Do Neighborhood Economic Characteristics,Racial Composition,and Residential Stability Predict Perceptions of Stress Associated with the Physical and Social Environment? Findings from a Multilevel Analysis in Detroit

As the body of evidence linking disparities in the health of urban residents to disparate social, economic and environmental contexts grows, efforts to delineate the pathways through which broader social and economic inequalities influence health have burgeoned. One hypothesized pathway connects economic and racial and ethnic inequalities to differentials in stress associated with social and physical environments, with subsequent implications for health. Drawing on data from Detroit, Michigan, we examined contributions of neighborhood-level characteristics (e.g., poverty rate, racial and ethnic composition, residential stability) and individual-level characteristics (e.g., age, gender) to perceived social and physical environmental stress. We found that neighborhood percent African American was positively associated with perceptions of both social and physical environmental stress; neighborhood percent poverty and percent Latino were positively associated with perceived physical environmental stress; and neighborhood residential stability was negatively associated with perceived social environmental stress. At the individual level, whites perceived higher levels of both social and physical environmental stress compared to African American residents of the same block groups, after accounting for other variables included in the models. Our findings suggest the importance of understanding and addressing contributions of neighborhood structural characteristics to perceptions of neighborhood stress. The consistency of the finding that neighborhood racial composition and individual-level race influence perceptions of both social and physical environments suggests the continuing importance of understanding the role played by structural conditions and by personal and collective histories that vary systematically by race and ethnicity within the United States.     

Experiences of Traumatic Events and Associations with PTSD and Depression Development in Urban Health Care-seeking Women

Posttraumatic stress disorder (PTSD) is an anxiety disorder that occurs after a traumatic event and has been linked to psychiatric and physical health declines. Rates of PTSD are far higher in individuals with low incomes and who reside in urban areas compared to the general population. In this study, 250 urban health care-seeking women were interviewed for a diagnosis of PTSD, major depressive disorder, and also the experience of traumatic events. Multivariate logistic regressions were used to determine the associations between traumatic events and PTSD development. Survival analysis was used to determine if PTSD developed from assaultive and nonassaultive events differed in symptom duration. Eighty-six percent of women reported at least one traumatic event, 14.8% of women were diagnosed with current PTSD, and 19.6% with past PTSD. More than half of women with PTSD had comorbid depression. Assaultive traumatic events were most predictive of PTSD development. More than two thirds of the women who developed PTSD developed chronic PTSD. Women who developed PTSD from assaultive events experienced PTSD for at least twice the duration of women who developed PTSD from nonassaultive events. In conclusion, PTSD was very prevalent in urban health care-seeking women. Assaultive violence was most predictive of PTSD development and also nonremittance.     

UHPP项目社区卫生服务机构发展状况分析

目的了解中英城市卫生服务与贫困医疗救助(UHPP)项目的社区卫生服务机构发展状况。方法采用分层抽样方法,在沈阳和成都共抽取13个社区卫生服务机构(CHS)。用定量和定性相结合的调查方法,对2001年～2004年间机构各方面发展状况进行调查分析。结果与2001年比较,UHPP项目的社区卫生服务机构设备配置明显增加,科室设置基本齐全,人员的职称和学历结构得到优化,机构服务内容得到拓展,服务量大幅提高,管理信息系统也有一定发展。结论UHPP项目的社区卫生服务机构发展迅速,但目前仍需加强城市社区卫生服务机构专业人才培养及完善管理信息系统。     

The Effect of Patient Navigation on Time to Diagnosis,Anxiety, and Satisfaction in Urban Minority Women with Abnormal Mammograms: A Randomized Controlled Trial

