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PubMed2002

Disentangling the effects of morbidity and life expectancy on labor market outcomes.

Using a unique longitudinal dataset tracking the experiences of patients diagnosed with HIV+ disease, this paper develops and estimates a model capable of recovering the effect of revisions in life expectancy on labor market outcomes. The data allow us to estimate the effect of changes in health status (as objectively measured by CD4 counts) and the impact of learning that one is HIV+, which we interpret as a negative shock to life expectancy. Both parametric and distribution-free models robustly indicate that decreases in health have little effect on labor demand but decrease probability of employment. We conclude that, in this sample, negative association between income and health is attributable mostly to the effect of altered incentives induced by changes in life expectancy.

AIDS-Related Opportunistic Infections↗
PubMed1996

Rab4 and cellubrevin define different early endosome populations on the pathway of transferrin receptor recycling.

During receptor mediated endocytosis, at least a fraction of recycling cargo typically accumulates in a pericentriolar cluster of tubules and vesicles. However, it is not clear if these endosomal structures are biochemically distinct from the early endosomes from which they are derived. To better characterize this pericentriolar endosome population, we determined the distribution of two endogenous proteins known to be functionally involved in receptor recycling [Rab4, cellubrevin (Cbvn)] relative to the distribution of a recycling ligand [transferrin (Tfn)] as it traversed the endocytic pathway. Shortly after internalization, Tfn entered a population of early endosomes that contained both Rab4 and Cbvn, demonstrated by triple label immunofluorescence confocal microscopy. Tfn then accumulated in the pericentriolar cluster of recycling vesicles (RVs). However, although these pericentriolar endosomes contained Cbvn, they were strikingly depleted of Rab4. The ability of internalized Tfn to reach the Rab4-negative population was not blocked by nocodazole, although the characteristic pericentriolar location of the population was not maintained in the absence of microtubules. Similarly, Rab4-positive and -negative populations remained distinct in cells treated with brefeldin A, with only Rab4-positive elements exhibiting the extended tubular morphology induced by the drug. Thus, at least with respect to Rab4 distribution, the pathway of Tfn receptor recycling consists of at least two biochemically and functionally distinct populations of endosomes, a Rab4-positive population of early endosomes to which incoming Tfn is initially delivered and a Rab4-negative population of recycling vesicles that transiently accumulates Tfn on its route back to the plasma membrane.

Animals↗
PubMed1982

The validity of a telephone-administered 24-hour dietary recall methodology.

This study assesses the operational feasibility and validity of a unique telephone-administered 24-h dietary recall methodology. Dietary interviews were conducted by telephone with 204 low-income elderly subjects. Food portion size estimation was done using a two-dimensional food portion visual aid the that was mailed to respondents' homes. The mean intakes and distributions of nine nutrients among males and females in the research sample were compared with those reported in the 1971 to 1974 Health and Nutrition Examination Survey. After correcting for time trends in nutrient intake, the mean intake values found in the survey were very similar to those reported by the Health and Nutrition Examination Survey. In testing the frequency distributions of intakes, only two nutrients for women and one for men had statistically significant differences. The telephone-administered dietary methodology thus produced acceptable estimates of the means and distributions of nutrient intakes among groups of individuals and has the potential of markedly reducing the cost, time, logistical, and personnel constraints associated with nutrition surveys.

Aged↗
PubMed2026

Strengthening supply chains for pathogen genomic surveillance in Asia.

INTRODUCTION: While pathogen genomics using next-generation sequencing (NGS) has been recommended by the WHO as an essential tool for national communicable disease surveillance programmes, procurement and supply chain management (PSM) systems for this new technology are still evolving. To assess the status of PSM systems for pathogen genomics, we examined perspectives from end-users and manufacturers across South and Southeast Asia. METHODS: Between 2022 and 2023, a cross-sectional survey was conducted among institutional partners supporting pathogen genomics among primarily low- and middle-income countries in South and Southeast Asia. This was complemented by qualitative interviews with the major regional NGS manufacturers. A PSM framework was employed to assess sales, procurement, production, distribution and post-sales support. Analyses are expressed as proportions and means or medians for continuous variables. RESULTS: A total of 42 partners across 13 countries, 3 genomics manufacturers and 22 laboratory personnel contributed data to this assessment. PSM challenges were reported by all countries and for all sequencing platforms. High costs of equipment and consumables were identified by 85% of respondents. Long equipment purchasing lead times and reagent re-supply times were reported by 69% and 77% of countries, respectively, with reagent resupply times averaging 8 weeks (IQR 6.2-9.0). Additional barriers included customs clearance, variability of import procedures, taxes and duties. Manufacturers reported a range of strategies to respond to PSM bottlenecks, including establishing regional hubs, distributor networks and financing schemes. CONCLUSION: Coordinated national and regional efforts are required to improve PSM systems for pathogen genomic sequencing to enhance timely early disease detection and response capacity in South and Southeast Asia.

