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PubMed1987

Patterns of use of the emergency department by elderly patients.

The spectrum of illness and use patterns of 540 elderly patients (greater than or equal to 65 years) admitted to an emergency department (ED) were compared to an equal number of nonelderly patients. The proportion of visits by the elderly group to the ED was similar to the proportion of elderly residents in the area surrounding the hospital. Elderly patients were more likely than nonelderly patients to have an emergent diagnosis (34.4 vs. 8.3%), to arrive by ambulance (54.6 vs. 23.5%), to be admitted to the hospital (51.1 vs. 14.4%), and to have a medical (as opposed to a surgical) illness (75.0 vs. 53.2%). The spectrum of diseases was different between the two groups. Elderly patients had a higher proportion of cardiac (28.4 vs. 7.2%) and pulmonary disease (5.3 vs. 2.8%). Nonelderly patients had more injuries (30.5 vs. 10.7%) and self-limited infectious disease (11.5 vs. 5.0%). The proportion of psychiatric disease and social problems was low in both groups, about 5%. Elderly patients had a significantly lower proportion of nonurgent diagnoses (19.4 vs. 32.0%) than the nonelderly patients. Use of the ED by elderly patients is different from nonelderly patients in that they are more likely to have a serious medical illness. There is little evidence that elderly persons use the ED for primary self-care or social problems.

Aged↗
PubMed1989

Detecting elder abuse: a guide for physicians.

Abuse and neglect of the elderly is not a new phenomenom, however, it recently has become recognized as a social problem throughout the United States. Much like child abuse, detection of elder abuse is contingent upon physicians' awareness of this problem and an understanding of the risk factors that often appear before a crisis occurs. Understanding elder abuse detection and risk factors will enable the practicing physician to identify and treat abuse. The purpose of this article is to provide physicians with detection and intervention strategies, with the hope that physicians will utilize their unique relationship with their patients to further the investigation of this growing social problem.

Aged↗
PubMed1994

[Reliability and factorial validity of the Child Behavior Checklist--an analysis of a clinical and field sample].

The purpose of this study was to assess the reliability (internal consistency), the correlations of the scale scores and the factorial validity of the German version of the Child Behavior Checklist (CBCL). The analyses were performed in a sample of patients at two child and adolescent psychiatric facilities (N = 1653) and in a community sample (N = 1622). The analyses were based on the 1991 American version of the CBCL. The internal consistency of most of the scales was good to excellent (rtt > .80). The reliability of the scales "Withdrawn", "Somatic complaints" and "Social Problems" was not completely satisfactory (rtt > .70). The reliability of the syndrome scales "Thought Problems" and "Sex Problems" and the Competence Scales was unsatisfactory (rtt < .70). The internal consistency of the syndrome scales in the German and American samples was very similar. The correlations between the scales were predominantly in the lower range, with some in a medium range (rtt > .50). Factor analyses in the clinical sample confirmed that the syndrome scales had been well-designed. With the exception of the scales "Social Problems" and "Withdrawn", where the items have loadings on a common factor, the scales proved to be factorially valid.

Adolescent↗
PubMed1997

Follow-up study of young stress-affected and stress-resilient urban children.

Reports follow-up study of 181 young highly stressed urban children, classified as stress-resilient (SR) and stress-affected (SA) 1 1/2-2 years earlier. At follow-up (T2), children were retested on five initial (T1) test measures: self-rated adjustment, perceived competence, social problem solving, realistic control attributions, and empathy; parents and teachers did new child adjustment ratings, and parents participated in a phone interview focusing on the T1-T2 interval. Child test and adjustment measures and parent interview responses at T2 sensitively differentiated children classified as SR and SA at T1. Test and interview variables used at T1 and T2 correlated moderately across time periods. At T2, four child test indicators (i.e., rule conformity, global self-worth, social problem solving, and realistic control attributions) and four parent interview variables (positive future expectations for the child, absence of predelinquency indicators, good parent mental health in the past year, and adaptive parent coping strategies) sensitively differentiated children classified as SR and SA at T1. No relationship was found between family stress experienced in the T1-T2 interval and changes in children's adjustment during that period.

Adaptation, Psychological↗
PubMed1984

International migration and ethnic minorities: new fields for post-war sociology in the Federal Republic of Germany.

