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PubMed1996

Immunization levels for preventing epidemics in a community of households made up of individuals of various types.

A method is proposed for computing an epidemic threshold parameter for the spread of a communicable disease in a community of households in which individuals are of p different types. The threshold parameter is the largest eigenvalue of a p x p matrix whose elements depend on the rates of disease transmission between types and the distribution of the household size. More explicit expressions are given for diseases that are highly infectious within households, to the point that the infection of any member of a household results in the infection of all susceptible members of that household. For a variety of vaccination strategies it is described how this approach can be used to determine the level of immunity required to prevent epidemics. A numerical example illustrates the results.

Communicable Disease Control↗
PubMed2004

Gambling households in Canada.

This paper examines the distribution of gambling dollars in Nova Scotia, Saskatchewan and Canada and studies the impact of this spending on households. We focus first on how gambling expenditures are related to the level and source of household income as well as to other demographic characteristics such as age, education, household composition, geographical area, and sources of income. Next we analyze how gambling expenditures are distributed among those households that gamble. We show how expenditure patterns differ in the intensity of gambling as measured by the proportion of household income or total amount of dollars spent on gambling. Then we study the affects that gambling has on spending on household necessities, changes in net worth, retirement savings and household debt. Finally we determine whether gambling expenditures act as a substitute or a complement to other recreational spending on entertainment products and services. Throughout the paper we offer a comparative analysis of provincial and national data.

Behavior, Addictive↗
PubMed1966

Distribution of tuberculous infection and disease among households in a rural community.

Clinical experience has led to a strong belief that tuberculosis is a family disease and contact examination is a sine qua non for case-finding programmes. Considerable doubts are cast on the usefulness of contact examination in tuberculosis control by the present study, which is based on a sample of an entire population rather than on family contacts of known cases only. Cases of tuberculosis occurred mostly singly in households, and contact examination could have revealed only a very small percentage of the cases in this community.Another common belief is that the prevalence of infection among children under five years of age is a good index of disease in households. In this study, however, a large proportion of households with cases of tuberculosis had no children of this age, and even in homes with a bacteriologically confirmed case, about 88% of the children did not show evidence of infection.The tuberculin reactions of infected contacts were, on the average, slightly larger than those among non-contacts. Further, the proportion of large tuberculin reactions among infected persons was found to be greater in the younger age-groups than in the older age-groups. This finding has been taken to indicate that new infection gives rise to large reactions that subsequently wane to some extent in persons not constantly exposed to infection, such as, for example, the members of households without cases.

Adolescent↗
PubMed1995

Evaluation of an organ-donor-card campaign in Sweden.

One of the aims of this study was to evaluate an information campaign carried out in three geographical areas of Sweden in the winter of 1992-93. The campaign was intended to increase public awareness of organ donation and to increase the signing of donor cards. Another objective was to test the effects of different kinds of information. These were: A) an extensive "package" of information including training of key groups, lecturing at meetings and exhibitions, and advertisements of donor cards: B) a brochure to households including two donor cards; and C) a combination of A and B. Yet another aim was to reassess public opinion on transplantation issues, which had been surveyed before in 1987, 1988, and 1990. Random samples of the population in three campaign areas and a control sample were surveyed before and after the campaign, altogether 5600 persons. The average response rate was 69% (1992) and 68% (1993). In the two areas where the brochure had been distributed to the households, the rate of donor card holders had more than doubled (from 3% and 5% to 13% and 12%). In the two areas where the brochure had not been distributed, the rate was unchanged (5%). In the "brochure areas" also a somewhat larger number of people had informed their relatives about their decisions, compared with people in the other areas. In all campaign areas considerably more people were aware of the cards than in the control area. No attitude changes could be shown in any area.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2006

Space-time clustering of childhood malaria at the household level: a dynamic cohort in a Mali village.

