[The gypsy population in Hungary in the 1990s].
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Age Distribution↗
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The prevalence of smoking in Austria.
BACKGROUND: A population-based cross-sectional study was performed to assess smoking prevalence in Austria and to compare the results with data from 1986. METHODS: A representative sample of Austrians (n = 2,400) who in 1995 were > or = 15 years of age was obtained. A total of 2,065 respondents were interviewed about their smoking habits. RESULTS: Approximately 31% of the population age > or = 15 are regular cigarette smokers, 12% are former smokers, 6% smoke occasionally, and 51% have never smoked. Among males, the prevalence of regular smoking increases with age and reaches its highest level between the ages of 25 and 34. The age distribution among female regular smokers shows a similar pattern, peaking in the same age group (35.7% smokers). No significant differences in smoking prevalence were found according to monthly household income, years of school, and number of inhabitants at place of residence. At the time of interview 45.7% of male and 20.9% of female regular smokers consumed > 20 cigarettes per day. Compared with data from 1986 the prevalence of regular smokers increased from 18.1 to 24.2% among females and from 35.5 to 38.9% among males. CONCLUSIONS: Smoking prevalence increased in Austria between 1986 and 1995 by 33.7% among females and by 9.6% among males. Patterns of smoking among females (prevalence and cigarettes per day) are approaching those of males.
Adolescent↗
[Women in the USSR].
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Abortion, Induced↗
Nutrient patterns and nutritional adequacy among French-Canadian children in Montreal.
OBJECTIVES AND METHODS: A representative sample of French Canadian Montrealers was surveyed to compile data on food habits, nutrient intakes and sociodemographic characteristics, using interviewer-administered questionnaires and 7-day food records (7D-FR). RESULTS: Complete 7D-FR and sociodemographic data were obtained from 614 adults aged 19 and over (40.1% males), and 182 children aged 5 to 18 (44.8% males). Average heights and weights of children were at the 50th percentile for both sexes and all age groups. Nutrient intakes surpassed most of the age- and sex-specific 1990 Canadian Recommended Nutrient Intakes (RNIs). Energy intakes were 83% to 98% of the RNIs, with 16-18 year old adolescent girls having systematically lower energy consumption. Calcium was most frequently found below the 66% age-sex specific RNI cut-off. On average, protein comprised 16% of energy, fat 36-37%, and carbohydrates 48-49%, for males and females, respectively. Simple sugars comprised 16-19% of energy among boys, and 16-20% among girls, fluctuating with age. Only a small proportion of respondents (15.4%) had low relative total fat and saturated fat intakes (ranging from 30-34%, and 10-12% of energy, respectively); no differences in mean nutrient levels were found between low, medium or higher fat consumers. Among those with inadequate intakes, 26% lived in one lower middle income sector of Montreal; however, no clear pattern emerged linking dietary adequacy and socioeconomic factors. CONCLUSIONS: While Montreal youngsters consume generally adequate diets, sufficient quantities of calcium-furnishing foods must be eaten, particularly by adolescent girls. Surveillance of children's food and nutrient intakes will contribute to the reduction of chronic disease by providing data for effective health care planning.
Adolescent↗
Preventive oral health behaviors among African-Americans and whites in Detroit.
OBJECTIVE: This study compared the preventive oral health behaviors of African-Americans and whites. METHODS: Face-to-face interviews were conducted with a probability sample of 384 African-American and 358 white adults living in the greater Detroit area. Questions focused on brushing, flossing, and dental visits. RESULTS: More than 95 percent of both groups reported brushing daily; however, whites were more likely to brush all teeth, including parts that do not show. Frequency of flossing did not differ between groups. African-Americans, however, were less likely to floss all of their teeth. Whites were more likely than African-Americans to get dental check-ups at least once a year and much less likely to indicate they had never had a dental check-up. African-Americans tended to have less education and lower family income than whites and were more likely than whites to have Medicaid. Race differences in brushing thoroughness and annual check-ups were greatly reduced when income, education, and insurance were controlled statistically. CONCLUSIONS: African-Americans are less likely than whites to brush thoroughly, floss thoroughly, and get dental check-ups. These differences are partly traceable to differences in socioeconomic status and access to professional oral health care.
