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PubMed1996

Monte Carlo exact methods used for analysing interethnic unions in Great Britain.

The value of using exact rather than asymptotic tests to measure intermarriage in the United Kingdom is examined. "We develop Markov chain Monte Carlo methods for estimating the exact conditional p-value and the exact distribution of the residuals, for quasi-independence and quasi-symmetry. These methods are used to analyse a sparse 10 x 10 symmetric table of interethnic unions, extracted from the 1% household sample of anonymized records from the 1991 U.K. census. With the exception of Pakistani/White and Other Asian/White unions, there is no evidence against quasi-symmetry. We conclude that, with these exceptions, there are no gender differences in the affinities between ethnic groups."

Culture↗
PubMed2006

Completion of advanced care directives is associated with willingness to donate.

OBJECTIVES: A useful framework for initiating organ donation discussions in the primary care setting may help increase willingness to donate and thereby increase the frequency of organ transplantation. Given the lower willingness to donate among African Americans and that a higher proportion of African Americans die while waiting for an organ transplant, this is an important group to consider in such an approach. We examined the association among completion of a living will and willingness to donate and the influence of race in this relationship. METHODS: A nationwide telephone interview survey using random digit dialing of households in high- and low-density African-American census blocks. RESULTS: One hundred-eighty-eight adults participated (41% cooperation rate). In a multivariate model, factors associated with willingness to donate included having signed a living will (OR=2.43, 95% CI=1.13-5.23), talking with a physician about organ donation (OR=3.04, 95% CI=1.07-8.67) and white race (OR=2.5, 95% CI=1.23-5). CONCLUSION: The public is generally supportive of organ donation although African Americans remain less willing to donate after controlling for confounding variables. Physicians interested in increasing donation rates should consider incorporating organ donation into discussions of advance care planning and end-of-life care.

Adolescent↗
PubMed2006

Why the tuberculosis incidence rate is not falling in New Zealand.

AIMS: To assess the role of migration from high-incidence countries, HIV/AIDS infection, and prevalence of multi-drug resistant organisms as contributors to tuberculosis (TB) incidence in New Zealand (NZ) relative to ongoing local transmission and reactivation of disease. METHODS: TB notification data and laboratory data for the period 1995 to 2004 and population data from the 1996 and 2001 Census were used to calculate incidence rates of TB by age and ethnicity, country of birth (distinguishing high and low -incidence countries), and interval between migration and onset of disease. Published reports of multi-drug-resistant TB for the period 1995 to 2004 were reviewed. Anonymous HIV surveillance data held by AIDS Epidemiology Group were matched with coded and anonymised TB surveillance data to measure the extent of HIV/AIDS coinfection in notified TB cases. RESULTS: Migration of people from high-TB incidence countries is the main source of TB in NZ. Of those who develop TB, a quarter does so within a year of migration, and a quarter of this group (mainly refugees) probably enter the country with pre-existing disease. Rates of local TB transmission and reactivation of old disease are declining steadily for NZ-born populations, except for NZ-born Maori and Pacific people under 40. HIV/AIDS and multi-drug-resistant organisms are not significant contributors to TB incidence in NZ and there is no indication that their role is increasing. CONCLUSION: TB incidence is not decreasing in NZ mainly due to migration of TB infected people from high-incidence countries and subsequent development of active disease in some of them in NZ. This finding emphasises the importance of regional and global TB control initiatives. Refugees and migrants are not acting as an important source of TB for most NZ-born populations. Those caring for them should have a high level of clinical suspicion for TB.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Benzodiazepine consumption in Porto Alegre].

Benzodiazepines has been largely used to control anxiety and other clinical pictures since it began to be traded in the 60's. In recent years, many studies have shown that they are used indiscriminately, contributing to increase associated morbidity, and to search for other more accessible tranquilizers. PURPOSE--To estimate the prevalence of benzoadiazepine and over-the-counter tranquilizers use in adults living in Porto Alergre-RS, Brazil. METHODS--480 inhabitants of Porto Alegre, aged 18 or older, selected through a random cluster sampling procedure (sectors of the Brazilian Census), were interviewed in their homes during June, 1991. RESULTS--The prevalence for BDZ use during life, in the past year and in the past month was, respectively, 46.7%, 21.3% and 13.11%. Prevalence was significantly higher among women and widowers or divorced. The majority of those who used BDZ during the past month did so at least 2 or 3 days per week. More than 40% reported frequent over-the-counter substances use to "tranquilize", with a 28.8% prevalence for past month use. CONCLUSION--Chemical substance use to alleviate anxiety and other symptoms is generally spread. Legislation, not always respected, has been insufficient to discipline its use. Understanding the complexity of reasons for the situation to be unchanged is needed. Also necessary is the investment in education on adequate use of BDZ, both for physicians and population, and the search for legal measures that should be more efficient.

