Residential setting as a risk factor for Lyme disease in a hyperendemic region.

The hypothesis that residence in a uniform medium-density residential development is associated with lower incidence of Lyme disease is tested with data from a rural, 12-town region of south-central Connecticut where the disease is hyperendemic. The residential setting for 424 cases identified by active surveillance from 1993 through 1995 was determined. Cases located within the Eastern Coastal ecologic region, where tick densities are known to be higher than inland and where most of the population in the region resides, were selected for further analysis. Within this region, residence in a homogeneous area of medium-density development at least 30 acres (12 ha) in size was associated with a two- to 10-fold lower level of risk than residence in surrounding less developed areas, depending on the estimate of residential population. Type of residential development may be an important factor to consider, in addition to other environmental variables, in studies of peridomestic vector-borne disease in human populations.

Demographic predictors of asthma treatment site: outpatient, inpatient, or emergency department.

OBJECTIVE: To identify the demographic predictors of asthma treatment site: outpatient clinic, emergency department, or hospital. METHODS: From the November 1993 to July 1995 claims data of the University of Connecticut Health Center, asthmatic patient sex, age, racial/ethnic group, address, and health insurance status were examined to identify predictors of treatment site. Patient addresses generated maps and census data. RESULTS: 3288 visits were made by 1455 patients; 8%, 34%, and 58% came from poverty level, low, and higher income residential areas, respectively. Insurance type and then age were the most significant predictors of treatment site. Adults having commercial insurance or Medicare were most likely treated as outpatients, self-pay patients 5 times more likely in the emergency department, and those receiving public assistance 2.4 times more likely in the hospital. Only 9% of Medicaid children and 22% with commercial insurance were evaluated as outpatients. Neither sex nor race/ethnicity was an important predictor of treatment site. CONCLUSION: Although not population-based, this group of asthmatic patients represents a group diverse in socioeconomic status and racial/ethnic background. Insurance category was the most influential factor predicting asthma treatment site, suggesting that economic status may be the most important determinant of higher morbidity. Children were treated predominantly in acute care settings.

An analysis of alternative classification schemes for medical atlas mapping.

Most national disease atlases adopt a classification scheme based on either the percentile distribution of rates or on the national mean. Although these schemes have a direct interpretation, they are based on the univariate statistical distribution of rates and not on their spatial distribution, and distort the underlying spatial autocorrelation in the data. If the purpose of the maps is to represent spatial patterns, alternative classification schemes might be more appropriate. This research proposes an alternative classification method that maximises spatial similarity among contiguous units in the same class interval. The method has been illustrated using selected data from the German Cancer Atlas published in 1984.

Multiple-site physician practices and their effect on service distribution.

OBJECTIVE: This study explores the impact of multiple-site practices on the distribution of physician services within a medical service region. DATA SOURCES AND STUDY SETTING: A questionnaire was mailed to all urologists (100 percent response rate) practicing in north central Connecticut (the Hartford medical service area) and adjacent communities in September 1990. Data on community characteristics were obtained from the 1990 U.S. census and state government documents. STUDY DESIGN: Descriptive statistics and maps were used to summarize the attributes of single- and multiple-site practices and the communities where they were located. Key practice and community variables were analyzed. DATA COLLECTION/EXTRACTION METHODS: The questionnaires were coded and entered into a digital database with the tabulated community data. Responses of individual physicians were grouped by practice. PRINCIPAL FINDINGS: Multiple-site practices were common. Second-order sites accounted for 23 percent of total appointment capacity and were located in communities with higher than average elderly populations and incomes and lower than average minority populations. CONCLUSIONS: Analysis of multiple-site practices is important for the accurate assessment of medical service availability. Further research is needed to document the functioning of multiple-site practices across other specialties and geographic areas.

Nutrition service availability: an interaction potential model.

Availability, defined as a measure of the supply of services relative to the needs in the community, is critical to older people, particularly the socially isolated and frail elderly who are less mobile than most of the population. This research proposes an interaction potential model to examine variation in availability of services by considering the capacity and location of service providers and demand for these services. The model does not constrain older people to meet their demand within their towns' borders. Several measures of availability are calculated for nutrition services in an area agency on aging region of Connecticut, using different beta values to represent varying levels of mobility for the total older population; considerable variation exists, depending on mobility assumptions. Availability measures can be used as independent variables in analyses of variation in actual use of services; a strong correlation exists between use and availability in Connecticut.

Locating ambulatory medical care facilities for the elderly.

The importance of effective planning strategies for the location of primary medical services for the independently living elderly increases as their absolute number and proportion in the general population increases. Current spatial planning strategies focus on providing services in centralized locations or decentralized at the level of the somewhat problematic residential "neighborhood" or catchment area. An alternative or supplemental strategy based on the actual use of community space by the elderly is presented in this article. Aggregate activity spaces are identified and illustrated using activity location data obtained for a sample of elderly urban residents. Subsequently, the aggregate spaces are used as a basis for suggesting the location of ambulatory care facilities. It is believed that the aggregate activity space represents a dynamic and more functional approach to spatial planning strategies than current approaches and, therefore, that it can be used more effectively to locate services for the elderly.

Pharmacy patronage among the elderly: selected racial and geographical patterns.

In the United States the number of elderly and their percentage of the total population continues to increase. The large majority will never require care in an institution, yet they are faced with increasing health problems and decreased mobility, and almost half require prescription drugs to pursue activities of daily living. In this paper selected patterns of pharmacy patronage among a sample of elderly are presented. Overall, the percentage of elderly requiring prescriptions reflects national estimates and no significant difference is found in the expressed need for prescriptions between black and respondents. 'Neighborhood' pharmacies are perceived as being very important, but relatively few use the most geographically convenient. Nevertheless, the large majority of elderly are satisfied with distances they presently have to travel to purchase prescriptions. The observed travel patterns for prescription purchases suggest that conventional wisdom pertaining to the nature of the pharmacy journey, the notion of convenience and the traditional concept of neighborhood among the elderly should be reexamined.

The establishment of health maintenance organizations: a geographical analysis.

Seven characteristics of 243 Standard Metropolitan Statistical Areas (SMSAs) were subjected to discriminant analysis to determine whether they distinguish SMSAs where at least one health maintenance organization (HMO) was organized between 1972 and 1980 from SMSAs where no HMO developed. The discriminant function correctly classifies 77 per cent of the metropolitan areas considered. Presence of a medical school, regional location, and SMSA population were positively related to HMO establishment. Number of Medicare recipients per 1,000 SMSA residents was not associated with HMO development. (Am J Public Health 1983; 73:184-187.)