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PubMed2004

Open Access to essential health care information.

Open Access publishing is a valuable resource for the synthesis and distribution of essential health care information. This article discusses the potential benefits of Open Access, specifically in terms of Low and Middle Income (LAMI) countries in which there is currently a lack of informed health care providers - mainly a consequence of poor availability to information. We propose that without copyright restrictions, Open Access facilitates distribution of the most relevant research and health care information. Furthermore, we suggest that the technology and infrastructure that has been put in place for Open Access could be used to publish download-able manuals, guides or basic handbooks created by healthcare providers in LAMI countries.

Journal Article↗
PubMed2001

Neuronal integration mechanisms have little effect on spike auto-correlations of cortical neurons.

Cortical neurons of behaving animals generate irregular spike sequences, but the sequences generally differ from an entirely random sequence (Poisson process), and they have temporal correlations (spike auto-correlations). Temporally correlated spike sequences can be brought about because of incoming synaptic inputs to the neuron, or because of the neuronal integration mechanism. In this paper, we attempt to determine which is the origin of spike auto-correlations observed in the spiking data recorded from neurons in the prefrontal cortex of a monkey preserving a cue information in the delay response task experiment. Each incoming input is assumed to be independent from its own spike events, and the temporal integration in the neuron is assumed to be reset by every spike event. So, the process to spike is assumed to be divided into two processes: the process independent from its own spikes, which drives the process reset by its own spikes. Under these assumptions, it is found that the spike-independent process needs to have temporal correlations, through examinations of two kinds of correlation coefficient of consecutive inter-spike intervals. It is also found that the spike-reset process has little effect on the spike auto-correlations and the interval distributions. This suggests that the spike auto-correlation does originate in the temporal correlation of incoming synaptic inputs and the neuronal integration mechanism has little effect on the spike auto-correlation.

Action Potentials↗
PubMed2007

Socioeconomic status, particulate air pollution, and daily mortality: differential exposure or differential susceptibility.

BACKGROUND: Short-term increases in particulate air pollution are linked with increased daily mortality and morbidity. Socioeconomic status (SES) is a determinant of overall health. We investigated whether social class is an effect modifier of the PM(10) (particulate matter with diameter <10 micron)-daily mortality association, and possible mechanisms for this effect modification. METHODS: Area-based traffic emissions, income, and SES were available for each resident in Rome. All natural deaths (83,253 subjects) occurring in Rome among city residents (aged 35+ years) during the period 1998-2001 were identified. For each deceased individual, all the previous hospitalizations within 2 years before death were available via a record linkage procedure. PM(10) daily data were available from two urban monitoring sites. A case-crossover analysis was utilized in which control days were selected according to the time stratified approach (same day of the week during the same month). Conditional logistic regression was used. RESULTS: Due to the social class distribution in the city, exposure to traffic emissions was higher among those with higher area-based income and SES. Meanwhile, people of lower social class had suffered to a larger extent from chronic diseases before death than more affluent residents, especially diabetes mellitus, hypertension, heart failure, and chronic obstructive pulmonary diseases. Overall, PM(10) (lag 0-1) was strongly associated with mortality (1.1% increase, 95%CI = 0.7-1.6%, per 10 microg/m(3)). The effect was more pronounced among persons with lower income and SES (1.9% and 1.4% per 10 microg/m(3), respectively) compared to those in the upper income and SES levels (0.0% and 0.1%, respectively). CONCLUSIONS: The results confirm previous suggestions of a stronger effect of particulate air pollution among people in low social class. Given the uneven geographical distributions of social deprivation and traffic emissions in Rome, the most likely explanation is a differential burden of chronic health conditions conferring a greater susceptibility to less advantaged people.

Adult↗
PubMed1999

Two hundred eighty-six cases of parathyroid carcinoma treated in the U.S. between 1985-1995: a National Cancer Data Base Report. The American College of Surgeons Commission on Cancer and the American Cancer Society.

