[Knowledge of children indispensable to teachers. The environment. Role of socio-cultural factors and economic factors].
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AIMS: The present study was designed to establish the relationship between personality factors, socio-economic factors and acute life stress with development, spontaneous cardioversion and recurrences of acute lone atrial fibrillation. METHODS: The study group consisted of 116 patients with lone atrial fibrillation cardioverted within 48h of the onset of arrhythmia; they underwent a series of cognitive tests to evaluate acute psychological stress and personality type. The socio-economic status and other covariates (alcohol consumption, smoking, and body mass index) were investigated. A control group, age- and sex-matched, was selected and compared. In the logistic regression analysis, the presence of spontaneous conversion to sinus rhythm was used as the dependent variable. Independent variables were indicator variables representing categories of stress, Type A behaviour pattern, coffee consumption and body mass index. Variables considered for logistic analysis were only those with independent prognostic value. RESULTS: Type A behaviour pattern was found in 23 (20%) patients with atrial fibrillation and in 11 (9%) controls (P<0.001). The mean score among patients with atrial fibrillation was 8+/-2.7, while in control subjects it was 5.5+/-2. The mean acute life stress score among patients with atrial fibrillation was 56+/-33, while in controls it was 34+/-27 (P<0.01). Spontaneous conversion of atrial fibrillation to sinus rhythm was observed in 72 patients (63%). In univariate analysis alcohol consumption, income, education and smoking habits did not affect spontaneous conversion. High coffee consumption (OR 0.3 95% CI 0.11-0.49; P<0.008) and high body mass index were associated with a significantly greater risk of atrial fibrillation (OR 1.5 95% CI 1.2-1.7). CONCLUSIONS: Type A behaviour pattern and acute life stress affect the development and spontaneous conversion of atrial fibrillation. Patients with acute stress showed the highest probability of spontaneous conversion followed by patients with Type A behaviour. Other socio-economic factors affect spontaneous conversion and recurrences of lone atrial fibrillation to a lesser extent.
The current leprosy elimination strategy focuses almost exclusively on delivery of leprosy diagnostic services and multi-drug treatment (MDT). However, the specific problems of people newly diagnosed with leprosy or cured with MDT primarily relate to impairment of nerve function and social and economic consequences of the diagnosis of leprosy. This study was carried out to investigate the relation between socio-economic factors and the development of nerve impairments and stigma. In addition the relation between socio-economic factors and selection for socio-economic assistance was studied. The study population was a cohort of 2364 newly diagnosed people with leprosy in rural Bangladesh in 1996, including 42.5% women, with an overall mean age of 31.4 years. Three hundred and sixty people (15.2%) had WHO grade 1 or 2 disability identified at diagnosis, and 50 (2.1%) had stigma identified on interview at home visit conducted within one month of diagnosis. One hundred and eighty-eight people (8%) were selected for specific assistance for rehabilitation, primarily interest-free loans for income generating activities or vocational training. Factors independently associated with WHO grade 1 or 2 disability at diagnosis were multibacillary (MB) classification, adult status, and manual occupations. Smear positivity, female sex, and the presence of dependents were associated with an increase in the experience of stigma. The presence of nerve impairments and stigma, as well as several indices of poverty were clearly associated with selection for inclusion in an integrated program for socio-economic assistance. An increased focus by leprosy services on the socio-economic factors associated with poorer physical and social outcomes is recommended. Where adequate finances and trained staff are available, efforts could be made to identify those at higher risk of poor outcomes, and to provide or to mobilize appropriately targeted socio-economic interventions.
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Substantial variation across socio-economic groups in general practitioner utilisation patterns is observed in Ireland. This may reflect both the influence of socio-economic factors on health and on the demand for health care, and the fact that lower income groups are entitled to free GP care whereas the remainder of the population must pay on a fee-per-item basis. The paper analyses the influence of economic incentives and socio-economic factors on GP utilisation using data obtained in a large-scale household survey. This allows the different utilisation patterns of different social classes/income groups, and those with entitlement to free care vs the remainder of the population, to be documented. The importance of attempting to control for health status is shown, and the difficulties in trying to disentangle the effects of incentives from those of social class or income illustrated.
