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Kinds of City Area Selected AbstractsAre patient assistance programmes able to meet the needs of New York City women with breast cancer?EUROPEAN JOURNAL OF CANCER CARE, Issue 1 2009Women's perspectives Women with breast cancer report needs that may interfere with their ability to obtain necessary treatments. High-quality community-based patient assistance programmes exist; however, their ability to identify and meet women's needs is unknown. We surveyed women with breast cancer attending such programmes to assess programmes' ability to identify and meet their needs. We surveyed 117 (42% minority) women utilizing nine programmes in the New York City area about expectations, needs and experiences. Ninety-two (89%) women wanted information, 102 (95%) psychosocial support and 15 (20%) practical assistance. Seventy-three per cent had all or most of their needs identified, and 74% had all or most of their needs met. Seventy per cent stated programmes met needs they were not previously aware they had. Needs identified and met were lower among minority women (57% vs. 84%; P = 0.003), those with lower income (46% vs. 79%; P = 0.02) and those in poor physical health (56% vs. 78%; P = 0.04), independent of the type of need. High-quality community-based patient assistance programmes effectively identify and meet the needs of women with breast cancer but traditionally at-risk women appear less likely to have needs identified and met. Programmes should enhance the systemization and sensitivity of needs assessments to improve women's experience with cancer. [source] The contribution of founder mutations to early-onset breast cancer in French-Canadian womenCLINICAL GENETICS, Issue 5 2009P Ghadirian In an ethnically-homogeneous population, it is valuable to identify founder mutations in cancer-predisposing genes. Founder mutations have been found in four breast-cancer-predisposing genes in French-Canadian breast cancer families. The frequencies of the mutant alleles have been measured neither in a large series of unselected breast cancer patients from Quebec, nor in healthy controls. These estimates are necessary to measure their contribution to the hereditary burden of breast cancer in Quebec and to help develop genetic screening policies which are appropriate for the province. We studied 564 French-Canadian women with early-onset invasive breast cancer who were treated at a single Montreal hospital. Patients had been diagnosed at age 50 or less, and were ascertained between 2004 and 2008. We screened all 564 patients for nine founder mutations: four in BRCA1, three in BRCA2 and one each in PALB2 and CHEK2. We also studied 6433 DNA samples from newborn infants from the Quebec City area to estimate the frequency of the nine variant alleles in the French-Canadian population. We identified a mutation in 36 of the 564 breast cancer cases (6.4%) and in 35 of 6443 controls (0.5%). In the breast cancer patients, the majority of mutations were in BRCA2 (54%). However, in the general population (newborn infants), the majority of mutations were in CHEK2 (54%). The odds ratio for breast cancer to age 50, given a BRCA1 mutation, was 10.1 (95% CI: 3.7,28) and given a BRCA2 mutation was 29.5 (95% CI: 12.9,67). The odds ratio for breast cancer to age 50, given a CHEK2 mutation, was 3.6 (95% CI: 1.4,9.1). One-half of the women with a mutation had a first- or second-degree relative diagnosed with breast or ovarian cancer. Thus, it can be concluded that a predisposing mutation in BRCA1, BRCA2, CHEK2 or PALB2 is present in approximately 6% of French-Canadian women with early-onset breast cancer. It is reasonable to offer screening for founder mutations to all French-Canadian women with breast cancer before age 50. The frequency of these mutations in the general population (0.5%) is too low to advocate population-based screening. [source] Decision-making in community-based paediatric physiotherapy: a qualitative study of children, parents and practitionersHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 2 2006Bridget Young BA PhD Abstract Approaches to practice based on partnership and shared decision-making with patients are now widely recommended in health and social care settings, but less attention has been given to these recommendations in children's services, and to the decision-making experiences of non-medical practitioners and their patients or clients. This study explored children's, parents' and practitioners' accounts of shared decision-making in the context of community-based physiotherapy services for children with cerebral palsy. Semi-structured interviews were conducted with 11 children with cerebral palsy living in an inner city area of northern England, and with 12 of their parents. Two focus groups were conducted with 10 physiotherapy