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PubMed1990

Expanding health insurance coverage: who will pay?

Recent discussions on extending health insurance to the more than thirty million uninsured Americans have focused on two strategies: expanding the Medicaid program and mandating that employers sponsor coverage for their employees. This analysis, using a microsimulation model of the U.S. health care financing system, suggests that these two options would result in very different distributions of financial burden. Employer-sponsored coverage is financed in a highly regressive fashion, in contrast to the Medicaid program, which is proportional to income. Furthermore, the burden of paying for health care under Medicaid varies little among generations, whereas the cost of employer-sponsored care is lowest in households headed by persons over sixty-five years old. Low health status populations do not pay disproportionately higher taxes or premiums to finance either the Medicaid program or employer-sponsored coverage. Their incomes, however, are more effectively protected by Medicaid, because it offers more comprehensive benefits.

Costs and Cost Analysis↗
PubMed2002

Study of self-reported hypersensitivity to electromagnetic fields in California.

Cases of alleged hypersensitivity to electromagnetic fields (EMFs) have been reported for more than 20 years, and some authors have suggested some connection with the "multiple chemical sensitivity" illness. We report the results of a telephone survey among a sample of 2,072 Californians. Being "allergic or very sensitive" to being near electrical devices was reported by 68 subjects, resulting in an adjusted prevalence of 3.2% (95% confidence interval = 2.8, 3.7). Twenty-seven subjects (1.3%) reported sensitivity to electrical devices but no sensitivity to chemicals. Characteristics of the people reporting hypersensitivity to EMFs were generally different from those of people reporting being allergic to everyday chemicals. Alleging environmental illness or multiple chemical sensitivity diagnosed by a doctor was the strongest predictor of reporting being hypersensitive to EMFs in this population. Other predictive factors apart from self-reporting chemical sensitivity were race/ethnicity other than White, Black, or Hispanic; having low income; and being unable to work. The perception of risk of exposure to EMFs through the use of hair dryers (vs. exposure to power and distribution lines) was the factor the most associated with self-reporting about hypersensitivity to EMFs. However, risk perception was not sufficient to explain the characteristics of people reporting this disorder.

Adolescent↗
PubMedDate not supplied

[Asthma and ascariasis in children aged two to ten living in a low income suburb].

OBJECTIVE: To assess the relation between children with asthma and ascariasis in the low income neighborhood of Pedregal, in Campina Grande (Paraíba, Brazil). MATERIAL AND METHOD: The International Study of Asthma and Allergies in Childhood (ISSAC) standard questionnaire was distributed to 1,095 children but only 742 of them answered it and provided stool samples for parasite examination. The cross-sectional study included those 742 children, whose age ranged from 2 to 10 years. The association between asthma and ascariasis was studied through Kappa rating. Demographic and clinic variants comparing the two groups were analyzed by chi-square test (chi(2)) or t Student test. RESULTS: Among the 742 children analyzed, 51.9% (385) were males and 48.1% (357) females. The prevalence of asthma was 59.7% (443) and that of ascariasis was 56.3% (418). The frequency of asthma in the ascariasis group (60.5%) was similar (chi(2)) = 0.27, p > 0.06) to the frequency of asthma in the non-infected group (58.6%). CONCLUSION: Despite the high prevalence of the diseases studied, there is no apparent relation between asthma and ascariasis in the population studied.

Ascariasis↗
PubMed2006

Demographic and spatial analysis of West Nile virus and St. Louis encephalitis in Houston, Texas.

This descriptive prevalence study describes the relationships between mosquito density and the presence of arboviruses (in mosquitoes and humans) with various socioeconomic and environmental factors present near the time of teh arbovirus outbreak in Harris County, Texas, in 2002. This study suggests that mosquito density increased if the trap was located in an area with a large number of containers that may inadvertently retain rainwater (P = 0.056). When considering only virus-positive mosquitoes, significant relationships were observed if the trap was located near waste materials (P < 0.001) or near containers that may inadvertently retain rainwater (P = 0.037). Furthermore, the presence of arbovirus activity (in mosquitoes or humans) in a geographic area tended to be associated with the socioeconomic status of the local community. Although the results of socioeconomic comparisons were not significant, they were suggestive, demonstrating an interesting trend. Compared with communities where virus activity was not observed, the socioeconomic status of the arbovirus-positive community was consistently lower. Specifically, results showed that the populations residing in virus-positive census tracts attained less education, earned less income per household, and were more likely to be below the poverty level. In addition, this study found that virus-positive mosquitoes were randomly distributed throughout the study area, whereas severe human infection cases were clustered. Based on the results of this study, we conclude that the health outcome of a local community as it relates to West Nile virus and St. Louis encephalitis is dependent on many factors, including eh socioeconomic and environmental characteristics of the community.