The influence of socio-economic factors on blood lipid values was studied in 4 groups of young female athletes. Based on type of sport (gymnastics and swimming) and of training intensity, the participants were subdivided into 25 talented, high achievement gymnasts (age 12.3 +/- 1.6 (SD) year), 42 non-talented, low achievement gymnasts (age 12.0 +/- 1.2 (SD) year), 12 high achievement swimmers (age 10.3 +/- 1.6 (SD) year), and 24 low achievement swimmers (age 10.8 +/- 1.6 (SD) year). With respect to socio-economic factors, no significant differences were observed between the two gymnastic groups nor between the two swimming groups. The blood lipid values revealed a significantly higher low density lipoprotein-cholesterol level and significantly lower high density lipoprotein-cholesterol/total cholesterol and high density lipoprotein-cholesterol/low density lipoprotein cholesterol ratios in the talented gymnasts as compared to the non-talented gymnasts. In the high achievement swimmers, low density lipoprotein-cholesterol and triglyceride levels were significantly lower and high density lipoprotein-cholesterol/total cholesterol was significantly higher as compared to the other swimmers. The Spearman rank order correlation coefficients for the relationships between socio-economic factors and blood lipid values were mostly weak or inconsistent. Therefore, no major influence of socio-economic factors on blood lipid values could be demonstrated in the groups investigated.
The association of socio-economic factors with functional capacity has received less research attention than their association with diseases and mortality. However, functional capacity is an important measure of health and independence in the elderly. This study explores the associations of socio-economic factors with physical and mental capacity as measured in laboratory tests and on the basis of self-report. The data were drawn from the Evergreen project, comprising all persons aged 75 (N=388) and 80 (N=291) in Jyväskylä, central Finland. Women with a higher level of education showed better functional capacity on all indicators, among men higher education was only associated with better vital capacity and cognitive capacity. Better perceived financial situation was associated with better functional capacity in both men and women. The association between socio-economic factors and functional capacity remained even when the number of chronic diseases was controlled for. The results lend support to the assumption that socio-economic factors are associated with physical and mental capacity in elderly people.
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Of 3841 children born alive in Malmö in Sweden in 1966, 188, 4.9% had a birth weight of larger than 2500 g. We studied these children with their families and a control in order to form an opinion on the role played by certain social and biological factors in the aetiology of LBW in a country with a relatively high average standard of living. Biological factors were analysed, such as the mother's age, parity, stature, and weight, as well as purely socio-economic factors such as the mother's civil staatus, the social group of the mother and father, income, mother's allowance in case of illness, social help or investigations regarding one or more members of the family, as well as the frequency of immigrants. The combined effect of various socio-economic factors was judged by help of a "social score". The results were analysed for 3 different groups of low birth weight, appropriate for gestational age, small for gestational age and multiple births. Judging from our investigation, biological factors probably play the greatest role in the question of LBW but these factors are difficult to distinguish from socio-economic factors which probably still play a certain role in the group preterm children, appropriate for gestational age.
Cultural and economic patterns from 130 sociological works on suicide from 1981 to 1995 are reviewed in this article. The traditional Durkheimian perspective on suicide was often questioned by research on the impact of the mass media, alcohol, class, modernization, religion, and politics. Major theoretical developments included the application of differential identification theory to Phillips's model of copycat suicide, the application of criminology's opportunity theory to suicide, and new explanations for the link between alcohol and the social suicide rate. Explanations are reviewed for the major new suicide trend: after half a century of convergence, male and female suicide rates are diverging. Finally, the review notes patterns of continued stability in suicide research findings in areas such as racial differences and economic strain.
OBJECTIVE: To explore the relationship of occupational injuries with social and economic factors in chemical industry during 2000.01 - 2001.12. METHOD: 1:2 paired case-control study, univariable logistic regression analysis, principal component analysis, and multiple logistic regression analysis were used in this study. RESULTS: Univariable analysis showed that occupational injuries had significant relationship with age, sex, education, employment pattern, technology, workplace, work changing, wage, family income, enterprise scale, enterprise proprietorship, projective device, operation rules, and training rules of work safety. The extracted four principal components (PC(1), PC(2), PC(3) and PC(4), ranked by contribution) gave good expressions to the initial 11 variables. The cumulative proportion of the four principal components reached 77.36%. PC(1) was the indicative factor of occupational injuries, which represented 46.69% information of initial variables. PC(2) was the kinetic factor of occupational injuries. PC(3) was the stable factor of occupational injuries. PC(4) was the sex factor of occupational injuries. The results of multiple conditional logistic regression analysis showed that occupational injuries had statistically significant relationship with PC(1) and PC(2). Among the initial variables, sex, employment pattern, income, scale of enterprise, and property of enterprise were more prominent. CONCLUSION: Occupational injuries are related with multiple social and economic factors, which often interact on each other. The prevention and control of occupational injuries should require a comprehensive approach, including training and education of work safety, improving workers' consciousness of self-protection, and enhancing proprietors' consciousness of work safety.
