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PubMed1996

Building health promotion into health care reform in Russia.

The health care system of the former Soviet Union, despite serious flaws, did provide the basis for community health activities, and for mandatory immunization and periodic health examinations for which primary care physicians were responsible. Since 1991, a new system of mandatory health insurance has been put into place. Health care funding has decreased substantially, owing to economic conditions. However, there is not yet widespread acceptance either of the strong association between personal behaviour and health consequences, nor of the importance of individual responsibility for one's health. To summarize, efforts at health promotion and disease prevention in Russia face numerous barriers: severe financial constraints owing to the general economic situation; social upheaval with loss of previous constraints on behaviour; cultural characteristics that include fatalism and encouragement of heavy alcohol and tobacco consumption; lack of acceptance of individual responsibility for health; lack of role modelling by the medical community; lack of critical appraisal of benefit and cost-effectiveness for preventive interventions; low priority for health care, and for prevention specifically. Disease prevention and health education must be built into the reformed health care system, to promote health for the Russian population.

Community Health Services↗
PubMed1999

Self-employment and economic leadership as two promising perspectives on rural disability and work.

A defining difference between rural and urban circumstances for people with disabilities involves opportunities for work. One of the most significant elements of the rural context is that economic conditions in rural communities consistently trail the national economy. This paper presents an overview of disability in rural America and outlines an ecological model for guiding the development of rural solutions to rehabilitation problems. Two promising examples of such solutions, self-employment as a rural vocational rehabilitation employment option and rural economic leadership by people with disabilities, are outlined.

Journal Article↗
PubMed1976

Peptic ulcer: (Analysis of predisposing and associated causes).

Age incidence, food habits and socio-economic condition were studied in a series of 478 predominantly male peptic ulcer patients. Age incidence of peptic ulcer increased in the second decade of life, reached a peak at the third decade and tapered off towards the end of fourth decade. As many as 57% of the patients belonged to the low socio-economic group and 78% were having only two meals a day. A ratio of 21 : 1 for duodenal ulcer to gastric ulcer was revealed from laparotomy findings.

Adult↗
PubMed2000

Aetiology of teenage childbearing: reasons for familial effects.

The aims of the present study were to evaluate the contribution of the genetic and environmental factors to the risk of teenage childbearing, and to study whether life style, socio-economic conditions, and personality traits could explain possible familial effects. We linked two population-based registers: the Swedish Twin Register and the Swedish Medical Birth Register. The study covers female twin pairs born between 1953 and 1958, having their first infant before the age of 30 years (n = 1885). In order to separate familial effects from other environmental influences, and genetic effects from shared environmental effects, only complete twin pairs with known zygosity were included, in all 260 monozygotic and 370 dizygotic twin pairs. We used quantitative genetic analyses to evaluate the importance of genetic and environmental effects for liability to teenage childbearing. Logistic regression analyses were used to estimate the effects of life style, socio-economic situation, and personality on the probability of teenage childbearing, and to study whether psychosocial factors could explain possible familial effects. Fifty-nine percent (0-76%) of the variance in being a teenage mother was attributable to heritable factors; 0% (0-49%) was due to shared environmental factors; and 41% (23-67%) was explained by non-shared environmental factors. Thus, the data were consistent with the hypothesis that the familial aggregation of teenage childbearing is completely explained by genetic factors, although the alternative hypothesis that familial aggregation is entirely explained by shared environmental factors cannot be ruled out. Significant effects of smoking habits, housing conditions, and educational level were found in relation to liability to teenage childbearing. However, the familial effects on risk of teenage childbearing were not mediated through similarities in life style and socio-economic factors. When studying risk factors for teenage childbearing, it is recommended to include life style and socio-economic variables as well as information about family history of teenage childbearing. Twin Research (2000) 3, 23-27.

Adolescent↗
PubMed1982

[Value scaling of family planning conditions].

