[Public health in transition--a social science perspective].
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Cost Control↗
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Social stratification, development and health in Pakistan: an empirical exploration of relationships in population-based national health examination survey data.
There is a growing literature on an overall direct relationship between health and social position in developed countries. The relationship, however, is less well documented in developing countries where social hierarchies are changing more rapidly, demographic and health transitions are less advanced, and this topic has received less attention from researchers than in some developed countries. This paper presents an empirical investigation of the relationship between social stratification and social development and population health using data on over 6000 adults from the National Health Survey of Pakistan, a nationally representative health examination survey of people in that country. We analyze four indicators of poor nutrition in adults from this data set. The findings reveal complex relationships among social development, social stratification and the consequences for the health of the people of Pakistan. Underweight is related to economic status, anemia to education and social development, and both severe dental caries and a monotonous diet are related to both development and economic status which interact with each other. These results suggest that continued conceptual refinement and the development of standardized measures of stratification and development would contribute to building cross-nationally comparable data sets addressing issues of the relationship among health and economic development and health transitions.
Adolescent↗
Making the transition from health professional to manager.
Health professionals who make a career change into a managerial role frequently find that the adjustment is a difficult one. Often they are not well prepared for the new role. They find that the world of the manager is different in a number of ways from the professional world they have known, and the skills required for effective performance are also different. This preliminary study, which involved interviews with a number of professionals who have made the transition, highlighted the adjustments they had to make and the transition difficulties they experienced. Attention is drawn to a number of ways in which health professionals can be assisted to develop into effective managers.
Administrative Personnel↗
Transitional society, health status and international migration of Muslim villagers in the lower part of southern Thailand.
A survey was carried out in a Malay-speaking Muslim community in southern Thailand to obtain baseline data for planning of long term multidisciplinary research and development. By using a 30-cluster sampling technique, 210 households of 1,308 subjects were studied in the post-Ramadan period. It was found that the community was in a social transition. The crude birth rate was 4% and 37.6% of the households had at least one migrant. About half of these migrants had been to Malaysia and mainly worked in rubber plantations. Ninety-five per cent of the households had electricity whereas only 23.8% had a latrine. Boiled or rain water was regularly drunk in only 13.3 per cent of the households. Home-grown agricultural products were not sufficient to provide adequate food. Twenty-six per cent of the adults were unemployed and 24.6% were illiterate. Of the pregnancies 26.7% had no antenatal care and complete tetanus toxoid was given to only 27.8%. Traditional birth attendants conducted 81.1% of the deliveries and only 28.9 and 24.4% of the umbilical cords were correctly cut and correctly dressed, respectively. Breast feeding was still a common (87.8%) practice. However, complete immunization was given to only 10.8%, and 37.8% of the infants had at least one diarrheal episode in the previous month. It was concluded that high birth rate, high migration, low education, low income and bad health of infants are major problems. These problems were interlinked and needed a special multidisciplinary approach. In addition to common obstacles for routine health delivery, migration may create international complications, particularly related to maternal and child care.
Adolescent↗
Interpreting the meaningfulness of changes in health-related quality of life scores: lessons from studies in adults.
The measurement of health-related quality of life (HRQL) in adults with cancer has proceeded more quickly than has similar measurement in children, so there may be value in applying some methods used in adults to studies in children. An example is a health-transition state instrument called the Subjective Significance Questionnaire (SSQ). The SSQ asks patients to give their own estimates of the degree to which their HRQL has changed with time and, thus, provides a method for interpreting the meaningfulness of changes in scores as derived from a general questionnaire, the EORTC QLQ-C30. The development of similar health-transition instruments for children poses special challenges and requires the development of appropriate methodology. It is suggested that, with the use of cartoons and the answers of proxies, it should be feasible to assess the meaningfulness of changes in HRQL over time in young children as well as in adolescents. Int. J. Cancer Suppl. 12:132-137, 1999.
Adult↗
Health-related quality of life in patients with coronary artery disease treated for angina: validity and reliability of German translations of two specific questionnaires.
