The severely to profoundly hearing impaired population in the United States: prevalence and demographics.
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Age Distribution↗
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Poverty in the United States, 1985.
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Black or African American↗
Combatting anemia in adolescent girls: a report from India.
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Adolescent↗
Street children of India -- a glimpse.
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Adolescent↗
Dental care considerations for young children.
Although the majority of America's children enjoy remarkably good oral health, a significant subset of low-income, minority, medically and developmentally compromised, and socially vulnerable children continue to suffer significant and consequential dental and oral disease. Most of this inequitably distributed disease burden is preventable through early and individualized preventive care. Yet the primary-care medical and dental workforce is ill-prepared to manage the oral health needs of young children. Demographic trends suggest that the problem of disparities in both oral health status and access to competent dental services will continue to worsen for young children. Impediments to improving the oral health of young children include barriers between medical and dental systems of care, paucity of private and safety-net facilities and providers in many areas where vulnerable children reside, and dysfunctional Medicaid insurance programs. Barriers are generated by parents, providers, payers, and systems of care as well as by the age-appropriate behaviors of young children. Vulnerable families often do not access the case management services and disease control information needed to effectively address their young children's needs. Approaches to improving the oral health of young children therefore include enhancing public education about oral health, the appropriateness of early and periodic dental care, and primary prevention. Improvements in workforce numbers, distribution, diversity, and competency are needed. Attention to delivery systems and public insurance capacities are also necessary to effectuate improvements. HRSA's Title VII and VIII health professions training programs could potentially address may of these barriers and shortcomings. Training enhancements for predoctoral, postdoctoral, and graduate dentists and hygienists as well as for primary-care medical providers hold the key to marked improvements in the oral health of young children. Enhanced training of health care providers is the necessary if not sufficient condition to children whose daily life experiences are compromised by dental and oral diseases that are overwhelmingly preventable.
Child, Preschool↗
Familial aggregation and determinants of post challenge blood glucose in four ethnic populations.
We determine the familial aggregation and determinants of post challenge blood glucose (BG) in four ethnic populations. A national health survey was conducted in Malaysia in 1996. 18,372 subjects aged 30 years or older had post challenge BG measurements and another 846 subjects were pre-diagnosed to have diabetes on drug treatment. We imputed the BG of diagnosed diabetics by randomly selecting a value from the BG distribution of undiagnosed diabetics. Covariates of interest include ethnicity, gender, age, urban-rural residence, body mass index (BMI), physical activity, education, and household income. Ethnic and gender differences in mean BG persisted after adjustment for other covariates. Age and BMI were the only two factors with strong, positive and consistent effects on mean BG in all ethnic-sex groups. Family resemblance for BG as measured by intraclass correlation was small and homogenous across all ethnic groups and did not differ from resemblance in BG between spouses. In conclusion, BMI was the only consistent modifiable predictor of BG in all ethnic-sex groups. Environmental factors are probably more important than genetic factors as determinant of BG in the four ethnic populations studied.
Adult↗
[Factors affecting the cooperation of hypertensive patients in the process of treatment].
INTRODUCTION: Arterial hypertension is one of the leading causes of cardiovascular morbidity and mortality. Despite rigorous knowledge of pathophysiology of this entity and wide accessibility to highly effective drugs the rate of hypertension control is still low. Currently the lack of appropriate patient cooperation including irregular drug taking and unhealthy lifestyle are regarded to contribute most to the low efficacy of hypertension treatment. Many studies demonstrated the role of educational programmes in better hypertension control. It is now necessary to indicate those groups that need such efforts particularly. AIM: The aim of this study was to assess the factors affecting regular drug taking among hypertensive patients. METHODS: 222 ambulatory patients (x=56 years, 123 males and 99 females) of the I Department of Cardiology of the Jagiellonian University Medical College in Krakow were analyzed in this study. We used a detailed, uniform own questionnaire to get the following information from the patients: regularity of drug taking, age, level of education, place of living, occupational category, incomes, coexisting diseases, costs of drugs and self-control of blood pressure. Afterwards we compared two groups: patients that use drugs systematically and those who do not. A computer software Statistica PI was used for statistical analyses. RESULTS: Most of patients (129; 58%) declared regular drug taking. We observed statistically significant differences between two analyzed groups for the following parameters: level of education, place of living, occupational category, incomes, knowledge of the definition of hypertension and regularity of blood pressure self-control. Patients living in cities, currently working, with higher level of education, higher incomes, well defining hypertension and measuring blood pressure regularly were more systematic in drug taking. The logistic regression analysis showed that only low incomes were independently associated with irregular drug using.
