Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Income Distribution”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 667 records · Page 37Linked to original sources
PubMed2005

A look at the (near) future based on the (recent) past - how our patients have changed and how they will change.

Remedies for dental diseases have been in use for as long as 4,000 years, and various materials and methods have been used over the millennia. Dentistry continues to change in response to changes in the age distribution, origins, financial means and health of the population, as well as to changes within the profession itself. The Canadian population is very unevenly distributed geographically and ethnically. Furthermore, it is aging rapidly and life expectancy is increasing. Although the average income of Canadians has increased, the increase was unevenly distributed, and the gap between rich and poor continues to expand. There has been a steady rise in the number of Canadians with dental insurance, although the proportion of the population with insurance varies from one province to another. Not surprisingly, people with dental insurance compared to those without are more frequent users of dental services. The rate of caries attack has diminished in industrialized countries, but people are keeping their teeth longer, so caries will remain a significant public health problem, particularly among elderly people. In addition, smoking tobacco is strongly associated with periodontal disease; thus, there should be more action within the dental community in support of smoking cessation programs. The composition of the dental care community is also changing. The ratios of dentists and dental hygienists to the population have increased, the services offered by dental technicians have expanded greatly, and the services offered by denturists have also increased as these services gain more widespread acceptance. Use of dental services in Canada remains reasonably broad; however, denture-wearers continue to regard uncomfortable dentures as a normal part of aging. The pattern of uneven distribution of disease and access to service remains the major challenge facing the dental profession.

Aged↗
PubMed2000

Welfare benefits' screening and referral: a new direction for community nurses?

The White Paper, Towards a Healthier Scotland considerably widens the community nursing scope for health promotion, as it recognises that disadvantaged life circumstances as well as unhealthy lifestyles contribute to poor health. It has been shown that income and health are interrelated. This evidence has demonstrated that it is not how rich a nation is that determines the overall health of its inhabitants; it is how equitably its wealth is distributed that counts: countries that have narrow income differentials tend to have better health. Both the income and health divide in Britain widened considerably between 1980 and 1992. It is argued that increasing income inequality leads to social isolation and chronic stress, which can impact on psycho-social pathways and damages life expectancy. This paper suggests that community nurses can address adverse life circumstances by finding ways of improving the economic status of their most vulnerable clients, and that one way of doing this would be to ensure that clients claim their full quota of welfare entitlement, given that there is several billion pounds of social security benefits that remain unclaimed in Britain every year.

Journal Article↗
PubMed2000

Mental health and nutritional status among the adult Serbian minority in Kosovo.

CONTEXT: Since the beginning of the North Atlantic Treaty Organization intervention in Kosovo in June 1999, few objective data have been available on relevant health indicators for the Serbian ethnic minority in Kosovo. OBJECTIVE: To determine the prevalence of undernutrition among Serbian adults aged 60 years or older and psychiatric morbidity among the adult Serbian population in Kosovo. DESIGN, SETTING, AND PARTICIPANTS: A systematic random sample survey of 212 households was conducted between September 27 and October 2, 1999, in Pristina, the capital city, and in 10 towns in the rural municipality of Gnjilane in Kosovo. Of the 212 households surveyed, 204 adults aged 15 years or older completed the General Health Questionnaire-28 (GHQ-28) and anthropometric measurements were taken for 98 adults aged 60 years or older and for a comparison group of 51 adults aged 18 to 59 years. MAIN OUTCOME MEASURES: Body mass index of less than 18.5 kg/m(2) in older adults; nonspecific psychiatric morbidity among adults; and self-reported use of health care services, access to food rations, and primary sources of prewar and postwar income. RESULTS: Undernutrition was found in 11.2% (95% confidence interval [CI], 5.7%-19.2%) of Serbian adults aged 60 years or older compared with 2.0% (95% CI, 0.1%-11.8%) of Serbian adults aged 18 to 59 years. The mean (SE) total score for the GHQ-28 was 13.0 (0.52). In a comparison of the GHQ-28 scores of the Serbian adults with the Kosovar Albanian adults (data from a recent survey), the mean (SE) score adjusted for age and sex was 12.8 (0.52) vs 11.1 (0.58); P =.03, respectively. The GHQ-28 scores were also higher for the Serbians in the subcategories of social dysfunction (2.8 [0.17] vs 2.2 [0.13]; P =.008) and severe depression (1.9 [0.15] vs 0.9 [0. 09]; P<.001), respectively. Serbian women and persons living alone or in small family units were more prone to psychiatric morbidity. Of the 141 respondents reporting the need for health care services, 83 (57.6%) reported not obtaining such services; 204 of 212 (96.2%) households were on a food distribution list. The majority of prewar income came from government jobs compared with farming and humanitarian aid for postwar income. CONCLUSIONS: The undernutrition of older Serbian adults in Kosovo should be monitored. The high prevalence of symptoms of social dysfunction and severe depression suggest the need for implementation of mental health programs in the Serbian community. JAMA. 2000;284:578-584

Adolescent↗
PubMed2006

Facilitating cleft palate team participation of culturally diverse families in South Africa.

