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PubMed1999

[Chronic low back pain in 40-year olds in 12 Norwegian counties].

In this study, a questionnaire and a short interview were used to estimate the prevalence of chronic low back pain alone and low back pain together with other musculo-skeletal pains among 40-year-old women and men in 12 Norwegian counties (a total of 67,338 persons). On average 2.4% of men and 1.7% of women had only chronic low back pain, while 5.7% of men and 9.2% of women in addition had other pains as well. Persons with low back pain only were approximately equally distributed across the counties. Greater variations across the counties and between the sexes were found in persons with additional pain. The duration of the pain did not vary significantly between the sexes or across the counties, but the duration was on average two years longer in cases of multi-cause pain. Reduced capacity for work because of pain was approximately equally distributed between the sexes and the groups. More women than men were unable to do their daily work. About one third in both groups (more men than women) had been absent from work because of pain during the last year. More women than men in both groups received national insurance benefits. Persons with only low back pains were approximately equally represented across all levels of education and regardless of marital status, while people with multi-cause pain were overrepresented among those with low levels of education and among the divorced.

Adult↗
PubMed2000

[Differences when it comes to induced abortion in different Danish counties].

The paper describes actual regional differences in the rate of legally induced abortions as well as different trends observed since abortion on request was introduced in 1973. The analysis is primarily based on national population-based and published data from the Registry of Legally Induced Abortions in the National Board of Health, supplemented with data from a linking with the Fertility Database. The rate of abortion has shown regional differences, being at the highest level in counties with large cities. The observed differences are related to higher age at first birth and fewer children per woman in counties with a high frequency of abortion. A large part of the differences are observed among women below age 30-35. Over time developments have shown a parallelism between the counties, even though some differences have also been observed as regards both induced abortion and fertility. Various background factors do not seem to have the same impact on the choice of induced abortion in all counties.

Abortion, Legal↗
PubMed2000

[Artificial respiration at home seen in a 5-year perspective. Established treatment, but remarkable differences among the counties].

The Swedish prevalence of home mechanical ventilation is 8.2 per 100.000 with 10% annual increase. There is a large span (20 vs 2 per 100.000) between "top level" and "low level" counties, in spite of Sweden's homogeneous publicly financed system for provision of health care. The largest prevalence difference was found in patients with obstructive sleep apnoea syndrome (Pickwickian type), but their blood gas and lung function data were identical in top-level vs low-level counties. These data refute the hypothesis of overprescription in top-level counties. We conclude that the most probable explanation is under-recognition of patients in low-level counties.

Adult↗
PubMed2000

An isonymic study of the population structure of early Kings County, NY.

Isonymy has proven a useful method for studying the genetic structure of historical populations. In the United States, the populations studied have been of predominantly British origin. Many of the early settlers in this country, however, came from different cultural backgrounds, which may have affected their settlement patterns and genetic structure. The first European settlers of Kings County, New York, were Dutch, and Dutch was still spoken there in the 19th century. In the early Colonial period, it was an isolated agricultural area, but it was increasingly drawn into the larger metropolis of New York City, a process that culminated at the end of the 19th century. This paper uses census data from 1698, 1738, 1790, and 1810 to assess synchronic and diachronic isonymy patterns within the county. These censuses subdivide the county into six towns, five founded by the Dutch (Brooklyn, Bushwick, Flatbush, Flatlands, and New Utrecht) and one by the English (Gravesend). All were founded at least a generation before 1698. Values of Iii, FST, and RST increased from 1698 to 1738, a period when Kings County received few immigrants, and decreased thereafter as the influence of the metropolis grew. Most new immigrants settled in Brooklyn, so the lowest levels of isonymy occurred there [Iii (1810) = 0.0029]. The highest levels occurred in Flatlands [Iii (1738) = 0.0838]. FST increased from 0.0050 to 0.0076, and then fell to 0.0052 and 0.0032; RST was approximately two-thirds as high, at 0.0033, 0.0053, 0.0033, and 0.0022. These values are more than twice as high as those reported from 19th-century Massachusetts or Pennsylvania, and are comparable to those found in rural European populations. The towns can be divided into two groups: Brooklyn, Bushwick, and Flatbush, with an average Iii of 0.01570, and Flatlands, Gravesend, and New Utrecht, with an average value of 0.03963. The three latter towns were geographically more distant from New York City and remained more isolated both culturally and biologically.

