County Unit Research Articles

Sociocultural influences on mental health service use by Latino older adults for emotional distress: Exploring the mediating and moderating role of informal social support

This study investigated the determinants of mental health services for emotional distress by low-income older Latinos living in Los Angeles County (United States). The functional effects of informal support on service use were tested while accounting for dimensions of support and sociocultural factors. Using data from a cross-sectional survey of older Latinos (n = 235), we preformed a secondary data analysis using path analysis with Poisson regression to assess mediation and moderation models by type of perceived support, emotional and instrumental. Data was originally collected between 1998 and 2005. Results indicated that no mediation effects were present however significant moderation effects emerged. Respondents with low levels of linguistic acculturation and informal support used fewer services. Variations by type of informal support emerged, with emotional support presenting the best model fit compared to instrumental support in the moderation model analysis. The direct effects of linguistic acculturation and age remained significant after controlling for need. Findings reveal limited informal support is a risk factor for the underutilization of mental health services by older Latinos with low levels of linguistic acculturation as they age. Integrating support resources that assist in navigating service systems and address language barriers can enhance service use by older Latino adults. Implications for service delivery and program development are discussed.

Risk assessment to China’s agricultural drought disaster in county unit

China faces drought disaster risk under the changing climate. Risk analysis is a suitable approach in order to design ex-ante measure able to anticipate effects of drought on agricultural production. In this article, with the support of historic drought disaster data from 583 agro-meteorological observations (1991–2009), a risk analysis method based on information diffusion theory was applied to create a new drought risk analysis model, and the risk of China’s agriculture drought disaster was evaluated on higher spatial resolution of county unit. The results show that in more than three hundred counties of China, risk probability was biyearly or annually when Drought Affected Index (DAI) was over 5%. When DAI was up to 40%, more than one hundred counties were prone to drought disaster annually or once every 5 years. This showed that the impact of drought disaster on China’s agriculture, whether in frequency or intensity, was large. With the different level of DAI, China’s agricultural drought risk pattern showed variable pattern characteristics. When DAI was low, the distribution of county agricultural drought risk in China presented the East–West pattern of differentiation, and high risk mainly lied in the eastern, low risk mainly in the western. On the other hand, when DAI was high, the distribution of county risk appeared a pattern of high in center, and the north areas higher than the south, increased gradually from southwest to northeast. Drought risk presents a clear zonal differentiation that may be result from stepped topography, different precipitation and hazard-affected bodies. Spread of high value area of drought risk in northern may be related to the southeast monsoon and ecological degradation in northern Ecotone.

A geographically weighted model of the regression between grain production and typical factors for the Yellow River Delta

The study of grain production is one of the crucial areas for grain security. In this paper, the quantile results for grain production reveal that the first-quantile county units include Kenli country, Lijin country, Hekou District and Dongying District. The second-quantile, the third-quantile and the fourth-quantile country units include five country units each. Moreover, a model of geographically weighted regression (GWR) between grain production and typical factors was used to explore the spatial adjacency relationship among them; grain production was regarded as the dependent variable, and some typical factors, namely the grain sowing area, the efficient irrigation area, and agriculture machinery, were thought of as the independent variable based on 19 county level areas of the Yellow River Delta in 2007. The GWR was established for predicting the grain production at the county level, the grain production of 14 random counties was regarded as the training data, and the grain production in Changyi country, Huimin country, Gaoqing country, Bincheng District and Lijin country was regarded as the test data. The GWR results showed that no underprediction and overprediction of values for the grain production arose in the study. The adjustment R2 value of the grain production in the GWR model is 0.988, standardized values of the residuals including five country units are positive, the predicted value and the observed value for the grain production of 19 county units showed a good fit, and the established GWR model can be used to carry out the prediction of grain production in Yellow River Delta.

Wpływ cech klientów na ocenę jakości usług świadczonych przez jednostki samorządu terytorialnego

The article aims to analyze the relationship between the individual SERVQUAL indicators and characteristics of customers. 1525 questionnaires completed by individual customers of different local government units (LGUs), surveyed in 2010 were analyzed. Surveys were conducted in the framework of the project Implementation of management improvements in local government units in the Zachodniopomorskie voivodship, which included county and municipal units. In the paper the logistic regression model has been used. Thus it was possible to identify the characteristics that have a significant impact on satisfaction and determination of odds ratios for subgroups of customer satisfaction.

