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PubMed1975

Studies on the clustering of multiple sclerosis in Finland II: microepidemiology in one high-risk county with special reference to familial cases.

The epidemiology of multiple sclerosis (MS) was investigated in a small selected area within the western high-risk county of Finland. The investigation was extended to the level of single communes, villages and even houses, together with the search for all familial cases born in this district. The results were compared to those obtained for Helsinki, a city of medium-risk for MS. Prevalences by present domicile that exceeded 100 per 1000,000 inhabitants were recorded in several communes of the western high-risk county. The highest prevalence was 174.2. Seventy patients were born in the small high-risk area. This was 25% of the MS patients born in the whole county and much higher than expected (16%). A positive familial history of another MS patient was recorded in 8 cases (11%). They were all living, first-degree relatives. A similar history was found in only 2 cases (2%) among the 99 MS patients born in Helsinki. The birthplaces of the 123 parents of these 70 MS cases could be confirmed. All villages with high MS frequencies were located along the rivers, running through the area. The birthplaces of the patients showed a similar accumulation to the valleys. No conjugal cases were found. If the preponderance of familial cases in the small high-risk area reflects the role of genetic factors in the aetiology of MS, it is only of polygenic nature. The pronounced clustering of the birthplaces in the small high-risk area and, especially, along the rivers also suggests the importance of environmental influences in early childhood.

Child, Preschool↗

PubMed1986

A Swedish county with unexpectedly high utilization of anti-parkinsonian drugs.

This report is based on the use of L-dopa-containing drugs within 24 Swedish counties in the period 1977-1984. The mean utilization of these drugs in Sweden in 1984 was 1.46 defined daily doses (DDD)/day X 10(3) inhabitants (inh). As Parkinson's disease is virtually the only condition for which these drugs are prescribed, it seems highly probable that the determining factor for their use today is the prevalence of the disease. The exceptionally high utilization (2.34 DDD/day X 10(3) inh) of L-dopa-containing drugs in the county of Gävleborg, warranted further analyses of subareas in this particular county. The use is discussed in relation to environmental factors.

Antiparkinson Agents↗

PubMed1986

Epidemiology of suicide in a Swedish county (Västerbotten) 1961-1980.

As the initial part of the development of a suicide prevention program in a county in northern Sweden, an epidemiologic study on all suicides in the Västerbotten county 1961-1980 was performed. The study confirms other studies which differentiate between an urban-alienated pattern and a rural-traditional. There is a considerable increase in the suicide rate during the 1970's in the county alongside the development of a marked difference between different socio-economic regions. The highest suicide rates are now found in the most sparsely populated mountainous areas in the western part and in the most rapidly expanding urban area.

Age Factors↗

PubMed1990

The autopsy and epidemiology--Olmsted County, Minnesota and Malmo, Sweden.

The existence of high quality, population-based, medical data facilitates the practice of modern epidemiology with its concomitant benefits for clinical practice and public health policy. Two exceptional examples of such databases are provided by Malmo, Sweden, and Olmsted County, Minnesota. This paper outlines briefly the similarities between these two geographic entities, and focuses, in particular, on the central role of the autopsy in Olmsted County. Changing temporal and spatial patterns of autopsy are reviewed as well as two important related issues: the role of consent and the medico-legal autopsy. The paper concludes with a summary of some of the more noteworthy contributions of autopsy-based epidemiological research in Olmsted County, and offers several recommendations for the establishment of a select network of special population-based study areas. These epidemiological "laboratories", through the interchange of data and tissue specimens, could make significant contributions to the study of diseases both nationally and internationally. Their interactive efforts and high quality data bases would help to increase the efficiency of the expenditure of scarce societal resources in epidemiology and health care.

Autopsy↗

PubMed2004

Access to health care among Latinos of Mexican descent in colonias in two Texas counties.