Subjective relevance of 26 different conditions of family planning was measured by means of Thurstone's indirect rating method of couple comparison. A population of 560 interviews had been subdivided by conditions of reproduction, that is desire for children, no desire, and not pregnant. Marital status was an additional criterion for subdivision. The following conclusions were drawn: - The rating given by all groups of probands to health and partnership factors was higher and thus more relevant to decision-making in family planning than that given to age, parity, and depending on marital status, was found to undergo variation which was more intensive than any assessment of socio-economic conditions. Reference is made to resulting conclusions of relevance to society.

Abortion, Induced↗
PubMed1997

Postpartum sexual abstinence in the era of AIDS in Ghana: prospects for change.

Postpartum sexual abstinence for females has been identified as one of the socio-cultural factors with the potential for creating conditions for the sexual spread of HIV in areas where it is practised. In general, women are expected to abstain from sex after childbirth in order to ensure the survival of the mother and child. Men are not similarly expected to abstain and that has been used to rationalize polygyny. With changes in socio-economic conditions making it more difficult now than before to maintain two or more wives, particularly in urban areas, some men will abstain like their wives for fear of HIV infection; but such men may press their wives to resume sex early. Some women, on the other hand, may give in to the demands of their husbands by reducing the prescribed duration of postpartum abstinence. If this happens without the use of effective modern contraception, fertility may be affected. Some may also enter short or long-term relationship outside marriage, hoping that they will be safe from sexually transmitted infection. Using data from the Ghana segment of the Social Dimensions of AIDS Infection Survey, the study examines the responses of women who reported postpartum sexual abstinence and that of their partners. Both men and women reported abstaining, but some women were aware that their partners did not abstain as they did. Some of the women knew the sexual partners of their partners. Mostly it was men who made the first move to resume sex. For any behavioural change to occur, attitudes towards socially-constructed practices such as postpartum sexual abstinence will need to be changed by intensive education of both men and women and also through community support.

Adolescent↗
PubMed1991

[Intervention program for prevention of premature deliveries in Beit Shemesh].

Programs for the prevention of premature births have been developed world-wide to reduce perinatal mortality and child morbidity and handicaps. The Beit Shemesh intervention program focused on locating and improving socio-economic conditions, in addition to medical-nursing aspects. Beit Shemesh (located 30 km SW of the nearest Jerusalem hospital; population 14,000; 350-400 births per year) was chosen because its rates for preterm delivery (36 weeks or less) and for low birthweight neonates were higher than the national rates, it was of low socio-economic status, and because of its well-developed and accessible local health services infrastructure. The main goals of the intervention program were to reduce significantly the rates of preterm deliveries and that of low birthweight neonates to at least the national rates. Pregnant women who received treatment at family health centers were interviewed and classified according to a preterm birth-risk screening scale. The scale was constructed for this project to measure the degree of risk according to medical, nursing and socioeconomic criteria. Women identified as at-risk were invited for more intensive medical, nursing and social follow-up, according to their individual needs. The intervention of a social worker was a special part of the project. The findings, after 4 years of project intervention, showed a significant decrease in the rate of preterm births: 8.6% in the control group before the program was implemented as compared to 5.4% in the case group (p less than 0.01). There was a decrease in the percentage of low birthweight neonates to 7.9% near the average rate for the Jewish population in Israel.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1994

Health and health care in the English-speaking Caribbean: a British public health physician's view of the Caribbean.

People of Caribbean origin form one of the United Kingdom's most important ethnic minority groups but health conditions in the West Indies are not well understood in the UK. This review outlines past and present health conditions in the West Indies and describes the system of health care and some of the problems it faces at present. The last 30 years have seen a transition from a pattern of high childhood mortality to high mortality from chronic non-communicable diseases in adult life. Over the last ten years the severity of economic conditions undermined this progress, with the threatened re-emergence of malnutrition and infectious diseases as important health problems. Although most people in the region have access to health care, the quality and outcomes of care may be compromised by financial constraints and an unresponsive management system. Adopting modern approaches to planning and managing the health system might be one path to improvement, one to which public health professionals could make a significant contribution.

