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At least 1,207 records · Page 67Linked to original sources
PubMed2007

Time trends of esophageal cancer in Hong Kong: age, period and birth cohort analyses.

This study was to examine the time trend of the incidence rates of esophageal cancer during the period 1979-2003 in Hong Kong and to identify the effects of year of diagnosis (period) and year of birth (cohort) on the observed time trends using regression models. Cancer incidence data were obtained from Hong Kong Cancer Registry and population data were from the Census and Statistics Department. Age-standardized incidence rates were computed by the direct method using the World population of 1966. Annual percentage change (APC) in incidence rate was calculated using nonlinear regression. Period and cohort effects were assessed using 2 separate Poisson regression models after adjusting for age. During the period 1979-2003, a steady decrease in the age-standardized incidence rate was observed for both males (APC = -3.38%, 95% confidence interval [CI]: -2.89%, -3.86%) and females (APC = -3.92%, 95% CI: -3.15%, -4.69%). The incidence rates were consistently higher among males than females. After the adjustment for age and with the period 1989-1993 or birth cohort of 1934-1938 as reference, the relative risk of more recent periods or birth cohorts significantly decreased. The age-cohort model provided a better description of the data than the age-period model. Given reasonable latency between exposures and esophageal cancer incidence, the declining birth cohort effects in the recent generations were in line with the increased intakes of fresh vegetables and decreased consumptions of alcohol drinking, tobacco smoking, and preserved foods observed in population, thus supported their importance in influencing the burden of esophageal cancer.

Adult↗
PubMed1999

Do blacks believe that HIV/AIDS is a government conspiracy against them?

BACKGROUND: We present the first study to explore the possibility that blacks believe that the human immunodeficiency virus was developed by the federal government in order to exterminate the black population. METHODS: Five hundred twenty black adults sampled door to door in 10 randomly selected census tracts completed a written survey in exchange for $10. They indicated their degree of agreement with the statement, "HIV/AIDS is a man-made virus that the federal government made to kill and wipe out black people." RESULTS: Twenty-seven percent of blacks held AIDS-conspiracy views and an additional 23% were undecided. Endorsing AIDS-conspiracy beliefs was not related to blacks' age or income but was related to higher levels of education. Blacks who agreed that AIDS is a conspiracy against them tended to be culturally traditional, college-educated men who had experienced considerable racial discrimination. CONCLUSIONS: The prevalence and health-related implications of blacks' AIDS-conspiracy beliefs must be fully investigated, and such beliefs must be addressed in culturally tailored, gender-specific AIDS prevention programs for blacks.

Acculturation↗
PubMed2006

Evaluation of a mass mailing recruitment strategy to obtain a community sample of women for a clinical trial of an incontinence prevention intervention.

OBJECTIVES: Questions exist about using mass mailings to recruit representative samples to participate in clinical trials. The MESA Prevention Study (Medical, Epidemiologic and Social Aspects of Aging), a randomized controlled clinical trial to prevent urinary incontinence (UI), utilized a mass mailing recruitment procedure to recruit a representative sample of women to participate in a behavioral modification program. This paper seeks to expand the literature of mass mailing recruitment strategies for prevention studies by describing the procedures used to recruit healthy, continent, post-menopausal women aged 55-80 years. METHODS: Sociodemographic data collected from recruited subjects is compared with on-line national census data to evaluate the representativeness of the sample recruited from a purchased mailing list. RESULTS: The mass mailing procedure resulted in 3.3% positive response. Of those that returned a positive response, 37.6% were deemed eligible at first screening. Comparisons of study demographic data with state and county census data indicate that the sample obtained was representative of the communities. CONCLUSIONS: The mass mailing strategy was an effective means of recruiting a representative sample of women, aged 55-80. Short falls and recommendations for successful community sample recruitment strategies for clinical trials in older adult women are elaborated upon.

Aged↗
PubMed2006

Prevalence of life-threatening arrhythmias in ED patients transported to the radiology suite while monitored by telemetry.

OBJECTIVE: The aim of this study was to determine the prevalence of life-threatening arrhythmias in monitored ED patients while in the radiology suite. METHODS: This is a retrospective analysis at a tertiary care hospital with an ED census of 52,000 visits. The patient population consisted of 3,051 adult ED patients with a chief complaint of chest pain, who were monitored with telemetry while they were sent to the radiology suite, and who were ultimately admitted to the hospital. RESULTS: Of a total of 3,051 consecutive patients with a cardiac presentation who received a nonportable chest x-ray, no patients were found to have incurred a life-threatening arrhythmia while in the radiology suite. CONCLUSION: The prevalence of a cardiac arrhythmia occurring during transport or while within the radiology suite in our study was zero. We conclude that stable patients can probably be transported to radiology safely without the use of bedside telemetry.

