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PubMed2006

[Evaluation of a community-based health education program for salt reduction through media campaigns].

PURPOSE: To provide the strategies, achievement and evaluation of a community health education program for salt reduction with media campaigns. METHODS: The intervention community was Kyowa town (A district of Chikusei city, census population in 1985 = 16,792) where we have systematically conducted a community-based blood pressure control program since 1981, and health education on reduction of salt intake since 1983 for primary prevention of hypertension. The education program was performed through media campaigns including use of banners, signboards, posters, and calendars with health catchphrases. We also used catchphrase-labeled envelopes when sending documents from the municipal health center to individuals. Health festivals were held annually to enhance health consciousnesses and to improve health behavior. Some of the posters and calligraphy were painted or drawn by elementary schoolchildren as part of their education. The program was evaluated by repeated questionnaires and examination of salt concentrations of miso soup and dietary salt intake. RESULTS: Between 1983 and 1988, the prevalence of persons who were aware that health consultation including blood pressure measurements were available at the town office increased from 65% to 84%. The prevalence of those who knew the salt intake goal (10 g or less/day) increased from 47% to 63% and that of those who reported to reduce salt intake also increased from 38% to 58%. As for salt concentrations of miso soup, the proportion with less than 1.1% increased from 47% to 66% between 1985 and 2004. Age-adjusted mean salt intake for persons aged 40-69 years declined from 14 g to 11 g in men and from 12 g to 10 g in women between 1982-1986 and 2000-2004. CONCLUSION: A long-term systemic education program through media campaigns proved feasible with the cooperation of community leaders, schools and food associations.

Communications Media↗
PubMedDate not supplied

[Use of an index of social welfare for health planning at a municipal level].

OBJECTIVE: This paper analyzes the relationship between a living standards index for small areas based on census data and information on morbidity and health care utilization. MATERIAL AND METHODS: The information was gathered through a health interview survey of a random sample of 1 238 households from rural areas of Tlaxcala, Mexico. RESULTS: The population from localities with lower living standards showed significantly higher prevalences of morbidity and worse self-reported health status measures, as compared to localities with higher living standards. On the contrary, higher living standards were related with a greater utilization of health services. CONCLUSIONS: The approach proved to be useful in discriminating localities and areas of high and low prevalence of morbidity and utilization of health care services, which in turn could be used to identify those areas where needs are greatest. The implications of the results for health planning and resource allocation (based on population health needs and underlying social conditions) at the local level are discussed.

Demography↗
PubMed1998

[Most common cardiovascular diseases and sleep apnea syndrome. A general population study].

BACKGROUND: The sleep apnea syndrome (SAS) is a frequent disease associated with significant morbidity. The aim of our study was to investigate diseases associated with the sleep apnea syndrome (SAS) in general population. METHODS: We selected a random sample of 110 people from the electoral census. These people were invited to the clinic where medical history, physical examination and monitoring for sleep-disordered breathing was done. RESULTS: Twenty two subjects were diagnosed of SAS. The prevalence of arterial hypertension in the SAS group was 36.4%, and coronary artery disease 13.6%. CONCLUSIONS: Although the prevalence of this diseases was increased in the SAS group, we do not see significant association with this disease.

Adult↗
PubMed2005

Is electronic stability program effective on French roads?

This paper proposes an evaluation of the effectiveness of the electronic stability program (ESP) in terms of reduction of injury accidents in France. The method consists of 3 steps: The identification, in the French National injury accident census, of accident-involved cars for which the determination of whether or not the car was fitted with ESP is possible. A sampler of 136 cars involved in injury accidents occurred in 2000, 2001, 2002 and 2003 was then selected. But we had to restrict the analysis to only 588 Renalut Laguna's. The identification of accident situations for which we can determine whether or not ESP is pertinent ( for example ESP is pertinent for loss of control accidents whilst it is not for cars pulling out of a junction). The calculation, via a logistic regression, of the relative risk of being involved in an ESP-pertinent accident for ESP equipped cars versus unequipped cars, divided by the relative risk of being involved in a non-ESP-pertinent accident for ESP equipped cars versus unequipped cars. This relative risk is assumed to be the best estimator of ESP effectiveness. The arguments for such a method, effectiveness indicator and implicit hypothesis are presented and discussed in the paper. Based on a few assumptions, ESP is proved to be likely effective. Currently, the relative risk of being involved in an ESP-pertinent accident for ESP-equipped cars is lower (-44%, although not statistically significant) than for other cars.

