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PubMed2002

Cancer prevention behaviors and socioeconomic status among Hispanics and non-Hispanic whites in a rural population in the United States.

OBJECTIVES: Socioeconomic status is explored as a predictor of differences between Hispanics and non-Hispanic Whites in cancer prevention behavior. METHODS: In a cross-sectional study, in-person interviews (n = 1795) were conducted in a population-based random sample of adults in 20 communities with a high proportion of Hispanics. RESULTS: Hispanics were significantly less likely than non-Hispanic Whites to ever have had cervical (p < 0.001), breast (p = 0.007), or colorectal cancer (FOBT p = 0.008; sigmoidoscopy/colonoscopy p < 0.002) screening. After adjusting for socioeconomic status (education and having health insurance), only differences in cervical cancer remained significant (p = 0.024). After adjusting for socioeconomic status, Hispanics had a significantly higher intake of fruits and vegetables per day (4.84 servings) than non-Hispanic Whites (3.84 servings) (p < 0.001); and fat behavior score was marginally significant after adjustment for socioeconomic status (p = 0.053). Significantly fewer Hispanics were current smokers than non-Hispanic Whites (p < 0.001). CONCLUSIONS: There is only limited support for the hypothesis that socioeconomic status is a major determinant of some cancer-related behaviors; specifically, socioeconomic status is related to mammography and colorectal screening, but not cervical cancer, dietary behavior, or smoking.

Adolescent↗

PubMed1991

Childhood appendicitis: factors associated with its incidence and perforation in Ethiopian children.

Acute appendicitis is a common paediatric emergency necessitating surgical intervention. Factors contributing to the incidence of the disease and appendiceal perforation in all children with acute appendicitis admitted to the Ethio-Swedish Children's Hospital in Addis Abeba, Ethiopia from Jan 1983 to December 1987 were studied. There were a total of 278 cases of appendicitis, with matched controls, seen. The incidence of perforation was 67%. Statistically significant differences between cases and controls were seen for the educational status of the parents (p less than .001), the parental income (p less than .001) and the nutritional status of the patient (p less than .001). The risk of perforation increased with increased duration of the illness. Perforation was common in children with normal height and better parental education. The incidence of appendicitis appears to be related to improved socioeconomic status. Prospective studies to examine this and other associations are warranted.

Acute Disease↗

PubMed2000

Pediatric renal transplantation in Turkey: a review of 56 cases from a single center.

In order to assess certain aspects of pediatric kidney transplantation (Tx) in Turkey, we retrospectively analyzed the results of 56 of these pediatric procedures performed at our center. From January 1986 to January 1998, 56 pediatric renal Tx (29 males, 27 females; 0-17 yr of age) were carried out at Başkent University Hospital. All were first-time Tx. Fifty-one (91%) patients were on hemodialysis and four (7.3%) were on peritoneal dialysis prior to Tx. Pre-emptive Tx was performed for only one patient. Living-related donors (LRD) provided 47 (84%) of the transplanted organs and cadaver sources were utilized for nine (16%) patients. The mean cold ischemia time (CIT) for cadaveric donors (CD) was 38.6 h (range 23-56 h). Among living-related graft (LRG) recipients, the average waiting time for Tx was 4 months for Tx performed after 1990 and 8 months for those prior to 1990 (p < 0.05). Median length of hospital stay for Tx was 17 +/- 1.1 and 18 +/- 1.4 days for LRG and cadaveric graft (CG) recipients, respectively. Fifteen of 47 (33%) LRG recipients and six of nine (67%) CG recipients received anti-rejection treatment within 30 days following the Tx surgery. Graft failure developed in 16 (12 LRG, four CG) recipients. Two patients developed Kaposi's sarcoma, 17 and 3 months after Tx. There were total of six deaths (four with functioning grafts). The 1-, 3-, and 5-yr graft survival rates were 93%, 75%, and 63%, respectively, and corresponding patient survival rates were 96%, 92%, and 77%. The social and educational status of 27 patients with functioning grafts were also evaluated. Our results showed that 56% of patients ended their education before high school and only three patients have been married. The high rate of school drop-out and unemployment among pediatric renal transplant recipients in our population underline the need for a more intensive rehabilitation program.

Adolescent↗

PubMed2005

Depressive mood and abdominal fat distribution in overweight premenopausal women.

