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PubMed2002

Environmental tobacco smoke exposure and nocturnal symptoms among inner-city children with asthma.

BACKGROUND: Environmental tobacco smoke (ETS) is a frequent exposure and is linked to asthma among inner-city children. OBJECTIVE: We sought to examine the relationship among ETS exposure, select asthma symptoms, and consequences among inner-city children with asthma. METHODS: Data from interviews with primary caregivers of inner-city elementary school children with asthma were evaluated (n = 590). Caregiver reports of child asthma symptoms, exercise limitations, asthma management, health care use, and ETS exposure were examined. RESULTS: Smoking in the home was reported by 29.4% of primary caregivers. ETS exposure (yes/no) was not related to frequency of child nocturnal symptoms or other select asthma morbidity markers. However, among children exposed to ETS, the frequency and severity of child nocturnal symptoms were highest among children exposed to moderate-to-heavy levels of ETS. After controlling for child age, anti-inflammatory medication use, asthma primary care, and caregiver's education, exposure to higher levels of ETS was associated with nearly a 3-fold increase in nocturnal symptoms in children (odds ratio, 2.83; 95% CI, 1.22-6.55). CONCLUSION: Among elementary school inner-city children with asthma, exposure to higher levels of ETS was associated with increased frequency of nocturnal symptoms. Reducing the exposure of children with asthma to ETS should be a clear priority in developing effective asthma management plans for inner-city families.

Adult↗
PubMed2003

The prevalence of rat allergen in inner-city homes and its relationship to sensitization and asthma morbidity.

BACKGROUND: Rat allergen has proved to be an important cause of IgE-mediated hypersensitivity in the occupational setting. The prevalence and significance of rat allergen in homes has not been studied. OBJECTIVE: The purpose of this study was to determine the prevalence of rat allergen in the homes of inner-city children with asthma and to examine the relationship between rat allergen exposure, sensitization, and asthma morbidity. METHODS: We developed a new monoclonal-based ELISA to determine the prevalence of rat allergen in dust samples from inner-city homes of the National Cooperative Inner-City Asthma Study population. Home characteristics were evaluated to detect variables that were associated with the presence of rat allergen. Data were also analyzed to assess the relationship between the presence of rat allergen, sensitization, and asthma morbidity. RESULTS: Thirty-three percent of inner-city homes had detectable rat allergen (Rat n 1). The presence of rat allergen was associated with reported rat and mouse infestation, as well as evidence of mouse infestation on home inspection. Twenty-one percent of the participants were sensitized to rat allergen; however, sensitization was not more common when rat allergen was found in the home. The number of hospitalizations, unscheduled medical visits, and days with slowed activity because of asthma were significantly increased in those individuals who were both sensitized and exposed to rat allergen. CONCLUSIONS: Rat allergen sensitization and exposure are associated with increased asthma morbidity in inner-city children.

Allergens↗
PubMed2000

Malignant neoplasms of the nasal cavity and paranasal sinuses: a series of 256 patients in Mexico City and Monterrey. Is air pollution the missing link?

Air pollution is a serious health problem in major cities in Mexico. The concentrations of monitored criteria pollutants have been above the US National Ambient Air Quality Standards for the last decade. To determine whether the number of primary malignant nasal and paranasal neoplasms has increased, we surveyed 256 such cases admitted to a major adult oncology hospital located in metropolitan Mexico City (MMC) for the period from 1976-1997 and to a tertiary hospital in Monterrey, an industrial city, for the period from 1993-1998. The clinical histories and histopathologic material were reviewed, and a brief clinical summary was written for each case. In the MMC hospital the number of newly diagnosed nasal and paranasal neoplasms per year for the period from 1976-1986 averaged 5.1, whereas for the next 11 years it increased to 12.5. The maximal increase was observed in 1995-1997, with an average of 20.3 new cases per year (P = 0.0006). The predominant neoplasms in these series were non-Hodgkin's lymphoma, squamous cell carcinoma, melanoma, adenocarcinoma, Schneiderian carcinoma, and nasopharyngeal carcinoma. In the Monterrey hospital a 2-fold increase in the numbers of newly diagnosed nasal and paranasal neoplasms was recorded between 1993 and 1998. The predominant MMC neoplasm in this series, namely nasal T-cell/natural killer cell non-Hodgkin's lymphoma, is potentially Epstein-Barr virus related. Nasal and paranasal malignant neoplasms are generally rare. Environmental causative factors include exposure in industries such as nickel refining, leather, and wood furniture manufacturing. Although epidemiologic studies have not addressed the relationship between outdoor air pollution and sinonasal malignant neoplasms, there is strong evidence for the nasal and paranasal carcinogenic effect of occupational aerosol complex chemical mixtures. General practitioners and ear, nose, and throat physicians working in highly polluted cities should be aware of the clinical presentations of these patients. Identification of this apparent increase in sinonasal malignant neoplasms in two urban Mexican polluted cities warrants further mechanistic and epidemiologic studies.

