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PubMedDate not supplied

MAPP in Chicago: a model for public health systems development and community building.

The Chicago Department of Public Health's (CDPH's) community planning efforts came from a city-wide strategic plan that called for the establishment of a city-wide network of community partnerships that focus on community needs and resource assessment and program development. Using Mobilizing for Action through Planning and Partnerships as a framework for planning at the community level, the CDPH supports five community coalitions through the Chicago Center for Community Partnerships. The overall goal of the Center is to increase community capacity, build new partnerships, provide coalitions with access to decision makers, and inform the role of local public health agencies in supporting this type of work. Bringing together a wide spectrum of stakeholders, coalition members work to conduct assessments and develop and implement strategies. While coalitions demonstrate outcomes related to specific strategies, they also exhibit infrastructure-level results, with increased levels of community organizing, leveraging of existing resources, and new systems for information dissemination. Simultaneously, the CDPH has gained new partners in public health, increased collaboration, and more information about communities. These outcomes are contingent on certain elements of success: (1) committed leadership; (2) commitment to a new way of doing business; (3) prepared public health workforces; and (4) community readiness.

Chicago↗
PubMed1993

Relationship of baseline major risk factors to coronary and all-cause mortality, and to longevity: findings from long-term follow-up of Chicago cohorts.

The focus here is on relationships between major risk factors and long-term mortality from coronary heart disease (CHD) and all causes, and on longevity, in Chicago cohorts: 25-year follow-up for Peoples Gas (PG) men aged 25-39 (n = 1,119), 30-year follow-up for PG men aged 40-59 (n = 1,235), 24-year follow-up for Western Electric (WE) men aged 40-55 (n = 1,882); also 15-year follow-up for five cohorts of the Chicago Heart Association (CHA) Study: men aged 25-39 (n = 7,873), 40-59 (n = 8,515), 60-74 (n = 1,490), and women aged 40-59 (n = 7,082) and 60-74 (n = 1,243); also 12-year findings for very low risk men (n = 11,098) and other men (n = 350,564) screened for the Multiple Risk Factor Intervention Trial (MRFIT). With a high degree of consistency, multivariate analyses showed independent positive relationships of baseline serum cholesterol, blood pressure and cigarette use to risk of death from CHD and all causes. For the WE cohort, with baseline nutrient data, dietary cholesterol was also independently related to these mortality risks. Combined risk factor impact was strong for both men and women of all baseline ages. Thus, for WE men, favorable compared to observed levels of serum cholesterol, blood pressure, cigarette use and dietary cholesterol were estimated to result in 24-year risk of CHD death 69% lower, all-cause death 42% lower and longevity 9 years greater. For CHA middle-aged and older women, favorable baseline levels of serum cholesterol, blood pressure and cigarette use were estimated to yield 15-year-CHD risk lower by about 60% and longevity greater by about 5 years. For MRFIT, very low risk men (serum cholesterol < 182 mg/dl, systolic/diastolic blood pressure < 120/<80), nonsmokers, nondiabetic, no previous heart attack), compared to all others, observed 12-year death rates were lower by 89% for CHD, 79% for stroke, 86% for all cardiovascular diseases, 30% for cancers, 21% for other causes, 53% for all causes, and longevity was estimated to be more than 9 years longer. These findings indicate great potentials for prevention of the CHD epidemic and for increased longevity with health for men and women, through improved life-styles and consequent lower risk factor levels.

Adult↗
PubMed1977

Alcohol consumption, cardiovascular risk factors, and mortality in two Chicago epidemiologic studies.

Multivariate analysis of the association at baseline between problem drinking and cardiovascular risk factors among 1,233 white male employees of the Chicago Peoples Gas Company age 40-59 showed the 38 problem drinkers with significantly higher blood pressures and cigarette consumption and significantly lower relative weights than the others. Similar analysis among 1,899 white male employees of the Hawthorne Works of the Western Electric Company in Chicago age 40-55 showed the 117 men consuming 5 or more drinks per day with significantly higher blood pressures and cigarette use than the others. No significant differences were recorded between heavy drinkers and the others in serum cholesterol level. The gas company problem drinkers had significantly higher 15-year mortality rates from all causes, cardiovascular diseases, coronary heart disease, and sudden death. These differences could not be entirely explained by their blood pressure, smoking, and relative weight status. The Western Electric heavy drinkers had increased 10-year mortality rates both for all causes and noncardiovascular causes.

Adult↗
PubMedDate not supplied

Measles immunization coverage determined by serology and immunization record from children in two Chicago communities.

