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PubMed1996

[Nutritional status of pre-school children of the semi-arid region of Bahia (Brazil): II--Vitamin A deficiency].

A survey of 754 preschool children was undertaken in the urban areas of seven small towns of the semi-arid region of Bahia, Northeastern Brazil, to determine the prevalence of vitamin A deficiency, as well as its association with variables such as a age, family income, mother's schooling and dietary adequacy in vitamin A. Protein energy malnutrition and anemia were also studied and are reported separately. The clinical ophthalmological examination did not reveal any signs or symptoms of xerophthalmia amongst these children. In 563 children serum retinol was determined and the average value found was 20.3 micrograms/dl (SD = 10.8 micrograms/dl); the prevalence of deficient serum retinol (below 10.0 micrograms/dl) was of 15.3%. In all 7 localities studied, the prevalence of deficient retinol levels was above 5.0%, the criterion recommended by WHO for considering it a Public Health Problem. The distribution of serum retinol was similar between the sexes, but there was an age trend: the prevalence of deficient and low levels decreased with age. There was no association between deficient serum retinol and family income per capita or mother's education. Results from the 24 h food consumption survey revealed that only 8% of children had an adequate intake of vitamin A through the diet; 66% received less than 1/2 and 35% less than 1/4 of the recommended daily intake of vitamin A. Vitamin A deficiency should be considered a Public Health Problem in the region due to the high prevalence of deficient levels of serum retinol as well as the large dietary inadequacy.

Age Factors↗
PubMed2001

A 3-year follow-up study of social, lifestyle and health predictors of cognitive impairment in a Chinese older cohort.

BACKGROUND: Longitudinal data on the older population in the Asian setting are limited. This paper reports the factors associated with the development of cognitive impairment (CI) in a cohort of Chinese elderly aged > or =70 years. METHODS: The study cohort comprising 2030 subjects aged > or =70 years was assembled in 1991-1992 and followed for 36 months. Baseline information on cognitive function, as well as a number of social and health variables were obtained through face-to-face interview at the respondent's place of residence. The outcome variable was the development of CI among 988 cohort members who were initially free from CI, and who could be contacted at the 36-month follow-up. The instrument used to assess CI was based on the information/orientation part of the Clifton Assessment Procedure for the elderly (CAPE), using a cut-off point of 7. RESULTS: Of the men, 6.7%, but 22.2% of women had CI at 3-year follow-up. The age-adjusted annual incidence of CI was 1.52% in men, and 6.37% in women. Multivariate logistic regression analysis showed that women had a 2.5-fold increased risk of having CI, compared with men. The risk increased by about 1.5-fold with every 5-year increase in age. Slow gait time, as assessed by the 16-foot walk, was a predictor of CI in both sexes (odds ratio [OR] = 1.03 per second increase, 95% CI : 1.0-1.07). Men residing in institutions had a 4.4-fold increased risk of having CI (95% CI : 1.7-11.1) compared with those residing in community, while the OR among women was 2.5 (95% CI : 1.3-4.9). Among women, no formal education increased the risk of having CI by 3.2-fold (95% CI : 1.8-5.5). Income dependency also increased the risk of CI by about fourfold, and no exercise at baseline was associated with a twofold increased risk of CI. Incident stroke during follow-up also increased the risk of CI (OR = 8.4, 95% CI : 1.2-59.4). CONCLUSIONS: Older age and female sex were independent factors associated with CI. No formal education, slow gait time and institutionalization increased the risk of CI in both sexes. While education had a stronger effect in women, institutionalization had a stronger effect in men. Financial dependency, lack of exercise and incident stroke played a significant role in women.

Aged↗
PubMed2006

The economic impact of visceral leishmaniasis on households in Bangladesh.

OBJECTIVES: To explore current patterns of diagnosis and treatment, quantify household economic impact and identify household strategies to cover the costs of visceral leishmaniasis (VL) care in rural Bangladesh. METHOD: Structured interviews with 113 VL patients from 87 households documenting all provider visits and expenditures for health care for VL, and the ways in which the expenditures were covered. RESULTS: Patients paid a median of 7 visits to six different providers before beginning VL treatment. All visited the subdistrict government hospital at least once. While health care, including antileishmanial drug therapy, is officially available free of charge at government facilities, 79% of patients reported making informal payments for provider access, diagnostics and drug administration; only 14% of patients received their full drug course from this source. For the 58% of patients who purchased the full treatment course, drug cost constituted 34% of direct expenditure. Median direct expenditure for one VL patient was US$87 and median income lost was $40; median total expenditure was 1.2 times annual per capita income of our study population. Households employed multiple coping strategies to cover expenditures, most commonly sale or rental of assets (62%) and taking out loans (64%). CONCLUSIONS: Visceral leishmaniasis treatment causes a major economic burden in affected families. Control strategies for VL should facilitate timely, affordable diagnosis and treatment of patients to decrease the infection reservoir and to alleviate the economic burden of VL on households.

