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PubMed2005

The age pattern of first-birth rates among U.S. women: the bimodal 1990s.

Between 1990 and 2002, the age pattern of Type I first-birth rates (i.e., the hazard of a first birth) among U.S. women was bimodal. This pattern, driven by changing differential fertility patterns among racial and ethnic groups, reached its apex at the mid-1990s and had almost vanished by the decade's end. Research on first-birth timing has tended to focus on Type II first-birth rates and therefore has failed to identify this larger, bimodal pattern. This article presents the benefits of using Type I rates, documents the emergence of the bimodal pattern via two new measures of bimodality, and uses a decomposition analysis to discuss the pattern's causes.

Adolescent↗
PubMed2000

Dental caries prevalence and dental care utilization among the very old.

BACKGROUND: This article reports on coronal and root caries prevalence and dental care utilization patterns of elderly Iowans aged 79 years or older. METHODS: The sample for this study was 449 people who were surviving members of the Iowa 65+ Rural Health Study cohort originally recruited in 1981. The authors focused their analyses on the 342 of these who were dentate. Examinations were conducted in subjects' homes by trained and calibrated examiners, using a halogen headlight, a mouth mirror, a color-coded periodontal probe and a no. 23 explorer. RESULTS: The mean age of subjects was 85.1 years (range 79-101 years), and they had a mean of 19.4 remaining teeth. Nearly all subjects (96 percent) had coronal decay experience, while 23 percent of the subjects had untreated coronal decay, about one-fourth of which was recurrent. Nearly two-thirds (64 percent) of the sample had root caries experience, with 23 percent having untreated root caries. Utilization of dental services was high among the dentate elderly, with nearly three-quarters reporting having visited a dentist within the past year. Nearly all reported that they paid for dental care themselves with no third-party coverage. CONCLUSIONS: The findings from this study of the very old suggest that coronal and root caries remain prevalent, with high levels of dental care utilization among those who have retained natural teeth. CLINICAL IMPLICATIONS: As the U.S. population ages, and more teeth are retained, demand for dental services in the population of the oldest elderly people is likely to increase.

Aged↗
PubMed2001

Endodontic status in older U.S. adults. Report of a survey.

BACKGROUND: Aging people experience a number of changes in the root canal systems of teeth that, while they are normal, have the potential to compromise the pulp's response to injury. METHODS: To better understand the dental perspective on these changes, the authors mailed a questionnaire to diplomates of the American Board of Endodontics. The questions dealt with the respondents' experiences, ages of their patient population and their perception of root canal changes in aging patients. The authors analyzed the data in terms of number of diplomates providing a response and stratified them on the basis of the respondents' number of years in practice. RESULTS: Respondents indicated that the number of patients aged 65 years and older in their practices is increasing. Virtually all of the diplomates agreed that the root canal gets smaller with age, but that this diminution does not contribute to the failure of treatment of affected teeth. Most respondents indicated that aging patients' teeth are in poorer condition than those of younger patients. CONCLUSIONS: As the U.S. population ages, clinicians need to have a better understanding of the physiological changes occurring in older patients' teeth that may influence the treatment required to help patients retain their natural dentition. Further studies are needed to determine the impact of aging on dental disease and treatment modalities. CLINICAL IMPLICATIONS: Recognition of changes in the dentition of aging patients will lead to more successful treatment, retention of functional natural dentition and better maintenance of general health.

Aged↗
PubMed2004

Madness, fear, and control in Bangladesh: clashing bodies of power/knowledge.

This article presents an understanding of how Bangladeshis cope with madness in relation to two assumptions: that systems of knowledge and of power are coterminous, and that actors in medical encounters draw on incompatible and unequal bodies of knowledge-power I first offer a perspective on psychiatry, emotion, and discourse in Bangladesh as a society increasingly caught up in globalizing modernity. Then I present two types of data to illumine tensions between various attempts to control the fears associated with schizophrenia. The first is a set of exchanges in the advice column of a new popular psychiatry magazine in Bangladesh that inculcate new perspectives on self Those who write to the editors signal their fears of what might, in the end, be impossible to control. Answers from the psychiatrists who edit the magazine reflect discourses circulating on the web, at international conferences, and at the institutions in the United Kingdom and the United States where one of them received his training. The second data set consists of video recordings of persons diagnosed with schizophrenia interacting with families and/or psychiatrists. In part because of knowledge-power asymmetries, attempts at controlling fears surrounding schizophrenia in these four cases fail to address the depths, tacitness, embodiment, and narrative embedding of anxieties experienced by all parties. I close with an argument about the implications for theories of culture and of medical pluralism that arise from cases in which the local Self is experienced from the perspective of powerful Others.

