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PubMed2006

A cross-national study of transitions in deficit counts in two birth cohorts: implications for modeling ageing.

Generally, health does not improve with age, and many physical and physiological functions are known to decline. These changes do not occur uniformly, however; for many reasons, some people experience significant improvement in their health over non-trivial time intervals. Earlier, we showed that 5-year transitions in health status in elderly people (age 65+ years) can be modeled as a stochastic process, using a modified Poisson distribution with four readily interpretable parameters. The original description was based on follow-up of a single cross-sectional study, thus mixing age and cohort effects. Here, we again used a multistate Markov chain to model 5-year deficit accumulation in relation to frailty in both a Swedish birth cohort (aged 70 years at inception) and, from the original cross-sectional study, a Canadian birth cohort, aged 69-71. In both datasets, we found again that a modified Poisson describes the transition in health status with high precision. The parameters of the model though different, are close to each other, even though the cohorts are from different countries, were assembled 20 years apart, and counted different deficits. The model suggests that all health transitions, including health improvement, worsening, and death, can be summarized in a unified stochastic model with a few interpretable parameters.

Aged↗
PubMedDate not supplied

[Primary health care: an analysis of the transition in Anadalucía].

The article develops an analysis of the process of transformation of primary health care in Andalucía (Spain), related to two fundamental aspects. On the one hand, the strategic aspects of reform are analysed, inspiring principles, as well as legislation and administration. So called "central" changes, that is, those that really suppose transformations in the services: geographic distribution, donation, organisation, human resources, etc., are also analyzed. The second aspect approached is an analysis of the situation of the system related to the limitations and malfunctions, important conditioners of the present functioning and immediate future of primary care.

Health Policy↗
PubMedDate not supplied

Determining transition probabilities: confusion and suggestions.

Confusion regarding proper use of the terms rate and risk persists in the literature. This has implications for the proper modeling of prognosis and transition between health states in decision analysis and related techniques. The issue is complicated by the plethora of terms related to rate and risk. Although the suggestion to use the terms force and probability as substitutes for rate and risk has some appeal, the change in terminology by itself is unlikely to solve all the confusion or misuse of terms. This paper clarifies the proper definitions and estimations of rates and risks and suggests critical factors for the decision analyst to remember when using, modeling, or interpreting transition rates and risks.

Actuarial Analysis↗
PubMed2006

Acupuncture use in the United States: findings from the National Health Interview Survey.

OBJECTIVE: Acupuncture has become an important provider-based complementary and alternative medicine (CAM) treatment. To improve understanding of its role in personal health care, an analysis of national data was conducted to examine user sociodemographics, conditions treated, and the relationship of use with conventional Western medical care. DESIGN: A nationally representative cross-sectional survey. SETTING: The 2002 National Health Interview Survey (NHIS), conducted in all 50 states and the District of Columbia. PARTICIPANTS: Thirty-one-thousand and forty-four (31,044) adults who completed the NHIS Sample Adult Core. OUTCOME MEASURES: The primary outcome measure was recent use of acupuncture, defined as use within the previous 12 months. RESULTS: In the 2002 NHIS sample, 4.1% of the respondents reported lifetime use, and 1.1% (representing 2.13 million Americans) reported recent use of acupuncture. Recent use (n = 327) was positively associated with being an Asian female, living in the West or Northeast, having poorer self-reported health status, a higher level of education, and being an ex-smoker. Among recent users, the most typical treatment regimen was two to four treatments (34.5%), with musculoskeletal complaints being the most frequently reported conditions, led by back pain (34.0%). Reports of perceived benefit were generally high. Respondents indicated that acupuncture was used both as an alternative and as a complementary therapy. A reasonable number also reported being referred to acupuncture by a conventional medical professional (25.3%). The cross-sectional nature of the data precluded analysis of transitions in health care use (between conventional and CAM treatments) over time. CONCLUSIONS: Utilization of acupuncture was somewhat lower than expected given its significant national and international recognition and its visibility in the media. This may in part be a function of provider availability and cultural factors.

Acupuncture Therapy↗
PubMed2001

High prevalence of diabetes, obesity and dyslipidaemia in urban slum population in northern India.