A review of studies concerning international migration and the development of ethnic minorities in the Federal Republic of Germany is presented. "This review will emphasize primarily the sociological literature in the Federal Republic of Germany in the context of developments since 1960. In addition to a discussion of the key issues and concepts employed, empirical research in the areas of social problems, housing and urban questions, education, the second generation, and return migration, among others, will be treated." (SUMMARY IN FRE)

Culture↗
PubMed1991

Problems at social re-integration of long-term cancer survivors.

To assess the long-term consequences of cancer for everyday life, a postal survey in the Netherlands was done among 849 ex-cancer patients. Almost all responders were self-supporting to a large extent. Compared with the period before diagnosis, the socioeconomic position had not changed in 62%. 28% of the responders who were employed at the time of diagnosis (10% of all responders), were now housekeepers (99% female). Absence from work at survey did not differ significantly from absence in the year before diagnosis. A history of cancer tended to have a negative impact on promotional prospects and income. Ex-cancer patients were often confronted with problems when they tried to take out insurance or to modify an existing policy. The psychological well-being of the responders was low, compared to the average Dutch population.

Activities of Daily Living↗
PubMed1988

[Social compensation problems of children and adolescents suffering from epilepsy against a background of neural infection].

Five hundred individuals with a history of neural infection in childhood or adolescence have been followed-up. Lower indicators, in particular with regard to academic performance, have been found in persons with CNS pathology, risk factors of epilepsy, and especially in epileptic patients, as compared to clinically healthy subjects. This is explained by psychic and neurologic abnormalities, above all by the presence of the cerebral asthenic, hypertensive CSF syndrome and affective aberrations, as well as by the rate and severity of attacks. The factors contributing to the improvement of social compensation include above all psychoneurologic and pedagogical observation over children with a history of neural infection attended by residual abnormalities, intensification of health education of teachers and parents and adequate individual professional orientation and employment.

Achievement↗
PubMed2006

Community decline and mortality.

UNLABELLED: This study of the relation of social problems to mortality in the context of growth and decline in 50 New York counties is guided by an ecological framework that sees communities depending on their many agencies and services for maintaining and improving the well-being of residents despite external problems/threats. Two all-purpose measures of threats are community growth and decline, especially the latter. If the specialized agencies typical of more urbanized places are weak, threats generate internal social problems like crime and unemployment and these lower population health. FINDINGS: when urbanization is held constant, growth is negatively associated with poverty-related problems while decline predicts deviance. Both poverty and deviance problems, in turn, predict mortality. The applied implications of this model are discussed.

Community Networks↗
PubMedDate not supplied

[Critical analysis of respiratory infectious disease investigations related to children attending day care centers]

OBJECTIVE: Social-economic and cultural changes are increasingly leading families to share the children's care and education with daycare centers. Nevertheless, this practice is being widely criticized. Medical literature, for example, points to the high risk of illnesses in these environments. Searching to assess theoretical- methodological aspects underlying disease/daycare research, a bibliography review was done. METHOD: The last five years production was reviewed, through Current Contents, Med-Line and Lilacs, using creche / daycare center as keywords. RESULTS: 665 papers were obtained and organized in subgroups. Selecting the group of papers on respiratory infectious diseases, 34 papers were obtained, being 22 of them empirical, and 12 theoretical or review article, etc. The empirical studies used large populations; data were collected by interviews, medical reports and laboratory analyses; 50% were cross-sectional. Disease/daycare relation was obtained mainly by quantitative analysis, based on a multivariate model and logistic regression. Seventy per cent concluded that attending daycare implies an illness high risk, especially for youngers than 2 years. The papers with a preventive character, and-in more subtler ways - 50% of the others point alternative solutions for this clinical and social problem (vaccination, immunity stimulation, environmental organization). CONCLUSION: The structure and the discussion of the majority of the studies seem to be guided by implicit assumptions, based on conceptions of an ideal situation of care (at house, by the mother). The results are legitimized by large populations and sophisticated statistic systems. Nevertheless, they express a prediction risk, which highlights static aspects, not the dynamic ones, of health/ disease processes. At last, they treat a social problem on clinical individual assumptions.

Journal Article↗
PubMed2000

Should hemophiliac patients be circumcised?

