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Child health care policy and delivery in France.

Medical and social protection of mothers, infants, and children began in France more than a century ago. A number of laws and regulations have improved the system, which is discussed in detail. The discussion includes an overview of health policy, service delivery, and the financing of care. Is the current French system of Maternal and Child Health responsible for the good health of today's children? This question is addressed through selected examples. Finally, failures and short-comings of the system are described, including the persistence of underserved groups, unequal access to care, and other problems. Solutions are feasible, and some are now being implemented.

Adolescent↗

[Health and morbidity of children in the North].

The author's many-years' experience and the literature data on research into the health of children and adults during adaptation in the Arctic are generalised. Significant changes are demonstrated in seasonal and circadian biological rhythms, in hormone levels, immunological tests and functional parameters of oxygen transport and consumption, and permanent exhaustion of these and other functional systems. At the same time, it has been proved that in the recent twenty years, the physical and mental development of children and adolescents has been quite satisfactory and their morbidity is not higher than that of Central Siberia, while childhood mortality level is noticeably lower. A conclusion has been drawn on the possibility of reducing the adaptational tension and functional reserve exhaustion, and of children's health improvement in the Arctic by means of social protection (housing, nutrition, etc.) and rational training (body hardening, physical exercises, etc.).

Adolescent↗

[Effects of late overstimulation in children with early maternal deprivation].

The reactions of ten minorities of a Social Protection Institution for forsaken children were studied, through the stimulation's impact of a travel to Disneyworld during 3 days. The methodology was based on semistructured interviews before the travel, by returning and 2 months after it. The results show that the stimulation, that the travel represented for 8 minorities, was an event beyond the ego's capacity of assimilation. The 2 children with better adapting capacity were those, in which foregoing histories, the affective lack had been less intensive than in the another minorities.

Adaptation, Psychological↗

[Penal deterrents and benefits of clemency: marginal notes on research].

The article refers to a volume recently issued by the Criminology Department of the National Centre for Prevention and Social Protection, which illustrates the results of some research carried out in order to verify the effects, if any, of the application of the benefits of amnesty and free pardon (not infrequent in the history of Italy) and of the application of the benefits of mercy, on recidivism. Although the research is focused on the formal figures of sentences of punishment, an attempt has been made to reach indicative conclusions based on the behaviour of those to whom these benefits were granted, in order to discover whether their application has reinforced or weakened the crimino-resistance of the subjects. The indications found in the examination lead to the conclusion that those who are predisposed to a certain type of delinquency, greater or lesser, (for example, towards crimes against the patrimony, especially if recidivous) continued to commit crimes at the same rhythm, or even in some cases at a greater rhythm, while those who may have fallen only rarely into crime (particularly women) tended to relapse less into crime. This is the case also with pardon, although in this case the benefit is individualized and conceded generally as a consequence of favourable prognostic evaluations. It is interesting to note that each time a general measure of amnesty or pardon is issued, the percentages of criminality are increased. The article brings these results to the attention of the reader, as material for reflection on the efficacy of reinforcement of the measures of pardon, with respect to the penal system.

Crime↗

[Critical age as the main parameter of deterioration of health in the elderly].

The concept of critical age (CA) relates to accelerated development of illness in the elderly and defines the decade in which there is the greatest increase in a specific pathological condition. Clinically, increased rates for pathological medical, biological, psychological and social conditions occur in defined populations. 78 parameters with linear increase in rate were excluded. 693 parameters were computed and classified according to both decade of life and to physiological and multisystem problems (such as diabetes). The most dangerous age is 70-79 years, when calamities of various degrees of severity "bomb" a subject approximately twice a month. CA was similar for some systems (immune, endocrine, and cardiovascular), and for diabetes and hypercholesterolemia. Among 351 CA distributions relating to 27 systemic and multisystemic problems, there were 103 statistically different CAs. We conclude that the rate of deterioration in health is largely system-oriented. Following the most dangerous decade, rates of increase in CA slow or CA even decreases, so that health is relatively stabilized. Such stabilization is related in part to improvement in risk factors. Improved health at age 80 seems to be related to selection by the death of the sick, but the concept of true functional improvement at this age is being seriously discussed. Physical, psychological and social bilateral adaptation of both old people and of western society, play important roles, because better medical and social protection improves living conditions. Our data confirm the identification of 2 subpopulations of the elderly, the young-old and the old-old. Study of frailty according to both age and physiological systems gives additional useful information.

Age Factors↗

Estimating increment-decrement life tables with multiple covariates from panel data: the case of active life expectancy.

