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[Migrant-specific participation barriers and accessiblity in The Child and Adolescent Health Survey].

The objective of the National Health Survey for Children and Adolescents has been to produce the first sets of representative data on health indicators including those of children and adolescents from migrant families. To ensure an adequate involvement of migrants corresponding to their percentage in the demographic profile, account must be taken of particular features in respondent behaviour. Up to now analyses of the respondent behaviour of migrants have been limited to surveys based on the 'oral interview' format. The pilot study format employed by the National Health Survey for Children and Adolescents for the first time produces findings relative to the willingness of migrants to participate in health surveys containing medical survey components. In comparison to "pure" questionnaire-based surveys, the pilot study reveals the role played by additional hurdles to, and motives for, participation which are partly cultural in origin and partly related to the specific condition of being a migrant. Such factors must also be taken into account in designing the course of the survey and in considering questions of migrant accessibility.

Adolescent↗

[Research on child health: the life story method and mothers' oral statement].

Children morbimortality rates in Brazil provide some indications about the life patterns of certain social groups, considered as risk groups, due to their vulnerability to a number of health impairments, but they do no display a clear picture of their quality of life. The present study aims to describe the steps undertaken by the authors to construct a qualitative research study on maternal living conditions and lifestyle, discussing certain aspects related to the study's design, such as, the definition of the research problem, the theoretical framework and data collection, particularly, the use of oral reports by mothers and the advantages and difficulties of this technique. Such narratives make it possible for researchers to come to know the needs, worries and strategies mothers use to care for their children's health, as well as, expose some wider social determinants of their life patterns. The knowledge thus generated is important to orientate the organization of policies and social practices to be developed by the health sector.

Adolescent↗

A needs assessment strategy for an era of limited resources.

Among the several methods of assessing need for health services, the social indicator and the rates under treatment approaches utilize routinely available data. A well designed community survey, considered by many as the criterion of need within an area, is costly, difficult to mount, and requires considerable expertise. Therefore, it would seem reasonable to attempt to limit the need to utilize this approach. Presented here is a schema which utilizes the social indicator and rates under treatment approaches for an entire catchment area, reserving the survey approach only for those areas in which the two readily available need assessments are at variance, suggesting questionable validity for one or both approaches. Within a suburban middle-class county containing pockets of small town poverty, a social area analysis was undertaken to characterize need for mental health services. Inpatient rates under treatment were developed to measure demand. Key informant and survey approaches were undertaken to study selectively those census tracts which were discordant as to need and demand. This resulted in reducing the size of the population to be surveyed to 25 per cent of the total county, thus more efficiently using the limited resources available for needs assessment purposes.

Cross-Sectional Studies↗

[Examination of motor fitness within the scope of The Child and Adolescent Health Survey].

Several studies indicate that physical performance of children and young people is declining. However, actually available data on physical performance and physical activity of children and young people are not representative and hence no countrywide predictions can be made. The examination of motor fitness in association with development and health of children and young people is indispensable for the implementation of appropriate measures of intervention. The module 'Motoric' in the National Health Survey for Children and Adolescents shall remedy the deficiency of information. For the module, 6,000 children and adolescents, age 4-17 years, will be representatively drawn from the total survey sample. Their physical performance and physical activity will be comprehensively assessed. For this purpose, appropriate tests have been developed. In pilot studies, all methods were tested for practicability, objectivity, reliability, and validity. The application of methods was coordinated between the Robert Koch-Institute and the Institute of Sport and Science of Sports, University of Karlsruhe.

Adolescent↗

Physically demanding work and inadequate sleep, pain medication use, and absenteeism in registered nurses.

Pain and fatigue are early indicators of musculoskeletal strain. This study examined associations among eight physical demands and inadequate sleep, pain medication use, and absenteeism in 3727 working registered nurses (RNs). Among the demands, awkward head/arm postures were associated with each outcome (inadequate sleep: odds ratio [OR], 1.96; 95% confidence interval [CI], 1.41 to 2.72; pain medication: OR, 1.65; CI, 1.12 to 2.24; absenteeism: OR, 1.60; CI, 1.26 to 2.04). A dose-response relationship was present; as the number of demands increased, the likelihood of each outcome increased. Odds ratios for eight demands versus no demands were as follows: inadequate sleep (OR, 5.88; CI, 2.30 to 15.50), pain medication (OR, 3.30; CI, 1.34 to 8.11), and absenteeism (OR, 2.13; CI, 1.15 to 3.94). Adjustment using multiple logistic regression for lifestyle, demographics, and work schedule did little to alter the findings. Interventions to promote nurses' health should limit the physical demands of the work.

