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PubMed2005

The Copenhagen County child cohort: design of a longitudinal study of child mental health.

BACKGROUND: Epidemiological studies of psychopathology in the first years of life are few, and the association between mental health problems in infancy and psychiatric disturbances later in life has not been systematically investigated. The aim of the present project was to study mental health problems and possibilities of intervention from infancy and onward. METHODS: The basic study population consists of a birth cohort of 6,090 children born in the year 2000 in the County of Copenhagen, the Copenhagen County Child Cohort, CCCC 2000. At stage one CCCC 2000 was established on data from the Civil Registration System, Danish national registers, and standardized, longitudinal data from the first year of living obtained by public health nurses. At stage two a subsample was assessed at 1(1/2) years of age concerning child psychiatric illness and associated factors in a case-control study nested in the cohort, including a random sample. Participation rate at stage one was 92%. PERSPECTIVES: Ongoing studies of CCCC 2000 include studies of failure to thrive, register studies, and studies of the predictive validity of public health screening. A follow-up study concerning the prevalence of psychopathology at age 5 is planned. SUMMARY: The Copenhagen County Child Cohort CCCC 2000 is a longitudinal study of mental health from infancy investigating psychopathology in early childhood. Results from this study will add to the knowledge of risk factors and course of mental health problems in childhood and contribute to the validation of the mental health screening made by public health nurses.

Adolescent↗
PubMed2001

Patterns of inpatient and outpatient care for asthma in Erie and Niagara Counties, western New York State.

The prevalence of asthma, as well as the morbidity and mortality due to asthma, has increased in the United States, especially among poor minority subpopulations. The causes of these increases are complex and not well understood. Our findings from an analysis of emergency room (ER) visits and hospitalizations for Erie and Niagara Counties in western New York State for the period 1984-1991 provides important background to this problem. Of all respiratory disorders, asthma was the most frequent reason for ER visits and was second only to pneumonia as a reason for hospital admissions. In Erie County the hospitalization rates for asthma in two inner-city communities with predominantly minority populations were 1.48 and 2.09 times higher than those in the rest of the county. Furthermore, the hospitalization rates for these communities showed an increasing trend over the study period. Gender differences were also found. Boys age 0 to 9 years were hospitalized for asthma twice as often as girls. However, over 15 years of age, females had admission rates that were twice those of males. In contrast, hospitalization rates for pneumonia were equal for males and females, which would suggest gender differences particular to asthma. Hospitalizations for asthma in the western New York region cost an estimated $6,000,000 in 1990. We conclude that asthma is a major cause of morbidity in this region with excessive and increasing impact on inner-city communities.

Adolescent↗
PubMed2005

This place is killing me: a comparison of counties where the incidence rates of AIDS increased the most and the least.

BACKGROUND: The objective of this study was to identify the socioeconomic and health characteristics of communities with the largest proportional increases in incidence rates of acquired immunodeficiency syndrome (AIDS). METHODS: Reported AIDS cases (1981-1990 and 1995-1999) were used for a comparison between 20 US counties with the largest proportional increases in incidence rates of AIDS and 20 US counties with the smallest increases. Data were obtained from Community Health Status Indicators Reports of the Health Resources and Services Administration (HRSA) and from the US Census Bureau. RESULTS: Counties with the largest increases in the incidence of AIDS had lower levels of income, education, and literacy; higher incidence rates of syphilis, age-adjusted mortality (all causes), and infant mortality; more low-birth-weight infants; and higher levels on all 9 specific mortality measures in the HRSA reports. CONCLUSIONS: The incidence of AIDS increased the most in areas where many other health problems occurred. Research is needed to identify and address the root causes of ill health.

Adolescent↗
PubMed2002

The Broward County jails hospice program: hospice in the jail.

Broward County's jail hospice program initiated service in 1995. Infirmary services for both men and women in the jail system are housed in one of Broward County's four jail sites. The County, in partnership with the local Medicare certified hospice, Hospice by the Sea, provides care to inmates both in the detention center and on release to the community. Compassionate release, "community control," and expedited case disposition are sometimes utilized. Jail stays are typically shorter than prison sentences. Consequently, expedient identification and enrollment of hospice-appropriate detainees differentiates hospice in a jail setting from prison hospice. Initial attitudinal resistance to hospice services for detainees has for the most part been overcome. Ongoing challenges largely consist of institutional impediments regarding supplies, special dietary needs of hospice patients, visitation procedures, and potential patient isolation.