OBJECTIVES: We compared the prevalence of measles immunization determined by serology with the prevalence of measles immunization determined by immunization records, and identified factors predictive of measles immunization among a sample of children from two Chicago communities. METHODS: We collected demographic information and blood specimens from a sample of children aged 12-71 months in two Chicago communities at risk for low measles immunization coverage levels. We collected immunization information from provider records, parent-held records, and the statewide immunization registry. We compared evidence of immunization determined by serology with evidence of immunization from these three sources of immunization records. RESULTS: The sample of children from the two communities had serologic measles immunity levels of 85% and 90%. Significantly fewer children had evidence of immunization by record in both communities (45% and 63%, respectively). CONCLUSIONS: Immunization coverage levels determined using immunization records were significantly lower than immunization coverage determined using serology. A fully populated immunization registry used by all immunization providers could prevent the problems of record loss and scatter.

Chicago↗
PubMed1994

An evaluation of the treatment effectiveness of the Chicago Health Outreach Acupuncture Clinic.

Acupuncture is a treatment modality that is particularly applicable for homeless clients because of its low cost and portability as well as because of its effectiveness in treating the symptomatology of pain syndromes, substance abuse, and human immunodeficiency virus infection. A two-part descriptive study was conducted to determine the response to acupuncture of homeless persons at the Chicago Health Outreach Clinic. Part 1 of the study consisted of a retrospective chart review of 45 patients to assess acupuncture treatment effectiveness. Part 2 of the study consisted of using a numerical rating scale report form to assess treatment effectiveness of 30 patients. Part 1 of the study indicated that 51% had a positive response to treatment, 42% were indeterminate or lacked documentation of response, and 7% had no response to treatment. Part 2 of the study demonstrated that 97% had a positive response to treatment, with 3% reporting no response to treatment. Acupuncture treatment did effectively decrease the symptomatology of the homeless clients seen in the Chicago Health Outreach Acupuncture Clinic. Further research should involve follow-up of these clients to assess the length of symptom relief to further determine long-range effectiveness and cost of treatment.

Acupuncture Analgesia↗
PubMed2002

Chicago area methyl parathion response.

The Illinois Department of Public Health participated in the Chicago, Illinois, area methyl parathion (MP) response with several other federal, state, and local government agencies beginning in April 1997. This response was initiated on evidence that hundreds of homes in the Chicago area were illegally treated for cockroaches with MP over a period of several years. Through applicator receipt books and information reported by property owners and tenants, 968 homes were identified as having been treated with MP. Upon implementation of a response plan developed by the Methyl Parathion Health Sciences Steering Committee, environmental sampling and urine monitoring were provided for eligible households. Environmental sampling was conducted in 903 homes, with MP detected above levels of concern in 596 residences. Residents of these homes were offered urine sampling to determine the extent of exposure to MP. Urine samples were collected and analyzed for p-nitrophenol in 1,913 individuals. Implementation of the protocol resulted in 550 residents being relocated during the remediation of 100 households.

Adolescent↗
PubMed1999

Characteristics of asthma care provided by hospitals in a large metropolitan area: results from the Chicago Asthma Surveillance Initiative.

INTRODUCTION: Little is known of the approaches of United States hospitals to the management of persons with asthma. The purpose of this study is to characterize the extent to which hospitals within a large community have implemented various types of asthma-specific health-care delivery processes. METHODS: A cross-sectional, self-administered survey was mailed to a "key informant" in asthma care at each of the hospitals in the Chicago area. The survey instrument covered the following content areas: asthma-related inpatient services, asthma-related outpatient services, selected asthma-related quality improvement activities, and asthma-related community outreach. The survey was administered between August 1996 and January 1997. RESULTS: Data were collected from respondents at 59 of the 89 eligible hospitals, yielding a response rate of 66.3%. Of the responding hospitals, 42.4% indicated they had clinical practice guidelines for inpatient asthma management, and 37.3% reported using critical pathways. Four selected aspects of bedside care were also explored. All of the responding hospitals reported routine provision of nebulization therapy at the bedside, and nearly all routinely obtained peak flow measurements (96.6%). In the area of patient instruction, 93.2% provided bedside evaluation of proper inhaler technique, and 86.4% routinely provided instruction on the use of peak flowmeters. Only 54.0% of the hospitals reported routinely administering some type of asthma education program prior to discharge. The hospitals with clinical practice guidelines in place were also more likely to have critical pathways (p < 0.01); to have asthma-specific ICU policies/guidelines/critical pathways (p < 0.01); to provide bedside instruction on the use of peak flowmeters (p < 0.01); to provide an asthma education (p < 0.01) prior to discharge; and to conduct utilization review. Very few hospitals indicated that they had community outreach programs for asthma care. CONCLUSION: The results of this survey suggest that among Chicago-area hospitals appropriate bedside care for persons with asthma is provided, but there are large variations in other types of asthma services and programs. The hospitals that have adopted asthma clinical practice guidelines are more likely to have other asthma-specific quality improvement activities than hospitals without guidelines. This relationship between use of guidelines and quality of services needs further exploration, as it may prove to be an important marker for hospitals with staff that are interested in improving asthma care.

