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PubMed2006

Increasing educational disparities in premature adult mortality, Wisconsin, 1990-2000.

CONTEXT: Public health agencies have identified the elimination of health disparities as a major policy objective. OBJECTIVE: The primary objective of this study is to assess changes in the association between education and premature adult mortality in Wisconsin, 1990-2000. DESIGN, SETTING, AND SUBJECTS: Wisconsin death records (numerators) and US Census data (denominators) were compiled to estimate mortality rates among adults (25-64 years) in 1990 and 2000. Information on the educational status, sex, racial identification, and age of subjects was gathered from these sources. MAIN OUTCOME MEASURE: The effect of education on mortality rate ratios in 1990 and 2000 was assessed while adjusting for age, sex, and racial identification. RESULTS: Education exhibited a graded effect on mortality rates, which declined most among college graduates from 1990 to 2000. The relative rate of mortality among persons with less than a high school education compared to persons with a college degree increased from 2.4 to 3.1 from 1990-2000-an increase of 29%. Mortality disparities also increased, although to a lesser extent, among other educational groups. CONCLUSION: Despite renewed calls for the elimination of health disparities, evidence suggests that educational disparities in mortality increased from 1990 to 2000.

Adult↗

PubMed2002

Maternal perception of pneumonia in children: a health facility survey in Enugu, eastern Nigeria.

In a health facility-based study to determine the knowledge of mothers regarding recognition of pneumonia in their pre-school children, 400 women were interviewed using a pre-tested structured questionnaire. Sixty-one per cent of them would recognise pneumonia by difficult breathing, 42% by fast breathing and 26.5% by severe cough. Few of the mothers mentioned signs suggestive of 'chest indrawing' (8.5%) and 'central cyanosis' (1%). The maternal knowledge score on pneumonia signs increased significantly with educational status and social class (p < 0.05). While a substantial number of mothers (51%) perceived fast breathing to be an indication of severe pneumonia, a sizeable number (87.5%) were unsure if late signs such as chest indrawing and central cyanosis suggested severe disease. On the basis of the WHO criteria, it is concluded that maternal recognition of pneumonia in children is at best modest while knowledge of signs indicating severe disease is poor. These findings underscore the need to modify the WHO criteria to include difficult breathing and to highlight during local ARI health education campaigns that late signs such as chest indrawing and central cyanosis indicate severe and potentially fatal pneumonia.

Adult↗

PubMedDate not supplied

Social and economic conditions at Tari.

A social and economic survey was conducted in 1984 to assess the impact of development at Tari and to supplement the demographic data being collected by the Tari Research Unit. Of 1604 adults aged 17 years and over selected from the demographic database, 1389 were interviewed and information was collected on the remainder from informants. The survey reveals an uneven pattern of change, with men living close to the town most advantaged in terms of education, employment, diet and possessions, and women in remote areas the least advantaged. There was, however, some evidence that peripheral parts of Tari were catching up with those in the centre. Observations since 1984, and some data collected in 1998, suggest that law and order problems and the decline in government services have led to a stagnation in social progress at Tari. This is despite considerable expansion of the district economy due to payments and remittances from resource projects operating in and around Tari. Women's educational status has nonetheless improved to some extent. Better governance and the restoration of services are required if the socioeconomic status of Tari people is to improve.

Adolescent↗

PubMed1992

Can mothers safely prepare labon-gur salt-sugar solution after demonstration in a diarrhoeal hospital?

Home-based salt-sugar solution (SSS) prepared with labon (locally produced sea salt) and gur (unrefined brown sugar) has been recommended as a cheap, locally available and a simple tool to prevent and treat diarrhoeal dehydration. Preparation of labon-gur SSS is demonstrated to the patients and the attendants at ICDDR, Bangladesh. To evaluate performances, 150 mothers were asked to measure labon and gur by finger pinch and first method and 100 mothers measured half a seer of water to prepare labon-gur SSS, shortly after the demonstration sessions. 4.0% of the samples exceeded the upper safety limit while 1.3% exceeded the upper danger limit for salt and 98.7% samples of gur were within safe and effective range. Mothers' performances were not different with regard to their educational status and prior practice at home. 80% knew about the solution before coming to the hospital and 45% had utilized this knowledge. Our study suggests that demonstration of home-based SSS in a diarrhoeal hospital may positively affect health education and that health personnel should actively participate in increasing health awareness.

