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PubMedDate not supplied

Childhood migraine in Nigeria. II: Psychosocial aspects.

The Social class of 298 children with migraine, together with the prevalence of psychiatric morbidity among them was studied, as part of a Community-based survey of childhood migraine in Enugu. A significantly greater proportion of the children belonged to the uppermost social classes. Also, a higher incidence of neurotic disorders occurred among the migraineurs than among age and sex-matched controls. Behavioural disorder was not significantly influenced by social class. With regard to intelligence, the migraineurs were not intellectually superior to the controls and none of them was mentally retarded.

Adolescent↗
PubMed1999

Socioeconomic differences in general practice consultation rates in patients aged 65 and over: prospective cohort study.

OBJECTIVE: To examine socioeconomic differences in general practice consultation rates among patients aged 65 years and over. DESIGN: Secondary analysis of data from the fourth national survey of morbidity in general practice. SETTING: 60 general practices in England and Wales. SUBJECTS: 71 984 people aged 65 years and over. MAIN OUTCOME MEASURES: Annual contact rates and home visiting rates with general practitioners and practice nurses. RESULTS: Social class differences in tact rates were greatest in 65-74 year olds, with rates 23% higher in patients from social class V than in class I (4.82 v 3.93 per person). In 75-84 year olds there was no clear association between social class and contact rates, and in people aged >/=85 years contact rates were highest in patients from class I. Home visiting rates were twice as high in patients from class V as in patients from class I (1.38 v 0.66 per person). Contact rates were 17% higher in people living in communal establishments and 8% higher in those living alone than in those living with others but not in a communal establishment. 66% of contacts with patients in communal establishments and 26% of those with patients living alone were in patients' homes compared with 18% with those living in standard accommodation. These differences persisted after adjustment in a generalised linear model. CONCLUSIONS: Elderly people show socioeconomic differences in consultation rates. The extra workload generated by elderly people living alone and in communal establishments suggests additional payments to general practitioners are needed.

Aged↗
PubMed2004

Work environment and somatic hospital admissions in Denmark 1994-1999.

OBJECTIVE: The aim was to elucidate the usefulness of the excess hospitalisation fraction (EHF) approach-as a practical alternative to the calculation of etiological fractions-for prioritising national preventive measures in the total environment. In this study we used the inequality in somatic hospitalisation across industrial sectors as an example. The presented EHFs may provide an estimate of the order of magnitude of the prevention potential, which may also be useful in priority setting in countries comparable to Denmark. METHODS: All economically active adults in Denmark were followed-up for 6 years after hospital discharge, and industrial specific EHFs for 58 industrial sectors were calculated for 11 main diagnostic groups. Assuming 'education and research' to be the industrial sector which is least exposed to occupational hazards, we calculated the EHFs as a practical approximation to the etiologic fraction for all other industries, using hospitalisation rates adjusted for age. In addition, we also controlled for social class since many risk factors may also be related to life style or living conditions. RESULTS: Compared to 'education and research' the EHF in all other industries was (additional control for social class in brackets): Women 11% (7%), men 15% (8%). The EHFs for some of the main diagnostic groups were as follows: Circulatory diseases: Women 18% (12%), men 16% (10%). Neoplasms: Women 3% (4%), men 8% (6%). Musculoskeletal diseases: Women 19% (12%), men 21% (10%). Diseases in the respiratory system: Women 12% (8%), men 16% (9%). Diseases in the nervous system: Women 12% (7%), men 17% (12%). Violent events (injuries and trauma): Women 6% (5%), men 17% (6%). CONCLUSIONS: The advantage of this method is that the EHF can be calculated for all diseases and for the whole population without detailed knowledge of causal risk factors and their distribution in the population. Two main methodological problems are that we cannot control for selection bias related to occupation, and that the control for social class may lead to conservative estimates. Our estimates are, however, close to estimates of etiologic fractions published in the literature. Large unexpected EHFs for diseases of the blood and blood-forming organs should be seen as challenges for future research.

Adult↗
PubMed2005

Socio-economic status of the patient and doctor-patient communication: does it make a difference?