Community Health Services↗
PubMed2004

Detection of p53 and K-ras mutations in sputum of individuals exposed to smoky coal emissions in Xuan Wei County, China.

Lung cancer mortality rates in the Xuan Wei County population are among the highest in China and are associated with exposure to indoor emissions from the burning of smoky coal. Previous studies of lung tumors from both non-smoking women and smoking men in this region showed high frequencies of mutations, consisting mostly of G-->T transversions in the p53 tumor suppressor gene and K-ras oncogene, suggesting that these mutations were caused primarily by polycyclic aromatic hydrocarbons. In this study sputum samples from 92 individuals with no evidence of lung cancer from Xuan Wei County were screened for p53 and K-ras mutations. Sputum cells were collected on glass slides by sputum cytocentrifugation, stained and cytopathologically analyzed. Cytologically non-malignant epithelial cells were taken from each sputum sample using a laser capture microdissection microscope and molecularly analyzed. Cells taken from the sputum of 15 (16.3%) individuals were mutation positive, including 13 (14.1%) individuals each with a p53 mutation, 1 (1.1%) individual with a K-ras mutation and 1 (1.1%) individual with a p53 and a K-ras mutation. p53 mutations were found in both the sputum of individuals with evidence of chronic bronchitis (3 of 46 or 6.5%) and those without evidence of this disease (11 of 46 or 23.9%). Therefore, mutations in the p53 gene and, to a lesser extent, the K-ras gene were frequent in non-malignant epithelial cells taken from the sputum of individuals without evidence of lung cancer who were exposed to smoky coal emissions in Xuan Wei County and were at a high risk for developing the disease.

Air Pollution, Indoor↗
PubMed1975

Studies of mortality and morbidity data. II. Mortality from all causes in Ontario Counties during 1964-1968.

Age-adjusted mortality rates, for all causes of death, are tabulated for all ages by sex for the 55 Ontario counties and districts. The rates are based on all deaths of Ontario residents during 1964-1968 and 1966 census populations. The consistent trends in rates, both for the two sexes and for various 10- and 20-year age groups, indicate that there is a region of about eight adjoining counties, across the center of the province, which has abnormally high mortality, and two regions to the east and west of York, each consisting of three adjoining counties which have abnormally low mortality. The relevance of these findings to aging studies is indicated, and possible further investigations of them are discussed.

Adult↗
PubMed1996

Urbanicity-related trends in lung cancer mortality in US counties: white females and white males, 1970-1987.

BACKGROUND: The effect of urbanization on age-adjusted lung cancer mortality rates in US counties is investigated. The data come from National Cancer Institute, and urban trends are estimated in time periods 1970-1979 and 1980-1987, for both white males and white females. To account for possibly different gradients in different parts of the country, the 48 contiguous states are divided into seven regions. METHODS: A measure of urbanness, urbanicity, is defined and is used to stratify counties. A multiplicative model is proposed that relates county mortality rates to urbanicity. The residuals from this multiplicative model serve as age- and urban-adjusted rates. RESULTS: Urban-rural gradients are significant for nearly all regions for both white males and white females, diminishing slightly in the latter time period for white males but becoming stronger for white females. CONCLUSIONS: The age- and urban-adjusted rates may be used in mapping to investigate geographical patterns that remain after removal of the urban factor.

Female↗
PubMed1996

Hispanic origin and neural tube defects in Houston/Harris County, Texas. I. Descriptive epidemiology.

High prevalences of anencephaly and neural tube defects (NTDs) have recently been recorded for several Texas counties bordering Mexico. In addition, a few investigators have reported Hispanics to be at elevated risk for NTDs (anencephaly and spina bifida). Factors contributing to this risk have not been established. The authors conducted a study of NTDs in Harris County, Texas, to determine the prevalence of each defect. Prevalence was established by identifying cases among resident live births and fetal deaths (stillbirths at > or = 20 weeks) occurring from April 1, 1989, through December 31, 1991. Using multiple case ascertainment methods, 59 cases of anencephaly and 32 cases of spina bifida were detected, resulting in prevalences of 3.8 (95% confidence interval 2.9-4.9) and 2.0 (95% confidence interval 1.4-2.8) per 10,000 live births, respectively. The ratio of anencephaly prevalence to spina bifida prevalence was 2:1 in 1989, 1:1 in 1990, and 3:1 in 1991, with a significant difference in 1991. The female:male prevalence ratio was 1.0 for spina bifida and 2.2 for anencephaly, and was higher still for anencephaly among non-Hispanics (prevalence ratio = 5.6). For each defect, Hispanics experienced a prevalence approximately three times that of non-Hispanics. This ethnic difference was greater for males with anencephaly and for females with spina bifida. For anencephaly, the Hispanic:white/Anglo prevalence ratio (4.2) and the African-American:white/Anglo prevalence ratio (1.9) were greatly elevated and the Hispanic:African-American prevalence ratio (2.2) was similar, relative to comparable studies from the past two decades. The prevalence of anencephaly recorded for public hospitals (7.0 per 10,000) was three times greater than that for private hospitals (2.4 per 10,000). Spina bifida figures were similar for public (prevalence = 2.2 per 10,000) and private (prevalence = 2.0 per 10,000) hospitals. A significantly higher prevalence of both defects was documented among Hispanics in Harris County. The higher anencephaly rates among Hispanics, African-Americans, and those using public hospitals in an era of NTD screening, prenatal diagnosis, and elective pregnancy termination suggest that socioeconomic and perhaps cultural/religious factors might influence the recorded birth prevalence of this defect in particular groups.