practitioners. Data were analysed using the constant comparative method. When asked explicitly about decision-making, parents, children and practitioners reported little or no involvement, and each party saw the other as having responsibility for decisions. However, when talking in more concrete terms about their experiences, each party did report some involvement in decision-making. Practitioners' accounts focused on their responsibility for making decisions about resource allocation, and thereby, about the usefulness and intensity of interventions. Parents indicated that these practitioner-led decisions were sometimes in conflict with their aspirations for their child. Parents and children appeared to have most involvement in decisions about the acceptability and implementation of interventions. Children's involvement was more limited than parents'. While parents could legitimately curtail unacceptable interventions, children were mostly restricted to negotiating about how interventions were implemented. In these accounts the involvement of each party varied with the type of issue being decided and decision-making appeared more unilateral than shared. In advocating shared decision-making, greater understanding of its weaknesses as well as its strengths, and greater clarity about the domains that are suitable for a shared decision-making approach and the roles of different parties, would seem a helpful step. [source] Long-term changes and regional differences in temperature and precipitation in the metropolitan area of HamburgINTERNATIONAL JOURNAL OF CLIMATOLOGY, Issue 8 2010K. H. Schlünzen Abstract Climate changes and the urban climate of the ,green city' Hamburg and its metropolitan region are analyzed using observational data for temperature and precipitation. Values for Hamburg's synoptic site HH-Fuhlsbüttel start in 1891 and are used to determine climate changes. Additional data from up to 45 climate stations are used to analyze the different aspects of the regional climate and urban effects on the temperature [urban heat island (UHI)] and precipitation [urban precipitation impact (UPI)]. The analysis of the long-term data shows that the climate has already changed. Annual precipitation significantly increases ,0.8 mm/year when focusing on years 1891,2007 and ,1.3 mm/year for 1948,2007. Precipitation increases are largest in November through March and March as well as June for 1978,2007. For April and July of this period, a precipitation decrease is found. The precipitation distribution shows that moderate daily precipitation amounts (,10 mm/day) have increased by about 10% between 1948,1977 and 1978,2007. Precipitation amounts > 10 mm/day have increased by 20% in the same period. Average temperatures significantly increase by 0.07 K/decade (1891,2007), 0.19 K/decade (1948,2007), 0.6 K/decade (1978,2007) with largest significant increases in fall. For the UHI, it is found that the average temperature is higher up to 1.1 K in the densely build-up city area than outside. Values are about halved for more green urban areas but also depend on more local impacts. The minimum temperatures are up to 3 K higher and maximum temperatures slightly lower in the inner city than in the rural during summer. The winter temperatures are higher throughout the urban area. The UHI differences depend on wind speed; this dependence is best described by using the inverse square root of the wind speed. Classification using different wind directions shows that the precipitation is significantly higher (5,20%) for downwind of urban areas compared with the upwind side. Copyright © 2009 Royal Meteorological Society [source] Distribution conventionality in the movie sector: an econometric analysis of cinema supplyMANAGERIAL AND DECISION ECONOMICS, Issue 8 2009Alan Collins This paper empirically analyzes the impact of several factors on a ,conventionality index (CI)' in the specific context of the cinema exhibition sector. To our knowledge, it is the first time that a standard CI has been constructed for this purpose. Econometric analysis of the determinants of variation in this index provides decision-makers with an empirical focus for analyzing distributional aspects of the movie exhibition market, with particular emphasis on product differentiation. Specifically, (i) do cinemas based in a city area have a different or ,specialized' focus in contrast to cinemas in small towns? or (ii) do multiplexes have a different or more specialized focus in comparison with cinemas? To this end, cross-sectional econometric models are estimated to help analyze these effects in three Italian regions for a sample of cinemas covering the 2006 season. Copyright © 2009 John Wiley & Sons, Ltd. [source] Adverse perinatal conditions in hearing-impaired children in a developing countryPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 