BACKGROUND: In combination with other Commission on Cancer programs, the National Cancer Data Base (NCDB), a national electronic registry system currently capturing > 60% of incident cancers in the U. S., offers a working example of voluntary, accurate, cost-effective "outcomes management" on a both a local and national scale. In addition, it is proving to be of particular value in capturing clinical information concerning rare cancers. METHODS: For accession years 1985-1995, the NCDB captured prospectively collected demographic, stage, treatment, and outcome information for a national hospital-based sample of 286 parathyroid carcinoma cases (0.005% of the total NCDB cancer cases). This report describes clinical and demographic features as well as patterns of care and 5-year and 10-year relative survival rates. RESULTS: The NCDB's 10-year accrual of parathyroid carcinoma cases exceeded the cumulative number reported in the English literature though 1991. Gender distribution was equal. The authors were unable to detect any disproportionate clustering by race, income level, or geographic region. Treatment overwhelmingly was surgical. The data from the current study suggest that neither tumor size nor lymph node status are significant prognostic factors. Overall relative survival at 5 years and 10 years was 85.5% and 49.1%, respectively. CONCLUSIONS: At 5 years of follow-up, and possibly beyond, neither tumor size nor lymph node status were found to be significant prognostic factors and basing a staging system on them would be useless. Although complete, en bloc resection of all tumor represents the best opportunity for cure, a substantial proportion of patients fail to receive such treatment. The authors speculate that the rarity of this condition and late intraoperative recognition occasionally prevent optimal treatment. [See editorial on pages 378-80, this issue.]

Adolescent↗
PubMed2001

The impact of economic crisis on health-care consumption in Korea.

This study uses urban household income-expenditure survey data, national health insurance claims data, and public health centre surveys to examine the impact of economic crisis on the consumption of health services in Korea. The analysis shows that the health-care consumption of Korean households has been adversely affected by the recent economic crisis, as measured by amount of expenditure on health. Distributional implications for health sector use are also found. Whereas the use of medical services by upper income groups is only slightly affected by the economic crisis, lower income groups are spending relatively less on medical services. Of all households, unemployed households are hit hardest by the crisis. Analysis shows that for all households, the rate of expenditure decrease is relatively higher for drug expenditure than for expenditure on medical services. That is, facing declining income, people cut their spending in the area where the need is non-essential or less inevitable.

Budgets↗
PubMed1996

The Virginia Twin-Family Study of Adolescent Behavioral Development: assessing sample biases in demographic correlates of psychopathology.

The Virginia Twin-Family Study of Adolescent Behavioral Development (VTSABD) is a current longitudinal study of psychopathology in 1412 pairs of 8-16-year-old Caucasian twins and their parents. The primary aim of the study is to evaluate family-genetic and environmental risk factors for major domains of psychopathology in families representative of the Virginia Caucasian population. In this report, we utilize census-derived indices of neighbourhood income and urban residence to identify departures from population representation arising at the time of family enrollment in the twin registry and family participation in a psychiatric interview. Furthermore, we consider whether demographic sample biases influenced prevalence rates of adult psychopathology (including major depression, generalized anxiety disorder, alcohol dependence, phobias, and panic disorder) in the VTSABD. Results indicated that families that enrolled in the twin registry (83% of those identified by Virginia schools) and that participated in the home interview (75% of those targeted) resided in urban and rural communities with a range of per capita income levels representative of the Virginia population. However, participation biases operated throughout the study and were primarily characterized by losses of families living in low income, urban communities. There was also a smaller number of families living in high income neighbourhoods that did not enroll in the twin registry or that indefinitely postponed the psychiatric interview. These biases had small effects on prevalence rates of adult psychopathology in the VTSABD sample, even though neighbourhood income was significantly related to a subset of adult diagnoses. We emphasize the usefulness of the census methodology in evaluating sample biases in population-based psychiatric genetic studies.

Adolescent↗
PubMed1995

[The distribution of cervical cancer mortality in Spain (1981-1986). An ecological study].