Humans↗
PubMed2006

[Factors affecting primary care referrals to specialised care in the community of Madrid].

OBJECTIVE: Identification of the variables relative to the population characteristics and the primary and specialised care services provision which determine the referral rates between both levels. DESIGN: Cross-sectional ecological study. SETTING: Basic health zones (BHZ) of the Community of Madrid (CAM), Spain, 2001. PARTICIPANTS: Population of the CAM. MAIN MEASUREMENTS: Dependent variable: population referral rate (PRR) (referrals per BHZ in 2001 divided by BHZ population). INDEPENDENT VARIABLES: population and their characteristics (income, unemployment, educational level, elderly and dependence level, marital status, immigrant rates); need of services (care frequency index and standardised mortality rate); primary care provision characteristics (number of doctors, distribution by age and sex, organisational model, number of years in primary care; specialised care provision characteristics (number of laboratory specialists, ratio of radio-diagnostic and clinical services doctors). RESULTS: The average PRR is 31.9 (0.87) per 100 inhabitants, with a tendency for similar values to group into three clusters. Five components which explain 81.87% of the variation have been identified: total population, demographic characteristics, socioeconomic status, need of services, and social mobility. In the regression analysis (R2=0.18), the last 3 reach statistical significance. CONCLUSIONS: The PRR is greater in the BHZ with higher levels of need of services and lower levels of socioeconomic status and social mobility. There is no relationship with either the provision or the organisation of primary care and specialised care. These variables should be included in the planning of the provision of services.

Adolescent↗
PubMed2001

Health insurance expansion through states in a pluralistic system.

The United States continues to stand almost alone among developed nations in its lack of universal health care coverage. In this essay, we argue that even though the debate over whether the federal government or states should lead the effort to expand health care coverage under the federal system is relevant in strategizing how to cover the uninsured; the more critical issues stem from the challenge of the mixed and fragmented mode of public-private financing of our pluralistic health care system. We base this argument on (1) an in-depth review of Oregon's and Tennessee's five years of experience with broad coverage reform in the context of the United States health care system and on (2) a more abbreviated review of other state experiences in providing health care coverage. We conclude from our review that when the will exists, states can substantially expand coverage. However, as one moves up the income scale, political support and resources are harder to come by. Further, concerns grow about the interface of public and private coverage, with issues of "crowd out" and other distributional questions dominating the discussion of coverage expansion as policy makers focus less on how to cover people than on how to make sure one kind of coverage doesn't preempt another. Concern for crowd out can then lead to policies that keep out some of the very people policy makers may want to cover. In this context the question whether states or the federal government is more likely to succeed in expanding coverage is eclipsed by the more fundamental challenges raised by pluralism. Neither federal nor state government is likely to be fully successful without first identifying ways of better coordinating public and private activities and resources to provide continuous and affordable coverage.

Health Services Research↗
PubMed2003

Prevalence of Toxocara infection in schoolchildren from the Butantã region, São Paulo, Brazil.

Visceral larva migrans syndrome by Toxocara affects mainly children between 2 and 5 years of age, it is generally asymptomatic, and the seroprevalence varies from 3 to 86% in different countries. A total of 399 schoolchildren from 14 public schools of the Butantã region, São Paulo city, Brazil, were evaluated by Toxocara serology (enzyme-linked immunosorbent assay). Epidemiological data to the Toxocara infection obtained from a protocol were submitted to multiple logistic regression analysis for a risk profile definition. Blood was collected on filter paper by finger puncture, with all samples tested in duplicate. Considering titers > or = 1/160 as positive, the seroprevalence obtained was 38.8%. Among infected children, the mean age was 9.4 years, with a similar distribution between genders. A significant association was observed with the presence of onychophagia, residence with a dirty backyard, living in a slum, previous wheezing episodes, school attended, and family income (p < 0.05). All data, except "living in a slum", were considered to be determinant of a risk profile for the acquisition of Toxocara infection. A monthly income > or = 5 minimum salaries represented a protective factor, although of low relevance. Toxocara eggs were found in at least one of the soil samples obtained from five schools, with high prevalence of Toxocara infections, indicating the frequent soil contamination by this agent.

