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PubMed2003

Service screening with mammography. Long-term effects on breast cancer mortality in the county of Gävleborg, Sweden.

In the current study the long-term effects of a pilot service screening programme in the Swedish county of Gävleborg were studied. Women aged 40-64 years in 13 sub-areas were followed from start of screening between 1974 and 1979. Two control groups were used for comparison; the neighbouring counties and all of Sweden. A reference period prior to the study period was used to facilitate an adjustment for possible differences in baseline breast cancer mortality. Only deaths from breast cancer diagnosed after the first invitation to screening were analysed. Two outcome measures were used for breast cancer mortality; the underlying cause of death and excess mortality. Using the neighbouring counties as a control group, the relative risk, after 22 years of follow-up, of 10 years of screening was estimated at 0.84 (95% CI 0.71-1.00) using excess mortality. Due to lead time bias the relative risk was overestimated by 4%. Hence, a significant 20% reduction of breast cancer excess mortality was found.

Adult↗
PubMed1990

Socioeconomic structure and fertility in China: a county level investigation.

Analysis of the general fertility rate in the counties of China shows significant associations with infant mortality, illiteracy, and the percentage of the population employed in industry, but not with industrial or agricultural output. Urban counties differ from rural in the importance of the illiteracy rate. The associations in the rural counties vary according to the region of China in which they are located.

Adolescent↗
PubMed2004

Gender differences in child survival in contemporary rural China: a county study.

Using data from a survey of deaths of children less than 5 years old conducted in 1997 in a county in Shaanxi Province, China, this paper examines gender differences in child survival in contemporary rural China. First, excess female child mortality in the county in 1994-96 is described, followed by an analysis of the mechanisms whereby the excess mortality takes place, and the underlying social, economic and cultural factors behind it. Excess female child mortality in this county is probably caused primarily by discrimination against girls in curative health care rather than in preventive health care or food and nutrition. Although discrimination occurs in all kinds of families and communities, discrimination itself is highly selective, and is primarily against girls with some specific characteristics. It is argued that the excess mortality of girls is caused fundamentally by the strong son preference in traditional Chinese culture, but exacerbated by the government-guided family planning programme and regulations. This suggests that it is crucial to raise the status of girls within the family and community so as to mitigate the pressures to discriminate against girls in China's low fertility regime. Finally, the possible policy options to improve female child survival in contemporary rural China are discussed.

Adult↗
PubMed2003

Outbreaks of Escherichia coli O157 infections at multiple county agricultural fairs: a hazard of mixing cattle, concession stands and children.

Escherichia coli O157 infections cause an estimated 60 deaths and 73 000 illnesses annually in the United States. A marked summer peak in incidence is largely unexplained. We investigated an outbreak of E. coli O157 infections at an agricultural fair in Ohio and implicated consumption of beverages made with fairground water and sold by a geographically localized group of vendors who were all on the same branch of the fairground water distribution system. To examine county fair attendance as a risk factor for infection, we conducted two further epidemiological studies. In the first, we enhanced surveillance for E. coli O157 infections in 15 Northeast Ohio counties during the 2000 agricultural fair season and showed increased risk of E. coli O157 infection among fair attendees. In the second study, we examined Ohio Public Health Laboratory Information Service (PHLIS) data for 1999 using a time-varying covariate proportional hazards model and demonstrated an association between agricultural fairs and E. coli O157 infections, by county. Agricultural fair attendance is a risk factor for E. coli O157 infection in the United States and may contribute to the summer peak in incidence. Measures are needed to reduce transmission of enteric pathogens at agricultural fairs.

Adolescent↗
PubMed2000

Descriptive epidemiology of thyroid cancer in Los Angeles County, 1972-1995.

OBJECTIVE: To examine the descriptive epidemiologic features of incident thyroid cancers diagnosed among Los Angeles County residents between 1972 and 1995. METHODS: The Los Angeles County/University of Southern California Cancer Surveillance Program (CSP) collected data on 8820 newly diagnosed thyroid cancer of cases occurring in Los Angeles County. Average annual age-adjusted incidence rates were calculated to study the epidemiology of each of the major histologic types of thyroid carcinoma. RESULTS: For all races combined, the age-adjusted incidence rates were 2.5 per 100,000 males and 6.0 per 100,000 females. Differences in incidence by ethnicity were particularly striking, with Filipinos demonstrating the highest incidence rates (4.44 per 100,000 males, 11.3 per 100,000 females). Over the 23-year period, thyroid cancer incidence rates increased 1.5% per year for males and 1% per year for females. By histology, papillary carcinoma rates increased over time and follicular carcinoma rates decreased. Non-Spanish surnamed white men employed in certain white-collar occupations and radiologic technicians were at greater risk of thyroid cancer. CONCLUSIONS: Additional research on the epidemiologic risk factors for thyroid cancer, particularly for gender and ethnicity, is needed to explain the marked elevated incidence rates among females and the Filipino population in Los Angeles County.

