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PubMed2005

Incidence of leukemias in children from El Salvador and Mexico City between 1996 and 2000: population-based data.

BACKGROUND: There are very few studies that report the incidence of acute leukemias in children in Latin America. This work assesses the incidence of acute leukemias, between 1996 and 2000, in children from 0-14 years old who were attended at the Mexican Social Security Institute in Mexico City and in children from 0-11 years old in El Salvador. METHODS DESIGN: Population-based data. Hospitals: In San Salvador, El Salvador, Hospital Nacional de Niños "Benjamin Bloom", the only center in El Salvador which attends all children, younger than 12 years, with oncologic disease. The Pediatric Hospital and the General Hospital of the Mexican Social Security Institute in Mexico City, the only centers in Mexico City which attend all those children with acute leukemia who have a right to this service. DIAGNOSIS: All patients were diagnosed by bone marrow smear and were divided into acute lymphoid leukemia (ALL), acute myeloid leukemia (AML), chronic myeloid leukemia (CML), and unspecified leukemias (UL). The annual incidence rate (AIR) and average annual incidence rate (AAIR) were calculated per million children. Cases were stratified by age and assigned to one of four age strata: 1) <1 year; 2) 1-4 years; 3) 5-9 years, or 4) 10-14 or 10-11 years, for Mexico City and El Salvador, respectively. RESULTS: The number of cases was 375 and 238 in El Salvador and Mexico City, respectively. AAIRs in Mexico City were 44.9, 10.6, 2.5, 0.5, and 58.4 per million children for ALL, AML, CML, UL, and total leukemias, respectively. The AAIRs in El Salvador could not be calculated because the fourth age stratum in El Salvador included children only from 0-11 years old. The incidence rates for the Salvadorian group of 0-11 year olds were 34.2, 7.1, 0.6, 0.2, and 43.2 per million children for ALL, AML, CML, UL, and total leukemias, respectively. CONCLUSION: Reported AIRs for each age group in El Salvador were similar to those from other American countries. The AAIR of ALL in Mexico City is one of the highest reported for North America.

Adolescent↗
PubMed2005

Risk factors for intrauterine growth restriction: a comparison between two Brazilian cities.

In Brazil, similar intrauterine growth restriction (IUGR) rates were observed between cities with distinct levels of socioeconomic development, challenging the current knowledge that higher rates of IUGR would necessarily be observed in poorer areas than in wealthier ones. Ribeirão Preto, a city located in the most developed area in Brazil, showed an IUGR rate of 18% in 1994, whereas this rate was 18.5% in 1997/1998 in São Luis, located in one of the poorest areas in the country. The objective of this study was to compare risk factors for IUGR in these two cities and to identify factors that are responsible for this unexpected lack of difference between the rates. Using data from two birth cohorts, including 2839 neonates who were from Ribeirão Preto and born in 1994 and 2439 neonates who were from São Luis and born in 1997/1998, a multivariable analysis was conducted to assess changes in the risk for IUGR in the poorer city compared with the wealthier one in a combined model, adjusting for some risk factors for IUGR. The wealthier city showed higher rates of maternal smoking, attendance in the private sector, and obstetric interventions than the less developed one. Differences in maternal smoking and obstetric interventions were possibly responsible for the similarity of the rates between cities. It seems that early detection of IUGR followed by cesarean section in the wealthier city is associated with increased low birth weight and IUGR rates but reduced stillbirth and infant mortality rates.

Adolescent↗
PubMed1995

Inner-city hospitals: a call for research.

Inner-city hospitals serve as safety nets for poor and underserved populations. They cope with serious issues of uncompensated care, aging facilities, and inadequate reimbursement. Yet, little research exists on their needs and problems. The authors argue that research on inner-city institutions is necessary to obtain "policy" attention, legitimize demand for resources, reframe inner-city health issues as a delivery problem, and gain insights on better ways to manage inner-city hospitals. They provide data-based illustrations of future research questions related to issues of inefficiency, overstaffing, case severity, and facility renovation that can contribute to better policymaking on inner-city hospitals. The authors recognize systemic barriers to research including the unpopularity of access issues, lack of data, and absence of input from practitioners working in inner-city institutions. To remove such barriers, they suggest creation of a representative forum, original databases, increased linkage with research and policy agencies, and increased cooperation between inner-city professionals and researchers.

Catchment Area, Health↗
PubMedDate not supplied

[The EMECAM project: a discussion of the results in the participating cities. Estudio Multicéntrico Español sobre la Relación entre la Contaminación Atmosférica y la Mortalidad].

