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PubMed2003

Association between clinically meaningful behavior problems and overweight in children.

OBJECTIVE: To determine whether there is a relationship between clinically meaningful behavior problems and concurrent and future overweight in 8- to 11-year-old children. METHODS: 1998 National Longitudinal Survey of Youth interview data for 8- to 11-year-old children and their mothers were analyzed. A Behavior Problems Index score >90th percentile was considered clinically meaningful. Child overweight was defined as a body mass index (BMI) >or=95th percentile for age and sex. Multiple logistic regression was used to control for potential confounders (selected a priori): child's sex, race, use of behavior-modifying medication, history of academic retention, and hours of television per day; maternal obesity, smoking status, marital status, education, and depressive symptoms; family poverty status; and Home Observation for Measurement of the Environment-Short Form (HOME-SF) cognitive stimulation score. In an attempt to elucidate temporal sequence, a second analysis was conducted with a subsample of normal-weight children who became overweight between 1996 and 1998 while controlling for BMI z score in 1996. RESULTS: The sample included 755 mother-child pairs. Of the potential confounding variables, race, maternal obesity, academic grade retention, maternal education, poverty status, and HOME-SF cognitive stimulation score acted as joint confounders, altering the relationship between behavior problems and overweight in the multiple logistic regression model. With these covariates in the final model, behavior problems were independently associated with concurrent child overweight (adjusted odds ratio: 2.95; 95% confidence interval: 1.34-6.49). The relationship was strengthened in the subsample of previously normal-weight children, with race, maternal obesity, HOME-SF cognitive stimulation score, and 1996 BMI z score acting as confounders (adjusted odds ratio: 5.23; 95% confidence interval: 1.37-19.9). CONCLUSIONS: Clinically meaningful behavior problems in 8- to 11-year-old children were independently associated with an increased risk of concurrent overweight and becoming overweight in previously normal-weight children.

Body Mass Index↗

PubMed1996

Diet and Parkinson's disease. II: A possible role for the past intake of specific nutrients. Results from a self-administered food-frequency questionnaire in a case-control study.

In a case-control study, we compared the past dietary habits of 342 Parkinson's disease (PD) patients recruited from nine German clinics with those of 342 controls from the same neighborhood or region. Data were gathered with a structured interview and a self-administered food-frequency questionnaire. Nutrient intakes were calculated from the reported food intakes through linkage with the German Federal Food Code and analyzed using multivariate conditional logistic regression to control for total energy intake, educational status, and cigarette smoking. At the macronutrient level, patients reported higher carbohydrate intake than controls after adjustment for total energy intake, smoking, and educational status (OR = 2.74, 95% confidence interval [CI]: 1.30-6.07, for the highest versus lowest quartile, p trend = 0.02). This was reflected in higher monosaccharide and disaccharide intakes at the nutrient level. There was no difference between patients and controls in protein and fat intake after adjustment for energy intake. We found an inverse association between the intakes of beta-carotene (OR = 0.67, 95% CI: 0.37-1.19, p trend = 0.06) and ascorbic acid (OR = 0.60, 95% CI: 0.33-1.09, p trend = 0.04) by patients, although only the trend for ascorbic acid intake reached statistical significance. There was no difference between groups for alpha-tocopherol intake after adjustment for energy intake. We also found that patients reported a significantly lower intake of niacin than controls (OR = 0.15, 95% CI: 0.07-0.33, p trend < 0.00005). Our results suggest that if antioxidants play a protective role in this disease, the amounts provided by diet alone are insufficient. Although the interpretation of the inverse association between niacin intake and PD is complicated by the high niacin content in coffee and alcoholic beverages, which were also inversely associated with PD in this study, the strength of this association and its biologic plausibility warrant further investigation.

Case-Control Studies↗

PubMedDate not supplied

Hospital-patient education. Current status and future trends.

With the increasing number of older patients and the decreased length of hospital stays, nurses are faced with the challenge of ensuring that the patient or caregiver can manage care after discharge. Patient education facilitates the maintenance and promotion of self-care behaviors. Health-care trends, educational materials, costs and reimbursements, and innovative methods for education all affect the future of hospital-based patient education.

