Demographic trends and saving propensities: "a revisit with life cycle theory"..
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Age Distribution↗
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Maternal mortality in rural and urban Zimbabwe: social and reproductive factors in an incident case-referent study.
A community-based incidence case-referent study was undertaken in a rural and an urban setting in Zimbabwe in order to define risk factors associated with maternal deaths at family, community, primary and referral health care levels. Referent subjects were drawn from place or area of delivery for each consecutive maternal death. Using a multiple source confidential reporting network for all maternal deaths, the maternal mortality rate for the rural setting was 168/100,000 live births and that for the urban setting was 85/100,000 live births. A model for interacting factors contributing to maternal mortality was designed. Haemorrhage and abortion sepsis were the major direct causes while malaria was the leading indirect cause in the rural setting. In the urban setting, eclampsia, abortion and puerperal sepsis were the leading causes of maternal deaths. It was found that all situations associated with diminished, or absent social support, that is, being single (Odds Ratio = 4.7, 95% CI = 2.2-9.8) divorced, widowed, one of several wives, cohabiting, or self-supporting carried an increased risk for maternal mortality, especially in the rural area. Income and level of education for index and referent subjects were comparable, probably because of the limited part of the population under study that belonged to a more affluent class. Distribution of cases and referents by religious-affiliation was also comparable. Age > 35 years and parity > 6 were significant risk factors for maternal mortality in the rural setting, whereas bad reproductive history with reported stillbirth or abortion constituted a high risk both in the city and in the rural areas (Odds Ratios 4-6).(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Street children in Pakistan: a situational analysis of social conditions and nutritional status.
This paper examines the social conditions and nutritional status of street children in Pakistan. Nutritional status is evaluated by an assessment of height and weight relative to age. A heterogeneous sample of 108 street children in the twin cities of Rawalpindi and Islamabad was studied. One hundred and one of them were children "on the street" having regular family contact; seven were "of the street", without any family contact. Most street children came from large families which had recently moved to the city in search of economic opportunities. Their parents had low education levels and were either unemployed or employed in unskilled occupations. Poverty clearly was an important factor. The majority of the children moved to the street to augment family income. Most of the children were males (81%) and the average age at beginning life on the street was under 10 years. The majority was working 8-12 h daily with an average income of Rs. 40-60 per day (USD 1 = Rs. 60). Important issues were parental exploitation, police harassment, abuse, and the impact of other street peers in their lives. The distribution of height-for-age relative to the National Center for Health Statistics (NCHS) reference standard showed that 20% were stunted and 12% had wasting. Wasting was equal between sexes, while fewer girls than boys were stunted. The study concludes that the issue of street children in Rawalpindi and Islamabad is mainly one of "children on the street," while "children of the street" are an exceptional phenomenon. It was noted that, with some exceptions, street children in other world regions share similar risk factors and backgrounds. Findings from this study will facilitate both the identification of high-risk families, i.e. those whose children are likely to take to the street, and timely preventive and rehabilitative measures.
Age Factors↗
Guess who's cooking? The role of men in meal planning, shopping, and preparation in US families.
OBJECTIVES: To determine the role of men in meal-related tasks in households with both a male and female head, and to identify households in which the man is more likely to be involved in these tasks. DESIGN: Data collected as part of the US Department of Agriculture's 1994 Continuing Survey of Food Intakes of Individuals were analyzed. SUBJECTS/SETTING: All analyses were restricted to sampled persons who were identified as a male head of household residing in a household that also had a female head (N = 1,204). STATISTICAL ANALYSES: Frequency distributions were calculated and logistic regression analyses were conducted. RESULTS: Approximately 23%, 36%, and 27% of men reportedly were involved in meal planning, shopping, and preparation, respectively. Men in lower income and smaller households were more likely to be involved in each of the meal activities. Younger men and men in households in which the female head of household worked full-time were more likely to be involved in meal planning and preparation. IMPLICATIONS: Current education efforts to improve family nutrition tend to target the female rather than the male head of household. Our findings confirm that this focus is appropriate for most dual-headed households.
Adult↗
A survey of blood lead levels among young Johannesburg school children.
Studies conducted around the world have established beyond doubt that elevated childhood blood lead levels may lead to detrimental health effects. Research has shown that certain groups of South African children are at particular risk of elevated blood lead levels. Johannesburg is the largest urban complex in southern Africa, with a population of around 3 million and extensive industrial and manufacturing activity. Among the challenges posed in the city are rapid urbanization, extensive poverty, and inequity. Little information on the blood lead distribution of Johannesburg children is available. This study was undertaken to determine blood lead levels among children living in three areas of Johannesburg: inner city suburbs and the low-income townships of Alexandra and Westbury to the north and west of the city center, respectively. The results indicated that blood lead levels ranged from 6 to 26 micro g/dL, with a mean level of 11.9 micro g /dL. The blood lead levels of 78% of children equaled or exceeded 10 micro g/dL, the current international action level. Maternal educational status, the presence of smokers in the home, and living in an informal dwelling were among the factors associated with elevated blood lead levels.
