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PubMedDate not supplied

An examination of population changes in Alabama's Black Belt counties: 1960-1970 and 1970-1980.

"Population changes in 11 Alabama Black Belt counties are examined by comparing annual average birth, death, and migration rates during the 1960s with those of the 1970s. The specific focus of the study is migration patterns among the nonwhite segment of the population. Data from the 1980 and earlier censuses are utilized, along with birth and death data from Alabama vital statistics reports." The results show "that net migration losses among nonwhites declined substantially during the 1970s compared with the 1960s and that in two Black Belt counties there was a reversal from heavy net losses to moderate net gains. Whites, on a county-to-county basis, however, were generally characterized by significantly higher rates of loss during the 1970s than in the 1960s."

Black or African American↗
PubMed2005

Tobacco outlet density, cigarette smoking prevalence, and demographics at the county level of analysis.

The geographic associations between tobacco outlet density, cigarette smoking prevalence, and demographic variables at the county unit of analysis were examined. End of year 2002 data were derived from licenses of 4745 tobacco selling retail outlets in all 99 Iowa counties. The 2000 census and the 2002 Iowa Behavioral Risk Factor Surveillance System (IBRFSS) were used to gather data for demographic variables and smoking prevalence rates. The IBRFSS telephone interviews were conducted from January through December in 2002 with a random sample of 3662 Iowa residents. As expected, results showed that counties with higher density of tobacco outlets and smoking prevalence also tended to have a higher percentage of minority residents. Contrary to previous studies, however, counties with higher tobacco outlet density and smoking prevalence also tended to have higher median household income. Findings are discussed in light of the state's low income inequality. Implications of the study and directions for future research are discussed.

Adolescent↗
PubMed2005

Investigation on road traffic safety of the mountain areas in southwest China based on Wulong County, Chongqing Municipality.

OBJECTIVE: To study the present situation, characteristics, and main problems of the traffic safety in the mountain areas of Southwest China. METHODS: A study was done on the traffic status of Wulong County, Chongqing Municipality, by means of document review, field investigation, and inquiry. RESULTS: The traffic crashes and deaths in Wulong County were increasing since 1999. From 1997 to 2001, there occurred 126 severe and very severe traffic crashes resulting in 175 deaths and 411 serious injuries, which accounted for 9.4% of total crashes, 96.1% of total deaths, and 48.4% of total serious injuries, respectively. The severe and very severe traffic crashes were highest in 2000. One part for 83 km in length accounting for 3.0% of No. 319 National Highway was responsible for 54.5% of very severe traffic crashes, which closely related to conditions of the road itself and its environment and defective execution of traffic laws. CONCLUSIONS: Wulong County, one of the mountain counties in Southwest China, is now facing a complex and serious road traffic situation and serious traffic safety, with a high incidence of severe and very severe road traffic crashes. The crashes closely relate to imperfect road design, defective execution of traffic laws, imperfect management, and environmental factors.

Accidents, Traffic↗
PubMed2000

Regional variations in the use of diagnostic coronary angiography. A one-year population-based study of all diagnostic coronary angiographies performed in a rural and an urban Danish county.

The aim of this study was to monitor coronary angiography activity and results, and to evaluate indications and treatment consequences using regional hospital registers and case records in the rural county of Ringkjøbing and urban county of Aarhus The study included all patients who had undergone a coronary angiography during 1996. For women, there were 606 (rural) and 1296 (urban) coronary angiographies per one million inhabitants (p < 0.0001) and for men, 1884 (rural) and 3051 (urban) coronary angiographies per one million inhabitants (p < 0.0001). In both counties the age distribution of the women examined was the same as that for the men. The angiographic rates were the same in the two counties for patients examined for valvular heart disease and severe arrhythmias. For patients with ischaemic heart disease, the angiographic rate for rural patients was two to three times lower than that for urban patients (p < 0.01). Revascularization procedures were performed in 39% (rural) and 40% (urban) of the examined women (NS) and 66% (rural) and 59% (urban) of the examined men (p < 0.05). Despite wide regional differences in coronary angiography activity, angiography was deployed to the same extent for examination of patients with valvular and severe arrhythmia heart disease. For patients examined for ischaemic heart disease, angiography activity was considerably lower in the rural area. The female patients had a higher frequency of normal coronary angiograms than the male patients.

Adult↗
PubMed2003

The Swedish Two-County Trial of mammographic screening: cluster randomisation and end point evaluation.

