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PubMed2001

The seasonality of live birth is strongly influenced by socio-demographic factors.

The number of births varies markedly by season, but the causes of this variation are not well understood. The proposed explanations include temperature or photoperiod (affecting hormonal concentrations, sperm quality or sexual activity), seasonal variation in pregnancy loss, or cultural factors. In this paper we examined whether birth seasonality is influenced by socio-demographic factors. We used data on all live births registered in the Czech Republic in 1989-1991 (n = 387 496). Differences in the degree of seasonality between socio-demographic groups (defined by maternal age, marital status, education and birth order) were examined by inspection of curves, by comparing coefficients of variations of monthly numbers of births, and by calculating the ratios of the number of births in the 3 peak months (March to May) to the number of births in the 3 lowest months (October to December). We found large differences in the size of the seasonal variation in births by socio-demographic factors. The seasonal variation was highly pronounced in mothers who were 25-34 years old, had higher education, were married, and were pregnant with their second or third child. By contrast, birth seasonality was weak in mothers who were < or =19 years or > or =35 years old, unmarried, had low education, and expected their first or fourth or higher order birth. In a multivariate model, all four socio-demographic variables contributed significantly to seasonal variation. These results suggest that the seasonality of births is, at least in this population, strongly influenced by socio-demographic factors.

Adult↗

PubMed2002

Prolonged use of oral contraception before a planned pregnancy is associated with a decreased risk of delayed conception.

BACKGROUND: The aim of this study was to investigate the association of total duration of oral contraceptive usage with time to conception. METHODS: This was a prospective study of 8497 planned pregnancies drawn from a population that recruited 85% of eligible couples in South-West England who were expecting a baby in a 21 month period. Self-completion questionnaires were administered at 18 weeks gestation to ascertain parity, paternity, co-habitation, use of the contraceptive pill, smoking and alcohol status, educational achievement, height, weight and time taken to conceive. Logistic regression was used to identify factors independently related to conception in < or =12 months. RESULTS: Of the participants, 74% conceived in < or =6 months, 14% in 6-12 months and 12% after 1 year. Previous prolonged oral contraceptive usage was statistically significantly associated with a decreased risk of delayed conception. Prolonged use of oral contraception was also associated with improved fecundity independent of other factors. Selection bias due to particularly fertile women using oral contraceptives is unlikely because similar odds ratios were calculated for nulligravid women. CONCLUSIONS: Women who have prolonged use of oral contraceptives might be reassured that they will not be disadvantaged in terms of time taken to achieve conception.

Adult↗

PubMed2003

Diverging associations of maternal age with low birthweight for black and white mothers.

BACKGROUND: In the US, the risk of low birthweight appears to increase more quickly with maternal age for black women than it does for white women. Our aim was to investigate correlates and causes of the racial/ethnic divergence in low birthweight by maternal age. METHODS: We analysed birth certificate data from 96 887 singleton births to black and white mothers in Chicago from 1994 to 1996 to determine if the association between maternal age and low birthweight differed by maternal ethnicity, marital status, and socioeconomic disadvantage. The association of maternal age with risk of low birthweight was examined, considering especially the interactions of maternal age with maternal race/ethnicity, marital status, education, and neighbourhood poverty. RESULTS: In unadjusted data, the risk of low birthweight rose steeply with maternal age for black, but not white, mothers. Adjustment for the main effects of maternal education, marital status, adequacy of prenatal care, cigarette smoking, and neighbourhood poverty accounted for some of the age-related excess risk of black mothers. Further adjustment for interactions of maternal age with these risk factors eliminated the ethnic divergence in age slopes. The fully adjusted analysis indicated that the risk of low birthweight rises more quickly with maternal age for disadvantaged women, regardless of race/ethnicity. CONCLUSION: This analysis suggests that hardships act cumulatively to threaten reproductive health. The particularly steep increase in risk of low birthweight with increasing maternal age for black women is explained by the high prevalence of disadvantage in this population.

Adolescent↗

PubMed2004

The association of maternal growth and socio-economic measures with infant birthweight in four ethnic groups.