Bangladesh↗

PubMed1997

[The risk of road traffic accidents among primary school children in Kuala Terengganu].

A case control study was conducted in 1996 among primary school student in Terengganu. The objective of the study is to determine the relationship between road traffic accidents and factors such as socio-economic status, distance from school, number of siblings, behavioural problems, knowledge and attitudes of pupil and their parents towards road safety and parents' educational status. A total of 140 cases was obtained from 3 urban schools and 3 from rural schools. Cases were matched with control according to age sex and locality of residence. There were significant associations between road traffic accidents and pupils' knowledge regarding road crossing (OR = 0.40, 95% CI = 0.19-0.85), parental supervision (OR = 0.43, 95% CI = 0.19, 0.64) and parents having driving licences (OR = 0.99, 95% CI = 0.856-0.999). Road safety education for pupils and parental supervision are key measures in preventing road traffic accidents among primary school children.

Accidents, Traffic↗

PubMed2000

Utilization of preventive medical services in the United States: a comparison between rural and urban populations.

Differences between rural and urban residents in their utilization of three clinical preventive services--Papanicolaou screening tests (Pap smears) for women aged 18 to 65, mammograms for women aged 50 to 69 and flu shots for people aged 65 or older--were examined using a nationally representative sample from the 1994 U.S. National Health Interview Survey. Eighty-two percent of urban women and 79 percent of rural women (P = 0.11) had Pap smears. Sixty-eight percent of urban women and 61 percent of rural women (P = 0.01) had mammograms. Flu shots were received by 55 percent of urban and 58 percent of rural elderly residents (P = 0.11). Of women aged 50 to 69 who had a high school education or whose annual household income was between $15,000 and $34,999, significantly fewer rural than urban women had mammograms (P < 0.01). However, the proportion of rural women receiving mammograms was not significantly different from that of urban women after adjusting for their education, household income and health insurance status. Education level, house-hold income and health insurance coverage were positively associated with utilizing mammograms. These results suggest that differences in the utilization of preventive services between rural and urban women vary by services. Improving socioeconomic status and health insurance coverage of rural women may reduce the disparity in mammogram use between rural and urban women. Mechanisms of how a woman's socioeconomic status affects her utilization of mammograms needs further study.

Adult↗

PubMed1997

Unintended childbearing, maternal beliefs, and delay of prenatal care.

BACKGROUND: Delay of prenatal care is an important risk for poor birth outcome, yet its association with maternal knowledge and beliefs remains insufficiently studied. This research examined the relationship of unintended childbearing and beliefs about the importance of prenatal care with initiation after the first trimester, adjusting for key sociodemographic determinants. METHODS: One hundred fifty-four Texas hospitals accounting for 80 percent of state births were asked to collect surveys from all women delivering infants during a one-week interval in 1986. Seventy-four percent of hospitals and 70 percent of women participated (n = 2032). No differences occurred between the sample and the population on rates of delayed care and low birthweight or maternal demographics. RESULTS: Since delayed prenatal care is more frequent among low-income women, analyses were limited to those below the 200 percent poverty level. After adjustment for maternal age, marital status, education, parity, race, and health insurance status employing logistic regression, unintended births were 1.6 times more likely to involve delayed care. Mothers who believed prenatal care was unimportant were 2.1 times more likely to delay care. These coefficients exceeded or about equaled those for the covariates. CONCLUSIONS: Preconception education about the value of prenatal care and family planning programs to prevent unintended pregnancies should be conducted together with efforts to overcome financial and structural barriers if progress toward national prenatal care objectives is to be achieved.

Adult↗

PubMed2002

Health-related consequences of overactive bladder.

