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PubMed1998

The rise and fall of levonorgestrel implants: 1992-1996.

OBJECTIVE: To assess shifts over a 4-year period in attitudes of low-income US women regarding use of levonorgestrel implants. METHODS: An anonymous questionnaire was administered at two different points in time to English-speaking women of reproductive age seeking gynecologic or obstetric care in southeast Texas. The first survey, administered to 762 women in 1992, elicited information on demographic and reproductive characteristics, as well as exposure to information on implants and attitudes regarding use of this method. This same survey was administered again in 1995-1996 to 502 women. chi2, Student t, or Kruskal-Wallis nonparametric tests were used to evaluate shifts in attitudes and perceived barriers to use across the 4-year period. RESULTS: Women portrayed less positive attitudes about levonorgestrel implants when surveyed in 1995-1996 as compared with 1992. Most notably, they appeared less appreciative of the convenience associated with implant use and more concerned with potential side effects. Nulliparous and parous women surveyed in 1995-1996 were significantly less likely than those surveyed in 1992 to state that they would consider using this method for birth control (P < .001) and were more likely to state that their partner, friends, and family would object to their use of levonorgestrel implants. CONCLUSION: This study documents the decline in popular perceptions of levonorgestrel implants among low-income English-speaking women over the 4-year period following the introduction of this contraceptive method to the US market.

Adult↗
PubMed1998

Outdoor work and the risk of pterygia: a case-control study.

AIM: To investigate the relationship between outdoor work and pterygium formation in a hospital-based case-control study in Singapore. METHOD: Sixty-one patients with pterygium (49 males, mean age 54.2 years) and 125 controls (41 males, mean age 50.2 years), excluding patients with cataract and age-related macular degeneration presenting at outpatient clinics of the Singapore National Eye Centre were interviewed face-to-face with a standard questionnaire. Demographic data and information on outdoor work and eye protection, were collected. RESULTS: Thirty-eight subjects (20.4%) were outdoor workers and 148 (79.6%) were indoor workers. Outdoor workers were more likely to be male smokers and alcohol drinkers with lower family income and higher sunlight exposure than indoor workers. The crude odds ratio for pterygium in outdoor workers was 7.0 (95% confidence interval 3.2, 15.3). The adjusted odds ratio was 4.2 (95% confidence interval 1.7, 10.1). CONCLUSION: There is a statistically significant association between outdoor work and pterygium formation, which may be related to the higher exposure to sunlight and dust in outdoor workers. Efforts may be made to educate outdoor workers to wear proper equipment to protect their eyes against excessive sunlight.

Adult↗
PubMed2004

[Health care consumption. Empirical evidence from a survey in a regional university hospital].

OBJECTIVES: Emergency departments of French hospitals have been coping with increasing activity for ten Years. This study is aimed at describing patterns of health care consumption for people admitted to emergency departments and at linking them to their declared socio-economic status. METHODS: In May 2001, a survey was conducted in the emergency department of the Saint Roch Hospital in Nice, identifying the nature and motives of the persons admitted, health care consumption over the last Year and a set of socio-economic characteristics of the patients. RESULTS: A persisting gap in health care consumption still remains to the detriment of poor people. There also seems to be a threshold effect for patients whose income only slightly exceeds the upper limit of revenues entitling them to universal health insurance or other social redistribution mechanisms. For this category of the population, health care consumption is significantly less than that of the rest of the population, although visits to the emergency department are more often unjustified. CONCLUSION: Emergency departments are the major access to health care for people excluded from, or on the borderline of the health system. The extension of health insurance to populations excluded up till now, appears to induce underprivileged health traps, but at the same time making up for lost time (only partially in this study). Such effects merit consideration in order to ensure a continuum in the management of health requirements in low income populations.

Adolescent↗
PubMed1994

A theoretical study of the socioecology of ungulates. II. A dynamic programming study of the stochastic formulation.

We develop a stochastic version of a previously discussed model of optimal herd size selection in ungulates. We assume that a large herd size confers to the animals a high level of protection against predators, but reduces the amount of food which can be eaten by each individual; on the contrary animals belonging to small herds would have access to large amounts of food but would bear a high risk of being killed by predators. Employing a dynamic programming approach we analyze the optimal trade-off between starvation and predation risks under the hypothesis that the animals would try to maximize their expected reproductive fitness during the incoming breeding period. We compare the optimal strategy in environments described by different kinds of stochastic food distributions (including the deterministic limit) for different values of predation pressure and of overall food availability. We obtain general information about the effect of the level of randomness of food distribution on the mean individual fitness and on the number of reproducers (the animals which survive to the beginning of the reproductive season). Moreover we discuss how a certain number of behavioral and ecological processes--which have been often described in natural populations of ungulates and which are usually explained in terms of phenological variations of the ecological landscape--may be interpreted as caused by intrinsic variations of the animals' strategy.

