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PubMedDate not supplied

Sterility in zambia.

BACKGROUND: Several regions such as Zambia in sub-Saharan Africa experience very high levels of sterility. Current explanations for high levels of sterility in Zambia have focused on biological determinants and have paid little attention to the plausible effects of social determinants of sterility. AIM: This study has two objectives. The first objective is to examine the extent of sterility in Zambia during 1980 and 1990. The second objective is to assess the contribution of selected social determinants to the current levels of sterility in Zambia. SUBJECTS AND METHODS: Sterility among women in Zambia is calculated for two periods in 1980 and 1990 using census data. The study used parity progression ratios for the calculation of sterility rates. Selected social determinants of Zambian sterility were obtained from the Demographic Health Survey (ZDHS). Net effects of selected social determinants were examined using logistic regression. RESULTS: High sterility levels were found in a few Zambian Provinces. During 1980 and 1990, the rates for North Western, Eastern and Western provinces remained considerably higher than for other Zambian provinces. It was found that social level variables remained strong and significant even after controlling for the effects of incidence of biological factors such as sexually transmitted diseases (STDs). CONCLUSIONS: The findings of the study support the importance of developing social policies for eradicating sterility. The argument that sterility is biological and that it is not amenable to social interventions perhaps needs revision in the light of the findings of this study.

Adolescent↗
PubMed2003

Unusually strong association between education and mortality in young adults in a community with a high rate of injection-drug users.

BACKGROUND: To examine the association between education and mortality for various causes of death in young adults in a community with a high rate of injection-drug users. METHODS: Linked mortality study based on mortality records for 1996 and 1997 and on 1996 population census data from the Region of Madrid (Spain). The association between educational level and mortality was estimated by the mortality rate ratio. RESULTS: After adjustment for age and other socioeconomic variables the mortality rate in men and women aged 25-44 years with no education was, respectively, 4.7 and 3.7 times higher than in men and women with the highest educational level. The causes of death with the strongest association were chronic liver disease and cirrhosis, AIDS and diseases of the heart in both sexes and suicide in men. For these causes of death the mortality rate ratio between persons with the lowest and highest educational level ranged from 6.8 to 21.8 in men and from 4.1 to 16.9 in women. CONCLUSIONS: These causes of death are the leading specific causes of death in persons aged 25-44 years. Given that probably a substantial part of deaths from diseases of the heart in this age category are drug-related, the common denominator of the excess mortality related poor education seems to be drug injection.

Adult↗
PubMed1996

Selection of key community descriptors for community-orientated primary care.

BACKGROUND: Community-oriented primary care (COPC) requires the development of practical tools if it is to be carried out. A previous study demonstrated a practical approach to carrying out one portion of a community assessment for COPC using a few representative health indicators. OBJECTIVE: To determine the validity of this process elsewhere, we tested whether these findings were generalizable to other settings and to the same setting a decade later. METHOD: In a cross-sectional study design, data on 18 health indicators were collected for census tracts in two target areas and for the entire state of Ohio, USA, for 1990. A factor analysis was performed to identify factors underlying the health indicators in the three areas examined. RESULTS: Two underlying factors, termed age and poverty, were present in all locations and over time. Each factor was defined by core indicators and a cluster of associated indicators. CONCLUSIONS: These results suggest that one part of a COPC community assessment can be done by selecting very few indicators. The distribution of indicators of age and income explains the variability of most of the health related indicators studied. These factors are stable over time and location. A community assessment should include indicators which, at a minimum, provide information on these two factors.

Adolescent↗
PubMed2002

Geographic inequalities in the availability of government-subsidized rental housing for low-income older persons in Florida.

