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PubMed2003

School and family participation in a longitudinal study of tobacco use: some methodological notes.

School-based recruitment of youth for a research purpose is problematic, as one has to deal with multiple ethical and practical constraints. This study reports on predictors of schools' and families' participation in a longitudinal study of tobacco use among 11-year-old children. School size, but not tobacco policy, was linked to participation. High parental education and average social status in the residence area were associated with parental consent. Given the social background, prevalence of parental tobacco use was close to the expected. Compliance of responsible adults in youth research cannot be predicted on the basis of simple behavioural models.

Child↗
PubMed2005

Characteristics of non-response in the Danish Health Interview Surveys, 1987-1994.

BACKGROUND: The types and quantity of non-response in surveys influence the extent to which the results may be generalized. This study analysed trends in non-response in the Danish Health Interview Surveys from 1987 to 1994 and used the National Patient Registry to assess whether non-response biased the estimated population prevalence of morbidity when solely based on responders. METHODS: The data were for the 23,096 adults sampled for the Danish Health Interview Surveys in 1987, 1991 and 1994. All were followed using the National Patient Registry to obtain such information as hospital admissions. RESULTS: Non-response increased from 20.0% in 1987 to 22.6% in 1994. Four combinations of background variables characterized the non-response: gender and age; gender and civil status; county of residence and age; survey year and age. Non-respondents and respondents had identical gender- and age-standardized hospital admission rates for approximately 5 years before and 2 years after data collection, but non-respondents had a significantly higher rate immediately before and during data collection. Admissions rates were analysed according to reasons for non-response. Refusers had a lower admission rate than respondents before data collection but similar during and after data collection. The rate was higher during the whole period among ill or disabled non-respondents. Among people who could not be contacted during the data collection period a higher admission rate was only found immediately before and during data collection. CONCLUSIONS: Although admission rates differed between respondents and non-respondents these differences were too small to bias the estimated population prevalence of morbidity when solely based on respondents.

Adolescent↗
PubMed1999

Scaling ADLs within the MDS.

BACKGROUND: Dependency in activities of daily living (ADLs) is a reality within nursing homes, and we describe ADL measurement strategies based on items in the Minimum Data Set (MDS) and the creation and distributional properties of three ADL self-performance scales and their relationship to other measures. METHODS: Information drawn from four data sets for a multistep analysis was guided by four study objectives: (1) to identify the subcomponents of ADLs that are present in the MDS battery; (2) to demonstrate how these items could be aggregated within hierarchical and additive ADL summary scales; (3) to describe the baseline and longitudinal distributional properties of these scales in a large, seven-state MDS database; and (4) to evaluate how these scales relate to two external criteria. RESULTS: Prevalence and factor structure findings for seven MDS ADL self-performance variables suggest that these items can be placed into early, middle, and late loss ADL components. Two types of summary ADL self-performance measures were created: additive and hierarchical. Distributional properties of these scales are described, as is their relationship to two external ADL criteria that have been reported in prior studies: first as an independent variable predicting staff time involved in resident care; second as a dependent variable in a study of the efficacy of two programs to improve resident functioning. CONCLUSIONS: The new ADL summary scales, based on readily available MDS data, should prove useful to clinicians, program auditors, and researchers who use the MDS functional self-performance items to determine a resident's ADL status.

Activities of Daily Living↗
PubMed1983

Distance and contacts: interactions of black urban elderly adults with family and friends.

Distance is the major factor determining the frequency of social interaction with family and friends for elderly whites. Age, sex, marital status, length of residence, and income also affect the number of social contacts. These relationships have not been studied for elderly blacks. Utilizing data from a survey of 655 black urban residents 60 years old and older, this study investigated contacts with family and friends. The major finding was that the neighborhood is an important place for socializing with both family and friends for this population as is the case for working-class white elderly adults. A surprising finding is that, whereas social contacts increase with higher income for working-class elderly whites, for these black elderly adults who are of the working class and poor, social contacts decrease with higher income.

Aged↗
PubMed1992

Living arrangements of elderly Japanese and attitudes toward inheritance.

