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PubMed2005

Incidence rates for alcohol dependence among adults: prospective data from the Baltimore Epidemiologic Catchment Area Follow-Up Survey, 1981-1996.

OBJECTIVE: Using prospectively gathered data, we assessed cumulative incidence of alcohol dependence using the Diagnostic Interview Schedule (DIS) based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R). METHOD: Probability samples of area residents were selected by census tracts and households in five communities of the Epidemiologic Catchment Area Survey program. The baseline interview for the Baltimore site was completed in 1981, and between 1993 and 1996 the original Baltimore site cohort was traced. After excluding individuals with current or prior history of alcohol dependence at the time of the baseline interview, we identified a cohort of 1,642 individuals who were at risk for alcohol dependence. Person-years of risk were calculated, cumulative incidence obtained, and survival analyses completed. RESULTS: Several principal findings that confirm some from studies of shorter follow-up intervals are as follows: (1) incidence of alcohol dependence is consistently greater for men and generally decreases with age; (2) problem drinkers have the highest incidence of dependence, and the male-to-female ratio is attenuated in this group; (3) no differences were found for risk of dependence by racial group; and (4) predictors of alcohol dependence include male gender, young age, not being married and having a history of tobacco smoking. CONCLUSIONS: The current study supplies data on the rate of development of DIS/DSM-III-R alcohol dependence in a population-based sample with an extended interval of follow-up. Methodological considerations in the analysis and interpretation of this type of prospectively gathered data are discussed.

Adolescent↗
PubMed2005

Gender-specific behavioral health and community release patterns among New Jersey prison inmates: implications for treatment and community reentry.

OBJECTIVES: We describe behavioral health diagnoses and community release patterns among adult male and female inmates in New Jersey prisons and assess their implications for correctional health care and community reentry. METHODS: We used clinical and classification data on a census of "special needs" inmates (those with behavioral health disorders) in New Jersey (n=3189) and a census of all special needs inmates released to New Jersey communities over a 12-month period (n=974). RESULTS: Virtually all adult inmates with special needs had at least 1 Axis I mental disorder, and 68% of these had at least 1 additional Axis I mental disorder, a personality disorder, or addiction problem (67% of all male and 75% of all female special needs inmates). Of those special needs inmates released, 25% returned to the most disadvantaged counties in New Jersey (27% of all male and 18% of all female special needs inmates). CONCLUSIONS: Two types of clustering were found: gender-specific clustering of disorders among inmates and spatial clustering of ex-offenders in impoverished communities. These findings suggest a need for gendered treatment strategies within correctional settings and need for successful reentry strategies.

Adult↗
PubMed1996

Incidence and risk factors of cancer among men and women in Norwegian agriculture.

OBJECTIVES: The objective of the study was to examine cancer incidence and identify risk factors among subjects born in 1925-1971 and engaged in agricultural activities in Norway. METHODS: A cohort was established through linkage between agricultural censuses in 1969-1989 and the Central Population Register, which identifies farm holders and their spouses. Available census information on the activity of the farm provided the exposure indicators. Incident cancer in 1969-1991 was identified in the Cancer Register. In an analysis for standardized incidence ratios (SIR), the cohort was compared with the total rural population of Norway. Associations with exposure indicators were investigated in a Poisson regression analysis. RESULTS: In the follow-up of 136,463 men for 1.5 million person-years and 109,641 women for 0.6 million person-years, 3333 and 2145 cancer cases were identified, respectively. The subset defined as farmers had an SIR of 77 [95% confidence interval (95% CI) 73-81] for the men and 92 (95% CI 85-99) for the women, with particularly low SIR values for lung cancer and other sites linked to life-style. The several positive associations found confirmed the a priori hypothesis of an association between dairy farming and acute leukemia among men [rate ratio 1.76, 95% CI 1.02-3.05]. Multiple myeloma was associated with pesticide indicators for both genders, mainly for subjects cultivating potatoes. CONCLUSIONS: The results support the hypothesis of a relationship between acute leukemia and animal contact and between multiple myeloma and pesticides in potato cultivation. Other exposure associations, especially for cancer among women, warrant further investigation.