Absenteeism↗

Correlations between family meals and psychosocial well-being among adolescents.

OBJECTIVE: To determine the association between frequency of family meals and multiple indicators of adolescent health and well-being (tobacco, alcohol, and marijuana use; academic performance; self-esteem; depressive symptoms; and suicide involvement) after controlling for family connectedness. METHODS: Data come from a 1998-1999 school-based survey of 4746 adolescents from ethnically and socioeconomically diverse communities in the Minneapolis/St Paul, Minn, metropolitan area. Logistic regression, controlling for family connectedness and sociodemographic variables, was used to identify relationships between family meals and adolescent health behaviors. RESULTS: Approximately one quarter (26.8%) of respondents ate 7 or more family meals in the past week, and approximately one quarter (23.1%) ate family meals 2 times or less. Frequency of family meals was inversely associated with tobacco, alcohol, and marijuana use; low grade point average; depressive symptoms; and suicide involvement after controlling for family connectedness (odds ratios, 0.76-0.93). CONCLUSIONS: Findings suggest that eating family meals may enhance the health and well-being of adolescents. Public education on the benefits of family mealtime is recommended.

Adolescent↗

Work losses related to inflammatory bowel disease in the United States: results from the National Health Interview Survey.

BACKGROUND: U.S. studies using varying methodologies have reported different estimates for the indirect, or nonmedical cost per person with inflammatory bowel disease (IBD). Our analysis contributes to this literature by using the 1999 sample of the National Health Interview Survey (NHIS) to estimate the work-loss effect of IBD on work in the United States and the associated cost to society. METHODS: A weighted logistic regression model was used to estimate the OR of being out of the labor force as determined by predictive variables, including having been diagnosed with IBD, with or without symptoms. Controls included health status indicators and demographic variables. For those people in the labor force, a second analysis was performed to determine the relative influence of the same variables on working less than 12 months versus the entire year. SUDAAN 8.0 was used to generate population estimates, systematically correcting for survey design. RESULTS: Of IBD patients who had experienced symptoms in the past 12 months, 31.5% reported being out of the labor force (OR = 2.14, relative to the non-IBD group). We estimated the excess in the nonparticipation rate attributable to IBD with symptoms in the past 12 months in the United States to be 12.3%. Based on this, the indirect cost of nonparticipation attributable to IBD in 1998/1999 was more than $3.6 billion U.S. dollars (USD) or $5228 USD per person with IBD and symptoms. According to the second weighted logistic regression, for those who are in the labor force, having IBD had no association with the duration of work. CONCLUSIONS: By using directly observed data in our analysis, this method of estimation can be used to predict the overall paid-employment burden of IBD.

Absenteeism↗

Health expectancy in Canada, late 1970s: demographic, regional, and social dimensions.

Based on estimates of activity restriction from the Canada Health Survey, institutional data on long-term care, and survival data from vital statistics, we have calculated an index of health expectancy (life expectancy in each state of health), and a summary of these indices which we have called quality-adjusted life expectancy. At birth, expected years of long-term institutionalization were 0.8 for men and 1.5 for women. Expected years of activity restriction not involving long-term institutionalization were 10.8 for men and 14.0 for women; 3.0 of the expected years of activity restriction for men and 1.3 of these years for women were in the most severe category of restriction (unable to do major activity). For both sexes together, quality-adjusted life expectancy was 1.4 years greater in Ontario and the Prairies than in the Atlantic region, 3.2 years greater in Canada's three largest cities than in rural areas and small towns, and 7.7 years greater among persons from high-income families than among persons from low-income families.

Activities of Daily Living↗

Compression, expansion, or dynamic equilibrium? The evolution of health expectancy in New Zealand.

STUDY OBJECTIVE: To evaluate the New Zealand evidence for three theories of population health change: compression of morbidity, expansion of morbidity, and dynamic equilibrium. DESIGN: Using the Sullivan method, repeated cross sectional survey information on functional limitation prevalence was combined with population mortality data and census information on the utilisation of institutional care to produce health expectancy indices for 1981 and 1996. SETTING: The adult population of New Zealand in 1981 and 1996. PARTICIPANTS: 6891 respondents to the 1981 social indicators survey; 8262 respondents to the 1996 household disability survey. MAIN RESULTS: As a proportion of overall life expectancy at age 15 the expectation of non-institutionalised mobility limitations increased from 3.5% to 6% for men, and from 4.5% to 8% for women; the expectation of agility limitation increased from 3% to 7.5% for men and from 4.5% to 8.5% for women, and the expectation of self care limitations increased from 2.0% to 4.5% for men and from 3.0% to 6.0% for women. These changes were primarily attributable to increases in the expectation of moderate functional limitation. CONCLUSION: The dynamic equilibrium scenario provides the best fit to current New Zealand evidence on changes in population health. Although an aging population is likely to lead to an increase in demand for disability support services, the fiscal impact of this increase may be partially offset by a shift from major to moderate limitations, with a consequential reduction in the average levels of support required.

