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PubMed2005

[Study on the identification of HIV/AIDS and its surveillance system in rural areas of central China].

OBJECTIVE: To explore the effective strategies for human immunodeficiency virus (HIV) surveillance and identification in rural areas of central China. METHODS: In a selected rural prefecture area of central China, an epidemiological investigation was conducted for all reported HIV/AIDS cases. A historical and analytic review was performed, with particular interests in examining the HIV epidemic reporting and identification system. RESULTS: Among all 626 reported HIV-infected individuals in the selected prefecture, 86.1% (539/626) of them were infected through commercial plasma donation or clinically operated blood transfusion. With respect to disease surveillance and identification in the area, 52.2% (327/626) of all the cases were reported by hospitals or clinics. The number and proportion of HIV/AIDS cases identified or reported at county, prefecture, and provincial levels were 207 (33.1%), 303 (48.4%) and 116 (18.5%), respectively. The number and proportion of HIV/AIDS identified through specific epidemiological investigations and/or voluntary testing had been increased in recent years. In addition, among HIV/AIDS cases that were clinically identified, the proportion of those who were identified as outpatients had steadily increased,with the highest proportion (59.3%) observed in 2004. CONCLUSIONS: In rural areas of central China where the major mode of HIV transmission was through commercial plasma donation or clinically operated blood transfusion, hospitals and clinics seemed to have played and would continue to play important roles regarding HIV identification and surveillance. The role of institutions or settings at the prefecture level regarding HIV identification and surveillance should not be ignored.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Menarcheal age for Norwegian women born 1830-1960.

Data from birth records from the maternity hospitals in the three main cities in Norway have been used to study the trend in menarcheal age for women born from about 1830 to about 1960. The investigation is based on a sample of 200-300 records around every 10th year from each of the three clinics in partly overlapping time periods relating to a total of 9152 women. The recollected age at menarche fell from just above 16 years for women born around 1830 to just above 13 years for those born around 1960, the decrease being not totally linear. These results correspond closely with a previously published investigation from Oslo from about the same period of time (Brudevoll, Liestøl and Walløe, 1979), but our results, which cover more of Norway, show a more linearily shaped curve than the results covering only Oslo. We have also analysed the relationships of several independent variables to menarcheal age, using multivariate linear regression methods. Besides the woman's year of birth, which was the most important variable throughout the whole period of time, various geographical variables were found to be of moderate importance. Being born in the countryside and in towns other than Oslo and Bergen led to a slightly higher age at menarche. No significant difference between Oslo, Bergen and Trondheim was detected except for the period up to about 1880 where the Bergen women had about 2.6 months earlier menarche than the Oslo women. Married women amongst the sample had experienced menarche a little earlier than the unmarried, and among married women there was an association between occupation and menarcheal age, women from the lowest social classes having the latest ages at menarche. The importance of these socially related parameters declined with time, and for women born after 1945 the difference seemed to have disappeared. The age at menarche was found to be positively related to a woman's age at first birth; the further back in time the stronger the relation. In addition, delayed age at menarche was also found to be associated with irregularities in the menstrual cycles in later life.

Adult↗

PubMed2005

Assessing alcohol misuse during pregnancy: evaluating psychometric properties of the CAGE, T-ACE and TWEAK in a Brazilian setting.

