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PubMed1997

The pattern and structure of one-person households in England and Wales and France.

"This paper examines the increase of one-person households during the 1980s in England and Wales and France set within the broader context of household change in Europe as a whole....One-person households vary geographically by age, with younger one-person households found especially in larger urban areas; older one-person households have a more varied distribution, although rural and traditional retirement areas have particular concentrations. Increases in numbers are a result of both compositional changes in the population (increasing numbers of divorced and never-marrieds as well as increasing numbers of elderly) and also an increasing propensity to live alone, especially among younger age groups."

Age Factors↗
PubMed2004

Occurrence of phthalates and musk fragrances in indoor air and dust from apartments and kindergartens in Berlin (Germany).

UNLABELLED: In this study, the occurrence of persistent environmental contaminants room air samples from 59 apartments and 74 kindergartens in Berlin were tested in 2000 and 2001 for the presence of phthalates and musk fragrances (polycyclic musks in particular). These substances were also measured in household dust from 30 apartments. The aim of the study was to measure exposure levels in typical central borough apartments, kindergartens and estimate their effects on health. Of phthalates, dibutyl phthalate had the highest concentrations in room air, with median values of 1083 ng/m(3) in apartments and 1188 ng/m(3) in kindergartens. With around 80% of all values, the main phthalate in house dust was diethylhexyl phthalate, with median values of 703 mg/kg (range: 231-1763 mg/kg). No statistically significant correlation could be found between air and dust concentration. Musk compounds were detected in the indoor air of kindergartens with median values of 101 ng/m(3) [1,3,4,6,7,8-hexahydro-4,6,6,7,8,8- hexamethylcyclopenta-(g) 2-benzopyrane (HHCB)] and 44 ng/m(3) [7-acetyl-1,1,3,4,4,6-hexamethyl-tetraline (AHTN)] and maximum concentrations of up to 299 and 107 ng/m(3) respectively. In household dust HHCB and AHTN were detected in 63 and 83% of the samples with median values of 0.7 and 0.9 mg/kg (Maximum: 11.4 and 3.1 mg/kg) each. On comparing the above phthalate concentrations with presently acceptable tolerable daily intake values (TDI), we are talking about only a small average intake [di(2-ethylhexyl) phthalate and diethyl phthalate less than 1 and 8% of the TDI] by indoor air for children. The dominant intake path was the ingestion of foodstuffs. For certain subsets of the population, notably premature infants (through migration from soft polyvinyl chloride products), children and other patients undergoing medical treatment like dialysis, exchange transfusion, an important additional intake of phthalates must taken into account. PRACTICAL IMPLICATIONS: The phthalate and musk compounds load in a sample of apartments and kindergartens were low with a typical distribution pattern in air and household dust, but without a significant correlation between air and dust concentration. The largest source of general population exposure to phthalates is dietary. For certain subsets of the general population non-dietary ingestion (medical and occupational) is important.

Air Pollution, Indoor↗
PubMed2003

The Harstad Injury Prevention Study. A decade of community-based traffic injury prevention with emphasis on children. Postal dissemination of local injury data can be effective.

OBJECTIVES: To evaluate the outcome of a community-based program for reducing traffic injury rates with special focus on children and to assess the impact of a Traffic Injury Report (TIR) in terms of awareness and attitudes about safety issues. SETTING: The Norwegian cities Harstad (23 000) and Trondheim (140 000), during ten years. METHODS: The outcome was evaluated using hospital-based injury recording. Sustainability of the prevention program was promoted by disseminating information on the community's traffic injury profile. Reports containing information about traffic injuries were distributed quarterly to all Harstad households, containing victim stories and statistics on medical data and the location of the accidents. The impact of the reports was evaluated, using a questionnaire mailed to persons 18-80 years old. RESULTS: From the first two years (mean rate 116.1/10,000 person years), to last two years, a significant 59% [confidence interval (CI): 42% to 71%] reduction of traffic injury rates was observed for Harstad children. Overall rates for all ages decreased 37% [CI:47% to 24%] in Harstad increased by 3% [CI:-4% to 10%] in Trondheim (reference city). Significantly higher scores were found in Harstad compared to Trondheim concerning the awareness of, and positive attitudes towards, safety issues (e.g. alcohol and driving, speeding and children's safety in traffic). 56.0% of respondents in Harstad reported having acquired information, or good advice, about traffic safety from the reports. CONCLUSIONS: Traffic injuries in children can be prevented by community-based interventions. Distributing written information may enhance the program's sustainability.

