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PubMed2003

Examining geographic patterns of mortality: the atlas of mortality in small areas in Spain (1987-1995).

BACKGROUND: Small-area mortality atlases have been demonstrated to be a useful tool for both showing general geographical patterns in mortality data and identifying specific high-risk locations. In Spain no study has so far systematically examined geographic patterns of small-area mortality for the main causes of death. This paper presents the main features, contents and potential uses of the Spanish Atlas of Mortality in small areas (1987-1995). METHODS: Population data for 2,218 small areas were drawn from the 1991 Census. Aggregated mortality data for 14 specific causes of death for the period 1987-1995 were obtained for each small area. Empirical Bayes-model-based estimates of age-adjusted relative risk were displayed in small-area maps for each cause/gender/age group (0-64 or 65 and over) combination using the same range of values (i.e. septiles) and colour schemes. RESULTS: The 'Spanish Atlas of Mortality' includes multiple choropleth (area-shaded) small-area maps and graphs to answer different questions about the data. The atlas is divided into three main sections. Section 1 includes the methods and comments on the main maps. Section 2 presents a two-page layout for each leading cause of death by gender including 1) a large map with relative risk estimates, 2) a map that indicates high- and low-risk small areas, 3) a graph with median and interquartile range of relative risk estimates for 17 large regions of Spain, and 4) relative-risk maps for two age groups. Section 3 provides specific information on the geographical units of analysis, statistical methods and other supplemental maps. CONCLUSION: The 'Spanish Atlas of Mortality' is a useful tool for examining geographical patterns of mortality risk and identifying specific high-risk areas. Mortality patterns displayed in the atlas may have important implications for research and social/health policy planning purposes.

Adolescent↗
PubMedDate not supplied

Factors associated with risk of low folate intake among adolescents.

OBJECTIVE: To evaluate factors associated with the risk of low folate intake among adolescents. METHODS: We employed cluster sampling, using a random selection of 40 representative census sectors and households within those sectors, including all individuals between 10 and 19 years of age. The weight, height and skin folds of subjects were measured and socioeconomic data on their families were collected. A 24-hour dietary recall and frequency questionnaire were used to estimate the quantity and frequency of folate intake. Folate consumption was quantified using Nutwin software. Risk of low folate intake was defined as Folate consumption below the estimated average requirement. The statistical analysis employed hierarchical logistic regression. RESULTS: A total of 722 adolescents were investigated and their mean folate intake was 145+/-117 microg. The frequency of subjects at risk of having a lower than recommended folate intake was 89%. Adolescents had a greater risk of inadequate folate intake if their body mass index was at or above the 85th percentile, their waist circumference was at or above the 80th percentile or they had a family history of cardiovascular disease. Adolescents who ate beans and dark green vegetables less than four times a week also exhibited an increased chance of having folate intake below recommended levels. CONCLUSIONS: These adolescents present a high risk of low folate intake and this risk is linked with increasing age, waist circumference above the 80th percentile and low frequency of beans and dark green vegetables consumption.

Adolescent↗
PubMed1990

[Estimation of vital statistics in rural areas of northern Haiti using a simplified sampling method].

In September 1983, we selected 30 villages in four rural counties of northern Haiti for a partial census and malaria prevalence survey. A cohort of 1,577 persons was enumerated in this census. Survey teams revisited the same houses in these villages in September 1984 and updated the previous census, inquiring about all listed family members. We administered an additional questionnaire to each household concerning the occurrence over the past year of deaths, births, pregnancies, and migration. Among the 1,218 persons who had been followed for one year, there were 21 deaths (crude mortality rate: 17 per 1,000 population; 95% confidence interval [95% CI]: 12 per 1,000, 25 per 1,000) and 35 births (birth rate: 29 per 1,000 population year; 95% CI: 19 per 1,000, 38 per 1,000). The infant mortality rate was 171 per 1,000 live births (95% CI: 81 per 1,000, 315 per 1,000), and the mortality rate for children less than 5 years old was 36 per 1,000 (95% CI: 24 per 1,000, 56 per 1,000). Although small sample surveys are subject to limitations of precision dependent on sample size, they can be a simple method by which researchers may estimate vital statistics for rural areas of less-developed countries.

