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PubMed1999

The epidemiology of cataract in Australia.

PURPOSE: To describe the prevalence and risk factors for cataract in an Australian population aged 40 years and older. METHODS: Participants were recruited by a household census and stratified, random cluster sampling to represent residents of Victoria, Australia, aged 40 years and older. The following information was collected: initial visual acuity and best-corrected visual acuity, demographic details, health history, dietary intake of antioxidants, lifetime ocular ultraviolet B exposure, and clinical eye examination, including lens photography. Cortical opacities were measured in sixteenths. Cortical cataract was defined as opacity greater than or equal to 4/16 of pupil circumference. Nuclear opacities were graded according to the Wilmer cataract grading scheme, and cataract was defined as greater than or equal to nuclear standard 2.0 of four standards. The height and width of any posterior subcapsular opacity was measured and recorded. Posterior subcapsular cataract was defined as posterior subcapsular opacity greater than or equal to 1 mm2. The worse eye was selected for analysis. Backward stepwise logistic regression was used to quantify independent risk factors for cataract. RESULTS: A total of 3,271 (83% of eligible) of the urban residents, 403 (90% of eligible) nursing home residents, and 1,473 (92% of eligible) rural residents participated. The urban residents ranged in age from 40 to 98 years (mean, 59 years), and 1,511 (46%) were men. The nursing home residents ranged in age from 46 to 101 years (mean, 82 years), and 85 (21%) were men. The rural residents ranged in age from 40 to 103 years (mean, 60 years), and 701 (47.5%) were men. The overall weighted rate of cortical cataract was 11.3% (95% confidence limits, 9.68%, 13.0%) excluding cataract surgery and 12.1% (95% confidence limits, 10.5%, 13.8%) including cataract surgery. The risk factors for cortical cataract that remained in the multivariate logistic regression model were age, female gender, diabetes duration greater than 5 years, gout duration greater than 10 years, arthritis diagnosis, myopia, use of oral beta-blockers, and increased average annual ocular ultraviolet B exposure. Overall, 12.6% (95% confidence limits, 9.61%, 15.7%) of Victorians aged 40 years and older had nuclear cataract including previous cataract surgery, and 11.6% (95% confidence limits, 8.61%, 14.7%) had nuclear cataract excluding previous cataract surgery. In the urban and rural cohorts, age, female gender, rural residence, brown irides, diabetes diagnosed 5 or more years earlier, myopia, age-related maculopathy, having smoked for greater than 30 years, and an interaction between ocular ultraviolet B exposure and vitamin E were all risk factors for nuclear cataract. The rate of posterior subcapsular cataract excluding previous cataract surgery was 4.08% (95% confidence limits, 3.01%, 5.14%), whereas the overall rate of posterior subcapsular cataract including previous cataract surgery was 4.93% (95% confidence limits, 3.68%, 6.17%) . The independent risk factors for posterior subcapsular cataract in the urban and rural cohorts that remained were age in years, rural location, use of thiazide diuretics, vitamin E intake, and myopia. CONCLUSIONS: The expected increase in the prevalence of cataract with the aging of the population highlights the need to plan appropriate medical services and public health interventions for primary and secondary prevention. Many of the identified risk factors for cataract in the population have the potential for being modified through public health interventions.

Adult↗
PubMed1998

Chronic conditions and disabilities among seniors: an analysis of population-based health and activity limitation surveys.