Using data from the 1988 Mainichi Newspaper/Nihon University National Family Survey, we analyzed the living arrangements and attitudes toward inheritance of Japanese aged 60 and over. Logit analysis indicates that living arrangements are influenced by gender, age, marital status, education, urban residence, and number of living children. Log-linear modeling of inheritance attitudes shows that living with married children, lower educational attainment, and living in a traditionally agricultural area are associated with favoring bequests to eldest sons, as opposed to bequests to all children equally or to whoever takes care of the elderly person. The results are consistent with modernization theory of gerontology and convergence theory of family sociology in that elderly persons with more "modern" characteristics are more likely to depart from prewar ideals of living with married children and preferring bequests to eldest sons only.

Aged↗
PubMed1994

Epidemic cholera during refugee resettlement in Malawi.

BACKGROUND: In June 1988 a cholera epidemic occurred in a Mozambican refugee population resettling in southern Malawi. METHODS: A case-control study was conducted to determine possible risk factors for disease. The characteristics of 48 refugee households with any member(s) hospitalized for suspected cholera were compared to 441 randomly sampled refugee households without hospitalizations. RESULTS: Vibrio cholerae 01 was isolated from 50% (5/10) of case-patient stool cultures. Having any water containers with > or = 10 T capacity was associated with a significantly lower odds of suspected cholera in households (adjusted odds ratio [aOR] = 0.02, 95% confidence interval [CI] : 0.003-0.12), as was having metal cooking pots (aOR = 0.3, 95% CI : 0.12-0.7), after adjusting for length of residence and socioeconomic status (logistic regression model). Households with two or more children < 5 years old were at markedly increased odds of suspected cholera (P < 0.0001). These results suggest that water containers and cooking pots served important preventive functions during this cholera outbreak. Young children may have contributed to cholera transmission, but the reason(s) remains undetermined.

Adolescent↗
PubMed1981

The relationship between birth weight, smoking during pregnancy and maternal weight gain.

To test the hypothesis that the lower birth weight of infants whose mothers smoke during pregnancy is mediated by lesser weight gain during pregnancy, the authors examined data from an original series consisting of 12,068 births in Northern Finland. Weight gain data were collected for every 10th case chosen by systematic sampling in such a way that every group of abnormal births was treated separately to assure correct representation in the sample. The weight gain of the smokers was 200 g less than that of the controls matched with them for age, parity, place or residence and marital status, but the difference in birth weight and placental weight accounted for about 85% of the total sample in order to quantify the separate and joint contributions to birth weight of smoking, maternal weight gain, pre-pregnant weight, height and duration of gestation. The effect of smoking alone was highly statistically significant in all models. Its effect was independent of weight gain, but when all the variables were introduced simultaneously, the effect was reduced to half. Another set of regression analyses were performed with weight gain as the dependent variable and the others as explanatory variables. The effect of smoking on weight gain was not statistically significant. The result was not affected by including parity in the explanatory variables.

Birth Weight↗
PubMed1988

A case-control study of brain gliomas and occupational exposure to chemical carcinogens: the risk to farmers.

During 1983 and 1984, 240 newly diagnosed cases of brain glioma and 742 controls (465 non-glioma nervous system tumors and 277 patients with other neurologic diseases) were recruited and interviewed in the neurologic and neurosurgical departments of two hospitals in Milan, Italy. The occupational histories of cases and controls were compared, and relative risk estimates, adjusted for sex, age, residence, and socioeconomic status, were computed using the Mantel-Haenszel method. A statistically significant risk increase was found for farmers (relative risk (RR) = 1.6, p = 0.0025). This risk increase was attributable to those farmers who reported the use of chemicals (insecticides or fungicides, herbicides, and fertilizers). Among the three groups of investigated agrochemicals, only the use of insecticides or fungicides was associated with a significant increase in relative risk (RR = 2.0, p = 0.006). Many farmers exposed to fungicides reported the use of commercial compounds of copper sulfate. Some of these compounds contain methyl urea, which has a specific carcinogenic effect on the nervous system in animals. These data suggest that the occupational exposure of farmers to agrochemicals might be responsible for the observed excess risk of brain glioma in farmers.

