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PubMed2006

[Spatio-temporal change and gradient differentiation of landscape pattern in Guangzhou City during its urbanization].

Guangzhou City is a rapidly urbanizing city in China, and a constructed city with holistic planning. By using the remote sensing images of 1985, 1990, 1995, 2000 and 2004, this paper studied the 20 years spatio-temporal changes of landscape pattern in Guangzhou, and analyzed the relationships between these changes and urbanization. The landscape and class-level pattern indices of whole Guangzhou City and its five districts were compared, and the results indicated that the landscape pattern in Guangzhou had an obvious spatio-temporal variation, and an increase of diversity and fractal dimension. The landscape structural complexity and fragmentation increased gradually from 1985 to 2004, and the variation intensity and tendency varied during four comparative stages 1985-1990, 1990-1995, 1995-2000, and 2000-2004. It was a rapid development period from 1985 to 1995 in Guangzhou. The represents of ten districts varied in their spatio-temporal landscape pattern, because of the different development progress and planning motive. The urbanization of Panyu was from 1990 to 2000, and its natural landscape was seriously disturbed by human activities. The represents of Conghua and Zengcheng districts were of integrative disturbance, and also, the urbanization process mainly took place during 1990-2000. In the city center consisting of 8 official constructed districts, the urbanization process happened earlier. In Huadu district, the landscape change revealed the frequent and severe human disturbance.

China↗
PubMed1994

Continuity and change within an HIV epidemic. Injecting drug users in New York City, 1984 through 1992.

OBJECTIVES: To examine trends in acquired immunodeficiency syndrome (AIDS) risk behavior and human immunodeficiency virus (HIV) seroprevalence among injecting drug users (IDUs) in New York City from 1984 through 1992. DESIGN AND SETTING: Comparisons were made between two surveys of IDUs at the same hospital-based New York City drug abuse detoxification program: 141 IDUs in 1984 and 974 IDUs in 1990 through 1992. National Death Registry, New York City Health Department, and drug treatment program records were also used. PARTICIPANTS: Persons attending detoxification program randomly selected for participation. Eligibility was based on injection within previous 2 months; 99% acceptance rates were obtained. Participants in the 1984 and 1990 through 1992 surveys were 66% and 79% men, 21% and 19% white, 33% and 34% African American, and 45% and 46% Latin American, respectively. INTERVENTIONS: Community-based AIDS prevention programs, including underground syringe exchanges. MAIN OUTCOME MEASURES: Acquired immunodeficiency syndrome risk behaviors; HIV serostatus; CD4+ cell counts; death rates among 1984 subjects; and injection and intranasal routes of drug administration. RESULTS: The HIV seroprevalence remained stable at slightly more than 50%. Mean CD4+ cell counts declined from 0.716 x 10(9)/L (716/microL) to 0.575 x 10(9)/L (P < .009). Annual death rate among 1984 subjects was 3%, with a significantly higher rate among HIV-seropositive subjects (relative risk, 2.57; 95% exact binomial confidence interval, 1.12 to 6.61). Large-scale declines were observed in AIDS risk behaviors, eg, use of potentially contaminated syringes declined from 51% to 7% of injections (P < .001). Recent additional risk reduction was associated with use of the underground syringe exchanges. Intranasal heroin use was the primary route of drug administration for 46% of heroin admissions to New York City drug treatment programs. CONCLUSIONS: The HIV seroprevalence has remained stable among this population of New York City IDUs for almost a decade. Continuation of current trends should lead to further reduction in HIV transmission, although reversal of the trend to intranasal use could lead to substantially increased transmission.

Adult↗
PubMed1994

Outcome of out-of-hospital cardiac arrest in New York City. The Pre-Hospital Arrest Survival Evaluation (PHASE) Study.

