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PubMed1999

Does employment improve the health of lone mothers? The ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood.

In Britain the government is currently proposing legislation that will encourage welfare recipients to gain employment. A central tenet of this 'welfare to work' policy is that employment will not only reduce the poverty of welfare recipients, but also improve their health. This research assessed the extent to which the movement from 'welfare to work' is likely to benefit the mental and physical health of lone mothers with preschool children. The sample was 719 lone mothers and a comparison group of 8779 women with partners drawn from the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC). Data collected by self completion questionnaire at 33 months postpartum provided information about average weekly take home family income and the mother's employment status. The health outcomes measured were general well being, both minor and major depression (using the Edinburgh Postnatal Depression Scale), self report of respiratory symptoms (cough/cold, wheeze, influenza) from 18-33 months postpartum and self report of symptoms common in the childbearing years (backache, haemorrhoids) also from 18-33 months postpartum. Lone mothers who were not employed were the poorest group in the sample; 94% of this group (402) had a family income of less than pound sterling 200 per week, compared with 72% (188) of lone mothers who were employed, 25% (905) of partnered women who were not employed and 12% (466) of partnered women who were employed. Lone mothers were significantly more likely than women with partners to report poorer well being (chi2 = 11.7, df = 3, P = 0.01), to have a major depressive disorder (chi2 = 92.6, df = 1, P = 0.0001) and to report wheeze (chi2 = 31.1, df = 1, P = 0.0001), but significantly less likely to report cough/cold (chi2 = 9.9, df = 1, P = 0.0001) or haemorrhoids (chi2 = 16.6, df = 1, P = 0.0001). Lone mothers who were unemployed and living on less than pound sterling 100 per week were significantly more likely to be depressed (chi2 = 3.9, df = 1, P = 0.05) than those who were employed and living on pound sterling 200 or more per week, and significantly less likely to report cough/cold (chi2 = 3.8, df = 1, P = 0.05). Logistic regression analyses showed no significant independent association between employment and better health for lone mothers. Rather, when compared with lone mothers who were not working, those who were employed were more likely to report minor respiratory symptoms such as cough/cold (OR = 1.51, 95% CI = 1.00,2.31). Overall, the results suggested that the movement from 'welfare to work' is unlikely to improve the health of lone mothers.

Adult↗
PubMedDate not supplied

Characteristics of fire station walk-in patients.

OBJECTIVE: To characterize the use of fire stations for walk-in health care and compare utilization patterns of fire stations in lower-income areas with those in higher-income areas. METHODS: The study was a retrospective review of emergency medical services (EMS) medical forms of patients who presented directly to a fire station for medical care during a 12-month period. RESULTS: During the study period, there were a total of 56,600 EMS calls by the studied fire department, with 155 visits by persons presenting to 19 fire stations in the 12 zip code areas. Of these, 131 were eligible for inclusion in our study. Of the 131 visits, 76 of 131 (58%) occurred in zip codes where more than 20% of residents lived below poverty level. Patients presenting to the fire station for medical care were disproportionately male, 84 of 131 (64%), aged 31-50 years, 61 of 131 (47%). Leading chief complaints were abrasion/laceration/hematoma, 20 of 131 (15%), shortness of breath, 18 of 131 (14%), loss of consciousness/syncope/dizziness/weakness, 17 of 131 (13%), musculoskeletal pain, 17 of 131 (13%), and chest pain, 14 of 131 (11%). Suicide, assault, alcohol, or substance intoxication (SAAD) was associated with 47 of 131 (36%) visits. Following evaluation at the fire station, 97 of 131 (82%) were transported by EMS; few patients were transported by private vehicle (n = 11) or did not need transport (n = 12). CONCLUSIONS: In the authors' EMS system, the use of fire stations for walk-in health occurs disproportionately in areas of poverty. SAAD features are present in more than one third of the visits.

Adolescent↗
PubMed2003

Different methods of membrane domains isolation result in similar 2-D distribution patterns of membrane domain proteins.

