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PubMed1996

Minority advantage in diabetic end-stage renal disease survival on hemodialysis: due to different proportions of diabetic type?

The objectives of this study were to identify predictors of survival on hemodialysis in patients with diabetic end-stage renal disease (ESRD) and to explain ethnic differences in survival among non-Hispanic whites, African-Americans, and Mexican-Americans. The study design was a survival analysis of an inception cohort and was conducted in dialysis centers in two urban counties in Texas. A population-based, tri-ethnic cohort of 638 adult patients with diabetic ESRD were studied. Follow-up was completed in 96% of the cohort, with a median length of follow-up of 3.8 years. Survival length on center hemodialysis was the main outcome measure. In a combined model of types I and II diabetes, Mexican-Americans (relative hazard [RH], 0.666; 95% confidence interval [CI], 0.457 to 0.944) and African-Americans (RH, 0.598; 95% CI, 0.414 to 0.864) showed a better survival than non-Hispanic whites. Other predictors independently associated with survival were age (RH, 1.015 per 10 years of age; 95% CI, 1.001 to 1.028), high self-reported physical disability (RH, 1.770; 95% CI, 1.213 to 2.583), coronary artery disease (RH, 1.445; 95% CI, 1.044 to 2.012), lower extremity amputations (RH, 2.049; 95% CI, 1.438 to 2.920), and average blood glucose levels prior to ESRD (RH, 1.002 per 1 mg/dL increment; 95% CI, 1.003 to 1.004). Non-Hispanic whites had a significantly higher rate of type I diabetes, but did not have a greater burden of any of the other predictors. In separate type I and II models, ethnicity was still a significant predictor of survival among type I but not among type II. In conclusion, we have reconfirmed the survival advantage on dialysis of African-Americans and Mexican-Americans over non-Hispanic whites with diabetic ESRD. However, among type II patients, this minority survival advantage disappears. Self-reported physical disability is an important predictor of survival among both diabetes types. Functional status at baseline is an important predictor of survival and should be assessed as an adjunct to measurement of co-morbidities. Macrovascular disease is important for type II, while educational status is important for type I. While amputation may be a marker for the severity of systemic illness, it could be a marker for quality of primary care provided to diabetic patients, since a majority of diabetic lower extremity amputations are thought to be preventable.

Adult↗

PubMed1982

Latin American nursing students in the United States.

The Latino students confront a unique set of difficulties and patterns of adjustment in the majority culture and the educational experiences in the United States. Careful consideration must be given not only to the general characteristics of this group, but also to the individual's history of immigration, socioeconomic status, educational experiences and background. Multicultural education for the international nursing students can benefit all students, but it should not gloss over conflicts of values and beliefs. It must honestly deal with differences and similarities. It must be based on experience, not on stereotypes of root cultures or ethnic characteristics. In addition to addressing the cognitive affect and skill needs of all students, the multicultural education must address the special needs of minorities. Anglo students or majority-group students need realistic opportunities for experience and interaction with minority students and minority-faculty. Every group has something to teach the other. Faculty advisors and majority students should be encouraged to acquaint themselves with the need to establish rapport with the Latino student. There is also a need to develop in the classroom an atmosphere that enhances the learning experiences. The learning experiences should be so designed that all students and school personnel can intellectually, emotionally and socially participate on equal terms in a culturally diverse society.

Acculturation↗

PubMed2003

[Quality of life of women after ischemic stroke].

OBJECTIVES: Stroke is an important cause of morbidity and mortality in postmenopausal women. The aim of the study was to evaluate functional and psychological quality of life in women after a first-ever stroke as well as to identify independent predictors of post-stroke quality of life. DESIGN: Cross-sectional and correlational study. MATERIAL AND METHODS: A group of 46 women (mean age 67.1 yrs) after a first-ever ischemic stroke was followed up for 6 months after the onset of the stroke. Quality of life was assessed with the Polish versions of Sickness Impact Profile and Quality of Life Index. The variables studied were neurological and functional status, depression, lateralization, age, gender, marital status, education, living arrangement, emotional support. RESULTS: The study has shown that the quality of life of investigated women was significantly worse than that of subjects' from a comparative group. Neurological status, depression and emotional support was the most important correlates of quality of life. CONCLUSIONS: Rehabilitation focused on fostering physical independency, treatment of depression and strengthening social support may be decisive factors in improving post-stroke quality of life.

