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PubMed1989

Women's education and its influence on attitudes to aspects of child-care in a village community in Kerala.

In this study of 78 rural mothers of preschoolers in Trichur District, Kerala, India, the author attempts to measure the impact of 10 years of schooling on their attitudes to five important aspects of child-care which have been hypothesized to be key factors in improved child survival. The possible reasons for the important findings of (1) stronger positive attitudes towards traditional aspects of child-care such as breast-feeding, and weaker positive attitudes towards immunization, and (2) no significant difference between educated and less educated women in any of the areas tested, are discussed. The study also explores the question of whether the education of husbands is more important in producing positive attitudes in women than their own educational status, and finds evidence to show that this is so with respect to immunization. The reasons for this are discussed.

Attitude to Health↗

PubMed2005

Risk factors for severe hypoglycaemia in type 2 diabetic patients admitted to hospital in Piraeus, Greece.

A 3-year study assessed the prevalence and causes of severe treatment-related hypoglycaemia in type 2 diabetes mellitus patients admitted to hospital in Piraeus. Out of the 2858 patients admitted, 207 (7.2%) had severe hypoglycaemia: 72 were being managed with insulin, 132 oral hypoglycaemic drugs and 3 combined insulin/oral drugs. Only 28.5% of patients were attending a diabetes clinic. The cause of the hypoglycaemic attack could be determined for 86.1% of cases; 30.8% were due to a missed meal. Interviews showed that education and level of knowledge about diabetes mellitus, and particularly hypoglycaemia symptoms, was inadequate. Logistic regression analysis showed that knowledge about diabetes mellitus correlated with educational status and with follow-up in a diabetes clinic.

Aged↗

PubMed2006

Voluntary counseling and testing among post-partum women in Botswana.

OBJECTIVE: To determine uptake and socio-demographics predictors of acceptance of voluntary counseling and testing (VCT) among post-partum women in Botswana. METHODS: Women attending maternal and child health clinics for their first post-partum or well baby visit in three sites in Botswana were offered VCT after a written informed consent. A standardized questionnaire was used to collect socio-demographic characteristics and reasons for declining VCT. RESULTS: From March 1999 to November 2000, we approached 1735 post-partum women. Only 937 (54%) of those approached accepted VCT. In multiple logistic regression analysis, younger maternal age, not being married, and less formal education were significant predictors of acceptance of VCT. Thirty percent of women who accepted VCT were HIV-positive. CONCLUSION: Our results indicated that in Botswana prior to the initiation of a government Mother to Child Transmission (MTCT) prevention program, younger, unmarried, and less educated post-partum women were more likely to undergo VCT. PRACTICE IMPLICATIONS: Our results have shown that interventions to improve VCT among post-partum women and more generally among women of reproductive age are warranted in Botswana. These interventions should account for differences such age, marital status, education, and partner involvement to maximize VCT uptake.

AIDS Serodiagnosis↗

PubMed2003

Risk factors associated with preterm labour.

A Prospective case control study was conducted in a tertiary hospital in Northern India to determine the risk factors associated with preterm labour. Ninety four consecutive patients with preterm spontaneous labour were selected as cases and 188 patients with term spontaneous labour as control. The incidence of preterm labour was found to be 23.3%. The cases were older, shorter and lighter than controls. They had lower body mass index (BMI) and mid arm circumference (MAC). They belonged to significantly lower income group and their educational status was lower. Mean pregnancy order was higher and mean parity was lower amongst the cases. Mean birth weight and apgar score of the babies were lower. Maternal weight <45 kg (OR 4.9), height <150 cm (OR 3.4), BMI <19 kg/m2 (OR 2.91), MAC <20 cm (OR 7.78), education <5 year (OR 2.73), income <2000 rupees (OR 5.05) and birth interval <12 months (OR 6.39) were significant risk factors for preterm labour.

Adult↗

PubMed2006

Cognitive function in childhood and early adulthood and injuries later in life: the Metropolit 1953 male birth cohort.

