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PubMed1986

A mental health center's influence in a county jail.

A case study that describes the process of establishing mental health services in the medium-sized Howard County (Maryland) jail is presented. Built in 1878, the county jail provided virtually no rehabilitative services to its inmates until 1972. At that time, personnel from the Howard County Bureau of Mental Health began to gain access to the jail, establish rapport with the jail staff, assess the mental health needs of the inmates, and implement various programs to meet these needs. Implementation and development of services are described for the 12-year span between 1972 and 1984. The concept of providing community-based services has been accepted and incorporated into the value system and structure of the jail. It is concluded that the viability of programs depended upon interactions among continuation of strong leadership for each component of the rehabilitation program, acceptance of the value of these services by the jail administration and staff, and availability of community resources. The linkage between the jail and community agencies is discussed.

Community Mental Health Services↗

PubMed1999

Pedestrian fatalities--Cobb, DeKalb, Fulton, and Gwinnett counties, Georgia, 1994-1998.

In 1997, a total of 5307 pedestrian fatalities occurred in the United States, accounting for 13% of motor-vehicle-related deaths. The Atlanta metropolitan statistical area (MSA) is reported to be the third most dangerous large metropolitan area for walking, behind Fort Lauderdale and Miami, Florida. This report summarizes an investigation of pedestrian fatalities in four central metropolitan Atlanta counties; the findings indicate that the annual pedestrian fatality rate for these counties combined has been consistently higher than the national rate, and from 1994 to 1998 the four-county area pedestrian fatality rate increased 13%.

Accidents, Traffic↗

PubMed1999

Outbreak of Escherichia coli O157:H7 and Campylobacter among attendees of the Washington County Fair-New York, 1999.

September 3, 1999, the New York State Department of Health (NYSDOH) received reports of at least 10 children hospitalized with bloody diarrhea or Escherichia coli O157:H7 infection in counties near Albany, New York. All of the children had attended the Washington County Fair, which was held August 23-29, 1999; approximately 108,000 persons attended the fair during that week. Subsequently, fair attendees infected with Campylobacter jejuni also were identified. An ongoing investigation includes heightened case-finding efforts, epidemiologic and laboratory studies, and an environmental investigation of the Washington County fairgrounds. This report presents the preliminary findings implicating contaminated well water.

Adolescent↗

PubMed1999

Trends in the prevalence and treatment of hypertension in Halifax County from 1985 to 1995.

BACKGROUND: The objective of this study was to document changes in the prevalence and treatment of hypertension in Halifax County from 1985 to 1995 in an effort to observe, at the population level, the consequences of the availability of new antihypertensive medications. METHODS: The study population comprised a random sample of Halifax County residents, aged 25-64 years, who responded to the 1985 and 1995 surveys of the Halifax County MONICA Project and residents who responded to the Nova Scotia Health Survey conducted in 1995. Data from the two 1995 surveys were pooled. Information on hypertension awareness and use of medication were obtained through questionnaires, and blood pressure was measured according to a standard protocol, using phase I and V of Korotkoff sounds as respective markers for systolic and diastolic pressures. Uncontrolled hypertension was defined as a systolic pressure of 140 mm Hg or greater and a diastolic pressure of 90 mm Hg or greater. Changes in the prevalence of hypertension, prescribing trends and medication costs were examined, and the association between the type of antihypertensive treatment and characteristics of the respondents with self-reported hypertension was investigated by multivariate logistic regression. RESULTS: Of the 917 people interviewed in 1985 and the 1338 in 1995, 274 (29.9%) and 356 (26.6%), respectively, reported a history of hypertension. When age was controlled for, the proportion of respondents reporting hypertension did not differ between survey years or between men and women. The proportion of treated respondents who had uncontrolled hypertension increased between 1985 and 1995, from 32.6% to 57.4% among men and from 38.0% to 42.6% among women. An increase was seen in the use of calcium-channel blockers (from 2.1% to 19.7%) and angiotensin-converting-enzyme inhibitors (from 5.2% to 25.4%); the proportion of patients receiving combination therapy or diuretics decreased (from 39.6% to 15.6% and from 31.3% to 17.2% respectively). These changes were associated with an increase in the average daily cost of medication from $0.48 to $0.85 per patient. INTERPRETATION: The shift to new antihypertensive drugs was not associated with improved blood pressure control, but it was associated with an increase in average medication costs per patient. Uncontrolled hypertension remains a public health problem.

