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PubMedDate not supplied

Racial discrimination and alcohol-related behavior in urban transit operators: findings from the San Francisco Muni Health and Safety Study.

OBJECTIVE: A growing body of literature is documenting the health effects of racial discrimination. The authors investigated the association between racial discrimination and alcohol-related behavior in a sample of urban transit operators. METHODS: Using data from a 1993-1995 cross-sectional study of transit operators in San Francisco, California, the authors analyzed responses to two sets of questions about racial discrimination; the first set focused on reaction to unfair treatment and the second on arenas, or domains, of discrimination. Alcohol-related variables were: number of drinks per month, heavy drinking, alcohol dependence, and negative consequences of alcohol consumption. RESULTS: Operators who reported five or more domains of discrimination drank an average of 13.4 more drinks per month than those who reported no domains of discrimination (P = 0.01). Similarly, they were more likely to be heavy drinkers (adjusted odds ratio [OR] = 2.16; 95% confidence interval [CI] 1.14, 4.09) and dependent on alcohol (adjusted OR = 2.02; 95% CI 1.08, 3.79) than operators who reported no domains of discrimination. The number of domains in which operators reported having experienced discrimination was not related to sex, age, household income, job seniority, or marital status, but varied significantly by educational level and race/ethnicity. CONCLUSIONS: Data from a sample of urban transit operators showed an association between the number of domains of discrimination and some alcohol-related outcomes, but not others.

Adult↗
PubMed1993

Effects of exercise on total and segmental colon transit.

To investigate the effect of aerobic exercise on total gastrointestinal and segmental colon transit, 16 male health care workers with a sedentary life-style were studied during 1 week of rest and 1 week of exercise. The exercise phase consisted of walking 4.5 km on a level treadmill for 1 h on each of 3 days. Total gastrointestinal and segmental colon transit times were measured using radiopaque markers ingested on each of 3 consecutive days with an abdominal radiograph obtained on the fourth day. With exercise, total gastrointestinal transit time decreased in 5, increased in 6, and did not change in 5 subjects. Using a paired t test, total transit did not show a significant change from rest (24.5 +/- 21.8 h) to exercise (20.9 +/- 16.8 h), p = 0.50. These observations support our previous findings that physical activity to the extent that average people consider routine exercise does not necessarily improve gastrointestinal transit. Therefore, the role of such exercise in the management of chronic constipation can be seriously questioned.

Adult↗
PubMedDate not supplied

Poverty is a predictor of non-communicable disease among adults in Peruvian cities.

BACKGROUND: Rapid health and nutrition transitional changes are resulting in greater prominence of non-communicable disease (NCD) in Latin America, particularly among the poor. OBJECTIVE: The study aims to examine the extent to which NCD pxfsrevails in Peru and the socioeconomic status (SES) as a risk factor. DESIGN: Between 1998 and 2000, health surveys and clinical assessments were completed on 2337 adults in six cities, 18 to 60 years of age. Stratified by social class, multi-staged random sampling was used. Anthropometric data, blood pressure and serum samples were collected. RESULTS: Adjusting for age, hypertension, low HDL cholesterol, high total cholesterol and diabetes was found in 47%, 40%, 21% and 17% of women and in 44%, 38%, 27% and 19% of men, respectively. Over one quarter of the population exhibited multiple risk factors, not including overweight and obesity. Across all study sites, lowest SES revealed highest burden of NCD and appeared as an independent risk factor for associated NCD indicators. CONCLUSION: The high prevalence of NCD in urban areas of Peru is not only associated with excess body weight, but also with poverty itself. The greater burden of NCD in the poorest areas of society requires a better understanding of causal determinants and may have implications in terms of public health policies and interventions.

Adolescent↗
PubMed1999

Using employer purchasing power to improve the quality of perinatal care.

