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PubMed2002

Willingness of patients to perform self-management of asthma and the role of inhaled steroids.

OBJECTIVE: Asthma self-management is a generally accepted effective treatment strategy for asthma patients. Acceptance by patients may be a barrier for successful implementation. In this study, the role of inhaled steroids in starting asthma self-management is described. DESIGN: Cross-sectional explorative study. SETTING: General practice. SUBJECTS: 283 adult steroid-requiring asthma patients were invited by their GP to participate in a self-management programme. MAIN OUTCOME MEASURES: In a multivariate logistic regression model, the relation between baseline dosage of inhaled steroids, occupational status, age and sex as independent variables and willingness to participate as dependent variables was explored. RESULTS: Of all invited, 148 (52%) were willing to participate. Subjects not using inhaled steroids were least willing to participate (43/143 = 30%). Subjects with low doses of inhaled steroids ( < 400 mcg daily) were most willing to participate (44/54 = 81%). Unemployed asthmatics had a higher tendency to participate than patients with a regular job. CONCLUSION: Acceptance of self-management by patients is not a limiting issue in promoting self-management of asthma in general practice. High acceptance in patients taking low or intermediate doses of inhaled steroids makes general practice the most appropriate setting for self-management. A selection procedure is recommended.

Administration, Inhalation↗
PubMed2004

Health inequalities in different age groups: the case of type 2-diabetes: a study with health insurance and medication data.

OBJECTIVE: This study investigates social differentials in the prevalence of diabetes type 2 in women and men in a health insurance population. It is considered whether social gradients are present over different age strata. METHODS: Analyses were performed with records obtained from a German statutory health insurance comprising 77,294 women (31.8%) and men (68.2%) of at least 20 years. Occupational status was used as indicator of socio-economic position. Individuals with diabetes were identified using information about antidiabetic medication or by hospital diagnoses according to ICD9. The analyses were performed for the entire insurance population and for different age strata (<40 yrs /40-55 yrs/ >55 yrs). RESULTS: The analyses revealed considerable social differences in diabetes risks. Considering the whole insurance population with the highest socio-economic category as reference group, the odds ratio (OR) for skilled non-manuals was OR = 2.9, for skilled manuals it was OR = 4.7, and OR = 5.6 for unskilled and semi-skilled individuals. After stratifying the insurance population into three age groups the social gradients were reproduced for each stratum, but their magnitudes increased with age. CONCLUSIONS: In the health insurance population considered health inequalities with respect to diabetes are considerable, and they are persisting after stratification into age groups.

Adult↗
PubMed1987

A study on the health hazard of toluene in the polythene printing industry in Singapore.

A study was conducted to determine if there were any health effects among the polythene printers who were exposed to toluene and to evaluate the use of urinary hippuric acid in biological monitoring. The study covered 54 printers from 6 plants out of the universe population of 32 polythene printing plants who used toluene as ink dilutants. They were matched with 54 controls for age, sex, race and similar occupational status. All were interviewed and examined clinically. 23 patients were selected for neurobehavioural tests. 26% of the printers had more than 10 years of exposure to toluene. No case of clinical encephalopathy or peripheral neuropathy was detected. 38.9% of the printers had hand dermatitis compared with 1.9% among the controls. Results of the neurobehavioural tests for the 23 printers were not statistically different from the controls. The results of the liver function test were within normal limits. The mean toluene-in-air level was 246 +/- 25 mg/m. Mean blood toluene was 0.63 +/- 0.14 microgram/ml. The mean urinary hippuric acid was 2.83 +/- 0.48 mg/ml as compared to 0.35 +/- 0.08 mg/ml in the controls. Urine hippuric acid corrected to SG of 1.016 was well correlated to air toluene level (r = 0.81). Toluene appears not to have any significant nervous system or liver effects in these printers. Urinary hippuric acid is a useful indicator for biological monitoring of atmospheric exposure to toluene.

Adolescent↗
PubMed1997

Children's dental health in Europe.

"Children's Dental Health in Europe" is a collaborative study of a total of 3200 children, comprising samples of 5- and 12-year-old children from eight EU-countries [Belgium, Germany, Greece, Ireland, Italy, Scotland (United Kingdom), Spain and Sweden] who have undergone clinical examination by well calibrated dentists. This study analyses the influence of a number of sociodemographic factors on the dental health of the actual children. Father's and/or mother's occupational status was used to determine the social class of the family, after construction of a family-social class variable, SocFam, and the accuracy of this variable was tested. In 15 of the 16 samples, both treatment provided and unmet treatment need were higher in children from low social class. The treatment need in children from low social class was significantly greater in the Belgium, German, Greek and Italian 5-year-old samples. The differences in both treatment need and treatment already received for children from high respectively low social class were significant in the Scottish and Spanish 12-year-old samples. Taking into account the total material of 1600 children in each age-group, risk indicators for caries, identified by logistic and multiple regression analyses, were social class of the family, the mother's smoking habits, and in the 5-year-olds the number of siblings.