Child↗
Health effects of forced evictions in the slums of Mumbai.
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Adult↗
Self-care abilities of patients with heart failure.
BACKGROUND: Self-care is difficult for patients with heart failure (HF) because early symptoms are subtle and the treatment regimen is complex. The primary purpose of this study was to describe HF self-care abilities and the difficulties that patients have in achieving success in self-care. A secondary purpose was to compare self-care abilities in patients experienced with HF with those patients who are newly diagnosed. METHODS: Descriptive, cross-sectional, comparative surveys were conducted to assess demographic and clinical factors that may interfere with self-care and lifestyle changes made to accommodate the diagnosis of HF. Symptoms the patients had and self-care responses to those symptoms were assessed by using the Self-Management of Heart Failure questionnaire. RESULTS: The 139 patients were primarily elderly, male, retired, unmarried, and earning less than $20,000 annually. Hearing and eyesight were impaired and most patients were functionally compromised. Most of the group had multiple HF symptoms during the past year, yet their knowledge of the importance of signs and symptoms was poor and many misperceptions were evident. Recognition of changes in signs and symptoms was difficult for most patients, but easier for those more experienced with HF. Experienced patients were more likely to use appropriate self-care remedies than newly diagnosed patients. Few patients were comfortable evaluating the effectiveness of their self-care actions and most had low self-confidence in their ability to perform self-care. CONCLUSIONS: With the low level of self-care ability and the number of difficulties these patients face, it is not surprising that rehospitalization rates remain high. Specific recommendations for the teaching and delivery of care are provided.
Age Distribution↗
"Women with self-esteem are healthy women": community development in an urban settlement of Guayaquil.
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Americas↗
Out-of-pocket health care costs among older Americans.
OBJECTIVES: Despite Medicare, elderly persons are exposed to substantial out-of-pocket health care cost burdens. As Medicare reform proposals are considered, it is important to determine the current size, distribution, and burden of these expenditures. METHODS: Data from the 1995 Medicare Current Beneficiary Survey were used to analyze out-of-pocket expenditures and their burden in relation to income; the proportion of total health care expenditures paid out-of-pocket; and the role of pharmacy, hospital, physician, and other services in overall out-of-pocket spending. RESULTS: Expenditures averaged 19.0% of income, for full-year Medicare beneficiaries alive during all of 1995. In bivariate analyses, higher-burden subgroups included those in poor health (28.5% of income), older than age 85 (22.4%), and with income in the lowest quintile (31.5%, despite Medicaid coverage for some). Those relying on fee-for-service Medicare only (23.0%) or with self-purchased supplemental insurance (25.5%) experienced more burden than those with employer-sponsored coverage or in HMOs. In multivariate analyses, functional impairment, number of medical conditions, self-perceived health and privately-purchased supplemental coverage were each associated with higher out-of-pocket burden, while HMO participation was associated with lower burden. Out-of-pocket expenditures averaged 15.2% of total health care expenditures with the proportion highest (22.6%) for those with no supplemental coverage. More than half of out-of-pocket payments for health care services were for prescription drugs and dental services. DISCUSSION: Out-of-pocket cost burdens fall most heavily on those with chronic health conditions and without employer-subsidized supplemental coverage or Medicaid. Impact of Medicare reform proposals on these subgroups needs to be carefully evaluated.
Aged↗
Use of the SF-36 in low-income Chinese American primary care patients.
BACKGROUND: Measures of health status have been increasingly utilized but most research in the United States has been conducted on middle-class, English-speaking white persons. Although Asians reportedly often have a better health status than white persons, previously surveyed samples may not be representative of low-income non-English-speaking Asian immigrant populations. MATERIALS AND METHODS: This cross-sectional study surveyed a convenience sample of low-income Chinese patients attending a community health center in Chinatown (New York City). We sought to evaluate the known-groups validity of self-administered Chinese and English versions of the Medical Outcomes Study (MOS) 36-Item Short-Form Health Survey (SF-36) and to determine if scores differed from a community-based sample of Chinese Americans and the United States general population. RESULTS: Eight hundred fifty-six persons were approached and data were obtained from 523 participants (61%); 90% completed the questionnaire in Chinese and 74% earned less than 15,000 US dollars. Known-group comparisons based upon differences in age, gender, and number of medical problems yielded support for the validity of the SF-36 in this sample. The sample's SF-36 subscale scores were lower than scores from the community-based sample of Chinese Americans and tended to be lower than scores from the United States general population. Mean scores were lowest for persons reporting depression, anxiety, or an emotional problem. CONCLUSIONS: The SF-36 demonstrated known-groups validity in this low-income Chinese sample. Collecting data in the primary care setting enables both a better understanding of the relative burden of disease in low-income Chinese and targeted program planning for preventive interventions.
