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Physical and intellectual development in Philippine children fed five different dietary staples.

Assessments of dietary intake, intelligence, physical growth, and clinical signs of malnutrition were made on 600 children from five Philippine communities. Five boys and five girls each at ages 8,9, and 10 from poor and less poor families drawn from town and rural schools in each community were examined. Dietary staples were rice, fish, corn, coconuts, and sweet potatoes, respectively, at the five sites. Analyses of variance indicated marked differences among communities in nutrient intake based on 24-hr recall, in intellectual and anthropometric measures and in clinical signs of malnutrition. There were few significant F ratios for urban-rural residence, socioeconomic status, sec, or age. There were positive correlations of approximately 0.20 between intake of calories and carbohydrates and intelligence; between calories and carbohydrates and anthropometric measures; and between intelligence and anthropometric measures. Clinical signs in the eye and on the skin showed low correlations of about-0.20 with dietary intake of protein, fat, thiamin, and riboflavin but not with vitamin A. In all communities energy intake was low reflecting limited fat consumption. Where rice or corn was the staple, thiamin and riboflavin were also frequent deficiencies; with fish, ascorbic acid; with sweet potatoes and coconuts, calcium, riboflavin, and thiamin. A very high incidence of eye changes, suggestive of a vitamin A deficiency, was found even where vitamin A intake seemed adequate.

Anthropometry↗

Factors contributing to conductance and outcome of specific immunotherapy: data from the German National Health Interview and Examination Survey 1998.

BACKGROUND: Allergies are an increasingly relevant public health problem. Specific immunotherapy (sIT) is presently the only causal treatment option. This study aimed to assess the frequency and determinants of sIT use and factors associated with treatment outcome. METHODS: A cross-sectional analysis based on data from the German National Health Interview and Examination Survey 1998. RESULTS: 2727 (39.2%) of study participants reported physician-diagnosed allergic disease. Among these, 16.5% (n = 296) stated to have undergone sIT. In this subset 43.4% (n = 129) reported improvement of symptoms, 21.9% (n = 65) had not changed, and 34.6% (n = 102) had discontinued treatment. The majority of patients treated with sIT showed multiple allergic symptoms and sensitisations. Factors significantly correlated with sIT treatment in multivariable analyses included rhinitis, asthma, several sensitisations, higher social status and residence in larger cities. Rhinitis and neurodermatitis were positively, and food allergy was negatively associated with the completion of sIT. No factors predicting improvement due to sIT could retrospectively be identified. CONCLUSION: Treatment with sIT under 'real life' conditions does not exactly follow current clinical guideline recommendations. In addition, patients may be selected for IT by socio-demographic factors. Whether this contributes to considerable discontinuation rates and limited effectiveness as observed here, needs further investigation.

Adult↗

Individual and collective exposure to political violence: Palestinian adolescents coping with conflict.

BACKGROUND: We conducted a survey of Palestinian adolescents in school. We hypothesized that collective and individual exposures to violence would both negatively affect adolescents' mental health. We also anticipated that the negative effect of collective exposures on mental health would be less than that of individual exposures. Our analysis was designed to test these hypotheses. METHODS: A representative sample of 3415 students of 10th and 11th grades from the Ramallah District of the West Bank participated in the survey. The primary independent variables were scales of individual and collective exposures to trauma/violence (ETV) by the Israeli military and settlers. Factor analysis revealed several sub-scales. Outcome measures were constructed and included: a binary measure of depressive-like states, and emotional, depressive-like state, and somatic scales. Several variables were identified as possible covariates: gender, age, school-type, residence, employment status of father, and identity documents held. RESULTS: Logistic and multiple regression analyses revealed a strong relationship between ETV and adolescents' mental health, with both individual and collective exposures having independent effects. There was a higher prevalence of depressive-like symptoms among girls compared with boys, and in adolescents living in Palestinian refugee camps compared with those living in cities, towns and villages. CONCLUSION: The findings confirmed our hypothesis that both individual and collective ETV independently affect the mental health of adolescents. Contrary to expectations, individual exposures did not consistently have a greater negative effect on health outcomes than collective exposures, although the sub-scale of direct personal exposures to violence consistently showed the strongest effect among sub-scales. The results emphasize the importance of going beyond individual experiences and including the health outcomes of collective violation when analyzing violent and traumatic contexts.

