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PubMed1996

Fetal alcohol syndrome--an ophthalmological and socioeducational prospective study.

BACKGROUND: The eye is a sensitive indicator of adverse effects of prenatal alcohol exposure. Anomalies of the eyes and their adnexa are known to be associated with the fetal alcohol syndrome (FAS), although long-term effects of these malformations are unknown. DESIGN: A prospective ophthalmologic follow-up (median, 11 years; range, 4 to 19 years) was performed in 25 children with FAS. Their social situation and educational status were also investigated. RESULTS: All but one of the children had ophthalmologic abnormalities. Fundus anomalies were observed in 23 children, of whom 19 had optic nerve hypoplasia. Thirteen children had concomitant strabismus. Microphthalmos, buphthalmos, phthisis, microcornea, coloboma of the iris and uvea, blepharoptosis, cataract, persistent hyperplastic primary vitreous, and nystagmus were observed in single cases. The dysmorphology of the eyes remained unchanged during the follow-up period. In 2 children with severe mental retardation and, initially, very poor vision, the severe visual handicap persisted. Seventeen children had an initial visual activity > or = 20/70, which remained unchanged in 10 children and improved in 7 children, despite the presence of optic nerve hypoplasia in 14 of the children. Ten mothers died, 8 of them because of alcohol-related diseases, and only 4 of the mothers were able to take care of their children. Sixteen children went to schools for the mentally retarded, and only 3 children had a normal school education without extra teaching assistance. CONCLUSIONS: In children with FAS, the major sequela, ie, brain, damage, remains despite extensive medical, educational, and social support. The presence of ophthalmic signs, which persisted but did not deteriorate during the follow-up period, strengthens the diagnosis of FAS, and the high frequency of ocular involvement indicates the importance of a complete ophthalmologic evaluation in children with FAS.

Adolescent↗

PubMedDate not supplied

Hepatitis A seroprevalence in a random sample of the Turkish population by simultaneous EPI cluster and comparison with surveys in Turkey.

This study was conducted to determine the hepatitis A virus (HAV) seroprevalence in nine provinces representative of Turkey as a whole. These provinces are representative of the country's geographical location, and demographic, economic and social characteristics. In each province, sample sizes were determined using published data on HAV seroprevalence, and sample sizes for each province and for the cluster were calculated for each group of subjects under the age of 30 for seroprevalence estimates within a 95% confidence interval. The samples were selected by a cluster method, and the planned recruitment was a total of 4,800 subjects, including 600 subjects each from five large provinces (Istanbul, Ankara, Izmir, Adana, Diyarbakir) and 450 subjects from each of the remaining four provinces (Samsun, Erzurum, Trabzon, Edirne). These numbers were distributed in accordance with the percentages for age groups in five-year increments starting from age five for the population under the age of 30 living in the rural and urban areas in each province. This study of 4,462 subjects under the age of 30 in nine provinces of Turkey identified an overall HAV seroprevalence rate of 71.3%. The distribution of HAV seroprevalences by age showed a steady increase from one year of age from 42.7% to 91.1% at 25-29 years of age. HAV seroprevalence was slightly higher in female subjects (73%) than in male subjects (69.3%). By educational status, seroprevalences were comparable except in young children under age six. Seroprevalence was notably higher in large families with six and more members (80.1%) than in small families with five or fewer members (66.7%). According to our study results, 50% of Turkish children are seropositive for HAV by the age of 10 years. We believe the date support the need for a routine primary immunization policy in Turkey and the development of effective prophylactic programs after possible exposure. Consequently, an immunization policy can be developed for each region according to its epidemiological conditions.

Adolescent↗

PubMed1998

Waiver of informed consent: a survey of emergency medicine patients.

Changes to Federal regulations pertaining to waiver of informed consent for acute care research were debated by the research and regulatory communities for more than 2 years before being finalized in October of 1996. Input from the general public was limited. This survey investigated the opinions of emergency medicine patients concerning waiver of informed consent for acute care research. A convenience sample of 212 patients were approached at a tertiary care academic urban emergency department. Seventy-three percent approved of waiver of informed consent if the absolute risks were minimal (50% if the absolute risks were greater than minimal but the incremental risks were minimal). Educational status and certain aspects of the patient's current health status (but not age, race, or gender) significantly affected the results. While most emergency medicine patients would want to be enrolled in a study if they had a serious illness and were unable to give informed consent, a significant percentage of patients would not want to be enrolled regardless of the degree of risk or availability of a family member to speak on their behalf. Waiver of informed consent for emergency research is an ethical dilemma pitting individual rights against societal needs and physician parentalism. A better understanding of what patients consider appropriate may help in resolving this dilemma.

