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PubMed2001

A stochastic model for the aggregation of Onchocerca volvulus in nodules.

A model is presented which describes the aggregation of female Onchocerca volvulus in nodules and their distribution in the human population. The basic model is based on a single parameter, the formation probability q, which represents the probability with which incoming larvae form a new nodule. This parameter describes parasite behaviour which cannot easily be recognized in available data without modelling. The estimate for the average formation probability of muq = 0.39 suggests an attraction of the invading infective larvae to already existing nodules or resident worms with probability 0.61. No significant difference in muq was found between the forest and savanna parasite strains. The model can be used inversely to estimate the worm burden of persons from palpation data. The observed variance in the number of nodules per person requires the assumption of a variance-increasing mechanism which was implemented by heterogeneity within the host population (extended model with 2 parameters). Possible reasons for this heterogeneity are presented and its implications concerning the reproductive biology of the parasite are discussed.

Animals↗
PubMed2006

Sociodemographic variations in parental role strain: results from a national general population survey.

OBJECTIVE: The aim of the study was to analyse sociodemographic differences in specific and overall parental role strains in the general population of parents of children under 18. METHODS: The study is based on a subsample of 872 Icelandic parents of children under 18, derived from a national postal health survey of Icelandic adults (response rate 69%). RESULTS: The study found that parents age 25-54, parents with more children living at home, employed parents, and mothers, especially single mothers and mothers in lower income families, were more exposed than other parents to specific and overall strains associated with the parental role. CONCLUSIONS: Parental role strains were unevenly distributed in the parental population. Describing and explaining the distribution of parental role strains contributes to the wider understanding of adult population mental health.

Adolescent↗
PubMed2006

Retirement patterns from career employment.

PURPOSE: This article investigates how older Americans leave their career jobs and estimates the extent of intermediate labor force activity (bridge jobs) between full-time work on a career job and complete labor-force withdrawal. DESIGN AND METHODS: Using data from the Health and Retirement Study, we explored the work histories and retirement patterns of a cohort of retirees aged 51 to 61 in 1992 during a 10-year period in both cross-sectional and longitudinal contexts. We examined determinants of retirement patterns in a multinomial logistic regression model. RESULTS: We found that a majority of older Americans with career jobs retire gradually, in stages, rather than all at once. We also found that the utilization of bridge jobs was more common among younger respondents, respondents without defined-benefit pension plans, and respondents at both the lower and upper ends of the wage distribution. IMPLICATIONS: Older Americans are now working longer than pre-1980s trends would have predicted. Given concerns about the traditional sources of retirement income (Social Security, employer pensions, and prior savings), older Americans may have to rely more on earnings. This article suggests that many are already doing so by moving to bridge jobs after leaving their career employment.

Aged↗
PubMed1993

A study of the importance of the enterotoxigenic E. coli in children with acute diarrhoea in Recife, Brazil.

Even today acute diarrhoea is a major cause of morbidity and mortality in young children. It is a serious public health problem in less-developed countries, primarily in households whose income is low. As such, it is one of the main causes of death, affecting the undernourished in particular. The potential enteropathogenic agents are distributed universally. However, there is a major difference in the prevalence, according to the areas and the characteristics of the population groups which were studied. In Brazil, since the 1970s, our attention has been drawn to the importance of the classic enteropathogenic strains of E. coli (EPEC) in the aetiology of diarrhoeal diseases, primarily those present in weaned infants in inner city neighbourhoods. On the other hand, Guerrant and co-workers, and Queiroz and co-workers found significant percentages of isolated colonies of enterotoxigenic coli (ETEC) in the stool material of children with symptoms of acute diarrhoea. In rural areas of less-developed countries the incidence of episodes of ETEC provoking diarrhoea is estimated to be between five and ten per person/year. Due to the social and medical gravity of acute diarrhoea, and to the lack of studies dealing with the aetiopathogenic role of the strains of ETEC in our area, we decided to analyse the frequency of isolation of ETEC in children with and without diarrhoea who were attending the out-patient department of the Instituto Materno Infantil de Pernambuco/IMIP.

Acute Disease↗
PubMed1984

Use of health services by chronically ill and disabled children.

Hospitalization and use of outpatient health care services during a 1-year period by 369 pediatric patients with cystic fibrosis, cerebral palsy, myelodysplasia, or multiple physical handicaps and 456 randomly selected children without congenital conditions from the Cleveland area were examined. Use of hospitalization and outpatient services by the average chronically ill or disabled child was 10 times that of the average comparison child. Physician specialists, occupational and physical therapists, and school nurses were the major outpatient categories used disproportionately by children with chronic illnesses or disabilities. The major share of health care used by children with chronic conditions was attributable to a small subset of children: All hospital care was accounted for by one third of the children, and three quarters of all outpatient care was accounted for by one quarter of that sample. Hospital care was used at similar rates by the four diagnostic groups. However, amount and type of outpatient care varied by diagnosis, level of functional impairment, race, and income. Estimated average expenditure for health services used by the chronically ill or disabled sample was 10 times that of the comparison sample. Relative distribution of estimated expenditures across types of services differed for the two samples as well as among diagnostic categories.