Adenocarcinoma↗
PubMed1987

On the size distribution of cities: an economic interpretation of the Pareto coefficient.

"Both the hierarchy and the stochastic models of size distribution of cities are analyzed in order to explain the Pareto coefficient by economic variables. In hierarchy models, it is found that the rate of variation in the productivity of cities and that in the probability of emergence of cities can explain the Pareto coefficient. In stochastic models, the productivity of cities is found to explain the Pareto coefficient. New city-size distribution functions, in which the Pareto coefficient is decomposed by economic variables, are estimated."

Demography↗
PubMedDate not supplied

Effect of lead on fetal growth in a Canadian smelter city, 1961-1990.

The fetuses of women who live adjacent to a large lead smelter may experience intrauterine growth retardation that results from the mothers' systemic availability of lead absorbed from their environment. In this study, the authors used 30 y of birth records (n = 9329) to obtain fetal growth measurements for the smelter city and a suitable control city. The authors determined rates of intrauterine growth retardation (small-for-date births) for 5-y periods, and they determined the estimated relative risk of intrauterine growth retardation that occurred in the smelter city and compared it with the control city. The risk of intrauterine growth retardation for women in the smelter city was not significantly greater (odds ratio = 0.83) for either the 30-y period or each of the 5-y periods (odds ratio range = 0.51-1.33). The authors concluded that fetal growth was not affected by the amount of lead absorbed by women who lived in a smelter environment.

Air Pollutants↗
PubMed2005

Prevalence of probable mental disorders among pediatric asthma patients in an inner-city clinic.

OBJECTIVE: To determine the screen-positive prevalence of anxiety disorders and depression among pediatric asthma patients in an inner-city asthma clinic and to investigate the association between probable diagnoses of anxiety disorders and depression and medical service use among inner-city pediatric asthma patients. METHOD: In this pilot study, a consecutive sample of pediatric asthma patients aged 5-11 in the waiting room of an inner-city asthma clinic was screened for mental disorders using the DISC Predictive Scales (DPS), which produces probable DSM-IV diagnoses. In addition, data on health service use for asthma were collected. Statistical analyses were performed to examine the relationship between probable anxiety disorders and depression and health service use for asthma among pediatric asthma patients. RESULTS: Approximately one in four (25.7%) pediatric asthma patients in an inner-city asthma clinic met criteria for a probable diagnosis of current anxiety disorders or depression (past 4-week prevalence). Specifically, childhood separation anxiety disorder was common among 8.1%, panic among 14.9%, generalized anxiety disorder among 4.1%, agoraphobia among 5.4%, and 2.7% had depression. Having more than one anxiety disorder or depression diagnosis was associated with higher levels of inpatient and outpatient medical services, compared with patients who were negative on screening for anxiety or depressive disorders, although differences failed to reach statistical significance. CONCLUSIONS: These findings are the first to provide preliminary evidence suggesting that mental health problems are common among pediatric asthma patients in an inner-city clinic. The results also suggest that mental health problems in pediatric asthma patients may be associated with elevated levels of medical service use for asthma. Replication of this pilot study is needed with a larger sample, more precise diagnostic methodology, and a comparison group with chronic medical illness.

Ambulatory Care Facilities↗
PubMed1997

The Australian Study of HIV and Injecting Drug Use. Part I: prevalence for HIV, hepatitis B and hepatitis C among injecting drug users in four Australian cities.

