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PubMed1993

Self-reported quality of life and the effect of different clinical and demographic characteristics in people with type 1 diabetes.

The aims of the present study were to describe how people with type 1 diabetes experienced their quality of life and to examine the effect of the different background characteristics of sex, age, social status, education, disease duration. HbA1 levels, regimen and the frequency of complications on self-reported quality of life. A self-administered questionnaire consisting of 28 items measuring satisfaction within the physical, psychological, social and activity/behavioural life-domain and 11 well-being scales was completed by 247 patients with type 1 diabetes who consecutively attended a Norwegian diabetes clinic. Main findings from the study showed that over 80% of patients reported their capacity for self-care, general well-being, satisfaction with life and social contacts to be quite good or better. Forty five percent of patients perceived their life situation to be negatively effected due to diabetes. Multivariate analysis showed that living alone had a negative effect on satisfaction in the physical, social and psychological life-domain. Higher levels of HbA1 were associated with reported lower satisfaction within the physical and activity/behavioural life-domain. The effect of the different background characteristics on reported well-being showed no consistent pattern. These findings indicate that the majority of patients in this study experienced a satisfactory quality of life despite living with a chronic illness such as diabetes.

Adolescent↗
PubMed1996

Possible environmental, occupational, and other etiologic factors for Parkinson's disease: a case-control study in Germany.

In a case-control study, we investigated the possible etiologic relevance to Parkinson's disease (PD) of rural factors such as farming activity, pesticide exposures, well-water drinking, and animal contacts; toxicologic exposures such as wood preservatives, heavy metals, and solvents; general anesthesia; head trauma; and differences in the intrauterine environment. We recruited 380 patients in nine German clinics, 379 neighborhood control subjects, and 376 regional control subjects in the largest case-control study investigating such factors and collected data in structured personal interviews using conditional logistic regression to control for educational status and cigarette smoking. The latter was strongly inversely associated with PD. There were significantly elevated odds ratios (OR) for pesticide use, in particular, for organochlorines and alkylated phosphates, but no association was present between PD and other rural factors. A significantly elevated OR was present for exposure to wood preservatives. Subjective assessment by the probands indicated that exposure to some heavy metals, solvents, exhaust fumes, and carbon monoxide was significantly more frequent among patients than control subjects, but this was not confirmed by a parallel assessment of job histories according to a job exposure matrix. Patients had undergone general anesthesia and suffered severe head trauma more often than control subjects, but a dose-response gradient was not present. Patients reported a significantly larger number of amalgam-filled teeth before their illness than control subjects. The frequency of premature births and birth order did not differ between patients and control subjects. Patients reported significantly more relatives affected with PD than control subjects. These results support a role for environmental and genetic factors in the etiology of PD.

Age of Onset↗
PubMed2003

[Income inequality and self rated health: an analysis from a contextual perspective in Chile].

BACKGROUND: The correlation between income inequality and life expectancy was demonstrated 10 years ago, but later, several studies suggested that the negative impact of a low economic income on the health status was disappearing. AIM: To assess the independent effects of community income inequality on self rated health in Chile. MATERIAL AND METHODS: Multilevel analysis of the 2000 National Socio Economic Characterization Survey (CASEN) data from Chile. Individual level information included self rated health, age, sex, ethnicity, marital status, education, income, type of health insurance and residential setting (urban/rural). Community level variables included the Gini coefficient and median income. The main outcome measure was dichotomized self rated health (0 if excellent, very good or good; 1 if fair or poor). RESULTS: 101,374 individuals (at level 1) aged 18 and above, nested within 285 communities (at level 2) and 13 regions (at level 3) were studied. Controlling for a range of individual level predictors, a significant gradient was observed between income and poor self rated health, with very poor most likely to report poor health (10.5%) followed by poor (9.5%) low (9%) middle (7%), high (6%) and very high (4.5%) income earners. Controlling for individual and community effects of income, a significant non linear effect of community income inequality was observed, with the most unequal communities being associated with approximately 5% higher likelihood of reporting poor health compared to the most equal communities. CONCLUSIONS: Individual income does not explain any of the between community differences and neither does it wash the significant effects of income inequality on poor self rated health. The contextual effect of inequality is almost as large as the differential observed in poor health comparing the very poor to the very rich individual income categories.

