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PubMed2004

[Evaluation of the nutritional status of children and adolescents with asthma].

OBJECTIVE: The aim of this study was to analyze the nutritional state of children and adolescents with asthma, and to relate this to patient age at the onset of disease, severity of the disease, family per capita income, and the level of maternal schooling. METHODS: A cross sectional study involved 66 patients from the Immunology, Allergy and Pulmonology outpatient clinic of the Hospital das Clínicas of the State University of Campinas (HC/UNICAMP). All of the patients suffered from atopic asthma and ranged in age from 4 to 14 years old. The patients were compared to 124 controls. RESULTS: There were no differences among male patients and the controls in the distribution of the z-scores for weight/age (p=0.24), height/age (p=0.61), body mass index (p=0.21), upper arm circumference (p=0.94) and triceps skinfold (p=0.49) in relation to disease severity, age at the first occurrence of disease, family per capita income, and the level of maternal schooling. Similarly, there were no significant differences in the z-scores for weight/age (p=0.13), height/age (p=0.46), body mass index (p=0.13), upper arm circumference (p=0.06) among female patients and their controls. However, there was a difference (p=0.002) between the triceps skinfold of female patients (-0.74 +/- 0.84) and the controls (0.17 +/- 1.21). No child with asthma was obese (z-scores for body mass index > or =2). There were no significant differences in of the anthropometrical measurements among patients in relation to family per capita income, the level of maternal schooling, severity of the disease, and age at first occurrence the disease, but the mean weight of boys suffering from moderate asthma was lower than that of the other patients (p=0.02). CONCLUSIONS: The nutritional status of the patients studied was satisfactory so that their body composition was unaffected by the disease, on environment, or by any interaction between these two factors. Our results reinforce the view that an anthropometrical evaluation should be done periodically to assess the consequences of the disease and the impact of any interventions and therapeutic measures used. This will provide a better evaluation of the patient's overall health.

Adolescent↗
PubMed1994

Correlates of tooth loss in a Canadian adult population.

Oral health data collected from a mail survey of an Ontario population of adults aged 18 years and over were used to conduct a preliminary investigation of the incidence and correlates of tooth loss and to explore its functional, psychological and social consequences. Of the sample of 500 dentate subjects, 10 per cent reported losing one or more teeth in the previous year. Comparisons between those with and without tooth loss showed significant differences according to age, household income and place of birth. Those subjects wearing partial dentures, possessing fewer teeth at the start of the study period, or who only attended the dentist when having pain or other trouble, were also more likely to have experienced tooth loss in the preceding year. Logistic regression analysis identified only age as a significant independent risk factor. Subjects who lost teeth were significantly more compromised in their oral functions and psychosocial behaviors, as measured by a battery of subjective oral health indicators. Whether or not these problems were pre-existing or the consequences of losing teeth during the past year cannot be determined from this study. This investigation suggests that tooth loss is still a concern for many Canadian adults, and demonstrates the importance of teeth in their overall well-being.

Adolescent↗
PubMed2002

Policy relevant determinants of health: an international perspective.

