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PubMed1976

Dentistry and the county home resident: a statewide survey.

A flow chart (illustration) depicts the delivery process whereby county home residents either receive or do not receive dental treatment. Also included are the major findings of the survey, given in triangles A, B, and C. The initial step involved in this delivery process is that of recognizing a need. If the need is not recognized, it remains unmet and the patient receives no treatment (terminate). If the need is recognized, a treatment decision is required. If the decision is negative, the need remains unmet and the patient receives no treatment. If the decision is positive, the patient proceeds toward the goal of receiving dental treatment. However, potential delivery problems exist and the patient may have to overcome one or more of these before proceeding toward the goal. If problems do exist and are not resolved, the patient either does not receive treatment or treatment is delayed until satisfactory solutions are found. The first finding, A, shows that more than 72% of dental needs were identified because of some dental emergency experienced by the patient, 39.3% of needs were identified through routine checkups, 16.4% by a county home requirement, 14.8% through a state requirement, and 4.9%, "other." The second finding, B, shows that the county home steward makes the decision about whether dental treatment should be rendered in more than 85% of the homes. Physicians made 54.1% of the dental treatment decisions; nurses, 31.1%; dentists, 26.2%; patients, 24.6%; patient's family, 13.1%; supervisor or trustee, 4.9%; and "other," 3.3%. The third finding, C, represents delivery problems. More than 44% of the stewards said that the patient's mental or physical disabilities were a delivery problem; 39.3% indicated availability of dentists; 36.1% said reluctance of patient; 19.7% responded inadequate funding; and 14.8% indicated "other." A hypothetical county home resident can be dentally characterized as an emergency patient whose need for treatment is determined by a county home steward, and the main problem in obtaining treatment, according to the steward, is the patient's own inability to receive treatment because of mental or physical disabilities, or both.

Community Participation↗
PubMed2004

Sensitivities of three county health department surveillance systems for child-related dog bites: 261 cases (2000).

OBJECTIVES: To determine incidence of child-related dog bites and sensitivities of 3 county health department dog-bite surveillance systems. DESIGN: Retrospective study. STUDY POPULATION: Child-related dog-bite data obtained from surveillance systems of 3 counties in Georgia in the year 2000. PROCEDURE: To characterize the sensitivity of health department dog-bite surveillance systems, 9 other potential sources of dog-bite records that matched records by victim name, age, gender, and incident date were evaluated. The number of reported bites and the most productive sources for identifying additional cases were determined. The Chandra Sekar-Deming capture-recapture method was used to estimate the number of unreported bites, and estimates of dog-bite incidence rates were made. RESULTS: 40, 36, and 185 dog bites were reported in the 3 counties, respectively. Capture-recapture calculations estimated an additional 9, 5, and 128 dog bites in these counties, respectively. Local health departments recorded 45.5% to 82.5% of dog bites. Local hospital emergency departments, police departments, and a rabies-testing laboratory received additional reports. Among these data sources, local hospital emergency department records were the best source for identifying additional cases. CONCLUSIONS AND CLINICAL RELEVANCE: Dog bites are a preventable cause of childhood injuries, and surveillance is a critical tool for tracking childhood dog bites in the community. Counties should use combined data from local health departments, local hospital emergency departments, and police departments to implement or revise dog-bite prevention programs.

Adolescent↗
PubMed1964

[Studies on paragonimiasis in Ko-Hoong County, Korea (Report 1.): An epidemiologic survey for human paragonimiasis by the use of intradermal screening test]

Authors carried out the survey for human paragonimiasis in Ko-Hoong County, Chun-Nam Province, Korea from July to September 1964 by the use of intradermal screening test with Veronal buffered saline antigen. Eight myuns (village) out of 13 myuns of this county were selected for the survey, regarding balanced selection. The number of 2,916 primary school children of high class and 764 residents of all age groups in these areas were examined (total 3,680; male 1,961; female 1,719). The following results were obtained in this survey. 1) As a whole, 20.1 per cent of the examiners showed positive reaction, with sexual difference of 20.9 per cent in male and 19.1 per cent in female. 2) In regional differences of positive rate, the highest rate(50.1 per cent) was showed at Po-Doo myun and lowest rate(3.6 per cent) was showed at Do-Yang myun. 3) In age group, the highest positive rate was showed in 16 to 20 age group (46.7 per cent). 4) In regional comparison of paragonimiasis infectivity of whole nation (province and county), Ko-Hoong County as nearly same as the Hea-Nam County, Chun-Nam Province follows next of Cheju Province, the highest prevalance area of paragonimiasis in Korea, in concentration of prevalence of paragonimiasis.

