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PubMed2005

Oral cancer knowledge and experience: a survey of South Carolina medical students in 2002.

BACKGROUND: Compared to the U.S. states and District of Columbia, the adult population in South Carolina ranks in the high five in oral cavity and pharynx cancer mortality rate and top ten for incidence rate. Previous studies revealed a lack of knowledge related to the diagnosis of oral cancer among health professionals in the USA. This study assessed the oral cancer knowledge and experience of medical students in an academic setting. METHODS: This IRB approved cross-sectional survey used a self-administered pilot-tested questionnaire and the census of the Medical University of South Carolina medical students. Data were summarized by frequencies and chi-square comparisons of pre-clinical (first and second year) and clinical (third and fourth year) students. RESULTS: The overall response rate was 79% (450/571 students), range 61-91% by year. Significant (p < 0.001) differences were found between pre-clinical and clinical students for knowledge of risk factors, signs and symptoms of oral cancer, and tobacco cessation techniques; with clinical students more knowledgeable but at less than 78% accuracy. All students were in high agreement of the role and responsibility of physicians in tobacco cessation, and in medical history taking. Four students had seen or been instructed on how to perform an oral biopsy. Most (75%) of fourth year students felt adequately trained to palpate neck lymph nodes. However, less than 7% of all students perceived they were adequately trained to examine patients for oral cancers. CONCLUSIONS: Results suggest that these students may not receive adequate exposure to oral cancer prevention and detection knowledge and practices. Additional training to increase knowledge of risk factors and cessation counseling, and knowledge of signs and symptoms and examination skills may improve oral cancer prevention and detection. The implication is that additional education for the medical students in prevention and detection may lead to improvements in South Carolina oral cavity and pharyngeal cancer incidence and mortality rates.

Adult↗
PubMed2005

Possible increasing risk of multiple sclerosis in Catania, Sicily.

OBJECTIVE: To update prevalence and incidence rates of multiple sclerosis (MS) in Catania, Italy during 1990 to 1999 and evaluate their temporal profiles to assess a possible increase in the MS risk in our study population. METHODS: We studied the frequency of MS in Catania, Italy (population of 313,110 as reported in the 2001 census). The primary sources for the case ascertainment were the neurologic and motor-rehabilitation departments, the MS centers, the Italian MS Association, private neurologists, and family doctors. We considered as prevalent and incident cases all patients who satisfied Poser's criteria for clinically definite MS (CDMS), laboratory-supported definite MS (LSDMS), clinically probable MS (CPMS), and laboratory-supported probable MS (LSPMS). RESULTS: We found 288 subjects with MS who had onset of disease before December 31, 1999 (prevalence day) in a population of 313,110 inhabitants. The prevalence rate was 92.0/100,000 (95% CI 81.8 to 103.2) and was higher in women (102.4/100,000) than in men (80.4/100,000). The age-specific prevalence showed a peak in the group aged 35 to 44 years (208.2/100,000). From 1990 to 1999, 155 patients with MS had the clinical onset of the disease. The mean annual incidence was 4.7/100,000 (95% CI 4.0 to 5.5). Age-specific incidence showed a peak in the group aged 25 to 34 years (11.7/100,000). Mean annual incidence for 5-year intervals increased from 3.9/100,000 during 1990 to 1994 to 5.5/100,000 during 1995 to 1999. CONCLUSIONS: Prevalence and incidence rates of multiple sclerosis have further increased during the last decade.

Adolescent↗
PubMed2005

Painting a truer picture of US socioeconomic and racial/ethnic health inequalities: the Public Health Disparities Geocoding Project.

OBJECTIVES: We describe a method to facilitate routine monitoring of socioeconomic health disparities in the United States. METHODS: We analyzed geocoded public health surveillance data including events from birth to death (c. 1990) linked to 1990 census tract (CT) poverty data for Massachusetts and Rhode Island. RESULTS: For virtually all outcomes, risk increased with CT poverty, and when we adjusted for CT poverty racial/ethnic disparities were substantially reduced. For half the outcomes, more than 50% of cases would not have occurred if population rates equaled those of persons in the least impoverished CTs. In the early 1990s, persons in the least impoverished CT were the only group meeting Healthy People 2000 objectives a decade ahead. CONCLUSIONS: Geocoding and use of the CT poverty measure permit routine monitoring of US socioeconomic inequalities in health, using a common and accessible metric.