A fundamental limitation of current multistate life table methodology-evident in recent estimates of active life expectancy for the elderly-is the inability to estimate tables from data on small longitudinal panels in the presence of multiple covariates (such as sex, race, and socioeconomic status). This paper presents an approach to such an estimation based on an isomorphism between the structure of the stochastic model underlying a conventional specification of the increment-decrement life table and that of Markov panel regression models for simple state spaces. We argue that Markov panel regression procedures can be used to provide smoothed or graduated group-specific estimates of transition probabilities that are more stable across short age intervals than those computed directly from sample data. We then join these estimates with increment-decrement life table methods to compute group-specific total, active, and dependent life expectancy estimates. To illustrate the methods, we describe an empirical application to the estimation of such life expectancies specific to sex, race, and education (years of school completed) for a longitudinal panel of elderly persons. We find that education extends both total life expectancy and active life expectancy. Education thus may serve as a powerful social protective mechanism delaying the onset of health problems at older ages.

Activities of Daily Living↗

[Environmental factors as risk factors for the health of the population: the results of epidemiological research and the means for its extension and deepening].

On the basis of the assessment of noncancer risk, main approaches were developed and approved to identifying the effects of the environmental factors on the health of the population, with special reference to nonspecificity of the action of the factors in question, polymorphism of the organism's responses, estimation of the threshold of the pollutants actions, specificities of the combined effects of environmental factors. The data obtained serve as a basis for identifying the extent of risk for exposure of the population to different factors, and it is on this foundation that priorities are to be established in designing health promotion measures, and the risk is to be correlated with the amounts of the necessary measures designed to provide an adequate social protection of the population.

Chronic Disease↗

[The state and dynamics of disability in childhood in the Russian Federation].

Characterizes the state and time course of childhood disability in Russia as reflected in statistical files of the service of social protection of the population. Presents the invalidity level in childhood: 79.7 per 10,000 population aged under 16 in 1992. The level of childhood invalidity increased by 4.8 times over 13 years. An unfavorable prediction regarding invalidity in 2000 is given. Epidemiological assessment of childhood invalidity as a regional level and for some territories is presented. Territories with stable and unstable levels of childhood invalidity were detected. Classification of territories of the Russian Federation by levels and rates of growth of childhood invalidity was made. Recommendations to solve present day problems of childhood invalidity are offered.

Adolescent↗

[The structure of childhood disability].

Characterizes the prevalence and structure of a population of disabled children registered in centers for social protection of the population as exemplified by Vologda Province. Analyzes the total and primary childhood disability. The results will help develop adequate measures aimed at preventing disability and for complex medicosocial rehabilitation of disabled children.

Adolescent↗

[The dynamics of the health status of pregnant women and children in the framework of the gynecological-therapeutical-pediatric complex].

A system has been developed for the follow-up of the health status of pregnant women and babies, applying an individualized approach to every subject and based on the comprehensive sanitization at an obstetrical, therapeutic, and pediatric unit, implemented on the general medical practice principle. Such an approach helps stabilize the main parameters of the health status of pregnant women, newborns, and infants and involve the social centers and territorial social protection service in the solution of these tasks.

Adult↗

[The problem of licensing healers and ensuring social security of patients].

Development of marketing in public health, cases of poor care of the patients, inadequate legal basis for relations between healers and the state organs responsible for the quality of medical care result in an increase of the number of popular healers, both real and false. The author emphasizes the need of creating as quickly as possible the laws ensuring social protection of a patient from incompetent treatment.

Licensure, Medical↗

The protective effect of social engagement on mortality in long-term care.

OBJECTIVES: To examine the effect of social engagement (SE) on mortality in long-term care. DESIGN: A retrospective cohort study. SETTING: A 725-bed long-term care facility. PARTICIPANTS: A total of 927 long-term care residents who had SE measurements and did not have a serious communication problem. MEASUREMENTS: Minimum Data Set information including psychosocial items comprising an internally reliable and valid SE scale, and mortality risk factor measurements. Mortality data during the 1,721-day follow-up period was obtained from facility records. RESULTS: Life table analyses indicate that higher levels of SE are associated with longer survival (P = .0001). Unadjusted proportional hazards analyses show that residents who did not engage socially were 2.3 times more likely to die during the follow-up period compared with residents who were the most socially engaged. Multivariate adjusted analyses showed the protective effect of SE on mortality remained even after simultaneously adjusting for mortality risk factors. Residents who did not engage socially were 1.4 times as likely to die during the follow-up period compared with residents who were the most socially engaged. CONCLUSIONS: Increased levels of SE were associated with longer survival independent of mortality risk factors. SE may be a modifiable risk factor for death among long-term care residents. More research is needed to understand psychological factors that may influence residents' desire and ability to engage socially.

