共查询到20条相似文献,搜索用时 15 毫秒
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Allacci MS 《The Journal of ambulatory care management》2005,28(1):2-15
This ongoing empirical study suggests a model for evaluating a combination of environmental risk factors to explain neighborhood differences in adult use of Harlem Hospital's Asthma Emergency Department services. A multilevel or "nested" model incorporates methods for hypothesis testing using geographic information systems (GIS) and existing data from Harlem Hospital Center, city agencies, and other sources to measure variables on both building and street segment levels. Selection of the best geographic scale by which to measure housing conditions, neighborhood physical quality, income indicators, and access to healthcare is an important strategy toward identifying neighborhood socioenvironmental patterns contributing to geographic clustering of asthma emergencies. Specific community interventions may then be defined to improve the health outcomes of residents with asthma. 相似文献
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Yueqin Zhou Elaine J Hallisey Gordon R Freymann 《International journal of health geographics》2006,5(1):53-11
Background
Child maltreatment and its consequences are a persistent problem throughout the world. Public health workers, human services officials, and others are interested in new and efficient ways to determine which geographic areas to target for intervention programs and resources. To improve assessment efforts, selected perinatal factors were examined, both individually and in various combinations, to determine if they are associated with increased risk of infant maltreatment. State of Georgia birth records and abuse and neglect data were analyzed using an area-based, ecological approach with the census tract as a surrogate for the community. Cartographic visualization suggested some correlation exists between risk factors and child maltreatment, so bivariate and multivariate regression were performed. The presence of spatial autocorrelation precluded the use of traditional ordinary least squares regression, therefore a spatial regression model coupled with maximum likelihood estimation was employed. 相似文献4.
J. Murray D. A. McFarland R. J. Waldman 《Bulletin of the World Health Organization》1998,76(4):343-352
Recent large epidemics of cholera with high incidence and associated mortality among refugees have raised the question of whether oral cholera vaccines should be considered as an additional preventive measure in high-risk populations. The potential impact of oral cholera vaccines on populations prone to seasonal endemic cholera has also been questioned. This article reviews the potential cost-effectiveness of B-subunit, killed whole-cell (BS-WC) oral cholera vaccine in a stable refugee population and in a population with endemic cholera. In the population at risk for endemic cholera, mass vaccination with BS-WC vaccine is the least cost-effective intervention compared with the provision of safe drinking-water and sanitation or with treatment of the disease. In a refugee population at risk for epidemic disease, the cost-effectiveness of vaccination is similar to that of providing safe drinking-water and sanitation alone, though less cost-effective than treatment alone or treatment combined with the provision of water and sanitation. The implications of these data for public health decision-makers and programme managers are discussed. There is a need for better information on the feasibility and costs of administering oral cholera vaccine in refugee populations and populations with endemic cholera. 相似文献
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Background
Birth defects are a major cause of infant mortality and disability in many parts of the world. Neural tube defects (NTDs) are one of the most common types of birth defects. In 2001, the Chinese population and family planning commission initiated a national intervention program for the prevention of birth defects. A key step in the program was the introduction of folic acid supplementation. Of interest in the present study was to determine whether folic acid supplementation has the same protective effect on NTDs under various geographical and socioeconomic conditions within the Chinese population and the nature in which the influence of environmental factors varied after folic acid supplementation. 相似文献7.