Anencephaly↗
PubMed1997

Concordance of Medicare data and population-based clinical data on cataract surgery utilization in Olmsted County, Minnesota.

The authors assessed concordance of local Medicare health care utilization data on cataract surgery and estimates generated using the databases of the Rochester Epidemiology Project, which capture virtually all medical care received by residents of Olmsted County, Minnesota. The Rochester Project databases identified 1,353 primary cataract extractions performed in Olmsted County between October 1989 and December 1993 among county residents aged > or = 65 years. Medicare data identified 1,148 claims-84.8% of the number of procedures identified by the Rochester Project. Ratios of numbers of encounters (Medicare/Rochester Project) were 189/350 (0.540) for 1992 versus 959/1,003 (0.956) for the other years combined. Changes in Medicare data file transfer procedures may have produced the 1992 data shortfall. Medicare data should periodically be compared with source data to assess concordance.

Aged↗
PubMed1986

Social ties and mortality in Evans County, Georgia.

In an attempt to replicate Berkman and Syme's study of social networks and mortality in Alameda County, California, the authors investigated the relationship between a social network index and survivorship from 1967 to 1980 in the Evans County, Georgia, cohort. They constructed an index modeled after the Berkman Social Network Index and tested it in race- and sex-specific proportional hazards models for 2,059 subjects who were examined in 1967-1969 during the Evans County Cardiovascular Epidemiologic Study. The present study emphasized a priori specification of the social network index and statistical hypothesis test. Descriptive analyses were consistent with a modest social networks effect (e.g., hazard ratio (95 per cent confidence interval) of 1.6 (1.2-2.2) ). Among white males, the age-adjusted hazard ratio comparing the lowest to the highest value of our six-level index was 2.0 (1.2-3.4), but control for potential confounders (principally cardiovascular disease risk factors) reduced this value to 1.5 (0.8-2.6). The social networks effect among white females, black males, and black females was weaker and clearly nonsignificant. Exploratory analyses suggested that marital status, church activities, and an alternate social network index predicted survivorship, but not in a dose-response fashion. Reduced survivorship among older subjects with few social ties was the most important feature of the data.

Adolescent↗
PubMed1988

Air pollution and lung cancer mortality in Harris County, Texas, 1979-1981.

Elevated lung cancer mortality rates in Harris County, Texas compared with other US counties and previously published reports that suggested a causal relation between air pollution and lung cancer in Houston prompted this ecologic analysis. A weighted regression analysis was used to examine the air pollution-lung cancer mortality relation for white males in Harris County, Texas, 1979-1981. The regression model included the following census tract-specific characteristics: median age for white males, two social and demographic factors not strongly correlated with pollution (family life cycle and migration), an age-dependent smoking index, and a pollution measure based on total suspended particulates. This model indicated a statistically significant contribution of the pollution measure in explaining the intracounty variation in lung cancer mortality rates. The relation between air pollution and lung cancer mortality, however, appeared to be highly dependent on which social and demographic factors were selected for inclusion in the analysis. Air pollution was not demonstrated to be a strong determinant of lung cancer mortality in this study in that the presence of air pollution accounted for less than 5% of the total variation in intraurban lung cancer mortality. In addition, the interpretation of geographic analysis must be guarded due to the introduction of potential bias due to aggregation. The hypothesis that air pollution is contributory to lung cancer cannot be tested until other, stronger individual risk factors for lung cancer can be better measured and controlled in studies of this association.

