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PubMed1992

Socio-economic health differences in The Netherlands: a review of recent empirical findings.

Evidence on variation in the frequency of health problems between socio-economic groups in the Dutch population has accumulated rapidly in recent years. This paper presents a review of these recent data. It is clear now that a lower socio-economic status is associated with a higher frequency of a wide range of health problems. This negative association has consistently been found for the following health indicators: birth weight; adult body height; prevalence of health complaints; prevalence of many chronic conditions; prevalence of disability; incidence of long-term work incapacity; perceived general health; adult mortality. Inconsistent findings were reported for: children's body height; prevalence of some chronic conditions; incidence of sickness absence (short-term work incapacity); perinatal mortality. The magnitude of the differences varies from study to study, and possibly from health problem to health problem. In studies categorizing the study population in 3-6 hierarchically ordered socio-economic groups on the basis of either education or occupational status, the Relative Risks (of the lowest versus the highest socio-economic group) mostly lie between 1 and 2. Exceptions are prevalence of disability and incidence of long-term work incapacity where Relative Risks between 2 and 4 have been found. A direct comparison with data from other countries is problematic, but at first sight the differences as observed in the Netherlands seem to be of the same order of magnitude as those observed in other industrialized countries. Although most Relative Risks imply 'weak associations' from a technical-epidemiological point of view, the Population Attributable Risks are substantial (generally between 0.25 and 0.40), underlining the public health impact of socio-economic health differences. Information on trends in health inequalities over time is limited to children's body height and adult mortality. For children's body height a substantial decrease of inequalities was found between 1964-1966 and 1980. For adult mortality, on the other hand, there is (indirect) evidence of a widening of the mortality gap between the 1950s and the 1980s. The evidence on specific factors which are involved in the 'causal chain' between socio-economic status and health problems is rather limited at the moment. A negative association with socio-economic status has been reported for the following risk factors: smoking; obesity; a number of unfavourable material living conditions; a number of unfavourable physical working conditions; psychosocial stress; lack of social support; less adequate supply/use of health care.(ABSTRACT TRUNCATED AT 400 WORDS)

Absenteeism↗
PubMed1998

[Women and AIDS: profile of an infected population and its social implications].

This study aimed to identify the profile of women with AIDS from a Health Service located in São Paulo City, from October to December, 1995. The data obtained from medical charts allowed to characterize the profile in terms of age, school degree, marital status, occupation, exposed category and mean survival time. Besides, it was possible to know the number of children--sons and daughters of those women--that might be real or potential AIDS' orphans, an important social problem involving the phenomena. Authors discuss the women's particularities in the process of the disease and the social implications related to the spread of the infection in this group.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Quality of life in males with spinal cord injury in Saudi Arabia.

OBJECTIVE: To assess the interests and post-hospitalization of quality of life (QOL) and career of patients with spinal cord injury (SCI). METHODS: This study took a period that extended for 20 years (1982-2003). Fifty-seven male patients in the Riyadh, Armed Forces Hospital and Al-Kharj Hospital Program (RKH), Kingdom of Saudi Arabia (KSA) with SCI responded to a questionnaire, which was distributed manually to 120 contributors. The questionnaire items include health status, occupation and educational level. RESULTS: The majority of the SCI patients belonged to the age group of 21-30 years (40.4%) and 31-40 years (33.3%). The injury levels were cervical (43.9%), thoracic (40.35%) and lumbar (23.5%). The urinary incontinence was managed by intermittent catheter (28%), indwelling catheter (17.5%), suprapubic cystostomy (15.8%), condom (12.3%) and continent (14.1%). Pressure sores were common and complication led urinary tract infections in 80.7% of patients. Spinal cord injury was a major cause and has a significant influence on patients' employment and career. Rehabilitation equipments and supplies support were provided by the RKH (45.6%), Ministry of Health (19.3%), self-purchasing (12.3%) and other source (22.8%). The important factors affecting the patient's QOL were financial status, employment, equipment supply and social isolation. CONCLUSION: Spinal cord injury is practically affecting the young adult population of KSA. The patient's QOL is significantly affected and hampered by factors such as accessibility, financial status and employment. Effective measures for the management and social awareness may improve the patient's style and QOL.