R. E. Quick B. L. Thompson A. Zuniga G. Dominguez E. L. De Brizuela O. De Palma S. Almeida A. Valencia A. A. Ries N. H. Bean P. A. Blake 《Epidemiology and infection》1995,114(2):249-255
In response to the Latin American cholera epidemic, El Salvador began a prevention programme in April 1991. The first case was confirmed in August, and 700 cases were reported within 3 months. A matched case-control study was conducted in rural La Libertad Department in November 1991. Illness was associated with eating cold cooked or raw seafood (odds ratio [OR] = 7·0; 95% confidence limits [CL] = 1·4, 35·0) and with drinking water outside the home (OR = 8·8; 95% CL = 1·7, 44·6). Assertion of knowledge about how to prevent cholera (OR = 0·2; 95% CL = 0·1, 0·8) and eating rice (OR = 0·2; 95% CL = 0·1, 0·8) were protective. More controls than patients regularly used soap (OR = 0·3; 95% CL = 0·1, 1·0). This study demonstrated three important points for cholera prevention: (1) seafood should be eaten cooked and hot; (2) populations at risk should be taught to treat household drinking water and to avoid drinking water outside the home unless it is known to be treated; and (3) education about hygiene can be an important tool in preventing cholera. 相似文献
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Cano MV Ponce-de-Leon GF Tippen S Lindsley MD Warwick M Hajjeh RA 《Epidemiology and infection》2003,131(2):907-914
Between 1992 and 1999, 93 cases of blastomycosis, including 25 laboratory confirmed cases, were identified in Missouri (annual incidence, 0.2/100,000 population). Mississippi County in southeastern Missouri had the highest incidence (12/100,000) with a much higher rate among blacks than whites in this county (43.21/100,000). The mortality rate, 44% was also higher among blacks. To determine risk factors for endemic blastomycosis, a case-control study was conducted among southeastern Missouri residents. Independent risk factors for blastomycosis were black race and a prior history of pneumonia. No environmental exposures or socioeconomic factors were significantly associated with increased risk. The increased risk among blacks may possibly be related to genetic factors, but further studies are needed to clarify this. However, heightened awareness of the disease and a better understanding of the risk factors are important and may lead to earlier diagnosis and start of treatment, possibly improving outcome. 相似文献
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目的:研究某沿海县城霍乱暴发流行的影响因素.为今后控制和应急处置霍乱疫情提供科学依据。方法:按1:1配对原则对50名病人,带菌者和健康人进行病例对照研究。结果:与霍乱病人或带菌者接触、聚餐、食用凉拌菜(主要是凉拌海带)是霍乱的主要危险因素,而喝生水不是引起本次疫情的重要原因。结论:重视海带等海产植物的带菌作用,应开展相关监测;重视流动人口传染病监测和防治工作。 相似文献
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Identifying factors associated with health care use: a hospital-based risk screening index 总被引:2,自引:0,他引:2
R L Evans R D Hendricks K V Lawrence D S Bishop 《Social science & medicine (1982)》1988,27(9):947-954
The purpose of the current study was to identify variables near hospital admission that could effectively discriminate patients at risk for nursing home placement, long hospital stay, or readmission. Risk factors reported in the literature were used to predict hospital outcome for 532 admissions. Factors that discriminated type of outcome included: two or more chronic medical conditions, living alone or being admitted from a nursing home, dependent ambulation, poor mental status, psychiatric comorbidity, prior admission, age over 75, and being unmarried. Using these criteria, an index was developed to determine risk for placement, readmission, or lengthy stay. Use of cumulative risk scores can result in accurate prediction of outcome and may be useful in targeting patients for intervention. Performance characteristics of the risk index are discussed. 相似文献
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John A. Morrison Philip Khoury Margot J. Mellies Kathe A. Kelly Charles J. Glueck 《Preventive medicine》1980,9(4):484-495
