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PubMed1995

Survival in breast cancer: a population-based study in Bangalore, India.

Survival from cancer reflects the aggressiveness of the disease, the effectiveness of treatment and host factors such as age. While hospital-based survival rates are typically used to evaluate the care provided in a particular hospital, population-based survival reflects the effectiveness of the overall cancer control strategy in the region. Here, we report the survival experience of 1514 breast cancer patients registered by the Bangalore population-based registry during 1982-1989. There have been very few reports on survival from cancer in India, mainly because of poor patient follow-up and inadequate system of registration of death. This has been largely overcome in this study by means of active follow-up through visits of homes of patients. Scrutiny of medical records and matching with death certificates, was also carried out in a small proportion (12%) of cases. Thus, information on vital status (whether dead or alive) as on January 1, 1993 was available for 1334 (88%) subjects and partial follow up data were available for a further 34 (2%). The observed 5 year survival was 42.3% and the corresponding relative survival was 46.8%. The observed survival was 57.4% for localized disease, 45.8% for direct extension, 37% for those with regional node involvement, 14.2% for distant metastasis and 38.3% for those with unstaged disease. The clinical extent of disease and the educational status were independent predictors of survival.

Adult↗

PubMed2025

Implementing secondary findings analysis in a genetic and environmental research study.

PURPOSE: Optimizing return of secondary findings (SFs) in research settings requires an understanding of the complexities and challenges. METHODS: Genome sequence was generated for 4737 participants in a genetic and environmental health study, and 4630 of them consented to SF return. Variants in the American College of Medical Genetics and Genomics v3.0 genes were classified using the American College of Medical Genetics and Genomics/Association for Molecular Pathology criteria with ClinGen-approved modifications. RESULTS: Eighty-six variants were eligible for return to 102 participants. Average time to initial recontact attempt was 5.8 years. Recontact attempts reached 95 of 102 individuals. Results were returned to 57 participants. The remainder passively declined (25), actively declined (11), were lost to follow-up (5), were deceased (3), or had prior knowledge of the result (1). Return of results was positively associated with education status (2 × 3 C2, P = .0035). CONCLUSION: The interest in receiving SFs was high at the time of consenting, but a clinically validated result was returned to just over half of the individuals with an SF. Approximately 1 in 3 participants with an SF who had consented to receive them subsequently actively or passively declined receipt of the result. Given the health importance of return of SF, minimizing the time from consent to results return and tailoring outreach to education level may optimize uptake of SF return.

Adult↗

PubMed2005

Factors associated with low birthweight in rural Bangladesh.

This study examines factors associated with low birthweight (LBW) in rural Bangladesh. Enrolled in early first trimester, 350 women were followed for duration of pregnancy and data gathered on maternal factors such as social, demographic, anthropometric, biochemical measures and newborn's birth weight within 48 hours of birth. Almost a quarter of babies (24%) were born with LBW and mean birth weight was 2961 g. Bivariate analysis found associations between LBW and mother's age, parity, weight and hemoglobin level at booking, weight gain and health problems during pregnancy, tobacco consumption, and gestational age. But no such association was seen for birth spacing, mother's height, economic status, educational level, body mass index, mid upper arm circumference and number of ANC visits. Multivariable analysis revealed gestational age, hemoglobin levels at first visit and weight gain during pregnancy as significant predictors of LBW in this rural setting. Although antenatal care provision is absolutely necessary, intervention approaches that go beyond clinical or primary care settings are also warranted for better nutrition of women. Concerted efforts in health and non-health sectors are necessary for improvement in health and social status of women in order to reduce low birthweight in Bangladesh.

Adolescent↗

PubMed2005

Nurses are what nurses do--are you where you want to be?

Nursing performance, or the skills a nurse exhibits in practice, is limited by the extent or level of a nurse's knowledge base; hence, the expression "nurses are what nurses do" probes nurses' levels of satisfaction with their present educational status. Given the rapid changes in health care today, nurses are questioning their level of commitment to lifelong learning in meeting ever-changing demands. This article examines measures being taken to assess the adequacy of nurses' knowledge base in a field that requires continuous adaptation to change.

