Urban Health District Research Articles

Violencia doméstica: prevalencia de sospecha de maltrato a ancianos

To determine the prevalence of suspected ill treatment of the elderly (ITE) in the population cared for in a health district and to analyse the associated variables. Cross-sectional study.Setting. Les Planes (Sant Joan Despí, Barcelona). Urban Health District. 307 patients over 70 years old seen in the Health District. The study had 39 losses, 31 exclusions because of cognitive disorder and 18 because it was impossible to hold the interview. 219 completed the study. The Pfeiffer test was administered through an interview, social and demographic variables were collected, a questionnaire on ill treatment was filled in (a positive reply was considered ITE), and physical dependence was evaluated (Katz index). Prevalence of ITE was 26 people or 11.9% (95% CI, 7.6-16.2), breaking down into 6 physically ill-treated, 20 psychologically, one sexually, 3 by negligence and 3 by neglect. Nine people suffered more than one kind of ill treatment. Significant associated variables were: being a woman 18% (p < 0.01), receiving social assistance 46% (p < 0.001), being a widow/widower 21% (p < 0.01), not having had paid employment 20% (p < 0.04) and having a rotating residence 28% (p < 0.003). On application of multivariate analysis, being a woman (OR 4.99) and receiving social assistance (OR 7.55) maintained their significance. The presumed perpetrators were son/daughter (57%), spouse (8%), son/daughter-in-law (23%). 19% of these were drug-dependent and 15% suffered psychiatric disorders. The high prevalence of ITE is clear. These results should alert doctors to a previously under-rated health problem.

Riesgo cardiovascular asociado a las nuevas categorías diagnósticas de la diabetes mellitus propuestas por la Asociación Americana de Diabetes

To study the cardiovascular risk (CVR) associated with the diagnostic criteria for diabetes proposed by the American Diabetes Association. Cross-sectional, descriptive study. Urban health district. 1840 patients > 14 years old, selected by simple randomised sampling from the clinical records (CR) archive, were studied. Through review of the CR, the patients were classified as having: normal glycaemia, disturbed basal glycaemia (DBG) and type-2 diabetes mellitus (DM2). CVR was studied through the simplified Framingham method and the CVR factors of obesity, tobacco dependency, hypertension, hypercholesterolaemia and hypertriglyceridaemia. The likelihood of having high or very high CVR and the CVR factors described in the patients with DBG or DM2 were compared with the same in those with normal glycaemia, through logistical regression with the odds ratio adjusted for age and sex. 1351 patients were classified: 995 with normal glycaemia, 146 with DBG and 210 with DM2. Patients with DBG or DM2 had greater likelihood of high or very high CVR, with some OR at 2.26 (95% CI, 1.39-3.69) and 2.74 (95% CI, 1.81-4.15), respectively. They also had differences (p < 0.05) for obesity (OR, 1.76 and 1.58), hypertension (OR, 1.75 and 2.15) and hypertriglyceridaemia (OR, 1.73 and 2.70), respectively. There were no differences (p > 0.05) for tobacco dependency and hypercholesterolaemia. No differences were found (p > 0.05) between DBG and DM2 for CVR and the CVR factors studied. Patients with DBG and DM2 are at high CVR.

Routine follow up after head injury: a second randomised controlled trial

OBJECTIVETo confirm that patients admitted to hospital with a head injury benefit from a routinely offered early intervention service.PATIENTS AND METHODSA mixed rural and urban Health District of 560 000...

Assault, post-traumatic amnesia and other variables related to outcome following head injury.

To estimate how many patients who sustain a head injury might benefit from intervention and support each year and to consider whether relationships can be found between demographic data relating to patients' circumstances at the time of head injury, and their outcomes six months later. Data collected on 625 patients through follow-up interviews and assessments by the Oxford Head Injury Service for a randomized controlled trial of intervention conducted in 1993-94. A mixed rural and urban Health District with a population of approximately 560,000. Patients were aged between 16 and 65 years and resident in Oxfordshire. They presented over 13 months to accident and emergency departments, or were admitted to hospital. All were diagnosed as having suffered a head injury. The Rivermead Head Injury Follow Up Questionnaire and the Rivermead Post Concussion Symptoms Questionnaire. Data are given on age, sex, social circumstances, employment, cause of injury, severity of associated injuries, post-traumatic amnesia (PTA), anticonvulsants, postconcussion symptoms and activities of everyday life. Outcome at six months was significantly worse for those who had been assaulted as against all other causes of injury combined (p = 0.0001); and/or had been admitted to hospital (p = 0.0001)l and/or had sustained more severe additional injuries (p = 0.04); and/or had experienced any PTA (p = 0.00001). The minimum incidence of such injuries in those aged 16-65, calculated for Oxfordshire, is 292 per annum (74/100,000 aged 16-65 per year). In the general population 52/100,000 patients per annum will experience more serious head injuries as indicated by hospital admission and/or one or more fractures and/or any length of PTA and/or having been assaulted. This group may benefit from monitoring and support and their needs should be considered when planning services.

