Clot waveform analysis of prolonged activated partial thromboplastin time in various disorders.

INTRODUCTION: The prolongation in APTT reflects various disorders affecting the blood coagulation system. Automated coagulation analyzers such as ACL TOP, help in evaluating the clotting cascade by displaying clot reaction curves or waveforms. The fibrin formation curve forms S-shaped curve showing the changes in the absorbance on X-axis and time in seconds on Y-axis. The clotting data is processed to obtain derivatives. MATERIALS AND METHODS: This observational study analyzed 80 samples including 20 samples from normal healthy individuals as control. The parameters studied were time (secs), height (mAbs), and width (secs) of first derivative (FD), fibrin clot time at ½ height, height (mAbs), and width (secs) of both first and second peaks of second derivative (SD). RESULT AND DISCUSSION: Hemophilia (n = 13) that consisted of factor VIII deficiency (n = 11) and factor IX deficiency (n = 2) showed biphasic patterns in both first DC and second DC. Cases with thrombosis (n = 8) showed marked elevation in first DC. Various other disorders (n = 39) that consisted of mainly hepatic dysfunction (n = 24) showed prolongation in fibrin formation, first DC, and second DC peak time. CONCLUSION: The atypical derivative curve analysis helps in determining the interferences in clotting cascade. It gives significant information and provides direction for further testing.

Validating self-reported mammography use in vulnerable communities: findings and recommendations.

BACKGROUND: Most health surveys ask women whether they have had a recent mammogram, all of which report mammography use (past 2 years) at about 70% to 80% regardless of race or residence. We examined the potential extent of overreporting of mammography use in low income African-American and Latina women, and whether self-report inaccuracies might bias estimated associations between patient characteristics and mammography use. METHODS: Using venue-based sampling in two poor communities on the west side of Chicago, we asked eligible women living in two west side communities of Chicago to complete a survey about breast health (n = 2,200) and to provide consent to view their medical record. Of the 1,909 women who screened eligible for medical record review, 1,566 consented (82%). We obtained medical records of all women who provided both permission and a valid local mammography facility (n = 1,221). We compared the self-reported responses from the survey with the imaging reports found in the medical record (documented). To account for missing data, we conducted multiple imputations for key demographic variables and report standard measures of accuracy. RESULTS: Although 73% of women self-reported a mammogram in the last 2 years, only 44% of self-reports were documented. Overreporting of mammography use was observed for all three ethnic groups. CONCLUSIONS: These results suggest considerable overestimation of prevalence of use in these vulnerable populations. IMPACT: Relying on known faulty self-reported mammography data as a measure of mammography use provides an overly optimistic picture of utilization, a problem that may be exacerbated in vulnerable minority communities.

Comparing selected measures of health outcomes and health-seeking behaviors in Chinese, Cambodian, and Vietnamese communities of Chicago: results from local health surveys.

We describe how local community organizations partnered to conduct a survey in the Chinese, Cambodian, and Vietnamese populations of Chicago to compare health outcomes and assess progress toward Healthy People 2010 goals. Interviews were conducted with 380 randomly selected Chinese adults through door-to-door sampling, and with 250 Cambodian adults and 150 Vietnamese adults through respondent-driven sampling. Data on 14 key health outcomes are described for this analysis. The three surveyed communities were generally poorer, less educated, more often foreign-born, and had less English proficiency than Asians nationally. There were few significant variations among the three populations, but there were notable differences in the burden of tuberculosis, obesity, diabetes, and arthritis. Insurance coverage and cancer-screening utilization were also significantly lower than for US Asians. Health information about Chinese, Cambodian, and Vietnamese populations in Chicago are available for the first time and serve as baseline data for community interventions. Findings highlight important health concerns for these populations and have implications for funders and policy makers in allocating resources, setting health priorities, and addressing health disparities.

Prevalence of obesity among children in six Chicago communities: findings from a health survey.

OBJECTIVES: We analyzed data from a community health survey to assess levels of obesity and overweight among children in some Chicago communities compared with national U.S. estimates. METHODS: Data came from the Sinai Improving Community Health Survey, which was conducted via face-to-face interviews with people living in six racially and ethnically diverse Chicago communities during 2002 and 2003. A stratified, three-stage probability study design was employed to obtain a representative sample from each community. Height and weight data reported by the primary caretakers of 501 randomly selected children aged 2-12 years were used to determine age- and gender-specific body mass index (BMI), which was then used to classify weight status (obese > or =95th percentile for age and gender). RESULTS: Compared with 16.8% for the U.S., the prevalence of obesity was 11.8% in a non-Hispanic white community on Chicago's north side, 34.0% in a Mexican American community on the west side, and 56.4% in a non-Hispanic black community on the south side. CONCLUSIONS: Surveillance of the childhood obesity epidemic at the local level is limited. Findings describe the extent of disparities in childhood overweight and obesity within one city and how local-level data can shape new initiatives for improved health, one community at a time.

