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PubMed2000

Early findings from a community-based, cluster-randomized, controlled oral cancer screening trial in Kerala, India. The Trivandrum Oral Cancer Screening Study Group.

BACKGROUND: Oral cancer satisfies the criteria for a suitable disease for screening, and oral visual inspection is a suitable test for oral cancer screening. The efficacy of screening in reducing mortality from oral cancer has not yet been evaluated. The authors describe a cluster-randomized, controlled oral cancer screening trial in southern India and its early results. METHODS: Apparently healthy subjects age 35 years or older in 13 clusters called panchayaths were randomized to either an intervention group (n = 7) or a control group (n = 6). Subjects in the intervention group will receive 3 rounds of screening consisting of oral visual inspection by trained health workers at 3-year intervals. The first round of screening was carried out between October 1995 and May 1998. Participants were visited in their homes and interviewed for sociodemographic details, tobacco-smoking and alcohol-drinking habits, and personal medical history. Those with tobacco or alcohol habits were advised to stop those habits. Subjects in the intervention group were offered screening, and those with lesions suggestive of oral leukoplakia, submucous fibrosis, or oral cancer were referred for examination by physicians. Confirmed leukoplakias were excised whenever possible, others were kept on follow-up, and those with confirmed oral cancers were referred for treatment. Data on oral cancer incidence, stage distribution, survival, and mortality in the study groups are obtained by record linkage with the Trivandrum population-based cancer registry and municipal death registration systems. RESULTS: There were 59,894 eligible subjects in the intervention group and 54,707 in the control group; 31.4% of the former group reported no tobacco or alcohol habits, compared with 44.1% of the latter. The distribution of age, education, occupation, income, and socioeconomic status were similar in the two groups. Of 3585 subjects in the intervention group referred, 52.4% were examined by physicians; 36 subjects with oral cancers and 1310 with oral precancers were diagnosed. Of the 63 oral cancers recorded in the cancer registry, 47 were in the intervention group and 16 were in the control group, yielding incidence rates of 56.1 and 20.3 per 100,000 person-years in the intervention and control groups, respectively. The program sensitivity for detection of oral cancer was 76.6% and the specificity 76.2%; the positive predictive value was 1.0% for oral cancer. In the intervention group, 72.3% of the cases were in Stages I-II, as opposed to 12.5% in the control group. The 3-year case fatality rates were 14.9% (7 of 47 patients) in the intervention group and 56.3% (9 of 16 patients) in the control group. CONCLUSIONS: Though compliance with referral for confirmatory examination in the first round was lower than the 70% anticipated, intermediate end points, such as stage at diagnosis and case fatality, indicate that the trial is making fairly satisfactory progress.

Adult↗
PubMed2006

[Antenatal care in immigrants].

The phenomenon of immigration has had an impact on the health care of the population. The immigrant population in Spain today represents approximately 8% of the total population. The majority of this population proceeds from countries with low income, and its origin and distribution is diverse. The immigrant population is characterised by its being young and healthy, and with a capacity to adapt to changes, but its social, economic and labour conditions are frequently insecure and favour vulnerability to disease. In spite of the number of immigrants of the male sex being globally higher than that of women, the percentage of immigrants of the female sex is growing. This increase of the female immigrant population has resulted in the appearance of specific health care needs, especially with respect to sexual and reproductive health. To which we must add a substantial increase in pathologies prevalent in the countries of origin, such as anaemia, tuberculosis, malnutrition, haemoglobinopathies, consanguinity, hypocalcaemia, hepatitis B and/or C, sexually transmitted infections, infectious diseases transmitted by arthropods, such as Chagas disease and other parasitoses, as well as genital mutilations. The aim of this article is to analyse the factors that make it difficult to control gestation in the immigrant population, as well as to establish guidelines for acting in antenatal care consultations. Insistence is placed on health education and prevention during pregnancy, and consideration is given to the appearance of rare diseases related to some of these groups.

Female↗
PubMedDate not supplied

Medicare reform: who pays and who benefits?

