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1.
Int J Health Geogr ; 19(1): 8, 2020 03 11.
Article in English | MEDLINE | ID: mdl-32160889

ABSTRACT

In December 2019, a new virus (initially called 'Novel Coronavirus 2019-nCoV' and later renamed to SARS-CoV-2) causing severe acute respiratory syndrome (coronavirus disease COVID-19) emerged in Wuhan, Hubei Province, China, and rapidly spread to other parts of China and other countries around the world, despite China's massive efforts to contain the disease within Hubei. As with the original SARS-CoV epidemic of 2002/2003 and with seasonal influenza, geographic information systems and methods, including, among other application possibilities, online real-or near-real-time mapping of disease cases and of social media reactions to disease spread, predictive risk mapping using population travel data, and tracing and mapping super-spreader trajectories and contacts across space and time, are proving indispensable for timely and effective epidemic monitoring and response. This paper offers pointers to, and describes, a range of practical online/mobile GIS and mapping dashboards and applications for tracking the 2019/2020 coronavirus epidemic and associated events as they unfold around the world. Some of these dashboards and applications are receiving data updates in near-real-time (at the time of writing), and one of them is meant for individual users (in China) to check if the app user has had any close contact with a person confirmed or suspected to have been infected with SARS-CoV-2 in the recent past. We also discuss additional ways GIS can support the fight against infectious disease outbreaks and epidemics.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Geographic Information Systems , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , COVID-19 , Humans , Pandemics , Public Health , SARS-CoV-2
2.
Value Health ; 20(4): 542-546, 2017 04.
Article in English | MEDLINE | ID: mdl-28407995

ABSTRACT

OBJECTIVE: The objective of this study was to estimate travel-related and environmental savings resulting from the use of telemedicine for outpatient specialty consultations with a university telemedicine program. METHODS: The study was designed to retrospectively analyze the telemedicine consultation database at the University of California Davis Health System (UCDHS) between July 1996 and December 2013. Travel distances and travel times were calculated between the patient home, the telemedicine clinic, and the UCDHS in-person clinic. Travel cost savings and environmental impact were calculated by determining differences in mileage reimbursement rate and emissions between those incurred in attending telemedicine appointments and those that would have been incurred if a visit to the hub site had been necessary. RESULTS: There were 19,246 consultations identified among 11,281 unique patients. Telemedicine visits resulted in a total travel distance savings of 5,345,602 miles, a total travel time savings of 4,708,891 minutes or 8.96 years, and a total direct travel cost savings of $2,882,056. The mean per-consultation round-trip distance savings were 278 miles, average travel time savings were 245 minutes, and average cost savings were $156. Telemedicine consultations resulted in a total emissions savings of 1969 metric tons of CO2, 50 metric tons of CO, 3.7 metric tons of NOx, and 5.5 metric tons of volatile organic compounds. CONCLUSIONS: This study demonstrates the positive impact of a health system's outpatient telemedicine program on patient travel time, patient travel costs, and environmental pollutants.


Subject(s)
Ambulatory Care/methods , Efficiency , Environmental Pollutants/adverse effects , Health Care Costs , Hospitals, University , Remote Consultation/methods , Transportation/economics , Vehicle Emissions/prevention & control , Ambulatory Care/economics , California , Cost Savings , Cost-Benefit Analysis , Environmental Monitoring , Humans , Program Evaluation , Remote Consultation/economics , Retrospective Studies , Time Factors , Time and Motion Studies
3.
Telemed J E Health ; 23(5): 430-434, 2017 05.
Article in English | MEDLINE | ID: mdl-27835073