Adult↗
PubMedDate not supplied

[Chronic and subacute subdural haematoma. An epidemiological study in a captive population].

INTRODUCTION: Although chronic and subacute subdural haematomas (CSSH) are amongst the commonest neurosurgical conditions, there are few studies on their incidence in the general population. OBJECTIVES: To determine the overall annual rate, the specific rates according to age and sex based on the Official Argentinian National Census of 1991 (OANC 91) for CSSH. PATIENTS AND METHODS: The Hospital Privado de Comunidad de Mar del Plata attends a captive population of 89,500 persons from the Instituto Nacional de Servicios Sociales de Jubilados y Pensionados (INSSJP) and the Prepaid Medical Schemes (PMP) of our institution. We studied the patients of INSSJP and PMP who had CSSH between 1992 and 1996. We determined the annual overall rate and the specific rates according to age and sex, and fitted to the OANC 91. RESULTS: 1. Annual overall rate: 14.1 CSSH/100,000 persons/year. 2. Specific rate for women: 11.6 CSSH/100,000 persons/year. 3. Specific rate for men: 18.1 CSSH/100,000 persons/year. 4. Specific rate 71-80 years old: 18.8 CSSH/100,000 persons/year. 5. Rate fitted to OANC9: 3.1 CSSH/100,000 persons/year. CONCLUSIONS: Our overall rate is higher, and the specific rate for the age group 71-80 years is intermediate, with regard to the rates found in other studies. Neuroepidemiological investigation should be stimulated so that more clinical studies are made regarding the results and costs based on the population.

Adult↗
PubMed1989

[Fertility, employment, and migration. Differential fertility according to migration experience using census data].

Differential fertility in Italy by occupation is analyzed using census data. The author uses the own-children method to develop retrospective estimates of period fertility for women in 1976 and 1981. The occupational status categories used are "employed in the same sector, employed in a different sector, no longer employed, new employed, never employed. A strong relation appears between work status changes and fertility trends: the women who recently obtained a new job touch the lowest level of fertility, while those who left their job reach the highest level." The impact of migration and nuptiality is also considered. (SUMMARY IN ENG AND FRE)

Demography↗
PubMed2003

[Suicide in the elderly at home and in retirement homes in France].

BACKGROUND: Suicide in the elderly attracts less attention that in the young. However it is more frequent among the former. The retirement home receives the populations most isolated from their families and those most vulnerable from a psychological and physical point of view. The aim of this research is to provide information concerning suicide in the elderly in France, to specify the means employed and to compare suicide rates at home and in retirement homes METHODS: The statistics utilized are those of population size (censuses) and medical causes of death. With these latter causes a relation cannot be made between place of residence and place where the death by suicide is registered. They therefore underestimate suicide rates which are only considered at the home or retirement home. Consequently different estimations have been made. RESULTS: Suicide rates are higher in the retirement home than at home for both sexes. However, for men, the suicide rates in retirement homes are similar to those recorded for isolated men living at home. On the contrary, for women, the retirement home seems to constitute a specific risk in itself with suicide rates quite distinct from the other situations studied. In the retirement homes, conversely to men, it is the youngest women, (65 to 74 years) who have the highest rates. Hanging is the most prevalent mean of suicide both at home and in the retirement homes. Jumping from a high place is the second mean utilized in the retirement homes where fire arms and consumption of substances are less represented CONCLUSIONS: There are few studies in France concerning suicide in the elderly. Due to the demographic evolution, the number of suicides among the aged may well increase considerably in the years to come.

Age Factors↗
PubMed1996

Trends and variations in the use of vascular surgery in Ontario.

