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PubMed2001

Management of diabetes mellitus in three settings in Jamaica.

OBJECTIVES: To evaluate the quality of diabetic care in three clinics (one of them private and the other two public) in Jamaica, which is a middle-income country with a high prevalence (13%) of diabetes. METHODS: During a six-week census in 1995 at the three clinics we collected data retrospectively on a total of 437 diabetic patients. One of the clinics was a specialist public-hospital clinic ("SPMC"), one was a private group general practice ("PRMC"), and one was a public polyclinic ("PUBMC"). The patients' median age ranged from 56 years at SPMC and PRMC to 63 years at PUBMC. Median follow-up had been 6.0 years at SPMC, 9.2 years at PRMC, and 6.3 years at PUBMC. RESULTS: Fewer than 10% of the patients were controlled with diet alone. Insulin was the most commonly prescribed agent at SPMC (46%), compared to 7% each at the two other clinics. Sulfonylurea drugs alone or in combination with metformin were the most common agents at PUBMC and PRMC. Overall, 40% of the patients had satisfactory blood glucose control (< 8 mmol/L fasting or < 10 mmol/L postprandial). There was no significant difference among the clinics in the proportion of patients with satisfactory blood glucose control (P = 0.26). A blood glucose measurement had been recorded in the preceding year in 84% of the patients at SPMC, 79% at PRMC, and 67% at PUBMC. Glycosylated hemoglobin was infrequently measured: 16% at SPMC, 10% at PRMC, and 0% at PUBMC. Overall, 96% of patients had had surveillance for hypertension, and 81% had had surveillance for proteinuria. Surveillance for foot and retinal complications was generally infrequent and had been noted in patients' clinic records most commonly at SPMC (14% for foot complications, and 13% for retinal complications). The staff at the three clinics seldom advised the diabetic patients on diet, exercise, and other nonpharmacological measures, according to the clinics' records. CONCLUSIONS: The management of diabetes in Jamaica fell short of international guidelines. Our results also indicate the need to better sensitize health care professionals to these standards in order to reduce the burden of diabetes.

Adult↗
PubMed2002

Determinants of optimal breast-feeding in peri-urban Guatemala City, Guatemala.

OBJECTIVE: This survey was conducted to identify factors affecting early initiation of breast-feeding and exclusive breast-feeding among mothers in peri-urban Guatemala City, Guatemala. MATERIALS AND METHODS: In early November 1999 a census was begun in four communities of peri-urban Guatemala City, Guatemala, to identify all children < 6 months old as well as all pregnant women who were expected to deliver during the two-month data-gathering period. After the census was completed, a survey of breast-feeding practices was administered to all mothers of infants < 6 months of age. RESULTS: The most important determinant of early initiation of breast-feeding was place of delivery. Children born at home (odds ratio (OR) = 4.1, 95% confidence interval (CI): 1.2-13.3) and at Ministry of Health health centers (OR = 4.9, 95% CI: 1.6-15.0) were significantly more likely than children born at private hospitals to initiate breast-feeding early. The most important determinant of exclusive breast-feeding was whether or not the mother worked outside the home. After controlling for infant's age and sex and mother's ethnicity, women who did not work outside the home were 3.2 times as likely (95% CI: 1.6-6.4) to exclusively breast-feed as were women who worked outside the home. Lack of exclusive breast-feeding was often associated with giving a bottle. CONCLUSIONS: Our findings suggest that global efforts must be continued to improve breast-feeding practices in delivery hospitals. In addition, community-based support of breast-feeding is needed well after delivery. Mothers who work outside the home should be provided with options to maintain exclusive breast-feeding when they are physically separated from their infants due to the demands of work.

Adult↗
PubMed1988

Job characteristics in relation to the prevalence of myocardial infarction in the US Health Examination Survey (HES) and the Health and Nutrition Examination Survey (HANES).

Associations between psychosocial job characteristics and past myocardial infarction (MI) prevalence for employed males were tested with the Health Examination Survey (HES) 1960-61, N = 2,409, and the Health and Nutrition Examination Survey (HANES) 1971-75, N = 2,424. A new estimation method is used which imputes to census occupation codes, job characteristic information from national surveys of job characteristics (US Department of Labor, Quality of Employment Surveys). Controlling for age, we find that employed males with jobs which are simultaneously low in decision latitude and high in psychological work load (a multiplicative product term isolating 20 per cent of the population) have a higher prevalence of myocardial infarction in both data bases. In a logistic regression analysis, using job measures adjusted for demographic factors and controlling for age, race, education, systolic blood pressure, serum cholesterol, smoking (HANES only), and physical exertion, we find a low decision latitude/high psychological demand multiplicative product term associated with MI in both data bases. Additional multiple logistic regressions show that low decision latitude is associated with increased prevalence of MI in both the HES and the HANES. Psychological workload and physical exertion are significant only in the HANES.

