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PubMedDate not supplied

[Chronic diseases and functional limitation in older adults: a comparative study in seven cities of Latin America and the Caribbean].

OBJECTIVE: To identify the relationship between selected chronic diseases and the presence of disability in inhabitants 60 years old or older in seven cities of Latin America and the Caribbean. METHODS: In 2000 and 2001 a descriptive cross-sectional study was conducted with a sample of 10 891 persons 60 or older in seven cities: Bridgetown, Barbados; Buenos Aires, Argentina; Havana, Cuba; Mexico City, Mexico; Montevideo, Uruguay; Santiago, Chile; and São Paulo, Brazil. This research was part of the Salud, Bienestar y Envejecimiento (Health, Well-Being, and Aging) project (known as the "SABE project"). The dependent variables in the study were difficulty in performing basic activities of daily living, and difficulty in performing instrumental activities of daily living. Compiled from self-reports, the independent variables were: age, sex, educational level, living alone or with other person(s), self-assessed health, and the presence or not of hypertension, diabetes mellitus, cancer, chronic obstructive pulmonary disease, ischemic heart disease, cerebrovascular diseases, and osteoarthritis. The presence of depression and cognitive impairment in the participants was evaluated, and body mass index was also calculated. To compare the degree of influence of the different variables on disability, a standardized coefficient for each association was calculated. RESULTS: In the seven cities studied, the variables that showed a direct association with difficulty in carrying out basic activities of daily living and instrumental activities of daily living were: suffering from a higher number of noncommunicable diseases, from cerebrovascular diseases, from osteoarthritis, or from depression; being older; being female; rating one's own health as bad; and experiencing cognitive impairment. In general the strongest associations were between difficulty in carrying out instrumental activities of daily living and depression, being older, reporting one's health as bad, and the presence of cerebrovascular diseases, osteoarthritis, or cognitive impairment. CONCLUSIONS: Our research provides the first systematized description of the associations between disability and chronic noncommunicable diseases in older adults in Latin America and the Caribbean. Difficulties that older adults have in carrying out instrumental activities of daily living are the first ones to appear. Therefore, follow-up mechanisms should be established that make possible the early detection of this type of disability.

Aged↗
PubMed2006

Stress and the city: urbanization and its effects on the stress physiology in European blackbirds.

Animals colonizing cities are exposed to many novel and potentially stressful situations. There is evidence that chronic stress can cause deleterious effects. Hence, wild animals would suffer from city life unless they adjusted their stress response to the conditions in a city. Here we show that European Blackbirds born in a city have a lower stress response than their forest conspecifics. We hand-raised urban and forest-living individuals of that species under identical conditions and tested their corticosterone stress response at an age of 5, 8, and 11 months. The results suggest that the difference is genetically determined, although early developmental effects cannot be excluded. Either way, the results support the idea that urbanization creates a shift in coping styles by changing the stress physiology of animals. The reduced stress response could be ubiquitous and, presumably, necessary for all animals that thrive in ecosystems exposed to frequent anthropogenic disturbances, such as those in urban areas.

Animals↗
PubMed1976

A comparison of suicide and non-suicide deaths involving psychotropic drugs in four major U.S. cities.

By use of a standard reporting form, extensive data were gathered on 651 deaths involving psychotropic drugs and recorded with the Coroner's or Medical Examiner's Office in each of four major U.S. cities. Thirty-six per cent of these deaths were listed as "Definitely Suicide" and 44% were listed as "Non-Suicide." A comparison was made of the age, sex, race, occupational category, and type of drug involved for each of these two groups, by city. In general, the Suicide group tended to be older, from higher occupational levels, and more often female. Blacks were under-represented among the Suicides but over-represented among the Non-Suicides. Suicide deaths tended to be associated with barbiturates, analgesics, and/or sedatives, while the Non-Suicides usually died from an accidental abuse of narcotics, usually heroin. These findings tended to be similar for each city, although some inter-city differences were noted.

Adult↗
PubMed1996

HIV risk behaviors among women living in low-income, inner-city housing developments.

OBJECTIVES: This study describes the prevalence and predictors of human immunodeficiency virus (HIV) risk behaviors among women living in low-income, inner-city housing developments. METHODS: Anonymous questionnaires were administered to 671 women living in 10 inner-city, low-income housing developments in five US cities to determine their levels of HIV risk behavior and predictors of HIV risk practices. RESULTS: Approximately one third of women were at high risk for HIV because of the risk behavior of their sexual partners. HIV risk was highest among women who accurately perceived themselves to be at increased HIV risk, held strong beliefs about barriers to condom use, and reported weak behavioral intentions to reduce risk. Women at higher risk were also younger and reported higher rates of alcohol and substance use. CONCLUSIONS: HIV prevention efforts are needed for inner-city women. Interventions should focus on overcoming women's barriers to condom use, strengthening their intentions to change behaviors, and managing the risk related to their use of substances.

