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PubMed1978

Sturdy childhood predictors of adult antisocial behaviour: replications from longitudinal studies.

Results are compared in studies of 4 male cohorts - 1 all white, 1 all black, and 2 racially representative of the population - growing up in different eras, followed past varying portions of their adult lives, living in different parts of the US. Despite sample differences and differences in sources of information and in the variables used to measure both childhood predictors and adult outcomes, some striking replications appear with respect to childhood predictors of adult antisocial behaviour. All types of antisocial behaviour in childhood predict a high level of antisocial behaviour in adulthood and each kind of adult antisocial behaviour is predicted by the number of childhood antisocial behaviours, indicating that adult and childhood antisocial behaviour both form syndromes and that these syndromes are closely interconnected. Also confirmed across studies are: (1) adult antisocial behaviour virtually requires childhood antisocial behaviour; (2) most antisocial children do not become antisocial adults; (3) the variety of antisocial behaviour in childhood is a better predictor of adult antisocial behaviour than is any particular behaviour; (4) adult antisocial behaviour is better predicted by childhood behaviour than by family background or social class of rearing; (5) social class makes little contribution to the prediction of serious adult antisocial behaviour.

Adolescent↗
PubMed2001

Self-preventive oral behavior in an Italian university student population.

BACKGROUND/AIM: The aim of this study was to assess the oral hygiene attitude and the professional preventive examination compliance in Italian university students. METHOD: A sample of 202 students attending the University of Bologna was randomly selected and interviewed about their preventive oral health attitude and compliance. All students reported using toothpaste and most of them (92.1%) brushed their teeth at least 2x a day using artificial, medium stiffness bristles. The toothbrush was generally (81.6%) replaced within 3 months. Few subjects (14.9%) said they used dental floss daily or utilized other devices. A majority of subjects (59.9%) had a dental examination within the year previous to the interview. Cluster analysis was performed. RESULTS: 4 groups were identified with homogeneous oral hygiene behavior and compliance toward professional preventive examination. Only one cluster, representing 33.6% of the sample, showed consistent frequency and modalities of oral hygiene habits. The other clusters seemed to be defective with interproximal cleaning procedures and compliance toward professional preventive care. Since the sample was characterized by a young, urbanized, homogeneous group with a high educational level and frequently from an upper middle class social status, the analysis probably gives a supra-estimation of the positive behavior. CONCLUSION: It is rational to suppose that strategies to promote dental service utilization, patients' compliance and a professional style oriented toward prevention may be useful to improve the oral health condition in the young adult Italian population.

Adult↗
PubMed2004

Social determinants for infant mortality in the Nordic countries, 1980-2001.

AIM: Social equity in health is an important goal of public health policies in the Nordic countries. Infant mortality is often used as an indicator of the health of societies, and has decreased substantially in the Nordic welfare states over the past 20 years. To identify social patterns in infant mortality in this context the authors set out to review the existing epidemiological literature on associations between social indicators and infant mortality in Denmark, Finland, Norway, and Sweden during the period 1980-2000. METHODS: Nordic epidemiological studies in the databases ISI Web of Science, PubMed, and OVID, published between 1980 and 2000 focusing on social indicators of infant, neonatal, and postneonatal mortality, were identified. The selected keywords on social indicators were: education, income, occupation, social factors, socioeconomic status, social position, and social class. RESULTS: Social inequality in infant mortality was reported from Denmark, Finland, Norway, and Sweden, and it was found that these increased during the study period. Post-neonatal mortality showed a stronger association with social indicators than neonatal mortality. Some studies showed that neonatal mortality was associated with social indicators in a non-linear fashion, with high rates of mortality in both the lowest and highest social strata. The pattern differed, however, between countries with Finland and Sweden showing consistently less social inequalities than Denmark and Norway. While the increased inequality shown in most studies was an increase in relative risk, a single study from Denmark demonstrated an absolute increase in infant mortality among children born to less educated women. CONCLUSIONS: Social inequalities in infant mortality are observed in all four countries, irrespective of social indicators used in the studies. It is, however, difficult to draw inferences from the comparisons between countries, since different measures of social position and different inclusion criteria are used in the studies. Nordic collaborative analyses of social gradients in infant death are needed, taking advantage of the population-covering registers in longitudinal designs, to explore the mechanisms behind the social patterns in infant mortality.