BACKGROUND AND AIMS: In this study, a prevalence survey of various atherosclerosis risk factors was carried out on hitherto poorly studied rural-urban migrants settled in urban slums in a large metropolitan city in northern India, with the aim of studying anthropometric and metabolic characteristics of this population in socio-economic transition. DESIGN: A cross-sectional epidemiological descriptive study. SUBJECTS: A total of 532 subjects (170 males and 362 females) were included in the study (response rate approximately 40%). METHODS AND RESULTS: In this study, diabetes mellitus was recorded in 11.2% (95% CI 6.8-16.9) of males and 9.9% (95% CI 7.0-13.5) of females, the overall prevalence being 10.3% (95% CI 7.8-13.2). Based on body mass index (BMI), obesity was more prevalent in females (15.6%; 95% CI 10.7-22.3) than in males (13.3%; 95% CI 8.5-19.5). On the other hand, classifying obesity based on percentage body fat (%BF), 10.6% (95% CI 6.4-16.2) of males and 40.2% (95% CI 34.9-45.3) of females were obese. High waist-hip ratio (WHR) was observed in 9.4% (95% CI 5.4-14.8) of males and 51.1% (95% CI 45.8-56.3) of the females. All individual skinfolds and sum of skinfolds were significantly higher in females (P<0.001). In both males and females above 30 y of age, there was a steep increase in the prevalence of high WHR, and in females, %BF was very high (particularly in %BF quartile>30%). Furthermore, total cholesterol and low-density lipoprotein cholesterol were high in both males and females. Stepwise multiple linear regression analysis showed that for both males and females BMI, WHR and %BF were positive predictors of biochemical parameters, except for HDL-c, for which these parameters were negatively associated. CONCLUSIONS: Appreciable prevalence of obesity, dyslipidaemia, diabetes mellitus, substantial increase in body fat, generalised and regional obesity in middle age, particularly in females, need immediate attention in terms of prevention and health education in such economically deprived populations.

Adolescent↗
PubMed2003

Epidemiological transition: model or illusion? A look at the problem of health in Mexico.

This paper discusses the validity of the epidemiological transition model to interpret changes in the structure of mortality and morbidity. Epistemological and political questions are posed. The case of Mexico is used to illustrate the limitations its use imposes on understanding the constellation of components explaining the epidemiological profile, and the problems involved in designing a public health policy on the basis of this sort of misinterpretation. It is suggested that the illusory certainty of a pre-determined destiny distorts the prospective that would enable to construct scenarios; what is actually happening remains hidden by the model and health policies are designed without adequate parameters for evaluating their effective impact. We conclude with some remarks on the usefulness of constructing alternative forms of interpretation for understanding changes in the epidemiological profile, one of the most important inputs for designing better policies to face the challenges posed by health care and dealing with illness in modern-day societies.

Causality↗
PubMed2002

Mental health, drug use, and the transition from welfare to work.

This study examines the effects of drug use and work requirements on psychological distress and employment among chronic drug-using and non-drug-using welfare recipients. Using a natural history design, 442 female Temporary Assistance for Needy Families (TANF) recipients (including 251 with chronic drug use problems) were interviewed every 4 months in order to assess changes in psychological functioning, employment status, and wages. Data from the first year (four waves) indicate that employment and wages increased substantially, though less so for drug users than non-drug users. Psychological distress decreased only slightly over the study period. Growth curve analyses show that drug use had no direct effect on wages; however, drug use did significantly increase psychological distress. Both the work mandate and psychological distress contributed to wages. The authors consider the implications of these trends for the mental health service needs of drug-using TANF recipients.

Adult↗
PubMed1999

An extended state-transition model for foot-and-mouth disease epidemics in France.

The dynamics of foot-and-mouth disease epidemics in France was examined through simulations based on an extended state-transition model. Contagion modelling depended on specific parameters: the so-called dissemination rates. Estimation of these parameters relied on a specific discrete-event simulation model. We were able to address the problem of the hidden spread of the epidemic, before the first outbreak is diagnosed. Furthermore, we took into account the silent development of the disease in affected herds before the diagnosis. The effect of control measures such as the active search for secondary outbreaks could thus be studied. We used the model to compare the development of FMD epidemics in two very different French regions and for different control strategies implemented by the animal-health authorities. These strategies gave similar results in a low herd density area, whereas in a high herd density area, the slaughter of contact herds greatly improved the stamping-out strategy. Finally, key parameters of the model were detected through a sensitivity analysis.

Animals↗
PubMed2005

Inequalities in mortality by education and socio-economic transition in Lithuania: equal opportunities?

