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A survey of breast feeding practices in infants seen in general practice.

This is a study of infant feeding practices of 126 mothers. Seventy-seven mothers or 61.1% practised breast feeding. The typical breast feeding mother was more likely to be a Malay, with lower family income and residing in the rural area. The educational status of the mother was not an important factor in influencing her to breast feed. Health education on breast feeding should be intensified in schools to reinforce the implementation of the Malaysian Code of Ethics for Infant Formula Products.

Breast Feeding↗

Use and evaluation of health services by women in a developing country: is age important?

Today, the majority of the world's older persons live in less developed countries, where they represent an increasing proportion of the population. Using interviews conducted with 136 female heads of households in rural Sri Lanka, we considered the importance of age relative to other factors (e.g., marital status, education, employment, diet, and health practices) in accounting for use and evaluation of health services. Marital status figured more importantly than age in the use of services. As unmarried heads of households increase in less developed places, their demands for health care at the village level likely will escalate.

Adolescent↗

The J-shaped effect of coffee consumption on the risk of developing acute coronary syndromes: the CARDIO2000 case-control study.

The effect of coffee consumption on cardiovascular disease has been debated for many years. In this work, we evaluated the association between coffee consumption and the risk of developing acute coronary syndromes, based on a random sample of 848 patients with their first coronary heart disease event and 1078 frequency-matched controls with no cardiovascular disease in their medical history, from the entire country. The multivariate analysis raises a J-shaped association between the risk of developing acute coronary syndromes and the quantity of coffee consumed per day. In particular, the odds ratios for moderate (<300 mL/d), heavy (300-600 mL/d), and very heavy (>600 mL/d), consumption, relative to no consumption, were 0.69 (95% CI, 0.50-0.86), 1.56 (95% CI, 1.10-2.34) and 3.10 (95% CI, 1.82-5.26), respectively, after controlling for the presence of hypertension, hypercholesterolemia, diabetes mellitus, family history of premature coronary heart disease, physical activity status, smoking habits, BMI, alcohol consumption, triglycerides, consumption of several food items, depression scale score and education status. The suggested J-shaped association between coffee consumption and the risk of developing acute coronary syndromes may partially explain the conflicting results from other studies in the past.

Aged↗

Effect of socio-economic factors on the association between HIV-1 and tuberculosis in Kenya.

A case control study was conducted in Western Kenya to determine the effect of socio-economic risk factors on the association between HIV-1 and tuberculosis. 144 sputum smear positive cases were matched on age, sex and neighbourhood status with 3 controls and were screened for HIV-1. Socio-economic information collected included educational status, marital state, occupation, distance from the nearest health unit, number of wives, land ownership and type of dwelling house. The overall association between HIV-1 and tuberculosis was found to be 4.9 (95% CI (2.6-6.8). This association was affected by social class, years of schooling and some occupations. It is therefore important to determine the socio-economic risk factors in the association between HIV-1 infection and tuberculosis to assist in tuberculosis control activities.

Journal Article↗

[Comparative study of anxiety in informed and non-informed patients in the preoperative period].

Operation anxiety constitutes a significant phenomenon, detectable in numerous sleep related and psychological symptoms, as in its impact on the patient's health, the operation and post-operation process. For decades this problem (almost unknown in Lebanese scientific research), was the object of a vast theoretical project and numerous North American and European studies. Within the framework of this investigation, we studied the influence of structured information, provided by operating room nurses, on the patient's anxiety during the preparatory stage. The problem is all the more significant and relevant given that it is all but ignored in Lebanese hospitals. By adopting the basic hypothesis that "structured preparatory information diminishes the patient's anxiety" we wanted to examine the eventual links between the patient's anxiety level and his/her personal, socio-cultural and psycho-medical characteristics (sex, age, marital status, education, standard of living, medical history, type of surgery, type of anesthesia, etc.). Using the same methodological approach, we adopted Spielberger's steps in measuring anxiety after having acquired the proper authorization from Professor Spielberger himself, who furnished us with the certified Arabic version of these steps and their interpretation. A questionnaire allowed the identification of test groups' characteristics. We chose our setting the operating theatre at the Nini hospital in Tripoli, North Lebanon. Our investigation essentially began in September/October 2003. We formulated a sample of sixty patients within the operating community by means of a random sampling technique and a well-defined exclusion criteria. With the same technique we divided two groups of thirty patients: group A1 which was informed and A2 which was uninformed and used as test subjects. The data gathered by the investigation was incorporated into the SPSS software. The results of the comparative analysis operating between the two groups' anxiety scores confirmed the afore-mentioned hypothesis. However, these results did not establish any significant links between anxiety levels and the majority of the test groups' characteristics. By confirming the hypothesis that preparatory information reduces the patient's anxiety, this investigation has opened the door to important practical consequences leading to the following recommmendation: quality health-care in Lebanese hospitals would greatly improve by adopting a protocol of information booklets and preparatory meetings with the patient, with the added benefit of valorizing the role of the operating room nurse. At present, the absence of any structured preparatory information represents a significant deficiency in Lebanese hospitals.

