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PubMed2004

Maternal anxiety associated with newborn genetic screening for type 1 diabetes.

OBJECTIVE: To describe maternal anxiety associated with newborn genetic screening for type 1 diabetes during the first year after risk notification. RESEARCH DESIGN AND METHODS: Mothers of at-risk infants (n = 435), identified through newborn genetic screening as part of the Prospective Assessment of Newborn for Diabetes Autoimmunity (PANDA) study, were administered a short form of the State Trait Anxiety Inventory (STAI) during telephone interviews approximately 3.5 weeks, 4 months, and 1 year after risk notification. Statistical analyses were conducted to examine predictors of maternal anxiety at each interview as well as changes in anxiety over time. RESULTS: For the total sample, initial state STAI scores were not elevated and declined further over time. However, Hispanic mothers, those with low levels of education, those who overestimated the child's risk for diabetes, and mothers of infants in the highest risk group exhibited significantly elevated initial state STAI scores. At 4 months, higher state STAI scores were associated with higher initial state STAI scores, single parent status, having an infant with a first-degree relative with diabetes, and overestimation of the child's actual risk. Initial and 4-month STAI scores remained predictive of STAI scores at 1 year. In addition, single mothers and mothers of female children reported higher STAI state scores 1 year after risk notification. CONCLUSIONS: For most mothers, newborn genetic screening to identify infants at increased risk for type 1 diabetes is not associated with significantly elevated maternal anxiety; anxiety further dissipates over time. However, anxiety levels vary considerably as a function of maternal ethnic status, education, marital status, maternal estimation of infant risk, and sex of the child and may be significantly elevated in some women.

Adult↗

PubMed1998

The influence of socioeconomic status, ethnicity and lifestyle on body mass index in a longitudinal study.

BACKGROUND: Few studies have attempted to disentangle the complex relationship between socioeconomic status (SES) and ethnicity and its influence on body mass index (BMI) and on change in BMI over a decade. The present study highlights the influence of ethnicity (country of birth) and SES on BMI, adjusting for certain lifestyle factors. METHODS: The longitudinal self-reported data, based on a simple random sample, were obtained from 1972 women and 1871 men, aged 25-74, interviewed in 1980/81 and re-interviewed in 1988/89 using the same questionnaire. The influence of the independent variables on BMI was analysed by the Generalized Estimation Equation (GEE) method. The change in BMI for different states of the independent variables was analysed in a linear model with the difference in BMI between 1988/89 and 1980/81 as dependent variable, by sex. RESULTS: There was a graded relationship between male SES, defined as educational status, and BMI when adjusted for background variables, while for females, only a low educational level was associated with a higher BMI. Southern European men and Finnish women showed a higher increase in BMI than the reference group (Swedes and West Europeans) when adjusted for age, smoking, exercise, education, marital status, and health status. Not taking exercise was related to a higher BMI compared with those who were taking exercise. The BMI levels and smoking habits were little changed between 1980/81 and 1988/89, while exercise habits showed a more variable pattern. When the focus was on change in BMI, former smokers had a larger increase in BMI than never smokers. Further, men who ceased taking exercise had a larger increase in BMI than those who were taking regular exercise on both occasions. CONCLUSION: When adjusted for smoking and the other background variables, SES and ethnicity are two separate independent factors influencing BMI in men and women. When the focus was on change in BMI, former smokers had a larger increase in BMI than never smokers. Further, men who ceased taking exercise had a larger increase in BMI than those who took regular exercise on both occasions.

Adult↗

PubMed2000

Clinical and demographic predictors of late-stage cervical cancer.

