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PubMed2002

Touched by homelessness: an examination of hospitality for the down and out.

OBJECTIVES: This study investigated patterns of "doubled-up" homelessness using an indirect measure based on host households. METHODS: In random household telephone surveys conducted in Alabama between 1990 and 2000 and nationally in 1997, respondents indicated whether any individual had stayed with them during the past year because that person was homeless. RESULTS: The percentage of Alabama households providing shelter during the past year declined from 16.2% in 1990 to 7.1% in 2000. The national rate for providing shelter in 1997 was 18.0%. CONCLUSIONS: Many households provide shelter to people to prevent them from being literally homeless. As the economy has expanded, these rates have declined in Alabama.

Adult↗
PubMedDate not supplied

Selected demographic and health characteristics--state variations, 1988-1991.

There is considerable regional variation in the distribution of persons over age 65, living on Social Security, living below the poverty level and with no health insurance. For the most part, such differences are reflected in low per capita income, low health care spending as well as less favorable health outcomes and health system utilization. These differences and disparities underscore the importance of considering a wide range of variables when drawing conclusions about the nation's health care system and when making policy decisions on various social programs.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[Epidemiologic aspects of leprosy in the province of Jaen].

Jaen is the province with the greatest number of patients with lepra. This study analyzes the prevalence of the disease in Jaen during 1984 and 1985. At that time, all the patients known to the health and consume provincial delegation of Jaén were studied. The 305 patients included received a protocol aimed to study the different risk factors (age, clinical form, the people living together, socioeconomic standing, ethnic, etc ...). The disease shows to have a highly significant and special predilection in gypsies and it is located in a significant geographical area in the province. Lepra did not show a rural distribution, however it prevails in middle size urban nuclei. Although all patients belonged to a low social class, the disease did not show to exhibit any association among the ecology and the income per inhabitant.

Adolescent↗
PubMed1994

Pediatric telephone advice: a new medical service in Israel.

Although controversy still exists about dispensing medical advice over the telephone, such services are widely offered by pediatricians in the USA. In Israel, however, such services have not yet been developed. In a joint project of the Moked Keshev (a private medical help line) at Magen David Adom (national ambulance service) and the Children's Medical Center of Israel, the first pediatric telephone advice service in Israel was established. In this study we analyzed 512 consecutive incoming calls received during the first 11 months of service operation. Of these, 42% of calls concerned children in the 1 month to 1 year age group. Unexpectedly, calls were almost evenly distributed throughout the week with a slight decrease on Fridays and Saturdays (sabbath), and 45.7% of the calls were received during the morning shift. The three most common reasons for contact were: of a general nature such as fever (23%), gastrointestinal problems (19%), and medical questions (18%). In only 20.7% of the cases were the patients advised to go to the nearest hospital emergency department, emphasizing the non-emergent nature of the calls. At the time of follow-up (within 24 h), patient status was assessed as: improved (73.7%), same (22.6%), and worse (3.8%). Of those who became worse, none required an emergency department evaluation. The present study demonstrates that a Pediatric Telephone Advice Service in Israel is technically functional, medically safe, and contributes to the health management of children.

Adolescent↗
PubMed1989

Utilization behaviour patterns of Siddha clinics in Salem, Tamil Nadu.

In Tamil Nadu, indigenous Siddha medicine (SM) is officially recognized and extensively used. Yet very little research information or published material is available on the extent of utilization behaviour of Siddha medicine in urban settings. This study examines the current patterns of utilization and consumer behavioural characteristics of SM through a field-based questionnaire survey of a sample of 300 patients attending 15 Siddha clinics in Salem, Tamil Nadu. Four areas were investigated: Socio-economic characteristics of the users; utilization behaviour pattern of patients; reasons for choice of Siddha therapy; opinions, attitudes, perception and satisfaction of users regarding Siddha therapy. The survey points out there is an inverse relationship between the number of patients using SM and income, education and distance travelled. Various factors were cited in choosing SM-such as, effectiveness of treatment, social influences of a relative or friend. Survey indicates that both modern medicine and SM seem to act as supporting rather than as competitive systems in a setting like Salem. People tend to seek both the system in search of a permanent cure.

Adolescent↗
PubMed1986

Anthropometric comparisons among low-income Mexican-American children aged 10 through 14.

