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PubMed1989

Epidemiology of long-term functional psychosis in three different areas in Stockholm County.

This study is the first in a series investigating different aspects of living conditions and care utilization in a total population with long-term functional psychoses (LFP). The study cohort (n = 302) was defined as people that: were aged 18-64 years, were affected by a nonorganic psychosis continuously during at least 6 months, showed psychotic features or residual symptoms during 1984, and had their home address in the study area during 1984. The study area consists of one rural and one suburban municipality, and one urban parish (57,035 inhabitants aged 18-64 years). The LFP concept used shows a high interrater reliability (kappa = 0.93). The one-year prevalence in the rural, suburban and urban areas was 3.4, 5.6 and 6.6 per 1000 respectively, thus producing a gradient from the rural to the urban areas. The prevalence of schizophrenia (DSM-III) was 2.6, 3.8 and 5.0 per 1000 respectively. The other diagnoses covered by the LFP concept (paranoia, major affective disorder with psychotic features, and psychotic disorder not elsewhere classified) showed the same gradient, with the exception of paranoia, which showed a lower rate in the urban area. The prevalence of schizophrenia was higher among males, while for paranoia the prevalence was higher among females.

Adolescent↗
PubMed2006

Reliability and validity of observer ratings of neighborhoods.

OBJECTIVES: The objectives were to examine the validity and reliability of a five-item neighborhood measurement scale. METHODS: Respondents were enrolled from two catchment areas: a poor inner city and a heterogeneous suburban area. Items combine for a total score of 5 (best) to 20 (worst). The authors compared scales across catchment areas and respondent ratings and assessed interviewer effects and retest reliability. RESULTS: Suburban neighborhood scale scores were 3 points lower (higher socioeconomic status, SES) than the inner-city scores. There was a strong relationship between scores and participants' neighborhood ratings. The retest correlation was substantial (.81), but only two of five items achieved kappas above .75. In regression models, interviewer experience and residence and individual interviewers contributed to different ratings, although there was still a marked difference between catchment areas. DISCUSSION: Observer ratings of neighborhoods show promise as a measure of neighborhood SES, despite problems with interviewer effects. Future work should improve objective criteria for ratings.

Catchment Area, Health↗
PubMed2005

Rural residence is not a risk factor for frequent mental distress: a behavioral risk factor surveillance survey.

BACKGROUND: Residents of rural areas may be at increased risk of mental health problems. If so, public health programs aimed at preventing poor mental health may have to be customized for delivery to rural areas. The purpose of this study was to examine the relationship between residing in a rural area and frequent mental distress, which is one indicator of poor mental health. METHODS: The Behavioral Risk Factor Surveillance System (BRFSS) survey for the state of Texas was the source of information about obesity, demographic characteristics, and frequent mental distress (FMD). FMD was defined as poor self-rated mental health during at least half of the days in the last month. Adjusted odds for FMD were computed for rural and suburban respondents relative to urban respondents. RESULTS: FMD was found to be independently associated with lower education, being younger, being non-Hispanic, being unmarried, and being female. FMD also was associated with being obese or underweight and suburban residence (relative to metro-central city). FMD was not more common among rural respondents than in the metro-central city. CONCLUSION: Rural respondents were not at greater risk of frequent mental distress than urban respondents in this sample. Programs seeking to improve community mental health should target persons with less education and extremes in body weight, along with women and single persons, regardless of whether they live in rural or urban areas.

Adolescent↗
PubMed2006

Racial/ethnic differences in the protective effects of self-management skills on adolescent substance use.

A variety of cognitive and behavioral self-management skills have been posited as protective in terms of adolescent substance use. This study examined whether these skills measured in the 7th grade served a protective function in 9th grade substance use across ethnically diverse samples of adolescents. Participants consisted of Black (n = 461) and Hispanic (n = 320) urban youth and White suburban youth (n = 757). Structural equation modeling indicated that a second order Self-Management Skills latent factor consisting of first order latent factors of Decision-Making, Self-Regulation, and Self-Reinforcement skills was protective for adolescent substance use across racial/ethnic subgroups. However, Self-Management Skills were more strongly protective for suburban White youth and less protective for urban minority youth. These findings are consistent with previous research showing that predictive power of risk and protective factors derived from psychosocial theories varies widely across racial/ethnic subgroups of youth and is weaker among racial/ethnic minority youth compared to White youth. An important next step is to broaden the focus of etiology research from individual-level determinants to studying adolescent substance use behavior in the context of the cultural background and primary social settings of young people, such as family, school, and community environments.