Adaptation, Psychological↗
PubMed2003

Dynamical simulations of zone axis electron channelling patterns of cubic silicon carbide.

We have observed and simulated energy-dependent intensity distributions in electron channelling patterns (ECP) of cubic silicon carbide (3C SiC) which were recorded close to the (111) zone axis. The kinetic energies used were in the range from 4 to 8 keV, covering the low-energy region of the ECP technique. We explain the observed patterns by dynamical many beam simulations using a bloch wave approach for the diffraction of the incoming beam and the forward-backward-approximation for the backscattering of the electrons. The dynamical simulations reproduce the experimental patterns very well. It is found that higher-order Laue zone reflections are responsible for the strong energy sensitivity of the intensity distributions.

Journal Article↗
PubMed2005

Obesity and household food insecurity: evidence from a sample of rural households in Malaysia.

OBJECTIVE: The study examined nutritional outcomes related to body fat accumulation of food insecurity among women from selected rural communities in Malaysia. DESIGN: Cross-sectional study. SETTING: Rural communities (seven villages and two palm plantations) in a district with high percentage of welfare recipients. SUBJECTS AND MEASUREMENTS: Malay (n = 140) and Indian (n = 60) women were interviewed and measured for demographic, socioeconomic, anthropometric, dietary and physical activity information. The women were measured for their body mass index and waist circumference (WC). Energy and nutrient intakes, food group intake and food variety score were analyzed from 24 h dietary recalls and food-frequency questionnaire. Daily physical activity of the women was examined as the number of hours spent in economic, domestic, leisure and sport activities. RESULTS: Using the Radimer/Cornell Hunger and Food Insecurity Instrument, 58% of the women reported some degree of food insecurity (household insecure 14%, adult insecure 9.5% and child hunger 34.5%). In general, food-insecure women had lower years of education, household income and income per capita, more children and mothers as housewives. More than 50% of food-insecure women were overweight and obese than women from food-secure households (38%). Similarly, more food-insecure women (32-47%) had at-risk WC (> or = 88 cm) than food-secure women (29%). Food-insecure women spent significantly more time in domestic and leisure activities than food-secure women. Overweight and abdominal adiposity among the women were associated with a number of independent variables, such as women as housewives, women with more children, larger household size, food insecurity, shorter time spent in economic activities, longer time spent in leisure activities and lower food variety score. After adjusting for factors that are related to both adiposity and food insecurity, women from food-insecure households were significantly more likely to have at-risk WC, but not obese. CONCLUSION: Among this sample of rural women, the relationship between food insecurity and obesity is a complex one, which involves the interaction with other factors. Nevertheless, given that obesity and food insecurity are of public health concerns in the developing nations, the association between the two should be further investigated.

Adipose Tissue↗
PubMed1976

The effect of measurement error on differences in hospital expenditures.

Differences in expenditures for medical care among various subgroups in the population according to age, income, residence, and ethnicity have important public policy implications. However, few efforts have been made to assess the extent to which these apparent differences among subgroups observed in social surveys may be influenced by measurement error. This paper provides a framework for examining the impact of various kinds of error including random error and biases. The framework is applied to data on hospital expenditures from a national survey of health services expenditure which includes in addition to consumer reports, verifying information from hospitals, physicians, and third-party payers who provided services to persons in the sample. Differential error according to demographic and social characteristics is estimated. The impact of such differential error on conclusions about the distribution of health resources is discussed.

Age Factors↗
PubMed1989

Health, income, and activities of retired physicians.

Driven to retire mainly by changes in the health care delivery system, physicians nevertheless find it difficult to reduce their professional activities as they grow older. Retired physicians in a seven-county region of upstate New York were surveyed to discover how they were faring in retirement and to elicit information of possible value to doctors planning to retire. Good health and adequate income were the prime factors in successful retirement, along with active involvement in postretirement activities, especially nonmedical ones. Three quarters of respondents found annual incomes between $25,000 and $50,000 to be comfortable. All agreed that private investments must make up at least a third of this amount, supplementing Social Security, pensions, individual retirement accounts, and Keogh plan distributions. There was diversity of opinion on remaining active in medical affairs after retirement. A large majority of those who found retirement better than anticipated advised a clean break with medicine. Most of their colleagues who rated retirement about as expected or not as good as anticipated counseled continued involvement in professional activities.