Social and cultural integration of hemophilic boys into society is one of the most important cornerstones of modern hemophilia therapy. Circumcision, a traditional procedure, is an important ritual for Muslims and Jews and an important social problem for the hemophiliac patient and his family. The aim of this study was to evaluate the psychosocial dimension of circumcision and the opinions of parents and children. A total of 105 hemophiliac patients and parents were interviewed and surveyed. Of these, 94% of the parents of uncircumcised patients wanted circumcision for their children. Most parents saw circumcision as a mandatory procedure. Hemophilic boys (60%) and their parents (82%) have an inferiority complex because the boys are unable to be circumcised. Bleeding risk is the primary reason of anxiety (70%). The parents of all the circumcised patients were happy after circumcision. In conclusion, circumcision is an important social problem of hemophilic patients that needs to be solved.

Adolescent↗
PubMed1994

Spare the rod and spoil the child. Is this a sensible justification for the use of punishment in child rearing?

This paper examines the validity of the well-used proverb Spare the rod and spoil the child. To do this, the original form of the proverb from the Bible is compared with the modern form, and some significant differences are highlighted. The definition of punishment is considered, and the differences between punishment and corporal punishment are examined. Punishment is explored in some detail with attention given to the criteria that need to be satisfied in order for punishment to be effective. Discrepancies in the literature concerning these criteria are pointed out, making punishment a complex issue. The negative effects of punishment are significant with links to social problems such as teenage delinquency and violence. Reference is made to cultures where corporal punishment has been banned and the effects of this action. Given the problems associated with punishment programs, especially those being used in families, alternatives to punishment are discussed. Finally, an alternative form of the proverb to the current adaptation is offered.

Adolescent↗
PubMed1997

Enrollment of a population-based cohort of newborns at higher risk of developing a chronic condition: the EDEN study. Etude du Developpement des Nouveau-nés Study.

OBJECTIVE: To describe the methods used at birth to recruit a population-based cohort of newborns of all birthweights at higher risk of having a chronic condition, and to present baseline results. METHODS: Screening of all newborns at hospital discharge for five non-exclusive criteria: (1) low birthweight (LBW), (2) congenital anomalies or genetic disease, (3) specified conditions associated with a high probability of chronicity, (4) referral to a neonatal intensive care unit (NICU), (5) or defined social problems. Calculation of Hobel risk scores for children satisfying > or = 1 criterion. SUBJECTS: All 6477 live births delivered in the 19 maternity hospitals of a geographically defined region (Vaud, Switzerland) to resident mothers in 1993-1994. RESULTS: Twelve per cent (n = 760) of newborns met > or = 1 criterion: 6.3% of all newborns had an LBW (criterion 1), 2.4% had a birth defect, 0.9% met criterion (3), 4.4% stayed in an NICU and 1.6% had serious social problems. Hobel prenatal score was high (> or = 10 points) for 41% of children with > or = 1 criterion, the intrapartum score for 87% and the neonatal score for 68%. CONCLUSIONS: Most newborns identified by the above simple criteria also had elevated perinatal risks. The validity of the criteria will later be tested against the results of the examinations of children with > or = 1 criterion at 18 months and 4 years of age, but the assessment at birth already shows that normal birthweight (NBW) children, in agreement with previous studies, contribute half the children at high risk perinatally.

Birth Weight↗
PubMed1990

[Pulmonary Tuberculosis in foreigners].

We studied the background and social problems of pulmonary tuberculosis in foreigners which we recently encountered at the National Chiba- Higashi Hospital and the Chiba Anti-tuberculosis Association. 1) The number of foreigners with pulmonary tuberculosis has been increasing year by year, one in 1983, none in 1984 and 1985, one in 1986, two in 1987 and four in 1988. 2) Most of these patients had been already infected or had some symptoms before their arrival to Japan. 3) Their background includes some serious social problems such as troubles in daily life coming from linguistic and cultural differences and economic difficulties, legal problems such as illegality of their stay in Japan, etc. 4) Most of the above cases could not be treated sufficiently because they are foreigners or because of their illegal stay.

Adolescent↗
PubMed2003

The relationship of anger and social skills to psychological symptoms.

The link between anger, social skills, and psychological symptoms was investigated in a college population. Seven hundred and nine individuals were administered the State Trait Anger Expression Inventory, the Anger Inventory, the Social Problem Solving Inventory, the Social Skills Inventory, and a series of questions about the degree to which anger affected their lives. Symptomatology was measured by the Brief Symptom Inventory and served as the criterion measure for a series of multiple regression analyses. Results indicated that both anger and social factors related to measures of psychological distress. Implications of the relationship between anger, social skills, and psychological symptoms are discussed in terms of research and assessment of individuals who may suffer from anger problems.

Adult↗
PubMed2001

Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae among at-risk women, young sex workers, and street youth attending community organizations in Quebec City, Canada.

