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PubMed2003

The river Rhine as a source of micropollutants in the canal sediments of the city of Delft (The Netherlands).

This paper presents a statistical analysis of the pollution levels for heavy metals and organic micropollutants at 182 sediment stations in the city canals of Delft. High pollution levels were especially observed in the inner city canal sediments, probably related to the import of polluted river Rhine water. In contrast, the more-or-less isolated outer city sites were generally much less polluted. Regression analysis on the database generally showed highly significant correlations between individual heavy metal contents. The heavy metal contents were usually significantly correlated with polycyclic aromatic hydrocarbons (PAHs) as well. This points to one or more common sources for these micropollutants. Factor analysis and the K-means cluster analysis technique were applied on the above database; it showed a large cluster of stations, nearly all located in the outer city of Delft, characterized by relatively low heavy metal and organic micropollutants' contents. Another cluster of 18 stations, mostly located in the inner city of Delft, possessed intermediate pollution levels, directly related with the supply of river Rhine water. Finally, the stations of a third cluster, situated in the inner city as well, were highly polluted, especially by local pollution sources. The above hypotheses were further supported by a more detailed statistical analysis for a number of inner city stations, together with 10-year river Rhine pollution data.

Cities↗
PubMed2004

The volume and capacity of colonoscopy procedures performed at New York City hospitals in 2002.

INTRODUCTION: Colorectal cancer is the second leading cause of cancer death in New York City. In March 2003, the New York City Department of Health and Mental Hygiene recommended colonoscopy every 10 years as the preferred screening test for adults aged 50 years and older in New York City. To screen all eligible adults in New York City would require that approximately 200,000 colonoscopy exams be performed annually. As part of this recommendation, we evaluated current colonoscopy capacity in New York City hospitals. METHODS: We surveyed endoscopy suite nursing or administrative staff at all 66 adult acute care hospitals performing colonoscopy in New York City. Data on colonoscopy procedures performed in 2002 were collected between February and June 2003. RESULTS: All hospitals and two affiliated clinics responded. The number of hospital-based colonoscopy exams performed in 2002 was estimated to be 126,000. Of these, 53,600 (43%) were estimated to be for screening. Hospitals reported their maximum annual capacity to be 195,200, approximately 69,100 more than current practice. Reported barriers to performing more colonoscopy exams included inadequate suite time and space (31%), inadequate staffing (28%), and insufficient patient referrals (24%). CONCLUSION: In 2003, endoscopy suites at New York City hospitals performed approximately one quarter of the estimated citywide need of 200,000 screening colonoscopies. Procedures conducted in outpatient office settings were not assessed. Most endoscopy suites, particularly private hospitals, reported having the capacity to conduct additional procedures. Hospitals and endoscopy suites should prioritize the development of institutional measures to increase the number of persons receiving screening colonoscopy.

Colonoscopy↗
PubMed1993

Trends in AIDS mortality among residents of Puerto Rico and among Puerto Rican immigrants and other Hispanic residents of New York City, 1981-1989.

This study contrasts the acquired immunodeficiency syndrome mortality experience of residents of Puerto Rico with that of New York City residents identified as either Puerto Rico-born and non-Puerto Rico-born Hispanics. Portions of the mortality data examined in this investigation update and extend the data previously published describing selected groups in New York City through the end of 1987 but which did not consider residents of Puerto Rico. The nine-year cumulative, age-adjusted acquired immunodeficiency syndrome mortality rate for males was found to be 5 x higher among Puerto Rico-born New York City residents compared with residents of Puerto Rico (702/100,000 v 141/100,000) and 1 1/2 x greater than that of other male Hispanic New York City residents (447/100,000). In New York City, Puerto Rico-born females had higher age-adjusted mortality rates (121/100,000) than female residents of Puerto Rico (25/100,000) and other female Hispanic residents of New York City (70/100,000). Within five of the six age categories considered, acquired immunodeficiency syndrome mortality rates for adult males and females are higher for Puerto-Rico-born, New York City residents. Limitations of acquired immunodeficiency syndrome incidence data, as they pertain to persons of Puerto Rican ancestry, are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Population density pattern and change in the city of Riyadh, Saudi Arabia.