Activities of Daily Living↗

PubMed1994

Reading ability of parents compared with reading level of pediatric patient education materials.

OBJECTIVES: To test the reading ability of parents of pediatric outpatients and to compare their reading ability with the ability necessary to read commonly used educational materials; to compare individual reading grade levels with the levels of the last grade completed in school; and to further validate a new literacy screening test designed specifically for medical settings. DESIGN: Prospective survey. SETTING: Pediatrics outpatient clinic in a large, public university, teaching hospital. PARTICIPANTS: Three hundred ninety-six parents or other caretakers accompanying pediatric outpatients. MEASUREMENTS: Demographics and educational status were assessed using a structured interview. Reading ability was tested using the Rapid Estimate of Adult Literacy in Medicine (REALM) and the Wide Range Achievement Test-Revised. Written educational materials were assessed for readability levels with a computer program (Grammatik IV). RESULTS: The mean score on the REALM for all parents placed them in the seventh to eighth grade reading range, despite the mean self-reported last grade completed in school being 11th grade 5th month. Wide Range Achievement Test-Revised scores correlated well with REALM scores (0.82). Eighty percent of 129 written materials from the American Academy of Pediatrics, the Centers for Disease Control, the March of Dimes, pharmaceutical companies, and commercially available baby books required at least a 10th grade reading level. Only 25% of 60 American Academy of Pediatrics items and 19% of all materials tested were written at less than a ninth grade level, and only 2% of all materials were written at less than a seventh grade level. CONCLUSION: This study demonstrates that parents' self-reported education level will not accurately indicate their reading ability. Testing is needed to screen at-risk parents for low reading levels. In a public health setting, a significant amount of available parent education materials and instructions require a higher reading level than most parents have achieved. In such settings, all materials probably should be written at less than a high school level if most parents are to be expected to read them. The REALM can easily be used in busy public health clinics to screen parents for reading ability.

Adolescent↗

PubMed1989

Dysthymic disorder in the aged in the community.

The prevalence of dysthymic disorder and and its relationship to social and health variables were investigated in a Finnish population aged 60 years or over. The prevalence was lower in men (17.2 per 100) than in women (22.9 per 100). In the total population the occurrence was higher in the widowed (24.9 per 100) than in the married (18.3 per 100). In men, dysthymic disorder was more common in those with a lower educational level (22.6 per 100) than with a higher educational level (15.1 per 100), and more common in persons receiving long-term institutional care or home nursing or home help (28.7 per 100) than in persons living independently at home (14.6 per 100). The rate was not related to age, marital status or occupation. In women, the occurrence was not related to age, marital status, education, occupation or form of social and health care. The female rate was higher than the male in the older group (70 yrs. +), in married persons, in those with a higher educational level and in those living independently at home. Underdiagnosing was evident. The occurrence of dysthymic disorder was related to poor health and poor functional status and to the occurrence of social and health stressors. No differences were found in the occurrence of the related factors between persons with dysthymic disorder and persons with major depression. Our results support the conclusion that the majority of cases of dysthymic disorders in the elderly are affective illnesses and not personality disorders.

Aged↗

PubMed2005

Patient and health service delay in pulmonary tuberculosis patients attending a referral hospital: a cross-sectional study.