ABSTRACT

BACKGROUND: Geospatial Information Systems (GIS) superimpose data on geographical maps to provide visual representations of data by region. Few studies have used GIS data to investigate if telemedicine services are preferentially provided to communities of greatest need. INTRODUCTION: This study compared the healthcare needs of communities with and without telemedicine services from a university-based telemedicine program. METHODS: Originating sites for all telemedicine consultations between July 1996 and December 2013 were geocoded using ArcGIS software. ZIP Code Tabulation Areas (ZCTAs) were extracted from the 2010 U.S. Census Bureau's Topologically Integrated Geographic Encoding and Referencing file and assigned a community needs index (CNI) score to reflect the ZCTA community's healthcare needs based on evidence-based barriers to healthcare access. CNI scores were compared across communities with and without active telemedicine services. RESULTS: One hundred ninety-four originating telemedicine clinic sites in California were evaluated. The mean CNI score for ZCTAs with at least one telemedicine clinic was significantly higher (3.32 ± 0.84) than those without a telemedicine site (2.95 ± 0.99) and higher than the mean ZCTAs for all of California (2.99 ± 1.01). Of the 194 telemedicine clinics, 71.4% were located in communities with above average need and 33.2% were located in communities with very high needs. DISCUSSION: Originating sites receiving telemedicine services from a university-based telemedicine program were located in regions with significantly higher community healthcare needs. Leveraging a geospatial information system to understand community healthcare needs provides an opportunity for payers, hospitals, and patients to be strategic in the allocation of telemedicine services.


Subject(s)
Community Health Services/statistics & numerical data , Geographic Information Systems , Health Services Accessibility/statistics & numerical data , Needs Assessment/statistics & numerical data , Rural Health Services/statistics & numerical data , Telemedicine/statistics & numerical data , California , Humans
4.
J Infect Public Health ; 10(1): 120-123, 2017.
Article in English | MEDLINE | ID: mdl-27707632

ABSTRACT

As evidence linking Zika virus with serious health complications strengthens, public health officials and clinicians worldwide need to know which locations are likely to be at risk for autochthonous Zika infections. We created risk maps for epidemic and endemic Aedes-borne Zika virus infections globally using a predictive analysis method that draws on temperature, precipitation, elevation, land cover, and population density variables to identify locations suitable for mosquito activity seasonally or year-round. Aedes mosquitoes capable of transmitting Zika and other viruses are likely to live year-round across many tropical areas in the Americas, Africa, and Asia. Our map provides an enhanced global projection of where vector control initiatives may be most valuable for reducing the risk of Zika virus and other Aedes-borne infections.


Subject(s)
Aedes/growth & development , Disease Transmission, Infectious , Mosquito Vectors , Phylogeography , Zika Virus Infection/epidemiology , Zika Virus Infection/transmission , Zika Virus/isolation & purification , Aedes/virology , Animals , Global Health , Humans , Topography, Medical
5.
J Psychosom Res ; 82: 11-16, 2016 Mar.
Article in English | MEDLINE | ID: mdl-26944393

ABSTRACT

OBJECTIVE: We investigated the associations between DSM-IV mental disorders and subsequent arthritis onset, with and without mental disorder comorbidity adjustment. We aimed to determine whether specific types of mental disorders and increasing numbers of mental disorders were associated with the onset of arthritis later in life. METHOD: Data were collected using face-to-face household surveys, conducted in 19 countries from different regions of the world (n=52,095). Lifetime prevalence and age at onset of 16 DSM-IV mental disorders were assessed retrospectively with the World Health Organization (WHO) Composite International Diagnostic Interview (WHO-CIDI). Arthritis was assessed by self-report of lifetime history of arthritis and age at onset. Survival analyses estimated the association of initial onset of mental disorders with subsequent onset of arthritis. RESULTS: After adjusting for comorbidity, the number of mood, anxiety, impulse-control, and substance disorders remained significantly associated with arthritis onset showing odds ratios (ORs) ranging from 1.2 to 1.4. Additionally, the risk of developing arthritis increased as the number of mental disorders increased from one to five or more disorders. CONCLUSION: This study suggests links between mental disorders and subsequent arthritis onset using a large, multi-country dataset. These associations lend support to the idea that it may be possible to reduce the severity of mental disorder-arthritis comorbidity through early identification and effective treatment of mental disorders.