Adult↗
[A physician demand and supply forecast model for Nova Scotia].
RATIONALE: There is well-founded concern about the current and future availability of Health Human Resources (HHR). Demographic trends are magnifying this concern -- an ageing population will require more medical interventions at a time when the HHR workforce itself is ageing. The lengthy and costly training period for most health care workers, especially physicians, poses a real challenge that requires planning these activities well in advance. Hence, there is definite need for a good HHR forecasting model. OBJECTIVES: To present a physician forecasting model that projects the Full-Time Equivalent (FTE) demand for and supply of physicians in Nova Scotia to the year 2020 for three specialties: general practitioners, medical, and surgical. The model enables gap analysis and assessment of alternative policy options designed to close the gaps. METHODOLOGY: The methodology for estimating demand fo physician services involves three steps: (i) Establishing the FT for each physician. To this end we calculate the income of each physician using Physician Billings Data and then identify the 40th and 60th percentile income levels for each of the 40 specialties. The income levels are then used to calculate the FTE using a formula developed at Health Canada; (ii) Calculating the FTE for each service by distributing the FTE of each physician at the service level (i.e., by patient age, sex, most responsible diagnosis, and hospital status group); and (iii) Using Statistics Canada's population projections to project future demand for three broad medical disciplines: general practitioners, medical specialist, and surgical specialists. The supply side of the model employs a stock/flow approach and exploits time-series and other data for variables, such as emigration, international medical graduates (IMGs), medical school entrants, retirements, mortality, and so on, which in turn allow us to access a host of policy parameters. RESULTS: Under the status quo assumption, demand for physician services will outstrip the growth in supply for all three specialties. CONCLUSIONS: The model can simulate supply-side policy changes (e.g. more IMGs, delayed retirements) and can also reflect changes in demand (e.g. a cure for leukemia; different work intensities for physicians). The model is highly parameterized so that it can accommodate shocks that may influence the future requirements for physicians. Once a future requirement is determined, the supply model can identify the policy levers (new entrants, immigration, emigration, retirement) necessary to close the gap between demand and supply. The model is a user-friendly tool made for policy makers to formulate appropriate physician workforce planning.
Adult↗
The demographic bias of email as a survey method in a pediatric emergency population.
UNLABELLED: Email has been considered as a communication medium between patients and clinicians in pediatric emergency departments, but the demographic bias involved in using email has not been fully explored. We developed a paper based survey to explore access, willingness to participate and the demographic bias of email within our parent population. METHODS: To 1733 possible subjects, 1200 surveys were distributed with a return of 1018, a survey response rate of 85%, and a population response rate of 59%. RESULTS: Subjects from families with incomes less than $60,000 per year had lower access rates (OR = 0.40, 95 (OR = 0.37, [0.17, 0.81]). Employment outside of the home was associated with increased email access rates (OR = 1.79, 95% CI [1.19, 2.70]). Visible minority status was associated with an increased willingness to participate (OR = 1.84, 95 as was low education (OR = 2.12, 95% CI [1.04, 4.32]). The population of theoretical responders to an email based quality assurance process would have been significantly different from the base population of adults accompanying children to our emergency department as a result of these biases. CONCLUSIONS: We have demonstrated a degree of demographic bias in email access rates, negatively affecting those individuals with lower income, less employment, and lower education. Email based surveys directed at parents in pediatric emergency departments should include questions on income, employment and education in order to permit those who analyze the data to correct for these variables. More research is needed to confirm these findings.
