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Long-term ambient air pollution levels in four Chinese cities: inter-city and intra-city concentration gradients for epidemiological studies.

The field data collection of an air pollution epidemiologic study was carried out from 1993 to 1996 in four Chinese cities of Lanzhou, Chongqing, Wuhan, and Guangzhou. In each city, an urban district and a suburban district were selected. Ambient concentrations of total suspended particles (TSP), size-fractionated particulate matter including PM2.5, PM2.5-10, and PM10, sulfur dioxide (SO2), and oxides of nitrogen (NOx) were measured in these districts. The results indicate the presence of wide inter-city and intra-city gradients in long-term ambient levels of these measured pollutants. Across the eight districts, the 1993-1996 4-year means of TSP, SO2, and NOx ranged from 198 to 659 microg/m3, from 14.6 to 331 microg/m3, and from 31.5 to 239 microg/m3, respectively, and the 1995-1996 2-year means of PM2.5, PM2.5-10, and PM10 ranged from 51.5 to 142 microg/m3, from 29.2 to 107 microg/m3, and from 80.7 to 232 microg/m3, respectively. These pollution ranges substantially extended the upper end of the pollution ranges of previous air pollution epidemiologic studies conducted in North America and Europe. In each district, significant correlations among the measured pollutants were observed for daily concentrations. However, the gradient patterns in long-term means of different pollutants were different across the eight districts. (e.g., PM2.5-10 and TSP were highest in the Lanzhou urban district, PM2.5 and PM10 were highest in the Guangzhou urban district, SO2 was highest in the Chongqing urban district, and NOx was highest in the Guangzhou urban district). In general, seasonal variations were present in the ambient concentrations with high levels often occurring in winter months. The eight districts may be classified into four district clusters based on integrated levels of all measured pollutants. These features of the ambient air pollution have important implications for epidemiological studies and may provide unique opportunities to study exposure-effects relationships in the four Chinese cities.

Air Pollutants↗
PubMed2004

["Healthy cities"--requirements and performance. Questionnaire results and a suggestion on quality monitoring (healthy-cities-barometer)].

PURPOSE: The overall goal of the WHO Healthy Cities Project was to translate some key points of the Ottawa Charter for Health Promotion (1986) into reality such as public health policies, creating health-promoting environments, strengthening community action through active public participation (empowerment of communities) and equity in health at the local level. These should be anchored within the local political administrative system (PAS), which means health should be on the agenda of policymakers in all sectors. To figure out how far this has been attained after almost 15 years of "healthy cities" policy in Germany was the focal point of the first questioning of local project coordinators. METHODS: A written questionnaire containing 128 items has been developed in collaboration with the Healthy Cities Network-Coordinator. The questionnaire consists of 78 standardised questions and some (23) open-ended questions for more specific qualitative information. Also included are 27 ten-point rating scales to evaluate the coordinators' view of some aspects of their healthy cities work and to assess its progress. Based on 30 questions of the questionnaire we generated six quality indices, summarised to a quality index for a monitoring model. 47 (90 %) project-coordinators from a list of 52 took part in the first German Healthy Cities survey in the spring 2002. RESULTS: Selected results of the network questioning concerning the local "healthy cities" offices, work priorities and methods demonstrate differences between East and West Germany and general weakpoints of the "healthy cities" projects. Data analysis based on six quality dimensions of the "Healthy Cities" work, Programme Equipment and Commitment (Structure), Concept Quality and Integration within the Network (Process), Self-reported Success and Integration within the City/Municipality (Outcome), revealed some weak points of the " Healthy Cities" work as follows: Basing on the six quality dimensions we present a monitoring model (Healthy-Cities Barometer) which can also be used for strategic controlling (benchmarking) within the German Healthy Cities Network. Based on the data we identified 13 Cities at an A-level (excellent), 22 Cities at a B-level (satisfactory) and 12 Cities at a C-level (INADEQUATE). CONCLUSION: The "Healthy-Cities Barometer" provides a surveillance instrument which - if constantly used over several years - could offer data for a longitudinal analysis of the Healthy Cities' development. With its help the Healthy Cities Network-Coordinator could gain more information for a better performance and a continuous quality improvement process of the local Healthy Cities projects.

Germany↗
PubMed2004

The management for tuberculosis control in Greater London in comparison with that in Osaka City: lessons for improvement of TB control management in Osaka City urban setting.