BACKGROUND: It has been suggested that cognitive function in childhood is a modifiable risk factor for adult injury. This study examines the relationship between cognitive function measured at the age of 12 and 18 years and fatal and non-fatal injuries later in adult life. METHODS: A total of 11 532 males born in Copenhagen, Denmark in 1953 were followed from 1978 until 2001 with outcomes (death from and hospital admission for unintentional injury) obtained from national registers. At the age of 12 years, 7987 of these cohort members had completed a questionnaire, which included information on cognitive performance. In addition, cognitive test scores measured on most (90%) cohort members were retrieved from the conscription board records (18 years). RESULTS: During follow-up, 100 of the men died as a result of and 2123 had been admitted to hospital at least once for injury. Cognitive function measured at both the age of 12 and 18 years was inversely associated with any form of unintentional injury. Adjustment for educational attainment at the age of 18 years attenuated these associations but did not remove them completely. The association was most evident for falls and poisoning, while associations with other injury types were weaker and disappeared after adjustment for educational status. Cognitive function was associated with repeated hospital admissions for injuries as well as length of hospital stay. CONCLUSIONS: We found marked inverse associations between cognitive function measured in ages 12 and 18 years and adult risk of fatal or non-fatal unintentional injury. An overall increase in educational level may result in a reduction in adult injury risk.

Accidental Falls↗

PubMed2002

Education, occupation, and perception of health amongst previous polio patients compared to their siblings.

Patients with previous polio represent a challenge for neurological rehabilitation. We examined 168 previous polio patients and 239 of their siblings, the patients either from the 1950-1954 epidemic cohort, or from a cohort of hospital-admitted rehabilitation patients. Ninety-four paralytic patients and 74 non-paralytic patients were included. All patients and siblings answered the same questionnaires for socioeconomic and health factors and chi-square comparisons were performed. Previous polio did not affect the level of education. Both patients and siblings rated their educational options to have been good. Significantly less patients were full-time employed at the age of 40 years compared to their siblings (P=0.015). This was the result of a lower full-time employment rate amongst the paralytic patients, only 52% of this group being employed full-time. Male patients and paralytic patients reported to have experienced reduced professional options. More patients were living alone compared to their siblings (P=0.035). The perception of general health was lower amongst patients than siblings, as was assessment of total life situation and patients reported more frequently symptoms like pain and tiredness. In conclusion, previous polio had not lowered the polio patients' educational status, but fewer patients were employed full-time at the age of 40 years.

Adult↗

PubMed2005

Socio-economic position across the life course and hysterectomy in three British cohorts: a cross-cohort comparative study.

OBJECTIVE: To examine the association between indicators of lifetime socio-economic position and rates of hysterectomy in three British cohorts. DESIGN: Cross-cohort comparative study. SETTING: Two cohorts: England, Scotland and Wales. Third cohort: Aberdeen, Scotland. POPULATION: Three thousand two hundred and eight women born between 1919 and 1940, participating in the British Women's Heart and Health Study (BWHHS); 1394 women from the MRC National Survey of Health and Development (NSHD), followed up since birth in 1946; 3208 women born between 1950 and 1955, participating in the Aberdeen Children of the 1950s study, all with complete information on lifetime socio-economic position and hysterectomy status. METHODS: Relative indices of inequality were derived for markers of socio-economic position in childhood and adulthood. Cox's regression models were used to test the association between these markers and hysterectomy. MAIN OUTCOME MEASURE: Self-reported hysterectomy with or without oophorectomy. RESULTS: Adverse socio-economic position in childhood and as indicated by educational status was associated with reduced rates of hysterectomy in the oldest of the three cohorts (BWHHS), whereas conversely in the NSHD and Aberdeen cohorts it was associated with increased rates of hysterectomy. The unadjusted hazards ratios for hysterectomy comparing worst to best socio-economic position for father's social class were 0.73 (0.56, 0.96) for women from the BWHHS, 1.77 (1.19, 2.65) for those from the NSHD and 2.06 (1.46, 2.89) for those from the Aberdeen cohort. Associations between markers of adult socio-economic position and hysterectomy tended to be weaker in all three cohorts and often did not reach conventional levels of statistical significance. CONCLUSIONS: Our results show that hysterectomy rates are influenced by childhood socio-economic position and educational attainment, but that the nature of this association varies across these three British cohorts born in different decades of the 20th century. That there were no consistent or strong associations between adult SEP and hysterectomy rates suggest that social factors influencing rates of hysterectomy are likely to be those experienced or which develop in early life rather than those which develop later.

Adult↗

PubMed1992

Has the climacteric been medicalized? A study on the use of medication for climacteric complaints in four countries.

In order to compare the use of hormone replacement therapy (HRT), non-hormonal treatment for the menopause, and tranquillizers, samples of about 300 women aged over 40 were interviewed in France, the United Kingdom, the former West Germany and Italy. The proportion of women in the samples using HRT varied from 3% in Italy to 25% in Germany. The figures for non-hormonal treatment ranged from 2-13%, and for tranquillizers from 5-28%. The use of both HRT and non-hormonal treatment was found to be related to the perimenopause and the corresponding age groups and that of HRT to higher educational level. Tranquillizer use was related to the postmenopause and lower educational level. After controlling for potential confounding effects of menopausal status, educational level, gainful employment and civil status, it emerged that HRT use rates varied significantly between the countries surveyed. It is concluded that cultural differences exist between these countries as to the prescription and acceptance of HRT.