Costs and Cost Analysis↗

PubMed1982

Biosocial factors and hypertension in urban and rural Zulus.

A study of 1,000 urban and 1,000 rural Zulus was carried out to determine the biosocial factors associated with hypertension. The prevalence of hypertension was 25% in the urban Zulu (males 23%, females 27%) and 10.5% in the rural Zulu (males 10%, females 10.75%). The mean arterial pressure was higher in the urban Zulu than in the rural Zulu at all ages and for both sexes (greater in females than in males). In both the urban and the rural Zulu the following factors were found to be significantly associated with hypertension: age, sex, obesity, marital status, urbanization and number of dependents. In the urban Zulu other parameters absent in the rural Zulu were associated with hypertension: insomnia due to anxiety, cigarette smoking, alcohol intake, conditions of work, educational status, income, number of children not working, lack of recreation or sport activity, and overcrowding. Likewise, in the rural Zulu other parameters absent in the urban Zulu were associated with hypertension: having a family member with hypertension and the educational status of the children. There was a relationship between hypertension and social variables which were observed to be stressful. Unlike the rural Zulu, the urban Zulu is exposed to a different lifestyle, acculturation, detribalization and various political ideologies. This could explain the difference in the prevalence of hypertension in urban and rural Zulus.

Adolescent↗

PubMed2005

Reciprocal relationship between pain and depression in elderly Chinese primary care patients.

BACKGROUND: Pain and depression are common in old age but the reciprocal relationship between pain and depression has not been established in a single study. Moreover, few studies have addressed this issue in a primary care setting. The purposes of this study were to examine the reciprocal relationship between pain and depression and to identify whether social support, functional disability or social functioning mediated the link between pain and depression among Hong Kong Chinese elderly primary care patients. METHOD: Subjects were 318 patients assessed by a trained assessor with MDS-HC at baseline and these subjects were randomly selected from attendants of three randomly selected elderly health centers in Hong Kong. These patients were re-assessed one year after baseline evaluation. RESULTS: Multiple regression analyses revealed that pain at baseline significantly predicted depression at 12-month follow-up assessment when age, gender, martial status, education, and depression at baseline were adjusted for, but depression at baseline was not associated with pain at 12-months after baseline measure while controlling for age, gender, martial status, education, and pain at baseline. However, depression did predict the onset of pain. Moreover, social support, physical disability or social functioning did not mediate the impact of pain on depression. CONCLUSIONS: These data suggest that pain is an important predictor of depression in elderly primary care patients. Therefore, aged care service practitioners must take this risk factor into consideration in their preventive intervention and treatment for psychological well-being.

Activities of Daily Living↗

PubMed1998

Lymphedema: patient and provider education: current status and future trends.

BACKGROUND: The majority of patients schedules for breast surgery or radiation therapy for breast carcinoma do not receive basic information about the risk of lymphedema or its treatment. METHODS: A review of the literature documenting patient and provider education on the risk, prevention and treatment of lymphedema was undertaken. RESULTS: Formal education about lymphedema is not a part of the training of most medical and allied health professionals. Thus, patients do not receive information about the risk, prevention, or treatment of lymphedema. CONCLUSIONS: Educational strategies for patients and providers need to be developed and implemented.

Allied Health Personnel↗

PubMed2003

Scholastic performance of adolescents.

OBJECTIVE: To find out the factors affecting scholastic performance of adolescents belonging to various groups and the determinants for poor scholastic performance. METHODS: 1892 adolescents of 13 to 19 years age group belonging to different category of schools were interviewed and assessed by a team consisting of pediatrician, psychologist and PG-DCCD* students using Teenage Screening Questionnaire--Trivandrum and Study Habit Rating Scale. Daily study pattern, Family environment, Education status of parents, Personal distractions, and Attitude towards studies were observed as factors affecting scholastic performance. RESULT: On multivariate analysis the predictor variables for poor scholastic performance were; lower studying daily lessons, poor concentration in studies, lower education status of father and unhappy family. CONCLUSION: It is feasible to identify determinants of scholstic performance and plan intervention strategies at school level.

