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PubMed1993

National growth rate method with varying internal migration rate.

"The assumption of 'uniform flow of internal migration' used in [the paper by] Rahman (1987) is generalised in this paper for cases when the flow of internal migration is increasing or even decreasing. In particular, the cases when the migration rate is proportional to the national population or to the regional population are analysed. Procedure for estimation of the migration rate and the pure migration are given. The formula for prediction of population is also provided. As an application of the procedure, migration to the Dhaka SMA is analysed with the help of Census data [for Bangladesh]."

Asia↗
PubMed1999

Ovarian cancer and occupational exposures in Finland.

BACKGROUND: No single occupational or environmental agent has been established as causing ovarian cancer, existing studies often being based on ecologic or proportional mortality data in which potential confounders related to reproductive history have not been taken into account. METHODS: This study linked 324 job titles of occupationally active Finnish women (n = 892,591) at 1970 census with incidence of ovarian cancer (Finnish Cancer Registry, 5,072 cases) during 1971-1995 (over 15 million person-years). The job titles were converted into indicators of exposure to 33 agents, using a national job-exposure matrix based on measurements and surveys (FINJEM). Poisson regression analyses were performed with stratification by birth cohort, follow-up period, and socioeconomic status, and adjusted for mean number of children, mean age at first delivery, and turnover rate for each job title. RESULTS: We found indications of elevated risks for aromatic hydrocarbon solvents (standardized incidence ratio 1.3 (95% CI 1.0-1.7), leather dust (1.4; 0.7-2.7), man-made vitreous fibers (1.3; 0.9-1.8), and high levels of asbestos (1.3; 0.9-1.8), and diesel (1.7; 0.7-4.1), and gasoline (1.5; 1.0-2.0) engine exhausts). Previously reported findings for hairdressers and women in the printing industry were supported in our data, but not for women in dry cleaning jobs. CONCLUSIONS: Given the various drawbacks in linkage studies and job-exposure matrices, the excesses found in this study need confirmation in individual-level studies.

Adult↗
PubMed1984

Correlates of urban mortality: a social area analysis.

A method of social area analysis developed by Shevky and Bell is used to analyze mortality among the census tracts of Des Moines, Iowa. "Social rank, urbanization, and segregation indices as well as age-standardized death rates were calculated for each census tract. All variables were treated as continuous, and correlation and regression procedures were used to analyze the data. The findings were consistent with those of previous studies and all relationships were as expected. Regression analysis revealed that segregation contributed little to the explanation of variation in age-standardized death rates, suggesting that segregation is not an important determinant of life styles affecting mortality independent of social rank. The results were interpreted in terms of social class differences in accessibility to medical assistance and assumption of the sick role."

Americas↗
PubMed2005

Closed reduction of prosthetic hip dislocation by emergency physicians.

OBJECTIVE: The purpose of this study was to determine the frequency of successful closed reduction (CR) of dislocated prosthetic hips performed by emergency physicians (EPs) as well as the incidence of acute complications. METHODS: The study design was an explicit chart review set at an academic ED with an annual census of 55,000. The study was performed on March 1, 1999 to February 28, 2004. Patients were identified using coded ED diagnoses, and data were obtained by a trained abstractor. RESULTS: One hundred twelve dislocations in 66 patients had attempted CR in the ED. Eighty-one had CR attempted solely by an EP with 91% success. Twenty-eight of the remaining 31 (90%) had successful CR performed by either an orthopedic surgeon or both an EP and an orthopedic surgeon. Overall, 10 patients (9%) failed ED CR. No postreduction complications were identified in any patient. CONCLUSIONS: EPs can safely and successfully perform CR on patients with dislocated total hip arthroplasties.

Adult↗
PubMed2005

Perceived and objective environmental measures and physical activity among urban adults.