OBJECTIVE: There is increasing evidence that depressive mood is associated with central obesity, but little is known about the association between depression and abdominal fat distribution. This study investigated this relationship in premenopausal women. RESEARCH METHODS AND PROCEDURES: We recruited 101 overweight premenopausal women who had no eating disorders as defined using the DSM IV criteria. Depressive mood was assessed using Zung's Self-Rating Depression Scale (SDS). Areas of visceral (VAT) and subcutaneous (SAT) adipose tissue at the level of vertebral body L(4)-L(5) were measured using computed tomography. Associations of VAT, SAT, and the ratio of VAT to SAT with natural logarithmic transformation [(ln)]SDS were evaluated using linear regression. Anthropometric indices and physical fitness were also measured. Information on socioeconomic status, education level, and alcohol and smoking habits was obtained using self-administered questionnaires. A hospital nutritionist assessed nutritional status. All of these factors were adjusted for as possible confounding factors in the analyses. RESULTS: The (ln)SDS score showed a positive association with the area of VAT, even after adjusting for the confounders mentioned above (p < 0.01). BMI, waist circumference, maximal oxygen uptake, and age were also associated with the area of VAT (all p < 0.05). In contrast, the (ln)SDS score was not associated with SAT (p > 0.10). DISCUSSION: We showed that depressive mood is associated with VAT, not with SAT, in overweight premenopausal women. These findings may explain some of the association between depression and coronary heart disease. More studies are needed to elucidate the causal relationship.

Abdomen↗

PubMed2002

Cross-sectional study of health-related quality of life in African Americans with chronic renal insufficiency: the African American Study of Kidney Disease and Hypertension Trial.

We measured health-related quality of life (HRQL) by using the Medical Outcomes Study 36-Item Short-Form (SF-36) in a cross-sectional study of 1,094 African American men and women with mild to moderate chronic renal insufficiency (mean glomerular filtration rate, 45.7 mL/min/1.73 m2) caused by hypertension before randomization onto the African American Study of Kidney Disease and Hypertension (AASK) Trial. Scales contributing to physical health and a summary measure, the Physical Component Summary (PCS) score (mean, 43.4 +/- 10.9 [SD]), were significantly lower than scales relating to mental health and the Mental Component Summary (MCS) score (51.3 +/- 10.3). All scales (except Role-Physical) and the PCS and MCS were significantly higher in men (44.3 +/- 10.9 and 51.8 +/- 10.0, respectively) than women (41.9 +/- 10.8 and 50.5 +/- 10.6, respectively). In multivariate analysis, employment status, education level, household income, body mass index, comorbid medical conditions, years of hypertension, number of antihypertensive drugs prescribed, exercise status, and male sex were significant independent predictors of PCS. Fewer factors predicted MCS and included employment status, marital status, current smoking, age, comorbid medical conditions, and male sex. In the entire AASK cohort, mean scores for individual scales, except Mental Health, and the PCS were lower, but the mean MCS score was slightly higher than values for the US general population. Values for individual scales of the SF-36 and the PCS were substantially higher among AASK participants compared with African-American hemodialysis patients. Six of the eight scales were lower in the AASK cohort compared with groups of racially mixed and exclusively African-American hypertensive subjects. We conclude that physical aspects of quality of life are substantially reduced compared with mental components among AASK participants, and a number of demographic and clinical characteristics significantly impact on HRQL.

Adolescent↗

PubMed2002

Survey of the use of complementary and alternative medicine among Turkish cancer patients.

OBJECTIVES: To measure the frequency of use of complementary and alternative medicine (CAM) among patients with malignancy undergoing or following conventional treatment, to determine demographic characteristics associated with the use of CAM, and to find out how benefits, if any, were perceived by patients. DESIGN: A 35-item survey questionnaire administered to 305 return patients with malignancy. SETTING: Clinical wards of the Oncology and Haematology departments of Gülhane Military Medical Academy, Ankara, Turkey. METHODS: Questionnaire-based measures of demographics, motives, expectations and effects of using CAM, and types and reported perceived benefits of CAM practised on patients with malignancy. RESULTS: The majority of return patients (n = 186, 61.0%) used at least one CAM practice; and birthplace, educational status, and family type were significant factors in such behaviour. CONCLUSIONS: Patients with malignancy born in villages, having less education and living in large families were more likely to use folk medicine. More than half of those using CAM (n = 99, 53.2%) reported as benefits the feelings of either strengthening of the body, being in good psychological condition, or the disappearance of several symptoms.