Adolescent↗
PubMed1997

Social class and premature mortality among men: a method for state-based surveillance.

OBJECTIVES: This study examined trends in mortality by social class for Black and White men aged 35 through 54 years in North Carolina, for 1984 through 1993, using an inexpensive, newly developed state-based surveillance method. METHODS: Data from death certificates and census files permitted examination of four social classes, defined on the basis of occupation. RESULTS: Premature mortality was inversely associated with social class for both Blacks and Whites. Blacks were at least twice as likely to die as Whites within each social class. CONCLUSIONS: Adoption of state-specific surveillance of social class and premature mortality would provide data crucial for developing and evaluating public health programs to reduce social inequalities in health.

Adult↗
PubMed2001

Using aggregate geographic data to proxy individual socioeconomic status: does size matter?

OBJECTIVES: This study assessed whether aggregate-level measures of socioeconomic status (SES) are less biased as proxies for individual-level measures if the unit of geographic aggregation is small in size and population. METHODS: National Health Interview Survey and census data were used to replicate analyses that identified the degree to which aggregate proxies of individual SES bias interpretations of the effects of SES on health. RESULTS: Ordinary least squares regressions on self-perceived health showed that the coefficients for income and education measured at the tract and block group levels were larger than those at the individual level but smaller than those estimated by Geronimus et al. at the zip code level. CONCLUSIONS: Researchers should be cautious about use of proxy measurement of individual SES even if proxies are calculated from small geographic units.

Data Collection↗
PubMed1997

Same eyes, different doctors: differences in primary care physician referrals for diabetic retinopathy screening.

OBJECTIVE: To analyze eye care specialist referral patterns for the diabetic patients of primary care physicians. RESEARCH DESIGN AND METHODS: In 1993, we conducted a census of primary care physicians to evaluate practice patterns relating to diabetes care in the state of Indiana. Using a logistic regression model and data from this census, we compared 1) physicians' odds of referring type II diabetic patients to an optometrist, as opposed to an ophthalmologist, with those of type I diabetic patients and 2) the referral odds ratios of type II to type I diabetic patients between metropolitan and nonmetropolitan counties. RESULTS: Overall, 10% of the physicians in our study most often refer some patients to an optometrist. Physicians are more likely to refer their type II diabetic patients to an optometrist, as opposed to an ophthalmologist, than they are to refer type I diabetic patients, both before and after adjustment for covariates. Physicians who practice in metropolitan counties are 1.55 times more likely to refer their type II diabetic patients than their type I diabetic patients to an optometrist. In nonmetropolitan counties, physicians are 2.5 times more likely to refer their type II diabetic patients to an optometrist. The difference between metropolitan and nonmetropolitan physicians is significant (P = 0.027). CONCLUSIONS: Some physicians mostly refer their diabetic patients to optometrists, instead of ophthalmologists, for eye examinations intended to discover early signs of diabetic eye disease. Type II diabetic patients are more likely to be referred to an optometrist, instead of an ophthalmologist, than are type I diabetic patients. In nonmetropolitan areas, the difference in referral patterns becomes even more marked.

Censuses↗
PubMed2000

How much does self-reported health status, measured by the SF-36, vary between electoral wards with different Jarman and Townsend scores?

BACKGROUND: The best way for practices to determine the health status of patients living in areas with different socioeconomic characteristics is unclear. AIMS: To see how much SF-36 health status varies between electoral wards, how much of this variation can be explained by census-derived Jarman and Townsend scores, and compare the performance of census scores with direct socioeconomic information. METHOD: A postal questionnaire survey of 3000 randomly selected 18 to 75-year-olds residing in 15 electoral wards and registered with two urban practices. RESULTS: The response rate was 73%. Only two of the eight SF-36 domains were significantly associated with Jarman scores, whereas seven domains were associated with the Townsend score. Of the four socioeconomic variables derived directly from the survey, unemployment showed the weakest association, housing tenure was associated with seven domains, and car ownership and low income were associated with all eight. Income explained between 47% to 71% of the variation across the eight domains. CONCLUSION: The most accurate predictions about health status were made from direct socioeconomic information. Nonetheless, the association between Townsend score and health status was strong enough to be of practical importance. This study cautions against assuming the Jarman score of a population has a clear relationship with its health status.

