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PubMed2004

Determinants of the geographical distribution of endemic giardiasis in Ontario, Canada: a spatial modelling approach.

Giardiasis surveillance data as well as drinking water, socioeconomic and land-use data were used in spatial regression models to investigate determinants of the geographic distribution of endemic giardiasis in southern Ontario. Higher giardiasis rates were observed in areas using surface water [rate ratio (RR) 2.36, 95 % CI 1.38-4.05] and in rural areas (RR 1.79, 95 % CI 1.32-2.37). Lower rates were observed in areas using filtered water (RR 0.55, 95 % CI 0.42-0.94) and in those with high median income (RR 0.62, 95 % CI 0.42-0.92). Chlorination of drinking water, cattle density and intensity of manure application on farmland were not significant determinants. The study shows that waterborne transmission plays an important role in giardiasis distribution in southern Ontario and that well-collected routine surveillance data could be useful for investigation of disease determinants and identification of high-risk communities. This information is useful in guiding decisions on control strategies.

Animals↗
PubMed2002

Role of drivers' personal characteristics in understanding traffic sign symbols.

This study investigated the role of age, marital status, gender, nationality, educational background and monthly income in drivers' comprehension of traffic signs. The populations sampled here were from five Arabian Gulf Countries. A total of 28 symbolic warning and regulatory signs were investigated. A questionnaire specially prepared to collect the necessary data was distributed to over 9000 drivers in the five countries; 4774 responded (53%). The results indicated substantial problems with the level of comprehension among the drivers about the traffic signs. The percentages of drivers who correctly identified the regulatory signs and warning signs were around 55 and 56%, respectively. Age, gender, education and income played major roles in determining drivers' comprehension of signs, whereas marital status showed no significant effect. Drivers who are young, female, those with lower levels of education or lower incomes understand the signs significantly worse than drivers who are older, male, with higher levels of education or higher incomes. Drivers from Europe and USA are significantly better than Asian and Arab drivers. These findings are believed to be important for the designers of road signs for international applications.

Age Factors↗
PubMed2003

Public funding for residential and nursing home care: projection of the potential impact of proposals to change the residential allowance in services for older people.

BACKGROUND: This paper investigates the potential effects of a policy change in the funding of UK residential care. The White Paper Modernising Social Services (Cm 4169, 1998) outlined plans to change the distribution of the Residential Allowance (RA), payable in support of residents in independent residential or nursing home care, from a component of income support paid direct to establishments to a grant to local authorities. This change was intended to remove the perverse incentive in accessing independent residential care more favourably than local authority care. A further objective was to encourage local authorities to use the grant to support home-based alternatives to residential care. The policy rests on a model in which price signals dictate the choice of care for an older person. By, in effect, raising the price of independent residential and nursing home care, the policy provides an incentive for authorities to seek alternatives to institutional care. METHODS: Managers from 16 UK social services departments attended a focus group discussion, completed questionnaires and provided information to assist in calculating the potential diversionary effect of the policy. RESULTS: Managerial estimates indicated a small diversionary effect of the policy; A potential effect of 0.26 and 0.19 per 1000 older people diverted from residential and nursing care respectively. CONCLUSIONS: The study indicated that wider organisational factors other than price are likely to play a greater role in deciding whether an older person is admitted to care. Changes in public funding alone do not reflect the complexities involved in decision-making concerning the residential placement of older people.

Aged↗
PubMed1992

Women's access to health care in developing countries.

Women in developing countries are frequently confronted with a myriad of socio-cultural factors which negatively impinge upon physical well-being and accessibility to appropriate health care services. Institutional, economic, and educational barriers effect and lowers their standard of living when compared to their male counterparts. Women must become agents of change to improve their situation. Factors such as access to income, legal rights, social status, and education may prove far more important in determining women's access to health care than technology distribution and governmental strategies.

Cross-Cultural Comparison↗
PubMed2003

Risk factors for myocardial infarction in Brazil.