BACKGROUND: International comparisons can provide clues to understanding some of the important policy-related determinants of health, including those related to the provision of health care services. An earlier study indicated that the strength of the primary care infrastructure of a health services system might be related to overall costs of health services. The purpose of the current research was to determine the robustness of the findings in the light of the passage of 5-10 years, the addition of two more countries, and the findings of other research on the possible importance of other determinants of country health levels. METHODS: Thirteen industrialized countries, all with populations of at least 5 million, were characterized by the relative strength of their primary care infrastructure, the degree of national income inequality, and a major manifestation of a behavioral determinant of health that is amenable to policy intervention (smoking), using international data sets and national informants. Health system and primary care practice characteristics were judged according to pre-set criteria. Major indicators of health were used as dependent variables, as were health care costs. FINDINGS: The stronger the primary care, the lower the costs. Countries with very weak primary care infrastructures have poorer performance on major aspects of health. Although countries that are intermediate in the strength of their primary care generally have levels of health at least as good as those with high levels of primary care, this is not the case in early life, when the impact of strong primary care is greatest. A subset of characteristics (equitable distribution of resources, publicly accountable universal financial coverage, low cost sharing, comprehensive services, and family-oriented services) distinguishes countries with overall good health from those with poor health at all ages. Neither income inequality nor smoking status accurately identified those countries with either consistently high or consistently poor performance on the health indicators. INTERPRETATION: A certain level of health care expenditures may be required to achieve overall good health levels, even in the presence of strong primary care infrastructures. Very low costs may interfere with achievement of good health, particularly at older ages, although very high levels of costs may signal excessive and potentially health-compromising care. Five policy-relevant characteristics appear to be related to better population health levels. There is no consistent relationship between income inequality, smoking, and health levels as measured by various indicators of health in different age groups.

Adolescent↗
PubMedDate not supplied

Prevalence of smoking and age of initiation in Alexandria, Egypt.

A cross-sectional survey on tobacco use in the city of Alexandria, Egypt, used an interview questionnaire based on World Health Organization guidelines. The study in 2000 included 2120 participants aged 15 to 86 years. More than a quarter (27.2%) were current smokers (25.5% daily smokers and 1.7% occasional smokers) and 3.5% were ex-smokers. Current smokers spent 23.1% of their family income on tobacco. The prevalence of current smoking was significantly higher among men (48.5%) than women (1.5%) and the mean age of initiation of smoking was lower among men (18.1 years) than women (22.6 years). The high prevalence of tobacco use among men is of concern, so too is the likelihood that tobacco use will increase among women. Further research is needed into factors that prevent people from starting smoking and assist them stopping smoking.

Adolescent↗
PubMed1983

The impact of publicly funded perinatal care programs on neonatal outcome, Georgia, 1976-1978.

The State of Georgia administers three publicly funded perinatal care programs for medically high risk and/or low-income women: the High Risk Pregnancy Program, the Medicaid Program, and the Maternal and Infant Care Projects. To assess the impact of these programs on infant health, we compared the birth weight distribution and neonatal mortality rates of infants born to women in each program with those of infants of a nonfunded group of women with less than 12 years' education. Infants of women in publicly funded groups were more likely to weigh less than or equal to 2,500 gm at birth than those of women in the nonfunded group. Neonatal mortality rates for publicly funded groups were similar to those of the nonfunded group. The neonatal mortality rates for infants of birth weight less than or equal to 2,500 gm of publicly-funded women were significantly lower than those of the nonfunded women. There were no significant differences between groups for neonatal mortality rates for infants of birth weight greater than 2,500 gm. These findings suggest that publicly funded perinatal care programs may improve neonatal survival of infants of birth weight less than or equal to 2,500 gm of low-income mothers.

Adult↗
PubMed2003

Using administrative data to analyze the prevalence and distribution of schizophrenic disorders.

OBJECTIVE: In order to effectively plan and implement psychiatric services, a clear estimate of the prevalence and distribution of the population in need is required. The authors examined the use of administrative data as a means of estimating the prevalence and distribution of schizophrenic disorders. METHODS: Administrative health services data for residents of the Canadian province of British Columbia in the age range 15 to 65 years (total population in 1997-1998 of 2,703,588) were examined over a three-year period. Potential cases of schizophrenic disorder were identified on the basis of the presence of a diagnostic code of 295 in one or more of three databases. One-year prevalence rates were estimated for each of the province's geographic regions, and associations with low income and unemployment were examined. RESULTS: One-year prevalence rate estimates were.45 cases per 100 population in 1996-1997 and 1997-1998 and.42 cases per 100 in 1998-1999. The prevalence estimates of all 88 local health areas in the province were consistent across the three-year period; Pearson correlations were determined to be approximately.9. One-year contact prevalence rates for schizophrenic disorders were significantly correlated in all three years to the percentage of persons with low income in the individual geographic regions but were not correlated with unemployment rates. CONCLUSIONS: In areas with well-developed health services, analyses of administrative data appear to provide cost-effective means of examining the prevalence and distribution of schizophrenic disorders.

