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PubMed1996

Patient satisfaction at health centres in Trinidad and Tobago.

The aim of this paper is to identify background characteristics of health centre users in Trinidad and Tobago and their perceptions of the services provided. Multi-staged sampling was used to select 1,500 health centre users throughout the country. Data were obtained using structured interviews conducted on regular clinic days. Results show that there is an overwhelmingly large percentage of unemployed persons (80.4%) and women (75.9%) among the users of health centres. The elderly is well represented, with 25.4 percent of the sample being over 60 years of age. Also, occupational status of family wage earners and educational attainment levels of respondents reflect a disproportionately higher number from lower socio-economic groupings among health centre users. On the other hand, proportions of different ethnic and religious groups among the respondents bear a striking similarity to the general population of Trinidad and Tobago. Respondents appear to be generally satisfied with the services of the health centres. When the categories for "satisfied' and "very satisfied' were combined, results show that 73.0% of respondents were satisfied with the comfort of the health centre, 81.7% with the ease and convenience of getting to the health centre and 67.4% with the medical care received at the health centre. According to respondents' opinions, the services in greatest need of improvement are the pharmacy and doctor services, especially through reducing the long waiting period. When the doctors, nurses and pharmacists were compared with respect to "courtesy and consideration', "Skills and Competence' and "advice provided', results show that the generally high levels of satisfaction are remarkably similar in all three cases.

Adult↗
PubMedDate not supplied

Differences in household characteristics by income distribution in Pakistan.

The authors examine household characteristics by income distribution in Pakistan using data from the 1979 Population, Labour Force and Migration (PLM) Survey. Tabular data, organized by measures of income and expenditure, are presented on average household size, dependency ratios, average number of children and average number of adults, proportion of female household members, labor force participation rates for various ages, and occupational status of heads of households. The authors conclude that "the findings for Pakistan generally are in consonance with those for other Third World countries and confirm that certain characteristics are associated with poverty." Comments by Karol J. Krotki are also included (pp. 668-9).

Adolescent↗
PubMed2004

Health disparities based on socioeconomic inequities: implications for urban health care.

Health is unevenly distributed across socioeconomic status. Persons of lower income, education, or occupational status experience worse health and die earlier than do their better-off counterparts. This article discusses these disparities in the context of urban medical practice. The article begins with a discussion of the complex relationship among socioeconomic status, race, and health in the United States. It highlights the effects of institutional, individual, and internalized racism on the health of African Americans, including the insidious consequences of residential segregation and concentrated poverty. Next, the article reviews health disparities based on socioeconomic status across the life cycle, beginning in fetal health and ending with disparities among the elderly. Potential explanations for these socioeconomic-based disparities are addressed, including reverse causality (e.g., being poor causes lower socioeconomic status) and confounding by genetic factors. The article underscores social causation as the primary explanation for health disparities and highlights the cumulative effects of social disadvantage across stages of the life cycle and across environments (e.g., fetal, family, educational, occupational, and neighborhood). The article concludes with a discussion of the implications of health disparities for the practice of urban medicine, including the role that concentration of disadvantage plays among patients and practice sites and the need for quality improvement to mitigate these disparities.

Cities↗
PubMed1990

Patient sociodemographic characteristics as predictors of satisfaction with medical care: a meta-analysis.

A meta-analysis was performed to examine the relation of patients' sociodemographic characteristics to their satisfaction with medical care. The sociodemographic characteristics were age, ethnicity, sex, socioeconomic status (three indices), marital status, and family size. Greater satisfaction was significantly associated with greater age and less education, and marginally significantly associated with being married and having higher social status (scored as a composite variable emphasizing occupational status). The average magnitudes of relations were very small, with age being the strongest correlate of satisfaction (mean r = 0.13). No overall relationship was found for ethnicity, sex, income, or family size. For all sociodemographic variables, the distribution of correlations was significantly heterogeneous, and statistical contrasts revealed the operation of several moderating variables. The meaning of the overall results and their relation to earlier reviews is discussed.

Age Factors↗
PubMed2001

Incidence of testicular cancer and occupation among Swedish men gainfully employed in 1970.