Career Choice↗

PubMed2006

Evaluation of patients followed up in a cigarette cessation clinic.

OBJECTIVES: The aim of this study was to evaluate the demographic characteristics and factors determining success in a smoking cessation clinic in smokers who completed a 1-year follow up. METHOD: A total of 349 patients were assessed retrospectively. RESULTS: There were 238 men (mean age: 41+/-13.5 years) and 111 women (mean age: 37+/-11.9 years) (t-test P=0.004). The average age at which they began to smoke, number of years of smoking and the number of cigarettes/day were 17.5+/-5.2 years (median 17), 22.1+/-13.3 years, 23.5+/-12.0, respectively. Cigarette smoking was mostly observed in university graduates (56.8%) and a moderate negative correlation existed between education status and smoking duration (r=-0.27, P=0.000). Patients with a Fagerström Tolerance Questionnaire score of >or=6 and those exposed to cigarette smoke in childhood tended to commence and become committed smokers later in life (chi2=4.915, P=0.027). In all, 151 patients (43.26%) were successful in quitting (chi2=36.4, P=0.000). Of these, 87 (24.93%) used medication such as nicotine patches (13.5%), bupropion (7.2%), nicotine patches+bupropion (4.3%) and 64 (18.33%) refused medication, but came for professional support. CONCLUSION: Increased education level, behavioural therapy and intensive motivational support, follow-up visits and phone calls all appear to play important roles in smoking cessation. Families also play a major role.

Adolescent↗

PubMed2001

Prevalence, awareness, treatment and control of hypertension among the elderly in Bangladesh and India: a multicentre study.

OBJECTIVE: To evaluate the prevalence, awareness, treatment and control of hypertension among elderly individuals in Bangladesh and India. METHOD: A community-based sample of 1203 elderly individuals (670 women; mean age, 70 years) was selected using a multistage cluster sampling technique from two sites in Bangladesh and three sites in India. FINDINGS: The overall prevalence of hypertension (WHO-International Society for Hypertension criteria) was 65% (95% confidence interval = 62-67%). The prevalence was higher in urban than rural areas, but did not differ significantly between the sexes. Multiple logistic regression analyses identified a higher body mass index, higher education status and prevalent diabetes mellitus as important correlates of the prevalence of hypertension. Physical activity, rural residence, and current smoking were inversely related to the prevalence of hypertension. Among study subjects who had hypertension, 45% were aware of their condition, 40% were taking anti-hypertensive medications, but only 10% achieved the level established by the US Sixth Joint National Committee on Detection, Evaluation and Treatment of Hypertension (JNC VI)/WHO criteria. A visit to a physician in the previous year, higher educational attainment and being female emerged as important correlates of hypertension awareness. CONCLUSIONS: Our findings emphasize the need to implement effective and low cost management regimens based on absolute levels of cardiovascular risk appropriate for the economic context. From a public health perspective, the only sustainable approach to the high prevalence of hypertension in the Indian subcontinent is through a strategy to reduce the average blood pressure in the population.

Aged↗

PubMed2003

[Study on the relationship between self-rated health situation and health status in the elderly-an 8-year follow-up study from Multidimentional Longitudinal Study of Aging in Beijing].

OBJECTIVE: To study the relationship between self-rated health (SRH) and prevalence of chronic diseases, and all-cause mortality in the elderly population. METHODS: In 1992, a cohort of 3257 people > or = 55 years old was selected from Beijing, the information of SRH and other related variables were collected from 3 157 subjects at the baseline survey. Three follow-up surveys were conducted in 1994, 1997 and 2000, respectively. RESULTS: The SRH was influenced by age, gender, marriage status and satisfaction on their own economic condition. Comparing the subjects with excellent SRH, the prevalence rates of chronic diseases, stroke, heart diseases and respiratory system diseases were almost doubled among those with average and poor SRH. By 2000, 993 death occurred. All-cause mortality was negatively associated with SRH, i.e. the risk of death was 12% which was 53% higher for the subjects with average SRH (HR = 1.12, 95% CI: 0.93 - 1.35) and poor SRH (HR = 1.53, 95% CI: 1.25 - 1.88) than those with excellent SRH, respectively. The risks of death from stroke and heart disease were 2.25 (HR = 2.25, 95% CI: 1.67 - 3.04) and 2.22 (HR = 2.22, 95% CI: 1.61 - 3.07) times higher among the subjects with poor SRH than those with excellent SRH respectively. After adjustment for age, gender, resident place, marriage status, education, satisfaction on their own economic condition, seeing doctors or hospitalized within the last 1 year, history of chronic disease, cognition function, body mass index, activities of daily living and depression, as well as deleted the subjects died within first or third year of the baseline survey respectively, poor SRH remained a significantly independent predictor to all-cause death as well as to the death of stroke and heart diseases. CONCLUSIONS: The frequency of poor SRH was influenced by age, gender, marriage status and satisfaction on their own economic condition. Poor SRH was associated with the prevalence of chronic conditions and mortality among the elderly. The findings suggested that SRH might have served as an important indicator in the evaluation on health status among the elderly.