Epidemiologic Methods↗
PubMed1998

The relationship between census-derived socio-economic variables and general practice consultation rates in three town centre practices.

BACKGROUND: The relationship between socio-economic factors and consultation rates is important in determining resource allocation to general practices. AIM: To determine the relationship between general practice surgery consultation rates and census-derived socio-economic variables for patients receiving the same primary and secondary care. METHOD: A retrospective analysis was taken of computerized records in three general practices in Mansfield, North Nottinghamshire, with 29,142 patients spread over 15 electoral wards (Jarman score range from -23 to +25.5). Linear regression analysis of surgery consultation rates at ward and enumeration district levels was performed against Jarman and Townsend deprivation scores and census socio-economic variables. RESULTS: Both the Townsend score (r2 = 59%) and the Jarman score (r2 = 39%) were associated with surgery consultation rates at ward level. The Townsend score had a stronger association than the Jarman score because all four of its component variables were individually associated with increased consultations compared with four out of eight Jarman components. CONCLUSIONS: Even in practices not eligible for deprivation payments there were appreciable differences in consultation rates between areas with different socio-economic characteristics. The results suggest that the variables used to determine deprivation payments should be reconsidered, and they support suggestions that payments should be introduced at a lower level of deprivation and administered on an enumeration district basis.

England↗
PubMed2005

Monitoring health inequalities through general practice: the Second Dutch National Survey of General Practice.

BACKGROUND: For the second time a plan to monitor public health and health inequalities in the Netherlands through general practice was put into action: the Second National Survey of General Practice (DNSGP-2, 2001). The first aim of this paper is to describe the general design of DNSGP-2. Secondly, to describe self assessed health inequalities in the Netherlands. Thirdly, to present differences in prevalence of chronic conditions by educational attainment using both self-assessed health and medical records of GPs. Finally, inequalities in 1987 (DNSGP-1) and 2001 will be compared. METHODS: Data were collected from 96 (1987) and 104 (2001) general practices. The data include background information on patients collected via a census, approximately 12,000 health interview surveys per time point and more than one million recorded contacts of patients with their GPs in both years. The method of statistical analysis is logistic regression. RESULTS: The analyses shows that the lower educated have significantly higher odds of feeling unhealthy and having chronic conditions in 2001. Diabetes and myocardial infarction (GP data) showed the largest difference in prevalence between educational groups (OR 2.5 and 2.4, self-reported data). The way the data is collected (self-assessment versus GP registration) hardly affects the magnitude of the educational differences in the prevalence of chronic conditions. The pattern of health inequalities across chronic conditions in 1987 and 2001 hardly differs. Diabetes doubled in prevalence and health inequalities were not significant in 1987, but compared to the other conditions were largest in 2001 (OR 1.1 versus 2.5). CONCLUSION: Health inequalities were shown to be substantial in 2001 and persistent over time. Socio-economic differences were shown to be similar using self-assessed health data and GP data. Hence, a person's educational attainment did not appear to play a part in presenting health problems to the GP.

Adult↗
PubMed1997

The re-based 1991 population estimates by marital status.

Shortly after preparing the re-based 1991 population estimates, the Office for National Statistics produced provisional population estimates by legal marital status (for England and Wales as a whole). These provisional estimates were calculated using a marital status distribution for 1991 that was updated from the 1981 Census. These estimates have now been revised to incorporate marital status information from the 1991 Census. This article outlines the options for re-basing the estimates, the method used, and assesses the effect of the revision on the rates of marriage, divorce and mortality by single year of age. The main differences between the provisional and final re-based estimates in 1991 are: estimates of widowed men and women are 7 per cent and 2 per cent higher, respectively, estimates of divorced men and women are 2 per cent and 3 per cent lower, re-marriage rates (amongst the divorced or widowed) for men 50-59 increased, and mortality rates for single and divorced men increased for those aged over 70.

Adolescent↗
PubMed2001

US graduate medical education, 2000-2001.

