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Sociodemographic characteristics of dropouts from a child guidance clinic.

OBJECTIVE: This study examined the characteristics of families who dropped out and families who maintained contact with a children's psychiatric outpatient clinic through various phases of intake and treatment. METHODS: One year after intake, the authors examined the status of all patients (N = 555) who had sought treatment at an urban, university-affiliated children's psychiatric outpatient clinic over a two-year period and had completed the intake process. Factors associated with dropout were identified at four points in the clinic process: during intake, during evaluation, at completion of evaluation, and during treatment. RESULTS: Urban residence, minority status, single-parent status, and Medicaid status were related to dropout at intake and during evaluation but not at subsequent clinic phases. Nonminority, two-parent, suburban families of higher socioeconomic status were more likely to drop out at the completion of the evaluation. CONCLUSIONS: These results indicate that factors associated with attrition vary with the clinic phase. Further investigations of the clinical course of minority children and families involved with children's mental health services are necessary to understand the needs of this population and to design interventions such as increasing minority staff and providing training in multi-cultural competence.

Adolescent↗

Compliance with therapy for cervical dysplasia among women of low socioeconomic status.

This paper reports results of a project designed to examine factors related to compliance with referral for follow-up and treatment of cervical dysplasia. Women studied had cervical dysplasia diagnosed by Pap smear between May 1989 and April 1990. These women had regular follow-up at the gynecology clinic of the Reynolds Health Center in Winston-Salem or at one of 14 county health departments in northwestern North Carolina. Data were collected by chart review, and included age, race, place of residence, marital status, parity/gravidity, education, previous papillomavirus infections, method of payment, and previous Pap smear results. Patients were traced through the treatment protocol, and compliance was assessed at each appointment. In these women of low socioeconomic status, approximately one third of those referred for treatment of dysplasia were noncompliant with referral.

Adult↗

The prevalence of allergic skin test reactivity to eight common aeroallergens in the U.S. population: results from the second National Health and Nutrition Examination Survey.

Immediate hypersensitivity skin tests to eight select allergens were performed on a sample (N = 16,204) of the civilian noninstitutional population of the United States, 6 to 74 years of age, in the second National Health and Nutrition Examination Survey (NHANES II). The eight allergens were house dust, cat, dog, Alternaria, mixed giant/short ragweed, oak, perennial ryegrass, and Bermuda grass. Skin test reactivity was defined as a mean erythema diameter greater than or equal to 10.5 mm at the 20-minute reading. Overall, 20.2% of the participants reacted to at least one allergen. Peak reactivity occurred in the 12 to 24-year-old age group. Reactivity was higher in blacks versus whites, but the difference did not reach statistical significance (23.2% versus 19.8%; p greater than 0.05). Male participants had an increased prevalence of reactivity versus female participants in whites (22.0% versus 17.6%), but not in blacks (23.2% versus 23.3%). Skin test reactivity increased in both whites and blacks with increasing income and education. The prevalence of skin test reactivity was higher in urban versus rural areas, but the difference was statistically significant only for whites (whites, 21.6% versus 16.4%; blacks, 23.8% versus 18.4%; p greater than 0.05). With logistic regression, the most important predictors of skin test reactivity in whites were age, sex, urban residence, and poverty status. In blacks, the most important predictors were age, urban residence, and poverty status.

Adolescent↗

The polygyny-fertility hypothesis revisited: the situation in Ghana.

Re-examination of the polygyny-fertility hypothesis, by multiple regression analysis of the 1988 Ghana DHS data, reveals that polygyny has no effect on the number of children ever born; i.e. polygynously married women are as fertile as those monogamously married. Husband's age has no significant role in determining the number of children ever born to a woman.

Adolescent↗

Do factors other than need determine utilization of physicians' services in Ontario?

BACKGROUND: Universal health care systems seek to ensure access to care on the basis of need, rather than income, but there are concerns about preferential access to cardiovascular and specialist care for high income patients. In this study, I used population-based, individual-level health, income and utilization data to determine whether whether there is evidence for differential access to physician care in relation to household income. METHODS: I studied data for 2170 Ontario respondents to the 1995 National Population Health Survey (aged 40 to 79 years) who had approved linkage of their survey responses to the administrative databases of the Ontario Health Insurance Plan and for whom income data were available. I used linear and generalized linear regression to model the mean per capita expenditures on physician care and the probability of referral to a specialist in relation to income and self-reported health status. RESULTS: Residents of higher income households incurred lower per capita expenditures for physicians' services than those in lower income households; for example, the mean per capita expenditure in the upper middle income group was $220 less (95% confidence interval -$87 to -$334) than the mean per capita expenditure in the lowest income group. Expenditures were significantly related to self-reported health status; for example, the mean per capita expenditure among those reporting fair health status was $590 higher (95% confidence interval $465 to $737) than among those reporting excellent health. After adjustment for health status, there was no association between income and the expenditures on all physician services, out-of-hospital services or specialist care. INTERPRETATION: Utilization of physicians' services in Ontario is based on need, rather than income.