Censuses↗
PubMed2005

Neighborhood racial composition, neighborhood poverty, and the spatial accessibility of supermarkets in metropolitan Detroit.

OBJECTIVES: We evaluated the spatial accessibility of large "chain" supermarkets in relation to neighborhood racial composition and poverty. METHODS: We used a geographic information system to measure Manhattan block distance to the nearest supermarket for 869 neighborhoods (census tracts) in metropolitan Detroit. We constructed moving average spatial regression models to adjust for spatial autocorrelation and to test for the effect of modification of percentage African American and percentage poor on distance to the nearest supermarket. RESULTS: Distance to the nearest supermarket was similar among the least impoverished neighborhoods, regardless of racial composition. Among the most impoverished neighborhoods, however, neighborhoods in which African Americans resided were, on average, 1.1 miles further from the nearest supermarket than were White neighborhoods. CONCLUSIONS: Racial residential segregation disproportionately places African Americans in more-impoverished neighborhoods in Detroit and consequently reduces access to supermarkets. However, supermarkets have opened or remained open close to middle-income neighborhoods that have transitioned from White to African American. Development of economically disadvantaged African American neighborhoods is critical to effectively prevent diet-related diseases among this population.

Black or African American↗
PubMed1994

Tuberculosis risk factors in adults in King County, Washington, 1988 through 1990.

OBJECTIVES: Tuberculosis has become a resurgent public health problem in the United States. Because resources are limited, control programs frequently must target populations at greatest risk. The purpose of the study was to examine risk factors for tuberculosis in adults. METHODS: In King County, Washington State, from 1988 through 1990, the characteristics of patients with tuberculosis were compared with census data, and a case-control study was conducted. Self-administered questionnaires were completed by 151 patients with active tuberculosis and 545 control subjects. RESULTS: Infection with the human immunodeficiency virus, non-White race/ethnicity, and foreign birthplace were each associated with a sixfold or greater increase in risk. Each of the following was associated with at least a doubled risk: history of selected underlying medical conditions; low weight for height; low socioeconomic status; and age 70 years or older. Men had 1.9 times the risk of women, smokers of 20 years' or more duration had 2.6 times the risk of nonsmokers, and heavy alcohol consumers had 2.0 times the risk of nondrinkers. CONCLUSIONS: Intervention targeting easily identified groups may be an effective way to reduce the incidence of tuberculosis.

Adolescent↗
PubMed1994

Completion rates of clients discharged from drug and alcohol treatment programs in Washington State.

OBJECTIVES: The primary goal of this study was to analyze completion rates of clients in drug and alcohol abuse treatment programs in Washington State and to assess the factors associated with treatment completion. A secondary goal was to examine the utility of a state information system as a source of evaluative data. METHODS: Analyses were conducted of 5827 client records contained in the Washington State Substance Abuse Monitoring System, representing a census of public clients discharged during the last quarter of 1990 from all state-funded alcohol and drug treatment programs in four treatment modalities. Logistic regression was performed to determine the independent predictors of treatment completion. RESULTS: Completion rates were highest for intensive inpatient alcohol treatment (75%) and lowest for intensive outpatient drug programs (18%). Factors associated with treatment completion included screening at a referral assessment center, education, age, ethnicity, and existence of a secondary drug problem. CONCLUSIONS: The fit between clients and treatment programs may be an important factor explaining why some clients complete treatment and others drop out. State client information systems are an important source of data for analyzing treatment completion and other outcomes.

Adolescent↗
PubMed1998

Rates and independent correlates of Pap smear testing among Korean-American women.

OBJECTIVES: This study reports population estimates of Pap smear testing among Korean-American women and evaluates correlates of testing. METHODS: Korean Americans in 2 California counties were surveyed by telephone. Frequencies were age-adjusted to the 1990 census to produce population estimates of testing. Logistic regression models were used to evaluate independent correlates of testing RESULTS: Only 50% of the Korean-American women surveyed had a Pap test in the previous 2 years. The strongest independent correlate was having had a regular check-up in the previous 2 years (odds ratio 7.2, 95% confidence interval 4.2, 12.1). CONCLUSIONS: Rates of Pap testing among Korean-American women are well below national objectives. Collaboration and community-sensitive research are essential to collect data and design programs to improve the health of ethnic minority communities.