Adolescent↗
Persistence in health expenditures in the short run: prevalence and consequences.
BACKGROUND: Knowing whether persons in the top percentiles of the health expenditure distribution exhibit persistently high expenditure is fundamental to developing health plan payment policies, containing costs, and understanding the consequences of costly illnesses. OBJECTIVES: To determine the extent of high expenditure persistence over a 2-year period. To identify the correlates and consequences of expenditure persistence. SUBJECTS: A national sample of the population from a longitudinal panel of the Medical Expenditure Panel Survey (MEPS). METHODS: Changes in a person's position in the expenditure distribution were examined. chi2 tests were used to identify differences in characteristics between high and low spenders. Logistic regression was used to predict the likelihood of expenditure persistence. Changes in income, employment, out-of-pocket expenditure burden, and health insurance were compared for high and low spenders. RESULTS: Of the top 5% of spenders in 1996, 30% retain this position in 1997 and 45% are in the top decile of 1997 spenders. High expenditures begin to regress to the mean over the study period. Cancer, mental disorders, diabetes, and infectious diseases and being in the top decile of 1996 spenders increase the probability of expenditure persistence (P < 0.05 for all). This probability also has a strong random component. An increased proportion of persons in the top expenditure decile for both years had out-of-pocket health spending greater than 20% of income in 1997 (P < 0.10). Persons with persistently high expenditures were less likely than low spenders to lose employment-based coverage (5.4% vs. 8.8%, P < 0.05) but no changes in income or employment status were detected. CONCLUSIONS: A sizable minority of persons exhibits persistently high expenditures, creating incentives for favorable risk selection. Few consequences of short-run expenditures persistence are observed.
Adult↗
Does cognitive functioning mediate the well-documented link between education and functional disability in middle-aged adults?
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Activities of Daily Living↗
Access to dental care by young South Australian adults.
BACKGROUND: Despite reported concern over the dental care of young adults little research has been done on their use of dental services in Australia. The aim of this study was to investigate the patterns of dental utilization of young South Australian adults aged 20-24 years. METHODS: A random sample of 2300 young adults was selected from the electoral roll. Partial or complete addresses and possible phone numbers were obtained for 1921 persons. Telephone interviews were conducted for 1261 subjects to obtain information on socio-demographics, health behaviour and dental visiting (response rate 65.6 per cent). RESULTS: One third of young adults (34 per cent) had not made a dental visit in the previous two years and 38 per cent usually visited for a problem rather than a check-up. Making a dental visit in the last two years was significantly associated with a number of socio-demographic variables including age and gender, with holders of private dental insurance and those who have not avoided care because of cost having higher odds of making a visit and males and government concession card holders having lower odds of visiting. Usual reason for visiting a dentist for a problem was significantly associated with no private dental insurance, holding a government concession card, no tertiary education and avoiding care because of cost. CONCLUSIONS: This study suggests that demographic and economic factors influenced use of dental services and reason for visiting of young South Australian adults.
Adult↗
Residual need for early orthodontic treatment and orthodontic treatment experience among 13- to 14-year-old school children in Kuwait.
OBJECTIVE: Our purpose was to determine the residual need for early orthodontic treatment and the parameters associated with orthodontic treatment experience in 13- to 14-year-old school children in Kuwait. SUBJECTS AND METHODS: A total of 788 boys and 795 girls, representing about 6.7% of the target population, were selected according to cluster sampling methods. Information on nationality, family income and orthodontic treatment experience was collected through subject and family interviews. The occlusal morphology was recorded in a well-lit classroom or from initial study models of subjects with orthodontic treatment experience. RESULTS: Only 6.7% of the 225 subjects with early treatment need, defined as overjet >or=6.5 mm, and functional posterior and anterior crossbite on 1 or more teeth, had treatment experience. Residual need for early treatment was present in 13.4% of the subjects. Only 26.8% of the subjects with treatment experience met our criteria for early treatment need. The odds of treatment experience were higher in the subjects attending private schools (p < 0.05), in those from families with an income of KWD >2,000 (USD 6,600; p < 0.01) and in subjects meeting the criteria for early treatment need (p < 0.01). CONCLUSIONS: About 15% of each birth cohort of school children in Kuwait need early orthodontic treatment. Less than 10% of those with a need have treatment experience at 13-14 years of age, and about 75% of those with treatment experience at that age do not need early treatment. The predictors for treatment experience at 13-14 years of age are private-school attendance, a high family income and need for early treatment.
