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PubMed2001

Determinants of child mortality in a rural Ugandan community.

OBJECTIVE: To estimate the rate of and risk factors associated with child mortality in rural eastern Uganda. DESIGN: A community based cross-sectional study using the preceding birth technique--a robust method of obtaining information of survival of the previous child. SETTING: A rural district in Eastern Uganda. PARTICIPANTS: In total, 2888 multigravidae were interviewed in April and May 1999. MAIN OUTCOME MEASURE: Number of deaths among children born alive. RESULTS: The under-two child mortality rate was 108 per 1000 livebirths. The annual child mortality was 82 per 1000 child-years of risk. Child mortality was associated with low parental education, being born to adolescent mothers or mothers aged 35 or more. Unconditional logistic regression showed that children born to uneducated parents had a doubled risk of not celebrating their second birthday. It was three times more likely for a child to die in the neonatal period than in the first year of life. Child mortality risk decreased by 4% and 6% for every year of education attained by mothers and fathers, respectively. Parity, residence and marital status were not associated with excess risk of child mortality. Seasonal mortality followed the El Nino rainfall pattern. Finally, there were geographical differences in child mortality although this was not statistically significant. CONCLUSION: Monitoring trends in child mortality at district level can be done using the preceding birth technique in antenatal settings. Maternal education, an important predictor of child survival should be included in routine data collection at clinics.

Adolescent↗

PubMed1992

Maternal occupational exposure and congenital malformations.

A case-referent study was conducted to assess the risk of congenital malformations in relation to maternal occupational exposure before and during pregnancy. Three hundred and twenty-five cases of major malformations and 325 normal (at birth) referents identified in 15 maternity hospitals were included in the study. The occupational history obtained from an interview of the mother was blindly reviewed by an industrial hygienist who assessed the presence of chemical exposure and the probability of exposure. The results suggested that mothers of the case children with oral clefts were more often exposed to solvents during pregnancy [odds ratio (OR) 7.9, 90% confidence interval (90% CI) 1.8-44.9] and worked more often as cleaners (four cases, no referents). Digestive anomalies (OR 11.9, 90% CI 2.0-149) and multiple anomalies (OR 4.5, 90% CI 1.4-16.9) were also associated with occupational exposure to solvents at work. These results were not modified when differences in maternal age, area of residence, and socioeconomic status were taken into account.

Abnormalities, Drug-Induced↗

PubMed1979

Training minorities for health careers: a five-year follow-up study.

This study investigates the economic status of 69 residents of Newark, New Jersey, who completed health career programs at the College of Medicine and Dentistry of New Jersey in June 1973. The subjects were black females from socially and economically disadvantaged backgrounds ranging in age from 20 to 37 years. Approximately 28% of the 85 subjects who started the program had dropped out of high school by the 11th grade: three had completed the ninth grade and 54 were high school graduates. None had received postsecondary education. Candidates were recruited from the city welfare roster and referred to a selection committee consisting of Newark officials, community residents and representatives from the New Jersey Medical School. Accepted candidates were given first, second and third choices for career selection. Prior to training, 44 subjects were unemployed or receiving public assistance. Only six graduates now receive public assistance.

Black or African American↗

PubMed1976

Transactions of an international conference. Worldwide concern: better dental care for more people. An international collaborative study. How social surveys were conducted.

It is assumed that utilization of dental care services and hence the state of oral health is dependent on social and psychological characteristics of both consumers and providers. The sociological variables studied included the basic facts of age, sex, residence and socioeconomic status. Attitudes to general health care, past oral health care and self assessment of oral health status were also investigated. Accessibility of oral health care facilities in terms of cost, loss of time and distance travelled was assessed, as was the consumers estimate of the dentist's sensitivity and competence, his attitude to preventive care, aesthetic values and knowledge of oral health care measures. Sociologists from the participating countries cooperated in the formulation of questionnaires which could be applied with comparable results despite differences in language and culture. Adults were interviewed in their own homes while younger groups completed the questionnaire in school under the supervision of the researchers. In all cases the sociological survey preceded the clinical examination to reduce the introduction of bias. The data were collected in Geneva and analysed to determine the extent to which oral health status could be related to perception of need, personal oral health practices, availability, accessibility, acceptability and utilization of services. Further analysis may help to determine whether observed differences between populations relate more to the characteristics of the systems of dental care or to features inherent in the population of the country.

