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PubMed2004

Smoking among adult males in an urban community of Karachi, Pakistan.

Smoking is the single most important avoidable cause of premature morbidity and mortality in the world. It is a major public health problem in Pakistan. The objectives of this study were to assess smoking status and its relationship to socio-demographic characteristics, and to determine the behavior of male smokers in an urban community in Karachi, Pakistan. A cross-sectional, household survey was conducted among 396 males, aged 15 years and above in January and February 2002. The overall prevalence of current smokers was 34%. By univariate analysis, the factors associated with smoking were younger age (15-29 years) (OR=4.2, 95% CI 2.1-7.3) as compared to older age (> 45 years), unmarried as compared to married (OR=3.1, 95% CI 1.9-5.4), educated for > 12 years compared to those with an education of 0-5 years (OR=2.0, 95% CI 1.2-3.3), and being student as compared to being an office/business worker (OR=3.2, 95% CI 1.8-5.4). The majority of smokers (55%) began smoking when younger than 25 years, smoked for more than 5 years (53%), smoked more than 10 cigarettes a day (55%) and smoked in public places (82%). Forty-two percent of the smokers used tobacco in other forms as well. Fifty-eight percent of smokers smoked to relieve anger and frustration and 30% smoked due to friend or peer pressure. In conclusion, smoking is a major problem in especially in younger age groups. There is an urgent need for health promotion and anti-tobacco education in combating the epidemic of smoking in Pakistan.

Adolescent↗
PubMed1991

Influences on the extent of breast-feeding: a prospective study in the Philippines.

There has been much controversy about the impact of the health sector and the infant food industry on breast-feeding behavior. This study links causal factors to breast-feeding decisions, using a longitudinal survey of more than 3,000 Filipino mother-infant pairs. Most factors decreasing the likelihood that mothers will breast-feed seem to be related to family economics. Delivery in a private hospital, urban residence, high income, absence of spouse, and having worked for wages affect adversely the initiation of breast-feeding. Formula advertising and distribution of samples appear to have relatively little impact on feeding decisions.

Advertising↗
PubMed1978

Work load management system ensures stable nurse-patient ratio.

The concept of adjusting work load to staffing is the reverse of most currently accepted practices. However, that is precisely how this management and measurement system works. Patient care units (PCU'S) are estimated for all incoming admissions, and patients are assigned to the units that have the lowest PCU count, the goal being an even distribution of work load among nursing units.

Efficiency↗
PubMed1997

Body mass index and the risk of cancers of the gastric cardia and distal stomach in Shanghai, China.

The divergent incidence patterns of gastric cardia and distal stomach cancers suggest different etiologies. Although obesity has recently been linked to cardia cancer in Western populations, its association with distal stomach cancer remains unclear. This study examined the relation of anthropometric measurements to risk by subsites of stomach cancer in a Chinese population. We identified 1124 population-based cases of stomach cancer, ages 20-69 years, newly diagnosed between December 1988 and November 1989 in Shanghai, China. Controls (n = 1451) were randomly selected from permanent Shanghai residents and frequency-matched to cases by age and sex. Information on demographic characteristics, height and weight, diet, smoking, and other exposures was obtained by trained interviewers in person. The body mass index (BMI) was calculated as weight in kilograms divided by height in square meters and categorized into quartiles based on the distribution among controls. Odds ratios and 95% confidence intervals were estimated using logistic regression models, simultaneously adjusting for age, education, income, cigarette smoking (men only), alcohol drinking (men only), intake of total calories, and chronic gastric diseases. For gastric cardia cancer, the odds ratios among men were 1.4, 1.5, and 3.0 in the second, third, and fourth quartiles of usual BMI (P for trend, < 0.01). Among women, elevated risks also were associated with excess weight, but the gradient in risk was not smooth. Risk patterns for usual body weight, maximum BMI, and minimum BMI were similar to those found for usual BMI. For distal stomach cancer, no association with usual BMI was observed among men, but a slightly elevated risk was seen among women. Our observations in China support recent findings in Western populations that obesity contributes to the risk of gastric cardia cancer, especially among men.

