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PubMed1994

Endemic fluorosis: an analysis of needs and possibilities based on case studies in Kenya.

The decline in prevalence of dental caries in the western world is largely ascribed to the protective role of fluoride in water. However, in several Third World regions, its presence in excessive amounts has been detrimental to the health of resident communities due to the resulting endemic dental and skeletal fluorosis. As a prelude to introduction of preventive intervention among the affected communities, there is need to assess knowledge and perception, and affordable and effective possibilities. The results of such an assessment which was based on response of mothers from two affected communities showed that objectionable dental fluorosis was not viewed as a common health problem in the context of other more common diseases. A reawakening of interest and concern was evident when issues pertaining to oral health were addressed. Dental fluorosis was viewed as an important problem because of its unfavourable effects on an individual's personality by between 60.4 and 84.3% of the respondents. While 60% and over of the respondents attributed the problem to water, knowledge on perceived methods of prevention of fluorosis were significantly lower. Only 12% of respondents from a relatively higher income group were instituting relevant preventive strategies. Although defluoridation of water had been instituted in one area, problems relating to wrong choice of water for defluoridation to inadequate distribution of the defluoridated water were evident. Education of the communities on methods of reducing fluoride ingestion and the significance of the defluoridated water, rationalizing the distribution of defluoridated water, facilitating collection of rain water, protection of available low fluoride surface water from contamination with agro-chemicals and household defluoridation were recommended.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

Spirometric criteria for asthma: adding further evidence to the debate.

BACKGROUND: Objective assessments of pulmonary function are considered essential for the diagnosis of asthma. The degree of reversibility of FEV(1) considered supportive of asthma varies between international asthma guidelines. OBJECTIVE: We sought to compare the relative performance of international guideline reversibility criteria for identifying impairment in persons with a significant bronchodilator response (SBR) without an asthma diagnosis. METHODS: The North West Adelaide Health (Cohort) Study, a population biomedical study of 4060 subjects, conducted spirometry according to American Thoracic Society criteria. SBR was defined as postbronchodilator FEV(1) responses of at least 12% or 15% of baseline values, 9% of predicted values, or 400 mL. A self-completed questionnaire assessed current asthma (CA), respiratory symptoms, and participant demographics. RESULTS: The prevalence of CA was 9.4% (n = 380), whereas 1.3% (>/=400 mL) to 4.5% (>/=9% of predicted value) of participants demonstrated an SBR in the absence of CA. With the exception of the 9% predicted criterion, prebronchodilator mean FEV(1) (percent predicted) in those demonstrating an SBR but no CA was significantly worse than that in the CA group. Significantly more respiratory symptoms were experienced by the SBR groups than the group without asthma. Logistic regression analyses identified different characteristics of those classified by the following criteria: 12% and 15%, age of 40 years or greater and household income of less than $40,000; 9% predicted, household income of less than $40,000; 400 mL, male sex (odds ratio, 4.5; 95% CI, 2.1-9.3). CONCLUSIONS: Different criteria identify different persons, but SBR by any criteria was associated with significant respiratory impairment, some of which might be attributable to asthma. Postbronchodilator change as a percentage of predicted value was the least biased of the criteria.

Adult↗
PubMed2003

Effects of the year 2000 influenza vaccine delay on elderly patients' attitudes and behaviors.

BACKGROUND: A substantial delay in distribution of influenza vaccine occurred in the 2000-2001 influenza season. Our objective was to quantify the impact of this delay on immunization rates, location of receipt of immunization, and patient attitudes and beliefs about the influenza vaccine. METHODS: Inner-city and suburban medical practices that received influenza vaccine supply on-time or late in the season (late-receipt) were selected. A random sample of elderly patients from each practice completed telephone interviews. RESULTS: Of 775 eligible patients, we interviewed 72%. The odds of receiving influenza vaccine in late-receipt practices compared to on-time practices did not significantly differ in either the suburban stratum (adjusted OR = 0.9, 95% CI 0.5-1.6) or the inner-city stratum (adjusted OR = 1.5, 95% CI 0.8-2.8). Very few respondents (4%-11%) reported changes in their beliefs about the vaccine, its safety or efficacy, from previous years. More patients in late-receipt practices reported receiving influenza vaccine at locations other than their regular doctor's offices in the shortage year compared with the previous year. CONCLUSIONS: The 2000-2001 influenza vaccine delay changed vaccination location, but did not change influenza vaccination rates.

