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PubMed1998

Influenza vaccination status of persons aged 65-79 years--Allegheny County, Pennsylvania, February-March 1997.

Because influenza disproportionately affects persons aged > or =65 years and persons who have chronic medical conditions, the Advisory Committee on Immunization Practices recommends annual influenza vaccination for persons in this age group and for all adults who have conditions that increase their likelihood of serious outcomes of influenza. Although no local surveys exist that routinely provide direct estimates of influenza vaccine use at the county level, Medicare claims for the 1996-97 influenza season indicated that 36% of Allegheny County, Pennsylvania (1990 population: 184,449), Medicare beneficiaries aged > or =65 years had Medicare claims submitted for reimbursement for influenza vaccine. However, other Medicare beneficiaries may receive influenza vaccine but do not have claims filed for reimbursement. To estimate the prevalence of influenza vaccination, assess barriers to influenza vaccine use in the county, and to evaluate Medicare claims as a measure of vaccination use, the Allegheny County Health Department (ACHD) conducted a telephone survey of residents aged 65-79 years during February-March 1997. This report summarizes the findings from this survey, which indicate that 75% of adults in this age group reported receiving influenza vaccination during the 1996-97 influenza season, primarily in physician's offices, in comparison with the 36% of Medicare claims submitted.

Aged↗
PubMed2006

Avoiding free care at all costs: a survey of uninsured patients choosing not to seek emergency services at an urban county hospital.

The purpose of this case study was to understand why many uninsured patients opt not to make use of a free public hospital when it is available, instead seeking emergency department care at sites where they will be billed for the services they receive. One hundred fifty seven uninsured patients were interviewed over an 8-week period at three emergency departments that bill for services near a county hospital that provides free care. Data was gathered on income, health status, and credit history. Subjects were also asked if they had previously sought care at the county hospital and, if they had, how satisfied they were with the quality of care and with the wait time. Seventy two percent of the subjects reported household incomes of <$20,000, 48% reported they were in fair or poor health, and 33% said they were unable to pay at least one medical bill at the site where they were seeking care. 65% reported they had previously received care at the county hospital, and of these 61% said they were not-too-likely or not-at-all likely to return. In a regression analysis, experience with wait time correlated with subjects willingness to return, whereas their satisfaction with quality, their income, problems with debt, and reported health status did not. Access involves more than geographic proximity and affordability. Excessive wait times can deter even patients who are poor, in ill health and in debt from making use of services that are intended for their benefit.

California↗
PubMed1995

A comparison of hospital policies for measles, mumps, and rubella infection control in Los Angeles County, 1989 and 1992.

BACKGROUND: A survey was conducted in 1992 in Los Angeles County, California, to assess changes since an earlier survey in 1989 in the numbers of acute care hospitals that had established policies on measles, mumps, and rubella infection control and the extent to which these policies were implemented. METHODS: A questionnaire inquiring about measles, mumps, and rubella infection control was sent to ICPs of 133 acute care hospitals in Los Angeles County. The results were compared with those of a similar survey conducted in 1989. The increase in the number of hospitals with such policies between 1989 and 1992 was analyzed. RESULTS: In 1989, 29 (28%), 9 (9%), and 65 (64%) of the 102 respondent hospitals had measles, mumps, and rubella infection control policies, respectively. Larger proportions of the 95 respondent hospitals in 1992 had measles (56, 59%), mumps (15, 16%), and rubella (69, 73%) infection control policies. CONCLUSIONS: The number of hospitals with infection control policies for measles, mumps, and rubella increased from 1989 to 1992. Efficiency and scope of such policies varied, however, and could be improved by making the policies mandatory, requiring written documentation of employee immunity, and extending policies to cover all employees. The most dramatic increase was in the number of hospitals with infection control policies for measles; this increase may have been caused by the 1987 to 1989 measles epidemic in Los Angeles County, by increased awareness of the Immunization Practices Advisory Committee recommendations, or by increased sensitivity to the issue of infection control triggered by the 1989 survey.

California↗
PubMedDate not supplied

Suicide and net migration in Texas counties, 1970 and 1980.

Recent research has examined the consequences of migration, with much of this work focusing on "boom" towns. This literature provides a useful framework for studying the consequences of population growth in other settings, however. The boom-town literature has generally used the social disruption hypothesis, which predicts social disruptions in communities growing rapidly through migration, to explain the results of migration in these communities. Suicide is one social disruption indicator which has not received much empirical attention. According to the social disruption hypothesis, a positive relationship is expected between the net migration and suicide rates. We examine this hypothesis using data from Texas nonmetropolitan counties for the last two decades. We also present separate analyses for metropolitan counties. The results fail to provide support for the hypothesis. There is generally no relationship between net migration and suicide rates in both nonmetropolitan and metropolitan counties. Alternative explanations fail to alter this finding.