BACKGROUND: Despite a relatively recent decline in the global incidence of Chlamydia trachomatis and Neisseria gonorrhoeae it seems that some segments of the population such as street youth, sex workers, and individuals with social problems or delinquent behavior could be part of a core group for STDs. These persons may be reluctant to undergo STD diagnosis in traditional medical settings. GOALS: To determine the prevalence of C trachomatis and N gonorrhoeae infection using polymerase chain reaction on urine samples among subjects attending an anonymous HIV testing clinic and four community organizations in Quebec City, and to identify associated risk factors. STUDY DESIGN: A cross-sectional study of 626 street youth, sex workers, and women with social problems or delinquent behavior was conducted. RESULTS: The prevalences of N gonorrhoeae and C trachomatis were, respectively, 1.1% (95% CI, 0.5%--2.3%) and 5.8% (95% CI, 4.1%--7.9%). No significant difference was found between men and women, but the sexually transmitted disease (STD) prevalence was much higher in subjects younger than 20 years: 11.4% versus 3.6% (P < 0.01). In a logistic regression model, factors independently associated with STD infection were age younger than 20 years (OR, 2.6; P = 0.007), occasional sex partners (OR, 2.9; P = 0.007), and injection of drugs (OR, 2.8; P = 0.002) in the preceding 6 months. CONCLUSIONS: A moderate STD prevalence was found in the study population. The prevalence, however, can be considered high (>10%) among street youth and young sex workers. Providing community-based STD screening and treatment services appear to be an efficient method for reaching these high-risk groups.

Adolescent↗
PubMed1994

You can't buy insurance when the house is on fire. Community rating kills health insurance.

Why does health insurance cost so much? According to the vice president at the insurance company that pioneered high-deductible health insurance to go with medical savings accounts, a big factor is that insurance companies are being asked to solve social problems. Mr Hartnedy offers a solution to America's healthcare-delivery plight that includes empowerment of individuals and preservation of choice.

Actuarial Analysis↗
PubMed1990

Welfare status and psychosocial adjustment among 100 Hmong refugees.

Although the mental health of recently employed persons has been well studied, the mental health of welfare recipients is not well understood. Among our increasing refugee population, many receive welfare benefits at some point. The Hmong are among those who are highly represented among welfare recipients in several areas of the United States. Do psychiatrists have anything to contribute toward the resolution of high welfare rates? This question is especially relevant in refugee populations who are at increased risk for several psychiatric disorders, including depression, paranoia, and adjustment disorders. This study was undertaken among 100 Hmong refugees who had been in the United States for 8 years. Indices of mental health included two rating scales (the Zung Depression Scale and the SCL-90), five-axis DSM-III diagnoses, Hamilton Anxiety and Depression Scales, Global Assessment Scale, Brief Psychiatric Rating Scale, Inpatient Multidimensional Scale, and Mini-Mental State Exam. These indices were compared with current welfare status and the duration of time on welfare. Other comparisons with welfare included demographic characteristics, material possessions, acculturation characteristics, health and social problems, and nonoccupation avocations. Results indicate that welfare recipients show lower acculturation and elevated psychiatric symptom levels. Suggestions for ameliorating this situation are extrapolated from studies in the literature on chronically unemployed persons.

Acculturation↗
PubMed1996

Knowledge and use of alcohol and other drugs among Vietnamese-speaking migrants.

A survey of the Vietnamese community in Sydney was conducted in 1992 to determine whether it was at a higher or lower risk of drug-related harm than the general community. Data was collected on knowledge, attitudes and behaviour associated with alcohol and other drug use and compared with overall NSW figures. The sample of 341 Vietnamese-speakers aged 15-65 years was obtained by face-to-face interviews conducted in private households using a cluster sampling technique. Of the sample, 72% indicated they did not speak English well or at all. Recognition of tobacco and alcohol as drugs and the specific health and social problems associated with use was much lower among the Vietnamese-speakers than the general community. Compared with the general community (1991 NCADA Household Survey), reported use of tobacco on the day of the survey among Vietnamese-speakers was higher among men (37% versus 26%) but much lower among women (4% versus 22%). Reported use of other drugs such as alcohol, analgesics, minor tranquillizers and illicit drugs was lower than in the general community. It is recommended that the low level of knowledge of the health and social problems associated with tobacco and alcohol in particular should be addressed by community-based education programmes.

Journal Article↗