Adolescent↗
PubMed2004

Predictive value of a cross-cultural asthma case-detection tool in an elementary school population.

OBJECTIVE: Bronchial asthma, which affects approximately 5 million US children, is vastly underdiagnosed and treated, particularly among minorities and those of low socioeconomic status. Because current methods of detecting those at greatest risk of asthma in a multicultural setting appear inadequate, we assessed the validity and reliability of a new asthma questionnaire across 3 dominant cultures in Orange County, California (white, Hispanic, and Vietnamese). METHODS: Children in grades 1, 3, and 5 and their families, in 3 different schools representative of these major ethnic groups, were randomly selected to participate in the validation process. Two schools with low socioeconomic status and dominant Hispanic or Vietnamese minorities were designated inner-city schools, whereas the third school was a suburban school with predominately white students. Participants completed a 7-question, 11-element questionnaire in their primary language, followed by an asthma evaluation (history, physical examination, and spirometry) by an asthma specialist (who was blinded with respect to the results of the questionnaire), at their respective schools. The physician then made a determination regarding the presence and severity (according to National Institutes of Health guidelines) of asthma. Several weeks later, the entire student body was asked to complete the questionnaire at home and return it to school for analysis. Validation of each item was evaluated for sensitivity, specificity, and positive and negative predictive values, and application of univariate analyses provided an estimated probability of an asthma diagnosis by the asthma specialist. A "best-fit" algorithm was determined with all 11 elements, if possible, and an abbreviated algorithm that selected the fewest-question combination that yielded the best asthma predictability was established. Reliability was established with the percent agreement between the 2 questionnaires and the kappa statistic. RESULTS: Of the 401 children/families who participated in the validation analysis, 45% were Hispanic, 22% white, 19% Vietnamese, and 15% other. The overall prevalence of asthma specialist-diagnosed asthma was 28%, with 65% of cases being graded as intermittent and 35% as persistent. Sixty-two percent of the children had not been previously diagnosed with asthma. There were no significant differences among cultures in sensitivity or specificity for any of the individual questions or the complete or abbreviated algorithms. The abbreviated algorithm with 3 questions, ie, question 1 (asthma in the past 2 years), question 4 (cough, chest tightness, trouble breathing, or wheezing with exercise), and question 6 (same symptoms in the morning or day in the past 4 weeks) yielded comparable sensitivity and specificity for the complete algorithm in all groups. The abbreviated algorithm had >86% predictability in detecting children with persistent asthma and 56% predictability in detecting children with intermittent asthma. Reliability was also excellent, with percent agreement usually > 80% and kappa values of >.70. CONCLUSIONS: This asthma detection tool has been shown to be suitable for detecting persistent asthma in a multicultural inner-city population, as well as in a suburban setting. An abbreviated algorithm with 3 questions and >80% predictability in detecting persistent asthma seems ideal for evaluating large numbers of school-aged children. The school setting is an excellent site for identifying children with asthma. Although there is concern that subjects detected in the school setting might not have access to ongoing medical care, case detection is an important first step that could lead to earlier diagnosis and treatment. Reducing the barriers to good care in inner-city environments is the next step.

Algorithms↗
PubMed2006

Asthma care and management before an emergency department visit in children in western Michigan: how well does care adhere to guidelines?