"This paper examines and assesses the changes in the population density pattern in the city of Riyadh, the capital of Saudi Arabia where the city has undergone dramatic changes in its physical as well as its social structure. Analysis of data revealed a decline in population density at an exponential rate from the city center with variation between city sectors and zones. The city's rapid horizontal expansion and dispersal of population is the result of factors such as increases in city population and in size and number of single family dwellings, widening of streets, rise in income and residential mobility rates, mass use of automobiles, change in family size, zoning regulations, leapfrogging, and huge governmental city development projects."

Asia↗
PubMed1996

The demographic profiles of the world's largest cities: a baseline analysis and policy implications.

"This paper examines the demographic profiles of 74 of the world's largest cities through cluster analysis, which classifies the cities into distinctive groups based on population size, net population change, rate of natural increase, sex ratio, age composition, and dependency ratios. Discussions of the results focus on: the strikingly different demographic profiles of the large cities in more developed countries (MDCs) and less developed countries (LDCs); the simultaneous similarities and differences among MDC cities and socialist and former socialist cities; and the particular demographic characteristics of certain MDC and LDC cities. The paper also draws research implications for the data and method used and urban policy implications for the demographic and socioeconomic conditions in very large MDC and LDC cities."

Demography↗
PubMed2005

Lower hypertension risk in Mexico City than in San Antonio.

BACKGROUND: We examined the effects of blood pressure (BP), weight, and weight gain on hypertension risk in two similar ethnic origin populations, subjects in Mexico City and Mexican Americans in San Antonio. METHODS: The Mexico City Diabetes Study and San Antonio Heart Study are population-based, epidemiologic studies with identical survey protocols. Incident hypertension (BP > or = 140/90 mm Hg or current antihypertensive treatment) was analyzed in subjects aged 35 to 64 years of Mexican ethnicity living in low-income neighborhoods (n = 1467 in Mexico City, n = 628 in San Antonio). RESULTS: In Mexico City, 10.6% of men and 13.1% of women developed hypertension in a 6.5-year period; in San Antonio, 28.6% and 28.7% in a 7.5-year period, respectively. Poisson regression analysis demonstrated a greater hypertension risk in San Antonio for both men (risk ratio [RR] = 1.75, 95% confidence interval [CI]: 1.19-2.56) and women (RR = 1.40, 95% CI: 1.05-1.86). In a multiple linear regression analysis, systolic BP change was associated with weight gain in Mexico City (P < .001 in men and women) and San Antonio (P = .045 in men, and P = .027 in women) independently of age, BP, obesity, alcohol consumption, cigarette smoking, diabetes, and antihypertensive treatment. These covariates did not fully explain greater increments of systolic BP in San Antonio than in Mexico City (P < .001 in men and women). CONCLUSIONS: Hypertension risk is lower in Mexico City than in San Antonio. Systolic BP increases with weight gain, independently of other determinants of hypertension.

Adult↗
PubMed2003

Spatial indoor radon distribution in Mexico City.