Adult↗
PubMed2000

An international comparison of cancer survival: relatively poor areas of Toronto, Ontario and three US metropolitan areas.

BACKGROUND: This study of cancer survival compared adults in Toronto, Ontario and three US metropolitan areas: Seattle, Washington; San Francisco, California; and Hartford, Connecticut. It examined whether socioeconomic status has a differential effect on cancer survival in Canada and the United States. METHODS: The Ontario Cancer Registry and the National Cancer Institute's Surveillance, Epidemiology and End RESULTS: (SEER) programme provided a total of 23,437 and 37,329 population-based primary malignant cancer cases for the Toronto and US samples, respectively (1986-1988, followed until 1994). Census-based measures of socioeconomic status were used to ecologically control absolute income status. RESULTS: Among residents of low-income areas, persons in Toronto experienced a 5 year survival advantage for 13 of 15 cancer sites [minimally one gender significant at 95 per cent confidence interval (CI)]. An aggregate 35 per cent survival advantage among the Canadian cohort was demonstrated (survival rate ratio (SRR) = 1.35, 95 per cent CI= 1.30-1.40), and this effect was even larger among younger patients not yet eligible for Medicare coverage in the United States (SRR = 1.46, 95 per cent CI = 1.40-1.52). CONCLUSION: Systematically replicating a previous Toronto-Detroit comparison, this study's observed consistent pattern of Canadian survival advantage across various cancer sites suggests that their more equitable access to preventive and therapeutic health care services may be responsible for the difference.

Censuses↗
PubMed2004

The Johns Hopkins Urban Health Institute: A collaborative response to urban health issues.

The authors provide background on the poor health and economic status of the residents of East Baltimore, Maryland--the neighborhood surrounding a significant part of Johns Hopkins University, including the School of Medicine, the School of Nursing, the Bloomberg School of Public Health, and the Johns Hopkins Hospital. The president of the Johns Hopkins University established a council on urban health, consisting of a broad array of individuals from across the university and the community to develop a recommended course of action to help deal with these conditions. Based on the recommendations of the council, the Johns Hopkins Urban Health Institute was established with the mission to marshall the resources of the university and external groups to improve the health and well-being of the residents of East Baltimore and to promote evidence-based interventions to solve urban health problems nationwide. After becoming fully operational in 2001, the institute established three major goals: (1) strengthen research and learning, (2) reduce disparities in health and health care for East Baltimore residents, and (3) promote economic growth in East Baltimore. The article describes the institute's major activities, including community-based participatory research projects, the Journal of Community-Based Participatory Research, and programs for research fellows to promote research and learning; HIV/AIDS counseling and testing centers and a primary care clinic for the uninsured to reduce health disparities; and a technology resource center providing training and job opportunities to promote economic growth. The authors conclude by outlining the next steps planned for the institute.

Academic Medical Centers↗
PubMed2000

Neurosurgery at the University of Pennsylvania Medical Center.

The University of Pennsylvania Medical School was the nation's first medical school, and its Department of Neurosurgery is one of the nation's oldest. The history of the Department of Neurosurgery at Penn is recounted, beginning with the pioneer surgeon Charles Harrison Frazier. The evolution of the current department, its contemporary status, and its residency program are described.

Academic Medical Centers↗
PubMedDate not supplied

Data mining methods find demographic predictors of preterm birth.

BACKGROUND: Preterm births in the United States increased from 11.0% to 11.4% between 1996 and 1997; they continue to be a complex healthcare problem in the United States. OBJECTIVE: The objective of this research was to compare traditional statistical methods with emerging new methods called data mining or knowledge discovery in databases in identifying accurate predictors of preterm births. METHOD: An ethnically diverse sample (N = 19,970) of pregnant women provided data (1,622 variables) for new methods of analysis. Preterm birth predictors were evaluated using traditional statistical and newer data mining analyses. RESULTS: Seven demographic variables (maternal age and binary coding for county of residence, education, marital status, payer source, race, and religion) yielded a .72 area under the curve using Receiving Operating Characteristic curves to test predictive accuracy. The addition of hundreds of other variables added only a .03 to the area under the curve. CONCLUSION: Similar results across data mining methods suggest that results are data-driven and not method-dependent, and that demographic variables offer a small set of parsimonious variables with reasonable accuracy in predicting preterm birth outcomes in a racially diverse population.