This article draws a comparison and provides a discussion of the findings resulting from the local analyses of the 14 cities participating in the EMECAM Project. An analysis is made of the time series related to mortality, pollutants (particles in suspension, SO2, NO2, O3 and CO), temperature and other factors taken from records of public institutions. By using Poisson autoregressive regression, an estimate has been made of the short-term relationship between the number of deaths and the air pollution indicators in each one of the following cities: Barcelona, metropolitan area of Bilbao, Cartagena, Castellón, Gijón, Huelva, Madrid, Pamplona, Seville, Oviedo, Valencia, Vigo, Vitoria and Saragossa. The findings reveal the air pollution figures in our country to be similar to those of other European cities. The levels of the different pollutants point toward road traffic as being the main source of most of this pollution. A relationship has been found between the mortality and different pollutants in most cities, although the results are not homogeneous among the cities and show variability in the different causes under study. In some cities, especially in those having smaller populations, there have been no findings providing any evidence of a relationship, or the findings themselves are not highly consistent. The meta-analysis will provide estimates for all of the cities as a whole and will allow the possibility of making a more clear-cut assessment of the time lag impact of air pollution on the mortality. Worthy of special mention is the participation in this project of public health officers as actively involved researchers.

Air Pollutants↗
PubMed1984

Changes in the functions of Soviet cities with growth.

"A sample of Soviet cities (the largest 100 cities in the RSFSR) is used to develop a model relating city size, city function and the city's force of attraction (in-migration rates)....[It is found that] city growth...is accompanied by a change in functional structure and an increase in the importance of some functions at the expense of others....A change in functional structure, in turn, produces a change in the city's force of attraction, resulting in either an increase or a decline of in-migration."

Demography↗
PubMed2006

Prostate cancer screening and detection in inner-city and underserved men.

CONTEXT: In the era of serum prostate-specific antigen (PSA) screening, the incidence of prostate cancer has increased dramatically. Simultaneously however, stage migration has occurred, and treatment outcomes have improved. Inner-city men have lower screening rates and, thus, may be diagnosed with more advanced disease that it less likely to be successfully treated. OBJECTIVE: To assess the detection rate of prostate cancer and tumor stage at presentation in inner-city men. DESIGN, SETTING, AND PATIENTS: A retrospective cohort of 368 men underwent transrectal ultrasound needle-guided biopsy at an inner-city hospital from January 2003 to May 2005. Clinical and pathologic data were collected and analyzed. MAIN OUTCOME MEASURES: Clinic and hospital records were reviewed for several key outcomes, including prostate cancer incidence, tumor stage and tumor grade. RESULTS: The median age of the cohort was 67 +/- 9.1 years (range, 23-93 years). Prostate cancer was diagnosed in 44% of subjects (161/368). The median PSA level at the time of diagnosis was significantly higher in African-American men than in Caucasian men (9.82 vs. 5.97 ng/mL, P=0.008). Abnormally high serum PSA levels (>20 ng/mL) were present in disproportionately more African-American men than Caucasian men with prostate cancer (32.9% vs. 19.7% P=0.011). African-American men in this inner-city cohort also had a higher incidence of advanced disease or distant metastasis (T3/T4, N1, or M1) than did Caucasians (16.1% vs. 3.8%; P=0.045). CONCLUSIONS: Compared with inner-city Caucasian men, disproportionately more inner-city, African-American men present with advanced prostate cancer. This observation warrants prostate cancer education and consideration of early detection programs in underserved inner-city communities.

Adult↗
PubMedDate not supplied

Differences in gay men's AIDS risk knowledge and behavior patterns in high and low AIDS prevalence cities.

Several studies have found reductions in acquired immunodeficiency syndrome (AIDS) risk practices among gay men in high AIDS-prevalence cities since the start of the AIDS crisis. Much less is known about risk behavior patterns among gay men in smaller cities, where AIDS cases are less common and the prevalence of human immunodeficiency virus infection is relatively lower. In the study, men entering gay bars in three cities, one large and two small, completed anonymous surveys of sexual practices and AIDS risk knowledge. Men in high AIDS-prevalence areas were found to have had a greater number of sexual partners, were more knowledgeable about AIDS, were much more likely to engage in low-risk practices (such as mutual masturbation or body rubbing), and had unprotected anal intercourse less frequently than gay men in smaller cities. The most common sexual activity among gay men in the larger city was mutual masturbation, a low-risk practice. The most common sexual activity among gay men in the smaller cities was unprotected anal intercourse. Increased efforts are needed to educate gay men and to promote risk behavior changes among those living in smaller cities and in communities outside the prominent AIDS epicenters.

