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Evidence from correlation and experimental studies supports the view that availability of dental insurance increases both utilization of services and oral health. These effects are most pronounced for individuals with middle or low incomes--those most in need of care. Defining optimal levels of care and the most effective distribution of resources remains, however, an evolving and still unanswered question.
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"Analysis of data from the 1996 Census of six Melbourne localities suggests that some recent explanations for spatial concentrations of the poor in metropolitan areas are incomplete. In these middle-suburban locations the better-off are moving out, leaving behind those with less resources. While people of Australian or English-speaking background are more likely than those of non-English-speaking background (NESB) to leave, the inflow from overseas is predominantly of poor NESB people. Together, these two processes are adding to the spatial concentrations of the poor in Melbourne."
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The globalization of obesity is not a myth. Scientific and technologic advances have increased food production and availability while decreasing demand for physical activity. These developments, in turn, have contributed to peoples' cognitive and behavioral relationship with food selection and consumption. The more you see, the more you want. Although disparities in food distribution and personal economics still exist, the problem of over consumption is becoming widespread among low income groups in developed countries and among the high income in developing countries. The development of innovative technologies such as described in this chapter may help ebb the tide of obesity and improve the global future of health.
In the GDR about 20% of the males and 40% of the females were estimated to be obese. In the country obesity is more spread than in the town. Increased disablement of obese persons leads to reduction of the national income. With higher expenses for nutrition the frequency of obestiy increases. Hypophages and hyperphages are differently distributed in persons with normal weight and obese ones, so that the average establishments do not reflect the differentiated situation in nutrition. Obesity correlates with the type of structure; with increasing obesity dominate pyknomorphous tendencies of growth. Also in normal weight pyknomorphous persons have a higher proportion of fat. We should speak of obesity in such a case, when, taking into consideration biological differentiations, the normal proportion of the fat in the body is increased by more than 1/3. For epidemiological serial examinations the degrees of relative weight basing on optimum weight are a favourable basis for the classification of obesity.
AIMS: To profile 26 year old New Zealand users of unconventional practitioners. METHODS: 977 members of the Dunedin Multidisciplinary Health and Development Study participating in the age-26 assessment (1998-1999) answered questions about twelve-month service use, education, income, recent medical history, current health status and avoidance of medical situations. RESULTS: 10% had used an unconventional practitioner in the previous twelve months. The majority (88%) had also used a conventional practitioner. Those using both types of practitioner were heavy users of health services (twelve visits/year). Compared to those who used conventional practitioners exclusively, they had significantly higher incomes and were more likely to report a serious injury, a current disability, a history of back problems, role limitations due to physical health problems, and more bodily pain (all p < 0.01). CONCLUSIONS: 26 year old New Zealand users of unconventional practitioners have a similar profile to their counterparts in other developed countries. It appears that their health needs are not fully met by conventional services, emphasising the need for more research into the aetiology and treatment of ailments (e.g. back pain) for which unconventional practitioners are commonly sought. The Medical Council of New Zealand guidelines on unconventional medicine are discussed in light of these findings.
BACKGROUND: Survival after acute myocardial infarction (AMI) varies with socioeconomic status. It is unknown whether these differences can be attributed, in part, to variations in the prevalence of atherogenic risk factors preceding the index AMI event. OBJECTIVES: To examine how cardiovascular risk factors varied according to person-level indicators of income and education among a cohort of younger patients (younger than 65 years of age) hospitalized with AMI in Ontario. METHODS: The Socio-Economic and Acute Myocardial Infarction study (SESAMI) prospectively assembled a cohort of 3335 patients hospitalized with AMI who consented to participate (75% consent rate) from 53 of 57 large-volume institutions (100 AMI cases per year or more) throughout Ontario between December 1, 1999, and June 1, 2002. Given the known challenges inherent in characterizing the socioeconomic status in elderly patients and the ubiquity of atherosclerosis in elderly persons, the study focused on 1635 nonelderly participants. The relationship between income or education and cardiovascular risk factors, after adjustment for age, sex, ethnoracial factors and geography (urban-rural status) was examined. RESULTS: The prevalence of diabetes, hypertension, smoking and pre-existing heart disease was higher among poorer, less educated patients, as were the total number of cardiovascular risk factors. After adjusting for baseline factors, both income (adjusted OR 0.50, 95% CI 0.31 to 0.82, P=0.006) and education (adjusted OR 0.52, 95% CI 0.31 to 0.87, P=0.01) were independently associated with cardiovascular risk factors or pre-existing heart disease. There were no significant interactions between income, education and baseline cardiovascular risk. CONCLUSIONS: Outcome differences across socioeconomic strata following AMI may reflect major income- and education-related differences in atherogenic risk profile.
