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PubMed2004

A strategy for the management of HIV/ AIDS in the health sector of the city of Johannesburg.

The HIV/AIDS pandemic is posing major challenges to all sectors in South Africa, including the health sector of the city of Johannesburg. The health sector of the city of Johannesburg, as a result of the pandemic, is faced with increasing demands on its scarce resources at a time of major reform at local government level including transformation of the health sector. The overall objective of the study is to explore and describe a strategy for the management of HIV/AIDS by the health sector of the city of Johannesburg. An exploratory, descriptive and quantitative research design was utilized and the UNAIDS "Guide to the strategic planning process for a national response to HIV/AIDS" (1998), was employed to formulate the strategy. The content validity of the strategy was determined according to the process originally described by Lynn (1986) and adopted by Muller (in Booyens, 1998:607-609). The research was conducted in two phases. The first phase, the developmental phase, involved the exploration and description of the theoretical framework and the response to the pandemic, and formulation of a draft strategy. The second phase, the quantification phase, involved the assertion of the content of the strategy by a group of experts and determination of the content validity index (CVI). The final strategy focused on the following: to lead and facilitate intersectoral collaboration; to strengthen primary health care services to provide comprehensive community-based care; prevention of new infections; community mobilization towards prevention, non discrimination and non stigmatization and empowerment of the health sector to deal with the AIDS.pandemic. The CVI results showed that the average content validity index determined during this study was adequate: full score (1.0) for acceptability and technical soundness, and 0.89 for feasibility and perceived affordability. The strategy formulated for the management of HIV/AIDS by the health sector of the city of Johannesburg is therefore acceptable, technically sound and feasible and perceived as affordable. It was finally recommended that the strategy be adopted for implementation within the health sector of the city of Johannesburg.

Acquired Immunodeficiency Syndrome↗
PubMed2004

[Mass screening for prostate cancer in Tokushima City: the results of 2001].

PURPOSE: Screening with prostate specific antigen (PSA) only to detect prostate cancer was started in Tokushima City from 2001 as one of health check lists. We evaluated the first year result. MATERIALS AND METHODS: Fifty-five years old or elder men living in Tokushima City who wants to measure serum PSA level to screen for prostate cancer were entered to screening program. The men whose PSA levels detected as over normal; range were recommended to visit to urologists for further examination to detect prostate cancer include prostate biopsy. The results of further examination were reported to Tokushima City and evaluated. RESULTS: The population of fifty-five or elder men in Tokushima City was 25,416 and 9,019 (35.5%) men were measured serum PSA levels. In 801 (8.9%) men, PSA levels were over normal range, and recommended further examination to detect prostate cancer. 451 (56.3%) men visited to urologists for further examination, and prostate biopsy was performed in 231 (51.2%) men. Finally, 121 men were diagnosed as prostate cancer, 52.1% of 231 men performed prostate biopsy, 26.7% of 451 men visited to urologist for further examination, 1.34% of 9,019 men measured serum PSA levels. Patient number for each clinical stages were 49 in B0, 16 in B1, 16 in B2, 29 in C, one in D1, and 10 in D2. Patients number in each age range were 3 in 55-59, 11 in 60-64, 22 in 65-69, 37 in 70-74, 33 in 75-79, 15 in 80 or elder. Patient number of Stage B and 74 years old or younger was 48 (39.7%). CONCLUSION: Prostate cancer was detected in 1.34% of 9,019 men who measured serum PSA levels, and early stage B was two thirds. PSA screening to detect prostate cancer as one of health check-lists in Tokushima City was useful to detect early prostate cancer.

Age Factors↗
PubMed1999

[Trends in 25-year evolution of coronary atherosclerosis in males fom some cities of Europe and Asia].

