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PubMed2001

Emergency medical care in rural America.

The delivery of high-quality emergency care in a rural setting requires a conceptual framework quite different from that required in urban and suburban environments, given that available resources are limited in the rural setting. The intermittent and episodic nature of seriously ill and injured patients who present to rural emergency departments makes it difficult to plan, staff, and equip in order to provide emergency medical care at the same level seen at higher volume urban or suburban institutions. The objective of this article is to describe the distinctive nature and widely unrecognized features of emergency medicine in rural and remote areas, with a focus on clinical, workforce, and economic issues. We present recommendations for a shift in thinking and a call to action on behalf of all emergency medicine professionals that are based on a realistic assessment of the current status of emergency medicine and that are needed to develop and sustain high-quality emergency medical care in rural America.

Emergency Medical Services↗
PubMedDate not supplied

Teachers' perceptions of school violence.

INTRODUCTION: Pediatric nurse practitioners, especially those working in the school settings, often interact with children and teachers who confront school violence. This descriptive study was conducted to obtain teachers' insights into the problems of school violence. METHOD: Voluntary questionnaire surveys were distributed to 536 elementary, middle, and high school teachers in a suburban school district in central Pennsylvania. Seventy-four percent returned usable surveys (n = 393). Data were tabulated and results are presented as percentages, frequencies, and chi-square analysis. RESULTS: Fifty-six percent of teachers believed that violence or the threat of violence had a direct impact on the quality of education they are able to provide. Elementary school teachers were more likely to be victims of a physical assault by a student (P =.0006) and more likely to fear parents (P =.002) than were other teachers. DISCUSSION: Even in suburban schools, teachers are likely to be victimized and fear students or their parents. This fear adversely affects the quality of education provided. Pediatric nurse practitioners play a significant role in addressing this public health concern.

Adolescent↗
PubMedDate not supplied

Effects of air pollution on adult pulmonary function.

We conducted a study in three representative areas of Beijing to determine respiratory health effects of indoor and outdoor air pollution. In August 1986, we measured the lung function of 1,440 adults who were 40-69 y of age and who had never smoked. Forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1.0) were adjusted for height, sex, and age. Outdoor ambient air pollution measurements from the World Health Organization Global Air Pollution Monitoring Station were very different in the three study areas; the annual mean concentrations of sulfur dioxide (SO2) in residential, suburban, and industrial areas were 128, 18, and 57 micrograms/m3, respectively, and annual mean concentrations of total suspended particulate matter (TSPM) were 389, 261, and 449 micrograms/m3, respectively. Coal was most frequently used for domestic heating in the residential (92%) and suburban (96%) areas compared with the industrial area (17%). Heating with coal was associated with a reduced FEV1.0 (-91 +/- 36 ml) and FVC (-84 +/- 41 ml). Living in the residential area was associated with an additional reduction in FEV1.0 (-69 +/- 34 ml) and FVC (-257 +/- 37 ml). After we adjusted for age, height, and sex, an inverse linear association was found between In outdoor SO2 (or TSPM) concentration and FEV1.0 and FVC in subjects who had and had not used coal stove heating. Regression analysis results showed that a per-unit increase in In SO2 (TSPM) concentration (microgram/m3) could result in a 35.6 (131.4) ml reduction in FEV1.0 and a 142.2 (478.7) ml reduction in FVC.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

A report of tuberculosis in cats in New Zealand, and the examination of strains of Mycobacterium bovis by DNA restriction endonuclease analysis.

Mycobacterium bovis was isolated from diagnostic samples from 57 cats submitted to New Zealand Animal Health Laboratories from 1974 to 1986. With six exceptions, these cats came from suburban and rural areas of New Zealand where M.bovis was also present in feral and wild animals, especially the brush-tailed possum. Tuberculous skin lesions were seen in 33 (58%) of the cats. Histologically, these lesions had some similarities to those of cat leprosy. Included in the 57 cats was a group of 12 tuberculous animals which were diagnosed in a suburban veterinary practice over a 3 month period. When these 12 M. bovis isolates were examined by DNA restriction endonuclease analysis, they were found to be identical. This evidence, together with the relatively short period during which the cases occurred, suggested that these cats were exposed to a single source of infection.