Adolescent↗
PubMed1997

Bladder cancer and drinking water: a population-based case-control study in Washington County, Maryland (United States).

A population-based case-control study was conducted in Washington County, Maryland (United States) to explore the association between incident bladder cancer and exposure to drinking water from chlorinated surface sources. Cancer cases were White residents, enumerated in a 1975 county census and reported to the Washington County Cancer Registry (n = 294) between 1975 and 1992. White controls, frequency matched by age (+/- 5 years) and gender, were selected randomly from the census (n = 2,326). Households receiving municipal water, which generally derived from chlorinated surface waters, were treated as having 'high exposure' and all others, as 'low exposure.' Duration of exposure to type of drinking water was based on length of residence in the census household prior to 1975. Odds ratios (OR) were calculated using logistic regression methods, adjusting for age, gender, tobacco use, and urbanicity. Bladder cancer risk was associated weakly in the general population with duration of exposure to municipal water. The association was limited to those who had smoked cigarettes. In ever-smokers compared with never-smokers with low exposure, the adjusted ORs for bladder cancer risk with increasing exposure were 1.3, 1.4, 1.4, 1.7, 2.2, 2.8, respectively, for 0, 1-10, 11-20, 21-30, 31-40, > 40 years' exposure duration. The ORs in smokers were not diminished after adjusting for smoking history and intensity.

Adult↗
PubMed1995

Drinking problems and self-reported criminal behavior, arrests and convictions: 1990 US alcohol and 1989 county surveys.

Use of general population surveys in addition to institutional samples is critical to disentangling the relationship between criminal behavior and alcohol problems or use of illicit drugs. Local area studies can be useful but generalizability of their results is seldom studied. Data from recent US national (n = 2058) and county (n = 3069) general population surveys are used to examine the role of alcohol problem and drug use history in predicting self-reported criminal behavior, arrest and conviction within a logistic regression framework. In the national and county surveys controlling for age, gender, income, marital status, employment, education, race and drug use, lifetime drinking problems significantly predicted current criminal behavior (odds ratios 1.3 and 1.5, respectively) with slightly stronger relationships noted in equivalent models predicting arrest (odds ratios 1.7 and 1.8) and conviction (odds ratios 1.7 and 1.6). Relationships between alcohol, drugs and criminal behavior/justice variables are discussed. Parallels between US and county results suggest that findings from intensive, articulated analyses of community-level population and institutional surveys may be cautiously generalized beyond their geographic locus.

Adolescent↗
PubMed2003

Clinical and microbiological epidemiology of Streptococcus pneumoniae bacteremia in eight French counties.

OBJECTIVE: To describe the incidence of pneumococcal bacteremia not associated with infection of the central nervous system, investigate the susceptibility of bacterial isolates to beta-lactams, evaluate risk factors for antibiotic resistance, and determine factors predicting patient outcome. METHODS: Over a period of 1 year, 919 Streptococcus pneumoniae isolates were collected from 919 patients with bacteremia in eight French counties. Their clinical and microbiological features were recorded. Univariate and multivariate analyses were used to determine risk factors for penicillin-non-susceptible pneumococcal bacteremia and predictors of fatal outcome. RESULTS: Of the 919 patients in the study, 27% were infected with penicillin-non-susceptible pneumococci (PNSP): 17.8% of the isolates were intermediate to penicillin, 7.2% were resistant to penicillin, 16% were intermediate to amoxicillin, and 11% were intermediate to cefotaxime; no PNSP were resistant to either of the last two antibiotics. The most common PNSP serotypes isolated were 14 (41%) and 23 (24%). A statistically significant relationship between PNSP infection and age below 5 years or above 60 years in the different counties was observed by univariate and multivariate analysis. Gender, origin of bacteremia, co-morbidity, immunodeficiency, previous hospitalization and nosocomial infection were not predisposing factors associated with PNSP. The mortality rate was 20.6%: there was no increase in mortality among patients with PNSP bacteremia. Age was the strongest risk factor for mortality, but immunodeficiency also seemed to have had an impact on mortality. Clinical outcome was more closely related to clinical conditions than to the susceptibility status of S. pneumoniae. CONCLUSION: Among cases of bacteremia, 27% were caused by PNSP, but this level varies according to the counties and the age of the patients. Infection-related mortality was high, but there was no increase related to penicillin G non-susceptibility of the infecting strain.

