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Recruiting young adults in an urban setting: the Chicago CARDIA experience.

The recruitment goal of Chicago Coronary Artery Risk Development in Young Adults (CARDIA) was 1,100 randomly selected young adults, in equal proportions for men and women, blacks and whites, two age groups, and two education groups. CARDIA is an ongoing multicenter study of the health and lifestyles of young adults designed to trace the development of risk factors for coronary heart disease over time. Participants completed a four-and-one-half hour exam and agreed to return two years later. In Chicago CARDIA, one of the four centers in the national collaborative study, random digit dialing of computer-generated telephone lists was the initial recruitment technique. Initial recruitment efforts resulted in too few low-socioeconomic status (SES) white participants and too few blacks. In response the sampling procedure was modified to focus on census tracts with a high density of blacks, more low-SES whites, and convenient public transportation. By being flexible, Chicago CARDIA improved recruitment in certain hard-to-fill cells and achieved the overall goals: 1,109 participants, 50% black and 50% white, near equal proportions by sex and age, and close to the recommended 40%/60% spread on education. The Chicago experience should benefit others conducting research in an urban setting.

Adult↗

Cancer profiles from several high-risk Chicago communities.

A descriptive epidemiologic study of Chicago's cancer rates during the present decade reveals that the worst cancer mortality rates occur among Chicago's black population.Blacks represent a large percentage of Chicago's total population and a disproportionately high segment of the low socioeconomic group. The excess black cancer mortality rates are directly linked to the multiple problems of the socioeconomically disadvantaged, who are unable to purchase or gain access to state-of-the-art medical services. This same trend is being observed nationally; however, only a few studies have been documented.The Chicago Department of Health recognized the magnitude of this problem in 1980 and initiated this ongoing study of cancer deaths in the city in an attempt to improve these rates in this decade.

Black People↗

Acute pulmonary hemorrhage among infants--Chicago, April 1992-November 1994.

A cluster of cases of acute pulmonary hemorrhage of unknown etiology occurred among eight infants in Cleveland during January 1993-November 1994 (1). During the investigation of these cases, a similar cluster was identified in the Chicago area. From April 1992 through November 1994, seven infants with acute pulmonary hemorrhage of unknown etiology were admitted to hospitals in the Chicago area. Four of the infants were treated at the same hospital in which, during the preceding 3 years (1989-1991), one case of pulmonary hemorrhage among infants had been diagnosed. This report summarizes the preliminary results of the ongoing epidemiologic, clinical, and laboratory investigations of these cases by pediatric pulmonologists in Chicago, the Illinois Department of Public Health, the Chicago Department of Public Health, the Cook County Department of Public Health, and CDC.

Acute Disease↗

The Chicago Health Corps: strengthening communities through structured volunteer service.

The Chicago Health Corps is an AmeriCorps*USA program, established in 1994 by the Corporation for National Service in partnership with the Health Resources and Services Administration (HRSA) of the U.S. Public Health Service. The Chicago Health Corps deploys 20 full-time equivalent corps members in selected community sites that offer primary health care services to Chicago's underserved families. Chicago Health Corps members provide a combination of outreach, home visit, and case management services to address unmet health needs identified by community members, including both laypersons and professionals. Providing meaningful opportunities for participants to assist their communities with health care helps corps members develop an awareness of their fellow community members and an ethic of service.

Chicago↗

Development of a teaching program in clinical medical ethics at the University of Chicago.

The University of Chicago Pritzker School of Medicine has developed and evaluated an extensive teaching program in clinical ethics coordinated primarily through the Center for Clinical Medical Ethics. The program provides medical students with a foundation in medical ethics during the four years of medical school and augments the clinical ethics knowledge and teaching skills of the housestaff and clinical faculty at the University of Chicago. Together, medical student teaching and clinical faculty development have made clinical ethics an integral part of medical education at the University of Chicago. Through these efforts, the teaching program aims to incorporate clinical ethics considerations into medical decisions and in this way contribute to improving patient care. (A detailed overview of all clinical ethics instruction at the school is provided.)

Bioethical Issues↗

Molecular defects of factor IX Chicago-2 (Arg 145----His) and prothrombin Madrid (Arg 271----cys): arginine mutations that preclude zymogen activation.

