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PubMed1994

[Tetracycline-resistant plasmid of Salmonella enteritidis isolated in Kumamoto City].

We isolated Salmonella choleraesuis subsp. choleraesuis serovar. Enteritidis (S. Enteritidis) from a mass of cases which broke out in September, 1991 in Kumamoto City. The isolates were shown to hold plasmids on which a tetracycline (TC)-resistant gene was located. The plasmid, about 9 kb in size, was capable of expressing the gene in Escherichia coli, unstable in S. Enteritidis and Escherichia coli. Thus in order to investigate the creeping prevalence of the TC-resistant plasmid in Kumamoto City and its spreading in other areas, the strains, a total of 41, including 37 isolates from sporadic cases with diarrhea in Kumamoto City, 3 isolates from 3 cases of food poisoning in Kitakyushu, Fukuoka and Chiba, and one strain isolated from egg solution in Kumamoto City, were examined by the hybridization test with this plasmid as a probe, as well as for their drug sensitivity and plasmid profile. As a result, 28 strains of 37 tested from the sporadic cases, the strains from food poisoning in Kitakyushu, Chiba and the one from egg solution, all harbored the same 9 kb TC-resistant plasmid. From the above observations, it was assured that, at the time of investigation, July to September in 1992, the prevalence of S. Enteritidis in Kumamoto City was Predominated by its strain carrying the TC-resistant plasmid. Furthermore, considering the fact that the strain harboring this plasmid was also found in the food poisoning in Kitakyushu and Chiba, it was suggested that spreading of this strain was not restricted to localities and was also associated with Chicken eggs according to its detection from the egg solution.

Humans↗
PubMed2004

[Relationship between absolute humidity and influenza prevalence in Odate and Akita cities, Akita Prefecture, in 2001 and 2002].

The dynamics of influenza viruses in relation to one meteorological factor, absolute humidity, was investigated. The number of influenza patients, absolute humidity, and isolation of influenza viruses were compared between Odate City the north and Akita City in central Akita Prefecture from 2001 to 2002. The results were as follows: 1) In both Odate and Akita cities, Influenza A (H1N1 and H3N2) and Influenza B (Victoria and Yamagata) viruses were isolated when absolute humidity ranged between 2.7 and 8.8 g/m3. 2) In Akita City in 2002, the influenza viruses were isolated in May (weeks 20 and 22), and the absolute humidity was below 9 g/m3, suggesting that the influenza season lasted until May in this year. 3) A correlation between absolute humidity and isolation of influenza viruses was observed, and the influenza prevalence may occur below 9 g/m3 of absolute humidity. 4) In Odate and Akita cities, the absolute humidity of 10 g/m3, a level at which 5% of influenza viruses can survive after six hours, was observed from January to June and October to December. 5) Influenza prevalence show differential occurrence by time and place. Therefore, further research is required to clarify the absolute humidity related to influenza prevalence.

Humans↗
PubMed2004

[An outbreak of legionellosis in a new facility of hot spring bath in Hiuga City].