This systematic review, in which 12 original research papers and meta-analyses were included, explored whether patients' socio-economic status influences doctor-patient communication. Results show that patients from lower social classes receive less positive socio-emotional utterances and a more directive and less participatory consulting style, characterised by significantly less information giving, less directions and less socio-emotional and partnership building utterances from their doctor. Doctors' communicative style is influenced by the way patients communicate: patients from higher social classes communicate more actively and show more affective expressiveness, eliciting more information from their doctor. Patients from lower social classes are often disadvantaged because of the doctor's misperception of their desire and need for information and their ability to take part in the care process. A more effective communication could be established by both doctors and patients through doctors' awareness of the contextual communicative differences and empowering patients to express concerns and preferences.

Affect↗
PubMed1993

Descriptive epidemiology of primary cancer of the brain, cranial nerves, and cranial meninges in New Zealand, 1948-88.

We used New Zealand data on occurrence of different types of brain cancer to investigate: (i) a possible secular increase which has been seen worldwide and has generated considerable debate; (ii) possibly higher rates among Maori; and (iii) possibly higher risks related to social class and occupation. Data from the NZ Cancer Registry on the 5,684 brain cancers diagnosed among NZ residents from 1948-88 were used to study the pattern of occurrence by gender, age, race, calendar year, social class, occupation, and histology. Age-standardized brain-cancer incidence rates per 100,000 more than doubled over the 41-year period (from 2.9 to 6.9 in males and from 2.1 to 5.1 in females). A strong trend of increasing incidence with increasing social class is seen in males (Ptrend = 0.01). Among Maori, the proportion of all brain cancer that is medulloblastoma is four times that among non-Maori, and the proportion of all brain cancers that lack histologic confirmation is about 40 percent higher. Elevated risks are seen among: dairy farmers (odds ratio [OR] = 3.4, 95 percent confidence interval [CI] = 1.9-6.0); sheep handlers (OR = 2.7, CI = 1.4-5.3); livestock workers (OR = 3.8, CI = 1.7-8.4); and farm managers (OR = 3.2, CI = 1.4-7.2); as well as among electrical engineers (OR = 8.2, CI = 20-34.7); electricians (OR = 4.6, CI = 1.7-12.2); and other electrical workers. Brain cancer rates in NZ have increased steadily since 1948, but this increase has leveled off in the most recent five-year period. Although brain cancer rates are likely to be underestimated among the Maori, an excess of medulloblastoma is evident in this group.

Adolescent↗
PubMed1999

Association between asthma and family size between 1977 and 1994.

STUDY OBJECTIVES: Several recent reports show a negative association between asthma and family size or birth order, but this association was not detected in data collected between 10 and 30 years ago. This study compared the association between sibship size and asthma in three surveys using the same methodology in 1977, 1985/86, and 1993/94. DESIGN: Cross sectional comparison of the 1977, 1985/86, and 1993/94 surveys. SETTINGS: Study areas in England and Scotland. PARTICIPANTS: Parents of children between 5 to 11 years in England and Scotland were asked about asthma and bronchitis attacks in the last 12 months, and wheeze in their child. Approximately 9000 children participated in each of the surveys. RESULTS: The overall association between asthma, defined as asthma attacks or wheeze, and total number of siblings was not significant (p = 0.22), but an only child had a higher prevalence of asthma than children with siblings (OR 0.87 95% CI 0.76 to 0.98). The interaction between year of survey and sibship size on asthma was not significant (p = 0.36). There was no association between asthma and birth order. A significant interaction between social class and year of survey on asthma was detected (p = 0.004). In the 1993/94 survey children whose fathers had a semi or unskilled manual occupation had a higher prevalence of asthma (16%) than children whose fathers belonged to other social classes (13%). CONCLUSIONS: This study provides only marginal support for a change over time of the association between sibship size and asthma. Based on recent reports the nature of the exposure agent that may explain the association remains controversial. This study suggests a disproportionate increase of asthma in lower social classes.

Asthma↗
PubMed1991

[TV and video watching among 11-15-year old children--a sociomedical perspective].

A material of 1,671 schoolchildren replied to a questionnaire about health, time spent watching television, the demographic and social situation, social network, and life satisfaction. These pupils spend two hours daily watching television and one tenth of this time is spent on video programmes. 48% of the children spend 0-10 hours weekly watching television, 35% 11-27 hours, 15% 28-37 hours and 3% more than 37 hours. Boys spend more time watching television than girls, younger pupils more than older and children from lower social classes more than children from higher social classes. The time spent watching television increases with increasing degree of urbanisation. Children who spend many hours watching television have more problems in life satisfaction, health and social network compared with children who spend a few hours watching television.