Adolescent↗

PubMed2006

Risk factors for the development of emotional and behavioural problems in children born to drug-dependent mothers.

BACKGROUND: The study of biological and psychosocial risk factors for the development of emotional and behavioural problems in children of drug-dependent mothers. METHODS: In a sample of 52 children and drug-dependent mothers participating in a residential intervention programme emotional and behavioural problems were studied in the children by use of the Child Behaviour Checklist (CBCL). The Symptom-Checklist Revised (SCL-90-R) served to assess mental problems in the mother. Drug exposure during pregnancy, various psychosocial risk factors due to the drug-career, and educational status of the mother were assessed by maternal interview. A brief assessment of intelligence of the mother was included. RESULTS: Among the various biological and psychosocial risk factors, maternal mental health problems, maternal educational status, and a small number of close social relationships correlated significantly with child outcome variables. Multiple regression analyses identified maternal mental health factors as the main predictors of child behaviour. CONCLUSIONS: Assisting drug-dependent mothers in overcoming the psychosocial sequelae of drug abuse implies also assistance to the children in terms of prevention of emotional and behavioural problems.

Adolescent↗

PubMed2005

A survey of the knowledge, attitude and practices of antenatal mothers in Lagos, Nigeria about the primary teeth.

To assess the knowledge, attitude and practices of antenatal mothers about the primary dentition. This cross-sectional study was carried out in Lagos. It assessed the knowledge, attitude and practices of 464 Nigerian mothers about the primary teeth. All the mothers were seen at the antenatal clinics of the Lagos University Teaching Hospital and primary health centres in the local government area of the teaching hospital. The mothers' knowledge of the 2 most commonly presenting oral conditions: bleeding gums and dental caries were evaluated. Results of the study showed that approximately 36.7% of the mothers had received information on oral health care from a dentist. About seventy percent (71.33%) reported that primary teeth were important and 79.31% agreed with the statement that tooth decay was preventable. However, only 8% of the mothers used toothbrush and toothpaste for cleaning their children's teeth. Only 37(7.97%) of the mothers had taken their children to a dentist before. The visits were for symptoms of pain and tooth decay. There was a statistically significant association between educational status and knowledge of primary teeth, (p=0.003308). Over half (51.3%) of the study sample associated caries with consumption of sugars. There was a statistically significant association between perceived aetiology of caries and educational status, p=0.00000. There was a statistically significant association between mother's past dental visit and child's past dental visit, p=0.000000005. The findings of the study show that oral health knowledge of the primary teeth by this group of Nigerian mothers is rather diffuse. It is recommended that medical professionals; obstetricians, gynaecologists and paediatricians encourage mothers to seek professional oral health counselling as soon as possible especially as soon as or before the primary teeth start to erupt. In addition, regular dental visits will ensure that the child benefits from age-specific information that is readily available to the mother.

Adult↗

PubMed2006

[The prevalence of generalized anxiety disorder and comorbidity among psychiatric outpatients].

OBJECTIVE: In this study, we aimed to investigate the prevalence, association with sociodemographic characteristics, and comorbidity with other anxiety and depressive disorders of generalized anxiety disorder (GAD) among psychiatric outpatients. METHOD: In the first phase of the study, outpatient psychiatry clinic physician interviewed with consecutive 950 patients who applied to psychiatry outpatient clinic of an university hospital by using GAD module of CIDI (Composite International Diagnostic Interview, version 2.1) during 4-month. Ninety-nine patients with diagnosis of GAD in the first phase were referred to the researcher physician for further evaluation. In the second phase, patients were interviewed by using CIDI anxiety and mood (major depression, dysthymic disorder) disorder modules. By this way, 12-month additional diagnoses were examined, and diagnosis of GAD was confirmed. One patient was excluded, because did not meet the GAD criteria during reexamination by the researcher physician. RESULTS: Ninety-eight patients (10.3%) met DSM-IV criteria for GAD. Eighty-nine (90.8%) of the cases had comorbid any anxiety or depressive disorder. The rates of comorbidity with any of depressive disorders and anxiety disorders were found 84.7% and 56.1%, respectively. The most common comorbid diagnosis was major depression (83.7%). The most common anxiety disorders were social phobia (30.6%), OCD (19.4%) and specific phobia (17.4%). The prevalence of GAD was observed significantly higher in women, married ones, housewives, unworking girls, subjects with history of medical illness and lower educational status. CONCLUSION: Our results show that among psychiatric outpatients, GAD has high comorbidity rates with depressive and other anxiety disorders, and it is associate with some sociodemographic characteristics such as gender, and marital, working and educational status.