OBJECTIVE: To determine survival from out-of-hospital cardiac arrest in New York City and to compare this with other urban, suburban, and rural areas. DESIGN: Observational cohort study. SETTING: New York City. PARTICIPANTS: Consecutive out-of-hospital cardiac arrests occurring between October 1, 1990, and April 1, 1991. INTERVENTION: Trained paramedics performed immediate postarrest interviews with care providers, using a standardized questionnaire. MAIN OUTCOME MEASURES: Entry criteria, elapsed time intervals, and nodal events conformed to Utstein recommendations. The single target end point was death or discharge home. RESULTS: Of 3243 consecutive cardiac arrests on which resuscitation was attempted, 2329 (72%) met entry criteria as primary cardiac events. Overall survival was 1.4% (99% confidence interval [CI], 0.9% to 2.3%). No patients were lost to follow-up. Survival from witnessed ventricular fibrillation was 5.3% (99% CI, 2.9% to 8.8%). Using survival from witnessed ventricular fibrillation for intersystem comparison, our survival rate was similar to that of Chicago, Ill (4.0%; 99% CI, 1.9% to 7.5%; P = .41), the only other large city on which data were available. However, it was significantly lower than that reported from midsized urban/suburban areas (33.0%; 99% CI, 30.4% to 35.6%; P < .0001) and suburban/rural areas (12.6%; 99% CI, 8.9% to 16.3%; P < .0001). Survival rate among arrests occurring after arrival of emergency medical services personnel (8.5%; 99% CI, 4.7% to 14.0%) was comparable with Chicago (6.6%; 99% CI, 3.3% to 11.5%; P = .41) but markedly lower than King County, Washington (36%; 99% CI, 28.6% to 43.8%; P < .0001). CONCLUSIONS: Survival from out-of-hospital cardiac arrest in New York City was poor. This was partly attributable to lengthy elapsed time intervals at every step in the chain of survival. However, examination of survival among arrests occurring after emergency medical services arrival suggests that other features may predispose residents of large cities to higher cardiac arrest mortality than individuals living in more suburban or rural settings. Since half the US population resides in large metropolitan areas, this represents a public health problem of considerable magnitude.

Aged↗
PubMed1997

[Costs of health services for the elderly and related factors in cities of Japan].

OBJECTIVES: To estimate the costs of health services for the elderly in 1994 and to examine factors affecting them. METHODS: Questionnaires were sent to 631 cities and responses from 339 cities were received. Data obtained from questionnaires were total cost, proportion of labor sent to total cost, cost per user, cost per person eligible to receive Health services for the elderly. These variables were measured for health counseling service, health education, health examinations, functional training, and home-visit guidance. RESULTS: The proportion of labor cost was smaller for health examinations than for other services. Health examinations and home-visit guidance showed higher correlation coefficients between the number of users and the total cost than other services. In most services, cost per eligible person were negatively correlated with the number of residents in the city and positively correlated with the number of public health nurses per resident. However, costs per user did not show a correlation. The cities which established municipal health centers had lower costs per user of health education and functional training than the cities which did not. Standardized mortality ratios of cerebrovascular disease and stomach cancer were not correlated with total cost, proportion of labor cost, cost per user, cost per eligible person in most services. CONCLUSIONS: For the economic evaluation of health services for the elderly, it is necessary to examine the relationship between cost, both quantity and quality, and effectiveness of health services.

Aged↗
PubMed1997

The needs of Asians and Pacific Islanders living with HIV in New York City.

This article familiarizes the reader with AIDS among Asians and Pacific Islanders (A&PIs) in New York City. The first section describes the epidemiology of AIDS among A&PIs in the United States and in New York City. In the United States 4,131 A&PIs have been diagnosed with AIDS. The age at diagnosis in the United States has been relatively stable over the past decade, although the proportion of diagnoses represented by older A&PIs (aged 40 to 49) has been increasing in New York City. The proportion of heterosexual diagnoses have been relatively stable over the past 6 years, whereas other racial groups have shown increases in the proportion of heterosexual transmissions. Data on defining opportunistic infections suggest that a different clinical pattern exists among A&PIs when compared with other racial groups diagnosed in New York City and the United States whereby A&PIs exhibit the highest proportion of Pneumocystis carinii pneumonia of all groups. The second section provides a discussion of some of the issues facing HIV positive A&PIs and their families in the process of accessing services at community-based HIV service organizations in New York City. One broad concept emerged from the client focus group that served to organize the analysis: family--a compelling case for HIV service organizations to initiate, expand, and maintain family services, however family is defined. The location of A&PI AIDS service organizations and its implications for recentering families in the caregiving process is discussed.

