Five-county Region Research Articles

Impact of pediatric vaccination with pneumococcal conjugate vaccine on the risk of bacteremic pneumococcal pneumonia in adults

Invasive pneumococcal disease in adults may be declining, reflecting a form of herd protection from a new pediatric pneumococcal conjugate vaccine. Our aim was to determine whether vaccination of children protects adults in the same home from bacteremic pneumococcal pneumonia. We conducted a case–control study with 43 participating hospitals across a five-county region in Pennsylvania. Eligible cases were adults with bacteremic pneumococcal pneumonia identified by the microbiology laboratories at participating hospitals. Controls were healthy adults from the region identified through random digit dialing. Cases and controls were interviewed by telephone. We analyzed vaccine protection in those adults who reported living in homes with at least one child ≤6 years of age. From April 2002 through June 2004, there was a significant decline in the proportion of adult pneumococcal bacteremia due to any of the seven serotypes in the conjugate vaccine ( p = 0.006). Within this time period, 17% of cases and controls reported living in homes with at least one child ≤6 years of age. In adjusted analysis, vaccination of the youngest child in the home was associated with an 80% reduction in the odds of bacteremic pneumococcal pneumonia among adults with children in the home (OR = 0.2, 95% CI 0.1–0.8). We conclude that introduction of a pneumococcal conjugate vaccine for children has reduced the population rate of adult pneumococcal bacteremia due to vaccine serotypes and is associated with a reduced risk of bacteremic pneumococcal pneumonia for adults with children in the home.

Vehicle impacts on the environment at different spatial scales: observations in west central Georgia, USA

Roads and vehicles change the environmental conditions in which they occur. One way to categorize these effects is by the spatial scale of the cause and the impacts. Roads may be viewed from the perspective of road segments, the road network, or roads within land ownership or political boundaries such as counties. This paper examines the hypothesis that the observable impacts of roads on the environment depend on spatial resolution. To examine this hypothesis, the environmental impacts of vehicles and roads were considered at four scales in west central Georgia in and around Fort Benning: a second-order catchment, a third-order watershed, the entire military installation, and the five-county region including Fort Benning. Impacts from an experimental path made by a tracked vehicle were examined in the catchment. Land-cover changes discerned through remote sensing data over the past three decades were considered at the watershed and installation scales. A regional simulation model was used to project changes in land cover for the five-county region. Together these analyses provide a picture of the how environmental impacts of roads and vehicles can occur at different spatial scales. Following tracked vehicle impact with a D7 bulldozer, total vegetation cover responded quickly, but the plant species recovered differently. Soils were compacted in the top 10 cm and are likely to remain so for some time. Examining the watershed from 1974 to 1999 revealed that conversion from forest to nonforest was highest near unpaved roads and trails. At the installation scale, major roads as well as unpaved roads and trails were associated with most of the conversion from forest to nonforest. For the five-county region, most of the conversion from forest to nonforest is projected to be due to urban spread rather than direct road impacts. The study illustrates the value of examining the effects of roads at several scales of resolution and shows that road impacts in west central Georgia are most important at local to subregional scales. The insights from these analyses led to several questions about resource management at different spatial scales.

Severity of illness and ambulatory care-sensitive conditions.

This study describes how severity of illness may refine the definition of ambulatory care-sensitive conditions, or ACSCs. Hospital discharge abstract data from Philadelphia were combined with census data to develop population-based adjusted rates of hospitalization for diabetes and asthma, two ACSCs. By stratifying ACSC hospitalization by severity of illness, variations were observed by age, race, and gender. Minority groups may be at higher risk for less access to outpatient primary care and were observed to have higher rates of more severely ill, Stage 3 hospitalization. Geographic map displays indicated wide ranges of age-sex-adjusted rates for high-severity hospitalization in the five-county Philadelphia region. This refined ACSC measure may help to identify specific groups and clinical conditions within a population to assist health care planners estimate health care resources such as facilities, manpower, and programs, as well as to evaluate their outcomes.

Disaster Management System for Southwestern Indiana

The Southwest Indiana Disaster Resistant Community Corporation (SWIDRCC) and Sandia National Laboratories formed a partnership in 1999 with the intent of developing and deploying a system that will significantly lessen the loss of human life and lower the cost of disaster recovery in a five-county region. Although this region currently has a response system in place that appears adequate to meet the challenges posed by a disaster, the partnership is considering substantial improvements that could significantly lessen the cost of disasters. As a result of the SWIDRCC-Sandia partnership, a policy portfolio for the SWIDRCC has been developed and a significant technology development activity has been structured using the virtual issue process (VIP). VIP is a strategic planning tool developed by Sandia to provide concise information from a community or group that can be used to resolve complex issues and problems. The disaster management system that was defined as the result of the VIP will integrate sensor technologies, modeling and simulation tools, telemetry systems, and computing platforms, in addition to nonautomated elements including increased community education and involvement. The system is expected to provide information (pre-event, during event, and in event recovery) to community leaders that will significantly enhance the ability of the community to manage disaster response. The value of the system will be manifest in both reducing the loss of human life and staying the economic well-being of the community. It is expected that the system will serve as a prototype for other communities throughout the country. To aid in system definition during the process, two dynamic simulation models were also developed: the policy portfolio analysis tool and the infrastructure modeling tool.