Adult↗
PubMed2005

High prevalence of overweight and obesity in women of Islamshahr, Iran.

This study determined the prevalence of overweight, overall and central obesity in female adolescents and women and their possible association with marital status, occupation, literacy, parity, daily meal and snack consumption. The study was a cross-sectional, random survey of households. Rural and urban areas of Islamshahr district in Iran were selected and 1003 female adolescents and women aged 10-65 years were studied. The frequency of overweight and obesity were similar in rural and urban areas. On the basis of body mass index (BMI), more than 19% of adolescents were overweight or at risk of it and 66.8% of adult females were overweight or obese. Frequency of central obesity [waist to hip ratio (WHR) > or = 0.85]was 35.7% in all females. The mean BMI was significantly higher in married women and in women with less than 8 years of formal education. The mean WHR was significantly higher in women with less than 8 years of education or with more than 6 parity female adults. In addition, the mean BMIs and WHRs were significantly higher in women without any daily snack consumption. Overweight and obesity was very common in adult females of Islam shahr thus prevention of overweight and obesity through a healthy diet and increased physical activity should now be an important priority area.

Adolescent↗
PubMed2001

Is self-reported morbidity related to the circadian clock?

Morningness and eveningness preference, an endogenous component of the circadian clock, is characterized by an interindividual difference in circadian phase and requires of humans a specific timing of behavior. The biological rhythms of morning and evening types are consequently phase shifted with fixed socioeconomic constraints. The impact of this phase shift on health is widely debated. The purpose of the authors' study was to determine the influence of morningness/eveningness preference on self-reported morbidity and health in an active population. A total of 1165 nonshift workers of the French national electrical and gas company, enrolled in the GAZEL cohort and aged 51.3+/-3.3 years, were included in this study. They replied by mail with a completed questionnaire, including morningness/eveningness preference, self-reported morbidity, subjective sleep patterns, and daytime somnolence and sleeping schedules for 3 weeks, during the spring of 1997. Annual self-reported health impairments were assessed with the annual general questionnaire of the GAZEL cohort for 1997. After adjustment for age, sex, and occupational status, morningness-like and eveningness-like participants reported a specific worse self-reported morbidity. Whereas morningness was associated with worse sleep (p = 0.0001), eveningness was associated with feeling less energetic (p = 0.04) and physical mobility (p = 0.02). These relationships were observed even in good sleepers, except for physical mobility. After adjustment for confounding variables, eveningness-like participants reported more sleep (p = 0.0004) and mood (p = 0.00018) disorders than morningness-like participants. Morningness/eveningness preference was related to specific chronic complaints of insomnia: morningness was related with difficulty in maintaining sleep (p = 0.0005) and the impossibility to return to sleep in the early morning (p = 0.0001) (sleep phase-advance syndrome); eveningness was related to difficulty in initiating sleep (p = 0.0001) and morning sleepiness (p = 0.0001). In good sleepers, morningness was related with sleep phase-advance syndrome (p = 0.0001) and eveningness with morning sleepiness (p = 0.0001). In conclusion, the expression (phase advance or delay) of the circadian clock could be related to worse self-reported morbidity and health. These findings must be verified by further epidemiological studies, but they suggest that the impossibility to return to sleep in the early morning is not only associated with age.

Adult↗
PubMed2005

The economic impact of GERD and PUD: examination of direct and indirect costs using a large integrated employer claims database.