Adult↗

PubMed1998

Dientes! Community dental clinic: dental care for low-income residents of Santa Cruz County.

Dientes! is a private nonprofit community dental clinic that was established in 1994 to provide dental care for low-income residents of Santa Cruz County. Its founders were successful in securing support from a diverse group of community agencies, including city and county governments, philanthropic foundations, the dental community, and corporate and individual donors. Dientes! provides approximately 250 visits per month in a three-chair clinic in Santa Cruz; a school-based program in Watsonville began March 1998. The major challenge facing Dientes! is to establish a reliable financial base that will allow the program to better meet the needs of low-income county residents over the long term.

California↗

PubMed1999

[Place of residence determines access to interferon-beta therapy in MS. Less than 15 per cent of patients are treated--big differences between the counties].

Interferon-beta (IFNB) is the first agent to be registered in Sweden for modifying disease course in multiple sclerosis (MS). A nationwide survey uncovered a tenfold variation between counties in the prescribing of IFNB. About 10% of patients received treatment in a few counties, while in most the figure was even smaller. No correlation was found between sales of IFNB and numbers of neurologists in the respective counties. Patients should receive treatment according to national medical guidelines, regardless of place of residence.

Drug Costs↗

PubMed1999

Identifying barriers to the administration of HIV medications to county correctional facility inmates.

The purpose of this study was to investigate the process of HIV medication administration at a county correctional facility. Anecdotal data suggested serious barriers to the process. Professional and licensed practical nursing staff practicing at a New Jersey county correctional facility participated in focus group interviews designed to discuss the process of medication administration and potential barriers to that process. Analysis of data revealed five contextual themes: uniqueness of the county correctional facility setting, barriers perceived by nursing staff, inmates' perceptions of HIV infection, internal systems' barriers, and the role of systems external to the correctional facility.

Anti-HIV Agents↗

PubMed2000

Survey of infectious skin diseases and skin infestations among primary school students of Taitung County, eastern Taiwan.

BACKGROUND: There are no complete records on the prevalence of childhood skin diseases in Taiwan. We conducted a survey of infectious skin diseases and skin infestations among primary school children in Taitung County, which is located in southeastern Taiwan. METHODS: From March 1998 through October 1998, a total of 3,029 students from four rural districts (Changbin, Yanping, Lanyu, and Dawu) and one urban area (Taitung City of Taitung County) were examined by dermatologists. Treatment and instructions for disease care were given immediately after the diagnosis of dermatoses, when appropriate. RESULTS: The most common infectious skin diseases and infestations were pediculosis capitis (12.9%), verruca vulgaris (5.1%), tinea versicolor (4.4%), tinea pedis (4.1%), verruca plantaris (1.8%), and scabies (1.4%). Most skin diseases, including pediculosis capitis, scabies, verruca vulgaris, verruca plantaris, folliculitis, pyoderma, tinea pedis, and tinea versicolor, were significantly more common in rural areas than in the urban area (p < 0.05 for all). Pediculosis capitis was more common among girls (p < 0.001), but tinea pedis and tinea versicolor were more common among boys (p < 0.05). CONCLUSIONS: The prevalence of most skin infections and infestations are much higher in rural Taitung County than in Taitung City. Prevention and treatment of these skin diseases should be reemphasized in the education of teachers, as well as students and their families. Adequate dermatologic training of nurses and physicians and the development of teleconsultation and teledermatology in rural areas might decrease the prevalence of these skin diseases in school children.

