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At least 793 records · Page 44Linked to original sources
PubMed2006

Socio-economic position and common mental disorders. Longitudinal study in the general population in the UK.

BACKGROUND: Individuals in lower socio-economic groups have an increased prevalence of common mental disorders. AIMS: To investigate the longitudinal association between socio-economic position and common mental disorders in a general population sample in the UK. METHOD: Participants (n=2406) were assessed at two time points 18 months apart with the Revised Clinical Interview Schedule. The sample was stratified into two cohorts according to mental health status at baseline. RESULTS: None of the socio-economic indicators studied was significantly associated with an episode of common mental disorder at follow-up after adjusting for baseline psychiatric morbidity. The analysis of separate diagnostic categories showed that subjective financial difficulties at baseline were independently associated with depression at follow-up in both cohorts. CONCLUSIONS: These findings support the view that apart from objective measures of socio-economic position, more subjective measures might be equally important from an aetiological or clinical perspective.

Adolescent↗
PubMed1991

Paraguayan pharmacies and the sale of pseudo-abortifacients.

This study was conducted in 1985 in Asunción, Paraguay, 6 years after the closure of the state supported family planning services. Data from national surveys in 1977 and 1987 permit a comparison of sources of contraceptive supplies before and after the elimination of government support for family planning. The purchase of pseudo-abortifacients from private pharmacies was used as an indication of induced abortion. After the loss of government clinics, it is suggested that some women turned to pharmacists to obtain pseudo-abortifacients when faced with unwanted pregnancy. There is an indication of increased pseudo-abortifacient use, particularly among unmarried women and those from poorer neighbourhoods.

Abortifacient Agents↗
PubMed2002

The association between biomarker-based exposure estimates for phthalates and demographic factors in a human reference population.

Population-based estimates of environmental exposures using biomarkers can be difficult to obtain for a variety of reasons, including problems with limits of detection, undersampling of key strata, time between exposure and sampling, variation across individuals, variation within individuals, and the ability to find and interpret a given biomarker. In this article, we apply statistical likelihoods, weighted sampling, and regression methods for censored data to the analysis of biomarker data. Urinary metabolites for seven phthalates, reported by Blount et al., are analyzed using these methods. In the case of the phthalates data, we assumed the underlying model to be a log-normal distribution with the mean of the distribution defined as a function of a number of demographic variables that might affect phthalate levels in individuals. Included as demographic variables were age, sex, ethnicity, residency, family income, and education level. We conducted two analyses: an unweighted analysis where phthalate distributions were estimated with changes in the means of these distributions as a function of demographic variables, and a weighted prediction for the general population in which weights were assigned for a subset of the population depending on the frequency of their demographic variables in the general U.S. population. We used statistical tests to determine whether any of the demographic variables affected mean phthalate levels. Individuals with only a high school education had higher levels of di-n-butyl phthalate than individuals with education beyond high school. Subjects who had family income less than $1,500 in the month before sampling and/or only high school education had higher levels of n-butyl benzyl phthalate levels than other groupings. Di(2-ethylhexyl) phthalate was higher in males and/or in urban populations and/or in people who had family income less than $1,500 per month. Our findings suggest that there may be significant demographic variations in exposure and/or metabolism of phthalates and that health-risk assessments for phthalate exposure in humans should consider different potential risk groups.

Adult↗
PubMed2003

How did Finland's economic recession in the early 1990s affect socio-economic equity in the use of hospital care?

The study evaluates the changes in socio-economic equity in the use of general hospital care in Finland from the late 1980s to the mid 1990s. In the early 1990s the Finnish economy plunged into a deep recession which slashed over 10% of GDP and resulted in a 12% decrease in national health expenditure. At the same time, the administration and financing of specialised health services were reformed. The impact on general hospital care was controversial: budgets were reduced but better productivity increased the supply of many services. According to the study, data, based on individual linkage of nationwide hospital registers to disposable family income data in population censuses, overall acute general hospital admission rates among Finns aged 25-74 increased by over 10% from 1988 to 1996. For some surgical procedures, such as cataract, coronary revascularisation and some orthopaedic operations, rates more than doubled. In both years, lower-income groups generally used hospital care more than the better-off. However, there was a slight shift towards a pro-rich distribution, mainly due to a larger increase in surgical care among the high-income groups. In 1988 the lowest income quintile used 8% and in 1996 15% fewer operations than the highest. For individual procedures and surgical diagnostic categories, the general trends of increasing disparities were similar. Despite cuts in expenditures in the early 1990s, the Finnish general hospital system based on public funding and provision managed to increase the supply of services. However, this increase coincided with widening socio-economic discrepancies in the use of surgical services. The paper proposes that these increasing inequities were due to certain features of the Finnish health care system which create social discrepancies in access to hospital care. These include the high profile of the private sector in specialised ambulatory care and in the supply of some elective procedures, and semi-private public hospital services requiring supplementary payments from patients.