OBJECTIVE: The present article evaluates the psychometric properties of the Portuguese-language versions of the CAGE, TWEAK and T-ACE questionnaires when used to identify alcohol misuse during pregnancy and compares these to historical data from the English-language versions. Also, construct validity of the Portuguese versions of those instruments was assessed. METHOD: Data were collected from March to September 2000 in three large public maternity wards in Rio de Janeiro, Brazil. Sample size varied according to the analysis. An intra-observer reliability evaluation involved 95 replications carried out within a 24-48 hour period. Kappa was used as an estimator. Cronbach's alpha coefficient, whether or not each item from the analysis was excluded, and the item-rest point-biserial correlations addressed internal consistency (N = 786). For the appraisal of construct validity (n = 528), the relationship between alcohol misuse (evaluated by each instrument according to different cutoff points) and several putative underlying theoretically related dimensions (schooling, age, smoking, marital status, social support, illicit drug use, domestic violence and per capita household income) were evaluated. RESULTS: All kappas were above 0.70. The alpha coefficients for the Portuguese versions ranged from 0.48 to 0.68, a finding consistent with studies assessing the original instruments in English. Yet, irrespective of the instrument concerned a systematic increase was observed whenever the item on morning alcohol use ("Eye-opener") was removed from the analysis. Regarding construct validity, most tested hypotheses were corroborated, except for the CAGE using the cut-off point of 2. CONCLUSIONS: This study confirms other authors' findings that all but the aforementioned CAGE may be recommended to identify heavy alcohol use during pregnancy in general as well as in Portuguese-speaking populations in particular.

Adult↗

PubMed2005

Real time spatial cluster detection using interpoint distances among precise patient locations.

BACKGROUND: Public health departments in the United States are beginning to gain timely access to health data, often as soon as one day after a visit to a health care facility. Consequently, new approaches to outbreak surveillance are being developed. When cases cluster geographically, an analysis of their spatial distribution can facilitate outbreak detection. Our method focuses on detecting perturbations in the distribution of pair-wise distances among all patients in a geographical region. Barring outbreaks, this distribution can be quite stable over time. We sought to exemplify the method by measuring its cluster detection performance, and to determine factors affecting sensitivity to spatial clustering among patients presenting to hospital emergency departments with respiratory syndromes. METHODS: The approach was to (1) define a baseline spatial distribution of home addresses for a population of patients visiting an emergency department with respiratory syndromes using historical data; (2) develop a controlled feature set simulation by inserting simulated outbreak data with varied parameters into authentic background noise, thereby creating semisynthetic data; (3) compare the observed with the expected spatial distribution; (4) establish the relative value of different alarm strategies so as to maximize sensitivity for the detection of clustering; and (5) measure factors which have an impact on sensitivity. RESULTS: Overall sensitivity to detect spatial clustering was 62%. This contrasts with an overall alarm rate of less than 5% for the same number of extra visits when the extra visits were not characterized by geographic clustering. Clusters that produced the least number of alarms were those that were small in size (10 extra visits in a week, where visits per week ranged from 120 to 472), diffusely distributed over an area with a 3 km radius, and located close to the hospital (5 km) in a region most densely populated with patients to this hospital. Near perfect alarm rates were found for clusters that varied on the opposite extremes of these parameters (40 extra visits, within a 250 meter radius, 50 km from the hospital). CONCLUSION: Measuring perturbations in the interpoint distance distribution is a sensitive method for detecting spatial clustering. When cases are clustered geographically, there is clearly power to detect clustering when the spatial distribution is represented by the M statistic, even when clusters are small in size. By varying independent parameters of simulated outbreaks, we have demonstrated empirically the limits of detection of different types of outbreaks.

Ambulatory Care↗

PubMed2005

Oral contraceptives and periodontal diseases: rethinking the association based upon analysis of National Health and Nutrition Examination Survey data.

BACKGROUND: Historic evidence suggests that use of high-dose combined oral contraceptives (OCs) (containing >50 microg of estrogen and>or=1mg progestin) places women at increased risk for periodontal diseases. Since the mid-1970s, OC formulations have dramatically changed. This study investigated the association between OC use and periodontal diseases among 4,930 National Health and Nutrition Examination Survey (NHANES) I and 5,001 NHANES III premenopausal U.S. women, aged 17 to 50 years, before and after the reduction of hormone levels in OCs. METHODS: Data for this cross-sectional study came from the first (NHANES I, 1971 to 1974) and third (NHANES III, 1988 to 1994) NHANES studies. RESULTS: The prevalence of OC use in the U.S. premenopausal female population in NHANES I was 22% and in NHANES III, 20%. Using multivariable logistic regression, a protective association between current OC use and gingivitis was suggestive but not significant in both NHANES I (odds ratio [OR]=0.65; 95% con- fidence interval [CI]: 0.42 to 1.01) and NHANES III (OR=0.80; 95% CI: 0.61 to 1.02) surveys. Current OC use was also associated with a decreased risk of periodontal disease in NHANES I (OR=0.36; 95% CI: 0.13 to 0.96) and a non-significant association in NHANES III (OR=0.73; 95% CI: 0.50 to 1.07). CONCLUSION: This analysis failed to validate the theory that earlier high- or current low-dose OC use is associated with increased levels of gingivitis or periodontitis and suggests an important reexamination of the perceived association between OC use and periodontal diseases.