Does routine follow up after head injury help? A randomised controlled trial.

OBJECTIVE: To evaluate the Medical Disability Society's 1988 recommendation that "every patient attending hospital after a head injury should be registered and offered an outpatient follow up appointment" by determining...

AKC Nevada: Developing a Platform for Public Health Communications

Introduction The Nevada All Kids Count immunization tracking system has as its primary goal the development of a statewide on-line immunization registry. In pursuing this goal, a major accomplishment has been the creation of a public health network that electronically links the Nevada State Health Division with other public health agencies. Design The design of this immunization registry calls for a phased implementation of the project; rural public health clinics were brought into the system; next, Nevada’s two urban health districts in Reno and Las Vegas were connected via a wide-area network (WAN). This topology now makes it possible to share public health information throughout Nevada. Results Throughout immunization registry implementation, a variety of opportunities for connecting public health entities has arisen. Bureaus within the Nevada State Health Division have been integrated into a local area network (LAN). The WAN implemented in Reno connected the Health Division to a large number of public health agencies in Washoe County through the county’s information system that was already in place. Conclusions A project such as All Kids Count Nevada can provide significant benefits to the public health community as a whole, which will help ensure its own long-term success.

Mother and teacher ratings of maladaptive behaviour in children with special needs

ABSTRACT Parents and teachers of 109 children selected from the Special Needs Register and living in a multiethnic urban health district participated in the study. Their perceptions of children's behaviour at home and at school were measured by the Aberrant Behavior Checklist(ABC). About two‐thirds of the subjects presented with at least one type of maladaptive behaviour of at least moderate severity within their family, and 50 per cent had similar difficulties at school. The dimensions of hyperactivity and irritability were the main causes for concern by both sources. Contrary to previous studies, high rates of parent‐teacher agreement were found. This significant association was not affected by factors such as age, ethnicity or type of school. The implications for the provision of services for children in special education are discussed.

ADAPTIVE FUNCTIONING AND BEHAVIOUR OF CHILDREN WITH SPECIAL NEEDS: COMPARISON BETWEEN ETHNIC GROUPS

AbstractThis study investigated the relationship between behaviour and adaptive functioning in 70 children of 5–16 years of age with special needs from three ethnic groups who lived in an urban health district. Parents were interviewed and completed the Vineland Adaptive Behaviour Scale (VABS) and the Aberrant Behaviour Checklist (ABC). The most pronounced developmental deficits were found in communication and daily living skills. Two‐thirds of the subjects were rated as having a moderately severe behaviour problem on at least one item of the ABC. Asian children presented slightly more difficulties in communication, and Afro‐Caribbean children did better than the other children on all domains (though this was not statistically significant). In addition, European children were rated significantly higher than the other two groups in the behavioural scales of hyperactivity and inappropriate speech. Within the whole sample, domains of adaptive functioning, particularly socialisation, were negatively correlated with behavioural problems. Inappropriate speech, as rated by the ABC, was associated with developmental delay on all three VABS domains.

Prevalence of lower limb ulceration in an urban health district: Lees TA, Lambert D. Br J Surg 1992;79:1032-4

Prevalence of lower limb ulceration in an urban health district: Lees TA, Lambert D. Br J Surg 1992;79:1032-4

The effect of a community hypertension control program.

A hypertension detection and control program sponsored by the Pan-American Health Organization and the World Health Organization (PAHO/WHO) was carried out in an urban health district of Havana City, Cuba. A baseline (initial) survey was conducted on a random sample of the population (greater than or equal to 15 years of age) to assess the problem of hypertension in that community. Subsequently, we extended the program in the same area by taking the blood pressure of as many people as we could, and a health education program on hypertension was developed and implemented. All hypertensive persons were treated. We surveyed about 90% of the adult population (29,640) over a 5-year period. We then conducted a final survey on a second random sample of the population to assess the effect of the program. The response rate to the letter of invitation to visit the hypertension clinic was 50%; 30% of the recall appointments were missed, and the dropout rate was 18.6%. Seventy percent of the hypertensive persons had Stage I disease (PAHO/WHO) with normal electrocardiograms. Before the program, 15.7% of the total number of hypertensive persons surveyed in the area had the disease under good control, and this increased to 31% after the program. Mortality due to cerebrovascular disease was reduced from 11/10,000/yr to 7/10,000/yr, whereas mortality caused by myocardial infarction did not change.