Large employers have become increasingly involved in helping to set the agenda for quality measurement and improvement. Moreover, they are beginning to hold health care organizations accountable for their performance through marketplace incentives, including the public reporting of comparative quality data and the linkage of reimbursement to performance on quality measures. The Pacific Business Group on Health (PBGH) is an employer coalition that has been prominent in establishing models for collaborative quality measurement and improvement in the California marketplace. PBGH's involvement in quality stems from an environment in which purchasers were faced with high health care costs, yet virtually no information with which to assess the value their employees received from that care. Research indicating widespread variation in performance across health care organizations and seemingly limited oversight for quality of care within the industry has further motivated purchasers' efforts to better understand the quality of care being delivered to their em-ployees. Using the purchasing power of employers representing 2.5-million covered lives, PBGH endeavors to encourage the transition of the health care marketplace from one that competes solely on price to one that competes on price and quality. This entails collaborating with the health care industry to develop and publicly report valid performance data for use by both large employers and consumers of health care services. It also includes communicating to the marketplace purchasers' commitment to making purchasing decisions based on quality as well as cost. PBGH efforts to measure, report, and improve quality have been demonstrated by several undertakings in the perinatal care arena, including research to assess cesarean section rates and newborn readmission rates across California hospitals.employer coalition, purchaser, quality measurement, quality improvement, report cards, perinatal quality of care.

California↗
PubMedDate not supplied

Consumer-directed health insurance: the next generation. Interview by James C Robinson.

Aetna has led the transition of the commercial health insurance industry from a focus on managed care to a focus on "consumer-driven" products that offer more information while demanding higher cost sharing from enrollees. But most health care costs are incurred by very sick patients who have spent beyond their cost-sharing limits and are not directly affected by these financial incentives. Aetna CEO Jack Rowe discusses his firm's initiatives to moderate the cost of care for ill as well as healthy patients, including providing information on provider prices, contracting for narrow physician specialty networks, and promoting disease management and case management programs.

Community Participation↗
PubMed1998

Social patterning of ill health in Helsinki and Moscow: results from a comparative survey in 1991.

Social inequalities in health are widely documented in the western countries including Finland, but research on Russia has so far been scarce. This article compares self-reported ill health of men and women and its social patterning in Helsinki and Moscow on the basis of a survey. The data (Helsinki N = 824, Moscow N = 545) were collected by mailed questionnaires in 1991. The Muscovites fared more poorly on perceived and psychological health, but the differences in self-reported morbidity (prevalence of chronic illnesses) between the cities were quite small. The sex differentials were greater in Moscow and Muscovite women had the poorest health of all. Education, family income and occupation had the most consistent associations with perceived health and morbidity among Helsinki women and the weakest among Muscovite women. With few exceptions, men of both cities fell between these groups. The differences in health between the cities were smaller in groups with low education. Thus, the role of education as a protective resource was more pronounced in Helsinki, and more notably among women. The possibility of a different impact of social stratification on health in a transitional socialist society compared to a western market economy is discussed.

Adult↗
PubMed1995

Influence of age, gender, hormonal status and smoking habits on colonic transit time.

The factors that influence colonic transit time in healthy humans are not yet clearly defined. The aim of this study was therefore to determine (a) if there are differences in colonic transit time between men and women and (b) if age, female hormonal status or smoking habits are associated with alterations in these parameters. Colonic transit time was measured in 164 asymptomatic subjects (80 males, 84 females) by a radio-opaque marker technique with one single plain abdominal X-ray. Colonic transit time was significantly shorter in men than in women (30 +/- 2 vs. 42 +/- 3 h, P < 0.05). Colonic transit time in non-smoking males was significantly shorter compared with smoking males (26 +/- 2 vs. 40 +/- 5 h, P < 0.05). In females only height and menstrual cycle influenced colonic transit times. We conclude that gender and smoking habits should be considered when studying colonic transit time in health and disease.

Adolescent↗
PubMed1991

Cross-sectional differences in health status in US racial/ethnic minority groups: potential influence of temporal changes, disease, and life-style transitions.

Racial or ethnic comparisons reveal marked health differentials within the US population. However, attempts to interpret these differentials are fraught with both conceptual and methodological pitfalls and are politically charged. The interpretational issues vary according to whether minority groups have disproportionately higher or lower risk compared to whites and according to whether differences can be readily explained by adjusting for recognized risk factors. Particularly when existing models are not sufficient to explain racial or ethnic differences, or lack of differences where they might have been expected on the basis of risk factor profiles, attention to changes in risk factors and disease patterns over time may be an important aspect of the analysis. "Life-style" diseases emerge and increase over time with social change. Thus, a population in an early or middle stage of urbanization or modernization can be expected to have a different epidemiologic profile from another population for which these processes are well established. Judging from the available time-trend data, US minority groups are at varying stages of chronic disease emergence. Attention to temporal changes will be critical if the increased emphasis on analyses involving race or ethnicity is to serve, rather than inhibit, the public policy and scientific objectives of these comparisons.