Acquired Immunodeficiency Syndrome↗
PubMed1983

Urban malaria control situation and environmental issues, Madras City, India.

Madras was one of 22 urban places in India where centrally sponsored urban malaria control schemes were introduced in 1971-1972. Yet since 1970, malaria cases have actually registered a significant increase in Madras. This paper deals with some critical environmental issues facing malaria control schemes. The overall spatial trends and patterns of malaria incidence are illustrated through maps for the years 1975-1981. Areas of high incidence are shown in the northern part of the city which is also traditionally an endemic area. The City Corporation has identified 17 high risk divisions accounting for 75% of the total registered cases in the city. High risk areas were found to be related to environmentally deteriorating areas such as high density, older, residential areas, slums and squatter settled areas along stretches of two rivers and a canal which traverse the city, and the low-lying poorly drained areas scattered over many parts of the city. The typical breeding grounds and sources of major vectors (anophelines and culicines) are presented. A relationship exists between the density of breeding sources (of Anopheles stephensi), such as private and public wells (in use and in disuse), overhead tanks and cisterns, and malaria cases. Field observations were made in detail in four selected high risk areas. Each area presents different environmental, epidemiological and human (social) factors in understanding malaria resurgence situation and demand different types of control measures. The problems of implementation of urban control schemes are found to be political, administrative, economic, social as well as environmental in nature. The persistence of malaria problems in the city has been attributed to slackening of malaria eradication measures, rapid urban growth and deteriorating environmental conditions with sewage, drainage and sanitation programmes lagging far behind the plans. The advantages and drawbacks of various antimalaria (mostly larval) measures in practice are presented. Biological and chemical control methods of malaria seem to provide only temporary control of the vectors. Some of the problems and constraints faced by Madras City Corporation in enforcing public health measures are discussed. The study also points out that environmental improvement, management techniques and health education, including raising the public awareness and cooperation, involvement and participation at neighbourhood/community levels in a meaningful way, have a long way to go in achieving permanent vector control and eliminating the reservoir of infection.

Animals↗
PubMed1995

[The City and Health--an analysis of recent (socio-) historical literature].

"The City and Health" - this title joints two all-encompassing words. The city is the birthplace of modern civilization. Today, we are confronted with huge urban agglomarations--beyond our grasp and nearly out of control. Are we dealing with transitory phenomena, such as the filthy and inhuman cities of the early industrial era seem from the historical point of view? This is our hope. Here inevitably, we strike upon the term "Health". For in the endeavor to create in a city first permanent and then "proper" conditions and finally to achieve proper behaviour, health became a central term. Today, to be healthy is our most heartfelt desire. Still, we do nor know what health is. The theme "City and Health" is therefore significant, historically as well as at present. So a brief historical survey will illustrate a few elements characteristic of the interrelationship of health and the city from the civilizational point of view ( = 1.). To determine the historical point of our inquiry, we will then outline the recent discussion on urban history ( = 2.). Upon this ground, we shall discuss cities as a special expression of community, the sciences of health as a special type of medicine, and the modern industrial living conditions with regard to the recent socio-historical and medico-historical literature published since 1980 ( = 3.).

Community Health Services↗
PubMed1997

Inner-city health care. American College of Physicians.

The fundamental problems that beset the U.S. health care system--cost, quality, and access--differ in scope and intensity in inner cities. Current trends in health care are system-wide but are more difficult to accommodate in inner cities because of scarce resources and stresses to the health care system. In this position paper, the American College of Physicians seeks to highlight directions and innovations in public policy for inner-city health care with renewed determination that health care problems in the United States must be solved, especially in cities, where they are most extreme. Many persons in inner cities experience an urban health penalty because of the concentration of economic decline, job loss, and major health problems. Because the problems originate in a complex interaction of socioeconomic factors, behavior, environment, and disease that is related to race and ethnicity, multifaceted approaches that extend beyond the medical model are needed to improve health status. The College argues for tackling health problems of the inner city in the context of a comprehensive urban policy that addresses the root causes of poverty. In addition, this position paper contains more specific recommendations to improve health care delivery to inner cities. The College calls for a comprehensive urban partnership initiative to address all aspects of the urban penalty--social, economic, and health-related--and recommends solutions through public and private collaborations that can be adapted to the circumstances of each community. In addition, policy recommendations address health care coverage, providers, public health initiatives, community involvement, and short-term improvements to such existing programs as Medicaid.

Health Care Costs↗
PubMed2000

Maternal mortality in New York City: excess mortality of black women.