Adolescent↗

PubMed2004

Barriers to sympatry between avian sibling species (Paridae: Baeolophus) in local secondary contact.

Range limits and secondary contact zones often occur at ecotones between major associations of habitat and climate. Therefore, understanding processes that limit sympatry between species in such areas provides an important framework for testing biogeographic and evolutionary hypotheses. Theoretical and empirical work has shown that the evolution of species borders is influenced by a complexity of factors, including gene flow from central to peripheral populations and the ability of species to adapt locally to environmental conditions. However, few studies have used bioclimatic models, combined with molecular and morphological data, to predict geographic range limits in the context of gene flow across a secondary contact zone. In this study, I applied these methods to test specific hypotheses about barriers to sympatry between closely related species where they approach and contact each other. Specifically, I examined the importance of historical isolation, local adaptation, and symmetry of gene flow in limiting sympatry and range expansion of ecologically distinct species across environmental gradients. Molecular (mitochondrial DNA, allozymes), morphological, and bioclimatic data were obtained for two avian sibling species (Baeolophus inornatus and B. ridgwayi) that exist in recent, narrow secondary contact in northern California. These species are broadly allopatric and occupy rangewide associations of oak and pinyon-juniper woodlands, respectively, although B. inornatus also inhabits mixed or juniper woodlands locally. Patterns of molecular variation generally were congruent with morphological and bioclimatic data, and support prior evidence for a history of isolation, adaptation, and divergence in distinctive, species-specific vegetation-climate associations. However, molecular and morphological clines fall east of the limit of oaks, and individuals of B. inornatus in this juniper-associated contact zone experience bioclimates that are more similar to B. ridgwayi than to B. inornatus in oak habitat. Thus, B. inornatus is able to adapt and expand locally into the range of its close relative, but not vice versa. These data support the hypothesis that gene flow is asymmetrical where peripheral populations meet at range boundaries. Physiological differences between species may play an important role in influencing these patterns. Empirical studies that highlight the importance of local adaptation and patterns of gene flow in which closely related species contact across ecotones are central to understanding limits on geographic ranges, sympatry, and introgression-a cornerstone of biogeographic and speciation theory.

Analysis of Variance↗

PubMed2006

Effect of race and ethnicity on perceptions of inflammatory bowel disease.

BACKGROUND AND AIMS: Historically, inflammatory bowel disease (IBD) was thought to predominantly affect whites. However, IBD is now increasingly recognized in diverse ethnic populations. There is a paucity of studies of IBD in nonwhite populations, especially in Mexican Americans. The aims of this study were to compare the impact of IBD on the quality of life of whites, African Americans, and Mexican Americans and to evaluate differing patient understanding and beliefs regarding IBD. MATERIALS AND METHODS: A questionnaire was administered to 148 patients between June 1999 and November 2003 at a university gastroenterology practice in Houston, Tex. RESULTS: Caucasians (W) comprised 40%, African Americans (AA) 37%, and Mexican Americans (MA) 20% of the respondents. AA and W had predominantly Crohn's disease (CD), whereas MA had predominantly ulcerative colitis (UC; P<0.05). We therefore compared W and AA with CD and W and MA with UC. W were more likely to tell their employers (57% vs 27.5%, P=0.02), fellow employees (68% vs 43.8%, P=0.02) and friends (100% vs 79%, P=0.034) that they had CD. W and AA were equally as likely to have regular checkups by a physician, and there was no difference in the access to gastroenterologists or surveillance colonoscopy. There were fewer differences between MA and W with UC. MA were more likely to believe that UC was caused by stress (70% vs 37%, p=0.044) and cigarette smoking. CONCLUSIONS: Significant differences appear among racial and ethnic groups with IBD regarding attitudes toward disease and impact on daily life. Appreciation of varying ethnic and racial perceptions, attitudes, and beliefs among patients with IBD may be critical to more effective management.