Journal Article↗
PubMed1999

Health deficiencies in Cape Breton County, Nova Scotia, Canada, 1950-1995.

Cape Breton County contains one of the most polluted areas in North America and is socioeconomically depressed. We evaluated mortality patterns in this area over the past 5 decades, focusing on life expectancy and life loss. Life loss refers to the difference in life expectancy of Cape Breton County residents and all Canadians, and was further broken down into disease-specific components using cause-eliminated life table methods. We observed lags in health of 20 to 25 years for residents of Cape Breton County. Life expectancy in some municipalities of Cape Breton County is reduced by more than 5 years. Life loss for these residents is greater than that of any single cause of death for Canadians. Life loss among Cape Breton County women is primarily attributable to cancer, and, among men, to cardiovascular diseases. Life loss from cancer is higher in the steel-producing communities; whereas life loss from respiratory diseases and lung cancer is higher in the coal mining communities. These (and other) decompositions of life loss disclose patterns in health deficiencies that give rise to etiologic hypotheses and provide clues and directions for prevention and interventions.

Adolescent↗
PubMed2000

Public health reforms and development of health service in the Dakovo sub-district and administrative county in the period 1850-1899.

In the long-lasting struggle for national identity and modernization of Croatia, the Parliament of the Kingdom of Croatia and Slavonia has passed many laws and regulations from 1874 on, affecting thus the health care and the development of the public health system. The aim of those laws was to establish and achieve the same level of public health care that had already been instituted in some other countries of the Austro-Hungarian Empire. In order to clarify the consequences of these reforms for the development of the health care system on the county and district levels of Slavonia, we collected data on the town of Dakovo as a market center, home of the diocese, and seat of the sub-district and administrative county. The data were divided into several categories in order to examine (1) the reorganization of health care in the Kingdom of Croatia and Slavonia from 1848 to 1894; (2) the development of health care in the Dakovo sub-district and Dakovo administrative county; (3) number, structure, and distribution of medical practitioners from 1807 to 1899; (4) hospitals from 1859 to 1900; and (5) selected indicators of health and living condition and health needs of the county inhabitants in the period 1850-1900. The analysis of historical material showed that new regulations of health care initiated the process of "medicalization" that was understood as a part of European modernization in the field of state medicine and health care administration. It brought more accurate knowledge of the main causes of illnesses, deaths and disabilities but did not significantly improve health and health conditions in the Dakovo County at the entrance of the 20th century.

Croatia↗
PubMed1999

Resurgent bacterial sexually transmitted disease among men who have sex with men--King County, Washington, 1997-1999.

During the late 1980s and early 1990s, King County, Washington (1998 population: 1.6 million), experienced a substantial epidemic of infectious syphilis (i.e., primary, secondary, and early latent). Subsequently, reported cases of infectious syphilis declined to six cases in 1995 and one in 1996; five of the 1995 cases and the case in 1996 were believed to have been acquired outside King County. However, in 1997, sustained spread of syphilis was reestablished in King County. To determine whether this reemergence was associated with changes in the epidemiology of other sexually transmitted diseases (STDs), Public Health-Seattle and King County (PHSKC) analyzed notifiable STD data for 1997-1999. This report summarizes the results of this analysis, which indicate that infectious syphilis among men who have sex with men (MSM) in King County increased to 46 cases during January-June 1999, and chlamydia and gonorrhea also increased among MSM attending public health clinics.

Adult↗
PubMed2001

[Multilevel analysis of regional disparities in survival after heart failure: differences between county health services affect little patients' prognosis].

The prognosis for patients suffering from heart failure in Sweden differs from county to county, indicating a need for a comparative study in order to uncover the reasons. Conventional single-level analytical methods, however, underestimate the statistical uncertainty in such studies, leading to an inappropriate ranking of regions. Consequently, public opinion and decision-making may be misled. Conventional methods are also unable to disentangle the extent to which differences in prognosis may depend on individual or regional factors. Multilevel analysis, on the other hand, provides a better estimate of statistical uncertainty, and can both identify and quantify the extent to which differences in prognosis depend on either patient-related or regional factors. Using multilevel analysis, we examined the one-year mortality of 38,343 heart failure patients for the period 1992-1995 in every county in Sweden. Regional differences in one-year mortality were found to be very small, the most relevant factors being individual ones. The limited differences distinguishable at the county level may be explained in part by physician density: the more physicians in a county, the better an individual patient's prognosis.

