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PubMed1976

Medicare in Quebec.

A provincial health insurance system was introduced through Canada more than five years ago. The program and fee schedules for optometric and some ophthalmologic services are presented. Statistics are provided by the government concerning the utilization of optometric and some medical eye services according to the distribution of age and sex in the Quebec population. Relative costs of these services as well as the incomes of health care professionals are compared. It is hoped that this information will aid in the planning and development of the U.S. Medicare program.

Adolescent↗

PubMed1995

[Prevalence of postpartum depression and associated factors in Santiago, Chile].

The aim of this study was to estimate the prevalence and factors associated to postpartum depression (PPD) in a sample of women attending clinics representative of different socioeconomic levels in Santiago. A total of 542 mothers selected from five health centres filled in the Edinburgh Postnatal Depression Scale which was used as the diagnostic criteria, a score of 10 and above being considered diagnostic of depression. Based in our findings, the prevalence of PPD would be 36.7% after adjusting for socioeconomic distribution in Santiago. An inverse relationship was found between socioeconomic status and prevalence of PPD. Mothers with lower incomes had a three-fold increase in prevalence of PPD in comparison to mothers with higher incomes. Single mothers (unmarried, separated and widows) were twice more likely to be cases of PPD.

Adolescent↗

PubMedDate not supplied

Taking stock of America's youth.

Approximately 40 million Americans are between the ages of 14 and 24. This age cohort currently represents about 15 percent of the total U.S. population. Members of this age group are developing their identities and experiencing occasional confrontation between generations. This period of development also includes education, training and job market testing. The direction these youths set out to follow will largely determine their course for much of their adult lives. A good start is therefore essential. Unfortunately, high school dropout rates are still very high and raise concerns about a widening economic gap between high income/low unemployment and low income/high unemployment members of society in an increasingly complex job world. The average income of young workers naturally tends to be low-a fact that belies the economic clout and future potential of this group. Every generation of young adults has left its mark on society as it passes through this stage of life, and the echo boomers--the offspring of the baby boomers--are certain to do just that.

Adolescent↗

PubMedDate not supplied

A portrait of Asians and Pacific Islanders in the United States.

Asians and Pacific Islanders (API) have an increasingly visible presence in the United States. This diverse population--encompassing persons with ancestry from East and Southeast Asia, the Indian subcontinent, and the Pacific islands--has grown at a faster rate than any other major racial or ethnic group. In 1996 Asian Americans numbered approximately 9.7 million (up from 3.8 million in 1980), nearly 4 percent of the U.S. population. The Census Bureau projects that this population group will reach 34.4 million by 2050, representing roughly 9 percent of all Americans. While immigration has fueled much of this growth, Asians' young age structure also will help boost their numbers in the next century. Fifty-six percent of Asian Americans live in three states--California, New York and Hawaii. Asian Americans comprise very small proportions of the populations of most other states. About 77 percent of the 2.8 million API households in 1996 were families, compared with 69 percent of white households. Roughly one in six Asian American households has five or more persons, compared with one in 12 white households. Educationally, Asians tend to be high achievers--42 percent of all API adults have at least a bachelor's degree, compared with 26 percent of while adults. Two-thirds of Asian Americans participated in the civilian labor force in 1996. Among employed Asians, one-third held managerial and professional jobs. Both proportions were roughly the same as for whites. Although the median income for API households was 9 percent higher than for white households in 1995, this difference is largely due to Asian households having more workers contributing to the household income. Despite these apparent measures of success, the poverty rates for Asian American families and individuals are nearly twice as high as those for whites.

Adult↗

PubMed1991

Utilization of dental services by older adults in four Ontario communities.

The elderly tend to use dental services less than most younger age groups. While the elderly's utilization rates may be rising, very low utilization by edentulous people depresses the overall rate for the group. We use data from the Ontario Study of the Oral Health of Older Adults to identify the variations in the use of dental services in the four study sites of Toronto, North York, Simcoe County and Sudbury and District. We reached 3,033 subjects by telephone and conducted dental examinations and a multi-item personal interview with 907 of them. The 907 subjects ranged in age from 50 to 87 years, 57 percent were female and two-thirds were born in Canada. Overall, 60.5 percent had seen a dentist or denturist in the previous year, but this was much lower among the edentulous (17 percent) when compared to the dentate (72 percent) (Chi-square test; p less than .0001). Of the 357 who did not visit a dentist or denturist in the previous year, nearly half (48 percent) felt they had nothing wrong and 20 percent reported they could not afford care. A high proportion (94 percent) of the edentulous reported visiting only for pain or trouble compared to 26 percent of the dentate (Chi-square test; p less than .0001). Using logistic regression, we found dental status (edentulous), community of residence (Sudbury), income (up to $20,000) and dental insurance coverage (none) were important factors in not making a dental visit in the last year. These same factors, plus education (elementary) were important where subjects reported visiting a dentist or denturist only when there was pain or trouble.