AIM: Detection of changes in the course of coronary atherosclerosis (CA) which took place for 25 years of observation in male population in different cities. MATERIAL AND METHODS: Epidemiological surveys of coronary AS by autopsy data according to WHO program were conducted in 1963-1966 (trial 1) and 1985-1989 (trial 2) in 9 cities: Ashkhabad (Turkmenistan), Bishkek (Kirghizia), Irkutsk, Yakutsk (Russia), Riga (Latvia), Tallinn, Tartu (Estonia), Kharkov, Yalta (Ukraine), Malme (Sweden), Prague (Czechia). The surveys enrolled males aged 20-59 years: 7470 males entered trial 1 and 9600 entered trial 2. AS was assessed visually-plan-imetrically in the three major coronary arteries (CA). By the data from Ashkhabad, Bishkek, Irkutsk, Kharkov, Yakutsk, AS in healthy males was also characterized. RESULTS: In 9 CIS countries' cities CS for 25 years has undergone noticeable changes: according to trial 2 atherosclerotic process accelerated, especially in males over 40, in healthy males as well. CA AS had the same features in both trials in Prague and was less pronounced in males from Malme. National differences between native population and immigrants in AS were evident in Ashkhabad, Bishkek and Yakutsk in both trials. In trial 2 CA stenoses were encountered more frequently in all the cities under study. Coronary arteries were more calcified. There was a direct relationship between severity of preatherosclerotic CA changes in young males (20-39-year-old) and speed of AS progression in older males. CONCLUSION: For 25 years there was a tendency to more severe course of coronary AS in CIS countries, in Prague males AS has undergone minimal changes, in Malme the situation with AS severity has improved. Severity of AS in males from different cities and CHD male mortality were correlated.

Adult↗
PubMed2000

Compliance with the law on car seat-belt use in four cities of Thailand.

Surveys to determine the scope of compliance with the law requiring seat-belt use in Thailand were conducted by observation and interviews with drivers in four cities: namely, Bangkok Metropolis, Chiang Mai, Phuket and Nakhon Ratchasima. The work was carried out in two separate sessions: during the first month following enactment of the law, and six months after its enactment. The sample comprised 46,949 vehicles in the first session (January 1996) and 76,188 vehicles in the second session (July 1996). The results showed that 42.7 per cent of drivers used seat-belts in January and 30.7 per cent in July. When the data were disaggregated according to cities, it was found that more Bangkok drivers complied with the seat-belt law than in Phuket, 24.6 per cent; Chiang Mai, 22.1 per cent; and Nakhon Ratchasima, 18.3 per cent relatively low compliance rate was encountered among drivers of pick-up trucks (including those with modified roofs) and vans, particularly farmers and the self-employed. Women drivers tended to abide by the law more often than men (OR = 1.7, 95% CI = 1.12, 1.23). Inter-city travelers wore seat-belts more than those traveling in the city (OR = 1.74, 95% CI = 1.68, 1.80). About one-fifth of non-users or those who rarely used seat-belts were unsure of the effectiveness of seat-belts in preventing serious injury or death in the case of an accident. Discomfort associated with using seat-belts and the perception that they were rendered unnecessary because of slow traffic in cities were other reasons for non-compliance in 50.6 per cent and 43.9 per cent of cases, respectively. The decline in compliance with the law six months after its enactment indicates that there may be a problem with uniform and consistent enforcement of the law.

Accidents, Traffic↗
PubMed2001

[Health status of the population in six cities in the Czech Republic: prevalence and therapy of various chronic diseases].

BACKGROUND: The aim of the study was to describe health status of the urban middle-age population in six cities of the Czech Republic, which were included into the System of Population Health Survey in Relation to the Environment. METHODS AND RESULTS: From the population of cities Brno, Ceské Budĕjovice, Hradec Králové, Karviná, Kolín, Ustí nad Labem 400 males and 400 females in the age of 45 to 54 years were included into the study. All respondents filled out a question-form, half of them also underwent a medical check up. Results has shown that 52.8% of males and 51.6% of females had their cholesterol level elevated (> 5.2 mmol/l), 47.3% of males and 38.3% if females had higher blood pressure (SBP > = 140 mmHg and/or DBP > = 90 mmHg) or they were cured of hypertension, 39.4% of males and 22.5% of females were obese. Significant differences were observed in the prevalence of hypercholesterolemia, hypertension and smoking habits among the cities in study. According to the case histories, 55.6% of males and 57.8% of females complained of long-lasting ill-being, 37.0% of males and 45.2% of females were treated for a chronic disease, 13.3% of males and 12.4% of females considered their health during the previous year as bad or very bad. 45.4% of males and 57.9% of females underwent long-term pharmacological treatment, most frequently on a cardiovascular disease. Above described parameters differed significantly among cities in study. CONCLUSION: In the middle-aged population in six Czech cities the high prevalence of chronic diseases, health troubles and risk factors of chronic disease were found. Though the death rate in CR has been declining, chronic diseases have became a serious problem. Since most of these health problems can be improved by correct regimen, high attention should be given to their prevention.