We present a spatial analysis of residential radon concentrations in the Mexico City Metropolitan Area, which we intend to use to assign radon exposure in an ongoing case-control study. As part of a probabilistic household survey, carried out between May and June 1999, 501 dwellings were selected for indoor placement of solid state nuclear track detectors (LR 115) in a cup array over a period of approximately 90 days. As part of the sampling design, the city was grid partitioned into nine zones and a sample of dwellings was selected in each zone. All zones were simultaneously surveyed. The stratified sampling design allowed us to obtain radon geometric means, adjusted for household characteristics, week of detector placement and number of days of measurement for these zones. Additionally, adjusted geometric means were estimated for the 100 census tracts surveyed and this information was used to obtain a more detailed spatial distribution of residential radon levels through kriging interpolation and surface contouring. Radon levels depended on the room of placement, the floor level and the ventilation habits but not on building materials. Regarding the city zone, the highest adjusted geometric mean was found in the southwest (136 Bqm(-3)), where 46% of the households had an estimated radon level in excess of 200 Bqm(-3). In the rest of the city, the geometric mean concentration ranged between 41 and 98 Bqm(-3). A more detailed spatial distribution showed that, in general, most of the eastern and middle zones of the city had estimated radon geometric means below 74 Bqm(-3), while the western ones had geometric means above this concentration. Very high geometric means, exceeding 111 Bqm(-3) and even reaching 288 Bqm(-3), are estimated for some areas located in the southern and western zones of Mexico City. The obtained spatial distribution shows that the areas with very high estimated residential radon concentrations are close to inactive volcanic mountains. We believe that the geo-statistical techniques, we have used, offer reasonably good estimates of the average spatial residential radon distribution in Mexico City under average ventilation in homes. The use of this indirect approach for radon exposure measurement in epidemiological studies is an inexpensive alternative to direct radon exposure measurement but may be subject to non-differential misclassification error. The effect of such error on the detection of a real increase in lung cancer risk from indoor radon remains to be determined.

Air Pollution, Indoor↗
PubMed1996

Emergency medicine credentials in St Louis and Kansas City: does the presence of an emergency medicine residency program have a geographic difference?

STUDY OBJECTIVE: To compare emergency physician (EP) credentialing characteristics in two metropolitan areas of Missouri: Kansas City, which has had an emergency medicine (EM) residency program since 1973, and St Louis, which is without a program approved by the Accreditation Council for Graduate Medical Education. METHODS: A cross-sectional, descriptive survey concerning EP training, certification, and practice characteristics was administered by standardized telephone interviews. Participants were all emergency department directors in Kansas City and St Louis general hospital EDs serving more than 10,000 patients annually. RESULTS: Twenty Kansas City EDs, with an annual census of 20,250 +/- 7,200; and 30 St Louis EDs, with an annual census of 27,100 +/- 13,800, were surveyed. In Kansas City, 68% of practicing EPs were EM trained, versus 10% in St. Louis (P < .0005). The percentage of board-certified EPs was also greater in Kansas City than in St Louis (82% versus 42%, P < .0005). Eighty-six percent of ED directors in St Louis, compared with 30% in Kansas City, reported that they did not attempt to recruit EM-trained staff or that recruitment was difficult (P < .0005). CONCLUSION: The presence of an EM residency training program is associated with favorable EP credentialing characteristics in the Kansas City metropolitan area. This information may prove useful to institutions attempting to establish EM training programs in areas where none currently exist.

Certification↗
PubMed2001

Study of distribution and factors affecting syphilis epidemic among inner-city minorities of Baltimore.

Disparities in health and medical conditions among ethnic and racial groups have been repeatedly documented. These inequalities, which have been noted in the recent past, include health outcomes such as quality of life and mortality, process, accessibility and appropriateness of care, and the prevalence of certain degenerative conditions and infectious diseases. Syphilis, a sexually transmitted disease (STD) which seemed to have disappeared or had been controlled over the years, has now re-emerged as a major public health problem in many rural, urban and suburban communities. Progression of the current rate of syphilis, which erupted in Baltimore during the later part of 1994, has continued unabated, most especially among the ethnic minorities, despite efforts of the Baltimore City Health Department and Maryland Department of Health and Mental Hygiene to control the epidemic. With the current incidence rates of 270 per 100 000 live births for congenital syphilis and 99.3 per 100 000 population for primary, secondary and latent syphilis (96% of the cases being in the non-white population), Baltimore becomes the city with the highest number of syphilis cases in the nation, surpassing the national average of 2.6 cases per 100 000 population. This study, which utilizes a combination of retrospective and questionnaire-oriented approach, was designed to assess factors that influenced the high incidence of syphilis among Baltimore inner-city dwellers between 1994 and 1998. Data for the study included syphilis reports from private physicians, the Baltimore City Health Department, STD clinics, the Center for Disease Control (CDC), and ethnographic interviews. Factors favoring the distribution and infectivity of the disease among the inner-city dwellers include greater poverty, high level of communication gaps between providers and a cross-section of minority inner-city dwellers, exchange of sex for crack cocaine, lower educational background, and inadequate and inappropriate health education/health promotion programs for the ethnic minorities.The paper calls for, among other things, culturally-sensitive and competent syphilis elimination/prevention health education and health promotion programs for the ethnic minority inner-city dwellers of Baltimore.