Adult↗
PubMed1994

Murder-suicide in Fulton County, Georgia, 1988-1991. Comparison with a recent report and proposed typology.

Our study of the characteristics of murder-suicide in Fulton County, Georgia is compared with published data, and the usefulness of a proposed typology for classifying murder-suicides is evaluated. Twelve murder-suicides involving 26 decedents occurred in Fulton County (Atlanta), Georgia, during 1988-1991. Similar to national statistics, most offenders were male (100%), there was usually one victim (83%) who was most often female (71%), a spousal or love relationship often existed between the victim and offender (64%), and a firearm was the lethal weapon in almost all incidents (92%). Important differences from published data included a higher incidence of murder-suicide (0.46/100,000), which accounted for a lower proportion of all homicides (1.4%) and a higher proportion of all suicides (3.6%) than is reported nationally, and a lower proportion of white offenders (17%) and higher proportion of male victims (29%). A total of 83% of incidents were intraracial. Murder-suicide in Fulton County was different from national data in ways that might be due to local demographics, the local homicide rate, and the local suicide rate. The proposed typology for classification of murder-suicides is in need of more precise definitions of terminology; further, it does not permit inclusion of some major details that might be useful for study. An alternative classification scheme is offered that enables documentation of more comprehensive information.

Adult↗
PubMed2000

Elevated mortality rates from circulatory disease in African American men and women of Los Angeles County, California--a possible genetic susceptibility?

OBJECTIVE: Reports of higher mortality in African Americans have often focused on socioeconomic differences. Such differences do not explain the excess mortality in African Americans compared with Hispanics in Los Angeles County. We suggest the existence of genetic factors to explain at least some of the differences in mortality risk. METHODS: We compared the mortality rates from circulatory diseases in African American and Hispanic adults of Los Angeles County for 1988 to 1992 with the frequency of the angiotensin-converting enzyme (ACE) genotype. RESULTS: African American adults 45 to 74 years old had a 2-fold higher overall mortality rate than Hispanics. The largest differences were seen for hypertensive disease and cardiomyopathy in men; the most striking differences were seen in the youngest age group. Rates were lower in women than in men, but African American women also showed substantial excess compared with Hispanics. ACE genotype also showed a significant difference between the Hispanic and African American population; the latter had a significantly higher prevalence of the DD genotype, which is associated with a higher level of circulating enzyme, and lower prevalence of the II genotype, which is associated with a lower enzyme level. CONCLUSION: African American adults aged 45 to 74 years in Los Angeles County have a substantial excess mortality from hypertensive diseases compared with a similar Hispanic population. The frequency of the ACE DD genotype was higher in African Americans than in Hispanics. These studies may indirectly support the possibility of a genetic contribution to the excess hypertensive disease mortality in African Americans.

Aged↗
PubMed1992

Geographical differences in myocardial infarction incidence in eight Swedish counties, 1976-1981.

Considerable regional variation in coronary heart disease mortality has been observed in Sweden. This variation is of public health concern and is also a point of departure for etiologic studies. The central aim of the present study was to investigate whether there are also regional differences in myocardial infarction incidence and to evaluate whether these are likely to be explained by regional differences in smoking, blood pressure, and serum cholesterol. The study base consisted of subjects age 30-64 living in eight Swedish counties during 1976-1981. Cases of myocardial infarction were identified using both hospital discharge and death records. A 30-40% increased incidence of myocardial infarction was found in the two northernmost counties compared with Stockholm county. The regional differences in myocardial infarction incidence were not related to differences in smoking but might be due in part to differences in serum cholesterol and blood pressure, and to socioeconomic factors as well.

Adult↗
PubMedDate not supplied

Predictors of breast and cervical screening in Vietnamese women in Harris County, Houston, Texas.

