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PubMed2001

Farming, rural lifestyle and atopy in adults from southern Germany--results from the MONICA/KORA study Augsburg.

BACKGROUND AND OBJECTIVE: The increasing urbanization and the decrease in the numbers of farms in southern Germany might be associated with an increasing prevalence of allergic diseases. We compared the prevalence of allergic diseases in farmers, and rural, suburban and urban residents in the small geographical area of Augsburg in southern Germany. METHODS: In a cross-sectional survey adults, aged 25-75 years selected from the community population register were investigated. Rural, suburban and urban residents were defined by community size and farmers by occupation. Allergic respiratory disorders were assessed by self-administered questionnaires and specific IgE antibodies to five common aeroallergens. RESULTS: In comparison to rural residents the urban population had an increased risk of allergic rhinitis (OR = 1.5; 95% CI: 1.2-1.9), atopic sensitization (OR = 1.2; 95% CI: 1.0-1.4) and sensitization against pollen (OR = 1.5; 95% CI: 1.2-1.9). There was no difference in the risk of asthma (OR = 1.0; 95% CI: 0.6-1.6) and a decreased risk in the sensitization against house dust mite (OR = 0.8; 95% CI: 0.7-1.0). The suburban residents did not differ from urban residents. Farmers had lower risks in allergic rhinitis, atopic sensitization, sensitization against pollen and mites (OR = 0.63; 0.86; 0.51 and 0.80, respectively) than rural non-farming residents, however, these differences were statistically not significant. Reported allergic rhinitis with sensitization to pollen was 2.5 times (95% CI: 1.8-3.6) more prevalent in urban than in rural residents. CONCLUSION: A farming environment and rural lifestyle might be associated with unknown protective factors impacting the prevalence of allergies.

Adult↗
PubMedDate not supplied

Effects of air pollution on children's respiratory health in three Chinese cities.

During the winter of 1988-1989, parents of 2,789 elementary-school students completed standardized questionnaires. The students were 5-14 y of age and were from three urban districts and one suburban district of three large Chinese cities. The 4-y average ambient levels of total suspended particles in the three cities differed greatly during the period 1985-1988: Lanzhou, 1,067 microg/m3; urban Wuhan, 406 microg/m3; Guangzhou, 296 microg/m3; and suburban Wuhan, 191 microg/m3. The authors constructed unconditional logistic-regression models to calculate odds ratios and 95% confidence intervals for prevalences of several respiratory symptoms and illnesses, adjusted for district, use of coal in the home, and parental smoking status. There was a positive and significant association between total suspended particle levels and the adjusted odds ratios for cough, phlegm, hospitalization for diseases, and pneumonia. This association was derived from only the 1,784 urban children and, therefore, the authors were unable to extrapolate it to the suburban children. The results also indicated that parental smoking status was associated with cough and phlegm, and use of coal in the home was associated only with cough prevalence (alpha = 0.05).

Adolescent↗
PubMedDate not supplied

Synergistic effects of air pollution and personal smoking on adult pulmonary function.

There is strong evidence that air pollution and cigarette smoking adversely affect respiratory health, but it remains uncertain whether the joint effects of air pollution and smoking are additive or synergistic. The authors investigated the hypothesized synergistic effects of air pollution and personal smoking on pulmonary function in a random sample of 3287 adults (40-69 y of age) who resided in residential, industrial, and suburban areas in Beijing. The authors used multiple linear regression and adjusted for age, sex, height, education, indoor use of coal stoves, crowding within a house, occupational exposures, and passive smoking. The annual mean total suspended particulates for the period 1981-1985 in residential, industrial, and suburban areas were 389 microg/m3, 449 microg/m3, and 261 microg/m3, respectively, and the annual mean sulfur dioxide levels were 128 microg/m3, 57 microg/m3, and 18 microg/m3, respectively. Compared with individuals in the suburban area, never smokers who resided in the industrial area had a 26-ml (standard error = 39) reduction in forced expiratory volume in 1 s and a 150-ml (standard error = 42) reduction in forced vital capacity; however, smokers in the same area suffered an additional 53-ml (standard error = 38) reduction in forced expiratory volume in 1 s and a 65-ml (standard error = 41) reduction in forced vital capacity. Similarly, never-smokers who resided in the residential area had a 72-ml (standard error = 35) reduction in forced expiratory volume in 1 s and a 274-ml (standard error = 38) reduction in forced vital capacity, and smokers in the same area suffered an additional 75-ml (standard error = 39) reduction in forced expiratory volume in 1 s and a 107-ml (standard error = 42) reduction in forced vital capacity. Long-term exposure to high levels of particulate and sulfur dioxide in Beijing was associated with significantly reduced pulmonary function in both never smokers and smokers. However, the associations were significantly greater among smokers than among never smokers, indicating a synergistic effect of air pollution and personal smoking on adult pulmonary function.

