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PubMed1994

The sanitary inspection in the conditions of social and economic transformation in Poland.

A great number of small, privately-owned companies appeared in Poland during the last five years as a result of the transformation process of the whole national economy. Continuous economic changes determine new requirements for the occupational hygiene branch of the State Sanitary Inspection which is designated to exercise control and sanitary supervision over working conditions in individual companies. The Sanitary and Epidemiological Stations are not capable now of ensuring permanent monitoring of various harmful agents even at those workposts which create true risk of health impairment. Lack of adequate legal regulations poses a significant problem in preparing a list of companies to be supervised. The majority of newly-formed, privately-owned companies not only fails to be subjected to any working-environment assessment procedures but also to be kept on any file. One of the crucial problems to be solved in the nearest future is to develop the efficient system for the supervision of working conditions and, at the same time, to find the ways how to improve them. Courses to train occupational hygiene specialists and to advance the skills of occupational hygiene workers seem to be equally important.

Health Policy↗
PubMed1998

Social differences in health in an affluent Danish county.

The aim of the present study was to examine whether selected health indicators were related to the level of social conditions in the municipalities in an affluent Danish county with a tax system aiming at narrowing income differences and with the same free health facilities for all. The 18 municipalities were separated into three groups by a sum score calculated on the basis of 10 social status variables. For each of the three groups average mortality, hospital discharge rates, cancer incidence and health services use were calculated with data from National Registers. There was a distinct gradient in all-cause, infant and cause-specific mortality, cancer incidence and use of health services related to level of social conditions. Apart from the incidence of breast cancer and melanoma, and use of general practice, all the analysed health indicators were most frequent in the group of the least affluent municipalities. It is concluded that even in an affluent county, the variation in the socioeconomic characteristics of neighbouring municipalities could be related to differences in health.

Adolescent↗
PubMed1984

International drug treaties: the connexion between ratification and social and economic conditions.

This study examines social and economic conditions in 152 countries and relates them to ratification of the two major international drug control treaties , the Single Convention on Narcotic Drugs and the Convention on Psychotropic Substances. The findings show that: (i) countries which ratified only the Single Convention had the greatest drug problems; (ii) ratifications were more common among developed countries than developing ones; (iii) ratifications were not more common among larger countries or those having higher expenditures on health and education, but they were more common among older U.N. member countries and those having ratified more non-drug treaties ; (iv) the best predictors of ratifications were a high level of life expectancy, a high degree of economic development and a substantial drug problem. The trend has been for more countries to ratify these treaties over time. However, a shorter-term solution would involve international support for those poorer countries which have not yet ratified them. Technical advice in the form of legal experts and translators is one example of such support.

Developing Countries↗
PubMed2006

Epidemiological trends in urolithiasis: impact on our health care systems.

The progressive increase of the social cost for treating urolithiasis could be related to an increased incidence of the disease and/or to an increase of costs for diagnosing and treating renal stones. In the course of the last century, the incidence of renal stones has progressively increased in Europe, North America, and other industrialised countries. This has been explained in terms of changing social conditions and the consequent changes in eating habits. In contrast, renal stones were less frequent than in developing countries of the world but in the last 20 years investigators began to report high incidences of upper urinary stone disease also from some areas of the Third World concurring with the changing of economic and social conditions. Each stone episode involves the costs for emergency visits, diagnostic work up, and medical or surgical treatment. Furthermore, we have to consider the costs of follow-up visits and the costs of testing and drugs for stone prevention. In adjunct of direct costs for diagnosis and treatment, we should also take into account the indirect individual and social cost of workdays lost. Finally, we should estimate the costs of complications and outcomes of treatment with particular attention to the costs of chronic renal failure secondary to stone disease. The strategy of treatment of each stone centre involves different costs for the treatment of each single stone episode. On the other hand the choice of treatment can be driven by National Health Systems and insurance companies by their policy of reimbursement for different procedures. The trends of renal stone incidence will have different impact on health care systems in different countries. In Europe and North America, the peak of incidence has been probably reached but the increase of costs for diagnosing and treating each single stone episode will still increase the social cost for managing stone disease. For this reason the actual objective should be to optimise protocols avoiding redundant or expensive diagnostic procedures or inappropriate treatments. In developing countries, the incidence of stone disease is still increasing and it could reach peaks even higher as a consequence of hot climate in some geographical areas. In those countries the demand for treatment of symptomatic stones could dramatically increase involving a huge financial outlay.

Delivery of Health Care↗
PubMed1982

Analysis of background variables in 350 patients with TMJ disorders as reported in self administered questionnaire.