Accidents, Traffic↗
PubMed1991

The population of Yugoslavia, 1948-1991.

"On 31 March, 1991, the sixth population census after World War Two was taken in Yugoslavia. The census of households, apartments and farms took place simultaneously to the population census. The census was taken in extremely difficult political, economic and other conditions, which greatly hindered its organization, and the work of the census takers and census commissions. The census was not taken in the province of Kosovo, nor partially in some other communes, thus the total population in these regions was estimated, which is explicitly stated in the tables. Furthermore, the method used to make this estimation is also cited. A comparison of the first results of the 1991 population census with data from previous censuses, and with available estimates, indicates the reliability of the results obtained in the territory in which the 1991 population census was taken."

Censuses↗
PubMed2006

Assessing adult mortality in HIV-1-afflicted Zimbabwe (1998 -2003).

OBJECTIVE: To compare alternative methods to vital registration systems for estimating adult mortality, and describe patterns of mortality in Manicaland, Zimbabwe, which has been severely affected by HIV. METHODS: We compared estimates of adult mortality from (1) a single question on household mortality, (2) repeated household censuses, and (3) an adult cohort study with linked HIV testing from Manicaland, with a mathematical model fitted to local age-specific HIV prevalence (1998 -2000). FINDINGS: The crude death rate from the single question (29 per 1000 person-years) was roughly consistent with that from the mathematical model (22 -25 per 1000 person-years), but much higher than that from the household censuses (12 per 1000 person-years). Adult mortality in the household censuses (males 0.65; females 0.51) was lower than in the cohort study (males 0.77; females 0.57), while mathematical models gave a much higher estimate, especially for females (males 0.80 -0.83; females 0.75 -0.80). The population attributable fraction of adult deaths due to HIV was 0.61 for men and 0.70 for women, with life expectancy estimated to be 34.3 years for males and 38.2 years for females. CONCLUSION: Each method for estimating adult mortality had limitations in terms of loss to follow-up (cohort study), under-ascertainment (household censuses), transparency of underlying processes (single question), and sensitivity to parameterization (mathematical model). However, these analyses make clear the advantages of longitudinal cohort data, which provide more complete ascertainment than household censuses, highlight possible inaccuracies in model assumptions, and allow direct quantification of the impact of HIV.

Adult↗
PubMed1994

Self-reported physical activity in a rural county: a New York county health census.

OBJECTIVES: Few studies have described physical activity in rural populations. This study describes the frequency, types, and correlates of physical activity in 29,304 free-living adults in a rural county in New York State. METHODS: Self-reported responses about regular physical activity (maintained long enough to work up a sweat) were analyzed from a private household census of Otsego County with an 86.6% response rate. RESULTS: This survey categorized 46.2% of county residents as sedentary. Walking, the most frequent choice of activity (62% of the women, 36% of the men), increased in frequency with age of respondents whereas cycling, jogging, aerobics, team sports, and swimming (listed in rank order of frequency) generally tended to decrease in frequency with age. Farmers demonstrated an increased amount of "sweat activity" compared with persons in most other occupations. CONCLUSIONS: This descriptive study of physical activity in a rural county shows that sedentary lifestyle is of high prevalence. The high frequency of walking and the gender differences in both the levels and choice of activity suggest that further research and public policy recommendations focus on these issues.

Adolescent↗
PubMed2004

Online consumer surveys as a methodology for assessing the quality of the United States health care system.

BACKGROUND: Interest in monitoring the quality of health care in the United States has increased in recent years. However, the policy objectives associated with collecting this information are constrained by the limited availability of timely and relevant data at a reasonable cost. Online data-collection technologies hold the promise of gathering data directly and inexpensively from large, representative samples of patients and consumers. These new information technologies also permit efficient, real-time assessment in such areas as health status, access to care, and other aspects of the care experience that impact health outcomes. OBJECTIVE: This study investigates the feasibility, validity, and generalizability of consumer online surveys to measure key aspects of health care quality in the United States. METHODS: Surveys about the health and health care experiences of a general adult population and of adults with diabetes were administered online and by telephone. The online survey drew from a sample frame of nearly 1 million consumers and used a single e-mail notification. The random-digit-dial methodology included 6 follow-up calls. Results from the online sample were compared to the telephone sample and to national benchmark data. RESULTS: Survey responses about quality of care collected using online and telephone methods were commensurate once they were weighted to represent the demographic distribution of the 2000 United States Census. Expected variations in health and health care quality across demographic and socioeconomic groups were largely observed, as were hypothesized associations among quality indicators and other variables. Fewer individuals were required to be contacted to achieve target sample sizes using online versus telephone methods. Neither method yielded representative cohorts of nonwhite individuals. CONCLUSIONS: Conclusions about the level and variations in health care quality in the United States are similar using data collected in this study compared to data collected using other telephone-based survey methods. As is typical for national telephone surveys conducted by the National Center for Health Statistics, stratified sampling and weighting of survey responses is necessary for results to be generalizable. Online methods are more appropriate for understanding health care quality than for conducting epidemiologic assessments of health in the United States.

