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Biomedical subjects

D M Fergusson

Publications and source records attributed to D M Fergusson.

At least 145 records · Page 8Linked to original sources

Reasons for holding health insurance: a study of a group of Christchurch families.

The reasons for holding private medical insurance were studied in a sample of 495 insured Christchurch families having school aged children. In one-third of these families health insurance was provided by an employer. Two major reasons for holding insurance were cited by those whose insurance was not provided by an employer: three-quarters of these families stated that health insurance helped them meet medical bills and nearly two-thirds claimed that insurance provided them with access to immediate health care if this was needed. A minority (24%) of those holding health insurance believed that public sector services were inadequate to provide health care but only 9% of families were able to cite some specific shortcoming of public sector services which had impelled them to take out insurance cover. It is concluded that the rapid rise of private health insurance in New Zealand is likely to have arisen from the net effects of the promotional activities of insurance companies, the declining real contribution of State health care funding and the effects of growing public uncertainty about the ability of public sector services to deliver health care.

Child↗

Relationships between exposure to additional fluoride, social background and dental health in 7-year-old children.

The relationship between social background, water fluoridation, use of fluoride tablets and dmf scores was studied in a birth cohort of 7-yr-old New Zealand children. This analysis showed that the level of exposure to additional fluoride was a complex variable influenced by at least three factors: the use of fluoride toothpaste; the child's length of residence in a fluoridated area; the length of time for which the child had been provided fluoride tablets. Log linear modelling of the data suggested the presence of a relatively complex relationship between exposure to additional fluoride, social background and dental health. First, both duration of residence in a fluoridated area and the provision of fluoride tablets made significant net contributions to the variability in the dmf score. However, exposure to additional fluoride from these sources was differentially influenced by social background: while there were relatively strong associations between social background and the use of fluoride tablets, there was no significant association between duration of residence in a fluoridated area and social background. Finally, independently of an association with exposure to additional fluoride, family social background made a significant net contribution to the variability in dmf scores.

Child↗

Inhalation powder and oral salbutamol combination.

Fifty six children with chronic asthma were treated with the inhaled dry powder of salbutamol or the combination of inhaled and oral salbutamol. Over three months the combination provided a significantly greater sustained symptomatic relief from asthma. Side effects were minimal and did not result in any withdrawals from the study.

Administration, Inhalation↗

Social and family factors in childhood hospital admission.

The relation between social, economic, and family life event measures and rates of hospital admission during the period from birth to 5 years was studied in a birth cohort of New Zealand children. Both family social background and family life events made a significant contribution to the variability in the risk of hospital admission. However, economic factors made no significant contribution to rates of admission when the correlated effects of family social background and life events were taken into account. In addition, the effects of family life events on risks of admission appeared to be far more marked than the effects of family social background. Possible explanations of the consistent association between life events and rates of morbidity during early childhood are discussed.

Accidents↗

Factors related to the age of attainment of nocturnal bladder control: an 8-year longitudinal study.

The age of attainment of nocturnal bladder control was studied in a birth cohort of New Zealand children. By 8 years of age, but all 3.3% of children had attained such control, but because some children had relapsed subsequent to the attainment of control, 7.4% of children had nocturnal enuresis. It was estimated that from 5 years of age onward between one half to two thirds of children experiencing nocturnal enuresis did so as a result of failure to attain nocturnal control and the remaining children had secondary or onset enuresis. Factors predictive of the age of attainment of nocturnal bladder control were a family history of enuresis, the child's developmental level at 1 and 3 years of age, and the child's early sleeping patterns. The age of attainment of bladder control was unrelated to a broad range of psychosocial factors including family social and economic background, family life-event measures, changes in parents in the family, and residential changes. These results favor the view that the etiology of primary enuresis is mainly biologic and that psychosocial factors play little role in this aspect of bed-wetting.

Age Factors↗

Childhood family placement history and behaviour problems in 6-year-old children.

The relationship between childhood family placement history and maternal/teacher reports of child behaviour at 6 years was studied in a birth cohort of New Zealand children. Children who had experienced a marital breakdown showed a tendency to increased aggressive/antisocial behaviour. Within the group of children experiencing a family breakdown, behavioural outcomes varied with the child's subsequent family history and children whose parents reconciled or whose mother remarried appeared to suffer more behavioural difficulties than children who remained in a single-parent family. Multivariate analysis suggested that these differences arose from social and contextual factors associated with differing family situations.

Aggression↗

Theory and practice of decision making in coronary care in general practice.

Decisions about coronary care made by 39 randomly selected general practitioners in New Zealand over one year were investigated. Demographic variables and variables relating to the patient's condition, history, and social circumstances were assessed for 113 patients, and practitioners' belief about the relevance of each variable to the decision was elicited. A comparison was made between the objective criteria found to be related to the decision, the criteria believed by the practitioners to be relevant to the decision, and a theoretical model of what should govern the decision to admit. The theoretical model was found to be built into the beliefs of the practitioners, but the objective model was far simpler. Further research is needed to determine whether the use of the more complex, theoretical models will confer any benefit, in terms of patient wellbeing, over the pragmatic model in use at present.

Age Factors↗

Private medical insurance and elective surgery during early childhood.