Adult↗
PubMed2001

Estimating middle-, neighborhood-, and urban-scale contributions to elemental carbon in Mexico City with a rapid response aethalometer.

A successive moving average subtraction method is developed and applied to black carbon measured over 5-min intervals at a downtown location near many small emitters and at a suburban residential site within the urban plume but distant from specific emitters. Short-duration pulses assumed to originate from nearby sources are subtracted from the concentrations at each site and are summed to estimate middle-scale (approximately 0.1-1 km) contributions. The difference of the remaining baselines at the urban and suburban monitors is interpreted as the contribution to the downtown monitor from source emissions mixed over a neighborhood scale (1-5 km). The baseline at the suburban site is interpreted as the contribution of the mixture of black carbon sources for the entire city. When applied to a 24-day period from February and March 1997 in Mexico City, the analysis showed that 65% of the 24-hr black carbon was part of the urban mixture, 23% originated in the neighborhood surrounding the monitor, and only 12% was contributed from nearby sources. These analyses indicate that a fixed-site monitor can reasonably represent exposures in its surrounding neighborhood even when many local sources, such as exhaust from diesel buses and trucks, affect the monitor.

Air Pollutants↗
PubMed2001

Canine paracoccidioidomycosis: a seroepidemiologic study.

Sera from 305 dogs were analyzed by enzyme-linked immunosorbent assay (ELISA) to determine presence of the antibody anti-gp43, which reacts to a specific antigen of Paracoccidioides brasiliensis. The dogs were divided into three groups according to their origin: urban dogs (animals with little or no contact with rural areas); suburban dogs (from the urban outskirts); and rural dogs. There was a significant difference between groups (P < 0.05). Rural dogs reacted positively in 89.5% of cases, followed by suburban (48.8%) and urban dogs (14.8%). There were no differences between male and female dogs. In an attempt to verify the feasibility of skin testing with gp43 to determine sensitization against P. brasiliensis in dogs, suburban (n = 61) and rural (n = 21) dogs were tested, showing positivity of 13.1 and 38.1%, respectively. Six dogs that had higher ELISA titers and also showed strong reactions in skin testing were killed in an attempt to isolate P. brasiliensis. The fungus was not detected by culture or histopathological analysis in these dogs, suggesting that dogs have a natural resistance or that they encounter an inoculum level that is insufficient to cause disease. These results indicate that ELISA and skin testing can be useful in the epidemiological study of paracoccidioidomycosis in dogs and that encounter with the fungus in nature is a frequent event.

Animals↗
PubMed1977

Racial differences in nitrogen content of nails among adolescents.

Ectodermal derivatives provide a readily accessible means of chemically evaluating body protein composition. Therefore, it has been postulated that the analysis of nail nitrogen content may reflect recent nutritional status. Assessment of nail nitrogen content has been previously reported in a small group of neonates and school children. The present study was undertaken to determine if standards for nail nitrogen content could be established for adolescents which could then be used in the assessment of protein nutritional status. Nail clippings were obtained from 118 economically indigent urban black youth, 10 black and 39 white subjects from wealthy suburban communities in the New York area, and 10 poor white-Indian adolescents residing within a barrio in Lima, Peru. Nail samples were analyzed for protein content using the micro Kjeldahl technique. Mean nail nitrogen content for wealthy suburban and impoverished urban black youth was 136 and 137 mg N/g of nail, respectively. Values for poor Peruvian white-Indian and affluent suburban white adolescents were 142 and 141 mg N/g of nail, respectively. The differences between ethnic groups were significant using t test analysis at a P value of less than 0.001. No differences, however, were found between either wealthy and poor of the same racial background or when the data were analyzed by gender. These results suggest that differences in nail nitrogen content are at least in part a reflection of ethnicity. These racial differences must be considered in assessing nutritional status by nail nitrogen analysis.

Adolescent↗
PubMedDate not supplied

Privileged but pressured? A study of affluent youth.