Adolescent↗
PubMed1999

The Chicago Asthma Consortium: a community coalition targeting reductions in asthma morbidity.

The problem of asthma in Chicago remains a complex one, and it is too early to know whether any programs and efforts have had a discernible effect, but the Chicago Asthma Consortium continues to expand its membership and to define its mission. The successes have come from harnessing the passion of the individual members to move the projects forward. As the focus of the consortium moves to addressing system-wide problems in asthma care and the delivery of that care, the consortium is undertaking the construction of a guide for future efforts. In this way, the consortium will fulfill its vision of creating a comprehensive, community-wide plan for the management of asthma, impacting on the unacceptable current levels of morbidity and mortality of the disease.

Asthma↗
PubMed1987

Long-term ventilator care. A Chicago problem and a national problem.

Patients who require long-term ventilator care in an acute care setting may have a problem because diagnosis-related group (DRG) payments are less than the cost of their medical care. An alternative for quality medical care at lower cost includes admission to a long-term ventilator facility. In Chicago, only two dedicated long-term ventilator programs exist, with only 33 beds. Within 50 to 150 miles of the immediate Chicago area are three more units, with only 42 operational beds. All of the long-term care beds are full, and over 50 patients await transfer. Since acute care is reimbursed on a DRG designation and long-term ventilator care has no DRG category, there is a bias in acute care settings against these patients. Medicare patients are reimbursed up to 100 days, after which patients become eligible for public aid. Unfortunately, long-term ventilator patients often wait in acute care settings for this 100 days to elapse, even though medical care may be superior in a long-term ventilator unit. In addition to not providing the best care, this situation is economically wasteful. Solutions to these problems will require a coordinated national, state, and local plan. National medical societies should be consulted regarding solutions to health care problems that provide the best medical care at a reasonable cost for patients on long-term ventilation.

Chicago↗
PubMed2004

On-time immunization rates among children who enter Chicago public schools.

OBJECTIVE: A primary objective of the Healthy People 2010 initiatives is to increase on-time immunization rates during the first 2 years of life and to decrease racial disparities in coverage. The objective of this study was to determine on-time immunization coverage rates among infants and toddlers stratified by race/ethnicity in a large metropolitan center. METHODS: A retrospective cohort study that was based on immunization records in the Chicago Public Schools computerized database was conducted using all 67376 children who completed kindergarten in 2001 and 2002. RESULTS: On-time immunization rates in Chicago public school children are low (31% at 7 months, 32% at 19 months, 59% at 36 months). At 19 months of age and thereafter, Hispanic children had the highest rate of on-time immunization coverage. Among children <48 months old, black children had the lowest rates of up-to-date immunization status. At 48 months of age, the up-to-date rate for black children improved to a rate similar to white children (58%) and by school entry surpassed the up-to-date rate for white children (71%). Compared with the recommended 2, 4, 6, and 15 to 18 months schedule, black children received 4 doses of diphtheria/tetanus/acellular pertussis at a mean age of 10.0, 14.6, 20.4, and 34.5 months of age. In contrast, Hispanic children received the same doses at a mean of 4.5, 7.4, 11.0, and 25.1 month of age. In addition, approximately 25% of black children received the majority of their vaccinations >12 months later than the recommended time intervals. CONCLUSIONS: Striking immunization delay still exists during the infant and toddler years. Targeted efforts are needed to increase on-time immunization rates and to decrease racial disparity in immunization coverage.

Chicago↗
PubMed2005

Smoking in 6 diverse Chicago communities--a population study.

