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PubMed2006

No difference in HIV incidence and sexual behaviour between out-migrants and residents in rural Manicaland, Zimbabwe.

OBJECTIVES: Migration is associated with HIV infection, but the relationship has been mostly assessed in cross-sectional studies. In a prospective study, we investigated whether out-migrants are a selection of high-risk individuals and whether rural-to-urban migration results in risky sexual behaviour for HIV incidence. METHODS: A population cohort was enrolled in a stratified household census in four different community types in Manicaland, east Zimbabwe, between July 1998 and February 2000, and followed-up after 3 years. Out-migrants to the national capital (Harare), the provincial capital (Mutare) and other study areas were followed-up. A structured questionnaire was administered and an HIV test was conducted at each interview. HIV prevalence and sexual risk behaviour at baseline, and HIV incidence and sexual behaviour during follow-up were compared for out-migrants and residents. RESULTS: At baseline, future migrants were significantly younger, better educated and more likely to be single than residents. For males, migration was highest from subsistence farming areas and roadside trading centres and lowest from estates. After adjusting for age, education, marital status and location, there were no differences in HIV prevalence and sexual risk behaviour between future migrants and residents at baseline, for either sex. No significant differences in HIV incidence or sexual behaviour during follow-up were detected between rural-to-urban out-migrants and residents. CONCLUSIONS: Out-migrants from rural Zimbabwe did not have higher levels of HIV infection or sexual risk behaviour than residents either before or after they moved. These findings may be related to the mature stage of the HIV epidemic and the social and living conditions of migrants in Zimbabwean cities.

Adolescent↗
PubMedDate not supplied

Creating a unit-specific charging system.

A totally nurse-dependent charging system developed specifically for the labor and delivery suite at the University of Maryland Medical System is described in the article. This easy and effective method of charging was incorporated into an already existing patient census and classification system. The number of relative value units has increased by more than 30%, and the amount of revenue billed has increased by more than $800,000 in the first 10 months after implementation.

Accounting↗
PubMed2000

Ulcerative colitis in Olmsted County, Minnesota, 1940-1993: incidence, prevalence, and survival.

BACKGROUND: There is significant geographic variation in the reported incidence of ulcerative colitis. AIMS: To update the incidence and prevalence of ulcerative colitis in Olmsted County, Minnesota, examine temporal trends, and determine overall survival. PATIENTS: All Olmsted County residents diagnosed with ulcerative colitis between 1940 and 1993 (incidence cases), and all residents with ulcerative colitis alive on 1 January 1991 (prevalence cases). METHODS: Incidence and prevalence rates were adjusted using 1990 US census figures for whites. The effects of age, sex, and calendar year on incidence rates were evaluated using Poisson regression. Survival from diagnosis was compared with that expected for US north-central whites. RESULTS: Between 1940 and 1993, 278 incidence cases were identified, for an adjusted incidence rate of 7.6 cases per 100 000 person years (95% confidence interval (CI), 6.7 to 8.5). On 1 January 1991, there were 218 residents with definite or probable ulcerative colitis, for an adjusted prevalence rate of 229 cases per 100 000 (95% CI, 198 to 260). Increased incidence rates were associated with later calendar years (p<0.002), younger age (p<0.0001), urban residence (p<0.0001), and male sex (p<0.003). Overall survival was similar to that expected (p>0.2). CONCLUSIONS: The overall incidence rate of ulcerative colitis in Olmsted County increased until the 1970s, and remained stable thereafter. Incidence rates among men and urban residents were significantly higher. The prevalence rate in Rochester in 1991 was 19% higher than that in 1980. Overall survival was similar to that of the general population.

Adolescent↗
PubMed2002

Risk of birth defects by parental occupational exposure to 50 Hz electromagnetic fields: a population based study.

