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PubMed2006

[Screening for cervical cancer in the county of Funen. Status of 25 years of development and experiences].

INTRODUCTION: Since 1979 screening against cervical cancer has been conducted in the County of Funen. In the period 1979-1988 the screening against cervical cancer was opportunistic, where women aged 25-55 years had a PAP-smear taken once a year by their GP or gynaecologists at the hospitals. In this period the coverage was only about 50% and the number of cervical cancer was not decreasing as seen in Counties with organised screening programmes. Since 1989 the screening has been organised in the County of Funen, which will be described in the following, including updating and quality improvements such as implementation of liquid based cytology and semiautomated screening (ThinPrep Imaging System, Cytyc). MATERIAL AND METHOD: The programme is based on an automated call-recall system designed to invite women aged 23-59 years. The offer is free of charge and the PAP-smears are taken by the general practitioners. All cervical cytological samples from the County are processed and screened at the Department of Pathology Odense University Hospital. Since 2001 the liquid based technique, ThinPrep-Paptest, has been used, and from 2004 an assisted screening (ThinPrep Imaging System) has been implemented in the routine screening. RESULTS: Switching from opportunistic to organised screening and implementation of liquid based cytology has resulted in a reduction in the number of samples, about 6,500 per year. The diagnostic quality has increased; the number of incidences of cervical cancer was reduced from 62 in 1988 to 18 in 2004 and the mortality from 29 in 1988 to 12 in 2001. CONCLUSION: Since implementation of the organized screening programme and later of the liquid based cytology the coverage and diagnostic quality have increased. The incidence and mortality of cervical cancer have decreased.

Adult↗
PubMed1990

Pneumococcal bacteremia in Charleston County, South Carolina. A decade later.

Since nationwide surveillance for pneumococcal bacteremia in the United States is not done, community-based studies are useful alternative methods to monitor trends in this disease. Data on the incidence of pneumococcal bacteremia in Charleston County, South Carolina, from 1974 to 1976, have been used to support cost-effective pneumococcal vaccine programs for the elderly. We reevaluated the incidence of pneumococcal bacteremia in Charleston County in 1986 and 1987 to assess whether earlier estimates remained valid given changes in medical practice. During 1986 and 1987, overall annual incidence of pneumococcal bacteremia in Charleston County was 18.7 per 100,000 (95% confidence limits, 13.7 to 23.6 per 100,000), which represents a 2.3-fold increase over the earlier rate. The increase coincided with a 2.2-fold increase in the annual number of blood cultures processed at four Charleston County hospital laboratories from 1975 to 1987 despite only a 1.1-fold increase in the number of patients discharged from these hospitals. Annualized rates increased 2.3-fold for adults more than or equal to 65 years old to 53 per 100,000 and 4.6-fold for children less than 2 years old to 162 per 100,000. The case-fatality rate of bacteremic patients was 18%, compared with 21% in the earlier study. The case-fatality rate for adults more than or equal to 65 years of age was 44%. Ninety-one percent of adults 19 to 64 years old with bacteremia had underlying medical conditions for which pneumococcal vaccine is recommended; all persons 55 to 64 years old had at least one underlying condition. The marked increases in pneumococcal bacteremia rates detected are likely due to more routine culturing of blood from symptomatic patients with pneumococcal disease. These findings emphasize the need for effective programs promoting use of pneumococcal vaccine in high-risk groups, particularly those more than or equal to 65 years old, and the development of a more immunogenic vaccine for children less than 2 years old.

Adult↗
PubMed1990

[The epidemiological study of esophageal cancer at Yangcheng County in Shanxi].

This paper indicated that counties with higher incidence of esophageal cancer in Shanxi were found to centre round Yangcheng, Jincheng, Qinshui etc. by means of an analysis of the gathered areas on mortality of esophageal cancer in every county or city in Shanxi. These form a higher incidence area of noticeable and centric distribution together with other counties in Henan and Hebei. In all towns in Yangcheng, however, there is no gathered areas. Since 1974, the observed tendency of esophageal cancer in Yangcheng has shown that the mortality ranges from 120-150/100,000, without change in male and in female. However, among the population, the mortality in male is always higher than in female. And it increases with age in people over 30 years. Hereditary epidemiological data at Yanli Town in the county has demonstrated that there is significant difference between the distribution of incidence and mortality of esophageal cancer and the probability of binomial distribution, showing obvious familiar gathering of esophageal cancer.

Adult↗
PubMed1988

Drowning mortality in Los Angeles County, 1976 to 1984.

