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PubMed1994

Results of the Dutch community project "Healthy Bergeyk".

BACKGROUND: This article reports on the results of a community health project that was implemented in the Dutch municipality of Bergeyk. The major goal was to reduce four cancer-related risk behaviors: smoking, high fat consumption, excessive alcohol use, and exposure to artificial sunlight. A control community received no new intervention. Intervention methods included mass media messages, self-help materials, small group activities, lectures, and structural activities. Community organization principles such as a social network approach, community participation, and intersectoral cooperation were applied in the project. METHODS: Data were collected from both communities among cohort research samples on three occasions using telephone interviews. RESULTS: The results indicate a significant reduction in fat intake in the experimental community. No other significant behavioral effects were found. Further analysis among respondents in the experimental condition showed that those personally exposed to the project as indicated by familiarity with and discussion about the project, had a greater decrease in fat consumption between baseline survey and second post-test than those who were not. Also, the percentage of smokers who quit between baseline survey and second post-test was greater among those who knew about the project than among those who did not. Finally, discriminant analysis was used to further examine the determinants of project exposure. Community involvement, marital status, education, and sex were related to project exposure. CONCLUSIONS: It is concluded that with the time limitations of the project in mind, the findings are encouraging.

Adult↗
PubMed2000

Psychosocial predictors of changes in physical activity in overweight sedentary adults following counseling in primary care.

BACKGROUND: Increasing regular physical activity in adults at elevated risk of cardiovascular disease is an important target for preventive medicine. This study evaluated demographic, social and cognitive predictors of self-reported changes in physical activity after 4 and 12 months in a randomized trial of behavioral counseling in primary care. METHOD: Data were analyzed from 234 male and 271 female sedentary patients with a body mass index of 25-35 (age 49.1 years, SD 11.2 years), who had been counseled by nurses in general practice using stage-matched behavioral methods or standard health promotion and who were reassessed after 4 months. A total of 187 men and 231 women were reassessed after 12 months. RESULTS: Physical activity at baseline was associated with educational status, having a partner who exercised, perceived barriers, and self-efficacy. Changes over 4 months were greater with behavioral counseling, in non-smokers and in patients with higher ratings of motivation to change and self-efficacy at baseline. Changes over 12 months were greater with behavioral counseling and were predicted in the behavioral group by social support variables, perceived benefits, and barriers. Stage of readiness to change predicted increased activity at 4 but not 12 months. CONCLUSIONS: Social support and cognitive variables predict increased physical activity following counseling in primary care of sedentary overweight adults. Different factors are relevant to short- and long-term modifications in behavior.

Adult↗
PubMed1996

Family history and socioeconomic factors as predictors of myocardial infarction, unstable angina and stroke in an Italian population. PROGETTO 3A Investigators.

A comprehensive case-control study was conducted in an Italian region in order to compare the influence of family history of cardiovascular events, socioeconomic factors, social networks, and their joint associations with major risk factors, on the risk, of myocardial infarction (MI), unstable angina (UA) and ischemic stroke (IS). A total of 513 patients with MI, 178 with UA, 237 with IS, and 928 hospitalised controls were recruited. The odds ratio (OR) of MI for two or more relatives with a positive history of MI was 3.6 (95% CI: 1.8-7.3). Family history of MI was predictive for UA (OR = 5.8; 95% CI: 1.2-28.7), but not for IS. A family history of stroke was more associated with the risk of MI than of IS. After adjustment for known risk factors, the OR of MI for more educated people was 2.1 (1.3-3.6) compared with less-educated people. Large family size seemed to be protective for MI. The effect of major risk factors on MI ranged from additive (diabetes) to multiplicative jointly with high education and family history of MI. A family history of stroke increased IS risk threefold jointly with smoking and hyperlipidemia, and eightfold with diabetes. Besides a family history of MI and IS, in this community a higher educational status seems to better identify groups at increased risk of MI. The joint associations have important preventive implications since by identifying high-risk individuals (for MI and IS) a more careful assessment and control of risk factors amenable to intervention may be performed.

Adult↗
PubMed1991

Coronary heart disease prevention: relationship between socio-economic status and knowledge, motivation and behaviour in a free-living male, adult population.