Adolescent↗

PubMed2000

Alpha-linolenic acid and risk of prostate cancer: a case-control study in Uruguay.

In the time period of 1994-1998, a case-control study on diet and prostate cancer was carried out in Uruguay to examine the risk associated with fat intake. Two hundred and seventeen (217) incident cases afflicted with advanced prostate cancer were frequency-matched with 431 controls on age, residence, and urban/rural status. The analysis was carried out using unconditional multiple logistic regression. Alpha-linolenic acid was associated with a strong positive association (fourth quartile of intake odds ratio, 3.91; 95% confidence interval, 1.50-10.1) after controlling for total calorie intake and for the other types of fat. The effect was similar when alpha-linolenic acid was analyzed by its sources of origin (odds ratio for vegetable linolenic acid, 2.03; 95% confidence interval, 1.01-4.07). Including this report, five of six studies that have examined the relationship between alpha-linolenic acid and prostate cancer yielded a positive association, which was significant in four studies. Thus, there appears to be evidence of a role of alpha-linolenic acid in prostate carcinogenesis.

Adult↗

PubMedDate not supplied

The prevalence and correlates of influenza vaccination among a home care population.

OBJECTIVE: To estimate the prevalence and correlates of influenza vaccination in a Home Care population. METHODS: This was a cross-sectional investigation involving linkage of three population-based databases from a rural Alberta Regional Health Authority, i.e., the Regional immunization and the Regional home oxygen information systems to the Regional home care information system. The sample comprised 649 persons who had been admitted or discharged from the Regional Home Care Program in the period Oct. 1-Dec. 31, 1998. An anonymous data file was released to the investigators. We estimated the proportion ever vaccinated against influenza, the proportion vaccinated in the period Oct. 1-Dec. 31, 1998 ("currently vaccinated"); and explored sociodemographic and program correlates of current vaccination. RESULTS: 67% had ever been vaccinated against influenza; 60.7% were currently vaccinated. Factors associated with current vaccination (multivariate analysis) include older age, being married, not receiving nursing services, district of residence and program status. CONCLUSIONS: Influenza vaccination rates were suboptimal. The correlates of vaccination suggest systems-level impediments to influenza vaccination.

Aged↗

PubMed1999

[Smoking, related cancers, and other diseases in shanghai: a 10-year prospective study].

OBJECTIVE: To explore the relationship between smoking and related diseases among residents of Shanghai. METHODS: A cross-sectional study on current smoking status among 213,800 residents aged 20 yr and over in Shanghai urban, suburb and rural areas was carried out during the early 1980s. The residents in the urban area were followed up for 12 years (1983 - 1994) and those in suburb and rural areas for 11 years (1984 - 1994). A Poisson regression model was used to estimate relative risks RRs of certain diseases for smoking adjusted for age with their 95% confidence intervals by sex and area among persons aged 40 yr and over at the beginning of the study. RESULTS: In the urban area, the RRs of death for smoking were 1.48 and 1.62 in males and females, respectively and for cancer death were 2.20 and 2.00. Statistically significant elevated RRs were seen for cancers of the lung and liver in both males and females and for cancers of the oesophagus, stomach, pancreas and bladder only in males. Significantly higher RRs were also observed for cerebrovascular disease, chronic bronchitis and emphysema, and pulmonary heart disease. RRs lower than in the urban area were found in the suburb and rural areas. The population attributable risks (%, PAR) for death due to smoking for males were estimated by area. PARs for death were 20.9, 18.9 and 16.3 in urban, suburb and rural areas, respectively. For all cancers, PARs were 40.0, 34.5 and 34.2 and for lung cancer were 71.7, 59.2 and 64.7. CONCLUSION: Smoking was associated with the mortality of some common cancers, chronic bronchitis, and emphysema, pulmonary heart, and cerebrovascular diseases.

China↗

PubMed1984

[Demographic measures].