Factor IX Chicago-2 and prothrombin Madrid were purified from patients with hemophilia B and congenital dysprothrombinemia, respectively. Each protein displays defects in zymogen activation secondary to the failure to cleave one of the sessile bonds whose cleavage is necessary for full coagulant activity. These proteins were isolated by immunoaffinity chromatography using conformation-specific antibodies directed at either factor IX or prothrombin. Factor IX Chicago-2 is cleaved abnormally by factor XIa, yielding a pattern consistent with the failure to cleave the sessile bond between Arg 145 and Ala 146. Prothrombin Madrid is cleaved abnormally by factor Xa, yielding a pattern consistent with the failure to cleave the sessile bond between Arg 271 and Thr 272. Peptide mapping was performed on reduced and alkylated factor IX, factor IX Chicago-2, prothrombin, and prothrombin Madrid, and the hydrolysates were separated by high-performance liquid chromatography. The mutant peptide in factor IX Chicago-2 was identified by automated Edman degradation as residues 143 through 188 of factor IX, and had a histidine substituted for arginine at residue 145. The mutant peptide identified in prothrombin Madrid corresponds to residues 267 through 285 of prothrombin and has the substitution of cysteine for arginine at residue 271. These mutations, each occurring at arginines, are identical to those in factor IX Chapel Hill and prothrombin Barcelona. These results suggest that a limited repertoire of point mutations, many affecting arginine residues, may be responsible for hereditary defects of the vitamin K-dependent proteins in patients with normal antigen levels.

Amino Acid Sequence↗

Neighborhood predictors of concealed firearm carrying among children and adolescents: results from the project on human development in Chicago neighborhoods.

BACKGROUND: Previous studies of concealed firearm carrying among children and adolescents have focused on individual risk factors. OBJECTIVE: To identify features of neighborhoods associated with concealed firearm carrying among a representative sample of youth from Chicago, Ill. DESIGN: Cross-sectional analysis of individual- and neighborhood-level data collected by the Project on Human Development in Chicago Neighborhoods. SETTING: Families and neighborhoods in Chicago. PARTICIPANTS: Population-based sample of 1842 multiethnic youth aged 9 to 19 years and the 218 neighborhoods in which they resided. Main Outcome Measure Whether youth had ever carried a concealed firearm. RESULTS: Lifetime estimates for concealed firearm carrying were 4.9% for males and 1.1% for females. We found that youth in safer and less disordered neighborhoods were less likely than youth in unsafe and more disordered neighborhoods to carry concealed firearms. Specifically, multilevel nonlinear regression models identified a positive association between concealed firearm carrying and (1) community members' ratings of neighborhoods as unsafe for children; (2) neighborhood social disorder; and (3) neighborhood physical disorder. Neighborhood collective efficacy was negatively associated with concealed firearm carrying. Models controlled for neighborhood economic indicators and individual and family factors associated with the carrying of concealed firearms by youth. CONCLUSIONS: Youth are less likely to carry concealed firearms in areas where there is less violence and increased safety. Interventions to improve neighborhood conditions such as increasing safety, improving collective efficacy, and reducing social and physical disorder may be efficacious in preventing firearm use and its associated injuries and death among youth.

Adolescent↗

Serogroup Y meningococcal disease in Chicago, 1991-1997.

CONTEXT: In 1994, surveillance by the Chicago Department of Public Health detected a growing trend in the proportion of invasive meningococcal infections caused by serogroup Y. OBJECTIVE: To examine the emergence of serogroup Y meningococcal disease and compare its clinical characteristics with those of other meningococcal serogroups. DESIGN: Population-based retrospective review of surveillance records; medical record review and cohort analysis of serogroup Y vs non-serogroup Y case patients. SETTING: Chicago, III. PARTICIPANTS: City residents with Neisseria meningitidis isolated from a normally sterile site from January 1, 1991, through December 31, 1997; cohort analysis included those identified through March 31, 1996. MAIN OUTCOME MEASURES: Serogroup-specific incidence, demographics, and clinical outcomes. RESULTS: We identified 214 case patients; 53 (25%) had serogroup Y. The attack rate of serogroup Y meningococcal disease increased from 0.04 cases per 100000 in 1991 to a peak of 0.82 cases per 100000 in 1995 and subsequently decreased to 0.26 cases per 100000 and 0.34 cases per 100000 in 1996 and 1997, respectively. Compared with patients infected by other serogroups, patients with serogroup Y were older (median age, 16 years vs 1 year; P = .001) and more likely to have a chronic underlying illness (prevalence ratio, 2.3; 95% confidence interval, 1.2-4.4). Outcome did not differ significantly between the 2 groups. Multilocus enzyme electrophoresis typing of isolates from 19 case patients identified 5 different types. We found no clustering among the enzyme types by age, race/ethnicity, community area, or time. CONCLUSIONS: Serogroup Y emerged as the most frequent cause of meningococcal disease in Chicago in 1995 and accounted for a substantial proportion of cases in 1996 and 1997. Current data suggest that the magnitude of serogroup Y meningococcal disease is sufficient for vaccine developers to incorporate serogroup Y into new vaccines.