Activities of Daily Living↗

PubMed2002

[Study of quality of life of patients with fibromyalgia: impact of a health education programme].

OBJECTIVE: To assess the impact of a programme of health education on the quality of life and frequency of attendance of persons with fibromyalgia. DESIGN: Community clinical trial with randomised allocation. SETTING: Sant Joan Despí urban Health District (Barcelona), with a population of 13 282 inhabitants. PARTICIPANTS AND METHODS: 67 women who attended our centre for consultation and were diagnosed with fibromyalgia by the Area Rheumatologist using the criteria of the American College of Rheumatology (1990). They were distributed at random into control and intervention groups. MAIN MEASUREMENTS: Social and demographic variables (age, marital status, educational background, job situation), health variables (physical exercise taken, current treatment, symptoms evolution time) and frequency of attendance were gathered. The Nottingham Health Profile (NHP) for measuring quality of life was administered. The presence of psychological malaise was determined through the Mini International Neuropsychiatric Interview. After the intervention, which consisted of four health education sessions, the NHP was administered again and frequency of attendance was measured again. RESULTS: The most important dimension on the NHP prior to intervention was pain (78.6 points), which was not modified either by physical exercise or the disease s time of evolution. Prevalence of psychological malaise was 64.6%. After the intervention there was a significant improvement in the pain dimension (P=.003). CONCLUSIONS: Health education for people with fibromyalgia modifies their perception of quality of life and reduces their pain. In addition, this kind of activity increases understanding of illness and reduces dependence on the health services.

Adult↗

PubMed1992

Public health implications of dietary differences between social status and occupational category groups.

STUDY OBJECTIVE: As there is a social status gradient in chronic disease mortality in Australia, this study aimed to establish whether there were substantial differences among socioeconomically defined groups with respect to food choice and nutrient intake, in the context of risk of nutrition related chronic diseases. DESIGN AND PARTICIPANTS: Cross sectional data were collected from a randomly selected population sample of 1500 urban Australian adults. Data were collected by postal questionnaire, which included an assessment of dietary intake and questions on sociodemographic details. Three measures of social position were collected: occupation, educational status, and income status. Occupation was interpreted both on a continuous, prestige scale, and also as categorical occupational groupings. MAIN RESULTS: The study achieved a 70% response rate. Higher social status was generally associated with healthier dietary intakes, with lower fat and refined sugar densities, and higher fibre densities, but also with higher alcohol density. No differences were found in salt, polyunsaturated fat, protein, or complex carbohydrate densities across groups. Food intake differences were also found between occupational status groups, with the upper social groups tending to consume more wholegrain cereal foods, low fat milk, and fruit, and less refined cereal foods, full cream milk, fried meat, meat products, and discretionary sugar; but also more cheese and meat dishes. CONCLUSIONS: Although this study did show statistically significant differences across social status groups in relation to nutrient and food intakes, these differences were small compared to the disparity between intakes of all groups and the recommended patterns of intake, and did not appear to be great enough to be a major explanatory variable in differences in disease risk across groups.

Adolescent↗

PubMed2005

Self-assessed health, sadness and happiness in relation to the total burden of symptoms from the lower urinary tract.