Anomie↗
PubMed2001

HIV incidence among repeat HIV testers at a county hospital, San Francisco, California, USA.

OBJECTIVES: To estimate HIV incidence, characterize correlates of HIV seroconversion, and monitor temporal trends in HIV transmission among patients repeatedly tested for HIV by a county hospital in San Francisco. DESIGN: Retrospective longitudinal study. METHODS: HIV incidence was retrospectively calculated among persons voluntarily tested for HIV antibody more than once at San Francisco's county hospital or one of its affiliated satellite community clinics between 1993 and 1999. Linkage of HIV test results in computerized databases identified "seroconverters" as individuals who had a negative antibody test followed by a positive test. The interval between tests was used as the person-time at risk. Cox proportional hazards analysis identified correlates of HIV seroconversion. RESULTS: A total of 84 HIV seroconversions were identified among 2893 eligible patients repeatedly tested for HIV antibody over a cumulative 5860 person-years (PYs) (incidence of 1.4 per 100 PYs, 95% confidence interval [CI]: 1.2-1.7). The majority of seroconversions (71 [84.5%]) were among injection drug users (IDUs) (incidence of 2.0 per 100 PYs, CI: 1.6-2.4). HIV incidence was highest among men who have sex with men (MSM) who were also IDUs (incidence of 3.8 per 100 PYs, CI: 2.7-5.1) and lowest among non-IDUs, heterosexual men, and non-IDU women (incidence of 0.3 per 100 PYs, CI: 0.1-0.6). In multivariate analysis, correlates of HIV seroconversion were age 25 to 29 years (hazard ratio [HR] = 3.9, CI: 2.4-6.3), MSM (HR = 2.9, CI: 1.9-4.4), and IDU (HR = 3.2, CI: 1.8-5.8). Overall, no temporal trend in annual HIV incidence was noted during the study period; however, HIV incidence among MSM IDUs increased from 2.9 per 100 PYs in 1996 to 4.7 per 100 PYs in 1998. CONCLUSIONS: The rate of seroconversion in this hospital and affiliated clinic population is unexpectedly high. Moreover, HIV transmission among IDU patients has not decreased over the last several years. The San Francisco county hospital provides a high-risk sentinel population to monitor emerging trends in HIV transmission, especially among IDUs, and presents multiple opportunities for prevention interventions, because these patients are being seen repeatedly by clinicians.

AIDS Serodiagnosis↗
PubMed1997

The impact of China's health sector reform on county hospitals.

The article describes the impact of China's health sector reform on relatively small hospitals in rural counties. It uses one county hospital to illustrate how pressures to increase revenue, combined with distortionary pricing policies, have led to cost increases. It argues that the introduction of hospital insurance could accelerate the cost increases unless measures are taken to control costs. These measures will include improvements to hospital management and changes to mechanisms of payment for hospital services. Government will have to play an active role to ensure that county hospitals serve the needs of rural people.

China↗
PubMedDate not supplied

Laparoscopic nephrectomy is cost effective compared with open nephrectomy in a large county hospital.

BACKGROUND AND OBJECTIVES: To evaluate the experience with laparoscopic nephrectomy in a large county hospital and perform a cost comparison between uncomplicated open and laparoscopic nephrectomy. METHODS: Eleven consecutive patients who underwent an uncomplicated laparoscopic nephrectomy in a large county hospital were compared with 8 patients who underwent uncomplicated open nephrectomy during the same period. Patient charts and corresponding billing records were reviewed to determine overall hospitalization cost and individual cost components. RESULTS: No perioperative complications occurred in either the laparoscopic or open group, and no statistically significant differences existed between groups with regard to patient demographics or operative parameters. The overall operating room costs favored the open nephrectomy group by dollars 1070 (P=0.003). However, the overall cost of hospitalization, surgeon professional fees, duration of hospitalization, room and board costs, laboratory, and radiology costs, pharmacy costs, intravenous solution and infusion pump costs all significantly favored the laparoscopic patient group. The mean difference in overall hospital cost between laparoscopic and open nephrectomy was dollars 1211 in favor of laparoscopy (P=0.037). CONCLUSIONS: Our experience with laparoscopic nephrectomy in a large county hospital demonstrates a clear economic advantage in favor of the laparoscopic approach. Given limited funding for public hospitals and a clear patient benefit, laparoscopic nephrectomy should constitute first-line therapy when nephrectomy is indicated.

