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PubMed2004

Driving and dementia in Ontario: a quantitative assessment of the problem.

BACKGROUND: The population is becoming increasingly aged, and concomitantly, the prevalence of dementia is steadily rising. Persons aged 65 years and over are likely to continue driving for many years and often well into the dementia process. METHODS: Ontario Ministry of Transportation driving data, census data, and dementia prevalence data were combined to determine the number of persons with potential dementia who are driving, both now and in about 25 years' time. RESULTS: Actual and projected Ontario figures show that the number of senior drivers will increase markedly from just under 500,000 in 1986 to nearly 2,500,000 in 2028. Similarly, the number of drivers with dementia is also increasing. Although not all drivers with dementia are necessarily dangerous, most are estimated to continue driving well into the disease process. By combining the above-mentioned data sets, a best estimate of the number of drivers with dementia in Ontario was derived. It is estimated that this group has grown from just under 15,000 in 1986 to about 34,000 in 2000 and will number nearly 100,000 in 2028. INTERPRETATION: Increasingly, the responsibility for identifying drivers with dementia has fallen on the health care system, a role for which it was never designed nor equipped to handle. The risks associated with the dramatically increasing number of drivers with dementia demand a psychometrically sensitive and efficient screening procedure.

Aged↗
PubMed1999

Cognitive disability and direct care costs for elderly people.

BACKGROUND: Population ageing and the high costs of care support for elderly people have concentrated attention on economic issues. Is there an association between costs and cognitive disability? AIMS: To compare service utilisation and direct costs for elderly people with different degrees of cognitive disability, and between people living in households and in communal establishments. METHOD: Secondary analysis of Office of Population Censuses and Surveys (OPCS) Disability Surveys data compared service utilisation and costs for 8736 elderly people with cognitive disability. Cost estimates were constructed for all health and social care services. RESULTS: A much greater proportion of people at higher levels of cognitive disability lived in communal establishments, where their (direct) costs were much higher than when supported in households. Service utilisation patterns and costs varied with cognitive disability. CONCLUSIONS: It is important to look at the full range of living arrangements and support services when examining costs. The potential cost implications of pharmacotherapies, other treatments or new care arrangements cannot be appreciated without such a broad perspective.

Aged↗
PubMed2001

Comorbid non-alcohol substance misuse among people with schizophrenia: epidemiological study in central London.

BACKGROUND: Few epidemiological studies have assessed the extent and nature of comorbid non-alcohol substance misuse in people with schizophrenia in the community in the UK. AIMS: To study the extent and nature of comorbid non-alcohol substance misuse in people with schizophrenia in central London. METHOD: Subjects were identified in an epidemiological census survey of South Westminster. Standardised assessment of each subject included demographic data, ratings of mental state and movement disorder and questioning about drug and alcohol misuse. RESULTS: Individuals with schizophrenia or related psychoses were identified (n=352) and 57 (16%) reported a lifetime history of non-alcohol substance misuse. Age and gender were the main variables relevant to the extent and pattern of misuse. Self-reported non-alcohol substance misuse showed no significant relationship with a range of outcome measures. CONCLUSIONS: The high proportion of subjects reporting non-alcohol substance misuse is comparable with figures from the USA. The reports of lifetime misuse most commonly referred to cannabis, psychostimulants, LSD, opiates and anticholinergics. Misuse was concentrated in those younger than 36 years and was reported more often by males.

Adolescent↗
PubMed2002

Cognitive activity and incident AD in a population-based sample of older persons.

