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PubMedDate not supplied

Factors influencing plasma zinc levels in low-income pregnant women.

Plasma zinc (Zn) concentrations were measured in 4376 indigent women (86% African-American), at at mean (+/- SD) gestational age of 15 (+/- 7.8) wk to determine the relationship between various maternal characteristics and plasma Zn levels during pregnancy. Mean Plasma An levels were lower in African-American women than in Caucasian women, in multiparous women than in primiparous women, and in women with body weight > 69.9 kg than in those with body weight < or = 69.9 kg (p < or = 0.001 for each comparison). There were no significant differences related to maternal age, marital status, education, or smoking habit. Multiple regression analysis, including maternal prepregnancy weight, race, age, parity, smoking habit, education, and marital status indicated that race, parity, and pregnancy weight were significantly associated with maternal plasma Zn levels, adjusted for gestational age. Maternal race was the best predictor of plasma Zn concentrations among the population of pregnant women studied A significant proportion of variance in maternal plasma Zn levels. remained unexplained after taking into account various maternal characteristics. The reasons for lower plasma Zn levels in African-American women, compared to Caucasian women, during pregnancy are unknown.

Adolescent↗
PubMed2000

Anemia in children: early iron supplementation.

Iron deficiency anemia is the most wide spread micronutrient deficiency disorder in the world, being most prevalent in women and young children. The present study was conducted to find out the prevalence of anemia in children and its contributory factors with reference to early iron supplementation. It was a cross sectional study done on 137 children of age 1-2 years in urban slums of Meerut. Prevalence of anemia in the study group was 59.9%. The socio-economic status, mother's educational status, birth weight, sibling order, and type of weaning food did not show any significant relationship with the prevalence of anemia in these children, whereas, weaning time, nutritional status and early iron supplementation had a positive impact on it. Exclusive breast feeding upto 4 months followed by weaning, adequate nutritional status and early iron supplementation have a definite role in prevention of anemia in children.

Age Factors↗
PubMed2005

Predictors of participation in clinical and psychosocial follow-up of the kConFab breast cancer family cohort.

INTRODUCTION: Prospective collection of epidemiological, psychosocial and outcome data in large breast cancer family cohorts should provide less biased data than retrospective studies regarding penetrance of breast cancer and modifiers of genetic risk. METHODS: The Kathleen Cuningham Foundation for Research into Breast Cancer (kConFab) recently commenced 3-yearly follow-up on over 750 families with multiple cases of breast cancer. Clinical follow-up was by mailed self-report questionnaire to all participants, while psychosocial follow-up was only of unaffected women and consisted of two components: a mailed questionnaire and an interview regarding stressful life events. RESULTS: To date, 1928 of 2748 (70%) participants returned the clinical follow-up questionnaire (10% opted out, 16% were non-responders, and 4% were not contactable). Of the unaffected females who returned the clinical follow-up questionnaire, 91% participated in the psychosocial follow-up. In multivariate analyses, sex, personal cancer status, marital status, age and educational status were independent predictors of response to the clinical follow-up questionnaire, and number of female children, age, and family history of breast cancer were independent predictors of response to the psychosocial follow-up. CONCLUSIONS: A first round of 3-yearly clinical and psychosocial follow-up using a mailed questionnaire was feasible in this cohort. High response rates were achieved by employing intensive tracing and reminder strategies. The predictors of response for the clinical and psychosocial follow-up components of this study should be considered in designing similar follow-up strategies for other family cancer cohorts.

Adult↗
PubMed1996

Use of analgesics in Sweden--the importance of sociodemographic factors, physical fitness, health and health-related factors, and working conditions.