For the last three quarters of a century, the American Medical Association's national collection of graduate medical education (GME) data has evolved in its scope and methods. This year's GME survey involved new technology. The National GME Census for 2000-2001, jointly administered by the American Medical Association and the Association of American Medical Colleges, was part of an Internet-based product called GME Track. Because of technical problems, data collection was less complete than in previous years. Similar to the 1999-2000 survey, we observed an increase in the number of subspecialty programs, with 79 more than last year (2.1% increase), and a decrease in the number of specialty programs, with 40 (0.9%) fewer. Parallel to this continuing trend was a decrease in the number of graduates of US medical schools who were matched into primary care residencies, particularly family practice programs (20% decrease compared with 1996-1997). The number of graduates of osteopathic medical schools training in allopathic programs continued to rise, increasing 7.9% from last year. Numbers of Hispanic and Asian graduates from US allopathic medical schools (USMDs) in graduate year 1 (GY1) positions increased numerically to 887 and 2356, respectively, and proportionally by 7.2% and 17.3%, respectively. Although the number of white USMDs in GY1 positions increased, their proportion decreased slightly among those with known race or ethnicity from 72.2% to 71.7%, and the number of black USMD GY1 residents, numbering 859, declined from the previous year. Although we observed an overall decline in the average number of on-duty hours expected of residents in their first year in a program (from 55 in 1996-1997 to 54 in 2000-2001; P<.001), the average number of hours reported by the majority of programs that typically report the most on-duty hours did not decrease. The issues of resident work hours and the diversity and specialty distribution of the physician workforce continue to foster debate.

Data Collection↗
PubMed1997

Profiling the care needs of the population with dementia: a survey in central Scotland.

OBJECTIVE: To demonstrate a low-cost method of producing local information for dementia service planning. DESIGN: (1) Multiservice census. (2) Stratified random sample survey (stratified by setting) to assess needs. SETTING: All community and institutional settings in Forth Valley Health Board area. PARTICIPANTS: (1) People age 65 + defined by health and social care professionals as having 'problems of memory/confusion (as is caused by dementia)' (N = 2060). (2) As (1) excluding those with score < 2 on Levin's checklist and no relevant known diagnosis (N = 286). MAIN OUTCOME MEASURES: Coverage of population with dementia against EURODEM prevalence. Place of residence of sufferers. Level of care needs. MAIN RESULTS: Identified population, pro-rating for identifiable non-response, accounted for 78% of EURODEM prevalence. Assuming unidentified 22% to live at home, 45% of total population with dementia were in some form of institutional care. Survey demonstrated high levels of need in local population with dementia known to services. Assistance was required more than once a day with mobility by 48%, personal care by 60%, domestic tasks by 75% and because of behavioural problems by 57%. Assistance was required at night by 59% because of personal care needs and by 54% because of behaviour problems. CONCLUSIONS: The value of a broad-based survey 'snapshot' across the range of settings was confirmed. It can be accomplished relatively quickly and cheaply and complements information collected in other ways.

Aged↗
PubMed2004

Co-worker fatalities from hydrogen sulfide.

BACKGROUND: Hydrogen sulfide is a colorless, odorless gas that may cause rapid loss of consciousness and respiratory depression without warning. It has produced toxicity in workers in numerous industries and occupations. METHODS: A review of the United States Bureau of Labor Statistics (USBLS) Census of Fatal Occupational Injuries (CFOI) for occupational deaths related to hydrogen sulfide from 1993 to 1999 was performed. RESULTS: Fifty-two workers died of hydrogen sulfide toxicity in this 7-year period. Deaths were most commonly reported in workers who were white (85%), male (98%), and in their first year of employment with the company (48%). Common industries included waste management, petroleum, and natural gas. In 21% of cases, a co-worker died simultaneously or in the attempt to save the workers. CONCLUSIONS: Hydrogen sulfide toxicity is uncommon, but potentially deadly. Toxicity is predominantly in new workers and co-worker fatalities occur in a significant minority of cases. Proper training and education on the warning signs of hydrogen sulfide toxicity may help reduce worker fatalities.

Adult↗
PubMed1996

Variation in staging and treatment of local and regional breast cancer in the elderly.

