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PubMed1999

Going bare: trends in health insurance coverage, 1989 through 1996.

OBJECTIVES: This study analyzed trends in health insurance coverage in the United States from 1989 through 1996. METHODS: Data from annual cross-sectional surveys by the US Census Bureau were analyzed. RESULTS: Between 1989 and 1996, the number of uninsured persons increased by 8.3 million (90% confidence interval [CI] = 7.7, 8.9 million). In 1996, 41.7 million (90% CI = 40.9, 42.5 million) lacked insurance. From 1989 to 1993, the proportion with Medicaid increased by 3.6 percentage points (90% CI = 3.1, 4.0), while the proportion with private insurance declined by 4.2 percentage points (90% CI = 3.7, 4.7). From 1993 to 1996 private coverage rates stabilized but did not reverse earlier declines. Consequently, the number uninsured continued to increase. The greatest increase in the population of uninsured [corrected] was among young adults aged 18 to 39 years; rates among children also rose steeply after 1992. While Blacks had the largest percentage increase, Hispanics accounted for 36.4% (90% CI = 32.3%, 40.5%) of the increase in the number uninsured. From 1989 to 1993, the majority of the increase was among poor families. Since then, middle-income families have incurred the largest increase. Northcentral and northeastern states had the largest increases in percent uninsured. CONCLUSIONS: Despite economic prosperity, the numbers and rates of the uninsured continued to rise. Principally affected were children and young adults, poor and middle income families, blacks, and Hispanics.

Adolescent↗
PubMed2006

GIS and remote sensing applications in the assessment of change within a coastal environment in the Niger Delta region of Nigeria.

In the last decades, the Niger Delta region has experienced rapid growth in population and economic activity with enormous benefits to the adjacent states and the entire Nigerian society. As the region embarks upon an unprecedented phase of economic expansion in the 21st century, it faces several environmental challenges fuelled partly by the pressures caused by human activities such as oil and gas exploration, housing development, and road construction for transportation, economic development and demographic changes. This continued growth has resulted in environmental problems such as coastal wetland loss, habitat degradation, and water pollution, gas flaring, destruction of forest vegetation as well as a host of other issues. This underscores the urgent need to design new approaches for managing remote costal resources in sensitive tropical environments effectively in order to maintain a balance between coastal resource conservation and rapid economic development in developing countries for sustainability. Notwithstanding previous initiatives, there have not been any major efforts in the literature to undertake a remote sensing and GIS based assessment of the growing incidence of environmental change within coastal zone environments of the study area. This project is an attempt to fill that void in the literature by exploring the applications of GIS and remote sensing in a tropical coastal zone environment with emphasis on the environmental impacts of development in the Niger Delta region of Southern Nigeria. To deal with some of the aforementioned issues, several research questions that are of great relevance to the paper have been posed. The questions include, Have there been any changes in the coastal environment of the study area? What are the impacts of the changes? What forces are responsible for the changes? Has there been any major framework in place to deal with the changes? The prime objective of the paper is to provide a novel approach for assessing the state of coastal environments while the second objective seeks a contribution to the literature. The third objective is to provide a decision support tool for coastal resource managers in the assessment of environmental impacts of development in tropical areas. The fourth objective is to assess the extent of change in a tropical ecosystem with the latest advances in geo-spatial information technologies and methods. In terms of methodology, the paper draws from primary and census data sources analyzed with descriptive statistics, GIS techniques and remote sensing. The sections in the paper consist of a review of the major environmental effects and factors associated with the problem: initiatives and mitigation measures. The project offers some recommendations as part of the conservation strategies. In spite of concerted efforts by managers to address the problems, results revel that the study area experienced some significant changes in its coastal environments. These changes are attributed to socio-economic and environmental variables.

Demography↗
PubMed2004

Prevalence of hyperprolactinemia in schizophrenia: association with typical and atypical antipsychotic treatment.