Adult↗
PubMedDate not supplied

Conflicting national recommendations and the use of screening mammography: does the physician's recommendation matter?

BACKGROUND: This study evaluated whether women's perceptions of the conflicting recommendations for breast cancer screening were associated with decreased use of mammography. METHODS: We conducted a random-digit-dial telephone survey of 1024 women in four communities of western Washington State. In addition to collecting data for demographics, beliefs about mammography, and insurance coverage, we inquired whether the respondents were aware of any conflicting recommendations about when to begin or how frequently to perform screening mammography, whether their physicians had recommended a mammogram, and whether they were likely to do what their physicians recommended. After grouping women according to whether they perceived conflicting recommendations, we used chi-square statistics to compare the distribution of proportions of women by age, race, household income, education, and insurance coverage. To estimate the odds of their having a mammogram in the previous 2 years (yes or no), we used multivariate logistic regression and included the above variables as covariates. RESULTS: Sixty-two percent of eligible women completed the survey, and 49 percent (479 of 985) perceived conflicting recommendations. The association between perceiving conflict and mammography use was not significant. Eighty-three percent of women who perceived conflicting recommendations reported being more comfortable using their own judgment about getting the procedure. After controlling for whether women perceived conflicting recommendations and all other factors, women who said they followed their physician's advice but did not recall their physician recommending mammography were 71 percent less likely to have received a recent mammogram than were women who reported their physician did recommend it (odds ratio 0.29, confidence interval 0.16-0.51). CONCLUSIONS: The conflicting recommendations surrounding breast cancer screening are not influencing women's choices about mammography. The physician recommendation and women's self-reported likeliness to follow it are the most important factors associated with mammography use.

Aged↗
PubMed1988

Effects of a televised smoking cessation intervention among low-income and minority smokers.

In November 1985, a television smoking cessation program was broadcast for 20 days on the noon and 9 p.m. news. Smokers in West Garfield Park, an inner-city impoverished area of Chicago, were randomly assigned either to a comprehensive intervention or to a no-intervention control condition. Although 100,000 self-help manuals had been distributed throughout Chicago, none of the controls in this low-income area had obtained a manual. The intervention consisted of providing the smokers a self-help manual, the televised broadcast, weekly support meetings, and supportive phone calls. At a 4-month follow-up, 20% of treatment participants were abstinent compared to 9% of controls. The results indicated that intensive supplementary opportunities enhanced participation by low-income smokers in a media smoking cessation program.

Adult↗
PubMed2004

Social factors and periodontitis in an older population.

OBJECTIVES: We assessed the prevalences of periodontitis by education and income levels among US adults with data from the third National Health and Nutrition Examination Survey. METHODS: The study was limited to non-Hispanic Blacks, Mexican Americans, and non-Hispanic Whites 50 years of age or older with a complete periodontal assessment during the dental examination. RESULTS: Blacks with higher education and income levels had a significantly higher prevalence of periodontitis than their White and Mexican-American counterparts. The relationship between income level and periodontitis was modified by race/ethnicity. High-income Blacks exhibited a higher prevalence of periodontitis than did low-income Blacks and high-income Whites. CONCLUSIONS: Our findings call attention to the importance of recognizing socioeconomic status-related health differences across racial/ethnic groups within the social, political, and historical context.

Black or African American↗
PubMed2001

The impact of income on children's and adolescents' preventive dental visits.

INTRODUCTION: Limited information is available on the effect of income level on whether people visit a dentist for preventive care, whereas more has been written regarding the effect of income on "any" dental visits--which may include emergencies. Also, little is known of the effects of "near-poor" income (101 to 200 percent of the U.S. federal poverty level) on dental visits and preventive dental visits. The authors examined the impact of income at the "poor" and "near-poor" poverty levels on preventive dental visits made by children and adolescents. METHODS: The authors used data from the 1996 Medical Expenditure Panel Survey for children and adolescents younger than 19 years of age to estimate the percentage of this group who had had preventive dental visits. They performed a multiple logistic regression analysis to adjust poverty levels by race and ethnicity, age and sex. RESULTS: The distribution of preventive dental visits for those who were poor was similar to that for those who were near-poor, but the percentage distribution of preventive visits for children and adolescents with higher income was significantly different from that for those in the lower income groups. This was true across all the variables considered. CONCLUSIONS: It is important to evaluate and monitor preventive care utilization trends for U.S. children and adolescents in the poor and near-poor categories separately, particularly in states that do not provide similar levels of access under the State Children's Health Insurance Program, or SCHIP. Enrollment of eligible children in Medicaid and SCHIP via oral health promotion outreach efforts, access to care and utilization of dental primary and secondary care services must be increased.