Adolescent↗
PubMed2005

[The self healing power of cities--civil qualities of urban life].

Health and hygiene are top issues from the early days down the history of a town or a city. Pestilence, epidemic plagues and infectious diseases are once in a while endangering the delicate equilibrium of a city as an organism. Many infra-structural measures are taken to ensure health in and of the city. What makes a healthy city is not just the absence of illness, a healthy city is inspired by the mentality of their citizens, it is a work of art and based on an consensus of what does mean quality of live for the city and its inhabitants. It is multifaceted and can develop the power to regenerate itself. In times of a demographic change with more elderly people in the future then ever and less money in public pursues we nevertheless have the civic duties and the obligation to look after health of our cities. Many faculties like science, visual art, engineering and design must cooperate and work together toward that goal.

Attitude to Health↗
PubMed2002

Measurements of personal exposure to nitrogen dioxide in four Mexican cities in 1996.

Nitrogen dioxide is a ubiquitous pollutant in urban areas. Indoor NO2 concentrations are influenced by penetration of outdoor concentrations and by indoor sources. The objectives of this study were to evaluate personal exposure to NO2, taking into account human time-activity patterns in four Mexican cities. Passive filter badges were used for indoor, outdoor, and personal NO2 measurements over 48 hr and indoor workplace measurements over 16 hr. Volunteers completed a questionnaire on exposure factors and a time-activity diary during the sample period. An unpaired t test, an analysis of variance (ANOVA), and a linear regression were performed to compare differences among cities and mean personal NO2 concentrations involving housing characteristics, as well as to determine which variables predicted the personal NO2 concentration. Sampling periods were in April, May, and June 1996 in Mexico City, Guadalajara, Cuernavaca, and Monterrey. All 122 volunteers in the study were working adults, with a mean age of 34 (SD +/- 7.38); 64% were female, and the majority worked in public offices and universities. The highest NO2 concentrations were found in Mexico City (36 ppb for outdoor, 57 ppb for indoor, and 39 ppb for personal concentration) and the lowest in Monterrey (19 ppb for outdoor, 24 ppb for indoor, and 24 ppb for personal concentration). Significant differences in NO2 concentrations were found among the cities in different microenvironments. During the sampling period, volunteers spent 85% of their time indoors. The highest personal NO2 concentration was found when volunteers kept their windows closed (p = 0.03). In the regression model adjusted by city and gender, the best predictors of personal NO2 concentration were outdoor levels and time spent outdoors (R2 = 0.68). These findings suggest that outdoor NO2 concentrations were an important influence on the personal exposure to NO2, due to the specific characteristics and personal behavior of the people in these Mexican cities.

Adult↗
PubMed2000

Effects of a community-wide health education program on cardiovascular disease morbidity and mortality: the Stanford Five-City Project.

The authors examined changes in morbidity and mortality from 1979 through 1992 during the Stanford Five-City Project, a comprehensive community health education study conducted in northern California. The intervention (1980-1986), a multiple risk factor strategy delivered through multiple educational methods, targeted all residents in two treatment communities. Potentially fatal and nonfatal myocardial infarction and stroke events were identified from death certificates and hospital records. Clinical information was abstracted from hospital charts and coroner records; for fatal events, it was collected from attending physicians and next of kin. Standard diagnostic criteria were used to classify all events, without knowledge of the city of origin. All first definite events were analyzed; denominators were estimated from 1980 and 1990 US Census figures. Mixed model regression analyses were used in statistical comparisons. Over the full 14 years of the study, the combined-event rate declined about 3% per year in all five cities. However, during the first 7-year period (1979-1985), no significant trends were found in any of the cities; during the late period (1986-1992), significant downward trends were found in all except one city. The change in trends between periods was slightly but not significantly greater in the treatment cities. It is most likely that some influence affecting all cities, not the intervention, accounted for the observed change.