Delay in follow-up after an abnormal mammogram is associated with advanced disease stage, poorer survival, and increased anxiety. Despite the implementation of many patient navigator programs across the country, there are few published, peer-reviewed studies documenting its effectiveness. We tested the effectiveness of a patient navigator in improving timeliness to diagnosis, decreasing anxiety, and increasing satisfaction in urban minority women after an abnormal mammogram. Women with suspicious mammograms were randomly assigned to usual care (N = 50) or usual care plus intervention with a patient navigator (N = 55). There were no demographic differences between the two groups. Women in the intervention group had shorter times to diagnostic resolution (mean 25.0 vs. 42.7 days; p = .001), with 22% of women in the control group without a final diagnosis at 60 days vs. 6% in the intervention group. The intervention group also had lower mean anxiety scores (decrease of 8.0 in intervention vs. increase of 5.8 in control; p < .001), and higher mean satisfaction scores (4.3 vs. 2.9; p < .001). Patient navigation is an effective strategy to improve timely diagnostic resolution, significantly decrease anxiety, and increase patient satisfaction among urban minority women with abnormal mammograms.     

A Review of Barriers to Utilization of the Medicare Hospice Benefits in Urban Populations and Strategies for Enhanced Access

Disparities in access to health care extend to end-of-life care. Lack of access to hospice mirrors lack of access to health maintenance and primary care. Patients who are served by hospice nationally are disproportionately white and likely to reside in economically stable communities. In many urban low-income communities, less than 5% of decedents receive hospice care in the last 6 months of life. This review focuses on barriers to palliative care and hospice in urban, predominantly low-income communities, including cultural and reimbursement factors and the paucity of hospice providers, outreach projects, and in-patient hospice beds in urban communities. This review will also address some strategies that are being implemented by hospices locally and nationally to overcome demographic barriers to hospice care.     

Positive Impact of a Shelter-based Hepatitis B Vaccine Program in Homeless Baltimore Children and Adolescents

Homeless youth are at increased risk for hepatitis B virus (HBV) infection and HBV vaccine coverage is poor in this group. The purpose of our study was to determine if a shelter-based HBV vaccine program in children and adolescents 2–18 years of age with a randomized controlled trial using a culturally appropriate HBV video could increase HBV vaccine coverage rates. Subjects were randomized to an 8 min HBV video or a control, smoking prevention video. Before exposure to the videos, HBV knowledge, and demographics were assessed in caregivers and adolescents. HBV vaccine no. 1 was offered to all subjects who did not produce a vaccine record; subsequently, an accurate HBV vaccine history was obtained from medical providers. Subjects were asked to return 1 and 3 months after visit 1, HBV vaccine was offered to all with incomplete coverage, and HBV knowledge was reassessed. There were 328 children and adolescents cared for by 170 caregivers enrolled in the study. One hundred and four had incomplete HBV vaccine coverage. Data are reported for all family units with at least one subject needing vaccine. There were 53 children and adolescents randomized to the HBV video vs. 51 to the smoking video. HBV knowledge scores of caregivers improved at Visit no. 2 vs. no. 1 in the HBV video group (p = 0.01) but not in the smoking group (p = 0.82). Similar results were observed for adolescents in the HBV video group (p = 0.05) but not in the smoking group (p = 0.40). Exposure to the HBV video vs the smoking video had a significant effect on return rates for vaccine at Visit no. 2 (59 vs. 31%; p = 0.05) but not at Visit no. 3 (47 vs. 18%, p = 0.06). The shelter-based vaccine program was very effective in increasing HBV coverage rates in the entire group of 328 children and adolescents enrolled in the study, from 68% coverage at baseline to 85% at the conclusion of the study. We conclude that shelter-based HBV vaccine programs can be highly effective in increasing vaccine coverage rates in older children and adolescents. A brief exposure to a culturally appropriate HBV video improves HBV knowledge and may improve return rates for vaccine.     