PURPOSE: This article investigates the extent to which government-subsidized affordable rental units available to low-income older persons are unequally and unfairly distributed throughout Florida's counties. DESIGN AND METHODS: Primary data sources from the U.S. Department of Housing and Urban Development and the U.S. Census were analyzed using two location inequality statistical measures: quintile analysis and the Dissimilarity Index. Three comparison standards measuring the county locations of the community-wide low-income elderly and nonelderly populations were used to judge whether these patterns are geographically unfair. RESULTS: Compared with the overall locations of Florida's low-income older population, elder-occupied government-subsidized rental housing units are concentrated in fewer counties. On the basis of several standards, these affordable housing units are judged to be unfairly located, resulting in most of the state's low-income elderly population living in counties that are underserved by these accommodations. IMPLICATIONS: The findings offer other states and local areas guideposts to assess and compare the extent of geographic inequality and unfairness in the availability of their affordable senior housing opportunities. Why these inequalities exist and their implications for older persons are researchable questions.

Demography↗
PubMed1994

HIV-1 infection among women of reproductive age in a rural district in Malawi.

OBJECTIVES: To determine HIV-1 seroprevalence in pregnant women attending antenatal clinics in a rural district in Malawi, and to estimate the rate of HIV-1 infection in the district among women of reproductive age. DESIGN AND SETTING: Cross-sectional survey conducted from 1987 to 1990 of women enrolled at antenatal clinics at four sites (two towns and two villages). METHODS: Questionnaires were administered and sera screened at delivery. Population infection estimates were based on national census and survey data. RESULTS: Of 3953 pregnant women tested, 283 (7.2%) were HIV-1-seropositive. Women enrolled at town sites were significantly more likely to be HIV-1-infected than village women (11.3 versus 3.9%; P < 0.001). Higher infection rates were associated with age 20-29 years, first or second pregnancy, increased education or socioeconomic status, and living within 8 km of the clinic. It was estimated that over 7300 women of reproductive age were HIV-1-infected in this rural district. CONCLUSIONS: Seroprevalence rates in pregnant women in rural towns were intermediate between rates in villages and previously documented rates in cities in Malawi. Although village sites had lower seroprevalence rates, they accounted for over half the estimated HIV-1 infection in childbearing women in this district.

Adolescent↗
PubMed2004

Illegal alcohol sales to obviously intoxicated patrons at licensed establishments.

BACKGROUND: Early studies assessing propensity of alcohol sales to underage youth found that, before intervention, likelihood of licensed alcohol establishments selling alcohol to underage youth was 50% or higher across many communities. Community-wide interventions successfully lowered underage alcohol sales rates in several communities. Across studies assessing propensity for alcohol sales to obviously intoxicated patrons, sales rate estimates ranged from 58% to 85% for on-premise establishments (e.g., bars). No previous studies have assessed likelihood of alcohol sales to obviously intoxicated patrons in off-premise establishments (e.g., liquor stores). One goal of this study was to assess propensity for illegal alcohol sales to obviously intoxicated patrons at on- and off-premise establishments. Another goal was to assess whether server and/or establishment characteristics were related to the likelihood of illegal sales. Results may inform future interventions to reduce illegal alcohol sales at licensed alcohol establishments. METHODS: Trained actors attempted to purchase alcohol while acting out signs of obvious intoxication at a census of on- and off-premise alcohol establishments (n = 372) in 11 communities. The outcome variable was whether an establishment sold alcohol to a buyer. Independent variables included age and gender of server/clerk, type of establishment, area, exterior maintenance, type of license, and time of purchase attempt. Bivariate and multivariate analyses were conducted. RESULTS: Seventy-nine percent of the establishments sold alcohol to a buyer (83% and 76% at off- and on-premise establishments, respectively). Servers/clerks who appeared younger than age 31 and off-premise establishments were significantly more likely than older appearing servers and on-premise establishments to sell alcohol to buyers. CONCLUSIONS: The likelihood of alcohol sales to obviously intoxicated patrons in licensed alcohol establishments is very high. Interventions to reduce illegal alcohol sales to intoxicated patrons are needed.

Adult↗
PubMed2005

Diabetes and hypertension in pregnancy in a rural community of Bangladesh: a population-based study.

