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Growth assessment in infants and toddlers using three different reference charts.

OBJECTIVE: To determine if the proportion of children < or =24 months old in a tertiary care facility defined as at risk of undernutrition or overnutrition differs according to different references used for assessment: the Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS) or Tanner-Whitehouse (Tanner) growth charts for weight-for-age and length-for-age. METHODS: Lengths and weights were measured on infants (207 female, 341 male) aged < or =24 months admitted from or attending clinics in the General Pediatric or Respiratory Medicine Programs at The Hospital for Sick Children, Toronto. Weight-for-age and length-for-age percentiles and percent ideal body weight were electronically computed. RESULTS: The proportion of all children whose weight-for-age was <3rd percentile (at risk of undernutrition) was greatest using the CDC growth charts (22.5%) compared with the NCHS (15.9%) or Tanner (19.2%) growth charts. Likewise, the proportion of all infants/toddlers with percent ideal body weight <90 (at risk of undernutrition) was greatest using the CDC (32.3%) compared with the NCHS (22.1%) or Tanner (25.9%) growth charts. In contrast, the percentage of children whose percent ideal body weight was > or =110% (at risk of overnutrition) was least using the CDC (18.1%) compared with the NCHS (26.1%) or Tanner (22.4%) growth charts. CONCLUSION: More children aged < or =24 months will be defined as at risk of undernutrition and fewer at risk of overnutrition when using weight-for-age or percent ideal body weight and the CDC growth charts compared with the NCHS or Tanner growth charts. As a result, requests for a more detailed nutritional assessment for undernutrition will likely follow implementation of the CDC growth charts in a tertiary care setting. As the CDC, NCHS and Tanner growth charts are growth "references" rather than "standards," other than for screening purposes, they should not be used in isolation when assessing growth and nutritional status.

Age Factors↗

Gender inequalities in health among older Brazilian adults.

OBJECTIVE: To investigate gender differences among older Brazilians in their health status and their use of health services. METHODS: Participants were individuals aged 60 years and older included in a national household survey conducted in Brazil in 1998. Data were analyzed by multiple logistic regression, taking into account the design effect due to multistage sampling. RESULTS: There were differences in the health and living conditions of older men and older women that were not explained by age or place of residence. Older women had worse indicators of schooling and personal income but better indicators of housing standards and per capita household income. The older women also reported more chronic diseases, had poorer indicators of independence and physical mobility, sought health services more often, and reported more medical visits in the previous year. Despite their apparent worse health conditions, elderly women in urban areas had lower hospitalization rates in the previous year (odds ratio = 0.89; 95% confidence interval, 0.82-0.96) than did elderly men in urban areas. CONCLUSIONS: Our results indicate that among older Brazilians there are gender inequalities in health that cannot be explained by age and place of residence. The findings raise questions on how health, socioeconomic, and cultural factors influence gender patterns of seeking and using health care in later life in the country. As pressures on health care and health funding increase in Brazil as a result of the aging of the population, there is a need to take a gender perspective into account.

Aged↗

Allocating resources in health care: alternative approaches to measuring needs in resource allocation formula in Ontario.

Maintaining or improving the welfare of the population is a complex issue involving individual and collective actions and institutions. Despite questions regarding the relevance of health care systems to these aims, they remain vital policy and treatment arenas with respect to curative and preventative regimes. As a component of social welfare, health care resources should be distributed equitably, according to need for health care. This paper evaluates alternative indicators of health status within Ontario against self-reported health as a means of allocating health care resources. Proxies of need for health care include standardized mortality ratios (based on the population aged 0-64) and a socioeconomic based indicator. Mortality indicators are found to be more closely correlated with self-reported health status than the socioeconomic indicator, suggesting that mortality is better able to reflect variations in health status and health care needs.

Adolescent↗

Postural change in blood pressure associated with age and systolic blood pressure. The National Health and Nutrition Examination Survey II.