Adaptation, Psychological↗

Correlates of senior center participation: a national analysis.

This paper presents results of a logit regression analysis of the correlates of senior center participation for a national sample of 13,737 elders from the Supplement on Aging of the 1984 National Health Interview Survey. Significant characteristics were higher levels of social interaction, decreasing income, living alone, fewer ADL-IADL difficulties, being female, and living in suburbs and rural nonfarm areas. Curvilinear relationships between center use and age and education were found. Race, self-reported health status, and residence in urban and rural farm areas were nonsignificant when the other variables were controlled.

Aged↗

Marital status of caregiving daughters and co-residence with dependent parents.

The role of caregiving daughters' marital status is examined as it relates to their sharing households with disabled elderly parents. Married daughters fared best in well-being, income, and social support. Never-married women were the most likely to have never moved out of the parental home. Separated/divorced caregivers, more than the married and widowed, had moved into the parent's home rather than the reverse and widowed daughters had lived in re-formed joint households longest. The main reason for re-forming shared households was disability of the parent. Among other reasons were death or withdrawal of previous caregiver and financial problems, with separated/divorced daughters the most likely to mention finances.

Adaptation, Psychological↗

Sustaining collaborative problem solving: strategies from a study in six Asian countries.

This paper presents findings from seven case studies of collaborative problem solving. The cases represent models of large-scale collaborative effort to improve the social, economic or health status of residents in poor communities. In these examples a variety of organizations worked together: government, business, voluntary agencies, community groups and people's organizations. A range of strategies was evident as these entities tried to sustain their collaboration. Strategies identified included those deployed collectively, those used by an individual organization to maintain its ability to participate and those used to persuade or pressure needed collaborators to become involved or stay the course. Specific strategies employed and descriptions of their use are presented and comprise a compelling profile of how collaborative problem solving functions.

Asia↗

Effects of husbands' smoking on the incidence of lung cancer in Korean women.

BACKGROUND: Although smoking remains uncommon among Korean women, lung cancer mortality is rapidly escalating. METHODS: We investigated the effects of spousal smoking in 160130 Korean women, aged 40-88, who received health insurance from the Korea Medical Insurance Corporation (KMIC). Exposure data were collected during medical examinations conducted between April 1992 and June 1994. The primary outcome variable was the incidence of lung cancer defined by hospital admissions between July 1994 and December 1997. Standardized rates for the incidence of lung cancer were assessed according to the smoking habits of their husbands. RESULTS: At baseline (n = 160 130), 53.9% of husbands were smokers and 23.3% were ex-smokers, while 1.1% of wives (n = 1756) were current smokers and 0.6% (n = 938) were ex-smokers. During follow-up, 79 cases of lung cancer occurred among non-smoking wives (n = 157436). Wives of heavy smokers were found to have a higher risk of developing lung cancer. The husbands' smoking habits did not affect their wives' risk of developing other cancers such as those of the stomach, liver and cervix, but they did affect breast cancer, which has a significantly higher risk in relation to the longer duration of husbands' smoking. In Poission regression models, adjusting for the age of both husband and wife, socioeconomic status, occupation, residency and vegetable intake, the rate ratio (RR) of lung cancer in non-smoking wives was 1.9 (95% CI: 1.0-3.5) in current smokers and 1.3 (95% CI: 0.6-2.7) in ex-smokers. The RR of lung cancer was 3.1 (95% CI: 1.4-6.6) in wives of husbands who had smoked for 30 years or more compared with wives of non-smoking husbands. CONCLUSION: In Korea, the incidence of lung cancer is higher among non-smoking women whose husbands smoke, and a dose-response relationship seems to exist.

