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PubMed2005

Food allergen sensitization in inner-city children with asthma.

BACKGROUND: Asthma continues to be an increasing cause of morbidity in the pediatric population, and studies have shown an association between food sensitivity and asthma. OBJECTIVE: We investigated the degree of food allergen sensitization in inner-city patients with asthma. METHODS: Five hundred four random serum samples from the National Cooperative Inner City Asthma Study were evaluated for specific IgE (UniCap) to 6 common food allergens (egg, milk, soy, peanut, wheat, and fish). Statistical analyses were performed to determine food sensitization prevalence and its association with asthma morbidity. RESULTS: Forty-five percent of patients had evidence of sensitization (food-specific IgE > or = 0.35 kU/L) to at least 1 food. Nineteen percent had IgE levels at > or = 50% positive predictive value for clinical reactivity to at least 1 food, with 4% of patients having levels > 95% positive predictive value for food allergy. Children sensitized to foods had higher rates of asthma hospitalization (P < .01) and required more steroid medications (P = .025). Sensitization to foods also correlated with sensitization to more indoor and outdoor aeroallergens (P < .001). CONCLUSION: Food allergen sensitization is highly prevalent in the inner-city population with asthma, and it is associated with increased asthma healthcare and medication use. Therefore, food allergen sensitivity may be a marker for increased asthma severity.

Animals↗
PubMed2005

Predictors of asthma-related health care utilization and quality of life among inner-city patients with asthma.

BACKGROUND: Asthma morbidity and mortality are highest among minority inner-city populations. OBJECTIVE: To identify factors associated with acute health care resource utilization and asthma-related quality of life among high-risk, minority patients with asthma. METHODS: We interviewed a prospective cohort of 198 adults hospitalized for asthma in an inner city hospital over a period of 1 year. Detailed information about sociodemographics, asthma history, access to care, asthma medications, and self-reported allergy to aeroallergens was collected at baseline. Data on resource utilization (emergency department visits and hospital admissions for asthma) and asthma-related quality of life were obtained at 6 months after discharge. Multivariate analyses were used to identify predictors of resource utilization and quality of life. RESULTS: The mean age of patients was 49.9 +/- 17.4 years, 78% were women, and 97% were nonwhite. At 6 months, 49% of patients had an emergency department visit or hospitalization. In multivariate analysis, adjusting for age, sex, medication regimen, and asthma severity, patients with a physician in charge of their asthma care had lower odds of resource utilization (odds ratio, 0.4; P=.03). Conversely, a self-reported history of cockroach allergy was associated with greater utilization (odds ratio, 2.3; P=.05). Asthma-related quality of life was worse among patients who spoke mostly Spanish or who reported allergy to cockroaches (P < .004). CONCLUSION: Lack of an established asthma care provider, language barriers, and self-reported allergy to cockroaches are associated with higher resource utilization and worse quality of life among minority, inner-city patients with asthma. Interventions targeting these factors may lead to better outcomes among these patients.

Animals↗
PubMed2005

Cost-effectiveness of a home-based environmental intervention for inner-city children with asthma.

BACKGROUND: Exposure to indoor allergens contributes to increased asthma morbidity. The Inner-City Asthma Study, a randomized trial involving home environmental allergen and irritant remediation among children aged 6 through 11 years with moderate-to-severe asthma, successfully reduced asthma symptoms. A cost-effectiveness analysis can help stakeholders to evaluate the potential costs and benefits of adopting such a program. OBJECTIVE: We sought to assess the cost-effectiveness of the environmental intervention of the Inner-City Asthma Study. METHODS: Incremental cost-effectiveness ratios for a 2-year study period were calculated. Health outcome was measured as symptom-free days. Resource use measures included ambulatory visits, hospitalizations, and pharmaceutical use. CIs were obtained by using bootstrapping. RESULTS: The intervention, which cost $1469 per family, led to statistically significant reductions in symptom days, unscheduled clinic visits, and use of beta-agonist inhalers. Over the year of the intervention and a year of follow-up, the intervention cost was $27.57 per additional symptom-free day (95% CI, $7.46-$67.42). Subgroup analysis showed that targeting the intervention to selected high-risk subgroups did not reduce the incremental cost-effectiveness ratio. CONCLUSIONS: A targeted home-based environmental intervention improved health and reduced service use in inner-city children with moderate-to-severe asthma. The intervention is cost-effective when the aim is to reduce asthma symptom days and the associated costs.