Membrane domains are highly specialized parts of the cell plasma membrane, carrying on and augmenting the incoming signals. To study their structural and functional properties, it is crucial to find the least damaging mode of their isolation. Using two different cell lines, epithelial HEK cells (clone E2M11) and S49 lymphoma cells, three methods of membrane domain isolation (i.e., detergent extraction, alkaline treatment, and "drastic" homogenization) were tested for similarity and reproducibility by 2-D electrophoresis. Our data show that the protein composition of membrane domains obtained by different isolation methods is similar and that approximately 60% of the spots are present in all membrane domain preparations. Furthermore, the same degree of similarity of 2-D profiles of the most intensively silver stained spots found in membrane domains of the two cell lines derived from different tissues suggests that the composition of a large part of membrane domains proteins is conservative. We suggest that these proteins may either be involved in the organization of membrane domain structure or represent the conservative component of signal transduction machinery.

CD59 Antigens↗
PubMedDate not supplied

Increased spending on health care: how much can the United States afford?

Perceptions of whether health care cost growth is affordable contribute greatly to pressures for health system reform. In this paper we develop a framework for thinking about affordability, concluding that a one-percentage-point gap between real per capita growth in health care costs and growth in GDP would be affordable through 2075. A two-percentage-point gap would only be affordable through 2039. In either case, the share of income growth devoted to health care would exceed historical norms. The value of care, which determines willingness to pay, and distributional issues are more important than our ability as a society to pay for care.

Actuarial Analysis↗
PubMed2001

Socio-economic differences in height and body mass index of children and adults living in urban areas of Karachi, Pakistan.

OBJECTIVE: To study the socio-economic differences in height and body mass index (BMI) in urban areas of Karachi. DESIGN: A comparative study was undertaken to compare the heights and BMIs of adults and children belonging to three distinctively different income groups living in urban areas of Karachi. SETTING: Data was collected from families living in small, medium and large houses located in the authorised urban residential areas of Karachi. SUBJECTS: A total of 600 families, 200 from each income group, were included in the study. Anthropometric measurements of 1296 females and 1197 males of different ages were taken. METHODS: All the housewives were interviewed to collect socio-demographic information. Height and weight of all the available family members were measured. In order to determine the socio-economic difference in height status, the mean height in cm of adults was compared. For children (2-17 y) means of height-for-age Z-scores determined on the basis of NCHS reference values were compared. For studying the weight status the BMI of all the respondents was calculated and they were grouped into categories of under-, normal or overweight according to the NCHS recommended cut-off points. For adult men and women BMI values <18.5 kg/m(2) indicated underweight and >25 kg/m(2) indicated overweight. Among children, those having BMI values below the 5th percentile of the NHANES III reference values were categorised as underweight and those above the 95th percentile were termed overweight. RESULTS: Height status improved with income level among adults and children of both sexes. Among males the difference in weight status was significant only among 2 to 18-y-olds (P<0.05 in each case). The rate of overweight among 2 to 18-y-old males was significantly higher (P=0.004) at the middle-income level (15%) as compared to low or high income. The rate of underweight was significantly higher (P=0.025) at the low-income level among 2 to 18-y-old males (31%, 21% and 22% at low-, middle- and high-income levels, respectively). Among females, rates of underweight were not significantly different at any age. Rates of overweight increased significantly (P=0.048) with income level among 41 to 60-y-old women (38%, 53% and 60% at low-, middle- and high-income levels, respectively). CONCLUSION: Chronic undernutrition as indicated by deficit in height decreased with increasing income level. Socio-economic differences in weight status were not uniform among various age-sex groups. The influence of increasing affluence is likely to be seen both in the form of increased obesity among older females and underweight among children. Differing patterns of association between income and weight status among male and female children need to studied further with more accurate birth records, so as to further clarify the situation. In terms of prevention of nutrition-related disorders both problems of under- and over-nutrition need to be addressed.

Adolescent↗
PubMed2003

Inequities in under-five child malnutrition in South Africa.