Adolescent↗
Infant mortality rates according to socioeconomic status in a Brazilian city.
OBJECTIVE: Data from municipal databases can be used to plan interventions aimed at reducing inequities in health care. The objective of the study was to determine the distribution of infant mortality according to an urban geoeconomic classification using routinely collected municipal data. METHODS: All live births (total of 42,381) and infant deaths (total of 731) that occurred between 1994 and 1998 in Ribeirão Preto, Brazil, were considered. Four different geoeconomic areas were defined according to the family head's income in each administrative urban zone. RESULTS: The trends for infant mortality rate and its different components, neonatal mortality rate and post-neonatal mortality rate, decreased in Ribeirão Preto from 1994 to 1998 (chi-square for trend, p<0.05). These rates were inversely correlated with the distribution of lower salaries in the geoeconomic areas (less than 5 minimum wages per family head), in particular the post-neonatal mortality rate (chi-square for trend, p<0.05). Finally, the poor area showed a steady increase in excess infant mortality. CONCLUSIONS: The results indicate that infant mortality rates are associated with social inequality and can be monitored using municipal databases. The findings also suggest an increase in the impact of social inequality on infant health in Ribeirão Preto, especially in the poor area. The monitoring of health inequalities using municipal databases may be an increasingly more useful tool given the continuous decentralization of health management at the municipal level in Brazil.
Brazil↗
Do cardiovascular risk factors explain the relation between socioeconomic status, risk of all-cause mortality, cardiovascular mortality, and acute myocardial infarction?
Much remains to be understood about how low socioeconomic status (SES) increases cardiovascular disease and mortality risk. Data from the Kuopio Ischemic Heart Disease Risk Factor Study (1984-1993) were used to estimate the associations between acute myocardial infarction and income, all-cause mortality, and cardiovascular mortality in a population-based sample of 2,272 Finnish men, with adjustment for 23 biologic, behavioral, psychologic, and social risk factors. Compared with the highest income quintile, those in the bottom quintile had age-adjusted relative hazards of 3.14 (95% confidence interval (CI) 1.77-5.56), 2.66 (95% CI 1.25-5.66), and 4.34 (95% CI 1.95-9.66) for all-cause mortality, cardiovascular mortality, and AMI, respectively. After adjustment for risk factors, the relative hazards for the same comparisons were 1.32 (95% CI 0.70-2.49), 0.70 (95% CI 0.29-1.69), and 2.83 (95% CI 1.14-7.00). In the lowest income quintile, adjustment for risk factors reduced the excess relative risk of all-cause mortality by 85%, that of cardiovascular mortality by 118%, and that of acute myocardial infarction by 45%. These data show how the association between SES and cardiovascular mortality and all-cause mortality is mediated by known risk factor pathways, but full "explanations" for these associations will need to encompass why these biologic, behavioral, psychologic, and social risk factors are differentially distributed by SES.
Adult↗
Multiple socio-economic circumstances and healthy food habits.
OBJECTIVE: To examine associations between seven indicators of socio-economic circumstances and healthy food habits, while taking into account assumed temporal order between these socio-economic indicators. DESIGN AND SETTING: Data were derived from cross-sectional postal questionnaires in 2000-2002. Socio-economic circumstances were assessed by parental education, childhood economic difficulties, own education, occupational class, household income, home ownership and current economic difficulties. Healthy food habits were measured by an index consisting of consumption of fresh vegetables, fruit or berries, rye bread, fish and choosing vegetable fats on bread and oil in cooking. Sequential logistic regression models were used, adjusting for age and marital status. PARTICIPANTS: Employees of the City of Helsinki, Finland (n=8960, aged 40-60 years). RESULTS: Healthy food habits were reported by 28% of women and by 17% of men. Own education, occupational class, household income, home ownership and current economic difficulties were associated with healthy food habits. These associations were attenuated but mainly remained after mutual adjustments for the socio-economic indicators. Among women, a pathway was found suggesting that part of the effects of education on food habits were mediated through occupational class. CONCLUSIONS: Employees in higher and lower socio-economic positions differ in their food habits, and those in lower positions and economically disadvantaged are less likely to report healthy food habits. Health promotion programmes and food policies should encourage healthier food choices among those in lower socio-economic positions and among those with economic difficulties in particular.