The prevalence of postural change in blood pressure and its association with age and systolic blood pressure were examined in data from 8,574 White nondiabetic persons aged 25-74 who participated in the second National Health and Nutrition Examination Survey (1976-1980). Postural change in blood pressure was defined as a drop of 20 mm Hg or more on change from supine to seated position. In subjects on no antihypertensive medications (n = 7,316), the prevalence of postural change in blood pressure increased with older age and with higher blood pressure levels, regardless of age. However, systolic blood pressure levels also increased with age. In logistic regression models, level of supine systolic blood pressure was strongly related to postural change in blood pressure (Relative odds (RO) = 1.59, 95% confidence interval (CI) = 1.49, 1.70 for a 10 mm Hg increase in systolic blood pressure) whereas age was not related to postural change in blood pressure (RO for age = 1.07, Cl = .89, 1.19 for a 10-year increase in age). Results were similar for those medicated for hypertension. All results were unchanged by addition of health status indicators, including reports of hospitalization and number of medical conditions, to the model. These data suggest that the age-related increase in the prevalence of postural hypotension previously reported may be partially explained by age-associated increases in systolic blood pressure.

Adult↗

Methodological issues in adolescent health surveys: the case of the Swiss Multicenter-adolescent Survey on Health.

In many countries, health care and prevention professionals face serious lack of data regarding health status, health care utilisation and lifestyles of adolescents. With reference to a survey on health and lifestyles of Swiss teenagers 15-20 years old, this paper reviews the different methodological issues linked with the conception and the realization of such a study. The main objective of the so-called "SMASH" project (Swiss Multicentric Adolescent Survey on Health) is, like other similar researches, to gather health indicators; that is, to measure attitudes and behaviour regarding different aspects of health and lifestyles, to identify the perceived health needs of the respondents and to describe their utilisation of health care services. The main issues which are addressed in the paper are related to: 1) the choice of the channel and the instrument to be used (telephone, vs. face-to-face interview vs. self-administered questionnaire; 2) the sampling procedures (pure random vs. cluster school-based samples; size of the sample); 3) the design and the content of the questionnaire (choice of the areas to be covered, selection and wording of the questions); 4) the ethical considerations linked with the collection of data. One of the specificities of SMASH is the inclusion of youth participation at various steps and levels: the design of the questionnaire, the strategies used to gather the data, and the analysis of the results. Two important issues emerge from this review. First, the importance in the future of being able to rely on common indicators that could be used in different countries and settings through the construction of a validated instrument. Second, the fact that most of the surveys conducted in this field neglect several sub-populations of adolescents with special and important needs: handicapped adolescents, drop-outs and recent immigrants coming either as unskilled workers or as refugees. Surveys in such special in-need groups will have to be planned with specific designs, both in terms of content and of approach.

Adolescent↗

[Perceived general health and mortality].

Many international studies underline the importance of the health indicator "perceived general health" (PGH). For Germany, only few Longitudinal studies are available from recent years, dealing with the question whether PGH is a predictor for overall mortality. Based on a Mortality-Follow-up Study (n = 7212) under the auspices of the Federal Institute for Population Research the importance of the indicator PGH for the prediction of the mortality experience in the general population has been analysed for the period 1984 - 1998. The age-adjusted relative risk of "less than good health" for overall mortality is 2.11 (p <0.001) for males and 2.05 (p <0.001) for females (reference category: "good/very good health"). The relative risks for "poor health" are 4.32 (p <0,001) in males and 3.07 (p <0.001) in females. An inclusion of several control variables remarkably reduces these relative risks. The results indicate that the indicator "perceived general health" is an important predictor of overall mortality in Germany.

Adult↗

Dental injury among Brazilian schoolchildren in the state of São Paulo.

To describe the distribution of dental trauma in Brazilian schoolchildren and its association with demographic, environmental and clinical factors. A random sample of 73 243 schoolchildren's oral examination records from private and public units, selected from 131 cities within the state of São Paulo, Brazil, was analysed. Trauma was assessed based on international methodological standards prescribed by the World Health Organization for Oral Health Surveys (1997). Proportions obtained were compared between urban and rural schools, as well as between private and public units. Oral health status indices were estimated based on the decayed, missing and filled teeth (DMFT) index - the average number of decayed, missing and filled teeth; the proportion of caries-free 5-year-old schoolchildren and anterior maxillary overjet among 12-year-old schoolchildren. The prevalence of dental trauma in anterior dentition was of 2.4, enrolling average 1.2 teeth per child. A rate of 2.4 impaired anterior teeth per thousand was obtained, upper central incisors being those that were most affected - 7.7 in every 10. Among 8- to 11-year-old children, the rates grew regularly. The proportion of dental trauma was significantly higher in boys than in girls (P < 0.01), and gender prevalence ratio was of 1.58 for boys. The results showed positive associations between dental trauma and caries-free 5-year-old schoolchildren (P = 0.003), anterior maxillary overjet > or =3 mm (P < 0.001), and private school as a socio-economic proxy indicator (P = 0.048).