OBJECTIVES: Asthma is one of the more common reasons for children's visits to the emergency departments (EDs). Many studies show that the level of asthma care and self-management in children before an ED visit for asthma is often inadequate; however, most of these studies have been conducted in the inner cities of large urban areas. Our objectives were to describe asthma care and management in children treated for asthma in 3 EDs located in an urban, suburban, or rural setting. METHODS: We studied a prospective patient cohort consisting of children aged 2 to 17 years who presented with an acute asthma exacerbation at 3 EDs in western Michigan. An in-person questionnaire was administered to the parent or guardian during the ED visit. Information was collected on demographics; asthma history; usual asthma care; frequency of symptoms during the last 4 weeks; current asthma treatment, management, and control; and past emergency asthma care. A telephone interview conducted 2 weeks after the ED visit obtained follow-up information. The 8 quality indicators of asthma care and management were defined based on recommendations from national guidelines. RESULTS: Of 197 children, 70% were enrolled at the urban site, 18% at the suburban site, and 12% at the rural site. The average age was 7.9 years; 60% were male, and 33% were black. At presentation, nearly half (46%) of the children had mild intermittent asthma, 20% had mild persistent asthma, 15% had moderate persistent asthma, and 19% had severe persistent asthma. One quarter of the children had been hospitalized for asthma, and two thirds had at least 1 previous ED visit in the past year. At least 94% had health insurance coverage and 95% reported having a primary care provider. Less than half of the children had attended at least 2 scheduled asthma appointments with their regular asthma care provider in the past year. Although only 5% of the subjects reported that the ED was their only source of asthma care, at least 30% reported that they always went directly to the ED when they needed urgent asthma care. Only 3 in 5 children possessed either a spacer or a peak-flow meter, whereas approximately 2 in 5 reported having a written asthma action plan. Among those with persistent asthma, there was considerable evidence of undertreatment, with 36% not on either an inhaled corticosteroid or a suitable long-term control medication. Only 20% completed a visit with their regular asthma care provider within 1 week of their ED visit. CONCLUSIONS: Despite very high levels of health care coverage and access to primary care, the overall quality of asthma care and management fell well short of that recommended by national guidelines.

Adolescent↗
PubMed2004

The importance of place of residence: examining health in rural and nonrural areas.

We examined differences in health measures among rural, suburban, and urban residents and factors that contribute to these differences. Whereas differences between rural and urban residents were observed for some health measures, a consistent rural-to-urban gradient was not always found. Often, the most rural and the most urban areas were found to be disadvantaged compared with suburban areas. If health disparities are to be successfully addressed, the relationship between place of residence and health must be understood.

Health Status Indicators↗
PubMed1995

Sources of variance affecting receipt of aggression.

36 boys and 33 girls from a suburban high school and 24 boys and 22 girls from an inner-city high school rated the frequency with which four other people hit or kicked them during the year. The four people were a brother, sister, non-family male (with whom they fought most during the year), and nonfamily female (with whom they fought most during the year). When responses were dichotomized into "hit" versus "not hit" by a particular person during the year, there was no effect of environment (suburban vs inner-city). The percentage of boys reporting being hit by girls was higher than the percentage of girls reporting being hit by girls. People with siblings were more likely to report being hit by them than by a nonfamily member (although frequency of contact might account for this finding).

Adolescent↗
PubMed1994

Diarrheal disease in Peru after the introduction of cholera.

Surveillance was conducted one day each week from December 1992 through May 1993 to determine the clinical features and etiology of diarrhea among a population in a suburban community of Lima, Peru. Patients who had had three or more loose stools during the previous 24 hr were enrolled at a clinic located in the community or at a nearby regional hospital. A total of 143 cases of diarrhea were detected for an overall rate of 7.1 cases per 1,000 population. The enteropathogens isolated were Vibrio cholerae 01 (31%), enterotoxigenic Escherichia coli (22%), and Salmonella, Shigella, Campylobacter, and Aeromonas species (10%). Specimens from the remaining cases were negative for enteropathogens. All isolates of V. cholerae were susceptible to tetracycline, doxycycline, nalidixic acid, norfloxacin, trimethoprim-sulfamethoxazole, trimethoprim, gentamicin, chloramphenicol, and cephalothin. Cases of diarrhea associated with V. cholerae were more common among adults, and more likely to experience severe dehydration and require hospitalization than the non-cholera cases. Data indicated that among the cases diagnosed, V. cholerae and enterotoxigenic E. coli were the more common causes of diarrhea in a suburban community of Lima during the summer season.

Adolescent↗
PubMed2000

[A case of external human ophthalmomyiasis by Oestrus ovis in Toulouse (France)].

We report a case of external human ophthalmomyiasis by OEstrus ovis was observed in a child living in southwestern France. The patient was contaminated on the playground of a school in a suburban village near Toulouse. Eleven first stage larvae were extracted from the eye. This case illustrates that contamination can occur in suburban areas of a large city remote from any cattle breeding zone.

Animals↗
PubMed2005

[Concentration and distribution characterization of polycyclic aromatic hydrocarbons in airborne particles with different sizes].