OBJECTIVE: To measure changes over time in overall surgical rates and geographic rate variations for three major vascular procedures (abdominal aortic aneurysm repairs, peripheral vascular disease procedures and carotid endarterectomies). BACKGROUND: There is little research literature on population-based usage profiles of vascular procedures. The three procedures profiled were all subject to marked shifts in evidence or surgical opinions, raising the issue of the interplay between temporal trends and geographic variations in their use. METHODS: Based on Ontario's hospital discharge abstracts and census data, population-based usage rates were calculated by site of patient residence from 1981 to 1991. Extent of rate variation was summarized with the coefficient of variation, systematic component of variation and the adjusted-likelihood ratio chi2. Spearman rank correlations were also calculated to assess stability of county rankings for each procedure. RESULTS: The overall rates of peripheral vascular procedures and repair for abdominal aortic aneurysms fell 24% and increased 42% respectively. The overall rate of carotid endarterectomies dropped from 46/100,000 in 1981 to 20/100,000 in 1989, but by 1991 had increased to 37/100,000. Through the decade measures of variation fell minimally for all three procedures. CONCLUSION: Overall use of vascular procedures shifted in apparent response to new research evidence and technologies. Despite marked changes in surgical rates, the extent of geographic variation was stable, suggesting that differing factors influence overall surgical rates and geographic rate variations. Audit at the local level using primary clinical data is needed to understand why disparities in use persist.

Aortic Aneurysm, Abdominal↗
PubMedDate not supplied

[Deprivation and mortality: a deprivation index suitable for geographical analysis of inequalities].

UNLABELLED: FOREGROUND: A national deprivation index suitable for geographical analysis of inequalities in health is not yet available in Italy, although the link between deprivation and health has been clearly demonstrated in our country in a number of studies. OBJECTIVES: 1) To describe a deprivation index in Italy at municipal level, based on the percentage of selected census variables (simple components) 2) To analyse general mortality according to deprivation categories at municipal level in Italy 3) To measure the size of ecological bias using the Turin Longitudinal Study. SETTING: Italy (1-2), Turin (3). MATERIALS: 1) 1991 census data base at municipal level 2) General mortality in Italy by municipality and age bands in 1990-92. 3) Turin Longitudinal study 1991-1995. METHODS: 1) Percentages of selected indicators of inequalities for all the 8.100 Italian municipalities present at 1991 census were calculated. Factorial analysis were performed in order to help in selecting the most valuable ones. The final choice led to five indicators (low education, unemployment, rented occupier housing, no indoor bathroom, lone parent with childhood). A simple additive index was computed using the method of the sum of normal standard deviates of each component 2) Correlation of indexes with mortality was performed; SMR for each deprivation category were computed; 3) Computation of the index at different levels: individual (one million individuals), census ward (3657 wards), statistic zone (92 statistic zones), two neighborough levels (23 and 10 neighboroughs) was conducted; differential analysis was performed for each level and index category, allowing for comparison among results, adjusting for age. MAIN RESULTS: Increasing deprivation was significantly associated with mortality from all causes: there was up to a 20 percent increase in mortality between the highest and lowest quintile. The relationship was linear with no apparent threshold. The slope of the relationship between deprivation and mortality varied among regions. Differentials in inequalities measured by individual and census tract level resulted to be very small; ecological bias arises when larger areas are taken into account. CONCLUSIONS: An area based measure of deprivation has proved a valuable tool in examining differentials in death and is likely to prove of continuing value to health authorities in planning the delivery of health care.

Adolescent↗
PubMed1980

Five-year age-specific incidence rates. I. Their nature and limitations.