5 2006Bolajoko O. Olusanya Summary Prevailing adverse perinatal conditions in developing countries have been associated with substantial mortality, but little evidence exists on their impact on permanent childhood disabilities and morbidity due to limitations in clinical investigations and medical records. This study aims to identify the possible association between parent-reported adverse perinatal conditions and permanent hearing loss, in order to establish service needs within current maternal and child health programmes. Structured questionnaires were administered to 363 parents of deaf children and 309 parents of normal-hearing children in an inner city area of Lagos, Nigeria. The parents were from all social classes. After a multivariable logistic regression analysis, birth asphyxia [OR 20.45; 95% CI 6.26, 66.85], difficult delivery [OR 8.09; 95% CI 2.76, 23.68], neonatal jaundice [OR 2.45; 95% CI 1.25, 4.79] and neonatal seizures [OR 2.30; 95% CI 1.09, 4.85] were associated with permanent hearing loss. Consanguineous marriages [OR 6.69; 95% CI 2.72, 16.46] and family history of deafness [OR 6.27; 95% CI 2.07, 18.97] also emerged as additional risk factors for permanent hearing loss. In addition, parents of children in state-owned schools for the deaf were significantly more likely to belong to higher social classes compared with normal-hearing children in mainstream state-owned schools. There is a need to incorporate services for the early detection of permanent hearing loss into current maternal and child healthcare programmes in developing countries. [source] Methadone-exposed newborn infants: outcome after alterations to a service for mothers and infantsCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 2 2007J. Miles Abstract Objective, To evaluate the impact of a shared care approach in clinical management with a drug liaison midwife (DLM) service for mothers and infants established in 1995,1996 in an inner city area and to address the problem of congenital abnormality and microcephaly with fetal drug exposure. Methods, Descriptive analysis of data in live births of women enrolled in a methadone maintenance programme in 1991,1994 (n = 78) and 1997,2001 (n = 98), including time spent in hospital, treatment for neonatal abstinence syndrome (NAS), admission to the neonatal medical unit (NMU) and follow-up for child health checks. Results, In 1997,2001 compared with 1991,1994, the mothers used more methadone in the last week of pregnancy (median 40.0 mg/day vs. 21.5 mg/day, P = 0.0006) and there were more preterm deliveries (36% vs. 21%, P = 0.03). The infants spent less time in hospital (median 5 days vs. 28 days, P < 0.0001), a smaller proportion had treatment for NAS (14% vs. 79%, P < 0.0001), and NMU admission was reduced (median 14 days vs. 26 days, P < 0.0003). Neonatal convulsions (P = 0.0001) and jaundice (P < 0.001) occurred less frequently, and more infants were breastfed (P = 0.001). One infant in each study group had a cleft palate and none had microcephaly. Child health checks for 18,24 months showed a favourable outcome in 1997,2001. Conclusions, We altered antenatal care and modified neonatal management, subsequently infants spent less time in hospital and NMU admissions were reduced with less NAS treatment. Congenital abnormalities and microcephaly were not common and as regular child health checks were possible, the impact of the DLM service in shared management merits further investigation, for mother,infant bonding and developmental outcome. [source] Factors affecting participation in Sure Start programmes: a qualitative investigation of parents' viewsHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 3 2007Mark Avis BA(Hons) MSc RN RNT Cert Ed Abstract The objectives of the present study were to examine the factors that parents identify as promoting or hindering participation in Sure Start programmes, and to identify methods for enhancing parents' engagement with Sure Start. A qualitative, in-depth interview study was conducted with parents registered with two local Sure Start programmes based in the East Midlands, UK, and located in inner city areas with a range of health and social problems associated with social exclusion and disadvantage. Sixty parents, guardians or carers of children living in both Sure Start areas were recruited during autumn of 2004 on the basis of whether they were identified as a ,frequent user' or ,non-frequent user' of Sure Start services. The data were analysed using a thematic approach supported by NVivo computer software, and explanatory themes were subsequently tested for completeness and adequacy. The results of the study indicated that parents who used Sure Start services were positive about the benefits that they obtained for themselves and their children, in particular in overcoming a