Adult↗
Epidemiology of diarrhea in urban slums.
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Adolescent↗
Sleep problems as a risk factor for falls in a sample of community-dwelling adults aged 64-99 years.
OBJECTIVES: The purpose of this study was to determine if reported nighttime sleep problems and daytime sleepiness were associated with reported falling during the previous 12 months in a representatively sampled older adult population. DESIGN: Random-digit dial telephone survey. SETTING: Representatively sampled older adult population living in northern California. PARTICIPANTS: Participants were 971 women and 555 men, aged 64 to 99 years. MEASUREMENTS: Twenty-minute telephone interview adapted from the National Health Interview Survey. RESULTS: Two hundred and eighty-four participants reported falling during the previous 12 months (19% of the sample). Significantly more women fell than men (20% and 14%, respectively, P < .001). The following variables were significant risk factors for falling in univariate analyses: female gender, being unmarried, living alone, income less than $15,000 per year, difficulty walking, having more than one chronic medical condition, history of cardiovascular disease, hypertension, arthritis, sensory impairment, psychological difficulties, and nighttime sleep problems. All of the nighttime sleep problem variables remained significant risk factors for falling after controlling for other risk factors for falling. CONCLUSIONS: The results provide support for an independent association between reported sleep problems and falls in an older population. One of the implications of these data is that behavioral research focusing on the effectiveness of insomnia treatment in old age should not only examine typical sleep-related outcomes (e.g., total time asleep, number of awakenings) but also the occurrence of falls as well.
Accidental Falls↗
Cancer is overtaking cardiovascular disease as the main driver of socioeconomic inequalities in mortality: New Zealand (1981-99).
BACKGROUND: Relative socioeconomic disparities in cardiovascular mortality have increased in New Zealand, as in many Western countries in Northern Europe, the US and Australia during the late 20th century. However, substantial declines in cardiovascular mortality mean that its absolute contribution to overall mortality has decreased. RESEARCH QUESTIONS: How did the absolute contribution of major causes of death to socioeconomic inequalities in New Zealand change during the 1980s and 90s? METHODS: Linked census-mortality cohorts were used to calculate the contribution of different causes of death to inequalities in mortality, measured with the slope index of inequality, by household income. RESULTS: Between 1981-4 and 1996-9, the contribution of cardiovascular disease (CVD) to total inequality declined from 55% to 28% among women, whereas at the same time the contribution of cancers increased from 14% to 37%. Among men, the contribution of CVD to total inequality peaked at 47% in 1986-9, then declined to 38% in 1996-9. The contribution of cancer increased from 19% to 26% in men. CONCLUSION: CVD mortality has declined at all income levels and so too has the contribution of CVD to mortality inequalities. Concurrently, the contribution of cancer to inequalities in mortality by income has increased and, in women at least, is now greater than the contribution of CVD. It is hypothesised that a similar crossover is occurring in other populations where CVD mortality has declined, although socioeconomic differences in the distribution and effect of the obesity epidemic for CVD may ensure its continuing importance. Prevention efforts aimed at reducing socioeconomic inequalities in mortality will need to increasingly focus on socioeconomic inequalities in cancer mortality.
Adult↗
Supply, distribution, and capacity of optometrists in Indiana.