OBJECTIVE: To evaluate the prevalence and severity of hyperprolactinemia among a large sample of patients with schizophrenia and related psychotic disorders treated with typical and atypical antipsychotic medications. METHOD: Three electronic databases (general medical, psychiatric, and pharmacologic) containing the census data from November 2002 through March 2003 for a state-funded, inpatient hospital serving the chronically mentally ill were merged (N = 470). This database was purged of patient names, while the unique hospital identification number and demographic variables in each record were retained. These records were then screened to exclude patients with medications (except neuroleptics) or medical conditions known to elevate or suppress prolactin, leaving an overall sample (N = 422) in which to evaluate the prevalence of hyperprolactinemia. The sample was composed of patients with DSM-IV schizophrenia (N = 213), other related psychotic disorders (N = 131), mood disorders (N = 44), and other disorders (N = 34). RESULTS: For the overall sample (N = 422), which combined men and women, the mean serum prolactin level was 41.5 ng/mL; 290 of 422 patients were above the normal range. For women (N = 133), the mean serum prolactin level was 57.9 ng/mL, and 67% had levels above normal. For men (N = 289), the mean level was 33.9 ng/mL, with a 70% prevalence of hyperprolactinemia. While age did not influence the prevalence of elevated prolactin among men, age (reflecting reproductive status) was a significant variable in women; older age was associated with lower prolactin levels. For the study sample, a highly significant correlation was observed between neuroleptic dose (chlorpromazine equivalent) and serum prolactin level; however, this relationship was not determined on a medication-by-medication basis. Medications known to elevate prolactin were associated with higher prevalence rates of hyperprolactinemia, and "prolactin-sparing" medications had lower prevalence rates. However, when they were used in combination, the prolactin-elevating medication overwhelmed the effects of prolactin-sparing medication. CONCLUSIONS: This study suggested that neuroleptic treatment of schizophrenia is strongly associated with hyperprolactinemia and showed important differences between prolactin-sparing and prolactin-elevating medications.

Adult↗
PubMedDate not supplied

Prevalence of hepatitis B infection in the general population: a rural community based study.

BACKGROUND: Available seroprevalence studies of hepatitis B in Indian population has limitations. A community based door to door epidemiological study was conducted between December 1997 and January 1988 to look for the dynamics of hepatitis B exposure in a single village of West Bengal. METHODS: In all, 960 inhabitants out of 1261 (according to 91 census) in a village of Birbhum district in West Bengal were interviewed and their blood were tested by ELISA for HBV exposure. Odds ratio was calculated to estimate the relative risks for each potential factor facilitating virus transmission. RESULTS: Participation rate in the present study was 76.1%. Over all HBsAg carrier rate was found to be 5.3%. Only 2/51 (3.9%) carriers were HBeAg positive. Injection by glass syringe (odds ratio = 3.01), age < 20 years (odds ratio = 1.41) and male sex (odds ratio = 1.57) were significant risk factor. CONCLUSION: The results of this rural, predominantly poor, agrarian worker based community data reveals a fairly large reservoir of infection (5.3%). It is mainly built-up early in life. Injection practices need to be safer in addition to HBV vaccination to fight this menace.

Adolescent↗
PubMed2001

The effects of income inequality and income level on mortality vary by population size in Texas counties.

OBJECTIVES: This study uses the counties of Texas to empirically test the predictions of Wilkinson's theory on the role of income and inequality in explaining health differentials in populations. Wilkinson predicts (1) that health is affected more by income inequality than average income in areas with large population, and (2) that health is affected more by average income than income inequality in areas with small population. We investigate how large the population of a unit must be for income inequality within the unit to affect mortality. METHODS: Measures of income inequality were computed from the 1990 U.S. census data and mortality was computed from Vital Statistics data. Poisson regressions estimated the age-adjusted relative risk of the top quintile relative to the bottom quintile for equality and for income among selections of Texas counties based on population size. County ethnic composition, educational level, and health care access were controlled for. RESULTS: Among counties with populations greater than 150,000, the risk of death was lower in counties with more equal income distribution than in counties with less equal income distribution. Among counties with population less than 150,000, median income affected relative risk in counties with less than 30 percent Hispanics, but not in those with more than 30 percent Hispanics. CONCLUSIONS: This study provides some support for the predictions of Wilkinson's theory.

Censuses↗
PubMed2005

The epidemiology of breast cancer in Maori women in Aotearoa New Zealand: implications for ethnicity data analysis.

