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PubMed1978

Meeting the special needs of Appalachian alcoholics.

The Appalachian Regional Comprehensive Alcoholism Program in Beckley, West Virginia, was established in 1972 to meet the needs of a four-county catchment area. In designing the program, planners took into account the special cultural and economic characteristics of the population to be served--individualism, isolation, religiosity, conservatism, distrust of newcomers, and economic deprivation--and set up a program they believe respects local norms. For instance, the program has been staffed mainly by local professionals. Individual therapy, family therapy, and crisis intervention are used much more frequently than group psychotherapy, and clients have a strong voice in treatment decisions. Local ministerial associations are involved whenever possible, and outreach efforts include home visits as well as the use of the media to disseminate information.

Adult↗
PubMed2003

[Individual and collective facilitators of and barriers to the use of clinical practice guidelines by physicians: a literature review].

BACKGROUND: The effectiveness of Clinical Practice Guidelines (CPG) diffusion to physicians depends on local barriers or facilitators related to the CPG, to the individual clinician and the professional context. Our project aimed to retrieve, by a literature review, all the facilitators of and barriers to physician's adherence to CPG and propose a classification of these barriers and facilitators. METHOD: A comprehensive review of the literature. We searched in Medline, Healthstar, Current contents, Cochrane library databases, consulted experts in the domain of CPG implementation and reviewed study bibliography to retrieve all original reports studying facilitators of and barriers to physician's adherence to CPG (inclusion criteria). The article selection followed a two stepped procedure: first, quick reading of the retrieved articles, then reading in depth of the potentially appropriate articles. RESULTS: Fifty nine studies published between 1986 and 2001 were eligible. The majority (29 studies) used a quantitative design, having studied the statistical association between some a priori defined barriers or facilitators (collected by questionnaires or by record audits) and CPG use. The others have used a qualitative design (barriers and facilitators collected through qualitative methods or open-ended questions in questionnaires) (21 studies) or a mixed design (qualitative and quantitative) (8 studies). Study samples sizes ranked between 10 and 1878 physicians. The CPG were mostly about prevention or curative care. The retrieved barriers or facilitators were classified into three categories: 1) the CPG characteristics (form, compatibility, trialability, scientific basis, observability, adaptability, legal implications) (27 articles), 2) the physician characteristics (knowledge about CPG, attitude and agreement to CPG, psychological and socio-demographic and economic characteristics, job satisfaction, training) (38 articles), 3) the physician environment (divided into 3a the physician human environment--the patient influence and the pairs influence (16 articles)--and 3b the physician organizational environment--the internal environment and the external environment (33 articles). CONCLUSION: The interpretation of the results is hampered by the absence of previous conceptual framework of the barriers or facilitators and by the absence of multifactorial analysis.

Clinical Competence↗
PubMed2001

Family effects on self-reported health among Russian wives and husbands.

Alcohol abuse and a transition to the market economy are often blamed for high mortality and low life expectancy in Russia, but little is known about proximate influences on individual health. This study estimates family influences on the self-reported health of Russian wives and husbands. Predicting gender differences in the determinants of health status, hypotheses are presented for the effects on spouses' self-reported health of five family characteristics: economic status, household division of labor, family decision-making, presence of young children, and housing conditions. Controls are included for age, education, sensitivity, alcohol use, job-related time, and urban-rural location. Data from a 1996 sample of couples (n = 925) from Moscow and two rural regions of Russia are analyzed using logistic regression. The findings provide mixed support for the hypotheses, though they do show the important role of family characteristics on spouses' health. Family economic standing is important to both spouses' self-reported health, though young children in the home is not. Family decision-making does influence spouses' health: when Russian wives are the primary decision makers in the family, their own health suffers, though their husbands' health is better. And support is found for the combined effects of job-related time and household labor but only for wives' health. When wife's household labor is low, the probability of her having poor health increases, the more time she devotes to her job. However, when she does substantially more domestic labor than her husband, her job-related time has the opposite effect, reducing the chances of poor health, the more time she spends on job activities. This study is important both in helping to account for poor health of Russians during the current economic and social transition and in identifying aspects of family life that affect men's and women's health cross-nationally.

Adult↗
PubMed1992

[Risk factors and mortality of myocardial infarction in Kristiansund, Alesund and Molde].