Adolescent↗
PubMed1997

Does growing old increase the risk for depression?

OBJECTIVE: Most research examining age as a risk factor for depression has been based on cross-sectional data. To investigate the effect of aging on rates of depression prospectively, the authors used two waves of data from a panel study of community residents 50 years old and older. METHOD: Data on symptoms of major depressive episodes were examined for the 1994 and 1995 cohorts of the Alameda County Study. The authors examined age, gender, marital status, education, financial strain, chronic medical conditions, functional impairment, cognitive problems, life events, neighborhood problems, social isolation, and social support. Depression was measured with 12 items covering DSM-IV diagnostic criteria for major depressive episodes. RESULTS: Point prevalence of major depressive episodes was 8.7% in 1994 and 9.0% in 1995. Among the subjects 60 years old and older, there was a tendency toward higher prevalence in 1995. The highest prevalence rates in 1994 and in 1995 were among those 80 years old and older. Subjects who were depressed in 1994 were at greater risk for depression in 1995. When the effects of age and other psychosocial risk factors in 1994 were controlled, there were no significant age effects on depression in 1995. Multivariate analyses demonstrated that the initial age effects were due mainly to chronic health problems and functional impairment. Gender, chronic health conditions, problems with activities of daily living, cognitive problems, neighborhood problems, and social isolation in 1994 all were significant predictors of depression in 1995. CONCLUSIONS: Healthy, normally functioning older adults are at no greater risk for depression than younger adults. What seem to be age-related effects on depression are attributable to physical health problems and related disability.

Adult↗
PubMed1992

Growth charts only marginally improved maternal learning from nutrition education and growth monitoring in Lesotho.

A study done in Lesotho in 1985-1986 assessed whether growth charts increased the impact of nutrition education and growth monitoring on maternal learning about weaning practices and diarrhea. Seven hundred and seventy six mothers were given three monthly sessions of group nutrition education along with growth monitoring of children and individual counseling. Growth charts, which were taught to one of two groups, fostered learning but only on issues related to diarrhea and only among new clinic attendants, mothers with less than secondary schooling and mothers of malnourished children. These benefits, however, were small (differences less than 10%) compared with the overall impact of the nutrition education and growth monitoring intervention (increases between baseline and post-intervention were greater than 50% for some questions). Our findings suggest that well-designed clinic-based nutrition education and growth monitoring can have a significant impact on maternal nutrition knowledge. Teaching growth charts to mothers may not be necessary for obtaining such results in programs conducted under ideal conditions. More research is needed to determine under what circumstances, for what purposes and for whom growth charts may be beneficial.

Audiovisual Aids↗
PubMed2000

Risk factors for ovarian cancer in central Italy.

OBJECTIVE: We conducted a case-control study to analyze risk factors for ovarian cancer. METHODS: Cases included 440 women (age range 13-80 years, median 54) with a histologically confirmed diagnosis of epithelial ovarian cancer who were admitted to the Gynecological Oncological Department of Gynecologic Oncology at the Catholic University Hospital in Rome, Italy. Controls were women admitted to the same hospital where cases were identified for acute nongynecological, nonhormonal, and nonneoplastic conditions. A total of 868 control women (age range 19-80 years, median 55) were interviewed. RESULTS: In comparison with ever married women, the multivariate odds ratios (OR) of ovarian cancers was 2.0 (95% confidence interval, CI 1.3-3.2) for never married women. Cases and controls were similar as regards educational status and body mass index. No clear relation emerged between ovarian cancer and age at menarche, menopausal status, and age at menopause. In comparison with nulliparae, the estimated ORs were 0.8, 0.9, and 0.7, respectively, in women reporting one, two, or three births. Women reporting two or more induced abortions were at decreased risk of ovarian cancer (OR 0.5, 95% CI 0.3-1.0). In comparison with women reporting their first birth before 20 years of age, the multivariate ORs were 1.8, 2.0, and 2.8, respectively, for women reporting their first birth at age 20-24, 25-30, and >/=31 (chi(2) trend = 10.1). Breast-feeding for more than 1 year was associated with an OR of 0.5 (95% CI, 0.4-0.8). Forty-two (9.5%) cases and 164 (18.9%) controls reported ever oral contraceptive use: in comparison with never users, the multivariate OR was 0.4 (95% CI 0.3-0.6) for ever users, and the risk decreased with duration of use. The OR for ovarian cancer was 2.9 (95% CI, 1.5-5.8) for women with a family history of the disease. CONCLUSION: This study, conducted on a relatively low-risk population, confirms the role of oral contraceptive on ovarian cancer risk and the direct association with family history of ovarian cancer. It also indicates that a later age at first birth is directly, and induced abortion and breast-feeding are inversely, related to the risk of the disease.