Black or African American↗

PubMed2006

[Spectrum of patients in prehospital emergency services. What has changed over the last 20 years?].

BACKGROUND: In Germany the physician staffed emergency systems have announced an increase in rescue missions over the years. The aim of this study is to analyse the development of the spectrum of patients in an emergency system over the last 20 years in order to highlight the significant changes. METHODS: In a retrospective study we analyzed the prehospital chart views from 2004, 1992 and 1984 with respect to patients' demography, type of rescue mission, degree of internal disease or injury (NACA), state of consciousness (GCS), as well as prehospital interventions performed by prehospital emergency physician. RESULTS: In 2004 (3,825), the absolute number of missions was 2 and 4 times higher than 1992 (2,114) and 1984 (957), resp. In all of these investigated time periods non-trauma missions (74%; 2,812 vs. 66%; 1,390 vs. 51%; 485) were leading, followed by trauma missions (18%; 690 vs. 22%; 464 vs. 39%; 375), aborted missions (3%; 126 vs. 7%; 154 vs. 6%; 56), and dead on arrival (5%; 197 vs. 5%; 106 vs. 4%; 41). Although, the percentage of patients with NACA IV-VI (39% vs. 50%) or patients with GCS < or =8 (18% vs. 34%) was lower in 2004, the absolute number of patients in each category was higher than in 1984 (NACA IV-VI: 1,434 vs. 448, p<0.01; GCS: 672 vs. 303, p<0.01). CONCLUSIONS: The results of this study demonstrate, that the percentage of trauma, severely ill/injured or unconscious patients is lower than in previous years. However, the higher absolute numbers of patients demonstrate that the emergency physician now encounters more critically ill/injured, unconscious and trauma patients. It does not seem necessary to question the qualifications for an emergency physician, which have previously been considered essential for the management of acute life-threatening situations.

Consciousness Disorders↗

PubMed2005

Sleep disturbances and teacher ratings of school achievement and temperament in children.

BACKGROUND: The current study examined the relationships between academic achievement, sleep, temperament and demographic-historical data in school-age children. METHODS: Teachers were asked to fill out the teacher temperament questionnaire and a form for school achievement, while mothers filled out a demographic-historical form and the sleep disturbance scale for children (SDSC), a 26-item questionnaire that consisted of six factors: difficulty in initiating and maintaining sleep (DIMS), sleep breathing disorders (SBD), arousal disorders (DA), sleep-wake transition disorders (SWTD), disorders of excessive somnolence (DOES), sleep hyperhydrosis (SHY). From a sample of 380 school children, 264 (70%) were suitable for the analyses (141 M and 123 F aged 8-11 years, mean 9.6 years). A school achievement index (SAI) was derived, summing up four items (reading ability, reading comprehension, mathematics, executive ability) of the teacher form for school achievement. RESULTS: SAI mean for the total sample was 11.1 (SD=2.8). A significant gender difference was found: females have higher SAI than males. The analysis of the demographic-historical form showed that only two factors appeared to affect SAI score: enuresis and the low educational level of the mother. The pattern of correlations showed that (a) the SAI was negatively related to the SDSC total score, in particular to DIMS and DOES sub-factors, and (b) the SAI was significantly and positively correlated with the temperamental traits of task-orientation and personal-social flexibility. A multiple stepwise regression analysis showed that the temperamental traits task-orientation and personal-social flexibility are the most predictive factors for SAI while the mother's educational level and the SDSC total score, although they contributed significantly to the prediction of SAI, accounted for only a small portion of variance. CONCLUSIONS: Temperament and sleep are important factors influencing school achievement, and their assessment could help to identify children at risk regarding school achievement.