We have examined mortality from ischaemic heart disease, prevalence of self-reported coronary heart disease and risk factor levels in three towns (Kristiansund, Alesund and Molde) in the county of Møre og Romsdal. The results for mortality were based on vital statistics for the age group 40-69 years, for the periods 1966-76 and 1977-87. Risk factor data and data on self-reported coronary heart disease for the age groups 40-42 years and 65-67 years were obtained from a health screening survey conducted in the county in 1990. According to the official statistics, the towns share important socio-economic characteristics, but Kristiansund is thought to have stronger roots in the coastal culture, with a historically economic basis in fishery and shipbuilding. We observed substantial differences between the three towns, both as regards risk factor levels and mortality from ischaemic heart disease. By far the highest mortality rates were found in Kristiansund, both for men and for women. A similar gradient existed for the levels of main risk factors, including serum cholesterol, systolic blood pressure and prevalence of smokers. We discuss the implications of these findings for prevention strategies.

Adult↗
PubMed2002

Consanguinity in Spain: socioeconomic, demographic, and geographic influences.

Information on consanguinity in Spain was reanalyzed in order to obtain a more complete picture of consanguinity patterns by considering temporal, geographical, demographic, and economic factors. To obtain data on consanguineous marriages, we reviewed 106 published references. Only populations with homogeneous geographical characteristics, economic activities, transportation facilities, and the like, were considered. Two-way analysis of variance (ANOVA) provided highly significant differences (p < 0.001) for a both for time periods and for urban versus rural patterns, but there was no interaction between the latter two. A regression analysis shows that for rural areas the geographic characteristics, economy, communications, and index of demographic tendency were significant predictors of the inbreeding coefficient. The results obtained indicate that urban and rural patterns differ significantly and that the temporal factor needs to be taken into account before comparing inbreeding coefficients. In urban areas the census size and altitude are included in the regression equation as significant variables, but association was not found between alpha and the index of demographic tendency (population increase or decrease). Instead, the absolute number of inhabitants (census size) was significant. In rural areas geographic characteristics, communications, and index of demographic tendency were significant predictors of the inbreeding coefficient.

Analysis of Variance↗
PubMed1984

Neighborhood variations in the use of hospital emergency rooms for primary care.

The purpose of the paper is to analyze neighborhood variations in the use of emergency rooms (ERs) as settings for primary care within Oklahoma County, part of the Oklahoma City MSA. The location of patients taken from a sample of ER records in four large hospitals were aggregated to census tracts. Tract visitation rates were estimated and related to the socio-economic character and the relative location of the tracts for two periods--'physicians' office hours' and 'non-office hours'. The results show that for the city as a whole primary care use in emergency rooms is associated with the socio-economic status and relative location of a residential area. Tracts with lower socio-economic status have higher rates of emergency rooms use for primary care than those of higher status. This relationship is true both during physicians' office hours as well as during the times their offices are closed. When visitation rates are analyzed separately for individual hospitals, location rather than neighborhood socio-economic characteristics is paramount. It was concluded that while primary care visits to emergency rooms are higher in lower socio-economic status neighborhoods, and that this is a function of the more accessible location of emergency rooms to these neighborhoods as well as to socio-economic effects on use.

Appointments and Schedules↗
PubMed1977

Socioeconomic characteristics of the elderly: some black-white differences.

This article compares several characteristics of the black and white population aged 60 and older in March 1972. To distinguish race from economic-status effects the population is divided into quintiles of elderly units ranked by size of money income, and comparisons of selected demographic and economic characteristics are made within and across quintiles. Differences between social security beneficiaries and nonbeneficiaries are also analyzed to ascertain the effects of social security benefits. The educational and occupational disadvantages of blacks were evident even at the highest income level--a status more likely to be achieved by married black couples with both spouses working. Black elderly units were less likely than whites to have social security benefits, other government or private pensions, or income from assets. They were generally more likely to have earned income or to receive public assistance payments.

Black or African American↗
PubMed1997

[An analysis of factors associated with the increase of in-patient medical expenditures for the elderly in Fukuoka Prefecture].

In order to evaluate factors associated with the increase in the in-patient medical expenditures for the elderly in Fukuoka prefecture during the period from 1987 to 1991, an analysis was conducted based on the data of 10 Health Care Regions. According to the results, there were two patterns in the increase. The first was the pattern observed in the southern part of the prefecture, where most of the increase in the in-patient medical expenditures for the elderly was explained by the increase of medical expenditures per capita. Furthermore, this increase per capita was due to the increase in utilization rate. This pattern is considered to be associated with the increase of general hospital beds as well as with the increase of the dependent elderly in the regions. The second pattern was observed in urban regions, such as Fukuoka and Kitakyushu, where the increase of in-patient medical expenditures for the elderly was mainly due to the increase in the number of elderly in the regions. This pattern is considered to be associated with the increase in the population categorized as the aged household. The present result suggests that in order to control the medical expenditures for the elderly, different service-mix strategies will be necessary, respecting the socio-economic characteristics of each region.