BACKGROUND: Approximately three-quarters of cardiovascular disease deaths in the world come from developing countries, and acute myocardial infarction (AMI) is an important cause of death. Brazil is one of the largest countries in Latin America and the contemporary evaluation of risk factors for AMI is crucial for a more efficacious disease management. METHODS: The Acute Myocardial Infarction Risk Factor Assessment in Brazil (AFIRMAR) study is a case-control, hospital-based study involving 104 hospitals in 51 cities in Brazil, designed to evaluate risk factors for a first ST-segment elevation AMI. RESULTS: A total of 1279 pairs, matched by age (+/- 5 years) and sex, were enrolled. The conditional multivariable analysis of 33 variables showed the following independent risk factors for AMI: > or =5 cigarettes per day (odds ratio [OR] 4.90, P <.00001); glucose > or =126 mg/dL (OR 2.82, P <.00001); waist/hip ratio > or =0.94 (OR 2.45, P <.00001); family history of CAD (OR 2.29, P <.00001), low-density lipoprotein-cholesterol 100 to 120 mg/dL (OR 2.10, P <.00001); reported hypertension (OR 2.09, P <.00001); <5 cigarettes per day (OR 2.07, P =.0171); low-density lipoprotein-cholesterol >120 mg/dL (OR 1.75, P <.00001); reported diabetes mellitus (OR 1.70, P =.0069); waist/hip ratio 0.90 to 0.93 (OR 1.52, P =.0212); alcohol intake (up to 2 days/week) (OR 0.75, P <.0309); alcohol intake (3-7 days/week) (OR 0.60, P =.0085); family income R$600 to R$1200 and college education (OR 2.92, P =.0499); family income >R$1200 and college education (OR 0.68, P = 0.0239) CONCLUSIONS: The independent risk factors for AMI in Brazil showed a conventional distribution pattern (smoking, diabetes mellitus and central obesity among others) with different strengths of association; most of them being preventable by implementation of adequate policies.

Alcohol Drinking↗
PubMed1997

Sex differences in the association between alcohol consumption and cognitive performance. EVA Study Group. Epidemiology of Vascular Aging.

Heavy alcohol drinking is associated with cognitive impairment, but little is known concerning the cognitive effect of moderate alcohol consumption. The Epidemiology of Vascular Aging (EVA) Study is a longitudinal study of cognitive and vascular aging. Between June 1991 and June 1993, 1,389 subjects aged 59-71 years (574 men and 815 women) who had been recruited from the electoral rolls of Nantes, France, were examined. Trained psychologists administered a battery of 10 neuropsychological tests assessing most areas of cognitive functioning. Detailed information on alcohol intake was collected during a structured interview. A multiple linear regression model was used to examine the relations between test scores and alcohol consumption at baseline in men and women separately, controlling for age, education, income, depressive symptoms, and smoking status. Odds ratios for being a high cognitive performer (i.e., being in the top 10% of the distribution of summary scores from the neuropsychological battery) were calculated. Among men, neuropsychological test scores were not associated with alcohol consumption in either univariate or multivariate analysis; nor did the proportion of high cognitive performers vary by alcohol consumption. In contrast, among women, significant positive associations between alcohol consumption and cognitive performance were observed for most tests in multivariate analysis. For example, for the Mini-Mental State Examination, the adjusted mean score for female nondrinkers was 27.5 and that for the heaviest drinkers 28.2 (p < 0.001). The odds ratio for being a high cognitive performer was 2.5 (95% confidence interval 1.1-5.7) for women who usually consumed two or more drinks per day in comparison with nondrinkers. These findings suggest that, among women, moderate alcohol consumption may have a beneficial effect on cognitive function.

Aged↗
PubMed1982

Effects of cost-sharing on users of a state's health service program.

This study analyzed some of the effects of the introduction of cost-sharing on users of the state's health service program. The study population had previously received services at no charge and consisted of people with provider-determined medical need, and included, but was not limited to people in financial need. The study sample was selected from 3 years of program service records (1977-1980). Sampling was random and stratified by key variables. Time-series analysis as well as pre/post-policy comparisons were employed. Analysis of changes in the distributions of service user characteristics and in services provided indicated that use of services was not affected adversely and that lower-income, medically needy people were not deterred from using services following the introduction of cost-sharing. Limitations to the study are reviewed, and implications of using cost-sharing in programs such as Medicaid are considered.

Adolescent↗
PubMed1987

The determinants of hospital utilization under a universal public insurance program in Canada.

This study employs the individual as the unit of analysis to examine the relative importance of medical need, sociodemographic and economic factors in determining the use or non-use of hospital care and the volume of service consumed by those who experienced an episode of hospitalization during the study period. The data were derived from the Canada Health Survey which is a stratified, multistaged sample of the entire population. The results of the discriminant and weighted regression analyses indicate that the use or non-use of hospital care and the volume of service consumed are largely determined by medical need and not by income. The findings are supportive of the view that the national health insurance scheme in Canada has resulted in a more equitable distribution of hospital care.