The relationship between private medical insurance coverage and rates of elective ENT surgery was studied in a birth cohort of seven-year-old children. This analysis suggested that private medical insurance coverage was associated with differences in patterns of elective surgery with children whose families were covered by insurance being more likely to receive elective ENT surgery by seven years and far more likely to receive this treatment at a private hospital. These trends persisted when the child's history of ear/throat infections and family social and economic background were taken into account statistically.

Adenoidectomy↗

Health insurance coverage amongst families with school aged children.

The level of private medical insurance coverage was studied in a sample of 1106 seven year old children and their families who were participants in the Christchurch Child Development Study. In the last seven years, there has been a rapid increase in the number of families who were covered by private medical insurance: in 1977 an estimated 18% of families had coverage and by 1984, this figure had risen to 43%. Levels of coverage were correlated with a large number of factors associated with family social background including single parenthood, low income, poor parental education, Polynesian ethnicity, depressed living standards, family size and parental age. However, multivariate analysis suggested that the primary determinants of insurance coverage were family earning power and family structure. The social implications of these findings are discussed.

Child↗

A comparative study of the inhaled dry powders of salbutamol and fenoterol and their delivery systems.

A study was designed to establish whether there was a difference in response to inhaled salbutamol powder (400 micrograms) and fenoterol powder (200 micrograms) and whether the specific inhaler devices were a contributing factor. In the study of 40 children no significant difference could be attributed to the devices, but the salbutamol treated group had a marginally better response in two parameters of lung function.

Adolescent↗

Ipratropium and fenoterol in the treatment of acute asthma.

A double-blind, randomized trial was carried out in 48 children to assess the effects of inhaled ipratropium bromide, fenoterol or a combination of both drugs in treating their moderately severe acute asthma. Doses were adjusted according to the age of the patients and administered by nebulizer. Measurements of pulse rate and respiratory rate and assessment of the severity of symptoms were made at fixed intervals during the first 2 hours on treatment. Repeat nebulizations were given, if necessary, at 2-hourly intervals. The results suggested that fenoterol provided the most adequate treatment and there was no evidence to indicate that the addition of ipratropium produced any improved benefit.

Acute Disease↗

Family life events, maternal depression, and maternal and teacher descriptions of child behavior.

The relationship between family life events, maternal depression, and teacher and maternal ratings of child behavior was studied in a birth cohort of New Zealand children. Analysis of variance and multiple regression analysis showed that for maternal ratings of child behavior, both maternal depression and family life events made significant independent contributions. For teacher ratings of child behavior, the only significant predictor was family life events. These results persisted when appropriate controls for family social, economic, and demographic characteristics were taken into account. The theoretical implications of these findings are discussed.

Child↗

Social and familial factors in the development of early childhood asthma.

The role of social and familial factors in the development of childhood asthma by age 6 years was studied in a birth cohort of New Zealand children. Rates of asthma varied markedly with the child's sex; boys had twice the rate of asthma as girls. In addition, the factors associated with asthma varied with the child's sex. For boys, wheeze during infancy, early eczema, and parental asthma were all significant risk factors; for girls, the only risk factor was early eczema. Proportional hazards modeling of the data failed to show any significant associations between the development of asthma and a large range of other social and familial factors including breast-feeding, parental smoking habits, pets in the child's family, stress in the family, or family social background. It was concluded that asthma in early childhood appeared to be inherited to some extent, its age of expression was related to the child's sex, and it had a complex interaction with other forms of allergic disease. There was no evidence to suggest that the structure, practices, or dynamics of the child's family played a significant role in the development of asthma for children in this birth cohort.

Asthma↗

Risks of drowning in fenced and unfenced domestic swimming pools.

A method for estimating the risks of drowning in fenced and unfenced domestic swimming pools is presented. Application of this method suggests that the probability of drowning occurring in an unfenced pool is between two to five times higher than that of a fenced pool. It is also estimated that the introduction of pool fencing would reduce the number of drownings in domestic swimming pools by 40% to 67%.

Child↗

The utilisation of preschool health and education services.

The distribution of the utilisation of health and education services during the period from birth to 5 years was studied in a birth cohort of New Zealand children. Overall patterns of service utilisation showed the presence of considerable inequities with children in the lowest 8% of the distribution receiving seven or fewer of the available services in contrast to the children in the top 8% of the distribution who received in excess of 15 services. Patterns of service utilisation showed a clear tendency to vary with the child's social and familial characteristics with children from socially disadvantaged home backgrounds, unplanned and later born children, children from economically depressed home environments and children in families facing various forms of stress and adversity showing a clear tendency to receive less care than other children. Path modelling of the results suggested that the child's family social background and family composition made the largest direct contributions to variations in rates of service utilisation with family economic situation and levels of adversity having smaller but nonetheless statistically significant effects. It is concluded that the findings provide a clear case study of the way in which well intentioned social policies may emphasise rather than eliminate inequities in the care received by children.

Birth Order↗

Life events and depression in women: a structural equation model.

A non-recursive structural equation model designed to examine the reciprocal relationship between life event reports and depressive symptoms in women is presented. The model was fitted to data from a 2-year longitudinal study of life events and depression in a sample of women with 5-year-old children. The findings suggest that life event reports may be influenced by mental state; however, even when this tendency is taken into account, there is still a substantial relationship between life events and depressive symptoms in women. This indicates that it is unlikely that the life events/depression correlation can be explained simply by a tendency for depressed women to over-report life events.

Adaptation, Psychological↗