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PubMed1999

Repeatable battery for the assessment of neuropsychological status as a screening test in schizophrenia I: sensitivity, reliability, and validity.

OBJECTIVE: Cognitive impairment is an important feature of schizophrenia and is correlated with functional outcome. However, psychiatry lacks a screening instrument that can reliably assess the types of cognitive impairment often seen in schizophrenia. The authors assessed the sensitivity, convergent validity, and reliability of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) as well as the relationship of the RBANS to symptoms and employment status. This newly published test takes 25 minutes to administer and was standardized on a U.S.-Census-matched adult population. The test provides a total score and five index scores, each with a mean value of 100 (SD = 15). METHOD: RBANS data were obtained from 129 patients with schizophrenia in the outpatient and inpatient programs of the Maryland Psychiatric Research Center. RBANS data were correlated with WAIS-III and Wechsler Memory Scale, 3rd ed. performance in 38 patients. Reliability data for alternate forms of the RBANS were obtained from 53 patients; symptom ratings were obtained from 48 patients; and employment status was examined in 77 patients. RESULTS: The patients with schizophrenia demonstrated marked impairment on the RBANS (their mean total score was 71.4). The patients' index scores suggested that they had relatively less impairment of language and visual functions than of memory and attention. The RBANS demonstrated high correlations with full-scale IQ and memory measures. The total score demonstrated good reliability. RBANS performance minimally correlated with Brief Psychiatric Rating Scale ratings but was strongly related to employment outcome. CONCLUSIONS: The RBANS appears to be a useful cognitive screening instrument in schizophrenia. The instrument may be a useful prognostic indicator and offers a means of assessing cognitive status.

Adult↗
PubMed2000

Clarifying the relationship between unexplained chronic fatigue and psychiatric morbidity: results from a community survey in Great Britain.

OBJECTIVE: The study examined the associations between several sociodemographic and psychosocial variables and unexplained chronic fatigue in the community before and after adjustment for psychiatric morbidity and determined the prevalence of fatigue and rate of disability resulting from fatigue in the general population. METHOD: The study is a secondary analysis of 1993 data from a household survey of psychiatric morbidity conducted by the Office for Population Censuses and Surveys in Great Britain. The survey included 12,730 subjects age 16-64 years. Unexplained chronic fatigue was used as the dependent variable in a logistic regression analysis, with various sociodemographic and psychosocial variables and psychiatric morbidity as the independent variables. Psychiatric morbidity was assessed by using the Revised Clinical Interview Schedule. Fatigue was measured by using the fatigue section of the Revised Clinical Interview Schedule. RESULTS: A total of 10,108 subjects agreed to cooperate (79.4% participation rate). The prevalence of unexplained chronic fatigue was 9%. Subjects with psychiatric morbidity had higher rates of fatigue. Adjustment for psychiatric morbidity had a minor effect on the associations between sociodemographic factors and chronic fatigue. After adjustment, older subjects, women, and couples with children had higher rates of fatigue. Single subjects, widowed subjects, adults living with parents, and economically inactive subjects had lower rates of fatigue. Fatigue was associated with considerable disability, but most of this disability was explained by the association between fatigue and psychiatric morbidity. CONCLUSIONS: Unexplained chronic fatigue is a common condition, strongly associated with psychiatric morbidity. The close relationship between fatigue and psychiatric morbidity should not obscure the possibility of differences as well as similarities in their etiologies.

Activities of Daily Living↗
PubMed2006

Socioeconomic differentials in premature mortality in Rome: changes from 1990 to 2001.

BACKGROUND: While socioeconomic inequalities in mortality have widened in many countries, evidence of social differentials is scarce in Southern Europe. We studied temporal changes in premature mortality across socioeconomic groups in Rome between 1990 and 2001. METHODS: We analysed all 126,511 death certificates of residents of Rome aged 0-74 years registered between 1990-2001. A 4-level census block index based on the 1991 census was used as an indicator of socioeconomic position (SEP). Using routine mortality data, standardised mortality rates (per 100,000 inhabitants) were calculated by SEP and gender for four time periods. Rate ratios were used to compare mortality by gender and age. RESULTS: Overall premature mortality decreased in both genders and in all socioeconomic groups; the change was greater in the highest socio-economic group. In both men and women, inequalities in mortality strengthened during the 1990s and appeared to stabilise at the end of the 20th century. However, for 60-74 year old women the gap continued to widen. CONCLUSION: Socioeconomic inequalities in health in Rome are still present at the beginning of the 21st century. Strategies to monitor the impact of SEP on mortality over time in different populations should be implemented to direct health policies.