Aged↗
PubMed1996

Melanoma awareness and self-examination practices: results of a United States survey.

BACKGROUND: Skin cancers are common and there has been a dramatic increase in their incidence, particularly melanoma. However, little is known about awareness of melanoma and early detection practices in the general U.S. population. OBJECTIVE: In 1995, the American Academy of Dermatology increased their efforts to promote awareness of melanoma. This study was conducted to document current knowledge of melanoma and self-examination practices. METHODS: In February 1995, a telephone survey was conducted in a nationally representative sample of 1001 persons at least 18 years of age (3% margin of error) that included questions on knowledge, attitudes, and practices regarding early detection of melanoma. RESULTS: Almost 42% of those surveyed were unaware of melanoma, and only 26% of those who were aware could identify its specific signs. Most recognized at least one common risk factor for melanoma (e.g., sun exposure, fair skin). However, many did not distinguish melanoma from other skin cancers in terms of risk factors, signs of early disease, and body site distribution. The lowest measures of melanoma knowledge and attitudes were found among those who are male, nonwhite, and parents, and those with the lowest level of education and income. More than half (54%) did not conduct a self-examination. This practice was most frequently reported by women, white persons, and the elderly, as well as those with a greater knowledge of melanoma. CONCLUSION: Our research documents deficiencies in knowledge and practices related to early detection of melanoma in the general U.S. population and supports the need for public education about melanoma.

Adult↗
PubMed1990

Divorce in contemporary Japan.

Data from the 1985-86 Japanese census are analysed to explore the determinants of the divorce rates in Japan's forty-seven prefectures, using two theoretical models: (a) the social integration model, which is shown to have a greater utility in predicting Japanese divorce levels than (b), the human capital model. Female emigration patterns play a significant role in affecting the divorce rate. Population increase and net household income are also important predictors of the Japanese divorce rate and urbanization has a great influence in modern Japan. Demographic and aggregate variables such as migration, urbanization, and socioeconomic factors are useful when organized under a social integration model.

Divorce↗
PubMed1998

Morbidity of homebound versus inpatient elderly psychiatric patients.

This study compares the demographic and clinical characteristics of homebound (HB) elders referred for psychiatric services (N = 251) with those of inpatients (IP) admitted to a geriatric psychiatry unit (N = 594). Demographically, HB patients were older (78.8 vs 74.7 years), were more likely to be women (83% vs 68%), were widowed (54% vs. 44%), and had fewer years of education (10.3 vs. 11.1), but were similar in race, income, and proportion living alone. Clinically, HB patients had less functional disability, less severe depression, less cognitive impairment, and fewer medical problems. However, they were similar in the distribution of most psychiatric diagnoses except dementia (higher in the IP group) and dementia with depression (higher in the HB group). Outcome data for the HB group over 15 (range, 1 to 38) months revealed medical hospitalization in 20.7%, psychiatric hospitalization in 16.3%, nursing home placement in 9.2% and mortality in 8.4%. These preliminary data show that the HB group had psychiatric problems that were comparable to those of the IP group but were not as severely impaired.

Age Distribution↗
PubMed1997

Adult attachment in a nationally representative sample.

The explosion of adult attachment research in the last decade has been limited by its reliance on college student and distressed samples. Using a large nationally representative sample of American adults, the authors examined the relation of sociodemographics, childhood adversity, parental representations, adult psychopathology, and personality traits to adult attachment in an effort to replicate previous findings and extend the theory. Distribution of adult attachment styles was similar to that in prior studies: 59% secure, 25% avoidant, and 11% anxious. Adult attachment was associated with several sociodemographic variables (e.g., income, age, race) not previously studied. Childhood adversities of an interpersonal nature were strongly related to insecure adult attachment. Various types of adult psychopathologies and personality traits were also strongly related to adult attachment. Implications for adult attachment theory and future research are discussed.

Adolescent↗
PubMed1998

Accretion rate of cosmic spherules measured at the South Pole.