BACKGROUND: Enhancing community environments to support walking and bicycling serves as a promising approach to increase population levels of physical activity. However, few studies have simultaneously assessed perceptions and objectively measured environmental factors and their relative association with transportation or recreational physical activity. METHODS: For this cross-sectional study, high- and low-income study areas were selected among census tracts in St. Louis MO ("low-walkable" city) and Savannah GA ("high-walkable" city). Between February and June 2002, a telephone survey of 1068 adults provided measures of the perceived environment and physical activity behavior. In this timeframe, objective measures were collected through environmental audits of all street segments (n =1158). These measures were summarized using 400-m buffers surrounding each respondent. Neighborhood characteristics included the land use environment, transportation environment, recreational facilities, aesthetics, and social environment. Associations were examined between neighborhood features and transportation- and recreation-based activity. RESULTS: After adjusting for age, gender, and education, transportation activity was negatively associated with objective measures of sidewalk levelness and perceived and objective neighborhood aesthetics. It was positively associated with perceived and objectively measured number of destinations and public transit, perceived access to bike lanes, and objective counts of active people in the neighborhood. Recreational activity was positively associated with perceived access to recreational facilities and objective measures of attractive features. CONCLUSIONS: These findings indicate that physical activities for transportation or recreational are associated with different perceived and objective environmental characteristics. Modifications to these features may change the physical activity behavior of residents exposed to them.

Adolescent↗
PubMed2004

Reported risk factors are useless in detecting HCV-positive subjects in the general population.

BACKGROUND: Chronic hepatitis C virus infection is mostly asymptomatic, so it will not be identified if specific diagnostic tests are not performed. AIMS: To evaluate the positive predictive value of some risk factors in detecting anti-hepatitis C virus-positive subjects in the general population. SUBJECTS: Two-thousand five hundred and sixty-one subjects randomly selected from the list of the census in three population-based surveys performed in hepatitis C virus endemic areas in Southern Italy. METHODS: The sensitivity, specificity and positive predictive value of blood transfusion, past use of glass syringes and surgical intervention in detecting hepatitis C virus positivity were assessed. Data were collected using a precoded questionnaire administered by an interviewer. RESULTS: All risk factors showed a poor positive predictive value (ranging from 21.0% for surgical intervention to 29.0% for blood transfusion). The positive predictive value was extremely low (ranging from 2.9 to 4.3%) in subjects younger than 46 years of age, who mostly could benefit from antiviral treatment. The combination of the simultaneous presence of more than one risk factor does not improve the detection of hepatitis C virus infection. CONCLUSIONS: Reported risk factors are useless in detecting hepatitis C virus-positive subjects in the general population.

Adolescent↗
PubMed2004

The role of area-level influences on prostate cancer grade and stage at diagnosis.

BACKGROUND: This research explores area-level social influences on prostate cancer, to test whether area-level influences explain disparities in U.S. prostate cancer burden. METHODS: The authors geocoded 23,993 1992-1997 Maryland prostate cancer cases, and linked cases to 1990 census data. The authors examined the effect of 17 area-level social variables, measured at block group, tract, and county, modeling individual and multilevel predictors of later stage and higher tumor grade. RESULTS: Younger age, black race, higher grade or ungraded tumors, and earlier year of diagnosis were associated with later stage. Block group percentage of white-collar workers (O.R. = 0.93, 95% C.I. = 0.89, 0.98), and county resources (O.R. = 0.94, 95% C.I. = 0.89, 0.98), were protective of later stage. Older age, black race, and earlier year of diagnosis were associated with higher grade. Block group income was protective for white men (O.R. = 0.92, 95% C.I. = 0.87, 0.96), but for all men, county resources increased risk of higher grade (O.R. = 1.23, 95% C.I. = 1.16, 1.31). CONCLUSIONS: Social resources did not significantly reduce racial differences. Results suggest tumor biology is related to relative resources, with better outcomes associated with greater small-area wealth in low-resource counties, but stage at diagnosis is associated with absolute resources, with better outcomes associated with higher small-area social class in high-resource counties.

Adolescent↗
PubMed2000

End-of-life decisions in neonatal intensive care: physicians' self-reported practices in seven European countries. EURONIC Study Group.