Adult↗

PubMed1984

Self-medication: an important aspect of primary health care.

The main objective of this study was to determine the degree to which individuals practised self-medication in relation to their educational status. Kalutara, a small town in Sri-Lanka is semi-urban and has a good mixture of literates and illiterates. Important findings include the fact that knowledge of drugs was grossly inadequate, literates self-medicated far more than illiterates and a high percentage of the total sample population by-passed other health personnel in preference for Western trained doctors. Self-medication, though desirable, can be dangerous and should be emphasized as a component of primary health care because (i) it is commonly practised even where health professionals are easily accessible, (ii) it encourages self-reliance for curative, preventive, promotive and rehabilitative care and (iii) literacy, which seems to enhance its practice, is increasing worldwide.

Adult↗

PubMed1987

Adolescent suicide attempts 1973-1982 in the Helsinki area.

Four hundred and twenty-two adolescent suicide attempts were examined. The intent to die was weaker than in adult persons. Within lethality no difference was found. Adolescents came mostly from the lowest social classes and their educational status was low. Their mental health was often unsatisfactory. The psychiatric treatment, which was arranged after the suicide attempt, was not more intensive than that arranged for adult suicide attempters.

Adolescent↗

PubMed1977

The dimensions of life quality in a community.

In this study the dimensions of the quality of life construct were investigated; 454 residents of a large suburban community were asked questions on life changes, psychiatric distress, happiness, and effective participation in life concerns. Selected variables from this survey were factor-analyzed in order to define the dimensions of life quality and six demographic variables; age, sex, marital status, education, income, and religious participation were studied to see how they influenced those dimensions. The results of the analysis revealed that life quality is measurable in terms of a person's happiness, his community participation, and his preferences, answering three major questions that person may pose for himself: (1) How well do I like the life I lead? (2) In what meaningful ways do I spend my time? (3) Why? Each of the six demographic variables influenced these dimensions. Marital status and age, two life-cycle statistics, had the most powerful effects on quality-of-life ratings.

Adolescent↗

PubMed1990

Depression, anxiety, and temporal lobe epilepsy. Laterality of focus and symptoms.

The association between anxiety, depression, and lateralization of an epileptogenic focus was explored in 18 adult patients with a left temporal lobe focus, 21 with a right focus, 20 with bilateral temporal foci, and 16 individuals with absence seizures. No significant difference in the level of anxiety was found among the groups. However, patients with left-sided temporal lobe epilepsy scored significantly higher than other groups on self-ratings for depression. This could not be accounted for by factors such as duration of epilepsy, employment status, education, age at seizure onset, or medication status. The left temporal lobe epilepsy group had a nonsignificantly larger number of males and left-handed subjects. The possible interactions between gender, handedness, seizure focus, and vulnerability to depression are described.

Adult↗

PubMed1995

Predictors of blood loss during total hip replacement surgery.

OBJECTIVE: To determine total blood loss and transfusion requirements during primary total hip replacement (THR) surgery; and, to identify predictors of increased blood loss. METHODS: This was a prospective cohort study of 295 consecutive patients undergoing primary THR at a 700-bed teaching hospital in Boston, Massachusetts. The main outcome measures were the total blood loss, which was defined (in units) as the initial hematocrit minus final hematocrit divided by 3 plus the number of units transfused, and the number of autologous and homologous units of blood transfused. RESULTS: The mean total blood loss was 3.6 units, and the mean total units transfused was 2.1. Univariate predictors of greater total blood loss (at P < 0.05) included being male, receiving general anesthesia, and higher American Society of Anesthesiologists (ASA) class. In multiple linear regression models which controlled for demographic and clinical variables (age, race, marital status, education, smoking history, obesity, underlying disease, payor status, cemented prosthesis, comorbidity, and season of operation), being male, receiving general anesthesia, and having an ASA score of 3 predicted greater total blood loss. CONCLUSION: Preoperative characteristics can help determine which patients should donate either more or less than the customary 2 units of blood.

Aged↗

PubMed2005

Alcohol intake is associated with altered pulmonary function.