CONTEXT: Critical to resolving the problem of health disparities among Latinos is examining the needs within ethnic subpopulations. This paper focused on the unique challenges encountered by one ethnic subpopulation-Latinos of Mexican descent living in colonias. Findings reaffirm the importance of looking within ethnic subpopulations to understand the complexities of health disparities. PURPOSE: This paper reports on data collected measuring access to health care among Latinos of Mexican descent living in several colonias in two southern Texas counties. METHOD: Observations are based on data gathered from a non-probability sample obtained through a face to face questionnaire focusing on health care access. Persons living in two Texas counties near the US border were included in this sample, and demographic data were compared to county, state and national statistics to examine the comparability of the sample to similar populations. FINDINGS: Findings from this snowball sample, N=271, suggested lower rates of health insurance coverage compared to the Latino population nationwide, decreased patterns of preventive screenings for blood pressure, diabetes, cholesterol, cancers (ie, breast, cervical, and prostate), and regular access to health care in Mexico by slightly more than half the sample. CONCLUSIONS: Seeking care in Mexico may be a viable solution for many indigent people of Mexican descent living in close geographic proximity to the border because it surmounts the political, cultural, linguistic, or economic barriers to health care services in the United States. Nonetheless, there are longer term questions regarding quality of care and health and wellness for this group of people.

Adolescent↗

PubMed1977

Cancer mortality in U.S. counties with petroleum industries.

A survey of cancer mortality from 1950 to 1969 was conducted in U.S. counties where the petroleum industry is most heavily concentrated. Male residents of these counties experienced significantly higher rates for cancers of the lung, the nasal cavity and sinuses, and the skin (including malignant melanoma) compared to male residents of counties with similar demographic characteristics. Further study is needed to determine whether these patterns result from exposure to chemical carcinogens, including polycyclic hydrocarbons, involved in the manufacturing of petroleum.

Environmental Exposure↗

PubMed1997

Eye care utilisation patterns in a rural county in Ireland: implications for service delivery.

AIMS/BACKGROUND: This investigation determined eye care utilisation patterns in a rural county in Ireland. Population based estimates of visual impairment and glaucoma were available, so the two studies will optimise planning for eye care services for the county. METHODS: Roscommon has a population of 55,000 served by one ophthalmologist and two optometrists. Data were collected on all outpatient visits for all providers for a 3 month period. Information was abstracted on demographics, presenting and final diagnoses. Expected number of visits for glaucoma were calculated using the population structure and rates of glaucoma, and assuming one visit per year per glaucoma patient. RESULTS: 1398 patients had a total of 1442 visits in 3 months. A third of the visits were to optometrists, and all but 21 visits were for normal eye examinations or glasses. The majority of children aged less than 16 years, and people older than 60 years were seen by the ophthalmologist. Among children, 81% of all visits were to the ophthalmologist and 92% were classified as a normal examination. Only an estimated 188 visits per year for glaucoma were observed, compared with 1100 expected. CONCLUSION: In this rural county, many of the visits to the ophthalmologist were for normal eye examination, particularly among children. Screening algorithms which would free the ophthalmologist to see more complicated problems could be considered. There is an underutilisation of services by glaucoma patients. Reasons for this are described.

Adolescent↗

PubMed2000

Ulcerative colitis in Olmsted County, Minnesota, 1940-1993: incidence, prevalence, and survival.

BACKGROUND: There is significant geographic variation in the reported incidence of ulcerative colitis. AIMS: To update the incidence and prevalence of ulcerative colitis in Olmsted County, Minnesota, examine temporal trends, and determine overall survival. PATIENTS: All Olmsted County residents diagnosed with ulcerative colitis between 1940 and 1993 (incidence cases), and all residents with ulcerative colitis alive on 1 January 1991 (prevalence cases). METHODS: Incidence and prevalence rates were adjusted using 1990 US census figures for whites. The effects of age, sex, and calendar year on incidence rates were evaluated using Poisson regression. Survival from diagnosis was compared with that expected for US north-central whites. RESULTS: Between 1940 and 1993, 278 incidence cases were identified, for an adjusted incidence rate of 7.6 cases per 100 000 person years (95% confidence interval (CI), 6.7 to 8.5). On 1 January 1991, there were 218 residents with definite or probable ulcerative colitis, for an adjusted prevalence rate of 229 cases per 100 000 (95% CI, 198 to 260). Increased incidence rates were associated with later calendar years (p<0.002), younger age (p<0.0001), urban residence (p<0.0001), and male sex (p<0.003). Overall survival was similar to that expected (p>0.2). CONCLUSIONS: The overall incidence rate of ulcerative colitis in Olmsted County increased until the 1970s, and remained stable thereafter. Incidence rates among men and urban residents were significantly higher. The prevalence rate in Rochester in 1991 was 19% higher than that in 1980. Overall survival was similar to that of the general population.