Adolescent↗

Neonatal tetanus: mortality rate and risk factors in Loralai District, Pakistan.

BACKGROUND: This study was conducted to estimate the neonatal tetanus (NNT) mortality rate and to identify the risk factors for NNT deaths in Loralai District, Pakistan. METHOD: We conducted a community-based cross-sectional survey during July-September 1997. We stratified the sample proportionate to population of union councils. The most populous village in a union council was selected first. We interviewed the women, selected randomly, who had a live birth in the 18 months preceding the survey. We conducted a matched case-control study to identify the risk factors for NNT deaths. We used the World Health Organization criteria to enrol cases, identified during the cross-sectional survey or registered at the district hospital. We enrolled three community-based controls per case, matched on the area of residence, immunization status and date of birth. RESULTS: Of the 1547 live births, there were 36 neonatal deaths due to tetanus. The NNT mortality rate in the district was 23 per 1000 live births (95% CI: 16-30). For the case-control study, we enrolled 41 cases and 123 controls. Using conditional logistic regression, the risk of NNT death was increased with the use of soil as delivery surface (O.R = 3.2, 95% CI: 1.1-10.2), father's illiteracy (OR = 3.2, 95% CI: 1.3-8.1) and possession of sheep at home (OR = 2, 95% CI: 1.0-5.0). The population attributable risk per cent for soil as delivery surface was 64%. CONCLUSION: Transmission of infection while using soil as the delivery surface can occur through direct or indirect contamination of the fresh umbilical wound. Use of safer delivery practices in general and clean surfaces in particular should be encouraged to reduce the NNT mortality rate in the area.

Adult↗

Suicide risk in relation to level of urbanicity--a population-based linkage study.

BACKGROUND: The extent to which the high suicide rate in urban areas is influenced by exposures to risk factors for suicide other than urbanicity remains unknown. This population-based study aims to investigate suicide risk in relation to the level of urbanicity in the context of other factors, and to study the risk variation in a sex, age, and calendar year perspective. METHODS: The study is a nested case-control study comprising 21 169 suicides and 423 128 population controls matched for age and sex. Personal data on place of residence, socioeconomic status and psychiatric history were retrieved from various Danish longitudinal registers. Data were analysed with conditional logistic regression. RESULTS: This study confirms that people living in more urbanized areas are at a higher risk of suicide than their counterparts in less urbanized areas. However, this excess risk is largely eliminated when adjusted for personal marital, income, and ethnic differences; it is even reversed when further adjusted for psychiatric status. Moreover, the impact of urbanicity on suicide risk differs significantly by sex and across age. Urban living reduces suicide risk significantly among men, especially young men, but increases the risk among women, especially women aged 24-35 or >65 years. In addition, during 1981-1997, the suicide risk associated with urbanicity remained rather constant among women, whereas it dropped significantly among men, a trend that seemingly gained strength during the last part of this period. CONCLUSIONS: Suicide risk associated with urbanicity varies significantly by sex and age groups and recent years have seen a decline in the urban-rural disparities among men. The increased risk in urban areas can largely be explained by the effects of marital status, ethnics, income, and psychiatric status.

Adolescent↗

Evaluation of mortality data for cervical cancer with special reference to mass screening programs, Denmark, 1961-1971.