BACKGROUND: The ethical issue of foregoing life-sustaining treatment for newborn infants at high risk of death or severe disability is extensively debated, but there is little information on how physicians in different countries actually confront this issue to reach end-of-life decisions. The EURONIC project aimed to investigate practices as reported by physicians themselves. METHODS: The study recruited a large, representative sample of 122 neonatal intensive-care units (NICUs) by census (in Luxembourg, the Netherlands, and Sweden) or stratified random sampling (in France, Germany, the UK, Italy, and Spain) with an overall response rate of 86%. Physicians' practices of end-of-life decision-making were investigated through an anonymous, self-administered questionnaire. 1235 completed questionnaires were returned (response rate 89%). FINDINGS: In all countries, most physicians reported having been involved at least once in setting limits to intensive care because of incurable conditions (61-96%); smaller proportions reported such involvement because of a baby's poor neurological prognosis (46-90%). Practices such as continuation of current treatment without intensification and withholding of emergency manoeuvres were widespread, but withdrawal of mechanical ventilation was reported by variable proportions (28-90%). Only in France (73%) and the Netherlands (47%) was the administration of drugs with the aim of ending life reported with substantial frequency. Age, length of professional experience, and the importance of religion in the physician's life affected the likelihood of reporting of non-treatment decisions. INTERPRETATION: A vast majority of neonatologists in European NICUs have been involved in end-of-life limitation of treatments, but type of decision-making varies among countries. Culture-related and other country-specific factors are more relevant than characteristics of individual physicians or units in explaining such variability.

Adult↗
PubMed2002

Long-term effect of psychological trauma on the mental health of Vietnamese refugees resettled in Australia: a population-based study.

BACKGROUND: What are the deleterious effects of mass trauma on the psychological wellbeing of refugees and other war-affected populations? Most epidemiological data are for short-to-medium term effects, leaving the possibility that early psychological reactions could reduce naturally over time. We aimed to assess the long-term effects of trauma on mental health and disability in Vietnamese refugees resettled in Australia. METHODS: In a population-based study, we identified a community sample of 1413 adult Vietnamese from census collection areas in Sydney, Australia. Participants were interviewed by trained bilingual workers who administered questionnaires to assess the frequency of international classification of disease, version 10 (ICD-10) mental disorders in the 12 months before interview; psychiatric symptoms, by use of a culturally-sensitive symptom measure; exposure to psychologically traumatic events; disability and use of health services; and social, economic, and cultural factors since migration. We did multivariate analyses with adjustment for stressors since migration to establish the risk factors for mental illness. FINDINGS: 1161 (82%) adults completed the interview. Mean length of residence in Australia was 11.2 years (SD 14.4) and mean time since the most severe traumatic event was 14.8 years (SD 10.8). 95 (8%) and 75 (7%) of participants had mental disorders defined by ICD-10 and the culturally-sensitive measure, respectively. Trauma exposure was the most important predictor of mental health status. Risk of mental illness fell consistently across time. However, people who had been exposed to more than three trauma events (199) had heightened risk of mental illness (23, [12%]) after 10 years compared with people with no trauma exposure (13, [3%]) (odds ratio 4.7, p<0.0001, 95% CI 2.3-9.5). INTERPRETATION: Most Vietnamese refugees were free from overt mental ill health. Trauma-related mental illness seemed to reduce steadily over time, but a subgroup of people with a high degree of exposure to trauma had long-term psychiatric morbidity. Our findings support the need to develop specialised mental health services to reduce disability in refugees whose exposure to extreme trauma puts them at risk of chronic psychiatric disability.

Adult↗
PubMed2001

The application of visual census on Mediterranean rocky habitats.