BACKGROUND: The Swedish Two-County Trial has been criticised on the grounds of the cluster randomisation and alleged bias in classification of cause of death. PATIENTS AND METHODS: In the Two-County Trial, 77 080 women were randomised to regular invitation to screening (active study population, ASP) and 55 985 to no invitation (passive study population, PSP), in 45 geographical clusters. After approximately 7 years, the PSP was invited to screening and the trial closed. We analysed data using hierarchical statistical models to take account of cluster randomisation, and performed a conservative analysis assuming a systematic difference between ASP and PSP in baseline breast cancer mortality in one of the counties. We also analysed deaths from causes other than breast cancer and from all causes among breast cancer cases diagnosed in the ASP and PSP. RESULTS: Taking account of the cluster randomisation there was a significant 30% reduction in breast cancer mortality in the ASP. Conservatively, assuming a systematic difference between ASP and PSP clusters in baseline breast cancer mortality, there was a significant 27% reduction in mortality in the ASP. Ignoring classification of cause of death, there was a significant 13% reduction in all-cause mortality in breast cancer cases in the ASP. CONCLUSIONS: Breast cancer mortality is a valid end point and mammographic screening does indeed reduce mortality from breast cancer. The criticisms of the Swedish Two-County Trial are unfounded.

Adult↗
PubMed1994

The Forsyth County Cervical Cancer Prevention Project--I. Cervical cancer screening for black women.

The Forsyth County Cervical Cancer Prevention Project was a 5 year National Cancer Institute-funded community-based public health education program implemented to address the problem of excess mortality from cervical cancer among black women in Forsyth County, North Carolina. The intervention was a community-based public health education program that included mass media, direct education workshops, and provision of education on cervical cancer and screening to health care providers. The intervention was implemented from November 1988 to September 1991. Evaluation of the community intervention used a quasi-experimental design, with Forsyth County, North Carolina, receiving the program and Durham County, North Carolina, serving as the control. Comparison of pre- and post-intervention telephone survey data revealed that, overall, awareness of cervical cancer and the Pap smear increased. Knowledge, attitudes and behaviors showed little change, considering those interviewed in aggregate. Among women defined as high-risk (elderly, low socioeconomic status, public health clinic patients and/or those who do not receive regular care), a significant trend toward greater participation in screening was detected for the 6 month period following the intervention. These results suggest that awareness of cervical cancer can be increased by public health education, but that the additional attention coming to patients through the actions of health care providers and health care delivery systems may supply the additional input needed to produce behavior change.

Adolescent↗
PubMed1976

Variola minor in Bragança Paulista County, 1956: overall description of the epidemic and of its study.

An overall description of the epidemic of variola minor (alastrim) affecting Bragança Paulista County (Brazil) in 1956 is given. A total of 484 cases were recorded for 210 households, one hotel and one boarding school. At least 95 per cent of the households with cases of the disease in the capital city were surveyed and 90 per cent of the households in the rural districts. An orphanage, an old folk's home, the County jail and 10 schools operating in the capital city and some other social groups without cases were also surveyed, as well as 125 households without cases but with one or more contacts with the disease. An overall attack rate of 1924 cases, 267 cases and 781 cases per 100,000 inhabitants was obtained, respectively, for the capital city, the rural environment and the whole County. Clinical, epidemiological, serological and environmental surveys were conducted. Evidence on identification of the epidemic disease is presented. Study of the epidemic was made at these levels: the disease itself (frequency and severity); the disease in the individual (association of characteristics of persons with occurrence and clinical severity of variola minor); the disease in social units (occurrence and spread in households and school classes); the disease in small communities (occurrence and spread in housing projects, city blocks and farms); the disease in two large communities with contrasting socio-economic characteristics (the capital city and the rural environment); and the disease in the County as a whole.

Brazil↗
PubMed1991

Distribution of St. Louis encephalitis viral antibody in sentinel chickens maintained in Sarasota County, Florida: 1978-1988.