BACKGROUND: Participation in cognitively stimulating activities is hypothesized to be associated with risk of AD, but knowledge about this association is limited. METHODS: A biracial community in Chicago was censused, persons aged 65 years and older were asked to participate in an interview, and 6,158 of 7,826 (79%) eligible persons did so. As part of the interview, persons rated current frequency of participation in seven cognitive activities (e.g., reading a newspaper) and nine physical activities (e.g., walking for exercise) from which composite measures of cognitive and physical activity frequency were derived. Four years later, 1,249 of those judged free of AD were sampled for a detailed clinical evaluation of incident disease and 842 (74% of those eligible) participated. RESULTS: The composite measure of cognitive activity ranged from 1.28 to 4.71 (mean 3.30; SD 0.59), with higher scores indicating more frequent activity. A total of 139 persons met National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for AD on clinical evaluation. In a logistic regression model adjusted for age, education, sex, race, and possession of the APOE epsilon4 allele, a one-point increase in cognitive activity score was associated with a 64% reduction in risk of incident AD (OR 0.36; 95% CI 0.20 to 0.65). By contrast, weekly hours of physical activity (mean 3.5; SD 5.1) was not related to disease risk (OR 1.04; 95% CI 0.98 to 1.10). Education was associated with risk of AD and a similar trend was present for occupation, but these effects were substantially reduced when cognitive activity was added to the model. CONCLUSION: Frequency of participation in cognitively stimulating activities appears to be associated with risk of AD and may partially explain the association of educational and occupational attainment with disease risk.

Aged↗
PubMed2004

Cervical cancer mortality by neighbourhood income in urban Canada from 1971 to 1996.

BACKGROUND: The reduction of socioeconomic inequalities in health is an explicit objective of health policy in Canada, yet rates of death from cervical cancer are known to be higher among women of low socioeconomic status than among those of higher socioeconomic status. To evaluate progress toward the World Health Organization's goal of "Health for All," we examined whether income-related differentials in cervical cancer mortality diminished from 1971 to 1996. METHODS: Death registration data for Canada's census metropolitan areas in 1971, 1986, 1991 and 1996 were assigned to census tracts through postal code, and the tracts were in turn assigned to income quintiles based on their proportion of the population below the Statistics Canada low-income cutoff values. We compared age-standardized death rates (using the 1966 world population standard) in the female population (excluding those in institutions) across the 5 income quintiles and calculated interquintile rate ratios (poorest over richest) and interquintile rate differences (poorest minus richest). RESULTS: From 1971 to 1996, the overall age-standardized cervical cancer death rate per 100 000 women (and 95% confidence interval) declined from 5.0 (4.5-5.6) to 1.9 (1.7-2.1), the interquintile rate ratio diminished from 2.7 (1.8-4.2) to 1.7 (1.1- 2.6), and the interquintile rate difference decreased from 4.6 (2.8- 6.4) to 1.1 (0.2-1.9). INTERPRETATION: The income-related disparity in rates of death from cervical cancer as measured by rate ratios and rate differences diminished markedly in urban Canada from 1971 to 1996. Among the numerous factors that may have contributed to the decline (including decline in fertility and improvement in diet), one important factor was probably the implementation of effective screening programs.

Adult↗
PubMed2006

[Trends in oral cancer mortality in the city of São Paulo, Brazil, 1980-2002].

The current study assessed trends in oral cancer mortality in the city of São Paulo, Brazil, from 1980 to 2002. The official mortality information system supplied data on deaths whose underlying cause was classified as oral cancer, stratified by sex, age, and anatomic site. Death rates were estimated and adjusted by the direct method, using population data supplied by national censuses from 1980, 1991, and 2000 and a population count performed in 1996. There was an upward trend in overall cancer mortality, at a yearly rate of 0.72%. Accounting for more than one third of these deaths, tongue cancer was the main mortality category. Labial, gengival, and retromolar cancer showed a downward trend, while oropharyngeal cancer and cancer in unspecified parts of the mouth and oropharynx showed increasing mortality. Monitoring the magnitude and trends in cancer mortality can assist the planning of health initiatives aimed at reducing the disease burden from oral cancer in Brazil.

Adult↗
PubMed1991

Geographic variation in the incidence of treated end-stage renal disease.

To facilitate identification of geographic clusters of areas with high or low incidence of treated end-stage renal disease, the 1983 to 1988 incidence by county was studied among whites and nonwhites less than 60 yr of age in the United States. End-stage renal disease incidence counts for 1983 to 1988 were obtained from the United States Renal Data System data base and linked to the 1985 county population obtained from U.S. Census data. Maps were smoothed by the method adopted by the National Cancer Institute that smooths only according to variability of the local rates, ignoring geographic information on clustering of events. In addition to identifying specific counties with exceptionally high or low incidence, geographic patterns were observed with many similarities across whites and nonwhites: notably high rates of disease in areas of the Southwest, the Southeast and in counties with Native American reservations and low rates in the West and Northwest. On the basis of these findings, several hypotheses are presented to explain the observed variation in treated end-stage renal disease incidence rates.