Cost-Benefit Analysis↗
PubMed1989

Management of acute head injuries in a Norwegian county--effects of introducing CT scanning in a local hospital.

Introducing a new diagnostic tool, a CT scanner, in a county hospital resulted in a marked redistribution of the handling of acute/severe head injuries. Before the introduction of the CT scanner, a substantial number of these patients were referred to the regional neurosurgical unit. After having acquired its own scanner, the county hospital took over most of the diagnostic and therapeutic tasks concerning acute head injuries, surgery inclusive. This change in policy resulted in more patients surviving without sequelae, and reduced the average latency to surgery. The proportion of operated patients increased considerably, from 23% to 64%. In a relatively large proportion of the patients, there were complications with continuous ICP monitoring using the subdural bolt. This procedure was therefore discontinued. In spite of the improved results caused by the observed redistribution, the study indicates a need for additional training of the county hospital staff.

Accidental Falls↗
PubMed1981

[Possibilities for rehabilitation in a county hospital].

A county hospital with an infirmary surely offers the possibilities for rehabilitation as much as any other institution. Due to its manageable size, the county hospital can probably guarantee deeper personal care. The following possibilities are discussed: activating care, mental stimulation in a reality orientation program, dance and music therapy, plus the opening of the infirmary outwards, which remains a very important aspect. The rehabilitation in a county hospital can be guaranteed only by the complete cooperation between hospital internal and external medicine. An outpatient ward such as the day- and night-clinic is also a useful institution. In the future, the employment of volunteers in and outside the hospital will be of greater importance. Already now, greater efforts should be made on behalf of continued training and greater social prestige for these volunteers.

Cooperative Behavior↗
PubMed1982

Prevalence of essential tremor. Results from the Copiah County study.

This investigation determined the prevalence of essential tremor in a US population. The findings were derived from a large-scale morbidity survey conducted in a rural, biracial Mississippi county (Copiah County). Both the household and the institutionalized populations of the county were included. Results were limited to persons 40 years old or older. Prevalence ratios were higher for women than for men and were higher for whites than for blacks. Age-specific prevalence ratios generally increased with age. The overall prevalence ratio was 414.6 per 100,000 inhabitants.

Adult↗
PubMed2003

Lake-associated outbreak of Escherichia coli O157:H7 in Clark County, Washington, August 1999.

CONTEXT: Escherichia coli O157:H7, one of hundreds of strains of the gram-negative bacterium E coli, has been implicated in numerous lake-borne outbreaks of infection during the past decade. In August 1999, several children who later became ill with E coli O157:H7 infection reported swimming in a lake in Clark County, Washington. The lake was closed and an investigation begun. OBJECTIVES: To identify the source of the outbreak and determine risk factors for infection with E coli O157:H7.Design, Setting, and Patients Two case-control studies were performed among residents of and visitors to Clark County in August 1999 by using community and campground-registrant control subjects. Main Outcome Measure Risk factors for infection with E coli O157:H7 among Clark County residents or visitors. RESULTS: We identified 37 case patients (including 29 primary-case patients) with a median age of 5 years (age range, 1-14 years for primary-case patients). Eight children were hospitalized, 3 with hemolytic uremic syndrome; none died. With analysis restricted to primary-case patients, illness was strongly associated with swimming in the lake (18 of 18 case patients vs 1 of 18 neighborhood-matched and age-matched control subjects; matched odds ratio undefined; P<.001). All primary-case patients were children younger than 15 years who swam in the lake. Illness was associated with placing the head underwater, getting lake water in the mouth, or swallowing lake water (26 of 27 case patients vs 43 of 62 control subjects; matched odds ratio = 11.5; P =.005). Cultures of lake water yielded E coli O157:H7 that matched the outbreak strain according to results of pulsed-field gel electrophoresis. CONCLUSIONS: To date, this is one of the largest documented outbreaks of E coli O157:H7 infection associated with unchlorinated recreational water and represents the first outbreak in which the strain was isolated from lake water. Guidelines are needed to decrease the risk of enteric illness associated with swimming in recreational lakes.

Adolescent↗
PubMed1996

Bacteremia with Streptococcus pneumoniae. Implications for therapy and prevention. Franklin County Pneumonia Study Group.