Adolescent↗

Health interview surveys. Towards international harmonization of methods and instruments.

With the strategy for health for all and its 38 targets, the WHO Regional Office for Europe has created a common health policy for Europe, and has developed internationally agreed indicators for measuring progress towards the attainment of the targets. Some of these indicators are "classical" health indicators, such as mortality rates and the incidence of notifiable diseases, while others reflect more recent public health concerns such as health-related behaviour and quality of life. For the latter group, gathering the information necessary for monitoring and evaluating progress is somewhat haphazard. Health interview surveys provide the best -- in some cases the only -- means of collecting data on many of these indicators, since they mirror the information that only properly approached individuals may be able to provide and ensure that all subgroups of the population are covered. Yet such surveys have enjoyed a long tradition only in a few countries. Moreover, when these indicators are covered, the results are often not comparable. The methods and instruments used to collect data have often been developed without international coordination or adapted from those used in other countries, usually with substantial modification to suit what are perceived to be local requirements. There has also tended to be considerable uncertainty among those countries lacking a tradition of health interviewing as to the best way of conducting surveys. Against this background, the WHO Regional Office and Statistics Netherlands organized a series of consultations, which have resulted in the internationally agreed methods and instruments for health interview surveys set out in this book. These methods and instruments are likely in the longer term to become standards, thus improving comparability of information. This book provides practical guidance on methods for health interview surveys. It is thus essential reading for all concerned in the planning and carrying out of such surveys, whether in national statistical offices or in public or private interviewing agencies. It will also be useful to all in the public health community, including students and academics.

Data Collection↗

Socioeconomic factors, perceived control and self-reported health in Russia. A cross-sectional survey.

Russia has the lowest life expectancy among industrialised countries, but little is known about other health outcomes and determinants of health in the Russian population. Here we report a cross-sectional study in a national sample of the Russian population of social and psychosocial determinants of two self-reported health indicators: self-rated health (shown to predict mortality in prospective studies) and physical functioning (validated against more objective health measures). A multi-stage sample of the Russian population aged 18 years and more was interviewed (n=1599, response rate 66%). The questionnaire included political attitudes, social and economic circumstances, psychosocial factors, smoking, alcohol consumption, self-rated health and physical functioning (from the SF36 instrument). Scores of perceived control over life and over one's health were calculated from 6 and 3 questions, respectively. Data were analysed in logistic regression for two dichotomised outcomes: poor self-rated health (worse than average) and low physical functioning (less than 60% of maximum). Overall, 25% of subjects rated their health as worse than average; this is substantially more than in western countries. Perceived control over life was strongly related to both outcomes; age- and sex-adjusted OR for 1 standard deviation increase in control were 0.60 (95% CI 0.52-0.69) for poor self-rated health and 0.67 (0.57-0.81) for low physical functioning. Adjustment for a battery of other factors reduced these estimates only slightly. Associations between control over one's health and both outcomes were also significant, but weaker and attenuated in multivariate models. Material deprivation was also strongly related to both outcomes. Education was inversely related to self-rated health, and unmarried men reported poor physical functioning substantially more often. Subjects not approving the economic changes reported poorer health but this association was removed by adjustment for socioeconomic factors and control. Subjects who could not rely on informal social structures when in problems reported worse health; this effect largely persisted in multivariate analyses. These results are consistent with the hypothesis that poor health status in Russia is related to dysfunction of social structures, socioeconomic deprivation, and lack of perceived control. The absence of informal social networks, vital for maintaining general welfare, seems to affect adversely self-rated health. Deprivation and low perceived control may be important mediators between the broad social environment and health in populations undergoing transition and can provide a useful framework for many biological and behavioural factors. Prospective studies are needed to address the issue of temporality and reporting bias, the major problems in interpreting these findings.

Activities of Daily Living↗

Pain and negative mood during rehabilitation after anterior cruciate ligament reconstruction: a daily process analysis.