BACKGROUND: Spatial and temporal heterogeneities in the risk of malaria have led the WHO to recommend fine-scale stratification of the epidemiological situation, making it possible to set up actions and clinical or basic researches targeting high-risk zones. Before initiating such studies it is necessary to define local patterns of malaria transmission and infection (in time and in space) in order to facilitate selection of the appropriate study population and the intervention allocation. The aim of this study was to identify, spatially and temporally, high-risk zones of malaria, at the household level (resolution of 1 to 3 m). METHODS: This study took place in a Malian village with hyperendemic seasonal transmission as part of Mali-Tulane Tropical Medicine Research Center (NIAID/NIH). The study design was a dynamic cohort (22 surveys, from June 1996 to June 2001) on about 1300 children (<12 years) distributed between 173 households localized by GPS. We used the computed parasitological data to analyzed levels of Plasmodium falciparum, P. malariae and P. ovale infection and P. falciparum gametocyte carriage by means of time series and Kulldorff's scan statistic for space-time cluster detection. RESULTS: The time series analysis determined that malaria parasitemia (primarily P. falciparum) was persistently present throughout the population with the expected seasonal variability pattern and a downward temporal trend. We identified six high-risk clusters of P. falciparum infection, some of which persisted despite an overall tendency towards a decrease in risk. The first high-risk cluster of P. falciparum infection (rate ratio = 14.161) was detected from September 1996 to October 1996, in the north of the village. CONCLUSION: This study showed that, although infection proportions tended to decrease, high-risk zones persisted in the village particularly near temporal backwaters. Analysis of this heterogeneity at the household scale by GIS methods lead to target preventive actions more accurately on the high-risk zones identified. This mapping of malaria risk makes it possible to orient control programs, treating the high-risk zones identified as a matter of priority, and to improve the planning of intervention trials or research studies on malaria.

Animals↗
PubMed2005

Out-of-pocket payments and utilization of health care services in Albania: evidence from three districts.

Like most countries in Central and Southeastern Europe, Albania is currently considering a number of alternative health sector reform strategies to improve the availability, quality and use of primary health care services. However, in order to assess the likely success of such reforms, more needs to be known about the current levels, distribution and determinants of household out-of-pocket spending on health. The purpose of this paper is to use the 2002 Albania Baseline Health Survey, a survey of 2,000 households in Berat, Kucova, and Fier, to understand the magnitude and distribution of out-of-pocket payments for health care services and to identify the factors that operate at the household- and provider-levels that determine whether individuals pay for health care and how much is paid within the month prior to the survey. Of particular interest in the study is examining the extent to which households incur out-of-pocket payments across a number of dimensions-including health insurance status, socio-economic status (SES), type of service, and type of facility. The findings suggest that out-of-pocket payments for care provided in government facilities are widespread, with marked differences in payment practices between inpatient and outpatient care. For outpatients using Primary Health Centers (PHCs), the type of facility that is the focus of the government's primary health care program, average payments appear to be nominal (0.6% of estimated total monthly household expenditure per capita). The multivariate findings indicate that insurance coverage significantly reduces the likelihood of paying for medicines to treat acute and chronic health problems, but not of paying for consultations. The policy implications of the findings on alternative health care financing reforms are briefly discussed.

Adolescent↗
PubMed1994

The impact of child-resistant containers on the incidence of paraffin (kerosene) ingestion in children.

The commonest cause of accidental poisoning in the South African black paediatric population is paraffin ingestion. In this intervention study a specifically designed child-resistant container (CRC) was introduced to evaluate whether its use would decrease the incidence of paraffin ingestion. CRCs were distributed to 20,000 households in the study area (Gelukspan district). No CRCs were distributed in the control area (Lehurutshe district). Health education about paraffin poisoning prevention was given in both the control and the study areas. The monthly incidence rates of paraffin ingestion were monitored during the 14-month intervention period after the distribution and were compared with the pre-intervention incidence rates in the study and control areas. The main finding was that the incidence of paraffin ingestion dropped by 47% in the study area during the intervention period. The circumstances surrounding the cases of paraffin ingestion that still occurred in the study and control areas were investigated by means of a questionnaire. We recommend that paraffin be sold in CRCs, and suggestions are made for improving health education to prevent paraffin poisoning.

Accidents, Home↗
PubMed2004

Material flow analysis of RDF-production processes.

The authors evaluate the possibilities of modifying the chemical characteristics of refuse-derived fuels (RDF) that are processed from residual household waste by mechanical operations to achieve and assure quality targets for relevant chemical concentrations, especially for heavy metals and chlorine. Quality assurance in the production of RDF demands that, together with an enrichment of the calorific value, highly toxic waste components are selectively separated and concentrated in a small stream to produce high yields of a relatively low polluted fuel. Based on the method of material flow analysis, a process evaluation is developed that considers the aspect of minimizing hazardous chemicals along with classical process data such as yield and product quality. Data on specific concentration of hazardous chemicals in waste components and their distribution in residual household waste as well as the results from large-scale test runs using different separation techniques demonstrate that mechanical operations alone are insufficient for separating hazardous chemicals. In the test runs, chemical compounds such as chlorine, cadmium and lead were often concentrated in the product. Even using optimized techniques, the ability to reduce hazards in the product is limited due to the distribution of the element concentration in the various components of the waste stream.