OBJECTIVE: To determine the incidence and mortality rates of patients with bacteremic infections with Streptococcus pneumoniae, and to determine the serotypes and antimicrobial susceptibilities of the pneumococcal isolates. DESIGN: Prospective case ascertainment and procurement of S pneumoniae isolates between January 1991 and April 1994. SETTING: Ten adult care hospitals in Franklin County, Ohio. PATIENTS: Patients (N = 590) in whom S pneumoniae was isolated from blood cultures. MEASUREMENTS: Demographic data from patients with pneumococcal bacteremia were obtained by chart review. Pneumococcal serotyping and antimicrobial susceptibility testing were performed on 499 bacteremic isolates. RESULTS: Among residents of Franklin County, the annual incidence of pneumococcal bacteremia was higher in patients at least 65 years old (83.0 per 100,000 population) compared with younger adults (9.6 per 100,000 population) (odds ratio [OR], 8.74; 95% confidence interval [CI], 7.19 to 10.62) and more common among African Americans than whites (OR, 1.36; 95% CI, 1.06 to 1.75). The relative risk of pneumococcal bacteremia among persons infected with the human immunodeficiency virus was 41.8 times (CI, 19.0 to 92.0) that of county residents 18 to 64 years of age. The overall mortality rate was 19% and was age-dependent, reaching 38% in patients at least 85 years old. The distribution of pneumococcal serotypes causing bacteremia was remarkably consistent over time. The incidence of drug-resistant strains increased during the study period; by 1994 14% were resistant to penicillin, 12% to ceftazidime, and 24% to trimethoprim-sulfamethoxazole. The resistant strains included several serotypes of S pneumoniae. Most serotypes (89.8%) of S pneumoniae causing bacteremia are contained in the pneumococcal vaccine. CONCLUSIONS: Increased use of pneumococcal vaccine and recognition of antimicrobial resistance patterns may assist physicians in treating patients with S pneumoniae bacteremia. Educational programs to discourage unnecessary antimicrobial drug use should be developed for patients and physicians.

Adult↗
PubMed1996

Geographical mapping of childhood diabetes in the northern English county of Yorkshire.

This study aimed to highlight geographical differences in childhood Type 1 (insulin dependent) diabetes mellitus (IDDM) by mapping incidence at 3 different geographical scales, within the northern English county of Yorkshire. Mapping techniques are applied to incident cases from a population-based regional register of childhood IDDM. The Yorkshire Children's Diabetes Register (YCDR) comprises 1310 children (0-14 years) diagnosed with IDDM from 1978-1990. Age standardized incidence rates (cases/100000/year) are given for administrative county, standardized incidence ratios (SIRs) are mapped by local government district and electoral ward. Heterogeneity between areas was assessed by a chi 2 test. At county level, incidence is 25% higher in Humberside (16.82 per 100000 per year) compared to West Yorkshire (12.21 per 100000 per year) (p < 0.001). SIRs for the 22 districts display significant heterogeneity (p < 0.001) with deficits in the urban areas of Kirklees (70 95% CI 57-85) and Bradford (81 95% CI 68-95) and significant excesses in the rural districts of Ryedale (147 95% CI 106-198), Beverley (149 95% CI 113-193), Holderness (166 95% CI 112-237) and Boothferry (186 95% CI 134-250). At the smallest scale, variation between wards is significant (p < 0.001) and low incidence in urban areas is notable. Geographical variation in the incidence of childhood IDDM may provide strong clues to its aetiology. Within Yorkshire, geographical distribution shows significant heterogeneity at three different scales. The magnitude of the variation is not explained by ethnic or genetic differences in the population and underlines the important influence of environmental factors in disease aetiology.

Adolescent↗
PubMed1976

Skin cancer and water arsenic in Lane County, Oregon.

It was expected that the incidence of skin cancer would be related to the known high arsenic levels in water supplies of Lane County, Oregon. Incidence rates were based on all histopathologically confirmed cases among Lane County residents diagnosed during 1958-1971 and were compared to mean water arsenic levels measured during 1968-1974. Basal cell carcinoma had a mean annual incidence rate of 88 per 100,000, a 5:4::M:F sex ratio, and an increasing risk for both sexes in urban areas. Squamous cell carcinoma incidence was 50 per 100,000 and showed 2:1:M:F sex ratio but no urban predilection. Neither type of skin cancer was directly related to the arsenic levels as expected, although sporadic individuals with sufficient exposure could manifest the relationship. Fewer than expected drinking water sources were found to contain high arsenic content, so that the Lane County data do not necessarily contradict previous reports of positive correlation. The basal cell carcinoma pattern suggested that this disease might be potentiated by urban air pollutants.

Aged↗
PubMed1977

A comparison of Hodgkin's disease in Alameda County, California, and Connecticut: histologic subtype and age distribution.