AIMS: Gestational diabetes mellitus (GDM) is associated with increased infant mortality. Diabetes and infant mortality is higher in Bangladesh but the prevalence of diabetes and hypertension in pregnancy is not known. Thus, this study addressed the prevalence of diabetes and hypertension in pregnancy. METHODS: We selected 10 villages randomly in a union council of Nandail subdistrict. Following a population census (n = 14 382: male/female = 7476/6906) on demography and marital status, we interviewed 2205 married women (18-44 years) for detection of pregnancy. Of a total of 172 pregnancies, we investigated 147 with a gestational age of 24-28 weeks for obstetrical history, clinical examination and blood pressure (BP). Fasting (FBG) and 2-h blood glucose (2hBG) were assessed by Hemocue cuvette. WHO diagnostic criteria were used. RESULTS: The overall prevalence (95% CI) of diabetes was 6.8% (1.88-9.32) and 8.2% (3.74-12.64) according to FBG and 2hBG, respectively. The crude prevalence of systolic and diastolic hypertension was 6.8 and 5.4%, respectively. The median (interquartile range) values for age, BMI and FBG of the participants were 25.0 (21.0-30.0) years, 19.5 (18.2-21.2) and 3.9 (3.6-4.3), respectively. The history of abortion, neonatal death and stillbirth was found in 19.9, 11.4 and 9.6%, respectively. The prevalence of GDM was higher among those with the history of stillbirth (15.4 vs. 6.0%) and neonatal death (11.8 vs. 6.2%) than those without. CONCLUSION: The prevalence of GDM in rural Bangladesh is comparable with any other population with higher prevalence of GDM. Increased morbidity and mortality among mothers and newborns in Bangladesh may, in part, be because of increased prevalence of GDM.

Adolescent↗
PubMed2004

Impacts of informal caregiver availability on long-term care expenditures in OECD countries.

OBJECTIVE: To quantify the effects of informal caregiver availability and public funding on formal long-term care (LTC) expenditures in developed countries. DATA SOURCE/STUDY SETTING: Secondary data were acquired for 15 Organization for Economic Cooperation and Development (OECD) countries from 1970 to 2000. STUDY DESIGN: Secondary data analysis, applying fixed- and random-effects models to time-series cross-sectional data. Outcome variables are inpatient or home heath LTC expenditures. Key explanatory variables are measures of the availability of informal caregivers, generosity in public funding for formal LTC, and the proportion of the elderly population in the total population. DATA COLLECTION/EXTRACTION METHOD: Aggregated macro data were obtained from OECD Health Data, United Nations Demographic Yearbooks, and U.S. Census Bureau International Data Base. PRINCIPAL FINDINGS: Most of the 15 OECD countries experienced growth in LTC expenditures over the study period. The availability of a spouse caregiver, measured by male-to-female ratio among the elderly, is associated with a $28,840 (1995 U.S. dollars) annual reduction in formal LTC expenditure per additional elderly male. Availability of an adult child caregiver, measured by female labor force participation and full-time/part-time status shift, is associated with a reduction of $310 to $3,830 in LTC expenditures. These impacts on LTC expenditure vary across countries and across time within a country. CONCLUSIONS: The availability of an informal caregiver, particularly a spouse caregiver, is among the most important factors explaining variation in LTC expenditure growth. Long-term care policies should take into account behavioral responses: decreased public funding in LTC may lead working women to leave the labor force to provide more informal care.

Adult↗
PubMed1998

Small area study of mortality among people living near multiple sources of air pollution.