Adolescent↗
PubMedDate not supplied

SSI eligibility and participation among the oldest old: evidence from the AHEAD.

The proportion of elderly SSI recipients aged 70 or older has been growing in recent years, perhaps because of rising life expectancies overall and a higher incidence of poverty among the oldest old. In 1999, 84 percent of all elderly SSI recipients were 70 or older. This article examines Supplemental Security Income (SSI) eligibility and participation among the oldest old. The analysis was based on 1993 data from the Study of Assets and Health Dynamics Among the Oldest Old that were used to build a detailed SSI eligibility model to identify individuals who meet the federal criteria for SSI income and resource eligibility. The participation rate among those eligible for federal SSI benefits is 53.9 percent, which is generally consistent with the findings of other studies. Furthermore, eligible participants would receive a significantly higher federal SSI benefit than eligible nonparticipants. Correspondingly, eligible participants have significantly lower incomes and assets than eligible nonparticipants. An econometric model is used to estimate the influence of various demographic, financial, and health care use characteristics on the probability of SSI participation among eligible individuals and couples. The model corrects for measurement error in calculated benefits and for misclassifying someone as ineligible. The empirical results show that the effect of higher SSI benefits on the probability of participation is substantial--a $100 increase in benefits would increase the probability of participating for an average eligible unit by 15 percentage points. Many of the demographic, financial, and health care use variables also are important predictors of SSI participation among the oldest old. The eligibility and participation models are also used to simulate the effect of increasing the SSI unearned income disregard from $20 to $125. Those made eligible by this policy change would receive a very low federal SSI benefit on average, suggesting that they are on the margin of eligibility under the original program rules. The simulated participation rate is 48.8 percent--5 percentage points lower than under the original program rules--reflecting the low benefit that new eligibles would receive. Only 36 percent of those made eligible by the new program rules are predicted to participate. These SSI eligibility and participation models are potentially useful tools for policy analysis. It is fairly straightforward to use these models to change a feature of SSI eligibility, reestimate the group of eligible individuals and couples, and predict participation among those who are eligible under the simulated program rules. New eligibles can be compared with those eligible under original program rules. New participants can be compared with old participants. Although these models focus only on individuals aged 70 or older, this type of analysis can be helpful in estimating the potential distributional effects of proposed SSI policy changes.

Aged↗
PubMed1984

The social distribution of illness: is Australia more equal?

The relationship between socioeconomic status and ill health has challenged researchers and health practitioners for many years. This paper outlines the way several basic measures of morbidity are related to occupation, income and education, with brief attention to class gradients in mortality and service utilization. The international literature contains many studies showing an inverse gradient in health by social standing: people who are socially and economically well off typically enjoy good health as well. Data from a recent health survey conducted in New South Wales, Australia do not confirm the British findings when occupational categories are studied, but when other measures of status are substituted for the crude occupation categories, a number of patterns appear. Income is significantly associated with the probability of chronic illness among middle-aged men and women, and among women over 65. The predicted pattern is also evident for recent illness among young men and for consulting among elderly respondents, but these associations are not statistically significant. Except among the elderly, better educated men and women are healthier than those with less education on most morbidity measures. The parallels and discrepancies between these findings from an Australian sample and overseas studies raise important research and policy questions.

Adolescent↗
PubMedDate not supplied

Profile of callers to the Centers for Disease Control and Prevention national sexually transmitted diseases hotline.