As Medicare's share of federal spending and gross domestic product (GDP) rises, the program may have increasingly important consequences not only for the health of Americans but also for their net income and financial well-being. We use incidence analysis to study payments and benefits in Medicare to various generations and income groups. We find that Medicare actually provides larger net dollar transfers to wealthier beneficiaries, although the "insurance value" of these dollars is greater for low-income households. We then evaluate a range of proposed Medicare reforms with regard to their impact on the distribution of both health care and disposable income.

Aged↗
PubMedDate not supplied

[Income as a condition of self care in the aged].

The current type of distribution of tasks between the generations leads to a system of income maintenance programs for the aged, which is based on their own past (largely statutory) provision for their old age income via public institutions. On the whole, the aged are to a very limited degree in the labor force. Most of them receive public transfer payments. On the average, the diverse income maintenance systems dependent on own past performance provide a fairly substantial income level when compared with wages and salaries. The transfer level is largely dependent on the type of old age security institution, on the extent of past labor force participation or contribution and past income; consequently it is quite diverse. Sex largely correlates with income differentials. While some groups end up with retirement incomes higher than their last wage income, others are definitely needy. Especially women constitute a substantial part of the poor. Besides low income, the danger of becoming a nursing case makes the aged dependent on other persons' or institutions' aid. The forthcoming reform of the public pension system shows little hope of eliminating the pockets of poverty among the aged by assuring a redistribution also among the aged.

Aged↗
PubMed1989

Prevalence and distribution of caries in a Jerusalem adolescent population by age, sex, and family income.

Four hundred and fourteen high school students aged 12-17 were examined clinically using the DMFS index and bitewing radiographs. Analyses by age, sex, economic status, and types of teeth and tooth surfaces were performed and results were compared with other international studies. Only 7.5 percent of the study population had a zero DMFS score. Females had a significantly higher DMFS score than males (13.21 vs 9.59). Caries experience increased with age and a general trend of increasing DMFS was observed with increasing levels of income. Socioeconomic status (SES) was related directly to DMFS in Israel, in contrast to an inverse relationship observed in most other western countries. First molars were most susceptible to caries attack and accounted for 41.2 percent of the total DMFS. Almost 50 percent of all affected surfaces were occlusal and 29.4 percent were proximal. Caries prevalence in general and proximal caries in particular were found to be much higher in the study population than corresponding figures in other industrialized countries. A significant decrease in caries prevalence could be expected in Israel in the next decade if primary preventive measures are implemented immediately.

Adolescent↗
PubMed1990

Assessing the economic status of the aged and nonaged using alternative income-wealth measures.

This exploratory article examines several aspects of the complex problem of combining data on income and wealth into a single measure of economic well-being. Examples of income-wealth measures that have been used are described. Estimates of the economic well-being of age groups in the current period are presented for several measures. To examine the sensitivity of the results to the choice of method, those estimates are compared. In this article, wealth is defined to include only financial assets. Data from the 1984 Survey of Income and Program Participation are used. The economic status of the aged relative to the nonaged improves when the measure of resources is changed from income to a combined income-wealth measure. The amount of improvement depends on the income-wealth measure used. When medians are examined, the differences among most of the measures compared are not very large. For every measure compared, the median rises as age increases, then falls. When the percentage of each age group that is in the bottom of the distribution is examined for several income-wealth measures, the differences among measures are small. In general, these percentages are relatively high for the young and old age groups, and relatively low for the middle age groups.

Adult↗
PubMed2005

Geographical variation of cerebrovascular disease in New York State: the correlation with income.