Adolescent↗
PubMed1993

Asian and Pacific Islander Americans: An Overview of Demographic Characteristics and Health Care Issues.

PURPOSE: To review the demographic characteristics of Asian and Pacific Islander Americans &lpar;APIAs&rpar; and their health care needs. METHODS: The author reviewed the 1990 Census data, later Current Population Surveys, monographs, books, and the medical literature on APIAs based on MEDLINE and other sources. FINDINGS: APIAs are the fastest growing minority in the U.S. They are mostly foreign&shy;born, highly diversified, heterogeneous, bipolar in socioeconomic status, and concentrated in the West and metropolitan areas. APIAs have many health care needs&colon; lack of health data, ethnocultural barriers, and high frequency of hepatitis B and tuberculosis and certain genetic disorders such as thalassemia and lactase deficiency. It is also questionable whether some U.S. norms and standards based on non&shy;APIA subjects are appropriate for APIAs. CONCLUSIONS: APIAs are a fast growing minority whose many unmet health care needs have been overshadowed by the myth of a model minority. The health care system should address these needs and assure equal access to health services for all minorities. KEY WORDS: Asian Americans, Culture, Ethnicity, Health Services Accessibility, Health Education, Health Policy, Hepatitis B, Minority Groups, Thalassemia, Tuberculosis

Journal Article↗
PubMed1975

Cancer in United States Jews.

The published studies of cancer of United States Jews are reviewed. Despite the lack of religious designation on death certificates, case reports, and census returns, a number of indirect methods for measuring the problem have been devised, which produce fairly consistent findings. In general, for American Jews, these show deficits in cancer mortality, among males, for the buccal cavity and pharynx and prostate and, among females, for the breast, uterine cervix and corpus, and bladder. Excesses in mortality, noted for both sexes, are esophagus, stomach, colon, pancreas, lymphomas, and leukemia and, in females, the lung and the ovary. The standardized mortality ratios for cancer of selected sites for Russian-born residents of upstate New York, 1969 through 1971, are presented as an indirect measure of the problem in the United States Jews. Statistically significant excesses were found in males for stomach and colon, with a striking deficit in cancer of the buccal cavity and pharynx. Among females, excesses were noted for stomach, pancreas, and lung with a sharp deficit in the uterine cervix. On the basis of the religious affiliation of the cemetery of burial, estimates of the Jewish and non-Jewish components of the 800 deaths in Russian-born residents were determined. Expected deaths in these two subgroups by sex, for each cancer site, were then calculated by use of the site-specific proportionate mortality of upstate New York for these years. This revealed a significant excess among Jewish males for colon cancer, with a deficit in lung cancer, while among the non-Jewish male components stomach cancer mortality was the only site significantly in excess. Among Jewish females, stomach and lung cancers were in excess, with a deficit in cancers of the breast and cervix uteri. In non-Jewish Russian-born females, the only site significantly in excess was stomach, with breast cancer showing a deficit.

Humans↗
PubMed1993

Fertility pattern of women in China: a parity progression analysis.

"Using the 1% sample data from China's fourth census and [the] period parity progression method...,this paper analyzes the reproductive age and parity patterns of Chinese women. In addition to the commonly used period parity progression and the total fertility rate obtained through the usage of this method, some other frequently ignored means of deducing and calculating statistical indexes are introduced here."

Age Factors↗
PubMedDate not supplied

[Authorization and accreditation: management of the conversion of hospital buildings].

The Emilia Romagna Region decided own accreditation and procedures pattern following decisions, by different levels and graduated stages: authorization, institutional accreditation and finally contractual agreements. For Emilia Romagna Health Administration, authorization step represented "the necessary minimum level of security to exercise health activity", carried out by self evaluation of general and specific requirements of health structures, outlined by specific check-list, to bring about the maximum time allowed five years realization of structure adjustment plans. Beginning from this context the Local Health Unit of Modena, introduced by an audit test of conformity levels caught up, the guide line of computer management of technical assistance, change to use or amplification of health permission of structure and installations take a census by the business administration. The method allows by operative guide lines standardization to certify the validity of innovations realized, in all Departements/Services, for own conformity of structures, plant design and installation, sanitary regulations and security for wards services, auxiliary rooms. The development of this method allow to link activity and professionality for different duties of supervision and inspection, to guarantee the maintenance of levels assurance of health structures.

