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PubMed2005

Do social and economic reforms change socioeconomic inequalities in child mortality? A case study: New Zealand 1981-1999.

BACKGROUND: Socioeconomic inequalities in child mortality are known to exist; however the trends in these inequalities have not been well examined. This study examines the trends in child mortality inequality between 1981 and 1999 against the background of the rapid and dramatic social and economic restructuring in New Zealand during this time period. METHODS: Record linkage studies of census and mortality records of all New Zealand children aged 0-14 years on census night 1981, 1986, 1991, 1996, each followed up for three years for mortality between ages 1-14 years. Socioeconomic position was measured using maternal education, household income, and highest occupational class in the household. Standardised mortality rates, rate ratios, and rates differences as well as regression based measures of inequality were calculated. RESULTS: Mortality in all socioeconomic groups fell between 1981 and 1999. Socioeconomic inequality in child mortality existed by all measures of socioeconomic position, however only trends by income suggested a change over time: the relative index of inequality increased from 1.5 in 1981-84 to 1.8 in 1996-99 (p trend 0.06), but absolute inequality remained stable (slope index of inequality 15/100 000 in 1981-84 and 14/100 000 in 1996-99. CONCLUSIONS: Dramatic changes in income in New Zealand possibly translated into increasing relative inequality in child mortality by income, but not by education or occupational class. The a priori hypothesis that socioeconomic inequalities in child mortality would have increased in New Zealand during a period of rapid structural reform and widening income inequalities was only partly supported.

Adolescent↗
PubMed2000

Targeting lead screening: The Ohio Lead Risk Score.

OBJECTIVE: Annual blood lead (BPb) screening is recommended for children </=2 years of age residing in high-risk areas. Strategies for identifying these areas exist but lack specificity. We sought to develop an efficient method for identifying risk factors for undue lead exposure in children by using community variables. DESIGN: Logistic regression for model development in one half of the sample followed by validation of the model in the remaining half. METHODS: The association between selected census tract characteristics from 19 Ohio counties and the BPb test results of children living in those census tracts was evaluated. The dependent variable, high-risk status, was defined as a census tract with >/=12% of BPb test results >/=10 microg/dL. RESULTS: Data from 897 census tracts were available. Higher risk for lead toxicity existed in areas where: 1) >/=55% of houses were built before 1950 (adjusted odds ratio [AOR]: 10.9 [6.1,19.6]); 2) >/=35% of residents were black (AOR: 3.5 [2.0,6. 3]); 3) >/=35% of residents had less than a high school education (AOR: 6.1 [3.6,10.4]); and 4) >/=50% of housing units were renter-occupied (AOR: 3.6 [2.1,6.2]). Receiver operator characteristic (ROC) curves demonstrated no significant differences after applying the model in a second dataset. CONCLUSIONS: Several community characteristics predict risk for lead toxicity in children and may provide a useful approach to focus lead screening, especially in communities where public health resources are limited. The approach described here may also prove helpful in identifying factors within a community associated with other environmental public health hazards for children.

Child↗
PubMed1996

Decreasing disability in the 21st century: the future effects of controlling six fatal and nonfatal conditions.

OBJECTIVES: This study assessed the effects of reducing fatal and nonfatal health conditions on the number of functionally limited older Americans in the coming decades. METHODS: Data from the 1990 census and the Longitudinal Study of Aging were used to project the number of functionally limited older Americans from 2001 to 2049, assuming 1% biennial reductions in five conditions that shorten life expectancy (coronary artery disease, stroke, cancer, diabetes, and confusion) and one condition that decreases functional ability (arthritis). RESULTS: Decreasing the prevalence of arthritis by 1% every 2 years would lead to a much greater reduction in functional limitation between 2001 and 2049 (4 million person-years) than would decreasing any of the other conditions by the same amount. Decreases in two fatal conditions (cancer and coronary artery disease) would lead to increases in functional limitation (0.9 and 0.1 million person-years, respectively). CONCLUSIONS: Advances against common nonfatal disabling conditions would be more effective than advances against fatal conditions in blunting the large increase in the functionally limited older population anticipated in the 21st century.

Aged↗
PubMed1993

Prevalence of otitis media and allied diseases in Korea--results of a nation-wide survey, 1991.

