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PubMed2005

A population-based description of glioblastoma multiforme in Los Angeles County, 1974-1999.

BACKGROUND: There have been reports that the incidence rates of brain tumors have increased over the past few decades, but most have considered all brain tumors together. The authors analyzed the pattern of glioblastoma multiforme (GBM) occurrence in Los Angeles County, California to shed light on the incidence and descriptive epidemiology of this type of brain tumor. METHODS: Data were obtained from the Los Angeles County Cancer Surveillance Program. Incidence rates were analyzed by gender, race, age at diagnosis, period of diagnosis (1974-1981, 1982-1988, or 1989-1999), and socioeconomic status (SES). In addition, data were stratified according to anatomic subsite. A multivariate model describing changes in rates by each of these variables was constructed. RESULTS: Age-specific incidence rates (ASIR) rose sharply after age 30 years. The peak ASIR was at age 70-74 years in males and at age 75-79 years in females. The age-adjusted incidence rate (AAIR) of GBM increased from 1974 to 1999 by an estimated 2.4% per year among males and 2.8% per year among females. Overall, males had a 60% increased risk of brain tumors compared with females. Males had a higher incidence of GBM compared with females at each anatomic subsite except the posterior fossa. The largest male:female ratio occurred in the occipital lobes. Non-Latino whites had the highest incidence rates (2.5 per 100,000) followed by Latino whites (1.8 per 100,000), and blacks (1.5 per 100,000). After 1989, compared with the period before magnetic resonance imaging (MRI) was available, there was an increase in GBM incidence rates among those with of higher SES that was most pronounced in females. The incidence of GBM was highest for frontal lobe tumors and for tumors that involved two or more lobes (overlapping tumors), followed by tumors in the temporal and parietal lobes. In the multivariate analysis, year of diagnosis, SES, gender, race (Latino but not black), site, and age at diagnosis all were important predictors of incidence rate. CONCLUSIONS: GBM incidence increased in Los Angeles County over the last 30 years and especially after 1989, suggesting that the introduction of MRI may have contributed to the increase. Individuals older than age 65 years experienced the greatest increase in incidence over time. Older age, male gender, higher SES, and non-Latino white race increased the risk of GBM. Previously unreported incidence rates for GBM among Latino whites were significantly lower than among non-Latino whites but were intermediate between non-Latino whites and blacks.

Adult↗
PubMedDate not supplied

Designing linked micromap plots for states with many counties.

This paper describes the design of linked micromap plots for showing county estimates on a state by state basis. The linked micromap template was specifically developed to represent spatially indexed statistical summaries. Each plot shows regional names, spatial patterns and statistical patterns while linking them all together. Thus the design is useful for communicating summaries from a host of health and environmental studies. The specific design challenge in this paper is to create one-page plots for the states with 60 to 120 counties. While the county names and micromaps take up substantial space, the three examples demonstrate that there is sufficient space to represent two variables. The basic design has the potential for showing more. Consequently the new designs are suitable for presenting sophisticated summaries.

Adolescent↗
PubMed1993

The shape of mortality curves: an analysis of counties in England and Wales, 1911.

"Previous analysis has shown that life tables may be distinguished by two orthogonal pieces of information, the level of mortality in the population and the relative shape of the mortality curve. We show that both the regions of England and Wales in 1911, and locality types (county boroughs, other urban, and rural) differ in the shape of their mortality curves. Using data for the administrative counties, we examine the underlying correlates of this differentiation, paying particular attention to the socio-economic structure of the counties as reflected in their wealth, opportunity levels, and degree of urbanisation." (SUMMARY IN FRE)

Demography↗
PubMed2000

Asthma and the home environment of low-income urban children: preliminary findings from the Seattle-King County healthy homes project.