Adolescent↗
PubMed1997

Dental disease in the Chinese Yin-Shang period with respect to relationships between citizens and slaves.

Seventy-one skulls from the Yin-Shang period tombs of Anyang, China, were examined for the incidence of observable dental diseases, including dental caries, alveolar bone resorption (an index of periodontal disease), ante-mortem tooth loss and tooth attrition. Because the remains were excavated from tombs with funerary items, the burials are believed to be of Anyang citizens. Our study indicates carious tooth frequency in the Yin-Shang period was rather low (2.9-4.0%). Periodontal disease frequency was 18.3-26.9%, and ante-mortem tooth loss frequency was 2.0-7.5%. To determine the relative prevalence of overall dental health in the Yin-Shang populations, observations from the 42 male crania were compared to those from 183 male crania of slaves from "sacrificial pits" from the Yin-Shang period (Inoue et al. [1992] J. Anthropol. Soc. Nippon 100:1-29). Results from this comparison indicate no apparent difference between social classes in younger age groups. However, in the older ages the rates of the ante-mortem tooth loss, periodontal disease and tooth attrition were significantly higher in the citizen sample. The findings would suggest dietary development in the Yin-Shang period was not dissimilar enough between social classes to induce clear differences in dental diseases at least at younger ages. Conversely, it appears there must have been significant differences between social classes diets in the earlier phase of the Yin-Shang period to produce the differences in dental disease present in the older samples.

Age Factors↗
PubMed1984

An evaluation of two antenatal information booklets.

The readability of two antenatal education books which are widely distributed to expectant mothers was assessed. There were some significant differences, and it was anticipated that this would be reflected in the levels of information imparted to the mothers, particularly when they were analysed by social class. In practice the differences were small, and the only one of significance was that the book which was believed to be more readable and more attractive in format resulted in higher knowledge scores in social classes I and II, but not in social classes III to V. Possible explanations for this are discussed. Clear benefit in terms of knowledge was demonstrated when mothers received a book in advance of their attendance at the antenatal booking clinic. They arrived better prepared and better informed, with knowledge to help the healthy development of the foetus at an early stage in pregnancy. The additional postage costs in sending out booklets is considered justifiable.

Evaluation Studies as Topic↗
PubMed2001

Social differentials in the decline of child mortality in nineteenth century Stockholm.

BACKGROUND: Mortality had declined dramatically by the end of the nineteenth century and the early twentieth century. Little is known about the development of social differentials in infant and child mortality in Stockholm at the turn of the century. This study investigates social differentials in child mortality during the years 1885, 1891 and 1910 in one parish in Stockholm. METHODS: Individual entries from computerised records originally collected for civil registration purposes in Stockholm for 1878-1925 (the Roteman Archives) were analysed with respect to social class of the head of household and marital status of the mother for 36,718 children aged 0-14 years. Age- and cause-specific mortality rates were calculated for each year of study. Cox' regression analysis was used to analyse the mortality risk (relative rates (RRs) of mortality) by socioeconomic group and by marital status of the mother. RESULTS: Child mortality rates were nearly halved between 1885 and 1910. Socioeconomic differentials in mortality between the four social classes emerged from 1891 as the overall mortality declined. The decline was sharpest in the upper and middle social classes. Children born out of wedlock had higher mortality rates than children of married mothers in all 3 years studied. CONCLUSION: The social differentials in child mortality risk were substantial and the gradient emerged sharper from 1891 to 1910. The results are in line with studies from England and Wales, Germany and the USA for the same time period. The differentials mostly increased because of a greater decline in mortality among higher socioeconomic groups.

Child, Preschool↗
PubMed1996

Income, social stratification, class, and private health insurance: a study of the Baltimore metropolitan area.