OBJECTIVES: To study the risk of birth defects by parental occupational exposure to 50 Hz electromagnetic fields. METHODS: The Medical Birth Registry of Norway was linked with census data on parental occupation. An expert panel constructed a job exposure matrix of parental occupational exposure to 50 Hz magnetic fields. Exposure to magnetic fields was estimated by combining branch and occupation into one of three exposure levels: <4 hours, 4-24 hours, and >24 hours/week above approximately 0.1 mu T. Risks of 24 categories of birth defects were compared across exposure levels. Out of all 1.6 million births in Norway in the period 1967-95, 836,475 and 1,290,298 births had information on maternal and paternal exposure, respectively. Analyses were based on tests for trend and were adjusted for parents' educational level, place of birth, maternal age, and year of birth. RESULTS: The total risk of birth defects was not associated with parental exposure. Maternal exposure was associated with increased risks of spina bifida (p=0.04) and clubfoot (p=0.04). A negative association was found for isolated cleft palate (p=0.01). Paternal exposure was associated with increased risks of anencephaly (p=0.01) and a category of "other defects" (p=0.02). CONCLUSION: The present study gives an indication of an association between selected disorders of the central nervous system and parental exposure to 50 Hz magnetic fields. Given the crude exposure assessment, lack of comparable studies, and the high number of outcomes considered, the results should be interpreted with caution.

Adult↗
PubMed1997

Smoking and bronchial responsiveness in nonatopic and atopic young adults. Spanish Group of the European Study of Asthma.

BACKGROUND: Smoking may influence the response of the lungs to other inhaled substances. A study was undertaken to assess the effect of the interaction between smoking and the immunoresponse to common aeroallergens (atopy) on bronchial responsiveness. METHODS: A random sample was selected from the general population census of five areas of Spain (Albacete, Barcelona, Galdakao, Huelva, and Oviedo). A total of 1169 (35%) subjects completed a face-to-face respiratory questionnaire, a methacholine bronchial responsiveness challenge, and underwent measurements of total and specific serum IgE levels to mites, pets and moulds. A survival model (Weibull) was used to examine the methacholine dose-response relation, adjusting for bronchial obstruction. RESULTS: Smokers showed greater bronchial responsiveness than never smokers (p < 0.05) at any dose of methacholine, but only among non-atopic individuals. Atopy had a large effect on responsiveness at low levels of methacholine, but smoking did not increase responsiveness in atopic subjects. There were no differences in intensity or cessation of smoking between atopic and non-atopic subjects, suggesting that smoking self-selection does not fully explain these results. CONCLUSIONS: The association between smoking and bronchial responsiveness varies with atopy, which may be explained by different immunological and/or inflammatory effects of smoking on atopy.

Adult↗
PubMed2005

Mortality from human transmissible spongiform encephalopathies: a record linkage study.

To evaluate the ability of the Italian Creutzfeldt-Jakob (CJD) register to detect human transmissible spongiform encephalopathy (TSE) cases we compared mortality data from the CJD register with those obtained from death certificates collected by the Italian National Census Bureau (ISTAT) between 1993 and 1999. We used the method of record linkage to compare and integrate data from these two sources. The integrated estimate of TSE deaths was 457: 183 deaths recorded by the CJD register and ISTAT, 210 cases only by the CJD register, and 64 cases only by ISTAT. The average integrated estimated mortality rate was 1.58 deaths per million people per year over the study period and peaked in 1999 at 2.13. This figure is similar to that obtained from data from the CJD register alone in the years 2000-2002. The increase in mortality rates is likely due to an improvement in case ascertainment. The misclassification of cases by ISTAT was above 50% from 1996 onward, suggesting that using only death certificates is not a reliable way to monitor TSE cases in Italy.

Adult↗
PubMed1996

Neonatal seizures in the United States: results of the National Hospital Discharge Survey, 1980-1991.

We present nationally representative estimates of neonatal seizure risk by gender, race and geographic region of the United States. National Hospital Discharge Survey data were analyzed for the period 1980-1991. Birth-weight-adjusted risks of neonatal seizures were calculated by the direct method for each gender or race group and for each census region by 4-year intervals. The overall risk of neonatal seizures was 2.84 per 1,000 live births. Risk estimates were consistently higher in low-birth-weight infants (relative risk 3.9). Unadjusted risks were similar across race and gender groups; birth weight adjustment had very little effect. No clear temporal trend was apparent over the 12-year study period. National Hospital Discharge Survey data provide reasonable, although conservative, estimates of neonatal seizure risks nationwide. Underascertainment of neonatal seizures, particularly among sick low-birth-weight infants, is likely due to data collection limitations of the National Hospital Discharge Survey.

Birth Weight↗
PubMed1995

Effects of interstate migration on the geographic distribution of stroke mortality in the United States.