Subject(s)
Arthritis/epidemiology , Arthritis/psychology , Mental Disorders/complications , Mental Disorders/epidemiology , Adolescent , Adult , Age of Onset , Anxiety Disorders/complications , Anxiety Disorders/epidemiology , Arthritis/prevention & control , Comorbidity , Databases, Factual , Diagnostic and Statistical Manual of Mental Disorders , Female , Humans , Impulsive Behavior , Male , Mood Disorders/complications , Mood Disorders/epidemiology , Odds Ratio , Prevalence , Retrospective Studies , Self Report , Severity of Illness Index , Substance-Related Disorders/complications , Substance-Related Disorders/epidemiology , Young Adult
6.
Environ Health Perspect ; 122(10): 1103-9, 2014 Oct.
Article in English | MEDLINE | ID: mdl-24954055

ABSTRACT

BACKGROUND: Gestational exposure to several common agricultural pesticides can induce developmental neurotoxicity in humans, and has been associated with developmental delay and autism. OBJECTIVES: We evaluated whether residential proximity to agricultural pesticides during pregnancy is associated with autism spectrum disorders (ASD) or developmental delay (DD) in the Childhood Autism Risks from Genetics and Environment (CHARGE) study. METHODS: The CHARGE study is a population-based case-control study of ASD, DD, and typical development. For 970 participants, commercial pesticide application data from the California Pesticide Use Report (1997-2008) were linked to the addresses during pregnancy. Pounds of active ingredient applied for organophophates, organochlorines, pyrethroids, and carbamates were aggregated within 1.25-km, 1.5-km, and 1.75-km buffer distances from the home. Multinomial logistic regression was used to estimate the odds ratio (OR) of exposure comparing confirmed cases of ASD (n = 486) or DD (n = 168) with typically developing referents (n = 316). RESULTS: Approximately one-third of CHARGE study mothers lived, during pregnancy, within 1.5 km (just under 1 mile) of an agricultural pesticide application. Proximity to organophosphates at some point during gestation was associated with a 60% increased risk for ASD, higher for third-trimester exposures (OR = 2.0; 95% CI: 1.1, 3.6), and second-trimester chlorpyrifos applications (OR = 3.3; 95% CI: 1.5, 7.4). Children of mothers residing near pyrethroid insecticide applications just before conception or during third trimester were at greater risk for both ASD and DD, with ORs ranging from 1.7 to 2.3. Risk for DD was increased in those near carbamate applications, but no specific vulnerable period was identified. CONCLUSIONS: This study of ASD strengthens the evidence linking neurodevelopmental disorders with gestational pesticide exposures, particularly organophosphates, and provides novel results of ASD and DD associations with, respectively, pyrethroids and carbamates.


Subject(s)
Carbamates/toxicity , Developmental Disabilities/epidemiology , Environmental Exposure/statistics & numerical data , Organophosphates/toxicity , Pesticides/toxicity , Pyrethrins/toxicity , Adult , California/epidemiology , Case-Control Studies , Child Development Disorders, Pervasive/epidemiology , Child, Preschool , Environmental Exposure/adverse effects , Female , Humans , Hydrocarbons, Chlorinated/toxicity , Male , Odds Ratio , Pregnancy , Prenatal Exposure Delayed Effects/epidemiology , Residence Characteristics
7.
Int J Drug Policy ; 25(2): 244-50, 2014 Mar.
Article in English | MEDLINE | ID: mdl-24495711

ABSTRACT

BACKGROUND: More than 50,000 new HIV infections occur annually in the United States. Injection drug users represent twelve percent of incident HIV infections each year. Pharmacy sales of over-the-counter (OTC) syringes have helped prevent HIV transmission among injection drug users in many states throughout the United States. However, concerns exist among some law enforcement officials, policymakers, pharmacists, and community members about potential links between OTC syringe sales and crime. METHODS: We used a geographic information system and novel spatial and longitudinal analyses to determine whether implementation of pharmacy-based OTC syringe sales were associated with reported crime between January 2006 and December 2008 in Los Angeles Police Department Reporting Districts. We assessed reported crime pre- and post-OTC syringe sales initiation as well as longitudinal associations between crime and OTC syringe-selling pharmacies. RESULTS: By December 2008, 9.3% (94/1010) of Los Angeles Police Department Reporting Districts had at least one OTC syringe-selling pharmacy. Overall reported crime counts and reported crime rates decreased between 2006 and 2008 in all 1010 Reporting Districts. Using generalized estimating equations and adjusting for potential confounders, reported crime rates were negatively associated with OTC syringe sales (adjusted rate ratio: 0.89; 95% confidence interval: 0.81, 0.99). CONCLUSION: Our findings demonstrate that OTC pharmacy syringe sales were not associated with increases in reported crime in local communities in Los Angeles during 2006-2008.