AIM: To describe the methods used to estimate breast cancer incidence and mortality in Maori and non-Maori women using multiple adjustors to assign ethnicity. METHODS: Age-specific incidence and mortality rates for breast cancer in Maori and non-Maori were calculated using registration and deaths data obtained from New Zealand Health Information Service (NZHIS) for 1996-2000. Four different methods were used to assign total and sole ethnicity: New Zealand Census Mortality Study (NZCMS)-adjusted, ever Maori-adjusted, National Health Index (NHI)-adjusted, and unadjusted source information. RESULTS: Unadjusted and NHI-adjusted estimates were least similar to the NZCMS-adjusted estimate used as the 'gold standard' in this study. Ever Maori-adjusted results closely approximated NZCMS-adjusted results in both incidence and mortality data. Sole Maori breast cancer incidence and mortality estimates were generally higher than total Maori estimates. DISCUSSION: Using four different estimates to assign ethnicity confirms previous findings showing poor quality of ethnicity data in routinely collected datasets. Future calculations of breast cancer incidence and mortality rates should assign total and sole ethnicity and reduce ethnicity misclassification by using NZCMS or ever Maori-adjusted estimates. This paper supports the need to collect better quality ethnicity data in order to identify and monitor Maori vs non-Maori cancer inequalities.

Breast Neoplasms↗
PubMedDate not supplied

Long-term health sequelae following E. coli and campylobacter contamination of municipal water. Population sampling and assessing non-participation biases.

BACKGROUND: Following bacterial contamination of a municipal water system in the rural town of Walkerton, Ontario, over 2,300 cases of acute gastroenteritis were documented. The Walkerton Health Study is currently underway to assess for long-term health sequelae among consenting inhabitants of Walkerton, related to the original outbreak. We explored whether the association between the acute exposure and preliminary long-term health outcomes may have been biased through differences between early- and late-recruited study participants. METHODS: Using multiple data sources, including the 1996 and 2001 Canadian Census, and records from the Regional Health Unit, hospital and Walkerton Health Study, we determined both sample representativeness and the anticipated effects of intensifying study participant recruitment. Selection bias was assessed by examining for differences between initial and late participants, and their subsequent risk of having hypertension, proteinuria and reduced renal clearance. RESULTS: Of the 4,315 participants, 2,756 were permanent residents of Walkerton, representing 55% of the town's total population. The sample was demographically similar to the population of interest, although statistically women were more likely to participate than men (55% of sample were women compared to 52% of population, p<0.01), and the proportion of both young and very elderly adults was smaller than expected (13% of sample were > or = 65 years of age compared to 18% of population, p<0.01). Comparing the initial 3,959 participants to the 356 persons additionally recruited with substantial effort, the latter were more likely to be free of symptoms during the outbreak (21% vs. 7%, p<0.001), but were otherwise similar in terms of age, sex, the use of medical care resources and underlying health state predating the outbreak. The risk of long-term hypertension or renal sequelae did not significantly differ between initial and late study recruits. CONCLUSIONS: Participants in the Walkerton Health Study represent the population of interest, and comprise those who were acutely ill during the infected water outbreak. The available study sample should provide reasonably unbiased estimates of the associated risk between acute bacterial gastroenteritis and long-term health sequelae.

Acute Disease↗
PubMed2005

Cardiac cath lab activation by the emergency physician without prior consultation decreases door-to-balloon time.

OBJECTIVE: The purpose of this before-and-after study is to determine whether an ED strategy which calls for cardiac catheterization lab (cath lab) activation directly by the emergency physician (EP) is effective in decreasing door-to-balloon time (DTBT). METHODS: In our active community teaching hospital ED, with an annual census of 55,000, the traditional practice for STEMI required cardiology consultation prior to cath lab notification. In November 2003 we instituted an ED protocol which mandated direct cath lab activation by the EP for eligible STEMI patients without prior notification of the cardiologist. We measured clinically relevant time intervals, including DTBT, prior to and after institution of the protocol. RESULTS: Twenty-four patients were enrolled after institution of the protocol; these were compared to twenty STEMI patients enrolled prior to the new protocol. DTBT decreased significantly, from 118 to 89 minutes, p=.039. Other ED parameters, including door to exam (17 vs. 15 minutes) and total ED time (80 vs. 56 minutes, p = .056) decreased post-protocol but were not significantly different for the two periods. Those arriving by ambulance continued to have a significantly lower DTBT than non-ambulance patients (pre: change of 47 minutes, p = .03, post: change of 33 minutes; p = .012). Both groups were affected similarly by the change in protocol, decreasing DTBT by approximately 25%. CONCLUSION: We conclude that a strategy which mandates cath lab activation by the emergency physician for STEMI without prior cardiology consultation, reduces door to balloon time.

