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PubMed2003

Breast cancer in Marin County.

Two articles previously published in Breast Cancer Research illustrate the high rates of breast cancer in Marin County, a wealthy, urban county immediately northwest of the city of San Francisco. I herein comment on these articles, and on the political/psychological/scientific dilemma presented by regions with high cancer rates, such as Marin County. I discuss possible causes for such cancer 'clusters', and conclude with some thoughts about the future.

Breast Neoplasms↗
PubMed2006

Hospital disaster preparedness in Los Angeles County.

BACKGROUND: There are no standardized measures of hospital disaster preparedness or hospital "surge capacity." OBJECTIVES: To characterize disaster preparedness among a cohort of hospitals in Los Angeles County, focusing on practice variation, plan characteristics, and surge capacity. METHODS: This was a descriptive, cross-sectional survey study, followed by on-site verification. Forty-five 9-1-1 receiving hospitals in Los Angeles County, CA, participated. Evaluations of hospital disaster plan structure, vendor agreements, modes of communication, medical and surgical supplies, involvement of law enforcement, mutual aid agreements with other facilities, drills and training, surge capacity (assessed by monthly emergency department diversion status, available beds, ventilators, and isolation rooms), decontamination capability, and pharmaceutical stockpiles were assessed by survey. RESULTS: Forty-three of 45 hospital plans (96%) were based on the Hospital Emergency Incident Command System, and the majority had protocols for hospital lockdown (100%), canceling elective surgeries (93%), early discharge (98%), day care for children of staff (88%), designating victim overflow areas (96%), and predisaster "preferred" vendor agreements (96%). All had emergency medical services-compatible radios and more than three days' worth of supplies. Fewer hospitals involved law enforcement (56%) or had mutual aid agreements with other hospitals (20%) or long-term care facilities (7%). Although the vast majority (96%) conducted multiagency drills, only 16% actually involved other agencies in their disaster training. Only 13 of 45 hospitals (29%) had a surge capacity of greater than 20 beds. Less than half (42%) had ten or more isolation rooms, and 27 hospitals (60%) were on diversion greater than 20% of the time. Thirteen hospitals (29%) had immediate access to six or more ventilators. Less than half had warm-water decontamination (42%), while approximately one half (51%) had a chemical antidote stockpile and 42% had an antibiotic stockpile. CONCLUSIONS: Among hospitals in Los Angeles County, disaster preparedness and surge capacity appear to be limited by a failure to fully integrate interagency training and planning and a severely limited surge capacity, although there is a generally high level of availability of equipment and supplies.

Cross-Sectional Studies↗
PubMed1988

Tourette's syndrome in Monroe County school children.

We examined children from Monroe County, New York, to establish the prevalence of Gilles de la Tourette's syndrome (TS) in the county's schools. Patients were recruited for free evaluations from physicians, other health professionals, school personnel, and through extensive coverage in the local news media. Forty-one TS patients were detected among the 142,636 pupils enrolled in the county's public and private schools at the time of the study (estimated prevalence, 28.7 per 100,000). Twenty patients had obsessive-compulsive symptoms, but only three had an impairing, diagnosable disorder. Fifty-six percent had a positive family history for TS or tics. Eighteen needed pharmacotherapy, although, for most, TS was a mild disorder requiring no drug treatment.

Adolescent↗
PubMed1990

A reappraisal of the epidemiology of multiple sclerosis in Olmsted County, Minnesota.

A review of multiple sclerosis (MS) case reports, using the unified record system at the Mayo Clinic for the Olmsted County population, revealed age- and sex-adjusted prevalence rates per 100,000 persons of 160 for Olmsted County and 173 for Rochester, Minnesota, on January 1, 1985. The annual age- and sex-adjusted incidence rate per 100,000 person-years from 1975 to 1984 for Olmsted County was 6.2 and for Rochester, 6.3. This incidence rate is significantly higher than what had been reported previously in Rochester (3.6/100,000) or in other communities. The estimated 25-year survival of the MS population was 76.2% +/- 4.5% compared with 87.7% for the general US white population of a similar age and sex. Survival for men was less than for women. There was no increase in survival for patients diagnosed with MS in more recent decades. No significant increase was found in cancer or autoimmune disease rates in the MS patients.