A comparison of the histologic patterns of Hodgkin's disease in Alameda County, California and Connecticut was made in relation to age. All Hodgkin's disease cases from the Alameda County Cancer Registry diagnosed between 1960 and 1969 for which adequate material was available for evaluation were reviewed and histologically subtyped according to the Rye classification (159 cases). The age-specific relative frequencies and incidence rates for the histologic subtypes of Hodgkin's disease in Alameda County were estimated and compared to those estimated for Hodgkin's disease in Connecticut. The morphologic ex pression of Hodgkin's disease in both areas was similar and characteristic of economically developed regions with high living standards. The comparison supports the hypothesis that the host immune capacity, influenced by socioeconomic factors, has a strong and measurable effect on the pathogenesis of Hodgkin's disease.

Adolescent↗
PubMed1981

Seneca County, New York: an area with low cancer mortality rates.

The combined mortality rates for all high-rate neoplasms and for all malignant neoplasms combined are considerably lower in Seneca County, New York, than in its surrounding counties. The possibility that these lower rates are attributable to the geochemical uniqueness of the two lakes that enclose the county, availability and concentration of selenium, high salinity of the lakes, and high concentration of potassium cations is discussed.

Aged↗
PubMed1997

Incidence of systemic sclerosis in Allegheny County, Pennsylvania. A twenty-year study of hospital-diagnosed cases, 1963-1982.

OBJECTIVE: To determine the incidence of hospital-diagnosed systemic sclerosis (SSc) among residents of Pittsburgh and Allegheny County, PA, from 1963 through 1982. METHODS: Medical records from all Allegheny County hospitals were searched using International Classification of Diseases codes for patients diagnosed with SSc. Each case was reviewed and verified by a physician, according to specified criteria. Age-adjusted incidence rates were computed for race and sex, and results were expressed as new cases per million population per year, with the 1970 Allegheny County population serving as the standard. RESULTS: Four hundred forty-four cases of SSc were identified during this 20-year survey, for a total annual incidence of 13.9 per million population. Overall, the incidence rate doubled during 1973-1982 compared with the first time interval of the study, with the greatest increase occurring in women. Among the younger population (ages 15-24), black women had the highest incidence of SSc (21.2 per million population). Overall, the female-to-male incidence ratio was 3:1, and was slightly higher (3.4:1) during the childbearing years (ages 15-44). Men under age 35 and children infrequently developed SSc. CONCLUSION: The incidence of SSc reported in this study increased with time. Although this trend was most likely due to improved detection and medical record techniques, the incidence rate stability in men compared with women suggests that there may have been a true increase in the incidence of SSc in this population, particularly in women.

Age Factors↗
PubMed2003

Pediatric neurobehavioral diseases in Nevada counties with respect to perchlorate in drinking water: an ecological inquiry.

BACKGROUND: Contamination of drinking water with perchlorate, a known thyrotropic agent, has been demonstrated in areas in the western United States. The health consequences of that exposure have been studied, particularly in the State of Nevada. Previous studies in Nevada, comparing the area with perchlorate in the drinking water and the areas without perchlorate in the drinking water, have found no difference in neonatal thyroxine (T(4)) or thyrotropin (TSH) levels, or in the prevalences of thyroid diseases and thyroid cancer. This same study design has now been applied to the major neurobehavioral diseases of childhood (i.e., attention deficit-hyperactivity disorder (ADHD) and autism) and to school performance in order to determine whether those conditions are more frequent in the area with perchlorate-contaminated water. METHODS: Medical services data on ADHD and autism were obtained from the Nevada Medicaid system for the period of January 1, 1996, to December 31, 2000, with county of residence used as the basis for residential information. Analyses of fourth-grade school performance results for two recent time periods came from the state government. Perchlorate concentrations in drinking water had been determined by local water authorities. ADHD and autism rates for the area with perchlorate in the drinking water (Clark County) were calculated and compared with the rates for the other areas in the state, as were fourth-grade school performances. RESULTS: Analysis of the data from the Nevada Medicaid program shows that the rates for ADHD and for autism in the area where perchlorate was in the drinking water did not exceed the rates in those areas where there was no perchlorate contamination in the drinking water. Fourth-grade standardized test results for students in Clark County were not different from those of the remainder of the state. CONCLUSIONS: This ecological study of children in the exposure area did not find evidence of an increased risk of either ADHD or of autism caused by perchlorate contamination in the drinking water. Furthermore, no difference in overall fourth-grade school performance was observed. No evidence was found that children from the area with perchlorate in the drinking water (up to 24 microg/liter) had either an increase in pediatric neurobehavioral disease (ADHD and autism) or a decrease in fourth-grade academic performance. The limitations of this ecological study relate to diagnostic criteria and ascertainment of geographic and demographic differences and to data on individual residence and water consumption during pregnancy.

Attention Deficit Disorder with Hyperactivity↗