The purpose of this study was to build on preliminary findings of unusually high internalizing symptoms and substance use among suburban high school students. The sample consisted of 302 sixth- and seventh-grade students in an affluent, suburban community. Findings corroborated expectations regarding several domains of vulnerability, showing (1) high rates of clinically significant depressive symptoms among older girls, (2) significant links between various internalizing symptoms and substance use among both boys and girls, and (3) peers' approval of substance use among older boys. In exploring potential causes of distress in this suburban sample, associations were found for achievement pressures (particularly excessive perfectionistic strivings), and isolation from parents (particularly low perceived closeness to mothers). Findings of this study are discussed in terms of widespread stereotypes about affluent families, as well as implications for future research and preventive interventions for a subgroup of youth typically viewed as being at "low risk."

Achievement↗
PubMed2005

Impediments to timely diagnosis of Alzheimer's disease in African Americans.

The purpose of this study was to identify early patterns of care for Alzheimer's disease (AD) in a cohort of African-American patients and their caregivers presenting at an inner city clinic and a suburban memory assessment clinic. Caregivers (N=79) of patients diagnosed with probable AD were interviewed. Data were collected about the delay from noticing first AD signs until recognition that a problem existed and delay from problem recognition until first physician consultation. Patients and caregivers had lower educational status, and patients had been diagnosed more recently at the inner city clinic than at the suburban clinic, although MMSE scores of patients at the two clinics did not differ; median delays in caregivers' recognizing a problem and in consulting a physician were also similar across clinics. Delay was as long as 7 years between noticing symptoms and problem recognition and between problem recognition and physician consultation. Although patients attending the suburban clinic were more likely to have previously seen a physician than those attending the inner city clinic, they were no more likely to have received a prior diagnosis of AD. Lack of physician contact is likely to be widespread in families caring for African Americans with AD. Physician consultation is more characteristic of more highly educated families but may not yield a correct diagnosis for the patient. Intensive efforts are needed to connect African-American families with physicians and to achieve more timely diagnosis of AD to enable families to understand the illness, plan for patient safety, and make long-term plans.

Activities of Daily Living↗
PubMed2000

Does advanced age matter in outcomes after out-of-hospital cardiac arrest in community-dwelling adults?

OBJECTIVE: To assess whether advanced age is an independent predictor of survival to hospital discharge in community-dwelling adult patients who sustained an out-of-hospital cardiac arrest in a suburban county. METHODS: A prospective cohort study was conducted in a suburban county emergency medical services system of community-dwelling adults who had an arrest from a presumed cardiac cause and who received out-of-hospital resuscitative efforts from July 1989 to December 1993. The cohorts were defined by grouping ages by decade: 19-39, 40-49, 50-59, 60-69, 70-79, and 80 or more. The variables measured included age, gender, witnessed arrest, response intervals, location of arrest, documented bystander cardiopulmonary resuscitation, and initial rhythms. The primary outcome was survival to hospital discharge. Results are reported using analysis of variance, chi square, and adjusted odds ratios from a logistic regression model. Age group 50-59 served as the reference group for the regression model. RESULTS: Of the 2,608 total presumed cardiac arrests, the overall survival rate to hospital discharge was 7.25%. Patients in age groups 40-49 and 50-59 experienced the best rate of successful resuscitation (10%). Each subsequent decade had a steady decline in successful outcome: 8.1% for ages 60-69; 7.1% for ages 70-79; and 3.3% for age 80+. In a post-hoc analysis, further separation of the older age group revealed a successful outcome in 3.9% of patients ages 80-89 and 1% in patients 90 and older. Patients aged 80 years or more were more likely to arrest at home, were more likely to have an initial bradyasystolic rhythm, yet had a similar rate of resuscitation to hospital admission. In the regression model, age 80 or older was associated with a significantly worse survival to hospital discharge (OR = 0.4, 95% CI = 0.20 to 0.82). CONCLUSIONS: There was a twofold decrease in survival following out-of-hospital cardiac arrest to discharge in patients aged 80 or more when compared with the reference group in this suburban county setting. However, resuscitation for community-dwelling elders aged 65-89 is not futile. These data support that out-of-hospital resuscitation of elders up to age 90 years is not associated with a universal dismal outcome.

Adult↗
PubMed1991

Comparison of immunisation rates in general practice and child health clinics.

