Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Cities”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 883 records · Page 49Linked to original sources
PubMedDate not supplied

Pharmacy syringe sale practices during the first year of expanded syringe availability in New York City (2001-2002).

OBJECTIVE: [corrected] To assess the role that customer characteristics, including race, age, and gender and pharmacy characteristics, including type and location, play on actual syringe-selling practice by pharmacies registered to sell syringes under the New York State Expanded Syringe Access Demonstration Program (ESAP). DESIGN: 89 syringe-purchasing visits were made in randomly selected ESAP-registered pharmacies, stratified by chain and independent status. SETTING: Visits were conducted in 14 New York City neighborhoods. Three neighborhoods (two with high need for human immunodeficiency virus [HIV] prevention services and one with low need) were selected in each of New York City's five boroughs (except Staten Island, where only two neighborhoods were visited, as only one exists with high need for HIV prevention services). PARTICIPANTS: Visits were conducted by syringe-purchasing testers with different demographic characteristics, including age (< or = 25 and > 25), race/ethnicity (white, black, Latino), and gender (men, women). RESULTS: Testers were able to purchase syringes in 69% of visits. Tester race, age, and gender did not significantly affect sales of syringe-selling practices. Location of pharmacy was statistically significant, with only 33% of the registered pharmacies selling syringes in the Bronx, but 67% to 89% selling in other four boroughs. CONCLUSIONS: ESAP has been widely implemented among registered pharmacies in four of New York City's five boroughs. The program's effectiveness could be enhanced through pharmacy-based efforts focused broadly on the ESAP goal of preventing the transmission of HIV and other blood-borne infections among injection drug users.

HIV Infections↗
PubMedDate not supplied

Potential health risks of recreational fishing in new york city.

BACKGROUND: Fish in the rivers around New York City are contaminated with polychlorinated biphenyls (PCBs) that have been increasingly associated with neurodevelopmental abnormalities. The New York State Department of Health has recommended that the consumption of fish from the rivers around New York City not exceed one meal per month and that no pregnant women or children less than 15 years of age eat any fish from these waters. DESIGN/METHODS: We systematically surveyed anglers at Manhattan fishing sites over a 3-month period to estimate the exposure of anglers, children, and women of childbearing age to PCB-laden fish. RESULTS: One hundred sixty anglers completed the interview. Eighty percent of these anglers were unaware of any advisory to limit fish consumption in order to limit PCB exposure. Most anglers ate the fish they caught. Of the anglers who said that they took the fish home (72.5% of the total sample), 17.7% reported that children regularly eat the fish, and 15.4% reported that an individual had been pregnant while regularly eating the fish. CONCLUSION: Despite state advisories, New York City anglers report high rates of fish consumption by themselves, pregnant women, and children. Although determining the consequences of such consumption will require further study, this represents a worrisome environmental exposure.

Adult↗
PubMedDate not supplied

Out of the frying pan: New York City hospitals in an age of deregulation.

For several decades New York City hospitals had been distinguished by their tightly regulated environment, chronically weak finances, high occupancy rates, teaching intensity, dependency on public payers, low managed care penetration, and minimal merger activity. Then in the late 1990s a rapid convergence of forces--the Balanced Budget Act, managed care growth, state deregulation of commercial rates, escalating costs, and plunging hospital occupancy rates--threw the city's hospital industry into turmoil. In this paper we describe this period of turbulent change that has left most of the city's safety-net and small community hospitals near bankruptcy.

Bankruptcy↗
PubMed1994

Demographic influences on asthma hospital admission rates in New York City.

Surveillance reports describe an increase in asthma prevalence, and cite New York City as an area of excessive asthma mortality. To assess trends and the influence of geography, race, and ethnicity on hospital admission rates for asthma between 1989 and 1991, data of all admissions for asthma to New York City hospitals were reviewed. The average citywide annual hospital admission rate was 681 per 100,000 population, and the racial and ethnic distribution was 1,003 per 100,000 Hispanic patients, 810 per 100,000 for blacks, and 242 per 100,000 for whites (p < 0.0001). Bronx and Manhattan had the highest admissions rates, and contained a few zip codes with very high rates. In these zip codes, admission rates were consistently highest among Hispanics, followed by blacks and whites. New York City asthma admission rates increased 12.7 percent during the study. Very high admission rates among Hispanic patients and high rates in blacks, in specific geographic areas, are responsible for this trend. Targeted education and treatment programs could reduce hospital admissions and mortality in small geographic areas with high asthma morbidity.