Chronic Disease↗
PubMed2001

Allergy test results of a rural and small-city population compared with those of an urban population.

The frequency of sensitization to environmental antigens changes in different regions. As such, the pattern of sensitivity to common allergens was studied at multiple sites across central Pennsylvania, an area composed of small cities and rural communities, to determine uniqueness of allergies in populations from this area in contrast to allergies as determined by skin testing in large urban centers. The study reported was undertaken to determine allergen variation from an urban population compared with a rural population of a Northeastern state so that environmental avoidance and immunotherapy can be more precisely prescribed. Patient charts were retrospectively reviewed to determine sensitivity to house dust mites (Dermatophagoides pteronyssinus, Dermatophagoides farinae), cockroach, Penicillium, Aspergillus spp, dog, cat, timothy grass, ragweed, oak, and Alternaria tenuis at five sites in Pennsylvania. All of these sites were classified as "small city" or "rural" for the study. One hundred patient records were examined at each site for the results of allergy testing by the prick puncture, radioallergosorbent test (RAST), or intradermal methods. These small-city and rural data were pooled and compared with that of the National Cooperative Inner-City Asthma Study (NCI-CAS), which included 1286 patients from urban environments. The prevalence of allergy to both species of dust mites, dog, timothy grass, and ragweed was significantly greater in the pooled rural group than in the NCICAS inner-city patients (P < .05). In contrast, sensitivity to cockroach antigens and Alternaria was significantly greater in the NCICAS urban population than in the pooled rural group (P < .05). No statistically significant difference was found between the NCICAS and the pooled rural patients in reference to Penicillium, cat, and oak (P > .05).

Animals↗
PubMed2001

The burden of disease in Maputo City, Mozambique: registered and autopsied deaths in 1994.

OBJECTIVE: To classify the causes of death in Maputo City, Mozambique, using the methods of the Global Burden of Disease study, in order to provide information for health policy-makers and to obtain a baseline for future studies in Maputo City and provincial capitals. METHODS: Data were taken from the Maputo City death register and autopsy records for 1994. FINDINGS: A total of 9011 deaths were recorded in the death register, representing a coverage of approximately 86%. Of these, 8114 deaths (92%) were classified by cause. Communicable, maternal, perinatal, and nutritional disorders accounted for 5319 deaths; noncommunicable diseases for 1834; and injuries for 961. The 10 leading causes of registered deaths were perinatal disorders (1643 deaths); malaria (928); diarrhoeal diseases (814); tuberculosis (456); lower respiratory infections (416); road-traffic accidents (371); anaemia (269); cerebrovascular diseases (269); homicide (188); and bacterial meningitis (178). CONCLUSIONS: Infectious diseases of all types, injuries, and cerebrovascular disease ranked as leading causes of death, according to both the autopsy records and the city death register. AIDS-related deaths were underreported. With HIV infection increasing rapidly, AIDS will add to the already high burden of infectious diseases and premature mortality in Maputo City. The results of the study indicate that cause of death is a useful outcome indicator for disease control programmes.

Autopsy↗
PubMed2001

[DOTS in Osaka City].