BACKGROUND AND OBJECTIVES: The Centers for Disease Control and Prevention funds a national telephone hotline as a source of information for persons with questions about sexually transmitted diseases. Hotline callers were last surveyed in 1980. GOAL: To determine the current profile of callers to the Centers for Disease Control and Prevention National sexually transmitted diseases hotline, assess their concerns, and identify their sources for the hotline telephone number. STUDY DESIGN: The survey sampled 1,100 callers: 19 per day distributed across 3 work shifts using a systematic random selection process. Nine short-answer questions were asked, and passively collected data were recorded. RESULTS: The survey showed callers' demographics (68.4% white); socioeconomics (47.6% with incomes < $15,000); residence (79.8% urban); information requests (20.7% general sexually transmitted diseases); concerns about exposure or infection (76.5% concerned they might be infected); acceptance of referrals (35.7% to public clinics); and hotline telephone number sources (20.4% from pamphlets). CONCLUSIONS: The hotline is called by persons from all segments of the public and addresses their concerns.

Adolescent↗
PubMed2002

Severe tooth loss among UK adults--who goes for oral rehabilitation?

A random probability sample of 2667 United Kingdom (UK) addresses was selected in a multistage sampling process. Participants were interviewed about their oral health status--number of teeth possessed and denture status. In addition information was collected about their socio-demographic characteristics (age, gender, social class and income level) and dental service factors--type of service used and difficulty accessing national health service (NHS) care. The response rate was 70%. Six percent (107) claimed they had less than 20 teeth but did not use a denture. Variations in this practice were apparent in relation to a number of socio-demographic factors: age (P < 0.05), gender (P < 0.01) and social class (P < 0.001) but not service related factors. In regression analysis, social class, gender and age emerged as important predictors of this practice. For example, those from lower social classes were approximately half as likely to use dentures despite experiencing considerable tooth loss (OR=0.53, 95% CI 0.34, 0.83), having controlling for other factors. More than one in 20, in Britain claim they have experienced considerable tooth loss but are without resource to a denture. Socio-demographic factors rather than service related factors are associated with this practice, particularly social class.

Adolescent↗
PubMed2004

Non-attendance in breast cancer screening is associated with unfavourable socio-economic circumstances and advanced carcinoma.

Our first objective was to assess changes in non-attendance, proportion of advanced breast cancer and survival in Malmö Mammographic Service Screening Program, MMSSP, compared to a former trial, Malmö Mammographic Screening Trial, MMST. Our second objective was to describe non-attenders in MMSSP in socio-economic terms and risk for advanced breast cancer compared to attenders. Information from hospital and national registers was used to identify 33,800 women invited to service screening in MMSSP 1990-93. Attendance rates at first screening, the proportion of advanced breast cancers (Stage II-IV) and survival among non-attenders in MMSSP were compared to the non-attenders and with the control group of the former trial, MMST. Various socio-economic factors were assessed as potential predictors of non-attendance in MMSSP. Odds ratios (OR) and 95% confidence interval (CI) were computed. Incidence of breast cancer during a 10-year-period, relative risks and 95% CI among non-attenders compared to attenders in MMSSP were computed. Attendance rates were significantly lower in MMSSP but a lower proportion of advanced breast cancers and a somewhat better survival among breast cancer cases (not significant) was seen in non-attenders in MMSSP compared to MMST. In MMSSP non-attendance was associated with being unmarried, being born abroad, being not currently employed, crowded housing conditions and low income. Incidence of advanced breast cancer was significantly higher among non-attenders than among attenders. Attendance has decreased over time and potential reasons are discussed. Stage distribution and survival among non-attenders seem to have improved. Several socio-economic factors predict non-attendance and non-attenders are at higher risk for advanced breast cancer.

Aged↗
PubMed1996

Low birthweight in a public prenatal care program: behavioral and psychosocial risk factors and psychosocial intervention.