Adolescent↗

Predicting the outcome of schizophrenia ten years later.

A total of 407 new admissions to Woodbridge Hospital, Singapore in 1975 with a diagnosis of schizophrenia were examined 10 years later to determine which variables were predictive of outcome. Useful predictors were marital status, duration of illness and Feighner's diagnostic criteria. Fairly useful predictors were age, sex and educational status. Race, family history, suicidal behaviour, thought disorder, affective blunting, delusions and hallucinations were not useful for predicting long term prognosis.

Adolescent↗

Differences in dietary intake associated with smoking status.

This study was designed to identify and describe smoking-related differences in dietary and nutritional factors that are potential independent predictors of cancer risk or effect modifiers or confounders of tobacco-cancer relationships. Data were obtained from a large hospital-based case-control study which was designed to estimate the cancer risk from various tobacco products and consisted of 465 male and 300 female incident lung cancer cases and 870 male and 556 female hospitalized patient controls matched on sex and age (+/- 5 years). Nutritional data were analysed as log-transformed frequencies of thirty food items, nine factor scores generated to describe overall patterns of dietary intake, and estimated daily nutrient scores for fat, vitamin A, fibre, and cholesterol. In general, the dietary habits of ex-smokers more closely resembled those of never-smokers than those of current smokers. We found that after controlling for case-control status, education, alcohol consumption, and age, there were many more significant differences in nutritional exposures by smoking status than could be explained merely by chance. For both sexes we observed significantly increased consumption of fruits and higher vitamin A and fibre scores in non-smokers compared to current smokers (for any smoking vs non-smoking comparison the P-value was always less than 0.002, 0.01, and 0.007, respectively). A similar but weaker relationship was observed for high-fat, sweet foods such as ice cream. An inverse association, also of smaller magnitude, was found for other high-fat foods items. Implications for further study and strengths and weaknesses of the current study are discussed.

Case-Control Studies↗

Data from the VITA Study do not support the concept of vascular depression.

OBJECTIVE: Cerebrovascular lesions that are apparent in magnetic resonance scans and regioselective atrophy of the brain have been proposed as a causative or exacerbating factor in depression with late-life onset. The objective of this study was to investigate whether deep white matter or periventricular hyperintensities, small ischemic lesions, and brain atrophy contribute to late-onset depression in the nondemented elderly. METHOD: Based on a group of 606 individuals of identical age (75.8 years, standard deviation: 0.45 years) residing in two districts of Vienna, the authors built a case-control cohort (ratio: 1:4) consisting of 51 individuals with late-onset major or minor depression matched with 204 subjects of identical gender and education status without depression, resulting in two groups that were homogenous with respect to age, place of residence, gender, and education. Scores for focal brain lesions, mediotemporal lobe atrophy, and ventricular enlargement as well as risk factors for vascular disease were compared with cognition and depression status. RESULTS: Depressed individuals had significantly lower scores than nondepressed subjects in all measures of cognitive and executive function. No significant relation was found between a diagnosis of depression and any type of discrete brain lesions, but measures of brain atrophy (Cella Media indices, mediotemporal atrophy) showed a clear statistical relation to depression. No relationship was found between depression and lipid parameters. CONCLUSION: The authors found no indication that white matter hyperintensities or minor ischemic lesions played a role in our depressed cohort, casting doubt on the vascular hypothesis of late-onset depression.