Triceps and subscapular skinfold measurements in 795 Mexican-American children, 10 through 14 years of age, were compared with corresponding data from the National Center for Health Statistics (NCHS). The sign test of significant differences in distributions was used to test for differences between NCHS triceps and subscapular reference standards and those derived from the study sample. Among the boys, analysis of the data revealed statistically significant differences (p less than .01) in both measurements for all age levels. For the girls, significant differences (p less than .01) also existed in triceps measurements among the 10-year-olds and subscapular measurements at all age levels. The results indicated a high degree of body fatness among the population group studied.

Adolescent↗
PubMed1998

Prostate-specific antigen levels are higher in African-American than in white patients in a multicenter registration study: results of RTOG 94-12.

PURPOSE: To compare serum prostate-specific antigen (PSA) levels in a national sample of African-American and white men with prostate cancer, and to attempt to explain any differences by using self-reported individual-level socioeconomic status adjustments. METHODS AND MATERIALS: During 4 1/2 months in 1994-95, 709 patients with nonmetastatic prostate cancer were enrolled in this prospective study; 17.5% were African-American and 82.5% were white. Information about clinical stage, tumor grade, pretreatment PSA, type of insurance, and educational and income status was obtained. Serum PSA levels were measured and racial differences were found; how the differences were influenced by other patient- or tumor-related factors and if the differences could be explained by socioeconomic status disparities were determined. In univariate analyses, factors associated with the mean PSA levels were studied; log-converted values were used to yield a normal distribution. Multivariate analyses were done on log-linear models for description of association patterns among various categorical variables; a perfectly fitted model should have a correlation value (CV) of 1.0. RESULTS: The mean PSA level was higher in African-Americans (14.68 ng/ml) than in whites (9.82 ng/ml) (p = 0.001). Clinical stage (p = 0.001), Gleason sum tumor grade (p = 0.0001), educational level (p = 0.001), and household income (p = 0.03) were also associated with mean PSA levels; age, type of biopsy, and insurance status were not. Disease stage (p = 0.0001), grade (p = 0.0001), education (p = 0.07), and income (p = 0.02) were all associated with PSA levels for whites, but none of these factors were important for African-Americans (all p values > 0.1). The best fitted log-linear model (CV = 0.99) contained PSA (< 10, 10-20, and > 20), Gleason sum grade (2-5, 6-7, and 8-10), race, and two interactions: PSA by race (p = 0.0012) and PSA by Gleason sum (p = 0.0001). Models replacing race for either income (CV = 0.82) or education (CV = 0.82) or both (CV = 0.78) did not fit as well. CONCLUSIONS: African-Americans with nonmetastatic prostate cancer have higher serum PSA levels at diagnosis than whites, implying a higher tumor cell burden. Individual-level household income, education, or insurance status alone or in combination account for racial differences, but only partially.

Analysis of Variance↗
PubMed2004

Self-referred whole-body imaging: where are we now?

PURPOSE: To identify current patterns and trends of computed tomographic (CT) screening, including geographic data, services provided, facility type, and demographic characteristics. MATERIALS AND METHODS: In March 2003, self-referred body imaging (SRBI) centers were identified by using the Internet. Data involving geographic location, type of facility, services provided, and demographic characteristics were collected. The 2000 U.S. census data were used to compare center locality demographics with national patterns. Descriptive statistics, t tests, and regression analyses were used to evaluate data. Nonstatistical comparisons were made with results obtained from a previously published analysis. RESULTS: The number of SRBI centers totaled 161 (vs 88 in a comparative study in 2001), and centers were distributed across 31 states and Washington, DC (vs 21 in 2001). Racial demographics of center localities more closely resembled national averages in the current study, with equal percentages of whites (76.0% vs 77.1% nationally) and Hispanics (11.5% vs 12.5% nationally). Center localities continued to exhibit greater wealth and levels of education, as reflected by higher income per capita and median household income (P < .05), as well as by higher percentages of people with college and advanced degrees (P < .05). Heart scanning was the most commonly offered service (n = 152, 94%), followed by whole-body scanning (n = 135, 84%), lung scanning (n = 126, 78%), and virtual colonoscopy (n = 88, 55%). Centers in the West were more likely to offer whole-body and organ-specific scanning, compared with centers in other regions (P < .001 for virtual colonoscopy, P < .05 for head scanning). Hospital-based centers were less likely to offer services other than heart scanning (P < .001). CONCLUSION: Compared with results of a prior analysis, SRBI centers have increased and are distributed more widely in areas with a population that more closely resembles national norms. The increased trend to broaden services may suggest possible saturation of the preexisting market.

Colonography, Computed Tomographic↗
PubMed2006

How hospitalists spend their time: insights on efficiency and safety.