Adolescent↗

Anchors of the community: community schools in Chicago.

In partnership with Chicago's public and private sectors, Chicago Public Schools (CPS) has successfully implemented a citywide education reform effort, designed to transform Chicago's neighborhood schools into vibrant centers of the community. Mayor Richard M. Daley and Arne Duncan, CEO of CPS, launched the Community Schools Initiative in January 2002. What started as an idea that was developed by a local foundation has now grown into the largest-scale community school effort in the nation, with sixty-seven schools in operation and a plan to move to one hundred community schools by 2007. This initiative currently involves seventeen private funders, ten technical assistance providers, thirty-four community-based organizations that offer on-site services to children and families, and over three hundred additional community partnerships that provide one-day events such as health fairs and violence prevention workshops.

Adolescent↗

Serum cholesterol and mortality from coronary heart disease in young, middle-aged, and older men and women from three Chicago epidemiologic studies.

The association of total serum cholesterol with mortality from coronary heart disease was examined in 1210 white men aged 42 to 60 in 1959 to 1963 and 1008 white men aged 45 to 64 in 1959 to 1969, followed up to 25 years from the Chicago Peoples Gas Company Study; in 1903 white men aged 41 to 57 in 1959, followed up to 24 years from the Chicago Western Electric Company Study; and in 17,880 white men aged 25 to 74 and 8327 white women aged 40 to 74 in 1967 to 1973, followed up to 18 years from the Chicago Heart Association Detection Project in Industry. In these studies total cholesterol level was related positively to coronary mortality in young men and in middle-aged and older men and women. Relative risks of mortality were generally higher in young and middle-aged persons compared to older persons, whereas absolute excess risks were generally greater in older than in younger persons.

Adult↗

Epidemiological characteristics of a Chicago-area Acanthamoeba keratitis outbreak.

PURPOSE: To characterize Acanthamoeba keratitis (AK) cases and analyze the geographical distribution within the Chicago-Gary-Kenosha metropolitan area, Chicago, Illinois, USA. DESIGN: Retrospective, population-based cohort study. METHODS: All AK cases diagnosed at the University of Illinois at Chicago Cornea Service from June 1, 2003, to November 30, 2005, were included in analysis. Patients with keratitis were defined as cases through confocal microscopy, histology, and/or positive cultures. Exploratory analyses were performed to evaluate whether AK cases were unequally distributed geographically. County population data were extracted from US Census 2000 data, and rates were age-standardized to Cook County. Poisson regression analysis was used to estimate the age-standardized rate ratio (RR) between AK cases and county of residence. Current cases (June 1, 2003 to November 30, 2005) were compared with historical cases (June 1, 2000 to November 30, 2002) to determine if the current rate of AK diagnosis differed from historical rates. RESULTS: Forty AK cases were diagnosed between June 1, 2003 and November 30, 2005. The average (+/-SD) age of patients with AK was 28.0 +/- 15.0 years (range, 13 to 70 years), 52.5% were men, and 95.0% wore contact lenses. Estimated RR measures demonstrated increased rates for all counties relative to Cook, and were significant for both DuPage County (RR 3.59; 95% confidence interval [95% CI] 1.44, 8.39) and Will County (RR 3.66; 95% CI 1.18 to 9.56). Current AK diagnosis rates were significantly higher than historical rates (RR 6.67; 95% CI 3.05 to 17.52). CONCLUSIONS: AK cases are increasing in frequency. The increased rates are unevenly distributed in the study area. Further research is warranted to better understand the increase and unusual geographical distribution.

Acanthamoeba Keratitis↗

Underimmunization in Chicago children who dropped out of WIC.

