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PubMed2002

Asthma, from childhood to adulthood: a prospective 20-year longitudinal study of a cohort of asthmatics.

This study analyzes the evolution of a group of children under 10 years of age with asthma over a period of 20 years. We selected a random group of 32 children with asthma and compared it with a control group composed of 33 children without asthma, similar in age, sex, and socio-economic characteristics. Throughout the 20 years we analyzed the number of ambulatory visits, morbidity, environmental tobacco smoke (ETS) as well as social and economic characteristics. The results after 20 years of evaluation showed that inflammatory and infectious processes in the airways (upper and lower) were more frequent among asthmatics than in the control group. ENT infections were more predominant in the group with inadequate sanitary conditions. There were no significant differences for the other pathologies. We studied the frequency of asthmatic crises requiring emergency care according to age and sex. Clinical ambulatory visits in asthmatic children were 2.8 times more frequent than in the control group. We found no differences between males and females, either in terms of global morbidity or the worsening of their asthmatic disease e.g., crises, going to emergency services and hospitalization. In the asthmatic group, the frequency of asthma crises, visits to emergency services and hospitalization were analyzed, with no differences being found between the sexes. We measured the PEFR, FEV1, and FEF25-75 in both groups for 20 years and compared those values to age, weight, height, and sex. We found that the parameters of lung function were lower in the asthmatic group than in the control group. We used as statistical method the chi 2 test, and regression analyses were made to relate the PEFR, FEV1, and FEF25-75 values to age and gender. A paired t-test was used to compare ambulatory visits, morbidity, emergency care, ETS, and sanitary housing conditions to age and sex in both groups. A p value < or = 0.05 was taken as indicating statistical significance.

Adolescent↗
PubMed2000

State youth-access tobacco control policies and youth smoking behavior in the United States.

CONTEXT: State policies aimed at controlling youth access to tobacco are an important component of public health efforts to reduce smoking prevalence among youth and prevent subsequent disease. OBJECTIVES: This study sought to assess the extensiveness of state youth access tobacco control legislation in the United States, describe how state policies changed over a 4-year period, explore how various political and economic characteristics are related to state policies, and determine the relationship of youth smoking behavior to state youth tobacco control policies. DESIGN: This descriptive and correlational study utilized data from multiple national surveillance, economic, and sociodemographic data sets. PARTICIPANTS: All 50 states and the District of Columbia provided economic and political data. A standard tobacco-control policy score was developed by an expert panel for each state. Aggregated state-level measures of youth smoking behavior were provided by 79,491 youth in 33 states and the District of Columbia. MAIN OUTCOME MEASURES: Included were extent of state tobacco control policies and changes over time, relationship between state political and economic characteristics and tobacco control policies, and relationship between state policies and youth smoking behavior. RESULTS: State policy scores increased in variability and in mean value over the 4-year period, from a mean score of 7.2 in 1993 to 9.0 in 1996. State policy scores were significantly correlated with several state political and economic variables. States with more extensive tobacco control policies had significantly lower youth smoking rates. There was some evidence that a strong state tobacco economy may limit the effectiveness of tobacco control policies on youth smoking rates. CONCLUSIONS: It is possible to reliably measure the extent to which states are achieving important public health goals in limiting youth access to tobacco products. Comprehensive state tobacco control policies are important for increasing prevention and cessation of smoking among youth.

Adolescent↗
PubMed2005

Assessment of sociodemographic factors and socio-economic status affecting the coverage of compulsory and private immunization services in Istanbul, Turkey.