OBJECTIVE: The Facial Cleft Deformities Clinic, University of Pretoria, Pretoria, South Africa, provides interdisciplinary team services to patients with cleft lip and palate and craniofacial anomalies. They represent the "rainbow nation" of South Africa and reflect the multicultural and multilingual nature of the population, which poses a challenge to effective and accountable service delivery. The aim of this study was to explore some cultural variations that exist in black families that influence their participation in the team approach and to describe the assets of families that may be used to empower them and to enhance service delivery. DESIGN: A descriptive survey research design. A questionnaire-by-interview procedure was utilized during routine visits of 35 black families to the Facial Cleft Deformities Clinic. RESULTS: The results are discussed from an ethnographic perspective of the family and describe the knowledge base of the participants, the diagnosis and treatment of the children's cleft lip and palate, family structure and support systems, family income and education, and the geographical distribution of the participants. Implications for building family partnerships and for improving professionals' cultural competence in order to improve the quality of service delivery are presented. CONCLUSIONS: By viewing cultural differences on a continuum, following the asset-based approach, applying knowledge based on contextually relevant research, and recognizing family uniqueness, families may be empowered to participate fully in the team approach to support their children with cleft lip and palate and craniofacial anomalies in attaining their full potential in the South African context.

Adolescent↗
PubMed2005

Achievements and challenges of medicare in Canada: Are we there yet? Are we on course?

Health care policy in Canada is based on providing public funding for medically necessary physician and hospital-based services free at the point of delivery ("first-dollar public funding"). Studies consistently show that the introduction of public funding to support the provision of health care services free at the point of delivery is associated with increases in the proportionate share of services used by the poor and in population distributions of services that are independent of income. Claims about the success of Canada's health care policy tend to be based on these findings, without reference to medical necessity. This article adopts a needs-based perspective to reviewing the distribution of health care services. Despite the removal of user prices, significant barriers remain to services being distributed in accordance with need-the objective of needs-based access to services remains elusive. The increased fiscal pressures imposed on health care in the 1990s, together with the failure of health care policy to encompass the changing nature of health care delivery, seem to represent further departures from policy objectives. In addition, there is evidence of increasing public dissatisfaction with the performance of the system. A return to modest increases in public funding in the new millennium has not been sufficient to arrest these trends. Widespread support for first-dollar public funding needs to be accompanied by greater attention to the scope of the legislation and the adoption of a needs-based focus among health care policymakers.

Canada↗
PubMed1997

Geographic distribution of pediatricians in the United States: an analysis of the fifty states and Washington, DC.

OBJECTIVES: To determine current geographic distribution of pediatricians in the United States, to assess the changes in the geographic distribution of pediatricians between 1982 and 1992, and to identify factors associated with the distribution of pediatricians among the 50 states. METHODS: A data set was constructed using several published data sources including the American Medical Association Physician Masterfile as the principal source for physician information. The pediatrician-to-child population ratio (PCPR, the number of pediatricians per 100 000 people under 18 years of age) was calculated to compare the distribution of pediatricians among states and the distributional changes between 1982 and 1992. Lorenz curves and Gini indices were used to describe distributions and to compare distributions across time periods. Linear regression analysis was performed to assess the relationship between PCPR (dependent variable) with 9 predictor variables. RESULTS: Between 1982 and 1992, there was a 5.4% increase in the United States (US) child population and a 46.1% increase in the number of pediatricians in patient care. During that time period, the PCPR increased by 38.6% from 35.1 per 100 000 to 48.6 per 100 000. There was a more than 4-fold difference in the PCPRs of the highest state (Maryland, 84.3) and the lowest state (Idaho, 18.5) in 1992. The PCPR increased in all 50 states, but varied from a 4.1% increase in Wyoming to a 63.4% increase in Massachusetts. The Lorenz curve showed that pediatricians were less evenly distributed than all physicians, but more evenly distributed than pediatric cardiologists. Between 1982 to 1992 the Gini index decreased 9.8% for all physicians and 10.2% for pediatric cardiologists, but only 1. 9% for pediatricians. Since a decrease in the Gini index signifies better overall distribution, these changes are relatively modest for pediatricians as a whole, especially when compared to other physicians. Regression analysis showed that a higher PCPR was associated with a greater number of residency positions per 100 000 children and with the per capita income of the state (R = .93). CONCLUSIONS: The distribution of pediatricians does not parallel the distribution of the child population in the US, nor has this distribution changed substantially in spite of a 38.6% increase in the PCPR. Pediatricians tend to concentrate in states with high per capita income and in states with a larger number of residency training positions. The failure of market forces to improve the geographic distribution may require manpower policy changes designed to improve distribution in underrepresented states. The uncertain impact of market changes due to increased use of managed care could affect distributional requirements of pediatricians in the future.

