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PubMed2003

Health-related quality of life of U.S. military personnel: a population-based study.

OBJECTIVE: This study evaluated the association between military service and health-related quality of life (HRQOL), using a large, population-based sample of U.S. adults. METHODS: Participants in the 2000 Behavioral Risk Factor Surveillance System were characterized as active duty personnel (N = 1,163), reserves (N = 1,055], veterans (N = 22,558), or no military service (N = 141,620). HRQOL was described by sex and military status. Logistic regression was used to calculate sex-specific adjusted odds ratios. RESULTS: Active duty men were more likely than men without military service to report 14 or more days of activity limitation, pain, and not enough rest in the past 30 days. Reserve personnel reported better overall HRQOL than nonmilitary participants, and no difference in HRQOL was observed between veterans and persons with no military service. CONCLUSIONS: Recommendations are made to monitor HRQOL of active duty and reserve personnel over time and to include HRQOL measures in military-based surveys of active duty troops.

Adolescent↗
PubMed2001

5 a day fruit and vegetable intervention improves consumption in a low income population.

OBJECTIVE: This study evaluated the Michigan Farmers' Market Nutrition Program in one Michigan county to determine its effect on fruit and vegetable consumption behavior. SUBJECTS/SETTING: Subjects were selected from WIC and Community Action Agency populations: 564 low income women completed the pretest; 455 completed the posttest. Attrition rate was 19.3%. INTERVENTION: Subjects were assigned to one of 4 interventions: education about the use, storage and nutritional value of fruits and vegetables, distribution of farmers' market coupons, both education and coupons, or no intervention. DESIGN: Education-only and coupon and education groups were randomly assigned; clinic appointment timing determined assignment to no-intervention and coupon-only groups. MAIN OUTCOME MEASURES: A self-administered questionnaire before and after intervention measured attitudes about fruit and vegetable consumption and intake of fruits and vegetables. WIC records documented redemption of coupons. STATISTICAL ANALYSES: Data analysis included 2-way multivariate analysis of covariance, univariate analysis of covariance, logistic regression, and covariance structure modeling. RESULTS: Both the education interventions and the coupon interventions had positive effects. Coupons had a direct effect on increasing fruit and vegetable consumption behavior but no effect on attitudes. Education had a direct effect on attitudes and seemed to exert an effect on consumption behavior through attitudes. The maximum impact of the intervention was achieved through a combination of education and coupons. APPLICATIONS: This study demonstrated that a low-income population may be more likely to increase its fruit and vegetable consumption behavior when incentives such as coupons improve affordability.

Analysis of Variance↗
PubMed1976

Distribution of private practice offices of physicians with specified characteristics among urban neighborhoods.

The office location of New York County physicians in private practice is determined for a verified subpopulation of the "Medical Directory of New York State" listing for the year 1970-71. Physicians are categorized by specialty status, medical schools attended, dates of graduation, and hospital affiliations. Multiple regression analysis is performed to relate numbers of physicians per Health Area (average population: 20,000) to demographic, economic, and medical care characteristics of the areas. There is considerable unevenness in the number of private physician offices among Health Areas (mean, 66; standard deviation, 173; range, 1 to 1,043). Multiple regression analysis shows a strong, positive association between practice location and median area income. The influence of population size on practice location is also found to be significant for many categories of physicians but less strong than that of income. Other independent variables are found to have a weaker to nonsignificant impact on practice location. Disaggregation of physicians into specified categories reveals differences in elasticity of location estimates that would have gone undetected had only the aggregated physician population been investigated. Itis concluded that policy decisions concerning physician distribution should be made on the basis of data on smaller areas than has been done in the past, and on specified categories of physicians rather than on aggregates.

Age Factors↗
PubMed2004

The impact of low family income on self-reported health outcomes in patients with rheumatoid arthritis within a publicly funded health-care environment.

