Journal of urban health : bulletin of the New York Academy of Medicine
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It is well known that there are social inequalities in health. Following the ecological approach, unemployment has been one of the most used indicators to study social inequalities. The aim of the present study was to investigate the relationships between indicators of extreme poverty and social unrest, along with unemployment, and mortality in Barcelona, during the years 1989 to 1993. ⋯ We concluded that we see different types of relationships between deprivation and mortality. Unemployment has been related to mortality because of pathologies with socially accepted risk factors (tobacco and alcohol). Causes of death with risk factors not socially accepted (illegal drug use) have been related to indicators of marginality as well as unemployment.
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Within the next 30 years, the proportion of urban dwellers will rise from under half to two thirds of the world's population. Such a shift will entail massive public health consequences, and most of this urban transition will occur in low-income regions of the world. Urban populations face very different health risks compared to those in rural areas, particularly in terms of malaria. ⋯ Decision makers are increasingly seeing remote sensing as a cost-effective solution to monitoring urbanization at a range of spatial scales. This review focuses on the progress made within the field of remote sensing on mapping, monitoring, and modeling urban environments and examines existing challenges, drawbacks, and future prospects. We conclude by exploring some of the particular relevance of these issues to malaria and note that they are of more general relevance to all those interested in urban public health.
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This article estimates the population prevalence of current injection drug users (IDUs) in 96 large US metropolitan areas to facilitate structural analyses of its predictors and sequelae and assesses the extent to which drug abuse treatment and human immunodeficiency virus (HIV) counseling and testing are made available to drug injectors in each metropolitan area. We estimated the total number of current IDUs in the United States and then allocated the large metropolitan area total among large metropolitan areas using four different multiplier methods. Mean values were used as best estimates, and their validity and limitations were assessed. ⋯ Proportions of drug injectors in treatment varied from 1.0% to 39.3% (median 8.6%); and the ratio of HIV counseling and testing events to the estimated number of IDUs varied from 0.013 to 0.285 (median 0.082). Despite limitations in the accuracy of these estimates, they can be used for structural analyses of the correlates and predictors of the population density of drug injectors in metropolitan areas and for assessing the extent of service delivery to drug injectors. Although service provision levels varied considerably, few if any metropolitan areas seemed to be providing adequate levels of services.
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We examined the progress of the nation's 100 largest cities and their surrounding suburban areas toward achieving Healthy People 2000/2010 goals for two measures of infant health: low birth weight (LBW) and infant mortality (IM). Using data from the National Center for Health Statistics, we compared 1990 and 2000 urban and suburban LBW and IM rates to target rates for Healthy People 2000 and 2010 objectives. Although the 2000 LBW weight rate for the 100 largest cities was higher than the average for the suburbs (8.9% vs. 7.1%), the increase in LBW rates for the suburbs was nearly four times that of the cities (15.7% vs. 4.1%). ⋯ However, the 100 largest cities on average did not meet the 2000 IM rate target of 7 infant deaths per 1000 live births; their suburbs did (8.5 vs. 6.4, respectively). The cities and suburbs that did not meet the 2000 target may be especially challenged to meet the 2010 goal for IM unless rates of preterm births are reduced. With the continuing black-white disparities in LBW and IM rates and the overall differences in the racial composition of the largest cities and suburbs, strategies for meeting Healthy People goals will likely need to be targeted to the specific populations they serve.
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Universal screening for the sexually transmitted diseases (STDs) of chlamydia and gonorrhea on intake in jails has been proposed as the most effective strategy to decrease morbidity in inmates and to reduce transmission risk in communities after release. Most inmates come from a population that is at elevated risk for STDs and has limited access to health care. However, limited resources and competing priorities force decision makers to consider the cost of screening programs in comparison to other needs. ⋯ However, for men universal chlamydia screening cost $4,856 more per case treated than presumptive treatment. Universal screening for both chlamydia and gonorrhea infection cost the health care system $3,690 more per case of pelvic inflammatory disease averted for women and $650 more per case of infection treated for men compared to universal screening for chlamydia only. Jails with a high prevalence of chlamydia and gonorrhea represent an operationally feasible and cost-effective setting to universally test and treat women at high risk for STDs and with limited access to care elsewhere.