Air Pollution, Indoor↗
PubMed2006

Seasonal distribution and phylogenetic analysis of human metapneumovirus among children in Osaka City, Japan.

BACKGROUND: Human metapneumovirus (hMPV) is one of the etiological agents of respiratory tract infection (RTI). Because clinical symptoms of hMPV resemble those caused by respiratory syncytial virus (RSV), clinical diagnosis of hMPV infection is difficult. Moreover, hMPV isolation using cultured cells is generally difficult and not efficient compared with reverse transcription-PCR (RT-PCR). OBJECTIVES: To assess infection and seasonal distribution of hMPV associated with RTI among children in Osaka City, Japan. STUDY DESIGN: To detect the hMPV gene, we extracted viral RNA from clinical specimens of patients with RTI and performed RT-PCR or nested-PCR for the fusion (F) gene. hMPV-specific amplicons were sequenced and subjected to phylogenetic analysis. RESULTS: From June 2004 to May 2005, we detected 29 (20.1%) hMPV strains among 144 clinical specimens. Fifteen strains were detected by RT-PCR and the remaining 14 by nested-PCR. Prevalence was principally in winter and spring with incidence peaking in April. We also detected the hMPV RNA from a patient with encephalitis. Approximately 80% of the hMPV-positive patients were younger than 3 years. To analyze these isolates precisely, a phylogenetic analysis using F gene was performed and demonstrated that Osaka City isolates of hMPV consists of two major genetic lineages each comprising two sublineages. CONCLUSIONS: We found two major genetic lineages of hMPV in Osaka City, Japan. We also found that nested-PCR was an efficient method for detecting the hMPV gene in clinical specimens. Of the 28 patients presenting with hMPV infection, 1 patient had associated encephalitis suggesting that hMPV infection might play a role in inducing encephalitis.

Adolescent↗
PubMed2005

School absenteeism in children with asthma in a Los Angeles inner city school.

OBJECTIVE: To investigate the pattern of school absenteeism in asthmatic children within a Los Angeles inner city school. STUDY DESIGN: Five hundred twenty-eight students of predominant Hispanic ethnicity, from a Los Angeles inner city school were divided into 3 groups: known asthma, high probability of asthma, and low probability of asthma using a previously validated instrument. Attendance records of these students were analyzed to determine total and respiratory absences over a year. School records were compared to the corresponding answers on 513 surveys to determine the accuracy of parental responses in regard to their children's absenteeism. RESULTS: Children with known asthma missed on average 2 more days of school than children with low probability of asthma and high probability of asthma. This was only significant in the younger age groups. Survey responses were found to have a 45.6% agreement with school attendance records. Underestimation occurred more often when school-recorded absentee rates were highest. Overestimation occurred more by parents of children with known asthma or a high probability of asthma. CONCLUSION: In a Los Angeles inner city population, younger children with known asthma miss more days of school than those with no asthma. Survey-reported absenteeism is less accurate than school attendance records.

Absenteeism↗
PubMed2006

Porcine circovirus type 2 antibody detection in backyard pigs from Mexico City.

PCV2 antibodies have been found in pigs from all continents. However, this finding has been mainly studied in domestic swine reared under intensive production conditions. Mexico City, with a human population over 19 million in 2005, has both urban and rural areas. The pig production in its rural area is based on small family backyard farms. Taking into account this rather unique form of rearing pigs, the objective of this study was to determine the seroprevalence in backyard pigs from the rural area of Mexico City. A total of 695 backyard pig serum samples from 108 small family farms belonging to seven municipal areas were studied by immunoperoxidase monolayer assay technique. One hundred six out of the 108 family farms (98.14%) had at least one positive serum sample. On the other hand, 136 (19.57%), 264 (37.99%) and 248 (34.82%) pigs had low, intermediate and high titres to PCV2, respectively. Only 53 samples (7.63%) were negative for PCV2 antibodies. No apparent differences in antibody titre groups were observed among backyard pigs from the different municipal areas. In conclusion, the present study, the first one performed in this kind of extensively produced pigs, indicates that PCV2 is ubiquitous in backyard pigs from Mexico City.