Adult↗
PubMed2006

[Factors associated with influenza vaccination among elderly persons in Southeastern Brazil].

OBJECTIVE: Even though influenza vaccination is free and widely available in Brazil since 1999, coverage is still inadequate in several of the country's municipalities. The aim of the present study was to estimate vaccine coverage and to identify factors related to vaccination against influenza in the elderly population. METHODS: A household survey was carried out using a systematic random sample (N=365) of the urban population older than 60 years from the city of Botucatu, Southeastern Brazil. A logistic regression model using vaccination in 2002 as the dependent variable was used. The following covariables were tested: sex, age, socioeconomic variables (per capita income, number of persons per dormitory, schooling, marital status, occupation, time living in the city), history of morbidity and hospital admission, smoking, respiratory symptoms in last 15 days, and community activities (voluntary work, neighborhood and church activities). RESULTS: Vaccine coverage was 63.2% (95% CI: 58.3-68.2). We found a lower proportion of vaccination among the 60-64 years age group. Variables associated with vaccination in the final model were age (OR=1.09 per year; 95% CI: 1.06-1.13); arterial hypertension (OR=1.92; 95% CI: 1.18-3.13); and participation in community activities (OR=1.63; 95% CI: 1.01-2.65). With the exception of hypertension, vaccination among subjects with chronic diseases did not reach adequate levels, as expected for this high-risk group. Participation in social and community activities was associated with vaccination status. CONCLUSIONS: Socioeconomic conditions, habits, and age did not restrict access to vaccination campaigns. On the other hand, specific campaigns aimed at the 60-64 years age group may increase vaccination coverage.

Age Distribution↗
PubMed1987

Employment characteristics and health status among men and women.

This study examines the characteristics of jobs held by women as compared to men during the 1970s and assesses associations between job characteristics and family status with health status by sex. Sex differences in perceptions about the meaning of work, commitment to the work role, and stresses and rewards are considered. Survey data on 1490 employed men and women, ages 18-64, drawn from a random sample of enrollees of a large health maintenance organization in 1970-71 are linked with medical record data covering seven years of outpatient and inpatient services. The findings suggest important differences in the characteristics of jobs held by men and women and in the relative importance of these job characteristics in relation to health. Men held jobs with higher quality intrinsic work characteristics and perceived their jobs to be less stressful and less physically and mentally tiring than did women. Social support and integration through work and occupational status were significantly related to health status for both sexes, however, family responsibilities interact with job characteristics to affect health status for women. Single motherhood, in combination with low social support and integration through work, was related to poor health among women.

Adolescent↗
PubMed2002

Investigating socio-economic explanations for gender and ethnic inequalities in health.

This paper examines inequalities in the self-reported health of men and women from white and minority ethnic groups in the UK using representative data from the Health Survey for England, 1993-1996. The results show substantially poorer health among all minority ethnic groups compared to whites of working-age. The absence of gender inequality in health among white adults contrasts with higher morbidity for many minority ethnic women compared to men in the same ethnic group. The analysis addresses whether socio-economic inequality is a potential explanation for this pattern of health inequality using measures of educational level, employment status, occupational social class and material deprivation. There are marked socio-economic differences according to gender and ethnic group: high morbidity is concentrated among adults who are most socio-economically disadvantaged, notably Pakistanis and Bangladeshis. Logistic regression analyses show that socio-economic inequality can account for a sizeable proportion of the health disadvantage experienced by minority ethnic men and women, but gender inequality in minority ethnic health remains after adjusting for socio-economic characteristics.

Adult↗
PubMed2005

A census-based socio-economic status (SES) index as a tool to examine the relationship between mental health services use and deprivation.