AIDS-Related Opportunistic Infections↗
PubMed1998

Increasing immunization rates among inner-city, African American children. A randomized trial of case management.

CONTEXT: Immunization rates in the inner city remain lower than in the general US population, but efforts to raise immunization levels in inner-city areas have been largely untested. OBJECTIVE: To assess the effectiveness of case management in raising immunization levels among infants of inner-city, African American families. DESIGN: Randomized controlled trial with follow-up through 1 year of life. SETTING: Low-income areas of inner-city Los Angeles, Calif. PATIENTS: A representative sample of 419 African American infants and their families. INTERVENTIONS: In-depth assessment by case managers before infants were 6 weeks of age, with home visits 2 weeks prior to when immunizations were scheduled and additional follow-up visits as needed. MAIN OUTCOME MEASURES: Percentage of children with up-to-date immunizations at age 1 year, characteristics associated with improved immunization rates, and cost-effectiveness of case management intervention. RESULTS: A total of 365 newborns were followed up to age 1 year. Overall, the immunization completion for the case management group was 13.2 percentage points higher than the control group (63.8% vs 50.6%; P=.01). In a logistic model, the case management effect was limited to the 25% of the sample who reported 3 or fewer well-child visits (odds ratio, 3.43; 95% confidence interval, 1.26-9.35); for them, immunization levels increased by 28 percentage points. Although for the case management group intervention was not cost-effective ($12022 per additional child immunized), it was better ($4546) for the 25% of the sample identified retrospectively to have inadequate utilization of preventive health visits. CONCLUSIONS: A case management intervention in the first year of life was effective but not cost-effective at raising immunization levels in inner-city, African American infants. The intervention was demonstrated to be particularly effective for subpopulations that do not access well-child care; however, currently there are no means to identify these groups prospectively. For case management to be a useful tool to raise immunizations levels among high-risk populations, better methods of tracking and targeting, such as immunization registries, need to be developed.

Black or African American↗
PubMed1997

Injuries to rescue workers following the Oklahoma City bombing.

The objective of this study was to identify and describe physical injuries to rescue workers in the aftermath of the Oklahoma City bombing. Data were obtained from medical records from 16 hospital emergency departments and specialty clinics in the Oklahoma City area, and reported visits to medical providers at the bombing site. Participants were rescue personnel from the Oklahoma City Fire Department, the mutual aid fire stations in the Oklahoma City area, the Federal Emergency Management Agency's Urban Search and Rescue teams, and military personnel stationed near Oklahoma City. All participants were involved in the rescue and recovery operation. The two main outcome measures were (1) the number, types, and rates of injuries; and (2) comparisons of case-finding methods, including medical chart review and telephone interview. The most common injuries were strains and sprains (21.4%), foreign bodies in eyes (14.5%), and laceration/crush/puncture wounds (18.4%). Of the four case-finding mechanisms, telephone interviews following the event identified the largest number of cases (84.5%). Most injuries were minor; some injuries such as chemical burns were preventable. The potential utility of other data collection mechanisms is considered.

Eye Foreign Bodies↗
PubMed1998

Correlation between the amounts of polycyclic aromatic hydrocarbons and mutagenicity of airborne particulate samples from Taichung City, Taiwan.

Taichung is the largest city in the central part of Taiwan, and its air pollution problems are similar to those in other large cities around the world. To evaluate the potential of the air pollution and identify major pollutant sources in this city, 181 airborne particulate samples were collected biweekly from seven locations around Taichung over an entire year. The mutagenicity of acetone extracts of the air samples was evaluated using the Salmonella/microsomal test with Salmonella typhimurium TA98 in the presence and absence of S9 mixtures. The air samples from September 1994 showed the highest direct and indirect mutagenicity among the 12 months, whereas those from October and June had the lowest direct and indirect mutagenicity, respectively. To elucidate the correlation between mutagenicity and polycyclic aromatic hydrocarbons (PAHs), high-performance liquid chromatography was used to determine the amount of each of 10 PAHs in the air samples. Among the 10 PAHs, the monthly average amount of B[g,h,i]P in the samples was the highest, followed by B[a]FA, B[a]P, and B[k]FA. Linear regression analysis showed a positive correlation between monthly average total amounts of PAHs and indirect mutagenicity. The monthly average amount of B[g,h,i]P was correlated more with indirect mutagenicity than with other PAHs. B[g,h,i]P is an indicator PAH emitted from both diesel and gasoline engine exhaust. Thus, we suggest that mobile air pollutant sources in Taichung City may be more significant than stationary ones. Moreover, B[g,h,i]P seems to act as a mutagenicity indicator compound in air samples from Taichung City.