Adult↗

PubMed2004

Awareness and practices of contraception among Pakistani women attending a tertiary care hospital.

Pakistan is one of the most populous nations in the world, with an annual growth rate of 2.8 and high total fertility rate, even among developing nations. The Pakistan Reproductive Health and Family Planning Survey highlighted the wide gap between knowledge (97%) and use of contraceptives (28%) among currently married women. Our actual need is to enhance contraceptive practice in our country. This study was designed to investigate contraceptive knowledge and practice in Pakistani women attending a tertiary care hospital. This questionnaire-based study was conducted at the Gynaecology Unit II of Sir Ganga Ram Hospital, Fatima Jinnah Medical College, Lahore, Pakistan. A total of 204 married women of reproductive age were interviewed by a registrar to record their age, occupation, educational status, number of children, knowledge about contraceptive methods, source of the knowledge, attitudes and practices of contraception. About 57% of women were between 26 and 35 years of age, while 52% of men were between 31 and 40 years. Educational status of the majority of females was below matriculation (33%), while 34% males were above matriculation; 88% of females were housewives and less than 1% of men were out of work. Regarding the social status of couples, 64% were living on income less than 5000 rupees /month (about 60 pound sterling). Of the women, 67% were para 2-5; 68% had some sort of awareness regarding contraception. The main source of information was television (26%) and relatives (24%). The majority knew about the pill (68%) and IUCD (55%). Only 47% were using some sort of contraception. The most common method chosen was the barrier method (15%), followed by IUCD (10%) and the pill (10%). The least common methods were sterilisation (2%) and the rhythm method (2%); 85% of the women and 74% of the men in the study group had a positive attitude toward contraception. In order to improve contraceptive use in Pakistan we need to use multiple media sources to educate couples and their parents regarding contraceptive services, strengthen the perceptions that religion not only allows but also recommends family planning and to create awareness among women to have their rights and opinions about the size of family. The concept of differentiation between sons and daughters should be discouraged. In addition government and non-governmental organisations (NGOs) should organise groups to provide counselling and promotion of contraceptive services at the doorstep. We must act as a team to control our growth rate for economic stabilisation of the country and to raise the living standards of our people.

Adult↗

PubMed1995

Computer-based learning for ESRD patient education: current status and future directions.

Computer use in everyday life has expanded human potential in virtually every possible arena. In health care, computer technology affects direct clinical care through diagnostics, treatment, monitoring, and documentation processes. Patient care systems use computer technology to manage billing, scheduling, and multiple other administrative functions. Computer technology for education of health care professionals has been primarily in selected undergraduate, graduate, and professional degree programs. Computer-based continuing education for health care professionals has been available for at least a decade, but computer-based patient education is just now beginning to emerge as a learning option. This article describes examples of patient education programs using different types of hardware and software and explores potential areas for further development of this area for end-stage renal disease patients and families. Computer technology is not a replacement for professional involvement in patient education, but rather offers a new arena of media to enhance and expand current teaching and learning resources. Computer-based learning is characterized by features representative of many highly regarded principles of adult education. Further, instructional design concepts used for program development are fundamentally sound for patient education.

Computer-Assisted Instruction↗

PubMed1998

Women's body figure preferences across the life span.

Body figure preferences were examined in a sample of 180 women 18 to 59 years old. Participants were presented with Fallon and Rozin's (1985) set of 9 silhouette drawings ranging from very thin to every heavy. Women of all ages rated their current figure as significantly larger than their ideal figure, indicating the presence of body dissatisfaction across the life span. The degree of body dissatisfaction did not vary with age, marital status, educational level, or occupational status. However, in contrast to the younger women's responses and to the results of previous studies, women over the age of 30 years rated their ideal figure as significantly larger than the one perceived as most attractive to men. Therefore, conclusions concerning this issue that are based on studies of college undergraduates cannot necessarily be generalized to other groups of women.

