Pediatric practice based evaluation of the Steps to Prevent Firearm Injury program.
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OBJECTIVE: To estimate the prevalence of gun ownership and methods of gun storage in homes of pediatric patients before and after an educational intervention. DESIGN: Before and after trial. SETTING: Hospital based, inner city, pediatric primary care practice. PARTICIPANTS: Consecutive sample of parents of patients with appointments August to November 1994. INTERVENTION: Before the intervention, participants completed an anonymous questionnaire regarding ownership and storage of guns in their home. The intervention followed the Steps to Prevent Firearm Injury program of the American Academy of Pediatrics. It began after the parent completed the questionnaire and was reinforced at subsequent visits until July 1995. Families completing a baseline questionnaire and returning to the office July to October 1995 were resurveyed. MAIN OUTCOME MEASURE: Reported change in gun ownership and methods of storage. RESULTS: A gun(s) in the home was reported by 8.7% of respondents. Matched baseline and follow up questionnaires were available for 23.6% of families. In these, gun ownership reportedly decreased after intervention from 9.4% to 7.0%, handgun ownership fell from 5.4% to 3.0%, and long gun ownership fell from 6.1% to 5.5%. Storing guns outside of a locked container did not change from the baseline prevalence of 2.7%, but keeping any gun loaded fell from 1.6% to 0.5%. All p values were >0.05. CONCLUSION: This study was unable to demonstrate a statistically significant decline in gun ownership or improvement in gun storage after a practice based intervention designed to encourage these behaviors. (+info)
Evaluating the impact of a street barrier on urban crime.
(42/7134)
OBJECTIVES: Violence is a major urban public health problem in the United States. The impact of a physical barrier placed across a street in a public housing project to prevent street violence and drug activity was evaluated. METHODS: Hartford Police Department data on violent and drug related crime incidence within the housing project containing the barrier were analyzed by use of a computerized geographic information system. RESULTS: Violent crime decreased 33% on the intervention street during the 15 month period after erection of the barrier, compared with the 15 month period before erection of the barrier, but there was no change in drug related crime. On adjoining streets and surrounding blocks, violent crime decreased 30%-50% but drug related crimes roughly doubled. A non-adjacent area of the housing project and the entire city experienced 26% and 15% decreases in violent crimes, and 414% and 25% increases in drug crimes, respectively. CONCLUSIONS: The barrier decreased violent crime but displaced drug crimes to surrounding areas of the housing project. These results have important implications for other cities that have erected or are considering erecting similar barriers. (+info)
Use of PCR in diagnosis of human american tegumentary leishmaniasis in Rio de Janeiro, Brazil.
(43/7134)
In Brazil, the most common etiological agent of American tegumentary leishmaniasis is Leishmania (Viannia) braziliensis. In general, diagnostic techniques envisage the visualization of the parasite, but that technique has a low sensitivity. The main purpose of the present work was to evaluate the PCR as a routine tool for the diagnosis of leishmaniasis. Biopsy specimens from cutaneous or mucosal lesions were taken from 230 individuals from areas where Leishmania is endemic: 216 patients who had a clinical picture suggestive of leishmaniasis and 14 individuals with cutaneous lesions due to other causes. Each specimen was processed for histopathologic examination, culture, touch preparation, and DNA isolation. Oligonucleotides that amplify the conserved region of the minicircle molecules of Leishmania were used in a hot-start PCR. While at least one conventional technique was positive for Leishmania for 62% (134 of 216) of the patients, PCR coupled to hybridization was positive for 94% (203 of 216) of the patients. The 14 patients whose clinical picture was not suggestive of leishmaniasis had negative results by all techniques. The impact of the PCR was striking in mucosal disease. While the disease in only 17% (4 of 24) of the patients could be diagnosed by conventional techniques, PCR was positive for 71% (17 of 24) of the patients. Hybridization showed that all cases of disease were caused by parasites belonging to the Viannia subgenus. Altogether, the results indicate that PCR is a valuable tool for the diagnosis of leishmaniasis on a routine basis and is likely to provide valuable epidemiological information about the disease in countries where it is endemic. (+info)
A two-decades (1975 to 1995) long experience in the incidence, in-hospital and long-term case-fatality rates of acute myocardial infarction: a community-wide perspective.
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OBJECTIVES: The purpose of the present study is to describe changes over two decades (1975 to 1995) in the incidence, in-hospital and long-term case-fatality rates associated with acute myocardial infarction (AMI) from a multihospital community-wide perspective. BACKGROUND: Despite the magnitude of, and mortality associated with acute myocardial infarction (AMI), relatively limited population-based data are available to describe recent and temporal trends in the attack and case-fatality rates associated with AMI from a representative population-based perspective. METHODS: The community-based study included 5,270 residents of the Worcester, Massachusetts, metropolitan area hospitalized with confirmed initial AMI in all metropolitan Worcester, Massachusetts, hospitals (1990 census population = 437,000) in 10 one-year periods between 1975 and 1995. RESULTS: The age-adjusted incidence rates of initial AMI increased between 1975 (244 per 100,000) and 1981 (272 per 100,000), after which time these rates declined through 1995 (184 per 100,000). The crude and multivariable-adjusted in-hospital case-fatality rates exhibited a consistent decline between 1975/1978 (17.8%), 1986/1988 (17.0%) and 1993/1995 (11.7%). Although there were no statistically significant differences in the unadjusted long-term case-fatality rates of discharged hospital survivors over the periods under study, declines in the multivariable-adjusted risk of dying within the first year after hospital discharge were observed between the earliest and most recently discharged patients with AMI. CONCLUSIONS: The results of this population-based study of patients with validated initial AMI provide encouragement for efforts directed at the primary and secondary prevention of AMI given declining incidence and case-fatality rates. (+info)
Getting a high response rate of sexual behavior survey among the general population in Japan: three different methods of survey on sexual behavior.