Catheterization↗
PubMed1990

[Telemetric surveys in plant pathology and for taking the census of ungulates].

Two new applications of the remote sensing techniques in the territory management which make use of a thermal scanner, are described here: the first concerned with the vegetal pathology field and the second with the big game censusing the Castelporziano farm. The former constitutes an improvement of the usual techniques either for its quick performance or for being an uncurrent intervention on plants, the latter allows to realize censuses also in thickly bushy or woody lands, where the usual methods of counting "at sight", besides to need a large staff are not much reliable.

Agriculture↗
PubMedDate not supplied

[The experiences and outlook of occupational epidemiology in Italy].

Occupational epidemiology has been developed and established in Italy thanks mainly to cancer risk studies. From these studies contributions have been derived for the identification of occupational carcinogenic agents which have received wide international recognition. However, an opportunity was missed when the question of "subjectivity" was abandoned since this is still topical and important for the identification and evaluation of exposure and notification of risk. Significant investigations have estimated the proportion of tumours that could be ascribed to occupational exposure in Italy. Another area where epidemiology in Italy has made significant contributions is the retrospective conversion of jobs in exposures to specific substances. The situation in Italy is still favourable for "record linkage" studies using census data. The main challenges awaiting occupational epidemiology in Italy concern method (for example, the use of molecular dosimetry for the assessment of internal dose or the choice of the most appropriate reference populations), the interpretation of the effects of exogenous exposure in terms of biological mechanisms (including the role of individual susceptibility), evaluation of the predictability of cytogenetic alterations, comparison with bioethical aspects, the ever closer link between occupational and environmental problems in the study of effects on industrial activity and products.

Epidemiologic Methods↗
PubMed2006

A new method of estimating the pollen dispersal curve independently of effective density.

We introduce a novel indirect method of estimating the pollen dispersal curve from mother-offspring genotypic data. Unlike an earlier indirect approach (TwoGener), this method is based on a normalized measure of correlated paternity between female pairs whose expectation does not explicitly depend on the unknown effective male population density (d(e)). We investigate the statistical properties of the new method, by comparison with those of TwoGener, considering the sensitivity to reductions of d(e), relative to census density, resulting from unequal male fecundity and asynchronous flowering. Our main results are: (i) it is possible to obtain reliable estimates of the average distance of pollen dispersal, delta, from indirect methods, even under nonuniform male fecundity and variable flowering phenology; (ii) the new method yields more accurate and more precise delta-estimates than TwoGener under a wide range of sampling and flowering scenarios; and (iii) TwoGener can be used to obtain approximate d(e) estimates, if needed for other purposes. Our results also show that accurately estimating the shape of the tail of the pollen dispersal function by means of indirect methods remains a very difficult challenge.

Flowers↗
PubMed1990

[Comparison of observed and expected person-years: a simulated approach].

In Epidemiology, no simple test is available for comparing an observed number of exposed person-years with an expected number. The number of person-years is a sum of lengths of stays which is not normally distributed under the null hypothesis. A method is proposed and an example is given. The objective was to study in the French territory of New-Caledonia the relationship between past places of living and occurrence of respiratory cancers. The total observed number of person-years in a zone, among cases, was compared to an expected distribution, based on censuses and controlling for two confounding factors, period of stay and ethnic group. Different methods are compared: a test based on a simulated distribution, and parametric approaches with normality assumption. If the number of cases is small, the simulation test seems to be the best approach.

Analysis of Variance↗
PubMed2002

HIV surveillance methods for the incarcerated population.