The tuberculosis (TB) notification in Osaka City has been persistently high compared with other urban areas in Japan. Although the TB notification in Greater London has kept much lower level compared with that in Osaka City, it has been also persistently high compared with other urban areas in the UK. Nonetheless, the contexts of the two cities relating TB control programme as well as the epidemiological situation greatly vary; there must be some lessons to be learnt from each other to improve each TB control programme to tackle against TB more effectively. Comparing the epidemiological situation of TB in both cities, it is obvious that Osaka City suffers TB more than Greater London in terms of the TB notification rate. Concerning the context of the TB control programme, Osaka City has centralised approach with strong local government commitment; Greater London, on the other hand, has an approach that is greatly fragmented but coordinated through voluntary TB Networks. This paper aims to draw some constructive and practical lessons from Greater London TB control management for further improvement of Osaka City TB control management through literature review and interview to health professionals. TB epidemiology in Greater London shows distinct features in the extent of TB in new entrants and TB co-infected with HIV in comparison with those in Osaka City. TB epidemiology in Osaka City is to a great extent specifically related to homeless people whereas in Greater London, this relationship occurs to a lesser extent. Both areas have relatively high TB-notification rates compared with national figures, and they have "TB hot spots" where remarkably high TB-notification rates exist. TB control in Greater London is characterised with decentralised and devolved services to local government health authorities supplemented with co-ordinating bodies across sectors as well as across Greater London. Sector-wide TB Network as well as London TB Group (LTBG) and London TB Nurses Network are major key functioning bodies to involve relevant professionals as wide as possible. The specialist TB nurses play key roles for TB case management across Greater London, while in Osaka City, TB control is characterised with strong leadership and commitment of Osaka City Government for the TB control programme. The Osaka City Public Health Centre (PHC) takes initiatives to expand "Cohort Analysis and Case Management Conferences" at each of the 24 Ward Health and Welfare Centres as well as "DOTS Conferences" at hospitals for improvement of case management by physicians and nurses at hospitals as well as by the health centre staff. Public health nurses (PHNs) play very important roles for TB case management as frontline in Osaka City. Comparing the TB control in both cities, the following suggested recommendations are made to both cities for further improvement. Four suggested recommendations to Osaka City are: more resource re-allocation to community-based TB care than to hospital-based TB care should be done; Cohort Analysis and Case Management Conferences should be strengthened through involving more multi-disciplinary sectors; specialist TB PHN at each of the 24 Ward Health and Welfare Centres should be assigned in order to concentrate more on TB control activities; and accessibility to laboratory data such as drug susceptibility test for health centre staff should be improved. Two suggested recommendations to Greater London are: screening for TB high-risk group like homeless people should be strengthened, and regular sector-wide multi-disciplinary case conferences for proper case management should be strengthened.

AIDS-Related Opportunistic Infections↗
PubMed1998

Application of the modified method of "rapid appraisal to assess community health needs" for making rapid city health profiles and city action plans for health.

AIM: To develop a method that Croatian cities could use in the development of the City Health Profile and City Health Plan. The assessment concerned cities that have recently experienced the war and thus the method had to be rapid, cheap, scientifically based, sensitive, participative (involving politicians, experts, and citizens), able to produce immediate action, and to sustain the gained benefits. METHOD: A utilization-focused strategy was selected. Through ongoing interactions with intended information users, research questions were focused and the method of Rapid Appraisal to assess community health needs was selected as appropriate. This method was modified to: 1. assess the health of each city and serve as the basis for creating the City Health Profile; 2. select (Healthy City Project) priority areas; 3. establish the working groups on priority areas; and 4. build on the three previous steps to develop the City Action Plan for Health. RESULTS: During 1996, the Rapid Appraisal was applied in three Croatian cities (Pula, Metkovic, Rijeka). The work resulted in the completion of the City Health Profile, selection of the Project Priority Areas, formation of thematic working groups on priority areas, and acceptance of the agreed City Action Plan for Health. The method provided a scientifically based account of health in each of the three cities and identified targets for the future by using health-related measures and citizens' observations about the community, its problems, and potentials. CONCLUSION: The method proved to be credible and sensitive to the social and cultural differences it encompassed.

Croatia↗
PubMed1977

Aged in cities: residential segregation in 10 USA central cities.