Adult↗
PubMed2002

Malaria transmission risk variations derived from different agricultural practices in an irrigated area of northern Tanzania.

Malaria vector Anopheles and other mosquitoes (Diptera: Culicidae) were monitored for 12 months during 1994-95 in villages of Lower Moshi irrigation area (37 degrees 20' E, 3 degrees 21' S; approximately 700 m a.s.l.) south of Mount Kilimanjaro in northern Tanzania. Adult mosquito populations were sampled fortnightly by five methods: human bait collection indoors (18.00-06.00 hours) and outdoors (18.00-24.00 hours); from daytime resting-sites indoors and outdoors; by CDC light-traps over sleepers. Anopheles densities and rates of survival, anthropophily and malaria infection were compared between three villages representing different agro-ecosystems: irrigated sugarcane plantation; smallholder rice irrigation scheme, and savannah with subsistence crops. Respective study villages were Mvuleni (population 2200), Chekereni (population 3200) and Kisangasangeni (population approximately/= 1000), at least 7 km apart. Anopheles arabiensis Patton was found to be the principal malaria vector throughout the study area, with An. funestus Giles sensu lato of secondary importance in the sugarcane and savannah villages. Irrigated sugarcane cultivation resulted in water pooling, but this did not produce more vectors. Anopheles arabiensis densities averaged four-fold higher in the ricefield village, although their human blood-index was significantly less (48%) than in the sugarcane (68%) or savannah (66%) villages, despite similar proportions of humans and cows (ratio 1:1.1-1.4) as the main hosts at all sites. Parous rates, duration of the gonotrophic cycle and survival rates of An. arabiensis were similar in villages of all three agro-ecosystems. The potential risk of malaria, based on measurements of vectorial capacity of An. arabiensis and An.funestus combined, was four-fold higher in the ricefield village than in the sugarcane or savannah villages nearby. However, the more realistic estimate of malaria risk, based on entomological inoculation rates, indicated that exposure to infective vectors was 61-68% less for people in the ricefield village, due to the much lower sporozoite rate in An. arabiensis (ricefield 0.01%, sugarcane 0.1%, savannah 0.12%). This contrast was attributed to better socio-economic conditions of rice farmers, facilitating relatively more use of antimalarials and bednets for their families. Our findings show that, for a combination of reasons, the malaria challenge is lower for villagers associated with an irrigated rice-growing scheme (despite greater malaria vector potential), than for adjacent communities with other agro-ecosystems bringing less socio-economic benefits to health. This encourages the development of agro-irrigation schemes in African savannahs, provided that residents have ready access to antimalaria materials (i.e. effective antimalaria drugs and insecticidal bednets) that they may better afford for protection against the greater vectorial capacity of An. arabiensis from the ricefield agro-ecosystem.

Agriculture↗
PubMed2002

Multinational corporations, the politics of the world economy, and their effects on women's health in the developing world: a review.

Presently, globalization and the world economy maintain power relations that hamper the economic integrity and the political autonomy of the developing world. My paper addresses specific economic conditions that perpetuate poverty and poor health. I examine multinational corporations and their effects on women's health, particularly in Mexico and parts of Asia. The advent of multinational corporate business in Mexico, Malaysia, Philippines, India, and Indonesia has led to increased poverty and human rights abuses. Women bear the brunt of this because of specific international economic arrangements and their low social status, both locally and globally. As a result, their physical, mental, and emotional health is suffering. Solutions to these health problems have been proposed on multiple levels: international top-down approaches (i.e., employing international protectionist regulatory standards, exposing multinationals who infringe on their workers' human rights), as well as local grassroots organizational campaigns (i.e., conducting informational human rights workshops for factory workers). Ultimately, the answers lie in holding corporations accountable to their laborers while developing countries maintain their comparative advantage; this is the only way women's health will improve and the developing world can entice corporate investment.

Asia↗
PubMed1989

[Myotonic dystrophy: I. Socioeconomic and residential characteristics of the patients].