Adolescent↗
PubMed1995

Predictors of first-contact care in a poor urban community.

OBJECTIVE: The aim of the study was to identify predictors of first-contact care in a population of poor urban residents. METHODS: Information from a community health needs survey was used for the study. The sample included adult residents in five urban census tracts with a large proportion of Puerto Rican Hispanics. Potential predictors included social characteristics, source of health insurance, perceived health status, number of chronic diseases, use of alternatives to medical care, smoking status, and problems with alcohol use. RESULTS: A total of 826 household interviews were completed for a participation rate of 78% among eligible households. Individuals with no health insurance were six times more likely to lack a source of first-contact care, compared with those who have traditional indemnity insurance. Those who only had Medicaid were four times more likely to lack a source of first-contact care. Respondents involved in Medicaid-managed care programs had similar access to first-contact care as those with commercial insurance. Individuals who reported problems with alcohol were three times more likely to lack a source of first-contact care. CONCLUSIONS: Health insurance is an important predictor of access to first-contact care for poor urban residents. Those who identify problems with alcohol and African-Americans have additional difficulty with access to first-contact care.

Adult↗
PubMedDate not supplied

Drowning in Alaskan waters.

OBJECTIVE: To enumerate drowning fatalities in Alaska in order to identify risk factors and areas for intervention. METHODS: Information from death certificates, state troopers' reports, and medical examiner reports were abstracted and analyzed. Rates were calculated using 1990 census figures as denominator data. RESULTS: There were 542 drowning fatalities in Alaska for the years 1988 to 1992. The 20-29 age group had the highest frequency and rate of drownings. The incidence rate for the state was 20 drownings per 100,000 population per year, almost 10 times higher than the overall U.S. rate of 2.11 per 100,000 per year. Incidence rates were highest among adolescent males (10-19), young adult males (20-29). Alaska Natives, and rural residents. Alaska Native males, ages 30-39 averaged 159 drownings per 100,000 per year, the highest drowning rates in the state. CONCLUSIONS: Drowning is a major public health concern in Alaska. People who fish commercially and young Native males are groups at high risk for drowning. Intervention efforts should be concentrated on these two populations.

Adolescent↗
PubMed2002

Utilising field assignments in survey methodology course at Ziauddin Medical University, Karachi.

OBJECTIVE: To describe the teaching-learning strategy employed in the module of Survey Methodology for undergraduate medical students at Ziauddin Medical University. SETTING: Medical students of Ziauddin Medical University, Clifton, Karachi. METHODS: The objectives of the Survey Methodology course were developed so that a student would be able to design and conduct a small survey independently. For this purpose the students were required to participate in a census survey of a squatter settlement. The questionnaire for the survey was developed with the students, which included the demographic information of the households. It was discussed and pretested with the medical students. The students edited and entered the data on computer using Epi-Info. They were trained in sampling methods, data collection, data editing and entry through lectures and small group sessions. At the end of the course, students filled the course evaluation form. RESULTS: Out of 117 students who responded, 63% found the course to be useful. Small group sessions were regarded as the most helpful teaching strategy by 91% of the students. Majority (74%) of the students recommended that field visits should be a part of teaching strategy. CONCLUSION: The Survey Methodology course reinforces the importance and practical application of research methods. The students appreciate the course especially the small group sessions and the field visits.

Adult↗
PubMed2005

Sexually transmitted infections in New Zealand in 2003.

AIMS: To describe the current burden and trends of sexually transmitted infections (STIs) in New Zealand (NZ) since 1999, as reported by current surveillance methods. METHODS: Clinic rates were calculated by dividing the number of diagnoses by the total number of clinic visits. Laboratory rates were calculated using the NZ Census 2001 population data for the Auckland, Waikato, and Bay of Plenty regions. RESULTS: In 2003, chlamydia was the most commonly diagnosed STI in sexual health (SHCs) and family planning clinics (FPCs), followed by genital warts. Laboratory surveillance reported a chlamydia rate of 653.0 per 100,000 population and a gonorrhoea rate of 90.2 per 100,000 population. The highest rates of chlamydia and gonorrhoea were in the 15 to 19 years age group. From 2002 to 2003, both chlamydia and gonorrhoea cases have increased by 14.0% in SHCs. In FPCs, chlamydia increased by 25.9% and gonorrhoea increased by 11.4%. Since 2002, numbers of chlamydia and gonorrhoea cases have increased by 14.0% in SHCs and by 25.9% and 11.4%, respectively, in FPCs. Maori and Pacific Peoples continue to be disproportionately affected by STIs. CONCLUSIONS: Current national surveillance methods are unrepresentative of the NZ population and do not provide accurate estimates of the population burden of STIs. Expansion of laboratory surveillance (to accurately reflect all areas of NZ) is needed and is currently under active consideration.