BACKGROUND: Despite increasingly widespread use of the Papanicolaou smear, almost half of all women with invasive cervical cancer are diagnosed at a late stage (regional or distant). Little is known about factors associated with late-stage diagnosis of cervical cancer. OBJECTIVE: To examine the relationship of age, race, education level, income level, smoking, marital status, health insurance type, comorbidity, and residence in an urban or rural setting to late stage at diagnosis of cervical cancer. METHODS: Incident cases of invasive cervical cancer occurring in 1994 in Florida were identified from the state tumor registry (N = 852). Cases were linked with state discharge abstracts and the 1990 US census. Multiple logistic regression was used to determine the relationship between predictor variables (age, race or ethnicity, marital status, smoking status, education level, income level, insurance type, comorbidity, and urban vs rural residence) and the odds of late-stage diagnosis. RESULTS: Age, marital status, and insurance type were associated with late-stage diagnosis. Each additional year of age was associated with a 3% increased odds of late-stage diagnosis (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.02-1.05; P<.001). Being unmarried was associated with a 63% increased odds of late-stage diagnosis (OR, 1.63; 95% CI, 1.18-2.25; P=.003). Being uninsured was associated with a 60% increased odds of late-stage diagnosis (OR, 1.60; 95% CI, 1.07-2.38; P=.02). Having commercial health maintenance organization insurance was associated with a 46% decreased odds of late-stage disease (OR, 0.54; 95% CI, 0.30-0.96; P=.04). Race, education level, income level, smoking status, comorbidity, and urban residence were not associated with stage at diagnosis. CONCLUSIONS: Women with cervical cancer who are elderly, unmarried, and uninsured are more likely to be diagnosed at a late stage. These women should be targeted for cervical cancer education and screening programs.

Adult↗

PubMedDate not supplied

Influences of income, education, age, and ethnicity on physical abuse before and during pregnancy.

OBJECTIVE: To examine the influence of socioeconomic status, education, ethnicity, and age on the prevalence of intimate partner abuse before and during pregnancy. DESIGN: Retrospective correlational analysis. SETTING: Data were collected at six postpartum maternity settings. PARTICIPANTS: 1,004 women from six ethnic groups. MAIN OUTCOME MEASURE: Prevalence of intimate partner violence. RESULTS: 15.9% of study participants reported physical abuse by their current partner and 5.2% reported abuse during pregnancy. Decreased income, not having a high school education, and ethnicity were significantly related to current abuse and abuse during pregnancy in bivariate analyses. Having less than a high school education emerged as the most significant predictor of both abuse variables in multivariate analyses. African American and Puerto Rican women had the highest incidence of abuse in their current relationship. No significant differences were found in rates of abuse during pregnancy among women from different ethnic groups. CONCLUSIONS: The results of this analysis support the notion that abuse is most prevalent among the most disadvantaged women. However, it is not income per se, but rather the highly related variables of education and ethnicity that have the largest effect. Abuse occurs frequently among all women, warranting universal screening during health care encounters. Further research is needed to evaluate relationships between education, ethnicity, income, and abuse.

Adolescent↗

PubMed2001

Externalizing behaviors and television viewing in children of low-income minority parents.

The parents of 151 children, ages 4-16 years, attending the pediatric outpatient clinic of an urban hospital were surveyed to determine if aggressive behavior among children of low literacy and low-income parents is related to excessive television viewing or to sociological variables such as ethnicity/race, education, occupation, and parents' marital status. The survey consisted of 22 questions about the ethnicity, marital status, education, and occupation of the parent, the television viewing behavior of the child, and the externalizing behavior scale of the Child Behavior Checklist of Achenbach (CBC). The television viewing habits of children in this study were not significantly different from viewing habits reported in national surveys of the US population. T scores in the aggression scale of CBC were unrelated to the hours of television watched by children and the control of viewing by the parent but were significantly associated with the employment and marital status of the mother. Children of unemployed and single mothers had higher externalizing-behavior scores, suggesting that family ecological variables may have more influence on children's behavior than the duration of television viewing.

Adolescent↗

PubMed1991

Socioeconomic status and visual impairment among urban Americans. Baltimore Eye Survey Research Group.

The Baltimore Eye Survey is a population-based study of ocular disorders conducted in East Baltimore, Md, designed to determine the prevalence and severity of vision loss and ocular disease and their relationships to socioeconomic and other risk factors. This survey comprised 5300 subjects (2911 whites and 2389 blacks). Visual impairment was associated with age, race, general health status, educational level, income, and employment status. An identified association of race with blindness and visual impairment was reduced, but not eliminated, after adjustment for these socioeconomic factors, indicating that socioeconomic status itself is an important determinant of visual impairment.

Adult↗

PubMed2004

Combined effect of vision and hearing impairment on depression in elderly Chinese.