During the years 1961-1971, a total of 3696 women died in Denmark from cervical cancer. The annual mortality per 1000 was 0.23 and was constant in this period. The mortality was 0.30 in the Capital where a mass screening program has existed since 1968; in the Provinces, where screening was negligible, the rate was 0.21; the time trend was also constant. The mortality was low in youth, reaching a level of 0.30 around 45 years. Single women had the lowest mortality; among married women it was double, among widows 2-4 times higher, among divorcees 4 times. Within the marital groups, the Capital had higher or the same rates as the Provinces, except for divorcees in the Provinces who had higher rates. The lowest socioeconomic groups had the highest death rates at young ages. The effects of a total vs. an age-specific case-finding program have been estimated under three circumstances, namely that mass screening could reduce the cervical cancer mortality by 10%, by 50%, or by 100%. The impact on the public's health has been evaluated by relating the hypothetically prevented cervical cancer deaths to all cancer deaths and to deaths from all causes. The general population was subdivided by age, marital status and residence and ranked according to cervical cancer mortality. These data were used to design programs which would minimize the number of examinees and maximize the number of prvented deaths.

Adult↗

Occupational risk factors for laryngeal carcinoma: Connecticut, 1975-1980.

A case-control study of possible occupational risk factors for laryngeal carcinoma in white males in the New Haven, Connecticut, area included 92 cases diagnosed between 1975 and 1980 and 181 hospital controls individually matched to the cases on age, year and hospital of admission, county of residence, smoking status (current vs. ex-smoker), and type of tobacco used at the time of admission. Only cases and controls who were alive at the time of the study were included. With the effects of tobacco and alcohol controlled in a conditional linear logistic model, elevated odds ratios were found for men who had ever worked in rubber products manufacturing or transportation equipment manufacturing other than shipbuilding, and for men who had ever been machinists, bartenders, farmers, masons, or metal grinders. However, only one occupation, machinists, had a statistically significant odds ratio (2.5, 95% confidence interval = 1.2-5.2) in these multivariate analyses. Asbestos and nickel were not found to be risk factors for laryngeal carcinoma. Amount of tobacco smoked and alcohol consumed were positively associated with risk for laryngeal cancer.

Aged↗

Responding to racial and ethnic disparities in use of HIV drugs: analysis of state policies.

OBJECTIVES: The objectives of this study were to assess racial/ethnic trends in surveillance data in four states--California, New York, Florida and Texas, identify structural barriers to and facilitators of access to HIV pharmaceuticals by individuals in Medicaid and the AIDS Drug Assistance Program (ADAP), and identify treatment education and outreach efforts responding to the needs of ethnic minority HIV patients. METHODS: State surveillance and claims data were used to assess trends by race/ethnicity in AIDS cases and mortality as well as participation rates in Medicaid and ADAP. Key informant interviews with state program administrators and local clinic-based benefit eligibility workers were used to identify social and policy barriers to and facilitators of access to HIV drugs and state strategies for overcoming racial/ethnic disparities. RESULTS: Racial/ethnic disparities in the reduction of AIDS-related mortality were identified in three of the four states studied. Policy barriers included Medicaid requirements for legal immigration status and residency, limits on Medicaid eligibility based on disability requirements, and state-imposed income and benefit limits on ADAP. Social barriers to accessing AIDS medications included lack of information, distrust of government, and HIV-related stigma. State strategies for overcoming disparities included contracting with community-based organizations for treatment education and outreach, the use of regional minority coordinators, and public information campaigns. CONCLUSIONS: State policies play a significant role in determining access to HIV drugs, and state policies can be used to reduce racial/ethnic disparities in pharmaceutical access. Overall, eliminating racial/ethnic disparities in access to HIV pharmaceuticals appears to be an achievable goal.

Acquired Immunodeficiency Syndrome↗

The spectrum of clinical and pathological manifestations of AIDS in a consecutive series of autopsied patients in Mexico.