Aged↗
PubMed1992

Field of blood, field of the forgotten. The Potter's Field of Milwaukee County.

A recent discovery of a forgotten pauper cemetery at the Milwaukee County Medical Center has profound and far-reaching ramifications. More than 5,000 are buried in this graveyard, compelling an investigation into the circumstances surrounding its loss. That the cemetery lies beneath county buildings without official knowledge is a disgrace. The proper dignity of a marked and undisturbed grave was denied to these former county residents because of their poverty. How this discovery is managed will reflect our commitment to both high ideals and the law. This project endeavors to reconstruct the origins of the pauper cemetery, containing a brief history of the poor in Milwaukee County, and an examination of the Almshouse, Milwaukee County's first medical institution. Finally, a postscript offers a parallel between the writings of Charles Dickens and the pauper cemetery.

Burial↗
PubMed2004

The medical cost of high serum cholesterol in Harris County, Texas.

High serum cholesterol levels are common among Texans, especially in the greater Houston metropolitan area (Harris County) where such levels are almost 50% higher than the national norm. By using actual medical care claims and cost data, an analysis was conducted to determine the direct medical care cost of high serum cholesterol tied to selected cardiovascular conditions in Harris County. As part of conducting the analysis, Health Management Associates obtained prevalence rates of Harris County residents with elevated cholesterol levels, actual inpatient cardiovascular claims and costs, and estimated outpatient cardiovascular claims and costs. The financial cost analysis of high cholesterol revealed that more than 25 million dollars was spent alone on selected cardiovascular conditions. This estimate is conservative because it did not factor in all types of cardiovascular claims associated with high serum cholesterol, did not factor in other (noncardiovascular) claims that may be associated with high serum cholesterol, and did not include indirect costs such as absenteeism, lost productivity, and medication costs associated with the selected conditions. As Harris County is home to approximately 1 of every 5 adults in Texas, extrapolating the county's direct costs for high serum cholesterol to the entire state would translate into a direct medical care tab of more than 120 million dollars.

Cholesterol↗
PubMed2004

Effect of revised population counts on county-level Hispanic teen birthrates--United States, 1999.

In 2002, teen birthrates for Hispanics were higher than for all other racial/ethnic populations. Because of the health and social risks associated with teen births, pregnancy prevention programs and accurate surveillance of teen birthrates are critical. To assess the effect of using revised population estimates for the 1990s (intercensal estimates) that take into account both the 1990 and 2000 U.S. Census counts, CDC analyzed county-level estimates of Hispanic teen birthrates for 1999. This report summarizes the results of that analysis, which indicated that Hispanic teen birthrates for 1999, when calculated on the basis of the 2000 census, were lower than birthrates based on the 1990 census for the majority of counties with substantial Hispanic populations. Population estimates for 1999 based on the 1990 census (postcensal estimates) had failed to capture the unprecedented and unanticipated migration of Hispanics, thereby overestimating the Hispanic teen birthrate. However, the increase in the Hispanic teen population and the corresponding decrease in Hispanic teen birthrates for 1999 were not experienced by all counties. This county-level variation provides essential information for programs targeting Hispanic teens at the county level.

Adolescent↗
PubMed2005

Diagnostic delays in access to tuberculosis care in counties with or without the National Tuberculosis Control Programme in rural China.

SETTING: A county covered by the National Tuberculosis Control Programme (NTP) (Jianhu) and a nonprogramme county (Funing) in Jiangsu Province, China. OBJECTIVE: To compare diagnostic delays among tuberculosis (TB) patients between counties with and without the NTP, and to study the impact of demographic, socioeconomic and policy factors on the delays. DESIGN: A cohort study of 493 newly diagnosed TB patients registered in the study sites during 2002 was conducted using a structured questionnaire interview. RESULT: The median total diagnostic delay was longer in Jianhu County, 31 (14-68) days, compared to Funing County, 19 (12-34) days, with a shorter patient's delay (10 vs. 16 days, P < 0.05) but a longer doctor's delay (6 vs. 0 days, P < 0.01) in Jianhu than in Funing. Smear-positive TB accounted for 86% of patients in Jianhu, compared to 37% in Funing. Less educated and uninsured patients had longer patient's or doctor's delays in Jianhu, while in Funing poor patients and farmers had both longer patient's and doctor's delays. CONCLUSION: The subsidised NTP leads to a shorter patient's delay, but a longer doctor's delay, with a substantially higher proportion of smear-positive TB diagnosis. Education, medical insurance, poverty and the system of TB control can influence patients' access to TB care.