Adolescent↗
PubMed2000

The association between intra-oral cancer and surrogate markers of smoking and alcohol consumption.

OBJECTIVES: 1) To describe the relationships between intra-oral cancer incidence, in England and Wales and the corresponding incidence of lung cancer (a surrogate for cigarette smoking), and liver cirrhosis mortality (a surrogate for alcohol consumption). 2) To elucidate the role and relative importance of cigarette smoking and alcohol consumption in the aetiology of intra-oral cancer. METHOD: Registration data for intra-oral cancer in males and females aged 35 years and over for the 15 regional health authorities (RHAs) in England and Wales in 1979-1983 were obtained from the Office of Population Censuses and Surveys and aggregated for the five-year period. Census-based population data enabled standardised incidence ratios (SIR) to be calculated for each RHA. Using the identical method. SIRs were also computed for lung cancer and standardised mortality ratios (SMR) for liver cirrhosis, the latter for the period 1974-1978 to reflect the shorter induction time for liver disease than for cancer. Correlation coefficients (Spearman's rho) were calculated between the surrogate measures and intra-oral cancer incidence. RESULTS: For all three diseases a north-south gradient, favouring the more southerly RHAs was generally apparent. For males, the correlation between liver cirrhosis mortality and intra-oral cancer incidence was greater and statistically more significant (rho=0.75, P<0.01) than that between lung and intra-oral cancer incidence (rho = 0.63, P<0.05). For females, the corresponding correlation coefficients were positive but not significant. CONCLUSION: For males at least, the association between a surrogate marker for alcohol consumption and intra-oral cancer was greater than that observed for cigarette smoking. This adds further evidence to the current view that alcohol consumption may be more important in the aetiology of intra-oral cancer than cigarette smoking.

Adult↗
PubMed1997

Studies of nonresponse and measurement error in the national household survey on drug abuse.

A summary of the results of a series of studies of nonresponse and measurement error in the National Household Survey on Drug Abuse (NHSDA) is given in this chapter. Two studies not previously reported, the Skip Pattern Experiment and the Census Match Study, are the primary focus of the chapter. The Skip Pattern Experiment involved a test of a modified NHSDA questionnaire that made extensive use of skip patterns in drug use questions. Compared to the standard NHSDA method, which avoids skip patterns, the modified questionnaire tended to produce lower rates of reported drug use. The Census Match Study involved linking 1990 NHSDA nonrespondent cases with data from the 1990 Decennial Census. Household and individual data for NHSDA nonrespondents were obtained from the Census and used to characterize NHSDA nonresponse patterns in detail. A multilevel logistic model of response propensity identified the important predictors of nonresponse, including characteristics of the sampled person, the selected household, the neighborhood, and the interviewer.

Bias↗
PubMed2001

On the wrong side of the tracts? Evaluating the accuracy of geocoding in public health research.

OBJECTIVES: This study sought to determine the accuracy of geocoding for public health databases. METHODS: A test file of 70 addresses, 50 of which involved errors, was generated, and the file was geocoded to the census tract and block group levels by 4 commercial geocoding firms. Also, the "real world" accuracy of the best-performing firm was evaluated. RESULTS: Accuracy rates in regard to geocoding of the test file ranged from 44% (95% confidence interval [CI] = 32%, 56%) to 84% (95% CI = 73%, 92%). The geocoding firm identified as having the best accuracy rate correctly geocoded 96% of the addresses obtained from the public health databases. CONCLUSIONS: Public health studies involving geocoded databases should evaluate and report on methods used to verify accuracy.

Abstracting and Indexing↗
PubMed1993

The challenge of operating within staffing budgets on the maternity unit at New England Memorial Hospital despite a fluctuating census.