Age Factors↗

Describing health states. Methodologic issues in obtaining values for health states.

In health status index construction quantitative values for different states of health are frequently obtained by presenting written descriptions to raters whose values are elicited using one or more methods. In this study the authors examined the influence of several aspects of this measurement process upon the quantitative results obtained. They prepared a set of written descriptions of health states, each state being described in both a standard point-form and a narrative format. The narrative format was written in the first person singular, and listed all symptoms or problems associated with the state, whereas the point-form description included only the most severe symptom or problem. Values for these states were elicited from a group of 64 patients using two commonly employed methods, the standard gamble of Von Neumann and Morgenstern and category rating. The results indicate that the type of scenario presented to the rater and the sequence in which the methods of assessment were used had a major influence on the results. This work indicates that there is a need to examine systematically the process of obtaining quantitative values before reliance can be placed upon the results.

Adult↗

Health status of the elderly and their labor force participation in the developing countries along the Asia-Pacific rim.

The authors examine the health status and labor force participation of and support systems for the elderly in developing countries in east, Southeast, and south Asia and compare them with Western norms. They find that "there are numerous psychological and emotional elements involved in institutionalizing support for the elderly, and the marked differences in social and cultural factors between the Asian countries and Western industrialized nations make it difficult for the former to use...old-age support systems prevailing in the latter as a model." (SUMMARY IN KOR)

Adult↗

Use of automated telephone disease management calls in an ethnically diverse sample of low-income patients with diabetes.

OBJECTIVE: We examined whether low-income patients with diabetes were able and willing to use automated telephone disease management (ATDM) calls to provide health status information that could improve the quality of their care. RESEARCH DESIGN AND METHODS: A total of 252 adults with diabetes, 30 of whom spoke Spanish as their primary language, were enrolled at the time of clinic visits in a Department of Veterans Affairs health care system (n = 132) or a county health care system (n = 120). Patients received ATDM calls for 12 months and responded to queries using their touch-tone telephones. We examined 1) whether patients completed ATDM assessments consistently over the year and used the calls to report their self-monitored blood glucose (SMBG) levels, 2) the characteristics of patients most likely to use the system frequently, 3) whether patients responded consistently within ATDM assessments, and 4) whether ATDM assessments differentiated among groups of patients with different clinical profiles at baseline. RESULTS: Half of all patients completed at least 77% of their attempted assessments, and one-fourth completed at least 91%. Half of all patients reported SMBG levels during at least 86% of their assessments. Patients completed assessments and reported glucose levels consistently over the year. Health status indicators were the most important determinants of assessment completion rates, while socioeconomic factors were more strongly associated with patients' likelihood of reporting SMBG data during assessments. Patients' responses within assessments were consistent, and the information they provided during their initial assessments identified groups with poor glycemic control and other health problems. CONCLUSIONS: Most low-income patients with diabetes can and will use ATDM calls as part of their care. The information they provide is reliable and has clinical significance. ATDM calls could improve the information base for diabetes management while relieving some of the pressures of delivering diabetes care under cost constraints.

Automation↗

Uses and issues of biomonitoring.

In the last two decades, an explosion in information and literature on human biomonitoring data has occurred. Symposia, workshops, and workgroups have been formed to discuss all issues surrounding biomonitoring. One such workgroup, formed by the International Life Sciences Institute's Health and Environmental Sciences Institute (HESI), developed a wheel which has biomonitoring at its hub; its spokes depict the uses of biomonitoring. As it rolls and picks up speed, the biomonitoring wheel will no doubt gain additional spokes. In this manuscript, we describe and give examples of these biomonitoring uses and some of their further applications as well as some of the issues surrounding biomonitoring. Special emphasis is placed on the uses and limitations of large-scale representative cross sectional studies such as the National Health and Nutrition Examination Surveys in the United States. Priority setting, improved modeling methods for interpreting the biomonitoring data, and an increase in studies designed to associate health indicators and health risks to selected environmental chemicals are needed to increase the power of biomonitoring.

Biomarkers↗