Subject(s)
Commerce/statistics & numerical data , Crime/statistics & numerical data , Pharmacies/statistics & numerical data , Syringes , Drug Users , Geographic Information Systems , Los Angeles , Models, Statistical
8.
Am J Public Health ; 104 Suppl 1: S183-9, 2014 Feb.
Article in English | MEDLINE | ID: mdl-24354821

ABSTRACT

OBJECTIVES: We used a geographic information system and cluster analyses to determine locations in need of enhanced Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Program services. METHODS: We linked documented births in the 2010 California Birth Statistical Master File with the 2010 data from the WIC Integrated Statewide Information System. Analyses focused on the density of pregnant women who were eligible for but not receiving WIC services in California's 7049 census tracts. We used incremental spatial autocorrelation and hot spot analyses to identify clusters of WIC-eligible nonparticipants. RESULTS: We detected clusters of census tracts with higher-than-expected densities, compared with the state mean density of WIC-eligible nonparticipants, in 21 of 58 (36.2%) California counties (P < .05). In subsequent county-level analyses, we located neighborhood-level clusters of higher-than-expected densities of eligible nonparticipants in Sacramento, San Francisco, Fresno, and Los Angeles Counties (P < .05). CONCLUSIONS: Hot spot analyses provided a rigorous and objective approach to determine the locations of statistically significant clusters of WIC-eligible nonparticipants. Results helped inform WIC program and funding decisions, including the opening of new WIC centers, and offered a novel approach for targeting public health services.


Subject(s)
Food Assistance , California/epidemiology , Child, Preschool , Cluster Analysis , Female , Food Assistance/statistics & numerical data , Geographic Information Systems , Humans , Infant , Pregnancy , Residence Characteristics/statistics & numerical data , Spatial Analysis
9.
Child Indic Res ; 6(2): 257-280, 2013 Jun.
Article in English | MEDLINE | ID: mdl-23646098

ABSTRACT

Extant measures of adolescent well-being in the United States typically focus on negative indicators of youth outcomes. Indices comprised of such measures paint bleak views of youth and orient action toward the prevention of problems over the promotion of protective factors. Their tendency to focus analyses at a state or county geographic scale produces limited information about localized outcome patterns that could inform policymakers, practitioners and advocacy networks. We discuss the construction of a new geo-referenced index of youth well-being based on positive indicators of youth development. In demonstrating the index for the greater Sacramento, California region of the United States, we find that overall youth well-being falls far short of an optimal outcome, and geographic disparities in well-being appear to exist across school districts at all levels of our analysis. Despite its limitations, the sub-county geographic scale of this index provides needed data to facilitate local and regional interventions.

10.
Public Health Rep ; 128(3): 221-30, 2013.
Article in English | MEDLINE | ID: mdl-23633737

ABSTRACT

OBJECTIVES: Insecticides reduce vector-borne pathogen transmission but also pose health risks. In August 2005, Sacramento County, California, underwent emergency aerial ultralow-volume (ULV) application of pyrethrin insecticide to reduce the population of West Nile virus (WNV)-infected mosquitoes and thereby interrupt enzootic and tangential transmission. We assessed the association between aerially applied pyrethrin insecticide and patterns of emergency department (ED) visit diagnoses. METHODS: We used geographic information systems software to determine ZIP Code-level exposure to pyrethrin. We used logistic regression models to examine the relationship between exposure status and three-digit International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes (785 in total) for all ED visits (n=253,648) within Sacramento County in 2005 and for specific diagnostic clusters (e.g., respiratory, gastrointestinal, skin, eye, and neurologic). All models were adjusted for age, gender, race/ethnicity (individual level), median income, ozone, and temperature (ZIP Code level). RESULTS: Exposure to aerially applied insecticide was not associated with clusters of respiratory, gastrointestinal, skin, eye, and neurologic complaints in adjusted models but was inversely associated with ICD-9-CM code 799 ("other ill-defined morbidity and mortality"), with adjusted odds ratios (AORs) ranging from 0.31 to 0.36 for 0-3 lag days (95% confidence interval 0.17, 0.68). Spraying was also directly associated with ICD-9-CM code 553 ("other abdominal hernia"), with AORs ranging from 2.34 to 2.96 for 2-3 lag days. CONCLUSIONS: The observed significant ICD-9-CM code associations likely represented chance findings. Aerial ULV pyrethrin applications were not associated with ED visits for specific diagnoses or clusters of diagnoses.