AIM: To measure the association of income, education, occupational class, small area socio-economic deprivation, car access and labour force status with mortality among 25-64 year old males and females using the 1991 census-cohort of the New Zealand Census-Mortality Study. METHODS: Mortality records for 1991-94 were anonymously and probabilistically linked to 1991 census records, thereby creating a cohort study of all New Zealand census respondents. Odds ratios of mortality comparing categories of each socio-economic factor were calculated using logistic regression. For income, education and deprivation (NZDep91) a modified relative index of inequality (RII(10:90)) was calculated. The RII(10:90) estimates the relative risk of mortality for low socio-economic people (10th percentile rank) compared to high socio-economic people (90 percentile rank) allowing direct comparisons across socio-economic factors. RESULTS: The relative risk of all-cause mortality for 25-64 year old males with an equivalised household income less than $20,000, compared to greater than $50,000, was 2.16 (95% confidence interval 1.99 to 2.34). For females, this relative risk was 1.68 (1.52 to 1.86). Using the RII(10:90) all-cause mortality was 2.22, 1.94 and 1.58 times greater among low compared to high socio-economic males for income, NZDep91 and education, respectively. For females, these RII(10:90) estimates were 1.77, 1.69 and 1.57, respectively. By cause of death, the strongest gradients were observed for respiratory diseases, followed by lung cancer, cardiovascular disease and unintentional injury. For suicide deaths, unemployed males and females had 2.70 (1.84 to 3.95) and 2.86 (1.19 to 6.85) greater rates than the employed. CONCLUSIONS: There are strong socio-economic gradients for all-cause mortality and most specific causes of mortality among both males and female adults in New Zealand, regardless of the choice of socio-economic factor. The gradients were strongest for income, followed by small area deprivation and education, and strongest for 'preventable' causes of death.
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The potential consequence of economic stress most frequently cited in the literature of medical sociology is the increase in the rate of suicide, it probably being the most valid and reliable indicator of collective mental health. To assess the probability of such being the consequence of current economic realignment in the Federal Republic of Germany, we deemed it promising to evaluate the extent to and manner in which economic factors have to date affected the frequency of suicide in Germany. The current study analyzed the effects of four economic variables (growth of the economy, average real income, unemployment and frequency of bankruptcy) on the rates of suicide in Germany from 1881 to 1989. We set the commencement date of the period analyzed as early as possible to include long-term developments as well as the effects of different moderator variables. The annual fluctuations of all four variables, in conformity with our hypothesis, correlated both in the period preceding World War II as well as in the postwar period with those in the rates of suicide. The strongest correlations held for the rate of unemployment and for the frequency of bankruptcy in times of obvious social disintegration coupled with diminished state safeguards against unemployment. Our hypothesis that the effects of economic factors would more strongly influence the rates of suicide by men as opposed to women could not be corroborated.
An ongoing debate exists among health care researchers about the mechanism that allocates physicians across medical specialties, and appropriate policy measures to correct imbalances that may arise from time to time. Most researchers believe that choice of residency program by medical school graduates is key to understanding how physicians are distributed across specialties, but there is much disagreement about whether economic or non-economic factors are most influential in determining this choice. We undertake an empirical investigation of two potentially important economic factors: income and leisure. To do so, we specify a two way error component regression model to estimate the effects of expected earnings and available leisure time, and uncertainty of earnings and leisure, on specialty choices of medical residents. Our findings indicate that economic factors are an important influence in the specialty choice process; in particular, medical residents are attracted to specialties that offer the prospect of longer and more certain annual vacations, higher earnings, shorter residency programs, and more certain work schedules. Our results suggest that employment contracts that provide generous annual vacation time and promise regular weekly work schedules may be more effective than increased earnings in correcting the current perceived shortage of primary care physicians.
According to the literature, socio-economic factors may contribute more to geographic variations in the aetiology and prognosis of childhood coma than has previously been recognised. This prospective study involving 118 children with strictly defined coma demonstrated that the commonest causes of coma in Ibadan were cerebral malaria (55%), meningitis (13%) and encephalitis (10%). The prognosis was poor. Forty-three (36%) of 118 cases died and 75 (64%) survived, including 23 who showed neurologic deficits. Noteworthy prognostic indices of coma were the aetiology of the condition, the presence of severe anaemia, hypoglycaemia and pneumonia. The findings are discussed in the context of the socio-economic background of children in the tropics.
Some social and economic factors related to breast-feeding durations in Tanzania are analysed using current status data taken from the 1991-92 Tanzanian Demographic and Health Survey. Proportional hazards and proportional odds models are estimated. The results show that breast-feeding durations vary according to the region of residence of the mother and child (and whether they are living in a rural or an urban area), the age of the mother at the time of the birth, the order of the birth, and the mother's religion.