Accreditation↗
PubMedDate not supplied

[A study of the fragile X syndrome among the employees of the Spanish National Telephone Company].

Our aim was to study the incidence rate of the X-fragile syndrome among the male employees throughout Spain and that of the physically handicapped dependants of those workers at the Spanish National Telephone Company (TESA), this last goal being to offer genetic counselling to their families. The method used was to check the census of the Telephone Company Handicapped Assistance Association (ATAM), which embraces all handicapped dependents of TESA employees. 386 mentally backward (IQ under 70) males were found. A cytogenic study was offered to all those cases of unknown etiology. A total of 49 cases (12.7%) without any data to lead us into thinking of other etiological factors refused to take part. Molecular genetic studies were carried out on families with male members diagnosed as having X-fragile syndrome. The results were as follows: the total number of patients suffering with this syndrome was eleven. The incidence rates of X-fragile syndrome in the group studied was 14.3/386 (3.7% of mentally backward males). Molecular genetics was more sensitive than cytogenetics in diagnosing the state of mother and sister carriers.

Adolescent↗
PubMed1996

Parental attitudes do not explain underimmunization.

OBJECTIVE: This article describes the results of a community-based study to determine the effect of family knowledge and attitudes on the immunization rates of a random sample of children younger than 2 years in the poorest census tracts of Baltimore. DESIGN AND METHODS: The two sources of data were (1) parent interviews that provided data on knowledge, attitudes, and beliefs related to immunization and sociodemographic characteristics, and (2) medical record audits from which data on immunization status were obtained. The protection motivation theory, a model of behavioral change, was used to select the variables to assess the relation of parental attitudes with immunization status. A multivariate logistic regression analysis included only variables found to be significantly associated with immunization outcome in the preliminary analysis. RESULTS: Mothers were well informed and generally had favorable attitudes toward immunizations. Immunization status was more strongly associated with the sociodemographic characteristics of the children than with the protection motivation theory variables. Only two protection motivation theory variables were associated with more than one immunization outcome. The children of mothers who perceived that timing of vaccination did not matter were less likely to be immunized than children of care takers who thought that it did matter and children whose parents believed in the safety of multiple immunizations were less likely to be immunized than children whose parents did not hold this belief. CONCLUSIONS: In this study, parents' attitudes and beliefs had little effect on their children's immunization levels. Interventions intended to heighten parental awareness about immunization may have little impact. In poor urban neighborhoods, African-American children whose mothers are young, have multiple siblings, and do not use the Women, Infants and Children program may be at highest risk for delayed immunization.

Adult↗
PubMed1996

[The prevalence of markers for the hepatitis A and B viruses in the population of Gijón between 6 and 25 years old].

BACKGROUND: The aim of this study was to know the prevalence of previous infection markers for hepatitis A and B viruses in a pediatric-juvenile population from Gijón, Spain. PATIENTS AND METHODS: A representative (according to the census) transversal randomized sample of a population from 6 to 25 years in age from Gijón, Spain, was included in the study analyzing demographic, epidemiologic and clinical variables, liver tests, anti-HAV IgG and anti-HBc. RESULTS: Of the 630 individuals selected a demographic error was detected in 28 (4.4%) and 453 subjects were studied (71.9%) in whom the anti-HAV IgG was positive in 37 cases (8.75% of prevalence adjusted for age), with 4.4% (12/271) (CI 95% 2.3%-7.6%) for the younger cases and 13.7% (25/182) (CI 95% 9.1%-19.6%) in the group ranging from 18 to 25 years in age (p < 0.001). No anti-HAV IgG positive case was detected in the population under the age of 10 years. Among the young adults the prevalence of anti-HAV IgG positive cases was higher in those born in the south of Spain (2/6, 33.3%) (CI 95% 4.3%-77.7%) with respect to those from the northern regions of Spain (9/259, 3.5%) (CI 95% 1.6%-6.4%). (p = 0.02). With respect to HBV markers, of the 433 unvaccinated cases, 6 (1.4%) presented markers of past infection and 2 (0.46%) HBsAg positivity. Both had normal serum ALT without viral replication. Six cases of hypertransaminasemia levels (1.3%) were detected all being related with obesity or alcoholism. All the cases with previous acute clinical hepatitis were found to be anti-HAV IgG positive and anti-HBc negative. CONCLUSIONS: The current prevalence of anti-HAV IgG in the population from 6 to 25 years from Gijón, Spain is very low and given the high degree of susceptibility (86%) for HAV infection in the young adult population (18-25 years) the implementation of vaccination programs is recommended even without previous serologic screening. The low prevalence of anti-Hbc would also undervalue its use as prevaccination screening against HB in this geographical area.