Aged↗

PubMed1997

The effects of economic and population growth on national saving and inequality.

This is a progress report on ongoing research into the effects of economic and population growth on national saving rates and inequality. The theoretical basis for the investigation is the life cycle model of saving and inequality. We report evidence that is conditional on the validity of the model, as well as evidence that casts doubt on it. Using time series of cross-sectional household surveys from Taiwan, Thailand, Britain, and the United States, we show that it is possible to force a life cycle interpretation on the data on consumption, income, and saving, but that the evidence is not consistent with large rate-of-growth effects, whereby economic and population growth enhances rates of national saving. The well-established cross-country link between economic growth and saving cannot be attributed to life cycle saving, nor will changes in economic or population growth exert large effects on saving within individual countries. There is evidence in favor of the life cycle model's prediction that within-cohort inequality of consumption and of total income--though not necessarily inequality of earnings--should increase with the age of the cohort. Decreases in the population growth rate redistribute population toward older, more unequal, cohorts, and can increase national inequality. We provide calculations on the magnitude of these effects.

Adult↗

PubMed2006

Differences in health-related socioeconomic characteristics among Pacific populations living in Auckland, New Zealand.

AIM: To describe, compare and contrast the health-related socioeconomic characteristics of the different Pacific ethnic groups surveyed in the Auckland Diabetes, Heart and Health Survey (DHHS). METHODS: The DHHS was carried out in Auckland in 2002-2003. Electoral roll based sampling and cluster sampling strategies were used to recruit a representative sample of Auckland Pacific populations. Participants answered a self-administered questionnaire about their demographic and socioeconomic position. RESULTS: The study surveyed 1011 Pacific people aged between 35-74 years of age. Of the 1011 Pacific participants, 484 were of Samoan, 255 Tongan, 116 Cook Island, 109 Niuean, 26 Fijian, and 21 were of 'Other Pacific' ethnic groups. Samoans were least likely to have no children, and most likely to hold a certificate qualification. Tongans were least likely to be born in New Zealand (NZ) and had the shortest residence time in NZ. Tongans were most likely to be married and had the largest families. Cook Islanders were most likely to be NZ-born and had the highest household income. Niueans were most likely to be in paid employment, to hold a diploma qualification, to own their own homes, and have the smallest families. CONCLUSIONS: In conclusion, a distinct pattern (continuum) emerged from the results. The Cook Island and Niuean ethnic groups generally had a similar and more favourable socioeconomic profile compared to the Samoan and Tongan ethnic groups. These differences are most likely to be related to the length of residence in NZ. As differences existed, each Pacific ethnic group should be investigated separately when there are sufficient numbers.

Adult↗

PubMed1997

The distribution of cataract surgery services in a public health eye care program in Nepal.

The cost-effectiveness of public health cataract programs in low-income countries has been well documented. Equity, another important dimension of program quality which has received less attention is analyzed here by comparisons of surgical coverage rates for major sub-groups within the intended beneficiary population of the Nepal blindness program (NBP). Substantial differences in surgical coverage were found between males and females and between different age groups of the same gender. Among the cataract blind, the surgical coverage of males was 70% higher than that of females. For both genders, the cataract blind over 55 received proportionately fewer services than younger people blind from cataract. Blind males aged 45-54 had a 500% higher rate of surgical coverage than blind males over 65. Blind females aged 35-44 had nearly a 600% higher rate of surgical coverage than blind females over 65. There was wide variation in overall surgical coverage between geographic zones, but little variation by terrain type, an indicator of the logistical difficulties in delivery of services. Members of the two highest caste groupings had somewhat lower surgical coverage than members of lower castes. Program managers should consider developing methods to increase services to women and to those over 65. Reaching these populations will become increasingly important as those most readily served receive surgery and members of the under-served groups form a growing portion of the remaining cataract backlog.

Adult↗

PubMed2004

The potential protective effect of youth assets on adolescent alcohol and drug use.