Adult↗
PubMed2004

Prevalence and correlates of high-quality basic pediatric preventive care.

BACKGROUND: The list of recommended pediatric preventive services has grown considerably in the past decade, and clinician variability, clinician distribution, and other correlates of provision of these basic preventive services (BPS) are not known. OBJECTIVE: To describe the proportion of high-quality basic pediatric preventive services, exclusive of immunizations, reported by parents and to identify sociodemographic and health system predictors and health service correlates of provision of these services. STUDY DESIGN: The study used cross-sectional data on 2041 children, 4 to 35 months of age, in the 2000 National Survey of Early Childhood Health. OUTCOME MEASURES: The BPS measure assesses the receipt of (1) developmental assessment, (2) injury prevention counseling, (3) screening for parental smoking, (4) guidance on reading to the child, and (5) guidance on 14 other topics (assessed as a composite score). The BPS scale categorizes the receipt of services as excellent, good, fair, or poor. RESULTS: Most children received excellent (34.9%) or good (31.5%) care, but many received fair (24.9%) or poor (8.7%) care. Sociodemographic and health care factors such as race/ethnicity, insurance, and practice setting were not associated with BPS levels. Higher BPS scores were associated with parental reports of longer well-child visits, more counseling regarding family and community risk factors, lower rates of delayed or missed care, and greater satisfaction. CONCLUSIONS: Two thirds of children receive good or excellent basic preventive care, as determined with this composite, and no disparities according to race/ethnicity, income, or health insurance status of families (which are often found to be associated with health care access) were found. This equitable distribution of high-quality care suggests a high level of clinician professionalism. Duration of visits may be a key factor to improve quality of care. Because of its association with other services, processes, and outcomes of care, the BPS scale may serve as a useful construct for monitoring quality and stimulating efforts to improve national pediatric preventive care.

Child, Preschool↗
PubMed2003

Prevalence of caries in 6-year-old Austrian children.

PURPOSE: The 2001 Austrian oral health survey investigated a representative sample of 6-year-old Austrian children. MATERIALS AND METHODS: 516 6-year-old Austrian children were investigated with respect to d1-3mft and d1-3mfs and visible plaque index (VPI). RESULTS: Forty-nine per cent of the children were caries free (d3ft = 0). The children had 2.1 d3ft (3.5 d1-3mft) and 3.9 d3fs (6.1 d1-3fs). 2.6 d3s unrestored carious lesions (d3s) predominated over 1.3 filled surfaces (fs). There was no statistical difference between girls and boys. The prevalence of caries showed a very skewed distribution: 50% of all d3s were concentrated in 8% of the children with 86% of all carious lesions in 25% of the children. The prevalence of caries was inversely related to the educational level of the parents (Spearman rank test p < 0.001; r = -0.219) and family income (p <0.001; r = -0.173): Children of parents with low educational levels (9 years of schooling) had 3.3 d3ft whereas children of parents with university degrees had only 1.0 d3ft. CONCLUSION: Six-year-old Austrian children showed a very skewed distribution of the prevalence of caries and high need for dental treatment. There is a great need for pediatric dentistry in Austria.

Analysis of Variance↗
PubMed1999

Bridging the emergency medical services for children information gap.

OBJECTIVE: To determine the epidemiological features of pediatric usage of prehospital emergency medical services (EMS) in a defined urban population. METHODS: Residents of Kansas City, Mo, younger than 15 years who used EMS during the calendar years 1993-1995 were included. In this geographic area there is a single provider of prehospital care; all numerator data were taken from this single source. Denominator data were provided by 1995 intercensal estimates based on the 1990 US Census. Rates were calculated as an annual average and reported as the number of children transported per 1 000 persons per year. RESULTS: There were a total of 7296 pediatric EMS transports during the study period, for an annual rate of 21.9. Infants younger than 1 year had the highest rate (47.4), followed by those aged 1 to 4 years (26.2), 10 to 14 years (17.5), and 5 to 9 years (17.3). Medicaid was the insurer for half and 27% were uninsured. One quarter of the patients used EMS more than once. Children living in ZIP codes in the lowest median income tertile were 5.8 times more likely to use EMS than those in the upper income tertile (95% confidence interval, 5.4-6.3). One third of all transports occurred between the hours of 4 and 8 PM. CONCLUSIONS: Children using the Kansas City EMS were more likely to be infants, insured by Medicaid or uninsured, and live in low-income ZIP codes. Further study is needed to determine if this increased usage is due to greater incidence and severity of illness and injury, lack of transportation, lack of education, or other factors.