OBJECTIVES: The primary objective of this study was to determine the coverage of the Expanded Programme of Immunization (EPI) of the Ministry of Health and the coverage of private vaccines in the Umraniye Health District in order to establish approaches for improving vaccination services. Other objectives were to define the areas that present higher risks for non-vaccination and to determine the factors that influence vaccination coverage. METHODS: A '30 x 7' cluster sampling design was adopted as the sampling method. Thirty streets were selected at random from each health care region. Sociodemographic and socio-economic characteristics of the population, utilization of vaccination services and vaccination status of children under the age of 5 years were determined by face-to-face interviews. Odds ratios for the sociodemographic and socio-economic characteristics, health centre region and inner country immigration were assessed as possible related factors with the vaccination coverage rates for children under 5 years and under 1 year using the backward elimination method in logistic regression. RESULTS: Vaccination coverage was as follows: hepatitis B third dose, 84.6%; Bacille Calmette-Guérin, 94.8%; diphtheria, tetanus, pertussis (DPT) third dose, 90.1%; oral polio virus (OPV) third dose, 90.0%; measles, 88.7%; DPT booster dose, 79.1%; OPV booster dose, 79.0%; measles, mumps, rubella (MMR), 13.3%; haemophilus influenza type b (Hib), 9.3%; and Varicella vaccine, 3.3%. The full vaccination rates for children under 5 years and under 1 year were 68.3 and 79.5%, respectively. Higher socio-economic status was associated with a higher rate of full vaccination and private vaccination for children under 5 years of age. CONCLUSIONS: Full vaccination rates for children aged less than 1 year and less than 5 years were higher in our district than in Istanbul. However, we did not meet the EPI aims for any of the vaccines, and differences were observed in vaccination coverage rates between different socio-economic groups in the district. Therefore, an intervention programme should be considered to achieve the EPI's goals, particularly in socio-economically disadvantaged groups. Also, the coverage of private vaccination (MMR, Hib, Varicella) is low and more children from higher socio-economic groups receive these vaccines.

Adolescent↗
PubMed1986

[Relationships between characteristics of community and health service and activity states of medical care facilities in four regions of Fukuoka Prefecture].

In the present study, we assigned a geographical range to promote community health service planning according to the life-behavior spaces of inhabitants in Fukuoka prefecture and regarded the country-life zone, defined by the Ministry of Construction, as a region in which health services should be investigated. The social and economic characteristics of each individual region were then analyzed. As a result, four factors related to "Industrialization" and "Urbanization" were detected. Further, the states of space distribution of medical care facilities and medical care-related facilities were clarified, and relationships between the states and the above socio-economic characteristics were investigated. The states of space distribution in both facilities in Fukuoka prefecture were proved to be remarkably similar on an axis of the "Accumulation of Urbanism" factor. Moreover, Path Analysis was performed in order to clarify the patterns of treatment received by the inhabitants, and a model of these trends in relation to health care received was constructed, highlighting problems in the necessary planning of health service provision. It was specifically indicated that the problem of aging in Chikuho region would be an important factor affecting such planning in the future. We also analyzed the present state of emergency medical services in Fukuoka prefecture and the activities of health nurses in each individual region.

Catchment Area, Health↗
PubMed2004

A tale of two continents: a multilevel comparison of the determinants of child nutritional status from selected African and Indian regions.

This paper compares individual and household predictors of underweight among young children in sub-Saharan Africa and India, while also assessing the impact of clustering of weight for age z-scores at the household, community and regional levels. Multilevel statistical models are employed to compare the strength of the correlates of underweight (using weight-for-age z-scores) in six sub-Saharan African countries and four Indian states. The multilevel approach controls for correlation among children resulting from clustering within families, communities, or regions and in addition enables tests for differences in the regional, community and household effects for children from families of different socio-economic characteristics. Findings demonstrate the importance of individual and household level predictors such as age, the size of child at birth, prolonged breast-feeding, recent diarrhoea episodes, and maternal education as predictors of low weight-for-age z-scores across regions. Strong family effects are observed as well as significant community and regional random effects on variation in weight for age z-scores. In some regions, socio-economic characteristics of the household result in significant differences in the household or community level variance in weight for age z-scores, suggesting that the impact of the geographical context varies by socio-economic status of the household.

Africa South of the Sahara↗
PubMed1990

The Po River Delta epidemiological study of obstructive lung disease: sampling methods, environmental and population characteristics.

A longitudinal study on chronic obstructive lung disease (AOD) has been started in the Po River Delta in northern Italy. The first cross-sectional study was conducted in this previously unpolluted rural area before the start of operation of a large thermoelectric power plant (2,649 megawatt). A significant output of air pollutants is expected. This will permit us to carry out a "natural experiment" to study the effects of air pollutants (SO2 and suspended particulates). A multistage stratified cluster design was chosen. Stratification was based on age and socio-economic characteristics (SES) of households, and was performed in two steps, using the different indices computed from the census data. Geographic zones represented four areas of different predicted pollution exposure, once the plant started operating. There were 3,289 subjects in the selected age group (8-64) who agreed to participate (78%); only 11% refused to participate. The participants were representative of the clusters and SES. Participants had slightly fewer employed males, who did not participate due to work. The stratification and staging method allowed us to keep an acceptable level of precision and efficiency in the sample. In fact age-related differences were not found among the SES strata and geographic zones; various socio-economic characteristics, verified from the questionnaire information, were consistent with the SES stratification. Differences between geographic zones were related to the number of households of different SES within clusters; however this reflects the characteristics of the general population in the area.