PURPOSE: To estimate occupation-specific risk of seminomas and nonseminoma subtypes of testicular cancer among Swedish men gainfully employed in 1970 over the period 1971-1989. METHODS: Age-period standardized incidence ratios were computed in a dataset linking cancer diagnoses from the Swedish national cancer register to occupational and demographical data obtained in the census in 1970. Log-linear Poisson models were fitted, allowing for geographical area and town size. Taking occupational sector as a proxy for socioeconomic status, occupational risks were recalculated using intra-sector analyses, where the reference group comprised other occupations in the same sector only. Risk estimators per occupation were also computed for men reporting the same occupation in 1960 and 1970, a more specifically exposed group. RESULTS: Seminomas and nonseminomas showed a substantial geographical variation. The association between germ-cell testicular tumors and high socioeconomic groups was found mainly for nonseminomas. Positive associations with particular occupations were more evident for seminomas, for which railway stationmasters, metal annealers and temperers, precision toolmakers, watchmakers, construction smiths, and typographers and lithographers exhibited a risk excess. Concrete and construction worker was the only occupation consistently associated with nonseminomas. CONCLUSIONS: Among the many occupations studied, our results corroborate the previously reported increased risk among metal workers, specifically related with seminomatous tumors in this study. Our results confirm the geographical and socioeconomical differences in the incidence of testicular tumors. These factors should be accounted for in occupational studies. The different pattern of occupations related with seminomas and nonseminomas support the need to study these tumors separately.

Adult↗
PubMed2004

[Incidence, air pollution and risk factors of acute otitis media in the first year of life: a prospective study].

BACKGROUND: Epidemiological studies of acute otitis media (AOM) are scarce and no prospective studies have been performed in Spain. OBJECTIVES: To describe the incidence of AOM in the first year of life and its associated risk factors, with special focus on air pollution. METHODS: We performed a prospective cohort study of 229 newborn infants during the first year of life stratified by pollution zones, and followed-up by their pediatricians in their health center. AOM was defined on clinical grounds. A questionnaire on risk/protective factors included items on the following: sex, older siblings, smoking, breastfeeding, socioeconomic status, parental education and the mother's occupational status. RESULTS: The incidence of AOM episodes during the first year of life was 45 % and the proportion of children who experienced at least one episode was 32 %. Independent risk factors were male gender (aOR: 2.03; 95 % CI: 1.09-3.7) and living in a polluted area (aOR: 2.01; 95 % CI: 1.05-3.84). Independent protective factors were being born in spring (aOR: 0.41; 95 % CI: 0.19-0.88) and having a mother with at least primary school education (aOR: 0,53; 95 % CI: 0.24-1.15). Socioeconomic markers indicated a lower mean level among families whose children had at least one AOM episode. CONCLUSIONS: Air pollution and low socioeconomic status are greater risk factors for AOM than having siblings or parents who smoke. A minimum educational level reduces the risk of AOM. The incidence of AOM could be reduced by modifying certain environmental factors.

Acute Disease↗
PubMed2001

[Accidents in preschool children in the Boblingen district--accident causes and risk groups].

The characteristics of childhood accidents including their socio-demographic distribution were analysed using a cross-sectional design. In December 1999, questionnaires were sent to 50 kindergartens in the 'Landkreis Böblingen' (Southern Germany). 2,963 children went to these kindergartens, and the parents of the children were asked to fill in the questionnaire which was then analysed anonymously by the local health authority of Böblingen. The parents of 1,866 children sent back the questionnaire; the response rate was 72.0% for children with German nationality and 31.6% for the other children. On the average the parents reported 26 'accidents leading to a physician contact' per 100 child-life-years. Four indicators were used for characterising the socio-economic status of the parents (per capita income, occupational status of the father, school education of the mother, summary index), and three groups (low, medium and high socio-economic status) were constructed with each including about 1/3 of the children. Children from the low status group had about 13% fewer accidents than children from the high status group; for severe accidents, however, a contrary association was found (OR of the low as compared with the high status group: 4.1; Conf. Inter.: 1.12-14.96). The children with another nationality than German had severe accidents more often than German children (OR: 4.63; Conf. Inter.: 2.24-9.52). Boys had 33% more accidents than girls. About 3/4 of all accidents took place at home or in its direct environment. Concerning the age distribution, a peak was seen at age 2. The following accidents occurred particularly often: falling from stairs (10.2% of the accidents), falling from a playground equipment (9.5%), falling from a bicycle (8.9%), falling from a high bed (6.0%), stabs or cuts (4.9%), burns or scalds (4.4%), falling from a high chair (3.9%), falling from a nursery table (3.2%). The results are used by a regional working group which is asked to develop a strategy aimed at reducing accidents of pre-school children in the 'Landkreis Böblingen' until 2006 by 10%.