Aged↗

Relation of parental education and life status to academic achievement by Xhosa children.

This study investigated the relationship between parental education and academic achievement of 1021 Xhosa pupils (369 boys and 652 girls) whose ages ranged from 13 to 17 years (M age, 15.6 yr.). The sample included 712 children for whom both parents were alive and 308 children for whom either or both parents were deceased. Children were chosen at random from the Standard 7/Year 9 population of Transkei, South Africa. A simple questionnaire was administered students to identify whether one or both parents were dead or both parents were living. A second questionnaire was administered parents or parent surrogates to obtain their formal education. The marks obtained by the pupils in the Standard 7 external examination conducted by the Department of Education of the Government of Transkei in seven subject areas were aggregated as the criterion measure. Analysis of variance showed significant effects of parental education on academic achievement of children regardless of whether the children's parents were deceased or alive.

Achievement↗

Trends in alcohol intake by education and marital status in urban population in Russia between the mid 1980s and the mid 1990s.

AIMS: We investigated changes in the distribution of alcohol consumption by education and marital status in Russia during the period of societal transformation after 1990. Such changes would indicate the potential role of alcohol in the rising social inequalities in mortality. METHODS: We analysed data from three surveys in random population samples conducted in Novosibirsk as part of the WHO MONICA project in 1985/86 (1533 men, 1292 women), 1988/89 (1700 men, no women) and 1994/95 (1526 men, 1510 women), coinciding with the period of societal transformation. Four measures of drinking were examined in relation to education and marital status: prevalence of drinking at least twice a week; the mean intake in the last week; the mean intake per drinking occasion; and the prevalence of binge drinking (>80 g ethanol for men and >60 g for women) at least once a month. RESULTS: Among men, those with university education had the lowest levels of all measures of drinking. Drinking indices increased over time in all educational groups but most sharply in men with high education, thus leading to a smaller education-related difference in the last survey. With respect to marital status, divorced and widowed men tended to drink most, but the pattern was inconsistent, and the difference between divorced and married men also narrowed over time. Among women, alcohol intake increased between the first and last survey. Differences by education and marital status in women were smaller than in men, and binge drinking was inversely related to education. CONCLUSIONS: All indices of alcohol consumption in men increased between the mid 1980s and the mid 1990s. The increase in alcohol intake among men was proportionally similar across categories of education and marital status but the absolute differences increased. The contribution of alcohol to the increase in social differentials in mortality in the 1990s was probably modest.

Adult↗

CPR or DNR? End-of-life decision in Korean cancer patients: a single center's experience.

PURPOSE: Whether or not physicians should conduct cardiopulmonary resuscitation (CPR) in terminal cancer patients has long been debated. We conducted this prospective observational study to characterize current CPR and do-not-resuscitate (DNR) practice among terminal cancer patients in South Korea. MATERIALS AND METHODS: The study involved patients with terminal cancer who were admitted at the Seoul National University Boramae Hospital for supportive care only, and who died between January 1, 2003 and April 30, 2004. We investigated the practices relating to the DNR directive, i.e., how many days before death was the directive effective, and from whom was it obtained. RESULTS: Of the enrolled 165 patients, 97 were male with a mean age of 65. Median duration of admission to death was 24 days (range 7-207, mean 31.7). The DNR directive was implemented in 143 patients (86.7%). All discussions about DNR took place between physician and family members, except in only one case. DNR directives were enacted at a median of 8.0 days (range 0-79, mean 12.15) before death. For 18 patients, the DNR directive was formally taken on the day of admission. In contrast, 14 cases (9.8%) were agreed on the day of death, 18.8% within 48 h of death, and 46.8% (67 of 143) within 1 week before death, 62% before 10 days, and 71.3% within 2 weeks. The worse the performance status of the patient, the earlier the DNR discussion was issued. Also, the lower the economic and educational status of the family member, the earlier the DNR directive was attained. Of the 165 patients with terminal cancer, CPR was performed in 13 cases (7.9%): in seven cases (4.2%) CPR was requested by a family member, and in six cases arrest occurred before DNR discussion was issued. None of the resuscitated patients survived. CONCLUSION: In relation to DNR decisions in South Korean cancer patients, proxy decision-making is overwhelming and issuance of DNR discussion is raised at a late stage.