OBJECTIVE: To compare immunisation uptake rates in general practice surgeries and community child health clinics. DESIGN: Cohort study using data from a computerised child health system. SETTING: Four health districts of North East Thames Regional Health Authority. SUBJECTS: 3616 children born January to March 1990 and resident in the four districts at the end of January 1991. MAIN OUTCOME MEASURES: Immunisation uptake rates at 10-12 months of age, age at immunisation, scheduling performance at the two locations, and odds ratios of outstanding immunisations. RESULTS: 80% of children registered at general practices had completed their third dose of pertussis immunisation compared with 68% of those at health clinics. Median ages at the third dose were 24 weeks and 29 weeks at the two locations respectively. Scheduling was more effective at general practice surgeries. Unscheduled immunisations were more likely to be given after the recommended age. Overall, children resident in rural and suburban areas had greater uptakes than those in inner cities. Odds ratios for not being fully immunised among children registered at health clinics were 1.4 times those among children immunised in general practice and 3.0 times greater among children resident in inner cities than among those in rural and suburban districts. Children who moved into a district, however, were no less likely to be fully immunised than children who were born there. CONCLUSIONS: The immunisation uptake rate was better in general practices than in child health clinics in both inner city and rural and suburban areas. Uptake may be increased with additional support to enable general practitioners to undertake immunisations, especially in inner cities.

Child Health Services↗
PubMed1998

Call to needle times after acute myocardial infarction in urban and rural areas in northeast Scotland: prospective observational study.

OBJECTIVE: To determine call to needle times and consider how best to provide timely thrombolytic treatment for patients with acute myocardial infarction. DESIGN: Prospective observational study. SETTING: City, suburban, and country practices referring patients to a single district general hospital in northeast Scotland. SUBJECTS: 1046 patients with suspected acute myocardial infarction given thrombolytic treatment. MAIN OUTCOME MEASURES: Time from patients' calls for medical help until receipt of opiate or thrombolytic treatment, measured against a call to needle time of 90 minutes or less, as proposed by the British Heart Foundation. RESULTS: General practitioners were the first medical contact in 97% (528/544) of calls by country patients and 68% (340/502) of city and suburban patients. When opiate was given by general practitioners, median call to opiate time was about 30 minutes (95% within 90 minutes) in city, suburbs, and country; call to opiate delay was about 60 minutes in city and suburban patients calling "999" for an ambulance. One third of country patients received thrombolytic treatment from their general practitioners with a median call to thrombolysis time of 45 minutes (93% within 90 minutes); this compares with 150 minutes (5% within 90 minutes) when this treatment was deferred until after hospital admission. In the city and suburbs, no thrombolytic treatment was given outside hospital, and only a minority of patients received it within 90 minutes of calling; median call to thrombolysis time was 95 (46% within 90 minutes) minutes. CONCLUSIONS: The first medical contact after acute myocardial infarction is most commonly with a general practitioner. This contact provides the optimum opportunity to give thrombolytic treatment within the British Heart Foundation's guideline.

Acute Disease↗
PubMed2003

Adolescence and other risk factors for Chlamydia trachomatis genitourinary infection in women in Melbourne, Australia.

OBJECTIVE: To establish the prevalence of and risk factors for Chlamydia trachomatis infection to determine the role of universal versus targeted testing. METHODS: A prospective study of 1107 women attending two sexual and reproductive health clinics in Melbourne, Australia, was carried out. A questionnaire was used to establish risk factors. Urine samples were tested for C. trachomatis by PCR. The main outcome measures were prevalence of and risk factors for C. trachomatis infection. RESULTS: Of 1107 recruitable women, 851 (76.9%) consented and were successfully tested. C. trachomatis was detected in 18 (4.8% (95% CI 2.9 to 7.5)) of 373 women in the inner city and eight (1.7% (95% CI (0.7 to 3.3)) of 478 women in the suburban clinic. Of women under 25 years, 17 (6.2% (95% CI 3.7 to 9.8)) of 273 in the inner city in contrast with three (1.7% (95% CI 0.4 to 5.0)) of 174 in the suburban clinic were infected. In the inner city clinic, age under 25 years (OR 5.4 (95% CI 0.7 to 41.5)), vaginal discharge (OR 4.1 (95% CI 1.5 to 11.1)), and recent change of sexual partner (OR 4.6 (95% CI 1.6 to 12.9)) were associated with C. trachomatis. In contrast, in the suburban clinic, only vaginal discharge (OR 3.5 (95% CI 0.9 to 14.3)) and recent change of sexual partner (OR 3.4 (95% CI 0.8 to 15.7)) were identified as risk factors. Multivariate analysis showed that recent change of partner (OR 4.5 (95% CI 1.5 to 13.8)) was the most strongly associated independent risk factor for infection in the inner city clinic. CONCLUSION: The high prevalence of C. trachomatis indicates that universal testing should be undertaken in the inner city clinic. Young age may not be a risk factor for C. trachomatis in more affluent populations with lower prevalence rates. No risk factors were identified with sufficient sensitivity and specificity to be useful for targeted testing. Prevalence and identifiable risk factors for C. trachomatis are not transferable between populations, even in the same city.