Asian↗
PubMed1999

Outcomes of 17,137 pregnancies in 2 urban areas of Ukraine.

OBJECTIVES: Frequent terminations of pregnancy and high rates of fetal loss have been reported, but not confirmed, in the former eastern bloc. A census of pregnancies in Ukraine, a former eastern bloc country, was conducted to determine the rates of these events. METHODS: All pregnancies registered in 2 urban areas were enumerated. During a 19-month period between 1992 and 1994, 17,137 pregnancies and their outcomes were recorded. RESULTS: Sixty percent of the pregnancies were voluntarily terminated, generally before the 13th week. In pregnancies delivered at 20+ weeks, fetal mortality was 29 per 1000, nearly 5 times the rate among Whites in the United States. There was a greater proportion of very early deliveries (20-27 weeks) in Ukraine, as well as higher death rates at all gestational ages. Perinatal mortality was estimated to be 35 per 1000, about 3 times the US rate. CONCLUSIONS: This is believed to be the first study in the former eastern bloc to ascertain all of the clinically recognized pregnancies in a specified period and to determine their outcomes. The data document elevated reproductive risks in a former Soviet state.

Abortion, Induced↗
PubMedDate not supplied

[Land ownership and infant health in Rio Grande do Sul: relationship between agricultural production, malnutrition and mortality].

The relationships between infant and preschool age mortality, malnutrition, and land tenure patterns in the State of Rio Grande do Sul, Brazil, were investigated with data from demographic and agricultural censuses, vital statistics, and a nutritional survey in urban and rural areas. These studies employed a variety of analytical methods and revealed that young children in areas with large ranches, livestock raising, and high proportion of agricultural wage-earners presented a higher mortality and a greater prevalence of malnutrition than children in areas with small farms, crop agriculture, and self-employed family workers. Children of landowners showed better nutritional status and smaller risk of death compared to children of laborers, although the differential seems to have narrowed in recent years. The conclusion is that land tenure patterns play a very important role in determining mortality and malnutrition of children in this Brazilian State.

Agriculture↗
PubMedDate not supplied

[Patterns of heroin consumption in a jail on the northern Mexican border: barriers to treatment access].

OBJECTIVE: To assess the prevalence of heroin use, patterns of initiation, intense use, and drug-dependency; also, to assess barriers to drug treatment access. MATERIAL AND METHODS: The study was conducted in the Ciudad Juarez, Chihuahua prison. Subjects were selected using simple random sampling from census of prison inmates. Barriers to drug treatment were identified and analyzed using a logistic regression model. RESULTS: The prevalence of heroin use for the last six months was 26.4%; 25.3% were intense heroin users; and 95% showed dependence. The mean age of initiation was 21 years. A multivariate model showed that the significant barriers to drug treatment access were: low education, withdrawal, overdosing, presence of chronic diseases, and duration of heroin use. CONCLUSIONS: Study findings should serve to devise potential applications to establish treatment programs in prisons.

Adult↗
PubMed1994

Quantifying disability: data, methods and results.

Conventional methods for collecting, analysing and disseminating data and information on disability in populations have relied on cross-sectional censuses and surveys which measure prevalence in a given period. While this may be relevant for defining the extent and demographic pattern of disabilities in a population, and thus indicating the need for rehabilitative services, prevention requires detailed information on the underlying diseases and injuries that cause disabilities. The Global Burden of Disease methodology described in this paper provides a mechanism for quantifying the health consequences of the years of life lived with disabilities by first estimating the age-sex-specific incidence rates of underlying conditions, and then mapping these to a single disability index which collectively reflects the probability of progressing to a disability, the duration of life lived with the disability, and the approximate severity of the disability in terms of activity restriction. Detailed estimates of the number of disability-adjusted life years (DALYs) lived are provided in this paper, for eight geographical regions. The results should be useful to those concerned with planning health services for the disabled and, more particularly, with determining policies to prevent the underlying conditions which give rise to serious disabling sequelae.

Adolescent↗
PubMed1993

Mortality and social class in Maori and nonMaori New Zealand men: changes between 1975-7 and 1985-7.