Daily diary methods were used to examine changes in pain and negative mood over the first 6 weeks of rehabilitation after surgical reconstruction of the anterior cruciate ligament (ACL). Participants (58 men and 33 women) completed measures of personal factors (i.e., age, athletic identity, neuroticism, optimism) before surgery and indices of daily pain, negative mood, and stress for 42 days after surgery. Multilevel modeling revealed that, as would be expected, daily pain ratings decreased significantly over the course of the study and that the rate of decline in pain ratings decreased over time. Age and daily negative mood were positively associated with daily pain ratings. Daily negative mood also decreased significantly over the course of the study and was positively associated with neuroticism, daily pain, and daily stress. Athletic identity and optimism interacted with time since surgery in predicting daily negative mood such that participants with high levels of athletic identity and low levels of optimism reported greater decreases in daily negative mood over time. Overall, the findings reveal a pattern of improved psychological functioning over the early stages of post-operative ACL rehabilitation.

Adolescent↗

Study of Health In Pomerania (SHIP): a health examination survey in an east German region: objectives and design.

OBJECTIVES: The reason for the Study of Health in Pomerania (SHIP) is the lack of epidemiological studies with a broad range of health indicators. Furthermore, in Germany there is a need for studies that take into account the particular situation of life after the reunification. One objective of SHIP is to provide prevalence estimates on a broad range of diseases, risk and health factors for a defined region in the former GDR. METHODS: A sample of 7008 women and men aged 20 to 79 years in a north-east region of Germany, 4900 expected participants. The sample was drawn in two steps: First, 32 communities in the region were selected. Second, within the communities a simple random sample was drawn from residence registries, stratified by gender and age. The data collection and instruments include four parts: oral health examination, medical examination, health-related interview, and a health- and risk-factor-related questionnaire. The oral health examination includes the teeth, periodontium, oral mucosa, craniomandibular system, and prosthodontics. The medical examination includes blood pressure measurements, electrocardiography, echocardiography, carotid, thyroid and liver ultrasounds, neurological screening, blood and urine sampling. The computer-aided health-related interview includes cardiovascular symptoms, utilisation of medical services, health-related behaviours, and socioeconomic variables. The self-administered questionnaire comprises housing conditions, social network, work conditions, subjective well-being and individual consequences from the German reunification.

Adult↗

Equity in self-reported adult illness and use of health service in South Africa: inter-temporal comparison.

The study was carried out to assess the magnitude of, and change in, inequities in self-reported adult illness and use of healthcare and to consider the policy implications of the findings. Datasets from three household surveys carried out in 1993, 1995, and 1998 were used. Inequities were measured using illness and healthcare-use concentration indices. Self-reported adult illness was greater among the rich in 1993, but this was reversed to reflect higher levels of reported illness among the poor in 1995 and 1998. Inequities were observed in self-reported injury and disability/chronic illness that favour the rich. The poor also reported more days of sickness compared to the rich. Overall, there were higher levels of use of doctors and hospital services by the rich, relative to their levels of reported illness. In contrast, there was a greater use of public-sector facilities by the poor. The time taken to reach a health facility also had a bias in favour of the rich. Although there were some favourable changes in the levels of inequities between the three time periods, there still remained considerable inequities that favoured the rich in self-reported adult illness and use of health services that need to be addressed. The consequences of higher concentration of chronic illness/disability and injury among the poor have far-reaching negative consequences on the socioeconomic welfare of the individuals and households. Redressing these inequities needs a holistic strategy that transcends the health sector.

Adult↗

Health risk appraisal: review of evidence for effectiveness.

Since its introduction some two decades ago, health risk appraisal (HRA) has become a standard offering in the health promotion repertoire. The technique's distinctive feature is its use of epidemiologic data to generate quantitative risk messages for the client. Yet despite the dedication and considerable investments that have gone into HRA's development, dissemination, and use, there is only limited empirical evidence that these quantitative risk messages have any effect on clients. There do not appear to be any formal studies of HRA's effect on participation in health promotion programs, although increasing recruitment is regarded as a major benefit of using HRA. There are few indications of HRA effects on health beliefs. Most positive reports of effects on behavior change come from uncontrolled studies; several randomized controlled trials have yielded ambiguous findings. Virtually no data exist concerning the impact of the quantitative risk messages that distinguish HRA from other assessment techniques and that have motivated the substantial efforts toward developing and refining HRA. HRA has evident appeal and is probably a useful health education device for middle-class, middle-aged, nonminority clients. It may well have desirable effects on health-related beliefs, attitudes, and behaviors when accompanied by counseling or education, but available evidence has not established its effectiveness. Given the difficulty of obtaining definitive evidence of the effectiveness of HRA and specifically of its use of quantitative risk projections, the need for such evidence is debatable. An adequately funded and reviewed research program to examine whether projections of absolute risk affect knowledge, beliefs, attitudes, and intention to change is recommended as the most fruitful next step. Epidemiologically based HRA procedures that provide feedback in terms of qualitative statements or relative risk may be a promising approach to prospective health assessment.