Child↗

PubMed2000

Local option policies and alcohol availability in North Carolina counties.

Concerned about social problems related to alcohol, communities are considering legal alternatives for restricting its availability. Whether restrictive local policies are realistic means for curtailing the physical availability of alcohol is unknown. Using North Carolina's 100 counties as the unit of analysis, the extent to which 1994 local option policies predicted 1995 rates of alcohol permits, controlling for other factors related to the demand for alcohol, was examined. Counties with restrictive policies were found to have lower rates of alcohol permits than counties with permissive policies, after accounting for alcohol demand. Local option policies may be a reasonable strategy for limiting the physical availability of alcohol. In turn, limiting alcohol availability may be effective in reducing alcohol-related community problems such as traffic crashes and violent assaults.

Alcohol Drinking↗

PubMed2000

Mosquito collections following local transmission of Plasmodium falciparum malaria in Westmoreland County, Virginia.

A 63-year-old woman from Colonial Beach, Westmoreland County, VA, was diagnosed with Plasmodium falciparum malaria on July 19, 1998. The woman had no history of international travel, intravenous drug use, blood transfusion, or other risk factor for contracting the disease. She seldom left the county and generally spent her evenings indoors, leading to the conclusion that she had been bitten locally by an infected mosquito. Colonial Beach is host to a population of migrant agricultural laborers from areas in which malaria occurs, but a blood survey of 89 Haitians and Mexicans failed to find Plasmodium parasites, specific antibodies, or clinical cases of malaria. Mosquito surveys were conducted during 2 days (July 22 and 28, 1998) with carbon-dioxide-baited light traps, larval and pupal collections, and landing collections. Thirteen species of mosquitoes were identified morphologically, including 4 potential vectors: Anopheles crucians, An. punctipennis, An. smaragdinus (new state record), and An. quadrimaculatus s.s. (new state record). Identifications of the latter 2 species were confirmed by sequencing of the ITS2 DNA region from adults reared from locally collected larvae. Anopheles smaragdinus was the most common biting species among the potential vectors, although An. crucians was the most abundant in other kinds of collections. In addition, Ae. albopictus was collected in Westmoreland County for the 1st time.

Aedes↗

PubMed2000

Knowledge of and attitudes towards infertility held by members of two county councils in Sweden.

BACKGROUND: To investigate Swedish county council members knowledge of the laws regulating infertility treatment, their understanding of the suggestions put forward in the report 'Priorities in Health Care' and their attitudes towards infertility. METHODS: All members (n=182) of the 1998 county councils of Linköping and Jönköping were asked to participate in the study. In total, 153 answered the questionnaire. RESULTS: Different age groups did not show different levels of knowledge. Similarly, there was no significant difference between men and women concerning their knowledge of infertility laws. Furthermore, those committee members who were very positive towards infertility treatment did not have any better knowledge of such treatment than those who were less positive. The men and women who themselves had previously had or were dealing with infertility problems at the time of the survey (12 per cent) displayed the same level of knowledge as the other council members. They also expressed similar attitudes. The members showed very little familiarity with the priority groups suggested in the report from the Health Care Priority Committee. For example, only 18 per cent knew that this committee in priority group III placed infertility treatment and investigation. 31.3 per cent answered that infertility was placed in group V, a group that does not exist. The majority stated that they had a positive attitude towards the treatment of infertility. This is indicated, for example, by their rejection of the statement 'it's [infertility is] a luxury problem'. CONCLUSIONS: The relative lack of knowledge of Swedish law and of the report from the Health Care Priority Committee might lead to a lower level of commitment to dealing with the problems that infertile couples face than if the members were better informed. In other words, this lack of knowledge might influence the decisions of the county council members.

Adult↗

PubMedDate not supplied

The burdens of uninsured hospitalizations in an urban county.