Air Pollutants↗
PubMed2006

Using geographical information systems and spatial microsimulation for the analysis of health inequalities.

The paper presents a spatial microsimulation approach to the analysis of health inequalities. A dynamic spatial microsimulation model of Britain, under development at the Universities of Leeds and Sheffield, uses data from the censuses of 1971, 1981 and 1991 and the British Household Panel Survey to simulate urban and regional populations in Britain. Geographical information systems and spatial microsimulation are used for the analysis of health inequalities in British regions in a 30 year simulation. The interdependencies between socio-economic characteristics and health variables such as limiting long-term illness are discussed. One of the innovative features of the model is the estimation of variables such as household income at the small area level, which can then be used to classify individuals. The health situation of different simulated individuals in different areas is investigated and the role of socio-economic characteristics in determining health is evaluated.

Adult↗
PubMed2002

Parental factors associated with regular use of dental services by second-year secondary school students in Quebec.

The aim of this study was to identify the parental factors associated with regular use of dental services by second year secondary school students in Quebec. Data were collected in 1996-97, as part of a provincial survey on the dental health of Quebec students. A stratified probabilistic sample of 1,351 students, representative at the provincial level, was obtained. Data about frequency of use of dental services, parents' socio-economic characteristics, dental insurance (private and public) and parents' utilization of dental services were selected for this study. Half of the students used dental services regularly (i.e., once every 6 months). Multivariate analysis showed that the strongest parental factors associated with regular use were (in decreasing order of importance) the date of the mother's most recent dental visit, dental insurance, household income and the date of the father's most recent dental visit. After adjustment for the parents' socio-economic characteristics and the availability of dental insurance, students with one parent (particularly the mother) who had visited the dentist within the previous year had better odds of using dental services every 6 months, as recommended by professional standards.

Adolescent↗
PubMed1996

Measuring the mental health status of a population: a comparison of the GHQ-12 and the SF-36 (MHI-5).

BACKGROUND: A comparison of the performance of the 5-item mental health dimension of SF-36 (MRI-5) with that of the 12-item General Health Questionnaire (GHQ-12) in a defined, non-patient population, using standard statistical tests. METHODS: A postal survey of 3000 patients aged 16-64 years was conducted. Patients were randomly selected from the practice lists of two general practices chosen to represent populations with different socio-economic characteristics. RESULTS: Considerable evidence was found for the internal consistency of both instruments (Cronbach's alpha 0.91 and 0.84 for GHQ-12 and the MHI-5 respectively) and for their construct validity in terms of distinguishing between groups with measured health differences. Both instruments showed a significant difference in the mean scores for men and women. In contrast to the GHQ-12, no correlation was found between age and score for the MHI-5. Both instruments were equally sensitive to socio-economic characteristics and to levels of social support. The scores on the two instruments were highly correlated (Spearman rank correlation-0.73). CONCLUSION: The MHI-5 has comparable psychometric performance to the GHQ-12, and can be used to measure and compare mental health in defined populations. Operational advantages of the MHI-5 over the GHQ-12 are that it is in the public domain, is part of a general health measure (SF-36) and is shorter.

Adolescent↗
PubMed1990

Socio-spatial perspectives on the utilization of emergency hospital services in two urban territories in Quebec.

Hospital emergency services located in urban areas have been severely congested for several years in the province of Quebec. This problem is not caused by ambulatory patients who are using emergency services as a regular source of care, but by patients in need of emergency services. To study the factors affecting the utilization rates of emergency services in two urban areas, the city of Laval and the Quebec metropolitan area, two samples of more than 30,000 patients each were drawn from the 1981 file of the Régie de l'assurance-maladie du Quebec. The utilization rates of emergency services for emergent and urgent causes in these two samples were computed on the basis of the census tract location of these patients. The socio-economic characteristics of these census tracts were taken from the 1981 Canadian census, the distance travelled from each census tract to the location of hospital emergency services was computed and included as a predictor of the utilization rates. Also, the prevalence of chronic and psychiatric diagnoses were obtained for each census tract. The result of the analysis showed that distance affected the utilization rates only in the Quebec metropolitan area where the hospitals are mostly located in the downtown area near deprived and working class neighbourhoods, while the socio-economic characteristics affected the utilization rates in both Quebec and Laval.