OBJECTIVE: Self-rated health (SRH) is an independent, strong predictor of morbidity and mortality. Socio-economic status (SES) is strongly associated with SRH. This study investigated the relationship between SES and SRH outcomes in a sample of patients with rheumatoid arthritis (RA) in Canada. METHODS: Both generic preference-based [Health Utilities Index Mark 3 (HUI3) and Short Form 6D (SF-6D)] and non-preference-based [disease-specific (Rheumatoid Arthritis Quality of Life, RAQoL) and a functional status (Health Assessment Questionnaire, HAQ)] SRH questionnaires were administered to 313 RA patients. Both proximate (education and annual household income) and contextual (neighbourhood income, education and unemployment) measures of SES were captured. Ordinary least squares (OLS) regression was used to adjust for RA severity while assessing the relationship between SRH and SES measures. Two-stage least-squares (TSLS) regression was used to determine if there was an inter-relationship between SES and SRH measures. RESULTS: The sample was well distributed across RA severity and SES measures. Contextual and proximate measures of SES were poorly correlated. Lower levels of proximate SES measures (but not contextual) were associated with poorer SRH outcomes. The OLS regressions showed significant associations between the HUI3 and the SF-6D overall scores and the HAQ for self-reported income. The RAQoL did not differ significantly across SES. TSLS regression confirmed the finding that self-reported income was similarly associated with the SRH measures. CONCLUSIONS: Even in a country with universal access to health-care, the impact of a chronic disease such as RA on SRH is associated with self-reported income. The finding that preference-based measures vary with income independently of RA severity could bias economic evaluation.

Adult↗
PubMed1994

Risk factors for total tooth loss in the United States; longitudinal analysis of national data.

The NHANES I Epidemiologic Follow-up Study (NHEFS) of 1982-84 collected longitudinal data from 10,523 individuals initially seen during the first National Health and Nutrition Examination Survey (NHANES I) of 1971-75. Among this additional data was information on the incidence of total tooth loss during the 10 years between the surveys, which could then be added to NHANES I data to identify risk factors. In this analysis, a series of bivariate analyses were carried out, followed by logistic regression analysis to assess the simultaneous effect of major variables. Results showed that 7.4 percent of dentate Americans aged 25-74 at NHANES I became edentulous over the next 10 years. In bivariate analyses, the incidence of edentulism was correlated with baseline measures of lower income and education status, poorer oral health, self-perceptions of poor general health and oral health, absence of a regular dentist, and a lower number of remaining teeth at baseline. No correlation was found with gender and geographic region, nor with self-reported diabetes and arthritis, and age was not a factor when the number of remaining teeth at baseline were taken into account. In a logistic regression model assessing the effect of these variables simultaneously, none of the demographic variables retained significance; the only variable statistically significant in both age groups was the number of teeth remaining at baseline. Other significant variables in younger persons were higher periodontal disease scores, perceived poor dental health, perceived need for extractions, history of smoking, and low ascorbic acid intake. Some of these variables were reflections of negative health behavior and attitudes rather than direct correlates. Principal findings from this study were the importance of early tooth loss in eventual edentulism and the virtual disappearance of gender and age as determinants of total tooth loss.

Adult↗
PubMed2004

Municipal socioeconomic status and mortality in Japan: sex and age differences, and trends in 1973-1998.

The purpose of this study was to examine the sex and age differences and the time trends in the association between municipal socioeconomic status (SES) and all-cause mortality across Japan from 1973 to 1998. Sex-specific mortality of municipalities (N=3319 in 1995) by age groups (total, under 75-year, and over 75-year populations) was linked to municipal SES indicators related to income, education, unemployment and living space, and two SES composite indices formulated by principle component analysis (Index 1 related to lower income and education, and Index 2 related to unemployment and overcrowding). The relation was assessed using mortality gradients by SES quintiles and Bayesian hierarchical Poisson regression. The results showed that a lower SES was related to higher mortality for all SES indicators and composite indices. The mortality gradient was steeper for the under 75-year population than the total and over 75-year populations, and the relation between mortality and income- and education-related indicators/index was stronger for males than for females. The time trend showed an increase in the relation for Index 2, while a decrease for Index 1. This study demonstrated that lower municipal SES had an adverse influence on population health, and the influence was marked for males and premature death. Although a substantial health disadvantage still remained in lower SES areas, the impact of SES factors on geographical health variation changed over time; the association with mortality has weakened for income and education, while it has strengthened for unemployment and living space.