The effect of population structure on five-year age-specific incidence rates was investigated using the one-year population data from life tables and a theoretical age incidence curve of the form: I = btk - where I is the incidence at age t, and b and k are constants. The five-year incidence rates differed systematically from the one-year rates of the central year of the five-year period. This difference depended on the change with age of both the population size and the incidence rate. Thus at ages 20-24 the five-year rate overestimates the mid-period one-year rate by about 4%, but the overestimate progressively decreases to become an underestimate of 0.5% at ages 75-79. In consequence the one-year and five-year rates produce fitted age incidence curves with different slopes; the value of k in the incidence equation is about 0.7% greater for the one-year rates. The population structures of developed and underdeveloped countries are markedly different and these were found to affect the five-year incidence rates, but never by more than 0.5%. The effect of the irregularities in one-year age structure of real populations on the observed five-year rates is also small, of the order of 0.5%. However, when incidence rates are calculated by recording tumours over several calendar years, these irregularities can create difficulties for the estimation of the appropriate denominator population. The use of the census population, even that of the central year of the observation period, can be in error by over 2%. A good method is to calculate the mean annual population of the observation period, estimating the intercensal year populations by interpolation between flanking censuses.

Adult↗
PubMed2004

Comparison of small-area analysis techniques for estimating county-level outcomes.

BACKGROUND: Since many health data are unavailable at the county level, policymakers sometimes rely on state-level datasets to understand the health needs of their communities. This can be accomplished using small-area estimation techniques. However, it is unknown which small- area technique produces the most valid and precise results. METHODS: The reliability and accuracy of three methods used in small-area analyses were examined, including the synthetic method, spatial smoothing, and regression. To do this, severe work disability measures were first validated by comparing the 2000 Behavioral Risk Factor Surveillance System (BRFSS) and Census 2000 measures (used as the gold standard). The three small-area analysis methods were then applied to 2000 BRFSS data to examine how well each technique predicted county-level disability prevalence. RESULTS: The regression method produces the most valid and precise estimates of county-level disability prevalence over a large number of counties when a single year of data is used. CONCLUSIONS: Local health departments and policymakers who need to track trends in behavioral risk factors and health status within their counties should utilize the regression method unless their county is large enough for direct estimation of the outcome of interest.

Adolescent↗
PubMedDate not supplied

Comparison of two methods for assessing child mortality in areas without comprehensive registration systems.

We compared the effectiveness of 2 approaches to assessing child deaths in a rural area of Burkina Faso, West Africa. Censuses, repeated yearly, identified 410 child deaths in the age range 6-59 months. Surveillance using community informants identified only 319 deaths. The estimated sensitivities of the 2 systems were 97% and 76%, respectively. Both systems appeared less effective at detecting child deaths before 6 months of age (sensitivities 74% and 57%). Most of the deaths missed by the census were of children born since the previous census. The cost of one year's surveillance was twice that of a single census. The marginal cost of the surveillance system per additional child death identified between 6 and 59 months was about US$ 1500. Thorough annual censuses may be sufficient to ascertain almost all child deaths over 6 months of age. In studies wishing to identify child deaths before 6 months of age, such an approach is unlikely to be adequate. In such situations, our data indicated that the use of unpaid community informants can improve assessment of deaths. Where accurate assessment of early infant death rate is required, regular visits to each household by members of the study team are likely to be the only reliable approach.

Birth Rate↗
PubMedDate not supplied

Estimating maternal mortality: the sisterhood method.

This paper describes a new indirect technique for deriving population-based estimates of maternal mortality. The technique, called the "sisterhood method," is relevant to developing countries where the alternative data sources and approaches to estimation are often inadequate and inappropriate. The sisterhood method uses the proportions of adult sisters dying during pregnancy, childbirth, or the puerperium reported by adults during a census or survey, to derive a variety of indicators of maternal mortality. The first field trial of the method was carried out in the North Bank Division of The Gambia, West Africa, in 1987. The results indicate a lifetime risk of maternal mortality of 0.0584, or 1 in 17, approximating a maternal mortality ratio of 1,005 per 100,000 live births, which is consistent with previous estimates for this region.

Data Collection↗
PubMed2005

A model-adjusted space-time scan statistic with an application to syndromic surveillance.

