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PubMed1994

Prevalence of antibodies to rickettsiae in the human population of suburban Bangkok.

Following a report of three cases of scrub typhus in suburban Bangkok, we performed a serosurvey in the patients' communities. Both IgG and IgM antibodies were measured in an indirect immunoperoxidase assay, using separate spots of antigen from Rickettsia tsutsugamushi (scrub typhus), R. typhi (murine typhus), and TT-118 spotted fever group rickettsiae. Of 215 people donating blood, antibody levels indicative of most recent exposure to R. tsutsugamushi were most prevalent (21%), followed by R. typhi (8%), and TT-118 (4%). Seroprevalence suggesting most recent exposure to R. tsutsugamushi varied by location (range 13-31%), gender (26% of females and 13% of males), age (61-80-year-old individuals were the highest, with a prevalence of 38%), and contact with orchards and orchid farms (29% of those with extensive contact, 38% of those with occasional contact, and 10% of those with no contact). These patterns indicated that exposure to R. tsutsugamushi was related to occupation and behavior, as has been observed in areas of rural transmission. Expansion of metropolitan Bangkok has created a situation in which people employed in agriculture live with people employed in the city. As a result, a serosurvey in suburban Bangkok reveals evidence of murine typhus, which is usually transmitted in urban areas, as well as scrub and tick typhus, which are usually transmitted in rural areas.

Adolescent↗
PubMed1998

Case management from urban and suburban perspectives.

The purpose of this research, commissioned by an Area Agency on Aging in Pennsylvania, is to identify the factors that impact on the process of case management in urban and suburban settings. Random samples of clients receiving the same service in an urban and a suburban area were compared as well as direct observations made of case managers in these same locations. The results indicate that clients in the urban environment face individual and structural barriers that would increase the difficulty for case managers to access services on the clients' behalf. Workers in the two settings also face different environmental circumstances that impact on how they carry out the case management process.

Aged↗
PubMed2000

Suburban versus urban: does it matter where the residency interview begins?

Geographic location is an important factor in students' ranking of residency programs. Our program's inner city location has a negative impact on our recruitment efforts. In an attempt to assess the impact of geography, we started half of the residency interview days at our suburban community medical center and then measured the effect on the applicant's perception of the program. During the 1998-1999 residency interview season we alternated the site at which the day began. Students were randomly assigned based on interview date requests to starting the day at the urban hospital or at the community hospital. At the conclusion of the day the students completed a questionnaire regarding various components of the interview day and how their perception of the program was influenced by the experience. Of 206 students asked to complete the questionnaire, 188 (91%) completed the survey. The degree to which the students' perception of the program was affected was remarkably similar regardless of where the interview day began; however, significant differences were found between the Chairman's Talk, the Teaching Session, and talking with current residents when compared by univariate analysis. We concluded that students' perception of the program at the conclusion of the interview day was similar regardless of whether the interview day began at an urban or suburban medical center.

Career Choice↗
PubMed2002

Obesity and health status in rural, urban, and suburban southern women.

BACKGROUND: Obesity has reached epidemic proportions over the past 20 years. METHODS: This study investigated the differences in rates of obesity and perceptions of health status between rural, urban, and suburban Southern women based on selected socioeconomic factors. Using data from a national health survey, the reports from 4,391 women aged 40 to 64 years were included in the study. RESULTS: Significantly more rural women lived in poverty, reported a poorer health status, and had a greater prevalence of obesity. Urban women had the next highest obesity rate and a moderate health status. The healthiest group with the lowest obesity and poverty rates were suburban women. CONCLUSION: Obesity and poor overall health are closely related in rural women. The greatest challenge to health care providers is to provide appropriate community-based weight-management programs.

Adult↗
PubMed2003

Vascular injuries to the extremities in a suburban trauma center.

The purpose of this study was to examine the experience with extremity vascular injuries of a level II suburban trauma center. A retrospective chart review was undertaken to include all patients admitted in a 6-year period with vascular injuries to the extremities. The vessels injured were identified along with the mechanism of injury. The method of repair was recorded. All associated neurologic injuries were investigated. Follow-up records, when available, were reviewed. Between January 1, 1996, and November 30, 2002, 48 patients were admitted with 56 vascular injuries to the extremities. Blunt trauma was the mechanism in 24 patients while penetrating trauma was the mechanism in the other 24 patients. The limb salvage rate was 95 per cent. Of the 28 injuries to upper extremity vessels, 24 were associated with neurologic injuries. In contrast, only 3 neurologic injuries were found in patients with lower extremity vascular injuries. In contrast to most urban centers, the distribution of vascular injuries to the extremities in a suburban setting was equally divided between blunt and penetrating injuries. The majority of functional impairment was related to neurologic injury rather than tissue ischemia from vascular injury.

