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Urban-rural mental health differences in Great Britain: findings from the National Morbidity Survey

PSYCHOLOGICAL MEDICINE 2000年第2期30卷 269-280页

作者： Paykel, ES Abbott, R Jenkins, R Brugha, TS Meltzer, H Univ Cambridge Dept Psychiat Cambridge England Dept Hlth London SE1 6TE England Off Natl Stat London England

Background. Studies of urban-rural differences in prevalence of non-psychotic mental disorder have not given consistent findings. Such differences have received relatively little study in Great Britain. Methods. Data from 9777 subjects in the Household Survey of the National Morbidity Survey of Great Britain were analysed for differences between urban, semi-rural and rural areas. Psychiatric morbidity was assessed by scores on the Revised Clinical Interview Schedule (CIS-R), together with alcohol dependence, drug dependence, receipt of treatment from general practitioners. Associations with other characteristics were examined by logistic regression. Results. Urban subjects had higher rates than rural of CIS-R morbidity, alcohol dependence and drug dependence, with semi-rural subjects intermediate. Urban subjects also tended to be members of more deprived social groups, with more adverse living circumstances and greater life stress, factors themselves associated with disorder. Urban-rural differences in alcohol and drug dependence were no longer significant after adjustment for these factors by logistic regression, and differences on CIS-R morbidity were considerably reduced. There were no differences in reatment. Conclusions. There are considerable British urban-rural differences in mental health, which may largely be attributable to more adverse urban social environments.

关键词：慢性酒精中毒/诊断慢性酒精中毒/流行病学横断面研究健康调查发病率精神障碍/诊断精神障碍/流行病学精神卫生服务/统计学和数值数据农村人口/统计学和数值数据物质相关性障碍/诊断物质相关性障碍/流行病学市区人口/统计学和数值数据青少年成年人女(雌)性人类男(雄)性中年人

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Clinical profile of hypertrophic cardiomyopathy identified de novo in rural communities

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第6期33卷 1590-1595页

作者： Maron, BJ Mathenge, R Casey, SA Poliac, LC Longe, TF Minneapolis Heart Inst Fdn Cardiovasc Res Div Minneapolis MN 55407 USA

OBJECTIVES The purpose of this study was to assess the extent to which hypertrophic cardiomyopathy (HCM) exists unsuspected and undetected in the general population. BACKGROUND Hypertrophic cardiomyopathy is a disease with diverse natural history for which the potential to produce adverse consequences has been emphasized. However, the possibility of this disease remaining clinically dormant for many years has not been as widely appreciated. Certainly, the clinical recognition of previously undiagnosed patients with HCM may be advantageous by permitting risk stratification for sudden cardiac death or for timely pharmacologic therapy when symptoms intervene. METHODS We prospectively conducted an echocardiographic survey in 64 primarily rural communities within Minnesota (populations <10,000) over a 33-month period. RESULTS A total of 15,137 echocardiograms were performed at the request of primary care physicians for the purpose of excluding cardiovascular abnormalities. Hypertrophic cardiomyopathy was identified in 44 patients during the survey (0.29%), and 29 of these patients (0.19% of the 15,137 echocardiograms) had not been previously identified as having cardiac disease or HCM. At diagnosis, ages were 16 to 87 years (mean 57);14 patients were greater than or equal to 60 years of age, and only two were <30 years, Twenty-four patients (83%) had either no or only mild or transient symptoms;5 (17%) evidenced severe functional limitation;in eight patients the Onset of symptoms had been deferred until greater than or equal to 70 years of age. Basal left ventricular outflow obstruction (gradients 20 to 82 mm Hg) was evident in 11 patients (38%). Relatively outflow phenotypic expression ofthe disease was substantiated by localized patterns of left ventricular wall thickening occurring more: commonly than diffusely distributed hypertrophy (48% vs. 7%, respectively), and electrocardiograms that were frequently normal (about 25%) and rarely showed evidence of left ventricul

关键词：心肌病肥厚性/诊断心肌病肥厚性/流行病学猝死心脏/流行病学猝死心脏/预防和控制超声心动描记术健康调查肥大左心室/诊断肥大左心室/流行病学明尼苏达/流行病学初级卫生保健/统计学和数值数据前瞻性研究危险性评估农村人口/统计学和数值数据青少年成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Creutzfeldt-Jakob disease cluster in an Australian rural city

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ANNALS OF NEUROLOGY 2002年第1期52卷 115-118页