A nation-wide survey was conducted to estimate the prevalence of otitis media and allied diseases through physical examination by otolaryngologic doctors from July to October, 1991. A sample study population was selected from a panel to be representative of the Korean population by multistage clustered and stratified random sampling method based on the National Census Data, 1990. Total number of subjects undertaken were 9,321, Which were drawn from 2,899 households residing in 60 different areas throughout the country. The overall prevalence of otitis media was 2.85% (3.10% of males and 2.61% of females). Prevalence of each subtype was as follows; acute otitis media, 0.02%; middle ear effusion, 0.60%; chronic otitis media, 2.19%, respectively. The prevalence of otitis media did not vary by sex, nor by urban-rural difference. There was an increasing tendency of the prevalence of otitis media by age. However, the prevalence of both middle ear effusion and acute otitis media showed a decreasing pattern by age. Particularly noteworthy was a significant geographic variation in the prevalence of otitis media by provinces. The prevalence rate of septal deviation was 21.93% and the presence of septal deviation was significantly related to that of otitis media (p < 0.05). The prevalence rates of nasal allergic symptoms, nasal polyposis and evident cleft palate were 1.14%, 1.00% and 0.07%, respectively. The presence of otitis media was significantly correlated with both nasal allergic symptoms (P < 0.1) and evident cleft palate (P < 0.05), but not with that of nasal polyposis.

Adolescent↗
PubMedDate not supplied

Disparity of physicians' utilization of tobacco treatment services.

OBJECTIVES: To evaluate the familiarity with and utilization of tobacco treatment resources among physicians. METHODS: The NJ State Physician Census was mailed to 30,639 physicians with 8150 responding (26.6%). Data from 4598 direct patient-care physicians were analyzed. RESULTS: Pulmonologists, cardiologists, and family physicians had the highest levels of familiarity and referral, whereas psychiatrists, neurologists, ophthalmologists, and surgeons had the lowest. Physicians who were younger, female, who had more teaching hours, and who accepted fewer new patients all had higher familiarity. CONCLUSIONS: Familiarity with tobacco dependence treatment resources varies by physician characteristics. Increasing physicians' utilization of these resources is an important research priority.

Female↗
PubMed2001

Epidemiological investigation of school-related injuries in Koprivnica County, Croatia.

AIM: To assess the prevalence of injuries in elementary schools and determine specific risk groups of school-age children. METHODS: According to the 1991 census, there were 6,398 children between 7 and 14 years of age in the study area of the former Koprivnica district. During the 1992-1997 period, 354 children were injured in school. The registration of injured children was performed via structured questionnaires filled out at the emergency clinic and outpatient surgical clinic of the General Hospital in Koprivnica. The mechanism of accident and activities preceding it were categorized according to the Nordic Medico-Statistical Committee classification. Chi-square test was used to determine groups of school children at specific risk and a classification tree was made on the basis of minimum entropy values for age, sex, activity, and mechanism of injury. RESULTS: The highest injury rate of was recorded in 12-year-olds (21.7%). Upper extremities were most common site of injury (52.8%), whereas the most common type of injury was contusion (45.2%). The rate of head injuries was 3.2 times higher in younger (aged 7-10) children, whereas the rate of sports injuries was 3.5-fold higher in older (aged 11-14) children (p=0.001). Entropy classification revealed younger school-age children to be at the highest risk of contusion due to a blow from a ball, an object, or contact during sports activities. CONCLUSION: In Koprivnica County, most school-related injuries occurred during sport activities (42%) and play during recess (55%), with specific differences in age and sex.

Adolescent↗
PubMed2004

Social and personal consequences of disability in adults with hip and knee arthroplasty. A French national community based survey.

OBJECTIVE: To describe and compare participation restrictions and environmental factors of persons with and without hip or knee arthroplasty in a national community based survey: the Handicap, Disability, Dependence Survey. METHODS: During the 1999 French Census, a screening questionnaire was proposed to 417,500 persons, for which the response rate was 86%. A stratified random sample with an overrepresentation of disabled persons was performed to constitute the selected population. A computer assisted interview was proposed to 21,760 persons, with a 78% response rate. Chronic conditions, impairment, disability, participation restrictions, and the description of environmental factors were ascertained from the subjects' reports. RESULTS: The hip and knee arthroplasty group was estimated at 691,000 persons in the French population. Although reporting a higher level of disability, this population did not report more participation restrictions than the general population in terms of their economic situation, housing, social relationships, and holidays. Moreover, when comparing environmental factors, this population reported better housing accessibility, more assistive devices (OR 5.2, 95% CI 3.7-7.2), specific fittings (OR 2.9, 95% CI 2.0-4.2), and helpers (OR 1.8, 95% CI 1.3-2.5). These environmental factors may have compensated for the higher level of disability. Nevertheless, individuals with hip and knee arthroplasty reported more disadvantages when moving within their environment (OR 2.1, 95% CI 1.5-2.9). CONCLUSION: This study provides a detailed description based on a national random sample of participation restrictions and environmental factors of adults with hip and knee arthroplasty.