Airborne particles with different sizes were collected in 2003 at two sampling sites(urban border and suburban area) of Beijing. Compositions of polycyclic aromatic hydrocarbons were detected by GC/MS. The results show that total concentrations of 17 PAHs ranged between 0.84 and 152.23 ng/m3, in urban border area were 1.07 - 6.60 times higher than those measured in suburban area. The total concentration of PAHs increased with decreasing ambient temperature (winter > autumn > spring > summer). About 68.4% - 84.7% of PAHs were absorbed on particles having aerodynamic diameter < or = 2.0 microm. The distribution of PAHs varies with the size of the molecules. Nearly bimodal distribution was found for two- and three-rings PAHs, four- to six-rings PAHs, however, followed unimodal distribution. The overall mass median diameter (MMD) for PAHs decreases with increasing molecular weight. Higher pollution level of PAHs in wintertime is probably ascribed to domestic heating and lower ambient temperature.

Air Pollutants↗
PubMed2001

[Distribution of sources of Toxocara spp. infection in urban and rural environments in Poland].

Soil examinations made in 5 regions of Poland in the 1990s comprised 1184 samples taken from urban areas and 590 samples from suburban and rural areas. Toxocara spp. eggs were found more often in urban areas (14% positive samples) than in suburban and rural once (12% positive samples). The average ratio of positive samples was: in the streets and roads--19.3% (0.36 eggs/100g of soil), near houses (backyards, gardens)--18.6% (1.11 eggs/100g), in sandpits--13.0% (0.23/100g), in parks and public gardens--10.5% (0.46 eggs/100g), on playgrounds and playing fields 9,4% (0,06 eggs/100g) and on the beaches--3.4% (0.03 eggs/100g). In children habitual play areas the prevalence of T. cati eggs was higher than T. canis eggs.

Adult↗
PubMed1979

Prevalences of removable dentures and edentulousness in an adult Swedish population.

In three geographic regions, urban, suburban and rural from the middle of Sweden 20,333 adults (over 15 yrs of age) were examined clinically regarding denture wearing and edentulousness. 30.3% had removable dentures of some kind and 1.0% were edentulous and did not wear any dentures. Removable dentures were significantly more common amongst females (33.8%) than amongst males (26.8%). For complete dentures in both jaws this sex differences was even more pronounced, 19.3% and 11.4%, respectively. The prevalence for removable dentures was highest in the rural region, and lowest in the suburban. This finding may, however, be partly explained by the different age distribution within the areas examined.

Adolescent↗
PubMed1979

Locational profiles: incoming veterinary students and outgoing new veterinarians, 1971-78, New York State College of Veterinary Medicine, Cornell University.

Relationships between the demographic areas of incoming veterinary students and first placement locations were examined during 1971-1978 for the New York State College of Veterinary Medicine at Cornell University. Seventy-four percent of the incoming students were New York residents whereas only 52 percent of the graduates selected New York sites for their first placement after graduation. Part of the net loss may be the result of temporary moves into the state to gain residence status, educational preparation and possibly some hope for improving admission eligibility. After completing their veterinary education, they are more likely to return to areas closely associated with family and childhood experiences for first placement choices or for advanced educational offerings. Three demographic classifications were used to identify patterns of movement into and out of the state (Urban, Suburban and Rural). No significant differences in area distribution patterns were observed between incoming and outgoing students/graduates. However, when the data were separated by sex, the outgoing distribution patterns were significantly different for female graduates (Urban and Rural areas preferred over Suburban). Sixty-five percent of the out-of-state placements were in New England and other Northeastern states, with Rural areas showing major strengths.

New England↗
PubMed1982

Family size composition differentials between central city-suburb and metropolitan-nonmetropolitan migration streams.

During the migration intervals 1965-19709, 1970-1975, and 1975-1979, families that migrated from Standard Metropolitan Statistical Areas (SMSAs) to nonmetropolitan areas and from central cities to suburban rings were larger in mean size than families that composed the respective counterstreams. Mean family sizes declined sharply for all groups throughout the period, but absolute differentials between opposing streams increased slightly. In terms of the selective attraction of families by size, nonmetropolitan net in-migration was very similar to suburbanization within SMSAs. A considerable portion of recent nonmetropolitan net gains resulted from the exchange of larger in-migrant families for smaller out-migrant families.

Demography↗
PubMed1992

Patients' knowledge about fats and cholesterol in the Community Cholesterol Survey Project.