"In this article, several measures of comparing demographic phenomena such as birth, death and migration in different years or in different population categories are discussed. In order to measure these phenomena, the demographic events occurring to persons with the same set of characteristics (i.e. with the same age, sex, marital status, place of residence etc.) are related to the number of persons in the category characterized by these same features." The geographic focus is on the Netherlands. (summary in ENG)

Demography↗

PubMed1993

[Emigration from the Soviet Union during its last years. Part 2].

The author "deals with the emigration of the citizens of the previous Soviet Union to the Federal Republic of Germany, the United States of America and to some other countries. It contains the data on numbers of ethnic Germans [who] emigrated to the Federal Republic of Germany during the years 1968-1981, on emigrants coming to the United States, by country of birth and on those receiving the status of permanent [residence] in the United States during 1961-1989." Future migration trends are estimated, and the impact of political changes and economic development is considered. (SUMMARY IN ENG AND RUS)

Americas↗

PubMed2002

Public health emergencies and the public health/managed care challenge.

The relationship between insurance and public health is an enduring topic in public health policy and practice. Insurers share certain attributes with public health. But public health agencies operate in relation to the entire community that they are empowered by public law to serve and without regard to the insurance status of community residents; on the other hand, insurers (whether managed care or otherwise) are risk-bearing entities whose obligations are contractually defined and limited to enrolled members and sponsors. Public insurers such as Medicare and Medicaid operate under similar constraints. The fundamental characteristics that distinguish managed care-style insurance and public health become particularly evident during periods of public health emergency, when a public health agency's basic obligations to act with speed and flexibility may come face to face with the constraints on available financing that are inherent in the structure of insurance. Because more than 70% of all personal health care in the United States is financed through insurance, public health agencies effectively depend on insurers to finance necessary care and provide essential patient-level data to the public health system. Critical issues of state and federal policy arise in the context of the public health/insurance relations during public health emergencies. These issues focus on coverage and the power to make coverage decisions, as well as the power to define service networks and classify certain data as exempt from public reporting. The extent to which a formal regulatory approach may become necessary is significantly affected by the extent to which private entities themselves respond to the problem with active efforts to redesign their services and operations to include capabilities and accountability in the realm of public health emergency response.

Disasters↗

PubMedDate not supplied

Voices from the wilderness: an interpretive study describing the role and practice of outpost nurses.

OBJECTIVE: Outpost nurses function as primary care providers and in a community health nursing role, providing comprehensive primary health care in Canada's underserved northern communities. Little information exists regarding how outpost nurses meet this expectation. The purpose of this interpretive study was to address the following research questions: 1) How do experienced outpost nurses perceive and enact their role? 2) How are practical knowledge and clinical wisdom revealed in the practice narratives of experienced outpost nurses? METHODS: Purposive sampling was used to recruit the nine experienced outpost nurses who participated by sharing narratives of clinical practice. Data analysis was conducted in accordance with Benner's model of interpretive phenomenology. Paradigm and exemplary cases served to ground the interpretation in the data. RESULTS: Four themes emerged from the data: a) primary care competencies are fundamental to outpost practice, b) nurses evolve into the outpost role by learning community health competencies and adapting to context-specific practice issues, c) experienced outpost nurses build and maintain responsive relationships with communities, and d) experienced outpost nurses become comfortable with the autonomy and responsibility of practice. DISCUSSION: The findings of this study reinforce the complex nature of outpost nursing; it is an anomalous community health nursing role grounded in primary care competency. Interpretation of the data suggests that outpost nurses share practice domains and competencies with nurse practitioners. A better understanding of the outpost nursing role clarifies how nurses might better contribute to improving the health status of northern residents, helping northern communities become healthy communities.

Adult↗

PubMed2003

Factors affecting utilization of health care services by mothers of children ill with diarrhea in rural Vietnam.