The objective of this study was to assess differences in HIV, hepatitis B and hepatitis C seroprevalence among injecting drug users (IDU) in four Australian cities. Eight hundred and seventh-two current IDU were recruited in approximately equal numbers from each of Adelaide, Melbourne, Perth and Sydney, and interviewed individually using a structured questionnaire. Fingerprick blood samples were taken from the majority of respondents, and tested for past exposure to the three viruses. HIV and hepatitis B and C raw seroprevalences were compared across cities, and comparisons were made of age-standardized seroprevalences for hepatitis B and C. Three percent of all respondents were HIV seropositive; 19% (23% age-standardized) were hepatitis B seropositive and 55% (60% age-standarized) were hepatitis C seropositive. There were general city differences and gender, sexual preference and treatment status group differences between the cities. Sydney respondents had the highest risk of infection for all three viruses in all comparisons. This was particularly striking for HIV among non-heterosexual men. Various explanations for the findings were considered, including city differences in demographic and drug use variables, underlying patterns of risk behaviour, and period/cohort effects. It was concluded that none of these explanations appeared to fit the pattern of findings, and that these probably represented true underlying differences in size of pools of infection. The reasons for this, however, cannot be ascertained from this study.

Journal Article↗
PubMed2003

Engines for experiment: laboratory revolution and industrial labor in the nineteenth-century city.

This article brings together what until now have been separate fields of nineteenth-century history: the development of experimental physiology, the growth of mechanized industry, and the city, where their threads intertwined. The main argument is that the laboratory in the city employed the same technological and organizational approaches to modernize that the city used to industrialize. To bring the adoption of technology into focus, the article discusses laboratory research as it developed after the introduction of small-scale power engines. With its machines, the industrialized city provided not only the key metaphor of the nineteenth-century life sciences but also a key technology that shifted experimental practices in animal research from a kind of preindustrial craft to a more mechanized production of knowledge. With its "factory-laboratories," the late-nineteenth-century city became the birthplace for the first living, data-producing hybird---part animal and part machine.

Employment↗
PubMed2002

Temperature and mortality in 11 cities of the eastern United States.

Episodes of extremely hot or cold temperatures are associated with increased mortality. Time-series analyses show an association between temperature and mortality across a range of less extreme temperatures. In this paper, the authors describe the temperature-mortality association for 11 large eastern US cities in 1973-1994 by estimating the relative risks of mortality using log-linear regression analysis for time-series data and by exploring city characteristics associated with variations in this temperature-mortality relation. Current and recent days' temperatures were the weather components most strongly predictive of mortality, and mortality risk generally decreased as temperature increased from the coldest days to a certain threshold temperature, which varied by latitude, above which mortality risk increased as temperature increased. The authors also found a strong association of the temperature-mortality relation with latitude, with a greater effect of colder temperatures on mortality risk in more-southern cities and of warmer temperatures in more-northern cities. The percentage of households with air conditioners in the south and heaters in the north, which serve as indicators of socioeconomic status of the city population, also predicted weather-related mortality. The model developed in this analysis is potentially useful for projecting the consequences of climate-change scenarios and offering insights into susceptibility to the adverse effects of weather.

Climate↗
PubMed1991

Effect of long-term community health education on body mass index. The Stanford Five-City Project.

Being overweight is a risk factor for cardiovascular heart disease and other medical problems. The purpose of this study was to examine the effect of a community-wide cardiovascular risk reduction trial (the Stanford Five-City Project) on body mass index. In the Stanford Five-City Project, two treatment cities (n = 122,800) received a 6-year mass media and community organization cardiovascular risk reduction intervention. Changes in the treatment cities were compared with two control cities (n = 197,500) for changes in knowledge of risk factors, blood pressure, plasma cholesterol level, smoking rate, body mass index, and resting pulse rate after 5-1/3 years of the education program. Both cohort and cross-sectional (independent) samples were used in the study. In the independent surveys, subjects in the treatment communities gained significantly less weight than subjects in the control communities (0.57 kg compared with 1.25 kg) over 6 years. In the cohort, there were no significant overall differences. The study provides some evidence that a community health education program may help reduce weight gain over time, but more effective methods must be developed if this important risk factor is to be favorably affected in broad populations.

