Suburban Cook County Research Articles

Suburban Migration and the Birth Outcome of Chicago-Born White and African–American Women: The Merit of the Healthy Migrant Theory?

The healthy migrant theory posits that women who migrate before pregnancy are intrinsically healthier and therefore have better birth outcomes than those who don't move. Objective. To determine whether migration to the suburbs is associated with lower rates of preterm (<37weeks) birth among Chicago-born White and African-American mothers. We performed stratified and multilevel logistic regression analyses on an Illinois transgenerational dataset of non-Latino White and African-American infants (1989-1991) and their mothers (1956-1976) with appended US census income information. Forty percent of Chicago-born White mothers (N=45,135) migrated to Suburban Cook County and 30% migrated to the more geographically distant collar counties. In contrast, 10% of Chicago-born African-American mothers (N=41,221) migrated to Suburban Cook and only two percent migrated to the collar counties. Chicago-born White and African-American migrant mothers to Suburban Cook County had lower preterm birth rates than their non-migrant counterparts; RR=0.8 (0.8-0.9) and 0.8 (0.7-0.8), respectively. When neighborhood income was singularly taken into account, the protective association of suburban migration and preterm birth disappeared among Chicago-born Whites. In race-specific multilevel multivariate regression models which included neighborhood income, the adjusted odds ratio of preterm birth, low birth weight, and small for gestational-age for Chicago-born White and African-American migrant (compared to non-migrant) mothers approximated unity. Neighborhood income underlies the protective association of suburban migration and birth outcome among Chicago-born White and African-American mothers. These findings do not support the healthy migrant hypothesis of reproductive outcome.

Rhabdomyolysis in Patients with West Nile Encephalitis and Meningitis

Since 1999, more than 6,500 cases of West Nile virus neuroinvasive disease (WNND) have been reported in the United States. Patients with WNND can present with muscle weakness that is often assumed to be of neurological origin. During 2002, nearly 3,000 persons with WNV meningitis or encephalitis (or both) were reported in the United States; in suburban Cook County, Illinois, with 244 persons were hospitalized for WNV illnesses. The objective of this investigation was to describe the clinical and epidemiological features of identified cases of WNV neuroinvasive disease and rhabdomyolysis. Public health officials investigated patients hospitalized in Cook County, and identified a subset of WNV neuroinvasive disease patients with elevated creatine kinase levels. Cases were defined as hospitalized persons with a WNV infection, encephalitis or meningitis, and rhabdomyolysis. Retrospective medical record reviews were conducted and data was abstracted with a standardized data collection instrument. Eight patients with West Nile encephalitis and one with West Nile meningitis were identified with rhabdomyolysis. Median age of the nine patients was 70 years (range, 45-85 years), and eight were men. For all nine patients, the peak CK level was documented a median of 2 days after hospitalization (range, 1-24 days). Median CK level during hospitalization for all case-patients was 3,037 IU (range, 1,153-42,113 IU). Six patients had history of recent falls prior to admission. Although the temporal relationship of rhabdomyolysis and neurological WNV illness suggested a common etiology, these patients presented with complex clinical conditions which may have led to development of rhabdomyolysis from other causes. The spectrum of WNV disease requires further investigation to describe this and other clinical conditions associated with WNV infection.

Did suburban zoning become more restrictive?

The US National Commission on Urban Problems in 1968 alleged that an increase in minimum residential lot sizes in the suburbs was a leading cause of suburban restrictiveness, and that part of the motivation for the increase was discrimination against households of low and moderate income. An examination of the zoning ordinances in all of the suburban municipalities in Cook County, Illinois for 1946 and 1971 shows that, except for a few prominent examples, such an allegation cannot be substantiated. Cook County is the second‐largest county in the USA and had a suburban population of 2.124 million in 1970. Suburban Cook County consisted largely of dormitory suburbs in 1940. Eleven suburbs increased the restrictiveness of zoning during the 1946–71 period, but only two of these are of major importance. Nine suburbs reduced the restrictiveness of zoning, of which eight reduced the land requirements for multi‐family housing. The study confirms the view that, in the 25 years after Word War II, some of the impact of restrictive zoning was mitigated by the availability of a wide variety of jurisdictions.