Adolescent↗
PubMed2001

Influence of dental care systems on dental status. A comparison between two countries with different systems but similar living standards.

OBJECTIVE: To evaluate the influence of two different dental care systems on dental status, taking into account relevant socio-economic factors. BASIC RESEARCH DESIGN: Questionnaire studies on randomly sampled subjects in Denmark and Sweden using questionnaire forms as identical as possible with regard to the different languages. SETTING: The studies were performed late in 1998 in both countries. PARTICIPANTS: Questionnaires were sent to 1,175 subjects aged 45-69 years in Denmark (response rate 73%) and to 1,001 subjects aged 55-79 years in Sweden (response rate 67%). MAIN OUTCOME MEASURES: Questions about dental status and about socioeconomic factors and attitudes toward dental care were included. In logistic regression models, various dichotomies of dental conditions were used as dependent variables. State (Denmark vs. Sweden) was used as an independent variable together with socioeconomic factors and attitudes. RESULTS: There were great differences between the countries in dental status. In the regression model with 'wearing removable denture(s)' as the dependent variable, state was the strongest predictor with an OR of above 4.1 for Denmark compared to Sweden. much stronger than variables such as age, income, education and residence. CONCLUSION: The results indicate that the Swedish dental care system has been superior to the Danish one regarding dental status in middle aged and older populations in these two countries.

Age Factors↗
PubMed1990

[Age, experience, educational status, and differences in income: the United States and Brazil].

"This paper analyses age and experience profiles of earnings inequality for American and Brazilian males. Decomposition of the inequality profiles using a human capital framework clarifies the determinants of cross-section inequality profiles and demonstrates a number of important differences in the shape of the two countries' profiles and in their underlying components. Changes in the distribution of schooling across cohorts are shown to play a central role in explaining cross-section inequality profiles within each country and in explaining differences in earnings inequality in the United States and Brazil." (SUMMARY IN ENG)

Age Factors↗
PubMed2005

[A cross-sectional study on prevalance and risk factors of disabilities in aged 0-6 years children in Beijing, China].

OBJECTIVE: To explore the epidemiological status of disabilities on vision impairment (VI), hearing loss (HL), mental retardation (MR), autism spectrum disorder (ASD) and motor disorder (MD) in aged 0-6 years old children in Beijing. METHODS: A total of 28 738 children under 7 years old were recruited from permanent residents of Beijing City by 2-phase cluster sampling. The screening procedure was 2-phase, and the diagnosis criteria were developed by the experts group. RESULTS: The overall disability rate was 11.45 per thousand (95 % CI:10.22-12.68). The false negative rates in HL and ASD were 0.14 per thousand, 0.80 per thousand, respectively, with a adjusted overall rate of 12.19per thousand. The prevalence rates of different kind disabilities from high to low were MR 9.31per thousand, MD 2.12per thousand, ASD 1.53per thousand (0.73per thousand before adjusted), HL 1.04per thousand (0.91per thousand before adjusted) VI 0.73per thousand. The results of logistic regression analysis showed that the possible non-biological risk factors for those disabilities were being male, living in city area, advancing age, mother with low education, mother engaged in labor work, and family with low income. It was primarily (49.62%) those prenatal factors other them the known suspected factors that causing disabilities. CONCLUSIONS: Compared with data from a countrywide study in 1987, the overall disability rate had a mild decrease (16.36%) with the most (56.85%) appeared in HL. It is indispensable to establish a disabilities surveillance program for the early recognition and intervention of children with disabilities. It is also crucial to clarify a disability definition for children combined with their characteristics of growth and development. We strongly recommended in developing a new definition on children' disabilities and establishing new criteria according to the contents of developmental disabilities of Center for Disease Control, USA.

Age Distribution↗
PubMed2006

Changes in seafood consumer preference patterns and associated changes in risk exposure.

