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PubMed2006

Decentralisation and convergence in health among the provinces of Spain (1980-2001).

This study measures the process of convergence in the state of health among the provinces and regions of Spain during 1980-2001 in order to analyse the possible influence of the decentralisation of healthcare management to the regions in this period. Sigma and beta convergence models, traditionally employed in macroeconomics, have been used, taking Life Expectancy at Birth (LEB) and Infant Mortality (IM) as health indicators. The analysis was carried out at two territorial levels: provinces and regions. The results reveal that the process of decentralisation either does not affect convergence or leads to divergence in health. Indeed, in the case of IM the so-called change of role scenario seems to have occurred. Thus, certain provinces with initially poor indicators have improved, overtaking those that were originally in a better position. The final result, however, is of greater dispersion than initially.

Empirical Research↗
PubMed2006

Longitudinal trends in race/ethnic disparities in leading health indicators from adolescence to young adulthood.

OBJECTIVE: To use ethnically diverse, national data to examine longitudinal trends in race/ethnic disparities in 20 leading health indicators from Healthy People 2010 across multiple domains from adolescence to young adulthood. Much of what is known about health disparities is based on cross-sectional measures collected at a single time point. DESIGN, SETTING, AND PARTICIPANTS: Nationally representative data for more than 14 000 adolescents enrolled in wave I (1994-1995) or wave II (1996) of the National Longitudinal Study of Adolescent Health (Add Health) and followed up into adulthood (wave III; 2001-2002). We fit longitudinal regression models to assess and contrast the trend in health indicators among racial/ethnic groups of adolescents as they transition into adulthood. MAIN OUTCOME MEASURES: Diet, inactivity, obesity, tobacco use, substance use, binge drinking, violence, sexually transmitted diseases, mental health, and health care access. RESULTS: Diet, inactivity, obesity, health care access, substance use, and reproductive health worsened with age. Perceived health, mental health, and exposure to violence improved with age. On most health indicators, white and Asian subjects were at lowest and Native American subjects at highest risk. Although white subjects had more favorable health in adolescence, they experienced greatest declines by young adulthood. No single race/ethnic group consistently leads or falters in health across all indicators. CONCLUSIONS: Longitudinal data indicate that, for 15 of 20 indicators, health risk increased and access to health care decreased from the teen and adult years for most US race/ethnic groups. Relative rankings on a diverse range of health indicators (and patterns of change over time) vary by sex and race/ethnicity, causing disparities to fluctuate over time.

Adolescent↗
PubMed1989

Simplifying the evaluation of primary health care programmes.

Currently, there is considerable attention for health impact--as measured by mortality, morbidity or nutrition indicators, in the evaluation of primary health care (PHC) programmes. In most cases, health impact evaluations tend to be dominated by methodological discussions on data collection, analysis and interpretation, which are not relevant to the majority of PHC programmes. In this paper a theoretical framework of variables, affecting child survival, is presented. The key to this action-oriented framework is the identification of a set of intermediate variables which directly affect the health status of children, but can be influenced by PHC interventions as well. It is recommended that evaluations of PHC programmes should focus on these intermediate variables and be less concerned with health impact of the interventions.

Developing Countries↗
PubMed1998

Socioeconomic inequalities in health expectancy in Finland and Norway in the late 1980s.

Studies on health inequalities have usually focused either on mortality or on morbidity. This concerns national studies as well as international comparisons of health inequalities. This paper seeks to bridge the gap by applying health expectancy as a synthetic overall measure of health. The purpose of the study is to compare socioeconomic inequalities in health expectancy in Finland and Norway in the late 1980s. Additionally, the major methodological issues in the use of health expectancy in the study of health inequalities are identified. Data on mortality by level of education derive from linked national follow-up studies (1986-1990) of population censuses. Data on the prevalence of morbidity by level of education derive from nationally representative surveys of the noninstitutionalised adult population in 1985/87. Persons aged 25-74 years were included. Four measures of morbidity were used: limiting long-standing illness, extremely limiting long-standing illness, functional disabilities and perceived less than good health. The association between mortality/morbidity and level of education in each 5-year age/sex group was determined by a regression-based method. Partial life expectancies and partial health expectancies for ages 25-74 were then calculated by using the mortality quotients and morbidity prevalences predicted by the regression model for those at the top and the bottom of the educational hierarchy in each 5-year age group, using an application of the method first presented by Sullivan. Although various measures of health expectancy were used, the result were consistent. In absolute terms the size of socioeconomic inequalities in health expectancy in Finland and Norway is on the same level. In relative terms, however, the size of inequalities in health expectancy is greater in Norway. If one considers premature mortality to be more severe than any indicator of morbidity, the mortality morbidity mix of the health inequalities is less favourable to Finland, since the size of absolute inequalities in mortality is greater in Finland. Health expectancy measures provide a promising measure for assessing and comparing the pattern and the size of health inequalities.