OBJECTIVE: The objective of this study was to examine the relationship of work loss associated with gastro- the relationship of work loss associated with gastro- the relationship of work loss associated with gastro-esophageal reflux disease (GERD) and peptic ulcer disease (GERD) and peptic ulcer disease (PUD) in a large population of employed individuals in the United States (US) and quantify the individuals in the United States (US) and quantify the economic impact of these diseases to the employer. METHODS: A proprietary database that contained work place absence, disability and workers' compensation data in addition to prescription drug and medical claims was used to answer the objectives. Employees with a medical claim with an ICD-9 code for GERD or PUD were identified from 1 January 1997 to 31 December 2000. A cohort of controls was identified for the same time period using the method of frequency matching on age, gender, industry type, occupational status, and employment status. Work absence rates and health care costs were compared between the groups after adjusting for demo graphic, and employment differences using analysis of covariance models. RESULTS: There were significantly lower (p < 0.05) prescription, and outpatient costs in the controls compared to the disease groups, although the eta-square values were very low. The mean work absence attributed to sick days was 2.8 (+/- 2.3) for controls, 3.4 (+/- 2.5) for GERD, 3.2 (+/- 2.6) for PUD, and 3.2 (+/- 2.3) days for GERD + PUD. For work loss, a significantly higher (p < 0.05) rate of adjusted all-cause absenteeism and sickness-related absenteeism were observed between the disease groups versus the controls. In particular, controls had an average of 1.2 to 1.6 days and 0.4 to 0.6 lower all-cause and sickness-related absenteeism compared to the disease groups. The incremental economic impact projected to a hypothetical employed population was estimated to be $3441 for GERD, $1374 for PUD, and $4803 for GERD + PUD per employee per year compared to employees without these diseases. CONCLUSIONS: Direct medical cost and work absence in employees with GERD, PUD and GERD + PUD represent a significant burden to employees and employers.

Absenteeism↗
PubMed2006

Decreasing rates of middle ear surgery in Western Australian children.

OBJECTIVE: To investigate temporal, social, demographic, and health care utilization factors associated with myringotomy with ventilation tube insertion (MVTI) in Western Australian (WA) children. DESIGN: Observational retrospective population-based cohort study using hospital administrative data. SETTING: All WA hospitals. PARTICIPANTS: A total of 53 673 children younger than 15 years who underwent surgery for MVTI in the period 1981-2004. MAIN OUTCOME MEASURES: Age-specific incidence rates and incidence rate ratios. RESULTS: The rate of MVTI in children younger than 15 years peaked in 1997 at 6.7 per 1000 person-years and decreased to 5.6 per 1000 person-years by 2004. Based on 2004 rates, 8.4% of WA children will undergo at least 1 MVTI procedure before reaching age 15 years. The rate of MVTI was 37% lower in Indigenous children, and the procedures were performed at an older age compared with non-Indigenous children. Higher rates of MVTI were associated with areas of higher economic resources, lower education and occupation status, and living in metropolitan areas. CONCLUSIONS: The rate of MVTI in WA is showing evidence of a decline, even among children younger than 5 years. There remains an issue regarding equity of access to care for Indigenous children. Increasing parental economic resources may be associated with higher rates of MVTI independent of educational status.

Adolescent↗
PubMed2005

Specific language impairment and child care by a domestic helper: a case-control study in Chinese children.

OBJECTIVE: To investigate the relationship between child care by domestic helper and specific language impairment (SLI). DESIGN: Retrospective case-control study. SETTING: A Child Assessment Center in Hong Kong that receives referrals from primary and secondary care settings. PARTICIPANTS: We reviewed medical records of all new referrals younger than 5 years during a 4-year period (1999-2003) and compared children with SLI (cases) with those referred with other behavioral problems and assessed to have normal language and overall development (controls) using the Griffiths Mental Developmental Scale. Specific language impairment was defined as a language quotient more than 1 SD below the mean and below the general developmental quotient in children with normal general developmental quotient but without neurological or other organic diseases. RESULTS: Four hundred ninety-six children were included (237 cases and 259 controls). The mean ages of cases and controls were 2.51 and 2.89 years, respectively. Boys predominated (cases = 73.4%, controls = 60.2%). The odds ratio (OR) of SLI for children cared for by a full-time domestic helper was 1.71 (95% confidence interval [CI], 1.06-2.77; P = .03), after adjusting for confounding sociodemographic variables. Male gender (OR = 1.91; 95% CI, 1.25-2.90), positive family history (OR = 2.70; 95% CI, 1.55-4.73), fewer siblings (P = .01), and lower paternal occupational status (P = .01) were also risk factors for an SLI. Childcare by a domestic helper was associated with a higher severity of an SLI in ordinal regression analysis (P = .048). CONCLUSIONS: Childcare by a domestic helper is associated with increasing risk and severity of an SLI. Further studies are required to confirm the association and to evaluate whether avoidance of childcare by a domestic helper could be recommended for children with an SLI or prone to develop an SLI.

Adult↗
PubMed1982

Primary unipolar depression and the prognostic importance of delusions.