AIM: The aim of this study was to examine the changes in mortality differentials by level of education during the period of socio-economic transition in Lithuania. METHODS: This analysis was based on routine mortality statistics and census data for 1989 and 2001 for the entire country. RESULTS: Despite a general improvement in the level of education in the Lithuanian population, some negative educational patterns were observed amongst its young members. Increasing inequalities in mortality by education have occurred due to a declining mortality rate in people with higher educational achievements and, conversely, an increasing mortality rate in people with a low level of education. Mortality inequalities by education amongst females exceeded those amongst males in 2001, particularly in middle-aged groups and due to external causes. The results of this survey predict an unfavourable forecast of increasing health inequalities in Lithuania in the near future. CONCLUSIONS: General policies for health promotion and disease prevention should be based on the realities faced by lower educated groups, rather than on experiences that are general for the total population or the class of society that has at least achieved an average education. Inequalities in health by the level of education should plateau as the society-at-large enters into a more stable stage of social and economic development.

Adult↗
PubMed1996

The family and demographic change in Sri Lanka.

Sri Lanka has almost completed the demographic transition with low mortality rates and fertility rates approaching replacement levels. Sri Lanka shares these characteristics with the South Indian states of Kerala and Tamil Nadu in contrast to elsewhere in South Asia where mortality and especially fertility rates remain much higher. A key part of the explanation for these differences lies in the nature of the family. The Sri Lankan family is essentially the conjugal unit of husband, wife and dependent children whereas in northern South Asia agnatic relations between son and parents are central to family structure. Related to this family system the position of women in Sri Lankan society was relatively high in South Asian terms. Consequently women had a strong say in health and fertility behaviour. When required, for example, mothers take the initiative in seeking health care for themselves and their children. Importantly family structure has facilitated female education which is associated with both mortality and fertility decline. There are few concerns that the values imparted by secular education are contrary to the values of the family or to women's roles within it. The egalitarian family structure has also contributed to fertility decline by raising the costs of children and reducing the long-run benefits to be gained from them. Sri Lanka is particularly distinctive in the contribution of changes in female age at marriage to its fertility decline, marriage age having risen six years this century. This change has been accompanied in recent times by a shift from family-arranged to self-selected (love) marriage. The explanation lies in changes in the socio-economic system which have reduced the centrality of the family in wider social and economic relations, and placed a greater premium on an individual's own abilities and attributes.

Birth Rate↗
PubMed1998

Association of oral spirochetes from periodontally healthy sites with development of gingivitis.

The purpose of this investigation was to determine whether the presence of selected disease-associated bacteria in health-associated plaque correlated with future gingivitis. Sites of periodontal health were identified in 65 adults. Six months later (recall 1) plaque was collected from sites that remained in periodontal health, and 5 species of specific bacteria and pathogen-related oral spirochetes were detected using monoclonal antibodies in a microscopic assay. Members of the spirochete morphogroup were also identified by phase contrast microscopy. The relationship between site-specific detection of bacteria at recall 1 and development of gingivitis at recall 2 or 3 was evaluated by means of logistic regression using generalized estimating equations, from which odds ratios (OR) were estimated. Significance was conservatively defined as OR > 2.0 and P < 0.05. We found that 488 of 1,424 healthy sites developed gingivitis over the 12-month interval between recall 1 and 3. Only the spirochete morphogroup (OR =2.04; P=0.002) was significantly associated with the transition from health to gingivitis. The association of Treponema socranskii with future gingivitis was higher than expected (OR=2.27), but the relationship was not statistically significant (P=0.163). Campylobacter rectus, Eikenella corrodens, Porphyromonas gingivalis, and pathogen-related oral spirochetes did not correlate well with gingivitis (OR < 2.0). Health-associated plaque from 5 sites contained Treponema denticola, and all 5 sites progressed to gingivitis. An OR could not be calculated because T. denticola was not detected in health-associated plaque from stable healthy sites. These findings indicated that the presence of T. denticola and unidentified spirochetes in health-associated plaque was associated with increased susceptibility to gingival inflammation. Future studies assessing a larger panel of dental plaque microorganisms, with shorter intervals between baseline and follow-up assessment, are necessary to more fully evaluate the association between detection of specific organisms at healthy sites and risk for gingivitis.

Adult↗
PubMedDate not supplied

Prevalence of cardiovascular risk factors in an African, urban inner city community.