Animal Nutritional Physiological Phenomena↗
PubMed1993

Rural emergency medical volunteers and their communities: a demographic comparison.

This research compares the personal, household, and professional characteristics volunteer emergency medical service (EMS) providers in Ulster County, NY with those of the general population of this rural upstate county, using a survey instrument implemented by the author in conjunction with the 1990 U.S. Census data. A principal objective of this research was to identify the characteristics of these volunteers in order to support the recruitment and retention efforts of volunteer EMS organizations. Statistically significant deviations between these two sample populations include age distribution, maximum educational attainment, size of household, years in residence, type of employer, employing industry, occupation, household income, and commuting distance from work. Population differences for race, sex, marital status, household site, home ownership, housing costs, and in-county employment were not statistically significant. Additional data reported for the EMS volunteers include total emergency responses, active squad membership, length of service, level of medical qualifications, and intensity and nature of individual participation, age of recruitment, family involvement, tenure in the community, rates of household work participation, other volunteer activity, motivation, and receptivity to alternative incentive programs. The relevance of these data is interpreted with respect to the prospects for effective recruitment of volunteers, the level of commitment and retention of the volunteers, the degree of support which volunteers can expect from their communities, and the extent of cohesiveness and integration which volunteer EMS squads provide to their communities.

Adult↗
PubMed2004

A comparative study on textural characterization: cation-exchange and sorption properties of crystalline alpha-zirconium(IV), tin(IV), and titanium(IV) phosphates.

Tetravalent metal phosphates (M=Zr, Ti, and Sn) were prepared and characterized by XRD, surface properties, and TG-DTA. The cation exchange and sorption behavior of these metal phosphates toward transition metal ions such as Cu(2+), Co(2+), and Ni(2+) have been studied comparatively as a function of temperature and concentration. The adsorption process was found to increases with increase in temperature and concentration. The selectivity order for alpha-titanium and alpha-tin phosphates is Cu(2+)>Co(2+)>Ni(2+), whereas for alpha-zirconium phosphate it is Cu(2+)>Ni(2+)>Co(2+). The ion exchange capacity of alpha-titanium phosphate is greater than those of other phosphates, which is explained on the basis of the surface behavior, disorderness of the system, degree of hydrolysis of incoming guest adsorbate metal ions, and structural steric hindrance of the exchangers during adsorption and sorption. The distribution coefficient, Gibbs free energy, enthalpy, and entropy values indicate that the ion-exchange processes are spontaneous.

Journal Article↗
PubMed1995

Black-white differences in the stage at presentation of prostate cancer in the District of Columbia.

OBJECTIVES: Prostate cancer (PC) is a major health problem for American black males. Blacks experience higher PC incidence and mortality compared to whites. Although the racial difference in PC incidence remains unexplained, the difference in PC mortality has been largely attributed to the late stage of disease at presentation. By using the incidence data on District of Columbia residents, this study compares the stage at diagnosis between black men and white men and attempts to determine if observed differences may be attributed to socioeconomic status (SES). METHODS: Reporting facilities staged PC using the Surveillance, Epidemiology, and End Results summary staging scheme. Averages of high school education, income, and home ownership at the census tract level were used as proxies for SES, and frequency distributions were reported. Data were stratified based on stage to examine the influence of race and SES on stage. RESULTS: For 1987 to 1991, 980 men (median age, 71 years) were reportedly diagnosed with PC. Black patients are younger and prostate tumors appear more likely to be more aggressive among blacks than whites. SES is negatively associated with late stage PC, and currently married men, compared with previously married, are less likely to be diagnosed with metastatic PC. Black men are more likely to present with later stage disease, and this racial difference persists even when SES is controlled. CONCLUSIONS: Late stage diagnosis is associated with favorable SES indicators. But substantial racial gradients in the distribution of diagnostic stage persisted even after adjustment for SES. This suggests the need for more intensive efforts to address issues related to access, quality, and utilization of cancer screening services as they pertain to all African-American men in the District of Columbia irrespective of their social status.

Aged↗
PubMed2004

A supply-demand model of fetal energy sufficiency predicts lipid profiles in male but not female Filipino adolescents.