Adult↗
PubMed2006

National Heart, Lung, and Blood Institute guidelines and asthma management practices among inner-city pediatric primary care providers.

BACKGROUND AND OBJECTIVE: Most surveys of pediatric outpatient asthma management obtain information from parents and caregivers. Studies based on surveys of primary health-care providers are sparse. Suboptimal outpatient management may play a role in the high hospitalization rates among inner-city asthmatic children. Asthma management practices were compared between hospital-based and community-based primary care providers (PCPs). Adherence to National Heart, Lung, and Blood Institute (NHLBI) guidelines was evaluated, along with practices not clearly defined in the guidelines such as use of oral cough medicines and albuterol suspension. DESIGN/METHODS: An 8-point questionnaire was administered to 48 community-based and 32 hospital-based PCPs practicing in inner-city neighborhoods. The questionnaire addressed three "positive" practices (classification of asthma severity, use of asthma action plan, and use of a spacer) and three "negative" practices (use of cough syrup, use of albuterol suspension, and preferential use of leukotriene modifiers instead of inhaled corticosteroids as the first line of preventive therapy). Response options were as follows: never, rarely, sometimes, and always, scored from 0 to 3. The two physician groups were compared on score means for the positive and negative practices using a t test with statistical significance set at p < 0.05. RESULTS: Overall, the rate of adherence to the positive practices was high, with no significant difference between the two groups. Negative practices, while present in both the groups, were reported significantly more often by the community-based group, particularly the use of cough suppressants and albuterol suspension. CONCLUSIONS: Greater emphasis is needed to increase the awareness among PCPs of the NHLBI guideline recommendations, as suboptimal outpatient asthma management may contribute to the disproportionately higher hospitalization rates among inner-city asthmatic children. Clarification on the use of potentially harmful medications and those of doubtful value need to be incorporated in the guidelines. The extent to which these negative practices contribute to the elevated pediatric hospitalization rates warrants further investigation.

Adult↗
PubMed1995

The role of social factors and individual characteristics in promoting alcohol use among inner-city minority youths.

OBJECTIVE: During seventh grade, many adolescents initiate alcohol use yet school drop-out rates are still low. Therefore, this is an ideal period of adolescence to examine predictors of alcohol use. The purpose of this study was to elucidate the etiology of alcohol use among an understudied population: disadvantaged inner-city minority youths. Specifically, we attempted to develop as complete a model of predictors of alcohol use as possible from three domains: background characteristics, social influences to drink and individual characteristics. METHOD: To explore alcohol use of youths who are living in poverty and are members of minority groups, New York City public schools from districts known to have predominantly minority student bodies with low socioeconomic status (SES) were identified. Self-reports of alcohol use and data concerning background, social environmental and individual characteristics hypothesized to promote drinking alcohol were collected from black and Hispanic seventh graders (N = 757). RESULTS: Logistic regression analyses indicated that social influences from friends, peers and parents predicted alcohol use. Most interestingly, the drinking status of the person the respondent most admired was related to drunkenness and future alcohol use. Individual characteristics, such as health-related knowledge concerning alcohol use and antidrinking attitudes, lowered the odds of drinking. CONCLUSIONS: These findings imply that effective prevention programs targeting inner-city minority youths should provide students with an awareness of the social influences to drink, provide them with positive role models and correct misperceptions about the prevalence of drinking among friends and peers.

Adolescent↗
PubMed1998

Depressive symptoms in inner-city mothers of young children: who is at risk?

OBJECTIVE: To identify factors associated with depressive symptoms in inner-city mothers of young children. DESIGN: A cross-sectional survey was administered to a convenience sample of English-speaking mothers attending a well-child visit for a child aged 6 months to 3 years in a hospital-based, inner-city, general pediatric clinic. The maternal interview collected data on sociodemographic characteristics, and mothers' health and financial status. Mothers completed the Psychiatric Symptom Index (PSI), a 29-item checklist shown to have very good validity and reliability in a multicultural population. A total score of >/=20 represents high levels of symptoms; scores >/=30 strongly suggest major depression. RESULTS: Two hundred seventy-nine mothers completed the PSI. Mothers ranged in age from 14 to 48 years (mean, 27 years). Seventy-one percent were unmarried; 57% received public assistance. Forty-two percent of mothers were Hispanic, 40% black, 9% white, and 10% mixed or other races. Forty-eight percent were foreign-born. Twenty-four percent reported having a medical condition; 6% had activity limitation because of illness. The mean PSI score was 19; 18% of mothers had a PSI score >/=30 and 39% scored >/=20. PSI scores did not vary by age, race, birthplace, educational level, employment, marital status, or family composition. PSI scores were higher for mothers receiving public assistance (21 vs 17), with self-reports of poor or fair financial status (22 vs 15) and poor health status (52 vs 17). Mothers with activity limitations because of illness had significantly higher PSI scores (34 vs 18). Multiple regression analyses confirmed the independent relationships of these maternal characteristics to high PSI scores. CONCLUSIONS: Depressive symptoms in inner-city mothers of young children are common. In this population of women with many risk factors, traditional sociodemographic risk factors did not successfully identify those who are depressed. However, mothers' self-reports of poor financial status, health status, or activity limitation because of illness were associated with higher levels of depressive symptoms. These findings may assist clinicians in distinguishing which mothers are likely to be depressed when almost all are at high risk.