Demography↗
PubMed1978

Economic status, family anomie, and adolescent suicide potential.

This study attempts to ascertain the existence and economic characteristics of the anomic family as a determinant of high suicide lethality among adolescents. An inverse relationship was hypothesized between economic status, family norm consensus, family power, and adolescent suicide risk. Fifty-five Ss of at least moderate suicide risk--and their families--were obtained from a total sample of 194 adolescents, 13 to 18 years old, who attempted suicide during a three month period. A summary of the descriptive demographic data is as follows: 32.7% of the sample were male and 67.3% female; their mean age was 16.3 years; race was categorized into 81.9% white and 18.1% nonwhite. Correlation coefficients were used to test the hypothesis. Statistically significant differences in the degree of family normlessness and powerlessness were found for suicidal and nonsuicidal adolescents and their families.

Adolescent↗
PubMed1995

The spatial and socio-economic patterns of minority ethnic groups in Great Britain.

"This paper considers the manner in which people from minority ethnic groups relate to the spatial and socio-economic organisation of Great Britain. It presents a classification of local authority districts based on 1981 and 1991 Census data and explores the distribution of nine minority ethnic groups across the eight types of district identified. The socio-economic characteristics of minority ethnic groups in each cluster are then examined in order to determine the types of locality in which minority ethnic groups fare relatively well or badly."

Culture↗
PubMed1990

Regional differences in immigration and economic structure in Australia.

"The scale of overseas immigration and the exceptional importance of the role played by migrants in demographic, economic and cultural trends in Australia makes the immigration policy one of the key components of Australian politics. Both the immigration policy and the outcomes of this policy are shaped by four major groups of factors: demographic, economic, cultural, and political in a broad sense. The weighting of these factors changes from period to period. This paper looks at the extent to which some of these factors affect regional differentiation of the immigration pattern. The analysis is focused on the influences of employment structure and other socio-economic characteristics of different Australian regions, exerted on overseas migration to these regions." (SUMMARY IN FRE AND SPA)

Australia↗
PubMed2005

Morbidity pattern and household cost of hospitalisation for non-communicable diseases (NCDs): a cross-sectional study at tertiary care level.

OBJECTIVE: To determine the pattern of morbidity and the demographic and socioeconomic characteristics of patients seeking in-patient services for noncommunicable diseases (NCDs) in medical units of a tertiary care hospital, and to estimate the economic burden imposed by these admissions on the households. METHODS: A descriptive cross-sectional study was conducted in medical units of the Colombo North Teaching Hospital, Ragama. Data were collected using a pre-tested interviewer-administered questionnaire. Morbidity patterns and demographic and socio-economic characteristics of patients with NCDs were determined. Direct and indirect components of the household cost of hospital stay were estimated. RESULTS: Fifty five per cent of the patients men male and the largest age group (11%) was 50-54 years. Seventy per cent were above 40 years of age, and 63% represented social classes 4 and 5. Diseases of the circulatory system were the commonest (31%). Median household cost of the total hospital stay was Rs. 852.00 (inter-quartile range Rs. 351.00-1885.00) of which 70% were direct costs. Median daily cost was Rs. 340.00 (interquartile range Rs.165.00-666.00). Only 44% of patients incurred an indirect cost. Cost of travelling was the main contributor (36%) to the household cost. Laboratory investigations contributed 16%. CONCLUSIONS: Most patients seeking in-patient services were from a poor socioeconomic background. The economic burden imposed by the admission to the household was mainly due to direct costs incurred for travelling and investigations.

Adolescent↗
PubMed1983

[The alcoholic patient in Costa Rica: characteristics and results].

At the Rehabilitation Center of the National Institute on Alcoholism (CREAT) a three years study was carried out on in-patient basis. This study took into consideration the socio-economic characteristics as well as the patients' intake of alcohol and their behaviour on abstinence-ingestion when they got out during a year follow-up. This work presents a profile of the patients, having interviewed 3.175 individuals, which, in general terms, is synthetized as follows; he is an individual whose age fits him within the economically active population, coming from rural areas and whose income derives from occupations not qualified far the urban areas of the country, where he has relatively rooted. Early incorporated to his type of work abandoning his education, soon he started indulging in alcohol due to circumstances socially accepted, and congruent with the cultural pattern of ingestion. Important enough he reveals alcoholic backgrounds within the family almost always in the person of his father. At the moment of this study the patient reveals excessive consumption of alcoholic beverages, equivalent to some 230 cc of absolute alcohol. He states, clearly enough, his inability to stop his alcoholic intake once it has started, and which leads him to alcoholic binges of more than a week of endurance. He has been previously treated for alcoholism at INSA and A.A. with no positive results. His referral for treatment had been made, in the majority of the cases by his kin and friends, and, likewise, he has come to the Center by his own will. It's striking among other features, his general impairment of many of the aforementioned aspects in younger patients. The results obtained during the period of abstinence point out to a fast relapse (in several instances immediately after having left the Center) positively associated with groups of lower age. The problems of alcoholism of the patients under study are present at a great scale, involved in a double and problematic socio-cultural situation. Thus, the patients show a deficient involvement in the socio-economical structure which leaves the basic needs unsatisfied frustrating their personal ambitions. But, furthermore, their involvement within a cultural model of compulsive alcoholic drinking accounts for his abstinence to be a determinant of a deviant situation or reluctance in regards to the actual values.