BACKGROUND: Few studies of practice variation in the management of early breast cancer for elderly women have examined the process of care in depth. This study evaluated the effects of age and other factors on surgical staging techniques and treatment. METHODS: Virginia cancer registry data were linked with Medicare claims and 1990 census data. The sample included all newly diagnosed patients with pathologic confirmed local and regional breast cancer in 1985-1989 (n = 3,361). Analyses included descriptive univariate statistics and multiple logistic regression analysis for staging and treatment alternatives. Process of care variables included tumor size determination, axillary lymph node dissection, use of adjuvant therapy, and radiation if breast conserving surgery (BCS) was performed. RESULTS: About 75 percent of women had tumor size and axillary node dissection. Increasing comorbidity was associated with a lower likelihood of axillary node dissection. Nine percent of local compared to 44 percent of regional disease patients received adjuvant therapy. Hormonal therapy increased from 13 percent of women in 1985-1988 to 24 percent in 1989. Hormonal therapy did not vary with patient age. One-third of the patients with positive lymph nodes compared to 8 percent of node negative women received hormonal therapy. Blacks were more likely to present with advanced disease. A logistic regression model evaluated the multiple effects of patients and clinical characteristics: older women were more likely to present with larger tumors, were less likely to have axillary node dissections, and were less likely to receive chemotherapy or radiation. CONCLUSIONS: Younger age was most consistently associated with staging and the use of chemotherapy in this cohort of elderly breast cancer patients. Based on the reported initial treatment plan, hormonal therapy was infrequently used and information from axillary lymph node assessment was used to stratify treatment. Although the low use of adjuvant hormonal therapy in elderly women may compromise survival, neither comorbid nor socioeconomic factors as measured in this study explained this practice pattern.

Black or African American↗
PubMed2005

Molecular methodology in determining vaginal flora in health and disease: its time has come.

The microbial flora of the human vagina can affect the health of women, their fetuses, and newborns. Conventional cultivation methods fail to detect some fastidious vaginal bacteria, leading to an incomplete census. Recent advances in molecular biology have facilitated the detection and identification of bacteria without cultivation, and the advantages and limitations of this approach are described. Molecular studies of the vaginal flora have discovered many uncultivated bacterial species. For instance, several novel bacteria in the Clostridiales order are highly specific indicators of bacterial vaginosis, and bacteria related to Megasphaera, Leptotrichia, Atopobium, and Dialister species are commonly found in subjects with bacterial vaginosis. A more complete understanding of vaginal microbial populations resulting from the adoption of molecular tools may lead to better strategies to maintain healthy vaginal floras and will create opportunities to explore the role of novel bacteria in reproductive tract diseases.

Journal Article↗
PubMed1996

Incidence of IDDM in children in urban population in southern India. Madras IDDM Registry Group Madras, South India.

This study was carried out to estimate the incidence of childhood insulin dependent diabetes mellitus (IDDM) in an urban southern Indian, population. A registry for IDDM has been set up in the city of Madras. South India. Details of newly diagnosed IDDM children, aged less than 15 years, were analysed retrospectively, for a period of 1991-1994. Primary sources were government and service hospitals, large diabetes clinics and secondary sources were diabetes camp, private diabetologists and endocrinologists. A capture-recapture method was used and the estimate of case in the population (1991 census) was calculated. Incidence (case/100,000) was calculated in the total group and then for boys and girls separately. The incidence for the 4 year period was 10.5/100,000/year (CI 5.0). The corresponding values for boys and girls were 12.6 +/- 11 and 9.6 +/- 4.7 respectively. The peak incidence was between 10 and 12 years. This is the first population based incidence data from India and showed that the incidence of childhood IDDM is not low in urban children.

Adolescent↗
PubMedDate not supplied

[Mortality in Catalonia: description and comparison by age and sex].

OBJECTIVE: To assess the fit of the parametric mortality laws proposed by Heligman and Pollard to the mortality experience of Catalonia (Spain) with the goal of describing and comparing mortality by age and gender, in the time periods 1985-86 and 1990-91. DATA AND METHODS: The data were obtained from the official mortality Registry and population Census for the respective years. Observed conditional probabilities of dying by age and gender were adjusted using the parametric mortality laws formulated by Heligman and Pollard. These laws provide information about mortality characteristics in childhood, in youth and in adults. Goodness of fit of the models was assessed using chi-square, sign, and Steven's tests. Significant outliners were also determined and considered in the analysis. RESULTS: In Catalonia from 1985-86 to 1990-91 the probability of dying increased among people aged 16 to 40 years, this being higher in males as compared to females. For people older than 40 years of age the probability of dying in males did not change, but decreased for females. In this time period, the probability of dying slightly decreased during childhood. The life expectancy at birth for males decreased from 74.12 years in 1985-86 to 73.85 years in 1990-91. In contrast, the life expectancy at birth for females increased from 80.08 years in 1985-86 to 80.88 in 1990-91, thus widening mortality differences by gender. CONCLUSIONS: Heligman and Pollard laws of mortality are useful in describing mortality by age and gender, as well as in analyzing the evolution of mortality over time. The unfavorable evolution of mortality among young men living in Catalonia has contributed to reversing the trend of life expectancy at birth in the twentieth century.