Adolescent↗
PubMed2006

Early home-based recognition of anaemia via general danger signs, in young children, in a malaria endemic community in north-east Tanzania.

BACKGROUND: Ethnographic studies from East Africa suggest that cerebral malaria and anaemia are not classified in local knowledge as malaria complications, but as illnesses in their own right. Cerebral malaria 'degedege' has been most researched, in spite of anaemia being a much more frequent complication in infants, and not much is known on how this is interpreted by caretakers. Anaemia is difficult to recognize clinically, even by health workers. METHODS: Ethnographic longitudinal cohort field study for 14 months, with monthly home-visits in families of 63 newborn babies, identified by community census, followed throughout April - November 2003 and during follow-up in April-May 2004. Interviews with care-takers (mostly mothers) and observational studies of infants and social environment were combined with three haemoglobin (Hb) screenings, supplemented with reports from mothers after health facility use. RESULTS: General danger signs, reported by mothers, e.g. infant unable to breast-feed or sit, too weak to be carried on back - besides of more alarming signs such as sleeping all time, loosing consciousness or convulsing - were well associated with actual or evolving moderate to severe anaemia (Hb </= 5-8 g/dl). By integrating the local descriptions of danger symptoms and signs, and comparing with actual or evolving low Hb, an algorithm to detect anaemia was developed, with significant sensitivity and specificity. For most danger signs, mothers twice as often took young children to traditional healers for herbal treatment, rather than having their children admitted to hospital. As expected, pallor was more rarely recognized by mothers, or primary reason for treatment seeking. CONCLUSION: Mothers do recognize and respond to symptoms and danger signs related to development of anaemia, the most frequent complication of malaria in young children in malaria endemic areas. Mothers' observations and actions should be reconsidered and integrated in management of childhood illness programmes.

Algorithms↗
PubMed2006

An ecometric analysis of neighbourhood cohesion.

BACKGROUND: It is widely believed that the social environment has an important influence on health, but there is less certainty about how to measure specific factors within the social environment that could link the neighbourhood of residence to a health outcome. The objectives of the study were to examine the underlying constructs captured by an adapted version of Buckner's neighbourhood cohesion scale, and to assess the reliability of the scale at the small-area-level by combining ecometric methodology with ordinal modelling of a five-point scale. METHODS: Data were analysed from 11,078 participants in the Caerphilly Health and Social Needs Study, who were sampled from within 325 UK census enumeration districts in Caerphilly county borough, Wales, UK. The responses of interest came from 15 question items designed to capture different facets of neighbourhood cohesion. Factor analysis was used to identify constructs underlying the neighbourhood cohesion item responses. Using a multilevel ecometric model, the variability present in these ordinal responses was decomposed into contextual, compositional, item-level and residual components. RESULTS: Two constructs labelled neighbourhood belonging and social cohesion were identified, and variability in both constructs was modelled at each level of the multilevel structure. The intra-neighbourhood correlations were 6.4% and 1.0% for the neighbourhood belonging and social cohesion subscales, respectively. Given the large sample size, contextual neighbourhood cohesion scores can be estimated reliably. The wide variation in the observed frequency of occurence of the scale item activities suggests that the two subscales have desirable ecometric properties. Further, the majority of between-neighbourhood variation is not explained by the socio-demographic characteristics of the individual respondents. CONCLUSION: Assessment of the properties of the adapted neighbourhood cohesion scale using factor analysis and ecometric analysis extended to an ordinal scale has shown that the items allow fine discrimination between individuals. However, large sample sizes are needed in order to accurately estimate contextual neighbourhood cohesion. The scale is therefore appropriate for use in the measurement of neighbourhood cohesion at small-area-level in future studies of neighbourhoods and health.

Journal Article↗
PubMed2006

[Descriptive epidemiologic studies on geographical clusterings of pancreatic cancer mortality and incidence--an analysis in Niigata, Japan].