Aged↗
PubMed1989

An economic approach to fertility in Britain since 1860.

This paper utilizes a dynamic economic approach to examine movements in fertility in Britain since 1860. The analysis and results indicate that fertility has responded positively to change in incomes. However, this positive effect has been more than offset by the increase in the opportunity cost of female time which has followed closely the educational attainment of women.

Adolescent↗
PubMed2000

Learning cortical topography from spatiotemporal stimuli.

Stimulus representation is a functional interpretation of early sensory cortices. Early sensory cortices are subject to stimulus-induced modifications. Common models for stimulus-induced learning within topographic representations are based on the stimuli's spatial structure and probability distribution. Furthermore, we argue that average temporal stimulus distances reflect the stimuli's relatedness. As topographic representations reflect the stimuli's relatedness, the temporal structure of incoming stimuli is important for the learning in cortical maps. Motivated by recent neurobiological findings, we present an approach of cortical self-organization that additionally takes temporal stimulus aspects into account. The proposed model transforms average interstimulus intervals into representational distances. Thereby, neural topography is related to stimulus dynamics. This offers a new time-based interpretation of cortical maps. Our approach is based on a wave-like spread of cortical activity. Interactions between dynamics and feedforward activations lead to shifts of neural activity. The psychophysical saltation phenomenon may represent an analogue to the shifts proposed here. With regard to cortical plasticity, we offer an explanation for neurobiological findings that other models cannot explain. Moreover, we predict cortical reorganizations under new experimental, spatiotemporal conditions. With regard to psychophysics, we relate the saltation phenomenon to dynamics and interaction in early sensory cortices and predict further effects in the perception of spatiotemporal stimuli.

Animals↗
PubMed1991

A surplus of physicians in Israel: any lessons for the United States and other industrialized countries?

In Israel, there is a consensus that there is a surplus of physicians. An examination of the Israeli situation may suggest some responses that will be taken by policy makers and physicians in the United States and other industrialized countries as the supply of physicians continues to increase. Specifically, we examine the impact of rising physician supply on the geographic distribution of physicians in Israel, the length of the training period for residency programs, the interaction between physicians and other professionals, and the level of physician incomes compared to other Israeli workers.

Delivery of Health Care↗
PubMed2006

Willingness to pay for praziquantel treatment in a hyperendemic community of Ogun State, Nigeria.

BACKGROUND: Schistosomiasis is highly endemic in Nigeria. However, very little is known about the usage and social marketing of praziquantel in the control of schistosomiasis in endemic communities and on the persons willingness to pay for the drug to support its extensive use and thus aid control efforts in Nigeria. OBJECTIVE: The study examined the willingness of people in a hyperendemic community, to pay for treatment with praziquantel before and after provision of the drug, with a view to assess the feasibility of achieving widespread coverage. METHODS: Data were collected through focus group discussions among household heads and other adult family members and through the use of a questionnaire to survey household heads in Imala-Odo, a community hyperendemic for schistosomiasis, in southwest Nigeria. The main outcome measure was the respondents' willingness to pay for schistosomiasis treatment. RESULTS: The results showed that in contrast to the 92.3% of respondents who expressed willingness to buy the drug in the preintervention study, only 46.5% actually purchased the drug during intervention for the treatment of their infected household members. The respondents' level of education, occupation, and income influenced their willingness to pay (P<.05). Statistical tests showed that those willing to pay for treatment had a higher income score than those unwilling to do so. Most respondents preferred their community head and reliable persons chosen by the community as convenient outlets for drug distribution. The number of household members respondents were willing to treat increased from 4 to 6 at N320.00 (US $2.52) in the preintervention and postintervention phases, respectively. Gender factor was found to influence the respondents' perceived average treatment cost; the females wanted N300.00 (US $2.36) against N100.00 (US $0.79) among the males. CONCLUSION: Efforts need to be made and sustained to ensure that all families can afford to praziquantel drug to achieve the ultimate goal of controlling the infection in endemic communities of Nigeria.

Adolescent↗
PubMed2001

The family as the health producer--when spouses are Nash-bargainers.

The Grossman model is extended to a situation in which the family is regarded as the producer of individual health and spouses are Nash-bargainers. The model has implications for the interaction between family structure, income and the stocks of health capital and the bargaining strength of different family members. The main insight is that the possibility of divorce affects the distribution of health capital between family members. We analyse, inter alia, the impact on the distribution of health (particularly regarding child health) of changes in family policies related to the dissolution of the family.

Adult↗
PubMed1999

Geographies of health perception in Québec: a multilevel perspective.