Adolescent↗
PubMed2006

Obesity, physical activity, and the urban environment: public health research needs.

Persistent trends in overweight and obesity have resulted in a rapid research effort focused on built environment, physical activity, and overweight. Much of the focus of this research has been on the design and form of suburbs. It suggests that several features of the suburban built environment such as low densities, poor street connectivity and the lack of sidewalks are associated with decreased physical activity and an increased risk of being overweight. But compared to suburban residents, inner city populations have higher rates of obesity and inactivity despite living in neighborhoods that are dense, have excellent street connectivity and who's streets are almost universally lined with sidewalks. We suggest that the reasons for this apparent paradox are rooted in the complex interaction of land use, infrastructure and social factors affecting inner city populations. Sometimes seemingly similar features are the result of very different processes, necessitating different policy responses to meet these challenges. For example, in suburbs, lower densities can result from government decision making that leads to restrictive zoning and land use issues. In the inner city, densities may be lowered because of abandonment and disinvestment. In the suburbs, changes in land use regulations could result in a healthier built environment. In inner cities, increasing densities will depend on reversing economic trends and investment decisions that have systematically resulted in distressed housing, abandoned buildings and vacant lots. These varying issues need to be further studied in the context of the totality of urban environments, incorporating what has been learned from other disciplines, such as economics and sociology, as well as highlighting some of the more successful inner city policy interventions, which may provide examples for communities working to improve their health. Certain disparities among urban and suburban populations in obesity and overweight, physical activity and research focus have emerged that are timely to address. Comparable research on the relationship of built environment and health is needed for urban, especially inner city, neighborhoods.

Cities↗
PubMed1999

Telemedicine in the emergency department: a randomized controlled trial.

Emergency physicians and nurses were trained in telemedicine techniques in two emergency departments, one rural (low volume) and one suburban (high volume). Fifteen patient complaints were selected as appropriate for the study. Of 122 patients who met the inclusion criteria, 104 (85%) consented to participate. They were randomized to control and experimental groups. The suburban emergency physician diagnosed and treated the control patients. Experimental patients presenting to the high-volume emergency department were evaluated and treated by the telemedicine nurse in person and the rural emergency physician via the telemedicine link. Immediately before discharge all telemedicine patients were re-evaluated by the suburban emergency physician. Data collected on each patient included: diagnosis; treatment; 72 h return visits; need for additional care; and satisfaction of patient, physicians and nurses. There were no significant differences (P > 0.05) for occurrence of 72 h return visits, need for additional care or overall patient satisfaction. The average patient throughput time (from admission to discharge) was 106 min for the telemedicine group and 117 min for the control group. Telemedicine was a satisfactory technique for the chosen group of patients in the emergency department and was acceptable to the participants.

Emergency Service, Hospital↗
PubMed2001

Otorrhea in young children after tympanostomy-tube placement for persistent middle-ear effusion: prevalence, incidence, and duration.