Subject(s)
Emergency Service, Hospital/statistics & numerical data , Infectious Disease Transmission, Vertical/prevention & control , Insecticides/administration & dosage , Pyrethrins/administration & dosage , West Nile Fever/transmission , West Nile virus/drug effects , Adolescent , Adult , Aged , California , Child , Child, Preschool , Cluster Analysis , Environmental Exposure , Female , Geographic Information Systems , Humans , Logistic Models , Male , Middle Aged , Mosquito Control/methods , West Nile Fever/diagnosis , Young Adult
11.
J Urban Health ; 90(6): 1079-90, 2013 Dec.
Article in English | MEDLINE | ID: mdl-23567984

ABSTRACT

Community pharmacies serve as key locations for public health services including interventions to enhance the availability of syringes sold over-the-counter (OTC), an important strategy to prevent injection-mediated HIV transmission. Little is known about the community characteristics associated with the availability of pharmacies and pharmacies that sell syringes OTC. We conducted multivariable regression analyses to determine whether the sociodemographic characteristics of census tract residents were associated with pharmacy presence in Los Angeles (LA) County during 2008. Using a geographic information system, we conducted hot-spot analyses to identify clusters of pharmacies, OTC syringe-selling pharmacies, sociodemographic variables, and their relationships. For LA County census tracts (N = 2,054), population size (adjusted odds ratio [AOR], 1.22; 95 % confidence interval [CI], 1.16, 1.28), median age of residents (AOR, 1.03; 95 % CI, 1.01, 1.05), and the percent of households receiving public assistance (AOR, 0.97; 95 % CI, 0.94, 0.99) were independently associated with the presence of all pharmacies. Only 12 % of census tracts had at least one OTC syringe-selling pharmacy and sociodemographic variables were not independently associated with the presence of OTC syringe-selling pharmacies. Clusters of pharmacies (p < 0.01) were located proximally to clusters of older populations and were distant from clusters of poorer populations. Our combined statistical and spatial analyses provided an innovative approach to assess the sociodemographic and geographic factors associated with the presence of community pharmacies and pharmacies that participate in OTC syringe sales.


Subject(s)
Community Pharmacy Services/statistics & numerical data , Racial Groups/statistics & numerical data , Residence Characteristics/statistics & numerical data , Syringes/supply & distribution , Adolescent , Adult , Age Factors , Female , HIV Infections/prevention & control , Humans , Los Angeles , Male , Public Assistance/statistics & numerical data , Regression Analysis , Socioeconomic Factors , Urban Health , Young Adult
12.
Am J Epidemiol ; 176(1): 14-23, 2012 Jul 01.
Article in English | MEDLINE | ID: mdl-22562660

ABSTRACT

Since 2005, California law allowed over-the-counter (OTC) syringe sales pending local authorization. Although pharmacy sales of OTC syringes are associated with reduced injection-mediated risks and decreases in human immunodeficiency virus infection rates, little is known about the factors associated with syringe purchase among injection drug users (IDUs). Using a cross-sectional design, the authors applied targeted sampling to collect quantitative survey data from IDUs (n = 563) recruited in San Francisco, California, during 2008. They also compiled a comprehensive list of retail pharmacies, their location, and whether they sell OTC syringes. They used a novel combination of geographic information system and statistical analyses to determine the demographic, behavioral, and spatial factors associated with OTC syringe purchase by IDUs. In multivariate analyses, age, race, injection frequency, the type of drug injected, and the source of syringe supply were independently associated with OTC syringe purchases. Notably, the prevalence of OTC syringe purchase was 53% lower among African-American IDUs (adjusted prevalence ratio = 0.47, 95% confidence interval: 0.33, 0.67) and higher among injectors of methamphetamine (adjusted prevalence ratio = 1.35, 95% confidence interval: 1.07, 1.70). Two neighborhoods with high densities of IDUs had limited access to OTC syringes. Increased access to OTC syringes would potentially prevent blood-borne infectious diseases among IDUs.