Adolescent↗

PubMed1989

The Swedish two county trial of mammographic screening for breast cancer: recent results and calculation of benefit.

The Swedish two county trial of breast cancer screening is now in its tenth year. This paper presents detailed results on mortality from breast cancer and from all other causes, and on the population denominators at risk for each of the first 8 years of follow up, for each county separately. These data represent a two year update on the last major report. Results show an increasingly significant deficit in deaths from breast cancer among the 77,092 women invited to screening relative to the 56,000 not invited (RR = 0.68, p = 0.002), with no significant difference between the effects of screening in the two counties (p = 0.5). These results remain the same when adjusted for age. Analysis of all cause deaths shows no significant effect of screening (p = 0.5), nor was there any significant effect of screening on deaths from all causes other than breast cancer (p = 0.9). The rates of deaths from intercurrent illness in breast cancer cases were almost identical in the group invited to screening and the group not invited (p = 0.7). This result remained the same when adjusted for age. We calculate that in the age group 50-69 at entry, one breast cancer death was prevented per 4000 woman/years, per 1460 mammographic examinations, per 13.5 biopsies, and per 7.4 breast cancers detected.

Adult↗

PubMed2001

Evaluation of "Live for Life", a health promotion programme in the County of Skaraborg, Sweden.

STUDY OBJECTIVE: To evaluate a health promotion programme, combining a population and individual based strategy, in the County of Skaraborg, Sweden, with special attention to outcome. DESIGN: The evaluation was subdivided into structure, process and outcome. The evaluation procedure as a total is described here, but the results presented refer only to outcome. In order to study the potential effect of the individually based health examination, 35 year old subjects who had participated five years previously were in 1994-1996 compared with 35 year old subjects who had not participated before, and compared with their own values five years earlier. The results during 1995-1996 were compared with those of 1989-1990 for corresponding ages in order to study the effect of, particularly, the population based strategy. SETTING: The County of Skaraborg in the south western part of Sweden with about 270 000 inhabitants. In addition to population strategy, involving the total county, men and women aged 30 and 35 years were invited to an individually based examination. MAIN RESULTS: Factors related to body weight increased during the study period, while other factors mostly changed in the direction wanted. As a whole the changes were rather modest. There were favourable changes in lifestyle variables, for example, concerning smoking and dietary habits. CONCLUSIONS: There were beneficial effects from the health promotion programme, but there is a need for continuous improvement of methods of intervention referred to lifestyle.

Adult↗

PubMed2003

Long term compliance with California's Smoke-Free Workplace Law among bars and restaurants in Los Angeles County.

OBJECTIVE: To assess long term compliance with the California Smoke-Free Workplace Law in Los Angeles County freestanding bars and bar/restaurants. DESIGN: Population based annual site inspection survey of a random sample of Los Angeles County freestanding bars and bar/restaurants was conducted from 1998 to 2002. MAIN OUTCOME MEASURES: The primary outcomes of interest were patron and employee smoking. The secondary outcomes of interest were the presence of ashtrays and designated outdoor smoking areas. RESULTS: Significant increases in patron non-smoking compliance were found for freestanding bars (45.7% to 75.8%, p < 0.0001) and bar/restaurants (92.2% to 98.5%, p < 0.0001) between 1998 and 2002. Increases in employee non-smoking compliance were found for freestanding bars (86.2% to 94.7%, p < 0.0003) and bar/restaurants (96.5% to 99.2%, p < 0.005). CONCLUSIONS: This study provides clear evidence that the California Smoke-Free Workplace Law has been effective at reducing patron and employee smoking in Los Angeles County bars and restaurants. Recommendations include educational campaigns targeted to freestanding bar owners and staff to counter perceptions of lost revenue, more rigorous enforcement, and more severe penalties for repeat violators such as alcohol licence revocation. Policymakers can enact smoke-free restaurant and bar policies to protect employees and patrons from secondhand smoke, confident that these laws can be successfully implemented.

Alcohol Drinking↗

PubMed1986

Tracers for paralysis agitans in epidemiological research. V. Prevalence of the disease in Swedish counties.