Adolescent↗
PubMed2006

Rapid needs assessment of two rural communities after Hurricane Wilma--Hendry County, Florida, November 1-2, 2005.

On October 24, 2005, Hurricane Wilma, the most intense hurricane (882 mb) ever recorded in the Atlantic Basin, made landfall on the southern tip of Florida. By landfall, Wilma had been downgraded from a Category 5 (i.e., winds of > or =156 mph) to a Category 3 hurricane but still contained winds of >110 mph. The storm moved slowly over the Florida Keys and south Florida, causing extensive wind and flood damage to homes and businesses. Approximately 3 million households were left without power, and thousands of residents were displaced to temporary shelters; 10 deaths were storm related. On October 27, the Florida Department of Health (FDOH) asked CDC and the North Carolina Division of Public Health (NCDPH) for assistance in performing a rapid needs assessment of communities most affected by the storm. On the basis of information from local public health officials, field assessment teams, and electric power companies, FDOH identified Hendry County, a rural county with a 2000 population of 36,210, as the most severely affected area. Two Hendry County communities, Montura Ranch Estates and Pioneer Plantation in the town of Clewiston (pop. 6,460), were of particular concern. According to the 2000 census, nearly 20% of Clewiston residents lived below the poverty level. The assessment determined that approximately one third of households also had been affected by at least one other hurricane that preceded Wilma during 2004 and 2005. More than half of the households surveyed lived in homes that were damaged but still habitable, and 10% of households in Montura Ranch Estates reported their homes as uninhabitable; approximately 73% of households had not received information about how to remain safe during clean-up activities. Results of the assessment were immediately provided to the Hendry County Emergency Operations Center, Hendry County Health Department, and FDOH for allocation of resources to help these communities recover from the hurricane.

Disasters↗
PubMed1991

[From psychiatric hospitals to local municipal departments. The county of Vejle 1973-1987].

On April 1, 1976 the Danish State handed over the responsibility for treatment of psychiatric patients to the counties. None of the state hospitals were situated in the county of Vejle. The changes of the admission pattern of the inhabitants of Vejle county aged 15+ years during the years from 1973 to 1987 are described. The annual bed occupancy per 1,000 inhabitants decreased markedly during the period (from 829 in 1973 til 366 in 1986) while the admission rates were relatively stable. Vejle county has successfully reduced the number of admissions to mental hospitals in other counties, but was, however, still not self-sufficient in 1987. The decrease in bed occupancy was significant in the groups of schizophrenia, manic-depressive psychosis, organic states, neurosis, alcohol and drug addiction, while in the group of other psychoses and other conditions the decrease was not significant. In the group of personality disorder the bed occupancy increased, but not significantly.

Bed Occupancy↗
PubMed1991

A perinatal audit of neonatal deaths in three Danish counties.

A perinatal audit of 109 neonatal deaths was carried out in three Danish counties (A, B and C) in order to investigate whether differences in the structure of antenatal care, delivery, and neonatal service had any influence on neonatal outcome and whether departure from generally accepted standards of satisfactory perinatal and neonatal care might have contributed to neonatal deaths. In the county (C) characterised by having no intensive neonatal care unit, significantly fewer liveborn infants with a gestational age of less than 28 weeks were reported to the Birth Register. County C had also significantly more potentially avoidable deaths compared with the county (B) which had a neonatal intensive care unit with specially trained staff available around the clock. The neonatal department in county A did not have specially trained doctors available in the hospital around the clock, and some cases of suboptimal care were caused by inadequate staffing and inappropriate decisions made by inexperienced junior doctors. The results indicate that it should be possible to improve the quality by having obstetric departments with access to neonatal intensive care units staffed with qualified personnel around the clock and by intensifying the postgraduate training of professionals performing peri- and neonatal care.

Denmark↗
PubMed1990

The emerging profile of dental manpower in Oklahoma. 1: Oklahoma county.