Acute Disease↗

PubMed1989

The male factor in the etiology of cervical cancer among sexually monogamous women.

To address the hypothesis that male sexual behavior may affect the etiology of invasive cervical cancer, a case-control study was undertaken in Panama, Costa Rica, Colombia and Mexico. The study enrolled husbands of those women with invasive cervical cancer and of those age-matched controls who reported only one lifetime sexual partner. A total of 204 case and 485 control husbands (78% and 72%, respectively, of identified husbands) were interviewed, clinically examined, and had penile swabs taken for papillomavirus assays. Risk increased significantly (p = 0.005) with the number of sexual partners reported by the husband (RR = 2.0 for 26+ vs. less than 6 partners). Low educational status of the husband was also an important predictor of risk, possibly indicating the role of unmeasured aspects of sexual behavior. Visits to prostitutes, circumcision status and sexually transmitted disease histories were not important predictors of risk, but evidence from clinical examination indicated that poor genital hygiene may be involved. Human papillomavirus (HPV) expression as defined by filter in situ hybridization was detected in 20-23% of subjects and, except in the small group with both HPV types 6/11 and 16/18, was not related to risk. This may reflect sampling problems in the male or the importance of host factors which enhance viral carcinogenicity in the female.

Circumcision, Male↗

PubMed2004

Socio-economic determinants of child labour and attitudes to child labour among school children in Ibadan.

This cross sectional study was designed to compare the characteristics of working and non-working school children. Two hundred and thirty one working and 236 non-working children were interviewed. The socio economic factors associated with child labour were trading as mother's occupation, father's educational status, religion, family type (monogamous vs polygamous) and type of residence. Family type (OR = 0.562, 95% C.I. 0.353-0.897, p = 0.016), religion (OR = 0.559, 95% C.I. 0.361-0.867, p = 0.009) and trading as mother's occupation (O.R = 2.49, 95% CI 1.68-3.68, p = 0.000) were sustained on logistic regression analysis. With regard to attitude to child work, 186 (40%) of all respondents thought that children should be allowed to work. The majority of those who held this opinion 150, were child workers. Ten percent of working children had themselves chosen to work without any parental influence to do so. Seventy five respondents had ever repeated a class. Forty nine of these were working children a prevalence of 21% of repeaters compared to 26 non working children, (11%.) p = 0.004. Sixty eight percent of children aspiring to careers in artisan trades were child workers. Road traffic accidents and poor school performance were the commonest adverse effects of child labour indicated by school children. Parents should be educated about the adverse effects of child labour on child development. As poverty is one of the major root causes of child labour, free and compulsory primary education may help to reduce the notion of child work as an option for survival in poor families.

Accidents, Traffic↗

PubMed1975

Variation in plasma folate levels among groups of healthy persons.

Levels of plasma folate, erythrocyte folate and serum vitamin B12 were measured in 106 essentially healthy persons grouped both as to race and economic--educational status. Whereas the mean values of the three assays did not differ significantly among groups, values of plasma folate below the usual limits of normal were more prevalent in the migrant worker and urban clinic groups. Persons with low plasma folate levels did not have symptomatic deficiency as evaluated by hematocrit, peripheral blood smears and erythrocyte folate levels. The interpretation of the plasma folate requires reference values from a healthy population selected to be comparable to the study group. The diagnosis of deficiency, or at least the degree of deficiency, requires clinical and laboratory evaluations beyond the plasma folate.

Adult↗

PubMed1993

Neurodevelopmental profile at five years of children born at < or = 32 weeks gestation.

Sixty children born preterm (gestational age < or = 32 weeks) and 60 control children matched by sex, and socio-economic and educational status of the parents were followed prospectively to the age of five years. Neurodevelopmental problems were surveyed by a detailed neurological and neuropsychological test battery, and by ophthalmological and hearing examinations. All except one of the preterm children with major disability had motor, visual-spatial and visual problems. The most frequent neurodevelopmental abnormalities encountered among preterm children without major disability were motor problems--emerging as gross and fine motor and/or visual-motor difficulties--and visual-spatial problems. Language difficulties were not associated with hearing problems. Among those without major disability, visual-spatial difficulties and ophthalmological problems seldom emerged simultaneously.

Adult↗

PubMed2007

Complementary/alternative medicine use in a pediatric oncology unit in Turkey.