A consecutive series of inpatients with primary unipolar depression was categorized by the presence or absence of delusions as noted in the charts. The systematically obtained follow-up material contained in these charts showed that delusional patients had a relatively poor short-term outcome regardless of whether they received somatic treatment. Recovery rate increased with longer follow-up periods in both groups. In accord with this, a 40-year follow-up revealed no differences between delusional and nondelusional groups in terms of marital, residential, or occupational status, psychiatric symptoms, a final diagnosis of bipolar disorder, or death by suicide.

Antidepressive Agents↗
PubMed1990

Outcome in Mania. A 4-year prospective follow-up of 75 patients utilizing survival analysis.

A 4-year follow-up of 75 patients was conducted to investigate outcome after recovery from an episode of mania. Predictors of an unfavorable outcome included poor occupational status prior to index episode, history of previous episodes, history of alcoholism, psychotic features and symptoms of depression during the index manic episode, male gender, and interepisode affective symptoms at 6 months' follow-up. The mortality risk during the follow-up period was 4%. The identification of specific risk factors depended on the definition of outcome and the length of follow-up.

Adult↗
PubMed2000

Adult functional outcome of those born small for gestational age: twenty-six-year follow-up of the 1970 British Birth Cohort.

CONTEXT: Although studies have documented cognitive impairment in children who were born small for gestational age (SGA), other studies have not demonstrated differences in IQ or other cognitive scores. The need exists for long-term studies of such children to assess functional outcomes not measurable with standardized testing. OBJECTIVE: To determine the long-term functional outcome of SGA infants. DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: A total of 14,189 full-term infants born in the United Kingdom on April 5 through 11, 1970, were studied as part of the 1970 British Birth Cohort; 1064 were SGA (birth weight less than the fifth percentile for age at term). Follow-up at 5, 10, 16, and 26 years was 93%, 80%, 72%, and 53%, respectively. MAIN OUTCOME MEASURES: School performance and achievement, assessed at 5, 10, and 16 years; and years of education, occupational status, income, marital status, life satisfaction, disability, and height, assessed at 26 years, comparing persons born SGA with those who were not. RESULTS: At 5, 10, and 16 years of age, those born SGA demonstrated small but significant deficits in academic achievement. In addition, teachers were less likely to rate those born SGA in the top 15th percentile of the class at 16 years (13% vs 20%; P<.01) and more likely to recommend special education (4.9% vs 2.3%; P<.01) compared with those born at normal birth weight (NBW). At age 26 years, adults who were SGA did not demonstrate any differences in years of education, employment, hours of work per week, marital status, or satisfaction with life. However, adults who were SGA were less likely to have professional or managerial jobs (8.7% vs 16.4%; P<.01) and reported significantly lower levels of weekly income (mean [SD], 185 [91] vs 206 [102] pound sterling; P<.01) than adults who were NBW. Adults who were SGA also reported significant height deficits compared with those who were NBW (mean [SD] z score, -0.55 [0.98] vs 0.08 [1.02]; P<.001). Similar results were also obtained after adjusting for social class, sex, region of birth, and the presence of fetal or neonatal distress. CONCLUSIONS: In this cohort, adults who were born SGA had significant differences in academic achievement and professional attainment compared with adults who were NBW. However, there were no long-term social or emotional consequences of being SGA: these adults were as likely to be employed, married, and satisfied with life.

Adolescent↗
PubMed1996

Women's work environment and health: clerical workers in Brazil.

Although women are participating more in the formal workforce, the majority are employed primarily in low-income and low-status occupations. While work roles may provide women with some rewards, employment may also create many stressful demands on their daily lives. As part of an international study, 60 female Brazilian clerical workers responded to a self-administered questionnaire describing what they liked, disliked, and found stressful about the structural, physical, and social aspects of their work environment. Participants also identified strategies they used to cope with stress in the work environment. Dimensions of healthy environments identified in the data included utility, challenge, participation, safety, pleasing workplace, valuation, clarity of roles, and empowerment. Unhealthy environments were characterized by hazards, bureaucracy, devaluation, and economic constraints. Participants described their concerns about the effect of the environment on their physical and mental health, but tended to adopt a passive, resigned coping style rather than a proactive approach to co-creating a healthier work environment. The results and their relationship to healthy work environments are discussed within the context of the larger sociopolitical environment of Brazil.

Adaptation, Psychological↗
PubMed2000

Are social-class differences in stature partly genetic? A hypothesis revisited.