In this study, factors related to analgesic use-independent of their association with pain-were studied in the general Swedish population. These included sociodemographics, health and health-related factors, physical fitness and working conditions. Data from the Swedish Survey of Living Conditions for the two-year period 1988/89 were used. In this survey a random sample (n = 13,295, response rate 79.4%) of the Swedish population aged 16 years and older was interviewed about health, medication use and related matters, among other things. In all, 35% of the population used analgesics at least once during a two-week period, and analgesic use was more than 50% higher among women than men. Analgesic use was less common among those aged 45-64 years and 65-74 years than those 18-44, after controlling for all other variables. The study showed that self-perceived poor health and pain explain much analgesic use. Analgesic use is further explained by lifestyle, sleeping problems, and health care utilization. Marital status, educational level, socioeconomic status, social network and working conditions were found to be of minor importance.

Adolescent↗
PubMed1996

Schooling, employment, and idleness in young adults with serious physical health conditions: effects of age, disability status, and parental education.

PURPOSE: Education, employment, and "idleness" in young adults with ongoing physical health conditions were examined in relation to parents' education and respondent's age and co-existing disabilities. METHODS: Telephone interviews were conducted with 421 individuals aged 20-24 years randomly drawn from public health programs in two midwestern states. In addition to a chronic health condition, 18% of the sample also had mental retardation, 21% also had a physical disability (but no retardation), and 11% also had a learning disability (but no mental retardation or physical disability). Youth were considered "idle" if they were not in school, not employed, not married, and had no children. RESULTS: Thirty-seven percent of the sample were enrolled in an educational program, and 48% were employed either part-time or full-time. Seventeen percent were both in school and employed, 50% were in school or employed, and 33% were neither in school nor working. Overall, 23% of the sample were idle. Youth with mental retardation were two to three times more likely to be in school compared to youth with a chronic physical condition alone. Youth with mental retardation and physical disabilities were less likely to be employed and more likely to be idle compared to youth with only a chronic condition. Parental education affected rates of schooling and employment. Compared to a general population sample of youth in the same states, youth with ongoing health problems were at higher risk for idleness. CONCLUSIONS: Youth with chronic health conditions and either mental retardation or physical disabilities are at higher risk for idleness compared to youth with a chronic condition alone or to youth in general.

Adult↗
PubMed2003

Why most women in Syria do not smoke: can the passive barrier of traditions be replaced with an information-based one?

To explore the subjective motivations why most Syrian women do not smoke, we performed a cross-sectional survey among primary healthcare patients in Aleppo using an interviewer-administered questionnaire with motivations categorized as traditions and norms, family values, health concerns, personal conviction, economic, religious and other. Study participants (n = 240) had a mean age of 29 years. Among non-smokers, traditions and norms, and health concerns were the main reasons for not smoking, followed by family values, husband's views about smoking, personal conviction, economic reasons and religious reasons. Motivations differed according to the participants' previous smoking, marital and educational status. Better-educated women tended to have their own motives based on a more complete awareness of the smoking problem. Tobacco control efforts should aim at replacing the passive barrier of traditions with a well-informed positive one.

Adolescent↗
PubMed1999

A retrospective cohort study of post mastectomy pain syndrome.

Post mastectomy pain syndrome is a condition which can occur following breast surgery and has until recently been regarded as uncommon. Recent reports have suggested that it may affect 20% or more of women following mastectomy. The symptoms are distressing and may be difficult to treat however treatment for neuropathic pain can be successful. This paper reports a retrospective cohort of consecutive mastectomy cases over a six year period in one region of whom 511 survivors were traced and eligible for survey. A total of 408 completed a questionnaire survey which revealed that 175 (43%) had ever suffered from postmastectomy pain syndrome and 119 (29%) reported current symptoms although the majority were decreasing in intensity. A striking finding was the very high cumulative prevalence in younger women (65%) decreasing to 26% in the over 70 year group. The details of the onset, frequency and intensity of symptoms are described along with their natural history. The age effect on the frequency of the syndrome influences the marital status, employment status, housing, and educational status of those who report typical symptoms. Body weight and height are also associated with the frequency of post mastectomy pain syndrome. Relationship between the frequency of post mastectomy pain syndrome and radiotherapy, chemotherapy and the use of tamoxifen are difficult to unravel because of the combinations of pre and post operative treatments received confounded by age. The implications of a much higher frequency of post mastectomy pain are discussed with regard to management and counselling. The high frequency of the syndrome in the younger women is important and possible explanations are explored.