Adolescent↗
PubMed1999

How does home management of asthma exacerbations by parents of inner-city children differ from NHLBI guideline recommendations? National Heart, Lung, and Blood Institute.

OBJECTIVES: 1) To describe the asthma morbidity, primary care practices, and asthma home management of inner-city children with asthma; 2) to determine the responses of parental caretakers to asthma exacerbations in their child; and 3) to compare these responses to the recommendations of the National Heart, Lung, and Blood Institute (NHLBI) asthma guidelines for home management of acute exacerbations of asthma. DESIGN AND METHODS: A 64-item telephone survey was administered between July 1996 and June 1997 to 220 parental caretakers of 2- to 12-year-old children who had been hospitalized with asthma at an inner-city medical center from January, 1995 to February, 1996. Sociodemographics, primary care practices, asthma morbidity, and asthma home management were assessed. Parents were asked what they would do if their child "began wheezing and breathing faster than usual." RESULTS: Morbidity measures indicated that there were an average of 2.5 +/- 4.5 emergency department visits for asthma in the last 6 months, 1.6 +/- 2.2 hospitalizations for asthma in the last 12 months, and 18.1 +/- 17.9 asthma-related school absences in the previous school year. Most, but not all, of the families had primary care providers and most had phone access to them. Half of the families (51%) reported having been given a written asthma action plan. Only 30% of families with children age 5 years and older had peak flow meters. In contrast, almost all families (97%) had equipment for inhalation of beta-agonists. Only 39% of the 181 children with persistent symptoms were receiving daily antiinflammatory agents as recommended in the guidelines of the NHLBI. In response to the scenario of an acute exacerbation of asthma, no one mentioned that they would refer to a written plan, only 1 caretaker would measure peak flow and 36% would give beta-agonists. Two percent would give oral steroids initially, and 1 additional person would do so if wheezing continued 40 minutes later. Only 4% responded that they would contact their clinician. Reports of actual practice differed from the scenario responses in that more people began beta-agonists and oral steroids in response to an exacerbation in the past 6 months than said they would in response to the scenario. CONCLUSION: In this population of previously hospitalized inner-city children with asthma, the NHLBI guidelines for the home management of asthma exacerbations are not being followed. Interventions are needed to affect both clinician and caretaker practices.

Adolescent↗
PubMed2005

Assessment of the risk of introduction of Anoplophora glabripennis (Coleoptera: Cerambycidae) in municipal solid waste from the quarantine area of New York City to landfills outside of the quarantine area: a pathway analysis of the risk of spread and establishment.

The risk associated with spread of Asian longhorned beetle, Anoplophora glabripennis (Motschulsky), from infested areas in New York City to the wide array of landfills across the eastern United States contracted by the city since 1997 was unknown, but of great concern. Landfills, some as far as South Carolina, Virginia, and Ohio, occupied forest types and climates at high risk of Asian longhorned beetle establishment. The city proposed a separate waste wood collection known as the "311 System;" this was estimated to cost federal and state agencies $6.1 to $9.1 million per year, including the cost of processing and disposal of the wood. Pathway analysis was used to quantify the probability that Asian longhorned beetle present in wood waste collected at curbside would survive transport, compaction, and burial to form a mated pair. The study found that in seven alternate management scenarios, risks with most pathways are very low, especially given existing mitigations. Mitigations included chemical control, removal of infested trees, and burial of wood waste in managed landfills that involved multiple-layering, compaction, and capping of dumped waste with a 15-cm soil cover at the end of each day. Although the risk of business-as-usual collection and disposal practices was virtually nil, any changes of policy or practice such as illegal dumping or disposal at a single landfill increased the risk many thousandfold. By rigorously maintaining and monitoring existing mitigations, it was estimated that taxpayers would save $75 to $122 million dollars over the next decade.