All 350 patients referred to the Department of Stomatognathic Physiology during a 4-month period were given a self-administered questionnaire intended to give a review of the patients' history. The questions concerning general somatic and psychic health, education and social conditions are dealt with in this article. Twenty-five percent of the patients, more women than men, considered their general state of health to be impaired or poor. Seventy-two percent of the patients denied having had nervous or psychic disorders while 9% were currently being treated for such symptoms. Patients who had answered with alternatives indicating a "poor social situation" had, for instance, more pain in the face and jaws, poorer general health, more nervous or psychic disorders and more symptoms of TMJ disorders than the other patients. When the influence of education was considered, the patients with low education reported more severe symptoms of TMJ disorders than those with higher education. The general level of somatic and psychic health of the patients in this study did not differ markedly from that of the general population, but a negative influence on the health of the masticatory system of poor social conditions and low educational level could be demonstrated.

Adolescent↗
PubMed1975

Psychosomatic research today: a clinician's overview.

Emphasis is placed on the opportunities and importance, at this time, of continuing with clinically oriented psychosomatic research. For instance, the multidimensional studies of sleep and of depression are beginning to throw new light on psychosomatic processes, and so too are the studies of life events and illness. Short-term prospective clinical investigations provide an attractive framework for such work and they can be complementary to long-term survey studies investigating relationships between constitutional characteristics including personality, and social conditions and disease. There are some useful new tools for measureing psychological characteristics.

Adaptation, Psychological↗
PubMed2003

Syndemics and public health: reconceptualizing disease in bio-social context.

The world of public health has undergone dramatic changes since the emergence of AIDS in the early 1980s. The appearance and global spread in recent years of wave after wave of new and renewed infectious diseases and their entwinement with each other and with the social conditions and biopsychological consequences of disparity, discrimination, and structural violence has produced a new significant threat to public health internationally. The term syndemic has been introduced recently by medical anthropologists to label the synergistic interaction of two or more coexistent diseases and resultant excess burden of disease. This article provides the fullest examination of this new concept to date, including a review of relevant new literature and recent research finds concerning coinfection and synergistic interaction of diseases and social conditions at the biological and population levels.

Anthropology, Cultural↗
PubMed1991

[Promoting the development of handicapped children--possibilities and limits and responsibilities of the pediatrician].

The assessment of strategies to improve the development of handicapped children is difficult. Results of empirical investigations show marked differences with regard to the underlying handicap or developmental risk. The major impact of social conditions is beyond doubt, and within these conditions the coping process of the parents plays an important role. A survey of the literature is given. From this the pediatrician's tasks are derived: Early diagnosis of severe developmental disturbances; early and sympathetic information of the parents including a realistic estimate of given possibilities of help with special regard to social conditions, and an optimal support for the parents' coping process.

Cerebral Palsy↗
PubMed1996

Epidemiology of urolithiasis.

The epidemiology of urolithiasis differs according to geographical area and historical period: changing socio-economic conditions have generated changes in the incidence and type of lithiasis in terms of both the site and the physical-chemical composition of the calculi. Reno-ureteral calculosis typical of adult age and featuring mainly calcium oxalate and phosphate is currently more frequent in economically developed countries, where the prevalence rate hovers between 4% and 20% and the annual incidence of hospitalization for calculosis ranges from 0.03 to 0.1%. On the contrary "primitive" vesical calculosis is fairly widespread in Asia, with calculi composed of ammonium urate and calcium oxalate. Vesical calculosis, due to malnutrition in the very early years of life, is currently frequent in huge areas of Turkey, Iran, India, China, Indochina and Indonesia, although the incidence is decreasing in proportion as social conditions gradually improve. At the beginning of the 20th century primitive vesical calculosis was relatively frequent in Europe also, but in the course of the last 100 years, there has been a gradual decrease in its incidence, while the reno-ureteral calculosis has become more common. This trend definited as "stone wave" has been explained in terms of changing social conditions and the consequent changes in eating habits. In Europe, Northern America, Australia, Japan, and, more recently, Saudi Arabia affluence has spread to all social classes, and with it the tendency to eat "rich" food in large quantities. Calcium oxalate and/or phosphate stones account for almost 70% of all renal stones observed in economically developed countries. The prevalence of this type of stones varies considerably on account of environmental factors, especially dietary intake and lifestyle, while radiolucent and infection stones seem to be less influenced by environmental conditions. In the seventies the pathogenetic role for calcium oxalate stones of a diet rich in proteins, refined carbohydrate and sodium has become evident, while the effect of alimentary calcium and oxalate is still debated. However, the concurrence of a genetic predisposition seem to be crucial for calcium stone formation. In fact the importance of family history for idiopathic calcium stone disease is clearly demonstrated, although little is known about the metabolic alterations underlying this predisposition and their genetic transmission mechanisms.