Arrhythmias, Cardiac↗
PubMed2006

Spatial analysis of prostate cancer incidence and race in Virginia, 1990-1999.

BACKGROUND: Racial disparities exist in prostate cancer incidence. An important contributor to these disparities may be socioeconomic status. METHODS: Virginia Cancer Registry data, 1990-1999 (37,373 cases) were geocoded to the Census tract and county level. The annualized, age-adjusted incidence rates for African Americans and whites were calculated, and crude and smoothed maps of these rates were produced. Statistical tests for clustering of cases were conducted. Prostate cancer incidence was statistically modeled as a function of area-based measures of poverty, median household income, education, rural status, ratio of physicians to population in each county, percentage of men in each county obtaining prostate cancer screening with the prostate-specific antigen (PSA) test, and percent of households headed by females. RESULTS: Prostate cancer incidence was elevated in the eastern and central portions of the state. Statistical tests for clustering were highly significant (Tango's test, p<0.008; spatial scan statistic, p<0.001). Poverty and lower education were associated with a decreased incidence among whites but not African Americans. Median household income and urban status were positively associated with incidence for both populations. Among whites, increased percent of female heads of households and ratio of physicians per population were associated with increased incidence. Associations between predictor variables and prostate cancer incidence were seen only in the census tract level analyses. CONCLUSIONS: Overall, the findings support the argument that area measures of poverty and education do not explain the increased incidence of prostate cancer among African Americans. Other factors, such as dietary practices, may help explain racial disparities in prostate cancer incidence. Because of the large differences between tract and county level results, the time and expense of obtaining data geocoded to the tract level seems worthwhile.

Adult↗
PubMed2005

Team assignment system: expediting emergency department care.

STUDY OBJECTIVE: We designed and implemented an emergency department (ED) team assignment system, each team consisting of 1 emergency physician, 2 nurses, and usually 1 technician. Patients were assigned in rotation upon arrival to a specific team that was responsible for their care. We monitored the time from arrival to physician assessment, percentage of patients who left without being seen by a physician, and patient satisfaction before and after team assignment system implementation. METHODS: This study was done in a suburban community hospital with an annual ED census of approximately 39,000. Time to physician assessment was defined from the completion of the medical screening evaluation by an ED nurse at triage to initiation of emergency physician evaluation. Times were documented on the ED paper record and manually entered into a computerized registration by the clerical staff. Patients who left without being seen was reported as percentage of total ED visits. Patient satisfaction scores using a 5-point Likert scale to assess satisfaction with the emergency physician, ED staff courtesy, and coordination of care were gathered every 3 months from random mailings to a subset of patients. RESULTS: The 12-month ED census was 38,716 before team assignment system implementation and 39,301 afterwards. Complete time data were recorded for 34,152 (88.2%) and 32,537 (82.8%) of the patients, respectively. The mean time to physician assessment was 71.3+/-7.0 minutes before and 61.8+/-6.4 minutes after team assignment system implementation (absolute difference -9.5 minutes; 95% confidence interval [CI] -5.8 to -13.5 minutes). The percentage of patients seen by a physician within 1 hour was 56.3% before and 64.0% after team assignment system implementation (absolute difference 7.7%; 95% CI 5.1% to 10.3%). The percentage of patients who waited more than 3 hours for physician assessment was 17.8% before and 11.8% after team assignment system implementation (absolute difference -6.0%, 95% CI -4.0% to -8.1%). Before team assignment system, the left without being seen rate was 2.3% compared to 1.6% after team assignment system (absolute difference -0.8%; 95% CI -0.4% to -1.1%). Patient satisfaction reported as very good or excellent showed improvement in satisfaction with the physician (absolute increase 3.1%; 95% CI 1.0% to 5.3%), staff courtesy (absolute increase 4.5%; 95% CI 2.3% to 6.7%), and coordination of care (absolute increase 3.6%; 95% CI 0.8% to 6.4%). CONCLUSION: The implementation of a team assignment system in our ED was associated with reduced time to physician assessment, a reduced percentage of patients who left without being seen, and improved patient satisfaction.

California↗
PubMed2005

The link between obesity and the built environment. Evidence from an ecological analysis of obesity and vehicle miles of travel in California.