BACKGROUND: Both maternal socio-economic status (SES) and growth measures are themselves interrelated and are also related to infant birthweight. The objective of this study is to compare the relative importance of such maternal measures as determinants of birthweight of female infants-the prospective mothers of the next generation. METHODS: The study base was derived from a population-based multiethnic intergenerational cohort: the Washington State Intergenerational Cohort. Infants of mothers from four ethnic groups were included: non-Hispanic Whites, African Americans, Native Americans, and Hispanics. We generated simple, partial, and multiple correlation coefficients to investigate the association between birthweight and the maternal growth and SES measures. RESULTS: While there were slight differences among the ethnic groups, generally each of three maternal pre-conceptional growth measures-birthweight, stature, and pre-pregnant weight-was a stronger predictor of female infant birthweight than were each of the five maternal SES factors-age, parity, marital status, educational attainment, and prenatal care onset. After accounting for the proportion of variation in birthweight explained by the maternal growth measures and maternal smoking, the addition of the five SES variables added relatively little to the prediction of infant birthweight. The maximal multiple correlation coefficients (R2) yield values ranging from 9.5% to 12.8%. CONCLUSIONS: A mother's growth before pregnancy is a stronger predictor of infant birthweight than is her current socio-economic circumstance. Since the mother's growth must have been influenced by the socio-economic circumstances of her family of upbringing, this further highlights the intergenerational contribution on a woman's reproductive success.

Adult↗

PubMed2003

Demographic and lifestyle predictors of body mass index among offshore oil industry workers: cross-sectional and longitudinal findings.

BACKGROUND: Significant overweight among offshore workers on North Sea oil and gas installations has been linked to high calorie intake, lack of active leisure-time pursuits, and environmental factors conducive to weight gain. However, the prevalence of overweight among offshore workers has not been examined in recent data, and no longitudinal studies of body mass index (BMI) in this occupational group have been reported. Aims The present study sought to examine BMI levels in a sample of UK offshore personnel, and to evaluate demographic factors, smoking and work-related physical activity as predictors of BMI, and 5 year change in BMI. METHODS: Survey data (including age, education, marital status, work-related physical activity and height/weight) were collected in 1995 from male workers on 17 North Sea installations (n = 1581, 83% response rate); follow-up data were obtained in 2000 (n = 354, 34.9% of the potential sample). RESULTS: Overall mean BMI was 25.6 (2.8) kg/m(2): rates of obesity (BMI > 30) and overweight (BMI = 25-30) were 7.5 and 47.3%, respectively. Mean age was 38.7 (8.9) years; linear and quadratic age terms predicted BMI. Age-adjusted BMI values were very similar to those reported from other offshore studies over the past 15 years. Age, marital status, education, smoking and physical activity significantly predicted baseline BMI, but only age (and some interactive effects) predicted 5 year BMI change. CONCLUSIONS: The present age-adjusted BMI values were closely similar to those found offshore in the mid-1980s, but also to recent national data; thus, North Sea personnel do not appear to reflect current population trends towards increased BMI levels. This result accords with the emphasis now given to health promotion (particularly dietary change) on offshore installations; the present findings also highlight the need to focus these initiatives on workers with sedentary jobs and/or low education.

Adult↗

PubMed1984

Risk factors for pathologically confirmed benign breast disease.

Between November 1981 and March 1983, data were collected to evaluate risk factors for benign breast lesions in a case-control study based on 288 women with histologically proven benign breast disease, admitted for biopsy to the Tumor Institute of Milan, and 285 age-matched controls. Questions were asked about menstrual and reproductive characteristics, marital status, education, history of various diseases, and lifetime use of oral contraceptives and other hormonal treatments. Nulliparity or low parity, late age at first birth, and late menopause were associated with an increased risk of benign breast disease. The elevated risk associated with late age at first birth was not accounted for by parity. Early age at menarche was associated with an increased risk, but the estimate was not statistically significant. The data do not suggest that the use of oral contraceptives or other female hormones (such as estrogen replacement therapy) is related to the risk of benign breast disease. Risk was apparently lower, however, among current and long-term oral contraceptive users. There was no evidence of a trend with reference to body mass index. The present data indicate a substantial agreement between the risk factors for (pathologically confirmed) benign and malignant breast disease, not only directly, by showing a relationship with parity, age at first birth, and age at menopause, but also indirectly, by failing to produce evidence that greater weight or the use of oral contraceptives has a protective effect.