Myotonic dystrophy is a dominantly inherited genetic disorder which, in medical literature, has been linked to peculiar socio-economical conditions. In order to document this assertion, a sociological study was conducted in the Saguenay-Lac-Saint-Jean region (Québec), using a representative sample (N = 218) drawn from the myotonic dystrophy population. A study of the patients' places of residence was also carried out. The results clearly indicate that myotonic dystrophy patients exhibit a socio-economic profile associated with disadvantaged milieux: high unemployment, low income and limited schooling. Many of these patients must rely on social welfare. Two families out of five (42%) live beneath the poverty line. The wage-earning history of these persons is closely linked to their self-evaluation of their working capabilities. After the age of forty, a high proportion of these people are unable to hold down a paying job and claim they are unable to do so. Within a well-screened urban area, a study of the patients' places of residence indicates census tracts where myotonic dystrophy is concentrated (ecological niches). These social areas are close to the downtown area and display characteristics of disadvantaged milieux. Accordingly, the My D gene seems to be confined to a specific socio-economic and socio-geographical environment, through which the spread of the gene is channelled among the population.

Adolescent↗
PubMed1982

The prevalence of gout in three English towns.

The prevalence of gout has been measured in three English towns by means of a postal questionnaire. The three towns were selected to give a range of socio-economic conditions. In each town questionnaires were sent to a sample of approximately 5000 men aged 45 to 74 years. The questionnaire elicited a history of gout and a history of an attack of severe pain in the great toe. There was a progressive increase in prevalence of gout from Ipswich, the town with the most favourable socio-economic status, through Wakefield to Preston, the town with the least favourable socio-economic status. Within each town there was no difference between the social class distribution of cases and age-matched controls

Aged↗
PubMed2001

Epidemiology of burn injury: experience in the Savannah region of Northern Nigeria.

Burn injury is a worldwide problem. We examine the epidemiological factors which cause conditions in which burns are more likely to occur. Seasonal variation influences (i.e. the cold dry harmattan period), certain cultural factors such as 'Wankan Jego', and using platforms with bedside fires, are contributing factors. The faulty storage of petroleum product has its toll. Poor architectural design and a low level of education in addition to poor socio-economic condition are factors that need to be addressed to reduce the incidence.

Adolescent↗
PubMed1988

[Studies on the current epidemiological situation of brugian filariasis in endemic areas of Korea]

An epidemiological study on brugian filariasis was carried out in endemic areas including Cheju Island in Korea, with a brief review of literatures.The results showed that the incidence among residents has remarkably decreased in Cheju Island, which was the main endemic area. Reviewing available informations on the prevalence of filariasis reported in recent years and also judging from the present socio-economic conditions which enable people to practice personal protection against mosquitos, it can be said with confidence that filariasis has almost disappeared from Cheju Island and inland areas. The disease is considered to remain at a low level of endemicity in Hugsan Islands. Certainly mass diethylcarbamazine (DEC) treatment carried out in Cheju Island in the 1960s and 1970s and remarkable economic growth followed by improved living standard and altered life-style of inhabitants could all have combined effects on the disappearance of this mosquito-borne diseae in this island. If the present trends go on, the possibility of resurgence of filariasis in Cheju Island is hardly postulated.

Journal Article↗
PubMed2002

Spatial patterns of tuberculosis incidence in Cologne (Germany).