Adult↗
PubMed1998

Transitions in health-related quality of life during the first nine months after diagnosis with prostate cancer.

Health-Related Quality of Life (HRQOL) is an important outcome measure in the study of prostate cancer. There are few data regarding the effect of sociodemographic variables, such as insurance status, educational level, marital status or income, on HRQOL. We examined whether these or other sociodemographic and clinical variables are predictive of HRQOL outcomes using an observational database of prostate cancer patients accrued from a wide array of clinical practice settings. We studied 131 patients with newly-diagnosed prostate cancer who had been followed for at least nine months. Patients were enrolled in CaPSURE(TM), a large, observational database of patients with prostate cancer. General and disease-specific HRQOL were measured with established, validated instruments at diagnosis and nine months later. Sociodemographic data and co-morbidity counts were recorded at baseline. Multivariate regression analysis was used to determine whether sociodemographic or clinical variables were predictive of baseline HRQOL or HRQOL changes during the study period. Several sociodemographic and clinical variables demonstrated significant associations with HRQOL. We found improvements in general and disease-specific domains of HRQOL during the nine months after diagnosis. For married patients, Emotional Well-Being and Family Functioning scores were better at baseline (+11.8, P<0.02), but Family Functioning declined over the nine month study period (-18.5, P=0.0006). Older patients had slightly better baseline performance in several domains of HRQOL, but experienced greater HRQOL decrements over time than did younger patients. Increasing comorbidity was associated with worse baseline general HRQOL. Early tumor stage was predictive of better scores in general HRQOL domains at baseline. Limited palpable disease stage (T2A/T2B) was predictive of worse Sexual Function and Sexual Bother at nine months (-8.6, P=0.04; -24, P=0.008). After initial decreases, patients appear to experience an improvement in general and disease-specific HRQOL within nine months of initial diagnosis with prostate cancer. Marital status is associated with better HRQOL, while advancing age is associated with more significant HRQOL declines over time. Patients with lower stage disease were noted to have better general HRQOL at baseline, although decreases in the physical domains were noted at nine months. These data shed new light on patients' experience with prostate cancer and suggest that HRQOL outcomes over time may occur in a predictable manner.

Journal Article↗
PubMed2000

Establishing the efficacy and cost effectiveness of community intensive case management of long-term mentally ill: a matched control group study.

OBJECTIVE: The study attempted to identify whether chronic mentally ill persons after receiving intensive case management (ICM) could demonstrate improved inpatient service utilisation compared with a matched control group cohort. Costings were measured to observe whether the increase in providing intensive outpatient contacts would be offset by savings in reduced inpatient service utilisation. METHOD: Eighty ICM patients were matched on ICD-9 diagnosis, age, gender, length of illness, age at first inpatient and outpatient contact, marital status, educational level, employment status, country of birth, year of arrival to Australia and religion. Inpatient bed-days and outpatient contacts were recorded and compared 12 months prior to ICM treatment, 12 and 24 months after ICM using within/between group repeated measures analysis of variance. RESULTS: The ICM group demonstrate significant reductions in inpatient service utilisation both within the 12- and 24-month period after receiving ICM treatment. The cost differential by 24 months of treatment was $801,475 in favour of the ICM model. The increase in costs of outpatient contacts were offset by a significant reduction in inpatient service utilisation. CONCLUSION: When outpatient contacts averaged one contact a week for the duration of the study period no significant reductions in inpatient service utilisation was recorded, as demonstrated by comparison with the matched control group. By increasing outpatient contacts by 3-4 contacts a week, inpatient contacts reduced by 36.8%. ICM is an efficacious and cost effective way to implement community-based services to the chronically long-term mentally ill.