BACKGROUND: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) serves a large proportion of Chicago infants, but some discontinue participation before age 1 year. To determine if children who remained active at WIC immunization-linked sites after their first birthday were more likely to be immunized by ages 19 and 25 months than those who dropped out, a retrospective cohort study was conducted. METHODS: Four Chicago WIC sites that used monthly voucher pick-up were chosen. Children born from July 1, 1997 to September 30, 1997 who attended these sites were eligible (N=1142). The cohort was divided into two groups: (1) active group (46%), who had a WIC visit on or after their first birthday; and (2) inactive group (54%), who had their last WIC visit before their first birthday. Children were enrolled through home visits. RESULTS: The records for 200 children were analyzed. By age 19 months, 65 (84%) of 77 active children had received one dose of measles-mumps-rubella vaccine (MMR), compared to 82 (67%) of 123 inactive children (risk ratio [RR]=1.3; 95% confidence interval [CI], 1.1- 1.5). By age 25 months, 64 (83%) active children had received four doses of diphtheria-tetanus-pertussis vaccine (DTP), one MMR, and three doses of Haemophilus influenzae type b vaccine (Hib), compared with 64 (52%) inactive children (RR=1.6; 95% CI, 1.3-2.0). CONCLUSIONS: In this cohort, children active in WIC after their first birthday were more likely to be immunized by ages 19 and 25 months, compared with those who were no longer active. Chicago children who drop out of WIC may represent those at highest risk for underimmunization and may require special strategies to improve coverage.

Bacterial Capsules↗

High-risk nutrient intakes among low-income Mexican women in Chicago, Illinois.

OBJECTIVES: The Cross-sectional Cooking, Eating, Nutrition, and Shopping (CENAS) Survey was used to obtain data on food consumption patterns of low-income Mexicans living in Chicago, Ill. DESIGN: As part of the CENAS Survey, 186 Mexican women provided 24-hour dietary recall data. OUTCOME MEASURES: Distributions of macronutrient and micronutrient intakes were determined. The proportions of CENAS Survey participants achieving the National Heart Association and National Cancer Institute dietary guidelines were calculated. Intakes of Mexican women in Chicago were compared with intakes of Mexican women of similar socioeconomic status in Texas, Mexican-American women participating in phase 1 of the third National Health and Nutrition Examination Survey (1988-1991), and Mexican-American women participating in the Hispanic Health and Nutrition Examination Survey (1982-1984). STATISTICAL ANALYSIS: Tests were used to compare the nutrient intakes of CENAS Survey respondents with published results from other studies. RESULTS: The proportion of respondents reporting intakes less than two thirds of Recommended Dietary Allowances for nine micronutrients ranged from 11% (thiamin and riboflavin) to 82% (folacin). Respondents also reported median fat (34% of energy) and fiber (16.9 g/day) intakes that departed from recommendations to reduce the risk of heart disease and cancer. APPLICATIONS AND CONCLUSIONS: Half or more of the Mexican women interviewed in Chicago reported inadequate consumption of calcium, folate, zinc, and iron; higher than recommended intakes of fats; and lower than recommended intakes of fiber, indicating the need for nutrition education and intervention. Their nutrient consumptions differed significantly from those of Mexican-American women in the United States, suggesting possible regional or temporal variation in dietary patterns and underscoring the need for population-specific interventions.

Adult↗

Relationships of race and socioeconomic status with prevalence, severity, and symptoms of asthma in Chicago school children.

BACKGROUND: Asthma mortality rates in Chicago are among the highest in the United States, with substantially greater rates in poor and minority populations. How much of the differential can be attributed to differences in prevalence versus severity or access to care has not been determined. OBJECTIVE: To examine rates of asthma prevalence, severity, and symptoms and to explore the relationships of these rates to race and socioeconomic status in a random sample of Chicago school children. METHODS: Self-administered survey. RESULTS: Overall, rates of asthma were higher than previously reported, with 16% of students in the stratified cluster random sample of 3,670 children in the 7th and 8th grades having had asthma. Prevalence rates were significantly higher in schools with >98% African Americans than in other schools, with the highest prevalence rates seen in African American schools in low income neighborhoods. Rates were associated with the percent of African American children in the school and with median income of the school's census tract. Relationships were most consistent with indices of more severe disease. CONCLUSIONS: Asthma prevalence is higher than previously noted, with rates greatest in minority and low income populations. Differences are more striking for measures of severity than for symptoms of wheezing, but are far less than previously reported differences in mortality, suggesting that additional factors, such as differential access to continuous health care, may be affecting high death rates from asthma in Chicago.

Adolescent↗

The rate and risk of heat-related illness in hospital emergency departments during the 1995 Chicago heat disaster.

OBJECTIVES: To conduct an Emergency Department (ED)-based treated prevalence study of heat morbidity and to estimate the rate and risk of heat morbid events for all Chicago MSA EDs (N = 95; 2.7 million visits per year). METHODS: ED patient log data were compiled from 13 randomly selected hospitals located throughout the Chicago MSA during the 2 weeks of the 1995 heat disaster and from the same 2-week period in 1994 (controls). Measurements included: age, sex, date, and time of ED service, up to three ICD-9 diagnoses, and disposition. RESULTS: Heat morbidity for Chicago MSA hospital EDs was calculated at 4,224 (95% CI = 2964-5488) cases. ED heat morbidity increased significantly 5 days prior to the first heat-related death. In 1995, there was an increase in the estimated relative risk for the city = 3.85 and suburbs = 1.89 over the control year of 1994. CONCLUSIONS: Real time ED-based computer automated databanks should be constructed to improve public health response to infectious or noninfectious outbreaks. Rapid area-wide M&M tabulations can be used for advancing the effectiveness of community-based prevention programs, and anticipating hospital ED resource allocation.