Bias↗
How old are U.S. fathers?
One in every six U.S. birth certificates have no information on the age of the baby's father; for more than four in 10 babies born to adolescent women, no data are available on the father's age. Information from mothers aged 15-49 who had babies in 1988 and were surveyed in the National Maternal and Infant Health Survey indicates that fathers for whom age is not reported on the birth certificate are considerably younger than other fathers. In 1988, 5% of fathers were under age 20, and 20% were aged 20-24. Fathers typically are older than mothers, especially when the mothers are teenagers. Fathers who are unmarried, black or partners of lower income women are younger than other fathers.
Adolescent↗
The effect of expansions in Medicaid income eligibility on abortion.
In this paper we examine the effect of expansions in Medicaid income eligibility on abortion, using individual-level data from South Carolina, Tennessee, and Virginia. The results suggest that for unmarried nonblack women with less than a high school degree, expansions of income eligibility lowered the probability of abortion by two to five percentage points. Most of the impact of the Medicaid expansions on abortion occurred in the first round of expansions from approximately 45% of the federal poverty level to 100%. For black unmarried women with less than a high school degree, we generally find no effect of expansions in Medicaid income eligibility on abortion.
Abortion, Induced↗
Treating grouped data as continuous in alcohol consumption measures.
In quantity-frequency methods used for self-report measurement of alcohol intake (or other exposures), respondents mark the appropriate ranges, e.g. '5 to 8 drinks', '5 or 6 times per week'. To calculate average consumption only single values, not ranges, can be multiplied, and midpoints are commonly used. This results in bias if the range lies in the tail of a distribution, as often happens with drinks per occasion. The same bias occurs when risk, for example, is plotted against consumption levels, which inevitable are grouped into ranges. Consequently, estimates of aggregate consumption can be exaggerated and curves of risk against exposure level can be misleading. A method is described to calculate a relatively unbiased representative value for a range, requiring only knowledge of the normal distribution table, the log-normal distribution, and basic arithmetic. Part of the procedure is also useful for estimating percentile points in data that have been grouped differently, such as income in dollar groups.
Alcohol Drinking↗
Characteristics of hospital users.
OBJECTIVES: For people living in the community, this article explores selected health problems and personal characteristics that are associated with having been hospitalized. DATA SOURCE: The data, collected from a sample of people aged 15 and over living in 27,263 households in the 10 provinces, are from the household component of the 1994/95 National Population Health Survey. ANALYTICAL TECHNIQUES: Bivariate and multiple regression analyses were used to determine associations between hospitalization and chronic health problems, demographic characteristics, health-related behaviours, and socioeconomic status. MAIN RESULTS: Having cancer or a long-term disability was strongly associated with hospitalization throughout adulthood. Among women under age 65, the odds of hospitalization were higher among those with inadequate income than among those with adequate income, even after controlling for differences in health status.
Adolescent↗
[Evolution of adolescent fertility and its association with evolution of income in the Spanish provinces during the period 1975-1985].
BACKGROUND: Fertility rates in women under 21, during the period 1975-1985 in Spain, have analyzed, as well as their association with the evolution of the socioeconomic indicators in order to study the distribution and associated factors to adolescent maternity in our environment. METHODS: The fertility rates have been elaborated from the Official Demographic Statistics. The socioeconomic indicators have been obtained from the Statistics Year Book of the National Institute of Statistics and from other complementary sources. The method of weighted linear regression has been used to analyze the association between the indicators and the rates at the provincial level. RESULTS: The fertility rates have decreased a 16% in mothers from 15 to 19 years old in Spain, between 1975 and 1985. The highest accumulated rates belong to the Communities of Canarias (42.8 births by 1000 women of 15 to 19, Galicia (38.1) Murcia (33.7) and Andalucía (30.3). In the regression analysis, the income evolution shows an association with the fertility evolution in the group from 15 to 19 years old, and this association remains when we take into account unemployment, index of provincial development and birth rate, which allows to explain a 49% of the variance. Fertility of adolescent under 15 is only associated with the income evolution, with a determination coefficient of 0.29. CONCLUSIONS: Results indicate that early maternity has decreased in Spain, although there are geographical differences, which cam, in some measure, be related with social-economic factors.
