Housing: rural roots to urban problems.
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A population-based case control study of primary liver cancer (PLC) was undertaken in Fusui County, Guangxi Autonomous Region. Ninety-nine PLC cases and 99 age-sex-matched controls were surveyed for their general conditions, life style features, dietary habits, types of drinking water and family history. Cases and controls were well distributed in nationality, education, marital status and annual income per person. Conditional logistic regression results showed that HBV infection, drinking pond-ditch water, family history and total alcohol intake were the risk factors of PLC with the relative risks 5.330 (2.502-11.35), 3.703 (1.251-10.96), 2.881 (1.289-6.441), 1.002 (1.000-1.004), respectively. And antibody of HBV surface antigen is protective factor with the relative risk of 0.418 (0.210-0.834).
The recent health care reform debate has questioned whether the health insurance market effectively pools risks and transfers income across states of health. We use data from the 1987 National Medical Expenditure Survey to examine how net health insurance benefits are distributed in the employment-related insurance market. We find this market to transfer income from those in good health to those with health problems and the tax subsidy from employer health insurance contributions to be a crucial determinant of the net benefit distribution. To the extent society views these transfers as meritorious, our findings suggest caution regarding initiatives to limit or eliminate the tax subsidy.
OBJECTIVE: To carry out a preliminary systematic review of literature to address the question - among rich nations (or states within nations) what is the evidence that income inequality and differences in macro-level social policy affect rates of infant mortality and low birthweight (LBW)? STUDY DESIGN: A systematic literature review. SEARCH STRATEGY: Medline database (1968-August 2003) was searched for empirical studies of the relationship between macro-level economic and social policies in rich nations and rates of infant mortality (IMR) and LBW. Cross-national comparison of infant mortality and LBW that did not compare the effects of macro-level economic and social policies was excluded from the review as were studies including less developed countries. Keywords representing IMR and LBW were entered into Medline along with exposures related to international comparison and macro-level policy. Abstracts obtained from the initial search were reviewed for relevant studies. Full papers of potentially relevant studies were obtained and reviewed for inclusion. Secondary search of papers cited in included papers was undertaken. For this review, papers were not excluded on the basis of quality although methodological limitations were commented on and taken into account in interpreting the results. Summary statistics were not estimated. RESULTS: Twelve studies, fulfilling the inclusion criteria, were identified. Ten studies examined the association of IMR with income inequality, eight of which reported a statistically significant positive association with higher levels of inequality after adjustment for a range of variables. Six studies reported significant positive associations of IMR with other indicators of less re-distributive social and economic policy. Associations with LBW were reported in four studies; three showed significant positive associations with higher levels of income inequality and one showed no association with low levels of parental leave entitlement. Methodological differences, particularly the wide range of variables used to adjust for confounding, make interpretation of the findings difficult. CONCLUSIONS: The results of this review represent a preliminary attempt to summarize the literature linking macro-level economic and social policies in rich nations with IMR and LBW. The findings, taking account of the methodological limitations of the review and of the included studies, suggest a statistically significant association between IMR and higher income inequality and other indicators of less re-distributive social policy. Only three studies examined the association of income inequality with LBW and, although they suggest a significant association, further studies will be needed to confirm this finding.
Previous research has attempted to infer dentists' pricing practices from aggregate data, such as those derived from insurance claims. In a disaggregated analysis based on a mail survey of 327 dentists in private practice, the authors find the most important influence on dental fees to be cost, followed by fees charged by other dentists and perceptions of patient sensitivity to prices. The relative importance of the various influences on dentists' fees is related to several practice characteristics, including location and gross income.