AIMS: Obesity and physical inactivity are known to be risk factors for many chronic diseases including hypertension, coronary artery disease, diabetes, and cancer. We sought to explore the association between an indicator of transportation data (Vehicle Miles of Travel, VMT) at the county level as it relates to obesity and physical inactivity in California. METHODS: Data from the California Health Interview Survey 2001 (CHIS 2001), the US 2000 Census, and the California Department of Transportation were merged to examine ecological correlations between vehicle miles of travel, population density, commute time, and county indicators of obesity and physical inactivity. Obesity was measured by body mass index (BMI). Physical inactivity was based on self-reported behaviors including walking, bicycling, and moderate to vigorous activity. The unit of analysis was the county. Thirty-three counties in California with population size greater than 100,000 persons per county were retained in the analyses. RESULTS: CHIS 2001 statewide obesity prevalence ranged from 11.2% to 28.5% by county. Physical inactivity ranged from 13.4% to 35.7%. Daily vehicle miles of travel ranged from 3.3 million to 183.8 million per county. By rank bivariate correlation, obesity and physical inactivity were significantly associated (p<0.01). Furthermore, by rank analysis of variance, the highest mean rank obesity was associated with the highest rank of VMT (p<0.01). Similar rank patterns were observed between obesity and physical inactivity and commute time. Associations between VMT and physical inactivity were examined but failed to reach statistical significance. CONCLUSION: This analysis adds to the growing evidence supporting the association between VMT (a measure of automobile transportation) and obesity. An urban design characterized by over dependence on motorized transportation may be related to adverse health effects.

Adolescent↗
PubMed2003

Deaths in construction related to personnel lifts, 1992-1999.

PROBLEM: This study examined deaths of construction workers due to personnel lifts (boom-supported and scissor lifts, suspended scaffolds, and crane platforms). METHODS: Deaths of construction workers for 1992-1999 were examined using data from the Census of Fatal Occupational Injuries, a Bureau of Labor Statistics database. RESULTS: The study identified 339 deaths: 42% from boom-supported lifts; 26% from suspended scaffolds; 19% from scissor lifts; 5% from crane platforms; and 7% from unapproved lifts (e.g., forklift platforms). The main causes of death were falls (36%), collapses/tipovers (29%), and electrocutions (21%). DISCUSSION: Recommendations include: following OSHA regulations, wearing personal fall protection equipment, adequate maintenance, inspection before use, and training on the model of lift used. Precautions are also needed to prevent contact with overhead power lines. IMPACT ON INDUSTRY: The increasing popularity of boom-supported lifts and scissor lifts, both in construction and other industries, make their safety an important issue.

Accidents, Occupational↗
PubMed2006

Food store availability and neighborhood characteristics in the United States.

OBJECTIVE: This study provides a multivariate analysis of the availability of food store outlets in the US and associations with neighborhood characteristics on race, ethnicity and socioeconomic status (SES). METHOD: Commercial food store outlet data are linked across 28,050 zip codes to Census 2000 data. Multivariate regression analyses are used to examine associations between the availability of chain supermarkets, non-chain supermarkets, grocery stores and convenience stores and neighborhood characteristics on race, ethnicity and SES including additional controls for population size, urbanization and region. RESULTS: Low-income neighborhoods have fewer chain supermarkets with only 75% (p<0.01) of that available in middle-income neighborhoods. Even after controlling for income and other covariates, the availability of chain supermarkets in African American neighborhoods is only 52% (p<0.01) of that in White neighborhoods with even less relative availability in urban areas. Hispanic neighborhoods have only 32% (p<0.01) as many chain supermarkets compared to non-Hispanic neighborhoods. Non-chain supermarkets and grocery stores are more prevalent in low-income and minority neighborhoods. CONCLUSION: The study results highlight the importance of various potential public policy measures for improving access to supermarkets that may serve to reduce systematic local area barriers that are shown to exist by race, ethnicity and income.

Censuses↗
PubMed2003

Effect of population density on mortality after motor vehicle collisions.

The objective of this study was to evaluate the effect of population density on mortality after traffic crashes. Subjects were the drivers of vehicles requiring towing after collisions, sampled by NASS-GES during 1994-1998. Cases were classified by population of crash location (greater or lesser than 25,000) and by population density of the driver's county of residence (using ZIP code and Census data). Cases were also categorized by age, belt use and vehicle speed. Analytic methods for weighted, stratified survey data were used to estimate effects on mortality. A total of 190,721 cases with a specified crash location were identified in the sample, of which 93.7% had a specified population at the crash location, and 94.1% could be linked to the driver's county data. Mortality was higher in locations with populations less than 25,000 and was inversely proportional to the driver's county population density. Age, belt use, and vehicle speed also affected mortality significantly, but the effect of rural location remained after controlling for these factors (O.R. 2.10, 95% C.I. 1.62-2.73). The excess risk for residents of rural areas to die in traffic crashes can be attributed in part to post-crash factors.