OBJECTIVES: To evaluate the effect of lower urinary tract symptoms (LUTS) on self-assessed health, sadness and happiness of men. SUBJECTS AND METHODS: The study included 504 men (aged 40-80 years) in the rural community of Surahammar, Sweden, who a year earlier had reported stress incontinence, urgency or postvoid dribbling in answer to a postal questionnaire, and 504 age-matched control men from the same community. The occurrence of 12 specific LUTS was rated using the Danish Prostatic Symptom Score. Health, sadness and happiness were measured by three questions from the Medical Outcomes Study Short-Form 36 health survey questionnaire. RESULTS: Completed questionnaires were returned by 74.2% of men (748/1008). A low score for health was reported by 34% of men with one to four LUTS, by 67% with five to eight, and by 75% with nine or more LUTS. The total LUTS burden correlated with lower scores for happiness and with higher scores for sadness. For each of the 12 specific LUTS, men with the symptom had lower scores for health and happiness, and higher scores for sadness, than men without the symptom. Comparing men with the symptom of 'other incontinence' to men with no 'other incontinence', the relative risk (95% confidence interval) of impaired health was 2.2 (1.8-2.8), while that of a high score for happiness was 0.5 (0.3-0.7) and that of greater sadness was 2.3 (1.7-3.3). Social status, marital status, education, smoking, physical activity and urinary tract infection all affected the impact of LUTS. CONCLUSIONS: The total burden of LUTS is related to self-assessed health, sadness and happiness.

Adult↗

PubMed1999

A survey of pregnant women's knowledge about sexual abuse.

STUDY OBJECTIVE: To assess pregnant women's understanding of sexual abuse prevalence and perpetrator characteristics. DESIGN: A multiple choice questionnaire concerning knowledge about sexual abuse prevalence and an understanding of potential perpetrators was presented to patients. Comparisons were made based on participant's age, educational status, and personal involvement in the care of children. SETTING: Prenatal clinic, Department of OB/GYN, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee. PARTICIPANTS: Patients presenting for new obstetrical evaluation (N = 289). MAIN OUTCOME MEASURES: Responses to the questionnaire. RESULTS: Less than half of the subjects correctly answered questions about sexual abuse prevalence. Only 22% of patients understood the potential youthfulness of juvenile sex offenders. Neither age nor child care responsibilities affected response. Subjects with greater than 12 years of formal education achieved significantly higher scores than those with less education, 59% of respondents were interested in more information. CONCLUSION: Pregnant women's knowledge about the dangers of sexual abuse was suboptimal in this population. The majority of patients were interested in more information.

Adolescent↗

PubMedDate not supplied

Surgical versus medical treatment for epilepsy. II. Outcome related to social areas.

We conducted a retrospective parallel cohort study comparing surgical and medical treatment for epilepsy. The surgical group contained all 201 patients treated with resective surgery for epilepsy in Norway since the first operation in 1949 until January 1988. The 185 patients in the control group, medically treated only, were closely matched for year of treatment, age at treatment, sex, seizure type, and neurologic deficit before treatment. Between 75 and 95% of the survivors (median 17 years after treatment) completed two questionnaires on their social situation. Although surgical treatment improved the seizure situation (about one-fourth had some neurologic deficit), a considerably smaller long-range influence on different social aspects was observed. There were no significant differences between the two groups in educational status, social pensions, social status, marital status, fertility, dependency in residential situation, the need for aid in daily activities of living (ADL), or the need for being looked after, when we controlled for pretreatment status. In all, 25.3% of the surgically treated patients and 8.5% of the controls were not receiving anti-epileptic drugs (AEDs) at the time of investigation (Mann-Whitney U test, two-tailed p = 0.0011). A considerably higher proportion of the surgically treated (53.2%) than control patients (24.2%) claimed that the treatment had improved their "working ability" (Mann-Whitney U test, two-tailed p less than 0.0001), but this resulted in significant improvements in the actual working situation only for those in regular education or work before treatment (chi 2 = 6.514, p = 0.038).

Cohort Studies↗

PubMed1992

Risk factor awareness and expectations of outpatients attending the Cardiology Clinic, Universiti Kebangsaan Malaysia.