Adolescent↗
Risk factors for Chlamydia trachomatis infection in 6810 young women attending family planning clinics.
Screening programmes are important for the control of Chlamydia trachomatis (Ct) infection, a disease spread mainly by asymptomatic carriers. Risk factors for Ct infection were assessed in 6810 consecutive asymptomatic young women seeking contraceptive advice. All women filled in a questionnaire and were offered Ct testing. Of the 5785 who consented to testing, 425 (7.3%) were Ct culture positive. Four variables were significantly related to increased risk of being infected: age 18-23 years, duration of present relationship less than 1 year, non-use of condoms, and a history of not having had a previous genital infection. It is not possible to devise screening criteria that would effectively identify women at high risk. Therefore a screening programme should be targeted at all sexually active young people. However, if after some years the programme succeeds in lowering general Ct prevalence, these factors may be important when selecting patients for Ct testing.
Adolescent↗
Utilization of public and private dental services in Sibu, Sarawak: a sociodemographic appraisal and types of treatment received.
This study investigated the sociodemographic profiles of patients attending public and private dental clinics and the types of treatment received. Patients (n=454) were interviewed using a structured questionnaire at two public and four private clinics in Sibu District, Sarawak. Generally, Chinese (74.7%), females (60.0%) and urban dwellers (83.7%) were more likely to visit the dentist. Both clinics had more females and more Chinese but private clinics had a lower percentage of female attendees (53.1% versus 67.0%) but a higher percentage of Chinese (85.0% versus 64.5%). Private attendees were younger (mean age of 31.0 years compared to 41.0 years) and from higher income households (median value of MR 2,000 versus MR 900) than public attendees. Treatments were mostly curative and a third of the visits were associated with painful conditions. Age (p=0.006), gender (p=0.003), ethnicity (p<0.001) and household income (p<0.001) were associated with the type of clinic visited. Choice of clinic was not related to having painful conditions (p=0.970). To ensure a more affordable and equitable distribution of oral healthcare, health planners need to identify disparities in the utilization of services and differences between public and private attendees.
Adolescent↗
[An approach to indirect costs of disability in Colombia].
OBJECTIVES: This document studies the relationships between economic policy and disability, representing an attempt at providing a theoretical analysis for economic policy of disability in Colombia. METHODS: The absolute figures and percentages of distribution of disability in the Colombian population from 1981 to 2003, obtained from 3 official sources, were used. The following variables were selected: age, education, employment, socio-economic level, income and dependence. Several hypotheses were formulated and contrasted with frequency analysis and the Chi-square test to estimate differences between groups. RESULTS: The analysis demonstrated that vulnerability to disability is different according to: 1. Sex, with a greater impact on males; 2. Age: greater impact for older age groups and, in the last 3 years, greatest impact in the 25 to 55 year age group under potential risk of disability; 3: Region: greater vulnerability in rural areas and 4. Socio-economic level: persons with disabling conditions belong to the lower socio-economic strata. The typical profile of persons with disabling conditions is poor education, income of less than a minimum monthly wage, unemployed, belonging to the 1 or 2 socio-economic strata, forming part of homes defined as poor, being male and living in rural areas. CONCLUSIONS: Poverty seems to enhance disability increasing vulnerability, risk and restricting opportunities for welfare. These results can be used as arguments for redirecting the policies and actions for greater access of disabled persons to social and economic opportunities.
Adolescent↗
Liver-associated large granular lymphocytes: morphological and functional aspects.
Large granular lymphocytes (LGLs) differ from other lymphocytes in their recirculation pattern and are distributed preferentially in nonlymphoid organs such as the liver and lung. The liver-associated LGLs adhere strongly to the sinusoidal endothelium and show a natural killer (NK) cytotoxicity against incoming metastatic tumor cells; this reaction occurs very rapidly because, in contrast to the immune response, it does not require complex processes in the lymphoid tissue. They have been extensively studied morphologically in terms of pit cells. LGLs have two characteristic cell organelles which participate in the NK cytolysis, i. e., dense granules and rod-cored vesicles. The former are lysosomes derived from multivesicular bodies and contain pore-forming proteins. The latter are the secretory vesicles exclusively seen in LGLs and are markedly increased in number when the NK function is augmented by biological response modifiers. These two structures are believed to be exocytosed in the space between LGL and the conjugated tumor cell. The microenvironment of the liver sinusoids, which includes Kupffer cells, endothelial cells and other lymphocytes, is considered to regulate the function of the liver-associated LGLs. Liver-associated LGLs, as well as Kupffer cells, are intrinsically involved in the defense system of the liver under various physiological and pathological conditions.
Animals↗