Female↗
PubMed1997

Sex ratios: are there natural variations within the human population?

OBJECTIVE: To investigate on a population basis the suggestion that certain factors naturally alter the odds of having a boy or a girl, and that some women are predisposed towards having children of one particular gender. DESIGN: Routine data analysis. POPULATION: Routinely collected data on singleton infants born in Scotland from 1975 to 1988, linked so that births (live and still) to the same mother could be identified. The analyses relate to 549,048 first to fifth order births occurring to 330,088 women whose records were complete from the first delivery onwards. MAIN OUTCOME MEASURES: Gender of infant. RESULTS: Of 549,048 births, 51.4% were male. Apart from random variation, the sex ratio of 1.06 remained constant at all birth orders (P = 0.18). The probability of a male infant appeared unrelated to the genders of the preceding siblings (P > 0.20 in second to fifth deliveries), and there was no evidence of variation with maternal age (P = 0.31), maternal height (P = 0.69), paternal social class (P = 0.12), maternal social class (P = 0.57), year of delivery (P = 0.84) or season of birth (P = 0.41). Whilst mothers whose children were all the same gender were more likely to continue childbearing than those with children of different genders, there was no evidence that those with daughters were more likely to continue than those with sons. CONCLUSIONS: The suggestion that some women have a natural predisposition towards having children of a particular gender is not supported by these data. On a population basis there is no evidence to suggest that gender determination is anything other than a chance process.

Birth Order↗
PubMed1994

Epidemiology of depression: prevalence, risk factors and treatment situation.

Depending on the way it is defined depression can be seen as a state of mood, as a symptom, as a syndrome or as a clinical diagnosis. Epidemiological studies show that depression is the most common mental disorder in man. Up to 4% of men and 8% of women suffer from a clinically significant depressive disorder, while depressive symptoms are much more common. The occurrence of depression is associated with factors such as age, marital status, social class, and social conditions. In Finland, only one third of persons suffering from depression are actually being treated for their disorder.

Adult↗
PubMed1989

Drug use and policy in Poland in the 1980s.

In this article, the author describes the recent changes in patterns of drug use in Poland in the light of available data. A much higher incidence of use has been seen in the 1980s, and there are indications that this can be accounted for by increased use among young people from the manual working class. Social deprivation may play a part in the etiology of the 1980s "epidemic," and evidence is put forward in support of this view. Both patterns of use and the policies that have been introduced to deal with them are viewed in terms of the political, economic, and social context of post-Solidarity perestroika.

Adolescent↗
PubMed1975

Decisions to treat critically ill patients: a comparison of social versus medical considerations.

A questionnaire survey shows that physicians in four medical specialties evaluate chronically and terminally ill patients not only in terms of the physiological aspects of illness but also in terms of the extent to which they are capable of interacting with others. A patient's potential capacity to perform his social roles depends upon his "salvageability," i;e., the likelihood that he will be able to resume his roles and the degree of irreversible physical or mental damage which indicates his capacity for resuming them. The priorities in terms of treatment are the following: (1) salvageable patients with physical damage; (2) salvageable patients with mental damage and unsalvageable patients with physical damage; (3) unsalvageable patients with mental damage. Within these catagories variables such as patient attitude, family attitude, age, and social class, which define the social environment of the patient, also influence the physician's decision to treat him. Studies of hospital records of cases in two of the specialties were consistent with they survey findings. The findings suggest that there is a disparity between the traditional ethic concerning the treatment of such patients and the actual behavior of many physicians. As a solution to the inconsistencies between ideal and actual behavior, the development of medical guidelines for the withdrawal of treatment with respect ot certain specifically defined conditions is recommended.

Adult↗
PubMed1999

The WOMB (Women's views of birth) antenatal satisfaction questionnaire: development, dimensions, internal reliability, and validity.