OBJECTIVES: To assess and quantify the magnitude of inequalities in under-five child malnutrition, particularly those ascribable to socio-economic status and to consider the policy implications of these findings. METHODS: Data on 3765 under-five children were derived from the Living Standards and Development Survey. Household income, proxied by per capita household expenditure, was used as the main indicator of socio-economic status. Socio-economic inequality in malnutrition (stunting, underweight and wasting) was measured using the illness concentration index. The concentration index was calculated for the whole sample, as well as for different population groups, areas of residence (rural, urban and metropolitan) and for each province. RESULTS: Stunting was found to be the most prevalent form of malnutrition in South Africa. Consistent with expectation, the rate of stunting is observed to be the highest in the Eastern Cape and the Northern Province - provinces with the highest concentration of poverty. There are considerable pro-rich inequalities in the distribution of stunting and underweight. However, wasting does not manifest gradients related to socio-economic position. Among White children, no inequities are observed in all three forms of malnutrition. The highest pro-rich inequalities in stunting and underweight are found among Coloured children and metropolitan areas. There is a tendency for high pro-rich concentration indices in those provinces with relatively lower rates of stunting and underweight (Gauteng and the Western Cape). CONCLUSION: There are significant differences in under-five child malnutrition (stunting and underweight) that favour the richest of society. These are unnecessary, avoidable and unjust. It is demonstrated that addressing such socio-economic gradients in ill-health, which perpetuate inequalities in the future adult population requires a sound evidence base. Reliance on global averages alone can be misleading. Thus there is a need for evaluating policies not only in terms of improvements in averages, but also improvements in distribution. Furthermore, addressing problems of stunting and underweight, which are found to be responsive to improvements in household income status, requires initiatives that transcend the medical arena.

Journal Article↗
PubMed1998

The effect of managed care on the incomes of primary care and specialty physicians.

OBJECTIVE: To determine the effects of managed care growth on the incomes of primary care and specialist physicians. DATA SOURCES: Data on physician income and managed care penetration from the American Medical Association, Socioeconomic Monitoring System (SMS) Surveys for 1985 and 1993. We use secondary data from the Area Resource File and U.S. Census publications to construct geographical socioeconomic control variables, and we examine data from the National Residency Matching Program. STUDY DESIGN: Two-stage least squares regressions are estimated to determine the effect of local managed care penetration on specialty-specific physician incomes, while controlling for factors associated with local variation in supply and demand and accounting for the potential endogeneity of managed care penetration. DATA COLLECTION: The SMS survey is an annual telephone survey conducted by the American Medical Association of approximately one percent of nonfederal, post-residency U.S. physicians. Response rates average 60-70 percent, and analysis is weighted to account for nonresponse bias. PRINCIPAL FINDINGS: The incomes of primary care physicians rose most rapidly in states with higher managed care growth, while the income growth of hospital-based specialists was negatively associated with managed care growth. Incomes of medical subspecialists were not significantly affected by managed care growth over this period. These findings are consistent with trends in postgraduate training choices of new physicians. CONCLUSIONS: Evidence is consistent with a relative increase in the demand for primary care physicians and a decline in the demand for some specialists under managed care. Market adjustments have important implications for health policy and physician workforce planning.

Age Distribution↗
PubMed2003

Distributional issues in the analysis of preventable hospitalizations.

OBJECTIVE: To describe patterns in ambulatory care sensitive (ACS) admissions at the zip code level based on zip code demographic and other characteristics. These patterns include trends over time, persistence within zip codes over time, and variation between and within socioeconomic strata. DATA SOURCES: New York State hospital discharge data 1990-1998, U.S. census data 1990, and New York State birth records 1990. STUDY DESIGN: Age- and sex-adjusted rates and volumes of ACS admissions are calculated at the zip code level. Descriptive statistics are analyzed cross-sectionally and over time. Kernel density functions are estimated across income strata. Ordinary and quantile regression techniques are used to determine the impact of socioeconomic variables on average and extreme values of the distribution of ACS admission rates. PRINCIPAL FINDINGS: Ambulatory care sensitive admissions rates declined during the study period but in conjunction with a greater decline in overall admission rates. Thus, as a percentage of total admissions, they actually rose by 4 percent. Ambulatory care sensitive admissions are geographically concentrated and rates are highly persistent within zip codes over time. Even on a log scale ACS admissions are typically greater and exhibit more variability among low-income zip codes. Other variables positively associated with ACS admissions are total population, births to unwed mothers (a proxy for family structure), black population, Hispanic population, and the number of non-ACS admissions. Births to immigrant mothers (a proxy for immigrant population) are negatively associated with ACS admissions. CONCLUSIONS: The concentration and persistence of ACS admissions point to a chronic, geographically limited deficiency of primary ambulatory care in the most underserved neighborhoods. Much of the difference in preventable hospitalization levels between high- and low-income areas is driven by very high volumes in the low-income areas unrelated to population density. New York data suggest that most costs from preventable hospitalizations could be saved by focusing on targeted neighborhoods. Socioeconomic and area utilization variables play a role in both average and extreme values of the rate of preventable hospitalizations at the zip code level. Since variables that affect the average volume of preventable hospitalizations can change the distribution of that volume, analysis based on averages alone may be inadequate. The findings on area demographics and non-ACS admissions point to the need to better understand social and cultural issues as well as local admitting practice patterns to encourage appropriate and efficient use of the health care delivery system.