Adult↗
PubMed2005

Psychosocial consequences of stroke: a long-term population-based follow-up.

PRIMARY OBJECTIVE: To investigate psychosocial status among nationally representative groups of stroke patients at long intervals post-stroke. METHODS AND PROCEDURES: From a Danish national register of hospitalizations, three representative groups of surviving patients were selected who had suffered a stroke 5, 10 and 15 years previously. A follow-up postal questionnaire was sent to them comprising items concerning symptomatology, functioning and social conditions, together with the Nottingham Health Profile (NHP). MAIN OUTCOMES AND RESULTS: Longer follow-up intervals were associated with younger age at stroke and better functioning at discharge. At follow-up, the majority of patients reported difficulties with attention, memory and emotional control, irrespective of follow-up interval. Return to employment, social relations and leisure activities were affected, but were comparatively better at longer follow-up intervals, as was self-rated functioning and several NHP symptom scales. However, multi-variate analyses suggest that these positive changes with time appear to be mediated by attrition related to age at stroke and discharge functioning rather than time since stroke itself. CONCLUSIONS: Symptomatology, functioning and social conditions remain affected and perhaps stagnant in long-term survivors of stroke.

Age Factors↗
PubMed1989

Use of dental services among Danish youths: role of the social environment, the individual, and the delivery system.

The purpose of the present study was to analyze the separate effect and the total effect of the social environment, the individual and the delivery system on frequency of use of dental services among youths. The variables of use were divided into the three main groups according to Coleman (12). Information concerning use of dental services, individual and structural variables was obtained by a self-administered questionnaire to 756 Danes 20-21 yr old in 1984-85. Information concerning social environmental variables was obtained by a postal questionnaire to the mothers of the individuals in 1974 (16). Information from 552 mothers was available. Firstly, the variables concerning the social environment were inserted into a multiple dummy regression analysis as independent variables, and it was found that the following characteristics of the mothers were significant predictors: regularity of dental visits and perceived economic barriers. Secondly, the variables concerning the individual resources were set into a multiple dummy regression model as independent variables. The results showed that the following variables had a significant effect: sex, social conditions, pain tolerance, dental anxiety, and perceived economic barriers. Thirdly, multiple dummy regression analysis showed that among the structural variables general assessment of Child Dental Care compared to Youth Dental Care, and a personality assessment of the general dental practitioner were significant predictors. Finally the predictors from the three main groups all together were inserted as independent dummy variables into a regression model. The results showed that sex, social conditions, pain tolerance, dental anxiety, perceived economic barriers of the youth themselves, general assessment of Child Dental Care compared to Youth Dental Care were significant predictors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

[Dental status, access to care and precariousness].

BACKGROUND: The oral status of people living in precarious conditions is problematic. Although the public universal health insurance should allow better access to care, access to dental care remains a critical issue. The analysis of the patient population of a hospital dental consultation (Groupe Pitié-Salpêtrière, Paris) seemed relevant to evaluate the needs of care and the means to provide it. The principal objectives are: to estimate dental health and needs of this population, to describe their sociodemographic characteristics and to compare them with patients living in common social conditions. METHODS: A cross sectional study was conducted from February to June 2003. A medical questionnaire and a dental file record were used. All outpatients coming to the dental consultation, in need of conservative or prosthetic treatment, were included. We analysed the risk factors associated with poor dental health. RESULTS: Three hundred and thirty three questionnaires were analysed: two third were men, 45% were foreigners. More than half of them benefited from a special social health insurance for disadvantaged people or didn't have any health insurance. The comparative analysis of this precarious group vs regular insured people showed significant differences for sociodemographic and oral characteristics. Namely, in the precarious group, a poor dental status was generally observed: more cavities (3.6 versus 2), more absent teeth not replaced (6.8 versus 3.5) and less treated teeth (1.9 versus 3.9)--p < 0.0001. Multivariate analysis showed that main risk factors of poor dental status were to be aged and to be a foreigner. CONCLUSION: This study stresses the importance of the dental care needs in a context of poor insurance refunding for the costs of dental treatments and the lack of structures able to provide dental care for patients living in difficult social condition. These findings question the organization of the dental care system in France.

Adolescent↗
PubMed1995

Genetic and environmental influences on growth.