OBJECTIVES: The objectives of this study were to determine the mortality for pancreatic cancer in the 47 prefectures of Japan and to reveal the geographical distribution of the mortality and incidence for pancreatic cancer in Niigata. METHODS: Standardized mortality ratio (SMR) for pancreatic cancer in the 47 prefectures from 1998 to 2002 was calculated on the basis of the census and vital statistics of Japan. The same SMR in the 36 cities and counties in Niigata from 1995 to 2002 was calculated. These SMRs were compared with that of the national population. Then, standardized incidence ratio (SIR) for pancreatic cancer in the 36 cities and counties in Niigata from 1995 to 2002 was calculated on the basis of the Niigata Cancer Registry, compared with that of the general population of Niigata. RESULTS: The SMRs for pancreatic cancer for both sexes in Hokkaido, Aomori, Akita, Miyagi and Shimane were significantly higher than that of the national population (p<0.05). The SMR for males in Niigata was significantly high, whereas that for females was near the SMR of the national population. Among the 36 cities and counties in Niigata, significantly high SMRs for both sexes were observed only in Higashikanbara county; the SMRs [95% confidence interval (CI)] were 158.4 (104.4-230.5) and 172.2 (114.4-248.9) for males and females, respectively. CONCLUSIONS: Significantly high SMRs for pancreatic cancer were observed in Hokkaido and most of the Tohoku region. A geographical clustering of pancreatic cancer in Higashikanbara county was found. Further studies are needed to clarify the determinants of the clustering.

Cluster Analysis↗
PubMed2003

Assessment of cardiovascular risk factors in a rural community in the Brazilian state of Bahia.

OBJECTIVE: To assess the frequency of cardiovascular risk factors in the rural community of Cavunge, in the Brazilian state of Bahia. METHODS: A cross-sectional study was carried out with 160 individuals (age>19 years) randomly drawn from those listed in the population census of the Cavunge Project. The following parameters were studied: arterial hypertension, dyslipidemia, diabetes, obesity, smoking, waist-hip ratio (WHR), physical activity, and overall cardiovascular risk classified according to the Framingham score. The assessing parameters used were those established by the III Brazilian Consensus on Hypertension and the II Brazilian Consensus on Dyslipidemia. RESULTS: Of the randomly drawn individuals, 126 with a mean age of 46.6 +/- 19.7 years were included in the study, 43.7% of whom were males. The frequency of arterial hypertension was 36.5%; 20.4% of the individuals had cholesterol levels > or =240 mg/dL; 31.1% of the individuals had LDL-C levels >130 mg/dL; 4% were diabetic; and 39.7% had a high-risk Framingham score. Abdominal obesity was observed in 41.3% of the population and in 57.7% of the females. High caloric-expenditure (HCE) physical activities were performed by 56.5% of the individuals. The HCE group had a greater frequency of normal triglyceride levels (63% vs 44%; P=0.05), no diabetes, and WHR tending towards normal (46% vs 27%, P=0.08) as compared with those in the low caloric-expenditure group. CONCLUSION: Cardiovascular risk factors, such as hypertension and hypercholesterolemia, are frequently found in rural communities. The greatest frequency of normal triglyceride levels and normal WHR in the HCE group reinforces the association between greater caloric expenditure and a better risk profile.

Adult↗
PubMed2004

All-cause and cause-specific mortality by socioeconomic status among employed persons in 27 US states, 1984-1997.

OBJECTIVES: We investigated mortality differences according to socioeconomic status (SES) for employed persons in 27 states during 1984-1997. METHODS: SES was determined for persons aged 35-64 years according to the "usual occupation" listed on their death certificates. We used US Census denominator data. RESULTS: For all-cause mortality, rate ratios from lowest to highest SES quartile for men and women were 2.02, 1.69, 1.25, and 1.00 and 1.29, 1.01, 1.07, and 1.00, respectively. Percentage of all deaths attributable to being in the lowest 3 SES quartiles was 27%. Inverse SES gradients were strong for most major causes of death except breast cancer and colorectal cancer. Heart disease mortality for highest and lowest SES quartiles dropped 45% and 25%, respectively, between 1984 and 1997. CONCLUSIONS: Mortality differences by SES were sustained through the 1990s and are increasing for men.