To assess maternal mortality in New York City, birth certificates and mortality records for New York City from 1988 through 1994 were linked and examined. During these 7 years, maternal mortality in New York City (defined by the International Classification of Diseases, 9th edition [ICD-9], as 630-676) per 100,000 live births significantly exceeded that of the country as a whole (20.2 vs. 8.2, respectively). Within New York City, an even greater variation of maternal mortality by race/ethnicity was noted, with the mortality ratio of whites, blacks, and Hispanics being 7.1, 39.5, and 14.4 per 100,000 live births, respectively. Socioeconomic characteristics such as educational attainment, marital status, and income influenced maternal mortality more in non-blacks than blacks. Analyses of cause-specific mortality revealed that, overall, ectopic pregnancy, embolism, and hypertension were the leading causes of death. However, the major factors explaining the excess maternal mortality among blacks were hypertension (mortality ratio of blacks to whites 5.57, 95% confidence interval 2.30-13.39), ectopic pregnancy (4.78, 95% confidence interval 2.40-9.51), and abortion (4.58, 95% confidence interval 1.72-12.22). These findings confirm a persisting gap in maternal death between black and white women. Indeed, if all New Yorkers who became pregnant enjoyed the survival of the city's non-Hispanic white residents, the difference in maternal mortality between the city and the nation would be eliminated.

Adolescent↗
PubMed1988

Threat to the New York City water supply--plutonium.

The mayor of the City of New York received an anonymous letter on April 1st 1985 threatening to contaminate the water supply with plutonium unless all criminal charges against Mr Bernhard Goetz, the suspect in a dramatic subway shooting incident, were dismissed by April 11th 1985. Local and Federal authorities were called upon to evaluate the credibility of the threat and to institute a "round the clock" monitoring program by New York City personnel. The Environmental Measurements Laboratory, EML, was requested by the City to analyse a composite, large volume (approximately 175 litres) drinking water sample collected by City personnel on April 16th 1985. The concentration measured was 21 fCi/l which was a factor of 100 greater than previously observed results in our data base, and the mass isotopic content of the plutonium was very unusual. Additional samples were collected one to three months later at various distribution points in the water supply system. The plutonium concentrations were much lower and comparable to EML's earlier data. Mass isotopic analysis of these samples provided more reasonable compositions but with high uncertainties due to very low plutonium concentration. Recent measurements of large volume samples, approximately 1000 litres, collected in the Fall of 1985 from the New York City and New Jersey water supplies showed identical plutonium concentrations of 0.05 fCi/l. Mass isotopic analyses indicated similar 240Pu/239Pu ratios which were slightly lower than global fallout estimates. Due to our inability to confirm the elevated plutonium concentration value for the composite sample of April 16th 1985, it is impossible to conclude whether the threat to contaminate the New York City water supply was actually carried out or whether the sample was contaminated prior to receipt at EML.

Crime↗
PubMed1992

Asbestos-containing materials in New York City buildings.

The New York City Department of Environmental Protection (DEP) carried out a survey to assess the public's risk of exposure in buildings to in-place asbestos-containing materials (ACM). Data regarding the presence of in-place asbestos and the potential for exposure to asbestos were collected in 886 buildings from 16 different building categories in New York City. Overall 68% of the buildings in New York City contain ACM. The estimated total amount of ACM in the city is 323 million ft2 most of which is thermal system insulation. Overall, 16% of all ACM had greater than 10% of its surface damaged and another 68% of ACM had some, but less than 10% of its surface damaged. About half of all ACM is in mechanical spaces within buildings. On the basis of results of the survey, buildings in New York City were prioritized for management and an in-place management bill was introduced into the New York City Council.

Air Pollution, Indoor↗
PubMed2001

Molecular epidemiology of tuberculosis among eight hospitals in New York City, 1996-1997.

OBJECTIVE: To determine the molecular epidemiology of tuberculosis isolated from patients cared for at eight hospitals scattered throughout New York City. MATERIALS AND METHODS: Cases of tuberculosis occurring in 1996 and 1997 at collaborating hospitals were identified, and demographic data were extracted from patient charts. All available isolates were analyzed by IS6110 for genetic relatedness. The molecular fingerprints were compared both to each other and to the larger repository of strains from New York City developed and maintained at the Public Health Research Institute. RESULTS: One hundred and eighty cases were fully characterized. Compared with New York City cases, study patients were more likely to be Asian and less likely to be non-Hispanic blacks. Overall, 97 (54%) of the cases were clustered with respect to other study strains or with respect to the other New York City isolates. Clustered strains were significantly more likely to be from non-Hispanic blacks or patients born in the United States. The largest cluster (n = 17) was the "W" strain previously associated with an outbreak of multidrug-resistant tuberculosis in New York City. In the current study, the majority of W strain isolates were fully drug-susceptible. CONCLUSIONS: High rates of genetically related tuberculosis continue to occur among patients in New York City, in spite of improved control of nosocomial outbreaks and dramatic decreases in the overall case rates. The use of molecular techniques to suggest patterns of transmission has become essential in developing and assessing routine tuberculosis control strategies.