Activities of Daily Living↗

[Socializing groups as protective factor against depression in elderly people. Barranquilla, Colombia].

BACKGROUND: The depression is a principal problem of public health. The principal aim of this study is to determine the role of the social groups as factor protective in elderly, to evaluate the agreement by American Psychiatric Association Criterions and Hamilton Depression test, and also to determine other socio-cultural risk factors associated with depressive syndrome in elderly. METHOD: Cross-sectional survey. The sample consisted of 602 elderly people (eligible subjects) were men (223) and women (379) between 60 and 94 years (males and females), residents in the south-west of Barranquilla, Colombia. A previously tested, self answer questionnaire was used, therefore, we needed a report consent. Risk measures: Odds Ratio (OR-95% Confidence intervalue), Kappa test to agreement by the nine criteria of the American Psychiatric Association and Hamilton test so, screening testing. RESULTS: The participation in social groups was a protector factor. (Odds Ratio = 0.5; 95% CI 0.34-0.73, p = 0.001). The rate 29.9% was obtained with prevalence of depression in elderly (21.4%-39.4%) affecting principally males (32.7%). The agreement by Kappa test = 0.63 was very important or good. Sensibility = 56.1% (48.5%-63.4%) Specificity = 0.93% (97.8%-99.8%) and Predictive Positive Value = 97.1% (91.2%-99.3%). CONCLUSIONS: This survey was to determine risk factors related to depression in elderly in anyway can be potentially modifiable. The familiar disfunction by moderate and serious, the lack as blindness and deafness, the loneliness, the housingness and low incomes were obtained with risk factors associated to depression. The participation in a social group is a protective factor to depression syndrome in elders. The nine criteria of the American Psychiatric Association to allow the depressed patient exactly as sick even though is not necessary to screening because this test is low sensibility for used in a population elderly.

Age Factors↗

Is social capital a protective factor against obesity and diabetes? Findings from an exploratory study.

PURPOSE: The aim of this exploratory study is to examine the relationship between social capital and the important public health variables of obesity and diabetes in the adult population in the United States. METHODS: State-level correlational analyses were conducted. Predictor variables included social capital (Putnam's measure), income inequality, and poverty. Outcome variables were state-level rates of obesity and diabetes as reported by the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System. RESULTS: Social capital and poverty had significant bivariate relationships with obesity and diabetes; multivariate linear regression showed social capital to be the strongest predictor of both outcome variables (explaining 10% of the variance in obesity and 44% of the variance in diabetes). Social capital was related inversely to both variables, indicating a protective effect. Sensitivity analyses showed that an alternate measure of income inequality had a bivariate relationship with diabetes, but was not as strong a predictor as social capital in multivariate analyses. CONCLUSIONS: These exploratory study results suggest that greater levels of social capital are protective against obesity and diabetes. This initial finding warrants subsequent empirical investigations designed to identify strategies that can be used to foster the creation of social capital in areas of the United States with an especially high prevalence of obesity and diabetes. In addition, these investigations should operate at multiple levels, examining individual, social-network, and community-level measures of social capital.

Adult↗

Behavioral and autonomic responses to intermittent social stress: differential protection by clonidine and metoprolol.