Animals↗
PubMed2004

A structured methodology to calculate traffic emissions inventories for city centres.

This study presents a methodology to estimate traffic emissions inventories for the case of city centres. It deals with the problem in a structured manner, identifying the sources and the formats of the input data as well as labelling the steps needed to perform the calculation. It describes a method to calculate the total mileage driven around the city using the concept of mileage per zone. Although the methodology employs a classical approach through the use of emission factors developed for mean speeds, it also discusses the possibility of applying these factors to instantaneous speeds. Finally, the study focuses on the influence of two critical factors: time resolution and the estimate of the total mileage. In both cases, the results indicate that the assumptions made are adequate and yield accurate results. The methodology has been applied to the city of Madrid as an example.

Journal Article↗
PubMed2004

Knowledge, attitudes and experiences of sex trafficking by young women in Benin City, South-South Nigeria.

Benin City, the headquarters of Edo State, is known to have one of the highest rates of international sex trafficking of young women in Nigeria. This study was designed to determine the knowledge, attitudes and experiences of young women in Benin City, towards international sex trafficking. A random household sample of 1456 women aged 15-25 years was interviewed with a structured questionnaire that elicited information on women's experiences of, and attitudes towards international sex trafficking. The results indicate that 97.4% of the women have heard of international sex trafficking; 70% had female relatives who lived in the receiving countries of Italy, Spain, and the Netherlands; while 44.0% knew of someone who was currently engaged in sex work abroad. Up to 32% of the women reported that they had been approached by someone offering to assist them to travel abroad. Women of poorer socio-economic status (being out-of-school, unemployed, parents uneducated and unemployed) were more likely to report having been offered assistance to travel abroad. Up to 81.5% of the women supported the notion that sex trafficking should be stopped, while 18.5% felt it should be allowed to continue. The perception that sex trafficking leads to wealth creation and economic gains for women was the most common reason proffered by those wanting the practice to continue. By contrast, the fear of adverse health consequences and the need to maintain social and religious morals were the reasons given by those wanting the practice to discontinue. These results suggest that programs that promote the economic well being of women, and social advocacy focusing on harm reduction will be most helpful in reducing the rate of sex trafficking in Benin City.

Adolescent↗
PubMed2005

Cities and population health.

A majority of the world's population will live in urban areas by 2007 and cities are exerting growing influence on the health of both urban and non-urban residents. Although there long has been substantial interest in the associations between city living and health, relatively little work has tried to understand how and why cities affect population health. This reflects both the number and complexity of determinants and of the absence of a unified framework that integrates the multiple factors that influence the health of urban populations. This paper presents a conceptual framework for studying how urban living affects population health. The framework rests on the assumption that urban populations are defined by size, density, diversity, and complexity, and that health in urban populations is a function of living conditions that are in turn shaped by municipal determinants and global and national trends. The framework builds on previous urban health research and incorporates multiple determinants at different levels. It is intended to serve as a model to guide public health research and intervention.

Emigration and Immigration↗
PubMed2004

Ecological analysis and description of the intestinal helminths present in dogs in Mexico City.