Adult↗

PubMed1975

The 1972 Cuban national child growth study as an example of population health monitoring: design and methods.

A stratified 3-stage random sample of 50 360 children ages 0-19 drawn from the whole population of Cuba was measured in a large-scale growth study during 1972-73. Fifteen anthropometric measurements were taken and puberty stages and menarche status were assessed. Hand-wrist radiographs were done on 10% of the sample. Information regarding the social and education status of the parents was obtained and parental heights were measured. One year later, 30% of the sample were re-measured and 10% re-X-rayed. The overall response rate was 96% at pre-school and primary school age, and a lettle less later. Quality control sessions were held at which the nine measuring teams compared results. No significant differences were found between teams working different parts of the island. Differences between duplicate measurements of stature by individual measurers had standard deviations approximating 0.20 cm. Individual measurers' means differed from the grand means of all measurers by up to +/- 0.2 cm for stature, +/- 0.4 cm for sitting height and +/- 0.5 mm (7% of mean) for triceps skinfold. One or more measurements lay outside the 3rd-97th centile limits in 21% of individuals. Scrutiny of these individuals' records resulted in elimination of measurements in amounts ranging from 0.1% (triceps skinfold) to 1.1% (crown-rump length). Problems of planning and execution of growth surveys designed to set national standards are described, and solutions given or suggested.

Adolescent↗

PubMed2004

An assessment of the utilization of complementary and alternative medication in women with gynecologic or breast malignancies.

PURPOSE: To describe and assess the current utilization of complementary and alternative medicines (CAMs) in women with a diagnosis of either gynecologic or breast cancer and evaluate their reasons for use. PATIENTS AND METHODS: This study included 250 female patients from the Multidisciplinary Breast Center and 250 patients from the Gynecologic Oncology Center of The University of Texas M.D. Anderson Cancer Center (Houston, TX). Patients were selected by having an odd-numbered medical record number, and they were contacted before their clinic visit. The goals of the study were explained, and verbal consent was obtained. Patients who agreed to participate were asked to bring a written list and the medication bottles of all over-the-counter prescriptions and CAMs with them to clinic. In clinic, the investigator obtained a written informed consent and administered the survey. All patients and surveys were assessable. RESULTS: The most frequently used herbal products and megavitamins/minerals were identified from the patient medication histories. Overall, we found the proportion of patients using CAM to be 48% (95% CI, 44% to 53%; 241 of 500 patients). CAM use was related to patients' educational status: 62% had postgraduate degrees, 50% had college degrees, 56% had some college, and 33% had a high school education or less. Also, among patients using CAMs, only 53.5% had spoken to a healthcare provider regarding CAM therapy. CONCLUSION: The use of CAM is common among women with cancer. Studies need to be conducted to establish if there are any potential drug interactions and/or therapeutic benefit of CAM products. Moreover, there is a need to educate patients and healthcare providers on appropriate and safe use of CAM products.

Adult↗

PubMedDate not supplied

[Perinatal factors which affect low birth weight].

The incidence of low-birth weight babies in the Santo Tomás maternity ward was 9% between the first of August of 1992 and the 31 of July of 1993. We found a higher risk of having low birth weight babies if the mother was toxemic, without prenatal care of low socioeconomic status and if she was single. We did not find an association with adolescence, short mother's height, low educational status and primi- or multiparity of 5 or more.

Apgar Score↗

PubMedDate not supplied

Alcohol intake in a rural village: physical signs and biological markers predicting excessive consumption in apparently healthy people.