BACKGROUND: The Indiana Optometric Association and the Indiana Health Care Professional Development Commission identified a need to collect and analyze data on the health professions workforce for formulating goals and strategies to accommodate demands for health care services in Indiana. This study looks at the supply, distribution, and services of optometrists practicing in Indiana. METHODS: Data compiled by the Indiana State Department of Health, Indiana Health Care Development Commission, and the Project HOPE Center for Health Affairs were analyzed with the results of a survey of practitioner members of the Indiana Optometric Association. Supply, distribution, services, provider-to-population ratios, per capita demand, and optometric productivity were used to evaluate the current and future capacity of Indiana optometrists to the year 2010. RESULTS: An estimated 893 optometrists practiced in 86 of 92 counties and comprised 77% of the state's licensed eye and vision care workforce in 1995. Optometric workforce capacity appeared to be related to county population, but unrelated to the urban/rural classification or the per-capita income of Indiana counties. Contact lenses, disease, geriatrics, and pediatrics were the most prevalent areas of practice specialty. CONCLUSIONS: Optometrist capacity in Indiana is sufficient at both the state and county levels, and optometric services are appropriately distributed such that patient access to optometric care is geographically unburdened. Estimates regarding supply are elastic, depending on the assumptions applied.
Health Personnel↗
Distribution of daily smokers by stage of change: Current Population Survey results.
BACKGROUND: Population-based national estimates of stage of change among daily smokers are unknown. This study described the proportion of U.S. daily smokers, 18 and older, by stage of change. Selected sociodemographic characteristics were delineated. METHODS: Cross-sectional data were collected via telephone or face-to-face interview in daily smokers who responded to the Current Population Survey in 1992-1993 (n = 39,706), 1995-1996 (n = 34,865), or 1998-1999 (n = 30,153). Main outcomes included stage of change: (1) Precontemplation-not interested in quitting smoking in next 6 months; (2) Contemplation-interested in quitting smoking in next 6 months but not next 30 days; (3) Preparation-interested in quitting smoking in next 30 days and stopped at least 1 day during past year. RESULTS: During 1992-1993, 59.1% of respondents were precontemplators, 33.2% contemplators, and 7.7% in preparation stage. This distribution was similar in subsequent surveys (1995-1996; 1998-1999). Gender differences were not apparent. Whites were more likely to be precontemplators. As education and income increased, the percentage in precontemplation decreased. Rural residents were more likely in precontemplation and less frequently in preparation. CONCLUSIONS: Among daily smokers, little movement in stage of change was apparent in the United States during the 1990s. Tobacco control efforts must receive high priority to address these static patterns.
Adolescent↗
A computer-based reading test for use as an index of premorbid general intellectual level in North American English-speaking adults.
Brief tests of vocabulary or reading ability are often used as an index of general intellectual level to hypothesize deficits in patients, to establish comparability of comparison groups, and as a covariate of performance on other neuropsychological tests. We evaluated a new variant of a reading test for potential use in estimating premorbid general intellectual ability and implementation as a computerized-adaptive test. A total of 319 outpatients who participated in an epilepsy self-management study were tested on three occasions, completing the Wide-Range Achievement Test-3 (WRAT-3) Reading test at baseline and the NES3 Adult Reading Test (ART) at the 3-month follow-up. At the 6-month follow-up, some participants completed the ART and some the NES2 Vocabulary test. ART and WRAT-3 Reading scores obtained 3 months apart were highly correlated (r=0.87, n=179), while ART and NES2 Vocabulary scores were somewhat less correlated (r=0.80, n=61). The ART test-retest correlation was high (r=0.95, n=79). The ART distribution was spread out more evenly at the high end than that of the WRAT-3 Reading. ART score was significantly related to education, race, income, and examiner category, but was unrelated to age category and depression status. Non-significant gender differences were observed. An item-response theory (Rasch model) analysis showed good fit of the model to the observed data and yielded an improved ranking of the ART items in order of difficulty. The NES3 ART exhibited high reliability and strong association with WRAT-3 Reading. These results suggest that the NES3-ART may be useful as an index of general intellectual ability for comparison of groups and for use as a covariate in data analyses among English-speaking, North American adults. The Rasch model analysis provides a basis for implementing the ART as a computerized-adaptive test, which should improve its time efficiency and reduce participant burden in taking the test.