BACKGROUND: Income is known to be associated with cerebrovascular disease; however, little is known about the more detailed relationship between cerebrovascular disease and income. We examined the hypothesis that the geographical distribution of cerebrovascular disease in New York State may be predicted by a nonlinear model using income as a surrogate socioeconomic risk factor. RESULTS: We used spatial clustering methods to identify areas with high and low prevalence of cerebrovascular disease at the ZIP code level after smoothing rates and correcting for edge effects; geographic locations of high and low clusters of cerebrovascular disease in New York State were identified with and without income adjustment. To examine effects of income, we calculated the excess number of cases using a non-linear regression with cerebrovascular disease rates taken as the dependent variable and income and income squared taken as independent variables. The resulting regression equation was: excess rate = 32.075-1.22 x 10(-4)(income)+ 8.068x10(-10)(income2), and both income and income squared variables were significant at the 0.01 level. When income was included as a covariate in the non-linear regression, the number and size of clusters of high cerebrovascular disease prevalence decreased. Some 87 ZIP codes exceeded the critical value of the local statistic yielding a relative risk of 1.2. The majority of low cerebrovascular disease prevalence geographic clusters disappeared when the non-linear income effect was included. For linear regression, the excess rate of cerebrovascular disease falls with income; each 10,000 dollars increase in median income of each ZIP code resulted in an average reduction of 3.83 observed cases. The significant nonlinear effect indicates a lessening of this income effect with increasing income. CONCLUSION: Income is a non-linear predictor of excess cerebrovascular disease rates, with both low and high observed cerebrovascular disease rate areas associated with higher income. Income alone explains a significant amount of the geographical variance in cerebrovascular disease across New York State since both high and low clusters of cerebrovascular disease dissipate or disappear with income adjustment. Geographical modeling, including non-linear effects of income, may allow for better identification of other non-traditional risk factors.

Journal Article↗
PubMed2001

Synchronous oscillatory activity in immature cortical network is driven by GABAergic preplate neurons.

Neurons dissociated from embryonic cerebral rat cortex form a differentiated network of synaptic connections and develop synchronous oscillatory network activity with the beginning of the second week in culture. During an initial phase lasting 3-4 d, synchronous calcium transients can be blocked completely by either CNQX or bicuculline, showing that both glutamatergic and GABAergic neurons are required for the generation of this form of activity. By manipulating dissociation and growth conditions, cultures containing different populations of GABAergic neurons were obtained. These cultures revealed that a distinct population of large GABAergic neurons is a key element in the generation of synchronous oscillatory network activity. A minimal number of two large GABAergic neurons per square millimeter are required for the occurrence of synchronous activity. Changes in the density of all other types of GABAergic or non-GABAergic neurons has no influence on the synchronous activity. Electron microscopic analysis shows that the large GABAergic neurons form an interconnected network. Exceptionally high somatodendritic innervation and extended axonal arborization enable these neurons to collect electric network activity and to distribute it effectively throughout the neuronal network. Additional experiments indicated that most neurons developing in culture to large GABAergic neurons are derived from the primordial plexiform layer and reside in the subplate at the time of birth. We suggest that they function as an integrating element that synchronizes neuronal activity during early cortical development by collecting incoming extrinsic and intrinsic signals and distributing them effectively throughout the developing cortical plate.

Animals↗
PubMed2006

Breast feeding patterns in a military hospital.

OBJECTIVE: To determine the status of breast feeding, exclusive breast feeding and other feeding patterns in infants upto 12 months age. DESIGN: Cross- sectional study. PLACE AND DURATION OF STUDY: Paediatrics Department and Immunization Center, Combined Military Hospital, Multan, from October 2004 to March 2005. SUBJECTS AND METHODS: This study was based on "current status analysis method" to eliminate the bias of recall method used in most previous studies. Mothers of 650 infants from 0-12 months of age, attending immunization centre and paediatrics OPD, were interviewed about current feeding patterns and other socioeconomic variables. They were divided in three groups depending upon their monthly income. Living conditions matched with monthly income status in all groups. Month-wise distribution of feeding pattern was determined. Analysis was made about the effect of education of mothers, family income, place and mode of delivery, gender of the baby on exclusive breast feeding, duration of breast feeding and initiation of breast feeding. Statistical analysis of the results was made by application of Parson's Chi-square test. RESULTS: Breast feeding was maintained at high level (more than 88%) throughout infancy. Exclusive breast feeding was also maintained at quite high level (66%) till 4 month age. But later there was a sharp decline to 16% at six months of age. The median duration of exclusive breast feeding was 3 months. Mothers with lesser education and lower family income were more likely to exclusively breast feed (p < 0.001). The time interval between birth and first feed observed was quite desirable (less than 3 hours) in most cases. Only 14% infants received pre-lacteal feeds (ghutti, honey, water etc.), while majority of them (59%) received breast milk. Formula milk was first feed in only 25% cases. Breast milk as first and early feed was observed more in babies born by normal delivery in hospital (p < 0.001). CONCLUSION: Status of breast feeding, exclusive breast feeding and other feeding practices was quite encouraging and desirable in this study. The factors responsible for these results are comprehensive, free and readily available medical facilities including motivational and preventive services provided to women and children in military hospitals. However, there is still need to improve the figures to achieve internationally set goals.