Adolescent↗
PubMedDate not supplied

[Detection of hyponutrition risk in non-institutionalised elderly].

BACKGROUND AND OBJECTIVE: an inadequate food intake in the elderly increases immunological system vulnerability, the risk for infections, and it also leads to muscle atrophy, high sugar and fat plasma levels, fatigue, apathy, greater risk for bone fractures, and lower response to medication. Physiological and pathological changes related to aging bring about changes in dietary habits and organ body use of nutrients. The main consequence is an increase in the prevalence of individuals with global or nutrient-specific hyponutrition. The aim of this work was to detect the percentage of non-institutionalised malnourished elderly patients from Murcia with hyponutrition risk, in order to being able of preventively act on them. MATERIAL AND METHODS: 360 elderly patients of both genders, non-institutionalised and residing in Murcia compose the population sample. Hyponutrition risk detection is based on performance of a test to each patient with nine questions relating to nutritional risk, which is a validated nutritional screening method, with a 95% positive predictive value and 81% negative predictive value. Besides, other factors that may affect hyponutrition risk were assessed in each patient (BMI, gender, age, persons living with him/her, marital status, educational level, and other conditions). Statistical analysis is done with the SPSS package, v. 12.0, using the Student's t test for comparison of independent variables with a normal distribution and Pearson's correlation to analyse the correlation level between variables. RESULTS: The population sample is composed by elder people aged 73.5 +/- 0.5 years (mean +/- SEM), with a BMI of 27.5 +/- 0.3 (Kg/m2), of which 41% are males and 59% females. Forty-six percent have incomplete primary education, and only 11% have university education. Seventy-five percent of these elder people live with somebody (with their spouse or other relatives), and 22% live alone. Sixty-percent are married, and 31% are widow. About age-related pathologies, we observe higher prevalence of diabetes (21%) and cardiovascular diseases, (21%), high cholesterol levels (32%), and high prevalence of arterial hypertension (42%). Seven percent have involuntarily lost weight for the last 3 months, and 11% find themselves thinner, 14% have difficulty eating. Seventeen percent of the studied elder people have a likely risk for malnutrition, with 3% of malnourished patients. When analysing gender differences we observe a greater percentage of women with arterial hypertension, as compared to men (p < 0.05) whereas men diagnosed with COPD outnumber women with COPD (p < 0.05). Significant differences (p < 0.05) are seen in malnutrition risk by gender, being higher in females as compared to men. BMI and malnutrition risk are negatively correlated (p < 0.01). A direct correlation is seen between the patient's age and his/her malnutrition risk (p < 0.05). CONCLUSIONS: In Murcia 17% of analysed elderly people have a likely risk for malnutrition and 2% are malnourished. This malnutrition refers to deficient nutrition, so for these results suggest the need to perform: 1) further studies to determine qualitatively and quantitatively nutritional deficits. 22 A nutritional intervention in this population to prevent deficient states associated to the development of several pathologies.

Aged↗
PubMed2001

Assessing health system provision of well-child care: The Promoting Healthy Development Survey.