Drowning is the fourth leading cause of unintentional injury death in Los Angeles County. We examined data collected by the Los Angeles County Coroner's Office on drownings that occurred in the county from 1976 through 1984. There were 1587 drownings (1130 males and 457 females) during this nine-year period, for an annual rate of 2.36 drownings per 100,000 persons (3.44 for males and 1.33 for females). The largest proportion of drownings (44.5%) for both sexes, and in almost every age group, occurred in private swimming pools. Children 2 to 3 years of age had the highest swimming-pool drowning rate (7.95). The elderly also experienced high drowning rates, primarily in swimming pools and bathtubs. Drowning-site profiles varied dramatically by age and sex. These findings indicate a need for Los Angeles County to address the problem of drownings among infants and toddlers in private swimming pools and to investigate the failure of regulations requiring fencing of swimming pools to prevent these deaths. These findings also suggest several potential opportunities for preventive intervention by physicians and demonstrate that health professionals cannot rely on national drowning-site profiles when developing local drowning prevention strategies.

Adolescent↗
PubMedDate not supplied

A study of underreporting of Down's syndrome on birth certificates in an Ohio County, 1970-78.

In a previous statewide assessment in Ohio of the percentage reporting of Down's syndrome (DS) on birth certificates, it was found that 33.9 percent of the cases chromosomally analyzed were so recorded. The objectives of this study were to gain a greater understanding of the basis of this low reporting percentage by concentrating on Hamilton County births only, to compare these percentages among hospitals in the county, and to determine the commonality of their causes. Since it was anticipated that both a thorough search of hospital records and access to chromosome analysis records would provide essentially complete ascertainment of DS births in the county during 1970-78, the data were also used to test the validity of chromosome analysis as a sampling procedure in estimating the total number of DS births by means of the Lincoln-Peterson capturerecapture method.The percentage of reporting of DS on the birth certificates by hospital ranged from 0.0 to 57.1, with a mean of 26.0 for the 6 hospitals within the county. Although variation among some hospitals was statistically significant, three of the six hospitals had zero percent reporting. The explanation for these low reporting percentages was fundamentally similar for all hospitals-a communications flow problem, produced by poor timing and use of the wrong sources of available information. The only data typically available to the birth certificate clerk were derived from the labor and delivery sheet, the form with the worst reporting percentage of DS of any in the medical record. On the other hand, by the time of discharge, 92.5 percent of the cases had either been definitely diagnosed as DS and were recorded on the face sheet or were entered as "chromosome analysis pending" in the file.The use of the chromosome analysis data gave an estimate of total DS births (N = 201 +/- 34) statistically consistent with the total observed, thereby providing support for this estimation procedure. Annual incidence rates for DS were also calculated for 1970-78, with a total incidence rate for the 9-year period of 1.14 per 1,000 live births.

Birth Certificates↗
PubMed1984

[Urban alternate host cycle of Taenia saginata in Wittstock County, district of Potsdam (East Germany)].

The urban alternate host cycle of Taenia saginata in the county of Wittstock, district of Potsdam (GDR). Investigations of the epidemiology of bovine cysticercosis and human taeniasis were carried out in the county of Wittstock from 1979 till 1980. The analysis was based on the examination of human faeces, sewage and sewage sludge, the registration of infested humans, anticestodica consumption, number of infested cattle, areas for squirting out sewage, fodder supply areas and location of cattle. These data were mapped. There is a direct connection between the prevalence of Cysticercus bovis in more than 50 per cent of the infested cattle of the county of Wittstock and the squirting out of the sewage of the county town. 21 to 27 million Taenia eggs per day get into the waste-water purification plant. The proportion of infested humans and infested cattle is 1: 250 or 1: 290, respectively. The prevalence of adult tapeworms is 0.008-0.18%, and that of cysticerci is 20%.

Animals↗
PubMedDate not supplied

Cancer mortality in United States counties with metal electroplating industries.

A survey of cancer mortality from 1950 to 1969 was conducted in U.S. counties where greater than 0.1% of the county's population was employed in the metal electroplating and coating industry. The mortality rates for several cancers, particularly of the esophagus and larynx, in these counties were higher than rates for a group of control counties with comparable demographic characteristics. Further study is needed to determine if these patterns result for worker exposures to substances such as caustic acids and alkalies, metals, and organic solvents commonly used in this industry.

Adult↗
PubMedDate not supplied

The Appalachian Rural Health Project in Chautauqua County, N.Y., 1973-78.