Adolescent↗
PubMed1999

Innovative methods for monitoring perinatal health outcomes in cities and in smaller geographic areas.

OBJECTIVES: Monitoring health in small localities such as cities or local communities is important, because rates of adverse outcomes often vary widely by geographic area. This article explores the utility of CUSUM (cumulative summation), a method developed and refined in industry, for monitoring health outcomes in cities and smaller geographic areas. METHODS: CUSUM monitoring methods were applied to rates of late or no prenatal care initiation and very low birthweight for the city of Baltimore as a whole and for a cluster of high-risk areas within the city. The performance of supplementary runs criteria was also assessed. The ability of both methods to flag significant increases or decreases in prenatal care initiation and very low birthweight rates was assessed. RESULTS: CUSUM and runs criteria detected most significant rate changes. The 2 methods performed better in regard to outcomes with higher prevalence and in larger geographic areas. CONCLUSIONS: CUSUM methods are convenient and reliable for use in the monitoring of moderately low prevalence outcomes in small geographic areas. Future research should examine their applicability to other health outcomes and further refine these methods, especially for rarer outcomes.

Baltimore↗
PubMed2003

Subjective symptoms and well-being 30 months after acute chest pain in a county hospital and a city university hospital in Sweden.

AIM: To compare various health-related aspects of quality of life during long-term follow-up after admission to hospital due to acute chest pain in a city university hospital and a county hospital. METHODS: This was a retrospective survey of all chest pain patients > or = 30 years of age at the Sahlgrenska University Hospital, Göteborg, covering an area with 706 inhabitants per km2 and at Uddevalla County Hospital, Uddevalla, covering an area with 34 inhabitants per km2 over a period of six months. After 30 months all patients alive were approached with a questionnaire in which they were asked about various aspects of health-related quality of life and use of medication. RESULTS: In all, 1,813 patients in the city hospital and 804 patients in the county hospital took part in the survey. The mortality and the overall proportion of patients requiring rehospitalization was similar in the two cohorts. Thirty months after onset of symptoms there was a difference between the two study populations. Patients in the county hospital smoked less frequently (p = 0.004). They tended to have less problems with chest pain at rest (p < 0.05) and dyspnoea at slight physical exercise (p = 0.01). Furthermore, they had less emotional symptoms (p = 0.003) and their state of health caused fewer problems when doing housekeeping (p = 0.008). Differences with regard to emotional symptoms and problems when doing housekeeping were particularly observed among women, whereas smoking habits differed only among men. CONCLUSION: When comparing patients admitted to hospital with acute chest pain in a city university hospital and a county hospital after 30 months some differences appeared. Patients in the county hospital appeared to suffer from less symptoms than patients in the city hospital. This was particularly observed among women. The mechanisms behind these observations are not clear.

Activities of Daily Living↗
PubMed1992

Genetic and environmental determinants of type II diabetes in Mexico City and San Antonio.

To study genetic and environmental determinants of non-insulin-dependent (type II) diabetes, we compared a random sample of 35- to 64-yr-old Mexican-American men and women living in several low-income barrio neighborhoods of San Antonio to similarly aged Mexicans living in a low-income colonia of Mexico City (Colonia Liberales). A total of 1138 Mexican Americans, representing 64.3% of the original sample, and 646 Mexicans, representing 69.2% of the original sample, participated in the survey. Diabetes was diagnosed using World Health Organization criteria. Genetic susceptibility to type II diabetes was inferred from the percentage of Native American genetic admixture as estimated from skin reflectance measurements. The prevalence of diabetes was 36% higher among San Antonio Mexican Americans than among Mexicans in Mexico City; this difference was highly statistically significant (age- and sex-adjusted prevalence ratio 1.36, P = 0.006). This excess was observed despite the fact that genetic susceptibility, as inferred from the admixture estimates, was similar in the two cities. On the other hand, Mexicans were somewhat leaner as measured by body mass index and skin folds. Mexican women consumed fewer total calories than Mexican-American women, but there was no difference in the caloric intake of men. Mexico City residents ate less fat (18-19% of total calories vs. 31-32% in San Antonio, P less than 0.001), more carbohydrate (64-65 vs. 49%, P less than 0.001), and performed more physical activity than San Antonio Mexican Americans. Mexicans appeared to consume more refined sugar than Mexican Americans.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

The prevalence of NIDDM and associated coronary risk factors in Mexico City.