Intrafamilial associations of high- and low-density lipoprotein cholesterol (C-HDL, C-LDL) were examined in 116 parent-child and 70 sibling combinations in subjects randomly recalled in the Lipid Research Clinic's Princeton School Study. The nature and extent of parent-child lipoprotein correlations were assessed, and the hypothesis was examined that knowledge of parental C-LDL and C-HDL can improve case-finding efficiency for identification of children at coronary heart disease (CHD) risk by virtue of their lipoprotein levels. For C-HDL there was a consistent, positive, and significant relationship between parents and children; nearly 25% of the variation of the children's C-HDL could be explained by knowledge of the parents' C-HDL. For C-LDL, there were significant positive correlations between parents and children, and between parents and daughters, and mothers and daughters. However, there were no significant C-LDL relationships between parents and sons, fathers and sons, or mothers and sons. For C-HDL, mother-offspring correlations were higher than those for father-offspring. Less consistently, mother-offspring C-LDL correlations were also higher than those for father-offspring. The sibling-sibling lipoprotein correlations were similar to those in parents-offspring; however, their C-LDL:C-LDL correlations were somewhat stronger than for C-HDL:C-HDL. After categorizing the data into parental and pediatric lipoprotein quartiles, 46% of the children whose parents had highest quartile C-LDL themselves had highest quartile C-LDL, 1.8 times (46% ÷ 25%) more than would be expected in the top quartile of a pediatric population, P < 0.01. Moreover, 47% of children whose parents had lowest quartile C-HDL, themselves had lowest quartile C-HDL, 1.9 times (47% ÷ 25%) more than would be expected in the lowest quartile of a pediatric population, P < 0.01. The appreciable nature of parent-child lipoprotein concordance was further highlighted by the finding of progressive increases in the mean levels of pediatric C-HDL and C-LDL with parental classification from the lowest to the highest parental C-HDL and C-LDL quartiles. Since CHD risk in adults appears to be continuous throughout the range of C-HDL and C-LDL levels, knowledge of parental C-LDL and C-HDL should be useful in identifying pediatric cohorts at varying degrees of risk for CHD, by virtue of high or low C-HDL and C-LDL. 相似文献
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Spatial filtering using a raster geographic information system: methods for scaling health and environmental data 总被引:2,自引:0,他引:2
Despite the use of geographic information systems (GIS) in academic research, it is still uncommon for public health officials to use such tools for addressing health and environmental issues. Complexities in methodological issues for addressing relationships between health and environment, investigating spatial variation of disease, and addressing spatial demand and supply of health care service, hinder the use of GIS in the health sector. This paper demonstrates simple spatial filtering methods for analyzing health and environmental data using a raster GIS. Computing spatial moving average rates reduces individual affects and creates a continuous surface of phenomena. Another spatial analytical method discussed is computation of exposure status surfaces including neighbors' influences weighted by distance decay. These methods describe how health and environmental data can be scaled in order to better address health problems. Spatial filtering methods are demonstrated using health and population surveillance data within a GIS that were collected for approximately 210,000 people in Matlab, Bangladesh. 相似文献
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《Vaccine》2021,39(43):6356-6363
This study is to examine the cost-effectiveness of deployment strategies of oral cholera vaccines (OCVs) in controlling cholera in Bangladesh. We developed a dynamic compartment model to simulate costs and health outcomes for 12 years for four OCVs deployment scenarios: (1) vaccination of children aged one and above with two doses of OCVs, (2) vaccination of population aged 5 and above with a single dose of OCVs, (3) vaccination of children aged 1–4 with two doses of OCVs; and (4) combined strategy of (2) and (3). We obtained all parameters from the literature and performed a cost-effectiveness analysis from both health systems and societal perspectives, in comparison with the base scenario of no vaccination. The incremental cost-effectiveness ratios (ICERs) for the four strategies from the societal