Animals↗
PubMed2003

Major review: The underutilization of vision screening (for amblyopia, optical anomalies and strabismus) among preschool age children.

BACKGROUND: Nearly 80% of preschool age children never get an eye examination (1). Many "back to school" physical exams do not test for common vision disorders. Untreated eye and vision problems can interfere with most life experiences. The prevalence of undetected vision problems among preschool age children is estimated to be 5% to 10% (2). Failure to detect visual impairment early may have a permanent effect on long term vision outcomes, education achievement, and self esteem (3). The most common vision disorders among children are strabismus, amblyopia and optical problems impairing visual acuity and depth perception. Various professional organizations, including the American Academy of Pediatrics (AAP), advise preschool vision screening to detect and correct vision problems before school entry. The AAP also recommends that children continue to receive periodic eye and vision examinations throughout childhood. However, resources for this level of care are rarely available. As such, only 21% of preschool age children receive vision screening and even fewer children get a comprehensive eye examination (1). PURPOSE: The purpose of this review is to determine, through a critical review of the literature, the social, economic, and political barriers which contribute to the underutilization of vision screening among preschool age children. A secondary aim is to identify gaps in the literature base that may be needed to complete a public policy response to this problem. METHOD: A comprehensive review and analysis of the pertinent available literature. RESULTS: A variety of barriers exist which prevent children from receiving proper vision screening. They include social, economic and even political problems. Social contextual barriers include ignorance, inconvenience, language, and a lack of providers. Financial barriers affect low income families. Political barriers reside in the disproportionately meager funding of preventative medicine. Moreover there are additional factors which put preventative medicine for vision at a disadvantage compared to other pediatric demands like immunizations, such as the danger to both the individual and society from the medical condition being prevented. CONCLUSION: Even considering large gaps in the literature concerning this topic, it is clear that low income, minority, uninsured families are at high risk of not utilizing vision screening. Ignorance remains a major problem at all levels so improvements in the distribution of information and education are needed and should yield improvement. Additional funding is necessary to pay for these remedies. Titration and direction of available resources to those at highest risk will create the greatest return on such efforts.

Amblyopia↗
PubMedDate not supplied

Simulation and fabrication of subwavelength structures for a nanometer feature enabling lens-less laser writers.

A set-up was proposed to propagate submicrometer light beams without resorting to the conventional approach of using a lens. The main target was to develop a method of either by passing or circumventing the diffraction limit to develop a new optical head for a laser writer system with submicrometer resolution. Starting from using surface plasma theory to explain the mechanism of extraordinary transmission phenomenon, we move to discuss the fabrication processes for free-standing metal films and the corresponding transmission light beam images in the far field. A finite difference time domain (FDTD) method was adopted to simulate the electromagnetic field distribution of transmission light beams from the near field to the far field. The experimental results confirm that surface structures on the incident side of incoming light beams can excite surface plasma and enhance the throughput energy of transmission light beams. In addition, we also established that surface structures on the exit side can suppress the diffraction effect and make transmission light beams directional. The experimental and simulation results were found to agree well with each other, which validates the effectiveness of the FDTD simulation approach. As a free-standing film was too fragile to be of practical use, a proposition to develop a substrate-based nanostructured film to ease the construction of an optical head for a laser writer was developed.

Journal Article↗
PubMed1997

Lack of correlation between the location of choroidal melanoma and ultraviolet-radiation dose distribution.

Ocular melanomas arise from the choroid. The results of our study of a total of 92 ocular melanomas would indicate that there is no preferential location for tumors on the eye. We estimated the ultraviolet (UV) radiation dose distribution using data available in the literature. We then compared tumor location and UV-radiation dose distribution. UVC and UVB do not reach the choroid, and UVA is filtered by the cornea and the lens. Only a small percentage of the incoming rays reach the posterior and inferior part of the retina, but none reach the superior and anterior part of the eye. We concluded that it is therefore very unlikely that UV-radiation exposure is responsible for choroidal melanoma.

Choroid Neoplasms↗
PubMed2001

Epidemiology of malocclusion and orthodontic treatment need of 12-13-year-old Malaysian schoolchildren.