OBJECTIVE: Overactive bladder (OAB) is a condition of urgency, with or without urge incontinence, usually with frequency and nocturia. This study assesses whether people with OAB are at greater risk for urinary tract infections (UTIs), falls and injuries, and increased number of visits to the doctor compared to age- and gender-matched controls. The study also estimates costs associated with these health-related consequences. PATIENTS & METHODS: A US representative telephone survey under the National Overactive Bladder Evaluation (NOBLE) Program was conducted with 5204 English-speaking adults older than 18 years. The survey asked respondents about bladder symptoms. Based on the telephone survey, 865 symptom-identified OAB cases and 903 age- and gender-matched controls were sent a postal questionnaire. A total of 397 cases and 522 controls returned the questionnaires. Nonrespondent cases and controls did not differ with regard to age, gender, educational status, diabetes, congestive heart failure, and self-rated health status. Regression analyses were conducted to assess the effect of OAB on health-related consequences, controlling for age, gender, race, education, marital status, number of previous births, self-reported health status, diabetes, and congestive heart failure. RESULTS: People with OAB reported 0.84 (20%) more visits to the physician (P < .05) and 0.21 (138%) more UTIs in the last year than people without OAB (P < .001). Overactive bladder cases also had over twice the odds of being injured in a fall than people without OAB (odds ratio = 2.26; 95% confidence interval 1.46, 3.51). Consistent with having more falls, OAB cases had an increased risk of bone fracture (P < .1). This effect, however, was not statistically significant (at alpha level 0.05) due to the limited sample size. The estimated cost of UTIs associated with OAB was approximately $1.37 billion US dollars in year 2000. The cost of falls without bone fracture due to OAB was $55 million. Falls with bone fracture accounted for approximately $386 million; however, further research with a larger sample is needed to accurately estimate these costs. CONCLUSION: People with OAB self-report significantly more UTIs and a greater risk of being injured in a fall. Given the large prevalence of UTIs and concerns of overprescribing antibiotics, these results are important for health plans and policy makers. In addition, people with OAB visit their physicians more often than people without OAB. These consequences entail significant economic costs, of which a large percentage will be incurred by health plans. To the extent that OAB causes these consequences, there may be significant savings from effectively treating OAB.

Accidental Falls↗

PubMed2005

Determinants of pain perception in labour among parturients at the University College Hospital, Ibadan.

This cross-sectional study of one thousand parturients aims to evaluate the factors, which are associated with pain perception in labour and to identify women who will benefit most from analgesia in labour. The instrument applied was a structured questionnaire incorporating the Box numerical scale (BNS) for pain assessment. Patients who delivered by elective or emergency caesarean section and women who did not give informed consent were excluded from the study. Spearman's and Pearson's correlational analyses were applied. Pain scores showed significant correlation with age (r=- 0.087, p<0.01), parity (r=- 0.226, p<0.01), gestational age at delivery (r=- 0.074, p<0.05), onset of labour (rho=0.195, p<0.01), mode of delivery (rho=0.160, p<0.01), booking status (rho=- 0.070, p<0.05) and educational status (rho=0.182, p<0.01). Certain groups of patients would benefit from obstetric analgesia. These patients include, nulliparous patients, young patients, patients who have had labour induced, those with preterm deliveries and those with an assisted vaginal delivery especially if they are well educated.

Adult↗

PubMed2006

Evidence of cognitive compensation associated with educational level in early relapsing-remitting multiple sclerosis.

BACKGROUND: Cognitive compensatory mechanisms may limit the cognitive dysfunction due to cerebral tissue destruction in multiple sclerosis (MS). OBJECTIVE: To explore the effect of educational status on cognitive performances in early relapsing-remitting (RR) MS. METHODS: 43 RRMS patients were individually matched for age, sex and educational level with 43 healthy controls. Each patient underwent neuropsychological tests, clinical assessment and magnetic resonance imaging (MRI). Cognitive scores of MS patients were compared to those of their paired controls according to educational level. RESULTS: Less educated patients had low performances on all but two neuropsychological tests, while more educated patients had low scores only for three tests. Cognitive performances of more educated patients but not those of less educated ones were strongly correlated with MRI parameters and decreased with the severity of cerebral tissue destruction. CONCLUSION: These different cognitive patterns suggest the existence of a cognitive compensation in more educated patients which is limited by the accumulation of tissue damage.

Adult↗

PubMed2006

Alcohol abuse and dependence in college and noncollege samples: A ten-year prospective follow-up in a national survey.

