Variations in infant mortality rates among municipalities in the state of Ceara, Northeast Brazil: an ecological analysis. (1/948)

BACKGROUND: Infant mortality rates vary substantially among municipalities in the State of Ceara, from 14 to 193 per 1000 live births. Identification of the determinants of these differences can be of particular importance to infant health policy and programmes in Brazil where local governments play a pivotal role in providing primary health care. METHODS: Ecological study across 140 municipalities in the State of Ceara, Brazil. RESULTS: To determine the interrelationships between potential predictors of infant mortality, we classified 11 variables into proximate determinants (adequate weight gain and exclusively breastfeeding), health services variables (prenatal care up-to-date, participation in growth monitoring, immunization up-to-date, and decentralization of health services), and socioeconomic factors (female literacy rate, household income, adequate water supply, adequate sanitation, and per capita gross municipality product), and included the variables in each group simultaneously in linear regression models. In these analyses, only one of the proximate determinants (exclusively breastfeeding (inversely), R2 = 9.3) and one of the health services variables (prenatal care up-to-date (inversely), R2 = 22.8) remained significantly associated with infant mortality. In contrast, female literacy rate (inversely), household income (directly) and per capita GMP (inversely) were independently associated with the infant mortality rate (for the model including the three variables R2 = 25.2). Finally, we considered simultaneously the variables from each group, and selected a model that explained 41% of the variation in infant mortality rates between municipalities. The paradoxical direct association between household income and infant mortality was present only in models including female illiteracy rate, and suggests that among these municipalities, increases in income unaccompanied by improvements in female education may not substantially reduce infant mortality. The lack of independent associations between inadequate sanitation and infant mortality rates may be due to the uniformly poor level of this indicator across municipalities and provides no evidence against its critical role in child survival. CONCLUSIONS: These results suggest that promotion of exclusive breastfeeding and increased prenatal care utilization, as well as investments in female education would have substantial positive effects in further reducing infant mortality rates in the State of Ceara.  (+info)

Geographical patterns of excess mortality in Spain explained by two indices of deprivation. (2/948)

STUDY OBJECTIVE: To analyse the geographical patterns and the magnitude of the association between deprivation and mortality in Spain. To estimate the excess of mortality in more deprived areas of the country by region. DESIGN: Cross sectional ecological study using 1991 census variables and mortality data for 1987-1992. SETTING: 2220 small areas in Spain. MAIN RESULTS: A geographical gradient from north east to south west was shown by both mortality and deprivation levels in Spain. Two dimensions of deprivation (that is, Index 1 and Index 2) obtained by exploratory factor analysis using four census indicators were found to predict mortality: mortality over 65 years of age was more associated with Index 1, while mortality under 65 years of age was more associated with Index 2. Excess mortality in the most deprived areas accounted for about 35,000 deaths. CONCLUSIONS: Two indices of deprivation strongly predict mortality in two age groups. Excess number of deaths in the most deprived geographical areas account for 10% of total number of deaths annually. In Spain there is great potential for reducing mortality if the excess risk in more deprived areas fell to the level of the most affluent areas.  (+info)

Isolation, cultivation, and characterization of Borrelia burgdorferi from rodents and ticks in the Charleston area of South Carolina. (3/948)