A questionnaire concerning knowledge, motivation and behaviour connected with coronary heart disease (CHD) prevention was administered to 6074 men aged 46 yrs, residents of Rome. The aim of this analysis was to evaluate whether differences exsisted between three socio-economic (SE) classes arbitrarily defined as medium-high (MH), intermediate (I), and medium-low (ML). Knowledge on CHD and its prevention was more satisfactory in the MH class than in the ML class. The same was observed for attitudes toward prevention (the MH class demonstrated more attention to prevention than ML class). Data were less straightforward for behaviour, which seemed to be dependent on both economic status and education. In fact the MH class claimed to smoke less than ML class, to spend more leisure time in physical activity and to check blood pressure and serum cholesterol more often. Their diets, however, were more expensive and rich than those of the ML class. By contrast the ML class, when compared to MH class, seemed to drink more alcoholic beverages and to be heavier, but they walked more and their diet resembled more closely the Mediterranean one. Altogether, in this study population, the highest social class seemed to be associated with better behaviours toward CHD prevention.

Coronary Disease↗
PubMed1982

Distribution of physiological adult lactase phenotypes, lactose absorber and malabsorber, in Germany.

A total of 1805 apparently healthy, adult and adolescent Germans (1572 males and 233 females with a mean age of 20.3 years) were examined for lactose absorption capacity employing a field version of the breath hydrogen (H2) test. The diagnostic parameter, maximal change of breath hydrogen concentration 120 or 150 min after a load of 50 g lactose, showed a bimodal distribution, separating lactose absorbers (n = 1537, 85.2%) and lactose malabsorbers (n = 268, 14.8%). The distribution of the adult lactase phenotypes was independent of age, sex, and educational status. The incidence of gastrointestinal symptoms after lactose administration demonstrated the incongruity of lactose malabsorption and lactose intolerance. In addition to grouping by residence, the probands were classified according to the birthplaces of their grandparents in order to reconstruct the distribution pattern of the lactase phenotypes prior to World War I, a period of relative population stability. Considerable differences in the frequency of lactose malabsorption were found in regions corresponding to traditional ethnic groups within the German population: northwest Germany 6-9%, west and south 13-14%, southwest 23%, east (including formerly German territories east of rivers Oder and Neisse) 22%. These differences are discussed with reference to population history. The present fairly even distribution of the lactase phenotypes in West Germany is the result of internal migrations at the end of World War II.

Adolescent↗
PubMed1983

Work satisfaction among rural mental health staff.

Previous studies demonstrating low levels of work satisfaction among mental health staff have failed to investigate specific correlates such as employment status, educational and caseload characteristics or to consider differences in a rural organizational context. Responses on 11 work satisfaction items were compared on 16 work and educational characteristics for 47 clinical staff in rural mental health facilities. The correlates of work satisfaction identified are compared to previous job satisfaction studies, and profiles of least and most satisfied staff are discussed.

Adult↗
PubMed1997

[Response rate and analysis of non-responses in a cohort study].

In 1987, a national survey on psychotropic substances and life styles was carried out by the Swiss Institute for Alcohol and Drug Problems (SIPAD). Out of 1910 participants, 1568 did agree to take part in a further study. In 1995, in order to execute a cohort type survey with minimal cost, the co-ordinates of 1472 of them were retrieved and a new questionnaire was sent to them. After 2 written reminders and another one by phone, the response rate reached 72.6%. It is therefore possible, at least in Switzerland, to lead a cohort type survey using a cross-sectional study as the starting point. Significant differences arise between the respondents and non-respondents at the level of linguistic region, age, income, civil status, educational level and alcohol or drugs consumption. On the other hand, neither sex, nor tobacco or cannabis consumption had an influence on the response rate.

Adult↗
PubMed1993

Overweight among Mexican Americans and its relationship to life style behavioral risk factors.

The hypothesis positing differences between Mexican Americans and whites regarding attitudes and behaviors concerning obesity and other health issues was tested. A random sample of 1171 whites and 155 Mexican Americans aged 18 to 65 was selected. Two analyses were carried out. First, overweight Mexican Americans were compared with overweight whites. Second, overweight individuals were compared with normal weight counterparts within each ethnic group. Differences between overweight Mexican Americans and overweight whites disappeared after adjusting for the effects of sex, income, educational status, and marital status. Among whites, several factors remained significantly different when comparing overweight with normal weight individuals. Among Mexican Americans, however, all but one of the significant differences between overweight and normal weight individuals disappeared after adjusting for other variables. The implications of these results as they relate to the implementation of public health programs to deal with the prevention and treatment of obesity among Mexican Americans are discussed.