BACKGROUND: The aim of the present study was to analyze the geographic distribution of mortality by cervical cancer in Spain from 1981-1986 and to examine the relationship with a group of variables such as per capita income, the occurrence of sexually transmitted diseases, the number of hotel rooms, and the prescriptions of oral contraceptives at a provincial level. METHODS: The causes standardized of death for cervical cancer in each Spanish province during the period from 1981 to 1986 were estimated. Multivariate analysis by Poisson regression was performed to determine the relationship between mortality and the variables collected. To do so the provinces were classified into four categories according to quartile distribution of each independent variable considered with the relative risk for each category created being estimated. RESULTS: A characteristic mortality pattern was observed in cervical cancer with the greatest mortality being found in the island and some coastal provinces and the lowest mortality in the peninsular inland provinces. Upon simple analysis of the relationship of mortality with the ecologic variables an important positive association was found with the number of hotel rooms and, to a lesser degree, with the oral contraceptive prescriptions, provincial per capita income, the percentage of urban population and the rate of illiteracy. CONCLUSIONS: A distribution of mortality by cervical cancer which appears to correspond to a certain leisure-tourism pattern, in addition to greater urban and lesser cultural development is reported. This may be in agreement with the hypothesis that cervical cancer is more frequent in more urban areas in which women demonstrate greater promiscuity and relaxation of sexual behaviours, together with the persistence of a low education level.

Bias↗
PubMed1998

Risk of low birth weight infants among black and white parents.

OBJECTIVE: To determine whether racial differences in risk of low birth weight infants among black and white parents can be attributed to differences in demographic, behavioral, medical, and socioeconomic factors. METHODS: We analyzed 203,815 singleton births from the 1992 California birth certificate data set for the risk of very low birth weight (500-1499 g) and moderately low birth weight (1500-2499 g) infants. Additional study variables included maternal (race, age, education, marital status, parity, obstetric history, tobacco use, medical complications, medical insurance, and use of prenatal care), paternal (race, age, and education), infant (gestational age and gender), and community (median household income from the 1990 US Census) characteristics. RESULTS: For both very low and moderately low birth weight infants, the unadjusted risk associated with parental race showed a gradient of risk, from highest to lowest, for black mother/black father, black mother/white father, white mother/black father, and white mother/white father parents. After adjusting for other risk factors, the odds ratio associated with black mother/black father parents was reduced from 3.37 to 1.73 for very low birth weight infants and from 2.51 to 1.60 for moderately low birth weight infants, but both remained elevated. Interracial parents no longer had an elevated risk of very low birth weight infants and white mother/black father parents no longer had an elevated risk of moderately low birth weight, compared with white parents. CONCLUSION: After controlling for parental, infant, and community factors, most but not all of the increased risk of low birth weight infants associated with black parental race was explained.

Black or African American↗
PubMedDate not supplied

[Concentration of hemoglobin and hematocrit in schoolchildren, Campinas, São Paulo, Brazil].

OBJECTIVE: The purpose of this study was to describe the distribution of hemoglobin and hematocrit levels, and to correlate the hemoglobin levels with age, sex, income per capita, intestinal parasites, maternal and parenteral education. METHODS: One hundred and forty-six schoolchildren were studied. They were 48.5% female and 51.5% male. The children were 7.3 +/- 0.6 years old and presented 1.1 +/- 1.8 Brazilian minimum salary per capita. About 31% of them presented intestinal parasites. The schooling of their mothers was 5.2 +/- 3.0 years and that of their fathers was 5.6 +/- 3.4 years. The cyanomethemoglobin method was used to determine hemoglobin concentration. Anemia was considered when the hemoglobin was below World Health Organization recommendations (<11 g/dl). RESULTS: The results showed no anemia among the schoolchildren. Most of them displayed hemoglobin concentration between 13 and 14 g/dl. Using the 25th percentile of the hemoglobin distribution (12.7 g/dl) to study the correlation between hemoglobin and the other variables, a positive association between hemoglobin and parenteral schooling (t=2.25, p=0.03) was detected. CONCLUSIONS: This correlation indicates the importance of education level for better life and health quality because education allows more information and understanding.

English Abstract↗
PubMed2006

The role of individual and neighborhood social factors on periodontitis: the third National Health and Nutrition Examination Survey.