BACKGROUND: Preventive care guidelines for children include parent education and counseling, developmental assessment, and screening for psychosocial and safety risks. Health care providers are in a unique position to identify and follow up on potential problems and to influence parenting knowledge, attitudes, and behavior to ensure the healthy development of young children. Few quality measures are available to assess health care system performance in this important area. OBJECTIVE: To develop a feasible, valid, and reliable methodology for evaluating health care system performance in providing family-centered anticipatory guidance and child and family assessment services on behalf of children from birth through 48 months old. Methods. The Promoting Healthy Development Survey (PHDS) was developed and tested with a diverse group of families in 3 managed care organizations (n = 1478). A standard mail administration protocol was used, including an informed consent with a waiver of documentation, 2 mailings, a postcard reminder, and telephone reminders. The 36-item parent survey assesses whether health care providers(1) talk with parents about topics recommended in Bright Futures and the American Academy of Pediatrics Guidelines for Health Supervision,(2) provide follow-up for children who may be at risk for developmental problems,(3) and address psychosocial well-being and safety within the family. The PHDS also assesses the degree to which parent's interactions with providers are family-centered, helpful, and facilitate parental confidence. Psychometric, bivariate, and multivariate analyses were conducted to assess the reliability, validity, and patterns of variation in the seven quality measures derived from the PHDS. RESULTS: Psychometric analyses demonstrated that the PHDS quality measure scales have strong construct validity (mean factor loading: 0.69) and internal consistency (mean Cronbach's alpha: 0.80). Parents reporting positive parenting behaviors had significantly higher scores on the anticipatory guidance quality measure compared with parents not reporting positive behaviors. Parents who reported that their questions on specific anticipatory guidance topics were answered were more likely to report higher confidence in related parenting activities (odds ratio [OR]: 5.9, 95% confidence interval [CI]: 3.4-10.2; OR: 8.3, 95% CI: 5-13.8)and were less likely to report concerns about their child's development in related areas compared with parents who reported they wished they had talked more with their child's doctor about these topics (OR: 0.46, 95% CI: 0.29-0.72; OR: 0.58, 95% CI: 0.37-0.89). The 7 PHDS quality measure scores for health plans ranged from 17 to 67 (on a 0-100 scale; where 100 is the best score possible) and varied significantly across health plans. Performance was highest for provision of anticipatory guidance information from health plans and lowest for family psychosocial assessment. Scores for families with Medicaid coverage were significantly higher on 2 of the PHDS measures and significantly lower for 3 measures compared with scores for families with commercial insurance. Age of child, whether child is first- born, parental marital status, education, income, and race were significant predictors for 1 or more of the PHDS quality measures (average R(2) = 0.05). CONCLUSIONS: The PHDS provides a comprehensive, psychometrically valid and reliable assessment of how well health plans and the health care providers working within these plans promote the healthy development of young children. The PHDS seems to differentiate among health care plans and among the different aspects of preventive care provided within a health plan. For the population studied here, there is significant room for improvement in ensuring families and children receive appropriate and family-centered care to promote the healthy development of children between 3 and 48 months old. Because the PHDS is conceptually based on national recommendations for child health supervision, improved performance on the PHDS would indicate greater adherence to these national recommendations and progress toward the achievement of Healthy People 2010 goals. The generalizability of the findings presented in this report are being examined using data collected in 5 statewide Medicaid samples (N = 11 696) and data from the National Survey of Early Childhood Health, which has incorporated most of the PHDS items.

Child Development↗
PubMed2004

Special Supplemental Nutrition Program for Women, Infants, and Children participation and infants' growth and health: a multisite surveillance study.

CONTEXT: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is the largest food supplement program in the United States, serving almost 7 500 000 participants in 2002. Because the program is a grant program, rather than an entitlement program, Congress is not mandated to allocate funds to serve all eligible participants. Little is known about the effects of WIC on infant growth, health, and food security. OBJECTIVE: To examine associations between WIC participation and indicators of underweight, overweight, length, caregiver-perceived health, and household food security among infants < or =12 months of age, at 6 urban hospitals and clinics. DESIGN AND SETTING: A multisite study with cross-sectional surveys administered at urban medical centers in 5 states and Washington, DC, from August 1998 though December 2001. PARTICIPANTS: A total of 5923 WIC-eligible caregivers of infants < or =12 months of age were interviewed at hospital clinics and emergency departments. MAIN OUTCOME MEASURES: Weight-for-age, length-for-age, weight-for-length, caregiver's perception of infant's health, and household food security. RESULTS: Ninety-one percent of WIC-eligible families were receiving WIC assistance. Of the eligible families not receiving WIC assistance, 64% reported access problems and 36% denied a need for WIC. The weight and length of WIC assistance recipients, adjusted for age and gender, were consistent with national normative values. With control for potential confounding family variables (site, housing subsidy, employment status, education, and receipt of food stamps or Temporary Assistance for Needy Families) and infant variables (race/ethnicity, birth weight, months breastfed, and age), infants who did not receive WIC assistance because of access problems were more likely to be underweight (weight-for-age z score = -0.23 vs 0.009), short (length-for-age z score = -0.23 vs -0.02), and perceived as having fair or poor health (adjusted odds ratio: 1.92; 95% confidence interval: 1.29-2.87), compared with WIC assistance recipients. Rates of overweight, based on weight-for-length of >95th percentile, varied from 7% to 9% and did not differ among the 3 groups but were higher than the 5% expected from national growth charts. Rates of food insecurity were consistent with national data for minority households with children. Families that did not receive WIC assistance because of access problems had higher rates of food insecurity (28%) than did WIC participants (23%), although differences were not significant after covariate control. Caregivers who did not perceive a need for WIC services had more economic and personal resources than did WIC participants and were less likely to be food-insecure, but there were no differences in infants' weight-for-age, perceived health, or overweight between families that did not perceive a need for WIC services and those that received WIC assistance. CONCLUSIONS: Infants < or =12 months of age benefit from WIC participation. Health care providers should promote WIC utilization for eligible families and advocate that WIC receive support to reduce waiting lists and eliminate barriers that interfere with access.