The present study investigated physiological and pharmacological characteristics of socially "stressed" animals. Specifically, we examined (1) to what degree autonomic and behavioral "stress" reactions during intermittent confrontations between an intruder male adult Long-Evans rat with an aggressive resident undergo habituation, and (2) to what extent the defeat-experienced animal can be protected against these "stress" reactions with clonidine or metoprolol, two adrenergic agents with clinical anxiolytic effects. We developed an acute social stress situation that consisted of initially placing an experimental rat as an intruder into the homecage of a resident while the resident was not present, thereafter permitting brief physical agonistic interactions with the reintroduced resident until the intruder was forced into a submissive supine posture and emitted ultrasonic vocalizations (USV), and eventually exposing the intruder to the resident's threats for one hour, while being shielded from potentially injurious attacks ("threat encounter"). Over the course of the initial 4-weekly threat encounters the acute tachycardia but not the hyperthermic stress responses decreased in magnitude. Following the first three threat encounters core temperature (Tc) was significantly elevated for at least 3 h. The Tc was already elevated when the repeatedly defeated intruder was confronted with the olfactory cues of the resident's cage. This conditioned "anticipatory" hyperthermia developed in the course of the first three confrontations and was paralleled by a decrease in exploratory and motor behavior and by an increase in defensive behaviors and in both types of USV emitted in the "low" (20-30 kHz) and the "high" (31-70 kHz) frequency range. Clonidine (0.01-0.1 mg/kg, IP), an alpha 2-adrenergic agonist and metoprolol, a beta-adrenergic blocker (1.0-10.0 mg/kg, IP), dose-dependently prevented the tachycardic response to stress. Only clonidine, but not metoprolol, also attenuated the rise in Tc during the 1-h agonistic interaction. Clonidine decreased those aspects of motor behavior (e.g. rearing, walking) that are of lesser "cost" for the individual but maintained high levels of defensive reactions and increased the duration of "low" USV. The high doses of clonidine (0.06, 0.1 mg/kg) attenuated the homeostatic regulation and sedated the intruder while exposed to threats during a social confrontation. The absence of attenuation of the high level of defensive behavior and the prolonged "low" USV suggest a stress intensification by the higher doses of clonidine. In conclusion, after the fourth encounter, the autonomic, behavioral and vocal response pattern prior to and during repeated weekly confrontations show no evidence for habituation for the following 6 weeks.(ABSTRACT TRUNCATED AT 400 WORDS)

Agonistic Behavior↗

Does knowledge influence melanoma-prone behavior? Awareness, exposure, and sun protection among five social groups.

PURPOSE/OBJECTIVES: To examine melanoma-related knowledge, sun exposure, and sun protection to determine whether increased awareness is associated with a reduction in risk. DESIGN: Quantitative/empiricist study conducted by purpose- designed mailed questionnaire. PARTICIPANTS: Consultant oncologists at one teaching hospital in London, England; specialist registrars (oncologists in training) contacted through a London-based educational group; oncology-trained nursing staff from oncology departments at two London teaching hospitals; medical students; general (nononcology) nurses; and members of the lay public from one London teaching hospital. SETTING: Two teaching hospitals in London, both registered cancer centers that possess specialist departments of oncology and are staffed by clinical and medical oncologists. METHODS: Anonymous, self-completion, mailed questionnaire. RESEARCH VARIABLES: Sun exposure; use of sun protection and avoidance; knowledge of the biologic effects of sun exposure, moles, and malignant melanoma; melanoma-prone behavior. FINDINGS: No significant differences were found in sun exposure or melanoma-prone behavior across the five groups studied. No correlation existed between knowledge and melanoma-prone behavior. Differences in knowledge and protection scores were demonstrated across all groups and were statistically significant, but they did not translate into changes in exposure or behavior scores. CONCLUSIONS: Public health policy that seeks to reduce the incidence of melanoma is based on the false premise that increasing awareness of melanoma risk will reduce melanoma-prone behavior. Increasing awareness of the risks of sun exposure may improve the use of sun protection, but it does not reduce melanoma-prone behavior, even among specialist healthcare professionals. IMPLICATIONS FOR NURSING: This study provides a new epidemiologic tool for nurses working in the specialty.

Adult↗

Functional decline in the elderly: evidence for direct and stress-buffering protective effects of social interactions and physical activity.

Advances in medical technology and improvements in health behavior have greatly increased the proportion of Americans who survive into old age. Consequently, identifying environmental and behavioral factors that enhance or protect the health and functional capacity of older adults is an important goal. This study investigated the extent to which social interactions and physical activity can protect older adults from the declines in functional ability that typically occur with age and the extent to which they buffer the negative effects of widowhood on physical functioning. Data were from the Longitudinal Study of Aging, a six-year follow-up of over 7,000 respondents in the 1984 National Health Interview Survey. Using individual growth curve models which examine the effects of predictor variables on change over time, this study investigated how physical activity, social interactions, and widowhood are related to the rate of change in functional health over a six-year period. Results suggested that physical activity and social interactions each exerted independent effects on functional decline. In addition, physical activity and social interactions buffered the effects of widowhood on functional decline, especially in men who died before the end of the study. Results suggest a need for health promotion programs to encourage both physical and social activities in the elderly.

Activities of Daily Living↗

[Medical-social problems of health protection of locomotive team workers].

Labor conditions and health status of locomotive drivers were studied. Factors affecting their morbidity were defined. Measures ensuring medical security in railway transport are discussed. A special complex of measures for medical and social protection of drivers' health status is presented.

Adult↗