Data Collection↗
PubMed1999

Dietary iron and cancer of the rectum: a case-control study in Uruguay.

In order to examine the relationship between dietary iron intake and risk of rectal cancer, a case-control study was carried out in Montevideo, Uruguay. In the time period 1994-1998, 216 newly diagnosed and microscopically verified cases of adenocarcinoma and 433 controls hospitalized for diseases not related with long-term changes in diet were enrolled in the study. Controls were frequency matched to cases on age, sex, residence and urban/rural status. Both series of patients were interviewed face-to-face in the four major hospitals in Montevideo by two trained social workers. Dietary iron was associated with significant increases in risk in men, women, and in both sexes together [odds ratio (OR) 3.2, 95% confidence interval (CI) 1.9-5.3 for the highest tertile of consumption versus the lowest one]. Since meat and its major macronutrients were potential confounders, iron intake was adjusted for these variables without major changes in the results. Furthermore, dietary iron and total fat combined its effects according to a multiplicative model (OR 3.3, 95% CI 1.8-5.8). Finally, an interaction between dietary iron and vitamin C was found. According to the results, iron displayed a significant increase in risk at low levels of vitamin C intake (OR 4.9, 95% CI 2.3-10.5). These results, together with the existing epidemiological and experimental evidence, suggest that dietary iron could play an important role in rectal carcinogenesis.

Adenocarcinoma↗
PubMed2001

Plant foods and risk of gastric cancer: a case-control study in Uruguay.

The association between plant foods intake and gastric cancer risk was investigated in a Uruguayan study on environmental factors and cancer. The study included 160 newly diagnosed and histologically verified cases of gastric carcinoma and 320 hospitalized controls. These controls were frequency-matched to the cases on age, sex, residence and urban/rural status. Total vegetable intake was associated with a reduction in risk (odds ratio (OR) 0.64, 95% confidence interval (CI) 0.38-1.08), which was markedly attenuated after adjustment for total fruit intake. The only group of vegetables that persisted as significantly protective after controlling for total energy and total fruit consumption were allium vegetables (OR 0.56, 95% CI 0.34-0.92). On the other hand, total fruit consumption displayed a strong inverse association after controlling for total vegetable intake (OR 0.35, 95% CI 0.21-0.59). Neither tubers nor pulses were associated with gastric cancer risk. Finally, total plant foods were strongly associated with a reduced risk of stomach cancer (OR 0.31, 95% CI 0.18-0.54). It is suggested that vitamins (vitamin C and carotenoids) and bioactive substances (diallyl sulfide) could be involved in the mechanisms of action of plant foods.

Adult↗
PubMed2002

Plant foods and differences between colon and rectal cancers.

A case-control study on plant food intake and its role in the risk of colon and rectal cancers was carried out in Montevideo, Uruguay. Four hundred and eighty-four (484) cases of colorectal cancer and 1452 controls were frequency matched on age, sex, residence and urban/rural status. Among cases, 260 patients had colon cancer whereas 224 had rectal tumours. Controls had non-neoplastic conditions. Both cases and controls were interviewed in the four major hospitals in Montevideo shortly after admittance for diagnosis or treatment. The questionnaire included a section on frequency of foods, which included 64 items, in particular, queries on 18 vegetables, 10 fruits and 6 cereal dishes were included. Thus, the amount of plant foods consumed was complete and included the main plant foods in the Uruguayan diet. The analysis showed that rectal cancer displayed inverse associations with total plant foods, total vegetables, cooked vegetables, potatoes and legumes. When data were stratified by tumour site and sex, only men showed a protective effect of plant foods (odds ratio (OR) of rectal cancer for men 0.4, 95% confidence interval (CI) 0.2-0.7). In contrast, women with rectal carcinoma were not associated with plant food intake. It can be concluded that plant foods are protective factors for men afflicted with colorectal cancer but that plant food intake is not associated with risk in women. This is, at least in part, due to the high risk associated with bread intake in this gender.