BACKGROUND: Despite the dramatic growth of hospitalists, no studies have evaluated the type and frequency of activities that hospitalists perform. To evaluate the types and frequency of activities that hospitalists perform during routine work, we conducted a time-motion study of hospitalist physicians at our institution. DESIGN: A research assistant shadowed hospitalist physicians for 3- to 5-hour periods. Observation periods were distributed in order to sample all parts of a typical day of a hospitalist, including both admitting and nonadmitting periods. Activities were recorded on a standardized data collection form in 1-minute intervals. Incoming pages were recorded as well. RESULTS: Ten hospitalists were shadowed by a single research assistant for a total of 4467 minutes. Hospitalists spent 18% of their time on direct patient care, 69% on indirect patient care, 4% on personal activities, and 3% each on professional development, education, and travel. Communication accounted for 24% of the total minutes. Multitasking, performing more than one activity at the same time, was done 21% of the time. Hospitalists received an average of 3.4 +/- 1.5 pages per hour. CONCLUSIONS: Hospitalists spent most of their time on indirect patient care activities and relatively little time on direct patient care. Hospitalists spent a large amount of time on communication, underscoring the need for hospitalists to have outstanding communication skills and systems that support efficient communication. Multitasking and paging interruptions were common. The inherent distraction caused by interruptions and multitasking is a potential contributor to medical error and warrants further study.

Adult↗
PubMed2005

Social inequality in perceived environmental exposures in relation to housing conditions in Germany.

In Germany the impact of socioeconomic factors on environmental exposures and adverse housing conditions has been rarely studied up to now. The aim of our study was to assess whether and, if yes, how perceived exposure to noise and air pollution is influenced by socioeconomic status in Germany. We used data from a large-scale population-based survey. In this survey, data on perceived exposure to noise and air pollution and on socioeconomic status and housing conditions were collected on an individual basis. The study population consisted of 7,275 adults aged 17-98 years (40% women), each representing the head of one household. For the association between perceived environmental exposure and social factors confounder-adjusted odds ratios (OR) with 95% confidence intervals were calculated by binary or ordinal logistic regression. In bivariate analyses subjects with non-German nationality, East Germans, respondents with low income, those with lower educational and occupational status, and subjects living in adverse housing conditions were more likely to report being highly exposed. In multivariate analyses high perceived exposure to noise was associated with low household income (OR 1.52 [95% CI 1.13-2.05] lowest versus highest income group). Perceived air pollution exposure was also related to household income (1.67 [1.14-2.44] lower middle versus highest income group). Further associated variables were need for renovation of the house, type of house, and type of neighborhood. This study shows that in Germany, as in other industrial countries, environmental exposures are distributed unequally and that especially economic differences play important roles.

Adolescent↗
PubMed2002

Spontaneous cessation of smoking and alcohol use among low-income pregnant women.

BACKGROUND: Despite the strong evidence of harmful effects, tobacco and alcohol use during pregnancy continue to be major public health challenges. Some women, however, do stop spontaneously when they learn of their pregnancy. No study has investigated spontaneous cessation of both behaviors in a low-income predominantly unmarried U.S. population. OBJECTIVE: To describe the prevalence of spontaneous cessation of cigarette and alcohol use alone and in combination and associated factors among low-income pregnant women. METHODS: Subjects (N=601) were currently smoking or smoking when they became pregnant and participating in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) programs in the greater Boston, Massachusetts, area. Baseline interviews assessed the factors being studied and the spontaneous cessation of cigarette and alcohol use with pregnancy. Saliva cotinine verified self-reported smoking status. RESULTS: Spontaneous cessation of smoking and alcohol use was reported by 28% and 80% of the women, respectively; 25% spontaneously quit both, and 15% stopped neither. Multivariable analyses indicated that smoking cessation was less likely in women who had previous births, had a husband or partner who smoked, were born in the United States, were black (non-Hispanic, non-Portuguese), had less than a high school education, were highly addicted, reported lower perceived risk to the fetus, and reported "too many other problems in life to stop." Hispanic ethnicity, younger age, and more social support to quit smoking were related to spontaneous alcohol abstinence. CONCLUSIONS: Targeted multiple strategies, including those aimed at increasing participation of partners, are needed for low-income pregnant smokers.

Adult↗
PubMed2003

How compatible are liberty and equality in structuring a health care system?