Adolescent↗
PubMed1994

Staffing in small rural hospital emergency rooms: dependence on community family physicians.

OBJECTIVE: This study describes the characteristics of emergency room staffing at rural hospitals in Kansas. METHODS: Administrators at 84 rural hospitals in communities of less than 5,000 were surveyed by telephone using a scripted interview. RESULTS: Seventy-seven hospitals provided physician-staffed emergency room services. Their average daily emergency room census was 4.4. The average hospital medical staff consisted of 2.9 physicians. Eighty-six percent of all hospital staff physicians were family physicians. Ninety-six percent of all hospital emergency room staffing was provided by the local medical staff. Fee-for-service was the only method of reimbursement to physicians in 44 hospitals. Alternatives to emergency room staffing by local physicians included contracted part-time emergency room physicians, locum tenens physicians, mid-level practitioners, or emergency room closure. CONCLUSIONS: Rural family physicians have considerable responsibility for providing emergency care. Physicians must have adequate training in emergency medical care to practice in communities such as these.

Emergency Service, Hospital↗
PubMed2005

Assessing spatial and nonspatial factors for healthcare access: towards an integrated approach to defining health professional shortage areas.

This research considers both spatial and nonspatial factors in examining accessibility to primary healthcare in Illinois. Spatial access emphasizes the importance of geographic barrier between consumer and provider, and nonspatial factors include nongeographic barriers or facilitators such as age, sex, ethnicity, income, social class, education and language ability. The population and socioeconomic data are from the 2000 Census, and the primary care physician data for the same year are provided by the American Medical Association. First, a two-step floating catchment area method implemented in Geographic Information Systems is used to measure spatial accessibility based on travel time. Secondly, the factor analysis method is used to group various sociodemographic variables into three factors: (1) socioeconomic disadvantages, (2) sociocultural barriers and (3) high healthcare needs. Finally, spatial and nonspatial factors are integrated to identify areas with poor access to primary healthcare. The research is intended to develop an integrated approach for defining Health Professional Shortage Areas (HPSA) that may help the US Department of Health and Human Services and state health departments improve HPSA designation.

Catchment Area, Health↗
PubMed1995

Trends and patterns in suicide in England and Wales.

BACKGROUND: Suicides among young men have been rising since the early 1970s while at the same time the rates for women of all ages and for men over age 44 been falling. Byu 1992 the highest risk group was men aged 25-44. In all age groups female rates have declined relative to those for men. METHODS: A case-control analysis was undertaken comparing suicide death with deaths from natural causes fo the years 1990-1992, based on data collected on the death certificate, and 1991 census data relating to the ward of residence of the person who died. Data for men and women aged 16-64 were analysed separately, with allowance for the fact that the effects of the factors analysed could be different above and 45. RESULTS: For men, different models were necessary for the two age groups, but or women a single model sufficed. For men and women occupations with access to effective methods of suicide, such as veterinarians, medical practitioners, nurses and pharmacists had much higher risks than other professions. Being widowed/divorced or marital status not stated was also an important risk factor, as was being single for men aged 45 and over and women of all ages. Country of birth was also significantly related to suicide risk. For older men, living in a ward with unemployment rates below 5% was a risk factor, as was living in a ward with high own occupancy rates. Younger men living in wards with owner occupancy rates below 55% were at reduced risk. For women owner occupancy and unemployment rates had little association with suicide rates.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2004

Prevalence of multiple sclerosis in a residential area bordering an oil refinery.