Aged↗

Hot flashes are associated with psychological symptoms of anxiety and depression in peri- and post- but not premenopausal women.

OBJECTIVE: To explore the relationship between anxiety, depression, vasomotor symptoms, and menopausal status among middle-aged women. DESIGN: A population-based study involving a rural Taiwanese population. Participants received a structured questionnaire, which included the hospital anxiety and depression scale (HADS), gynecological history and a checklist of menopausal symptoms in the most recent 2 weeks. RESULTS: A total of 1273 women with no history of surgical menopause and hormonal therapy history participated. The mean anxiety, depression, and total HADS scores were 4.3 +/- 3.3, 3.3 +/- 2.8 and 7.6 +/- 5.3, respectively, and did not differ according to menopausal status. A total of 10.5% participants reported hot flashes within the previous 2 weeks. After controlling for educational status and insomnia, anxiety (6.0 +/- 3.8 versus 4.1 +/- 3.1) and depression scores (4.0 +/- 3.3 versus 3.2 +/- 2.7) were significantly higher (p < 0.001) compared with those without hot flashes. These differences were attributed to peri- and postmenopausal subjects. CONCLUSIONS: Hot flashes in peri- and postmenopausal women were associated with anxious and depressive symptoms in East Asian population with low prevalence of vasomotor symptoms.

Adult↗

Musculoskeletal pain and analgesic therapy in a very old population.

The aim of this study was to examine the prevalence of musculoskeletal pain and use of analgesic drugs in a population of very old people. The investigation is based on data from the Kungsholmen project. Of the 2638 inhabitants aged 75 or more in a parish of central Stockholm 1800 were examined. Of the subjects. 60% reported trouble with pain at musculoskeletal locations, while only 40% of the pain reporting subjects used analgesics, one third of which were non-prescription minor analgesics. Prescription analgesics (non-steroidal antiinflammatory drugs or centrally acting drugs) were used by one fourth of the pain reporting subjects, and taken on a regular basis in only half of the cases. Potent opioids were used by less than 1% of the population. There was no increase in pain with increasing age, but an increase in use of minor analgesics with age >85. Women more often reported pain and had a higher consumption of analgesics. Light opioids were more often used by subjects with multifocal pain. Subjects living in sheltered accommodation used more analgesics, particularly light opioids, than did those living in their own homes or in institutions. Subjects with low or intermediate educational status more often reported pain and used light opioids to a larger extent than did the highly educated. These results indicate that musculoskeletal pain is relatively common among the very old, but does not seem to be a severe problem for the majority, considering the low proportion of subjects using prescription analgesics regularly. However, the very low use of potent opioids indicates that some of the elderly suffering from cancer and other severe pain causing diseases might be undertreated.

Journal Article↗

Demographic survey of Filipino American nurses.

BACKGROUND AND OBJECTIVE: Recruitment of nurses trained in the Philippines is one strategy employed by US hospitals to increase our nursing workforce. As well, some Filipino American nurses obtained their nursing education in US schools. The objective of our study was to describe demographics, years of practice, work status, educational background, job satisfaction, and years to retirement of a sample of Filipino American nurses. METHODS: A nonexperimental descriptive study was conducted utilizing a convenience sample of 327 Filipino American nurses. RESULTS: Filipino American nurses were primarily educated in the Philippines, held BSNs, worked full time, had high job satisfaction, and planned to retire, on average, in 12 years. CONCLUSIONS: The retirement plans of Filipino American nurses recruited to US hospitals during past workforce shortages forecast vacancies of nurses who have consistently worked full time and report high job satisfaction. Current workforce stakeholders should be alerted to these nurses' plans.

Adult↗

Demographic and socio-economic status of women in different family structures in a rural area of south India.

The authors study "women's demographic and socio-economic position in different family types...[using data] from a sample survey conducted in a rural area of Tamil Nadu [India] during May and June of 1988....Comparison of demographic characteristics of ever-married women in the reproductive age, such as marital status, age, marriage duration, age at marriage and living children, and socio-economic characteristics, such as educational status, occupational status, per capita annual income of the family and number of rooms in the house, is made between family types."