BACKGROUND: This study investigates whether race/ethnicity, individual income, education, and neighborhood socioeconomic characteristics are independently associated with periodontitis in adults>or=18 years of age who participated in the third National Health and Nutrition Examination Survey (NHANES III). METHODS: Analyses were limited to participants in NHANES III who self-identified as non-Hispanic black, non-Hispanic white, or Mexican American, received a periodontal examination, and whose records were linked to the 1990 U.S. Census data (N=13,090). Periodontitis was investigated using a combination of clinical attachment loss and probing depth. Marginal logistic regression models were used to assess the association of race/ethnicity, individual income, education, and neighborhood socioeconomic characteristics with periodontitis before and after adjusting for selected covariates. A survey program was used to account for the survey sampling design and for the intraneighborhood correlation of outcomes of participants selected from the same neighborhood. RESULTS: Race/ethnicity, education, and neighborhood socioeconomic conditions were associated with periodontitis before and after controlling for selected covariates. After adjustment, blacks were twice (1.58 to 2.53) as likely to have periodontitis as whites. Compared to those with more than a high school education, those with less than a high school diploma were twice (1.48 to 2.89) as likely to have periodontitis. Individuals living in a neighborhood in the lowest tertile of the socioeconomic score were 1.81 times (1.36 to 2.41) more likely to have periodontitis than those living in a neighborhood in the highest tertile of the socioeconomic score. CONCLUSION: This study indicates that race/ethnicity, individual education, and neighborhood socioeconomic circumstances are important for periodontal health.

Adolescent↗
PubMed1997

[Consumption of psychoactive substances by school-age adolescents of Ribeirão Preto, SP (Brazil). II--Distribution of consumption by social levels].

INTRODUCTION: Many of the epidemiological studies on the consumption of legal and illegal psychoactive substances have included the evaluation of the influence of social context on the levels of prevalence of this consumption using indirect social indicators such as family income, and educational and housing levels in an attempt to identify individuals or groups in different social contexts. The present study investigates the distribution of consumption of psychoactive substances according to social class in a sample of teenage pupils in Ribeirão Preto, SP, Southeastern Brazil. MATERIAL AND METHOD: A self-applicable questionnaire duly adapted and submitted to a reliability test was applied to a proportional sample of 1,025 teenagers enrolled in the 8th, 9th, 10th and 12th grades in public and private city schools. The questionnaires contained questions about the use of ten classes of psychoactive substances, demographic questions and validation information, as well as questions about the perception and intrinsic behavior related to drug consumption. The adaptation of a model that identifies 5 social class strata (business middle class, managerial middle class, lower middle class, proletariat and subproletariat) on the basis of indicators that situate the individuals within the social relations of production, was used. RESULTS: The 3 middle class strata were more often represented, whereas the proletariat and subproletariat were less frequently represented in this teenage pupil population than in the population in general. There was no difference in alcohol or tobacco consumption according to social class, although prevalence tended to be higher at the two extremes of the social ladder. In contrast, the consumption of illegal substances was higher in the middle class and lower in the proletariat. CONCLUSION: Although the consumption of legal substances did not differ among social classes, the higher consumption of illegal substances by the wealthier teenagers was probably due to the higher cost of these products as compared those of alcohol and tobacco.

Adolescent↗
PubMed2001

Reduced neuropsychologic measures as predictors of treatment outcome in patients with temporomandibular disorders.

AIMS: To determine via a prospective investigation whether the presence of neuropsychologic or cognitive deficiencies could be identified in patients with temporomandibular disorders (TMD) and used to predict treatment outcome. This was based on the theory that measurable reductions in neuropsychologic and cognitive function might have a negative impact on treatment outcome in patients with essentially nontraumatic TMD, as has been shown for patients with posttraumatic TMD. METHODS: Various neuropsychologic, psychosocial, and clinical parameters (including but not limited to the Peterson-Peterson Consonant Trigram Test and the California Verbal Learning Test) were used to pretest patients suffering from TMD prior to treatment. Patients were then entered into treatment, after which determination of treatment success was made both by the use of visual analog scales for pain and global transitional outcome measures (e.g., "better," responders versus "same/worse," nonresponders). After determination of treatment success was made, treatment response was correlated with the various clinical, cognitive, and neuropsychologic test scores. RESULTS: Overall, the nonresponders did worse in both the neuropsychologic and psychosocial assessments, with greater memory deficits, sleep disturbances, depression, and fatigue and lower energy levels as compared to responders. Among the best predictors of treatment outcome were the Peterson-Peterson Consonant Trigram Test scores, as well as the scores on the California Verbal Learning Test (i.e., poorer test outcomes predicted nonresponse). Neither responders nor nonresponders could be distinguished from one another based on clinical parameters of maximum interincisal opening or muscle tenderness. Three psychosocial variables were also found to be predictors of poor outcome: sleep disturbance, fatigue, and income. Pretreatment pain on chewing was also found to be a reliable predictor of poor treatment outcome. CONCLUSION: We conclude that various neuropsychologic, psychosocial, and some clinical parameters may provide pretreatment prediction of treatment outcome in an idiopathic TMD population.