Adolescent↗
PubMed2000

The use of advance directives by persons with serious mental illness for psychiatric treatment.

OBJECTIVE: A health care proxy is an advance directive that allows an individual to indicate in writing who can act on his behalf when he lacks the capacity to make health care decisions, and what limitations he is placing on this authority. Of great interest in medical settings, health care proxies are beginning to receive more attention in psychiatric settings. Are these proxies useful when applied to psychiatric treatment decisions? This paper examines health care proxies in Massachusetts and their potential use for decisions about psychiatric interventions at one Massachusetts state hospital. METHOD: A point in time study of a state hospital's entire census was done by reviewing all patients' records for demographic, diagnostic, and legal data, and for the presence and content of the state required health care proxy form. RESULTS: Of the 161 patients in the hospital, 71 (44%) had full guardians and were ineligible to complete their own proxies. Of the remaining 90 patients, 53 (33% of the total population) had a proxy form in their chart, but 34 (21%) of these patients refused to sign them. Of the 19 (12%) signed proxies, 16 (10%) of the patients were deemed competent to have executed meaningful health care proxies. CONCLUSIONS: This preliminary analysis reveals that only 10% of a state hospital population had meaningful health care proxies. Further outcome studies are needed to determine if the process of offering health care proxies and the presence of properly executed proxies are meaningful and beneficial to chronically ill psychiatric patients.

Advance Directives↗
PubMed2001

The fundamental plan of the retina.

The retina, like many other central nervous system structures, contains a huge diversity of neuronal types. Mammalian retinas contain approximately 55 distinct cell types, each with a different function. The census of cell types is nearing completion, as the development of quantitative methods makes it possible to be reasonably confident that few additional types exist. Although much remains to be learned, the fundamental structural principles are now becoming clear. They give a bottom-up view of the strategies used in the retina's processing of visual information and suggest new questions for physiological experiments and modeling.

Animals↗
PubMed2000

Visual function tests, eye disease and symptoms of visual disability: a population-based assessment.

PURPOSE: To examine associations between eye disease and tests of visual function with self-reported visual disability. METHODS: The Blue Mountains Eye Study is a cross-sectional census-based survey of eye disease in two postcode areas in the Blue Mountains, west of Sydney, Australia. Of 4433 eligible residents, 3654 (82,4%) participated. Subjects had a detailed eye examination, including tests of visual acuity, contrast sensitivity, disability glare and visual field. Lens and retinal photographs were taken and graded according to standardized protocols for presence of cataract, early and late age-related maculopathy, glaucoma, diabetic retinopathy, retinal vein occlusion and other eye diseases. An interviewer-administered questionnaire included questions about perception of visual disability. RESULTS: Scores on all tests of visual function significantly decreased with age (P < 0.0001). This decrease persisted for all tests except disability glare after excluding subjects with identifiable eye disease. The presence of one or more eye diseases was significantly associated with all (self-reported) measures of visual disability (trouble driving at night, difficulty recognizing a friend across the street, reading a newspaper or recognizing detail on televsion): mixed cataract (cortical and nuclear, or posterior subcapsular and nuclear) was associated with trouble driving at night and difficulty recognizing a friend across the street. A 10-letter (two-line) decrease in best corrected or presenting visual acuity was significantly associated with all self-reported measures of vsual dsability, as was a two-step decrease in contrast sensitvity. A five-point increase in points missing in the visual field was weakly but significantly associated with all self-reported measures of visual disability except trouble driving at night. CONCLUSIONS: Visual function declines with age. Impaired visual function was strongly, and eye disease relatively weakly associated with reports of visual disability.