BACKGROUND: Community concerns about a potential excess of multiple sclerosis (MS) prompted this study. OBJECTIVE: To determine the period prevalence of MS in a community bordering a closed oil refinery and a control community. METHODS: Cases seen by a neurologist during 1998 to 2001 were obtained from area neurologists and hospital discharge data. Population data were obtained from the year 2000 US Census. Patient data were abstracted by a trained abstractor onto a standardized report form. A consulting neurologist reviewed the form and made a final diagnosis using the Poser criteria plus the category of presumed. Age-adjusted prevalence rates and rates of agreement were calculated. RESULTS: The direct age-adjusted period prevalence for both sexes and all races for the entire study area was 113 per 100,000 (95% CI = 93 to 136). For white subjects only, the prevalence was 123 per 100,000 (95% CI = 102 to 147). With use of an indirect method of age adjustment, the number of observed cases in the community bordering the refinery was similar to the number of cases expected (standardized morbidity ratio = 130.8, 95% CI = 62.3 to 199.3), based on rates from the comparison area. The agreement between the treating neurologist (for definite plus probable cases) and the consulting neurologist (for definite plus probable plus presumed cases) was good (kappa = 0.5733). CONCLUSIONS: The prevalence of multiple sclerosis (MS) for this area was generally consistent with prevalence estimates calculated in previous studies in other areas. No significant excess was seen in the exposed area. MS was more prevalent in females than in males. The overall agreement between the consulting and treating neurologist was good.

Adult↗
PubMed1998

Airway management in the emergency department: a one-year study of 610 tracheal intubations.

STUDY OBJECTIVE: To describe the methods, success rates, and immediate complications of tracheal intubations performed in the emergency department of an urban teaching hospital. METHODS: This was an observational, consecutive series undertaken in an urban university hospital with an emergency medicine residency training program and an annual ED census of 60,000 patients. The study population included all patients for whom intubation was attempted in the ED during a 1-year period (July 1, 1995 through June 30, 1996). At the time of each intubation, the intubator filled out an intubation data collection form. If an intubation was performed in the ED but no form was filled out, the data were obtained from the medical record. RESULTS: A total of 610 patients required airway control in the ED; 569 (93%) were intubated by emergency medicine residents or attending physicians. Rapid-sequence intubation (RSI) was used in 515 (84%). A total of 603 patients (98.9%) were successfully intubated; 7 patients could not be intubated and underwent cricothyrotomy. In 33 patients, inadvertent placement into the esophagus occurred; all such situations were rapidly recognized and corrected. Eight (24%) of the 33 esophageal intubations resulted in a reported immediate complication. Overall, 49 patients (8.0%; 95% confidence interval [CI], 6% to 11%) experienced a total of 57 immediate complications (9.3%; 95% CI, 7% to 12%). Three patients sustained a cardiac arrest after intubation; two of these patients had agonal rhythms before intubation, and one probably had a succinylcholine-induced hyperkalemic cardiac arrest. CONCLUSION: At this institution, the majority of ED intubations were performed by emergency physicians and RSI was the most common method used. Emergency physicians intubated critically ill and injured ED patients with a very high success rate and a low rate of serious complications.

Adolescent↗
PubMed2004

[Epidemiology of lipid profile of the Spanish elderly population: the EPICARDIAN study].

BACKGROUND AND OBJECTIVE: The aim of this study was to describe the lipid profile, the levels of serum total cholesterol (TC), LDL cholesterol (C-LDL), HDL cholesterol (C-HDL) and triglyceride (TG), to compare these levels between geographical areas and to estimate the prevalence of dyslipidemia in elderly residents (65 years and older) from urban and rural areas of Spain. PATIENTS AND METHOD: Epidemiological, observational, multicentre study of Spanish elderly people residents (>or= 65 years old) of 3 communities in 3 Spanish regions: Arévalo (Avila) and Begonte (Lugo) as rural areas and Lista (Central Madrid) as urban area. Stratified randomized sample by age and sex from population census of each area. The participation rate was: 84.6%. At-home interviews (phase 1) (n = 4522): with determination of capillary blood cholesterol levels (Reflotron) and clinical visit (phase 2) (1/3 selected randomly, n = 1907): determination of serum TC levels (enzymatic colorimetric method CHOP-PAD), C-HDL, C-LDL (Friedewald equation) and TG (Trinder Method). RESULTS: Mean concentrations of TC was 230.3 (46.8) mg/dl. These levels decreased significantly with increasing age (p < 0.001), higher in women (p = 0.001); lower in Lugo (226.4 [49.7] mg/dl) than in Madrid (233.2 [42.3] mg/dl) and Arévalo (236.5 [43] mg/dl) (p = 0.002). Global prevalence of hypercholesterolemia by SEA simplified criteria was: 68.9% (95% confidence interval, 66.8-71). Mean concentrations of C-LDL was: 159.4 (37.9) mg/dl; C-HDL: 48.2 (15) mg/dl, and TG: 119.7 (63.85) mg/dl. 31% of cases were awarded about the hypercholesterolemia. Only 30% of them were under treatment with lipid lowering drugs; and 30% of the subjects showed CT concentrations < 200 mg/dl, with no differences by sex, age, study area or education level. Female sex, urban habitat and hypertension were the only variables independently associated to hypercholesterolemia in the logistic model. CONCLUSIONS: The prevalence of dyslipidemia is slightly higher to SEA estimation for the European elderly population (50%), greater in women and in younger groups. The awareness, treatment and control of hypercholesterolemia are low among the Spanish elderly population.