The German versions of two patient-perceived heart disease specific health-related quality of life (HRQL) questionnaires, the Seattle Angina Questionnaire (SAQ) and the MacNew Heart Disease questionnaire, were examined for their psychometric properties in patients with angiographically documented coronary artery disease and angina who were treated either medically or invasively and followed up for 1 year. Both HRQL questionnaires and the modified Canadian Cardiovascular Society (CCS) angina-associated disability scale were completed by 158 patients at baseline and 12 months later when they also completed a generic health status questionnaire, the SF-36. Both specific HRQL questionnaires were acceptable to patients. Three of the four MacNew scales, but none of the SAQ scales, discriminated between patients by baseline CCS disability levels I and IV. Internal consistency ranged from 0.75 to 0.94 for the SAQ and from 0.86 to 0.97 for the MacNew scales. Test-retest reliability over a 4-week period of time ranged from 0.45 to 0.81 for the SAQ scales and 0.61 to 0.68 for the MacNew scales. Over 12 months, HRQL improved (p < 0.001) on three of the five SAQ and on all four of the MacNew scales with the responsiveness statistic ranging from 0.59 to 1.55 for the SAQ and 0.86 to 1.12 for the MacNew. The 12 month scores on all SAQ and MacNew scales were significantly higher in patients who improved than those who deteriorated on the SF-36 reported health transition question. We conclude that the SAQ and the MacNew are both valid, reliable, and responsive in German, that the MacNew discriminates better between angina grades at baseline, that HRQL improves over 12 months with both measures, that the SAQ angina frequency and disease perception scales have the largest effect sizes, and that the 12-month change in HRQL with both instruments was associated with change in SF-36 reported health transition status.
Aged↗
Responding to the threat of chronic diseases in India.
At the present stage of India's health transition, chronic diseases contribute to an estimated 53% of deaths and 44% of disability-adjusted life-years lost. Cardiovascular diseases and diabetes are highly prevalent in urban areas. Tobacco-related cancers account for a large proportion of all cancers. Tobacco consumption, in diverse smoked and smokeless forms, is common, especially among the poor and rural population segments. Hypertension and dyslipidaemia, although common, are inadequately detected and treated. Demographic and socioeconomic factors are hastening the health transition, with sharp escalation of chronic disease burdens expected over the next 20 years. A national cancer control programme, initiated in 1975, has established 13 registries and increased the capacity for treatment. A comprehensive law for tobacco control was enacted in 2003. An integrated national programme for the prevention and control of cardiovascular diseases and diabetes is under development. There is a need to increase resource allocation, coordinate multisectoral policy interventions, and enhance the engagement of the health system in activities related to chronic disease prevention and control.
Adolescent↗
Time travel with Oliver Twist--towards an explanation foa a paradoxically low mortality among recent immigrants.
First-generation immigrant populations in industrialized countries frequently have a lower mortality than the host population, a finding that is unexpected and often dismissed as the result of bias. We propose an alternative explanation for a real, albeit temporal, mortality advantage. We base our argument on two premises: First, that there are differences in the progression of the health transition between the immigrants' countries of origin and industrialized host countries; and, second, that there are differences in the speed at which changes in mortality from various causes occur after migration. Mortality from treatable communicable and maternal conditions, still high in many countries of origin, quickly declines to levels close to those of the host country. Mortality from ischaemic heart disease, the most common cause of death in the host countries, takes years or decades to rise to comparable heights. This is because of the time lag between increases in risk factor levels and an increased risk of coronary death. Hence, first-generation immigrants may initially experience a lower mortality than the host population, a point that has so far been under-appreciated in discussions of immigrant mortality. After adopting a western lifestyle immigrants face an increasing risk of ischaemic heart disease. The increase occurs on top of a persisting risk from conditions associated with childhood deprivation, e.g. stomach cancer and stroke--the unfinished agenda of the health transition that immigrants experience.
Communicable Diseases↗
Cambodian health in transition.
As conflict and suffering in Bosnia, Chechnya, Rwanda, and Zaire continue to be at the forefront of world attention, some countries seem to be largely forgotten. It is timely to take stock of conditions in the small country of Cambodia as it struggles to take its place after a long period of isolation. Countless Cambodians and ethic Vietnamese have died there this year and during the past 25 years, victims of senseless killing or preventable disease.
Cambodia↗
The effect of prepartum injection of vitamin E on health in transition dairy cows.
The objective of this study was to investigate parenteral vitamin E for the prevention of peripartum disease in dairy cows. A randomized clinical trial was conducted in 21 commercial dairy herds. Cows (n = 1142) were randomly assigned to receive either a single subcutaneous injection of 3000 IU of vitamin E, or placebo, 1 wk before expected calving. Serum alpha-tocopherol was significantly increased in treated cows at 7 and 14 d, but not at 21 d after injection. Overall, there were no significant differences between treatment groups in the incidence of retained placenta, clinical mastitis, metritis, endometritis, ketosis, displaced abomasum, or lameness. However, there was a conditional benefit of treatment for reduction of the incidence of retained placenta. Cows with marginal pretreatment vitamin E status (serum alpha-tocopherol to cholesterol mass ratio < 2.5 x 10(-3)) that received an injection of vitamin E tended to have reduced risk of retained placenta. However, in cows with adequate serum vitamin E, there was no reduction in the incidence of any disease. For clinical application, primiparous animals were most likely to benefit from prepartum injection of vitamin E.