Ambulatory Care↗
PubMed1999

The "Let's Get Alarmed!" initiative: a smoke alarm giveaway programme.

OBJECTIVES: To reduce fires and fire related injuries by increasing the prevalence of functioning smoke alarms in high risk households. SETTING: The programme was delivered in an inner London area with above average material deprivation and below average smoke alarm ownership. The target population included low income and rental households and households with elderly persons or young children. METHODS: Forty wards, averaging 4000 households each, were randomised to intervention or control status. Free smoke alarms and fire safety information were distributed in intervention wards by community groups and workers as part of routine activities and by paid workers who visited target neighbourhoods. Recipients provided data on household age distribution and housing tenure. Programme costs were documented from a societal perspective. Data are being collected on smoke alarm ownership and function, and on fires and related injuries and their costs. RESULTS: Community and paid workers distributed 20,050 smoke alarms, potentially sufficient to increase smoke alarm ownership by 50% in intervention wards. Compared with the total study population, recipients included greater proportions of low income and rental households and households including children under 5 years or adults aged 65 and older. Total programme costs were 145,087 Pounds. CONCLUSIONS: It is possible to implement a large scale smoke alarm giveaway programme targeted to high risk households in a densely populated, multicultural, materially deprived community. The programme's effects on the prevalence of installed and functioning alarms and the incidence of fires and fire related injuries, and its cost effectiveness, are being evaluated as a randomized controlled trial.

Adolescent↗
PubMed1993

Determinants of incident non-insulin-dependent diabetes mellitus among blacks and whites in a national sample. The NHANES I Epidemiologic Follow-up Study.

The excess incidence of non-insulin-dependent diabetes mellitus noted among African Americans in the past two decades may be attributable to variations in the distribution of specific risk factors, or the impact of these risk factors may differ by ethnicity or sex. Over the 16 years (1971-1987) of the First National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study, 880 incident cases of diabetes mellitus developed among 11,097 white and black participants who were between the ages of 25 and 70 years at baseline. There were substantial differences among the four race/sex groups with respect to age at baseline, as well as marked differences in the distribution of several major risk factors for diabetes, including obesity, subscapular and triceps skinfold thickness, blood pressure, income, activity, and educational level. The age-adjusted incidence of diabetes over the course of the study was 15.0% among black women, while it was 10.9% among black men. White women and men experienced similar, more moderate risks of 7.0% and 6.9%, respectively. The 100% excess risk among black women and the 50% excess among black men can in large measure explain the recent marked increase in diabetes rates in the black community. Furthermore, at nearly every level of obesity, blacks had a higher risk of diabetes than whites, suggesting that other factors contributed to risk. A significant interaction between race and body mass index (weight (kg)/height(m)2) was likewise demonstrated in multivariate analysis. Baseline age, race, body mass index, and ratio of subscapular skinfold to triceps skinfold were significantly related to incident diabetes, both overall and in separate models for men and women; in the entire cohort and in women alone, blood pressure, activity level, and education also contributed to risk. Other interactions were tested but were not found to be important. Despite sampling difficulties and inconsistencies in the data, the NHANES I Epidemiologic Follow-up Study provides evidence that the associations of anthropometric and sociodemographic variables with diabetes may vary among subgroups which have different mean levels and distributions of these risk factors.

Adult↗
PubMedDate not supplied

Trends in specialized surgical procedures at teaching and nonteaching hospitals.

Teaching hospitals are the principal site of many specialized surgical procedures. The recipients of these procedures tend to be younger, male, and nonwhite and tend to reside in either the poorest or the most affluent neighborhoods. Although the numbers of these procedures performed at major teaching hospitals increased dramatically between 1989 and 1995, they accounted for only a modest proportion of hospital discharges and patient days. Concentration of specialized surgical procedures in major teaching hospitals will likely continue. This trend has implications not only for these hospitals but for health care purchasers, policymakers, medical educators, and clinical researchers as well.

Adolescent↗
PubMed2001

Trapping of an activated HF molecule inside a double four-ring unit: a quantum chemical model of the microporous fluorinated gallium phosphate ULM-18.