Adult↗
PubMed2006

[Evolution of mortality and current status of an HIV-infected population cared for at a comprehensive HIV/AIDS center in Chile].

BACKGROUND: Chile, a middle-income country with an HIV epidemic of moderate proportions (global infection rate 0.2%) began a government sponsored, free, highly active antiretroviral therapy (HAART) for patients from the public health system in 2001 reaching in 2004 a 100% coverage. Arriaran Foundation (AF) is the largest public AIDS care center for adults in the country. AIM: To show the present status of the AF population and the evolution of mortality. MATERIAL AND METHODS: Review of AF database from 1991-2004 that at 12/31/2004 had a total cumulative population of 2,259 adult patients; an active census of 1,065 patients and admitting rate 160-190 patients per years. RESULTS: The global mortality registered was 33.4%, with decreasing annual mortality from 15.7% of its active population in 1995 to 1.9% in 2004. As of 12/31/2004, 817 patients (76.7%) were receiving antiretroviral therapy (ART); and 19.3% either did not require nor accept it. Thirty one percent received Combivir and nevirapine, with undetectable viral load (<400 copies per ml) in 78%. Thirty percent received Combivir and efavirenz with undetectable viral load in 80% at last count. Both regimens were used mainly as first therapy. Lopinavir/ritonavir was received by 6.3% of patients, mainly for post failure therapy and 58% had undetectable viral load. A baseline CD4 count <200 x mm(3) was present in 70% of patients, 45.3% had a count below 100 and 47.8% had clinical AIDS. At the last follow up assessment, CD4 count was <200 in 36.8%, <100 in 10.6% and 200-350 in 44.9%. CONCLUSION: The expanded access program to ART in a public, comprehensive AIDS care center in Chile has been highly successful in reaching high undetectability (75%), reducing mortality and improving immune status despite very advanced baseline disease.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Identifying the race or ethnicity of SSI recipients.

The Social Security Administration (SSA) has, from its beginnings, recorded the race and ethnicity provided by those who apply for a Social Security card. Although some of these data are eventually used in published tabulations when persons file for benefits, problems with the data prevent a larger selection of published tables. These problems stem from: incomplete internal SSA computer processing; changes in the racial coding schemes over time; and missing codes for younger cohorts of applicants. In spite of these problems, more data can be shared with the public. This article shows how matching administrative files and using statistical techniques make it possible to associate a race/ethnicity code with the great majority of persons receiving a payment under the Supplemental Security Income (SSI) program, a means-tested program for persons who are aged or disabled. The article follows a 1-percent sample of SSI recipients through several steps in an attempt to develop a race code. This approach can provide data for the next several years on the race of all SSI recipients, as well as data on race and ethnicity for recipients under age 40. Beyond the next few years, these techniques will become less useful, and other methods will be needed. SSA is in the process of revising its standards for classification of federal data on race and ethnicity. The census for year 2000 will include coding changes. Other federal agencies will be given as long as January 2003 to comply with the new guidelines.

Adolescent↗
PubMedDate not supplied

Income inequality and health. Coastal communities in British Columbia, Canada.

OBJECTIVE: An imbalance in the distribution of economic resources, i.e., income inequality, is a characteristic of a community that may influence the aggregate health of the population. In North America, income inequality seems to be strongly related to mortality rates among American communities such as states and metropolitan areas but largely irrelevant for health at similar levels of geopolitical aggregation in Canada. This article summarizes relevant international and North American evidence and then explores relationships between income inequality and mortality rates among coastal communities in the province of British Columbia, Canada. METHODS: Cross-sectional analysis was conducted among twenty-four coastal communities in British Columbia, utilizing four measures based on the 1996 Census to measure income inequality and crude, age-standardized and age- and gender-specific mortality rates averaged over the five-year period 1994-98 to measure health. RESULTS: The three valid measures of income inequality were positively and significantly related to the crude mortality rate but were not significantly related to the age-standardized mortality rate. Two of the inequality measures were related to mortality rates for males aged 0-44 and for males aged 45-64 before but not after controlling for mean household income. DISCUSSION: Health researchers have yet to report a meaningful relationship between income inequality and population health within Canada. At the risk of committing the ecological fallacy, these findings provisionally support a psycho-social interpretation of the individual-level relationship between income and health wherein members of these communities compare themselves to an encompassing community, e.g., all Canadians.