The Appalachian Regional Commission awarded a 5-year grant to the Chautauqua County Department of Health to establish primary health care services to medically underserved rural areas of the county. Four clinics were opened at various stages as the project grew.What began as an open system multidisciplinary approach to the delivery of primary health care changed abruptly to a closed system in March 1976, when the county medical society members voiced a strong objection to the rural health project. Among other assertions, the medical society claimed that the clinics of the project were "too costly and unnecessary as they now exist." Equally strong voices of community people demanded that the project be allowed to operate. An unprecedented public hearing was held and, as a result, a compromise plan was developed that permitted the medical services of the clinics to be continued, but most of the multidisciplinary components devoted to social development were eventually dropped.By September 30, 1978, when the project grant ended, three of the four clinics had been taken over on a private basis by physicians who had previously been assigned to the clinics and supported by the project.The effects of grassroots support and power of the people in a community in determining their health rights and needs were demonstrated and documented in this pioneer program. It is anticipated that the Chautauqua County experience may be a helpful model in planning other projects that attempt to institute change in the health care delivery system in underserved rural areas.

Appalachian Region↗
PubMedDate not supplied

Deterring sales and provision of alcohol to minors: a study of enforcement in 295 counties in four states.

The authors analyzed patterns of criminal and administrative enforcement of the legal minimum age for drinking across 295 counties in four States. Data on all arrests and other actions for liquor law violations from 1988 through 1990 were collected from the Federal Bureau of Investigation Uniform Crime Reporting System, State Uniform Crime Reports, and State Alcohol Beverage Control Agencies. Analytic methods used include Spearman rank-order correlation, single-linkage cluster analysis, and multiple regression modeling. Results confirmed low rates of enforcement of the legal drinking age, particularly for actions against those who sell or provide alcohol to underage youth. More than a quarter of all counties examined had no Alcoholic Beverage Control Agency actions against retailers for sales of alcohol to minors during the three periods studied. Analyses indicate that 58 percent of the county-by-county variance in enforcement of the youth liquor law can be accounted by eight community characteristics. Rate of arrests for general minor crime was strongly related to rate of arrests for violations of the youth liquor law, while the number of law enforcement officers per population was not related to arrests for underage drinking. Raising the legal age for drinking to 21 years had substantial benefits in terms of reduced drinking and reduced automobile crashes among youths, despite low level of enforcement. Potential benefits of active enforcement of minimum drinking age statutes are substantial, particularly if efforts are focused on those who provide alcohol to youth.

Adolescent↗
PubMed1995

Surveillance of cancer incidence in Connecticut counties and towns, 1989-91.

Using the population-based Connecticut Tumor Registry, cancer incidence was examined for residents of Connecticut's eight counties and 169 towns in 1989-91. Findings included high standardized incidence ratios (SIRs) for: certain smoking-related cancers for women in New London County; several cancers (bladder, kidney, and mesotheliomas) for men in Middlesex County; Kaposi's sarcoma in Fairfield County, and in the towns of Hartford and New Haven; skin melanoma in certain ocean-shoreline towns; and invasive cervical cancer in several larger cities. Cancer surveillance data should be useful for promoting such efforts as smoking prevention and cessation, the collection of data on occupation and smoking by physicians and hospitals, reduction in excessive sun exposure, and increased screening for cervical cancer in large towns.

Adolescent↗
PubMed1994

Aedes albopictus distribution, abundance, and colonization in Lee County, Florida, and its effect on Aedes aegypti.

In 1992 the known southern limit of Aedes albopictus in Florida was in Lee County. Through oviposition surveillance, the distribution of Ae. albopictus was determined, and its frequency relative to Aedes aegypti and colonization pattern of areas previously occupied by Ae. aegypti were examined in Lee County. The data collected in the first year of surveillance demonstrate the ability of Ae. albopictus to rapidly and preferentially colonize large expanses of rural southwest Florida. Urban and suburban areas of the county showed slower colonization rates. In suburban areas, Ae. albopictus became the dominant container-breeding mosquito species, whereas it did not become dominant in urban areas. During the study period, Ae. albopictus did not displace Ae. aegypti in urban or suburban habitats. The southern limit of Ae. albopictus moved a distance of 8.1 km (5 mi.) in 6 wk to the southern border of the county.

Aedes↗
PubMed1994

[Breast cancer in the county of Viborg during 1983-1989. A quality control study].