Air Pollutants↗
PubMed1992

The high incidence of psychiatrically treated disorders in the inner city of Mannheim. Susceptibility of German and foreign residents.

In earlier investigations in the city of Mannheim we examined the spatial distribution of the incidence of treated mental disorders in 1965 and 1974-80. In studying the ecology of psychiatric disorders over time, it is important to consider major demographic developments. In Mannheim between the mid-sixties and 1980 the most striking demographic change was the increase of foreign residents, whose proportion almost trebled during this period. In this study we test the hypothesis whether the excess morbidity in the inner city where housing conditions are relatively poor and the percentage of foreign residents is far above average can be explained by the high proportion of immigrants, mainly from Turkey, living there. Due to motivational and administrative factors, most immigrant workers being recruited on the basis of good physical and mental health, the age-adjusted incidence of treated psychiatric disorders between 1974 and 1980 among the German population exceeded that of foreign residents. The high concentration of psychiatric disorders in the inner city is due solely to the German and not to the foreign residents. The most plausible explanation for this is provided by the segregation hypothesis. Individuals with vulnerable personalities tend to move to socially disorganized districts of the city. Furthermore, the health status of those Germans who left areas of poor environmental conditions was probably better in comparison to those who remained in the inner city.

Cross-Cultural Comparison↗
PubMed1987

Neighborhood variations in the use of city-supported primary health care services by an elderly population.

The purpose of this paper is to examine the elderly's use of city-supported primary health care services. The provision of free or low cost health care to the elderly population is a major health policy issue, especially as the size of the elderly population increases and there is a concomitant increase in the need for health services and increases in the out-of-pocket cost of health care. The data analyzed here are based on client records for approximately 6,000 persons 65 and older who utilized the City of Philadelphia's Family Medical Care Program in 1982. Demographic and socioeconomic characteristics, diagnoses and types of services used are examined for all clients citywide and by neighborhood. Elderly clients of the city primary care system tended to be 65-74, female and black. Most clients had low incomes, with about 75-87% having incomes below $6,000. The problems for which care is sought involve long-term, ongoing care. The data show that the elderly are underrepresented in the city-supported primary care system relative to their numbers in the general population. Our findings on diagnosis and services utilization characteristics of those elderly who do use city-supported primary health care services indicate that the elderly are likely to place demands on the existing system for a substantial amount of resources. The demands for such services are likely to increase especially as the size of the elderly population increases.

Black or African American↗
PubMed1998

Development and evaluation of an inner city mental health team.

The objective of this study was to examine the development and activity of a Community Mental Health Team, originally targeted to meet the needs of African Caribbean, Asian and homeless populations in an inner city area. The study was based on all (n = 1046) client referrals to the Bristol Inner City Community Mental Health Team between 1987 and 1994. Additional qualitative interviews were held with general practitioners (GPs) from each of the nine practices in the area. The setting was the inner city area of Bristol, an area with a population of around 35,000 27% of whom are from ethnic minority communities. This is an area shown in previous research to have a high level of mental health problems. Trends in referral rates, demographic characteristics and seriousness of psychiatric illness amongst those referred to the Inner City Mental Health Team were the main outcome measures used. In the years studied there were significant increases in the number and proportion of overall referrals from GPs and psychiatrists and decreases in referrals from other agencies. In particular, there were reductions in the referral both of clients from the originally identified target groups and of patients with serious mental illness. GPs tended to refer a greater proportion of patients with less serious mental illness. The results of the study showed that a team originally developed to meet the needs of the homeless and those from ethnic minorities has, with the removal of special project funding, shifted its focus away from the client groups for whom it was originally developed to those with less serious mental health problems. These changes are partially attributable both to changes in the remit of the team, making it more acceptable to GPs, and to a growing acceptance of community-based mental health services among GPs and their patients. Changes in the geographic catchment area served by the team has also played a role in the observed trends. Commissioners of mental health services need to bear in mind the needs of high-risk groups when making contracts. It may be that in order to meet effectively the needs of inner city populations with a high prevalence of mental health problems, there is a need for specialist teams with a specific remit.

