Dissecting the "black box" of community intervention: lessons from community-wide cardiovascular disease prevention programs in the US and Sweden.
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Adult↗
Biomedical subjects
S Wall
Publications and source records attributed to S Wall.
Public health in Scandinavia--the case of Sweden.
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Health Policy↗
Sociodemographic predictors of self-rated health in patients with diabetes of short duration.
AIMS: To examine the impact of gender and socioeconomic factors on health-related quality of life (HRQoL) one year and eight years after diabetes diagnosis. METHODS: Two national incidence cohorts who contracted diabetes between the ages of 15 and 34 years (n=554) and matched control groups from the general population of Sweden (n=1,029) were surveyed. Data on HRQoL, diabetes treatment, marital status, education, social class, and employment were collected via a questionnaire mailed to the younger cohort (aged 16-35) one year after diagnosis and to the older cohort (aged 23-42) eight years after diagnosis. Response rates were 73% among people with diabetes and 68% among the controls. Multivariable linear regression models were used to analyse the impact of gender and socioeconomic factors on HRQoL in the diabetic and control groups. The dependent variable was the "general health perceptions" score of the SWED-QUAL instrument, which corresponds to the "global self-rated health" concept. RESULTS: A model including all the sociodemographic variables explained 6% of the variance in self-rated health one year after diabetes diagnosis and 13% of the variance eight years after diagnosis. In the control groups, the level of explanation was 2-3%. Female gender was an independent predictor of poor self-rated health in the older diabetic cohort, but not in the younger cohort. CONCLUSIONS: Gender and socioeconomic factors were more closely associated with self-rated health eight years after diabetes diagnosis than one year after diagnosis, indicating early sociodemographic stratification in the health of the diabetic populations studied.
Adolescent↗
Monitoring of HIV-1 infection prevalence and trends in the general population using pregnant women as a sentinel population: 9 years experience from the Kagera region of Tanzania.
In the Kagera region of Tanzania, a population-based study was initiated in 1987 followed by the establishment of antenatal-clinic-based sentinel surveillance system in the town of Bukoba in 1990. Repeat studies in both populations in Bukoba in 1993 and 1996 made it possible to study the dynamics of HIV infection prevalence and incidence in the area. This study aims at comparing the findings from this sentinel surveillance system with those of cross-sectional studies in the general population to assess its validity in estimating HIV prevalence and their trends in the general population. A multistage cluster sampling technique was used in the population-based studies whereas the antenatal-clinic-based population was obtained by consecutively recruiting antenatal care attenders coming for the first time during a given pregnancy. Antibodies against HIV infection were tested using two independent enzyme-linked immunosorbent assay (ELISA) antibody detection tests. Unlinked anonymous testing strategy was adopted for the sentinel population. Age-adjusted prevalence among antenatal care attenders decreased from 22.4% (95% confidence interval [CI], 20.6-25.2) in 1990 to 16.1% (95% CI, 15.9-18.8) in 1993 and further to 13.7% (95% CI, 11.8-14.3) in 1996. These results closely resemble those of the general population of adult women in the clinic's catchment area (the town of Bukoba) where the age-adjusted prevalence of 29.1% (95% CI, 24.4-34.6) in 1987 showed a decrease in the studies in 1993 18.7% (95% CI, 15.1-23.0) and in 1996 14.9% (95% CI, 12.0-17.1). The study indicates that general population trend estimates can be generated using sentinel surveillance data based on pregnant women visiting an antenatal clinic for the first time during a given pregnancy. The benefits of using this group outweigh its limitations that are brought about by possible selection bias. Continued surveillance of the epidemic based on antenatal care patients as a sentinel population is therefore recommended.
Adolescent↗
Racial differences in respiratory-related neonatal mortality among very low birth weight infants.
OBJECTIVE: To examine racial differences in the secular trends in respiratory-related neonatal mortality among very low birth weight (VLBW) infants in the United States, temporally associated with surfactant availability. DESIGN: Comparison of time trends in African American and non-Hispanic white (NHW) VLBW infants of cause-specific neonatal mortality and neonatal and infant mortality for 2 consecutive 3-year periods. RESULTS: From 1985 to 1988 there was no racial difference in the rate of decline of each mortality outcome. From 1988 to 1991 rates of decline in neonatal mortality caused by respiratory distress syndrome and by all respiratory causes were significantly greater for NHWs compared with African Americans. However, the rate of decline in nonrespiratory neonatal mortality was similar for African Americans and NHWs. Compared with African American VLBW infants, NHWs had a greater rate of decline in both neonatal (31% vs 20%; P <.01) and infant mortality (32% vs 21%; P <.01) during this period. CONCLUSIONS: Between 1988 and 1991, declines in neonatal mortality risks caused by respiratory distress syndrome and all respiratory causes were greater for NHW infants than for African American VLBW infants. The decline in nonrespiratory mortality risk showed no racial differences. These findings suggest possible racial disparities in timely access or racial differences in the efficacy of respiratory treatments for VLBW infants.