OBJECTIVE: To determine the prevalence of diabetes and associated coronary risk factors in the Mexico City population. RESEARCH DESIGN AND METHODS: A sample of 805 adults was selected from Mexico City. The participants, 20-90 years of age and living in the city, were selected by the method of multistage cluster sampling with proportional allocation. Diabetes was diagnosed by previous history or if fasting blood glucose was > or = 7.8 mmol/l ( > or = 7.8 mmol/l ( > or = 140 mg/dl). RESULTS: The crude rate prevalence of NIDDM was 8.7%, with an age-adjusted rate of 10.6% for women and 6.0% for men. Age strongly influenced diabetes prevalence, with a chi 2 of risk tendency of 39.1 (P < 0.00005). A significant proportion (5.9%) of younger individuals (35-44 years of age) was affected by the disease. Diabetes was associated with advanced age, had a greater impact in the low-income group, and showed increased odds ratio for hypertension, dyslipidemias, and myocardial infarction in men and women and for obesity only in women. CONCLUSION: There is a high prevalence of NIDDM in Mexico City that also strikes a significant group of younger individuals. Associated coronary risk factors are also common and more prevalent in diabetic individuals. Current epidemiological data in Mexico and Mexican-Americans in the U.S. suggest that we may be on the ascending limb for diabetes and cardiovascular disease. There is a critical need for resources to be allocated to programs for primary and secondary prevention, which must be well structured and organized so that proper standards of care are followed to prevent progression of the disease.

Adult↗
PubMed1998

Beef customer satisfaction: role of cut, USDA quality grade, and city on in-home consumer ratings.

An in-home beef study evaluated consumer ratings from moderate-to-heavy beef users as influenced by cut (top loin, top sirloin, and top round steaks), USDA quality grade (Top Choice, Low Choice, High Select, and Low Select), and city (Chicago, Houston, Philadelphia, and San Francisco). Consumers (n = 2,212) evaluated each steak for overall like (OLIKE), tenderness (TEND), juiciness (JUIC), flavor desirability (DFLAV), and flavor intensity (IFLAV) using 23-point hedonic scales (23 = like extremely, extremely tender, extremely juicy, like extremely, and an extreme amount of flavor; 1 = dislike extremely, not at all tender, not at all juicy, dislike extremely, and no flavor at all). A USDA grade x cut interaction existed for OLIKE (P < .05). Consumers rated top loin steaks highest (P < .05) in OLIKE and ranked Top Choice highest of all steaks (P < .05). Within the top loin, consumers were not (P > .05) able to distinguish OLIKE differences between Low Choice and High Select or between High Select and Low Select. For OLIKE, top sirloin was rated intermediate (P < .05) of the three cuts, and consumers were not able to detect (P > .05) USDA quality grade differences. For OLIKE, top round was the lowest-rated (P < .05) cut. However, consumers preferred (OLIKE, P < .05) Top Choice to the other USDA grades offered. Grade and city interacted to affect TEND, JUIC, DFLAV, and IFLAV. The cut x city interaction was significant for all palatability attributes. Cut and city affected customer satisfaction more than USDA quality grade. Tenderness and flavor were important and equal contributors to OLIKE, r = .85 and r = .86, respectively.

Adult↗
PubMed1999

A successful effort to improve asthma care outcome in an inner-city emergency department.

The purpose of this study was to improve asthma care and outcome in an inner-city emergency department. Consecutive adult patients (19,802) presenting with the diagnosis of acute asthma exacerbation to an inner-city municipal hospital emergency department, between July 1991 and December 1993, were prospectively evaluated. These patients were compared to a historical control group of 7923 consecutive asthma emergency department patients presenting in the year prior to our intervention. An asthma treatment guideline was implemented through a continuous quality improvement process. Asthma relapse rate and admission rate were obtained before and after the guidelines were instituted. Data after interventions were also prospectively compared to asthma outcomes at all other New York City municipal hospital emergency departments. After intervention, mean monthly asthma relapse rates showed a significant reduction from 12.18% to 7.83% (p < 0.001). A similar decrease was also noted in the monthly asthma admission rate, from 4.85 to 3.90 per 100 emergency department visits (p < 0.05). Asthma treatment guidelines along with continuous quality improvement techniques can significantly improve the outcome of inner-city emergency department asthma patients.

Adolescent↗
PubMed2000

Excess coronary mortality among Australian men and women living outside the capital city statistical divisions.