Consumers world-wide are driving changes in the agriculture and food sector. Rising consumer income, changing demographics and lifestyles, and shifting preferences due to new information about the links between diet and health all contribute to new demands for foods. At the same time, technological changes in production, processing and distribution, growth in large-scale retailing, and changes in product availability, as well as expansion of trade world wide, have contributed to a rapidly changing market for food products. Changes in seafood consumption reflect these changes. The changes in consumer consumption patterns, new technologies and trade in product offer both expanded markets as well as new challenges to consumer exposure to food-borne risks. The strict quality control requirements of retail brokers, growth of private labels, and development of value-protecting marketing channels have become increasingly important in food markets. This paper addresses major trends that affect seafood consumption and the market for seafood products and the implications of these changes for consumer risk exposure to food safety hazards. The current economic environment highlights similarities and differences between the developed and developing countries, as well as diversity worldwide in consumption of seafood. Within this context, four major trends affect consumer consumption of foods, including seafood and fish products today: rising income; changing demographics; changing markets for food; and an increasingly global market for food products. Changes in consumer risk exposure to food safety problems are addressed in the context of these trends.

Animals↗
PubMed2006

[Health care financing: is it enough and appropriate?].

INTRODUCTION: The object of this short paper is to present the results of Spanish public health care expenditures projections until 2013 according to the expected impact of the main demographic and technological health cost drivers. MATERIAL AND METHODS: Future annual health expenditures are estimated using a simple method based on the decomposition of the past main growth factors in two scenarios. The main cost drivers considered were the following: demography, which includes the increasing number of people and the impact of population ageing; the increase in the price of health care inputs above the general price level; and the impact of changes in medical practice related with expanding medical technology. RESULTS AND DISCUSSION: In 2013, public health care expenditure may be around 5.7% and 6% of gross domestic product (GDP); that is, at least, between 0.24 and 0.53 additional GDP points will be spent on public health care. The main factor responsible for the future expenditure increase will continue to be the increase in the average health service intensity, followed by demographic factors. In the base-case scenario, public expenditure increase until 2013 will be compatible with a real 2.5% annual increase in consumption of non-health goods and services. In order to finance the future costs, the Spanish population will have to devote to public health expenditure less than 7% of income increase until 2013. CONCLUSION AND PERSPECTIVES: Despite being important, the expected Spanish GDP growth until 2013 may be enough to finance the increase in public health expenditure as a result of the impact of demographic changes. Expanding medical technology is expected to continue being the main driver of future costs.

Age Distribution↗
PubMed2004

'There just aren't enough hours in the day': the mental health consequences of time pressure.

In this paper I examine the association between subjective time pressure and depression and consider whether time pressure mediates the relationship between roles and depression, whether social and economic resources moderate the association between time pressure and depression, and whether time pressure explains gender differences in depression. Results of a telephone survey of 790 respondents indicate that time pressure is significantly associated with distress for men and women, and that subjective time pressure accounts for the significantly higher depression of employed women. Time pressure mediates the impact of housework and the volunteer role among women and it partially explains the differential depression of divorced men. Several resources moderate the impact of time pressure on depression: income among both men and women and perceived co-worker social support among men. Results suggest that the subjective experience of time pressure can be thought of as a potentially important mechanism by which lived experience is transformed into depression. However, in spite of the ubiquity of time pressure in the North American context, the depressing consequences of this subjective experience are not distributed equitably, suggesting that the capacity to manage time pressure and avoid depression may be another benefit associated with strategically advantageous social locations.

Adult↗
PubMed1987

The impact of population ageing on the social security expenditure and economic growth in Japan.

The author considers the impact of demographic aging in Japan on the social security system and on economic growth. It is argued that "First of all, as the cost of social security (including social services) increases remarkably at the earlier stage of ageing, the disposable (after tax) income and private consumption of the present labour force generation tend to increase at a lower growth rate than that of the GNP....Secondly if pension systems are based on terminal funding schemes, the ageing of the population increases savings (net increase of the amount of the pension funds) at the earlier stage of the ageing of the population. Thirdly, there is a time lag between the increase of social security benefits and the decrease in the personal savings ratio. The high ratio of savings and the shortage of aggregate demand as well as the high pressure for export in...recent Japan can partly be attributed to the above factors." Possible future economic scenarios as demographic ageing in Japan proceeds are described, and policies to avert anticipated problems are outlined. (SUMMARY IN JPN)

Adult↗
PubMed1984

[Mortality differential for cancer based on social class: the metropolitan region of Montreal, 1971].