This is the first report of a three part study. Part I focuses upon the dental manpower profile of Oklahoma County between the years 1972-1989 (Part II will emphasize the dental manpower profile of Tulsa County, and Part III, will be inclusive of the dental manpower profile of all other Oklahoma counties). In all phases of the study, data has been stratified into six categories, namely, general practitioners, specialists, full time general practice dental faculty, full time specialist dental faculty, and public health dentists. The demographic data analyzed in Part I, demonstrated an increasing average age of the dentists from 45.33 years of age in 1972 advancing to 48.33 years of age in 1989. The University of Oklahoma College of Dentistry is currently the primary resource of the dental manpower pool in Oklahoma County. The data indicated a downward turn in the percentage of dentists choosing to locate in Oklahoma County.

Dentistry↗
PubMed1990

[Myocardial infarction mortality among men 30-69 years of age in Norwegian counties 1966-87].

The article describes mortality from ischaemic heart disease, including sudden, unexpected death, among males aged 30-69 years in all 19 Norwegian counties for the period 1966-87. During this period, the age-adjusted mortality rate in Norway for the 30-69 year age group was highest in 1966-70, and declined by 15% until 1983-87. The decline in mortality was greatest in the 40-49 year age group, but was also clearly evident in the 50-59 and 60-69 year groups. In twelve of the counties there was a statistically significant (p less than 0.05) decrease in mortality from 1966-70 to 1983-87. In one county, Oppland, located in central south-eastern Norway, mortality increased by 19% (p less than 0.01). The increased mortality in this county was most prominent in the 50-59 year group (34%, p less than 0.01). The most favourable change in mortality took place in Rogaland, in south-western Norway, where mortality decreased by 29% (p less than 0.001) from 1966-70 to 1983-87. Positive changes in mortality were also seen in Finnmark, a county with traditionally very high mortality rates. This study was not designed to explain the regional differences in mortality, but the authors point to principal explanatory factors. The regional differences in mortality time trends might be an argument for geographical differentiation of preventive measures.

Adult↗
PubMed1989

Cardiovascular mortality trends in Harris County, Texas: 1980 to 1986.

Cardiovascular diseases are the leading causes of death in Texas and in the United States. This study determines the trend in mortality rates attributed to cardiovascular diseases in Harris County from 1980 to 1986. The region of the county that does not include the City of Houston was specifically studied. Mortality of cardiovascular diseases in these two areas follow patterns similar to that of the United States in the same time period. Both the entire county and Harris County excluding Houston show declines in cardiovascular mortality rates in the 7-year period. The populations were divided into four ethnic categories (white, black, Hispanic and "other"), and each ethnic group reported significant declines in overall cardiovascular mortality except in the "other" population, which showed an increase in the male group. Significant downward trends were noticed in the white and Hispanic population in the two major subcategories of cardiovascular diseases: diseases of the heart and cerebrovascular diseases. The black population in each geographic area studied was consistently higher in cardiovascular mortality than the other three ethnic groups observed (white, Hispanic and "other"). Knowledge of cardiovascular disease mortality rates by ethnicity, sex, and age as well as temporal changes in mortality rates within Harris County are important for health planners in continuing and implementing programs aimed at awareness, prevention, and treatment of cardiovascular diseases.

Cardiovascular Diseases↗
PubMedDate not supplied

Prevalence of isolated systolic hypertension in Alameda County, California.

Clinical research has suggested that isolated systolic hypertension differs from essential hypertension in terms of pathophysiological change. Yet little is known of the descriptive epidemiology of isolated systolic hypertension. This paper examines the prevalence of isolated systolic hypertension in biracial Alameda County, California. Baseline survey data from the Alameda County Hypertension Project (1978) were used to calculate age and sex percentage of prevalence by race. This condition was rare below age 40, but the percentage of prevalence increased with age. Defining isolated systolic hypertension as diastolic blood pressure less than 90 and systolic blood pressure greater than 160, age-adjusted prevalence was 1.15, 1.31, 1.01, and 2.47 for white men, black men, white women, and black women, respectively. Comparison with the prevalence estimates of isolated systolic hypertension from biracial, rural Evans County, Georgia, indicated that the Alameda County prevalence was significantly lower for white women (p less than .01), black women (p less than .03), and total population (p less than .01). We posit that the larger number of people under care for essential hypertension is responsible for the lower occurrence of pure, isolated systolic hypertension in Alameda County. The results suggest the importance of female family members in the acceptance and promulgation of health promotion efforts for both essential and isolated systolic hypertension at the population level.

Adult↗