Adult↗

Poisoning: an unnatural cause of morbidity and mortality in rural India.

BACKGROUND: Ninety-nine percent of fatal poisonings occur in developing countries, particularly among agricultural workers. In a particular area, it is important to known the magnitude and pattern of acute poisonings, as it is important for early diagnosis and treatment and also for preventive measures. METHODS: Hospital records of all unnatural causes of deaths were reviewed at Shri Vasantrao Naik Government Medical College, Yavatmal, Maharashtra during the five years period, 1997-2001. Autopsy records in fatal poisonings were studied for age, sex, residence, marital status, type of poison and manner of poisoning (accidental, suicidal or homicidal). Admission and death rates of acute poisonings were compared with those from other unnatural causes. RESULTS: Acute poisoning is the leading most cause of unnatural deaths and third common cause of emergency hospitalizations in this rural part of India. Of all fatal cases, 67% were males, 63% married, 83% with rural residence and 63.4% suicides. Responsible poison could not be ascertained in 16% of clinical and 9.9% of fatal cases. Insecticides were responsible for 35% of clinical and 55.4% of fatal cases. CONCLUSIONS: Young married males of rural background with agricultural occupation and failure of monsoon are the risk factors associated with poisoning cases.

Adolescent↗

Physicians in rural West Virginia emergency departments: residency training and board certification status.

OBJECTIVE: To describe the training and certification of physicians who staff small EDs in rural West Virginia. METHODS: A survey of rural hospital-based EDs was performed. The authors chose to study all hospitals in counties with populations of <30,000 and in which the hospital was the only one in the county. Interviews were conducted with the medical director of the ED or the hospital administrator, depending on who was available at the time of interview. Data collected describing the emergency physicians (EPs) employed at each facility included: medical school and residency training, specialty board certification, and certification in a variety of life support courses. General information about each ED, such as census and hospital resources, was also obtained. Interview data were collected on a survey form and subsequently entered into a database. Descriptive analyses were performed. RESULTS: 20 hospitals met rural criteria for inclusion in the study and all were included. The median number of full-time physicians per ED was 2 (IQR 2-4). 98 part-time doctors were identified; 28 (29%) of these were residents in training. 13/40 (33%) of full-time and 37/98 (38%) of part-time physicians were foreign medical graduates. Only 3/40 (7.5%) of full-time EPs completed residency training in emergency medicine (EM). Only 4/98 (4%) of part-time EPs were residency-trained in EM. 50% of full-time EPs were board-certified in a primary care specialty. Only 5/42 (12%) of full-time EPs were board-certified in EM. One third of full-time and the majority of part-time EPs were not board-certified in any specialty whatsoever. The majority of EPs had been certified in Advanced Cardiac Life Support, but fewer had been certified in Advanced Trauma Life Support and/or Pediatric Advanced Life Support/Advanced Pediatric Life Support. CONCLUSIONS: The majority of physicians staffing small rural EDs in West Virginia are neither residency-trained nor board-certified in EM. Further studies are warranted to determine the most efficient and effective way to maximize the skills and availability of emergency care providers in rural settings.

Certification↗

[A basic set of indicators for mapping migrant status. Recommendations for epidemiological practice].

Data on the health status of migrants are still scarce. One of the reasons for this is that migration status has not been well recorded in official statistics and epidemiological studies. In order to obtain an adequate and standardised operationalisation of migrant status, we first need an exact definition of the terms "migrant" and "migration background". We discuss approaches to the definition of terms and the surveying of ethnic minorities and migrants, and then develop a basic set of migration status indicators for use in epidemiological research. This set of indicators includes country of birth of the father and mother, year of immigration, mother tongue, German language skills and status of residence. The key indicator for the identification of migrants is the country of birth of the parents and not the nationality as was previously often the case. Thus, the classification based on the judicial category of nationality is replaced by a classification based on the biographical event "migration". Migration brings with it specific life conditions and challenges that can impact health across several generations. An instrument for surveying migrant status must be further developed both to reflect the special conditions of the life situation resulting from the migration experience and to take as full account as possible of all aspects of a migrant's history.

Algorithms↗

Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino whites.