Adult↗
PubMed2004

Local area deprivation and urban-rural differences in anxiety and depression among people older than 75 years in Britain.

OBJECTIVES: We sought to determine the association of depression and anxiety with "area deprivation" (neighborhood socioeconomic deprivation) and population density among people older than 75 years in Britain. METHODS: Postal codes were used to link census area information to individual data on depression and anxiety in 13349 people aged 75 years and older taking part in a trial of health screening. RESULTS: Living in the most socioeconomically deprived areas was associated with depression (OR=1.4), but this relation disappeared after adjusting for individual deprivation characteristics. There was no association with anxiety. Living in the highest density and intermediate low-density areas was associated with depression (OR=1.6 and 1.5) and anxiety (OR=1.5 and 1.3) compared with the lowest density areas. CONCLUSIONS: An association between area deprivation and depression in older people was explained by individual health, demographic, and socioeconomic factors. Higher population density was consistently associated with increased depression and anxiety.

Aged↗
PubMed1999

[Changes in 24-hour urinary excretion of sodium and potassium in a community-based heath education program on salt reduction].

PURPOSE: To examine changes in urinary excretion of sodium, potassium and sodium/potassium ratio in a community-based health education program on salt reduction. SUBJECTS AND METHODS: The surveyed community was Kyowa town (census population in 1985 = 16,792) where we have conducted a community-based blood pressure control program since 1981 and health education on reduction of salt intake since 1983 for primary prevention of hypertension. A 24-hour urine collection was conducted for systematically selected samples of the participants aged 40-69 in cardiovascular risk surveys in 1982-86 (early period) and in 1990-94 (later period) to estimate changes in urine excretion of sodium, potassium, and sodium/potassium ratio. RESULTS: A 24-hour urine collection was available for 565 persons (410 men and 155 women) in 1982-86 and 1,461 persons (571 men and 890 women) in 1990-94. A decline in mean sodium excretion was larger in ages 40-49 than in other age groups, and for ages 40-69 combined, the decline was 0.9-1.1 g per day for men and women. Mean sodium excretion declined to 10 g or less per day for men and women aged 60-69. Mean potassium excretion did not change except for men aged 60-69 with an increase in potassium. Sodium/potassium ratio tended to decline for women aged 40-49, and declined significantly for other sex-age groups. A larger reduction in sodium excretion was seen among persons with a history of hypertension compared to those without it. CONCLUSIONS: A significant reduction in urinary excretion of sodium and sodium/potassium ratio was observed in a community-based health education program. Men and women aged 60-69 reached a recommended level of 10 g or less in sodium intake.

Adult↗
PubMed2002

Physically demanding situations as predictors of disability pensioning with soft tissue rheumatism among persons 30-39 years old in Norway, 1981-90.

OBJECTIVE: Physically demanding work is a predictor of disability pensioning with musculoskeletal diseases. Being a parent is probably also physically demanding. Having manual work and being a parent will be analyzed as possible predictors of becoming a disability pensioner with soft tissue rheumatism (DPSTR) after controlling for level of education, employment, number of hours worked, income, age, sex, and marital status. METHODS: In this prospective study based on census data of persons 30-39 years old in 1980, predictors of becoming DPSTR during the followup period 1981-90 were identified by logistic regression analysis. RESULTS: Manual work was a predictor for becoming DPSTR for both men and women, while being a parent was neither a risk factor nor a protective factor for becoming DPSTR. Being employed was a predictor of becoming DPSTR for married women, but a protective factor for unmarried women and all men. Low level of education and being married or divorced were predictors of becoming DPSTR for both men and women. Working part time and having low income were predictors of becoming DPSTR among men. CONCLUSION: Physically demanding employment, but not a physically demanding private life, predicts becoming DPSTR. This may reflect that factors concerning a patient's private life are not taken into account when evaluating whether or not a disability pension should be granted, at least not for patients with uncertain medical conditions.

Adult↗
PubMed2003

Breakthrough measuring neighborhoods.