Journal Article↗
PubMed2006

Looking beyond urban/rural differences: emergency department utilization by asthmatic children.

Asthma causes pediatric morbidity throughout the US with substantial regional variability. Emergency department (ED) utilization data were studied to determine if geographic variability of pediatric asthma cases exists within a state. Records for non-neonatal Maryland children less than 18 years of age seen and discharged from Maryland EDs from April 1997 through March 2001 were analyzed. While Baltimore City had the highest rates of asthma visits, adjusted odds ratios identified the wealthiest suburban county to have a higher risk of an asthma ED visit. Children from rural counties, for the most part, had fewer ED asthma visits than children from urban and suburban counties.

Adolescent↗
PubMedDate not supplied

The second national growth and development survey of children in China, 1985: children 0 to 7 years.

To evaluate the normal physical growth and development of Chinese children and to compare the nutritional status of today with that of ten years ago, a second national cross-sectional growth survey was undertaken in the same urban and suburban rural areas of nine main cities in China in 1985 as in 1975. In this survey 152,874 boys and girls from birth to age 7.0 years were measured for weight, height, sitting height, and chest, head and upper arm circumferences. Compared with the results in 1975, the condition of growth and development of children for both boys and girls from urban or suburban rural areas has been relatively much improved. Average weight and height had increased in the past 10 years by 0.40 kg and 1.8 cm respectively, in 6-7-year-old children. The greater part of the increase in height has been due to increase in leg length. The urban-rural difference in stature has become smaller, as the increase has been greater in rural areas. The data from this survey can be used as a new growth standard for Chinese children.

Anthropometry↗
PubMedDate not supplied

Age at menarche and urbanization in Cameroon: current status and secular trends.

Status quo data on the age at menarche were obtained on samples of Cameroonian girls living in urban (Yaoundé) (n = 205), suburban (n = 505) and rural areas (n = 201). Mean ages at menarche, estimated by probit analysis, are 13.18 years (SD 1.08) in Yaoundé, 13.98 years (SD 1.55) in the suburban area, and 14.27 years (SD 1.65) in the rural area. The early menarcheal age observed in Yaoundé girls attending 'privileged schools' (12.72 years, SD 1.18) substantiates the hypothesis that in good environmental conditions Africans are as early-maturing as Asiatic or Mediterranean populations. Comparison with retrospective data on age at menarche during previous decades reveals the presence of a clear secular trend towards earlier maturation, at a rate of 2.5-3.2 months per decade, only in the main cities of the country (Yaoundé/Douala) and a lack of temporal variation in rural areas. The degree of urbanization influences maturational age and its evolution, probably through improvements in the nutritional standards.

Adolescent↗
PubMed2005

Association between moringness-eveningness preference and mental/physical premenstrual symptoms in Japanese females 12 to 31 years of age.

This study investigates the relationship between circadian typology, i.e., morningness-eveningness (M-E) preference, and the occurrence and severity of premenstrual mental and physical symptoms among 154 young Japanese female university students (range, 18 to 31 yrs; mean+/-S.D., 20.69+/-3.69 yrs) and 417 junior high school students (range, 12 to 15 yrs; mean+/-S.D., 14.29+/-0.67 yrs) living in an urban or suburban area of Kochi prefecture. Female university students experienced melancholy mood more frequently than did males, and the female university students who frequently became melancholy were more evening-typed than those who did not experience melancholy. Female university students who experienced frequent fluctuations in mood and/or menstrual pain were more evening-typed than those who were not so affected. M-E preference of junior high school students was not correlated with stability of mood or frequency of menstrual pain. In urban areas, however junior high school students who had very stable menstrual cycles were significantly more morning-typed than those whose menstrual cycles were not stable. In suburban areas, the bedtimes of female junior high students who had stable menstrual cycles were significantly earlier than those whose menstrual cycle duration was not stable. A physiological relationship between the circadian system, M-E, and attributes of the menstrual cycle seems to be present in adolescent female Japanese junior high school students.

Adolescent↗
PubMedDate not supplied

A meta-analysis of prehospital care times for trauma.