Increasing Intensity of Pasture Use with Dairy Cattle: An Economic Analysis

Intensive grazing is a fast growing dairy production system in the USA, New Zealand, and Ireland. The key concept underlying intensive grazing systems is the substitution of cow-harvest for machinery harvest of forages. Study objectives were: (i) to determine whether randomly selected, representative dairy farms using intensive grazing were profitable, (ii) to determine whether grazing was more or less profitable than other crop enterprises, and (iii) to identify factors statistically associated with increasing intensity of grazing. Data were collected on 53 farms in a prominent dairy region of Pennsylvania in 1993. Results indicated that moderate intensive grazing achieved a $129/acre return to operator management and labor, compared with $20 and $58 returns for all hay and corn silage enterprises, respectively. Dairy enterprise returns averaged about $317/cow. Debt per cow was substantially higher for farmers increasing grazing intensity. Pasture acres per cow, high debt-to-assets, and negative cash flows were statistically associated with increasing intensity of pasture use. Thus, this study suggests that farm financial constraints of high debt and poor cash flows provide an important motivation to increase grazing intensity. A major drawback of intensive grazing is the likelihood of achieving slightly lower milk production than with confinement feeding. The primary economic benefit of intensive grazing was the reduction of costs associated with the production of pasture forage vs. production of other crops.

Green tobacco sickness: occupational nicotine poisoning in tobacco workers.

In this study the authors describe the investigation of a 1992 outbreak of green tobacco sickness, a form of nicotine poisoning from dermal exposure, among 47 tobacco workers in a five-county region of central and south-central Kentucky. Cases were identified through medical record searches at participating hospitals, as well as from reports submitted to the Occupational Health Nurses in Agricultural Communities program. A case-control study was undertaken to assess risk factors for green tobacco sickness. In a 20-min telephone interview, 40 cases and 83 controls responded to questions contained in a questionnaire. In 1992, 47 persons (3 were under age 16 y) in the study region sought medical treatment for green tobacco sickness. Twelve persons were hospitalized and 2 required intensive-care treatment. The crude incidence in 1992 was 10.0/1,000 tobacco workers. In 1993, 66 cases (7 were under age 16 y) of green tobacco sickness were identified in the study region (i.e., annual incidence of 14.0/1,000). A case-control study demonstrated that ill workers were younger, and were more likely to have worked in wet conditions, compared with workers who were not ill. Green tobacco sickness is a common problem among tobacco workers that may be prevented by avoiding work in wet tobacco or by use of protective clothing. Children younger than 16 y of age represented 9% of the green tobacco sickness cases in 1992 and 1993. Current occupational safety and health laws do not address protection of tobacco workers with respect to green tobacco sickness.

Half-century of cause-specific mortality experience of chemical manufacturing employees.

Cause-specific mortality was surveyed among 23,180 male (580,000 person-years) and 3,860 female (86,898 person-years) employees with 1 or more years of service from 1940 through 1989 at a large chemical plant. Vital status was ascertained for 99.1% of the males (n = 5,658 deaths) and 98.6% of the females (n = 355 deaths). Comparisons of observed mortality with expected levels based on any of three population comparisons (United States, Texas, or five local counties) showed lower mortality for all causes of death, diseases of the circulatory system, diabetes mellitus, and cirrhosis of the liver. There was an increased risk for lung cancer mortality among male operations employees when compared to the U.S. and Texas populations but not to the local five-county region. Additional evidence suggests this increase was primarily attributable to cigarette smoking. Male operations employees also had an elevated, although not statistically significant, risk for kidney cancer. Prior research had shown an association with work in the cell maintenance area of chlorine production. As a result of a high prevalence of deaths certified by justices of the peace, a mortality excess was observed of cancer of other and unspecified sites and symptoms, senility, and ill-defined conditions. Although specific chemical exposures were not studied, the generally favorable mortality experience suggests that major hazards are unlikely.

Decline in stroke mortality in North Carolina. Description, predictions, and a possible underlying cause.

Data from the National Center for Health Statistics were used to describe the decline in age-adjusted stroke mortality rates from 1962 to 1987 for North Carolina and for six regions of the state. For the state as a whole, stroke mortality decreased from 0.0050 to 0.0018 (64% decrease) for white males, 0.0039 to 0.0016 (59% decrease) for white females, 0.0072 to 0.0030 (58% decrease) for black males, and 0.0064 to 0.0025 (61% decrease) for black females. Under the hypothesis that the rate of decline in stroke mortality will slow and approach a "floor," a four-parameter logistic model was fit to the data. This model suggests that most of the decline in North Carolina stroke rates had occurred by 1987 and that the rates are now approaching the floor. For example, the estimated 1987 white male stroke mortality rate was 0.00190 and the floor 0.00176, suggesting only a 7% decline in the future. Similar percentage differences between 1987 levels and the floor were estimated for the three other race-gender groups. This analysis also suggested that while the absolute disparity by sex and race decreased between 1962 and 1987, the ratio of black to white mortality rates and the ratio of male to female mortality rates remained relatively constant. Estimates of 1-year case-fatality rates from two surveys of hospitalized stroke patients in a high-mortality five-county region of North Carolina decreased from 51% in 1970 to 38% in 1980. This decrease in stroke fatality rate is sufficient to account for 64% of the decrease in mortality estimated for this region over the same period.