This paper discusses the development and application of a socio-economic status (SES) index, created to explore the relationship between socio-economic variables and psychiatric service use. The study was conducted in a community-based mental health service (CMHS) in Verona, Northern Italy, utilising service use data from 1996. An ecological SES index was constructed through a factor analysis from 1991 Census data, at census block level. Three factors reflected the following domains: the educational-employment sector (with four components), the relational network (with three components) and the material conditions (with three components). All service users were assigned a SES value, according to their place of residence in 1996. When these data were explored spatially, using ArcView 8.3, an association was observed between socio-economic deprivation and psychiatric service use. The SES index was then successfully validated using occupational status at the individual level. This study confirms the usefulness of developing and validating an ecological census-based SES index, for service planning and resource allocation in an area with a community-based system of mental health care.

Community Mental Health Services↗
PubMed1998

Highway crash costs in the United States by driver age, blood alcohol level, victim age, and restraint use.

This paper estimates 1993 U.S. highway crash incidence and costs by driver age, alcohol use, victim age, occupant status, and restraint use. Notable findings are: (1) crash costs of novice drivers are high enough to yield preliminary benefit-cost ratios around 4-8 for a provisional licensing system that restricts driving after midnight and 11 for zero alcohol tolerance for young drivers with violators receiving a 6-month suspension; (2) the costs to people other than the intoxicated driver per mile driven at BACs of 0.08-0.099% exceed the value of driver mobility; (3) the safety costs of drunk driving appear to exceed $5.80 per mile, compared with $2.50 per mile driven at BACs of 0.08-0.099%, and $0.11 per mile driven sober; (4) highway crashes cause an estimated 3.2% of U.S. medical spending, including more than 14% of medical spending for ages 15-24; (5) ignoring crash-involved occupants whose restraint use is unknown, the 13% of occupants who police reported were traveling unrestrained accounted for an estimated 42% of the crash costs; and (6) if these unrestrained occupants buckled up, the medical costs of crashes would decline by an estimated 18% (almost $4 billion annually) and the comprehensive costs by 24%.

Accidents, Traffic↗
PubMed2004

Motor vehicle driver injury and marital status: a cohort study with prospective and retrospective driver injuries.

OBJECTIVE: To investigate the association of marital status with risk of motor vehicle driver injury. DESIGN: A cohort study with prospective and retrospective outcomes. SETTING: New Zealand. PARTICIPANTS: A total of 10,525 adults (a volunteer sample of a multi-industry workforce, n = 8008; and a random sample of urban electoral rolls, n = 2517). EXPOSURE VARIABLE: Self reported marital status, assessed from a questionnaire administered in 1992-93 (baseline). MAIN OUTCOME MEASURE: Motor vehicle driver injury resulting in admission of the driver to hospital and/or the driver's death, during the period 1988-98; hospitalisation and mortality data were obtained by record linkage to national health databases. RESULTS: During 108 741 person-years of follow up, 139 driver injury cases occurred (85 before baseline, 54 after). After adjustment for age, sex, and study cohort, never married participants had twice the risk of driver injury (hazard ratio [HR] 2.06, 95% confidence interval [CI] 1.35 to 3.16) as married participants (HR 1.00). The relative risk for never married participants was slightly higher (HR 2.29), though less precise (95% CI 1.39 to 3.76), after further adjustment for alcohol intake, driving exposure, area of residence, body mass index, and occupational status. CONCLUSIONS: After taking age, sex, and other variables into account, never married people had a substantially higher risk of driver injury than married people. While requiring corroboration, these findings imply that it may be appropriate for driver injury countermeasures to be targeted to never married people.

Accidents, Traffic↗
PubMed2002

Serum IgG antibody response to periodontal pathogens in minority populations: relationship to periodontal disease status and progression.