Accidental Falls↗
PubMed1999

Sexual knowledge and practice in Pakistani young men.

BACKGROUND: There is a shortage of scientific data on the subject of sexuality from Pakistan. We decided to document misconceptions among Pakistani young men, regarding masturbation and nocturnal emissions and to make a case for sex education in the country. OBJECTIVE: To study the knowledge, attitude and practice of Pakistani young men as regards masturbation and nocturnal emissions and to see any associations with demographic factors like age, marital status, occupation, level of education and socio economic status. METHOD: A questionnaire was developed, based on the objectives of the study. It was administered to 188 men between the age's 18-30 years, who presented to the outpatient department of the Aga Khan University Hospital. There was double entry of the data from questionnaires and the demographic form into the computer program, using the Fox Pro for windows and the SPSS for windows. RESULTS: We found a high prevalence of misconceptions and guilt associated with both these acts. Eighty percent of the respondents had masturbated while a 94% had experienced nocturnal emissions. 31.4% and 62.8% of the respondents reported association of physical illness and weakness with masturbation. Responses were 14.9% and 42.6% for nocturnal emissions. Association of guilt with masturbation and nocturnal emissions was 68.6% and 32% respectively. We also studied the association of demographic variables with these prevalence figures, in order to point out areas for future studies and interventions. CONCLUSION: We have documented the misconceptions regarding masturbation and nocturnal emissions among Pakistani young men and have made a case for sex education of our youth.

Adult↗
PubMed1980

[The influence of occupational stressors on the outbreak of psychic crises: a clinical study (author's transl)].

The etiological relevance of occupational stressors has been estimated among 87 patients of a Crises-Intervention-Ward. This relevance was distinct in 23% of the patients and was predominant in further 7%--mostly in patients having attempted suicide. The relations of this finding to age, sex, diagnosis and occupational status have been tested. Among 22 single occupational stressors the following were the most frequent: low income, debts; unemployment; monotonous, boring work; non-attainment of the aspired qualification; massive pressure of a superior; too much responsibility.

Adjustment Disorders↗
PubMed2005

Occupational magnetic fields and female breast cancer: a case-control study using Swedish population registers and new exposure data.

Several recent epidemiologic studies on occupational magnetic field exposure have suggested an association with female breast cancer. The purpose of this study was to test this hypothesis by using the extensive Swedish population registers in combination with improved exposure assessment. The study base consisted of all women between 1976 and 1999 gainfully employed in Stockholm or Gotland County in Sweden. A total of 20,400 cases of breast cancer were identified from the cancer registry, and 116,227 controls were selected randomly from the study base. Information was available on estrogen receptor status, occupation, socioeconomic status, and age. Parity was available for a subset. The exposure was assessed by linkage to a newly developed job-exposure matrix based on personal magnetic field measurements on women. All risk estimates were close to unity regardless of exposure cutpoint or choice of exposure parameter. The overall odds ratio for women exposed to 0.30 microT or more was 1.01 (95% confidence interval: 0.93, 1.10). The size of the study allowed for estimates with good precision also in subgroups where previous studies have suggested increased risk, but the findings do not support the hypothesis that magnetic fields influence the risk of female breast cancer.

Adult↗
PubMed1986

Does economic development necessarily lead to a decline in population? Some contrary evidence.

This is a summary of a micro-level study conducted in three villages in India to examine the impact of economic development on population growth. The emphasis is on variables pertaining to social structure, particularly occupational status. "It was found that there was no significant relationship between level of income and occupational prestige on the one hand and the size of the family on the other in every village....The correlations between educational level of the head of the household and the size of his family were....small and because of the low levels of literacy they have not played any significant role in the demographic change in any of the villages." The author concludes that "if the parents try to restrict the size of their families it is not so much because they do not derive...economic benefits from their children but because thereby they hope to improve the career prospects of their children."