Injuries cause 9% of deaths and 14% of ill health in the WHO European Region. This problem is neglected; injuries are often seen as part of everyday life. However, although western Europe has good safety levels, death and disability from injury are rising in eastern Europe. People in low-to-middle-income countries in the Region are 3.6 times more likely to die from injuries than those in high-income countries. Economic and political change have led to unemployment, income inequalities, increased traffic, reduced restrictions on alcohol, and loss of social support. Risks such as movement of vulnerable populations and transfer of lifestyles and products between countries also need attention. In many countries, the public-health response has been inadequate, yet the cost is devastating to individuals and health-service budgets. More than half a million lives could be saved annually in the Region if recent knowledge could be used to prevent injuries and thus redress social injustice in this area.
The anatomical localization of neuropeptide FF receptors was examined by in vitro autoradiography techniques in rat brain sections by using [125I][D.Tyr1, (NMe)Phe3]NPFF. The specific binding of [125I][D.Tyr1, (NMe)Phe3]NPFF reached 90% of the total binding at 0.05 nM in rat spinal cord sections. Up to 40% of the specific binding of[125I][D.Tyr1, (NMe)Phe3]NPFF to rat spinal cord sections was still detectable following fixation with glutaraldehyde. Afterwards, the distribution of NPFF receptors was studied by light microscopy and their densities by microdensitometry with an image analysis system. In the light microscope, [125I][D.Tyr1, (NMe)Phe3]NPFF labelling appeared more or less uniformly distributed over nerve-cell bodies and surrounding neuropil. High concentrations of binding sites were detected in the presubiculum, parafascicular thalamic nucleus, gracile nucleus, spinal trigeminal tract nucleus, and a number of brainstem nuclei, with virtually no labelling in the cerebellum. In several areas a rostrocaudal gradient of sites concentration was observed. Neuropeptide FF receptors are well-placed to control incoming sensory and autonomic information processing. In contrast, the more recently developed areas of the forebrain possessed low density of sites. The distribution of [125I][D.Tyr1, (NMe)Phe3]NPFF binding sites should suggest anatomical substrates for the actions of neuropeptide FF.
Several studies have suggested that the health of Mexican-Americans is better than expected given their low socioeconomic status. The healthy migrant hypothesis and the acculturation hypothesis, stating that the foreign-born and the less acculturated enjoy better health, have been proposed as possible complementary explanations. However, it is not clear which are the socioeconomic, cultural, and personal characteristics that favor good health and that differentiate foreign-born from US-born and unacculturated from acculturated Mexicans. In this paper, we compare, by nativity and acculturation level, the socioeconomic, cultural, and personal characteristics in a sample of low income mostly female Mexican-origin individuals living in Texas and investigate their contribution to differences in self-reported physical health, mental health, and self-rated health (SRH) status. Using a multistage probability sample, we completed 1745 interviews with Mexican-origin individuals. The survey instrument included the SF-12, demographic and socioeconomic information, and questions on social support, religiosity, fear of victimization, trust, perceived racism, and perceived opportunity. Nativity and use of the Spanish language were combined into a nativity/acculturation variable. We estimated multivariate regressions and ordered logit regressions to investigate the association of health outcomes to nativity/acculturation and socioeconomic, cultural, and personal characteristics. Overall, the distribution of strengths (more social support, trust, perceived personal opportunities and less perceived victimization) reflected a nativity-based income gradient and an education gradient reflecting language use. Health outcomes varied by nativity/acculturation after controlling for socioeconomic, cultural, and personal characteristics. Physical health differed by nativity, supporting the healthy migrant hypothesis, while nativity-based differences in mental health were explained by socioeconomic and personal characteristics. SRH varied by language use, suggesting a culturally conditioned response. The socioeconomic, cultural, and personal factors affected health outcomes differently. These findings suggest a complicated interaction between nativity, acculturation, and economic factors in determining social and personal strengths and their influences on health.