Adult↗
PubMed2002

The World Cities Project: rationale, organization, and design for comparison of megacity health systems.

This article provides an overview of the World Cities Project (WCP), our rationale for it, our framework for comparative analysis, and an overview of current studies in progress. The WCP uses New York, London, Paris, and Tokyo as a laboratory in which to study urban health, particularly the evolution and current organization of public health infrastructure, as well as the health status and quality of life in these cities. Comparing world cities in wealthier nations is important because of (1) global trends in urbanization, emerging health risks, and population aging; (2) the dominant influence of these cities on "megacities" of developing nations; and (3) the existence of data and scholarship about these world cities, which provides a foundation for comparing their health systems and health. We argue that, in contrast to nation-states, world cities provide opportunities for more refined comparisons and cross-national learning. To provide a framework for WCP, we define an urban core for each city and examine the similarities and differences among them. Our current studies shed light on inequalities in health care use and health status, the importance of neighborhoods in protecting population health, and quality of life in diverse urban communities.

Delivery of Health Care↗
PubMed2005

CitI, a transcription factor involved in regulation of citrate metabolism in lactic acid bacteria.

A large variety of lactic acid bacteria (LAB) can utilize citrate under fermentative conditions. Although much information concerning the metabolic pathways leading to citrate utilization by LAB has been gathered, the mechanisms regulating these pathways are obscure. In Weissella paramesenteroides (formerly called Leuconostoc paramesenteroides), transcription of the citMDEFCGRP citrate operon and the upstream divergent gene citI is induced by the presence of citrate in the medium. Although genetic experiments have suggested that CitI is a transcriptional activator whose activity can be modulated in response to citrate availability, specific details of the interaction between CitI and DNA remained unknown. In this study, we show that CitI recognizes two A+T-rich operator sites located between citI and citM and that the DNA-binding affinity of CitI is increased by citrate. Subsequently, this citrate signal propagation leads to the activation of the cit operon through an enhanced recruitment of RNA polymerase to its promoters. Our results indicate that the control of CitI by the cellular pools of citrate provides a mechanism for sensing the availability of citrate and adjusting the expression of the cit operon accordingly. In addition, this is the first reported example of a transcription factor directly functioning as a citrate-activated switch allowing the cell to optimize the generation of metabolic energy.

Bacterial Proteins↗
PubMed2001

Comparing meta-analysis and ecological-longitudinal analysis in time-series studies. A case study of the effects of air pollution on mortality in three Spanish cities.

STUDY OBJECTIVE: The objective of this paper is to introduce a different approach, called the ecological-longitudinal, to carrying out pooled analysis in time series ecological studies. Because it gives a larger number of data points and, hence, increases the statistical power of the analysis, this approach, unlike conventional ones, allows the complementation of aspects such as accommodation of random effect models, of lags, of interaction between pollutants and between pollutants and meteorological variables, that are hardly implemented in conventional approaches. DESIGN: The approach is illustrated by providing quantitative estimates of the short-term effects of air pollution on mortality in three Spanish cities, Barcelona, Valencia and Vigo, for the period 1992-1994. Because the dependent variable was a count, a Poisson generalised linear model was first specified. Several modelling issues are worth mentioning. Firstly, because the relations between mortality and explanatory variables were non-linear, cubic splines were used for covariate control, leading to a generalised additive model, GAM. Secondly, the effects of the predictors on the response were allowed to occur with some lag. Thirdly, the residual autocorrelation, because of imperfect control, was controlled for by means of an autoregressive Poisson GAM. Finally, the longitudinal design demanded the consideration of the existence of individual heterogeneity, requiring the consideration of mixed models. MAIN RESULTS: The estimates of the relative risks obtained from the individual analyses varied across cities, particularly those associated with sulphur dioxide. The highest relative risks corresponded to black smoke in Valencia. These estimates were higher than those obtained from the ecological-longitudinal analysis. Relative risks estimated from this latter analysis were practically identical across cities, 1.00638 (95% confidence intervals 1.0002, 1.0011) for a black smoke increase of 10 microg/m(3) and 1.00415 (95% CI 1.0001, 1.0007) for a increase of 10 microg/m(3) of sulphur dioxide. Because the statistical power is higher than in the individual analysis more interactions were statistically significant, especially those among air pollutants and meteorological variables. CONCLUSIONS: Air pollutant levels were related to mortality in the three cities of the study, Barcelona, Valencia and Vigo. These results were consistent with similar studies in other cities, with other multicentric studies and coherent with both, previous individual, for each city, and multicentric studies for all three cities.