Age Factors↗
PubMed2004

Patterns of General Practitioner consultation for mental illness by young people in rural areas. A cross-sectional study.

The prevalence of psychiatric morbidity appears to be lower in rural than urban areas. Using the Fourth National GP Morbidity Survey (1991-1992) we have compared patterns of GP consultation for mental illness by young people living in rural and urban areas to investigate whether patterns of morbidity are reflected in GP help-seeking. We investigated whether urban-rural differences were due to differences in the socio-economic characteristics of residents. The crude rate ratio for consultation for mental disorder in rural compared to urban males was 0.55 (95% Cl 0.47 to 0.65) and for females was 0.78 (0.71 to 0.86). After controlling for socioeconomic differences between rural and urban areas, consultation rates for mental illness were 30% (95% Cl 19% to 41%) lower in males and 16 per cent (8% to 24%) lower in females in rural compared to urban areas. These findings are in line with population surveys indicating that levels of mental illness are lower in rural compared to urban areas. Part of the difference economic characteristics of people living in these areas. Further studies are needed to investigate possible area effects on the prevalence of mental illness. reflects differences in the socio-

Adolescent↗
PubMed1989

Piecework, repetitive work and medicine use in the clothing industry.

This study was designed to examine the potential effects of severe time constraints on workers' health. Medicine use is considered to be an indicator of non-specific morbidity that is worthy of interest in industrial health research when it is possible to compare workers who share the same culture and socio-economic characteristics, but are submitted to different work conditions. In the clothing industry, our hypotheses were that (1) piecework paid operators would have a higher percentage of medicine users than the hourly paid and (2) operators who did repetitive work would have a higher percentage of medicine users than those who did non-repetitive work. Women selected into the study were between the ages of 45 and 70, natives of Canada, spoke French and lived in the metropolitan region of Montreal. The occupational data came from the files of The Ladies' Clothing Joint Commission. They encompass the 30-year period 1956-85. Data on socio-economic characteristics, smoking status and medicine use of the 800 respondents were obtained by questionnaires administered by specially trained nurses. Among currently employed women, the probability of using stomach medication was higher for pieceworkers than among women who received an hourly wage: OR = 2.57 (1.19-3.96). The probability was also higher for women who did repetitive work than for women who did non-repetitive work: OR = 2.43 (1.26-3.60).

Aged↗
PubMed1999

Public preferences regarding rabies-prevention policies in the UK.

The current 6-month quarantine system for all cats and dogs entering the UK has kept the UK rabies-free since 1922. However, pressure is mounting for a change to a system of vaccination, microchip identification and serological testing. In response to the increasing controversy surrounding the quarantine system, the UK government recently set up an independent review panel to assess the alternatives. This paper quantifies public preferences for the current policy and three alternative rabies-prevention measures. A survey was used not only to assess the overall preferences for rabies-prevention policies but also to assess the importance of policy attributes and socio-economic characteristics in determining policy preferences. We interviewed a sample of pet-owners in North Yorkshire. The results showed that the existing system was the single most-preferred policy option. However, a large proportion of the sample preferred the vaccination-based policies. A logistic-regression model and ordered probit models were used to find that safety and animal welfare were the most-important factors determining policy preferences. The respondents' awareness of the rabies-policy review, a desire to take a pet abroad, the amount of foreign travel, occupation and previous experience of quarantine were all important factors in policy choice. Socio-economic characteristics such as income, pets owned and the number of children were not significant determinants of policy preference.

Animals↗
PubMed1997

The socio-economic distribution of heart diseases: changing gradients in The Netherlands.

Two different Dutch data-sets were used to examine trends in the association between socio-economic characteristics and the risk of heart disease. Data of the Dutch Quality of Life Surveys allowed the examination of trends in the association between educational level and self-reported heart disease during the period 1974-1993. For both the general Dutch population and the subpopulation of men aged 40 years and older, we found an inverse gradient during the whole period. The gradient climaxed at 1980-1983, and narrowed afterwards. Furthermore, ecological analyses, relating regional mean personal incomes to regional directly standardised mortality rates of coronary heart diseases (CHD) and all heart diseases, showed similar patterns of social differentials. The findings suggest that, in the Netherlands, there is a narrowing gradient of the association between socio-economic characteristics and heart disease in the late eighties and early nineties.