The prevalence of parkinsonism varies severalfold between different countries in the world. This could be due to an accumulation of risk factors in certain areas. In the present paper we have analyzed the regional distribution of parkinsonism in Sweden in order to see if such areas could be found within one country. The study was based on sales of levodopa in the different counties of Sweden, and the results were standardized for age and quality of health services as indicated by the local infant mortality rates. The mean prevalence of the different Swedish counties was estimated to be in the middle range of known prevalences. There was a 60% variation within Sweden between the different counties, but the regional distribution did not show a systematic pattern. Further analysis of the causes for this variation showed that differences in case ascertainment and in drug policy could well account for the observed regional differences in parkinsonism prevalence.

Adult↗

PubMed2002

Limited transmission of multidrug-resistant tuberculosis despite a high proportion of infectious cases in Los Angeles County, California.

Preventing transmission of multidrug-resistant tuberculosis is critical because of treatment toxicity, cost, and the lack of effective therapy for latent infection. We attempted to determine the extent of transmission in Los Angeles County by comparing relatedness of multidrug-resistant tuberculosis cases using restriction fragment length polymorphism and by cross-matching contact information to the Tuberculosis Registry. Strain typing was done on isolates of 102 pulmonary multidrug-resistant cases identified between August 1993 and 1998. Seventy-one (70%) of the cases had cavitary lesions on chest radiograph, and 94 (92%) had sputa smear-positive for acid fast bacilli. Fifteen (15%) of the cases were known to be infected with human immunodeficiency virus. Four molecular clusters of two cases each and one closely related pair were identified among the 102 cases; contact investigation successfully identified all clusters but one. Among 946 contacts identified and cross-matched with the county's Tuberculosis Registry, one secondary case due to drug-resistant Mycobacterium bovis was found. To summarize, a very high proportion of pulmonary multidrug-resistant tuberculosis cases in Los Angeles County were infectious. Molecular strain typing indicated limited spread of disease, although it underestimated transmission compared with contact investigation. We believe aggressive surveillance and case management were critical to limiting the spread of multidrug- resistant tuberculosis.

Analysis of Variance↗

PubMed2002

Transmission dynamics of tuberculosis in Tarrant county, Texas.

To understand the transmission dynamics of tuberculosis in Tarrant County, Texas, we performed a population-based study of 159 patients with culture-proven tuberculosis, combining restriction fragment length polymorphism (RFLP) analysis of Mycobacterium tuberculosis isolates with prospective interviewing to identify epidemiologic links between patients. Patients whose isolates had identical or closely related RFLP patterns were considered a cluster. Seventy-six (48%) of 159 patients were in 19 clusters, suggesting that recent transmission accounted for 36% of tuberculosis morbidity. Unconditional logistic regression showed that birth in the United States, continuous residence in Tarrant County, a history of homelessness, and a history of visiting or working in bars were independent predictors of clustering. Four homeless shelters and five bars were associated with specific clusters, suggesting that they were sites of tuberculosis transmission. Patients in some clusters recognized more photographs of patients in their cluster than did patients outside their cluster. We conclude that (1) homeless shelters and bars are important sites of tuberculosis transmission in Tarrant County, and (2) the use of photograph recognition of patients with tuberculosis, in combination with RFLP analysis, has the potential to enhance tuberculosis control by facilitating identification of epidemiologic links between patients.

Adult↗

PubMed1994

An epidemiologic, clinical, and family study of simple schizophrenia in County Roscommon, Ireland.

OBJECTIVE: The authors sought to estimate the prevalence of simple schizophrenia, compare the clinical presentations and courses of simple and "typical" schizophrenia, and examine psychopathology in first-degree relatives of probands with simple schizophrenia, probands with typical schizophrenia, and community comparison subjects. METHOD: The authors followed up all individuals with a recorded diagnosis of schizophrenia (N = 285) and 75% of those with a diagnosis of severe affective illness (N = 99) from the Roscommon County Case Register, which includes all individuals seeking psychiatric care in a rural county in western Ireland. The authors interviewed all available first-degree relatives of these groups and of matched unscreened community comparison subjects. RESULTS: Eleven cases of simple schizophrenia were diagnosed in the probands, for an estimated population prevalence and morbid risk in County Roscommon of 5.3 (SE = 1.6) and 6.2 (SE = 1.9) per 10,000, respectively. Individuals with typical schizophrenia (N = 126) had more marked delusions, hallucinations, and positive thought disorder; individuals with simple schizophrenia had more pronounced negative thought disorder and a more chronic course. Neither social/occupational functioning nor negative symptoms differed between the two groups. The risks for schizophrenia and all nonaffective psychoses were greater in the relatives of the probands with simple schizophrenia than in the relatives of the community comparison subjects. CONCLUSIONS: In this sample, simple schizophrenia was relatively rare, was rather debilitating, and resembled typical schizophrenia in presentation and course except for the absence of positive psychotic symptoms. From a familial perspective, simple schizophrenia appears to be related to typical schizophrenia.