Accidents, Traffic↗
PubMed1997

Urologic manpower issues for the 21st century: assessing the impact of changing population demographics.

OBJECTIVES: To evaluate the impact of changing population demographics on urologic staffing over the coming decades. METHODS: A model was constructed using data obtained from the U.S. Bureau of the Census for population projections; clinical studies to assess the percentages of men with symptomatic benign prostatic hyperplasia (BPH) and those undergoing prostatectomy; the American Medical Association regarding numbers and annual percent change of practicing urologists; and the American Urological Association regarding numbers of physicians completing residency training programs. Sensitivity analyses were performed varying both the rate of surgical intervention for symptomatic BPH and the annual increase in the number of practicing urologists. RESULTS: Regardless of variations in the surgical rate to as low as 4%, the average number of transurethral resections of the prostate gland/surgical interventions for BPH per urologist will increase by the year 2020 when compared with the known basepoint value obtained for 1990. Additionally, even with an annual net increase of 200 urologists per year, by 2020, the rapidly expanding population over 65 years of age will nearly offset even such a large increase in the number of practicing urologists. CONCLUSIONS: The greatest factor concerning future urologic staffing issues will be the changing population demographics. The need for urologic services will continue to rise. An oversupply of urologists can be avoided as long as the net increase does not exceed an average of 200 urologists annually.

Age Factors↗
PubMed2002

Maternal mortality among Afghan refugees in Pakistan, 1999-2000.

BACKGROUND: Estimated at 3.6 million, Afghans are the largest population of refugees in the world. Information on the magnitude, causes, and preventable factors of maternal deaths among Afghan refugees may yield valuable information for prevention. METHODS: Deaths were recorded between Jan 20, 1999, and Aug 31, 2000, during a census carried out in 12 Afghan refugee settlements in Pakistan. Deaths among women of reproductive age (15-49 years) were further investigated by verbal autopsy interviews to determine their cause, risk factors, and preventability, and to ascertain the barriers faced to obtaining health care. FINDINGS: The census identified 134406 Afghan refugees and 1197 deaths; a crude mortality rate of 5.5 (95% CI 5.2-5.8) per thousand population. Among the 66 deaths among women of reproductive age, deaths due to maternal causes (n=27) exceeded any other cause (41% [95% CI 29-53]). 16 liveborn and nine stillborn infants were born to women who died of maternal causes; six of the liveborn infants died after birth. Therefore, 60% (15 of 24) of infants born to these women were either born dead or died after birth. Compared with women who died of non-maternal causes, women who died of maternal causes had a greater number of barriers to health care (p=0.001), and their deaths were more likely to be preventable (p<0.05). INTERPRETATION: Maternal deaths account for a substantial burden of mortality among Afghan refugee women of reproductive age in Pakistan. The high prevalence of barriers to health care access indicates opportunities for reducing maternal deaths in refugee women and their children.

Adult↗
PubMed1998

Mammography screening among California Medicare beneficiaries: 1993-1994.

BACKGROUND: Over half of all breast cancer deaths occur among women 65 years of age or older. However, mammography screening decreases with increasing age, despite better survival rates for tumors detected early. METHODS: Health Care Financing Administration data from 1993 and 1994, and 1990 United States Census data were used to assess the impact of race, age, Medicaid coverage, and community-level socioeconomic indices on mammography screening for over 800,000 California Medicare beneficiaries. RESULTS: Women who were African American, older, or had Medicaid coverage were significantly less likely to have a biennial mammogram than their counterparts. Women living in areas with fewer college educated residents, with a higher proportion of Mexican or Asian residents had lower use of mammography. However, African-American and Caucasian women with Medicaid coverage had equally low mammography rates (AOR = 1.01, 95% CI .97-1.04), while African-American women with and without Medicaid had similarly low mammography rates (AOR = .96, 95% CI .92-1.01). CONCLUSIONS: Despite dual coverage, Medicare beneficiaries enrolled in Medicaid had few mammograms. African-American Medicare beneficiaries, with and without Medicaid, had low mammography rates. Intervention efforts should be targeted toward these women.