This study focuses on the segregation of the aged in ten USA cities. The objectives are to determine the degree of segregation of elderly within cities, and how the pattern varied from 1960 to 1970 by size of city, age of city, and for cities that are growing and declining in population. Census data were used to compare proportions of the population 65 and over living in central city and suburban locations, and a summary Index of Dissimilarity was computed to measure the degree of age segregation by census tracts. In all metropolitan areas there was a disproportionate share of the elderly residing within the central city and considerable segregation in certain census tracts within the city. However, the degree of segregation showed no pattern of increase between 1960 and 1970. There was less segregation of the aged in older, declining cities and greater segregation in younger, growing cities. These findings suggest that age segregation is in part a function of the urbanization process.

Aged↗
PubMed2006

Implementation of the Healthy Cities' principles and strategies: an evaluation of the Israel Healthy Cities network.

The Israel network of Healthy Cities has been operating since 1990, and the first evaluation of its performance was carried out in 2004. The objectives were to evaluate the level of implementation of the 'Healthy Cities' principles and strategies in each network city and to assess the contribution of the network to its member cities. Coordinators of 18 active healthy cities participated in the study by completing a questionnaire with the aid of key informants in the municipality. The survey covered six dimensions of Healthy Cities' principles and strategies, and each was analyzed as a sum of scores of separate components and measures, converted to a 0-10 scale. Cities were found to differ in their performances. The dimension of intersectoral collaboration received the highest mean score (8.0 +/- 1.6), while the environmental protection dimension received the lowest one (4.5 +/- 2.2). Time investment by the coordinator of > 20 h a week is significantly associated with a higher score on the management dimension (7.8 versus 4.4 where the coordinator invests 20 h a week or less, P < 0.001). Previous work experience in either public health or community work was associated with higher scores of the community participation and intersectoral partnership dimensions (6.9 versus 5.2 and 8.5 versus 6.8, respectively, P < 0.05). Political support was associated with the city equity policy dimension (8.1 versus 4.8 in cities with high versus low political support, P < 0.01). Coordinator's participation in the network's activities is associated with better scores on all the dimensions except for environmental protection. It appears that political commitment and support is a significant enabling condition, which, together with the capacity building of the coordinator, may lead to better implementation of Healthy Cities' policy. Environmental issues should be incorporated into training sessions to enhance the environmental protection dimension.

Adult↗
PubMed2000

[Factors related to the slowdown in the reduction of the tuberculosis incidence rate in Osaka City--structure of the high incidence rate of tuberculosis in Osaka City analyzed by administrative-ward group, five-year period and age group].

The tuberculosis incidence rate in Osaka City is the highest in Japan. We analyzed the incidence rate in Osaka City in five-year period from 1978 to 1997, namely, 1978-1982 (period I), 1983-1987 (period II), 1988-1992 (period III), and 1993-1997 (period IV). Until the first half of 1980, the tuberculosis incidence rate in Osaka City had been dropping every year, but the rate of decline has been slowed substantially or even stopped since 1983. The incidence rate ratio of Osaka City compared with the national rate was 2.0 to 2.3 from 1970 to 1975, but it has been increasing from 1983 and is now higher than 3. We divided 24 wards of Osaka City into five groups based on selected employment indicators of population 15 years of age and over of 1995 National Census. Group A consists of two wards characterized by extremely high unemployment rate, Group B of four wards by high unemployment rate and high rate of manufacturing workers, Group C of six wards by high rate of non-manufacturing workers (tertiary industry workers), Group D of five wards by high rate of manufacturing workers, and Group E of seven wards by residential areas. The incidence rate of Group A had been declining during periods I and II but started to rise after period III. The rates of Group B and C had been declining from period I to II but the decline slowed down substantially even for every age class in periods III and IV. The incidence rates of Groups D and E have been falling. The incidence rate of the 50-69 year-old age group has been increasing substantially. The proportion of newly registered patients in Group A to all patients of Osaka City increased from 25.2% in period I to 32.7% in period IV. The number of newly registered patients of the 40-69 age class in Group A accounted for 45.1% of that in Osaka City in period IV. The slowdown in the reduction of the tuberculosis incidence rate has occurred not in all, but in only a few wards and it is a typical phenomenon of the middle-aged in those wards. It would be worth investigating whether a substantial decline in the tuberculosis incidence rate in Osaka City cannot be achieved by means of uniform control measures for all wards. Intensified tuberculosis control measures should focus on patients in specific wards and age groups.

Adolescent↗
PubMed1986

The AIDS epidemic in New York City, 1981-1984. New York City Department of Health AIDS Surveillance.