作者： Collins, S Boyd, A Fletcher, A Kaldor, J Hill, A Farish, S McLean, C Ansari, Z Smith, M Masters, CL Univ Melbourne Australian Natl Creutzfeldt Jakob Dis Registry Dept Pathol Parkville Vic 3010 Australia Univ New S Wales Natl Ctr HIV Epidemiol & Clin Res Unit Sydney NSW Australia Univ Melbourne Sch Populat Hlth Epidemiol & Biostat Unit Melbourne Vic Australia Dept Human Serv Publ Hlth Div Hlth Outcomes Sect Melbourne Vic Australia Royal Melbourne Hosp Melbourne Hlth Shared Pathol Serv Mol Biol Lab Parkville Vic 3050 Australia

Through the Australian National Creutzfeldt-Jakob Disease Registry, 6 pathologically confirmed sporadic cases were recognized over a 13-year period in persons who had been long-term residents of a moderate-sized rural city, whereas the expected number was 0.923. An extensive investigation could not find any point-source or case-to-case transmission links. This occurrence is highly statistically significant (p = 0.0027) when viewed in isolation and remains significant (p < 0.02) when only the cases that arose after the cluster was recognized were taken into account. However, a more conservative statistical analysis suggests that such a grouping could have arisen by chance in at least one population group of this size when the whole country is taken into consideration.

关键词：澳大利亚/流行病学聚类分析克-亚综合征/流行病学泊松分布登记/统计学和数值数据农村人口/统计学和数值数据老年人女(雌)性人类男(雄)性中年人

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Decreasing seasonal variation of births in schizophrenia

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PSYCHOLOGICAL MEDICINE 2000年第2期30卷 315-324页

作者： Suvisaari, JM Haukka, JK Tanskanen, AJ Lönnqvist, JK Natl Publ Hlth Inst Dept Mental Hlth & Alcohol Res FIN-00300 Helsinki Finland Natl Publ Hlth Inst Dept Nutr FIN-00300 Helsinki Finland

Background. Patients with schizophrenia have a winter-spring excess of births compared with the general population, the cause of which is unresolved. Fluctuations in the magnitude of the seasonal variation may provide clues to its aetiology. Methods. All Finnish patients with schizophrenia born between 1950 and 1969 (N = 15 892) were identified from two nationwide health-care registers. Their background demographic information was obtained from the Population Register Centre, which also provided monthly numbers of births in each municipality of Finland as multidimensional tables, with sex and year, month and place of birth as marginals. The incidence of schizophrenia was modelled using Poisson regression analysis, with sex, onset age, birth cohort, place of birth (urban/rural), trend and seasonal variation as explanatory variables. We also constructed a monthly time series and decomposed it into three components - seasonal, trend and remainder. Results. Seasonal variation of births among patients born in the 1950s, especially between 1955 and 1959, was marked, but decreased among patients born in the 1960s. No interaction between place of birth or sex and seasonal variation was observed. The incidence was higher among the rural-born than the urban-born, but declined more slowly among the urban-born than the rural-born. Conclusions. The intensity of the factor causing the seasonal variation of births in schizophrenia may be decreasing. Urban birth may be emerging as a risk factor for schizophrenia in Finland, as elsewhere.

关键词：横断面研究芬兰/流行病学发病率寿命表危险因素农村人口/统计学和数值数据精神分裂症/流行病学精神分裂症/病因学季节市区人口/统计学和数值数据成年人女(雌)性人类男(雄)性中年人

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National oral health survey Zimbabwe 1995: Dental carries situation

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INTERNATIONAL DENTAL JOURNAL 1999年第1期49卷 3-9页

作者： Frencken, JE Sithole, WD Mwaenga, R Htoon, HM Simon, E Dept Prevent & Community Dent NL-6500 HB Nijmegen Netherlands

Ten years after completion of the first national oral health survey, the second such survey was carried out in 1995. Application of a multi-stage sampling procedure resulted in 3,709 persons being examined according to the WHO oral health assessment form and criteria. The background variables studied were age, gender, type of location, socio-economic status. Comparison with results from major studies in other African nations are presented. It was concluded that the prevalence of dental caries in all age groups was high but that the severity was low. The prevalence of unmet treatment needs was very high with extraction as the predominant mode of treatment. The survey has shown that the vast majority of Zimbabweans are not receiving and/or are not seeking oral care.