Adolescent↗
PubMed1975

Equity in paying for health care services under a national insurance system.

The debate over the future of the health care delivery system evolves around the policy issue of what constitutes a fair distribution of the medical services which are considered essential to prolonging life, curing disease, and relieving pain. A case can be made that a socially equitable distribution implies that consumption of medical services is independent of the consumer's income and payment for them unrelated to utilization. The present paper examines to what extent the provisions for financing a national health insurance system are likely to advance or hinder the fair distribution of health care services. Almost all bills specify a mix of direct (cost-shared) and indirect (prepaid) financing. When cost-sharing is based on the quantity of services or on the level of medical expenditure, it helps divert medical care and health insurance benefits to high-income persons at the expense of their low-or moderate-income counterparts. When indirect payments or premium levels are determined by insurance risks rather than by income, they may be too high for persons with moderate means, and are likely to exclude such persons from the national insurance program. When health insurance is tied to salaried employment, it discriminates against the unemployed and the self-employed. To rectify such inequities, some NHI proposals specify separate insurance plans for the disadvantaged. Such programs, which require income-testing to determine eligibility, are likely to be plagued by administrative complications currently engulfing other means-tested social welfare programs. The present paper makes some recommendations for the purpose of avoiding these difficulties and fostering equity in health care.

Deductibles and Coinsurance↗
PubMed2002

Methodological rigor with internet samples: new ways to reach underrepresented populations.

We present several rigorous methods for sampling difficult-to-reach and empirically underrepresented populations via the Internet. The methodology's representativeness was tested by comparing the demographics of a small sample of 82 lesbian and bisexual females with a much larger Gallup Organization sample of the general population (n > 1,000) obtained via random digit dialing. Compared to the latter poll, the rigorous sampling designs developed for the Internet were found to be significantly more robust and equally representative of the U.S. general population. The Gallup Organization reached a sample more representative of the age distribution of the United States. The Internet sample reached a sample more representative of the population, with less education, lower incomes, and a broad spectrum of ethnic diversity. The samples were equally effective in representing the distribution of the population with rural and urban residence.

Adolescent↗
PubMed2006

Horizontal equity in health care utilization evidence from three high-income Asian economies.

This paper compares the extent to which the principle of "equal treatment for equal need"(ETEN) is maintained in the health care delivery systems of Hong Kong, South Korea and Taiwan. Deviations in the degree to which health care is distributed according to need are measured by an index of horizontal inequity. Income-related inequality in utilization is split into four major sources: (i) direct effect of income; (ii) need indicators (self-assessed health status, activity limitation, and age and gender interaction terms); (iii) non-need variables (education, work status, private health insurance coverage, employer-provided medical benefits, Medicaid status (low-income medical assistance), geographic region and urban/rural residency and (iv) a residual term. Service types studied include western doctor, licensed traditional medicine practitioner (LTMP), dental and emergency room (ER) visits, as well as inpatient admissions. Violations of the ETEN principle are observed for physician and dental services in Hong Kong . There is pro-rich inequity in western doctor visits. Unusually, this inequity exists for general practitioner but not specialist care. In contrast, South Korea appears to have almost comprehensively maintained ETEN although the better-off have preferential access to higher levels of outpatient care. Taiwan shows intermediate results in that the rich are marginally more likely to use outpatient services, but quantities of western doctor and dental visits are evenly distributed while there is modest pro-rich bias in the number of LTMP episodes. ER visits and inpatient admissions in Taiwan are either proportional or slightly pro-poor. Future work should focus on the evaluation of policy interventions aimed at reducing the observed unequal distributions.

Asia↗
PubMed2003

Effect of 10 kV, 30 microT, 60 Hz electric and magnetic fields on milk production and feed intake in nonpregnant dairy cattle.

Milk production is the main agricultural income in the province of Québec, and the electrical distribution network traverses the rural dairy production region. This study evaluates the hypothesis that electric and magnetic fields may affect dairy production. Sixteen multiparous nonpregnant lactating Holstein cows (weighing 662 +/- 65 kg and with 150.4 +/- 40 days of lactation) were confined to wooden metabolic crates during the experiment with a 12:12 h light:dark cycle. The cows were divided into two replicates of eight cows each and exposed to a vertical EF of 10 kV/m and an uniform horizontal MF of 30 microT at 60 Hz. Replicate one was exposed for three periods. Each period was represented by an estrous cycle ranging from 24 to 27 days. During the first period, the electric and magnetic fields (E&MF) were off; during the second period they were on; and during the final period, they were off. The second replicate was exposed for three periods also, but the exposure protocol was reversed (first period, on; second period, off; last period, on). Exposure to E&MF (on) resulted in an average decrease of 4.97, 13.78, and 16.39% in milk yield, fat corrected milk yield, and milk fat, respectively; and an increase of 4.75% in dry matter intake.