CONTEXT: Few data at the level of local health jurisdictions are available to characterize health problems specific to persons without health insurance. PRACTICE PATTERN EXAMINED: Hospitalization patterns of residents of DeKalb County, Georgia, who have no health insurance. DATA SOURCE: 1996 Georgia hospital discharge records for persons living within ZIP code areas included in or overlapping with DeKalb County. RESULTS: Of 67,156 hospital discharges, 6781 (10%) were for uninsured patients. Sixty-eight percent of uninsured hospitalizations took place in publicly owned and controlled hospitals, where uninsured persons represented 45% of all discharges. Charges associated with uninsured hospitalizations amounted to $51.3 million in 1996, of which $35.3 million (69%) was claimed by public hospitals. The uninsured were overrepresented in many diagnostic groups, including diabetes, injury and poisoning, chronic liver disease, skin disease, and infectious or parasitic disease. CONCLUSIONS: In DeKalb County, Georgia, the burden of uninsured hospitalizations falls disproportionately on the public sector. Policy initiatives are needed to more equitably share the burden of uninsured hospitalization with for-profit hospitals. Because the uninsured were overrepresented in several conditions, public health initiatives aimed at preventing these conditions should also be a priority.

Adolescent↗

PubMed2001

Firearm-related fatality surveillance in Hartford County, Connecticut.

OBJECTIVES: To evaluate the feasibility of implementing a firearm fatality surveillance system in Hartford County, Connecticut. METHODS: Medical examiner, police, and crime lab data were collected for firearm deaths occurring in Hartford County during 1997. Data included characteristics of victims, suspects, and firearms. We used standard criteria for evaluating an epidemiological surveillance system. RESULTS: The surveillance system detected 52 firearm-related fatalities; 31 were suicides and 21 were homicides. Handguns accounted for 50% of the suicides and 72% of the homicides. Sensitivity was 96%, specificity was 100%, representativeness adequate, simplicity enhanced by a common case identifier, flexibility constrained by the use of existing data, timeliness varied by data source, and system acceptable to all data sources. Estimated statewide cost is $200 per case, or $52,000 per year. CONCLUSION: Firearm injury surveillance in Hartford County is feasible and expansion to statewide coverage possible. The surveillance yielded considerable data at reasonable costs.

Connecticut↗

PubMed2001

Psychiatric defenses in New York County: pleas and results.

Studies that have investigated the use of the insanity defense have revealed that the defense is rarely interposed. Few of these studies provide information on the use of psychiatric defenses other than insanity or report on how such cases were adjudicated (e.g., by trial or plea agreement). The current investigation examined all defendants who were indicted for felonies and who proffered any type of psychiatric defense in New York County (one of the five counties that comprise New York City) from 1988 to 1997. Plea, acquittal, and success rates and the manner by which cases were adjudicated are summarized. Prior research reveals that the general public believes that the defense is frequently used and often succeeds. However, in New York County, psychiatric defenses were proffered by only .16 percent of all indicted defendants.

Commitment of Persons with Psychiatric Disorders↗

PubMed2001

Ochlerotatus j. japonicus in Frederick County, Maryland: discovery, distribution, and vector competence for West Nile virus.

Ochlerotatus japonicus japonicus is reported for the 1st time south of the Mason-Dixon Line, in Frederick County, Maryland. Fifty-seven oviposition trap samples were collected throughout the county between June 30 and August 24, 2000. From 971 larvae reared from the oviposition traps, 5 species were identified: Ochlerotatus triseriatus (45%), Oc. j. japonicus (43%), Aedes albopictus (7%), Culex pipiens (4%), and Toxorynchites ritulus septentrionalis (<1%). Ochlerotatus j. japonicus was found widely distributed over the area sampled. This is the 1st record of Ae. albopictus in the county as well. Vector competence studies indicated that Oc. j. japonicus is an efficient laboratory vector of West Nile (WN) virus. Depending on the viral titer at time of feeding, the estimated transmission rates for Oc. j. japonicus for WN virus were 2-4 times higher than that for Cx. pipiens. Studies of the viral titer in mosquitoes over time showed that titers in the bodies of infected Oc. j. japonicus reached their peak (approximately 10(6.5) plaque-forming units/mosquito) between 7 and 11 days after taking an infectious blood meal, and that virus became detectable in the legs (an indicator of disseminated infection) as early as 3 days after taking an infectious blood meal.