Achievement↗

PubMed2002

An approach to forecasting health expenditures, with application to the U.S. Medicare system.

OBJECTIVE: To quantify uncertainty in forecasts of health expenditures. STUDY DESIGN: Stochastic time series models are estimated for historical variations in fertility, mortality, and health spending per capita in the United States, and used to generate stochastic simulations of the growth of Medicare expenditures. Individual health spending is modeled to depend on the number of years until death. DATA SOURCES/STUDY SETTING: A simple accounting model is developed for forecasting health expenditures, using the U.S. Medicare system as an example. PRINCIPAL FINDINGS: Medicare expenditures are projected to rise from 2.2 percent of GDP (gross domestic product) to about 8 percent of GDP by 2075. This increase is due in equal measure to increasing health spending per beneficiary and to population aging. The traditional projection method constructs high, medium, and low scenarios to assess uncertainty, an approach that has many problems. Using stochastic forecasting, we find a 95 percent probability that Medicare spending in 2075 will fall between 4 percent and 18 percent of GDP, indicating a wide band of uncertainty. Although there is substantial uncertainty about future mortality decline, it contributed little to uncertainty about future Medicare spending, since lower mortality both raises the number of elderly, tending to raise spending, and is associated with improved health of the elderly, tending to reduce spending. Uncertainty about fertility, by contrast, leads to great uncertainty about the future size of the labor force, and therefore adds importantly to uncertainty about the health-share of GDP. In the shorter term, the major source of uncertainty is health spending per capita. CONCLUSIONS: History is a valuable guide for quantifying our uncertainty about future health expenditures. The probabilistic model we present has several advantages over the high-low scenario approach to forecasting. It indicates great uncertainty about future Medicare expenditures relative to GDP.

Accounting↗

PubMed1997

Population history of north Africa: evidence from classical genetic markers.

After an intensive bibliographic search, we compiled all the available data on allele frequencies for classical genetic polymorphisms referring to North African populations and synthesized the data in an attempt to reconstruct the populations' demographic history using two complementary methods: (1) principal components analysis and (2) genetic distances represented by neighbor-joining trees. In both analyses the main feature of the genetic landscape in northern Africa is an east-west pattern of variation pointing to the differentiation between the Berber and Arab population groups of the northwest and the populations of Libya and Egypt. Moreover, Libya and Egypt show the smallest genetic distances with the European populations, including the Iberian Peninsula. The most plausible interpretation of these results is that, although demic diffusion during the Neolithic could explain the genetic similarity between northeast Africa and Europe by a parallel process of gene flow from the Near East, a Mesolithic (or older) differentiation of the populations in the northwestern regions with later limited gene flow is needed to understand the genetic picture. The most isolated groups (Mauritanians, Tuaregs, and south Algerian Berbers) were the most differentiated and, although no clear structure can be discerned among the different Arab- and Berber-speaking groups, Arab speakers as a whole are closer to Egyptians and Libyans. By contrast, the genetic contribution of sub-Saharan Africa appears to be small.

Africa, Northern↗

PubMed2005

Invasion genetics of the Eurasian spiny waterflea: evidence for bottlenecks and gene flow using microsatellites.

