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PubMed1998

Factors associated with the initiation of smoking by Kuwaiti males.

PURPOSE: To estimate the age patterns in cumulative probability of smoking initiation among Kuwaiti adult males and to study the differentials in smoking initiation in relation to factors such as age-cohort, marital status, educational level, income, type of residence, and history of smoking among family members and friends. METHODS: A stratified three stage cluster sampling design was implemented for the selection of the sample. A self-administered questionnaire was completed by 1798 Kuwaiti adult males working in different ministries. RESULTS AND IMPLICATIONS: Of the 1798 respondents, 34.4% were classified as current smokers, 17.7% as former smokers and 47.9% as non-smokers. The highest probability of smoking initiation (among current and former smokers) was found for the age group 15-20 years, where almost 29% of the respondents initiated smoking. In the univariate analysis, marital status, education, income, type of residence, and history of smoking among family members and friends showed significant variation in the age-patterns of initiation. In the Cox proportional hazard regression model, education, type of residence, and history of smoking among family members and friends were found to be independently associated with the risk of initiation. The highest risk of initiation (Relative Risk (RR) = 1.85; 95% CI: 1.62-2.10) was found among those who had a history of smoking in family and friends. Individuals in the lowest education category (RR = 1.64; 95% CI: 1.32-2.04) and those residing in apartments (RR = 1.65; 95% CI: 1.43-1.92) were at a higher risk of initiation compared with those who had university education or those who resided in villas. The results of the study should prompt further efforts to develop tobacco control policies in Kuwait and the other Arabian Gulf countries to help establish norms for not initiating smoking through persistent messages to not start or to stop smoking. There is also a need to enhance awareness about the influence of smokers in family or friends on other people to initiate smoking.

Adolescent↗
PubMed1988

Women in medical education. A status report.

Women now make up 37 percent of medical school applicants, 34 percent of medical students, 28 percent of residents, and 19 percent of full-time medical school faculty members. These proportions have grown from 26, 25, 19, and 15 percent, respectively, 10 years ago. A comparison of the academic performance of male and female medical students reveals few differences, particularly on standardized measures. However, women trainees experience more stress than men. Traditional differences in the choice of specialty by men and women are not diminishing. Women's accession to senior faculty positions has not kept pace with their increasing representation on the faculty--a cause of continuing concern. The percentage of female faculty members who are professors has changed from 8 to 9 percent in 10 years (as compared with 32 percent of male faculty members in 1988). I conclude that the numbers of women are increasing rapidly at the lower levels of medical education, but not at the upper levels.

Education, Medical↗
PubMed2003

Use of complementary and alternative medicine by patients with localized prostate carcinoma: study at a single institute in Japan.

BACKGROUND: The use of complementary/alternative medicine (CAM) has recently received considerable attention throughout the world. We evaluated the prevalence and predictors of CAM use among Japanese patients with localized prostate cancer. METHODS: A total of 177 patients with localized prostate carcinoma underwent radical retropubic prostatecotomy or external beam radiation therapy between January 1994 and January 2001. Of them, 138 (78%) answered a self-administered questionnaire on CAM use and were eligible for this study. The overall prevalence, types of CAM used, and costs of CAM were assessed. The effects of age, prostate-specific antigen (PSA) level, clinical stage, pretreatment Gleason score, patients' income, patients' final educational status, and general health-related quality of life at baseline and 1 year after treatment, as estimated using the European Organization for Research and Treatment of Cancer Prostate Cancer Quality of Life Questionnaire on the prevalence of CAM use, were evaluated. RESULTS: Twenty-seven patients (20%) had once used or had been using some types of CAM. Herbal medicine and vitamins were the most common types of CAM used. Preoperative Gleason score was significantly associated with CAM use, as determined by the chi(2) test ( P = 0.0198), and PSA level and posttreatment physical function domain were marginally associated with CAM use, as determined by the Mann-Whitney U-test ( P = 0.0734 and P = 0.0597, respectively). Patient age, income, and final educational status had no impact on CAM use. CONCLUSION: A relatively small proportion of Japanese patients with localized prostate cancer have tried CAM compared with the proportions of patients described in previous reports from Western countries.

Age Factors↗
PubMed2005

Subjective daytime sleepiness: dimensions and correlates in the general population.