BACKGROUND: Delays in diagnosis and initiation of effective treatment increase morbidity and mortality from tuberculosis as well as the risk of transmission in the community. The aim of this study was to determine the time taken for patients later confirmed as having TB to present with symptoms to the first health provider (patient delay) and the time taken between the first health care visit and initiation of tuberculosis treatment (health service delay). Factors relating to these 'delays' were analyzed. METHODS: A cross-sectional survey, of 231 newly diagnosed smear-positive tuberculosis patients was conducted in Mulago National referral Hospital Kampala, from January to May 2002. Socio-demographic, lifestyle and health seeking factors were evaluated for their association with patient delay (> 2 weeks) and health service delay (> 4 weeks), using odds ratios with 95% confidence intervals (CI) including multivariate logistic regression. RESULTS: The median total delay to treatment initiation was 12 weeks. Patients often presented to drug shops or pharmacies (39.4%) and private clinics (36.8%) more commonly than government health units (14%) as initial contacts. Several independent predictors of 'patient delay' were identified: being hospitalized (odds ratio [0R] = 0.32; 95% CI: 0.12-0.80), daily alcohol consumption (OR = 3.7; CI: 1.57-9.76), subsistence farming (OR = 4.70; CI: 1.67-13.22), and perception of smoking as a cause of TB (OR = 5.54; CI: 2.26-13.58). Independent predictors of 'health service delay' were: > 2 health seeking encounters per month (OR = 2.74; CI: 1.10-6.83), and medical expenditure on TB related symptoms > 29 US dollars (OR = 3.88; CI: 1.19-12.62). Perceived TB stigma and education status was not associated with either form of delay. CONCLUSION: Delay in diagnosis of TB is prolonged at the referral centre with a significant proportion of Health service delay. More specific and effective health education of the general public on tuberculosis and seeking of appropriate medical consultation is likely to improve case detection. Certain specific groups require further attention. Alcoholics and subsistence farmers should be targeted to improve accessibility to TB treatment. Continuing medical education about TB management procedures for health providers and improvement in the capacity of TB control services should be undertaken.

Adult↗

PubMed1987

Physician familiarity with the educational programs of their special needs patients.

As part of an analysis of health care for children in special education programs, physician familiarity with the educational status and program enrollment of their disabled patients was examined. Telephone interviews were performed with a random sample of 411 of the children's physicians. The majority (70%) of the physicians interviewed professed no knowledge of their patients' current special educational program. Certain physician, child, and family characteristics were associated with physician awareness of the children's programs. These were physician specialty, physician gender, child's disability, and severity of the child's problem. This study suggests that, although some physicians of very involved patients do familiarize themselves with their patients' day-to-day school life, many other physicians are poorly informed about the school activities and functional status of their young patients with disabilities. Better mechanisms are needed to ensure physicians' understanding of these aspects of child health.

Affective Symptoms↗

PubMed2004

Income and mortality: the shape of the association and confounding New Zealand Census-Mortality Study, 1981-1999.

OBJECTIVE: To determine the shape of the income-mortality association, before and after adjusting for confounding by other socioeconomic variables. METHODS: Poisson regression analyses were conducted on 11.7 million years of follow-up of 25-59 year old New Zealand census respondents spanning four separate cohort studies (1981-1984, 1986-1989, 1991-1994, and 1996-1999). RESULTS: Mortality among low-income people was approximately two times that among high-income people. Adjustment for potential socioeconomic confounders (marital status, education, car access, and neighbourhood socioeconomic deprivation) halved the strength of the income-mortality association, but did not appreciably change the shape of the association. Further adjustment for labour force status largely removed the income-mortality association. The association of non-transformed income with mortality was non-linear, with a flattening out of the slope at higher incomes. Both the logarithm and rank of income appeared to have a better linear fit with the mortality rate, although the association of mortality with the logarithm of income flattened out notably at low incomes. CONCLUSIONS: Much, but not all, of the crude association of income with mortality could be due to confounding. Adjusting income-mortality associations for labour force status (also a proxy for health status) is problematic: on the one hand, it over-adjusts the association as poor health will be on the pathway from income to mortality; on the other hand, it appropriately adjusts for both confounding by labour force status and reverse causation whereby income changes as a result of poor health. Both logarithmic and rank transformations of income have a reasonable linear fit with income.

Censuses↗

PubMed1990

Psychological distress and somatic symptoms after natural disaster: differential vulnerability among older adults.

