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PubMed1979

Impacts of the medical malpractice slowdown in Los Angeles County: January 1976.

The Los Angeles County (California) physician strike of January 1976 resulted in a partial withdrawal of physician services. Among recorded impacts were a $17.5 million loss in hospital revenues and an $8.5 million pay loss for hospital employees. Several surveys revealed no evidence of a significant impact on the general public in finding medical care. Analysis of emergency room visits and paramedical ambulance calls showed no significant increases during the strike. County mortality statistics for the strike were not affected. Eighty-eight fatalities among 2,171 patients transferred during the strike were analyzed; a Case Attributable Mortality Probability generated on 21 cases selected for final review by a five-physician multispecialist panel indicated that 29 per cent of the Attributable Mortality could be ascribed to the strike itself and 71 per cent to ongoing "patient dumping" from private sector to County hospitals. Even if sample attributable mortality rates were generalized to overall county deaths, the resultant figures are below the estimated range of 55 to 153 deaths that did not occur because of the number of elective operations not performed secondary to the strike.

Allied Health Personnel↗
PubMed2006

Cancer mortality in Greece: where are we heading? A 20-year comparative study in four Greek counties.

AIM: Comparison of cancer mortality rates in four Greek counties during the decades 1979-1988 and 1989-1998 and drawing out of cause and effect relationships that could lead to organization of prevention programs. METHODS: We used the Wilcoxon-White test to statistically compare data between the two decades as well as between the four counties separately. RESULTS: We found that the total proportional mortality during the decade 1988-1998 significantly increased, compared to 1979-1988, in all counties we studied. We noted a statistically significant increase of the proportional mortality of organs of the gastrointestinal tract and peritoneum (W = 55, p < 0.001 for both decades), of the respiratory system and intrathoracic organs (W = 71, p = 0.009 for 1979-1988 and W = 55, p < 0.001 for 1988-1998) and the skin and breast (W = 136, p = 0.019 for 1979-1988) in Attiki compared to Thessaloniki. As far as Achaia and Trikala are concerned, we found a minor, though statistically significant increase of the proportional mortality of organs of the gastrointestinal tract and peritoneum (W = 78, p = 0.043), of the respiratory system and intrathoracic organs (W = 77, p = 0.035) and the skin and breast (W = 76, p = 0.029) during the decade 1988-1998. CONCLUSIONS: Statistically significant differences were noted concerning the incidence rates between four different counties as well as between two different decades. Although genetic factors might partially explain our results, environmental factors seem to be the main culprits.

Greece↗
PubMed2004

The crisis of the Los Angeles County public hospital system: a harbinger for the nation.

The public hospital system in Los Angeles County, California, is in the midst of a major fiscal crisis that has already led to a serious reduction of capacity and could continue to worsen. Given the importance of the public system in a county where 30 percent of the population is uninsured and private hospitals provide very little uncompensated care, what happens in L.A. County is a harbinger for other cities and counties in the United States. This article highlights the issue of the extent to which local taxpayers, as opposed to state or federal taxpayers, are responsible for the continued operation of public hospitals and safety-net facilities in their communities.

Bankruptcy↗
PubMed1993

An epidemic of childhood diabetes in the United States? Evidence from Allegheny County, Pennsylvania. Pittsburgh Diabetes Epidemiology Research Group.

OBJECTIVE: To evaluate IDDM trends in Allegheny County, Pennsylvania, from 1965 to 1989. RESEARCH DESIGN AND METHODS: A population-based registry established in 1976--the Allegheny County Registry--was used for this study through a retrospective chart review of all cases diagnosed in the county from 1965. Through this registry, cases of IDDM patients < 20 yr of age were identified. In addition, pediatricians in the county were contacted about IDDM cases they diagnosed between 1965 and 1989 in individuals < 20 yr of age. RESULTS: For the first time a major increase in IDDM was seen (1985-1989). This increase in IDDM was heterogenous with the rise for males being double that for females. The increase for non-white males was considerably greater than that seen for white males, and an exceptionally large increase in the youngest age-group (0-4 yr of age) was observed. CONCLUSIONS: Ecological analyses indicated an association between chicken pox infection and IDDM, and this suggested that at least part of the rise may be of an infectious origin.

Adolescent↗
PubMed1998

Was there an epidemic of diabetes in nonwhite adolescents in Allegheny County, Pennsylvania?