Mammography screening in six diverse communities in Chicago--a population study.

BACKGROUND: Despite the fact that recent studies suggest a narrowing in access to mammography, Black women are much more likely to die from breast cancer than White women. Data at the community level regarding mammography screening can help explain health disparities and inform plans for improved screening efforts. METHODS: In 2002-2003, a comprehensive household health survey in English or Spanish was conducted in six community areas with 1700 households. The module on mammography was based on a state-based nationwide health survey and included questions on frequency of mammography, repeat screenings, and several demographic variables. RESULTS: The proportion of women >or=40 years (n=482) who received a mammogram in the past 2 years ranged from 74% to 90% across the six communities. The community with the highest screening proportion was predominantly Mexican and included recent immigrants. The screening proportion in the poorest community area, which was all Black, was 77%. Women with health insurance, higher income, and more education were more likely to receive a mammogram. Proportions for women >or=50 years (n=286) were slightly higher but similar. Repeat screening, which is recommended, occurred at lower levels. CONCLUSIONS: Access to and utilization of mammography have grown in recent years so that even these vulnerable communities had screening proportions at or even higher than the national average and the Healthy People Year 2010 objective. Nonetheless, repeat screening sequences were lower and may require attention if mammography screening efforts are to have a greater impact on female breast cancer mortality.

Disproportionate impact of diabetes in a Puerto Rican community of Chicago.

We assessed the impact of diabetes in a large Puerto Rican community of Chicago by measuring the prevalence of diagnosed diabetes and calculating the diabetes mortality rate. Data were analyzed from a comprehensive health survey conducted in randomly selected households in community areas. Questions on diagnosed diabetes and selected risk factors were asked. In addition, vital records data were analyzed in order to calculate the age-adjusted diabetes mortality rate. When possible, rates were compared to those found in other studies. The diabetes prevalence located in this community (20.8%: 95% CI = 10.1%-38.0%) is the highest ever reported for Puerto Ricans and one of the highest ever reported in the United States for a non-Native American population. For instance, it is twice the prevalence for Puerto Ricans in New York (11.3%) and Puerto Rico (9.3%-9.6%). Diagnosed diabetes was found to be significantly associated with obesity (p = 0.023). The prevalence was particularly high among older people, females, those born in the US, and those with a family history of diabetes. Notably, the diabetes mortality rate (67.6 per 100,000 population) was more than twice the rate for all of Chicago (31.2) and the US (25.4). Understanding why the diabetes prevalence and mortality rates for Puerto Ricans in this community are so much higher than those of other communities is imperative for primary and secondary prevention. Collaboration between researchers, service providers and community members can help address the issues of diabetes education, early screening and diagnosis, and effective treatment needed in this community.

Variations in the health conditions of 6 Chicago community areas: a case for local-level data.

OBJECTIVES: Although local-level chronic disease and risk factor data are not typically available, they are valuable for guiding public health interventions and policies. To present a case for disaggregated community-level health data, we conducted a study exploring the relevance of such data to research on health disparities. METHODS: We designed a population-based health survey to gather information on many health measures, 13 of which are presented here. Interviews were conducted with 1699 adults (18-75 years) in 6 Chicago community areas between September 2002 and April 2003. RESULTS: Statistically significant variations in health measures were found between the 6 communities themselves (108 of 195 pairwise comparisons were significant) and between the communities and Chicago as a whole (35 of 54 comparisons were significant). CONCLUSIONS: The local-level variations in health revealed in this study emphasize that geographic and racial/ethnic health disparities are still prominent in Chicago and shed light on the limitations of existing city- and regional-level data.

Smoking in 6 diverse Chicago communities--a population study.

OBJECTIVES: We analyzed smoking survey data across communities in Chicago, Ill, to explore community-level variations in smoking behavior. METHODS: We conducted a health survey of 6 racially and ethnically diverse Chicago communities during 2002-2003. The survey included questions about current smoking, smoking history, and cessation attempts. RESULTS: Smoking prevalence varied from 18% in the wealthiest (predominately White) community to 39% in the poorest (predominately Black) community. In a contiguous pair of communities, one Mexican and the other Black, smoking prevalence varied by a factor of 2. Men, residents in poorer households and households without telephones, and residents with less education were most likely to smoke. CONCLUSIONS: The high proportions of current smokers who had attempted to quit indicate a prevalent desire to stop smoking. However, less than 4% of the Master Tobacco Settlement Agreement funds are being spent on smoking prevention, or even on health in general, in Illinois. Although much is known about the prevalence of smoking at the national level, few studies of smoking have been done at the community level, presenting difficulties for the allocation of resources and the design of smoking cessation programs in response to community needs. Understanding community-level smoking rates could improve the allocation of resources and assist the shaping of culturally meaningful prevention efforts.