PURPOSE: To describe the prevalence of disabilities and the medical conditions and risk factors associated with mobility and agility disabilities among seniors. METHODS: In the 1986 and 1991 Canadian Census, every fifth person answered a screening question about activity limitation and disabilities. A probability sample of both those reporting and not reporting disability was selected to complete the Health and Activity Limitations Surveys (HALS) in 1986 and 1991. These two cross-sectional surveys conducted five years apart collected detailed activity limitation information about persons over 15 years of age. The current analysis was based on only respondents aged 65 years and older. The sample size for 65 years and older was 38518 in 1986 and 5106 in 1991. A computer link with the Census data provided household income and additional socio-demographic data for all respondents. RESULTS: Over 40% of Canadian seniors reported at least one disability, and approximately a quarter of disabled seniors were classified as severely disabled. Mobility and agility disabilities accounted for over 80% of all disabilities reported by seniors, and senior women were more likely than men to report having a mobility or agility disability. Arthritis/rheumatism was reported as the cause of over 30% of all mobility and agility disabilities. CONCLUSIONS: The continued monitoring of disabilities through surveys such as HALS will help determine the prevalence as well as aid in the identification of the causes of disabilities. Such information may be used to guide the implementation of appropriate public health interventions that will meet the changing health care needs of seniors.

Activities of Daily Living↗
PubMed2001

Influence of socio-economic crisis on epidemiological characteristic of suicide in the region of Nis (southeastern part of Serbia, Yugoslavia).

It is well known that gross social crises greatly influence the change in epidemiological features of suicide. The aim of this study is to determine whether the social-economic crisis in Yugoslavia influenced the change in epidemiological features of suicide in the region of Nis (southeastern Serbia). The material included death certificates for 1987-1999. The rates were calculated per 100,000 inhabitants (1991 Census) and standardization was performed by direct method (Segi's world population was used as standard population). Generally, trends for suicide rates in the region of Nis from 1987 to 1999 have decreasing tendency among both sexes. The average annual suicide rate in the region during the period 1987/1989 (relatively economically and politically stable) was 14.8 among males, and 6.8 among females. In 1999 (maximum influence of socio-economical and political crisis) suicide rate among males was 13.8 and among females it was 3.7. The decrease in suicide rate in females can be observed in all age groups, and in males in the age groups 15-29 and 50-64. During 1999, compared to 1987/1989, the increase in the number of suicides is perceived in the summer months (1999 -41.5%; 95% CI: 30.8-52.2%; 1987/ 1989 -23.8%; 95% CI: 18.9-28.7%), as well as the decrease of suicide on Monday (1987/1989 -21.2%; 95% CI: 16.2-26.1%; 1999 -9.8%; 95% CI: 3.4 16.2%). During 1999 the rate of suicides committed by fire arms increased (from 8.1 to 14.5%), while there was a decrease in poisoning, in both males (from 26.3 to 9.7%; p < 0.05) and females (from 39.1 to 10.0%; p < 0.05). During 1999 significant changes in epidemiological features of suicide were registered, compared to 1987/1989. These changes were probably enhanced by changed socio-economic factors (primarily war action and the bombing of Serbia, as well as the decline of standard of living and other aspects of economic and political crisis), which requires additional, more complete and thorough research.

Adolescent↗
PubMed2001

Food and nutritional profile of high energy density consumers in an adult Mediterranean population.

OBJECTIVE: To test if an adult Mediterranean population consumes different food volumes while spontaneously ingesting diets of different energy density and to estimate which are the food and nutritional profiles of these diets. DESIGN: A cross-sectional study of food consumption. SETTING: Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus. SUBJECTS: Five hundred and seventy two adult individuals (25 65 y) randomly selected from the population census of Reus. INTERVENTION: 24 hour recall method for 3 non-consecutive days including one holiday. The population was classified into three groups of differing energy densities by simple linear regression analysis. Means were compared by ANOVA. RESULTS: Both sexes consume similar food volumes across the different levels of energy density. High energy density consumers ingest significantly more red meat, olive oil, sweet cereals, cereals and sugars and less reduced fat milk, green vegetables and fruit compared to low energy density consumers. Male and female high energy density consumers show a significantly higher consumption of energy (1686 kJ and 2200 kJ, respectively) (P < 0.001), a 5.2% (P < 0.001) and 2.3% (P < 0.05) respectively higher energy intake derived from fat and a 1.3% (P < 0.05) and 1.3% (P < 0.05) respectively higher energy intake derived from saturated fatty acids compared to low energy density consumers. CONCLUSIONS: Our adult Mediterranean population normally consumes similar food volumes, independently of the energy density ingested. High energy dense diets in our population could represent an important health risk because they are excessively rich in energy, fats and saturated fatty acids.