Cardiology↗
PubMed1997

Spinal cord injuries in Arkansas due to violence: 1980-1989.

In some areas of the US the incidence of violence-related spinal cord injuries (SCIs) is double or triple that of 10 years ago. The purpose of this study was to determine if this trend is evident in Arkansas, a small rural state. For the study period 15.3% of traumatic SCIs identified in Arkansas were violence-related. The overall incidence rate of traumatic SCIs in Arkansas declined from 41.11 per million in 1980 to 33.18 per million in 1989. However, the rate of violence-related SCIs rose from 3.5 per million in 1980 to 5.14 in 1989. The incidence of violence-related SCIs in Arkansas did not increase dramatically during the 1980s. However, the incidence of women with violence-related SCIs nearly tripled. With the dramatic rise in violence-related SCIs in women and the decrease in violence-related SCIs in men, the gender gap has been virtually eliminated in violence-related SCIs.

Adolescent↗
PubMed1983

Gastrointestinal cancer mortality in New Jersey counties, and the relationship with environmental variables.

The State of New Jersey (NJ) USA has been thought to have an unusually high cancer mortality rate; this assumption has been based on 1950-1969 mortality data for its 21 counties. This paper presents an analysis of gastrointestinal (GI) cancer mortality rates in New Jersey counties during 1968-1977, a comparison with the 1950-1969 rates, and associations between current GI cancer mortality rates and selected environmental variables. Age-adjusted mortality rates for GI cancers were calculated for the 21 NJ counties during the period 1968-1977, and were compared with the period 1950-1969, with the Surveillance, Epidemiology and End Results (SEER) survey and with cancer mortality in the US, 1973-1977. The county rates were also correlated with: the distribution of chemical toxic waste disposal sites; annual per capita income; the rates of low birth weight, birth defects, and infant mortality; chemical industry distribution; percentage of the population employed in chemical industries; the density of population; and the urbanization index for each of the counties. Some of the major findings are: Age-adjusted GI cancer mortality rates (all sites combined) were higher than national rates in 20 of 21 NJ counties. In comparison with national trends, NJ stomach cancer rates have declined less, oesophageal cancer rates have declined more, and pancreatic cancer mortality rates have followed similar patterns. Cancer mortality rates in NJ during the period 1968-1977 significantly (p less than 0.0001) exceeded national rates for cancer of the oesophagus (white male, non-white male), stomach (men and women), colon (white male, white female, non-white female), and rectum (whites only). In 18 of the 21 NJ counties, the observed number of cancer deaths for at least one GI cancer site was significantly greater than expected at the 0.0001 level for at least one population subgroup. Among white men, a significant (p less than 0.0001) excess of observed over expected cancer deaths was observed for three or more GI cancer sites in seven counties. The environmental variables that were most frequently associated with GI cancer mortality rates (except pancreatic cancer) were degree of urbanization, population density, and chemical toxic waste disposal sites. Some of the implications of the study findings are discussed and recommendations made for future investigations.

Adult↗
PubMed1976

Analysis of the geographical distribution of anesthesia manpower in the United States.

The 1970 geographical distributions of total anesthesia manpower, anesthesiologists, and nurse anesthetists by state were analyzed by multiple regression to account for their unevenness. Independent variables included factors relating to prior professional contact in the state, professional satisfaction, practice income, demand for services, and environment. The distribution of training programs accounted for 41 per cent of the variance in the distribution of total manpower, but 55 per cent was explained by the number of operations, location of nurse anesthesia schools, and proportion of total state employment in service occupations (a proxy for the availability of consumer services). Location of training programs and the absence of the other type of personnel were good predictors for the manpower subgroups. The distribution of nurse anesthesia schools, anesthesiologists, number of surgical operations, and the relative value schedule conversion factor together accounted for 60 per cent of the variance in the nurses' distribution. The location of residency programs (or positions) was a better predictor for the anesthesiologists' location than medical schools or factors characterizing the demand for services. The distribution of nurse anesthetists, hospital cost per day (considered a proxy for a satisfying professional life and for regionalization of services), and residency programs explained 81 per cent of the variance in the anesthesiologists' distribution. Although the regression predicts that increasing the number of residency programs in an underserved state should be associated with an increase the number of anesthesiologists, such a policy may be infeasible dur to pending federal health manpower legislation unless matched by decreasing a greater number of programs in relatively oversupplied states.