OBJECTIVE: Data on malocclusion and orthodontic treatment need in Malaysia are limited. The purpose of this study was to evaluate malocclusion and orthodontic treatment need in a sample of 12-13-year-old schoolchildren using the Dental Aesthetic Index (DAI), and to assess the relationship between malocclusion and socio-demographic variables, perceptions of need for orthodontic treatment, aesthetic perception and social functioning. METHOD: The sampling procedure involved a multistage, clustered and stratified random sampling. The sample comprised of 1,519 schoolchildren attending 20 secondary government and government-aided schools in urban and rural areas of Klang District in Peninsular Malaysia. There were 772 males and 747 females. Each subject was administered a questionnaire eliciting standard demographic information such as gender, parents' income and ethnic origin and questions on perception of need for orthodontic treatment and satisfaction with dental appearance and function. Intra-oral examination for occlusal status using the DAI was performed for each subject. RESULTS: Most subjects (62.6%) require no orthodontic treatment. Only about 7% had handicapping malocclusion that needed mandatory treatment. Malocclusion, as defined in this study, was found to be significantly associated with gender and subjects' area of residence. There were no significant differences in mean DAI scores for Malays, Chinese and Indian children. Significant associations were found between DAI scores and perception of need for orthodontic treatment, satisfaction with dental appearance and social functioning (P<0.01). CONCLUSION: The findings will be useful for the public dental service to determine priority for orthodontic treatment as part of the comprehensive care provided by the School Dental Service (SDS).

Adolescent↗
PubMed2000

Symptoms of depression and psychological distress among Hispanics with rheumatoid arthritis.

OBJECTIVE: To explore the roles played by Hispanic ethnic background and acculturation to the mainstream English language culture of the United States in the depressive symptoms and mental health of rheumatoid arthritis (RA) patients. METHODS: Members of a consecutive cohort of patients with RA were studied cross-sectionally. All underwent a comprehensive clinical and psychosocial evaluation. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D), and psychological distress was measured with the Medical Outcomes Study Short Form 36 (SF-36) mental health scale. RESULTS: Two hundred thirty-six patients were studied. Women had significantly higher median CES-D scores than men (19 versus 14, P = 0.0004), Hispanics scored higher than non-Hispanics (14 versus 8, P = 0.0002), and foreign-born scored higher than US-born patients (14 versus 10, P = 0.009). Compared with those who were fully acculturated, patients who were partially acculturated were more likely to have a score > or = 16 on the RA-adjusted CES-D (odds ratio [OR] = 1.79, 95% confidence interval [95% CI] 1.37 to 2.35, P < or = 0.001). Among unacculturated patients, the likelihood of a score > or = 16 increased 6-fold (OR = 6.68; 95% CI 3.50 to 12.72; P < or = 0.001). A similar, inverse pattern was observed for the SF-36 mental health scale. In multivariate models accounting for age, sex, education, income, articular pain, deformity, and the level of disability, low acculturation was independently associated with high depressive symptoms, and a Hispanic background was independently associated with lower SF-36 mental health. CONCLUSIONS: In this consecutive series of RA patients, Hispanics, particularly those who are not fully acculturated to the mainstream Anglo society, had more depressive symptoms and psychological distress than did non-Hispanics.

Acculturation↗
PubMed2006

Countdown to 2015: tracking donor assistance to maternal, newborn, and child health.

BACKGROUND: Timely reliable data on aid flows to maternal, newborn, and child health are essential for assessing the adequacy of current levels of funding, and to promote accountability among donors for attainment of the Millennium Development Goals (MDGs) for child and maternal health. We provide global estimates of official development assistance (ODA) to maternal, newborn, and child health in 2003 and 2004, drawing on data reported by high-income donor countries and aid agencies to the Organisation for Economic Development and Cooperation. METHODS: ODA was tracked on a project-by-project basis to 150 developing countries. We applied a standard definition of maternal, newborn, and child health across donors, and included not only funds specific to these areas, but also integrated health funds and disease-specific funds allocated on a proportional distribution basis, using appropriate factors. FINDINGS: Donor spending on activities related to maternal, newborn, and child health was estimated to be US1990 million dollars in 2004, representing just 2% of gross aid disbursements to developing countries. The 60 priority low-income countries that account for most child and newborn deaths received 1363 million dollars, or 3.1 dollars per child. Across recipient countries, there is a positive association between mortality and ODA per head, although at any given rate of mortality for children aged younger than 5 years or maternal mortality, there is significant variation in the amount of ODA per person received by developing countries. INTERPRETATION: The current level of ODA to maternal, newborn, and child health is inadequate to provide more than a small portion of the total resources needed to reach the MDGs for child and maternal health. If commitments are to be honoured, global aid flows will need to increase sharply during the next 5 years. The challenge will be to ensure a sufficient share of these new funds is channelled effectively towards the scaling up of key maternal, newborn, and child health interventions in high priority countries.