Adolescent↗
PubMed2004

Socio-economic status and surgery in children: myringotomies and tonsillectomies in Ontario, Canada, 1996-2000.

AIM: To examine the relation between socio-economic status and (1) receipt of paediatric otolaryngological surgery, and (2) inclusion of adjuvant procedures. METHODS: Using data on myringotomies with insertion of tympanostomy tube and tonsillectomies for all children in Ontario, Canada, from 1996 to 2000, and census data on socio-economic status, we examined the association between socio-economic status and (1) the probability of surgery (myringotomy or tonsillectomy), and (2) the probability that surgery was accompanied by an adjuvant procedure. RESULTS: Lower socio-economic status was associated with increased likelihood that a child's initial surgery was a tonsillectomy rather than a myringotomy (odds ratio per unit increase in the deprivation index = 1.09, p = 0.01, confidence interval 1.06-1.11), and with increased likelihood that those children having a myringotomy would undergo a tonsillectomy during the same hospitalization (odds ratio 1.14, p < 0.0001, confidence interval 1.11-1.16). Children from neighbourhoods with larger immigrant populations were less likely to receive either procedure (odds ratios per 1% increase in the proportion of immigrants = 0.97 (p < 0.0001, confidence interval 0.96-0.97) for myringotomies and 0.97 (p < 0.0001, confidence interval 0.97-0.98) for tonsillectomies). CONCLUSIONS: Socio-economic status was associated with treatment selection for the two most common paediatric surgical procedures. Further research should examine whether differences in treatment arise at the level of the primary care physician, the specialist, and/or are due to parental preference.

Adenoidectomy↗
PubMed1982

Major histologic types of cancers of the gum and mouth, esophagus, larynx, and lung by sex and by income level.

Incidence rates by income level were computed for squamous cell carcinomas of the gum and mouth, larynx, and esophagus and for squamous cell carcinoma, small cell carcinoma, and adenocarcinoma of the lung in white males and females aged 35--64 years, with the use of data for the nine geographic areas of the Third National Cancer Survey and the 1970 U.S. census. Within sex, age, and geographic area groups, patterns of cancer incidence by income level were analyzed by use of a nonparametric statistical method. Higher rates for males than for females were found for every histologic type studied, and the ratio of male-to-female rates increased with age (especially for squamous cell carcinomas of the larynx and lung). A strong inverse relation to income level was found for all of the histologic types studied in males and for squamous cell carcinomas of the gum and mouth and esophagus and small cell carcinoma of the lung in females. These findings are discussed with reference to patterns of smoking and alcohol use by sex and social class.

Adult↗
PubMed1994

Changing asthma mortality and sales of inhaled bronchodilators and anti-asthmatic drugs.

BACKGROUND: Increasing rates of death from asthma in the United States have stabilized somewhat since 1988. Case-control studies have suggested possible adverse effects of inhaled beta-adrenergic agonists that may have contributed to mortality. OBJECTIVE: To examine possible relationships between changing asthma mortality and sales of inhaled antiasthmatic drugs. METHODS: The National Center for Health Statistics supplied numbers and rates of death from asthma (ICD 493) by year. The Bureau of the Census supplied population data. IMS America provided estimates of total hospital and drugstore sales of inhaled beta-adrenergic agonists, cromolyn sodium, and inhaled corticosteroids by year and annual sales of AeroChambers and InspirEase kits. I calculated sales of the antiasthmatic drugs as puffs per person in the general population or doses per person for cromolyn sodium, defining a dose as a 20-mg capsule or vial or 2 mg by metered dose inhaler. RESULTS: Rates of death from asthma in the United States increased from 0.8 per 100,000 general population in 1977 and 1978 to 2.0 in 1989, then decreased to 1.9 in 1990 before increasing again to 2.0 in 1991. Rates of death for blacks 5 through 34 years of age increased from 0.9 in 1980 to 1.3 in 1990 and decreased to 1.2 in 1991. Estimated total hospital and drugstore sales of beta-adrenergic metered dose inhalers increased from 10.3 puffs per person in the general population in 1976 to 31.0 in 1991; those for inhaled corticosteroids, from 0.44 puffs per person in 1976 to 5.44 in 1991. Sales of cromolyn increased from 0.047 doses per person in 1978 to 0.91 in 1991. Sales of AeroChambers and InspirEase kits have also increased. CONCLUSIONS: Since 1988 there has been some moderation in increases in rates of death from asthma while progressive increases in sales of inhaled antiasthmatic drugs have continued. These data are consistent with the likelihood that previous increases in rates of death from asthma were partly due to undertreatment.