Adolescent↗
PubMed1993

[Social inequality in myocardial infarct and stroke in West Germany].

It is examined to which extent social inequalities exist in West-Germany (old federal states) regarding myocardial infarction and stroke in the general population. Databases were the regional and national health surveys which were conducted in the framework of the German Cardiovascular Prevention Study (GCP) from 1984 to 1991. 12.445 males and 13,335 females aged 40-69 years were included in this analysis. The assessment of myocardial infarction and stroke was done by a self administered questionnaire. 648 (5.2%) males and 252 (1.9%) females reported a myocardial infarction. 209 (1.7%) males and 143 (1.1%) females reported a stroke. Social class was measured using an additive index comprising the dimensions income, occupational status and education. For both genders it was found that the prevalence of myocardial infarction and stroke increased significantly with decreasing social class. This association remained significant also under control for age and the cardiovascular disease risk factors cigarette smoking, hypertension, hypercholesterolemia and overweight. The results clearly demonstrate that in West-Germany--as was shown already for many other western industrialized nations--social factors independently from the classical risk factors have a significant effect on the incidence of myocardial infarction and stroke.

Adult↗
PubMed1997

Diet, obesity and risk for renal cell carcinoma: results from a case control-study in Germany.

Increasing incidence of renal cell carcinoma in Western countries raises particular attention to its etiology. Diet may be related to risk for renal cell carcinoma since obesity has been linked with this malignant condition. A case-control study with 277 incident renal cell cancer patients (ICD 189.0) and 286 population controls was conducted in the Rhein-Neckar-Odenwald area, Germany, in the period of 1989 to 1991. The core study protocol included a face-to-face interview about demographical parameters, previous diseases, medication, tobacco smoking, occupational history, occupational exposures, beverage consumption, and obesity. In addition, study participants were asked to fill in a self-administered food frequency questionnaire with 122 food items to estimate overall food intake. Fifty-six % of the cases and 74% of the controls participated in this part of the study (n = 155 cases and 212 controls). This was 47% of the original cases (n = 328) and 56% of the controls (n = 381). No selection bias could be identified with regard to age group, gender, educational status or recent BMI in the analyzed group compared with the eligible cases and controls. Relative risk (RR) estimates for tertiles of consumption revealed a significantly increased risk with increasing intake of fat spread (RR of high intake compared to low intake: 1.90 (95% CI 1.08-3.32)). Increased risk was also found for intake of meat and meat products (RR of high intake compared to low intake: 1.71 (95% CI 0.96-3.04)) and energy adjusted fat (RR of high intake compared to low intake: 1.64 (95% CI 0.95-2.83)). A decreased risk was seen with increasing intake of fruit (RR of high intake compared to low intake: 0.40 (95% CI 0.23-0.69)) and of vitamin C (RR of high intake compared to low intake: 0.62 (95% CI 0.37-1.05)). Beverage consumption, preparation of food and eating pattern were not linked with risk of renal cell cancer. The relative risk estimates of spreading fat (sauce and vitamin C intake were tested in two models, with and without including BMI as covariate. In both models significant associations of these nutritional variables with risk for renal cell cancer remained. The current results indicate that specific food pattern associated with obesity explain differences in incidence of renal cell carcinoma in industrialized countries.

Adult↗
PubMed1995

Risk factors for laryngeal cancer.

This case-control study comprised 100 histologically verified laryngeal cancer patients and 100 hospital controls matched with cases by sex, age and place of residence. The following variables were tested for their association with cancer of the larynx: marital status, educational level, hard liquor consumption, cigarette smoking, unfavorable working conditions, sudden and frequent temperature changes at work, cold housing, loud speech at work, frequent hoarseness, frequent and persistent cough, persistently swollen neck glands, tonsillectomy and laryngeal surgery. According to conditional logistic regression analysis, significant association with laryngeal cancer was found for unfavourable working conditions for more than 10 years (OR = 4.36; 95% CI = 1.92-9.91), hard liquor consumption for more than 5 years (OR = 2.59; 95% CI = 1.14-5.87), cigarette smoking for more than 10 years (OR = 7.29; 95% CI = 2.41-22.09), tonsillectomy (OR = 4.80; 95% CI = 1.61-14.30) and frequent and persistent cough prior to disease (OR = 8.17; 95% CI = 1.72-38.76).