Accident Prevention↗
PubMed2003

Declining subscriptions to the Maliando Mutual Health Organisation in Guinea-Conakry (West Africa): what is going wrong?

Mutual Health Organisations (MHOs) are a type of community health insurance scheme that are being developed and promoted in sub-Saharan Africa. In 1998, an MHO was organised in a rural district of Guinea to improve access to quality health care. Households paid an annual insurance fee of about US$2 per individual. Contributions were voluntary. The benefit package included free access to all first line health care services (except for a small co-payment), free paediatric care, free emergency surgical care and free obstetric care at the district hospital. Also included were part of the cost of emergency transport to the hospital. In 1998, the MHO covered 8% of the target population, but, by 1999, the subscription rate had dropped to about 6%. In March 2000, focus groups were held with members and non-members of the scheme to find out why subscription rates were so low. The research indicated that a failure to understand the scheme does not explain these low rates. On the contrary, the great majority of research subjects, members and non-members alike, acquired a very accurate understanding of the concepts and principles underlying health insurance. They value the system's re-distributive effects, which goes beyond household, next of kin or village. The participants accurately point out the sharp differences that exist between traditional financial mechanisms and the principle of health insurance, as well as the advantages and disadvantages of both. The ease with which risk-pooling is accepted as a financial mechanism which addresses specific needs demonstrates that it is not, per se, necessary to build health insurance schemes on existing or traditional systems of mutual aid. The majority of the participants consider the individual premium of 2 US dollars to be fair. There is, however, a problem of affordability for many poor and/or large families who cannot raise enough money to pay the subscription for all household members in one go. However, the main reason for the lack of interest in the scheme, is the poor quality of care offered to members of the MHO at the health centre.

Attitude to Health↗
PubMed2000

Community financing of local ivermectin distribution in Nigeria: potential payment and cost-recovery outlook.

The preferred payment mechanism in a community financing scheme for local ivermectin distribution was elicited from randomly selected household heads from three communities in Nigeria using interviewer-administered structured questionnaires. The majority of the respondents in the three communities were prepared to pay for local ivermectin distribution. Additionally, the average amounts the respondents were prepared to pay per person treated ($0.28, $0.30 and $0.38 in Nike, Achi and Toro, respectively) were all more than the $0.20 ceiling recommended by the partners of the African Programme on Onchocerciasis Control (APOC). Thus, the cost-recovery outlook is bright in these communities. However, the preferred payment modality varied. Fee-for-service was the predominant payment modality in the Achi and Nike communities, while the Toro community preferred pre-payment. This study demonstrates that many communities have different payment preferences for endemic disease control efforts. This knowledge will help in developing acceptable and sustainable schemes. The imposition of unacceptable payment mechanisms will lead to an unwillingness to pay.

Adult↗
PubMed2000

Mental health and nutritional status among the adult Serbian minority in Kosovo.

CONTEXT: Since the beginning of the North Atlantic Treaty Organization intervention in Kosovo in June 1999, few objective data have been available on relevant health indicators for the Serbian ethnic minority in Kosovo. OBJECTIVE: To determine the prevalence of undernutrition among Serbian adults aged 60 years or older and psychiatric morbidity among the adult Serbian population in Kosovo. DESIGN, SETTING, AND PARTICIPANTS: A systematic random sample survey of 212 households was conducted between September 27 and October 2, 1999, in Pristina, the capital city, and in 10 towns in the rural municipality of Gnjilane in Kosovo. Of the 212 households surveyed, 204 adults aged 15 years or older completed the General Health Questionnaire-28 (GHQ-28) and anthropometric measurements were taken for 98 adults aged 60 years or older and for a comparison group of 51 adults aged 18 to 59 years. MAIN OUTCOME MEASURES: Body mass index of less than 18.5 kg/m(2) in older adults; nonspecific psychiatric morbidity among adults; and self-reported use of health care services, access to food rations, and primary sources of prewar and postwar income. RESULTS: Undernutrition was found in 11.2% (95% confidence interval [CI], 5.7%-19.2%) of Serbian adults aged 60 years or older compared with 2.0% (95% CI, 0.1%-11.8%) of Serbian adults aged 18 to 59 years. The mean (SE) total score for the GHQ-28 was 13.0 (0.52). In a comparison of the GHQ-28 scores of the Serbian adults with the Kosovar Albanian adults (data from a recent survey), the mean (SE) score adjusted for age and sex was 12.8 (0.52) vs 11.1 (0.58); P =.03, respectively. The GHQ-28 scores were also higher for the Serbians in the subcategories of social dysfunction (2.8 [0.17] vs 2.2 [0.13]; P =.008) and severe depression (1.9 [0.15] vs 0.9 [0. 09]; P<.001), respectively. Serbian women and persons living alone or in small family units were more prone to psychiatric morbidity. Of the 141 respondents reporting the need for health care services, 83 (57.6%) reported not obtaining such services; 204 of 212 (96.2%) households were on a food distribution list. The majority of prewar income came from government jobs compared with farming and humanitarian aid for postwar income. CONCLUSIONS: The undernutrition of older Serbian adults in Kosovo should be monitored. The high prevalence of symptoms of social dysfunction and severe depression suggest the need for implementation of mental health programs in the Serbian community. JAMA. 2000;284:578-584