Adult↗
PubMed2005

Projected national impact of colorectal cancer screening on clinical and economic outcomes and health services demand.

BACKGROUND & AIMS: Colorectal cancer (CRC) screening is effective and cost-effective, but the potential national impact of widespread screening is uncertain. It is controversial whether screening colonoscopy can be offered widely and how emerging tests may impact health services demand. Our aim was to produce integrated, comprehensive estimates of the impact of widespread screening on national clinical and economic outcomes and health services demand. METHODS: We used a Markov model and census data to estimate the national consequences of screening 75% of the US population with conventional and emerging strategies. RESULTS: Screening decreased CRC incidence by 17%-54% to as few as 66,000 cases per year and CRC mortality by 28%-60% to as few as 23,000 deaths per year. With no screening, total annual national CRC-related expenditures were 8.4 US billion dollars. With screening, expenditures for CRC care decreased by 1.5-4.4 US billion dollars but total expenditures increased to 9.2-15.4 US billion dollars. Screening colonoscopy every 10 years required 8.1 million colonoscopies per year including surveillance, with other strategies requiring 17%-58% as many colonoscopies. With improved screening uptake, total colonoscopy demand increased in general, even assuming substantial use of virtual colonoscopy. CONCLUSIONS: Despite savings in CRC care, widespread screening is unlikely to be cost saving and may increase national expenditures by 0.8-2.8 US billion dollars per year with conventional tests. The current national endoscopic capacity, as recently estimated, may be adequate to support widespread use of screening colonoscopy in the steady state. The impact of emerging tests on colonoscopy demand will depend on the extent to which they replace screening colonoscopy or increase screening uptake in the population.

Colorectal Neoplasms↗
PubMed1998

Galaxies and large scale structure at high redshifts.

It is now straightforward to assemble large samples of very high redshift (z approximately 3) field galaxies selected by their pronounced spectral discontinuity at the rest frame Lyman limit of hydrogen (at 912 A). This makes possible both statistical analyses of the properties of the galaxies and the first direct glimpse of the progression of the growth of their large-scale distribution at such an early epoch. Here I present a summary of the progress made in these areas to date and some preliminary results of and future plans for a targeted redshift survey at z = 2.7-3.4. Also discussed is how the same discovery method may be used to obtain a "census" of star formation in the high redshift Universe, and the current implications for the history of galaxy formation as a function of cosmic epoch.

Journal Article↗
PubMedDate not supplied

Speech and language therapy service delivery for bilingual children: A survey of three cities in Great Britain.

BACKGROUND: Speech and language therapy (SLT) managers are expected to ensure that there are appropriate services available for bilingual and multilingual clients in order to ensure an equitable service to all clients. However, there is a paucity of data available to inform service planning. AIMS: To identify the level to which SLT services in three UK cities meet the recommendations of The Royal College of Speech and Language Therapists (RCSLT) Good Practice Guidelines. Socio-demographic information is provided about the number of children from ethnic minorities in the population and the proportion of (bilingual) children from ethnic minorities on the speech and language therapy caseload. Based on this information, it is estimated whether there is proportionate representation of bilingual children on SLT caseloads, and whether services are in place to meet the needs of those clients. METHODS & PROCEDURES: Population statistics were gathered from Census data and data were gleaned from Local Education Authorities. The study used a combination of interview and postal questionnaires to SLTs, with particular emphasis on the issues that may affect service provision. OUTCOMES & RESULTS: As in previous studies, it was difficult to find reliable data. However, two of the three cities studied appeared to be offering a proportionate service to both monolingual and bilingual children in terms of the relative numbers of children on caseloads. Only one city was confident that their SLT service was fully meeting the RCSLT Good Practice Guidelines on bilingualism, although all three cities were aware of them and appeared to be making an effort at varying levels to address the principles of those guidelines. CONCLUSIONS: There is a need for a change in how data on linguistic diversity in society are collected and disseminated, both at a national level and within SLT services, so that informed decisions can influence the future of quality services to minority groups.