Following cerebrating ceremony in 20 June 2002, for the completion of Hiuga Sun-Park Hot Spring Bath "Ofunade-no-Yu" facilities, Miyazaki Prefecture, Kyushu Island, 200 neighbors were invited each day to experience bathing on 20 and 21 June. The Bath "Ofunade-no-Yu" officially opened on 1 July 2002. On 18 July, Hiuga Health Center was informed that 3 suspected Legionella pneumonia patients in a hospital and all of them have bathing history of "Ofunade-no-Yu". Health Center officers notified Hiuga City, the main proprietor of the Bath business, that on-site inspection on sanitary managements will be done next day and requested the City to keep the bath facilities as they are. On 19 July, Health Center officers collected bath water from seven places and recommended voluntary-closing of "Ofunade-no-Yu" business. Because of various reasons, Hiuga City did not accept the recommendation and continued business up to 23 July. Because Legionella pneumophila serogroup 1 strains from 4 patients' sputa and several bath water specimens were determined genetically similar by Pulsed Field Gel Electrophoresis of Sfi I-cut DNA. "Ofunede-no-Yu" was regarded as the source of infection of this outbreak. On 24 July, "Ofunade-no-Yu" accepted the Command to prohibit the business. Among 19,773 persons who took the bath during the period from 20 June to 23 July, 295 became ill, and 7 died. Among them, 34 were definitely diagnosed as Legionella pneumonia due to L. pneumophila SG 1, by either one or two tests of positive sputum culture, Legionella-specific urinary antigen, and significant rise of serum antibody titer against L. pneumophila SG 1. In addition to the 8 items shown by Miyazaki-Prefecture Investigation Committee as the cause of infection. Hiuga City Investigation Committee pointed out following 3 items: 1) Insufficient knowledge and understanding of stuffs on Legionella and legionellosis; 2) Residual water in tubing system after trial runs might lead multiplication of legionellae in it; and 3) Inadequate disinfection and washing for whole circulation system prior the experience bathing. The Hiuga City Committee directed 24 measures to improve the sanitary condition of the facility including following 5 items. 1) Fix the manual for maintenance and management of the bath. 2) Keep sufficient overflow of bath water. 3) Put disinfection of filters into practice. 4) Precise measurement and control of the residual chlorine concentration in bath water. 5) Replacement of filtrating material from crushed porous ceramic into natural sand.

Disease Outbreaks↗
PubMed1994

Markers of hepatitis C and B virus infections among blood donors in Ho Chi Minh City and Hanoi, Vietnam.

Blood donors in two cities in Vietnam were tested for markers of hepatitis C virus (HCV) and hepatitis B virus infections. Antibody to HCV was detected by passive hemagglutination with antigens of the second generation in 101 (20.6%) of 491 donors in Ho Chi Minh City; it was detected less frequently (P < 0.001) in donors in hanoi (4 [0.8%] of 499). HCV RNA was tested for in donors with antibody by PCR with nested primers from the 5'-noncoding region and detected in 79 donors in Ho Chi Minh City and 4 donors in Hanoi. HCV RNA was genotyped by PCR with type-specific primers from the core gene. Of 83 HCV carriers from Vietnam, 24 (29%) were infected with HCV of genotype I/1a 19 (23%) were infected with II/1b, 4 (5%) were infected with III/2a, and 2 (2%) were infected with mixed genotypes (I/1a and II/1b); HCV genotypes in the remaining 34 (41%) donors, including all 4 donors in Hanoi, were not classifiable into I/1a, II/2a, IV/2b, or V/3a. Of the 10 isolates with unclassifiable genotypes, 2 showed substantial sequence divergence within the 5'-noncoding region from reported isolates with known genotypes (I/1a to 6a). An analysis of part of the core gene sequence indicated that six of the remaining isolates most likely represented new HCV genotypes. Hepatitis B surface antigen and the corresponding antibody, respectively, were detected in 15 (3.1%) and 234 (47.7%) donors in Ho Chi Minh City as well as 15 (3.0%) and 248 (49.7%) donors in Hanoi. These results indicate an extensive spread of HCV among Ho Chi Minh City donors and HCV of novel genotypes in vietnam.

Adult↗
PubMed1998

Where children sit in motor vehicles: a comparison of selected European and American cities.

OBJECTIVES: To ascertain whether there are differences in child seating location between selected cities in the US and continental Europe, and if differences exist, to ascertain what factors predict them. SETTING: Boston and New Orleans, which have no laws regarding child seating location, and Paris, Frankfurt, and Brussels, which for approximately 20 years have had laws requiring children under the ages of 10 or 12 to sit in the rear. METHODS: Observations were made in the first quarter of 1997 at several locations in or near each city. The vehicle seating capacity, total number of occupants, the seating location of adults and children, and driver shoulder belt use were recorded for each vehicle with at least one child. The predictors of a vehicle having a child in the front were estimated using logistic regression. RESULTS: Data on 5501 children riding in 3778 vehicles were collected. Adjusting for differences in vehicle seating capacity, occupant mix, and driver shoulder belt use, vehicles in the European cities are significantly less likely to have a child in the front seat than vehicles in the American cities. CONCLUSIONS: Cities with no history of laws prohibiting children from sitting in the front, vehicles with low seating capacity, vehicles with no adult (other than the driver) or many child passengers, and unbelted drivers were associated with a higher likelihood of children riding in the front seat. It is feasible for a society to insist, through custom and/or law, that children sit in the back seat.