The space-time scan statistic is often used to identify incident disease clusters. We introduce a method to adjust for naturally occurring temporal trends or geographical patterns in illness. The space-time scan statistic was applied to reports of lower respiratory complaints in a large group practice. We compared its performance with unadjusted populations from: (1) the census, (2) group-practice membership counts, and on adjustments incorporating (3) day of week, month, and holidays; and (4) additionally, local history of illness. Using a nominal false detection rate of 5%, incident clusters during 1 year were identified on 26, 22, 4 and 2% of days for the four populations respectively. We show that it is important to account for naturally occurring temporal and geographic trends when using the space-time scan statistic for surveillance. The large number of days with clusters renders the census and membership approaches impractical for public health surveillance. The proposed adjustment allows practical surveillance.

Censuses↗
PubMed1984

How many Samoans? An evaluation of the 1980 census count of Samoans in the United States.

"This paper reports the results of applying demographic methods, in combination with assumptions about vital rates and migration, to estimate the total Samoan population of the United States in 1980." The authors conclude that the most plausible estimate of the Samoan population in the United States in 1980 is between 46,600 and 50,800. These estimates are 10 to 17.5 percent higher than the census count.

American Samoa↗
PubMed1984

[Methods for teaching problem-solving in medical schools].

The need to include in the medical curriculum instructional activities to promote the development of problem-solving abilities has been asserted at the national and international levels. In research on the mental process involved in the solution of problems in medicine, problem-solving has been defined as a hypothetical-deductive activity engaged in by experienced physicians, in which the early generation of hypotheses influences the subsequent gathering of information. This article comments briefly on research on the mental process by which medical problems are solved. It describes the methods that research has shown to be most applicable in instruction to develop problem-solving abilities, and presents some educational principles that justify their application. The "trail-following" approach is the method that has been most commonly used to study the physician's problem-solving behavior. The salient conclusions from this research are that in the problem-solving process the diagnostic hypothesis is generated very early on and with limited data; the number of hypotheses is small; the problem-solving approach is specific to the type of medical problem and case in hand; and the accumulation of medical knowledge and experience forms the basis of clinical competence. Four methods for teaching the solution of problems are described: case presentation, the rain of ideas, the nominal groups technique and decision-making consensus, the census and analysis of forces in the field, and the analysis of clinical decisions. These methods are carried out in small groups. The advantages of the small groups are that the students are active participants in the learning process, they receive formative evaluation of their performance in a setting conductive to learning, and are able to interact with their instructor if he makes proper use of the right questioning techniques. While no single problem-solving method can be useful to all students or in all the problems they encounter, teachers of medicine can improve their students' performance by adjusting these available methods to their particular needs and to those of their schools. The problem-solving methods described can help teachers shape the learning environment so as to develop in their students the most coherent, logical, concrete and complete set of skills possible. These methods can so be of value in improving the training of future doctors and the quality of their decisions to the benefit of their patients.

Curriculum↗
PubMed2006

Clusters of census tracts with high proportions of men with distant-stage prostate cancer incidence in New Jersey, 1995 to 1999.

BACKGROUND: Although the etiology of prostate cancer is uncertain, cancer control programs need to know the factors that contribute to variations in prostate cancer incidence from place to place. Geographic patterns of prostate cancer cases diagnosed at the distant stage are particularly important, because survival is substantially lower than for prostate cancer diagnosed at earlier stages. The purpose of this study was to identify and characterize clusters of census tracts in New Jersey with significantly high proportions of men diagnosed with distant-stage prostate cancer. METHODS: Prostate cancer cases diagnosed in New Jersey residents from 1995 to 1999 (n=30,505) were geocoded at the census tract level (n=1938) based on their residences at time of diagnosis. A spatial scan statistic (SaTScan) then was applied to identify clusters of census tracts with elevated proportions of cases of distant stage prostate cancer, using a case-control Bernoulli probability model study design. Distant-stage prostate cancers were defined as cases (n=1230), and all other prostate cancers as controls. Population characteristics from the 1990 Census for the area of the most likely cluster were compared to the remainder of the state. RESULTS: SaTScan identified a large geographic area in northeast New Jersey as the most likely cluster (RR=1.25, p=0.001). Compared to the remainder of the state, the underlying population in the most likely cluster area had higher proportions of African-American, Hispanic, and Asian men, and was more likely to be foreign-born, undereducated, in poverty, and have limited English speaking ability. CONCLUSIONS: Spatial analyses of late stage prostate cancer cases can provide additional insights into less favorable outcomes for disadvantaged populations and racial and ethnic minorities.