Body Height↗
PubMed2005

The education and employment status of patients with inflammatory bowel diseases.

Inflammatory bowel disease (IBD) has the propensity to affect patients who are in their late teens and early 20s, an age when most people decide on their educational and career directions. This review describes the effects that IBD has on the continuum of education and employment. Patients with Crohn's disease and ulcerative colitis attain a similar level of education as that of the general population. The quality of life of such patients in school, as measured by both patients' and teachers' perceptions, indicates that, despite the difficulties that students face in terms of missed school time and physical inconveniences, teachers are generally perceived by students to have favorable attitudes toward helping them. Even though earlier work in the area of employment has suggested that the occurrence of IBD is clustered among people in white-collar positions, recent data have suggested that certain environmental risks for IBD (i.e., sedentary or indoor jobs) may be associated with jobs classified as being white-collar, and therefore having a white-collar job may in itself not be a risk factor for the development of IBD. Patients with IBD have a higher rate of nonparticipation in the labor force, and the participation rate seems to maintain steady levels over time. A majority of patients with IBD continue in the same employment positions over a period of years. Patients with IBD, especially those who have undergone surgery, took more sick leave than their counterparts without IBD. A majority of patients with IBD favored the disclosure of their diagnosis to their employers and perceived little discrimination in the workplace. Furthermore, most employers were perceived by their employees with IBD as having fair attitudes toward the compensation provided for their employees with IBD.

Education↗
PubMedDate not supplied

Barriers to follow-up of abnormal Papanicolaou smears in an urban community health center.

OBJECTIVE: To determine factors predictive of failure to return for colposcopy among women with significant abnormalities on Papanicolaou smears in a high-risk clinical population. DESIGN: Telephone survey. SETTING: An urban community health center. PARTICIPANTS: Two hundred seventy-nine women randomly selected from all women seen at the health center with abnormal Papanicolaou smears requiring colposcopy during 1993 to 1994. Six (2%) refused participation, and 19% could not be reached for inclusion. Subjects were mostly minority women receiving Medicaid. MAIN OUTCOME MEASURE: Completion of colposcopy. RESULTS: Of the 279 selected women, 79% were interviewed. The rate of adherence with colposcopy was 75% for the respondents. Women who did not know the results of their smear or who incorrectly understood their results were significantly less likely to return for colposcopy (P = .001). Younger women, especially teenagers, were less likely to return (P = .02). Socioeconomic status, education, primary language, health beliefs, fear of cancer, and clinician's gender or discipline were not associated with rate of follow-up. Barriers involving transportation, child care, and insurance also did not predict follow-up. CONCLUSIONS: Effective communication of results is the most important factor related to follow-up after abnormal Papanicolaou smear in this setting. In other settings, other factors may be of greater importance.

Adolescent↗
PubMed1998

Dyspepsia in the community is linked to smoking and aspirin use but not to Helicobacter pylori infection.