Adolescent↗
Redistributive effects of the Swedish social insurance system.
BACKGROUND: Four principles are used to distribute payments via the Swedish social-insurance system in cases of temporary or permanent illness and death. This paper studies the redistributive effects on income of these four principles. METHODS: The analysis is based on aggregate social-insurance data from the 25 municipalities that comprise Stockholm County in Sweden. For nine different types of social-insurance payments based on the four principles, the degree of income redistribution is measured according to concentration indexes and differences between Gini coefficients with social-insurance payments excluded and included. RESULTS: The concentration indexes for payments from the nine social-insurance schemes in total is -0.0469. The Gini coefficient falls from 0.0437 excluding insurance payments (i.e. for income only from gainful work, IGW) to 0.0379 when including insurance payments with income from gainful work (IGW + TP). That is, the Gini coefficient is 15% lower when insurance payments are included. Decomposition by payment shows that the largest redistribution effect on income inequality is made by disability pension. CONCLUSION: Municipalities with low average income are favoured by the Swedish social-insurance system. Payment principles can be ranked according to their redistributive capacity: mix of compensating-lost-income and flat-rate, compensating-lost-income, means-testing, flat-rate, and need-based respectively. The nine social-insurance schemes contribute very differently to income redistribution. Disability pension and sickness allowance contribute most to income redistribution and reducing income inequality.
Cost of Illness↗
Starting a nursing consultation practice.
Because the clinical nurse specialist (CNS) role has been changed or eliminated in many hospital organizations, many CNSs in career transition are considering establishing collaborative or independent nursing consultation practices. Opportunities for consultants exist in diverse practice settings and specialties. Before starting a consultation practice, the CNS should carefully examine goals, identify resources, and begin contacting potential referral sources. He or she must also decide what form of business organization to establish and write a business plan to solidify ideas and prepare for the unexpected. Most CNS consultants rely on personal savings to cover initial business and personal expenses, and many continue working as a CNS until the consultation practice is established. Fees can be set based on community standards, what the market will bear, desired projected income, or a third-party payor's fee schedule. The consultation practice can be marketed by word of mouth, inexpensive advertising techniques such as distributing flyers and business cards, direct mall, and media advertising. In today's healthcare marketplace, opportunities abound for the CNS risk-taker interested in starting a nursing consultation practice.
Consultants↗
Economic aspects of village health.
Given the poor quantity and quality of medical care in most villages in the developing countries, the economic determinants of village health are the supply of labour, the cash flow associated with that labour and the availability of land. The paper examines these in the three classical 'time periods', arguing that inability to meet labour peaks is of great significance in explaining seasonal shortage of food and chronic shortage of cash. It also explains community indifference to upkeep of social overhead capital. Substitution of capital goods for labour is socially differentiated, not least by labour availability, and leads inevitably to a regressive distribution of land and the creation or enlargement of a class of landless labourers. Under certain limited conditions this class may enjoy a rising real income with associated health-promotive expenditures. The more normal case, however, is extreme poverty, whether rural or urban, with all that that implies for the undermining of health. Land reform therefore becomes a necessary precondition of health promotion.
Agriculture↗
Sociodemographic, behavioral, and psychological correlates of current overweight and obesity in older, urban african american women.
To better understand obesity and overweight among urban African American women, the authors examined sociodemographic, behavioral, and psychological factors within body mass index (BMI) categories. A total of 496 women were recruited for cardiovascular risk factor screening from 20 urban African American churches. Study participants had a mean age of 52.8 years, 13.5 years of education, and an average BMI of 32 kg/m2. Bivariate analyses showed increased overall energy intake and decreased physical performance on a walk test, and general well-being declined as the BMI class increased; obese women had the lowest physical performance and well-being levels and the highest energy intake levels. There was no difference by BMI category, however, in social variables such as educational attainment, employment, marital status, or household income. This study suggests that although women with increasing BMI have some physical and well-being concerns, the major social variables are not differentially distributed by BMI in this sample of women.
Adult↗