Aged↗
PubMed1980

Some new techniques for applying the housing unit method of local population estimation.

The housing unit method of population estimation is often characterized as being imprecise and having an upward bias. We believe that the method itself cannot properly be characterized by a particular level of precision or direction of bias. Only specific techniques of applying the method can have such characteristics. In this paper we discuss several new techniques we have developed for estimating households and the average number of persons per household. Estimates produced by these techniques are compared to estimates produced by several other techniques. Special census results from Florida provide preliminary evidence that the new techniques produce more precise, less biased estimates than the other techniques.

Florida↗
PubMed2005

Deprivation: different implications for forensic psychiatric need in urban and rural areas.

BACKGROUND: Ecological relationships between deprivation and forensic psychiatric admission rates may differ in urban and rural areas. AIMS: The aim of the study was to compare the relationship between material deprivation and forensic admission rates in rural and urban areas for a whole-national service in Ireland over a 3-year period. METHOD: All Irish forensic admissions from 1997 to 1999 were allocated to the appropriate small area. Material deprivation scores were calculated from census data. Mean annual admission rates and Bayesian standardised forensic admission ratios for small areas were aggregated by material deprivation score and population density. RESULTS: At small area level, there were significant non-linear increases in forensic admissions with increasing deprivation. The increases in urban areas (population density >10/hectare) were absent in less densely populated areas. CONCLUSIONS: Deprivation alone may not be the key factor in predicting forensic service utilisation. Factors associated with specifically urban deprived areas may be of greater relevance in planning services.

Adolescent↗
PubMed2006

Cardiovascular disease and risk factors among 345 adults in rural India--the Andhra Pradesh Rural Health Initiative.

BACKGROUND: Heart attack and stroke are problems already faced by some urban populations of India, but less is known about cardiovascular disease and risk factors in rural areas. The aim of the study was to investigate the levels and management of major cardiovascular risk factors and the prevalence of cardiovascular disease in two villages in rural Andhra Pradesh, India. METHODS: A cross-sectional survey was done by selecting a random sample stratified by age and gender from each village using census lists compiled in 2002. For each individual, trained study staff administered a Telugu-translation of a structured questionnaire, performed a brief physical examination and collected a fasting venous blood sample. Weighted estimates of mean (or percentages with) risk factor levels in the population were calculated and are reported with confidence intervals unless otherwise specified. RESULTS: Data was collected from 345 adults aged 20 to 90. The average household size was 4.2 and the mean combined household income was about Indian Rupees 25,454 (580 US dollars) per year. The mean systolic blood pressure was 116 (114-117) mm Hg, diastolic blood pressure 73 (114-120) mm Hg, total cholesterol 4.6 (4.5-4.7) mmol/L, HDL-cholesterol 0.8 (0.8-0.9) mmol/L, LDL-cholesterol 3.2 (3.1-3.3) mmol/L and triglyceride 1.3 (1.2-1.4) mmol/L. The prevalence of current smoking was 19.9% (15.4-24.4%), hypertension 20.3% (16.2-24.4%), diabetes 3.7% (1.8-5.5%), overweight 16.9% (12.3-21.5%) and obesity 4.4% (1.9-6.8%). A medical diagnosis of cardiovascular disease (previous heart attack, stroke or angina) was reported by 2.5% (1.1-3.9%) and a further 1.1% (0.1-2.1%) had angina by the 'Rose' classification. CONCLUSIONS: The possibility of increasing cardiovascular risk factors and prevalence of vascular disease in areas of rural India represent a public health concern. Larger and repeated epidemiological studies focusing on chronic diseases are required to inform treatment and prevention strategies suitable for use in these areas and other resource poor settings.

Adult↗