Adolescent↗
PubMed1993

Trauma and multiple sclerosis: a population-based cohort study from Olmsted County, Minnesota.

Utilizing the Olmsted County, Minnesota, population-based records-linkage resource at Mayo Clinic, we identified an incidence and a prevalence cohort with multiple sclerosis (MS), a head injury cohort, and a lumbar disk surgery cohort to evaluate the association between mechanical trauma and MS onset or exacerbation. The MS cohorts consisted of 225 incidence cases (1905 to 1991) and 164 prevalence cases (December 1, 1991) of definite MS in the population of Olmsted County. We assessed the effect of mechanical trauma in the form of spinal injury or extremity fracture with regard to precipitation of MS or exacerbation of an existing neurologic deficit. Fifty-four episodes of trauma, as defined, occurred among 39 MS prevalence cases; most occurred 10 years or more after the onset of disease and were associated with existing MS-related disability. We compared the final disability status of the groups with and without trauma. We found no correlation between the occurrence of peripheral fractures and the onset of MS, exacerbation of MS, or final disability due to MS in the prevalence cohort. In a cohort of 819 head injury cases from the Olmsted County population, none developed MS within 6 months of the trauma. In a lumber disk surgery cohort of 942 local residents, there were five with MS, but onset of MS had preceded the spinal surgery in four of the five. Thus, we found no association of head injury and spinal disk surgery with onset of MS.

Cohort Studies↗
PubMed1995

Optic neuritis: a population-based study in Olmsted County, Minnesota.

We reviewed the records of all patients with optic neuritis (ON) in Olmsted County, Minnesota, identified through the comprehensive records-linkage system at the Mayo Clinic, and identified 156 ON patients from 1935 to 1991 who had onset of the disease while residing in Olmsted County (incidence cases). Poisson regression analysis revealed that age, gender, and calendar year were associated with incidence. The annual age- and sex-adjusted incidence rate was 5.1 per 100,000 person-years from 1985 to 1991. On December 1, 1991, 128 patients with a documented history of ON resided in Olmsted County (prevalence cohort). The age- and sex-adjusted prevalence rate per 100,000 was 115. The average length of follow-up for the incidence cohort was 13.2 years. Life table analysis showed that 39% of the 95 patients with isolated ON in the incidence cohort had progressed to clinically definite multiple sclerosis (MS) by 10 years of follow-up, that 49% had by 20 years, 54% by 30 years, and 60% by 40 years. There was no difference in the risk of developing MS between men and women. The presence of venous sheathing (p = 0.044) and evidence for recurrent ON (p < 0.0001) were associated with an increased likelihood of developing MS. The estimated 25-year survival rate was 88.3% +/- 5.8% for the incidence cohort with isolated ON, compared with 83.9% for the general US population of similar age and sex.

Adolescent↗
PubMed2001

Helicobacter pylori prevalences and risk factors among school beginners in a German urban center and its rural county.

In 1998, the Helicobacter pylori [(13)C]urea breath test was offered to all school beginners (birth cohort 1991/1992) in the city of Leipzig and in Leipzig County, Germany, to determine the colonization prevalence and potential transmission pathways of the bacterium. A total of 3,347 school beginners participated in the test, and 2,888 parents completed the detailed, self-administered questionnaire. The H. pylori prevalence was 6.5% [95% confidence interval (CI), 5.3-7.6] in the city and 5.7% (CI, 4.2-7.0) in the county. Using cluster analysis (WARD's method, Euclidean distances), we identified different sets of variables (confirmed by multivariate logistic regression analyses [odds ratios (ORs)] that are signficantly associated with H. pylori positivity. Among city children, the risk is significantly increased with contact to a pet hamster (OR = 2.4; 95% CI, 1.2-4.7; p < 0.015) and travels to Asian countries (OR = 3.7; 95% CI, 1.6-8.7; p < 0.002). Among county children, H. pylori positivity increased significantly with drinking of water from nonmunicipal sources (OR = 16.4; 95% CI, 3.1-88.5; p < 0.001), more than 3 children living in a household (OR = 4.2; 95% CI, 1.2-14.6; p < 0.02), and contact with pet hamsters (OR = 2.4; 95% CI, 1.0-5.7; p < 0.04). These data suggest that, in a general population sample, indirect fecal-oral transmission and living conditions are important risk factors in the spread of H. pylori infection. However, clinical symptoms do not necessarily indicate H. pylori positivity.