PROJECT: Improve staffing policies and procedures on the Maternity unit to reduce the chronic practice of exceeding the budget for nursing hours per patient day (NHPPD). Principals: Maternity Service nursing staff and unit secretary. Process Improvement Method: Plan-Do-Check-Act. Timeline: Begun: March 1991. RESULTS reported here: FY 1992 (October 1, 1991-September 30, 1992). KEY FINDINGS: Patient census fluctuated dramatically from shift to shift. To staff the unit during peak times, nurses from other units were floated in, but many lacked sufficient obstetrics training. Conversely, at slack times, OB nurses were floated to other units. All the above factors resulted in nursing dissatisfaction as well as the Maternity unit exceeding its nurse staffing budget by 25 percent. Improvements: Unit-based staffing, which eliminated floating and increased ownership on the unit, was implemented, along with other changes in operations, policies, and procedures. A charge nurse position was created and implemented to coordinate activities between shifts. Staffing policies and procedures were clarified and updated. RESULTS: Nursing hours per patient day are now on budget, and nursing morale is also improved.

Bed Occupancy↗
PubMed2005

The incidence and prevalence of orphanhood associated with parental HIV infection: a population-based study in Rakai, Uganda.

BACKGROUND: There are limited empirical data on the prevalence and incidence of orphanhood due to parental HIV infection. OBJECTIVE: To assess the prevalence and incidence of orphanhood, and the population attributable fraction (PAF) of incident orphanhood associated with parental HIV infection, in a rural population with a 14.8% adult HIV prevalence. METHODS: The data are derived from a community cohort in Rakai District, Uganda. Census data were collected on all resident members in 10,657 households, including survival of parents of resident children in 1996/1997. Consenting adults were interviewed, provided blood for HIV testing, and were followed up 10 months later to determine parental death and incident orphanhood. The incidence rate ratio (IRR) of orphanhood associated with parental HIV-infection was estimated by Poisson multivariate regression. RESULTS: A total of 22,712 children aged 0-14 years were enumerated in 1996/1997. The overall prevalence of orphanhood was higher among children of HIV-infected parents (22.7%) compared with children of uninfected parents, 7.9%. The annual incidence of orphanhood was 8.2% if at least one parent was HIV positive, and 0.5% if both parents were HIV negative (adjusted IRR = 18.93). Older age of children, and older maternal age were significantly associated with an increased risk of orphanhood. The PAF of incident orphanhood due to parental HIV infection was 37.3%, and was highest among younger children (adjusted PAF = 50.6% for 0-4 year olds), and children with younger mothers aged < 25 years (adjusted PAF = 75.7%). CONCLUSIONS: Parental HIV infection markedly increased the incidence of orphanhood, especially among younger children and the children of younger mothers.

Adolescent↗
PubMed2004

Estimating local interaction from spatiotemporal forest data, and Monte Carlo bias correction.

We point out a general problem in fitting continuous time spatially explicit models to a temporal sequence of spatial data observed at discrete times. To illustrate the problem, we examined the continuous time Markov model for forest gap dynamics. A forest is assumed to be apportioned into discrete cells (or sites) arranged in a regular square lattice. Each site is characterized as either a gap or a non-gap site according to the vegetation height of trees. The model incorporates the influence of neighboring sites on transition rate: transition rate from a non-gap to a gap site increases linearly with the number of neighbors that are currently in the gap state, and vice versa. We fitted the model to the spatiotemporal data of canopy height observed at the permanent plot in Barro Colorado Island (BCI). When we used the approximate maximum likelihood method to estimate the parameters of the model, the estimated transition rates included a large bias-in particular, the strength of interaction between nearby sites was underestimated. This bias originated from the assumption that each transition between two observation times is independent. The interaction between sites at local scale creates a long chain of transitions within a single census interval, which violates the independence of each transition. We show that a computer-intensive method, called Monte Carlo bias correction (MCBC), is very effective in removing the bias included in the estimate. The global and local gap densities measuring spatial aggregation of gap sites were computed from simulated and real gap dynamics to assess the model. When the approximate likelihood estimates were applied to the model, the predicted local gap density was clearly lower than the observed one. The use of MCBC estimates, suggesting a strong interaction between sites, improved this discrepancy.

Data Interpretation, Statistical↗
PubMed1996

Epidemiology and prevention of severe assault and gun injuries to children in an urban community.