Aerosols↗
PubMed1995

Effectiveness of disseminating culturally appropriate smoking-cessation information: Programa Latino Para Dejar de Fumar.

BACKGROUND: The need for a culturally appropriate smoking-cessation intervention for Latinos is based on data on current patterns of tobacco use, possible targeting by the tobacco industry, and the lack of smoking-cessation interventions that are appropriate to the cultural characteristics of Latino smokers. PURPOSE: Our goal was to evaluate the effectiveness of the Programa Latino Para Dejar de Fumar (PLDF) in disseminating smoking-cessation information in San Francisco's Latino community. METHODS: Annual cross-sectional telephone surveys were conducted from 1986 to 1993 of Latino adults, 18-65 years of age, living in census tracts with at least 10% Latinos. Surveys in 1986 and 1987 formed the base line for comparison of PLDF effects. RESULTS: Awareness of a Hispanic smoking-cessation program (odds ratio [OR] = 1.11; 95% confidence interval [CI] = 1.09-1.14), awareness of PLDF specifically (OR = 1.14; 95% CI = 1.10-1.17), awareness of available printed information to help smokers quit (OR = 1.09; 95% CI = 1.06-1.12), and having a copy of the Guía Para Dejar de Fumar (OR = 1.09; 95% CI = 1.05-1.14) were significantly associated with year of survey. In addition, those same variables were significantly associated with a lower acculturation score (respective ORs = 3.95, and 95% CI = 3.57-4.37; OR = 5.40, and 95% CI = 4.86-6.01; OR = 0.63, and 95% CI = 0.58-0.69; and OR = 4.54, and 95% CI = 3.89-5.30). Women were more likely than men to report awareness of a Hispanic smoking-cessation program (OR = 0.88; 95% CI = 0.81-0.96), awareness of PLDF (OR = 0.84; 95% CI = 0.77-0.92), and awareness of available printed information (OR = 0.78; 95% CI = 0.72-0.85). Cigarette-smoking prevalence decreased from 1986 through 1990, stabilized in 1991, and appeared to increase among all groups in 1993. Prevalence of smoking cessation remained stable overall, but it showed a steady increase among less acculturated respondents. CONCLUSION: We conclude that a culturally appropriate community intervention to promote nonsmoking can be successful at disseminating information about smoking cessation. Latino community norms about smoking are evolving, leading to decreased social acceptability.

Acculturation↗
PubMed1997

Epidemiology of falls among the elderly community dwellers in Singapore.

AIM: Falling is a serious medical problem for elderly persons. This study was done to look at prevalence and risk factors for falls in community dwelling elderly in Singapore. METHOD: A random sample of 3,000 persons aged 60 years and above was chosen from a database based on the 1990 population census. Letters were sent out to 2,582 subjects who had local and complete addresses. In the letter, they were informed about the purpose of the survey, and invited to participate in a questionnaire and clinical health screening at an appointed date at a polyclinic. Participants were reminded the day before their appointment by telephone, and a new appointment could be given at the subject's convenience. RESULTS: We found a prevalence rate of falls of 17.2%. Two-thirds of these had single falls, while one-third had recurrent falls, defined as having more than one fall within the previous one year. The following factors were found to be significantly associated with increase falling in the elderly: age > or = 75 years (O.R. = 1.82, 95% C.I. 0.95-3.50), female sex (O.R. = 2.5, 95% C.I. 1.40-4.48), Malay race (O.R. = 2.66, 95% C.I. 1.21-5.86), poor vision (O.R. = 1.7, 95% C.I. 0.99-2.90), Barthel's score of less than 20 (O.R. = 1.76, 95% C.I. 0.94-3.28), those taking 2 or more drugs daily (O.R. = 2.1, 95% C.I. 1.22-3.72) and the presence of hypertension (O.R. = 1.78, 95% C.I. 1.06-3.01). Fall rate is also twice as high in women as in men. At the same time, we found that women in the group we studied also tend to exercise less than the men. Fallers also had significantly more mobility and activities of daily living (ADL) disabilities (reflected by a lower Barthel's score) and this is consistent with other results. The only factor that reduced the risk of falling was regular exercise (O.R. = 1.64, 95% C.I. 0.93-2.93). CONCLUSION: In our study, we found differences between the group with single and recurrent falls. In the group with single falls, the fall tend to occur outdoors (O.R. = 2.97, 95% C.I. 1.03-8.60) and during the day (O.R. = 3.47, 95% C.I. 1.20-10.0), tend to be accidental (O.R. = 3.16, 95% C.I. 1.05-9.50) and tend to seek medical attention (O.R. = 3.68, 95% C.I. 1.23-11.0). Overall, 32 persons (46.4%) seek medical treatment after their falls, and of these, 65.6% were women. Risk factors for falls should be screened for all elderly.