Adult↗
PubMed2002

Explosive spread and high prevalence of HIV infection among injecting drug users in Togliatti City, Russia.

OBJECTIVE: To establish the prevalence of antibodies to HIV (anti-HIV) and associated risk factors among injecting drug users (IDU) in Togliatti City, Samara Oblast, Russian Federation. DESIGN: An unlinked anonymous cross-sectional community recruited survey with oral fluid sample collection. METHODS: Between September and October 2001, 426 IDU were recruited by trained fieldworkers. Participants completed an interviewer administered questionnaire, and oral fluid samples were tested for anti-HIV. Univariate and multivariate analyses compared potential risk factors for anti-HIV. RESULTS: Anti-HIV prevalence was 56% (234/418). Three-quarters of anti-HIV-positive IDU (74%) were unaware of their positive status. In an adjusted model, the odds of HIV infection were higher among IDU who had ever injected home-produced drugs, who reported injecting with used needles and syringes in the past 4 weeks, and who were living in one particular district of the city (Komsomolksii). CONCLUSION: The high prevalence of HIV, and a recent increase in HIV detected through routine screening tests since 2000, suggests that an explosive epidemic has occurred among IDU in Togliatti City. In the face of currently inadequate HIV prevention coverage among IDU, this has urgent implications for maximizing the distribution of sterile injecting equipment as well as for enhancing sexual risk reduction. Recognizing that it is likely that similar explosive epidemics are taking place in other Russian cities, we recommend community-wide HIV prevention coverage supported by city and state policies oriented to harm reduction.

AIDS Serodiagnosis↗
PubMed2006

Retrospective survey of 452 patients with inflammatory bowel disease in Wuhan city, central China.

BACKGROUND: Inflammatory bowel disease (IBD) had been uncommon in China until about 1990, but since then, it has been seen in the clinical setting more and more. The prevalence and phenotype of IBD in the Chinese population is not well known. The present study investigates the trend of prevalence in ulcerative colitis (UC) and Crohn's disease (CD) in Wuhan City, central China, and evaluates clinical features, extraintestinal manifestations, and the treatment of IBD in the last 14 years. METHODS: Three hundred and eighty-nine patients with UC and 63 patients with CD were retrospectively collected from 5 central hospitals in Wuhan City, in which high-quality endoscopic and histological diagnoses were available from 1990 to 2003. UC and CD were diagnosed based on clinical, experimental, radiological, endoscopic, and histological examinations according to the internationally accepted Lennard-Jones criteria. RESULTS: The trend toward prevalence of UC and CD increased between 1990 and 2003 in Wuhan City. There was no change in the sex and age distribution comparing 1990 to 1996 with 1997 to 2003 both in UC and CD. However, the number of individuals with higher education and a professional occupation during 1997 to 2003 was significantly higher than that during the period 1990 to 1996 in patients with UC (OR 2.1, 95% CI 1.27-3.35, P = 0.004; OR 2.2, 95% CI 1.31-3.61, P = 0.003). The mean age of patients with CD was significantly younger than that of UC at the time of diagnosis (32.6 +/- 12.5 vs. 42 +/- 14.5, P < 0.0001). The ratio of male to female patients was 1.53:1 in UC and 2.32:1 in CD, respectively. The mean duration of onset of the disease to diagnosis was 1.4 years in UC and 1.1 years in CD. The extra intestinal manifestations of UC and CD were 5.7% and 19%, respectively, and complications of UC and CD were 6.4% and 50.8%, respectively. Only 3% of UC patients required surgery, whereas 27% of CD patients underwent surgical procedures (P < 0.001). CONCLUSION: The prevalence of IBD has increased in Wuhan City, central China, but is not as high as in Western countries. The disease in Wuhan City has often been associated with young adult professional males with a high level of education. The clinical presentation of UC was often mild and had few extra intestinal manifestations.

Adolescent↗
PubMed2006

Prevalence of HIV, hepatitis C and syphilis among injecting drug users in Russia: a multi-city study.