Chlorine↗
PubMed2000

Psychiatric disorder and dysfunction in the UK National Survey of Psychiatric Morbidity.

BACKGROUND: Psychiatric symptoms are wide-spread in the general population, but have little effect on performance. Deficits in performance and psychiatric symptoms may be the end point of processes common to both, or they may be caused by quite different factors. In this paper we examine the epidemiological distribution of psychiatric symptoms and performance deficits, as indicated by difficulties in activities of daily living (ADL). We hypothesised that ADL difficulties are partly independent of psychiatric symptoms, and that this is reflected in a different demographic distribution. METHOD: The household component of the National Surveys of Psychiatric Morbidity was based on a sample of around ten thousand subjects selected at random from the population of Great Britain. Psychiatric symptoms were elicited by lay interviewers using the revised Clinical Interview Schedule. Performance was assessed by asking about difficulties experienced in performing seven types of everyday activity. In this paper, our chosen variables were overall symptom and ADL deficit scores, and these were related to standard demographic variables. RESULTS: There were significant differences in the epidemiological distribution of psychiatric symptoms and ADL difficulties. In particular, men experienced more ADL difficulties at a given symptom level than women. There were also differences in relation to social class, employment status, marital status, ethnic group and age. CONCLUSIONS: ADL deficits and psychiatric symptoms are related in the general population, and this probably represents common factors in their origin. However, discrepancies in the social distribution of these phenomena suggest there are also aetiological differences. These do not appear to be the result of the impact of physical illness on activities of daily living. Our results emphasise that ADL difficulties should be studied separately, particularly in investigations of treatment seeking.

Activities of Daily Living↗
PubMed2005

Inequality in willingness-to-pay for community-based health insurance.

The purpose was to provide information for devising community-based health insurance (CBI) policies that reduce inequality in enrolment and further inequality in access to health services. A two-stage cluster sampling was used in the household survey. Inequalities in willingness-to-pay (WTP) for CBI are examined by expenditure quintile using data collected from a household survey. Interviews were conducted with 2414 individuals, 705 of whom were household heads. A bidding game method was used to elicit WTP. Individuals and households were assigned to 6-month expenditure quintiles. We found that mean and median individual WTP for CBI was significantly higher for higher spending quintiles, as was mean and median household WTP. The curves of cumulative percentage of individual and household WTP shifted rightwards for higher quintiles, implying that at any given premium the lower the quintile the lower the uptake of CBI. The Gini coefficient for individual WTP and household WTP was 0.15 and 0.08, respectively, and for individual 6-month expenditure and household 6-month expenditure is 0.68 and 0.63, respectively. The results imply that the premium needs to be adjusted for income; otherwise, a lower proportion of poor people will enrol in CBI and without exemptions or subsidies the poor will have less access to health services than the rich. Thus, exemptions and subsidies for the poor for enrolling in CBI are an important issue for decision-makers with an objective of improving equity of health and helping the poor to break out of the cycle of poverty. Since the distribution of WTP by household is less unequal than the distribution of WTP by individuals, the household might be a better unit of enrolment in terms of equity than the individual.

Adult↗
PubMed2006

Provincial income inequality and self-reported health status in China during 1991-7.

BACKGROUND: The relationship between income inequality and health has been widely explored. Today there is some evidence suggesting that good health is inversely related to income inequality. After the economic reforms initiated in the early 1980s, China experienced one of the fastest-growing income inequalities in the world. The state of China in the 1990s is focussed on and possible effects of provincial income inequality on individual health status are explored. METHODS: A multilevel regression model is used to analyse the data collected in 1991, 1993 and 1997 from nine provinces included in the China Health and Nutrition Survey. The effects of provincial Gini coefficients on self-rated health in each year are evaluated by two logistic regressions estimating the odds ratios of reporting poor or fair health. The patterns of this effect are compared among the survey years and also among different demographic groups. RESULTS: The analyses show an independent effect of income inequality on self-reported health after adjusting for individual and household variables. Furthermore, the effect of income distribution is not attenuated when household income and provincial gross domestic product per capita are included in the model. The results show that there is an increased risk of about 10-15% on average for fair or poor health for people living in provinces with greater income inequalities compared with provinces with modest income inequalities. CONCLUSIONS: In China, societal income inequality appears to be an important determinant of population health during 1991-7.