With the epidemiological transition phenomenon, more countries are expected to move from a disease pattern dominated by infectious diseases to one characterised by non-communicable diseases. Many developing countries are contending with infectious diseases as well as non-communicable diseases, yet little is known about the prevalence of cardiovascular risk factors in poor urban communities in developing countries. The objective of this community based study was to determine the prevalence of selected cardiovascular risk factors in an urban inner city community which had been followed up prospectively from 1993 to 1998. Results show that the prevalence of hypertension (Blood Pressure BP > 160/95 mm Hg) was 12.4 percent with an age-adjusted rate of 7.4 percent. This is higher than what is found in the rural parts of the country but much lower than what is generally observed in industrialized countries of the world. Though there was no significant difference in the proportion with hypertension by gender (P > 0.05), the mean systolic BP was significantly higher for men (123.9 +/- 23.9) mm Hg) than for women (120.6 +/- 26.8 mg Hg) t = 2.93, p < 0.01. The mean diastolic BP was similarly higher for men (75.8 +/- 14.9) mm Hg than women (74.0 +/- 14.9) mm Hg t = 2.76 p < 0.01). Eight percent of the study population were obese (BMI > 30), and generally, more women than men were obese. However, at ages 15-19 significantly more males than females were obese (X2 = 73, p < 0.01). Both mean systolic and diastolic BP increased with increasing weight. When adjusting for gender, the association between hypertension and other CVD risk factors remained similar for males and females and gender was not a modifier of the factors. Of the CVD risk factors studied, Age > 40 years and obesity, were significantly associated with the presence of hypertension in this community (P < 0.0001 and P < 0.0001), smoking, alcohol intake and gender were not (P > 0.05). It is necessary to implement a national plan for the control of cardiovascular diseases in order to reduce and keep to minimum cardiovascular diseases and its complications in the country.

Adolescent↗
PubMed1993

A severity index designed as an indicator of acuity in palliative care.

Patients who are facing terminal illness frequently experience changes in health care settings which are necessitated by acute events during palliative care. This pilot study evaluates the reliability, criterion validity, and appropriateness of the San Diego Severity Index (SDSI) in a population of advanced cancer patients in different care settings. The SDSI includes diagnostic, acuity, and psychosocial assessments. Cancer patients were evaluated in an outpatient oncology clinic (SCRF), a hospice home care (HC) program, and an acute care hospital/hospice centre (ACC). Scores were lowest for SCRF (9.51 +/- 3.7), HC was intermediate (24.04 +/- 8.8), while patients at the ACC scored the highest (29.33 +/- 7.0). Patients admitted to the ACC were significantly more acute, as assessed by the SDSI, than those utilizing outpatient services. This instrument may be useful as an indicator of appropriate transitions between health care settings.

Acute Disease↗
PubMed2000

Fat intake in Hong Kong Chinese children.

The people of Hong Kong are experiencing a transition in dietary practices and lifestyle that can be observed in the fat intakes of Hong Kong children as compared with those of their counterparts on mainland China. The studies described here include 1) a longitudinal and observational dietary survey beginning with a cohort of 174 newborns and concluding with 124 children at age 7 y; 2) a biochemical study of serum lipids in relation to dietary fat intake at age 7 y; 3) a chemical fatty acid analysis and comparison of duplicate meals collected from 20 Hong Kong and 20 mainland Chinese children at age 7 y; 4) a dietary assessment of 52 lactoovovegetarian children aged 4-14 y; and 5) a comparison of the growth of all subjects with US National Center for Health Statistics standards. About 30% of the total daily energy intake of Hong Kong Chinese children aged 1-7 y was contributed by fat-much more than that in the traditional Chinese diet. Growth of the children was not impaired, including that of children on the mainland and of those lactoovovegetarians in Hong Kong whose fat intakes were lower. Mean serum cholesterol of Hong Kong Chinese children at age 7 y was 4.59 mmol/L, significantly higher than that of their counterparts on the mainland, 4.16 mmol/L. Foods consumed in Hong Kong had a significantly lower ratio of 18:2 to 14:0. Nutritional deficiency was uncommon. Chinese children in Hong Kong had a dietary fat intake that was both quantitatively and qualitatively different from the traditional Chinese diet.

Adolescent↗
PubMed2002

Where does the black population of South Africa stand on the nutrition transition?