OBJECTIVES: We analyzed smoking survey data across communities in Chicago, Ill, to explore community-level variations in smoking behavior. METHODS: We conducted a health survey of 6 racially and ethnically diverse Chicago communities during 2002-2003. The survey included questions about current smoking, smoking history, and cessation attempts. RESULTS: Smoking prevalence varied from 18% in the wealthiest (predominately White) community to 39% in the poorest (predominately Black) community. In a contiguous pair of communities, one Mexican and the other Black, smoking prevalence varied by a factor of 2. Men, residents in poorer households and households without telephones, and residents with less education were most likely to smoke. CONCLUSIONS: The high proportions of current smokers who had attempted to quit indicate a prevalent desire to stop smoking. However, less than 4% of the Master Tobacco Settlement Agreement funds are being spent on smoking prevention, or even on health in general, in Illinois. Although much is known about the prevalence of smoking at the national level, few studies of smoking have been done at the community level, presenting difficulties for the allocation of resources and the design of smoking cessation programs in response to community needs. Understanding community-level smoking rates could improve the allocation of resources and assist the shaping of culturally meaningful prevention efforts.

Adolescent↗
PubMed2006

Racial and ethnic disparities in diagnosed and possible undiagnosed asthma among public-school children in Chicago.

OBJECTIVES: We examined racial and ethnic disparities in the total potential burden of asthma in low-income, racially/ethnically heterogeneous Chicago schools. METHODS: We used the Brief Pediatric Asthma Screen Plus (BPAS+) and the Spanish BPAS+, validated, caregiver-completed respiratory questionnaires, to identify asthma and possible asthma among students in 14 racially/ethnically diverse public elementary schools. RESULTS: Among 11490 children, we demonstrated a high lifetime prevalence (12.2%) as well as racial and ethnic disparities in diagnosed asthma, but no disparities in prevalences of possible undiagnosed asthma. Possible asthma cases boost the total potential burden of asthma to more than 1 in 3 non-Hispanic Black and Puerto Rican children. CONCLUSIONS: There are significant racial and ethnic disparities in diagnosed asthma among inner-city schoolchildren in Chicago. However, possible undiagnosed asthma appears to have similar prevalences across racial/ethnic groups and contributes to a high total potential asthma burden in each group studied. A better understanding of underdiagnosis is needed to address gaps in asthma care and intervention for low-income communities.

Adolescent↗
PubMed1997

Mortality in Chicago attributed to the July 1995 heat wave.

OBJECTIVES: This study assessed mortality associated with the mid-July 1995 heat wave in Chicago. METHODS: Analyses focused on heat-related deaths, as designated by the medical examiner, and on the number of excess deaths. RESULTS: In July 1995, there were 514 heat-related deaths and 696 excess deaths. People 65 years of age or older were overrepresented and Hispanic people underrepresented. During the most intense heat (July 14 through 20), there were 485 heat-related deaths and 739 excess deaths. CONCLUSIONS: The methods used here provide insight into the great impact of the Chicago heat wave on selected populations, but the lack of methodological standards makes comparisons across geographical areas problematic.

Age Distribution↗
PubMed2003

Design of the Chicago Health and Aging Project (CHAP).

The design of the Chicago Health and Aging Project (CHAP) is described. CHAP is a longitudinal population study of common chronic health problems of older persons, especially of risk factors for incident Alzheimer's disease, in a biracial neighborhood of the south side of Chicago. Special attention is given to three unusual design features of the study. One feature is that clinical evaluation for Alzheimer's disease is confined to a stratified random sample of all participants. This feature results in substantial cost savings and substantially less bias than screening approaches but has the disadvantages of adding analytic complexity and requiring the use of indirect means to identify a disease-free cohort for the development of incident Alzheimer's disease. The second unusual feature is efficiently combining in analyses the successive independent multiple samples that are drawn, one from each data collection cycle. The third unusual feature is entering successive age cohorts of community residents into the study as they attain 65 years of age. This has the advantages of enhancing direct investigation of the effect of age on the action of risk factors for Alzheimer's disease and direct examination of cohort effects. The interaction of these features is described, especially as they pertain to a study in which data are collected in successive waves. The results from these waves must be combined for effective analysis of the relation among risk factors and incident disease.

Age Factors↗
PubMed1979

St. Louis encephalitis: the Chicago experience.

The largest laboratory-documented outbreak of St. Louis encephalitis (SLE) in the United States occurred in the Chicago metropolitan area in the summer and early fall of 1975. Of 1,456 illnesses investigated, 326 cases of confirmed or probable SLE and 420 cases of suspected SLE were found in the six-county area. The outbreak peaked in early September, but cases continued to occur through October. Cases clustered geographically in the southwestern suburbs. There was a direct correlation between age and attack rate, severity of illness, and mortality rate--all of which increased with successive age groups. Thirty-six persons died. Males and females were equally affected. This epidemic marked the first time that St. Louis encephalitis has been documented in the Chicago area.