Immunization practices and beliefs of physicians in suburban Cook County, Illinois.

This study was conducted to ascertain the vaccination beliefs and practices of physicians who provide care for low income children. Sixty-two (56.9%) of a sample of 109 physicians in suburban Cook County, Illinois responded to a mail survey. A majority of physicians reported a willingness to immunize during well child care, follow-up, and chronic illness visits; yet, a substantial lack of willingness to immunize given certain acute mild illnesses was reported. Twenty-six percent of providers did not routinely identify children who were behind in immunizations and only 16% had completed a chart audit in the past three years. Seventy-four percent were willing to provide all shots needed at a single visit. Misconceptions regarding true contraindications was found among the group. Missed well child visits were identified as the greatest barrier to complete immunization. Improvements in vaccination rates are expected if physicians utilize all types of medical encounters to monitor the immunization status of patients and provide vaccines using only true medical contraindications.

A preschool immunization project to enhance immunization levels, the public-private relationship, and continuity of care.

This study was conducted to determine whether implementing a program aimed at providing a variety of incentives to physicians who provide immunizations to preschool-aged children would help to improve immunization rates and reduce fragmented care for patients. Twenty physicians from 14 private practices that provide care to preschool-aged children from low income families in suburban Cook County, Illinois participated in the project. A randomly selected subset of patient case records from the physicians' offices were audited after the implementation of the project to determine the immunization status of children in the practices and the nature of services provided. These 310 records of children under three years of age who were treated between 1991-1994 (the intervention sample) were compared to 310 charts from a 1988-1990 cohort of records (baseline sample). The groups did not differ on race or gender; however, significantly more families in the 1988 through 1990 cohort of children under 3 years of age were insured privately when compared to the 1991 through 1994 cohort. Seventy percent (218) of the records in the intervention sample were up to date for age on immunizations compared to 45% (141) of the baseline records, reflecting a statistically significant difference (p < .00001). The intervention sample showed significantly more well child visits where immunizations were given and follow up visits where immunizations were given when compared to the baseline sample. Physicians completed surveys before and after implementation of the project. They were questioned about their knowledge and practices regarding immunizations as well as their opinion of specific project components. All of the physicians viewed the project as an effective means to improve immunization services to low income children. The project demonstrates a potential means of enhancing immunization levels and continuity of care among preschool-aged children. It also highlights the workable nature of the partnership between public and private sectors.

Accessibility of cigarettes to minors in suburban Cook County, Illinois.

This study assessed the problem of under age sale of cigarettes, educated vendors about the law restricting the sale of tobacco to minors, and determined the effectiveness of a vendor education intervention. Twenty-one teen volunteers, 14 to 17 years in age, attempted to purchase cigarettes in suburban Cook County from over-the-counter merchants and vending machines. Of the 347 vendors that were checked, the minors were successful in 37.2% of their attempts to purchase cigarettes. After information was sent to each vendor about the State of Illinois law, follow up visits were made to all the vendors who were willing to sell cigarettes to the minors during the first visits. Approximately 50% of the vendors were again willing to sell cigarettes to minors. This study's findings suggest that minors can easily purchase cigarettes in suburban Cook County. The education intervention component of the study had a limited but promising effect on compliance rates of the vendors.