Activities of Daily Living↗
PubMed2004

Regional variation in dental procedures among people with an intellectual disability, Ontario, 1995-2001.

BACKGROUND: The literature indicates that people with an intellectual disability have a prevalence of dental caries that is either lower than or similar to that of the general population. However, many of their caries go untreated, and extractions are more often used as a means of treatment than in the general population. A substantial percentage (40%) of day admissions to hospital of people with intellectual disabilities in Ontario is related to dental diseases. In this paper, we examine whether rates of in-hospital dental procedures are evenly distributed across Ontario and discuss possible explanations for the findings. MATERIALS AND METHOD: A retrospective analysis was made of routinely collected hospital admission data for people with an intellectual disability. Age- and gender-adjusted rates for dental procedures were calculated using the direct method of adjustment and 1996 census population estimates of Ontario. Three different summary measures for the assessment of regional variation were used. RESULTS: Two areas had dental procedure rates among those with an intellectual disability that were significantly lower than the overall Ontario rate: Hamilton-Wentworth and Quinte-Kingston and Rideau. The 3 district health council areas with the highest rates for dental procedures were Niagara, Essex-Kent and Lambton, and Durham-Haliburton-Kawartha and Pine Ridge; all 3 rates were higher than the overall Ontario rate. CONCLUSIONS: The use of day surgery and in-hospital visits to treat dental diseases in people with an intellectual disability varies considerably by region in Ontario. Observed differences may indicate inequities.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

[Adenocarcinoma of the gallbladder as a histopathological finding after cholecystectomy].

OBJECTIVE: We wanted to determine the incidence in our population of gallbladder adenocarcinoma based on a histopathologic study done after cholecystectomy in patients with a diagnosis of gallstones. MATERIAL AND METHODS: We made a census-type study during the last 3 years that included a total of 4548 gallbladders. Histopathologic results were analyzed and recollected in an established format. Finally, we calculated the incidence of malignant neoplasias of gallbladder in our hospital. RESULTS: The most common histopathologic finding was cholesterolosis (incidence: 26%), followed by xanthogranulomatous gallbladder (incidence: 0.94%). The incidence of gallbladder cancer was 0.54% (25 cases), the most common type being adenocarcinoma (incidence: 0.48%). CONCLUSIONS: The incidence of gallbladder cancer in our hospital is among the lowest limits compared with the literature worldwide.

Adenocarcinoma↗
PubMed2005

Can we rely on public data as a source of information for cancer registry in developing countries?

BACKGROUND/AIMS: Although a "hospital-based cancer registry" is important in improving patient care, a "population-based cancer registry" with emphasis on epidemiology is important in allocating health care resources and prioritizing public health programs. Because of its reliance on retrieved clinical and para-clinical documents, there is some limitation in registering all cancer incidents in this system, especially in developing countries. In this study we examined the possibility of using public data as a complementary source of information for recording cancers in a population-based cancer registry. METHODS: Along with the annual census in rural areas, a survey was performed in Golestan province in March 2004 to identify public awareness about cancer incidents in the community. Individuals were questioned about history of cancer in their close relatives during the last two years. Those who reported cancer in their relatives were also asked to name the main organ of involvement. A similar list was retrieved from the cancer registry at the Ministry of Health in Gorgan, and cases with upper GI (esophagus and gastric) cancer diagnosis from 21 March 2002 through 20 March 2004 were selected for this study. Finally, these two lists were compared for examining accuracy of the collected data. RESULTS: We included 137 cases in our study with rural residence and known addresses. Only 35 (25.5%) cases were reported by the relatives and among them only 20 (57.1%) relatives correctly reported the tumor location. Although we found a difference in accurate reporting of cancer incidents by year of diagnosis (more correct cases reported during the second versus the first year), the difference was not statistically significant between the two years. CONCLUSION: In this study, we examined the possibility of using public awareness about cancer incidents as a complementary source of information for a population-based cancer registry. We found that this approach is not ideal for reducing limitations. Therefore, we recommend a nationwide cancer registry to record all cancer-related information at the time of diagnosis. This strategy will reduce the need for performing retrospective surveys in collecting cancer-related information.

Aged↗
PubMed2005

[Infant mortality in Asker and Baerum in the 18th and 19th century].