Black People↗
Perinatal death and tocolytic magnesium sulfate.
OBJECTIVE: To determine whether there is a significant association between perinatal mortality and exposure to total doses of tocolytic magnesium sulfate larger than 48 g. METHODS: We did a case-control study in which cases were defined as neonates or fetuses who died after being exposed to tocolytic magnesium sulfate and controls were those who survived exposure. The study included fetuses and neonates who weighed between 700 and 1249 g and whose mothers had received tocolytic magnesium sulfate at Chicago Lying-in Hospital between January 1, 1986, and March 31, 1999. We excluded women who received prophylactic magnesium sulfate for preeclampsia or preeclampsia superimposed on chronic hypertension, and fetuses or neonates with major congenital anomalies. Data were analyzed by Fisher exact test, chi(2) test, Student t test, Mann-Whitney U test, multivariable logistic regression, and Cochrane-Armitage trend test. RESULTS: Controlling for birth weight or gestational age, year of delivery, receipt of betamethasone, acute maternal disease, and maternal race in a multivariable model, we found that exposure to total doses of tocolytic magnesium sulfate exceeding 48 g was significantly associated with increased perinatal mortality (adjusted odds ratio 4. 7; 95% confidence interval 1.1, 20.0; P =.035). Using the Cochrane-Armitage trend test, we found that a significant dose response was present (P =.03), but one that was most consistent with a threshold effect. CONCLUSION: Our findings support the hypothesis that high doses of tocolytic magnesium sulfate are associated with increased perinatal mortality among fetuses and neonates weighing 700-1249 g.
Adult↗
Excess costs of medical care 1 and 8 years after diagnosis of diabetes: estimates from young and middle-aged incidence cohorts in Sweden.
To analyze the excess costs of medical care during the first decade after diabetes diagnosis, we surveyed two national incidence cohorts who contracted diabetes at age of 15-34 years and matched control groups from the general population of Sweden. Ninety percent of the diabetic subjects were on insulin treatment. Data on healthcare utilization and use of glucose lowering drugs and medical devices were collected via a questionnaire mailed to a recent cohort 1 year after diagnosis and a previously registered cohort 8 years after diagnosis. Costing was based on average national costs of hospital inpatient and out-patient care, an original study of daycare costs, and sales prices of the National Corporation of Swedish Pharmacies. One year after diabetes diagnosis, the annual excess costs of care were US$4743 among men and US$4976 among women (1997 prices). Hospital inpatient care accounted for more than 50% of the excess costs. Eight years after diagnosis, the excess costs were US$2010 among men and US$2734 among women. The higher costs for women were mainly related to hospital out-patient care, but also to more intensive self-monitoring. We conclude that diabetes in young and middle-aged people is a major economic challenge even before significant complications may have developed.
Adolescent↗
What else adds to hypertension in predicting stroke? An incident case-referent study.
OBJECTIVES: To examine to what extent traditional biomedical risk factors and social factors can predict, separately or jointly, first-ever stroke event, and to explore to what extent other risk factors might add to hypertension/elevated blood pressure as a stroke risk factor. DESIGN: An incident case-referent study. SETTING: The study was nested within the Västerbotten Intervention Program (VIP) and the Northern Sweden MONICA cohorts. SUBJECTS: The study involves 129 stroke cases with two randomly selected referents per case from the same study cohorts. RESULTS: History of diabetes, daily smoking, obesity (body mass index greater than or = 30 kg m(-2)), hypertension and living as an unmarried person were associated with an increased risk in univariate analysis. However, in the multivariate logistic regression analysis, only hypertension, diabetes and single marital status remained significant. There was a statistically significant interaction between hypertension and smoking and stroke. Interaction of possible clinical relevance was also observed between hypertension, history of diabetes and stroke. CONCLUSIONS: The study both emphasizes the multifactorial nature of stroke and illustrates that knowledge of interactions offers different strategic approaches when preventing stroke in clinical work. It is important, but not enough, to focus on blood pressure control. Diabetes prevention as well as prevention of smoking must also be considered as factors of major importance.
Adult↗
Public health in transition.