OBJECTIVE: To review data on selected risk factors related to the emergence of noncommunicable diseases (NCDs) in the black population of South Africa. METHODS: Data from existing literature on South African blacks were reviewed with an emphasis placed on changes in diet and the emergence of obesity and related NCDs. DESIGN: Review and analysis of secondary data over time relating to diet, physical activity and obesity and relevant to nutrition-related NCDs. SETTINGS: Urban, peri-urban and rural areas of South Africa. National prevalence data are also included. SUBJECTS: Black adults over the age of 15 years were examined. RESULTS: Shifts in dietary intake, to a less prudent pattern, are occurring with apparent increasing momentum, particularly among blacks, who constitute three-quarters of the population. Data have shown that among urban blacks, fat intakes have increased from 16.4% to 26.2% of total energy (a relative increase of 59.7%), while carbohydrate intakes have decreased from 69.3% to 61.7% of total energy (a relative decrease of 10.9%) in the past 50 years. Shifts towards the Western diet are apparent among rural African dwellers as well. The South African Demographic and Health Survey conducted in 1998 revealed that 31.8% of African women (over the age of 15 years) were obese (body mass index (BMI) > or = 30kg m(-2)) and that a further 26.7% were overweight (BMI > or = 25 to <30 kg m(-2)). The obesity prevalence among men of the same age was 6.0%, with 19.4% being overweight. The national prevalence of hypertension in blacks was 24.4%, using the cut-off point of 140/90 mmHg. There are limited data on the population's physical activity patterns. However, the effects of the HIV/AIDS epidemic will become increasingly important. CONCLUSIONS: The increasing emergence of NCDs in black South Africans, compounded by the HIV/AIDS pandemic, presents a complex picture for health workers and policy makers. Increasing emphasis needs to be placed on healthy lifestyles.

Adolescent↗
PubMed2002

An accelerated nutrition transition in Iran.

OBJECTIVE: To describe the emergence of the nutrition transition, and associated morbidity shifts, in the Islamic Republic of Iran. DESIGN: Review and analysis of secondary data relating to the socio-political and nutritional context, demographic trends, food utilisation and consumption patterns, obesity, and diet-related morbidity. RESULTS AND CONCLUSIONS: The nutrition transition in Iran is occurring rapidly, secondary to the rapid change in fertility and mortality patterns and to urbanisation. The transition is occurring against the backdrop of lack of sustained economic growth. There is considerable imbalance in food consumption with low nutrient density characterising diets at all income levels, over-consumption evident among more than a third of households, and food insecurity among 20% of the population. Obesity is an emerging problem, particularly in urban areas and for women, and both diabetes and other risk factors for heart disease are becoming significant problems.

Adolescent↗
PubMed1986

Concepts of normality applied to the measurement of lung function.

Lung function testing has become an integral part of the clinical assessment of pulmonary disease. However, increasing application of such testing in research into the origins of disease as well as in the assessment of health raises the issue of what is meant by normal respiratory function. In essence, this depends on the sources of variation in lung function measurements that are of interest (the signal) and those that are not (the noise). For instance, clinicians are primarily interested in variation due to disease, all other sources of variation being considered noise. Physiologists are concerned with sources of variation other than disease, and the interest of epidemiologists (and their definition of normality) varies according to the specific objectives of each particular study, report or program. Consideration of the sources of variation in lung function (within a subject, between subjects, and between populations) not only is useful in clarifying the concepts of normality for clinical application, physiologic studies, and epidemiologic purposes, but also is mandatory for an understanding of lung function in the transition between health and disease, a major thrust in all three areas of endeavour.

Adult↗
PubMedDate not supplied

Regional, temporal, and seasonal variations in births and deaths: the effects of famines.

A knowledge of the seasonal variation in births and deaths during normal years is important for analyses of the effects of wars, famines, epidemics or similar privations on these two variables. In studies of seasonality, multiple trigonometric regression models are more flexible than the simple sine curve. The seasonal variation in mortality in Iceland, 1856-1990, shows a strong secular decrease, and a connection between this and the epidemiological transition is considered. As a consequence of the severe famine in Finland in 1867-68, the mortality for the whole year 1868 was almost four times as high as during normal years, and the seasonality of the mortality was even more accentuated. The birth rate in Finland during 1868 was about 70 percent of that during normal years and showed an aberrant seasonality, with a strong trough from October 1868 to February 1869 (fewer conceptions between January and May 1868, when the food shortage was severe).

Birth Rate↗