Automobiles↗
PubMed1995

Opiates or cocaine: mortality from acute reactions in six major Spanish cities. State Information System on Drug Abuse (SEIT) Working Group.

STUDY OBJECTIVE: To describe temporal and geographical variations in mortality from acute reactions to opiates or cocaine and the demographic and toxicological characteristics of persons who died from these in major Spanish cities between 1983 and 1991. DESIGN: Descriptive study. Data were obtained retrospectively from pathologists' reports. SETTING: Cities of Madrid, Barcelona, Valencia, Seville, Zaragoza, and Bilbao. SUBJECTS: Deaths from acute reactions to opiates or cocaine were defined as those in which pathologists' reports did not indicate any other cause of death and in which evidence was found of recent consumption of these drugs. MAIN RESULTS: The mortality rate from acute reactions to opiate/cocaine per 100,000 population in the six cities as a whole rose from 1.2 in 1983 to 8.2 in 1991. Average annual rates for the whole period ranged from 1.7 in Seville to 4.9 in Barcelona. The male/female rates ratio was 5.9:1. The mean age of persons who died rose from 25.1 years in 1983 to 28 years in 1991. In more than 90% of the cases in whom toxicological tests were undertaken opiates were detected, and the proportion in which benzodiazepines or cocaine were detected increased during the period studied. CONCLUSIONS: Between 1983 and 1991 mortality from acute reactions to opiates/cocaine rose dramatically in major Spanish cities and significant differences in mortality between cities were found. Deaths were concentrated among men and young people. Acute drug reactions became one of the leading causes of death in persons 15-39 years of age, representing 11.1% of mortality from all causes in 1988 for this age group. Future studies should examine the relationship between the temporal and geographical variations in this type of mortality and various personal, environmental and social factors.

Adolescent↗
PubMed1988

Aneurysmal subarachnoid hemorrhage in Izumo City and Shimane Prefecture of Japan. Outcome.

The overall outcome of patients with aneurysmal subarachnoid hemorrhage was investigated in Izumo City and Shimane Prefecture. Of the patients from Izumo City, the clinical grade on admission was Grade I or II in 41% and Grade IV or V in 31%. Of those from Shimane Prefecture, 49% were graded as Grade I or II and 24% as Grade IV or V. The overall mortality rates 1 year after subarachnoid hemorrhage were 46% for Izumo City and 35% for Shimane Prefecture, while the surgical mortality rates were 18 and 15%, respectively. The mortality rates were particularly high among the elderly over the age of 70 years and among unoperated cases. The leading cause of death in these cases was the effect of aneurysm rupture itself, followed by rebleeding and vasospasm. The 5-year survival probabilities according to life table analysis were 50% for Izumo City and 59% for Shimane Prefecture, and a significant difference was observed in survival curves between Izumo City and Shimane Prefecture. It is concluded that the smaller the community studied, the less favorable the overall outcome, mainly because of poorer clinical conditions on admission.

Actuarial Analysis↗
PubMed1994

Empowering communities: action research through healthy cities.

The Healthy Cities process uses action research to empower communities to take action for health. Five concepts that link community empowerment and action research are: focus on community, citizen participation, information and problem solving, sharing of power, and quality of life. Two city examples from Healthy Cities Indiana, a pilot program of CITYNET Healthy Cities, provide illustrations of these concepts. The dynamics of community participation in action research and the successes and barriers to community participation are presented. Outcomes that empowered the community are suggested: the extent to which Healthy City projects are initiated, their progress monitored, continued action in health supported, resources obtained, and policies promoted that contribute equity in health.

Community Participation↗
PubMed2003

Short-term effects of ambient particles on mortality in the elderly: results from 28 cities in the APHEA2 project.