Adult↗
PubMed1985

Pelvic inflammatory disease, intrauterine contraception, and the conduct of epidemiologic studies.

Pelvic inflammatory disease (PID) has been described in the medical literature for more than a century as a specific entity. Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma hominis, along with Bacteroides fragilis and other anaerobic bacteria, have been most frequently associated with PID. Factors affecting the occurrence of PID have been extensively studied during the past two decades and include number of sexual partners, age, race, socioeconomic status, education, and contraceptive method. As knowledge concerning factors that contribute to PID increases, epidemiologic studies addressing such issues must become increasingly sophisticated, and the literature needs to be re-evaluated in light of present knowledge. Various risk factors for PID, types of epidemiologic studies, methods for conducting such studies, and data interpretation are reviewed.

Epidemiologic Methods↗
PubMed1988

[Sex-specific utilization of medical aid. Results of the Munich Blood Pressure Study].

Sex differences in the frequency of physician visits, participation in cancer screening tests, number of drugs consumed, intake of antihypertensive drugs, and participation in hypertension screening have been investigated with data from the Munich Blood Pressure Study I and II (MBS 1981 and 1982). The study population was a random sample of the adult population of Munich (30-69 yrs.). 2216 men and women participated in MBS I (response 69.3%). The results from descriptive analyses and multivariate logistic regression showed significant relationships between sex and the various types of medical care utilization described above, with the exception of participation in hypertension screening, that is participation in the Munich Blood Pressure Study. Also, after controlling for age, marital status, education, occupational position, subjective physical well-being, number of chronic diseases, women went more often to the doctors and consumed more drugs than men. The sex differences were the largest in the participation of cancer screening tests (odds ratio 7.7), and the smallest in the frequency of physician visits (odds ratio 1.8) and participation in hypertension screening (not significant). Additionally, the sex differences in medical care utilization decreased with age.

Adult↗
PubMed1990

[The motivation and assessment of the success of adult patients undergoing orthodontic treatment--the interpretation of a questionnaire].

In order to analyze orthodontic treatment of adults concerning information, motives and retrospective evaluation 225 patients with fixed appliances were questioned. The dentist had a key position as a mediator of information. The decision to an orthodontic treatment was led by esthetic and functional motives. The extent of the respective motives depended from age, personal status, education and cooperation. Interest and understanding in functional improvements as they could be found above all by people with a higher education level were decisive for a durable regard of the treatment.

Adult↗
PubMed2006

A pilot study on body image, attractiveness and body size in Gambians living in an urban community.

OBJECTIVE: We investigated the attitudinal and perceptual components of body image and its link with body mass index (BMI) in a sample of urban Gambians. We also looked at cross-cultural differences in body image and views on attractiveness between Gambians and Americans. METHODS: Four groups of 50 subjects were assessed: men 14- 25y (YM); women 14-25y (YW); men 35-50y (OM); women 35-50y (OW). Socio-economic status, education, healthy lifestyle and western influences were investigated. Height and weight were measured. Body dissatisfaction was assessed with the body dissatisfaction scale of the Eating Disorder Inventory. Perceptions of body image and attractiveness were assessed using the Body Image Assessment for Obesity (BIA-O) and Figure Rating Scale (FRS). RESULTS: Different generations of Gambians had very different perceptions and attitudes towards obesity. Current body size was realistically perceived and largely well tolerated. Older women had a higher body discrepancy (current minus ideal body size) than other groups (p<0.001). Regression analysis showed they were not worried about their body size until they were overweight (BMI=27.8 kg/m2), whilst OM, YM and YW started to be concerned at a BMI respectively of 22.9, 19.8 and 21.5 kg/m2. A cross-cultural comparison using published data on FRS showed that Gambians were more obesity tolerant than black and white Americans. DISCUSSION: The Gambia is a country in the early stage of demographic transitions but in urban areas there is an increase in obesity prevalence. Inherent tensions between the preservation of cultural values and traditional habits, and raising awareness of the risks of obesity, may limit health interventions to prevent weight gain.