Animals↗

PubMed1999

Profile of Tuberculosis among Foreign-born Asians Residing in Los Angeles County, California, 19851994.

PURPOSE. To present a profile of tuberculosis %lpar;TB) among foreign& shy;born Asians residing in Los Angeles County and priorities in eliminating TB. SUMMARY OF METHODS UTILIZED. The demographic and diseaserelated data were analyzed from a total of 3,364 TB cases among Asians, which were obtained over a 9year period (1985& shy;1994) by the Los Angeles County Tuberculosis Control Program. Various sources were used to obtain the denominators needed to calculate case rates because no one source had all the information. The data were analyzed using the standard SAS statistical software system. PRINCIPAL FINDINGS. Ninety& shy;eight percent of Asians with TB were foreign& shy;born, and 91 percent of the foreign& shy;born with TB were born in countries with high endemic rates of TB (Vietnam, Philippines, South Korea and the People's Republic of China). The TB case rate of foreign& shy;born Asians increased linearly with increase in percent household income below poverty level. The relative risk of TB among newly arrived Vietnamese, Filipinos, Chinese from People's Republic of China and Koreans was 112.0, 91.0, 36.8 and 28.1 times higher than that of the overall U.S., respectively (risk). CONCLUSIONS. The current screening procedures identify large numbers of TB cases among newly arrived Asians who contribute significantly to the occurrence of TB in Los Angeles County. Better strategies should be developed to effectively reduce morbidity in foreign& shy;born Asians from countries with high endemic rates of TB. They include the development of a comprehensive, ethnic& shy;specific, culturally sensitive educational intervention campaign and readily accessible outreach clinics with culturally sensitive TB preventive therapy program. KEY WORDS. Asians, tuberculosis, immigrants, Filipinos, Koreans, Chiense, Vietnamese.

Journal Article↗

PubMed2001

[Creutzfeldt-Jakob syndrome in the county of Storstrom during the period 1990-1999. Was there a significant accumulation of cases?].

INTRODUCTION: In the county of Storstrøm with about 250,000 inhabitants, ten cases of Creutzfeldt-Jacob disease (CJD) were diagnosed at the Department of Neurology, Naestved County Hospital during the decade 1990-1999. Only one case is to be expected every four years in the county. Therefore we decided to investigate if a significant accumulation had occurred. METHODS: Case records were examined to see whether the patients complied with the WHO criteria for possible, probable, or certain sporadic CJD. Poisson distribution with correction for age was used to compare the observed incidence with the expected incidence of 1 case/million/year. RESULTS: Eight cases complied with the diagnostic criteria: two certain, three probable, two possible, and one familial. The incidence of certain and probable cases was 1.9 per million per year during the period, which does not constitute a significant increase (p = 0.18). CONCLUSION: The result is consistent with the fact that all time or space clustering of CJD ever reported has proved ascribable to familial cases, and with the fact that case-control studies have never identified environmental risk factors for sporadic CJD.

Aged↗

PubMed2000

[Land use dynamic monitoring supported by remote sensing and GIS--a case study in Kenli County of Yellow River delta].

By remote sensing both visual interpretation and computer aided classification, the land use information of Kenli County of Yellow River delta in 1981, 1991 and 1995 was compared and analyzed. The unifying land use dynamic monitoring classification system was made, and the methods of land use dynamic monitoring both on land use type areas and on their spatial distribution were proposed. The changes of land use type areas of Kenli County were analyzed, and the spatial dynamics of land use types from 1981 to 1995 was analyzed under GIS support. In addition, the land use changes of outdoor monitoring plots were analyzed, and the basic patterns of land use dynamics of Kenli County were proposed.

City Planning↗