Sentinel chicken flocks monitored arboviral transmission at 12 sites in Sarasota County, Fla., from 1978 through 1988. During this time, 3,452 serum samples were analyzed for hemagglutination inhibition antibody to St. Louis encephalitis virus (SLE) and eastern equine encephalomyelitis virus (EEE). Overall, 91 chickens seroconverted to SLE and three to EEE. The intensity of SLE transmission showed considerable year-to-year variation. Chickens from south-county flocks were more likely to seroconvert to SLE virus than chickens maintained at the north-county sites. The SLE seroconversion rate for midcounty sentinels was intermediate between north- and south-county sites. Chickens were caged in four habitat types: oak hammocks, slash pine-saw palmetto areas, pastures, and urban-residential areas. There was no significant difference in SLE seroconversion rates between habitats.

Animals↗
PubMed1999

Incidence of neonatal seizures in Harris County, Texas, 1992-1994.

This study estimated the incidence of clinical neonatal seizures among infants born between 1992 and 1994 in Harris County, Texas, a county with a large and ethnically diverse population. Infants with neonatal seizures were ascertained from four sources: hospital discharge diagnoses, birth certificates, death certificates, and a study of neonatal seizures conducted concurrently with this study at a large tertiary care center in Houston, Texas. There were 207 cases of clinical neonatal seizures among 116,048 live births (an incidence of 1.8 per 1,000 live births). The incidence was highest among infants weighing less than 1,500 g (19/1,000) and decreased as birth weight increased. There was no significant difference in incidence by ethnicity. Twenty-six percent of the seizures (54/207) occurred after the infants had been discharged from the hospital where they were born. The incidence of neonatal seizures in Harris County was lower than the incidence reported recently for Fayette County, Kentucky, for 1985-1989 (3.5/1,000) and for Newfoundland, Canada, for 1990-1995 (2.5/1,000), but was higher than the incidence estimated for Rochester, Minnesota, for 1935-1984 (1/1,000).

Age Factors↗
PubMed1980

Measles in rural Ohio county.

Between December 23, 1975, and March 31, 1976, 169 cases of measles were reported from Defiance County, Ohio, a small rural county in the northwest corner of the State. The outbreak spread from a single junior high school basketball player to eventually involve 19 of the 28 county schools. Among the affected schools, measles attack rates varied from 0.3-7.2% with a mean of 2.0%. A likely source of illness was determined for 160 of the 169 cases (95%). Intraschool transmission was most common, accounting for 97 of the 169 cases (57%) followed by sibling contact for 23 cases (14%). The pattern of measles spread was complex and would have been difficult to predict in advance even if surveillance systems reported each case the day it occurred. A control program held between February 2 and February 20, 1976, vaccinated 5145 of the 11,114 (46.3%) county schoolchildren. Forty-four cases of measles occurred 4 or more days following school clinics, 22 (50%) in children who requested measles vaccine at school clinics, 17 of whom were actually vaccinated. Most of the other cases occurred in students whose parents thought their children to be protected. Measles is a disease which spreads rapidly in a complex pattern over wide geographic areas. A control program vaccinating a large proportion of the children without definitive history of adequate vaccination or disease was apprently effective in curtailing the outbreak.

Adolescent↗
PubMed1989

Poisson regression modeling of temporal variation in incidence of childhood insulin-dependent diabetes mellitus in Allegheny County, Pennsylvania, and Wielkopolska, Poland, 1970-1985.

Contradictory observations have accumulated regarding a secular trend and/or an epidemic pattern in the incidence of insulin-dependent diabetes mellitus. In this study, insulin-dependent diabetes mellitus incidence below age 15 years was examined in Allegheny County, Pennsylvania, and in Wielkopolska, Poland, two areas diverse in terms of their geography and average risk for this disease. Numerator data were extracted from individual patient records, and annual denominator data were available for the years 1970-1985. Poisson regression models were used to disentangle the contributions of country, race, sex, age, period, and cohort effects to the observed variation in incidence. Poles and Allegheny County nonwhites were at greatly and moderately reduced risk, respectively, relative to Allegheny County whites. An increase in risk with age was significant and proportional in all three groups. There was significant time variability in Wielkopolska, where an epidemic began in 1982 and continued through 1985. This was a period rather than a cohort phenomenon and was a result of a recent outbreak of the disease rather than a long-term trend. In Allegheny County, changes in risk over the 16-year period were insignificant, although incidence doubled among whites aged 0-9 years during 1982-1983. The Poisson regression modeling provided a quantification and formal comparison of determinants of the incidence of insulin-dependent diabetes mellitus.

Adolescent↗
PubMed1989

Congenital cardiac anomalies in relation to water contamination, Santa Clara County, California, 1981-1983.