Adult↗
PubMed2003

[Functional characteristics of pharmacy services related to home care--results from two pharmaceutical association surveys in suburban and old town areas].

In order to investigate the implementation about pharmacy services focusing on home care and to identify differences in functional characteristics in accordance with pharmacy location, questionnaire surveys were conducted on all 75 pharmacies belonging to T-City Pharmaceutical Association in a suburban area and on all 161 belonging to K-Ward Pharmaceutical Association in a central downtown district. Using data, a principal component analysis was performed. The following services were investigated: medication guidance for patients and their families; provision of drug information to patients; management of patients' drug history; dispensing; advice to physicians; inquiries; management of prescriptions for home infusion services; sales of items such as over-the-counter [OTC] drugs [commercially available drugs that do not require a physician's prescription]; display and catalogue sales of nursing items; consultation on home care; holding events such as health education programs; guidance for drug management by home visits; and information exchange with other medical professionals and social workers. The results of these surveys were as follows. (1) The following services were regularly performed in both urban and suburban areas: medication guidance for patients and their families; provision drug information to patients; management of patients' drug history; dispensing; advice to physicians; inquiries; and sales of OTC drugs. (2) The following services were not difficiently regularly performed in both areas: display and catalogue sales of nursing items; consultation on home care; holding events such as health education programs; guidance for drug management by home visits; and information exchange. (3) As to principal component analysis, pharmacy functions were divided into 3 components and the dispensing service strongly influenced the functional characteristics in T-City. Whereas, in K-Ward, pharmacy functions were divided into 4 components and consultation and information exchange were strong influences. (4) Home care-relate pharmacy services were closely associated with information exchange on both areas. This implies that enforcing information exchange among pharmacists and other health practitioners and social welfare practitioners is an essential factor to expand implementation of home-care related pharmacy services.

Community Pharmacy Services↗
PubMed1992

Adolescent drug and alcohol usage: a comparison of urban and suburban pediatric practices.

Few pediatric practice-based drug and alcohol surveys have been conducted with adolescent patients. This study reports on similarities and differences in adolescent drug and alcohol use between urban (95% black) pediatric practices and a suburban (89% white) pediatric practice. While there were greater similarities between patient substance use and reported problems than differences, a number of significant differences emerged. White suburban youth were heavier users of tobacco products, alcohol, and inhalants, and experienced more difficulties with blackouts, family conflict, school absence, suicidal ideation, and loss of peer relationships. Other racial/ethnic and practice site differences are discussed. This study highlights characteristics of youth drug abuse in the private pediatric practice setting and implications for the pediatrician in caring for adolescents.

Adolescent↗
PubMed1991

Epidemiology of hepatitis C virus infection in a suburban Detroit community.

A serum analysis for antibodies to the hepatitis C virus (HCV) was performed on a group of patients in a large suburban Detroit community hospital. The first 50 anti-HCV-positive patients with clinically suspected chronic non-A, non-B hepatitis were studied. Blood transfusions (58%) and intravenous drug use (22%) were the source of infection in most of these patients. A significant difference in age-related epidemiology was observed (p = 0.001). A remote history of intravenous drug use or tattoo application was elicited in 55% of individuals less than 40 yr old. "Sporadic" transmission occurred in 28% of individuals older than 50 yr. Sixteen percent (8/50) had no identifiable risk factors. Five of these eight patients (63%) were born and raised outside North America. Eighty percent of the 35 persons who underwent liver biopsy were found to have either chronic active hepatitis or cirrhosis. Twenty-nine percent (5/17) of the patients with anti-HCV-related cirrhosis presented with hepatocellular carcinoma. None of the patients with noncirrhotic liver disease had a primary liver tumor. We conclude that a significant number of patients in suburban America with chronic hepatitis C have no identifiable risk factors for HCV. Sporadic transmission of hepatitis C may play an important role in patients with chronic HCV-related liver disease, especially among patients born and raised outside North America.

Adult↗
PubMedDate not supplied

Childhood injury prevention in a suburban Massachusetts population.