An empirical strategy is presented for transforming ordinal counts and percentages to interval scale measures by recoding them as ordered categories and estimating Rasch model rating scale parameters. This strategy is demonstrated for a neighborhood construct socioeconomic disadvantage operationally defined by eight characteristics of Chicago neighborhoods (N = 77). Results show surprisingly sound model fit and satisfactory scale invariance between 1980 and 1990 census. A striking finding obscured by traditional methods is many Chicago neighborhoods are four times more disadvantaged than official U.S. poverty threshold. Intramodel construct validation confirms this scale structure is consistent with sociological expectations about property values, income, and race. A general benefit of this approach over conventional categorical socioeconomic indices is neighborhood measurement on a linear scale.

Chicago↗
PubMed2003

[Quantitative analysis of the demand for emergency medicine in Yokohama City, Japan].

PURPOSE: We analyzed regional characteristics that potentially might affect regional demand for emergency medicine in Yokohama city and projected the number of future ambulance users. METHODS: The number of patients transported by ambulance was regarded as an index of the demand for emergency medicine. Various factors that may affect regional demand for emergency medicine were used as dependent variables in multiple regression analysis. The future population was estimated by the cohort change rate method based on the 1995 and 2000 censuses. Data pertaining to ambulance use were obtained from the Annual Fire Fighting Bulletin, Yokohama. Data pertaining to regional factors were obtained from the Annual Health Statistics Report, Yokohama; the Annual Health Statistics Report, Kanagawa; and the Statistics Report, Yokohama. RESULTS: Statistically significant relations were observed between ambulance use per 1000 population and particular regional characteristics, i.e. the proportion of persons undergoing health examinations conducted by public health centers, the number of educational health promotion programs managed by the public sector, the proportion of persons in receipt of livelihood protection, the proportions of roads and commercial areas in each district in relation to the total area, the mean land price, the age-adjusted mortality rate, and the proportion of persons aged 65 years or over. The demand for emergency medicine in Yokohama city was predicted to increase dramatically as the population ages. The number of patients transported by ambulance, which was 121,606 in 2000, was projected to exceed 250,000 in 2030 and to approximate 300,000 in 2050. CONCLUSION: The demand for emergency medicine will increase dramatically in Yokohama city as the society ages, Regional emergency medical systems should be improved accordingly.

Ambulances↗
PubMedDate not supplied

[Infant death surveillance as an indicator of health care system effectiveness--a study conducted in northeastern Brazil].

OBJECTIVE: To evaluate the access to and quality of health care administered to infants based on postmortem data. METHODS: A descriptive cross-sectional census-based study was carried out to assess the infant deaths that occurred in the town of Bom Conselho, state of Pernambuco, between January 1st 1999 and December 31st 1999. Home interviews and inspection of medical records were used for data collection. Deaths were identified by consulting the Mortality Information System, health centers, public notary services, cemeteries, health workers, and midwives. RESULTS: Seventy-one of 72 deaths were investigated, with a loss of 1.4%. The majority (69.4%) of deaths occurred in the postneonatal period and 67.6% of them occurred at home. In 77.5% of the cases medical help was sought at least once, most frequently at emergency units (65.1%). However, 22.5% of the patients were not taken to any kind of health care service. Most health care services (90.9%) were less than one hour away from the patient's home, 78.5% were located in the town of residence and 97% of the consultations were carried out by doctors. Of 88 consultations, 39.8% resulted in hospitalization and 27.3% in discharge without arrangement of a follow-up appointment. In 84% of the cases the medication was provided free of charge. CONCLUSIONS: Death surveillance revealed restricted access to medical care and poor quality of health care administered to infants living in the referred town. The high rate of home deaths is related to access, whilst the journeys made by some of the mothers to health care units, during the illness that caused the death of their infants, points to the precarious organization of those services.

English Abstract↗
PubMed1986

Geographic areas with extremely high mortality correlations for cancers in the province of Alberta, Canada.