关键词：年龄分布龋失补指数龋齿/流行病学牙健康调查氟化物/分析年患病率/发展趋势口腔保健患病率随机分配可重复性结果农村人口/统计学和数值数据性别分布市区人口/统计学和数值数据给水/分析津巴布韦/流行病学青少年成年人儿童学龄前女(雌)性人类男(雄)性

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The North Staffordshire Suicide Study: A case-control study of suicide in one health district

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PSYCHOLOGICAL MEDICINE 1999年第1期29卷 27-33页

作者： Boardman, AP Grimbaldeston, AH Handley, C Jones, PW Willmott, S Guys Hosp Div Psychiat & Psychol London SE1 9RT England S Staffordshire Hlth Author Stafford England Keele Univ Dept Psychiat Postgrad Med Sch Keele Staffs England Keele Univ Dept Math Keele Staffs England

Background. The aim of the study was to identify sociodemographic and clinical risk factors for death from suicide and undetermined injury in residents of one health district. Method. Data were collected on all cases of suicide (ICD-9 E950-959) and undetermined injury (ICD-9 E980-989) for residents in North Staffordshire Health District between 1991 and 1995. Controls, identified from the Coroner's inquest register, who died from other causes, were matched for age and sex. Results. Two hundred and twelve pairs of cases and matched controls were identified. Multivariate analysis (conditional logistic regression) showed that the risk of death due to suicide and undetermined death was associated with: recent separation, relationship difficulties, experience of financial difficulties, history of past criminal charges or contact with the police, a past history of deliberate self-harm, being on psychotropic medication at the time of death and a diagnosis of bipolar affective disorder. For sociodemographic variables, a univariate analysis found associations between the cases and being separated, living alone, having a past history of criminal charges and unemployment. Cases were more likely to have a psychiatric disorder, past history of deliberate self-harm and a past history of psychiatric contact for themselves or a family member. Controls were more likely to have a current medical disorder. Cases were more likely than controls to be on any form of medication at the time of death and to have received a prescription for psychotropic or nonpsychotropic medication in the week and month before death. Cases were more likely than controls to have had contact with medical services in the week and month before death, with the general practitioner in the week before death and with psychiatric services at any time in the year before death. Strong associations were found between suicide and undetermined injury and life events such as recent separation and bereavement, and financia

关键词：病例对照研究生活变动事件病人接受卫生保健的程度回顾性研究危险因素农村人口/统计学和数值数据自杀/心理学自杀/统计学和数值数据市区人口/统计学和数值数据青少年成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Ecological and geographic characteristics predict nutritional status of communities: rapid assessment for poor villages

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HEALTH POLICY AND PLANNING 1998年第4期13卷 408-416页

作者： Kusumayati, A Gross, R Univ Indonesia SEAMEO TROPMED Reg Ctr Community Nutr Jakarta 10038 Indonesia Univ Indonesia Fac Publ Hlth Jakarta Indonesia Deutsch Gesell Tech Zusammenarbeit GMBH Eschborn Germany

The quality of poverty alleviation programmes relies heavily on appropriate targeting and priority setting. Major problems in assessing poverty include identification of the indicators of poverty and the methods used for its assessment. Nutritional status, expressed by anthropometric indices, has been proposed as a poverty indicator because of its validity, objectivity, reliability and feasibility. This study was conducted to explore the application of remote sensing to poverty mapping based on nutritional status at the community level. Relationships between the nutritional status within a community and the ecological characteristics of the community were investigated. Multiple linear regression tests were executed, and the resultant equations were tested for their validity in predicting communities with poor nutritional status. Among geographical and ecological indicators used, distance to the nearest market, main soil type, rice field area, and perennial cultivation area were found to be most useful predictors for the ranking of the communities by nutritional status. Among non-ecological determinants, food consumption, health service status and living conditions were also found as predictors. The highest correlation was found if total population was also taken into account in the regression model (R-2 = 0.69;p < 0.0001). In the assessment of the sensitivity and specificity of the eight models studied, 'undernutrition' was defined as a condition where a community belongs in the first quartile for nutritional status (highest prevalence of undernutrition), and the baseline nutritional survey was considered as a standard method for final diagnosis. Most models which included only ecological factors in the equations had lower sensitivity and specificity than models which included all determinant factors in the equations. All models which took into account the total population had higher sensitivity and specificity than those that did not take total population into acco

关键词：数据收集发展中国家生态学地理学健康状况指标印度尼西亚线性模型营养调查贫困/统计学和数值数据农村人口/统计学和数值数据人类

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Hospital separation rates from osteoporotic and non-osteoporotic fractures in metropolitan and rural Australia

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INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED 1999年第2期30卷 101-103页

作者： Peach, HG Bath, NE Univ Melbourne Ballarat Hlth Serv Base Hosp Ballarat Vic 3353 Australia