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Health Policy↗
Changing patterns in the use of the Mental Health Act 1983 in England, 1984-1996.
BACKGROUND: The Mental Health Act 1983 (MHA) is due to be revised by Parliament in the near future. AIMS: To explore changes in the use of the Act since its introduction. METHOD: The Department of Health and the Home Office routinely collect data on the numbers of patients admitted to psychiatric hospitals under the MHA. We present absolute figures, by year, for the total numbers admitted under each section of the Act. We used the total psychiatric hospital admissions and total prison populations as denominator data. RESULTS: Formal admissions rose from 16,044 in 1984 to 26,308 in 1996, a 63% increase. Admissions under the MHA have increased as a proportion of all admissions. The increase is mainly accounted for by changes in the use of Part II of the Act, in particular sections 2 and 3. The use of forensic sections (Part III) has also increased, with a marked increase of sections 47 and 48. Use of Part X of the Act (sections 135 and 136) declined in the late 1980s but rose again in the 1990s. CONCLUSIONS: Formal admissions are more common than they were in 1984, despite there being fewer psychiatric beds. This is probably due to changes in the provision of psychiatric services, and changing societal pressures on psychiatrists away from libertarianism and towards coercion.
Commitment of Persons with Psychiatric Disorders↗
The effect of poverty, social inequity, and maternal education on infant mortality in Nicaragua, 1988-1993.
OBJECTIVES: This study assessed the effect of poverty and social inequity on infant mortality risks in Nicaragua from 1988 to 1993 and the preventive role of maternal education. METHODS: A cohort analysis of infant survival, based on reproductive histories of a representative sample of 10,867 women aged 15 to 49 years in León, Nicaragua, was conducted. A total of 7073 infants were studied; 342 deaths occurred during 6394 infant-years of follow-up. Outcome measures were infant mortality rate (IMR) and relative mortality risks for different groups. RESULTS: IMR was 50 per 1000 live births. Poverty, expressed as unsatisfied basic needs (UBN) of the household, increased the risk of infant death (adjusted relative risk [RR] = 1.49; 95% confidence interval [CI] = 1.15, 1.92). Social inequity, expressed as the contrast between the household UBN and the predominant UBN of the neighborhood, further increased the risk (adjusted RR = 1.74; 95% CI = 1.12, 2.71). A protective effect of the mother's educational level was seen only in poor households. CONCLUSIONS: Apart from absolute level of poverty, social inequity may be an independent risk factor for infant mortality in a low-income country. In poor households, female education may contribute to preventing infant mortality.
Adolescent↗
Ethnic differences in the impact of advanced maternal age on birth prevalence of Down syndrome.
OBJECTIVES: This study explored whether ethnic differences in the impact of advanced maternal age on the risk of Down syndrome might reflect differences in use of prenatal diagnostic technologies. METHODS: Maternal age-specific odds of Down syndrome and amniocentesis use were compared among African Americans, Mexican Americans, and non-Hispanic Whites via birth data for the years 1989 to 1991. RESULTS: The odds ratio and population attributable risk of Down syndrome due to maternal age of 35 years or older were highest for Mexican Americans, intermediate for African Americans, and lowest for non-Hispanic Whites. CONCLUSIONS: Advanced maternal age has a greater impact on the risk of Down syndrome for African American and, particularly, Mexican American women than for non-Hispanic White women. This difference in impact might reflect lower availability or use of prenatal diagnostic technologies.
Adult↗
Evaluation of caries preventive measures.
This article describes the aims, methods and baseline results of a project evaluating preventive measures within a selected high-risk group. In 1995 a cohort of 3373 12-year-olds was examined with regard to caries. A high-risk group was identified and randomly divided in four different groups, receiving different preventive programs. The whole study group will be examined every other year until the adolescents are 18 years old. The high-risk group will be examined every year and given the four different preventive measures until the adolescents are 18 years of age. A questionnaire will be answered by the adolescents every other year, in order to learn more about the links between demographic data, social background, lifestyle and health behaviour. Analysis of baseline results showed that the social distribution of the study group is comparable to that of the background population as well as to the distribution in rural and urban areas. The mean DMFT was 1.5, which is in accordance with the national figure. The 28 dentists who collect the data and perform the caries diagnostics were calibrated and the mean inter- and intra-reproducibility was 0.78 and 0.82, respectively. In conclusion, it seems that the study group is representative of 12-year-olds in Sweden; thus, inferences drawn from the results of the project may be valid for adolescents in Sweden as a whole.
Cariostatic Agents↗
Aims, options and outcomes in measuring maternal mortality in developing societies.