Twenty-eight Borrelia burgdorferi isolates from the Charleston, S.C., area are described. This represents the first report and characterization of the Lyme disease spirochete from that state. The isolates were obtained from December 1994 through December 1995 from the tick Ixodes scapularis, collected from vegetation, and from the rodents Peromyscus gossypinus (cotton mouse), Neotoma floridana (eastern wood rat), and Sigmodon hispidus (cotton rat). All isolates were screened immunologically by indirect immunofluorescence with monoclonal antibodies to B. burgdorferi-specific outer surface protein A (OspA) (antibodies H5332 and H3TS) and B. burgdorferi-specific OspB (antibodies H6831 and H614), a Borrelia (genus)-specific antiflagellin antibody (H9724), Borrelia hermsii-specific antibodies (H9826 and H4825), and two polyclonal antibodies (one to Borrelia species and another to B. burgdorferi). Six of the isolates were analyzed by exposing Western blots to monoclonal antibodies H5332, H3TS, H6831, and H9724. All isolates were also analyzed by PCR with five pairs of primers known to amplify selected DNA target sequences specifically reported to be present in the reference strain, B. burgdorferi B-31. The protein profiles of six of the isolates (two from ticks, one from a cotton mouse, two from wood rats, and one from a cotton rat) also were compared by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. We conclude that the 28 Charleston isolates are B. burgdorferi sensu stricto based on their similarities to the B. burgdorferi B-31 reference strain.  (+info)

Analysis of falling mortality rates in Edinburgh and Glasgow. (4/948)

BACKGROUND: The aims of the study were to describe and interpret trends in mortality in Glasgow and Edinburgh METHODS: A comparison was made between observed all-cause and cause-specific mortality rates for 1989-1993 for men and women aged 35-74 and rates predicted on the basis of modelled mortality data for residents of Glasgow and Edinburgh aged 25-74 in quinquennia based on Census years 1961, 1971 and 1981. RESULTS: All-cause mortality rates fell between 1979-1983 and 1989-1993 by a larger amount in Edinburgh than in Glasgow (24.5 versus 14.5 per cent in men; 20.4 versus 10.5 per cent in women). Differences in life expectancy between the cities at age 35 increased by 44 per cent to 4.7 years in men and by 19 per cent to 2.5 years in women. Mortality rates improved in all age and sex groups but trends were least favourable in Edinburgh men and women aged 35-44. Mortality rates in both cities fell by a larger amount than predicted, by 10 per cent in men and 6 per cent in women. CONCLUSIONS: The widening of differences in life expectancy between Glasgow and Edinburgh is mainly due to a historical trend of longevity increasing more quickly in Edinburgh. Although precise explanations are not possible, it seems likely that this difference between the cities is explained in large measure by their consistently and markedly contrasting socio-economic profiles. Comparison of the cities conceals, however, a trend of falling mortality rates in both populations, comprising most of the observed reduction in mortality rates in Glasgow, which appears to result in part from factors operating in the short term. Interpretation of trends in cause-specific mortality rates needs to take account of the possibility of long-term and short-term trends in all-cause mortality in different social groups.  (+info)

An international comparison of cancer survival: relatively poor areas of Toronto, Ontario and three US metropolitan areas. (5/948)

BACKGROUND: This study of cancer survival compared adults in Toronto, Ontario and three US metropolitan areas: Seattle, Washington; San Francisco, California; and Hartford, Connecticut. It examined whether socioeconomic status has a differential effect on cancer survival in Canada and the United States. METHODS: The Ontario Cancer Registry and the National Cancer Institute's Surveillance, Epidemiology and End RESULTS: (SEER) programme provided a total of 23,437 and 37,329 population-based primary malignant cancer cases for the Toronto and US samples, respectively (1986-1988, followed until 1994). Census-based measures of socioeconomic status were used to ecologically control absolute income status. RESULTS: Among residents of low-income areas, persons in Toronto experienced a 5 year survival advantage for 13 of 15 cancer sites [minimally one gender significant at 95 per cent confidence interval (CI)]. An aggregate 35 per cent survival advantage among the Canadian cohort was demonstrated (survival rate ratio (SRR) = 1.35, 95 per cent CI= 1.30-1.40), and this effect was even larger among younger patients not yet eligible for Medicare coverage in the United States (SRR = 1.46, 95 per cent CI = 1.40-1.52). CONCLUSION: Systematically replicating a previous Toronto-Detroit comparison, this study's observed consistent pattern of Canadian survival advantage across various cancer sites suggests that their more equitable access to preventive and therapeutic health care services may be responsible for the difference.  (+info)