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BACKGROUND: A good understanding of the association between obesity and socioeconomic status (SES) has many important public health and policies implications, particularly for the prevention and management of obesity. OBJECTIVE: The objective was to examine secular trends in the relations between overweight (body mass index > or = 95th percentile) and SES. DESIGN: We examined secular trends in the relation between overweight and SES using nationally representative data collected in the National Health and Nutrition Examination Surveys (NHANES) between 1971 and 2002 for 30 417 US children aged 2-18 y. Poverty income ratio tertiles at each survey were used to indicate low, middle, and high SES. RESULTS: Considerable race, sex, and age differences were observed in the association between overweight and SES. A reverse association only existed in white girls; African American children with a high SES were at increased risk. Socioeconomic disparities in overweight have changed over time, with an overall trend of weakening. Compared with the medium-SES group, the adjusted odds ratios and 95% CIs were 0.79 (0.47, 1.33), 1.08 (0.73, 1.61), 1.24 (0.73, 2.09), and 1.04 (0.82, 1.33) in NHANES I, II, and III and in the 1999-2002 NHANES for the low-SES group and 0.66 (0.43, 1.00), 0.60 (0.35, 1.03), 0.42 (0.23, 0.76), and 0.99 (0.68, 1.43) for the high-SES group, respectively. Between 1988-1994 and 1999-2002, the ratio in the prevalence of overweight between adolescent boys with a low or high SES decreased from 2.5 to 1.1 and from 3.1 to 1.6 in girls. Consistently across almost all SES groups, the prevalence of overweight was much higher in blacks than in whites. CONCLUSIONS: Complex patterns in the association between SES and overweight exist. Efforts solely targeting reductions in income disparities probably cannot effectively reduce racial disparities in obesity.
Like all health care professionals, orthodontists are concerned about the need and demand for their services. Orthodontists should experience an increase in demand for their services as a result of an increasing population and an aging orthodontist population. How many additional orthodontic graduates do we need per year in Texas? Based on many factors, Texas dental schools could graduate additional students per year to be consistent with those factors. In conclusion, it appears that Texas can easily support three graduate orthodontic residency programs. As we enter the next millennium, the future of orthodontics has never looked better.
The compelling evidence linking small size at birth with later cardiovascular disease has renewed and amplified a clinical and scientific interest in the determinants of fetal growth. Although the effects of maternal nutrition on fetal growth have been extensively studied, comparatively little is known about the effects of maternofetal hypoxia. This study tested the hypothesis that in highland regions, high altitude rather than maternal economic status is associated with reduced and altered fetal growth by investigating the effects of high altitude versus economic status on birth weight and body shape at birth in Bolivia. Bolivia is geographically and socioeconomically unique. It contains several highland (>3500 m above sea level) and lowland (<500 m) cities that are inhabited by very economically divergent populations. Birth weight, body length, and head circumference were compared between a high- (n = 100) and low- (n = 100) income region of La Paz (3649 m; largest high-altitude city) and a high- (n = 100) and low- (n = 100) income region of Santa Cruz (437 m; largest low-altitude city). In addition, the frequency distribution across the continuum of birth weights was plotted for babies born from high- and low-income families in La Paz and Santa Cruz. Mean birth weights were lower in babies from La Paz than in babies from Santa Cruz in both high- and low-income groups. The cumulative frequency curve across all compiled birth weights was shifted to the left in babies from La Paz compared with those from Santa Cruz, regardless of economic status. The frequency of low birth weight (<2500 g) was higher in babies from La Paz than from Santa Cruz in both high- and low-income groups. In addition, at high altitude but not at low altitude, high income was associated with an increase in the head circumference:birth weight ratio. These findings suggest that high altitude rather than economic status is associated with low birth weight and altered body shape at birth in babies from Bolivia.
OBJECTIVE: Data from two household surveys on infant and child health status undertaken in the mid-80s and mid-90s, complemented with previous data collected from maternity hospitals records and more recent data provided by the state system on birth registries, allowed to characterize and analyse secular trends in birth weight in the city of S. Paulo, Brazil. METHODS: The household surveys included random samples of children under 5 years old (n = 1,016 children in 1984-85 and n = 1,280 children in 1995-96). A random sample of births that took place in the city's hospitals in the year of 1976 (n = 5,734) was drawn from the hospital records. Birth registries refer to children born in the city between 1993 and 1998 (around 200,000 per year). The study of the social distribution of birth weight took into account the per capita family income and maternal schooling. For the analysis of the determinants of secular trends, hierarchical causal models, multivariate regression analyses and calculations analogous to the ones used to assess population attributable risks were applied. RESULTS/CONCLUSIONS: Birth weight distribution in S. Paulo city (an average of 3,160 g and 8.9% of the values < 2,500 g) is below the expected for optimum fetal growth conditions (average 3,400-3,500 g and 4-5% of the values < 2,500 g). The birth weight distribution did not change substantially along the study period (1976-1998). However, there are evidences of changes when different socioeconomic strata are considered separately. Among the lower strata trends have been positive and this seems to be due to increases in intrauterine growth as a result of an improvement in family's purchasing power, women's weight and height, prenatal care and, possibly, the reduction in smoking. Among the higher socioeconomic strata, birth weight trends have been negative apparently due to an increase in premature births of unknown origin.