To examine the use of health services for the treatment of childhood diarrhea in three southern provinces of Vietnam, and identified household, maternal, child and health service characteristics associated with this use, a cross-sectional household survey was conducted between November 1998 and January 1999. Women with a pre-school aged child living at home were the primary respondents for the survey questionnaires. Respondents were asked to recall diarrheal disease events experienced by their child during the two weeks prior to interview, and their responses to these events. Prevalence ratios (PR) were used to identify associations between maternal age, education, occupation, ethnicity, knowledge about diarrhea, feeding practises during diarrhea, household residence and economic status, disease severity, use of oral rehydration solution (ORS), time to nearest health care facility and overall satisfaction with local medical services, and the use of health care services for children ill with diarrhea. The two-week period prevalence of childhood diarrhea was 10% and varied by the province and ethnicity of the child's mother. Forty-three percent of mothers reported using ORS during diarrheal episodes. Seventy percent of mothers sought advice or treatment when their child became ill with diarrhea. After controlling for potential confounders in regression models, maternal ethnicity, maternal high school education (in comparison to no education or incomplete primary education), more severe disease and the use of ORS were factors associated with increased utilization of health care services. There was a low level of the utilization of ORS to treat children with diarrhea, especially by ethnic minority mothers. A high percentage of mothers reported low levels of satisfaction with medical services, especially those from ethnic minorities. Mothers from ethnic minorities and those with lower levels of education were less likely to seek advice or treatment. These findings suggest the need for programs to promote the use of ORS and use of appropriate services for the treatment of childhood diarrheal disease. Interventions are needed to improve the access of ethnic minority children to child health care services for the treatment of diarrhea.

Chi-Square Distribution↗

PubMed2003

A survey of drug use patterns in western Nepal.

BACKGROUND: In Nepal, self-treatment is common and complementary medicine practitioners play an important role in providing health services. Previous studies on drug use patterns have been mainly carried out in the Kathmandu valley. Studies in the Pokhara valley, western Nepal are lacking. The objectives of our study were to obtain: 1) baseline information on drug use patterns in the preceding six-month period, 2) reasons for using complementary and self-medication and 3) any association of drug use patterns with demographic variables. METHODS: Health workers of the community medicine department carried out the study in Pokhara city and Bedabari village using a semi-structured questionnaire. Differences in the proportion of patients using self-medication and complementary medicines according to sex, age, place of residence and socioeconomic status of the family were analysed by the z test of proportions (p < 0.05). FINDINGS AND CONCLUSIONS: One hundred and twenty individuals from 112 households had used prescribed allopathic or complementary remedies. Seventy-one point six percent of the respondents had used allopathic medicines. The commonest allopathic medicines prescribed were antibiotics and paracetamol. Complementary medicine use was more common among older respondents (> 30 years). Thirty-nine families practiced self-medication with home remedies accounting for 18.9% of the drugs used. Self-medication was more common among rural households. Complementary practitioners should be integrated into the health care system to provide health care in the rural areas. Studies on drug use patterns and on factors influencing drug use in the remote areas of Nepal are urgently required.

Adult↗

PubMed1992

Factors affecting survival of patients with hip fractures.

The preoperative findings of 111 patients after 117 fractures of the proximal femur were recorded retrospectively. Data on survival, present type of residence and ambulatory status were analyzed. After age and sex, the presence of dementia, renal insufficiency and cardiac failure seemed to be the most important factors affecting the outcome. A full preoperative evaluation of patients with a proximal femoral fracture is needed to identify those at risk. This evaluation may help in the selection of the operative procedure.

Aged↗

PubMed2003

Factors influencing the use of maternal healthcare services in Ethiopia.

This study examined the factors that influence the use of maternal healthcare services in Ethiopia and particularly assessed the use of antenatal and delivery-care services. Data for the study were drawn from the 2000 Ethiopia Demographic and Health Survey. Multivariate logistic regression analysis was employed to explore the relative importance of a number of demographic and sociocultural variables in the likelihood of using these services. Results of the study showed that the coverage of maternity-care services was very low in Ethiopia, i.e. about 27% and 6% of women, respectively, received professionally-assisted antenatal and delivery-care services in the five years preceding the survey. The study also revealed that demographic and sociocultural factors were the most important aspects that influenced the use of maternal healthcare services in Ethiopia. The independent factors influencing the use of maternal healthcare services included education of mothers, marital status, place of residence, parity, and religion. However, this cannot detract from the relevance of service-related factors, especially in the rural areas of the country.

Adolescent↗

PubMedDate not supplied

[Surveillance of congenital malformations in Italy: an investigation in the province of Siracusa].