The penetration of a proton into the prenucleation building unit of a microporous gallophosphate and its interaction with an encapsulated fluorine anion have been investigated by means of DFT calculations. The inorganic part of the fluorinated gallophosphate ULM-18 has been modeled by a neutral, double four-ring (D4R) unit of formula [(GaOH)4(HPO4)4-H2O] encapsulating the fluorine ion. Assuming the cage to be rigid and to retain throughout the calculations the geometry determined from X-ray diffraction (XRD), the position of F(-) has been optimized, either as an isolated guest species or in the presence of an incoming proton. In agreement with the XRD structure, the fluorine atom has been shown to occupy in both cases a nonsymmetric position in the cage, being attached to three gallium atoms out of four. The distribution of the molecular electrostatic potential inside and outside the (F(-))@[(GaOH)4(HPO4)4-H2O] system has provided indications concerning the pathways that could be used by an incoming proton to penetrate the D4R unit and to approach the fluorine anion. The migration of a proton from an external site of fixation to the interior of the D4R unit has been found possible through two faces out of six. In both cases, the process has been found exothermic by approximately 0.17 eV and the energy barrier was estimated to approximately 0.8 eV. Inside the gallophosphate cage, the proton first adopts a position typical of a strong F...H...O bond made possible through an important shift of the fluorine anion away from the tripod of bonded gallium atoms. Then, the F(-)...H(+) system can easily evolve back and forth on a flat potential curve between one of the F...H...O bonded conformations and a situation characterized by the cleavage of the H...O link and the formation of a moderately activated F-H molecule, with the fluorine still attached to three gallium atoms.

Journal Article↗
PubMedDate not supplied

The relation of body mass index to depressive symptoms.

OBJECTIVE: Data from the 1995 Nova Scotia Health Survey were analyzed to determine the relation between body mass index (BMI) and the risk of depression as measured by the Center for Epidemiological Studies Depression Scale (CES-D). METHODS: Clinical measures for height and weight and CES-D scores were available for 2,482 subjects from an initial sample of 5,578 Nova Scotians stratified probabilistically to be representative of age, gender and area of residence. BMIs were categorized according to the international standards (BMI 18.5-24.9 acceptable weight; 25-29.9 overweight; > or = 30 obese). RESULTS: More men than women were classified as overweight (43.2% vs. 28.3%) but slightly more women than men were obese (25.6% vs. 23.4%). Based on the summary score of the CES-D, 14.2% were categorized as at risk for depression (> or = 16). Logistic regression indicated that lower education (p < 0.001) and income (p < 0.001), and BMI category (p < 0.05) were all significantly related to an increased risk of depression. The odds ratio for the association between obesity and depression, after controlling for education and income, was 1.41 [95% CI = 1.07-1.86]. DISCUSSION: More studies are needed to ascertain the mechanism by which obesity and depression could be related and the significance of this relation for the prevention and treatment of both obesity and depression. Given the effects of depression, we suggest that health professionals should assess their obese patients for risk of depression before embarking on a weight management protocol.

Adult↗
PubMed2005

Stated preferences for the removal of physical pain resulting from permanently disabling occupational injuries. A contingent valuation study of Taiwan.

Within the process of calculating the true costs of illness, physical pain is a component of intangible, or human, costs. One method of estimating the monetary value of such costs is the 'contingent valuation method' (CVM), a stated preference method based upon the elicitation of levels of willingness to pay (WTP) facilitated through surveys. This study is amongst the first of its kind to apply CVM to the estimation of the cost of the removal of physical pain resulting from permanently disabling occupational injuries. We assume that a painkilling drug has been invented to mitigate physical pain with the advantages of validity and instantaneity, and without any side effects. The WTP of each of the respondents is determined by a two-step sequential-bidding process. The maximum WTP under log normal distribution was NT 1791 US dollars/day (65.1 US dollars), whilst under Weibull distribution it was NT 1913 US dollars/day (69.6 US dollars). Older respondents, those with higher household income, fall injuries, longer periods of hospitalization, or with a perceived demand for the painkilling drug in excess of one day, displayed a positive independent effect on the eliciting of their WTP. In addition, respondents with higher 'out-of-pocket' expenses, or where the interview took place 2 years or more after the injury occurred, responded with a lower WTP.

Adult↗