Within the framework of the APHEA2 (Air Pollution on Health: a European Approach) project, the effects of ambient particles on mortality among persons > or = 65 yrs were investigated. Daily measurements for particles with a 50% cut-off aerodynamic diameter of 10 microm (PM10) and black smoke (BS), as well as the daily number of deaths among persons > or = 65 yrs of age, from 29 European cities, have been collected. Data on other pollutants and meteorological variables, to adjust for confounding effects and data on city characteristics, to investigate potential effect modification, were also recorded. For individual city analysis, generalised additive models extending Poisson regression, using a locally weighted regression (LOESS) smoother to control for seasonal effects, were applied. To combine individual city results and explore effect modification, second stage regression models were applied. The per cent increase (95% confidence intervals), associated with a 10 microg x m(-3) increase in PM10, in the elderly daily number of deaths was 0.8%, (0.7-0.9%) and the corresponding number for BS was 0.6%, (0.5-0.8%). The effect size was modified by the long-term average levels of nitrogen dioxide (higher levels were associated with larger effects), temperature (larger effects were observed in warmer countries), and by the proportion of the elderly in each city (a larger proportion was associated with higher effects). These results indicate that ambient particles have effects on mortality among the elderly, with relative risks comparable or slightly higher than those observed for total mortality and similar effect modification patterns. The effects among the older persons are of particular importance, since the attributable number of events will be much larger, compared to the number of deaths among the younger population.

Aged↗
PubMed2000

Association of fine particulate matter from different sources with daily mortality in six U.S. cities.

Previously we reported that fine particle mass (particulate matter [less than and equal to] 2.5 microm; PM(2.5)), which is primarily from combustion sources, but not coarse particle mass, which is primarily from crustal sources, was associated with daily mortality in six eastern U.S. cities (1). In this study, we used the elemental composition of size-fractionated particles to identify several distinct source-related fractions of fine particles and examined the association of these fractions with daily mortality in each of the six cities. Using specific rotation factor analysis for each city, we identified a silicon factor classified as soil and crustal material, a lead factor classified as motor vehicle exhaust, a selenium factor representing coal combustion, and up to two additional factors. We extracted daily counts of deaths from National Center for Health Statistics records and estimated city-specific associations of mortality with each source factor by Poisson regression, adjusting for time trends, weather, and the other source factors. Combined effect estimates were calculated as the inverse variance weighted mean of the city-specific estimates. In the combined analysis, a 10 microg/m(3) increase in PM(2.5) from mobile sources accounted for a 3.4% increase in daily mortality [95% confidence interval (CI), 1.7-5.2%], and the equivalent increase in fine particles from coal combustion sources accounted for a 1.1% increase [CI, 0.3-2.0%). PM(2.5) crustal particles were not associated with daily mortality. These results indicate that combustion particles in the fine fraction from mobile and coal combustion sources, but not fine crustal particles, are associated with increased mortality.

Adolescent↗
PubMed1997

An evaluation of climate/mortality relationships in large U.S. cities and the possible impacts of a climate change.

A new air mass-based synoptic procedure is used to evaluate climate/mortality relationships as they presently exist and to estimate how a predicted global warming might alter these values. Forty-four large U.S. cities with metropolitan areas exceeding 1 million in population are analyzed. Sharp increases in mortality are noted in summer for most cities in the East and Midwest when two particular air masses are present. A very warm air mass of maritime origin is most important in the eastern United States, which when present can increase daily mortality by as many as 30 deaths in large cities. A hot, dry air mass is important in many cities, and, although rare in the East, can increase daily mortality by up to 50 deaths. Cities in the South and Southwest show lesser weather/mortality relationships in summer. During winter, air mass-induced increases in mortality are considerably less than in summer. Although daily winter mortality is usually higher than summer, the causes of death that are responsible for most winter mortality do not vary much with temperature. Using models that estimate climate change for the years 2020 and 2050, it is estimated that summer mortality will increase dramatically and winter mortality will decrease slightly, even if people acclimatize to the increased warmth. Thus, a sizable net increase in weather-related mortality is estimated if the climate warms as the models predict.

Aged↗
PubMed1998

A comparison of HIV risk behaviors among women drug users from two cities in a rural state: recommendations for targeted prevention.

