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PubMedDate not supplied

Factors associated with self-reported STDs: data from a national survey.

BACKGROUND AND OBJECTIVES: STD prevention programs need to identify population subgroups and risk behaviors that are associated with higher rates of disease. GOAL OF THE STUDY: To see what levels of STD experience were reported by respondents to a national survey and what factors were associated with self-reported STDs. STUDY DESIGN: The survey data are from Cycle IV (1988) of the National Survey of Family Growth (NSFG), a nationally representative household-based sample of 8450 women ages 15 to 44 years. We examined characteristics of survey respondents who reported STD experience, characteristics of STD cases reported to the national STD surveillance system, and factors related to self-reported STDs using multiple logistic regression. RESULTS: The self-reported survey data indicate that the majority of respondents who ever had gonorrhea (55%) were white, but white women account for only 19% of the annual cases in the surveillance system. Logistic regression analysis of survey data indicates factors associated with reported gonorrhea experience, sexual behavior, race/ethnicity, socioeconomic background, perceived risk of AIDS, receiving birth control education, and region of residence. Reporting of chlamydia appears to be strongly related to knowledge of this infection. CONCLUSIONS: Because of basic differences in the statistics being compared, we cannot rule out other explanations. Our results suggest that the surveillance data may reflect underreporting of higher socioeconomic groups making use of private health care. Survey data, on the other hand, are probably affected by underreporting of STD experience. Questions to measure STD experience, treatment, and source of care on surveys of this type would greatly increase the understanding of STDs in the national population.

Adolescent↗
PubMed1991

The prevalence, risks, and management of Chlamydia trachomatis infections in fertile and infertile patients from the high socioeconomic bracket of the South African population.

OBJECTIVE: The main objective of the study was to evaluate the prevalence of Chlamydia trachomatis endocervicitis in an infertile population. DESIGN: Forty consecutive patients were enrolled in the study group and 41 in the control group. SETTING: The study was undertaken in the Department of Obstetrics and Gynaecology of the University of the Orange Free State, Bloemfontein, Republic of South Africa. PATIENTS: Infertile white females, visiting an infertility clinic in an academic hospital and fertile white female patients visiting an antenatal clinic. INTERVENTIONS: Endocervical swabs were taken, and monoclonal direct immunofluorescence for C. Trachomatis were done on each. MAIN OUTCOME MEASURES: A difference was expected between the prevalence of C. trachomatis infection in the fertile and infertile population. RESULTS: In the study group, 14(35.9%) positive, 25(64.1%) negative, and 1 fallout were obtained. In the control group, 3 patients (7.32%) tested positive. CONCLUSION: Although no correlation was found between C. trachomatis infection of the female genital tract and the clinical history, it showed a significant correlation with infertility. This justifies routine screening tests and antibiotic treatment of positive infertile couples. Analysis of cost-effectiveness showed that empirical treatment of new infertile couples is justified in some populations.

Chlamydia Infections↗
PubMed1997

Readiness to change smoking behavior in a community health center population.

This study examines predictors of readiness to change smoking behavior in a sample of smokers who receive care at a community health center that serves a predominantly low income African American population. Prior to initiating interventions we conducted a telephone survey with a random sample of 1318 adult users who had visited the center in the last 18 months; 379 (28.8%) were current smokers (40.3% of males, 23.9% of females, 42.7% of Whites, and 25.3%, of African Americans). Multiple logistic regression analysis showed nine factors significantly associated with readiness to change smoking behavior: male gender; a previous quit attempt; a perception of risk of lung cancer from smoking; greater desire to quit smoking; a perception that smoking bothers others; doctor advice to stop smoking at last health visit; records kept for scheduling doctor appointments; thinking that losing a pleasure would not be a problem if quit smoking; and poorer self-reported health status. These findings provide direction for developing interventions for similar low income, high risk populations. The results indicate that it may be useful to heighten awareness of the risks of smoking and to assure that smokers receive clear quit smoking messages from their providers. Women need special attention since they are less ready to quit than men.