Asia↗
PubMed1996

Social mobility and mental health in a Swedish cohort.

Data from Project Metropolitan, a study of a Stockholm cohort born in 1953, is used to investigate the relationship between social mobility and mental health. The analysis was based on 6928 males and included data gathered on the parents of the cohort at birth and during childhood, at draft board examinations conducted at age 19 years, census records when the cohort was aged 27 years and hospital records for the period during which the cohort was aged 20-30 years. At the age of 19 years, the sons of unskilled working class parents had a prevalence of psychiatric disorder that was approximately twice that of those born into upper-middle class families and they were one-third as likely to be rated as having a high coping ability. There was a strong association between mental health and the occupational status of the cohort members themselves at the age of 27 years. The health of those not fully employed and, to a lesser extent, those classified as students, was especially problematic. The sons of parents who exhibited downwards mobility during the childhood of the cohort had a greater risk of psychiatric disorder during early adulthood than those with parents who either rose in status or remained static. Intergenerational mobility, comparing the occupation of sons at the age of 27 years with that of their fathers at the time of their birth, was associated with a clear gradient in mental health; sons who rose in status had high ratings for coping ability and a low risk of psychiatric disorder, those who fell in status had low ratings for coping ability and a relatively high risk of impairment. Comparisons between Project Metropolitan and the British National Child Development Study (NCDS) cohort suggest that the selective effects of health may be more important in determining intergenerational social mobility that has sometimes been claimed.

Adaptation, Psychological↗
PubMed1984

Occupation and blood pressure.

Australian-born men in low-status occupations have, on average, higher blood pressures than those classified as professional or technical workers, according to the results of a national survey carried out by the National Heart Foundation and the Commonwealth Department of Health, Australia, in 1980. The expected correlations between age, alcohol consumption, body mass, and blood pressure were found. The association between occupation and blood pressure persisted after statistical adjustments for differences in age, obesity, and self-reported alcohol consumption. Though small, the differences in group averages are statistically significant, and suggest the potential for differences of cardiovascular morbidity for workers in different occupations. These findings are consistent with similar gradients in occupational mortality reported in Australia and elsewhere. It is likely that these effects are related to work, both through neuroendocrine stress mechanisms associated with certain job characteristics and through job-determined adverse health-related behaviour. The public health and preventive significance of such associations is stressed.

Adult↗
PubMed1994

Measuring socioeconomic status in studies of child development.

Income is more difficult to measure fully and accurately than occupation. Detailed occupational codes may be mapped into standard socioeconomic scales, and occupational status is related to other variables in much the same way as repeated or long-term measures of income. For these reasons, whether or not an attempt has been made to measure income, the measurement of socioeconomic status may be improved by ascertaining the occupation (and industry) of a job held by 1 or both parents. Income and household composition are preferable to the official poverty line in classifying economic standing, and housing tenure is a simple and powerful measure of economic consumption. Wherever possible, paternal as well as maternal education should be ascertained. However well they are measured, race-ethnicity and socioeconomic status do not capture all of the effects of family background.

Adolescent↗
PubMed1994

The relationships between sexual behaviour and health lifestyle.

The aim of this paper is to study sociodemographic and lifestyle differences between different AIDS/HIV risk groups in the general population. Respondents reporting more than three sexual partners in the previous five years, dichotomized into condom and non-condom users, are contrasted with the remaining respondents. The data consists of 7,717 interviews collected by telephone in the metropolitan areas of London, Glasgow and Edinburgh. The data show that while age and marital status are strongly related to sexual behaviours, there is evidence of individuals engaging in risky behaviours in all age and marital status groups. The relationship between sexual behaviours and occupational status is weak; there is a considerable and consistent difference between sexually more active and sexually less active respondents with regard to healthy 'lifestyle' indicators, such as smoking, alcohol use, exercise and safety behaviour, but this difference is less strong with regard to condom use. The paper supports the conclusion that in concentrating resources on the young and on unmarried individuals large numbers of individuals at an elevated risk for AIDS/HIV in other population groups will be missed. The strong relationships between indicators of health lifestyle and sexual behaviour seem to be a factor to be considered in the development of future AIDS/HIV-related health interventions.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Social gradients in cardiovascular risk factors and symptoms of Swedish men and women: the Göteborg MONICA Study 1995.

