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PubMed2001

Predicting pathways of specific language impairment: what differentiates good and poor outcome?

A group of 117 children who met criteria for Specific Language Impairment (SLI) at 7 years of age were reassessed at 11 years of age. The data gathered from both stages were used to identify predictors of good and poor outcome from earlier test assessments. Results of logistic regressions indicated that measures of narrative retelling skills and expressive syntax were the strongest predictors of overall prognosis. This finding persisted when a nonverbal measure was included as a predictor alongside language measures in the regression model. There was found to be a lack of independent predictive contribution of early measures of articulation to later overall prognosis. Demographic factors (maternal education and family income) were not differently distributed across outcome groups. The theoretical and practical implications of the findings are discussed.

Adolescent↗
PubMed1994

Psychosocial adjustment in a large cohort of adults with growth hormone deficiency treated with growth hormone in childhood: summary of a questionnaire survey. Committee for the Study Group of Adult GH Deficiency.

The quality of life of adult patients with growth hormone (GH) deficiency, who ceased GH therapy before the age of 20 years, was surveyed. Questionnaires were sent to 1116 patients and their physicians, asking about socioeconomic status and for medical information, respectively. Response rates were 64% and 69%, respectively. The final height of the patients was about -2 SD in 61% of those surveyed. The distributions of occupation and income were similar to those in the general population. Patients with a final adult height below 155 cm (men) and below 140 cm (women) felt disadvantaged in terms of obtaining employment and finding partners. Slight psychological problems in these patients were revealed by the Cornell Medical Index health questionnaire.

Adult↗
PubMed2003

Distribution and determinants of mouse allergen exposure in low-income New York City apartments.

Previous studies of mouse allergens and laboratory-animal-worker-related allergy and asthma suggest that quantifying mouse allergen levels in homes could augment our understanding of inner-city asthma. We hypothesized that levels of mouse allergen in inner-city homes would be related to certain household characteristics. Dust samples were collected from the kitchens and beds of 221 mothers enrolled in a prospective birth cohort study, 92 of African American and 129 of Dominican ethnicity. Samples were analyzed for mouse urinary protein. The geometric mean for kitchen samples was 4.6 micro g/g [95% confidence interval (95% CI), 3.2-6.5] and for bed samples was 0.9 micro g/g (95% CI, 0.8-1.1). The variables associated with mouse allergen levels in the home were frequency of mouse sightings, use of traps or pesticides for mice, presence of holes in ceilings or walls, absence of a cat, and living in a building with fewer than eight floors. Statistically significant neighborhood differences in levels of mouse allergen and report of rodents in the home were also observed. In conclusion, mouse allergen was prevalent among inner-city apartments, and the positive predictive value of self-reported frequent mouse sightings was high (90% for kitchens). However, high levels of mouse allergen were also found in many homes where mothers reported never seeing mice.

Black or African American↗
PubMed2005

Labor markets and economic inequality in the United States since the end of the 1970s.

By most measures, the United States is the most unequal of the world's advanced capitalist economies, and inequality has increased substantially over the past 30 years. This article documents trends in the inequality of three key economic distributions--hourly earnings, annual incomes, and net wealth--and relates these developments to changes in economic and social policy over the past three decades. The primary cause of high and rising inequality is the systematic erosion of the bargaining power of lower- and middle-income workers relative to their employers, reflected in the erosion of the real value of the minimum wage, the decline in unions, widescale deregulation of industries such as airlines and trucking, the privatization and outsourcing of many state and local government activities, increasing international competition, and periods of restrictive macroeconomic policy.

Employment↗
PubMed1991

Crack: new directions in drug research. Part 2. Factors determining the current functioning of the crack economy--a program for ethnographic research.

Factors which hypothetically influence rates, volumes, and methods of income generation in crack distribution, use, and misuse are indicated, and a research program to investigate them is suggested. This research will contribute significantly to the development of a theoretical framework which adequately relates substance using/abusing and trafficking populations to the wider community and will explain why crack use and distribution have had such different outcomes than marijuana. Factors to be researched include: polyethnicity, crack-related deculturation, gender differentiation in crack use and effects, neighborhood effects, vertically organized crack-distributing organizations, crack-related violence and crime, and replacement of previous drug markets by crack.

Crack Cocaine↗
PubMed1986

Prevalence of probable kerosene dermatoses among ball-bearing factory workers.