Adult↗
PubMed1998

Near-fatal heat stroke during the 1995 heat wave in Chicago.

BACKGROUND: In July 1995, Chicago sustained a heat wave that resulted in more than 600 excess deaths, 3300 excess emergency department visits, and a substantial number of intensive care unit admissions for near-fatal heat stroke. OBJECTIVE: To describe the clinical features of patients admitted to an intensive care unit with near-fatal classic heat stroke. Patients were followed for 1 year to assess delayed functional outcome and mortality. DESIGN: Observational study. SETTING: Intensive care units in the Chicago area. PATIENTS: 58 patients admitted to the hospital from 12 July to 20 July 1995 who met the case definition of classic heat stroke. MEASUREMENTS: The data collection tool was designed to compile demographic and survival data and to permit analysis of organ system function by abstracting data on physical examination findings, electrocardiography and echocardiography results, fluid resuscitation, radiography results, and laboratory findings. Data on functional status at discharge and at 1 year were collected by using a modified Stanford Health Assessment Questionnaire. RESULTS: Patients experienced multiorgan dysfunction with neurologic impairment (100%), moderate to severe renal insufficiency (53%), disseminated intravascular coagulation (45%), and the acute respiratory distress syndrome (10%). Fifty-seven percent of patients had evidence of infection on admission. In-hospital mortality was 21%. Most survivors recovered near-normal renal, hematologic, and respiratory status, but disability persisted, resulting in moderate to severe functional impairment in 33% of patients at hospital discharge. At 1 year, no patient had improved functional status, and an additional 28% of patients had died. CONCLUSIONS: Near-fatal classic heat stroke is associated with multiorgan dysfunction. A high percentage of patients had infection at presentation. A high mortality rate was observed during acute hospitalization and at 1 year. In addition, substantial functional impairment at discharge persisted 1 year. The degree of functional disability correlated highly with survival at 1 year.

Adult↗
PubMed1991

Good neighbors. A collaborative effort develops housing for the low-income elderly on Chicago's southeast side.

On Chicago's southeast side, the Claretian missionaries--in collaboration with the Oblates of Mary Immaculate, members of the local community, and local business interests--will soon open Villa Guadalupe, a housing project for low-income seniors. Recent developments have combined to make the creation of low-income housing for the elderly more compelling than ever from a mission perspective and more feasible from a structuring and financing perspective. Since 1925, the Claretians have served a predominantly Hispanic population in south Chicago. The neighborhood suffered economic devastation in the 1960s with the collapse of the local steel industry. A 1985 needs assessment determined that nearly one in five elderly residents in the area lives at or near the poverty level. As a result of the assessment, the Claretians decided to develop the Villa Guadalupe project. For assistance in managing and financing the project, the Claretians drew on the resources and expertise of the Oblates of Mary Immaculate, who have a history of ministering to the elderly. The project also had to overcome legal obstacles to securing property tax exemption from the state of Illinois. The project cleared another hurdle when it secured financing by issuing tax-exempt bonds secured by a letter of credit issued by a commercial bank. In addition, interest in monies from an endowment fund will make up the difference between funds Villa Guadalupe will receive through rents and the income that is required to support the project.

Aged↗
PubMed1999

High prevalence of chlamydial and gonococcal infection in women entering jails and juvenile detention centers--Chicago, Birmingham, and San Francisco, 1998.

The prevalence of sexually transmitted diseases (STDs) is high among women entering corrections facilities. Screening for STDs in these facilities, however, is difficult because of the large number of persons admitted each day and the frequent shortage of medical staff and examination space. New, sensitive urine tests for gonorrhea and chlamydia have made screening practical outside of medical settings. To assess the feasibility of screening women in corrections facilities for chlamydial and gonococcal infection using urine tests and to determine the prevalences of these infections, the Chicago Department of Public Health and the University of Alabama at Birmingham (UAB) began testing women and adolescent females entering the Cook County Jail and the Cook County Juvenile Temporary Detention Center in Chicago and the Jefferson County Jail and the Jefferson County Youth Detention Center in Birmingham, respectively, in 1998. The San Francisco Department of Public Health has been testing women at the San Francisco County jails for chlamydial and gonococcal infections using urine tests since 1996 and adolescent females at the San Francisco Youth Guidance Center since 1997. This report summarizes the findings for testing incarcerated women in 1998 in the three cities; preliminary results indicate that, in these facilities, testing for chlamydial and gonococcal infections is feasible and that a high percentage of women test positive for these infections.

Adolescent↗