Adaptation, Psychological↗
PubMed2005

[Geriatric outpatient healthcare: hierarchical demand structuring].

In Brazil, the rapid growth of the elderly population has been causing a great impact on the healthcare system, with increased costs and service utilization. The inefficiency of traditional models for geriatric healthcare has made it essential to change the healthcare concepts for this population. This can take place through the development of new healthcare models that include the means to identify, assess and treat elderly patients with a variety of morbid and functional conditions, and which can be applied diverse healthcare scenarios. An outpatient model is proposed, with two stages that differ in the depth and coverage of their actions. These stages are organized as increasing levels of complexity and are capable of selecting subgroups of individuals that, because of their risk characteristics, should follow different paths through the healthcare structure. This paper discusses the first stage of this model, which involves risk identification among large groups of elderly people, by means of structuring a hierarchical flow of actions and using assessment tools of adequate sensitivity and specificity. Individuals aged 65 years or over who are detected through walk-in outpatient consultation, home visits or telephone interview are classified using a rapid screening risk evaluation instrument composed of eight items. Depending upon the level of risk presented, the individual will either be referred to another level of functional evaluation (medium-high and high risk levels), or to normal clinical care and old people's community centers (low and medium risk levels). The second stage will be the subject of a subsequent paper.

Adolescent↗
PubMed1999

Why do we need randomized and epidemiological studies on cardiovascular disease? Evidence-based cardiology VII.

Over the last two decades the results of randomized clinical studies, which are powerful aids for correctly assessing therapeutical strategies, have consolidated cardiological practice. In addition, scientifically interesting hypotheses have been generated through the results of epidemiological studies. Properly conducted randomized studies without systematic errors and with statistical power adequate for demonstrating moderate and reasonable benefits in relevant clinical outcomes have provided reliable and strong results altering clinical practice, thus providing adequate treatment for patients with cardiovascular disease (CVD). The dissemination and use of evidence-based medicine in treating coronary artery disease (CAD), heart failure (HF), and in prevention will prevent hundreds of thousands of deaths annually in developed and developing countries. CVD is responsible for approximately 12 million deaths annually throughout the world, and approximately 60% of these deaths occur in developing countries. During recent years, an increase in mortality and morbidity rates due to CVD has occurred in developing countries. This increase is an indication that an epidemiological (demographic, economical, and health-related) transition is taking place in developing countries and this transition implies a global epidemic of CVD, which will require wide-ranging and globally effective strategies for prevention. The identification of conventional and emerging risk factors for CVD, as well as their management in high-risk individuals, has contributed to the decrease in the mortality rate due to CVD. Through a national collaboration, several multi-center and multinational randomized and epidemiological studies have been carried out throughout Brazil, thus contributing not only to a generalized scientific growth in different Brazilian hospitals but also to the consolidation of an increasingly evidence-based clinical practice.

Cardiology↗
PubMed2003

[The aging process in the Brazilian population: a demographic approach].

Contrary to common sense, the population aging process is due to the decline in fertility rather than mortality. The aging process began around the end of the 19th century in a number of Western European countries, expanded to the rest of the so-called First World over the past century, and reached several Third World countries afterwards, including Brazil over the last decades. In the Brazilian case, a sharp and widespread fertility decline began by the end of the 1960s, and an accelerated population aging process can thus be expected. This process will necessarily be faster and with deeper structural changes, demographically speaking, than in First World countries, for two reasons: the fertility decline in Brazil was faster, and it took place in a population with a younger age structure.

Age Distribution↗
PubMed2003

[Health, work, and aging in Brazil].

The rapid aging process of the Brazilian population is accompanied by a similar change in the composition of the country's work force. The objective of this study is to determine health differentials in the elderly according to their insertion in the work market, after considering the influence of socio-demographic factors. This study included 2,886 males > or = 65 years residing in ten Brazilian metropolitan areas and included in the National Household Survey conducted by the National Institute of Geography and Statistics, or National Census Bureau (IBGE) in 1998. The analysis included the chi-square and odds ratios estimated by multiple logistic regression. More than a fourth of the elderly worked. Among the formally retired elderly, those who still worked were younger seniors, those with more schooling, and those with higher per capita family income; they reported fewer chronic diseases and presented less difficulty in performing their activities of daily living, but did not show any differences in relation to health services utilization. According to our results, health and especially indicators of autonomy and physical mobility are independent predictive factors for the elderly to remain active.