In a panel study, more than 200 older adults were interviewed before and after a severe flood in southeastern Kentucky in 1984. The issue in this study was whether older adult flood victims were differentially vulnerable to increases in psychological and physical symptoms on the basis of their age, sex, marital status, occupational status, education level, and preflood symptom levels. Flood exposure was related to increases in depressive, anxiety, and somatic symptoms at 18 months postflood. Within this older adult sample, men, those with lower occupational status, and persons aged 55-64 were at significantly greater risk for increases in psychological symptoms. Sociodemographic status did not moderate the impact of flood exposure on physical health. Implications for crisis-intervention services to older adult disaster victims are discussed.

Adaptation, Psychological↗

PubMed1997

Goal setting as a predictor of return to work in a population of chronic musculoskeletal pain patients.

To assess prospectively the association between personal attributes, vocational factors, and the return to work outcome for patients with chronic, nonmalignant, musculoskeletal pain, we assessed return to work (RTW) motivation though an open-format listing of treatment goals in 59 chronic pain patients admitted to a university pain management program. Patients were then followed (average of 17.9 months) in the posttreatment period to determine whether they had in fact returned to employment. Results indicated that a number of pretreatment factors predicted future employment status in this patient population. Age, marital status, education and decreased length of unemployment were predictive of RTW outcome. Overall, RTW goal was the single best predictor of return to work outcome. In contrast, increased number of premorbid jobs, compensation status, patient's race and sex were not predictive. The present study suggests that the assessment of an individual's motivation as defined by goal-setting may be a key factor in predicting a favorable outcome in this typically refractory population of patients.

Adult↗

PubMed1991

Teething myths in Nigerian rural Yoruba communities.

Systemic and local disturbances have often been attributed to the eruption of human primary dentition. Several orthodox and folk remedies exist in some populations to prevent and treat these symptoms blamed on teething. The inherent danger in the persistence of teething myths is the danger that signs and symptoms of some diseases and conditions may be ignored if they are viewed as being merely a part of the teething process. Such behaviour could sometimes be detrimental to the child's health. This study investigated the knowledge and beliefs of two rural Yoruba communities about teething. 58% of the 622 respondents believed that teething may be accompanied by various problems including fever, diarrhoea and conjunctivitis. The higher the educational status, the lower the proportion of respondents who believed that teething is accompanied by a disease. There is clear indication of the need to include scientific information on teething in the health educational packages directed at different levels within these communities.

Child↗

PubMed2003

Glaucoma and survival: the National Health Interview Survey 1986-1994.

OBJECTIVE: Associations between glaucoma and survival have not been studied extensively, in part, because of the relatively low prevalence of this condition. This study examines associations between self-reported glaucoma and mortality in a nationally representative sample of U.S. adults. DESIGN: Annual cross-sectional multistage area probability survey of the U.S. civilian noninstitutionalized population living at addressed dwellings. PARTICIPANTS: Mortality linkage with >96% of participants from the 1986 to 1994 National Health Interview Survey was performed by the National Center for Health Statistics through 1997. Complete data were available on 116796 adults >or=018 years old. METHODS: Adults within randomly selected households were administered a chronic conditions list that included questions about glaucoma and visual impairment. Proxy information on these conditions was obtained when household members were unavailable for interview. Statistical methods included Cox regression models with adjustments for covariates, as well as for the complex sample survey design. MAIN OUTCOME MEASURE: All-cause mortality and cardiovascular and cancer mortality. RESULTS: A total of 1559 (1.3%) glaucoma cases were reported. Nearly 19% of participants with reported glaucoma also had reported visual impairment (n = 303). Mortality linkage identified 8949 deaths; the average follow-up was 7.0 years. After controlling for survey design, gender, age, race, marital status, education level, and self-rated health, participants with reported glaucoma but without reported visual impairment were at significantly increased risk of death relative to participants without reported glaucoma, irrespective of visual impairment status (hazard ratio [HR], 1.35; 95% confidence interval [CI], 1.19-1.53); similar associations were found for participants with reported glaucoma and visual impairment vs. participants with no reported glaucoma (HR, 1.39; 95% CI, 1.14-1.71). An increased risk of cardiovascular disease mortality was found for participants with reported glaucoma both without (HR, 1.31; 95% CI, 1.11-1.55) and with (HR, 1.53; 95% CI, 1.15-2.05) reported visual impairment. Risk of mortality due to cancer was increased only in participants with reported glaucoma but without reported visual impairment (HR, 1.57; 95% CI, 1.25-1.98); this association was stronger when the mortality analysis was restricted to cancers amenable to early screening, including breast, cervical, colon, and prostate cancer (HR, 1.99; 95% CI, 1.41-2.81). CONCLUSIONS: Among adults residing in the United States, reported glaucoma is associated with an increased risk of all-cause and cardiovascular disease mortality. Associations between glaucoma and cancer were inconsistent and may reflect, in part, a detection bias, in which glaucoma is more likely to be diagnosed in adults receiving health care because of other medical conditions.