Self perceived health is a widely used measure and, in Quebec, it has been shown to vary significantly between geographical areas. In the present study, these geographical variations are examined in a multilevel analysis in order to disentangle compositional (individual characteristics) and contextual (place) effects. The analysis recognizes four levels of variation: individual, household, local and regional. Similar analyses carried out in Britain, have considered only two levels: individual and local. Data come from the 1992-1993 Quebec Health and Social Survey, a general household survey using a stratified two-stage sampling design. Health perception (the response variable) is considered with a set of individual predictor characteristics reflecting gender, lifestyle, socio-economic conditions, marital status and social support. Results show the existence of significant local area variations in health perception after having allowed for individual characteristics and variations at the household level. At the regional level, however, no systematic and significant variations remain although some individual regions are found to have a significant impact on health perception.

Adult↗
PubMed1982

Use of a symptom scale to study the prevalence of a depressive syndrome in young adolescents.

The entire student enrollment (n = 624) in a public junior high school in Raleigh, North Carolina were visited in their homes between October 1978 and February 1979. Eleven (2.9%) of 384 students completing the Center for Epidemiologic Studies self-report depression scale reported symptoms patterns consistent with the Research Diagnostic Criteria for major depressive disorder. These 11 subjects were concentrated in the top 12% of the distribution of symptom scores and had symptom prevalences exceeding those in the overall study population by a factor of three or more. Black males from low income households predominated. A self-report questionnaire may be usable to detect a depressive "syndrome" in young adolescents. The prevalence of such a syndrome is similar to prevalence estimates for adults and young adolescents, but considerably lower than estimates derived from total scale scores and cutoff points. A syndrome-oriented analytic approach for symptom scales should be explored as an alternative to the use of cutoff scores for epidemiologic studies of psychiatric disorders.

Adolescent↗
PubMed2006

Uncovering and responding to needs for sexual and reproductive health care among poor urban female adolescents in Nicaragua.

BACKGROUND: To meet the needs of female adolescents from low-income urban areas for sexual and reproductive health (SRH) care, vouchers providing free-of-charge access to SRH care at 19 primary care clinics were distributed in Managua, Nicaragua. These vouchers substantially increased the use of services, demonstrating that many adolescents are willing to use such services, if readily accessible. The voucher redemption made it possible to identify the nature of existing, but largely unmet, needs for SRH care. METHOD: The medical files from 3301 consultations with female adolescents were analysed using descriptive statistical methods and multiple logistic regression. RESULTS: Female adolescents presented SRH problems that merited medical attention. The mean number of problems presented was 1.5 per consultation: 34% of the vouchers were used for contraceptives, 31% for complaints related to sexually transmitted infection (STI) or reproductive tract infection (RTI), 28% for advice/counselling, 28% for antenatal check-up and 18% for pregnancy testing. A new category of health care users emerged: sexually active girls who were neither pregnant nor mothers and who sought contraceptives or STI/RTI treatment. Contraceptive use doubled among the sexually active non-pregnant voucher redeemers. Consultation with a female doctor younger than 36 years was associated with a higher chance of having contraceptives prescribed. CONCLUSION: Accessible and appropriate SRH care has the potential to make an important contribution to the increased contraceptive use, decreased risk of unwanted teenage pregnancies and decreased prevalence of STIs/RTIs among underserved adolescents. Once adolescents access the services, providers have a crucial role in ensuring current and continuing needs are met.

Adolescent↗
PubMed1985

Evaluation of social inequality of use of dental services in Norway.

It is tempting to assume that the increase in use-rates in Norway throughout the 1970's reflects a decrease in social inequality concerning use of dental services. In order to assess whether or not equalization has been achieved from 1973 to 1983, the application of a conservative and a radical standard led to different conclusions about equalization. Therefore, a formal model containing explicit assumptions was constructed and used to test the null hypothesis of no significant change in social inequality concerning regular use of dental services as well as no significant change in use-rates from 1973 to 1983. The model corrects for the ceiling effect as the proportion of regular dental visitors from a social status group increases, by assuming that the dental visiting potential is normally distributed within each social status group. The empirical basis was formed by nationwide interview surveys in 1973 (n = 1630) and in 1983 (n = 1410). Level of income was selected as indicator of social status and grouped into seven categories. Regular visitor rates for each income group were transformed to standard normal deviates (z-scores) and regressed upon level of income separately for 1973 and 1983. There was a net improvement of proportions of regular dental visitors from 1973 to 1983 as measured by a significant decrease of the intercept, but no equalization between social status groups as measured by no significant change of the slope.

Adult↗