In many European countries, the decline of tuberculosis notification rates levelled off in the mid 1980s. Germany has been facing only a very modest resurgence of tuberculosis (TB) in the early 1990s, but until now, the notification rate does not yet fulfil the WHO definition of a low incidence country. Mainly immigration from high incidence countries is held responsible for the delayed decline and temporary increase of TB. This paper seeks to investigate the inner-urban strength of association between tuberculosis and several potential risk factors in the city of Cologne using geographical and statistical methods within a small-area division based, GIS-supported ecological study, which never before has been conducted for a German city. Standardised annual TB incidence rates for 78 urban subdistricts between 1986 and 1997, disaggregated by age, have been analysed. Twelve independent variables representing contemporary ethnic and socioeconomic conditions are used to calculate Poisson regression models. For the entire population and for the <60 age group, a strong positive association was found between tuberculosis incidence and share of immigrants. Interestingly enough the share of German-origin immigrants from eastern Europe was seen not to be instrumental in increasing TB rates. Reflecting strong ecological correlations between variables depicting economic conditions and TB as well as immigration variables, the deprivation of certain ethnicities rather than high prevalence immigration background is inferred to be significant to TB level. As for the 60 + age group regression analysis fails to model the TB incidence patterns sufficiently it seems reasonable to assume an autonomous, spatially disaggregated TB epidemic of the elderly, echoing a severe post-war epidemic by reactivation, only marginally associated with contemporary living conditions, but contributing substantially to the current TB incidence level. This assumption is reinforced by further results of the statistical analysis (deviance of regression null models, testing for Normal distribution, time trends). It could be shown that in Cologne the HIV/AIDS epidemic is not significantly influencing the TB incidence rate of men aged 30-49 being the most AIDS-afflicted population subgroup.

Adult↗
PubMed1995

Short stature as an effect of economic and social conditions in childhood.

Only a few studies on the effect of environmental factors on height are based on adults and none, that we could find, relates adult height to both economic and psycho-social conditions in childhood. The aim of this study is to investigate whether four indicators of economic and psycho-social conditions during childhood are related to a variation in adult height and whether these factors can explain the variation in height between men and women from different childhood classes. The study is based on data derived from a study of living conditions in Sweden conducted in 1991. Beside childhood socio-economic group, indicated by father's occupation, we employ four indicators of economic and psycho-social conditions during the childhood period, previously employed elsewhere. These are economic hardship, large family, dissension in the family and disunited family during childhood. The prevalence of short stature differs significantly by three of the four indicators on economic and psycho-social childhood conditions. It is also more common if the person has grown up in a disunited family, but this effect is not significant. The proportion of short persons also varied significantly by childhood socio-economic group. On the whole, short stature in adulthood seems to be a reflection of a number of adverse conditions in childhood, both economic, status related and psycho-social, and can, consequently, be seen as summing up the whole childhood period rather than merely reflecting differences in nutrition or any other specific condition.

Adolescent↗
PubMed1996

Fertility decline in Bangladesh: toward an understanding of major causes.

Bangladesh has undergone a considerable decline in fertility, despite the absence of conditions believed to be necessary for such reproductive changes. Indeed, Bangladesh is the only one among the world's twenty poorest countries where such a change has occurred. The paper examines the nature of fertility transition in Bangladesh, looks at the trends in contraceptive use and fertility, and identifies the major factors accounting for the fertility decline, despite poor socio-economic conditions. Two types of factors in the decline are: (a) positive factors which encourage eligible couples to contracept, and (b) negative factors which compel women to contracept, for spacing or limiting births. The effects of positive and negative factors on contraceptive use and fertility are analysed with data from a rural sample of 4,194 women from the 1993-94 Bangladesh Demographic and Health Survey (BDHS), 2,597 women from the MCH-FP Extension Project area, and 8,110 women from the Matlab MCH-FP Project area. Logistic regression is used in the analysis. Strong and highly significant effects of female education, female employment and access to media on contraceptive use and fertility have been found.

Adult↗
PubMed1988

The rising long-term trend in occupational injury rates.

Establishment survey data for the United States as a whole and workers' compensation data for the State of California were used to document long-term trends in occupational injury and acute illness rates. After declining throughout the first half of the century, national rates of disabling injuries in manufacturing, construction, and the trade sector have risen sharply in recent decades. Injury rates in mining show no strong trend either up or down since 1960. Increases over recent years have been especially pronounced for strains and sprains, cuts, lacerations and punctures, bone fractures, and acute illnesses. Injury rates in the manufacturing sector are strongly influenced by general economic conditions--rising sharply with business upsurges and declining during recessions. Increases in the rate of unemployment, which decrease worker and labor union bargaining power, are associated with increases in injury rates within manufacturing.

Accidents, Occupational↗