In November 1981, a leak of solvents from an underground storage tank was detected at an electronics manufacturing plant in Santa Clara County, California. Solvents (predominantly 1,1,1-trichloroethene, or methyl chloroform) were found in a nearby well which supplied drinking water to the surrounding community. Residents were concerned about a possible relation between adverse reproductive outcomes and consumption of contaminated water. To address this concern, the California Department of Health Services conducted two epidemiologic studies: one of these, reported here, is a county-wide study of cardiac anomalies. This study, which looked at major cardiac anomalies among births throughout Santa Clara County in 1981-1983, found an increased prevalence in the service area of the water company which operated the contaminated well. During the potentially exposed time period (January 1981 through August 1982), 12 babies with major cardiac anomalies were born to residents of this area. This represents an excess of six cases over the number expected based on the prevalence in the remainder of the county (relative risk = 2.2, 95 per cent confidence interval 1.2-4.0). No excess was observed in the unexposed time period (September 1982 through December 1983). However, the temporal distribution of major cardiac cases born during the exposed time period suggests that the solvent leak is an unlikely explanation for this excess.

California↗
PubMedDate not supplied

Assessing the burden of disease and injury in Los Angeles County using disability-adjusted life years.

OBJECTIVE: This study was designed to assess the burden of disease and injury in the Los Angeles County population using Disability-Adjusted Life Years (DALYs), a composite measure of premature mortality and disability that equates to years of healthy life lost. METHODS: DALYs, stratified by gender and race/ethnicity, were calculated for 105 health conditions and aggregated groups of conditions for the Los Angeles County population for 1997. Years of Life Lost (YLLs) were calculated using 1997 county mortality statistics and published life tables. Years Lived with Disability (YLDs) were derived from age- and gender-specific disease incidence and disability data from the Global Burden of Disease Study. RESULTS: DALYs produced a substantially different ranking of disease and injury burden than did mortality rates alone. The leading five causes of DALYs for males in the county were ischemic heart disease, violence, alcohol dependence, drug overdose and other intoxications, and depression. For females, the leading five causes were ischemic heart disease, alcohol dependence, diabetes, depression, and osteoarthritis. Differences in the rank order were also observed by race/ethnicity. The age-adjusted rate of DALYs for all health conditions combined was highest in African Americans (190 per 1,000), followed by American Indians (149 per 1,000), whites (113 per 1,000), Latinos (94 per 1,000), and Asians/Pacific Islanders (77 per 1,000). CONCLUSIONS: The DALYs measure is a promising new tool to improve the capacity of local health departments and other health agencies to assess population health and establish an evidence base for public health decisions.

Cause of Death↗
PubMed1995

From roadside to bedside: the regionalization of trauma care in a remote rural county.

OBJECTIVE: To determine the current role of rural hospitals and prehospital agencies in the care of motor vehicle crash victims in a remote, rural county prior to the statewide regionalization of trauma care. Specifically, we determined the proportion of crashes that required a response by emergency medical services (EMSs), the timeliness of the response, the proportion of patients treated in local hospitals, and the factors that predicted referral to trauma centers. DESIGN: Population-based retrospective cohort study linking emergency medical services, emergency department, and hospital discharge data to police motor vehicle crash reports and coroner data. SETTING: Okanogan County, Washington. SUBJECTS: All motor vehicle occupants, pedestrians or pedalcyclists who were involved in a motor vehicle collision with a response by emergency medical system personnel or the county coroner. INTERVENTION: None. MAIN OUTCOME MEASURES: EMS response times, emergency department and hospital discharge disposition, Injury Severity Scores, hospital length of stay, procedures, deaths. RESULTS: Twelve percent of 669 crashes reported to the police led to the dispatch of EMS. Crashes with EMS involvement were more likely to include occupants without restraints, who were ejected from the vehicle or who had alcohol as a contributing circumstance. The median interval between crash and EMS dispatch was 5 minutes (95th percentile: 40 minutes), the median scene time was 15 minutes (95th percentile: 35 minutes), and the median interval between dispatch and emergency department arrival was 48 minutes (95th percentile: 95 minutes). Among the 210 patients treated by EMSs, 67 (32%) were admitted to local hospitals, and 19 (9%) were referred to a distant trauma center. Of these, 17 were referred directly from the emergency department, one from the scene, and one after local admission. Compared with patients who were admitted locally, referred patients had a significantly higher mean Injury Severity Score (14.4 vs. 5.1), hospital length of stay (9.1 vs. 1.8 days), and rate of operative procedures (37% vs. 9%). Of the 13 crash-related deaths during the year, nine were declared dead at the scene before EMS arrival, three were asystolic at the time of EMS arrival at the scene, and one died at a referral hospital. CONCLUSIONS: The linkage of data from police, prehospital agencies, and hospitals can reveal important information about the sequence of health care for trauma patients. The rural hospitals in this county currently play a major role in the stabilization and treatment of motor vehicle crash victims.