Most studies of inequalities and access to health care have used income as the sole indicator of social stratification. Despite the significance of social theory in health insurance research, there are no empirical studies comparing the ability of different models of social stratification to predict health insurance coverage. The aim of this study is to provide a comparative analysis using a variety of theory-driven indicators of social stratification and assess the relative strength of the association between these indicators and private health insurance. Data were collected in a 1993 telephone interview of a random digit dialing sample of the white population in the Baltimore Metropolitan Statistical Area. Indicators of social stratification included employment status, full-time work, education, occupation, industry, household income, firm size, and three types of assets: ownership, organizational, and skill/credential. The association between social stratification and private health insurance was strongest for those having higher household incomes, having attained at least a bachelor's degree, and working in a firm with more than 50 employees, followed by being an owner or manager, and by being employed. The addition of education and firm size improved the prediction of the household income model. The authors conclude that studies of inequalities in health insurance coverage can benefit from the inclusion of theory-driven indicators of social stratification such as human capital, labor market segmentation, and control over productive assets.

Adult↗
PubMed2003

Health selection: the role of inter- and intra-generational mobility on social inequalities in health.

This paper investigates the effect of health selection and its contribution to the social class gradient in health. Both inter- and intra-generational mobility were examined. Longitudinal data on health and social class at three life stages (16, 23, 33 years) are from the 1958 British birth cohort. Individuals with poor health were more likely to move down and less likely to move up the social scale, especially at the inter-generational transition. The effect of health selection on the social gradient was variable, of modest size and cannot be regarded as a major explanation for inequalities in health in early adulthood.

Adolescent↗
PubMed1981

Caries in primary dentition related to age, sex, social status, and county of residence in Finland.

The study material consisted of 1417 children 6-8 years old representing 86% of a stratified random sample from the Finnish population. Data on caries and social class were obtained by questionnaire from the municipal dental clinics in 1978. Clinical findings for primary teeth were recorded by local dentists. Incisors were excluded from the study. 80% of the children had caries lesions, and 63% were in need of restorative care. Mean dmft value was 4.4 mean dt, ft, and mt values were 2.3, 2.6 and 0.3, respectively. Occurrence of untreated caries lesions did not vary according to age. Compared to the girls, boys had lost twice as many teeth due to caries. No other differences were observed between sexes. Both past caries experience and need of restorative care increased continuously from the highest social class to the lowest. Observed regional differences were explained mainly by variation in social stratification, except in an area with abundant natural fluoride. More active dental care is needed for children with primary teeth, especially in lower social class.

Age Factors↗
PubMed1997

[Consumption of psychoactive substances by school-age adolescents of Ribeirão Preto, SP (Brazil). II--Distribution of consumption by social levels].

INTRODUCTION: Many of the epidemiological studies on the consumption of legal and illegal psychoactive substances have included the evaluation of the influence of social context on the levels of prevalence of this consumption using indirect social indicators such as family income, and educational and housing levels in an attempt to identify individuals or groups in different social contexts. The present study investigates the distribution of consumption of psychoactive substances according to social class in a sample of teenage pupils in Ribeirão Preto, SP, Southeastern Brazil. MATERIAL AND METHOD: A self-applicable questionnaire duly adapted and submitted to a reliability test was applied to a proportional sample of 1,025 teenagers enrolled in the 8th, 9th, 10th and 12th grades in public and private city schools. The questionnaires contained questions about the use of ten classes of psychoactive substances, demographic questions and validation information, as well as questions about the perception and intrinsic behavior related to drug consumption. The adaptation of a model that identifies 5 social class strata (business middle class, managerial middle class, lower middle class, proletariat and subproletariat) on the basis of indicators that situate the individuals within the social relations of production, was used. RESULTS: The 3 middle class strata were more often represented, whereas the proletariat and subproletariat were less frequently represented in this teenage pupil population than in the population in general. There was no difference in alcohol or tobacco consumption according to social class, although prevalence tended to be higher at the two extremes of the social ladder. In contrast, the consumption of illegal substances was higher in the middle class and lower in the proletariat. CONCLUSION: Although the consumption of legal substances did not differ among social classes, the higher consumption of illegal substances by the wealthier teenagers was probably due to the higher cost of these products as compared those of alcohol and tobacco.

Adolescent↗
PubMedDate not supplied

Inequalities in women's health in England and Wales: mortality among married women according to social circumstances, employment characteristics and life-cycle stage.