Adolescent↗
PubMed1997

Sources of funding for schools.

Public school finance mechanisms differ from state to state, and they are often extremely complex. Most commonly, the federal government contributes about 7% of the total school budget, and the remainder is split fairly evenly between local contributions (primarily raised through local property taxes) and state contributions (primarily raised through state income taxes and sales taxes). The average amount of money provided per pupil varies greatly from one state to another. The method of distributing the state contribution to school districts is equally complex, often involving some combination of basic funding (which guarantees a minimum level of general purpose support per student), power equalization (which guarantees that a certain level of local taxation will yield a given level of per-pupil funding), local option (higher levels of taxation approved in some school districts, not equalized by the state), and categorical funding (supplemental state and federal funds, earmarked for specific needs such as special education or compensatory services to schools with a concentration of poverty, or to meet state-dictated priorities, such as reducing class size or purchasing state-approved textbooks). This complexity often leads to significant variation from district to district in the percentage of funding received from federal, state, and local sources and wide disparities in the level of support for the educational program. Typically, wealthier districts provide more of their funding from local taxes, while lower-income districts are more heavily dependent on state and federal sources.

Adolescent↗
PubMed1995

Regional comparisons of child abuse and related variables in the United States.

The objective of this article is to familiarize the health care professional with 1990 national data on child abuse and to review some of the trends reported in the literature. The United States was divided into Northeast, Midwest, South, and West. Data were collected, analyzed, and transformed to calculate the incidence and types of abuse reported by region. Variables of interest were income, marital status, perpetrator, age of victim, and drug use by region. To determine significant differences among regions for each type of abuse and related variable, frequency distributions were calculated and chi-squared tests were used. State data summaries were measured for correlation analysis. The West was highest in reported incidence of child abuse (5.9%) and, specifically, physical abuse (36.7%). California reported 55% of the physical abuse in the West. In all regions, neglect and physical maltreatment were reported more than sexual and emotional abuse. The incidence of neglect in the south (52.8%) was greater than in any other region and did not correlate to income in this region. Early detection of child abuse can aid in preventing fatalities. This information should increase awareness of child abuse and result in an increase in reporting if abuse is suspected.

Adolescent↗
PubMed2006

Projections of global mortality and burden of disease from 2002 to 2030.