Adult↗
PubMed2005

Assessing the effects of race and ethnicity on use of complementary and alternative therapies in the USA.

OBJECTIVE: To investigate the use of alternative therapies among different racial/ethnic groups in the USA. Specifically, we examined whether alternative medicine use differs for working aged whites, Asian Americans, African Americans, and Hispanics. DESIGN: Using the 1996 Medical Expenditure Panel Survey, racial differences in utilization were investigated at two levels: (1) the bivariate level with no controls for other factors and (2) at the multivariate level with controls for age, sex, region, marital status, education, income, health status, satisfaction with conventional healthcare, and access measures. RESULTS: Americans in this sample population used alternative and complementary therapies at a fairly low rate (6.5%). This 6.5%, however, was not consistent across all groups. African Americans and Hispanics were less likely than whites to utilize alternative therapies, whereas Asian Americans did not differ significantly from whites. CONCLUSIONS: The use of alternative and complementary therapies varied across racial/ ethnic groups. Evidence showed that individuals who were dissatisfied with the availability of conventional healthcare, who were in poor health, but very satisfied with their conventional provider were more likely to use complementary and alternative medicine (CAM) therapies. The addition of these variables to a logistic regression model did not change the findings for differential use by ethnicity, the relative ranking of groups, or the overall strength of the relationship.

Adolescent↗
PubMed2004

Association between depressive symptoms and serum concentrations of homocysteine in men: a population study.

BACKGROUND: Results of studies of the association between blood concentrations of homocysteine and depression in general populations and among psychiatric patients are inconsistent. OBJECTIVE: The objective was to study the association between depression and serum concentrations of total homocysteine (tHcy). DESIGN: A cross-sectional study of a sample of 924 men aged 46-64 y was conducted as a part of the Kuopio Ischaemic Heart Disease Risk Factor Study. Those who had a history of psychiatric disorder (6.0%) were excluded. Depressive symptoms were assessed with the 18-item Human Population Laboratory Depression Scale. Those who scored > or =5 at baseline or at the 4-y follow-up were considered to have a tendency toward depression. RESULTS: The participants were ranked according to their blood tHcy concentration and divided into tertiles. Those in the upper tertile for serum tHcy had a more than twofold (odds ratio: 2.30; 95% CI: 1.35, 3.90; P=0.002) higher risk of being depressed than did those in the lowest tertile for serum tHcy. The results remained significant after adjustment for the month of study, history of ischemic heart disease, smoking habits, alcohol consumption, marital status, education, and socioeconomic status in adulthood (odds ratio: 2.23; 95% CI: 1.30, 3.83; P=0.004). CONCLUSION: High serum concentrations of tHcy may be associated with depression in middle-aged men.

Cohort Studies↗
PubMed2003

Social relations in women with coronary heart disease: the effects of work and marital stress.

BACKGROUND: Studies have previously shown that psychosocial stress, related to both work and family, is associated with the increased risk of coronary heart disease (CHD) morbidity and mortality. The objective of this study was to examine how social relations are affected by marital stress and work stress in a population-based sample of Swedish women with CHD. METHOD: Data was obtained from the Stockholm Female Coronary Risk Study, comprising 292 women aged 65 years or younger, with a mean age of 56 (SD=7) years admitted for an acute event of CHD and examined 3-6 months after hospitalization. Marital and work stress was assessed using the Stockholm Marital Stress Scale and the Swedish version of the Karasek demand-control questionnaire, respectively. Condensed versions of the Interview Schedule for Social Interaction (ISSI) and of Interpersonal Support Evaluation List (ISEL) were used to assess social relations and social support. RESULTS: Marital stress was associated with less social integration (P<0.001), less appraisal support (P<0.001), a lower sense of belonging (P<0.01) and less tangible support (P<0.01) even after controlling for work stress. Adjustment for age, socioeconomic status (education and occupational status) did not alter these results significantly. Work stress did not show statistically significant effects on any of the measured social relations. CONCLUSION: The present study showed that marital stress influenced women's social relations. These results suggest that marital stress needs to be further investigated not only as an independent but also as an interactive risk factor for women with CHD.