A retrospective, observational study of 3073 low income African American, Latina, and White women receiving comprehensive prenatal care at 26 provider sites was completed. The purpose of the study was to test three hypotheses. First, after adjustment for biomedical complications, the presence of maternal behavioral and psychosocial factors would be associated with an increased rate of low birthweight infants. Second, increased time spent in psychosocial services would negate the relationship between maternal psychosocial factors and low birthweight. Third, after adjusting for biomedical, behavioral, and psychosocial factors, rates of low birthweight would no longer differ by race. Maternal smoking (over five cigarettes per week), maternal low weight for height and/or weight gain, negative mood (depression, anxiety, and/or hostility) and rejection of the pregnancy were found to be related to an increased rate of low birthweight birth (< 2500 g). Receiving more than 45 min of psychosocial services was related to a reduced rate of low birthweight birth for all women regardless of risk profile. The rate of low birthweight remained higher in African American women after adjusting for all significant maternal biomedical, behavioral, and psychosocial risk and intervention factors. Further analyses revealed that the strength and direction of the relationship between time spent in psychosocial services and low birthweight remained after controlling for the number of prenatal care visits, the time spent in nutrition or health educational services, and gestational age. Also, the time spent in psychosocial services was related to a reduced rate of low birthweight even after excluding time spent in psychosocial services in the third trimester of pregnancy or excluding women who received their first psychosocial assessment in the third trimester from the analysis. Although definitive evidence from randomized trials of psychosocial services is lacking, receiving over 45 min of psychosocial services was related to a reduced risk of low birthweight for all women in this study. Therefore, general psychosocial services appears to be an important component of prenatal care for all low income women.

Adult↗
PubMed1976

UV laser scanning and fluorescence monitoring of analytical ultracentrifugation with an on-line computer system.

A new optical system for the analytical ultracentrifuge is described, which permits sedimentation to be monitored by fluorescence. The optical system is based on a laser light source, which is focused to a narrow (50 micron) beam. The radical scanning of the beam provides information on the distribution of fluorescing material with distance in the centrifuge cell. Data collection and processing are performed in conjunction with an on-line computer system which sorts incoming fluorescence pulses according to rotor hole and cell sector, averages families of pulses to improve signal to noise ratios and fits the data (in the experiments reported here) to equations to determine sedimentation coefficients. Initial experiments with the system have been performed with bovine serum albumin and indicate that sedimentation can be readily monitored by fluorescence with solutions at concentrations as low as 20 micrograms per ml, with excitation at 257 nm. At these concentrations, the optical density is only in the 0.01 range, too low for experiments with absorption-scanner optical system. Even lower concentrations can be used when fluorescent labels are used with excitation in the visible region of the spectrum. The preliminary studies indicate that fluorescence monitoring of sedimentation will substantially enhance the range of experimental possibilities in ultracentrifugation by improving both the sensitivity of measurements and the discrimination between sedimenting species on the basis of their fluorescence characteristics.

Computers↗
PubMed2003

Casualisation of the nursing workforce in Australia: driving forces and implications.

This article provides an overview of the extent of casualisation of the nursing workforce in Australia, focusing on the impact for those managing the system. The implications for nurse managers in particular are considerable in an industry where service demand is difficult to control and where individual nurses are thought to be increasingly choosing to work casually. While little is known of the reasons behind nurses exercising their preference for casual work arrangements, some reasons postulated include visa status (overseas trained nurses on holiday/working visas); permanent employees taking on additional shifts to increase their income levels; and those who elect to work under casual contracts for lifestyle reasons. Unknown is the demography of the casual nursing workforce, how these groups are distributed within the workforce, and how many contracts of employment they have across the health service--either through privately managed nursing agencies or hospital managed casual pools. A more detailed knowledge of the forces driving the decisions of this group is essential if health care organisations are to equip themselves to manage this changing workforce and maintain a standard of patient care that is acceptable to the community.

Australia↗
PubMed2004

Low effectiveness of highly active antiretroviral therapy and high mortality in the Greenland HIV-infected population.