Micrometeorites are terrestrially collected, extraterrestrial particles smaller than about 1 mm, which account for most of the mass being accreted to the Earth. Compared with meteorites, micrometeorites more completely represent the Earth-crossing meteoroid complex and should include fragments of asteroids, comets, Mars and our Moon, as well as pre-solar and interstellar grains. Previous measurements of the flux of micrometeoroids that survive to the Earth's surface have large uncertainties owing to the destruction of particles by weathering, inefficiencies in magnetic collection or separation techniques, low particle counts, poor age constraint or highly variable concentrating processes. Here we describe an attempt to circumvent these problems through the collection of thousands of well preserved and dated micrometeorites from the bottom of the South Pole water well, which supplies drinking water for the Scott-Amundsen station. Using this collection, we have determined precise estimates of the flux and mass distribution for 50-700-microm cosmic spherules (melted micrometeorites). Allowing for the expected abundance of unmelted micrometeorites in the samples, our results indicate that about 90% of the incoming mass of submillimetre particles evaporates during atmospheric entry. Our data indicate the loss of glass-rich and small stony spherules from deep-sea deposits, and they provide constraints for models describing the survival probability of micrometeoroids.

Antarctic Regions↗
PubMed2002

Inpatient hospital care for lumbar intervertebral disc disorders in Finland in relation to education, occupational class, income, and employment.

The object of the study was to describe socioeconomic and demographic determinants of inpatient hospital care for lumbar intervertebral disc disorders (LIDD) in Finland. Information from the 1996 Finnish Hospital Discharge Register was linked with the 1995 Population Census. Poisson regression analyses were made with the total and the gainfully employed workforce aged 20-64 y as reference. All 48 public and seven private acute care general hospitals treating LIDD patients in Finland. In the workforce, 4643 patients aged 20-64 y (3692 among the gainfully employed) were admitted to the hospital due to LIDD (ICD-10: M51.1-M51.9) in 1996. About one-half were treated surgically. The duration of unemployment in 1995 was inversely associated with hospitalisation for LIDD in 1996, allowing for age, sex, education and personal income (unemployed for 12 months vs 0 months: rate ratio 0.66; 95% CI 0.57-0.77). Among those employed for 12 months in 1995, the level of education was inversely associated with the hospital admission rate. The rate was also higher in manual occupations as compared with the upper white-collar employees. The associations were clearer among the medically than the surgically treated patients. Hospitalisation for back disorder was, however, less common in the lowest income group as compared with the highest (0.65; 0.57-0.77) allowing for education, occupational class, age and sex. Women were less often admitted to the hospital than men, allowing for the socioeconomic factors (0.83; 0.77-0.90). When indicated by education or occupation, low socioeconomic status was associated with a relatively high rate of inpatient hospital care for LIDD. When indicated by personal income, the situation was the reverse. Unemployment and female gender predicted a relatively low rate of hospitalisation.

Adult↗
PubMed2001

Challenges to meet: food and nutrition security in the new millennium.

Before about 1750 there was no substantial secular fall in protein-energy malnutrition (PEM) over large areas, nor reason to expect it. We have since learned that sufficient economic advance (poverty reduction) plus scientific advance (in medicine and food production) are achievable to eliminate mass PEM. The two advances are linked via increased demand for labour, and hence wages and employment, for those formerly too poor to afford adequate food. The extra employment income arises first from smallholder and employee food production, and later, as labour is released, from a wide range of specialised, increasingly non-farm, production, with employment income traded for food. This process eliminated mass hunger in Europe in 1750-1960. Only by 1975 had PEM in the developing world retreated to (very high) 1936-8 levels, but it fell sharply in Asia and Latin America in 1975-1990, due to unprecedented growth in staples yields, smallholder and farm employment income, and hence the poor's purchasing power over food. However, since 1990, poverty reduction has slowed (before reaching most of Africa), alongside much slower-staples yield growth, increasing water shortages, and big shifts of grain and land from man to farm animals. These trends prefigure declining progress against PEM in coming decades, unless there is renewed, employment-intensive food-staples-yield growth. That process requires reorienting crop biotechnology and water science towards the needs of small tropical farmers and their staple food crops, and shifting land towards them. Mass PEM is indeed largely due to inadequate 'food entitlements' by the hungry, but will not be remedied without growth in their employment, based on further advances in food-staples yields per unit land and water. Recent evidence suggests that early PEM may increase lifelong risks of infection and/or degenerative disease. This factor would increase the 'squeeze' on health resources in low-income countries, between the diseases of poverty and those of old age. That situation increases the need to readdress PEM by renewed progress in food production and land distribution.