OBJECTIVE: To determine the incidence of IDDM in children aged < 20 years at diagnosis in Allegheny County, Pennsylvania, for the period from 1 January 1990 to 31 December 1994 and to compare the incidence between whites and nonwhites in the same area and for the same time period. RESEARCH DESIGN AND METHODS: All new patients diagnosed between January 1990 and December 1994 who were aged < 20 years, on insulin, and residents of Allegheny County at diagnosis were identified from medical records of 23 hospitals in the Allegheny County area. To verify the completeness of the hospitals using the capture-recapture method, pediatricians and diabetologists were used as a secondary source. RESULTS: A total number of 257 patients were identified. The overall age-standardized incidence rate was 16.7/100,000. Nonwhites had a slightly higher incidence (17.6/100,000) than whites (16.5/100,000). In the 15-19 years age-group, the incidence in nonwhites (30.4/100,000) was almost three times higher than that in white (11.2/100,000) and more than two times higher than that in the previous period (from 1985 to 1989) (13.8/100,000). CONCLUSIONS: For the first time in the Allegheny County registry, and in any other registry, nonwhites showed a higher incidence of IDDM than whites. The high incidence in the 15-19 years age-group was responsible for this phenomenon. This epidemic of diabetes in adolescent nonwhites may be the result of a rising incidence of classical IDDM or another type of diabetes. Further studies using population-based registries are needed to determine whether this increase is being seen in other areas and other ethnic groups and to clarify the reasons for the increase in IDDM among blacks.

Adolescent↗
PubMed2006

Barriers to SCHIP enrollment: A cross-county study of the State Children's Health Insurance Program in Pennsylvania.

BACKGROUND. Enrollment in the State Children's Health Insurance Program (SCHIP), created under the federal Balanced Budget Act of 1997, had a distressingly slow start and varied substantially county-to-county in many states, including Pennsylvania. METHODS. We performed a quantitative county-level analysis of barriers to enrollment in Pennsylvania's Children's Health Insurance Program (CHIP) for the year 2000, seven years after it was implemented and three years after federal SCHIP legislation. Using multivariate regression analysis with a county as the unit of observation, we modeled enrollment in SCHIP as a function of accessibility to health care, availability of clinicians, and community economic health. RESULTS. High clinic density and Medicaid managed-care membership predicted SCHIP enrollment success, while female head-of-household predicted SCHIP enrollment failure. A principal-components factor analysis revealed four underlying barriers to enrollment: accessibility, availability, affordability, and effort. CONCLUSIONS. The most formidable barriers to SCHIP enrollment success in Pennsylvania were not programmatic; they were correlates of poverty itself.

Journal Article↗
PubMed1990

Factors of importance for the use of PAP-SMEAR in a Danish county without systematic screening.

Do various General Practice factors influence the participation rate (PR) in the cytological investigation for preventing cancer of the cervix uteri in counties without systematized screening? This was studied in the county of Aarhus, Denmark, where there are no systematic cytological examinations (CE). We studied a random sample of 2023 women aged 27.5 years to 47.5 years. Essential differences in PR depended on various practice characteristics. Practices with the highest average use of CE services, as counted by the Regional Health Authorities, also had the best PR. The relative chance of being sufficiently examined was almost twice as great among patients in active practices compared with other practices. Furthermore, practices with at least one female practitioner and practices that wanted the introduction of systematic screening had a significantly higher PR. There was a slightly higher PR for patients in large practices. Type of practice, i.e. whether single or partnership, and the individual practitioner's attitude to the efficiency of the present opportunistic screening were not related to the PR. Finally, a slightly lower PR was found among patients in the city of Aarhus, whereas the PR in the major cities of the county as a whole did not differ from the coverage rate in the county in general. It is concluded that the Health Authorities' average figure for CE-use/1000 women in the individual practice is the most significant factor that determines the CE rate for any given patient. Variation in the PR in different practices is unacceptably large if all the women are to receive a uniform CE screening offer.

Adult↗
PubMedDate not supplied

What happens to depressed men? Application of the Stirling County criteria.