The Eurasian spiny waterflea (Bythotrephes longimanus) is a predacious zooplankter that has increased its range in Europe and is rapidly invading inland water-bodies throughout North America's Great Lakes region. To examine the genetics of these invasions, we isolated five microsatellite DNA loci with between 5 and 19 alleles per locus. We sampled three populations where B. longimanus has been historically present (Switzerland, Italy, and Finland) as well as an introduced European population (the Netherlands) and three North American populations (Lakes Erie, Superior, Shebandowan). Consistent with a bottleneck during colonization (i.e. founder effect), average heterozygosities of the four European populations ranged from 0.310 to 0.599, and were higher than that of three North American populations (0.151-0.220). Pairwise F(ST) estimates among North American populations (0.002-0.063) were not significantly different from zero and were much lower than among European populations (0.208-0.474). This is consistent with a scenario of high gene flow among North American populations relative to that of European ones. Contrary to an invasion bottleneck, however, Erie and Superior populations contained similar numbers of rare alleles as European populations. Assignment tests identified several migrant genotypes in all introduced populations (the Netherlands, Erie, Superior, Shebandowan), but rarely in native ones (Switzerland, Italy and Finland). A large number of genotypes from North America were assigned to our Italian population suggesting a second, previously unidentified, invasion source somewhere in the region of northern Italy. Together, our results support an invasion bottleneck for North American populations that has been largely offset by gene flow from multiple native sources, as well as gene flow among introduced populations.

Animals↗

PubMed2006

Extreme temperatures and mortality: assessing effect modification by personal characteristics and specific cause of death in a multi-city case-only analysis.

BACKGROUND: Extremes of temperature are associated with short-term increases in daily mortality. OBJECTIVES: We set out to identify subpopulations and mortality causes with increased susceptibility to temperature extremes. METHODS: We conducted a case-only analysis using daily mortality and hourly weather data from 50 U.S. cities for the period 1989-2000, covering a total of 7,789,655 deaths. We used distributions of daily minimum and maximum temperature in each city to define extremely hot days (>/= 99 th percentile) and extremely cold days (</= 1st percentile) , respectively. For each (hypothesized) effect modifier, a city-specific logistic regression model was fitted and an overall estimate calculated in a subsequent meta-analysis. RESULTS: Older subjects [odds ratio (OR) = 1.020 ; 95% confidence interval (CI) , 1.005-1.034], diabetics (OR = 1.035 ; 95% CI, 1.010-1.062) , blacks (OR = 1.037 ; 95% CI, 1.016-1.059) , and those dying outside a hospital (OR = 1.066 ; 95% CI, 1.036-1.098) were more susceptible to extreme heat, with some differences observed between those dying from a cardiovascular disease and other decedents. Cardiovascular deaths (OR = 1.053 ; 95% CI, 1.036-1.070) , and especially cardiac arrest deaths (OR = 1.137 ; 95% CI, 1.051-1.230) , showed a greater relative increase on extremely cold days, whereas the increase in heat-related mortality was marginally higher for those with coexisting atrial fibrillation (OR = 1.059 ; 95% CI, 0.996-1.125) . CONCLUSIONS: In this study we identified several subpopulations and mortality causes particularly susceptible to temperature extremes. This knowledge may contribute to establishing health programs that would better protect the vulnerable.

Adolescent↗

PubMed2006

The influence of race on the attitudes of radiation oncology patients towards clinical trial enrollment.

OBJECTIVES: Enrollment of adult cancer patients in clinical trials remains low, particularly in the minority population. Understanding patient attitudes towards clinical trials during the recruitment process may enhance accrual. Unfortunately, data describing patient attitudes towards clinical trials are limited, particularly in the radiation oncology clinic setting. METHODS: A piloted questionnaire assessing basic demographics and attitudes toward clinical trials was offered in 2 radiation oncology clinics between April 2003 and October 2003. The questionnaire was completed by 166 patients. The mean age of the patients completing the questionnaire was 56 years (range, 15-84 years). Of the 166 patients included in the analysis, 108 (65%) were White. The most common cancer diagnoses included prostate (19%), head and neck (16%), and breast (14%). RESULTS: There was no statistical difference between Whites and non-Whites regarding their interest in learning about clinical trials (84.3% versus 84.9%, P = 0.92); nor was there a significant difference in the rate of previous or current trial enrollment (21.3% versus 34.0%, P = 0.08). White patients were more likely to gather information about clinical trials from the Internet (30.6% versus 11.3%, P = 0.007), and they were more likely to use physicians as a source of this information (50.0% versus 34.0%, P = 0.05). Non-White patients were more likely to obtain information about clinical trials from other patients (24.5% versus 12.0%, P = 0.04). In addition, more non-White patients believed they had been treated on clinical trials without their knowledge (21.6% versus 9.3%, P = 0.032). Patients differed somewhat in their expectations of clinical trials. More non-Whites indicated that they would need a >50% chance of benefiting from a trial (64.4% versus 45.0%, P = 0.03) to enroll on that trial, though there were no statistical differences in outlook towards potential toxicities associated with treatment on a clinical trial. CONCLUSIONS: Minority patients historically enroll in clinical trials at a significantly lower rate. Our study of radiation oncology patients documents significant differences in attitudes towards clinical trials between Whites and non-Whites. Understanding the differences in attitudes may allow physicians to overcome barriers that would otherwise hinder the enrollment of non-White patients into clinical trials.