BACKGROUND: Global and regional projections of mortality and burden of disease by cause for the years 2000, 2010, and 2030 were published by Murray and Lopez in 1996 as part of the Global Burden of Disease project. These projections, which are based on 1990 data, continue to be widely quoted, although they are substantially outdated; in particular, they substantially underestimated the spread of HIV/AIDS. To address the widespread demand for information on likely future trends in global health, and thereby to support international health policy and priority setting, we have prepared new projections of mortality and burden of disease to 2030 starting from World Health Organization estimates of mortality and burden of disease for 2002. This paper describes the methods, assumptions, input data, and results. METHODS AND FINDINGS: Relatively simple models were used to project future health trends under three scenarios-baseline, optimistic, and pessimistic-based largely on projections of economic and social development, and using the historically observed relationships of these with cause-specific mortality rates. Data inputs have been updated to take account of the greater availability of death registration data and the latest available projections for HIV/AIDS, income, human capital, tobacco smoking, body mass index, and other inputs. In all three scenarios there is a dramatic shift in the distribution of deaths from younger to older ages and from communicable, maternal, perinatal, and nutritional causes to noncommunicable disease causes. The risk of death for children younger than 5 y is projected to fall by nearly 50% in the baseline scenario between 2002 and 2030. The proportion of deaths due to noncommunicable disease is projected to rise from 59% in 2002 to 69% in 2030. Global HIV/AIDS deaths are projected to rise from 2.8 million in 2002 to 6.5 million in 2030 under the baseline scenario, which assumes coverage with antiretroviral drugs reaches 80% by 2012. Under the optimistic scenario, which also assumes increased prevention activity, HIV/AIDS deaths are projected to drop to 3.7 million in 2030. Total tobacco-attributable deaths are projected to rise from 5.4 million in 2005 to 6.4 million in 2015 and 8.3 million in 2030 under our baseline scenario. Tobacco is projected to kill 50% more people in 2015 than HIV/AIDS, and to be responsible for 10% of all deaths globally. The three leading causes of burden of disease in 2030 are projected to include HIV/AIDS, unipolar depressive disorders, and ischaemic heart disease in the baseline and pessimistic scenarios. Road traffic accidents are the fourth leading cause in the baseline scenario, and the third leading cause ahead of ischaemic heart disease in the optimistic scenario. Under the baseline scenario, HIV/AIDS becomes the leading cause of burden of disease in middle- and low-income countries by 2015. CONCLUSIONS: These projections represent a set of three visions of the future for population health, based on certain explicit assumptions. Despite the wide uncertainty ranges around future projections, they enable us to appreciate better the implications for health and health policy of currently observed trends, and the likely impact of fairly certain future trends, such as the ageing of the population, the continued spread of HIV/AIDS in many regions, and the continuation of the epidemiological transition in developing countries. The results depend strongly on the assumption that future mortality trends in poor countries will have a relationship to economic and social development similar to those that have occurred in the higher-income countries.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Evaluating the performance of the Global Registry of Acute Coronary Events risk-adjustment index across socioeconomic strata among patients discharged from the hospital after acute myocardial infarction.

BACKGROUND: Cardiac risk-adjustment indices for acute coronary syndromes have important clinical and research applications, especially if proven to be valid and robust across heterogeneous socioeconomically diverse populations. The objective of this study was to validate the Global Registry of Acute Coronary Events (GRACE) risk-adjustment index for 6-month all-cause mortality across socioeconomic strata. METHODS: The study cohort consisted of patients who were enrolled in the SESAMI study and discharged alive from the hospital between December 1, 1999, and February 28, 2003. Socioeconomic information was obtained through self-report. Hospital chart abstraction was used to ascertain clinical detail required for the derivation of the GRACE risk index. Six-month mortality rates were obtained through data linkage using encrypted health card numbers. The accuracy (c-statistic) and calibration (Hosmer-Lemeshow) characteristics of the GRACE risk index were generated using logistic regression across income and education strata. RESULTS: Predicted and observed mortality rates were significantly higher among patients of lower incomes and education (ie, observed 6-month mortality: 5.1% vs 1.8% among low income vs high income patients, respectively, P < .0001; 4.6% vs 2.9% among low-educated vs highly educated patients, respectively, P = .02). The predicted 6-month mortality as derived using GRACE closely mirrored observed mortality rates with strong accuracy and precision (c-statistic = 0.80 for the overall cohort and within each income and education strata; Hosmer-Lemeshow goodness-of-fit test was not significant within each income and education strata). CONCLUSION: The GRACE risk score for 6-month all-cause mortality is an accurate, well-calibrated, and robust predictor across socioeconomic strata and can be used as a valid risk-adjustment index when examining socioeconomic-mortality differences after acute MI.

Adult↗
PubMed1996

Race, socioeconomic status, and obesity in 9- to 10-year-old girls: the NHLBI Growth and Health Study.