Animals↗
PubMed2006

The impact of New York City's 1975 fiscal crisis on the tuberculosis, HIV, and homicide syndemic.

In 1975, New York City experienced a fiscal crisis rooted in long-term political and economic changes in the city. Budget and policy decisions designed to alleviate this fiscal crisis contributed to the subsequent epidemics of tuberculosis, human immunodeficiency virus (HIV) infection, and homicide in New York City. Because these conditions share underlying social determinants, we consider them a syndemic, i.e., all 3 combined to create an excess disease burden on the population. Cuts in services; the dismantling of health, public safety, and social service infrastructures; and the deterioration of living conditions for vulnerable populations contributed to the amplification of these health conditions over 2 decades. We estimate that the costs incurred in controlling these epidemics exceeded 50 billion US dollars (in 2004 dollars); in contrast, the overall budgetary saving during the fiscal crisis was 10 billion US dollars. This history has implications for public health professionals who must respond to current perceptions of local fiscal crises.

Disease Outbreaks↗
PubMed1992

Variations in asthma hospitalizations and deaths in New York City.

BACKGROUND: Recent reports have identified New York City as having asthma mortality rates that are substantially higher than expected based on US rates. This study investigates the problems of asthma morbidity and mortality in New York City. METHODS: Data on asthma hospitalizations (1982 to 1986) and deaths (1982 to 1987) among persons aged 0 to 34 years were studied. Descriptive and multivariate techniques were used to examine differences in rates among subgroups and across geographic areas. RESULTS: The average annual hospitalization rate was 39.2 per 10,000; the mortality rate was 1.2 per 100,000. Hospitalization and death rates among Blacks and Hispanics were 3 to 5.5 times those of Whites. Large geographic variations in hospitalizations and mortality occurred. Asthma hospitalization and mortality rates were highly correlated (r = .67), with the highest rates concentrated in the city's poorest neighborhoods. Household income, percentage of population Black, and percentage of population Hispanic were significant predictors of area hospitalization rates (adjusted R2 = .75). CONCLUSION: These findings provide a basis for focusing investigations of the causes of variations in asthma outcomes and targeting interventions to reduce the disproportionate morbidity and mortality borne by poor and minority populations.

Abstracting and Indexing↗
PubMed1993

New York City's tuberculosis control efforts: the historical limitations of the "war on consumption".

New York City began America's first campaign to control tuberculosis in 1893, and the disease declined until the 1970s. Throughout the 20th century, New York relied on three control strategies: screening, supervised therapy, and detention of noncompliant persons. Officials consistently identified the persistent foci of tuberculosis to be minorities and the poor, and they concentrated efforts among these populations. Recently, however, in the setting of rising human immunodeficiency virus infection and homelessness, tuberculosis--including multidrug-resistant strains--has returned to New York with a vengeance. Tuberculosis control in the city has been limited by two problems that hamper many public health programs: (1) antituberculosis measures, while appropriately targeting the poor, have been inconsistently funded and poorly coordinated; and (2) efforts have emphasized detection and treatment of individual cases rather than improvement of underlying social conditions. Renewed efforts by New York and other cities must address these limitations.

AIDS-Related Opportunistic Infections↗
PubMed1998

Breast-feeding initiation in New York City, 1979 to 1996.

OBJECTIVES: The purpose of this study was to explore changes in breast-feeding initiation from 1979 to 1996 among infants born in New York City hospitals. METHODS: All New York City hospitals were surveyed every 2 years. Hospital staff reported feeding method at newborn discharge. RESULTS: New York City breast-feeding initiation rates increased consistently from 1979 to 1996 (from 29% to 58%, P < .0001), including 1984 to 1990, when rates decreased nationally. CONCLUSIONS: A 1984 New York State regulation requiring each hospital to designate a lactation coordinator may have been associated with the continuing increases in breast-feeding initiation.

Breast Feeding↗
PubMed1999

Mortality among homeless shelter residents in New York City.