OBJECTIVE: The authors investigated whether there are disparities in the rates of specialty mental health care for Latinos and African Americans compared with non-Latino whites in the United States. METHODS: Data were analyzed from the 1990-1992 National Comorbidity Survey, which surveyed a probability sample of 8,098 English-speaking respondents aged 15 to 54 years. Respondents self-identified their race or ethnicity, yielding a sample of 695 Latinos, 987 African Americans, and 6,026 non-Latino whites. Data on demographic characteristics, insurance status, psychiatric morbidity, whether the respondent lived in an urban or a rural area, geographic location, income, and use of mental health services were determined for each ethnic or racial group. Logistic regression analyses were used to examine the associations between ethnic or racial group and use of specialty services, with relevant covariates adjusted for. RESULTS: Significant differences between ethnic groups were found in demographic characteristics, geographic location, zone of residence, insurance status, income, wealth, and use of mental health services. The results indicated that poor Latinos (family income of less than $15,000) have lower access to specialty care than poor non-Latino whites. African Americans who were not classified as poor were less likely to receive specialty care than their white counterparts, even after adjustment for demographic characteristics, insurance status, and psychiatric morbidity. CONCLUSIONS: To understand ethnic or racial disparities in specialty care, the effects of ethnicity or race should be analyzed in combination with variables related to poverty status and environmental context. Further research needs to address the complex construct of social position in order to bridge the gap in unmet need in specialty care.

Adolescent↗

Evaluation of an oral health education program for nursing personnel in special housing facilities for the elderly. Part II: Clinical aspects.

In Sweden, efforts are being made to create strategies for evaluating realistic dental treatment needs among the elderly, who are retaining more natural teeth. These strategies focus on the importance of maintaining adequate oral hygiene. Elderly in long-term-care facilities often depend on nursing personnel for carrying out daily oral hygiene procedures. Therefore, the nursing personnel's knowledge about and attitudes toward oral health make oral health education for health care professionals an important concern. The purpose of this study was to evaluate the clinical oral health outcome in residents after their caregivers had undergone a one-session, four-hour oral health education program. The study consisted of an intervention with a pre- and a post-test and was carried out in three municipalities in the southwestern part of Sweden. A newly developed oral health screening protocol was carried out for 170 subjects living in long-term-care facilities both before and 3-4 months after nursing personnel had attended an oral health education program. Following the intervention, a statistically significant improvement was recorded for changes in oral mucosal color, a modified plaque index which measured oral hygiene status, and a mucosal index which recorded mucosal inflammation. This study indicated that a limited, one-session, four-hour oral health education, offered to caregivers within long-term-care facilities, had a positive impact on the oral health status of residents.

Aged↗

Population characteristics and environmental factors that influence level and cause of mortality. A review.

Responsible evaluation of energy production effects on human health requires prior accounting for the socioeconomic, cultural, and climatic characteristics known to influence mortality rate and cause. Fifteen population characteristics and environmental variables (education, income, occupation, industrial mix, socioeconomic status, housing quality, climate, urban residence, geographic residence, internal migration, cigarette consumption, alcohol consumption, marital status, foreign birth or stock, and religious affiliation) and three age subgroups are discussed. An initial set of eight variables is indicated for mortality rate standardization, based on the reliability of their relationships with mortality. These eight variables are: education, occupation, industrial mix, urban residence, marital status, ethnic mix, and cigarette and alcohol consumption. Education and occupation are negatively related to mortality. Occupational exposure to toxicants (indicated by industrial mix), cigarette consumption, and alcohol consumption have positive linear relationships with various specific causes of mortality. Urban residence, marital status, and ethnicity have non-linear relationships with mortality and show consistent patterns for certain causes of death. In addition to these characteristics three age subgroups ( less than 1 year, 1-14 years, greater than or equal to 65 years) are discussed because of their relatively high or low rates compared to the rest of the population. A brief review of water and air pollution effects on mortality is included for completeness. Unique to this review is the quantitative summary (presented as an appendix) of the variables influencing adult mortality. It is a compilation of numerical relationships, derived either directly or indirectly from the published data, that support the choice of influencing variables.

Age Factors↗

Accumulation of health risk behaviours is associated with lower socioeconomic status and women's urban residence: a multilevel analysis in Japan.