Age Distribution↗
PubMed2004

The long-term effect of physical activity on incidence of coronary heart disease: a 12-year follow-up study.

BACKGROUND: This study analyzed the long-term effect of leisure-time physical activity on incident cases of coronary heart disease (CHD) among women and men. METHODS: A national, random sample of 2,551 women and 2,645 men, aged 35-74, was interviewed in 1988 and 1989 and followed until December 31, 2000, with respect to CHD incident cases. Women and men hospitalized for CHD 2 years before the start of the study and those who rated their general health as poor were not included in the sample. Leisure-time physical activity was divided into four levels according to the frequency of physical activity. The relationship between leisure-time physical activity and CHD was studied in a Cox regression model, adjusted for sex, age, income, smoking, and BMI. RESULTS: When leisure-time physical activity increased, the risk of CHD decreased. Women and men who were physically active at least twice a week had a 41% lower risk of developing CHD than those who performed no physical activity (hazard ratio = 0.59, CI = 0.37-0.95), after adjustment for all the explanatory variables. CONCLUSIONS: The positive long-term effect of leisure-time physical activity on CHD risk among women and men remains even after accounting for income and other important CHD risk factors.

Adult↗
PubMed2004

Predictors of breastfeeding intention among low-income women.

OBJECTIVE: Breastfeeding rates are below the Healthy People 2010 goals despite recognized benefits of breastfeeding. This study determined factors that predict breastfeeding initiation among low-income pregnant women. METHODS: A self-administered closed-ended questionnaire was introduced to 694 pregnant women who were certified for WIC in Mississippi. The questionnaire collected data about demographics, breastfeeding intention, breastfeeding knowledge, self-efficacy, and three recognized barriers to breastfeeding: embarrassment, time and social constraints, and lack of social support. RESULTS: In bivariate analysis, women who intended to breastfeed were more often white and had at least some college education, higher income, a smaller family size, fewer children, and previous breastfeeding experience than women who did not intend to breastfeed. Intenders had higher levels of breastfeeding knowledge and self-efficacy and reported fewer barriers to breastfeeding than nonintenders. In multivariate logistic regression, fewer children, past breastfeeding experience, breastfeeding knowledge, self-efficacy, and perceived social support were independent predictors of breastfeeding intention. CONCLUSIONS: Women at high risk for not wanting to breastfeed can be identified for additional support. Interventions should focus on improving breastfeeding knowledge, enhancing confidence in one's ability to breastfeed, and overcoming barriers to breastfeeding, especially lack of social support, among low-income women.

Adult↗
PubMed2005

Use of pharmacy data to evaluate smoking regulations' impact on sales of nicotine replacement therapies in New York City.

OBJECTIVES: Recently, New York City and New York State increased cigarette excise taxes and New York City implemented a smoke-free workplace law. To assess the impact of these policies on smoking cessation in New York City, we examined over-the-counter sales of nicotine replacement therapy (NRT) products. METHODS: Pharmacy sales data were collected in real time as part of nontraditional surveillance activities. We used Poisson generalized estimating equations to analyze the effect of smoking-related policies on pharmacy-specific weekly sales of nicotine patches and gum. We assessed effect modification by pharmacy location. RESULTS: We observed increases in NRT product sales during the weeks of the cigarette tax increases and the smoke-free workplace law. Pharmacies in low-income areas generally had larger and more persistent increases in response to tax increases than those in higher-income areas. CONCLUSIONS: Real-time monitoring of existing nontraditional surveillance data, such as pharmacy sales of NRT products, can help assess the effects of public policies on cessation attempts. Cigarette tax increases and smoke-free workplace regulations were associated with increased smoking cessation attempts in New York City, particularly in low-income areas.