A controlled population-based study of a childhood injury prevention program in four suburban Massachusetts communities was able to demonstrate a 15.3 percent decrease in injury rates for children ages 0-5 years. A substantial improvement was seen in the relative risk for injury in the intervention as compared with control communities. The major intervention was a pediatric counseling program taking place within a context of various community education efforts. Process data on patient satisfaction and physician compliance, and educational and behavioral outcomes from previously reported studies, when combined with injury incidence data in this report, support the hypothesis that physician counseling may be an important factor in the favorable results observed in these suburban communities. These data also suggest that a decrease in injury incidence may be possible when interactive physician counseling takes place within the context of community education programs. A comprehensive strategy that includes technological, legislative, and educational activities is suggested as the optimal approach to childhood injury prevention.

Accident Prevention↗
PubMed1988

Meeting the health care needs of suburban youth: review of a clinical service.

The demographic and medical data from the first 1,000 patients registered at a suburban adolescent health service were reviewed and the findings compared with the results of an initial survey performed in the same community and other health services located in urban communities. Most of the patients were white (92%), girls (82%), and 16 to 18 years of age (63%) and had parents who graduated from high school (59%) or college (28%). They reported higher rates of participation in health-risk behaviors, including smoking (50%), drinking (60%), drug use (67%), and sexual intercourse (83%), than their peers. Seventy-two percent of the patients sought medical attention for sexuality-related or gynecologic concerns, including contraception (39%), pregnancy determination (20%), and evaluation of possible sexually transmitted disease (9%), and 28% sought attention for general medical or emotional needs, including checkups or immunizations (11%), nutritional or weight problems (4%), and emotional issues or substance abuse (4%). Management of sexuality-related issues differed from that reported in urban settings, whereas laboratory screening tests indicated that problems were similar to those in other settings. Many problems described in an initial survey of youth in the community were not seen at the adolescent health service. We conclude that a suburban-based health service may meet certain health care needs of the higher risk youth of the community but that ultimate care for adolescents remains with the private physicians in this setting.

Adolescent↗
PubMedDate not supplied

Placement of health promotion columns in suburban newspapers--an analysis.

In the fall of 1982, the Office of Disease Prevention and Health Promotion, Public Health Service, engaged the services of the North American Precis Syndicate, Inc., to distribute two columns on health promotion to suburban newspapers. An analysis of the placement of these two health promotion columns in local newspapers was undertaken to determine if this method of disseminating health information to the public is effective and cost-conscious. The information gained from this analysis, though limited in scope, provides information to decision makers responsible for disseminating health information to the public. North American Precis Syndicate, Inc. (NAPS), distributes public information through various channels. One service NAPS provides is a clip sheet of publication-ready newspaper columns complete with artwork which an editor can "clip" and use directly in a newspaper. NAPS is able to use existing information and artwork to develop its columns, so agency staff time is minimal in developing material. NAPS also provides clippings of the articles as they actually appear in the 3,800 suburban newspapers it services. It is the information from the NAPS "clipping service" on which this report is based.

Costs and Cost Analysis↗
PubMed1979

Patterns of suburban population growth, 1970--75.

Population redistribution within U.S. suburban rings between 1970 and 1975 was characterized by frequent population declines for individual suburbs. On the whole, recent spatial patterns of suburban population decline are similar in nature, if not overall levels, to those found in the 1950s and 1960s. Population decline is greatest in the inner suburbs, and is also evident, to some extent, in the most peripheral suburbs. Patterns for all metropolitan areas mask clear variation among metropolitan areas. This variation is related to metropolitan age or historical period of development.

Employment↗
PubMed1980

A comparison of children's spatial reasoning: rural Appalachia, suburban, and urban New England.

This study compared the developmental levels of spatial concepts in children from 3 different environments in the United States. Matched groups of 20 10-year-olds from a rural Appalachian community, a middle-class suburban community, and a lower-middle-class urban community were selected and given a Piaget-based map-drawing task. 20 separate elements, each of which is a spatial concept applied to a map feature, were assessed for developmental level (1--6). The element scores were partitioned by individual spatial concept means and analyses of variance were performed on the partitioned scores to compare the groups' developmental levels. Scheffé tests for determining all possible comparisons were then performed on the partitioned scores reaching significance between the groups. Results showed that the suburban and urban groups' mean levels of development on each of the spatial concepts did not differ significantly, and that the Appalachian children performed significantly better than one or both of the other groups on 3 out of the 4 spatial concepts. These findings support research that has demonstrated social/environmental influences on cognitive development and present evidence that urban/suburban environments in the United States are not optimal for the development of all cognitive skills.

Appalachian Region↗
PubMed1995

Prevalence of lead poisoning in a suburban practice.