Animals↗
PubMed2002

An analytical review of environmental justice research: what do we really know?

This article presents a review of major empirical research on environmental justice. Forty-two empirical research studies spanning three decades were evaluated and categorized on the basis of how well they meet reasonable scientific standards. Twelve of those studies are described and critiqued in detail, and an overview of trends in the literature is presented. The author concludes that the empirical foundations of environmental justice are so underdeveloped that little can be said with scientific authority regarding the existence of geographical patterns of disproportionate distributions and their health effects on minority, low-income, and other disadvantaged communities. If environmental managers and policy-makers do not recognize the high levels of empirical uncertainty surrounding the issue, they are apt to attribute an empirically unwarranted level of concreteness to the empirical research findings, thus leading to poorly conceptualized and therefore potentially harmful policy and management decisions.

Conservation of Natural Resources↗
PubMed1990

Patient sociodemographic characteristics as predictors of satisfaction with medical care: a meta-analysis.

A meta-analysis was performed to examine the relation of patients' sociodemographic characteristics to their satisfaction with medical care. The sociodemographic characteristics were age, ethnicity, sex, socioeconomic status (three indices), marital status, and family size. Greater satisfaction was significantly associated with greater age and less education, and marginally significantly associated with being married and having higher social status (scored as a composite variable emphasizing occupational status). The average magnitudes of relations were very small, with age being the strongest correlate of satisfaction (mean r = 0.13). No overall relationship was found for ethnicity, sex, income, or family size. For all sociodemographic variables, the distribution of correlations was significantly heterogeneous, and statistical contrasts revealed the operation of several moderating variables. The meaning of the overall results and their relation to earlier reviews is discussed.

Age Factors↗
PubMed1994

Lateness of diagnosis of oral and oropharyngeal carcinoma: factors related to the tumour, the patient and health professionals.

The risk of presenting with advanced stage vs. early stage disease was evaluated in a prospective study of 336 consecutive patients with oral and oropharyngeal carcinomas referred to three head and neck surgery services in Sao Paulo, Curitiba and Goiania during the period from February 1986 to December 1988. Income and educational levels were not associated with stage distribution. The risk of having advanced disease was dependent upon male gender. Another important determinant of advanced stage was tumour location on the less visible surfaces of the oral cavity and oropharynx. Although there was a clear increase in delay of referral among cases who were seen by more than one health professional, duration of symptoms and patient and professional delays were not associated with the risk of advanced disease in unifactorial analysis. The following factors were independently associated with the risk of advanced disease for lip carcinoma: a painful ulcer, alcoholism and delay caused by a non-specialist medical doctor. The risk factors associated to advanced oral carcinoma were: type of lesion, odynophagia/dysphagia, delay caused by a dentist and delay caused by a non-specialist medical doctor. Two of the most important immediate consequences of advanced stage were a conspicuous increase in treatment costs and a longer hospital stay.

Adolescent↗
PubMedDate not supplied

Equity in mental health.

AIM: The aim of this paper is to discuss the study of equity in mental health contexts. METHODS: We review major principles and theories of distributive justice, covering various disciplines such as ethics, philosophy, economics, medicine and sociology. Recent literature on empirical analysis of inequalities in the mental health field is also reviewed. RESULTS: The review of literature reveals a general lack of debate on equity principles in relation to mental health. Robust empirical evidence on inequalities in the field is also scarce. CONCLUSIONS: There is need for better exposition of the relevance of different equity principles for mental health policy and practice. There is also a need for developing standardised methods for the empirical analysis of equity, to examine the distribution of psychiatric morbidity and use of services by income, socio-economic group, ethnicity, gender and place of residence, and, of course, to examine how equity can be promoted.

Humans↗
PubMed1977

Geographic patterns of breast cancer in the United States.

To seek explanations for the geographic variation of breast cancer across the continental United States, we calculated the correlations between mortality rates for premenopausal and postmenopausal women and demographic data for the 3,056 U.S. counties. The northern predominance of this tumor was primarily among postmenopausal women, whereas mortality among premenopausal women was distributed almost uniformly across the country. Socioeconomic status (particularly income), German ethnicity, and colon cancer mortality were strong indicators of the rates for postmenopausal women, but only partly explained the northern excess and latitudinal gradient. In contrast, fertility patterns and ovarian cancer mortality were more closely linked to breast cancer among premenopausal women. The geographic peculiarities of this tumor in older women suggest extrinsic risk factors that remain to be identified, whereas the patterns for younger women point to the primary role of reproductive and genetic determinants.

Adult↗