Adolescent↗

PubMed1996

First-episode schizophrenia: I. Early course parameters.

Concepts and definitions pertaining to the early course of schizophrenia are reviewed, along with recent illustrative studies of first-episode schizophrenia. Early course parameters of a Norwegian first-episode sample are presented. This sample (n = 43) demonstrated strong gender differences, with male patients having significantly higher frequency of single marital status, lower educational status, schizophrenia, early age at onset, and lower Global Assessment of Functioning scores the last year before hospitalization. The duration of untreated psychosis (DUP) was long (mean = 114 weeks), as in other studies. Longer DUP was associated with poorer work, social, and global functioning in the year before admission, with more insidious onset of psychosis, and with more negative symptoms at first clinical presentation. Longer DUP was not associated with the age at onset of psychosis. These findings were mostly gender independent. The data help to frame questions about why patients can be psychotic for so long before getting help. Finally, suggestions are offered for the definition and measurement of early course parameters for schizophrenia.

Adolescent↗

PubMedDate not supplied

Pain intensity assessment in older adults: use of experimental pain to compare psychometric properties and usability of selected pain scales with younger adults.

OBJECTIVES: To determine: (1) the psychometric properties and utility of 5 types of commonly used pain rating scales when used with younger and older adults, (2) factors related to failure to successfully use a pain rating scale, (3) pain rating scale preference, and (4) factors impacting scale preference. METHODS: A quasi-experimental design was used to gather data from a sample of 86 younger (age 25-55) and 89 older (age 65-94) adult volunteer subjects. Responses of subjects to experimentally induced thermal stimuli were measured with the following pain intensity rating scales: vertical visual analog scale (VAS), 21-point Numeric Rating Scale (NRS), Verbal Descriptor Scale (VDS), 11-point Verbal Numeric Rating Scale (VNS), and Faces Pain Scale (FPS). RESULTS: All 5 pain scales were effective in discriminating different levels of pain sensation; however the VDS was most sensitive and reliable. Failure rates for pain scale completion were minimal, except for the VAS. Although age did not impact failure to properly use this pain intensity rating scale, but rather those conditions more commonly associated with advanced age, including cognitive and psychomotor impairment did. The scale most preferred to represent pain intensity in both cohorts of subjects was the NRS, followed by the VDS. Scale preference was not related to cognitive status, educational level, age, race, or sex. CONCLUSION: Although all 5 of the pain intensity rating scales were psychometrically sound when used with either age group, failures, internal consistency reliability, construct validity, scale sensitivity, and preference suggest that the VDS is the scale of choice for assessing pain intensity among older adults, including those with mild to moderate cognitive impairment.

Adult↗

PubMed1985

Filipino workers in the Middle East: social profile and policy implications.

The characteristics of international labor migrants from the Philippines are examined. "Based on an analysis of a sample of 495 Middle East workers and 1983 worker placements, this paper presents a profile of Filipino workers in the Middle East with reference to such variables as occupation, gender, age and work experience, civil status, education, Philippine residence, household size and number of dependents." (summary in FRE, SPA)

Africa↗

PubMed1986

Post-war immigration in the United States and the state of Minnesota: the process of entering an all-American community.