Characteristics of Typhoid Fever in Children and Adolescents in a Major Metropolitan Area in the United States

To examine the epidemiology of typhoid fever in children in an area that was not endemic, we analyzed 55 cases of typhoid fever in children and adolescents who were < or = 18 years and whose cases were reported to the Chicago and suburban Cook County Health Departments over 7 years. Cases had positive blood and/or stool cultures for Salmonella typhi. The ethnic distribution of the patients was as follows: 25% Asian, 22% Hispanic, 15% African American, 9% Caucasian, 18% other, and 11% unknown. Of the 55 cases, 35% were aged 0-5 years, 25% were aged 6-10 years, 31% were aged 11-15 years, and 9% were aged 16-18 years. Twelve patients did not have a history of travel. All patients recovered; none became carriers. Symptoms in 41 patients whose charts were available for review included fever (100%), diarrhea (77%), vomiting (50%), and dehydration (30%). Bacteremia was documented in 27 (66%) of 41 cases. In 17 of 41 cases, the household contacts were food handlers or health care workers. Eight (31%) of 26 isolates were resistant to both ampicillin and trimethoprim-sulfamethoxazole. The findings in our study were as follows: typhoid fever occurred frequently in children aged 0-5 years (in contrast with reports from areas of endemicity), approximately 20% of patients did not have a history of travel, and multidrug-resistant strains were prevalent.

Potential Defoliation of Trees by Outbreak Populations of Gypsy Moth in the Chicago Area

The gypsy moth, Lymantria dispar, will soon become established in much of the Midwest. If an outbreak with extremely high population levels of this serious defoliator is allowed to occur in the Chicago area, what kind of damage can be expected? A model for defoliation, refoliation and mortality was developed based on the number of trees and associated leaf biomass for each tree species classified according to its attractiveness to or probability of infestation by gypsy moth. Data for eight land uses in the Chicago metropolitan area were used in the model. Vacant lands, institutional lands dominated by vegetation (e.g., parks, cemeteries, golf courses), and residential areas have the highest tree densities and other characteristics that make them valuable as well as vulnerable to gypsy moth infestation. The highest percentage of most-preferred tree species and highest percent defoliation is predicted to occur on vacant lands, followed by institutional lands dominated by vegetation, and residential areas. The potential defoliation by gypsy moth in the Chicago area is relatively modest, ranging from 14% in Chicago and suburban Cook County to 26% in DuPage County. Localized defoliation can be higher, however, particularly on institutional lands dominated by vegetation and vacant lands, where defoliation estimates range between 23 and 40%. Less than one-tenth of one percent of the total number of trees in the entire Chicago area are predicted to die because of gypsy moth defoliation during an outbreak.

Hospital variables associated with quality of care for breast cancer patients

<h3>Objective.</h3> —To determine the degree of compliance with clinical standards among hospitals for care of breast cancer patients and account for variations in compliance. <h3>Design.</h3> —Analysis of cancer registry data submitted to the American Cancer Society, Illinois Division, Chicago, for a concurrent prospective descriptive study of breast cancer, supplemented by other hospital data from public sources. <h3>Setting.</h3> —Ninety-nine Illinois hospitals evenly distributed among rural counties, counties with small cities outside the Chicago metropolitan area, exurban counties in the Chicago metropolitan area, suburban Cook County, and urban Chicago. <h3>Patients.</h3> —A total of 5766 newly diagnosed patients with histologically confirmed breast cancer in 1988, representing 84% of the estimated 6900 new cases in the state for that year. <h3>Main Outcome Measures.</h3> —Descriptive statistics and multiple linear regression analyses of five dependent quality variables from clinical indicators related to early diagnosis, hormone receptor determination, adjuvant therapy, radiation therapy, and axillary lymph node dissection. <h3>Results.</h3> —At the hospitals studied, (1) late stage (IIb through IV) at diagnosis was associated with urban location, higher proportion of poorly insured patients, fewer breast cancer cases treated, and lower oncology charges (proportion of variance explained,<i>R</i>²=.50,<i>P</i>&lt;.00001); (2) omission of hormone receptor test for stages II through IV was associated with urban location and higher proportion of poorly insured patients (<i>R</i>²=.18,<i>P</i>&lt;.00003); and (3) omission of indicated radiation therapy was associated with urban location and fewer breast cancer cases (<i>R</i>²=.21,<i>P</i>&lt;.00001). Omission of adjuvant therapy and omission of axillary lymph node dissection were not significantly associated with any of the hospital variables examined. Conclusions. —The findings suggest that there is a group of urban hospitals, generally small and marginally reimbursed, where comprehensive diagnosis and treatment of breast cancer are not obtained. (<i>JAMA</i>. 1991;266:3429-3432)