Child↗
PubMed2003

Duration of employment is not a predictor of disability of cleaners: a longitudinal study.

AIMS: Cleaning is a high-risk occupation for developing musculoskeletal disorders. Sickness absence is twice as high as in other occupations. Disability pensions for musculoskeletal disorders are twice as high in cleaners as in other employed women. However, a result from Norwegian and Danish studies shows that female cleaners do not report higher morbidity of musculoskeletal disorders than other women. The objective was to analyse whether female cleaners have a higher risk of obtaining a disability pension than women in other unskilled occupations and whether the length of employment influences the risk. METHODS: The material is from the National Census in 1980 and 1990 and supplemented with disability pensioning data from the National Insurance Administration and the Population registry. Women aged 20-49, working as cleaners, seamstresses, nursing, kitchen, or shop assistants in 1980 were followed until 1990 or until receiving disability pension. Female cleaners aged 30-59 years in 1990 were categorized into two cohorts by occupation in 1980. They were followed from 1991 to 1994, to the date they died, or received disability pension. Incidence rates and incidence rate ratio for disability pension and mortality was calculated by Poisson regression. Cox regression calculated the relative risk of obtaining disability pension. RESULTS: Disability pension rates were higher among cleaners than among other women in unskilled occupations (1.4 per 1,000 person years (CI 95% 1.35-1.46)), but the risk of obtaining disability pension did not increase with increasing exposure to cleaning (HR 0.8 (CI 95% 0.6-1.2)). CONCLUSIONS: The cleaning occupation has high disability rates compared with other unskilled occupations. A contribution factor to these high rates is a selection of women with poor health into the occupation.

Adult↗
PubMed2002

Effect of parental social class, own education and social class on mortality among young men.

BACKGROUND: The aim of the study is to examine the effects of parental class, own education and social class on mortality by cause of death among young men. METHODS: The study is based on 1990 census records for 186,408 Finnish men, aged 30-34 in 1990, linked with death records for 1991-95 (1530 deaths). RESULTS: Parental class was associated with all-cause (Index of Relative Dissimilarity (IRD) = 12%) and cause-specific mortality before adjustment for one's own social class and education. Adjustment reduced the IRD by 18-58%, depending on the cause of death, and caused mortality differences to disappear for causes other than cardiovascular diseases and those related to alcohol. The unadjusted variation in all-cause mortality by educational attainment (IRD = 33%) and by own class (IRD = 38%) was greater than by parental class. Adjustment for parental class had only a minor effect on the variation by education and own class. Adjustment for own class reduced the IRD for education in all-cause mortality by 31%, in mortality from disease by 17%, and in mortality from external causes by 33%. For own class the reductions in the IRD obtained by adjustment for education were 36%, 46%, and 33%, respectively. CONCLUSIONS: The effect of parental class on the mortality of young men is indirect and mainly mediated through its influence on education and social class. The effect of education on mortality is as strong as that of occupation-based social class. These variables are not interchangeable measures of socioeconomic status; they both should be taken into account in studies on inequalities in mortality.

Adult↗
PubMed2002

Alcohol-related deaths contribute to socioeconomic differentials in mortality in Sweden.