Breath Tests↗
PubMed1997

Triazine herbicide exposure and breast cancer incidence: an ecologic study of Kentucky counties.

The incidence of breast cancer in the United States has steadily increased for the past three decades. Exposure to excess estrogen, in both natural and synthetic forms, has been implicated as a risk factor for the development of this disease. Considerable interest has been focused on organochlorines, such as the triazine herbicides, and their possible role in the initiation or promotion of human breast cancer. To explore this relationship, an ecologic study of Kentucky counties was designed. Exposure to triazines was estimated by use of water contamination data, corn crop production, and pesticide use data. A summary index of triazine herbicide exposure was developed to classify counties into low, medium, or high exposure levels. Data on county breast cancer rates were obtained from the state registry. A Poisson regression analysis was performed, controlling for age, race, age at first live birth, income, and level of education. Results revealed a statistically significant increase in breast cancer risk with medium and high levels of triazine exposure [odds ratio (OR) = 1.14,p<0.0001 and OR = 1.2, p<0.0001, respectively]. The results suggest a relationship between exposure to triazine herbicides and increased breast cancer risk, but conclusions concerning causality cannot be drawn, due to the limitations inherent in ecologic study design.

Adult↗
PubMedDate not supplied

Marital status and birthrate of deaf people in two Swedish counties: the impact of social environment in terms of deaf community.

Deafness affects many social interactions. The impact of deafness depends on several factors, e.g., the type of social environment in terms of the particular Deaf community a person lives in. The authors recorded the birthrate and the proportions of married and divorced people among deaf people in two Swedish counties: Narke, which had a strong Deaf community, and Varmland, whose Deaf community was weak. In both counties, the authors found that deafness was associated with low marriage rates and low birthrates. Further, in Narke, 99% of the people in the sample were married to another deaf person; only 10% were in Varmland. In Narke, the divorce rate among deaf people was about the same as that of the reference population (i.e., the county's marriage-age population). In Varmland, deaf people had a relatively low divorce rate. The findings are discussed from medical and social perspectives.

Adult↗
PubMed2006

Urban-rural differences in excess mortality among high-poverty populations: evidence from the Harlem Household Survey and the Pitt County, North Carolina Study of African American Health.

Black youth residing in high-poverty areas have dramatically lower probabilities of surviving to age 65 if they are urban than if they are rural. Chronic disease deaths contribute heavily. We begin to probe the reasons using the Harlem Household Survey (HHS) and the Pitt County, North Carolina Study of African American Health (PCS). We compare HHS and PCS respondents on chronic disease rates, health behaviors, social support, employment, indicators of health care access, and health insurance. Chronic disease profiles do not favor Pitt County. Smoking uptake is similar across samples, but PCS respondents are more likely to quit. Indicators of access to health care and private health insurance are more favorable in Pitt County. Findings suggest rural mortality is averted through secondary or tertiary prevention, not primary. Macroeconomic and health system changes of the past 20 years may have left poor urban Blacks as medically underserved as poor rural Blacks.

Adult↗
PubMed2005

Using surveillance data to develop and disseminate local childhood lead poisoning screening recommendations: Miami-Dade County's experience.

Before 1999, few children in Florida's Miami-Dade County were being screened for lead poisoning. To improve screening rates, the county's department of health developed screening recommendations and a screening tool using surveillance and census data and disseminated these materials to primary care providers. Each year, recommendations have been reviewed to assess their sensitivity, and revised recommendations have been disseminated to health care providers. The percentage of children 6 years or younger screened in Florida who reside in Miami-Dade County increased from 4.1% in 1998 to 20.3% in 2002. Analysis and dissemination of blood lead surveillance data not only guide development of screening recommendations but also educate health care providers regarding the importance of childhood screening.