Subject(s)
Commerce , Disease Transmission, Infectious/prevention & control , Drug Users , Pharmacies , Residence Characteristics , Substance Abuse, Intravenous , Syringes , Adult , Cross-Sectional Studies , Dangerous Behavior , Drug Users/psychology , Female , Geographic Information Systems , Health Surveys , Humans , Male , Middle Aged , Multivariate Analysis , Regression Analysis , Risk , San Francisco , Socioeconomic Factors , Substance Abuse, Intravenous/ethnology , Substance Abuse, Intravenous/psychology , Syringes/economics
13.
J Organ End User Comput ; 23(4): 17-30, 2011.
Article in English | MEDLINE | ID: mdl-24729759

ABSTRACT

In this paper, the authors present the results of a qualitative case-study seeking to characterize data discovery needs and barriers of principal investigators and research support staff in clinical translational science. Several implications for designing and implementing translational research systems have emerged through the authors' analysis. The results also illustrate the benefits of forming early partnerships with scientists to better understand their workflow processes and end-user computing practices in accessing data for research. The authors use this user-centered, iterative development approach to guide the implementation and extension of i2b2, a system they have adapted to support cross-institutional aggregate anonymized clinical data querying. With ongoing evaluation, the goal is to maximize the utility and extension of this system and develop an interface that appropriately fits the swiftly evolving needs of clinical translational scientists.

14.
Am J Respir Crit Care Med ; 182(2): 269-77, 2010 Jul 15.
Article in English | MEDLINE | ID: mdl-20339144

ABSTRACT

RATIONALE: Although obstructive sleep apnea is associated with physiological perturbations that increase risk of hypertension and are proatherogenic, it is uncertain whether sleep apnea is associated with increased stroke risk in the general population. OBJECTIVES: To quantify the incidence of ischemic stroke with sleep apnea in a community-based sample of men and women across a wide range of sleep apnea. METHODS: Baseline polysomnography was performed between 1995 and 1998 in a longitudinal cohort study. The primary exposure was the obstructive apnea-hypopnea index (OAHI) and outcome was incident ischemic stroke. MEASUREMENTS AND MAIN RESULTS: A total of 5,422 participants without a history of stroke at the baseline examination and untreated for sleep apnea were followed for a median of 8.7 years. One hundred ninety-three ischemic strokes were observed. In covariate-adjusted Cox proportional hazard models, a significant positive association between ischemic stroke and OAHI was observed in men (P value for linear trend: P = 0.016). Men in the highest OAHI quartile (>19) had an adjusted hazard ratio of 2.86 (95% confidence interval, 1.1-7.4). In the mild to moderate range (OAHI, 5-25), each one-unit increase in OAHI in men was estimated to increase stroke risk by 6% (95% confidence interval, 2-10%). In women, stroke was not significantly associated with OAHI quartiles, but increased risk was observed at an OAHI greater than 25. CONCLUSIONS: The strong adjusted association between ischemic stroke and OAHI in community-dwelling men with mild to moderate sleep apnea suggests that this is an appropriate target for future stroke prevention trials.


Subject(s)
Sleep Apnea, Obstructive/epidemiology , Stroke/epidemiology , Aged , Female , Humans , Longitudinal Studies , Male , Middle Aged , Polysomnography , Proportional Hazards Models , Prospective Studies , Severity of Illness Index , Sex Factors
15.
J Am Board Fam Med ; 23(1): 88-96, 2010.
Article in English | MEDLINE | ID: mdl-20051547