STUDY OBJECTIVE: Discrepancies between several widely used assessment tools suggest that subjective daytime sleepiness is not a unitary phenomenon. Most research, however, has been based on patients. The aim of this study was to examine whether qualitatively different facets of subjective daytime sleepiness exist in the general population and to assess how different aspects of subjective sleepiness varied by age, gender, education status, body mass index, sleep debt, Stanford Sleepiness Scale, and objectively measured sleepiness (Multiple Sleep Latency Test). DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: Population-based sample of 1562 women and 1351 men, mean age of 46.6 +/- 7.9 years, including a subset of 145 participants who underwent an Multiple Sleep Latency Test. MEASUREMENTS: Self-reported sleepiness problems, Epworth Sleepiness Scale items, sleep habits, Multiple Sleep Latency Test, and Stanford Sleepiness Scale. RESULTS: Principal-axis factor analysis of 13 self-reported daytime-sleepiness measures yielded 3 factors, labeled perceived daytime sleepiness (Cronbach's alpha = 0.74), subjective sleep propensity in active situations (alpha = 0.82), and subjective sleep propensity in passive situations (alpha = 0.63). The factor-based scores were all related to increased body mass index and lower education status, but the associations of scores for perceived and subjective propensity factors differed with gender, age, sleep debt, MSLT, and Stanford Sleepiness Scale. Worse perceived sleepiness factor-based score was significantly related to female gender, younger age, higher sleep debt, and worse Stanford Sleepiness Scale scores. Worse factor-based scores for subjective sleep propensity in both active and passive situations were significantly associated with male gender, older age, and worse Multiple Sleep Latency Test scores. CONCLUSION: Findings from the present analysis on a general population sample support the hypothesis that subjective daytime sleepiness has multiple dimensions.

Adult↗
PubMed1999

Aldehyde dehydrogenase genotypes and male alcohol use disorders: a case-control study in Khon Kaen, north-east Thailand.

A genetic epidemiological case-control study on aldehyde dehydrogenase 2 (ALDH2) genotype and male probable alcohol use disorders (AUD) was performed in Khon Kaen province, northeast Thailand. One hundred and twenty-four of cases (probable AUD) were obtained from male villagers aged 18-65 years using the modified Michigan Alcoholism Screening Test-Thai version. The same number of controls were selected, being matched with the cases in terms of age (+/-4 years) within the same village. Marital status, education history and past or present histories of physical illnesses were essentially the same for the cases and the controls. All of the cases and 85.5% of the controls were current drinkers, and the cases tended to drink significantly more often than the controls. Genomic DNA was extracted from fingernails and ALDH2 genotypes were determined by polymerase chain reaction technique and digested by Ksp 632I. The ALDH2 genotypes of the cases and the controls were not significantly different: 90.3% versus 91.1% normal homozygote; 8.1% versus 8.9% heterozygote; and 1.6% versus 0.0% mutant homozygote, respectively. Among the normal homozygote, the daily amount of alcohol intakes of the cases were significantly larger than that of the controls (56.2+/-40.6g vs. 8.1+/-14.1 g), the same was found among the ALDH2 deficient (55.9+/-43.4 vs. 2.2+/-5.8 g). Multivariate analysis based on the conditional logistic regression model showed no significant association of AUD with ALDH2 genotype, marital status, education history, or past history of injury, however, occupation and daily amount of alcohol intake were found to be significantly associated with AUD (OR = 10.72, 95% CI = 1.15-99.99, P = 0.037, and OR = 1.12, 95% CI = 1.06-1.18, P = 0.000, respectively). Non-farmers showed 10.7 times larger risk of developing AUD compared to farmers, and the subjects had three times more chance of developing AUD for each increase of 10 g of the daily amount of alcohol intake.

Adult↗
PubMed1977

Oral health status in relation to socioeconomic and ethnic characteristics of urban adults in the U.S.A.

Nearly 1,300 adult members of a prepaid medical group plan in New York City were screened through automated multiphasic health testing in a series of test stations including a dental station, during 1971-1973. Oral status indicators were developed including a number of missing teeth, scores to measure levels of gingival and periodontal disease, Simplified Oral Hygiene Index scores, and ratios of decayed teeth. Ratios of filled teeth were calculated to measure levels of restorative care. The present paper examines the interrelationships of economic status, education and ethnic origin with each of the above oral status measures. It was found that variations in ratios of decayed and of filled teeth were primarily due to economic status while variations in a number of missing teeth, oral hygiene levels and levels of gingival and periodontal diseases were primarily due to screenees' educational level. Ethnic group differences could be explained in part by differences among these groups in economic and and educational levels. There were no consistent ethnic patterns, however, and while some differences could be explained by controlling for education and economic status, others persisted.