Accidental Falls↗
PubMed1998

[Dietary intake in the urban and rural populations of the Cap-Bon].

BACKGROUND: An assessment of nutriment intake (protein, carbohydrates, fat) was collected from a baseline survey of risk factors for cardiovascular diseases from the urban and rural population of the North East of Tunisia (Cap-Bon). METHODS: 692 men and women, 35-50-year-old, were examined. The sample was randomly selected on the basis of the 1984 census from the population of Cap-Bon. A standardized 24-hour recall and a semi-quantitative food frequency questionnaire were used. RESULTS: The amount of food consumed differed between men and women (expressed in absolute value), but no significant difference was shown between men and women when food intake was expressed in relative value (contribution to total energy intake). The living area (urban, rural) appears to be an important factor influencing nutritional intake. CONCLUSION: In the urban population, the increase of protein and fat intake (saturated fat and dietary cholesterol) and the decrease of carbohydrates and fiber intake schematize the trend of dietary habits in Tunisia.

Adult↗
PubMed2005

Changes of multiple metal accumulation (MMA) in New Orleans soil: preliminary evaluation of differences between survey I (1992) and survey II (2000).

Soil metal surveys were conducted in Baltimore, MD (1976-1979), Minnesota (1981-1988) and most recently, New Orleans, LA (1989-present). The unique characteristic of New Orleans is that it has two surveys; Survey I was completed in 1992 and Survey II was completed in 2000. This paper seeks to determine if there is a perceptible change in the amount of metals during less than a decade that separated these surveys. The Survey I collection was 4,026 samples stratified by 283 census tracts. All samples were collected in residential neighborhoods at least one block from a busy street. The Survey II collection was 5,467 samples stratified by 286 census tracts (plus City Park). The Survey II collection included busy streets as a category of samples. For comparison, the busy street category of 1,078 samples was excluded from Survey II for a total of 4,388 samples. The extraction methods of the two surveys used the same protocol for strength of acid (1 M HNO3), shaker-time (2 hours), and room temperature (approximately 22 degrees C). However, Survey II differed in amount of sample used in extraction. For Surveys I and II, 4.0g and 0.4g were used respectively. The same ICP-AES was used to measure 8 metals in both surveys. To evaluate the analytical results of the two methods, reference soi 1 samples (n=36) from the Wageningen Evaluating Programs for Analytical Laboratories, International Soil-analytical Exchange (WEPAL; ISE) were used. The relationship between the 4.0 and 0.4 g results were linear and the Survey I results were adjusted for sample:acid ratio. Further evaluation was done by creating interpolated Multiple Metal Accumulation (MMA) maps based on the median MMA for each census tract. A new map was created by dividing Survey II MMA by Survey I MMA. The ratio indicates increases of soil metals in the inner city and decreases of soil metals in the outlying areas of Metropolitan New Orleans. Comparing fresh parent alluvium from the Mississippi River with urban soil metal quantities demonstrates that the soils of New Orleans have undergone a massive accumulation of metals. The preliminary results provide ideas about methods needed to further evaluate the changes between these surveys.

Cities↗