Adult↗
PubMed1990

[Immigration and the economy of the United States].

"This paper is concerned with how immigration and immigration policy have influenced the economy of the United States. It focuses on the events of the past quarter century, particularly since the enactment of the 1965 Amendments to the Immigration and Nationality Act. It begins with a review of the demographic characteristics of immigrants and how these characteristics have changed over time, in part in response to changes in immigration policy.... This is followed by a discussion of the labor market (economic) characteristics and adjustment of immigrants. The impact of immigrants, particularly low-skilled immigrants, on the level and inequality of income in the economy is explored." (SUMMARY IN ENG AND SPA)

Americas↗
PubMed1988

Sociological analysis of migration of agricultural labourers from eastern to north-western region of India.

The authors examine rural-to-rural migration of agricultural workers from eastern to northwestern India. "The specific objectives of this study were: (a) to identify the socio-economic characteristics of the immigrant farm workers; (b) to explicate the causes of migration; (c) to analyse the impact of migration on the pattern of employment, wages, acculturation and interpersonal relations; and (d) to examine the socio-cultural and economic impact of migration on the migrants' families." Data are from a 1984-1986 survey.

Acculturation↗
PubMed2003

Socio-economic factors associated with the purchasing of insecticide-treated nets in Afghanistan and their implications for social marketing.

Malaria is often a major health problem in war-torn countries in the tropics owing to the collapse of health services and the vulnerability of displaced populations to epidemics. Insecticide-treated nets (ITN) represent one of the few options for obtaining protection against malaria in unstable settings deficient in health infrastructure. Social marketing of subsidized ITN by a consortium of non-governmental organizations began in Afghanistan in 1993 and has continued every year since then despite regular political turmoil. Almost 350,000 nets have been sold and approximately 1.2 million people protected. In 2000 we examined the determinants of ITN purchasing among households in Nangarhar province, eastern Afghanistan, as part of an effort to increase ITN uptake. The survey was conducted using a structured questionnaire to collect data on socio-economic characteristics and malaria beliefs and practices among more than 400 net-owning and non-net-owning households. A composite socio-economic index was created using principal components analysis, and survey households were divided into socio-economic quartiles. ITN were 4.5 times more likely to be purchased by families from the richest quartile and 2.3 times more likely to be purchased from the upper-middle quartile than from the two lower quartiles. Even so, a significant minority from the lower quartiles did prioritize and buy ITN. In conflict affected countries where livelihoods are compromised, it is necessary to target subsidies at the most impoverished to make ITN affordable and to improve overall coverage.

Adult↗
PubMed2005

Neighbourhood social and socio-economic composition and injury risks.

AIM: To investigate whether social and socio-economic characteristics of the population within a parish influence childhood injury. METHODS: The study encompasses all children aged 0-15 y living in Stockholm County over the 3-y period 1999-2001 (about 360,000 children per year), grouped into parish of residence (138 parishes). The effect of parish attributes on injury rate were analysed based on three indices (deprivation, socio-economic status and social integration) derived by a factor analysis of 11 characteristics of the parishes' population, each index being split into three levels. Childhood injury resulting in at least one night of hospitalization during the period 1999-2001 was considered (n = 5540) by index, and rate ratios were calculated for 12 injury causes using parishes forming the best level of the index as the reference group. RESULTS: Higher levels of deprivation negatively influenced pedestrian injury rates, had a protective effect on other traffic-related injuries, and negatively affected some other types of unintentional injuries. Higher concentrations of people with low socio-economic status did not impact on the risk of traffic and fall injuries, but increased that of burns/scalds and cases of poisoning. Parishes with lower levels of social integration had significantly higher rates of bicycle- and moped-related injuries, and also of self-inflicted ones. CONCLUSION: Compositional characteristics of the population in a residential area affect injury to varying degrees and direction according to type of injury. The underlying mechanisms are likely to be specific to injury type.

Accident Prevention↗