OBJECTIVE: To characterize the occurrence of tube otorrhea after tympanostomy-tube placement (TTP) for persistent middle-ear effusion (MEE) in a group of otherwise healthy infants and young children. METHODS: In a long-term, prospective study of child development in relation to early-life otitis media, we enrolled by 2 months of age healthy infants who presented for primary care at 1 of 2 urban hospitals or 1 of 2 small-town/rural and 4 suburban private pediatric group practices. We monitored their middle-ear status closely. Children who developed persistent MEE of specified durations within the first 3 years of life became eligible for random assignment to undergo TTP either promptly or after an extended period if MEE persisted. The present report concerns 173 randomly assigned children who underwent bilateral TTP between ages 6 and 36 months and were followed for at least 6 months thereafter. Episodes of tube otorrhea were treated with oral antimicrobial drugs and, if persistent, with ototopical medication. RESULTS: Socioeconomic status, as estimated from maternal education and type of health insurance, was lowest at the urban sites and highest at the suburban sites. The tenure of the 230 tubes that were extruded during the observation period ranged from 19 days to 38.5 months (mean = 13.8 months; median = 13.5 months). During the first 18 months after TTP, the proportion of children who had tubes in place and who developed 1 or more episodes of otorrhea increased progressively, reaching 74.8% after 12 months and 83.0% after 18 months. The mean number of episodes per child was 0.79 in the first 6 months, 1.50 in the first 12 months, 2.17 in the first 18 months, and 2.82 in the first 24 months. Overall, otorrhea occurred earliest and was most prevalent among urban children and occurred latest and was least prevalent among suburban children. The mean estimated duration of episodes of tube otorrhea was 16.0 days (standard deviation = 16.9 days), the median was 10 days, and the range was 3 to 131 days. The duration was >30 days in 13.2% of the episodes. Six of the 173 children (3.5%) developed on 1 or more occasions tube otorrhea that failed to improve satisfactorily with conventional outpatient management. Five of these children were hospitalized to receive parenteral antibiotic treatment, 1 child twice and 1 three times, and 1 also underwent tube removal. The sixth child underwent tube removal as an outpatient. CONCLUSIONS: Tube otorrhea is a common and often recurrent and/or stubborn problem in young children who have undergone tube placement for persistent MEE. The extent of the problem seems to be related inversely to socioeconomic status. Tube otorrhea does not always respond satisfactorily to outpatient management and for resolution may require parenteral antimicrobial treatment and/or tube removal.

Anti-Bacterial Agents↗
PubMed2002

Reducing geographic, racial, and ethnic disparities in childhood immunization rates by using reminder/recall interventions in urban primary care practices.

CONTEXT: An overarching national health goal of Healthy People 2010 is to eliminate disparities in leading health care indicators including immunizations. Disparities in US childhood immunization rates persist, with inner-city, black, and Hispanic children having lower rates. Although practice or clinic-based interventions, such as patient reminder/recall systems, have been found to improve immunization rates in specific settings, there is little evidence that those site-based interventions can reduce disparities in immunization rates at the community level. OBJECTIVE: To assess the effect of a community-wide reminder, recall, and outreach (RRO) system for childhood immunizations on known disparities in immunization rates between inner-city versus suburban populations and among white, black, and Hispanic children within an entire county. SETTING: Monroe County, New York (birth cohort: 10 000, total population: 750 000), which includes the city of Rochester. Three geographic regions within the county were compared: the inner city of Rochester, which contains the greatest concentration of poverty (among 2-year-old children, 64% have Medicaid); the rest of the city of Rochester (38% have Medicaid); and the suburbs of the county (8% have Medicaid). INTERVENTIONS: An RRO system was implemented in 8 city practices in 1995 (covering 64% of inner-city children) and was expanded to 10 city practices by 1999 (covering 74% of inner-city children, 61% of rest-of-city children, and 9% of suburban children). The RRO intervention involved lay community-based outreach workers who were assigned to city practices to track immunization rates of all 0- to 2-year-olds, and to provide a staged intervention with increasing intensity depending on the degree to which children were behind in immunizations (tracking for all children, mail, or telephone reminders for most children, assistance with transportation or scheduling for some children, and home visits for 5% of children who were most behind in immunizations and who faced complex barriers). STUDY PARTICIPANTS: Three separate cohorts of 0- to 2-year-old children were assessed-those residing in the county in 1993, 1996, and 1999. STUDY DESIGN: Immunization rates were measured for each geographic region in Monroe County at 3 time periods: before the implementation of a systematic RRO system (1993), during early phases of implementation of the RRO system (1996), and after implementation of the RRO system in 10 city practices (1999). Immunization rates were compared for children living in the 3 geographic regions, and for white, black, and Hispanic children. Immunization rates were measured by the same methodology in each of the 3 time periods. A denominator of children was obtained by merging patient lists from the practice files of most pediatric and family medicine practices in the county (covering 85% to 89% of county children). A random sample of children (>500 from the suburbs and >1200 from the city for each sampling period) was then selected for medical chart review at practices to determine demographic characteristics (including race and ethnicity) and immunization rates. City children were oversampled to allow detection of effects by geographic region and race. Rates for the 3 geographic regions and for the entire county were determined using Stata to adjust for the clustered sampling. MAIN OUTCOME MEASURES: Immunization rates at 12 and 24 months for recommended vaccines (4 diphtheria-tetanus-pertussis:3 polio:1 measles-mumps-rubella: > or =1 Haemophilus influenzae type b on or after 12 months of age). RESULTS: DISPARITIES BY GEOGRAPHIC REGION: Baseline immunization rates (1993) for 24-month-olds were as follows: inner city (55%), rest of city (64%), and suburbs (73%), with an 18% difference in rates between the inner city and suburbs. By 1996, immunization rates rose faster in the inner city (+21% points) than in the suburbs (+14% points) so that the difference in rates between the inner city and suburbs had narrowed to 11%. In 1999, rates were similar across geographic regions: inner city (84%), rest of city (81%), and suburbs (88%), with a 4% difference between the inner city and suburbs. DISPARITIES BY RACE AND ETHNICITY: Immunization rates were available in 1996 and 1999 by race and ethnicity. Twenty-four-month immunization rates in 1996 showed disparities: white (89%), black (76%), and Hispanic (74%), with a 13% difference between rates for white and black children and a 15% difference between white and Hispanic children. In 1999, rates were similar across the groups: white (88%), black (81%), and Hispanic (87%), with a 7% difference between rates for white and black children, and a 1% difference between white and Hispanic children. CONCLUSIONS: A community-wide intervention of patient RRO raised childhood immunization rates in the inner city of Rochester and was associated with marked reductions in disparities in immunization rates between inner-city and suburban children and among racial and ethnic minority populations. By targeting a relatively manageable number of primary care practices that serve city children and using an effective strategy to increase immunization rates in each practice, it is possible to eliminate disparities in immunizations for vulnerable children.