Since the epidemic of the acquired immunodeficiency syndrome (AIDS) was first recognized in 1981, New York City has had more cases and a higher incidence than any other city in the world. As of July 31, 1985, 4,133 cases had been reported to the New York City Department of Health, a cumulative incidence of 59 cases per 100,000. The incidence of disease continues to increase with each year of the epidemic, with 28% more cases diagnosed and reported in the first six months of 1985 (874 cases) than in a similar period of 1984 (680 cases). The authors examined surveillance data of the New York City Department of Health for 3,145 AIDS cases for the period 1981-1984 and for which reporting has been completed. As in the rest of the United States, the groups most affected include homosexual or bisexual men who do not use intravenous drugs (1,761 cases (56%)) and male and female intravenous drug users (1,029 cases (33%)). The percentage of cases represented by intravenous drug users in New York City is higher than in the United States as a whole, and 79% of all intravenous users with AIDS have had residence in New York City. Major changes observed over the period 1981-1984 include a decrease in the proportion of homosexual and bisexual men (63% to 56%); an increase in the proportion of intravenous drug users (13% to 29%); and the appearance of cases in three new groups at risk: children of parents in risk groups, transfusion recipients, and female sexual contacts of men in risk groups. The epidemic trends for the latter three groups appear to be similar to, but two years later than those seen for the epidemic in homosexual and bisexual men and intravenous drug users in New York City.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Residential mobility between cities and suburbs: race, suburbanization, and back-to-the-city moves.

Information from the 1979 to 1986 waves of the Panel Study of Income Dynamics is merged with data on respondents' tract and metropolitan area of residence to examine patterns and determinants of residential mobility between central cities and suburbs. Consistent with the life-cycle model of residential mobility, mobility in both directions declines with age, but on balance the presence of young children deters moving to the suburbs. Among blacks, education increases the probability of moving from cities to suburbs, while high income retains blacks and whites in suburbs. Consistent with the place stratification model, blacks are substantially less likely than whites to move from cities to suburbs, and substantially more likely to move from suburbs to cities, even after standardizing for racial differences in sociodemographic characteristics. High levels of violent crime and unemployment in cities relative to suburbs also tend to spur city-to-suburb mobility or inhibit suburb-to-city moves.

Adolescent↗
PubMed1993

Trends in the first ten years of AIDS in New York City. The New York City Department of Health AIDS Surveillance Team.

With over 37,000 cases of acquired immunodeficiency syndrome (AIDS) reported by the end of 1991, New York City had reported nearly 20% of all US cases in the first decade of the AIDS epidemic. This report examines cases diagnosed through 1990 and reported through 1991 to describe rates and trends in the affected subpopulations. Case data were collected by the New York City Department of Health AIDS Surveillance Team, using a format standardized by the federal Centers for Disease Control. Deaths attributable to human immunodeficiency virus (HIV) infection were examined using data provided by the New York City Department of Health Bureau of Vital Statistics. From 1981 through 1990, 37,436 cases of AIDS were diagnosed: 83% in men over the age of 19 years, 15% in women over 19, 2% in children under 13, and less than 1% in teenagers aged 13-19. Cumulative rates in New York City adults were as high as 100 per 10,000 in nine neighborhoods. Predominant trends included a sustained plateau in reported incidence in men who reported having sex with men and a continuing rise in cases in injection drug users and women infected through heterosexual intercourse. HIV-related deaths in men, women, and children were continuing to rise at the end of the decade. During the first decade of the AIDS/HIV epidemic, case surveillance in New York City measured the visible portion of the epidemic and provided important data on subepidemics.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Prevalence and risk factors of hypertension and age-specific blood pressures in five cities: a study of Indian women. NKP Salve Institute of Medical Sciences, Nagpur, India. Five City Study Group.

OBJECTIVE: To measure the prevalence of hypertension and age-specific blood pressure in urban populations from five Indian cities. Cross-sectional surveys were conducted in six-twenty urban streets in different cities from five different corners of India, using similar methods of sample selection and criteria. There were 3212 randomly selected women from Moradabad (n=902), Trivandrum (n=760), Calcutta (n=365), Nagpur (n=405) and Bombay (n=780), aged 25-64 years, inclusive. Evaluation was by a physician and a dietitian, an administered questionnaire, a physical examination and using a sphygmomanometer. The diagnosis of hypertension was based on old World Health Organisation criteria and new World Health Organisation/International Society of Hypertension criteria. The prevalence of hypertension (>140/90 mm Hg) was significantly (P<0.01) high in Trivandrum, South India (30.7%), and Bombay, West India (28.0%), compared to Moradabad, which is in northern India (22.6%), Nagpur, in central India (24.2%), and Calcutta, in east India (19.1%). Mean systolic and diastolic blood pressures were significantly higher in Trivandrum and Bombay compared to the other three cities. The overall prevalence of hypertension was 25.6% (n=823) and isolated diastolic hypertension was the most common form of hypertension (50.5%, n=1506) in the five Indian cities. According to old criteria, the overall prevalence of hypertension (>160/95 mm Hg) was 14.8% (n=481). Multivariate logistic regression analysis on pooled data from the five cities, after adjustment for age, showed that age (odds ratio 1.16), body mass index (1.68) and obesity were strongly associated with hypertension. A sedentary lifestyle and salt intake were weakly associated and alcohol intake was not a factor with these women.