OBJECTIVE: This prospective study examines the association of educational status in 1984 and the risk for past-year Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), alcohol-use disorders (AUDs) in 1994, 10 years later. METHOD: A sample of 8,661 respondents was drawn from the National Longitudinal Survey of Labor Market Experience in Youth. Measures included baseline heavy episodic drinking, alcohol-dependence symptoms, early problem behaviors (antisocial behaviors, illicit substance use, family history of alcoholism, and age at onset of alcohol use), demographic characteristics (gender, race/ethnicity, age, marital status), and 1994 assessment for past-year DSM-IV AUDs. RESULTS: Findings from this 10-year prospective study indicate that education beyond high school had a protective effect for alcohol dependence, and dropping out of high school resulted in an elevated long-term risk for alcohol dependence. These associations remained significant when other early behavioral problems were included in the models. CONCLUSIONS: The risk of alcohol dependence and, consequently, the need for appropriately tailored prevention efforts is greater among high school dropouts and college nonattenders than among college students, although much of the current literature has focused on the latter.

Adult↗

PubMed1998

Gender differences in the schooling experiences of adolescents in low-income countries: the case of Kenya.

Although a growing proportion of young people is spending some time in school between puberty and marriage, little research on education in developing countries has been focused on adolescent issues. This article examines the school environment in Kenya and the ways it can help or hinder adolescents. Gender differences are considered with a view toward illuminating some factors that may present particular obstacles or opportunities for girls. Using both qualitative and quantitative data, 36 primary schools in rural areas in three districts of Kenya are studied. These schools are chosen to reflect the spectrum of school quality in the country. The focus in this study is on primary schools because the majority of adolescents in school attend primary school. In these schools, where considerable variation in performance and parental educational status is found, disorganization coexists with strict punishment, minimal comforts are lacking, learning materials are scare, learning is by rote, and sex education is not provided. In the primary-school-leaving exam, girls' performance is poorer than that of boys. Teachers' attitudes and behavior reveal lower expectations for adolescent girls, traditional assumptions about gender roles, and a double standard about sexual activity.

Adolescent↗

PubMed1998

Compliance considerations with hormone replacement therapy.

OBJECTIVE: The purpose of this study was to determine women's own reasons for postmenopausal hormone replacement therapy (HRT) utilization and discontinuation in a Turkish population and to investigate the variables that have influenced the compliance to treatment. DESIGN: The study was comprised of 613 postmenopausal women who presented to the Menopause Unit in the Marmara University Hospital. RESULTS: A total of 437 women (71.2%) reported that they continued using postmenopausal HRT and 176 women (28.7%) discontinued treatment with an average 4.5 months duration of use (range 1-60 months). Hot flashes was the most common reason for initiating therapy (258 women, 42.0%). Prevention of osteoporosis was mentioned by 149 (24.3%) women as a reason to begin HRT. Bleeding episodes (44.8%) was the most common factor in the patient's decision to discontinue HRT. Continuation of HRT was significantly more common among women who started HRT either because of physician recommendation or osteoporosis concern (p < 0.05). Additionally, a greater percentage of surgically menopausal women began and continued HRT (p < 0.0001) than naturally menopausal women. The educational status of the patients was directly related to incidence of beginning HRT but was not related to the discontinuation of HRT. CONCLUSIONS: Education of menopausal women about the long-term benefits of HRT is critical in improving compliance.

Adult↗

PubMed1990

On the relationships between rural labor productivity, family investment in education, and population quality.

The authors consider "the relationships between labor productivity and population quality in order to demonstrate the importance of economic development, and of improving population quality in rural areas. This study is made on the basis of surveys conducted in 1979 and 1986 on the age-specific VP and VC [volume of production and volume of consumption] in certain areas of Jiangsu Province [China]." Population quality is defined primarily in terms of the educational status of the labor force.

Asia↗

PubMed1995

Risk factors for periodontal diseases in Ilala, Tanzania.

The purpose of this study was to evaluate associations between periodontal diseases and the common risk factors in Ilala, Tanzania. To determine behavioural and socioeconomic background, a total of 1764 subjects (827 males and 937 females) aged 3-84 years were randomly selected and interviewed. The subjects were examined clinically for the presence of plaque, calculus, gingival inflammation, periodontal probing depths and gingival recessions. Logistic regression analyses showed that the risk factors for gingivitis were male sex, presence of plaque or calculus and use of local "mswaki", the risk factors for periodontal pockets were age of 35 years or more, presence of plaque, and rural residence. The risk factors for gingival recession were identified as age of 35 years or more, male sex, lower educational status, presence of plaque and gingival inflammation. The most significant risk factors to have periodontal diseases in this study population were age, sex, education, rural residence, plaque and calculus.

Adolescent↗

PubMed2000

The satisfaction with the removable partial denture therapy in the Croatian adult population.