Adult↗

PubMed2005

The social patterning of relative body weight and obesity in Denmark and Finland.

BACKGROUND: Relative body weight is typically inversely associated with social status in affluent societies but studies comparing the social patterning of relative body weight and obesity in different countries have only seldom been conducted. The aim of this study was to analyse and compare the social patterning of relative weight and obesity by occupational status, educational attainment and marital status between Danish and Finnish women and men. METHODS: Data from the Finnish Survey on Living Conditions and the Danish Health and Morbidity Survey, both collected in 1994, were compared. Relative weight was studied by using body mass index (BMI), and those with BMI > or =30 kg/m(2) were regarded as obese. Logistic regression analysis was used to examine the social patterning of obesity in the pooled dataset. Two-variable interaction effects were tested separately. RESULTS: Compared with their Danish counterparts, Finnish women and men had higher average relative weight and they were more often obese. There were no country differences in the socio-economic patterning of obesity by educational attainment, but a stronger patterning of obesity by occupational status was found among Danish women. Moreover, non-married women in Denmark were more likely to be obese than their married counterparts. CONCLUSIONS: Finns have higher relative weight and they are more often obese than Danes. The social patterning of obesity was similar in both studied countries but stronger in Denmark.

Adult↗

PubMed2001

Hormone replacement therapy. Knowledge, attitudes and practices of women attending a gynaecology outpatient clinic in Trinidad.

A questionnaire was used to assess the knowledge, attitudes, and practices of a sample of 218 outpatients attending the Port of Spain General Hospital Gynaecology Outpatient Clinic. The questionnaire investigated women's knowledge of menopause, risks and benefits of Hormone Replacement Therapy (HRT), their attitudes concerning HRT and menopause as well as practices of postmenopausal women with respect to HRT. Comparisons were made between women of differing menopausal status, educational background and ethnicity. The results showed that overall knowledge was lacking regardless of menopausal status, ethnicity or educational background. Less educated women were more inclined to believe that HRT was inappropriate principally because they regarded the menopause as a natural process (p = 0.023). Only 24% of postmenopausal women were practicing some form of HRT. A minority (7%) had previously been undergoing the therapy but had stopped. Most postmenopausal women (69%) simply never considered treatment because the majority had never heard about HRT. The main source of patient information was from the clinic they were attending. This study reveals low awareness of menopausal information and therapeutic options in a Trinidadian population. A targeted education programme may substantially fill this void.

Adult↗

PubMed2003

The prevalence and risk factors of anemia in pregnant women.

OBJECTIVE: To determine the prevalence and risk factors of anemia in pregnant women. METHOD: The pregnant women were screened with complete blood count, hemoglobin electrophoresis and serology tests for hepatitis B, syphilis and HIV. In cases of anemia, serum for iron and ferritin were investigated. Anemia was defined as a hemoglobin level less than 11.0 g/dl in the first and third trimester of pregnancy or less than 10.5 g/dl in the second trimester. Factors associated with anemia were analyzed by using student's t-test and chi-square. The statistically significant factors were tested with the use of multiple logistic regression. RESULTS: A total of 1,304 pregnant women were recruited. The prevalence of anemia was 19.2 per cent (251 cases). Classified in each trimester, the prevalence was 14.8 per cent, 20.5 per cent and 38.6 per cent in the first, second and third trimester, respectively. One hundred and sixty-one cases of anemia were available for serum iron and ferritin levels. Iron deficiency anemia, by means of serum ferritin, was detected in 32 cases (19.9%). An abnormal pattern of hemoglobin electrophoresis was detected in 367 cases (28.1%). Gestational age at first prenatal visit, abnormal hemoglobin electrophoresis and educational status were associated with anemia during pregnancy. CONCLUSION: The prevalence of anemia in pregnant women who first attended the prenatal visit was 19.2 per cent. Factors associated with anemia during pregnancy were gestational age at first prenatal visit, abnormal hemoglobin electrophoresis and educational status.