Risk Assessment Model to Natural Disaster in County Unit Based on Information Diffusion Technology

Accurate assessment to disaster risk is one of the keys to reducing disaster losses. However, due to the fact that the disaster situation data series in county unit are always relatively short, available data are often not sufficient for disaster risk analysis. In this paper, a risk analysis method based on information diffusion theory was applied to create a new disaster risk analysis model (CURAM), and the risk of disaster can be evaluated on higher spatial resolution of county unit. Visual Basic and Map Objects were used to establish CURAM applying object oriented technique and component technique. CURAM provided risk evaluate function to natural disaster in county unit, and thematic map making and output, etc. The risk assessment results calculated by CURAM indicated that information diffusion technology was highly capable of extracting useful information and therefore improved system recognition accuracy.

Residual soil nitrate in irrigated Southern High Plains cotton fields and Ogallala groundwater nitrate

Nitrate (NO3) is the most important contaminant of the Ogallala aquifer in West Texas, especially in counties south of Lubbock. Twenty percent of the wells in the 11-county study area of West Texas had >10 mg L-1 (ppm) NO3-N in the groundwater. The source of this NO3 is not clear. Leaching of residual soil NO3 from the 1.2 million ha (3 million ac) cotton land is a possibility, but it may take several decades for percolating water to reach the depth of the Ogallala groundwater. In this paper, soil profile NO3 data from eight cotton fields from five counties across the Southern High Plains of West Texas are presented. Soils were sampled to 90 cm (36 in) in four depth increments. Nitrate-N levels in the surface 0 to 15 cm (0 to 6 in) soil were low, averaging 15 kg N ha-1 (13 lb ac-1). However, extractable NO3-N content averaged 58 and 96 kg NO3-N ha-1 (52 and 86 lb ac-1) in the 0 to 60 (0 to 24 in) and 0 to 90 cm (0 to 36 in) soil profiles, respectively. Soil profile NO3-N was greatest in calcareous soils, soils with petrocalcic horizons and in Acuff loam soils. Soil profile NO3-N content or profile distribution was not consistently related to soil type. We also compiled and analyzed Texas Water Development Board irrigation well NO3-N concentrations by county and soil map unit. Well water NO3-N was greatest in Lynn county (12.8 mg L-1) and lowest in Hale county (2.7 mg L-1). Groundwater NO3-N and soil map unit data were not related in a consistent pattern in terms of soil texture. Well depth and well water NO3-N concentration were negatively correlated (r = -0.56). Irrigated cotton producers should test their well water for NO3, as this can be a significant source of N. Good N management requires N fertilizer applied at rates appropriate for yield goals for specific irrigation systems and water availability, resulting in minimal residual soil NO3 at harvest. Deep soil sampling, i.e. 0 to 60 or 90 cm (0 to 24 or 36 in) can help maximize profits and protect NO3 contamination of the Ogallala aquifer.

A plan for the adjustment of water distribution in the Korean waterworks system

The primary objective of this plan is to consolidate the current water supply system of Korea organized in the unit of city and county into wide area in order to supply the deficient region by fully utilizing the superfluous water volume of neighboring city and county. Furthermore, it also aims to prepare for the penetration of large foreign water supplier into domestic market by securing competitiveness through consolidation of domestic medium and small water suppliers in consideration of the forthcoming market opening. We determined the regions for which supplying system needs to be adjusted by analyze regions with deficient and superfluous water through the forecast of water supply and demand for established life areas. Further, we established a plan to utilize the superfluous water volume as an adjusted multi-regional water supply system such as a water supply plan in populated areas.

Fine-Particulate Air Pollution and Life Expectancy in the United States

Exposure to fine-particulate air pollution has been associated with increased morbidity and mortality, suggesting that sustained reductions in pollution exposure should result in improved life expectancy. This study directly evaluated the changes in life expectancy associated with differential changes in fine particulate air pollution that occurred in the United States during the 1980s and 1990s. We compiled data on life expectancy, socioeconomic status, and demographic characteristics for 211 county units in the 51 U.S. metropolitan areas with matching data on fine-particulate air pollution for the late 1970s and early 1980s and the late 1990s and early 2000s. Regression models were used to estimate the association between reductions in pollution and changes in life expectancy, with adjustment for changes in socioeconomic and demographic variables and in proxy indicators for the prevalence of cigarette smoking. A decrease of 10 microg per cubic meter in the concentration of fine particulate matter was associated with an estimated increase in mean (+/-SE) life expectancy of 0.61+/-0.20 year (P=0.004). The estimated effect of reduced exposure to pollution on life expectancy was not highly sensitive to adjustment for changes in socioeconomic, demographic, or proxy variables for the prevalence of smoking or to the restriction of observations to relatively large counties. Reductions in air pollution accounted for as much as 15% of the overall increase in life expectancy in the study areas. A reduction in exposure to ambient fine-particulate air pollution contributed to significant and measurable improvements in life expectancy in the United States.