In a recent issue of the Harvard Review of Psychiatry, results from the Stirling County Study showed that the prevalence and incidence rates of depression were similar in men and women when "gender-fair" criteria were used and help-seeking was not required. We attempted to replicate these findings by applying the criteria for depression from the Stirling County Study to two national and six international epidemiologic surveys conducted in the 1980s and 1990s. Depression was defined as dysphoric mood and disturbances of sleep, appetite, and energy, with at least a mild degree of impairment. The rates of depression were computed using this algorithm with data from the US Epidemiologic Catchment Area Study, conducted in the 1980s, the US National Comorbidity Survey, conducted in the 1990s, and independent community surveys from Canada, Puerto Rico, France, Taiwan, Korea, and New Zealand. For the US studies, these rates were recalculated after persons seeking treatment were removed from the analyses, where such data were available. Using Stirling County Study criteria, the lifetime prevalence rate of depression remains approximately twice as high in women as in men cross-nationally, except in Puerto Rico. Excluding help-seeking as a criterion and controlling for birth cohort do not change the findings. The Stirling County findings on absence of a sex difference in rates of depression using "gender-fair" criteria may be due to methodological variance in the collection of data, sample size, or the social and/or genetic uniqueness of the Atlantic Canadian community.

Adolescent↗
PubMedDate not supplied

Estimating the effect of native Indian population on county alcohol consumption: the example of Ontario.

Multiple regression analysis of cross-sectional 1985-1986 Ontario county data indicated that the presence of Native Indians on reserves is a significant factor in explaining differences in county alcohol consumption levels. Consumption in counties with reserves was higher than in those without reserves by roughly 1.48 liters of absolute alcohol per adult; consumption increased as the Native reserve population increased (p less than 0.05). When income, employment, household crowding, type of industrial activity, northern isolation, and tourism were included, we could account for over 60% of the variation in alcohol consumption between Ontario counties (p less than 0.01). Every extra $1,000 in income per tax return was associated with a 0.297-liter reduction in absolute alcohol consumption. Efforts to reduce alcohol consumption in the Native population would have their greatest impact when associated with improved economic conditions.

Adolescent↗
PubMed2004

Limited spread of penicillin-nonsusceptible pneumococci, Skåne County, Sweden.

In response to increasing frequencies of penicillin-nonsusceptible pneumococci (PNSP), for which the MIC of penicillin was >0.12 mg/L, in Skåne County, southern Sweden, national recommendations were initiated in 1995 to limit the spread of pneumococci with high MICs (> or =0.5 mg/L) of penicillin (PRP), especially among children of preschool age. Traditional communicable disease control measures were combined with actions against inappropriate antimicrobial drug use. During the first 6 years that these recommendations were applied in Skåne County, the average frequency of penicillin-resistant pneumococci has been stable at =2.6%, as has the average PNSP frequency (7.4%). However, PNSP have been unevenly distributed in the county, with the highest frequencies in the southwest. Simultaneously, the rate of antimicrobial drug use for children <6 years of age was reduced by 20%. Thus the spread of PNSP between and within the municipalities in the county has been limited.

Anti-Bacterial Agents↗
PubMed2003

An analysis of esophageal cancer incidence in Cixian county from 1974 to 1996.

AIM: To describe the incidence of esophageal cancer (EC) in Cixian, a county of Hebei province during 1974-1996. We analyzed the sex and age characteristics as well as the geographic distribution of EC, in order to determine the impact so that methods of preventing and controlling EC in Cixian can be put in place. METHODS: Since the early 1970s, the cancer registry system has been established, which collects the cancer incidence in Cixian county. The malignant tumors were coded according to International Classification of Disease IX (ICD-9). All the data were checked and analyzed using EPIINFO. RESULTS: The trend of the incidence rate of EC from 1974 to 1996 had declined, (229.9/100 000 vs 178.5/100 000, Odds ratio=1.47, 95 % CI:1.32-1.63, chi(2)=52.89. trend chi(2)=26.54, P<0.001). The incidence rate of males declined significantly (281.81/100 000 vs 157.96/100 000, Odds ratio=1.61, 95 % CI: 1.41-1.84, chi(2)=47.85. Trend chi(2)=44.86, P<0.001), whereas, the females remained steady (157.96/100 000 vs 133.41/100 000, odds ratio=1.28, 95 % CI:1.17-1.49, chi(2)=9.26. trend chi(2)=2.69, P>0.05). Male average annual incidence rate was 142.80/100 000 and the female's was 95.18/100 000. The sex ratio (males to females) was 1.50:1. The incidence rate was increasing along with the age. As to the geographic distribution, the incidence rate in mountainous areas and hilly areas showed a significantly declining trend (mountainous areas, trend chi(2)=149.93, P<0.001; hilly areas, trend chi(2)=42.70, P<0.001). The incidence rate of EC in plain areas had increased (trend chi(2)=22.39, P<0.001). CONCLUSION: The incidence rate of EC in Cixian county shows a trend and has declined after two decades, especially in mountainous area. But compared to other regions in the world, Cixian county still had a high incidence rate of EC.