AIMS: Social class mortality differences in Maori and nonMaori New Zealand men aged 15-64 years have previously been examined for the period 1975-7. The analysis has now been repeated for the period 1985-7 in order to examine changes over time. METHODS: Numerator data were obtained from national death registrations and denominator data were obtained from the 1976 and 1986 censuses. These were used to calculate age-standardized death rates in Maori and nonMaori. RESULTS: Mortality declined by 28% in Maori and 14% in nonMaori between 1975-7 and 1985-7. The death rate for diseases amenable to medical intervention fell by 54% in Maori and 23% in nonMaori, but the Maori death rate was still 2.8 times the nonMaori death rate, whereas the relative risk for nonamenable causes was only 1.4. CONCLUSIONS: Some progress has been achieved in reducing ethnic differences in mortality in New Zealand men, but substantial differences remain for diseases which are amenable to medical intervention (including chronic rheumatic heart disease, hypertensive heart disease, and tuberculosis). It is likely that these differences reflect poor access to culturally safe and appropriate health care in Maori people.

Adolescent↗
PubMed1996

Production of fruits and vegetables at the homestead is an important source of vitamin A among women in rural Bangladesh.

BACKGROUND: Vitamin A deficiency is considered to be an important public health problem in Bangladesh. A universal biannual distribution of high-dose vitamin A capsules has been in place for over the past two decades. This supplementation has been beneficial for preschool children. Bangladesh has been exploring more sustainable approaches for all segments of the population. To support this initiative, Helen Keller International has implemented a homegardening promotion project since 1993. This project is executed on a large scale and currently reaches an estimated 244,000 families. METHODS: This paper presents data from 7341 women of reproductive age which were collected as part of the baseline census of a community monitoring system whose objective is to track progress and measure the impact of home-gardening activities. RESULTS: Vitamin A intake in this population derived almost entirely from the consumption of fruits and vegetables. Logistic regression analyses showed that maternal vitamin A intake was determined by qualitative indicators of homestead gardens (type of home garden, the total quantity of provitamin A-rich food produced and the number of fruits and vegetables varieties grown in the garden) after adjusting for socio-economic status. CONCLUSIONS: These results indicate that traditional production of provitamin A-rich fruits and vegetables in the homestead may provide a valuable contribution to vitamin A intake in communities where alternative dietary sources of vitamin A are scarce.

Agriculture↗
PubMed1997

Impact of vestibular disorders on fitness to drive: a census of the American Neurotology Society.

BACKGROUND: Legislation for reporting unfit-to-drive patients by physicians varies dramatically among U.S. states and Canadian provinces. The impact of vestibular disease on driving safety is not well described in the literature. OBJECTIVES: (1) to learn more about the critical issues and current practices of neurotologists regarding reporting of vestibular patients and (2) to make recommendations for reporting patients with vestibular disorders. STUDY DESIGN: A mailed census of members of the American Neurotology Society using a questionnaire based on a modified Dillman Total Design Survey Method. RESULTS: Most respondents are aware of the potential safety risks of patients who drive with vestibular diseases, most notably those with Tumarkins' attacks. Although many have counselled patients (94%) and considered reporting vestibular patients (75%), few actually have (14%). There was no consensus of opinion on a method of reporting unfit-to-drive patients. Only 18.9% of respondents supported mandatory physician reporting. Respondents who live in states where reporting is not mandatory and who are aware of this fact are (a) more satisfied with their state's legislation (chi 2 = 60.1, p = 0.001) and (b) less likely to report patients who they consider unfit-to-drive (chi 2 = 10.6, p = 0.03). CONCLUSIONS: In that there is no general consensus amongst respondents and the relative safety risks seem low in comparison to other disorders, at present we do not advocate mandatory reporting of patients with vestibular disorders.

Accidents, Traffic↗
PubMed1985

The use of epidemiology, scientific data, and regulatory authority to determine risk factors in cancers of some organs of the digestive system. 1. Introduction.

Continuing concern about cancer provides an impetus for continuing efforts to reduce its incidence and improve its treatment. Efforts to improve treatment are seen as highly desirable and excite little controversy, but attempts to reduce cancer incidence by regulatory intervention raise questions about cost-benefit ratios. Difficulties of making cost-benefit decisions are compounded by the lack of adequate data, especially in the area of cancer incidence and mortality, to demonstrate that regulatory or program intervention has effected any improvement. Regulatory agencies such as Food and Drug Administration can use descriptive epidemiological methods to determine trends in disease and magnitudes of exposed populations largely from readily available data, e.g., mortality data, data from National Cancer Institute surveys, census data, and food consumption data. The goal of these studies is to identify any unexpected changes in incidence or mortality through surveillance of the available data for time trends and through probes of specific data collected during research activities or gathered in support of regulatory decisions.