The objective of this study was to investigate the prevalence rate of dermatoses among workers in a ball-bearing factory and its possible association with their exposure to kerosene. Two groups of female workers participated in the study. The first group included 79 persons with major kerosene exposure during work, while the second, a reference group, was composed of 263 zipper-manufacturing workers with a similar age distribution, educational background, and income. Dermatologic examinations were used to determine the prevalence rate of hand dermatoses (erythema, scaling, and eczema). In the exposed group 51 persons (65%) had erythema with or without desquamation over the interdigital spaces, 12 persons (15%) had eczematous lesions, 3 persons (4%) had defatting dermatitis, and only 13 persons (16%) were apparently asymptomatic. In the reference group only one person had hand eczema (less than 1%). The difference in the occurrence of dermatoses between the two groups was significant according to the Mantel-Haenszel summary chi-square test. Patch tests on five workers with eczematous lesions revealed one to be sensitive to mercury. The findings indicate that kerosene is a skin irritant. Antirust oil used on the ball-bearings may also contribute to the irritant effect.

Adolescent↗
PubMed2000

Reduced mortality associated with body mass index (BMI) in African Americans relative to Caucasians.

Although obesity is especially common in African-American women, the relationship between body mass index (BMI, kg/m2) and mortality primarily has been studied in Caucasians, and almost exclusively in average weight populations. In order to examine the relationship between race and mortality in a predominately overweight population, we assessed mortality in 6,602 parents of obese African-American and Caucasian subjects. Most parents of both races were overweight or obese: 87.8% of African-American mothers (mean BMI = 37.7) and 78.6% of Caucasian mothers (mean BMI = 34.9) had a BMI > or =27.3; 61.9% of African-American fathers (mean BMI = 31.5) and 63.6% of Caucasian fathers (mean BMI = 31.8) had a BMI > or =27.8. Even though African Americans had equivalent (fathers) or higher (mothers) average BMI and percentage overweight or obesity than Caucasians, unadjusted mortality rates were consistently lower in African Americans than in Caucasians. In a combined sample, income, age (linear, quadratic and cubic effects), gender, BMI (linear and quadratic), and race were significant predictors of mortality. Linear and quadratic effects of BMI were significant within race and in the combined sample, after controlling for the effects of all other predictor variables. Therefore, the mortality differences cannot be due to differences in age, income, BMI, or gender distributions. In addition, there was significant heterogeneity between races for all models examined, suggesting interactions between race and all other predictor variables. Moreover, there was a strong residual effect for race after accounting for the other variables. The highly selective and cross-sectional nature of this sample limits our ability to make specific BMI-associated risk estimates. However, the consistent differences between comparably ascertained racial groups sampled from the upper extreme of the BMI distribution provide support for a lower BMI-associated mortality rate in African Americans relative to Caucasians.

Adult↗
PubMed1990

Population aging and social security: a politico-economic model of state pension financing.

"The present paper attempts to provide a positive, politico-economic explanation of actual social security policies [in developed countries]. A theoretical framework is devised which integrates individual utility maximization and governmental maximization of expected political support. Individual support depends on how net economic benefit from a pay-as-you-go financed state pension scheme is translated into a probability of voting for the government. The relation between net economic positions, public policy parameters, and voting probabilities is made explicit by referring to the logit model of qualitative choice. The analysis is set in an overlapping generations framework. Optimal state pension policies are characterized, relating such diverse factors as population aging, political power distribution, social solidarity, and income taxation." (SUMMARY IN FRE AND GER)

Demography↗
PubMedDate not supplied

Vitamin A and acute respiratory infections.

By questionnaire we studied the occurrence of acute respiratory infections (ARI) in 1961 children between 0 and 5 years old from a total of 3225 families in Cikutra, Bandung. In 38.7% of them 200.000 IU vitamin A supplement had been given at least once during the preceding year. Mild or moderate ARI occurred in 54.7% of the children during the previous month and in 87.9% during the previous year; severe ARI occurred in 5.5% during the previous month and in 16.8% during the previous year. Surprisingly slightly more ARI occurred in children with vitamin A supplementation. However, vitamin A had been distributed more to low income than high income families, and in the latter group significantly less children suffered from ARI (p less than 0.05; 44% versus 54 a 56%).

Acute Disease↗
PubMedDate not supplied

Barriers to effective family planning in Nepal.

To investigate why family planning (FP) services in the Kathmandu Valley of Nepal are underused, a study was initiated under the auspices of the Nepal Family Planning/Maternal--Child Health Project. The study was intended to provide a user perspective, by examining interactions between FP clinic staff and their clientele. "Simulated" clients were sent to 16 FP clinics in Kathmandu to request information and advice. The study revealed that in the impersonal setting of a family planning clinic, clients and staff fall into traditional, hierarchical modes of interaction. In the process, the client's "modern" goal of limiting her family size is subverted by the service system that was created to support this goal. Particularly when status differences are greatest, that is, with lower-class and low caste clients, transmission of information is inhibited.