Adolescent↗
PubMed2006

Changes in Wuchereria bancrofti infection in a highly endemic community following 10 rounds of mass administration of diethylcarbamazine.

Mass drug administration (MDA) is the principal strategy of the programme to eliminate lymphatic filariasis (LF). Evaluation of MDA in highly endemic 'sentinel' communities is necessary to understand its impact on LF infection. This study examined the changes in Wuchereria bancrofti infection following 10 rounds of annual mass administration of diethylcarbamazine (DEC) in a highly endemic community. The mean number of DEC treatments received per adult in the community was 7.4+/-2.0. Following 10 rounds of DEC administration, the number of microfilaria (mf) carriers fell from 565 to 55. None of the pre-MDA amicrofilaraemic individuals showed circulating filarial antigen (CFA). However, 54.5% of the pre-MDA microfilaraemic individuals were positive for CFA. All the pre-MDA high intensity mf carriers continued to be positive for CFA, and some of them also showed blood mf. These patients are the most difficult to be cured by MDA and were distributed in 8.2% of the households. All the children born during the last 7 years of the MDA programme were negative for CFA. The study suggests that six to seven DEC treatments per individual suppresses microfilaraemia, except in some people with heavy infection, and repeated MDA has very good potential to prevent infection in children.

Adult↗
PubMed1997

Social class, gender and intrahousehold food allocations to children in South Asia.

In the 1980s research on gender-biased food distribution to children within the household in South Asia yielded important findings. Many studies report evidence of substantial discrimination against daughters, but others do not. This paper reviews research of the 1980s with attention to social differentiation in gender bias. My hypothesis is that different results concerning gender bias in intrahousehold allocations are expectable, given variations in gender hierarchy throughout South Asia. Results of the review indicate that seemingly "contradictory" results are often accurate reflections of social status differences within South Asia that create varying female health and nutritional outcomes.

Child↗
PubMed1997

Culture-specific strategies for capturing local dietary intake patterns.

To capture cultural reality and apply it to nutrition research, ethnographic research should be integrated with nutrition research and community-based nutrition research designs should be dictated by the local culture. Choosing the most appropriate dietary assessment for a study population requires attention to culture-specific technology for food acquisition, storage, exchange, processing, and preparation, as well as consideration of cultural rules pertaining to food distribution and consumption at the household level. Nutrition researchers should work with ethnographers to determine whether the assessment method used in a specific culture should capture the food intake of the household as a unit or of the individuals in each household.

Culture↗
PubMed1993

Detection of Mycobacterium leprae nasal carriers in populations for which leprosy is endemic.

In order to better understand the role of Mycobacterium leprae nasal carriage in the maintenance of infection reservoirs and transmission of leprosy, we applied a polymerase chain reaction (PCR) that detected a 531-bp fragment of the pra gene of M. leprae on nasal swab specimens collected through a total population survey from individuals living in an area in which leprosy is endemic. Among the total tested population of 1,228 people, 7.8% were found to be PCR positive. PCR positivity was shown to be randomly distributed among the population for which leprosy is endemic. No association was observed between PCR positivity, age, or sex. The observed distribution of PCR positivity among households of different sizes confirmed the expected values, with the exception of two households, each with three people with PCR-positive nasal swab specimens. Although nasal carriage does not necessarily imply infection or excretion of bacilli, the finding of nasal carriage supports the theory of a disseminated occurrence of M. leprae in populations for which leprosy is endemic.

Adolescent↗
PubMed2005

Decreasing socioeconomic inequalities and increasing health inequalities in Spain: a case study.