Adolescent↗
PubMed1998

Predictors of pain self-report in nursing home residents.

The purpose of this study was to examine the influence of cognitive function and other biopsychosocial factors on test-retest agreement, four-week variability, and intensity of self-reported pain using the verbal 0 to 10 scale and a pain thermometer in 115 nursing home residents over four weeks. Pain was assessed twice on three days during week 1, and once each during weeks 2, 3 and 4. A forward stepwise regression procedure was used to examine the influence of biopsychosocial parameters (age, race, gender, educational status, marital status, comorbidity, cognitive function, depression, social support, physical function and self-rated health) on pain intensity, test-retest agreement and variability. There was a quadratic association between cognitive function and test-retest agreement with the 0-10 scale; residents with Folstein scores of 22-26 were more likely to show disagreement (50% of 34) than residents with scores < 22 or > 26 (7% of 71). Higher Folstein scores were also associated with greater pain intensity for both pain scales (p < 0.001). Baseline pain intensity was significantly related to pain variability (0-10 scale only). The clinician should be cognizant of these relationships when interpreting verbalizations of pain in long-term care facilities.

Adult↗
PubMed2006

A rural-urban comparison of the characteristics of the metabolic syndrome by gender in Korea: the Korean Health and Genome Study (KHGS).

The number of cases of the metabolic syndrome is increasing dramatically in Western countries. However, the evaluation of the metabolic syndrome is limited in Asian countries. Thus, our objectives were: 1) to investigate parameters of the metabolic syndrome defined by the National Cholesterol Education Program (NCEP)-Adult Treatment Panel III (ATPIII) in the subjects representing Korean general population and 2) the modification of which factor is most effective in reducing the metabolic syndrome. A total of 10,044 (5024 rural and 5020 urban) Korean men and women in the age range 40-69 yr voluntarily participated in this community-based cross-sectional study (a rural and an urban community was selected). Anthropometric parameters (weight, height, waist and hip circumference and blood pressure), social factors (smoking, alcohol, exercise and education status) as well as biochemical parameters (fasting glucose and insulin, lipids and body composition) were measured. Twenty-six point one per cent of the total subjects were classified as having the metabolic syndrome. Age- and sex-adjusted prevalences were 29.3 and 22.3% in the rural and urban community, respectively (p< 0.01). Abdominal obesity (46.9%) and high blood pressure (45.2%) were major components in the rural community; hypertriglyceridemia (37.6%) and low HDL-cholesterolemia (37.0%) in the urban community. In conclusion, abdominal obesity in the rural community and dyslipidemia in the urban community should be a main subject of intervention, aimed at reducing the prevalence of the metabolic syndrome in Korea. Given the rapid progression of the Korean economy over the past 30 yr, the prevalence of the metabolic syndrome is expected to increase continuously. A strategy to prevent this expected extraordinary event should be conducted at a national level.

Adult↗
PubMed2003

The Victorian ambulatory care sensitive conditions study: rural and urban perspectives.

OBJECTIVES: Ambulatory Care Sensitive Conditions (ACSCs) are those for which hospitalisation is thought to be avoidable with the application of preventive care and early disease management, usually delivered in the ambulatory setting. This study presents detailed analyses of ACSCs as a measure of health outcome that might vary with access to primary health care in rural and urban regions of Victoria. METHOD: The Victorian Admitted Episodes Dataset (VAED), and data from the Health Insurance Commission, Medical Labour Force Annual Survey, socio-economic indexes for areas, and accessibility/remoteness index of Australia were merged to identify individual and aggregate level predictors of urban/rural differentials of ACSCs. Estimates of odds ratios and 95% confidence intervals were based on random effect multi-level generalised linear models. RESULTS: After adjustment for age, sex, and severity of illness, significant predictors of higher admission rates of ACSCs within rural areas include lack of insurance, emergency admissions, higher degree of remoteness, lower population density, lower number of general practitioners/10,000 population by local government area (LGA), lower number of general practitioner visits per person by LGA, and areas with lower socio-economic status, education and occupation, and economic resources. CONCLUSIONS: This study suggests that lack of timely and effective care may have a significant impact on rates of admissions for ACSCs in rural areas of Victoria especially in lower socio-economic groups.

Adolescent↗