The objective of the present study was to determine the prevalence of parasitoses in stray dogs from Mexico City, as well as to describe the structure of the intestinal helminth communities present in said hosts. One hundred and twenty dog intestines were collected and dissected to evaluate their parasitic load; finding parasites in 102 dogs (85%). The cestodes collected were: Dipylidium caninum in 72 dogs (60%), Taenia hydatigena in three (2.5%), Taenia pisiformis in two (1.6%), Echinococcus granulosus, Mesocestoides vogae and Mesocestoides variabilis in only one animal each (0.83%), the latter two being collected for the first time ever in Mexico City. Nematodes collected were: Ancylostoma caninum in 75 (62.5%) animals, Toxocara canis in 16 (13.3%) and Toxascaris leonina in 5 (4.16%). By age, D. caninum and A. caninum were the most prevalent species in older animals, while T. canis was more prevalent in young animals (P<0.05). By season, T. canis was most common in the dry season (P<0.05). At the parasitic community level, the diversity value was 0.32, while that of equality was 0.1; the dominant species was M. vogae (Berger-Parker index of 0.95). At the infracommunity level, both diversity and equality were low (0.31 and 0.32, respectively) as compared to that observed in wild canines; the dominant species was A. caninum (Berger-Parker index of 0.37). Qualitative similarity was 33.8%, while quantitative similarity was 32.2%. Based upon the low values for mean diversity, equality and species richness, it is possible to deduce that helminth fauna in dogs from Mexico City is weakened, especially if one compares it to that of other wild canines.

Age Factors↗
PubMed2000

[Evolution of the prevalence of HIV infection and risk behavior of drug injection among intravenous drug users infected or not infected by HIV in 3 Spanish cities. Working Group of Physicians of the World for the monitoring of HIV infection and risk behaviors in intravenous drug users].

OBJECTIVE: To know the evolution of HIV prevalence and risk behavior practices of drug injection in three spanish cities on the basis of the serologic status of injecting drug users. METHODS: Cross-sectional surveys among users in syringe interchange programmes. RESULTS: HIV prevalence (self-reported) decreased in Madrid from 50% (1992) down to 41% (1996) (p = 0.01) and did not change in Seville and Valencia from 1994 to 1996. Among HIV-positive injecting drug users, a decrease was observed in the practice of giving and taking used syringes in the three cities, although this decrease reached a statistically significance (p = 0.006) only for giving in Valencia from 1994 to 1996 and was almost significant (p = 0.08) for taking in Madrid from 1993 to 1996. Among HIV-negative injecting drug users, no decreases were observed in the practice of giving and taking used syringes and even a significant increase in giving syringes in Seville was recorded (p = 0.01) from 1994 to 1996. CONCLUSIONS: HIV prevalence among injecting drug users is stabilized or decreasing in the three studied cities. The prevalence of injecting risk behavior evolves differently according to the serologic status.

Adult↗
PubMed2003

[Short-term relationship between air pollution and mortality in 13 Spanish cities].

BACKGROUND AND OBJECTIVE: EMECAM is a collaborative project that seeks to evaluate the short-term effects of air pollution on mortality in Spain. MATERIAL AND METHOD: We collected data for air pollutants (particles and gases), daily mortality (total except external, cardiovascular and respiratory causes) and co-variables (temperature, humidity, influenza and calendar variables) in 13 Spanish cities. The magnitude of the association in every city was estimated using GAM under a Poisson distribution. Combined estimates for each cause and pollutant were obtained under 'fixed effects' and 'random effects'models. RESULTS: An increase of 10 (g/m3 in the levels of the average of the concurrent and one day lag for black smoke was associated with a 0.8% (CI: 0.4-1.1) increase in mortality. The same increase in the concentration of SO2 was associated with a 0.5% (CI: 0.1-1.0) increase in daily deaths, and a 0.6% (CI: 0.3-0.8) increase in the case of NO2. An increase of 1 mg/m3 in the levels of CO was associated with an increase of 1.5% (CI: 0.5-2.6) in daily deaths. CONCLUSIONS: There is a short-term association between increases of daily levels of air pollutants and the number of daily deaths in Spanish cities.

Air Pollution↗
PubMed1989

Leptospiral and hepatitis A antibodies amongst windsurfers and waterskiers in Bristol City Docks.

Previous epidemiological studies have detected a substantial risk of gastroenteritis associated with snorkel swimming events in the Bristol City Docks. The event has since been discontinued. Similar risks were not identified at that time for surface-based events. A subsequent fatality from Weil's disease (Leptospirosis) and a case of Hepatitis A associated with surface water immersion in the Bristol City Docks water prompted this study of Leptospiral and Hepatitis A immunity amongst regular windsurfers and waterskiers. Although one person showed evidence of past Leptospiral infection and several people showed evidence of previous Hepatitis A, a causal association with Docks water exposure was not established. Nevertheless, there was sufficient public concern to justify the introduction of precautions against the potential health risks associated with immersion in the City Docks. The study findings and these preventive measures are described.