Differences in periodontal disease prevalence, severity, subgingival microflora and host immune response have been reported for various ethnic/racial groups, which implies that risk factors for destructive periodontal disease progression may also vary in these populations. As it is possible that these differences may be due to confounding variables other than ethnicity/race, we have measured serum IgG antibody response to six periodontal pathogens, and compared these data with microbiological, clinical and demographic parameters in three urban minority populations. The study population consisted of 23 Asiatic, 48 African-American and 37 Hispanic subjects, who were resident in the greater New York region. Clinical indices that were recorded included pocket depth, attachment level, gingival erythema, bleeding upon probing, suppuration and supragingival plaque. Attachment level measurements were taken twice at each visit, and the difference between the means of pairs of measurements taken at baseline and two months later was used to determine disease progression. Subgingival microbiological species were identified and enumerated using DNA-DNA checkerboard hybridization. Serum IgG antibody levels to Actinobacillus actinomycetemcomitans serotyopes a and b, Bacteroides forsythus, Campylobacter rectus, Porphyromonas gingivalis and Prevotella intermedia were measured by enzyme-linked immunosorbant assay (ELISA). Mean serum IgG antibody to P. gingivalis was found to be higher in the African-American group, while IgG antibody to B. forsythus was lower in the Hispanic group. However, the African-American group also had greater mean probing depth, attachment loss, number of missing teeth and numbers of individuals within the unskilled occupational group. When the data were analyzed by occupational status, mean serum IgG antibody to P. gingivalis increased from professional to skilled to unskilled groups. For the entire study population, prior disease and subsequent attachment loss were associated with elevated serum IgG antibody to P. gingivalis. Increasing pocket depth, attachment level, gingival erythema and age were also positively correlated with serum IgG antibody to P. gingivalis, but not with serum IgG antibody to the other five subgingival species. No correlation was found between whole-mouth bacterial levels and homologous serum IgG antibody levels. These results suggest that elevated serum IgG antibody to P. gingivalis reflects destructive periodontal disease status, and may be considered a risk factor for disease progression in these ethnic/racial populations. In addition, although differences in serum IgG antibody profiles to subgingival species were found among the three ethnic/racial groups, environmental and socioeconomic variables may have a greater influence on serum IgG antibody levels in these populations.

Adult↗
PubMed1992

Dental anxiety and attendance in the north-west of England.

The aim of this study was to record the level of anxiety and last recorded visit for a dental check-up of a random sample of 300 workers at three sites in the North-west of England. All subjects were asked to complete a short written questionnaire and 255 (85 per cent) usable forms were returned. The mean level of anxiety using the Corah Dental Anxiety Scale (DAS) (N.L. Corah, 1969, J. Dent. Res. 48, 596) was 9.1. Females had a statistically higher mean DAS than males but there was no correlation between DAS and either age or occupational status. Those subjects who claimed not to have had a check-up in the past year had a significantly higher mean DAS than those who claimed to have been in the past year. Multiple regression analysis showed that the reported time interval since the last check-up was the most important predictor of the DAS score. The implications of the results are considered for the future of restorative dentistry.

Adolescent↗
PubMed1996

Mental disorder and criminality. Male alcoholism.

This study investigated the lifetime prevalence of criminal behavior in a population of 360 Research Diagnostic Criteria alcoholics. The same number of control subjects were drawn from the general population of the same catchment area and matched with the patients with regard to sex, age, marital status, occupational level, and community size. The full account of conviction records in a criminal register was used as a measure of criminal behavior. Altogether, 68% of patients vs. 37% of controls had any criminal record. Higher rates were found for alcoholics than for controls for all types of crime; differences were especially pronounced in crimes against property and in violent crimes. We conclude that alcoholism contributes to criminal behavior to a considerable degree, independently of sociodemographic factors.

Adolescent↗
PubMed2004

Inflammatory bowel disease: the role of environmental factors.