Little is known about the effect of moderate alcohol intake on lung function in the general population. Because moderate alcohol intake appears to reduce cardiovascular disease risk, we hypothesized that moderate alcohol intake is associated with better pulmonary function. To test this hypothesis, we examined the association between alcohol intake and pulmonary function, measured by spirometry, in a representative sample of U.S. adults who participated in the Third National Health and Nutrition Examination Survey. A stratified multistage clustered probability design was used to select a population-based sample. Data analyzed included alcohol intake, smoking status, education, body mass, sex, age, race, diabetes status, and CHF status. The Third National Health and Nutrition Examination Survey was conducted from 1988 to 1994 by the National Center for Health Statistics of the Centers for Disease Control and Prevention, Atlanta, GA. We analyzed data from 15,294 study participants who completed extensive questionnaires in the household and a comprehensive physical examination, including pulmonary function testing, either in the household or at a specially equipped mobile examination center. Low-to-moderate alcohol intake was not associated with reduced odds of obstructive lung function. In fact, increased odds for obstructive lung pattern were observed only in former heavy drinkers. In contrast, low-to-moderate alcohol intake was associated with better forced vital capacity and forced exhaled volume in 1s in the absence of obstruction, consistent with reduced odds for lung restriction. Using a logistic regression model, we found that individuals reporting alcohol consumption had a lower risk of lung restriction both before and after adjusting for confounding factors including smoking (P< or =.001). Alcohol intake-related reduced risk for restriction was associated with lower risk of CHF, diabetes, obesity, and lower markers of inflammation (white blood cell, fibrinogen, and C-reactive protein) consistent with less lung congestion, external restriction, and/or lung inflammation. Our analyses indicate that alcohol consumption, even at very modest intake levels, is associated with less lung restriction.

Adolescent↗

PubMed2004

Association between leisure time physical activity and markers of chronic inflammation related to coronary heart disease.

BACKGROUND: Some markers of chronic inflammation have been recognized as predictors of cardiovascular risk in apparently healthy subjects and in patients with coronary heart disease (CHD). High sensitivity C-reactive protein (CRP) appears to be the most useful marker in clinical settings. Several studies reported associations between inflammatory markers and other cardiovascular risk factors, such as age, obesity, cholesterol levels, the presence of diabetes mellitus, physical activity, social level and smoking habits. We focussed on the association between C-reactive protein, serum amyloid A (SAA), fibrinogen and leisure time physical activity (LTPA). METHODS: This report deals with the results observed in a sub-sample of the BELSTRESS study. 892 male subjects, free from clinical CHD and major ECG abnormalities, working in the same environment, aged 35-59 years, were selected. A questionnaire was used to estimate the level of leisure time physical activity. Associations between CRP, SAA, fibrinogen and leisure time physical activity were evaluated through univariate and multivariate methods. Subjects taking statins or other lipid lowering medication were excluded from the study. RESULTS: Regular leisure time physical activity is associated with reductions of several cardiovascular risk factors, such as body mass index (BMI), waist hip ratio and the lipid profile. Smokers and low educated subjects had a lower physical activity status. Age adjustment did not alter the means of inflammatory parameters according to the levels of leisure time physical activity. After correction for personal characteristics (BMI, current smoking status, educational level, presence of diabetes and alcohol consumption) no significant relation was found between leisure time physical activity and levels of inflammatory markers. The differences of CRP and fibrinogen according to the level of physical activity, found in bivariate analysis, seem to be explained by linked differences in BMI, or related to current smoking habits. Leisure time physical activity, as reported in this study, is not significantly related to C-reactive protein, serum amyloid A or fibrinogen levels, after correction for other cardiovascular risk factors. CONCLUSION: These data indicate that leisure time physical activity, as reported in our study, is not an independent predictor of C-reactive protein, serum amyloid A or fibrinogen levels. Possible interactions of physical activity and other cardiovascular risk factors might explain the (indirect) relation we found in the bivariate analysis.

Adult↗

PubMed2007

Perceptions and behaviour of access of the Internet: a study of women attending a breast screening service in Sydney, Australia.