BACKGROUND: Little is known about the socioeconomic differences in health-related behaviours in Japan. The present study was performed to elucidate the effects of individual and regional socioeconomic factors on selected health risk behaviours among Japanese adults, with a particular focus on regional variations. METHODS: In a nationally representative sample aged 25 to 59 years old (20,030 men and 21,076 women), the relationships between six risk behaviours (i.e., current smoking, excessive alcohol consumption, poor dietary habits, physical inactivity, stress and non-attendance of health check-ups), individual characteristics (i.e., age, marital status, occupation and household income) and regional (N = 60) indicators (per capita income and unemployment rate) were examined by multilevel analysis. RESULTS: Divorce, employment in women, lower occupational class and lower household income were generally associated with a higher likelihood of risk behaviour. The degrees of regional variation in risk behaviour and the influence of regional indicators were greater in women than in men: higher per capita income was significantly associated with current smoking, excessive alcohol consumption, stress and non-attendance of health check-ups in women. CONCLUSION: Individual lower socioeconomic status was a substantial predictor of risk behaviour in both sexes, while a marked regional influence was observed only in women. The accumulation of risk behaviours in individuals with lower socioeconomic status and in women in areas with higher income, reflecting an urban context, may contribute to their higher mortality rates.

Adult↗

How prepared are psychiatry residents for treating nicotine dependence?

OBJECTIVE: Nicotine dependence is the most prevalent substance abuse disorder among adult psychiatric patients and a leading cause of death and disability. The authors examined the extent to which psychiatry residents are prepared to treat nicotine dependence in clinical practice. METHODS: Residents from five psychiatry residency programs in northern California completed an anonymous survey of their knowledge, attitudes, and behaviors regarding treating nicotine dependence among their patients. RESULTS: Respondents (N = 105, 60% female) represented all 4 years of residency training. Residents' smoking status was 11% current, 17% former, and 72% never. Knowledge scores averaged 54% correct. Confidence ratings averaged 3 (SD = 0.6) on a 5-point scale. Seventy six percent rated their overall ability to help patients quit using tobacco as fair or poor. The percent reporting often or always engaging in the National Cancer Institute's 5-A intervention for smoking cessation was: 58% ask; 29% advise; 17% assess; 18% assist; and 13% arrange follow up. Most residents reported none or inadequate tobacco cessation training during medical school (74%) or residency (79%), and nearly all (94%) reported moderate to high interest in learning more about helping patients quit smoking. CONCLUSION: Psychiatry residents appear unprepared to treat nicotine dependence, but report considerable interest in this area. The findings demonstrate the need for and interest in tobacco cessation curricula in psychiatry residency training.

Clinical Competence↗

Factors relating to the use of physical restraints in geriatric care settings.

Physical restraints are commonly used on older persons living in geriatric care settings. The aim of this study was to investigate the influence of environmental and organizational variations and resident and staff characteristics on restraint prevalence. In this cross-sectional study of 33 nursing home wards and 12 group living units for old persons with dementia in two municipalities in northern Sweden, 540 residents (mean age 82) and 529 staff members were evaluated for resident and staff characteristics and organizational and environmental variables. The proportion of residents with impaired mobility function, the number of behavioral disturbances, and nursing staff's attitudes towards use of restraints were the strongest discriminators between restraint-free wards and wards that used restraints. A classification function analysis showed that these three variables could correctly classify the wards as restraint-free, low-use, and high-use wards in 63.6% of the cases, with the highest figures for restraint-free wards (91%). This study has shown that the use of physical restraints is strongly connected with residents' functional status and nursing staffs' attitudes toward their use.

Aged↗

Easily measurable adverse outcome indicators in a Veterans Affairs nursing home.

Indicator data were collected from October 1986 through April 1987 for 356 residents of the nursing home at the North Chicago, Illinois, Veterans Administration Medical Center. Measures of prevalence, incidence, and rates of change were studied for 17 adverse outcome indicators of four main types: death, undernutrition, skin breakdown, and loss of activities of daily living (eating, mobility, transfer, and toileting). Indicator values can be calculated from data routinely collected for administrative and other clinical purposes and can be used to help nursing home administrators monitor trends in the physical status of residents and to establish and track compliance with quality assurance goals.

Activities of Daily Living↗

Farming and mortality from multiple myeloma: a case-control study with the use of death certificates.

A case-control study of multiple myeloma among males was conducted with the use of digitized mortality listings for 1968-76 from the State of Wisconsin. Age, year of death, race, county of usual residence, marital status, and usual occupation were available for the 411 male deaths due to multiple myeloma and for a matched series of deaths due to other causes. Farmers were at an elevated risk compared to nonfarmers [odds ratio (OR) = 1.4], with decedents 65 years of age or older having a stronger association (OR = 1.5) than younger farmers (OR = 1.1). County levels of selected agricultural characteristics were used as surrogate measures of exposure. Significantly elevated OR were observed for farmers residing in counties high in chicken inventory (OR = 1.6), fertilizer use (OR = 1.7), and acres treated with insecticides (OR = 1.9). Further investigation of multiple myeloma among farmers is warranted.

Adult↗