Cancer mortality rates vary from area to area. Part of this variation is due to socio-economic characteristics of the area and part to other factors including the availability of health services. Three social indicators associated with cancer mortality are used to estimate variations between low and high census sectors within the metropolitan region of Montreal. The components of socio-economic status which have been used are revenue (median family income), education (college and university level) and occupation (higher status profession). For each of the three zones of the metropolitan area: the city of Montreal, the island of Montreal not included the city of Montreal, the north and south shores of the metropolitan area twenty five census sectors have been chosen which having higher or lower positions for each of the socio-economic components. For each group standardized death rates were evaluated for each type of cancer and the Poisson test was applied to judge whether the differences between the projected rate and the observed rate were significant. The results indicate a strong indirect relation between the standardized mortality rates and the socio-economic status in the central city. In the case of lung cancer, the spatial distribution showed district gradients of occurrence between the central-city and the suburbs.

Adult↗
PubMed2004

[Nutritional surveillance and morbidity of children under 5 years of age seen in a primary health care unit: historical series 1987-91].

This paper presents preliminary analysis of the nutritional status assessment (NS) and morbidity of low-income children under 5 years of age seen by the Food and Nutritional Surveillance System of a primary health care unit in Rio de Janeiro between 1987 and 1991. The distribution of lengh/stature for age (LSA) was skewed to the left as early as the first semester of life. Approximately 20% of the children had values of body mass for age (BMA) below the 10th percentile of the reference growth curve (NCHS). The prevalence of stunting (Z LSA < - 2) decreased yearly during the period. The eight most frequent causes of visit to the unit were the same but the frequencies varied from year to year. In the last three years upper respiratory (URD) and digestive diseases (DD) and undernutrition prevailed. NS did not correlate with UPD but the prevalence of DD was inversely associated with BMA percentile. These data indicate relevant growth deficits in the children which justifies the implementation of nutritional surveillance in health units. It is also clear that morbidity and NS must be correlated in future studies, so that, the role of nutritional surveillance is enhanced in the Health Sector.

English Abstract↗
PubMed1996

The National Cancer Data Base report on endometrial cancer.

BACKGROUND: Previous Commission on Cancer data from the National Cancer Data Base (NCDB) have examined time trends in stage of disease, treatment patterns, and survival for selected cancers. The most current (1992) data for endometrial cancer are described here. METHODS: Four calls for data have yielded a total of 560,455 cancer cases diagnosed in 1986-1987, and 599,597 cancer cases diagnosed in 1992, from hospital cancer registries across the United States. RESULTS: Data were received for 36,341 endometrial cancer patients. No significant change in stage distribution for patients who were staged was noted with time, however, markedly fewer patients were reported with unknown stage in 1992 (15.6%) compared with 1986-1987 (45.1%). Blacks and low income groups were more likely to present with advanced stage disease. A 12.6% increase in patients undergoing nodal dissection as part of their surgical treatment occurred during this time period. More patients received surgery only as part of their treatment in 1992 (53.8%) vs. 42.6%). Advancing age, minority status, low income, and increasing grade all had a negative impact on survival. Blacks experienced a 25% reduction in survival compared to non-Hispanic Whites and Hispanics. CONCLUSIONS: Lack of improvement in detecting early disease indicates the lack of acceptable screening methodology for this disease. Blacks present with more advanced disease and subsequently have a decreased survival compared to non-Hispanic Whites. Time trends indicate that nodal dissection is becoming a more common surgical practice in this disease, and that radiation therapy is utilized less often. The current American Joint Committee on Cancer staging accurately reflects differences in prognosis by stage.

Adult↗
PubMed1986

Extending urban services in developing countries: policy options and organizational choices.

Governments in developing countries will face serious problems in extending basic social services, public facilities, and infrastructure for their rapidly growing urban populations during the next decade. The steadily increasing concentration of the poor in cities will exacerbate already severe strains on urban services. Innovative solutions will be needed to meet the growing demands for urban services. In addition to expanding national and municipal efforts, governments in developing countries must also explore alternative policies and organizational arrangements for meeting the basic needs of their urban population. Among the potential alternatives are: using market surrogates to improve service delivery; lowering the costs of service provision through changes in regulations and controls on urban development; actively supporting self-help and service upgrading schemes by the poor; promoting public-private cooperation and private sector participation in service delivery; increasing effective demand for services by promoting employment and higher incomes; and enacting and implementing policies that attempt to redistribute migration to small and intermediate-sized cities. Each alternative has advantages and limitations that planners and policy-makers must take into consideration in forging effective urban development strategies.

Demography↗