Adolescent↗
PubMed1999

Removal of cockroach allergen from inner-city homes.

BACKGROUND: Allergen avoidance has been shown to improve the morbidity and physiology of asthma. Although cockroach allergen has been implicated in chronic asthma, little work has been reported on the feasibility of allergen removal from infested homes. OBJECTIVE: The objective of this study was to examine the effect of professional pest control and home cleaning on cockroach infestation and allergen concentrations in settled dust samples from the kitchens, bedrooms, and television-living rooms of inner-city homes. METHODS: Thirteen homes in inner-city Baltimore, Maryland, received a professional cleaning, with vacuuming and a thorough cleaning in the kitchen. Pest control technicians applied abamectin 0.05% gel to the kitchen and, to a limited extent, to the rest of the home and the cleaning was repeated. Technicians visited monthly from month 2 to month 8 to inspect, collect dust samples, and place passive cockroach traps. Bla g 1 concentrations in dust extract were measured by means of ELISA. RESULTS: The number of cockroaches captured in passive traps decreased rapidly in 11 homes, but complete extermination was achieved in only 7 homes. Bla g 1 concentrations were reduced by 93% in kitchens, 77% in television-living rooms, and 74% in bedrooms. The relative reduction in cockroach allergen was not related to successful extermination or to signs of poor house-cleaning. CONCLUSION: We concluded that cockroach extermination is feasible in inner-city homes but that standard house-cleaning procedures are only partially effective in removing residual allergen over 8 months.

Allergens↗
PubMed2003

Hopelessness and risk behaviour among adolescents living in high-poverty inner-city neighbourhoods.

Ethnographic literature on inner-city life argues that adolescents react to their uncertain futures by abandoning hope, leading them to engage in high levels of risk behaviour. However, few quantitative studies demonstrate this relationship. This study tests this relationship using a survey of 2468 inner-city adolescents, asking them questions about hopelessness, violent and aggressive behaviour, substance use, sexual behaviour, and accidental injury. Nearly 50% of males and 25% of females had moderate or severe feelings of hopelessness. Moreover, hopelessness predicted of each of the risk behaviours considered. These results suggest that effective prevention and intervention programmes aimed at inner-city adolescents should target hopelessness by promoting skills that allow them to overcome the limitations of hopelessness.

Adolescent↗
PubMed1998

Risks and benefits of private health care: exploring physicians' views on private health care in Ho Chi Minh City, Vietnam.

As in a number of other low- and middle-income countries, the health sector in Vietnam is transforming with a rapid shift from fully state run and financed health care towards more private financing and delivery of health care. This development has been particularly noticeable in the largest city in the country, Ho Chi Minh City, where a majority of physicians now are practising in private clinics and where the private health care sector is an increasingly popular option for people. While the private sector is an important part of the health care system in Vietnam, few data are available on the characteristics and quality of private health care services. This case study describes some aspects of the re-emerging private health care sector in Ho Chi Minh City, Vietnam, from the view of 27 private and non-private physicians. The paper explores physicians' reasons for going private, physicians' notions of patients' health care preferences, and physicians' views on potential influence of financial incentives on characteristics of private health care. The characteristics of private health care are discussed in relation to a context of private health care characterised by a fully patient-financed fee-for-service payment system, weak regulatory mechanisms, and a public health care system (government-run and-financed health care) that operates under resource constraints. Issues to consider when attempting to steer private health care in Vietnam in a direction where it can optimally contribute to public health, are discussed while considering the interplay between authorised private practitioners, private pharmacies, the informal private sector, and the public health care sector.

Adult↗
PubMed1996

Lifestyle, environmental pollution and lung cancer in cities of Liaoning in northeastern China.