BACKGROUND: Sensory impairment and depression are common in old age and the relation between depression and vision as well as hearing impairment have been established. However, few studies have directly compared their effects and examined the impact of dual sensory loss. The purpose of this study is to compare impacts of self-reported hearing and vision loss as well as the effect of double sensory impairment on depression. METHOD: This article analyzes cross-sectional data collected from a representative community sample of 2,003 Chinese elderly people aged 60 or above in Hong Kong. Respondents were interviewed in a face-to-face format and data including vision and hearing impairment, socio-demographic variables, health indicators, family support, and depression were obtained. RESULTS: Logistic regression analyses revealed that visual impairment was significantly related to depression even after age, gender, marital status, education, self-reported health status, the presence of 11 diseases, functional limitation and family support were controlled but hearing loss was not. Hearing impairment did not add to the likelihood of depression where visual impairment was already present. CONCLUSION: The impact of visual impairment on psychological well-being among elderly Chinese is more robust than hearing loss. Therefore, aged care service practitioners must take this risk factor into consideration in their preventive intervention and treatment for psychological well-being.

Age Distribution↗

PubMed2001

Timing of nephrologist referral and arteriovenous access use: the CHOICE Study.

Recent clinical practice guidelines recommend the creation of an arteriovenous (AV) vascular access (ie, native fistula or synthetic graft) before the start of chronic hemodialysis therapy to prevent the need for complication-prone dialysis catheters. We report on the association of referral to a nephrologist with duration of dialysis-catheter use and type of vascular access used in the first 6 months of hemodialysis therapy. The study population is a representative cohort of 356 patients with questionnaire, laboratory, and medical record data collected as part of the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease Center Study. Patients who reported being seen by a nephrologist at least 1 month before starting hemodialysis therapy (75%) were more likely than those referred later to use an AV access at initiation (39% versus 10%; P < 0.001) and 6 months after starting hemodialysis therapy (74% versus 56%; P < 0.01). Patients referred within 1 month of initiating hemodialysis therapy used a dialysis catheter for a median of 202 days compared with 64, 67, and 19 days for patients referred 1 to 4, 4 to 12, and greater than 12 months before initiating hemodialysis therapy, respectively (P trend < 0.001). Patients referred at least 4 months before initiating hemodialysis therapy were more likely than patients referred later to use an AV fistula, rather than a synthetic graft, as their first AV access (45% versus 31%; P < 0.01). These associations remained after adjustment for age, sex, race, marital status, education, insurance coverage, comorbid disease status, albumin level, body mass index, and underlying renal diagnosis. These data show that late referral to a nephrologist substantially increases the likelihood of dialysis-catheter use at the initiation of hemodialysis therapy and is associated with prolonged catheter use. Regardless of the time of referral, only a minority of patients used an AV access at the initiation of treatment, and greater than 25% had not used an AV access 6 months after initiation. Thus, further efforts to improve both referral patterns and preparation for dialysis after referral are needed.

Adolescent↗

PubMed2001

Racial and ethnic differences in advanced-stage prostate cancer: the Prostate Cancer Outcomes Study.

BACKGROUND: African-Americans have twice the risk of non-Hispanic whites for presenting with advanced-stage prostate cancer. To investigate the reasons for this difference, we evaluated the association between race/ethnicity and advanced-stage prostate cancer, adjusting for demographic, socioeconomic, clinical, and pathologic factors. METHODS: A population-based cohort of 3173 men diagnosed with prostate cancer between October 1, 1994, and October 31, 1995, was analyzed. Medical record abstracts and self-administered survey questionnaires were used to obtain information regarding race/ethnicity, age, marital status, insurance status, educational level, household income, employment status, comorbidity, urinary function, prostate-specific antigen level, tumor grade, and clinical stage. The odds ratio (OR) for advanced-stage prostate cancer was estimated with weighted logistic regression analysis. All P: values were two-sided. RESULTS: Clinically advanced-stage prostate cancers were detected more frequently in African-Americans (12.3%) and Hispanics (10.5%) than in non-Hispanic whites (6.3%). Socioeconomic, clinical, and pathologic factors each accounted for about 15% of the increased relative risk. After adjusting for all covariates, the risk remained statistically significantly increased for African-Americans (OR = 2.26; 95% confidence interval [CI] = 1.43 to 3.58) but not for Hispanics (OR = 1.23; 95% CI = 0.73 to 2.08). CONCLUSION: Traditional socioeconomic, clinical, and pathologic factors accounted for the increased relative risk for presenting with advanced-stage prostate cancer in Hispanic but not in African-American men.