BACKGROUND: This study aims at estimating the contribution of alcohol to socioeconomic mortality differentials in Sweden. METHODS: Data were obtained from a Census-linked Deaths Registry. Participants in the 1980 and 1990 censuses were included with a follow-up of mortality 1990-1995. Socioeconomic status was assigned from occupation in 1990 or 1980. Alcohol-related deaths were defined from underlying or contributory causes. Poison regressions were applied to compute age-adjusted mortality rate ratios for all-causes, alcohol-related and other causes among 30-79-year-olds. The contribution of alcohol to mortality differentials was calculated from absolute differences. RESULTS: Around 5% (9,547) of all deaths were alcohol-related (30-79 years). For both sexes, manual workers, lower nonmanuals, entrepreneurs and unclassifiable groups had significantly higher alcohol-related mortality than did upper nonmanuals. Male farmers had significantly lower such mortality. The contribution of alcohol to excess mortality over that of upper nonmanuals was greatest among middle-aged (40-59 years) men who were manual workers or who belonged to a group of 'unclassifiable & others' (25-35%). It was of considerable size also for middle-aged lower nonmanuals (both sexes), male entrepreneurs, female manual workers and 'unclassifiable & others'. Among men, the total contribution of alcohol (30-79 years) was estimated at 16% for manual workers, 10% for lower nonmanuals and 7% for entrepreneurs; and among women, 6% (manual workers, lower nonmanuals) and 3% (entrepreneurs). CONCLUSION: Although deaths related to alcohol were probably underreported (e.g. accidents), alcohol clearly contributes to socioeconomic mortality differentials in Sweden. The size of this contribution depends strongly on age (peak among the middle-aged) and gender (greatest among men).

Adult↗
PubMed1996

Socioeconomic differences in 'avoidable' mortality in Sweden 1986-1990.

BACKGROUND: 'Avoidable' mortality is commonly studied as an indicator of the outcome of health care. In this study socioeconomic differences in avoidable mortality in Sweden from 1986 to 1990 are analysed and related methodological issues discussed. METHODS: The 1985 Swedish Population and Housing Census was linked to the National Cause of Death Register 1986-1990. Mortality from potentially 'avoidable' causes of death was analysed for the age group 21-64 years. Analyses were performed for different socioeconomic groups, blue-collar workers, white-collar workers and the self-employed as well as for individuals outside the labour market. Standardized Mortality Ratios were calculated using standardization by age and sex. RESULTS: For all indicators studied, the death rates for those not in work were higher than for people at work. The largest differences were found for chronic bronchitis, diabetes, bacterial meningitis, ulcer of the stomach and duodenum, chronic rheumatic heart disease, asthma and hypertensive and cerebrovascular disease. For these causes of death the risk of dying was between 3.1 and 7.5 times greater in the non-working population than in the work-force. The differences in avoidable mortality between blue-collar workers and white-collar workers and the self-employed were, however, much smaller. For most of the indicators no significant differences were found. For ulcers of the stomach and duodenum, however the death rate for blue-collar workers was 2.8 times higher than those for other categories in work. CONCLUSIONS: The small difference in mortality outcome for different socioeconomic groups within the work-force indicates an equal quality of care for these groups. The greatly increased risk among the non-working population, however, is a warning sign. These results may be due to a 'healthy worker' effect. The measurement of socioeconomic differences in mortality may be dependent on the time-period chosen between occupational exposure and mortality outcome.

Adult↗
PubMed2006

No association of neighbourhood volunteerism with mortality in New Zealand: a national multilevel cohort study.

BACKGROUND: The association of social capital with health and mortality is contentious, and empirical findings are inconsistent. This study tests the association of neighbourhood-level volunteerism with mortality. METHODS: Cohort study of 1996 New Zealand census respondents aged 25-74 years (4.75 million person years) using multilevel Poisson regression analyses. Neighbourhood (average population 2,034) measures included indices of social capital (volunteering activities for all census respondents) and deprivation. RESULTS: Adjusting for just age and marital status, the mortality rate ratios for people living in the quintile of neighbourhoods with the lowest compared with highest volunteerism were 1.16 (95% confidence interval 1.08-1.24) and 1.09 (1.01-1.18), for males and females, respectively. Adjusting for potential individual-level and neighbourhood-level socioeconomic confounders reduced the rate ratios to 0.94 (0.88-1.01) and 0.92 (0.85-1.01), respectively. There was no significant association with any cause of death, including suicide [rate ratios 0.89 (0.64-1.22) and 0.57 (0.31-1.05), respectively]. Restricting the analyses to only those census respondents living at their census night address for five or more years, and therefore 'exposed' to that level of volunteerism for a longer period, did not substantially alter findings. CONCLUSIONS: This study, one of the largest multilevel studies yet, found no statistically significant independent association of a structural measure of neighbourhood social capital with mortality-including suicide. Assuming social features of neighbourhoods are important determinants of health, future research should examine other features (e.g. social fragmentation) and other outcomes (e.g. behaviour).