Adult↗
PubMed1995

[Social policy and the problems of handicapped persons: the concurrent influence of ethics and power].

The paper describes in a very concise manner the importance of social policy in solving certain societal problems that are influenced on the one hand by ethical values and realpolitik power structures on the other. Social policy as a means of societal policy itself is not governed by ethical principles, it can however be used as a tool of transforming society. However, apart from the necessary political power, certain economic preconditions have to be fulfilled in order to realise sociopolitical ideas and a "socially just" distribution of the national income. Social measures thus are a compromise between societal policy and political and economic power, aimed at eliminating societal problems that have resulted, or could result, in political activities of individual groups. People with disabilities therefore should not be content with pointing out existing societal problems but should act as political pressure group in order to force solution of their problems.

Persons with Disabilities↗
PubMed2000

National Cancer Data Base survey of breast cancer management for patients from low income zip codes.

BACKGROUND: The National Cancer Data Base (NCDB), a joint project of the American College of Surgeons Commission on Cancer and the American Cancer Society, is a cancer management and outcomes data base for health care organizations. It provides a comparative summary of patient care that is used by participating hospitals and communities for self-assessment. The most current (1995-1996) breast cancer data on patients from low income zip codes are described here. METHODS: Since 1989, eight Calls for Data have been issued, yielding a total of 191,714 reports of non-Hispanic white patients with breast cancer for the years analyzed, 1995-1996. A total of 1961 hospital cancer registries have participated in at least one of the Calls for Data. RESULTS: A diverse range of breast cancer cases was reported from a variety of geographic locations and medical care environments. There were general similarities in the treatment of patients from the different income groups; however, some differences were reported. Among patients from lower income zip codes, 60.7% were age 60 years or older, compared with 55.1% from other income zip code groups. The AJCC stage distribution was reported as less favorable for patients from low income zip codes than for other patients. The percentage of patients from low income zip codes diagnosed as Stage 0 or I was 51.2%, compared with 55.9% of patients from the other income zip codes. Of patients from lower income zip codes, 12.1% were reported to have Stage III or IV disease, compared with 10.0% of patients from other income zip codes. Patients from low income zip codes received less tissue-sparing surgery. Of patients from low income zip codes, 14.9% received partial mastectomy with or without radiation or systemic therapy, compared with 18.3% of patients from other income zip codes. The percentage of patients from low income zip codes who received a partial mastectomy with axillary lymph node dissection was 23.3% for patients from other income zip codes, the percentage was 30.5%. Conversely, 49.8% of patients from lower income zip codes received a modified radical mastectomy, compared with 40.5% of patients from other income zip codes. CONCLUSIONS: Further improvements in the early diagnosis and surgical treatment of low income patients can probably be achieved. Programmatic activities that further explain or reduce the apparent nonpreferred treatment of some low income patients should be encouraged.

Adult↗
PubMed2007

Income-related inequality in mental health in Britain: the concentration index approach.

BACKGROUND: Reduction of health inequalities is a major policy goal in the UK. While there is general recognition of the disadvantaged position of people with mental health problems, the extent of inequality, particularly the association with socio-economic characteristics, has not been widely studied. We aimed to measure income-related inequality in the distribution of psychiatric disorders and to compare with inequality in other health domains. METHOD: The concentration index (CI) approach was used to examine income-related inequality in mental health using data from the Psychiatric Morbidity Survey 2000 for Britain. RESULTS: There is marked inequality unfavourable to lower income groups with respect to mental health disorders. The extent of inequality increases with the severity of problems, with the greatest inequality observed for psychosis. Income-related inequality for psychiatric disorders is higher than for general health in the UK. Standardized CIs suggest that these inequalities are not due to the demographic composition of the income quintiles. CONCLUSIONS: Income-related inequalities exist in mental health in Britain. As much of the observed inequality is probably due to factors associated with income and not due to the demographic composition of the income quintiles, it may be that these inequalities are potentially 'avoidable'.

Adolescent↗
PubMed2006

The distribution of net benefits under the National Health Insurance programme in Taiwan.