BACKGROUND: The purpose of this study was to determine the prevalence of elevated blood lead levels (EBLLS, lead > or = 10 micrograms/dL [0.48 mumol/L]) in a suburban family practice setting and to assess the utility of a questionnaire as an alternative to universal screening in identifying individuals with EBLL in a low-risk population. METHODS: Parents bringing children aged 1 through 3 years into the office for any type of visit were offered the opportunity to complete a questionnaire concerning risk for lead poisoning and to obtain free blood lead testing for their child. No child in this study had previously been tested for lead toxicity. The lead levels found on testing were correlated with the questionnaire results. RESULTS: Two hundred thirty-two children with an average age of 20 months were tested. Blood lead levels ranged from 0 to 53 micrograms/dL (2.56 mumol/L). Elevated blood lead levels were found in 5.6% of the study population. The five questions suggested by the Centers for Disease Control and Prevention (CDC) were taken as a group, and any "yes" or "don't know" response was considered a risk factor. These questions had a sensitivity of 84.6% and a specificity of 41.6% in identifying children with EBLL. An additional question regarding residence in a home built before 1960 (or not knowing the age of the home) was a better screening test for EBLL (sensitivity 92.3%, specificity 57.1%) than the five CDC questions. Lower household income was associated with an EBLL, but sex, race, and home location (urban, suburban, rural) were not. CONCLUSIONS: Risk-assessment questionnaires are useful tools in selecting children who are at risk for an EBLL from low-risk populations. Comparison of this study with similar studies suggests that the most useful questions for this purpose may vary according to location. In this and other studies to date, however, questionnaires show less than 100% sensitivity in identifying children with EBLL.

Child, Preschool↗
PubMedDate not supplied

Possession and carrying of firearms among suburban youth.

Despite a growing body of anecdotal evidence suggesting the spread of firearms to suburban juvenile populations, most studies of firearm activity by juveniles focus either on urban youth or on nationally representative samples that blur urban and nonurban distinctions. This study represents the first systematic empirical investigation specifically of a suburban population of juveniles. The authors examine both ownership and carrying behaviors, distinguish types of handguns involved, and assess the influence of drug activity, violent criminality, and the perception of one's social environment as dangerous upon the possession and carrying of firearms. Among the variables linked at the bivariate level to possession and carrying of guns were sex, involvement in criminal activity, involvement in drug activity, and most indicators of a dangerous social environment. At the multivariate level, however, only sex was associated with possession of a revolver, and only sex, criminal activity (for boys only), and one indicator of dangerous environment (having been threatened with a gun, for girls only) were associated with possession of an automatic or semiautomatic handgun. Aside from sex, criminal and drug activities were associated with gun carrying. Despite its importance among urban samples, in this study the dangerous environment was not linked to firearm activity. Possible reasons for this difference are explored in the conclusion.

Adolescent↗
PubMed1994

Is there lead in the suburbs? Risk assessment in Chicago suburban pediatric practices. Pediatric Practice Research Group.

OBJECTIVE: This study was designed to determine: (1) the prevalence of elevated blood lead (BPb) levels (BPb > or = 10 micrograms/dL) in Chicago suburban children attending Pediatric Practice Research Group practices at 12 and 24 months of age, and (2) the efficacy of the Centers for Disease Control and Prevention (CDC) and Illinois lead exposure risk assessment questions. METHODS: Parents bringing their 1- and 2-year-old children for health supervision visits at pediatric practices completed questionnaires. BPb levels were drawn on children. Both questionnaire and an analyzable BPb level were obtained on 1393 subjects (79.2%). RESULTS: Only 2.1% of our sample had a venous BPb level > or = 10 micrograms/dL (0.48 mumol/L); no subjects had a level > or = 30 micrograms/dL (1.45 mumol/L). The CDC risk assessment questions had a sensitivity of .69 and specificity of .70. Due to the low prevalence of elevated BPb levels in this sample, CDC and Illinois screening strategies had high negative predictive values (.99) and low positive predictive values (.05 and .04, respectively). However, some of the subjects with BPb levels > or = 10 micrograms/dL were not at high risk by CDC and Illinois screening questions; 9 of 29 subjects with elevated lead levels (31%) did not respond affirmatively to any CDC risk assessment questions. The question best predicting an elevated BPb was the determination that the house the child lives in was built before 1960 (sensitivity = .83, specificity = .67). This question is not currently included in CDC or Illinois screening strategies. Screening based on the single question "Was your house built before 1960?" would have missed only five (17%) of the children with BPb levels > or = 10 micrograms/dL. Three of these five children were among the 17.1% of 1-year-olds and 26.3% of 2-year-olds in our sample who had moved. CONCLUSIONS: In this sample, children living in houses built before 1960 should be considered at high risk for high-dose lead exposure. Due to the high mobility of our sample, phrasing the question to include lifetime exposure (ie, Has your child ever lived in a house built before 1960?) should also be considered. Selective BPb testing of high-risk children in low-prevalence suburban areas using this question would miss few children with elevated BPb. Useful risk assessment questions in other areas and other populations may differ.