BACKGROUND: Time to definitive care is a major determinant of trauma patient outcomes yet little is empirically known about prehospital times at the national level. We sought to determine national averages for prehospital times based on a systematic review of published literature. METHODS: We performed a systematic literature search for all articles reporting prehospital times for trauma patients transported by helicopter and ground ambulance over a 30-year period. Forty-nine articles were included in a final meta-analysis. Activation time, response time, on-scene time, and transport time were abstracted from these articles. Prehospital times were also divided into urban, suburban, rural, and air transports. Statistical tests were computed using weighted arithmetic means and standard deviations. RESULTS: The data were drawn from 20 states in all four U.S. Census Regions and represent the prehospital experience of 155,179 patients. Average duration in minutes for urban, suburban, and rural ground ambulances for the total prehospital interval were 30.96, 30.97, and 43.17; for the response interval were 5.25, 5.21, and 7.72; for the on-scene interval were 13.40, 13.39, and 14.59; and for the transport interval were 10.77, 10.86, and 17.28. Average helicopter ambulance times were response 23.25, on-scene 20.43, and transport 29.80 minutes. CONCLUSIONS: Despite the emphasis on time in the prehospital and trauma literature there has been no national effort to empirically define average prehospital time intervals for trauma patients. We provide points of reference for prehospital intervals so that policymakers can compare individual emergency medical systems to national norms.

Efficiency, Organizational↗
PubMed2004

Size distribution and characterization of ultrafine particles in roadside atmosphere.

The number concentration and number size distributions of ultrafine particles were measured with a Scanning Mobility Particle Sizer (SMPS) at a roadside in early autumn and winter, and the results are discussed with regard to the contribution of traffic activity and meteorological conditions. The number concentration of the <50 nm fraction increased in the morning under calm wind conditions, and this increase corresponded with the increase in total traffic volume and nitric oxide. The increase in ultrafine particles was influenced not only by the increase in total traffic but also by the high contribution of diesel engine vehicles. The number concentration decreased around noon as the wind speed increased, although the total traffic and the number of diesel engine vehicles were at the same level as in the morning. The number size distribution in the morning was bimodal, with a first peak diameter of around 30 nm and a second of around 90 nm in both periods. The volatility of ultrafine particles was investigated using a thermal denuder operating at 250 degrees C. The first peak consisted mainly of volatile components, whereas the second one consisted of solid materials plus some volatile components. These results were consistent with the mass size distribution of elemental and organic carbon. The number size distribution with a peak diameter of around 30 nm was also observed in the afternoon at a suburban site; however, it was produced not by vehicle emissions directly but by photochemical reactions. Although a relatively high number concentration was also observed in the morning at the suburban site due to vehicle emission, the peak diameter ranged from 40 to 90 nm, which was larger than at the roadside.

Air Pollutants↗
PubMed2001

Geographic, demographic, and seasonal differences in penicillin-resistant Streptococcus pneumoniae in Baltimore.

We examined the epidemiology of invasive penicillin-resistant Streptococcus pneumoniae (PRSP) infections among residents of the Baltimore metropolitan area from 1995 through 1997. During this period, the proportion PRSP cases increased 42%, from 5.7% to 8.1% of cases. PRSP rates were highest among persons aged <5 and > or =65 years, black patients, and urban dwellers. However, the proportion of PRSP cases was higher among white persons (10%) than it was among black persons (5%) and among residents of suburban counties (10%) versus urban counties (6%). PRSP cases were more common in November-April (8%) than they were in May-October (5%), particularly for persons aged > or =65 years (10% vs. 1%). By use of logistic regression, white race, suburban residence, and winter respiratory season were found to be independent predictors of infection with PRSP. The incidence of PRSP is increasing in Baltimore, and the seasonality of PRSP suggests that recent antibiotic use, which is more common in winter months, may rapidly affect the prevalence of resistant pneumococcal infections.

Adolescent↗
PubMed2002

Effectiveness of virtual reality for teaching pedestrian safety.