Biotechnology↗
PubMedDate not supplied

Canadian Indian mortality during the 1980s.

This study concerns itself with an investigation of general and cause-specific mortality differentials between Canadian Registered Indians (a subset of all aboriginals) and the larger Canadian population over two points in time, 1981 and 1991. Multivariate analyses are executed separately across four segments of the life cycle: adulthood, infancy, early childhood and late childhood. With respect to adults, Indians share relatively high rates of suicide, homicide and accidental causes of death; over time, their conditional risks of death due to cancer and circulatory afflictions have gone up significantly. Mortality disadvantages for the Indians are also pronounced in infancy, early childhood (ages 1-4) and late childhood (ages 5-14). Suicide, accidents, and violence constitute serious problems among 5-14 year olds, while infectious/parasitic, respiratory and circulatory complications, plus accidents and violence, are principle killers in infancy. For children aged 1-4, respiratory problems and accidents/violence are prime causes of premature death. This less-than-optimal mortality profile is reflective of persistent problems associated with prolonged socioeconomic marginalization. The temporal pattern of change in chronic/degenerative disease mortality among adult Indians suggests a movement of this population toward a mature stage of epidemiological transition.

Accidents↗
PubMed2005

Receiving marijuana and cocaine as gifts and through sharing.

This paper presents estimates of the probability that individuals who use marijuana and cocaine receive some of their drug as a gift or through sharing. The analysis utilizes data from the National Household Survey of Drug Abuse in the United States of America. This research expands upon the observation of field researchers that sharing and gift giving are common distribution mechanisms in drug markets. The likelihood an individual marijuana or cocaine user receives drug gifts or receives drugs through sharing by others depends on age, race, gender, income and the amount they consume. These findings should assist policy makers designing drug abstinence programs and drug rehabilitation administrators trying to prevent relapse.

Adolescent↗
PubMed2001

Urban cause-specific socioeconomic mortality differences. Which causes of death contribute most?

BACKGROUND: Cause-specific information on socioeconomic differences in health is necessary for a rational public health policy. At the local level, the Municipal Health Service studies these differences in order to support the authorities in policy making. METHODS: Mortality data of the under 65 age group in The Hague were analysed (1982-1991) at residential area level. RESULTS: Causes of death with a high socioeconomic gradient among males were: homicide, chronic liver disease, 'other' external causes of injury, diabetes, bronchitis, emphysema and asthma, and motor vehicle accidents; and among females: diabetes, ischaemic heart disease, 'other' diseases of the circulatory system, signs, symptoms and ill-defined conditions, malignant neoplasm of cervix, and 'other' diseases. Main contributors to the mortality differences between the highest and lowest socioeconomic quartiles among males were: ischaemic heart disease (17.3%), 'other' diseases of the circulatory system (10.2%), signs, symptoms and ill-defined conditions (9.0%), 'other' external causes of injury (8.6%), and chronic liver disease (7.2%); and among females: ischaemic heart disease (25.5%), 'other' diseases (20.1%), signs, symptoms and ill-defined conditions (18.6%), 'other' diseases of the circulatory system (11.0%), and diabetes (9.1%). Among females the contributions of malignant neoplasms of breast (-16.3%) and colon (-5.5%) and suicide (-4.3%) were negative. CONCLUSIONS: The diseases that are the main contributors to urban socioeconomic mortality differences can be influenced by public health policy.

Adolescent↗
PubMed2006

The relationship between parity and overweight varies with household wealth and national development.