Adult↗
PubMed1990

Use of contraceptives by women of upper socioeconomic status.

This was a descriptive correlational study of the contraceptive knowledge, methods, and consistency of contraceptive use by women of upper socioeconomic class. Socioeconomic class was determined using Hollingshead's Four-Factor Index of Social Status (1975) and was based on the woman's own educational and occupational status. The mean socioeconomic score for participants in this study (N = 83) was high in the second of five socioeconomic classes. Study participants were found to be consistent users of their contraceptive method and had fewer unplanned pregnancies in their history than the general population. They were more knowledgeable about contraceptives and reproduction than others tested with the same contraceptive knowledge instrument. They used barrier methods predominantly, with the use of less theoretically effective methods correlating significantly with a greater number of contraceptive methods used in the past.

Adult↗
PubMed1999

The burden of disease among the global poor.

BACKGROUND: Global and regional estimates show that non-communicable diseases in old age are rising in importance relative to other causes of ill health as populations age, and as progress continues against communicable diseases among infants and children. However, these estimates, which cover population groups at all income levels, do not accurately reflect conditions that prevail among the poor. We estimated the burden of disease among the 20% of the global population living in countries with the lowest per capita incomes, compared with the 20% of the world's people living in the richest countries. METHODS: Estimates for the global poorest and richest 20% were prepared for 1990 for deaths and disability-adjusted life years (DALYs), by a procedure used in a prominent recent study of the global disease burden. Projected mortality rates in the year 2020 were established for the world's poorest and richest 20% under various assumptions about the future rate of decline in communicable and non-communicable diseases. FINDINGS: In 1990, communicable diseases caused 59% of death and disability among the world's poorest 20%. Among the world's richest 20%, on the other hand, non-communicable diseases caused 85% of death and disability. A raised baseline rate of communicable disease decline between 1990 and 2020 would increase life-expectancy among the world's poorest 20% around ten times as much as it would the richest 20% (4.1 vs 0.4 years). However, the poorest 20% would gain only around a quarter to a third as much as the richest 20% from a similar increase in non-communicable diseases (1.4 vs 5.3 years). As a result, a faster decline in communicable diseases would decease the poor-rich gap in 2020, but under an accelerated rate of overall decline in non-communicable diseases, the poor-rich gap would widen. INTERPRETATION: Our estimates are crude, but despite their limitations, they give a more accurate picture of changes in attributable mortality among the world's poor than do the global averages in current use.

Global Health↗
PubMed1986

Human capital and the rise and fall of families.

"This paper develops a model of the transmission of earnings, assets, and consumption from parents to descendants. The model assumes utility-maximizing parents who are concerned about the welfare of their children. The degree of intergenerational mobility is determined by the interaction of this utility-maximizing behavior with investment and consumption opportunities in different generations and with different kinds of luck. We examine a number of empirical studies for different countries. Regression to the mean in earnings in rich countries appears to be rapid. Almost all the earnings advantages or disadvantages of ancestors are wiped out in three generations." A comment by Robert J. Willis is included (pp. 40-7).

Behavior↗
PubMed1978

WHO collaborative study on breast feeding.

WHO, concerned with the declining breast feeding rate in developing countries, has organized investigations in nine different countries of different aspects of breast feeding and breast milk with the ultimate aim of formulating programmes of intervention. The basic epidemiological study on 24000 mother/child pairs is just completed and some preliminary data are reported on the pattern of breast feeding in the three studied socio-economic groups--urban elite, urban poor and traditional rural--which differ significantly in their breast feeding rate as well as in the pattern of return of menstruation in breast-feeding and non-breast-feeding mothers.

Breast Feeding↗
PubMed1993

Health care in Brazil.