The author focuses on characteristics of Polish immigrants in Minnesota in the years since World War II. Particular attention is given to the immigrants' adaptation to the American way of life and to democratic institutions after being accustomed to centralized power in a socialist system. "This article is based on participant observation, publications concerning immigration to the United States, and unstructured interviews with newcomers from Poland and other Eastern European countries." Distinctions are made among the characteristics of Polish-Americans, pre-World War II immigrants, war immigrants, and those who have come during the last 20 years, including groups that the author identifies as the "calculated-decision" immigrants, the post-Solidarity immigrants, and the "adjusted visitor" immigrants. Consideration is given to the demographic characteristics, legal status, education and employment, and territorial mobility of 35 Poles living in Minnesota who were interviewed by the author. (SUMMARY IN FRE AND SPA)

Acculturation↗

PubMed1996

Smoking during pregnancy and preterm birth.

OBJECTIVE: To evaluate the association between smoking during pregnancy and preterm birth. DESIGN: A follow up study. SETTING: Department of Gynaecology and Obstetrics, Aarhus University Hospital, Denmark. PARTICIPANTS: Four thousand one hundred and eleven nulliparous women with singleton pregnancies who returned questionnaires about smoking habits at 16 weeks of gestation. RESULTS: The overall rate of preterm delivery was 4.3%. Smokers had a 40% higher risk of preterm birth compared with nonsmokers. A dose response relationship was found between smoking and risk of preterm birth. Adjustment for women's height, prepregnancy weight, age of the mother, marital status, education, occupational status, and alcohol intake did not change the results. Among women with an intake of less than 400 mg of caffeine per day no difference in the risk of preterm birth between smokers and nonsmokers was found. However, among women with an intake of more than 400 mg of caffeine per day, the risk of preterm birth was increased almost threefold among smokers compared with nonsmokers. Furthermore, among women with a high intake of caffeine a dose-response relationship was found; women smoking one to five cigarettes per day had no increased risk of preterm birth compared with nonsmokers with the same intake of caffeine, women smoking six to ten cigarettes per day had almost three times higher risk of preterm birth, and women smoking more than 10 cigarettes per day had almost five times higher risk of preterm birth compared with nonsmokers with the same intake of caffeine. CONCLUSIONS: Smoking increases the risk of preterm birth. The association between smoking and preterm birth was only present among women with a high intake of caffeine. However, whether smoking alone influences the risk of preterm birth among heavy consumers of caffeine needs further investigation.

Adolescent↗

PubMed1988

Health services utilization and special education: development of a school nurse activity tool.

Increasing competition exists for resources to support health services for children receiving special education. Consequently, management tools to document services when claiming these resources need to be developed. The purposes of this study were to develop a time study instrument based on nursing activities in the school, compare nursing time provided to special education children and their nondisabled peers in general education settings, compare nursing process activities in traditional settings and in special education settings, and elicit feedback from nurses to improve the validity and reliability of the time study process. Eighteen nurses representing rural, urban, and suburban schools completed a time study for two weeks, quantifying services provided in the health room. Nurses recorded student educational status, special education category or not, nursing process activity, and the time utilized per student contact. Results indicated 48.2% of school nursing time was attributed to services for special education students during the study period. Most nursing process activities for both settings were in assessment of problems and in direct services. Findings indicate the instrument can provide objective documentation of special education health services, providing a base for claiming important resources for school health services.

Education, Special↗

PubMed2003

Income inequality and health: multilevel analysis of Chilean communities.

STUDY OBJECTIVE: The evidence supporting the effect of income inequality on health has been largely observed in societies far more egalitarian than the US. This study examines the cross sectional multilevel associations between income inequality and self rated poor health in Chile; a society more unequal than the US. DESIGN: A multilevel statistical framework of 98 344 people nested within 61 978 households nested within 285 communities nested within 13 regions. SETTING: The 2000 National Socioeconomic Characterization Survey (CASEN) data from Chile. PARTICIPANTS: Adults aged 18 and above. The outcome was a dichotomised self rated health (0 if very good, good or average; 1 if poor, or very poor). Individual level exposures included age, sex, ethnicity, marital status, education, employment status, type of health insurance, and household level exposures include income and residential setting (urban/rural). Community level exposures included the Gini coefficient and median income. MAIN RESULTS: Controlling for individual/household predictors, a significant gradient was observed between income and poor self rated health, with very poor most likely to report poor health (OR: 2.94) followed by poor (OR: 2.77), low (OR: 2.06), middle (OR: 1.73), high (OR: 1.38) as compared with the very high income earners. Controlling for household and community effects of income, a significant effect of community income inequality was observed (OR:1.22). CONCLUSIONS: Household income does not explain any of the between community differences; neither does it account for the effect of community income inequality on self rated health, with more unequal communities associated with a greater probability of reporting poor health.