Adult↗
PubMed2004

Tuberculosis in New York city: recent lessons and a look ahead.

In the late 1980s and early 1990s, after decades of decline, the incidence of tuberculosis began to rise in New York city, reaching a peak of 3811 cases by 1992. The epidemic took root in a setting of inadequate treatment regimens, homelessness, a diminished public-health system, and the onset of the HIV/AIDS epidemic. In addition, a subepidemic of drug-resistant tuberculosis occurred throughout New York city, most notably in a series of well documented nosocomial outbreaks. By 1994, using broadened initial treatment regimens, directly observed therapy, and improved US Centers for Disease Control and Prevention guidelines for hospital control and disease prevention, New York city began to effectively halt the progression of the epidemic. By 2002, tuberculosis rates in New York city reached an historic low of 1084. However, given the presence of a large reservoir of latently infected individuals in the city and an ongoing tuberculosis pandemic, New York city continues to face significant challenges from this persistent pathogen.

Centers for Disease Control and Prevention, U.S.↗
PubMed2002

Indoor tanning facility density in eighty U.S. cities.

The purpose of this study was to examine the number of tanning facilities in select U.S. cities. The twenty most populated cities from each of 4 U.S. regions were selected for the sample. For each city, data on the number of tanning facilities, climate, and general demographic profile were collected. Data for state tanning facility legislation also were collected. A tanning facility density variable was created by dividing the city's number of facilities by its population size. The 80 cities had an average of 50 facilities each. Results of linear regression analysis indicated that higher density was significantly associated with colder climate, lower median income, and higher proportion of Whites. These data indicate that indoor tanning facilities are prevalent in the environments of U.S. urban-dwellers. Cities having the higher density profile may be logical targets for interventions promoting less or safer use of these facilities.

Beauty Culture↗
PubMed2003

Lead contamination of soils in Belize City, Belize, Central America.

In order to assess the amount and distribution of lead pollution in soils in Belize City, Belize, seventy-five samples were collected from three distinct areas around the city (roadsides, houses, and playgrounds and schools). This study has provided data to establish the first soil lead database for Belize City, Belize. The soil samples generally exhibited pH values above 7, less than 18% organic matter, and more than 50% sand was found in 92% of the samples. These physical and chemical characteristics prevent the lead from accumulating in the upper layers of soil. However, high or hazardous levels were found in all sample categories. In the schoolyards and playgrounds category. the levels range from 3 ppm to 780 ppm, and average 131 ppm. The roadside samples had a range of 3 ppm to 5450 ppm, and average 445 ppm. The housing samples had the highest concentrations, with the range from 9 ppm to 104, 500 ppm and an average of 638 ppm. The geographic distribution of lead within the city appears to be somewhat random, although the most contaminated areas are generally in the south part of the city. The distance to potential source of contamination, for example peeling paint or a road, affects lead concentration, as does percent of organic matter in the soil. The physical characteristics that normally aid in the retention of lead in soil are not generally present in Belize City; however, the lead levels are dangerously high.

Belize↗
PubMed2001

From the urban to the civic: the moral possibilities of the city.

Relating bioethics to the philosophy of the city creates the possibility for developing the field along paths not yet explored. In the Western tradition, the city has been understood as the venue for two quite different forms of activity and two different types of moral possibility. In one guise, the city is an urbs, a center of commerce, market exchange, and social individualism. In another guise, the city is a civitas or polis, the space of active democratic citizenship, equality under law, and civic virtue. As civitas, classical philosophers regarded the city as the place of moral growth and full human self-realization. These two possibilities of human moral and political experience in the city have given rise to distinct traditions of political theory--liberalism and civic republican and democratic theory. This article traces these conceptual configurations into the domain of contemporary bioethics, arguing that most work in the field has drawn on the liberal tradition and hence has been insufficiently critical of the moral paradigm of market individualism and unduly inattentive to the values of civitas and the civic tradition. It argues for the creation of a form of civic bioethics and explores some of the theoretical foundations that type of bioethics would require.

Bioethics↗