OBJECTIVE: In the area of Malagrotta, a suburb of Rome (Italy), a large waste disposal site, a waste incinerator plant, and an oil refinery plant became operational in the early 1960s and have represented three major sources of air pollution. To evaluate the potential health risk due to airborne contamination around these point sources, a small area analysis of mortality was conducted. Cancer of the liver, larynx, lung, kidney, lymphatic, and haematopoietic systems were evaluated. METHODS: Sex and age specific mortality (1987-93) and population denominators (1991) were available for the census tracts of the metropolitan area of Rome. Standardised mortality ratios (SMRs) were computed separately for males and females in bands of increasing distance from the plants, up to a radius of 10 km. Stone's test for the decline in risk with distance was performed with increments in radius of 1 km; SMRs were also computed after adjusting for a four level index of socioeconomic status. RESULTS: No overall excess or decline in risk with distance was found for liver, lung, and lymphohaematopoietic cancers in either sex. For laryngeal cancer, an increased but not significant risk was found at 0-3 km and at 3-8 km. A significant decline with distance in mortality from laryngeal cancer was found among men (p = 0.03); the trend remained after adjusting for the socioeconomic index (p = 0.06). CONCLUSIONS: The study showed no association between proximity to the industrial sites and mortality for most of the several conditions considered. However, mortality from laryngeal cancer declined with distance from the sources of pollution. This result is interesting, as previous findings of an increased risk of laryngeal cancer near incinerators have been controversial.

Air Pollution↗
PubMed2003

Who are the high hospital users? A Canadian case study.

OBJECTIVES: Researchers have taken two different approaches to understanding high use of hospital services, one focusing on the large proportion of services used by a small minority and a second focusing on the poor health status and high hospital use of the poor. This work attempts to bridge these two widely researched approaches to understanding health care use. METHODS: Administrative data from Winnipeg, Manitoba covering all hospitalizations in 1995 were combined with public use Census measures of socio-economic status (neighbourhood household income). High users were defined as the 1% of the population who spent the most days in hospital in 1995 (n = 6487 hospital users out of population of 648715 including non-users). RESULTS: One per cent of the Winnipeg population consumed 69% of the hospital days in 1995. Thirty-one per cent of the highest users were among the 20% of residents of neighbourhoods with the lowest household incomes, and 10% of the highest users were among the 20% from neighbourhoods with the highest household incomes. However, on most other dimensions, including gender, age, average days in hospital, average admissions, percentage who died in hospital and diagnostic reasons for being hospitalized, the similarities between high users, regardless of their socio-economic group, were striking. CONCLUSIONS: The lower the socio-economic status, the more likely an individual is to make high demands on hospitals. However, patterns of use as well as the diseases and accidents that produce high use among residents of low income neighbourhoods are not much different from those that produce high use among residents of high income neighbourhoods.

Adolescent↗
PubMed2006

Relationship between resident workload and self-perceived learning on inpatient medicine wards: a longitudinal study.

BACKGROUND: Despite recent residency workload and hour limitations, little research on the relationship between workload and learning has been done. We sought to define residents' perceptions of the optimal patient workload for learning, and to determine how certain variables contribute to those perceptions. Our hypothesis was that the relationship between perceived workload and learning has a maximum point (forming a parabolic curve): that either too many or too few patients results in sub-optimal learning. METHODS: Residents on inpatient services at two academic teaching hospitals reported their team and individual patient censuses, and rated their perception of their learning; the patient acuity; case variety; and how challenged they felt. To estimate maximum learning scores, linear regression models with quadratic terms were fit on learning score. RESULTS: Resident self-perceived learning correlated with higher acuity and greater heterogeneity of case variety. The equation of census versus learning score, adjusted for perception of acuity and case mix scores, showed a parabolic curve in some cases but not in others. CONCLUSION: These data suggest that perceived resident workload is complex, and impacted by additional variables including patient acuity and heterogeneity of case variety. Parabolic curves exist for interns with regard to overall census and for senior residents with regard to new admissions on long call days.

Acute Disease↗
PubMed1997

The Hampstead Schizophrenia Survey 1991. II: Incidence and migration in inner London.

BACKGROUND: The previous paper reports a high prevalence of schizophrenia (broad definition) in an inner London area. In this paper we test hypotheses for this finding and examine the characteristics of people with schizophrenia who move frequently. METHOD: People with schizophrenia in the Hampstead area were identified by key informant methodology, at two censuses five years apart. This allowed identification of incident cases during these five years and identification of people who had moved into and out of the area. RESULTS: The incidence of DSM-III-R schizophrenia in Hampstead between 1986 and 1991 was at least 0.21 per 1000 of the population aged 15 to 54. There was a significant movement of people with schizophrenia to this inner London area from outer London between 1986 and 1991. People with schizophrenia who were relatively mobile were significantly more likely to be male, to suffer with prominent hallucinations, and to have no contact with a GP. CONCLUSIONS: The high prevalence of broad schizophrenia in this inner London area is, in part, due to geographical drift. A significant excess of the people with schizophrenia who move frequently are men with positive symptoms.