OBJECTIVES: To describe the perceptions and behaviour in accessing health information from the Internet by women attending a BreastScreen, New South Wales (NSW) Service in Northern Sydney. DESIGN: Cross-sectional study. SETTING: A BreastScreen NSW Service in Northern Sydney. MAIN OUTCOME MEASURES: Behaviour and perceptions of accessing of the Internet for breast health and screening information and other related health information. PARTICIPANTS: Four hundred and fifteen women aged > or =40 years who had a screening mammogram at a BreastScreen NSW Service in Northern Sydney. Data were collected from 1 October to 22 December 2004 (study interval). RESULTS: Four hundred and sixty-one eligible women were invited to participate in the study and of these 415 women agreed to participate in the study (participation rate=90%). Of the 415 women enrolled in the cohort, 80% (333/415) of women accessed the Internet in general and 62% (205/333) of the women who accessed the Internet also accessed health related information from the Internet, but only 7% of the total women accessed breast health and screening information from the Internet. Two hundred and eighty (70%) women in the cohort expressed their intention to access the Internet if they were diagnosed with breast cancer. Age (OR=0.94; 95% CI=0.91-0.97), marital status (OR=2.65; 95% CI=1.45-4.83), educational status (OR=3.26; 95% CI=1.77-6.02) and behavioural intention of accessing the Internet if diagnosed with breast cancer (OR=3.31; 95% CI=1.83-5.98) were found to be associated with access of Internet for general information. Furthermore, behavioural intention (OR=2.43; 95% CI=1.30-4.55), rating of computer skills as 'average' (OR=0.42; 95% CI=0.22-0.79) and 'not good to poor' (OR=0.23; 95% CI=0.11-0.49) were found to be associated with access of health related information from the Internet. CONCLUSIONS: Information searching from the Internet is common among women having a screening mammogram. There is potential to provide guidance to women regarding accessing the BreastScreen NSW website and other reliable sources of Internet information on breast health, breast screening and cancer-related information.

Aged↗

PubMed2006

Factors associated with the use of maternity services in Enugu, southeastern Nigeria.

The maternal mortality ratio and other maternal health indicators are worse for developing countries than for the developed world due to improved access to quality care during pregnancy and especially at delivery in the industrialized world. This study was carried out to identify the factors which influenced choice of place of delivery by pregnant women in Enugu, southeastern Nigeria, and to recommend ways to improve women's access to skilled attendants at delivery. A pre-tested questionnaire was administered by interviewers to women who had delivered within 3 months prior to date of data collection. The response rate was 75.5% (n=1098). Of the respondents, 52.9% delivered outside health institutions and 47.1% in health institutions. The major factors influencing choice of place of delivery included promptness of care, competence of midwife/doctor, affordability, health education, 24 h presence of doctors, team work among doctors and presence of specialist obstetricians. There were statistically significant associations between choice of institutional or non-institutional deliveries and socio-demographic/economic factors such as place of residence (urban/rural), religion, educational status, tribe, marital status, occupational level, husband's occupational and educational levels, age and parity (p<0.05). We conclude that factors which will positively influence women to deliver in health institutions in Enugu, Nigeria include a variety of interacting social, economic and health system factors, which operate at various levels-the household, community, the health institutions and the larger social and political environment. Attention to these factors will not only improve maternity utilization but, hopefully, also will reduce the high maternal mortality and improve other maternal health indicators in the study area.

Adolescent↗

PubMed1997

Factors associated with aggressive and delinquent behaviors among patients attending an adolescent medicine clinic.

PURPOSE: The purpose of this study was to examine the associations among delinquency/aggressiveness and alcohol or drug use, sexual risk behaviors, and other scales from the Problem-Oriented Screening Instrument for Teenagers (POSIT). METHOD: A total of 173 15- to 18-year-olds attending adolescent medicine clinic completed a 183-item questionnaire. The questionnaire contained the POSIT, the CAGE questions, a 22-item alcohol and drug screen (AOD), and a human immunodeficiency virus and sexual risk behavior screen. The dependent variable was the Aggressive Behavior/Delinquency (ABD) scale from the POSIT. RESULTS: There were no gender or racial differences in the ABD scale (p > 0.05). The ABD scale was significantly (p < or = 0.001) associated with the POSIT AOD scale (r = 0.46), the 22-item AOD drug screen (r = 0.57), the CAGE questions (r = 0.39), the sexual risk behavior scale (r = 0.39), and the POSIT physical health (r = 0.34), mental health (r = 0.51), family relations status (r = 0.37), peer relations (r = 0.57), educational status (r = 0.44), social skills (r = 0.31), and leisure/recreation (r = 0.16) scales. Multiple regression analysis indicated that the AOD screen and problems in the area of peer relations, family relations, and mental health accounted for 47.7% of the variation in the ABD scale (p < or = 0.00001). CONCLUSIONS: These findings suggest that adolescents who engage in more aggressive and delinquent behaviors are more likely to use alcohol and other drugs, engage in sexual risk behaviors, report problems with peer and family relationships, and report more mental health symptoms.

Adolescent↗