Adult↗
PubMed1999

Comparisons of urban and rural bioclimatological conditions in the case of a central-European city.

This paper examines the influence of a medium-sized city (Szeged, Hungary) on the bioclimatological conditions of human beings. With the help of suitable indices for the available data set, differences in the annual and diurnal variation of human bioclimatic characteristics between an urban and rural environment are evaluated over a 3-year period. These indices are the thermohygrometric index (THI, defined by air temperature and relative humidity), the relative strain index (RSI, defined by air temperature and vapour pressure) and the number of "beergarden days" (defined by air temperature at 2100 hours). In urban and rural areas, "hot" THI conditions characterize 6% and 1% of the year, "comfortable" conditions 30% and 20%, "cool" conditions 10% and 12%, and "cold" conditions 54% and 66% respectively. Over longer periods (e.g. one, month) RSI remains below the threshold value for strong heat stress in the city. The monthly frequencies of beergarden days show that these days appears from May until October and the city has almost twice as many pleasant evenings as the rural areas. Consequently, the city favourably modifies the main climatological elements within the general climate of its region; periods likely to be comfortable are therefore found more frequently in the city than in rural areas.

Climate↗
PubMed2003

Genetic diversity of enterovirus 71 isolated from cases of hand, foot and mouth disease in Yokohama City between 1982 and 2000.

Enterovirus 71 (EV71) is known as one of the major causative agents of hand, foot and mouse disease (HFMD) and is also associated with neurological manifestations such as aseptic meningitis, polio-like paralysis and encephalitis. Recently, large HFMD outbreaks, involving severe neurological complications, have been experienced in Malaysia, Taiwan and some other countries in the Western-Pacific region. To investigate the genetic diversity of EV71 isolates in a single community in Japan, nucleotide sequences of the VP4 region of 52 EV71 isolates in Yokohama City from 1982 to 2000 were determined and the phylogenetic relationship was compared with other referential EV71 strains in Japan and in the world. There were two major genotypes of EV71 in Yokohama City through the 1980's and 1990's. Six EV71 isolates in the early 1980's in Yokohama City were closely related to those from HFMD outbreaks in Japan and from outbreaks of polio-like paralysis in Europe in the 1970's. During recent HFMD outbreaks in 1997 and 2000, two distinct genotypes of EV71 were co-circulating in Yokohama City as in HFMD outbreaks in Malaysia and Taiwan. However, the genetic diversity of EV71 in Yokohama City was not directly correlated with the severity of HFMD. The results confirmed the circulation of two distinct genotypes of EV71 over the past 20 years in Japan.

Amino Acid Sequence↗
PubMed1983

The growth of large cities in India, 1961-1971.

"The general characteristics and the growth 1961-1971 of class 1 cities (those with more than 100,000 population in 1971) in India are examined. An unexpected correlation shows that the larger cities are more specialized, and growing faster. A factor analysis reduces the original variables to apparently significant factors, but these fail to classify the individual cities convincingly. An alternative simple classification of cities in terms of growth rates and degree of specialization shows strong regional components, dividing India into an emerging system of dynamic interdependent cities, and areas of stagnation and lack of specialization."

Asia↗
PubMedDate not supplied

Alcohol, drugs, and urban violence in a small city trauma center.

Substance abuse and urban trauma go hand in hand. But research focuses on large cities served by major academic medical centers. Do small cities face the same problems? Two hundred thirty-three urban trauma inpatients from a metro area of 250,000 were studied using patient interviews and medical records. As in large cities, one half used alcohol or drugs when attacked. Seventy percent were likely to be young, male, poor African-Americans. Only 3% were gang members, but demographic characteristics failed to explain substance abuse as they have for larger cities. A culture of violence pervades the small city, as it does in large urban ghettos. Two fifths were repeat urban trauma victims. Two fifths witnessed assaults in the past year. One third carried a knife or gun. Fifteen percent used a weapon on another person in the last year. Contextual variables, like being hurt in a bar, were related to drinking and drugs. The best predictor of present substance abuse and urban trauma was medical history of substance abuse. The need for (a) toxicology screens for all trauma victims, (b) referrals to substance abuse programs, (c) targeting at-risk populations for prevention, and (d) eliminating environments fostering violence and substance abuse is supported.