Adult↗
PubMed2003

Reproductive health in school-based health centers: findings from the 1998-99 census of school-based health centers.

PURPOSE: To describe the state of reproductive health services, including access to contraception and health center policies, among school-based health centers (SBHCs) serving adolescents in the United States METHODS: We examined questionnaire data on provision of reproductive health services from the 1998-99 Census of School-Based Health Centers (response rate 70%). We examined 551 SBHCs in schools with high or middle school grades. We used logistic regression to define factors independently associated with services and policies. RESULTS: Most SBHCs (76%) were open full-time; over one-half (51%) of centers had opened in the past 4 years. Services provided, either on-site or by referral, included gynecological examinations (95%), pregnancy testing (96%), sexually transmitted disease (STD) diagnosis and treatment (95%), Human Immunodeficiency Virus (HIV) counseling (94%), HIV testing (93%), oral contraceptive pills (89%), condoms (88%), Depo-Provera (88%), Norplant (78%), and emergency contraception (77%). Counseling, screening, pregnancy testing, and STD/HIV services were often provided on-site (range 55%-82%); contraception was often provided only by referral (on-site availability = 3%-28%). SBHCs with more provider staffing were more likely to provide services on-site; rural SBHCs and those serving younger grades were less likely to provide these services on-site. Over three-quarters (76%) of SBHCs reported prohibitions about providing contraceptive services on-site; the sources of these prohibitions included school district policy (74%), school policy (30%), state law (13%), and health center policy (12%). While SBHCs generally required parental permission for general health services, many allowed adolescents to access care independently for certain services including STD care (48%) and family planning (40%). Older SBHCs were more likely to allow independent access. CONCLUSIONS: SBHCs provide a broad range of reproductive health services directly or via referral; however, they often face institutional and logistical barriers to providing recommended reproductive health care.

Adolescent↗
PubMed2006

[Gallbladder cancer: trend and risk distribution in Chile].

BACKGROUND: Gallbladder cancer (GBC) is the first cause of death by cancer among Chilean women and mortality has not improved in the last 20 years. AIM: To study GBC mortality trend from 1985-2002, analyze risk differentials by age, sex, geographic region and accessibility to surgery. MATERIAL AND METHODS: Mortality data was obtained from death certificate databases. Population data was obtained from the census and biliary surgery information, from Ministry of Health registries. Standardized Mortality rates were based in the world population; trend was analyzed with point of change methods. RESULTS: From 1985 to 2002, 27,183 GBC deaths occurred, 1,510 per year. The absolute number of deaths increased in 65% but standardized mortality rates remained unchanged at 11.3 per 100,000. These were higher among women than men (15.6 and 7.0, respectively, with a risk ratio of 2.2). Sex ratio peaked at ages 35-54 with risk ratio of 4.1. Death risk increased from North to South, peaking in poorer areas, especially in places with rural population and Mapuche ethnic admixture. Mortality appear to correlate with the rate of people waiting for gallbladder surgery, but not reaching statistical significance (r(2) 0.27, ns). Compared with other countries, Chile has a higher rate of GBC deaths in relation to its gross domestic product per capita. CONCLUSIONS: There is a high and persistent persistent risk for GBC in Chile, particularly among women, from the Southern regions where gallbladder surgery is insufficient for the needs, as reflected by the rates of people waiting for biliary surgery. GBC rates could be dropped by offering gallbladder surgery to everyone waiting for it and to those incident cases with gallstones.

Adolescent↗