Health Promotion↗
PubMed1997

Tax-deferred annuity plans: meeting the IRS audit challenge.

A growing number of nonprofit organizations are being fined for violations of IRS regulations following IRS audits of their tax-deferred annuity (TDA) plans. To ensure that their organizations can withstand the scrutiny of an IRS audit, TDA plan administrators must ensure that plans meet IRS regulations and be prepared for IRS audits. Documentation--particularly of the TDA plan itself, and procedures related to salary reduction programs, compensation limits, excess deferrals and other excess contributions, loans, and distributions--must be comprehensive and in compliance with IRS regulations.

Financial Audit↗
PubMedDate not supplied

Twenty-year trends in physical activity among Canadian adults.

OBJECTIVE: Physical inactivity is associated with increased risk of mortality and chronic diseases, yet trend information is lacking in most countries. This investigation examines physical activity levels of Canadian adults aged 18 years and older. METHODS: Data were collected in six national surveys between 1981 and 2000. Sample sizes ranged from 2,500 to 18,000. Prevalences were tested using Chi-square and Student's t-tests. Socio-demographic correlates were examined using odds ratios adjusted for age, sex, education and income. RESULTS: Physical activity increased in the 1980s and 1990s among men and women and for all age, education and income groups (p<0.01). Although education differentials narrowed over the period, age differentials widened and income differentials emerged. DISCUSSION: The positive trend in Canada is consistent with Finland, but contrary to recent trends for Australia, England and the United States. Despite increases, sedentary living remains a public health issue particularly among women, older adults and lower income groups.

Adolescent↗
PubMed1995

Childhood malnutrition: an analysis of the effects of nutritional advice.

An analysis of malnutrition was done in 65 infants and preschool children (18 boys and 47 girls) who were under the third percentile of weight for age. Fifty-seven percent of cases has hematocrits of less than 36%, 7% had hematocrits of less than 30% and two had iron deficiency anemia which improved after iron supplement. Eosinophils of more than 400 cells/mm3 were found in 35% of cases. Eleven percent had eosinophils of more than 1,000 cells/mm3. Parasites were found on stool examination in 12.5% of cases. Bone development was retarded in 39% of 23 cases. In 7 cases with bone development delayed more than 6 months, thyroid function and trace elements were analysed and found to be within normal limits. In 5 cases with delayed bone development and height less than 5 cm/year, growth hormones showed normal levels. Proper nutritional advice resulted in improvement in body weight and height in 57% of cases, tricept skin fold in 73%, bicept skin fold in 60%, arm muscle area in 50% and arm fat area in 29% of cases. Improvement was not associated with family income or education of the people who cared for the patients.

Anthropometry↗
PubMed1993

Cell wall assembly in Staphylococcus aureus: proposed absence of secondary crosslinking reactions.

The distribution of muropeptides formed by muramidase digestion of peptidoglycan from Staphylococcus aureus H was determined by gel-filtration HPLC. The observed crosslinking pattern supports the conclusion that incorporation of peptidoglycan in S. aureus proceeds by a similar mechanism to that proposed earlier for Bacillus megaterium. In this mechanism single glycan-peptide strands are incorporated into the sacculus by crosslinking reactions that take place only between the monomer muropeptide units of the incoming glycopeptide and muropeptides present in the innermost region of wall at the wall-membrane interface: such crosslinking reactions take place only during incorporation and no other crosslinking reactions occur. This assembly process has now been termed restricted monomer addition. The present analysis shows that the distribution of muropeptides in S. aureus peptidoglycan is in excellent agreement with that predicted by this mechanism. We propose that cell wall assembly in S. aureus proceeds via restricted monomer addition without any requirement for the secondary crosslinking reactions that have been suggested to occur in this organism. The high degree of crosslinking in S. aureus, 80% in this study, may result mainly from the freedom for crosslinking provided by the pentaglycine bridge peptide.