Adolescent↗

PubMed2006

Impact of traditional and novel risk factors on the relationship between socioeconomic status and incident cardiovascular events.

BACKGROUND: Persons of lower socioeconomic status have greater cardiovascular risk than those of higher socioeconomic status. However, the mechanism through which socioeconomic status affects cardiovascular disease (CVD) is uncertain. Virtually no data are available that examine the prospective association between novel inflammatory and hemostatic CVD risk indicators, socioeconomic status, and incident CVD events. METHODS AND RESULTS: We assessed the relationship between 2 indicators of socioeconomic status (education and income), traditional and novel CVD risk factors (high sensitivity C-reactive protein, soluble intercellular adhesion molecule-1, fibrinogen, and homocysteine), and incident CVD events among 22,688 apparently healthy female health professionals participating in the Women's Health Study. These women were followed up for 10 years for the development of myocardial infarction, ischemic stroke, coronary revascularization, and cardiovascular death. More educated women were less likely to be smokers; had a lower prevalence of hypertension, diabetes, and obesity; and were more likely to participate in vigorous physical activity than less educated women. At baseline, median total cholesterol, low-density lipoprotein, triglyceride, C-reactive protein, intercellular adhesion molecule-1, fibrinogen, and homocysteine levels for women in 5 categories of education (< 2 years of nursing education, 2 to < 4 years of nursing education, a bachelor's degree, a master's degree, and a doctoral degree) and 6 categories of income [< or = 19,999 dollars, 20,000 dollars to 29,999 dollars, 30,000 dollars to 39,999 dollars, 40,000 dollars to 49,999 dollars, 50,000 dollars to 99,999 dollars, and > or = 100,000 dollars) decreased progressively with increasing education or income levels (all P<0.001), whereas an opposite pattern was observed for high-density lipoprotein (P<0.001). Overall, in age-adjusted Cox proportional hazards models, the relative risk of incident CVD events decreased with increasing education (1.0, 0.7, 0.5, 0.4, and 0.5; P for trend <0.001) and income (1.0, 1.0, 0.9, 0.7, 0.6, and 0.4; P for trend <0.001) categories. In multivariate models that assessed the impact of traditional and novel CVD risk factors on the relationship between education/income and CVD events, the relative hazard of incident CVD associated with a 1-category-higher level of education changed from 0.79 in age- and race-adjusted analysis to 0.89 in fully adjusted analysis. The 11% lower risk per 1 category of education remained significant (P for trend=0.006), suggesting that controlling for both novel and traditional risk factors could not explain the protective effect of education. A similar analysis for income revealed that its relationship with CVD events was explained largely by these noted risk factors. CONCLUSIONS: In this prospective analysis, we observed a decrease in incident CVD events with increasing levels of education and income. In contrast to the relationship between income and CVD events, the relationship of CVD events with education was explained only partially by traditional and novel risk factors for CVD.

Adult↗

PubMed1990

Dissociative experiences in the general population.

The Dissociative Experiences Scale was administered to a random sample of 1,055 adults in the city of Winnipeg. Results showed that scale scores did not differ between men and women and were not influenced by income, employment status, education, place of birth, religious affiliation, or number of persons in the respondent's household. Dissociative experiences are common in the general population and decline with age. The findings suggest that dissociative disorders may also be common in the general population.

Adult↗

PubMed2002

National trends in the use of outpatient psychotherapy.