Adult↗
PubMed2006

The role of cardiovascular disease in the identification and management of depression by primary care physicians.

OBJECTIVE: The objective of this study was to describe the influence of cardiovascular disease (CVD) on identification and management of depression by primary care physicians. METHOD: Three hundred fifty-five adults with and without significant depressive symptoms who were screened in primary care offices and invited to participate completed a baseline in-home assessment. CVD was assessed by self-report and psychologic status was assessed with commonly used, validated standard questionnaires. At the index visit, doctors' ratings of depression and reports of active management were obtained on 340 of the 355 patients who completed in-home interviews. RESULTS: Older adults who reported heart failure were more likely to be identified as depressed than were older adults who did not report heart failure (unadjusted odds ratio [OR]: 2.34; 95% confidence interval [CI]: 1.13-4.85; Wald chi(2) = 5.20, df = 1, p = 0.023). In multivariate models that controlled for potentially influential characteristics such as age, marital status, education, ethnicity, functional status, level of depression, cognitive impairment, attitudes about depression, use of medical care, and number of medications, the findings remained statistically significant. Among older adults identified as depressed, older adults with heart failure were significantly less likely to be actively managed for depression than were older adults without heart failure (unadjusted OR: 0.33; 95% CI: 0.14-0.76; Wald chi(2) = 6.73, df = 1, p = 0.009). After controlling for potentially influential covariates, these findings remained substantially unchanged. CONCLUSIONS: CVD, in particular heart failure, may influence the identification and management of depression among older patients by primary care physicians. The findings underlie the importance of developing interventions that integrate the management of depression and CVD in primary care settings.

Aged↗
PubMed2004

Urbanization and hospital admission rates for alcohol and drug abuse: a follow-up study of 4.5 million women and men in Sweden.

AIMS: This study analyses whether the level of urbanization is associated with hospital admissions for alcohol and drug abuse, after adjustment for individual demographic and socio-economic characteristics. DESIGN: Follow-up study from 31 December 1996 to 31 December 1999. SETTING: Sweden. PARTICIPANTS: The entire Swedish population aged 25-64 yeras, in total 4.5 million women and men. MEASUREMENTS: Hospital admission rates for alcohol abuse (12,812 events) and drug abuse (6459 events). Level of urbanization was defined by population density and divided into quintiles. Cox proportional hazard models were used to analyse the data. FINDINGS: The results showed an apparent gradient for both women and men; with increasing level of urbanization the hospital admission rates for alcohol abuse and drug abuse increased sharply. After adjustment for age, marital status, education and immigrant status, the hazard ratios for hospital admission for alcohol abuse were 1.76 [confidence interval (CI) = 1.58-1.96] for women and 1.71 (CI = 1.60-1.82) for men in the most densely populated areas (quintile 5). For drug abuse the corresponding hazard ratios were 1.89 (CI = 1.67-2.15) for women and 2.38 (CI = 2.12-2.67) for men. CONCLUSIONS: A high level of urbanization was associated with increased hospital admission rates for alcohol abuse and drug abuse. The level of urbanization should be considered in the distribution of resources for prevention and treatment of alcohol and drug abuse.

Adult↗
PubMed1997

Older women and hormone replacement therapy: factors influencing late life initiation.