Adolescent↗
PubMed2004

Ecological study of solar radiation and cancer mortality in Japan.

Geographic observation of the increased mortality of some cancers at higher latitudes has led to a hypothesis that vitamin D produced after exposure to solar radiation has anti-carcinogenic effects. However, it is unclear whether such association would be observed in countries like Japan, where fish consumption, and therefore dietary vitamin D intake, is high. Pearson correlation coefficients were calculated between averaged annual solar radiation levels for the period from 1961 through 1990 and cancer mortality in the year 2000 in 47 prefectures in Japan, with adjustments for regional per capita income and dietary factors. A moderate, inverse correlation with solar radiation was observed for cancers of the esophagus, stomach, colon, rectum, pancreas, and gallbladder and bile ducts in both sexes (correlation coefficient, ranging from -0.6 to -0.3). The results of this study support the hypothesis that increased exposure to solar radiation reduces the risk of cancers of the digestive organs.

Body Burden↗
PubMed2003

Nutritional risk factors for older refugees.

This study describes risk factors for poor nutrition among older Rwandan refugees. The most important areas of nutritional risk for older refugees are: physical ability and mobility; income and access to land; access to appropriate food rations; meeting basic needs such as water, fuel, shelter; equal access to essential services (food distribution, health services, mills, feeding programmes); and psycho-social trauma. Women and older elderly (> 70 years) are significantly more often in disadvantaged positions, such as having poor socio-economic status, poor health, poor mobility, lower food intake, diminished social status, respect and social network. Older refugees are at higher risk than younger refugees and at higher risk than older people in stable situations. They should remain in good nutritional and general health for their own well-being and that of their dependants. In addition to an adequate diet, a support network seems to be an important preventive aspect.

Aged↗
PubMed2005

Socially unbiased parenting support on the Internet: a cross-sectional study of users of a large Swedish parenting website.

BACKGROUND: The Internet is becoming increasingly recognized as a source of social support. Parents of children with cancer and autism have been shown to find social support online, and many parents of healthy infants and children seek information about parenting online. However, access and use of the Internet is greater among socio-economically advantaged groups, a phenomenon known as the 'digital divide'. Our aim was to investigate whether users of a Swedish general parenting website perceived support in the parenting role and, if so, whether this support was socially biased because of the digital divide phenomenon. METHODS: Users of the largest Swedish parenting website were asked to participate in the study. A total of 2221 users completed the anonymous survey posted on the website during a one-week period. RESULTS: Most respondents (95%) were female (mean age 30.6 years). Respondents' educational level was slightly, but not significantly, higher than that in the general population, whereas 68% had income levels at or under the national average, contradicting the intuitive hypothesis that users would be socio-economically privileged. Perceived social support, measured by the Interpersonal Support Evaluation List (ISEL) appraisal subscale, indicated high perceived support. Living without a partner and having lower levels of income and education increased perceived support. The perception that other parents' opinions are more valuable than the advice of experts was influential in the regression equation for ISEL scores, indicating that peer help is important in online social support. CONCLUSIONS: Internet use for general parenting issues in Sweden, mainly by women, does not seem to follow the digital divide phenomenon. Therefore, the internet provides an exciting opportunity for future infant and child public health work. The lack of fathers, however, was a surprising finding and introduces a gender bias into this seemingly socially unbiased medium.

Adolescent↗
PubMed2002

Achieving equity in Medicare disproportionate share payments to rural hospitals: an assessment of the financial impact of recent and proposed changes to the disproportionate share hospital payment formula.

Historically, the Medicare Disproportionate Share Hospital (DSH) payment program has been less favorable to rural hospitals: eligibility thresholds were higher and the payment adjustment was smaller for rural than for urban hospitals. Although the Medicare, Medicaid, and SCHIP Benefit Improvement and Protection Act (BIPA) of 2000 established a uniform low-income threshold and increased the magnitude of the adjustment for certain small and rural hospitals as a means to promote payment equity, the DSH distribution formula continues to vary by location. This study examines how the DSH revisions mandated under BIPA are likely to affect rural hospitals' financial performance and simulates the financial impact of implementing a uniform DSH payment adjustment. Using data from the 1998 Medicare cost report and impact files, this study found that two-thirds of both rural and urban hospitals would have qualified for DSH payments following BIPA compared with only one-fifth of rural hospitals and one-half of urban hospitals prior to BIPA. Although the impact of BIPA revisions on rural hospitals' total margins were found to be modest, the financial impact of a uniform payment adjustment would be somewhat greater: rural hospitals' average total margins would have increased by 1.6 percentage points. Importantly, 20% of rural hospitals with negative total margins would have been "in the black" if rural and urban hospitals were reimbursed using the same DSH formula. These findings suggest that elimination of rural and urban disparities in DSH payment could strengthen the rural health care safety net.