One hundred consecutive patients attending the UKM (Universiti Kebangsaan Malaysia) Cardiology Clinic completed a questionnaire enquiring about their own assessment of their knowledge about their illness, their awareness of cardiac risk factors and their expectations in their management. Only 11% of our patients had graduated from tertiary education. 59% of our patients were being treated for ischaemic heart disease. Although only 28% of our patients considered having considerable knowledge of their illness, a majority of our patients were aware of cardiac risk factors. This was independent of the formal education achieved. However this awareness did not necessarily result in appropriate behaviour; 32% of patients admitted to smoking despite being aware of the harmful effects of smoking. 74% of our patients expected a cure from their doctors; only 37% of our patients thought they required medication indefinitely. Thus, patients could be made aware of their illness regardless of their formal educational status. However this may not necessarily result in appropriate behaviour. The high expectations which the patients have of their doctors is unrealistic and may be detrimental to appropriate long-term management of their chronic illness.

Adult↗

PubMed1999

Outcome of Hispanic patients treated with thrombolytic therapy for acute myocardial infarction: results from the GUSTO-I and III trials. Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries.

OBJECTIVES: We sought to describe the differences in the process of care and clinical outcomes between Hispanics and non-Hispanics receiving thrombolytic therapy for myocardial infarction (MI). BACKGROUND: Hispanics are the fastest growing and second largest minority in the U.S. but most cardiovascular disease data on Hispanics has been derived from retrospective studies and vital statistics. Despite their higher cardiovascular risk-factor profile, better outcomes after MI have been reported in Hispanics. METHODS: We studied the baseline characteristics, resource use and outcomes of 734 Hispanics and 27,054 non-Hispanics treated for MI in the GUSTO-I and -III trials. The primary end point of both trials was 30-day mortality. RESULTS: Hispanics were younger, shorter, lighter and more often diabetic and began thrombolysis 9 min later, compared with non-Hispanics. Measures of socioeconomic status (educational level, employment and health insurance) were lower among Hispanics. Fewer Hispanics than non-Hispanics underwent in-hospital angiography (70% vs. 74%, p = 0.013) or bypass surgery (11% vs. 13.5%, p = 0.04). Hispanics received more angiotensin-converting enzyme (ACE) inhibitors and less calcium-channel blockers, prophylactic lidocaine and inotropic agents. Mortality at 30 days and at one year did not differ significantly between Hispanics and non-Hispanics (6.4% vs. 6.7% and 9.0% vs. 9.7%, respectively). We noted no interactions between thrombolytic strategy and Hispanic status on major outcomes (30-day death, stroke and major bleeding). CONCLUSIONS: The care of Hispanics with MI differed slightly from that of non-Hispanics. Nevertheless, these differences in care did not affect long-term outcomes.

Aged↗

PubMed1987

Hearing-impaired children in Venezuela: 1985.

The first Venezuelan Survey of Deaf Children during the 1984-85 school year was a collaborative effort of the Ministry of Education in Venezuela and Gaullaudet University in the U.S. Limited in its first year to the capital city of Caracas, the study used a survey methodology developed over 18 years in the U.S. Annual Survey of Hearing-Impaired Children and Youth. In its first year of operation the Venezuelan study collected information on 804 deaf students, over 90% of whom were between the ages of 3 and 14, had severe or profound hearing losses (i.e., hearing level of 71 dB or greater in the better ear), and experienced their hearing impairments before the age of 3. Significant findings of the Venezuelan Survey include a large number of children (29%) with hearing losses caused by maternal rubella. This result is important to educators because rubella-deafened children tend to have other handicaps in addition to their hearing impairment. Meningitis was the most frequently reported after-birth cause of hearing losses in Caracas. Thirty-six percent of the Venezuelan students were reported to have other handicaps in addition to their hearing impairments. Survey results also raise questions about the educational status of less severely hearing impaired children and older deaf adolescents; these two groups were not reported in any significant numbers to the survey. Implications of the Venezuelan data are discussed, and, where appropriate, comparisons with data from the U.S. 1985 survey are made.

Adolescent↗

PubMed1996

The national diet and nutrition survey of 1.5 to 4.5 year old children: summary of the findings of the dental survey.