The Plan on the Adjustment of Water Distribution System in Korea Waterworks System

The primary objective of this plan is to consolidate the current water supply system of Korea organized in the unit of city and county into wide area in order to supply the deficient region by fully utilizing the superfluous water volume of neighboring city and county. Furthermore, it also aims to prepare for the penetration of large foreign water supplier into domestic market by securing competitiveness through consolidation of domestic medium and small water suppliers in consideration of the forthcoming market opening. We determined the regions for which supplying system needs to be adjusted by analyze regions with deficient and superfluous water through the forecast of water supply and demand for established life areas. Further, we established plan to utilize the superfluous water volume as an adjust multi-regional water supply system local water supply system such as water supply plan in the life areas, water supply plan between the life areas.

SPATIAL PATTERNS OF LYME DISEASE RISK IN CALIFORNIA BASED ON DISEASE INCIDENCE DATA AND MODELING OF VECTOR-TICK EXPOSURE

Ixodes pacificus, particularly the nymphal life stage, is the primary vector to humans of the Lyme disease agent Borrelia burgdorferi in California. During 2004, we collected I. pacificus nymphs from 78 woodland sites in ecologically diverse Mendocino County, which has a moderately high incidence of Lyme disease. Within this county, nymphal density was elevated in forested areas with a growing degree day range of 2,600-3,000 (10 degrees C base). Using a geographic information systems approach, we identified all areas in California sharing these environmental characteristics and thus projected to pose high acarologic risk of exposure to host-seeking nymphal ticks. Such areas were most commonly detected in the northwestern part of the state and along the Sierra Nevada foothills in the northeast, but the analysis also identified isolated areas with high acarologic risk in southern California. This mirrors the spatial distribution of endemic Lyme disease during 1993-2005; most cases occurred in counties to the northwest (58%) or northeast (26%), whereas fewer cases were reported from southern California (16%). Southern zip-codes from which Lyme disease cases had been reported were commonly located in close proximity to areas with high projected acarologic risk. Overall, Lyme disease incidence in zip code areas containing habitat with high projected acarologic risk was 10-fold higher than in zip code areas lacking such habitat and 27 times higher than for zip code areas without this habitat type within 50 km. A comparison of spatial Lyme disease incidence patterns based on county versus zip code units showed that calculating and displaying disease incidence at the zip code scale is a useful method to detect small, isolated areas with elevated disease risk that otherwise may go undetected.

Tobacco Outlet Density, Cigarette Smoking Prevalence, and Demographics at the County Level of Analysis

The geographic associations between tobacco outlet density, cigarette smoking prevalence, and demographic variables at the county unit of analysis were examined. End of year 2002 data were derived from licenses of 4745 tobacco selling retail outlets in all 99 Iowa counties. The 2000 census and the 2002 Iowa Behavioral Risk Factor Surveillance System (IBRFSS) were used to gather data for demographic variables and smoking prevalence rates. The IBRFSS telephone interviews were conducted from January through December in 2002 with a random sample of 3662 Iowa residents. As expected, results showed that counties with higher density of tobacco outlets and smoking prevalence also tended to have a higher percentage of minority residents. Contrary to previous studies, however, counties with higher tobacco outlet density and smoking prevalence also tended to have higher median household income. Findings are discussed in light of the state's low income inequality. Implications of the study and directions for future research are discussed.

Usage of Antifungal Drugs for Therapy of Genital CandidaInfections, Purchased as Over‐the‐Counter Products or by Prescription: 2. Factors that May have Influenced the Marked Changes in Sales Volumes During the 1990s