Asia↗

Condom awareness and use in the Arusha and Kilimanjaro regions, Tanzania: a population-based study.

A cross-sectional study of condom awareness, perceived availability, and use was conducted using a questionnaire in the Arusha and Kilimanjaro regions in northern Tanzania. The questionnaire was administered to a random sample (n = 1,081) of males and females (15-54 years of age) from four localities in the Arusha, Babati, Moshi, and Same districts. Of the 1,081 respondents, 69.9% knew what condoms are and, of these, 31.7% reported having ever used a condom, while 20.7% stated that they used condoms regularly. Furthermore, of the 756 respondents who knew what condoms are, 62.2% stated that condoms were available in their localities and, of these, 44.1% reported having used condoms regularly. The results suggested that, while the majority of the respondents knew about condoms and stated that condoms were available in their localities, reported regular condom use was low. Age, gender, marital status, occupation, and place of residence appeared to be significant determinants of condom awareness and use, while educational status was not. Although barmaids and professional drivers have been shown to practice high-risk sexual behavior, reported condom use among them was low.

Adolescent↗

Psychosocial and demographic predictors of quality of life in a large sample of cancer patients.

In recent years, there has been increasing emphasis on understanding how the cancer experience affects individuals' quality of life (QOL). The goal of this study was to assess the QOL and to identify psychosocial predictors of QOL among a large sample of patients with a variety of cancers. Specifically, we assessed the unique contribution of demographic variables, medical variables, and social support on patients' QOL and psychological adjustment. Three hundred and fifty-one participants completed measures of social support, depression, anxiety, and QOL at their follow-up medical visits. Analyses indicated that patients who were older and had better social support reported less anxiety (p<0.001), and patients who were older, married or who had more social support reported less depressive symptoms (p<0.01). Men, individuals whose cancer had not recurred, and those not undergoing active treatment reported better QOL in the physical health domain (p<0.05). Patients who were older, married, with more formal education, less advanced disease, and better social support reported better QOL in the mental health domain (p<0.05). Demographic variables (age, gender, marital status, education) were generally associated with measures of adjustment and QOL whereas medical variables (time since diagnosis, recurrence status, treatment variables, stage of disease) were not. Patients with more support reported less anxiety and depression and better QOL in the mental health domain, independent of demographic and medical variables. Assessing patients' level of social support may help to identify patients at risk for distress.

Adaptation, Psychological↗

Intellectual psycho-educational and functional status of low birth weight survivors beyond 5 years of age.

To determine the intellectual, psycho-educational and functional status of low birth weight (LBW) survivors (birth weight < or = 2000 gms) beyond 5 years of age and to compare their status with normal birth weight counterparts. This was cross-sectional study. On hospital based cohort on longitudinal follow-up at the High Risk and Well Baby Clinics of a teaching hospital. The demographic data of these children was recorded. A detailed physical examination was performed. The tests of cognition included the Stanford Binet and the Raven's Progressive Matrices. Academic achievement was evaluated by the Wide range achievement test-Revised (WRAT-R). Assessment of visuo motor integration was done by the Bender Gestalt Test. The proportion of children having soft neurological signs was determined. Vineland Social Maturity Scale was performed on all children. Fifty-nine LBW children and fifty-seven matched control children participated in the study. 27 of LBW children were examined at a mean age of 7.0 +/- 1.1 years (group I) and 32 were examined at a mean age of 10.6 +/- 1.2 years (group II). The LBW children as a group performed in the normal range on the tests of cognition and academic achievement, but were significantly disadvantaged (p < 0.005) as compared to controls. A higher percentage of LBW children had low scores on the Bender Gestalt. Test as compared to controls but the difference was not significant. A significantly higher proportion of LBW children of both the groups showed the presence of soft neurological signs as compared to controls. The social quotient as assessed by the vineland Social Maturity Scale was significantly lower in the LBW children as compared to controls. Thus, though the LBW children were performing in the normal range on various measures, comparison with the control group showed that they were clearly disadvantaged on nearly every measure tested, emphasizing the need for early detection and referral for special education.

Child↗