Greenland is a high-income country with free access to human immunodeficiency virus (HIV) care, including highly active antiretroviral therapy (HAART). We aimed to examine the HIV prevalence, age and gender distribution, and the effectiveness of HAART on CD4 positive cell count, viral load (VL), and mortality in the Greenland HIV-infected population. In this population-based cohort study we collected demographic, clinical and biochemical data on all HIV-infected patients followed in health clinics since 1995. For each case, we identified 100 age- and gender-matched population controls. The HIV cohort included 103 patients of whom 91% were Inuit; 81% were infected heterosexually. Only 40% of the patients had a VL <400 copies/ml at 48 weeks after starting HAART, and patients on HAART had a substantial excess relative mortality compared with the general population (mortality rate ratio [MRR]: 10.6; 95% confidence interval [CI]: 6.9-16.4). After the introduction of HAART, the mortality decreased (MRR: 2.5; 95% CI 0.9-6.8), but remained high with a mortality rate of 62 per 1000 person-years (py) (95% CI 29-129). Our findings underline the difficulties of implementing successful HIV treatment even with unlimited economic resources and free access to health care.

Adult↗
PubMed2003

Bose-Einstein condensation in random directed networks.

We consider the phenomenon of Bose-Einstein condensation in a random growing directed network. The network grows by the addition of vertices and edges. At each time step the network gains a vertex with probability p and an edge with probability 1-p. The new vertex has a fitness (a,b) a,b>0, with probability f(a,b). A vertex with fitness (a,b), with in-degree i and out-degree j, gains a new incoming edge with rate a(i+1) and an outgoing edge with rate b(j+1). The Bose-Einstein condensation occurs as a function of fitness distribution f(a,b).

Journal Article↗
PubMed1994

Evaluation of an area-based measure as an indicator of inequalities in oral health.

The literature on inequalities in health provides convincing evidence that lower socioeconomic groups have poor oral health when compared to higher socioeconomic groups. Since conventional measures of socioeconomic status such as occupation, income and education have a number of weaknesses which may limit their ability to describe and explain health inequalities, alternatives in the form of area-based measures are increasingly being used. In this paper, a conventional measure, household income, and an area-based measure of socioeconomic status are compared in terms of their ability to identify inequalities in oral health. The data used in the analysis were taken from a telephone interview survey of the oral health of older adults in the province of Ontario, Canada. While household income proved to be a marginally better predictor of these inequalities than the area-based measure, the latter had a number of distinct advantages from an epidemiological and planning perspective. Moreover, it identified variations in measures of oral health that were independent of household income, and the region of the province in which subjects lived.

Chi-Square Distribution↗
PubMed2004

Self-esteem, stress and self-rated health in family planning clinic patients.

BACKGROUND: The independent effects of stress on the health of primary care patients might be different for different types of clinic populations. This study examines these relationships in a low-income female population of patients attending a family planning clinic. METHODS: This study investigated the relevance of different sources of personal stress and social support to self-rated health, adjusting for mental health, health behavior and demographic characteristics of subjects. Five hundred women who attended family planning clinics were surveyed and 345 completed the form for a response rate of 72 percent. RESULTS: Multiple logistic regression analysis revealed that liking oneself was related to good self-rated health (Odds ratio = 7.11), but stress or support from children, parents, friends, churches or spouses were not significant. White non-Hispanic and non-white non-Hispanic respondents had lower odds of reporting good self-rated health than Hispanic respondents (odds ratios were 2.87 and 2.81, respectively). Exercising five or more days per week also was related to good self-rated health. Smoking 20 or more cigarettes per day, and obese III were negatively related to good self-rated health (odds ratios were.19 and.22, respectively with corresponding p-values equal to.0043 and.0332). CONCLUSIONS: Among younger low-income women, addressing low self-esteem might improve health status.

Adult↗