Four hundred and ninety-two (232 males and 260 females) randomly selected inhabitants older than 15 years of La Esperanza, a rural village of Tenerife, have been inquired about their daily alcohol intake, analyzing the relationship between this parameter and sex, age, marital status, educational level, job and smoking habit, physical signs, and biological markers of excessive ethanol consumption. One hundred and seventy-four out of them (35.4%) were teetotalers, while 318 (64.6%) consumed alcoholic beverages; 18.2% (34.1% of the males and 4.2% of the females) referred excessive ethanol consumption (more than 80 g/day and 40 g/day, respectively). Men consumed 62.3 +/- 4 g/day ethanol and women, 8 +/- 1 g/day. The distribution of the population according to the amount of ethanol consumed fits into Lederman's curve, most of the individuals being consumers of small amounts of ethanol. Male sex, middle age, married or separated status, unskilled job, sometimes unemployed, low educational level, daily drinking (mainly wine), and smoking, were all related to a higher ethanol consumption. When assessed by logistic regression, only liver enlargement, parotid swelling, retches and tremor in the morning, and hoarseness, out of the physical signs, showed independent predictive value as indicators of excessive consumption as well as serum GGT, ASAT, MCV, and urate levels out the biological markers. When all those physical and analytical signs that had previously shown predictive independent value are analyzed together, all the five physical signs (liver enlargement, parotid swelling, retches and tremor in the morning, and hoarseness) but only urate, out of the biochemical markers, showed independent predictive value.

Adult↗

PubMed2000

Social inequality and environmentally-related diseases in Germany: review of empirical results.

A literature search was conducted aiming at all empirical studies from Germany till mid 1997 containing data on the association between environmentally-related diseases and the socio-economic status (education, occupation, income, social class) and/or on the association between the exposure to harmful substances and the socio-economic status. With respect to the exposures, a clear picture becomes visible: the concentration of harmful substances in the ambient air as well as indoors is considerably higher with regard to the lower social class as compared with the higher social class. This applies to children as well as to adults and to West Germany as well as to East Germany. However, with respect to environmentally-related diseases, no such clear picture becomes visible. For example, several studies indicate that allergies, atopic eczema and croup occur less frequently in the lower social class than in the higher social class. Malignant tumours (lung cancer, kidney cancer or bladder cancer), however, seem to occur more frequently in the lower social class than in the higher social class. Environmental-epidemiological studies should increasingly integrate socio-epidemiological study approaches and explicitly present their results.

Adolescent↗

PubMed2003

Polyunsaturated fatty acid status and relapse vulnerability in cocaine addicts.

There is mounting evidence that low levels of some polyunsaturated fatty acids (PUFAs) play a role in the pathophysiology of depressive and aggressive disorders, including homicides. There is also evidence derived mostly from the animal literature that PUFAs could play a role in the abuse of substances through their action on central serotonergic and dopaminergic systems that are both known to play a role in reward mechanisms. In this study, we explored the possibility that the relapse rates of cocaine addicts discharged after a period of detoxification on an inpatient unit would be associated with their PUFA status. Thirty-eight patients were enrolled in the study. PUFA status was assessed only at baseline, shortly after admission. Resumption of substance use was assessed 3 months, 6 months and 1 year following discharge. Thirty-two patients remained available for follow-up for the duration of the study. Subjects who relapsed at 3 months had significantly lower baseline levels of total n-6 PUFAs, linoleic acid (LA, 18:2n-6), arachidonic acid (AA, 20:4n-6) and total n-3 PUFAs when compared to non-relapsers by ANCOVAs with age and weight as covariates. Lower baseline total n-6 PUFAs, LA and AA continued to predict relapse 6 months and 12 months following discharge. Age, marital status, educational level, cocaine use parameters or psychopathology did not differ between relapsers and non-relapsers. In conclusion, low PUFA status at baseline was a better predictor of relapse than cocaine use, sociodemographic or clinical parameters. These data suggest, but do not prove, the existence of a causal relationship between n-6 or n-3 status and relapse vulnerability in cocaine addicts, and provide a rationale for the exploration of possible relationships between relapse to addictive disorders and PUFA status in observational and interventional trials.

Adult↗

PubMed2006

Associations of area based deprivation status and individual educational attainment with incidence, treatment, and prognosis of first coronary event in Rome, Italy.