Age-adjusted mortality rates, calculated by the direct method and based on the 1971 census-population of Alberta, for 24 male and 26 female cancer sites, from 29 census sub-divisions of the province of Alberta, collected over the period 1961 through 1981, were employed in this study. A total of 50,374 cases of cancer mortality were utilized. Correlations between pairs of cancer sites across census sub-divisions were calculated and cancer sites noted that varied little in mortality rates over Alberta's geographic areas. Significant correlations of mortalities (p less than 0.01) were observed between 5 pairs of male cancer and 18 pairs of female cancer sites. Risk factors common to correlating pairs are discussed. Similarities of our results with other studies are pointed out. The geographical distribution of extreme mortality correlations is analyzed and possible risk factors are discussed.

Alberta↗
PubMed1995

[The epidemiology of chronic venous insufficiency in Portugal].

The prevalence of chronic venous insufficiency (CVI) was investigated in 44,777 unselected primary care outpatient clinics in 17 of the 20 districts in Portugal, during 1993. The diagnosis of CVI was established clinically by 427 participating general practitioners. CVI was more prevalent in females, with a female to male ratio of 2.1:1. The disease affects all age groups, but in females its prevalence increases sharply between 15 and 20 years, while in males it begins to become important about 10 years later. The maximum age-specific prevalence is reached between 55 and 64 years in both sexes, when CVI is present in 58% of females and in 35% of males. Overall prevalence of CVI was calculated using the data from the population census of 1991, by the direct standardization method. The estimated prevalence of CVI in males is 17.8% and in females is 34.1%, corresponding to 812 thousand and 1,741 thousand cases in Portugal, respectively. In the population over 15 years old, the prevalence is 20.7% in males and 40.8% in females. These estimates have an error of +/- 2.5% with 95% confidence. The geographical distribution of the disease showed different patterns in males and in females. Prevalence decreases from coast to inland in males, and from south to north in females.

Adolescent↗
PubMed1995

Which physicians limit their Medicaid participation, and why.

OBJECTIVE: This study identifies factors differentiating Medicaid participating physicians who accept all Medicaid patients from those limiting their Medicaid participation. DATA SOURCES: Data come from periodic telephone surveys of random samples of physicians conducted by the American Medical Association (AMA). STUDY DESIGN: Surveys conducted in 1990-1993 were pooled to form a sample of 4,188 Medicaid-participating office-based physicians. Respondents were classified as accepting all Medicaid patients or as limiting their Medicaid participation. Descriptive statistics are used to examine differences between these groups with respect to selected personal, practice, community, and reimbursement variables. Logistic regression analysis is used to identify factors associated with physicians accepting all Medicaid patients or limiting their Medicaid participation in some way. DATA COLLECTION METHODS: Survey data were supplemented with 1990 census data, 1990 AMA Physician Masterfile data, and 1989 data on physician payment levels. PRINCIPAL FINDINGS: Less than half of Medicaid-participating physicians and only about one-third of participating primary care physicians accept all Medicaid patients. Higher Medicaid fees are associated with physicians participating fully, but the marginal effects of changes in fees on the probability of physicians participating fully is small. CONCLUSIONS: Increases in Medicaid reimbursement aimed at primary care physicians or those in underserved areas may convert limited participants into full participants and, in so doing, improve the access of Medicaid eligibles to care. The increases in payment level needed to increase the proportion of physicians participating fully would be substantial, however, and may not be politically feasible.

Data Collection↗
PubMed1994

Caries prevalence in the United Kingdom.

Since 1973, national surveys of dental caries in children, one series directed decennially by the Office of Population Censuses and Surveys and another, using analogous methods, coordinated regionally on a regular basis by the British Association for the Study of Community Dentistry, have produced a comprehensive record of trends in caries experience of children in England and Wales. Between 1973 and 1993 a decline in caries experience of 55 per cent in deciduous teeth of 5-year-old children, 75 per cent in permanent teeth of 12-year-old, and 74 per cent in 14-year-old children, was documented. However, the most recent surveys, carried out since the end of the 1980s, suggest that caries levels have now levelled out and may even have started to rise in younger children while in adolescents the rate of decline has slowed substantially. Possible explanations for these trends are discussed. The national data conceal wide disparities between different regions of the country and a notable worsening in the caries experience of children in lower socio-economic groups. In order to consolidate the gains of the last 20 years and safeguard the future dental health of both children and adults, implementing population preventive methods such as water fluoridation should be vigorously pursued.

Adolescent↗