Centers for Disease Control and Prevention, U.S.↗
PubMed1994

Prevalence of rheumatic diseases in Taiwan: a population study of urban, suburban, rural differences.

OBJECTIVE: To determine the prevalence of symptomatic rheumatic disease in rural, urban and suburban areas of Taiwan by a 2-staged population survey. METHODS: Nine thousand subjects over 20 years old were sampled proportional to age and sex for the area from 3 administrative areas in Taiwan. A pretested questionnaire to screen for potential rheumatic disorders and/or disability was administered in the communities by health workers. Subjects who screened positive were examined by a rheumatologist who assigned a final diagnosis based on established criteria. RESULTS: A total of 8998 persons over age 20 residing in Hen-San (rural area), Sien-Dien (suburban), and Cu-Tien (urban) were studied. Twenty-five percent (2272) of the population indicated rheumatic problems: 1124 of 2271 were evaluated by a rheumatologist with serological and radiological testing. The response rates were 49.7% in Hen-San, 50.7% in Sien-Dien and 48.5% on Cu-Tien. After age and sex adjustment, the prevalence of rheumatic symptoms in Hen-San, Sien-Dien, and Cu-Tien was 24.3, 18.4 and 26.3% respectively. It was significantly higher in rural Hen-San and urban Cu-Tien than in Sien-Dien. The prevalence of rheumatoid arthritis (RA) in Hen-San, Sien-Dien, and Cu-Tien was 0.26, 0.78, and 0.93%, osteoarthritis (OA) was 6.3, 5.8, 5.1%, ankylosing spondylitis (AS) was 0.54, 0.19, 0.4%, gout was 0.16, 0.67, 0.67%, respectively. The prevalence of RA in Sien-Dien and Cu-Tien was significantly higher than in Hen-San (p < 0.05) but were not statistically different for OA, AS and gout among those 3 sites. Only one case of systemic lupus erythematosus (SLE) was found in urban Cu-Tien for a prevalence of 0.033%. CONCLUSION: Our results suggest that the prevalence of RA and AS is similar to that reported in Caucasians. We could not confirm anecdotal reports that SLE was common or that it is more common than RA in people of Chinese ancestry. The prevalence of OA of the hip is comparatively uncommon in our population. The difference in prevalence of rheumatism, RA, OA and gout in these areas suggests areas of further study.

Adult↗
PubMed1994

Factors influencing bone lead concentration in a suburban community assessed by noninvasive K x-ray fluorescence.

OBJECTIVE: To determine the influence of demographic, exposure and medical factors on the bone lead concentration of subjects with background (nonindustrial) environmental lead exposure. DESIGN: Survey. SETTING: Suburban residential community. PARTICIPANTS: A total of 101 subjects (49 males, 52 females; aged 11 to 78 years) were recruited from 49 of 123 households geographically located in a suburban residential neighborhood unexposed to any major source of industrial lead emissions. MAIN OUTCOME MEASUREMENTS: Cortical bone lead concentrations in the midshaft of the tibia were noninvasively measured by in vivo K x-ray fluorescence. Blood lead concentrations were measured by anodic stripping voltammetry. An administered questionnaire assessed potential sources of lead exposure and medical conditions affecting bone metabolism. RESULTS: After the exclusion of one outlier, log-transformed bone lead concentration was highly correlated with age (r = .71; P < or = .0001). Bone lead concentration showed no significant change up to age 20 years, increased with the same slope in men and women between ages 20 and 55 years, and then increased at a faster rate in men older than 55 years. In addition to the variables age and sex, the best fitting multiple regression model for bone lead concentration (R2 = .66; P < or = .0001) revealed a positive correlation with total pack-years of cigarette smoking and a negative correlation with a history of having nursed an infant for longer than 2 weeks. Blood lead concentrations of the subjects were low (geometric mean, 0.24 mumol/L [4.9 micrograms/dL]) and after log transformation were weakly correlated with log-transformed bone lead concentration (r = .23; P = .02). CONCLUSIONS: The age- and sex-related increases in bone lead concentration found by K x-ray fluorescence concur with published postmortem studies of bone lead concentration and are consistent with the kinetics of bone turnover and secular trends in lead exposure. These data help to establish a reference range for assessing the lead burden of other populations with environmental or occupational lead exposure.

Adolescent↗