OBJECTIVES: To estimate the prevalence of HIV, hepatitis C virus (HCV) and syphilis in injecting drug users (IDUs) in Russia. METHODS: Unlinked anonymous cross-sectional survey of 1473 IDUs recruited from non-treatment settings in Moscow, Volgograd and Barnaul (Siberia), with oral fluid sample collection for HIV, HCV antibody (anti-HIV, anti-HCV) and syphilis testing. RESULTS: Prevalence of antibody to HIV was 14% in Moscow, 3% in Volgograd and 9% in Barnaul. HCV prevalence was 67% in Moscow, 70% in Volgograd and 54% in Barnaul. Prevalence of positive syphilis serology was 8% in Moscow, 20% in Volgograd and 6% in Barnaul. Half of those HIV positive and a third of those HCV positive were unaware of their positive status. Common risk factors associated with HIV and HCV infection across the cities included both direct and indirect sharing of injecting equipment and injection of home-produced drugs. Among environmental risk factors, we found increased odds of anti-HIV associated with being in prison in Moscow, and some association between official registration as a drug user and anti-HIV and anti-HCV. No associations were found between sexual risk behaviours and anti-HIV in any city. CONCLUSIONS: HIV prevalence among IDUs was markedly higher than city routine surveillance data suggests and at potentially critical levels in terms of HIV prevention in two cities. HCV prevalence was high in all cities. Syphilis prevalence highlights the potential for sexual risk and sexual HIV transmission. Despite large-scale testing programmes, knowledge of positive status was poor. The scaling-up of harm reduction for IDUs in Russia, including sexual risk reduction, is an urgent priority.

Adolescent↗
PubMed1998

Rates of dental service provision between capital city and non-capital locations in Australian private general practice.

Variations in service provision between geographical locations may be associated with factors such as imbalances in the availability of health services. The aim of this analysis was to examine differences in dental service provision between capital city and non-capital locations. Data were used from a survey collected in 1993/94 from a random sample of Australian dentists, providing 817 responses (a response rate of 74%). Dentists from capital city locations comprised 71.8% of responding private general practitioners. Significantly more services per visit (Mann-Whitney, P < 0.05) were provided at capital city locations (mean = 2.16, 95% CI = 2.08-2.24) compared to non-capital locations (mean = 1.84, 95% CI = 1.74-1.94). Controlling for age of patient, insurance status and visit type, capital city locations included significantly higher rates of service per visit (P < 0.05) for adult dentate patients (rate ratios, 95% CI) of diagnostic (1.17, 1.09-1.25), preventive (1.20, 1.09-1.32), periodontal (2.71, 1.72-4.26), and crown and bridge (1.25, 1.03-1.53) services, but lower rates of prosthodontic (0.80, 0.67-0.94) services compared to non-capital locations. These findings indicate that compared to non-capital locations, capital city patients received care that was more orientated towards prevention and maintenance of teeth, rather than replacement by dentures.

Adult↗
PubMed2006

Off-axis symbiosis found: Characterization and biogeography of bacterial symbionts of Bathymodiolus mussels from Lost City hydrothermal vents.

Organisms at hydrothermal vents inhabit discontinuous chemical 'islands' along mid-ocean ridges, a scenario that may promote genetic divergence among populations. The 2003 discovery of mussels at the Lost City Hydrothermal Field provided a means of evaluating factors that govern the biogeography of symbiotic bacteria in the deep sea. The unusual chemical composition of vent fluids, the remote location, and paucity of characteristic vent macrofauna at the site, raised the question of whether microbial symbioses existed at the extraordinary Lost City. If so, how did symbiotic bacteria therein relate to those hosted by invertebrates at the closest known hydrothermal vents along the Mid-Atlantic Ridge (MAR)? To answer these questions, we performed microscopic and molecular analyses on the bacteria found within the gill tissue of Bathymodiolus mussels (Mytilidae, Bathymodiolinae) that were discovered at the Lost City. Here we show that Lost City mussels harbour chemoautotrophic and methanotrophic endosymbionts simultaneously. Furthermore, populations of the chemoautotrophic symbionts from the Lost City and two sites along the MAR are genetically distinct from each other, which suggests spatial isolation of bacteria in the deep sea. These findings provide new insights into the processes that drive diversification of bacteria and evolution of symbioses at hydrothermal vents.