OBJECTIVES: Childhood asthma is a growing public health concern in low-income urban communities. Indoor exposure to asthma triggers has emerged as an important cause of asthma exacerbations. We describe indoor environmental conditions related to asthma triggers among a low-income urban population in Seattle/King County, Washington, as well as caregiver knowledge and resources related to control of these triggers. METHODS: Data are obtained from in-person, structured, closed-end interviews with the caretakers of children aged 4-12 years with persistent asthma living in households with incomes less than 200% of poverty. Additional information is collected during a home inspection. The children and their caregivers are participants in the ongoing Seattle-King County Healthy Homes Project, a randomized controlled trial of an intervention to empower low-income families to reduce exposure to indoor asthma triggers. We report findings on the conditions of the homes prior to this intervention among the first 112 enrolled households. RESULTS: A smoker was present in 37.5% of homes. Mold was visible in 26.8% of homes, water damage was present in 18.6% of homes, and damp conditions occurred in 64.8% of households, while 39.6% of caregivers were aware that excessive moisture can increase exposures to allergens. Dust-trapping reservoirs were common; 76.8% of children's bedrooms had carpeting. Cockroach infestation in the past 3 months was reported by 23.4% of caregivers, while 57.1% were unaware of the association of roaches and asthma. Only 19.8% of the children had allergy-control mattress covers. CONCLUSIONS: Many low-income urban children with asthma in King County live in indoor environments that place them at substantial risk of ongoing exposure to asthma triggers. Substandard housing and lack of resources often underlie these exposures. Initiatives involving health educators, outreach workers, medical providers, health care insurers, housing agencies, and elected officials are needed to reduce these exposures.

Asthma↗
PubMed2006

The Barents project in psychiatry: a systematic comparative mental health services study between Northern Norway and Archangelsk County.

BACKGROUND: There is virtually no readily accessible systematically recorded evidence on how the organization of mental health services in Europe's largest country, Russia, may differ from other national systems. This study systematically compares the mental health services in Archangelsk County and Northern Norway using instruments developed for trans-cultural use. METHODS: The European Service Mapping Schedule (ESMS) and The International Classification of Mental Health Care (ICMHC) were used to describe: (i) resources, organisation and utilisation of the services; (ii) their decentralisation and differentiation; (iii) some interventions delivered by the mental health service units (n = 132) in both regions. RESULTS: The Norwegian services are more decentralised and differentiated, while the Russian services are largely hospital-based. The GPs are of considerable importance to the Norwegian services, functioning as gatekeepers-both centrally and peripherally. In contrast, the GP model is still poorly established in Archangelsk County. There are more units for long term stay in the Russian services than in Norway. General health care and taking over daily living activities are more organised in Archangelsk County, while psychopharmacological treatment and psychosocial interventions are more developed in Norway. CONCLUSION: The study has revealed several differences in resources, organisation and utilisation of the mental health services between the two compared areas. The very large variations indicate that underlying local patterns of service delivering must be further investigated and taken into account in the planning of the services development.

Catchment Area, Health↗
PubMed1999

Fracture incidence in Olmsted County, Minnesota: comparison of urban with rural rates and changes in urban rates over time.

Using the data resources of the Rochester Epidemiology Project, we carried out a descriptive study of fracture incidence among the residents of Olmsted County, Minnesota. During the 3-year period 1989-91, 2901 County residents > or = 35 years of age experienced 3665 separate fractures. The age- and sex-adjusted (to 1990 United States whites) incidence of any fracture was 2205 per 100,000 person-years (95% CI, 2123 to 2286) and that of all fractures was 2797 per 100,000 (95% CI, 2705 to 2889). Age-adjusted fracture rates were 40% greater among women. Incidence rates increased with age in both sexes. One-third of the fractures involved the hip, spine or distal forearm - the skeletal sites traditionally associated with osteoporosis. The age- and sex-adjusted incidence of fractures due to moderate trauma (2205 per 100,000 person-years; 95% CI, 2106 to 2303) was twice that of fractures due to more severe trauma (1164 per 100,000; 95% CI, 1106 to 1223) and 12 times that of pathological fractures (178 per 100,000; 95% CI, 133 to 222). Overall fracture rates were 15% greater among residents of the central city of Rochester compared with the rural portion of Olmsted County. The incidence of limb fractures among Rochester residents was 14% higher than comparable rates documented for this community 20 years earlier in 1969-71, due mainly to a substantial increase in the incidence of leg fractures.