Adult↗
PubMed1976

Sociocultural influences upon preventive health behavior and attitudes towards dentistry.

One hundred eighty adults who presented for general dental care at an urban dental school clinic were interviewed and given epidemiological screening examinations. The findings presented include a profile of a clinic population with respect to ethnic identity, family income, education, nuclear family structure, and residence. The two major racial groups (black and white) are found to have highly significant differences in their perception of dental services and their experiences with dental disease and treatment. An assessment of dental health status indicates that whites were more likely to have filled teeth, and blacks, decayed or unfilled teeth. This relates to different patterns in seeking recent preventive dental services and a marked disparity in utilization early in life. Fear and anxiety about dental care, degree of orientation towards prevention and differences in exposure to preventive information varied with race. Consumerist orientation is examined in terms of willingness to criticize services, be cared for by auxiliary health workers and accept professional fees. The identification of diversity in perception and values with respect to dental health care is characterized as an element in developing understanding between providers and consumers.

Adult↗
PubMed1999

Distribution of waist-to-hip ratio, other indices of body fat distribution and obesity and associations with HDL cholesterol in children and young adults aged 4-19 years: The Third National Health and Nutrition Examination Survey.

BACKGROUND: Little data has been published on the association of indices of body fat distribution and HDL cholesterol (HDL), a risk factor for cardiovascular morbidity, in representative samples of total populations of children and adolescents including blacks and Hispanics. OBJECTIVE: To describe the distribution of waist-to-hip ratio (WHR) in US children and adolescents and to assess the association with HDL. DESIGN: Cross-sectional survey of a large national sample, the Third National Health and Nutrition Examination Survey. PARTICIPANTS: People aged 4-19 y. MEASUREMENTS: Body circumferences, skinfold thickness, body mass index (BMI), and serum total and HDL cholesterol concentrations. RESULTS: Mean WHR varied consistently with age, gender, and ethnic group. Levels were highest in Mexican Americans. WHR showed significant negative associations with HDL cholesterol concentration and positive associations with the ratio of total serum cholesterol to HDL in pre- and postpubertal girls independent of age and BMI. However, associations were often not as strong as those with BMI. Other indices of body fat distribution were not superior to WHR. CONCLUSION: Further research is needed on the association of WHR, other indices of body fat distribution and HDL measured in childhood with subsequent risk of atherosclerosis.

Adolescent↗
PubMed2002

Health monitoring of the migrant population in Northrhine-Westphalia, Germany: experiences, implications, and perspectives.

AIM: To describe the benefits and restrictions that emerged in health monitoring of the Northrhine-Westphalian migrant population. METHODS: Analysis of official register data, description and classification of benefits and restrictions, and systematic derivation of implications of general validity. RESULTS: The comparison of the native German and migrant populations revealed which health relevant fields with specific problems require political intervention and further research. The results clearly reflected strongly differing socio-demographic structures. Moreover, insufficiencies in the design of official statistics were found, which led to the formulation of general principles of an integrated system for the health monitoring of migrant populations. CONCLUSIONS: To serve as adequate data sources relevant for health monitoring that takes into account different dimensions of migration, official registers should fulfill certain requirements. Different indicators of migration and socioeconomic situation should be recorded, and classifications, such as national background and age, should be standardized in different statistical sources.

Adolescent↗
PubMed1983

Measurement of values for states of health with linear analog scales.

Medical decisions may be greatly influenced by the values that patients place on different states of health. Previous attempts to obtain quantitative estimates of such values have assumed the numerical values assigned to different levels of health will remain constant regardless of the context in which the measurement is made. To examine this assumption, 64 ambulatory patients ranked five scenarios describing different states of health in order of preference. One of the scenarios was ranked as worse than death by 22 percent of raters, and two scenarios were ranked as worse than death by 31 percent of raters. The states were then rated using linear analog scales, first with the anchors or endpoints of perfect health and death, then with the anchor of perfect health replaced by each of the other health states, in descending order of preference, and finally with the anchor of death replaced by each of the other health states, in ascending order of preference. The numerical values assigned to scenarios were substantially and systematically influenced by the anchors on the scale. Relative to the values assigned to health states when anchors of perfect health and death were employed, the same states were assigned systematically higher values when the anchor of death was replaced by other health states, and systematically lower values when the anchor of perfect health was replaced. These findings persisted when states considered worse than death were excluded from the rating process. These results indicate that the quantitative values assigned health states are strongly influenced by the context in which the measurement is made, and that health cannot be regarded as a continuum with death as its lower boundary.

Analysis of Variance↗
PubMed2006

Adolescents health in Georgia: a national portrait.