Adolescent↗
PubMed2005

Design of a questionnaire to measure trust in an emergency department.

OBJECTIVE: To develop a valid and reliable questionnaire for measuring patient trust in an emergency department (ED) that can be administered by phone, direct interview, or mail. METHODS: This was a survey conducted at a Level 1 urban trauma center with an annual census of 52,000 visits. Literature review, focus group discussions, and direct patient interviews identified potential items for pilot surveys. Fifteen ED nurses, residents, and faculty scored the items on a 1-10 scale, rephrasing or removing ambiguous items to ensure face and content validity. A telephone survey with responses recorded on a five-point Likert scale was conducted. Reliability and internal consistency of items were tested using SPSS software. Factor analyses were performed using principal components analysis and Varimax rotation with Eigen values set at 1.0. RESULTS: A total of 383 patients seen in the ED were surveyed. Using two pilot surveys, 18 of 42 potential items were extracted among five factors identified as important to the development of trust. Internal consistency for the final 18 items was calculated, and a Cronbach's alpha of 0.88 was obtained for all items. Test-retest reliability was calculated by telephoning 38 patients twice, two weeks apart, and correlation coefficients of >0.748 were obtained for all items. CONCLUSIONS: This questionnaire can be used for telephone or direct interview to survey patients' trust in EDs.

Factor Analysis, Statistical↗
PubMed1999

Mortality differentials among Israeli men.

OBJECTIVES: This study examined differentials in mortality among adult Israeli men with respect to ethnic origin, marital status, and several measures of social status. METHODS: Data were based on a linkage of records from a 20% sample of the 1983 census to records of deaths occurring before the end of 1992. The study population included 72,527 men, and the number of deaths was 17,378. RESULTS: Differentials is mortality by origin show that mortality was higher among individuals of North African origin than among those of Asian and European origin. After allowance for several socioeconomic indicators, the excess mortality among North African Jews was eliminated. Substantial and consistent differences in mortality were found according to education, occupation, income, possession of a car, housing, and household amenities. Differentials among the elderly were markedly narrower than those among men younger than 70 years. CONCLUSIONS: Some sectors of Israeli society have higher risks of death than others, including, among the male population, these who are poor, less educated, unmarried, unskilled, out of the labor force, and of North African origin.

Adult↗
PubMed2002

No care for the caregivers: declining health insurance coverage for health care personnel and their children, 1988-1998.

OBJECTIVES: This study examined trends in health insurance coverage for health care workers and their children between 1988 and 1998. METHODS: We analyzed data from the annual March supplements of the Current Population Survey (CPS), a Census Bureau survey that collects information about health insurance from a nationally representative sample of noninstitutionalized US residents. RESULTS: Of the health care personnel younger than 65 years, 1.36 million (90% confidence interval [CI] = 1.28 million, 1.45 million) were uninsured in 1998, up 83.4% from 1988; the proportion uninsured rose from 8.4% (90% CI = 7.8%, 9.1%) to 12.2% (90% CI = 11.5%, 12.9%). Declining coverage rates in the growing private-sector health care workforce---and declining health employment in the public sector, which provided health insurance benefits to more of its workers---accounted for the increases. Households with a health care worker included 1.12 million (90% CI = 1.05 million, 1.20 million) uninsured children, accounting for 10.1% (90% CI = 9.5%, 10.8%) of all uninsured children in the United States. CONCLUSIONS: Health care personnel are losing health insurance coverage more rapidly than are other workers. Increasingly, the health care sector is consigning its own workers and their children to the ranks of the uninsured.