Adult↗
PubMed1999

Tools for Groundwater Protection Planning: An Example from McHenry County, Illinois, USA.

/ This paper presents an approach for producing aquifer sensitivity maps from three-dimensional geologic maps, called stack-unit maps. Stack-unit maps depict the succession of geologic materials to a given depth, and aquifer sensitivity maps interpret the successions according totheir ability to transmit potential contaminants. Using McHenry County, Illinois, as a case study, stack-unit maps and an aquifer sensitivity assessment were made to help land-use planners, public health officials, consultants, developers, and the public make informed decisions regarding land use. A map of aquifer sensitivity is important for planning because the county is one of the fastest growing counties in the nation, and highly vulnerable sand and gravel aquifers occur within 6 m of ground surface over 75% of its area. The aquifer sensitivity map can provide guidance to regulators seeking optimal protection of groundwater resources where these resources are particularly vulnerable. In addition, the map can be used to help officials direct waste-disposal and industrial facilities and other sensitive land-use practices to areas where the least damage is likely to occur, thereby reducing potential future liabilities. KEY WORDS: Geologic mapping; Groundwater; Aquifers; Aquifer sensitivity; Land-use planning

Journal Article↗
PubMed2006

The impact of government decentralization on county health spending for the uninsured in California.

We analyze Program Realignment, California's 1991 policy of decentralizing control of health, mental health, and social services, from the state to the counties. Drawing from the economics literature on intergovernmental transfers and using data constructed for this study, we analyze the impact of Realignment on uninsured health spending. We find a change in the pattern of spending on indigent health services by counties following decentralization. Our results suggest, however, that county-level governments maintain a level of commitment to social-service spending that recent studies indicate may be lacking at the state level.

California↗
PubMed1986

Effect of intervention on coronary heart disease risk factors in some Norwegian counties.

Since 1974, a cardiovascular disease screening and intervention program has been carried out in three of the 19 Norwegian counties, namely Finnmark, Sogn og Fjordane, and Oppland. The program strategy was designed to affect both the general population and a defined high-risk group. Procedures were based upon the organization and implementation already well in place through the national tuberculosis prevention program established in the 1940s. The National Health Screening Service performed two screenings, three to five years apart, to identify cardiovascular disease risk factors in all county residents aged 35 to 49 years (age at first screening), and in representative samples of residents aged 20 to 34 years. After each screening, the local general practitioners and public health nurses were responsible for follow-up and intervention against risk factors among defined high-risk persons, as well as for intensified health education in the general population. Between the first and second screenings, a substantial reduction occurred in the level of smoking and in the mean level of total serum cholesterol. A risk score, including values for cholesterol, systolic blood pressure, and cigarette smoking, showed a reduction of approximately 20 percent (in males aged 35 to 49 years). A more detailed analysis of the Finnmark data revealed that the mean reduction was mainly due to a marked reduction within the high-risk group. This occurred particularly with mean cholesterol levels. Since the screening and intervention program was based upon the model established by the Oslo Study, it is reasonable to expect the county program to have had a similar preventive effect. This question will be addressed in future studies.

Adult↗
PubMed1993

Outcome of 328 pregnancies in 205 women with insulin-dependent diabetes mellitus in the county of Northern Jutland from 1976 to 1990.