An explanation of the persistent doctor-mortality association. (6/948)

STUDY OBJECTIVE: The aim of the study is to explain the persistent but puzzling positive correlation of physicians per capita and mortality rates, when income is controlled, which has been reported many times since it was first observed in 1978. The explanation that is proposed and tested is that expanding urban-industrial regions attract an oversupply of doctors. Also, but independently, rural people migrate to urban-industrial areas where they suffer from the stress of adapting to urban-industrial life. Consequently, their death rates rise. SOURCE MATERIAL: Using data from the 47 Japanese prefectures, the 3000+ counties of the USA and a set of 29 mostly European countries, the explanation was examined by adding the appropriate test variable to a basic equation linking physicians per capita to mortality, net of income. RESULTS: The test variables dissolved or reduced the original correlation in two of the three samples, but the signs did not change from positive to negative, as would be expected on the basis of conventional biomedical theory. The available test variable (refugees) did not reduce the correlation for the 29 countries but a particular subset of countries was identified that did. CONCLUSION: The conceptual and empirical analysis exposed the positive correlation as spurious, but the availability of medical specialists had little impact on mortality rates in competition with the social and economic variables that were used as controls.  (+info)

Microbial etiology of community-acquired pneumonia in the adult population of 4 municipalities in eastern Finland. (7/948)

To determine the etiology of community-acquired pneumonia in the adult population of a defined area, specific antibody responses in paired serum samples, levels of circulating pneumococcal immune complexes in serum samples, and pneumococcal antigen in urine were measured. Samples (304 paired serum samples and 300 acute urine samples) were obtained from 345 patients > or =15 years old with community-acquired, radiologically confirmed pneumonia, which comprised all cases in the population of 4 municipalities in eastern Finland during 1 year. Specific infecting organisms were identified in 183 patients (including 49 with mixed infection), as follows: Streptococcus pneumoniae, 125 patients; Haemophilus influenzae, 12; Moraxella catarrhalis, 8; chlamydiae, 37 (of which, Chlamydia pneumoniae, 30); Mycoplasma pneumoniae, 30; and virus species, 27. The proportion of patients with pneumococcal infections increased and of those with Mycoplasma infections decreased with age, but for each age group, the etiologic profile was similar among inpatients and among outpatients. S. pneumoniae was the most important etiologic agent. The annual incidence of pneumococcal pneumonia per 1000 inhabitants aged > or =60 years was 8.0.  (+info)

Fine particulate matter and polycyclic aromatic hydrocarbon concentration patterns in Roxbury, Massachusetts: a community-based GIS analysis. (8/948)

Given an elevated prevalence of respiratory disease and density of pollution sources, residents of Roxbury, Massachusetts, have been interested in better understanding their exposures to air pollution. To determine whether local transportation sources contribute significantly to exposures, we conducted a community-based pilot investigation to measure concentrations of fine particulate matter (particulate matter < 2.5 microm; PM(2.5)) and particle-bound polycyclic aromatic hydrocarbons (PAHs) in Roxbury in the summer of 1999. Community members carried portable monitors on the streets in a 1-mile radius around a large bus terminal to create a geographic information system (GIS) map of concentrations and gathered data on site characteristics that could predict ambient concentrations. Both PM(2.5) and PAH concentrations were greater during morning rush hours and on weekdays. In linear mixed-effects regressions controlling for temporal autocorrelation, PAH concentrations were significantly higher with closer proximity to the bus terminal (p < 0.05), and both pollutants were elevated, but not statistically significantly so, on bus routes. Regressions on a subset of measurements for which detailed site characteristics were gathered showed higher concentrations of both pollutants on roads reported to have heavy bus traffic. Although a more comprehensive monitoring protocol would be needed to develop robust predictive functions for air pollution, our study demonstrates that pollution patterns in an urban area can be characterized with limited monitoring equipment and that university-community partnerships can yield relevant exposure information.  (+info)

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