In the United States, monitoring the HIV/AIDS epidemic among the incarcerated population is done by (a) conducting a census of persons in prisons and jails reported to be infected with HIV or diagnosed with AIDS, (b) seroprevalence surveys in selected correctional facilities, and (c) population-based HIV/AIDS case surveillance by state health departments. We describe methods for HIV/AIDS case surveillance in correctional settings and present data from the HIV/AIDS Reporting System (HARS) and the Supplement to HIV and AIDS Surveillance (SHAS) to describe the demographic, behavioral, and clinical characteristics of HIV-infected persons who were incarcerated at the time of diagnosis. HARS data showed a higher proportion of females and a lower proportion of injection drug users for incarcerated persons diagnosed with HIV (not AIDS) compared to those initially diagnosed with AIDS. The SHAS data showed a high prevalence of injection drug use, crack use, alcohol abuse, and exchanging sex for money or drugs. Together, HARS and SHAS collect fairly comprehensive information of risk behaviors from persons with HIV infection and AIDS. Advances in HIV prevention and care for the incarcerated community will require an accurate and timely description of the magnitude of the HIV epidemic in correctional settings. These data are needed to guide programmatic efforts to reduce HIV transmission in prisons and jails and in the general community upon release and ensure needed risk reduction and health care services for incarcerated persons.

Adolescent↗
PubMed1999

Dynamics of the forest communities at Pasoh and Barro Colorado: comparing two 50-ha plots.

Dynamics of the Pasoh forest in Peninsular Malaysia were assessed by drawing a comparison with a forest in Panama, Central America, whose dynamics have been thoroughly described. Census plots of 50 ha were established at both sites using standard methods. Tree mortality at Pasoh over an eight-year interval was 1.46% yr(-1) for all stems > or = 10 mm diameter at breast height (dbh), and 1.48% yr(-1) for stems > or = 100 mm dbh. Comparable figures at the Barro Colorado Island site in Panama (BCI) were 2.55% and 2.03%. Growth and recruitment rates were likewise considerably higher at BCI than at Pasoh. For example, in all trees 500-700 mm in dbh, mean BCI growth over the period 1985-1995 was 6 mm yr(-1), whereas mean Pasoh growth was about 3.5 mm yr(-1). Examining growth and mortality rates for individual species showed that the difference between the forests can be attributed to a few light-demanding pioneer species at BCI, which have very high growth and mortality; Pasoh is essentially lacking this guild. The bulk of the species in the two forests are shade-tolerant and have very similar mortality, growth and recruitment. The Pasoh forest is more stable than BCI's in another way as well: few of its tree populations changed much over the eight-year census interval. In contrast, at BCI, over 10% of the species had populations increasing or decreasing at a rate of >0.05 yr(-1) compared to just 2% of the species at Pasoh). The faster species turnover at BCI can probably be attributed to severe droughts that have plagued the forest periodically over the past 30 years; Pasoh has not suffered such extreme events recently. The dearth of pioneer species at Pasoh is associated with low-nutrient soil and slow litter breakdown, but the exact mechanisms behind this association remain poorly understood.

Ecosystem↗
PubMed2003

Assessment of a national health interview survey-based method of measuring community socioeconomic status.

PURPOSE: Increasingly researchers are interested in assessing the role of community socioeconomic status (SES) in poor health outcomes, above and beyond the influence of low individual SES. However, the feasibility of conducting these multi-level studies is often limited by restrictions on release of confidential identifiers for linkage to census data, resources for the linkage, and the availability of data sources with individual SES measures. This study assessed a new method of measuring community socioeconomic status (SES) that can be used with the publicly available National Health Interview Survey (NHIS) and preserves confidentiality and can be used with individual SES measures from the NHIS. METHODS: The associations between community SES and mortality from all causes and breast cancer in women were assessed in two samples: 1) deaths in 1987-1993 NHIS respondents linked to community SES measures developed with the new method; and 2) deaths in 1991 from the National Multiple Cause of Death Files linked to 1990 county-level census SES measures. The magnitude of crude mortality rates, direction of trend, and age-adjusted relative risk of mortality for low vs. high SES were compared in the two samples. RESULTS: Crude all-cause mortality and breast cancer mortality rates were similar in both samples in terms of magnitude and direction of trend. In both samples, as SES decreased, rates of all-cause mortality increased, whereas breast cancer mortality rates tended to decrease. Age-adjusted relative risks of mortality from all causes and breast cancer for low vs. high SES were similar in the two samples. CONCLUSIONS: Similarity of associations between community SES and mortality from all causes and breast cancer in the two samples provides support for the validity of a new NHIS-based method of measuring community SES. Since the NHIS is a large, nationally representative survey with high response rates and low loss to mortality follow-up, this method represents an important resource for multi-level studies.