BACKGROUND: The relationship between Helicobacter pylori infection and symptoms remains controversial. We aimed to determine if an association exists between unexplained dyspepsia (pain or discomfort centered in the upper part of the abdomen) and H pylori. METHODS: A validated questionnaire was completed by 592 healthy blood donors. Helicobacter pylori serologic values (via enzyme-linked immunosorbent assay), blood group status, and Rh status were measured; 4.9% of subjects who had a history of peptic ulcer disease were excluded from the analyses. RESULTS: The prevalence of dyspepsia and no ulcer history was 11% (95% confidence interval [CI], 8.6%-13.8%); 15.4% of subjects with dyspepsia had H pylori while 14.6% of subjects without dyspepsia were infected (P=.90). The mean dyspepsia impact scores (combining frequency and severity) in those with and without H pylori were 4.7 and 5.4, respectively (P=.20). The median H pylori optical density values in dyspepsia vs no dyspepsia were not significantly different (P=.30). Independent risk factors for dyspepsia were the use of aspirin (odds ratio [OR], 2.2; 95% CI, 1.3-3.7) and smoking (OR, 2.1; 95% CI, 1.3-3.6) but not age, sex, marital status, educational level, income, or the use of alcohol, coffee, or nonsteroidal anti-inflammatory drugs. Independent risk factors for H pylori were increasing age (OR, 1.8 per decade; 95% CI, 1.5-2.3), male sex (OR, 2.1; 95% CI, 1.3-3.4), and net family income (OR, 1.8; 95% CI, 1.2-3.3). CONCLUSION: Dyspepsia in the community is linked to smoking and aspirin use, but not to H pylori infection.

Adult↗
PubMedDate not supplied

Depressive symptoms, unemployment, and loss of income: The CARDIA Study.

BACKGROUND: Previous studies have suggested an association between depression and low socioeconomic status, but few have empirically examined the effect of depressive symptoms on income and employment over time. OBJECTIVE: To determine whether depressive symptoms are associated with subsequent unemployment or loss of family income. METHODS: We performed a prospective cohort study of 5115 adults aged 18 to 30 years. These participants included approximately equal numbers of African Americans and whites and men and women from 4 cities in the United States who completed the 1990-1991 examination of the Coronary Artery Risk Development in Young Adults (CARDIA) study. For this analysis, we included 2334 participants who were employed full or part time and who reported an annual family income of $25 000 or more. Participants completed the Center for Epidemiologic Studies Depression Scale and were considered to have depressive symptoms if they scored 16 or higher on the 60-point scale. We evaluated self-reported unemployment and annual family income during 5 years of follow-up. RESULTS: Thirty-three percent (118/354) of participants with depressive symptoms (Center for Epidemiologic Studies Depression Scale score >/=16) in 1990-1991 and 21% (335/1581) of participants without substantial depressive symptoms (Center for Epidemiologic Studies Depression Scale score <16) reported new unemployment during the subsequent 5 years (odds ratio, 1.9; 95% confidence interval, 1.4-2.4; P<.001). This association remained strong after adjusting for potential confounding variables, including marital status, education, history of unemployment, current part-time (vs full-time) employment, and cigarette smoking (odds ratio, 1.6; 95% confidence interval, 1.2-2.0; P =.001). Seventeen percent (62/371) of participants with depressive symptoms and 7% (113/1631) of participants without substantial depressive symptoms in 1990-1991 reported that their family income had decreased below $25 000 by 1995-1996 (odds ratio, 2.7; 95% confidence interval, 1.9-3.8; P<.001). This association also remained strong after adjusting for potential confounding variables (odds ratio, 1.9; 95% confidence interval, 1.3-2.7; P<.001). CONCLUSIONS: Depressive symptoms are associated with subsequent unemployment and loss of family income among working young adults. Socioeconomic indicators, such as income and employment, should be considered in evaluating the potential benefits of treatment for patients with depressive symptoms.

Adolescent↗
PubMed2006

Concurrent visual and hearing impairment and risk of mortality: the National Health Interview Survey.