Adolescent↗

PubMed2003

Role of exercise and lung function in predicting work status in cystic fibrosis.

With larger numbers of adult patients with cystic fibrosis (CF) in the workplace, the issue of disability has arisen increasingly. We examined relationships between measures of pulmonary impairment and work/school capability and then determined whether quantification of aerobic fitness improved predictability of disease-related disability. We studied 73 patients with CF who performed lung function and exercise capacity tests, completed a work/education questionnaire, and were scored for clinical and chest radiographic status. Patients who were characterized as unemployed and in poor health had more severe pulmonary disease according to American Thoracic Society impairment/disability criteria. Subjects were further classified into three groups based on employment or education status over the preceding 12 months. FEV1, maximal oxygen consumption, Schwachman-Kulczycki clinical and Brasfield radiographic scores, and frequency of pulmonary exacerbations over 2 years were associated with disability, but change in FEV1 over 2 years and oxygen saturation at rest or exertion were not. FEV1 and Schwachman-Kulczycki scores were the best independent predictors of impairment/disability; specific thresholds used in other pulmonary diseases were of limited utility. We conclude that after accounting for either current level of FEV1 or Schwachman-Kulczycki scores, no other physiological or clinical measures contribute to predicting limitation in a work or school environment.

Adult↗

PubMed2006

The prevalence and correlates of occupational injuries in small-scale manufacturing enterprises.

Workers involved in small-scale manufacturing businesses are known to comprise a high-risk population for occupational injury. The present study investigated the prevalence and correlates of occupational injury in this population. A self-administered questionnaire that solicited answers about occupational information including injury, demographic characteristics, health conditions and lifestyle factors was collected from a sample of 1,298 workers in 228 small-scale manufacturing enterprises (defined as fewer than 50 workers) aged 16-78 (mean 46) yr in Yashio city, Saitama, Japan (response rate 65.5%). The enterprises were randomly selected from the 2000 edition of the city commercial directory corresponding to the distribution of types of businesses in the city. Occupational injury was assessed by asking subjects, ;Have you ever been injured during your work, including minor scratches and cuts in the previous 1-yr period?' The possible response was either ;yes' or ;no.' The prevalence of study-defined occupational injury among the workers was 35.6% (male 43.0%, female 17.9%). Among job types, manufacturing (44.2%) and driving (43.5%) had high rates of occupational injuries. Similarly, occupational injuries were high in the papermaking (54.5%) and machinery (47.7%) industries. For males, younger age, current or former smoking, insomnia symptoms, and disease(s) currently under treatment were correlated with injury, whereas for females, being unmarried, higher educational status, and insomnia symptoms were the correlating factors. Occupational injury is common among small-scale manufacturing businesses, and is associated with multiple controllable factors. Countermeasures such as prohibiting smoking during work, sleep health education, job safety training for young/inexperienced workers are appropriate methods for eliminating or reducing injuries.

Accidents, Occupational↗

PubMed2005

[Nonbiologic risk factors of pulmonary tuberculosis among adults in Henan: a case-control study].