2005年济南市历城区部分居民超重肥胖和慢性病患病情况调查

[目的]了解城乡居民超重、肥胖患病现状及其与几种慢性非传染性疾病(慢性病)患病情况,分析其关系,促进慢性病预防控制工作.[方法]2005年8月,在济南市历城区抽取部分15岁以上城乡居民进行调查分析.[结果]调查5 134人,标化超重率为30.89%,男性、女性分别为33.07%、28.75%(P＜0.05),城区、农村分别为34.07%、29.29%(P＜0.01);标化肥胖率为10.34%,男性、女性分别为10.10%、10.49%(P＞0.05),城区、农村分别为13.29%、8.93%(P＜0.01).调查并检测6 084人,高血压、冠心病、脑卒中、骨关节病患病率分别为29.60%、5.72%、1.33%、12.54%.检测2 137人,糖尿病、血脂异常、代谢综合征患病率分别为9.41%、32.57%、15.11%.肥胖和超重与糖尿病、高血压、冠心病、血脂异常、骨关节病、代谢综合征密切相关(P＜0.01),RR值分别为2.91、2.25、2.36、2.79、1.65、8.98.[结论]历城区城乡居民超重率、肥胖率处于全国大城市水平,超重、肥胖具有患多种慢性病的风险.     

用ELES模型分析城镇居民药品需求弹性

目的:定量研究我国城镇居民药品需求弹性。方法:运用扩展的线性支出系统模型分析2003年我国城镇居民各项消费支出及可支配收入的截面数据,计算边际消费倾向值、需求收入弹性值和需求价格弹性值。结果与结论:药品价格的变化对药品需求影响较小,城镇居民的药品消费属于生活必需品消费。     

Need and demand in psychiatric emergency service utilization: explaining topographic differences of a utilization sample in Mannheim

Up to now all investigations about the topographic distribution of psychiatric utilization rates ignore whether or not the patients really require care (need for care) respectively express that need by themselves (demand for care). To analyze utilization rates of the psychiatric emergency service of the Central Institute of Mental Health in Mannheim (CIMH), variables differentiating between need and demand for emergency care were included. The investigation is based on contacts in the psychiatric emergency service between 1982 and 1993 and comprises 6463 patients with 14,628 contacts. To operationalize the concepts of need and demand the items “instance of consultation”, “reasons for consultation”“inpatient admission” and “rated urgency” from the standardized record system of the psychiatric emergency service were used. The association between need, demand and ecological, socio-demographic and distance-related factors were analyzed. The results show that demand for psychiatric emergency care is an important factor for explaining topographic diferences in service utilization. Demand correlates with ecological, socio-demographic and distance related factors; need only correlates with age. The amount of demand also varies with specific mental disorders. Received: 21 July 1999 / Accepted: 31 May 2000     

Gene-environment interaction in patterns of adolescent drinking: regional residency moderates longitudinal influences on alcohol use

BACKGROUND: Drinking frequency escalates rapidly during adolescence. Abstinence declines markedly, and drinking monthly or more often becomes normative. Individual differences in adolescent drinking patterns are large, and some patterns are predictive of subsequent drinking problems; little, however, is known of the gene-environment interactions that create them. METHODS: Five consecutive and complete birth cohorts of Finnish twins, born 1975-1979, were enrolled sequentially into a longitudinal study and assessed, with postal questionnaires, at ages 16, 17, and 18.5 years. The sample included 1786 same-sex twin pairs, of whom 1240 pairs were concordantly drinking at age 16. Maximum likelihood models were fit in longitudinal analyses of the three waves of drinking data to assess changes in genetic and environmental influences on alcohol use across adolescence. Secondary analyses contrasted twin pairs residing in rural versus those in urban environments to investigate gene-environment interactions. RESULTS: Longitudinal analyses revealed that genetic factors influencing drinking patterns increased in importance across the 30-month period, and effects arising from common environmental influences declined. Distributions of drinking frequencies in twins residing in urban and rural environments were highly similar, but influences on drinking varied between the two environments. Genetic factors assumed a larger role among adolescents residing in urban areas, while common environmental influences were more important in rural settings. Formal modeling of the data established a significant gene-environment interaction. CONCLUSIONS: The results document the changing impact of genetic and environmental influences on alcohol use across adolescence. Importantly, the results also reveal a significant gene-environment interaction in patterns of adolescent drinking and invite more detailed analyses of the pathways and mechanisms by which environments modulate genetic effects.