BACKGROUND: Antenatal services continue to change, stimulated by the Changing Childbirth report. Women's views should be an important component of assessing the quality of such services. To date, no published quantitative multidimensional assessment instrument has been available to measure their satisfaction with care. AIM: To develop a valid, reliable, multidimensional questionnaire to assess quality of antenatal care. METHOD: A multidimensional satisfaction questionnaire was developed using psychometric methods. Following fieldwork to pilot a questionnaire, three successive versions of it were given by midwives to pregnant women in their final trimester in nine trusts in the old South Western region of England. Their replies were analysed by principal components analysis (PCA) with varimax rotation; internal reliability was assessed by Cronbach's alpha. Face, content, and construct validity were all assessed during development. RESULTS: Out of 196 women, 134 (68.4%) returned the pilot questionnaires. One hundred and seventy-two (57.3%) out of 300 women returned version 1 of the WOMB (WOMen's views of Birth) antenatal satisfaction questionnaire proper, 283 (56.6%) out of 500 returned version 2, and 328 (65.6%) out of 500 returned the final development version. This final version consisted of 11 dimensions in addition to a general satisfaction one. These were [Cronbach's alpha]: five related to antenatal clinic characteristics (travelling to clinic [0.75], waiting at clinic [0.90], clinic environment [0.69], timing of appointment [0.78], car parking [0.85]), three 'professional' characteristics (professional competence [0.80], knowing carers [0.79], information provided [0.81]), antenatal classes [0.76], social support from other pregnant women [0.83], checking for the baby's heart beat [0.63]. There were significant moderate correlations (range = 0.24 to 0.77) between individual dimensions and the general satisfaction dimension. Women's dimension scores were significantly related to age, parity, social class, and best educational achievement. CONCLUSION: This multidimensional satisfaction instrument has good face, content, and construct validity, and excellent internal reliability. It could be used to generally assess antenatal services or to screen them to detect areas where further in-depth qualitative enquiry is merited. Its sensitivity to change over time, external reliability, and transferability to non-Caucasian groups needs to be assessed.

Adult↗
PubMed1991

[Affective, schizoaffective and schizophrenic psychoses. A comparative long-term study].

A total of 402 patients were followed up for, on average, 25 years after the onset of their illness. The diagnoses, made longitudinally, were as follows: schizophrenic disorder (n = 148); schizoaffective disorder (n = 101); affective disorder (n = 106). The remaining 47 patients did not fulfil the criteria for any of these diagnoses. A distinction was made between "episode" (cross-sectional diagnosis) and "illness" or "disorder" (longitudinal diagnosis). The "episodes" (cross-sectional diagnosis) were classified according to slightly modified DSM-III criteria into schizophrenic, affective (melancholic, manic, manic-depressive mixed), schizoaffective (schizodepressive, schizomanic, schizomanic-depressive mixed) and non-characteristic episodes. The criteria for the episodes are: Schizophrenic episode: criteria of DSM-III, slightly modified. Melancholic episode: according to "Major Depression, Melancholic Type" of DSM-III-R. Manic episode: according to the criteria of DSM-III, slightly modified. Manic-depressive mixed episode: Presence of manic and depressive symptomatology during one episode. Schizodepressive episode: Presence of schizophrenic and depressive symptomatology during one episode. --Schizomanic episode: presence of schizophrenic and manic symptomatology during one episode. Schizomanic-depressive mixed episode: Presence of schizophrenic, manic and depressive symptomatology during one episode. The diagnosis of an "illness" or "disorder" (longitudinal diagnosis) took account of all the kinds of episodes that occurred during the whole course. The final diagnosis (longitudinal diagnoses) were defined as follows: Schizophrenic disorder: only schizophrenic episodes during the whole course Affective disorder: only affective episodes during the whole course (melancholic, manic, manic-depressive mixed episodes). Schizoaffective disorder: at least one schizoaffective episode during the course (schizodepressive, schizomanic, schizomanic-depressive mixed episode), independently of the type and number of other episodes, or sequential manifestation of schizophrenic and affective episodes. The principal instruments of investigation and evaluation were: Global Assessment Scale (GAS); Disability Assessment Schedule (WHO/DAS); Psychological Impairment Rating Schedule (WHO/PIRS); Present State Examination (PSE); Criteria for social class and social mobility according to Kleining and Moore (also transferred to the criteria of Hollingshead and Redlich) - A pool of items based on WHO instruments for social parameters; Items for pharmacological treatment and prophylaxis.

Activities of Daily Living↗
PubMed1990

[Physical exercise among school children. A nation-wide sociomedical study of 1,671 children 11-15 years of age].