The purpose of this investigation was to determine whether measures of socioeconomic status (SES) are inversely associated with obesity in 9- to 10-year-old black and white girls and their parents. Subjects were participants in the Growth and Health Study (NGHS) of the National Heart, Lung, and Blood Institute. Extensive SES, anthropometric, and dietary data were collected at baseline on 2379 NGHS participants. The prevalence of obesity was examined in the NGHS girls and parents in relation to SES and selected environmental factors. Less obesity was observed at higher levels of household income and parental education in white girls but not in black girls. Among the mothers of the NGHS participants who were seen, lower prevalence of obesity was observed with higher levels of income and education for white mothers, but no consistent patterns were seen in black mothers. Univariate logistic models indicated that the prevalence of obesity was significantly and inversely associated with parental income and education and number of parents in the household in white girls whereas caloric intake and TV viewing were significantly and positively associated with obesity. Among black girls, only TV viewing was significantly and positively associated with the prevalence of obesity. Multivariate logistic regression models revealed that lower parental educational attainment, one-parent household, and increased caloric intake were significantly associated with the prevalence of obesity in white girls; for black girls, only increased hours of TV viewing were significant in these models. It is concluded that socioeconomic status, as measured by education and income, was related to the prevalence of obesity in girls, with racial variation in these associations. A lower prevalence of obesity was seen at higher levels of socioeconomic status in white girls, whereas no clear relationship was detected in black girls. These findings raise new questions regarding the correlates of obesity in black girls.

Black People↗
PubMed2001

Early indicators of the effect of a breast cancer screening program for low-income women.

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) was developed to increase screening among low-income women who are uninsured or underinsured. This study reports early indicators of the effectiveness of this breast screening program in Iowa. Using data from the Census Bureau and the Iowa Behavioral Risk Factor Surveillance System, we found that racial and ethnic minorities aged 50 to 64 more likely were screened by the NBCCEDP than were their counterparts. Data collected by the Iowa BCCEDP showed a breast cancer detection rate (7.1 per 1,000 women screened) that was at least three times higher than its historical comparison, an indication of the lead time of the screened over the nonscreened population. Predictive values positive (referral and biopsy) and stage distribution were typically higher than for the national program but lower than in other countries. In conclusion, a breast cancer screening program among low-income women can be implemented successfully, judged by early indicators of program effectiveness.

Breast Neoplasms↗
PubMed2005

Free does not mean affordable: maternity patient expenditures in a public hospital in Bangladesh.

OBJECTIVE: This study investigated a) the amount and types of out-of-pocket expenditures by patients for nominally free services in a large public hospital in Bangladesh, b) the factors influencing these expenses, and c) the impact of these expenses on household income. METHODS: Eighty-one maternity patients were interviewed during their hospitalization in the Dhaka Medical College Hospital. Patients were selected by quota sample to match the distribution of maternity patient categories in the hospital. Patients were interviewed with a semi-structured, in-depth questionnaire. RESULTS: All interviewees incurred substantial out-of-pocket expenditures for travel, hospital admission fees, medicine, tests, food, and tips. Only two of the expenditures, travel expenses and admission fees, were not supposed to be provided free of charge by the hospital. The median total per-patient expenditure was $65 (range $2-$350), equivalent to 7% (range 0.04%-225%) of annual household income. Half of all patients reported that their families had to borrow to pay for care at interest rates of 5%-30% per month. A third of these families reported selling jewelry, land or household items to moneylenders. The rural patients reported more difficulty in paying for care than the urban patients. Factors increasing the expenditures were duration of hospitalization, rural residence, and necessary (e.g. C-section, hysterectomy) and unnecessary (e.g. episiotomy) medical procedures. CONCLUSION: Free maternity services in Bangladesh impose large out-of-pocket expenditures on patients. Authorities could reduce the burden by reducing the duration of hospital stays, limiting use of medical procedures, eliminating tips, and moving routine services closer to potential users. Fee for service could reduce unofficial expenditures if the fee were lower than and replaced typical unofficial expenditures, otherwise adding service fees without reform of current hospital practices would lead to even more burdensome expenditures and inequities.

Journal Article↗