Little is known about the outcomes of treatment and patient's satisfaction with removable partial dentures in adult Croatian population. Therefore patient's satisfaction with their partial dentures in relation to some socio-economic variables was studied. Patient's satisfaction with denture retention, speech, aesthetics, comfort of wearing dentures, chewing ability was also studied in relation to different denture classification, construction, material, denture base shape (major connectors), denture support and the number of missing teeth. A total of 165 patients, 59 males and 105 females between 38 and 87 years took part in this study. A questionnaire, devised for a purpose of the study, was divided into three parts. In the first part, patients answered questions about age, gender, marital status, education, general health, socio-economic status, self-supporting life, period of tooth loss and number of previous denture experiences and in the second part, patients graded their partial dentures, depending on the level of satisfaction, by using a scale from 1 to 5. In the third part a dentist determined Kennedy classification and their modifications, denture material and denture support, denture base shape and the number of missing teeth and graded a denture construction. Influence of these factors on patient's satisfaction was analyzed. A majority of the examined patients were satisfied with the partial prosthesis, but a small amount of dissatisfaction existed. More then half of them scored all the examined parameters to the best score category. Considering chewing with lower partial dentures, women were more satisfied than men (p < 0.05). Patients with more missing teeth gave lower grades for the comfort of wearing dentures (p < 0.05). Patients of higher education gave lower grades (p < 0.05) for the aesthetics. Patients were not satisfied with speech if the dentist graded a construction of a lower partial denture low (p < 0.05). Dissatisfaction was related to mastication, aesthetics, number of missing teeth and ability of speech. These findings can aid a clinician in discussing a treatment plan and help a patient understand the risk of dissatisfaction in the presence of certain factors.

Adult↗

PubMed2003

The self-assessed oral health status of individuals from White, Indian, Chinese and Black Caribbean communities in South-east England.

OBJECTIVES: To determine the level of self-assessed oral symptoms and the impact of such symptoms among individuals from four ethnic groups resident in South-east England and the relationship between self-assessed oral health status, age, gender, employment status, educational level and ethnicity. METHOD: Cross-sectional survey of a convenience sample of 366 individuals drawn from four ethnic groups. MEASURES: Subjective Oral Health Status Indicators (SOHSI). PARTICIPANTS: Individuals were recruited through community groups. All participants self-classified their ethnicity. Only completed questionnaires from participants categorising themselves as White, Black Caribbean, Chinese or Indian were included in the data analysis. FINDINGS: Univariate statistical analysis revealed significant differences between ethnic groups in all but one of the SOHSI scales. Age and ethnicity (in particular membership of the Chinese community) emerged as significant predictors of SOHSI scale scores. CONCLUSIONS: Within the limitations imposed by convenience sampling, it has been found that differences exist among four ethnic groups in the UK in their reporting of self-assessed oral health status. Ethnicity and age, in particular, predict the reporting of self-assessed oral symptoms and the impact of such symptoms.

Adolescent↗

PubMed2004

Life after cancer in childhood: social adjustment and educational and vocational status of young-adult survivors.

PURPOSE: To evaluate the long-term social effect of illness and its treatment on young-adult survivors of pediatric cancer by addressing a selection of general social adjustment criteria. METHODS: In a cross-sectional case-control study, 30 young-adult survivors of childhood cancer were compared with (1). controls with no history of serious illness, matched by sex, age, and geographic area of residence, and (2). general population norms on the subject of educational and vocational factors, habitation, family/partner relationships, parenthood, and leisure activities. RESULTS: The educational status of survivors was similar to that of controls, although a smaller proportion of the patients expressed concrete plans for future vocational or educational advancement. Survivors had less frequently entered higher education compared with general population norms. A longer duration of treatment was related to a lower estimated socioeconomic level, and poor psychological coping with the illness experience was associated with the fact that they were still living with their parents, a shorter education, and a lower socioeconomic level. CONCLUSIONS: The social, vocational, and educational adjustment of relapse-free survivors from childhood cancer appears as only moderately, if at all, negatively affected by the illness and treatment history. However, the treatment intensity and particularly the survivors' coping with their illness experience may influence their ability to achieve long-term social goals. These findings suggest that special attention should be given to matters concerning education and partner relationships at long-term follow-up of pediatric cancer patients.

Adult↗