Breast Feeding↗
PubMedDate not supplied

Occupation and the clinical characteristics of infertile couples.

BACKGROUND: The influence of social class on the composition of infertile groups and on their use of health care services could reflect how the latter meet the non-urgent needs for health care in populations. METHODS: Clinical, demographic, and occupational variables were collected prospectively from 2,198 couples newly registered in 11 infertility clinics. Time to diagnostic laparoscopy and time to treatment were evaluated with the use of proportional hazards analysis. RESULTS: 1) In the upper quartile of family income, the duration of infertility was six months less than for couples with the lowest incomes; 2) Tubal infertility was independently associated with lower family income; 3) Occupation and income were unrelated to the likelihood of either a complete diagnostic assessment or treatment for the infertility. CONCLUSIONS: Social class seems an important factor in the distribution of infertility diagnoses, although occupation and income were not associated with important clinical management decisions.

Adult↗
PubMed1992

AIDS prevalence by income group in Philadelphia.

We sought to track recent changes in AIDS incidence and prevalence in the city of Philadelphia (PA, U.S.A.) using morbidity and mortality data reported to the health department. We stratified the data by the mean per capita income in census tracts where people with AIDS resided. Estimates made without adjustment for the time lag between events and their entry into the database undercount both recent AIDS diagnoses and recent AIDS deaths. Therefore, we used a previously published method to adjust for the lag in reporting diagnoses and developed a method to adjust for the lag in reporting deaths. We calculated prevalent cases as the difference between cumulative cases and cumulative deaths. Between 1988 and 1990, annual AIDS incidence per 100,000 Philadelphia residents increased by 21% (from 25.9 to 31.4) and AIDS prevalence per 100,000 population increased by 62% (from 30.2 to 48.8). AIDS prevalence increased 113% (from 29.8 to 63.6) in low-income tracts, 88% (from 27.8 to 52.3) in middle-income tracts, and 14% (from 32.5 to 37.2) in high-income tracts. The 62% increase in AIDS prevalence and the shift toward people in poorer neighborhoods imply a need for public funding for AIDS care that is far larger than would be suggested by the general 21% increase in AIDS incidence over the same period.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Sexual abuse and sexual risk behaviors of minority women with sexually transmitted diseases.

The relationship between sexual abuse and sexually transmitted disease (STD) represents an important and underinvestigated context of domestic violence. This study examined the association between sexual abuse, sexual risk behaviors, and risk for reinfection and HIV among minority women with STD. Mexican American and African American women (n = 617) with active STD entered a randomized study of behavioral intervention to reduce STD recurrence. Each underwent questioning at entry regarding sexual abuse and sexual risk behaviors. Comparisons of these behaviors using chi-square, t tests, and logistic regression were made by history of sexual abuse. Sexually abused women were more likely to have lower incomes, earlier coitus, STD history, currently abusive partners, new sex partners, anal sex, and bleeding with sex, placing them at increased risk for STD reinfection and HIV. Due to this association with sexual risk behavior, assessment for sexual abuse is essential in programs focusing on STD/HIV prevention.

Adult↗
PubMed1995

Physicians' opinions and use of controversial technologies. The case of mammographic screening in Norway.

In a survey of 196 Norwegian radiologists and 37 breast imaging centers, physicians' preferences were found to be likely to influence the use of mammography. In their decision making, the radiologists appear to be influenced by income motives and by perceptions of the risk of misdiagnosing breast cancer. Despite opinions favorable to mammographic screening, most radiologists would prefer a CT scanner or a magnetic resonance imaging unit to a mammographic unit if the x-ray department were in a position to acquire capital equipment.