The tuberculosis (TB) incidence rate and the smear positive TB incident rate in Osaka City were 107.7 and 34.7 per 100,000 respectively in 1999, which were approximately 3 times higher than the national average. The TB mortality rate in Osaka City was 6.9 per 100,000 in 1999, which was highest in Japan. The TB incidence in the "AIRIN" area, where about 20% TB patients are homeless, shows highest rate of above 1,000/100,000. The treatment defaulter rate in Osaka City is about 10% against the average rate of 4% in Japan. A new strategic plan to intensify TB control is now being prepared by Osaka City government. A goal has been set up to make the TB incidence half in ten years. The plans consists of 4 points of "DOTS", "early detection of patient", "education and campaign", and "cohort analysis of treatment outcome". "DOTS" is being expanded in Osaka City. DOT is applied not only to the special group of homeless patients but also to the patients in the hospitals and in the community. Further systematic development of "DOTS" is necessary to achieve the goal.

Communicable Disease Control↗
PubMed1984

The satellite city in Soviet urban development.

"This paper examines the impact of satellite-city policies [in the USSR] during the period 1959-80. First, it traces the evolution of satellite-city policies that evolved in response to Khrushchev's interest in regulating the growth of large cities. Second, it examines the extent to which these policies have affected actual urban growth during the period 1959-80. The analysis suggests that, despite satellite-city policies designed to restrict their growth, large cities have become even more dominant in the Soviet Union."

Demography↗
PubMed1987

City-size distributions and the world urban system in the twentieth century.

"In this paper we trace and interpret changes in the geographical pattern and city-size distribution of the world's largest cities in the twentieth century. Since 1900 the geographical distribution of these cities has become increasingly dispersed; their city-size distribution by rank was nearly linear in 1900 and 1940, and convex in 1980. We interpret the convex distribution which emerged following World War 2 as reflecting an economically integrated but politically and demographically partitioned global urban system. Our interpretation of changes in size distribution of cities emphasizes demographic considerations, largely neglected in previous investigations, including migration and relative rates of population change."

Demography↗
PubMed1988

City size, quality of life, and the urbanization deflator of the GNP: 1910-1984.

The authors attempt to determine the net effect of city size on quality of life by developing a welfare measure of urbanization. "The estimation procedure suggested in the theoretical part of the paper (section II) is implemented in the empirical part (section III) using 1980 census data from the [U.S.] PUMS (Public Use Micro Data Sample). The results indicate there is no single optimal city size, but rather a worst city size, and about 90 percent of the U.S. population reside in cities smaller than worst city size. If quality of life is related to the degree of urbanization, then long-term trends in the locational distribution of the population should be accounted for in any welfare-oriented measure of national income. One application of our results is, as indicated, the derivation of a GNP welfare deflator reflecting changes in the degree of urbanization (section IV). The findings suggest an urban deflator on the order of six to seven percentage points, which is steadily increasing at a rate of about half a percentage point per decade."

Americas↗
PubMed1985

The cities of the RSFSR: trends and prospects of development.

The relationship between function and city size in cities of the Russian part of the USSR with a population of over 100,000 is examined for the period 1939 to 1980. The results suggest that "the relationship between city growth and functional change is wavelike in nature. In the initial stages of development of a city, it is the construction and transport functions that predominate, and they are associated with high rates of population growth. Increasing functional complexity leads to slower rates of population growth. When the given city reaches a higher stage of development...it again begins to attract population, with relatively low rates of growth."

Demography↗
PubMedDate not supplied

Turkey: distribution of cities and change over time.

Patterns of urbanization in Turkey from 1945 to 1975 are examined, with emphasis on the analysis of rank-size patterns. Attention is given to changes over time in the national rank-size distribution of cities, the growth rates of new cities, and the rank-size distribution of cities in various regions. "In general, the patterns of distribution of cities in Turkey are quite regular when compared with other developing countries. Since 1945 the city system has moved to a state more adjusted to the rank-size rule, paralleling the economic development of the country."

Asia↗
PubMedDate not supplied

Prevalence in two mexican cities of human papillomavirus DNA sequences in cervical cancer.