Adolescent↗

PubMed2006

Asylum nursing as a career in the United Kingdom, 1890-1910.

BACKGROUND: Nursing staff in lunatic asylums provided the day-to-day care and containment of patients and were the direct occupational ancestors of today's mental health nurses. AIM: This study explores (1) How was asylum nursing seen by asylum nurses themselves and by others, particularly other healthcare workers? (2) What were the demographic characteristics of those who became asylum nurses and what were their patterns of employment? METHODS: Information regarding contemporary views of asylum nursing were gathered through searching a range of contemporary journals and other publications. Statistical information regarding patterns of employment was gathered from asylum records and census data. FINDINGS: During the period from 1890 to 1910 the image of asylum nursing was poor. Allegations of brutality continued to effect its image, despite claims by asylum nurses and medical superintendents that such generalizations were unfair and that asylum nursing was at least as valuable as any other from of nursing. The middle class leadership of voluntary hospital general nursing was particularly critical. At the Three Counties Asylum in Southern England, the majority of asylum nurses came from unskilled or semi-skilled backgrounds. 43% were recruited locally; 43% of nursing staff left after less than a year, and less than a quarter remained after 3 years. Even those individuals thought to be suitable by prior experience, such as ex-servicemen, often did not stay long. Dismissals were common, especially amongst male staff (22%). The discipline was hard, hours long and the work often unpleasant. CONCLUSIONS: For asylum nurses conditions were poor, the work difficult and their public image negative. The reality was that people from working class backgrounds entered asylum nursing at a relatively young age, often travelling some distance to do so, and then many only stayed for short periods. However, some women were able to take advantage of the possibilities offered by asylum work to develop a career for themselves in the absence of other opportunities.

Adolescent↗

PubMed1982

The World Fertility Survey: charting global childbearing.

Interviewing some 350,000 women in 42 developing countries and 20 developed countries representing nearly 40% of the world's population, the World Fertility Survey (WFS) is in a unique position to document the historic 1970s slowdown in global population growth. This Bulletin describes efforts begun in 1972 to ensure high quality, internationally comparable, accessible data, the data's importance for policymakers, planners and researchers, and major findings available by early 1982 from directly assisted WFS surveys in 29 developing countries and contraceptive use data from WFS-type surveys in 16 developed countries. Marital fertility has declined in all developing regions except Africa but still averages from 4.6 children/woman in Latin America to 6.7 in Africa, while preferred family size ranges from 3.0 children in Turkey to 8.9 in Senegal--far above the average 2.2-2.5 children/woman needed to end developing countries' population growth in the long run. However, women ages 15-19 prefer nearly 2 children fewer than the oldest women ages 45-49; 3.8 vs. 5.7 on the average. Nearly 1/2 (48%) of married women surveyed in 27 countreis said they wanted no more children. Preventing all unwanted births would reduce birth rates up to 15 births/1000 population in these countries. Overall, 32% of married, fecund women in developing countries are using contraception compared to an average 72% in 16 developed countries. Education, literacy, and more available family planning services increase contraceptive use. Age at marriage is rising in Asia, but this factor alone has little effect on fertility. Infant mortality is higher in many developing countries than previously thought. Breastfeeding is an important restraint on fertility in most developing countries but is declining among more educated, employed, and urban women which could raise fertility if not compensated for by gains in contraceptive use.