In their normative role in shaping the basic structure of a health care system, liberty and equality are often thought to conflict so sharply that health policy is condemned to remain an ideological battleground. In this paper, I will articulate my own view of why much of the apparently fundamental conflict between individual liberty and responsibility, on the one hand, and equality and equality's related concern for cost-efficiency, on the other hand, is less intractable than it is usually assumed to be. The result will be to break the rigid and stereotypical association of liberty-emphasizing social philosophies with the pluralistic market paradigm for a health care system and egalitarian, equity-emphasizing social philosophies with the unitary public system paradigm. Understanding better the moral ingredients of liberty and equitable distribution as well as the complexity of how liberty and equality actually intersect in a health care system opens the door to seeing the possibility of significant reconciliation. I will conclude, among other things, that even semi-libertarian views of distributive justice should strongly embrace compulsory, universal coverage of health care for some significant level of care, and that egalitarian views ought not to regard different levels of coverage for people of different income levels as necessarily unjust.

Cost-Benefit Analysis↗
PubMed2003

Risk factors for low back pain among office workers in Ibadan, Southwest Nigeria.

BACKGROUND: Low back pain is the most common musculo-skeletal problem in the workplace. Data from low-income countries are scant. OBJECTIVES: To determine the prevalence and risk factors for low back pain among office workers in Ibadan, Nigeria. METHODS: A cross-sectional study design was utilized. Questionnaires were distributed among office workers in the civil service in Ibadan, Nigeria. RESULTS: Eight hundred and forty questionnaires were analysed, with a response rate of 66%. The 12 month prevalence of low back pain was 38% and the point prevalence was 20%. Low back pain was significantly associated with senior staff grade and smoking. Severity of low back pain was associated with sitting for >3 h. Only 16 respondents (5%) reported sickness absence due to back pain in the previous year. A total of 75 days were lost, a mean of 4.7 days per year. CONCLUSIONS: The occurrence of low back pain in this study is comparable with that reported in studies from more industrialized countries, but does not constitute a major cause of sickness absence in this group of workers.

Adult↗
PubMed2004

[Profile of members and non members of mutual health insurance system in Rwanda: the case of the health district of Kabutare].

The establishment of mutual health insurance systems is one of the priorities of the Rwandan government. Pilot studies have been conducted in three districts of the country. Nonetheless, after 4 years of implementation (1999-2003), the population coverage by these insurance systems remains relatively low. A cross-sectional study of 1042 households in the Kabutare health district allowed for a comparison of socio-economic and demographic variables, and the medical, surgical, gynaecological, and obstetrical history of health insurance scheme members and non-members. The results of the study demonstrate that the distribution of members and non-members is similar in terms of sex, marital status, professional status and medical history. However, larger households (more than five members) and those having a relatively higher income (more than USD 230 per annum) are more likely to be insured than other households. Members of the mutual health insurance use more the health services than non-members, spend less on health care and increasingly maintain membership. The study emphasizes the relevance to further promote mutual health insurance, but also points to the need for mechanisms to ensure financial access for the poor rural population.

Cross-Sectional Studies↗
PubMed2005

The role of NGOs in global health research for development.

BACKGROUND: Global health research is essential for development. A major issue is the inequitable distribution of research efforts and funds directed towards populations suffering the world's greatest health problems. This imbalance is fostering major attempts at redirecting research to the health problems of low and middle income countries. Following the creation of the Coalition for Global Health Research - Canada (CGHRC) in 2001, the Canadian Society for International Health (CSIH) decided to review the role of non-governmental organizations (NGOs) in global health research. This paper highlights some of the prevalent thinking and is intended to encourage new thinking on how NGOs can further this role. APPROACH: This paper was prepared by members of the Research Committee of the CSIH, with input from other members of the Society. Persons working in various international NGOs participated in individual interviews or group discussions on their involvement in different types of research activities. Case studies illustrate the roles of NGOs in global health research, their perceived strengths and weaknesses, and the constraints and opportunities to build capacity and develop partnerships for research. HIGHLIGHTS: NGOs are contributing at all stages of the research cycle, fostering the relevance and effectiveness of the research, priority setting, and knowledge translation to action. They have a key role in stewardship (promoting and advocating for relevant global health research), resource mobilization for research, the generation, utilization and management of knowledge, and capacity development. Yet, typically, the involvement of NGOs in research is downstream from knowledge production and it usually takes the form of a partnership with universities or dedicated research agencies. CONCLUSION: There is a need to more effectively include NGOs in all aspects of health research in order to maximize the potential benefits of research. NGOs, moreover, can and should play an instrumental role in coalitions for global health research, such as the CGHRC. With a renewed sense of purpose and a common goal, NGOs and their partners intend to make strong and lasting inroads into reducing the disease burden of the world's most affected populations through effective research action.

Journal Article↗