Journal of urban health : bulletin of the New York Academy of Medicine
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Although public health surveillance system data are widely used to describe the epidemiology of communicable disease, occurrence of hepatitis B and C virus (HBV and HCV, respectively) infections may be misrepresented by under-reporting in injection drug users (IDUs). This study was carried out to examine the relationship between HBV and HCV incidence and case-reporting of hepatitis B and C in Seattle IDUs. Names of participants in a Seattle IDU cohort study who acquired HBV or HCV infection over a 12-month follow-up period were compared to a database of persons with acute hepatitis B and C reported to the health department surveillance unit over the same period. ⋯ Of 113 cohort subjects who acquired HBV or HCV, only 2 (1.5%) cases were reported; both had acute hepatitis B. The upper 95% confidence limit for case-reporting of hepatitis C in the cohort was 5.7%, and for hepatitis B, it was 7.5%. In this study, reporting of acute hepatitis in IDUs was extremely low, raising questions regarding the use of community surveillance data to estimate underlying incidence in that population group.
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Review Comparative Study
The World Cities Project: rationale, organization, and design for comparison of megacity health systems.
This article provides an overview of the World Cities Project (WCP), our rationale for it, our framework for comparative analysis, and an overview of current studies in progress. The WCP uses New York, London, Paris, and Tokyo as a laboratory in which to study urban health, particularly the evolution and current organization of public health infrastructure, as well as the health status and quality of life in these cities. ⋯ To provide a framework for WCP, we define an urban core for each city and examine the similarities and differences among them. Our current studies shed light on inequalities in health care use and health status, the importance of neighborhoods in protecting population health, and quality of life in diverse urban communities.
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Comparative Study
Incidence of violence against HIV-infected and uninfected women: findings from the HIV Epidemiology Research (HER) study.
The effect of human immunodeficiency virus (HIV) infection on the incidence of violence against women was addressed in a prospective cohort of HIV-infected and uninfected women. Participants were enrolled between 1993 and 1995 in four US cities and followed up semiannually through 1998. Among 1,087 women with a total accrual of 2,988 person-years (PY) of follow-up, there were 185 reports of abuse (incidence rate = 6.19 per 100 PY). ⋯ In multivariate analysis, being separated or divorced, having a history of abuse in adulthood, using marijuana, using crack, and having multiple sex partners were each significantly associated with an elevated abuse rate; being older was inversely associated with abuse. Among HIV-infected women, those with fewer CD4+ cells/ micro L continued to show a decreased abuse rate (hazard ratio = 0.55, 95% CI = 0.36, 0.82) after adjustment for these factors. It is important to complement existing and future HIV prevention and intervention strategies with efforts to reduce violence against women.
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When mosquito-borne West Nile virus emerged in the United States in 1999 and triggered pesticide spraying, society was faced with a controversy over an important risk-risk tradeoff-the risks of pesticide exposure versus those of West Nile encephalitis. Effective public communication about risk-risk tradeoffs is important because it can assist individuals and society in investing resources optimally. This study examined how effectively major North American print media in the year 2000 provided information on this risk-risk tradeoff. ⋯ The media were also ineffective in mentioning the efficacy of pesticide spraying or comparing the economic costs of pesticide spraying with those of West Nile encephalitis. We suggest that greater effort in collecting and reporting precise risk information, fostering more active relationships between journalists and scientists/public health professionals, and recognizing biases resulting from preconceptions can help improve reporting by the print media and public health agencies on risk-risk tradeoffs associated with emerging insect-borne infectious diseases. These efforts could help improve public health by improving decision making related to the control of insect-borne diseases.
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In Baltimore, over 1,000 vacant industrial sites persist across its urban landscape, yet little is known about the potential environmental health risks that may undermine future cleanup and redevelopment activities and the health of those in communities near these sites. This study examined the characteristics of urban brownfield properties in southeast Baltimore, Maryland, and screened sites for their potential environmental hazards. In addition, demographic and health data were evaluated to profile the social and health status of those in brownfield communities. ⋯ Moreover, these sites are concentrated in communities in which excess mortality rates due to respiratory disease, cancer, and heart disease exist when compared to the city, state, and national averages. This investigation demonstrated the usefulness of historic archives, real estate records, regulatory files, and national hazard-tracking systems based on standard industrial classification (SIC) to screen brownfield properties for their hazard potential. This analysis provides the foundation for further site monitoring and testing, cleanup and redevelopment priority setting, risk management strategies, and neighborhood planning, and it illustrates the need for increased health surveillance and disease prevention strategies in affected communities.