Adolescent↗
PubMed1998

Infectious diseases and anemia in a sample of out-of-treatment drug users.

OBJECTIVE: To understand how the prevalence of anemia, human immunodeficiency virus (HIV), and syphilis in a sample of out-of-treatment drug users affected delivery of care in a managed care model. STUDY DESIGN: A snowball sampling design with multiple zero order contacts was used in targeted census tracts with a high incidence of illicit drug use and sexually transmitted diseases. PATIENTS AND METHODS: Out-of-treatment drug users were recruited as part of a national multisite study of HIV risk behaviors in this population. Subjects were recruited using targeted community-based sampling. RESULTS: The rate of individuals who tested positive for both syphilis and HIV was 2.5 times greater than those who tested positive for syphilis only and 2.8 times greater than those who tested positive for HIV only. Of the men, 16.1% were anemic, and 33.3% of women were anemic. Rates of HIV (10.7%) and syphilis (19.8%) were found to be high among both male and female drug users. These statistics, coupled with the prevalence of anemia, indicate that drug users have many more problems other than drug use, a conclusion which can have an impact on how managed care plans approach drug users. CONCLUSION: A multipronged interdisciplinary approach may be warranted for both the patient and the managed care organization.

Adult↗
PubMed2000

Injury to Maori. II: Serious injury.

AIMS: To determine the significance of serious injury in Maori relative to other health problems, to describe the leading causes, and to determine age specific rates for major classes of injury. METHOD: We used New Zealand Health Information Services' public hospital inpatient data files. The New Zealand Census classification of 'Sole-Maori' was used to determine injury mortality rates. RESULTS: On average, one in every eight admissions in Maori, was for injury. Injury was the leading reason for admission for those 5-44 years old. Unintentional injury accounted for 85% of injuries, with those ages 1-14 and 15-24 years having the highest numbers and rates. Falls, followed closely by motor vehicle traffic crashes, were the leading causes, accounting for 23% and 20% respectively. CONCLUSIONS: In order to address the priorities identified here, appropriate partnerships between crown agencies and social agencies, both Iwi and/or community based, must be established.

Accidental Falls↗
PubMed2002

Infant mortality at time of birth and cause-specific adult mortality among residents of the Region of Madrid born elsewhere in Spain.

BACKGROUND: To investigate the association between infant mortality at time of birth and mortality from various causes of death in adulthood in men and women. METHODS: Linked mortality study based on mortality records for 1996 and 1997 and on 1996 population census data of the Region of Madrid (Spain). Deaths from five cancer sites and from five chronic diseases were estimated for 1 224 894 people aged 35-74 years residing in the Region of Madrid who were born elsewhere in Spain. RESULTS: A gradient in mortality by infant mortality quartile was seen for mortality from stomach cancer, colon cancer, diabetes mellitus and chronic liver disease in men, and for stomach cancer, ischaemic heart disease and chronic liver disease in women. The association was positive for stomach cancer and negative for all other causes. The relative mortality rates adjusted for age and adult socioeconomic factors for men belonging to infant mortality quartiles 3 and 4 (highest) versus those belonging to quartiles 1 and 2 as baseline were 1.06 (95% CI : 0.75-1.56) for stomach cancer, 0.67 (95% CI : 0.47-0.95) for colon cancer, 0.59 (95% CI : 0.35- 1.00) for diabetes mellitus, and 0.70 (95% CI : 0.49-0.99) for chronic heart disease. The relative mortality rates for women were 2.06 (95% CI : 1.09-3.88) for stomach cancer, 0.58 (95% CI : 0.41-0.80) for ischaemic heart disease, and 0.44 (95% CI : 0.27-0.70) for chronic liver disease. CONCLUSION: Higher infant mortality at time of birth is associated with adult mortality from diabetes mellitus and colon cancer in men, from ischaemic heart disease in women, and from stomach cancer and chronic liver disease in both sexes. These results most likely reflect adverse living conditions and/or nutritional deprivation in childhood.

Adult↗