Air Pollutants↗
PubMed1996

Healthy Cities: toward worldwide health promotion.

Healthy Cities is a community problem-solving process for health promotion that began in Canada and Europe in the mid-1980s. Although Healthy Cities have expanded worldwide, there is limited scientific literature that documents the effects of these efforts. This review describes the dynamic status of Healthy Cities globally and summarizes what is known about these efforts. It is difficult to draw generalizations or clear differences between Healthy Cities and other efforts with similar objectives in the United States. There appears to be less variation among Healthy Cities in Europe, most likely because of the extensive technical support provided by the WHO European Regional Office to the Healthy Cities Project. Case descriptions present the diversity and types of activities of Healthy Cities. It is concluded that community participation and broad involvement from different sectors of the community are promising approaches to addressing urban problems.

Community Participation↗
PubMedDate not supplied

A comparison of pregnancy health practices of women in inner-city and small urban communities.

OBJECTIVE: To examine whether the relationships among pregnancy health practices, maternal-fetal attachment, and prenatal depression differ between women living in the inner city and women living in a smaller urban community. DESIGN: Cross-sectional, descriptive survey. SETTING: Clinics in inner-city and small urban communities in the Midwest. PARTICIPANTS: Fifty-five pregnant women living in the inner city and 197 pregnant women living in a smaller urban setting. MAIN OUTCOME MEASURES: Health Practices Questionnaire, a self-report instrument that measures pregnancy health practices. RESULTS: Women living in the inner city reported lower levels of health practices than women in urban settings, but this was moderated by maternal-fetal attachment. Inner-city women with lower levels of maternal-fetal attachment had poorer health practices than inner-city women with higher levels of maternal-fetal attachment; there was no relationship for women residing in the small urban area. Depression was negatively associated with health practices for all women; however, there was no difference by residence. CONCLUSION: Maternal-fetal attachment contributed differently to health practices in women from the inner city compared with women from small urban communities. Nurses can use this information to help identify women at risk for poor pregnancy health practices. More research is needed to identify the interventions that most effectively improve health practices.

Cross-Sectional Studies↗
PubMed2000

Assessing community change at multiple levels: the genesis of an evaluation framework for the California Healthy Cities Project.

More than 40 cities have participated in the California Healthy Cities Project since its inception in 1988. Because Healthy Cities efforts are community driven, these cities address diverse health and social issues using a wide variety of strategies. This complexity, in addition to the usual difficulties associated with evaluating community interventions, creates many challenges for evaluation. Given the community building and process orientation of Healthy Cities, it may be most appropriate to measure intermediate community changes that have been linked to health outcomes in previous research or, at a minimum, theoretically. The California Healthy Cities evaluation framework conceptualizes change at five levels: individual, civic participation, organizational, interorganizational, and community. The framework, developed collaboratively with Healthy Cities participants, attempts to synthesize current thinking and practice on evaluation of community projects by applying concepts from community capacity/competence, social ecology, and urban planning.

California↗