Animals↗
Impaired glucose tolerance and elevated blood pressure in low birth weight, nonobese, young south african adults: early programming of cortisol axis.
Low birth weight is associated with increased cardiovascular and metabolic disorders in adult life, although the mechanisms of this effect remain uncertain. There is one report of increased morning plasma cortisol levels in an elderly low birth weight cohort, but whether this is primary or secondary to other aspects of the phenotype is unclear. We investigated the association between low birth weight and glucose intolerance, blood pressure, and dyslipidemia in young, nonobese adults from a community undergoing the health transition with a high prevalence of both noncommunicable diseases and low birth weight. Additionally, we investigated whether altered basal and stimulated cortisol levels as a marker of hypothalamic-pituitary-adrenal responsiveness or cortisol metabolism were associated with low birth weight in these young adults. Twenty-year-old, historically disadvantaged, urbanized South Africans (n = 137) with birth weights either below the 10th percentile [underweight for age (UFA)] or between the 25th and 75th percentiles [appropriate for gestational age (AFA)] had anthropometry, blood pressure, lipid levels, and glucose tolerance measured. In a subset (n = 62), 0900 h plasma cortisol concentrations, cortisol responses to 1 microg ACTH, and urinary glucocorticoid metabolites were measured. The mothers of UFA infants were themselves lighter and had a lower body mass index (P: = 0. 0016). At age 20 yr, although the UFA group was still smaller and lighter, with a lower body mass index, they had higher fasting plasma glucose levels (P: = 0.047), and a greater proportion demonstrated glucose intolerance (11.9% vs. 0%; P: < 0.01). The UFA group also had higher systolic [UFA, 126.0 +/- 13.3 (+/-SD); AFA, 122.0 +/- 11.7 mm Hg; P: = 0.007] and diastolic (72.3 +/- 8.4 vs. 69. 5 +/- 8.7 mm Hg; P: = 0.02) blood pressures, after covarying for current weight and gender. Plasma cortisol levels determined at 0900 h were higher in the UFA group (484.9 +/- 166.3 vs. 418.6 +/- 160.6 nmol/L) and showed a greater plasma cortisol response to low dose ACTH stimulation (area under the curve for cortisol: UFA, 77,238 +/- 19,511; AFA, 66,597 +/- 16,064 nmol/L.min; P: = 0.04). In conclusion, the link between low birth weight and adult glucose intolerance and blood pressure elevation occurs in young adults in a high risk, disadvantaged population despite a lack of full catch-up growth. Moreover, cortisol axis activation is an early feature in the process linking low birth weight with adult cardiovascular and metabolic disease and is not dependent upon adult obesity or full catch-up growth, at least in this population undergoing the health transition.
Adrenocorticotropic Hormone↗
Transitions in health status among community-dwelling elderly people with arthritis. A national, longitudinal study.
We used the Longitudinal Study on Aging, a national study of community-dwelling elderly people, to 1) estimate the number of elderly persons with arthritis, with and without other chronic conditions, living in the community in 1984, who reported limitations in physical activities, activities of daily living (ADL), and instrumental activities of daily living (IADL); 2) enumerate the population of the elderly with arthritis who were receiving help or paid help with ADL or IADL; and 3) estimate the number of such persons experiencing a change in health status in the ensuing 2 years. In 1984, 14% of all 15.6 million community-dwelling elderly people had arthritis and no other chronic conditions; 41% had arthritis concurrently with other chronic conditions. Of the former group, 66% experienced limitations in physical activities, but only approximately 25% reported limitations in ADL or IADL in 1984. Among the group with arthritis and other chronic conditions, 82% were limited in at least 1 physical activity, and 41% were limited in ADL. With the passage of 2 years, 2% of elderly persons with arthritis and no other conditions had entered a nursing home, 7% had died, and the percentage reporting no limitation declined significantly. Among elderly persons with arthritis and other conditions, 4% entered a nursing home, 12% died, and the rates of all forms of limitation increased. It is essential to gather data such as these, on the prevalence and incidence of limitation among the elderly with arthritis, to ensure adequate long-term care services for an increasing aged population.