Adolescent↗

Heat-related deaths during the July 1995 heat wave in Chicago.

BACKGROUND: During a record-setting heat wave in Chicago in July 1995, there were at least 700 excess deaths, most of which were classified as heat-related. We sought to determine who was at greatest risk for heat-related death. METHODS: We conducted a case-control study in Chicago to identify risk factors associated with heat-related death and death from cardiovascular causes from July 14 through July 17, 1995. Beginning on July 21, we interviewed 339 relatives, neighbors, or friends of those who died and 339 controls matched to the case subjects according to neighborhood and age. RESULTS: The risk of heat-related death was increased for people with known medical problems who were confined to bed (odds ratio as compared with those who were not confined to bed, 5.5) or who were unable to care for themselves (odds ratio, 4.1). Also at increased risk were those who did not leave home each day (odds ratio, 6.7), who lived alone (odds ratio, 2.3), or who lived on the top floor of a building (odds ratio, 4.7). Having social contacts such as group activities or friends in the area was protective. In a multivariate analysis, the strongest risk factors for heat-related death were being confined to bed (odds ratio, 8.2) and living alone (odds ratio, 2.3); the risk of death was reduced for people with working air conditioners (odds ratio, 0.3) and those with access to transportation (odds ratio, 0.3). Deaths classified as due to cardiovascular causes had risk factors similar to those for heat-related death. CONCLUSIONS: In this study of the 1995 Chicago heat wave, those at greatest risk of dying from the heat were people with medical illnesses who were socially isolated and did not have access to air conditioning. In future heat emergencies, interventions directed to such persons should reduce deaths related to the heat.

Aged↗

Carboxyhemoglobin trend in Chicago blood donors, 1970-1974.

An 18% reduction in the carboxyhemoglobin (HbCO) saturation in nonsmoking Chicago blood donors occurred between 1970 and 1974, indicating that current donors are being exposed to a lower average carbon monoxide (CO) concentration than had been experienced by 1970 donors. In contrast to the situation in 1970, when it was discovered that 74% of the nonsmokers in Chicago were being exposed to CO in excess of the amount permitted by the federal air quality standards, in 1974 only 41% of the nonsmokers were being overexposed. The observed reduction in HbCO correlates well with both the ambient CO levels recorded at the air monitoring stations and the reduction in CO emission from automobiles. If the current trend continues, Chicago should reach compliance with air quality standards for CO by 1985. The measurement of HbCO in a representative urban population is an accurate index of actual CO exposure and supplements the air pollution data provided by air monitoring stations.

Air Pollutants↗

Supply and segregation of nursing home beds in Chicago communities.

OBJECTIVE: Previous research suggests that a shortage of nursing home beds in Latino communities and segregation within facilities in urban settings may contribute to low utilization patterns that both Latino and African American elders exhibit. In order to explore structural barriers to nursing home care for African American and Latino families, this study examines the supply and ethnoracial composition of nursing homes in Chicago communities. DESIGN: With data from the 1990 US Census of Population and Illinois' 1994 Long-Term Care Facility Survey, regression was used to determine if Latino nursing home residents in Chicago follow neighborhood residential patterns in the same way that African American nursing home residents do. Next the availability of nursing home beds by ethnoracial community is examined using analysis of variance. Finally, we present correlations between the racial/ethnic composition of Chicago's facilities, community demographics and facility characteristics that have been associated with quality outcomes. RESULTS: Both African American and Latino nursing home residents follow residential housing patterns, tending to reside in facilities located in their own communities. Latino communities have the fewest beds. However, Latinos appear to be more mobile in their utilization of nursing facilities in other communities than either African Americans or whites and tend to reside in smaller homes with fewer Medicaid recipients. CONCLUSION: Health policy makers must actively address racial and ethnic differences in access to long-term care or risk reinforcing the effects of poverty and segregation. In order to ensure that Latino elders living alone are not going without needed care city leaders must promote a range of culturally sensitive alternatives to nursing home care within Latino communities while promoting geographic mobility for African Americans.

Black or African American↗