The aim of the study was to assess the basic indicators of health of adolescents in Georgia. A self-administered anonymous questionnaire was adapted from the Swiss Survey (SMASH2002), translated into Georgian and other languages mainly used in schools (Russian, Armenian and Azeri). It contained 87 questions. Two-stage cluster sampling was devised. Weight was adjusted. A total of 599 classes were selected. All questionnaires before being processed into the Epidata (www.epidata.dk) were edited. The final data were analysed by SPSS 11.0. General health status was considered as excellent and very good by 34.0+/-0.8% of respondents. 21.5% claimed to never miss the school due to the illness. The frequencies of physical disability and chronic diseases were 8.0% and 5.0% correspondingly. Among health-related problems the most frequent are problems with teeth, headache and acne. 5.9% of girls had some kind of gynecological problems quite often and very often. Performed survey is a first one done among adolescents in Georgia. It gave us basic information for planning and implementation of necessary measures in order to improve the health of adolescents and raise awareness of professionals involved in health care and prevention settings for adolescents. The data can be also used for monitoring of health status of adolescents in Georgia.

Adolescent↗
PubMed1986

[Determinants of preventive health behavior of the Swiss population. Results of the SOMIPOPS study].

In the context of the first Swiss National Health Survey preventive health behaviour was tested in 3419 Swiss citizens aged over 20 years. A health behaviour index including favourable health attitudes and good utilization of preventive health services was correlated with different social indicators. Age, sex and a good self-rated health were the most important factors associated with a high preventive health behaviour score. Education showed a less strong but also significant influence on positive health behaviour. Overall utilization of health services decreased with high preventive health behavior index.

Adult↗
PubMedDate not supplied

Assessment of acute health effects from the Medfly Eradication Project in Santa Clara County, California.

Surveys were performed to assess the acute health effects of aerial application of malathion bait over a large urban area. Three indirect attempts to assess utilization of health care services were made: (1) surveillance of a major hospital emergency department was undertaken, (2) ambulance dispatches were reviewed, and (3) emergency treatments for asthma at a university hospital were reviewed. These assessments were negative but insensitive. Prevalence of self-reported symptoms was assessed with two surveys that were subject to severe time constraints. Personal interviews of the same individuals, before and after the spraying, were conducted: one was conducted by telephone and the other by residential visit. Results indicated no detectable increase in acute morbidity. Also, after the spraying, there was a decrease in anxiety-related symptoms.

Adolescent↗
PubMed1997

Measuring excess risk of child mortality: an exploration of DHS I for Burundi, Uganda and Zimbabwe.

This paper proposes a new method of measuring excess risk of child mortality in cross-sectional surveys, which is applied to DHS I data for Burundi, Uganda and Zimbabwe. The expected child mortality experience is estimated for each mother on the basis of child's age, mother's age at child's birth and her parity, and compared with her observed experience. Mothers who exceed their expected child mortality experience and also had more than one child die are considered to have excess child mortality. Zimbabwe had the greatest concentration of child deaths as measured by a simple ratio of mothers to deaths, but when observed experience was compared with expected it had less than half as many excess deaths as Uganda and Burundi. In all three countries mother's education had a strong negative association with the risk of excess child mortality, and in Zimbabwe and Burundi there were significant regional differences.

Adolescent↗
PubMed2002

[Laboratory tests in The Child and Adolescent Health Survey].

Laboratory tests will be performed as part of the National Health Survey for Children and Adolescents to identify health risks and to determine the seroprevalence of disease markers. The parameters were selected from haematology, clinical chemistry, allergology, endocrinology and serology of infectious diseases as indicators of individual health risks, to validate information collected by means of the questionnaires and to identify age specific immunity gaps of vaccine-preventable diseases.

Adolescent↗
PubMed1995

The relation of reported symptoms to social, individual, and behavioral indicators of ill-health: is the number of reported symptoms a unique general dimension of ill-health?

Counts of functional symptoms are an accepted measure of ill-health in general populations. However, their relation to other indicators of ill-health are still poorly understood. The aim of this study was to investigate such relations in order to reach a better understanding of the 'meaning' of the number of symptoms. The data analyzed was drawn from a telephone health survey conducted among a representative sample of 2111 Swiss adults as part of the Intercantonal Health Indicators Project in 1989. In a logistic regression analysis the Number of symptoms (a summery score of eleven severe function symptoms) was found to be strongly associated with eight social, behavioral, and psychological indicators of ill-health ('Unable to work', 'Frequently consulting a physician', 'Use of analgesics', 'Use of sedatives', 'Poor coping with ill-health', 'Social impairment', 'Poor health', and 'Poor psychological well-being'). To control for effects due to individual symptoms, they were included in the models by stepwise procedure. Although individual symptoms became predictive for all indicators (except for Poor coping with illness), the association between the Number of symptoms and the indicators (except for Social impairment) remained statistically significant. Despite methodological provisos our results seem to support an interpretation of the Number of symptoms as a distinct and general dimension of ill-health.