Brazil has great geopolitical importance because of its size, environmental resources, and potential economic power. The organisation of its health care system reflects the schisms within Brazilian society. High technology private care is available to the rich and inadequate public care to the poor. Limited financial resources have been overconcentrated on health care in the hospital sector and health professionals are generally inappropriately trained to meet the needs of the community. However, recent changes in the organisation of health care are taking power away from federal government to state and local authorities. This should help the process of reform, but many vested interests remain to be overcome. A link programme between Britain and Brazil focusing on primary care has resulted in exchange of ideas and staff between the two countries. If primary care in Brazil can be improved it could help to narrow the health divide between rich and poor.

Brazil↗
PubMed1993

Influence of socioeconomic factors on attaining targets for reducing teenage pregnancies.

OBJECTIVE: To determine the rate of pregnancy and outcome in teenagers in areas of different socioeconomic conditions, and to assess the implication for achievement of government and local targets in reducing unwanted pregnancies in teenagers. DESIGN: Records of pregnancies were obtained from hospital discharge files and rates of live and still births and abortions calculated for each postcode sector. Postcodes were grouped by categories of deprivation and by local government district. SETTING: Tayside, Scotland. SUBJECTS: Teenage girls admitted to National Health Service hospitals for delivery or abortion in 1980-90. MAIN OUTCOME MEASURES: Conception in girls aged under 16 by area of residence and relative proportion leading to live births or terminations. Rate of different outcomes in girls under the age of 20 by area of residence. RESULTS: The pregnancy rate in girls aged under 16 was three times as high, and in all girls under 20 six times as high in the most deprived areas as in the most affluent areas. The proportion of teenage pregnancies ending in abortions was higher in the affluent areas, where two out of three ended in abortion compared with one out of four in the deprived areas. CONCLUSIONS: Although there was a higher pregnancy rate in teenagers in more deprived areas, the proportion ending in abortion was greater in more affluent areas, possibly due to social and parental pressure. The wide geographical variation in patterns of teenage pregnancy indicates the need for a small area rather than a regional approach to setting targets and devising measures of achieving them.

Abortion, Legal↗
PubMed1987

The effect of women's labor force participation on the distribution of income in the United States.

The effect of women's labor force participation on income distribution in the United States is reviewed. "Because the wives of highly paid men participate less in the labor force, the earnings of working wives make the distribution of pretax, money income more equal for families than it might otherwise be. Although there is considerable speculation that future developments in women's labor force participation may foster greater inequality, the empirical results are mixed." The factors that need to be considered in future research are outlined.

Americas↗
PubMed2006

Systematic review of prognostic models in traumatic brain injury.

BACKGROUND: Traumatic brain injury (TBI) is a leading cause of death and disability world-wide. The ability to accurately predict patient outcome after TBI has an important role in clinical practice and research. Prognostic models are statistical models that combine two or more items of patient data to predict clinical outcome. They may improve predictions in TBI patients. Multiple prognostic models for TBI have accumulated for decades but none of them is widely used in clinical practice. The objective of this systematic review is to critically assess existing prognostic models for TBI METHODS: Studies that combine at least two variables to predict any outcome in patients with TBI were searched in PUBMED and EMBASE. Two reviewers independently examined titles, abstracts and assessed whether each met the pre-defined inclusion criteria. RESULTS: A total of 53 reports including 102 models were identified. Almost half (47%) were derived from adult patients. Three quarters of the models included less than 500 patients. Most of the models (93%) were from high income countries populations. Logistic regression was the most common analytical strategy to derived models (47%). In relation to the quality of the derivation models (n:66), only 15% reported less than 10% pf loss to follow-up, 68% did not justify the rationale to include the predictors, 11% conducted an external validation and only 19% of the logistic models presented the results in a clinically user-friendly way CONCLUSION: Prognostic models are frequently published but they are developed from small samples of patients, their methodological quality is poor and they are rarely validated on external populations. Furthermore, they are not clinically practical as they are not presented to physicians in a user-friendly way. Finally because only a few are developed using populations from low and middle income countries, where most of trauma occurs, the generalizability to these setting is limited.

Brain Injuries↗