"Data obtained from follow-up of the Office of Population Censuses and Surveys Longitudinal Study 1971 Census sample have been used to look at women's mortality differentials at ages 15-59 in England and Wales....In this paper we focus on married women and use age of youngest child as a measure of life-cycle stage. We relate this to whether the woman was a housewife, or was in full or part-time paid employment, so as to examine how these affect differences in mortality by social class. We find that socio-economic mortality differences persist irrespective of life-cycle stage.... Housewives married to men in manual occupations experienced death rates over one and a half times as high as those married to men in non-manual occupations. For women in employment the differences by husbands' social class are of a lesser magnitude.... Differences in the mortality of those in full and part-time work depend on the woman's own social class and are greater for non-manual than manual classes." (SUMMARY IN FRE AND ITA)

Demography↗
PubMed2005

Cause-specific hospital admission and mortality among working men: association with socioeconomic circumstances in childhood and adult life, and the mediating role of daily stress.

BACKGROUND: The aim of this study was to investigate the association of childhood and adulthood social class with the occurrence of specific diseases, including those not associated with a high mortality rate, and to investigate daily stress as the mechanism for that part of any association which cannot be accounted for by established risk factors. METHODS: This was a prospective cohort study with 25 years of follow-up for cause-specific morbidity and mortality. A total of 5577 Scottish men were recruited from 27 workplaces in the West of Scotland. Childhood social class was determined from the occupation held by the individual's father, and adulthood social class from the individual's occupation at enrolment. Daily stress was measured at enrolment using the Reeder Stress Inventory. RESULTS: Health differentials were found for cardiovascular diseases, lung cancer, peptic ulcer, asthma, accidents and violence, alcohol-related diseases, and perhaps psychiatric illness. Adulthood circumstances were associated with the incidence of most diseases in adulthood, the exception being stroke, which was strongly associated with less privileged circumstances in childhood. Both childhood and adulthood circumstances contributed to the incidence of coronary heart disease. Daily stress did not underlie any of these associations once the influence of established risk factors had been taken into account. CONCLUSIONS: Socioeconomic circumstances in childhood and adulthood both contribute to health differentials in adulthood, the relative contributions depending upon the particular disease. Where known risk factors explained only part of the excess of a disease among individuals raised or living in less-privileged circumstances, there was no evidence to suggest that daily stress was the reason for the unexplained excess.

Activities of Daily Living↗
PubMed2003

Socioeconomic effects on breast cancer survival: proportion attributable to stage and morphology.

Breast cancer patients of lower socioeconomic status tend to have poorer survival. Among 10 865 cases of breast cancer from the East Anglian Cancer Registry diagnosed between 1982 and 1993, we estimated the extent to which the differences in survival by socioeconomic status, measured by both occupational and area-based methods, can be explained by differences between socioeconomic groups in stage and morphological type of tumour. In univariate survival analyses, lower social class (manual occupation) was associated with a relative hazard of 1.32 (95% CI 1.12-1.55) for death from breast cancer as underlying cause. Women resident in the most deprived area had a relative hazard of 1.21 (0.95-1.54) for death from breast cancer as underlying cause. Stage of disease accounted for 28% of the effect of social class on survival but for none of the effect of deprivation category. Morphological type accounted for 3% of the effect of social class and none of the effect of deprivation category. Thus, stage at presentation explains some but not all of the socioeconomic differences in breast cancer survival. Future research on histological grade and socioeconomic status is indicated.

Breast Neoplasms↗
PubMed1989

Mortality from congenital malformations in England and Wales: variations by mother's country of birth.

Stillbirth and infant mortality from congenital malformations in England and Wales during 1981-5 was investigated according to the mother's country of birth. Significant differences remained after standardising for maternal age and social class. The highest overall mortality was in infants of mothers born in Pakistan (standardised mortality ratio 237), followed by infants of mothers born in India (standardised mortality ratio 134), East Africa (standardised mortality ratio 126), and Bangladesh (standardised mortality ratio 118). Caribbean and West African mothers showed an overall deficit. Mortality was inversely related to social class in all groups except the Afro-Caribbean. Infants of mothers born in Pakistan had the highest mortality in every social class except I, and for most anomalies investigated. Their ratios were particularly high for limb and musculoskeletal anomalies (standardised mortality ratio 362), genitourinary anomalies (standardised mortality ratio 268), and central nervous system anomalies (standardised mortality ratio 239). Our findings highlight the need for further research to identify the causes underlying these differences.

Africa↗