diagnosed between 1963 and 1989. Incidence rates were computed for the Olmsted County population. The number of cases and rates per 100,000 persons younger than 18 years of age in that population were 2 cases (0.3) for 1920 through 1962, 4 cases (0.7) for 1963 through 1980, and 1 case (0.4) for 1981 through 1989. Although cases found during the earlier periods may have included disorders that mimic Reye's syndrome, the recommended criteria from the Centers for Disease Control were applied to review of medical records and supported by pathologic findings in the liver. The data showed an age distribution tending toward young patients and no seasonality of occurrence. The incidence rates in Olmsted County, Minnesota, showed an increase for 1963 through 1980 over previous decades, followed by a decrease. The small numbers preclude any conclusion about trends in the incidence rates.

Child↗
PubMed1999

Things ain't what they ought to be: social forces underlying racial disparities in rates of sexually transmitted diseases in a rural North Carolina county.

Social forces shaping a region can also affect behaviors that facilitate the transmission of sexually transmitted diseases (STDs), including HIV. We sought to understand the social forces underlying high rates of infection, particularly among blacks, in a rural county of North Carolina in which 40% of the county is black. In the context of ongoing research on STDs we collected information from archival data on the county since the 1940s and interviewed local residents knowledgeable about the county's history. We present local data in the context of national economic and demographic trends. Successive changes in the national economy and farming policies disproportionately affected black farmers. A rural ghetto formed when poor blacks left their farms to seek work in the central town of the county. Segregationist housing policies and race-based differentials in employment opportunities exacerbated the concentration of poverty. Migration to northern industrial cities, predominantly by skilled black men, decreased the social capital of the community and lowered the ratio of men to women. Poverty, income disparity, social capital and the ratio of men to women can all affect the behaviors that facilitate transmission of STDs. Knowledge of social forces and their effects is critical for designing and evaluating interventions to prevent STDs and to decrease extreme racial disparities in rates of disease.

Adult↗
PubMed1993

Traumatic spinal cord injuries in the rural region of Taiwan: an epidemiological study in Hualien county, 1986-1990.

In order to survey the epidemiological characteristics of traumatic spinal cord injuries (SCI) in Hualien county, a retrospective study was conducted from January 1986 to December 1990 in four local general hospitals. During this period, 135 traumatic SCI patients were identified and 99 of them were residents of Hualien county. The estimated annual incidence of traumatic SCI in Hualien county was 56.1 per million population. As a result of injury 36 patients were tetraparetic, 33 tetraplegic, 12 paraparetic and 18 paraplegic. The male/female ratio was 4:1. The mean age of onset for male patients was 44 years, and that for female patients was 46 years. The major causes of SCI were traffic accident (61.6%) followed by accidental falls (23.3%). The average duration of hospitalisation ranged from 62 days in paraparetics to 132 days in tetraplegics. Ten patients died of respiratory failure or sepsis, and the mortality rate was 10.1%. Our data revealed that traumatic SCI was prevalent in Hualien county in comparison with epidemiological studies elsewhere. The special population composition of Hualien county and the preponderance of the motorcycle as a transportation vehicle in this area might result in its unique epidemiological characteristics.

Accidental Falls↗
PubMedDate not supplied

Selenium in forage crops and cancer mortality in U.S. counties.

The potential protective effect of selenium status on the risk of developing cancer has been examined in animal and epidemiologic studies. This ecological study investigated the association between U.S. county forage selenium status and site- and sex-specific county cancer mortality rates (1950-1969) using weighted least squares regression. Consistent, significant (p less than .01) inverse associations were observed for cancers of the lung, rectum, bladder, esophagus, and cervix in a model limited to rural counties and for cancers of the lung, breast, rectum, bladder, esophagus, and corpus uteri in a model of all counties. No consistent significant positive associations were observed in the rural county models. This remarkable degree of consistency for the inverse associations strengthens the likelihood of a causal relationship between low selenium status and an increased risk of cancer mortality.

Agriculture↗
PubMed2003

Early implementation of Proposition 36: criminal justice and treatment system issues in eight counties.

This article examines key differences emerging in implementation of California's Proposition 36 voter initiative across eight diverse large, medium, and small counties. The data were collected in 2001 in a key informant survey of county policymakers. Unlike most major California criminal justice initiatives of recent years, Proposition 36 represents a potential lessening of adjudicatory and penal controls rather than an increase in their severity, in this case in response to charges of drug use, possession, or transportation. Furthermore, Proposition 36 was written broadly enough to allow considerable discretion in implementation across the counties, including the specification of funding to support mandated provisions of the Act and division of oversight responsibilities among criminal justice and treatment stakeholders. Hence actual content and scope of criminal justice system procedural changes, and impact of the proposition on criminal justice and treatment systems and on arrestees, are likely to vary by county. The article identifies key approaches and decisions made in the sampled counties that are predicted to affect the proposition's impact in the areas of treatment versus criminal justice resources, prosecutorial implementation, defendant and defense responses, assessing criminal histories and treatment needs, treatment versus criminal justice supervisory responsibility, and procedural variations and client behavior.

California↗