Attitude to Health↗

Use of outpatient clinics as a health indicator for communities around a coal-fired power plant.

The permit to operate the first coal fired power plant in Israel was issued with the condition that a comprehensive network to monitor its effects on the environment, health, and agriculture must be installed and operated around the plant. The health monitoring system consists of four studies, which started 1 year prior to the operation of the plant and were carried out for 10 years. In the framework of the health monitoring system, a study of requests for health services was carried out. In this survey, 8 clinics of the Sick Fund, served by 16 physicians, were followed up. The clinics were located as near as possible to air pollution monitoring stations and represent expected different levels of pollution. A health recorder summarized each day's visits to each physician and tabulated the total visits for each day and the visits due to respiratory tract complaints. Multivariate stepwise regressions on total as well as on respiratory complaints were carried out. The independent variables in the regressions were sulfur dioxide, meteorological parameters (such as temperature and humidity), and flu epidemics. Temperature was almost always significantly correlated with respiratory complaints, but less correlated with total visits among, adults and children. Sulfur dioxide, most meterological parameters and flu epidemics were not meaningful explanatory factor in the regressions. Ambient air pollution levels did not exceed the Israeli air quality or the more stringent local air quality standards, the monthly and annual average sulfur dioxide and nitrogen oxides values were very low.

Adult↗

An integrative index of biological effects of lead.

Biological indicators of lead effects on the central nervous system (as measured by performance tests), hematogenous bone marrow (hemoglobin levels) and kidney function (BUN Levels) can be combined in an integrative index (INDEX). This integrative index can be in turn related to indicators of lead exposure and absorption. Such an index was calculated by removing age effects in measures of performance and kidney function and then transforming all the variables to Z (standard) units. Secondary lead smelter workers and a control group were studied. In secondary lead smelter workers this INDEX was found to be significantly correlated with ZPP, blood lead levels, and duration of lead exposure. In this population the magnitude of the correlation coefficients with ZPP levels was much higher than than for blood lead levels. INDEX had a higher correlation with ZPP than with each of its components: performance test scores, hemoglobin, and BUN levels. Although performance test scores, hemoglobin, and BUN levels were shown to discriminate between the control, non-lead-exposed population, and the lead-exposed group, INDEX (and particularly one pair of its components, CNS and hemoglobin levels) achieved the best discrimination between groups. The concept of an integrative index of biological effects of lead may be especially useful in defining populations at high risk for developing chronic, potentially irreversible neurologic and kidney dysfunction, and in assessing the severity of lead effects in individual cases.

Analysis of Variance↗

Ethnic indicators of dental health for young Asian schoolchildren resident in areas of multiple deprivation.

The aim of the study was to explore the use of two social indicators in a dental caries epidemiological study of 5-year-old Asian schoolchildren in an area of multiple deprivation. The two indicators selected were religious background and the mother's ability to speak English. Six hundred and forty-three 5-year-old schoolchildren from three schools were examined; the mean dmft was 2.84 (SD 3.63). Children were classified into three groups on broad ethnic/facial characteristics, and the mean dmft for Asians (3.64) differed statistically significantly from those of both Whites (1.83) and Afro-Caribbeans (1.87). When the Asian population was divided into four groups, to explore the effects of religion and the mother's ability to speak English, a statistically significant interaction was observed between religion and language for mean dmft and dental cleanliness. The Asian non-Muslim children whose mothers were English speaking (ES) compared well with the White and Afro-Caribbean group for mean dmft, percentage caries-free and oral cleanliness. When these variables were examined for the two Muslim groups and the non-Muslim group whose mothers were non-English speaking (NES), no statistically significant differences were observed. Oral health promotion should therefore consider that there are three distinct dental high-risk groups for young Asian children: Muslim ES and NES mothers and non-Muslim NES mothers. Each group will require a different health promotion strategy. Non-English speaking mothers need adequate translation, whereas all Muslim mothers need help to find proper alternatives to baby-foods which, although common in the UK, are culturally inappropriate to Muslims.

Asia↗