A total of 1,671 children aged 11, 13 and 15 years from a nationwide random sample of schools completed an anonymous questionnaire on their social backgrounds, social networks, health, life satisfaction, and health behaviour. The proportion practising outdoor activities at least three times a week was 57%; 37% did some physical exercise in their leisure time sufficient to make them breathless or sweat at least four times a week; 43% at least four hours a week. Two thirds were active members of a sports club. A minority of 8% did not carry out any physical exercise during their leisure time sufficient to make them breathless or sweat. Boys did more physical exercise than girls irrespective of the measurement of exercise. The most important motives for physical exercise were to improve health, to get in good shape, to have fun, and to make new friends. More than 90% of the children intended to do physical exercise at the age of 20. High intensity of physical activity was associated with high social class, strong social integration in the peer group, easy contact with parents and friends, physical exercise among parents and best friends, high degree of life satisfaction, and good health.

Adolescent↗
PubMed1989

[Influence of caries preventive measures on prevalence and incidence of caries in Hamburg preschool children].

A decline in caries prevalence and incidence was observed in preschool children in Hamburg kindergardens and day care centres. On the occasion of dental exams staff and children were interviewed about measures of caries prevention. It was possible to establish complete records about oral hygiene, intake of sweets in the institutions, and ingestion of fluorides. Statistical analyses demonstrated that, apart from age and social class, the social environment of the children was of significant influence. The prevalence of caries also was significantly a function of the intake of sweets in the institution. The incidence of caries and fluoride ingestion at home correlated with high significance. The reduction of caries in Hamburg preschool children is predominantly due to the reduced intake of sweets in kindergardens and day care centres.

Child, Preschool↗
PubMed2002

Urbanisation and cariogenic food habits among 4-24-month-old black South African children in rural and urban areas.

OBJECTIVE: To determine if social class, education level and group environment (rural and urban) influence particular food habits commonly associated with dental caries incidence among 4-24-month-old black South African children. DESIGN, SETTING AND SUBJECTS: Information was collected by trained interviewers using a food-frequency questionnaire from mothers of children in two areas in South Africa: Ndunakazi, a rural area in KwaZulu/Natal (n = 105) and two urban areas in Gauteng - Soweto (low to middle socio-economic area) (n = 100) and the northern suburbs of Johannesburg and Sandton (middle to upper socio-economic area) (n = 101). Education level and occupation of the parents, which define social class, were also recorded. A linear logistic (Proc Catmod) analysis tested social class, education level and group environment as the independent variables and the food habits as the dependent variables. RESULTS: Group environment was significantly associated with nine of the 18 food habits investigated. More urban than rural mothers added sugar to their child's comforter. More mothers in urban Soweto than in urban Johannesburg were still breast-feeding their infants at 24 months. More rural than urban mothers were giving 'mutis' (common and traditional medicines). Together with group environment, education level was significantly associated with giving of 'mutis' and the frequency of giving them. Social class was significantly associated with the frequency of breast-feeding and when the child was breast-fed. Mothers from the upper social class breast-fed less frequently than mothers from the lower class. CONCLUSION: The study showed a strong influence of rural/urban environment on specific cariogenic food habits among young black South African children, enabling the development and implementation of a nutrition strategy.

Black or African American↗
PubMed1997

Socioeconomic differences in cancer survival: a review of the evidence.

In the discussion of social inequalities in health there has been much debate on the role of medical care. Large differences in cancer incidence and mortality from cancer have been consistently observed. To understand the potential importance of socioeconomic differences in prompt detection and treatment of cancer it is essential to have data on cancer survival. These have been examined less extensively than differences in cancer incidence. We have reviewed 42 studies on social class differences in cancer survival. Twenty-three studies were conducted in North America, and 15 in western European countries. Twenty-three studies were carried out through population-based cancer registries and 17 through hospitals or hospital-based registries. Seven studies examined survival differences for multiple cancer sites. Social class differences in cancer survival appear remarkably general. Patients in low social classes had consistently poorer survival than those in high social classes. The magnitude of the differences for most cancer sites was fairly narrow, with most relative risks falling between 1 and 1.5. The widest differences were observed for cancers of good prognosis and specifically cancers of the female breast, corpus uteri, bladder and colon. The pattern of the social differences in survival did not vary consistently by sex, country, or source of the study population and did not depend on the socioeconomic indicator used.