Twenty-three different, socially homogenous groups of 19-year-old males were selected from a total sample of 57,000 Polish conscripts examined in 1986 and in 1995. Each group consisted of age-mates equated for six criteria of social background: 1) maternal and 2) paternal education, 3) maternal and 4) paternal occupational status, 5) number of children in the family, and 6) degree of urbanization of the subject's locality of residence. Within every one of the 23 groups, subjects who at the age of 19 years were secondary-school or college students, were taller than socially similar peers, who by that age had never moved beyond the level of basic vocational school. Thus, a significant association exists between an individual's potential for upward social mobility and tallness. Such associations must be taken into account when considering the origin and nature of the commonly observed taller stature of the upper over the lower social strata in present-day industrial societies. Am. J. Hum. Biol. 12:97-101, 2000. Copyright 2000 Wiley-Liss, Inc.

Journal Article↗
PubMed1983

Factors related to job stability of direct-care staff of residential facilities for mentally retarded people.

Direct-care staff turnover has frequently been cited as a major problem in the management of both public and nonpublic residential facilities. This article reports on a follow-up study of over 100 direct-care staff one year after an initial interview. Staff members were employees of facilities in a national, stratified random sample of public and nonpublic facilities. Demographic, experiential, job satisfaction, geographical, and institutional factors related to occupational status at the time of the follow-up are reported.

Data Collection↗
PubMed2006

Leg length, cognitive impairment and cognitive decline in an African-Caribbean population.

BACKGROUND: Shorter leg length is associated with an adverse environment in early childhood and has been found to be associated with a variety of disorders occurring in mid- to late-life, including dementia in a Korean population. In a community population of African-Caribbean elders, in whom leg length had been measured, we sought to compare associations with cognitive impairment at baseline and cognitive decline over a three-year follow-up period. METHODS: Of 290 African-Caribbean residents in south London recruited at baseline, 216 (74%) were re-interviewed after a three-year period and 203 had sufficient data for this analysis. Cognitive impairment was derived as a binary category from a battery of cognitive tests administered at baseline and cognitive decline was derived from change in performance on a subset of these tests. Leg length (iliac crest to lateral malleolus) was also measured. RESULTS: Shorter leg length was associated with female sex, lower occupational social class and reported hypertension and diabetes. Shorter leg length (lowest quartile) was significantly associated with cognitive impairment but there were no apparent associations with cognitive decline. The association with cognitive impairment was independent of age, sex and education. Social class appeared to be an important mediating factor. CONCLUSIONS: Shorter leg length may be a marker of early life stressors which result in reduced cognitive reserve. Interestingly this association was mediated more strongly by social class (previous occupational status) than by education in this population.

Aged↗
PubMed2004

Price discrimination in obstetric services--a case study in Bangladesh.

This article examines the existence of price discrimination for obstetric services in two private hospitals in Bangladesh, and considers the welfare consequences of such discrimination, i.e. whether or not price discrimination benefited the poorer users. Data on 1212 normal and caesarean section patients discharged from the two hospitals were obtained. Obstetric services were chosen because they are relatively standardised and the patient population is relatively homogeneous, so minimising the scope and scale of product differentiation due to procedure and case-mix differences. The differences between the hospital list price for delivery and actual prices paid by patients were calculated to determine the average rate of discount. The welfare consequences of price discrimination were assessed by testing the differences in mean prices paid by patients from three income groups: low, middle and high. The results suggest that two different forms of price discrimination for obstetric services occurred in both these hospitals. First, there was price discrimination according to income, with the poorer users benefiting from a higher discount rate than richer ones; and second, there was price discrimination according to social status, with three high status occupational groups (doctors, senior government officials, and large businessmen) having the highest probability of receiving some level of discount.

Bangladesh↗
PubMed2006

Total and specific fluid consumption as determinants of bladder cancer risk.

We pooled the data from 6 case-control studies of bladder cancer with detailed information on fluid intake and water pollutants, particularly trihalomethanes (THM), and evaluated the bladder cancer risk associated with total and specific fluid consumption. The analysis included 2,729 cases and 5,150 controls. Odds ratios (OR) and 95% confidence intervals (CI) for fluid consumption were adjusted for age, gender, study, smoking status, occupation and education. Total fluid intake was associated with an increased risk of bladder cancer in men. The adjusted OR for 1 l/day increase in intake was 1.08, (95% CI 1.03-1.14, p-value for linear trend <0.001), while no trend was observed in women (OR=1.04, 0.94-1.15; p-value=0.7). OR was 1.33 (1.12-1.58) for men in the highest category of intake (>3.5 l/day) as compared to those in the lowest ( 2 l/day vs. 5 cups of coffee daily vs. <5 and for THM exposure, but neither exposure confounded or modified the OR for tap water intake. The association of bladder cancer with tap water consumption, but not with nontap water fluids, suggests that carcinogenic chemicals in tap water may explain the increased risk.

Age Factors↗