OBJECTIVES: We examined the evolution of income inequalities and health inequalities in Spain from the time of the country's entry into the European Union. METHODS: We estimated distributions of provincial income and household income, relations of provincial income with mortality and disability, and relations of household income with disability in 1984-1986 and 1999-2001. RESULTS: Inequalities in average provincial income and household income were lower in 2000 than in 1985. Differences in mortality and disability according to income were greater in 2000 than in 1985, in both absolute and relative terms, except for differences in mortality among individuals aged 25 to 44 years. In most cases, differences in mortality from leading causes of death and differences in major types of disabilities were also greater in 2000. CONCLUSIONS: Our results show that redistribution of income might achieve greater social justice but probably does not lead to reduced health inequalities, despite observed improvements in material circumstances as well as in most health indicators among disadvantaged population groups.

Adult↗
PubMed2002

Control of malaria: a successful experience from Viet Nam.

OBJECTIVE: To follow malaria prospectively in an ethnic minority commune in the south of Viet Nam with high malaria transmission and seasonal fluctuation, during malaria control interventions using insecticide-treated bednets (ITBNs) and early diagnosis and treatment (EDT) of symptomatic patients. METHODS: From 1994 onwards the following interventions were used: distribution of ITBNs to all households with biannual reimpregnation; construction of a health post and appointment of staff trained in microscopic diagnosis and treatment of malaria; regular supply of materials and drugs; annual cross-sectional malaria surveys with treatment of all parasitaemic subjects, and a programme of community involvement and health education. Surveys were held yearly at the end of the rainy season. During the surveys, demographic data were updated. Diagnosis and treatment of malaria were free of charge. Plasmodium falciparum infection was treated with artesunate and P. vivax infection with chloroquine plus primaquine. FINDINGS: The baseline survey in 1994 recorded 716 inhabitants. Of the children under 2 years of age, 37% were parasitaemic; 56% of children aged 2-10 years, and 35% of the remaining population were parasitaemic. P. falciparum accounted for 73-79% of these infections. The respective splenomegaly rates for the above-mentioned age groups were 20%, 56%, and 32%. In 1999, the proportion of parasitaemic subjects was 4%, 7% and 1%, respectively, of which P.falciparum contributed 56%. The splenomegaly rate was 0%, 5% and 2%, respectively. CONCLUSIONS: A combination of ITBNs and EDT, provided free of charge, complemented by annual diagnosis and treatment during malaria surveys and community involvement with health education successfully brought malaria under control. This approach could be applied to other regions in the south of Viet Nam and provides a sound basis for further studies in other areas with different epidemiological patterns of malaria.

Antimalarials↗
PubMed2004

Improving environmental conditions of a slum in Chandigarh by an awareness campaign.

An intervention project, in the form of an environmental awareness campaign was conducted in a slum of Chandigarh with a population of about 40,000, from December 1998-April 1999. The activities enforced during this campaign included focus group discussions with general public and mothers, household visit by medical students, distribution of literature, use of mass media by involving local residents, primary child care workers, teachers and school children. Evaluation of this campaign was carried out in May 1999 and compared with the baseline data obtained from a survey done in 1997. The study revealed that the method of storing water in covered buckets and utensils had improved significantly from 14.3% and 4.7% in the baseline survey to 35.2% (P < 0.001) and 16.2% (P < 0.01) respectively. Refuse disposal in the community bin and own bin had significantly improved to 22.2% (P < 0.001) and 19% (P < 0.01) from 8.4% and 11.2% respectively in the baseline survey. 51.2% of the residents using own bins disposed the refuse finally into the community bin. The use of community latrines had significantly increased among males (50.0%), females (47.7%) and children (41.2%) after intervention as compared to 32.8%, 32.5% and 16.7% respectively as found in the baseline survey (P < 0.001) and similarly open defaecation had significantly reduced among them. Further the study shows that the awareness regarding diarrhoea as hazard of unsafe water had improved significantly from 28.7% in baseline survey to 55.6% after intervention (P < 0.001). Knowledge of the residents regarding hazards of refuse disposal in the open and open defaecation had also improved significantly. Simple environmental awareness campaign can change the knowledge and behavioural practices of slum dwellers and could be a model for launching similar projects in other slums of India and other developing countries.

Adult↗
PubMed1991

Cystic echinococcosis in the Xinjiang/Uygur Autonomous Region, People's Republic of China. II. Comparison of three levels of a local preventive and control program.