In this study we examined the effect of: observer presence; observer speed; and the impact that multiple surveys had on the number of counted fish in a visual census survey in a typical Mediterranean rocky habitat. SCUBA observer presence had no influence on the number of fish per survey. An improvement in the methodology to estimate the number of fish was demonstrated by using two different speeds: slow speed for benthic species and higher speed for epibenthic ones. No differences in the number of fish per survey were found among successive surveys along the same transects, even with the shortest time interval used: 5 min. We also examined the ability of observers to estimate fish length during visual census by using wooden fish models. Significant differences in size estimations were found using two different estimation methods (i.e. size-classes estimates and continuous measures). Estimating fish length to a size class was more accurate in estimating size, while transformed size to calculate biomass from length estimates was more accurate using continuous measures.

Animals↗
PubMed1997

Access to emergency care under TennCare: do patients understand the system?

STUDY OBJECTIVE: To determine patient understanding of how to properly gain access to urgent and emergency medical care under TennCare, a government-mandated managed health care initiative designed to replace Medicaid in Tennessee. METHODS: We prospectively surveyed a convenience sample of ED patients at university hospital ED with an annual census of 50,000 during two periods (summer 1994 and summer 1995). In 1994, 250 TennCare patients were enrolled (part 1). In 1995, 199 were enrolled (part 2). RESULTS: Patients from seven different TennCare managed care organizations (MCOs) were interviewed. Thirty-eight percent of part 1 patients and 37% of part 2 patients did not have or did not know the names of their primary care physicians (PCPs). Fifty-eight percent of the part 1 patients who knew their PCPs' names had never visited them. This figure had decreased to 25% by the time part 2 patients were surveyed. Seventy-three percent of part 1 patients interviewed did not call their PCPs before coming to the ED. This figure had decreased to 48% by the time part 2 patients were interviewed. Thirty-two percent of part 1 patients were aware that they were supposed to contact the PCP before visiting the ED, whereas 94% of part 2 patients were aware of this requirement. Thirty-one percent of part 1 patients and 40% of part 2 patients who tried to contact their PCPs were unsuccessful, most often because of a delay on the part of PCPs in returning calls. Fifty-six percent of part 1 patients and 69% of part 2 patients did not know that they might be held responsible for the bill if an ED visit was not considered a true emergency and was not approved by the MCO. CONCLUSION: Improvements in communication of pertinent information must be implemented in managed care systems such as TennCare to better inform participants of the proper use of the system. MCOs will not reduce inappropriate use of the ED if patients are not aware of their responsibilities and do not know their PCPs or how to gain access to them. PCP responsiveness to patients must also be improved.

Adult↗
PubMed1998

How do physicians and nurses spend their time in the emergency department?

STUDY OBJECTIVES: To determine how emergency physicians and nurses spend their time on emergency department activities. METHODS: An observational time-and-motion study was performed at a 36-bed ED with annual census of 84,000 in a central city teaching hospital sponsoring an emergency medicine residency program. Participants were emergency medicine faculty physicians, second- and third-year emergency medicine resident physicians, and emergency nurses. A single investigator followed individual health care providers for 180-minute periods and recorded time spent on various activities, type and number of activities, and distance walked. Activities were categorized as direct patient care (eg. history and physical examination), indirect patient care (eg. charting), or non-patient care (eg. break time). RESULTS: On average, subjects spent 32% of their time on direct patient care, 47% on indirect patient care, and 21% on non-patient care Faculty physicians, residents, and emergency nurses differed in the time spent on these three categories of activities. Although the overall time spent on direct patient care activities was not significantly different, emergency nurses spent more of their time (2.2%) providing comfort measures (a subcategory of direct patient care) than did faculty physicians (.05%) or resident physicians (.03%). Emergency nurses spent 38.9% of their time performing indirect care, whereas faculty physicians spent 51.3% and resident physicians 53.7%. Resident physicians spent more time charting than did faculty physicians or emergency nurses (21.4%, 11.9%, and 6.9%, respectively). Emergency nurses spent more time on personal activities than did physicians, and faculty physicians walked less than either emergency nurses or resident physicians. CONCLUSION: Emergency physicians and nurses spent almost half of their time on indirect patient care. Physicians spent significantly more time on indirect patient care activities and significantly less time on personal activities than did nurses.