Adolescent↗
PubMed2003

Dietary intake of fruits, vegetables, and fat in Olmsted County, Minnesota.

OBJECTIVE: To assess self-reported dietary intake in the adult population of Olmsted County, Minnesota. SUBJECTS AND METHODS: We conducted a random-digit-dial telephone survey between March 1 and April 21, 1999, of 1232 adults residing in Olmsted County, Minnesota. We then mailed a structured questionnaire to the survey respondents and achieved a response rate of 732 individuals. Percentages of individuals and predictors of those who meet recommendations for intake of fruits and vegetables and for dietary fats were determined by using chi2 tests of general association and multivariate logistic regression. RESULTS: Only 16% of the population of Olmsted County reported meeting standard dietary recommendations for consuming both 5 or more servings of fruits and/or vegetables per day and no more than 30% of calories from fat. Fifty-one percent of the population was meeting neither recommendation. Women were more likely than men to report meeting both goals (22% vs 8%, P<.001), but still more women were meeting neither goal than were meeting both goals (40% vs 22%, P<.001). Multivariate logistic regression revealed the following factors to predict adherence to both goals: female sex, lower body mass index, nonsmoker, history of high cholesterol, and daily physical activity. CONCLUSION: Few individuals in Olmsted County are meeting national recommendations for intake of fruits, vegetables, and dietary fat. More effective interventions are needed to improve dietary habits in all subgroups of this community.

Adult↗
PubMed2004

Incidence of tuberculosis in Olmsted County, Minnesota, 1990-2001.

OBJECTIVE: To describe and compare the incidence and clinical characteristics of tuberculosis in Olmsted County, Minnesota, among US-born and foreign-born persons. PATIENTS AND METHODS: We performed a retrospective cohort study at the Mayo Clinic in Rochester, Minn, of all residents of Olmsted County (2000 population: 124,277) diagnosed as having tuberculosis between January 1, 1990, and December 31, 2001. Potential cases were identified with use of a computerized diagnostic coding database and microbiological laboratory data; all identified medical records were abstracted. Definite cases were those in which Mycobacterium tuberculosis was recovered in culture. Probable cases were those that met predefined clinical or radiographic evidence of tuberculosis and other criteria. Age-specific, sex-specific, and country of origin-specific incidence rates were calculated with use of Olmsted County census data. Variables were compared among risk groups using the Fisher exact test. RESULTS: During a 12-year period, 71 cases of tuberculosis (53 definite, 18 probable) were identified, for an incidence of 5.3 per 100,000 person-years. Of these cases, 54 (76%) occurred during the second half of the study (incidence: 7.7 per 100,000 person-years). The incidence among US-born persons was similar throughout the study period; however, the Incidence among foreign-born persons increased more than 3-fold during the second half of the study period. Twenty-five patients (35%) were former refugees. All isoniazid-resistant infections (12% of isolates) and multidrug-resistant infections (6% of isolates) occurred among foreign-born persons. CONCLUSION: The incidence of tuberculosis increased substantially in Olmsted County between 1990 and 2001, primarily because of an increase in the number of cases among foreign-born persons.

Adult↗
PubMed2006

[Type 1 diabetes mellitus incidence in Santiago, Chile. Analysis by counties in the period 2000-2004].

BACKGROUND: There are great geographical differences in the incidence of type I diabetes mellitus. AIM: To determine the incidence rate of type 1 diabetes mellitus (DM1) in the Metropolitan Region of Santiago, Chile from January 1, 2000 to December 31, 2004 and to observe the distribution of cases in the different counties of Santiago. MATERIAL AND METHODS: All the cases diagnosed with DM1 in the Metropolitan Region who fulfilled the following requirements were included in the study: age of onset <15 years, insulin treatment from onset, permanent residency in the area, and a diagnosis made between January, 2000 and December, 2004. RESULTS: The incidence of DM1 was 6.58/100,000 inhabitants/year, and showed a significant increase from 2001 to 2004 (5.44 and 8.33 inhabitants/year, respectively, p <0.04). The incidence of DM1 also increased significantly in children younger than 4 years old. The incidence by counties exhibited large differences, ranging from 1.5 to 26.6/100,000 inhabitants. Counties with higher income, urbanization and low aborigine component showed a high incidence rate of type 1 diabetes. CONCLUSIONS: In the Metropolitan Region of Santiago, an increase of the incidence of DM1 has occurred in the period 2000-2004, especially in children younger than 4 years old. Large differences among counties were observed.