Environmental factors are essential components of the pathogenesis of inflammatory bowel disease (IBD) and primarily responsible for its growing incidence around the globe. Epidemiological, clinical and experimental evidence support an association between IBD and a large number of seemingly unrelated environmental factors, which include smoking, diet, drugs, geographical and social status, stress, microbial agents, intestinal permeability and appendectomy. Data supporting the involvement of each of these factors in predisposing to, triggering, or modulating the course or outcome of IBD vary from strong to tenuous. Smoking and the enteric bacterial flora are the ones for which the most solid evidence is currently available. Smoking increases the risk of Crohn's disease (CD) and worsens its clinical course, but has a protective effect in ulcerative colitis (UC). Presence of enteric bacteria is indispensable to develop gut inflammation in most animal models of IBD, and modulation of the quantity or quality of the flora can be beneficial in patients with IBD. Surprisingly, evidence for a major role of the diet in inducing or modifying IBD is limited, while that for nonsteroidal anti-inflammatory drugs is more convincing than for oral contraceptives. Northern geographic location, and a high social, economical, educational or occupational status increase the risk of IBD, an observation fitting the hygiene hypothesis for allergic and autoimmune diseases. Stress is also associated with IBD, but more as a modifier than an inducing factor, and its contribution is more obvious in IBD animal models than human IBD. Finally, an increased intestinal permeability may increase the risk for developing CD, whereas an appendectomy lowers the risk of developing UC.

Animals↗
PubMed1998

Risk factors for suicide in Caucasians and in African-Americans: a matched case-control study.

It is known that suicide rates for Caucasians are higher than those for African-Americans. However, there has been little research examining whether risk factors associated with suicide differ by race, when the effects of age, gender, and educational-occupational status are taken into account. A matched case-control study was constructed from the 1986 National Mortality Followback Survey to address such concerns. Cases included all individuals aged between 25 and 64 years dying from suicide. Controls were those who died of natural causes, who were frequency matched to cases by age and gender. The study results for Caucasians indicate that those who had at least a high school education were more likely to commit suicide [odds ratio (OR) = 1.91; 95% confidence interval (CI) = 1.37-2.67] than those who had less than a high school education; those who were heavy drinkers were more likely to commit suicide (OR = 1.64; 95% CI = 1.16-2.33) than those who were light or moderate drinkers; those who lived alone were more likely to commit suicide (OR = 1.72; 95% CI = 1.28-2.30) than those who lived with others, those who had blue-collar occupations were more likely to commit suicide (OR = 1.79; 95% CI = 1.33-2.42) than those who had white-collar occupations, and those who had used mental health services were more likely to commit suicide (OR = 3.07; 95% CI = 2.34-4.01) than those who had not used them. For African-Americans, use of mental health services was the only factor significantly associated with suicide (OR = 4.56 95% CI = 1.69-12.29).

Adult↗
PubMed1995

Incorporating psychological debriefing techniques within a brief group psychotherapy programme for the treatment of post-traumatic stress disorder.

BACKGROUND: The Royal Air Force Wroughton Post-Traumatic Stress Disorder (PTSD) Rehabilitation Programme is described. It comprised a 12-day structured in-patient 'course' of group psychotherapy and day-case group follow-up sessions over a one-year period. Psychological debriefing was the main therapeutic technique employed. METHOD: This is a 'before and after' open outcome study. A comprehensive assessment protocol confirmed the presence and severity of PTSD and measured co-morbid psychopathological status, occupational and social function longitudinally. RESULTS: A highly significant global response to treatment is demonstrated in the 34 subjects included in the study, with 85.3% not fulfilling the DSM-III-R criteria for PTSD at one year after treatment. CONCLUSIONS: Further controlled studies assessing the value of psychological debriefing techniques in the treatment of established PTSD are required.

Adaptation, Psychological↗
PubMed2000

Excess type 2 diabetes in African-American women and men aged 40-74 and socioeconomic status: evidence from the Third National Health and Nutrition Examination Survey.