Activities of Daily Living↗
Immigrant transitions and health care: an action plan.
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Emigration and Immigration↗
Physical inactivity is the major determinant of obesity in black women in the North West Province, South Africa: the THUSA study. Transition and Health During Urbanisation of South Africa.
OBJECTIVE: We investigated the association between measures and determinants of obesity in African women. METHODS: For a cross-sectional study of adult black women in the North West Province, South Africa, we used a stratified sample of 1040 volunteers from 37 randomly selected sites in the province according to the level of urbanization. We analyzed the association between measures of obesity, namely body mass index (BMI), waist circumference, waist-to-hip ratio, triceps and subscapular skinfolds, and socioeconomic factors, dietary intakes, and physical activity. RESULTS: The rate of obesity (BMI > 30) in the sample was 28.6%. We found a significant positive association between household income and measures of obesity. After exclusion of underreporters and adjustments for age, smoking, and household income, we found significant positive correlations between total energy intake, fat intake, and BMI. Physical activity index (derived from a subset of 530 subjects) correlated negatively with BMI and waist circumference. Subjects in the highest third of physical activity were less likely to be obese (odds ratio-0.38, 95% confidence interval-0.22-0.66). CONCLUSIONS: Women with higher incomes and lower physical activity were at the greatest risk of increased BMI. Physical inactivity showed the strongest association with measures of obesity in this study.
Adolescent↗
Obesity in African women in the North West Province, South Africa is associated with an increased risk of non-communicable diseases: the THUSA study. Transition and Health during Urbanisation of South Africans.
The objective of the present study was to assess the relationship between anthropometric measurements and risk factors for non-communicable diseases (NCD) in South African black women. A cross-sectional sample of 1040 apparently healthy black female volunteers, 15-70 years old, was recruited from thirty-seven randomly selected sites in the North West Province, stratified according to level of urbanisation. We analysed the association between BMI, waist:hip (WHR), waist circumference (WC) and skinfold measurements and the following risk factors for NCD: blood pressure, serum lipids, fasting serum glucose and insulin and plasma fibrinogen, by using age-adjusted correlation analyses and stepwise regression analysis. Of the subjects, 28.6 % were obese (BMI>30). After adjustment for age and smoking status, BMI correlated significantly with diastolic blood pressure (r 0.21, P=0.037), serum triacylglycerols (TG) (r 0.30, P=0.003), fasting glucose (r 0.29, P=0.005) and log fasting insulin (r 0.24, P=0.02). There was a significant negative correlation between BMI and HDL-cholesterol (r -0.38, P<0.001). Similar but stronger correlations were found between both WC and WHR and these risk factors. Together with age, WC was a significant predictor of TG, HDL-cholesterol and fasting glucose in regression analysis, while subscapular skinfold was a significant predictor of diastolic blood pressure and fasting glucose concentration. Triceps skinfold was a significant predictor of total serum cholesterol, LDL-cholesterol, plasma fibrinogen and the insulin sensitivity index. Measures of obesity, particularly WC, are associated with the risk for NCD in black South African women, in which a high rate of obesity has been found.
Adolescent↗
Diets in transition: human health and animal production. Consequences for agriculture and some possible new approaches.
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Agriculture↗
Rural U.S. women: traditions and transitions affecting health care.
Warren (1972) proposed a means for determining differences between rural and urban social contexts that expands on the population definitions. Essentially, these differences are geographical, social, and economic in nature, and the health status of individuals in either setting may be affected by these variations. The health issues of women that evolve from these rural factors are the focus of this article.
Community Participation↗
Gaps and transitions in health insurance: what are the concerns of women?
This is a study of women's health insurance that makes both disaggregated and longitudinal comparisons between men and women to identify and describe gaps and sources of insecurity that are important for women. Income and family status are more important than gender in explaining health insurance differences. In many respects, the health insurance experiences of single women are more similar to those of single men than those of married women. Although married women often depend on their husbands for employer-sponsored insurance, the health insurance of married men and women is otherwise quite similar. Married women are at no greater risk of losing employer-sponsored insurance than married men, and married women experience fewer gaps and changes in coverage than single women (and single men). An expansion of coverage to all poor and uninsured adults would benefit more women than men by a small margin, despite the focus of Medicaid on low-income women. The married uninsured are concentrated just above the poverty line and have a big stake in whether public coverage programs extend above poverty. The main issue for women at higher income levels, especially for single women who cannot fall back on a spouse for coverage, is the danger of losing health insurance as a result of changes in employment.
Adult↗