OBJECTIVE: To determine the association between reported concurrent visual and hearing impairment and risk of mortality. DESIGN, SETTING, AND PARTICIPANTS: Annual cross-sectional multistage area probability surveys of the US civilian noninstitutionalized population living at addressed dwellings were conducted by the National Center for Health Statistics, Hyattsville, Md. Mortality linkage with the National Death Index of participants from 1986 to 1994 was performed through 1997. Complete reported visual and hearing impairment data and survival status were available for 116 796 adults aged 18 years and older. A total of 3620 participants reported visual impairment only, 12 330 reported hearing impairment only, and 1461 reported concurrent visual and hearing impairment. MAIN OUTCOME MEASURE: Risk of mortality. RESULTS: Mortality linkage identified 8949 deaths with an average follow-up of 7.0 years. After controlling for survey design, age, marital status, educational level, self-rated health, and number of nonocular and nonauditory conditions, white participants and "other-race" participants, but not African American participants, reporting concurrent visual and hearing impairment had significantly increased risk of mortality in comparison with their counterparts reporting no impairment (white participants: hazard ratio [HR] = 1.23, 95% confidence interval [CI], 1.04-1.46 for men and HR = 1.63, 95% CI, 1.37-1.93 for women; African American participants: HR = 1.50, 95% CI, 0.94-2.40 for men and HR = 0.92, 95% CI, 0.51-1.63 for women; participants of other races: HR = 2.47, 95% CI, 1.33-4.57 for men and HR = 2.23, 95% CI, 1.01-4.90 for women). Risk of mortality was generally greater for participants reporting concurrent impairment as compared with that for participants reporting either visual impairment alone or hearing impairment alone. CONCLUSIONS: In the United States, white persons and those of other races, but not African American persons, reporting concurrent visual and hearing impairment have an increased risk of mortality. Reported concurrent impairment is an independent predictor of mortality among white persons and those of other races for both men and women.

Adolescent↗
PubMed2002

Caretaker-child concordance for child's exposure to violence in a preadolescent inner-city population.

BACKGROUND: Effective screening for exposure to violence (ETV) in the pediatric setting depends on informant reliability and recognition of patients at increased risk. Pediatricians screening for children's ETV often rely on parent reporting. HYPOTHESIS: That there would be poor caretaker-child concordance given that children would report events occurring outside the home not witnessed by the caretaker and that ETV would be higher among immigrant families. OBJECTIVES: To examine concordance between caretaker and child self-report of the child's ETV in a preadolescent population and to explore factors related to increased risk. DESIGN: Community-based survey. SETTING: Urban community health center. PARTICIPANTS: One hundred sixty-five caretaker-child pairs. METHODS: The ETV was assessed by means of a standardized interview questionnaire on location and frequency of ETV. A Rasch model was used to develop summary scores of ETV (frequency and severity). RESULTS: Caretaker-child concordance on reports of child's ETV was poor. The kappa statistics ranged from -0.04 for seeing someone knifed to 0.39 for witnessing a shooting. Children reported ETV more often in their neighborhood or at school, whereas caretakers reported more events near or at home. Univariate predictors of child's self-reported ETV were female sex (beta +/- SE, -10.1 +/- 4.6; P =.03) and caretaker being divorced (beta +/- SE, 12.6 +/- 6.0; P =.04). In multivariate analyses, country of origin predicted child's ETV, adjusting for child's age and sex, and caretaker educational status and marital status. CONCLUSIONS: Caretakers and their children have poor agreement on reports of the child's ETV. Intervention strategies around ETV should include assessment of the child independent of caretaker report for preadolescents. Screening may be more effective if pediatricians are aware of factors related to increased risk, including immigration status and caretaker marital status.

Adolescent↗
PubMed2006

Television exposure and overweight risk in preschoolers.

OBJECTIVE: To test the independent effect of television exposure in preschool-aged children on overweight risk. DESIGN: Cross-sectional and longitudinal analysis of the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. SETTING: Ten US sites. PARTICIPANTS: One thousand sixteen children selected via conditional random sampling. MAIN EXPOSURE: Being awake in the room with the television on for 2 hours or more per day, by maternal report at age 36 months. MAIN OUTCOME MEASURES: Child overweight (body mass index [calculated as weight in kilograms divided by the square of height in meters] > or =95th percentile) calculated from measured anthropometrics at ages 36 and 54 months. Covariates tested included child sex and race; maternal marital status, education, age, and depressive symptoms; income-needs ratio, child behavior problems; Home Observation for Measurement of the Environment total score; hours per week in nonparental care; and proportion of television exposure that was educational. RESULTS: At age 36 months, 5.8% of children were overweight; at age 54 months, 10.0% were overweight. Exposure to 2 or more hours of television per day was associated with an increased risk of overweight at both age 36 months (odds ratio, 2.92; 95% confidence interval, 1.36-6.24) and age 54 months (odds ratio, 1.71; 95% confidence interval, 1.03-2.83) in unadjusted analyses. Only maternal age altered the concurrent relationship, and the effect of television remained significant (odds ratio, 2.61; 95% confidence interval, 1.21-5.62). Television exposure at age 36 months was no longer a significant predictor of overweight at age 54 months when controlling for covariates. CONCLUSION: Excessive television exposure is a risk factor for overweight in preschoolers independent of a number of potential confounders associated with the quality of the home environment.