STUDY OBJECTIVE: To determine the degree of centralization and to describe the outcome of all pregnancies among Type 1 (insulin-dependent) mothers in the county of Northern Jutland from 1976-90. DESIGN: Retrospective, hospital record based study. SETTING: Data were collected from all departments of surgery (n = 8) and obstetrics (n = 3) in the county covering 550,000 inhabitants (approx. 10% of the total Danish population). PATIENTS: Three hundred and twenty-eight consecutive, unselected pregnancies among 205 women with Type 1 diabetes mellitus admitted to the hospitals in the county from 1976-90. MAIN RESULTS: Thirty-two (11%) pregnancies were terminated with spontaneous abortions and ten (3.3%) abortions were induced for medical reasons. There were eleven (4.3%) neonatal deaths. There was no additional fetal loss within the first year of life. Eight (3.1%) babies had major and additionally six (2.4%) minor malformations. Total fetal loss was 53/297 = 18%. Twenty-eight percent of the babies were large-for-gestational age. No pregnancies terminated at primary level hospitals and only 6% at the non-sub specialized obstetrical Departments. CONCLUSION: We have achieved an almost complete centralization of the management of pregnant women with diabetes mellitus and our outcome is comparable to the results published from other regional surveys taking care of these patients.

Abortion, Induced↗
PubMed1992

Chromium exposure assessment of outdoor workers in Hudson County, NJ.

A large quantity of chromate chemical production waste, containing hexavalent chromium, has been used as fill at over 150 sites in Hudson County, New Jersey. One site is in a state park, and several other sites are adjacent to the park. Blood and urinary chromium levels were compared between 17 employees at the Hudson County park and 35 employees from two other state parks. A limited number of soil and personal air samples were also taken. Urinary and RBC chromium levels between the two groups were similar, even after adjusting for potentially confounding variables. The air sampling results demonstrated slightly higher chromium levels at Hudson County, but these were still very low level in nature (mean = 0.18 micrograms/m3). These results call into question the utility of chromium biomonitoring under environmental exposure conditions.

Adult↗
PubMed1988

Alameda County redux: replication in Michigan.

This article describes an attempt to reproduce, in Michigan, cross-sectional findings concerning the relationship between health habits and health status previously obtained in Alameda County, California by Belloc and Breslow. Data for this study were gathered by a telephone interview of a state-wide sample of 3,259 adult Michigan residents. The ridit (relative to an identified distribution) analyses presented include a comparison of findings from the Michigan and Alameda County studies. In Michigan, as in Alameda County, health status was found to be associated with various health practices, both individually and in combination. Consistent relationships were found between physical health status and individual health practices regarding hours of sleep, eating breakfast, eating between meals, cigarette smoking, weight for height, and physical activity. Physical health status was also linked to the overall number of health practices individuals engaged in. When the confidence interval for each ridit value was taken into account, however, only some of the findings proved statistically reliable.

Adolescent↗
PubMedDate not supplied

Serum cholesterol and 20-year mortality in black and white men and women aged 65 and older in the Evans County Heart Study.

Serum cholesterol and 20-year mortality rates were studied in 396 Evans County black and white men and women who were 65 years and older and free of prevalent coronary heart disease (CHD) at baseline examination in 1960 to 1962. Previous reports on Evans County men and women younger than 65 found cholesterol levels to be significantly associated with all-cause and CHD mortality in white men, with CHD mortality in black men, and with cardiovascular disease mortality in white women. The independent role of total serum cholesterol as a predictor of CHD and all-cause mortality in the 65-and-older age group was evaluated using Cox proportional hazards models. Among white men, serum cholesterol level was positively associated with CHD mortality (relative risk of 1.54, P < 0.05 for an increment of 40 mg/dL [1.03 mmol/L], or one standard deviation in cholesterol). A significant J-shaped relationship of cholesterol with all-cause mortality was found among white men. Among black women, cholesterol was negatively associated with all-cause mortality. Neither all-cause nor CHD mortality was related to serum cholesterol among black men or white women. Although based on small numbers, the results of this study suggest that in Evans County, total serum cholesterol is an independent predictor of mortality in white men aged 65 and over, while these results should not be generalized to other race-gender groups in this cohort.