Black or African American↗
PubMedDate not supplied

Relationships between stream size, suspended particles, and filter-feeding macroinvertebrates in a great plains drainage network.

Suspended fine particles (seston) are an important component of energy and nutrient cycling in streams, but they can also be pollutants. We examined seston dynamics and filter-feeding macroinvertebrate communities in sites representing headwaters to large rivers in the Kansas River drainage, northeastern KS. Seston samples were collected at least seasonally during low to moderate flows for one year beginning in the summer of 1999, and quality was assessed by determining organic content and C to N ratio. A rapid bioassessment approach was used to examine filter-feeders. Relationships between stream size and seston concentrations were markedly influenced by anthropogenic activities. There was no relationship between total seston concentration and stream size across all sites (r = 0.14, p > 0.05), but a significant, positive relationship was evident when impounded and suburban sites were excluded (r = 0.73, p < 0.01); this same trend was evident for organic and inorganic components. Seasonal patterns of C to N ratio were evident, with generally lower values during winter and highest values in summer. However, seasonal patterns were dampened in suburban sites and virtually absent below impoundments. Filter-feeder richness was correlated with average organic seston concentrations (r = 0.8, p < 0.01), but this relationship was also obscured by impoundments and suburban development. In particular, impoundments had a dramatic, negative effect on richness. Abundance of most hydropsychid caddisfly taxa was positively correlated with organic seston concentration. Results indicate there are significant patterns regarding seston, filter-feeders, and stream size in this Great Plains river system, but patterns are strongly influenced by human activities. These relationships are relevant to management issues regarding suspended particles and the potential development of bioassessment techniques.

Animals↗
PubMed1988

[Recent patterns of Enterobius vermicularis infection in some school children, Korea]

To investigate the infection status of Enterobius vermicularis the author tried surveys by scotch-tape anal swap on school-children and household environmental factors considered to have influences on the infection were analyzed by an inquiry method with questionnaire. The survey was carried out in October 1986 and 1988 in urban and suburban areas and the results could summarized as follow: The egg positive rate in anal swab was 16.0 per cent (male 14.5 per cent, female 17.6 per cent) out of 2,156 school-children and higher in female group. The egg positive rate in suburban school-children (17.5 per cent out of 1,305 children of two primary school)was a little higher than that of urban school-children(13.6 per cent out of 851 children of one primary schools). The questionnaire analysis on environmental factors showed some significant relations between the egg positive rate and such factors as the number of brothers and sisters, householder's occupation, and avalibility of childroom or bathroom. The result indicate that, although enterobiasis in school-children has shown decreasing tendency in Korea, it is still considerably high in some urban and suburban areas.

Journal Article↗