Anesthesiology↗
PubMed1995

Occupation and the risk of malignant melanoma.

BACKGROUND: The incidence of malignant melanoma is increasing rapidly. The risk for development of malignant melanoma has been reported to be higher in persons of higher socioeconomic status. METHODS: This case-control study explores the relation between occupation and malignant melanoma relative risk through analysis of data collected by the American Cancer Society. A total of 1.2 million people were enrolled in a study of lifestyles and environmental factors in relation to mortality from cancer and other diseases. A total of 2780 persons had a history of malignant melanoma when the study began or developed malignant melanoma during the 6-year study follow-up period. The controls were matched for age, sex, race, and geographic location on an approximately 1:3 basis to persons selected from the remaining people enrolled. RESULTS: In men, malignant melanoma risk was significantly higher in high-paying versus low-paying occupations (odds ratio [OR], = 1.58; P < 0.001) and in white-collar versus blue-collar occupations (OR = 1.33; P < 0.001). No significant conclusions could be drawn for women. No significant difference in risk was noted between those with indoor versus outdoor occupations. Among specific occupational exposures, only exposure to X-rays significantly raised malignant melanoma risk (OR = 1.37; P = 0.002). CONCLUSION: Upper pay scale and white-collar occupations significantly increase the risk for development of malignant melanoma.

Case-Control Studies↗
PubMed1992

The Canadian health care system: a model for American to emulate?

The American health care system has the world's highest per capita costs and over 30 million citizens uninsured. The neighbouring Canadian system provides coverage for all basic medical and hospital services, at costs per capita that are about US$700 lower. Single-agency public funding allows tighter control of Canadian expenditures, and reduces administrative overheads. Hospitals are run as non-profit private corporations, funded primarily by a fixed annual allocation for operating costs. Most physicians are in private fee-for-service practice, but cannot charge more than the insured tariff negotiated between their provincial government and medical association. This approach, while attractive in its decentralization, tends to separate the funding and management of clinical services. Thus, hospital information systems lag a decade behind the USA, managed care initiatives are few, health maintenance organisations do not exist, and experimentation with alternative funding or delivery systems has been sporadic. Strengths of the system compared to the USA include: higher patient satisfaction, universal coverage, slightly better cost containment, higher hospital occupancy rates, and reduction in income-related rationing with more equitable distribution of services. Weaknesses in common with the United States are: cost escalation consistently outstripping the consumer price index with costs per capita second highest in the world, ever rising consumption of services per capita, inadequate manpower planning and physician maldistribution, poor regional co-ordination of services, inadequate quality assurance and provider frustration. Additional weaknesses include: an emerging funding crisis caused by the massive federal deficit, less innovation in management and delivery of care as compared to the USA, implicit rationing with long waiting lists for some services, and recurrent provider-government conflicts that have reduced goodwill among stakeholders. Thus, while the Canadian model has important advantages, it does not offer a panacea for American health care woes.

Canada↗
PubMed2001

[Neurocysticercosis: an imported disease?].

BACKGROUND: Neurocysticercosis is the CNS involvement caused by Taenia solium larvae and the most frequent cerebral parasitation. It has a cosmopolitan distribution but endemic in the low income countries. The paper analizes the geographic origin, clinical characteristics of patients and the diagnostic and therapeutic modalities. PATIENTS AND METHOD: Retrospective revision of clinical files in patients with the diagnosis of neurocysticercosis between the period January 1990 to March 2000. RESULTS: Ten patients were included of which only one was of Spanish nationality. The others were immigrants or travellers to Central/South America (7), Africa (1) and South East Asia (1). Nine patients presented with convulsive crisis, generalized in 7 and 3 cases suffered headaches. The diagnosis was obtained through biopsy technique (3 cases) and the rest through CT scan or MR and serology. ELISA specific serology was positive in 60% of cases. Eight patients were treated with praziquantel or albendazol solely with good clinical evolution. CONCLUSIONS: Neurocysticercosis is prevalent among the immigrant population and in our case imported mostly from Latin America. Diagnosis is reached through imaging and serological techniques. Treatment with praziquantel or albendazol improves the clinical picture and controls the convulsive crisis.