The epidemiology of vulvovaginal candidiasis (VVC) and such recurrent infections (RVVC) has been difficult to study as the majority of episodes of these conditions are self-treated by the women affected. In Sweden, all pharmacies are owned by the state and all prescriptions and over-the-counter (OTC) products, such as antifungals, are registered in a database, which offers unique possibilities to study the epidemiology of VVC/RVVC. To analyze all prescriptions and OTC products purchased for therapy of VVC/RVVC and to establish reasons for any observed variation in the sales figures. Sales figures in the Swedish county of Skåne of antifungal drugs for therapy of VVC/RVVC were analyzed by the aid of the 'ACS' database of the National Corporation of Swedish Pharmacies for the years 1990--1999. The size of the female population in the county is approximately half a million. The study showed that 93% of all antifungal drugs for VVC/RVVC were sold as OTC products. An increase in sales of the drugs occurred until mid- 1993/94, followed by a decrease until end of the study period in 1999. Demographic factors (e.g. the number of female inhabitants in the county, pharmacies and health-care units), the pregnancy rate and pharmacy-dependent factors (such as the introduction of shelves for self-selection of antifungal products) did not explain the observed variations in sales. Distinct short-term variations in the number of prescriptions of fluconazole and itraconazole could be explained by drugs company sales campaigns and logistics factors in drug distribution. The sales volumes in the 33 municipalities in the county correlated with the density of the population, which was not the case for the total number of prescriptions made in the county during the 1990s. The variation in antifungal drug sales was similar to that of hormonal intrauterine devices, but this was not the case for oral contraceptives. The total Swedish usage of antibiotics showed a similar variation to that of the antifungal drugs analyzed. The study stresses the limited impact on the treatment of VVC/RVVC by the medical community. Behavior-related factors in the female population are the most likely explanation for the marked variations found in the usage of drugs for the two conditions.

Physician Recruitment Strategies for a Rural Hospital

St. Vincent Randolph Hospital, Winchester, Indiana James Full, FACHE, serves as CEO for St. Vincent Randolph Hospital in Indiana. Mr. Fuller has previously worked for Alliant Management Services in Louisville, Kentucky, and was the executive director for the Greater Randolph Community Health Plan in Winchester, Indiana. In these positions he has coordinated the merging of a rural hospital system with the St. Vincent Hospital System/Ascension Health; is coordinating the planning for construction of a new critical access hospital; and has activated specialty clinics, comprehensive wellness and occupational medical programs, and model rural health clinics and training centers to provide rural exposure for medical residents and students. Prior to these experiences, Mr. Full worked as a CEO for a Charter Medical Corporation Hospital in Lafayette, Indiana, and as administrator for the Veterans Administration in Colorado and Illinois. Mr. Full is a member of the National Association of Social Workers, the Indiana Hospital and Health Association Council on Rural Health, the Indiana Primary Care Association, and the Indiana Rural Health Association. He has received several awards for innovative program development and volunteers his time with Junior Achievement, Boy Scout Medical Explorers, Rotary International, and the Randolph County United Way. He has been a member of the American College of Healthcare Executives since 1985 and achieved Fellow status in 1999. This case study represents a part of his Fellow project and was voted one of the best case studies in 1999.

Risk factors for penile cancer: results of a population-based case-control study in Los Angeles County (United States).

The etiology of penile cancer is poorly understood, with neonatal circumcision being one of the few recognized nondemographic risk factors. Multiple logistic regression was used to analyze interview data from 100 matched case-control pairs; cases of carcinoma in situ (CIS) and invasive carcinoma of the penis were analyzed separately as well as together. Phimosis was strongly associated with invasive carcinoma (adjusted odds ratio [OR] = 16; 95% confidence interval [CI] = 4.5-57) but not CIS (OR = 1.7; 95% CI = 0.32-7.8), and these associations persisted when the analyses were restricted to uncircumcised subjects. Neonatal circumcision was inversely associated with invasive carcinoma (OR = 0.41; 95% CI = 0.13-1.1) but not CIS, and the observed association with invasive carcinoma was weakened appreciably when the analysis was restricted to subjects with no history of phimosis (OR = 0.79; 95% CI = 0.29-2.6). Other factors positively associated with invasive carcinoma or CIS or both were injury to the penis, cigarette smoking, physical inactivity and, to a lesser extent, genital warts and other infections or inflammation of the penis. Although many effects were imprecisely estimated in this study, the protective effect of circumcision on invasive penile cancer appears to be mediated in large part by phimosis; furthermore, the effects of certain factors such as phimosis and circumcision appear to differ for CIS and invasive carcinoma.

Creating A New Government Culture: The Search For Champions

The Situation In January of 1997, a newly elected governor appointed a new Chairman of the Indiana State Board of Tax Commissioners. The three commissioners of the Tax Board are responsible for overseeing and approving the budgets, levies, and local property tax rates for the 2300 taxing units in the state. This includes schools, county and local units of government as well as other special taxing units and districts. The Tax Board is also responsible for administering the assessment of property in Indiana including training and certifying all local assessors and the equalization of local assessments in all 92 Indiana counties. The new commissioner was appointed by the governor to implement the governor's "Smaller and Smarter Government" initiative. The commissioner's task was to analyze the agency and make changes that would improve the performance of the agency while making the Indiana property tax system simpler, fairer, and conducive to economic development. At a briefing of state agency heads in March of 1997, the governor directed all agency leaders to "find ways to enable citizens and local officials to do things, rather than create impediments that prevent them from getting things done." It was clear that the new governor wanted agencies to facilitate action on the part of citizens and local officials, and to not focus on flexing their regulatory and watchdog muscles.