A Model for Primary Care Delivery to a Widely Dispersed Medically Indigent Population

Access to Care is a unique program uniting private and public resources to provide primary care to the uninsured poor. The model was designed to serve a medically indigent population that is dispersed over a large geographic area, where clinics are not a practical option. Care for illness is provided in the offices of private physicians throughout the area and supported by laboratory, radiology, and pharmacy services. The program is designed for the estimated 88,000 persons in suburban Cook County, Illinois, with family incomes of less than twice the federal poverty level, who are uninsured and ineligible for Medicaid and Medicare. Supported by grants from foundations and local governments, the program, which has been in operation for 2 years in two demonstration areas, is administered by a private not-for-profit confederation of four health and social service organizations.

Nutrition program for the elderly: participants' perception of food quality by type of food service system.

A survey of 1028 clients who participated in 21 nutrition sites for the elderly funded by the Suburban Cook County Area Agency on Aging in Chicago, Illinois revealed that participants who received meals prepared on-site were more satisfied with the quality of the meals than participants who received meals that were satellited as hot bulk food or as preplated cook/freeze meals. Participants who judged the meals as fair or poor were more likely than those who rated the food as excellent or good to respond that they would increase their donation if the food were improved. Data from a national survey used as a standard for judging participant satisfaction of food service are presented in this article.

The Incidence of Collective Bargaining Amongst Public School Teachers in Suburban Cook County, Illinois

The Incidence of Collective Bargaining Amongst Public School Teachers in Suburban Cook County, Illinois

PHOTOCHROMOGENIC MYCOBACTERIAL PULMONARY DISEASE.

During the past several years there has been an increasing interest in the diseases caused by mycobacteria other than M. tuberculosis (I). Though by no means new (2, 3), the infections caused by these organisms have captured the attention of a growing number of bacteriologists and clinicians. This paper is a report on the analysis and results of treatment of 152 cases of pulmonary disease caused by photochromogenic mycobacteria. According to Runyon's classification, these are Group I ( M. kansasii) ( 1). (The other three groups in his classification are not discussed in this paper.) For reasons not yet clear, the incidence of pulmonary disease due to M. kansasii appears to be much higher in the area served by the suburban Cook County Tuberculosis HospitalSanitarium than that in most other areas of the United Satates. Up to the present time, approximately 7 per cent of the patients admitted to this hospital have had pulmonary disease due to this organism.

TUBERCULIN TESTING—THE NECESSARY STEP IN ERADICATION*

Journal of School HealthVolume 30, Issue 2 p. 68-70 TUBERCULIN TESTING—THE NECESSARY STEP IN ERADICATION* Edward Piszcek M.D., Edward Piszcek M.D. Executive Director, Suburban Cook County Tuberculosis Sanatorium District, IllinoisSearch for more papers by this author Edward Piszcek M.D., Edward Piszcek M.D. Executive Director, Suburban Cook County Tuberculosis Sanatorium District, IllinoisSearch for more papers by this author First published: February 1960 https://doi.org/10.1111/j.1746-1561.1960.tb06951.x * Presented at the annual meeting of the National Tuberculosis Association, May 24. 1959, and sponsored by the Committee on Tuberculosis of the A.S.H.A., Dr. J. Arthur Myers, Chairman. Delivered at the American School Health Association session of the National Tuberculosis Association meeting, Chicago, May 24, 1959. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume30, Issue2February 1960Pages 68-70 RelatedInformation