Fee-for-Service Plans↗
PubMed2004

The wealth effects of smoking.

OBJECTIVE: To investigate the impact of smoking on the wealth of US young baby boomers. METHODOLOGY: The research analyses self reported responses of both smoking habits and wealth holdings from a nationally representative sample of US individuals born between 1957 to 1964 (n = 8908). Data are from four waves (1984, 1992, 1994, 1998) of the National Longitudinal Survey of Youth 1979 cohort, a random survey of individuals conducted by the US Department of Labor using a stratified multistage area sample design. RESULTS: Regression results show lower net worth is associated with smoking, after holding constant a variety of demographic factors. Respondents who were ever heavy smokers are associated with a reduction in net worth of over 8300 dollars while light smokers are 2000 dollars poorer compared to non-smokers. Beyond this reduction, each adult year of smoking is associated with a decrease in net worth of 410 dollars or almost 4%. CONCLUSIONS: While a causal relation cannot be proven, smokers appear to pay for tobacco expenditures out of income that is saved by non-smokers. Hence, reductions in smoking will boost wealth, especially among the poor.

Adult↗
PubMedDate not supplied

Pediatric hospitalists: quality care for the underserved?

Despite the rapid growth in pediatric hospitalist services, there is little empiric information about the impact of pediatric hospitalists. This study compared process and outcome variables related to the inpatient care of 182 pediatric patients, half of whom were cared for by hospitalists and half by their primary care providers (PCP). Results indicated that, while hospitalists cared for patients of substantially lower socioeconomic status, they delivered care more economically for patients with asthma, with no significant differences in rates of return to the emergency room or rehospitalizations. Children in both services demonstrated equivalent levels of returning to their PCP for follow-up visits and were in equally good health 1 month after discharge. Additionally, no negative impact was evident on patient satisfaction at discharge; in fact, the hospitalists' patients were more satisfied with aspects of their care. Hospitalists may, therefore, provide a vital service by ensuring quality inpatient care for low-income children.

Analysis of Variance↗
PubMed1992

The Older Americans Act: should participants share in the cost of services?

Since its inception in 1965, the Older Americans Act has provided social services free of charge to older people, regardless of income. In recent years, the scarcity of resources has sparked a debate as to whether participants who can afford to pay for services should be required to do so. Of concern is whether charging fees will change the fundamental nature of these popular programs by imparting a "welfare" stigma. Other programs that require fees vary enormously by state, and there has been little documentation of their impact on participation, equity of service delivery, or public attitudes. In order to evaluate current proposals, it is necessary to analyze the distributional effects of the cost-sharing system, how the program will be administered, what impact it will have on service use, which services would be subject to cost sharing and at what income levels, and what constitutes a "reasonable" fee for service.

Aged↗
PubMed1996

Socioeconomic differentials in mortality risk among men screened for the Multiple Risk Factor Intervention Trial: I. White men.

OBJECTIVES: This study examined socioeconomic differentials in risk of death from a number of specific causes in a large cohort of White men in the United States. METHODS: For 300 685 White men screened for the Multiple Risk Factor Intervention Trial between 1973 and 1975, data were collected on median income of White households in the zip code of residence, age, cigarette smoking, blood pressure, serum cholesterol, previous myocardial infarction, and drug treatment for diabetes. The 31 737 deaths that occurred over the 16-year follow-up period were grouped into specific causes and related to median White family income. RESULTS: There was an inverse association between age- adjusted all-cause mortality and median family income. There was no attenuation of this association over the follow-up period, and the association was similar for the 22 clinical centers carrying out the screening. The gradient was seen for many-but not all-of the specific causes of death. Other risk factors accounted for some of the association between income and coronary heart disease and smoking-related cancers. CONCLUSIONS: Socioeconomic position, as measured by median family income of area of residence, is an important determinant of mortality risk in White men.

Adult↗
PubMed1996

Socioeconomic differentials in mortality risk among men screened for the Multiple Risk Factor Intervention Trial: II. Black men.