A vitamin A survey was conducted among school children attending primary schools located in urban residential compounds categorised according to their socio-economic status based on average income, as well as in pre-school children from one compound. The study was done in order to find out the effect of socio-economic status on the distribution of vitamin A levels and to ascertain whether vitamin A deficiency is a public health problem in Zambian children. A total of 814 school going and 381 pre-school children were studied. The serum samples were analysed by High Pressure Liquid Chromatography (HPLC). Using a Chi square analysis there was a significant difference in the results between the more affluent areas with higher monthly average income and the less affluent ones (p < 0.05) showing that the socio-economic status of communities is an important factor in interpreting the distribution of vitamin A levels in children. Vitamin A deficiency was found to be a public health problem only in the pre-school age group. Intervention efforts to reduce vitamin A deficiency should mainly target this group.
Cardiovascular diseases are a leading cause of mortality, and systemic hypertension is a major risk factor. There is an increasing prevalence of hypertension in urban areas of developing countries, due to lifestyle changes associated with economic transition and urbanisation. This study aimed to describe the prevalence and identify risk factors for hypertension in an urban area of South America (Coroa do Meio district in Aracaju, Sergipe State, north-east Brazil) and to examine intraurban hypertension prevalence differences. A cross-sectional survey of 400 adults aged 25 years and over was carried out. Information about health and lifestyle was obtained from a structured interview, followed by assessment of blood pressure (BP) and anthropometry. There were 31.8% (95% confidence interval 27.3-36.6%) participants with hypertension (defined as a systolic BP >140, diastolic BP >90 mmHg, or on antihypertensive medication). Hypertension was independently associated with older age, central obesity (greater waist-to-hip ratio), shorter height and residing in a high socio-economic residential area. Of the four neighbouring areas, hypertension prevalence was 52% in the area of highest income and education, compared with 19, 24 and 34% in the other three areas. The high prevalence of hypertension in this population, and the strong independent association with relative affluence, demonstrates the need for effective primary prevention of hypertension, targeted at modifiable risk factors.
This paper compares long term care (LTC) systems in four OECD countries (UK, Japan, Sweden and Germany). In the UK, provision is means tested, so that out of pocket payments depend on levels of income, savings and assets. In Sweden, where the system is wholly tax-financed, provision is essentially free at the point of use. In Germany and Japan, provision is financed from recently introduced compulsory insurance schemes, although the details of how each scheme operates and the distributive consequences differ somewhat. The paper analyses the effects of importing the other three countries' systems for financing LTC into the UK, focussing on both the distributive consequences and the tax burden. It finds that the German system would not be an improvement on the current UK system, because it uses a regressive method of financing. Therefore, the discussion of possible alternatives to the present UK system could be restricted to a general tax-based system as used in Sweden or the compulsory insurance system as used in Japan. The results suggest that all three systems would imply increased taxes in the UK.
In a sample of low-income families (N = 239), structural equation models assessed predictors of fathers' involvement with preschool-aged children in instrumental, behavioral, and emotional realms. Results suggest that parental conflict has a strong negative relation with father involvement. Fathers' human capital characteristics, healthy psychosocial functioning, and past stability in family relationships all predicted greater father involvement directly and/or indirectly through parental conflict. Numerous differences emerged in the predictive models between resident and nonresident fathers, although few differences were statistically significant. Results suggest that policy efforts aimed at enhancing fathers' responsible parenting should focus both on increasing fathers' human and social capital and on supporting positive family processes.