Adult↗
PubMedDate not supplied

[Back pain in the general population of Catalonia (Spain). Prevalence, characteristics and therapeutic behavior].

BACKGROUND: Back pain is a common symptom of health assistance in Western countries. The goal of the present survey was to establish the prevalence of back pain in the general population in Catalonia, as well as to establish its characteristics, its relationship to sociodemographic variables, the therapeutic behavior followed by those affected and the associated-impairment and disabilities for the sufferers. METHODS: The survey was a descriptive study including a sample of 1,964 people, obtained from the census (1991) and representative of the population older than 18 years. The study was done in 1994 and data were obtained by means of a telephone interview. The prevalence of pain in the last six months was determined. Among those suffering back pain, additional information was obtained concerning its characteristics, the relationship with socio-demographic variables, the therapeutic behaviors used by patients, and the personal, social and work impairment and disabilities. RESULTS: Back pain was highly prevalent (50.9%), appeared in all ages (mean age of 47.6 years), was the highest in women (60.7%), in manual workers (54.9%) and in those less educated (71.1%). Back pain was long lasting (69.2% more than 3 years), frequent (49.7% more than the half of the days), and highly painful (severe-unbearable in 51.4%). The therapeutic behaviors most commonly used were the visit to the physician (71.9%), the use of alternative medical treatments (24.7%), physical therapy (22.7%, physical exercises and electrotherapy) and self-medication (14.6%, being acetylsalicylic acid the most employed). In general, the duration and degree of improvement was variable. Back pain limited the daily activities (36.7%) and forced to bed rest (22.7%). It was also a significant reason for time off work (17%) and disability pension (6.5%). CONCLUSIONS: Back pain has a very high prevalence in the Catalonian population and is an important reason to seek medical attention. It greatly limits the daily personal and professional activities.

Absenteeism↗
PubMed1999

[Prevalence of chronic bronchitis, asthma and airflow limitation in an urban-industrial area of Catalonia].

OBJECTIVES: To determine the prevalence of chronic bronchitis, asthma and airflow limitation in the general population of the urban-industrial area in and around the town of Sabadell (Catalonia, Spain), and to assess its degree of association with smoking and exposure to secondhand smoke. METHODS: Transversal study of 642 men and women between 20 and 70 years of age listed on census rolls. The standardized questionnaire of the American Thoracic Society was used to interview 576 subjects (90%). Tests of forced spirometry with bronchodilation were administered to 497 individuals (77%). RESULTS: The prevalence of chronic bronchitis was 11.6% (21% of men and 2.7% of women). Asthma had been diagnosed by a subject's doctor in 3.3% of the sample (2.1% of men and 4.4% of women). The prevalence of several asthma-related symptoms was higher. Dyspnea with wheezing was reported by 10.6% of the population (11.4% of men and 9.8% of women); wheezing within the past year was reported by 38.2% (45.4% of men and 31.4% of women). The prevalence of airflow limitation (defined as FEV1 < 80% with an FEV1/FVC index < 70%) in the population sample was 7.2% (10.4% of men and 4.1% of women); in men aged 60 to 70 years, however, the prevalence was 30.8%. Exposure to secondhand smoke was related to the presence of chronic coughing (OR = 4.6) and wheezing (OR = 1.8), but not to significant spirometric changes. CONCLUSIONS: The prevalence of respiratory symptoms and airflow limitation is high in our area, particularly among men and older patients (60 to 70 years old). Like active smokers and ex-smokers, subjects who have been exposed to secondhand smoke are at greater risk of developing respiratory symptoms.

Adult↗
PubMed2004

The risk of child and adolescent mortality among vulnerable populations in Rio de Janeiro, Brazil.