ABSTRACT

OBJECTIVES: Geographic information systems (GIS) tools can help expand our understanding of disparities in health outcomes within a community. The purpose of this project was (1) to demonstrate the methods to link a disease management registry with a GIS mapping and analysis program, (2) to address the challenges that occur when performing this link, and (3) to analyze the outcome disparities resulting from this assessment tool in a population of patients with type 2 diabetes mellitus. METHODS: We used registry data derived from the University of California Davis Health System's electronic medical record system to identify patients with diabetes mellitus from a network of 13 primary care clinics in the greater Sacramento area. This information was converted to a database file for use in the GIS software. Geocoding was performed and after excluding those who had unknown home addresses we matched 8528 unique patient records with their respective home addresses. Socioeconomic and demographic data were obtained from the Geolytics, Inc. (East Brunswick, NJ), a provider of US Census Bureau data, with 2008 estimates and projections. Patient, socioeconomic, and demographic data were then joined to a single database. We conducted regression analysis assessing A1c level based on each patient's demographic and laboratory characteristics and their neighborhood characteristics (socioeconomic status [SES] quintile). Similar analysis was done for low-density lipoprotein cholesterol. RESULTS: After excluding ineligible patients, the data from 7288 patients were analyzed. The most notable findings were as follows: There was, there was found an association between neighborhood SES and A1c. SES was not associated with low-density lipoprotein control. CONCLUSION: GIS methodology can assist primary care physicians and provide guidance for disease management programs. It can also help health systems in their mission to improve the health of a community. Our analysis found that neighborhood SES was a barrier to optimal glucose control but not to lipid control. This research provides an example of a useful application of GIS analyses applied to large data sets now available in electronic medical records.


Subject(s)
Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/therapy , Geographic Information Systems , Healthcare Disparities/statistics & numerical data , Hypercholesterolemia/epidemiology , Hypercholesterolemia/therapy , Outcome Assessment, Health Care/statistics & numerical data , Aged , California , Cholesterol, LDL/blood , Diabetes Mellitus, Type 2/blood , Disease Management , Female , Glycated Hemoglobin/metabolism , Humans , Hypercholesterolemia/blood , Logistic Models , Male , Medical Records Systems, Computerized/statistics & numerical data , Middle Aged , Needs Assessment/statistics & numerical data , Registries , Socioeconomic Factors
16.
J Occup Environ Med ; 50(3): 249-54, 2008 Mar.
Article in English | MEDLINE | ID: mdl-18332774

ABSTRACT

OBJECTIVE: To estimate the effects of increasing gas prices on mortality. METHOD: We developed a simulation-based partial equilibrium model that estimated the public health effects of a 20% rise in gas prices. Estimates on price elasticity for gasoline, price elasticity of motor vehicle crashes, relations among gasoline use, air pollution, and mortality were drawn from literature in economics, epidemiology, and medicine. RESULTS: For sustained 20% increases in gasoline prices over 1 year, and assuming other prices and factors were constant, we estimated: 1994 (range, 997 to 4984) fewer deaths from vehicle crashes and 600 (range, 300 to 1500) fewer deaths from air pollution. Combining both, we estimated 2594 fewer deaths. A Monte Carlo simulation involving varying assumptions on elasticities and relations indicated that 95% of the combined reduction in deaths was between 1747 and 3714. CONCLUSION: Results suggest that high gas prices have public health implications.


Subject(s)
Accidents, Traffic/mortality , Air Pollution/prevention & control , Commerce/economics , Gasoline/economics , Vehicle Emissions/prevention & control , Accidents, Traffic/prevention & control , Air Pollutants , Computer Simulation , Humans , Models, Econometric , Monte Carlo Method , Particulate Matter , United States/epidemiology
17.
J Gen Intern Med ; 22(12): 1641-7, 2007 Dec.
Article in English | MEDLINE | ID: mdl-17922171