Adolescent↗
Utilization of dental care after the introduction of the Swedish dental health insurance.
The dental care utilization rate in an urban Swedish population over an 11-year period was studied, starting at the time of the introduction of a national dental health insurance. The systematically selected samples comprised, for each calendar year of the period, approximately 11,000 inhabitants more than 20 years of age in the city of Göteborg. In 1976 and 1984 information on utilization was coupled to information about various demographic, socioeconomic, and disablement factors. In addition, a longitudinal study was performed of 8012 people who resided in Göteborg in 1976 and 1984, correlating dental attendance rates with the same factors. The results showed that dental care utilization increased among both men and women, mostly in age groups more than 65 years of age. Utilization rate in 1976 and in 1984 was independently associated with age, sex, income, marital status, disablement, and regions of the city, and it is concluded that the goal of the dental insurance act, which was, among other things, to contribute to a more equitable distribution of dental care, in many respects has not been achieved. Early identification of people with low utilization may provide a means to obtain the most pronounced improvement in dental health.
Adult↗
[Emergency contraception in Latin America and the Caribbean].
Introducing the post-coital birth control method in the family-planning services of Latin American countries has not been an easy task. Catholic and other conservative groups with great influence in the political arena have time and again stopped it from being adopted as an alternative method and have even succeeded in having it removed from official directives after formal acceptance by health authorities. The main objections are triggered by the erroneous supposition that "emergency contraception" pills are abortifacients. However, a large dose of cultural discrimination against women seems also to be involved. It has been extremely difficult to register dedicated products and make them available in drug-stores and even more difficult to distribute them without charge at public health centers. They are hard to find, expensive, and unavailable to adolescents at risk for unwanted pregnancies and to most low-income women, especially in rural areas. Dissemination of appropriate information has been scarce and slow and there are still great numbers of people that do not understand how or why the method works. Brazil has been the only exception, as its open society has readily accepted this method of contraception. The Latin American Consortium on Emergency Contraception founded in the year 2000 and its regional conference two years later had an important impact on the situation, as they encouraged the coordination of efforts by governmental and nongovernmental entities with those of women's groups to fight for sexual and reproductive rights. A number of studies have shown that the more people learn about emergency contraception, the more they find it acceptable and necessary, and radio spots and other media techniques have begun to educate the public about this matter. In spite of the many difficulties encountered, in the last few years several countries have made strides to include this method in their public health guidelines. However, because of the powerful forces against it, accessibility and distribution of the emergency pills are not always implemented as planned and there are still many areas that require work. Details are given on the situation in Argentina, Bolivia, Chile, Colombia, Ecuador, Honduras, Mexico, Paraguay, and Peru.
Adolescent↗
The economic status of the elderly.
Augmented by public programs such as Social Security and Medicare, incomes of the elderly in the United States have grown more rapidly during the last several decades than have the incomes of other groups, so that on average the elderly are at least as well off as the nonelderly. Not all elderly, however, have done as well: widows, in particular, have high poverty rates. The economic prospects of the elderly during the next few decades are good because of the large work force from the baby-boom cohort. In the distant future a large fraction of the population will be elderly, which will probably lead to a deterioration in their economic status. Today, the main problems center on the distribution of economic resources among the elderly and on uncertainties such as costs of medical care.
Aged↗