BACKGROUND: Socioeconomic gradients in the occurrence of myocardial infarction are well known, but few studies have examined socioeconomic disparities in post-infarction outcomes. The objective of this study was to explore relations of socioeconomic status with the incidence, treatment, and outcome of first coronary event in Rome, Italy, during the period 1998-2000, examining effect modification by gender. METHODS: Subjects were Rome residents aged 35-84 years who died from first acute coronary event before reaching the hospital (n=3470) or were hospitalised for first acute myocardial infarction (n=8467). Area based deprivation status and patients' educational attainment were the exposure variables. The outcomes were: incidence of coronary event; recanalisation at the index hospitalisation and fatality within 28 days of hospitalisation; cardiac readmissions and fatality between 28 days and one year of index hospitalisation. RESULTS: Incidence rates increased as area based deprivation status increased; the effect was stronger among women than among men (men RR=1.40, 95%CI:1.30, 1.50, women RR=1.78, 95%CI:1.60, 1.98, most compared with least deprived). Rates of recanalisation were significantly lower in the most deprived patients than in the least deprived (OR=0.77, 95%CI:0.59, 0.99) and in the less educated than in the highly educated (OR=0.73, 95%CI:0.58, 0.90). Associations of short term fatality with area based deprivation status and educational attainment were weak and inconsistent. However, neither deprivation status nor education was associated with one year outcomes. CONCLUSIONS: Area based deprivation status is strongly related to incidence of coronary events, and more so among women than among men. Deprivation status and educational attainment are weakly and inconsistently associated with short term fatality but seem not to influence one year prognosis of acute myocardial infarction. Deprived and less educated patients experience limited access to recanalisation procedures.

Adult↗

PubMed1984

Educating patients with rheumatoid arthritis: a prospective analysis.

Twenty-two men with rheumatoid arthritis were randomly assigned to either a patient education group, receiving standard inpatient medical care in addition to a formal education program, or a control group receiving only the inpatient medical care. Members of the groups were not significantly different in terms of age, degree of life stress, socioeconomic status, educational level, or years since onset of rheumatoid arthritis. Dependent measures included the Arthritis Knowledge Inventory (AKI), the Arthritis Impact Measurement Scales (AIMS), and the Beck Depression Inventory (BDI), and they were collected preeducation, posteducation, and at a three-month followup. Results from the AIMS revealed improvement in dexterity, social role, depression, and overall health status for both groups. The BDI also revealed significantly less depression for both groups, reflecting a general improvement following medical intervention. Although the patient education group revealed significantly higher scores on the knowledge measure, they also revealed significantly more impairment of activity levels and significantly higher pain scores. Education was effective for increasing rheumatoid arthritis knowledge, but such topics as joint protection and disease process may adversely affect how patients view their physical capacities and interpret their pain.

Adaptation, Psychological↗

PubMed2000

Validity of self-reported weight and height in the French GAZEL cohort.

OBJECTIVE: To examine the validity of self-reported weight and height and the resulting body mass index (BMI), and to explore the associations between demographic, socioeconomic, and health-related factors on the one hand and bias in self-reported weight and height on the other, in order to determine the groups most likely to exhibit bias. DESIGN: Prospective cohort study. SUBJECTS: 7350 middle-aged subjects, 5445 men and 1905 women, from the GAZEL cohort, who have been followed up since 1989 and work at the French national company Electricité De France-Gaz De France (EDF-GDF) in various occupations. MEASUREMENTS: Self-reported weight and height were based on information from yearly mailed questionnaires, and measured weight and height, used here as true values, were provided by occupational physicians from 1994 to 1997. Sex, age, marital status, education, occupation, history of ischemic heart disease, and treatment for cardiovascular risk factors were obtained from the mailed questionnaires or from data provided by the Company's personnel and medical departments. RESULTS: Strong correlations were found between measured and self-reported values, but self-reported weight and height displayed significant systematic errors. Weight was significantly underestimated for men (0.54 kg) and for women (0.85 kg), and height overestimated for men (0.38 cm) and women (0.40 cm). These biases led to significant underestimations of BMI (0.29 and 0.44 kg/m2 for men and women respectively). Consequently, the prevalence of overweight, defined as BMI > 26.9 kg/m2 for women and BMI > 27.2 kg/m2 for men, was also underestimated, by 13% for men and 17% for women. The five factors associated with bias in self-reported weight and height were: overweight status, end-digit preference, age, educational level and occupation. CONCLUSION: These findings suggest that self-reported weight and height should be treated with caution, because of biases leading to misclassification for overweight and obesity, especially in certain segments of the population.

Adult↗

PubMed1998

Hospital admissions through the emergency department: does insurance status matter?