OBJECTIVE: The study describes briefly the current situation of the surveillance of congenital anomalies in Italy and gives an insight into the province of Siracusa in order to better characterise health status of populations residing in an area at high environmental risk. PARTICIPANTS: The authors, who coordinate the Italian registries of congenital malformations, have collaborated with the Eastern Sicily Registry of congenital malformations (ISMAC) and the registry of diseases of the Siracusa province. DESIGN AND SETTING: Data collected by the ISMAC Registry were used to calculate the prevalence of malformed newborns, resident in the municipalities of the province of Siracusa between 1991-2000. This prevalence was compared to that observed in the rest of the Siracusa province (RSP), in the whole area covered by the ISMAC Registry (ESR) and to the mean prevalence at birth of the North-East, Emilia Romagna, Toscana and Campania Registries (IR). Comparisons were made for all malformations and for groups of malformations (with the exclusion of groups with a 10 year frequence <10 cases in the province of Siracusa). In addition, heterogeneity among the municipalities of the province and temporal trends were statistically tested. MAIN OUTCOME MEASURES: Total, groups and specific congenital malformations. RESULTS: Results were statistically borderline considering all malformations when the Priolo-Augusta-Melilli area was compared to IR and ESR (standardized morbidity ratio SMR(IR)=1.1, SMR(ESR)=1.2) and statistically significant when compared to RSP (prevalences ratio PR(RSP)=1.9). Significant excesses resulted in this area also for hypospadias (SMR(IR)=1.9, SMR(ESR)=2.4, PR(RSP)=2.5) and anomalies of the digestive system (SMR(IR)=2.1, SMR(ESR)=1.9, PR(RSP)=2.6). CONCLUSION: Following these results a case-control study on malformations observed in excess has been activated and a protocol for the surveillance of sensitive diseases in areas at environmental risk is being elaborated.

Catchment Area, Health↗

PubMed2003

Summary health statistics for the U.S. population: National Health Interview Survey, 2000.

OBJECTIVES: This report presents health statistics from the 2000 National Health Interview Survey for the civilian noninstitutionalized population of the United States, classified by age, sex, race and Hispanic or Latino origin, family income, poverty status, education, place of residence, region of residence, and, where appropriate, health insurance coverage. The topics covered are health status and limitations in activities, special education or early intervention services, injuries and poisonings, health care access and utilization, and health insurance coverage. SOURCE OF DATA: The NHIS is a household, multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention, National Center for Health Statistics. Household interviews were completed for 100,618 persons living in 38,633 households, reflecting a household response rate of 89%. SELECTED HIGHLIGHTS: Nearly 7 in 10 persons were in excellent or very good health in 2000, and fewer than 1 in 10 were in fair or poor health. About 31 million people (11%) were limited in their usual activities due to one or more chronic health conditions, and about 3 million people (2%) required the help of another person with activities of daily living such as bathing and dressing. Persons with the least education and the lowest incomes were the most likely to be limited in their ability to work. About 5% of children received special education or early intervention services. The three leading causes of medically attended injury and poisoning episodes were falls, being struck by a person or an object, and transportation. Among people under age 65 years, about 40 million (17%) did not have any health insurance coverage.

Adolescent↗

PubMed2004

Summary health statistics for the U.S. population: National Health Interview Survey, 2002.

OBJECTIVES: This report presents both age-adjusted and unadjusted health statistics from the 2002 National Health Interview Survey (NHIS) for the civilian noninstitutionalized population of the United States, classified by age, sex, race and Hispanic or Latino origin, family income, poverty status, education, place of residence, region of residence, and, where appropriate, health insurance coverage. The topics covered are health status and limitations in activities, special education or early intervention services, injuries and poisonings, health care access and utilization, and health insurance coverage. SOURCE OF DATA: The NHIS is a household, multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention's National Center for Health Statistics. In 2002, household interviews were completed for 93,386 persons living in 36,161 households, reflecting a household response rate of 89.6%. SELECTED HIGHLIGHTS: Nearly 7 in 10 persons were in excellent or very good health in 2002. About 34 million persons (12%) were limited in their usual activities due to one or more chronic health conditions, and about 4 million persons (2%) required the help of another person with activities of daily living. About 6% of children received special education or early intervention services. Among persons under age 65 years, about 40 million (17%) did not have any health insurance coverage. The most common reason for lacking health insurance was cost, followed by a change in employment.

Activities of Daily Living↗