OBJECTIVE: To test the hypothesis that the balance between fetal nutritional demand and maternal nutritional supply during pregnancy will predict lipid profiles in offspring measured in adolescence. SUBJECTS AND METHODS: A total of 296 male and 307 female Filipino offspring (aged 14-16 y) and mothers enrolled in a longitudinal birth cohort study (begun in 1983-84) had lipid profiles measured. Data on maternal height (as a proxy for offspring growth potential and thus fetal nutritional demand) and third trimester maternal arm fat area (as a proxy for maternal supply) were used to create four groups hypothesized to reflect a gradient of fetal energy sufficiency. RESULTS: As fetal energy sufficiency increased among males, there was a decrease in total cholesterol (TC) (P<0.05 for trend), low-density lipoprotein cholesterol (LDL-C), and the ratios of TC/HDL-C cholesterol and LDL-C/HDL-C (all P<0.001), while HDL-C increased (P<0.05). Similar associations were identified when lipid levels were modeled as dichotomous 'high-risk' cut-points used in cardiovascular disease prevention in adolescents. These relationships were stronger, or only present, among offspring of mothers in the lower half of the third trimester energy intake distribution, and were independent of the child's current adiposity, dietary energy and fat intake, maturity, household income, and birth weight. In females, the supply-demand model did not predict any lipid outcome or clinical risk criteria. CONCLUSIONS: Our findings in males support the hypothesis that the balance between fetal nutritional demand and maternal nutritional supply has implications for future lipid profiles. The lack of significant associations in females adds to mounting evidence for sex differences in lipid metabolism programming, and may reflect sex differences in fetal nutritional demand. SPONSORSHIP: The National Science Foundation, the Mellon Foundation, the Nestle Foundation, and the Emory University Internationalization Program.

Adaptation, Physiological↗
PubMed1999

Developing a media- and school-based program for substance abuse prevention among Hispanic youth: a case study of Mirame!/Look at Me!

Mirame!/Look at Me! is a substance abuse prevention program for low-income Mexican-American youth aged 9-13 years. The theory-driven curriculum, developed for mass distribution via a satellite television network, features social models who demonstrate cognitive-behavioral skills and display conservative norms regarding substance abuse. An 18-session curriculum contains 5-min videos that are assigned to be followed by discussion and social reinforcement from a teacher or volunteer. This case study reports the program development process and experiences in the initial dissemination of the program through national networks for schools and cable television subscribers.

Adolescent↗
PubMed2001

Social economic development in the prevention of global blindness.

AIMS: To assess the relation between a country's economic developmental status and its prevalence of blindness. METHODS: Available epidemiological data on worldwide visual loss and its causes compiled by the World Health Organization were reviewed. Findings were compared with economic development data from the involved countries and regions. Analysis was completed in view of the socioeconomic status of each country and region. RESULTS: Analysis of the global distribution of blindness indicates a trend of higher prevalence existing in developing countries with lower per capita income. Preventable causes of blindness (that is, cataract, trachoma) are also more prevalent in these countries. CONCLUSIONS: Because economic development is shown to be a factor in blindness, programmes for blindness prevention should not be the only route to the elimination of unnecessary blindness throughout the world. Concomitant economic development is also necessary to reduce and eventually eradicate much of the preventable and avoidable causes of blindness.

Blindness↗
PubMed2006

Differences between Belgian and Brazilian group A Streptococcus epidemiologic landscape.

BACKGROUND: Group A Streptococcus (GAS) clinical and molecular epidemiology varies with location and time. These differences are not or are poorly understood. METHODS AND FINDINGS: We prospectively studied the epidemiology of GAS infections among children in outpatient hospital clinics in Brussels (Belgium) and Brasília (Brazil). Clinical questionnaires were filled out and microbiological sampling was performed. GAS isolates were emm-typed according to the Center for Disease Control protocol. emm pattern was predicted for each isolate. 334 GAS isolates were recovered from 706 children. Skin infections were frequent in Brasília (48% of the GAS infections), whereas pharyngitis were predominant (88%) in Brussels. The mean age of children with GAS pharyngitis in Brussels was lower than in Brasília (65/92 months, p<0.001). emm-typing revealed striking differences between Brazilian and Belgian GAS isolates. While 20 distinct emm-types were identified among 200 Belgian isolates, 48 were found among 128 Brazilian isolates. Belgian isolates belong mainly to emm pattern A-C (55%) and E (42.5%) while emm pattern E (51.5%) and D (36%) were predominant in Brasília. In Brasília, emm pattern D isolates were recovered from 18.5% of the pharyngitis, although this emm pattern is supposed to have a skin tropism. By contrast, A-C pattern isolates were infrequently recovered in a region where rheumatic fever is still highly prevalent. CONCLUSIONS: Epidemiologic features of GAS from a pediatric population were very different in an industrialised country and a low incomes region, not only in term of clinical presentation, but also in terms of genetic diversity and distribution of emm patterns. These differences should be taken into account for designing treatment guidelines and vaccine strategies.