BACKGROUND AND PURPOSE: This study examines the effects of lifetime net interstate migration on the geographic distribution of stroke mortality in the United States. METHODS: National Center for Health Statistics and Bureau of the Census data were used to map the geographic distribution of age-adjusted, race-, and race/sex-specific stroke mortality rates by interstate migration status for natives, outmigrants, nonmigrants, inmigrants, and residents in the United States for 1979 to 1981. RESULTS: High age-adjusted stroke mortality rates were significantly clustered in the southeastern United States for both whites and blacks; in addition, for whites, low-rate states were concentrated in some Mountain and northeastern states. Migrant status did not change this large-scale pattern, but individual states showed significant migration effects, which varied in magnitude and direction. Among whites, states that benefited from migration, with markedly lower stroke mortality rates among residents than natives, included Arizona, Colorado, District of Columbia, and Florida, whereas states that suffered from migration included California, Idaho, Montana, North Dakota, Nevada, and Oklahoma. Among blacks, only Colorado showed an apparent large benefit from migration, whereas 21 states suffered from migration. CONCLUSIONS: Although the overall large-scale spatial distribution of resident stroke mortality rates cannot be explained by migration effects, some individual states had rates that were strongly influenced by migration. Patterns of mortality among migrant groups in Sun Belt retirement destination states probably result from differential selection effects for retirement migration in older adults. Patterns of mortality for black migrants to the North are probably influenced by "carryover" effects from their origin states.

Adult↗
PubMed1995

Geographic variation in the decline of stroke mortality in the United States.

BACKGROUND AND PURPOSE: This study examines the geographic variation in the decline of stroke mortality rates in the United States. METHODS: National Center for Health Statistics and Bureau of the Census data were used to assess regional and state level temporal trends of stroke mortality in the United States for 1970 to 1989. RESULTS: Underlying- and multiple-cause stroke mortality rates have declined fairly steadily in all regions of the United States and for all race/sex groups, although the rates of decline were greater during 1970 to 1978 than during 1979 to 1989. The declines in underlying-cause rates could not be attributed to a shift toward reporting stroke as a contributing rather than underlying cause of death, since both underlying- and multiple-cause rates declined similarly. There was significant regional variation in the rate of decline, particularly during 1979 to 1989. The South initially had the highest rates, but it experienced the most rapid decline, so that by 1989 the South no longer had the highest rates. States with the most rapid rates of decline were significantly clustered in the South and particularly the Southeast. Most of the decline in overall stroke mortality was due to declines in ischemic stroke mortality. CONCLUSIONS: During 1970 to 1989 there was significant geographic variation in the rate of decline of stroke mortality rates, with the most rapid rates of decline concentrated in the high-rate areas of the South and particularly the Southeast. As a result, there has been a decrease in interregional and interstate variation in stroke mortality rates, which is apparently not due to an artifact of changing reporting patterns.

Age Factors↗
PubMed1996

Comparison of additive and multiplicative models of regional variation in the decline of stroke mortality in the United States.

BACKGROUND AND PURPOSE: Although previous studies have shown that geographic variation in the decline of stroke mortality rates may be an important contributor to the changing geographic distribution of stroke mortality in the United States, some concern has been raised that this phenomenon may be model dependent. This study examines the geographic variation in the decline of stroke mortality rates in the United States with the use of both additive and multiplicative models. METHODS: National Center for Health Statistics and Bureau of the Census data were used to assess regional-level temporal trends of underlying-cause stroke mortality rates in the United States for 1979 through 1989. Both additive and multiplicative models were fit to the data. RESULTS: Underlying-cause stroke mortality rates have declined fairly steadily in all regions of the United States and for all race-sex groups, although there was significant regional variation in the rate of decline during the period 1979 through 1989. The South, which initially had the highest rates, had the most rapid decline for all race-sex groups when either additive or multiplicative models were used. CONCLUSIONS: From 1979 through 1989 there was significant geographic variation in the rate of decline of stroke mortality rates, with the most rapid rates of decline in the South. As a result, there has been a decrease in interregional variation in stroke mortality rates.

Age Factors↗
PubMed1997

Geographic distribution of stroke mortality among immigrants to the United States.