OBJECTIVE: Little is known about the clinical profile of AIDS in Latin American populations. This study characterizes the clinical and pathological manifestations of AIDS in a representative series of Mexican AIDS patients at autopsy. DESIGN: The clinical and pathological findings were abstracted retrospectively for a sequential series of autopsied AIDS patients. SETTING: Autopsies were conducted at the four major tertiary level hospitals that serve the majority of AIDS patients in Mexico City. PATIENTS: Subjects included 177 consecutive patients diagnosed with AIDS between March 1984 and January 1989 who subsequently died and were autopsied in the same period in the study hospitals. MAIN OUTCOME MEASURES: Demographic characteristics, including age, gender, residence, socioeconomic status, and risk group; clinical presentation and autopsy findings, including opportunistic infections and malignancies. RESULTS: Sixty per cent of the AIDS patients presented with wasting syndrome. The most common infections were cytomegalovirus (69%), tuberculosis (25%), and Pneumocystis carinii pneumonia (24%). Central nervous system infections were also common and included toxoplasmosis (19%) and cryptococcoses (10%). Kaposi's sarcoma was present in 30% of cases and non-Hodgkin's lymphoma in 9%. CONCLUSION: Clinical manifestation, and types and frequency of opportunistic infections in our Mexican AIDS patients were more similar to those seen in AIDS patients in Africa and Haiti than in the United States and Europe. These findings suggest that the AIDS epidemic in Mexico has an 'intermediate' pattern and may be a prototype for Latin American countries.

Acquired Immunodeficiency Syndrome↗

The current status of faculty staffing and resident training in emergency radiology. Results of a survey.

The results of a survey of United States and Canadian radiology residency programs in hospitals maintaining major emergency departments indicate that (1) radiologic faculty assignment to emergency medicine may include "all faculty," "specific faculty," "specific and other faculty," "general," and "musculoskeletal" faculty; (2) a chief of emergency radiology section is designated in less than 35% of radiology departments providing emergency room services; (3) radiology resident rotation in emergency radiology occurs in less than 2/3 of the surveyed programs; and (4) radiology resident experience in emergency radiology ranges from two to 16 weeks in 40% of these programs, the remainder being "unspecified." The effect of this circumstance upon the emergency department patient care and resident teaching in emergency radiology is discussed and remedial suggestions presented.

Canada↗

Current opinion regarding indications for emergency department thoracotomy.

BACKGROUND: Emergency department thoracotomy (EDT) is a dramatic but rarely lifesaving intervention. Clinical variability regarding indications for EDT has yet to be quantified. Members of the Eastern and American Associations for the Surgery of Trauma were questioned by mail to evaluate which clinical and demographic factors influence the decision to perform EDT and whether physicians perform EDT in accordance with current practice guidelines. METHODS: A single mailing of an anonymous survey was sent to 1,124 surgeons to collect institutional and physician demographics as well as indications for EDT on the basis of variable mechanisms of trauma, duration of arrest, and signs of life (SOL). Statistical analysis included the Pearson and linear-by-linear association chi(2) tests, independent samples t test, and univariate and multivariate analyses of variance; p values of < 0.05 were considered significant. RESULTS: Completed surveys were received from 358 respondents. After 54 surveys were excluded that were incomplete, late, or from noneligible respondents, 304 surveys were analyzed. There were no significant differences in EDT indications among institutions of differing caseload volume, exposure to penetrating trauma, trauma level designation, American College of Surgeons verification status, or residency program affiliation. In addition, neither the respondent's position nor whether attendings versus residents performed the majority of EDTs influenced clinical decision-making. Performance criteria for EDT were liberal in comparison with established guidelines, especially for blunt trauma. The presence or recent loss of SOL influenced responses, but respondents varied greatly in their definition of SOL. CONCLUSION: A lack of agreement exists regarding the indications for EDT in multiple clinical scenarios as well as in defining SOL. Indications for EDT were liberal, especially for blunt trauma-related indications, and were determined by clinical parameters, not by physician or institutional factors. Our results suggest that clinical practice is at variance with Advanced Trauma Life Support guidelines. We recommend that practice guidelines for EDT be established on the basis of a consensus definition of SOL to allow for a more uniform and selective approach to EDT.

Decision Making↗