ABSTRACT

BACKGROUND: The contribution of physician and organizational factors to visit length, quality, and satisfaction remains uncertain, in part, because of confounding by patient presentation. OBJECTIVE: To determine associations among visit length, quality, and satisfaction when patient presentation is controlled. DESIGN: A factorial experiment using standardized patients to make primary care visits presenting with either major depression or adjustment disorder, and a musculoskeletal complaint. PARTICIPANTS: One hundred fifty-two primary care physicians, each seeing 2 standardized patients. MEASUREMENTS: Visit length was determined from surreptitiously obtained audiorecordings. Other key measures were derived from physician and standardized patient report. RESULTS: Mean visit length for 294 completed encounters was 22.3 minutes (range = 5.8-72.2, SD = 9.4). Key factors associated with visit length were: physician style (rho = 0.68 and 0.54 after multivariate adjustment), nonprofessional experience with depression (11% longer, 95% CI = 0-23%), practicing within an HMO (26% shorter, 95% CI = 61-90%), and greater practice volume (those working >9 half-day clinic sessions/week had 15% shorter visits than those working fewer than 6, 95% CI = 0-27%, and those seeing >12 patients/half-day had 27% shorter visits than those seeing <10 patients/half-day, 95% CI = 13-39%). Suicidal inquiry (a process-based quality-of-care measure for depression) was not associated with adjusted visit length. Satisfaction was linearly associated with visit length but not with suicide inquiry or follow-up interval. CONCLUSIONS: Despite experimental control for clinical presentation, wide variation in visit length persists, largely reflecting individual physician styles. Visit length is a significant determinant of standardized patient satisfaction.


Subject(s)
Depressive Disorder/therapy , Patient Satisfaction , Physician-Patient Relations , Primary Health Care/standards , Quality Indicators, Health Care , Adult , Female , Health Maintenance Organizations/standards , Humans , Male , Medical Audit , Middle Aged , Office Visits , Patient Simulation , Surveys and Questionnaires , Time Factors , Workload/statistics & numerical data
19.
Radiology ; 228(2): 352-60, 2003 Aug.
Article in English | MEDLINE | ID: mdl-12893897

ABSTRACT

PURPOSE: To determine size-dependent technique factors for pediatric computed tomography (CT) by using physically measured objective data. MATERIALS AND METHODS: Six phantom cylinders (10-32 cm in diameter) were scanned with a clinical multi-detector row CT scanner. CT noise was statistically characterized for CT technique factors from 80 to 140 kVp and from 10 to 300 mAs. Dose measurements were performed with each phantom. Dilute iodine and tissue contrast were determined with computer calculations validated with measured data. The dose, noise, and contrast data were computer fit, and pediatric CT technique factors (milliampere seconds) necessary to maintain the contrast-to-noise ratio (CNR) were computed. RESULTS: As compared with that in a reference cylindric adult abdomen of 28 cm in diameter, CNR was maintained at a constant level in pediatric patients of 25, 20, and 15 cm in diameter, respectively, when milliampere second values of 0.557, 0.196, and 0.054 of the adult milliampere second values were used. The corresponding doses were reduced to 0.642, 0.287, and 0.090 of the 28-cm-diameter adult dose, respectively. CT techniques for examination of pediatric heads measuring 15 and 13 cm, respectively, can involve the use of milliampere second values of 0.572 and 0.366 of those used for examination of a standard 17-cm-diameter adult head. CONCLUSION: CT technique charts for pediatric abdominal and head examinations were produced on the basis of physically measured data; use of these tables will enable pediatric radiation dose to be reduced while CNR is preserved.


Subject(s)
Pediatrics , Radiation Dosage , Tomography Scanners, X-Ray Computed , Tomography, X-Ray Computed/methods , Adult , Humans , Linear Models , Phantoms, Imaging , Radiography, Abdominal
20.
Radiology ; 228(3): 857-63, 2003 Sep.
Article in English | MEDLINE | ID: mdl-12881576

ABSTRACT

Techniques for estimation of an individual's height, weight, body mass index (BMI), and body surface area (BSA) with a single abdominal computed tomographic (CT) image were developed. Eighty-seven abdominal CT examinations performed in adult humans were analyzed. Anatomic structures were outlined on the CT section that included L1. Multiple linear regression analysis was used to derive sex-specific predictive equations. Correlation for height was good (r > 0.65). Relationship between predicted weight and actual weight was good (r > 0.93). For BMI and BSA, r was greater than 0.893 and greater than 0.895, respectively. In this study, predictive equations for height, weight, BMI, and BSA were generated.


Subject(s)
Body Height , Body Mass Index , Body Surface Area , Body Weight , Radiography, Abdominal , Tomography, X-Ray Computed/methods , Female , Humans , Male , Middle Aged , Regression Analysis , Reproducibility of Results , Retrospective Studies
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