In Mexico, about 30% of all malignant tumors in women are uterine cervix carcinomas. It is one of their main causes of death. We have previously shown that in Mexico City, 31% (5/16) of the analyzed tumoral samples contained HPV-16 DNA sequences. We have now extended this observation in Mexico City and included the city of Monterrey and found that the prevalence of HPV-16 is similar in both: 26% (6/23) for Monterrey and 29% (4/14) for Mexico City. HPV-18 was detected in only 10% (1/10) and 7% (1/14) of the tumors in these two populations when assayed with an HPV-18 specific probe. In both cities, the majority of the samples analyzed (including samples from the four stages of severity of the disease) contained integrated papillomavirus DNA sequences. Our results suggest that the mexican population contains a rather low proportion of HPV-16 and HPV-18 sequences in uterine-cervix carcinoma.

DNA, Viral↗
PubMed2003

[Comparison of hepatitis B virus serotype and genotype among HBsAg positive hepatitis B patients in a northern and a southern city of China].

OBJECTIVE: To understand HBV serotypes and genotypes epidemiology in a northern city and a southern city in China. METHODS: Using polymerase chain reaction (PCR) and direct sequencing of HBV DNA PCR products, the serotypes and genotypes of HBV in 530 from HBsAg positive samples. The enrolled patients were from Harbin, a northern city and Lianjiang, a southern city in China. RESULTS: Comparison of the serotypes and genotypes of HBV between Harbin and Lianjiang showed that adrq+ was the most predominant hepatitis B virus serotype in both Harbin and Lianjiang (87.2% and 73.5%,respectively), adw2 was the next (12.0% and 25.7%, respectively); genotype C was the most frequent in Harbin and Lianjiang (87.8% and 73.2%, respectively), and genotype B was the next (12.2% and 26.1%, respectively) only 1 patient was infected by genotype D, and 1 patient was found to be co-infected by genotype B and C in Lianjiang. CONCLUSION: The results suggest that the percentage of HBV serotypes and genotypes between Harbin and Lianjiang was significantly different (P less than 0.001), but the main HBV serotype and genotype of the two cities were similar.

China↗
PubMed2004

Effects of social intervention on detection and efficacy of treatment for arterial hypertension. Main results of the Polish Four Cities Programme.

BACKGROUND: Cardiovascular diseases are the main cause of death in the adult Polish population. Beside lipid disorders and cigarette smoking, hypertension represents the most important risk factor leading to cardiovascular complications. Representative studies conducted in Poland in 1994-2002 showed that in 2002 the number of respondents in the survey who stated they knew their own blood pressure values dropped by 3.5 million, compared with 1994. This decrease was predominantly seen in small towns and in the countryside. Preventive programmes should therefore be addressed mainly to the most vulnerable communities. Modern methods of social marketing may play a substantial role in the creation of a healthy lifestyle. AIM: The aim of the Polish Four Cities Programme (PP4M), conducted in 2000-2001, was to develop the most effective methods of detection of and improvement in treatment for hypertension among the residents of small towns and rural areas. One of the programme tasks was to compare the effectiveness of a standard medical screening intervention with a similar approach combined with the use of social marketing methods.Methods. The programme was conducted by an interdisciplinary team in three small Polish towns -- Kartuzy, Oborniki Wlkp. and Braniewo, as well as in one of the districts of a large city Łódź -- Olechów. Medical intervention combined with social marketing (community intervention) took place in Oborniki Wlkp. whereas the residents of Kartuzy and Łódź were subjected only to the traditional medical intervention. Braniewo served as a control location -- neither medical nor community intervention was implemented. Community intervention with elements of social marketing consisted of a three-month, intensive education and information campaign, initiated four weeks prior to the start of medical intervention. Epidemiological situation was assessed in all the four cities before and after the completion of the preventive interventions (screening), using representative surveys, with the objective to assess the changes in the awareness of one's own blood pressure values, detection of hypertension and knowledge concerning cardiovascular risk factors.Results. In two survey locations -- Kartuzy and Łódź - awareness of one's own blood pressure values after the medical intervention did not significantly change (61% and 67.6% at baseline versus 62.1% and 71.6% after the intervention, respectively). In contrast, social marketing activities conducted in Oborniki significantly increased this parameter from 61.5% to 79.8% (p<0.01). While medical intervention did not change the proportion of non-diagnosed hypertension in a small town (a non-significant decrease from 49% to 45% in Kartuzy), its effect in a large city was clearly visible (a decrease from 46% to 28% in Łódź). In Oborniki Wlkp. (medical intervention combined with social marketing) the effects were the most noticeable -- a reduction from 50% to 27% was achieved. The efficacy of hypertension treatment at baseline was low (4.7% in Kartuzy, 6.6% in Oborniki, and 6.5% in Łódź), but it then improved significantly (a twofold increase in Kartuzy and Oborniki, and more than twofold increase in Łódź). When the target value of blood pressure was set at 160/95 mmHg, the highest efficacy of hypotensive therapy was observed directly after the completion of medical and community intervention in Oborniki (an almost twofold increase in treatment efficacy). CONCLUSIONS: 1. Medical intervention combined with a community intervention and marketing campaign leads to a statistically significant improvement in self-awareness of blood pressure values among residents of small towns. 2. Medical intervention combined with community intervention brings the detection rate of hypertension in small towns up to the level observed in large cities. 3. Medical intervention, especially when combined with community intervention, improves the efficacy of the treatment of hypertension, regardless of the size of agglomeration.