Adult↗
PubMed1993

Performance of semiquantitative food frequency questionnaires in international comparisons. Mexico City versus San Antonio, Texas.

International dietary comparisons present a number of methodologic difficulties. We developed two semiquantitative food frequency questionnaires for use in Mexico City and San Antonio, Texas. The Mexico City questionnaire contained 85 food items and the San Antonio questionnaire contained 108. Thirty-six items were common to both questionnaires. The questionnaires were administered to 128 Mexican Americans, 35 to 64 years old, residing in a low-income barrio neighborhood of San Antonio and to 644 similarly aged Mexicans residing in a low-income "colonia" of Mexico City. Major differences in fat and carbohydrate intake as a percent of total kilocalories were observed between the two study groups, with Mexico City residents consuming approximately 18 to 21% of calories from fat and 68 to 72% from carbohydrate compared to 29 to 33% from fat and 48 to 52% from carbohydrate for Mexican Americans from San Antonio. Both of these differences were highly statistically significant (P < 0.001). A number of arguments support the validity of these findings. First, the distribution of high- and low-fat foods was similar on both questionnaires. Also, of the top-ten foods (as contributors to total kilocalorie intake) in San Antonio, seven were high in fat (> 30% of kilocalories), whereas this was true of only three of the top-ten foods in Mexico City.

Adult↗
PubMed2004

Does irrigated urban agriculture influence the transmission of malaria in the city of Kumasi, Ghana?

To verify the possible impact of irrigated urban agriculture on malaria transmission in cities, we studied entomological parameters, self-reported malaria episodes, and household-level data in the city of Kumasi, Ghana. A comparison was made between city locations without irrigated agriculture, city locations with irrigated urban vegetable production, and peri-urban (PU) locations with rain-fed agriculture. In the rainy as well as dry seasons, larvae of Anopheles spp. were identified in the irrigation systems of the urban farms. Night catches revealed significantly higher adult anopheline densities in peri-urban and urban agricultural locations compared to non-agricultural urban locations. Polymerase chain reaction (PCR) analysis of Anopheles gambiae sensu lato revealed that all specimens processed were A. gambiae sensu stricto. The pattern observed in the night catches was consistent with household interviews because significantly more episodes of malaria and subsequent days lost due to illness were reported in peri-urban and urban agricultural locations than in non-agricultural urban locations. In Kumasi, urban agriculture is mainly practised in inland valleys, which might naturally produce more mosquitoes. Therefore more detailed studies, also in other cities with different water sources and irrigation systems, and a better spatial distribution of sites with and without urban agriculture than in Kumasi are needed.

Adolescent↗
PubMed2004

The impact of urban health insurance reform on hospital charges: a case study from two cities in China.

During the transition from a centrally planned to a market economy, China's urban health insurance system is being reformed. The control of the rapidly increasing hospital expenses will be a major determinant of the success of the reform. This study aims to examine the impact of the reform on hospital charges by comparing changes between two cities with different insurance systems and identifying determinants for those changes. Data was collected from six hospitals in two cities, one city implemented an urban health insurance reform, the other did not. Acute appendicitis and normal childbirth were used as tracers for calculating hospital charges. Methods included the retrospective review of medical records, interviews with health policy makers and hospital staff, focus group discussions, and the review of hospital and health insurance documents. The results showed that hospital charges per case of acute appendicitis and childbirth increased 101 and 94%, respectively, in the city without reform, and 41 and 34% in the city with reform, between 1995 and 1999. Health insurance arrangements and average LOS were the major determinants for hospital charges. Drugs and non-pharmacological treatments were the major service categories for charge containment. The combined measures of a single insurer, selective contracts, a new payment system, and use of an essential drug list, is regarded as the key features for an effective hospital charge control, and would appear to be successful measures for hospital expenditure containment within health insurance reform.

Acute Disease↗