Rural populations of the United Kingdom and Scandinavia have lower hospital discharge and incidence rates for hip fractures than urban ones. We compared hospital separations from fractures in rural health regions of Victoria, Australia, with those in metropolitan regions. Fractures were grouped into those commonly (1A), often (1B) or not often (2) associated with osteoporosis. For group 1A fractures, we found rural separation rates were significantly higher among both men and women who were aged either 20-24 or 45-64. The rural separation rates for group 1B fractures were also significantly higher in these age groups but only among men. For group 2 fractures, rural separation rates were significantly higher among young adults. Fractures of the neck, trunk, radius and ulna, but not neck of the femur, contributed to the rural excess of group 1A fractures. If rural adults are not hospitalised more often, risk factors for group 1 and group 2 fractures, which in the middle aged includes osteoporosis, may be more prevalent in rural Victoria. Our findings suggest that international studies of rural-urban differences in fracture rates are needed which include a range of anatomical sites. (C) 1999 Elsevier Science Ltd. All rights reserved.

关键词：年龄分布澳大利亚/流行病学髋骨折/流行病学髋骨折/病因学髋骨折/死亡率发病率骨质疏松/并发症病人出院/统计学和数值数据危险因素农村人口/统计学和数值数据市区人口/统计学和数值数据成年人女(雌)性人类男(雄)性中年人

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National oral health survey Zimbabwe 1995: periodontal conditions

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INTERNATIONAL DENTAL JOURNAL 1999年第1期49卷 10-14页

作者： Frencken, JE Sithole, WD Mwaenga, R Htoon, HM Simon, E Dept Prevent & Community Dent NL-6500 HB Nijmegen Netherlands

Ten years after completion of the first national oral health survey, a second national oral health survey was carried out in 1995. Application of a multi-stage sampling procedure resulted in 3,709 persons being examined. WHO's oral health assessment form and CPITN index was used. The background variables studied were age (15-19, and 35-44-year olds), gender, type of location, socio-economic status and level of education. Results suggest that the periodontal health of adolescents was better in 1985 than in 1995. Overall, the prevalence of periodontal conditions in both age groups was high but its severity was low. The need for complex periodontal treatment was only 4 per cent for adults. The survey has shown that the vast majority of Zimbabweans are not receiving and/or are not seeking periodontal care.

关键词：年龄分布牙健康调查年患病率/发展趋势口腔保健牙周疾病/流行病学牙周指数患病率农村人口/统计学和数值数据市区人口/统计学和数值数据津巴布韦/流行病学青少年成年人女(雌)性人类男(雄)性中年人

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Wilderness mortalities: A 13-year experience

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ANNALS OF EMERGENCY MEDICINE 2001年第3期37卷 279-283页

作者： Goodman, T Iserson, KV Strich, H Univ Arizona Coll Med Dept Surg Sect Emergency Med Tucson AZ 85721 USA

Study objective: To analyze the epidemiology of wilderness mortalities in a localized area with diverse terrain. Methods: We conducted a retrospective review of the Pima County (Arizona) Sheriff's Office (PCSO) search and rescue logs and case reports, hospital records, and autopsy reports for all wilderness deaths from 1980 to 1992, The study group comprised all victims of injury or illness in Pima County wilderness who died during a 13-year period in a location remote enough so that standard ground-based emergency medical services units could not extract the body. Results: One hundred fatalities occurred during the 13-year study period. There were 59 unintentional traumas, 18 suicides, 9 homicides, 12 medically related deaths, and 2 deaths of unknown causes. Toxicology tests performed on body fluids yielded positive findings for alcohol in a total of 50 (50%) cases and positive findings for drugs of abuse in 12(12%)cases. It was estimated that alcohol was " a very probable" or " a probable" causative factor in 23 (40%) of the 59 unintentional trauma deaths, and in 1 (8.3%) of the 12 medically related deaths. Fifty-five (55%) deaths were witnessed events, with 45 (80%) of these victims reported as dying immediately or before arrival of search and rescue personnel. Ten (10%) victims received resuscitation in the field, and according to a review of hospital charts and autopsy reports, only 2 victims had a potentially survivable injury or illness. Conclusion: Many wilderness mortalities are related to incidents involving alcohol. Once the accident or injury has occurred, the majority of deaths are immediate, or at least before the arrival of medical personnel. Higher levels of medical care would not have improved the outcomes of those who did survive long enough to receive medical care. Therefore, primary efforts to reduce mortalities in the wilderness should be directed toward prevention, especially diminishing alcohol use in wilderness areas.

关键词：酒精中毒急性/死亡率运动损伤/死亡率死亡原因闲暇活动死亡率救济工作回顾性研究农村人口/统计学和数值数据物质相关性障碍/死亡率青少年成年人老年人老年人 80以上儿童儿童学龄前女(雌)性人类男(雄)性中年人

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