OBJECTIVES: To provide an overview of the factors associated with growth in primary school children in England and Scotland and to provide information about the secular trend of growth in the last 20 years. SETTING: Representative English and Scottish samples and an English inner city sample. METHODS: The study had a mixed longitudinal design from 1972 to 1994. Between 8000 and 10,000 children participated in each survey. Height was measured in at least 95% of the children in most surveys, and 75% to 85% of parents provided information about family background. Main results are based on published information. Multiple regression was used for most of the analyses. RESULTS: Parents' height, child's birth weight, mother's age at child's delivery, ethnic background and, in white children, family size are the only factors markedly associated with height. Variables that have traditionally been used to assess the possible effect of social conditions were generally not associated with height. The height increase was more marked in Scotland than England over the period 1972 to 1990, and the differences in height of children in the two countries is now minimal. CONCLUSIONS: Most factors cannot be neatly classified as purely genetic or environmental, but seem to indicate that genes are relatively more important. Social factors usually assessed in growth studies do not have an important effect on growth. The marked increase of height over time indicates that the environment and social conditions have allowed children to grow taller. Sibship size is the only factor that was shown to be related to the secular trend in growth.

Adult↗
PubMed2001

Beyond health gain: the range of health system benefits expressed by social groups in Mexico and Central America.

Current health reform proposals in most developing countries stress health gain as the chief evaluation criterion. Essential service packages are formulated using cost-effectiveness methods for the selection of interventions without sufficient regard for other factors that are significant for successful implementation and acceptance by the needy. This paper presents the results of research undertaken in Mexico and Central America to test the hypothesis that population groups view health gain as only one among several benefits derived from health systems. The goal at this stage was two-fold: (a) to identify through qualitative methods the range of benefits that are significant for a wide cross-section of social groups and (b) to classify such benefits in types amenable to be used in the development of instruments to measure the benefits intended and actually produced by health systems. Fourteen focus groups were undertaken in Costa Rica, El Salvador, Guatemala, Mexico and Nicaragua representing diverse age, gender, occupation and social conditions. Six major types of health system benefits were identified besides health gain: reassurance/uncertainty reduction, economic security, confidence in health system quality, financial benefits derived from the system, health care process utility and health system fairness. Benefits most often mentioned can be classed under health care process utility and confidence in system quality. They also have the most consensus across social groups. Other benefits mentioned have an affinity with social conditions. Human resource-derived utility stands out by its frequency in the range of benefits mentioned. Health systems and health sector reform proposals must emphasise those aspects of quality related to human resources to be in accord with population expectations.

Adolescent↗
PubMed1994

Social handicaps of multiple sclerosis and their relation to neurological alterations.

The social conditions of 73 patients with multiple sclerosis (MS) were studied in relation to the most common neurological disorders observed among them. The Environmental Status Scale (ESS) and Kurtzke's Neurological Functional System (NFS)--both included within the Minimal Record of Disability (MRD)--were used. Pyramidal alterations were the more frequent neurological findings, whereas the need for personal care was the most common social handicap. The chi 2 test applied to contrast each of the dicotomic ESS and NFS variables showed a significant relationship between pyramidal alteration (weakness) and the need for personal care (p < 0.001), the use of community services (p < 0.01), and transportation problems (p < 0.05). Cerebellar disorders were significantly related to the need for community services (p < 0.01) and transportation problems (p < 0.01). Vision disorders were significantly related to the need for personal care (p < 0.05), transportation problems (p < 0.05), and social activity (p < 0.05). In turn, spasticity was significantly related to the need for personal care (p < 0.001), financial (p < 0.001) and transportation problems (p < 0.001), laboral situation (p < 0.05), and the use of community services (p < 0.05). Contrasting the four NFS and 7 ESS nondicotomic variables showed a marked correlation between the pyramidal alterations and personal care (r = 0.71) and transport (r = 0.62). Pyramidal alterations influence the social situation of MS patients and may be the foremost alterations to be considered for the optimal social integration of these patients.

Activities of Daily Living↗
PubMed1981

Home visiting by a geriatric department.

The practice of home visiting by the geriatrician in an inner city area is described. Visiting was of two kinds: domiciliary consultations made at the request of the general practitioner, and visits made with the consent of the general practitioner to see whether hospital admission was essential. Since 1962, 4,000 visits have been made, and in a sample of 100 visits made in 1977, 45 were domiciliary consultations and 55 followed requests for admission. Fifty-six patients were admitted at once and five following a subsequent outpatient appointment. The patients were referred by 51 general practitioners. At none of the consultations was the geriatrician accompanied by the general practitioner. Referral information given by the general practitioners was analysed. Information about acute physical disease and social conditions was commonly given but reference to psychological state, chronic disabilities, and drug therapy was much less common. Drugs were mentioned in only 27 referrals. More complete referrals would have been valuable to the geriatrician and to the general practitioner in deciding their courses of action. More accompanied visits and reference to a check-list consisting of acute physical disease, psychological state, social conditions, chronic disabilities, and drug therapy is suggested to improve communication and the quality of referrals.

Aged↗