Censuses↗
PubMed2001

Suicide in Travis County, Texas, from 1994 through 1998.

Suicide, the ninth leading cause of death in the United States, has not been adequately studied in Travis County, Texas. To describe the occurrence of completed suicide in Travis County, 426 cases of completed suicide from 1994 through 1998 were collected and the data were analyzed with the chi 2 test and the t test. The annual suicide rate in Travis County is 13.0 per 100,000. Caucasian males have the highest annual suicide rate among all races, followed by Hispanics and, then, blacks. The highest suicide rate was seen in persons aged 75 years and older. The second most frequent rate was for those aged 45 through 54 years. Guns are the most common means of suicide in both males and females (60.8% and 37.3%, respectively). A person who is Caucasian, male, and aged 75 years and older is at the highest risk. Reducing the availability of firearms may have a significant impact on the suicide rates in Travis County.

Adolescent↗
PubMed1993

Public Mental Health Services to Asian American Ethnic Groups in Two California Counties.

PURPOSE OF THE STUDY: The purpose of this article is to examine the use of public mental health services among Chinese, Filipino, Southeast Asians, Japanese, and other Asian Americans. SEARCH METHODS USED: This article used two data sources from San Francisco City and County and Santa Clara County. By combining data from these two counties, the study had access to information on 3,095 adult Asian users of services. SUMMARY OF IMPORTANT FINDINGS: The study found differences among various Asian ethnic groups in their likelihood of using individual service modalities, but fewer statistically significant differences in the amount of use once services started. MAJOR CONCLUSIONS: Differences in the use of public mental health services were related to differences in the two counties' implementing services. KEY WORDS: Asian Americans, Public Mental Health Services, Utilization, Ethnic Differences

Journal Article↗
PubMed2001

[Clinical guidelines developed by the STRAMA group in the county of Stockholm: urinary tract infections in primary health care].

In order to minimize the emergence of antibiotic-resistant strains among common pathogens seen in primary care in Stockholm County, the County Medical Officer in 1995 established a multidisciplinary regional STRAMA-group (Swedish Strategic Programme for the Rational Use of Antimicrobial Agents and Surveillance of Resistance). The group started out by studying antibiotic sensitivity for common pathogens in the County and in Sweden. Then the group analyzed the use of antibiotic drugs and differences in prescribing patterns among different groups of physicians in the County. In order to minimize resistance and achieve the goal of optimal use of antibiotics the group decided to publish guidelines for primary care physicians treating patients with respiratory tract infections (printed in 1997) and urinary tract infections (printed in 1999). In this article we present the guideline for urinary tract infections.

Adult↗
PubMed2001

[Clinical guidelines developed by the STRAMA group in the county of Stockholm: skin and soft tissue infections].

In 1999 the County Medical Officer in Stockholm County established the third regional STRAMA-group (Swedish Strategic Programme for The Rational Use of Antimicrobial Agents and Surveillance of Resistance) to deal with skin and soft tissue infections. The group decided to publish guidelines for physicians in the county, and this third book was distributed among the 7,000 physicians in Stockholm County.

Anti-Bacterial Agents↗
PubMed2001

[Blood donors at the county of Funen. Status based on more than five years of experience, 1995-2000].