Child↗
PubMed1984

The National Evaluation of School Nutrition Programs: program impact on anthropometric measures.

This report describes the anthropometric analysis component of the National Evaluation of School Nutrition Programs. It addresses two research questions: First, is there a relationship between participation in the school nutrition programs and students' height, weight, and triceps fatfold, and, second, are the impacts of program participation on height, weight, and triceps fatfold different for students with different characteristics? The anthropometric analyses suggest that long-term participation in the School Lunch Program has no relationship to height but does have a small relationship to the weight of school-aged children. This is at least partly due to an increase in body fat. Program impacts do not differ for students with different income and ethnic characteristics; however, impacts are greater for older children than for younger children. The School Breakfast Program has no relationship with students' height and only weak relationships with students' weight and triceps fatfold. The Breakfast Program tends slightly to move participants toward the middle of the weight distribution and away from the extremes. Although there are statistically significant increases in weight and triceps fatfold thickness associated with participation in the School Lunch Program, they are small compared with effects of the child's sex, height, and ethnic background. Other variables, such as parents' height and weight, parents' education and family income, also have greater impacts on weight and triceps fatfold measurements than participation in the School Nutrition Programs.

Adolescent↗
PubMed1990

Correlates of age at first sexual intercourse in a national sample of young women.

A subsample of 814 sexually experienced adolescent females from the 1979 U.S. National Survey of Young Women was analyzed to assess the correlates of age at 1st sexual intercourse. Multiple regression procedures were used to examine sets of variables sequentially. In the hierarchical regression model, the control variables (respondent's age, race, religion, and age at menarche), along with 3 independent variables (household income, ideal age at 1st marriage, and ideal age for 1st birth), predicted age at 1st intercourse. The control variables accounted for a major portion of the variance in the model. Of the controls, chronological age and age at menarche were highly significant across all models tested.

Adolescent↗
PubMed1996

Demographic characteristics of the population of Greater Soweto, 1993.

"This research note provides information and findings on some aspects of urbanisation in Greater Soweto. It outlines the demographic characteristics of the population, namely the characteristics of households; household preferences for services; perceptions on accommodation; age and gender profiles; education levels; the origin of the inhabitants and mobility in and migration to Greater Soweto. Some findings are particularly important for future planning of services and low-income or subsidised housing."

Africa↗
PubMed2004

Explaining income-related inequalities in doctor utilisation in Europe.

This paper presents new international comparative evidence on the factors driving inequalities in the use of GP and specialist services in 12 EU member states. The data are taken from the 1996 wave of the European Community Household Panel (ECHP). We examine two types of utilisation (the probability of a visit and the conditional number of positive visits) for two types of medical care: general practitioner and medical specialist visits using probit, truncated Negbin and generalised Negbin models. We find little or no evidence of income-related inequity in the probability of a GP visit in these countries. Conditional upon at least one visit, there is even evidence of a somewhat pro-poor distribution. By contrast, substantial pro-rich inequity emerges in virtually every country with respect to the probability of contacting a medical specialist. Despite their lower needs for such care, wealthier and higher educated individuals appear to be much more likely to see a specialist than the less well-off. This phenomenon is universal in Europe, but stronger in countries where either private insurance cover or private practice options are offered to purchase quicker and/or preferential access. Pro-rich inequity in subsequent visits adds to this access inequity but appears more related to regional disparities in utilisation than to other factors. Despite decades of universal and fairly comprehensive coverage in European countries, utilisation patterns suggest that rich and poor are not treated equally.

Decision Making↗
PubMed1997

The socio-economic distribution of heart diseases: changing gradients in The Netherlands.

Two different Dutch data-sets were used to examine trends in the association between socio-economic characteristics and the risk of heart disease. Data of the Dutch Quality of Life Surveys allowed the examination of trends in the association between educational level and self-reported heart disease during the period 1974-1993. For both the general Dutch population and the subpopulation of men aged 40 years and older, we found an inverse gradient during the whole period. The gradient climaxed at 1980-1983, and narrowed afterwards. Furthermore, ecological analyses, relating regional mean personal incomes to regional directly standardised mortality rates of coronary heart diseases (CHD) and all heart diseases, showed similar patterns of social differentials. The findings suggest that, in the Netherlands, there is a narrowing gradient of the association between socio-economic characteristics and heart disease in the late eighties and early nineties.

Adult↗