OBJECTIVES: This study examined socioeconomic differentials in risk of death from a number of causes in a large cohort of Black men in the United States. METHODS: For 20 224 Black men screened for the Multiple Risk Factor Intervention Trial between 1973 and 1975, data were collected on median family income of Black households in zip code of residence, age, cigarette smoking, blood pressure, serum cholesterol, previous heart attack, and drug treatment for diabetes. The 2937 deaths that occurred over the 16-year follow-up period were grouped into specific causes and related to median Black family income. RESULTS: There was an inverse association between age-adjusted all-cause mortality and median family income. There was no attenuation of this association over the follow-up period, and the association was similar for the 22 clinical centers carrying out the screening. The gradient was seen for most of the specific causes of death, although the strength of the association varied. Median income was markedly lower for the Black men screened than for the White men, but the relationship between income and all-cause mortality was similar. CONCLUSIONS: Socioeconomic position is an important determinant of mortality risk for Black men. Even though Blacks lived in areas with substantially lower median family income than Whites, the association of income with mortality was similar for Blacks and Whites.

Adult↗
PubMed1997

The relationship between the race/ethnicity of generalist physicians and their care for underserved populations.

OBJECTIVES: The purpose of this study was to examine empirically the relationship between physicians' race or ethnicity and their care for medically underserved populations. METHODS: Generalist physicians who received the MD degree in 1983 or 1984 (n = 1581) were surveyed. The personal and background characteristics of four racial/ethnic groups of physicians were compared with the characteristics of their patients. RESULTS: When the potentially confounding variables of gender, childhood family income, childhood residence, and National Health Services Corps financial aid obligations were controlled, generalist physicians from underrepresented minorities were more likely than their nonminority counterparts to care for medically underserved populations. CONCLUSIONS: Physicians from underrepresented minorities are more likely than others to care for medically underserved populations.

Adult↗
PubMed2000

Mobility impairments and use of screening and preventive services.

OBJECTIVES: Primary care for people with disabilities often concentrates on underlying debilitating disorders to the exclusion of preventive health concerns. This study examined use of screening and preventive services among adults with mobility problems (difficulty walking, climbing stairs, or standing for extended periods). METHODS: The responses of non-institutionalized adults to the 1994 National Health Interview Survey, including the disability and Healthy People 2000 supplements, were analyzed. Multivariable logistic regressions predicted service use on the basis of mobility level, demographic characteristics, and indicators of health care access. RESULTS: Ten percent of the sample reported some mobility impairment; 3% experienced major problems. People with mobility problems were as likely as others to receive pneumonia and influenza immunizations but were less likely to receive other services. Adjusted odds ratios for women with major mobility difficulties were 0.6 (95% confidence interval [CI] = 0.4, 0.9) for the Papanicolaou test and 0.7 (95% CI = 0.5, 0.9) for mammography. CONCLUSIONS: More attention should be paid to screening and preventive services for people with mobility difficulties. Shortened appointment times, physically inaccessible care sites, and inadequate equipment could further compromise preventive care for this population.

Adult↗
PubMed2005

Household income is associated with the risk of metabolic syndrome in a sex-specific manner.

OBJECTIVE: To assess the relationship between household income and metabolic syndrome in men and women. RESEARCH DESIGN AND METHODS: A total of 1,695 men and 1,664 women, aged 35-64 years, from three distinct geographical areas of France were investigated. Waist girth, plasma triglycerides, HDL cholesterol, glucose, and systolic blood pressure were used to define metabolic syndrome according to the National Cholesterol Education Program (NCEP)/Adult Treatment Panel III (ATPIII) guidelines. Household income, educational level, occupational category, working status, consumption of psychotropic drugs, accommodation status, household composition, physical activity at work and during leisure time, alcohol consumption, and smoking habits were recorded with a standardized questionnaire. RESULTS: There were 390 (23.0%) men and 381 (16.9%) women who satisfied NCEP/ATPIII criteria for metabolic syndrome. Household income (P < 0.0001) and consumption of psychotropic drugs (P = 0.0005) were associated with metabolic syndrome in women but not in men. In contrast, educational level, occupational category, working status, and accommodation status were associated with metabolic syndrome in both men and women. After adjustment on lifestyle variables, household income (interaction P < 0.004) remained inversely associated with metabolic syndrome in women but not in men. CONCLUSIONS: These data suggest that limited household income, which reflects a complex unfavorable social and economic environment, may increase the risk of metabolic syndrome in a sex-specific manner.

Adult↗
PubMedDate not supplied

Helping employees stretch their retirement dollars.

Under a provision of the Deficit Reduction Act of 1984, employees who participate in qualified defined contribution pension programs can increase retirement income by spreading out the installments over an annually redetermined life expectancy. The provision also enables employees to withdraw more than the minimum required distribution during periods of inflation and to continue receiving payments beyond age 100. In most cases, the change in distribution will provide payments throughout the participant's lifetime and a small balance for the participant's estate--rather than a fixed number of mandatory withdrawals spread over a shorter period.

Actuarial Analysis↗