Approaches to the control of AIDS within the community

Infection with the Human Immunodeficiency Virus (HIV) is a public health threat whose significance in the UK has only been generally appreciated over the last 12–18 months. The size of the problem (both current and potential) is difficult to assess, but epidemiological data would suggest that for an urban health district (outside London) one or two residents would have developed Acquired Immune Deficiency Syndrome (AIDS) in 1986, four will do so in 1987 and six in 1988. The incidence of HIV infections during the same period might be as high as 200, 400 and 600 respectively. This may seem a small number in comparison with overall morbidity and mortality; but between September 1990 and June 1991 the same health district might expect 48 AIDS cases to present if the epidemiological patterns remain constant (ie a doubling time for cases of 10 months).

Prevention of neural tube defects in an urban health district.

An evaluation of voluntary prenatal screening for neural tube defects with serum alphafetoprotein (s-AFP) is presented. During a three year period, there were 52 fetuses with neural lesions. Of 46 mothers who bore a fetus with an open neural lesion, 25 were detected, of whom 23 agreed to the termination of their pregnancies. An unscreened group of 2331 mothers (17% of all deliveries) produced 14 fetuses with neural tube defects, an incidence of 6.0 per 1000, 1.8 times the incidence (3.3 per 1000) in the screened group. Pitfalls occurring in the assessment of hyper-alphafetoproteinemia included inaccurate gestational dating and allowance for excessive body weight. The results of a robust AFP-NTD screening programme supported in selected cases by ultrasonar visualisation of the spine argue for its continuance in this district.

THE EPIDEMIOLOGY OF PSYCHIATRIC EMERGENCIES IN AN URBAN HEALTH DISTRICT.

THlls paper reports an exercise in community diagnosis. Epidemiological data are frequently demanded by those engaged in planning community health services, and they are entitled to the best available information regarding the incidence and prevalence of conditions requiring service. In the mental health specialties, such planning has depended very heavily on mental hospital admission rates; to these data have recently been added information about clinic utilization patterns. When these data are combined with prevalence surveys, such as that recently reported by Srole and Langner2 in the midtown area of New York, a rather confusing picture emerges. Admission rates which are, in all conscience, high enough, are contrasted with enormously higher prevalence rates of significant psychiatric disorder. A cooperative venture by the School of Public Health and the Department of Psychiatry at Columbia University has led to a number of studies which seek to provide more information of practical value to those who are organizing services in our immediate health district. Each year some 700 residents of this district are admitted to all state, private and voluntary psychiatric hospitals within New York State. Of these, approximately 300 are admitted directly to these institutions, while the other 400 go via the psychiatric unit of the municipal general hospital which serves the district, as well as a much larger part of the city. This hospital is not located within the district. However, an additional 500 patients per year from the district pass through the municipal general hospital psychiatric unit without being referred to State Hospitals. This group of patients does not appear in statistics available from any administrative source at this time. Even when we have hospital statistics, they tend to give us information only about age, sex, color, and diagnosis. But as in other fields of medicine, diagnosis leaves the thoughtful student of community health problems uncertain as to the level of severity and the nature of the service problems that the particular patients present. Thus, from one point of view, knowing the number of diabetics in a population is the most important measure of the prevalence of diabetes. However, for community diagnosis, and to provide information for community health services, the number of cases of diabetic coma is at least as important. We wondered whether it was possible

Observations on Current Practices in Municipal District Health Administration

IN the development of urban health departments, the principle of decentralization-neighborhood health centers-has been casually accepted. In routine fashion, local planning has provided for health officers of urban health districts, tables of organization, and carefully vague limitations on autonomy. Most of the larger cities have now, on paper or in fact, divided the city into health districts, adopted an organizational plan for staffing these districts, and to a greater or lesser degree provided structures for district operations. Philosophically, the stimulus for such programs, and the easy, unquestioning acceptance of the principle, probably stem from American tradition. We remember nostalgically the town meeting and the benefits that accrue from public administration close to the source of responsibility and sensitive to local needs. The great bugbear of political and economic life is centralization, the curse of bigness, monopoly, and impersonal administration. In addition, it is felt that the job to be done, specifically health education in its many manifestations, depends on a homogeneous group. In 1915, in an address