Most HIV prevention programs for women target individual risk behaviors while the influence of larger contextual factors, such as city of residence, are often neglected. This preliminary study compares women drug users from two different cities in the largely rural state of Kentucky on HIV risk behaviors. The women are from Lexington, a medium sized metropolitan area, and from Louisville, a large metropolitan area. Comparisons between the women from the two cities indicate that there are many similarities in their risk behaviors, but also some important differences. The women from Lexington (the smaller city), are more likely to be at risk for becoming infected with HIV due to their drug use, while the women from Louisville (the larger city) are more likely to be at risk because of their sex exchange practices and economic situation. The implications for prevention are discussed.

Adult↗
PubMed1999

Physician perceptions of barriers to care for inner-city Latino children with asthma.

This article describes physician perspectives on barriers to quality primary care experienced by inner-city children with asthma and presents policy recommendations to reduce these barriers. The authors interviewed 30 physicians who take care of children with asthma in an inner-city Latino neighborhood, conducted a qualitative analysis of interview themes, and used a consensus group method to recommend policy actions. Inner-city physicians described significant access, quality of care, and other barriers in providing state-of-the-art primary care for asthma. Physicians recommended that eliminating financial barriers to care, including lack of health insurance and/or comprehensive health coverage for necessary medications and equipment, is the most important required policy action. In addition, inner-city physicians recommended that medical care and public health programs provide bilingual education for children with asthma and their families and train primary care physicians about how to provide effective asthma care to children with asthma in the inner city.

Adult↗
PubMed1999

The relationship between psychosocial factors and asthma morbidity in inner-city children with asthma.

OBJECTIVE: Children living in the inner city are affected disproportionately by asthma morbidity and mortality. Previous research has shown that behavioral and psychosocial factors affect asthma morbidity in children. The National Cooperative Inner-City Asthma Study investigated the factors that contribute to asthma morbidity among inner-city children. This article examines the relationship between psychosocial factors and asthma morbidity in this population. METHODS: A total of 1528 English- and Spanish-speaking children 4 to 9 years of age with asthma and their primary caretakers were recruited from 8 research centers in 7 metropolitan inner-city areas in the United States. Psychosocial variables were assessed at baseline and included measures of child and caretaker mental health, caretaker's problems with alcohol, life stress, social support, and parenting style. Morbidity measures were evaluated at baseline and at 3-, 6-, and 9-month follow-up intervals. These included number of hospitalizations and unscheduled visits for asthma in the past 3 months and number of days of wheeze and functional status in the previous 2-week period. RESULTS: Of the psychosocial variables assessed, mental health had the strongest relationship to children's asthma morbidity. Children whose caretakers had clinically significant levels of mental health problems were hospitalized for asthma at almost twice the rate as children whose caretakers did not have significant mental health problems. Children with clinically significant behavior problems had significantly more days of wheeze and poorer functional status in the follow-up period. CONCLUSION: Psychosocial factors, particularly the mental health of children and caretakers, are significant factors in predicting asthma morbidity. They may need to be included in intervention programs aimed at decreasing asthma morbidity in inner-city children with asthma in order for these programs to be successful.

Asthma↗
PubMed2002

[Health promotion evaluation: focus on "healthy cities"].

Since the Healthy City movement is a health promotion strategy, an update study was carried out to put into context the health promotion evaluation debate stressing the principles to be considered in an evaluation initiative and in the problematic of Health Cities projects. A literature review of "Healthy Cities" was conducted. A typology based on of Healthy Cities papers found in MEDLINE, LILACS and published in the "Health Promotion International" between 1985 and 2000 was proposed taking into consideration the main focus of each paper. Articles on evaluation were analyzed in more details according to stressing methods, research tools, indicators, study results, and critical appraisal of their models. Finally, it is highlighted initiatives that would come close to the principles of "Health Promotion" and adopt evaluation as a tool for building up capabilities and the empowerment of community groups involved with Healthy Cities initiatives.

Community Participation↗
PubMed2000

[Vaccination coverage in the first year of life in 4 cities of the state of São Paulo, Brazil].