China↗
PubMed1994

Sampling guidelines for testing secondary attack rates associated with short-latency infectious diseases.

This paper discusses power and efficiency properties of the model proposed by Longini and Koopman for quantifying and testing secondary attack rates gathered from final size distribution data on infections in households. Sample size requirements are offered for a generalized likelihood ratio test that makes use of the secondary attack rate parameter implicated in the Longini-Koopman model. The appropriateness of this statistic is also considered. In addition, a sequential likelihood ratio test of a secondary attack rate parameter is derived for infectious diseases with short latency or asymptomatic periods. A comparison of the proposed sequential and fixed sample tests is described. Finally, applications involving final size distributions of household influenza infections are used to illustrate the practical merits of the proposed tests.

Humans↗
PubMed1985

Horizontal transmission of hepatitis B virus among children and adults in five rural villages in Zambia.

To determine whether horizontal transmission of the hepatitis B virus contributes to the high prevalence of infection with this virus in an endemic region, residents of five villages in Zambia were tested for hepatitis B serologic markers. The prevalence of hepatitis B was determined by testing samples from 620 residents. By examining paired serum samples from 79 children and 80 adults, it was determined that new infections occurred during the five years of this study in at least 14 children (18%) (aged 4-17 years) and ten adults (12%) (aged 23-65 years). These 24 new infections were distributed among 20 households and were not associated with active HBV infections in the mother or, in most cases, other family members. Intervention to prevent hepatitis B in regions such as rural Zambia will require vaccination of susceptible children and adults as well as newborn infants.

Adolescent↗
PubMed1980

Cattle ecology of upland and deltaic areas of West Bengal.

Two large cattle populations were enumerated by a house to house survey in several villages in upland and deltaic regions of rural West Bengal, India. The basic population parameters of the 2 were compared and their inter-relationships related to the different environmental setting of each region. The total number, density, sex ratio, age distribution, number per household, basic productivity and general management of the cattle differed significantly. While the male cattle were activity bought and sold into and out of each region, the female cattle appeared to represent a relatively unmanipulated subpopulation in both regions. The cattle in each area consumed items of little direct human utility and converted them into valuable materials highly desired by the respective human populations.

Age Factors↗
PubMed2003

Acute outbreak of gnathostomiasis in a fishing community in Sinaloa, Mexico.

An increasing number of human cases of gnathostomiasis have been reported in Sinaloa, Mexico, most of whom have a custom of eating of raw fish dishes such as 'cebiche'. Here we report five adult patients, three women and two men, having an acute episode of vomiting and abdominal pain a few minutes after eating a dish of cebiche prepared from a spotted sleeper perch (Eleotris picta) fished from a nearby lake in southern Sinaloa. All five patients experienced acute throat pain, chest and joint pains, headache and fever. One patient, a 55-year-old male, was hospitalized with suspected pancreatitis and pneumonia. By 8-9 days later, all five patients developed between three and 12 edematous, migrating skin lesions on the back, abdomen, upper and lower extremities, face, eye and scalp. By ELISA, all of them were sero-positive to Gnathostoma doloresi antigen and had elevated IgE levels. Eosinophilia was found in two patients. These patients lived in an agricultural and fishing community. In this community we carried out a sero-epidemiological survey and study of living conditions in a random sample of 309 individuals distributed in 74 households. Frequent consumption of raw fish was reported in 36% of households, and 12 individuals had a clinical history of migrating skin lesions. The sero-prevalence to Gnathostoma antigens was 34.95%. Five fish species and four species of ichthyophagous birds collected from three lakes in the village and a nearby estuary were infected with the advanced third-stage larvae of G. binucleatum, a species found in Ecuador and Mexico. The results describe the first known outbreak of acute gnathostomiasis on the American continent.

Acute Disease↗
PubMed1995

Evaluation of mouth self-examination in the control of oral cancer.