Cause of Death↗
PubMed1997

[Competence and work identity--an evaluation of Norwegian continuing education in psychiatric nursing].

Mental health services are in transition. The question is to what extent professional training programmes within the health and social sectors have taken into consideration claims and expectations on professionals following this organizational transition. The purpose of this descriptive study was, by means of a semi-structured questionnaire, to evaluate Norwegian postgraduate programmes of psychiatric nursing with respect to what extent they had met the psychiatric nurses' need for competence in their clinical work. Only few evaluations of this type are reported from Scandinavia, and, consequently, it is important to conduct such studies to elucidate strengths and weaknesses in existing programmes. In all 154 psychiatric nurses participated (response rate 48%). The study revealed that psychiatric nurses perceived their training as significant to their practice--and that their professional identity and competence had been strengthened. This was connected to the possibility of studying their own professional field in depth--and to clarify their field of responsibility. Thus, the respondents regarded an alteration of the postgraduate programme in an interdisciplinary direction as unfortunate. Such an alteration might contribute to a weakening of their specific competence and professional perspective. The respondents held that productive interdisciplinary co-operation presupposes a multi-disciplinary approach. The postgraduate programmes seem definitely to qualify psychiatric nurses for working in psychiatric institutions, but their training is also relevant for working in the community health services.

Adult↗
PubMed1998

Childhood vs. adolescence transitional object attachment, and its relation to mental health and parental bonding.

871 participants, 375 boys and 496 girls, mean age 16.7 + 1, were administered the Parental Bonding Instrument (P.B.I.), the Brief Symptom Inventory (B.S.I.), the General Well-Being Questionnaire (G.W.B.) and the Chestnut Lodge Transitional Object Scale. Results supported Winnicott's theory: participants reporting attachment to a Transitional Object (T.O.) in their childhood reported significantly more optimal maternal bonding than participants who were not attached to a T.O. Participants reporting attachment to a T.O. in adolescence had significantly more psychiatric symptoms and less general well-being. Adolescence T.O. attachment might be considered a marker of mental distress in the general, normal population.

Adaptation, Psychological↗
PubMed2001

Health and service utilization patterns among homeless men in transition: exploring the need for on-site, shelter-based nursing care.

Between September 1999 and May 2000, as part of a larger faculty/student teaching project, data describing the demographic, health problem and service utilization patterns of 183 newly sheltered homeless men (mean age = 42) seeking on-site nursing clinic services were collected and analyzed. Upon arrival to the transitional shelter, 46% of the study participants were medically uninsured or received state subsidized health benefits (49%). Almost all (99%) were in recovery from substance addiction. Despite numerous self-reported health problems, 44% had no primary care provider and 35% were seen only sporadically in local hospital clinics or in emergency departments. During the study period, nurse practitioner students and faculty managed most of the residents' episodic illnesses on-site, while assisting them to secure insurance coverage and medical appointments as a prelude to independent living. This was an attempt to curtail residents' previous pattern of waiting until medical problems became serious before seeking treatment. These findings mirrored those in studies of similar populations equating on-site delivery of health care to cost reduction. Unfortunately, many nurse-managed clinics, like our study site, fail to generate data supporting nurses' clinical efficiency and cost effectiveness in caring for homeless individuals. As such, nurses' work remains invisible and underappreciated. This article argues that future studies examining nurses' work and worth in caring for homeless individuals are necessary in determining future health care service planning with this vulnerable population.

Adult↗
PubMed2003

Bosnian immigrants' perceptions of the United States health care system: a qualitative interview study.

During the 1990s, approximately 300,000 Bosnian immigrants came to the United States as a result of the Balkan wars. In contrast to immigrants from less developed countries, Bosnian refugees were typically older, had experienced significant war related trauma, and were accustomed to universal health insurance coverage. There is little information about Bosnian immigrants' transition to the U.S. health care system. As part of a related project, 12 Bosnian immigrants were interviewed about their perceptions of the U.S. health care system and their experiences as patients. Participants were universally critical of the U.S. system and described several core issues: confusion about insurance coverage, personalized quality of care, access to primary and specialty care; and a perception of U.S. health care as bureaucratic. Participants compared their experience with prewar Bosnian health care along these dimensions. Implications of the findings and suggestions for improving care to the Bosnian immigrant population are provided.

Adult↗