INTRODUCTION: The Danish blood donor organisation is considered to be one of the best organised in the world. At the same time, Denmark has very high numbers of blood donations and blood transfusions, compared to the number of inhabitants. In recent years, pressure has been put on the donor organisation, owing to a decline in the number of donors and because new treatment modalities and other initiatives take blood transfusion for granted. MATERIAL AND METHODS: Information from the electronic databases of the County of Funen Transfusion Service on all blood donors in the county and its donor organisations from 1995 to September 2000 was extracted and analysed. RESULTS: In September 2000, the County of Funen had 21,087 active blood donors organised in eight bodies, i.e. 4% of the inhabitants. There are significant differences between these bodies, but common to all is a relative lack of donors between the age of 18 and 35 years. Each year about 10% of the donors withdraw, which is equal to 14,127 donors in the period analysed. This withdrawal is only partly balanced by 7820 new donors, with the result that the total number of donors in the county is declining by an average of 1100 donors a year. DISCUSSION: Several possibilities for action are proposed, for instance intensive recruitment campaigns, mobile blood drawing units, a change in the opening hours of blood banks, optimisation of the stocks, but, above all, the possibilities of reducing the amount of blood needed for transfusion. The Funen as well as the Danish health authorities must realise that blood for transfusion is no longer in unlimited supply, but in the future will be a rather restricted good.

Adolescent↗
PubMed2002

A study of hepatitis A seropositivity in Dallas County, Texas, 1998 through 1999.

This paper provides background information on the epidemiology and a descriptive analysis of infection with hepatitis A virus in Dallas County, Texas, for 1998 and 1999. Reported cases were obtained from the Dallas County Health Department, and incidence rates per 100,000 population were calculated. Persons who tested seropositive for hepatitis A virus between January 1, 1998, and December 31, 1999, were included. Variables of interest included age, sex, race, and date of occurrence. The overall incidence rate of this infection in Dallas County for 1998 was 1.9 times higher than that of the United States; in 1999, the overall rate for Dallas County increased by more than 1.6 times. Rates were significantly higher among males, highest among Hispanics, and lowest among blacks for both years. Incidence rates among age groups varied between years by increasing in people 50 years and older from 1998 to 1999 as a result of a single cafeteria-related outbreak of 150 cases in March 1999. Infection with hepatitis A virus remains the most reported vaccine-preventable disease in the United States.

Adolescent↗
PubMed1992

[Treatment of injuries in the county of Ringkøbing. 4. Referral and transport of severe traffic accident traumas].

In Denmark, all cases of severe injuries are referred to the nearest hospital regardless of the size of the hospital and the county boundaries. In order to investigate whether this type of referral functions according to plan, the authors investigated referral of all traffic accidents in the County of Ringkøbing during the period 1 January 1983 to 31 December 1990. It was demonstrated that in only one out of 310 traffic accidents with fatal outcome, referral did not function according to plan and that the patient had been transported to a hospital which was not the nearest. It is thus concluded that referral now functions according to plan in its present form. In addition, the authors investigated whether there was any basis for establishing prehospital treatment of injuries in the country. It was found, however, that during a period of eight years (analysed on the basis of post mortem data) a maximum of 20 relevant patients would be involved annually and in whom the mortality might be reduced was concerned. Simultaneously, the average distance for transport to the nearest hospital was found to be only 12.9 km. There is thus no basis for employing massive resources for advanced prehospital service in the County of Ringkøbing. With an ambulance service staffed by doctors from the anaesthetic and intensive care units of the central hospitals it is possible to provide prehospital treatment in 70% of all severe traffic injuries in the County of Ringkøbing.

Accidents, Traffic↗
PubMed2003

Teen pregnancy in South Carolina: a local needs assessment of Charleston County.

Although there has been recent improvement, teen pregnancy continues to be a significant problem, especially in South Carolina where the birth rate to adolescents is higher than the national average. As this is a complex issue, many different interventions including both primary and secondary prevention as well as modification of programs to fit each individual community will be necessary. One initial approach to pregnancy prevention program implementation is a needs assessment of current interventions compared with teen birth rates in a community. This report of a needs assessment for Charleston County revealed a discrepancy between the location of most pregnancy prevention programs (urban areas of the county) and the higher teen birth rates (rural areas of the county,) establishing areas that will be targeted for additional services. Other counties throughout South Carolina may find this approach useful in coordination of community efforts to reduce teen pregnancy.