Digestive System Neoplasms↗
PubMed2000

Incidence and prevalence of rheumatoid arthritis in the county of Troms, northern Norway.

OBJECTIVE: To investigate the population incidence and prevalence of rheumatoid arthritis (RA) in persons above the age of 20 in the county of Troms, northern Norway, during the period 1987-1996. METHODS: All records of patients with RA registered at the Department of Rheumatology at the University Hospital of Tromsø during the years 1987 to 1996 were reviewed. The diagnosis of RA was set in accordance with the 1987 American Rheumatism Association criteria, and the population data were based on the 1989 and 1994 census. Total and age-specific incidence rates were calculated as number of new cases per 100,000 inhabitants and year. Age adjusted incidence rates were obtained by the direct method. Prevalence rates of RA for January 1, 1989, and January 1, 1994, were estimated. RESULTS: The total annual incidence rate for the period 1987-1996 was 28.7/100,000 per year (36.0/100,000 in women and 21.4/100,000 in men). No significant difference in incidence rates was found between the periods 1987-1991 and 1992-1996. Total prevalence of RA was 0.39% in 1989 and 0.47% in 1994. The corresponding data for women and men were 0.54% and 0.24% in 1989, and 0.63% and 0.30% in 1994, respectively. CONCLUSION: We found a rather low incidence and prevalence of RA in the county of Troms in northern Norway. Females contracted RA significantly more often than males. There was no change in incidence rates during the observation period, lending no support to suggestions of a continuously decreasing occurrence of RA.

Adult↗
PubMed1991

The ecologic method in the study of environmental health. II. Methodologic issues and feasibility.

This paper reviews some methodological aspects of ecologic studies of human health, with emphasis on investigations of environmental quality. A recent census of Canadian and U.S. data sets potentially suitable for this type of study is summarized. It is concluded that despite the considerable utility of the ecologic design for this purpose, substantial practical difficulties are common in their implementation. Particular problems are the relative scarcity of relevant environmental data and complications associated with rendering them compatible with health data.

Canada↗
PubMed2001

Using census data and birth certificates to reconstruct the early-life socioeconomic environment and the relation to the development of Alzheimer's disease.

The early-life environment and its effect on growth and maturation of children and adolescents are associated with several adult chronic diseases, including Alzheimer's disease. Because it is not feasible to collect information prospectively over the average life span, methods to reconstruct the early-life environment of the aged are necessary to evaluate these associations. In a community-based case-control study conducted in the United States, we collected U.S. census records and birth certificates to reconstruct the early-life socioeconomic environment of each elderly subject. Information was found on 82% of the available Alzheimer's disease cases (239 of 292) and 87% of the available controls (245 of 282). We investigated risk of Alzheimer's disease associated with father's occupation, parental age, household size, sibship size, and birth order. Subjects whose fathers were unskilled manual workers or laborers were at higher risk for Alzheimer's disease (odds ratio = 1.80, 95% confidence interval = 1.19--2.73). The risk of Alzheimer's disease was increased with increasing number of people in the household. We also evaluated whether subjects with the apolipoprotein epsilon 4 allele (APOE epsilon 4), a strong genetic risk factor that is not a necessary cause or a sufficient cause by itself for the development of Alzheimer's disease, were at higher risk than subjects who did not carry this allele. Among subjects with the APOE epsilon 4 allele whose fathers held lower-socioeconomic level occupations, the odds of developing Alzheimer's disease were higher (odds ratio = 2.35, 95% confidence interval = 1.07--5.16) compared with subjects without the allele (odds ratio = 1.40, 95% confidence interval = 0.78--2.52). Subjects carrying the APOE epsilon 4 allele alone have a threefold increased risk of Alzheimer's disease (odds ratio = 3.17, 95% confidence interval = 1.99--5.04). Compared with subjects with neither risk factor, subjects with both the genetic and the environmental risk factors (household size of seven or more and father's occupation being manual) had a relatively high risk of Alzheimer's disease (odds ratio = 14.8, 95% confidence interval = 4.9--46). The data suggest that APOE epsilon 4 may modify the associations between father's occupation, other early-life environmental factors, and development of Alzheimer's disease in late life.

Adolescent↗