Emigration and Immigration↗
PubMedDate not supplied

Hyperinsulinemia and abdominal obesity are more prevalent in non-diabetic subjects with family history of type 2 diabetes.

BACKGROUND: This study was undertaken in order to identify the relationships between family history of type 2 diabetes and cardiovascular risk factors in non-diabetic Mexican individuals. METHODS: The design was a cross-sectional, population-based study stratified by age and sex. Participants consisted of 189 non-diabetic volunteers 30-64 years of age, both males and non-pregnant females randomly selected from a middle income neighborhood in Durango, Mexico and distributed into two groups, with and without family history of type 2 diabetes mellitus. Hypertensive subjects were excluded. Body mass index (BMI) and waist-to-hip ratio (WHR) were assessed. Hematocrit, both fasting and 2-h post 75-g glucose load insulin, and glucose levels, lipid profile, serum albumin, and proteinuria were measured. RESULTS: Ninety-four (49.7%) individuals with family history of type 2 diabetes, and 95 (50.3%) in the control group were included. The prevalence of obesity was greater among women with family history of diabetes, 39 (73.6%) vs. 27 (50.0%) of the control group, p = 0.02. Adiposity tended to be centrally distributed in 86 subjects, of whom 22 (25. 6%) males and 54 (62.8%) females were in the group with family history of diabetes and four (4.6%) males and six (7.0%) females in the control group, p <0.000. Multivariate logistic regression analysis showed a strong relationship between family history of type 2 diabetes with both abdominal obesity (odds ratio [OR] 4.2, CI 95% 1.9-10.1, p <0.05) and fasting hyperinsulinemia (OR 3.1, CI 95% 1. 4-11.2, p <0.05). CONCLUSION: In the absence of additional risk factors such as diabetes and hypertension, there is a strong relationship between family history of diabetes with hyperinsulinemia and abdominal obesity in middle-aged Mexican individuals.

Adult↗
PubMed1997

Patterns of intra-familiar distribution of undernutrition: methods and applications for developing societies.

OBJECTIVE: To propose a method to assess patterns of intra-familiar distribution of undernutrition and apply it to different socioeconomic strata of the Brazilian population. DESIGN: A large nationally representative cross-sectional anthropometric survey undertaken in 1989 is the primary source of information. Undernutrition was defined as body mass index (adults) and weight-for-age (children) below the 5th percentile of a healthy and non-malnourished reference population. Log-linear models were used to assess patterns of intra-familiar distribution of nutritional status in four income strata. SUBJECTS: Two thousand, one hundred and seventy-four families composed by at least one child 6-36 month-old and his/her father and mother. SETTING: All regions in Brazil. RESULTS: Undernutrition was significantly associated among household members only for the 25% poorest families (P < 0.0001). In this group, the presence of undernutrition in the mother or the father increased 1.6-1.9 times the risk of undernutrition in the child and the presence of undernutrition in the father made it 2.7 times more frequent in the mother. The relatively small prevalence ratios suggest that even in extremely poor families only a small proportion of undernutrition could be attributed to common household determinants. CONCLUSION: Our results are consistent with the hypothesis that in transitional societies undernutrition would appear as a global family problem only for those at the earlier stages of the nutrition transition. Policies and strategies to overcome undernutrition should take this fact into account.

Adolescent↗
PubMed1996

Selection of key community descriptors for community-orientated primary care.

BACKGROUND: Community-oriented primary care (COPC) requires the development of practical tools if it is to be carried out. A previous study demonstrated a practical approach to carrying out one portion of a community assessment for COPC using a few representative health indicators. OBJECTIVE: To determine the validity of this process elsewhere, we tested whether these findings were generalizable to other settings and to the same setting a decade later. METHOD: In a cross-sectional study design, data on 18 health indicators were collected for census tracts in two target areas and for the entire state of Ohio, USA, for 1990. A factor analysis was performed to identify factors underlying the health indicators in the three areas examined. RESULTS: Two underlying factors, termed age and poverty, were present in all locations and over time. Each factor was defined by core indicators and a cluster of associated indicators. CONCLUSIONS: These results suggest that one part of a COPC community assessment can be done by selecting very few indicators. The distribution of indicators of age and income explains the variability of most of the health related indicators studied. These factors are stable over time and location. A community assessment should include indicators which, at a minimum, provide information on these two factors.

Adolescent↗