Adolescent↗
PubMed2003

Diffraction of short X-ray pulses in the general asymmetric Laue case - an analytic treatment.

After briefly describing the concept of short X-ray pulses (delta-function), the diffraction of such a short pulse by a crystal in the asymmetric Laue case is given. The results of the dynamical theory are adopted and an analytic result for the intensity distribution behind the crystal in the diffracted direction as well as in the forward direction is given and discussed in detail. The incoming delta pulse is no longer infinitely short but shows a pronounced structure over a limited temporal or spatial region which is connected to the well known Pendellösung effect. Also the limitations of these findings are critically inspected.

Journal Article↗
PubMed1988

Multiperiod migration patterns: the timing and frequency of household responses.

"The structure of intertemporal patterns of household migration responses is empirically examined. The findings indicate that migration decisions are often related to changes in household conditions in both prior as well as following periods, are dependent on the duration of household status characteristics (e.g., marital status) and not just their presence at any point in time, and finally that migration response in any particular period very often differs among households as a result of differences in the underlying structure of migration frequency behavior. These findings suggest that inferences based on comparisons of household migration responses over only a single period of time are incomplete, possibly to the point of being misleading." The study is based on a calculation of "the distribution of migration patterns between 1976 and 1979 for a sample of 4,739 households in the [U.S.] Michigan Panel Survey on Income Dynamics (PSIC)."

Americas↗
PubMed1991

The relationship of suicide rates to sociodemographic factors in Canadian census divisions.

The correlates of suicide rates were determined by conducting a multivariate study of sociodemographic indicators and suicide rates of 261 Canadian census divisions. Twenty-one sociodemographic variables were entered into a stepwise multiple linear regression to develop a model for suicide rates. The important variables were mortality rate for all causes of death, the age of the population, average family income, population density, proportion with no religious affiliation, proportion of Francophones, unemployment, immigration, proportion of Native people, a regional effect for British Columbia and the north, and growth by mobility, explaining 62% of the observed variation. This spatial ecologic analysis highlights the importance of cultural differences in explaining the variation of suicide rates. The analysis supports the previously found negative relationship between income and suicide while contrasting from previous studies in determining a inverse relationship with unemployment and an inverse relationship with the age distribution.

Canada↗
PubMed1977

Public policy for health manpower: nursing student loans.

This paper seeks to determine the extent to which the Nursing Student Loan program (NSL) has accomplished its primary objectives of increasing the supply and effecting a more equitable geographic distribution of nurses. The history and provisions of the program are discussed and data from a survey of nursing schools on students' incomes, borrowing practices and withdrawal rates are analyzed. The major conclusion of the paper is that although NSL has fallen far short of its principal goals, it has produced some secondary benefits. A review of the program is recommended as a means of determining which activities should be emphasized to maximize its overall effectiveness.

Education, Nursing↗
PubMed2002

Sociodemographic differentials of adult death in a rural population.

Mortality rates in this country are very high, but most of the deaths occur unattended by a health worker and hence pass unrecorded. As a result, there is a critical lack of information to make sound judgement on what kind of interventions are needed to reduce the high toll of death. This case-control study was conducted in the Meskan and Mareko District, in the ten kebeles that are under continuous demographic surveillance by the Butajira Rural Health Program (BRHP). Included in the study were 515 cases, of which 49.3% were females and 50.7% were males, and 785 controls, of which 52.1% were females and 47.9% males. The most important sociodemographic factors that were found to influence adult death were single marital status (OR 1.63; 95% CI: 1.13, 2.35), having no educated person in the family (OR 1.91; 95% CI 1.11, 3.29), not having gainful occupation (OR 1.40; 95% CI 1.01, 1.82), and perceived poor and very poor economic status (OR 1.97; 95% CI 1.31, 2.94 and OR 2.98, 95% CI 1.73, 5.13, respectively). The male sex (OR 1.46; 95% CI 1.09, 1.95) and living in the rural lowlands (OR 1.54; 95% CI 1.03, 2.31) are also significantly associated with adult mortality. This study revealed that many of the factors associated with adult mortality are related to poor socio-economic conditions and to the prevailing under development of the rural areas.

Adolescent↗