BACKGROUND: Even though coronary mortality in middle and old age is decreasing, social gradients may be increasing; but they need not necessarily be the same for men and women. In order to develop efficient preventive strategies more knowledge of the current distributions of risk factors both for men and for women is needed. OBJECTIVE: To investigate and to compare the socio-economic gradients for coronary risk factors of men and women. DESIGN: A cross-sectional study. METHODS: We studied 686 men and 825 women aged 25-64 years from a random population sample. Socio-economic status (SES) was classified according to the occupation-based Swedish Socio-economic Index. RESULTS: For women, high SES was associated with lower levels of total and low-density lipoprotein cholesterol, lower serum levels of triglycerides, higher levels of high-density lipoprotein cholesterol and lower blood pressure. For men, no relation between occupational status and levels of lipids and blood pressure was found. Obesity was associated with low SES both for men and for women. Socioeconomic differences in smoking habits were more pronounced for women than they were for men. The proportion of post-menopausal women was higher among the unskilled workers, despite there being no differences in age. Optimal risk factor status (non-smoker, total cholesterol level < 5 mmol/l, blood pressure < 140/90 mmHg without treatment and body mass index < 25 kg/m2) was unusual both among men and among women, but 34% of the higher officials among the women had optimal risk factor status, compared with 10% of the unskilled workers. Corresponding values for the men were 16 and 9% (P for interaction 0.09). The relation between low SES and level of low-density lipoprotein cholesterol was independent of smoking, post-menopausal state, use of oestrogen and waist:hip ratio (P = 0.04) and so was the relation between systolic blood pressure and low SES (P = 0.0003). CONCLUSIONS: In Sweden, low SES exerts a stronger adverse influence on cardiovascular risk factors of women than it does on those of men.

Adult↗
PubMed2002

A preliminary examination of the relationship between employment, pain and disability in an amputee population.

PURPOSE: To examine amputees' use of health, social and voluntary services and to assess the perceived benefit of such use. Additionally, to examine the degree and type of changes made in occupational status in relation to both pain and prosthetic limb use following amputation. METHOD: A survey methodology was employed to examine the services used by amputees and their experiences of occupational change. A response rate of 62% resulted in 315 amputees completing the study. The study sample was drawn from patient records at three artificial limb and appliance centres in the central belt of Scotland. RESULTS: Overall the data suggest that few amputees make use of the available services for general amputation-related problems. Even fewer services were utilized for phantom limb pain or for other pain problems. Moreover, of those services that were used, very few were reported as being helpful. Amputation had severe consequences in terms of employment with 75% of the sample in employment prior to the amputation and only 43.5% remaining following amputation. Additionally, of those who did remain in employment there were a number of changes from pre- to post-amputation occupational classification. Employment status was related to the intensity of phantom limb pain, and daily prosthetic limb use with unemployed amputees reporting higher levels of pain and lower levels of prosthesis use. CONCLUSIONS: The study demonstrates the need for further research to determine whether the results obtained regarding occupational changes following amputation result pain, disability, amputees' attitudes towards themselves in relation to work, or to employers' attitudes and beliefs about their capabilities. Further research is also required to determine why so few amputees make use of available services and why, even when they are used, such services are not perceived as being helpful. Finally, there is a need to clarify the relationship between the extent of daily prostheses use, the experience of phantom limb pain and employment status.

Adult↗
PubMed1991

Migrant women in Australia.

The author compares the status of non-English speaking (NES) migrant women with that of their native-born counterparts in Australia. She concludes that "Australian born women and migrant women have certain experiences in common; low economic position, being the target of discriminatory practices in education and in work, and their overall marginality in the power structure. In addition their jobs have much in common: for all women are disadvantaged compared with men in terms of earnings, occupational status, and job mobility. However,...NES migrant women tend to be employed in much lower-level, lower-status, and lower-paying occupations than Australian born women.... They face circumstances unique to their ethnic groups which they share with the men of their ethnic groups. Migrant women, even more than indigenous working class women see the family as a site of solidarity and supportive alliance against a hostile or new environment...."

Australia↗