Animals↗
PubMed2001

Social disadvantage and variation in the incidence of end-stage renal disease in Australian capital cities.

OBJECTIVE: To evaluate variation in the incidence of end-stage renal disease (ESRD) within Australian capital cities. To explore the relation between the incidence of ESRD and socioeconomic disadvantage. METHODS: We obtained data from the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) regarding 5,013 patients from capital cities who started ESRD treatment between 1 April 1993 and 31 December 1998. We used the postcode at the start of treatment to calculate the average annual incidence of ESRD for each of 51 capital city regions using 1996 Census counts based on place of usual residence. We calculated standardised incidence ratios with 95% confidence intervals for each region. The standardised incidence ratios were examined in relation to the SEIFA Index of Relative Socio-economic Disadvantage (IRSD), derived from the 1996 Census. Low IRSD values indicate more disadvantaged areas. RESULTS: There is significant variation in the standardised incidence of ESRD within capital cities. There was a significant correlation (r=-0.41, p=0.003) between the standardised incidence ratio for ESRD and the SEIFA IRSD. CONCLUSIONS AND IMPLICATIONS: Capital city areas that are more disadvantaged have a higher incidence of ESRD. Socioeconomic factors may be important determinants of the risk of developing ESRD.

Australia↗
PubMedDate not supplied

A targeted testing program for tuberculosis control and prevention among Baltimore city's homeless population.

OBJECTIVE: To identify cases of latent tuberculosis infection (LTBI) and improve access to TB treatment among the inner-city homeless. DESIGN: This is an intervention study describing the impact of a public health program on TB prevention and control. SAMPLE: The target population for the project was residents and recent graduates of a residential addictions recovery program in a faith-based, inner-city mission. INTERVENTION: Faculty and student nurses administered purified protein derivative (PPD) tuberculin skin tests and TB symptom assessments on site to homeless Mission residents. Residents testing positive for TB infection were referred to the local city health department for follow-up. Residents placed on prophylactic therapy received intensive tracking and coaching interventions to encourage adherence to the 9-month regimen. RESULTS: Ninety-eight percent of the target population was screened for LTBI. Ninety percent of residents requiring treatment for LTBI successfully accessed treatment services. Thirty-three percent of residents completed at least 6 months of treatment. CONCLUSION: The program demonstrated a modest improvement in treatment completion among the inner-city homeless when compared with local City Health Department treatment completion rates. This program demonstrates how a faith-based organization, an academic institution, and local government can successfully partner together to meet community needs.

Baltimore↗
PubMed2005

Total fluoride intake in children aged 22-35 months in four Colombian cities.

OBJECTIVE: To obtain information on the level of total fluoride intake from food, beverages and toothpaste by children at the age of 22-25 months of low and high socioeconomic status (SES) in major Colombian cities. METHODS: Daily fluoride intake was assessed by the duplicate plate method and by recovered toothpaste solution during a 3-day period and afterwards analysed by the microdiffusion method. RESULTS: Mean daily fluoride intake was 0.11 (+/-0.10), 0.14 (+/-0.12), 0.10 (+/-0.07) and 0.07 (+/-0.06) mg/kg body weight (bw)/day in Bogota, Medellin, Manizales and Cartagena, respectively. The total fluoride intake was higher in low-SES subjects in the cities of Medellin and Bogota. In the high-SES children of the four cities, the average intakes ranged from 0.06 to 0.09 mg F/kg bw, whereas, the low-SES children in three cities had intakes between 0.11 and 0.21 mg F/kg bw (Cartagena, 0.07). Toothpaste (containing 1000-1500 ppm F, with 1500 ppm F being more common) accounted for approximately 70% of total fluoride intake, followed by food (24%) and beverages (<6%). More than half the children had their teeth brushed by an adult, on average twice a day, using 0.22-0.65 g of toothpaste. CONCLUSION: Children from three Colombian cities have a mean total daily fluoride intake above the 'optimal range'. Health authorities should promote an appropriate use of fluoridated dentifrices discouraging the use of dentifrices containing 1500 ppm F in children younger than 6 years of age and promoting a campaign of education of parents and oral health professionals on adequate toothbrushing practices.

Analysis of Variance↗