Adult↗
PubMed2000

Disability and handicap in rheumatoid arthritis and ankylosing spondylitis--results from the German rheumatological database. German Collaborative Arthritis Centers.

OBJECTIVE: To describe indicators of disability and handicap in the 2 major inflammatory rheumatic diseases rheumatoid arthritis (RA) and ankylosing spondylitis (AS) and to estimate the burden of illness in terms of functional status, pain, and global well being, as well as with regard to unemployment and early retirement. METHODS: Data from the German rheumatological database on 52,444 patients with RA and 8,776 patients with AS seen at 21 collaborative arthritis centers in Germany between 1993 and 1997 were analyzed. To estimate the burden of the 2 diseases at different biographical phases, age and sex matched groups of patients were compared for functional disability, pain, global assessment of health status, education level, and employment status. RESULTS: For comparable ages, disability in female patients with AS or RA was rated similarly by the physicians (e.g., 61-70 years: 42% severe disability in RA and 44% in AS), whereas men with AS were rated more disabled than men with RA (61-70 years: 35% in RA and 48% in AS). Patients' self-ratings of disability were generally worse for women than for men (age 61-70: women 37% severe disability in RA and 35% in AS, men: 24% in RA and 19% in AS). Pain intensity was rated similarly by women and men with RA and AS at ages < 51 years (33% severe pain at ages 41-50 in men and 34% in women in both diseases). It increased with age in women (> 70 years: 41% severe pain in RA and 44% in AS) and remained stable in men (27% RA and 29% AS > 70 years). At 71.3% the employment rate in AS was clearly higher than in RA (49.5%). There was significant influence of the education level (men 51-60 years with AS: low education 56% employment rate, high education 79%) and the labor market (men 51-55 years with AS: 80% employment rate under good, 59% under bad overall labor market conditions). CONCLUSION: Age and sex matched groups of patients with RA and AS in tertiary rheumatological care show similar amounts of disability, pain, and reduction in well being. Therefore, the offer of comprehensive care and pain management to both groups should be comparable.

Activities of Daily Living↗
PubMed2005

Supplement use among men with prostate cancer.

OBJECTIVES: To characterize supplement use within a sample population of men diagnosed with prostate cancer. METHODS: A census of men diagnosed with prostate cancer at Duke University Medical Center from 1997 to 2002 (n = 1402) was mailed a survey that ascertained data on health status, education, diet, exercise, smoking status, and information on supplement use. Differences between demographic and treatment subgroups were described and tested, as was change in supplement use after diagnosis. RESULTS: Data from 805 respondents indicated that a majority (73%) used supplements, and 68% claimed that this information was shared with their cancer care provider. The most commonly reported supplements were multivitamins (56%), vitamin E (43%), vitamin C (33%), and calcium (26%). On average, 2.7 +/- 2.8 supplements per day were taken, and use increased significantly after diagnosis for most supplements. Use was significantly higher among men who were white (P = 0.043), were more highly educated (P = 0.002), exercise regularly (P = 0.020), and who consume five or more daily servings of fruits and vegetables (P = 0.040). CONCLUSIONS: A high percentage of men with prostate cancer take supplements, especially those who are white, more educated, and who pursue healthful behaviors. Systematic means of capturing these data are necessary to begin to understand the potential impact of supplements on disease outcome, especially because no data exist to suggest that supplements are of any benefit after diagnosis.

Aged↗
PubMed2002

Visual acuity impairment and mortality in US adults.