Cell Wall↗
PubMed1997

Age, gender and health among African Americans.

Public policy and epidemiological studies have not adequately addressed age and gender differences on important health dimensions among African Americans. The purpose of this study was to examine gender and health among five age groups of African Americans. A sample of 1,174 respondents age 24 to 85 was selected from the 1986 Americans' Changing Lives (ACL) Study. Regression analysis was performed using a hierarchical model to examine age and gender on five dimensions of health: functional health, chronic conditions, satisfaction with health, self-ratings of health, and activities of daily living (ADL) limitations controlling for age, education, income, and marital status among five age groups of African Americans. Results revealed that in the 24-39 age group, men had fewer chronic conditions and less ADL limitations, yet rated their health poorer than their female counterparts. In the 75 and over age group men had better functional health yet were less satisfied with their health than women. Control variables were significantly related to objective and subjective dimensions of health especially among the younger age groups. Overall, gender differences persist mainly among the youngest and oldest age groups despite variations in the above demographic variables. Implications for social work practice and future research are discussed.

Activities of Daily Living↗
PubMed2004

Prevalence and 3-year incidence of abuse among postmenopausal women.

OBJECTIVES: We examined prevalence, 3-year incidence, and predictors of physical and verbal abuse among postmenopausal women. METHODS: We used a cohort of 91,749 women aged 50 to 79 years from the Women's Health Initiative. Outcomes included self-reported physical abuse and verbal abuse. RESULTS: At baseline, 11.1% reported abuse sometime during the prior year, with 2.1% reporting physical abuse only, 89.1% reporting verbal abuse only, and 8.8% reporting both physical and verbal abuse. Baseline prevalence was associated with service occupations, having lower incomes, and living alone. At 3-year follow-up, 5.0% of women reported new abuse, with 2.8% reporting physical abuse only, 92.6% reporting verbal abuse only, and 4.7% reporting both physical and verbal abuse. CONCLUSIONS: Postmenopausal women are exposed to abuse at similar rates to younger women; this abuse poses a serious threat to their health.

Age Distribution↗
PubMed1990

Socio-economic status and prevalence of intestinal parasitic infection in Thai adults residing in and around Bangkok metropolis.

Socio-economic factors relating to prevalence of intestinal helminthic infections were studied in 189 Thai adults residing in and around Bangkok. Questionaires were used to interview each individual about occupation, income, family occupation, family income and educational level. All participants were subjected to three microscopic stool examinations and to stool cultures for Stronglyoides stercoralis. Of 189, 34 were students (20%), 60 were unemployed (35%), and the remainder were employed in private or public sectors. The overall average personal incomes were low (less than US$ 1,000/year), while 56 per cent of them came from middle class families (US$ 2,000-4,000/year). Regarding the educational level, only 151 persons answered this question. Fourteen (9.3%) did not complete primary school; 20 (13.2%) completed primary school; 97 (64.2%) completed secondary or vocational school and 20 (13.2%) were university graduates. Prevalence of intestinal parasitic infection was 25 per cent (47/189) and 23.4 per cent (11/47) of infected individuals had multiple infections. The distribution among them was as follows: strongyloidiasis 30.5 per cent, hookworm 25.5 per cent, giardiasis 23.4 per cent, opistorchiasis 17 per cent, amoebiasis 12.8 per cent, trichuriasis 4.3 per cent, taeniasis 2 per cent and ascariasis 2 per cent. There were no statistical differences in incomes, occupations, family incomes and educational levels between infected and uninfected individuals.

Adult↗