A dental health survey was included as part of a large scale study of nutrition in preschool children. The survey was carried out in 1992/93 and was published in spring 1995. Information on dental health status and on dietary intake was gathered from a total of 1658 children from 100 geographical sectors in the United Kingdom. This article summarises the main findings and highlights some of the most important findings regarding dental health and its relationship to dietary factors. Seventeen per cent of children had some caries experience and in 83% of cases this was untreated. Dental decay was most strongly related to social background. The factors most strongly related to caries prevalence were: receipt of income benefits, in the 1.5-2.5-year-old children; the educational status of the mother in the 2.5-3.5-year-old children and social class of the head of household in the 3.5-4.5-year-old children. Consumption of sugary drinks at bedtime, children being left to brush their teeth themselves, household expenditure on confectionery and geographical region were also strongly associated with caries prevalence.

Beverages↗

PubMed1989

Independence in activities of daily living for end-stage renal disease patients: biomedical and demographic correlates.

Factors associated with physical well-being were examined in a population-based sample of adult end-stage renal disease (ESRD) patients in Michigan (n = 459). The dependent variables were two measures of physical functioning: (1) a ten-item measure of activities of daily living (ADL), and (2) the 45-item physical dysfunction dimension of the Sickness Impact Profile (SIP). Independent variables included four modalities of treatment (in-center hemodialysis, continuous ambulatory peritoneal dialysis [CAPD], related transplant, and cadaver transplant); primary cause of ESRD (eg, diabetes, glomerulonephritis); comorbidity (other illnesses besides primary cause of ESRD); and demographic characteristics (sex, race, age, marital status, education). ADL and SIP unadjusted mean scores differed significantly by category for each of the eight study factors (analysis of variance [ANOVA], P less than 0.0001), with the exception of sex for SIP means. The highest levels of dependency in ADL were reported by patients who were older, female, black, widowed, less educated, treated with in-center hemodialysis, had diabetes as the primary cause of ESRD, and/or reported more comorbidity. The partial effect of each factor on the dependent measures with adjustment for the seven other factors was assessed using analysis of covariance (ANCOVA). In the ADL analysis, sex, race, age, primary cause of kidney failure, and comorbidity were significant factors (probability values ranging from 0.05 for race to 0.0001 for sex, primary cause of ESRD, and comorbidity). The SIP physical dysfunction measure gave slightly different results. Race, age, primary cause of ESRD, comorbid status, and modality of treatment were significantly related to physical dysfunction (P less than 0.05 to P less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗

PubMed2002

Fatigue and physical function after orthotopic liver transplantation.

Over the last two decades, orthotopic liver transplantation (OLT) has become an established treatment for acute and chronic liver failure. OLT impacts not only on survival, but also on health-related quality of life. This study was undertaken to describe the self-rated health of Danish liver transplant recipients, compare their self-rated health against that of the general population, and to investigate associations between sex, age, diagnosis, time after OLT, and postoperative physical function and fatigue. All adult surviving liver transplant recipients who underwent OLT in Copenhagen, Denmark, from 1990 to 1998 (n = 154) were contacted by mail and asked to complete a self-administered questionnaire. The questionnaire contained the 36-Item Short Form Health Survey, the Multidimensional Fatigue Inventory, the Hospital Anxiety and Depression Scale, and questions on marital status, education, and work. The response rate was 84.4% (n = 130). Liver transplant recipients reported poorer self-rated health than the general population in physical, but not in mental, health areas. One health aspect, fatigue, was investigated in great detail. This study found that liver transplant recipients experienced physical, rather than mental, fatigue. Diagnosis was found to be a predictor of postoperative physical function and fatigue because patients with an alcoholic or cryptogenic cirrhosis background had significantly poorer physical function and experienced more physical fatigue than liver transplant recipients with other diagnoses. Work status and survival time after OLT had significant effects on postoperative physical function and fatigue. Working and having undergone transplantation 4 to 5 years previously were associated with significantly better physical function and less physical fatigue than not working and having undergone transplantation 1 to 3 years previously. This study suggests that liver transplant recipients experience physical, rather than mental, impairment and fatigue and that diagnosis, work status, and survival time after OLT are associated with physical function and fatigue.

Adult↗