Adolescent↗
PubMed2001

Patient reported quality of care before vs. after the implementation of a diagnosis related groups (DRG) classification and payment system in one Swedish county.

Patient reported quality of care before vs. after the implementation of a diagnosis related groups (DRG) classification and payment system in one Swedish county. The purpose was to evaluate the effects of a diagnosis related groups (DRG)-intervention on the quality of care as perceived by patients at two surgical clinics in the County Council of Gävleborg, Sweden. The study was planned as a nonequivalent control groups design, but external factors turned it into a prospective longitudinal design. Changes in patient experiences of received care were evaluated for the period 1992-1996. Of the 40 included consecutive patients per year from each hospital, > 85% completed the questionnaire. The selection of patients was defined by diagnoses and surgical treatments, and by geographical area. The results demonstrated a decrease of the quality of care as seen from the patient perspective, especially with respect to treatment by staff. Previously stated DRG goals were partially fulfilled and the DRG-intervention was gradually implemented. Other presumed causal variables were: other reforms, restrained resources, quality assurance activities, organizational and structural changes within the county council. Further studies of the effects of health care reforms would yield more distinct conclusions, provided it would be possible to evaluate interventions prior to full-scale implementation.

Adolescent↗
PubMed1977

Violent death in a metropolitan county. Changing patterns in homicide (1958-74).

Analysis of homicide patterns in Cuyahoga County, Ohio (metropolitan Cleveland), for 1958-1974 discloses the following major trends: a dramatic rise in overall homicide rates in the city (320 per cent) and suburbs (200 per cent); an increase in justifiable homicide; a doubling of the percentage of homicides incident to other felonies; a markedly increased incidence of homicide among younger persons; a conspicuous rise in firearm killings (now 81 per cent of all homicides); and a continued preponderance of intraracial homicide, with the highest rates among nonwhite males in the city. The trends in Cuyahoga County are consistent with those in other United States metropolitan counties. Homicide is responsible for a major part of the decreased life expectancy among young, urban, non-white men. The factor most consistently associated with these trends is the increased use of handguns.

Adolescent↗
PubMed1990

The prevalence of illicit-drug or alcohol use during pregnancy and discrepancies in mandatory reporting in Pinellas County, Florida.

Florida is one of several states that have sought to protect newborns by requiring that mothers known to have used alcohol or illicit drugs during pregnancy be reported to health authorities. To estimate the prevalence of substance abuse by pregnant women, we collected urine samples from all pregnant women who enrolled for prenatal care at any of the five public health clinics in Pinellas County, Florida (n = 380), or at any of 12 private obstetrical offices in the county (n = 335); each center was studied for a one-month period during the first half of 1989. Toxicologic screening for alcohol, opiates, cocaine and its metabolites, and cannabinoids was performed blindly with the use of an enzyme-multiplied immunoassay technique; all positive results were confirmed. Among the 715 pregnant women we screened, the overall prevalence of a positive result on the toxicologic tests of urine was 14.8 percent; there was little difference in prevalence between the women seen at the public clinics (16.3 percent) and those seen at the private offices (13.1 percent). The frequency of a positive result was also similar among white women (15.4 percent) and black women (14.1 percent). Black women more frequently had evidence of cocaine use (7.5 percent vs. 1.8 percent for white women), whereas white women more frequently had evidence of the use of cannabinoids (14.4 percent vs. 6.0 percent for black women). During the six-month period in which we collected the urine samples, 133 women in Pinellas County were reported to health authorities after delivery for substance abuse during pregnancy. Despite the similar rates of substance abuse among black and white women in our study, black women were reported at approximately 10 times the rate for white women (P less than 0.0001), and poor women were more likely than others to be reported. We conclude that the use of illicit drugs is common among pregnant women regardless of race and socio-economic status. If legally mandated reporting is to be free of racial or economic bias, it must be based on objective medical criteria.

Black or African American↗
PubMed1989

A non-linear multi-criteria programming approach for determining county emergency medical service ambulance allocations.