BACKGROUND: Important in the cancer therapy is the increasingly use of complementary/alternative medicine (CAM). The current study aims to establish the extent of use, the types of therapies employed, factors influencing, the reasons for choosing and the cost of CAM used in pediatric cancer patients in our clinic in Ankara, Turkey. PROCEDURE: A detailed questionnaire regarding demographic data and information about the use of CAM was completed by 95 patients who have attended the clinic between 1999 and 2000. RESULTS: Forty-nine patients (51.6%) had used one or more than one type of CAM. The most frequent (71.4%) was herbal medicine and biologic intake (stinging nettle, plant essence, honey of Anzer). The second one was religious therapy (40.8%). No correlation could be found between the use of CAM and parents education status, the level of income, number of siblings, the prognosis of the disease, the rate of satisfaction with the level of information given by the doctor at the time of diagnosis or the belief in the information given by the doctor about the prognosis (P > 0.05). All patients used CAM in addition to conventional therapy. CONCLUSIONS: More than half of the patients used CAM, with stinging nettle being the most common agent. Our patients place a high level of trust in their physicians and the conventional therapies offered by them; however, they also believe that the complementary therapies are harmless and, therefore, worth trying.

Biological Therapy↗

PubMedDate not supplied

Influence of maternal, foetal and socio-economic factors on neonatal morbidity: a study on hospital born babies.

Present study revealed several significant associations. Firstly, two related variables, like duration of antenatal care and birth-weight of newborn were significantly associated with incidence of neonatal morbidity. Apart from these, attributes like mother's educational status and per capita family income were also found as important factors determining occurrence of illness during neonatal period. Moreover, children of working mothers suffered more from illness. However, it should be pointed out here that majority of the attributes discussed here, such as, occupation, literacy, income etc, are inter-dependant. So, to quantify correctly the relative risk and attributable risk of these factors in causing childhood disease needs cohort study with matched control to neutralise the effects of confounding variables.

Birth Weight↗

PubMed1998

Mini-Mental State Examination (MMSE) performance of partially remitted community-dwelling patients with schizophrenia.

Patients with schizophrenia perform worse than healthy controls on many neuro-psychological tests. However, previous studies of neuro-cognitive function have mostly been carried out on acutely ill or institutionalized patients. The objective of this study was to generate norms for performance of partially remitted community-dwelling patients with schizophrenia on the Mini-Mental State Examination (MMSE). Partially remitted outpatients attending a depot antipsychotic clinic or a clozapine clinic (n = 272) were tested using the MMSE. Demographic and clinical characteristics associated with MMSE performance, as well as the performance of specific items, were examined. MMSE score was significantly associated with educational status and race. Patients in our sample performed approximately 2-3 points below the population norms at all ages, but the mean score for the group was not in the impaired range. There was no apparent widening of this gap with advancing age. Patients who did poorly most frequently had difficulty with memory, attention and construction tasks. The MMSE is easy to administer to outpatients with schizophrenia and most patients score in the un-impaired range. The MMSE may be used to identify a subgroup of patients who score in the impaired range, for further investigations.

Acute Disease↗

PubMed2003

Women's perception of the benefits of mammography screening: population-based survey in four countries.

BACKGROUND: Screening programmes are often actively promoted to achieve high coverage, which may result in unrealistic expectations. We examined women's understanding of the likely benefits of mammography screening. METHODS: Telephone survey of random samples of the female population aged > or =15 years in the US, UK, Italy, and Switzerland using three closed questions on the expected benefits of mammography screening. RESULTS: A total of 5964 women were contacted and 4140 women (69%) participated. Misconceptions were widespread: a majority of women believed that screening prevents or reduces the risk of contracting breast cancer (68%), that screening at least halves breast cancer mortality (62%), and that 10 years of regular screening will prevent 10 or more breast cancer deaths per 1000 women (75%). In multivariate analysis higher number of correct answers was positively associated with higher educational status (odds ratio [OR] = 1.44, 95% CI: 1.25, 1.66) and negatively with having had a mammography in the last 2 years (OR = 0.86, 95% CI: 0.73, 1.01). Compared with US women (reference group) and Swiss women (OR = 0.98, 95% CI: 0.82, 1.18) respondents in Italy (OR = 0.61, 95% CI: 0.50, 0.74) and the UK (OR = 0.73, 95% CI: 0.60, 0.88) gave fewer correct answers. CONCLUSION: In the US and three European countries a high proportion of women overestimated the benefits that can be expected from screening mammography. This finding raises doubts on informed consent procedures within breast cancer screening programmes.