Brain temperature exceeds systemic temperature in head-injured patients

To identify the temperature differences in readings taken from the brain, jugular bulb, and core body in head-injured patients. Prospective, observational study. Neurosurgical intensive care unit of a university-affiliated county hospital. Thirty patients with severe head injuries had measurements of brain and core body temperatures. Fourteen patients also had measurements of jugular venous blood at the level of the jugular bulb. None. Brain temperature was increased an average of 2.0 degrees F (1.1 degrees C) over the core body temperature. In individual patients, the average brain temperature increase over the core body temperature ranged from -0.5 degrees to 3.8 degrees F (-0.30 degrees to 2.1 degrees C). Jugular vein and core body temperatures were similar. The difference in the brain and body temperatures increased when cerebral perfusion pressure decreased to between 20 and 50 mm Hg. The difference in the brain and body temperatures decreased in those patients treated with barbiturate coma. Direct measurement of temperature in head-injured patients is a safe procedure. Temperatures in the brain are typically increased over the core body temperature and the jugular bulb temperatures. Jugular vein temperature measurement is not a good measurement of brain temperature since it reflects body, not brain temperature. These findings support the potential importance of monitoring brain temperature and the importance of controlling fever in severely head-injured patients since brain temperature may be higher than expected.

Forensic psychiatric services in Norway

Abstract This paper focuses on some features of Norwegian forensic psychiatry. It presents an overview of the system and recent developments. Over the past 15 years Norwegian psychiatry has undergone a decentralization of services, and the build-up of regional and county council secure units has taken place. A number of health policy decisions have also improved the psychiatric health care offered to prisoners. The organization of inpatient care is then described, focusing on the environment, level of staffing and patient characteristics. Emphasis is also placed on interdisciplinary communication and the problems of discharge and transfer of forensic psychiatric patients to general services. The discussion highlights areas of success and issues of continuing concern. Similarities between the developments seen in Norway and in England and Wales are also noted.

Low measured auto-positive end-expiratory pressure during mechanical ventilation of patients with severe asthma: hidden auto-positive end-expiratory pressure.

To describe the occurrence of low measured auto-end-expiratory pressure (auto-PEEP) during mechanical ventilation of patients severe asthma. Observational clinical study. Medical intensive care unit of a university-affiliated county hospital. Four mechanically ventilated patients with severe asthma who had low measured auto-PEEP despite marked increase in both peak and plateau airway pressures. None. Peak pressure, plateau pressure, and auto-PEEP were measured at an early time point, when airflow obstruction was most severe, and again at a later time after clinical improvement. Auto-PEEP was measured by the method of end-expiratory airway occlusion. From the early to the late point, there was a marked decrease in peak pressure (76 +/- 7 to 53 +/- 6 cm H2O; p<.001) and in plateau pressure (28 +/- 2 to 18 +/- 3 cm H2O; p<.001), but only minimal change in auto-PEEP (5 +/- 3 to 4 +/- 3 cm H2O). The difference between plateau pressure and auto-PEEP decreased between the early and late time points (23 +/- 1 to 14 +/- 1 cm H2O; p<.01), even though tidal volume was larger at the late time point. In three patients, low auto-PEEP and a large difference between plateau pressure and auto-PEEP was only seen after expiratory time was prolonged. In these three patients, prolongation of expiratory time resulted in a large decrease in measured auto-PEEP (14 +/- 4 to 5 +/- 4 cm H2O), but a much smaller change in plateau pressure (31 +/- 3 to 29 +/- 3 cm H2O). We conclude that measured auto-PEEP may underestimate end-expiratory alveolar pressure in severe asthma, and that marked pulmonary hyperinflation may be present despite low measured auto-PEEP, especially at low respiratory rates. This phenomenon may be due to widespread airway closure that prevents accurate assessment of alveolar pressure at end-expiration.

Patterns of Federal Urban Spending

A review of federal expenditures between 1983 and 1992 is presented in this study of per capita spending in central cities and their metropolitan suburbs. The Census Bureau provides data for 41 of the nation's metropolitan areas, of which 7 central cities are defined as county units of government and analyzed in greater detail. In constant dollars, central cities led suburbs in per capita receipt of federal funds; however, suburbs generally received an increase in their relative shares. In central cities, grants-in-aid increased but changed to entitlements directed to individuals.

Lagoons and ponds

Lagoons and ponds