BACKGROUND AND PURPOSE: This study examines the geographic distribution of stroke mortality among immigrants and natives of the United States. METHODS: National Center for Health Statistics and Bureau of the Census data were used to determine the geographic distribution of age-adjusted, race-, and race/sex-specific stroke mortality rates among immigrants and natives of the United States for 1979 to 1981. RESULTS: For whites and blacks and for each of the respective race/sex groups, immigrants had markedly and highly statistically significantly lower age-adjusted stroke mortality rates than either the entire US-born resident population or the US-born interregional migrant population. The spatial pattern of immigrant rates did not parallel the patterns for US-born populations. Immigrant rates were highest in the West and lowest in the Midwest for whites and highest in the Midwest and lowest in the Northeast for blacks, whereas for both US-born whites and blacks, resident and native rates were highest in the South and lowest in the Midwest. With few exceptions, region-specific immigrant rates for whites and blacks were significantly lower than rates for either US-born regional residents, US-born migrants to the regions, or US-born natives of the regions. In contrast, white immigrants to the West had significantly higher rates than US-born groups in that region. CONCLUSIONS: Selection factors strongly influence stroke mortality rates among immigrants to the United States. The aberrantly high rates among white immigrants to the West may in part reflect a bias due to large census undercounts of this population.

Adult↗
PubMed2003

Central corneal thickness in Latinos.

PURPOSE: To characterize central corneal thickness (CCT) in Latinos aged 40 or more years. METHODS: A population-based cohort of Latinos from two census tracts in La Puente, California, underwent measurements of CCT and intraocular pressure (IOP). CCT was measured with an ultrasonic pachymeter, and IOP was measured by applanation tonometry. One eye of each of 1699 participants was included in the analyses. RESULTS: The mean (+/-SD) CCT was 546.9 +/- 33.5 micro m. Older participants (>or=70 years) had significantly thinner CCs compared with participants 40 to 49 years of age (P < 0.05). Eyes with ocular hypertension had thicker CCs than did normal and glaucomatous eyes (P < 0.05). Multivariate adaptive regression spline analyses and analysis of variance contrasting IOP subgroups revealed that eyes with thinner CCs had lower IOP than did eyes with thicker CCs (P < 0.001). The absolute range of interocular differences in CCT in the same subject was as high as 24 micro m. CONCLUSIONS: On average, CCT in Latinos was less than that previously reported in whites but greater than that reported in African Americans and Asians. Older Latinos had thinner corneas compared with younger Latinos. Asymmetry in CCT of 25 micro m or more should be evaluated for potential corneal disease. Spline analyses suggest that although the relationship between IOP and CCT is best explained by a nonlinear equation, when measuring IOP with the Goldmann tonometer, it is likely that IOP is underestimated in eyes with thinner CCs and overestimated in eyes with thicker CCs.

Adult↗
PubMed1996

Trends in state and county mental hospitals in the U.S. from 1970 to 1992.

OBJECTIVE: The authors document changes in state mental hospitals from 1970 to 1992 in four areas: the number of hospitals, the average daily census, expenditures, and number of full-time-equivalent staff. METHODS: Data examined were derived from information collected in the Inventory of Mental Health Organizations and General Hospital Mental Health Services. RESULTS: From 1970 to 1992, the number of state hospitals dropped from 310 to 273, and their inpatient populations were drastically reduced (a 77 percent decrease), a continuation of a trend that began in 1956. Most of the reduction was due to the downsizing of existing hospitals rather than to hospital closings. A complex combination of medical, social, economic, legal, and political factors were responsible for the decrease. Although expenditures for state hospitals were nearly $8 billion in 1992, a 339 percent increase over 1970, the level of expenditures in current dollars has leveled off in recent years, and expenditures measured in constant dollars (adjusted for inflation) have actually decreased since the early 1980s. The number of professional patient care staff increased by about half, while nonprofessional staff decreased by about the same proportion. CONCLUSIONS: In the near future, it appears that state hospitals will continue to reduce their patient populations, although at a slower rate than in the past, and will continue to care for large numbers of persons who either are involuntarily admitted or do not have alternative living arrangements. However, state hospitals are likely to decrease in importance.

Forecasting↗
PubMed2005

Photo-identification, site fidelity, and movement of female gray seals (Halichoerus grypus) between haul-outs in the Baltic Sea.