This study was planned to evaluate the feasibility of mouth self-examination (MSE). Some 450 college students distributed to 9000 households a brochure describing the risk factors of oral cancer, the appearance of premalignant and malignant lesions of the oral cavity and the methods of MSE with pictures. All subjects with tobacco habits and/or aged 30 years or over were asked to read the brochure carefully and to report to the clinic conducted in their locality on fixed days, if they suspected an abnormality while practising MSE. Out of the approximately 22,000 eligible subjects, 8028 (36%) practised MSE. Among the 247 subjects reporting to the clinics seven (3%) had oral cancer and 85 (34%) had oral precancerous lesions; the others had either benign lesions or normal anatomical variations. Six of the seven subjects with oral cancer had stage I disease, five of whom accepted treatment and were alive disease-free 5 years later. The detection rates of oral cancer compared favourably with the previously reported detection rates using trained health workers. Although this study demonstrated that MSE is feasible, larger studies are required to evaluate whether health education could result in a sustained practice of MSE resulting in reduction in incidence of and mortality from oral cancer.

Adult↗
PubMed2001

Comparison of the cost and cost-effectiveness of insecticide-treated bednets and residual house-spraying in KwaZulu-Natal, South Africa.

Residual house-spraying (RHS) has been the mainstay of South African malaria prevention for more than 50 years, but it has been argued that insecticide-treated bednets (ITBN) could be a more effective and appropriate method of control. To provide a rational basis for choosing between the interventions, a trial was conducted during 1998 and 1999 in northern KwaZulu-Natal to collect comparable data on the effectiveness, acceptability and cost of the two interventions. The current practice of house-spraying once a year was compared with ITBN, distributed free to households and retreated annually at several specific centres. The base case results show ITBN to be significantly more effective in preventing malaria cases than RHS (overall adjusted rate ratio of 0.69), and also more costly, with an incremental economic cost per person of ITBN compared with RHS of R8.68 (US$1.42) per year, giving a gross incremental cost per case averted of R111 ($18) (1999 prices). Estimating the number of deaths averted, based on the average case fatality rate, gave a gross incremental cost per death averted of R11 718 ($1915). The additional cases averted were estimated to lead to drug cost savings of around R1 ($0.16) per capita per year, giving a net cost per case averted of R98 ($16), and net cost per death averted of R10 377 ($1696). Although the finding that the economic costs of ITBN were higher than those for RHS was relatively robust to parameter variations, the extent of the cost margin was sensitive to changes in the price and useful life of the net, and the price of the insecticide. Moreover, a switch to ITBN could lead to net financial savings if the price per net fell below $3.57 (R21.85), or if a change in policy allowed a significant reduction in the number of permanent full-time malaria control staff. In view of the greater effectiveness of ITBN, policy makers may view ITBN as a cost-effective use of resources, even if the economic costs are higher. If ITBN are implemented, close monitoring will be required of use, retreatment and useful life of nets, and resistance to insecticides, to assess any change over time in relative cost-effectiveness, and any threat to the role of the programme as a barrier to the spread of malaria transmission to other areas.

Bedding and Linens↗
PubMedDate not supplied

Contamination of individuals by radon daughters: a preliminary study.

Body radon daughter contamination reflects relative individual respiratory exposures to radon daughters; counts can be related both to household radon levels and to lung cancer risk factors such as sex and tobacco smoking. Radon daughters were counted by gamma spectroscopy from 180 adult residents of eastern Pennsylvania. A seven-position, 35-min scan was conducted in a mobile body counter, generally during afternoon or evening hours. Track-etch detectors for household radon were distributed, and were recovered from 80% of the subjects. Over 75% of the population had environmentally enhanced radon daughter contamination. House radon levels were strongly related, as anticipated, to radon daughter contamination in the 112 subjects for whom both sets of measurements were available (p less than .001); basement measurements were as strongly related to personal contamination as were living area measurements; bedroom measurements were slightly more strongly correlated. Both sex (p less than .02) and cigarette smoking (p less than .01) significantly modified the relationships, after nonlinear adjustment for travel times. Using a logarithmic model, a given house living-area radon level was associated in females with body contamination by radon daughters 2-3 times that in males. Nonsmokers had 2-4 times higher levels of contamination than smokers. Results are for the total of internal and external contamination, these being highly correlated in preliminary experiments. Time usage and activity patterns of the subjects are believed to be important in explaining these findings, and may become important variables in radon risk assessment.

Adult↗