OBJECTIVE: To examine whether socioeconomic status (SES) explains differences in the prevalence of type 2 diabetes between African-American and non-Hispanic white women and men. DESIGN: Cross sectional study of diabetes prevalence, SES, and other risk factors ascertained by physical examination and interview. SETTING: Interviews were conducted in subjects' homes; physical examinations were conducted in mobile examination centres. PARTICIPANTS: 961 African-American women, 1641 non-Hispanic white women, 839 African-American men and 1537 non-Hispanic white men, aged 40 to 74 years, examined in the Third National Health and Nutrition Examination Survey (NHANES III), a representative sample of the non-institutionalised civilian population of the United States, 1988-1994. MAIN RESULTS: Among women, African-American race/ethnicity was associated with an age adjusted odds ratio of 1.76 (95% confidence intervals 1.21, 2.57), which was reduced to 1.42 (95% confidence intervals 0.95, 2.13) when poverty income ratio was controlled. Controlling for education or occupational status had minimal effects on this association. When other risk factors were controlled, race/ethnicity was not significantly associated with type 2 diabetes prevalence. Among men, the age adjusted odds ratio associated with African-American race/ethnicity was 1.43 (95% confidence intervals 1.03, 1.99). Controlling for SES variables only modestly affected the odds ratio for African/American race/ethnicity among men, while adjusting for other risk factors increased the racial/ethnic differences. CONCLUSIONS: Economic disadvantage may explain much of the excess prevalence of type 2 diabetes among African-American women, but not among men.

Adult↗
PubMed2006

Posttraumatic stress disorder among hospital surgical physicians exposed to victims of terror: a prospective, controlled questionnaire survey.

BACKGROUND AND OBJECTIVE: Surgical physicians often treat victims of terror-related multiple-casualty incidents. This may cause secondary posttraumatic stress disorder (PTSD), impairing their ability to care for patients. The objective of this study was to determine whether professional exposure to victims of terror caused PTSD in Israeli physicians from surgical disciplines. METHOD: This was a validated questionnaire survey of physicians (November 2002 through March 2003) from 2 Jerusalem hospitals (a tertiary trauma center and a secondary regional hospital) divided into study (physicians from surgical disciplines regularly exposed to victims of terror) and control (physicians not regularly exposed) groups. Questionnaires included the PTSD Symptom Scale-Self-Report to diagnose PTSD (DSM-IV criteria) and allowed exclusion of other causes of similar symptoms. The main outcome measure was the difference in the prevalence of PTSD between groups. RESULTS: Included were 212 (102 study, 110 control) participants. The study group experienced a significantly higher level of exposure to terror victims at work, validating prospective group definitions. The prevalence of PTSD was similar in both groups (study group = 16%, control group = 15%; p = 1.00). The study and control groups were similar in all predicting variables except for number of years in medical practice, occupational status, and workplace. The groups had similar levels of exposure to terror outside work (p = .24). The probability that a physician would have PTSD was related to use of nonadaptive coping strategies (OR = 5.1; p = .009) and a higher level of exposure to terror out of work (OR = 3.5; p = .013). CONCLUSION: Hospital physicians from surgical disciplines who were professionally exposed to victims of terror did not demonstrate a higher incidence of PTSD than their less exposed counterparts.

Adaptation, Psychological↗
PubMed1980

[Coronary heart disease: psychosocial aspects of its prevention].

The paper presents results of a retrospective study on 380 male patients (age 30-55) with first myocardial infarction (MI) following a rehabilitation program and 190 healthy controls matched by age, sex and occupational status. It is asked whether by simultaneous analysis of several psychosocial stress conditions related to the time before onset of MI (workload, life events, coronary prone behavior, chronic difficulties combined with loss of social support) it is possible to separate the two groups better than by analysis of somatic risk factors. The hypothesis can be verified in different ways. Findings can be substantiated by a follow-up study relating psychosocial high risks to the rate of cardiac deaths and/or recurrence of cardiac symptoms. Consequences for individual as well as global intervention and prevention are briefly discussed.

Adult↗