Analysis of Variance↗
PubMed1998

Effect of Nancy Reagan's mastectomy on choice of surgery for breast cancer by US women.

CONTEXT: While the actions of popular figures are believed to influence the behavior of the general public, including health care decisions, little research has examined such an effect. OBJECTIVE: To determine whether a temporal association exists between use of breast-conserving surgery (BCS) for treatment of breast cancer and Nancy Reagan's mastectomy in October 1987. DESIGN/SETTING: Population-based observational cohort study. PATIENTS: Two sources of data: (1) 82 230 women aged 30 years and older who were included in the Surveillance, Epidemiology, and End Results tumor registry because of a diagnosis of local or regional breast cancer from 1983 to 1990; and (2) 80057 female Medicare beneficiaries aged 65 to 79 years who received inpatient surgery for local or regional breast cancer in 1987 or 1988. MAIN OUTCOME MEASURE: Percentage of use of BCS vs mastectomy over time. RESULTS: Compared with women undergoing surgery for breast cancer in the third quarter of 1987 (just prior to Mrs Reagan's mastectomy), women were 25% less likely to undergo BCS in the fourth quarter of 1987 (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.66-0.85) and in the first quarter of 1988 (OR, 0.76; 95% CI, 0.67-0.86). In subsequent quarters, the rate returned to the baseline. In multivariate analyses, the decline was significant among white but not nonwhite women. It was most prominent among women aged 50 to 79 years in the central and southern regions of the country, and most sustained among women living in areas with lower levels of income and education. CONCLUSIONS: Celebrity role models can influence decisions about medical care. The influence appears strongest among persons who demographically resemble the celebrity, and those of lower income and educational status.

Adult↗
PubMed2000

Marital stress worsens prognosis in women with coronary heart disease: The Stockholm Female Coronary Risk Study.

CONTEXT: Psychosocial stress has been associated with incidence of coronary heart disease (CHD) in men, but the prognostic impact of such stress rarely has been studied in women. OBJECTIVE: To investigate the prognostic impact of psychosocial work stress and marital stress among women with CHD. DESIGN AND SETTING: Population-based, prospective follow-up study conducted in the city of Stockholm, Sweden. PARTICIPANTS: A total of 292 consecutive female patients aged 30 to 65 years (n = 279 working or cohabiting with a male partner) who were hospitalized for acute myocardial infarction or unstable angina pectoris between February 1991 and February 1994. Patients were followed up from the date of clinical examination until August 1997 (median, 4.8 years). MAIN OUTCOME MEASURES: Recurrent coronary events, including cardiac death, acute myocardial infarction, and revascularization procedures, by marital stress (assessed using the Stockholm Marital Stress Scale, a structured interview) and by work stress (assessed using the ratio of work demand to work control). RESULTS: Among women who were married or cohabiting with a male partner (n = 187), marital stress was associated with a 2.9-fold (95% confidence interval [CI], 1.3-6. 5) increased risk of recurrent events after adjustment for age, estrogen status, education level, smoking, diagnosis at index event, diabetes mellitus, systolic blood pressure, smoking, triglyceride level, high-density lipoprotein cholesterol level, and left ventricular dysfunction. Among working women (n = 200), work stress did not significantly predict recurrent coronary events (hazard ratio, 1.6; 95% CI, 0.8-3.3). CONCLUSIONS: Our results indicate that marital stress but not work stress predicts poor prognosis in women aged 30 to 65 years with CHD. These findings differ from previous findings in men and suggest that specific preventive measures be tailored to the needs of women with CHD.

Adult↗