Adolescent↗
PubMedDate not supplied

[Effects of the survivor and dependent children law on social security of widows and widowers and distribution of pensions].

The article takes up the discussion about the individual social security of spouses in Germany and describes some effects of German legislation which went into effect in 1986 and regulates the social security of surviving dependents and requires declaration of child-care provision by pensioners (the so-called "Hinterbliebenen- und Erziehungszeitengesetz"). The primary question is, what effect the most current family income has on the individual replacement rate for widows and widowers. What additional information is needed to record the distributional effects of the act is also discussed.

Aged↗
PubMed2000

Factors related to noncompliance with screening mammogram appointments among low-income African-American women.

Despite current mammography recommendations, screening rates among African-American women are suboptimal. The purpose of this case-control study was to identify the psychological, demographic, and health care system barriers to screening mammography use among low-income African-American women. A total of 574 women with screening mammogram appointments at an urban hospital were interviewed to determine the predictors of mammogram appointment noncompliance. Predictor variables included: demographics; breast cancer knowledge, attitudes, beliefs, and screening practices; and type of health care provider making the referral. Age was inversely related to mammogram appointment noncompliance. Relative to women 40 to 49 years old, women 70 years of age and older were the least likely to miss their appointments (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.2, 0.5). Women referred for mammography by a physician's assistant or nurse practitioner were less likely to miss their appointments than women referred by a physician (OR, 0.3; 95% CI, 0.1, 0.8). Embarrassment, lack of breast symptoms, and forgetfulness also contributed to noncompliance. Key demographic, attitudinal, and health care system factors hinder low-income African-American women from obtaining screening mammograms. These findings have significant health education and policy implications for health care delivery to women in this population.

Adult↗
PubMed1990

The Soviet country profile: health of the U.S.S.R. population in the 70s and 80s--an approach to a comprehensive analysis.

This paper reviews data from 1970 onwards on the distribution of health resources and health status for urban and rural areas and for the 15 Soviet republics. Major disparities exist between republics and especially between the European republics in the North and West and those of Central Asia and Transcaucasia. The former show relatively low infant death rates but high adult mortality, particularly for middle-aged males; rates of death due to circulatory diseases and malignant neoplasms have increased in these republics and special studies reveal a high incidence of alcohol-related diseases. In contrast, the Central Asian and Transcaucasian republics have extremely high infant mortality but high levels of life-expectancy thereafter. An index of medical inequality shows a much lower level of resources in these republics. Recent long-term strategies are described which aim to raise the income and status of health personnel from their relatively low levels and to equalize the distribution of health care across the country.

Adult↗
PubMed1999

Transitions and inequalities in acute myocardial infarction mortality in New South Wales, 1969-94.

OBJECTIVE: To chart the transition in myocardial infarction mortality in NSW between 1969 and 1994 and to determine whether spatial, marital and occupational status differentials increased over time, despite overall mortality decline. METHOD: The study was undertaken in NSW for the 25-year period from 1969 when mortality from ischaemic heart disease declined. The demographic and spatial analysis involved descriptive epidemiology and utilised the unit list mortality files of the Australian Bureau of Statistics which are based on detailed death certificate information. RESULTS: Spatial, marital and occupational status differentials in myocardial infarction mortality increased over time, more especially variations by occupational status, inland/metropolitan differences, and married/divorced or widowed variation. Spatial variations in mortality were not simply the result of occupational status differences as mortality from white collar groups was also elevated in inland areas. Spatial variation in mortality was not diluted due to the impact of immigration. CONCLUSIONS: Particular subgroups of people remained at risk and it is likely that differential access to ambulance services and travel time contribute, more particularly in inland rural areas. IMPLICATIONS: Groups at risk need to be more precisely targeted for preventative measures and public health initiatives, with particular implications for groups in inland rural areas, the Hunter Region, and outer lower income areas of Sydney.

Adult↗