OBJECTIVE: To study the nonbiologic risk factors of tuberculosis (TB) among adults. METHODS: 1:2 matched case-control study was conducted. 158 new smear positive pulmonary TB patients with 25 - 60 years of age were notified and registered from three county anti-TB institutions in Henan from October 2002-March 2004, were selected as cases. Two healthy persons were selected to match each case, with the same sex and age group, from the nearest neighbors of the case as controls. Interview was carried out with a uniform designed questionnaire at the residence of the object. Univariate and multivariate condition logistic regression models were used. RESULTS: The results of univariate analysis showed that marital status, education, self-employed occupation, smoking, out-migration for work away from hometown, household annual income level and household property were significantly associated with TB prevalence (P < 0.05); multivariate analysis showed that marital status, self-employed occupation, smoking, household economic condition and out-migration for work, away from home were also associated with TB (P < 0.05), and OR values were 2.826, 2.350, 1.536, 0.707, 2.096, respectively. CONCLUSION: Being single, smoking, self-employed occupation and out-migration for work were nonbiologic risk factors of TB while good household economic condition was a protective factor.

Adult↗

PubMed1999

Need for education on footcare in diabetic patients in India.

OBJECTIVES: The patient himself plays the crucial role in the prevention of diabetic foot disease and therefore education on foot care is important. In this study, we have evaluated the knowledge of the diabetic subjects regarding the foot problems and the care of feet in order to identify areas that require stress in the education programme. PATIENTS AND METHODS: Two hundred and fifty, consecutive cases of Type 2 diabetes (M:F, 176:74, age 57.2 +/- 9.7 yrs, duration 12.9 +/- 7.9 yrs) were selected for this study from the out-patient department of our hospital. A questionnaire was filled up for each patient by personal interview. The total score was 100 and a score of < 50 was considered as a low score for foot care knowledge. RESULTS: A score of < 50 was obtained in 67.2%. Low score was more common in women (78.5%) than in men (62.5%) (chi 2 = 5.26, P = 0.022). Low scores (< 50) were more common among those with lower level of formal education (chi 2 = 70.0, P < 0.0001), there were more women with low educational status. Significant foot problems like gangrene, foot ulcers were present in 27.2% and low scores were more common among those with these complications (82% vs 62%) (chi 2 = 8.3, P = 0.004). In general the scores on awareness of general foot care principles and basic facts about the foot complications were poor. Most of them (72%) had good knowledge about the right usage of foot wear. There was a trend to have lower scores with poor formal education (chi 2 = 51.1, P < 0.0001) and also with increasing age. There was no correlation between the scores and the number of hospital visits. Multiple linear regression analyses showed that 31.2% of the variations in the scores were explained by the level of education. CONCLUSIONS: This study underscores the importance of patient education on foot care principles, especially so, considering the magnitude of the problem of diabetes and the lower levels of literacy and poor socio economic status of many patients in this country.

Adult↗

PubMed1991

Incidence of falling injuries leading to medical treatment in the elderly.

The incidence of falling injuries leading to medical treatment was described by sex, age, marital status, education, amount of daily motion, self-perceived health, mechanism of fall and severity of injury. Material was collected regarding persons aged 65 years or over seeking medical treatment due to a fall during a period of one year. Altogether 3.8% of the elderly population (men: 2.5%; women: 4.4%) sought medical treatment due to a fall at least once during this year. When repeated falls were taken into account, the total incidence rate was 5.5 per 100 persons per year. The cumulative incidence rate (percentage of persons seeking medical treatment due to a fall) of women was higher than that of the men and in both sexes it increased with age. It was also higher for unmarried, widowed or divorced persons than for married ones, and higher in less educated persons than in better educated ones. It was also higher in persons with a low amount of daily motion or poor self-perceived health than in persons with a moderate or high amount of daily motion or good health status. The multivariate analyses based on log-linear models showed two-term interactions. A low amount of daily motion, poor self-perceived health and high age were independently related to the occurrence of a fall leading to medical treatment in both sexes.

Accidental Falls↗

PubMed1990

Homelessness: health-care implications.

The homeless population is changing in relation to age, race, income status, educational level, gender, and composition of families. Economic, social, and political factors are identified as increasing the risk of becoming homeless. The implications of homelessness on the health of an individual and strategies to improve the health status from multiple avenues is explored.

Community Health Nursing↗