Black or African American↗
PubMed2005

Trends in helmet use and head injuries in San Diego County: the effect of bicycle helmet legislation.

The purpose of this study is to evaluate the effect of California's bicycle helmet law on bicycle-related head injuries in San Diego County with a year 2000 population of approximately 3 million people. The study design is an ecological trend design based on observational data from a Trauma Registry. Outcome measures include helmet use compliance, site/severity of injury and abbreviated injury scale (AIS). There were 1116 bicycle trauma patients recorded in the San Diego County Trauma Registry between 1992 and 1996. The percentages of pre-law and post-law helmet use were 13.2 and 31.7%, respectively. Over the whole study period, the overall helmet use increased by an average of 43% per year with an averaged 84% rate increase in helmet use among children. Only 16.1% of patients with serious head injury used helmets, compared to 28.2% in those who did not have serious head injury. The odds ratio of helmet use against serious head injuries is 0.43 (95% CI 0.28-0.66) after adjusting for age, ethnicity and time. The p-values for comparing pre- and post-legislation serious head injury rates are p=0.764, 0.4 and 0.194 for the overall, adult and child populations, respectively. Helmet legislation increased helmet use in the targeted child population and the effect was carried over to the adult population. Helmet use has a protective effect against serious head injury. Probably due to several of its limitations, the current study did not confirm that helmet legislation alone significantly reduced head injury rates in San Diego County during the study period.

Adolescent↗
PubMed2006

Increased cardiovascular risk associated with diabetes in Dallas County.

BACKGROUND: Diabetes mellitus is a major public health problem in the United States. We assess the prevalence of diabetes in Dallas County, quantify the association between diabetes and subclinical cardiovascular disease, and assess the use of evidence-based cardiovascular disease risk-modifying therapies. METHODS: This study uses data from 3392 participants aged 30 to 65 years from the Dallas Heart Study, a probability-based, multiethnic sample of residents living in Dallas County, Texas. Three primary outcomes were examined: (1) diabetes prevalence, (2) adjusted odds ratios for detectable coronary calcium stratified by diabetes diagnosis status, and (3) rates of use of evidence-based cardiovascular disease risk-modifying therapies among subjects with diabetes stratified by diabetes diagnosis status. RESULTS: The estimated prevalence of diabetes in Dallas County was 7.8%, with >40% of diabetic patients undiagnosed before participation in the Dallas Heart Study. Both previously diagnosed and previously undiagnosed diabetes were independently associated with the presence of coronary artery calcium (diagnosed: OR 3.55, 95% CI 1.56-8.05) (undiagnosed: OR 2.98, 95% CI 1.39-6.39). The rates of use of aspirin, angiotensin-converting enzyme inhibitors, and statins were suboptimal, and blood pressure and low-density lipoprotein cholesterol targets were rarely met, especially among subjects with previously undiagnosed diabetes. CONCLUSIONS: Diabetes is prevalent and is associated with subclinical cardiovascular disease; this association is present even at the time of diagnosis. Despite the cardiovascular risk associated with diabetes, evidence-based risk-modifying therapies continue to be underused, and therapeutic targets remain unmet, especially among people unaware of their diabetes diagnosis.

Adult↗
PubMed2006

Differences in individual-level terrorism preparedness in Los Angeles County.