In this paper an integer, non-linear mathematical programming model is developed to allocate emergency medical service (EMS) ambulances to sectors within a county in order to meet a government-mandated response-time criterion. However, in addition to the response-time criterion, the model also reflects criteria for budget and work-load, and, since ambulance response is best described within the context of a queueing system, several of the model system constraints are based on queueing formulations adapted to a mathematical programming format. The model is developed and demonstrated within the context of an example of a county encompassing rural, urban and mixed sectors which exhibit different demand and geographic characteristics. The example model is solved using an integer, non-linear goal-programming technique. The solution results provide ambulance allocations to sectors within the county, the probability of an ambulance exceeding a prespecified response time, and the utilization factor for ambulances per sector.

Ambulances↗
PubMed2004

Prevalence and predictors of food insecurity among low-income households in Los Angeles County.

OBJECTIVES: To assess the prevalence and identify the predictors of food insecurity among households in Los Angeles County with incomes below 300% of the federal poverty level. METHODS: The Six-Item Short Form of the US Department of Agriculture's Household Food Security Scale was used as part of a 1999 county-wide, population-based, telephone survey. RESULTS: The prevalence of food insecurity was 24.4% and was inversely associated with household income. Other independent predictors of food insecurity included the presence of children in the household (odds ratio (OR) 1.7, 95% confidence interval (CI) 1.2-2.3) and a history of homelessness in the past five years (OR 5.6, 95% CI 3.4-9.4). CONCLUSION: Food insecurity is a significant public health problem among low-income households in Los Angeles County. Food assistance programmes should focus efforts on households living in and near poverty, those with children, and those with a history of homelessness.

Adult↗
PubMed1999

Use of protease inhibitors among persons with AIDS in Los Angeles County.

We evaluated the access to, and the factors associated with, protease inhibitor use among persons with AIDS in Los Angeles County. A population-based sample of adult persons with AIDS is routinely interviewed in Los Angeles County and includes a 30% random sample of men who have sex with men and all other persons reported with AIDS. Since May of 1996, all participants were asked if their physician had ever prescribed a protease inhibitor for their use. The possible association between protease inhibitor use and sociodemographic, temporal and health care factors was assessed for the 12-month period May 1996 through April 1997. Logistic regression was employed for multivariate analysis. Over the 12-month study period, 61.7% (209/339) persons interviewed reported that their physician had prescribed a protease inhibitor as part of their therapy. In bivariate analysis, treatment with protease inhibitor use was more common for whites (71.4%) and US-born Latinos (68.2%) than blacks (53.4%) and foreign-born Latinos (56.6%), among person of higher income (71.2%) than lower (< $10,000) income (50.3%), in those who reported having insurance (66.7%) than those uninsured (47%) and among persons receiving care at private clinics (86.4%) than at HMOs (63.4%) or public clinics (55.2%). An increasing trend of protease inhibitor use with higher educational level and declining CD4+ count was observed. A temporal increase was noted and this trend was most pronounced for persons receiving care at public clinics. In multivariate analysis, persons receiving care at private facilities (adjusted OR = 2.9, 95% CI 1.0, 8.2) and those with higher incomes (adjusted OR = 2.5, 95% CI 1.5, 4.3), were more likely to report that their physician had prescribed a protease inhibitor. The effect of facility type was modified by time. During the first six months of the study period (May 1996-October 1996) persons with AIDS receiving care at public facilities and HMO sites were substantially less likely to report having been offered a protease inhibitor (adjusted OR = 0.13, 95% CI 0.03, 0.58 and adjusted OR = 0.23, 95% CI 0.05, 1.2, respectively). However, no significant facility-specific differences were observed over the last six-month period (November 1997-April 1997) evaluated. Our findings suggest that substantial differences exist in the prescribing and use of protease inhibitors among persons with AIDS in Los Angeles County. Several factors, including facility of HIV care, calendar time, income, education level and level of immunosuppression were independently associated with protease inhibitor use and suggest the existence of important barriers to access. Efforts should be made to identify and remove barriers that will ensure the widest possible access to protease inhibitors for patients with a clinical indication for their use.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Background air concentrations of Cr(VI) in Hudson County, New Jersey: implications for setting health-based standards for Cr(VI) in soil.