BACKGROUND: The decline in infant mortality is an important part of the secular decline in mortality in the western world. The major causes of the decline are subject to controversy. MATERIAL AND METHODS: Individual event records from censuses, church records and land registers from two Norwegian parishes during the years 1814-1878 were registered and linked into individual life course records. Around 15,000 infants, of whom 1500 died, were analysed in depth with Cox regression analysis. The total yearly counts of births and infant deaths from 1735 were analysed using ordinary linear regression. RESULTS: Infant mortality hovered around 23 per cent during the middle of the 18th century and fell to a level around 10 per cent by the end of the 19th century. The decline was strongest during the neonatal period. Women born during the first decade of the 19th century, a decade known for a succession of years with bad harvests, war and high infant mortality, gave birth to infants with increased neonatal mortality. INTERPRETATION: The decline in infant mortality during the first part of the 19th century can thus be attributed to an improvement in the health of the mothers dating back to their own fetal or infant stage. The decline took place in the absence of trained medical personnel.

Cause of Death↗
PubMedDate not supplied

[Changes in factors associated with the nutrition transition in Mexico].

OBJECTIVES: To describe the demographic and socioeconomic changes, food availability and food expense in Mexico during 1980-2000. METHODS: From official statistics (Population Census, FAO Food Balance Sheets, Family Income and Expense National Survey and Economic Census) we estimated the evolution of population distribution according to locality size, occupational structure, woman participation in the wage-earning labor force, minimum wage, availability of food establishments and expense in food. RESULTS: The percentage of the population that lives in urban areas has increased, they are employed in the tertiary sector, womens participation in the labor market has increased but real minimum wages have decreased. Vegetables, oleaginous, oils, fish and seafood availability have decreased whereas animal fat, vegetables, fruits, softdrinks, meats and egg availability have increased. The number of inexpensive restaurants (cocinas económicas and fondas) has also increased. Food expenses have decreased while amount of money spent in food consumed away from home has increased. CONCLUSIONS: In Mexico, the growth in urban areas and the tertiary job sector shows a parallel growth in the availability of high fat and protein food, a greater diet variety and more opportunities to consume food not prepared in the home. On the other hand, the sale of equipment and places designed for recreational physical activity have increased. By reducing employment in the primary sector it is foreseeable that labor intensive physical activity will become less important overtime.

Female↗
PubMed1990

Improving management of urinary incontinence in geriatric centres and nursing homes. Victorian Geriatricians Peer Review Group.

OBJECTIVE: To study prevalence and management of urinary incontinence in institutes and to recommend improved strategies of managing this problem. METHOD: A one-day census of ten geriatric assessment and rehabilitation services and nursing homes was undertaken to estimate the extent and management of urinary incontinence in Victoria. The definition of incontinence was extended to include patients with 'dependent continence', i.e. being dry of urine only as a result of being reminded or physically assisted. RESULTS: A total of 1659 patients, comprising 333 short-stay and 1326 nursing home type patients, was surveyed. The mean age was 77 and 81 years respectively. Only 43% and 23% of these patients respectively were independently continent, whilst 26% and 11% respectively of all patients were dependent continent. Incontinence occurred once or more per day in 85% of these patients and had usually been present for at least one month. There was a high association between incontinence and physical and mental infirmity. Dependent continent patients were as physically handicapped as their wet counterparts. A diverse range of management strategies, including various toileting programmes, was employed to deal with the incontinence. It is concluded that urinary incontinence is more common than reported in previous studies, largely as a result of the additional group of patients with dependent continence, a condition that often can be achieved. Proposed management protocols are outlined which aim to define different population subgroups that might respond more effectively to the various interventions available. The need for follow-up appraisal of these interventions is emphasized.

Activities of Daily Living↗
PubMed2006

Are rapid population estimates accurate? A field trial of two different assessment methods.

Emergencies resulting in large-scale displacement often lead to populations resettling in areas where basic health services and sanitation are unavailable. To plan relief-related activities quickly, rapid population size estimates are needed. The currently recommended Quadrat method estimates total population by extrapolating the average population size living in square blocks of known area to the total site surface. An alternative approach, the T-Square, provides a population estimate based on analysis of the spatial distribution of housing units taken throughout a site. We field tested both methods and validated the results against a census in Esturro Bairro, Beira, Mozambique. Compared to the census (population: 9,479), the T-Square yielded a better population estimate (9,523) than the Quadrat method (7,681; 95% confidence interval: 6,160-9,201), but was more difficult for field survey teams to implement. Although applicable only to similar sites, several general conclusions can be drawn for emergency planning.