The growing gray seal population in the Baltic Sea has led to increased conflicts with fisheries. Despite limited data on gray seal ecology, management measures, such as culling, have been implemented recently. We studied movements and site fidelity of Baltic gray seals using mark-recapture analysis based on photographic identification of individuals (photo-id). Seals were photographed at the major summer haul-out sites. Profile photographs of the head and neck were matched using purpose-written software to generate a database of capture histories from 1995-2000. The haul-outs were grouped into seven areas. Darroch's method (20) for a two-sample capture-recapture census was adapted to estimate rates of movement between the areas. The majority of seals were estimated to remain within the same area, suggesting that Baltic gray seals exhibit a high degree of site fidelity during the summer, and that fidelity to a site lasts for more than one season.

Animals↗
PubMed1998

Measuring the burden of disease: healthy life-years.

OBJECTIVES: This paper presents the background and rationale for a composite indicator, healthy life-year (HeaLY), that incorporates mortality and morbidity into a single number. HeaLY is compared with the disability-adjusted life-year (DALY) indicator, to demonstrate the relative simplicity and ease of use of the former. METHODS: Data collected by the Ghana Health Assessment team from census records, death certificates, medical records, and special studies were used to create a spreadsheet. HeaLYs lost as a result of premature mortality and disability from 56 conditions were estimated. RESULTS: Two thirds of HeaLYs lost in Ghana were from maternal and communicable diseases and were largely preventable. The age weighting in DALYs leads to a higher value placed on deaths at younger ages than in HeaLYs. This spreadsheet can be used as a template for assessing changes in health status attributable to interventions. CONCLUSIONS: HeaLY can aid in setting health priorities and identifying disadvantaged groups. The disaggregated approach of the HeaLY spreadsheet tool is simpler for decision makers and useful for country application.

Cost of Illness↗
PubMed1998

Income inequality and mortality in metropolitan areas of the United States.

OBJECTIVES: This study examined associations between income inequality and mortality in 282 US metropolitan areas. METHODS: Income inequality measures were calculated from the 1990 US Census. Mortality was calculated from National Center for Health Statistics data and modeled with weighted linear regressions of the log age-adjusted rate. RESULTS: Excess mortality between metropolitan areas with high and low income inequality ranged from 64.7 to 95.8 deaths per 100,000 depending on the inequality measure. In age-specific analyses, income inequality was most evident for infant mortality and for mortality between ages 15 and 64. CONCLUSIONS: Higher income inequality is associated with increased mortality at all per capita income levels. Areas with high income inequality and low average income had excess mortality of 139.8 deaths per 100,000 compared with areas with low inequality and high income. The magnitude of this mortality difference is comparable to the combined loss of life from lung cancer, diabetes, motor vehicle crashes, human immunodeficiency virus (HIV) infection, suicide, and homicide in 1995. Given the mortality burden associated with income inequality, public and private sector initiatives to reduce economic inequalities should be a high priority.

Adolescent↗
PubMed2003

Delivering equitable care: comparing preventive services in Manitoba.

OBJECTIVES: This study examined preventive care delivered in Manitoba during the 1990s by 3 different methods -childhood immunizations (by physicians and public health nurses under a government program), screening mammography (through a government program introduced in 1995), and cervical cancer screening (no program). METHODS: Longitudinal administrative data, an immunization monitoring system, and Canadian census databases were used. RESULTS: Cervical cancer screening rates remained static and showed strong socioeconomic differences; childhood immunization rates remained high with small socioeconomic gradients. The introduction of the Manitoba Breast Screening Program resulted in rising rates of screening and vanishing socioeconomic gradients. CONCLUSIONS: Manitoba government programs in childhood immunization and screening mammography actively helped the provision of preventive care. Organized programs that target population groups, recognize barriers to access, and facilitate self-evaluation are critical for equitable delivery.

Adult↗
PubMedDate not supplied

Neighborhood, family, and child predictors of childhood injury in Canada.

OBJECTIVE: To examine independent and combined effects of child, family and neighborhood on medically attended childhood injuries. METHODS: Logistic modeling of longitudinal data (n=9796) from the Census Linked National Longitudinal Survey of Children and Youth. RESULTS: Child age and gender were strong predictors of injuries. Smaller effects were found for parenting, neighborhood cohesion among difficult children less than 2 years old, and neighborhood disadvantage among aggressive children 2-3 years old. CONCLUSION: Neighborhood in addition to parenting can affect injury risk. Further research is needed into the influence of neighborhood disadvantage and the processes of neighbor's cohesion at different childhood stages.

Adolescent↗