sense of isolation. Parents who were non-frequent users identified a number of practical reasons that prevented them using Sure Start services, although parents also recognised a loss of confidence and trust in the local communities summarised in the phrase ,keeping myself to myself'. Parents' awareness of the targeted nature of Sure Start can also lead to stigma and reluctance to use services. It is concluded that continued investment of time and effort in maintaining communication networks between Sure Start staff and local parents is vital if parents and children are to make the best use of Sure Start services. [source] Immigrants as crime victims: Experiences of personal nonfatal victimizationAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 4 2010Krista Wheeler MS Abstract Background Immigrants to the United States are disproportionately victims of homicide mortality in and outside the workplace. Examining their experiences with nonfatal victimization may be helpful in understanding immigrant vulnerability to violence. Methods We compared the annual prevalence of nonfatal personal victimization experienced by immigrant and US-born adults by sociodemographics, employment, occupation, industry, smoking, alcohol and drug use using data from Wave 1 National Epidemiologic Survey on Alcohol and Related Conditions. Results The prevalence of victimization among immigrants was comparable to that among US-born adults [3.84% (95% CI: 3.18,4.63) vs. 4.10% (95% CI: 3.77,4.44)]. Lower percentages of victimization experienced by immigrants were seen among the unmarried, those age 30,44 years, and among residents of central city areas as compared to those groups among the US-born. For immigrants entering the US as youth, the victimization prevalence declines with greater years of residency in US. Multivariate logistic regression models suggest that, the odds of victimization was significantly associated with age, family income, marital status, central city residency, smoking, and drug use while employment status was not a significant factor. Immigrant workers with farming/forestry occupations might face a higher risk of being victims of violence than their US-born counterparts. Conclusions The prevalence of victimization among immigrants was comparable to that among US-born adults. Employment status and industry/occupation overall were not significant risk factors for becoming victims of violence. Am. J. Ind. Med. 53:435,442, 2010. © 2010 Wiley-Liss, Inc. [source] Mobility, Residential Location and the American Dream: The Intrametropolitan Geography of Minority HomeownershipREAL ESTATE ECONOMICS, Issue 3 2008Stuart A. Gabriel This article applies data from Washington, DC, Chicago and Los Angeles to estimate three-level nested multinomial logit models of household mobility, residential location and homeownership tenure choice. Model simulation indicates that shocks to income can significantly elevate the homeownership attainment of minority households; however, their urban settlement and homeownership patterns remain substantially more concentrated than those of whites. Simulated equilibration of black economic status with that of whites results in an approximate doubling of homeownership rates among black movers to central city areas. In contrast, homeownership rates among black movers to suburban and outlying areas lag far behind those of whites. [source] Relative oral health outcome trends between people inside and outside capital city areas of AustraliaAUSTRALIAN DENTAL JOURNAL, Issue 3 2010LA Crocombe Abstract Background:, The aim of this study was to evaluate relative change over 17 years in clinical oral health outcomes inside and outside capital city areas of Australia. Methods:, Using data from the National Oral Health Survey of Australia 1987,88 and the National Survey of Adult Oral Health 2004,06, relative trends in clinical oral health outcomes inside and outside capital city areas were measured by age and gender standardized changes in the percentage of edentate people and dentate adults with less than 21 teeth, in mean numbers of decayed, missing and filled teeth, and mean DMFT index. Results:, There were similar reductions inside and outside capital city areas in the percentage of edentate people (capital city 63.7%, outside capital city 60.7%) and dentate people with less than 21 teeth (52.5%, 50.1%), in the mean number of missing teeth (34.3%, 34.5%), filled teeth (0.0%, increase of 5.5%), and mean DMFT index (21.2%, 19.2%). The reduction in mean number of decayed teeth was greater in capital city areas (78.0%) than outside capital city areas (50.0%). Conclusions:, Trends in four of the five clinical oral health outcomes demonstrated improvements in oral health that were of a similar magnitude inside and outside capital city areas of Australia. [source] | |||||||||||||