OBJECTIVES: To compare rates of mortality from coronary heart disease (CHD) between populations living within and outside Australian capital city statistical divisions. DESIGN AND SETTING: Descriptive epidemiological study based on data for all residents of Australia aged 30-69 years who died between 1986 and 1996 in all States and Territories of Australia. MAIN OUTCOME MEASURES: Standardised mortality rates from all causes and coronary heart disease as coded by the Australian Bureau of Statistics, and estimated excess deaths in populations living outside capital city statistical divisions. RESULTS: Between 1986 and 1996, mortality from CHD declined by 46% in men and 51% in women, and accounted for 61% of the decline in mortality from all causes in men and 48% in women. More deaths than expected from acute myocardial infarction resulted in mortality rates from CHD up to 30% higher in men and 21% higher in women living outside the capital city statistical divisions, and accounted for an overall estimated excess of 3835 deaths from CHD in men (32% of excess deaths from all causes), and 1385 deaths from CHD in women (27% of excess deaths from all causes) over the 11-year study period. CONCLUSIONS: Although there were impressive declines in coronary mortality in all Australian States and Territories from 1986 to 1996, populations living outside capital cities continue to have higher death rates from CHD. These differences in mortality rates indicate a need for further research into factors which may influence mortality rates for CHD in rural and remote areas, and immediate measures to ensure optimal treatment of coronary risk factors and acute coronary events in such populations.

Adult↗
PubMed1999

Continuing water fluoridation in the City of Calgary, Alberta, 1997-1998.

The issue of water fluoridation has a long history in the City of Calgary (population 820,000). There were five plebiscites before 1998, with only the 1989 plebiscite receiving a majority vote in favour of fluoridation. Calgary introduced water fluoridation in 1991. In the fall of 1997, the City sponsored a review of water fluoridation as a public policy based on information provided by a group of concerned citizens. An expert panel was formed to look at the new scientific information on the subject; four of the five members agreed that there was not sufficient evidence upon which to make substantial changes to the water fluoridation policy. Nevertheless, the City's Standing Policy Committee on Operations and Environment recommended that a plebiscite on water fluoridation be held in conjunction with the 1998 municipal election. This decision was ultimately supported by City Council. Under the direction of the Calgary Regional Health Authority, the Fluoride Education Steering Committee undertook three strategies for the campaign: building partnerships, educating health professionals and educating the public. In spite of the anti-fluoridation activities, Calgarians voted 55 per cent in favour of continuing fluoridation of the municipal water supply.

Alberta↗
PubMed1999

[Prevention of alcohol-related problems. From therapy to primary health care: experience at the Udine "Healthy City"].

This paper is about a community action for the implementation of a WHO Collaborative Project on the reduction of hazardous drinking in Primary Health Care Settings called "Drink-less". The article stresses the need to shift the attention from alcoholic treatment towards the reduction of alcohol consumption. After the development of a valid screening instrument and counselling material ("Drink-less" Package), the strategies to involve General Practitioners in early intervention are studied. A Pilot Project was implemented in the City of Udine by the Municipality through its Healthy City Project Office. "Healthy City" is a WHO project that stimulates Local Administrations to implement health promotion and Community actions through an intersector work. Besides the undoubted validity of the overall "Drink-less Project", the study emphasizes the importance of GPs in secondary prevention of hazardous drinking and the necessity to re-orient programmed action in Public Health and health promotion. "Healthy City WHO Project" can be an important tool for the implementation of Community actions in Public Health.

Adolescent↗
PubMed1999

Population effects of the bombing of Oklahoma City.

BACKGROUND AND PURPOSE: The explosion at the Murrah Federal Building in Oklahoma City on April 19, 1995, affected many members of the community as well as direct victims. Our goal was to measure the exposure and effects among the general population. METHODS: We conducted surveys of the Oklahoma City metropolitan area and a control area to measure exposure and impact, primarily stress and psychological distress. RESULTS: Of the adults in the Oklahoma City MSA, 61.5 percent (58.5 percent to 64.5 percent with 95 percent confidence) reported experiencing at least one direct result of the bombing. In population terms, about 433 thousand adults (between 412 thousand and 457 thousand, with 95 percent confidence) were exposed to one or more of the consequences of the bombing. Oklahomans reported higher rates (about double) of increased alcohol use, smoking more or starting smoking. They reported more stress (about double), psychological distress (about double), post-traumatic stress-disorder components, and intrusive thoughts (double) related to the bombing than in the control area. Oklahomans also reported higher rates of seeking help for their stress or taking steps to reduce stress. The differences persisted into 1996, more than a year after the bombing. CONCLUSION: The exposure to the bombing was widespread, including more than half the adults in the metropolitan area surrounding Oklahoma City. The psychological effects were high and, while decreasing, persisted more than a year after the bombing. Primary care practitioners should screen their patients, who may normally not be considered victims, for exposure to the effects of a terrorist disaster for an extended period of time.