The Vietnamese are a quickly growing, important part of the Texas population. Breast cancer is known to have different biologic characteristics in Vietnamese women. In order to develop appropriate intervention and screening strategies, we conducted a study of barriers to cervical and breast screening in Vietnamese women in Harris County, Tex. Our objective was to characterize the demographic factors, beliefs, and barriers to cervical and breast cancer screening in our study population and test the effect of these on Papanicolaou test, breast self-examination (BSE), medical breast examination (MBE), and mammography use. The Health Belief Model Scales for Measuring Beliefs Related to Breast Cancer (Champion VL, Nursing Research 1993;42:139-143) was the framework used to assess attitudes regarding risk of breast cancer and to design a component assessing risk of cervical cancer. The questionnaire addressed susceptibility, seriousness, benefits, barriers, and health about screening for breast and cervical cancer. It was translated into Vietnamese and back-translated into English prior to use. The questionnaire was mailed to Harris County residents. Those returned were entered into a database. The data were analyzed for validity using Chronbach's alpha. Simple descriptive analyses and nominal logistic regression identified predictors of Papanicolaou test, BSE, MBE, and mammography use. Twelve hundred surveys were mailed out to Vietnamese women using the telephone directory and the church directories in Harris County; 209 were returned and entered into the database. Of the respondents, 67% had ever received a Papanicolaou test; of these, 89% had received a Papanicolaou test within the past year; 55% of respondents had performed a BSE, 45% of patients received an MBE, and 45% of respondents had ever received a mammogram (15% of respondents had a mammogram during the previous year). The most significant predictors of Papanicolaou test, BSE, MBE, and mammography use were marital status (being married), high educational level, lack of barriers, a family history of the cancer, older age, and increased perception of seriousness. Compared to other studies of Vietnamese women, the women in Texas are among the highest users of the Papanicolaou test, BSE, MBE, and mammography. Barriers and incentives to breast and cervical screening were similar to those in other studies.

Adult↗
PubMedDate not supplied

Predictors of lawsuit activity against nursing homes in Hillsborough County, Florida.

The objective of this study is to examine the litigation experience of twenty-eight nursing homes in Hillsborough County, Florida. Primary data were collected from Hillsborough County Circuit Court's Clerk's Recording Computer System about lawsuit activity from 1996 to 2000 and linked to the Centers for Medicare and Medicaid Services Online Survey, Certification, and Reporting system. We found that registered nurse levels, size, and being part of a chain or system impacted litigation in Hillsborough County.

Florida↗
PubMed2001

Radon measurements and analysis for central Pennsylvania counties having elevated radon levels.

The U.S. EPA identified South Central Pennsylvania as a region having elevated radon levels. The thnist of this paper is to examine in some detail the TCS Industries, Inc., data base for eight Central Pennsylvania counties having a combined population of about 1.7 million people, which is 14% of the state population. TCS has been making and analyzing radon measurements since 1986. During the period 1986 to 1999 more than 125,000 measurements were recorded in the TCS data base. The data consisted of analyzed results from four subsets. Results were from mail order charcoal canisters, bulk orders from RMP certified companies for their placement, wholesales to retail vendors, and also direct home placement of canisters, track detectors, and continuous radon monitors. The data base for the eight South Central Pennsylvania counties for tile 13-y period consists of more than 27,000 screening measurements from non-duplicated addresses. The results were assembled into three studies. The locations of tile measurements were converted into individual latitude and longitude values. The data were divided into four blocks of concentrations from 740 Bq m(-3) to over 4,440 Bq m(-3). The data were plotted on computer generated maps for South Central Pennsylvania. The plots indicated both hot spots and regions of relatively uniform chronic levels of 740 to 1,480 Bq m(-3). An average value of the basement to first floor concentrations ratio was constructed from measurements made by TCS for real estate purposes. The ratio represents 1,608 sets of simultaneous measurements of basements and first floor radon values above 37 Bq m(-3). The measurements were made by trained personnel performed under tile EPA protocol for closed house conditions. The ratio was 2.3 at 1 standard deviation of 0.05 of the mean. A third study assembled all of the data into first floor radon concentrations and separately for addresses with only basement values. The average concentration data within each of the eight counties were converted into the probability of fatal lung cancers and compared with occupational risk of fatal cancers for nuclear power plant workers. This study illustrates the importance of a continuing strong measurement program in South Central Pennsylvania.

Air Pollutants, Radioactive↗
PubMed2003

Smoking as a confounder in ecologic correlations of cancer mortality rates with average county radon levels.

Cohen has reported a negative correlation between lung cancer mortality and average radon levels by county. In this paper, the correlation of U.S. county mortality rates for various types of cancers during the period 1970-1994 with Cohen's radon measurements is examined. In general, quantitatively similar, strongly negative correlations are found for cancers strongly linked to cigarette smoking, weaker negative correlations are found for cancers moderately increased by smoking, whereas no such correlation is found for cancers not linked to smoking. The results indicate that the negative trend previously reported for lung cancer can be largely accounted for by a negative correlation between smoking and radon levels across counties. Hence, the observed ecological correlation provides no substantial evidence for a protective effect of low level radon exposure.

Air Pollutants, Radioactive↗