Aged↗
PubMed1999

Water fluoridation and the sudden infant death syndrome.

AIMS: To determine whether exposure to fluoridated water supplies prenatally or postnatally at the time of death increases the risk of sudden infant death syndrome (SIDS). METHODS: A nationwide, case-control study, with infant's water fluoridation status determined from census area unit information for mother's usual address at the time of the infant's birth, infant's usual address at the time of death / nominated sleep and address where infant died / was at nominated sleep. SIDS risk associated with fluoride exposure postnatally was assessed according to method of infant feeding (breast or reconstituted formula), for the two days prior to infant's death / nominated sleep. RESULTS: Infants exposed to fluoridated water supplies during pregnancy were not at increased risk for SIDS, adjusted odds ratio (OR) 1.19 (95% confidence interval (CI) 0.82, 1.74). For breast-fed infants at the time of death / nominated sleep, fluoridated water exposure was not associated with an increased risk for SIDS, adjusted OR 1.09 (95% CI 0.66, 1.79). Similarly, 'fluoridated' formula feeding, when compared with 'unfluoridated' formula feeding, showed no increased risk of SIDS, adjusted OR 1.25 (95% CI 0.73, 2.13). There was no evidence of an interaction between fluoridation and infant feeding for the last two days (chi2 = 0.171, df = 1, p = 0.68). CONCLUSION: Exposure to a fluoridated water supply prenatally or postnatally at the time of death did not affect the relative risk for SIDS.

Analysis of Variance↗
PubMed1999

Who calls 999 and why? A survey of the emergency workload of the London Ambulance Service.

BACKGROUND: In 1996-97 there were 623,000 emergency (999) calls made to the London Ambulance Service (LAS) and this represents a 30% increase over the previous five years. The reasons for this increase, which is also observed nationally, remain unknown. It has been suggested that some callers may be using the 999 service "inappropriately" but no data are available from the ambulance service. OBJECTIVE: To describe the workload of the emergency ambulance service in London with specific reference to the nature and characteristics of 999 calls, to determine who dials 999 and why, and to establish the number and types of calls that could most appropriately be dealt with by other agencies. DESIGN: A one week census of all emergency calls responded to by the LAS. SETTING: Sixty eight LAS stations. METHODS: Collation of all routine LAS incident forms (LA4) including the classification of the crews' free text description of the incident. This was supplemented by a detailed workload questionnaire for 25% of calls. RESULTS: There were 10,921 calls responded to from 29 April to 5 May 1996. The census showed that the daily number of calls was highest on Saturday and lowest on Wednesday with about half being made during normal general practitioner (GP) working hours. Half of all calls were for women and one third were for people aged > or = 65. Accidents were the commonest type of incident (24%). The remainder comprised various medical conditions such as respiratory, cardiac, and obstetric problems. In 1.5% of calls there was no illness, injury, or assistance required and 5% were for "general assistance" and mostly concerned people aged > or = 65. The workload survey indicated that two thirds of incidents occurred at home and 70% of callers had not tried to contact a GP before dialing 999. In the professional opinion of the responding crew, 60% of calls required a 999 response, with the remainder thought more appropriately dealt with by other services such as primary care, psychiatric services, and social services. CONCLUSIONS: This study suggests that while the majority of 999 calls were "appropriate", part of the 999 workload could be dealt with by other services. More research is required to clarify why people contact the 999 service for non-emergency incidents and also to establish the views of GPs and other agencies as to the role and function of the IAS.

Emergency Medical Service Communication Systems↗