The aim of the present study was to compare the quality of treatment for breast cancer in Viborg County to that provided in the rest of Denmark during the period 1983 to 1989. Women younger than 70 years of age with the diagnosis of invasive breast carcinoma and registered in the DBCG (Danish Breast Cancer Cooperative Group) were included, 435 from Viborg county and 11,434 from the rest of Denmark. No differences were found between the two patient-groups with regard to tumoursize, degree of anaplasia, number of axillary lymph nodes removed or number of positive lymph nodes. There were also no differences in overall survival or recurrence-free survival (RFS). It was concluded that the quality of treatment for breast cancer in Viborg County was equal to that in the rest of Denmark. Moreover, the magnitude of registration of breast cancer patients in the DBCG from Viborg county was evaluated. More than 90% of all breast cancer patients were registered.

Adult↗
PubMedDate not supplied

Activities associated with drownings in Imperial County, CA, 1980-90: implications for prevention.

Statewide surveillance in California determined that the highest drowning rate from 1980 through 1989 was for the rural, desert county of Imperial (21.9 drownings per 100,000 population). To identify activities associated with drowning in this county, the authors abstracted data from the county sheriff-coroner's reports. From 1980 through 1990, there were 317 unintentional drownings; 85 percent occurred in irrigation canals. The activity prior to drowning was known for 262 persons (83 percent), and the most common activity was illegal entry into the United States. Overall, 140 persons (53 percent) were illegal entrants. Ninety-three percent of illegal entrants drowned in the All American Canal; the monthly drowning rate increased as the monthly average water velocity in the canal increased (r = 0.36; P < 0.001). Forty-eight persons (18 percent) drowned while riding in or on a land vehicle (automobile, pick-up truck, motorcycle, dune buggy, or tractor), the second most common activity associated with drowning. Seventy percent of the 23 drivers had an alcohol concentration of 100 milligrams per deciliter or more, California's limit for intoxication. To reduce drownings in Imperial County, prevention strategies should target persons engaged in at-risk activities near bodies of water. These strategies should include the identification and use of effective canal safety devices.

Accidents, Traffic↗
PubMed1993

Lead poisoning among low-income children in Orange County, California. A need for regionally differentiated policy.

OBJECTIVE: To estimate the prevalence of elevated lead levels among children in Orange County, California, and to evaluate the appropriateness of a universal pediatric blood lead screening policy in this community. DESIGN: Venous blood lead testing was conducted and results were analyzed according to seven blood lead strata ranging from less than 0.50 mumol/L (10 micrograms/dL) to 3.35 mumol/L (70 micrograms/dL) or higher. A cost analysis of the lead-testing program in Orange County was conducted. SETTING: Children meeting poverty eligibility criteria and attending the Child Health and Disability Prevention Program, the state's implementation of the federal Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services program. PARTICIPANTS: A total of 5115 Orange County children between 12 and 72 months of age using EPSDT services from March through December 1992. MAIN OUTCOME MEASURES: Blood lead levels and associated costs of the testing program stratified by level of blood lead elevation. RESULTS: Blood lead levels of 0.50 mumol/L (10 micrograms/dL) or higher were found in 371 children (7.25%; 95% confidence interval, 6.66% to 7.85%), but only six children (0.12%; 95% confidence interval, 0.04% to 0.20%) had elevations greater than 1.20 mumol/L (25 micrograms/dL). Five children (83.3%) had histories of lead consumption unrelated to ingestion of lead-containing paint but related to the use of lead-containing folk remedies and cooking utensils. Costs for detection of children with blood levels elevated to 0.50 mumol/L (10 micrograms/dL) or higher was $310 per child and for levels of 1.20 mumol/L (25 micrograms/dL) or higher was $19,139 per child. CONCLUSIONS: These data suggest that lead poisoning is not a major public health problem among Orange County children and detection of infrequent cases would involve a high cost per child. In jurisdictions with newer housing, initial screening for a history of possible lead exposure alone may offer reasonable efficacy that is cost-effective. The scope of lead-testing programs should be determined according to local needs and conditions.

California↗
PubMed1993

Risk factors for lung cancer in non-smokers in Xuanwei County of China.