OBJECTIVES: To describe the epidemiology of severe assault and gun injuries to children in an urban population and consider the impact of a comprehensive injury prevention program. MATERIALS AND METHODS: Pediatric injury deaths and hospital admissions for Northern Manhattan (1983-1992) were linked to census counts to compute incidence. Poisson regression was used to compare trends in incidence of assault and gun injuries before and during a community-wide pediatric injury prevention program in Central Harlem. MAIN RESULTS: The incidence of severe nonfatal assault injury was 60.94/100,000/year, 10 times the fatality rate. The incidence of all gun injuries was 31.13. In adolescence, guns were the leading cause of both fatal and severe nonfatal assault injury, and were the most lethal method of assault (case-fatality = 18.5% for gun vs. 1.2% for all non-gun assault injury). Rates of assault and gun injuries declined by nearly 50% in the intervention community, while they increased in a neighboring community. CONCLUSIONS: Comprehensive interventions may be effective in curbing the incidence of severe assault injuries to urban youth. Further controlled evaluations are needed to confirm the effectiveness of programs such as this and to better understand the prevention of violent injuries.

Adolescent↗
PubMed2003

Economic potential and entry into marriage and cohabitation.

This article explores the relationship between economic potential and rates of entry into marriage and cohabitation. Using data from the 1990 census and the 1980-1992 High School and Beyond (Sophomore Cohort), we developed a method for explicitly estimating five time-varying measures of earnings potential. The analyses of union formation are based on an intergenerational panel study of parents and children, to which our measures of earnings potential were appended. The results indicate that all five measures of earnings potential strongly and positively influence the likelihood of marriage for men, but not for women. Earnings potential does not affect entry into cohabiting unions for either men or women.

Adult↗
PubMedDate not supplied

Stage of breast and cervical cancer diagnosis in disadvantaged neighborhoods: a prevention policy perspective.

INTRODUCTION: Public health research on cancer and socioeconomic status (SES) has shown that higher SES is related to greater access to services. Using neighborhood-level measures of SES, we test hypotheses related to stage of breast and cervical cancer diagnosis. METHODS: SEER data on women diagnosed with breast or cervical cancer in 1989 and 1990 in San Francisco, Atlanta, and Detroit were matched with 1990 Census tract data. Cases were grouped as "in situ" or "invasive" at diagnosis. Using multivariate logistic regression in two separate models, we investigated whether residence in a poverty-tract or, alternatively, a disadvantaged neighborhood is associated with increased likelihood of diagnosis with invasive tumors. RESULTS: Living in a socioeconomically disadvantaged neighborhood was a strong, consistent predictor of invasive cancer. Living in a neighborhood with a high proportion of households in poverty was also a significant predictor for cervical cancer. CONCLUSIONS: Our results suggest specific neighborhoods that would benefit from clinical interventions. Lack of economic and social resources constrains individuals living in these neighborhoods from taking advantage of interventions targeting individual behavior. Thus, interventions in the small proportion of disadvantaged neighborhoods, we argue, need to target the entire community. Further, policy reform at the community level becomes more feasible when need can be specified for a particular census tract.

Adult↗
PubMed2001

Avoidable mortality in New Zealand, 1981-97.

OBJECTIVE: To describe avoidable mortality in New Zealand, including trends and variations between groups by age, gender, ethnicity and degree of deprivation. METHOD: New Zealand Health Information Service mortality unit records, 1981 to 1997, were classified as 'avoidable' or 'unavoidable' based on a reassessment of ICD9 codes and an upper age limit of 75 years. 'Avoidable' causes of death were further subcategorised according to the level of intervention involved (primary, secondary or tertiary). Deaths were assigned a deprivation score using a Census-based small area deprivation index, the NZDep96. Mortality rates were age standardised by the direct method, with Segi's world population as the reference. RESULTS: Avoidable mortality declined 38% from 1981 to 1997; unavoidable mortality declined only 9%. In 1996-97 almost 70% of deaths in the 0-74 age range were still considered to be potentially avoidable. Almost 80% of avoidable deaths occur in the 45-74 age group. These deaths are dominated by the emergence of chronic diseases such as ischaemic heart disease, diabetes and smoking-related cancers. In younger age groups, injury (including suicide) dominates avoidable mortality. Males experience a greater burden of avoidable mortality than females--a relative excess of 54% (approximately 2,000) in 1996-97. The gender difference is largely attributable to diseases and injuries amenable to primary prevention, with the largest single contribution coming from ischaemic heart disease. The ethnic gap in avoidable mortality remains wide: rates for Mäori and Pacific people were 2-2 1/2 times higher than European rates in 1996-97. Similar gradients are seen with deprivation. CONCLUSION AND IMPLICATIONS: Avoidable mortality analysis provides a useful tool for evidence-based health needs assessment and health policy development.

Acute Disease↗