Adult↗
PubMed1999

Current estimates of and future projections for adult deaths attributed to HIV infection in Zimbabwe.

OBJECTIVE: Estimates of HIV prevalence in 1995 among all adults in Zimbabwe range between about 18% and 24%. The objective of this study was to estimate, for Zimbabwe, the impact of HIV infection on adult mortality, by age and gender, between 1995 and the year 2000. METHODS: For this analysis, we used 1992 census data to estimate the number of non-HIV-related deaths, and a short-term projection model to estimate the number of deaths attributed to HIV infection in 1995 and the year 2000. RESULTS: It was estimated that between 52% and 60% of all adult deaths in 1995 were attributed to HIV infection, and between 69% and 76% in both males and females in the group between 20 and 39 years of age. The estimated adult mortality rate per 1000 increased from 9.8 in 1987 (based on census data) to between 20.6 and 24.3 in 1995. For the year 2000, it was projected that between 66% and 73% of all adult deaths would be attributed to HIV infection, and between 81% and 86% in those aged 20 to 39 years. The estimated adult mortality rate in the year 2000 increased to between 29.1/1000 and 36.6/1000. Even if all transmission was assumed to cease after 1995, it was projected that >60% of adult deaths would be attributed to HIV in the year 2000. Adult population growth is projected to decrease to between 0.3% and 1.0% in the year 2000. CONCLUSION: Results suggest that the impact of HIV infection on mortality in Zimbabwe is already severe and will continue to increase. Efforts to reduce numbers of new HIV infections today will serve to reduce the future burden of mortality, particularly in the longer term.

Adolescent↗
PubMed1976

Emotional disorders in six Israeli villages.

This is a report on a psychiatric epidemiological census conducted in six Israeli villages. The method of case identification relied on data extracted from medical cards and the use of two shortened versions of the CMI. The results showed a distribution affected by sex, age, ethnicity, education, and "status consumer". A comparison with other Israeli studies is made.

Adult↗
PubMed2006

Prevalence and risk factors for trachoma and ocular Chlamydia trachomatis infection in Niger.

AIMS: To determine the association of personal and household risk factors for trachoma and ocular Chlamydia trachomatis infection in Niger. METHODS: 12 villages were randomly selected. A census of all households was carried out, and 651 children aged 1-5 years were randomly selected and examined. Household and personal characteristics were determined, trachoma was clinically assessed and a swab for ocular C trachomatis infection was taken. RESULTS: The prevalence of trachoma was 43% (95% confidence interval (CI) 39% to 47%) and of infection was 21% (95% CI 18% to 24%). Children aged 3-5 years had a stronger association of clinical signs with infection, compared with those aged 1-2 years. Those with unclean faces were three times more likely to have clinical trachoma or ocular C trachomatis infection, compared with those with clean faces (OR 3.1 (95% CI 1.6 to 6.2) and 3.0 (95% CI 1.4 to 6.3), respectively). 75% of compounds were within 30 min of a water source. Flies on the face were a risk factor for trachoma but not for C trachomatis infection. CONCLUSIONS: The different association of clinical signs with infection in younger versus older children may be an age-dependent difference in the duration of clinical disease. In Niger, unclean faces are a major risk factor for trachoma. The ready availability of water for washing suggests that further research on the effect of a strong health education campaign promoting clean children is warranted in this area.

Age Distribution↗
PubMed1996

Socioeconomic circumstances and the risk of bowel cancer in Northern Ireland.