Adult↗
PubMed1997

HIV seroprevalence in women of childbearing age in Benin City, Nigeria.

HIV seroprevalence was still low in some parts of Nigeria from 1989 to 1991, and only limited reports were available on seroprevalence in childbearing women. In order to assess HIV seroprevalence in pregnant women in Benin City and Bendel State, two sampling methods, unlinked anonymous testing and voluntary testing, were employed. Data obtained from testing 358 sera from pregnant women attending antenatal clinics and cord blood from labour wards in Benin City were compared with data obtained from testing 833 pregnant women at four sentinel surveillance sites in Bendel State. The samples were all analysed by ELISA technique at the University Teaching Hospital, Benin City. Repeatedly reactive samples were confirmed by Western blot. The seroprevalence of HIV-1 in Benin City and in Bendel State was 0.28 percent and 0.36 percent, respectively. At this point in time, intensive health education campaigns targeted at the general population are necessary.

Adolescent↗
PubMedDate not supplied

City of Faith Medical and Research Center, Tulsa, Oklahoma.

The gold towers of the City of Faith command the viewer's attention as they soar into the Tulsa sky. Built by Evangelist Oral Roberts, the City of Faith combines a 60-story clinic and diagnostic center, a 30-story full-service hospital and a 20-story research center on one 80-acre site adjacent to the Oral Roberts University campus. Due in part to their futuristic architectural features, the campus and the City of Faith are one of the top tourist attractions in Oklahoma. Construction began in early 1978. The clinic, first opened in June 1981 with nine physicians, is now staffed with more than 80, all with faculty appointments to the Oral Roberts School of Medicine. The hospital accepted its first patient in November, 1981 and is currently certified for 294 beds (final plans call for a total of 777). The research center began operations last June and focuses on cancer, heart disease, arthritis, diabetes and geriatrics. Built entirely through contributions from followers of the Oral Roberts Ministries, the debt-free City of Faith is expected to cost more than $500 million when completed in 1988.

Central Supply, Hospital↗
PubMedDate not supplied

[Victimization by urban violence: incidence and associated factors in cities in Latin America and Spain].

This article looks at eight cities in Latin America and Spain and compares the chances of and variables associated with being a victim of various kinds of urban violence. The analysis was done using data from the ACTIVA Multicenter Study, which was coordinated by the Pan American Health Organization in 1996. The study sample consisted of 10,821 persons who were representative of residents between the ages of 18 and 70 in eight metropolitan areas of Latin America and Spain: Rio de Janeiro, Brazil; Salvador, Brazil; Santiago, Chile; Cali, Colombia; San José, Costa Rica; San Salvador, El Salvador; Caracas, Venezuela; and Madrid, Spain. The results show that the likelihood of being a victim of different types of violence varies from city to city. The variables associated with a greater likelihood of being a victim in most--though not all--of the cities are sex, age, and consumption of alcohol.

Adolescent↗
PubMedDate not supplied

[The short-term effects of air pollution on mortality. The results of the EMECAM project in the city of Vigo, 1991-94. Estudio Multicéntrico Español sobre la Relación entre la Contaminación Atmosférica y la Mortalidad].

BACKGROUND: In the Autonomous Region of Galicia, no study has been made of the impacts of air pollution on human health, despite the fact that several of its major cities have moderate levels of pollution. Therefore, we have considered the need of making this study in the city of Vigo. The main objective of this analysis is that of analyzing the short-term impact of air pollution on the daily death rate for all reasons in the city of Vigo throughout the 1991-1994 period, by using the procedure for analysis set out as part of the EMECAM Project. METHOD: The daily fluctuations in the number of deaths for all causes with the exception of the external ones are listed with the daily fluctuations of sulfur dioxide and particles using Poisson regression models. A non-parametric model is also used in order to better control the confusion variables. RESULTS: Using the Poisson regression model, no significant relationships have been found to exist between the pollutants and the death rate. In the non-parametric model, a relationship was found between the concentration of particles on the day immediately prior to the date of death and the death rate, an effect which remains unchanged on including the autoregressive terms. CONCLUSIONS: Particle-based air pollution is a health risk despite the average levels of this pollutant falling within the air quality guideline levels in the city of Vigo.

Air Pollution↗