Black or African American↗

PubMed1996

Correlates of past-year status among treated and untreated persons with former alcohol dependence: United States, 1992.

Past-year status was investigated in a sample of 4,585 adults with prior DSM-IV alcohol dependence. Those who had and had not received treatment for alcohol problems were compared in terms of past-year status and its correlates, to see if the experience of treatment samples would be reflective of the course of alcoholism in the general population. In the past year, 27.8% of the total sample met the criteria for alcohol abuse or dependence, 22.3% were abstinent, and 49.9% were drinkers who did not satisfy the criteria for either abuse or dependence. Persons who had been treated for alcohol problems were about twice as likely to be abstainers as those who had not been treated (38.8% vs. 16.4%), but only about half as likely to fall into the past-year category of drinking without abuse or dependence (28.0% vs. 57.8%). These differentials were of constant magnitude, regardless of the interval since the onset of dependence. For the sample as a whole, persons who had received treatment were slightly more likely than their untreated counterparts to have had alcohol abuse or dependence in the past year (33.2% vs. 25.8%), and this differential increased with the interval since the onset of dependence. The odds of both past-year abstinence and drinking without abuse or dependence were decreased by male gender, Black race, rapidity of the onset of dependence and ethanol intake per drinking day, and were increased by ever having been married and by later ages at onset of dependence. The odds of drinking without abuse or dependence relative to abstinence were increased by college attendance and reduced by the number of dependence symptoms, and having been a daily drinker was associated with increased odds of past-year abstinence. Treatment history modified the associations between past-year status and race, marital and educational status, number of past alcohol problems, and rapidity of onset of dependence and age at onset. These results suggest that treatment studies may not be generalizable to alcoholics who do not seek treatment.

Adolescent↗

PubMed2000

Association between psychosocial work characteristics and health functioning in American women: prospective study.

OBJECTIVE: To examine prospectively the relation between psychosocial work characteristics and changes in health related quality of life over four years in a cohort of working women in the United States. DESIGN: Longitudinal cohort study. SETTING: United States. PARTICIPANTS: 21 290 female registered nurses who completed the Karasek's job content questionnaire and a modified version of the short form 36 questionnaire (SF-36) as used for a survey of health status by the medical outcomes study. MAIN OUTCOME MEASURES: Seven dimensions of health status: physical functioning, role limitations due to physical health problems, bodily pain, vitality, social functioning, role limitations due to emotional problems, and mental health. RESULTS: Examined separately low job control, high job demands, and low work related social support were associated with poor health status at baseline as well as greater functional declines over the four year follow up period. Examined in combination, women with low job control, high job demands, and low work related social support ("iso-strain" jobs) had the greatest functional declines. These associations could not be explained by age, body mass index, comorbid disease status, alcohol consumption, smoking status, education level, exercise level, employment status, marital status, or presence of a confidant. CONCLUSIONS: Adverse psychosocial work conditions are important predictors of poor functional status and its decline over time.

Adult↗

PubMed2003

Feasibility and safety of day care laparoscopic cholecystectomy in a developing country.