Sixty percent to 70% of pedestrian injuries in children under the age of 10 years are the result of the child either improperly crossing intersections or dashing out in the street between intersections. The purpose of this injury prevention research study was to evaluate a desktop virtual reality (VR) program that was designed to educate and train children to safely cross intersections. Specifically, the objectives were to determine whether children can learn pedestrian safety skills while working in a virtual environment and whether pedestrian safety learning in VR transfers to real world behavior. Following focus groups with a number of key experts, a virtual city with eight interactive intersections was developed. Ninety-five children participated in a community trial from two schools (urban and suburban). Approximately half were assigned to a control group who received an unrelated VR program, and half received the pedestrian safety VR intervention. Children were identified by group and grade by colored tags on their backpacks, and actual street crossing behavior of all children was observed 1 week before and 1 week after the interventions. There was a significant change in performance after three trials with the VR intervention. Children learned safe street crossing within the virtual environment. Learning, identified as improved street-crossing behavior, transferred to real world behavior in the suburban school children but not in the urban school. The results are discussed in relation to possibilities for future VR interventions for injury prevention.

Accidents, Traffic↗
PubMed2001

Stability and change in children's intelligence quotient scores: a comparison of two socioeconomically disparate communities.

The authors estimated the influence of familial factors and community disadvantage on changes in children's intelligence quotient (IQ) scores from age 6 years to age 11 years. Data were obtained from a longitudinal study of the neuropsychiatric sequelae of low birth weight in two socioeconomically disparate, geographically defined communities in the Detroit, Michigan, metropolitan area. Representative samples of low birth weight and normal birth weight children from the City of Detroit (urban) and nearby middle-class suburbs (suburban) were assessed at age 6 years (in 1990-1992) and age 11 years (in 1995-1997) (n = 717). Children's IQs were measured using the Wechsler Intelligence Scale for Children-Revised. The familial factors considered included maternal IQ, education, and marital status. Multiple regression analysis applying generalized estimating equations was used. The IQs of urban children, regardless of birth weight, declined from age 6 years to age 11 years. The downward shift increased by 50% the proportion of urban children scoring 1 standard deviation below the standardized IQ mean of 100. A negligible change was observed in suburban children. Maternal IQ, education, and marital status and low birth weight predicted IQ at age 6 years but were unrelated to IQ change. Growing up in a racially segregated and disadvantaged community, more than individual and familial factors, may contribute to a decline in IQ score in the early school years.

Birth Weight↗
PubMed2004

Ultrafine particulate matter and high-level benzene urban air pollution in relation to oxidative DNA damage.

Air pollution, containing high-level of ultrafine particles (UFP) and benzene, is a prominent environmental health problem in many cities of the World. We investigated the level of oxidative DNA damage in mononuclear blood cells (MNBC) by the comet assay as DNA strand breaks (SB) and formamidopyrimidine DNA glycosylase (FPG) sensitive sites in residents from three urban locations in Cotonou, Benin (taxi-moto drivers, subjects living near roads with intense traffic and suburban residents) and rural residents. Exposure was characterized by urinary excretion of S-phenylmercapturic acid (S-PMA), a biomarker of benzene exposure, and by ambient UFP. There were clear stepwise gradients with respect to ambient UFP, S-PMA excretion and oxidative DNA damage with rural subjects < suburban subjects < residents living near highly trafficed roads<taxi-moto drivers. Polymorphisms in glutathione peroxidase (GPX), NAD(P)H:quinone oxidoreductase 1 (NQO1) and glutathione S-transferase (GST) genes were assessed for effect modification. Subjects with GSTT1 null genotype had lower urinary S-PMA excretion than subjects carrying the plus genotype. Urinary S-PMA excretion correlated with SB (R = 0.17) and FPG sites (R = 0.25) in MNBC. The correlation between S-PMA and SB was strongest in subjects with NQO1*1/*2 and *2/*2 genotypes (R = 0.37), and between S-PMA and FPG sensitive sites in subjects with the GSTP1*B/*B genotype (R = 0.39). In conclusion, this study shows that urban air with high levels of benzene and UFP is associated with elevated levels of SB and FPG sites in MNBC, and that NQO1 and GST genes may modulate the effect.

Air Pollutants↗
PubMed1984

Residential location and nutritional adequacy among elderly adults.