Adolescent↗
PubMed2004

Should we be worried? Investigation of signals generated by an electronic syndromic surveillance system--Westchester County, New York.

INTRODUCTION: In January 2003, the Westchester County Department of Health (WCDH) began conducting electronic syndromic surveillance of hospital emergency department (ED) chief complaints. Although methods for data collection and analysis used in syndromic surveillance have been described previously, minimal information exists regarding the responses to and investigations of signals detected by such systems. This paper describes WCDH's experience in responding to syndromic surveillance signals during the first 9 months after the system was implemented. OBJECTIVES: The objectives of this analysis were to examine WCDH's responses to signals detected by the county's syndromic surveillance system. Specific goals were to 1) review the actual complaints reported by hospital EDs to determine whether complaint data were accurately identified and classified into syndrome categories, and provide feedback from this review to data collection and analysis staff to refine text terms or filters used to identify and classify chief complaints; 2) develop procedures and response algorithms for investigating signals; 3) determine whether signals correlated with reportable communicable diseases or other incidents of public health significance requiring investigation and intervention; and 4) quantify the staffing resources and time required to investigate signals. METHODS: During January 27-October 31, 2003, electronic files containing chief-complaint data from seven of the county's 13 EDs were collected daily. Complaints were classified into syndrome categories and analyzed for statistically significant increases. A line listing of each complaint comprising each signal detected was reviewed for exact complaint, number, location, patient demographics, and requirement for hospital admission. RESULTS: A total of 59 signals were detected in eight syndrome categories: fever/influenza (11), respiratory (6), vomiting (11), gastrointestinal illness/diarrhea (8), sepsis (7), rash (7), hemorrhagic events (3), and neurologic (6). Line-listing review indicated that complaints routinely were incorrectly identified and included in syndrome categories and that as few as three complaints could produce a signal. On the basis of hospital, geographic, age, or sex clustering of complaints, whether the complaint indicated a reportable condition (e.g., meningitis) or potentially represented an unusual medical event, and whether rates of hospital admission were consistent with medical conditions, 34 of 59 signals were determined to require further investigation (i.e., obtaining additional information from ED staff or medical providers). Investigation did not identify any reportable communicable disease or other incidents of public health significance that would have been missed by existing traditional surveillance systems. Nine staff members spent 3 hours/week collectively investigating signals detected by syndromic surveillance. CONCLUSIONS: Standardized sets of text terms used to identify and classify hospital ED chief complaints into syndrome categories might require modification on the basis of hospital idiosyncrasies in recording chief complaints. Signal investigations could be reasonably conducted by using local health department resources. Although no communicable disease events were identified, the system provided baseline and timely objective data for hospital visits and improved communication among county health department and hospital ED staff.

Disease Outbreaks↗
PubMed2005

Counties selecting public health priorities--a "bottom-up" approach (Croatian experience).

The subject of this paper is how to incorporate a multi-disciplinary and inter-sectored approach into development of public health policy and plans at the local (county) level in Croatia by educational program. Method used was the public health capacity building program "Health--Plan for it", which was developed with the aim to assist the counties to overcome recognized weaknesses and introduce more effective and efficient local public health practices. Two main instruments were used: Local Public Health Practice Performance Measures Instrument, and Basic Priority Rating System. This program has helped counties to asses population health needs in a participatory manner, to plan for health and, ultimately, assure provision of the right kind and quality of services (better tailored to population health needs). This program's benefits are going beyond and above the county level. It provides support for the Healthy Cities project locally, and facilitates changes in national policymaking body's mindset that a "one-size-fits-all" approach is sufficient.

Croatia↗
PubMed2005

[An epidemiological study on vaccine derived polio virus circle in Zhenfeng County of Guizhou Province].

