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PubMedDate not supplied

Mortality from diabetes mellitus, ischemic heart disease, and cerebrovascular disease among blacks in a higher income area.

According to the 1980 census, blacks in Suffolk County on Long Island, NY, had a median family income of almost $20,000 versus $12,618 for blacks in the entire United States, or only 20 percent lower than that for whites in the county. Black-white ratios of age-specific death rates for 1979-83 in Suffolk County were elevated for all causes for men and women in age groups from 35-44 to 55-64 years (but not for those 75 years or older), for ischemic heart disease for women (but not men) for age groups from 35-44 to 55-64 years, for diabetes mellitus for most ages (especially for females), and for cerebrovascular disease for both men and women for all age groups from 35-44 to 65-74 years. The age-specific proportional mortality ratios (PMRs) for ischemic heart disease within educational level (less than 12 years and 12 or more years of school) were lower for black than for white men but more similar for black and white women. For diabetes, the PMRs were higher for black versus white women within both educational levels. PMRs for cerebrovascular disease were higher for black than white men within the group of decedents with less than 12 years of education. The findings are discussed with reference to racial differences in the prevalence of poverty as well as possible differences in risk factors (for example, obesity) or medical care independent of poverty.

Adult↗
PubMed1990

Impact of advanced maternal age on the outcome of pregnancy.

We assessed the impact of advanced maternal age on the outcome of pregnancy by studying all 1,328 women who were primarily cared for and delivered at our institution between 14 September 1984 and 12 February 1985. Important peripartum maternal complications were no more frequent in women aged 35 years or more than in women 20 to 34 years old, although operative delivery was significantly more common. Similarly, adverse outcomes of infants were no more frequent. Perinatal mortality tended to be lower. In addition, we noted a trend for fewer infants with congenital anomalies to be born among older women. This trend was related, in part, to the choice to terminate the pregnancy by women with fetuses that had documented chromosomal anomalies. We conclude that advanced maternal age was not associated with an excess of adverse pregnancy outcome and suggest that, with early registration and careful surveillance during pregnancy, women aged 35 years or more can experience excellent pregnancy outcomes.

Abortion, Induced↗
PubMed1989

Risk groups and risk areas.

The risk approach to health management usually relates to groups of people. An alternative method is to concentrate on the areas at risk, which may sometimes be more useful in decision-making.

Health Planning↗
PubMedDate not supplied

Social and environmental factors influencing contraceptive use among black adolescents.

In 1979 survey among sexually active unmarried black adolescents from Chicago found that 28 percent of the young women and 18 percent of the young men used a contraceptive at first intercourse. Statistically significant differences in such contraceptive use among teenage women were found for three social and environmental characteristics: social class, parents' marital status and neighborhood quality. Thus, 41 percent of the young women from the highest social class used contraceptives at first intercourse, but only 17 percent of those from the lowest class did so. The proportions were 35 percent for young women from neighborhoods of high socioeconomic status and 17 percent for those from ghetto neighborhoods. Thirty-six percent of teenage women whose parents had intact marriages as of the adolescent's 11th birthday used contraceptives at first intercourse, compared with 23 percent of those from single-parent and divorced families. Among males, social class was the only one of these three characteristics that was statistically significant; 32 percent of adolescents from the highest class and 11 percent from the lowest practiced contraception at first intercourse. For teenagers of both sexes, career aspirations were of marginal statistical significance in the practice of contraception. Thirty-six percent of young women with high aspirations used contraceptives at first intercourse and 19 percent of those with low aspirations did so. Only four percent of the young men with low career aspirations used contraceptives, compared with 25 percent of those with high aspirations. Number of siblings, parental supervision of dating and having a sister who had become a teenage mother showed no association with contraceptive use.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Barriers to effective family planning in Nepal.

To investigate why family planning (FP) services in the Kathmandu Valley of Nepal are underused, a study was initiated under the auspices of the Nepal Family Planning/Maternal--Child Health Project. The study was intended to provide a user perspective, by examining interactions between FP clinic staff and their clientele. "Simulated" clients were sent to 16 FP clinics in Kathmandu to request information and advice. The study revealed that in the impersonal setting of a family planning clinic, clients and staff fall into traditional, hierarchical modes of interaction. In the process, the client's "modern" goal of limiting her family size is subverted by the service system that was created to support this goal. Particularly when status differences are greatest, that is, with lower-class and low caste clients, transmission of information is inhibited.

Adult↗
PubMed1995

Problems associated with early discharge of newborn infants. Early discharge of newborns and mothers: a critical review of the literature.