Adolescent↗
PubMed2006

Prevalence and characterization of Escherichia coli O157 isolates from Minnesota dairy farms and county fairs.

Samples were collected from 26 organic and conventional farms and 12 county fairs in Minnesota during 2001 and 2002 to identify the presence of Escherichia coli O157. Immunomagnetic separation was used for isolation of E. coli O157. Isolates were further characterized by the presence of virulence marker genes (stx1, stx2, eaeA, E-hly, katP, etpD, and espP), antimicrobial susceptibility profiles, and genotypes. During 2001, E. coli O157 was isolated from 16 (5.2%) of 305 fecal samples and from 7 (36.8%) of 19 farms. During 2002, E. coli O157 was isolated from 6 (4.5%) of 132 fecal samples from weaned calves at 4 (23.5%) of 17 farms. During 2001 and 2002, cattle manure samples were collected from 12 county fairs, and E. coli O157 was isolated from 19 (11%) of 178 samples and 9 (75%) of 12 county fairs. Among 40 E. coli O157 isolates, 17 isolates (43%) had both the stx1 and stx2 genes, and 21 strains (53%) had the stx2 gene only. Thirteen percent of O157 isolates were resistant to tetracycline, and 25% were resistant to sulfadimethoxine. Heterogeneity of E. coli O157 strains was demonstrated by the presence of 22 different pulsed-field gel electrophoresis (PFGE) patterns. Four PFGE patterns matched those of isolates previously found in humans. The presence of E. coli O157 at county fairs suggests the potential for transmission to the public, who may have contact with cattle or their environment.

Animals↗
PubMedDate not supplied

Creating an occupational therapy Level II fieldwork experience in a county jail setting.

Although occupational therapy services have been rendered in prisons historically, only one occupational therapy program currently exists in a county jail: the Allegheny County Jail Project (ACJ Project). The offenders who populate county jails experience occupational deprivation. The participants of the ACJ Project have benefited from occupational therapy intervention that was initiated during incarceration and continued following their release from jail in order to help them resume productive life roles and to reduce the reoccurrence of engagement in criminal behaviors (recidivism rate). As of June 2003, the ACJ Project has successfully affected the lifestyle patterns of its participants and overall public safety by helping 63% of participants secure gainful employment and by helping 91.8% of participants maintain their freedom after prison. The purpose of this report is to describe the process and benefits of implementing fieldwork opportunities for Level II occupational therapy students in a best practice occupational therapy program in a nontraditional environment: a county jail.

Clinical Competence↗
PubMed1995

Patterns of health maintenance organization service areas in rural counties.

This study analyzes the 1993 National Directory of HMOs to determine the extent to which rural counties are included in health maintenance organization (HMO) service areas. Two specific questions are addressed: (1) How do the patterns of service areas differ across HMO model types? (2) What are the characteristics that distinguish rural counties served by HMOs from those that are not? Although a majority of rural counties are in HMO service areas, substantially fewer are served by non-individual practice association (non-IPA) models. Access to HMO services is found to decrease with county population density, and adjacency to metropolitan areas is an important predictor of inclusion in service areas.

Catchment Area, Health↗
PubMed1999

Third-party funding of health care services for the uninsured of Tarrant County.

This study investigated how many citizens of Tarrant County do not have health insurance, what sources fund their health care, and how this level of funding compares with the privately insured population. Data for 1995 were obtained from various government agencies, local hospitals, local charitable organizations, and a survey of local private physicians. Medicare and Medicaid were considered to be forms of health insurance. Approximately 20% of the citizens of Tarrant County did not have health insurance. Third-party funding for health care for this population was approximately 56% of the funding for the privately insured population ($967 vs $1726 per person per year). The Tarrant County Hospital District contributed 52% of the uninsured funding; private hospitals and physicians, 26%; other state and local agencies, 21%; and charitable donations, 1%. I conclude that health care for the uninsured of Tarrant County is rationed compared with that of the privately insured population.

Adult↗