The association of lung cancer incidence with income and education and the effect of adjustment for socioeconomic distribution on black-white differences in lung cancer rates were evaluated using data from the Third National Cancer Survey. Included in this study were 20,868 cases of lung cancer (18,514 among whites and 2354 among blacks) diagnosed among metropolitan residents of the survey during 1969-1971. Median family income and median years of education by census tract of residence were used to indicate socioeconomic group. Strong significant inverse trends between lung cancer incidence and both income and education were apparent among white and black males, and the effect of income exceeded that of education. Lung cancer rates among black males compared with white males were significantly higher (p less than 0.001) before socioeconomic adjustment, nonsignificantly higher after adjustment for education, and nonsignificantly lower after adjustment for income. Strong trends in risk with income or education were not observed for lung cancer among females of either race.
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The present aimed at characterizing the retired old population (members of the retired people and pensioners Association of Ribeirão Preto, São Paulo) who live in this town. The study was carried out from 01/01/89 through 31/12/89. This population was composed of 38 retired and old age pensioners: 30 (78.9%) males and 8 (21.1%) females. It was used the method for data collecting which was the questionnaire with close and open questions; the used technique was the recorded interview. As in our country the retired benefit is inferior to be work's remunerations in the period of activity, the retired person is obliged to look for other ways of income to complement that benefit, and the medical assistance, where it was not expected by the population.
Teaching at medical schools has been supported principally through research and clinical income, but these resources have become more scarce, faculty have begun to look elsewhere for support of student teaching. Yale University School of Medicine has developed a model for distributing a portion of general revenue funds to departments based entirely on their faculty members' commitment to the teaching of undergraduate medical students. This model combines both a qualitative measure (effectiveness) and a quantitative measure (effort) to assess the commitments of faculty to teaching. Initial response has been primarily positive. Both faculty members and chairs have acknowledged that faculty should receive financial support for major teaching responsibilities. Although the amount of funding may not be proportional to the actual effort of faculty members, by apportioning tuition dollars for teaching Yale hopes to send a powerful message about its commitment to its teaching faculty and to its medical students.
The authors analyzed the mean net income of a cohort of male and female dentists with similar demographics and practice characteristics. The authors found that the average net income of these male dentists is higher than it is for their female counterparts. This difference is statistically significant and monetarily tangible, amounting to an annual net income balance of about $26,000 (22 percent) in favor of male dentists. If such a difference in net income persists, it could affect the profession as well as the distribution of dental school enrollments.
Enhancing patient satisfaction offers a way of optimising health status and helps in the reduction of wastage of medical resources. The direct measurement of patient satisfaction is new in Kuwait. This study aimed to assess patient satisfaction with respect to physicians' services in primary health care (PHC) and to determine the association of patients sociodemographic variables on their satisfaction level. The sample consisted of 301 patients selected systematically from five primary healthcare centres (PHCC) to represent various geographic areas in Kuwait. The data were collected by personal interview using a structured questionnaire. The overall mean satisfaction with physician services was 2.21 points out of a maximum of five points. The results from multiple regression analysis indicated that gender, marital status, occupation and income are the most important predictors, with females, married, labourers and higher income levels having the highest mean satisfaction score. The principal component analysis indicated that the most important aspect is 'communication' which accounted for 54% of the total variance. The results suggested a need for an educational programme to inform patients of the objectives and limits of primary health services.
We used data from a prospective investigation of full-time workers aged 58 to 64 years and residing in a North Carolina metropolitan area at baseline to examine a causal model for depressive symptomatology among White men, White women, African American men and African American women. We found significant group differences. (1) White men were more vulnerable to social network losses than White women; (2) Work stressors had long-term effects on African American men whose levels of depressive symptoms were also elevated by poor health and retirement; and (3) The influence of income was more dominant among African Americans and its effect was greater for African American women.