BACKGROUND: Although day care laparoscopic cholecystectomy (DCLC) has been shown to be safe in centres with adequate infrastructure for day care surgery, its feasibility and safety in developing countries has never been studied. Because of differences in the quality of health care delivery, western guidelines for day care surgery cannot be universally applied to developing countries. PATIENTS AND METHODS: Patients less than 65 years who were graded I and II on the American Society of Anesthesiologists physical status score, irrespective of their educational status, living within 20 km, and willing to make their own arrangements for a return to hospital in case of problems were selected for DCLC. Follow up was done by patients calling the hospital the morning after surgery. RESULTS: 50% of the eligibility criteria were new; 313/383 patients were suitable for DCLC. The commonest cause for rejection was that the patient lived out of the defined area (50%). Altogether 92% were discharged within eight hours of surgery. The reasons for failure to discharge were the presence of abdominal drains in four (2%), nausea and vomiting in nine (3%), and conversion to open surgery in five (2%). Ten patients (3%) were readmitted; of these only two (<1%) had complications needing re-exploration. Analysis of results showed that the inclusion and discharge criteria were valid and that the readmission and complication rates as well as the ease and accuracy of follow up were comparable to published data. DCLC reduced waiting times and increased patient turnover and may have a positive impact on resident training. CONCLUSIONS: DCLC is safe, feasible, and has potential benefits for health care delivery in developing countries. Each surgical service needs to develop their own guidelines based on local patient demography.

Adolescent↗

PubMed2005

Household income and earnings losses among 6,396 persons with rheumatoid arthritis.

OBJECTIVE: Rheumatoid arthritis (RA) causes disability and reduced productivity. There are no large quantitative studies of earnings and productivity losses in patients with clinical RA, and no studies of household income losses. We describe methods for obtaining earnings and household income losses that are applicable to working as well as nonworking RA patients, and we perform such studies using these methods. METHODS: We estimated cross-sectional expected annual earnings and household income losses in 6,649 persons with RA from Current Populations Survey (CPS) and O*NET (Occupational Information Network) data, and we estimated expected household income and earnings losses based on demographic characteristics after adjustment to Medical Outcomes Study Short-Form 36 (SF-36) population norms (internal method). Workplace productivity was measured by the Work Limitations Questionnaire (WLQ). RESULTS: 27.9% of patients aged < or = 65 years considered themselves disabled after 14.6 years of RA, and 8.8% received disability benefits. Annual earnings losses ranged between USD 2,319 and USD 3,407 by the CPS and internal method (preferred), with losses of 9.3% and 10.9%. A 0.25 difference in Health Assessment Questionnaire (HAQ) score was associated with a $1,095 difference in annual earnings. Productivity losses were 6% based on work limitations identified by the WLQ. Household income loss (percentage loss) including transfer payments was USD 6,287 (11.8%) for all patients, USD 4,247 (6.9%) for employed patients, and USD 7,374 (14.8%) for nonworking patients. Among nonworking nondisabled patients aged < or = 65 years, income loss was 14.1%. CONCLUSION: As measured by annual household income loss, the overall impact of RA is USD 6,287 (11.8%). Earnings and household income are dependent on functional status, education, age, ethnicity, and marital status. Income loss is predicted by the HAQ, HAQ-II, Modified HAQ, and SF-36.

Aged↗

PubMed1995

Serologic evidence of Chlamydia trachomatis infection and risk of preterm birth.

OBJECTIVE: To determine whether serologic evidence of Chlamydia trachomatis during pregnancy is a risk factor for preterm delivery (before 37 weeks' gestation). DESIGN: Chart review. SETTING: Antenatal clinics associated with a teaching hospital. PATIENTS: A group of 103 unselected consecutive patients presenting for routine prenatal care. OUTCOME MEASURES: Pregnancy outcome and C. trachomatis serologic status. RESULTS: A total of 21 women (20%) were found to be seropositive for IgG antibodies to C. trachomatis. They were similar to the seronegative women with respect to maternal age, parity, history of preterm birth, obstetric or medical problems, smoking status, history of drug abuse, educational status and psychosocial stressors. The seropositive women were significantly more likely than the seronegative women to have a preterm birth (24% [5/21] v. 7% [6/82]i p = 0.029, odds ratio 3.96, 95% confidence interval 1.08 to 14.57), an infant with a lower mean gestational age at birth (262 [standard deviation (SD) 19] days v. 273 [SD 15] days; p = 0.0052) and an infant with a lower mean birth weight (3125 [SD 692] g v. 3473 [SD 696] g; p = 0.0434). The positive predictive value of a seropositive result for preterm birth was 31% (5/16); the negative predictive value of a seronegative result for preterm birth was 8% (6/76). CONCLUSION: Women with serologic evidence of C. trachomatis may be at risk for preterm birth. Further study is required to determine whether serologic testing for C. trachomatis should be a routine part of prenatal care.