Immunization is an important disease prevention measure, and evaluating the effectiveness of immunization programs is crucial to ensuring their success. This study describes the results of a household survey in four cities in the state of São Paulo, Brazil: Francisco Morato, Guarulhos, Osasco, and São Paulo. The survey was done in order to estimate immunization coverage for the cohort of children born in 1996. The city of São Paulo was divided into five strata, according to socioeconomic and living conditions. The survey followed the methodology that the Pan American Health Organization recommends for immunization coverage surveys. The proportion of children who had received a complete set of the recommended vaccinations at the time of the interview, taking into account both oral reports and information recorded on the children's immunization cards, was above 90% for all the cities except Francisco Morato, which had the worst living conditions. In the city of São Paulo, the worst coverage was found in the lowest and highest strata. When only the doses received during the first year of life were considered, the coverage was not adequate to produce herd immunity. The use of private vaccination services was higher in the areas with better living conditions. The difference between the coverage calculated based on data from health services and the coverage calculated based on the survey was inversely proportional to living conditions. Our results suggest that surveys similar to the one described here should be carried out in other cities. Employees who provide vaccination services should be trained to correctly record vaccination data. In addition, it is important to make health professionals aware of the official immunization calendar, and to facilitate the public's access to health services.

BCG Vaccine↗
PubMed1978

The incidence of sudden infant death syndrome in North Carolina's cities and counties: 1972--1974.

Between January 1, 1972 and December 31, 1974, 534 Sudden Infant Death Syndrome cases were reported in North Carolina. All but the out-of-state cases were mapped by county and city locations to determine if urban or rural cases predominated. The mapping was also undertaken to see if significant spatial variabilities could be detected between the county and city populations of infants at risk. The state had an overall SIDS rate of 2.06 per thousand live births. The mapping revealed that counties had a range from zero to a high of 6.6 and that cities with populations of over 10,000 had SIDS rates which ranged from zero to a high of 10.6. The proportions of SIDS cases occurring in either urban or rural locations roughly approximated the distribution of the state's population, with neither location accounting for disproportionately more cases. The larger cities, however, reported more cases than did their suburbs and the immediately surrounding rural areas. The largest and smallest cities, when grouped accordingly, had the lowest urban SIDS rates. The summary SIDS rates for whites was 1.23 per thousant live births, for blacks it was 3.75, and for Indians it was 6.56 per thousand live births.

Autopsy↗
PubMed2003

Long-term morbidity in patients with acute chest pain. A comparison between a city university hospital and a county hospital.

AIM: To compare long-term morbidity after hospital discharge in patients admitted to the emergency department with acute chest pain in a city university hospital and a county hospital. METHODS: Patients with acute chest pain admitted to the emergency department due to acute chest pain at Sahlgrenska University Hospital in Göteborg, Sweden, and at Uddevalla County Hospital in Uddevalla, Sweden, between October 21, 1996, and April 30, 1997, were retrospectively followed for 30 months. RESULTS: The mortality during the subsequent 30 months was similar in the two cohorts (16% in the city university hospital and 15% in the county hospital, respectively). In the city university hospital 1575 patients and in the county hospital 715 patients took part in the evaluation of survivors. Coronary angiography was performed less frequently in patients in the city hospital (14% versus 20%; p = 0.002) but there was no difference with regard to development of myocardial infarction (6% versus 7%), stroke (2% in both cohorts) or requirement of percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG) after hospital discharge. The proportion of patients who were rehospitalized did not differ, but the mean number of days in hospital per patient and per hospitalized patient was higher in the county hospital (10.2 +/- 17.2 versus 6.7 +/- 13.7 (p = 0.0003) and 17.3 +/- 19.5 versus 13.2 +/- 16.8 (p = 0.003), respectively). P-values were adjusted for differences in the patient's characteristics. The proportion of patients rehospitalized due to stable angina pectoris, cardiac arrhythmias and heart investigation was higher in the county hospital. CONCLUSION: In chest pain patients admitted to a city university hospital and a county hospital morbidity differences were found after hospital discharge indicating a higher requirement of rehospitalization for various cardiac reasons and a higher use of coronary angiography in the county hospital after discharge from hospital. The mechanisms behind this observation are not clear at present.

Acute Disease↗