OBJECTIVE: To analyze the event and cause of vaccine derived polio virus (VDPV) circle happened at Yaoshang Village, Wanlan Township, Zhenfeng County, Qianxinan Prefecture, Guizhou Province in August 2004. METHODS: Virus isolation was performed for stool specimens collected from two children cases with acute flaccid paralysis (AFP) reported at Yaoshang Village and 21 normal children under five years old in the same village. And, routine immunization coverage at the Village and AFP incidence and performance of AFP surveillance system in Zhenfeng County were investigated, as well. RESULTS: Vaccine derived polio virus 1 (VDPV1) was identified in the feces of two affected children at Yaoshang Village and three other normal children at the same village. Totally, seven cases of AFP have been underreported in Zhenfeng County since 2002. Routine immunization coverage was rather low at Wanlan Township, and nearly nil at Yaoshang Village. CONCLUSIONS: Oral polio vaccine (OPV) with attenuated live virus has been used in China for many years to prevent polio. Circulation of VDPV in Zhenfeng County issues a new challenge to eradication of polio. It is necessary to strengthen routine immunization and AFP surveillance to prevent occurrence of VDPV event.

Child, Preschool↗
PubMed1991

[A seroepidemiological survey of neutralization antibodies to polioviruses in Linqu and Yucheng counties of Shandong Province, China].

Two hundred and fifty two serum samples from Linqu county and 249 serum samples from Yucheng county, in Shandong province, China, were collected among the age group of 0-, 1-, 2-, 3- and 5-9 years old and assayed by microneutralization test in 1989. The results showed that the positive rates (PRs) and geometric mean titres (GMTs) of antibodies to poliovirus type 1-3 in Linqu county were 82.54%, 80.56%, 82.94% and 27.06, 22.94, 24.24, respectively, and much significantly higher than those, in Yucheng county (84.34%, 51.81%, 59.04% and 16.78, 2.79, 3.40) except the PR to typel.for children in both countries, the PRs and GMTs were highest in the age group of 2-4 years old, and no significant difference was found between male and female. All above indicated that EPI was helpful for improving immune status of children, the coverage of TOPV and quality of vaccination should still be emphasized in future EPI works.

Antibodies, Viral↗
PubMed2006

Rapid community needs assessment after Hurricane Katrina--Hancock County, Mississippi, September 14-15, 2005.

On August 29, 2005, Hurricane Katrina moved northeast from Louisiana and made its second landfall over Hancock County, Mississippi, with measured wind speeds as high as 132 mph. Katrina's strong winds and high storm surge (an estimated 27 feet in Hancock County) ravaged the Mississippi coast, making it one of the strongest storms to strike the United States during the past 100 years and likely the nation's costliest natural disaster to date. Hurricane Katrina left thousands of residents without shelter, food, water, utilities, and access to health care. To obtain information about the effects of the hurricane on residents in Hancock County, the Mississippi Department of Health (MDH) asked CDC to conduct a rapid community needs assessment in what was presumed to be the state's most severely affected county. The objectives of the assessment were to 1) identify the public health needs of the community and 2) estimate the effect of the hurricane on households to assist response and recovery activities. This report describes the results of that assessment, which indicated that more than one third of the homes had been destroyed, many in the area lacked critical household services and remained dependent on relief agencies, and some were in need of health services such as medical care and prescription refills.

Disasters↗
PubMed2006

National Children's Study: environmental exposures in Waukesha County.

The National Children's Study (NCS), launched in September of 2005, will investigate the effects of environmental exposures and children's health and development. Waukesha County, Wis was selected as 1 of 7 sites to spearhead this ambitious undertaking. Residents of Waukesha County may experience different kinds of environmental exposures from water, land, and air based on where they live, work, and play. A selected number of Waukesha County's environmental exposures described briefly in this report will serve the NCS well with their heterogeneity of potential exposures: from private well water and community water supplies that obtain water from both surface and groundwater; from the variable exposures to ambient air pollution from mobile sources, local industrial sources, and distant sources (ozone); and the different levels of exposures from soil and dust depending on the prevalence of pesticide use and lead-based paints. By combining data gathered from Waukesha County's participants with other study sites, a holistic picture of environmental exposures in the United States can be evaluated as it influences the health of our nation's children.

Child↗