Aged↗
PubMed1996

The association between birthplace and mortality from cardiovascular causes among black and white residents of New York City.

BACKGROUND: Life expectancy is shorter and mortality from cardiovascular disease higher among blacks than among whites in the United States. We studied whether place of birth was associated with mortality from cardiovascular causes among non-Hispanic black and white residents of New York City. METHODS: We linked mortality records from 1988 through 1992 with 1990 U.S. census data for New York City. Mortality data for blacks born in the U.S. South and Northeast and in the Caribbean were compared with those for whites born in the Northeast. RESULTS: Among blacks, the rates of overall mortality and mortality from cardiovascular causes exceeded those among whites. Among persons born in the Northeast, the rates of death from cardiovascular disease for white men (285 per 100,000), as compared with black men (299), and for white women (155), as compared with black women (165), were similar. However, Southern-born black men and women both had mortality from cardiovascular disease that was substantially higher than that of their counterparts born in the Northeast, and Caribbean-born blacks had rates substantially lower than their Northeastern-born counterparts. The differences among the groups in the rates of death from coronary heart disease were greater than those for death due to stroke or hypertension. In each category defined by age and sex, Caribbean-born blacks had significantly lower rates of death from coronary heart disease than did whites. Black men who were 25 to 44 years of age and were born in the South had a rate of death from coronary heart disease that was 30 percent higher than that of Northeastern-born blacks, and four times that of Caribbean-born blacks of the same sex and age. CONCLUSIONS: The higher rate of mortality from cardiovascular causes among blacks, as compared with whites, in New York City masks substantial variation among blacks based on their place of birth.

Adult↗
PubMed1995

Effect of human T-lymphotropic virus type I infection on non-Hodgkin's lymphoma incidence.

BACKGROUND: We previously reported from a case-control analysis that T-cell non-Hodgkin's lymphoma (NHL) was strongly associated with human T-lymphotropic virus type I (HTLV-I) infection in Jamaica and Trinidad and that the relative risk for HTLV-I infection was very high in younger patients. PURPOSE: The objective of this study was to estimate the age-specific incidence rates of NHL among HTLV-I-infected and HTLV-I-uninfected adults in Jamaica and Trinidad. METHODS: Population rates of HTLV-I infection were calculated from available census reports and serosurvey data. Incidence rates for NHL were calculated from all incident cases in Jamaica during 1984-1987 (n = 135) and from all incident cases in Trinidad during 1986-1990 (n = 117). Using biopsy material, we determined whether the immunophenotype of the tumor cells was T cell, B cell, or other. NHL incidence rates were computed according to HTLV-I status, age, sex, and tumor phenotype for each country separately and for both countries combined by weighting to the relative population size of each country. RESULTS: The age-standardized NHL incidence rate (mean +/- SE) in Jamaica was 1.9 +/- 0.2 per 100,000 person-years (PY). In Trinidad, the rate was 2.9 +/- 0.4 per 100,000 PY. Overall, the incidence of NHL increased with age and was higher in males than in females. In the HTLV-I-infected population, the incidence of NHL was inversely related to age, and age-specific rates were higher in males than in females. The NHL incidence in those estimated to have acquired HTLV-I infection in childhood, however, showed no sex difference, and one in 1300 such carriers (95% confidence interval: one in 1100 to one in 1600) per annum were estimated to be at such risk. For T-cell NHL, as proxy for adult T-cell lymphoma/leukemia, incidence was highest in those patients infected with HTLV-I early in life (perinatally or via breast milk), with high, sustained risk from early adulthood in both sexes. CONCLUSIONS: While overall NHL incidence rates reveal that HTLV-I endemicity does not impose an exaggerated lymphoma burden on these populations, the risk for lymphoma among carriers who acquire infection early in life is dramatic and is consistent with the hypothesis that virus exposure early in life is most important for lymphoma-genesis. IMPLICATIONS: Studies of HTLV-I carriers known to be infected in childhood may provide insight into markers intermediate in the lympho-magnetic process. Strategies to disrupt early-life transmission of HTLV-I, notably mother-infant transmission, may be critical in reducing the burden of lymphoreticular disease in these populations.

Adolescent↗