Adult↗

PubMed2005

Rearrest and linkage to mental health services among clients of the Clark County mental health court program.

OBJECTIVE: This study examined rearrest and linkage to mental health services among 368 misdemeanants with severe and persistent mental illness who were served by the Clark County Mental Health Court (MHC). This court, established in April 2000, is based on the concepts of therapeutic jurisprudence. This study addressed the following questions about the effectiveness of the Clark County MHC: Did MHC clients receive more comprehensive mental health services? Did the MHC successfully reduce recidivism? Were there any client or program characteristics associated with recidivism? METHODS: A secondary analysis of use of mental health services and jail data for the MHC clients enrolled from April 2000 through April 2003 was conducted. The authors used a 12-month pre-post comparison design to determine whether MHC participants experienced reduced rearrest rates for new offenses, reduced probation violations, and increased mental health services 12 months postenrollment in the MHC compared with 12 months preenrollment. RESULTS: The overall crime rate for MHC participants was reduced 4.0 times one year postenrollment in the MHC compared with one year preenrollment. One year postenrollment, 54 percent of participants had no arrests, and probation violations were reduced by 62 percent. The most significant factor in determining the success of MHC participants was graduation status from the MHC, with graduates 3.7 times less likely to reoffend compared with nongraduates. CONCLUSIONS: The Clark County MHC successfully reduced rearrest rates for new criminal offenses and probation violations and provided the mental health support services to stabilize mental health consumers in the community.

Adolescent↗

PubMed1976

Designing a mental health center to replace a county hospital.

An architectural team worked closely with a county building committee and the administrative staff of a Wisconsin county hospital to design a new active-treatment facility. The goals included changing the hospital's negative image in the community, fostering a close relationship between all programs and all groups of users, and encouraging inpatients to make the best possible use of various treatment areas. Planning was interrupted by a community-wide controversy over the location, and the facility was eventually built on a compromise site. The new facility, a community mental health center serving two counties, has an open, split-level design accommodating six inpatient programs and a day hospital. An informal evaluation of the environment was made a year after the center was occupied.

Community Mental Health Services↗

PubMed1998

Hospitalization for lower respiratory disease during 20 yrs among under 5 yr old children in Stockholm County: a population based survey.

Lower respiratory disease (LRD) is a common cause of hospitalization in infants, and episodes of obstructive LRD increase the risk for asthma later in life. The purpose of this study was to assess time trends and geographical variation of first time hospitalization for LRD among children in Stockholm County, Sweden. Data on first time admittance for LRD among children aged up to 5 yrs from 1973 through 1992 were obtained from the Stockholm County Council hospital discharge register, and population register data were used for estimation of the population at risk. Municipal data were available for 1982-1992 on outbreaks of respiratory syncytial virus (RSV) infections and socio-economic factors. A total of 12,450 children had been hospitalized for the first time with LRD. For children aged <2 yrs a 100% increase in the rate of first time hospitalization for LRD was observed during the study period and children aged up to 1 yr predominated (50%). The average yearly increase in the population based first time hospital admission rate for LRD was 1.82%. Males constituted 65% of the cases. Of the diagnoses, 89.6% were consistent with obstructive LRD, e.g. asthma and obstructive bronchitis. In children aged up to 1 yr, peaks in the rate of hospitalization tended to coincide with outbreaks of RSV infections. Differences in hospitalization between municipalities seemed to be partly explained by differences in the admission practices of the four paediatric hospitals in the area. We conclude that the increased rate of hospitalization for lower respiratory disease in infants of Stockholm County may reflect a true increase in the incidence of obstructive respiratory disease. However, several factors determine admittance to hospital and the results need to be interpreted with caution.

Age Distribution↗