perspective were $2,236, $2,250, $1,109, and $2,112 per DALY averted, respectively, with herd immunity being considered. Without herd immunity, the ICERs increased substantially for all four scenarios except for the scenario that vaccinates children aged 1–4 only. The major determinants of ICERs were the case fatality rate and the incidence of cholera, as well as the efficacy of OCVs. The projection period and frequency of administering OCVs would also affect the cost-effectiveness of OCVs. With the cut-off of 1.5 times gross domestic product per capita, the four OCVs deployment strategies are cost-effective. The combined strategy is more efficient than the strategy of vaccinating the population aged one and above with two doses of OCVs and could be considered in the resource-limited settings. 相似文献
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何浙生 《国际流行病学传染病学杂志》2009,36(2)
霍乱是由霍乱弧菌引起的急性肠道传染病,因其发病迅猛,传播速度快,波及面广,持续时间长,对人类生命威胁大,而被列为<国际卫生条列>及<中华人民共和国国境卫生检疫法>中规定的必须实施检疫的3种国际检疫传染病之一[1].在我国的传染病防治法中,又规定将霍乱列为必须实施强制管理的甲类传染病来加以重视和防范[2]. 相似文献
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Parkinson's disease: a case-control study of occupational and environmental risk factors 总被引:12,自引:0,他引:12
C Hertzman M Wiens D Bowering B Snow D Calne 《American journal of industrial medicine》1990,17(3):349-355
We compared personal histories of 57 cases and 122 age-matched controls to identify possible environmental determinants of Parkinson's disease (PD). Odds ratios (OR) adjusted for sex, age, and smoking were computed using stepwise logistic regression. We found a statistically significant increased risk for working in orchards (OR = 3.69, p = 0.012, 95% CI = 1.34, 10.27) and a marginally significant increased risk associated with working in planer mills (OR = 4.11, p = 0.065, 95% CI = 0.91, 18.50). A Fisher's exact test of the association between PD development and (1) paraquat contact, and (2) postural tremor gave statistically significant probability estimates of 0.01 and 0.03, respectively. The relative risk of PD decreased with smoking, an inverse relationship supported by many studies. 相似文献
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目的探讨胚胎停育患者在生活和工作中的环境行为危险因素。方法采用病例-对照研究对192例胚胎停育患者和192例正常妊娠者进行问卷调查,内容包括研究对象一般情况、生活和工作中的可疑环境行为危险因素等。结果经多因素非条件logistic回归分析,结果显示,年龄大(OR=1.064,95%CI:1.005~1.126)、孕前3个月或孕期吸入二手烟(OR=2.185,95%CI:1.028~4.644)、使用染发剂(OR=2.780,95%CI:1.328~5.821)、居室装修(OR=3.258,95%CI:1.813~5.856)是胚胎停育的危险因素,教育程度高(OR=0.668,95%CI:0.523~0.852)、孕前健康状况良好(OR=0.184,95%CI:0.078~0.435)、主动获取优生知识(OR=0.494,95%CI:0.265~0.920)、孕期情绪状况愉快(OR=0.496,95%CI:0.291~0.845)、孕期与家庭成员关系和睦(OR=0.475,95%CI:0.241~0.934)是胚胎停育的保护因素。结论年龄大、孕前3个月或孕期吸入二手烟、使用染发剂、居室装修可能与胚胎停育的发生有关系,而教育程度高、孕前健康状况良好、主动获取优生知识、孕期情绪状况愉快、孕期与家庭成员关系和睦则可以减少胚胎停育发生。 相似文献
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BACKGROUND: The problem of control selection was considered in a population-based case-control study on pleural mesothelioma in Spain. Random sampling from the population was discarded because of potential selection bias due to low participation. Selection of hospital controls by matching them to cases by hospital seemed unsuitable for investigating environmental exposures, as the choice of hospital may be related to the place of residence; controlling for residence may avoid bias but could produce overmatching. METHODS: A three-step procedure was proposed. First, a random sample of primary controls from the population census of the province of Barcelona was obtained. Second, the hospital closest to the residence of the primary control was identified as the control hospital. Third a secondary control was chosen among patients admitted to the hospital matched to the primary control by sex, age and municipality. RESULTS: An overall participation rate of 85% was achieved. The hospital control group showed a distribution of residences similar to that of the general population, and independent of the distribution of cases. CONCLUSIONS: This procedure may be considered as an alternative for control selection when studying environmental factors or, generally, when matching cases and controls by hospital is to be avoided. Its validity was assessed according to the principles of comparability with cases regarding the study base, accuracy of information, deconfounding and efficiency. 相似文献