OBJECTIVE: To describe the variation in the incidence of colorectal cancer across Northern Ireland and relate it to factors associated with community deprivation. DESIGN: This was a cross sectional descriptive study. SETTING: Incidence data were obtained from a population based register for the period 1990-91. Small areas were characterised by their "affluence", or lack of it, by deriving a Townsend deprivation score for each electoral ward, using information from the 1991 census. PARTICIPANTS, MAIN OUTCOME MEASURES, AND STATISTICAL METHODS: The age standardised incidence was calculated for all colorectal cancer cases diagnosed histologically in 1990-91. Electoral wards were grouped into quintiles of the population after ranking of their Townsend scores and the association with incidence was studied using Poisson regression. RESULTS: The age standardised colorectal cancer incidence ranged from 22.5 (for quintile 1) to 29.9/100,000 (quintile 5) for men but the trend for women was less regular and rates were 18.4, 23.8, 27.3, 26.5, and 23.9/100,000 for quintiles 1-5 respectively (that is, from the most "affluent" to the most "deprived" fifths of the population). After adjusting for age and sex in Poisson regression, there was a significant association between the total colorectal cancer incidence and levels of community deprivation. The rate ratio for the most deprived quintile of the population (compared with the least) was 1.28 (95% CI 1.06,1.53). The effect was stronger for rectal cancer than for colonic cancer. There was no association between community deprivation and the cancer stage at diagnosis. CONCLUSIONS: In this population, the colorectal cancer incidence is associated with the level of material deprivation. The disease stages at the time of diagnosis in patients from more deprived areas seem to be comparable with those of patients from affluent areas. As others have shown, associations such as these are not explicable entirely on the basis of the distribution of known risk factors. Further research is needed to determine plausible mechanisms for the association.

Adolescent↗
PubMed2000

Age specific prevalence of impairment and disability relating to hemiplegic stroke in the Hai District of northern Tanzania. Adult Morbidity and Mortality Project.

OBJECTIVES: To determine the age specific prevalence of impairment and disability relating to hemiplegic stroke in one rural area of Tanzania. METHODS: During the yearly house to house census of the study population of 148 135 (85 152 aged 15 and over) in August 1994, specific questions were asked to identify those who might be disabled from stroke. People thus identified were subsequently interviewed and examined by one investigator. In those in whom the clinical diagnosis of stroke was confirmed a more detailed interview and examination relating to risk factors and recovery was carried out. RESULTS: One hundred and eight patients, 61 men and 47 women, were identified with a median age of 70 (range 18-100). Median age at first stroke was 65 years. The age specific rates in this study were lower than previous studies in developed countries. All were cared for at home although 23 (21%) were bedbound. CONCLUSIONS: Although prevalence of impairment and disability related to stroke in this population as a whole was low this is mainly explained by the age structure, with less than 6% being aged 65 and over. Age standardised rates for stroke with residual disability were about half those found in previous studies in developed countries. Death from stroke in Africa may be higher but data are limited. With the demographic transition stroke is likely to become a more important cause of disability in sub-Saharan Africa.

Adolescent↗
PubMedDate not supplied

[Trends in social inequalities in mortality in the city of Seville [Spain] [1994-2002]].

OBJECTIVES: To know trends of social inequalities in general mortality in Seville (Spain) between 1997 and 2002. MATERIAL AND METHOD: Socioeconomic level of its the residential census tracts was assigned for each death, taken from the Socio-economic Synthetic Index built up after applying a principal components analysis from 2001 census variables. Using mortality indicators its magnitude and trend was described according socio-economic level. RESULTS: General mortality standardized rates by age in the census tracts of lowest socio-economic level were 1.32 and 1.25 times greater than in the highest census tracts in men and 1.19 and 1.08 in women respectively in each periods. The truncated rates ratio and potential years of lost life in men went from 1.66 to 2.28 in men and 1.74 to 2.10 in women, respectively. The four years difference in life expectancy at birth between the census tracts of highest and lower level remained unchanged in men, and fell from 1.90 to 0.82 in women. The population attributable risk (all ages) went from 13.18% to 10.46% in men and 10.02% to 2.58% in women. CONCLUSIONS: Social inequalities in mortality for the general population decreased mainly in women. The inequalities increased in the early death and between 35-64 years old in men, basically due to a reduced mortality in higher socio-economic level census tracts.

Adult↗