Black or African American↗
PubMed1995

CQI action team: responding to the detoxification patient.

BACKGROUND: The management of detoxification patients is a complex interdisciplinary effort requiring involvement, cooperation, and understanding from staff at all levels of the facility. In 1992-93, alcohol-related diagnoses were the highest admission diagnosis at the Royal C. Johnson Veterans Affairs Medical Center (VAMC). Yet only 44% of the detoxification patients admitted to the VAMC were placed in beds specifically designed for detoxification. Initially, the action team believed that the issues were apparent and that the problems were the result of uncooperative and noncompliant providers who were not following established policy. METHODS AND RESULTS: Data analysis of admission and discharge trends, laboratory results, and bed census revealed discrepancies with several widespread myths held by local health care workers. These misperceptions and attitudes often interfered with treatment. CONCLUSIONS: Recommended changes included the development of a clinical pathway for the detoxification patient, implementation of an alcohol withdrawal assessment tool to manage and treat the patient at risk for experiencing alcohol withdrawal, and hospitalwide education on management of the detoxification patient.

Alcoholism↗
PubMed2004

Attenuation of social class and reproductive risk factor associations for Hodgkin lymphoma due to selection bias in controls.

OBJECTIVE: Hodgkin lymphoma (HL) risk has been linked with higher social class and lower parity, but our prior population-based case-control study in adult women had unexpected null findings for these variables. Because subject participation was 87% for cases but 65% for random digit-dialing (RDD) controls, we examined representativeness of our controls and the impact of detected bias on prior results. METHODS: Using data from RDD enumeration, abbreviated interviews with nonparticipating controls, and the US census, we compared participating and nonparticipating RDD controls across several age groups and then recomputed odds ratios for risk factor associations adjusted for bias. RESULTS: The 325 RDD control participants were younger, more likely to be white, better educated, and of lower birth order and lower parity than the nonparticipants. Adjustment of odds ratios for bias strengthened previously null findings for education and for parity, breast-feeding and miscarriages in young adult women; these latter changes eliminated previously apparent age modification of risks. CONCLUSIONS: Selection bias in female RDD controls resulted from differential participation by socioeconomic factors, varied with age, and produced underestimations of several associations in young women, including reproductive factors. Thus, our prior conclusions of etiologic irrelevance for some study variables may have been inaccurate.

Abortion, Spontaneous↗
PubMed2001

Determinants of prescribing costs amongst single-handed general practitioners.

OBJECTIVE: To investigate the contribution of patient and doctor characteristics in explaining observed variations in prescribing costs between individual doctors. METHOD: Secondary analysis of data collected from general practitioners, Family Health Services Authorities, 1991 Census data set and the Prescription Pricing Authority. RESULTS: A multiple regression model with four variables (social class, training status, generic prescribing and length of time in general practice) explained only 16.5% of the variation in costs/ASTRO-PU. CONCLUSION: This study highlights that very little of the variation in prescribing costs can readily be explained. Further research is needed to document contributing factors.

Adult↗
PubMed2005

Social mobility, marital status, and mortality risk in an adult life course perspective: the Malmö Preventive Project.

AIMS: Adverse social factors predict increased mortality. This study aimed to assess the influence of social class and marital status on mortality, adding an adult life course perspective. METHODS: In total, 32,907 males and 20,204 females were evaluated based on census data in Malmö, Sweden. Of these subjects, 22,444 males and 10,902 females also took part in health screening. The main outcomes were all-cause and cause-specific mortality rates in subgroups based on social class and marital status, either measured once or repeatedly in adult life. Results were based on a total of 522,807 years of follow-up in men (5,761 deaths) and 239,815 in women (1,354 deaths). RESULTS: Total and cardiovascular mortality were significantly higher in manual male employees with age-adjusted risk ratios (RR) of 1.7 (95% CI 1.5-1.9) and 1.6 (1.3-2.0) in skilled manual workers, and 2.0 (1.7-2.2) and 1.9 (1.6-2.3) in unskilled manual workers, compared with high-level non-manual employees. The differences remained after adjustment for baseline risk factors and prevalent cardiovascular disease, and were similar for women. Increased mortality risk was also documented for subjects who were divorced or unmarried (adjusted for social class), as well as being downward socially mobile or in a permanent low social class (manual) position. CONCLUSIONS: Social class based on occupation, either measured once or repeatedly in adult life, is associated with marked differences in mortality risk in middle-aged subjects. People who remain married/cohabiting or remarry are at lower risk of early death than people who remain unmarried or divorced.

Adult↗