OBJECTIVE: To determine whether research supports the advisability of early discharge of healthy newborns and mothers. METHODS: Critical review of English-language literature cited in the Index Medicus or the International Nursing Index. FINDINGS: No adequately designed studies have examined discharge before 48 hours after delivery without additional postdischarge services. Few studies have examined the consequences of recommending a clinic visit within the first days after discharge; studies of this practice among low-income populations found high no-show rates. Some small studies suggest that early discharge is likely to be safe for selected populations at low psychosocial, socioeconomic, and medical risk, with careful antenatal screening and preparation and multiple postpartum home visits. Some studies suggested adverse outcomes associated with early discharge even with early follow-up. CONCLUSIONS: Published research provides little knowledge of the consequences of short maternal/newborn hospital stays or varying postdischarge practices for the general population. The studies that have concluded that early discharge was safe were applied under restricted circumstances or were too small to detect clinically significant effects on important outcomes. Further research is needed to inform clinical and reimbursement policy on health services in the first days of life and parenting. Rigorous studies of sufficient size are needed to examine the impact of different hospital stays and different postdischarge practices on a range of outcomes for mothers and newborns in diverse populations and settings. Given a priori concerns, decisions on neonatal/obstetric discharge planning should be made cautiously.

Adult↗
PubMed2006

Out-of-pocket health spending between low-and higher-income populations: who is at risk of having high expenses and high burdens?

OBJECTIVE: We studied the effects of health insurance, health care needs, and demographic and area characteristics on out-of-pocket health care spending for low and higher income insured populations. MATERIALS AND METHODS: We used the 2002 National Survey of America's Families to analyze out-of-pocket health spending. People were classified into 3 levels of expenses based on their out-of-pocket health care spending and 3 levels of financial burden based on spending as a share of family income. We used a multinomial logit model to estimate the effect of insurance status and other factors on expense and burden levels. RESULTS: Public insurance appears to offer the best financial protection from high out-of-pocket expenses and financial burden for those who are eligible. Families with private nongroup coverage have the highest odds of being in the high-expense and high-burden categories for all incomes. For higher-income families, having a family member in fair or poor health is a significant risk factor for high out-of-pocket expenses and financial burden. Having higher penetration of health maintenance organizations in an area appears to lower the odds of being in the high-burden category for all families. CONCLUSIONS: Health insurance may not prevent people from having high health care spending. Low-income people with serious health needs appear to be financially constrained and spend less on health care relative to higher-income people, and the presence of health maintenance organizations may help reduce out-of-pocket health care spending.

Cost of Illness↗
PubMed1994

Global patterns of seasonal variation in human fertility.

Pronounced and persistent seasonal patterns in fertility are observed in virtually all human populations. This paper presents evidence on these seasonal patterns. We note that the most pronounced seasonal patterns are in the southern United States, where births decline substantially in April and May, and in northern Europe, where births increase substantially in March and April. Although seasonal variations in fertility were more pronounced in earlier agricultural populations, we show that seasonality has increased in this century in some high income, low fertility populations such as Sweden. We use data on monthly temperature to analyze the potential role of temperature in explaining seasonal patterns. We find strong evidence that summer heat plays an important role in explaining the July-August trough in conceptions in the southern United States. We find little evidence, however, that temperature plays any role in explaining the pronounced June-July peak in conceptions in Sweden. Temperature also appears to be relatively unimportant in several other populations with substantial seasonal variations in births, suggesting that other factors play an important role in birth seasonality.

Birth Rate↗
PubMed1997

High prevalence of cholelithiasis in a low income Mexican population: an ultrasonographic survey.

The authors present the results of a population-based survey of cholelithiasis carried out in a low-income area of Mexico City using high-resolution gallbladder ultrasound. The purpose of the study was to estimate the prevalence and selected associated risk factors of cholelithiasis (CL). The population of the studied area was 15,532 subjects, of whom 3,505 (22.6%) were eligible for the baseline survey (men and non-pregnant women between 35-64 years of age). Of this group, 1,735 (76.03%, 702 men and 1,033 women) were located for a follow-up study. Ultrasonography was performed on all except for 100 subjects who had undergone previous cholecystectomy. Crude prevalence of CL was 14.1% (95% CI 12.5-15.5). The prevalence was 5.8% (95% CI 4.1-7.5) in men and 19.7% (95% CI 17.3-22.1) in women. Presence of gallstones was associated with age, sex (men p<0.006, women p<0.001), and multiparity (p<0.002). Centrality index in men and body mass index in women were positive and significantly associated with CL when compared with subjects without CL. High levels of fasting and post-glucose load insulin in women and men respectively were associated with CL. The authors conclude that the population of this study has a high prevalence of CL and confirm some known risk factors such as age, sex, BMI and multiparity. Proper assessment of the magnitude problem and characterization of potentially modifiable risk factors will play a major role in preventing this pathology.

Adult↗