Adolescent↗
PubMed1997

Local population differences and the needs of people with cognitive impairment.

INTRODUCTION: Variations in local population age structure have attracted less attention than national population ageing. As moderate and severe cognitive impairment is a major cause of need for long-term care, population-based estimates of the numbers and characteristics of this group were calculated, to explore the effects of local differences. METHOD: The UK Office of Population Census and Surveys (OPCS) study of disability in adults (N > 14000) was reanalysed. A group with moderate or severe cognitive impairments was identified and age-specific estimators of sociodemographic characteristics, household types, disabilities and service use were combined with population estimates for district health authorities in England and Wales. RESULTS: The proportion of the 65 plus population who are 85 plus varies from 8% to 15% across districts, equivalent to national population projections for 1986 and 2031 respectively. The estimated prevalence of the study group varies from 53 to 70 per 1000 population aged 65 plus, with 34-48% of cases aged 85 plus. Curiously, the proportion with severe disabilities varies little across districts. If national norms applied, local rates of institutionalization would vary from 18 to 27 per 1000 aged 65 plus. CONCLUSION: Local differences in population age structure age large compared to national changes over decades. Local differences have substantial effects on overall prevalence and on the proportion of the cognitively impaired who would be institutionalized if national patterns applied. Service design should be influenced by these complex variations, with estimates modified by local surveys.

Activities of Daily Living↗
PubMed1997

A population based survey of hepatitis B virus infection in a southern Italian town.

BACKGROUND: The level of endemicity and modes of transmission of hepatitis B virus infection may change over time. AIMS: To assess prevalence of and risk factors for hepatitis B infection in the general population. SUBJECTS: A total of 1352 subjects residing in a Southern Italian town in the year 1996. METHODS: Subjects were selected from the census by a systematic 1:4 random sampling procedure. Hepatitis B surface antigen and antibodies to hepatitis B core antigen were detected by ELISA. The association (Odds Ratio) linking hepatitis B seropositivity to potential risk factors was estimated by univariate and multivariate analysis. RESULTS: The participation rate was 96.6%. The overall prevalence of hepatitis B surface antigen and antibodies to hepatitis B core antigen were 0.8% and 21.5%, respectively. Hepatitis B surface antigen prevalence was 0.2% in subjects younger than 30 years, peaked to 2.5% in the age-group 40-49 years, and decreased to 0.3% in those 60 years and older. Antibodies to hepatitis B core antigen positivity linearly increased from 6.2% in subjects < 30 years of age to 37.1% in those 60 years or older (p < 0.01). The results of multiple logistic regression analysis showed that age > 45 years (Odds Ratio = 1.9; Confidence Intervals 95% = 1.2-3.0), use of glass syringes (Odds Ratio = 2.2; Confidence Intervals 95% = 1.5-3.4), surgical intervention (Odds Ratios = 1.8; Confidence Intervals: 95% = 1.3-2.6), and positivity for antibodies to hepatitis C virus infection (Odds Ratios = 2.6; Confidence Intervals 95% = 1.5-4.3) were all independent predictors of the likelihood of hepatitis B positivity. CONCLUSIONS: Given that a significant proportion of the general population undergoes surgical intervention, the association found between hepatitis B positivity and this exposure highlights the importance of further developing efficient procedures for the sterilization of instruments as well as the use of disposable materials to control the spread of infection.

Adult↗
PubMed1995

The impact of estimation method and population adjustment on Canadian life table estimates.

Abridged life tables centred on 1991 were produced from the 1991 Canadian census, net census undercoverage estimates, and death data from 1990 to 1992. The sensitivity of life table values to differing methods of estimation and population estimates was investigated. The results from four methods by Greville, Chiang, and Keyfitz were compared, and population estimates, both adjusted and unadjusted for net census undercoverage, were used to test the effects of method and type of population estimates on life table values. The results indicate that the method used to derive the estimates had much less influence on the life table values than did the choice of population estimate. The change in life expectancy at birth due to the method of calculation chosen was at most 15 days, whereas the change due to the population estimate chosen was about 73 days. Since there are age, sex and provincial variations in net undercoverage rates, life expectancies differed accordingly.

Adolescent↗