BACKGROUND: Recent studies support a positive relationship between parity and overweight among women of developing countries; however, it is unclear whether these effects vary by household wealth and national development. Our objective was to determine whether the association between parity and overweight [body mass index (BMI) > or =25 kg/m(2)] in women living in developing countries varies with levels of national human development and/or household wealth. METHODS: We used data from 28 nationally representative, cross-sectional surveys conducted between 1996 and 2003 (n = 275 704 women, 15-49 years). The relationship between parity and overweight was modelled using logistic regression, controlling for several biological and sociodemographic factors and national development, as reflected by the United Nations' Human Development Index. We also modelled the interaction between parity and national development, and the three-way interaction between parity, household wealth and national development. RESULTS: Parity had a weak, positive association with overweight, which varied by household wealth and national development. Among the poorest women and women in the second tertile of household wealth, parity was positively related to overweight only in the most developed countries. Among the wealthiest women, parity was positively related to overweight regardless of the level of national development. CONCLUSIONS: As development increases, the burden of parity-related overweight shifts to include poor as well as wealthy women. In the least-developed countries, programmes to prevent parity-related overweight should target wealthy women, whereas such programmes should be provided to all women in more developed countries.

Adolescent↗
PubMed1998

A critical assessment of high-earning orthodontists in the General Dental Services of England and Wales (1990-1991)

Cases from the Dental Practice Board's 2 per cent random sample of completed cases which had been treated by orthodontic practitioners with high gross earnings, were compared to all the cases within the sample from other practitioners. They were assessed using the PAR index and IOTN. High earning orthodontists treated slightly more cases with lower objective need for treatment, but treated no more cases 'Unnecessarily' than other practitioners. They used more fixed appliances, and had marginally better levels of residual need for treatment at finish, although this was at least partially explained by lower levels at start. Generally, their standards were not substantially different to other practitioners. Appliance type had a marked effect on outcome, as did levels of malocclusion and need for treatment at start. Both groups of practitioners performed similarly (better) with dual arch fixed appliances: however, overall standards could only be described as mediocre. There is no justification to single out high earning orthodontists for special scrutiny. However, it may be beneficial if the system of remuneration in the General Dental Services could be modified to give more positive incentive to quality, rather than simply quantity of treatments.

Analysis of Variance↗
PubMedDate not supplied

Advance directives use in acute care hospitals.

It is a federal requirement for health care organizations to provide and obtain information from admitted patients about their rights to self-determination and executing an advance directive. But how compliant are acute care organizations with this law? This article explores the extent to which hospitalized patients in one Southeastern United States organization had advance directive documentation; its correlation with socioeconomic factors, and the success of educating patients and providing care that is consistent with patient's wishes.

Acute Disease↗
PubMed2005

Two-dimensional hard x-ray beam compression by combined focusing and waveguide optics.

A two-dimensionally confining x-ray channel waveguide structure is combined with a high gain Kirkpatrick-Baez prefocusing mirror system yielding a hard x-ray beam with a cross section of 25 x 47 nm(2) (FWHM). Unlike the previously employed resonant beam coupling scheme, the incoming beam is coupled in from the front side of the waveguide and the waveguided beam is no longer accompanied by spurious reflected or transmitted beams. The field distribution in the waveguide channel has been calculated numerically. The calculated transmission and far-field intensity pattern are in good agreement with the experimental results.

Journal Article↗
PubMed1998

Family health and health services utilisation in Belmont, Western Australia: a community case study.

This case study was designed to examine the self-defined health needs of families in one urban Western Australian community. We conducted 157 family interviews to examine the relationship between family sociodemographic variables and patterns of use of health services, which included services used within the previous 12 months, and what the family needed and wanted from these services. Questions covered perceptions of health, family health concerns and the role of the family health guardian. Quantitative analysis included frequencies, cross-tabulations, chi-squared tests and multiple regression analysis. Open-ended responses were categorised and analysed for common themes. Approximately 80 per cent of participants had used one or more health services during the previous 12 months and, despite 35.9 per cent of families having at least one family member with a long-standing illness, disability or infirmity, most (82.1 per cent) considered the family healthy. The correlational analysis revealed several associations. Predictably, younger persons reported higher health ratings and older persons had more health concerns. Larger families reported better perceived levels of health. Higher utilisation rates were recorded for families with children, who tended to use the general practitioner for general care and medication, whereas one-parent families used hospital and specialist care more often, and 98.7 per cent reported satisfaction with services. What they needed and wanted from their health service providers was 'full disclosure' and 'not being talked down to', and for specialists especially to be approachable and impart information simply and honestly.

Adult↗