An accurate measure of "background" airborne Cr(VI) concentrations will be necessary to derive site-specific health-based Cr(VI) soil concentrations at sites containing chromite ore processing residues (COPR) in Hudson County, NJ. To date, no such data have been collected in New Jersey. This paper describes an air sampling program designed to measure background concentrations of Cr(VI) in Hudson County and compare those concentrations with the air sampling results obtained previously at 30 COPR sites in Hudson County. Background airborne Cr(VI) concentrations ranged from 0.2 to 3.8 ng/m3 with an arithmetic mean of 1.2 ng/m3. Comparisons of the airborne Cr(VI) concentrations previously measured at 30 COPR sites indicated that more than two-thirds of the sites had mean airborne Cr(VI) concentrations that were not statistically significantly greater than background. Our findings suggest that, in general, vehicle disturbance is required for significant soil suspension to occur at these sites. Since airborne Cr(VI) concentrations at many of these sites are close to background, it is critical that background airborne Cr(VI) levels be considered when deriving health-based soil standards at the COPR sites.

Air Pollution↗
PubMed2006

Evaluation of weather conditions for methyl bromide ambient air monitoring in Monterey, Santa Cruz, and Kern Counties in the year 2000.

Weather condition is one of the most important factors affecting spatial and temporal distributions of air pollutants, especially for short-term air dispersion. Abnormal weather conditions might lead to higher or lower ambient air concentrations than they would be under normal weather conditions. Therefore, testing for normality of weather conditions during the air monitoring period is an essential step for evaluating ambient air monitoring results. In this paper, a distance method was used to select a most representative weather station from the available candidates. An array of meteorological elements were identified that affect air dispersion and transportation. A statistical method was used to determine whether the weather conditions during the air monitoring period were significantly different from that of previous years. Using methyl bromide ambient air monitoring as a case study, this paper documents the methods, procedures, and results of weather analysis for Monterey, Santa Cruz, and Kern Counties during ambient air monitoring periods for methyl bromide in the year 2000. With a few exceptions, the meteorological elements and atmospheric stability factors, such as wind speeds, wind directions, and stability classes, during the monitoring period were in the normal range. Although there were higher frequencies of stable atmospheric conditions in Monterey/Santa Cruz Counties than in Kern County, weather conditions during the monitoring period were not significantly different from normal local weather conditions of previous years. Consequently, the subchronic air concentrations observed during the ambient air monitoring periods for methyl bromide in the year 2000 was taken under typical weather conditions of those areas at that time of the year.

Air Pollutants↗
PubMedDate not supplied

Impact evaluation of the "not me, not now" abstinence-oriented, adolescent pregnancy prevention communications program, Monroe County, New York.

"Not Me, Not Now" is an abstinence oriented, adolescent pregnancy prevention integrated communications program developed by Monroe County, NY. The evaluation utilized a cross-sectional time series approach in the analysis of items from several waves of youth surveys administered to two different age groups: (1) a survey of 7th and 8th graders on awareness, attitudes and intended behavior, and (2) the Youth Risk Behavior Survey administered to 9th through 12th graders. The trends found in the surveys demonstrated high levels of awareness of the program, changing attitudes and intended behaviors consistent with the program's messages. Analysis of pregnancy rates for 15-17 year-olds in the county were compared to reductions found in similar geographic areas. Pregnancy rates in Monroe County declined faster than in comparison areas. The authors conclude that there is a strong likelihood that the program had independent effect on the outcome of pregnancies in the population exposed to the program.

Adolescent↗
PubMedDate not supplied

Impact of an after-hours on-call emergency physician on ambulance transports from a county jail.

OBJECTIVE: The authors sought to determine if the availability of an after-hours on-call emergency physician by telephone for consultation to the staff at a county jail would safely reduce ambulance emergency department (ED) transport of inmates in the community. METHODS: The authors conducted a prospective comparison study during the first ten months of an emergency physician on-call program for the county jail in which prospective data were collected on all consultations, including reason for call and disposition (ambulance, deputy, or no ED transport of inmate). They compared this time with a similar period a year before the program in terms of total ambulance transports from the jail. They also reviewed all hospital and jail medical records to assess for any adverse consequences within one month, or subsequent ambulance transport within 24 hours as a result of inmate care after the consultation call. RESULTS: Total after-hours ambulance transports from the jail decreased significantly from 30.3 transports/month (95% confidence interval [CI], 21.0-39.6) to 9.1 transports/month (95% CI, 4.1-14.0) (p < 0.05). The most common reasons for consultation calls were chest pain (16%), trauma (15%), and abnormal laboratory or radiology results (14%). Of all calls, only 30% resulted in ambulance transport to the ED. On review of records, no adverse outcome or subsequent ambulance transport was identified. CONCLUSIONS: The initiation of an on-call emergency physician program for after-hours consultation to jail nursing and law enforcement staff safely reduced ambulance transports from a county jail with no adverse outcomes identified.

After-Hours Care↗