Aged↗
PubMed2003

[Aging with dependence: family needs and responsibilities].

This article highlights the phenomenon of "aging with dependence" as a challenge to be dealt with by the field of collective health and discusses responsibilities for providing health care to this population contingent, comparing the necessary and existing conditions for families to assume responsibility for such care. The analysis is based on authors and theoretical references involving studies on aging, dependence, public policies, and available community resources for health care for the elderly. The following themes are emphasized: dependence and aging, the economic issue of dependence, family care, and family needs. The article concludes that since dependence is a dynamic process, it should be approached through programs that range from health promotion strategies to the establishment of support networks for long-term care in the community. These programs should be part of a public policy that involves all sectors of society and that can provide back-up for dependent seniors, with or without family support.

Activities of Daily Living↗
PubMed2005

The role of the built environment in the disablement process.

The Disablement Process model explicates the transition from health conditions to disability and specifically emphasizes the role of intervening factors that speed up or slow down the pathway between pathology and disability. We used hierarchical Poisson regression analyses with data on older adults from central North Carolina to examine the role of the built environment as a modifying factor in the pathway between lower extremity functional limitations and activities of daily living. We found that, despite declining physical function, older adults report greater independence in instrumental activities when they live in environments with more land-use diversity. Independence in self-care activities is modified by housing density, in part through the effect of substandard and inadequate housing.

Activities of Daily Living↗
PubMed1998

Smoking and dietary risk factors for cervical cancer at different age group in Japan.

The importance of the major risk and protective factors for cervical cancer in women by age group was evaluated with the use of data from the Hospital-based Epidemiologic Research Program at Aichi Cancer Center (HERPACC), Japan. This study included 416 cervical cancer cases and 20,985 referents confirmed as free of cancer. Cases and referents were divided into three age groups: the younger, middle and older age groups (30-44, 45-54 and 55-69 years old, respectively). Logistic model was applied separately to the three groups to estimate odds ratios (ORs) of smoking, beverage and dietary habits with adjustment for marital and reproductive factors. The elevated OR of current smokers was observed consistently in all age groups, while alcohol intake did not show any increased ORs. Dietary control for health lowered ORs for all three age groups, and the effect appeared to be more pronounced among the older age group (OR = 0.49, 95% confidence interval: 0.30-0.80). Higher frequency intake of green-yellow vegetables consistently afforded lower ORs among all three age groups. This risk increment of smoking and risk reduction by dietary control were consistent in all age groups. These findings suggested practicable prevention strategy for the cervical cancer by modifying general life style.

Acculturation↗
PubMed1999

Process and current status of the epidemiologic studies on cedar pollinosis in Japan.

This paper reviews the present situation and future aspects of epidemiologic studies on Japanese cedar pollinosis. Increase of allergic rhinitis patients is observed in both the Patient Survey and the Reports on the Surveys of Social Medical Care Insurance Services, however, these surveys are conducted when cedar pollens do not pollute the air. Many have reported on the prevalence of pollinosis in limited areas but only a few nationwide epidemiologic surveys have been conducted. Most of the studies were conducted at special medical facilities such as university hospitals. There is a high possibility that patients who visit the specific facilities do not exactly represent the actual number of patients and epidemiologic pictures of pollinosis in Japan. The rapid advances in laboratory test methods may change the diagnostic criteria and increase the number of reported patients. Therefore, the prevalence of Japanese cedar pollinosis in Japan has not been determined yet. Determination of the prevalence of cedar pollinosis and description of the epidemiologic pictures constitute the essential steps toward the control of this clinical entity. Thus it is necessary to conduct an epidemiologic survey on Japanese representative samples with a standardized survey form with clear and concise diagnostic criteria.

Allergens↗
PubMed2000

Development and quality of life: a critique of Amartya Sen's Development as freedom.

Presented here is a critical analysis of some of the major theses of Amartya Sen, as presented in his seminal work Development As Freedom. The author suggests that Sen's work, while representing a major break with the dominant neoliberal position reproduced in most national and international development agencies, is insufficient to explain the key relationship between freedom and development. The absence of an analysis of the power relations that cause and reproduce underdevelopment through national and international political institutions leaves Sen's work wanting. The author shows how Sen's interpretation of events and the conclusions derived from them, such as an explanation of famine in Bangladesh, are insufficient--when not faulty. The author also critically analyzes the United Nations Development Program reports, which, while documenting the nature and consequences of underdevelopment, barely touch on the political context in which underdevelopment occurs.

Communism↗