Measured versus Estimated Creatinine Clearance in a High‐Functioning Elderly Sample: MacArthur Foundation Study of Successful Aging

To assess the validity of several equations for estimating creatinine clearance in a large sample of high-functioning, community-dwelling elderly. Serum and 12-hour urine samples were collected and assayed for creatinine using the Jaffe total chromagen method. Fifteen clearance-estimating equations were evaluated for bias, accuracy, correlation with measured clearance values, and frequency of erroneous placement into renal function categories. Stepwise regression modeling and reliability testing were performed on a split sample to construct and assess a novel creatinine-clearance-estimating equation. New Haven, Connecticut, East Boston, Massachusetts, and a five-county region in and around Durham, North Carolina. A subsample of community-dwelling men and women (age range 70-79 years) from the Established Populations for Epidemiological Studies of the Elderly was screened for physical and cognitive functioning and placed into high-, medium-, and low-functioning groups (n = 1354). High-functioning respondents who provided blood and complete urine samples (n = 762) were included in the present study. In general, estimated creatinine clearance was more closely correlated to measured values in males than in females. Most equations underestimated creatinine clearance, with average bias ranging from -33.1 mL/min to +19.6 mL/min. Predictive accuracy ranged from 18.2 mL/min to 38.0 mL/min. Equations were variable in their erroneous placement of individuals into renal function categories. Regression modeling yielded an equation which contained novel components but failed to provide better estimates of creatinine clearance than those already available. The equations evaluated here provide unacceptable predictions of creatinine clearance in normally aging individuals. We advocate the use of serum drug concentration measurements when available and encourage investigation into timed urine collections of short duration as alternatives to clearance-estimating equations in the elderly.

Timber Market Development from Private Forests in Northwestern Minnesota

Abstract Expanding timber industries in Minnesota are increasing the demand for timber. Questions about the suitability of public lands to increase timber output imply a more significant role for nonindustrial private forest (NIPF) land. Surveys of both NIPF landowners and industry in a five-county region assessed NIPF owner marketing behavior and opportunities to increase timber utilization from these lands. Results showed that former experiences of owners are suggestive of future behavior. Landowners who had used forestry advice in the past displayed a greater willingness to harvest timber than nonusers of forestry advice. Absentee owners in the study area represented a reserve of comparatively underutilized timber and expressed a need for marketing process guidance including timber pricing information. Industry respodents forecast increased reliance on NIPF timber and were dedicated to greater contributions of time and financial support of programs to stimulate timber harvesting and management on NIPF lands. North. J. Appl. For. 8(4):153-155.

Outplacement in the public sector.

The authors' reviewed their experience with a formalized outplacement project used in New York State during 1984 to preserve continuity of employment for those affected by staff reductions in state MR facilities. Mr. Torino's perspective is agencywide, reflecting his responsibility for manpower management throughout New York State's 20 MR/DD facilities. Mr. Whitehead's experience was based on his work at one of the centers involved, Craig developmental--a hundred-year-old, rural facility, serving a five-county region south of Rochester. The paper was presented at the 1984 AMHA annual meeting in Chicago.

The Southern California Earthquake Preparedness Project: Evolution of an “Earthquake Entrepreneur”

A major problem for at governments in earthquake-prone countries is how to improve the process of preparedness. In the U.S., a relatively novel mechanism was created to accelerate the pace and intensity of preparedness, including prediction response. Known as the Southern California Earthquake Preparedness Project (SCEPP), the entity had federal and state mandates and funding. It was an extension of federal and state policy into local government and the private sector. Established in 1980 as a temporary, three-year organisation under one agency in California, it continues today with a five-county region of southern, California (including Los Angeles) that would be devastated by an expected great earthquake on the south-central San Andreas fault. Although it had a limited budget, small staff, and experienced delays and leadership crisis in its early life, SCEPP is widely regarded today as having made a contribution to earthquake preparedness and prediction response in southern California. This article reviews the evolution of SCEPP as an “earthquake entrepreneur” and draws lessons from its record of relevance to government and earthquake preparedness generally. SCEPP represents an organizational model that may be considered by other earthquake-threatened settings.

Applications of Centrographic Techniques to the Study of Urban Phenomena: Atlanta, Georgia 1940-1975

"A limited number of centrographic techniques are applied to data for total population, black population, households by income quartiles, and housing characteristics for the five-county metropolitan region of Atlanta over the period from 1940 to 1975. Results of the analysis are compared to expectations from urban economic theory, and descrepancies are noted."