Adolescent↗
PubMed1983

The family and the reproduction of the population.

"The causes for the lowering of the birthrate below the necessary level for a simple reproduction of society [in the USSR are] sought within the family itself and in the conditions surrounding its existence....The present demographic situation requires the elaboration of a whole program for the development of marital and family relationships and the optimization of population reproduction processes....[Such a program] must encompass the issues of preparing youth for family life, the prestige of the family and its economic status, the optimal distribution of functions among individuals in the family and in society,....[and] the equalization of per capita income levels between one-child and large families...."

Birth Rate↗
PubMed2000

[Secular trends in malnutrition and obesity among children in the city of São Paulo, Brazil (1974-1996)].

OBJECTIVE: Data from three household surveys undertaken in the city of S. Paulo, Brazil, from mid-80s to mid-90s allow to characterize and analyse secular trends in malnutrition and obesity among infants and children. METHODS: The three surveys included random population samples aged from zero to 59 months (1,008 children in the period of 1974-75; 1,016 in 1984-85 and 1,280 in 1995-96). The malnourished status was diagnosed when height-for-age and/or weight-for-height indices were below two standard deviation of the mean values expected according to the international growth reference. The obesity status was determined when weight-for-height indices fell two standard deviations above the reference. The study of the social distribution of malnutrition and obesity in each survey took into account tertiles of the per capita family income. For the study of the determinants of secular trends, hierarchical causal models, multivariate regression analyses and calculations analogous to the ones used to assess population attributable risks were applied. RESULTS/CONCLUSIONS: In the period of 22 years covered by the three surveys, child malnutrition was controlled in the city and became relatively rare even among the poorest families. The risk of obesity remained low and restricted to the richest families. Positive changes in distal (family income and maternal schooling) and intermediate determinants (sanitation, access to heath services and reproductive past history) of child nutritional status substantially explained part of the decline in the prevalence of malnutrition seen in the mid-80s to mid-90s.

Body Height↗
PubMedDate not supplied

Care of the older person with kidney failure.

Dialysis and renal transplants have become a reality in the XXIst century. Their use in third world countries has profound impacts on social, economic, political and cultural aspects. Extraordinary achievements for the medical world, that is constantly concerned in improving the health levels for the population; but what are the repercussions for the lower income groups? Is the cost/benefit relationship being analysed? Is there ample information available and is it well distributed regarding how to avoid the need for dialysis or a kidney transplant? What recommendations are made to the health care workers? And, what has been revealed to us after reflecting on the philosophical/historical aspects of the human existence? How valuable are Dr. Ivan Illich's observations and what can we expect from health care workers in relation to such significant achievements as we face the XXIst century?

Aged↗
PubMed2006

The shape of the socioeconomic-oral health gradient: implications for theoretical explanations.

OBJECTIVES: The nature of the relationship between status and health has theoretical and applied significance. To compare the shape of the socioeconomic -oral health relationship using a measure of relative social status (MacArthur Scale of Subjective Social Status) and a measure of absolute material resource (equivalised household income); to investigate the contribution of behaviour in attenuating the socioeconomic gradient in oral health status; and to comment on three hypothesised explanatory mechanisms for this relationship (material, psychosocial, behavioural). METHODS: In 2003, cross-sectional self-report data were collected from 2,915 adults aged 43-57 years in Adelaide, Australia using a stratified cluster design. Oral conditions were (1) < 24 teeth, (2) 1+ impact/s reported fairly often or very often on the 14-item Oral Health Impact Profile; (3) fair or poor self-rated oral health, and (4) low satisfaction with chewing ability. Prevalence ratios and 95% confidence intervals (PR, 95%CI) were calculated from a logistic regression model. Covariates were age, sex, country of birth, smoking, alcohol use, body mass index, frequencies of toothbrushing and interdental cleaning. RESULTS: There was an approximately linear relationship of decreasing prevalence for each oral condition across quintiles of increasing relative social status. In the fully adjusted model the gradient was steepest for low satisfaction with chewing (PR = 4.1, 95%CI = 3.0-5.4). Using equivalised household income, the shape more closely resembled a threshold effect, with an approximate halving of the prevalence ratio between the first and second social status quintiles for the adverse impact of oral conditions and fair or poor self-rated oral health. Adjustment for covariates did not attenuate the magnitude of PRs. CONCLUSIONS: The nature of the relationship between social status and oral conditions differed according to the measure used to index social status. Perception of relative social standing followed an approximately straight-line relationship. In contrast, there was a discrete threshold of income below which oral health deteriorated, suggesting that the benefit to oral health of material resources occurs mostly at the lower end of the across the full socioeconomic distribution.