A project to compare different levels of a hydatid disease control program was instigated and evaluated in 16 randomly selected villages in the Xinjiang/Uygur Autonomous Region, PRC (China). Factors tested included the effect of: 1) the role of a village hydatid disease control officer, 2) the use of praziquantel-medicated "bait" tablets for treatment of Echinococcus granulosus tapeworms in dogs, and 3) the use of educational materials for children and adults. Evaluation of contrasting treatment levels was done by determining infection rates of E. granulosus in about 25 dogs examined from each of the 16 villages before and after the trial period, and by use of pre- and post-treatment questionnaires distributed to 40 randomly selected households in each village. Optimum results were obtained in those villages which received medicated tablets and support visits from a control officer on a monthly basis (so-called "moderate intervention level").

Adolescent↗
PubMed1997

[Knowledge and treatment of malaria in rural Senegal].

Evaluating knowledge about the diagnosis and treatment of malaria is a prerequisite for both understanding the development of chemoresistance and improving ongoing programs of chemotherapy and chemoprophylaxis. To gain such knowledge we distributed a questionnaire to 900 household heads in twelve villages in the M'Backe district of Senegal. Awareness of the main symptoms of malaria was satisfactory in comparison with previous references. Public health care facilities such as dispensaries were cited as the first resort for treatment by 72.6% of respondents. Chloroquine was mentioned as the first line antimalarial by 23% of respondents who practiced self-medication. Improper dosages were stated by 60% of the respondents. A total of 52.3% of respondents practiced chemoprophylaxis mainly using chloroquine. In 65.8% of cases antimalarial drugs were obtained from public health care units but drugs were purchased on the market in 15.7% of cases. These findings indicate the threefold Bamako initiative should be reinforced and that a campaign should be undertaken to educate people living in rural areas about malaria.

Antimalarials↗
PubMed1980

[Acute poisonings in Barcelona. Epidemiology and therapeutic considerations (author's transl)].

During the first semester of 1977, 330 patients were admitted with acute intoxication to a general hospital in Barcelona, representing 1.8% of the total admissions through the Emergency Room during that time. The patients with acute intoxication were distributed as follows: 48.2%, voluntary intoxication; 39.1%, household accidents; and 11.8%, acute alcoholic intoxication. While most household accidents occurred in children less than 5 years of age (87.5%), suicidal attempts were seen mostly between ages 13 and 30. Regarding sex distribution, 68.6% of suicidal attempts occurred in females, while males accounted for 82.1% of admissions for acute alcoholism. No seasonal distribution of the different types of intoxication could be detected. Concerning the type of toxic compound implicated, household accidents were due principally to drug ingestion (47.7%) followed by ingestion of caustics, detergents, and other cleansing products (37.1%), while most (88.8%) suicidal attempts were due to drug ingestion. In both cases the drugs more frequently utilized were, in this order, barbiturates, benzodiazepines, alcohol, analgesics, and antidepressants. As far as it regards gravity of intoxication, benzodiazepines offered the greatest margins of security. It was observed that gastric cleansing was carried out independently of the age and level of consciousness of the patient and without regards to the time elapsed between ingestion of the offending agent and first evaluation. It was also noted that diuresis was enhanced in 40% of cases without pharmacological justification. Finally, therapeutic plans are discussed and measures to rationalize them are proposed.

Accidents, Home↗
PubMed2005

Comparison or consumption? Distinguishing between different effects of income on health in Nordic welfare states.

In the relation between income and health it has been suggested that individual level mechanisms are related either to absolute or to relative income. Both absolute income level and the individual's own income in relation to that of others are likely to affect health, but to distinguish between these effects in analyses has been difficult. The aim of this study is to distinguish between the effect on health of one's own position in the income distribution and the effect on health of the individual's ability to consume. Combining data from Sweden, Finland and Norway provides a setting where individuals with the same absolute income level may occupy different positions within their national income distribution. The data come from Swedish, Finnish and Norwegian surveys of living conditions from the mid 1990s. Both the position in the income distribution and the ability to consume is measured by household disposable equivalent income. In order to eliminate differences in price levels, household income is adjusted for purchasing power parities. The outcome measure used is limiting long-standing illness. There was a clear income gradient in health over the individual's relative position in their national income distribution. Stratifying for groups of household income adjusted for purchasing power parities, we still find a significant effect of the individual's relative position. In Nordic welfare states the relative position in the income distribution is related to limiting long-standing illness independently of the ability to consume among individuals with high ability to consume.

Female↗