Factors affecting nutritional adequacy of elderly persons in urban, suburban, and rural areas were assessed in an analysis of data from the first Health and Nutritional Examination Survey conducted by the National Center for Health Statistics. The specific purpose of this study was to determine whether there were residential differences among elderly adults in nutritional adequacy and to assess the predictive importance of any residential differences in relation to other predictive factors of nutritional adequacy. No significant differences in nutritional adequacy between rural and urban elderly adults were found; however, significant nutritional differences were found between the residents of suburban areas and the residents of either urban or rural areas. It was concluded that residential nutritional levels are most likely due to the educational and economic status of the individuals in an area and not to any causal effect of residential location.

Aged↗
PubMed1997

Ross River virus in mosquitoes (Diptera:Culicidae) during the 1994 epidemic around Brisbane, Australia.

During the summer 1994 outbreak of epidemic polyarthritis in suburban Brisbane, 29,931 adult female mosquitoes were collected by octenol-CO2 light traps and tested for virus by species in pools of approximately 20 using an in situ enzyme-linked immunoassay. Overall, 63 isolations of Ross River (RR) virus were made from 7 different mosquito species, including 23 from freshwater-breeding Culex annulirostris Skuse, 13 from peridomestic Aedes notoscriptus (Skuse), 4 from Aedes procax (Skuse), 12 from the brackish water-breeding Aedes funereus (Theobald), 9 from saltmarsh Aedes vigilax (Skuse), and 1 each from Culex sitiens Wiedemann and Aedes alternans (Westwood). The RR virus minimum infection rate in mosquitoes ranged from 1.6 to 2.5/1,000 from March to June 1994. This study implicates freshwater and brackish water mosquitoes as important suburban vectors of RR virus and indicates the need for refocusing mosquito control priorities.

Aedes↗
PubMed2001

Where health and welfare meet: social deprivation among patients in the emergency department.

CONTEXT: As a safety net provider for many disadvantaged Americans, the emergency department (ED) may be an efficient site not only for providing acute medical care, but also for addressing serious social needs. OBJECTIVE: To characterize the social needs of ED patients, and to evaluate whether the most disadvantaged patients have connections with the health and welfare system outside the ED. DESIGN: Cross-sectional survey conducted over 24 hours in the fall of 1997. SETTING: Three EDs: an urban public teaching hospital, a suburban university hospital, and a semirural community hospital. PARTICIPANTS: Consecutive patients presenting for care, including those transported by ambulance. The survey response rate was 91% (N = 300; urban = 115, suburban = 102, rural = 83). MAIN OUTCOME MEASURE: Index of socioeconomic deprivation described by the US Census Bureau (based on food, housing, and utilities). RESULTS: Of all ED patients, 31% reported one or more serious social deprivations. For example, 13% of urban patients reported not having enough food to eat, and 9% of rural patients reported disconnection of their gas or electricity (US population averages both less than 3%). While 40% of all patients had no consistent health care outside the ED (< or = 1 visit/year), those with higher levels of social deprivation had the least contact with the health care system outside the ED (P < .01). Although those with higher levels of deprivation were more likely to receive public assistance, still almost one-quarter of patients with high-level social deprivation were not receiving public aid. CONCLUSION: Many ED patients suffer from fundamental social deprivations that threaten basic health. The most disadvantaged of these patients frequently lack contact with other medical care sites or public assistance networks. Community efforts to address serious social deprivation should include partnerships with the local ED.

Cross-Sectional Studies↗
PubMed1977

Changing patterns in the incidence of Rocky Mountain Spotted Fever on Long Island (1971-1976).

Clinical data from 124 Rocky Mountain Spotted Fever (RMSF) cases submitted by Long Island physicians and hospitals were compiled for the six-year period 1971-1976. This information was subsequently compared to two parameters: first, the geographic distribution of human cases and rickettsia-infected Dermacentor variabilis (Say), and, secondly, the human population dynamics in Long Island towns since 1950. Despite an overall decline in the rate of suburbanization and population growth, cases of RMSF have increased significantly not only in eastern towns where RMSF has been endemic, but also in well-established western towns where recent population increases have been negligible. Phenomena associated with suburbanization, primarily the association of domestic and sylvan animals and their exposure to infected vector populations, may be instrumental in explaining the increased transmission of RMSF.

Adolescent↗