OBJECTIVES: We examined the association between adolescent alcohol and drug use and 9 youth assets in a low-income, inner-city population. METHODS: An in-person survey of 1350 adolescents and parents assessed youth assets and risk behaviors. We analyzed data with chi(2) tests and logistic regression analyses. RESULTS: When we controlled for appropriate variables, there were significant positive relationships between several youth assets and nonuse of alcohol and drugs. Furthermore, youths who possessed all of the statistically significant youth assets were 4.44 times more likely to report nonuse of alcohol and 5.41 times more likely to report nonuse of drugs compared with youths who possessed fewer youth assets. CONCLUSIONS: Our study supports the view that specific youth assets may protect youths from alcohol and drug use.

Adolescent↗

PubMed2006

Financing mental health services in low- and middle-income countries.

Mental disorders account for a significant and growing proportion of the global burden of disease and yet remain a low priority for public financing in health systems globally. In many low-income countries, formal mental health services are paid for directly by patients out-of-pocket and in middle-income countries undergoing transition there has been a decline in coverage. The paper explores the impact of health care financing arrangements on the efficient and equitable utilization of mental health services. Through a review of the literature and a number of country case studies, the paper examines the impact of financing mental health services from out-of-pocket payments, private health insurance, social health insurance and taxation. The implications for the development of financing systems in low- and middle-income countries are discussed. International evidence suggests that charging patients for mental health services results in levels of use which are below socially efficient levels as the benefits of the services are distributed according to ability to pay, resulting in inequitable access to care. Private health insurance poses three main problems for mental health service users: exclusion of mental health benefits, limited access to those without employment and refusal to insure pre-existing conditions. Social health insurance may offer protection to those with mental health problems. However, in many low- and middle-income countries, eligibility is based on contributions and limited to those in formal employment (therefore excluding many with mental health problems). Tax-funded systems provide universal coverage in theory. However, the quality and distribution of publicly financed health care services makes access difficult in practice, particularly for rural poor communities.

Developing Countries↗

PubMed1997

Increasing car seat use for toddlers from inner-city families.

OBJECTIVES: The purpose of this project was to increase toddler car seat use in low-income minority families. METHODS: Families from Newark, NJ, were divided into two study groups. Both groups were given car seats; one group also received education regarding car restraint use. Observations were made of car seat use before car seat distribution, immediately after distribution, 4 to 5 months later, and 1 year later. RESULTS: Car seat use increased markedly immediately after distribution and remained high 1 year later, regardless of education. CONCLUSIONS: These results indicate that distributing car seats results in long-term use among a currently low-use population.

Child, Preschool↗

PubMed1978

The diencephalic course of regenerating retinotectal fibres in Xenopus tadpoles.

The normal retinotectal path in the diencephalon of Xenopus tadpoles is widely distributed in the form of a wedge of fibres extending from the central grey to the outer margin of the diencephalon. Regenerating optic nerve fibres were shown, by silver-staining and proline autoradiography, to follow an abnormal path up the extreme lateral edge of the diencephalon. Study of tadpoles at various stages of development, and of optic nerves allowed to regenerate for various periods, indicates that all new incoming optic fibres pass up the lateral edge of the diencephalon. The inner/outer order of the fibres in the normal diencephalon thus reflects the radial distribution of the retinal cells of origin.

Animals↗

PubMed1999

The effects of economic reform on health insurance and the financial burden for urban workers in China.

Since 1980, Chinese enterprises have been undergoing reforms in employment practice, taxation, and workers' health/welfare benefits coverage. In particular, Chinese businesses have been facing a major challenge with respect to the financial burden of providing medical benefits to their workers. The purpose of this paper is to analyse the impact of enterprise reform on workers' health care benefits and their financial burden due to medical expenses. This study is based on a 1992 survey conducted in 22 cities, and included 406 enterprises and 5920 workers. It was found that there were wide variations of coverage for health care benefits among urban Chinese workers. It was also found that workers with partial coverage were as likely to incur out-of-pocket medical expenditures as workers without coverage. These out-of-pocket medical expenditures could reach as high as 25% of a worker's annual income. Policy recommendations are discussed at the end of the paper.

Adult↗

PubMed1961

Dangerous and Hypnotic Drug Act.