Africa↗

PubMed2005

The health status of southern children: a neglected regional disparity.

PURPOSE: Great variations exist in child health outcomes among states in the United States, with southern states consistently ranked among the lowest in the country. Investigation of the geographical distribution of children's health status and the regional factors contributing to these outcomes has been neglected. We attempted to identify the degree to which region of residence may be linked to health outcomes for children with the specific aim of determining whether living in the southern region of the United States is adversely associated with children's health status. METHODS: A child health index (CHI) that ranked each state in the United States was computed by using state-specific composite scores generated from outcome measures for a number of indicators of child health. Five indicators for physical health were chosen (percent low birth weight infants, infant mortality rate, child death rate, teen death rate, and teen birth rates) based on their historic and routine use to define health outcomes in children. Indicators were calculated as rates or percentages. Standard scores were calculated for each state for each health indicator by subtracting the mean of the measures for all states from the observed measure for each state. Indicators related to social and economic status were considered to be variables that impact physical health, as opposed to indicators of physical health, and therefore were not used to generate the composite child health score. These variables were subsequently examined in this study as potential confounding variables. Mapping was used to redefine regional groupings of states, and parametric tests (2-sample t test, analysis of means, and analysis-of-variance F tests) were used to compare the means of the CHI scores for the regional groupings and test for statistical significance. Multiple-regression analysis computed the relationship of region, social and economic indicators, and race to the CHI. Simple linear-regression analyses were used to assess the individual effect of each indicator. RESULTS: A geographic region of contiguous states, characterized by their poor child health outcomes relative to other states and regions of the United States, exists within the "Deep South" (Mississippi, Louisiana, Arkansas, Tennessee, Alabama, Georgia, North Carolina, South Carolina, and Florida). This Deep-South region is statistically different in CHI scores from the US Census Bureau-defined grouping of states in the South. The mean of CHI scores for the Deep-South region was >1 SD below the mean of CHI scores for all states. In contrast, the CHI score means for each of the other 3 regions were all above the overall mean of CHI scores for all states. Regression analysis showed that living in the Deep-South region is a stronger predictor of poor child health outcomes than other consistently collected and reported variables commonly used to predict children's health. CONCLUSIONS: The findings of this study indicate that region of residence in the United States is statistically related to important measures of children's health and may be among the most powerful predictors of child health outcomes and disparities. This clarification of the poorer health status of children living in the Deep South through spatial analysis is an essential first step for developing a better understanding of variations in the health of children. Similar to early epidemiology work linking geographic boundaries to disease, discovering the mechanisms/pathways/causes by which region influences health outcomes is a critical step in addressing disparities and inequities in child health and one that is an important and fertile area for future research. The reasons for these disparities may be complex and synergistically related to various economic, political, social, cultural, and perhaps even environmental (physical) factors in the region. This research will require the use and development of new approaches and applications of spatial analysis to develop insights into the societal, environmental, and historical determinants of child health that have been neglected in previous child health outcomes and policy research. The public policy implications of the findings in this study are substantial. Few, if any, policies identify these children as a high-risk group on the basis of their region of residence. A better understanding of the depth and breadth of disparities in health, education, and other social outcomes among and within regions of the United States is necessary for the generation of policies that enable policy makers to address and mitigate the factors that influence these disparities. Defining and clarifying the regional boundaries is also necessary to better inform public policy decisions related to resource allocation and the prevention and/or mitigation of the effects of region on child health. The identification of the Deep South as a clearly defined subregion of the Census Bureau's regional definition of the South suggests the need to use more culturally and socially relevant boundaries than the Census Bureau regions when analyzing regional data for policy development.

Adolescent↗