Several studies were conducted in cities of Liaoning Province, one of the areas of China with heavy concentrations of industry, to investigate the effects of life-style factors and environmental pollutants on lung cancer causation. A case-control study involving 1249 lung cancer patients and 1345 population-based controls was conducted in 1985-1988 in Shenyang, the capital of Liaoning. Cigarette smoking was found to be the principal cause of lung cancer in this population, accounting for 55% of the disease in males and 37% in females. There was also a significant increase in lung cancer risk associated with an overall index of indoor air pollution due to coal-burning emission. The population attributable risk (PAR) for indoor air pollution was 13% for males and 17% for females. Risks were significantly increased for workers in the non-ferrous smelter (odds ratio (OR) = 2.6, 95% CI, 1.3-5.1), chemical and drug manufacturing (OR = 3.0, 95% CI, 1.0-8.0), and the glass and pottery industry (OR = 1.6, 95% CI, 1.0-2.5). Studies in the Anshan Iron-Steel Complex showed a significant excess of lung cancer for workers exposed to a variety of dusts. A standardized proportional mortality ratio (SPMR) study of 8887 deaths during 1980-1989 among male workers of the complex indicated a 37% excess risk of lung cancer compared to residents of the city. A nested case-control study was then conducted in that complex. A total of 610 cases of lung cancer diagnosed during 1987-1993 and 959 randomly selected controls from 196 993 active and retired employees of the complex were interviewed. Historical monitoring records for dust and benzo(a)pyrene (B(a)P) were collected from 1956-1992 to calculate cumulative exposure for each person. Results suggested that risks were increased for all occupations in which there was exposure to dusts, with the highest risks seen among coke oven workers (OR = 3.5, 95% CI, 2.0-6.4) and fire-resistant brick makers (OR = 2.9, 95% CI, 1.9-4.4). Significant dose-response patterns between cumulative total dust, cumulative total B(a)P and lung cancer risk were observed. The findings suggest that smoking and environmental pollution combine to account for elevated rates of lung cancer in cities of northeastern China.

Adenocarcinoma↗
PubMed1991

Prevalence of HIV antibody in a noninner-city university hospital emergency department.

STUDY HYPOTHESIS: To determine the prevalence of antibody to human immunodeficiency virus (HIV) in trauma and nontrauma patients not identified as having known HIV infection in a noninner-city university teaching hospital emergency department, and to determine the frequency with which treating emergency physicians are knowledgeable of patients' risk factors for HIV infection. POPULATION: ED patients between 18 and 59 years old with injuries that met trauma center triage criteria or with nontrauma-related illness who had blood drawn for physician-requested laboratory tests and for whom an extra aliquot of blood was available for HIV antibody testing. METHODS: All serum samples were first tested for antibody to HIV by enzyme-linked immunosorbent assay. If positive, the specimen was retested. All repeatedly reactive specimens were analyzed by Western blot test. The treating physician completed a questionnaire regarding the patient's illness and risk factors for HIV infection after the patient's care was completed. RESULTS: Two of 100 major trauma patients (confidence interval, 0% to 5%) and seven of 100 nontrauma patients (confidence interval, 2% to 12%) had antibody to HIV. The seropositive rate by age and clinical group varied from 0% to 12.5%, with the highest rates in the 30- to 39-year-old group of nontrauma patients. The difference in proportions of seropositivity between the sexes was not statistically significant. Physicians obtained information regarding homosexual or bisexual behavior, IV drug use, and hemophilia from 52% of the nontrauma patients and only 17% of trauma patients. None of 30 trauma patients for whom data were available and only two of the 100 nontrauma patients gave a history of any high-risk behavior. CONCLUSION: Although the sampling technique we used has limitations, the prevalence of HIV infection in our noninner-city ED is similar to that recently reported from inner-city EDs. This is in contrast to previous reports of low rates of HIV infection among ED patients in nonurban settings. Physician assessment of risk factors was incomplete in the majority of our patients. Patients rarely acknowledged any high-risk behavior. It is essential that emergency health care workers take maximum diligence to prevent exposure to blood and other body fluids from all ED patients.

Adult↗