This study investigated the importance of socioeconomic factors such as education, income, religion, family structure and residence in explaining the increased risk of mortality among vulnerable populations aged less than 20 years in Rio de Janeiro, Brazil. Data used were from the 1991 Brazilian Demographic Census and comprised 121,060 women aged 15-49 residing in Rio de Janeiro. Two alternative statistical methods were used to calculate the risk of death: the widely used Brass method (an indirect estimate which assesses population risks) and a case-control study (which assesses individual risks). The study also focused on the importance of indicators of human and social capital, the lack of which may explain the higher risk of death among children and adolescents. Lack of education was found to be a major determinant of mortality at young ages. Residence in a favela (shantytown), families in which mothers were the head of the family, and a lower median level of income were found to be significant determinants of mortality among vulnerable populations in Brazil. However, religion was not found to be as important a predictor of high mortality.

Adolescent↗
PubMed2006

The incidence of visual impairment due to diabetic retinopathy in Leeds.

AIM: A key aim of the photographic screening model for diabetic retinopathy advocated by the National Screening Committee is a reduction in new blindness due to diabetic retinopathy within 5 years. This study determines the incidence of visual impairment due to diabetic retinopathy in Leeds in 2002 and provides a benchmark against which the success of the retinopathy screening programme in Leeds will be judged. METHODS: A retrospective review of all blind and partially sighted registrations for 2002 was conducted. The 2001 Census data and the diabetes prevalence model developed by the Yorkshire and Humber Public Health Observatory were used to determine the total and diabetic populations of Leeds. RESULTS: Diabetic retinopathy was the primary cause of registration in 24 of the 398 completed records obtained; seven patients were registered blind and 17 partially sighted. For the total population in 2002, the incidence of blind and partially sighted registration due to diabetic retinopathy was 10 per million and 24 per million per year, respectively. For the diabetic population of Leeds in 2002, the incidence of blind and partial sighted registration due to diabetic retinopathy was 337 and 817 per million per year, respectively. CONCLUSIONS: The incidence of blind registration due to diabetic retinopathy in Leeds in 2002 is similar to the estimate provided by the National Screening Committee but higher than the figure from other UK centres.

Adolescent↗
PubMedDate not supplied

Prevalence of headache in Puerto Rico.

BACKGROUND: Headache is one of the most frequently reported disorders in the general adult population. Despite the fact that this disorder is common, no official estimate of the prevalence of headache exists in Puerto Rico. PURPOSE: To examine the prevalence of headache and migraine, specifically, in Puerto Rico. METHODS: A telephone survey of 1610 individuals was conducted. The telephone calls were distributed using the 1990 census adjusted to the population of Puerto Rico in 1998, and according to gender, geographical area, and age. RESULTS: The prevalence of headache in Puerto Rico was 35.9% and migraine, in particular, 13.0%. When prevalence was fractionated by age, gender, and geographical areas, the prevalence of headache was similar for all ages, with females exhibiting a 2:1 preponderance over males. In the younger population (between 20 and 50 years of age), the female-male ratio for migraine was 3:1, and the prevalence for migraine was lower in the Metropolitan area. CONCLUSION: This study, the first of its type in Puerto Rico, demonstrates that headache (and migraine specifically) is a common disorder in this country.

Adult↗
PubMed2003

Neighbourhood deprivation and health: does it affect us all equally?

BACKGROUND: Neighbourhood socioeconomic status (SES) may affect rich and poor residents differentially. Two models are proposed. Model 1: living in a non-deprived neighbourhood is better for health because better collective material and social resources are available. Model 2: being poor (rich) relative to the neighbourhood average is associated with worse (better) health because of the discrepancy between an individual's situation and those around them. METHODS: Individual data from the Whitehall II study covering health, SES, and perceived status were linked to census data on neighbourhood deprivation. RESULTS: Both individual and neighbourhood deprivation increased the risk of poor general and mental health. There was a suggestion that the effect of living in a deprived area was more marked for poorer individuals, although interactions were not statistically significant. Poor people in poor neighbourhoods reported more financial and neighbourhood problems and rated themselves lowest on the ladder of society. CONCLUSIONS: We found no evidence that personal poverty combined with affluent neighbourhood had negative health consequences. Rather, living in a deprived neighbourhood may have the most negative health effects on poorer individuals, possibly because they are more dependent on collective resources in the neighbourhood.

England↗