BACKGROUND: Effective methods for measuring maternal mortality in developing countries are important, particularly in assessing interventions aiming for safer motherhood. Here the performance of different approaches is compared in the same setting. METHODS: Estimates of maternal mortality in a rural Ethiopian community are reported, made by direct observation, a case-control approach, and the sisterhood method. RESULTS: Adjusted estimates of MMR using these methods ranged between 440 and 665 per 100,000 live births. CONCLUSIONS: The advantages and disadvantages of the different approaches are compared, both for operational feasibility and outcome.
Adolescent↗
Trends in the use of the Mental Health Act: England, 1984-96.
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Commitment of Persons with Psychiatric Disorders↗
Surface Electrical Properties of Polystyrene Latex.
The surface electrical properties of a polystyrene latex have been studied with several experimental methods. Previous studies by other authors have shown discrepancies between the surface potential and the surface charge density determined by different methods. This work is an attempt to produce more experimental data for the discussion concerning these discrepancies. Both electrophoretic mobility and electrical conductivity methods have been used. Also, gel permeation chromatography has been used to estimate the number of endgroups on the latex particle that carry charged surface groups. Synthesis and cleaning methods of polystyrene latex are also discussed. Calculations on a Poisson-Boltzmann level of approximation have been performed in an attempt to connect the quantities determined with dynamic (electrophoresis and static conductivity) methods and static (titration) methods. The discrepancies can be explained by introducing a pH- and electrolyte-dependent surface structure such as the hairy layer model. A Stern layer conductance model can also to some extent explain these discrepancies, but this model contains several parameters not directly attainable by experiments. This means that a unique set of parameters cannot be determined without further studies on several latex systems. Copyright 1999 Academic Press.
Journal Article↗
Thirty-five millimeter versus digital photography: comparison of photographic quality and clinical evaluation.
The objective of this article is to assess the quality of digital images versus standard 35-mm photodocumentation and to undertake a comparative assessment of 35-mm and digital photography in a clinical setting in facial plastic surgery. For evaluation of image quality, 10 subjects had images captured via a conventional 35-mm single lens reflex (SLR) camera and a digital camera under identical lighting conditions. The digital images were transferred to computer hard drive and processed for production of slides. Direct side-by-side comparison of projected images was performed by the authors. The standard photographic slides were of slightly finer detail and crispness than the computer-generated images. In a clinical setting, the quality of both the 35-mm and digital photographs enables complete preoperative evaluation and assessment of postsurgical outcome.
Face↗
Prevalence of HIV infection among hospital patients in north west Tanzania.
In order to estimate hospital HIV prevalence, the economic impact of AIDS on health care and to assess the implications of HIV testing on clinical suspicion of AIDS this hospital based study was done at the government regional hospital of Kagera, Tanzania. Consecutive admissions were recruited into the study, and those consenting had a blood specimen taken, one portion of which was used to aid clinical diagnosis, while the other was tested anonymously for HIV antibodies using two ELISA systems. A short questionnaire was used to specify demographic characteristics, hospital ward of admission and diagnosis of each study subject. The overall age adjusted HIV-1 prevalence was 32.8% (N = 1422) and there was no significant difference in the age adjusted sex specific prevalence. The highest prevalence (53.3%) was found in the 25-34 years age group as well as in the gynaecological and medical wards (41.2% and 40.4%, respectively). The diagnostic category of clinical AIDS had a sensitivity of 11.3% and a specificity of 99.3%, indicating that only 11.3% of the HIV seropositives would have been HIV tested on clinical suspicion of AIDS. Similarly, the HIV-1 antibody sensitivity and specificity for tuberculosis were 5.9% and 97.9%, respectively. Patients who were HIV-1 infected were more likely to have a history of previous hospital admissions, RR = 1.34 (95% CI = 1.16-1.56), and were at an increased risk of developing tuberculosis, RR = 2.02 (95% CI = 1.50-2.70). The diagnostic categories with the highest HIV-1 infection prevalence were clinical AIDS (88.5%), herpes zoster and other HIV-1 skin manifestations combined (85.7%) and pulmonary tuberculosis (58.3%). In conclusion, the prevalence of HIV-1 infection was high among hospitalized patients in Bukoba hospital indicating that the major cause of illness leading to admission to the hospital may have been underlying HIV-1 infection. The findings also indicate that in a high HIV-1 prevalence area, testing for HIV infection on the basis of clinical suspicion of AIDS alone is not sufficient to provide rational care to the majority of HIV infected patients.
AIDS-Related Opportunistic Infections↗