OBJECTIVE: To describe factors associated with initiation of hormone replacement therapy (HRT) by older women. DESIGN: A cross-sectional study of 671 randomly selected women aged 65 to 80 who participated in a larger telephone survey on preventive health behaviors. SETTING: A large health maintenance organization (HMO) in Seattle, Washington. PARTICIPANTS: Of the 521 women who responded (78%), 51 had begun taking HRT at age 60 or older and were identified as initiators. Women who had never used HRT or past users who had begun HRT before age 60 were classified as noninitiators (n = 362). Current users who started HRT before age 60 (n = 108) were excluded. MEASUREMENTS: Sources included the telephone survey, automated HMO pharmacy data, and HMO utilization and provider databases. RESULTS: Initiators were similar to noninitiators with respect to age, marital status, education, and health status. Initiators were more likely to have had a hysterectomy at age 60 or later than noninitiators. Sixty-two percent of the non-initiators said they had received no information about the benefits of HRT from their providers compared with 18% of initiators. HRT initiation was associated with belief in prevention benefits of HRT for fractures and cardiovascular disease and with reported encouragement from the physician to use HRT. CONCLUSIONS: Other than hysterectomy status, there were few sociodemographic or health characteristics that markedly distinguished older initiators from noninitiators. Our findings show the importance of physician counseling in an older woman's decision to initiate HRT.

Age Factors↗
PubMed2001

Consumption of alcoholic beverages and subjective health in Spain.

STUDY OBJECTIVE: To examine the relation between alcohol and main alcoholic beverage consumption and subjective health in Spain. DESIGN: Logistic regression analysis using a cross sectional survey based on self reported data on alcohol and alcoholic beverage consumption, subjective health and the principal confounding factors (age, sex, civil status, educational level, job status, social support, region of residence, size of town or city, tobacco consumption, physical activity during leisure time and work hours, and chronic disease). SETTING: The 1993 Spanish National Health Survey. PARTICIPANTS: A 19 573 person sample, representative of the non-institutionalised Spanish population aged 16 years and over. MAIN RESULTS: Among Spaniards, 31.4% reported their health as suboptimal (fair, poor or very poor) and 56.9% consumed alcohol regularly, with the majority having a preference for wine. Light (1-2 drinks per day) or moderate consumption (3-4 drinks per day) was the most frequent pattern. After adjusting for confounding factors, a negative dose-response relation was observed between consumption of total alcohol, wine and beer, and prevalence of suboptimal health (linear trend: p<0.001 for total alcohol, p=0.023 for wine, and p=0.030 for beer). In contrast, for consumption of spirits the prevalence of ill health in moderate drinkers was lower than in non-drinkers, with no clear relation at higher consumption. While persons reporting a preference for wine had a lower frequency of suboptimal health than did abstainers, they showed no difference in frequency of subjective ill health with respect to persons with preference for other types of drink or no preference whatsoever. CONCLUSIONS: The higher the consumption of total alcohol, wine and beer, the lower the prevalence of suboptimal health. These results differ from those obtained in several Nordic countries, where a "J shaped" relation has been observed for total alcohol and wine, and suggest that the relation between alcohol consumption and subjective health may be different in Mediterranean countries.

Adolescent↗
PubMed2004

The effects of budget, delegation, and other variables on the future of school nursing.

The purpose of this exploratory research study was to survey Kansas school nurses to determine the impact of budget, delegation, and other variables on the future of school nursing. Issues of education and certification status, educational budget, delegation, school nurse-to-student ratio, number of school buildings assigned, Metropolitan Statistical Area, and years of school nursing experience were also investigated. The Budget Impact School Nurse Questionnaire online survey was used to gather data. Findings revealed that school nurses were well prepared academically, but that many school nurses lacked certification. The use of UAPs and the future of school nursing were significantly affected by budget constraints, delegation, number of buildings assigned, legislative contact, and Metropolitan Statistical Area (urban location). Education in delegation and years of experience as a school nurse significantly affected opportunities for health education. The findings depicted budget, school nurse staffing, delegation, and geographic areas as the main variables that have an impact on school nursing.

Adult↗