Adult↗

PubMed1988

Parental educational background and residency training selection of minority and nonminority medical students.

The subject of background variables influential in the choice of postgraduate medical specialty training has been described in numerous papers. Few, if any, have examined the influential patterns in minority students' residency training selection when compared with nonminority students. No studies reviewed examined the differential patterns that may have an impact on specialty selection in these subgroups, especially in regard to maternal and paternal educational status. This study analyzes the interrelationship between minority and nonminority medical students, their parental educational background, and selection of postgraduate specialty, and suggests that parental educational background be investigated further as a predicative indicator of medical student specialty career selection.

Career Choice↗

PubMed1977

Determinants of pattern and degree of utilization of health services in Western State, Nigeria.

A survey of the determinants of the pattern and degree of utilization of health services in two divisions of Western State, Nigeria was carried out. There was generally a close similarity between the two divisions in the choice and use of services even though one is "urban" and the other "rural" in terms of socioeconomic characteristics and available health facilities. The study showed that the choice of a particular service was based on a complex of factors, such as age, educational status, type of occupation, place of work, medical cost, the individual's perception of and attitudes towards services or dispensers of service, and the quality and location of the services. The individual effects of age, education, type of occupation or place of work on attitudes towards health services could only be inferred from the study; these need to be empirically investigated and validated. The implications of the determining factors for health planning and public health education are outlined.

Adult↗

PubMed1991

International comparative study of childhood malignancy comparative study of pediatric malignancy between Kurume and Karachi (K-K Project 1991).

UNLABELLED: A study was undertaken to compare Pediatric Malignancy at Kurume (Japan) and Karachi (Pakistan) with reference to international data collected over the years, in order to identify essential differences between developed and developing conditions and factors influencing the etio-pathogenesis of pediatric cancer. The study was retrospective encompassing all types of cancer in children over a period of three years i-e 1988-1990. Essential factors related to present study were: 1. POPULATION: The population of Karachi is about 10 million while that of Kurume is only half a million. 2. Socio-economic conditions: The average socio-economic condition of people in Karachi is poor while in Kurume it appears to be good. 3. Educational status: Only 25% people in Karachi are educated beyond middle class while Kurume reveals a 100% education up to high school level. 4. Environmental conditions: The environmental conditions of Kurume and surrounding areas are very clean and free from pollution, sewage problems and traffic hazards. Karachi and its surroundings on the other hand pose very serious air and water industries! It was concluded that whereas genetic predisposition predominates, the environmental conditions, educational and socio-economic status of a society immensely influence the pattern and trends of pediatric carcinogenesis.

Adolescent↗

PubMed2005

Health-related quality of life of Turkish stroke survivors.

Stroke is a major, chronically disabling neurological disease, which often radically and permanently changes the lives of the victims. Improvement of motor coordination and the degree of independence achieved in activities of daily living have been the usual criteria used to measure outcome in stroke rehabilitation. The objective of our study is to compare health-related quality of life (HRQOL) between stroke patients 6 months after rehabilitation and a control group who did not have any major illness. The associations of several factors with the quality of life were also examined. Sixty consecutive stroke patients and 58 healthy control participants were included in the study. Functional independence measure (FIM), Nottingham health profile (NHP) and demographic variables were used as the main outcome measures. There were significant improvements in both motor coordination and functional status as measured by FIM at discharge and also 6 months after stroke and these variables were significantly associated with the HRQOL. The NHP, which is a validated quality-of-life measurement in Turkish patients, was used and the scores were compared with the healthy control participants. The scores of NHP domains (energy level, emotional reactions, sleep, social isolation and physical mobility) of the stroke patients were higher than those of the healthy group (P<0.01). Age, marital status, lesion side and multiple stroke history showed no significant correlation with NHP scores. Being a woman, lower educational status, tendency to depression and the presence of several comorbidities were significantly correlated with the NHP scores. Stroke survivors in our society have lower HRQOL than healthy individuals. HRQOL is correlated with the functional status in the stroke population. Additionally, the reduced HRQOL after stroke appears to be related to several demographic properties such as sex, education, comorbidities and psychological factors.

Adult↗