Adult↗
PubMed2007

Measuring dietary diversity in rural Burkina Faso: comparison of a 1-day and a 3-day dietary recall.

OBJECTIVES: To compare dietary diversity scores measured over a 1-day and a 3-day period, and to assess their relationships with socio-economic characteristics and the nutritional status of rural African women. DESIGN: A qualitative dietary recall allowed calculation of a dietary diversity score (DDS; number of food groups consumed out of a total of nine). Body mass index (BMI) and body fat percentage (BFP) were used to assess the nutritional status of women. SETTING AND SUBJECTS: A representative sample of 550 mothers in north-east Burkina Faso. RESULTS: The DDS increased from 3.5 to 4.4 when calculated from a 1-day or a 3-day recall (P < 0.0001), although for the latter the DDS was affected by memory bias. The DDS calculated from a 1-day recall was higher when a market day occurred during the recall period. Both scores were linked to the sociodemographic and economic characteristics of the women. Women in the lowest DDS tertile calculated from the 1-day recall had a mean BMI of 20.5 kg m-(2) and 17.7% of them were underweight, versus 21.6 kg m (-2) and 3.5% for those in the highest tertile (P = 0.0003 and 0.0007, respectively). The DDS calculated from the 1-day recall was also linked to mean BFP; all these links remained significant after adjustment for confounders. For the 3-day period, no such relationships were found to be significant after adjustment. CONCLUSION: The DDS calculated from a 1-day dietary recall was sufficient to predict the women's nutritional status. In such a context attention should be paid to market days.

Adolescent↗
PubMed1996

The error of using returns-to-work to measure the outcomes of health care.

This article uses data from The Survey of Ontario Workers With Permanent Impairments. the world's largest survey of injured workers, to show that, as currently used, return-to-work is a misleading measure of the effectiveness of health care. The article discusses examples of two serious limitations on the use of return-to-work to measure the outcomes of health care, where health care refers to all the medical and rehabilitative services provided to a worker following a workplace injury. The first limitation is that return-to-work, like many other outcomes of health care, is influenced by factors that are not directly related to health care. Using a logit model to estimate the determinants of first absences from work after an injury, we find that socioeconomic characteristics, economic incentives, and job characteristics have a significant influence on return-to-work. The second limitation on return-to-work as an outcome measure is that the first return-to-work after an injury, like a hospital discharge, frequently marks the end of only the first of several episodes of work disability caused by the original injury. Using first post-injury returns-to-work as a proxy for recovery, we would assume that 85% of the Ontario workers recovered from their injury when, in fact, 61% had subsequent spells of work disability. We identified four mutually exclusive patterns of post-injury work and work disability. Multinomial logit estimates of the determinants of the patterns show that health care is only one of several influences on return-to-work. The results also demonstrate that if return-to-work is used to measure outcomes, it must be evaluated over a time horizon that permits multiple spells of work disability.

Bias↗
PubMedDate not supplied

Type I diabetic nephropathy: clinical characteristics and economic impact.

Approximately one-third of type I diabetic patients develop diabetic nephropathy with confounding pathogenesis--frequently manifested as heavy persistent proteinuria, fall in glomerular filtration rate, and increased arterial hypertension. There is increasing incidence and prevalence of type I diabetes, particularly in northern Europe and the United States. Increased morbidity and mortality occur in type I diabetic patients with renal disease. Among type I patients with persistent proteinuria, death occurs on the average within 5-10 years. The economic impact of endstage renal disease due to diabetic nephropathy is overwhelming, and the cost is increasing at an alarming rate.

Cost of Illness↗
PubMed2004

Health care resource allocation and individuals' health care needs: examining the degree of fit.

Previous studies examine associations between health system resources and an individual's use of health services, yet the importance of these resources in meeting an individual's health care needs is unclear. This paper examines the relationship between health care system characteristics, other social and economic characteristics of counties in a mid-western U.S. state and an individual's ability to meet health care needs over a 12-month period. We conclude that policy interventions are needed that look beyond health resource allocation to address problems in health care access that contribute to inequities in health.

Adolescent↗