Tobacco smoking and some types of occupational exposures have consistently been considered as important etiologic factors of lung cancer in industrial countries. At the First World Conference of Lung Cancer (Wyndwer, 1983), it was stressed that more attention should be paid to finding out the causes of lung cancer in non-smokers. In Xuanwei County, Yunnan Province, annual lung cancer death rate was 27.7 per 100,000 in males, among China's highest, and 25.3 per 100,000 in females, the China's highest. The female's lung cancer death rate in Xuanwei County was even much higher than that of the same period in USA white women (ECACM, 1979; Mulvihill, 1976). Marked district variation in cancer mortality exists within Xuanwei County. The county can be divided into high-, medium- and low-mortality areas. Over 90% of the population are farmers. The local residents traditionally burned three major kinds of fuels: "smoky" coal, "smokeless" coal and "wood", for heating and cooking. The three lung cancer high mortality areas, including "Chengguan", "Rongcheng" and "Laibin" communes, mainly burned the "smoky" coal from Laibin smoky-coal mine. The fuel was burned in a shallow, unventilated fire pit in the floor of the dwelling. Fuel burning in shallow unventilated pits has resulted in high indoor air pollution levels. The concentrations of airborne particles (pm 10) inside houses during smoky coal and wood combustion were very high. Indoor concentration of suspended particulates and dichloromethane extractable organics were 24.4mg/m3 and 17.6mg/m3 in burning of "smoky" coal; 22.3mg/m3, 12.3mg/m3 for burning wood; and 1.8mg/m3, 0.5mg/m3 for burning of smokeless coals.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

Hypertension among Mexican Americans in Starr County, Texas.

THE MEXICAN-AMERICAN POPULATION in the United States has generally elevated frequencies of several chronic conditions, including non-insulin-dependent diabetes mellitus (NIDDM), gallbladder disease, and obesity. Prevalence of cardiovascular disease and hypertension is less clear. To document prevalence and risk factors of hypertension in this population, we measured blood pressure in 1004 randomly selected Mexican Americans in Starr County, Texas, ages 15 to 74. We defined hypertension as systolic blood pressure greater than or equal to 140 mmHg or diastolic pressure greater than or equal to 90 mmHg or current (within the last 48 hours) use of antihypertensive medications. Prevalences by age and gender are elevated in this population group compared with those in the general population. In addition to age and gender, body mass and diabetes status were also predictors of hypertension. Comparison of the Starr County results with those reported from the Third National Health and Nutrition Examination Survey (NHANES III) sampling of Mexican Americans indicates a slight increase in frequency of hypertension in Starr County, while comparison with results from San Antonio Mexican Americans indicates a marked increase in frequency in Starr County. These differences are not simple functions of measurement protocols, but are likely to be caused by differences in population structure, employment and socioeconomic status, education, and other such factors.

Adolescent↗
PubMed1997

[Prevalence of tobacco dependence in 6 counties of Lleida].

OBJECTIVE: To find the prevalence of tobacco dependency in the population of six counties in Lleida and in patients with chronic diseases or vascular risk factors. DESIGN: Cross-sectional study. A descriptive analysis of the data. SETTING: Six counties in Lleida: 5 Pyrenean counties with a rural population and the Segrià county with an urban population. PARTICIPANTS: A personal questionnaire covering 900 people over 15 (95% CI, 4% accuracy), chosen by randomised sampling, stratified for urban or rural, from the Municipal Rolls. MEASUREMENTS AND MAIN RESULTS: 543 individuals took part. Prevalence of tobacco dependency was 19.7%, higher in men (27.7%) than in women (12%) (p < 0.05). However, among the young there were no difference between the sexes. CONCLUSIONS: We found a low, in comparison with other studies, percentage of smokers in our sample, with a high prevalence of ex-smokers among patients with ictus or Coronary Disease. However, the high prevalence of smokers among the individuals with some cardiovascular risk factor points to the need to redouble efforts in health education on tobacco.

Adolescent↗
PubMedDate not supplied

Studying non-Hodgkin's lymphoma in two Oklahoma counties: a call for centralized cancer data management.

Anecdotal evidence for an increased incidence of non-Hodgkin's lymphoma (NHL) had been informally discussed within several clinical practices in north central Oklahoma. This study was conducted to determine the incidence rates of NHL in Garfield and Kingfisher counties and to evaluate whether these counties represented unique cancer clusters. Data were collected from medical records and tumor registries in 22 area hospitals between 1990-1994. The annual incidence rate per 100,000 persons for Garfield county was 15.51 (95% CI: 10.9-20.1), and for Kingfisher county, 24.22 (95% CI: 12.4-36.1). Both of these rates are increased from the national incidence rate of 13.7 cases of NHL per 100,000 persons, suggesting a significant clinical impact. However, a statistical significance was not detected given the conservative methodology and the small populations involved. The difficulties of performing community-based research, the need for epidemiological studies to reduce clinical experience bias, and the need for centralized cancer data management are discussed.

Adult↗