OBJECTIVE: The Community Cholesterol Survey Project assessed attitudes, knowledge, and behaviors relating to cholesterol. DESIGN: Survey. SETTING: Six outpatient primary care practice sites (two urban, two suburban, and two rural) in northeast Ohio. PARTICIPANTS: Four hundred seventy-seven site-, age-, and gender-stratified adult patients were enrolled from a total of 604 approached (79% recruitment). INTERVENTIONS: Self-administered questionnaire and structured dietitian interview. MAIN OUTCOME MEASURES: A knowledge score derived from responses to multiple-choice questions and a knowledge rating given by the study dietitian. Motivation and dietary health were similarly measured. RESULTS: Subjects did worse than random guessing for seven of 12 knowledge questions regarding label reading, fats, and cholesterol. In particular, the meaning of "hydrogenated" and the relative energy content of fats was poorly understood. Knowledge scores and ratings were significantly correlated (r = .52). Knowledge ratings were higher in those who were receiving a cholesterol-lowering diet or who had received other advice or treatment from their physician for high cholesterol level. By analysis of variance, knowledge measures were found to have significant independent positive associations with higher social status (P < .001) and living in a suburban area (P < .05). Motivation and dietary health demonstrated similar relationships to social status. CONCLUSIONS: To make use of patients' motivation for change, it will be essential to provide education at an effective level. Instruction in label reading or creation of more meaningful food labels may have the greatest impact. A particular challenge is the education of less advantaged patients to promote healthy nutrition practices.

Adult↗
PubMed2006

Lowering the threshold for discussions of domestic violence: a randomized controlled trial of computer screening.

BACKGROUND: Women experiencing domestic violence (DV) frequent health care settings, but DV is rarely identified. METHODS: We conducted a randomized controlled trial to determine the effect of computer screening on health care provider-patient DV communication at 2 socioeconomically diverse emergency departments (EDs). Consenting nonemergent female patients, aged 18 to 65 years, were randomized to self-administered computer-based health risk assessment, with a prompt for the health care provider, or to "usual care"; all visits were audiotaped. Outcome measures were rates of DV discussion, disclosure, and services. RESULTS: Of 2169 eligible patients, 1281 (59%) consented; 871 (68%) were successfully audiotaped, and 903 (71%) completed an exit questionnaire. Rates of current DV risk on exit questionnaire were 26% in the urban ED and 21% in the suburban ED. In the urban ED, the computer prompt increased rates of DV discussion (147/262 [56%] vs 123/275 [45%]; P = .004), disclosure (37/262 [14%] vs 23/275 [8%]; P = .07), and services provided (21 [8%] vs 10 [4%]; P = .04). Women at the suburban site and those with private insurance or higher education were much less likely to be asked about experiences with abuse. Only 48% of encounters with a health care provider prompt regarding potential DV risk led to discussions. Both inquiries about and disclosures of abuse were associated with higher patient satisfaction with care. CONCLUSIONS: Computer screening for DV increased but did not guarantee that DV would be addressed during ED encounters. Nonetheless, it is likely that low-cost interventions that allow patients the opportunity to self-disclose can be used to improve detection of DV.

Adolescent↗
PubMed1999

Beach week: a high school graduation rite of passage for sun, sand, suds, and sex.

BACKGROUND: Every year, thousands of suburban high school graduates from mid Atlantic states flock to nearby coastal beaches for a long-anticipated rite of passage known as "beach week." Sand, sun, and sea, and also smoking, binge drinking, drugs, and sex, are reported to be dominant themes. OBJECTIVE: To document risk-taking behaviors by girls during beach week. METHOD: Fifty-nine female suburban high school graduates who attended beach week in 1996 volunteered to fill out a confidential printed survey. Twenty-five girls (42%) completed the survey during a typical beach week party. Their activities were verified on site by a peer, recommended by her grade advisor for her integrity and popularity. Breath alcohol values were obtained at entry and departure from the party. The remaining 34 girls completed the supervised survey 2 to 3 months later. RESULTS: Daily cigarette smoking (54%), daily drunkenness (75%), and sex (46%) were the norm among respondents of our survey. Few reported first-time sex (n = 4) or drug use (n = 2). Abstinence from drugs (67%) and sex (55%) was not unusual but only 12% abstained from getting drunk. Sixteen girls (64%) reported that they drank 8 or more beers/wine during a typical beach week party. By departure from the party, 15 girls had breath alcohol values of 0.017 mmol/L or greater (reference range, <21.7 mmol/L), and 8 additional girls had breath alcohol values of 0.01 mmol/L to 0.015 mmol/L. Fifteen percent of the 59 reported injuries or illness were related to alcohol or drugs. CONCLUSION: Most respondents enjoyed beach week but a large percentage engaged in serious risk-taking behaviors.

Adolescent↗