Adult↗
PubMed2002

Participation in labor-intensive public works program (LIPWP): effect on staple crop production in southeastern Botswana.

A labor-intensive public works program (LIPWP) aims to improve the income of rural households. One of the common criticisms of the LIPWP is that it is a disincentive for staple crop production. This study, conducted between February and May 2000, examined the association between participation in an LIPWP and staple crop production in southeastern Botswana. Participant households were those with at least one member on a semipermanent LIPWP. A control group was drawn from households that were eligible to participate in the LIPWP. All participants in the LIPWP were included, while nonparticipant households were randomly selected. A structured questionnaire was administered to 160 control and 153 participant households. The odds of having no staple crop in the control group were 1.8 times (95% CI, 0.98 to 3.54) higher than that of the LIPWP participants (p = .087), while the odds of having no staple crop in a household with a head between 45 and 64 years of age were 2.5 times (95% CI, 1.06 to 5.96) higher than that of a household with a head less than 45 years old (p < .037). Having more than 10 livestock equivalent units reduced the risk of having no harvest by 40% (95% CI, 0.29 to 1.12). The view that participation in the LIPWP results in reduced staple crop production does not seem to be supported by our data.

Adult↗
PubMed2001

Safe and sorry: risk, environmental equity, and hazardous waste management facilities.

Many empirical environmental equity analyses have attempted to determine if hazardous waste treatment, storage, or disposal facilities (TSDFs) are in disproportionately minority or low-income areas. These prior analyses did not explain the extent of the risks posed by TSDFs, nor did they weight the distribution of those risks by the individual characteristics of the TSDFs. This study evaluated the risks posed by TSDFs in general and then examined whether any such risks were distributed inequitably when each TSDF was weighted by the amount of hazardous waste that it managed. Based on an assessment of the nature of the hazardous wastes that TSDFs manage, the possible exposure paths to risk from TSDFs, the laws designed to minimize the risks that TSDFs pose, and TSDFs' safety records, the attention devoted to TSDFs by environmental equity researchers is greatly exaggerated. Furthermore, based on this study's analyses, there was no pattern of the TSDFs or the risks that they posed being inequitably concentrated in disproportionately minority or low-income areas. Most of the TSDFs and the hazardous waste that they manage are in areas that are either unpopulated or have fewer minority or low-income people than the national average. There are, however, some TSDFs that are in highly populated, heavily minority or low-income areas, which results in such people being more likely overall to be in close proximity to these facilities.

Censuses↗
PubMed1999

Is race a poor prognostic factor in breast cancer?

BACKGROUND: African American breast cancer patients have a higher mortality rate than their Caucasian counterparts. The purpose of this study was to evaluate whether race is a poor prognostic factor in breast cancer survival after multiple other prognostic factors are taken into account. STUDY DESIGN: The tumor registry data from two institutions between the years 1982 and 1995 were combined for the analysis. A total of 1,745 patients, including 1,297 African American and 448 Caucasian women, were available for analysis. Race, age, income, stage, histologic findings, type of operation, and treating institution were evaluated as possible key prognostic variables. RESULTS: In a univariate Cox proportional hazards regression analysis, African American patients with breast cancer were 1.27 times more likely to die than Caucasians when death from disease was measured (p = 0.01, 95% confidence interval 1.03 to 1.47). When all factors were included in a Cox regression analysis, only the stage of disease at diagnosis, age, and whether the patient had a therapeutic surgical treatment were statistically significant. Race, income, hospital, and histologic findings were not significant, although they were significant when used in a univariate analysis. CONCLUSIONS: Poor survival of African American breast cancer patients seems to be related to their advanced stage at presentation and young age. To improve survival in these women, efforts should be concentrated on aggressive screening at a young age to detect the disease at an earlier stage.

Adult↗