Adult↗
PubMed2003

Exploring the city of Rubble: botanical fieldwork in bombed cities in Germany after World War II.

In recent decades, the flora and fuana of cities have become the objects of the inter-disciplinary research field of urban ecology and related policies of urban nature conservation. Although the term "urban ecology" is quite recent, it is argued in this paper that the formation of urban nature as an object of ecological knowledge has a much longer history. For example, in Germany, after World War II, the large rubble areas that existed in all bombed cities soon became important research fields for botanists studying plant migration and vegetation development in the context of the city. This paper uses the case of these botanical research activities to shed light on the historical origins of ecological thinking about nature in the city. Drawing upon a socio-spatial approach to science and practice, the paper explores the interaction between the social and material order of the city and the formation of ecological knowledge. As will be shown, botanists studying the rubble areas created various representations (e.g., lists, statistical tabulations, maps) of urban space that contributed to the transformation of the cultural and political meaning of urban wastelands. At the same time, it will be argued, urban wastelands were practically appropriated as scientific workplaces in which these representations were locally crafted. What later became the science and politics of urban ecology is to a large extent the outcome of this mutual shaping of knowledge and urban space in the post-Second World War period.

Botany↗
PubMed1994

Trends in the susceptibility of tuberculosis in New York City, 1987-1991. New York City Area Tuberculosis Working Group.

The annual number of cases of tuberculosis in New York City has increased since 1978. In addition, in 1991 a 1-month survey of cases of tuberculosis in New York City found that 33% of all cases were resistant to at least one drug. To determine susceptibility trends from 1987 to 1991, a period during which an unprecedented rise in resistant tuberculosis occurred in New York City, we reviewed the microbiology records of 44 New York City hospitals (comprising > 14,000 cases). The percentage of cases resistant to at least one drug rose from 19% in 1987 to 28% in 1991, and the percentage of cases resistant to isoniazid rose from 13% in 1987 to 23% in 1991, while resistance to at least both isoniazid and rifampin rose from 6% to 14%. The rise of multidrug-resistant tuberculosis occurred in all four surveyed boroughs (counties) of New York City. These data demonstrate how rapidly multidrug-resistant tuberculosis can appear, and they suggest that initial empirical regimens should be broadened at certain hospitals.

Antitubercular Agents↗
PubMed2002

Addressing the unique challenges of inner-city practice: a direct observation study of inner-city, rural, and suburban family practices.

Previous research on geographic variations in health care contains limited information regarding inner-city medical practice compared with suburban and rural settings. Our main objective was to compare patient characteristics and the process of providing medical care among family practices in inner-city, suburban, and rural locations. A cross-sectional multimethod study was conducted emphasizing direct observation of outpatient visits by trained research nurses involving 4,454 consecutive patients presenting for outpatient care to 138 family physicians during 2 days of observation at 84 community family practices in northeast Ohio. Time use during office visits was assessed with the Davis Observation Code; satisfaction was measured with the Medical Outcomes Study nine-item Visit Rating Scale; delivery of preventive services was as recommended by the US Preventive Services Task Force; and patient-reported domains of primary care were assessed with the Components of Primary Care Instrument. Results show that inner-city patients had more chronic medical problems, more emotional problems, more problems evaluated per visit, higher rates of health habit counseling, and longer and more frequent office visits. Rural patients were older, more likely to be established with the same physician, and had higher rates of satisfaction and patient-reported physician knowledge of the patient. Suburban patients were younger, had fewer chronic medical problems, and took fewer medications chronically. Inner-city family physicians in northeast Ohio appear to see a more challenging patient population than their rural and suburban counterparts and have more complex outpatient office visits. These findings have implications for health system organization along with the reimbursement and recruitment of physicians in medically underserved inner-city areas.

Adult↗