(45/7134)
The purpose of this study was to specify the most accurate, reliable and valid technique for a general sexual behavioral survey in Japan. This pilot study was conducted to assure a high response rate and to keep respondents' privacy confidential by using an anonymous questionnaire survey technique. The sample (360 potential respondents) was selected randomly from basic resident registers in two geographically different areas. From the registries, 90 residents, aged 20 to 49 years old, were randomly selected to represent each sex from each area. The subjects were randomly assigned to three groups each having a different procedure of requesting the completion of the survey and providing the questionnaires: (1) Postal Group, (2) Telephone Group, and (3) Face-to-face Group. The survey was carried out from October 1995 to February 1996. Effective response rates for the above mentioned three groups were 69.2%, 69.2% and 55.8%, respectively. It is difficult to determine the best method when only considering the effective response rates. However, judging from our effort and expense, the mail survey is the best possible procedure and would be a reasonable method for a national sexual behavior survey. (+info)
Organochlorines in breast milk from two cities in Ukraine.
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Reports of environmental problems in the former Soviet Union, including excess use of pesticides, have led to concerns about high levels of contamination in humans, but little information is available to assess whether these concerns are warranted. Samples of breast milk from 197 women from two cities in Ukraine were analyzed for p,p'-DDT, p,p'-DDE, endrin, dieldrin, heptachlor epoxide, trans-nonachlor, oxychlordane, hexachlorobenzene, ss-hexachlorocyclohexane (HCH), and 18 polychlorinated biphenyl congeners, and results were compared to previous reports from Europe. The median ss-HCH concentration was 731 ng/g milk fat, which is higher than other reports from Europe but lower than reports from other parts of the world. The median DDE concentration was 2,457 ng/g milk fat, which is higher than most but not all other reports from Europe. Concentrations of other chemicals were comparable to or lower than other reports from Europe. Concentrations from the city of Kyiv were generally lower than those from Dniprodzerzhinsk, but the magnitudes of these differences were modest. (+info)
8-hydroxy-2'-deoxyguanosine, a major mutagenic oxidative DNA lesion, and DNA strand breaks in nasal respiratory epithelium of children exposed to urban pollution.
(47/7134)
Southwest metropolitan Mexico City children are repeatedly exposed to high levels of a complex mixture of air pollutants, including ozone, particulate matter, aldehydes, metals, and nitrogen oxides. We explored nasal cell 8-hydroxy-2'-deoxyguanosine (8-OHdG), a major mutagenic lesion producing G-->T transversion mutations, using an immunohistochemical method, and DNA single strand breaks (ssb) using the single cell gel electrophoresis assay as biomarkers of oxidant exposure. Nasal biopsies from the posterior inferior turbinate were examined in children in grades one through five, including 12 controls from a low-polluted coastal town and 87 Mexico City children. Each biopsy was divided for the 8-OHdG and DNA ssb assays. There was an age-dependent increase in the percentage of nasal cells with DNA tails > 10 microm in Mexico City children: 19 +/- 9% for control cells, and 43 +/- 4, 50 +/- 16, 56 +/- 17, 60 +/- 17 and 73 +/- 14%, respectively, for first through fifth graders (p < 0.05). Nasal ssb were significantly higher in fifth graders than in first graders (p < 0.05). Higher levels (2.3- to 3-fold) of specific nuclear staining for 8-OHdG were observed in exposed children as compared to controls (p < 0.05). These results suggest that DNA damage is present in nasal epithelial cells in Mexico City children. Persistent oxidative DNA damage may ultimately result in a selective growth of pr eneoplastic nasal initiated cells in this population and the potential for nasal neoplasms may increase with age. The combination of 8-OHdG and DNA ssb should be useful for monitoring oxidative damage in people exposed to polluted atmospheres. (+info)
An association between fine particles and asthma emergency department visits for children in Seattle.
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Asthma is the most common chronic illness of childhood and its prevalence is increasing, causing much concern for identification of risk factors such as air pollution. We previously conducted a study showing a relationship between asthma visits in all persons < 65 years of age to emergency departments (EDs) and air pollution in Seattle, Washington. In that study the most frequent zip codes of the visits were in the inner city. The Seattle-King County Department of Public Health (Seattle, WA) subsequently published a report which showed that the hospitalization rate for children in the inner city was over 600/100,000, whereas it was < 100/100,000 for children living in the suburbs. Therefore, we conducted the present study to evaluate whether asthma visits to hospital emergency departments in the inner city of Seattle were associated with outdoor air pollution levels. ED visits to six hospitals for asthma and daily air pollution data were obtained for 15 months during 1995 and 1996. The association between air pollution and childhood ED visits for asthma from the inner city area with high asthma hospitalization rates were compared with those from lower hospital utilization areas. Daily ED counts were regressed against fine particulate matter (PM), carbon monoxide (CO), sulfur dioxide, and nitrogen dioxide using a semiparametric Poisson regression model. Significant associations were found between ED visits for asthma in children and fine PM and CO. A change of 11 microg/m3 in fine PM was associated with a relative rate of 1.15 [95% confidence interval (CI), 1.08-1.23]. There was no stronger association between ED visits for asthma and air pollution in the higher hospital utilization area than in the lower utilization area. These findings were seen when estimated PM2.5 concentrations were below the newly adopted annual National Ambient Air Quality Standard of 15 microg/m3. (+info)