It is unprofessional conduct within the meaning of the Medical Practice Act to prescribe a dangerous drug without either a medical examination by a physician or other medical indications. Dangerous and hypnotic drugs are specifically defined by both state and federal law and distribution is strictly regulated.A physician may administer to his own patients such amounts of dangerous drugs as are necessary for the immediate needs of the patient. The physician may obtain such needed amounts of these drugs by an order placed with a pharmacist marked "for administration to immediate needs of patients." A licensed physician may also prescribe dangerous and hypnotic drugs for patients and such prescriptions may be refilled on the specific authorization of the physician.A physician who dispenses dangerous and hypnotic drugs to patients must obtain a hypnotic drug license; he must use specific purchase orders when purchasing; the drugs must be labeled in the manner provided by law; and all records of sale shall be open to inspection by authorized officers of the law and kept for three years. By the Principles of Medical Ethics physicians are bound to limit the source of their professional income to medical services actually rendered. Recent decisions of the Judicial Council answer questions concerning a physician's interest in a corporation which purchases, packages and sells medicines under a corporate name. Also answered are questions as to the measures that exist to prevent physicians from abusing the privilege of owning a pharmacy, and whether a physician can ethically rent space in a building owned by him to a pharmacist with a percentage of the income of the pharmacy as rental. The public welfare of California and the nation as determined by legislation strictly regulates the distribution of dangerous drugs. It is in the best interest of the medical profession and its patients that these laws be understood and carefully observed.

California↗

PubMed1993

Spells without health insurance: the distribution of durations when left-censored spells are included.

In a previous paper (1990), we estimated the distribution of durations of uninsured spells for which the beginning could be observed. We raised the concern that uninsured spells that were in progress when the Survey of Income and Program Participation began might not be proportionally represented in a sample of uninsured spells restricted to spells with observed beginnings. This paper includes spells in progress when SIPP began. Including left-censored spells, and correcting for length bias inherent in such spells, does not fundamentally change our previous estimate of the distribution.

Humans↗

PubMed1991

[Dental caries: age, income level and dental care].

We have studied a population of 527 school children between 6 and 17 years old, having as main characteristic to have free odontological care. The prevalence of caries found was 40.4%. The age appears as a risk factor. However, we have not found any influence in the social status. The odontological care is considered essential in the decrease of prevalence of dental caries.

Adolescent↗

PubMed2004

[The development of obesity in Germany in the period from 1985 until 2000].

Due to the great increase in the prevalence of obesity in the industrialised countries during the last two decades we examined the development of this prevalence in Germany between 1985 and 2002. Data sources are four national health surveys conducted between 1985 and 1998 and three surveys of the "Bertelsmann Health Monitor" in 2002 and 2003. Included in these representative cross-sectional surveys were all persons aged 25-69 years. The total number of study participants was 12 984 males and 13 630 females. Based on recommendations of the WHO, moderate obesity is defined as body-mass-index > or = 30 and pronounced obesity as body-mass-index > or = 35. From 1985 to 2002, there was an increase in the prevalence of moderate obesity in males from 16.2 to 22.5 % and in females from 16.2 % to 23.5 %, whereas the increase in the prevalence of pronounced obesity in males was from 1.5 to 5.2 % and in females from 4.5 to 7.5 %. The most important social characteristics related to pronounced obesity prevalences are low educational status, low occupational status and low household income. Thus, the quality of future preventive measures aiming at reducing obesity prevalence among the general population should be evaluated inter alia in respect of their ability to cope with the social origins of obesity.

Adult↗

PubMed2005

Safety-net dental clinics.

BACKGROUND: Federal policy supports and funds community-based clinics to provide health care to low-income and underserved groups. This study examines the role of community dental safety-net clinics in providing dental care for these populations. METHODS: The authors administered a cross-sectional survey of all identified safety-net dental clinics in Illinois. Seventy-one of 94 clinics responded (response rate, 76 percent), describing their history, operations, patients, staffing and dentist relationships. An in-depth analysis of 57 clinics presents comparisons of three categories of clinics, sponsored by community health centers (23), local health departments (21) and private services agencies (13). RESULTS: Clinics were distributed across the state; 80 percent were located in facilities with other health care providers, and all provided dental care to low-income and other underserved groups. Clinics provided more than 3100 annual dental visits, operated with limited staffing and budgets, and had referral relationships with local dentists. Clinics with full-time dentists or any dental hygienists had higher annual numbers of dental visits. CONCLUSIONS: These clinics provide dental care to groups with traditional access barriers. Although they represent a small portion of all dental care, their mission and role make them a key component of strategies to address the dental access problem. PRACTICE IMPLICATIONS: Local and state dental practitioners and coalitions seeking to expand dental access should consider their community dental safety-net clinics as partners. Efforts to expand theese clinics should include considering optimizing staffing for better dental productivity.

Budgets↗