Accidents, Traffic↗
PubMed1997

Assessing public health performance in Iowa's counties.

Local health agencies in Iowa were surveyed to assess the performance of public health practices in their communities. Responses were received from 97 percent of counties. Less than 50 percent of counties were performing half of the indicators of the Assessment function. Policy Development functions also were frequently not performed. Performance was best in the Assurance function, with 86 percent of counties reporting that they inform and educate the public. However, the other three types of Assurance practices (Manage, Implement, and Evaluate) were performed less frequently. Comparison of the performance of Iowa's rural counties reveals a profile nearly identical to that reported elsewhere for a group of six other states.

Benchmarking↗
PubMedDate not supplied

Extending the REACH of health coverage: a program for the uninsured in Anne Arundel County, Maryland.

The Anne Arundel County Department of Health, in Maryland, is expanding access to care for the uninsured through the development of the Residents Access to a Coalition of Health (REACH) program. The goals of REACH, developed in collaboration with the county medical society, are to improve the quality of health care, decrease unnecessary hospitalizations, and reduce usage of emergency room services among county residents who are ages 19 to 64. This is accomplished through a voluntary network of partners who have formally agreed to accept discounted fees for services. Over 3,200 county residents with a network of 400 providers and three hospitals have received over 4.8 million US dollars of uncompensated care since the program's inception in 1999.

Adult↗
PubMedDate not supplied

Utilizing a national performance standards local public health assessment instrument in a community assessment process: the Clarendon County Turning Point Initiative.

The Clarendon County Turning Point Initiative was launched with the goals of conducting a community-wide health assessment and developing a community health improvement plan. For the community assessment, the National Association of County and City Health Officials' (NACCHO's) Mobilizing for Action through Planning and Partnerships (MAPP) model was used. One of the assessments conducted through the MAPP model was the National Public Health Performance Standards Local Public Health Systems Assessment. The process for conducting the assessment using the local performance instrument is described. Clarendon County Turning Point Initiative conducted a one-and-a-half-day retreat to complete the local performance instrument. The committee planning the process identified and recruited stakeholders, collected data/information from stakeholders, and hired a consultant to facilitate the one-and-a-half-day retreat. The data analyzed with the local performance instrument identified opportunities and gaps in public health services in Clarendon County.

Community Health Services↗
PubMedDate not supplied

Health department costs of managing persons with suspected and noncounted tuberculosis in New York City, Three Texas counties, and Massachusetts.

OBJECTIVES: To describe persons with suspected (did not meet the national tuberculosis [TB] surveillance case definition) and noncounted TB (met the TB case definition but transferred and were counted by another jurisdiction) and estimate costs incurred by public health departments for managing them. METHODS: We reviewed TB registry, medical records, budgets, bills, salaries, organizational charts, and travel/activity logs from the year 2000 at health departments in New York City (NYC), three Texas (TX) counties (El Paso, Hidalgo, and Webb), and Massachusetts (MA). We also interviewed or observed personnel to estimate the time spent on activities for these patients. RESULTS: In 2000, NYC and MA had more persons with suspected (n = 2,996) and noncounted (n = 163) TB than with counted (n = 1,595) TB. TX counties had more persons with counted TB (n = 179) than with suspected (n = 55) and noncounted (n = 15) TB. Demographic and clinical characteristics varied widely. For persons with suspected TB, NYC spent an estimated $1.7 million, with an average cost of $636 for each person; TX counties spent $60,928 ($1,108 per patient); and MA spent $1.1 million ($3,330 per patient). For persons with noncounted TB, NYC spent $303,148 ($2,180 per patient), TX counties spent $40,002 ($2,667 per patient), and MA spent $84,603 ($3,525 per patient). CONCLUSIONS: Health departments incurred substantial costs in managing persons with suspected and noncounted TB. These costs should be considered when allocating TB program resources.

Health Care Costs↗