Child↗
PubMed2006

Characteristics of black and white suicide decedents in Fulton County, Georgia, 1988-2002.

OBJECTIVES: We compared the prevalence of risk factors for Black and White suicide decedents in Fulton County, Georgia, from 1988-2002. METHODS: We used data from the Fulton County Medical Examiner's Office to compile information on suicides that occurred in Fulton County between 1988 and 2002. We used the chi2 test and logistic regression to identify associations between suicide risk factors and race. RESULTS: Black suicide decedents were more likely than White suicide decedents to be male (odds ratio [OR]=2.06; 95% confidence interval [CI]=1.38, 3.09), to be younger, (< or =24 y [OR = 4.74; 95% CI = 2.88, 7.81]; 25-34 y [OR = 2.79; 95% CI = 1.74, 4.47]; 35-44 y [OR = 1.86; 95% CI = 1.13, 3.07]), and to hurt others in a suicide (OR = 4.22; 95% CI = 1.60, 11.15) but less likely to report depression (OR=0.63; 95% CI=0.48, 0.83), to have a family history of suicide (OR=0.08; 95% CI=0.01, 0.61), or to leave a suicide note (OR=0.37; 95% CI=0.26, 0.52). CONCLUSIONS: Future research should consider that Black suicide decedents are less likely to report depression than White suicide decedents. This suicide risk difference is important when developing effective suicide prevention programs.

Adult↗
PubMed1978

The incidence of sudden infant death syndrome in North Carolina's cities and counties: 1972--1974.

Between January 1, 1972 and December 31, 1974, 534 Sudden Infant Death Syndrome cases were reported in North Carolina. All but the out-of-state cases were mapped by county and city locations to determine if urban or rural cases predominated. The mapping was also undertaken to see if significant spatial variabilities could be detected between the county and city populations of infants at risk. The state had an overall SIDS rate of 2.06 per thousand live births. The mapping revealed that counties had a range from zero to a high of 6.6 and that cities with populations of over 10,000 had SIDS rates which ranged from zero to a high of 10.6. The proportions of SIDS cases occurring in either urban or rural locations roughly approximated the distribution of the state's population, with neither location accounting for disproportionately more cases. The larger cities, however, reported more cases than did their suburbs and the immediately surrounding rural areas. The largest and smallest cities, when grouped accordingly, had the lowest urban SIDS rates. The summary SIDS rates for whites was 1.23 per thousant live births, for blacks it was 3.75, and for Indians it was 6.56 per thousand live births.

Autopsy↗
PubMed1985

The barefoot doctor: Shanghai County revisited.

Since a 1981 review of health status and health services in Shanghai County, there have been considerable social and economic changes in the People's Republic of China. A major question currently is the impact of the new economic "responsibility system," which was introduced in 1982, on the cooperative health structure and the "barefoot doctors" (BFDs). Investigators in other areas of China have reported the collapse of the cooperative systems and a shift in the role of the BFDs as a result of incentives for them to spend more time in agricultural production. In Shanghai County, however, BFDs continue essentially full time as before, salaried by the brigade, with fee-for-service charges prohibited. Recent evidence from Shanghai County shows that the health care system and those who direct it can remain flexible and respond positively to changes in the social, economic, and political structures.

China↗
PubMed1989

Results of routine restaurant inspections can predict outbreaks of foodborne illness: the Seattle-King County experience.