Adolescent↗

PubMed1999

The prevalence of lower urinary tract symptoms in Austrian males and associations with sociodemographic variables.

The aim of our study was to assess the prevalence of lower urinary tract symptoms (LUTS) in Austrian males and to correlate the findings with sociodemographic variables. In a population-based cross-sectional study in Austria in the year 1995, data on voiding symptoms were collected from a representative sample of men by using the International Prostate Symptom Score (IPSS). Only 28.6% of the males aged 15 to 89 years (total n = 939) reported no LUTS at all (IPSS = 0). In the group of males who report symptoms, a positive correlation of the IPSS with age is found. Furthermore IPSS correlates with weekly alcohol and nicotine consumption, but not with the respondent's body-mass index (BMI), educational status and monthly household income. The bothersomeness of LUTS increases with age, leaving more than 12% of the males aged 40 to 89 dissatisfied with urinary symptoms. Extrapolated to population numbers, more than 87,000 males in Austria (aged 15 to 89 years) would feel 'terribly' if they were to spend the rest of their lives with urinary symptoms as they were at the time of the survey. Due to an estimated future increase of the proportion of older people in Austria, the number of males with LUTS will rise significantly, thereby placing increased burden on medical resources in the future.

Adolescent↗

PubMed1998

Patients' understanding and opinion about informed consent for coronary angiography in a rural Japanese hospital.

Based on an anonymous questionnaire obtained from 102 Japanese in-patients at a rural Japanese hospital who underwent coronary angiography, the patients understanding of information about the procedure, their perception of consent and their attitude toward it were investigated. The patients were able to recall 63.8% of the contents of the information. There was a statistically significant correlation between the patients' educational status and the recall test score of the information. Older (65 years old and above) patients had a tendency to entrust decision making to their physicians. Only 19.6% of the patients made the decision to undergo a coronary angiography by themselves. After being informed of the risks 40.2% of the patients felt more anxious. In conclusion, our patients could not recall the contents of the information sufficiently. There still existed a tendency to entrust important decisions to the physician especially in older patients. The patients had a tendency not to face difficult problems solely by themselves but with the support of family members.

Aged↗

PubMed1989

Compliance with chemotherapy in childhood leukaemia in Africa.

Compliance with chemotherapy in childhood leukaemia is usually good because of parental fear of the disease. However, poor compliance and refusal of treatment have been reported from both the USA and the UK. Little is known about African concepts of leukaemia, attitudes to treatment or compliance. A study was undertaken to investigate factors which might affect compliance in 15 black and 30 white families of leukaemic children in Johannesburg. The socio-economic and educational status of the black families was lower than that of the white. Only 53% of black children attended hospital on the appointed day compared with 90% of white children. Less than 50% of black parents understood the nature of their child's illness. Both black and white families had unused medication at home. White parents more frequently reported toxic effects related to chemotherapy and more white children than black children exhibited lymphopenia during maintenance therapy. Assessment of drug compliance should be included as an independent variable when evaluating factors affecting response to chemotherapy in communities of diverse ethnic, socio-economic and cultural backgrounds.

Black or African American↗

PubMed1987

Profile of Danish women undergoing reversal of sterilization, 1978-1983.

To help identify those women who might regret undergoing sterilization, the Danish women refertilized from 1978 to 1983 were contacted by mailed questionnaire. Eighty-three percent (120/144) responded. These women were younger at the time of sterilization than Danish women sterilized in the same period (mean age 29 years versus 34 years). Furthermore, they had more children at the time of sterilization and had their first and last child at a younger age than Danish women generally, in the same age group. Their social and educational status was lower than the background population and fewer were in gainful employment. At sterilization, most of the women were in an emotionally stressful situation (e.g., marital disharmony (78% of the married women), single parenthood (28%), unwanted pregnancy (27%], or had chronic health problems in the family. Alternative contraceptive methods had not been fully explored. Thirty-eight percent complained of late secondary effects attributable to the sterilization, but the main reason for wanting reversal of sterilization was a new partner (75%). The study suggests that the psycho-social situation and contraceptive alternatives should be carefully evaluated in women requesting sterilization, especially in those below the age of 30.

Adult↗

PubMed1999

Prevalence of communicable disease among restaurant workers along a highway in Assam, India.