Adult↗
PubMed1995

Health system reform: a blueprint for the future of public health.

As the state of Washington formulated its health reform legislation, public health successfully advocated for its inclusion as integral to successful reform. The blueprint for public health's role within health reform is The Public Health Improvement Plan. The plan describes standards for the infrastructure and performance required to carry out the core functions of public health. It contains outcome standards, threshold standards, and interventions for key problems currently affecting the health status of Washington residents. The plan also recommends the shared financing and governance responsibilities for public health functions within a reformed health system.

Forecasting↗
PubMed2005

Hepatitis C virus and HIV co-infection in people with severe mental illness and substance use disorders.

OBJECTIVES: The 5-7% of adults in the United States with severe mental illness (SMI), especially the 50% who are 'dually diagnosed' with co-occurring substance use disorders (SUD), are at an elevated risk of HIV and hepatitis C virus (HCV). However, little is known about HIV/HCV co-infection in this population. This paper examines the prevalence and correlates of HIV, hepatitis C, and HIV/HCV co-infection in a large, multisite sample of SMI clients. DESIGN: We conducted a re-analysis of data on prevalence and correlates of blood-borne infections in a multisite sample of SMI clients. METHODS: In 1997-1998, 755 SMI clients were tested for HIV, hepatitis B virus and HCV, and assessed for demographic, illness-related and other behavioral risk factors for blood-borne infections. The prevalence and correlates of co-infection were examined, as well as the knowledge, attitudes and risk behaviors of individuals with HCV mono-infection. RESULTS: Of the 755 participants, 623 (82.5%) were negative for both HIV and HCV, 23 (3.0%) were positive for HIV, 109 (14.4%) were positive for HCV, and 13 (1.7%) were co-infected with HIV and HCV. Overall, 2.5% of dually diagnosed participants were co-infected, whereas only 0.6% of SMI participants without a comorbid SUD diagnosis were co-infected. Co-infection was associated with psychiatric illness severity, ongoing drug abuse, poverty, homelessness, incarceration, urban residence and minority status. HCV-mono-infected clients continued to engage in high levels of risk behavior for HIV. CONCLUSION: In addition to efforts to identify and treat SMI patients with HIV/HCV co-infection, HCV-mono-infected clients should be targeted for prevention interventions.

Adult↗
PubMed2005

Drinking behavior from high school to young adulthood: differences by college education.

BACKGROUND: Recent serious alcohol-related events have raised public awareness of the prevalence of at-risk alcohol use among college undergraduates, but heavy alcohol consumption during late adolescence and young adulthood is not limited to college students. Alcohol consumption typically peaks in young adulthood regardless of education level, and risks related to alcohol misuse are shared by young adults, regardless of their educational choices. Differences in alcohol risk between college-attending and non-college-attending young adults are generally small, and emphasize the need for research examining the drinking patterns of both of these groups. METHODS: To better understand patterns of at-risk alcohol use and its association with education, this study compared at-risk alcohol use from 12 grade to young adulthood (age 24) in a sample of never-married young adults. Three groups were formed based on completed education when the survey was administered in young adulthood: high school or less, postsecondary education without a four-year college degree, and completed college. RESULTS: Men who completed college experienced the greatest increase in at-risk drinking from grade 12 to young adulthood; however, their at-risk alcohol use did not differ markedly from men in the other education groups in young adulthood. Men who did not complete college had high levels of alcohol risk in 12 grade and maintained or increased those levels in young adulthood, demonstrating a pattern of prolonged risk. Women whose completed education was high school or less experienced the fewest increases in at-risk alcohol use. Education group differences were not explained by place of residence or employment status. CONCLUSIONS: These results emphasize the need to intervene early to prevent at-risk alcohol use, and emphasize that at-risk alcohol use is neither unique, nor necessarily the highest among individuals who complete college.

Adolescent↗