To analyze the association between the results of routine inspections and foodborne outbreaks in restaurants, we conducted a matched case-control study using available data from Seattle-King County, Washington. Case restaurants were facilities with a reported foodborne outbreak between January 1, 1986 and March 31, 1987 (N = 28). Two control restaurants with no reported outbreaks during this period were matched to each case restaurant on county health district and date of routine inspection (N = 56). Data from the routine inspection that preceded the outbreak (for case restaurants) or the date-matched routine inspection (for control restaurants) were abstracted from computerized inspection records. Case restaurants had a significantly lower mean inspection score (83.8 on a 0 to 100 point scale) than control restaurants (90.9). Restaurants with poor inspection scores and violations of proper temperature controls of potentially hazardous foods were, respectively, five and ten times more likely to have outbreaks than restaurants with better results. Although this study demonstrates that Seattle-King County's routine inspection form can successfully identify restaurants at increased risk of foodborne outbreaks, it also illustrates that more emphasis on regulation and education is needed to prevent outbreaks in restaurants with poor inspection results.

Disease Outbreaks↗
PubMed1994

Child and adolescent drownings in Harris County, Texas, 1983 through 1990.

OBJECTIVES: This study described childhood drowning rates and circumstances in Harris County, a large metropolitan area in Texas, and compared case ascertainment between data sources. METHODS: Drowning rates among Harris County residents newborn through 19 years of age were calculated from death certificate data (1983 through 1989), and local childhood drowning hazards were described on the basis of medical examiner data (1983 through 1990). Cases from both sources were compared to determine sensitivity of sources. RESULTS: The drowning rate among Harris County residents newborn through 19 years of age was 3.8 per 100,000 person-years. The drowning rates among Blacks and Hispanics exceeded that of Whites by 56% and 19%, respectively. The majority of the 196 unintentional drownings occurred in swimming pools. Half of the pool drownings occurred in apartment pools and 33% in private home pools. The medical examiner logbook identified a slightly higher number of drownings than did death certificates. International Classification of Diseases external cause of death codes were of limited use in describing drowning circumstances. CONCLUSIONS: Childhood drowning hazards not previously reported were identified, specifically hazards in apartment pools and those among Hispanic children.

Adolescent↗
PubMed1994

Risk behavior and correlates of risk for HIV infection in the Dallas County Household HIV survey.

OBJECTIVES: The Dallas County study of a proposed national household seroprevalence survey was designed to assess the feasibility of conducting a national survey and to estimate the prevalence of human immunodeficiency virus (HIV) and hepatitis B virus infection for Dallas County. Risk behavior data were collected and correlated with HIV infection. METHODS: Participants in this survey represented a probability sample of the county. A self-administered questionnaire on demographic characteristics and HIV risk behavior was completed and a blood sample was obtained. RESULTS: Of the 1724 adults eligible for the survey, 1446 completed the questionnaire and 1374 provided a blood sample. The prevalence estimates were 0.4% for HIV and 7.3% for hepatitis B virus. A strong relationship was observed between HIV and hepatitis B status and risk behavior. CONCLUSIONS: In this study population, receptive anal intercourse and increasing numbers of male partners had the strongest correlation with the prevalence of HIV and hepatitis B virus infection in men. The high level of risk reporting for individuals positive for HIV or hepatitis B suggests that survey participants who engage in risk behaviors were willing to report those behaviors.

Adult↗
PubMed2000

Effects of pool-fencing ordinances and other factors on childhood drowning in Los Angeles County, 1990-1995.

OBJECTIVES: This study estimated the effects of local pool-fencing ordinances and other factors on the rate of childhood drowning in Los Angeles County, California. METHODS: Stage 1 was a retrospective dynamic cohort study of all drownings among children younger than 10 years that occurred in residential swimming pools in Los Angeles County between 1990 and 1995. Stage 2 was a matched case-control study that compared pools in which childhood drownings occurred (cases) with randomly selected pools in which drownings did not occur (controls). RESULTS: The drowning rate was relatively high among toddlers (aged 1-4 years), boys, and African Americans and in areas with a high density of residential swimming pools. Pool-fencing ordinances were not associated with a reduced overall rate of childhood drowning. CONCLUSIONS: Local ordinances enacted in Los Angeles County before 1996 do not appear to have been effective in reducing the rate of childhood drowning in residential pools. Possible reasons for this ineffectiveness are insufficient building codes for isolating pools from homes, inadequate enforcement of the ordinances, and inadequate operation or maintenance of fencing equipment by pool owners.

Age Distribution↗