Adaptation, Psychological↗
PubMed1984

A model of child nutrition, fertility, and women's time allocation: the case of Nicaragua.

"This study had two main goals. The first was to test the hypothesis that women who work in the informal sector of the labor force have better-nourished children, ceteris paribus, than women who work in the formal sector. A simple home production model for child nutrition incorporating this hypothesis was specified and the behavior of a utility-maximizing household investigated. The empirical estimates of the nutritional status production function provided no convincing support for the hypothesis." The second goal was "to investigate the joint determinants of child nutrition and of women's fertility and work choices....[It is suggested] that increases in women's education and formal sector wages will induce declines in fertility and improvements in child nutrition. Increases in informal sector wages will improve nutrition but have little impact on fertility, and income effects are minimal on all three variables." Data are from a household survey conducted in Nicaragua in 1977 and 1978.

Americas↗
PubMed1994

A study of the gender differences in morbidity among individuals diagnosed with alcohol abuse and/or dependence.

The majority of studies on medical consequences of excessive alcohol consumption have been carried out with male subjects, mostly from clinical or hospitalized samples. The purpose of this report was to study differences in morbidity outcomes of men and women among respondents diagnosed with alcohol abuse and/or dependence. Utilizing data from the 1988 National Health Interview Survey, this study compared several indicators of physical morbidity among male and female respondents meeting the criteria for Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association, 1987) alcohol abuse and/or dependence. The results revealed complex gender differences, not all of which can be explained by differences in sociodemographic characteristics or drinking practices. Moreover, the results indicated that it is inadequate to generalize results based on morbidity data of men with alcohol abuse and/or dependence to their female counterparts or female drinkers. Implications of these findings are discussed.

Adolescent↗
PubMedDate not supplied

[Surgical treatment of kyphotic spinal deformities in ankylosing spondylitis using the Harrington compression system: long-term results based on the MOPO scales in the framework of a retrospective questionnaire].

INTRODUCTION: Meanwhile a lot of papers have been published concerning the operative treatment of kyphotic deformities of the spine in ankylosing spondylitis. Long term results from the patient's view-point on the basis of standardized parameters are not available. This was the intention of this study. MATERIAL AND METHODS: From 1979 to 1982 34 patients underwent surgical correction of a flexion deformity of the spine in ankylosing spondylitis. Correction was achieved with four v-shaped lumbar osteotomies using Harrington's compression system. Seven to ten years postoperatively the patients were asked to answer a questionnaire containing the Mopo-scales and a few additional questions in order to compare the patients pre- and postoperative status and evaluate the long-term quality of the operative procedure. The Mopo-scales exist of the 8 subscales mobility, physical-, daily-, household-, social activity, pain, depression, anxiety with 60 questions (items). The statistical analysis was carried out with the Wilcoxon- and Chi-Square-test using a level of significance of p < 0.01. RESULTS: Within all Mopo-subscales most items (n = 47) demonstrated significant improvement of function (p < 0.01). Whereas 11 times no significant changes could be proved, twice a significant impairment was noticed. The latter mentioned 13 items tested activities that would have been performed better in inclination, so that the results do not amaze. Visual analog scales for pain and general health status indicated significant improvement of both. 85.7% of the patients were very satisfied with the result of the operation. CONCLUSION: The results prove the long term value of the operative treatment of kyphotic deformities of the spine in ankylosing spondylitis using Harrington's compression system, although meanwhile transpedicular screw fixation instead of hooks is used, as it is well known. It can now be said in detail, which long term influences vertebral osteotomies of the spine for correction have on specific activities and health conditions in these patients.

Activities of Daily Living↗
PubMed1991

Meat consumption and its associations with other diet and health factors in young adults: the CARDIA study.

Using cross-sectional data from the longitudinal Coronary Artery Risk Development in Young Adults (CARDIA) study, we assessed associations between meat consumption and other dietary- and health-status indicators. Less than one percent of this sample (n = 32) ate no red meat or poultry, and another 1% (n = 47) ate red meat or poultry less than once per week. Individuals who ate red meat and poultry less than once per week were less likely to drink alcohol (P = 0.003); reported more physical activity (P less than or equal to 0.001); had lower [corrected] Keys scores (P less than or equal to 0.001); consumed diets higher in carbohydrates, starch, fiber, vitamins A and C, and calcium and lower in energy, fat, and protein (P less than or equal to 0.001); had smaller body sizes as indicated by the body mass index [calculated as wt(kg)/ht(m2)] (P = 0.01); and had lower concentrations of total serum cholesterol (P = 0.001), low-density-lipoprotein cholesterol (P = 0.001), and triglycerides (P = 0.015) compared with individuals who consumed meat more frequently.

Adult↗