Adult↗
PubMed2005

Population-based estimates of the cumulative risk of hospitalization potentially associated with rotavirus diarrhea among children living in two cities in Akita Prefecture, Japan.

A 4-year retrospective population-based survey was conducted in two cities in Akita Prefecture, Japan, to estimate the incidence rate and the cumulative risk of hospitalization potentially associated with rotavirus diarrhea. At monthly occasions of the 3-year-old checkup, we asked each parent if his or her child had ever been hospitalized because of rotavirus diarrhea. Based on 3-year follow-up of the four consecutive birth cohorts (1996-1999), we calculated the incidence rate and the cumulative risk of rotavirus-associated hospitalizations by the age of 3 years. The incidence rates of rotavirus-associated hospitalization in 1-year-old children in Akita city and Honjo city were 9.7 and 16 hospitalizations per 1,000 children per year, respectively, whereas 1.9% of children in Akita city and 3.3% of children in Honjo city were hospitalized by their third birthday because of rotavirus-associated diarrhea. The burden of rotavirus diarrhea in this region of Japan, and probably across the nation, appears substantially large.

Age Factors↗
PubMedDate not supplied

Maintenance asthma treatment with fluticasone/salmeterol combination via Diskus: effect on outcomes in inner-city children enrolled in TennCare.

Although current national guidelines suggest combination inhaled corticosteroid/long-acting inhaled beta2-agonist as the preferred treatment in moderate and severe persistent asthma for children, trials aimed at reducing emergency department (ED) visits and hospitalizations in minority inner-city children have not been conducted with the combination product of fluticasone/salmeterol via Diskus (Advair). This study assessed the effect of fluticasone/salmeterol combination via Diskus therapy on hospitalizations and ED visits in children with asthma. We conducted a prospective 1-year study with an intervention group compared with a usual care control group. This study took place at an inner-city university-affiliated children's medical center allergy clinic. Inner-city patients with asthma aged 4-17 years with a history of frequent ED visits and hospitalizations for the 2 previous years were enrolled beginning in July 2001. A control group of inner-city asthmatic patients was identified via hospital medical records. Patients were prescribed fluticasone/salmeterol combination via Diskus (n = 39) for 1 year and were compared with a usual care control group (n = 39). Although the investigators did not intervene in the control patients, review of their records revealed that all control patients had inhaled corticosteroids prescribed during the intervention period. Outcome measures included ED visits and hospitalizations for 1 year after enrollment versus the mean for acute care visits for 2 years before enrollment in the study. The intervention group had a 20% reduction in ED visits, which was significant compared with the control group (p = 0.017); both groups had significant reductions in hospitalizations. The risk of experiencing an asthma exacerbation (ED visit or hospitalization) was reduced by 33% in the intervention group compared with the control group (risk ratio, 0.67; 95% confidence interval, 0.49-0.90; p = 0.005). Our results suggest that fluticasone/salmeterol combination via Diskus is associated with a reduction in risk of acute exacerbations of asthma in inner-city children, including ED visits and hospitalizations.

Administration, Inhalation↗