PURPOSE: To assess the effect of insurance status on the probability of admission and subsequent health status of patients presenting to emergency departments. SUBJECTS AND METHODS: We performed a prospective cohort study of patients with common medical problems at five urban, academic hospital emergency departments in Boston and Cambridge, Massachusetts. The outcome measure for the study was admission to the hospital from the emergency department and functional health status at baseline and follow-up. RESULTS: During a 1-month period, 2,562 patients younger than 65 years of age presented with either abdominal pain (52%), chest pain (19%) or shortness of breath (29%). Of the 1,368 patients eligible for questionnaire, 1,162 (85%) completed baseline questionnaires, and of these, 964 (83%) completed telephone follow-up interviews 10 days later. Fifteen percent of patients were uninsured and 34% were admitted to the hospital from the emergency department. Uninsured patients were significantly less likely than insured patients to be admitted, both when adjusting for urgency, chief complaint, age, gender and hospital (odds ratio = 0.5, 95% confidence interval 0.3 to 0.7), and when additionally adjusting for comorbid conditions, lack of a regular physician, income, employment status, education and race (odds ratio = 0.4, 95% confidence interval 0.2 to 0.8). However, there were no differences in adjusted functional health status between admitted and nonadmitted patients by insurance status, either at baseline or at 10-day follow-up. CONCLUSIONS: Uninsured patients with one of three common chief complaints appear to be less frequently admitted to the hospital than are insured patients, although health status does not appear to be affected. Whether these results reflect underutilization among uninsured patients or overutilization among insured patients remains to be determined.

Abdominal Pain↗

PubMed2006

Breast cancer screening and health behaviors among African American and Caribbean Women in New York City.

A telephone-based survey regarding breast cancer screening practices among 300 African American and Caribbean women age 40 and over in New York City revealed that while U.S.-born women had significantly different sociodemographic profiles (in terms of insurance status, marital status, educational attainment), they were no more likely to have had a mammogram than the foreign-born women. Adjusting for insurance status and source of care, women with a provider recommendation were 8 times more likely ever to have had a mammogram (AOR 8.01, 95%CI: 3.74-17.14). Among foreign-born Caribbean women in the U.S. for less than half their lives, only 52% ever had a provider recommend a mammogram, compared with 77% of U.S.-born women. The findings confirm previous reports of the importance of physician recommendation in increasing mammography screening among urban Black women, and suggest that efforts to reach Caribbean-born women with breast cancer screening messages should emphasize the important role of providers.

Adult↗

PubMed1996

Barriers to care in non-insulin-dependent diabetes mellitus. The Michigan experience.

OBJECTIVE: To determine the barriers to optimal care at the community level for patients with non-insulin-dependent diabetes mellitus (NIDDM). DESIGN: Comprehensive evaluation of the clinical, psychosocial, and educational status of community-based patients with NIDDM, with subsequent review by local diabetes advisory councils of this status and the care those patients have received. The frequency with which patients visited their physician for diabetes management, received patient education, received diet counseling, and were examined by an ophthalmologist-four services universally recognized to be components of optimal diabetes care-was determined for all patients. SETTING: Eight Michigan communities, four large and four small. PATIENTS: From 1988 to 1994, 1056 patients with NIDDM defined by stimulated C-peptide criteria) were studied. RESULTS: The frequency with which all patients with NIDDM visited their community primary care physician in 1994 was 3.7 times per year (4.6 times for patients taking insulin and 3.2 times for those not taking insulin). Thirty-three percent of all patients with NIDDM (48% of those taking insulin and 24% of those not taking insulin) had received all three other essential services, whereas 15% (6% taking insulin and 20% not taking insulin) had never received any of these services. Factors contributing to this level of care and barriers preventing more intensive management of community-based patients with NIDDM were identified by the diabetes advisory councils as they analyzed data from their own communities. The councils determined that the main barriers to optimal care of community-based patients with NIDDM are that 1) NIDDM is not considered or managed as a serious problem by most physicians and their patients; 2) the genetic basis for and refractory nature of obesity are not generally appreciated; and 3) as a complex, multisystemic chronic illness, diabetes fits poorly in a health care delivery system designed to deal with acute and episodic illnesses. CONCLUSION: Most community-based patients with NIDDM are not aggressively managed because of attitudinal, educational, and systemic factors that act as barriers to optimal health care delivery.

Attitude to Health↗