BACKGROUND: Increasing individual preparedness for disasters, including large-scale terrorist attacks, is a significant concern of public health planners. As with natural disasters, individuals can help protect their health and safety by preparing for the emergency situation that may follow a terrorist event. Our study describes variations in preparedness among the population of Los Angeles County after the September 11, 2001 and subsequent anthrax attacks. METHODS: In 2004, the data were analyzed from the Los Angeles County Health Survey, a random-digit-dialed telephone survey of the non-institutionalized population in Los Angeles County fielded October 2002 through February 2003. RESULTS: Overall, 28.0% of respondents had emergency supplies, and 17.1% developed an emergency plan in the past year in response to the possibility of terrorism. Factors associated with having emergency supplies included African American (adjusted odds ratio [AOR] 1.8, 95% confidence interval [CI]=1.1-3.1) and Latino (AOR=1.5, 95% CI=1.0-2.4) race/ethnicity; having a household dependent aged<or=18 years (AOR=1.4, 95% CI=1.0-2.0); being born outside the United States (AOR=1.9, 95% CI=1.3-2.9); some college or trade school education (AOR=1.9, 95% CI=1.3-2.9); and higher perceived likelihood of a bioterrorist attack (AOR=2.2, 95% CI=1.6-3.0). Factors associated with having an emergency plan included African American (AOR=2.6, 95% CI=1.5-4.6) race/ethnicity; having a household dependent aged<or=18 years (AOR=2.4, 95% CI=1.6-3.5); and physical disability (AOR=1.7, 95% CI=1.1-2.7). CONCLUSIONS: Some groups were more likely to adopt some, but not all, recommended preparedness activities. Identifying subpopulation differences in preparedness is important since different public health messages, programs, and distribution channels are required for different subgroups.

Adult↗
PubMed2005

Assessing the ecological security of the Tibetan plateau: methodology and a case study for Lhaze County.

A system for assessing the ecological security of Lhaze County in China's Tibetan Autonomous Region was developed using a pressure-state-response model and the analytic hierarchy process. We then used this model to comprehensively evaluate the status of ecological security in Lhaze County. Our results showed that the ecological environment in Lhaze County has deteriorated from an 'early stages of damage status' in the 1980s to 'moderately damaged status' today. This deterioration has become a major barrier to local economic development and social advancement. Natural and social aspects related to the population explosion, resource exploitation, and climate change that led to this ecological deterioration are discussed. Furthermore, we have suggested proposals for improving the ecological environment that include controlling population growth and enhancing the system of laws that protect the environment, upgrading 3 882.6 ha of low-yield farmland, planting 2 425.8, 548.8, and 1 207.4 ha of shelter belts for farmland protection, soil and water conservation, and fuelwood, respectively, and seeding 2 358.1 ha of artificial grassland. In the meantime, we propose strengthening the controls that limit soil and water loss, and optimizing industrial sectors that aspire to achieve high-efficiency, ecologically responsible agriculture.

China↗
PubMed2006

Molecular epidemiology of meticillin-resistant coagulase-negative staphylococci in a Swedish county hospital: evidence of intra- and interhospital clonal spread.

During a 10-month period in 2003, consecutive routine clinical cultures from patients treated in 15 different ward units in a Swedish county hospital were screened for the presence of meticillin-resistant coagulase-negative staphylococci (CNS). Genetic similarity between isolates was analysed using pulsed-field gel electrophoresis (PFGE). The results were compared with multi-drug-resistant Staphylococcus epidermidis isolated previously at the tertiary referral hospital. In total, 428 isolates of CNS were identified, of which 188 (44%) were meticillin resistant. Three clusters (Groups A, B and C) of S. epidermidis, each consisting of more than 10 isolates, with a PFGE-DNA similarity of >90% were identified. The strains in Groups A and B (N=15 and N=13, respectively), which were generally resistant to gentamicin, co-trimoxazole and clindamycin, originated from 24 patients, of whom 21 had been treated in the intensive care unit (ICU) before sampling. The third cluster, Group C, involved 14 isolates from 14 patients. Only two of these patients had stayed at the ICU, and all for less than one day. Isolates in Group C were less resistant than those in Groups A and B. Isolates belonging to Group A showed an identical PFGE profile compared with multi-drug-resistant S. epidermidis isolated from patients at the referral hospital. This study demonstrated the persistence and spread of meticillin-resistant clones of CNS within the county hospital, especially in the ICU, and possible interhospital spread of a multi-drug-resistant clone between the county and referral hospitals.

Anti-Bacterial Agents↗