OBJECTIVES: This study examined the rates and predictors of mortality among sheltered homeless men and women in New York City. METHODS: Identifying data on a representative sample of shelter residents surveyed in 1987 were matched against national mortality records for 1987 through 1994. Standardized mortality ratios were computed to compare death rates among homeless people with those of the general US and New York City populations. Logistic regression analysis was used to examine predictors of mortality within the homeless sample. RESULTS: Age-adjusted death rates of homeless men and women were 4 times those of the general US population and 2 to 3 times those of the general population of New York City. Among homeless men, prior use of injectable drugs, incarceration, and chronic homelessness increased the likelihood of death. CONCLUSIONS: For homeless shelter users, chronic homelessness itself compounds the high risk of death associated with disease/disability and intravenous drug use. Interventions must address not only the health conditions of the homeless but also the societal conditions that perpetuate homelessness.

Adult↗
PubMed2000

HIV incidence among injection drug users in New York City, 1992-1997: evidence for a declining epidemic.

OBJECTIVES: We assessed recent (1992-1997) HIV incidence in the large HIV epidemic among injection drug users in New York City. METHODS: Data were compiled from 10 separate studies (N = 4979), including 6 cohort studies, 2 "repeat service user" studies, and 2 analyses of voluntary HIV testing and counseling services within drug treatment programs. RESULTS: In the 10 studies, 52 seroconversions were found in 6344 person-years at risk. The observed incidence rates among the 10 studies were all within a narrow range, from 0 per 100 person-years at risk to 2.96 per 100 person-years at risk. In 9 of the 10 studies, the observed incidence rate was less than 2 per 100 person-years at risk. The weighted average incidence rate was 0.7 per 100 person-years at risk. CONCLUSIONS: The recent incidence rate in New York City is quite low for a high-seroprevalence population of injection drug users. The very large HIV epidemic among injection drug users in New York City appears to have entered a "declining phase," characterized by low incidence and declining prevalence. The data suggest that very large high-seroprevalence HIV epidemics may be "reversed."

Adult↗
PubMed2004

Childhood obesity in New York City elementary school students.

OBJECTIVES: We estimated overweight and obesity in New York City elementary school children. METHODS: A multistage cluster sample of New York City public elementary school children was selected. Nurses measured children's height and weight and used a standard protocol to determine body mass index (BMI). Demographic information was obtained from official school rosters. Overweight and obese were defined as BMI-for-age at or above the 85th and 95th percentiles, respectively. RESULTS: Of 3069 sampled students, 2681 (87%) were measured. The prevalence of overweight was 43% (95% confidence interval [CI] = 39%, 47%), more than half of whom were obese. Overall prevalence of obesity was 24% (95% CI = 21%, 27%), with at least 20% obesity in each grade, including kindergarten. Hispanic children had significantly higher levels (31%; 95% CI = 29%, 34%) than Black (23%; 95% CI = 18%, 28%) or White children (16%; 95% CI = 12%, 20%). Asian children had the lowest level of obesity among all racial/ethnic groups (14.4%, 95% CI = 10.9, 18.7). CONCLUSIONS: Obesity among public elementary school children in New York City is an important public health issue. Particularly high levels among Hispanic and Black children mirror national trends and are insufficiently understood.

Black or African American↗
PubMed2002

The health care workforce in Los Angeles County and New York City: a comparison and analysis.

New York City and Los Angeles County have the largest health systems in the United States, but they differ significantly in structure. This study compares and analyzes the structural and workforce differences between the two. The health system in New York City is centered around its large hospitals, and as a result New York employs many more health workers than Los Angeles County, where the health system is centered around physician groups. Health care is a significant contributor to the economy of both areas, but a larger contributor to the economy in New York City.

Adolescent↗
PubMed1990

Epidemic in the war zone: AIDS and community survival in New York City.

The characteristics and consequences of the AIDS/HIV epidemic in New York City are examined, with special attention to its impact on inner-city communities. The high numbers of AIDS cases are the source of increasing stress on public and community treatment and family and neighborhood networks of support. As the epidemic deepens (8 to 10 thousand new cases per year are expected by 1992) these resources, already weakened by years of underfunding, are becoming overwhelmed and are in danger of collapse. The high rates of HIV infection in these communities (5 to 20 percent of adults aged 25 to 45) and their linkage to widespread drug use prefigure the development of endemic levels in several population subgroups, with substantial risk of heterosexual spread. Simultaneously, there is a steady diffusion of infection to adjacent urban areas and, via migration patterns, to localities quite distant from New York City (e.g., Puerto Rico). Some hope can be found in the advent of more effective methods of early intervention for presymptomatic HIV infection. These offer an opportunity for combining clinical care with public health strategies that may restrict the spread of HIV while providing humane care for large numbers of people with AIDS and support for their families.

Acquired Immunodeficiency Syndrome↗