Adolescent↗

PubMed2000

Male systemic sclerosis and occupational silica exposure-a population-based study.

BACKGROUND: The continuing uncertainty about the silica-systemic sclerosis relationship led to the investigation of its role as a disease determinant in a large population-based study of systemic sclerosis. AIMS: To compare the frequency, socioeconomic and educational status, age-specific prevalence and duration of occupational silica exposure in males with and without systemic sclerosis. To assess the temporal relationship between exposure and disease onset. To estimate disease latency. To compare disease characteristics between silica-exposed and non-silica-exposed male cases. METHODS: The study was case-control in design. The exposure variable was occupational silica exposure as assessed by an occupational health officer blinded to case/control status and the outcome variable was systemic sclerosis. The employed instrument comprised either a standardised telephone questionnaire (interviewed cases and controls) or medical records (deceased or living-status-unknown cases). RESULTS: Sixty of 160 cases (37.5%) and 11 of 83 (13.3%) controls had occupational silica exposure (OR=3.93; 1.84-8.54). Comparison of data between 64 interviewed cases and all controls demonstrated initial occupational silica exposure occurring before age 40, comparable educational status but significantly different cumulative socioeconomic status with cases being over-represented in semi-skilled and unskilled occupations. Cross-sectional 'current' occupational data underestimated cumulative silica exposure by more than 50%. Silica exposure uniformly preceded onset of second disease symptoms and disease diagnosis. In most, it also preceded onset of first disease symptoms. Disease latency approximated two decades. No disease features distinguished silica-associated systemic sclerosis from idiopathic systemic sclerosis. The duration of silica exposure in the interviewed silica-exposed cases did not significantly exceed that of silica-exposed controls. CONCLUSIONS: Male systemic sclerosis displays socioeconomic dependence. Silica is a disease determinant in male systemic sclerosis, with disease features including a long latency and clinical characteristics indistinguishable from idiopathic disease. Cross-sectional 'current' occupational data underestimate cumulative occupational silica exposure.

Adolescent↗

PubMed1998

Trends in breast cancer screening in Missouri from 1987 to 1995, and predictions for the years 2000 and 2010.

BACKGROUND: Breast cancer is a major cause of morbidity and mortality in the United States (U.S.) and Missouri. In 1992, 3,915 new breast cancer cases were diagnosed and in 1995, 1,006 deaths from breast cancer were reported in Missouri. Although breast cancer incidence has increased in Missouri in the past 20 years, there are indications that early detection has also increased during the same period. Knowledge about which segments of the population have experienced the greatest increase in mammography screening rates helps in planning and implementation of breast cancer control programs at the state level. OBJECTIVES: Examine the prevalence and trends of lifetime mammography and 2-year mammography compliance in Missouri by age, race, and education from 1987 to 1995 and make predictions for the years 2000 and 2010. METHODS: We used data from the Missouri Behavioral Risk Factor Surveillance System (BRFSS), 1987 to 1995, to estimate the prevalence of ever having had a mammogram and compliance with mammography screening guidelines within two years by race, age, and education status among Missouri women over age 18. Using linear models, we regressed breast cancer screening prevalence estimates on time to obtain trends and predictions. RESULTS: Overall, African-American women were more likely to have had a lifetime mammogram than white women. However, we found a steady increase in the prevalence of ever having had a mammogram for all groups of women defined by age and education status, except among African Americans. Increase in the prevalence of ever having had a mammogram was much higher in women age 50 and older and slightly higher among women with a high school education or less. The average prevalence of 2-year mammography screening compliance was about 60% for all groups, a rate which did not significantly change between 1987 and 1995. By the year 2000, white women will have mammography rates equal to or higher than African-American women, and the majority of all women age 50 and older (98.3% to 100%) will have had a lifetime mammogram. CONCLUSION: Missouri target populations are predicted to attain Year 2000 National Health Objectives concerning lifetime mammography. Current efforts should be continued in order to maintain levels of mammography, particularly among African-American women.

Adolescent↗