105 workers of 29 roadside restaurants along a highway in Assam were interviewed for their habits, educational status and were examined for their hygienic status and presence of communicable diseases (STDs,TB etc). Most of them were young, males with 40% literacy; more than half were unmarried. About 30% of them were alcoholic and smokers and 2.9% were addicted to cannabis. The hygienic conditions of the workers were poor. More than one third had sexual contact with multiple sex partners or commercial sex workers and 2% were engaged in homosexual activity. Most of them did not use condom. 25.7% of them had genital lesions suggestive of sexually transmitted disease, 11.8% showed gram negative diplococci in urethral smears and 5.1% were VDRL reactive. Skin infections followed by gastrointestinal disorders and respiratory tract infections were other prevalent problems. 70.6% were positive for intestinal parasites and 22.2% were sputum positive for acid fast bacilli. However all the collected blood samples were negative for HIV.

Adult↗

PubMed1992

Bacteriological quality of infant feeding bottle-contents and teats in Addis Abeba, Ethiopia.

Bacteriological quality of 244 infant feeding-bottles and 61 teats were studied from January 1989 to November 1989. Samples were collected from feeding-bottles of babies who were brought by nursing mothers to clinics and hospitals for varying complaints. Of the 244 bottle-content samples, 144 (59%) harboured more than 2 x 10(6) colonies of bacteria per ml. of samples. The predominant bacterial isolates both from bottle-contents and teat-swabs were the coliform group of bacteria, such as E. coli, Enterobacter spp., Klebsiella spp., and Citrobacter spp. Enteric pathogens such as enteropathogenic E. coli, Shigella spp., S. aureus, and Bacillus cereus, were also isolated from some samples. In some cases enteropathogenic E. coli (EPEC) serotype were isolated both from feeding utensils and from the stools of the bottle-fed babies. Neither the different handling care of bottles used in the studied population, nor the educational status of the nursing mothers made a significant difference in the bacteriological quality of the infant feeding bottles in terms of the total bacterial counts per ml. of the bottle-contents. Preparation of food in advance of need combined with improper storage and inadequate cooking, and poor hygiene could be factors that resulted in a highly contaminated bottle contents. The superior quality of breast milk, and continual teaching of bottle feeding mothers on better handling of feeding bottles and feeds should be constantly emphasized. Teaching mothers on proper handling of feeding utensils accompanied by regular home visiting of health workers to observe hygienic condition of feeding utensils and home environment may improve the prevailing condition. Further and well controlled community based, longitudinal studies are also needed if we are to reduce gastroenteritis in babies as a result of using feeding bottles.

Adult↗

PubMed2005

[Demographic and socioeconomic factors associated with needs for home assistance among community-dwelling elderly: a study from the French Home Survey Handicaps-Disabilities-Dependence].

BACKGROUND: Gains in life expectancy in western countries have mainly come hand in hand with growing chronic diseases and disabilities related to the activities of daily living (ADL) and instrumental activities of daily living (IADL). Although these disabilities have been identified as predictors of institutionalization, the elderly in France continue to live at home, in the community, alone or with others. This work aims at identifying and assessing their needs for assistance and looks especially at the demographic and socioeconomic associated features. METHODS: Reported needs for assistance with ADL and IADL are studied through a representative sample of 8,745 people aged 60 years and older and living at home in 1999, taken from the French cross-sectional "Handicaps-Disabilities-Dependence" survey. Statistical associations (non-adjusted and adjusted Odds-Ratio-OR) have been computed in a conceptual framework derived from Andersen and Newman's behavioural model. RESULTS: More than 1 million people aged 60 years and older need assistance from another person to perform at least one ADL (bathing, dressing, going to toilet, eating, transferring, getting outside) and about 2.5 millions persons for at least one IADL (shopping, food preparation, housekeeping). Need for assistance for at least one ADL is associated with age (OR=1.4 for 70-79, 3.6 for 80+); male aged 80 and older (OR=0.5); low educational status (OR=1.5); being married (OR=1.7) or living with an other person (OR=2); a disposable income less than 540 euro per capita and per month or between 540 and 1,080 euro (OR=1.3); impairments: motor (OR=3), language (OR=2.1), visual (OR=1.7), mental (OR=1.5) and other (OR=1.2); availability of home equipment devices (OR=3.5), technical devices for moving inside (OR=3) and others (OR=2.1). Need for assistance is especially high among those who required assistance (OR=4) or proxies (OR=5.5) to answer. Declared need for assistance for at least one IADL is roughly associated with the same factors. CONCLUSION: These results suggest that the declared needs for human assistance are based not exclusively on functional limitations but are also related to the social and environmental setting.

Activities of Daily Living↗