OBJECTIVE: This article reports recent trends in the use of outpatient psychotherapy in the United States. METHOD: Data from the household sections of the 1987 National Medical Expenditure Survey and the 1997 Medical Expenditure Panel Survey were analyzed. Trends in the rate of psychotherapy use from these nationally representative samples are presented by age, sex, race/ethnicity, marital status, education, employment status, and income. Psychotherapy users are compared over time by provider specialty, concomitant psychotropic medication use, number of annual visits, and costs. In addition, trends in payment source and primary diagnosis are assessed for psychotherapy visits. RESULTS: Between 1987 and 1997, there was no statistically significant change in the overall rate of psychotherapy use (3.2 per 100 persons in 1987 and 3.6 per 100 in 1997). However, significant increases were observed in psychotherapy use by adults aged 55-64 years and by unemployed adults. Among psychotherapy patients, there was a marked increase in the use of antidepressant medications (14.4% to 48.6%), mood stabilizers (5.3% to 14.5%), stimulants (1.9% to 6.4%), and psychotherapy provided by physicians (48.1% to 64.7%). A smaller proportion of patients made more than 20 psychotherapy visits in 1997 (10.3%) than in 1987 (15.7%). Over this period, psychotherapy visits for mood disorders became more common. In 1997, 9.7 million Americans spent $5.7 billion on outpatient psychotherapy. CONCLUSIONS: From 1987 to 1997, access to psychotherapy in the United States remained constant overall but was characterized by increased use by some socioeconomically disadvantaged groups. However, the number of visits per user markedly decreased during this period. Psychotherapy was increasingly administered by physicians and provided in conjunction with psychotropic medications. These changes occurred during a period of expansion in the number of available psychotropic medications and growth in managed behavioral health care.

Adult↗

PubMedDate not supplied

Executive functions in elementary school children with and without problems in written expression.

This study examined the executive functioning of 55 elementary school children with and without problems in written expression. Two groups reflecting children with and without significant writing problems were defined by an average primary trait rating across two separate narratives. The groups did not differ in terms of chronological age, ethnicity, gender, socioeconomic status, special education status, or presence of attention problems or receptive vocabulary capabilities; however, they did differ in reading decoding ability, and this variable was controlled for in all analyses. Dependent measures included tasks tapping an array of executive functions grouped conceptually in accordance with a model of executive functioning reflecting the following domains: initiate, sustain, set shifting, and inhibition/stopping. Analysis of covariance (ANCOVA) procedures revealed statistically significant group differences on the initiation and set shift domains, with the sustaining domain approaching significance. Children with writing problems performed more poorly in each of these domains, although the effect sizes were small. A multiple regression that employed these four factors and the reading decoding variable to predict the primary trait score from the written narratives revealed a statistically significant regression function; however, reading decoding contributed most of the unique variance to the writing outcome. These findings point out the importance of executive functions in the written language process for elementary school students, but highlight the need to examine other variables when studying elementary school-age children with written expression problems.

Child↗

PubMed1993

Palliative home care and place of death among cancer patients: a population-based study.

This population-based study of all cancer deaths (n = 12,343) occurring in Genoa, Italy, from 1986 to 1990 investigated the relation between place of death and age, sex, marital status, education, cancer site and provision of palliative home care (PHC). The proportion of home deaths significantly increased from 27.9% (1986) to 33.0% (1990) and was twice as frequent among PHC users (60.8%) than among nonusers (29.3%). The number of patients dying of cancer who received PHC increased from 41 in 1986 (1.6% of cancer deaths) to 191 in 1990 (8.0% of cancer deaths). PHC users, when compared to nonusers were younger, more frequently married, had a higher level of education and were more frequently affected by cancers of the lung, breast or prostate. Multivariate analysis shows that the probability of home death increased with increasing age and education level and was higher in females and in married patients. The provision of PHC was the strongest predictor of home death (OR = 4.00; 95% CI = 3.33-4.81), while the temporal trend almost disappeared. These results suggest that most of the increase in home deaths from 1986 to 1990 is attributable to the PHC and that expansion of the PHC services may enable about 60% of cancer patients to die at home. These results appear to be desirable from the individual patient's viewpoint and in a public health perspective.

Age Factors↗