Breast Neoplasms↗
PubMed1997

Inequality in men's mortality: the socioeconomic status gradient and geographic context.

Lower mortality for older rural Americans, compared to urban residents, runs counter to rural-urban disparities in health care services and residents' socioeconomic resources. This paradox calls into question the ways in which community conditions influence mortality and contextualize the relationship between individuals' socioeconomic status and health. Drawing on 24 years of data from the National Longitudinal Survey of Older Men, we observe that rural older men's life expectancy advantages occur even after controlling for residential differences in social class and lifestyle factors. Our results also show that rural advantages in mortality coincide with a more equitable distribution of life chances across the social classes. The association between social class and mortality is strongest among urban men, arising from socioeconomic conditions throughout the life cycle.

Adult↗
PubMed1978

Sperm basic proteins in cervical carcinogenesis: Correlation with socioeconomic class.

Two types of basic protein, a histone and a protamine, were separated from single ejaculates of human sperm and a ratio between their contents in a given number of sperm established. The ratio varied widely in different males and correlated with ranking by social class: the lower the social class, the greater the proportion of protamine. Statistically similar correlations link social class with the incidence of venereal disease and the incidence of in-situ carcinoma of the cervix, both of which are epidemiological variables in squamous cervical cancer. The basic proteins of the sperm head, especially the protamines, may thus also have a role in the aetiology of squamous cervical cancer.

Carcinogens↗
PubMed2005

A "fair innings" between the sexes: are men being treated inequitably?

In most modern developed communities, women are known to live longer than men. A less known fact is that in many statistics reporting differences in life expectancy between socio-economic classes, on average women in the worst-off social class live as long as men in the best-off social class, if not longer. It is true that women tend to have higher morbidity, or lower health-related quality of life, especially at advanced age, but this female disadvantage does not offset the life expectancy advantage sufficiently to lead to the conclusion that men and women enjoy comparable lifetime health prospects in these communities. Although there is much public and policy discussion about the inequity of health inequalities between the social classes, there is relatively little discussion about such inequalities between the sexes. The paper first discusses the applicability of the fair innings argument to the issue of inequality in health between the sexes. It critically examines six arguments concerning why inequality in health between the sexes may or may not be an inequity. Next, special attention is given to the argument that it is wrong to judge the fairness or unfairness of health inequalities in isolation, but that this judgement should be made only after considering other inequalities relevant to overall human well-being, many of which are believed to work to the disadvantage of women. An analytical framework based on the Gender-related Development Index (a supplementary index to the Human Development Index) is taken as a starting point, to address the issue of health and overall well-being. But this is found wanting, and suggestions are made as to how its conceptual and empirical properties could be improved. Meanwhile we conclude that a prima facie case has been made that the current distribution of health in most countries does not give men a "fair innings", but the broader question about general well-being remains unresolved.

Attitude to Health↗
PubMed1983

Self-referral: social and demographic determinants of consulting behaviour.

This report, which is one of a series, is concerned with socio-demographic correlates of self-referral, and the extent to which the observed associations can be explained by variations in symptom prevalence and severity. Social class, marital status, employment status, and distance from health centre, all show small but significant associations with self-referral. For social class the effect appears to be mediated by symptoms. People in social classes IV and V, women who are widowed, divorced or separated, and people who live near the health centre are more likely to visit their general practitioner.

Female↗
PubMed1993

Injuries in primary care practices.

A study of injuries among 0-15 year old children attending primary care clinics in a low social class and a middle class neighbourhood was carried out during a period of one year. Data were collected in a structured form by the physicians while the patient was in the clinic. The rate of injuries was 121.3/1000 children per year in the clinic from the lower social class neighbourhood and 70.7/1000 children per year in the clinic from the middle class neighbourhood. Injuries in playgrounds, and on pavements and streets occurred in higher proportions in the low social class than in the middle class neighbourhood clinics. The most frequent causes of injuries were falls and being struck and injured by cutting/piercing instruments; these caused mostly contusions and lacerations. The clinic was the first place of treatment in 65% of the cases in the middle class area and in 45% in the lower social class area; 28% and 10% respectively were referred to the hospital for additional treatment. Data from primary care clinics should be considered when estimating the incidence of injuries in the community, in planning intervention programmes, and future research.

Adolescent↗