Adolescent↗
PubMed1995

Measuring disadvantage: changes in the underprivileged area, Townsend, and Carstairs scores 1981-91.

OBJECTIVE: To compare the intercensal change for each of the underprivileged area (UPA), Townsend, and Carstairs scores calculated from 1981 and 1991 census data. SETTING: England and Wales. METHODS: The method described enables comparison of change in composite scores such as the UPA, Townsend, and Carstairs scores which are derived from normalised variables. The national values of equivalent variables derived from the censuses are calculated and normalised on the same baseline of the 1981 electoral ward mean and SD values. The resultant change in composite scores for different censuses can then be compared directly. MAIN OUTCOME MEASURE: Change in the composite score values for the 1991 census when compared with the 1981 census. RESULTS: For England and Wales, the UPA score increased by 5.62 units (0.35 of the SD) but the Townsend and Carstairs scores fell by 2.39 and 1.13 units respectively (0.71 and 0.33 of the SDs). CONCLUSION: The Townsend and Carstairs scores are good measures of material deprivation and show a general improvement as such between 1981 and 1991. The UPA score, however, includes additional factors relating to family structure, social deprivation, and health need and shows a decline in the overall situation.

Data Interpretation, Statistical↗
PubMed1996

Interval-censored event history analysis.

"Event history analysis...has [over time] branched out in two directions: on the one hand, surveys collecting retrospective information on respondent's life course, family and occupational histories, residential mobility...; on the other, individual biographies compiled by extracting information from administrative sources (vital registration data, census schedules, notifications of residence...). Each method has constraints--the second, in particular, because of depending on the availability of administrative data: job changes are never registered and in France, neither are residential moves. That limits observation to the information collected when a census is held or a vital event registered. [The authors] test here the validity of these incomplete data by comparing them to information supplied by an ad hoc survey."

Data Collection↗
PubMed2006

Unstable inferences? An examination of complex survey sample design adjustments using the Current Population Survey for health services research.

Statistical analysis of the Current Population Survey's Annual Social and Economic Supplement is used widely in health services research. However, the statistical evidence cited from the Current Population Survey (CPS) is not always consistent because researchers use a variety of methods to produce standard errors that are fundamental to significance tests. This analysis examines the 2002 Annual Social and Economic Supplement's (ASEC) estimates of national and state average income, national and state poverty rates, and national and state health insurance coverage rates. Findings show that the standard error estimates derived from the public use CPS data perform poorly compared with the survey design-based estimates derived from restricted internal data, and that the generalized variance parameters currently used by the U.S. Census Bureau in its ASEC reports and funding formula inputs perform erratically. Because the majority of published research (both by academics and Census Bureau analysts) does not make use of the survey design-based information available only on the internal ASEC data file, we argue that the Census Bureau ought to use alternative methods for its official ASEC reports. We also argue that for public use data the Census Bureau should produce a set of replicate weights for the ASEC or release a set of sample design variables that incorporate statistical "noise" to maintain respondent confidentiality (e.g., pseudo-primary sampling units) as other federal government surveys do. This is essential to make appropriate inferences using the ASEC data regarding statistical significance and estimate variance for health policy analysis.

Censuses↗
PubMed1994

Estimating maternal mortality in rural areas of Mexico: the application of an indirect demographic method.

OBJECTIVE: To measure maternal mortality levels in rural areas of Mexico. METHODS: In a cross-sectional study, a census of 13,378 households was carried out in the municipalities of Yecapixtla and Tlaltizapan, Morelos, Mexico. Information on 10,443 subjects from 12 to 49 years old was included in the analysis. An indirect method of measuring maternal mortality--the sisterhood method--was used to estimate maternal mortality. Information about the number of sisters of the interviewees who died due to maternal causes was collected in the census. With this information, estimates of maternal mortality related to a period of 10-12 years before the application of the census were obtained. An innovation to the original method was the calculation of a confidence interval for the estimated maternal mortality rate (MMR). RESULTS: The MMR in this region was 18.68/10,000 live births (95% CI 15.79-21.58/10,000 live births). The average risk of dying due to maternal causes was 1 in 87 for women between 12 and 49 years of age. CONCLUSIONS: The sisterhood method was effective for estimating maternal mortality in a small region, with no previous information about this indicator. The method proved to be useful for identifying a priority region for the implementation of maternal mortality reduction programs. Furthermore, the method was particularly convenient since it was applied as part of a multipurpose survey.

Adolescent↗