The redistributive effects of a social insurance programme are determined by how the programme is paid for-who pays and how much do they pay?-and how the benefits are distributed. As a result, the redistributive effects of a social health insurance programme should be evaluated on the basis of its net benefit-the difference between benefits and payment. Among the rich body of empirical analysis on equity in health care financing, however, most studies have relied on partial analysis, assessing equity by source of financing while ignoring the benefit side, or looking at equity in benefits but ignoring the funding side. Either approach risks misleading findings. In this study, therefore, the primary objective was to assess the distribution of net benefits across income groups under Taiwan's National Health Insurance (NHI) programme. This study observed a nationally representative sample of 74 012 NHI enrolees from 1996 to 2000. The unique NHI databases in Taiwan provide comprehensive enrolment and utilization information, and allowed linkage to each enrolee's income tax files. In addition to crude estimates, two-part models and ordinary least-square models were used to adjust inpatient and outpatient benefits for health care needs (age, sex, major disease status and physical disability). After adjusting for health care needs, the distribution of net benefits showed an apparent pro-poor pattern, with the lowest income group receiving the highest net benefits (NT$3353) and the top income group receiving the lowest net benefits (-NT$3072) in 1996. Although a clear pro-poor pattern was observed among those enrolees who paid wage-based premiums, this vertically equitable pattern was less evident among the enrolees who paid fixed premiums. Overall, a trend of increasing net benefits was observed in all income groups between 1996 and 2000, and all the NHI enrolees can be considered better off over time. In addition to contributing to the limited literature on equity in net benefits, the study provides an important policy reference to developing countries with large underground economies and relatively small populations of regular wage-earners as it indicates that using fixed premiums as a major financing scheme may pose a serious equity concern and policy challenge.

Adult↗
PubMed2005

Changes in women's use of hormones after the Women's Health Initiative estrogen and progestin trial by race, education, and income.

BACKGROUND: We examined the impact of race, education, and household income on changes in rates of discontinuation and initiation of hormone therapy before and after release of the Women's Health Initiative estrogen plus progestin trial results. METHODS: We conducted an observational cohort study of 221 378 women aged 40-80 years enrolled in five health maintenance organizations to estimate the prevalence and rates of discontinuation and initiation of estrogen plus progestin and estrogen only between September 1, 1999, to June 31, 2002 (baseline), and December 31, 2002 (follow-up). We identified the census block group for each participant by geocoding her 2003 residential address. We categorized women into racial, education, and income groups based on the distribution of these characteristics in her community from year 2000 census data and the distributions of these characteristics within her HMO. RESULTS: There were significant differences in estrogen plus progestin and estrogen only prevalence by race, education level, and household income, and in estrogen plus progestin initiation by race and education level, but not by household income at follow-up. However, there were no differences by community race, education, or household income in change in the prevalence of either hormone therapy use at follow-up or in the rates of hormone therapy discontinuation or initiation from baseline to follow-up. CONCLUSIONS: Given the wide spread media attention to the Women's Health Initiative estrogen plus progestin trial results, our findings suggest comparable dissemination of this information across diverse socioeconomic groups.

Adult↗
PubMed2003

Socioeconomic gradients and low birth-weight: empirical and policy considerations.

OBJECTIVE: To examine whether socioeconomic status (SES) gradients emerge in health outcomes as early as birth and to examine the magnitude, potential sources, and explanations of any observed SES gradients. DATA SOURCES: The National Maternal and Infant Health Survey conducted in 1988. STUDY DESIGN: A multinomial logistic regression of trichotomized birth-weight categories was conducted for normal birth-weight (2,500-5,500 grams), low birth-weight (LBWT; < 2,500 grams), and heavy birth-weight (> 5,500 grams). Key variables included income, education, occupational grade, state-level income inequality, and length of participation in Women-Infants-Children (WIC) for pregnant mothers. PRINCIPAL FINDINGS: A socioeconomic gradient for low birth-weight was discovered for an adjusted household income measure, net of all covariates in the unrestricted models. A gross effect of maternal education was explained by maternal smoking behaviors, while no effect of occupational grade was observed, net of household income. There were no significant state-level income inequality effects (Gini coefficient) for any of the models. In addition, participation in WIC was discovered to substantially flatten income gradients for short-term participants and virtually eliminate an income gradient among long-term participants. CONCLUSIONS: Although a materialist explanation for early-life SES gradients seems the most plausible (vis-à-vis psychosocial and occupational explanations), more research is needed to discover potential interventions. In addition, the notion of a monotonic gradient in which income is salutary across the full range of the distribution is challenged by these data such that income may cease to be beneficial after a given threshold. Finally, the success of WIC participation in flattening SES gradients argues for either: (a) the experimental efficacy of WIC, or (b) the biasing selection characteristics of WIC participants; either conclusion suggests that interventions or characteristics of participants deserves further study as a potential remedy for socioeconomic disparities in early-life health outcomes such as LBWT.

Educational Status↗