Adult↗
PubMed1995

Malnutrition and poverty in the early stages of famine: North Darfur, 1988-90.

In this article we report findings on the relationship between malnutrition and poverty during a period of acute food insecurity in Darfur, Sudan. Children of rich and poor families were equally likely to be malnourished, which is explained in terms of people's responses to the threat of famine. This finding has important implications for targeting interventions in the early stages of famine. Appropriate interventions at the early stages of famine are livelihood and income support to the most vulnerable. The entitlement theory of famine causation assumes that the poor are most vulnerable, and become malnourished and die during famines. In this article we show that this assumption does not hold. Even though poverty is the root cause of malnutrition, it does not follow that anthropometric status can be used to target individual poor families, or even that targeting the poor is appropriate in famine situations.

Chi-Square Distribution↗
PubMed1985

Psychiatric symptomatology among Mexican American farmworkers.

The paper presents findings from an epidemiologic field survey of 500 Mexican American farmworkers conducted in central California. The survey was intended as a health needs assessment of this population and the Health Opinion Survey was used to establish normative psychiatric symptom distributions. Analyses of the data by gender, age and income revealed that these socio-demographic variables were not important predictors of symptom levels, although the highest mean scores were reported in the 40-59 age group. Income levels were modest and fairly uniform, which contributed to the lack of mean score variation. Symptom distributions were analyzed for the variables age and sex using the HOS criteria of caseness and it was found that approx. 20% of the sample reached the criteria of caseness. A comparison of HOS mean scores with a national sample of surveys indicated that Mexican American farmworkers had symptom levels which resemble those of other low income socio-economic groups, such as southern blacks. Another analysis was conducted which reported a striking correspondence between self perception of health with psychiatric symptoms. A conclusion reached from the survey is that the Mexican American farmworkers in this sample appear to be experiencing psychiatric symptom levels which place them at extraordinary risk. Stresses associated with this group, i.e., limited social mobility, transience, poverty, discrimination and a high rate of traumatic life events were identified as possible contributors to this risk proneness.

Acculturation↗
PubMed2003

Income inequality and mortality: time series evidence from Canada.

In this paper, we apply the standard model used in the income strand of the socio-economic status (SES)-population health literature to explain the relationship between mortality and income to pooled cross-section time-series data for Canada. The use of time-series data increases the available degrees of freedom and allows for the possibility that the effects of inequality take time to translate into poorer health outcomes. In light of recent criticisms of aggregate level studies, we do not attempt to differentiate between the absolute and relative inequality hypotheses, but test for the existence of a relationship between mortality and a measure of income inequality. We find that whether an exogenous trend is incorporated or an auto-regressive distributed lag form is used, the coefficients on mean income and the Gini are not significantly different from zero, which contradicts the findings in other parts of the literature, but which is consistent with earlier cross-section evidence for Canada. The results suggest that models that focus exclusively on income as a measure of the impact of SES on mortality are not complete and that health spending and unemployment may be even more important than income growth and dispersion.

Age Factors↗
PubMed2002

Representing inequities in the distribution of socio-economic benefits and environmental risk.

There is currently no standard method for analyzing claims of environmental inequity. Neither is there a database of statistics on the extent of relationship between regional indicators of environmental quality, likely sources of pollution, and the demographic characteristics of affected populations. The resolution of environmental disputes is often hampered by inadequate communication between stakeholder groups about their perceptions and prioritization of the issues in dispute and by differential access to information about the issues by each stakeholder group. This paper describes a web-based tool, ICEP, that uses multi-layered GIS maps to establish a standard method for analyzing claims of environmental inequity and establish a database of correlation coefficients between environmental indicators, industry type by SIC code, and demographic characteristics of the population in proximity to noxious facilities. The maps are generated from stakeholder reports of environmental quality and are designed to be accessible via the Internet. This provides stakeholders with direct access to graphical displays of the perceptions of their co-stakeholders and provides all groups with links to relevant information sources about the issues in dispute. ICEP enhances existing community environmental websites like Scorecard and Envirofacts by providing displays of median household income as a measure of the distribution of benefits accrued within an area.

Databases, Factual↗