OBJECTIVE: To examine the associations between reported visual impairment (VI) and mortality in a nationally representative sample of US adults. METHODS: The National Health Interview Survey is a multistage probability survey of the US civilian population. Adults within households were administered questions about VI and selected eye diseases (n = 116 796). Mortality linkage data with more than 96% of the 1986-1994 survey participants were available through December 31, 1997. Statistical analyses included Cox proportional hazards regression analysis. MAIN OUTCOME MEASURES: All-cause, cardiovascular disease-related, and cancer-related mortality. RESULTS: A total of 327 participants (0.3%) had severe bilateral VI; an additional 4754 (4%) had some VI and/or severe VI in at least one eye. Mortality linkage identified 8949 deaths. After controlling for survey design, age, race, marital status, educational level, reported health status, glaucoma, cataract, and retinopathy, women, but not men, with reported severe bilateral VI were at a significantly increased risk of death relative to their counterparts without VI (hazard ratio [95% confidence interval], 2.21 [1.61-3.02] and 1.33 [0.96-1.84], respectively); risk of mortality was also slightly but significantly elevated in women and men with some reported VI compared with those reporting no VI. Similar patterns of associations were found for cardiovascular disease-related mortality. Risk of cancer-related mortality was not associated with VI. CONCLUSION: Reported severe bilateral VI and, to a smaller extent, less severe VI are associated with an increased risk of all-cause mortality and cardiovascular disease-related mortality in US women; there is weaker evidence for an association between VI and mortality in US men.

Adolescent↗
PubMed1998

Current status of education and treatment resources for lymphedema.

BACKGROUND: Secondary lymphedema (LE) resulting from breast cancer surgery has continued to be an ignored medical diagnosis in U.S. medicine. Subsequently, the majority of women/men undergoing axillary lymph node dissection have not received education in pre- or postoperative LE prevention, causing hundreds of thousands of patients to develop LE. As a result of this ignorance, once the LE develops, these patients receive no or harmful treatment. METHODS: Over the last decade, the National Lymphedema Network (NLN) has created awareness in the medical community, among patients, and in the general public through information dissemination, educational materials, a national conference, and the activism of patients and a small group of concerned professionals. Complete decongestive physiotherapy (CDP), which includes manual lymph drainage, is a successful treatment for LE that has now been introduced. RESULTS: Slowly, the U.S. medical community is beginning to recognize and support this condition and its treatment, and secondary LE has now become an acceptable diagnosis (ICD9-457.0). Subsequently, due to patient and medical activism and the work of the NLN, Medicare now covers 2 weeks of CDP treatment (in Florida), and two landmark bills (AB-12 and S-609) that will cover LE treatment for postbreast carcinoma patients are currently pending (as of February 22, 1998). CONCLUSIONS: In the last decade, the NLN has developed a strong foundation of knowledge and has planted LE on the medical map in the United States. With collaboration between the NLN and all breast carcinoma groups and LE specialists, it is hoped that lymphology will become a standard course of study in medical schools across the country and that LE will become a household word, with proper treatment available for postbreast carcinoma LE patients in the United States.

Breast Neoplasms↗
PubMed1995

Prostate cancer risk in U.S. blacks and whites with a family history of cancer.

Prostate cancer occurs more frequently in U.S. blacks than whites. A population-based case-control study which investigated the association with family history of cancer was carried out among 981 men (479 black, 502 white) with pathologically confirmed prostate cancer, diagnosed between August 1, 1986, and April 30, 1989, and 1,315 controls (594 black, 721 white). Study subjects, aged 40-79, resided in Atlanta, Detroit, and 10 counties in New Jersey, geographic areas covered by population-based cancer registries. Prostate cancer risk was significantly elevated among those who reported a history of prostate cancer in first-degree relatives (O.R. = 3.2; 95% C.I.: 2.0-5.0), with blacks and whites having similarly elevated risks. These risks were unchanged by statistical adjustment for job-related socio-economic status, education, income, and marital status. Overall, the ORs associated with history of prostate cancer in fathers and brothers were 2.5 (95% C.I.: 1.5-4.2) and 5.3 (95% C.I.: 2.3-12.5), respectively. Risks associated with a family history of prostate cancer were consistently elevated among younger and older subjects. Only small non-significant excesses of prostate cancer risk were associated with a family history of breast, colorectal, or other cancers. While familial occurrence is a key risk factor for prostate cancer and likely to be genetically based, the similar familial risks among blacks and whites suggest that the ethnic disparity in incidence is influenced by environmental factors.

Adult↗
PubMed1981

Spouse similarity in newlyweds with respect to specific cognitive abilities, socioeconomic status, and education.

Newlywed spouses (N = 215 couples) were tested on 21 tests of specific cognitive abilities and responded to a questionnaire on their educational and socioeconomic (SES) background. A comparison of the present spouse correlations with those of long-standing marriages suggests that spouses resemble each other in abilities from the start and that the degree of resemblance changes little over time. The low spouse correlations for SES of origin (their parents) suggests that education is the chief SES variable by which spouse selection takes place. Spouse resemblance in education and parental SES could explain almost all of the spouse correlations in perceptual speed and spatial ability. However, a small but significant degree of spouse similarity in verbal and reasoning abilities was independent of education and SES.

Adolescent↗
PubMed1995

The Swedish SF-36 Health Survey--I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden.

We document the applicability of the SF-36 Health Survey, which was translated into Swedish using methods later adopted by the International Quality of Life Assessment (IQOLA) Project procedures. To test its appropriateness for use in Sweden, it was administered through mail-out/mail-back questionnaires in seven general population studies with an average response rate of 68%. The 8930 respondents varied by gender (48.2% men), age (range 15-93 years, mean age 42.7), marital status, education, socio-economic status, and geographical area. Psychometric methods used in the evaluation of the SF-36 in the U.S. were replicated. Over 90% of respondents had complete items for each of the eight SF-36 scales, although more missing data were observed for subjects 75 years and over. Scale scores could be computed for the vast majority of respondents (95% and over); slightly fewer in the oldest subgroup. Item-internal consistency was consistently high across socio-demographic subgroups and the eight scales. Most reliability estimates exceeded the 0.80 level. The highest reliability was observed for the Bodily Pain Scale where all subgroups met the 0.90 level recommended for individual comparisons; coefficients at or above 0.90 were also observed in most subgroups for the Physical Functioning Scale. Tests of scaling assumptions including hypothesized item groupings, which reflect the construct validity of scales, were consistently favorable across subgroups, although lower rates were noted in the oldest age group. In conclusion, these studies have yielded empirical evidence supporting the feasibility of a non-English language reproduction of the SF-36 Health Survey. The Swedish SF-36 is ready for further evaluation.

Adolescent↗
PubMedDate not supplied

Sociodemographic predictors of temperament and character.

The Unified Biosocial Theory of Personality postulates that human personality is organized around four temperaments - Novelty Seeking, Harm Avoidance, Reward Dependence, and Persistence - and three characters - Self-Directedness, Cooperativeness, and Self-Transcendence. The objective of the present study was to investigate the influence of sociodemographic factors on temperament and character without the confounding influence of mental disorders. Volunteers (n=94) did not meet criteria for any Axis I and Axis II diagnosis, had no first-degree relatives with mental disorders, and were medically healthy. After giving written informed consent, volunteers completed the Temperament and Character Inventory. Analyses were conducted to determine the degree of association of each sociodemographic factor (i.e., age, gender, ethnicity, marital status, educational attainment, and occupational status) to personality dimension, while controlling for possible interactions with other sociodemographic factors. Partial correlation analysis showed a significant association between gender and Reward Dependence, and occupational status was significantly related to Reward Dependence, Cooperativeness, and Self-Transcendence. Stepwise regression analysis indicated that gender and occupational status were significant predictors of Reward Dependence. Occupational status was the only predictor of Cooperativeness and Self-Transcendence. These data suggest that sociodemographic factors should be considered in studies investigating temperaments and characters as defined by the Unified Biosocial Theory of Personality.

Adult↗
PubMed2003

Sero-epidemiology of hepatitis B infection in an urban paediatric population in Turkey.

The hepatitis B virus (HBV) seroprevalence rate is known to be 25-60% in Turkey with the highest prevalence in the east and south-east. There are insufficient data on sero-epidemiology of HBV infection in children living in East Turkey. The objective of this study was to estimate the seroprevalence of HBV infection in 6-17 year olds living in the largest city in East Turkey, and to correlate the serological results with epidemiological data. A total of 1091 serum samples were tested for hepatititis B surface antigen (HBsAg), antibody to HBsAg (anti-HBs) and antibody to hepatitis B core antigen (anti-HBc) using a commercially available enzyme-linked immunosorbent assay. The overall seroprevalence rate was 9.7% and was correlated with age (P = 0.011). No statistical difference was detected between subjects with or without risk factors (P = 0.77). The seroprevalence of HBsAg was 1.8%, and it was higher in children with a low socio-economic status (P = 0.047). The educational status of the parents and sibling size did not affect the rate of total seroprevalence or HBsAg seroprevalence. Although we found that the HBV seroprevalence rate in East Turkey was not as high as reported previously, we emphasize the importance of screening children in order to identify asymptomatic patients in Turkey until HBV infection is entirely eradicated with vaccination programmes.

Adolescent↗